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POST SURGICAL CARE

Implications for better nursing practice: psychological aspects of


patients undergoing post-operative wound care
Reiko Murakami, Mizue Shiromaru, Reiko Yamane, Hiroko Hikoyama, Mikiyo Sato, Natsuko
Takahashi, Sumie Yoshida, Misuzu Nakamura and Yoshikazu Kojima

Aims and objectives. To understand the psychological aspects in patients undergoing post-operative wound care and to gain
insights for improving nursing practice.
Background. Very few studies have examined education on or practice of wound care with a view towards the patients
psychology.
Design. Descriptive exploratory qualitative study.
Methods. Four patients who had undergone open surgery of the upper gastrointestinal tract were interviewed using a semistructured format to gain an understanding of their feelings and opinions with regard to wound care. Interview transcripts
were analysed using an inductive coding approach.
Results. Fifteen categories of responses were finally identified from the data. Patients wanted nursing staff to observe their
wound more often so that patients could recognise improvement, to have better knowledge of the patients disease and
condition, to explain the patients situation more completely and to appropriately answer questions. Patients also said that
they felt more comfortable in posing questions or concerns regarding their condition to nursing staff than to their surgeons
and did so while the wounds were being taken care of by nurses.
Conclusions. These findings suggested the importance of nursing staff to fully understand and to be ready to share feelings
regarding a patients postoperative condition and to have skills in properly explaining the importance of each procedure or
steps in treatments that a patient must undergo. The present study also indicates that it is imperative for nursing staff to
learn methods to build relationships with patients so that they can express their feelings of fear or anxiety freely to nurses.
Relevance to clinical practice. It is not possible to develop nursing practice without understanding psychological aspects of
patients undergoing postoperative wound care.
Key words: postoperative care, practice nursing, psychology, wound care
Accepted for publication: 24 June 2012

Authors: Reiko Murakami, RN, DHSc, Associate Professor, Jichi


Medical University School of Nursing, Shimotsuke, Tochigi; Mizue
Shiromaru, RN, Professor, Department of Nursing, School of
Health Sciences, Sapporo Medical University, Sapporo, Hokkaido;
Reiko Yamane, RN, Certified Nurse, Showa University, Northern
Yokohama Hospital, Yokohama, Kanagawa; Hiroko Hikoyama,
RN, Head Nurse, Showa University, Higashi Hospital, Shinagawa,
Tokyo; Mikiyo Sato, RN, Instructor, Department of Nursing,
School of Health Sciences, Tokai University, Isehara, Kanagawa;
Natsuko Takahashi, RN, MSN, Graduate Student, St. Lukes College of Nursing Graduate School, Chuo-ku, Tokyo; Sumie Yoshida,

RN, PHN, PhD, Associate Professor, Tokyo Womens Medical


University School of Nursing, Shinjuku-ku, Tokyo; Misuzu Nakamura, RN, PhD, Professor, Jichi Medical University School of Nursing, Shimotsuke, Tochigi; Yoshikazu Kojima, RN, MSN, Associate
Professor, Department of Nursing, School of Health Sciences,
Tokai University, Isehara, Japan
Correspondence: Reiko Murakami, Associate Professor, Jichi Medical University School of Nursing, 3311-159 Yakushiji, Shimotsuke,
Tochigi 329-0498, Japan. Telephone: +81 285 58 7294.
E-mail: murarei@jichi.ac.jp

2012 Blackwell Publishing Ltd


Journal of Clinical Nursing, 22, 939947, doi: 10.1111/j.1365-2702.2012.04352.x

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R Murakami et al.

