How to Improve the Patient and Family Experience When in the Perioperative Area.

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• Published: 07 April 2020

Assessing needs of patients and families during the perioperative menses at King Abdullah Medical City

• Ahmed Alhadithi^two,
• Faisal Salem Alhumaidi³,
• Abdullah Mutlaq Al Khudhair⁴,
• Saeed Altheeb^two &
• Ahmed Saad Badri³

Perioperative Medicine volume nine, Article number:x (2020) Cite this article

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Abstract

Background

This paper explores constituent surgery patients' and family members' needs during the perioperative period, in a specialized hospital in Saudi arabia. Needs are influenced past context and could differ from a setting to some other.

Methods

Two questionnaires, one for the patient grouping and the other for the family member grouping, were adopted from a previous similar written report. The participants were asked to rate the importance of each demand and how much it was satisfied. Data were collected in v weeks. Descriptive statistics were used to make up one's mind the average charge per unit and standard deviation of each item.

Results

Patients highly rated the need for adequate symptom management in the recovery expanse. Family members highly rated the importance of existence informed if the surgical procedure is taking more time than expected and communicating with the surgeon later the procedure.

Decision

Systematically involving the family member in the perioperative care of the patient is advantageous. However, interventions and extent of involvement of the family member to the care of the patient would take to be adapted co-ordinate to the cultural context.

Groundwork

The perioperative fourth dimension is a stressful menstruation for both the patient and the family member (Leske 1993; Marker 2003). Understanding their prioritized needs is essential to improve their experience. Because prioritized needs and satisfaction factors differ culturally, information technology is of import to explore them in local settings (Halligan 2006).

In the Kingdom of Saudi Arabia (KSA)—like to other middle eastern cultures—families form strong ties, and they are an essential source for social, emotional and spiritual back up of the patient (Saleh Al Mutair et al. 2014). For instance, family members would address health professionals for information near the patient and could influence decision making (Halligan 2006; Almutairi et al. 2015). Also, a family fellow member is expected to stay with the patient in the hospital, and family members would be receiving and facilitating breaking the bad news to the patient (Saleh Al Mutair et al. 2014). Concordantly, it was establish that patients are inclined toward family unit involvement in their healthcare rather than an autonomous patient approach when their perceptions were explored in a local infirmary in KSA (Mobeireek et al. 2008). Nonetheless, the boundaries of the function of family members as role of the care providers in the infirmary are confusing to healthcare professionals, particularly to nurses (Halligan 2006; Alshahrani et al. 2018).

The conflicting cultural values and ambiguity of family member boundaries to expatriate nurses was an impetus to explore cultural competence in healthcare in Saudi Arabia (Almutairi et al. 2015). KSA is a vast state with a 32,000,000 population, and the majority are youth (WHO due north.d.). To meet the healthcare needs of this growing population, a big number of expatriate nurses joined the healthcare workforce (Aldossary et al. 2008). Consequently, research initiatives to explore and utilize the concept of cultural competence were undertaken and emphasized the unique cultural challenge of nursing-family unit member relationship (Almutairi et al. 2015; Alshahrani et al. 2018; Almutairi and Rondney 2013). For example, nurses were worried most the constant presence of the family members as sometimes they pose a risk on patient safety as the family member is trying to take care of the patient's needs (Alshahrani et al. 2018). Nurses also felt emotionally stressed about family members involved in decision making that sometimes put the patients through a lot of unnecessary interventions (Halligan 2006). The studies on cultural competence raised the importance of a family-centred arroyo in healthcare in Saudi arabia (Almutairi and Rondney 2013).

In the perioperative setting, the role of family members had been recognized on a global level (Shields 2007). Bodily integration started initially at paediatric care and extended to the adult perioperative setting (Smykowski and Rodriguez 2003). The high measured level of anxiety of both the patient and the family member in the perioperative period was a significant gene in developing patient and family-centred interventions to address stressors (Marker 2003; Dexter and Epstein 2001). I example is the postanaesthesia care unit (PACU) visits of family unit members, the visits were found to improve satisfaction and feet for both patients and family unit members (Carter et al. 2012). Furthermore, anxiety levels of family members could meliorate with in-person progress written report while waiting for the patient in surgery, especially when the surgical fourth dimension is extended (Stefan 2010; Blum and Burns 2013).

Given the cultural context that reinforced family unit interest and the stress on both family and patient in the perioperative setting, it is crucial to explore their needs in the Saudi surroundings. Nosotros did not observe whatsoever studies washed in Saudi Arabia that examined the needs of patients and family members during the perioperative period. We also did not find whatsoever example for a model of family unit-centred intendance in healthcare in KSA in whatever healthcare setting. For this purpose, in this study, we aimed to survey and depict the prioritized perceived needs of patients and their family members who were admitted for elective surgery in KAMC and asses their level of satisfaction. We will contrast that to established needs in western societies and how it might differ to needs in KSA.

