Pre-operative Patient Education: Impact On Outcome Of Surgical Procedures

1.Identify a clinical issue and propose a research question about this clinical issue.

2.Write a Literature Review that describes what is already known about your research question.

3.How well does the existing literature address your research question?

The significance of patient education

1.The pre-operative period is a very sensitive period for the patient and the nurse. There are so many uncertainties especially with the patient who expresses concerns about the surgical procedure and the conclusion of going under total anaesthesia. Pre-operatively patients are prepared on the surgical procedure they will undergo, the complications that may arise from the procedure, the possible outcome of the procedure, the medications that will be used and the expected hospital stay after the procedure.

The outcome of a surgical procedure is determined by many factors, most important question being Does patient education pre-operatively impact on the patient’s outcome?

2.Patient education is a very significant strategy used in a health care facility. Educating patients makes them feel involved in their treatment and disease process.  Pre-operative patient education is a form of health education that is performed by the theatre nurse prior to the actual procedure. Patients need to be educated step by step about their disease process in patients scheduled for surgical procedures. Surgical procedures can either be minor or major; however patient education is a requisite despite the sensitivity of the procedure.  A human physiologic mechanism react differently to many factors; therefore disregarding pre-operative patient education because of the simplicity of the procedure to be done can be very detrimental to the outcome of the procedure because of the many uncertainties associated with surgery. Most major surgeries are performed under general anaesthesia; therefore the client needs to know what general anaesthesia is and its effects after the procedure together with the outcome of the procedure whether positive or negative. Alternatively a minor surgery is performed under epidural or local anaesthesia and the patient undergoing such a procedure should also be given pre-operative patient education about the expectations of the procedure and the anticipated outcome whether positive or negative. There many types of surgical procedures performed in a health care facility to different client; therefore each client is provided with pre-operative education relevant to the procedure they are due for, because different surgical procedures have different outcomes.

After a surgical procedure so many thing are expected the most expectation being patient satisfaction and pain. A study conducted by (Bouchard and Grawe et al,,, 2010) concluded that there was a remarkable decrease in post-operative pain for patients who had received pre-operation patient education before the surgical procedure was performed, because these patients had an overview of the outcome before-hand which made them adopt to the post-operative period effectively (Bouchard, 2010).

Pre-operative patient education prepares the client on the most likely outcome post-operatively. Patients are different some recover from anaesthesia calmly while others become very violent post-operatively when recovering from anaesthesia because of the disorientation associated with the effects of the anaesthetic drugs. How these patients adapt during the post-operative period is highly reliant on the patient education provided. Adequate patient education which covers the most sensitive area such as the possibility of complications, excessive pain, and poor outcome of the procedure ensures that a patient is well prepared for anything post-operatively (K, 2018).

Pre-operative patient education should be patient-centred. The more individual the education is the better the outcome post-operatively. When giving pre-operative education the nurse should ensure that it is patient-centred, this gives the patient the autonomy to make all the decisions regarding the procedure. Ethical considerations should be put in place and the patient has the final say, even if the opt out of the procedure hours before it is started their decisions should be respected. Ethical considerations should be the guiding factor during patient education; Veracity should be exercised at all times regardless of the situation surrounding the procedure (Oates, 2000). For instance some procedures are very complex, sensitive and rare for example separating conjoined twin or transplantation of a major organ such procedures are the type of procedure that bring so much attention to the hospital and the surgical team. This procedure if performed successfully is able to boost the rating of the hospital and attract more investors and donors. However such procedures carry the most and the worst form of complication if they were to go south; therefore patient-centred pre-operative health education should ignore the attention brought to the hospital and truthfully educate the client on all the expectations associated with such a procedure and focus on the patient’s needs (Guo, 2015).

A study conducted by (Gia, 2015) concluded that patient-centred pre-operative education ensures that a patient’s diversity, beliefs and cultures are respected. During pre-operative patient care, the client will be educated on everything that will be done to them during the surgical procedure. Some people belong to cultures that do not allow some procedures to be done, others belong to religions that do not allow some procedures to be performed on them for instance the Jehovah witnesses do not belief in blood transfusion. The diversity of patient’s beliefs should be put in place and alternatives availed to them. This ensures optimal patient outcome and patient satisfaction after the surgical procedures (L, 2015).

Some surgical procedures may not turn out as expected, some outcomes may be worse than the present state for example a kidney transplant that results with the recipient rejecting the organ resulting in a serious chronic condition that the patient ends in an intensive care unit, transparency about the possibility of the clients body rejecting the organ helps a lot in such an outcome, because the patient was psychologically prepared for such an outcome.

Pre-operative patient education plays a very important role in ensuring that the client is psychologically prepared for the pain that is associated with surgical procedures and the coping mechanisms for reducing the pain. The most effective pain reduction strategies is pharmacologic intervention the patient should be made aware of such options and the side effects of the medications used in pain management. This form of detailed education ensures that the client makes an informed choice it also gives the client the autonomy to choose the surgeon performing the procedur (Rothrock, 2014).