Introduction
The importance of basic nursing education to enable nurses
to provide advanced and diverse nursing care in the health
and medical sector has been pointed out from a variety of
fields. Wound care including observation of the postoperative wounds, in particular, by nurses is needed for patients
at all healthcare levels and nursing situations, such as from
acute to the chronic or terminal phase, from the newborn
to the elderly, in emergency medicine such as traffic accident trauma, perioperative nursing care and in-home medical assistance. Reflecting on this critical need, the Ministry
of Education, Culture, Sports, Science and TechnologyJapan (2004)s Committee on Nursing Education proposed
that decubitus ulcer care can be performed by student
nurses with guidance by teachers and nurses and that bandaging and wound care can be done with guidance by
teachers and instructors. Tanabe et al. (2006) stated that
practice in postoperative wound care before training in
adult nursing was effective for understanding the need for
wound care and learning wound care techniques and indicated that learning wound care was possible during basic
nursing education. However, in a survey conducted in 2005
by Murata (2006) on decubitus ulcer care, more than 60%
responded that knowledge learned in school on this subject
was useless and more than 70% responded that techniques
learned in school were useless. This suggested a gap
between basic nursing education and actual practice; filling
this gap is part of the agenda for nursing education of
rookies entering the work force. In addition, Watanabe
(2006) stated that information on wound care in basic
nursing education is primarily through lectures, with training in actual practice occurring in the workplace. Further,
it was stated that education on wound care, a field in which
advancements are constant, should begin with basic nursing
education, continue during clinical training and finally
become part of specialised education, such as certified nurse
programs.
Furthermore, the importance of psychological care related
to wound care for patients with acute trauma was addressed
(Magnan 1996, Devlin-Rooney & James 2005). For those
patients, nursing practice should not only involve technical
competence and attitudes that consider the patient psychologically both in providing wound care but also in other
nursing situations. However, the psychological needs of
patients undergoing wound care have been little studied, and
studies have been scant regarding education on or practice
of wound care with a view towards the patients psychology.
In this study, we aimed to understand the psychology of
patients undergoing postoperative wound care, such as

940

their thoughts and feelings, and to gain insights towards


improving nursing practice.

Methods
This study used a descriptive exploratory qualitative
research approach, which is useful in summarising and
understanding an area of interest and was deemed appropriate for this study, which was intended to describe and
explore the psychology of patients undergoing postoperative wound care.
Survey period was six months from December 2007May
2008. Study participants had undergone abdominal surgery
of the gastrointestinal tract at a hospital to which the
investigator belongs. Participants were selected who could
understand the purpose of the study and consent to participate, had epidural anaesthesia with insertion of one or
more drains (open or closed) and could communicate verbally. The interview was conducted within three days after
suture removal, and study participation was approved by
the patients surgeon.
Semi-structured interviews were used to collect information relevant to the aims of the study, and questions were
consistent among all four patients. In these interviews,
participants were asked to describe thoughts and feelings
on their postoperative wound care. The interviewer listened
intently to the participants responses and, when appropriate, requested clarification of responses or further explored
issues raised by the participant. Where necessary, additional
open-ended questions were asked of the participant such as:
What do you think during receiving wound care, and also
before and after? and What do you feel during receiving
wound care, and also before and after?. A certified nurse
interviewed all of the patients.
Interviews ranged in length from 1530 minutes
(mean = 26 min) and were conducted two or three days
after removal of sutures. The interview was conducted
where privacy was ensured, such as in a private room. During the interview, consideration was given to minimise the
physical and mental burden on the patient. A digital voice
recorder was used to record each interview with the
patients consent, and this recording was transcribed verbatim. Moreover, patients non-verbal behaviours during the
interview were noted in transcripts. Transcripts were
repeatedly read and analysed using an inductive coding
approach. In addition, basic data from nursing and medical
records were used to understand the background of each
patient. Our goal was to devise a list of items that
expressed the patients feelings and that could be examined
for useful information on wound care. On each transcript,
2012 Blackwell Publishing Ltd
Journal of Clinical Nursing, 22, 939947

Post surgical care

Psychology of patients undergoing wound care

notes were placed in the margins to identify ideas and/or


concepts of interest. Margin notes were reviewed and similar concepts and ideas were grouped together. Respective
groups were then designated using a sentence that captured
the patients expressions of their psychological state, making sure not to compromise subjective expressions of the
participants. From these groups, the preliminary categories
were formed. The content of each preliminary category was
reviewed to ensure best fit of content. Groups containing
similar content were combined to create major categories
and, where appropriate, subcategories were identified. Coding agreement was achieved between the authors following
discussion. The patients were consulted to determine
whether the authors had correctly understood the information obtained.
This study was conducted with the approval of the ethics
committee of the authors university and the cooperating
hospital. When a patient was approached to become part
of the study, the purpose of the study, and the interview
method were described. Before asking a patient to provide
consent to participate, it was clearly stated that participation was voluntary and that there were no disadvantages
related to their medical care if they declined to participate
or decided to discontinue an interview. They were told that
basic information was collected from nursing and medical
records and that their privacy would be protected. They
were also told that the interview would be recorded only if
consent was given.

