Nursing intervention to meet the family members’ needs during the surgery waiting time

Objective: to assess the effect of a care intervention focused on meeting the needs of family members of surgical patients during the surgery waiting time, when compared to conventional care. Method: a study with a quasi-experimental design that was developed from December 2019 to February 2020 and included 313 family members (Intervention Group=149 and Control Group=164) from a private hospital. The intervention consisted in four moments: “knowing the surgical environment and process”, “information when the surgery starts”, “information when the surgery ends”, and “family-patient reunion”. The “satisfaction” variable was assessed through the “Patient Satisfaction with Nursing Care Quality Questionnaire” instrument. The data were analyzed using descriptive and analytical statistics. The study observed the ethical principles in research. Results: the family members in the Intervention Group presented greater satisfaction with Nursing care, 90.07(9.8), when compared to the Comparison Group, 78.72(16.38), with an 11.35-point increase(p=0.000). Conclusion: the results showed that the families that received the intervention on the patient’s status during the surgery waiting time were more satisfied with Nursing care in comparison to the conventional intervention.


Introduction
Surgeries are stressing moments for patients and families due to the death risk implied, as well as to the sequelae after recovery (1) ; therefore, it is necessary to meet the families' needs arising in this process.
During the surgery and when the patient enters the operating room, the family loses contact and experiments a series of concerns that are strongly related to the scarce information provided in relation to what will happen in the surgical environment. This lack of information triggers anxiety and fear in the patient's family members (2) .
During the surgery waiting period, the family members must be informed as to whether the procedure is demanding more time than the expected and offered the possibility of communicating with the surgeon after the procedure (3) . In turn, the uneasy situation becomes one of the main barriers to learning and, as time progresses (4) and the family remains unaware of what is happening to the patient, these fears are increased, the family members' need for information is high (5) , and many family members can feel dissatisfied with the support and information received (6) .
Knowledge about the surgical environment and the patients' ability to prevent post-operative complications (7) is of great interest for the peri-operative nurses, since it is fundamental for them to carry out innovating strategies in a uniform and structured manner for the patients and their family members (8) , as it is them that connect the relatives and enhance satisfaction with care.

It is important to develop educational strategies from
Nursing, capable of addressing specific needs of each individual and applying them at the right moment, in order to avoid generic information that saturates and confuses the patients and the care provided to them (9) . In this sense, multimedia education in the video format has been increasingly applied, since it is an ideal means which offers the advantage of providing relatively useful information to the patients, as it saves time and is easy to understand (10) .
In addition, it is advantageous to systematically involve the family members in the patients' peri-operative care.
Nevertheless, the interventions and the involvement degree of the family member in the patient's care must be adapted to the cultural context (11) .
In this sense, the objective of the study was to assess the effect of a care intervention focused on meeting the needs of family members of surgical patients during the surgery waiting time, when compared to conventional care.

Method Design
Quasi-experimental with two groups: experimental group and non-randomized comparison group.

Population
The research was conducted with family members of patients who were in the surgery waiting room.

Collection locus
A health institution in Chía, from the Cundinamarca Department, Colombia. The institution has four operating rooms with modern equipment adapted for complex and minimally invasive surgeries (from laparoscopies to microsurgery and laser surgery). The institution specializes in general surgery, orthopedic surgery and thoracic surgery. The patients who access the service come from the neighboring region of the institution and belong to the contributive health regime, to which they are linked by paying a fee, individual and family group, or through a previous funded contribution.

Time period
During December 2019 and January and February 2020.

Selection criteria
Selection was for convenience, based on the following pre-requisites: individuals over 18 years old who accompanied their family member during the surgery,

Sample
The following algebraic expression was used to calculate the sample size for each group, as well as to determine the required size to ground judgment of the null hypothesis of means equality, assuming homoscedasticity and the condition of balanced sample size (12) .  The "satisfaction with Nursing care" variable was assessed through the "Patient Satisfaction with Nursing Care Quality Questionnaire" (PSNCQQ) instrument. Reliability (Cronbach's Alpha: 0.94, Content validity: 0.9) (13) .
Based on the qualitative results of a study that aimed at knowing the experience of the family members of surgical patients during the surgery waiting time (14) , the intervention was developed following the guidelines for the development of Nursing interventions (15) .
The following were established as modifiable factors:

Data analysis
For a general evaluation of the answers obtained, they were consolidated in an Excel database file. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) statistical program, version 24.

