PATIENT SATISFACTION WITH INTERVENTIONS TO CONTROL

PREOPERATIVE ANXIETY AMONG ADULT PATIENTS FOLLOWING A MAJOR

SURGERY AT PARIRENYATWA HOSPITAL

FACULTY OF MEDICINE AND HEALTH SCIENCES

NURSING SCIENCE UNIT

A research project submitted in partial fulfillment of the Bachelor of

Science Honors Degree in Nursing Science (HNSc)

BY

CHAWA LIBERTY R203027Y

November 2023
Table of Contents

CHAPTER 1: BACKGROUND AND CONCEPTUAL FRAMEWORK............................................................1

Introduction............................................................................................................................................................1

Background............................................................................................................................................................1

Problem statement.................................................................................................................................................2

Purpose of the study...............................................................................................................................................4

Objectives of the study..........................................................................................................................................4

Significance of the study to nursing......................................................................................................................4

Conceptual framework...........................................................................................................................................5

Definition of terms.................................................................................................................................................8

CHAPTER 2 LITERATURE REVIEW................................................................................................................9

Introduction............................................................................................................................................................9

Anxiety..................................................................................................................................................................9

Management of anxiety.......................................................................................................................................11

Interventions to control preoperative anxiety......................................................................................................12

Assessing patient satisfaction..............................................................................................................................14

Impacts of interventions to control preoperative anxiety....................................................................................15

Literature review of other studies which used Roy’s Adaptation Model............................................................16

CHAPTER 3: RESEARCH METHODOLOGY.................................................................................................19

Introduction..........................................................................................................................................................19

Research design...................................................................................................................................................19

Study site and setting...........................................................................................................................................20

Target population.................................................................................................................................................20

Accessible population..........................................................................................................................................20

Sampling plan......................................................................................................................................................20

Sampling procedure.............................................................................................................................................21

Sampling criteria..................................................................................................................................................21
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Inclusion criteria..................................................................................................................................................21

Exclusion criteria.................................................................................................................................................22

Variables..............................................................................................................................................................22

Conceptual and operational definitions...............................................................................................................22

Instruments..........................................................................................................................................................22

Reliability............................................................................................................................................................25

Validity................................................................................................................................................................25

Pre-testing of the instrument................................................................................................................................25

Data collection plan.............................................................................................................................................26

Data collection procedure....................................................................................................................................26

Ethical considerations..........................................................................................................................................26

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 CHAPTER 1: BACKGROUND AND CONCEPTUAL FRAMEWORK

Introduction

Preoperative anxiety refers to the fear, worry, and nervousness that people feel before undergoing a surgical
treatment. It is a frequent emotional response that can occur in patients of all ages and throughout a variety of
surgeries, ranging from minor to major. Patients may have a variety of fears and anxieties as they prepare for
surgery. Some typical variables that lead to preoperative anxiety include the fear of the unknown, probable
problems, anesthesia, discomfort, loss of control, and the outcome of the surgery. Furthermore, previous
traumatic events, underlying physical issues, and personal characteristics can all influence an individual's level
of anxiety. The anxiety prior to surgery is a common problem among patients undergoing major surgery, and
its impact on patient well-being and surgical outcomes should not be underestimated. According to studies,
approximately above 40% of surgical patients report moderate to severe anxiety prior to their surgeries. This
high prevalence emphasizes the significance of researching on the effectiveness of preoperative anxiety
management. Despite the fact that preoperative anxiety has been identified as a serious worry, there are still
gaps in the research, particularly in the context of Parirenyatwa Hospital. While several therapies exist to
alleviate preoperative anxiety, there has been little study into their usefulness in this scenario. As a result, it is
critical to analyze patient satisfaction with these interventions at Parirenyatwa Hospital in order to evaluate
their effectiveness and find areas for improvement.

Background

Anxiety levels typically peak on the day before a scheduled procedure (Friedrich et al., 2022). If left
unaddressed, high levels of preoperative anxiety can have negative physiological and psychological impacts.
Physiologically, anxiety can elevate blood pressure, increase heart rate, disturb gastrointestinal function, and
weaken the immune system response (Eberhart et al., 2020). Psychologically, excessive anxiety prior to
surgery is associated with increased risk of postoperative delirium, prolonged hospital stay, higher
postoperative pain intensity, and lower patient satisfaction.

There are several interventions commonly used by hospitals to help control patients' preoperative anxiety
levels. One approach is providing informational support such as pre-surgical counseling and educational
materials explaining the surgical process and what to expect. This aims to alleviate anxiety by reducing
uncertainty for patient. Relaxation techniques like guided imagery, music therapy, and deep breathing
exercises are also employed to help patients cope with anxiety through relaxation of both body and mind
(Dias et al., 2022). Pharmacological interventions involving anxiolytic medications such as benzodiazepines

1
are another option used in certain cases depending on a patient's baseline anxiety levels and surgical risk
profile (Lanini et al., 2022).

At Parirenyatwa Hospital in Harare, Zimbabwe, addressing preoperative anxiety among surgical patients is
recognized as an important factor in achieving quality patient care outcomes. Currently, the hospital utilizes a
combination of informational counseling sessions led by nurses as well as over-the-counter relaxation
resources like books and videos. For higher-risk cases, physicians may prescribe mild sedative medications as
needed. However, there has been no formal assessment of how effective these existing anxiety control
measures are from the patient perspective in satisfaction and alleviating anxiety.

Problem statement

Preoperative anxiety is a significant concern in adult patients undergoing major surgery because it can
negatively impact the overall surgical experience and postoperative outcomes. The global pooled prevalence of
preoperative anxiety among 14 000 surgical patients was reported to be 48% (Friedrich et al., 2022).

Studies conducted in the European region showed that the prevalence of preoperative anxiety among surgical
patients varied from 27–80% where the highest was observed in Spain and the smallest was in Holland.
Studies conducted in India revealed that the prevalence of preoperative anxiety was varied from 47-70.3%
while the prevalence of preoperative anxiety in Pakistan was ranged from 62–97%. Studies done in the United
States of America showed that the prevalence of preoperative anxiety was as high as 20.2% while the
prevalence of preoperative anxiety among surgical patients in Ethiopia was very high which varied from 47-
70.3% and other studies in Africa; Nigeria and Tunisia showed that the prevalence of preoperative anxiety was
51 to 90% and 67.5% respectively (Abate et al., 2020). According to the study which was done in Zimbabwe
to look at levels of preoperative anxiety in patients who are to have caesarian section under spinal anesthesia
and determine if availing an information booklet to the patients would reduce anxiety 69% had preoperative
anxiety and the information booklet did not reduce anxiety. The high need for information was significant in
the group that did not have access to the booklet (Machaya, 2016).

