AN INVESTIGATIC.lJ OF TYPES OF I\iURSE-
PA'l'IE.i\ T STRESS
BY
HOnors Thesis
In l\urslng
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TliliLE OF CON'l'Ei\'l'S
Page
Chapter
I.
Il\iTrtODUCT IOl'l
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Problem
Perscna1 Interest
Significance
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Method and Analysis
L1n: 1 ta t ions
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II.
L1.terature
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FI1,DH.GS
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15
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A~'.JD
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Collection of Data
Presentation of Data
Analysis of Data
IV.
1
rl.ta.•.id'ElJ LI'l'.c.;iiA'l'UriE AIIJ0 RESEARCH
ResE~arch
1
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48
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CC1\CLUSIONS
Problem and Met1:Jedclogy
Find lngs
Conclusions
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b IBLI oGRA PH Y
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48
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53
11
LI ST OF' 'l'dB LES
Tab 1e
1.
2.
3.
4.
5.
6.
7·
8.
9.
Page
Blood Pressure Readings of Male Cardiac Patients
Before and after Limited or No, Distracting,
and Patient-Centered Com~unication With the
tmrse
15
Pulse Pressure Readings of Male Cardiac Pat&ents
Before and After Limited or ~o, Distracting,
and Patient-Centered Communication \oitth the
l\iurse
•
•
•
•
•
•
17
blood Pressure Headings of Female Cardiac Patients Befere and After Limited or No, Distracting, and Patient-Centered Communication
With the Nurse
•
•
19
Pulse Pressure Readings of Female Cardiac Patients
Before and After Limited or No, Distracting,
and Patient-Centered Communication With the
Nurse
21
Blood Pressure Read ings of f'ia Ie Ga stce intest ina 1
Pa t ients Before a nd Aft er No or Limtt ed, Distracting, and Patient-Centered Communication
with the Nurse
•
•
23
Pulse Pressure Read ings of lVlale Gastrointest inal
Patients Before and After No or Limited, Distracting, and Patient-Centered ComiTlunication
'/I l t t the NUrse
25
Blood Pressure Head ings of Female Gastrointestinal Patients BefQre and After 1'.0 or Limited,
Distracting, and Patient-Centered Communication
~H t~ the Nurse
28
Puhle Pressure Read iugs of Fema Ie Gastrointesttna1 Patients Bef·;::,re and After 1~0 or Limited,
IHstracting, and Patient-Centered Comn!unic~;:ti::::,n
W1.th toe imrse
30
PUlES Readings of l'I81e Cardiac Patients Before and
After ~o or Llmlted, ~istracting, and PatientCentered Corrmunicatlon wlth the ~urse
33
ili
Pa;;,;e
1'ab le
10.
Pulse ~ead ings of Fema le Car:) iac PatiEnts Before
and After No or Limited, ~istracting, and
Patient-Centered Communication with tae hurse
35
11.
Pulse Readings of Na1e GastrGintestinal Patients
Before and ~fter ~o or Limited, Distracting,
and Patient-Centered Communication with the
Nurse
• 37
12.
Pulse dead ings of Fema le Ga strointes t i r1a 1
Patients Before and After No or Li~ited, Distracting, and Patient-Centered ComrlUt1ication
wit h th e Nu r s e
39
Mean of Pulse Beats Dtfference With No or
Limited, Distracting, and Patient-Centered
COIDITunication with t~e Nurse
40
13·
14.
Respiration Readings of Male Cardiac Patients
~efore and After ~o or Limited, Distracting,
and Patient-Centered Communication with the
•
15.
16.
17.
41
Respiration R.eadings of Female Cardiac Patients beforp and rifter No or Limited, Distracting, and Patlent-Ce~tered Communication
witi1 the Nurse
42
Respiration deading2 of Male Gastrointestinal
Patients Before and After ~o or Limited, Di8trac t ing, and. Pa t ient-Centered ConFliurJ ica t ion
with the .i:'ourse
43
Resp irat ion dead lngs of ii'ema le Gsstroi n test inal
Patients Before and After No or Limited, uistracting, and Patient-Centered Communication
with tne i~urse
44
iv
LIST OF' FIGURES
Page
F'igure
1.
2.
Pulse Pressure l"iear.s of I'ila le Card lac Patients
Before and After No or Limited, Dlstracting,
and Pat1ent-Centered Communication wit':l the
f,urse
Pulse Pressure heans of F'emale Carc.lac P8tients
before and After ~o or Limlted, Distracting,
and Patient-Centered COITiITJllIunicat1on l':ith the
22
l~urse
3.
4.
. 18
Pu13e Pressure heans of he Ie Gc.strGintestlna1
Patients Before and After No or Limited, ~is­
tracting, and Patient-Centered Communication
witn the l'mrse
27
Pulse Pressure i'iearls of Female Gastrointestinal
Patients Before and After Limited or No, 0istracting, and Patiet:lt-Centere~ Communication
~'1 i t h the t, u r s e
32
v
ChAPTER I
INTiWDUCTIGN
The sciences of psychology and sociology have established
the principle that man is basically a social being who satisfies most of his needs through relationships with other persons.
This principle may be applied aptly to the hospital setting as
it is becoming reoognized increasingly that adequate nursep8tient comITunication is necessary if the needs of the patient
are to be met. l ,2
Problem
The question which the examiner chose to investigate
wa s:
Do nurse-pa t tent commun iea t ions ic the nurs ing care of
the medieal patient in the general hospital setticg increase
or decrease patients' stress?
The following definitions were
utilized in the investigation:
1. Communication: the verbal conveying of a message or
idea between two or more individuals. 3
1 Joyce Travelbee, "Wh8t Do We Nean By Rapport?" hmerican
Journal of ~ursin£, LXIII ( February, 1963 ), p. 72.
ican
2betty Hart and hnn iiohweder, "Support in NurSing," ~­
of N~~pJng, LIX {Cctobp.rJ1959),pl~Ol.
Journa~
JCharles hofling, Madeleine Leininger, and Elizabeth
Bregg, Eas ic Ps,Ycn i.?j:r tc. C_o_rl..gepts in Nu:r:'s ing (Ph 11adelph ia:
J.B. Lippincott Co., 19bi), p. 1+3.
-2-
2. Stress: a process in which there is interplay between various stimuli and the defenses erected
aga iGst them. 4
3. Nursing cere:
any procedure or activity performed by
the professional nurse upon the patient
f~r the purpose of promoti~g the health
or comfort of the pat tent.
4. Professional nurse:
a nurse with a minimum preparation
of a baccalaureste degree in
in nursing who incorporates the
three essential components of cGre,
cure, and coordination. 5
In addition to examining the overall relationship between nurse-patient communication and stress, the examiner also investigated the following questions:
stress patients?
Do all communications
What communications stress patients?
communications do not stress patients?
What
Whet communications
produce the greatest or least amount of stress?
Personal Interest
The examiner chose to study the subject of nurse-patient
communication because she believed this to be an area of vital
concern for determining the manner in which the nurse may
give effect1.ve patient care.
In her own personal obervations
--------- ---- - - --..
4Wll1i&m Caudill, Effects of SOcial and Cultural ~ystems
in Reactions to Stress (New York: Social Science Research Council, 1958), p. 63 .
.5
,"American Nurses' hssoctation's First Position
on Educatic'-m-l-n-Nursing," l1.merican ~Journal of Nursing ( December,
1965), p.lo6-111.
-3-
of the hospital setting, the examiner haa found that patients
frequently appeared to benefit from direct communication with
the nursing personnel.
Unfortunately, the examiner also found
that the nursing personnel spent what appeared to be a minimum of available time in direct communication with patients
or in patient teaching.
The examiner has felt strongly that
the nurse has a tremendous potential to playa truly significant role in alleviating the stresses of patients, especially
1n that nursing personnel care for patients twenty-four
h~urs
a day.
Significance
Throughout the greater part of its history, nursing
has been viewed as a airect ana individualized service concerned with the comfort ana personal needs of the patient. 6
Yet with the advent of increased medical knowledge and aavanced
technology, physicians expect more assistance from nurses with
technical procedures, while hospital administrators require
more assistance in business management.
These added demands
have tended too often to remove nurses from the realm of direct
patient care and communication. 7
With less time to communicate
with patients, it is essential that nurses understand what
6Dorothy E. Johnson, "The Significance of Nursing Care,"
American ,~~·.?.l.lrnal of Nursing, IXI (t-.overnber,1961), p. 63.