Results
Overview of the participants
Four adult patients (age 57 48 years) participated in this
research (Table 1). In one patient, the current hospital
admission was his first for surgery, while the other three
patients had had previous surgeries. Only four patients who
fit the conditions for participation in the study agreed to
participate. All patients had been provided wound care
from the first day after surgery and had a good postoperative recovery and wound healing.

Psychology of patients undergoing wound care


Analysis of the interviews revealed 15 categories on the
patients psychology with regard to undergoing wound
care (Table 2). The categories are described below
within brackets and comments are given to place these
categories within context of the patients condition and
feelings.
1 [I want to be looked at often rather than be left alone and
want someone to check if my wound condition is good.]
This originated from the patients strong desire for
wound care to ensure that the wound was improving rather
than being neglected, even if only to receive disinfection
treatment.

Table 1 Characteristics of surgery in study participants


A (male age
56 years)
Surgical procedure

Surgical experience
Number of
indwelling drains
Number of wound
care sessions

Hepatic
segmentectomy,
small bowel
fistula closure
3rd
2
15

B (female, age 59 years)

C (male, age 48 years)

D (male, 62 years)

Partial hepatectomy,
intra-abdominal tumor
resection

Radical cholecystectomy
lymph node dissection

Esophagectomy and
reconstruction

4th
2

2nd
2

1st
6

16

19

30

Continuous epidural anaesthesia use


Pain control

Until
postoperative
day 3 with the
patients request
for pain relief

2012 Blackwell Publishing Ltd


Journal of Clinical Nursing, 22, 939947

Until postoperative day 3 with


the patients request for pain
relief, oral pain medication on
a regular basis from the 4th
day after surgery

Until postoperative day 3 with


the patients request for pain
relief, oral pain medication on
a regular basis from the 4th
day after surgery

Until postoperative day 5


with the patients request
for pain relief, then
continuous epidural
anaesthesia catheter
removal

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R Murakami et al.
Table 2 Psychology of patients undergoing post-operative wound
care
Psychological aspects of patients
I want to be looked at often rather than be left alone and want
someone check if my wound condition is good
I feel a lift in my mood and a sense that I am recovering each
time a drain is removed or gauze is replaced
I feel anxiety when I have strong pain, such as immediately after
surgery, and I want someone to come as soon as possible
I feel more at ease with quick and well-practiced procedures
from an experienced surgeon when I am calm and composed,
but I feel better with slow, careful handling when I am
uncomfortable and anxious
If I can leave the ward for a while, I want you to tell me
beforehand the time of wound care and let me know who
would perform it
I do not have any thoughts in particular about care of the
wound because the procedures were performed effectively by an
experienced caregiver
I do not have any complaints in particular because I get
disinfection procedures done when necessary and I get a
response to my concerns each time
The attending nurses change daily, which is unavoidable but
confusing
I feel more comfortable asking questions of nurses than surgeons
about my concerns when undergoing disinfection procedures.
Therefore, when a nurse disinfects, I tell her of my worries
I felt anxious when I thought a nurse was hesitant to tell me
something or when she did not reply to my question
I want a nurse to have all information and knowledge relevant
to my situation if possible and to be able to provide me with
answers to my questions
If a surgeon seldom speaks, I will be disappointed, but I am glad
when I am addressed by surgeons even if not the surgeon in
charge
I feel better when a surgeon gives me positive information in a
cheery voice, although this may be difficult for some surgeons if
it is not naturally part of their character
I feel nervous when I hear surgeons voices in the hallway after
the disinfection procedure since I am wondering what they are
discussing
I am happy to be seen since surgeons and nurses are kind and
I feel confidence in them

2 [I feel a lift in my mood and a sense that I am recovering each time a drain is removed or gauze is replaced.]
This expressed feelings of physical and mental recovery
when receiving wound care. This statement indicated a feeling that the wound was getting better and that anxiety was
decreasing when dressings were changed or the number of
drains was decreased.
3 [I feel anxiety when I have strong pain, such as immediately after surgery, and I want someone to come as soon
as possible.]

