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Industry: Email Alert RSS FeedPreoperative teaching received and valued in a day surgery setting
AORN Journal, March, 2003 by Mary Jane Bernier, Dolora C. Sanares, Steven V. Owen, Patricia L. Newhouse
The current shift in health care to managed care models has resulted in a redesign of health care delivery systems, with a focus on achieving quality outcomes by the most cost-effective means. (1) One consequence of managed care models has been the precipitous relocation of surgical procedures from inpatient to outpatient settings. Currently, there are more than 2,500 ambulatory surgery centers in the United States. (2) It has been reported that 65% of surgeries performed in the year 2000 were performed on an outpatient basis, and a 28% growth is expected during the next five years. (3) This trend is evident in traditional health care institutions as well as academic medical centers where the delivery of quality care in an environment of cost containment predominates. For patients, this change from inpatient to outpatient surgery means that they arrive at the hospital on the day of surgery and are discharged the same day to manage recovery at home.
This type of restructured surgical care presents a challenge for providing preoperative teaching in a reduced time frame and for knowing what kind of information will be most useful to patients and family members responsible for postoperative care activities at home. It also provides an opportunity to develop ongoing, evolving research programs in areas of perioperative nursing care that are grounded in patient data. The study presented here provided the foundation and impetus for developing a teaching model and two subsequent studies that used an action research approach to develop specific teaching materials for the preparation of patients undergoing same day surgery.
PURPOSE
This article describes the first in a series of studies conducted or to be conducted by perioperative nursing staff members employed at a university-based, academic medical center. The study reported here involved two phases. In phase one, a methodological study of instrument development and psychometric testing was conducted. Phase two involved administration of the validated instrument to evaluate the substantive nature, scope, and value of preoperative teaching provided to a sample of same day surgery patients at a university-based, academic medical center.
DEFINITION OF TERMS
In this study, the term preoperative teaching describes an interactive process of providing information and explanations about surgical processes, expected patient behaviors, and anticipated sensations and providing appropriate reassurance and therapeutic listening to patients who are about to undergo surgery. Preoperative teaching, therefore, goes beyond the mere provision of information. It involves influencing emotions and attitudes with the intent of altering behavior. Within the framework of this definition, the terms preoperative teaching, patient teaching, and patient education are used synonymously. The term perioperative care refers to "nursing activities performed in the preoperative, intraoperative, and postoperative phases of the patient's surgical experience." (4)
LITERATURE REVIEW
Literature specific to nurse and patient perceptions of valuable preoperative information, nurses' roles in preoperative preparation of same day surgery patients, outcomes of successful postoperative recovery, and patient satisfaction were reviewed for this study. Two studies of nurse and patient perceptions of valued preoperative teaching information conducted in inpatient settings (5) and one study conducted in an outpatient setting with day surgery patients (6) were foundational to this study. All three studies used the 73-item Providence Portland Medical Center, Ore, preoperative teaching questionnaire (PTQ) to survey nurse and patient perceptions about the categories of information that were valued in preoperative teaching. (7) The five categories of the PTQ address content areas consistent with psychoeducational interventions. (8) Specifically, the content areas address information about procedures, events, sensations, self-care actions, skill teaching, and psychosocial support. Meta-analysis has documented the value of psycho educational information in reducing hospital length of stay; medical complications; use of pain, anxiety, and anti-emetic medications; and productive time lost after discharge. (9) Studies examining nurse and patient perceptions about the value of such information are an important link in developing preoperative teaching programs that yield positive outcomes.
One group of researchers asked a sample of 159 RNs working in an acute care, urban hospital to rank the importance of the items on the PTQ and indicate the optimal time for conducting preoperative teaching. (10) In order of importance, the types of perioperative information most valued by nurses were psychosocial support, skills training, situational/procedural information, patient role information, and sensation/discomfort information. The mean rankings for each category ranged from important to very important. Eighty-seven percent of nurses reported that the optimum timing for conducting inpatients' preoperative teaching was after hospital admission but before surgery. In a related study, two researchers compared these same nurse ratings (n = 159) of important preoperative information with rankings from 116 surgical patients. (11) Psychosocial support information was valued most by both groups; however, patients ranked skills training last, and nurses listed it as second in importance. Sensation/discomfort information was ranked last by nurses and next to last by patients.
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