Professional Documents
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The Effect of Nursing Intervention On Anxiety of Post Operative P
The Effect of Nursing Intervention On Anxiety of Post Operative P
The Effect of Nursing Intervention On Anxiety of Post Operative P
ScholarWorks at WMU
4-1978
Recommended Citation
Nicolaou, Phyllis C., "The Effect of Nursing Intervention on Anxiety of Post Operative Patients" (1978).
Dissertations. 2745.
https://scholarworks.wmich.edu/dissertations/2745
by
P h y l l i s C . N ic o la o u
A D is s e rta tio n
S u b m it te d to th e
F a c u l t y of T h e G r a d u a te C o lle g e
in p a r t i a l f u lf il l m e n t
of th e
D e g r e e of D o c t o r of E d u c a tio n
W e s t e r n M ic h ig a n U n i v e r s i ty
K a l a m a z o o , M ic h ig a n
A p r i l 1978
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
ACKNOW LEDGM ENTS
In a p p r e c i a t i o n to D r . U ld is S m id c h e n s w h o d i r e c t e d th is
s tu d y a n d g a v e n e e d e d s u p p o r t a n d g u id a n c e a t c r u c i a l p e r i o d s
th ro u g h o u t its p r e p a r a tio n . T h e a s s i s t a n c e of D r s . B a r b a r a H o r n ,
R o b e r t T r a v e r s , an d C h ris K o ro n a k o s, w ho s e r v e d on m y c o m m it
t e e , i s a l s o d e e p ly a p p r e c i a t e d .
T o P a t r i c i a M id d le to n a n d M u r i e l O 'L e a r y , D i r e c t o r s of
N u r s in g , a n d t h e i r n u r s i n g s ta f f m y s i n c e r e a p p r e c i a t i o n . T h e ir
e f f o r t s a n d c o o p e r a t io n e n a b le d th is s tu d y to b e d o n e .
T o th e p a t i e n t s w ho s e r v e d a s s u b je c t s in t h is s tu d y I a m v e r y
g ra te fu l. E a c h o n e of th e m p a r t i c i p a t e d s o t h a t n u r s i n g m ig h t l e a r n
m o r e a b o u t th e d e l i v e r y of h e a lt h c a r e to th e p a t i e n t s w h o c o m e
a f te r th e m .
P h y l li s C . N ic o la o u
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
IN FOR M ATION TO USER S
2. When an image on th e film is ob lite rate d w ith a large round black m ark, it
is an indication th a t th e ph o to g rap h e r suspected th a t th e copy m ay have
m oved during exposure and th u s cause a blurred image. Y ou will find a
good image o f th e page in th e adja cen t fram e.
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7 8 -1 0 ,4 1 3
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T A B LE O F CONTENTS
PAGE
L IS T O F T A B L E S ........................................................................................... vi
L IS T O F F I G U R E S ........................................................................................... ix
CH APTER
I P U R P O S E O F S T U D Y ............................................. 1
S i g n if ic a n c e a n d N u r s in g I m p l i c a t i o n s
o f th e S t u d y ..................................................................... 2
T h e o r e t i c a l a n d O p e r a ti o n a l D e f in i t io n s
of C o n c e p t s ..................................................................... 8
O u tlin e o f th e R e p o r t .................................................... 9
II L I T E R A T U R E R E V I E W ........................................ H
C o n c e p t of A f f e c t r r~ . . . . H
T h e o r i e s of A n x i e t y ....................................... 14
I n t e r r e l a t e d n e s s o f A n x ie ty a n d P a i n . . . . 20
M e a s u r e m e n t o f P h y s i o lo g i c a l A r o u s a l . . . 23
T h e o r e t i c a l a n d C l in i c a l B a s i s f o r
D e v e lo p m e n t of th e N u r s e
I n t e r v e n t i o n T r e a t m e n t ............................ 27
H y p o t h e s e s ........................................................... 32
HI D E S IG N AND P R O C E D U R E S . 34
S u b j e c t s a n d S e t t i n g ........................................... 34
E x p e r i m e n t a l a n d D a ta C o l le c t io n
P r o c e d u r e s ..................................................... 37
i ii
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T a b l e o f C o n t e n ts - - C o n ti n u e d
CH APTER PA GE
I n s t r u m e n t a t i o n .............................................................. 39
D a ta A n a l y s is P l a n ......................................................... 49
IV R E S U L T S ..................................................................................... 51
A n a l y s is of M a jo r H y p o t h e s e s ............................... 51
I n t e r - r a t e r C o r r e l a t i o n of R a t e r s on
D i g i ta l S w e a t P r i n t s ............................................... 70
A d d i t io n a l P o s t H o c D a ta A n a l y s e s ..................... 70
A n a l y s is of D i g i ta l S w e a t M e a s u r e O v e r
T h r e e a n d F i v e T im e C o n d itio n s . . . . 75
R e s u l t s of S t r u c t u r e d I n te r v ie w
Q u e s t i o n n a i r e .............................................................. 79
S u m m a r y of R e s u l t s .................................................... 91
L i m i t a t i o n s of th e S t u d y ............................................... 94
T h e o r e t i c a l I n t e r p r e t a t i o n s of R e s u l t s . . . 99
C o n c l u s io n s a n d N u r s in g I m p l ic a t io n s . . . 107
I m p l i c a t i o n s f o r F u r t h e r R e s e a r c h ..................... 110
S u m m a r y .............................................................................. H2
" A P P E N D IC E S
A p p e n d ix A - - D a t a S h e e t ............................................................... 123
A p p e n d ix B - - P e r m i s s i o n S l i p .................................................... 126
iv
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T a b le of C o n t e n ts - - C o n ti n u e d
PA G E
A p p e n d ix C - - N u r s i n g I n t e r v e n t i o n P r o c e d u r e . . . . 128
A p p e n d ix D - - S t r u c t u r e d I n t e r v i e w ................................. 131
A p p e n d ix E - - R e c o r d o f N u r s in g I n t e r v e n t i o n D a ta .. 134
A p p e n d ix F - - D e t a i l e d F i n g e r S w e a t P r i n t (F S P )
P r o c e d u r e f o r E x p e r i m e n t ...................................... 137
A p p e n d ix G - - D e t a i l e d F i n g e r S w e a t P r i n t ( F S P )
P r o c e d u r e .......................................................................... 139
A p p e n d ix H - - P h o t o g r a p h of D i g i ta l S w e a t P r i n t s . .. 146
A p p e n d ix I - - S c h e d u l e o f R e c e n t E x p e r i e n c e s
Q u e s t i o n n a i r e ................................................................ 148
A p p e n d ix K - - M a t e r i a l to S e c u r e M e d ic a l S ta f f
P e r m i s s i o n ..................................................................... 157
A p p e n d ix L - - M a t e r i a l to S e c u r e N u r s in g S ta ff
P e r m i s s i o n ..................................................................... 162
A p p e n d ix M - - A c k n o w le d g m e n t C o r r e s p o n d e n c e . .. 167
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L IS T O F T A B L E S
TA BLE PA GE
• 1 T y p e of S u r g e r y .......................................................................... 34
2 S u m m a r y of O ne F a c t o r A n a l y s i s of V a r i a n c e
f o r M e a n A n x ie ty L e v e l f o r P o s t o p e r a t i v e
P e r i o d , H o u r s 1 - 2 4 ......................................................... 53
3 S u m m a r y of O ne F a c t o r A n a l y s i s of V a r ia n c e
f o r M e a n A n x ie ty L e v e l f o r' P o s t o p e r a t i v e
P e r i o d , H o u r s 24 - 48 54
4 S u m m a r y of O ne F a c t o r A n a l y s i s o f V a r ia n c e
f o r M e a n A n x ie ty L e v e l f o r P o s t o p e r a t i v e
P e r i o d , H o u r s 48 - 72 55
5 S u m m a r y of O ne F a c t o r A n a l y s i s o f V a r i a n c e
f o r M e a n A n x ie ty L e v e l f o r P o s t o p e r a t i v e
P e r i o d , H o u r s 1 - 7 2 ......................................................... 56
6 S u m m a r y of O ne F a c t o r A n a l y s i s of V a r ia n c e
fo r N u m b e r of A n a lg e s ic s A d m in is te r e d
P o s t o p e r a t i v e l y , H o u r s 1 - 2 4 .................................... 57
7 S u m m a r y of O ne F a c t o r A n a l y s is of V a r i a n c e
f o r N u m b e r of A n a l g e s i c s A d m i n i s t e r e d
P o s t o p e r a t i v e l y , H o u r s 2 4 - 48 58
8 S u m m a r y of O ne F a c t o r A n a l y s i s of V a r ia n c e
f o r N u m b e r of A n a lg e s ic s A d m in is te r e d
P o s t o p e r a t i v e l y , H o u r s 48 - 72 59
9 i S u m m a r y of O n e F a c t o r A n a l y s is of V a r i a n c e
f o r N u m b e r of A n a lg e s ic s A d m in is te r e d
P o s t o p e r a t i v e l y , T o t a l 72 H o u r s ............................... 60
10 S u m m a r y of O ne F a c t o r A n a l y s i s of V a r i a n c e
fo r M ean B ody T e m p e r a tu r e fo r P o s t
o p e r a t iv e P e r i o d , H o u r s 1 - 2 4 ............................... 62
vi
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L i s t of T a b l e s - - C o n t i n u e d
TABLE PA GE
11 S u m m a r y of O n e F a c t o r A n a l y s is o f V a r i a n c e
fo r M ean B ody T e m p e r a tu r e fo r P o s t
o p e r a t i v e P e r i o d , H o u r s 24 - 48 ............................... 63
12 S u m m a r y of O n e F a c t o r A n a l y s is o f V a r i a n c e
fo r M ean B ody T e m p e r a tu r e fo r P o s t
o p e r a t i v e P e r i o d , H o u r s 48 - 72 .......................... 64
13 S u m m a r y o f T w o F a c t o r A n a l y s is of V a r i a n c e
f o r E f f e c t of L e v e l of P r e o p e r a t i v e
A n x ie ty a n d E x p e r i m e n t a l T r e a t m e n t o n
M e a n P o s t o p e r a t i v e A n x ie ty L e v e l,
H o u rs 1 - 7 2 . ............................... 67
14 S u m m a r y of T w o F a c t o r A n a l y s is o f V a r i a n c e
f o r E f f e c t of A m o u n t of P r e v i o u s L i f e
S t r e s s a n d E x p e r i m e n t a l T r e a t m e n t on
T o t a l P o s t o p e r a t i v e M e a n A n x ie ty L e v e l . . 69
15 S u m m a r y of O n e F a c t o r A n a l y s is of V a r i a n c e
f o r D i f f e r e n c e s B e tw e e n E x p e r i m e n t a l a n d
C o n t r o l G r o u p s on A d m i s s i o n P r e o p e r a t i v e
A n x ie ty L e v e l ........................................................ 71
16 S u m m a r y of O n e F a c t o r A n a l y s is o f V a r i a n c e
f o r D i f f e r e n c e s B e tw e e n E x p e r i m e n t a l a n d
C o n t r o l G r o u p s on I m m e d ia t e P r e o p e r a t i v e
A n x ie ty L e v e l ....................................................... 72
17 S u m m a r y of O n e F a c t o r A n a l y s is of V a r i a n c e
fo r D iffe re n t S u rg ic a l P r o c e d u r e s A n tic i
p a te d a n d P r e o p e r a t i v e A n x ie ty L e v e l . . . 73
18 S u m m a r y of O n e F a c t o r A n a l y s is of V a r i a n c e
f o r E x p e r i e n c e w ith P r e v i o u s S u r g e r y a n d
P r e o p e r a t i v e A n x i e t y ....................................... 74
v ii
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L i s t of T a b l e s - - C o n t i n u e d
TABLE PA G E
19 S u m m a r y of T w o F a c t o r A n a l y s is of V a r i a n c e
f o r I n t e r a c t i v e E f f e c t of A g e a n d E x p e r i
m e n t a l T r e a t m e n t on M e a n T o ta l P o s t
o p e r a t i v e A n x i e t y .............................................................. 76
20 S u m m a r y of O n e F a c t o r R e p e a te d M e a s u r e
A n a l y s is o f V a r i a n c e f o r C o n d itio n s of
A d m i s s i o n A n x ie ty , I m m e d ia t e P r e
o p e r a t i v e A n x ie ty , a n d M e a n A n x ie ty
on th e T h i r d P o s t o p e r a t i v e D a y ............................... 78
21 S u b j e c t s ' P e r c e p t i o n of S o u r c e s of
P r e o p e r a t i v e A n x i e t y ......................................................... 81
22 S u b j e c t s ' P e r c e p t i o n o f S o u r c e s of P o s t
o p e r a t i v e A n x i e t y .............................................................. 84
23 A c t iv i t y of C a r e G i v e r s P e r c e i v e d a s
T e n s io n R e d u c in g .............................................................. 85
24 S u b j e c t s ' P e r c e p t i o n o f O n e A c tio n of O t h e r s
M o s t H e lp fu l D u r in g P a i n E x p e r i e n c e . . . 88
25 P r e s e n c e of P h y s i o l o g i c a l V a r i a b l e s A s s o
c ia t e d W ith A n x ie ty D u r in g th e P o s t
o p e r a t i v e P e r i o d ................................................................... 90
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L IS T O F F IG U R E S
1 M e a n D i g i ta l S w e a t L e v e ls (D SL ) O v e r
F i v e T i m e C o n d i t i o n s .................................................... 79
ix
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CH APTER I
P U R P O S E O F ST U D Y
T h is s tu d y w a s i n te n d e d to s u b j e c t to e x p e r i m e n t a l i n v e s t i g a
tio n th e e f f e c t of a n u r s i n g i n t e r v e n t i o n t r e a t m e n t on th e a n x ie t y
c o m p o n e n t of p a t i e n t s ' p o s t o p e r a t i v e p a in e x p e r i e n c e s . S e v e ra l
c l i n i c a l l y s p e c i f ic r e c o v e r y r a t e i n d ic e s a n d th e p o s t o p e r a t i v e a n x
i e t y l e v e l w e r e u s e d a s a m e a s u r e of t h e e f f e c t o f th e e x p e r i m e n t a l
tre a tm e n t. A d d i t io n a l ly t h i s s tu d y i n v e s t i g a t e d w h e th e r a d i f f e r e n
t i a l e f f e c t of th e n u r s i n g i n t e r v e n t i o n t r e a t m e n t e x is t e d f o r s u b j e c t s
w ho h a d e x p e r i e n c e d h ig h o r lo w l e v e l s of l if e s t r e s s in th e y e a r
p re c e d in g s u rg e r y . A l s o , th e s tu d y i n v e s t i g a t e d w h e t h e r a d i f f e r
e n ti a l e f f e c t of th e n u r s i n g i n t e r v e n t i o n t r e a t m e n t e x is t e d f o r s u b
j e c t s w ho e x p e r i e n c e d h i g h o r lo w l e v e l s of a n x ie ty p r e o p e r a t i v e l y .
T h e a s s u m p t io n u n d e r l y i n g th e r e l a t i o n s h i p of a n x ie ty to th e
p a in e x p e r i e n c e i s t h a t w h e n o n e e x p e r i e n c e s p a in t h e r e i s a c o r r e
s p o n d in g i n c r e a s e in a n x ie t y o r e m o t i o n a l it y . A n x ie ty i n c r e a s e s th e
p e r c e i v e d i n t e n s i t y o f t h e p a in s e n s a t i o n w h ile s im u lt a n e o u s ly
d e c r e a s i n g th e t o l e r a n c e l e v e l f o r p a in . T h is r e l a t i o n s h i p h a s a n
o b v io u s ly c u m u l a ti v e e f f e c t a n d p o in ts to th e i m p o r ta n c e o f i n t e r
v e n tio n to r e d u c e th e c i r c u l a r i n t e r a c t i n g r e l a t i o n s h i p t h a t e x i s t s
b e tw e e n a n x ie ty a n d p a in . L e s s e (1 9 7 0 ) s u g g e s t s t h a t th e r e d u c t i o n
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
2
o f a n x ie ty a s s o c i a t e d w ith th e e x p e r i e n c e of p a in w o u ld c o r r e s p o n d
i n g ly d e c r e a s e th e p a in i n t e n s i t y a n d r a i s e th e i n d i v i d u a l 's t o l e r a n c e
f o r th e p a in e x p e r i e n c e . M c C a f f e r y (1 9 7 2 ) s t a t e s , " W h e n a n x ie ty
b e c o m e s a s s o c i a t e d w ith p a in , a r e d u c t io n in t h is a n x ie t y w ill c o n
t r i b u t e to p a in r e l i e f . T h e b a s i c r e a s o n f o r e a r l y a p p li c a ti o n o f a
p a in r e l i e f m e a s u r e i s r e l a t e d in p a r t to th e c o n tr o l of a n x ie ty "
(p. 101).
S i g n if ic a n c e a n d N u r s in g I m p l ic a t io n s
o f th e S tu d y
A s e a r c h o f th e l i t e r a t u r e r e v e a l e d t h a t c o n s i d e r a b l e r e s e a r c h
h a s b e e n d o n e on th e e f f e c t of p r e o p e r a t i v e , c o g n itiv e p r e p a r a t o r y
i n f o r m a t io n on p o s t o p e r a t i v e r e c o v e r y r a t e in d ic e s ( A n d re w , 1970;
fe w s tu d i e s h a v e s u b je c t e d to c l i n i c a l e x p e r i m e n t a l i n v e s t ig a t io n th e
e f f e c t o f p o s t o p e r a t i v e i n t e r v e n t i o n s on th e a n x ie ty l e v e l o f s u r g i c a l
p a ti e n ts a n d r e c o v e r y r a t e i n d ic e s (B o c h n a k , R h y m e s , fk L e o n a r d ,
T h e s u b je c t io n of n u r s i n g i n t e r v e n t i o n t e c h n i q u e s to e m p i r i c a l
c l i n i c a l s tu d y i s b a s i c to th e d e v e lo p m e n t o f a t h e o r y o f n u r s i n g .
A y d e lo tte (1976) s t a t e s ,
G r e a t a tt e n ti o n s h o u ld b e g iv e n to th e d e v e lo p m e n t
of c r i t e r i a t h a t c a n b e u s e d to m e a s u r e th e e f f e c ti v e n e s s
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
o f n u r s i n g p r a c t i c e in t e r m s of p a t i e n t o u t c o m e s . W h a t
i s g r e a t l y n e e d e d a r e s tu d i e s d e m o n s t r a t i v e o f t h e e f f e c
t i v e n e s s o r n o n - e f f e c t iv e n e s s o f n u r s i n g p r a c t i c e u p o n
p a t i e n t r e c o v e r y , (p. 6)
T h e n e e d f o r o u tc o m e m e a s u r e s w h ic h d i f f e r e n t i a t e q u a li t y of
n u r s i n g c a r e is a p r i m a r y r e s e a r c h f o c u s in n u r s i n g , r e s p o n d in g to
q u a li t y a s s u r a n c e a n d n u r s i n g a c c o u n t a b il i ty to t h e c li e n t. I t is
in te n d e d t h a t th e m e a s u r e of a n x ie ty u s e d in t h i s s tu d y m a y u l t i
m a t e l y s e r v e a s a v a li d a te d a n d r e l i a b l e d i s c r i m i n a t o r o f th e q u a lity
o f n u r s i n g c a r e f o r th e p o s t o p e r a t i v e p a ti e n t. S u ch an u n o b tru s iv e
a n d e a s i l y o b ta in e d q u a li t y a s s e s s m e n t t o o l w o u ld , t h r o u g h i t s
d i s c r i m i n a t o r y p o w e r , s e r v e th e n e e d o f e v a lu a t io n o f p a r t i c u l a r
n u r s i n g p r a c t i c e s a n d q u a lity of h e a lt h c a r e d e l i v e r y . S u c h a to o l
w o u ld c o n t r i b u t e to th e u l ti m a t e l y n e c e s s a r y p s y c h o lo g i c a l c r i t e r i o n
m e a s u r e s on w h ic h q u a li t y n u r s i n g c a r e m ig h t b e e v a lu a t e d . S tra u s ,
b e c o m e g e n u in e l y a c c o u n ta b le f o r t h e i r p a in w o r k , t h e r e w ill b e
l i t t l e i m p r o v e m e n t in th e c a r e o f th e p a t i e n t s , e x c e p t t h a t w h ic h is
e f f e c te d f o r t u i t o u s l y o r t e m p o r a r i l y b y v i r t u e o f a n u n u s u a lly s k il le d ,
c o m p a s s i o n a t e o r s e n s i b l e s ta f f m e m b e r " (p . 5 6 1 ).
N u r s in g h a s a tt e m p t e d to a c h ie v e c o n s e n s u s a m o n g n u r s i n g
e x p e r t s , t h r o u g h u s e of th e D e lp h i te c h n i q u e , a b o u t th e m o s t i m p o r
ta n t a r e a s f o r n u rs in g r e s e a r c h . T h e f o llo w in g i t e m s w e r e c o n s id
e r e d to b e th e m o s t i m p o r t a n t a r e a s o f r e s e a r c h v a lu e f o r th e
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
p r o fe s s io n : (1) th e d e t e r m i n a t i o n o f v a li d a n d r e l i a b l e i n d i c a t o r s o f
q u a li t y n u r s i n g c a r e ; (Z) th e d e v e lo p m e n t o f a s e t o f p h y s i c a l a n d
p s y c h o lo g i c a l a s s e s s m e n t p r o c e d u r e s t h a t p r o v id e i n f o r m a t i o n n e c
e s s a r y f o r n u r s i n g i n te r v e n t i o n a n d im p r o v e d p a t i e n t c a r e ; (3) th e
d e t e r m i n a t i o n a n d e v a lu a tio n of i n te r v e n t i o n s b y n u r s e s t h a t a r e
m o s t e f f e c ti v e in r e d u c in g p s y c h o lo g i c a l s t r e s s o f p a t i e n t s ; (4) th e
e v a lu a t io n , in t e r m s of p a t i e n t o u tc o m e s , of p r o c e s s e s u s e d to p r o
v id e n u r s i n g c a r e ; a n d (5) th e s tu d y of n u r s i n g i n t e r v e n t i o n s o f th e
m a n a g e m e n t of p a in ( L in d e m a n , 1975). I f th e m e a s u r e s u s e d in t h is
s tu d y d i s c r i m i n a t e s ig n i f ic a n tl y b e tw e e n th e e x p e r i m e n t a l a n d c o n
t r o l g r o u p , e a c h of th e r e s e a r c h n e e d s c it e d b y L i n d e m a n w ill in
so m e w ay be s e rv e d .
N u rs in g th e o ry an d c lin ic a l p r a c tic e d e s c r ib e n u m e ro u s te c h
n iq u e s w h ic h m a y a p p r o p r i a t e l y b e u s e d to p r o v id e p s y c h o lo g i c a l
s u p p o r t a n d c o m f o r t to th e p a ti e n t in p a in . T h is p s y c h o l o g i c a l s u p
p o r t i s v i e w e d b y e s s e n t i a l l y a l l n u r s i n g a u th o r s a s a p r i m a r y r o l e
f u n c tio n o f t h e n u r s e in t r e a t i n g p a ti e n ts w ith p a in . M c C a f f e r y (1 9 7 2 )
h a s i n d i c a t e d , h o w e v e r , t h a t in a c tu a l p r a c t i c e t h i s f u n c tio n is
r a r e ly p e rf o r m e d by n u r s e s . M c C a f f e r y (1 9 7 2 ) s t a t e s ,
I n a b i l it y to d e s c r i b e n u r s i n g i n t e r v e n t i o n s i s p r o b
a b ly o n e r e a s o n n u r s e s te n d to do s o l i t t l e f o r t h e p a t i e n t
w ith p a in . B o th r e s e a r c h a n d i n f o r m a l o b s e r v a t i o n
r e p e a t e d l y c o n f i r m th e i d e a t h a t m o s t n u r s i n g i n t e r v e n
tio n r e l a t e d to p a in i s c o n fin e d to th e a d m i n i s t r a t i o n of
a n a n a l g e s i c , (p. 79)
with permission of the copyright owner. Further reproduction prohibited without permission.
N u r s in g i n t e r v e n t i o n p r o c e s s e s to r e d u c e th e a n x ie ty c o m p o
n e n t of th e p a in e x p e r i e n c e a r e d e s c r i b e d a n d d e li n e a te d b y s e v e r a l
n u r s i n g a u th o r s ( B r u n n e r , E m e r s o n , F e r g u s o n , & S u d d a r th , 1970;
(i. e. , N u r s in g I n t e r v e n t i o n T r e a t m e n t ) u s e d in t h is s tu d y w a s b a s e d
on th e e f f ic a c y r e p o r t e d f o r s u c h i n te r v e n t i o n s b y n u r s i n g t h e o r i s t s ,
c li n i c i a n s , a n d d i r e c t p a t i e n t t e s t im o n y .
P a i n i s a p s y c h o lo g i c a l l y d i s c o m f o r t in g e x p e r i e n c e , a n d a s
s u c h t h o s e i n t e r v e n t i o n s w h ic h p r o m o t e p s y c h o lo g i c a l a n d p h y s i c a l
c o m f o r t a r e s ig n i f ic a n t in th e t r e a t m e n t of p a in . T h e r e m o v a l of
e x tr a n e o u s n o x io u s s t i m u l i i s o n e m e th o d o f p r o m o t in g c o m f o r t.
T h e p o s t o p e r a t i v e p a t i e n t i s f r e q u e n tl y s u b je c t e d to th e f o llo w in g
a n d o d o r s ; (4) w e t, s o il e d , w r i n k le d b e d d in g a n d d r e s s i n g s ; (5)
m is a l i g n m e n t of b o d y p a r t s ; a n d (6) w e t a n d u n c le a n s k in . The
r e m o v a l of s u c h n o x io u s s t i m u l i to p r o m o t e p s y c h o p h y s i o l o g ic a l
c o m f o r t a n d r e d u c e th e a n x ie t y r e s p o n s e to s u c h s t i m u l i w a s p r o
p o s e d a s o n e a s p e c t o f th e e x p e r i m e n t a l t r e a t m e n t b e in g t e s t e d .i n
t h is s tu d y .
A n x ie ty a r i s e s w h e n o n e f e e l s o n e i s in a n u n p r e d i c t a b l e s i t u
a tio n w h e r e o n e i s u n c e r t a i n a n d l a c k s c o n tr o l . S tu d ie s ( B a d ia ,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
s h o w n t h a t r e d u c t io n o f s ti m u l i i m p a c t o c c u r s w h e n o n e b e li e v e s
o n e h a s th e a b il i ty to c o n tr o l th e s t i m u l u s a n d w h e n o n e h a s k n o w l
e d g e w h ic h r e s u l t s in a n i n c r e a s e d p r e d i c t a b i l i t y a b o u t th e s t i m u l u s .
A s p e c ts of th e N u r s in g I n t e r v e n t i o n T r e a t m e n t of t h is s tu d y w e r e
d e s ig n e d to a d d r e s s th e n e e d f o r c o n t r o l a n d p r e d i c t a b i l i t y of th e
p a in e x p e r i e n c e b y th e p a ti e n t. S u ch c o n tr o l an d p r e d ic ta b ility m a y
r e d u c e th e a n x ie t y c a u s e d b y h e l p l e s s n e s s a n d la c k o f k n o w le d g e
a b o u t w h a t to e x p e c t in a s it u a ti o n .
N e u f e ld a n d D a v id s o n (1 9 7 5 ) s u g g e s t t h a t a s t a t e of u n c e r t a in t y
i n c r e a s e s a n x ie ty . W h en o n e i s u n f a m i l i a r w ith p r e s e n t in g s ti m u l i
s u c h a s i n tr a v e n o u s in fu s io n , s u t u r e s in o n e 's s k in , a n d e x tr a n e o u s
tu b in g l e a d in g f r o m b o d y o r i f i c e s , o n e i s f a c e d w ith a h ig h d e g r e e of
u n c e r t a i n t y a n d p o t e n t i a l a n x ie ty a b o u t s u c h e q u ip m e n t. A n a d d it i o n a l
a s p e c t of th e N u r s in g I n te r v e n t i o n T r e a t m e n t d e s ig n e d f o r u s e in t h is
s tu d y a d d r e s s e d th e n e e d f o r p a t i e n t k n o w le d g e a n d r e a s s u r a n c e
a b o u t th e f u n c tio n in g of s u c h a p p a r a t u s .
R e v ie w in g d e s c r i p t i o n s a n d c o m m e n ts of p a ti e n ts a b o u t p a in ,
th e fo llo w in g n e e d s e m e r g e d (C o p p , 1 9 7 4 ). P a t i e n t s f e e l a n e e d to
t a l k a b o u t a n d d e s c r i b e th e p a in to a p e r s o n w h o m th e y p e r c e i v e a s
h a v in g th e n e c e s s a r y k n o w le d g e a n d r e s o u r c e s to r e l i e v e th e p a in .
T h e n e e d f o r p a ti e n ts to e x p e r i e n c e a p r o m p t r e s p o n s e f r o m h e lp in g
p e o p le to th e e x p r e s s i o n of t h e i r p a in i s a l s o i m p o r t a n t . T h is n e e d
p o s s i b l y a s s u m e s g r e a t i m p o r t a n c e d u e to th e a l t e r e d a n d d i s t o r t e d
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
7
t i m e p e r c e p t i o n w h e n one i s in a n a n x io u s s t a t e . P a t i e n t s id e n tif y
t h e n e e d to b e li e v e t h a t p e r s o n s in th e h e lp i n g r o l e h a v e th e n e c e s
s a r y s k i l l a n d r e s o u r c e s to p r o v id e r e l i e f f r o m p a in . A n o th e r
i m p o r t a n t n e e d id e n t i f i e d t h ro u g h p a t i e n t a c c o u n t s , i s th e n e e d f o r
t h e p h y s i c a l p r e s e n c e of a n o th e r ; n o t to b e l e f t to s u f f e r a lo n e d u r
in g th e p a in e x p e r i e n c e .
T h is s tu d y p r o p o s e d th e n to s u b j e c t to e x p e r i m e n t a l i n v e s t i g a
t io n th e e f f e c t of a N u r s in g I n te r v e n t i o n T r e a t m e n t on t h e a n x ie ty
l e v e l , in r e s p o n s e to th e p a in e x p e r i e n c e , o f p o s t o p e r a t i v e a b d o m i
n a l s u r g e r y p a tie n ts . In a d d itio n th e s tu d y a t t e m p t e d to d e t e r m i n e
t h e r e l a t i o n s h i p s b e tw e e n r e d u c t io n o f p o s t o p e r a t i v e a n x ie t y d u r in g
t h e p a in e x p e r i e n c e to o t h e r i n d ic e s w h ic h m ig h t p r e d i c t b o th th e
q u a li t y a n d r a t e of r e c o v e r y f r o m th e s t r e s s o f s u r g i c a l i n t e r v e n
t io n . T h e s e i n d ic e s in c lu d e d : (1) m e a n b o d y t e m p e r a t u r e d u r in g th e
i n i t i a l 7 2 - h o u r p o s t o p e r a t i v e c o u r s e , (2) t h e m e a n n u m b e r o f a n a l
g e s i c s r e c e i v e d d u r in g th e i n i t i a l 7 2 - h o u r p o s t o p e r a t i v e p e r i o d , a n d
(3) th e m e a n n u m b e r of a m b u l a to r y e f f o r t s d u r in g th e i n i t i a l 7 2 - h o u r
p o s to p e r a tiv e p e rio d .
A d d i tio n a lly , t h is s tu d y p r o p o s e d to i n v e s t i g a t e th e d i f f e r e n
t i a l e f f e c t of th e N u r s in g I n te r v e n t i o n T r e a t m e n t on t h o s e p o s t o p e r
a t i v e p a t i e n t s w ho e v id e n c e d e x t r e m e l y h i g h o r e x t r e m e l y lo w
s c o r e s on th e S c h e d u le of R e c e n t E x p e r i e n c e s S c a le (R a h e , 1 974).
T h is s c a l e m e a s u r e s a m o u n t o f l if e s t r e s s w h ic h a p e r s o n h a s
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
e x p e r i e n c e d b e c a u s e o f s i g n i f ic a n t c h a n g e s in h i s l if e . In th e c o n
t e x t of t h i s s tu d y , s u b je c t s w h o h a d e x p e r i e n c e d h ig h l i f e s t r e s s d u r
in g th e y e a r p r e c e d i n g s u r g e r y m a y sh o w a d e c r e a s e d c o p in g a b il i ty
f o r th e a d d it i o n a l s t r e s s of s u r g e r y . C o n s e q u e n tly , t h e s e s u b je c t s
m ig h t r e q u i r e a n d r e s p o n d d i f f e r e n t ly to th e N u r s in g I n t e r v e n t i o n
T r e a t m e n t th a n t h o s e s u b je c t s w ho e x p e r i e n c e d o n ly m i n i m a l r e c e n t
l if e s t r e s s a n d w o u ld t h e r e f o r e b e b e t t e r a b le to c o p e i n d e p e n d e n tly
a n d w ith l e s s a n x ie t y to th e p a in a n d s t r e s s o f s u r g e r y . A ls o th e
s tu d y i n v e s t i g a t e d w h e t h e r a d i f f e r e n t i a l e f f e c t o f th e N u r s in g I n t e r
v e n tio n T r e a t m e n t o p e r a t e d f o r t h o s e s u b je c t s e x p e r i e n c i n g h ig h
l e v e l s of p r e o p e r a t i v e a n x ie ty .
T h e o r e t i c a l a n d O p e r a ti o n a l D e f in i t io n s
o f C o n c e p ts
P a i n - - " A c o m p le x p s y c h o - p h y s i o lo g i c a l r e s p o n s e to n o x io u s
e x p e r i e n c e , a n a f f e c t, a n d i s d e fin e d b y th e p e r s o n e x p e r i e n c i n g i t,
a n d e x i s t s w h e n h e s a y s i t d o e s " ( M c C a f f e ry , 19 7 2 , p . 7 ). F o r p u r
p o s e s o f t h i s s tu d y , p a in is a n a f f e c ti v e r e s p o n s e to n o x io u s s t i m u l i
a n d w ill b e s a i d to e x i s t w h e n th e p a ti e n t s a y s i t d o e s .
A n x ie ty - - A p s y c h o p h y s io lo g ic r e s p o n s e t h a t m a y b e e l i c i t e d b y
i z e d b y s u b j e c t i v e f e e l in g s o f a p p r e h e n s io n a n d t e n s i o n a c c o m p a n ie d
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
9
b y o r a s s o c i a t e d w ith p h y s io l o g ic a l a c ti v a ti o n o r a r o u s a l " ( P a u l,
1969, p . 6 4 ). A d i s t i n c t i o n b e tw e e n f e a r a n d a n x ie ty w i l l n o t b e
m a d e f o r p u r p o s e s o f t h is s tu d y , t h e r e f o r e a r e s p o n s e - o r i e n t e d
d e f i n i ti o n r a t h e r th a n a s t i m u l u s - o r i e n t e d d e f in itio n w ill b e u s e d
(B a rc la y & S ro u fe , 1970).
N u r s in g I n t e r v e n t i o n T r e a t m e n t - - A s e r i e s of i n t e r v e n t i o n s
d e s ig n e d to p r o m o t e a s t a t e o f p s y c h o p h y s i o l o g ic a l r e l a x a t i o n a n d
f e e l in g s of c o m f o r t. L a z a r u s (1 9 6 6 ) a n d W o lp e a n d L a z a r u s (1 9 6 6 )
c o n c lu d e t h a t th e f e e l in g s o f r e l a x a t i o n a n d w e l l- b e in g a r e p r e s u m e d
to b e i n c o m p a ti b le w ith a n x ie ty .
T h e N u r s in g I n t e r v e n t i o n T r e a t m e n t u s e d in t h is s tu d y w a s
d e s ig n e d to a d d r e s s p a t i e n t n e e d s f o r : (1) r e c o g n i ti o n o f p a t i e n t
s e lf h o o d b y th e c a r e g i v e r , (2) c o g n itiv e i n f o r m a t io n a b o u t a n a l g e s i c
m e d i c a ti o n s c h e d u l e , (3) p r o m p t r e s p o n s e o f c a r e g i v e r to p a t i e n t 's
c o m m u n i c a t io n of p a in , (4) th e p h y s i c a l p r e s e n c e o f th e c a r e g i v e r
d u r in g th e a c u te p h a s e of t h e p a in e x p e r i e n c e , (5) r e m o v a l o f e x t r a
n e o u s n o x io u s s t i m u l i , (6) c o g n itiv e i n f o r m a t io n a b o u t th e f u n c t i o n
in g of u n f a m i l i a r e q u ip m e n t b e in g u s e d , a n d (7) r e i n f o r c e m e n t b y th e
c a r e g i v e r o f th e p a t i e n t 's p r e v i o u s l y s u c c e s s f u l p a in c o p in g s k i l l s .
O u tlin e o f th e R e p o r t
C h a p t e r II i s a r e v i e w o f r e l e v a n t t h e o r e t i c a l l i t e r a t u r e a n d
e m p i r i c a l a n d c l i n i c a l r e s e a r c h f in d in g s . C h a p t e r III d e t a i l s th e
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
e x p e r i m e n t a l d e s ig n , m e t h o d o l o g y o f t h e s tu d y , a n d in c l u d e s
m e t h o d s u s e d to t r a i n th e n u r s i n g s ta f f in t h e e x p e r i m e n t a l N u r s in g
I n te r v e n t i o n T r e a t m e n t . C h a p t e r IV i s a n a n a l y s i s o f th e r e s u l t s o f
th e s tu d y . C h a p te r V d e t a i l s t h e l i m i t a t i o n s o f th e s tu d y , p r o p o s e s
t h e o r e t i c a l i n t e r p r e t a t i o n s o f t h e f in d i n g s , d i s c u s s e s i m p l ic a ti o n s
of th e s tu d y f o r n u r s i n g c a r e , a n d p r o p o s e s r e c o m m e n d a t io n s f o r
fu rth e r re s e a rc h .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
C H A P T E R II
L I T E R A T U R E R E V IE W
C o n cep t of A ffe c t
T h e i n t e r r e l a t i o n s h i p a m o n g m a n 's p h y s io l o g ic a l , a f f e c tu a l ,
a n d c o g n itiv e s t a t e s h a s b e e n t h e o r i z e d b y p h i l o s o p h e r s , th e o l o g i a n s ,
p h y s i o l o g i s t s , a n d p s y c h o lo g i s ts . M il e s to n e t h e o r e t i c i a n s i n c lu d e
D a r w in , J a m e s - L a n g e , a n d C a n n o n . A s u r v e y o f th e p r i m a r y t h e o
r i e s of a f f e c t s t a t e s w a s c o n d u c te d a n d p r e s e n t e d h e r e b e c a u s e
a f f e c t i s g e n e r i c a l l y r e l a t e d to th e s p e c i f i c c o n c e p t o f a n x ie ty .
D a r w in (1897) t h e o r i z e d t h r e e b a s i c p r i n c i p l e s o f e m o tio n .
T h e f i r s t b e in g t h a t m a n e x p r e s s e s c e r t a i n m in d s t a t e s b y h a b it u a l
b e h a v io r. D a r w in e q u a te s h a b it u a l b e h a v i o r a n d r e f l e x a c ti o n s . The
s e c o n d p r i n c i p l e , " A n t i t h e s i s , " is s ta t e d :
W h e n a c ti o n s o f o n e k in d h a v e b e c o m e f i r m l y a s s o
c ia t e d w ith a n y s e n s a t io n o r e m o tio n , i t a p p e a r s n a t u r a l
t h a t a c ti o n s of a d i r e c t l y o p p o s it e k in d , th o u g h of no u s e ,
s h o u ld b e u n c o n s c i o u s ly p e r f o r m e d th r o u g h h a b i t a n d
a s s o c i a t i o n , u n d e r th e i n f l u e n c e o f a d i r e c t l y o p p o s ite
s e n s a t i o n o r e m o tio n , (p. 6 5)
T h e t h i r d p r i n c i p l e s ta t e d b y D a r w in i s t h a t c e r t a i n b e h a v io r s a r e a
d i r e c t r e s u l t o f th e a c ti o n o f th e n e r v o u s s y s t e m a n d t h e s e b e h a v io r s
a r e n o t s u b je c t to e i t h e r w ill o r h a b it . D a r w in a n t i c i p a t e s l a t e r
a t t e m p t s to m e a s u r e e m o t i o n a l it y b y p h y s io l o g ic a l m e a s u r e s w h e n
11
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
12
h e d i s c u s s e s th e e f f e c t of m in d s t a t e s on h e a r t a c ti o n , m u s c u l o
s k e l e t a l s y s te m , g a s t r o - i n t e s t i n a l s y s te m , a n d v a s o - m o t o r f u n c tio n .
H i s t o r i c a l l y , th e J a m e s - L a n g e t h e o r y of e m o tio n h a s i m p o r
t a n c e in th e d e v e lo p m e n t of th e f o llo w in g p a r a d i g m : p e r c e p t i o n of
e v e n t— o r g a n i c b o d ily c h a n g e s ( a c t io n ) — ^ f e e l i n g s —^ r e s u l t a n t
e m o t i o n a l it y ( P lu t c h ik , 196 8 , p . 28). T h is p a r a d i g m e x p la in e d th e
r e l a t i o n s h i p of e a c h c r i t i c a l c o n c e p t in J a m e s - L a n g e 's t h e o r y of
e m o tio n . J a m e s - L a n g e 's t h e o r y a tt e m p t e d to r e p l a c e t h e e a r l i e r
p a r a d i g m of e m o t i o n a l it y a s , " p e r c e p t i o n of a s it u a ti o n , f e e l in g of
a n e m o tio n , a n d th e n a c ti o n , e i t h e r o v e r t o r i n t e r n a l o r b o th "
( P lu t c h ik , 1968, p. 20).
C a n n o n (1927) t h e o r i z e d f r o m h i s e x p e r i m e n t s w ith d e c o r t i c a t e d
c a ts t h a t th e th a l m u s w a s th e s e a t of th e e m o tio n s a n d t h a t b o d ily
c h a n g e s ( a c tio n s ) w e r e n o t t h e d i r e c t p r e c u r s o r s o f e m o t i o n a l
changes. C a n n o n 's r e s e a r c h w a s th e f i r s t a t t e m p t to e x p lo r e th e
s p e c i f ic n e u r o p h y s i o lo g i c a l s t r u c t u r e s w h o s e f u n c tio n w o u ld e x p la in
th e d e v e lo p m e n t of e m o t i o n a l it y .
