Present study aimed to compare emergency and elective orthopedic patients concerning emotional states and personality traits. In fact, we hypothesized that identifying patients’ personality and emotional state and therefore, implementing appropriate care facilities, such as protocols, nurse selection and hospital room design, can impact the clinical outcomes of surgery.
According to our results, there was no statistically significant difference in anxiety score between two groups. This finding is supported by Zanardo et al. [11] and in contrast with several previous studies. [7–10] Since our study population came from a public hospital with relatively poor patient mental care and absence of healthcare provider-patient effective interaction, both emergency and elective candidates are affected by lack of information about the course of their condition and management, that consequently made them more susceptible to anxiety. Therefore, no significant difference in the level of anxiety could be expected. Nevertheless, although emergency surgery candidates are introduced to more acute mental pressure, elective patients tend to have plenty of time to develop different reasons for anxiety in mind. These reasons include the uncertainty of the exact day of surgery, concerns about their family, financial loss due to surgery expenses, postop pain, difficult recovery, and fear of different issues such as surgery itself, unknown causes, anesthesia, complications, death, and disability. [10] Thus, a high level of anxiety could also be expected in elective cases.
In the current study, neuroticism was significantly higher in emergency patients. Based on previous studies, neuroticism is correlated with risky driving/cycling behavior (RDBs) while RDBs directly predict the risk of being involved in crash-related conditions. [18, 19] This greater risk explains the higher neuroticism in orthopedic patients who need emergency intervention. Moreover, neuroticism is known to be an integration of genetic, neurobiological, and environmental contributions. [20] Since stress levels were statistically higher in emergency patients in our study, this could play the role of an environmental risk factor to induce the neuroticism trait. According to the results of the present study, there was no statistically significant difference between the groups in terms of extraversion. This finding is supported by previous studies [19, 21, 22] Conversely, some studies found that higher extraversion is associated with more RDBs, traffic accidents, and violations. [23–29]. As stated by Dahlen et al. [22], these disparate findings are clarified by several factors including inconsistent instruments utilized to assess the personality traits, using broader age ranges [27, 29], or exclusively male respondents. [24, 25, 28] Besides, demographics such as gender, age, or distance driven were not controlled in a few of them. [22]
Some of the previous studies [19, 30] support our findings, that the level of conscientiousness was not statistically significantly different between emergency and elective groups. In contrast results of some other studies showed that conscientiousness can negatively predict factors like loss of vehicle control, risky driving, crash involvement, at-fault crashes, not-at-fault crashes, and moving violation tickets that are all related to RDBs. [22, 31, 32] This contrast could be explained in the light of various reasons. First, samples of previous studies were either not matched for gender or too limited to make generalization possible. Second, whereas most of the former studies recruited a peri-teenage population [22, 31, 32], our sample was chosen from an urban area with a relatively young to middle mean age. This makes them more prone to crash involvements than younger drivers, due to more daily activities, regardless of their personality traits. [30] Moreover, Parr et al. found that only in teenage drivers, was conscientiousness associated with more distracted driving [23], and according to Sween et al. conscientiousness is positively associated with higher cell phone risk appreciation scores (CRAS), a measurement designed to assess the risk of talking either on a cellphone or to a passenger while driving. [21] Even so, given the complexity of human behavior and these heterogeneous results, there is a need for multivariate models to predict this association more precisely.
Openness is defined as having traits of creativity and sophistication [22] and is associated with a greater proclivity for adventure, novelty seeking, and social risk-taking. [23, 33–36] According to the current study, there was no statistically significant difference between the groups regarding openness. This is in concordance with a handful of previous studies [19, 36] and contrast to most of them. [22, 30, 31] Considering new regulations for driving-related behaviors, there is evidence for lower openness to be associated with less and delayed rule adherence. [21] In other words, RDBs are potentially increased by lower openness. However, taking this complex association into account, multivariate models seem necessary for a more robust conclusion. Parts of the previous literature [21, 37], support that agreeableness was not different between emergency and elective groups. But some studies found a negative relationship between RDBs and agreeableness. [19, 22, 38–48] The generalizability of much-published research on this issue is problematic, due to non-randomized sampling [22, 37, 40–48] or very specific characteristics of the population such as being students of a single college, institution, etc. [22, 46–48], male/female dominant [22, 37, 40, 41, 44, 46–48], or of limited age ranges. [22, 42–44] In contrast, none of these limitations are found in the present study.
Clinical applicability:
We can hypothesize to implement protocols in medical centers for different caregiver choices and room designs, depending on whether the patients’ condition is emergency or elective. Since patients with higher neuroticism are more susceptible to negative effects of anxiety and depression [49], along with the fact that an interaction of neuroticism trait with a life stressor often results in episodes of anxiety [50], considering patients’ personality and emotional states in the emergency room measures can be of significance. According to John et al. keeping the balance between two sets of factors, helps healthcare professionals control patients’ anxiety. Factors like fear of the unknown treatment process, concern about how their personal and family life will be influenced by their health issues, and death aggravate patients’ anxiety, whereas on the other hand, building trust relationship and supportive environment, interpersonal teaching, and application of flexible approach will have a countereffect. [51] In addition, some previous studies highlighted the importance of factors like proper communication with patients, and providing sufficient information and answers [52] on several issues like the medical assessments and the logic behind them, routines of the ED, who to contact if the situation worsens, triage categorization and its implication, and severity of their condition. [53] Furthermore, we can use words to help patients cope with anxiety and stress. [54] One of the proposed sets of keywords are categorized as an acronym “AIDET”, that stands for Acknowledge, Introduce, Duration, Explanation, and Thank You. [55] The primary role of AIDET words is to keep patients informed and manage their expectations regarding wait time in the ED, as well as to address their pain. [54] The more we keep the patients informed about their treatment and help them feel in control of their disease, the less likely they will be anxious. [56] As well, keeping patients’ information private is critical to making them feel safe and less anxious. [57] Additionally, some studies have found that including nature images and videos in emergency rooms can reduce stress [58], subjective pain [59], and improve mood [60], to the point where some emergency departments have used this. [61]
Present cross-sectional study can be the basis for further longitudinal investigations. Also, findings will be strengthened by larger sample size and applying more objective evaluations, since our data were based on self-report assessments. Additionally, further investigations comparing anxiety and depression in patients before and after surgery, examining factors leading to anxiety and depression, and the effects of anxiety and depression on the results of the operation could be the next steps for the resolution of this issue. As the present study was conducted in one health center in Iran, generalizations should be treated with caution.