A prospective, single cohort design was used to: describe the changes over time in symptom distress and functional status experienced by ambulatory surgery patients; determine the relationship between symptom distress and functional status over time; determine the relationship between patient perceived nurse caring behaviors and symptom distress, and between patient perceived nurse caring behaviors and functional status. Preoperative comorbidity was held constant in all analyses. A consecutive sample of 100 consenting adults, ages 18 to 64 years and conversant in English, who had elective ambulatory surgery with regional or general anesthesia, or monitored anesthesia care were recruited to the study from an urban academic medical center, a suburban community hospital, and a suburban teaching hospital. Measurements of symptom distress and functional status were obtained through four verbal interviews. Measurements of patient perceived nurse caring behaviors were obtained for the preoperative and postoperative periods. Symptom distress was measured with the General Symptom Distress Scale, functional status with the Functional Status Questionnaire, and patient perceived nurse caring behaviors with the Caring Behaviors Inventory. Comorbidity was categorized according to the American Society of Anesthesiologists' Physical Status classification. The data analysis plan included descriptive statistics, repeated measures analysis of variance, Pearson correlations, multivariate analysis of variance, and linear regression analyses.

Symptom distress persisted until the seventh postoperative day, especially in the ASA classification III group. Subjects experienced low levels of functional status during the first seven postoperative days, especially in the ASA classification III group. Symptom distress and functional status were inversely related throughout the perioperative period. Symptom distress accounted for a significant amount of the variance in functional status not accounted for by ASA classification. Postoperative patient perceived nurse caring behaviors played a role in decreasing symptom distress on the seventh postoperative day and improving functional status on the fourth and seventh postoperative days.

This examination of symptom distress and functional status in adults following ambulatory surgery, and the role patient perceived nurse caring behaviors plays, extends current empirical knowledge about the relationships between these three variables. Findings from this study provide an important step in building a body of knowledge to direct approaches to design nursing care to improve patient outcomes.