S c h a c h te r (1966) p r o p o s e d t h a t i t w a s n o t b o d ily s t a t e s n o r th e
t h a l m u s w h ic h w e r e p r i m a r i l y r e s p o n s i b l e f o r th e d e v e lo p m e n t of
e m o t i o n a l s t a t e s , b u t t h a t c o g n itiv e f a c t o r s m ig h t b e t h e m a j o r
d e t e r m i n a n t s of e m o tio n (p . 1 94). S c h a c h te r (1 9 6 6 ) c i t e s o t h e r
a u t h o r s , H u n t e t a l. (1958) a n d R u c k m ic k (1 9 3 6 ), w ho h a v e a l s o s u p
p o r t e d th e a p p r a i s a l , e v a lu a t io n o f t h r e a t , a n d la b e l in g f u n c tio n o f
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
13
c o g n itio n in r e s p o n s e to th e p h y s io l o g ic a l a r o u s e d s t a t e . T h e r o le
of c o g n itiv e a p p r a i s a l of s t i m u l i , a s p o s it iv e o r n e g a ti v e , w a s a l s o
th e o riz e d by A rn o ld (I9 6 0 ). S c h a c h te r (1 9 6 6 ) c i t e s th e s u b j e c t i o n o f
h i s t h e o r y to a s e r i e s of e x p e r i m e n t a l s tu d i e s b y S c h a c h t e r a n d
S in g e r on 185 m a l e c o ll e g e s tu d e n t s u b je c t s . The r e s e a r c h e r s
m a n i p u l a t e d p h y s i o l o g i c a l a r o u s a l th r o u g h i n je c ti o n s of a s y m p a t h o -
m e t i c d r u g ( a d r e n a l i n e ) ; s y m p a t h o m e t ic b lo c k in g d r u g ( c h l o r p r o m a -
z in e ); a n d c o g n it i o n t h r o u g h s t a t e s of i n f o r m a t io n , no i n f o r m a t i o n ,
and m is in f o r m a tio n . T h e p r i m a r y r e s u l t s s u p p o r t e d t h e d u a li t y
p r e t a t i o n o r l a b e l in g o f f e e l in g , i n f l u e n c e d b y p r e s e n t s i t u a t i o n
s ti m u l i , c o m b in e to r e s u l t in a s t a t e d e fin e d a s e m o t i o n a l it y .
S c h l o s b e r g (1 9 5 4 ) p o s t u l a t e d th e a c ti v a ti o n t h e o r y o f e m o tio n .
T h is t h e o r y v ie w s a l l e m o t i o n a l it y on a q u a n ti t a t iv e b e h a v i o r c o n ti n
u u m f r o m m i n i m a l o r g a n i s m a c t i v i t y s t a t e s to h ig h o r g a n i s m a c t i v
q u a li t a t iv e d i m e n s i o n s of p l e a s a n t - u n p l e a s a n t n e s s , a n d a t t e n t i o n -
r e j e c t i o n a r e p a r t s o f t h is m o d e l" ( P lu t c h ik , 1 968, p . 3 0 ).
L e e p e r (1 9 4 8 ) h a s t h e o r i z e d e m o tio n s a s m o ti v a ti n g f o r c e s
w h ic h a r o u s e , s u s t a i n , a n d d i r e c t b e h a v io r . A c c o r d in g to P l u tc h i k
(1968) th is t h e o r y i s s i m i l a r to th e e m e r g e n c y o r s t r e s s t h e o r y of
H a n s S e ly e , b u t d i f f e r s f r o m S e l y e 's s t r e s s t h e o r y in t h a t p o s i t i v e
e m o tio n s a r e i n c l u d e d in th e m o ti v a ti o n t h e o r y of L e e p e r .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
14
T h e b e h a v i o r i s t i c t h e o r i e s o f e m o tio n a r e p a r t i a l l y e x e m p l i
f ie d b y th e w r i ti n g s of W a ts o n , T o lm a n , a n d S k i n n e r . P l u tc h i k
r e s p o n s e o r g r o u p of r e s p o n s e s w h ic h o c c u r w ith s o m e c o n s i s t e n c y
o u t t h a t T o lm a n c o n c e p t u a li z e s e m o tio n s a s o r g a n i s m i c r e s p o n s e s to
" a p a r t i c u l a r s t a t e o f s t r e n g t h o r w e a k n e s s in o n e o r m o r e r e s p o n s e s
T h e o r i e s o f A n x ie ty
d e v e lo p m e n t o f a n x ie ty a s a d i s c r e e t e m o tio n a n d t h e r e f o r e i t m a y
b e c o n c e p t u a li z e d a s a s p e c i f i c a f f e c tu a l r e s p o n s e . E n g e l (1 9 6 3 )
c o n c lu d e d t h a t a n x ie t y i s , " a t r u e e g o s t a t e , t h a t i n v o lv e s n o t o n ly
th e c o n c e p t of d a n g e r b u t a l s o o f r e l i e f t h r o u g h th e a c ti v it y o f a n
i c a l l y f r o m th e i n f a n t 's e x p e r i e n c e w ith p r i m a l a n x ie ty a n d th e
a c c o m p a n y in g r e l i e f of t h i s a n x ie t y b y th e p r e s e n c e of s ig n i f ic a n t
o th e rs. E n g e l (1963) f u r t h e r e l a b o r a t e s o n th e i n t e r p s y c h i c e x p e r i
e n c e s of s e l f - w e a k n e s s a n d h e l p l e s s n e s s w h ic h th e e x p e r i e n c e o f
a n x ie ty g e n e r a t e s a n d w h ic h c a n b e r e l i e v e d th r o u g h i n t e r p e r s o n a l
e x p e r i e n c e (pp. 2 7 6 - 2 7 7 ).
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
15
T h e p h i lo s o p h ic a l a n d r e l i g i o u s l i t e r a t u r e r e l a t i v e to a n x ie ty
i s t a n g e n t ia l to t h is s tu d y a n d t h e r e f o r e w ill n o t b e r e v i e w e d . M ay
(1950) r e v i e w s th e c o n c e p t u a li z a ti o n s o f s u c h n o t a b l e t h e o r i s t s a s
P . T i ll ic h , R . N i e b u h r , M . H e i d e g g e r , a n d S. K i e r k e g a a r d f o r
t h o s e w ho d e s i r e f u r t h e r u n d e r s t a n d in g o f t h e c o n c e p t u a li z a ti o n of
a n x ie ty b y r e l i g i o u s a n d p h i lo s o p h ic a l t h e o r i t i c i a n s .
A n x ie ty a s a s u b je c t iv e r e s p o n s e to c a t a s t r o p h i c e v e n ts i s th e
t h e o r e t i c a l d e v e lo p m e n t of K u r t G o l d s te i n (1 9 4 0 ). T h is t h e o r y p o s t u
l a t e s b o th th e s ig n i f ic a n c e o f th e i n d iv i d u a l's s u b je c t iv e r e s p o n s e
b a s e d on h i s i n t e r p r e t a t i o n of th e m e a n in g t h a t a n e x t e r n a l e v e n t h a s
f o r h i m a n d th e o b j e c t iv e r e a l i t y t h r e a t i n h e r e n t in th e e v e n t. "A n
o r g a n i s m n e e d s to m a k e i t s e l f a d e q u a t e to i t s e n v ir o n m e n t a n d i t s
e n v ir o n m e n t a d e q u a te to i t s e l f . W h e n t h is c a n n o t b e d o n e , a n x ie ty
o r y t h a t o n e 's p r e v i o u s e x p e r i e n c e s w ith th e p r e s e n t i n g s t i m u l i te n d
to s t r u c t u r e o n e 's p r e s e n t p e r c e p t i o n of d e g r e e of t h r e a t o r n o n
t h r e a t w h ic h th e e v e n t p o s e s . T h e a m o u n t a n d q u a li t y o f p r e v i o u s
e x p e r i e n c e w ith p r e s e n t s t i m u l i m a y s e r v e a n a d a p ti v e o r m a l a d a p
t iv e p u r p o s e a s o ne a t t e m p t s to c o p e w ith s ti m u l i . G o l d s te i n (1 940)
a l s o p o s t u l a t e s th e e f f e c t of a c c u m u l a t i v e s t r e s s on th e in d iv id u a l:
th e " t h r e s h o l d " of c o p in g b e y o n d w h ic h a d d it i o n a l s t r e s s b e c o m e s
" c a t a s t r o p h i c " a n d a n x ie t y e x i s t s . G r i n k l e r a n d S p i e g e l (1 9 4 5 ) a n d
J a n i s (1965) a ls o e l a b o r a t e on th e a c c u m u l a t i o n o f s t r e s s p r o d u c in g
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
e v e n ts , r e a c h i n g to a n i n d iv id u a l t h r e s h o l d o f t o l e r a n c e , a f t e r w h ic h
d i s t r e s s a n d a n x ie t y o c c u r .
F r e u d (1 9 3 6 ) t h e o r i z e d a b o u t a n x ie ty f r o m h i s c l i n i c a l a n a l y t
i c a l i n t e r a c t i o n s w ith t h e m e n t a ll y i l l of th e V i c t o r i a n e r a . H is
e a r l y t h e o r y of a n x ie t y w a s t h a t a n x ie t y a r o s e a s a r e s u l t of
r e p r e s s e d s e x u a l te n s io n . L a t e r , h e c o n c e p t u a li z e d t h a t a n x ie ty
w a s a s i g n a l of t h r e a t w h ic h a r o s e f r o m e x t e r n a l s i t u a t i o n s w h ic h
n e u r o t i c a n x ie t y on t h e b a s i s of th e s o u r c e o f t h r e a t ; n o r m a l a n x ie t y
a r i s e s f r o m e x t e r n a l s o u r c e s o f t h r e a t a n d n e u r o t i c a n x ie t y f r o m
in te rn a l r e p r e s s e d th re a t so u rc e s . S i g n if ic a n t w a s F r e u d 's d e s c r i p
tio n of t h e u n p l e a s a n t, a n t i c i p a t o r y d r e a d a n d p h y s i o l o g i c a l a r o u s a l
d i m e n s io n s o f a n x ie ty ( S p ie l b e r g e r , 19 6 6 , p . 9).
M u lla h y (1 9 7 0 ), w r i ti n g a b o u t th e t h e o r e t i c a l f o r m u l a t i o n s of
a n x ie t y p r o p o s e d b y th e p s y c h o a n a l y s t H a r r y S t a c k S u l li v a n , s t a t e s ,
In S u l l i v a n 's m o r e m a t u r e f o r m u l a t i o n s , i t i s a
f e l t t h r e a t to , o r a c tu a l l o s s of, s e l f - e s t e e m o w in g to
t h e a c t u a l , a n ti c ip a t e d , o r i m a g i n a r y d i s a p p r o v a l of
s i g n i f i c a n t o t h e r p e o p le o r o f d i s a p p r o v a l o f o n e 's s e lf ,
o w in g to th e v a lu e s a n d i d e a l s o n e h a s a c q u i r e d o r
d e v e lo p e d , (p. 484)
T h e p r o to t y p e h u m a n i n t e r a c t i o n f o r th e d e v e lo p m e n t o f a n x ie t y , w a s
in S u l l i v a n 's v ie w , th e m o t h e r - i n f a n t r e l a t i o n s h i p . S i g n if ic a n t w a s
S u l l i v a n 's c o n tr i b u ti o n t h a t th e p r e s e n c e of a n x ie t y d i s t o r t s a n d
l i m i t s t h e i n d i v i d u a l 's p e r c e p t io n of r e a l i t y a n d e x t e r n a l s t i m u l i .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
17
C a t te l l (1 9 6 6 ) e x p e r i m e n t a l l y v a li d a te d a t w o - d i m e n s i o n a l
n a t u r e of a n x ie t y . ( F r e u d t h e o r i z e d in h i s c o n c e p ts o f n e u r o t i c a n d
o b je c t a n x ie ty a t w o - d i m e n s i o n a l n a t u r e o f a n x ie ty ; n e u r o t i c a n x ie t y
b e in g g e n e r a t e d b y i n t e r n a l s o u r c e s of d a n g e r a n d r e l a t i v e l y p e r s o n
a li t y p e r v a s i v e ; o b j e c t a n x ie t y b e in g g e n e r a t e d b y e x t e r n a l s o u r c e s
o f d a n g e r a n d r e l a t i v e l y c o n s c i o u s ly s ti m u l u s b o u n d . ) C a t t e l l (1 9 6 6 )
f a c t o r e d v a r i a b l e s t h a t a p p e a r e d to b e a s s o c i a t e d w ith a r e l a t i v e l y
a b id in g p e r s o n a l i t y s t a t e ( t r a i t a n x ie ty ) a n d th o s e t h a t e x i s t e d in a
t im e l im it e d , s i t u a t i o n a l s t a t e ( s t a t e a n x ie ty ). T h is c o n c e p t u a l
to r e s e a r c h w h ic h c o n t r i b u t e d to th e i d e n t i f i c a t io n of s t i m u l u s s i t u a
t io n s w h ic h a r o u s e s t a t e a n x ie t y a n d th e " p r o p e r t i e s o f th e a n x ie t y
of S p e n c e , a n d S p i e l b e r g e r a n d S m ith in r e l a t i n g t r a i t a n x ie t y to
s t a t e a n x ie ty . T h e s e r e s e a r c h e r s fo u n d t h a t th e s ti m u l u s o f s t r e s s
h a s g r e a t e r p o t e n t i a l i t y f o r s t a t e a n x ie ty g e n e r a t io n , p r o v id e d t h a t
th e i n d iv id u a l c o g n it i v e l y v ie w s th e s ti m u l u s a s t h r e a t e n i n g , in p e r
s o n s w ho e v id e n c e h ig h l e v e l s o f t r a i t a n x ie ty a s m e a s u r e d b y t h e
T a y l o r M a n if e s t A n x i e ty S c a le ( S p ie l b e r g e r , 1 966, p. 15).
A tk in s o n (1 9 6 4 ) h y p o t h e s i z e d t h a t th e f e a r o f f a i l u r e i s a
th e s t r e s s of s u r g e r y a n d h o s p i t a l i z a t i o n , o n e m ig h t h y p o t h e s i z e ,
t h a t th e f e a r o f f a i l u r e m ig h t b e r e l a t e d to th e i n d i v i d u a l 's f e a r o f
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
18
t h e f a i l u r e of h i s ow n c o r p o r e a l b o d y to w i t h s t a n d a n d p r e v a i l
th r o u g h th e s t r e s s of s u c h s t i m u l i . B e t te l h e im (1 9 6 2 ) s t a t e s , " o n e
o f th e g r e a t e s t a n x i e t i e s of e v e r y h u m a n b e in g i s th e f e a r f o r th e
i n t e g r i t y o f h i s b o d y " (p. 7 3 ). O n e g e n e r a l i z e s f e a r a n d a n x ie ty
r e s p o n s e s f r o m o n e s e t of s t i m u l i to o t h e r s t i m u l i c lo s e l y a s s o c i
a te d , e i t h e r t e m p o r a l l y o r c o g n it i v e l y (W o lp e & L a z a r u s , 1966,
c o g n itiv e ly w ith p o t e n t i a l d e a th ( f a i l u r e o f th e c o r p o r e a l b o d y ).
T h e r e f o r e f e a r of f a i l u r e m a y b e a n a r o u s i n g s ti m u l u s f o r s t a t e
a n x ie t y in t h e s e s i t u a t i o n s . A d d i t io n a l ly , f e a r o f f a i l u r e c o n n o te s
i m p o t e n c e of s e l f a n d a l a c k o f c o g n itiv e a w a r e n e s s o f a p p r o p r i a t e
c o p in g s k i l l s w ith w h ic h to a m e l i o r a t e th e f e l t i m p o t e n c e . Iz a r d and
T o m k in s (1 9 6 6 ), w ho do n o t d i f f e r e n t i a t e f e a r f r o m a n x ie ty , le n d
c r e d e n c e to th e a b o v e d i s c u s s i o n b y s a y in g ,
F e a r i s th e m o s t c o n s t r i c t i n g o f a l l th e a f f e c t s .
I t c a n r e s u l t in p e r c e i v i n g w h a t i s c h a r a c t e r i z e d a s
" tu n n e l v i s i o n , " w h e r e th e v i c t i m b e c o m e s f u n c t i o n a l l y
b lin d to a l a r g e p r o p o r t i o n of th e p o t e n t i a l p e r c e p t u a l
f ie l d . F e a r g r e a t l y r e d u c e s b e h a v i o r a l a l t e r n a t i v e s .
F e a r i s e x p e r i e n c e d a s a p p r e h e n s io n , u n e a s i n e s s ,
u n c e r t a i n t y , i n s e c u r i t y . T h e p e r s o n h a s th e f e e lin g
t h a t h e l a c k s s a f e t y , a f e e lin g of d a n g e r a n d im p e n d in g
d i s a s t e r . H e f e e l s a t h r e a t to th e e x i s t e n c e o f th e
p e r s o n - h e - i s ; t h i s m a y b e s e n s e d a s a t h r e a t to th e
b o d y , th e p s y c h o lo g i c a l s e l f o r b o th . (p . 107)
T h e c u r v i l i n e a r e f f e c t o f a n x ie t y , b a s e d o n th e r e s e a r c h of
Y e r k e s a n d D o d s o n , h a s b e e n e x te n s i v e l y s tu d i e d a n d r e p o r t e d b y
G r i n k l e r (1 9 6 6 ). M o d e r a t e a m o u n t s of a n x ie t y a p p e a r to b e
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
f a c i l i t a t i v e of e f f e c ti v e f u n c tio n in g a n d b e h a v io r ; w h e r e a s , e i t h e r
v e r y lo w o r v e r y h ig h l e v e l s o f a n x ie ty c o n t r i b u t e to i n e f f e c t iv e ,
m a l a d a p t i v e f u n c tio n in g ( G r in k l e r , 1 966, p . 1 2 9 ). H ig h l e v e l s of
a n x ie t y th e n s e e m to c a u s e i n e f f e c t u a l b e h a v io r o r c o p in g a t t e m p t s .
A s s u c h a t t e m p t s f a i l to r e l i e v e th e a f f e c t of a n x ie t y , th e i n d iv id u a l
e x p e r i e n c e s i n c r e a s i n g d e p e n d e n c y , h e l p l e s s n e s s a n d im p o t e n c y .
G r i n k l e r (1 9 5 6 ) d i s c u s s e s a ls o th e c i r c u l a r s p i r a l i n g e f f e c t of
a n x ie t y . A n x ie ty te n d s to b e c o m e m o r e i n t e n s e ( h ig h e r ) if th e i n i t i a l
a t t e m p t s to r e d u c e i t p r o v e i n e f f e c t iv e . O n e m ig h t d i a g r a m t h is
c ir c u la r s p ir a l: A n x i e ty ^ c o p in g s k i l l s w h ic h a r e in e f f e c t iv e
^ i n c r e a s e d h e l p l e s s n e s s — ^ d e c r e a s i n g l y e f f e c ti v e c o p in g s k i l l s
— ^ h i g h e r l e v e l s of a n x ie ty .
W o lp e a n d L a z a r u s (1 9 6 6 ) h a v e c o n t r i b u t e d t h e p r i n c i p l e of
O n e p r i m a r y r e s u l t of t h e i r l a b o r a t o r y r e s e a r c h w ith c a t s , a n d t h e i r
c l i n i c a l r e s e a r c h w ith s e v e r e p h o b ia s of n e u r o t i c c l i e n t s , i s t h a t th e
i n t e n s i t y o f th e a f f e c t of a n x ie ty i s r e d u c e d w h e n th e a n x ie t y p r o d u c
in g s t i m u l u s i s t e m p o r a l l y p a i r e d w ith a r e s p o n s e a n t i t h e t i c a l to
a n x ie t y . O n e e x a m p le of t h is p h e n o m e n o n w o u ld b e t h e p a ir i n g of a
s t a t e of r e l a x a t i o n w ith th e a n x io u s s t a t e e x p e r i e n c e d in th e p r e s e n c e
s t a t e s of r e l a x a t i o n a r e a n t i t h e t i c a l to th e a n x ie t y s t a t e .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
20
I n t e r r e l a t e d n e s s o f A n x ie ty a n d P a i n
T h e i n t e r r e l a t e d , u n if ie d t h e o r y o f th e m in d a n d b o d y , in c o n
t r a s t to th e d u a l i s t i c t h e o r y , h a s b e e n h i s t o r i c a l l y d e v e lo p e d b y th e
th in k in g of S p i n o z a , D a r w in , a n d F r e u d . I n t e r r e l a t e d n e s s o f m in d
a n d b o d y p h e n o m e n a s p e a k s to th e c o n c e p t u a li z a ti o n o f p a in a s h a v in g
tw o d i s c r e t e , b u t i n t e r r e l a t e d , c o m p o n e n ts . O n e c o m p o n e n t b e in g
s e n s o r y a n d th e s e c o n d c o m p o n e n t b e in g th e o r g a n i s m 's r e s p o n s e to
th e s e n s o r y in p u t; n a m e l y , d i s t r e s s o r a n x ie ty ( e m o t io n a l it y ) .
D a r w in (1897) c r e d i t s H e r b e r t S p e n c e r w ith t h e o r i z i n g t h a t t h e r e is
a " c l e a r d i s t i n c t i o n b e tw e e n e m o tio n s a n d s e n s a t i o n s , t h e l a t t e r
b e in g g e n e r a t e d in o u r c o r p o r e a l f r a m e w o r k " (p. 2 7 ). W e is e n b e r g
(1975) d e f i n e s t h e p a in e x p e r i e n c e in a m a n n e r t h a t a d d r e s s e s th e
i n t e r r e l a t i o n s h i p o f t h e m in d a n d b o d y in p a in : " P a in is a c o m p le x
p s y c h o lo g i c a l p h e n o m e n o n t h a t in c l u d e s c o g n itiv e , e m o t i o n a l , a n d
r e l a t e d n e s s o f m in d a n d b o d y b y h e r s ta t e m e n t : " O n e a s p e c t o f th e
h u m a n o r g a n i s m c a n n e v e r b e s e p a r a t e d f r o m th e w h o le . E ven
th o u g h p h y s i c a l p a in c a n b e l o c a l i z e d in o n e p a r t o f th e b o d y , in
a c tu a l it y th e i n d iv i d u a l a s a w h o le s u f f e r s , n o t j u s t th e b o d y p a r t "
(p. 73).
H a r d y , W o lff, a n d G o o d e ll (1 9 6 7 ) s tu d ie d s e v e r a l v a r i a b l e s to
d e t e r m i n e t h e i r e f f e c t on th e p a in r e a c t i o n t h r e s h o l d . T he r e s u lts
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
21
i n d ic a te d th a t:
T h e r e a c t i o n t h r e s h o l d , a s m e a s u r e d b y th e m i n i
m a l i n t e n s i t y of t h e r m a l r a d i a t i o n w h ic h w i l l e v o k e i t,
is m o r e v a r i a b l e th a n th e p a in t h r e s h o l d a n d i s m o r e
e a s i l y a ff e c te d b y a n a l g e s i c d r u g s , h y p n o s is , l a b o r a t o r y
c o n d itio n s ( r o o m t e m p e r a t u r e ) , a n d th e s u b j e c t s ' a t t i
tu d e a n d e m o tio n a l s t a t e . F e e l i n g s of r e l a t i v e t r a n q u i l
i t y a r e a s s o c i a t e d w ith a r i s e in th e r e a c t i o n t h r e s h o l d ,
a n d i n v e r s e l y , f e e l in g s of a n x ie t y a r e a s s o c i a t e d w ith a
lo w e r i n g . ( H a r d y , W o lff, & G o o d e ll, 1967, p. 305)
T h e n e u r o p h y s i o lo g i c a l t h e o r y o f p a in a s d e v e lo p e d b y M e lz a c k
t h e o r y h a s p r i m a r i l y r e p l a c e d th e e a r l i e r s p e c i f i c i t y a n d p a t t e r n
p a in t h e o r i e s in p h y s io lo g y . T h e " g a te c o n tr o l t h e o r y " h a s a s a
c o r e c o n c e p t a p h y s io l o g ic a l g a te c o n t r o l s y s t e m " w h ic h m o d u la t e s
s e n s o r y in p u t f r o m th e s k in b e f o r e i t e v o k e s p a in p e r c e p t io n a n d
c o n s i d e r a b l e s u b s ta n t ia t io n a n d o n g o in g r e f i n e m e n t f r o m b a s i c
p h y s io l o g ic a l r e s e a r c h on th e c e n t r a l n e r v o u s s y s t e m . The m o d el
e x p lo r e s th e r e l a t i o n s h i p o f a n x ie t y a n d p a in b y h y p o t h e s i z in g t h a t a
s e n s o r y in p u t o r s ti m u l u s g o e s t h r o u g h a p r o c e s s of b e in g " i d e n t i
f ie d , e v a lu a t e d in t e r m s of p r i o r e x p e r i e n c e , l o c a l iz e d , a n d i n h i b
i t e d b e f o r e th e a c tio n s y s t e m r e s p o n s i b l e f o r p a in p e r c e p t io n a n d
a ll y , th e n , p s y c h o lo g i c a l f a c t o r s s u c h a s " p a s t e x p e r i e n c e , a t t e n
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
22
t h e o r y i s r e f l e c t e d in th e c o n t e m p o r a r y r e s e a r c h r e l a t i v e to p a in
w h ic h s e e k s to d i s c o v e r th e e f f e c t of v a r i o u s t r e a t m e n t a p p r o a c h e s
on th e m o ti v a ti o n a l , a f f e c ti v e , a n d c o g n itiv e d i m e n s io n s o f t h e p a in
e x p e rie n c e .
M e r s k e y (1 9 7 5 ) r e v i e w s t h r e e p r i m a r y p s y c h o lo g i c a l t h e o r i e s
o f p a in : " p a in a s a c o n s e q u e n c e of h o s t i l i t y ; p a in a s a m e a n s o f
c o m m u n i c a t io n ; a n d p a in a s a c o n s e q u e n c e of a t h r e a t to t h e i n t e g
l a t t e r t h e o r y b y p o s tu l a ti n g t h a t th e b o d y i s v ie w e d b y t h e e g o a s a n
o b j e c t a n d p a in a r i s e s w h e n th e s e l f p e r c e i v e s t h r e a t to th e b o d y
(p . 30 ). S z a s z i n c l u d e s in h i s t h e o r y th e c o n c e p t o f th e c o m m u n i c a
t io n o f p a in a s a c r y f o r h e lp .
B e e c h e r (1 9 7 5 ) d i s c u s s e s th e M a r s h a l l - S t r o n g c o n c e p t o f p a in .
T h is c o n c e p t p r o p o s e s t h a t s u f f e r in g c o n s i s t s o f tw o d i s c r e e t c o m
p o n e n ts , th e o r i g i n a l s e n s a t io n a n d th e r e a c t i v e c o m p o n e n t (p. 6 1 ).
B e e c h e r 's r e s e a r c h on th e e f f e c t of p l a c e b o s a n d M o r p h in e i n d i c a t e s
t h a t p l a c e b o s a r e 10 t i m e s m o r e e f f e c tiv e in r e l i e v i n g p a in d u e to
p a th o lo g y t h a n th e y a r e in r e l i e v i n g e x p e r i m e n t a l l y p r o d u c e d p a in .
T h e d i s c u s s i o n le n d s s u p p o r t to th e c o n c e p t t h a t in a d i s e a s e s t a t e
th e a m o u n t of c o n c o m i ta n t a n x ie ty a s s o c i a t e d w ith p a in i s g r e a t e r ,
a n d t h a t r e l i e f i s a f f o r d e d w h e n i n t e r v e n t i o n s a d d r e s s t h e a n x ie ty
c o m p o n e n t of th e p a in e x p e r i e n c e .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
23
M e a s u r e m e n t o f P h y s i o lo g i c a l A r o u s a l
M a n y i n d i c a t o r s o f p h y s io l o g ic a l a r o u s a l h a v e b e e n i d e n t i f i e d
a n d a r e d e t a i l e d b y C a t t e l l (1 9 6 6 ). P h y s i o lo g i c a l f a c t o r s w h ic h
C a t t e l l (1 9 6 6 ) f o u n d to b e s ig n i f ic a n tl y r e l a t e d to a n x ie t y i n c l u d e
i n c r e a s e in s y s t o l i c b lo o d p r e s s u r e , i n c r e a s e in h e a r t r a t e ,
i n c r e a s e in r e s p i r a t o r y r a t e , a n d o t h e r p h y s io lo g ic v a r i a b l e s a s s o
t u r e r e v i e w w i l l b e on t h e p h y s io l o g ic a l i n d i c a t o r , d i g i t a l s w e a tin g
( a l s o k n o w n a s p a l m a r s w e a tin g ) , c h o s e n a s th e m e a s u r e o f a n x ie t y
u s e d in t h i s s tu d y . L a z a r u s a n d O p to n (1 966) d i s c u s s t h e p r o b l e m s
a t t e n d a n t to th e u s e of a u to n o m i c n e r v o u s s y s t e m , b e h a v i o r a l , a n d
s e l f - r e p o r t m e a s u r e s to i n f e r th e p r e s e n c e o f a n x ie t y . T hey co n
c lu d e t h a t e a c h c a t e g o r y of i n s t r u m e n t m e a s u r e s d i f f e r e n t d i m e n
s io n s o f a m u l t i - d i m e n s i o n a l c o n c e p t ( L a z a r u s & O p to n , 1 9 6 6 ,
p. 2 35).
K u n o 's (1 9 5 6 ) r e s e a r c h fo u n d t h a t t h e r e i s c o n s t a n t s w e a t
s e c r e t i o n to th e v o l a r s u r f a c e of th e h a n d . K uno s ta te s th a t, "a n y
m e n t a l s t r e s s a n d e m o t i o n a l a n d s e n s o r y a g e n ts m a y i n c r e a s e th e
c a te s t h a t t h e r e a r e p a r a d o x i c a l e f f e c ts on p a l m a r s w e a ti n g i n d u c e d
u n d e r e x t r e m e s of e n v i r o n m e n t a l t e m p e r a t u r e , b u t t h a t a n i n c r e a s e
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
24
in b o d y t e m p e r a tu r e , a s m e a s u r e d b y r e c t a l t e m p e r a t u r e , h a s no
i n th e a x il l a e h a s b e e n f i r m l y e s t a b l i s h e d a s b e in g r e l a t e d to p s y
c h o lo g i c a l a n d s e n s o r y p r o c e s s e s r a t h e r t h a n to b o d y t e m p e r a t u r e
H a y w o o d a n d S p i e l b e r g e r (1 9 6 6 ) i n v e s t ig a t e d i n d iv id u a l d i f f e r
e n c e s in a n x ie ty in 61 m a l e u n d e r g r a d u a t e s tu d e n t s , a s m e a s u r e d b y
s c o r e s on th e T a y l o r M a n if e s t A n x ie ty s c a l e a n d p h y s io l o g ic a l
a r o u s a l a s m e a s u r e d b y t h e P a l m a r - S w e a t In d e x , p h o t o m e t r i c t e c h
n iq u e . T h e r e s u l t s i n d i c a t e t h a t p a l m a r s w e a tin g i s a " s e n s i t i v e
e r s i n d ic a te t h a t, " E v e n t h e m il d ly s t i m u l a ti n g s it u a ti o n e m p lo y e d
in t h is e x p e r i m e n t ( p r e s u m a b l e a n ti c ip a t io n o f a s im p le v e r b a l
c o n d itio n in g ta s k ) p r o d u c e d m e a s u r a b l e d i f f e r e n c e s in p a l m a r
s w e a tin g w h ic h m o r e o v e r , w e r e s ig n i f ic a n tl y r e l a t e d to a n x ie ty "
(p. 104).
T h e s p e c i f ic p r e p a r a t o r y a n d a d m i n i s t r a t i o n p r o c e d u r e o f th e
D i g i ta l S w e a t T a p e B a n d m e a s u r e , u s e d in th e p r e s e n t s tu d y , i s
d e ta i le d in C h a p t e r III.
M in c k le y (1974) u s e d p a l m a r s w e a tin g to m e a s u r e th e s t r e s s
e x p e r i e n c e d b y p a ti e n ts in r e s p o n s e to e a r l y d e f i n i te o r l a t e i n d e f i
n i te s c h e d u lin g of s u r g e r y . S h e s t a t e s t h a t a u to n o m ic r e s p o n s e s
a r e " r e l i a b l e in t h e i r a p p e a r a n c e in r e l a t i o n to th e s y n d r o m e
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
25
r e s p o n s e to m e n t a l s t r e s s " (p . 4 0 0 ).
D r o p p l e m a n a n d M c N a ir (1 9 7 1 ) t e s t e d th e e f f e c t of a s i m u
la t e d p u b lic s p e a k in g s i t u a t i o n on p a l m a r s w e a tin g in 12 a d u lt s u b
je c ts . P a l m a r s w e a tin g of s u b je c t s w a s m e a s u r e d b y s w e a t p r i n t s
( p h y s i o l o g ic a l m e a s u r e ) . S e l f - r e p o r t r a t i n g s of e m o t i o n a l a r o u s a l
w e r e a l s o o b ta in e d f r o m th e s u b j e c t s . A n t i c i p a to r y a n d a c t u a l
s t r e s s p e r i o d of p u b lic s p e a k in g r e s u l t e d in s ig n i f ic a n t d i f f e r e n c e s
on b o th th e p h y s io l o g ic a l a n d p s y c h o lo g i c a l m e a s u r e s of a r o u s a l ,
c o m p a r e d w ith n o n - s t r e s s p e r i o d s .
L i p p e r a n d M c N a ir (1 9 7 2 ) c o n d u c te d a s tu d y to i n v e s t i g a t e
w h e t h e r th e a r o u s a l s t a t e in d ic a te d by i n c r e a s e d p a l m a r s w e a tin g
in D r o p p l e m a n a n d M c N a i r 's (1 971) s tu d y m ig h t b e s p e c i f i c a l l y
t e r m e d a n x ie t y a n d d i f f e r e n t i a t e d f r o m o t h e r a r o u s e d s t a t e s .
T h e a t t e m p t of t h is s tu d y w a s to i n v e s t ig a t e w h e t h e r p a l m a r
s w e a tin g w a s s p e c i f i c a l l y i n d ic a ti v e of th e e m o t i o n a l s t a t e of
a n x ie t y s u c h t h a t d e g r e e of p a l m a r s w e a tin g m ig h t b e u s e d a s a n
e v a lu a t iv e m e a s u r e of th e e f f e c ti v e n e s s of a n t i - a n x i e t y t r e a t m e n t
in te r v e n tio n s . T h e r e s u l t s o f t h is s tu d y i n d ic a te t h a t , " S i m u l a te d
p u b lic s p e a k in g in d u c e d a n x ie ty a s in d ic a te d b y m a r k e d a n d s i g n i f i
c a n t e le v a t io n s of b o th p a l m a r s w e a tin g a n d s u b je c t iv e t e n s i o n -
a n x ie ty r a t i n g s w ith o u t i n c r e a s e in o t h e r a s p e c t s o f s u b je c t iv e
th a t m e a s u r e s of p a l m a r s w e a tin g a r e u s e f u l i n d i c a t o r s of e m o t i o n a l
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
26
a n d m o t i v a ti o n a l a r o u s a l a s w e l l a s c l i n i c a l a n x ie ty .
M c N a ir , D r o p p l e m a n , a n d K u s s m a n (1 967) a n d P a u l (1 9 6 4 )
c o n d u c te d a s e r i e s of e x p e r i m e n t s to v a li d a te th e u s e o f d i g i t a l
s w e a t p r i n t t a p e b a n d s to m e a s u r e th e a m o u n t o f d i g it a l s w e a t.
T h e i r f in d in g s w e r e t h a t t h e s im p li f ie d m e a n s ( d ig i ta l s w e a t b a n d s )
v a li d l y d e te c t e d th e p h y s io l o g ic a l e f f e c t o f a n a n t i c h o l i n e r g i c d r u g
a d m i n i s t e r e d u n d e r d o u b l e - b l in d e x p e r i m e n t a l c o n d itio n s .
F S P t a p e b a n d s , t h u s , r e p r e s e n t a n a c c e p t a b le
a l t e r n a t i v e to o t h e r t e c h n i q u e s f o r o b ta in in g s im p le
d i s c r e t e m e a s u r e s o f f i n g e r s w e a tin g . T h e t e c h n iq u e
h a s th e d e f i n i te a d v a n ta g e t h a t i t i s u s e f u l in s it u a ti o n s
w h e r e f o r e x p e r i m e n t a l o r p r a c t i c a l r e a s o n s th e E d o e s
n o t w is h to i m m o b i l i z e S s d u r in g th e m e a s u r e m e n t
p e r i o d . I n v i e w o f t h e i r s i m p l i c i t y a n d m in i m a l c o s t,
th e t a p e b a n d s s h o u ld p r o v e m o r e u s e f u l in g r o u p s e t
t in g s a n d in n a t u r a l l y o c c u r r i n g s t r e s s s it u a ti o n s .
( M c N a ir , D r o p p l e m a n , & K u s s m a n , 1967, p . 78)
I n a n o th e r s tu d y D r o p p l e m a n a n d M c N a ir (1 969) f u r t h e r e s t a b
l is h e d th e p a r a m e t e r s f o r u s e o f th e F i n g e r S w e a t P r i n t T a p e B a n d s .
T h e r e s u l t s s h o w e d t h a t f i n g e r c o n ta c t w ith th e ta p e b a n d f o r p e r i o d s
of 0. 5 to 3. 0 m i n u t e s i s a s e n s i t i v e i n d i c a t o r o f t r e a t m e n t e f f e c ts
(p. 6 6 3 ). P a u l (1 9 6 4 ) s u g g e s t s t h a t 90 s e c o n d s a r e r e q u i r e d f o r a
v a li d m e a s u r e of p a l m a r s w e a t u s in g d i g it a l s w e a t p r i n t t a p e b a n d s .
P a u l (1964) s p e c i f i e d t h a t 30 s e c o n d s d r y in g t im e of th e d r y in g a g e n t
on th e v o l a r s u r f a c e of th e s u b j e c t 's f in g e r i s s u f f i c i e n t (p . 2 6 4 ).
H a r r i s o n , M a c K in n o n , a n d M o n k - J o n e s (1 9 6 2 ) s t a t e t h a t
p a l m a r s w e a t a s m e a s u r e d b y th e c o l o r m e t r i c m e th o d i s d e c r e a s e d
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
27
a t h ig h a l t i t u d e s , in p r e g n a n c y , d u r in g s le e p , a n d j u s t b e f o r e a n d
f o r 1 o r 2 w e e k s a f t e r s u r g e r y d e p e n d in g on th e s e x . H o w e v e r,
M in c k le y (1974) c o n d u c te d a s tu d y o n p a t i e n t s in th e p r e o p e r a t i v e
a n d p o s t o p e r a t i v e p h a s e w h ic h r e v e a l e d o p p o s ite f in d in g s in r e g a r d
to p a l m a r s w e a tin g p r e o p e r a t i v e l y a n d p o s t o p e r a t i v e l y . U s in g a
p e r s p i r a t i o n m e t e r e s p e c i a l l y d e s ig n e d f o r t h is s tu d y , th e r e s u l t s
T h e p a l m a r s w e a t v a l u e s o b t a in e d in th e p o s t o p e r
a ti v e p e r i o d in d ic a te d t h a t t h i s v a r i a b l e f lu c t u a t e d a s
m u c h a s p u l s e a n d b lo o d p r e s s u r e in th e d a y s fo llo w in g
s u r g e r y , a n d d id n o t r e m a i n a t z e r o a s H a r r i s o n e t a l.
(1962) s u g g e s t . I t i s d i f f ic u l t to a c c o u n t f o r th e f lu c t u
a ti o n of p a l m a r s w e a t o n t h e b a s i s of e x t e r n a l s t r e s s
s ti m u l i , a n d i t d id n o t a p p e a r e v e n to c o r r e s p o n d w ith
th e p a t i e n t 's s e l f r e p o r t o f a n x ie t y . T h e f lu c t u a t i o n of
p a l m a r s w e a t m ig h t h a v e b e e n a c o r o l l a r y to th e d e g r e e
of d i s c o m f o r t o r p a in t h e p a t i e n t e x p e r i e n c e d , (p. 398)
T h e o r e t i c a l a n d C l i n i c a l B a s i s f o r D e v e lo p m e n t
of th e N u r s e I n t e r v e n t i o n T r e a t m e n t
T h e e x p e r i m e n t a l N u r s in g I n t e r v e n t i o n T r e a t m e n t , u s e d f o r
t h is s tu d y , i n c lu d e d b e h a v i o r s o n th e p a r t o f th e n u r s e t h a t w e r e
d e s ig n e d to a m e l i o r a t e s e v e r a l d i m e n s io n s of th e p o s t o p e r a t i v e
e x p e r i e n c e t h a t a r e a n x ie ty p r o d u c i n g a s e n u m e r a te d b y n u r s i n g
p r i a t e l y d e s ig n e d to " a l t e r f a c t o r s t h a t c a u s e o r i n c r e a s e th e
g o a l m a y b e r e d u c t io n of p a in to a t o l e r a b l e l e v e l o r a lo w e r in g of
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
28
a n x ie t y p r e c e d i n g a n d fo llo w in g p a in " ( M c C a f f e r y , 1 9 7 2 , p . 7 8 ).
A n e x a m i n a ti o n of r e s e a r c h s tu d i e s a n d n u r s i n g p r a c t i c e
l i t e r a t u r e r e v e a l s t h a t s p e c i f i c b e h a v i o r s m a y b e u s e d in n u r s i n g
i n t e r v e n t i o n to r e d u c e p a t i e n t p a in a n d a tt e n d a n t a n x ie t y . T h ese
m a y b e s u m m a r i z e d a s f o llo w s a n d th e b a s i s f o r th e u s e o f e a c h w ill
b e d e s c r i b e d in s u b s e q u e n t d i s c u s s i o n . I t i s to b e n o te d t h a t th e
b e h a v i o r s a s p r e s e n t e d w e r e i n c o r p o r a t e d in to t h i s i n v e s t i g a t i o n a s
th e e x p e r i m e n t a l N u r s in g I n t e r v e n t i o n T r e a t m e n t . T he b e h a v io r s
of th e N u r s in g I n t e r v e n t i o n T r e a t m e n t w e r e d e s ig n e d to m e e t
p a tie n t n e e d s fo r: (1) r e c o g n i ti o n o f p e r s o n h o o d b y c a r e g i v e r s ,
(2) r a p i d i t y o f r e s p o n s e b y c a r e g i v e r s to a n e x p r e s s e d n e e d b y th e
p a t i e n t , (3) r e m o v a l of n o x io u s e n v ir o n m e n t a l s t i m u l i , (4) e x p la n a
tio n to a llo w p a t i e n t s th e o p p o r tu n i ty to d e v e lo p r e a l i s t i c e x p e c t a
tio n s a n d t h e r e f o r e i n c r e a s e s i t u a t i o n a l p r e d i c t a b i l i t y , (5) to u c h a s
i t c o n t r i b u t e s to p r o x im it y of th e c a r e g i v e r a n d th e p a t i e n t , a n d
(6) f a c i l i t a t i o n of d e v e lo p m e n t o f th e n u r s e - p a t i e n t r e l a t i o n s h i p
th r o u g h a c ti v e l is te n i n g a n d v e r b a l s u p p o r t of p a t i e n t s ' c o p in g s k i l l s
to r e d u c e h e l p l e s s n e s s . E f f i c a c y f o r t h is a p p r o a c h i s fo u n d i n th e
fo llo w in g s t a t e m e n t b y E n g le (1 9 6 3 ):
In t h e r a p y th e e m o t i o n s a r e n e v e r o b s e r v e d in th e
p u r e s t a t e ; a n d in th e t h e r a p e u t i c p r o c e s s o f a tt e m p t in g
to a l t e r d i s o r d e r e d s t a t e s , w e d o n o t in f a c t a t t e m p t to
d i s s e c t a l l of th e e m o t i o n a l c o m p o n e n ts of a g iv e n s t a t e
e v e n i f t h is w e r e c o n c e i v a b le . W e r a t h e r a t t e m p t to
a l t e r th e s t a t e b y c e n t e r i n g o u r a t t e n ti o n on o n e o r
a n o th e r a s p e c t of th e e m o t i o n a l s t a t e w h ic h w e f e e l to b e
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
29
e s p e c i a l l y c r u c i a l i n th e h o p e t h a t t h is w ill t h e r a p e u t i
c a ll y m o b il iz e t h e e n t i r e s t a t e , (p p . 2 9 6 -2 9 7 )
C o p p (1 9 7 4 ), in a s tu d y d e s ig n e d to o b ta in p a ti e n t r e s p o n s e s
w h e n a s k e d w h a t p h y s ic i a n s a n d n u r s e s c o u ld do a b o u t p a t i e n t s '
p a in , fo u n d t h a t r e c o g n i ti o n o f p e r s o n h o o d , r a p i d i t y o f c a r e g i v e r s
r e s p o n s e , a n d r e m o v a l of n o x io u s s t i m u l i w e r e c o n s i d e r e d i m p o r
ta n t by p a tie n ts . O n t h i s b a s i s o f t e s t i m o n y in C o p p 's s tu d y , e a c h
o f t h e s e b e h a v io r s e n u m e r a t e d b y p a t i e n t s w a s in c lu d e d in th e
e x p e r i m e n t a l N u r s in g I n t e r v e n t i o n T r e a t m e n t f o r th e p r e s e n t s tu d y .
