Cognitively Empowering Internet-Based Patient Education for Ambulatory Orthopaedic Surgery Patients

Tiedollista voimavaraistumista tukeva internet-perustainen ohjaus päiväkirurgisille ortopedisille potilaille Tutkimuksen tarkoituksena oli kehittää tiedollista voimavaraistumista tukeva Internetperustainen potilasohjausohjelma sekä arvioida sitä. Tutkimusprosessi jaettiin kahteen vaiheeseen. Ensimmäisessä vaiheessa luotiin sisältö tiedollista voimavaraistumista tukevalle Internet-perustaiselle ohjaukselle päiväkirurgisia ortopedisia potilaita varten. Toisessa vaiheessa arvioitiin Internet-perustaisen ohjauksen (koeryhmä) hyväksyttävyyttä käyttäjien arvioimana ja ohjauksen tuloksia sekä verrattiin Internet-perustaisen ohjauksen (koeryhmä) tuloksia tiedollisesti voimavaraistumista tukevan sairaanhoitajan välittämään ohjauksen (kontrolliryhmä) tuloksiin. Tutkimuksen tavoitteena oli luoda uusi potilasohjausmuoto joka tarjoaa yksilöllisen, osallistavan ja aikaan ja paikkaan sitomattoman ohjauksen päiväkirurgiseen ortopediseen leikkaukseen tulevalle potilaalle. Tutkimuksen ensimmäisessä vaiheessa käytettiin kuvailevaa ja vertailevaa tutkimusmenetelmää (ennen ja jälkeen testaus). Tutkimukseen osallistui 120 päiväkirurgista ortopedista potilasta joiden tiedon odotuksia ja heille välitettyä tietoa tarkasteltiin. Tutkimuksen ensimmäisen vaiheen tuloksien ja aikaisemman voimavaraistumista käsittävän tiedon perusteella luotiin sisältö tiedollista voimavaraistumista tukevalle Internet-perustaiselle ohjaukselle. Sisältö rakentui voimavaraistavan tiedon kuudesta eri osa-alueesta. Tutkimuksen toisessa vaiheessa käytettiin randomoitua kokeellista tutkimusasetelmaa. Päiväkirurgiseen ortopediseen leikkaukseen tulevat potilaat randomoitiin koeryhmään (n=72) Internetperustaiseen ohjaukseen ja kontrolliryhmään (n=75) sairaanhoitajan välittämään ohjaukseen. Aineisto kerättiin strukturoitujen mittareiden avulla ja tulokset analysoitiin tilastollisesti. Tutkimuksen tulokset osoittavat, että kehitettyä tiedollisesti voimavaraistumista tukevaa Internet-perustaista potilasohjausmenetelmää voidaan suositella käytettäväksi ortopedisten päiväkirurgisten potilaiden ohjauksessa ja potilailla on hyvät mahdollisuudet voimavaraistua tiedollisesti sen avulla. Monipuolista tietoa sisältävä Internet-perustainen ohjaus osoittautui käyttäjien näkökulmasta hyväksyttäväksi. Vaikka Internet ohjauksen hyväksyttävyys koettiin osittain heikommaksi kuin sairaanhoitajan välittämän ohjauksen, potilaat käyttivät nettisivustoa ongelmitta ja arvioivat sen helppokäyttöiseksi. Ohjausmuodolla ei ollut vaikutusta hoidosta aiheutuneisiin kustannuksiin. Sen sijaan kustannuksista organisaatiolle voitiin puolittaa sairaanhoitajan ohjaukseen käyttämä aika Internet-perustaisen ohjauksen avulla. Internet-perustaiseen ohjaukseen osallistuneiden potilaiden tiedon taso ja kokemus tiedon riittävyydestä lisääntyivät ohjauksen jälkeen enemmän kuin sairaanhoitajan välittämään potilasohjaukseen osallistuneiden potilaiden tiedot. Ohjausmuodolla ei ollut vaikutusta potilaiden kokemien tunteiden ja oireiden voimakkuuteen. Yhteenvetona voidaan todeta, että tiedollisesti voimavaraistava Internet-perustaista ohjausta voidaan suositella vaihtoehtoiseksi menetelmäksi sairaanhoitajan välittämälle ohjaukselle päiväkirurgiseen ortopediseen leikkaukseen tuleville potilaille.The aim of this study was to create and evaluate an Internet-based patient education programme aiming to cognitively empower ambulatory orthopaedic surgery patients. The research process was divided into two phases. In Phase I, the purpose was to create the content for cognitively empowering Internet-based patient education for ambulatory orthopaedic surgery patient care. In Phase II, the purposes were: to evaluate cognitively empowering Internet-based patient education (experiment group) user acceptance and the outcomes of this education, and to compare the outcomes of cognitively empowering Internet-based patient education to the outcomes of cognitively empowering face-to-face education (control group). The ultimate goal of this study was to create a new type of cognitively empowering patient education intervention which offers an individualized and engaging method that is free of time and place for patients having ambulatory orthopaedic surgery operations. In Phase I, we used a descriptive comparative cross-sectional study (pre- and post-test) design and 120 consecutive ambulatory orthopaedic surgery patients evaluated their perceptions of their knowledge expectations and their received knowledge. On the basis of the results of this study, as well as earlier research knowledge on empowerment, we created a website to support the cognitive empowerment of an ambulatory orthopaedic patient. The content of the website is multidimensional. In Phase II we evaluated the programme using a randomized controlled trial. Elective ambulatory orthopaedic surgery patients were randomized to either an experiment group (n=72) receiving education through a website or to a control group (n=75) receiving face-to-face education with a nurse. We collected the data at the two phases of the research with structured instruments and analysed it using statistical methods. This study showed that patients’ possibilities to become cognitively empowered can be increased with the help of cognitively empowering Internet-based patient education. Users accepted the website that included multidimensional knowledge. Thus, the utility of cognitively empowering Internet-based patient education was partially lower than cognitively empowering face-to-face patient education; patients used the website without any problems and evaluated it as easy to use. There were no differences between the out-of-pocket costs of education. However, the nurses saved time when using the cognitively empowering Internet-based patient education. This study also showed that cognitively empowering Internet-based patient education increased patients’ knowledge level and their sufficiency of knowledge more than did face-to-face education. Patients’ experiences of their emotions and intensity of symptoms did not differ between the education groups. In summary, cognitively empowering Internet-based patient education can be recommended as an alternative to the face-to-face education method for ambulatory orthopaedic surgery patients.Siirretty Doriast