Although Parirenyatwa Hospital implements various interventions to manage preoperative anxiety, there are
few studies focused on understanding patient satisfaction with these interventions. Patient satisfaction plays an
important role in evaluating the effectiveness of interventions and improving the quality of healthcare.
Therefore, it is necessary to study patient satisfaction with interventions aimed at controlling preoperative
anxiety in adult patients following a major surgery at Parirenyatwa Hospital. Understanding patient

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satisfaction with interventions to manage preoperative anxiety is important for health care providers and
policymakers so as to see areas of improvements in the current interventions to reduce preoperative anxiety.

Patient satisfaction reflects the extent to which interventions meet their needs, expectations, and preferences,
and can provide valuable information about areas requiring improvement. By assessing patient satisfaction,
healthcare professionals can identify gaps in current interventions and make informed decisions to optimize
anxiety management strategies. Additionally, exploring patient satisfaction with interventions to manage
preoperative anxiety would contribute to existing knowledge in this field.

Although studies have examined the effectiveness of various interventions in reducing preoperative anxiety,
few studies have focused specifically on patient satisfaction. By studying patient satisfaction, this study aims
to provide a comprehensive understanding of the effectiveness and acceptability of interventions performed at
Parirenyatwa Hospital.

Ultimately, the results of this study will serve as a guide for health care providers and policymakers to improve
preoperative anxiety management interventions and improve patient experience during surgery. By addressing
patient satisfaction, healthcare professionals can tailor their interventions to better meet patient needs and
preferences, resulting in better outcomes for patients. This study aims to close the knowledge gap and
contribute to the development of more effective, patient-centered interventions to manage anxiety in adult
patients undergoing major surgery

Purpose of the study

Purpose of the study is to assess the level of patient satisfaction with interventions aimed at controlling
preoperative anxiety in adult patients following major surgery at Parirenyatwa Hospital.

Objectives of the study

To assess the level of patient satisfaction with interventions aimed at controlling preoperative anxiety in adult
patients following major surgery at Parirenyatwa Hospital. This objective focuses specifically on measuring
patient satisfaction with the interventions implemented to manage preoperative anxiety.

Significance of the study to nursing

By assessing patient satisfaction with interventions, nurses can gain valuable insights into the effectiveness of
various strategies and tailor their care accordingly. Understanding patient preferences and experiences can help
nurses prioritize interventions that align with patients' needs, leading to more patient-centered care.

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Patient satisfaction research allows nurses to identify gaps in communication and education regarding
preoperative anxiety interventions. By understanding patients' perceptions and experiences, nurses can
improve their communication skills and provide accurate and comprehensive information to patients,
addressing their concerns and alleviating anxiety. The study's findings can guide nursing administrators in
allocating resources effectively. By identifying the interventions that yield higher patient satisfaction levels,
healthcare organizations can allocate resources to those interventions, ensuring efficient use of limited
resources and promoting cost-effective care delivery. The study contributes to the growing body of evidence
on preoperative anxiety management. Nurses can rely on this evidence to inform their clinical practice and
decision-making processes, ensuring that interventions are based on the best available evidence and have a
positive impact on patient outcomes.

Assessing patient satisfaction with preoperative anxiety interventions provides feedback for quality
improvement initiatives. Nurses can identify areas of improvement and implement changes to enhance the
patient experience, leading to improved overall quality of care and patient outcomes. The study's findings can
facilitate collaboration between nurses, anesthesiologists, surgeons, and other healthcare professionals
involved in preoperative care. By understanding patient satisfaction levels and preferences, interdisciplinary
teams can work together to develop comprehensive preoperative anxiety management strategies that address
patients' holistic needs.

Conceptual framework

A conceptual framework is used to help identify the problem by using a broad set of ideas and theories (Varpio
et al., 2020). Using a conceptual framework helps the investigator to identify the problem better and find the
best solutions (Varpio et al., 2020). This is where the idea of putting things into focus comes into play, that is,
the building of a conceptual framework. The conceptual framework works like a map that sets the direction of
research or thesis writing. The theoretical framework guiding this study is the Roy Adaptation Model. Roy's
Adaptation Model presents a person as an adaptive system which is in constant interaction with the
environment (Roy et al., 2009). This model comprises of 4 major concepts and these are person, health,
nursing and environment. Roy's model sees the person as a biopsychosocial being in constant interaction with
a changing environment. The person is an open system that is able to adapt to change and has coping skills to
deal with stressors. Roy sees the environment as all conditions, circumstances and influences that surround and
affect the development and behavior of the person (Roy et al., 2009) and stressors as stimuli. Roy defined
nursing as a scientific and humanistic profession, and emphasized the importance of their specialized
knowledge in contributing to health needs. According to Roy the purpose of nursing is to ensure adaptation,
increase compliance and life expectancy. Roy defined health as a process of being and becoming an integrated
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and complete person. Health is an anticipated dimension of human life and represents a health-disease
continuum according to Roy's model.

The Roy Adaptation Model nursing theory focuses on individuals' adaptation to their environment in response
to stressors. The central concept of the Roy Adaptation Model is adaptation, which refers to the individual's
ability to respond positively to stressors and maintain their well-being. In the context of my study the stressor
is preoperative anxiety, and adaptation would involve the patient's ability to cope with this anxiety and
maintain a satisfactory level of emotional well-being.

Input variables represent the factors that influence the individual's adaptation process. Relevant input variables
may include the patient's demographic characteristics (age, gender and education), surgical procedure, severity
of preoperative anxiety, and previous experience with surgery. Stimulus refers to the specific stressor or
demand that triggers the adaptation process. In this case, the stimulus is preoperative anxiety experienced by
adult patients following major surgery at Parirenyatwa Hospital.

The Roy Adaptation Model identifies four adaptive modes through which individuals respond to stressors
which are physiological mode, self-concept mode, role function mode and interdependence mode (Roy et al.,
2009). The physiological mode focuses on the patient's physiological responses to stressors. The physiological
responses may include increased heart rate, blood pressure, and respiration, as well as other physical
manifestations of anxiety.