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Patients expressed anxiety over pain and its intensity and


felt that the drugs given were not sufficiently effective. They
wanted to tell someone of this pain immediately.
4 [I feel more at ease with quick and well-practiced
procedures from an experienced surgeon when I am
calm and composed, but I feel better with slow, careful
handling when I am uncomfortable and anxious.]
Patients expressed the desire for wound care conducted
according to the state of the wound recovery. Patients who
were relaxed and mentally prepared felt comfortable about
quick procedures done by an experienced surgeon, even if
the procedures were a little rough. However, when they
were having discomfort or were not well prepared mentally
for a procedure, they preferred the procedure to be done
slowly and gently.
5 [If I can leave the ward for a while, I want you to tell
me beforehand the time of wound care and let me know
who would perform it.]
This was a thought based on patients expectation of
consideration for the postoperative recovery and increasing
independence as wound care progressed. They wanted to be
informed of the schedule for wound care and who would
perform the care so that they could regain some control
over the pattern of their life.
6 [I do not have any thoughts in particular about care of
the wound because the procedures were performed effectively by an experienced caregiver.]
This was the attitude of patients who had peace of mind
when the disinfection procedures were performed quickly
and effectively by an experienced caregiver.
7 [I do not have any complaints in particular because I get
disinfection procedures done when necessary and I get a
response to my concerns each time.]
This expressed the patients sense of satisfaction when
procedures were done carefully and an explanation was
provided each time that wound care was administered.
They felt reassured because the wound was visually checked
by the caregiver rather than the caregiver just asking about
it. Patients had no complaints because they could tell the
caregiver about anything of concern and have those
concerns addressed.
8 [The attending nurses change daily, which is unavoidable but confusing.]
That expectations for consistency in nurses in charge of
treatments were not fulfilled had an impact on the psychology of the patient in that this reality differed from what
they might have expected before hospitalisation. That
nurses changed daily, which is unavoidable, was confusing
to the patient.

2012 Blackwell Publishing Ltd


Journal of Clinical Nursing, 22, 939947

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9 [I feel more comfortable asking questions of nurses than


surgeons about my concerns when undergoing disinfection procedures. Therefore, when a nurse disinfects, I
tell her of my worries.]
Many patients feel much more comfortable questioning
nurses than surgeons. This category expresses the feelings
of patients who consider that when a nurse performs the
disinfection procedure it will be a good time to express feelings and ask questions about their condition.
10 [I felt anxious when I thought a nurse was hesitant to tell
me something or when she did not reply to my question.]
Patients were disappointed when they desired sincere and
informative answers to their questions but did not get them.
Patients felt that there might be a reason for the hesitancy
in providing information either because the nurse did not
know the answer or perhaps the nurse was not sure how to
convey possible bad news.
11 [I want a nurse to have all information and knowledge
relevant to my situation if possible and to be able to
provide me with answers to my questions.]
This expressed patients feelings of wanting nurses to
have accurate and reliable information. They understood
that it was difficult for nurses to have complete knowledge
on the conditions of all of their patients but wanted the
nurse to know as much as possible. Patients felt a greater
sense of security if the nurse was able to provide plain
explanations in response to questions.
12 [If a surgeon seldom speaks, I will be disappointed, but
I am glad when I am addressed by surgeons even if not
the surgeon in charge.]
In this category, patients expressed the feeling of wanting
to get information from a surgeon, as a surgeons words
carry significance. Patients understood that the surgeons
time may be limited or that the wound may be healing well
and not much needs to be said, but still they would like to
hear more from the surgeon.
13 [I feel better when a surgeon gives me positive information
in a cheery voice, although this may be difficult for some
surgeons if it is not naturally part of their character.]
Patients expressed this thought in relation to their desire
for encouraging and positive words from the medical staff.
Patients understood that there are a variety of personalities
among caregivers and having a cheery positive attitude may
not be natural for some.
14 [I feel nervous when I hear surgeons voices in the hallway after the disinfection procedure since I am wondering what they are discussing.]
Partially overhearing discussions in the hallway after
wound care created anxiety. Patients think surgeons may be
discussing their status and perhaps something about the
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Journal of Clinical Nursing, 22, 939947

Psychology of patients undergoing wound care

patient that they do not want the patient to hear or that


they think would upset the patient.
15 [I am happy to be seen since surgeons and nurses are
kind and I feel confidence in them.]
Kindness has a psychological impact on the patients happiness because wound care performed by the medical staff
with kindness builds a sense of trust and confidence. Being
seen by the medical staff in an atmosphere of kindness and
trust leaves the patient in a better mood.