Day surgery nurses' selection of patient pre-operative information

Aims and Objectives: To determine selection and delivery of pre-operative verbal information deemed important by nurses to relay to patients immediately prior to day surgery. Background: Elective day-case surgery is expanding, patient turnover is high and nurse/ patient contact limited. In the brief time-frame available, nurses must select and precisely deliver information to patients, provide answers to questions and gain compliance to ensure a sustained, co-ordinated patient throughput. Concise information selection is therefore necessary especially given continued day surgery expansion. Study Design: Electronic questionnaire. Methods: A survey investigating nurses’ choice of patient information prior to surgery was distributed throughout the United Kingdom via email addresses listed on the British Association of Day Surgery member’s website (Jan 2015 - Apr 2015). Results: Participants were requested to undertake the survey within 2 to 3 weeks with n=137 completed giving a 44% response rate. Verbal information deemed most important by nurses pre-operatively was checking fasting time, information about procedure/ operation, checking medication, ensuring presence of medical records/ test results and medical investigations checks concluded. To a lesser extent was theatre environment information, procedure/ operation start time and possible time to discharge. Significant differences were established between perceived importance of information and information delivery concerning the procedure/ operation and anaesthesia details. Conclusion: Nurses working with competing demands and frequent interruptions, prioritised patient safety information. Although providing technical details during time-limited encounters, efforts were made to individualise provision. A more formal plan of verbal information provision could help ease nurses’ cognitive workload and enhance patient satisfaction. Relevance to clinical practice: This study provides evidence that verbal information provided immediately prior to day surgery may vary with experience. Nurse educators and managers may need to provide greater guidance for such complex care settings as delivery of increasingly technical details during brief encounters is gaining increasing priority