T r a v e l b e e (1971) i n d i c a t e s t h a t a p r i m a r y s u p p o r t i v e i n t e r
v e n ti o n to r e d u c e th e a n x ie t y a tt e n d a n t to th e s u r g i c a l e x p e r i e n c e i s
th e g iv in g of c o g n itiv e i n f o r m a t i o n . T h e in d iv i d u a l n e e d s to k n o w
w h a t i s a n d w i l l b e h a p p e n in g to h i m . W ith o u t s u c h k n o w le d g e o n e
i s f o r c e d to a u t i s t i c a l l y i n t e r p r e t a n d f a n t a s i z e a b o u t th e m e a n in g o f
e x t e r n a l e v e n ts a n d s i t u a t i o n a l h a p p e n in g s . A r i s i n g f r o m t h is c o n
c e p tu a l iz a ti o n i s th e h y p o t h e s i s t h a t " t h e r e i s a d i r e c t r e l a t i o n s h i p
b e tw e e n th e e x te n t to w h ic h t h e i n d i v i d u a l 's n e e d f o r c o g n itiv e
c l a r i t y a n d s e c u r i t y a r e m e t a n d th e i n d i v i d u a l 's a n x ie ty l e v e l "
(T ra v e lb e e , 1971, p. 1 90). D a r w in (1 8 9 7 ) v e r b a l i z e s t h is c o n c e p t,
" M y w ill a n d r e a s o n w e r e p o w e r l e s s a g a i n s t th e im a g i n a t io n o f a
d a n g e r w h ic h h a d n e v e r b e e n e x p e r i e n c e d " (p . 3 8). S ta u b , T u r s k y ,
a n d S c h w a r tz (1 9 7 5 ) r e p o r t r e s e a r c h w h ic h s u b s t a n t i a t e s e a r l i e r
f in d in g s " t h a t c o n t r o l a n d p r e d i c t a b i l i t y r e d u c e t e n s i o n a n d th e
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
30
d i s r u p t i o n o f b e h a v io r p r o d u c e d b y a v e r s i v e s t i m u l i " (p . 175).
T h e r e f o r e a n e x p la n a t io n to a llo w p a t i e n t s th e o p p o r tu n i ty to d e v e lo p
r e a l i s t i c e x p e c t a ti o n s to i n c r e a s e s i t u a t i o n a l p r e d i c t a b i l i t y w a s
i n c l u d e d in t h e e x p e r i m e n t a l N u r s in g I n t e r v e n t i o n T r e a t m e n t .
A m o n g o t h e r p r e s c r i b e d b e h a v i o r s n o t e d to b e e f f e c ti v e in
n u r s i n g i n t e r v e n t i o n i s th e u s e o f to u c h b y th e c a r e g i v e r . T ouch
m a y s e r v e to p h y s ic a l ly r e i n f o r c e t h e p r e s e n c e o f a n o th e r p e r s o n ,
w h o , b y r e m a in i n g w ith th e p a ti e n t in p a in , s i g n i f i e s to h i m r e c o g
n i ti o n a n d a c c e p t a n c e of th e v a l i d i t y o f h i s p a in . M c C o r k le (1 9 7 4 )
c i t e s C l a r k 's s t a t e m e n t th a t: " B y t o u c h in g a p a t i e n t , th e n u r s e m a y
c o n v e y to h i m t h a t h e i s n o t a l o n e - - t h a t s h e i s t h e r e , t h a t s h e h a s
t i m e to l i s t e n , a n d t h a t s h e w ill e x e r t e v e r y e f f o r t to m a k e h i m a s
c o m f o r t a b l e a s p o s s i b l e " (p . 125). A d d i t io n a l ly , to u c h m a y s e r v e
a s a d i s t r a c t o r in t h a t i t o f f e r s s e n s o r y i n p u t w h ic h i s a n a l t e r n a t i v e
to t h a t s e n s o r y in p u t o f f e r e d b y th e p a in . A ls o to u c h o f a m a s s a g i n g ,
r e p e titiv e n a tu r e , su c h a s a b a c k ru b , m a y p r o m o te a g e n e ra liz e d
s t a t e o f i n c r e a s e d r e l a x a ti o n .
M c C o r k le (1974) c o n d u c te d a s tu d y o n t h e e f f e c ts of to u c h on
s e r io u s ly ill p a tie n ts . T h e f in d in g s s u p p o r t th e u s e o f t o u c h a s a n
i n d i c a t o r to p a t i e n t s t h a t th e n u r s e c a r e s a b o u t th e p a ti e n t.
F i s h e r ' s (1 9 7 7 ) r e s e a r c h fo u n d " t h a t a n x ie t y c a n b e r e d u c e d i f a
n u r s e to u c h e s a p a t i e n t 's a r m o r s h o u ld e r d u r in g p r e s u r g e r y c o u n
s e li n g " (p . B - 6 ) .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
31
T h e g a te c o n t r o l t h e o r y o f p a in a l s o p r o p o s e s t h a t th e u s e of
to u c h , a s i t s t i m u l a t e s l a r g e - d i a m e t e r , c u ta n e o u s , a f f e r e n t n e r v e s
on th e s u r f a c e of th e s k in , i s a m e a n s o f " c lo s i n g th e g a te to
i m p u l s e s e n t e r i n g th e s p in a l c o r d " ( S ie g e le , 1 974, p . 4 9 9 ). S ie g e le
(1974) s t a t e s " th e g a te c o n t r o l t h e o r y r e - e s t a b l i s h e s th e v a lu e o f
to u c h in g , b a c k r u b s , s c r a t c h i n g , m o d e r a t e m a s s a g e , a n d th e a p p l i
c a ti o n o f m e n t h o l ru b b in g a g e n ts " (p. 5 0 2 ). T h e r e f o r e , to u c h , in
th e f o r m of a 2 - 3 m in u t e b a c k r u b , w a s in c l u d e d a s a b e h a v i o r i n th e
e x p e r i m e n t a l N u r s in g I n t e r v e n t i o n T r e a t m e n t .
T i t c h e n e r ( I9 6 0 ) s p e a k s to th e n e e d f o r s u p p o r t i v e m e a s u r e s
to d e c r e a s e t h e s t r e s s w h ic h a w e a k e n e d p h y s i c a l c o n d itio n p l a c e s
u p o n th e i n d i v i d u a l 's p s y c h o lo g i c a l a d a p ta t io n a b i l i t i e s . T itc h e n e r
(I9 6 0 ) s t a t e s t h a t t h is c y c le m a y b e p o s it iv e l y a f f e c te d b y " e m o
tio n a l ly s u p p o r t i v e t e c h n i q u e s , w h ic h r e p l e n i s h th e p a t i e n t 's ow n
r e s o u r c e s a n d b o l s t e r h i s m e c h a n i s m s o f d e f e n s e " (p . 2 5 7 ).
T h e c o n c e p t of p o w e r l e s s n e s s is a l s o r e l e v a n t in s u p p o r tin g
n u r s i n g i n t e r v e n t i o n d e s ig n e d to a tt e n d th e p a t i e n t to h i s p r e v i o u s l y
s u c c e s s f u l c o p in g m e c h a n i s m s in r e s p o n s e to p a in . M c C a ffe ry
(1972) c i t e s th e d e f i n i ti o n of p o w e r l e s s n e s s , d e v e lo p e d b y S e e m a n
d e t e r m i n e th e o u tc o m e s o r th e r e i n f o r c e m e n t s h e s e e k s " (p . 5 9 ).
T h e r e f o r e th e r e d u c t io n o f f e e l in g s o f p o w e r l e s s n e s s b y f o c u s in g
th e p a t i e n t 's a tt e n ti o n on h i s p r e v i o u s l y s u c c e s s f u l p a in c o p in g
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
32
s k i l l s w o u ld a p p e a r to b e a v i a b l e m e a n s o f r e d u c i n g th e a n x ie ty
w h ic h m a y a c c o m p a n y d e p e n d e n c y a n d h e l p l e s s n e s s . D a r w in (1 897)
s t a t e s , " I f w e e x p e c t to s u f f e r w e a r e a n x io u s ; if w e h a v e no h o p e
a l s o o f f e r s s u p p o r t to th e r e i n f o r c e m e n t of p r e v i o u s l y s u c c e s s f u l
p a in c o p in g m e c h a n i s m s . T h is d i m e n s io n of c a r e g iv in g w a s i n c o r
p o r a t e d in to th e e x p e r i m e n t a l N u r s in g T r e a t m e n t I n te r v e n t i o n b y
h a v in g th e n u r s e e n c o u r a g e th e p a t i e n t to v e r b a l i z e h i s p r e v i o u s l y
s u c c e s s f u l p a in c o p in g s k i l l s . A l s o , th e n u r s e b e h a v io r w a s to
v e r b a l l y r e i n f o r c e t h o s e p a t i e n t p a in c o p in g s k i l l s a p p r o p r i a t e d u r
in g th e p o s to p e r a ti v e p a in e x p e r i e n c e .
H y p o th e s e s
T h is s tu d y th e n p r o p o s e d to i n v e s t i g a t e th e f o llo w in g t h e o r e t
ic a l h y p o th e s e s .
H y p o th e s is 1: A n x ie ty d u r in g th e 72 h o u r p o s t o p e r a t i v e p e r i o d
i s l e s s f o r s u b je c t s in th e e x p e r i m e n t a l g r o u p th a n f o r s u b je c t s in
th e c o n tr o l g r o u p .
H y p o th e s is 2; T h e a m o u n t o f a n a l g e s i c m e d i c a ti o n is l e s s f o r
s u b j e c t s in th e e x p e r i m e n t a l g r o u p th a n f o r s u b je c t s in th e c o n tr o l
g ro u p .
H y p o th e s is 3: P o s to p e r a tiv e r e c o v e r y r a te a s m e a s u re d by
m e a n p o s t o p e r a t i v e b o d y t e m p e r a t u r e , m e a n n u m b e r of a m b u l a to r y
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
33
e f f o r t s , a n d m e a n n u m b e r of a n a lg e s ic m e d i c a t i o n s a d m i n i s t e r e d
i s g r e a t e r f o r s u b je c t s in th e e x p e r i m e n t a l g r o u p t h a n f o r s u b je c t s
i n t h e c o n tr o l g r o u p .
L e v e l of p r e o p e r a t i v e a n x ie ty a n d l e v e l o f p r e o p e r a t i v e l if e
s t r e s s w i l l h a v e a n i n t e r a c t i v e e f f e c t w ith th e t r e a t m e n t s u c h th a t:
H y p o t h e s is 4: T h e d i f f e r e n c e in th e a n x ie t y d u r in g th e 72 h o u r
p o s t o p e r a t i v e p e r i o d b e tw e e n th e e x p e r i m e n t a l g r o u p s u b je c t s w ith
h ig h l e v e l s of p r e o p e r a t i v e a n x ie ty a n d t h o s e w ith lo w l e v e l s of p r e
o p e r a t i v e a n x ie ty i s l e s s th a n th e s a m e d i f f e r e n c e f o r th e c o n tr o l
g ro u p s u b je c ts .
H y p o t h e s is 5: T h e d i f f e r e n c e in th e a n x ie t y d u r in g th e 72 h o u r
p o s t o p e r a t i v e p e r i o d b e tw e e n th e e x p e r i m e n t a l g r o u p s u b je c t s w ith
h i g h l if e s t r e s s s c o r e s a n d t h o s e w ith lo w l if e s t r e s s s c o r e s i s l e s s
th a n th e s a m e d i f f e r e n c e f o r th e c o n tr o l g r o u p s u b j e c t s .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
C H A P T E R III
D E S IG N AN D P R O C E D U R E S
S u b j e c t s a n d S e ttin g
T h e s a m p l e c o n s i s t e d o f a t o t a l of 36 a d u lt p a t i e n t s , 18 y e a r s
of a g e o r o l d e r , a d m i t te d f o r g e n e r a l a b d o m i n a l s u r g e r y to o n e of
tw o h o s p i t a l s in th e K a l a m a z o o a r e a . G e n e r a l a b d o m in a l s u r g e r y
w a s d e f in e d a s t h o s e p r o c e d u r e s w h ic h n e c e s s i t a t e d a n o p e n in g i n to
th e a b d o m i n a l w a l l. T a b le 1 d e t a i l s th e s p e c i f ic t y p e s o f s u r g e r y
u n d e r g o n e b y s u b j e c t s in t h is s tu d y .
T a b le 1
T y p e of S u r g e r y
N o . of N o. of
C o n tro l E x p e r im e n ta l
T ype of S u rg e ry S u b je c ts S u b je c ts
A b d o m in a l H y s t e r e c t o m y 9 3
C h o l e c y s t e c to m y 8 10
E x p lo ra to ry L a p a ro to m y 1 4
M a rs h a ll M a rc h e tte P r o c e d u r e 0 1
N = 18 N = 18
34
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
E i g h te e n s u b je c t s w e r e i d e n t i f i e d f r o m H o s p i ta l I a n d
a s s i g n e d to th e e x p e r i m e n t a l g r o u p . E i g h te e n s u b je c t s w e r e i d e n
t i f i e d f r o m H o s p i ta l II a n d a s s i g n e d to th e c o n t r o l g r o u p .
S u b je c ts w e r e s e l e c t e d f r o m th e o p e r a t in g r o o m s c h e d u l e s
d u r in g a 4 - m o n th p e r i o d f r o m F e b r u a r y , 19 7 7 , t h r o u g h M a y , 1 977.
T h e s u b je c t s w e r e c o n s e c u t iv e l y s e l e c t e d a s th e y a p p e a r e d on th e
o p e r a t in g r o o m s c h e d u l e . O f th e t o t a l n u m b e r s c h e d u le d in t h is
m a n n e r , a p p r o x i m a t e ly f o u r s u b j e c t s w e r e n o t i n c lu d e d in th e s tu d y
b e c a u s e of in v e s tig a to r s c h e d u le c o n s tr a in ts .
S u b je c t a n o n y m ity w a s m a i n t a i n e d b y u s e o f a c o d e n u m b e r
w h ic h c o n s i s t e d of t h e s u b j e c t 's f i r s t i n i t i a l , l a s t i n i t i a l , a n d b i r t h -
d a te .
S u b j e c t s w e r e e x c lu d e d f r o m t h e s tu d y w h o e x h ib ite d u n u s u a l
o r a ty p i c a l p s y c h o lo g i c a l o r p h y s i c a l h i s t o r i e s . S p e c if i c a l ly , s u b
j e c t s w ith a l t e r e d l e v e l s o f c o n s c i o u s n e s s , s ig n i f ic a n tl y a l t e r e d
l e v e l s of m o b il it y , e m e r g e n c y c o n d itio n s n e c e s s i t a t i n g th e s u r g e r y ,
s i g n i f ic a n t a u d it o r y o r v i s u a l i m p a i r m e n t , d o c u m e n te d a l l e r g y h i s
t o r y , a n d d o c u m e n te d a b u s e o f a n a l g e s i c s w e r e e x c lu d e d f r o m th e
s a m p le .
D e m o g r a p h i c d a ta o n e a c h s u b je c t w a s o b ta in e d f r o m th e
p a t i e n t 's m e d i c a l r e c o r d b y t h e i n v e s t i g a t o r . T h e d e m o g r a p h ic
i n f o r m a t io n o b ta in e d w a s ( s e e A p p e n d ix A):
1. A ge
with permission of the copyright owner. Further reproduction prohibited without permission.
36
2. Sex
3. H e ig h t a n d w e ig h t
4. N u m b e r of p r e v i o u s s u r g i c a l p r o c e d u r e s
5. D a te o f m o s t r e c e n t p r e v i o u s s u r g e r y
6. P h y s i c i a n 's n a m e
7. P r e o p e r a t i v e t e m p e r a t u r e , p u l s e , r e s p i r a t i o n , a n d b lo o d
p ressu re
8. H o s p i ta l a d m i s s i o n d a te
9. S u r g e r y d a te a n d tim e
10. P re s e n t su rg e ry
11. P r e o p e r a t i v e m e d i c a ti o n
12. A n a e s th e t ic
13. P o s t o p e r a t i v e p a in m e d i c a ti o n
T h e tw o h o s p i t a l s s e l e c t e d f o r t h i s s tu d y w e r e c h o s e n o n th e
b a s i s of g e o g r a p h i c a l p r o x im it y to K a l a m a z o o , s i z e a n d s t a b i l i t y of
s ta f f , a n d s i m i l a r i t y of: (1) e d u c a t i o n a l p r e p a r a t i o n o f n u r s i n g
s ta f f , (2) ty p e s of a u x i l i a r y p e r s o n n e l u s e d to a d m i n i s t e r p a t i e n t
h o s p i t a l s w e r e i n i t i a l l y c o n ta c t e d b y th e i n v e s t i g a t o r to a s s e s s
t h e i r i n t e r e s t in p a r t i c i p a t i o n in th e s tu d y . T w o o f th e t h r e e h o s p i
t a l s c o n ta c t e d a g r e e d to p a r t i c i p a t e . O n e w a s d e s ig n a t e d a s H o s p i
t a l I ( E x p e r i m e n t a l H o s p ita l) a n d th e s e c o n d w a s d e s ig n a t e d a s H o s
p i t a l II ( C o n t r o l H o s p i ta l ) . T h e d e c i s i o n to p a r t i c i p a t e in th e s tu d y
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
37
w a s m a d e b y t h e N u r s in g D i r e c t o r o f e a c h h o s p i t a l a f t e r p r e s e n t a
t io n of a n a b s t r a c t of t h e p r o p o s e d s tu d y a n d a f t e r c o n s u lt a ti o n w ith
th e h o s p i t a l n u r s i n g s ta f f . F i n a l a p p r o v a l f o r i m p l e m e n t a t i o n o f th e
s tu d y w a s s o u g h t a n d g r a n t e d b y t h e M e d ic a l S ta ff of e a c h h o s p i t a l .
E x p e r i m e n t a l a n d D a ta C o l le c t io n P r o c e d u r e s
E a c h s u b j e c t w a s c o n ta c t e d in h i s h o s p i t a l r o o m b y t h e i n v e s
t i g a t o r on t h e d a y b e f o r e th e s c h e d u l e d s u r g e r y to s e e k h i s w r i t t e n
p e r m i s s i o n f o r p a r t i c i p a t i o n in th e s tu d y ( s e e A p p e n d ix B ). The
i n v e s t i g a t o r i d e n t i f i e d h e r s e l f a s a n u r s e w h o w a s c o n d u c tin g a
s tu d y w h ic h h a d r e c e i v e d p r i o r a p p r o v a l of th e N u r s in g a n d M e d ic a l
s ta f f of th e h o s p i t a l . T h e n a t u r e o f th e s tu d y w a s v e r b a l l y e x p la i n e d
to th e p a t i e n t b y t h e i n v e s t i g a t o r . T h e e x p la n a t io n g iv e n w a s , " T h i s
s tu d y i s b e in g c o n d u c te d to g a in i n f o r m a t i o n a b o u t y o u r r e s p o n s e s
a f t e r s u r g e r y w h ic h m a y b e of s o m e h e lp to u s in l e a r n i n g m o r e
ab o u t n u rsin g c a r e . " A ll p a t i e n t q u e s ti o n s w e r e a n s w e r e d t r u t h f u l l y
a n d a s c o m p l e te l y a s p o s s i b l e a t t h is t im e . A ll p o t e n t i a l s u b je c t s
w h o w e r e c o n ta c t e d a g r e e d to p a r t i c i p a t e .
T h e fo llo w in g i s a d e t a i l e d t e m p o r a l s e q u e n c e of e v e n ts s c h e d
u l e d f o r th e e x p e r i m e n t a l p r o c e d u r e a n d d a ta c o ll e c ti o n p h a s e s :
1. L a t e a f t e r n o o n o r e a r l y e v e n in g o f d a y b e f o r e s u r g e r y
1. 1 O b ta in s u b j e c t 's w r i t t e n p e r m i s s i o n to p a r t i c i p a t e .
1. 2 O b ta in i n i t i a l p r e s u r g e r y D i g i ta l S w e a t m e a s u r e .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
38
1. 3 A d m i n i s t e r S c h e d u le of R e c e n t E x p e r i e n c e Q u e s t io n
n a ir e .
1 .4 A d m i n i s t e r th e p r e s u r g e r y q u e s ti o n s (5) o f t h e S t r u c
t u r e d I n t e r v i e w Q u e s t io n n a i r e .
2. O n e - h a lf h o u r b e f o r e s u r g e r y a n d b e f o r e p r e o p e r a t i v e
m e d ic a tio n is a d m in is te re d
2 . 1 O b ta in a D i g i ta l S w e a t m e a s u r e .
3. S u b je c t u n d e rg o e s s u rg e r y .
4. F i r s t 72 h o u r s p o s t o p e r a t i v e l y a n d f o r e a c h p a in e x p e r i
ence
4. 1 C o m p la in t of p a in c o m m u n i c a t e d b y s u b je c t .
4 . 2 A d m i n i s t e r m e d i c a ti o n o r d e r e d f o r p a in .
4 . 3 O b ta in D i g i ta l S w e a t m e a s u r e w ith in 5 m in u t e s o f
a d m i n i s t r a t i o n o f m e d i c a ti o n .
4 .4 C a r r y o u t s e q u e n t i a l s t e p s o f N u r s in g I n t e r v e n t i o n
T r e a t m e n t . ( D e ta ile d o n p a g e 39 a n d in A p p e n d ix C. )
5. S e v e n ty - tw o h o u r s a f t e r s u r g e r y
5. 1 A d m i n i s t e r r e m a in i n g 16 q u e s ti o n s of th e S t r u c t u r e d
I n t e r v i e w Q u e s t io n n a i r e ( A p p e n d ix D).
5 .2 O b ta in d e m o g r a p h ic d a ta f r o m s u b j e c t 's m e d i c a l c h a r t .
^ O r ig i n a ll y th e D i g i ta l S w e a t M e a s u r e w a s a l s o to h a v e b e e n
o b t a in e d o n e - h a l f h o u r a f t e r th e N u r s in g I n t e r v e n t i o n T r e a t m e n t w a s
a d m i n i s t e r e d . E a r l y in th e e x p e r i m e n t , i t b e c a m e n e c e s s a r y to
a b a n d o n t h i s s e c o n d D i g i ta l S w e a t m e a s u r e b e c a u s e o f th e N u r s in g
s t a f f 's r e f u s a l to d i s t u r b th e p a t i e n t w h o , b y t h i s t i m e , w a s f r e
q u e n tly a s l e e p a s a r e s p o n s e to th e s o m n o l e n t e f f e c t o f th e p a in
m e d i c a ti o n ; n a m e l y , D e m e r o l a n d M o r p h in e S u l f a t e . I n a s m u c h a s
a s t a t e of s l e e p i s r e c o g n i z e d a s th e m o s t d e f i n i ti v e e x a m p le of a
s t a t e o f a t a r a x y , th e d e c is i o n n o t to a t t e m p t to o b ta in a s e c o n d
D i g i ta l S w e a t m e a s u r e w a s d e e m e d j u s t i f i e d in r e s p o n s e to p a ti e n t
n e e d s fo r r e s t and r e c o v e r y f ro m s u r g ic a l in s u lt.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
39
5. 3 O b ta in r e c o v e r y i n d ic e s ( p o s t o p e r a t iv e t e m p e r a t u r e ,
n u m b e r of p a in m e d i c a ti o n s r e c e i v e d in f i r s t 72
h o u r s , n u m b e r of a m b u l a to r y e f f o r ts m a d e b y s u b
j e c t d u r in g t h e f i r s t 72 h o u r s p o s t o p e r a t i v e l y ) f r o m
s u b j e c t 's m e d i c a l c h a r t .
In s tru m e n ta tio n
In d e p e n d e n t E x p e r im e n ta l V a r ia b le
T h e e x p e r i m e n t a l t r e a t m e n t w a s th e N u r s in g I n t e r v e n t i o n
T r e a t m e n t w h ic h c o n s i s t e d o f th e fo llo w in g s e q u e n t i a l b e h a v i o r s on
th e p a r t of t h e n u r s e :
1. T h e p a t i e n t i s c a l l e d b y n a m e a n d th e n u r s e i n t r o d u c e s
h e r s e l f to th e p a t i e n t u p o n h i s r e t u r n to th e u n i t f r o m th e
r e c o v e ry ro o m .
2. T h e p a t i e n t i s t o ld t h a t h e h a s a m e d i c a ti o n o r d e r e d f o r
p a in a n d th e t im e s c h e d u l e b y w h ic h t h is m e d i c a t i o n m a y
b e a d m in iste re d .
3. W h e n t h e p a t i e n t e x p r e s s e s t h a t h e is in p a in , t h e p r o c e
d u r e a d h e r e d to i s a s fo llo w s :
3. 1 T h e n u r s e e n c o u r a g e s th e p a ti e n t to d e s c r i b e a n d
l o c a t e th e p a in .
3. 2 T h e o r d e r e d a n a l g e s i c is g iv e n w ith in 5 m i n u t e s .
(If th e t im e c o n ti n g e n c ie s p r o h ib i t t h i s , th e n u r s e so
i n f o r m s t h e p a t i e n t t h a t th e m e d i c a ti o n w i l l b e g iv e n
a t th e f i r s t a llo w a b le t im e a n d p r o c e e d s w ith th e
r e m a i n d e r of th e s te p s of th e p r o c e d u r e ) .
3. 3 T h e p a t i e n t i s g iv e n a 2 - 3 m in u te b a c k r u b a n d r e p o s i
tio n e d f o r c o m f o r t.
3. 4 L i n e n s a r e c h e c k e d f o r s o ilin g , w e t n e s s , w r i n k li n g ,
an d c h a n g ed o r s tra ig h te n e d .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
40
3. 5 T h e o p p o r tu n i ty to v o id i s o f f e r e d .
3 .6 T h e d r e s s i n g i s o b s e r v e d , c h a n g e d o r r e i n f o r c e d if
n e c e s s a r y , a n d a v e r b a l r e p o r t on i t s c o n d itio n i s
g iv e n to th e p a ti e n t.
3. 7 T h e i n tr a v e n o u s in f u s io n , n a s o - g a s t r i c s u c tio n ,
c a t h e t e r , if p r e s e n t , a r e o b s e r v e d a n d a r e p o r t on
t h e i r f u n c tio n in g i s g iv e n to th e p a ti e n t.
3. 8 T h e n u r s e s i t s q u i e t l y w ith th e p a ti e n t, e li c it in g a n d
r e s p o n d in g to t h e p a t i e n t 's v e r b a l i z a t i o n s . D u r in g
th is tim e s h e a s k s th e p a ti e n t a b o u t h i s u s u a l w a y s
of d e a lin g w ith p a in , a n d r e i n f o r c e s a n d e n c o u r a g e s
h i s p r e s e n t u s e of t h o s e p a in c o p in g s k i l l s w h ic h a r e
a p p r o p r i a t e in t h i s s it u a ti o n .
E a c h m e m b e r of th e n u r s i n g a n d n u r s i n g a u x i l l i a r y s ta f f in th e
E x p e r i m e n t a l H o s p i ta l w e r e t r a i n e d in th e s te p s o f t h is p r o c e d u r e
b y th e i n v e s t i g a t o r . S m a ll g r o u p s o f s ta f f w e r e t r a i n e d in a p p r o x
i m a t e l y 6 o n e - h a l f h o u r s e s s i o n s c o n s is t in g of tw o s e s s i o n s w ith
e a c h of th e t h r e e s t a n d a r d s h i f t s of p e r s o n n e l . O p p o r t u n it ie s to
c l a r i f y , q u e s ti o n , a n d b e c o m e f a m i l i a r w ith e a c h s te p of th e p r o c e
d u re w e re o ffe re d . T o p r o v id e f o r v i s u a l r e m i n d e r s a n d r e v i e w o f
th e N u r s in g I n te r v e n t i o n T r e a t m e n t , a c o p y o f i t w a s p l a c e d on a
c l i p b o a r d on th e f o o t of e a c h s u b j e c t 's b e d . T o i n s u r e t h a t th e
t r e a t m e n t w a s m a i n t a i n e d f o r e a c h s u b je c t , e a c h p e r s o n c a r r y i n g
o u t th e t r e a t m e n t w a s r e q u i r e d to c h a r t e a c h s te p on a R e c o r d of
N u r s in g I n te r v e n t i o n T r e a t m e n t (A p p e n d ix E ). T h is c h a r t in g r e c o r d
t a g s w e r e a tt a c h e d to th e f o o t o f e a c h s u b j e c t 's b e d , to th e f r o n t of
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
41
e a c h s u b j e c t 's c h a r t , a n d to th e m e d i c a ti o n K a r d e x o f e a c h s u b je c t ,
l a b e l in g t h a t t h i s p e r s o n w a s a s u b je c t in th e N u r s in g R e s e a r c h
S tu d y .
T h e N u r s in g I n t e r v e n t i o n T r e a t m e n t w a s c a r r i e d o u t e a c h
t im e th e s u b je c t c o m m u n i c a t e d t h a t h e w a s in p a in f o r th e f i r s t 72
th e o n s e t o f s u r g e r y a n d e n d in g 72 h o u r s l a t e r .
T h e n u r s i n g s ta f f in th e C o n t r o l H o s p i ta l w e r e to ld t h a t th e
s tu d y w a s b e in g c o n d u c te d to l e a r n m o r e a b o u t p a t i e n t 's r e a c t i o n s
a fte r su rg e ry . T h e y r e c e i v e d no i n f o r m a t io n a b o u t t h e N u r s in g
I n te rv e n tio n T r e a tm e n t. I n f o r m a l o b s e r v a t io n c a r r i e d o u t on a
r a n d o m o b s e r v a t i o n b a s i s d e m o n s t r a t e d t h a t a p r o m p t r e s p o n s e of
m e d i c a ti o n a d m i n i s t r a t i o n o c c u r r e d . H o w e v e r, a m i n i m a l l i k e l i
h o o d e x is t e d t h a t a n y r o u ti n e n u r s i n g i n t e r v e n t i o n u s e d w o u ld
r e a l i s t i c a l l y a p p r o x i m a t e th e h ig h d e g r e e o f s t r u c t u r e a n d c o n s i s t
e n c y in v o lv e d in th e e x p e r i m e n t a l N u r s in g I n t e r v e n t i o n T r e a t m e n t .
D e p e n d e n t V a r ia b le s
A n x ie ty M e a s u r e - - D i g i t a l S w e a t I n d e x . In b o th t h e C o n t r o l
a n d E x p e r i m e n t a l H o s p i ta l s t h e n u r s i n g s ta f f w a s t r a i n e d b y t h e
i n v e s t i g a t o r in th e p r o c e d u r e to o b ta in th e D i g i ta l S w e a t P r i n t . A
d e m o n s t r a t i o n of th e p r o c e d u r e w a s g iv e n in s m a l l g r o u p s of
a p p r o x i m a t e ly s ix to e ig h t s ta f f . S ta ff w e r e e n c o u r a g e d to g iv e a
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
42
p r o f i c ie n c y d e m o n s t r a t i o n o f t h e p r o c e d u r e , h a n d le th e e q u ip m e n t,
a n d s e e k c l a r i f i c a t i o n of a n y q u e s ti o n s . A w r itte n s te p - b y - s te p
p r o c e d u r e f o r o b ta in in g th e D i g i ta l S w e a t M e a s u r e w a s a tt a c h e d to
a c l i p b o a r d a t th e f o o t of e a c h s u b j e c t 's b e d (A p p e n d ix F ) .
T h e D ig ita l S w e a t i n s t r u m e n t m e a s u r e s th e l e v e l of s t a t e
a n x ie ty . T h e p r o c e d u r e f o llo w e d w a s o n e r e c o m m e n d e d b y M c N a ir ,
D r o p p le m a n , a n d K u s s m a n (1 9 6 7 ). T h e s p e c i f ic p r o c e d u r e w a s
c o m m u n ic a te d in w r i ti n g b y th e P s y c h o l o g i c a l C lin ic a t th e U n i v e r
s i t y of T e n n e s s e e (A p p e n d ix G ).
I n g e n e r a l , th e p r o c e d u r e c o n s i s t s of f o u r p r i m a r y s te p s .
F i r s t , th e p a p e r s t r i p s a r e p r e p a r e d u s in g T a n n ic A c id , T h y m o l,
an d d is tille d w a te r. S e c o n d , th e F e r r i c C h l o r id e (d ry in g s o lu tio n )
S o lu tio n i s p r e p a r e d u s in g F e r r i c C h l o r id e , H y d r o c h lo r i c A c id , a n d
A c e to n e . T h i r d , th e a c t u a l f i n g e r s w e a t p r i n t s a r e o b ta in e d .
F o u r th , th e p r i n t s a r e r a t e d u s in g a p h o to g r a p h o f d e n s it y o f p r i n t ,
s c a l e d f r o m 1 to 15 w ith 1 b e in g l e a s t d e n s e to 15 b e in g m o s t d e n s e .
T h e T a n n ic A c id S o l u ti o n w a s p r e p a r e d in th e fo llo w in g m a n
n e r. D i s t i l l e d w a t e r in t h e a m o u n t o f 1000 c c w a s p l a c e d in a p y r e x
f la s k . T o th e d i s t i l l e d w a t e r w a s a d d e d 50 g r a m s o f T a n n ic A c id
a n d 1 g r a m of T h y m o l. T h e m i x t u r e w a s h e a te d g e n tly w ith c o n s ta n t
m e c h a n ic a l s tir r in g . W h e n th e i n g r e d i e n t s w e r e in s o lu tio n , th e
s o lu tio n w a s f i l t e r e d i n to a n o p a q u e , b r o w n b o t tl e a n d s to p p e r e d .
T h is s o lu tio n w a s s t o r e d u n d e r r e f r i g e r a t i o n f o r th e d u r a t i o n o f th e
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
43
e x p e rim e n t.
T h e p a p e r s t r i p s w e r e p r e p a r e d b y c u ttin g W h a tm a n F i l t e r
p a p e r i n to 1 i n c h w id e s t r i p s . N ew s ta in le s s s te e l s c is s o r s w e re
u s e d a n d p l a s t i c g l o v e s w e r e w o r n d u r in g a l l a s p e c t s of p r e p a r a t i o n
of th e p a p e r s tr i p s . T h e s t r i p s w e r e t h e n c u t in to 11 i n c h l e n g th s
a n d p l a c e d f o u r a t a t im e in to th e b o t to m o f a n 8 x 11 i n c h p y r e x
b a k in g d i s h . J u s t e n o u g h T a n n ic A c id S o lu tio n w a s p o u r e d on th e
s t r i p s to c o v e r t h e m c o m p l e te l y . N o o v e r l a p p in g of s t r i p s w a s
a llo w e d to o c c u r . T h e s t r i p s w e r e s o a k e d f o r 3 m in u t e s ; r e m o v e d
f r o m th e d is h ; e x c e s s T a n n ic A c id S o lu tio n w a s r e m o v e d b y g e n tly
s h a k in g ; a n d th e s t r i p s w e r e p l a c e d on a c l e a n f o r m i c a c o u n te r to
d ry . A f t e r a b o u t 10 m in u t e s d r y in g t im e , th e s t r i p s w e r e m o v e d
to a c le a n , d r y s p o t on th e f o r m i c a c o u n te r a n d a llo w e d to d r y c o m
p l e t e l y ( a p p r o x i m a t e l y 1 h o u r , d e p e n d in g on th e a t m o s p h e r i c h u m id
ity le v e l).
A g a in u s in g p l a s t i c g lo v e s a n d s t e e l s c i s s o r s , th e s t r i p s w e r e
c u t i n to a p p r o x i m a t e ly 1 x 2 in c h le n g t h s . P l a s t i c s p l i n t s of
1 x 2 x 1 /1 6 in c h s i z e w e r e c u t f r o m 1 in c h d i a m e t e r p l a s t i c tu b in g .
T h e s e s p li n ts w e r e f le x i b le a n d a d a p te d to a n y r e a s o n a b l e f i n g e r
s i z e b y a tt a c h in g t h e m to th e f in g e r w ith a s m a l l r u b b e r b a n d .
T h e F e r r i c C h l o r id e S o lu tio n ( d ry in g s o lu tio n ) w a s p r e p a r e d
u s in g 13 g r a m s of A n h y d r o u s F e r r i c C h l o r id e , 3 d r o p s of h y d r o
c h l o r i c a c id , a n d 1 p in t o f A c e to n e . T h is s o lu t io n w a s s t i r r e d ,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
44
w ith o u t h e a ti n g , u n t il a l l i n g r e d i e n t s w e r e in s o lu tio n . T h e n th e
s o lu t io n w a s f i l t e r e d i n to a n o p a q u e g l a s s c o n ta i n e r . S m a ll i n d i
v i d u a l o p a q u e g l a s s c o n t a i n e r s w e r e u s e d to s t o r e th e F e r r i c
C h l o r id e S o lu tio n in th e s u b je c t s m e d i c in e b o x f o r th e 72 h o u r d u r a
tio n o f t h e e x p e r i m e n t . ^
T h e D i g i ta l S w e a t m e a s u r e w a s t a k e n o n th e m id d le f i n g e r of
th e r i g h t h a n d o f a l l s u b j e c t s . T h e d i s t a l p a r t o f th e f i n g e r w a s
s w a b b e d b y m e a n s o f a Q - t ip w ith th e F e r r i c C h l o r id e S o lu tio n a n d
i t w a s a llo w e d to d r y f o r 30 s e c o n d s . T h e n th e p l a s t i c s p li n t w ith
a p a p e r s t r i p i n s e r t e d w a s a tt a c h e d to th e f i n g e r w ith a r u b b e r b a n d
a n d a llo w e d to r e m a i n in p l a c e f o r 60 s e c o n d s .
T h e c o m p l e te d s t r i p s w e r e th e n r e m o v e d a n d p l a c e d in
g l a s s i n e e n v e lo p e s w h ic h w e r e l a b e l e d w ith th e s u b j e c t 's n a m e ,
d a te , a n d t im e t a k e n . T h e D i g i ta l S w e a t p r i n t s w e r e s c o r e d b y
t h r e e r a t e r s , t r a i n e d b y th e i n v e s t i g a t o r , u s in g th e p r o c e d u r e
d e t a i l e d b y th e P s y c h o l o g i c a l C lin ic a t th e U n i v e r s i t y o f T e n n e s s e e
( D r o p p le m a n , 197 3). (S e e A p p e n d ix G . ) T h e p r i n t s w e r e r a t e d
u n d e r th e s a m e e n v ir o n m e n t a l a n d l ig h tin g c o n d itio n s f o r a l l r a t i n g
s e s s i o n s , a n d u s in g th e p h o t o g r a p h of f in g e r p r i n t s n u m b e r e d f r o m
1 to 15 ( A p p e n d ix H ).
^ T h e a s s i s t a n c e of M r . J a m e s S t e w a r t , D i r e c t o r of C h e m i s
t r y S t o r e s , W e s t e r n M ic h ig a n U n i v e r s i t y , in th e o b ta in in g a n d
p r e p a r a t i o n o f th e n e c e s s a r y s o lu t io n s a n d e q u ip m e n t, i s g r a t e
fu lly a p p r e c i a t e d .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
T h is m e a s u r e w a s o b ta in e d f o r e a c h s u b j e c t o n t h r e e o c c a
s io n s : (1) on th e d a y p r e c e d i n g s u r g e r y , (2) o n t h e d a y of s u r g e r y ,
j u s t p r e c e d i n g th e a d m i n i s t r a t i o n o f t h e p r e o p e r a t i v e m e d i c a ti o n ,
a n d (3) w ith in 5 m in u t e s a f t e r th e a d m i n i s t r a t i o n o f e a c h a n a lg e s ic
m e d i c a t i o n f o r p a in d u r in g t h e f i r s t 72 h o u r s p o s t o p e r a t i v e l y .
L if e S t r e s s M e a s u r e - - S c h e d u l e o f R e c e n t E x p e r i e n c e . T h is
s c a l e m e a s u r e s th e a m o u n t o f l if e s t r e s s to w h ic h a n in d iv i d u a l h a s
b e e n s u b je c t e d b e c a u s e of s i g n i f i c a n t c h a n g e s in h i s l if e ( R a h e ,
197 4 , p . 6 7 ). T h is s c a l e (A p p e n d ix I) h a s b e e n d e v is e d b y R a h e
to b e u s e d in h i s r e s e a r c h on th e p r e d i c t i o n of f u t u r e i l l n e s s b y
r e t r o s p e c t i v e l y e x a m in in g a n d id e n t i f y i n g s ig n i f ic a n t lif e e v e n t
s t r e s s o r s (R a h e , 1972, 19 7 4 , 1 9 7 5 ). T h e e v e n ts t h a t t h is q u e s ti o n
n a i r e s e e k s to id e n t i f y a r e b o th p o s i t i v e a n d n e g a ti v e e v e n ts , b u t
a l l r e p r e s e n t s o m e i n f e r r e d c h a n g e o r a d a p ta t io n in th e s u b j e c t 's
l if e . W h ile th e u s e of t h is m e a s u r e f o r p u r p o s e s o f t h is p r e s e n t
s tu d y d i f f e r s s o m e w h a t f r o m th e p r e d i c t i v e u s e f o r w h ic h i t w a s
o r i g i n a l l y d e v is e d , n e v e r t h e l e s s , i t a p p e a r s to h a v e c o n te n t v a li d i ty
f o r d e ta i li n g c o m m o n l if e s t r e s s e s e x p e r i e n c e d b y a d u lt s in p r e s e n t
A m e r i c a n s o c ie t y .
E a c h p o t e n t i a l s t r e s s e v e n t h a s a n u m e r i c a l v a lu e c a ll e d th e
L i f e C h a n g e U n it. F o r p u r p o s e s o f t h i s p r e s e n t s tu d y , th e L ife
C h a n g e U n its c i r c l e d b y th e s u b j e c t a s h a v in g h a p p e n e d in h i s l if e
in th e y e a r i m m e d i a t e l y p r e c e d i n g s u r g e r y w e r e s im p ly s u m m e d .
with permission of the copyright owner. Further reproduction prohibited without permission.
