ArticleLiterature Review

The impact of preoperative education on postoperative pain. Part 2

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Abstract

The second of this two-part article examines the impact of preoperative education on postoperative anxiety, pain and recovery. The first part (Oshodi, 2007) explored the general concept of preoperative education. Surgery can be physically and psychologically stressful for patients. It is hypothesized that education before surgery reduces anxiety and enhances postoperative outcomes. This article critically reviews some of the published research in this field since 1994 through a rigorous methodology to evaluate the impact of preoperative education on postoperative outcomes. Despite inconsistencies in the evidence, the studies all point to the fact that preoperative education is beneficial to adult surgical patients. Based on the evidence presented, implications for nursing are discussed and recommendations for practice are made.

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... Statistical analysis showed that the total degree of the respondents toward the booklet was high (mean = 4,21) The highest percentages of agreement were that drawings helped to understand the information (mean 4,8). Regarding DVD impact statistical analysis showed that the total degree of the respondents toward watching the DVD was very high (mean = 4,47). ...
... They found that the majority of the patients were positive about the programme and were empowered to take control of anxious situations in their lives. Moreover the critical review by Oshodi aimed to analyze and discuss published research in the effect of preoperative education on postoperative outcomes such as pain, anxiety and recovery since 1994, he found that all studies reported one or more statistically significant effect in the outcome measures and all support the use of preoperative education [4]. while ...
... This study was also interested in exploring the impact of booklet and DVD on CABG patient's in the intervention group and their ability to deal with the problems they may face during the recovery period while they were at home. The analysis of these results revealed that the DVD and the booklet had a high positive impact on patients in the intervention group regarding all items (DVD mean [4,36] and booklet mean [4,21]. Obviously the impact of DVD was higher than the impact of booklet in most of the items, for example 80% of patients mentioned that watching DVD was extremely easy while 72,5% of patients mentioned that booklet was easy a lot. ...
Article
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Abstract Background: Quality of life (QoL) has emerged as an important concept and outcome in health and health care. Aims and Objectives: The aim of this study was to determine the effectiveness of the health education program to improve QoL of patients with coronary artery bypass graft surgery (CABG) and to reduce the problems encountered after discharge. The objectives were to help patients to develop healthy behavior s to deal properly with the problems caused by the disease and to enhance their QoL after discharge. Design: The study was clinical trial with experimental correlation design. Methods: Hundred and sixty patients were included in this experimental study and divided into two groups as; the intervention group (n = 80) and the control group (n = 80). Patients in the intervention group were given planned educational program of booklet and DVD by the research nurse beginning from hospitalization and reinforced at discharge, while the patients in the control group did not receive planned educational program other than the ordinary verbal instructions. The patient data were collected using the”Personal Information Form”, “The Home Follow-Up Form after Discharge” and “SF-36 Health Survey” and “effectiveness of the educational program. The forms were used for data collection before and after intervention. follow up after discharge was provided within three intervals; 2 days, 10 days and one month after discharge. Results: It was found that the mean QoL scores of the patients in the intervention group were higher than in the control group one month after discharge, significant difference was observed between the intervention and control group in all QoL domains (p < 0,05). Conclusion: The educational program that consists of booklet and DVD given to CABG patients in the intervention group had a positive impact on the QoL of these patients and on alleviating the problems they encountered. Keywords: Patient Educational; Quality of Life; Discharge Problems; Coronary Artery Bypass Graft Surgery
... Moreover, Preoperative nonpharmacological interventions for patients suffering from traumatic limb injuries may be necessary to prepare them for the surgical procedures, and for the recovery period in advance (McDonald, Hetrick& Green 2004). Patients, who are more knowledgeable about what to expect after surgery, and have an opportunity to express their goals and opinions, often cope better with postoperative pain, and anxiety (Oshodi 2007). ...
... Some patients want as much information as possible. While, other patients prefer only a minimal information because too much knowledge may increase their anxiety (Oshodi 2007). Furthermore, patients have different abilities to comprehend medical procedures; some prefer printed information or watch the videotape, whereas, others learn more from oral presentations. ...
Article
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Patients with traumatic limb injury differ from orthopaedic patients having elective surgery as they are already in pain, and have high levels of anxiety and stress of many aspects that may change their life such as unexpected complications, negative outcomes, changes in body image, diminished self-esteem. Also, uncertainty about their physical status, for example, having a disability that may affect their productivity, or make them unable to perform their responsibilities, Therefore, patients with traumatic limb injuries require specific care for their pain.
... [11,12] One of the strategies designed to reduce postoperative complications and disability is preoperative patient education. [13] Anatomical and biomechanical explanations are usually used in preoperative education, aiming at increasing patients' knowledge level and reducing their surgical anxiety, postoperative pain, and length of hospital stay. ...
... In addition to non-steroidal anti-inflammatory drugs, muscle relaxants, antidepressants, and antiepileptics, perioperative rehabilitation programs are also frequently used for the prevention of postoperative pain. [30,31] Perioperative rehabilitation is usually enhanced with some type of education as a conceivable strategy to improve surgical success [13] and a survey study reported that many surgeons provided some of education form of education to their patients before they underwent surgery for LR. [32] The education mainly covers anatomical and biomedical topics in the previous preoperative education studies and such educational form seems to be ineffective, when patients are still experiencing pain and disability. ...
Article
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Objectives: This study aims to investigate the postoperative short-term effectiveness of preoperative pain neurophysiology education on pain severity, kinesiophobia, and disability in patients undergoing lumbar surgery for radiculopathy. Patients and methods: Between April 2019 and August 2019, a total of 41 patients (22 males, 19 females; mean age 52.1±9.5 years; range, 37 to 64 years) scheduled for lumbar radiculopathy surgery were randomized to receive either preoperative routine education only (control group, n=20) or a 70-min pain neurophysiology education in addition to preoperative routine education (intervention group, n=21). The patients were evaluated for the following outcomes prior to surgery (baseline) and at 12 weeks after surgery: low back pain and leg pain using Numeric Pain Rating Scale, disability using Oswestry Disability Index), and kinesiophobia using Tampa Scale for Kinesiophobia. Results: There were no statistically significant differences in low back pain (p=0.121), leg pain (p=0.142), and the length of stay hospital (p=0.110) between the groups. However, the interaction effects of intervention group were superior to control group regarding disability (p=0.042) and kinesiophobia (p<0.001). Conclusion: The addition of pain neurophysiology education to routine education following lumbar radiculopathy surgery yields significant improvements for disability and kinesiophobia, although no additional benefits is seen regarding the pain severity and length of stay in hospital in the short-term.
... Also, reducing social and health costs. (8) Furthermore, nursing professionals are trained to educate patients in the control and management of pain. We know that one of the obstacles to manage effectively post-surgical pain is the patient's lack of knowledge or misunderstandings. ...
... (24) The studies included analyzed the effectiveness of different educational interventions aimed at the management and relief of post-surgical pain. In this sense, some of the studies analyzed the effectiveness of educational interventions online, (1,3) others on educational interventions aimed at managing pain and anxiety; (2,4,5,7) certain studies inquired on the relationship between knowledge on the consumption of opioids and the pain management, (6,8,10,11) while others analyzed the effectiveness of an educational intervention in ambulatory surgery (22) or the relationship between pain and post-surgical rehabilitation. (12) Furthermore, certain heterogeneity was found regarding the types of interventions used in the studies, finding the following interventions: educational interventions based on the delivery of graphic material, (15,17,19,22,25) use of audiovisual material and new technologies (14,16,24,25) as support to the educational intervention and interventions based on informative talks. ...
Article
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Objective. Analyze and integrate studies that inquire on the benefits of nursing educational interventions to manage post-surgical pain. Methods. A systematic search was conducted in the databases of Scopus, Medline (Pubmed), Web of Science, The Cochrane Library, and CINAHL of systematic reviews, randomized clinical trials, and quasi-experimental studies published in English and Spanish until 2018 that analyzed the effectiveness of educational interventions in managing post-surgical pain in adult patients. Results. Twelve studies complied inclusion criteria, of which nine reported less pain in the group receiving the educational intervention. These interventions also helped to diminish the level of anxiety and improved functionality to perform activities of daily life. The level of quality of the studies was medium. Conclusion. Although the review showed that nursing educational interventions could influence on the relief of post-surgical pain, more rigorous studies are necessary, with bigger sample sizes and higher methodological quality, which help to establish the real effectiveness in managing post-surgical patients with pain.
... A review concluded that pre-operative education is beneficial for patients. 13 A randomized control trial reported that pre-operative information from nurses could significantly improve patients postoperative comfort and the patients' quality of life. 14 For patients with total laryngectomy, it is recommended that pre-operative education includes education regarding wound care, nasogastric feeding, oral care, and airway management. ...
... A no was allocated to criteria 2 if patients answered "totally unknown" in 3 or more than 3 items. Item 7,8,9,11,13,14, 15 is focused on the basic knowledge and skills of wound care, oral hygiene, airway management and body-image changes. A no was allocated to criteria 4 if the patient replied totally unknown to one of the above 7 items and mentioned the nurse hadn't informed it. ...
Article
BACKGROUND Pre-operative assessment and education plays an essential part in perioperative nursing practice. Due to the clinical consequences of total laryngectomy, sufficient pre-operative assessment and education would improve patient’s post-operative journey. OBJECTIVES The aim of this implementation project was to integrate the available evidence of pre-operative assessment and education into practice, and to improve the compliance of best practice to audit criteria, to reduce the incidence of complications. METHODS This project utilized the audit and feedback model using the Joanna Briggs Institute Practical Application of Clinical Evidence System. This included a baseline audit, feedback and implementation of strategies, and a follow-up cycle. Five evidence based audit criteria were audited in an ear, nose and throat ward of a hospital in Fudan. 32 patients and 29 nursing staff were involved in this project. RESULTS Improvements in the compliance rates of all criteria have been shown, ranging from 94% to 100% in the follow up audit cycle. CONCLUSIONS This project demonstrated an improvement in evidence-based practices in regards to pre-operative education and assessment. Further challenges will focus on developing strategies to sustain these improvements in compliance.
