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The Effects of Structured Preoperative Instruction on Anxiety and Self-care Compliance in Patients with Cataract Surgery

Mi Jung Choi1, Jeong Sook Park2
Korean Journal of Adult Nursing 2013;25(4):473-482.
Published online: August 18, 2013

1Department of Nursing, Daekyung College, Gyeongsan

2College of Nursing, Keimyung University, Daegu, Korea

Corresponding author: Park, Jeong Sook College of Nursing, Keimyung University, 1095 Shindang-dong, Dalsseo-gu, Daegu 704-701, Korea. Tel: +82-53-580-3907, Fax: +82-53-580-3904, E-mail: jsp544@kmu.ac.kr
• Received: January 25, 2013   • Accepted: August 19, 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 investigate the effects of a structured preoperative instruction upon anxiety and postoperative self-care compliance.
  • Methods
    A randomized control group pre-post design was used. Sixty subjects undergoing cataract surgery were randomly assigned to one of two groups. The instruction consisted of cataract surgery procedure, sensory information, deep breathing, use of eye drop, and post op self-care regimen and was provided to the experimental group with control group receiving an usual treatment. State anxiety NRS, pulse, BP, and self-care compliance scale developed by Cho & Rho were used. Data were collected at two time periods: on the day of surgery in the clinic and prior to anesthesia in the operating room. The postoperative self-care compliance scores were measured at their second visits to the hospital after surgery. Data were analyzed using Kolmogorov Smirnov test, t-test, and Mann-Whitney U test.
  • Results
    There were significant differences between the two groups in the postoperative state anxiety (t=-3.57, p=.001) and the postoperative self-care compliance score (t=3.92, p<.001). There were no significant difference between the two groups in the postoperative blood pressure and pulse rate.
  • Conclusion
    The results of this study suggest that the structured preoperative instruction could be a nursing intervention for cataract surgery patients.
  • Key Words: Structured preoperative instruction; Anxiety; Self-care compliance; Cataract surgery
Table 1.
Homogeneity Test of General Characteristics and Pretest Dependent Variables (N=60)
Characteristics or variables Categories Exp. (n=30) Cont. (n=30) x2 or t p
n (%) or M±SD n (%) or M±SD
Gender Male 13 (43.3) 13 (43.3) 0.00 1.000
Female 17 (56.7) 17 (56.7)
Age (year) ＜60 7 (23.3) 8 (26.7) 2.75 .252
60~69 8 (26.7) 13 (43.3) 1.30 .197
≥70 15 (50.0) 9 (30.0)
Mean age 68.13±11.12 64.77±8.74
Education level ≤Elementary school 19 (63.3) 12 (40.0) 8.06 .073†
Middle school 2 (6.7) 4 (13.3)
≥High school 9 (30.0) 14 (46.7)
Occupation Yes 10 (33.3) 8 (26.6) 10.39 .065
No 20 (66.7) 22 (73.4)
Monthly income (10,000 won) ＜100 23 (76.7) 20 (66.7) 6.20 .105†
100~200 3 (10.0) 9 (30.0)
＞200 4 (13.3) 1 (3.3)
Accompanier Spouse 8 (26.7) 11 (36.7) 3.39 .372†
Son or Daughter 15 (50.0) 17 (56.7)
Relative 3 (10.0) 1 (3.3)
None 4 (3.3) 1 (3.3)
Smoking Yes 8 (26.7) 5 (16.7) 0.88 .532†
No 22 (73.3) 25 (83.3)
Knowledge of cataract Do not know 19 (63.3) 17 (56.7) 0.27 .598
Know a little bit 11 (36.7) 13 (43.3)
Type of anesthesia Topical 15 (50.0) 13 (43.3) 0.26 .605
Retrobulbar 15 (50.0) 17 (56.7)
Anxiety Trait anxiety 43.47±8.98 45.60±7.33 -1.00 .318
State anxiety 4.53±2.65 3.67±2.36 1.33 .187
Blood pressure SBP 135.23±20.48 135.27±20.70 438.00 .859‡
DBP 78.03±10.96 81.00±12.89 -0.96 .341
Pulse rate   76.80±12.96 79.30±16.10 -0.66 .510

Exp.=experimental group; Cont.=control group; SBP=systolic blood pressure; DBP=diastolic blood pressure.

†Fisher's exact test;

‡Mann-Whitney U test.

