Preoperative 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

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The lower value rating for items in the sensation/discomfort information subscale was not consistent with the findings of studies described in the literature review. Only 55% of participants in the current study recalled receiving information on the sensation/discomfort information subscale from health professionals as part of preoperative teaching. The absence of teaching in this area may have influenced patients' perceptions about the importance of the information. It may be that patients regard pain management in the immediate postoperative period as a given standard of care, and they may be more interested in other, less familiar information about the surgical experience during preoperative instruction. The reality of sending patients home the same day that surgery is performed, however, means that patients and family members will be dealing with postoperative discomfort on their own. The inclusion of sensation/discomfort information, therefore, would seem to be of higher priority than indicated by patient report of teaching received.

It is difficult to determine why skills training information received the lowest value rating because there was only one item on that subscale. The PTIG question regarding deep breathing received a "yes" rating by only 41% of participants, whereas 75% rated the item as a three or four (ie, more important, very important) in the preoperative teaching valued domain. The practice of teaching deep breathing and including return demonstrations by patients before surgery is a cost-effective way to assist patients in their recovery from the effects of anesthesia and surgery.

The finding that income and gender were related to type of information preferred by participants is interesting. Participants with annual income less than $20,999 preferred situational/procedural information more than participants in higher income brackets. Items in the situational/procedural information subscale tell patients what to expect regarding preparatory procedures and the sequence of events. The roles of health care providers also are clarified in situational/procedural information. It may be that income influences participation in and exposure to various life experiences that influence knowledge of health care systems; therefore, information specific to the surgical situation may be valued most highly by people who lack previous experience with such systems. It is important for nurses to assess patient knowledge, prior experience, interest, and valuing of information as components of preoperative teaching.

The researchers anticipated that there might be gender differences in assignment of value to various preoperative teaching activities. The finding that psychosocial support information was valued differently by males and females was not surprising, but the direction of that difference was unanticipated. The researchers expected females to demonstrate a greater valuing of psychosocial support information. The opposite was true. An example of an item that addressed psychosocial support is "Before surgery, did hospital staff members encourage you to discuss any fears or concerns you had about surgery?" Health care providers who subscribe to societal stereotypes of females as more expressive about their psychosocial needs and males as more stoic and unexpressive may be missing an important opportunity to provide much needed psychosocial support at the time of surgery.