46
A m e d i a n L i f e C h a n g e S c o r e f o r a l l s u b je c t s (N = 36) w a s o b ta in e d .
T h o s e s u b j e c t s a b o v e th e m e d i a n w e r e p l a c e d in t h e H ig h S t r e s s
G r o u p , a n d t h o s e s u b je c t s b e lo w th e m e d i a n w e r e p l a c e d in th e L o w
S t r e s s G r o u p f o r p u r p o s e s of d a ta a n a l y s i s . ^
T h is m e a s u r e w a s a d m i n i s t e r e d b y th e i n v e s t i g a t o r o n th e d a y
of t h e s u b j e c t 's a d m i s s i o n to th e h o s p i t a l a t a t im e , in th e l a t e a f t e r
n o o n o r e a r l y e v e n in g , t h a t w a s d e te r m i n e d to b e m u tu a l ly c o n v e n
i e n t to s u b j e c t a n d s ta f f . T h e s u b je c t w a s i n s t r u c t e d to c i r c l e th e
n u m b e r s w h ic h c o r r e s p o n d e d w ith e v e n ts h e h a d e x p e r i e n c e d in h i s
l if e in t h e y e a r p r e c e d i n g s u r g e r y .
S u b j e c t 's s e l f - r e p o r t o f p o s t o p e r a t i v e p a in e x p e r i e n c e - -
S t r u c t u r e d I n t e r v i e w Q u e s t io n n a i r e . T h e S t r u c t u r e d I n te r v ie w
Q u e s t i o n n a i r e w a s d e s ig n e d b y th e i n v e s t i g a t o r a n d c o n s i s t e d o f a
t o t a l of 21 q u e s ti o n s (A p p e n d ix D ). A n s w e r s to t h e f i r s t f iv e q u e s
tio n s w e r e s o u g h t d u r in g th e f i r s t i n v e s t i g a t o r - s u b j e c t c o n ta c t on
th e d a y p r e c e d i n g s u r g e r y . T h e s e q u e s ti o n s w e r e d e s ig n e d to
s t a t e o f e m o t i o n a l it y , (2) h i s s e l f - r e p o r t of c a u s a t i v e f a c t o r s f o r
h i s p r e s e n t s t a t e , a n d (3) w h a t h e a n d o t h e r s h a d d o n e in th e i m m e
d i a t e p r e a d m i s s i o n p e r i o d to e i t h e r i n c r e a s e o r d e c r e a s e th e l e v e l
• ^ P e r m i s s i o n to u s e a n d r e p r o d u c e th e L if e C h a n g e E v e n ts
Q u e s t i o n n a i r e w a s s o u g h t a n d g r a n t e d b y R i c h a r d H . R a h e , C a p ta in ,
M C , U S N R ( A p p e n d ic e s M a n d N ).
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
47
of e m o t i o n a l it y h e w a s e x p e r i e n c i n g .
T h e f in a l 16 q u e s ti o n s of th e S t r u c t u r e d I n t e r v i e w Q u e s t io n
n a i r e w e r e a s k e d on th e f o u r t h p o s t o p e r a t i v e d a y . T h e s e q u e s ti o n s
w e r e d e s ig n e d to o b ta in s e l f - r e p o r t i n f o r m a t io n on th e fo llo w in g
d i m e n s io n s of th e p o s t o p e r a t i v e p a in e x p e r i e n c e : (1) d e g r e e of
e m o t i o n a l it y e x p e r i e n c e d a f t e r s u r g e r y , (2) f a c t o r s p e r c e i v e d a s
a l t e r h i s l e v e l o f e m o t i o n a l it y , (4) s u b j e c t 's p e r c e p t i o n of th e e f f e c t
of o t h e r p e r s o n s i n f lu e n c e on h i s l e v e l of e m o t i o n a l it y , (5) a m o u n t
of p a in e x p e r i e n c e d p o s t o p e r a t i v e l y , (6) c o n c o m i ta n t e m o t i o n a l it y
e x p e r i e n c e d d u r in g th e p a in s it u a ti o n , a n d (7) a c ti o n s of o t h e r s
w h ic h w e r e p e r c e i v e d b y th e s u b je c t to a m e l i o r a t e o r e x a c e r b a t e
h i s p a in e x p e r i e n c e .
T h e r e s u l t s of th e q u e s t i o n n a i r e w e r e a n a ly z e d b y s im p ly
s u m m in g a n d r e p o r t i n g th e r e s p o n s e s of s u b je c t s to e a c h q u e s tio n .
R e c o v e ry r a te in d ic e s -- p o s to p e r a tiv e body te m p e r a tu r e ,
n u m b e r of p a in m e d i c a ti o n s r e c e i v e d , n u m b e r of a m b u l a to r y e f f o r t s .
T h e m e a s u r e s u s e d in t h i s s tu d y , w h ic h w e r e p r e s u m e d to b e i n d i c
a ti v e of r e c o v e r y r a t e , w e r e th o s e w h ic h h a v e b e e n u s e d b y o t h e r
r e s e a r c h e r s (A n d re w , 1970; C o h e n L a z a ru s, 1975; M in c k le y ,
B o d y t e m p e r a t u r e w a s o b ta in e d f r o m th e s u b j e c t 's m e d i c a l
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
w a s o b ta in e d : f i r s t 24 h o u r s (1 - 2 4 h o u r s p o s t o p e r a t i v e l y ) , s e c o n d
24 h o u r s (2 4 - 48 h o u r s p o s t o p e r a t i v e l y ) , a n d t h i r d 2 4 h o u r s (48 -
72 h o u r s p o s t o p e r a t i v e l y ) .
T h e n u m b e r of a n a l g e s i c m e d i c a t i o n s r e c e i v e d w a s o b ta in e d
f r o m t h e s u b j e c t 's m e d i c a l c h a r t . T h e m e a n n u m b e r of a n a lg e s ic s
f o r e a c h of t h r e e p e r i o d s w a s fo u n d : f i r s t 24 h o u rs ( 1 - 2 4 h o u rs
p o s t o p e r a t i v e l y ) , s e c o n d 2 4 h o u r s (2 4 - 48 h o u r s p o s t o p e r a t i v e l y ) ,
t h i r d 24 h o u r s (48 - 72 h o u r s p o s t o p e r a t i v e l y ) .
T h e n u m b e r of a m b u l a to r y e f f o r t s w a s p r o p o s e d to b e o b ta in e d
f r o m t h e s u b j e c t 's c h a r t . T h is r e c o v e r y r a t e i n d e x w a s n o t u s e d in
th e a n a l y s i s of d a ta f o r t h is s tu d y f o r t h e f o llo w in g r e a s o n s . The
n u m b e r o f a m b u l a t o r y e f f o r ts d u r in g th e p e r i o d o f 1 to 2 4 h o u r s
a f t e r s u r g e r y i s l a r g e l y d e t e r m i n e d b y s p e c i f i c p h y s ic i a n o r d e r s to
t h a t e f f e c t. In th e E x p e r i m e n t a l H o s p i ta l th e p h y s i c i a n 's o r d e r s
u s u a l l y in c l u d e d o r d e r s f o r p a t i e n t a m b u l a ti o n d u r in g th e f i r s t 24
h o u r p e r i o d p o s t o p e r a t i v e l y ; s u c h w a s n o t t h e c a s e in th e C o n tr o l
H o s p i ta l . T h e r e f o r e th e m e a s u r e l o s t i t s v a lu e a s a d i s c r i m i n a t i n g
v a r i a b l e b e tw e e n E x p e r i m e n t a l a n d C o n t r o l g r o u p s . A d d itio n a lly ,
i t w a s o r i g i n a l l y p r o p o s e d to o b ta in t h is d a t a f r o m th e s u b j e c t 's
m e d i c a l c h a r t a n d w h e t h e r t h is a c t i v i t y w a s c h a r t e d , in th e N u r s in g
N o te s o f th e M e d ic a l R e c o r d , v a r i e d c o n s i d e r a b l y , d e p e n d in g u p o n
w h o w a s c h a r t in g f o r th e p e r i o d o f t im e s p e c i f i e d . T h is l a t t e r
f a c t o r w a s e s p e c i a l l y t r u e f o r th e t h i r d 24 h o u r p o s t o p e r a t i v e p e r i o d
with permission of the copyright owner. Further reproduction prohibited without permission.
49
w h e n m a n y o f t h e s u b j e c t s w e r e up a n d a b o u t i n d e p e n d e n tly in t h e i r
r o o m a n d h a l l s w ith o u t t h e N u r s in g s ta f f o b s e r v i n g t h e m d u r in g
e a c h a m b u l a to r y e f f o r t.
D a ta A n a l y s is P l a n
S p e c if i c a l ly , th e fo llo w in g s t a t i s t i c a l a n a ly s e s w e r e c o m p l e te d
i n t e s t in g t h e n u l l h y p o t h e s e s u s in g a p r o b a b i l it y of . 05 f o r c o m m i t
tin g a T y p e I e r r o r ( a lp h a ):
H y p o t h e s is 1: A fix e d e f f e c ts , o n e f a c t o r a n a l y s i s o f v a r i a n c e
b e tw e e n t h e c o n t r o l a n d e x p e r i m e n t a l g r o u p s on th e d e p e n d e n t v a r i
a b le of m e a n a n x ie t y l e v e l d u r in g th e f i r s t 72 h o u r s p o s t o p e r a t i v e l y .
H y p o t h e s is 2: A f ix e d e f f e c ts , o n e f a c t o r a n a l y s i s o f v a r i a n c e
b e tw e e n th e c o n t r o l a n d e x p e r i m e n t a l g r o u p s on th e d e p e n d e n t v a r i
a b le of m e a n n u m b e r of a n a l g e s i c m e d i c a ti o n s (a r e c o v e r y r a t e
in d e x ) a d m i n i s t e r e d d u r in g th e f i r s t 72 h o u r s p o s t o p e r a t i v e l y .
H y p o t h e s is 3: A f ix e d e f f e c ts , o n e f a c t o r a n a l y s i s o f v a r i a n c e
b e tw e e n th e c o n t r o l a n d e x p e r i m e n t a l g r o u p s on th e d e p e n d e n t v a r i
a b le of m e a n b o d y t e m p e r a t u r e (a r e c o v e r y r a t e in d e x ) d u r in g th e
f i r s t 72 h o u r s p o s t o p e r a t i v e l y .
H y p o t h e s is 4: A f ix e d e f f e c ts , tw o f a c t o r a n a l y s i s o f v a r i a n c e
on th e i n t e r a c t i v e e f f e c t of p r e o p e r a t i v e a n x ie ty l e v e l w ith t h e
e x p e r i m e n t a l t r e a t m e n t on th e d e p e n d e n t v a r i a b l e of m e a n a n x ie t y
l e v e l d u r in g th e f i r s t 72 h o u r s p o s to p e r a ti v e ly .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
50
H y p o t h e s is 5: A f ix e d e f f e c t s , tw o f a c t o r a n a l y s i s of v a r i a n c e
o n th e i n t e r a c t i v e e f f e c t of p r e v i o u s l if e s t r e s s w ith th e e x p e r i
m e n t a l t r e a t m e n t on th e d e p e n d e n t v a r i a b l e of m e a n a n x ie t y d u r in g
th e f i r s t 72 h o u r s p o s t o p e r a t i v e l y .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
C H A P T E R IV
RESULTS
T h e d a ta a n a l y s i s c o n s i s t e d of f o u r s e c t i o n s : (1) a n a l y s i s o f
th e f iv e m a i n h y p o t h e s e s , (2) a n a l y s i s of th e i n t e r - r a t e r r e l i a b i l i t y
f o r th e D i g i ta l S w e a t m e .a s u r e , (3) p o s t h o c a n a l y s e s o f d a ta t h a t
w e r e g e n e r a t e d b y a d d it i o n a l i n s i g h ts a n d q u e s ti o n s p o s e d b y th e
a n a l y s i s of d a ta r e l a t i v e to th e f iv e m a j o r h y p o t h e s e s , a n d (4) a n a l
y s i s of t h e r e s u l t s of th e S t r u c t u r e d I n te r v ie w Q u e s t i o n n a i r e .
A n a l y s is of M a jo r H y p o th e s e s
H y p o t h e s is 1
A n x ie ty d u r in g t h e 72 h o u r p o s t o p e r a t i v e p e r i o d i s l e s s f o r
s u b je c t s in t h e e x p e r i m e n t a l g r o u p th a n f o r s u b j e c t s i n t h e c o n t r o l
g ro u p .
F o r th e p u r p o s e o f t e s t in g w h e t h e r th e e x p e r i m e n t a l t r e a t m e n t
a f f e c te d p o s t o p e r a t i v e a n x ie t y l e v e l s , th e d a ta a n a l y s e s f o r
H y p o t h e s is 1 w a s d i v id e d i n to th e fo llo w in g f o u r c o m p o n e n ts :
1. T h e e f f e c t of th e e x p e r i m e n t a l t r e a t m e n t o n
th e m e a n a n x ie t y l e v e l d u r in g th e f i r s t 2 4 h o u r p e r i o d
p o s t o p e r a t i v e l y ( h o u r s 1 - 2 4 ).
2. T h e e f f e c t of th e e x p e r i m e n t a l t r e a t m e n t o n
th e m e a n a n x ie t y l e v e l d u r in g th e s e c o n d 2 4 h o u r p e r i o d
51
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
52
p o s t o p e r a t i v e l y ( h o u r s 24 - 4 8 ).
3. T h e e f f e c t of th e e x p e r i m e n t a l t r e a t m e n t on
th e m e a n a n x ie t y l e v e l d u r in g th e t h i r d 24 h o u r p e r i o d
p o s t o p e r a t i v e l y ( h o u r s 48 - 7 2 ).
4 . T h e e f f e c t of th e e x p e r i m e n t a l t r e a t m e n t on
th e m e a n a n x ie t y l e v e l d u r in g t h e t o ta l 72 h o u r p e r i o d
p o s t o p e r a t i v e l y ( h o u r s 1 - 7 2 ).
A f ix e d e f f e c t s , o n e f a c t o r a n a l y s i s of v a r i a n c e m o d e l w a s u s e d
to t e s t e a c h of th e a b o v e c o m p o n e n t s .
E f f e c t of e x p e r i m e n t a l t r e a t m e n t on m e a n a n x ie ty , h o u r s
1 - 2 4 p o s to p e r a tiv e ly . F r o m T a b le 2 one c a n in fe r th a t t h e r e w a s
n o s ig n i f ic a n t d i f f e r e n c e b e tw e e n th e e x p e r i m e n t a l a n d c o n tr o l g r o u p s
on m e a n a n x ie ty l e v e l d u r in g t h e f i r s t 24 h o u r p e r i o d p o s t o p e r a t i v e l y
( h o u r s 1 - 24).
F o r a n a lp h a o f . 05, th e r e q u i r e d c r i t i c a l v a lu e of F f o r 1 a n d
33 d e g r e e s of f r e e d o m i s a p p r o x i m a t e l y 4. 17, so t h a t th e o b t a i n e d
_F v a lu e of . 04 i s n o t s i g n i f i c a n t a t th e . 05 l e v e l . T h e r e f o r e no
e v id e n c e i s fo u n d to r e j e c t th e n u ll h y p o t h e s i s of no d i f f e r e n c e
b e tw e e n g r o u p s . T h e d e p e n d e n t v a r i a b l e , m e a n l e v e l of a n x ie t y in
th e f ir s .t 24 h o u r p e r i o d p o s t o p e r a t i v e l y , i s n o t s i g n i f ic a n tl y a f f e c te d
b y th e e x p e r i m e n t a l t r e a t m e n t ( N u r s in g I n te r v e n t i o n T r e a t m e n t )
b a s e d on th e p r e s e n t r e s u l t s .
E f f e c t of e x p e r i m e n t a l t r e a t m e n t on m e a n a n x ie ty , h o u r s
24 - 48 p o s t o p e r a t i v e l y . F r o m T a b le 3 o n e m a y i n f e r t h a t t h e r e w a s
n o s i g n i f ic a n t d i f f e r e n c e b e tw e e n t h e e x p e r i m e n t a l a n d c o n t r o l
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
53
T a b le 2
S u m m a r y of O n e F a c t o r A n a l y s is of V a r i a n c e
f o r M e a n A n x ie ty L e v e l f o r P o s t o p e r a t i v e
P e r io d , H o u rs 1 - 2 4
G ro u p N M SD
E x p e r im e n ta l G ro u p 17 3. 03 1. 84
C o m p a ris o n G ro u p 18 3. 15 1 .6 6
S o u r c e of
V a r ia n c e df MS F £
B e tw e e n G r o u p s 1 0. 13 0. 04 0. 84
W ith in G r o u p s 33 3. 06
T o ta l 34
g r o u p s on m e a n a n x ie t y l e v e l d u r in g th e s e c o n d 24 h o u r p e r i o d
p o s t o p e r a t i v e l y ( h o u r s 24 - 4 8 ).
F o r a n a lp h a of . 05, th e r e q u i r e d c r i t i c a l v a lu e f o r _F f o r 1 a n d
33 d e g r e e s of f r e e d o m i s a p p r o x i m a t e l y 4 . 17, s o t h a t th e o b ta in e d
_F v a lu e of . 45 is n o t s ig n i f ic a n t a t th e . 05 l e v e l . T h e n u ll h y p o t h
e s i s of no s ig n i f ic a n t t r e a t m e n t d i f f e r e n c e i s n o t r e j e c t e d . T hese
r e s u l t s sh o w t h a t th e m e a n l e v e l o f a n x ie t y in th e s e c o n d 24 h o u r
p e r i o d p o s t o p e r a t i v e l y i s n o t s i g n i f i c a n t l y a f f e c te d b y th e e x p e r i
m e n t a l N u r s in g I n te r v e n t i o n T r e a t m e n t .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
54
T a b le 3
S u m m a r y of O n e F a c t o r A n a l y s is of V a r i a n c e
f o r M e a n A n x ie ty L e v e l f o r P o s t o p e r a t i v e
P e r i o d , H o u r s 24 - 48
G ro u p N M SD
E x p e r im e n ta l G ro u p 17 4. 25 3. 04
C o m p a ris o n G ro u p 18 3 .6 6 2. 18
S o u r c e of
V a r ia n c e df MS F £
B e tw e e n G r o u p s 1 3. 09 0. 45 0. 51
W ith in G r o u p s 33 6 . 92
T o ta l 34
E f f e c t of e x p e r i m e n t a l t r e a t m e n t o n m e a n a n x ie t y , h o u r s
48 - 72 p o s t o p e r a t i v e l y . F r o m T a b le 4 o n e m a y i n f e r t h a t t h e r e
w a s no s ig n i f ic a n t d i f f e r e n c e b e tw e e n th e e x p e r i m e n t a l a n d c o n t r o l
g r o u p s on m e a n a n x ie t y l e v e l d u r in g th e t h i r d 24 h o u r p e r i o d p o s t
o p e r a t i v e l y ( h o u r s 48 - 72).
F o r a n a lp h a o f . 05, th e r e q u i r e d c r i t i c a l v a lu e of _F f o r 1 a n d
27 d e g r e e s of f r e e d o m i s 4 . 21, s o t h a t th e o b ta in e d F v a lu e o f . 30 is
n o t s ig n i f ic a n t a t th e . 05 l e v e l . T h e n u ll h y p o t h e s i s of n o s i g n i f i c a n t
d i f f e r e n c e b e tw e e n th e e x p e r i m e n t a l a n d c o n tr o l g r o u p s i s n o t r e j e c t e d .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
55
T a b le 4
S u m m a r y o f O n e F a c t o r A n a l y s is of V a r ia n c e
f o r M e a n A n x ie ty L e v e l f o r P o s t o p e r a t i v e
P e r i o d , H o u r s 48 - 72
G ro u p N M SD
E x p e rim e n ta l G ro u p 14 3. 46 2. 50
C o m p a ris o n G ro u p 15 3. 01 1. 9 4
S o u r c e of
V a r ia n c e df MS F £
B e tw e e n G r o u p s 1 1. 51 0. 30 0. 59
W ith in G r o u p s 27 4. 97
T o ta l 28
E f f e c t of e x p e r i m e n t a l t r e a t m e n t on m e a n a n x ie ty , h o u r s
1 - 7 2 p o s to p e r a tiv e ly . F r o m T a b l e 5 o n e m a y i n f e r , a s m ig h t b e
e x p e c te d f r o m th e r e s u l t s r e p o r t e d a b o v e , t h e r e w a s n o s i g n i f i c a n t
d i f f e r e n c e b e tw e e n th e e x p e r i m e n t a l a n d c o n tr o l g r o u p s on m e a n
a n x ie t y l e v e l d u r in g t h e t o t a l 72 h o u r p e r i o d p o s t o p e r a t i v e l y .
T h e c r i t i c a l v a lu e of _F f o r 1 a n d 34 d e g r e e s of f r e e d o m ,
s e tt in g a lp h a a t . 05 , i s a p p r o x i m a t e l y 1. 38, s o t h a t th e o b t a i n e d _F
v a lu e of . 02 i s n o t s i g n i f i c a n t . T h e n u ll h y p o t h e s i s of no s i g n i f i c a n t
d i f f e r e n c e b e tw e e n e x p e r i m e n t a l a n d c o n tr o l g r o u p s i s n o t r e j e c t e d .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
56
T a b le 5
S u m m a r y of O n e F a c t o r A n a l y s is of V a r i a n c e
f o r M e a n A n x ie ty L e v e l f o r P o s t o p e r a t i v e
P e r io d , H o u rs 1 - 7 2
G ro u p N M SD
E x p e r im e n ta l G ro u p 18 9. 57 6. 02
C o m p a ris o n G ro u p 18 9. 32 4 . 00
S o u r c e of
V a ria n c e df MS F £
B e tw e e n G r o u p s 1 0. 58 0. 02 0. 88
W ith in G r o u p s 34 2 6 . 14
T o ta l 35
H y p o t h e s is 2
T h e a m o u n t of a n a l g e s i c m e d i c a t i o n i s l e s s f o r s u b je c t s in th e
e x p e r i m e n t a l g r o u p t h a n f o r s u b je c t s in th e c o n t r o l g r o u p . T h e d a ta
a n a l y s i s f o r H y p o th e s is 2 w a s d iv id e d i n to th e m llo w in g f o u r c o m p o
n e n ts . T h e e f f e c t of th e e x p e r i m e n t a l t r e a t m e n t on th e n u m b e r of
a n a l g e s i c m e d i c a ti o n s r e c e i v e d :
1. D u r in g th e f i r s t 24 h o u r s p o s t o p e r a t i v e l y ,
h o u r s 1 - 24.
2. D u r in g th e s e c o n d 2 4 h o u r s p o s t o p e r a t i v e l y ,
h o u r s 24 - 48 .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
57
3. D a r in g th e t h i r d 24 h o u r s p o s t o p e r a t i v e l y ,
h o u r s 48 - 72.
4. D u r in g th e t o ta l 72 h o u r s p o s t o p e r a t i v e l y ,
h o u r s 1 - 72.
T a b l e s 6, 7, 8, a n d 9 sh o w th e r e s u l t s of th e f ix e d e f f e c t s , o n e
f a c t o r a n a l y s i s of v a r i a n c e m o d e l t h a t w a s u s e d to t e s t th e n u m b e r
of a n a l g e s i c m e d i c a ti o n s a d m i n i s t e r e d in e a c h of th e t h r e e 24 h o u r
p e r i o d s p o s t o p e r a t i v e l y , a n d f o r t h e t o ta l 72 h o u r p o s t o p e r a t i v e
p e rio d .
T a b le 6
S u m m a r y of O n e F a c t o r A n a l y s is of V a r i a n c e
f o r N u m b e r o f A n a l g e s i c s A d m i n is te r e d
P o s to p e r a tiv e ly , H o u rs 1 - 2 4
G ro u p N M SD
E x p e r im e n ta l G ro u p 18 3. 83 1. 50
C o m p a ris o n G ro u p 18 3. 28 0. 96
S o u r c e of
V a r ia n c e df MS F £
B e tw e e n G r o u p s 1 2. 78 1. 74 0. 20
W ith in G r o u p s 34 1. 59
T o ta l 35
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
58
T a b le 7
S u m m a r y of O n e F a c t o r A n a l y s is of V a r ia n c e
f o r N u m b e r of A n a l g e s i c s A d m i n is te r e d
P o s t o p e r a t i v e l y , H o u r s 24 - 48
G ro u p N M SD
E x p e r im e n ta l G r o u p 18 3. 00 1. 50
C o m p a ris o n G ro u p 18 3. 72 1. 36
S o u r c e of
V a r ia n c e df MS F £
B e tw e e n G r o u p s 1 4. 69 2. 29 0. 14
W ith in G r o u p s 34 2. 05
T o ta l 35
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
59
T a b le 8
S u m m a r y of O n e F a c t o r A n a l y s is o f V a r i a n c e
fo r N u m b e r of A n a lg e s ic s A d m in is te r e d
P o s t o p e r a t i v e l y , H o u r s 48 - 72
G ro u p N M SD
E x p e r im e n ta l G ro u p 18 2. 28 1 .4 1
C o m p a ris o n G ro u p 18 2. 67 1. 37
S o u r c e of
V a ria n c e df MS ¥_ £
B e tw e e n G r o u p s 1 1. 36 0. 70 0. 41
W ith in G r o u p s 34 1 .9 3
T o ta l 35
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
60
T a b le 9
S u m m a r y of O n e F a c t o r A n a l y s is of V a r i a n c e
f o r N u m b e r of A n a lg e s ic s A d m in is te r e d
P o s t o p e r a t i v e l y , T o ta l 72 H o u r s
G ro u p N M SD
E x p e r im e n ta l G ro u p 18 9. 11 3. 82
C o m p a ris o n G ro u p 18 9. 67 2. 70
S o u r c e of
V a r ia n c e df MS F £
B e tw e e n G r o u p s 1 2. 78 0. 25 0. 62
W ith in G r o u p s 34 10. 93
T o ta l 35
F o r a n a lp h a of . 05, t h e r e q u i r e d c r i t i c a l v a lu e of F f o r 1 a n d
34 d e g r e e s of f r e e d o m i s a p p r o x i m a t e l y 4. 17, t h e r e f o r e n o n e o f th e
F v a lu e s in T a b l e s 6, 7, 8, a n d 9 a r e s ig n i f ic a n t. H y p o t h e s is 2 i s
n o t s u p p o r t e d b y t h is d a ta a n d th e n u ll h y p o t h e s i s i s n o t r e j e c t e d .
H y p o t h e s is 3
P o s to p e r a tiv e r e c o v e r y r a te a s m e a s u r e d by m e a n p o s to p e r a
tiv e b o d y t e m p e r a t u r e , m e a n n u m b e r of a m b u l a to r y e f f o r t s , a n d
m e a n n u m b e r of a n a l g e s i c m e d i c a ti o n s a d m i n i s t e r e d i s g r e a t e r f o r
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
61
s u b je c t s in t h e e x p e r i m e n t a l g r o u p t h a n f o r s u b je c t s i n t h e c o n tr o l
g ro u p .
T o d e t e r m i n e w h e t h e r th e e x p e r i m e n t a l t r e a t m e n t s ig n i f ic a n tl y
a f f e c te d p o s t o p e r a t i v e r e c o v e r y r a t e , d a ta a n a l y s i s w a s c a r r i e d o u t
f o r e a c h s e p a r a t e i n d e x m e a s u r e a s f o llo w s : (1) b o d y t e m p e r a t u r e ,
(2) a m b u l a to r y e f f o r t s , a n d (3) n u m b e r of a n a l g e s i c m e d i c a t i o n s .
E f f e c t of e x p e r i m e n t a l t r e a t m e n t on m e a n b o d y t e m p e r a t u r e
p o s to p e r a tiv e ly . T h e e f f e c t o f th e e x p e r i m e n t a l t r e a t m e n t o n m e a n
b o d y t e m p e r a t u r e w a s d i v id e d in to t h r e e c o m p o n e n ts f o r d a ta
a n a ly s i s :
1. M e a n b o d y t e m p e r a t u r e f o r th e f i r s t 2 4 h o u r s
p o s t o p e r a t i v e l y ( h o u r s 1 - 2 4 ).
2. M e a n b o d y t e m p e r a t u r e f o r th e s e c o n d 24
h o u r s p o s t o p e r a t i v e l y ( h o u r s 24 - 4 8 ).
3. M e a n b o d y t e m p e r a t u r e f o r th e t h i r d 2 4 h o u r s
p o s t o p e r a t i v e l y ( h o u r s 48 - 7 2 ).
T h e r e s u l t s of th e f ix e d e f f e c ts , o n e f a c t o r a n a l y s i s o f v a r i
a n c e m o d e l t h a t w a s u s e d to t e s t m e a n b o d y t e m p e r a t u r e in e a c h of
th e t h r e e 24 h o u r p e r i o d s p o s t o p e r a t i v e l y a r e r e p o r t e d in T a b l e s 10,
11, a n d 12.
F o r a n a lp h a of . 05, th e r e q u i r e d c r i t i c a l v a lu e o f IT f o r 1 a n d
34 d e g r e e s of f r e e d o m i s a p p r o x i m a t e ly 4 . 17, t h e r e f o r e n o n e o f th e
F v a lu e s in T a b l e s 10, 11, a n d 12 a r e s ig n i f ic a n t. T h e r e s u l t s of
th is s tu d y s h o w t h a t th e e x p e r i m e n t a l t r e a t m e n t d id n o t s ig n i f ic a n tl y
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62
a f f e c t th e r e c o v e r y i n d e x o f m e a n p o s t o p e r a t i v e b o d y t e m p e r a t u r e .
T a b le 10
S u m m a r y o f O n e F a c t o r A n a l y s is of V a r i a n c e f o r
M ean B ody T e m p e r a tu r e fo r P o s to p e r a tiv e
P e r io d , H o u rs 1 - 2 4
G ro u p N M SD
E x p e rim e n ta l G ro u p 18 9 8 . 89 0 . 81
C o m p a ris o n G ro u p 18 98. 97 0 . 69
S o u r c e of
V a r ia n c e df MS F £
B e tw e e n G r o u p s 1 0. 05 0. 09 0 . 77
W ith in G r o u p s 34 0. 57
T o ta l 35
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
63
T a b le 11
S u m m a r y of O n e F a c t o r A n a l y s is o f V a r i a n c e f o r
M ean B ody T e m p e r a tu r e fo r P o s to p e r a tiv e
P e r i o d , H o u r s 24 - 48
G ro u p N M SD
E x p e r im e n ta l G ro u p 18 99 . 51 0. 55
C o m p a ris o n G ro u p 18 99. 38 0. 58
S o u r c e of
V a r ia n c e df MS F £
B e tw e e n G r o u p s 1 0. 15 0. 46 0. 50
W ith in G r o u p s 34 0. 32
T o ta l 35
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
64
T a b le 12
S u m m a r y of O n e F a c t o r A n a l y s is o f V a r i a n c e f o r
M ean B ody T e m p e r a tu r e fo r P o s to p e r a tiv e
P e r i o d , H o u r s 48 - 72
G ro u p N M SD
E x p e r im e n ta l G ro u p 18 9 9 .4 6 0. 76
C o m p a ris o n G ro u p 18 9 9 . 03 0. 58
S o u r c e of
V a r ia n c e df MS F £
B e tw e e n G r o u p s 1 1. 6 4 3. 59 0. 07
W ith in G r o u p s 34 0 .4 6
T o ta l 35
E f f e c t of e x p e r i m e n t a l t r e a t m e n t o n n u m b e r o f a m b u l a to r y
e ff o r ts p o s to p e r a tiv e ly . T h is r e c o v e r y r a t e in d e x w a s n o t u s e d in
th e a n a l y s i s of d a ta f o r t h is s tu d y f o r th e f o llo w in g r e a s o n s . The
n u m b e r of a m b u l a t o r y e f f o r ts d u r in g th e p e r i o d o f 1 to 24 h o u r s
a f t e r s u r g e r y i s l a r g e l y d e t e r m i n e d b y s p e c i f i c p h y s ic i a n o r d e r s to
t h a t e f f e c t. In th e E x p e r i m e n t a l H o s p i ta l th e p h y s i c i a n 's o r d e r s
o r d i n a r i l y r e q u i r e d p a ti e n t a m b u l a ti o n d u r in g th e f i r s t 24 h o u r p e r
io d p o s t o p e r a t i v e l y ; s u c h w a s n o t th e c a s e in th e C o n t r o l H o s p i ta l .
T h e s e d i f f e r e n t i a l h o s p it a l p r a c t i c e s r e s u l t e d in th e m e a s u r e lo s in g
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65
i t s v a l u e a s a d i s c r i m i n a t i n g v a r i a b l e b e tw e e n e x p e r i m e n t a l a n d
c o n tro l g r o u p s . A d d i t io n a l ly , i t w a s o r i g i n a l l y p r o p o s e d to o b ta in
t h is d a tu m f r o m th e s u b j e c t 's m e d i c a l c h a r t a n d w h e t h e r t h is a c ti v it y
w a s c h a r t e d , in th e N u r s in g N o te s of th e M e d ic a l R e c o r d , v a r i e d
c o n s i d e r a b l y , d e p e n d in g u p o n w h o w a s c h a r t in g f o r th e p e r i o d of
tim e s p e c i f i e d . T h is l a t t e r f a c t o r w a s e s p e c i a l l y t r u e f o r th e t h i r d
24 h o u r p o s t o p e r a t i v e p e r i o d w h e n m a n y of th e s u b j e c t s w e r e up a n d
a b o u t in d e p e n d e n t ly in t h e i r r o o m a n d th e h a l l s w i t h o u t th e n u r s i n g
s ta f f o b s e r v i n g t h e m d u r in g e a c h a m b u l a to r y e f f o r t .
E f f e c t of e x p e r i m e n t a l t r e a t m e n t on n u m b e r of a n a l g e s i c
m e d ic a tio n s a d m in is te re d p o s to p e r a tiv e ly . T h e e f f e c t of th e e x p e r i
m e n t a l t r e a t m e n t on th e r e c o v e r y r a t e in d e x , n u m b e r of a n a l g e s i c
m e d i c a t i o n s a d m i n i s t e r e d p o s t o p e r a t i v e l y , w a s t e s t e d u s in g a f ix e d
e f f e c t s , o n e f a c t o r a n a l y s i s of v a r i a n c e m o d e l . T h e r e s u l t s of th is
a n a l y s i s a r e d e t a i l e d in T a b l e s 6, 7, 8, a n d 9. N o s i g n i f ic a n t
r e s u l t s w e r e o b ta in e d in t h e s e a n a l y s e s . T h e r e f o r e th e e x p e r i
m e n t a l t r e a t m e n t , N u r s in g I n te r v e n t i o n T r e a t m e n t , d id n o t s i g n i f
i c a n t l y a f f e c t th e r e c o v e r y r a t e in d e x of n u m b e r of a n a l g e s i c m e d i
c a ti o n s a d m i n i s t e r e d p o s t o p e r a t i v e l y .
N o n e of th e r e c o v e r y r a t e i n d ic e s u s e d in t h i s s tu d y w e r e
s u p p o r t e d b y th e d a ta . T h e r e f o r e H y p o t h e s is 3 i s n o t s u p p o r t e d a n d
th e n u ll h y p o th e s is is n o t r e je c te d .
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66
H y p o t h e s is 4
T h e d i f f e r e n c e in th e a n x ie t y d u r in g th e 72 h o u r p o s t o p e r a t i v e
p e r i o d b e tw e e n th e e x p e r i m e n t a l g r o u p s u b je c t s w ith h ig h l e v e l s of
p r e o p e r a t i v e a n x ie t y a n d t h o s e w ith lo w l e v e l s of p r e o p e r a t i v e a n x i
e ty i s l e s s t h a n th e s a m e d i f f e r e n c e f o r th e c o n tr o l g r o u p s u b j e c t s .
F o r th e p u r p o s e of t e s t in g th e i n t e r a c t i v e e f f e c t o f th e l e v e l of
p r e o p e r a t i v e a n x ie t y , th e e v e n in g b e f o r e s u r g e r y , a n d th e e x p e r i
m e n t a l t r e a t m e n t , N u r s in g I n t e r v e n t i o n T r e a t m e n t , on m e a n p o s t
o p e r a t i v e a n x ie t y l e v e l f o r th e t o ta l 72 h o u r p e r i o d p o s t o p e r a t i v e l y ,
a tw o f a c t o r a n a l y s i s of v a r i a n c e m o d e l w a s u s e d . P r e o p e r a tiv e
a n x ie ty l e v e l s w e r e d iv id e d i n to H ig h a n d L o w a n x ie ty b y c o n s id e r in g
a n x ie t y v a lu e s a b o v e th e m e d i a n (8. 33) to b e H ig h a n d t h o s e b e lo w
th e m e d i a n to b e L o w . T a b le 13 s u m m a r i z e s th e r e s u l t s of th e tw o
f a c t o r a n a l y s i s of v a r i a n c e m o d e l u s e d to t e s t H y p o t h e s is 4.
F o r a n a lp h a o f . 05 , th e r e q u i r e d c r i t i c a l v a lu e of F f o r 1 a n d
31 d e g r e e s of f r e e d o m i s a p p r o x i m a t e ly 4. 17. T h e r e f o r e t h e d a ta
do n o t s u p p o r t H y p o t h e s is 4 a n d th e n u ll h y p o t h e s i s o f no s ig n i f ic a n t
d iffe re n c e is not r e je c te d .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
67
T a b le 13
S u m m a r y of T w o F a c t o r A n a l y s is o f V a r ia n c e f o r
E f f e c t of L e v e l o f P r e o p e r a t i v e A n x ie ty a n d
E x p e r i m e n t a l T r e a t m e n t on M e a n P o s t o p e r a t i v e
A n x ie ty L e v e l, H o u r s 1 - 7 2
G ro u p
L e v e l of E x p e r im e n ta l C o m p a ris o n
P r e o p e r a t i v e A n x ie ty G ro u p G ro u p
H ig h P r e o p e r a t i v e A n x ie ty :
N 9 9
M 10. 08 9. 06
SD 7. 36 4. 71
L o w P r e o p e r a t i v e A n x ie ty :
N 8 9
M 7 .9 9 10. 60
SD 4 . 19 3. 87
S o u r c e of
V a r ia n c e df MS £ £
(A) B e tw e e n G r o u p s 1 0. 42 0. 02 0. 90
( S tru c tu re d an d U n s tru c
t u r e d N u r s in g T r e a t m e n t )
(B ) B e tw e e n H ig h a n d L ow
A d m i s s i o n A n x ie ty 1 4 .8 4 0 .1 8 0 .6 8
A x B In te r a c tio n 1 28. 71 1 .0 4 0 .3 2
W ith i n 31 2 7 . 55
T o ta l 34
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
68
H y p o t h e s is 5
T h e d i f f e r e n c e in th e a n x ie t y d u r in g th e 72 h o u r p o s t o p e r a t i v e
p e r i o d b e tw e e n th e e x p e r i m e n t a l g r o u p s u b je c t s w ith h ig h lif e s t r e s s
d i f f e r e n c e f o r th e c o n tr o l g r o u p s u b j e c t s .
F o r th e p u r p o s e of t e s t i n g t h e i n t e r a c t i v e e f f e c t of l e v e l of
p r e v i o u s l if e s t r e s s a n d th e e x p e r i m e n t a l t r e a t m e n t on m e a n p o s t
o p e r a t i v e a n x ie ty l e v e l f o r th e t o t a l 72 h o u r p o s t o p e r a t i v e p e r i o d , a
tw o f a c t o r a n a ly s i s of v a r i a n c e m o d e l w a s u s e d . H ig h a n d L o w
l e v e l s of p r e v i o u s l if e s t r e s s w e r e d e t e r m i n e d b y e s t a b l is h i n g th e
m e d i a n a n d c a llin g a ll l if e s t r e s s v a l u e s a b o v e th e m e d ia n , H ig h ,
a n d a l l l if e s t r e s s v a lu e s b e lo w t h e m e d i a n , L o w . T a b le 14 s u m m a
r i z e s th e r e s u l t s of th e tw o f a c t o r a n a l y s i s of v a r i a n c e m o d e l u s e d
to t e s t H y p o th e s is 5.
F o r a n a lp h a of . 05, th e r e q u i r e d c r i t i c a l v a lu e of jT f o r 1 a n d
31 d e g r e e s of f r e e d o m i s a p p r o x i m a t e l y 4 . 17. T h e d a ta do n o t
s u p p o r t H y p o th e s is 5 a n d th e n u ll h y p o t h e s i s i s n o t r e j e c t e d .
In s u m m a r y , th e d a ta s u p p o r t e d n o n e o f th e f iv e m a j o r h y p o th
eses. D i s c u s s i o n of t h e s e f in d i n g s w i l l b e c o n s i d e r e d in C h a p t e r V .
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69
T a b le 14
S u m m a r y of T w o F a c t o r A n a l y s is of V a r i a n c e f o r
E f f e c t of A m o u n t of P r e v i o u s L if e S t r e s s a n d
E x p e r i m e n t a l T r e a t m e n t on T o t a l P o s t o p e r a t i v e
M e a n A n x ie ty L e v e l
G ro u p
L e v e l of E x p e r im e n ta l C o m p a ris o n
P r e v i o u s L if e S t r e s s G ro u p G ro u p
H ig h P r e v i o u s L if e S t r e s s :
N 5 13
M 10. 61 9 . 17
SD 6 . 24 6. 14
L o w P r e v i o u s L if e S t r e s s :
N 13 4
M 9. 68 8 . 36
SD 3. 86 5. 41
S o u r c e of
V a ria n c e df MS Z £
(A) B e tw e e n G r o u p s 1 5. 08 0 .1 8 0 .6 9
(S tr u c tu r e d an d U n s tr u c
t u r e d N u r s in g T r e a t m e n t )
(B) B e tw e e n H ig h a n d L o w
P r e v i o u s L if e S t r e s s 1 12. 83 0 .4 5 0 . 50
A x B I n te r a c tio n 1 0. 02 0. 00 0. 98
W ith in 31 2 8 . 22
T o ta l 34
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
70
I n t e r - r a t e r C o r r e l a t i o n of R a t e r s
on D i g i ta l S w e a t P r i n t s
A ll of th e s w e a t p r i n t s o b ta in e d f r o m e a c h a d m i n i s t r a t i o n o f
th e D i g i ta l S w e a t P r i n t M e a s u r e w e r e r a t e d b y th e s a m e t h r e e r a t e r s
f r o m a s t a n d a r d p h o t o g r a p h of s w e a t p r i n t s ( A p p e n d ix H ). T h e p r in ts
w e r e r a t e d u n d e r th e s a m e e n v ir o n m e n t a l a n d l ig h tin g c o n d it i o n s f o r
a ll r a tin g s e s s io n s . T w o r a t e r s (R1 a n d R 2) r a t e d th e p r i n t s a t th e
e n d of e a c h 24 h o u r p e r i o d . T h e t h i r d r a t e r (R 3 ), b e c a u s e of
s c h e d u l e c o n s t r a i n t s , r a t e d th e p r i n t s f r o m 2 to 4 w e e k s l a t e r t h a n
R1 a n d R 2 .