Discussion
The 15 categories on the psychology of patients related to
wound care were divided into two viewpoints: psychology
regarding wound care conducted during the postoperative
recovery state and the attitude of the medical staff performing wound care. The characteristics of these categories
and the implications for improving nursing practice are
discussed.

Psychology regarding wound care performed during the


postoperative recovery state and nursing practice
Patients thoughts and/or feelings at the time of wound care
related to postoperative recovery, including the status of
the wound and the patients overall health, were addressed
by the following seven categories: [I want to be looked at
often rather than be left alone and want someone check if
my wound condition is good.], [I feel a lift in my mood
and a sense that I am recovering each time a drain is
removed or gauze is replaced.], [I feel anxiety when I have
strong pain, such as immediately after surgery, and I want
someone to come as soon as possible.], [I feel more at ease
with quick and well-practiced procedures from an experienced surgeon when I am calm and composed, but I feel
better with slow, careful handling when I am uncomfortable and anxious.], [If I can leave the ward for a while,
I want you to tell me beforehand the time of wound care
and let me know who would perform it.], [I do not have
any thoughts in particular about care of the wound because
the procedures were performed effectively by an experienced caregiver.] and [I do not have any complaints in particular because I get disinfection procedures done when
necessary and I get a response to my concerns each time.].
Within the psychology of the patient, it was shown that
wound care gave a patient a sense of recovery and reduced
anxiety. These categories indicated that patients got a sense
of recovery by becoming aware of objective signs of wound
healing, such as reduction in postoperative pain and reduction in the need for drainage.

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R Murakami et al.

Anxiety regarding recovery can begin immediately after


surgery, when there is intense wound pain, and can continue until the drains are removed, particularly if drainage
has been profuse. Therefore, in wound care immediately
after surgery, not only from the perspective of early detection of abnormalities, but to relieve anxiety, it is necessary
to visit the patient frequently and to check for the presence
or absence of pain, changes in the intensity of pain, amount
of drainage from the drains, and contamination of the
gauze. Also each time wound care is performed the patient
should be given information on the current status, what is
expected to happen, and prospects for recovery so that the
patient can fully understand the situation. Magnan (1996)
reported that acceptance of ones body image after surgery
takes place through several steps and that this can be a difficult path depending on the patients understanding of the
wound size, changes in the structure, and the degree of dysfunction. In other words, helping the patient to accept his
or her present condition in relation to the wound step by
step would promote acceptance of the body image after
surgery.
Psychology of burn patients with regard to their care has
been studied (Pint et al. 2010, Kornhaber & Wilson 2011,
Yuxiang et al. 2012). Inadequate pain control has a negative physical and psychological effect, and in management
of burns the psychological effect of disfigurement must be
considered. These issues are to some extent present with
postoperative wound management. In the present study if
postoperative trouble did not occur, wound care resulted in
a favourable recovery. Healing of a postoperative wound
occurs more quickly than that of a burn. However, the psychological impact of the treatment of burns is similar to
that of the postoperative patient. It is considered that
wound care in surgical patients should require the same
nursing attention as care of patients with burns.
The following categories indicate that thoughts on
wound care change as the recovery status changed. Those
categories are: [I feel anxiety when I have strong pain,
such as immediately after surgery, and I want someone to
come as soon as possible.], [I feel more at ease with quick
and well-practiced procedures from an experienced surgeon when I am calm and composed, but I feel better with
slow, careful handling when I am in uncomfortable and
anxious.] and [If I can leave the ward for a while, I want
you to tell me beforehand the time of wound care and let
me know who would perform it.]. Patients wanted frequent care and careful application of procedures when the
postoperative pain was intense. But as they became aware
of wound recovery, they felt secure that recovery was progressing well with more rapid application of procedures