7Ibid.
-4effective communication involves.
As the nurse has become the most constant professional
person in the patient's environment, effective nurse-patient
communication has become most important.
Patients need in-
formation and reassurances concerning the questions, problems,
and anxieties involved in their illnesses and hospitalizations,
and irr::parting information· requires that nurses learn to communicate well.
AS medical advancements have increased and more informed
patients seek inforrr::ation concerning their illnesses, the need,
for teaching by nurses has increased. 8 Although the need for
teaching and certainly the
op~ortunities
such opportunities have been utilized.
exist, one wonders if
Since effective teach-
ing predisposes the need for effective cOffimunication, the study
of such communication is significant to improved patient teaching.
It has become well recognized that a person's hospitallzation and illness are often the bases for increased stress
on his part. 9,10
As factors concerned with stress have been
511argaret L. Pohl, IITeaching Activities of the Nurse Practitioner," Nursing ReseB],,gh, XIV (Fall, 1965), p.4.
9Roslyn rl.Elms and Robert C. Leonard, "Effects of Nursing
Approach During Admission," ~ursing Research, XV (Winter, 1966),
p·39.
10I.L. JaniS, PS~Ch010giCal Stress, (New York: John Wiley
and Sons, 1958), p. 39 .
-sstudied and analyzed, it has
bec~me
evident that nurses have
a definite responsibility for reducing such stress. ll ,12,IJ
Any new event impinges upon an individual a certain amount
of stress and anxiety.
Only when the individual is able to
attach some meaning to the event will the stress be decreased.
It would then seem to be one of the major functions of the
nurse to help the pst lent find meaning in the stressing sltuation of hospitalization and illness through her communication with him.
~s
Sullivan writes: rtAnxiety is created in
the interpersonal relat lonsh ip, and with favorable rela t ionships,one learns to handle anxiety profitably.14
The final consideration of the signiflcance of this
study concerns the fact that little research has been conducted
1~
relation to nurse-patient communication or the
effects of nursing approach upon patients.
As Elms ststes:
"Prescr ir;t iens for nul'S ing pract ice intended to promote patient welfare are too often not substantiated by empirical
evidence. IS
--------------l~Dorothy ~. Gregg, "Anxiety-A Factor in Nursing Care,"
American~ournal
12Johnson,
of Nursing, LII(November, 1952), p.lJ6J.
.QQ.
cit., 64.
IJlvlary Meyers, "Thfl Effect of Types of Commun icat ion on
Patients' Reactions to Stress,rt Nursing Research, XIII ( Spring,
1964 ), p. 126.
14Harry Sullivan, Conceptions of Modern Psychiatry
(Washington, D.C.: The Wiliam Alanson White Psychiatric Foundotten, 1947).
15E1ms and Leonard, QQ. cit.
-6-
l1ethod and Analysis
The method of data collection and analysis at
will only be briefly discussed.
t~is
time
Randomly selected male and
female medical patients at a general hospital were given nursing care consisting of a back rub during which time various
structured comrr:unicetitJn approaches were utilized by thA examiner.
Research was confined to those patients having cardiac
or gastrointestinal illnesses.
Prior to and following the
structured communication, the patients' blood pressures,
pulses, and respirations were rr.easured and recorded by the
examiner.
The collected data were then analyzed and compared
using tables, graphs, and statistics.
Limitations
The study was limited to male and female patients of
a 650-bed general hospital in a small Midwest town.
tients were medical patients.
months of August and September.
Data
~ere
All pa-
collected during the
Further 11m i tat 10ns tnc Iud ed
the fact that the entire investigation was plannen and conducted
by a single researcher.
It was realized that total consist-
ency on the part of the investigator in communicating
wit~
a large number of pat tents was not poss ible, yet the invest igator attempted in as far as it was possible to maintain a certain degree of consistency with the use of structured communication.
Finally, the patients were also exposed to the
-7communications of other hospital personnel and visitors during the period of time in which data were collected, although an attemot was made to limit these communications.
CHAPTER II
RELATED LITERATURE AND RESEARCH
Literature
Numerous nursing articles have stressed the extreme
importance of nurse-patient communicatton in the alleviation
of anxiety and stress.
AS
Gregg stated: liThe person-to-
persen relationship of the patient with the nurse becomes
the most important fact in the anxious patient's nursing
care. 16
Another author feels that thE nurse's dlstinctive
contribution to the pattent's welfare is the matntenance of a
stable, minimally stressing state, and this can be accomplished t'nrough effect 1. ve nurse-pat tent commun icat 10n. 17
Research
Meyers has advanced the theory that any new situation
such as hospitalization or illness produces a certain amount
of stress which can be decreased by the teachln~ and patientcentered com:runicatton of nurses. 18 Meyers, in a study, introduced a stress-producing situations involving the presentation to the patients of a tray containing gauze, applicators, and tap water in a covered metal container.
l6Gregg, QQ. ctt., 1364.
17' Johnson, £Q.~.,64.
Ul-l
1; eyers,
op. c 1. t., 131.
-8-
During
-9the situation a
pai~less
procedure of applying tap water to
the arm was carried out.
It was concluded that less stress
was produced when patients were presented structured communication which explained the procedure .19
Distracting or no
comILunication produced elevated levels of stress as shown by
five indices of stress developed by Meyers.
In a second study, Pride utilized urine potassium output as a stress index in studying patients in a general hospi tal.
F'ind longs of the study demonstrated decreased urine
potassiurr output in those patients in the experimental group
in which the examiner focused communication on the patients'
needs,
expectatl~ns,
and illnesses. 20
and perceptions of their hospitalizations
The control groups in which communication
remained "friendly and unfocused" demonstrated increased potassLum levels.
Pride then concluded that nursing care and com-
.
municatLon played a defLnite role tn determining the effectiveness with which the adaptive mechanism to stress operated.
Elms and Leonard in studying the effects of rmrsing approach on patients during admission concluded that communication
focused on determining and dealing with individual needs of
patients produced less stress than applying the cormal admission procedure according to the hospital manual. 21
Increased
----,-,---------- - - - - - - - - - - - - - - - , - - - - - 19 Ibid .
---
.
20prancis L. Pride. "An Adrenal Stress Index As a Criterion N43asurement for Nursing," Nursing Research, XVII (JulyAUgust,1968), p.)02.
2l:i!:lms and Leona rdr;'.9..Q. c it., 47.
-10-
blood pressure, pulse, and respirations were the criteria
utilized in indicating increased stress.'
Anderson also stressed the importance of nurse-patient
communication directed toward determining and dealing with
the individual needs of patients.
In two separate experi-
mental Situations, newly admitted patients to an emergency
room of a general hospl.tal and patients being: admitted to
a large state mental hospLtal were presented various nursLng approaches.
Those patients presented patient-centered
communication focused on patient needs displayed decreased
stress. 22
Again, decreased blood pressure and pulse read-
lngs were used as indlcators of decreased stress.
In this
particular study, blood pressure readings appeared to decrease more significantly than pulse readings with petientcentered ccmTunication.
The research of Pohl concerning teaching activities
of the nurse practitioner further attested to the necessity
of effective nurse-patient communication.
Pohl mailed a
questionnalre to nurses employed in areas of nursing practice such 8S private duty, general duty, public health, and
office nursing.
The questionnaire concerned the amount of
time the nurse felt she engaged in teaching among other
things.
Pohl concluded from her results that teaching was
22Barbara J. Anderson, "l'wo Experimental Tests of a
Patient-Centered Admission Procedure," Nursing Research,
XIV (Sprlng,1965), p.156.
-11-
best performed by the nurse practitioner, and that mast
nurse practtioners needed improvement in communicating effectively to insure that meaningful teaching of patients
c ou ld occur. 23
The hypothesis that physiological processes such as
blood pressure, pulse, and reptrations are affected by the
level of stress in a human being has been explored by many
reseerchers.