I n t e r - r a t e r c o r r e l a t i o n s w e r e fo u n d to b e . 98 b e tw e e n R1 a n d
R 2 , . 98 b e tw e e n R1 a n d R 3 , a n d . 97 b e tw e e n R 2 a n d R 3 . A ll o f
t h a t th e d i g it a l s w e a t p r i n t s m a y d a r k e n o v e r t im e . T h e s ig n i f ic a n t
c o r r e l a t i o n s of th e r a t i n g s o f R 3 w ith th e r a t i n g s o f R1 a n d R 2
i n d ic a te t h a t s u c h d a r k e n i n g of p r i n t s w a s n o t fo u n d to o c c u r in th e
p r e s e n t s tu d y .
A d d i t io n a l P o s t H o c D a ta A n a l y s e s
T h e f o llo w in g a d d it i o n a l a n a l y s e s w e r e c o n d u c te d in a n a t t e m p t
to p r o v id e e v id e n c e t h a t w o u ld s u p p o r t o r m o r e c o n c lu s i v e l y r e f u t e
th e f iv e m a i n h y p o t h e s e s o f th e s tu d y .
A f ix e d e f f e c t s , o n e f a c t o r a n a l y s i s of v a r i a n c e m o d e l w a s
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
u s e d to d e t e r m i n e if a s i g n i f i c a n t i n i t i a l d i f f e r e n c e e x i s t e d b e tw e e n
th e e x p e r i m e n t a l a n d c o n t r o l g r o u p s p r i o r to e x p e r i m e n t a l t r e a t
m e n t a s to th e l e v e l of a d m i s s i o n a n x ie ty a n d th e l e v e l o f i m m e d i a t e
p r e o p e r a t i v e a n x ie t y . T a b l e s 15 a n d 16 p r e s e n t s u m m a r i e s o f t h is
a n a ly s is . A s i s e v id e n t f r o m a r e v i e w o f t h e s e t a b l e s , n o n e o f t h e s e
r e s u l t s w e r e s i g n i f i c a n t a t th e . 05 l e v e l f o r 1 a n d 33 d e g r e e s o f
f r e e d o m f o r d i f f e r e n c e s b e tw e e n th e e x p e r i m e n t a l a n d c o n t r o l g r o u p s
on l e v e l s of p r e o p e r a t i v e a n x ie ty .
T a b le 15
S u m m a r y of O n e F a c t o r A n a l y s is of V a r i a n c e f o r
D i f f e r e n c e s B e tw e e n E x p e r i m e n t a l a n d C o n t r o l
G r o u p s on A d m i s s i o n P r e o p e r a t i v e
A n x ie ty L e v e l
G ro u p N M SD
E x p e r im e n ta l G ro u p 18 9. 24 2. 80
C o m p a ris o n G ro u p 17 8. 37 3. 39
S o u r c e of
V a r ia n c e df MS F £
B e tw e e n G r o u p s 1 6. 58 0. 69 0. 41
W ith in G r o u p s 33 9. 58
T o ta l 34
with permission of the copyright owner. Further reproduction prohibited without permission.
T a b le 16
S u m m a r y of O n e F a c t o r A n a l y s is o f V a r ia n c e f o r
D i f f e r e n c e s B e tw e e n E x p e r i m e n t a l a n d C o n tr o l
G r o u p s on I m m e d ia t e P r e o p e r a t i v e
A n x ie ty L e v e l
G ro u p N M SD
E x p e r im e n ta l G ro u p 15 7. 49 2 .4 2
C o m p a ris o n G ro u p 13 7. 36 3. 33
S o u r c e of
V a r ia n c e df MS F £
B e tw e e n G r o u p s 1 0. 12 0. 01 0 . 90
W ith in G r o u p s 26 8. 26
T o ta l 27
T h e p o s s i b i l i t y e x i s t e d t h a t th e ty p e of s u r g e r y a n ti c ip a t e d
m ig h t h a v e a n e f f e c t on th e a d m i s s i o n p r e o p e r a t i v e a n x ie ty l e v e l o f
s u b je c ts . S p e c if i c a l ly , b e c a u s e p a t i e n t s u n d e rg o in g a n a b d o m in a l
h y s t e r e c t o m y w e r e in c l u d e d in th e s a m p l e , i t w a s d e e m e d n e c e s s a r y
to i n v e s t ig a t e w h e t h e r th e l o s s of a n o r g a n , p r e s u m a b l y h ig h ly
r e l a t e d to b o d y i m a g e , w a s m o r e a n x ie t y p r o d u c in g th a n th e l o s s of
o th e r o rg a n s , su c h a s a g a ll b la d d e r . A s u m m a r y of th e f ix e d e f f e c t s ,
o n e f a c t o r a n a ly s i s of v a r i a n c e m o d e l u s e d to t e s t t h e s e v a r i a b l e s is
i n c lu d e d in T a b le 17. N o s i g n i f i c a n t d i f f e r e n c e w a s fo u n d , a t t h e . 05
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
73
l e v e l , b e tw e e n t y p e s of s u r g e r y to b e p e r f o r m e d a n d s u b j e c t s '
p r e o p e r a t i v e a n x ie t y l e v e l . In t h is s tu d y , th e ty p e of a n ti c ip a t e d
s u r g e r y d id n o t s ig n i f ic a n tl y i n f lu e n c e th e l e v e l o f p r e o p e r a t i v e
a n x ie t y w h ic h s u b je c t s e x p e r i e n c e d .
T a b le 17
S u m m a r y o f O n e F a c t o r A n a l y s is o f V a r i a n c e f o r
D i f f e r e n t S u r g i c a l P r o c e d u r e s A n t i c i p a te d a n d
P r e o p e r a t i v e A n x ie ty L e v e l
T y p e of S u r g e r y N M SD
C h o l e c y s t e c to m y 18 8. 37 3. 13
A b d o m in a l H y s t e r e c t o m y 12 9. 72 3. 33
E x p lo ra to ry L a p a ro to m y 4 8. 17 2. 50
M a r s h a l l - M a r c h e tt e
P ro c ed u re 1 8. 66 0. 00
S o u r c e of
V a r ia n c e df MS F £
B e tw e e n G r o u p s 3 5. 03 0. 51 0. 68
W ith in G r o u p s 31 9 .9 2
T o ta l 34
W h e th e r th e p a t i e n t h a d p r e v i o u s l y e x p e r i e n c e d a n y m a j o r
s u r g i c a l p r o c e d u r e s w a s a p o s s i b l e v a r i a b l e t h a t m ig h t i n f lu e n c e
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74
p r e o p e r a t i v e a n x ie t y l e v e l . T h e r e f o r e a f ix e d e f f e c t s , o n e f a c t o r
a n a l y s i s of v a r i a n c e m o d e l w a s u s e d to t e s t f o r th e s ig n i f ic a n c e of
e x p e r i e n c e w ith p r e v i o u s s u r g e r y on p r e o p e r a t i v e a n x ie t y l e v e l .
T h e r e s u l t s w e r e n o t s ig n i f ic a n t a t th e . 05 l e v e l a n d a r e s u m m a
r i z e d in T a b le 18.
T a b le 18
S u m m a r y o f O ne F a c t o r A n a l y s is o f V a r i a n c e f o r
E x p e r i e n c e w ith P r e v i o u s S u r g e r y a n d
P r e o p e r a t i v e A n x ie ty
G ro u p N M SD
E x p e r im e n ta l G ro u p 18 9. 69 2. 91
C o m p a ris o n G ro u p 17 7. 90 3. 07
S o u r c e of
V a ria n c e df MS F £
B e tw e e n G ro u p s 1 27. 84 3. 12 0. 09
W ith in G r o u p s 33 8 . 94
T o ta l 34
T h e r e f o r e , in t h is s tu d y , w h e t h e r t h e p a t i e n t h a d a n y p r e v i o u s
e x p e r i e n c e w ith s u r g e r y d id n o t s ig n i f ic a n tl y i n f l u e n c e th e l e v e l o f
p r e o p e r a t i v e a n x ie t y h e e x p e r i e n c e d . T h e g r o u p o f s u b je c t s h a v in g
p r e v i o u s e x p e r i e n c e s w ith s u r g e r y w e r e n o t s ig n i f ic a n tl y l e s s
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75
a n x io u s p r e o p e r a t i v e l y th a n th e g r o u p h a v in g no p r e v i o u s e x p e r i e n c e
w ith s u r g e r y .
T o d e t e r m i n e th e i n t e r a c t i v e e f f e c t o f s u b j e c t s ' a g e ( a g e w a s
d iv id e d a t 50 y e a r s i n to Y o u n g o r O l d e r s u b je c t s ) a n d t h e e x p e r i
m e n t a l t r e a t m e n t w ith m e a n t o ta l p o s t o p e r a t i v e a n x ie t y , a tw o f a c t o r
a n a ly s i s of v a r i a n c e m o d e l w a s u s e d a n d is s u m m a r i z e d in T a b le 19.
N o s ig n i f ic a n c e w a s fo u n d a t th e . 05 le v e l .
A n a l y s is of D i g i ta l S w e a t M e a s u r e O v e r
T h r e e a n d F i v e T im e C o n d itio n s
T h e D i g i ta l S w e a t m e a s u r e i s r e p o r t e d to b e a v a li d i n d i c a t o r
o f s u b je c t e m o t i o n a l it y a s d i s c u s s e d in C h a p t e r II. In o r d e r to t e s t
w h e t h e r i t i s a r e l i a b l e a n d v a li d i n d i c a t o r of c h a n g e s in s u b j e c t
e m o t i o n a l it y in th e c l i n i c a l s e tt in g w ith s u b je c t s d u r in g t h e p r e o p e r
a ti v e a n d p o s t o p e r a t i v e s u r g i c a l e x p e r i e n c e , c e r t a i n a n a l y s e s a r e
i m p o r ta n t . If th e l e v e l of a n x ie t y p r e o p e r a t i v e l y , w h e n a n ti c ip a t io n
of t h r e a t i s p r e s u m a b l y g r e a t , i s s ig n i f ic a n tl y g r e a t e r t h a n th e m e a n
l e v e l of a n x ie t y on th e t h i r d p o s t o p e r a t i v e d a y ( h o u r s 48 - 7 2 ), w h e n
th e m a j o r t h r e a t i s p a s t , s u p p o r t is d e r i v e d f o r th e u s e o f d i g it a l
s w e a t l e v e l s a s v a li d a n d r e l i a b l e p h y s io l o g ic a l c r i t e r i o n o r o u t
c o m e m e a s u r e s of e m o t i o n a l it y .
A o n e f a c t o r r e p e a t e d m e a s u r e of a n a l y s i s o f v a r i a n c e m o d e l
w a s u s e d to t e s t th e d i f f e r e n c e in a m o u n t o f d i g i t a l s w e a t o v e r th e
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76
T a b le 19
S u m m a r y o f T w o F a c t o r A n a l y s is o f V a r i a n c e f o r
I n te r a c tiv e E ffe c t of A ge an d E x p e rim e n ta l
T r e a t m e n t o n M e a n T o ta l
P o s t o p e r a t i v e A n x ie ty
G ro u p
E x p e r im e n ta l C o m p a ris o n
A ge
G ro u p G ro u p
A b o v e 50 Y e a r s of A g e:
N_ 13 5
M 9. 39 10. 04
SD 5. 55 7. 82
B e lo w 50 Y e a r s o f A g e :
N 11 7
M 9. 83 8 . 51
SD 3. 30 5. 10
S o u r c e of
V a r ia n c e df MS F £
(A) B e tw e e n G r o u p s 1 0. 38 0. 01 0. 91
(E x p e rim e n ta l and
C o m p a ris o n G ro u p s)
(B ) B e tw e e n O l d e r a n d
Y o u n g er A ge 1 1. 40 0. 25 0. 82
A x B In te r a c tio n 1 7. 56 0. 28 0. 60
W ith in 32 27. 49
T o ta l 35
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77
c o n d itio n s of a d m i s s i o n s t r e s s ( n ig h t b e f o r e s u r g e r y ) , i m m e d i a t e
p r e o p e r a t i v e s t r e s s ( o n e - h a lf h o u r b e f o r e s u r g e r y ) , a n d p o s t o p e r
a ti v e s t r e s s ( m e a n l e v e l of d i g i t a l s w e a t on th e t h i r d p o s t o p e r a t i v e
d a y , h o u r s 48 - 72). T h is a n a l y s i s w a s p e r f o r m e d on th e t o t a l s u b
j e c t p o p u la tio n f o r w h o m a r e a d i n g e x is t e d on e a c h of th e t h r e e v a r i
a b l e s b e in g a n a ly z e d (N = 2 3 ). T a b l e 20 s u m m a r i z e s th e r e s u l t s of
th is a n a ly s is .
T h e s e r e s u l t s r e v e a l t h a t t h e r e i s a s ig n i f ic a n t d i f f e r e n c e ,
b e y o n d th e . 0001 l e v e l , of d i g i t a l s w e a t a s m e a s u r e d o v e r th e t h r e e
t r e a t m e n t c o n d itio n s o f a d m i s s i o n p e r i o d ( n ig h t b e f o r e s u r g e r y ) ,
i m m e d ia te p r e o p e r a t i v e p e r i o d ( o n e - h a l f h o u r b e f o r e s u r g e r y ) , a n d
t h i r d d a y p o s t o p e r a t i v e p e r i o d (48 - 72 h o u r s ) . T h e re fo re su p p o rt
i s g e n e r a t e d f o r M in c k l e y 's (1 9 7 4 ) fin d in g th a t:
T h e p a l m a r s w e a t v a l u e s o b ta in e d in th e p o s t o p e r
a ti v e p e r i o d i n d ic a te d t h a t t h i s v a r i a b l e f lu c t u a t e d a s
m u c h a s p u l s e a n d b lo o d p r e s s u r e in th e d a y s fo llo w in g
s u r g e r y , a n d d id n o t r e m a i n a t z e r o a s H a r r i s o n e t a l.
(1962) s u g g e s t , (p. 398)
A d d itio n a lly , a o n e f a c t o r r e p e a t e d m e a s u r e a n a l y s i s o f v a r i
a n c e w a s u s e d to t e s t f o r d i f f e r e n c e s o v e r f iv e t im e c o n d itio n s of th e
d i g it a l s w e a t l e v e l: (1) a d m i s s i o n p e r i o d , (2) i m m e d ia te p r e o p e r a
t iv e p e r i o d , (3) f i r s t d a y p o s t o p e r a t i v e l y (1 - 24 h o u r s ) , (4) s e c o n d
d a y p o s t o p e r a t i v e l y (2 4 - 48 h o u r s ) , a n d (5) t h i r d d a y p o s t o p e r a t i v e l y
(48 - 72 h o u r s ) . T h e s e r e s u l t s w e r e a l s o s ig n i f ic a n t w ith a n _F v a lu e
of 34. 60 b e y o n d th e . 0001 l e v e l .
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78
T a b l e 20
S u m m a r y of O n e F a c t o r R e p e a t e d M e a s u r e A n a l y s is
of V a r ia n c e f o r C o n d itio n s o f A d m i s s i o n A n x ie ty ,
I m m e d ia t e P r e o p e r a t i v e A n x ie ty , a n d M e a n
A n x ie ty on th e T h i r d P o s t o p e r a t i v e D a y
C o n d itio n s of T im e N M SD
A d m i s s i o n A n x ie ty L e v e l 23 8. 55 2. 73
I m m e d i a t e P r e o p e r a t i v e A n x ie ty
Level 23 7. 55 2. 94
M e a n A n x ie ty L e v e l,
H o u r s 48 - 72 P o s t o p e r a t i v e l y 23 3. 43 2. 13
S o u r c e of
V a ria n c e SS df MS F £
B e tw e e n G r o u p s 231. 24 22
W ith in G r o u p s 561. 41 46
T re a tm e n t 3 3 9 .0 5 2 1 6 9 .5 0 33. 54 0. 00
R e s id u a l 2 22. 36 44 5. 05
T o ta l 7 9 2 . 66 68
T h e m e a n s of th e d i g it a l s w e a t l e v e l s a r e i l l u s t r a t e d in F i g u r e
1. T h e s e m e a n s sh o w c o n s i d e r a b l e v a r i a b i l i t y o v e r th e f iv e t r e a t
m e n t p e r i o d s a n d le n d f u r t h e r s u p p o r t f o r M i n c k l e y 's (1 9 7 4 ) fin d in g ,
e . g . , t h a t d i g it a l s w e a t l e v e l s d o v a r y d u r in g th e p r e o p e r a t i v e a n d
p o s to p e r a tiv e s u rg ic a l s t r e s s p e rio d . T h e r e is c o n s id e r a b le
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79
F ig u re 1
M e a n D i g i ta l S w e a t L e v e ls (D SL ) O v e r F i v e T i m e C o n d itio n s
15. 0
14. 0
13. 0
12. 0
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9. 0
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v a r i a n c e in th e m e a n s o f t h e s e d i g it a l s w e a t p r i n t r e s u l t s f o r th e tw o
p r e o p e r a t i v e p e r i o d s a s c o m p a r e d to th e t h r e e p o s t o p e r a t i v e t im e
p e rio d s a s F ig u re 1 sh o w s.
R e s u l t s of S t r u c t u r e d I n t e r v i e w Q u e s t io n n a i r e
T h e S t r u c t u r e d I n te r v ie w Q u e s t io n n a i r e (A p p e n d ix D) c o n s i s t e d
o f a s e r i e s of f iv e o p e n e n d e d q u e s ti o n s d e s ig n e d to a s s e s s th e s u b
j e c t ' s p e r c e p t i o n of h i s l e v e l of e m o t i o n a l it y , a n d f a c t o r s c o n t r i b u t
in g to h i s p r e s e n t s t a t e on th e d a y p r e c e d i n g s u r g e r y . A d d itio n a lly ,
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80
15 o p e n e n d e d q u e s ti o n s a n d o n e f o r c e d c h o ic e q u e s ti o n (w ith 10
s u b s e c t io n s ) , d e s ig n e d to a s s e s s s u b j e c t s ' p e r c e p t i o n o f t h e i r e m o
tio n a l it y a n d p a in e x p e r i e n c e d u r in g th e p o s t o p e r a t i v e p e r i o d , w e r e
a d m i n i s t e r e d on th e f o u r t h d a y a f t e r s u r g e r y .
Q u e s t io n 1 a s k e d i f s u b je c t s w e r e t e n s e o r n e r v o u s b e f o r e
th e ir s u rg e ry . F i f t e e n s u b je c t s in d ic a te d t h a t th e y w e r e v e r y t e n s e ,
t h i r t e e n s u b j e c t s t h a t th e y w e r e m o d e r a t e l y t e n s e , a n d e ig h t s u b je c t s
d e n ie d t h a t th e y w e r e t e n s e o r n e r v o u s on th e d a y p r e c e d i n g s u r g e r y .
F r o m t h i s r e s p o n s e i t a p p e a r s t h a t th e s u b je c t s w e r e a b le to d i s
c r i m i n a t e o n t h e i r l e v e l o f e m o t i o n a l it y a n d w e r e w illin g to v e r b a l i z e
th e ir p e rc e p tio n s .
A n a n a l y s i s w a s d o n e of th e r e s p o n s e s of s u b j e c t s w h o e v i
d e n c e d h ig h a d m i s s i o n a n x ie t y l e v e l s (a b o v e th e m e d i a n of 8. 33 on
th e D i g i ta l S w e a t m e a s u r e ) to q u e s ti o n 1 w h ic h w a s s t a t e d , " A r e
you te n se o r n e rv o u s b e fo re y o u r s u rg e r y ? " T h e r e s u l t s of t h is
a n a l y s i s w e r e t h a t e ig h t s u b je c t s i n d ic a te d p r e o p e r a t i v e l y t h a t t h e y
n e r v o u s , " a n d t h r e e s u b je c t s d e n ie d b e in g n e r v o u s o r t e n s e . T h e re
f o r e , o f th e 18 s u b j e c t s w h o e v id e n c e d h ig h l e v e l s o f p r e o p e r a t i v e
a n x ie t y (a b o v e m e d i a n of 8. 33) on th e D i g i ta l S w e a t m e a s u r e , 15
g a v e s e l f - r e p o r t s o f m o d e r a t e to h ig h l e v e l s o f t e n s i o n a n d t h r e e
s u b je c t s in t h i s c a t e g o r y d e n ie d b e in g t e n s e . S o m e s u p p o r t is
g e n e r a t e d b y t h i s s tu d y f o r th e a c c u r a c y of s e l f - r e p o r t in a s s e s s i n g
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81
a n x ie ty l e v e l of s u b j e c t s p r e o p e r a t i v e l y . A ls o s u p p o r t i s e v id e n c e d
f o r t h e r e s e a r c h o f G r a h a m a n d C o n le y (1 9 7 1 ) w h o fo u n d t h a t s u b
j e c t s ' s e l f - r e p o r t s o f p r e o p e r a t i v e a n x ie ty a r e " th e m o s t u s e f u l a n d
W h e n a s k e d to d e s c r i b e th e s o u r c e o f t h e i r p r e o p e r a t i v e a n x i
e ty in q u e s ti o n 2, s u b j e c t s g a v e a v a r i e t y of r e s p o n s e s . The
r e s p o n s e s w e r e g r o u p e d in to g e n e r a l c a t e g o r i e s a n d a r e d e t a i l e d in
T a b le 21.
T a b le 21
S u b je c ts ' P e r c e p tio n of S o u rc e s
o f P r e o p e r a t i v e A n x ie ty
N u m b e r o f S u b j e c t s I d e n tif y in g
S o u r c e o f A n x ie ty C o n tr o l E x p e r im e n ta l T o ta l
C o n c e r n s a b o u t f a m i ly f u n c
tio n in g a t h o m e 9 3 12
U n c le a r e x p e c ta tio n of s e lf
and r e s u l ts of s u rg e r y 4 8 12
C u ttin g a n d p a in 4 3 7
P o s s i b i l i t y of s u r g i c a l
c o m p l i c a t io n s 1 4 5
C o n cern s ab o u t a n a e s th e sia
(n o t b e in g a s l e e p , n o t w a k in g
u p , l o s s of c o n tr o l ) 1 3 4
P r e v i o u s " b a d " e x p e r i e n c e of
s e l f o r o t h e r s w ith s u r g e r y 1 1 2
F e a r of v o m it in g 2 0 2
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82
T h e s e r e s p o n s e s in d ic a te th a t th e g r e a t e s t s o u rc e of p r e o p e r
a ti v e a n x ie t y p e r c e i v e d b y s u b je c t s a r e t h o s e r e l a t i v e to : (1) f a m i ly ,
(2) u n c l e a r e x p e c t a ti o n s f o r b e h a v io r o r r e s u l t s o f s u r g e r y , a n d
(3) th e th o u g h t o f c u ttin g a n d a tt e n d a n t p a in .
W h en s u b je c t s w e r e a s k e d h o w th e y w e r e a tt e m p t in g to c o p e
w ith t h e i r ow n a n x ie t y , th e p r i m a r y c o p in g s k i l l m e n t i o n e d w a s
p h y s ic a l a c ti v it y . T h e r e w e r e 14 r e s p o n s e s to th e e f f e c t t h a t s o m e
ty p e o f p h y s ic a l a c t i v i t y h a d b e e n u s e d to t r y to c o p e w ith th e a n x ie ty
b e in g e x p e r i e n c e d . S e v e n s u b je c t s a ls o m e n tio n e d d e l i b e r a t e l y t r y
s m o k in g , s e e k in g i n f o r m a t io n , a n d f a i t h w e r e m e n t i o n e d b y o n e o r
tw o s u b j e c t s . P h y s i c a l a c t i v i t y a n d d i s t r a c t i o n a p p e a r to b e th e
m o s t u s u a l w a y s in w h ic h s u b je c t s a tt e m p t e d to c o p e w ith t h e i r
a c k n o w le d g e d a n x ie ty .
Q u e s tio n 4 a s k e d w h a t o t h e r p e o p le w e r e d o in g t h a t h e lp e d to
re d u c e s u b je c ts ' te n s io n p r e o p e r a tiv e ly . T h e tw o r e s p o n s e s g iv e n
m o s t o f te n w e r e : (1) th e e x p la n a tio n of w h a t to e x p e c t a n d th e
a n s w e r in g of q u e s ti o n s b y th e p h y s ic i a n w e r e m e n t i o n e d b y 10 s u b
j e c t s , a n d (2) th e s u p p o r t of f a m i ly a n d f r i e n d s w a s m e n t i o n e d b y 18
s u b je c ts . F a m i l y / f r i e n d s u p p o r t i s s e e n a s th e m o s t h e lp f u l in
r e d u c in g s u b j e c t s ' a n x ie t y b e f o r e s u r g e r y .
T h e r e w a s a p a u c it y o f r e s p o n s e s to q u e s ti o n 5 w h ic h a s k e d
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83
s u b je c t s to i d e n tif y b e h a v i o r o n t h e p a r t o f o t h e r s w h ic h i n c r e a s e d
th e ir te n s io n p re o p e r a tiv e ly . O n ly e ig h t s u b je c t s w e r e a b le o r
w illin g to r e s p o n d to t h is q u e s ti o n . F i v e s u b je c t s i n d ic a te d t h a t th e
s h a r i n g b y o t h e r s of t h e i r ow n s u r g i c a l e x p e r i e n c e s i n c r e a s e d t h e
s u b j e c t s ' a n x ie ty . T h r e e s u b j e c t s g e n e r a l l y id e n t i f i e d f a m i ly p r o b
l e m s a s c o n tr i b u ti n g to t h e i r p r e s e n t p r e o p e r a t i v e a n x ie ty .
P o s t o p e r a t i v e l y , on th e f o u r t h d a y , s u b je c t s w e r e a s k e d if
th e y h ad fe lt te n s e o r n e rv o u s a f te r s u r g e r y . The re s p o n s e s w e re
a p p r o x i m a t e ly e q u a lly d i s t r i b u t e d : 16 p e r s o n s s a id th e y w e r e t e n s e
a f t e r s u r g e r y a n d 18 p e r s o n s s a i d t h e y w e r e n o t t e n s e a f t e r s u r g e r y .
I n th e e x p e r i m e n t a l a n d c o n t r o l g r o u p s , e q u a l n u m b e r s o f s u b j e c t s
d e n ie d b e in g t e n s e p o s t o p e r a t i v e l y . T w o m o r e s u b je c t s in th e
e x p e r i m e n t a l g r o u p , t h a n in th e c o n t r o l g r o u p , s ta t e d t h a t th e y w e r e
te n s e a fte r su rg e ry . W h e n a s k e d to id e n t i f y th e s o u r c e of t h e i r p o s t
o p e r a t i v e a n x ie ty , if a n y , t h e r e s p o n s e s w e r e v a r i e d a n d i d i o s y n
c ra tic . T h e r e s p o n s e s w e r e c a t e g o r i z e d a n d a r e d e t a i l e d in T a b le
22.
In r e s p o n s e to q u e s ti o n 8, s u b je c t s w e r e a b le to i d e n t i f y s o m e
of t h e i r ow n c o p in g s k i l l s f o r r e d u c i n g t h e i r a n x ie ty p o s t o p e r a t i v e l y .
c a lm a n d r e l a x " w a s i d e n t i f i e d b y 12 s u b je c t s a s a c o p in g s k i l l .
F o u r s u b je c t s i d e n t i f i e d p r a y e r a n d f a i t h , a n d tw o s u b je c t s s a i d t h a t
c r y i n g h e lp e d th e m to c o p e w ith t h e i r p o s t o p e r a t i v e a n x ie ty .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
84
T a b l e 22
S u b j e c t s ' P e r c e p t i o n o f S o u r c e s of
P o s t o p e r a t i v e A n x ie ty
N u m b e r of S u b je c ts
S o u r c e of A n x ie ty Id e n tify in g
U l t im a te e f f e c t of s u r g e r y o n h e a l t h 9
P a in and d isc o m fo rt 6
B r e a k in g o r d i s t u r b in g s u t u r e s 5
H o m e s ic k n e s s 4
B e h a v i o r a n d n u m b e r of v i s i t o r s 3
C e s s a ti o n of s m o k in g b e h a v i o r 2
N a u s e a a n d v o m itin g 1
B e in g u n a b le to e a t 1
Q u e s tio n s 9 a n d 10 a s k e d w h a t o t h e r p e r s o n s d id to r e d u c e th e
s u b j e c t s ' t e n s i o n a n d c o n v e r s e l y w h a t o t h e r s d id t h a t r a i s e d th e s u b
j e c t s ' te n s i o n . T h e p r i m a r y c a t e g o r y of h e lp f u l a c ti v it y , b y o t h e r s ,
w a s i d e n t i f i e d b y s u b je c t s a s s o m e a s p e c t o f n u r s i n g c a r e : N u rse s
ta lk in g to m e (n in e r e s p o n s e s ) , b a c k r u b s ( t h r e e r e s p o n s e s ) , a n d
n u r s e s c o m in g p r o m p t ly in r e s p o n s e to a s u b j e c t 's r e q u e s t ( s e v e n
re s p o n s e s ). T a b le 23 d e t a i l s th e a c t i v i t y o n th e p a r t of c a r e g i v e r s
w h ic h s u b je c t s in e a c h g r o u p p e r c e i v e d a s te n s i o n r e d u c in g d u r in g
th e p o s t o p e r a t i v e p e r i o d .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
85
T a b l e 23
A c t iv i t y o f C a r e G i v e r s P e r c e i v e d
a s T e n s io n R e d u c in g
A c t iv i t y C o n tro l E x p e r im e n ta l T o ta l
N u r s e s ta lk in g to m e 2 7 9
B ack ru b s 0 3 3
N u r s e s c o m in g p r o m p t ly in
r e s p o n s e to s u b j e c t 's
req u e st 5 2 7
I n th e e x p e r i m e n t a l g r o u p , w h e r e s it ti n g d o w n a n d ta lk in g to
p a t i e n t s a n d g iv in g b a c k r u b s w e r e p a r t o f t h e e x p e r i m e n t a l t r e a t
m e n t, 10 s u b je c t s i d e n t i f i e d t h e s e c a r e g i v e r b e h a v io r s a s t e n s i o n
r e d u c i n g ; in th e c o n t r o l g r o u p , t h e s e b e h a v i o r s w e r e m e n t i o n e d b y
tw o s u b j e c t s . O t h e r p e r s o n s i d e n t i f i e d a s b e in g h e lp f u l w e r e th e
p h y s i c i a n 's e x p la n a t io n s (tw o r e s p o n s e s ) a n d h a v in g s p o u s e p r e s e n t
(tw o r e s p o n s e s ) . T h e b e h a v i o r s o f o t h e r p e r s o n s v ie w e d b y s u b je c t s
a s n o t h e lp f u l w e r e s i n g u l a r a n d v a r i e d , a n d t h e t o t a l n u m b e r of
r e s p o n s e s a p p e a r e d to r e f l e c t e i t h e r a n i n a b i l i t y o r u n w i l li n g n e s s to
id e n tify su c h b e h a v io r s . T h e f o llo w in g b e h a v i o r s w e r e i d e n t i f i e d
o n ly o n e t im e : A r o o m m a te w h o c r i e d , h a v in g to t u r n a n d c o u g h ,
r e m o v a l o f s u r g i c a l ta p e , d i f f ic u l ty s t a r t i n g i n t r a v e n o u s i n fu s io n ,
a n d b e h a v io r o f f a m i ly , a s i n c r e a s i n g p o s t o p e r a t i v e te n s i o n .
W h en a s k e d if v i s i t o r s i n c r e a s e d o r d e c r e a s e d p o s t o p e r a t i v e
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
86
t e n s i o n ( q u e s t io n 11), 21 s u b je c t s r e s p o n d e d t h a t v i s i t o r s w e r e
h e lp f u l . N in e s u b je c t s fo u n d v i s i t o r s m i n i m a l l y h e lp f u l o r a c tu a l ly
u n h e lp f u l, d e p e n d in g on th e m a n n e r of th e v i s i t o r ' s b e h a v io r .
W h e n s u b je c t s w e r e a s k e d if th e y h a d p a in a f t e r t h e i r s u r g e r y ,
31 r e s p o n d e d y e s , a n d tw o r e s p o n d e d n o . T he d e s c r ip tio n of th e ir
p a in b y s u b j e c t s r e s u l t e d in 22 r e s p o n s e s t h a t t h e i r p a in w a s " a
s o r e n e s s , t e n d e r n e s s , a n d / o r s tin g in g s e n s a t i o n a r o u n d th e a r e a o f
th e i n c i s i o n . " E i g h t s u b je c t s in d ic a te d t h a t " s h a r p , s e v e r e g a s
o n e o r tw o s u b je c t s o f f e r e d th e fo llo w in g d e s c r i p t i o n s o f t h e i r p a in :
V e ry te n s e an d r e s t l e s s , g e n e ra l bod y s o r e n e s s , t e r r ib l e in c is io n a l
p a in , s h a r p a b d o m i n a l p a in w ith c o u g h in g , n a u s e a , a n d a d e e p ,
p u llin g s e n s a t i o n in t h e a b d o m e n .
S u b j e c t s a p p e a r e d to h a v e d i f f ic u l ty i d e n tif y in g o r v e r b a l iz i n g
w o r r i e s o r c o n c e r n s t h a t th e p a in e x p e r i e n c e r a i s e d in t h e i r m in d s .
O n ly 10 r e s p o n s e s w e r e e l i c i t e d a n d e a c h r e s p o n s e b y o n ly o n e o r
tw o s u b j e c t s . C o n c e r n s v o ic e d w e r e t h a t: " T h e i n c i s i o n w o u ld
th e s u r g e r y r e a l l y c o r r e c t e d m y h e a l t h p r o b l e m , a n d c o n c e r n s a n d
g e n e r a l a n x ie t y a b o u t you n g c h i l d r e n f o r w h o m th e s u b je c t h a d
p r im a r y re s p o n s ib ility .
S e v e n te e n s u b je c t s d e s c r i b e d t h e i r p a in a s b e in g g r e a t e r th a n
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
87
t h e y e x p e c t e d ; t h i r t e e n a s b e in g a b o u t w h a t t h e y e x p e c te d ; a n d
s e v e n a s b e in g l e s s t h a n t h e y h a d e x p e c t e d . T h e l e v e l of p a in
e x p e c t a ti o n w a s a p p r o x i m a t e ly e q u a l in t h e e x p e r i m e n t a l a n d c o n
t r o l g r o u p s in e a c h o f t h e s e t h r e e c a t e g o r i e s .
Q u e s t io n s 16 a n d 17 w e r e d e s ig n e d to e l i c i t s u b j e c t s \ p e r c e p
t io n s a b o u t w h a t e x p e r i e n c e s r a i s e d a n d l o w e r e d t h e i r t e n s i o n a f t e r
s u rg e ry . A g a in , i t a p p e a r e d t h a t th e s u b j e c t s h a d s o m e d if f ic u lty
id e n t i f y i n g o r v e r b a l i z i n g t h e s e c a u s a t i v e f a c t o r s .
F a c t o r s w h ic h s u b je c t s i d e n t i f i e d a s r a i s i n g t h e i r t e n s i o n w e r e
p r i m a r i l y c o n c e r n e d w ith th e e q u ip m e n t a n d p h y s i c a l t r e a t m e n t s
n e c e s s i t a t e d b y th e s u r g e r y . I n tr a v e n o u s i n f u s i o n s w e r e n a m e d a s
t e n s i o n p r o d u c in g b y f iv e s u b je c t s ; in d w e llin g u r i n a r y c a t h e t e r b y
t h r e e s u b j e c t s ; n a s o g a s t r i c tu b e b y o n e s u b je c t ; a n d r e m o v a l of
s u r g i c a l a d h e s i v e t a p e b y o n e s u b je c t . A d d i t io n a l c a u s e s w e r e t h o s e
r e l a t e d to p h y s i c a l a c ti v it y s u c h a s t u r n i n g , c o u g h in g , d e e p b r e a t h
in g , a n d a m b u l a ti n g . Tw o s u b je c t s e x p e r i e n c e d u r i n a r y t r a c t
i n f e c t i o n s a n d t h is w a s a c a u s e o f c o n c e r n to t h e m .
Q u e s t io n 17 a s k e d f o r e x p e r i e n c e s t h a t d e c r e a s e d s u b je c t
te n s io n p o s to p e r a tiv e ly . T h e s e r e s p o n s e s c a n b e g r o u p e d in to c a r e
g i v e r r e s p o n s e s w h ic h s u b je c t s p e r c e i v e d a s t e n s i o n r e d u c in g a n d
r e s p o n s e s o f f a m i ly a n d f r i e n d s w h ic h h e lp e d to m in i m i z e t e n s i o n .
S p e c i f i c a l l y , e n c o u r a g e m e n t b y n u r s e s w a s n a m e d b y s ix s u b je c t s ;
t h e m a n n e r in w h ic h c a r e g i v e r s h e lp e d m e a m b u l a te b y f iv e
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
s u b j e c t s ; a n d t a lk in g to c a r e g i v e r s b y f o u r s u b j e c t s . E x p la n a tio n
b y p h y s ic i a n , b a c k r u b s , b a th in g a n d c le a n b e d , a n d p r o m p t n e s s of
c a re g iv e r s w e r e e a c h id e n tifie d o n ce a s a s o u rc e of p o s to p e r a tiv e
te n s io n re d u c tio n . A d d itio n a l s o u r c e s o f t e n s i o n r e d u c t io n p r o v id e d
b y f a m i ly a n d f r i e n d s w e r e m e n tio n e d b y f iv e s u b j e c t s .
T h e r e s p o n s e s to q u e s ti o n 18 a r e d e t a i l e d in T a b le 2 4 . T h is
q u e s ti o n a s k e d s u b je c t s to i d e n tif y th e o n e a c ti o n o f o t h e r s w h ic h
s u b je c t s p e r c e i v e d to h e lp t h e i r p a in th e m o s t .
T a b le 24
S u b j e c t s ' P e r c e p t i o n o f O n e A c tio n o f O t h e r s
M o s t H e lp f u l D u r in g P a i n E x p e r i e n c e
N u m b e r of S u b j e c t s
A c tio n Id e n tif y in g
P r o m p t n e s s of a d m i n i s t r a t i o n of a n a lg e s ic
m e d ic a tio n 23
A tt e n t i o n p a id to d e s c r i p t i o n o f p a in 5
B ack ru b s 4
C a r e g i v e r s ta k in g tim e to t a l k to m e 4
C a r e g i v e r s b e li e v in g m e w h e n I s a id I h a d
p a in 1
S u b j e c t s h a d d i f f ic u l ty i d e n tify in g o r v e r b a l i z i n g w h a t a c ti o n s
w e r e n o t d o n e , b u t w h ic h t h e y w o u ld h a v e fo u n d h e lp f u l , in r e d u c in g
with permission of the copyright owner. Further reproduction prohibited without permission.
89
t h e i r p a in e x p e r i e n c e , a s a s k e d b y q u e s ti o n 19. T h e r e w e r e o n ly
f iv e r e s p o n s e s to t h is q u e s ti o n : " C h a n g e p o s it io n m o r e o f te n , "
a n a l g e s i c m e d i c a ti o n a b o u t o n e - h a l f h o u r b e f o r e a m b u l a ti o n i s
a tt e m p t e d . "
Q u e s tio n 20 a s k e d s u b je c t s to d e s c r i b e t h e i r m o o d t o d a y
( f o u r th p o s t o p e r a t i v e d a y ). T h e r e s p o n s e s w e r e c a t e g o r i z e d in to
a d j e c t i v e s i n d ic a ti n g : (1) p o s i t i v e m o o d s , (2) n e g a ti v e m o o d s , a n d
(3) v a r i a b l e m o o d s . T w e n ty - o n e s u b je c t s d e s c r i b e d p o s it iv e m o o d s
dow n. " E i g h t s u b je c t s d e s c r i b e d a n e g a ti v e m o o d s u c h a s i r r i t a b l e ,
m e a n , and d e p re s s e d . A p p r o x i m a t e l y a n e q u a l n u m b e r o f s u b je c t s
in th e c o n t r o l a n d e x p e r i m e n t a l g r o u p s d e s c r i b e d t h e i r m o o d a s
b e in g p o s it iv e , n e g a ti v e , a n d v a r i a b l e .
I n o r d e r to a s s e s s s u b j e c t s ' p e r c e p t i o n s a n d a w a r e n e s s of
o t h e r p h y s io l o g ic a l v a r i a b l e s t h a t a r e g e n e r a l l y th o u g h t to b e a s s o
a s c e r t a i n w h e t h e r s u c h p h y s io l o g ic a l i n d i c a t o r s w e r e e x p e r i e n c e d b y
t h e s u b je c t s p o s t o p e r a t i v e l y . T h e r e s u l t s o f t h is q u e s ti o n a r e
d e t a i l e d in T a b le 25.
T h e s e r e s u l t s i n d i c a t e t h a t p h y s io l o g ic a l v a r i a b l e s p r e s u m e d
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
90
to b e c o n c o m i ta n t to a n x ie t y a r e e x p e r i e n c e d a n d c a n b e i d e n t i f i e d
b y s u b je c t s p o s t o p e r a t i v e l y . T h e r e s p o n s e of 23 s u b j e c t s t h a t t h e y
" a tt e m p t e d to b e b r a v e a n d c o n t r o l t h e m s e l v e s " a p p e a r s to i n d i c a t e
t h a t s u b je c t s a t t e m p t to c o n c e a l th e l e v e l of t e n s i o n o r e m o t i o n a l it y
th a t th e y e x p e rie n c e p o s to p e r a tiv e ly .
T a b le 25
P r e s e n c e of P h y s i o l o g i c a l V a r i a b l e s A s s o c i a t e d
W ith A n x ie ty D u r in g th e P o s t o p e r a t i v e P e r i o d
P re se n t
N ot P re se n t M o s t of
V a r ia b l e P re se n t S o m e ti m e s th e T im e
A w a r e n e s s of h e a r t p o u n d in g 25 2 6
R a p id , d i f f ic u l t b r e a t h i n g 23 6 4
I n c r e a s e d s w e a tin g 11 14 8
I n c r e a s e d n e e d to u r i n a t e *
T im e g o in g b y s lo w ly 13 9 11
A tte m p tin g to b e b r a v e a n d
c o n tr o l s e lf 7 3 23
W a n tin g n o t to b e a lo n e 16 6 12
D e c r e a s e d d e s i r e to t a l k to o t h e r s 17 12 4
I n c r e a s e d d e s i r e to t a l k to o t h e r s 9 12 8
'■'The p r e s e n c e o f a n in d w e llin g u r i n a r y c a t h e t e r in a p p r o x i
m a t e ly 50 p e r c e n t o f th e s u b j e c t s p r e c l u d e d s u b j e c t s ' a b i l i t y to
r e s p o n d to t h i s v a r i a b l e a n d t h e r e f o r e i t w a s o m it te d f r o m a n a l y s i s .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
91
T h e r e s u l t s o f t h e a n a l y s i s o f th e S t r u c t u r e d I n t e r v i e w Q u e s
t i o n n a i r e i n d i c a t e t h a t t h e s u b je c t s r e s p o n s e s to th e q u e s ti o n s d o
n o t d i s c r i m i n a t e b e tw e e n th e e x p e r i m e n t a l a n d c o n t r o l g r o u p s on
a n y of t h e d i m e n s io n s a d d r e s s e d . T h is a n a l y s i s d o e s , h o w e v e r ,
i n d ic a te s o m e t r e n d s a n d a r e a s f o r f u r t h e r r e s e a r c h i n v e s t i g a t i o n
w h ic h w ill b e d i s c u s s e d i n C h a p t e r V .
