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The Effect of the Perceived Social Support on Surgical Fears of Pregnancy Decision for Cesarean: An Emergency Department Example
Abstract
This study was conducted to determine the effect of perceived social support level of pregnant women who applied to the emergency department on the level of surgical fear they experienced before cesarean section. The sample of the study consisted of 100 women who applied to the emergency department of a training and research hospital between 19.01.2022- 31.03.2022 and were given a cesarean section decision. Data were collected using the Introductory Information Form, the Surgical Fear Scale, and the Multidimensional Scale of Perceived Social Support. Percentage distribution, mean, standard deviation, t test for independent groups, One Way ANOVA and Pearson correlation test were used to evaluate the data. It was found that the mean age of the women participating in the study was 29.38±5.98 years, 43% were primary school graduates, 67% did not work, and 85% lived with a nuclear family. The mean score of the women on the perceived social support scale was 57.30±17.58, and the mean score on the surgical fear scale was 39.23±19.65. There was no statistically significant correlation between the total score of the scale of perceived social support and the total score of the surgical fear scale (r=0.082; p=0.416). It was concluded that the women had a moderate level of fear of surgery, and the perceived level of social support did not affect the fear of surgery. In line with these results, it may be recommended to include training that addresses the possibility and process of emergency cesarean section in childbirth preparation training and carry out studies with larger sample groups.
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High-risk pregnancy increases the morbidity and mortality of the mother and the fetus. Pregnant women under high risks suffer anxiety and stress related to many reasons such as health problems concerning her and the baby, uncertainty, hospitalization and leaving the family. As the pregnancy will be at risk in a high-risk condition, the mother may be anxious in contacting the fetus and the connection can be effected negatively. In pregnancy, high anxiety and weak prenatal attachment, affects the pregnant and fetus’ health negatively. It has been reported that some practices such as social support, listening or singing music/lullaby, yoga and meditation both reduce anxiety and increase prenatal attachment during pregnancy. In the prenatal period, the nurse has many roles such as educator, role model, consultant and resource person in order to cope with the risky conditions of the pregnant woman, to connect with the fetus in a healthy way and to protect her mental health. Nurses have to determine and follow the anxiety and attachment levels of the pregnant, to benefit from evidence based practices to reduce anxiety and increase prenatal attachment by considering the possible harms of anxiety and insufficient maternal attachment on the pregnant and the fetus.
Surgery is a relatively commonplace medical procedure in healthcare settings. The mental health status of the person undergoing surgery is vital, but there is dearth of empirical studies on the mental health status of surgery patients, particularly with regard to the factors associated with anxiety in surgical conditions. This study investigated the roles of religious commitment, emotion regulation (cognitive reappraisal and expressive suppression) and social support in preoperative anxiety in a sample of 210 surgical inpatients from a Nigerian tertiary healthcare institution. A cross-sectional design was adopted. Before the surgery, respondents completed the state anxiety subscale of State-Trait Anxiety Inventory, Religious Commitment Inventory, Emotion Regulation Questionnaire and Multidimensional Scale of Perceived Social Support. After controlling for relevant demographic factors, regression results showed that cognitive reappraisal, social support and interpersonal religious commitment were negatively associated with preoperative anxiety, while expressive suppression was positively associated with preoperative anxiety. The emotion regulation strategies made robust and significant explanation of variance in preoperative anxiety. Appropriate interventions to promote interpersonal religious commitment, encourage cognitive reappraisal and enhance social support quality may improve mental health outcomes in surgery.
Cesarean section (C-section or cesarean delivery) is a life saving surgical procedure for mother and baby when unexpected complications occur during pregnancy or delivery. However, in recent years, current ceseraen section rates in Turkey and in the world are above the medically justifiable level. Over the past 24 years, there has been over %30 increase in cesarean delivery rates in some countries. Turkey was the country with the highest rate of cesarean delivery among OECD countries in 2015. The reasons for the constant increase
in cesarean delivery rates have not yet been fully understood. As well as medical factors, the lack of trust among the physician, the patient and the health system is also influential
in choosing cesarean delivery. Besides, women’s fears and social and cultural beliefs also lead women to cesarean birth. Determining the cesarean section rates, identifying the
reasons for resorting to cesarean delivery and monitoring short and long term results of cesarean births are essential for the development of policies to improve cesarean practices.