The self-concept mode refers to the patient's perceptions and beliefs about themselves. Preoperative anxiety
may impact the patient's self-concept, leading to feelings of vulnerability, fear, or uncertainty about the
surgical procedure and its outcomes. Role function mode relates to the patient's ability to fulfill their roles and
responsibilities. Preoperative anxiety may affect the patient's ability to engage in their usual roles and
responsibilities, such as work, family, or social activities. Interdependence mode emphasizes the patient's
interactions and relationships with others. Preoperative anxiety may impact the patient's social interactions
and support systems, affecting their ability to seek and receive emotional support during the surgical process.

Adaptive responses represent the patient's actions and behaviors aimed at maintaining adaptation and well-
being. Adaptive responses would involve the patient's utilization and satisfaction with interventions to control
preoperative anxiety, such as pharmacological interventions, psychological interventions, or a combination of
both.

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Outcome variables refer to the results or outcomes of the adaptation process. In this study, outcome variables
would include patient satisfaction with the interventions, reduction in preoperative anxiety levels, and overall
emotional well-being following major surgery.

Feedback represents the information received by the patient regarding the effectiveness of their adaptive
responses. Patient feedback on interventions and their satisfaction levels would provide valuable information
for healthcare providers to assess the effectiveness of the interventions and make necessary adjustments if
required.

By employing the Roy Adaptation Model as a conceptual framework, the relationships between input
variables, adaptive modes, adaptive responses, outcome variables, and feedback can be analyzed. This
framework provides a comprehensive structure for studying patient satisfaction with interventions to control
preoperative anxiety in adult patients following major surgery at Parirenyatwa Hospital, while considering the
broader adaptation process and its various components.

Residual
Contextual stimuli are the
Focal stimuli is the stimuli is the risks one may
major surgical anxiety which a get from
procedure which the patient surgery like
patient is going to experiences death or
undergo prior to a major worsening the
surgery condition

Fig 1.1

Definition of terms

Anxiety-.a mental health condition marked by intense emotions of concern, anxiety, or terror that interfere
with day-to-day functioning (Craske et al., 2011).
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Preoperative-Anything that happens before a patient has surgery is preoperative

Preoperative Anxiety- Preoperative anxiety refers to the fear, worry, and nervousness that people feel before
undergoing a surgical treatment (Friedrich et al., 2022).

Major surgery- Any surgical procedure in which a patient has an operation is considered major surgery. An
organ or body part removal or large-scale body part repair is referred to as major surgery (chspecialist.org).

CHAPTER 2 LITERATURE REVIEW

Introduction

The processes included in a literature review, include identifying and searching for information on a topic as
well as creating a comprehensive overview of the state of knowledge on the topic (Snyder, 2019). This study
aims to evaluate the variables that are linked to preoperative anxiety in patients having major surgery. Given
the uncertain and potentially dangerous conditions that characterize the preoperative phase, anxiety is
somewhat expected, particularly in cases when patients are having their first surgical experience. The same
author claims that because it activates and fortifies the protective forces, sight anxiety is thought to be
advantageous. It increases one's awareness of their surroundings and the potential for impending danger.

Anxiety

Any individual can experience anxiety, whether it be temporary or chronic. Aggressive behaviors from anxiety
can lead to increased stress expression by the patient, which makes pain management more challenging during
the recovery phase (Friedrich et al., 2022). Prior to surgery, patients undergoing medical procedures can suffer
worry and anxiety (Michaelides & Zis, 2019). However, the same author claims that a high degree of anxiety
is highly harmful to a patient's health, thus it's critical to pinpoint the satisfaction of the patients with the
interventions to control anxiety. Humans react with anxiety to every uncertain circumstance. It is also defined
as an uncomfortable feeling of tension or uneasiness that may be linked to changes in heart rate brought on by
stimulation of the sympathetic, parasympathetic, and endocrine systems. Anxiety and fear are sometimes used
interchangeably. Anxiety is linked to the threat of perceived subjectivity without a known risk factor, whereas
fear is characterized as "the dread of real danger."

Major Surgery

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Extensive surgery are large procedures which typically require an overnight or longer hospital stay since they
are so involved. A large amount of work is involved in these surgeries, such as entering bodily cavities,
extracting organs, or changing the anatomy of the body. Major surgery patients typically need anesthesia or
respiratory support, and perhaps even both. Major surgical procedures encompass a variety of treatments
including heart surgery, intestine cavity surgeries, reconstructive surgery, deep tissue procedures, transplant
procedures, and surgeries involving the belly, chest, or skull (Oakbend medical center, 2018). It is appropriate
to use clinical judgments and to consider a minor operation as a large surgery if there is higher than expected
blood loss, fluid changes, and invasiveness, all of which are likely caused by unusual pathology. Major
surgeries for scar, nose, throat, and oral surgery include laryngectomy, removal of a big benign or malignant
growth, lymph node dissection necessitating an overnight hospital stay, and reconstructive surgery, if
necessary. Major surgical procedures in general surgery include open cholecystectomy, large incisional,
epigastric, or ventral hernia repairs; biopsy or axillary dissection; or laparoscopic or open repair or resection of
stomach, small bowel, colon, liver, pancreas, spleen, or liver.

Effects of anxiety

Preoperative anxiety is a prevalent occurrence that has a negative impact on a patient's physical and mental
health (Chen et al., 2022). Numerous symptoms, whether behavioral, emotional, or physiological, are brought
on by anxiety. Increased arterial pressure, elevated muscle tone, elevated heart rate, increased respiratory rate,
and stomach pain are among the physiological symptoms (Chen et al., 2022). According to , Ji et al., (2022)
among the mental symptoms are fatigue, a sense of being threatened, low self-esteem, withdrawal from social
interactions, and cognitive problems. Behavioral symptoms include twitches, repetitive position changes,
motor anxiety, and meaningless activities; occasionally, sleeplessness is also noted (Ji et al., 2022). Problems
including problematic venous access, delayed jaw relaxation and coughing during anesthesia induction,
autonomic oscillations, and higher anesthetic demand are linked to preoperative worry. Additionally, it has
been linked to a longer recovery duration, a higher risk of infection, and increased pain, nausea, and vomiting
during the postoperative phase. Research revealed that patients with preoperative anxiety "needed higher
dosages of anesthetic medications at induction and to maintain optimal level of anesthesia, had longer hospital
stays and recovery times, greater postoperative pain scores, increased painkiller intake, and increased
morbidity. In addition to having an impact on patient satisfaction and health care results, all of these problems
have financial ramifications for hospitals, patients, and the nation (Michaelides & Zis, 2019).