S u m m a r y of R e s u l ts
T h e r e s u l t s o f t h e d a ta a n a l y s i s m a y b e s u m m a r i z e d a s
f o llo w s :
1. N o n e o f t h e f iv e m a j o r h y p o t h e s e s w e r e s u p p o r t e d b y th e
d a ta .
2. T h e i n t e r - r a t e r r e l i a b i l i t y c o r r e l a t i o n s on t h e D i g i ta l
S w e a t m e a s u r e w e r e s i g n i f ic a n t a t th e . 05 l e v e l . T h is
s i g n i f i c a n t c o r r e l a t i o n , in s p it e o f a t i m e l a p s e o f 2 to
4 w e e k s in th e r a t i n g b y th e t h i r d r a t e r , s u g g e s t s t h a t
d i g i t a l s w e a t p r i n t s do n o t d a r k e n s ig n i f ic a n tl y o v e r t im e
so a s to b e u n r e l i a b l e m e a s u r e s of e m o t i o n a l it y .
3. R e s u l t s of th e p o s t h o c a n a l y s e s w e r e :
3. 1 T h e r e w a s n o s ig n i f ic a n t i n i t i a l d i f f e r e n c e b e tw e e n
th e e x p e r i m e n t a l a n d c o n t r o l g r o u p s ( b e f o r e e x p e r i
m e n t a l t r e a t m e n t ) o n th e l e v e l of a d m i s s i o n a n x ie t y
a n d of i m m e d i a t e p r e o p e r a t i v e a n x ie t y .
3. 2 T h e ty p e of a n ti c ip a t e d s u r g e r y d id n o t s i g n i f i c a n t l y
a f f e c t th e l e v e l o f p r e o p e r a t i v e a n x ie t y w h ic h s u b je c t s
e x p e rie n c e d .
3. 3 W h e th e r t h e s u b j e c t h a d a n y p r e v i o u s e x p e r i e n c e w ith
s u r g e r y d id n o t s ig n i f ic a n tl y in f l u e n c e t h e l e v e l of
p r e o p e r a t i v e a n x ie t y h e e x p e r i e n c e d .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
92
3 .4 N o s ig n i f ic a n t i n t e r a c t i v e e f f e c t o f s u b j e c t s ' a g e a n d
th e e x p e r i m e n t a l t r e a t m e n t w ith m e a n t o t a l p o s t o p e r
a ti v e a n x ie t y w a s fo u n d .
3. 5 A s ig n i f ic a n t d i f f e r e n c e w a s fo u n d b e tw e e n p r e o p e r
a ti v e d i g i t a l s w e a t l e v e l s a n d m e a n t h i r d d a y p o s t
o p e ra tiv e d ig ita l s w e a t le v e ls .
4. T h e r e s u l t s of th e S t r u c t u r e d I n t e r v i e w Q u e s t io n n a i r e a r e
d e t a i l e d on p a g e s 79 - 91.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
CH APTER V
D IS C U S S IO N AN D SU M M A R Y
T h e p r e s e n t s tu d y s o u g h t to m e a s u r e th e e f f e c t o f s p e c i f i c
n u r s i n g i n t e r v e n t i o n s ( N u r s in g I n te r v e n t i o n T r e a t m e n t ) o n a n x ie t y
l e v e l s a s s o c i a t e d w ith th e p a in e x p e r i e n c e o f p o s t o p e r a t i v e p a t i e n t s .
T h e r e s u l t s r e p o r t e d d o n o t o f f e r s u p p o r t f o r th e f iv e m a j o r h y p o t h
e s e s w h ic h s t a t e th e e x p e c t e d e f f e c ts of th e i n d e p e n d e n t v a r i a b l e
( N u r s in g I n te r v e n t i o n T r e a t m e n t ) on th e d e p e n d e n t v a r i a b l e s o f
p o s t o p e r a t i v e a n x ie t y l e v e l s , b o d y t e m p e r a t u r e , a n d n u m b e r o f
a n a lg e s ic m e d i c a ti o n s a d m i n i s t e r e d p o s t o p e r a t i v e l y . A d d i t io n a l ly ,
no s u p p o r t w a s o b ta in e d f o r th e i n t e r a c t i v e e f f e c t o f p r e o p e r a t i v e
a n x ie ty l e v e l s a n d s u b j e c t s ' p r e v i o u s l if e s t r e s s w ith th e i n d e p e n d
e n t t r e a t m e n t v a r i a b l e o n th e d e p e n d e n t v a r i a b l e s .
D i s c u s s i o n in t h i s c h a p t e r w i l l a d d r e s s th e d e s ig n l i m i t a t i o n s
of t h i s s tu d y , th e t h e o r e t i c a l i n t e r p r e t a t i o n s of th e r e s u l t s o f th e
a n a ly s i s of th e d a ta , a n d c o n c lu s i o n s a n d n u r s i n g i m p l i c a t i o n s o f
th e s tu d y . F i n a l l y s u g g e s t i o n s f o r f u r t h e r r e s e a r c h , o f f e r e d b y th e
f in d in g s of t h is s tu d y , w i l l b e p r o p o s e d a n d a c o n c lu d in g s u m m a r y
to th e r e p o r t o f f e r e d .
93
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
94
L i m i t a t i o n s o f th e S tu d y
T h e s tu d y w a s l i m i t e d in s e v e r a l s ig n i f ic a n t w a y s . F irs t,
th e in d e p e n d e n t t r e a t m e n t , N u r s in g I n t e r v e n t i o n T r e a t m e n t , w a s
d e s ig n e d f o r t h is s tu d y a n d w a s b a s e d on th e e ff i c a c y f o r s u c h
m e a s u r e s o f f e r e d b y n u r s i n g t h e o r e t i c i a n s a n d p a ti e n t t e s t im o n y .
T h e b e h a v io r s of th e N u r s in g I n t e r v e n t i o n T r e a t m e n t w e r e a ls o
d e s ig n e d to a m e l i o r a t e s e v e r a l t h e o r e t i c a l l y p r o p o s e d d i m e n s io n s
of th e p o s t o p e r a t i v e p a in e x p e r i e n c e w h ic h a r e p u r p o r t e d to i n c r e a s e
p a t i e n t s ' a n x ie t y l e v e l s . S p e c i f i c a l l y t h e s e b e h a v io r s c o n s i s t e d of:
(1) r e c o g n i ti o n of p e r s o n h o o d b y c a r e g i v e r s , (2) r a p i d i ty of
r e s p o n s e b y c a r e g i v e r s to n e e d s e x p r e s s e d b y p a t i e n t s , (3)
r e m o v a l o r m i n i m i z a t i o n o f n o x io u s e n v ir o n m e n t a l s ti m u l i , (4) p r o
v i s i o n of i n f o r m a t io n to f a c i l i t a t e p a t i e n t o p p o r tu n i ti e s to d e v e lo p
r e a l i s t i c e x p e c t a ti o n s of t h e i r p r e s e n t s it u a ti o n , (5) to u c h to
f a c i l i t a t e th e p r e s e n c e o f a n o t h e r p e r s o n a n d th e n o n v e r b a l d e v e l
o p m e n t of th e n u r s e - p a t i e n t r e l a t i o n s h i p , a n d (6) d e v e lo p m e n t of
th e n u r s e - p a t i e n t r e l a t i o n s h i p t h r o u g h l is te n i n g a n d v e r b a l s u p p o r t
of p a t i e n t s ' p a in c o p in g s k i l l s to m i n i m i z e th e p a t i e n t e x p e r i e n c e of
h e lp le s s n e s s .
T h e r e s u l t s of t h i s s tu d y i n d ic a te t h a t t h e s e p r o p o s e d b e h a v
i o r s do n o t s ig n i f ic a n tl y a f f e c t p o s t o p e r a t i v e a n x ie ty l e v e l s a s
m e a s u r e d by a p h y s io l o g ic a l i n d i c a t o r o f e m o t i o n a l it y , n a m e ly ,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
p a lm a r o r d ig ita l p e r s p ir a tio n . T h e r e m a y b e a c r i t i c a l d i m e n s io n
o f a n x ie ty r e d u c t io n t h a t i s n o t a d d r e s s e d b y th e b e h a v i o r s i n c o r
p o r a t e d in th e N u r s in g I n t e r v e n t i o n T r e a t m e n t ; o r t h e s e b e h a v i o r s
m a y e f f e c ti v e ly r e d u c e a n x ie t y f o r s o m e s u b j e c t s , a n d n o t f o r
o t h e r s , b a s e d on p e r s o n o l o g i c a l v a r i a b l e s t h a t w e r e n o t m e a s u r e d
o r a s s e s s e d in t h is s tu d y . F o r e x a m p l e , c o p in g s t y l e s m a y b e a n
i m p o r t a n t p e r s o n a l v a r i a b l e t h a t i n f l u e n c e s w h ic h n u r s i n g b e h a v i o r s
a r e e f f e c ti v e in a n x ie t y r e d u c t io n . A d d itio n a lly , th e p l a c e o f th e
in d iv i d u a l in t h e l if e c y c le , a s e v id e n c e d b y n u m b e r a n d a g e s of
p e r s o n s w h o m t h e y p e r c e i v e a s d e p e n d e n t on t h e m , m a y b e a s i g
n i f i c a n t v a r i a b l e in flu e n c in g p r e o p e r a t i v e a n x ie ty l e v e l s . I t i s to
b e n o te d a s s h o w n in T a b le 21 t h a t 12 s u b j e c t s , o r o n e - t h i r d o f th e
t o t a l s a m p l e , p e r c e i v e d " f a m il y c o n c e r n s " a s th e p r i m a r y s o u r c e
o f th e s u b j e c t s ' p r e o p e r a t i v e a n x ie ty .
A s e c o n d m a j o r l i m i t a t i o n of t h is s tu d y i s r e l a t e d to th e
d e s ig n w h ic h u s e d o n e h o s p i t a l a s a n e x p e r i m e n t a l s i t e a n d o n e
h o s p i t a l a s a c o n tr o l s i t e . T h is m e a n t t h a t th e e x p e r i m e n t a l
t r e a t m e n t w a s a s s i g n e d b y h o s p i t a l a n d n o t r a n d o m l y b y i n d iv i d u a l
s u b je c t . T h is d e s ig n h a s s e v e r a l i n h e r e n t l i m i t a t i o n s a tt e n d a n t to
it. F i r s t , i t i s p o s s i b l e t h a t th e tw o s m a l l h o s p i t a l s a n d t h e i r
m e d i c a l s ta f f s e r v e a n d t h e r e f o r e a d m i t p a t i e n t p o p u la tio n s w h ic h
a r e s ig n i f ic a n tl y d i f f e r e n t on s o m e u n k n o w n v a r i a b l e o r v a r i a b l e s .
T h u s th e c o n t r o l a n d e x p e r i m e n t a l g r o u p s m a y h a v e d i f f e r e d in
with permission of the copyright owner. Further reproduction prohibited without permission.
96
u n k n o w n w a y s f r o m th e o u t s e t o f th e s tu d y , w a y s w h ic h m ig h t h a v e
c o n tr i b u te d in u n k n o w n m a g n i t u d e to th e l a c k o f s ig n i f ic a n t r e s u l t s
r e l a t e d to th e m a j o r h y p o t h e s e s of t h e s tu d y . A d d itio n a lly , a s s i g n
m e n t of e x p e r i m e n t a l t r e a t m e n t b y h o s p i t a l , a n d n o t b y in d iv i d u a l
s u b je c t , c o m b in e d w ith th e r e l a t i v e l y s m a l l s a m p l e s i z e (N = 3 6),
m a y n o t h a v e a f f o r d e d s i g n i f i c a n t c o n t r o l o v e r th e l a r g e n u m b e r of
i n te r v e n i n g v a r i a b l e s w h ic h w e r e i m p o s s i b l e to c o n tr o l in th e
c l i n i c a l e x p e r i m e n t a l s i t u a t i o n o f th e s tu d y . T h i r d l y , b e c a u s e tw o
s m a l l h o s p i t a l s w e r e u s e d in t h i s s tu d y , i t r e q u i r e d a t im e p e r i o d
o f a p p r o x i m a t e ly 4 m o n th s to o b t a i n th e r e q u i r e d s a m p l e s i z e of
36 s u b j e c t s . T h e l o n g e v ity o f t h e s tu d y m a y h a v e in f lu e n c e d th e
n u r s i n g s t a f f 's i n t e r e s t , e n t h u s i a s m , a n d l e v e l of c o n s is t e n c y in
m a i n t a i n in g th e d e s i r e d t r e a t m e n t l e v e l a n d / o r o b ta in in g a D i g i ta l
S w e a t m e a s u r e e a c h t im e th e p a t i e n t c o m p la in e d o f p a in , a s th e
s tu d y r e q u i r e d .
T h e i n v e s t i g a t o r o b s e r v e d t h a t th e n u m b e r of n u r s i n g s ta f f
c o m p l a in t s , w h ic h m a y b e v ie w e d a s r e s i s t a n c e to th e s tu d y ,
i n c r e a s e d in l a t e F e b r u a r y a n d M a r c h , T h is p e r i o d c o in c id e d w ith
e x t r e m e l y p o o r w e a t h e r c o n d it i o n s f o r d r iv i n g , a b l i z z a r d w h ic h
n e c e s s i t a t e d th e s ta f f w o r k in g 12 h o u r s h if t s o r d o u b le s h if t s w ith
m i n i m a l n u m b e r s of c a r e g i v e r s o n d u ty . E a c h of t h e s e f a c t o r s
m a y h a v e s ig n i f ic a n tl y i n f l u e n c e d t h e l e v e l o f in c e n t iv e , c o n s i s t e n c y ,
a n d m a n n e r in w h ic h th e e x p e r i m e n t a l N u r s in g I n te r v e n t i o n
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
T r e a t m e n t w a s c a r r i e d o u t.
A t h i r d m a j o r l i m i t a t i o n o f t h e s tu d y i s r e l a t e d to th e p a t t e r n
of s ta f f a s s i g n m e n t w h ic h e x i s t e d in b o th th e e x p e r i m e n t a l a n d c o n
t r o l h o s p ita ls . B o th s u r g i c a l u n i t s u s e d e s s e n t i a l l y th e f u n c t i o n a l
m e th o d o f a s s i g n m e n t . T h is a s s i g n m e n t p a t t e r n m e a n t t h a t p r e
p a r e d , b u t n o n p r o f e s s io n a l , c a r e g i v e r s ( n u r s i n g a id e s a n d a s s i s t
a n ts ) w e r e a d m i n i s t e r i n g s i g n i f i c a n t a m o u n ts of c a r e to th e s u b
je c ts . N u r s in g p e r s o n n e l ( p r a c t i c a l a n d r e g i s t e r e d n u r s e s ) p r i m a
r i l y a d m i n i s t e r e d th e r e q u i r e d a n a l g e s i c m e d i c a ti o n s a n d c a r r i e d
o u t th e t r e a t m e n t s o r d e r e d b y t h e p h y s ic i a n . F o r t h is r e a s o n , a l l
d i r e c t c a r e g i v e r s w e r e t r a i n e d in th e s t e p s o f th e e x p e r i m e n t a l
N u r s in g I n te r v e n t i o n T r e a t m e n t . T h is m e a n t t h a t a t t im e s tw o
d i f f e r e n t p e r s o n s w e r e s i m u l t a n e o u s l y a d m i n i s t e r i n g v a r i o u s s te p s
o f th e N u r s in g I n te r v e n t i o n T r e a t m e n t p r o c e d u r e . T h is f r a c t i o n -
a li z a ti o n of c a r e f o r th e e x p e r i m e n t a l t r e a t m e n t m a y h a v e s i g n i f i
c a n tly r e d u c e d i t s e f f e c t i v e n e s s . S p e c if i c a l ly , o n e i m p o r t a n t
d i m e n s io n of th e e x p e r i m e n t a l t r e a t m e n t m a y h a v e b e e n d ilu te d b y
t h is f u n c tio n a l s ta f fin g p a t t e r n ; n a m e l y , th e d i m e n s io n s of th e
N u r s in g I n te r v e n t i o n T r e a t m e n t w h ic h w e r e d e s ig n e d to p o t e n t i a t e
th e d e v e lo p m e n t of th e n u r s e - p a t i e n t r e l a t i o n s h i p . I t m ay b e, and
l ik e l y i s , t h a t w ith m o r e th a n o n e p r i m a r y c a r e g i v e r , th e s u p p o r t
w h ic h a w o r k in g h e l p e r - h e l p e e r e l a t i o n s h i p a f f o r d s i s m a r k e d l y
reduced.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
98
L a s t l y , th e S t r u c t u r e d I n t e r v i e w Q u e s t i o n n a i r e i s a l i m i t a t i o n
o f th e s tu d y . T h is i n t e r v i e w q u e s t i o n n a i r e w a s c a r r i e d o u t b y th e
in v e s tig a to r. W h ile t h is f a c t m a y h a v e a d d e d r e l i a b i l i t y in e li c it in g
a n d r e c o r d i n g s u b je c t r e s p o n s e s , i t a l s o m a y h a v e c o n tr i b u te d a
d e g r e e o f i n t e r v i e w e r b i a s in t h a t th e i n t e r v i e w e r o f n e c e s s i t y k n e w
to w h ic h g r o u p th e s u b je c t w a s a s s i g n e d . A d d itio n a lly , th e q u e s
tio n s of th e S t r u c t u r e d I n t e r v i e w Q u e s t i o n n a i r e , w h ile y ie ld in g
d e s c r i p t i v e d a ta , do n o t a p p e a r to b e w o r d e d o r d e s ig n e d p r o p e r l y
to e l i c i t d i f f e r e n t i a l r e s p o n s e s f r o m th e g r o u p s , s h o u ld s u c h
r e s p o n s e s h a v e b e e n a c tu a l ly , p o t e n t i a l ly p r e s e n t . A ls o , th e f i r s t
f iv e q u e s ti o n s of th e q u e s t i o n n a i r e w e r e a s k e d d u r in g th e p r e o p e r a
t iv e p e r i o d , b e c a u s e of c o n c e r n t h a t s u b j e c t s w o u ld n o t r e m e m b e r
t h e i r p r e o p e r a t i v e c o n c e r n s d u r in g t h e p o s t o p e r a t i v e p e r i o d . It is
c o n c e i v a b le t h a t s u b j e c t s a c t u a l l y w o u ld f e e l m o r e f r e e p o s t o p e r a
tiv e l y to r e v e a l t h e i r p r e o p e r a t i v e a n x i e t i e s b e c a u s e th e y h a v e
s u c c e s s f u lly b e e n th ro u g h s u rg e r y . A ls o th e p o s t o p e r a t i v e p e r i o d
w o u ld a f f o r d th e s u b je c t m o r e f a m i l i a r i t y w ith th e i n t e r v i e w e r i n a s
m u c h a s t h is w o u ld b e th e s e c o n d c o n ta c t b e tw e e n th e tw o p e r s o n s .
G r a h a m a n d C o n le y (1971) fo u n d t h a t s u b je c t s p o s t o p e r a t i v e l y d id
r e m e m b e r t h e i r p r e o p e r a t i v e c o n c e r n s a n d a n x i e t i e s a n d w e r e in
s o m e i n s t a n c e s m o r e w illin g to v e r b a l i z e t h e s e p r e o p e r a t i v e c o n
c e r n s d u r in g th e p o s t o p e r a t i v e p e r i o d .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
99
T h e o r e tic a l I n te r p r e ta tio n s of R e s u lts
T h e o r e t i c a l i n t e r p r e t a t i o n s w i l l b e m a d e of th e r e s u l t s of:
(1) t h e f iv e m a j o r h y p o t h e s e s a n d (2) a d d it i o n a l p o s t h o c a n a l y s e s of
s e l e c t e d d a ta g e n e r a t e d b y th e r e s u l t s o f t h e a n a l y s i s o f th e f iv e
m a jo r h y p o th e s e s .
T h e f i r s t t h r e e m a j o r h y p o t h e s e s w e r e t h o s e w h ic h p r o p o s e d
a s ig n i f ic a n t e f f e c t o f th e e x p e r i m e n t a l N u r s in g I n t e r v e n t i o n T r e a t
m e n t on th e s u b j e c t s ' f i r s t 72 h o u r p o s t o p e r a t i v e a n x ie ty l e v e l s a n d
r e c o v e r y i n d i c e s of m e a n b o d y t e m p e r a t u r e a n d n u m b e r o f a n a l g e s i c
m e d i c a ti o n s r e c e i v e d . N o s i g n i f i c a n t f in d in g s w e r e fo u n d f o r t h e s e
m a jo r h y p o th e s e s . T h e s tu d y f a i l e d to s u p p o r t a s ig n i f ic a n t e f f e c t
o f th e e x p e r i m e n t a l N u r s in g I n t e r v e n t i o n T r e a t m e n t o n f i r s t 72
h o u r p o s t o p e r a t i v e a n x ie ty l e v e l s , m e a n b o d y t e m p e r a t u r e , a n d
n u m b e r of a n a l g e s i c m e d i c a ti o n s a d m i n i s t e r e d . T h e s e n o n s ig n i f i
c a n t r e s u l t s m a y i n d ic a te t h a t th e b e h a v i o r s of th e e x p e r i m e n t a l
N u r s in g I n t e r v e n t i o n T r e a t m e n t a r e , i n a n d o f t h e m s e l v e s , i n e f f e c
t u a l in r e d u c in g a n x ie ty a t t e n d a n t to p a in d u r in g th e p o s t o p e r a t i v e
p e rio d . I t m a y b e t h a t th e d e v e lo p m e n t o f a p o s i t i v e n u r s e - p a t i e n t
r e l a t i o n s h i p i s th e c r u c i a l d i m e n s io n w ith o u t w h ic h a n y a d d itiv e
b e h a v i o r s o r n u r s i n g i n t e r v e n t i o n s a r e i n e f f e c t iv e in r e d u c in g a n x i
b e h a v i o r s a r e p e r f o r m e d to r e d u c e a n x ie t y a r e m o r e c r u c i a l th a n
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100
"w h a t" is d o n e.
F u r t h e r s u p p o r t f o r t h i s p o s s i b l e i n t e r p r e t a t i o n o f th e r e s u l t s
i s g a in e d f r o m th e d e g r e e of d i s c o m f o r t e x p r e s s e d b y n u r s i n g s ta f f ,
i n t h e i n i t i a l t r a i n in g s e s s i o n s o f t h e e x p e r i m e n t a l N u r s in g I n t e r
v e n ti o n T r e a t m e n t , p r i o r to i m p l e m e n t a t i o n of th e s tu d y . S e v e ra l
s ta f f m e m b e r s e v id e n c e d a n d v o i c e d c o n s i d e r a b l e c o n c e r n a b o u t
s it ti n g a n d c o m m u n ic a tin g w ith t h e p a t i e n t a b o u t h i s f e e l in g s d u r in g
t h e p a in e x p e r i e n c e a n d h i s h a b i t u a l w a y s o f c o p in g w ith p a in . I t is
c o n c e i v a b le t h a t in a c t u a l i m p l e m e n t a t i o n o f t h i s a s p e c t of th e
N u r s in g I n te r v e n t i o n T r e a t m e n t , t h e d e g r e e o f d i s c o m f o r t f e l t b y
t h e s ta f f w a s g r e a t e n o u g h to u n c o n s c i o u s ly o r c o n s c i o u s ly i m p e d e
th e m a j o r i n te n t o f t h e s e b e h a v i o r s , i . e . , t h a t o f r e l a t i o n s h i p
f o r m a t i o n th r o u g h c o m m u n i c a t io n a n d r e d u c t io n o f p a t i e n t s ' h e l p
l e s s n e s s t h r o u g h f o c u s in g th e p a t i e n t on s u c c e s s f u l p a s t c o p in g
b e h a v io r s .
A d d itio n a lly , p e r s o n a l i t y v a r i a b l e s , n o t c o n tr o l le d in t h is
s tu d y , m a y h a v e b e e n s i g n i f ic a n t in a f f e c ti n g th e s u b j e c t s ' r e s p o n s e
to t h e e x p e r i m e n t a l N u r s in g I n t e r v e n t i o n T r e a t m e n t . F o r e x a m p le ,
i t m a y b e t h a t th e t r e a t m e n t h a d a n a v e r s i v e e f f e c t on s u b je c t s
w h o s e h a b it u a l r e s p o n s e to a n x ie t y i s to w i t h d r a w f r o m i n t e r p e r
s o n a l c o n ta c t . S u c h s u b je c t c o p in g s k i l l s m ig h t c a u s e a n e g a tiv e
r e s p o n s e to a tt e m p t s on th e p a r t o f o t h e r s f o r r e l a t i o n s h i p f o r m a
t io n a n d a c ti v e i n t e r a c t i o n . I f t h i s w e r e t r u e , th e N u r s in g
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101
I n t e r v e n t i o n T r e a t m e n t m ig h t h a v e h a d a n e g a ti v e e f f e c t on th e
p o s t o p e r a t i v e a n x ie ty l e v e l f o r s u c h p e r s o n s . T h is p h e n o m e n o n
c o u ld o b s c u r e a n y p o s it iv e e f f e c t o f t h e N u r s in g I n te r v e n t i o n T r e a t
m e n t on t h o s e p e r s o n s w ho c o p e w ith a n x ie t y b y s e e k in g h u m a n c o n
t a c t a n d r e l a t i o n s h i p to r e d u c e th e i n t e n s i t y o f t h e i r a n x ie ty .
T h e r e c o v e r y r a t e in d ic e s o r c r i t e r i o n m e a s u r e s of m e a n
b o d y t e m p e r a t u r e a n d n u m b e r of a n a l g e s i c m e d i c a ti o n s m a y h a v e
b e e n s u b je c t to o t h e r in te r v e n i n g v a r i a b l e s . I n te r v e n i n g v a r i a b l e s
r e l a t e d to th e g e n e r a l p o s t o p e r a t i v e c o u r s e , s u c h a s l e v e l of
h y d r a t i o n a n d a m o u n t of s u r g i c a l m a n i p u l a t io n m a y h a v e a f f e c te d
body te m p e ra tu re . S u c h v a r i a b l e s m a y o b s c u r e s ig n i f ic a n t r e s u l t s
u s in g m e a n b o d y t e m p e r a t u r e a s a c r i t e r i o n m e a s u r e to a s s e s s
r e s u l t a n t e f f e c ts of s p e c i f ic n u r s i n g i n t e r v e n t i o n s . I n d ic e s s u c h a s
b o d y t e m p e r a t u r e a n d n u m b e r of a n a l g e s i c s a d m i n i s t e r e d h a v e b e e n
u s e d in m a n y s tu d i e s a s i n d i c a t o r s o f r e c o v e r y r a t e . H o w e v e r,
W o lf e r (1973) p o in ts o u t t h a t in c l i n i c a l n u r s i n g r e s e a r c h t h e r e i s a
c o n s i d e r a b l e n u m b e r of u n c o n tr o l la b l e a n d n o n r a n d o m iz e d i n t e r
v e n in g v a r i a b l e s w ith a s m a l l s a m p l e w h ic h m a y e x e r t a n e f f e c t o n
re c o v e ry ra te . T h e e f f e c t e x e r t e d m a y b e of s u c h a m a g n itu d e to
o b s c u r e a n y s ig n i f ic a n t e f f e c t of th e e x p e r i m e n t a l in d e p e n d e n t
t r e a t m e n t v a r i a b l e b e in g s tu d ie d .
T h e f o u r t h h y p o t h e s i s p r o p o s e d a n i n t e r a c t i v e e f f e c t of h ig h
l e v e l s of p r e o p e r a t i v e a n x ie ty w ith th e e x p e r i m e n t a l t r e a t m e n t ,
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102
s u c h t h a t t h o s e s u b je c t s w ith h ig h l e v e l s o f p r e o p e r a t i v e a n x ie ty
w o u ld e x h ib i t a g r e a t e r p o s it iv e r e s p o n s e to t h e e x p e r i m e n t a l
N u r s in g I n t e r v e n t i o n T r e a t m e n t t h a n w o u ld s u b j e c t s w ith lo w p r e
o p e r a t i v e a n x ie t y l e v e l s . T h e r e s u l t s w e r e n o n s ig n i f ic a n t f o r t h is
p r o p o s e d i n t e r a c t i v e e f f e c t. J a n i s 's (1 9 5 8 ) r e s e a r c h i n d ic a te s t h a t
a m o d e r a t e l e v e l of p r e o p e r a t i v e a n x ie t y i s m o r e f a c i l i t a t i v e of a
p o s i t i v e p o s t o p e r a t i v e r e c o v e r y th a n a r e e i t h e r o f th e h ig h o r lo w
e x t r e m e s of p r e o p e r a t i v e a n x ie ty . M o d e r a t e l e v e l s of p r e o p e r a t i v e
a n x ie ty a p p e a r to f a c i l i t a t e a c ti v e s u b j e c t p r e p a r a t i o n a n d c o p in g
p r o c e s s e s ; w h e r e a s , h ig h l e v e l s of p r e o p e r a t i v e a n x ie t y l e a d to
r a n d o m i n e f f e c t u a l a tt e m p t s to c o p e , in a p r e p a r a t o r y w a y , w ith
th e a n ti c ip a t e d s t r e s s of s u r g e r y . L ow le v e ls of p r e o p e r a tiv e
a n x ie t y a p p e a r to in d ic a te a d e n ia l of th e a p p r o a c h i n g s t r e s s a n d
h e n c e no a c ti v e p r e p a r a t o r y c o p in g . T h is d e n ia l p h e n o m e n o n l e a d s
to r e d u c e d a b i l i t y to c o p e w ith p o s t o p e r a t i v e s t r e s s e s of th e s u r g i c a l
e x p e rie n c e . In l ig h t of J a n i s 's (1 9 5 8 ) f in d i n g s , i t is d i f f ic u l t to
e x p la in th e f a i l u r e of th e r e s u l t s of t h is s tu d y to s h o w a s ig n i f ic a n t
e f f e c t on s u b je c t s w ho e x p e r i e n c e d h ig h p r e o p e r a t i v e a n x ie ty .
T h e s e s u b je c t s w o u ld , fo llo w in g J a n i s 's f in d i n g s , b e n e f i t f r o m th e
s t r u c t u r e d e x p e r i m e n t a l N u r s in g I n t e r v e n t i o n T r e a t m e n t . T h is
e x p e r i m e n t a l t r e a t m e n t s h o u ld f a c i l i t a t e th e c o p in g s k i l l s p o s t o p e r
a ti v e ly of s u b j e c t s w h o s e p r e o p e r a t i v e c o p in g s k i l l s w e r e i n e f f e c
t u a l b e c a u s e of h ig h l e v e l s of a n x ie ty . T h e r e f o r e th e r e s u l t s a g a in
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103
i n d i c a t e t h a t th e e x p e r i m e n t a l N u r s i n g I n t e r v e n t i o n T r e a t m e n t
b e h a v i o r s d id n o t s ig n i f ic a n tl y a l t e r t h e p o s t o p e r a t i v e a n x ie t y a s s o
c i a t e d w ith th e p a in e x p e r i e n c e .
O f i n t e r e s t , h o w e v e r , i s J a n i s ' s (1 9 5 8 ) s t a t e m e n t th a t:
P e r s o n s w ho r e a c t w ith a m o d e r a t e l e v e l of a n t i c
i p a t o r y f e a r a r e l e s s l ik e l y to h a v e a h i s t o r y of p s y c h o
n e u r o t i c d i s o r d e r th a n t h o s e w h o r e a c t w ith lo w o r h ig h
a n t i c i p a t o r y f e a r . (p. 404)
I f t h i s i s t r u e , h ig h a n x ie ty s u b j e c t s p r e o p e r a t i v e l y m a y b e e x h ib i t
in g e v id e n c e s of t r a i t a n x ie ty w h ic h t h e e x p e r i m e n t a l t r e a t m e n t of
t h i s s tu d y d id n o t p r o p o s e to m e a s u r e o r a f f e c t. T h is in tr o d u c ti o n
b y J a n i s (1958) of t r a i t a n x ie ty l e n d s i n s i g h t in to th e n o n s ig n i f ic a n t
r e s u l t s r e l a t e d to H y p o th e s is 4. H ig h l e v e l s of p r e o p e r a t i v e a n x i
e ty m a y b e p r i m a r i l y th e r e s u l t o f t r a i t a n d n o t s t a t e a n x ie ty .
T h e r e f o r e , o n e w o u ld n o t e x p e c t t h e e x p e r i m e n t a l t r e a t m e n t of th e
p r e s e n t s tu d y to e x e r t a s ig n i f ic a n t p o s t o p e r a t i v e e f f e c t on a n x ie ty
le v e ls .
H y p o t h e s is 5 s o u g h t to e s t a b l i s h a n i n t e r a c t i v e e f f e c t o f h ig h
l e v e l s of l if e s t r e s s in th e y e a r p r e c e d i n g s u r g e r y w ith th e e x p e r i
m e n t a l t r e a t m e n t , N u r s in g I n t e r v e n t i o n T r e a t m e n t . It w as p ro p o se d
t h a t h ig h l e v e l s of s t r e s s in th e y e a r p r e c e d i n g s u r g e r y w o u ld r e n d e r
t h e s u b je c t s m o r e v u l n e r a b le to t h e a d d it i o n a l s t r e s s of s u r g e r y ,
a n d h e n c e th e e x p e r i m e n t a l N u r s in g I n t e r v e n t i o n T r e a t m e n t w o u ld
p r o v i d e d i f f e r e n t i a l l y g r e a t e r s u p p o r t to s u c h p e r s o n s . T h is
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
s u p p o r t w o u ld th e n e n a b le m o r e h i g h ly s i t u a t i o n a l l y a n d lif e
s t r e s s e d s u b je c t s to c o p e w ith l e s s a n x ie t y to th e p o s t o p e r a t i v e
p a in e x p e r i e n c e . H o w e v e r, no s u c h i n t e r a c t i v e e f f e c t w a s s u p p o r t e d
b y t h i s s tu d y . T w o p o s s i b l e r e a s o n s f o r th e n o n s ig n i f ic a n t r e s u l t s
g e n e r a t e d f o r th is h y p o t h e s i s a r e p r o p o s e d .
F i r s t , th e S c h e d u le of R e c e n t E x p e r i e n c e q u e s t i o n n a i r e u s e d
in t h i s s tu d y to a s s e s s p r e v i o u s l if e s t r e s s w a s o n e d e v e lo p e d by
R a h e (1 9 7 2 ). T h is q u e s ti o n n a ir e w a s d e s ig n e d to r e p o r t lif e
c h a n g e s of m a n y v a r i e t i e s w h ic h R a h e 's r e s e a r c h i n d i c a t e s a r e
a s s o c i a t e d c lo s e l y w ith m e n t a l s t r e s s a n d f u t u r e p h y s ic a l i l l n e s s .
T h e n o r m a t i v e s tu d i e s of t h is i n s t r u m e n t i n d i c a t e t h a t m id d le c l a s s
p e r s o n s of w id e ly d i v e r g e n t " c u l t u r e s s h o w e x t r e m e l y c lo s e a g r e e
m e n t in th e w e ig h tin g s of th e v a r i o u s l i f e c h a n g e e v e n ts " (p . 2 5 3 ).
H o w e v e r , n o r m in g d a ta of t h is i n s t r u m e n t i n d i c a t e s th a t:
T h e m a j o r f a c t o r in d e t e r m i n i n g h o w p e o p le
s c a l e th e lif e e v e n ts is t h e i r s o c io - e c o n o m i c b a c k
g r o u n d . T h e M e x i c a n - A m e r i c a n s , f o r e x a m p le ,
r a t e d d e a th of f a m i ly m e m b e r s , j a i l t e r m , b e in g
f i r e d f r o m w o r k - a ll l if e c h a n g e e v e n ts w ith h ig h
L C U v a lu e s f o r S e a t t l i t e s - a s n o t m u c h h i g h e r in
L C U m a g n itu d e th a n f in a n c ia l c h a n g e s , m a k in g
e x p e n s i v e p u r c h a s e s , a n d a r e s i d e n t i a l m o v e - l if e
c h a n g e e v e n ts w ith lo w L C U v a l u e s f o r S e a t t l i t e s .
( R a h e , 1972, p. 255)
T h e r e f o r e , p o s s ib l y th e S c h e d u le o f R e c e n t E x p e r i e n c e s q u e s t i o n
n a i r e u s e d in th e p r e s e n t s tu d y , a s a m e a s u r e of p r e v i o u s l if e
s t r e s s in th e y e a r p r e c e d i n g s u r g e r y , m a y n o t h a v e a c c u r a t e l y
with permission of the copyright owner. Further reproduction prohibited without permission.
105
i d e n t i f i e d s u b je c t s w ho e x p e r i e n c e d v a r i o u s l e v e l s o f l if e s t r e s s
b e c a u s e th e s o c io -e c o n o m ic v a r ia b le w a s n o t c o n s id e r e d .
M o r e r e c e n t r e v i s i o n s o f th e S c h e d u le of R e c e n t E x p e r i e n c e s
q u e s t i o n n a i r e ( r e n a m e d th e R e c e n t L if e C h a n g e s Q u e s t io n n a i r e )
i n c l u d e a n a d d it i o n a l 13 l if e c h a n g e q u e s ti o n s a s w e ll a s a n o p p o r
tu n it y f o r s u b je c t s to s e l f - e v a l u a t e a n d s c a l e th e l if e c h a n g e s th e y
h a v e e x p e r i e n c e d b y e s ti m a t in g th e i m p a c t w h ic h t h e y b e l i e v e s u c h
e v e n ts to h a v e h a d on t h e m . T h e s c o r i n g of t h is r e v i s e d m e a s u r e
p . 136). P e r h a p s th e r e v i s e d m e a s u r e w ith i t s s c o r i n g p o s s i b i l i t i e s
w o u ld p r o v id e a b e t t e r m e a s u r e of a c t u a l s t r e s s l e v e l f e l t b y th e
s u b je c t b e c a u s e of r e c e n t l if e e x p e r i e n c e s .
P o s t h o c a n a l y s i s o f th e d a ta a tt e m p t e d to s u p p o r t th e p r e
t r e a t m e n t e q u a li ty of th e e x p e r i m e n t a l a n d c o n t r o l g r o u p s on
c ru c ia l v a ria b le s . N a m e ly , th e e x p e r i m e n t a l a n d c o n t r o l g r o u p s
w e r e c o m p a r e d f o r p r e t r e a t m e n t e q u a li ty on th e v a r i a b l e s of:
(1) l e v e l of a d m i s s i o n a n x ie t y a n d (2) l e v e l of i m m e d i a t e p r e o p e r a
tiv e a n x ie ty . N o s ig n i f ic a n t d i f f e r e n c e w a s fo u n d b e tw e e n th e
e x p e r i m e n t a l a n d c o n t r o l g r o u p s o n t h e s e tw o v a r i a b l e s . T h erefo re
a s ig n i f ic a n t p r e t r e a t m e n t d i f f e r e n c e on t h e s e v a r i a b l e s c a n n o t b e
h e ld a c c o u n t a b le f o r th e r e s u l t a n t i n s i g n if i c a n c e fo u n d on th e p o s t
t r e a t m e n t r e s u l t s b e tw e e n th e tw o g r o u p s .
T h e s ig n i f ic a n t f in d in g t h a t ty p e of s u r g e r y ( a b d o m in a l
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
h y s t e r e c t o m y a n d c h o le c y s te c t o m y ) a n t i c i p a t e d d id n o t h a v e a
s i g n i f i c a n t e f f e c t on th e l e v e l o f p r e o p e r a t i v e a n x ie t y is i n t e r e s t i n g .
P r e v i o u s l y i t h a s b e e n t h e o r i z e d t h a t a n t i c i p a t o r y a n x ie t y a tt e n d a n t
to a n a b d o m i n a l h y s t e r e c t o m y i s g r e a t e r th a n a n t i c i p a t o r y a n x ie t y
a tt e n d a n t to o t h e r n o n s e x r e l a t e d a b d o m in a l s u r g e r y . S u c h fin d in g s
r e q u i r e f u r t h e r s tu d y , i n v e s t ig a t io n , a n d a t t e m p t s to s u b s t a n t i a t e .
T h e a g e of p e r s o n s u n d e rg o in g a h y s t e r e c t o m y ( e . g . , of c h ild
b e a r i n g o r n o n c h ild b e a r i n g y e a r s ) m a y b e t h e c r i t i c a l v a r i a b l e in
l e v e l of a n x ie t y p r e p a r a t o r y to a n a b d o m i n a l h y s t e r e c t o m y . It m ay
a ls o b e t h a t a c r u c i a l v a r i a b l e is t h a t t h e r e i s a c h a n g in g f e m a le
v ie w of th e p r e s e n c e o r a b s e n c e of c e r t a i n o r g a n s a s i n d i c a t o r s of
f e m a l e n e s s a n d t h e r e f o r e of g r e a t e g o s y n to n ic v a lu e . If su ch is
th e c a s e , r e m o v a l of t h e s e o r g a n s m a y n o t g e n e r a t e th e a d d it i o n a l
a n t i c i p a t o r y a n x ie t y t h a t e x is t e d u n d e r p a s t c u l t u r a l b e l i e f s y s t e m s .
S u b j e c t s ' p r e v i o u s e x p e r i e n c e w ith m a j o r s u r g e r y w a s n o t
fo u n d to s ig n i f ic a n tl y a f f e c t p r e s e n t p r e o p e r a t i v e a n x ie t y l e v e l s .
T h is f in d in g i n d i c a t e s t h a t o n e c a n n o t p r e d i c t f r o m th e s u b j e c t s '
p r e v i o u s f a m i l i a r i t y w ith s u r g e r y h i s p r e s e n t e m o t i o n a l it y in
r e s p o n s e to s u r g e r y . T h is fin d in g s u p p o r t s th e r e s e a r c h of
G r a h a m a n d C o n le y (1971) w ho fo u n d t h a t " p r e v i o u s h o s p i t a l i z a t i o n
f o r m a j o r s u r g e r y c a n n o t b e s a id to b e a s s o c i a t e d w ith e i t h e r lo w
o r h ig h l e v e l s of a n x ie t y " (p . 120).
A d d i t io n a l ly , a s w o u ld b e e x p e c te d f r o m th e l a c k of
with permission of the copyright owner. Further reproduction prohibited without permission.
107
s ig n i f ic a n c e fo u n d o v e r a l l f o r th e e f f e c t of th e e x p e r i m e n t a l t r e a t
m e n t , t h e r e w a s a l s o no s ig n i f ic a n t i n t e r a c t i o n o f a g e w ith th e
e x p e rim e n ta l tre a tm e n t.
C o n c l u s io n s a n d N u r s in g I m p l i c a t i o n s
C o n c l u s io n s w h ic h c a n b e d r a w n f r o m th e r e s u l t s o f t h is
s tu d y a r e d e t a i l e d f o r th e p u r p o s e of p r o p o s i n g p o s s i b l e n u r s i n g
i m p l i c a t i o n s b a s e d on th e r e s u l t s o f t h is s tu d y .