... Furthermore, a clinical trial may need to establish if patients who receive the GMI training in the dormant period result in superior outcomes compared to patients receiving the usual 3-week rest period. It has been shown that various perioperative issues influence surgical outcomes including: expectations (Toyone et al, 2005); fear (Archer et al, 2014; Louw, Louw, and Crous, 2009; Oshodi, 2007); pain (Fletcher and Martinez, 2014; Louw, Diener, Butler, and Puentedura, 2013; Oshodi, 2007); pain catastrophization (Clarke et al, 2013 ...
... Furthermore, a clinical trial may need to establish if patients who receive the GMI training in the dormant period result in superior outcomes compared to patients receiving the usual 3-week rest period. It has been shown that various perioperative issues influence surgical outcomes including: expectations (Toyone et al, 2005); fear (Archer et al, 2014; Louw, Louw, and Crous, 2009; Oshodi, 2007); pain (Fletcher and Martinez, 2014; Louw, Diener, Butler, and Puentedura, 2013; Oshodi, 2007); pain catastrophization (Clarke et al, 2013 ...
Article
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Representational body maps are dynamically maintained in the brain and negatively influenced by neglect, decreased movement and pain. Graded motor imagery (GMI) utilizing various tactile and cognitive processes have shown efficacy in decreasing pain, disability and movement restrictions in musculoskeletal pain. Limited information is known about these cortical changes patient undergoing lumbar surgery (LS), let alone the therapeutic effect of GMI for LS. A 56-year old patient underwent LS for low back pain, leg pain and progressive neurological deficit. Twenty-four hours prior to and 48h after LS various psychometric, physical movement and tactile acuity measurements were recorded. Apart from predictable postoperative increases in pain, fear-avoidance, disability and movement-restrictions, pressure pain thresholds (PPT), two-point discrimination (TPD) and tactile acuity was greatly reduced. The patient underwent 6 physiotherapy (PT) treatments receiving a GMI program aimed at restoring the PPT, TPD and tactile acuity. The results revealed that GMI techniques applied to a patient immediately after LS, caused marked improvements in movements (flexion average improvement/session 3.3 cm; straight leg raise average 8.3°/session) and an immediate hypoalgesic effect. GMI may provide PT with a non-threatening therapeutic treatment for the acute LS patient and establish a new role for PT in acute LS patients.
... Forskning om vård under den preoperativa fasen ses inriktad mot hur information och undervisning ges till patienten inför operation (Fitzpatrick & Hyde, 2005), mot den stress och oro patienten upplever (Carr, Brockbank, Allen, & Strike, 2006), men även hur preoperativ utbildning anses ha en positiv inverkan för att minska patientens oro (Oshodi, 2007a(Oshodi, , 2007b. Att via vårdåtgärder säkerställa att patienten är varm inför ett operativt ingrepp har också visat sig bidra till minskad oro och ökat välbefinnande (Wagner, Byrne, & Kolcaba, 2006). ...
... Att via vårdåtgärder säkerställa att patienten är varm inför ett operativt ingrepp har också visat sig bidra till minskad oro och ökat välbefinnande (Wagner, Byrne, & Kolcaba, 2006). Studier om vård under den postoperativa fasen har bland annat beskrivit patientens återhämtning och anpassning (Leinonen & Leino-Kilpi, 1999), postoperativ smärtlindring samt information till patienten vid utskrivning från sjukhuset (Oshodi, 2007a(Oshodi, , 2007bPop, m.fl., 2007;Richards & Hubbert, 2007;van Raders, m.fl., 2007). ...
... Patients with low education receive preoperative support and get good information from medical personnel regarding their condition to reduce preoperative psychological stress. This condition will improve the quality of patient recovery and minimize the length of stay in the hospital [24]. ...
Article
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BACKGROUND: The quality of post-operative patient recovery is part of the indicators of the quality of anesthesia services. However, side effects were still found in post-operative patients, which resulted in the speed and quality of recovery (QoR) and an increase in the length of stay for patients in the hospital. AIM: This study aims to describe the quality of a patient’s recovery after general anesthesia for patients undergoing surgery in the emergency room. MATERIALS AND METHODS: This research is a descriptive study with a cross-sectional design conducted from February to July 2020. Patients numbered 52 people who are patients aged 18–59 years who are willing to fill out a questionnaire QoR-40 on the day after surgery. All data were analyzed using the statistical program SPSS. The median of the QoR-40 score will be used as a cutoff point between good and poor recovery quality. RESULTS: Fifty-two patients responded to the study with a median age of 44 years. The median QoR-40 score was 188, with most of the good category’s recovery quality (55.8%). The middle-aged group showed better QoR (68.2 vs. 31.8%), as well as the female compared to male (65 vs. 35%). Patients who underwent neurosurgery showed poor recovery 61.9 vs. 38.1%). CONCLUSION: More than half of the patients who underwent emergency surgery under general anesthesia in the emergency room of Sanglah Hospital have good recovery quality.
... In both arms of our study, there was no difference in patient satisfaction with pain management. This contrasts literature indicating that speci c preoperative information improves patient satisfaction [12,35]. In our study population, the outcomes of patient satisfaction maybe more related to the varied nursing care received [12,36]. ...
Preprint
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Background: Preoperative information about pain has been shown to improve postoperative pain perception and reduce postoperative analgesia requirements. However, there is limited data regarding the effect of preoperative counselling in low resource settings. This study aimed at assessing the effect of preoperative information about pain on postoperative pain experience measured as postoperative pain using a verbal numerical rating scale (VNRS) and patient satisfaction with pain management. Methods: A randomised, double blind, controlled trial was done in Mulago National Referral Hospital (MNRH), Kampala. We prospectively enrolled 400 participants aged 18years and above scheduled for elective orthopaedic surgery. The consented patients were randomised to either receive the specific preoperative information about pain or not. The primary end points were postoperative pain score and patient satisfaction. A total of 340 were analysed with 170 in either arm. Secondary analyses where done to determine the factors that were associated with postoperative pain and patient satisfaction. Results: In both arms, the lowest pain score was 0/10 at 0 hours and the highest was 7/10 at 12 hours. A statistically significant difference between the intervention and control arms for the median pain score at 48hours (4/10 vs. 5/10) P-value= 0.029 was seen but none at 0, 12, 24hours. There was no difference in satisfaction with pain management (P value=0.059). Conclusion: Preoperative information about pain improves postoperative pain experience and may negatively impact patients’ satisfaction with pain management due to unmet expectations. Trial registration: Clinicaltrials.gov, NCT03056521. Registered 17 February 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03056521
... [26][27][28][29][30] Joint replacement programs in HICs often require patients to attend perioperative education programs in attempts to manage patient expectations, mitigate anxiety, and maximize outcomes. [31][32][33][34][35] Patients in LMICs who receive TJR during international surgical brigades deserve the same access to health information as their counterparts in HICs. However, the transient nature of surgical brigades creates challenges for patient education and follow-up, which may leave patients at higher risk for suboptimal outcomes or complications. ...
Article
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Background: Temporary brigade trips to deliver international surgical care are increasingly common. For the purposes of this work, we use the term brigade to describe self-contained short-term medical or surgical mission trips where healthcare professionals are brought in from foreign regions to provide care to an underserved population. Many brigade programs have begun to collect and publish data on outcomes and complications, but few have examined their own patient education practices. Methods: We used evidence-based readability and suitability analyses along with patient interviews to develop improved patient education materials for a total joint replacement surgical brigade in the Dominican Republic. Results: Existing patient education materials required an eighth grade reading level and lacked suitability based on the principles of educational theory. The redesigned materials required fifth grade reading skills or less and had superior suitability. Pilot testing with patients from the target population suggested that the materials were appealing and appropriate. Conclusions: Patient education may play an important role in optimizing outcomes in the setting of medical or surgical brigades where resources and access to follow-up care are limited. More research is needed to bring attention to the importance of patient education during brigades, and programs should work with patients to develop educational materials that are suitable and effective.
... Ek olarak; hastalara verilen eğitim ve danışmanlık hizmetlerinde farklı yöntemler vardır. Hastalara verilen eğitimlerde sözel anlatıma dayalı bilgilendirmelerin yanı sıra; görsel, işitsel, video eğitimleri gibi multimedya kullanımını içeren eğitim yöntemlerinin de kullanılması gerekmektedir26 . Yapılandırılmış iyi bir hasta eğitimi hastaların anksiyete, depresyon düzeylerini azaltabilir 27 . ...