Pain Coping Skills Training for Patients Who Catastrophize About Pain Prior to Knee Arthroplasty: A Multisite Randomized Clinical Trial

BACKGROUND: Pain catastrophizing has been identified as a prognostic indicator of poor outcome following knee arthroplasty. Interventions to address pain catastrophizing, to our knowledge, have not been tested in patients undergoing knee arthroplasty. The purpose of this study was to determine whether pain coping skills training in persons with moderate to high pain catastrophizing undergoing knee arthroplasty improves outcomes 12 months postoperatively compared with usual care or arthritis education. METHODS: A multicenter, 3-arm, single-blinded, randomized comparative effectiveness trial was performed involving 5 university-based medical centers in the United States. There were 402 randomized participants. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Scale, measured at baseline, 2 months, 6 months, and 12 months following the surgical procedure. RESULTS: Participants were recruited from January 2013 to June 2016. In 402 participants, 66% were women and the mean age of the participants (and standard deviation) was 63.2 ± 8.0 years. Three hundred and forty-six participants (90% of those who underwent a surgical procedure) completed a 12-month follow-up. All 3 treatment groups had large improvements in 12-month WOMAC pain scores with no significant differences (p > 0.05) among the 3 treatment arms. No differences were found between WOMAC pain scores at 12 months for the pain coping skills and arthritis education groups (adjusted mean difference, 0.3 [95% confidence interval (CI), -0.9 to 1.5]) or between the pain coping and usual-care groups (adjusted mean difference, 0.4 [95% CI, -0.7 to 1.5]). Secondary outcomes also showed no significant differences (p > 0.05) among the 3 groups. CONCLUSIONS: Among adults with pain catastrophizing undergoing knee arthroplasty, cognitive behaviorally based pain coping skills training did not confer pain or functional benefit beyond the large improvements achieved with usual surgical and postoperative care. Future research should develop interventions for the approximately 20% of patients undergoing knee arthroplasty who experience persistent function-limiting pain. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence

Pain Management Strategies in Hand Surgery.

Modern anesthetic agents have allowed for the rapid expansion of ambulatory surgery, particularly in hand surgery. The choice between general anesthesia, peripheral regional blocks, regional intravenous anesthesia (Bier block), local block with sedation, and the recently popularized wide-awake hand surgery depends on several variables, including the type and duration of the procedure and patient characteristics, coexisting conditions, location, and expected length of the procedure. This article discusses the various perioperative and postoperative analgesic options to optimize the hand surgical patients\u27 experience

Knowledge expectations of surgical orthopaedic patients: a European survey

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern (Finland, Iceland, Lithuania and Sweden) and Southern Europe (Cyprus, Greece and Spain). The aim was to analyse associations between expected knowledge and background factors. The data were collected from European arthroplasty patients with the Knowledge Expectations of hospital patients- scale, (KE(hp) - scale), including bio-physiological, functional, experiential, ethical, social and financial dimensions. Patients had essential bio-physiological and functional knowledge expectations. Women expected more than men, employed less than retired, unemployed or who worked at home. Generally, patients in Northern countries expected more than in Southern countries. However, highest expectations were found in Sweden and Greece, lowest in Spain and Cyprus. There are differences in knowledge expectations based on patients' backgrounds. Development of common standards in European patient education needs further research

The influence of a preoperative information brochure on the experience of patients undergoing awake surgery in private hospitals