ÖZET
Amaç: Bu çalışma riskli gebelerde prenatal bağlanma ve sosyal destek düzeylerinin belirlenmesi amacıyla yapılan analitik tipte bir araştırmadır. Gereç ve Yöntemler: Bu araştırmanın evrenini Konya ili Doğumevi Riskli Gebelik Servisinde yatan tüm gebeler, örneklem grubunu ise gönüllü olarak katılmak isteyen, 18 yaşından büyük, psikolojik sorunları olmayan 82 gebe oluşturmuştur. Veriler, araştırmacılar tarafından oluşturulan sosyodemografik soru formu, Çok Boyutlu Algılanan Sosyal Destek Ölçeği [Multidimensional Scale of Perceived Social Support (MSPSS)] ve Prenatal Bağlanma Envanteri [Prenatal Attachment Inventory (PAI)] ile öz bildirime dayalı olarak toplanmıştır. Bulgular: Gebelerin %32,9'u erken doğum tehdidi, %14,6'sı ağrı, %13,4'ü fetal distres, %12,2'si oligohidramniyoz tanısı %26,8'i ise diğer nedenler (gebelik kolestazı, gestasyonel diyabet, hipertansiyon, intrauterin gelişme geriliği, idrar yolu enfeksiyonu, idrarda protein, kanama vs.) ile riskli gebelik servisine kabul edilmiştir. Gebelerin PBE ortalaması 56,76±9,23 (min=34, max=74), ÇBSDÖ ortalaması 55,34±15,96 (min=21, max=84) olarak bulunmuştur. Gebelerin PAI puanları ile ÇBSDÖ puanları arasında pozitif bir ilişki belirlenmiştir (p<0,05). PAI puanları ile MSPSS alt boyut puanları arasında ilişki bulunmamıştır (p>0,05). Sonuç: Çalışmamızda gebelerin PAI puan ortalamaları ile ÇBSDÖ puan ortalamaları arasında pozitif bir ilişki bulunmuştur. Ancak bu ilişki yüksek düzeyde değildir. Gebelerin aldığı sosyal destek arttıkça prenatal bağlanmanın artması beklenmektedir. Çünkü gebenin; eşinden, ailesinden ve arkadaşlarından sosyal destek görmesi gebeliğin getirdiği değişikliklere, özellikle riskli durumlara uyum sağlamasını kolaylaşmaktadır. Bu bağlamda doğum öncesi bakımda rol alan ebeler, gebelerin sosyal destek ve prenatal bağlanma durumlarını göz önünde bulundurarak bakımı planlayabilirler.
Anahtar Kelimeler: Gebelik, yüksek riskli; sosyal destek; ebelik
ABSTRACT
Objective: This analytical study was aimed to determine the level of prenatal attachment and social support in risk pregnancies. Material and Methods: The population of this research was formed all women who hospitalized in risk pregnancy department of Maternity Hospital in Konya. The sample group was composed of 82 volunteered pregnant women who was older than 18 years and without psychological problems. The self reported data were collected via socio-demographic questionnaire form created by the researchers, the Multidimensional Scale of Perceived Social Support (MSPSS) and Prenatal Attachment Inventory (PAI). Results: The pregnant women hospitalized at the department of risk pregnancy were diagnosed as preterm labour (32.9%), pain (14.6%), fetal distress (13.4%), the diagnosis oligohydramniosis (12.2%), other reasons (intrahepatic cholestasis of pregnancy, gestational diabetes, hypertension, intrauterine growth retardation, urinary tract infection, proteinuria, bleeding, etc.) (26.8%). The mean range of pregnant women?s PAI score was 56.76±9.23 (min=34, max=74), MSPSS score was 55.34±15.96 (min=21, max=84). There was a positive correlation determined between PAI scores and MSPSS scores of pregnant women. There were no correlation between the PAI scores and subscales scores of MSPSS. Conclusion: In this study was positive correlation with PAI and MSPSS mean scores between of pregnant. However, this relationship is not high level. It was expected that when the pregnant women perceived more social support, the prenatal attachment levels become higher. Because perceived social support from husband, family and friends adapt pregnant women to the changes in pregnancy especially risky situations. In this context midwives are taking part in prenatal care, could be planned to take into consideration social support and prenatal attachment status of pregnant women.