Article
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Amaç: Bu çalışma karaciğer nakli olacak hastalara verilen video eğitiminin anksiyete, depresyon ve uyku düzenine etkisinin incelenmesi amacıyla yapılmıştır.Gereç ve Yöntem: Çalışmamızın örneklemini ise araştırmamızın kritelerlerine uyum sağlayan 60 hasta birey oluşturmuştur. Hastalar kontrol (n=30) ve deney (n=30) olmak üzere iki gruba ayrılmış ve gruplara seçilen hastalar rastlantısal örnekleme yöntemiyle seçilmiştir. Çalışma verilerinin elde edilmesinde Sosyo-Demografik Özellikler Formu, Hastane Anksiyete ve Depresyon Ölçeği ve Pittsburg Uyku Kalitesi Ölçeği kullanılmıştır. Veriler yüz yüze görüşme tekniği ile toplanmıştır. Deney grubundaki karaciğer nakli hastalarına anksiyete/depresyon düzeylerini azaltmak ve uyku kalitelerini artırmak için nakil öncesi ve sonrası olmak üzere iki bölümlük video eğitimi verilmiştir. Bu video eğitimi kliniğin rutin hemşirelik bakımı dışında deney grubu hastalarına verilmiş ve video destekli eğitim 40 dakika sürmüştür. Kontrol grubuna ise kliniğin rutin uygulamasındaki hemşirelik bakımı yapılmıştır. Bulgular: Çalışmaya katılan bireylerde hastane anksiyete ve depresyon ölçeğinin tüm alt boyut puanları nakilden sonra düşmesine rağmen istatiksel olarak anlamlı bir fark saptanamamıştır Hastaların uyku kalitesini değerlendirmek için kullanılan PUKİ uyku kalitesi ölçeği alt boyut puanları arasında hem deney hemde kontrol grubu hastalarında anlamlı bir fark bulunmamıştır. Sonuç: Karaciğer nakli olan hastalara nakil öncesi ve sonrası korku yaşayan hastaların anksiyete/depresyon düzeylerini azaltmaya yönelik eğitim programlarının ve girişimlerinin planlanması, hastaların psikolojik ve fizyolojik gereksinimlerini karşılamak, uyku kalitesini yükseltmek üzere girişimlerin planlanması, önerilmektedir.
... In line with the current best evidence about the timing of preoperative education, it is recommended to organize the first session during the week before surgery. 16,85,88 Hospitalization and surgery can provoke high levels of stress and anxiety in patients, 89 with the highest levels the day before surgery, possibly blocking effective learning. 90 Therefore, we suggest not providing the education the day before surgery. ...
Article
Around 20% of patients undergoing surgery for lumbar radiculopathy develop chronic pain after surgery, leading to high socioeconomic burden. Current perioperative interventions, including education and rehabilitation, are not always effective in preventing prolonged or chronic postoperative pain and disability. Here, a shift in educational intervention from a biomedical towards a biopsychosocial approach for people scheduled for lumbar surgery is proposed. Pain neuroscience education (PNE) is a biopsychosocial approach that aims to decrease the threat value of pain by reconceptualizing pain and increasing the patient's knowledge about pain. This paper provides a clinical perspective for the provision of perioperative PNE, specifically developed for patients undergoing surgery for lumbar radiculopathy. Besides the general goals of PNE, perioperative PNE aims to prepare the patient for postsurgical pain and how to cope with it.
... Mounting evidence demonstrates the positive clinical outcomes of perioperative patient teaching, such as reduced anxiety and pain as well as reduced postoperative complications. 6,7 But what and how to deliver information to patients undergoing day surgery is a great challenge to medical staff. To this end, we have designed questionnaires for patients and medical staff to analyze their perioperative information needs. ...
Article
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Purpose The development of day surgery in China is still in its infancy. The aim of this study is to examine the difference in perception between patients and medical staff about day surgery and to find out what kind of information should be delivered to patients perioperatively. Methods The study was designed as a cross-sectional study using survey questionnaires. Patients undergoing day surgery and medical staff working in the day surgery center received a preoperative teaching questionnaire (PTQ). The PTQ consisted of preoperative, operative, postoperative and anesthesia information. Participants were asked to rate accurately what day surgery information they perceived as important on a five-point Likert-type scale that ranged from very important to not important. The main outcome was the value patients and staff place on perioperative information. Results For patients, details of anesthesia (82.6%) was the most important day surgery information, while for medical staff, preoperative (58.1%), postoperative (60.7%) and anesthesia (60.0%) information were of the same importance. Patients ranked surgery effect (83.3%) and pain management (82.5%) as two of the top five most important details about day surgery, but these were not listed in the top 5 rankings of staff. Student’s t-test results of mean rankings also showed that patients placed more importance on surgery effect (4.8±0.6, 4.6±0.6, P=0.036) and pain management (4.8±0.5, 4.5±0.5, P=0.031) than the medical staff did. Conclusion In China, day surgery is an emerging practice with both patients and medical practitioners still lacking experience, so high-quality perioperative teaching is necessary and important. Our study examining patients and staffs’ views on day surgery information should be considered when developing perioperative teaching programs. To increase patient satisfaction of the day surgery experience, delivery of patient-specific information tailored to individual circumstances is necessary.
... On the other hand, growing evidence shows that preoperative anxiety contributes greatly to postoperative pain and discomfort [14]. Studies in patients have demonstrated that specific education, via verbal instruction and/or in conjunction with pamphlet, photo file or illustration, given prior to the surgery [15] can help patients obtain better pain relief [16,17], alleviate anxiety and discomfort [18,19]. However, for patients with low literacy skills, preoperative education via pictures and illustrations are especially useful [20]. ...
Article
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Background: Catheter-related bladder discomfort (CRBD), secondary to catheterization of urinary bladder is distressing. The aim of this study was to assess the efficacy of preoperative education on CRBD with image illustration for alleviating CRBD. Methods: Sixty adult male patients, undergoing elective colonal and rectal surgery, were randomized to receive tetracaine mucilage instilled into the urethra and applied to the catheter (tetracain group), or receive tetracaine mucilage in combination with image illustration on CRBD (image group) before urethral catheterization. The incidence and severity of CRBD were assessed at 0.5, 1, 2, and 6 h after patients' extubation. The severity of postoperative pain, incidence of postoperative agitation and other adverse events were also recorded. Results: Patients in image group reported remarkably less CRBD than those in tetracaine group at 0.5,1, 2 and 6 h after extubation (20, 20, 6.7 and 6.7% v.s. 60, 73.3, 53.3 and 53.3%, respectively, P<0.01). Severe CRBD was not reported in either group. However, the incidence of moderate CRBD was significantly lower in image group, with 6.7% at 1 h and thereafter none occurred, compared to 6.7% at 0.5 h, and increasing to 20% at 1 h, 2 h and 6 h in tetracaine group, respectively. Moreover, patients in image group suffered less moderate to severe postoperative pain than that of tetracaine group (13.3% v.s. 40.0% at 1 h, P = 0.039, 33.3% v.s. 60% at 2 h and 6 h, P = 0.038). Conclusions: Preoperative education on uretheral catheterization via image illustrations could enhance the effect of tetracaine mucilage in reducing both the incidence and severity of CRBD. Trial registration: The trial was registered at www,clinicaltrials.gov with registration number NCT03199105 (retrospectively registered). Date of trial registration which is "June 26, 2017".
... Preoperative teaching, that is, an interactive process of pro- viding patients with information and explanations about surgi- cal procedures, postoperative recovery processes, and psychosocial support, 8,9 is beneficial to patients in reducing anxiety, length of hospital stay, postoperative physiological com- plications (ie, pain); improving knowledge 6,10 ; and promoting self-care management, adherence, and postoperative recov- ery. 11,12 Preoperative teaching is imperative and beneficial, as empirical evidence highlights the importance of identifying patients' individual learning needs, styles, and preferences as it has the potential to affect patient's information processing, retention, and application. [13][14][15] In addition to providing preoperative teaching, appropriate and timely postoperative rehabilitation is important to ensure recovery from breast cancer surgeries (ie, segmental mastec- tomy, total mastectomy, axillary lymph node dissection, and breast reconstruction). ...
Article
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Purpose Most of the breast cancer diagnoses are recommended for breast surgery. Unfortunately, many patients report preoperative anxiety, which can affect postoperative recovery. Preoperative teaching sessions have been shown to reduce anxiety and improve recovery for the patients with breast cancer. To better support the patients at our cancer center, a multidisciplinary preoperative teaching session was developed and delivered as a quality improvement initiative. Methods Participants scheduled for breast surgery were invited to attend a group-delivered preoperative teaching session, either for breast-conserving surgery or mastectomy. The sessions were presented by a nurse, occupational therapist, and physiotherapist. Data were collected through a researcher-developed 2-item questionnaire administered before and after sessions to compare self-reported anxiety and knowledge levels, along with qualitative feedback. Results A total of 94 participants attended the preoperative sessions, piloted over a year. The majority were scheduled for breast-conserving surgery. Wilcoxon signed rank tests showed that after session, self-reported levels of anxiety decreased, whereas levels of knowledge increased. Most participants found the session to be very helpful and would recommend it to other patients/families awaiting surgery. Conclusions Patients awaiting surgery for breast cancer may be better supported through a multidisciplinary group teaching session by decreasing anxiety and improving knowledge related to the procedure. Future directions could explore the effect of specific session elements on anxiety, knowledge, and postoperative complications using psychometrically sound instruments and additional time points. Implications for cancer survivors Standardization of these preoperative teaching sessions may enhance breast cancer care, reduce postoperative complications, and improve patient recovery.
... Die vorliegende Studie lässt sich gut vorangegangenen Arbeiten zuordnen, die auch positive Effekte auf postoperative Outcomes nachweisen konnten [111][112][113][114][115][116][117]. Einschränkend muss angemerkt werden, dass die Gruppenzuteilung nicht randomisiert erfolgte, da dies im klinischen Praxisalltag nicht möglich war. ...