Table 2.
Mean Differences in Dependent Variables between Experimental and Control Group (N=60)
Variables Groups Pretest Posttest Difference t or U p
M±SD M±SD M±SD
State anxiety Exp. (n=30) 4.53±2.65 3.53±2.47 -1.00±2.32 -3.57 .001
Cont. (n=30) 3.67±2.37 4.47±2.39 0.80±1.49
SBP Exp. (n=30) 135.23±20.48 146.70±30.65 11.47±22.79 384.50 .333†
Cont. (n=30) 135.27±20.70 152.13±27.29 16.87±18.34
DBP Exp. (n=30) 78.03±10.96 77.83±11.18 -0.20±14.31 -0.33 .743
Cont. (n=30) 81.00±12.89 81.90±14.65 0.90±11.37
Pulse rate Exp. (n=30) 76.80±12.96 66.37±12.48 -10.43±6.21 -1.78 .079
Cont. (n=30) 79.30±16.11 72.17±16.21 -7.13±7.99

Exp.=experimental group; Cont.=control group; SBP=systolic blood pressure; DBP=diastolic blood pressure.

†Mann-Whitney U test.

Table 3.
Comparison of Self-care Compliance Score between Experimental and Control Group (N=60)
Variables Exp. (n=30) Cont. (n=30) t p
M±SD M±SD
Total 4.39±0.41 3.90±0.54 3.92 ＜.001
Eyedrop 4.36±0.54 3.74±0.73 3.69 ＜.001
  1. I have washed my hands before the eyedrops 4.20±0.92 3.20±1.29 3.43 .001
  2. I have not let the tip of bottle touch the eye or eyelid 4.30±0.79 3.60±1.00 2.99 .004
  3. I have instilled eyedrops as indicated frequency 4.67±0.60 4.47±0.77 1.11 .271
  4. I have instilled different eyedrops at 5-minute intervals 4.27±1.23 3.70±1.39 1.67 .100
Hygene 4.01±1.25 3.39±1.38 1.82 .073
  5. I have washed my hair but did not wet in my operated eye 3.37±1.97 2.47±1.96 1.77 .082
  6. I have washed my face but did not wet in my operated eye 4.87±0.73 4.57±1.22 1.15 .254
  7. I have washed shower but did not wet in my operated eye 3.80±1.86 3.13±2.03 1.32 .190
Protection of operation site 4.40±0.86 3.96±0.93 1.87 .066
  8. I have applied protective eye shield during bedtime 3.97±1.52 3.37±1.60 1.48 .143
  9. I have refrained from rubbing or compressing the eye 4.83±0.37 4.57±0.67 1.87 .065
Daily life 4.79±0.34 4.52±0.42 2.70 .009
  10. I have visited the clinic on the reservation date 5.00±0.00 4.90±0.40 1.36 .179
  11. I have continued normal daily actives, included watching TV, cooking, cleaning 4.37±1.03 3.93±0.82 1.79 .078
  12. I have avoided strenuous exercise like soccer and swimming 5.00±0.00 4.73±0.69 2.11 .039

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

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    Korean J Adult Nurs. 2013;25(4):473-482.   Published online August 31, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.4.473
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    The Effects of Structured Preoperative Instruction on Anxiety and Self-care Compliance in Patients with Cataract Surgery
    Korean J Adult Nurs. 2013;25(4):473-482.   Published online August 31, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.4.473
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    The Effects of Structured Preoperative Instruction on Anxiety and Self-care Compliance in Patients with Cataract Surgery
    The Effects of Structured Preoperative Instruction on Anxiety and Self-care Compliance in Patients with Cataract Surgery

    Homogeneity Test of General Characteristics and Pretest Dependent Variables (N=60)

    Characteristics or variables Categories Exp. (n=30) Cont. (n=30) x2 or t p
    n (%) or M±SD n (%) or M±SD
    Gender Male 13 (43.3) 13 (43.3) 0.00 1.000
    Female 17 (56.7) 17 (56.7)
    Age (year) ＜60 7 (23.3) 8 (26.7) 2.75 .252
    60~69 8 (26.7) 13 (43.3) 1.30 .197
    ≥70 15 (50.0) 9 (30.0)
    Mean age 68.13±11.12 64.77±8.74
    Education level ≤Elementary school 19 (63.3) 12 (40.0) 8.06 .073†
    Middle school 2 (6.7) 4 (13.3)
    ≥High school 9 (30.0) 14 (46.7)
    Occupation Yes 10 (33.3) 8 (26.6) 10.39 .065
    No 20 (66.7) 22 (73.4)
    Monthly income (10,000 won) ＜100 23 (76.7) 20 (66.7) 6.20 .105†
    100~200 3 (10.0) 9 (30.0)
    ＞200 4 (13.3) 1 (3.3)
    Accompanier Spouse 8 (26.7) 11 (36.7) 3.39 .372†
    Son or Daughter 15 (50.0) 17 (56.7)
    Relative 3 (10.0) 1 (3.3)
    None 4 (3.3) 1 (3.3)
    Smoking Yes 8 (26.7) 5 (16.7) 0.88 .532†
    No 22 (73.3) 25 (83.3)
    Knowledge of cataract Do not know 19 (63.3) 17 (56.7) 0.27 .598
    Know a little bit 11 (36.7) 13 (43.3)
    Type of anesthesia Topical 15 (50.0) 13 (43.3) 0.26 .605
    Retrobulbar 15 (50.0) 17 (56.7)
    Anxiety Trait anxiety 43.47±8.98 45.60±7.33 -1.00 .318
    State anxiety 4.53±2.65 3.67±2.36 1.33 .187
    Blood pressure SBP 135.23±20.48 135.27±20.70 438.00 .859‡
    DBP 78.03±10.96 81.00±12.89 -0.96 .341
    Pulse rate   76.80±12.96 79.30±16.10 -0.66 .510