Management of anxiety

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Numerous techniques have been used to help patients who are scheduled for surgery feel less anxious,
including written material, films, reassurance, and listening to certain music before to the procedure. There is
no concrete evidence that one approach is better than another. Speaking with patients and staying in contact
with them during the intraoperative phase was one of the strategies examined. It may be beneficial to speak
with patients just before they are put under anesthesia, to give them the choice of maintaining some level of
physical touch during the procedure, and to lessen the impact of external stimuli like noise, smell, and sight.
Additionally, it might be advantageous to allow a companion to go with the patient to the operating room or
right after (Mauleen, 2007). Therefore, it's crucial to employ language that creates a true sense of safety
phrases like "you will be continuously monitored" and "the medications used are very safe and effective".
When used in combination, these terms provide patients with the "tools" to encourage fewer negative thinking
(Chan, 2007).

A few studies have examined the impact of hypnosis on anxiety. Goldm et al. conducted one investigation of
this kind. Patients were chosen from among those who had day cases for gynecological procedures. They were
given a brief conversation of equal duration or a brief prior hypnotic induction. The findings indicated that
preoperative hypnosis might offer a rapid and effective means of lowering preoperative patient anxiety and the
need for anesthesia on the day of gynecological surgery.

Patients can be informed in the preoperative phase by seeing videos of the perioperative events that take place:
In a prospective randomized controlled research, Jlala (2010) showed that patients undergoing elective surgery
under regional anesthesia experienced less anxiety after watching a brief informative film before to the
procedure. This kind of information is easily disseminated and is helpful to a large number of patients.
Research has been done on the topic of using music to lessen anxiety. Providing music that the patients had
personally chosen prior to surgery helped lower anxiety and physiological markers in a Hong Kong research
involving patients slated for day case surgery (Cookie Chaboyer, Schluter, Huratos, 2005).

Many of the studies that are analyzed here for evidence have come from different cultures and disciplines
because there is a dearth of study being done on the subject. While extrapolating and applying data from study
conducted in hostile cultures might be challenging, these studies pave the path for further investigation.
Anxiety can significantly impact the result of surgery. Optimizing patient care requires the development of
evidence-based, practical anxiety-reduction techniques (Machaya, 2015). There are a few research on
preoperative anxiety in Africa.

Interventions to control preoperative anxiety

9
Before major surgery, a number of therapies have been devised and put into practice to manage preoperative
anxiety and improve patient well-being. This section delves into the various therapies, both non-
pharmacological and pharmaceutical, that have demonstrated efficacy in managing anxiety levels before to
surgery (Agüero‐Millan et al., 2023).

Preoperative anxiety has frequently been reduced by pharmacological therapies. Before surgery, patients are
often administered anxiolytic drugs, such as benzodiazepines and SSRIs, to help them relax and feel less
anxious. Calming effects are produced by benzodiazepines, which include lorazepam and diazepam, by acting
on the central nervous system. It is crucial to remember that these drugs may have adverse effects, including
drowsiness, respiratory depression, and decreased cognitive function, so they should be used carefully. The
patient's features, the degree of anxiety, and the planned surgical treatment should all be taken into
consideration when selecting a pharmaceutical intervention.

Non-pharmacological interventions have gained recognition as effective approaches to managing preoperative

anxiety and reducing reliance on medication. Cognitive-behavioral therapies (CBT) have shown promise in
helping patients cope with preoperative anxiety. Cognitive restructuring techniques aim to challenge and
modify negative thoughts and beliefs related to surgery, while relaxation techniques, such as progressive
muscle relaxation and deep breathing exercises, help patients achieve a state of calmness and reduce anxiety.
Guided imagery, where patients are guided to visualize positive and relaxing scenarios, has also been used as a
non-pharmacological intervention to reduce preoperative anxiety.

Preoperative anxiety has been found to be effectively managed using music therapy, a non-pharmacological
intervention (Agüero‐Millan et al., 2023). It has been demonstrated that surgery patients' general well-being is
enhanced, anxiety levels are lowered, and relaxation is encouraged when relaxing and soothing music is
played. Music has the power to uplift the spirit, divert attention from unfavorable ideas, and create a calm
atmosphere. To enhance the therapeutic advantages of music therapy in lowering preoperative anxiety,
considerations such as individual preferences and music genre choice should be made.

While these interventions have shown promise in managing preoperative anxiety, it is crucial to recognize
their limitations. Not all patients respond equally to interventions, and individual variability in anxiety levels
and coping mechanisms should be considered. Additionally, the effectiveness of interventions may be
influenced by factors such as cultural background, socioeconomic status, and previous experiences with
medical procedures. Future research should aim to further investigate the effectiveness of these interventions,
identify optimal combinations, and consider the specific patient population at Parirenyatwa Hospital to ensure
tailored and effective anxiety management strategies.

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In conclusion, various pharmacological and non-pharmacological interventions have been developed and
implemented to control preoperative anxiety in patients undergoing major surgery. Pharmacological
interventions, such as anxiolytic medications, can provide short-term relief but should be used judiciously due
to potential side effects. Non-pharmacological interventions, including cognitive-behavioral therapies,
relaxation techniques, and music therapy, offer alternative approaches to managing preoperative anxiety and
promoting patient well-being. The subsequent sections of this literature review will delve further into the
impact of these interventions on patient satisfaction at Parirenyatwa Hospital following major surgery.

Assessing patient satisfaction

Assessing patient satisfaction is crucial for evaluating the quality of healthcare services and understanding the
impact of interventions on patients' experiences. Various tools and measurement scales that have been used to
assess patient satisfaction in healthcare settings. Patient satisfaction is a multifaceted construct that
encompasses various dimensions, including perceived quality of care, communication with healthcare
providers, pain management, and involvement in decision-making, and overall hospital experience. To capture
these dimensions, researchers and healthcare organizations have developed and utilized a range of
measurement tools and scales.

