The mode of daytime operation has been proposed firstly by the pediatric surgeon Nichol in 1909. The International Association for Ambulatory Surgery (IAAS) defined the Ambulatory Surgery or Day Surgery as a surgery with admission, operation, and discharge of patients within 1 day (excluded the outpatient operation at the clinic or in the hospital) (1) (http://www.iaas-med.com).
Compared with the mode of traditional hospitalization, the mode of daytime operation has the characteristics of fast pace of work, the short in-hospital stay, and little time to communication with each other (2,3). However, this new mode has been reported that it is more likely for the patients undergoing daytime operation to face the prominent psychological stress response and anxiety, which will affect the recovery of the disease (4,5).
On the other hand, the number of senior citizens has been ascending in the recent years, and cataract, which is the most common ocular disease of the old, is the main cause of blind in the middle aged and elderly people (6). Surgery, the most effective therapy, may make patients nervous, terrified, and dysphoric, because of the dark environment, the surgical stimulation, and the postoperative complications. Furthermore, the poor adaptive capacity and psychological endurance of the aged may affect the effect of the treatment and prognosis (7-11).
In addition, more and more medical dispute was increased, because the length of stay (LOS) of inpatients and the time of communication between medical staff and patients were shortening in the daytime operation. The 37.7% of the complaints were related to the inappropriate behavior, and 11.5% of the complaints were concerned with the poor communication (12). Communication skills training can help reduce the number of complaints. Under such circumstances, medical staff should establish a better relationship with the patients, be fulfilled with the principle of people oriented, cooperate and trust each other.
Therefore, the model of communication called Acknowledge-Introduce-Duration-Explanation-Thank you (AIDET), which is a patient-centered communication tool, has been published by Studer Group of USA in 2006 (13). This mode of communication was performed to lots of medical institutions in the United States, and it was benefit to obtain better achievements by third-party survey. AIDET is a common communication model in American medical institutions, and it is the first letter of the five key words which make up the communication framework: A for Acknowledge, I for Introduce, D for Duration, E for Explanation, and T for Thank you (13). AIDET includes the progress and standard phrases of communication in all respects that it can contribute to improve the experiment of the patients (Table 1) (14). In the previous studies, the AIDET communication mode has reduced the anxiety of patients and improved their satisfaction during the clinical nursing work (13). In order to improve the patients’ satisfaction of all kinds of medical treatment, some of the medical institutions have trained the medical staff with the AIDET communication mode, which can improve the nursing care for patients and their family members (15,16). In addition, the AIDET communication mode has been applied in the maternal care, as well as in the laparoscopic surgery (17,18). Preoperative education and postoperative rehabilitation were combined to relieve the maternal anxiety in the maternal care (17). In the laparoscopic surgery, preoperative was used to increase the experiment of patients for improving the effect of treatment (19). On the other hand, the AIDET communication mode can enhance the initiative of nurses during the multiple complex work based on the research by Edwardson N (17). In china, the AIDET communication mode has been applied. Yue Zhang used the AIDET communication mode in the patients with liver transplantation to adjust the depressive state for conductive to the operation of live transplantation (20). Xiaojing Wang also applied the AIDET communication mode to the patients with hysteromyoma, and he found that the patients’ satisfaction of psychological nursing was significantly higher in the test group with the AIDET communication mode compared with the control group (21). Furthermore, the applications of AIDET communication mode also included alleviating the negative emotions of the elderly parturient, improving the outcome of labor, enhancing the communication effect between nurses and patients during the maintenance of peripherally inserted central catheter (PICC) catheter, and reducing related complications (22,23).
In this study, we applied AIDET communication mode to the nursing service in the daytime operation of cataract, and evaluated its effect.