944

when the caregiver was very experienced in these techniques. Moreover, with the realisation that recovery was
taking place not only from the wound, but through regaining general physical and mental strength, wound care
became only part of hospital life and their focus on
wound care was reduced.
From these observations, variations are evident in how
patients adapt to wound care and that patients expect
wound care to contribute to their recovery status after surgery. Therefore, nurses should understand how patients perceive their recovery status. When patients are anxious about
their recovery, nurses should talk to them frequently, clearly
explain their status, and treat them gently. On the other
hand, for patients who believe that their recovery is progressing, nurses should make sure that they clearly understand their status and help them return to their normal life
as much as possible and with as few difficulties as possible.
Some categories showed that patients placed their confidence in the medical staff during wound care and it was
also shown that the medical staff helped the patients understand the need for wound care and the nature of the
wound. Therefore, these findings suggest that performing
wound care while appropriately explaining reasons for decisions made by the medical staff helps the patient to better
understand such decisions. In that way, patients can feel
comfortable placing their trust in the medical staff. Also,
communication with the medical staff is facilitated during
wound care and a relationship is fostered in which patients
can ask and get answers to questions instead of just leaving
everything to the medical staff.
On the other hand, as for effective and experienced
care in relation to the category [I do not have any thoughts
in particular about care of the wound because the procedures were performed effectively by an experienced caregiver.], providing safe and comfortable nursing techniques
is expected as a matter of course and the need to learn
techniques in this role has been described in the literature
(Murata 2006, Tanabe et al. 2006, Watanabe 2006,
Shimada & Niiyama 2008). However, a variety of issues
are involved in meeting patients needs for effective and
experienced care in the current state of nursing education
where it is difficult for not only new nurses, but also for
student nurses to get a chance to practice, as has been
described (Aso 2002). However, what the patients considered to be effective and experienced care was not
revealed in the present study. Specific procedures (nursing
techniques) that should be considered effective and experienced in wound care need to be clarified in the future.
What have been described so far are the perspectives
inherent in the statement: mastering nursing techniques is
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Post surgical care

not only mastering the basics of the techniques but also to


provide the appropriate nursing techniques depending on
the situation, as stated by Shimada and Niiyama (2008).
For example, appropriate nursing techniques depending on
the situation (Shimada & Niiyama 2008) include support
to reduce the patients postoperative anxiety, such as about
the possibility of delayed recovery, which is an important
nursing technique in wound care. However, previous studies have not described the specifics on how to relieve anxiety or what actually leads to relief of anxiety. Therefore, in
the present circumstances, relieving a patients anxiety is
dependent on the ability of nurses to improve their skills
and master techniques as well as the experience of individual nurses. However, it was found that intentionally promoting a sense of recovery according to the actual stage of
recovery in a particular patient is an aid to reducing the
patients anxiety immediately after surgery and to promoting a sense of independence in the patient. Reducing a
patients anxiety results in improving the quality of nursing
practice for patients undergoing wound care. To reduce the
gaps in the ability to relieve anxiety in clinical practice and
to enhance a nurses ability in clinical practice, communication skills, in which the status of the wound is evaluated
and the results are clearly conveyed, are important.

Psychology regarding the attitude of the medical staff


involving wound care and nursing practice
The following eight categories are related to psychology
regarding the attitudes of the medical staff involved in
wound care: [The attending nurses change daily, which is
unavoidable but confusing.], [I feel more comfortable asking questions of nurses than surgeons about my concerns
when undergoing disinfection procedures. Therefore, when
a nurse disinfects, I tell her of my worries.], [I felt anxious
when I thought a nurse was hesitant to tell me something
or when she did not reply to my question.], [I want a nurse
to have all information and knowledge relevant to my situation if possible and to be able to provide me with answers
to my questions.], [If a surgeon seldom speaks, I will be disappointed, but I am glad when I am addressed by surgeons
even if not the surgeon in charge.], [I feel better when a
surgeon gives me positive information in a cheery voice,
although this may be difficult for some surgeons if it is not
naturally part of their character.], [I feel nervous when
I hear surgeons voices in the hallway after the disinfection
procedure since I am wondering what they are discussing.]
and [I am happy to be seen since surgeons and nurses are
kind and I feel confidence in them.]. In each category the
following was suggested: (1) patients have different expec 2012 Blackwell Publishing Ltd
Journal of Clinical Nursing, 22, 939947

