Patient's and Family Members Perceptions of Stressors During Hospitalization in a Rural Community

Background: Health care providers are in a strategic position to identify and minimize anticipated stressors that affect patients and family members during hospitalization especially in rural communities. Identifying appropriate interventions to minimize such stressors have the potential to promote effective disease management, meet required educational needs, encourage family participation in the care plan, and overall improve quality of healthcare. Moreover, the current lifestyle mandates having access to phones, IPad, and Wi-Fi during hospital stay may play a major role in decreasing patient and family stress during hospitalization. Lack of recent studies investigated both patients’ and family members’ perception of stressors during hospitalization in rural community, accessibility to technology, and its effects of the client’s health outcomes guided the aims of this study.

Aims: The specific aims of this study are as follows, (1) Identify patient’s and family members perception of stressors during hospitalization. (2) Investigate any significant correlation between subject’s stress perceptions during hospitalization and needs for further education related to health issues process. (3) Update the Environmental Stressors Questionnaire (ESQ) tool developed by Cornock in (1998) to investigate the impact of using phones in bedside and digital healthcare setting effects on participant’s stress perception during hospitalization.

Methods: Descriptive correlational study. IRB approval obtained from the targeted hospital located in South Dakota, United States. Consent forms obtained from subjects. An updated version of the Environmental Stressors Questionnaire (ESQ) tool developed by Cornock in (1998) was used after approval from primary authors with a total score of more than 150 indicates a stressful expereince. The sample included 60 patients admitted to the medical oncology unit, and 50 family members. Data collection dates were from July.2018 to October.2018.

Results: Quantitative results reflected the top five stressors reported by patients (n=60) as follows: “Being in pain” (n=46, mean stress score= 198), “Being unable to sleep” (n=45, mean= 192), “Being restricted by tubes and lines” (n=42, mean=173). “Financial worries” (n=33, mean=168), and “Being unable to fulfill family roles” (n=31, mean=166). On the other hand, the top five stressors reported by family members (n=50) from the perspective of their patient included “Being in pain”, “Being restricted by tubes and lines”, “Not being able to sleep”, “Not knowing the diagnostic lab tests results”, and “Financial worries”. Moreover, this study updated ESQ tool by adding ten survey items focused on the use of technology in hospital setting, this included “Having access to cell phones, iPad, access to Wi-Fi, phone charger, access to TV- movies” and its effects on patient’s stress perception during hospitalization. Qualitative themes for patient’s stressors included: “Being poked several times for blood tests”, “No pain control is achieved”, “Having to wait on test results”, and “Not knowing when to expect things to be done”. Rural community specific theme included the lengthy trip from home to the hospital, and “Ambulance trip to hospital was bumpy”. There was positive significant correlation between the mean stress score (M = 179, SD = 7.33) and patients and their family members need for further education related to disease management (M = 4.7, SD = 1.54, r = .35, p = < .001, n = 90).

Implications for practice: This study has implications related to policy making and healthcare quality improvement aiming to the patient’s satisfaction. The findings of this study can guide the implementation of policies to address the patient’s stressors during hospitalization, including triage protocols, admission protocol, waiting times for diagnostic testing, identifying educational pamphlets or phone apps to inform patients’ and family members’ about the various aspects related to health issues and hospitalization. Moreover, the updated questionnaire will be validated in future studies with more sample size, and have the potential to be used in future studies that focus on the same phenomena.