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2018.Undergoing surgery without having general anaesthesia has become an option for many surgical patients. Awake patients are able to communicate with the surgical team which allows the surgical team to gain understanding of the patient’s experience. This is an important aspect of perioperative care and is in line with the theory of Human Becoming according to Parse, (2011). Literature suggests that patients who have received information preoperatively about their planned perioperative journey experience less anxiety and fear relating to their surgery. The purpose of this study was to explore the perioperative experiences and needs of patients undergoing awake surgery. A qualitative exploratory descriptive three step design of data collection was implemented for this study. In step one an integrative review identified patient experiences of the perioperative journey. The literature was critically analysed for relevance and inclusion. This information formed the basis for inclusion in step two. Step two explored the perioperative experience of participants who had undergone awake surgery by interviewing a group of participants using interviews and probe questions extracted from the literature. The information gleaned from the interviews was grouped for content similarity and was used to create an information pamphlet which informed participants about their perioperative journey. In step three the information pamphlet was handed to participants preoperatively and the same participants rated the usefulness of the information pamphlet postoperatively by answering a dichotomous question. Participants had the opportunity to add comments. The population for this study was all patients who were scheduled for ophthalmic, orthopaedic, urological or plastic, surgery using awake surgery in four large private hospitals in Gauteng and Mpumalanga. Patients younger than 18 years of age as well as those receiving sedation or general anaesthesia were excluded from the population. This study showed that participants had positive experiences of being awake during surgery. A number of participants found the experience of being awake during surgery interesting and enjoyed being able to ask questions and participate in dialogue. Participants rated the information pamphlet as useful. Two areas of concern was elicited, namely communication and nursing care within the operating theatre environment. The objectives for this study were met. Key words: perioperative journey, awake surgery, regional and local anaesthesia, nursingLG201

Empowering education in surgical care of patients with spinal stenosis

Patients undergoing surgery for lumbar spinal stenosis have many preoperative educational expectations due to the complexity of the care pathway. Although empowering patient education (EPE) has proven effective in many patient groups, no previous literature exists on its use in spinal stenosis patients. The purpose of the present study was (A) to describe the use of knowledge tests in patient education, and (B) to assess the impact of a specific patient education intervention on the empowerment of patients undergoing surgery for lumbar spinal stenosis. The aim was to improve the quality of patient education in this patient group. In this randomised controlled double blinded clinical trial, 100 spinal stenosis patients were randomised into either the intervention group (IG) or the control group (CG). The intervention (Knowledge Test Feedback Intervention, KTFI) was conducted on an average 9 days before surgery, and consisted of an empowering telephone discourse based on a specifically designed knowledge test (KNOWBACK Test). Primary outcome variables were (A) preoperative knowledge level (cognitive outcome), and (B) preoperative anxiety (clinical outcome). As secondary outcomes, verbal and visual understanding of the surgical procedure as well as health-related quality of life (HRQoL), disability and pain were measured. The data were gathered at admission to hospital, at discharge, and at three and six months after surgery. A significantly higher preoperative knowledge level was noted in the IG compared to the CG. Preoperative anxiety reduced more in the IG than in the CG, but there was no statistically significant difference between the study groups at any of the measuring time points. Verbal and visual understanding of the surgical procedure increased in both study groups during follow-up with no significant differences between the groups. Similarly, HRQoL, disability and pain improved in both groups after surgery; the differences between the groups were not statistically significant. In conclusion, empowering knowledge feedback was an effective preoperative patient education method in increasing the patients´ knowledge level. Our results suggest that it may reduce preoperative anxiety. However, this finding did not reach statistical significance between the two study groups. The increased knowledge level was not reflected in the clinical outcome of surgery.Spinaalistenoosileikkaukseen tulevien potilaiden voimavaraistumista tukeva potilasohjaus Lannerangan spinaalistenoosileikkaukseen tulevilla potilailla on runsaasti tiedollisia odotuksia hoitopolun moninaisuudesta johtuen. Vaikka voimavaraistumista tukeva potilasohjaus on osoittautunut tehokkaaksi useissa potilasryhmissä, sen käytöstä selkäleikkauspotilailla ei juurikaan ole tutkimustietoa. Tutkimuksen tarkoituksena oli (A) selvittää tietotestien rooli potilasohjauksessa ja (B) arvioida tätä tutkimusta varten suunnitellun potilasohjausmenetelmän (Tietotesti-Palaute -Interventio, TTPI) vaikutusta spinaalistenoosipotilaan voimavaraistumisprosessiin sekä kognitiivisten (tiedon taso ja toimenpiteen ymmärtäminen) että kliinisten tulosmuuttujien (preoperatiivinen ahdistus, elämänlaatu, toimintakyky ja kipu) kautta. Tässä satunnaistetussa kontrolloidussa kaksoissokkoutetussa kliinisessä tutkimuksessa 100 spinaalistenoosileikkaukseen tulevaa potilasta satunnaistettiin joko interventio- tai kontrolliryhmään. TTPI toteutettiin keskimäärin 9 päivää ennen suunniteltua leikkausta ja se koostui puhelimitse toteutetusta voimavaraistumista tukevasta keskustelusta. Keskustelu pohjautui potilaan täyttämään tätä tutkimusta varten kehitettyyn tietotestiin (KNOWBACKtesti). Primaaritulosmuuttujina käytettiin (A) voimavaraistumista tukevan tiedon tasoa (kognitiivinen tulosmuuttuja) ja (B) leikkausta edeltävän ahdistuksen tasoa (kliininen tulosmuuttuja). Sekundaarisia tulosmuuttujia olivat toimenpiteen ymmärrys verbaalisesti ja visuaalisesti kuvattuna, elämänlaatu, toimintakyky ja kipu. Tietoa kerättiin potilailta sairaalan tullessa ja sieltä kotiutuessa, sekä kolmen ja kuuden kuukauden kuluttua leikkauksesta. Interventioryhmässä todettiin tilastollisesti merkittävä voimavaraistumista tukevan tiedon tason nousu. Leikkausta edeltävä ahdistus lieveni merkittävästi koeryhmässä, mutta tutkimusryhmien välillä ei missään vaiheessa todettu merkittävää eroa. lievittyminen kontrolliryhmään verrattuna. Kirurgisen toimenpiteen verbaalinen ja visuaalinen ymmärrys parani kummassakin tutkimusryhmässä seurannan aikana. Elämänlaadussa, toimintakyvyssä ja kivussa todettiin merkittävä parantuminen kummassakin ryhmässä, mutta ryhmien välillä ei ollut tilastollisesti merkittäviä eroja. Johtopäätöksenä voidaan todeta, että TTPI paransi potilaiden voimavaraistumista tukevan tiedon tasoa ja mahdollisesti lievitti preoperatiivista ahdistusta. Leikkauksen kliiniseen lopputulokseen tällä ei kuitenkaan vaikuttanut olevan merkitystä