Results
The Comparison Group (CG) consisted of 164 family members, and the Intervention Group (GI) comprised 149 family members. Table 1 shows the sociodemographic data. In the CG, the mean age was 43±14.17 years old, with a minimum of 18 and a maximum of 77; in the IG, the mean was 43±14.25 with a minimum of 18 and a maximum of 78. Most of them were women (65.8%), with complete high school (31.6%), employees (53%), married (48%), their kinship with the surgical patient was that of spouse (36%), having accompanied the family member to the pre-surgical consultation (55%), and having had the experience of accompanying the family member during the surgery waiting time (55%). and the quantitative variables, through mean and standard deviation. The data normality assumptions were assessed using the Shapiro-Wilk test. The Mann-Whitney U test was used to compare performance between the groups. The standard significance level of 0.05 for the p-value and 95% confidence interval was adopted.

Ethical aspects
The research was initiated after approval by the  In relation to the study objective of assessing the effect of a care intervention focused on meeting the needs of family members of surgical patients during the surgery waiting time, comparing it with conventional care, it was found that, globally, greater satisfaction of the family members who received the intervention was evident, when compared to the group that did not receive the intervention, with an 11.35-point increase (p=0.000). Table 2 presents the comparison of the "patient satisfaction with Nursing care" dimensions between the comparison and intervention groups. In the «Concern and care» dimension, the IG presented a 4.24-point increase that allows it to rate the care provided as excellent, with significant differences (p=0.000).
In the «Information» dimension, the group that received the intervention considers care quality as excellent, in contrast with the comparison group, which considers it as good (p=0.000).
In the «Overall quality» dimension, it is considered good in both groups. The group that received the intervention did not present significant differences with the comparison group; only a 1.70-point increase was observed (p = 0.000).
The questions related to the "Care coordination and discharge instructions" aspect obtained significantly better scores in the intervention group, when compared to the group that did not receive the intervention. They went from being considered as with a good score to presenting excellent scores.
The results suggest that an intervention based on informing the family about what is happening to the patient during the surgery waiting time exerts an influence on the improvement of patient satisfaction with Nursing care quality. In this aspect, the Nursing team plays a fundamental role for its development.

Discussion
Meeting the family members' needs during the surgery waiting time must be considered as a quality attribute and, therefore, interventions that improve this process must be developed. According to the results obtained in this research, Nursing concern and care is the dimension with the greatest change after the intervention, a result that is coherent with previous studies which emphasize that the actions performed it is for this reason that the interventions that provide information about what the patient will hear, smell, see, taste or feel during the surgical process (18) are valued as positive. In this sense, Nursing care is an effective factor in attaining quality in the health service (19) .
In relation to the "Discharge instructions" information to support both patients and caregivers (20) .  (21) . Helping the patients to better know their condition and offering them basic skills to daily manage their diseases can result in physical and psychological benefits for the patient and, in some cases, reduce their dependence on the service (22) .
Likewise, the patients' privacy is fundamental for care, since its absence can be interpreted as lack of humanization in the Nursing service (23) . There can be oversimplification of the patient's perspective regarding this topic and its impact, given the scarcity of research studies in the area (24) . The evidence suggests that, although in this study the family members' perceptions about the care provided were good and the value was high, it is necessary to review the impact of using technologies in health to mitigate the concerns about privacy.
As the family members of surgical patients play an important role in their recovery, their needs must be met during hospitalization and after discharge (25) . It is for this reason that it is necessary to continue developing research studies in this area which allow caring for the family member from the moment the surgical process is initiated, during the surgery waiting time and hospitalization, up to