W.B. Cannon in his research concerning bodily
changes during various human emotional situations concluded
that blood pressure,
pul~e,
and respirations were appreciably
elevated during situations of feel' and anxiety.24
Morris
also reached the same conclusions in his experiments concerning the effects of excitement on pulse, blo01 pressure,
and blood sugar.25
Springer in a preliminery study concluded
that situations eliciting stress resulted in elevated blood
pressure, pulse, and respiration levels. 26
ether researchers
in the areas of psychology and physiology such as Jost, Rollo,
and Schachter have also verified the hypothesis that increased
stress results 1n increased blood pressure, pulse, and respiration levels.
23 Pohl, .2.£. cit. ,p. 1124W.b. Carloon, Bodily Changes 1n Pain, Binger. Fear,
and rlage.(boston:Charles T. Bradford Co., 1953), p. 73.
25p.F'. 1"101'1' is , "Effects of Emotional Excitement on
Pulse, Blood Pressure, and Blood Sugar," Yale Journal of
Biological Medicine, VII(f>Iay, 1935), p.40l-20.
26r-iorton Springer, "Card iac Act ivity During Emot ion, "
American Journal of Psychology, XVIII (February,1935),
CHAPl'ER III
DATA Al\D
AN.ALY~IS
The question the investigator chose to examine was:
Do nurse-patient communications in the nursing care of the
medical patient in a general hospital increase or decrease
patients l stress?
Patients' stress in this study was meas-
ured by an increase in the blood pressure, pulse, and respiration readings of the patient.
Such an increase tn vital
signs indicated increased stress levels.
This particul8r study was ltrniteo to cardiac and gastrointestinal patients of a 650-bed general hospital in a
small )\,i1dwest town.
Data were collected on a total of 15
male and female cardiac pat1.ents and 15 male and female gastrolntest Lna I pat ients, during the months of August a nd September.
All of the patients were alert and able to communi-
cate verbally during the l.nvesttgation.
None were consider-
ed to be tn crtttcal cOY"Jd itlon as determined by their phys1.cians.
In as far as was possible, the investigator attempted
to ma inta in a certa in degree of cons isten~ in approach ing
tne patients by the use of structured communication.
An at-
tempt was also made to limit the patients' commucications
with other person, although th1.s was not always possible.
-12-
-13-
Collection of Data
Data were collecten by the investigator between the
hours of 3:00 p.m. and 11:00 p.m.
During the time in which
data were collected other perscnnel and visitors were asked
not to corr:munic8te '.'Jith the patient if pOBsi-ble.
Data on
each patient were collected during three consecutive days
during which time three types of verbal communication were
presented to each patient.
The investigator first entered the patient's room 8nd
made the comment: "11m going to take your blood pressure and
pulse."
BIGod preEsure, pulse, and respirations were meas-
ured and recorded.
No other verbal communication transpired
during this period unless a question or comment of the patient abSOlutely required comment from the investigator.
Ten to f tfteen minutes later the invest igator aga in entered
the patient's room Bnd began giving a backrub during which
time she did nct intiate any verbal communication.
Only
when a question by the patient made a response nece8sery,
was it given.
If a ressonse were necessary, only mcnosyl-
lables were used.
Following the teckrut, blood pressure,
pulse, and respirations were
B~ain
measured and recorded.
ThUS, on the first day of data collecting, only limited or
no communication took place between tlJe icvestigator and the
pat lents.,
Dul'ing the second day of investigation, structured,
distracting communication was initiated by the investigator
-14-
durlog the backrub.
Cn this day the patient was asked
whether he w0uld like a backrub to be given.
BltJod pressure,
pulse, Bcd respirations were egaiD measured and recorded
prior to and following
tracting
com~unication
the backrub.
The structured dis-
centered about matters not particularly
l'e18ted to the p8tient's inidividual needs.
'l'he investiga-
tor first commented upon the weather durlog that particular
day and next initiated a alscussion of the news headlines
of the day.
Thirdly, the investigator discussed herself as
a student nurse, and the fact that Munice needed a new hospital.
During the third day of investigation the same procedure
for rreasurlng and recordlng
etions
W~lS
blo~d
pressure, pulse, and respir-
used, but the nurse-patient communicaticn during
the bacKr'ub was patient-centered, aod the investigator attempted to fccus upOn thp
in~ividual
nee~s
of the patient.
The patient again wes asked if he wanted a beckrub to be
given.
Again the communication was structured with the fo1-
lowing questions and comments being presented to the patient
by t':'le il:'nest igator:
1.
2.
3.
4.
5.
How are you feeling today?
Tell me about what kind of day you've had.
How long have you been in the hospital?
How do you feel about being in the hospital?
Tell me a little about your family.
-15-
Presentation of Data
Due to the large amount of data which were collected,
the investigator organized the data into three major areas
of blood pressure, pulse, and respiration readings.
The
four major types of patients stL<died were also grouped separately.
'l'hese groupings were: male cardiac, fpmale aardiac,
male §.:.a strointest 1nal, and female gastrointest lnaL
The blood pressure readings obtai.ned on each of the
three days of investigation of male cardiac patients are presented in Table 1.
Tr..BLE 1.
BLOOD PRESSURE RbADIl'JGS OF filALE CARDIAC PA'J1IEi';TS
BEFORE Al~lJ AFTER LHlIr:I.'ED OR NO, DIS'l'RACTING, AND PAr:I.'IENTCE1"r:I.'ERED CONNUNICATION \HTH THE NURSE
Patient
Number
1
2
3
4
5
6
7
8
Nean
1st Day'* Blood
Pressure
2nd Day@ Blood
Pressure
3rd DaYff Blood
Pressure
Before
After
Before
After
Before
After
92/70
94/68
132/78
102/74
124/82
110/78
144/88
104/"e
94/70
106/72
132/78
98/72
128/80
110/80
146/92
108/72
92/70
102/74
132/80
100/68
122/82
110/78
148/90
106/74
92/70
102/74
130/80
98/66
122/82
106/74
148/90
110/78
94/70
102/74
136/82
102/70
124/80
112/76
142/86
106/68
90/70
100/72
128/80
107/72
118/76
106/70
113/76
115/77
114/78
113/77
115176
-.~
--
-~~-----
.
- -,..----..
-
--
'* no or limited communication
-1st day
~ distracting communication
-2nd day
ff patient-centered communication -3rc1 day
146/88
102/66
113/74
-16-
From the table it can be seen that blood pressure readings of the first day before communication ranged from 92/70144/88.
Pulse pressure, which is a measure of the tone of
the arterial walls, ranged for this day from 22-56 prior to
communication.
Blood pressure readings following communica-
tion on the first day ranged from 94/70-146/92, while the
pulse pressure ranged from 24 to 54..
During thE second day
of investigation blood pressure readings before communication
ranged from 92/70 to 148/90.
Pulse pressure readings ranged
from 22 to 58 both prior to and following communication.
On
the third day of investigation blood pressure readings prior
to and following communication ranged from 94/70 to 142/86 and
90/70 to 146/88, respectively.
Pulse pressure readings be-
fore communication ranged from 24 to 56, while the range following communication was 20 to 58.
It can be seen that the
greatest range of pulse pressures occurred during the third
day of investigation in which
p~tient-centered
communication
took place.
Mean blood pressure readings increased during the day
in wbich no or limtted comThunication was initiated by the
nurse.
h
decrease in mean blood pressure readings was noted
cIur1.ng the day in which distracting communication was initiated as well as the day of patient-centered communication,
with the greatest decrease occurring with patient-centered
communicat ton.
Table 2 is a more detailed presentation of pulse pressure readings of male cardiac patients during the three days
of investigation.
-17TABLE 2.
PULSE PRESSURE READINGS OF NALE CliRDIj.,C PhTIEi\i'I'S
BEFORE liND AFTER Ln~I'rED OR l'JO, DISIJ.'RAC'l'ING, AND PhTIENTCEl\J'l'ERED CCNNU1'.ICATION WI'l'H THE NURSE
Mea~
pulse pressure readings obtained by the investlga-
tor during no or limited communication shows a slight increase
of 1.50, while the mean pulse pressures during the second and
third days are decreased slightly, with the greater decrease
occurring during the third day.
for the sec8nd and
thl~d
Decr9ases of .50 and 1.50
days, respectively, occurred.
-It)-
Pulse Pressure Mean
llO-
------
-------
30.
