The relationship between preoperative psychological distress and postoperative recovery

A major goal in Nursing; is to identify situations that are potentially stressful to patients, and to provide care that enables patients to prevent, relieve, mitigate or at least tolerate stress. It is generally agreed that surgery constitutes a potent source of stress for most people. A number of investigations have attempted to determine if special preoperative preparation and care improve patients' postoperative recovery. However, little research has attempted to determine the extent of relationship, if any, between preoperative fear and anxiety and postoperative recovery. The present study attempted to see if the most distressed patients could be identified by using selected instruments for measuring fear and anxiety and to test the assumption that the more distressed the patient is preoperatively, the more adverse will be his postoperative recovery in terms of somatic and psychological complications. Twenty-seven female patients scheduled for abdominal or vaginal hysterectomy were administered the following preoperative and postoperative measures: (a) the IPAT Anxiety Scale; (b) the Multiple Affect Adjective Check List (MAACL); (c) Palmer's Patients' Perceptions Toward Surgery Scale (PPS). Criteria for recovery were the number of pain reducing and sedative medications counted over five postoperative days, and comparison of pre- and postoperative scores on the MAACL. The mean IPAT anxiety score was higher than the means reported in the manual. There was no significant change in the mean MAACL anxiety, hostility, and depression scores pre- and postoperatively. Pearson product moment correlations were computed between the measures of preoperative distress and postoperative recovery. There were no significant correlations found between these measures. This failed to support the assumption that high preoperative distress would be associated with poor postoperative recovery in terms of increased number of pain relieving and sleep inducing medications. Further research is necessary to ascertain the extent of relationship between degree of preoperative distress and postoperative recovery. The correlations between Palmer's Patients' Perception Scale and the IPAT Anxiety Scale and the MAACL were not significant. Therefore, patients' attitudes toward surgery (PPS) were not related to the preoperative level of psychological distress. The results of this study indicate that further development and refinement of pre- and postoperative measures is necessary. It would be worthwhile for future research to attempt to develop a rating scale to measure non-verbal behavior and correlate this with patients' performance on the paper-and-pencil tests. To add strength to the use of pain reducing medications as a recovery measure a comparison should be made of nurses' and patients' assessment of pain and the need for medication.