Preoperative teaching received and valued in a day surgery setting

Journal of Physical Therapy Education, Spring 2004 by Woodrow, Randi

Bemier MJ, Sanares DC, Owen SV, Newhouse PL Preoperative teaching received and valued in a day surgery setting. AORN J, 2003;77(3):563-4,568-9.

The shift in health care to managed care has resulted in changes in service delivery, with a focus on achieving quality outcomes by cost-effective means. A consequence of this model is the shift of surgical procedures from the inpatient to the outpatient setting, which creates a challenge for providing preoperative teaching within a reduced timeframe, but also an opportunity to develop relevant research in the area of nursing care based on data collection. This article describes studies carried out by perioperative nursing staff at a university-based academic medical center. The two-phase study involved development and psychometric testing of an instrument, and the administration of the validated instrument to evaluate the substantive nature, scope, and value of the preoperative teaching provided to a sample of same-day surgery patients.

A literature review specific to nurse and patient perceptions of valuable preoperative information was conducted. Relevant articles utilized a preoperative teaching questionnaire (PTQ) to survey nurse and patient perceptions regarding types of information valued in preoperative teaching. Following one study, researchers recommended expectations for the postoperative course and home pain management be included in preoperative teaching plans. Another study identified time limitations to provide patient information by 90% of nurses surveyed. In a third study, patients who perceived caring behaviors from nurses experienced less symptom distress and higher functional status postoperatively. Researchers also found that nurses and patients do not always concur on topics that are most important to patients.

The study in this article was conducted in two phases. Phase I involved constructing a tool to measure the nature and value of preoperative teaching for patients undergoing same-day surgery. The PTQ included items from domains including: situational/procedural information, sensation/discomfort information, patient role information, skills training, and psychosocial support. Patients were asked whether they received specific teaching and then rated the value of the teaching for each item. Each item was rated using a I.ikert-type scale. Conlenl experts identified 26 items which were included in the preoperative teaching interview guide (PTIG) which were then rated on two scales, one used to determine whether or not patients received preoperative training and another to determine the value that patients placed on the teaching. In addition, six open-ended questions regarding patient satisfaction with the surgery and the preoperative teaching were developed. Demographic data including gender, race, age, education level, and annual household income was collected on all patients. The sample study included 50 patients who met the inclusion criteria of at least 18 years old, speak English, have undergone no other surgery in the past 2 years, and were discharged home following the surgery. Surgical procedures included in the study were laparoscopic surgery, closed or open reduction of a fractured hand, bimionectomy, excisional biopsy, carpal tunnel release, and cataract extraction.

Data collected at the first postoperative clinic visit was analyzed utilizing the Statistical Package for the Social Sciences (SPSS). Acceptable levels of internal consistency were obtained in the first part of the study and researchers initiated the second phase of the study utilizing an additional 116 participants with the same inclusion criteria. Phase H addressed the substantive research questions regarding the nature, scope, and value of preopcratlve teaching received by day surgery patients. Research questions for Phase II were: What is the nature of the preoperativc teaching that patients received at a large university-based academic medical center before same-day surgery? What preoperative teaching is valued most by patients undergoing same-day surgery? What is the relationship between preoperative teaching received and preoperative teaching valued most by same-day surgery patients?

The relationship between participant demographics and receiving and valuing of preoperative teaching was analyzed. The correlation for preoperative teaching received and preoperative teaching valued was significant. The ratings given for preoperative teaching received were consistent with the results of the open-ended questions regarding information that patients found to be most helpful. To address the relationship between preoperative teaching received and preoperative teaching valued, a canonical variate analysis was performed which demonstrated that teaching received explained a significant amount of teaching valued. This meant that patients may assume mat information may not be important because it was not provided. Income and gender were related to the type of information preferred by participants; patients with lower incomes preferred situational/procedural information more than did those with higher incomes, and men valued psychosocial support more man women.