20-
o· ' - - - ------t-r--_._-1- -- -. ---- - r------"t----ot-'
0 m
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z
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ro
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C:+(J)
..... H.l
0
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CD
0
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0 m
3 rt
3
c: t:
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ro
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I!l :trtH.l
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(1)
:::s '-:1
ON
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8
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;::5
c: 0
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......<
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c: 0
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0 0
:::s 'i
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n'
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.- H.l
0 0
:::s 'i
---r--~"
O\.".)
0 'i
a aa
c: t:!
:::s (p
..... "<
()
C1 ~rt H.l
. - <.T
0 (J)
., 'i
(J)
Figure 1. Pulse Pressure I·leans of Male Cardiac Pattents Before
and After No Or Limited, Distracting, and Patient-6entered
Communic8tion With the Nurse.*
* 1st
Day-
2nd Day3rd Day-
no or limited communication
distracting communication
patient-centered communication
During the first day mean pulse pressure increased
following communication, while decreases occurred during the
second awl third days, with the greater decrease occurring on
the third day.
In studying the blood pressure readings of the female
cardiac patients Table 3 was dtilized.
-19-
'l'ABLE 3. BLOOD PRE!::lSURh READINGS OP FEMAIE CARDIAC PATIENTS
BEFORE hND AFTER UNITED OR NO, l..iISTRACTING, AND PhTIENTCEN'l'EflliD COfiir1U1ICJ._TIGN WITH ThE NURSE
1st Day* Blood
Pressure
2nd Day@ Blood
Pressure
Before
After
Before
After
Before
After
1
98/64
98/64
94/70
94/70
102/72
100/72
2
124/82
130/84
124/82
124/82
128/8~
122/74
J
94170
94/72
100/66
98/68
102/72
98/70
4
156/92
162/96
152/86 ...
152/86
156/86
160/88
5
116/78
116/78
116/76
118/80
118/78
110/72
6
142/86
146/84
138/82
132/80
142/84
144/84
7
122/80
120/76
122/86
122/86
120/82
118/80
Nean
122/76
124/79
121/78
121/79
124/79
121/77
Patient
Number
* 1st Day- no or limited
3rd Day# E100n
Pressure
com~unication
@ 2nd Day- distracting communication
ff 3rd Day- patient-centered communicetion
Blood pressure readings of female cardiac patients before and after no c)r limited communication with the nurse ranged
from 94/70 to 156/92 and 94/72
to 162/96, respectively.
The
range of blood pressure readings from the second day of nurse
communication ranged from 94/70 to 152/86 prior to communication, while rear-Hngs following communication remained within
the same range.
On the thirj day it was noted that prior to
communication the range was 102/72 to 156/86 while 100/72 to
-20-
160/88 was the range following communication.
The greatest
range of blood pressure readings for female cardiac patients
occurred on the first day of investigation in which no or limi ted c ommun ica t ion wa s in it iated .
Mean blood pressure readings during the first
~ay
of
communication increased but decreased during the third day of
communication considerably.
An increase the first day of
two points on the systolic reading and three points on the
diastolic reading was noted.
The decrease during the third
day was three points on both the systolic and diastolic readings.
During the second day of distracting communication the
mean blood pressure readings remained stable.
Table 4 presents pulse pressure readings of the female
cardiac patients as well as mean pulse pressure readings for
the three days of investigation.
-2lIJ.'.a1:H..E 4.
PULSE PRESSUfiE READINGS OF FENJ..LE CARDIAC Pa'l\II:a~TS
BhF(;.B..E. ri.l"D AFIJ.'EH. LINITl!.D OR hO, DISTRj.~CIJ.1I~G, A.i\;D PaTIENTCENIJ.1EiiED C0r1i'lU fHCATIOl\J HIIJ.'H THE :l\iURSE
Patient
Number
1st Day* Pulse
Pressure
2nd Day@ Pulse
Pressure
.3rd Dayft Pu 1se
Pressure
Before
After
Before
After
Before
After
1
.34
34
24
24
30
28
2
42
46
42
42
48
48
3
24
22
34
30
30
28
4
64
66
66
66
70
72
5
38
38
40
38
40
38
6
56
62
56
52
58
60
7
42
44
.36
36
38
38
lYlean
42.59
44.59
42.59
41.14
44·86
44.59
* 1st Day- no or limited communication
@ 2nd D8Y- distracting com~unication
ff 3rd Dey- patient-centered communication
From this table it can be seen that the range of pulse
pressure readings during the first dey of communication was
24 to 64 prior to communication and 22 to 66 following communicstton.
During the second day, pulse pressure readings
ranged from 24 to 66 before communication end remained the
same following the comn:unication.
Prior t.o and following com-
municat ion on the th ird day the range of pulse pressures Nas
-2230 to 70 and 28 to 72, respectively.
The rrean pulse pressure increased two points on the first
day, while decreasing oaly slightly during the second ana
third day, with the greater decrease occurring during the second
day of distracting communication.
Figure 2 depicts the differences tn mean pulse pressures
of the female cardiac patients during the three days of invest igation.
Pulse Pressure Nean
5040-
-
30
20
J'
!J:!I-'
~rn
I
:r-I-'
t;C1\)
~
0
I-4)rt
H)(D
0
H)0s
rtrt
~tD
'it::!
OJ
0
'it1
'it)
~
0«
m
«
(")
0
0
a
8
0
;:J
t-
t-
0
c;
0
8
c
()
(U
rt
.....
0
p
"<
8
~
(1)
8
~
t-
I
I
~N
1-4)0
rtOs
(1)
'i C'
---.-tJ:<1u)
(1) 'i
I-I)p.
0
'it.)
0
(")
0
;::j
8
0,,<
9
~
0
0
;::j
~
t-
;:3
(l)
t()
o
rt
cT
rt
m
t-
0
0
0
cT
.....
0
0
.....
;:l
(1)
'it:!
OJ
()
C\.i
1-4)'i
rtO;
('[) \Xl
ro
()
ro
~\...o.)
.....
0
:::I
«
0«
8
::::
~
0
t()
OJ
rt
t-
0
0
Figure 2. Pulse Pressure Means of Female Cardiac Patient Prior
To and Following No or Limited, Distracting, ana PatientCenteree Commun icat ion With the lIIurse. *
*lst Day- no or limited communication
2nd ~ay- distracting communication
Jrd Day- patient-centered communication
-2JFrom Flgure 2 it was seen that the mean pulse pressure for
fema1~
cardiac
patien~s
increased during the first
day of no or linited commurlication wi+:h the nurse, while decreasing with distractlng
an~
patient-centered commuutication.
The greater decrease occurred during
t~e
second day in which
distracting communication occurred.
Blood pressure read ings of male ga strointest ina 1 patlents are presented in Table 5.
TABLE 5.
bLGGD FRESSURE REiillll~GS OF Hhlli GASTRGli~'l'E.S'l'INAL
Pio.'IIl!Jll'S bE.FUhL Al\.u AF'l'ER NO Uti LHIITED, lJIS1l'd.bC'l'n"G, li.l~D
Pi-.'T Ihl~T_(a;~\jTERED CCNivlUi\lICh'l'1Ci\ 'vH1'H ThE l\iURSE
Patient
1st Day*B1ood
Pressure
.l~ulIJber
2nd lJay@ Blood
Pressure
Jrd l)ayff
Bloed Pressure
Before
hfter
Befclre
l1fter
Befere
1-.fter
1
148/94
150/96
156/92
156/92
160/92
164/90
2
112/76
112/76
118/78
116/74
110/76
ll2/76
3
182/102
182/104
176/96
182/98
184/102
182/98
4
1J4/86
138/88
130/82
130/52
138/86
138/86
5
98/66
104/68
102/74
102/72
98/68
98/66
6
124/80
122/80
1Jo/84
1J4/84
132/84
134/84
7
1)6/86
1J2/80
142/86
140/86
136/80
132/80
i1ea[[
133/84
1J4/85
136/85
1J 7 184
137/78
137/83
-----_
--
.
~
.
..
*
i"3J
ff
1st Day2nd Day3rd Dey-
no or 1irr:i. ted communication
distracting communication
p3tient-centered communicAtion
-24-
DJring the f lrst day of comrnun 1.eat ion the ra nge of
tlood pressure readings prier to and following communicatlon was 98/66 to 182/102 and 104/68 to 182/104, respectively.
During the second day of commun1.cation ranges of 102/74
to 176/96 before
dlstracti~g co~munication
182/98 were found.
and 102/72 to
Ranges of 98/68 to 184/102 prior to com-
munication and 98/66 to 182/9b followlng communic&tlon were
noted on the third day of patient-centered communication
wi th the tnv88t igal-or.