Thesis
In der vorliegenden Dissertationsschrift sollen psychologische Prädiktoren und Möglichkeiten der psychologischen Prävention akuter und persistierender postoperativer Schmerzen und schmerzbedingter Beeinträchtigungen untersucht werden. Ziel der vorliegenden Arbeit war es, psychologische Prädiktoren zu identifizieren, die das Erkennen von Risikopatienten für postoperative Schmerzen und schmerzbedingte Beeinträchtigungen ermöglichen. Des Weiteren sollte eine auf dysfunktionale schmerzspezifische Emotionen und Kognitionen zugeschnittene perioperative psychologische Prophylaxeintervention bezüglich ihrer Wirksamkeit überprüft werden. Als signifikante Prädiktoren der Akutschmerzintensität nach Hysterektomie erwiesen sich in Studie I Schmerzangst und die präoperative attentionale Präferenz sozial bedrohlicher und schmerzbezogener Wörter in einer Dot-Probe-Aufgabe. In Studie II zeigte sich bei allen Hysterektomiepatientinnen mit persistierenden Schmerzproblemen die gleiche präoperative attentionale Präferenz für sozial bedrohliche Wörter sowie eine hohe postoperative Akutschmerzintensität. In Studie III zeigte sich, dass durch eine perioperative psychologische Prophylaxeintervention, die besonders auf schmerzspezifische Emotionen und Kognitionen fokussiert, das postoperative Ergebnis nach operativer Korrektur einer Brustwanddeformität verbessert werden konnte. Sowohl die akute Schmerzintensität als auch die subakute schmerzbedingte Beeinträchtigung nach 3 Monaten konnten hierdurch gesenkt werden. Zudem ließen in der Prophylaxegruppe dysfunktionale schmerzbezogene Emotionen und Kognitionen schneller nach und ein Wiederauftreten erhöhter Schmerzangst konnte verringert werden. Schlussfolgernd ist festzuhalten, dass schmerzspezifische psychologische Prädiktoren wie Schmerzangst von größerer Relevanz zu sein scheinen als allgemeine psychologische Prädiktoren. Zudem liefert ihre Modifikation einen Beitrag zur postoperativen Schmerzprävention. In der Zukunft bedarf es weiterer prospektiver Längsschnittstudien bezüglich psychologischer Prädiktoren postoperativer Schmerzen mit dem langfristigen Ziel der Entwicklung eines Screening-Tools für den klinischen Alltag zur Identifikation von Risikopatienten. Zudem bedarf es randomisiert-kontrollierter prospektiver Längsschnittstudien zur Überprüfung der Wirksamkeit psychologischer Prophylaxeinterventionen auf postoperative Outcomes. Hierbei sollten sowohl Patienten mit als auch ohne präoperative Schmerzen einbezogen werden.
... Different methods are used in the education given before the operation, during the hospitalization, after the operation or when discharged. In addition to verbal education, which is the basis of patient education, printed and multimedia-supported educational materials are also used [10]. A well-planned education provides active participation of the patient in the healing process. ...
Article
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In this study, it was aimed to determine how the postoperative pain level, state-trait anxiety level, and respiratory function were affected by the health education given through a patient education booklet to patients with lung cancer, in comparison with control group, before pulmonary resection through thoracotomy. The 60 patients (n = 60) having pulmonary resection indication because of lung cancer were recruited in the present study. The patients were separated as control (n = 30) and experimental groups (n = 30). The patient education was applied to patients in the experimental groups via the education booklet 24 h before the surgery. Patients in the control groups received only usual clinical nursing information. The pain was evaluated via visual analog scale (VAS). The State-Trait Anxiety Scale (STAS) was used for evaluating the anxiety level. The evaluated pulmonary functions were peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and forced expiratory flow 25–75 (FEF25–75). The pain level of the experimental group was statistically lower than control group (p < 0.05). The state anxiety level of experimental group received education was statistically lower than control group (p < 0.05). There was no any statistical difference in trait anxiety levels between control and experimental groups (p > 0.05). The FEV1 and FEF25–75 values in experimental group were statistically higher than control group. A planned health education applied via the thoracotomy patient education booklet has a positive effect on clinical recovery process by affecting postoperative pain, state anxiety, and FEV1 and FEF25–75 values.
... In line with the current best evidence about the timing of preoperative education, it is recommended to organize the first session during the week before surgery. 16,85,88 Hospitalization and surgery can provoke high levels of stress and anxiety in patients, 89 with the highest levels the day before surgery, possibly blocking effective learning. 90 Therefore, we suggest not providing the education the day before surgery. ...
... La educación terapéutica se define como cualquier conjunto de actividades educativas planificadas, las cuales estarán destinadas a mejorar el estado de salud de un paciente. Estas actividades tienen por objeto facilitar el conocimiento que tenga de base del paciente (25). La educación al paciente siempre ha tenido una larga historia en la enfermería; no obstante, en la fisioterapia siempre se ha visto como una intervención no específica. ...
Article
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Pain is considered an important public health problem since it represents 70% of emergency assistance and a third of medical consultations. Musculoskeletal disorders correspond to approximately 80% of outpatient physiotherapy services, with pain being the most frequent symptom. Chronic pain is classified as pain that persists beyond the normal tissue healing time, lasting more than three months and with no apparent biological value. Chronic pain affects approximately 60 million people, corresponding to 10% of the world's population. A survey that in 2006 studied 4839 people found that 20% suffered from chronic pain and many reported a reduction in quality of life.
... Because pain is a complex and subjective biopsychosocial experience, management of patient expectations and education regarding realistic goals of pain treatment is crucial to an effective pharmacological approach. Thus, we recommend this includes analgesic treatment plans and goals for postoperative pain management (Wood 2010;Oshodi 2007a;Oshodi 2007b). While the exact timing, methods, and content of preoperative education will be locally determined, we suggest that patient education and expectation management occur through all phases of care and include information about choice and risks of analgesic technique, goals of analgesia, anticipated patient participation in recovery activities, and non-pharmacological methods that can be employed to reduce reliance on rescue analgesics (see Fig. 2) (Chou et al. 2016b;O'Connor et al. 2014). ...
Article
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Background Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver “optimal analgesia,” which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects. Methods With input from a multi-disciplinary, international group of clinicians, and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients. Discussion As a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery ERP. The goal was two-fold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus from the preoperative period to the post-anesthesia care unit. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of optimal analgesia as set forth in this document.
... This finding verifies the already existing data of the literature that information regarding the treatment of the pain is considered important by patients. 15,16,17,19,28 The study sample included all surgical patients because a previous study by Bradshaw et al 29 revealed that the subtype of surgery has no effect in kind of information which patients desire. Seventy-eight percent of our patients believe that they will be calmer if their questions about the POP are answered, a finding that agrees with previously contacted study by Kratz. ...
Article
Purpose: The aim of this study was to determine the kind of information patients need preoperatively about postoperative pain (POP) and whether this is affected by previous surgery experience. Design: A descriptive study design using preoperative questionnaires. Methods: Questionnaires with fixed questions related to POP and its management were distributed preoperatively to consenting, consecutive surgical patients. Patients were divided into two groups: patients with previous surgery experience (group A) and patients without previous surgery experience (group B). Finding: Of the patients who participated in the study, 94.2% wanted information about POP and 77.8% of them believe that they will feel calmer if they get the information they need. The patients' biggest concern relates to pain management issues after discharge. Next, in order of preference is information about the analgesics that they need to take. The patients want to be informed primarily with a personal interview (59.4%). Previous surgery experience has no effect on patients' needs for information. Conclusions: Most of the patients want to be informed about the management of the POP after being discharged. It is remarkable that patients who had previous surgery experience need the same information with those who had no previous surgery.
... Cognitive behavioral therapy (CBT) interventions have been widely used to manage chronic pain, and their impact on pain is well established through a multitude of randomized controlled trials across diverse populations [3,4]. In regard to acute pain, particularly postoperative pain, educational interventions have been the most frequently studied and helpful approaches for about 30 years [5][6][7][8][9]. Nonetheless, both for acute and chronic pain management, significant barriers such as time, cost, and distance generate considerable treatment accessibility issues and inhibit the improvement of pain management, allowing for other formats of interventions other than face to face to be implemented [3,[10][11][12]. ...
Article
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Background Information technologies can facilitate the implementation of health interventions, especially in the case of widespread conditions such as pain. Tailored Web-based interventions have been recognized for health behavior change among diverse populations. However, none of the systematic reviews looking at Web-based interventions for pain management has specifically addressed the contribution of tailoring. Methods The aims of this systematic review are to assess the effect of tailored Web-based pain management interventions on pain intensity and physical and psychological functions. Randomized controlled trials including adults suffering from any type of pain and involving Web-based interventions for pain management, using at least one of the three tailoring strategies (personalization, feedback, or adaptation), will be considered. The following types of comparisons will be carried out: tailored Web-based intervention with (1) usual care (passive control group), (2) face-to-face intervention, and (3) standardized Web-based intervention. The primary outcome will be pain intensity measured using a self-report measure such as the numeric rating scale (e.g., 0–10) or visual analog scale (e.g., 0–100). Secondary outcomes will include pain interference with activities and psychological well-being. A systematic review of English and French articles using MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library will be conducted from January 2000 to December 2015. Eligibility assessment will be performed independently in an unblinded standardized manner by two reviewers. Extracted data will include the following: sample size, demographics, dropout rate, number and type of study groups, type of pain, inclusion and exclusion criteria, study setting, type of Web-based intervention, tailoring strategy, comparator, type of pain intensity measure, pain-related disability and psychological well-being outcomes, and times of measurement. Disagreements between reviewers at the full-text level will be resolved by consulting a third reviewer, a senior researcher. DiscussionThis systematic review is the first one looking at the specific ingredients and effects of tailored and Web-based interventions for pain management. Results of this systematic review could contribute to a better understanding of the mechanisms by which Web-based interventions could be helpful for people facing pain problems. Systematic review registrationPROSPERO CRD42015027669
... 30,31 In health care literacy, it is thus encouraged to provide additional strategies to maintain gained health care knowledge, such as providing refresher educational sessions, booklets, follow-up phone calls or electronic mail. [32][33][34] This study, however, demonstrates a maintained, albeit slightly lower, NPQ score (76.9%) at 6-month follow-up. It could be argued that the ongoing classes during the 6-months after the TNE, which contained biological and physiological information likely pertaining to the TNE presentation, could have helped with the maintenance of knowledge as described before. ...