ZET Doğum, fizyolojik bir olay olmakla beraber, doğurganlık dönemi kadınlar için psikolojik kaygılar açısından yüksek riskli bir dönemdir. Bu çalışma, vajinal ve sezaryen doğum yapan gebelerde antepartum ve postpartum dönemde durumluk kaygı düzeyinin karşılaştırılması amacıyla yapılan tanımlayıcı bir çalışmadır. Bu çalışma, Ege Üniversitesi Hastanesi Doğumhanesine Ocak-Mart 2012 tarihlerinde vajinal ya da sezaryen doğum yapan 200 kadın alınmıştır. Çalışmada veri toplama aracı olarak sosyodemografik ve doğurganlık bilgileri içeren tanılama formu ve Spielberger Durumluk Kaygı Ölçeği kullanılmıştır. Verilerin analizinde; yüzdelik, t testi, ki-kare ve korelasyon kullanılmıştır. Vajinal doğum yapan gebelerin %45'i 24-29 yaş aralığında olup sezaryen doğum yapan gebelerin %39'u 30-35 yaş aralığındadır. Ayrıca gebelerin %50'si vajinal doğum ve %50'si sezaryen doğum yapmıştır. Gebelerin doğum yöntemine göre durumluk kaygı puan ortalamaları incelendiğinde; vajinal ve sezaryen doğum yapacak iki grupta da antepartum dönemde yüksek kaygı puan ortalaması belirlenirken (sırasıyla X=48.88±11.61, X=46.75±12.32), postpartum dönemde kaygı puan ortalamasının azaldığı saptanmıştır (sırasıyla X=29.20±7.21, X=30.38±7.89). Doğum yöntemi ile antepartum ve postpartum dönemdeki kaygı durumu arasında istatistiksel olarak anlamlı bir fark bulunmamaktadır (p>0.05). Çalışmanın sonucunda, antepartum dönemde kaygının her iki grupta da postpartum dönemdeki kaygıdan daha yüksek olduğu ve vajinal doğum yapanlar ile sezaryen doğum yapanların kaygı düzeylerinin benzer olduğu saptanmıştır. Sağlık profesyonellerine antepartum takipler ve eylem süresince gebe kadınları doğuma hazırlama ve doğum kaygılarının azaltılmasında önemli görevler düşmektedir.
Background
Hospitalization and surgery are critical negative life events that lead to the experience of considerable anxiety in patients. Patients may perceive the day of surgery as the biggest and the most threatening day in their lives. There is paucity of information on predictors of anxiety in the current study area. The main objective of this study is to assess predictors of preoperative anxiety among patients scheduled for surgery in Jimma University Specialized Teaching Hospital.
Methods
A facility based cross-sectional study was conducted using quantitative data collection technique in Jimma University Specialized Teaching Hospital from February 13 to April 13, 2012 on 239 patients scheduled for surgery. The data were collected by five trained diploma nurses using structured interviewer administered questionnaires that were prepared based on state trait anxiety inventory measurement scale. The quantitative data were entered into SPSS for windows version 16. 0 and descriptive, simple and multiple linear regression analyses were performed.
Results
A total of 239 patients were enrolled in the study with a response rate of 93.0%. Their mean age was 42.7 ± 1.8 years (range 16 to 85 years). Nearly over half 53.6% were females, while 48.1% illiterate, 72.4% Oromo and 56.5% were Muslim followers. Significant preoperative anxiety was seen in 70.3% patients. The most common factors that lead to anxiety were fear of death 38.1% and fear of unknown origin 24.3% and the most common strategy mentioned by patient in reducing anxiety were talking to other patient 79.8% and religious belief.
Conclusions
In the present study, two third 70.3% of preoperative patients had anxiety. Factors which were positively correlated with anxiety were trait anxiety, single and divorced, time of operation and income. Factors which were shown to reduce anxiety were preoperative anxiety related information provision and afternoon operation. Health professionals working in the hospital should provide anxiety related information for patients.
Objectives
Because existing instruments for assessing surgical fear seem either too general or too limited, the Surgical Fear Questionnaire (SFQ) was developed. The aim of this study is to assess the validity and reliability of the SFQ.
Methods
Based on existing literature and expert consultation the ten-item SFQ was composed. Data on the SFQ were obtained from 5 prospective studies (N = 3233) in inpatient or day surgery patients. These data were used for exploratory factor analysis (EFA), confirmatory factor analysis (CFA), reliability analysis and validity analysis.
Results
EFA in Study 1 and 2 revealed a two-factor structure with one factor associated with fear of the short-term consequences of surgery (SFQ-s, item 1–4) and the other factor with fear of the long-term consequences of surgery (SFQ-l, item 5–10). However, in both studies two items of the SFQ-l had low factor loadings. Therefore in Study 3 and 4 the 2-factor structure was tested and confirmed by CFA in an eight-item version of the SFQ. Across all studies significant correlations of the SFQ with pain catastrophizing, state anxiety, and preoperative pain intensity indicated good convergent validity. Internal consistency (Cronbach's alpha) was between 0.765–0.920 (SFQ-total), 0.766–0.877 (SFQ-s), and 0.628–0.899 (SFQ-l). The SFQ proved to be sensitive to detect differences based on age, sex, education level, employment status and preoperative pain intensity.