It can be seen that these ranges
were considerably greater than those found for both male
and female cardiac patients.
Mean blood pressure
readin~s
of male gS8trointestinal
patients increased with no or limited communication.
An in-
crease of one point on both the systolic and diastolic readings was Doted.
This was less of an increase than was found
fer both male and femble cardiac patients.
Systolic readings
of mean bloed pressures increased, wh ile the diastolic read Lng
decreased one point.
During the third day of patient-centered
communication it was found that systoliC read lngs for mean
blood pressure remained the same, while the diastoliC reading
increased a total of five points.
In comparison with both
male and female cardiac patients who sho\lled a decrease in
mean bloed pressure with patient-centered
c~m~unic8tion,
this
increase of blood pressure readlcgs with male gastrointestlnal
pEtients demonstrated what could be an increased level of
stress.
The invest igatcr found that the rna Ie gastroin.tes inal
patients, unlike the cardiac patients, appeared to become
v is ibly upset by pa tie nt -centered commun ica t ion for th e rr.ost
-2.5part.
Many of these patients 5ttempted to direct the
con~er-
sat ion to subjects which were more general than the ones
selected by tne investigator as being patient-centered.
Table
~
represents pulse pressure reedings of the male
gastrolntestinal patients as well as the mean pulse pressures
for the three days of communication with the investigator.
TF..BLE 6. PUL..'::lE PRESSURE
.i:iEADII~GS OF lilALE GASlJ.'H.OINTES1' INAL
AND AFTER NO GR Lli'.llJ.'ED, nIcTRAC'l'ING, i-~bD
PATIENT-CEl\lTEHED C(;~GmNICATION \oJ 1'Th lJ.1rtE NURSE.
P}-~Tlt;~~TS 1.:r~F(irtE
--------->,~-
----------_.,-_._- ------1st Day* Pulse
Pressure
Patient
l~umber
2nd DaylQJ Pulse
Pressure
3rd DayH Pulse
Pressure
--'-"
Before
After
Before
After
before
After
1
54
54
64
64
68
74
2
36
36
40
42
34
36
3
80
78
80
84
82
84
4
48
50
48
48
52
52
5
32
36
28
30
30
32
6
44
42
46
50
48
50
7
50
52
56
54
56
52
49.14
49.71
51.71
I~lean
---_.._--------
53.14
-- ----
-,-.-----~-
* 1st Day- no or limited communic8t1.on
~
2nd Day- distract1.ng communication
# .3 ro Day- pc; t ient-centered comrrun iC8 t ion
52.86
54.28
-26Ranges for the first day of no or limited
com~unication
were 32 to 80 prier to and 36 to 78 followiGg communication.
With j1stracting communicettcn the ranges pri0r to and following communication were 28 to 80 and 30 to 84,respectively.
lJ.lhe range of pu lse pressure read lngs on the th ird day before comlliunication was 30 to 82, while the range following
cornn""oicat 10n was 32 to 84.
Pulse pressure ranges for each
of the three days of communication remained basically stable
with the exception of the first day in which the range was
36 to 78.
h
slight increase of .57
for the mean pulse pressure
was noted during the first day of investigation.
Greater
mean pulse pressure increases occurred during the second and
third days with the greater increase during the day of
d.1.str&ctilag
communication.
The second and tY}ird days
demonstrated increases of 1.4) and 1.42, respectively.This
increase in mean pulse pressures with distract iog and pat ientcentered c ommun teat ion wa s not found 1. n either male or femsle care, iac pa t ients and aga tn may tna icate increased stress
in the
mEl
Ie gastro tnt est ina 1 pa t ients follow ir:.g verba 1 com-
munication by the tnvestigator.
Figure 3 shows mean pulse pressure of rrale gastrointestinal patients tn graphic form.
-27Pulse Presf'mre Nean
F1.gure 3. Pulse Pressure Heans of Male Gastrol.ntestl.nal
Patients Before and After No Or L1.m1.ted, Distracting,
and Patient-Centered ComIT<unication with the Nurse.*
* 1st Day-
2nd Day3rd Day-
no or limited communication
distracting communication
patient-centered communication
Pulse pressure means for rna Ie ga str':Jintest ina1 pat ients
increase(i on each of the three days of invest1.gat1.on, wtth
the least amount of increase occurring with no or 11.m1.ted
communicat1.on.
Increases during the second and third days
of investigation d1.ffered by only .61 .
-28-
Table 7 shows blood pressure read tngs obta tned from
8 female gastrotntestinal patients during three consecutive
days of l.nvest tgat ion.
BLOOD PilliSSURE READINGS OF FEhtd..E GA~)fI'}WIi"TES'l;Il\iAL
BEFCHE Ai'.D il.J:j1IJ.'ER NO OB. Llhl'l'ED, DIS'l'R.nCTING, Al\JD
PA'l'I.l:!.N'r-CE.i\TEriEL CCA11' iUNICl-'.TI()N WI'1'h ThE .NURSE.
TABLE
7.
pl1Tlm~T
Pat lent
i.umber
1st Day" blood
Pressure
2nd
before
After
Before
After
Before
After
--_.-
Day~ Blood
Pressure
3rd DaYff blood
Pressure
1
122/78
122/78
120/82
120/82
124/80
126/80
2
128/82
120/80
126/78
126/78
128/84
128/82
3
136/72
132/70
134/90
130/86
136/86
138/86
4
166/84
166/84
164/92
158/90
164/82
164/80
5
158/92
160/96
156/86
152/84
150/76
156/78
6
118/70
114/68
122/80
124/82
118/72
118/74
7
94/62
92/60
98/70
104/72
90/70
92/72
8
128/82
128/80
132/78
130/74
136/84
132/76
Mean
126/78
121/77
1)0/82
130/81
131/79
132/78
*lst Day(g.;2nd DayffJrd lJay-
no or limited communication
distracting communication
patiect-centered communic8tion
The range of blood pressure readings before no or
limited communication was 94/62 to 166/84, while the range
-29-
following communication was 92/60 to 166/84.
During the second
day blood pressure readings ranged from 98/70 to 164/92 prior
to
com~unication
and 104/72 to 158/90 following communication
with the investigstor.
Third day blood pressure readings
were 90/70 to 164/82 before communication and 92/72 to 164/80
following communication.
The greatest range occurred during
the first day of no or limited communication, while the smallest range was during the cay of distracting communication.
Nean blood pressure readings for female gastrointestinal
pstients show a definite decrease with no or limited communication as compared with increases in the previous three
groups of patients.
A decrease of five points in the systolic
readings and one point in the diastoliC was noted.
With dis-
tracting communication during the second day mean blood pressure readings showed a one point oecrease in the diastolic
pressure, while the systolic pressure remained the same.
Unlike the three groups of putients already studied, female
gastrOintestinal patients showed a slight increase of mean
systolic readings with patient-centered communication.
An
increase of one point in the mean systolic pressure was noted
during the third day, with a decrease of one point occurring
in the diastolic reading fer the same day.
Pulse pressure read ings of the same blood pressure
readings presented 1n Table 7 ere presented in Table 8.
-30T.hBLE 8.
PULSE PiiESSUhE rlEADll'iGS OF FENM I.E GA::/l'RCIN'I'ES'l'I1~AL
.P.r.'l'ihl"'l'.s bEFO.::ib.. .n.ND l'_F'l'ER NO OR LII>llfJ.'ED, DIS'l'.n.hC'l H~G, h.i\iD
PA'l'I~l\j'l'-CJ~l'oJThiiED COHhUNICA'l'ION WI'l'i:{ ThE NURSE
Pat ient
Number
1st Day* Pulse
Pressure
2nd Day@ Pulse
Pressure
3rd Daytf Pulse
Pressure
Before
After
----Before
After
Before
1
44
44
38
38
44
46
2
46
40
48
48
42
46
3
64
62
44
44
50
52
4
82
82
72
68
82
84
5
66
64
70
68
74
78
6
48
46
42
42
46
46
7
32
32
28
32
20
20
8
46
48
54
56
52
56
Nean
53·5
49.5
49.5
-_._--_._-
.. 1st Day@ 2nd DayIf 3rd Day-
52.25
After
51.25
53.5
no or limited communication
distract ing commun tcet i:)n
patient-centered communication
Prior to communication during the first day the range
of pu18e pressures was fro::o 32 to 84, while the r8r'.ge following
communicc1ti:)n was the S8r.1e.