Article
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Objective: To determine if a 3-hour therapeutic neuroscience education session alters physical therapy student's knowledge of pain and effects their attitudes and beliefs regarding treating chronic pain. Methods: Seventy-seven entry-level doctoral physical therapy students participated in the study. Following consent, demographic data were obtained and then the subjects completed the Neuroscience of Pain Questionnaire, the Health Care Provider's Pain and Impairment Relationship Scale and an additional questionnaire designed by the researchers. The subjects then received a 3-hour educational session developed by the researchers, focusing on the neurobiology and physiology of pain. The questionnaires were re-administered immediately after the educational session and at 6 months post-education. Results: Seventy-seven subjects (mean age = 24.7 years, 57.1% female and 81.8% white) completed the questionnaires pre- and post-educational session with 75 completing the questionnaires at 6 months. To assess the effect of the education on the scores of the questionnaires, a repeated measures ANOVA was conducted. Students demonstrated significantly higher scores on the neuroscience of pain questionnaire (p < 0.001) with no significant effect found on the attitudes and beliefs questionnaire at any of the time points. There were significant differences found on some of the individual questions that were part of the additional questionnaire. Discussion: An educational session on the neuroscience of pain is beneficial for educating entry-level doctoral physical therapy students immediately post-education and at 6 months. This educational session had no effect on the student's attitudes and beliefs regarding treating the chronic pain population. There were additional significant findings regarding individual questions posed to the subjects.
... These habits in eastern societies such as Iran include sitting on the floor for purposes such as praying, eating meals and toileting in deep squat, putting the hip joint in deep flexion. Unfortunately, there is no study on the THR failure rate in the Iranian population, but considering the habitual and cultural behaviours, it could be deduced that Iranian THR patients are more vulnerable to post-surgical dislocation (Oshodi, 2007a(Oshodi, , 2007b. Therefore, considering protective strategies to reduce the failure rate and improve functional, occupational and participation outcomes is of great importance for these patients. ...
Article
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The aim of this randomized controlled trial was to assess the effect of an occupational therapy protocol of teaching the usage of adaptive devices to older individuals in Iran who have had a total hip replacement as compared with conventional occupational therapy on functional outcomes and independence. Forty individuals diagnosed with osteoarthritis and a total hip replacement aged >60 years were randomly allocated to either control group (n = 20) or experimental (n = 20) group. Pain, disability, independence and hip muscle strength were assessed with visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis and Barthel Index and dynamometer, 2 days before and 6 weeks after the hip operation. Both groups received conventional occupational therapy, but the experimental group was additionally supervised on the use of adaptive devices. Correct use of the devices was instructed during the training session. Both groups significantly improved on all variables post-operatively. However, the experimental group showed significantly more improvement in all dependent variables post-operatively. No data were available on the use of the devices by the control group patients. Supervision of the utilization of the adaptive devices during regular home visits by the occupational therapist is recommended. Further research is needed to clarify which aspects of this supervision were most beneficial for the patients. Copyright © 2015 John Wiley & Sons, Ltd.
... A systematic review on the impact of the preoperative education on the postoperative pain showed that this intervention is indeed effective but none of the studies compared the effects of preoperative education and 'no form of education,' and therefore the actual impact may have been underestimated. Nevertheless, sufficient evidence was found to support the effectiveness of preoperative patient education in the improvement of postoperative outcomes [25]. ...
Article
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Background: Postoperative (PO) pain interferes with the recovery and mobilization of the surgical patients. The impact of the educational status has not been studied adequately up to now. Methods: This prospective study involved 400 consecutive general surgery patients. Various factors known to be associated with the perception of pain including the educational status were recorded as was the preoperative and postoperative pain and the analgesia requirements for the 1(st) PO week. Based on the educational status, we classified the patients in 3 groups and we compared these groups for the main outcomes: i.e. PO pain and PO analgesia. Results: There were 145 patients of lower education (junior school), 150 patients of high education (high school) and 101 of higher education (university). Patients of lower education were found to experience more pain than patients of higher education in all postoperative days (from the 2(nd) to the 6(th)). No difference was identified in the type and quantity of the analgesia used. The subgroup analysis showed that patients with depression and young patients (< 40 years) had the maximum effect. Conclusions: The educational status may be a significant predictor of postoperative pain due to various reasons, including the poor understanding of the preoperative information, the level of anxiety and depression caused by that and the suboptimal request and use of analgesia. Younger patients (< 40), and patients with subclinical depression are mostly affected while there is no impact on patients over 60 years old.
... Additionally, several studies have shown that pain, especially level of pain intensity and unexpected high levels of pain after surgery, is a critical issue within orthopedic surgery (Niskanen and Strandberg, 2005;Parker, Handoll, and Griffiths, 2004;Pitimana-aree et al, 2005;Sinatra, Torres, and Bustos, 2002;Wulf et al, 1999). Preoperative education is a strategy designed to decrease postoperative pain, complications and disability (Oshodi, 2007a;Oshodi, 2007b). To date, only a handful of studies have been conducted on the outcome of preoperative education for lumbar surgery, and those with a focus on procedural information and informed consent have demonstrated limited benefit for post-surgical outcomes (Douglas, Mann, and Hodge, 1998;Johansson et al, 2005;Krupp, Spanehl, Laubach, and Seifert, 2000;LaMontagne, Hepworth, Salisbury, and Cohen, 2003;Walters and Coad, 2006). ...
... In the same harmony, Seers et al. (2008) reported that relaxation is increasingly suggested as a pain control technique that can be used by nurses in daily practice. These findings are also consistent with a number of studies that have concluded that preparatory preoperative information can have a positive effect on a patient's experience of acute surgical pain (Niemi-Murola, et al., 2007; Oshodi, 2007; Walker, 2007). Roykulcharoen & Good (2004) found that that systematic relaxation reduced patient's pain and increased their sense of control. ...
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... 1.2. Providing information may help prepare patients for surgery, however, evidence is mixed The potential benefits of providing patients with pre-operative education on physical and psychological outcomes has been explored in multiple medical conditions [7][8][9][10][11][12][13][14][15][16]. However, the evidence for the effectiveness of pre-operative education is mixed. ...
... Additionally, several studies have shown that pain, especially level of pain intensity and unexpected high levels of pain after surgery, is a critical issue within orthopedic surgery (Niskanen and Strandberg, 2005;Parker, Handoll, and Griffiths, 2004;Pitimana-aree et al, 2005;Sinatra, Torres, and Bustos, 2002;Wulf et al, 1999). Preoperative education is a strategy designed to decrease postoperative pain, complications and disability (Oshodi, 2007a;Oshodi, 2007b). To date, only a handful of studies have been conducted on the outcome of preoperative education for lumbar surgery, and those with a focus on procedural information and informed consent have demonstrated limited benefit for post-surgical outcomes (Douglas, Mann, and Hodge, 1998;Johansson et al, 2005;Krupp, Spanehl, Laubach, and Seifert, 2000;LaMontagne, Hepworth, Salisbury, and Cohen, 2003;Walters and Coad, 2006). ...
Article
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Therapeutic neuroscience education (TNE) has been shown to be effective in the treatment of mainly chronic musculoskeletal pain conditions. This case study aims to describe the changes in brain activation on functional magnetic resonance imaging (fMRI) scanning, before and after the application of a newly-designed preoperative TNE program. A 30-year-old female with a current acute episode of low back pain (LBP) and radiculopathy participated in a single preoperative TNE session. She completed pre- and post-education measures including visual analog scale (VAS) for LBP and leg pain; Oswestry Disability Index (ODI); Fear Avoidance Beliefs Questionnaire (FABQ); Pain Catastrophizing Scale (PCS) and a series of Likert-scale questions regarding beliefs and attitudes to lumbar surgery (LS). After a 30-minute TNE session, ODI decreased by 10%, PCS decreased by 10 points and her beliefs and attitudes shifted positively regarding LS. Immediately following TNE straight leg raise increased by 7° and forward flexion by 8 cm. fMRI testing following TNE revealed 3 marked differences compared to pre-education scanning: deactivation of the periaqueductal gray area and cerebellum, and increased activation of the motor cortex. The immediate positive fMRI, psychometric and physical movement changes may indicate a cortical mechanism of TNE for patients scheduled for LS.
... ,35,39 -41 reduced postoperative pain,6,8,35,42,43 decreased length of hospital stay,5,26,43,44 and facilitated a faster return to preoperative functional levels.6,13,26,28,42 ...
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We sought to determine current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. An online cross-sectional survey was used to study a random sample of spine surgeons in the United States. The Spinal Surgery Education Questionnaire (SSEQ) was developed based on previous related surveys and assessed for face and content validity by an expert panel. The SSEQ captured information on demographics, content, delivery methods, utilization, and importance of preoperative education as rated by surgeons. Descriptive statistics were used to describe the current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. Of 200 surgeons, 89 (45% response rate) responded to the online survey. The majority (64.2%) provide preoperative education informally during the course of clinical consultation versus a formal preoperative education session. The mean time from the decision to undergo surgery to the date of surgery was 33.65 days. The highest rated educational topics are surgical procedure (96.3%), complications (96.3%), outcomes/expectations (93.8%), anatomy (92.6%), amount of postoperative pain expected (90.1%), and hospital stay (90.1%). Surgeons estimated spending approximately 20% of the preoperative education time specifically addressing pain. Seventy-five percent of the surgeons personally provide the education, and nearly all surgeons (96.3%) use verbal communication with the use of a spine model. Spine surgeons believe that preoperative education is important and use a predominantly biomedical approach in preparing patients for surgery. Larger studies are needed to validate these findings.