Patient Perceptions Regarding Outpatient Hip and Knee Arthroplasties

Background There has been increasing interest in outpatient total joint arthroplasty (TJA) in the orthopedic community, but how patients feel about outpatient TJA is unknown. The purpose of this study was to understand patient perspectives on hip and knee replacements performed in an outpatient setting. Methods We surveyed 110 consecutive patients scheduled for primary TJA in an academic suburban arthroplasty practice regarding their knowledge and perceptions of outpatient TJA. Questionnaires were administered during preoperative clinic visits before discussion of surgery location, length of stay, and before preoperative joint replacement education. Results Fifty-seven percent of respondents were female, and 42.7% were aged 65 years or older. Very few patients expected same-day discharge (n = 3) or a one night stay in the hospital (n = 17). Fifty-four percent of patients were expected to stay in the hospital two or more nights. Only 54.5% of patients were aware that outpatient TJA is an option, with 55.3% of men and 31.7% of women reporting that they were comfortable with outpatient TJA (P = .030). In contrast, 61% and 72.8% believed that faster recovery and decreased likelihood of infection are likely advantages of outpatient TJA. Interestingly, 51.9% felt ambulatory surgery centers are as safe as hospitals, and 62.6% believed that home is the best place to recovery from TJA. Conclusion These observations suggest that there is need for patient education regarding outpatient TJA. As outpatient procedures become more common, it is essential that patients understand the ambulatory surgery process, the benefits and risks of same day discharge, and their role in a successful outpatient experience