During the second day of investi-
gation pulse preseure readings
range~
from 28 to 72 before
distracttng communication and 32 to 68 following the same
-31communication.
The third day pulse pressure readings ranged
from 20 to 82 prior to patient-centered communication, while
follo\'l1.ng the commun iCEi t ion the ra nge we s 20 to 84.
'rhe grea t-
est range occupred with pat tent-centered communication, wh ile
the smallest range was seen with distracting communication.
1I1ean pulse pressures of fema Ie gastrointestinal pat ients
were slightly decreased follovTing no or limited communication,
while in each of the other three groups the mean pulse pressure showed an increase during the first day of communication.
The decrease of mean pulse pressure for the female gastrointestinal patients during no or limited communic2tion was
1.25.
Mean pulse pressure remained the same prior to and
following distracting communication during the second day
but increased 2.25 with patient-centered communicaticn. This
increase with patient-centered communication was not noted
in each of the other three groups of pot ients stud ied ,as each
of these groups showed a decrease of mean pulEe pressure readings following patient-centered
com~unication.
In Figure 4 the mean pulse pressure read ings of the
female gastrointestinal patients are presented.
-32-
Pulse Pressure Mean
60-
-------
-
50
40·
0
~,-~
01--'
01--'
o
a
c~
~tu
o 00
8c-t
000
Srt
c c'
s::t::
a
::stu
,.....~
0
<Xltr.'
c-t(O
,.....H:I
o 0
~'"1
(J)
"t
ON
~~
t--"<l
~
80..
8
t-- '<
0
tub::'
0
\XI ~
c-tH:l
<:T(j)
,.....H:I
o
00
::s'"1
,..... rt
Cl>
~'1
Cl>
r
T
O\..)
~
0'"1
ON
o
80.
a
ct;:)
::s<Xl
Elo.
a
t::t::;'
;:3
tu
I
0'-'->
o '"1
So,
a
ct:
~
t--~
,.....~
cn:t>
0
0
\XIlJ:I
,.....C+
,.....H:I
0
C'J
(T H:I
c-tH:l
0(0
~'"1
rt(O
o 0
o '"1
>
t--rt
o
1st Day2nd Day3rd l..lay-
Cl>
no or limited communication
distractlng communication
patient-centered communication
Mean pu18e pressure readings for gastrointestinal
female patients decreased,
du~ing
tbe 1 first day of commun-
ication, while they increased during the day of patientcentered
com~unicatiGn.
Mean pulse pressure readings re-
molned the same with distracting communication.
Cl>
~'"1
Figure 4. Pulse Pressure l'1eans of Female Gastrointestinal
Patients Before and hfter No Or Limited, ~istracting, and
Pat lent-Centered Communication With the Nurse.*
it
<Xl
t--~
-33-
Pulse readings of male cardiac patients during the
three days of communication with the nurse are shown 1n
Table 9.
'l'iiBi..E 9. i?ULSE dEAD INGS OF HiiLE CARDIAC P.t'.'l'IENTS BEF0RE A~D
AFTEB. NO OR LHlITED, iJlSr:I'RAC'l'ING, Ar~D Pi::P IENT-CEl\i'l'ERED COI1~IUN­
ICATIGN H l'l'li TI:-.iE NUaSE
Pat ient
Number
2nd DayiS;
Pulse
1st Day*
Pulse
3rd Daylf
Pulse
Before
After
Before
After
Before
After
1
116
136
116
116
116
112
2
108
96
88
84
88
88
3
80
88
80
88
84
80
4
100
102
96
92
96
92
5
84
88
84
84
88
80
6
80
84
80
80
80
78
7
76
80
76
72
76
72
8
72
68
76
72
78
80
93.0
87.0
84.75
88.0
85.25
Nea n
89.5
--------
--.
* 1st Day2nd J)ayIf 3rd Day@
no or limited communication
distracting communication
patient-centered communication
Pulse readings ranged from 72 to 116 prior to no or
limited communication and 68 to 136 following the same
municatlon.
During the second day of
investi~atton,
COID-
ranges
-J4-
before and 8fter d istra ct tng commun tC8 t ion were 76 to 116 and
72 to 116, respecttvely.
Raoges of 76 to 116 before communi-
catton and 72 to 112 following cornmunicetton occurred during
the day of patient-centered communication.
Mean pulse readtngs for the ftrst day of investtgation
increased 3.5 pOints, while a decrease occurred wtth distfacttng and patient-centered cornmunic8tton.
With distracting
communication the decrease was 2.25,while a decrease of 2.75
occurred with pat ient-c entered cornmu 0 tcat ion.
It would ap-
pear that less stress occurred with patient-centered communication than the other two types.
In studying pulse readtngs of female cardiac patients
Table 10 was used.
-J5-
TABLE 10. PULSE B.Ei:JHl~GS OF It'm;lJd.E Ci,RDIAC PArrIBNTS bEFORE
.b.l11D AF'I'EB. NO OR LHlI'l'ED, DISTRAC'l'ING, .h1~D PF~'l)IEM)-CE1\TERED
COMlViUl'iICA'rICN iHTH THE NURSE
Patient
Number
1st Day*
Pulse
2nd Day@
Pulse
Jrd Day#
Pulse
Before
After
Before
After
Before
After
1
76
76
76
80
76
72
2
76
76
76
76
76
80
J
80
84
80
80
80
76
4
76
80
76
72
76
76
5
72
78
72
72
72
64
6
64
68
68
64
68
64
7
76
84
76
76
76
68
74.0
78.0
74.9
Nean
* 1st Day-
@ 2nd Day-
# Jrd Day-
74.3
74.89
71.4J
no or limited cC'''1municatlon
distracting communication
patient-centered communication
Mean pulse readings during the first day of communication
increased substantially following limited or no communication,
while mean pulse readings
du~ing
the second and third days
of communication decreased, with the greater decrease occurring following patient-centered comnunication. The increase
-36of mean pulse readings for the first day was 4.0, while the
decreases for the second and third days were 0.6 and 3.46,
respectively.
The range of pulse readings prior to no or limited communlcation was from 64 to 80, while that following the same
communication was 68 to 84.
During the second day in which
distracting communication occurred ranges of pulse readings
were 68 to 80 before communication and 64 to 80 following
communication.
Durlng the third day ranges of 68 to 80
prior to patient-centered comwunication and 64 to 80 following tae cornnunication were noted.
Ranges for the three
consecutlve days of pulse readings varied little.
Pulse readings of male gastrointestinal patients, as
s~own
in Table 11, did not follow the pattern set previously
by male ano female 9ardiac patients in Tables 9 and 10.
-37T.t>..6,LE 11.
R.c.£)ING~
O.B' JllliLE G.AS'l'RCliVl'E.3'l'l ~A.L Pr.T l.c.l"'l'S
.LI IS'l'rl.i-.C'l'ING, lil~D PA'l'I ili~T­
CONilUlIIICA'lIOIIJ '~ITh 'l'h£ NuRSE.
PG.L.S,t;
b.l:!;it'Cht.. .twD .hli''l'iili. N(, Oti Will 'J'iW,
C~i~'l'.B.H.l:!.D
Pa t lent
l. . umber
1st Day*
Pulse
2nd Day@
Pulse
3rd Day#
Pulse
Before
After
Before
After
Before
After
1
88
92
92
92
88
84
2
64
64
64
64
64
68
3
88
92
92
88
92
92
4
72
76
76
72
80
76
5
60
68
56
56
64
6it
6
76
76
72
72
76
76
7
84
84
84
80
84
88
"~eao
76.0
78.85
77.59
*" 1st Daylfy
ff
2nd Daj3rd Day-
74.86
78.28
78.28
no or limited communication
distracting communication
pa t lent-cent erect CODJEJUn lea t ion
b.lthough mean pulse
munic8tlon increased and
r~adings
re£~ings
'luring the first day of
COID-
during the second day of dis-
tracting CQrnmunicaticn decreRsed, mean pulse readings following
patient-centered comrr,unication remained the same.