Article
Introduction: Preoperative anxiety is a common attitude in patients scheduled to undergo r surgery and represents with psychological and physical disturbances affecting postoperative recovery and quality of life (QoL). Objective: The aim of this study was to identify the effect of preoperative education on preoperative and postoperative anxiety and postoperative QoLin patients scheduled to undergo laparoscopic cholecystectomy (LC) and inguinal hernia (IH) repair, without prior surgical experience. Methods: Patients scheduled to underwent LC and IH repair were randomly assigned to control group (CG) and to interventional group (IG). The 'State-Trait Anxiety Inventory for Adults' questionnaire was used to validate anxiety before surgery and after 3 months postoperatively. The 36- item Medical Outcomes Short Form Health Survey (SF-36) was used to investigate mental, physical and emotional domains of QoL. The CG was received only routine information by doctors. The IG received additionally oral information plus a booklet from an experienced surgical nurse. Data analyzed using paired and unpaired t-test and Αnova tests. The level of statistical signicance was set at ≤ 5%. Results: Four hundred and fty patients were scheduled to undergo either LC or IH repair, with 200 assigned to the IG and 250 to the CG. Age, sex, marital status and educational level were similar in both groups. Postoperative State anxiety was signicantly lower in IG (p<0.001). Patients of the IG showed greater improvement in all of the SF-36 scale domains, specically in physical functionality (p<0.001), physical role (p<0.001), physical pain (p<0.001), general health (p<0.001), vitality (p<0.001), social functionality (p<0.001), emotional role (p<0.001) and mental health (p<0.001). There was not mortality or signicant morbidity in both groups. Conclusion: Preoperative education by an experienced nurse with oral and written information improves perioperative state anxiety and QoL. This method could be used for all surgical patients, irrespective for the surgical procedure.
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Objective. We aimed to assess the level of patient’s satisfaction and associated factors regarding postoperative pain management. Methods. An institution-based cross-sectional study was conducted from April to May 2018 at the University of Gondar comprehensive specialized hospital . Data were collected through semistructured questionnaire and chart review. Level of satisfaction was measured using five-point Likert scale. Statistical analysis was done using SPSS software version 23. Both bivariable and multivariable logistic regression analyses were done. Variables of P value ≤0.2 in the bivariable analysis were a candidate for multivariable logistic regression. A P value ≤0.05 was considered as significantly associated with patient’s level of satisfaction at 95% CI. Results. A total of 418 patients were included in this study with a response rate of 98.58%. *e overall proportion of patients who were satisfied with pain management services was 72.2% (95% CI: 67.7–76.6). ASA1 (AOR � 3.55: 95% CI � 1.20–10.55) and ASA2 patients (AOR � 3.72: 95% CI � 1.04–13.28), absence of postoperative pain (AOR � 1.86: 95% CI � 1.02–3.39), peripheral nerve block done (AOR � 9.14: 95% CI � 3.93 20.86), received analgesic before request (AOR � 6.90: 95% CI � 3.72–12.83), and received systemic analgesics (AOR � 6.10: 95% CI � 1.17–33.91) were significantly associated with the level of satisfaction. Conclusion. *e level of patient satisfaction with postoperative pain management was considerably low. Hence, it is vital to implement time-interval pain assessment method during the first 24 hours of postoperative period and treat accordingly based on the WHO pain ladder. Moreover, we suggested that all patients who underwent major surgery should receive peripheral nerve block as part of multi modal analgesia to decrease the incidence and severity of post op pain.
Article
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Female gender has been identified as one of the risk factors closely linked to perioperative anxiety and a lower level of satisfaction. A successful preoperative anesthesia education may improve such negative outcomes. The aim of this study was to investigate whether preoperative anesthesia education via an Anesthesia Service Platform (ASP) could reduce the anxiety levels in female patients scheduled for laparoscopic cholecystectomy under general anesthesia, and accelerate rehabilitation. A total of 222 patients scheduled for elective laparoscopic cholecystectomy were randomly assigned to the control group and the ASP group. Patients’ baseline and post-intervention psychological status was measured by the State-Trait Anxiety Inventory and General Well-Being Schedule. Pain management and recovery were assessed by VAS every 12 h for 48 h after surgery; length of stay (LOS) and postoperative analgesic consumption were also assessed. Patients in the control group experienced higher anxiety levels before surgery and had longer LOS than those in the ASP group. Patients in the ASP group had a higher general well-being score; however, they suffered more pain and consumed more analgesics after surgery. ASP is effective for preventing anxiety in female patients before laparoscopic cholecystectomy, improving patients’ general well-being levels, and shortening their LOS, but negatively influences patients’ postoperative pain levels.
Article
Preoperative preparations of the patients physically and psychologically are the cornerstone of the good outcomes. This prospective quasi-experimental hospital-based study was conducted in Sudan, Shendi city at Elmek Nimer university hospital to evaluate the impact of preoperative preparation on patients outcome among patients undergoing general surgery. In the period of June 2016 to May 2019. The study was included a hundred patients undergoing general elective surgery, data were collected by interviewing questionnaire, anxiety scale, pain assessment tool, postoperative parameter, and patients satisfaction tool, data were collected in two phases (pre& postoperative). The data were analyzed by the computer software program (SPPS) version 20. The results showed that more than two third (79.4%) of the patient had poor knowledge about the importance of preoperative preparations, but improve after implemented program and this was reflected on patient behavior and outcome in the postoperative phase. (70%) had reported no anxiety to mild in the postoperative phase. in regard of postoperative pain, majority of patients (70%) experienced moderate to severe level of pain in the first 4 hours, this level of pain reduce to mild to no pain level in (82%) of patients in next 12hours. Most of the patients had full to good satisfaction regarding preparations and outcome. The study support and justifies the effectiveness of the preoperative preparations on patient outcomes. The study recommended surgical nurses have to provide proper explanation and teaching for elective surgical patients to be adherence with the care plan to promote good surgical outcome.
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Background: The main aim of this study was to assess the level of patient’s satisfaction and associated factors in post-operative pain management. Methods: An institutional based cross sectional study was conducted from April, 11-May 15, 2018. Data were collected by structured, pre-tested patient interview questionnaire and chart review. Level of patient satisfaction was measured by using five-point Likert scale and checklist. The coded data were entered to Epi-info software version 7 and analyzed using statistical package for social sciences software version 23.The strength of the association was presented using adjusted odd ratio with 95% confidence interval and p-value<0.05 was considered as statistically significant. Results: A total of 418 patients were included in this study with a response rate of 98.58 %. The overall proportion of patients who were satisfied with pain management services was 72.2 % [95%CI:67.7-76.6].ASA1[AOR=3.55:95%CI=1.20-10.55]&ASA2 patients[AOR=3.72:95%CI=1.04-13.28],Patients with no post-operative pain [AOR=1.86:95%CI=1.02-3.39],post-operative nerve block [AOR=9.14:95%CI=3.93-20.86],analgesic before request[AOR=6.90:95%CI=3.72-12.83] and receiving postoperative analgesics [AOR=6.10:95%CI=1.17-33.91)] were significantly associated with level of satisfaction. Conclusion: Pain assessment during immediate postoperative period, providing regular based analgesia before patient request and to promote the practice of post-operative nerve block are important to increase the level of satisfaction.
Article
Background Surgical patients consider information about pain and pain management to be highly important (Apfelbaum, 2003). At the same time, evidence indicates that members of racial and ethnic minorities are more likely to experience inadequate pain management (Green, Anderson, Baker, Campbell, Decker, Fillingim, & Todd, 2003; Mossey, 2011). Aims This study investigated the needs of general day surgery patients who spoke primarily Cantonese, Italian, or Portuguese at home for information about postoperative pain. Design This was a mixed methods, descriptive study. Setting The day surgery unit of a large, quaternary care hospital in downtown Toronto. Partipants/Subjects Inclusion criteria were day patients who were at least 18 years of age or older and spoke primariy Cantonese, Italian or Portugues at home. and were able to read and write in their primary language. Methods Participants who had undergone a day surgery procedure completed a telephone information needs survey in their primary language (Cantonese, Italian, Portuguese) within 72 hours after discharge. Composite mean scores were calculated for each item. Chi-squared analyses were used to probe for intergroup differences and compare with English-fluent participants from phase 1 of this study (Kastanias, Denny, Robinson, Sabo, & Snaith, 2009). Results Sixty-three participants in total completed the survey: 21% Cantonese, 41% Italian, and 38% Portuguese. The mean age of the sample was 70 years old; 89% were born outside of Canada, and 52% were male. For the combined group, the average importance rating score range for the information items was 6.2-8.9 out of a possible score of 10. All items were rated as moderate (5-6 out of 10) to high (≥7out of 10) importance. Surgical subtype, health status, and age had no effect on the importance of any information item. There were no significant differences between the three language groups on any of the information items. This lack of difference may have been a result of a lack of power due to the small sample size of the individual language groupings. Overall, the top-ranked information items were “the plan for which drugs to take and when,” “what I can do if I still have pain or side effects,” and “side effects I was most likely to get.” Conclusions Similar to English-fluent participants (Kastanias et al., 2009), participants who primarily spoke either Cantonese, Italian, or Portuguese at home placed moderate to high importance on all of the information items. and neither surgical subtype, health status nor age had any effect on the importance of any item. The multilingual sample in this study placed more importance than English-fluent participants on information regarding help with paying for pain medication (p = .001) and the side effects they were most likely to experience (p < .05). Due to a paucity of literature in this area, further research is warranted. Results may assist with evaluating and improving current approaches to surgical patient pain management education.
Chapter
Educational programs to minimize acute postoperative pain are endorsed by the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists. The focus of educational curriculum is variable and both patient and situation specific but should address reasonable post-operative expectations, alleviate anxiety and provide specific instructions on chronic medication management prescribed for other co-morbidities. Continued focused efforts are needed to best delineate educational content and methods of teaching for optimal patient care.