The 100 cases of cataract undergoing daytime operation from Zhongshan Ophthalmic Center from February to July 2019 were divided into test group and control group. Due to simultaneous operations or patients in the same ward was tended to confuse the information of the two groups, all of the 100 cases were grouped according to the order of admission, and each group had 50 cases which were accorded with the inclusion and exclusion criteria. The 50 cases hospitalized in the earlier time were classified as the test group, while other 50 cases admitted to hospital later were grouped as the control group. The test group in accordance with the AIDET communication mode was performed on admission, pre-operation and post-operation (see Table 1). The control group was given health education and nursing according to the traditional way of communication. Written informed consent was obtained from the donor prior to the study. There were 29 cases of male and 21 cases of female with an average age of (63.52±3.78) years in the test group. In the control group, there were 21 cases of male and 29 cases of female with an average age of (60.43±3.60) years. There was no statistically significant difference in the basic conditions such as education level, living environment, income, medical expenses, and anamnesis between the two groups (P>0.05), showing comparability for two groups.
Inclusion criteria: (I) cataract patients undergoing daytime operation; (II) patients with clear consciousness, and without serious basic disease; (III) voluntary cooperation from patients. Exclusion criteria: (I) personal or family history of mental disorders; (II) patients with non-initial admission to hospital; (III) patients not able to cooperate or unwilling to participate.
Nursing satisfaction questionnaire
The nursing satisfaction questionnaire (Table S1), which was designed by Zhongshan Ophthalmic Center, was used in this study. The content included these following six items: (I) your satisfaction with nurses’ responsibility; (II) your satisfaction with the nurses' service attitude; (III) satisfaction with nurses’ psychological nursing; (IV) your satisfaction with the nurses’ health education; (V) your satisfaction with the nurses’ communicational skills; (VI) your satisfaction with nurses’ communication effect. Each item was scored on a five-point scale: 1–5 points indicate very unsatisfied, unsatisfied, common, satisfied and very satisfied respectively. The total score was 6–30 points. The higher the score, the higher the patients' satisfactions with the nursing care.
Self-Rating Anxiety Scale (SAS)
SAS, which was established by professor Zung, was used in this study (24) (Table S2). It includes 20 items, and each item was graded in 4 classes: 1–4 points mean none or occasionally, sometimes, often, and always respectively; except the item of 5, 9, 13, 17, 19, which were scored reversely. All the 20 items were summed up, and a rough score was received. Then the standard score was obtained by multiplying the rough score by 1.25 and taking the integer part. Based on the Chinese norm results, the standard score was divided into 50 points: 50–59 points were defined as mild anxiety, 60–69 points as moderate anxiety, and above 70 as severe anxiety (24).
The SPSS 19.0 software was used in this study for all of data analysis. The measurement data of normal distribution was showed by (
Comparison between two groups about the socioeconomic information
To avoid the different basic information of patients, which may affect the results of the comparison between two groups, we firstly compared the age, gender, educational level, medical care, living environment, anamnesis, and so on between the test group and the control group. There were 29 cases of male and 21 cases of female with an average age of (63.52±3.78) years in the test group. In the control group, there were 21 cases of male and 29 cases of female with an average age of (60.43±3.60) years. There were 32 cases in the test group with the education of junior high school and below, and 18 cases with senior high school and above, as similar as that 25 cases in the control group with junior high school and below, and 25 cases with senior high school and above (P=0.157). The medical care, including health insurance and self-paying, was also without statistic difference between the test group (n=38 and n=12, respectively) and the control group (n=42 and n=7, respectively) (P=0.308). In addition, the difference between these two groups of living environment and anamnesis also showed no statistical significance (see Tables 2,3).
Comparison between two groups about the nursing satisfaction
In order to solve whether cataract patients were satisfied with the nursing service in different communicational mode, our hospital designed the nursing satisfaction questionnaire. The nursing satisfaction questionnaire was divided into six dimensions, including conscientiousness of nurses, service attitude of nurses, psychological nursing of nurses, heath education of nurses, communication skills of nurses, communication effect of nurses. The results showed that the scores of these six dimensions of the nursing satisfaction in the test group were higher than that in the control group (see Table 4). In addition, the highest score in the test group and control group was both 30, and the lowest score in the test group was 24, while that in the control group was 18 (see Table 5). The score of nurse satisfactions in the test group (28.06±1.50) was significantly higher than that in the control group (26.32±3.14), showing statistically significant difference (P=0.001) (see Table 5).