1. T h e l e v e l o f e m o t i o n a l it y , a s m e a s u r e d b y th e p h y s io l o g
i c a l i n d i c a t o r , D i g i ta l S w e a t In d e x , i s c o n s i d e r a b l y g r e a t e r d u r in g
t h e 24 h o u r p e r i o d p r e c e d i n g m a j o r e le c t iv e a b d o m i n a l s u r g e r y
t h a n d u r in g th e 72 h o u r i m m e d ia te p o s t o p e r a t i v e p e r i o d . M ean
d i g it a l s w e a t v a lu e s a r e a l s o e le v a t e d a b o v e z e r o p o s t o p e r a t i v e l y
a lth o u g h to a l e v e l c o n s i d e r a b l y l e s s t h a n t h a t l e v e l o b s e r v e d b e f o r e
s u rg e ry . T h is fin d in g m a y le a d to th e u s e o f a s im p le to o b ta in a n d
n o n i n t r u s i v e p h y s io l o g ic m e a s u r e of e m o t i o n a l it y in c l i n i c a l n u r s i n g
p ra c tic e . T h e a v a i l a b i l i t y of c r i t e r i o n o u tc o m e m e a s u r e s o f e m o
t io n a l it y t h a t c a n s e r v e a s i n d i c a t o r s o f e f f e c t i v e n e s s o f n u r s i n g
i n t e r v e n t i o n s on a n x ie t y l e v e l s of c li e n ts is i m p o r t a n t . Such
m e a s u r e s s e r v e a s o n e m e a n s of e v a lu a tin g a p r i m a r y f u n c tio n of
n u r s i n g , n a m e l y , a f f e c tin g a l t e r e d p s y c h o lo g i c a l s t a t e s .
2. T h e r e s u l t s s h o w t h a t , u s in g th e D i g i ta l S w e a t m e a s u r e ,
h ig h l e v e l s of e m o t i o n a l it y do o c c u r in th e p r e o p e r a t i v e p e r i o d w h ic h
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
108
m a y b e a c r u c i a l t im e f o r n u r s i n g i n t e r v e n t i o n to o c c u r . G r a n te d ,
p r e o p e r a t i v e te a c h i n g a n d p r e p a r a t o r y i n f o r m a t io n g iv in g h a v e b e e n
e x te n s i v e l y s tu d i e d a n d th e v a lu e o f s u c h m e a s u r e s s e e m s a s s u r e d .
O t h e r p r e o p e r a t i v e n u r s i n g i n t e r v e n t i o n s n e e d to b e i n v e s t i g a t e d .
I t m a y b e t h a t th e h e u r i s t i c v a lu e o f th e p r e s e n t s tu d y l i e s in
a d d r e s s i n g p a t i e n t n e e d s d u r in g th e c r u c i a l 24 h o u r p r e o p e r a t i v e
p e r i o d f o r th e d i m e n s io n s o f c a r e w h ic h t h is s tu d y a tt e m p t e d to
i n v e s t i g a t e d u r in g th e i m m e d ia te p o s t o p e r a t i v e p e r i o d . F u r th e r
r e s e a r c h n e e d s to b e d o n e to d e t e r m i n e i f n u r s i n g c a r e w h ic h
r a p i d i t y o f r e s p o n s e b y c a r e g i v e r s to p a t i e n t e x p r e s s e d n e e d s , a n d
(3) to u c h , l i s t e n i n g , a n d v e r b a l s u p p o r t to f a c i l i t a t e th e d e v e lo p
m e n t of th e n u r s e - p a t i e n t r e l a t i o n s h i p d u r in g th e p r e o p e r a t i v e
p e r i o d w i l l h a v e a n e f f e c t on p a t i e n t 's p o s t o p e r a t i v e r e c o v e r y .
3. T h e r e s u l t s of th e S t r u c t u r e d I n te r v ie w Q u e s t i o n n a i r e a r e
of i m p o r t a n c e in th e r e s p o n s e s o f f e r e d to s e v e r a l q u e s t i o n s . F irs t,
28 s u b je c t s w e r e a b le to i d e n tif y a n d v e r b a l i z e t h a t t h e y w e r e
a n x io u s to a h ig h o r m o d e r a t e d e g r e e p r e o p e r a t i v e l y . T h is f in d in g
le n d s s o m e s u p p o r t to th e u s e of s e l f - r e p o r t q u e s ti o n in g a s a m e a n s
of a s s e s s i n g th e p a t i e n t 's l e v e l o f e m o t i o n a l it y .
4. T h e f in d in g t h a t " c o n c e r n s a b o u t f a m i ly f u n c tio n in g a t
h o m e " w a s i d e n t i f i e d b y 12 s u b je c t s a s a s o u r c e o f t h e i r p r e o p e r a
t iv e a n x ie t y i n d i c a t e s t h a t n u r s i n g i n t e r v e n t i o n s m ig h t b e d e s ig n e d
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
109
to s u p p o r t p a t i e n t s a n d t h e i r f a m i l i e s p r e p a r a t o r y to h o s p i t a l
a d m is s io n fo r s u r g e r y . F o r e x a m p le , n u r s e - l e d g r o u p d i s c u s s i o n s
b e tw e e n s e v e r a l p a t i e n t s a n d t h e i r f a m i l i e s w h o a r e a n ti c ip a t in g
s u r g e r y m ig h t p r o v i d e s u p p o r t a n d p la n n in g m e c h a n i s m s to r e d u c e
th e s t r e s s f u l i m p a c t w h ic h im p e n d in g s u r g e r y a n d a b s e n c e f r o m
f a m i ly a p p a r e n t l y g e n e r a t e s .
5. T h e u s e o f " p h y s i c a l a c ti v it y " a s a p r i m a r y c o p in g s k i l l
f o r p r e o p e r a t i v e a n x ie t y w a s m e n tio n e d b y 14 s u b j e c t s . T h is m a y
i n d i c a t e t h a t p r o v i s i o n f o r th e u s e o f p h y s ic a l a c t i v i t y b y p a ti e n ts
d u r in g th e p r e o p e r a t i v e p e r i o d s h o u ld b e a n u r s i n g i n t e r v e n t i o n
m ea su re.
6. T h a t fa m ily an d f rie n d su p p o rt is s e e n a s s ig n if ic a n t by
18 s u b je c t s in r e d u c i n g p r e o p e r a t i v e a n x ie ty m a y v a l i d a t e a n d le n d
s u b s t a n t i a t i o n to s e v e r a l n u r s i n g i n t e r v e n t i o n s d e s ig n e d to p o t e n
t i a t e f a m i ly s u p p o r t . I n t e r v e n t i o n s s u c h a s in c lu d in g f a m i ly in
p r e o p e r a t i v e t e a c h i n g , a llo w in g th e f a m ily to r e m a i n n e a r th e
p a ti e n t b y p r o v id i n g c o m f o r ta b l e w a itin g r o o m s if t h e y d e s i r e , e v e n
p r o v is i o n f o r s e e i n g th e p a t i e n t b r i e f l y in th e r e c o v e r y r o o m a s
soon a s h e is aw a k e . T h e s e a r e o n ly e x a m p l e s o f th e p o s s i b l e
m e a n s t h a t c a n b e u s e d to m a x i m iz e th e s u p p o r t w h ic h s o m e
p a ti e n ts s e e a s a c r u c i a l m e a n s of r e l i e v i n g t h e i r a n x ie t y .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
110
I m p lic a tio n s fo r F u r th e r R e s e a rc h
T h e r e s u l t s o f th e p r e s e n t s tu d y l e a d to r e c o m m e n d a t i o n s f o r
f u r t h e r r e s e a r c h i n t h e fo llo w in g a r e a s .
1. T h e b e h a v i o r s o f th e N u r s in g I n te r v e n t i o n T r e a t m e n t n e e d
to b e s u b je c t e d to s tu d y in o t h e r a n x ie t y p r o d u c in g s i t u a t i o n s
e x p e r i e n c e d b y p a t i e n t s u n d e r th e s t r e s s of i l l n e s s o r h o s p i t a l i z a
tio n . F o r e x a m p l e , t h e s e b e h a v io r s m ig h t b e t e s t e d f o r t h e i r a n x
ie t y r e d u c i n g e f f e c t on p a t i e n t s a s t h e y e x p e r i e n c e s u r g i c a l p r o c e
d u r e s c o n d u c te d u n d e r l o c a l o r r e g i o n a l a n a e s t h e s i a . L e s s e (1 9 7 0 )
h a s r e p o r t e d h i s i n v e s t i g a t i o n s o f a n x ie ty l e v e l s a t t e n d a n t to th e
s t r e s s e x p e r i e n c e d b y s c h i z o p h r e n i c p a ti e n ts u n d e r g o in g c r a n i
o to m ie s u n d e r l o c a l a n a e s t h e s i a . H o w e v e r, o n e m ig h t c o n s i d e r th e
m o r e c o m m o n s t r e s s e s o f g e n e r a l h o s p i t a l p a ti e n ts e x p e r i e n c i n g
m a jo r in tr u s iv e d ia g n o s tic p r o c e d u r e s . A ls o , th e e f f e c t o f s u c h
m e a s u r e s in r e d u c i n g t h e a n x ie t y e x p e r i e n c e d b y r e l a t i v e s of
p a ti e n ts w ho h a v e b e e n a d m i t te d to a c o r o n a r y c a r e u n i t m ig h t b e
in v e s t ig a t e d . T h e s e ty p e s o f s tu d i e s w o u ld c o n tr i b u te to th e n e e d
f o r p r o c e s s - o u t c o m e s tu d i e s w h ic h B lo c h (1 9 7 5 ) s p e a k s to a s b e in g
g r e a tly n e e d e d d im e n s io n s of n u rsin g r e s e a r c h . B lo c h (1 9 7 5 ) in
d i s c u s s in g p r o c e s s - o u t c o m e r e s e a r c h s tu d i e s s ta t e d :
T h e s e l a t t e r ty p e s o f s tu d i e s w o u ld s e e m to b e
th e m o s t a p p r o p r i a t e m a n n e r f o r t e s t in g n u r s i n g p r a c
ti c e a n d f o r d e v e lo p in g n u r s i n g k n o w le d g e a n d n u r s i n g
p r a c t i c e t h e o r y . I t s h o u ld b e c o n s i d e r e d a t a s k f o r th e
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Ill
r e s e a r c h e r ( w ith e x te n s i v e p r a c t i t i o n e r in v o lv e m e n t ,
o f c o u r s e ) , r a t h e r t h a n a g o a l f o r q u a li t y c o n t r o l p r o
g r a m s . (p. 262)
2. T h is s tu d y l i m i t e d th e m e a s u r e m e n t of a n x ie t y to th e f i r s t
72 h o u r s p o s t o p e r a t i v e l y . I t i s p o s s i b l e t h a t th e e x p e r i m e n t a l
N u r s in g I n t e r v e n t i o n T r e a t m e n t w o u ld n o t e f f e c t i m m e d i a t e p o s t
o p e r a t i v e a n x ie t y , b u t q u a li t y o f l if e a s e v id e n c e b y s u b je c t
r e s p o n s e s to t h e i r s u r g i c a l e x p e r i e n c e s s o m e w e e k s p o s t o p e r a t i v e l y .
T h e p o s s i b l e e f f e c t of t h is p h e n o m e n o n on h e a lt h c a r e s e e k in g b e h a v
i o r s of s u b je c t s in th e f u t u r e m ig h t b e i n v e s t i g a t e d .
3. F u t u r e c l i n i c a l n u r s i n g r e s e a r c h s tu d i e s m ig h t f o c u s on
a f f e c tin g r e c o v e r y r a t e i n d i c e s b y e x p lo r in g th e e f f e c t o f s p e c i f ic
n u r s i n g c a r e b e h a v i o r s on p a t i e n t s e x p e r i e n c i n g d i f f e r e n t ty p e s of
s u rg e ry . A d d i t io n a l ly , s u b j e c t s m ig h t b e s e l e c t e d f o r t r e a t m e n t
on p r e d e t e r m i n e d p e r s o n o l o g i c a l v a r i a b l e s th o u g h t to b e c o n t r i b
u t o r y to t r e a t m e n t e f f e c t. F o r e x a m p l e , o n e s u c h c a te g o r y m a y b e
s u b je c t s w ith o u t m a j o r i n t e r p e r s o n a l f a m i ly s u p p o r t . T he re s u lts
of t h is s tu d y i n d ic a te t h a t 12 s u b je c t s f e l t s u c h s u p p o r t to b e a
s ig n i f ic a n t f a c t o r in t h e i r c o p in g a n d l e v e l o f a n x ie ty d u r in g th e
s u rg ic a l e x p e rie n c e . W h e n t h is d i m e n s io n o f f a m i ly s u p p o r t i s
a b s e n t , c a n n u r s i n g b e h a v i o r s b e s p e c i f ie d a n d i n v e s t i g a t e d w h ic h
w o u ld b e e f f e c ti v e in p r o v id i n g s u c h s u p p o r t a n d a n x ie t y r e d u c t io n .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
112
S u m m ary
T h is i n v e s t ig a t io n e x p l o r e d t h e e f f e c t of a n u r s i n g i n t e r v e n
a t i v e p a in e x p e r i e n c e s a n d (2) t h e r e c o v e r y r a t e i n d ic e s of p o s t
o p e r a t i v e b o d y t e m p e r a t u r e , a m b u l a t o r y e f f o r t s , a n d n u m b e r of
a n a l g e s i c m e d i c a ti o n s r e q u i r e d . T h e s tu d y a l s o s o u g h t to i n v e s
t i g a t e w h e t h e r t h e r e w a s a d i f f e r e n t i a l n u r s i n g i n te r v e n t i o n t r e a t
m e n t e f f e c t f o r s u b je c t s w h o h a d e x p e r i e n c e d : (1) h ig h a n d lo w
l e v e l s of lif e s t r e s s in t h e y e a r p r e c e d i n g s u r g e r y a n d (2) h ig h a n d
lo w l e v e l s of a n x ie ty d u r in g th e p r e o p e r a t i v e p e r i o d . E v i d e n c e to
s u p p o r t a n e f f e c t r e l a t e d to u s e o f th e e x p e r i m e n t a l N u r s in g I n t e r
v e n ti o n T r e a t m e n t w a s n o t fo u n d .
T h e s a m p l e c o n s i s t e d o f 36 a d u lt p a t i e n t s u n d e rg o in g e l e c t i v e
m a j o r a b d o m in a l s u r g e r y in tw o s m a l l h o s p i t a l s in S o u t h w e s te r n
M ic h ig a n . O ne h o s p i t a l s e r v e d a s a n e x p e r i m e n t a l h o s p i t a l in
w h ic h n u r s i n g s ta f f w e r e t r a i n e d in th e p r o c e d u r a l s te p s of th e
e x p e r i m e n t a l N u r s in g I n t e r v e n t i o n T r e a t m e n t (N = 18). T he seco n d
h o s p i t a l s e r v e d a s th e c o n t r o l h o s p i t a l in w h ic h th e n u r s i n g s ta f f
c a r r i e d o u t t h e i r u s u a l n u r s i n g c a r e in r e s p o n s e to th e s u b j e c t s '
p o s t o p e r a t i v e p a in e x p e r i e n c e (_N = 18).
T h e l e v e l of a n x ie t y w a s o b t a in e d p r e o p e r a t i v e l y on a d m i s s i o n ,
o n e - h a l f h o u r b e f o r e s u r g e r y , a n d p o s t o p e r a t i v e l y w h e n th e s u b j e c t
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
113
c o m p l a in e d of p a in . T h e l e v e l of a n x ie t y w a s o b ta in e d t h r o u g h th e
m e a s u r e m e n t of d i g it a l s w e a t i n t h e m a n n e r d e v e lo p e d b y M c N a ir ,
D r o p p l e m a n , a n d K u s s m a n (1 9 6 7 ). T h e s u b j e c t s ' l e v e l of p r e v i o u s
l if e s t r e s s w a s a s s e s s e d th r o u g h a d m i n i s t r a t i o n of th e S u b j e c t s '
R e c e n t E x p e r ie n c e Q u e s t i o n n a i r e d e v e lo p e d b y R a h e (1 9 7 2 ).
A d d itio n a lly , a d e s c r i p t i v e S t r u c t u r e d I n te r v ie w Q u e s t io n n a i r e ,
d e v e lo p e d f o r th is s tu d y , w a s a d m i n i s t e r e d to a s s e s s s u b je c t s e l f -
r e p o r t s on v a r i o u s a s p e c t s o f t h e i r e m o t i o n a l s t a t e d u r in g th e
T h e f in d in g s d id n o t s u p p o r t th e f iv e m a j o r h y p o t h e s e s of a n
e x p e r i m e n t a l t r e a t m e n t e f f e c t o n p o s t o p e r a t i v e a n x ie t y l e v e l s
a s s o c i a t e d w ith th e p a in e x p e r i e n c e , m e a n b o d y t e m p e r a t u r e , o r
n u m b e r of a n a lg e s ic m e d i c a t i o n s a d m i n i s t e r e d .
P o s t h o c a n a l y s e s , g e n e r a t e d b y th e r e s u l t s of a n a l y s i s of
th e f iv e m a j o r h y p o t h e s e s , r e v e a l e d f in d in g s r e l a t i v e to : (1) th e
D i g i ta l S w e a t m e a s u r e a s a s i g n i f i c a n t i n d i c a t o r o f c h a n g in g l e v e l s
o f e m o t i o n a l it y d u r in g s u r g i c a l p a t i e n t s ' p r e o p e r a t i v e a n d p o s t o p e r
a t i v e c o u r s e , (2) l e v e l of p r e o p e r a t i v e a n x ie t y w a s n o t s ig n i f ic a n tl y
d i f f e r e n t f o r ty p e of s u r g e r y a n t i c i p a t e d , a b d o m in a l h y s t e r e c t o m y
a n d c h o le c y s te c t o m y , a n d (3) w h e t h e r s u b je c t s h a d e x p e r i e n c e w ith
p r i o r s u r g e r y d id n o t s i g n i f i c a n t l y e f f e c t t h e i r p r e o p e r a t i v e a n x ie t y
l e v e l in r e s p o n s e to th e p r e s e n t s u r g i c a l e x p e r i e n c e .
I m p o r t a n t f in d in g s o f t h e S t r u c t u r e d I n te r v ie w Q u e s t io n n a i r e
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w e r e t h a t s u b je c t s : (1) a p p e a r a b le to i d e n t i f y a n d r e p o r t t h e i r
l e v e l of e m o t i o n a l it y d u r in g th e p r e o p e r a t i v e p e r i o d , (2) m a n i f e s t a
p r i m a r y p r e o p e r a t i v e a n x ie ty r e l a t e d to " c o n c e r n s a b o u t f a m i ly
c o p in g s k i l l in t h e i r a t t e m p t s to a m e l i o r a t e p r e o p e r a t i v e a n x ie ty .
P o s s i b l e e x p la n a tio n s f o r th e f in d in g s w e r e d i s c u s s e d ; i m p l i
c a ti o n s f o r n u r s i n g p r a c t i c e p r o p o s e d ; a n d s u g g e s t i o n s f o r f u r t h e r
r e s e a r c h d e v e lo p e d .
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115
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P l u tc h i k , R . T h e e m o tio n s : F a c t s , t h e o r y a n d a n e w m o d e l . N ew
Y o r k : R a n d o m H o u s e , 1968.
R a h e , R . H . S u b j e c t s ' r e c e n t l if e c h a n g e s a n d t h e i r n e a r - f u t u r e
i l l n e s s r e p o r t s . A n n a ls o f C l i n i c a l R e s e a r c h , 19 7 2 , _4 (5 ),
2 5 0 -2 6 5 .
R a h e , R . H . T h e p a th w a y b e tw e e n s u b j e c t s ' r e c e n t l if e c h a n g e s
a n d t h e i r n e a r - f u t u r e i l l n e s s r e p o r t s . In B . S. D o h r e n w e n d
fk B . P . D o h r e n w e n d ( E d s . ), S t r e s s f u l l if e e v e n ts : T h e i r
n a t u r e a n d e f f e c t s . N ew Y o r k : J o h n W ile y & S o n s , 1 9 74.
R a h e , R . H . E p i d e m i o lo g i c a l s tu d i e s o f l if e c h a n g e a n d i l l n e s s .
I n t e r n a t i o n a l J o u r n a l P s y c h i a t r y in M e d ic i n e , 19 7 5 , _6 ( 1 /2 ) ,
1 3 3 -1 4 6 .
S c h a c h t e r , S. T h e i n t e r a c t i o n of c o g n it i v e a n d p h y s io l o g ic a l
d e t e r m i n a n t s of e m o t i o n a l s t a t e . I n C . D . S p i e l b e r g e r (E d . ),
A n x ie ty a n d b e h a v io r . N e w Y o r k : A c a d e m i c P r e s s , 1 966.
S c h l o s b e r g , H . T h r e e d i m e n s io n s o f e m o tio n . P s y c h o lo g i c a l
R e v i e w , 1954, 6J,, 8 1 - 8 8 .
S i e g e l e , D . S. T h e g a te c o n tr o l t h e o r y . A m e r i c a n J o u r n a l of
N u r s i n g , 1974, 74 (3), 4 9 8 - 5 0 2 .
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S im e , A . M . R e l a ti o n s h ip o f p r e o p e r a t i v e f e a r , ty p e of c o p in g ,
a n d i n f o r m a t i o n r e c e i v e d a b o u t s u r g e r y to r e c o v e r y f r o m
s u r g e r y . J o u r n a l of P e r s o n a l i t y a n d S o c i a l P s y c h o lo g y , 1976,
34 (4 ), 7 1 6 - 7 2 4 .
S p ie lb e r g e r , C. D. A n x ie ty a n d b e h a v io r . N ew Y o rk : A c a d e m ic
P r e s s , 1966.
S ta u b , E . , T u r s k y , B . , fk S c h w a r tz , G . E . S e l f - c o n t r o l a n d
p r e d i c t a b i l i t y . In M . W e is e n b e r g (E d . ), P a i n , c l i n i c a l a n d
e x p e r i m e n t a l p e r s p e c t i v e s . S t. L o u is : C . V . M o s b y , 1975.
S t r a u s , A . , F o g e r b a u g h , S. Y . , fk G l a s s e r , B . P a i n : A n
o r g a n i z a t i o n a l - w o r k - i n t e r a c t i o n a l p e r s p e c t i v e . N u r s in g
O u tlo o k , 1974, 2 2 , 5 6 0 - 5 6 6 .
T i t c h e n e r , J . L . , fk L e v i n e , M . S u r g e r y a s a h u m a n e x p e r i e n c e .
N e w Y o r k : O x f o r d U n i v e r s i t y P r e s s , I9 6 0 .
T r a v e l b e e , J . I n t e r p e r s o n a l a s p e c t s of n u r s i n g (2 n d e d . ).
P h i la d e l p h ia : F . A . D a v is C o . , 1971.
W e is e n b e r g , M . (E d . ). P a i n , c l i n i c a l a n d e x p e r i m e n t a l p e r s p e c
t i v e s . S t. L o u is : C. V . M o s b y , 1975.
W o lf e r , J . A . D e f in itio n a n d a s s e s s m e n t o f s u r g i c a l p a t i e n t s '
w e l f a r e a n d r e c o v e r y : S e l e c t e d r e v i e w o f th e l i t e r a t u r e .
N u r s in g R e s e a r c h , 19 7 3 , _22, 3 9 4 -4 0 1 .
W o lf e r , J . A . , & D a v is , C. E . A s s e s s m e n t of s u r g i c a l p a t i e n t s '
p r e o p e r a t i v e e m o t i o n a l c o n d itio n a n d p o s t o p e r a t i v e w e l f a r e .
I n M . W e is e n b e r g (E d . ), P a i n , c l i n i c a l a n d e x p e r i m e n t a l
p e r s p e c t i v e s . S t. L o u is : C . Y . M o s b y , 1 9 75.
W o lp e , J . , fk L a z a r u s , A . A . B e h a v i o r t h e r a p y t e c h n i q u e s .
N e w Y o r k : P e r g a m o n P r e s s , 1 9 66.
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A P P E N D IC E S
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A p p e n d ix A
D a ta S h e e t
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Code #
D a ta S h e e t
H o s p i ta l A d m i s s i o n D a t e _
P e r m i s s i o n to p a r t i c i p a t e _
L i f e C h a n g e s Q u e s t i o n n a i r e ___________
I n i t i a l f i n g e r p r i n t (d a y b e f o r e s u r g e r y ) _
I m m e d i a t e p r e o p f i n g e r p r i n t _____________
S u r g e r y d a te a n d t im e ___________ _
4 th p o s to p d a y Q u e s t i o n n a i r e ________
A g e _____________ S e x H t.
P r e o p te m p . ___________
P r e v io u s s u rg e r y ( s ) 1_
P r e s e n t s u r g e r y ______________ _
P r e o p m e d i c a t i o n ________ .__________ ( d r u g , d o s e , r o u te )
A n a e s th e t ic _______________ _
P o s t o p m e d i c a ti o n p r n p a in _______________ ( d r u g , d o s e , r o u te )
O t h e r p o s to p m e d i c a ti o n o r d e r s
1_________________ 3__________
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T e m p e r a tu r e
1 s t 24 h r s p o s to p
2nd 24 h r s p o s to p
3 r d 24 h r s p o s to p
A m b u la to ry A c tiv itie s
1 s t 24 h r s p o s to p
2nd 24 h r s p o s to p
3 r d 24 h r s p o s to p
P R N p a in m e d g iv e n p o s to p ( d ru g , d o s e , r o u te )
1 s t 2 4 h r s p o s to p
2nd 2 4 h r s p o s to p
3 r d 24 h r s p o s to p
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A p p e n d ix B
P e r m i s s i o n S lip
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N am e
C o d e # __________________________
P e r m i s s i o n S lip
T h e n a t u r e of t h i s n u r s i n g s tu d y h a s b e e n e x p la in e d to m e a n d
I a g r e e to p a r t i c i p a t e in i t b y : (1) a n s w e r in g s o m e q u e s ti o n s a b o u t
c h a n g e s in m y lif e o v e r th e p a s t y e a r a n d a b o u t m y e x p e r i e n c e s
a f t e r s u r g e r y , a n d (2) a llo w in g a p r i n t o f m y f i n g e r to b e ta k e n a t
in te r v a ls a fte r s u rg e r y .
I u n d e r s t a n d t h a t m y p a r t i c i p a t i o n i s v o l u n t a r y a n d m y i d e n t i ty
w i l l r e m a i n u n k n o w n b y u s in g a c o d e n u m b e r f o r p u r p o s e s o f t h is
s tu d y .
P a t i e n t 's S i g n a t u r e __________________________
W itn e s s _____________________________________
D a te ______________________________________
T h a n k y o u f o r y o u r c o o p e r a t io n a n d p a r t i c i p a t i o n in t h is s tu d y .
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128
A p p e n d ix C
N u r s in g I n te r v e n t i o n P r o c e d u r e
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129
N u r s in g I n t e r v e n t i o n P r o c e d u r e
T h e t r e a t m e n t c o n s i s t s of th e f o llo w in g s e q u e n t i a l b e h a v io r s
on t h e p a r t of th e n u r s e ( f o r 1 s t 72 h r s . p o s to p ) .
1. T h e p a ti e n t i s c a ll e d b y n a m e a n d th e n u r s e i n tr o d u c e s
h e r s e l f to th e p a ti e n t u p o n h i s r e t u r n to th e u n it f r o m th e
r e c o v e r y r o o m . R e c o v e r y r o o m n u r s e a ls o d o e s t h is .
2. T h e p a t i e n t i s to ld t h a t h e h a s a m e d i c a t i o n o r d e r e d f o r
p a in a n d th e t im e s c h e d u le b y w h ic h t h is m e d i c a ti o n m a y
be a d m in iste re d .
3. W h e n th e p a ti e n t e x p r e s s e s t h a t h e i s in p a in ( o r o b s e r v e d
to b e so) th e fo llo w in g p r o c e d u r e i s fo llo w e d :
3. 1 T h e n u r s e e n c o u r a g e s th e p a t i e n t to d e s c r i b e a n d
l o c a t e th e p a i n / d i s c o m f o r t .
3. 2 T h e o r d e r e d a n a l g e s i c i s g i v e n w ith in f iv e m in u t e s .
(If th e t im e c o n ti n g e n c ie s p r o h i b i t t h i s , th e n u r s e so
i n f o r m s th e p a ti e n t t h a t t h e m e d i c a t i o n w ill b e g iv e n
a t th e f i r s t a llo w a b le t i m e a n d p r o c e e d s w ith th e
r e m a i n d e r o f th e s te p s o f t h e p r o c e d u r e . )
3. 3 T h e p a t i e n t i s g iv e n a 2 - 3 m in u t e b a c k r u b a n d r e p o s i
t io n e d f o r c o m f o r t.
3 .4 L i n e n s a r e c h e c k e d f o r s o il in g , w e t n e s s , w r in k lin g ,
an d c h a n g ed o r s tr a ig h te n e d .
3. 5 T h e o p p o r tu n ity to v o id i s o f f e r e d .
3 .6 T h e d r e s s i n g i s o b s e r v e d , c h a n g e d o r r e i n f o r c e d if
n e c e s s a r y , a n d a v e r b a l r e p o r t on i t s c o n d itio n i s
g iv e n to th e p a tie n t.
3. 7 T h e i n tr a v e n o u s in f u s io n , n a s o - g a s t r i c s u c ti o n , c a t h
e t e r , if p r e s e n t , a r e o b s e r v e d a n d a r e p o r t i s g iv e n
to th e p a ti e n t.
3. 8 T h e n u r s e s i t s q u ie tly w ith th e p a ti e n t, e li c it in g a n d
r e s p o n d in g to th e p a t i e n t 's v e r b a l i z a t i o n s . D u rin g
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130
t h is t im e s h e a s k s t h e p a t i e n t a b o u t h i s u s u a l w a y s
of d e a lin g w ith p a in , a n d r e i n f o r c e s a n d e n c o u r a g e s
h i s p r e s e n t u s e of t h o s e p a in c o p in g s k i l l s w h ic h a r e
a p p r o p r i a t e in t h is s it u a ti o n .
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A p p e n d ix D
S tru c tu re d In te r v ie w
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132
C ode #
S tr u c tu r e d In te r v ie w
B e fo re S u rg e ry (a d m iss io n day)
2. P l e a s e d e s c r i b e w h a t y o u a r e t e n s e o r n e r v o u s a b o u t?
3. W h a t a r e y o u d o in g to r e d u c e y o u r t e n s e n e s s / n e r v o u s n e s s ?
4. W h a t a r e o t h e r s d o in g to r e d u c e y o u r t e n s i o n ( p h y s ic ia n ,
f a m i ly , s ta f f) ?
5. W h a t a r e o t h e r s d o in g t h a t s e e m s to i n c r e a s e y o u r t e n s i o n ?
A f t e r S u r g e r y (4 th p o s t o p e r a t i v e d a y )
6. W e re you te n s e o r n e rv o u s a f t e r y o u r s u rg e r y ?
7. P l e a s e d e s c r i b e w h a t y o u w e r e t e n s e o r n e r v o u s a b o u t?
8. W h a t d id y o u do to r e d u c e y o u r t e n s i o n ?
9. W h a t d id o t h e r s d o t h a t r e d u c e d y o u r t e n s i o n ? (cu e p re o p
t e a c h in g )
10. W h a t d id o t h e r s do t h a t i n c r e a s e d y o u r te n s io n ?
11. D id th e v i s i t o r s y o u h a d i n c r e a s e o r d e c r e a s e y o u r t e n s i o n ?
12. D id y o u h a v e p a in a f t e r y o u r s u r g e r y ?
13. P l e a s e d e s c r i b e , in y o u r o w n w o r d s , w h a t y o u f e l t ?
15. W as th e p a in t h a t y o u h a d , m o r e th a n , l e s s th a n , o r a b o u t w h a t
y o u e x p e c te d ?
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133
16. A f t e r s u r g e r y , w h a t o n e a c ti o n o r e x p e r i e n c e i n c r e a s e d y o u r
y o u r te n s i o n m o s t ?
17. D e c re a s e d y o u r te n s io n m o s t?
18. W h a t a c ti o n , on th e p a r t o f o t h e r s , h e lp e d y o u m o s t d u r in g
y o u r p a in ?
19. W h a t a c ti o n s c o u ld o t h e r s h a v e ta k e n w h ic h y o u th in k w o u ld
h a v e b e e n of h e lp to y o u d u r in g y o u r p a in ?
2 0. P l e a s e d e s c r i b e y o u r m o o d to d a y .
21. T o w h a t e x te n t w e r e y o u a w a r e of th e fo llo w in g w h e n y o u w e r e
in p a in ?
N ot Som e M ost
a t a ll S e ld o m o f t im e O f te n of t im e
P o u n d in g of h e a r t
R a p id o r d i f f ic u l t b r e a t h in g
I n c r e a s e d s w e a tin g
N e e d to u r i n a t e
T im e g o in g b y s lo w ly
I n c r e a s e in i r r i t a b i l i t y
A t t e m p t to " c o n t r o l " y o u r s e l f
D e c r e a s e d e s i r e to t a l k to
o th e rs
I n c r e a s e d d e s i r e to t a l k to
o th e rs
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134
A p p e n d ix E
R e c o r d of N u r s in g I n t e r v e n t i o n D a ta
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R e p ro d u c e d
with
Code #
p e r m is s io n
R e c o r d o f N u r s in g I n t e r v e n t i o n D a ta
D a te / D a te / D a te / D a te / D a te / D a te / D a te / D a te / D a te / D a te /
of the
T im e T im e T im e T im e T im e T im e T im e T im e T im e T im e
c o p y rig h t o w n e r .
P t. c a lle d by n a m e /
n u r s e s e lf in tr o .
P t . t o ld r e p r n m e d .
sc h e d u le
F u rth e r re p r o d u c tio n
P a in d e s c r ib e d and
n o te d
P R N p a in m e d g iv e n
F in g e r p r in t ta k e n
2 - 3 m in . b a c k r u b /
p ro h ib ite d
re p o s itio n e d fo r
co m fo rt
L in e n s c h e c k e d and
w ith o u t p e r m i s s i o n .
c h a n g e d o r s m o o th e d
V o id in g o f f e r e d
135
R e p ro d u c e d
with
D a te / D a te / D a te / D a te / D a te / D a te / D a te / D a te / D a te / D a te /
p e r m is s io n
T im e T im e T im e T im e T im e T im e T im e T im e T im e T im e
D rsg . o b se rv e d , r e in
f o r c e d a n d r e p o r t to
of the
p t.
c o p y rig h t o w n e r .
T u b in g c h e c k e d ,
r e p o r t to p t.
N u r s e s i t s w ith p t.
en c . v e rb a liz a tio n
su p p o rts a p p ro p ria te
c o p in g m e c h a n i s m s
F u rth e r re p ro d u c tio n
F i n g e r p r i n t 1 /2 h r .
p o st p rn m ed.
K ey: D o n e - - n o te d a te , t i m e , i n i t i a l s
N ot d o n e --n o te re a s o n , and in itia l
p ro h ib ite d
w ith o u t p e r m i s s i o n .
137
A p p e n d ix F
D e t a il e d F i n g e r S w e a t P r i n t ( F S P ) P r o c e d u r e
fo r E x p e r im e n t
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138
D e t a il e d F i n g e r S w e a t P r i n t ( F S P ) P r o c e d u r e
f o r E x p e r im e n t
W h e n to o b ta in f in g e r p r i n t
1. I m m e d ia t e l y b e f o r e g iv in g p r e o p m e d i c a ti o n .
F o r 1 s t 72 h r s . p o s to p :
2. I m m e d ia t e l y a f t e r a d m i n i s t e r i n g e a c h p r n p a in m e d i c a ti o n .
3. O n e - h a lf h o u r a f t e r e a c h p r n p a in m e d i c a ti o n h a s b e e n a d m i n
iste re d .
H o w to o b ta in f in g e r p r i n t
1. D ip c le a n , c o tto n s w a b i n to th e F e r r i c C h l o r id e S o lu tio n .
2. S w ab d i s t a l p a r t of m id d l e f i n g e r o f R t. H a n d .
3. A llo w to d r y f o r 30 s e c o n d s .
4. P l a c e p a p e r s t r i p in p l a s t i c s p li n t (to u c h o n ly c o r n e r o f p a p e r ) .
5. P l a c e s p li n t on d i s t a l m id d l e f i n g e r (w ith s p li n t c o v e r i n g f i r s t
j o in t of f in g e r ) a n d a t t a c h w ith r u b b e r b a n d .
6. L e a v e s p li n t in p l a c e f o r 1 m in u t e . (H o ld f in g e r u p to p r e v e n t
p r e s s i n g f in g e r a g a i n s t a h a r d s u r f a c e . )
7. R e m o v e p a p e r f r o m s p l i n t (to u c h in g o n ly c o r n e r ) a n d p l a c e
p a p e r in s e p a r a t e g l a s s i n e e n v e lo p e .
8. L a b e l e n v e lo p e w ith
8. 1 P t 's co d e n u m b e r
8 .2 D a te
8. 3 T im e t a k e n / y o u r i n i t i a l s
8 .4 A t p rn m e d . o r 1 /2 h r . p o s t p rn m e d .
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139
A p p e n d ix G
D e t a il e d F i n g e r S w e a t P r i n t ( F S P ) P r o c e d u r e
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D E T A IL E D F IN G E R S W E A T P R IN T ( F S P ) P R O C E D U R E
T h e p u r p o s e o f t h i s d o c u m e n t i s to d e t a i l in " c o o k b o o k "
f a s h i o n th e f i n g e r s w e a t p r i n t p r o c e d u r e ( F S P ) , s o t h a t o t h e r i n v e s
t i g a t o r s m a y u s e t h e te c h n iq u e w ith a m in i m u m o f t r o u b l e .
In g e n e r a l th e p r o c e d u r e in v o lv e s :
1. P r e p a r i n g p a p e r s t r i p s u s in g T a n n ic A c id , T h y m o l, a n d
d is tille d w a te r.
2. P r e p a r i n g a F e r r i c C h l o r id e S o lu tio n u s in g F e r r i c
C h l o r id e , H y d r o c h lo r i c A c id , a n d A c e to n e .
3. A c t u a ll y ta k in g th e p r i n t s .
4. R a tin g th e p r i n t s .
P r e p a r in g P a p e r S trip s
A. M ix in g th e T a n n ic A c id S o lu tio n
1. P u t 1000 c c . of d i s t i l l e d w a t e r in a p y r e x g l a s s c o n t a i n e r .
2. T o th e d i s t i l l e d w a t e r a d d 50 g r a m s o f T a n n ic A c id a n d
o n e g r a m of T h y m o l.
3. S t i r m i x t u r e w h ile h e a ti n g i t g e n tly . P o s s ib ly a g la s s
s t i r r e r w o u ld b e b e s t .
4. W h en th e i n g r e d i e n t s a r e in s o lu t io n , f i l t e r t h e s o lu t io n
u s in g a g l a s s f u n n e l i n to th e o p a q u e c o n ta i n e r a n d p u t th e
lid on.
5. U n d e r r e f r i g e r a t i o n th e s o lu t io n w i l l " k e e p " f o r 6 m o n th s .
B. T he P a p e r S trip s
1. S h e e ts of W h a tm a n F i l t e r P a p e r , G r a d e #1 o r #3 in 2, 3,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
141
4 c m . o r 1 in . w id th s c a n b e u s e d . U s in g p a p e r of
d i f f e r i n g w id th s f o r d i f f e r e n t s u b je c t s s e e m s to b e a n
u n n e c e s s a r y c o m p l i c a t in g a d d itio n . I n m y e x p e r i e n c e
1 in . w a s s u f f i c i e n t f o r th e w i d e s t f i n g e r e n c o u n te r e d .
(T h e s a m e g r a d e s h o u ld b e u s e d th ro u g h o u t a s in g l e
e x p e rim e n t. )
2. L e n g th : T h e f i n a l le n g th of th e p r i n t s t h a t w i l l b e u s e d is
r o u g h ly 1 1 /2 to 2 i n c h e s ; h o w e v e r , a t t h i s s t a g e cut
t h e m j u s t lo n g e n o u g h to f it f l a t in th e b o t to m o f a "p y rex "
d i s h . T h e p u r p o s e o f t h is i s to m a k e t h e m e a s i e r to
h a n d le a t t h i s s ta g e w h ile s o a k in g t h e m a n d to c u t d o w n on
v a r i a b i l i t y in s o a k in g t im e .
W e a r p l a s t i c g l o v e s w h ile c u ttin g th e p a p e r s t r i p s to k e e p
f in g e r p r i n t s off th e p a p e r . C u t th e p a p e r w ith s t a i n l e s s
s te e l s c i s s o r s . C u t m o re s tr ip s th a n y o u w ill n e e d ,
s in c e s o m e m a y b e " s p o i l e d . "
4. W e a r in g a p l a s t i c g lo v e , la y s e v e r a l o f th e p a p e r s t r i p s
in th e d i s h s o t h a t t h e y do n o t o v e r l a p .
5. A f t e r t h r e e m in u t e s o f s o a k in g , t a k e th e s t r i p s o u t of th e
s o lu t io n ( w e a r a p l a s t i c g lo v e ) . S h a k e th e e x c e s s T a n n ic
A c id off t h e s t r i p s a n d la y th e m on a c le a n f o r m i c a
c o u n te r to d r y . A f t e r a b o u t 5 -1 0 m in u t e s p i c k u p th e
s t r i p s a n d m o v e t h e m to a d r y s p o t on th e c o u n t e r . T h is
r e m o v e s th e e x c e s s T a n n ic A c id a n d p r e v e n t s th e e d g e s
o f th e s t r i p s f r o m tu r n i n g d a r k .
6. T h e s t r i p s w ill d r y in a b o u t a n h o u r . G iv e t h e m a t l e a s t
t h is m u c h t i m e . T h e y t e n d to c u r l a l i t t l e a s t h e y d r y .
7. U s in g p l a s t i c g lo v e s a n d th e s t e e l s c i s s o r s , c u t th e
s t r i p s in to d e s i r e d le n g t h s . If t h e r e a r e b l a c k d o ts on th e
p a p e r , c u t a r o u n d th e m . W h en d r i e d th e s t r i p s s h o u ld
h a v e a v e r y lig h t , t a n n i s h c o lo r .
8. Do n o t r e u s e th e T a n n ic A c id S o lu tio n , s in c e t h e r e i s th e
d a n g e r t h a t i r o n m a y g e t in to i t a s i t i s b e in g u s e d . T h e r e
i s e n o u g h s o lu t io n f o r s e v e r a l b a t c h e s . A d d i t io n a l T a n n ic
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
142
A c id S o lu tio n c a n b e m a d e if n e c e s s a r y .
9. I f b l a c k d o ts a p p e a r on th e p a p e r t h is i n d i c a t e s t h a t th e
i r o n s o m e h o w w a s i n tr o d u c e d in to th e p r o c e d u r e . If
t h e r e a r e m a n y of t h e m , th e n a c a r e f u l e x a m i n a ti o n of
t h e t e c h n i q u e s u s e d s h o u ld b e c a r r i e d o u t to r e v e a l th e
s o u r c e . P a p e r f r e e o f b l a c k d o ts a n d o f l ig h t , ta n n i s h
c o l o r m e e t s th e c r i t e r i a f o r a p p r o p r i a t e u s e .