This pheno-
menon was not observed with male anrl female cardiac patlents
-30-
who demonstrated a decrease tn mean pulse readlngs followlng
patient-centered communication as shown by Tables 9 and 10.
The increase tn mest! pulse reading8 for the first Clay of
COID-
mubicaticn was 2.85, while the decrease for distractlng commuhtcation was 2.73.
The range of pu18e readings prier to no or distracting
commun iCEj t ion
\'188
60 to 88, wh i 1e th8 t follm-J i og the commun-
ication was 64 to 9?
ing communic8ticn
W8S
Dur~ng
the second day in which distract-
inttiated a raoge of 56 to 92 occurred
both prior to and following the communication.
A range of
64 to 92 prior to ano fol1owl.ng p8tit-'nt-centered com:-:junic8tion
was noted.
The greatest range of pulse readings occurred
with distracting
CO~~UGic8tl.on,
while the range occurricg
with no or limited communication was least.
'lIable 12, tr-;e final table of pulse readir..gs, shows
the pulse resdings of 8 female gastrointestinal pbtients.
-39-
'l'ABLE 12.
PULSE REJill1l\GS OF FENALE GA.ST.i1CIl-.;'rr.;STINAL P-tiT 1E1'o'1'S
b£E'ORE AND AF'l'E.R NO vR LHiITED, :JISTRACTlhG, AND Pf-.'l'IE;l\I'l'CEi\j'llEdED COI"Il"jUNICA'l'ION WITH 'l'hE NURSE
---_.
------ ---_.-----_._.--.--"---"-- -------.- Pat ient
lllumber
1st Day*
Pulse
----------------~~---.-----.--
2nd Day@
Pulse
3rd Dayft
Pulse
-_._---------before
after
--,----
Before
._---,
After
before
hftf'!'
--,--
1
72
76
72
76
72
72
2
76
76
76
76
76
76
3
72
72
72
68
72
72
4
80
84
80
80
80
76
5
80
88
80
80
80
80
6
72
72
76
72
72
72
7
92
100
88
88
96
96
8
68
68
64
64
68
64
76.5
79.5
76.0
75.5
77.0
76.0
I"Iean
-----
---- ----- - - - -
* 1st Day-
@ 2nd Dayff
ThE!
3rd Day-
no or limited communication
distracting communication
patient-centered communication
prevailing pattern of mean pulse readings was again
evidencef in this table.
increase of 3.0 occurred.
tracting
creased
"Hld.
J
_._------
--------.-.~----.
With no or limited communication an
Mean pulse readings following dis
pEtleot-centered commucication were again de-
with the greater increase occurring the
thl~d
day_
-40These decreases were not as great as those occurring in the
male and female cardtac groups.
Pulse readings during the first day ranged from 68 to
92 prior to conl:Iiud.catt-:m and 68 to 100 following the communication.
During the second day the ranges before and after
communication were 64 to 88 in both instances.
to
Ranges prior
following patient-centered communication were 68 to 96
80d
and 64 to 96, respectively.
Table 13 demonstrates the mean of pulse beats difference
for the three days of investigation.
MEAN o.F' PUL~_)E BE.k'l'SD1FFEREi\CE WITH NC OR T.1i\1'l'ED,
D1E>'IRbC'l'1NG,' Ju'llD PA'l'1EN'l-CE1',TERED CON:'Ul"rCAT10N WI'l'H TriE NURSE.
TABLE 13.
------------1st Day*
Patient
Group
2nd Day@
3rd Day#
Ma le Cara tae
3.25
-.50
-J.OO
Female Cardiac
3.70
~.57
-3.43
Male G1
2.86
-1.
3.00
-.50
t
Female G1
* 1st Day@ 2nd Day-
ff
3rd Day-
r
G1-
71
no or limited communication
distracting communication
patient-centered communication
gastrointestinal
During the first day of communic5tton each group
showed an increase 1.n mean pulse beats wi t~1 the gree. test
.00
-1.
00
-41increase occurring in the female cardiac group.
~he day
of di.stracti.ng communicsti'Jn showed a decrease in mean pulse
beats for each group wi.th the greatest decrease occurri.ng tn
the mele g8strotntestinal group.
Durtng the thircl day the
greBtest decreBse occurred 1n tYie female csrc1 iac g'roup,
The
male gastI''Jirltestinal group's pulse be8+: difference remained
the SBme.
Respiration readings of nale cardiac patlents are sh'Jwn
tn Table 14.
TAbIE 14.
RESPlRATICl'l REAi'Il\GS CF NALE ChR~iIl'\.C PF.'l'iEN'l'S
BE..FCB.l~ hND Alt''l'ER NO OR LIIUTED, DIS'l'RF.C'I'n~G, bl\lD FliT lEl\jTCEi'ITERED COMr-lUNICA'l'IOi'o VlI'lb THE NURSE
Patient
Number
1st Day*
Respiratlons
2nd Day@
Respirations
before
hfter
Before
After
1
24
28
24
24
2l}
24
2
20
24
20
20
20
18
J
16
16
16
18
16
16
4
20
20
20
20
18
16
5
20
20
20
20
20
20
6
20
20
20
20
20
20
7
16
16
16
16
16
16
8
16
16
16
16
20
20
20.00
19.00
19.25
Nean
19.00
* 1st
Day-
2nd Day# 3rd Day~
Jrd DaYff
Resptrattons
Before
19.25
no or limited corn~unlcation
distractlng communication
patient-centered communication
After
18 75
-42Mean respiratlon readings for the first day increased
1.0, while an increase of
.25 was noted the second day.
A
sllght dec'rease with patient-centered communication occurred
the thlrd jay.
Table
1~
describes resplratlon rates of female cardiac
patlents for the three days of tnvesttgatlon.
TiiliLE lh.
B.ESPIRhTICN READINGS OF FEI'l}l.LE CARDIAC PA'l'IEi'lTS
BEFORE AhD AF'l'ER .NO OR LIEITlill, DISTIh~CTli·;G, AND PAT IENTCEl'i'l'E,;RED COMMU1\lICi-I.lJ'I:::>N WI'I'H ThE NUIiSE.
Pat lent
l'-lumber
1st Day*
Resptrations
2nd Day'@
Resp1.ratlons
:3rd Dayff
.tiesptretlons
before
Before
hfter
before
After
After
----1
16
16
16
16
18
16
2
20
20
20
16
18
18
:3
20
22
20
20
20
16
4
20
20
20
18
20
16
5
16
18
16
16
16
16
6
16
18
16
16
16
16
7
20
20
20
20
;:>0
16
Nea n
18.00
* 1st Day@ 2nd Day-
11-
:3rr1 Day-
,19 .. 00
18.00
17.40
no or limited communication
nistracting communication
patient-centered communication
18.28
16.29
-43During the first day of communication the mean respiration rate Lncreased 1.0, while decreases occurred during the
second and third days.
A decrease of .60 was noted with dis-
tract ieg comrr.unica t ion a od a decree se of 1. 99 the th ird")day •
desplrat10n rates of male gastrointest1nal patients are
presented in Table 16.
TABLE 16.
RES? lRATION REb.Dn~GS OF' MALE GhSTROI1\j'l'E~TI1"AL
P.,,-'l'Ihi... rr·S BE.FO.:ib iU\iD AFr:I'ER NO OR LIY:I'I'ED, :JIS'l'B.ACTING, A.ND
Pb.'l'I£N~l'-CE~'l'ERED CONj":UN ICATION hI I 'i'rl 'J'hE NURSE
1st Day*
fiespirutions
2nd DaY'g)
Respirations
3rd Day#
Respirations
Before
After
Before
After
Before
.tI.fter
1
16
18
16
16
20
18
2
16
16
16
16
16
16
3
20
24
20
20
20
16
4
16
16
16
16
20
16
5
20
20
20
16
20
20
6
20
20
20
20
20
24
7
20
20
20
20
20
20
18.28
19.14
18.28
Patient
l~umber
i'lean
* 1st Day-
2nd DayIf 3rd IJay@
17.71
no or limited communication
distracting communication
patient-centered communication
19.43
18.59
-44Mean respiration rates for the first day increased .86,
w~ile
decreases occurred the second and third days.
A decrease
of .57 occ'Jrred the second daY,and .84 was the decrease with
patient-centered communication.
Kespirati~ns
of female gastrointestinal patients are
shown tn Table 17.