Article
Interventional radiology (IR) is a rapidly expanding specialty within medicine. As a result, a new population of patients has emerged in Ireland; those discharged home with an IR drain for curative or preventative purposes requiring the care of nurses working in the community setting. The purpose of this study is to describe the experiences of nurses in the community caring for patients with an IR drain, with the objective of assisting in developing a new body of knowledge to enhance a patient's journey as they transition from an IR department to the community. The study is based on individual interviews analyzed using Colaizzi seven-step framework. Three themes emerged from the data findings: knowledge gap, information gap, and educational gap, whereby license professionals require additional education and training to care for this patient population. The study findings concluded that nurses in the community are unprepared to care for this patient cohort because of a knowledge deficit, inaccurate and poorly written discharge summaries, and a lack of education and training among nurses and patients regarding the intervention performed.
Article
Background Managing patient expectations is essential in the treatment of patients undergoing spinal surgery. Patient satisfaction is associated with improved clinical outcomes and can be improved when patient and surgeon expectations are aligned and patient preferences are met. Methods Patients presenting to clinic for management of spinal disease were asked to complete a questionnaire assessing demographics, current pain, reason for visit, and expectations and preferences surrounding the clinic experience. Variables were compared with χ² tests to determine factors associated with patient expectations. Subsets of new patients and returning patients were compared by the use of matched pair tests. One-way analysis of variance was used to compare means of clinic expectations in patients depending on their level of education. Results A total of 240 patients were included. New patient evaluation was the most common reason for evaluation (26.6%), and pain relief was the most common chief concern (39.3%). Patients preferred their surgeon wash their hands in the room instead of before entering (P < 0.001) and wear professional attire over scrubs (P < 0.001). Patients believe their wait time will be longer than it should be (P = 0.002), they will spend longer in clinic than they should (P = 0.03), and they will get less face-to-face time with their surgeon than they should (P < 0.01) but also that the surgeon is not getting paid enough for the clinic visit (P = 0.02). Conclusions Because spine surgery is largely elective, patients often seek treatment to improve quality of life and alleviate subjective symptoms. Understanding patient expectations is critical to ensure that patients and physicians are working toward similar goals.
Article
Total knee arthroplasty has a high success rate. In the interest of enhancing patient outcomes, numerous perioperative interventions have been studied, including preoperative education, preoperative rehabilitation, postoperative inpatient rehabilitation, continuous passive motion, postoperative outpatient rehabilitation, unsupervised in-home exercises, telerehabilitation, and various combinations of these. This comprehensive review analyzes the existing body of evidence on these perioperative interventions and examines some burgeoning opportunities in rehabilitation after total knee arthroplasty in the interest of improving patient outcomes and ensuring sustainable health care utilization for the future of total knee arthroplasty. [Orthopedics. 201x; xx(x):xx-xx.].
Article
Objective: This literature review was conducted to better understand the factors associated with optimal post-operative results following lumbar spinal fusion for chronic back pain, and the current tools used for evaluation. Background: Despite widespread use of lumbar spinal fusion as a treatment for back pain, outcomes remain variable. Optimizing patient selection can help to reduce adverse outcomes. Methods: The PubMed database was searched for clinical trials related to psychosocial determinants of outcome following lumbar spinal fusion surgery, evaluation of commonly used patient subjective outcome measures, and perioperative cognitive, behavioral, and educational therapies. The reference lists of included studies were also searched by hand for additional studies meeting inclusion and exclusion criteria. Results: Patients' perception of good health prior to surgery and low cardiovascular comorbidity predict improved postoperative physical functional capacity and greater patient satisfaction. Depression, tobacco use, and litigation predict poorer outcomes following lumbar fusion. Incorporation of cognitive-behavioral therapy perioperatively can address these psychosocial risk factors and improve outcomes. The SF-36, EQ-5D, visual analog pain scale, brief pain inventory, and ODI can each provide specific feedback which can track patient progress and are important to understand when evaluating the current literature. Conclusions: This review provides a summary of current information and explains commonly used assessment tools to guide clinicians in decision making when caring for patients with lower back pain. When determining a treatment algorithm, physicians must consider predictive psychosocial factors. Furthermore, utilization of perioperative cognitive behavioral therapy and patient education can improve outcomes following lumbar spinal fusion.
Article
Objective: To obtain descriptive information about patient treatment with acute peri-operative pain receiving parenteral analgesics in hospital environments. Methodology: Epidemiologic descriptive multicentre study. Patients admitted in the following Surgery services: General, Thoracic, Cardio-vascular, Angiology, Gynaecology, Orthopaedic and Urology. Results: Participation of 76 hospitals, distributed along the country; and 439 investigators. 1972 patients were assessed. 43.9% and 25.5% were admitted in General and Orthopaedic surgery services respectively. 52.8% of patients were over 60 years old. 31.2% did not present any concomitant illness. 36.78% had arterial hypertension and 16.5% diabetes mellitus. Pain scales to measure pain intensity, were used by 5.8% of patients at admission. In the following visits, these percentages ranged from 10% to 15%. During postoperative period NSAIDs were the most widely used (specially metamizol, administrated from 63.6% to 40.5% of the patients) and acetaminophen which was used by 41.3% of the patients in the first 12 hours and 27% in the 4th day. The percentage of patients that received rescue medication decreases from 25.7 % at first control to 6% at 4th day control; being acetaminophen the most commonly used medication. Conclusions: Despite pain treatment is considered important in surgical environments, treatment protocols are seldom used. The elaboration and the use of therapeutics guidelines for perioperative pain treatment could improve the patient comfort and their recuperation.
Article
Dermatologists perform many procedures that require acute pain control with local anesthesia and, in some cases, management of postoperative pain. Identifying early risk factors before a procedure can better prepare both the patient and provider anticipate acute postsurgical pain needs. Taking a multimodal, algorithmic approach to managing acute postsurgical pain in dermatology practice can effectively attenuate acute postsurgical paint and reduce patient opioid requirements.
Article
The management of pain is one of the greatest clinical challenges for nurses who care for patients during the postoperative period. It can be even more challenging for patients who must manage their own pain after discharge from the health care facility. Research shows that postoperative pain continues to be undermanaged despite decades of education and evidence-based guidelines. Ineffective management of postoperative pain can negatively impact multiple patient outcomes. The purpose of this quality improvement project was to evaluate the effectiveness of a preoperative pain management patient education intervention on improving patients' postoperative pain management outcomes. The project was conducted with patients undergoing same-day laparoscopic cholecystectomy in an outpatient general surgery service at a teaching institution. Patients in the intervention and comparison groups completed the American Pain Society Patient Outcome Questionnaire-Revised during their first postoperative clinic visit 2 weeks after surgery. Results showed that patients who received the preoperative education intervention reported less severe pain during the first 24 hours postoperatively, experienced fewer and less severe pain medication side effects, returned to normal activities sooner, and used more nonpharmacologic pain management methods postoperatively compared with those who did not receive the education. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
Article
Recently a preoperative pain neuroscience education (NE) program was developed for lumbar surgery (LS) for radiculopathy as a means to decrease postoperative pain and disability. This study attempts to determine the short term effects, if any, of providing NE before surgery on patient outcomes. A case series of 10 patients (female = 7) received preoperative one-on-one educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet, prior to LS for radiculopathy. Post-intervention data was gathered immediately after NE, as well as 1, 3 and 6 months following LS. Primary outcome measures were Pain Catastrophization Scale (PCS), forward flexion, straight leg raise (SLR) and beliefs regarding LS. Immediately following NE for LS for radiculopathy, all patients had lower PCS scores, with 5 patients exceeding the MDC score of 9.1 and 8 of the patients had PCS change scores exceeding the MDC by the 1, 3 and 6 month follow ups. Physical changes showed that fingertip-to-floor test in 6 patients had changes in beyond the MDC of 4.5 cm and 6 patients had changes in SLR beyond the MDC of 5.7°. The main finding, however, indicated a positive and more realistic shift in expectations regarding pain after the impending LS by all patients. The results of the case series suggest that immediately after NE, patients scheduled for LS for radiculopathy had meaningful detectable changes in pain catastrophizing, fingertip-to-floor test, passive SLR and positive shifts in their beliefs about LS.
Article
To provide evidence-based information on when patients should receive preoperative education, how education should be delivered, and what content needs to be included in the education for the elective spinal surgery patient.Methods Literature review from December 2009 to November 2011 using Academic Search Premier, CINAHL, and MEDLINE.ResultsPatients should be informed that they have power over their care and recovery process following elective spinal surgery. Preoperative education helps patients understand how to actualize their power in the recovery process. Education obtained far enough in advance to allow more time to consider choices assists the patient in actualizing their power. Involvement in learning can be affected by the amount of information included in the content, various educational settings, or the educational modality. Freedom to have content adjusted to the patient’s learning needs is important.ImplicationsMore research needs to be performed specifically on elective spinal surgery patients to evaluate learning needs and the effect of preoperative education on postoperative outcomes.
Article
Full-text available
Sample size calculations are now mandatory for many research protocols, but the ones useful in common situations are not all easily accessible. This paper outlines the ways of calculating sample sizes in two group studies for binary, ordered categorical, and continuous outcomes. Formulas and worked examples are given. Maximum power is usually achieved by having equal numbers in the two groups. However, this is not always possible and calculations for unequal group sizes are given.
