READINESS FOR DISCHARGE AFTER TOTAL KNEE REPLACEMENT: EXPLORING PATIENTS’ PERCEPTIONS OF DISCHARGE PREPARATION AND PROVIDERS’ DESCRIPTIONS OF PRE-OPERATIVE EDUCATION

Discharge readiness following total knee replacement (TKR) has often been defined using quantitative factors, such as knee range of motion or walking a specified distance. These measurements fail to include other features that could impact readiness for discharge, such as social support or patient perceptions. Most patients have positive results following TKR surgery, however others experience negative outcomes such as falls, reduced functional performance, and hospital readmission. Readiness for returning home after TKR begins with pre-operative education to prepare patients for surgery and the post-operative phase. Health care providers must have a clear understanding of patients’ perceptions of readiness to return home after surgery. It is also essential to describe the current structure of pre-operative education nationally as a mechanism for better preparing patients to return home following knee replacement. This dissertation includes three studies that explore aspects of discharge readiness following TKR including patients’ perceptions of readiness for discharge as well as the structure of pre-operative education for TKR across the United States. The first study examined patients’ experiences preparing for discharge home from the acute care setting following TKR surgery. Results indicated that patients felt prepared overall for discharge and received appropriate supports for returning home after surgery, but some felt unprepared for certain aspects of recovery such as the amount of pain experienced in the post-operative phase. The second study surveyed health care providers who participated in pre-operative education before TKR to identify the current structure of education programs in the United States. This pilot study revealed that pre-operative education teams were commonly interprofessional with education being typically provided in a group format in a single session lasting between 1 and 1.5 hours. Verbal and written instruction were common delivery methods to provide education. The final dissertation study used mixed-methods to explore the current structure of pre-operative education for TKR in the United States with a large, national sample. Orthopedic nurses completed an online survey to describe their pre-operative education program. The majority of participants provided pre-operative education as part of interprofessional teams in either a group format or a format that included both group and individual education. Verbal instruction was the most common educational delivery method followed by written instruction. Most pre-operative education classes lasted between 1 and 1.5 hours, were delivered in a single session, and included a variety of topics. Ten orthopedic nurses were then interviewed and interview transcripts were analyzed qualitatively for common themes among participants. Participants expressed that pre-operative education was a significant component impacting patient outcomes following surgery. Interprofessional pre-operative education was valued by participants, but pragmatic factors were identified as barriers to the inclusion of other disciplines within these programs. Education programs were constantly evolving based on current evidence-based practice and changes to orthopedic protocols. Descriptions of pre-operative programs nationally combined with providers’ perceptions provides a strong basis for determining best practice to support better post-operative patient outcomes. This dissertation research culminated in recommendations for best practice as well as the creation of a model, the ICF-I-EDUCATE, which combines the International Classification of Health, Functioning and Disability (ICF), interprofessional practice, and the EDUCATE model for providing patient and family education. Research is needed to examine the ICF-I-EDUCATE model in clinical practice for patients with planned TKR

Perfectionism in Occupational Science Students: Occupational Therapy Implications

Purpose The purpose of this study is to categorize perfectionism and determine how perfectionism impacts the occupations and perceived health of students in a Bachelor of Science in Occupational Science program. Design/methodology/approach A descriptive study with a survey component was conducted. Participants were categorized as perfectionists or non-perfectionists using the Almost Perfect Scale-Revised (APS-R). Time logs were collected to compare categories of time-use between groups over a one-week period. An online survey was conducted with a sub-sample of the perfectionists. Findings More students were categorized as perfectionists (N = 41) than non-perfectionists (N = 3). Both groups spent similar amounts of time engaged in productive, pleasurable and restorative occupations. Some perfectionists reported that perfectionism supported health, but others reported negative impacts on well-being. Research limitations/implications This study included a small sample size limited to one Occupational Science program in the USA. Originality/value Results demonstrated positive and negative health impacts because of perfectionism. The majority of participants were identified as perfectionists; rigorous academic programs may attract students with perfectionistic qualities. Findings are relevant for Occupational Therapy, as these students will become future occupational therapists after completing a Master’s program in Occupational Therapy and may be susceptible to negative outcomes associated with perfectionism such as workaholism and poor health

Patient Experiences When Preparing for Discharge Home after Total Knee Replacement

Purpose: Following total knee replacement (TKR), patients must prepare quickly for discharge to home via education and rehabilitation. Patient needs may not fully be met prior to discharge after TKR surgery. The purpose of this descriptive study using transcendental phenomenology methods was to understand patients’ experiences when preparing to return home after TKR surgery. Method: Data was collected using semi-structured interviews that occurred 1 to 2 days prior to discharge in patients’ hospital rooms. Four participants were interviewed prior to discharge and interviews were transcribed verbatim for data analysis. Data analysis and data collection were concurrent, permitting subsequent interviews to be altered as needed based on results from previous participants. Thematic analysis of the interview transcriptions was conducted to identify significant meaning statements through a process of horizonalization. Significant statements were organized into shared themes among participants. Results: Three themes emerged: being supported for discharge home; having confidence in self, family and health care staff; and persevering: overcoming obstacles. Participants overall felt prepared for their surgery and the post-operative phase. The following factors increased readiness for discharge: having prior positive experience with TKR through the experiences of others, attending pre-operative education, interacting with knowledgeable staff, and having the appropriate support at home. Some patients were unprepared for the amount of pain they experienced after surgery. Conclusions/Recommendations: Health care providers should educate patients about safety for the home environment, adaptive techniques for functional tasks, and when to resume normal activities at home. Other implications include encouraging patients to attend pre-operative education, addressing patients’ previous experiences with TKR, both positive and negative, as well as providing realistic information regarding pain after surgery

The Faculty Scholar Role in Peer Review of a Journal Article

Peer review is a process to help ensure publication of high-quality research. Manuscripts submitted for publication are evaluated by others with similar content or methodological expertise, and the feedback is used by editors to determine suitability for publication. Participation in the peer review process may help improve agile teaching as well as contribute to the faculty scholar roles of professional service. This paper describes the process of peer review, including criteria for becoming a reviewer and how to perform a review

The Editors’ Perspective: A Successful First Year of the Journal of Occupational Therapy Education

The Journal of Occupational Therapy Education (JOTE) has enjoyed a successful first year of publication. The inaugural issue was published in April 2017 to coincide with the Centennial for the occupational therapy profession, and we were excited to meet many of our authors and readers at the annual American Occupational Therapy Association Conference in Philadelphia