Psychology of patients undergoing wound care

tations for nurses and surgeons because of differences in


the on-duty systems for nurses and surgeons, (2) patients
felt it was easier to ask questions of nurses and indicated
that they felt closer to nurses, and (3) patients felt it was
easier to ask questions and express their anxieties and concerns to the nurses, with whom they developed a greater
feeling of closeness than with the surgeons. On the other
hand, when they could not get answers, they felt very disappointed but did not fault the nurses as they thought there
was a reason why the nurses could not provide an answer.
At the same time, it was shown that the patients had expectations that the nurses involved in their wound care would
share information and have the appropriate knowledge
necessary to answer the patients questions and concerns.
Nurses should keep this in mind so that patients undergoing wound care can express their thoughts and ask questions comfortably. In addition, it is necessary for nurses to
create a friendly atmosphere wherein patients can talk
freely and ask questions easily. Nurses should also learn
communication skills so that they can appropriately ask the
patients if there are any questions.
With regard to surgeons, it was shown that patients want
attention and caring, not only from their own surgeon, but
also from other surgeons. Moreover, it was suggested that
this same attitude was expected from nurses. Patients felt
that medical staff members who showed that they cared
about the patients were kind and reliable. In addition, this
sense of reliability enabled the patients to trust medical
staff, to feel happy about receiving wound care from such
trusted people, and to maintain a positive feeling about the
medical staff. Therefore, it is thought that faith by a patient
can be achieved similarly by surgeons and nurses by their
intentionally expressing care and consideration in the case
of a patients wound care. This also contributes to a
patients recovery. Information is required to be provided
both from a surgeon and a nurse.
As mentioned above, patients undergoing wound care
hope that wound care is performed by medical staff that
cares about each patient and that the medical staff would
create a friendly atmosphere in which questions can be
asked and concerns expressed easily. Also, patients
expressed hope that the medical staff would talk to them
cheerfully and have sufficient information and communication skills to answer questions and address their concerns.
Therefore, it is important to learn techniques in forming
relationships with patients, in understanding patients
anxieties, sharing information and communicating clearly
to ensure clinical practice skills of high quality.
All of these matters are important in nursing, not only in
wound care, but in any type of nursing practice that is

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R Murakami et al.

relevant to basic attitudes required for the nursing staff as


stated in the report of the committee on improvement of
clinical practice skills of new nursing staff (Ministry of
Health, Labour and Welfare, Medical Affairs Bureau
Nursing Division 2004). Among these matters, particularly
with regard to attitudes in performing wound care, identifying the need to address the patients psychology and expectations for specific actions by the nurses are major
achievements of this study. Among these specific actions
expected for nurses are observing the wound site as well as
the patient, creating a friendly atmosphere in which questions can be asked easily, talking to the patient cheerfully,
and having accurate information with which to answer
questions sincerely.

Conclusion
These thoughts and feelings of patients undergoing wound
care were studied from two perspectives: psychology
regarding wound care in relation to the postoperative
recovery status and psychology regarding the attitudes of
medical staff that perform wound care. The study results
suggest that in nursing practice nurses should: (1) have
postoperative information on their patients and share this
information with team members, (2) fully understand the
postoperative recovery process to be able to answer
patients question, (3) have the communication skills
required to explain clearly the meaning of wound care and
the status of recovery and (4) have learned techniques to
build relationships with patients so that patients can easily
ask questions. Therefore, when newly licensed nurses or
expert nurses collaborate with medical staff of various disciplines to gain an understanding of a patients condition,
they can provide appropriate care leading to the patients
recovery as well as discuss wound care with the patient.

Furthermore, it is necessary to refine the training in nursing


skills so that wound care can always be exactly performed
according to a patients state of recovery.

Relevance to clinical practice


All of the participants of this study experienced steady
recovery. Therefore, the thoughts and feelings of patients
who do not recover smoothly were not determined. It is
necessary to determine the psychology of patients with different levels of recovery and find more practical approaches
to nursing care for patients with a variety of states and outcomes of recovery to improve clinical practice skills in the
future. In addition, this study included both patients who
had undergone surgery for the first time and those who had
previous surgical experiences. Therefore, it is necessary in
the future to find out if there are differences in the feelings
of patients based on whether or not they had previously
undergone surgery. This would necessitate a larger number
of participants.

Acknowledgements
We thank the patients who cooperated in this study and
everyone in the cooperating facilities.

Contributions
Study design: RM, MS; data collection and analysis: RM,
MS, MN, YK, SY, MS, NT, HH, RY and manuscript
preparation: RM, MS.

Conflict of interest
The authors declare to have no conflict of interests.

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