TABLE 17. .d.ESPIRA'1' I0N riBJ..Dli\GS OF FEhALE GASTROli,TES'1' INAL
Pl-.']' IZN'l'S EEFGRE AJ.\iD J.l.FTER NO OR LHiITED, DIS'l'RP.CTli.l.lG, A~D
Pr.T .iE~\jll'-Cbl\;TErlEU COI-Ilv:UNICATIOl\ 'vIITH TrlE NURSE
Pat lent
l'.umber
1st Day*
Respirations
2nd Day@
Respirations
3rd DaYif
Respirations
before
After
Before
After
before
After
1
16
16
16
16
16
10
2
20
24
20
20
20
20
:3
18
18
16
16
16
16
4
20
16
20
16
20
18
5
20
20
20
20
20
20
6
16
16
16
18
16
16
7
24
24
24
20
24
20
8
16
16
16
16
20
18
I"lean
18.76
18.76
18.50
17.75
19.00
__4 _ _
~·_·.
18.00
-------* 1st Day(rj) 2no Dayfl 3rd Day-
no or limited communication
distracting communication
pa tieDt-centered COIDTI"Un iea t ion
Medn respiration rates remained the same the first day,
but decreased the other two days.
A decrease of .75 occurred
the seconc! day and 1. 0 the t:l ird day was the decrease.
-45Analysis of Data
Data concerning blood pressure read ings of ma Ie carc1iac
patients indicated that stress had increased following no or limited
comlT:un~~cat1.on
by the nurse,
Pulse readings also indicated
stress had lLncreased the first day.
With distracting communication
decreased mean blood pressure, pulse pressure, and pulse readings
indicated stress had been decreased.
pulse pressure, and pulse
readin~s
Decreased blood pressure,
stowed that patient-centered
communication resulted in less stress fer the male cardiac patient.
Female cardiac patients had increased mean blood pressure,
pulse pressure, and pulse readings
followi~g
municatlon, indicating increased stress
cation.
~ith
no or limited comthis type of communi-
Mean blood pressure readings remained stable with dis-
tratting communication but mean pulse pressure and pulse readings
decreased.
This conflicting data was inconclusive in determin-
ing a relati::mship between distracting communication and patients'
stress.
Pa t ient-centered commun tcat ioO with the fema Ie card iac
patients resulted 1n lowered wean blood pressure, pulse pressure,
and pulse readings, indicating decreased stress.
Increased mean blood pressure, pulse pressure, and pulse
readings irldicated
th~"lt
limited or no communicat1.on resulted tn
increased stress for the rna Ie gastrointest tna 1 pat ient.
pulse
press~re
increased with·dlst.;ioacting eommuntcetl.on, but
mean blood pressure readings rema1.ned stable.
decreased.
Nean
Pulse readings
It was concluded that data concerning the relationship
between distracting communication and patient stress was
-46inconclusive.
an increased mean blood pressure reading was
noteo to follow patient-centered comn,untcation, although pulse
readings remained stable.
Pulse pressure mean was also increased
with this type of comrrunicetion.
From the available data it
appears that male ga strointest ina 1 pat ients stud ied foubd pat ientcentered conmunication to be stressful.
A decrease in mean blood pressure and pulse pressure was
ri.oted in the female gastrointestical group.
pressure of this group
tion increased.
fol~o""ing
Yet the mean pulse
the same no or limited communica-
From the data it was not pessible to determine
the effect of no or limited communication on the stress of female
gastrointestinal patients.
Mean pulse pressure and blood pressure
remained stable and were insignificant in oetermining whether
t'l"istracting
communica~ion
increased or decreased patient stress.
Decrea sed mea n pulse read ings 0 id occur
, ind ica t ing tha t d is-
tract tng commun icat ion had poss it: ly lowered the fema le ga stro intest ina 1 group stress level.
cation mean
blo~d
Follo,,! tng pat ient-centered comn!un i-
pressure remained stable, mean pulse pressure
increased, and mean pulse rate decreased.
With this cooflictlng
data it was impCtssible to determine a definite relationship between patient-centered communicattcn and patients' stress.
'l1able 13, wb ich presented the mean pulse beat differences
for the four groups of pat ients, demonstrated that no or 1 in, Hed
communicDttCtn result(d tn increased stress for each group of
patients.
Distr8ctt~g
cornrrunlcation for each group of patients
resulted in decreased stress, while in each group but the male
g&stro1.nteBttnal, patient-centered comrr,unication resulted in
less stress than did distracting communication.
-47-
alth~ugh
the respiration rates of each of the four groups
of patients were presented 1n this paper, in few instances were
the data particularly significant in determining a definite relationship between the type of nurse-patient communication and
the patients' stress.
CHAPTER IV
PIN DINGS Ai\D CONCLUSIONS
Problem and Nethodology
The question the examiner chose to investigate was:
Do
nurse-patient communications in the nursing care of the medical
patient tn the general hospital setting increase or decrease
patients' stress.
Patients' stress was measured by the differ-
ence in blood pressure, pulse, and respirations of patients prl.or
to and following communicatl.on.
An increase in blood pressure,
pulse, or respiration indicated an increase in stress,
Three types of communication were presented to thitty male
and female cardiac and gastrointestinal patients while a bakcrub
was given by the investigator.
No or llmited, distracting, and
patient-·centered cornr!unication were initiated by the investigator,
and blood
pressure, pulse, and respirations were recorded prior
to end following the communication .
.B'ind ings
The findtngs of this investigation included the following:
1.
Iilale card iac patients showed increased stress following no
or limited comrr;unication, decreased following distracting
communication, and decreased folloiAling patient-centered c:;rnmunicat ion.
-4b-
-492.
For female cardiac patients, no or limited commuricstion
caused increased stress, p8ttent-centered communication caused
decreased stress, and data were inconclusive in determlning the
effect of distracting comrrunicatlon.
J.
For male gastrointestinal patients, no or limited communica-
tion resulted in increased stress, patient-centered communicaticn
caused increased stress, and distracting communication data were
inconclusive in determining an effect of this type of communication.
4.
For femE,le gastr:Jiotestinal patients, data for each type of
communication was conflicting, and no definite relationshLp between the COlTJfI'unication by the invest1.gator and the patients'
stress coulct be deterrn1.oed.
5.
1'leao respiration rates for each of the four groups of pa-
tients were not appreicably affected by the type of communication
presented by the investigator.
NO d1.rect relationship between
comr:IUU ica t ion a ad pat lents f stress cou let be determ 1.ued by the
respiration rate data.
6.
julse rate was the most consistent criterion in determining
a rel&tivoshl.p between type of nurse-patient communtcation and
an increase or decrease in stress of the patient.
7.
Data collected on cardiac pattents, both male and ferrlale,
was more consistent in determintng a relationship between type
of nurse-patient communication and an increase or
~ecrease
in
pat ient stress, than were data on ga strcintest ioa 1 pat ients.
-50-
Cone lus tons
It is becoming recognized increasingly that the professional nurse has a major responsibility for determining what type of
nurse-patient communtcation is most effective in reducing patients' stress and meeting the individual needs of patients.
Literature and research which have already been discussed previously in this tnvestigation have shown that a patient's illness and hospitalization are often sources of anxiety for him.
If the nurse is to play a vlta 1 ro Ie in the a lleviat ion of such
stress, she must be able to comrrunicate effectively with the
patient.
Finally, effective teaching of the patient by the
nurse, also presumes tae need for effective nurse-patient
municat ion.
C0ID-
Conc lus ions of th is invest igat ton were the follow-
ing:
1.
Limited or no communtcation by the nurse resulted in in-
creased patient stress.
2.
Data were inadeauate 1.n determining a relationship be-
ti~een
distracting commu(J1.cation initiated by the nurse and an
increase or decrease in pEtients' stress.
3.
Pat tent-centered comn-un iea t ton in it lsted by the nurse re-
sulted in decreased stress of male and female cardiac patients.
4.
Respiration rates were not significant in determining a re-
l~tionship
between the type of nurse-patient communicstion ini-
ti6ted and an increase or decrease in patient stress.
5.
Pulse ra t e was th e most sign if icant c r iter ion in determ
1 (l ing
a relationsht.;:. between type of (lUrse-patient corumun1.catton and
-51an tncrease or decrease in patients' stress.
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-52-
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