One commonly used tool for assessing patient satisfaction is the Patient Satisfaction Questionnaire (PSQ). The
PSQ is a self-report instrument that measures patients' satisfaction with different aspects of healthcare
delivery. It consists of multiple items that cover areas such as communication, accessibility, technical
competence of healthcare providers, and overall satisfaction with the healthcare experience. The PSQ has been
widely used in various healthcare settings and has demonstrated good reliability and validity in assessing
patient satisfaction.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is another widely
recognized tool for measuring patient satisfaction. This standardized survey assesses patients' experiences
during their hospital stay and covers areas such as communication with nurses and doctors, responsiveness of
hospital staff, pain management, cleanliness of the facility, and discharge instructions. The HCAHPS survey
provides a comprehensive assessment of the patient experience and is used by many healthcare organizations
to monitor and improve the quality of care.

In addition to these standardized tools, researchers have developed specific scales and questionnaires to assess
patient satisfaction in the context of preoperative care and surgical experiences. These scales may focus on
dimensions such as preoperative communication, information provision, emotional support, and satisfaction
with the surgical outcome. Examples include the Preoperative Patient Satisfaction Scale (PPSS) and the
11
Surgical Satisfaction Questionnaire (SSQ). These scales have been used in various studies to evaluate patient
satisfaction with preoperative care and surgical interventions.

It is important to note that assessing patient satisfaction is not solely reliant on quantitative measures.
Qualitative methods, such as interviews or focus groups, can also provide valuable insights into patients'
experiences and satisfaction levels. These methods allow for in-depth exploration of patients' perspectives,
allowing researchers to capture nuanced and context-specific information that may not be captured by
standardized scales alone.

When assessing patient satisfaction, it is essential to consider the limitations of the measurement tools used.
Patient satisfaction is a subjective construct that can be influenced by individual expectations, cultural factors,
and personal biases. Additionally, there may be limitations associated with the specific measurement tools,
such as response bias or limited generalizability.

Impacts of interventions to control preoperative anxiety

In a randomized controlled trial by Johnson et al. (2019), the researchers investigated the impact of music
therapy on preoperative anxiety in adult surgical patients. The study found that patients who received music
therapy experienced significantly lower levels of anxiety compared to those who did not receive the
intervention. The findings suggest that music therapy can be an effective intervention in reducing preoperative
anxiety.

In a systematic review and meta-analysis conducted by Wang et al. (2018), the researchers examined the
effects of acupuncture on preoperative anxiety. The review included multiple randomized controlled trials and
found that acupuncture significantly reduced preoperative anxiety levels compared to sham acupuncture or no
intervention. The results suggest that acupuncture may be a beneficial intervention for managing preoperative
anxiety.

A study by Smith et al. (2020) explored the impact of preoperative education on anxiety levels in surgical
patients. The researchers implemented a preoperative education program that provided information about the
surgical procedure, postoperative care, and coping strategies. The study found that patients who received the
education program had significantly lower levels of preoperative anxiety compared to those who did not
receive the intervention. The findings highlight the importance of preoperative education in reducing anxiety.

In a study by Chen et al. (2017), the researchers examined the effects of aromatherapy on preoperative anxiety
in patients undergoing cardiac surgery. The study found that patients who received aromatherapy with
lavender oil experienced significantly lower levels of anxiety compared to the control group. The findings
12
suggest that aromatherapy can be a helpful adjunctive intervention in managing preoperative anxiety in cardiac
surgery patients.

A systematic review by Mavrides et al. (2019) explored the impacts of virtual reality (VR) interventions on
preoperative anxiety in various surgical procedures. The review included multiple studies and indicated that
VR interventions were effective in reducing preoperative anxiety levels. The immersive and distracting nature
of VR technology was found to provide relaxation and alleviate anxiety in surgical patients.

These studies collectively demonstrate the positive impacts of various interventions in controlling preoperative
anxiety. Music therapy, acupuncture, preoperative education, aromatherapy, and virtual reality interventions
have shown promise in reducing anxiety levels and promoting a more relaxed preoperative experience.
Healthcare professionals can consider implementing these interventions as part of a comprehensive approach
to managing preoperative anxiety and enhancing patient well-being.

Literature review of other studies which used Roy’s Adaptation Model

Other research that used Roy's Adaptation Model were reviewed in the literature. Roy's adaption model, a
theory that guided this study, has also guided numerous other studies. The primary purpose of nursing,
according to the paradigm, is to encourage patient adaption.

In a study by Smith et al. (2018), Roy's Adaptation Model was employed to examine the adaptation
experiences of individuals with chronic illness. The researchers used qualitative interviews to explore the
adaptive processes and coping strategies employed by participants in managing their illness. The findings
highlighted the significance of the model in understanding the psychological and behavioral adaptations of
individuals living with chronic conditions.

Jones and Brown (2019) conducted a quantitative study applying Roy's Adaptation Model to investigate the
adaptation of older adults to retirement. The researchers utilized a survey questionnaire to assess various
aspects of adaptation, including changes in daily routines, social interactions, and emotional well-being. The
study revealed that the model provided a useful framework for understanding the complex process of
retirement adaptation among older adults.

In another study, Lee et al. (2020) utilized Roy's Adaptation Model to examine the experiences of family
caregivers of individuals with dementia. Through qualitative interviews, the researchers explored the
caregivers' adaptive responses, coping strategies, and the impact of caregiving on their overall well-being. The

13
findings highlighted the relevance of the model in understanding the multifaceted challenges faced by family
caregivers and their adaptive processes.

A study by Garcia et al. (2017) applied Roy's Adaptation Model in the context of nursing education. The
researchers utilized a mixed-methods approach, combining surveys and focus group discussions, to explore
nursing students' adaptation to the academic and clinical aspects of their training. The study revealed that the
model provided a comprehensive framework for understanding the students' adaptive behaviors, stress
management, and learning experiences within the nursing education environment.

In a quantitative study by Kim and Song (2018), Roy's Adaptation Model was used to examine the adaptation
experiences of individuals with spinal cord injuries. The researchers employed standardized questionnaires to
assess various domains of adaptation, including physiological, psychological, and social aspects. The findings
demonstrated the applicability of the model in understanding the adaptive processes and outcomes in
individuals with spinal cord injuries.

These studies collectively demonstrate the versatility and utility of Roy's Adaptation Model in various
healthcare contexts. They emphasize the model's effectiveness in understanding the adaptive responses, coping
strategies, and outcomes of individuals facing different health challenges, ranging from chronic illness to
caregiving and nursing education. The findings from these studies contribute to the broader understanding of
adaptation and provide insights for healthcare professionals to enhance patient care and support.

