The Study Of Preoperative Psychological Stress And The Effect Of Early Nursing Intervention For Day Surgery Patients

Background In recent decades, day surgery has been developed rapidly in developed countries. In recent years, it has attracted more attention and developed quickly in domestic. More and more inpatient surgery will be carried out in the form of day surgery. Foreign nursing studies showed that the day surgery patients confronted with higher psychological stress compared with inpatient surgery patients, and needed professional and effective supports. Several studies found that patient's high preoperative stress level had a great influence on their recorery after surgery. Anxiety is the most typical clinical manifestations of preoperative psychological stress response. Anxiety management in the day surgery patients has become a hot research abroad. At present, day surgery is in the infant stage in domestic, and there is no one research dealing with patients psychological stress. This study aimed to find the preoperative psychological stress level and influence factors of day surgery patients. On the basis of it,we implemented early intervention and evaluated its effectiveness for the day surgery patients undergoing thyroid surgery. We aimed to improve our service quality,enrich the content of nursing work and sought for the effective and feasible nursing intervention under the new medical model.Object To investigate the preoperative anxiety lever and its influence factors of day surgery patients and to evaluate the impact of early nursing intervention on the preoperative stress and postoperative outcomes of the day surgery patients undergoing thyroid surgery.Methods This study consists of two sections:at the first one,we used a descriptive study to investigate the preoperative anxiety lever and coping style of 208 day surgery patients in a single center. Stepwise regression analysis was selected for choosing the influence factors of the preoperative anxiety lever. And thus established the necessity and feasibility of early intervention. At the second part,78 patients undergoing thyroid surgery programmed for day surgery were enrolled in our study,they were divided into two groups:intervention group(n=39) and control group(n=39). There was no statistic differences between two groups with regard to age,gender,education,career,marital status and family income(P>0.05).The patients in the control group received routine nursing care. And the patients in the intervention group received early nursing intervention by a nurse besides that. The changes of anxiety degree, pulse rate, blood pressure were recorded. We compared the differences between groups with regard to postoperative pain, incidence of adverse events, knowledge about health care and satisfaction. The data were analyzed by T-test, Chi-square test, ANOVA and analysis of covariancc when needed.Results 1. Average score of preoperative anxiety in day surgery patients (S-AI) was 43.98±9.90, significantly higher than that in the norm (P＜0.01), it suggests that day surgery patients have high level of psychological stress; stepwise regression analysis found that the influence factors of preoperative anxiety were resigntion coping style and surgical information awareness.2. The score of three medical coping modes in day surgery patients were significantly lower than that in the patients (P<0.01),it suggests that the coping style of day surgery patients need to be actively guided. 3.The early nursing intervention could significantly decrease the the preoperative anxiety lever and stabilize the vital signs of day surgery patients undergoing thyroid surgery (P<0.01).4.The early nursing intervention could significantly reduce the level of postoperative degree of pain,incidence of adverse events,enhance the acquaintance of health knowledge and patient satisfaction of day surgery patients undergoing thyroid surgery(P<0.05).Conculsions Day surgery patients with preoperative psychological stress response can't be ignored. The coping style of day surgery patients need to be actively guided. Medical staff should pay attention to explore the efficient means of intervention to reduce the level of psychological stress in patients,and promote their physical and psychological rehabilitation. The early nursing intervention can help effectively reduce the preoperative anxiety lever of the day surgery patients undergoing thyroid surgery and stabilize their vital signs,and benefit their postoperative recovery.