Comparison between two groups about SAS
In addition, to further figure out if patients showed anxiety in the new mode, we also used the SAS to estimate the degree of anxiety. The rough score of the SAS was graded into 4 groups, including the score of <50, the score of 50–59, the score of 60–69, the score of ≥70. The result showed that the score of 96% cases in the test group was <50, while only 70% cased in the control group had the score of <50. And the SAS in the test group (32.53±5.20) was significantly lower than the control group (42.93±9.78) with the P value of 0 (see Tables 6,7).
In this study, all of the 100 cases were divided into test group and control group according to the order of admission, and the socioeconomic information between the two groups showed no statistical difference (P>0.05), so that it had comparability. We performed the satisfaction of nursing service and SAS to compare two modes of communication.
The nursing satisfaction questionnaire was divided into six dimensions in this study. These results showed that the score was significantly higher in the test group than that in the control group, suggesting that the AIDET communication mode significantly improved the patients’ satisfaction of nurses’ responsibility, psychological nursing, and the effect of communication. In the previous study, the inadequate communication skills of nurses could not only affect the communication with patients, but also the satisfaction of patients (25). Therefore, the medical institutions should improve the quality and communicational skills of nurses (26). The mode of AIDET has eliminated strange sense of patients to the medical environment and staff. In addition, the AIDET mode also increased the patients’ trust to the medical team, and made the patients feel the sincerity and the difficult of the doctors and nurses (27,28). Furthermore, it is helpful for establishing the good relationship of doctor-patient and nurse-patient, and reducing the incidence of dispute between medical staff and patients by friendly greeting, professional introduction, patiently explanation, and heartfelt thanks (21,28).
Cataract is the main cause of blindness and visual impairment in the world. The most effective method for treatment of cataract should be surgery (27). Compared with other researches, the AIDET communication mode in this study was used in daytime operation with cataract, showing the characteristics including short operation time, huge number of surgical patients, mainly of senior citizens, broader age spectrum, and higher expectation of surgery effect. Because of these characteristics in the cataract daytime operation, patients undergoing cataract are more prone to anxiety, and the doctor-patient conflicts are more likely to be developed (27). In this study, the nurse explained to the patients of test group the process of surgery, how to cooperate with the doctor during the operation, and the purpose of each operation, as much detailed as possible. The results of SAS between these two groups showed that the mode of AIDET reduced the anxiety of patients, suggesting that the mode of AIDET had improved the patients’ mastery degree of the cataract-related knowledge, reduced the patients’ anxiety caused by the uncertainty of the surgery, made the patients adjust the negative emotion by themselves, and hold an active and optimistic attitude towards the operation. The patients treated with the mode of AIDET were assured to accept surgical treatment, and cooperated with the nurses to complete the nursing work before and after operation, thereby establishing a healthy model conducive to the recovery of the disease (29). In the study of patients with liver cancer, the AIDET communication mode could reduce preoperative psychological disorders and stabilize patients’ emotions because of the standardized language and flexible propaganda and education (30). As similar as other researches, the AIDET communication mode in this study, which was appropriate for surgery or treatment, was applied to the medical work for alleviating the anxiety of patients and improving patients’ compliance.
Therefore, the AIDET communication mode in the cataract daytime operation in this study, which is applied for the post-operation of patients, can reduce the patients’ anxiety, improve their satisfaction to nursing service, and promote the good relationship of nursing-patient, and can provide the basis for other clinical work.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/aes.2020.03.01). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Written informed consent was obtained from all patients.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
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Cite this article as: Fu K, Li S, Lu S. Application and effect evaluation on Acknowledge-Introduce-Duration-Explanation-Thank you (AIDET) communication mode in cataract daytime operation nursing. Ann Eye Sci 2020;5:12.