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 CHAPTER 3: RESEARCH METHODOLOGY

Introduction

Research methodology is a systematic approach to issue solving. It is a science that studies how to conduct
research, addressing all of the processes that researchers employ in describing, interpreting, and forecasting
phenomena of interest (Dowson, 2019). Research methodology is sometimes defined as the set of methods and
procedures used to gain knowledge. Its goal is to develop a comprehensive work plan for conducting a
research project (Dowson 2019). The goal of this study is to assess patient satisfaction with interventions to
control preoperative anxiety in adult patients following a major surgery. This chapter focuses on many aspects
of research methodology, such as the research design, population sample, sampling procedures, data collection
instruments, and pilot plan. This chapter will also cover ethical issues. A thorough comprehension of the
research design will improve the quality of any research investigation.

Research design

A study's research design outlines the core tactics that researchers will use to generate reliable and
interpretable findings (McCombes, 2021). Essentially, the research design establishes a solid basis for the
entire study and assists in accomplishing the intended task simply and in a methodical manner, so that once
accomplished, the actual work may be readily begun (McCombes, 2021). The goal of this study is to assess
patient satisfaction with interventions to control preoperative anxiety in patient’s aged 25 to 65 undergoing
major surgical procedures at the Parirenyatwa group of hospitals in Harare, Zimbabwe. The researcher will
conduct a descriptive cross-sectional study in order to meet the study's objectives. The absence of
manipulation of variables under examination will also improve the ethical soundness of this research study.

Study site and setting

Wayne at al., (2016) define study site as the overall location, while settings are more precise locations where
data will be collected. Parirenyatwa is the location of this research in the medical and surgical wards of the

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hospital. Data will be acquired from qualified volunteers who are on postoperative phase following a major
surgical procedure. Data will be collected, but in a way that does not disrupt service delivery procedures.
Because the Parirenyatwa Group of Hospitals is a referral hospital, the findings of this study can be applied to
the entire Zimbabwean population.

Target population

The complete group of subjects in which a researcher is engaged and whose results can be appropriately
generalized (GROSSMANN, 2019) .Patients on postoperative phase following major surgical procedures at
Parirenyatwa group of hospitals are the study's target population.

Accessible population

The aggregate of all cases that meet the specified criteria and are reachable accessible to the researcher as a
pool of subjects for a study is referred to as the accessible population. It fits the defined criteria and is also
accessible, taking into account time, money, researcher availability, and so on (Porter, 1999). The study's
accessible population will include all patients aged 25-65 following a major surgery at PGH in Harare during
the study period.

Sampling plan

A sampling strategy is a formal plan that specifies the sampling method, sample size, and subject recruitment
methods. Thus, sampling is defined as the act of selecting a subset of a population to participate in a research
study while representing the complete population in order to collect information about the phenomenon of
interest Wayne at al., (2016). A sample is a subset of the population that is chosen to participate in a study.
Sample size

The number of people needed in the study to produce representative results is referred to as sample size. A
sample size is required for identifying a link, determining the effect of therapy, and explaining phenomena,
according to (Andrade, 2016). A big sample is more typical of the population, but there is no guarantee of
accuracy.

Sampling procedure

The type of sampling procedure that will be used is consecutive sampling to select study participants.
Consecutive sampling is where each subject that meets the inclusion criteria is selected until the needed
sample is selected. Thus in this case patients who are on postoperative phase after a major surgery aged 25 to
65 within the period of the study are eligible to for selection. The sampling procedure is going to take place at

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Parirenyatwa Group of Hospitals and the researcher will seek permission from sisters who are in charge of the
wards and look for patients who are suitable for the study sample.

Sampling criteria

Sampling criteria refers to the specific characteristics that the population should possess in order to qualify in
the study.

Inclusion criteria

Inclusion criteria refers to the specific characteristics that the subjects should possess in order to qualify for the
study.

 Willingness to participate in the study

 English and Shona speaking participants

Exclusion criteria

Exclusion criteria are qualities that a population must possess in order to be excluded from a study. The
exclusion criteria for this study will be

 Patient reluctance owing to refusal to engage in the study

 Those aged under 25 and above 65
 Patients who are neither Shona nor English speaking

Variables

Polit and Hungler (2008) describe variables as notions with values that differ from one person to the next. For
example, height can take any value and vary from one subject to the next. An operational definition is when a
concept or variable is defined in terms of the operation or technique by which it is measured. The variables of
interest in this study are parameters linked with preoperative anxiety and demographic characteristics.
Subjects' demographic information will include characteristics such as age, gender, residence location, and
educational level.

Conceptual and operational definitions

The abstract or theoretical interpretation of the concepts being researched is referred to as conceptual
definition. A conceptual definition employs words to define the attributes of a concept, hence conveying the

17
idea's broad meaning. Moule and Goodman (2009) define operational definition as "assigning meaning to a
concept or construct by specifying the operations that must be performed in order to measure or manipulate the
concept under investigation." It defines or lends meaning to a variable under study by stating what the
investigator must do in order to measure it.

Instruments

A tool or instrument is used to collect data from participants during measurement. According to Polit and Beck
(2003), an instrument is a device used to collect data from participants, such as a questionnaire, test, or
observation program. The data collection instrument for this project will be an interview schedule with a
questionnaire administered in either English or Shona. As this is a structured self-report, a questionnaire will
be presented to the subjects, and the instruments will be completed by the respondents themselves, usually on
paper and pencil (Polit and Hungler, 2008).

Data collection will involve the administration of a structured questionnaire to the participants. The
questionnaire will be developed based on a review of the literature and prior research on patient satisfaction
with preoperative interventions. The questionnaire will consist of several sections, including personal
information, preoperative anxiety assessment, interventions to control preoperative anxiety, effectiveness of
interventions, patient satisfaction, and suggestions for improvement.

The questionnaire will include the following sections and their respective contents:

Personal Information:

This section will collect demographic data about the participants, including age, gender, educational level, and
occupation. It will provide a brief overview of the participants' characteristics.

Surgical Procedure Information:

This section will capture information about the type of surgery the participants are scheduled for and the date
of the surgery. It will help establish the context of the study and provide details about the specific surgical
procedures involved.

Preoperative Anxiety Assessment:

This section will assess the level of preoperative anxiety experienced by the participants. It will include
multiple questions using a rating scale to measure anxiety levels. Participants will be asked to rate their overall
preoperative anxiety level and specific anxieties related to the surgery itself, anesthesia, postoperative pain,
and potential complications.
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Interventions to Control Preoperative Anxiety:

This section will focus on the interventions implemented to manage preoperative anxiety. Participants will be
asked to indicate which interventions they received. The questionnaire will provide a list of interventions,
including information and education, supportive communication, medications, relaxation techniques,
cognitive-behavioral therapy (CBT), music therapy, and an option to specify other interventions if applicable.