Methods

Study design

A descriptive cross-sectional survey study design was used to assess the prioritized perioperative needs of the patients and accompanying family unit members subsequently constituent surgery.

The study was conducted in the perioperative administration at King Abdullah Medical City (KAMC), Makkah, Saudi Arabia. KAMC is a tertiary and fourth governmental healthcare centre. Nosotros gained ethical approval from the Institutional Review Board at KAMC before starting the data drove process.

Our targeted population was all patients who were admitted for constituent surgery and were sent back to the ward after surgery and their accompanying family unit members. A convenience sampling was used. Participants were selected based on a list of patients who take been received in the recovery area. Our population was the whole number of patients who met the criteria during the fourth dimension of the report. The reason for that is that the catamenia and type of patient would differ throughout the year, peculiarly with pilgrimage seasons. Population number was estimated to be 215 participants in total. With a confidence interval of 95% and a margin of error of 10%, the sample size would be 67 participants from each grouping. This was accepted in alignment with the exploratory nature of the report (Denscombe 2014).

All patients and family members were approached to survey the day after surgery in their rooms at KAMC from 24 of July to 24 of August 2017. The investigators introduced themselves every bit they were non staff members of KAMC and took the consents for participation in the study. The investigators explored with the participants the benefits from their participation in the written report with emphasis on confidentiality every bit the survey did not include any nominative information. The investigators then asked them to fill the questionnaire and added any further needs that were not included in the survey. The questionnaire took not more than 5 min for completion. The investigators were nowadays with the participants to support them fill the questionnaire and were present when the questionnaire is beingness answered and so that they would attend to whatsoever needs for clarifications.

Inclusion/exclusion criteria

Our inclusion criteria for patients and accompanying family unit members were as follows: to exist 18 years or more than of age, the patient was admitted for constituent surgery and the power to cooperate and communicate with the investigator. Nosotros excluded participants who were unable to speak Arabic, same-twenty-four hours surgery patients and patients who were sent to ICU after surgery.

Information collection tool

Two similar questionnaires were used one for the patient participant and the other for the accompanying family member participant. These questionnaires were adapted from a previous report and translated (Davis et al. 2014). The reason nosotros adjusted these questionnaires is that they were the but that we found that would appraise the needs of the participant for the whole perioperative menstruation. The questionnaires were reviewed by ii nurses, were also linguistically reviewed and were piloted on iv others who are none healthcare professionals. Each questionnaire had two groups of questions concerning the needs of the participants. In the first question, the participant was asked to charge per unit the need by a 4-level Likert scale regarding importance. In the second question, the participant was asked to determine how much the need was met. Also, questions about logistical information before coming to the hospital and demographic information were nerveless. We were limited to the items of the survey, though some spaces for comments were left. The survey would allow for baseline noesis on how such needs might differ in our local community and support further research and exploration.

The patient's questionnaire had 26 needs, and the family fellow member's questionnaire had eighteen needs. These needs were grouped into time periods in the perioperative fourth dimension. In that location was a space to annotate after each fourth dimension period in the questionnaire. The questionnaire's items focused on the following: communication with hospital staff, data giving and physical comfortability. There have been some patients and family unit members who refused to participate in our written report (estimated No. 5–10 participants). The reasons why they did not desire to exist part of the study were as follows: they were not educated enough to understand the content, were too sick to participate in the study, or simply did non accept time to make full the survey.

Data was inserted electronically into SPSS. Importance of each need was assigned a numerical code for coding purposes: 0 = not of import at all, 1 = not important, ii = important and 3 = very important. Moreover, whether the particular was met or not was assigned a numerical value for coding purposes: 0 = not met, 1 = partially met and 2 = met. Descriptive statistics were used to reflect patients and family fellow member needs and experience. The average ways and standard difference were calculated for each need, and the needs were ranked appropriately. Missing data was amputated from the calculation.

Results

We accept surveyed 144 participants over 5 weeks; 77 of them were patients, while 67 were family members. The total response rate among participants in the report was around 85 %. The hateful age of patients was 49.58 (SD = ± 16.three) years, while the hateful age of family members was 35.03 (SD = ± 9.83) years. The vast majority of participants were Saudis, with various educational levels. Family member participants were 38.8% of the time the sons or daughters of the patients. Near 80–90% of patients and family members reported that they were informed nigh the fourth dimension of access. 51.9% of patients and 67.two% family unit members reported receiving information before coming to the infirmary well-nigh the location for access, and 55.viii% of patients received data on taking their usual medications before admission. The majority of patients and accompanying family members reported that they had not received whatsoever data before coming to the hospital virtually where to park, items to bring to the hospital and the location of the family waiting expanse (see Table 1).

Table i Characteristics of patient and family member participants

Total size tabular array

Patients' mean scores for responses to the importance of each need and how well these needs were met during each time period within the perioperative menstruation are summarized in Table 2. The overall top-ranked needs for patients in the perioperative menses are equally follows: being treated with respect by hospital personnel, adequate symptom management past the recovery room staff and physical comfortability of the recovery area. Hateful scores for how well patient needs were met during the perioperative experience were 1.5 out of ii for all surveyed needs

Tabular array two Patients boilerplate (±SD) scores for importance of perioperative needs and how often those needs were perceived to have been met

Full size tabular array

Family members' hateful scores for responses to the importance of each need item and how well these needs were met during each fourth dimension period within the perioperative period are summarized in Table 3. The overall height-ranked needs for family unit members in the perioperative period are every bit follows: being treated with respect past hospital personnel, having advice with the surgeon or other physicians afterward the procedure and being informed about delays in the operating room schedule. Hateful scores for how well family members' needs were met during the perioperative experience were 1.4 out of 2 for all surveyed needs.

Table iii Family members' boilerplate (±SD) scores for importance of perioperative needs and how frequently those needs were perceived to take been met

Full size tabular array

Very few participants wrote in the comment sections. Repeated comments were concerning the unavailability of a waiting area for the family unit members during the surgical operation fourth dimension.

Word

In this study, nosotros explored and described the prioritized needs of patients and their family members who were admitted for elective surgery in KAMC. For this purpose, a questionnaire that was used in a previous similar report was adopted and translated to fit the intended context (Davis et al. 2014).

The needs listed in the questionnaire were all averagely rated to be at least of import. The needs were partially satisfied past the patients and their family members on average, indicating a room for improvement and further exploration of those needs and their attributes. The lowest-ranked need was given an average charge per unit of 2.xi of importance in a four-point Likert scale (very important [3], important [2], not of import [ane], non important at all [0]). Our result shows that the summit three almost of import needs from the perspective of the patient are equally follows: adequate symptom management in the recovery surface area along with concrete comfortability of its environment, and reassurance by a healthcare provider just earlier surgery and communication if the surgery schedule was delayed. On the other manus, our results demonstrate that the highly ranked needs from the family unit members' perspective are as follows: existence informed about the surgical procedure, communication if the surgery is taking longer than expected and reassurance from the surgeon in one case the procedure is done. The top demand for both patients and family members, namely "being treated with respect past hospital personnel" were not considered here in the discussion due to acquiescence bias. This is explained by the nature of the question request them about the rating importance of respectful treatment. All participants graded this need every bit highly important in the survey.

Nosotros constitute that the literature described interventions to tackle patients' and family members' anxiety that are relevant to the pinnacle-ranked needs in our results. In the following, nosotros would list these interventions and their correlated needs:

First, preoperative didactics programme with data on postoperative symptom management and information nearly the surgical procedure itself could improve the anxiety level of patients and improve symptom management postoperatively (Garretson 2004; Kiyohara et al. 2004; Bailey 2010). Supplementation with written educational materials was found to reduce the feet level of patients. In particular, when written content about the process and postoperative pain and nausea management were included (Kiyohara et al. 2004). This correlates with the first need of patients mentioned above and is likewise a indicate for service improvement (Bailey 2010; Hughes 2002; Spalding 2003). Our results show that information given to patients near postoperative symptom management was found to exist partially met.

2nd, Hughes suggested that nurse communication after access with the patient helps salvage anxieties (Hughes 2002). A top need for patients in our results is the need for reassurance just before surgery and if the functioning is delayed. This need is related to a high level of anxiety before elective surgery (Jawaid et al. 2007).

Tertiary, in concordance with the second- and third-ranked needs of family members, a systematic review suggests that a person to person progress report in the intraoperative menstruum reduces the anxiety level of accompanying family unit members, particularly if the surgical fourth dimension is taking longer than expected (Dexter and Epstein 2001). Intraoperative progress report by phone also decreases the anxiety level and improves the satisfaction level of accompanying family unit members (Blum and Burns 2013).

Additionally, a systematic review was done to explore the various prove-based approaches to tackle patients' feet during the perioperative period listed that relaxation techniques and music therapy were effective in reducing feet (Bailey 2010).

Our surprising finding in this inquiry is that dissimilar patients, family members highly ranked the demand to exist informed of surgical procedures. This is different from the previous study of Davis et al. (Davis et al. 2014) where the patients and their family members both ranked this need equally the highest demand. The literature suggests that preoperative education to patients well-nigh surgical process improves their anxiety but does not explore that on the family members' side (Kiyohara et al. 2004). Having this need ranked highly past family members and not patients in our survey raises a similar question discussed in the introduction to the unique cultural setting in Kingdom of saudi arabia. It also raises questions virtually relevant factors involved such as age, gender, wellness status, educational level or other cultural influences. At that place is an indication that the family fellow member in Saudi culture plays an essential part in the emotional back up and decision making for the patient; however, research in this is limited (Halligan 2006; Saleh Al Mutair et al. 2014). We also noticed in our results that the bulk of patients are older and have a lower educational level in comparison to family members, and these could play a factor in our results. Nevertheless, nosotros do non know the patients' perspectives on such family unit member's need, and we exercise not know its affect on family unit members' anxiety level here or in other cultures, which could be explored in farther enquiry.

We realize several limitations in our study. Start, we could not generalize our effect to other contexts and hospitals as it explores the characteristics of KAMC population of patients in a non-pilgrimage flavour time in a limited period. Second, the validity of the questionnaire from Davis et al. (Davis et al. 2014) was express to content validity. Tertiary, we did not explore the types of surgery these patients went through.

Conclusions

In conclusion, in our study, we explored the needs and the satisfaction level of patients and accompanying family unit members in a third and quaternary center in Kingdom of saudi arabia. The results could be used as an impetus to co-produce patients and family unit-centred interventions. Nosotros would likewise like to explore how staff would perceive and prioritize patients' and family unit members' needs and compare them to the current results. Family unit members are an essential component of uniform cultural commitment of healthcare in Saudi; therefore, sensitivity to patients' and family unit members' needs is a competency when embraced would pb to better experience and outcome. Studies that explore the cultural context in Saudi Arabia particularly, autonomy in health-related problems related to age, gender and educational level and how to arroyo such differences professionally are needed, as western values in healthcare would need to be tailored. Future action research to evaluate the impact of initiatives on satisfaction and anxiety level, determining anxiety levels in patients and family members are recommended.

Availability of data and materials

All data generated or analysed during this study are included in this published article and its supplementary information files.

Abbreviations

PACU:

Postanesthesia care unit

KAMC:

Rex Abdullah Medical City

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Acknowledgements

Special thanks to Dr. Rawabi Daafi Majrashi and Dr. Salwa Obed Alomeri for assist with data drove. And special thank you to Dr. Manal Seraj Mashaat the perioperative administration director for her support and approval to comport the research.

Funding

No funding was received.

Author data

Affiliations

1. Perioperative Medicine Administration, King Abdullah Medical City-Makkah, Makkah, Saudi Arabia

   Wid Alsabban

2. Higher of Medicine, Male monarch Khalid University, Abha, Saudi arabia

   Ahmed Alhadithi & Saeed Altheeb

3. College of Medicine, Umm Al Qura University, Makkah, Saudi Arabia

   Faisal Salem Alhumaidi & Ahmed Saad Badri

4. College of Medicine, Imam Abdularhman bin Faisal University, Dammam, Kingdom of saudi arabia

   Abdullah Mutlaq Al Khudhair

Contributions

All authors contributed to reviewing the literature, adopting the survey, writing the proposal, collecting and entering the data and writing the final manuscript. ST was responsible for information management and analysis. AH majorly contributed to writing the introduction. AK and AB contributed to writing the methodology part. FH, AB and ST contributed to writing the results. AH contributed to writing the discussion. WS was a pregnant contributor to the writing of the final manuscript and was closely supervising and guiding the group in their work. All authors have read and approved the terminal version of the manuscript.

Corresponding author

Correspondence to Wid Alsabban.

Ethics declarations

Ethics approval and consent to participate

We just started the study after gaining approval from the Institutional Review Board of KAMC. The participation in this study was entirely voluntary after the caption of the enquiry and obtaining exact consent, and ethical conduct was respected.

Consent for publication

Non applicable.

Competing interests

The authors declare that they have no competing interests.

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Alsabban, Westward., Alhadithi, A., Alhumaidi, F.S. et al. Assessing needs of patients and families during the perioperative period at King Abdullah Medical City. Perioper Med 9, 10 (2020). https://doi.org/ten.1186/s13741-020-00141-9

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• Received: 19 September 2019

• Accepted: 18 March 2020

• Published: 07 April 2020

• DOI : https://doi.org/10.1186/s13741-020-00141-9

Keywords

• Patient satisfaction
• Patient feel
• Perioperative
• Advice
• Family needs

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