Article
This study examined some effects of providing preoperative education to patients prior to their hospital admission for a total hip replacement. The preoperative education programmes are organised and presented by an occupational therapist with the assistance of a physiotherapist, an anaesthetist, an orthopaedic nurse and a dietician. The content includes information on preparation for surgery, what to expect of admission, surgery and rehabilitation, and how to prepare for discharge. A quasi-experimental design was used to compare a group of patients who had attended an education programme with, as control, a group of patients who had not. The variables Investigated were length of hospitalisation, morphine usage, mobility independence and discharge preparation. The results showed that the patients in the experimental group had a mean of 4 days' less hospitalisation than the control group, required less postoperative morphine and achieved mobility independence sooner. The control patients' lack of knowledge of what to expect from their surgery was evident from the lack of preparation for their discharge home. Large financial savings were then calculated as a direct consequence.
Article
Newell D J (Department of Medical Statistics, University of Newcastle upon Tyne, UK). Intention-to-treat analysis: implications for quantitative and qualitative research. International Journal of Epidemiology 1992, 21: 837–841 Intention-to-treat analysis is an important aspect of randomized controlled trials of health care interventions. The concept is now widely accepted in theory, but not always implemented in practice. Failure to analyse by intention-to-treat can give misleading and indeed life-threatening interpretations. In some studies, a case is put for estimating the effect that would have been observed if all patients had received the allocated treatment. Situations where this is valid are rare, but an example is given of such an exceptional study. The relevance of the intention-to-treat concept is not always taken into account in qualitative research. Interviews with new mothers who delivered their babies at home in a hypothetical controlled trial of home versus hospital confinement would provide fascinating accounts of the pleasures of successful delivery at home. But by definition the interviews would exclude the hazard and drama of necessary transfers to hospital due to complications in late pregnancy and early labour. The intention-to-treat approach would avoid this bias.
Article
The challenge for nurse researchers is to design their intervention studies with sufficient sensitivity to detect the treatment effects they are investigating. In order to meet this challenge, researchers must understand the factors that influence statistical power. Underpowered studies can result in a majority of null results in a research area when, in fact, the interventions are effective. The sensitivity of a research design is not a function of just one element of the design but of the entire research design: its plan, implementation and statistical analysis. When discussing factors that can increase a research design's statistical power, attention is most often focused on increasing sample size. This paper addresses a variety of factors and techniques, other than increasing sample size, that nurse researchers can use to enhance the sensitivity of a research design so that it can attain adequate power.
Article
This study tested the effects of preadmission teaching brochures on morning admission surgical patients' performance of specific postoperative exercises, teaching time, state anxiety, length of hospital stay, patient satisfaction, and return to functional status. The study participants were 38 women undergoing abdominal hysterectomies. Although the study results show no significant difference between those who received the preoperative teaching brochures and those who did not, the implications for further research are clearly defined. Preoperative nursing interventions that may help patients undergoing hysterectomies manage anxiety and return to function should be tested further.
Article
The aim of this study was to evaluate the effect of pre-operative visits by theatre nurses on pre- and post-operative levels of anxiety in two groups of general surgical patients, and to see if the outcome was reflected in the level of post-operative pain, nausea, mobility or length of hospitalisation. One group received pre-operative visits while the other group did not. Results of the study showed a significant decrease in anxiety 24 to 72 hours post-operatively for the visited group. A positive relationship between pre-operative anxiety levels and the level of pain, nausea and lack of independence experienced by both groups was also found. Length of hospitalisation was unaffected by the level of anxiety experienced in both groups. The author recommends that all surgical patients should receive a visit from theatre nurses before their operation.
Article
In-hospital education can reduce anxiety, improve coping and shorten hospital stays of surgical patients. However, hospitals are containing costs by shortening pre- and postoperative stays and reducing the time available for in-hospital teaching. This study evaluated prehospital education for total hip replacement (THR) surgery. Half of the patients waiting for admission for THR surgery were randomly selected to receive a THR education booklet in the mail 4-6 weeks before their scheduled THR surgery. Compared to the No-Booklet patients, patients who had received the booklet were less anxious at the time of hospital admission and at discharge, were more likely to have practised physiotherapy exercises prior to hospitalization, and required significantly less occupational therapy and physiotherapy while in hospital. There were no group differences for length of hospital stay.
Article
This study aimed to provide an objective view of the relationship between the giving of information, anxiety and hospital admission. Previous research has suggested that patients are already anxious on admission to hospital and that any information given at this time may be forgotten easily or misunderstood. Forty patients listed for simple elective surgery participated in this study. Using an experimental design, subjects in the experimental group were interviewed and information given to them in their own home before admission and again on their first day in hospital. A state-trait anxiety questionnaire was used to compare both groups. The resultant difference in the anxiety level shown between both groups on admission was found to be significant.
An anaesthetic nurse intervention was performed in order to evaluate the effects of extended preoperative information, given by anaesthetic nurses, on perioperative stress in patients operated on for breast cancer or total hip replacement (THR). Forty-six consecutive patients scheduled for surgery for breast cancer, and 55 for THR, were randomized into two groups which were given different modes of preoperative information. Patients in the control group were informed about pre- and postoperative routines by a ward nurse. Patients in the intervention group were given extended formalized information by an anaesthetic nurse. Wilcoxon rank sum test was used to show relations between variables. There were no significant differences between the intervention group and control group for patients with breast cancer or for patients with THR. Breast cancer patients in the intervention group were significantly more anxious than THR patients in the intervention group (P < 0.01). Breast cancer patients in the intervention group showed the highest anxiety scores on the Hospital Anxiety and Depression Scale (HADS) scale on the day of surgery. This information may reflect an increased level of anxiety due to the extended information given preoperatively. The information may thus have had a negative effect on breast cancer patients, resulting in an increased state of anxiety. The result indicates a need for individualized modes of information to provide a proper balance between enough and too much information.
Article
Patient-controlled analgesia (PCA) therapy was designed to provide patients with greater control in managing their pain. However, many patients continue to suffer from moderate to severe pain due to lack of knowledge about how to use PCA therapy. The results of this quasi-experimental study demonstrated that patients who received structured preoperative teaching had statistically significant higher knowledge regarding the use of PCA therapy and more positive attitudes toward using pain medicine. Patients who received the video teaching reported better pain control and satisfaction with pain management 4 and 8 hours following their surgical procedures.
Article
Seminal research by Boore (Boore, J., 1978. Prescription for Recovery. RCN, London) and Hayward (Hayward, J., 1975. Information--a Prescription against Pain, RCN, London) demonstrated that pre-operative information reduces post-operative stress, pain and anxiety in general surgical patients. Both studies used experimental designs and the results are frequently cited in the UK nursing literature. However, they are now more than twenty years old and surgical practices, patterns of hospitalisation and nursing as well as patients' knowledge and expectations have changed enormously. Other more recent studies have sought to evaluate the impact of pre-operative education on post-operative recovery. This paper reviews the research published in this field since 1985. It focuses on studies in which an experimental design was used and considers the types of educational intervention employed and the impact on patient outcomes. A sequel paper will evaluate the research methods used in the light of current practice in the design and reporting of randomised controlled clinical trials.
Article
The primary objective of this study was to test whether specific information given prior to surgery can help patients obtain better pain relief after total knee arthroplasty (TKA). Secondary objectives were to study the impact of preoperative information on state and trait anxiety, satisfaction with pain management and satisfaction with nursing care. The study was an intervention study with two groups of equal size (n=30). The intervention group was given specific information while the control group received routine information. Pain assessments were made preoperatively and every 3h for the first three postoperative days, using the visual analogue scale (VAS). The results of this study suggest that information does influence the experience of pain after surgery and related psychological factors. The postoperative pain declined more rapidly for patients in the treatment group, the degree of preoperative state anxiety was lower and they were more satisfied with the postoperative pain management.
Article
Cardiovascular diseases cause more disability and economic loss in industrialized nations than any other group of diseases. In previous work [Nurs Res 49 (2000a) 1], most coronary artery bypass graft patients (CABG, N=225 ) reported unrelieved pain and received inadequate analgesics. This study proposed to evaluate a preadmission education intervention to reduce pain and related activity interference after CABG surgery. Patients (N=406) were randomly assigned to (a) standard care or (b) standard care+pain booklet group. Data were examined at the preadmission clinic and across days 1-5 after surgery. Outcomes were pain-related interference (BPI-I), pain (MPQ-SF), analgesics (chart), concerns about taking analgesics (BQ-SF), and satisfaction (American Pain Society-POQ). The impact of sex was explored related to primary and secondary outcomes. The intervention group did not have better overall pain management although they had some reduction in pain-related interference in activities ( t(355)=2.54, P<0.01) and fewer concerns about taking analgesics ( F(1,313)=2.7, P<0.05) on day 5. Despite moderate 24-h pain intensity across 5 days, patients in both groups received inadequate analgesics (i.e. 33% prescribed dose). Women reported more pain and pain-related interference in activities than men. The booklet was rated as helpful, particularly by women. In conclusion, the intervention did not result in a clinically significant improvement in pain management outcomes. In future, an intervention that considers sex-specific needs and also involves educating the health professionals caring for these patients may influence these results.
Article
We examined whether pre-operative information benefited patients receiving patient-controlled analgesia (PCA) after major surgery. We investigated whether patients felt better informed about PCA and also whether pre-operative information altered the use of PCA, the adequacy of pain relief, worries about addiction and safety, and knowledge of side-effects. We investigated the effectiveness of information provided in two ways, namely by a patient-determined leaflet or an interview by a trained nurse from the pain team, compared with routine pre-operative information. We studied 225 patients, 75 in each group. Patients in the leaflet group were better informed about PCA, became familiar with using PCA more quickly and were less confused about PCA than the control group. However, there were no effects on pain relief, worries about addiction and safety, and knowledge of side effects. The pre-operative interview resulted in no benefits. Our findings indicate that the detailed provision of pre-operative information failed to improve patients' experiences of PCA.
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