Effectiveness of Interventions:

This section will evaluate the effectiveness of the interventions in reducing preoperative anxiety. Participants
will be asked to rate the effectiveness of the interventions using a rating scale. The questionnaire will assess
the overall effectiveness of the interventions and their effectiveness in addressing specific areas of anxiety,
such as the surgery itself, anesthesia, postoperative pain, and potential complications.

Patient Satisfaction:

This section will measure patient satisfaction with the interventions and overall preoperative care. Participants
will be asked to rate their satisfaction levels using a rating scale. The questionnaire will assess overall
satisfaction as well as satisfaction with specific aspects, including information and education provided,
communication and support from healthcare providers, effectiveness of medication (if applicable), and
satisfaction with non-pharmacological interventions (if applicable).

Suggestions for Improvement:

This section will provide an open-ended question allowing participants to provide any suggestions or feedback
on how the interventions and preoperative care could be improved. It will offer an opportunity for participants
to share their perspectives and offer insights for enhancing the quality of care.

The structured questionnaire will serve as the primary instrument for data collection, enabling systematic data
gathering on patient experiences, perceptions, and satisfaction levels related to preoperative anxiety
interventions.

Reliability

Reliability relates to the constancy in that measurement that the questionnaire always measure what it is
supposed to measure and will identify similarities in answers across a number of participants but will also
measure differences (Moule and Goodman, 2009). An instrument can be said to be reliable if it measures
accurately, reflect the true scores of the attribute under investigation (Polit & Hungler, 2008), so to increase
the reliability of this instrument the questions will be the same throughout and the researcher will try to cater
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for the transient personal factors that may cause bias in the study. The researcher will prepare a Shona
questionnaire that is the same as the English one for those who would prefer to answer in the Shona language
and so that the participants will be asked the same questions throughout.

Validity

The veracity of the measurement in assessing the phenomenon of interest in a given sample or population is
referred to as validity. A questionnaire's validity is related to its capacity to measure what it is supposed to
measure (Moule and Goodman, 2009). To ensure the validity of the instrument utilized in this study, the
researcher will create research questions based on the study objectives. The individuals will be asked to rate
their level of anxiousness. To assist remove bias, the instrument will be examined by the project's supervisor
and other research-experienced lecturers.

Pre-testing of the instrument

The instrument will be pre-tested on 5 patients to determine its validity and reliability. The instrument will be
tested on different subjects from those in the trial at Parirenyatwa Hospital, but participants will be chosen
using the same inclusion criteria. This is done to guard against any participant bias via the Hawthorne effect
and to rectify the instrument if there are any flaws prior to data collection. To ensure genuine responses and
maximal validity and reliability of the instrument, participants will be provided informed consent and full
information about the study.

Data collection plan

The data collecting plan defines the specifics of how the study will be carried out (Burns & Groove, 1995).
This study's data will be collected over the course of one week in February 2023. Permission will be sought
from the Joint Research Ethical Committee (JREC), Parirenyatwa hospital management and consultants, and
the Department of Nursing Science (UZ) to conduct this study.

Data collection procedure

 First, the researcher chooses patients who meet the inclusion criteria.
 Give them a brief overview of the study and ensure that all participants understand the goal of the
study.
 Participants will be given consent documents to read and sign if they agree with the terms.
 Following the completion of the form, the researcher will interview patients using a structured
questionnaire in a private location (side ward or screen curtains) to protect the participants' privacy.

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  The participants will respond to the questions posed by the researcher.
 Before the participants leave, the researcher will thank them.

Ethical considerations

When humans are employed as study participants, as is common in nursing research, care must be taken to
ensure that their rights are maintained (Polit & Beck, 2014). Human rights are described as moral principles,
which are the extent to which the researcher adheres to the legal and social obligations owed to the study
participants (Polit & Hungler, 2008). Human rights must be prioritized throughout the research. In a research
study, three primary principles must be considered: the principle of beneficence, the principle of fairness, and
the principle of respect for human dignity.

Individuals will be viewed as autonomous agents; hence, the investigator must guarantee that the participant
has received full disclosure of the nature of the study, the risks, benefits, and alternatives, as well as ample
chance to ask questions (Ressnik, 2010). The researcher will allow participants to voluntarily withdraw from
the study. The participants will be fully informed about the research so that they can volunteer fully informed
about the study. Beneficence is the act of doing kindness to individuals. The Belmont report defines
beneficence as a commitment to cause no damage and to maximize benefits while minimizing possible costs to
the particular research participant (the Belmont report, 1974). The researcher will ensure that confidentiality
and privacy are preserved during the research, and that the participants are autonomous. There will be no
manipulation of participants. Exposing study volunteers to events that cause serious or permanent injury is
obviously inappropriate (Polit & Beck, 2014). Participants should not be exploited in any way.

The information they supply will be kept private and will not be used against them (McCombes, 2021). Above
all, the researcher assesses and shares the risks and advantages that individual volunteers may encounter.
Another concept is justice, which states that the researcher will ensure equitable selection of participants
through the use of inclusion criteria and distribution of study benefits. Participants in the study have the right
to fair and] equitable treatment before, during, and after the study. Participants have the right to anticipate that
any information they disclose will be kept private. This will be accomplished by the researcher's use of
anonymity and other confidentiality methods, while in this situation the participants will not fill out
questionnaires with their names.

To ensure that this research is ethical, the researcher will submit a research proposal to the department of
nursing science, the consultant, the nurse in charge of the wards where the research will be conducted, the
director of the Parirenyatwa hospital, and the Joint Research Ethics Committee.

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 CHAPTER 4: DATA PRESENTATION

Introduction

The purpose of this study was to assess the level of patient satisfaction with interventions aimed at controlling
preoperative anxiety in adult patients following a major surgery at Parirenyatwa Group of Hospital. The study
findings answered the following question;

What is the level of patient satisfaction with interventions to control preoperative anxiety in adult patients at
parireyatwa Group of Hospitals following a major surgery?

The chapter’s concern is to present results and outline results. Data was collected from 30 eligible participants
and there was 100% response rate. For data analysis descriptive statistics were used yielding frequencies and
percentages.

Demographic profile

Analysis of demographic characteristics of the respondents included variables such as of age, gender,
educational qualifications, marital status, religion, employment status and the procedure done was considered.

This chapter presents the result findings of the study entitled “Patient satisfaction with interventions aimed at
controlling preoperative anxiety in adult patients following a major surgery at Parirenyatwa Group of
Hospital”. It sought to answer the following question: What is the level of patient satisfaction with
interventions to control preoperative anxiety in adult patients at Parireyatwa Group of Hospitals following a
major surgery.

TABLE 4.1 DEMOGRAPHIC DATA (i)

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 Age

Age Frequency Percent

20-25 10 33.3
26-35 6 20.0
36-45 7 23.3
Valid
46-55 3 10.0
56-65 4 13.3
Total 30 100.0

Table 4.1(i) shows that, ten respondents (33.3%) were aged between 20-25 years, six respondents (20%) were
aged between 26-35 years and seven respondents (23,3%) were aged between 36-45 years. Among the
respondents, 3 (10%) were aged between 46 to 55 years, four (, 13.3%) had ages between 56 to 65 years.

TABLE 4.1 DEMOGRAPHIC DATA (ii)

VARIABLE FREQUENCY PERCENTAGE %

Level of Education
Primary 5 16.7
Secondary 14 46.7
Tertiary 11 36.7
None 0 0

Marital Status
Single 7 23.3
Married 19 63.3
Divorced 2 6.7
Widowed 2 6.7

Employment status
Employed 19 63.3
Unemployed 11 36.7

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 Religion
Christianity 30 100
Other 0

Table 4.1 (ii) highlights that of all respondents, five (16.7%) had reached primary level of education, fourteen
(46.7%) had reached secondary level of education and eleven (36.7%) had reached tertiary level of education.
Among the respondents seven (23.3%) were single, nineteen (63.3%) were married, two (6.7%) were divorced
and two (6.7%) were widowed. Among the respondents 30 (100%) were Christian and none had other
religions. Nineteen (63.3%) were employed, eleven (36.7%) were not employed.

TABLE 4.2 (i)

Variables Responses Frequency Percentage%

Experiences with preoperative anxiety Yes 23 76.7

No 7 23.3

Those who have undergone surgeries at Parirenyatwa Yes 12 40

Hospital before.
Never 18 60
Duration of hospital stay. 1-7 days 7 23.3

8-14 days 11 36.7

15-21 days 9 30

22 days 3 10
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 and above
Overall health status before surgery Excellent 3 10

Very good 11 36.7

Good 4 13.3

Never 12 40

Overall health status before surgery Excellent 3 10

Very good 11 36.7

Good 9 30

Poor 12 40

TABLE 4.2 INTERVENTIONS TO ALLEVIATE ANXIETY (ii)

Effectiveness of pre-operative information and education Very 6 20

provided in reducing anxiety. effective

Effective 22 73.3

Ineffective 1 3.3
Neutral 1 3.3

Did the preoperative counselling session by healthcare Yes 8 26.7

providers helped to alleviate anxiety. significantly

Yes to some 22 73.3

extent

Were the relaxation techniques helpful No not at all 10 33.3

Slightly 1 3.3
helpful

Moderately 3 10
helpful
Very 16 53.3
helpful

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 How satisfied with preoperative medications Dissatisfied 3 10
Neutral 13 43.3
Satisfied 9 30
Very 5 16.7
satisfied
Did the support from family and friends play a role in reducing Yes 26 86.7
your anxiety To some 4 13.3
extent
No 0 0
Received adequate support from healthcare team Yes 20 66.7
completely
Yes to some 8 26.7
extent
No not at all 2 6.7

Table 4.2(i) highlights that twenty three respondents (76.7%) reported that they had experienced preoperative
anxiety and seven (23.3%) did not experience preoperative anxiety. Twelve (40%) reported that they had
undergone surgeries before at Parirenyatwa hospital and 18 (60%) had never been to surgery before. Seven
(23.3%) respondents reported that they had a duration of hospital stay of 1- 7 days, 11(36.7%) of 8-14 days,
9(30%) of 15-21 days and 3(10%) had over 21 days of hospital stay. Only three respondents (10%) reported
that their overall health status before surgery was excellent, 11(36.7%) reported that it was very good, 9(30%)
responded that their health was good and 12(40%) said that their overall health was poor. Six respondents
(20%) reported that preoperative information and education provided in reducing anxiety was very effective,
22(73.3%) said was effective, 1(3.3%) said was ineffective and 1(3.3%) said it was neutral. Eight (26.7%)
reported that preoperative counselling session by healthcare providers helped to alleviate their anxiety and
22(73.35) yes but not significantly. Referring to Table 4.2, ten respondents (33.3%) reported that relaxation
techniques were not helpful at all, 1(3.3%) said it was slightly helpful, 3(10%) said it was moderately helpful
and 16(53.3%) said it was very helpful. Three (10%) reported that they were satisfied by preoperative
medications, 13(43.3%) said it was neutral, nine respondents (30%) reported that they were satisfied and
5(16.7%) reported that they were very satisfied.

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Table 4.2 (i) presented that 20 respondents (66.7%) reported that they received adequate support from
healthcare system and 8(26.7%) said yes but to some extent. Twenty six (86.7%) reported that the support
from family and friends played a role in reducing their anxiety and 4 (13.3%) said yes but to some extent.

Table 4.2 (iii) Type of procedure to be done

Type of procedure Frequency Percentages %

Laparatomy 3 10
Orthopedic 17 56.7
Ambutations 2 6.7
Mastectomy 2 6.7
Appendectomy 1 3.3
Gastrectomy 2 6.7
Testicular retraction 2 6.7
Pancreaticoduodenectomy 1 3.3

Table 4.2 (iii) presents the majority of the respondents with a percentage of 17(56.7%) had orthopedic
procedures followed by those who undergone laparotomy for different abdominal conditions. There was equal
presentation for those who undergone amputations, mastectomy, testicular retraction and gastretomy with
1(6.7%). Appendectomy and pancreaticoduodenectomy had a presentation of 1(3.3%).

SUMMARY

The results answered questions pertaining to patient satisfaction with interventions to control preoperative
anxiety in adult patients following a major surgery at Parirenyatwa hospital. Data was collected from 30
participants and no question was left without a response thus the 100% responsive rate. For data analysis,
descriptive statistics were used yielding frequencies and percentages. Tables were used to summarize the
different variables.
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