As I said earlier the human body is very diverse and it reacts differently to medications used during surgical procedures. Most of the anaesthetic drugs make the recipient drowsy and disoriented after the procedure, such details should not be left out, the patient should know what to expect as a result of the medication used. Sharing information about the mode of action and the different 

Pre-operative patient education for different surgical procedures

anaesthetic drugs that will be used during the procedure impacts positively on the patient outcome post-operatively.Pre-operative education ensures that the client feels comfortable before total anaesthesia is achieved, this will positively impact the period of recovery from anaesthesia, and during pre-operative education the client has the chance to meet the whole surgical team; therefore promoting patient’s confidence which enhances a positive outcome postoperatively.

In a study by (Lubbeke and Perneger, 2015) “about influence of pre-operative patient education on the risk of hip dislocation after primary total hip arthroplasty” the study concluded that patient education is very relevant in reducing the occurrence of complications after the surgical procedure was done.  This applies to all surgical procedure performed on clients. Surgical procedure whether minor or major possess the risk of developing complications, some complications may arise minutes to hours to days after the procedure others may arise months to years after the procedure, all of the possible complications should be discussed with the patient pre-operatively, because it provides the patient with psychological preparedness in case of any complication s after a surgical procedure is performed (A, 2009).

Preparing a patient pre-operative ensures that they are psychologically prepared for the outcome good or bad. Pre-operatively patient education applies to all surgical procedures from major ones to minor ones such as dental procedures. Such preparation enhances positive recovery period despite the outcome. It ensures that a patient makes decision autonomously without coercion. It also helps relieve anxiety which can really complicate the procedure if a client is not relaxed physically and psychologically.

Extensive research has been conducted supporting the relevance of pre-operative patient education and its impact across various surgical procedures performed in the hospital. Some of the subjects studied express their gratitude to pre-operation education which they attribute to the success of the procedure and the coping mechanisms used especially in patients who have undergone amputation procedures, they say they are able to adapt to their present condition because of the pre-operative education they received.

This education helps the client adapt better to the changes that occur in their bodies; therefore pre-operative patient education is advocated for and taught in nursing schools in order to enhance service provision to clients. The main aim for pre-operative patient education is ensuring that the client is well informed and ensuring that the client make autonomous choices about their health. It should be patient-centred addressing the differing needs of every patient. Nurses should be well versed with the best strategies for offering patient education, nurses should be able to listen and allay all patients’ anxiety regarding any procedure to be performed.

Impact of pre-operative education on pain and satisfaction

Over the years the efficacy of pre-operative patient education has increased tremendously enabling and promoting a better patient outcome and impacting positively on their health. Currently a patient-centred approach is being adopted because of the diversity of clients in order to achieve the objective and goals of health care which is provision of safe and quality care. Nowadays patient are actively involved in the surgical choices and overall health choices. Gone are the days when information was withheld from the client, now the client is given all the information associated with the surgical procedures they are undergoing and the expected outcome.

3.According to the literature review conducted from Medline and CINAHL sources my question is fully answered from the extensive research conducted on pre-operative patient education. The question answered is pre-operative patient education positively influences the outcome and patient’s impact on the surgical procedures performed. Patient are able to appreciate the effort put in place to ensure that they are the centre for attention, which is what should be in any health care setting.

Research should be further conducted to analyse the effectiveness of simulation involvement in ensuring a patient has a glimpse of what will happen to their bodies during the procedure. Simulation involvement entails an artificial real life scenario that the patient can be showed to and explained step by step by the lead surgeon on what will happen and the reason for the many complications that may be associated with the surgical procedures. This sounds scary especially in people who do not understand the human body; it can however be done as an option whereby the client can request to be shown a simulation of what will happen. In my opinion this will help the clients understand more about their condition and the reason for the surgical procedure.

The research design should be a qualitative analysis by use of a questionnaire whereby all patients who are confirmed candidates for surgical procedures. The question should entail be about how they would feel if they were to be shown a simulation of what  will happen during the surgery and what would happen complications are experienced. This analysis is used to determine the effectiveness of pre-operative simulation education. It would the set the pace for implementation of such a program or not.

Some of the ethical considerations related to such research studies are confidentiality, autonomy, veracity, confidentiality. The clients have to know the truth about the study and their confidentiality should be maintained, they also should be able to make choices whether to participate or not. Ethical consideration is very important aspect of research, because it enables the researcher to practice professionalism and protect the rights of the study subjects. Conducting research on any subject requires the subjects to be voluntarily involved without coercion and that is the purpose of ethics in research to ensure that rights of people are not violated.

References

A, L. (2009). Influence of preoperative patient education on the risk of dislocation after primary total hip arthroplasty. Athritis Rheuamtism:Pubmed, 4(61), 552-8.

Bouchard, R. (2010). [Impact of preoperative patient education on postoperative pain in consideration of the individual coping style]. Articles in German:Pubmed, 6(24), 575-86.

Guo, P. (2015). Preoperative education interventions to reduce anxiety and improve recovery among cardiac surgery patients: a review of randomised controlled trials. Journal of clinical nursing,, 1-2(24), 34-46.

K, L. A. (2018). Immediate preoperative outcomes of pain neuroscience for patients undergoing total knee arthroplasty. A case series . Physiotherapy Theory & Practice, 1-11.

L, G. (2015). Preoperative Education: A Patient-Centered Care Approach. USF Scholarship: a digital repository @ Gleeson Library |, 2-10.

Oates, J. W. (2000). The impact of patient-centered care on outcomes. Fam Pract,, 9(49), 796-804.

Rothrock, J. C. (2014). Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences.