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Original Research

Effects of a Simulation-based Educational Program for Gastroendoscopic Surgery Patients

Su Young Kwon1, Jia Lee2
Korean Journal of Adult Nursing 2013;25(5):494-503.
Published online: October 18, 2013

1Education Graduate School, Kyung Hee University, Seoul

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Corresponding author: Lee, Jia College of Nursing Science, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-701, Korea. Tel: +82-2-961-0894, Fax: +82-2-961-9398, E-mail: leejia@khu.ac.kr
• Received: May 20, 2013   • Accepted: October 25, 2013

© 2013 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to examine the effects of a simulation-based educational program on anxiety and discomfort in patients with early stage of stomach cancer or stomach adenoma undergoing gastroendoscopic surgery.
  • Methods
    The study employed a non-equivalence control group and non-synchronized design to prevent diffusion of treatment. Data were collected from 110 patients (experimental group=55, control group=55) admitted to a department of gastroenterology to undergo gastroendoscopic surgery for early stage of stomach cancer or stomach adenoma. The program was conducted as a 30-minute simulation-based education including 12 processes which patients would experience. Outcome variables were state anxiety, objective discomfort, and subjective discomfort.
  • Results
    The scores of state anxiety in the experimental group significantly decreased over time compared to those in the control group. The scores of objective and subjective discomfort after surgery in the experimental group were significantly lower than those in the control group.
  • Conclusion
    The study findings suggested that the simulation-based educational program making a person feel sense of real experiences could reduce anxiety and discomfort in gastroendoscopic surgery patients.
  • Key Words: Anxiety; Surgery; Endoscopy; Program
Figure 1.
Research design.
kjan-25-494f1.jpg
Table 1.
Simulation-based Educational Program for Gastroendoscopic Surgery Patients
No Process Contents Rationale
1 Introduction Purpose and significance of pre-education Through introduction facilitating commitment and motivation to participate in the program is important before education
2 Indication Indications and effects of patient's surgery To check understanding of participants' own surgery and to consult if needed
3 Before surgery Taking a degassing agent on a ward and its precautions Degassing agent will reduce normal bubble and gas in the stomach to secure a clear view.
4 Endoscopic room m Positioning in an endoscopic room and taking a neck anesthesia Pre-education of positioning will save preparation time in the endoscopic room and reduce disconcertment. Neck anesthesia will reduce pain during endoscope insertion.
5 Mouth piece Monitoring process and taking a mouth piece Pre-education of mouth piecing will reduce anxiety. Mouth piece secures endoscopic route and protects tongue.
6 Sedation Administration of sedative medication Sedative medication before the endoscopic insertion is used to induce or maintain anesthesia during surgery.
7 Surgery Operation process edited with important scenes (by surgery type) Understanding of operation process will reduce anxiety or fear
8 Recovery room Assessing patients: Contents and rationale Vital sign to check recovery from anesthesia or bleeding tendency. Monitor continuous pain or bleeding.
9 Radiographic test t Taking a radiographic inspection and its rationale Radiographic tests to monitor complications including bleeding or perforation.
10 On a ward Monitoring process on a ward Participants need to expect monitoring process back to the ward to check complications
11 Next day Blood tests, radiographic test, and gastroendoscopy Pre-education of various tests to monitor patient's condition will reduce disconcertment. The gastroendoscopy next day will confirm the success of surgery.
12 Discharge Checking the test results, diets and discharge process Self-management methods including diets need to be educated before discharge to reduce recurrence of disease
Table 2.
Homogeneity Test of General Characteristics and Anxiety of Participants (N=110)
Characteristics Categories Exp. (n=55) Cont. (n=55) x2 or t p
n (%) or M±SD n (%) or M±SD
Age (year)   64.4±9.6 57.6±10.7 3.52 .001
≤49 3 (5.5) 13 (23.6) 12.28 .006
50~59 15 (27.3) 21 (38.2)
60~69 17 (30.9) 12 (21.8)
≥70 20 (36.4) 9 (16.4)
Gender Male 33 (60.0) 34 (61.8) 0.04 .845
Female 22 (40.0) 21 (38.2)
Marital status Married 54 (98.2) 52 (94.5) 1.04 .308
Not married 1 (1.8) 3 (5.5)
Religion Yes 28 (50.9) 24 (43.6) 0.58 .445
No 27 (49.1) 31 (56.4)
Level of education Elementary school 16 (29.1) 17 (30.9) 0.54 .911
Middle school 11 (20.0) 11 (20.0)
High school 22 (40.0) 19 (34.5)
College or above 6 (10.9) 8 (14.5)
Number of endoscopy 1~2 22 (40.0) 22 (40.0) 3.16 .206
3~4 17 (30.9) 24 (43.6)
≥5 16 (29.1) 9 (16.4)
Trait anxiety   1.83±0.41 1.94±0.41 -1.33 .186
State anxiety   4.79±2.29 4.89±2.53 -0.21 .834

Exp.=experimental group; Cont.=control group.

Table 3.
Changes of State Anxiety over Time and after Age Control (N=110)
Measures Exp. (n=55) Cont. (n=55) t p Source F p Bon-ferroni F p
M±SD M±SD
Admissiona 4.79±2.29 4.89±2.53 -0.21 .834 Group 23.86 ＜.001 a＞b＞c    
Before surgeryb 1.91±0.30 4.51±0.30 -6.15 ＜.001 Time 113.51 ＜.001   36.07 ＜.001
After surgeryc 0.58±0.24 2.76±0.24 -6.36 ＜.001 Group∗Time 20.30 ＜.001   39.04 ＜.001

Exp.=experimental group; Cont.=control group.

Table 4.
Comparison of Objective and Subjective Discomfort after Surgery (N=110)
Variables Categories Exp. (n=55) Cont. (n=55) t p
M±SD M±SD
Objective discomfort   1.16±0.18 1.69±0.51 -7.15 ＜.001
Sweating 1.04±0.19 1.44±0.60 -4.71 ＜.001
Facial change 1.16±0.42 1.76±0.61 -6.03 ＜.001
Postural change 1.02±0.13 1.65±0.67 -6.88 ＜.001
Voice change 1.44±0.54 1.91±0.67 -4.07 ＜.001
Subjective discomfort   0.95±0.73 1.97±1.54 -4.45 ＜.001
Abdominal pain 2.04±2.05 3.27±2.48 -2.85 .005
Nausea 0.40±0.87 0.87±1.90 -1.68 .096
Irritation of throat 0.40±1.26 1.78±2.64 -3.51 .001
Abdominal distension 0.96±1.36 1.98±2.11 -3.01 .003

Exp.=experimental group; Cont.=control group.

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    Effects of a Simulation-based Educational Program for Gastroendoscopic Surgery Patients
    Korean J Adult Nurs. 2013;25(5):494-503.   Published online October 31, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.5.494
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    Effects of a Simulation-based Educational Program for Gastroendoscopic Surgery Patients
    Korean J Adult Nurs. 2013;25(5):494-503.   Published online October 31, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.5.494
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    Effects of a Simulation-based Educational Program for Gastroendoscopic Surgery Patients
    Image
    Figure 1. Research design.

    Figure 1.

    Effects of a Simulation-based Educational Program for Gastroendoscopic Surgery Patients

    Simulation-based Educational Program for Gastroendoscopic Surgery Patients

    No Process Contents Rationale
    1 Introduction Purpose and significance of pre-education Through introduction facilitating commitment and motivation to participate in the program is important before education
    2 Indication Indications and effects of patient's surgery To check understanding of participants' own surgery and to consult if needed
    3 Before surgery Taking a degassing agent on a ward and its precautions Degassing agent will reduce normal bubble and gas in the stomach to secure a clear view.
    4 Endoscopic room m Positioning in an endoscopic room and taking a neck anesthesia Pre-education of positioning will save preparation time in the endoscopic room and reduce disconcertment. Neck anesthesia will reduce pain during endoscope insertion.
    5 Mouth piece Monitoring process and taking a mouth piece Pre-education of mouth piecing will reduce anxiety. Mouth piece secures endoscopic route and protects tongue.
    6 Sedation Administration of sedative medication Sedative medication before the endoscopic insertion is used to induce or maintain anesthesia during surgery.
    7 Surgery Operation process edited with important scenes (by surgery type) Understanding of operation process will reduce anxiety or fear
    8 Recovery room Assessing patients: Contents and rationale Vital sign to check recovery from anesthesia or bleeding tendency. Monitor continuous pain or bleeding.
    9 Radiographic test t Taking a radiographic inspection and its rationale Radiographic tests to monitor complications including bleeding or perforation.
    10 On a ward Monitoring process on a ward Participants need to expect monitoring process back to the ward to check complications
    11 Next day Blood tests, radiographic test, and gastroendoscopy Pre-education of various tests to monitor patient's condition will reduce disconcertment. The gastroendoscopy next day will confirm the success of surgery.
    12 Discharge Checking the test results, diets and discharge process Self-management methods including diets need to be educated before discharge to reduce recurrence of disease

    Homogeneity Test of General Characteristics and Anxiety of Participants (N=110)

    Characteristics Categories Exp. (n=55) Cont. (n=55) x2 or t p
    n (%) or M±SD n (%) or M±SD
    Age (year)   64.4±9.6 57.6±10.7 3.52 .001
    ≤49 3 (5.5) 13 (23.6) 12.28 .006
    50~59 15 (27.3) 21 (38.2)
    60~69 17 (30.9) 12 (21.8)
    ≥70 20 (36.4) 9 (16.4)
    Gender Male 33 (60.0) 34 (61.8) 0.04 .845
    Female 22 (40.0) 21 (38.2)
    Marital status Married 54 (98.2) 52 (94.5) 1.04 .308
    Not married 1 (1.8) 3 (5.5)
    Religion Yes 28 (50.9) 24 (43.6) 0.58 .445
    No 27 (49.1) 31 (56.4)
    Level of education Elementary school 16 (29.1) 17 (30.9) 0.54 .911
    Middle school 11 (20.0) 11 (20.0)
    High school 22 (40.0) 19 (34.5)
    College or above 6 (10.9) 8 (14.5)
    Number of endoscopy 1~2 22 (40.0) 22 (40.0) 3.16 .206
    3~4 17 (30.9) 24 (43.6)
    ≥5 16 (29.1) 9 (16.4)
    Trait anxiety   1.83±0.41 1.94±0.41 -1.33 .186
    State anxiety   4.79±2.29 4.89±2.53 -0.21 .834

    Exp.=experimental group; Cont.=control group.

    Changes of State Anxiety over Time and after Age Control (N=110)

    Measures Exp. (n=55) Cont. (n=55) t p Source F p Bon-ferroni F p
    M±SD M±SD
    Admissiona 4.79±2.29 4.89±2.53 -0.21 .834 Group 23.86 ＜.001 a＞b＞c    
    Before surgeryb 1.91±0.30 4.51±0.30 -6.15 ＜.001 Time 113.51 ＜.001   36.07 ＜.001
    After surgeryc 0.58±0.24 2.76±0.24 -6.36 ＜.001 Group∗Time 20.30 ＜.001   39.04 ＜.001

    Exp.=experimental group; Cont.=control group.

    Comparison of Objective and Subjective Discomfort after Surgery (N=110)

    Variables Categories Exp. (n=55) Cont. (n=55) t p
    M±SD M±SD
    Objective discomfort   1.16±0.18 1.69±0.51 -7.15 ＜.001
    Sweating 1.04±0.19 1.44±0.60 -4.71 ＜.001
    Facial change 1.16±0.42 1.76±0.61 -6.03 ＜.001
    Postural change 1.02±0.13 1.65±0.67 -6.88 ＜.001
    Voice change 1.44±0.54 1.91±0.67 -4.07 ＜.001
    Subjective discomfort   0.95±0.73 1.97±1.54 -4.45 ＜.001
    Abdominal pain 2.04±2.05 3.27±2.48 -2.85 .005
    Nausea 0.40±0.87 0.87±1.90 -1.68 .096
    Irritation of throat 0.40±1.26 1.78±2.64 -3.51 .001
    Abdominal distension 0.96±1.36 1.98±2.11 -3.01 .003

    Exp.=experimental group; Cont.=control group.
    Table 1. Simulation-based Educational Program for Gastroendoscopic Surgery Patients

    Table 2. Homogeneity Test of General Characteristics and Anxiety of Participants (N=110)

    Exp.=experimental group; Cont.=control group.

    Table 3. Changes of State Anxiety over Time and after Age Control (N=110)

    Exp.=experimental group; Cont.=control group.

    Table 4. Comparison of Objective and Subjective Discomfort after Surgery (N=110)

    Exp.=experimental group; Cont.=control group.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Korean J Adult Nurs : Korean Journal of Adult Nursing

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