Discussion
The SFQ is a valid and reliable eight-item index of surgical fear consisting of two subscales: fear of the short-term consequences of surgery and fear of the long-term consequences.
Objective: There are contradictory findings in the literature about the effects of delivery type on
postpartum depression and mother–infant interaction. The aim of this study was to investigate the
relationship between delivery mode and postpartum depression, perceived social support, and maternal
attachment.
Method: Forty females, who had vaginal delivery (VD) and 40 females, who had cesarean delivery (CD) were
recruited to participate in the study. Edinburgh Postpartum Depression Scale (EPDS) was used to screen
depressive symptoms and Maternal Attachment Scale (MAS) was used to detect maternal attachment.
Social support was assessed by using Multidimensional Scale of Perceived Social Support (MSPSS).
Results: We found no significant differences in postpartum depression and perceived social support scores
between the two groups. On the other hand, MAS scores were significantly lower in CD women.
Discussion: Our findings support that delivery mode had no impact on the development of postpartum
depression. However CD may have negative effect on maternal attachment.
The development of a self-report measure of subjectively assessed social support, the Multidimensional Scale of Perceived Social Support (MSPSS), is described. Subjects included 136 female and 139 male university undergraduates. Three subscales, each addressing a different source of support, were identified and found to have strong factorial validity: (a) Family, (b) Friends, and (c) Significant Other. In addition, the research demonstrated that the MSPSS has good internal and test-retest reliability as well as moderate construct validity. As predicted, high levels of perceived social support were associated with low levels of depression and anxiety symptomatology as measured by the Hopkins Symptom Checklist. Gender differences with respect to the MSPSS are also presented. The value of the MSPSS as a research instrument is discussed, along with implications for future research.
The author discusses 3 variables that assess different aspects of social relationships—social support, social integration, and negative interaction. The author argues that all 3 are associated with health outcomes, that these variables each influence health through different mechanisms, and that associations between these variables and health are not spurious findings attributable to our personalities. This argument suggests a broader view of how to intervene in social networks to improve health. This includes facilitating both social integration and social support by creating and nurturing both close (strong) and peripheral (weak) ties within natural social networks and reducing opportunities for negative social interaction. Finally, the author emphasizes the necessity to understand more about who benefits most and least from social- connectedness interventions.
This study intended to determine the correlation between elective surgery patients’ degree of
surgical fear and their states of night sleep.
Method: The population of the study included 146 patients who underwent elective surgeries in the
surgery clinics of a university hospital in Turkey between October 2016 and July 2017. The study data were
collected using a personal information form, the Richard-Campbell Sleep Questionnaire (RCSQ), and the
Surgical Fear Questionnaire (SFQ).
Result: The patients' mean score on the Surgical Fear Questionnaire was 42.57±25.40, and on the
RCSQ was 46.90±32.50. There was a strong negative correlation between the subdimension mean scores and
the total mean score on the Surgical Fear Questionnaire (Long Term and Short Term) and the total mean score
on RCSQ (p<0.01).
Conclusion: The researcher suggests that these results should be used to determine an individual’s
level of fear related to upcoming surgery; effective methods for coping with fear should be included in presurgery preparation and training programs.
Keywords: Elective surgery; fear of surgery; sleep
Purpose
Preoperative surgical fear is an emotional reaction that can be observed in many patients who are waiting to undergo a surgical procedure. The Surgical Fear Questionnaire (SFQ) was originally developed to determine the level of fear in patients who are to undergo surgery; this study aims to translate the questionnaire into the Turkish language and to test the validity and reliability of this Turkish version.
Design
Methodological research model.
Methods
The population of this methodological study included the patients who presented to surgical clinics at a university hospital in Turkey between January and August 2016 and were scheduled to undergo elective surgery; the sample involved 405 patients who met the inclusion criteria.
Findings
Results of the analyses showed that the SFQ can be used with two subscales—the S subscale, which shows the short-term consequences, and the L subscale, which shows the long-term consequences of surgery. The mean score of the patients was 18.03 ± 11.44 on the former, 19.52 ± 11.87 on the latter, and 37.55 ± 21.11 for the entire questionnaire. The Cronbach's α coefficient was 0.96 for the SFQ-S subscale, 0.90 for the SFQ-L subscale, and 0.93 for the entire questionnaire.
Conclusions
In this study, the translated SFQ was found to have a similar structure to the original questionnaire and a high level of validity and reliability and therefore can be used in Turkey.
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