T h e F e r r i c C h lo r id e S o lu tio n
C. M a te ria ls
1. T h i r t e e n g r a m s o f A n h y d r o u s F e r r i c C h l o r id e ( F e C l g ) .
W e u s e d : F e r r i c C h l o r id e , A n h y d r o u s , R e a g e n t, P o w d e r ,
S u b l im e d , F e C l 3 .
2. T h r e e d r o p s o f h y d r o c h l o r i c a c id . U s e f u ll s t r e n g t h ,
s in c e i t i s m ix e d w ith 4 00 c c . of A c e t o n e , a n d t h e r e i s
n o d a n g e r to S s .
3. G e t a o n e p i n t b o t tl e o f A c e to n e . W e u s e d : A c e to n e :
B a k e r A n a ly z e d R e a g e n t. 40 0 c c . of A c e t o n e w ill b e u s e d
in th e F e r r i c C h l o r id e S o lu tio n . I t m ig h t b e b e s t to g e t
2 b o t t l e s of A c e to n e to h a v e a n e x t r a a m o u n t on h a n d .
4. A n o p a q u e g l a s s c o n ta i n e r in w h ic h to s t o r e s o lu t io n .
5. A g l a s s m e d i c in e d r o p p e r .
6. A f ilte r. C o ffe e f i l t e r s s e e m to w o r k o k a y .
7. P u t 4 0 0 c c . of A c e to n e R e a g e n t g r a d e i n to a 1000 M L
G r a d u a t e C y l in d e r .
8. A d d 13 g r a m s of F e C l g a n d t h r e e d r o p s o f u n d i lu t e d H C L .
9. DO N O T H E A T T H E M IX T U R E ; A C E T O N E IS H IG H L Y
FLAM M ABLE.
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143
T a k in g th e P r i n t
1. T h e f i n g e r u s e d i s a m a t t e r o f p e r s o n a l c h o ic e . I t s h o u ld
b e h e ld c o n s ta n t . M o s t w o r k h a s b e e n d o n e w ith th e
i n d e x f i n g e r . A v a r i e t y o f w a y s o f c le a n in g th e f in g e r
h a v e b e e n t r i e d , e . g . , w a s h in g , a lc o h o l , a c e t o n e . I t
m ig h t b e w o r t h m e n tio n in g t h a t th e S c o u ld s im p ly w a s h
h i s h a n d s b e f o r e th e e x p e r i m e n t . I c o l l e c t e d s o m e d a ta
w h ic h I f e l t d id n o t j u s t i f y p u b l ic a ti o n b e c a u s e of th e
i n s i g n i f i c a n c e of th e p r o b le m t h a t i n d i c a t e d t h a t w a s h in g
th e h a n d s o r c le a n in g th e m w ith a c e t o n e d id n o t y i e l d
p r i n t s d i s t in g u i s h a b le f r o m t h o s e f r o m u n w a s h e d h a n d s
o r t h o s e c l e a n e d w ith a c e t o n e .
2. D ip c le a n , c o tto n sw a b in to th e F e r r i c C h l o r id e S o lu tio n .
T h e n s w a b th e d i s t a l p a r t of th e f i n g e r , f i r s t o n e h a n d
t h e n t h e o t h e r . T h e F e r r i c C h l o r id e S o lu tio n s h o u ld d r y
in 30 s e c o n d s o r l e s s . I t i s u s e f u l to h a v e s o m e s m a l l
(2 o r 3 o u n c e ) b o t t l e s to p o u r F e C l 3 i n to s o e a c h S c a n
h a v e h i s ow n f r e s h s o lu t io n w ith o u t w a s tin g to o m u c h
F e C 13 .
3. W h ile th e F e r r i c C h l o r id e S o lu tio n i s d r y in g on th e f in g e r ,
p l a c e a s t r i p o f p a p e r in th e m id d l e o f a p l a s t i c s p li n t.
T h e w id th o f t h e p a p e r a n d s p li n t s h o u ld b e a p p r o p r i a t e
f o r th e s i z e of th e S s f in g e r . A p i e c e o f a d h e s i v e ta p e
s h o u ld h a v e b e e n p l a c e d o n th e s p li n t c r o s s w i s e s o t h a t
th e s id e e d g e of th e t a p e a n d o n e e n d e d g e of th e p l a s t i c
s p l i n t c o in c id e . P r e l a b e l i n g th e p r i n t s e e m s to f a c i l i t a t e
o p e r a t i o n s f o r th e e x p e r i m e n t e r .
4. W h e n th e F e r r i c C h l o r id e S o lu tio n i s d r y ( a f t e r 30 s e c o n d s )
h a v e th e S p l a c e th e d i s t a l p a r t of h i s f i n g e r on th e p a p e r
s t r i p . T h e n , q u ic k ly w r a p th e a d h e s i v e t a p e a r o u n d th e
f i n g e r to fo ld th e s p li n t a n d p a p e r f i r m l y a g a i n s t th e
f i n g e r , S T A R T T IM IN G . T e l l th e S to h o ld h i s f in g e r
u p (to p r e v e n t h i s p r e s s i n g th e f i n g e r a g a i n s t a h a r d
su rfa c e ).
5. U s e t h e p r i n t d u r a t i o n t h a t b e s t f i t s th e d e s ig n of y o u r
s tu d y w ith p r e f e r e n c e g iv e n to s h o r t e r t im e p e r i o d s .
6. A f t e r th e t im e d p e r i o d q u ic k ly r e m o v e t h e t a p e , p a p e r ,
a n d s p l i n t f r o m th e f in g e r .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
T h e G r e e n G lo p P r o b l e m
W h e n F e C l 3 i s t r a n s f e r r e d to th e T a n n ic A c id t r e a t e d f i l t e r
p a p e r in th e p r e s e n c e of s w e a t ( w a te r ) , i t l e a v e s a g r e e n r e s i d u e
tu rn g r a y is h b la c k . T h e c o lo r i s e a s i l y d i s t i n g u i s h a b l e f r o m th e
o r d i n a r y p r i n t c o lo r w ith a l i t t l e e x p e r i e n c e . T h e g r e e n g lo p p r o b
l e m u s u a ll y o n ly o c c u r s t o w a r d th e e n d of a s e r i e s of r e p e a t e d
m e a s u r e m e n t , a n d c a n b e g r e a t l y r e d u c e d b y th e fo llo w in g p r e c a u
i. e . , t r y to r e d u c e e v a p o r a t io n of th e a c e t o n e w h ic h a c t s s o le l y a s
a d r y in g a g e n t b y : (a) k e e p in g a lid on th e F e C l 3 e x c e p t w h e n
d ip p in g a n d (b) u s in g a s m a l l a m o u n t of F e C l 3 a t a t im e a n d c h a n g
in g t h e s o lu t io n a f t e r X n u m b e r of p r i n t s o r X a m o u n ts o f t im e .
P r i n t R a t in g s
1. A p h o t o g r a p h of " s t a n d a r d " p r i n t s m a y b e u s e d to r a t e
th e p r i n t s . I t c a n b e o b ta in e d f r o m D r . D o u g la s M c N a ir ,
7 00 H a r r i s o n A v e n u e , B o s to n , M a s s a c h u s e t t s f o r $2. 00.
M a k e t h e c h e c k o u t to th e P s y c h o p h a r m a c o l o g y L a b o r a
t o r y , B o s to n U n i v e r s i ty M e d ic a l C e n t e r .
2. W e u s e a p h o to g r a p h of a 1 5 - p o in t s c a l e ( i n t e r r a t e r r =
. 9 4 - . 97). W e u s e t h r e e r a t e r s w h o h a v e v a r i e d f r o m
o n e s tu d y to a n o th e r . E a c h r a t e r s e e m s to h a v e h i s
o w n m e a n l e v e l o f r a t i n g , s o t h a t i t i s a d v is a b l e to u s e
th e s a m e t h r e e r a t e r s f o r a l l r a t i n g s in a s tu d y .
I t s e e m s a d v is a b l e to h a v e a l l th e r a t i n g s d o n e in th e s a m e
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145
p l a c e to k e e p lig h tin g c o n d itio n s a s s t a n d a r d a s p o s s i b l e . R a te rs
a r e e a sily tra in e d . W e f e e l t h a t r a t i n g th e d a r k e s t s p o t o r th e
" b l a c k n e s s " of th e d a r k e s t s p o t g i v e s t h e m o s t v a li d r a t i n g , s o t h is
is how we in s tr u c t new r a t e r s . T h e o n e e x c e p t i o n to th is i s w h e n
t h e r e i s o n ly o n e d o t t h a t i s v e r y d a r k r e l a t i v e to a g r o u p of l i g h t e r
d o ts. W e do n o t f e e l t h a t o n e d o t p r o v i d e s s u f f i c i e n t e v id e n c e to
m a k e a v a li d r a t i n g , so t h a t w e r a t e t h e l i g h t e r d o t s .
W e r a t e th e p r i n t s a t th e e n d o f e a c h d a y 's t e s t in g o r a t s o m e
c o n s t a n t p o s t - m e a s u r e m e n t t im e s i n c e P a u l 's (1 9 6 6 ) d a ta s u g g e s t
t h a t th e p r i n t s m a y d a r k e n o v e r t i m e . W e s im p ly u s e th e s u m of
t h e t h r e e r a t i n g s in th e a n a ly s i s o f t h e r e s u l t s , b u t th e m e a n r a t i n g
w i l l p r o v id e th e s a m e r e s u l t s w i t h in r o u n d in g e r r o r .
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146
A p p e n d ix H
P h o t o g r a p h o f D i g i ta l S w e a t P r i n t s
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Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
148
A p p e n d ix I
S c h e d u le of R e c e n t E x p e r i e n c e s
Q u e s t io n n a i r e
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149
C o d e # ______
S c h e d u le of R e c e n t E x p e r i e n c e s Q u e s t i o n n a i r e
C i r c l e t h o s e e v e n ts w h ic h y o u h a v e e x p e r i e n c e d in t h e p a s t y e a r .
L C U V a lu e s
F a m il y :
D e a th of s p o u s e 100
D iv o rc e 73
M a rita l s e p a r a tio n 65
D e a th o f c l o s e f a m i ly m e m b e r 63
M a rr ia g e 50
M a r ita l r e c o n c ilia tio n 45
M a jo r c h a n g e in h e a l t h of f a m i ly 44
P re g n an c y 40
A d d itio n of n e w f a m i ly m e m b e r 39
M a jo r c h a n g e in a r g u m e n t s w ith s p o u s e 35
S o n o r d a u g h te r l e a v in g h o m e 29
I n -la w tro u b le s 29
S p o u s e s t a r t i n g o r e n d in g w o r k 26
M a jo r c h a n g e in f a m i ly g e t - t o g e t h e r s 15
P e rso n a l:
D e te n tio n in j a i l 63
M a jo r p e r s o n a l i n j u r y o r i l l n e s s 53
S e x u a l d iffic u ltie s 39
D e a th of a c l o s e f r i e n d 37
O u ts ta n d in g p e r s o n a l a c h ie v e m e n t 28
S t a r t a n d e n d of f o r m a l s c h o o lin g 26
M a jo r c h a n g e in liv in g c o n d itio n s 25
M a jo r r e v i s i o n of p e r s o n a l h a b it s 24
C h a n g in g to a n e w s c h o o l 20
C h an g e in r e s id e n c e 20
M a jo r c h a n g e in r e c r e a t i o n 19
M a jo r c h a n g e in c h u r c h a c t i v i t i e s 19
M a jo r c h a n g e in s le e p in g h a b i t s 16
M a jo r c h a n g e in e a tin g h a b it s 15
V a c a ti o n 13
C h ristm a s 12
M in o r v i o la t io n s o f th e la w 11
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150
L C U V a lu e s
W o rk :
B e in g f i r e d f r o m w o r k 47
R e tir e m e n t f ro m w o rk 45
M a jo r b u s i n e s s a d ju s t m e n t 39
C h a n g in g to d i f f e r e n t l in e of w o r k 36
M a jo r c h a n g e in w o r k r e s p o n s i b i l i t i e s 29
T r o u b le w ith b o s s 23
M a jo r c h a n g e in w o r k in g c o n d itio n s 20
F i n a n c i a l:
M a jo r c h a n g e in f i n a n c i a l s t a t e 38
M o r t g a g e o r lo a n o v e r $ 1 0 , 000 31
M o rtg a g e f o r e c lo s u r e 30
M o r t g a g e o r l o a n l e s s th a n $ 1 0 , 000 17
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A p p e n d ix J
P r e lim in a ry C o rre s p o n d e n c e
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152
J a n u a r y 6, 1977
T h o m a s F . M o o n e y , E d . D.
2 1 1 8 G r i s w o ld
P o r t H u r o n , M ic h ig a n 480 6 0
D e a r D r. M ooney:
B y w a y o f s e l f - i n t r o d u c t i o n , I a m c o m p l e ti n g th e E d . D . in E d u c a
tio n a l L e a d e rs h ip and h a v e h a d m y p r o p o s a l a c c e p te d . D r. R o b e rt
T r a v e r s i s a m e m b e r of m y c o m m i t t e e . I a m p r o p o s i n g to i n v e s
t i g a t e th e e f f e c ts of c e r t a i n d i m e n s io n s o f n u r s i n g i n t e r v e n t i o n on
t h e a n x ie t y c o m p o n e n t of th e p o s t o p e r a t i v e p a in e x p e r i e n c e . T o
t h a t e n d I w is h to u s e , a s o n e m e a s u r e , t h e DSI w h ic h y o u u s e d in
y o u r re s e a rc h h e re .
S p e c i f i c a l l y , I w is h to i n q u ir e a b o u t a n y m e c h a n i c a l ty p e i n f o r m a
t io n y o u m a y h a v e l e a r n e d f r o m a d m i n i s t e r i n g th e m e a s u r e . Y o u
o u t li n e t h e p r o c e d u r e v e r y c o m p r e h e n s i v e l y in y o u r d i s s e r t a t i o n
b u t I th o u g h t, b e f o r e b e g in n in g , t h a t a n i n q u i r y a n d a n y b e n e f i t of
y o u r e x p e r i e n c e m ig h t b e h e lp f u l to m e . S h o u ld y o u h a v e a n e x t r a
p r o to t y p e of th e a c t u a l f i n g e r p r i n t d e v i c e , t h a t w o u ld b e e s p e c i a l l y
r e a s s u r i n g to h a v e .
I v e r y m u c h a p p r e c i a t e y o u r c o n s i d e r a t i o n a n d r e s p o n s e to th is
re q u e s t. T hank you.
S in c e r e ly ,
P h y l l i s C . N ic o la o u , R . N . , M . S. N.
3410 R u n n y m e d e D riv e
K a l a m a z o o , M ic h ig a n 4 900 7
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
153
J a n u a r y 17, 1977
M s . P h y l l i s C. N i c o la o u
3 410 R u n n y m e d e D r i v e
K a l a m a z o o , M I 490 0 7
D e a r P h y l li s :
T h a n k y o u v e r y m u c h f o r y o u r l e t t e r o f J a n u a r y 6. E n c l o s e d y o u
w i l l fin d v a r i o u s a r t i c l e s d e s c r i b i n g th e D. S. I. T h e s e a r t i c l e s r e p
r e s e n t a r e l a t i v e l y t h o r o u g h r e v i e w o f t h e l i t e r a t u r e u p t h r o u g h 19 7 3 .
E n c l o s e d a ls o i s a p i c t u r e o f t h e v a r i o u s p r i n t s to b e u s e d f o r s c o r
in g . D e s p i te th e s o m e w h a t c u m b e r s o m e a p p a r a t u s r e q u i r e d to t a k e
th e D. S. I. , i t r e a l l y p r o v e d to b e a f a s c i n a t i n g p a r t o f m y r e s e a r c h
a s w e ll a s a v a li d i n d i c a t o r of c h a n g e s in e m o t i o n a l it y .
T o p r e p a r e th e v a r i o u s s o lu t io n s , I s u g g e s t y o u c o n ta c t s o m e o n e in
th e C h e m i s t r y D e p a r tm e n t. I h a d w o r k e d w ith D r . J . L i n d s a y F o o te
o f th e B i o c h e m i s t r y D e p a r t m e n t a t W . M . U. a n d fo u n d h im to b e
m o s t h e lp f u l. If m y m e m o r y s e r v e s m e c o r r e c t l y I r e c a l l le a v in g
s o m e of t h e s e m a t e r i a l s w ith D r . T r a v e r s - - b u t t h a t w a s a l m o s t f o u r
y e a rs ago.
I a m v e r y m u c h i n t e r e s t e d in y o u r r e s e a r c h a n d w o u ld h o p e t h a t y o u
w o u ld s e n d m e w h a t e v e r y o u c a n f r o m y o u r f in d i n g s . Y o u no d o u b t
r e a l i z e t h a t w o r k in g w ith D r . T r a v e r s i s a u n iq u e a n d f o r t u n a te
e x p e r i e n c e . W h e n y o u s e e h i m n e x t p l e a s e g iv e h i m m y w a r m e s t
r e g a r d s and if J a n i s s t i l l w o r k in g f o r h i m p l e a s e t e l l h e r t h a t w e
h a v e a w e d d in g p r e s e n t f o r h e r (o n ly a few m o n th s la t e ) a n d w ill b e
g e ttin g i t to h e r .
W ith b e s t w i s h e s f o r a s u c c e s s f u l s tu d y .
M o s t c o r d i a ll y ,
T h o m a s F . M o o n e y , E d . D.
P s y c h o lo g y D e p a r tm e n t
P . S. P l e a s e r e t u r n t h e s e m a t e r i a l s w h e n y o u h a v e f in i s h e d w ith
th e m .
C_Q_PY
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
154
J a n u a r y 19, 1977
T h o m a s F . M ooney, E d . D.
S t. C l a i r C o u n ty C o m m u n ity C o lle g e
232 E r i e S t r e e t
P o r t H u r o n , M ic h ig a n 4 8 0 6 0
D e a r D r. M ooney:
I r e c e i v e d y o u r p a c k e t of m a t e r i a l s y e s t e r d a y a n d a m v e r y a p p r e
c i a t i v e of y o u r p r o m p t r e s p o n s e a n d g e n e r o u s s h a r i n g o f m a t e r i a l s .
C e r t a i n l y t h e v e r y d e t a i l e d p r o c e d u r e f o r o b ta in in g th e D i g i ta l
S w e a t m e a s u r e a n d th e a r t i c l e s w ill b e of n e c e s s a r y h e lp .
I s h a l l c o n v e y y o u r m e s s a g e s to D r . T r a v e r s a n d J a n (if s h e i s
s t i l l w ith h im ) , a n d r e t u r n t h e m a t e r i a l s to y o u w h e n I a m f in i s h e d
w ith th e m . A ls o , I s h a l l b e h a p p y to s h a r e a n y of th e r e s u l t s o f t h e
s tu d y w h ic h m ig h t b e of i n t e r e s t to y o u .
A g a in m y s i n c e r e a p p r e c i a t i o n f o r y o u r h e lp f u l n e s s .
S i n c e r e ly ,
P h y l l i s C. N ic o la o u
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155
J a n u a r y 20, 1977
R . H . R a h e , M . D. , C D R . M . C. , U S N R
B io c h e m ic a l C o r r e la te s D iv isio n
U. S . N a v y M e d ic a l N e u r o p s y c h i a t r i c R e s e a r c h U n it
S a n D ie g o , C a l if o r n ia 9 2 1 5 2
D e a r D r. R ahe:
B y w a y of s e l f - i n t r o d u c t i o n , I a m a d o c t o r a l c a n d id a t e f o r t h e E d . D .
d e g r e e a t W e s t e r n M ic h i g a n U n i v e r s i t y a n d a ls o a N u r s e e d u c a t o r .
T h e s u b je c t o f m y a p p r o v e d p r o p o s a l f o r th e d i s s e r t a t i o n r e s e a r c h
i s , " N u r s in g I n t e r v e n t i o n i n to th e A n x ie ty C o m p o n e n t o f P o s t o p e r a
t iv e P a i n in S e l e c t e d A d u l t s . "
I w o u ld l ik e to u s e t h e r e v i s e d R e c e n t L if e C h a n g e s Q u e s t i o n n a i r e
(R L C Q ) a s a m e a s u r e to g r o u p s u b je c t s i n to H ig h a n d L o w r e c e n t
l if e s t r e s s c a t e g o r i e s i n o r d e r to t e s t o n e o f m y h y p o t h e s i s ;
n a m e ly , t h a t s u b je c t s w i l l r e s p o n d d i f f e r e n t i a l l y to th e e x p e r i m e n t a l
t r e a t m e n t on th e b a s i s o f th e a m o u n t of l if e s t r e s s t h e y h a v e e x p e r i
e n c e d in th e y e a r p r i o r to th e p r e s e n t s u r g e r y .
In th e b o o k C o n c e p tu a l M o d e ls f o r N u r s in g P r a c t i c e e d it e d b y R i e h l
a n d R o y , y o u i n d i c a t e in y o u r c h a p t e r (p. 79) t h a t a c u r r e n t e d itio n
of th e R L C Q c o n ta in s 54 l if e c h a n g e q u e s ti o n s a n d p r o v i d e s f o r
o b ta in in g a s u b je c t iv e l if e c h a n g e u n it s c o r e (S L C U ).
M a y I s p e c i f i c a l l y r e q u e s t y o u r a s s i s t a n c e w ith th e f o llo w in g :
1. I s th e m o s t r e c e n t e d itio n o f th e R L C Q w ith s c o r i n g
in s tr u c tio n s a v a ila b le f o r p u rc h a s e ? If so , ca n you
p r o v id e m e w ith i n f o r m a t i o n s o t h a t I m ig h t o r d e r
s ix t y (60) c o p ie s of t h i s i n s t r u m e n t ?
2. I f th e i n s t r u m e n t i s a v a il a b le f r o m y o u r u n it, w o u ld
y o u b e a b le to h a v e 60 c o p ie s s e n t to m e a n d I s h a l l
r e m it c o s t by r e tu r n m a il?
I v e r y m u c h a p p r e c i a t e y o u r c o n s i d e r a t i o n a n d r e s p o n s e to t h is
re q u e s t.
S i n c e r e ly ,
P h y l li s C . N ic o la o u , R . N. , M . S. N.
3410 R u n n y m e d e D r i v e
K a la m a z o o , M ic h ig a n 4 9 0 0 7
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156
7 F e b r u a r y 1977
P h y l li s C . N ic o la o u , R . N . , M. S .N .
3410 R u n n y m e d e D r iv e
K a la m a z o o , M I 490 0 7
D e a r M s . N ic o la o u :
E n c l o s e d y o u w ill fin d a r e c e n t r e p r i n t w h ic h i n c l u d e s in th e
A p p e n d ix th e R e c e n t L if e C h a n g e s Q u e s t io n n a i r e . T h e v a r i e t i e s of
m e th o d s f o r s c o r i n g th e R L C Q a r e o u tlin e d in th e e n c lo s e d i n s t r u c
t io n s to i n v e s t i g a t o r s p a g e s . S in c e I w o r k f o r a g o v e r n m e n t l a b o
r a t o r y , I c a n n e i t h e r g iv e y o u n o r s e l l y o u c o p ie s of t h is i n s t r u m e n t .
Y ou a r e c e r t a i n l y f r e e to p r o d u c e 60 c o p ie s on y o u r o w n , h o w e v e r ,
w ith o u t a n y w o r r y a b o u t c o p y r i g h t i n f r i n g e m e n t s .
B e s t of lu c k in y o u r r e s e a r c h ,
R IC H A R D H. R A H E
C A P T A IN , M C , USNR
R H R :b ln
E n c l.
COPY
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
157
A p p e n d ix K
M a t e r i a l to S e c u r e M e d ic a l S ta ff P e r m i s s i o n
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158
M a t e r i a l f o r M e e tin g w ith M e d ic a l S t a f f
E x p e r i m e n t a l H o s p i ta l
P u r p o s e a n d I m p o r t a n c e of T h is P r o p o s e d R e s e a r c h
T h is s tu d y i s d e s ig n e d to m e a s u r e th e e f f e c t o f a s p e c i f i c ,
c o n s is t e n t l y a d m i n i s t e r e d n u r s i n g i n te r v e n t i o n i n to t h e a n x ie t y c o m
p o n e n t of t h e p o s t o p e r a t i v e p a in e x p e r i e n c e of s e l e c t e d a d u lt
p a tie n ts . T h e s t e p s of t h i s n u r s i n g i n te r v e n t i o n a r e d e s ig n e d to
r e d u c e th e a m o u n t of a n x ie t y th e p a ti e n t e x p e r i e n c e s d u r in g h i s
p o s t o p e r a t i v e p a in e x p e r i e n c e a n d a r e i n t e r v e n t i o n s in a d d it i o n to
th e a d m i n i s t r a t i o n of th e o r d e r e d a n a lg e s ic m e d i c a t i o n f o r p a in .
( A tta c h e d a r e t h e s p e c i f i c s t e p s o f th e N u r s in g I n t e r v e n t i o n T r e a t
m e n t. )
T h e s e s t e p s a r e d e s ig n e d to r e s p o n d to th e p a t i e n t 's n e e d f o r
p r e d i c t a b i l i t y , i n f o r m a t i o n , a p h y s ic a l e n v ir o n m e n t w h ic h p r o m o t e s
c o m f o r t, a n d t h e p s y c h o lo g i c a l s u p p o r t w h ic h t h e p r e s e n c e of a
T h e r e s e a r c h n u r s e w ill o b ta in a s ig n e d c o n s e n t f r o m e a c h
p a ti e n t w h o a g r e e s to p a r t i c i p a t e in t h is s tu d y . A n o n y m ity o f e a c h
s u b je c t w i l l b e m a i n t a i n e d . E a c h p a r t i c i p a ti n g p a t i e n t w i l l b e a s k e d
to:
1. C o m p le t e t h e L if e S t r e s s S c a le . T h is s c a l e i s d e s ig n e d
to a s s e s s th e l if e s t r e s s e s t h a t th e p a t i e n t m a y h a v e
e x p e r i e n c e d in t h e y e a r p r e c e d i n g s u r g e r y .
2. A llo w th e D i g i ta l S w e a t m e a s u r e to b e t a k e n a t
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159
p r e d e t e r m i n e d , p e r i o d i c t im e i n t e r v a l s . T h is m e a s u r e
h a s b e e n w id e ly u s e d in r e s e a r c h to m e a s u r e t h e a m o u n t
of p e r s p i r a t i o n in th e i n d e x f i n g e r . I t a p p e a r s to b e a
v a li d i n d i c a t o r of l e v e l o f e m o t i o n a l it y w h ic h o n e is
e x p e rie n c in g .
3. R e s p o n d v e r b a l l y on th e f o u r t h p o s t o p e r a t i v e d a y to a
s h o r t i n t e r v i e w . T h is i n t e r v i e w i s d e s ig n e d to o b ta in th e
p a t i e n t 's th o u g h ts a n d f e e l in g s a b o u t h i s r e c e n t p a in
e x p e rie n c e .
T h is p r o p o s e d s tu d y h a s b e e n r e v i e w e d a n d a p p r o v e d b y th e
fo llo w in g c o m m i t t e e s :
1. T h e s t u d e n t 's D o c t o r a l R e s e a r c h C o m m i t te e .
2. T h e H u m a n S u b j e c t s R e v ie w C o m m i t te e o f W e s t e r n
M ic h ig a n U n i v e r s i ty .
T h e s tu d y m e e t s t h e s e c o m m i t t e e s ' s t a n d a r d s o f r e s e a r c h
m e th o d o lo g y a n d s t a n d a r d s a n d p r o c e d u r e s f o r r e s e a r c h in v o lv in g
h u m a n s u b je c ts .
T h a n k y o u f o r_ y o u r c o n s i d e r a t i o n o f t h i s p r o p o s a l to c o n d u c t
n u r s i n g r e s e a r c h in y o u r h o s p i t a l .
P h y l l i s C . N i c o la o u , R . N. , M . S. N.
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160
N u r s in g I n te r v e n t i o n P r o c e d u r e
T h e t r e a t m e n t c o n s i s t s of th e f o llo w in g s e q u e n t i a l b e h a v io r s
on th e p a r t of t h e n u r s e ( f o r th e f i r s t 72 h o u r s p o s t o p e r a t i v e l y ) .
1. T h e p a t i e n t i s c a ll e d b y n a m e a n d t h e n u r s e i n t r o d u c e s
h e r s e l f to t h e p a t i e n t u p o n h i s r e t u r n to th e u n i t f r o m th e
r e c o v e r y ro o m . R e c o v e ry ro o m n u r s e a ls o d o e s th is .
2. T h e p a t i e n t i s to ld t h a t h e h a s a m e d i c a t i o n o r d e r e d f o r
p a in a n d th e t im e s c h e d u le b y w h ic h t h i s m e d i c a ti o n m a y
be a d m in iste re d .
3. W h e n th e p a t i e n t e x p r e s s e s t h a t h e i s in p a in ( o r i s
o b s e r v e d to b e so ) th e fo llo w in g p r o c e d u r e i s f o llo w e d :
3. 1 T h e n u r s e e n c o u r a g e s th e p a t i e n t to d e s c r i b e a n d
l o c a t e th e p a i n / d i s c o m f o r t .
3. 2 T h e o r d e r e d a n a lg e s ic i s g iv e n w i t h in 5 m in u t e s .
(If t h e t im e c o n ti n g e n c ie s p r q h i b i t t h i s , th e n u r s e
s o i n f o r m s th e p a ti e n t t h a t t h e m e d i c a t i o n w i l l b e
g iv e n a t th e f i r s t a llo w a b le t i m e a n d p r o c e e d s w ith
t h e r e m a i n d e r of th e s te p s o f t h e p r o c e d u r e . )
3. 3 T h e p a t i e n t i s g iv e n a 2 - 3 m in u t e b a c k r u b a n d r e p o
s i t io n e d f o r c o m f o r t.
3 .4 L i n e n s a r e c h e c k e d f o r s o il in g , w e t n e s s , w r in k lin g ,
and ch a n g ed o r s tra ig h te n e d .
3. 5 T h e o p p o r tu n ity to v o id i s o f f e r e d .
3 .6 T h e d r e s s i n g is o b s e r v e d , c h a n g e d , o r r e i n f o r c e d if
n e c e s s a r y , a n d a v e r b a l r e p o r t o n i t s c o n d itio n is
g i v e n to th e p a ti e n t.
3. 7 T h e i n tr a v e n o u s i n f u s io n , n a s o - g a s t r i c s u c tio n ,
c a t h e t e r , if p r e s e n t , a r e o b s e r v e d a n d a r e p o r t is
g iv e n to th e p a ti e n t.
3. 8 T h e n u r s e s i t s q u ie tly w ith th e p a t i e n t , e li c it in g a n d
r e s p o n d i n g to th e p a t i e n t 's v e r b a l i z a t i o n s . D u rin g
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
t h is t im e s h e a s k s th e p a t i e n t a b o u t h i s u s u a l w a y s
o f d e a lin g w ith p a in , a n d r e i n f o r c e s a n d e n c o u r a g e s
h i s p r e s e n t u s e o f t h o s e p a in c o p in g s k i l l s w h ic h a r e
a p p r o p r i a t e in t h is s it u a ti o n .
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162
A p p e n d ix L
M a t e r i a l to S e c u r e N u r s in g S ta ff P e r m i s s i o n
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163
M a t e r i a l f o r M e e tin g w ith N u r s in g S ta ff
E x p e r i m e n t a l H o s p i ta l
J a n u a r y 11, 1977
P u r p o s e a n d I m p o r t a n c e of T h is R e s e a r c h
T h is s tu d y i s d e s ig n e d to m e a s u r e t h e e f f e c t of a s p e c i f ic ,
c o n s i s t e n t l y a d m i n i s t e r e d n u r s i n g i n t e r v e n t i o n i n to th e a n x ie ty c o m
p o n e n t of th e p o s t o p e r a t i v e p a in e x p e r i e n c e o f s e l e c t e d a d u lt
p a tie n ts . T h e s te p s of th is n u r s i n g i n t e r v e n t i o n (N IT ) a r e d e s ig n e d
to r e d u c e th e a m o u n t of a n x ie ty th e p a t i e n t e x p e r i e n c e s d u r in g h i s
p o s t o p e r a t i v e p a in e x p e r i e n c e . R e s e a r c h h a s s h o w n t h a t a n x ie ty
i n c r e a s e s th e i n t e n s i t y of th e p a in s e n s a t i o n a n d s im u lt a n e o u s ly
d e c r e a s e s th e t o l e r a n c e l e v e l f o r p a in .
T h e s te p s of th e n u r s i n g i n t e r v e n t i o n to b e u s e d in t h is s tu d y
a r e n o t n e w to n u r s e s . W h a t i s n e w a n d i m p o r t a n t i s o u r a tt e m p t
to m e a s u r e th e e f f e c t of n u r s i n g c a r e on th e p a t i e n t 's l e v e l o f a n x
i e t y (a n d o t h e r m e a s u r e s o f h i s r e c o v e r y r a t e ) . V e ry little
re s e a rc h has been H
d o n e on th e e f f e c t o f p s y c h o lo g i c a l s u p p o r t b y
n u r s e s d u r in g th e p o s to p e r a ti v e p a in e x p e r i e n c e . A d d itio n a lly ,
l i t t l e r e s e a r c h h a s b e e n d o n e to a t t e m p t to m e a s u r e th e c o n tr i b u ti o n
o f p h y s ic a l c a r e m e a s u r e s to th e p s y c h o lo g i c a l c o m f o r t f o r p o s t o p e r
a ti v e p a t i e n t s . A n o th e r i m p o r t a n t c o n tr i b u ti o n , w h ic h s u c h a s tu d y
m a y m a k e , i s t h a t of t e s t in g a n o u tc o m e m e a s u r e a g a in s t w h ic h
q u a li t y of n u r s i n g c a r e c a n b e m e a s u r e d .
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164
W a lk T h r o u g h of P r o c e s s o f P r o p o s e d R e s e a r c h
1. P r e o p e r a tiv e p h ase
1. 1 R e s e a r c h e r o b t a i n s s ig n e d s u b je c t p e r m i s s i o n s li p .
1. 2 R e s e a r c h e r a d m i n i s t e r s L if e S t r e s s Q u e s t io n n a i r e
to s u b je c t .
1. 3 R e s e a r c h e r o b t a i n s i n i t i a l D i g i ta l S w e a t m e a s u r e of
s u b je c t.
1 .4 R e s e a r c h e r p u ts s u b j e c t c a s e f o ld e r on p a t i e n t 's
c h a rt.
1. 4. 1 DSI f i n g e r p r i n t s p li n ts
1. 4. 2 D e m o g r a p h i c d a ta s h e e t
1 .4 . 3 N u r s in g I n t e r v e n t i o n D a ta s h e e t
1. 5 S ta ff n u r s e o b ta in s D i g i ta l S w e a t m e a s u r e i m m e d ia te l y
p r e c e d i n g a d m i n i s t r a t i o n o f p r e o p e r a t i v e m e d i c a ti o n
on d a y of s u r g e r y .
2. P o s to p e r a tiv e p h a se
E a c h tim e th e p a ti e n t i n d i c a t e s h e i s in p a in , th e s ta f f
n u r s e im p l e m e n ts th e f o llo w in g p r o c e d u r e f o r th e f i r s t 72
h o u r s p o s to p e r a ti v e ly :
2. 1 T h e p a ti e n t i s c a l l e d b y n a m e a n d n u r s e i n tr o d u c e s
h e r s e l f to th e p a t i e n t .
2. 2 P a t i e n t i s i n f o r m e d o f th e s c h e d u le b y w h ic h h e m a y
r e c e i v e h i s m e d i c a t i o n f o r p a in .
W h en th e p a ti e n t e x p r e s s e s t h a t h e i s in p a in , th e f o llo w
in g p r o c e d u r e i s f o llo w e d :
2. 3 T h e n u r s e e n c o u r a g e s t h e p a ti e n t to d e s c r i b e a n d
lo c a t e th e p a in .
2. 4 T h e o r d e r e d a n a l g e s i c i s g iv e n w ith in 5 m in u t e s .
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165
(If th e tim e c o n ti n g e n c ie s p r o h i b i t t h i s , th e n u r s e
so i n f o r m s th e p a t i e n t t h a t t h e m e d i c a ti o n w ill b e
g iv e n a t th e f i r s t a ll o w a b l e t im e a n d p r o c e e d s w ith
t h e r e m a i n d e r o f th e s t e p s o f th e p r o c e d u r e . )
2. 5 T h e p a ti e n t i s g iv e n a 2 - 3 m in u t e b a c k r u b a n d r e p o
s it io n e d f o r c o m f o r t.
2 .6 L in e n s a r e c h e c k e d f o r s o il in g , w e t n e s s , w r in k li n g ,
and ch an g ed o r s tr a ig h te n e d .
2. 7 T h e o p p o r tu n ity to v o id i s o f f e r e d .
2 .8 T h e d r e s s i n g i s o b s e r v e d , c h a n g e d o r r e i n f o r c e d if
n e c e s s a r y , a n d a v e r b a l r e p o r t on i t s c o n d itio n i s
g iv e n to th e p a ti e n t.
2. 9 T h e i n tr a v e n o u s i n f u s i o n , n a s o - g a s t r i c s u c tio n ,
c a t h e t e r , if p r e s e n t , a r e o b s e r v e d a n d a r e p o r t i s
g iv e n to th e p a ti e n t.
2 .1 0 T h e n u r s e s i t s q u i e t l y w ith th e p a ti e n t, e li c it in g a n d
r e s p o n d in g to th e p a t i e n t 's v e r b a l i z a t i o n s . D u rin g
t h is tim e s h e a s k s th e p a t i e n t a b o u t h i s u s u a l w a y s
of d e a lin g w ith p a in , a n d r e i n f o r c e s a n d e n c o u r a g e s
h i s p r e s e n t u s e of t h o s e p a in c o p in g s k i l l s w h ic h a r e
a p p r o p r i a t e in t h i s s it u a ti o n .
2 .1 1 N u r s e r e c o r d s e a c h N u r s in g I n te r v e n t i o n T r e a t m e n t
on th e N u r s in g I n t e r v e n t i o n D a ta S h e e t.
2 .1 2 I m m e d ia t e l y a f t e r a d m i n i s t e r i n g th e p a in m e d i c a ti o n
(w ith in 3 -5 m in u t e s ) a n d o n e - h a l f h o u r a f t e r c o m
p l e t i o n o f e a c h N IT , a D i g i ta l S w e a t P r i n t is
o b ta in e d .
3. F o u r th p o s to p e ra tiv e d ay
R e s e a r c h e r c o n d u c ts a s t r u c t u r e d i n t e r v i e w w ith th e
p a ti e n t. T h is i n t e r v i e w i s d e s ig n e d to o b ta in th e p a t i e n t s '
r e t r o s p e c t i v e f e e l in g s a b o u t h i s p a in e x p e r i e n c e .
B e f o r e b e g in n in g th e a c t u a l d a ta g a th e r in g f o r th is s tu d y , th e
r e s e a r c h e r w i l l p e r s o n a l l y p r e t e s t , w ith a c t u a l p a t i e n t s , a l l of th e
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166
e q u ip m e n t a n d m a t e r i a l s to b e u s e d in t h i s s tu d y f o r a c c u r a c y a n d
e a s e of u s e , a n d t e a c h e a c h p a r t i c i p a t i n g n u r s e h o w to u s e th e d a ta
g a th e r in g a n d r e p o r t i n g m e a s u r e s .
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
167
A p p e n d ix M
A c k n o w le d g m e n t C o r r e s p o n d e n c e
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168
M a y 10, 1977
M s . P a t r i c i a M id d le to n
D i r e c t o r of N u r s in g
L a k e v ie w C o m m u n ity H o s p i ta l
P a w P a w , M ic h ig a n
D e a r M s . M id d le to n :
T h e d a ta c o ll e c ti o n p h a s e o f th e N u r s in g S tu d y w h ic h I h a v e b e e n
c o n d u c tin g a t y o u r a g e n c y i s n o w c o m p l e te . I w is h to ta k e t h is
o p p o r tu n i ty to t h a n k y o u a n d y o u r s ta f f f o r th e c o o p e r a t io n , e f f o r t,
a n d f a c i l i t a t i o n w h ic h y o u h a v e p r o v id e d f o r t h i s s tu d y . O n e
r e a l i z e s t h a t c l i n i c a l n u r s i n g s tu d i e s , a n d th e n u r s i n g k n o w le d g e
to w h ic h s u c h s tu d i e s u l ti m a t e l y c o n tr i b u te , c o u ld n e v e r b e c a r r i e d
o u t w ith o u t f a r s i g h t e d n u r s e s d e d ic a t e d to th e d e l i v e r y of q u a li t y
h e a lth c a re .
M y g r e a t p e r s o n a l a p p r e c i a t i o n a n d r e g a r d f o r a l l o f th e e f f o r ts y o u
h a v e m a d e in b e h a lf of t h is s tu d y . I s h a l l b e in to u c h w ith y o u w h e n
th e r e p o r t w r i ti n g p h a s e i s c o m p le te d s o t h a t th e f in i s h e d s tu d y m a y
b e s h a r e d w ith t h o s e w ho p a r t i c i p a t e d .
S in c e r e ly ,
P h y l l i s C . N ic o la o u
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169
M a y 10, 1977
M s . M u r i e l O ’L e a r y
D i r e c t o r o f N u r s in g
P i p p C o m m u n ity H o s p i ta l
P l a i n w e l l , M ic h ig a n
D e a r M s . O 'L e a r y :
T h e d a t a c o l l e c t i o n p h a s e of t h e N u r s in g S tu d y w h ic h I h a v e b e e n
c o n d u c tin g a t y o u r a g e n c y i s n o w c o m p l e te . I w is h to t a k e t h is
o p p o r tu n i ty to th a n k y o u a n d y o u r s ta f f f o r th e c o o p e r a t io n , e f f o r t,
a n d f a c i l i t a t i o n w h ic h y o u h a v e p r o v id e d f o r t h is s tu d y . O n e
r e a l i z e s t h a t c l i n i c a l n u r s i n g s tu d i e s , a n d th e n u r s i n g k n o w le d g e
to w h ic h s u c h s tu d i e s u l t i m a t e l y c o n tr i b u te , c o u ld n e v e r b e c a r r i e d
o u t w ith o u t f a r s i g h t e d n u r s e s d e d ic a t e d to th e d e l i v e r y of q u a li t y
h e a lth c a r e .
M y g r e a t p e r s o n a l a p p r e c i a t i o n a n d r e g a r d f o r a l l of th e e f f o r t s y o u
h a v e m a d e in b e h a lf of t h is s tu d y . I s h a l l b e in to u c h w ith y o u w h e n
th e r e p o r t w r i ti n g p h a s e i s c o m p l e te d so t h a t th e f in i s h e d s tu d y m a y
b e s h a r e d w ith t h o s e w ho p a r t i c i p a t e d .
S in c e r e ly ,
P h y l l i s C . N i c o la o u
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.