    Exp.=experimental group; Cont.=control group; SBP=systolic blood pressure; DBP=diastolic blood pressure.

    †Fisher's exact test;

    ‡Mann-Whitney U test.

    Mean Differences in Dependent Variables between Experimental and Control Group (N=60)

    Variables Groups Pretest Posttest Difference t or U p
    M±SD M±SD M±SD
    State anxiety Exp. (n=30) 4.53±2.65 3.53±2.47 -1.00±2.32 -3.57 .001
    Cont. (n=30) 3.67±2.37 4.47±2.39 0.80±1.49
    SBP Exp. (n=30) 135.23±20.48 146.70±30.65 11.47±22.79 384.50 .333†
    Cont. (n=30) 135.27±20.70 152.13±27.29 16.87±18.34
    DBP Exp. (n=30) 78.03±10.96 77.83±11.18 -0.20±14.31 -0.33 .743
    Cont. (n=30) 81.00±12.89 81.90±14.65 0.90±11.37
    Pulse rate Exp. (n=30) 76.80±12.96 66.37±12.48 -10.43±6.21 -1.78 .079
    Cont. (n=30) 79.30±16.11 72.17±16.21 -7.13±7.99

    Exp.=experimental group; Cont.=control group; SBP=systolic blood pressure; DBP=diastolic blood pressure.

    †Mann-Whitney U test.

    Comparison of Self-care Compliance Score between Experimental and Control Group (N=60)

    Variables Exp. (n=30) Cont. (n=30) t p
    M±SD M±SD
    Total 4.39±0.41 3.90±0.54 3.92 ＜.001
    Eyedrop 4.36±0.54 3.74±0.73 3.69 ＜.001
      1. I have washed my hands before the eyedrops 4.20±0.92 3.20±1.29 3.43 .001
      2. I have not let the tip of bottle touch the eye or eyelid 4.30±0.79 3.60±1.00 2.99 .004
      3. I have instilled eyedrops as indicated frequency 4.67±0.60 4.47±0.77 1.11 .271
      4. I have instilled different eyedrops at 5-minute intervals 4.27±1.23 3.70±1.39 1.67 .100
    Hygene 4.01±1.25 3.39±1.38 1.82 .073
      5. I have washed my hair but did not wet in my operated eye 3.37±1.97 2.47±1.96 1.77 .082
      6. I have washed my face but did not wet in my operated eye 4.87±0.73 4.57±1.22 1.15 .254
      7. I have washed shower but did not wet in my operated eye 3.80±1.86 3.13±2.03 1.32 .190
    Protection of operation site 4.40±0.86 3.96±0.93 1.87 .066
      8. I have applied protective eye shield during bedtime 3.97±1.52 3.37±1.60 1.48 .143
      9. I have refrained from rubbing or compressing the eye 4.83±0.37 4.57±0.67 1.87 .065
    Daily life 4.79±0.34 4.52±0.42 2.70 .009
      10. I have visited the clinic on the reservation date 5.00±0.00 4.90±0.40 1.36 .179
      11. I have continued normal daily actives, included watching TV, cooking, cleaning 4.37±1.03 3.93±0.82 1.79 .078
      12. I have avoided strenuous exercise like soccer and swimming 5.00±0.00 4.73±0.69 2.11 .039

    Exp.=experimental group; Cont.=control group.
    Table 1. Homogeneity Test of General Characteristics and Pretest Dependent Variables (N=60)

    Exp.=experimental group; Cont.=control group; SBP=systolic blood pressure; DBP=diastolic blood pressure.

    Fisher's exact test;

    Mann-Whitney U test.

    Table 2. Mean Differences in Dependent Variables between Experimental and Control Group (N=60)

    Exp.=experimental group; Cont.=control group; SBP=systolic blood pressure; DBP=diastolic blood pressure.

    Mann-Whitney U test.

    Table 3. Comparison of Self-care Compliance Score between Experimental and Control Group (N=60)

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

    Table 1.

    Table 2.

    Table 3.

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