Information provided to surgical patients versus information needed

AORN Journal,  March, 2003  by Siti Zubaidah Mordiffi,  Seo Peng Tan,  Mei Kin Wong

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This study initially focused on the feasibility of implementing preoperative visits because they are considered part and parcel of the practice of perioperative nursing. (1) After extensive review of the literature, however, fundamental questions or issues pertaining to providing preoperative information to patients were unclear. The literature describing the positive outcomes of providing preoperative information to patients abounds. Most studies show that structured preoperative teaching elicits improved patient outcomes. (2) Other studies on preoperative information focus on the timing, (3) single versus group delivery, (4) or method of delivery. (5) In these studies, physiological (eg, respiratory), psychological (eg, anxiety, stress, pain), or general well-being assessments (eg, length of stay, return to normal activities) were used as markers to determine levels of satisfaction and establish the effectiveness of preoperative teaching. Most of these studies compare the merits of one method of providing preoperative information to another.

Providing information to patients is effective, as suggested by the literature; however, does the information given to patients correspond to the information patients want? Many studies are based on the assumptions that having information is good for patients, preoperative information must be given and it simply is a matter of when and how, and preoperative information should be delivered by perioperative nurses based on what information nurses think patients should have and not on what information patients want.

Another assumption of many studies is that nurses and physicians are experts and deliver information they deem important; thus, the fundamental issues of patients' interests and information needs are not addressed fully. Little literature was found that discusses the importance of specific aspects of preoperative information provided in relation to patients' needs. Through the current study, investigators aim to ascertain the information patients want and determine the extent of the information gap.

PURPOSE

This study focused on patients scheduled for elective surgery in an acute care tertiary hospital. Two research questions were asked, including

* what preoperative information do patients receive from health care providers and

* is there a difference between patients' and health care providers' perceptions of whether the information provided is adequate.

The objectives of the study were to

* establish the relative importance of the different kinds of preoperative information given to patients,

* evaluate whether patients are getting the information they want from nurses and physicians,

* evaluate nurses' and physicians' effectiveness in delivering information, and

* evaluate patients' satisfaction with preoperative information provided.

CONCEPTUAL FRAMEWORK

The study is based on human communication models. Three models of human communication describe the process of individuals interacting with each other and relaying and receiving messages. (6) The first of these models describes the linear approach in which a message is relayed unidirectionally from one person to another. An example is the Shannon-Weaver model. In this model, communication is described as a system that requires a source to transmit a message to the receiver via a channel. The receiver interprets the message. In this model, communication may be distorted during transmission and interpretation of the communication. (7)

The second model describes the transactional approach to communication in which each individual involved is both a source and receiver; individuals involved in the interaction affect and are affected by each other. The emphasis in this type of interaction is the attitude and behavior of each individual. How a person behaves will affect the response of the other people involved in the communication. An example is the source, model, channel, and receiver model. (8)

The third model describes the multidimensional approach in which content (eg, information) and relationship (eg, interaction) dimensions exist and are interconnected. More often it is the relationship dimension that determines the interpretation of the message, which affects the outcome of the communication. An example is Leary's model of communication. (9)

Health communication, in general, adopts the multidimensional approach (eg, Leary's model) in which communication is viewed along the lines of dominant-submissive and hate-love dimensions. This view can be applied aptly to the health care setting in which health care providers are viewed as dominant. Within this framework, health care providers should take patients' needs into consideration. Often, however, health care providers use a paternalistic approach to communication. Whatever model health care providers adopt determines the effectiveness of the communication between themselves and their patients.

LITERATURE REVIEW

A review of the literature found only one unpublished report discussing the importance of different kinds of preoperative information provided to patients. (10) Investigators noted that there was not much literature discussing aspects of preoperative information. Five facets of preoperative information were explored in this study, including details of the procedure, preoperative preparation, OR environment, postoperative expectations, and details of anesthesia. The study established that patients regarded information on the details of the procedure and postoperative expectations as most important and information on the OR environment as unimportant. No studies about patients receiving insufficient preoperative information from health care providers were found.