Effect of a Pre-operative Instructional DVD

on Patient Knowledge and Preparedness for Engaging in

Post-operative Care Activities

Joe Ong, RN, MSNStaff Nurse Evidence-based Practice Fellow

July 2007

Clinical Clinical Practice Practice ProblemProblem

Clinical Issues• Inconsistencies regarding pre-operative

instruction for thoracic surgical patients existed.• Lack of knowledge and ability of patients to

engage in post-operative care activities, for example:– Ambulating– Pain management, etc.

• This can lead to an in patient anxiety, a potential in post-operative complications, and an in length of stay.

Existing Practice

• Ideally, a written pre-operative instructional handout was to be given during the pre-operative surgical visit.

• Baseline data indicated that 23 out of 25 (92%) of patients did not receive the written handout;

• Therefore, patients had a lack of knowledge and preparedness to engage in post-operative care activities.

• Thus, the challenge was to develop structures and processes so that thoracic surgical patients would consistently receive thorough pre-operative teaching.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yes, Pre-op

Teaching

No, Pre-op

Teaching

Pre-Intervention

Baseline Pre-operative Teaching

% Patients n=25

What does the Research and Evidence Tell Us?

• Evidence supports the benefit of pre-operative teaching in anxiety & complications and recovery.

• Well-informed patients are more likely to experience positive outcomes & satisfaction with their care.

• Evidence supports the use of video-teaching vs. routine care as an effective teaching method that resulted in a in post-operative complications & LOS in CABG patients (Shaban et al., 2002).

Why Use DVD Technology for Teaching?

• Benefits patients who are able to refer back to and review the information.

• Timing of teaching is best when the DVD is viewed at home before the operation and in a less stressful environment.

• Pre-operative teaching should be provided close to the time of surgery.

• Teaching should not be provided too early--Otherwise, patients will forget.

Evidence-based Articles

• Whyte, R. & Grant, P. (2005). Preoperative p[atient education in thoracic surgery. Thoracic Surgery Clinics, 15(2), 195-201.

• Oektker-Black, A., Jones, S., Estok, P. et al. (2003). Preoperative teaching and hysterectomy outcomes. Association of Operating Room Nurses Journal, 77(6), 1215.

• Shaban M, Salsali M, Kamali P & Poormirza Kalhony R (2002) Assessment [sic] the effects of respiratory exercise education in acute respiratory complication and the length of patient hospitalization, for undergoing coronary artery by-pass surgery in Kermanshah Emam Ali Hospital [Farsi]. The Journal of Tehran Faculty of Nursing & Midwifery 8, 1-8.

• Doering, S., Katzlberger, F., Rumpold, G. et al. (2000). Videotape preparation of patients before hip replacement surgery reduces stress. American Psychosomatic Society, 62, 365-373.

Evidence-based Project Question

Among a population of Thoracic Surgical Patients who are on 4E MOU, what is the effect of a pre-operative instructional DVD on patients’ level of knowledge, preparedness & perceived ability to participate in post-operative care activities?

InterventionsInterventions

Interventions

• Developed a pre-operative instructional DVD for thoracic surgical patients that was evidence-based which prepared patients to engage in post-operative care activities.

• Created system changes by which patients were consistently provided with a pre-operative instructional DVD.

Pre-operative Instructional DVD• Instructional DVD content:

– Pain management– Surgical drainages– Vital signs– Incentive spirometer– Cough & Deep breathe– Chest PT– Ted hose/ SCD– Ambulation– Diet/Bowel activity/Urine output– Discharge

Pre-operative Instructional DVD

DVD Implementation • Assessed & implemented a process for the pre-operative

instructional DVD to be given to patients.

• Process included:– Pre-operative packet given to patients at their pre-operative

clinic visit.• Packet included DVD & survey to evaluate patients self reported

knowledge & preparedness for surgery.

– Mailing instructions to obtain completed patients surveys.– Collaborated w/ Clinic Staff & Nurse Specialist to assist in

providing patients w/ DVD & obtaining survey results.

OutcomesOutcomes

Outcomes

Two outcomes were measured:1. RN assessment of patient knowledge &

preparedness to engage in post-operative care activities.

– Pre-intervention– Post-intervention (data pending)*

2. Patient knowledge & perceived ability to participate in post-operative care activities.

RN Survey RN Survey ResultsResults

Demographic Characteristics of the Sample for Pre-intervention RN Survey

Variable

(n= 35)

No. % Gender Female Male Clinical Ladder CNI CNII CNIII

28 7 1 33 1

80 20 2.9 94.3 2.9

Demographic Characteristics of the Sample for Pre-intervention RN Survey

Variable No. % Shift days Days Nights Rotate Years of RN Experience Less than 1 year 1-5 years 6-10 years >10 years Work in Unit Less than 1 year 1-5 years 6-10 years >10 years

1 3 31

4 30 0 1 6 28 1 0

2.9 8.6 88.6

11.4 85.7

0 2.9

17.1 80.0 2.9 0

Results: Patient Knowledge of Post-operative Activities Reported by Nurses

The following slides report the mean results of RN responses on a Likert scale of 1 to 4, in the pre-intervention survey.

1= not knowledgeable2= somewhat knowledgeable3= knowledgeable4= very knowledgeable

• How KNOWLEDGEABLE do you feel your thoracic-surgical patients were about each of the following important aspects of post-operative care?

1

2

3

4

PainManagement

SurgicalDrainages

Vital Signs IncentiveSpirometer

Cough &Deep Breathe

Chest PT

Results: Patient Knowledge of Post-operative Activities Reported by Nurses

• How KNOWLEDGEABLE do you feel your thoracic-surgical patients were about each of the following important aspects of post-operative care?

1

2

3

4

Ted hose /SCD Ambulation Diet Bowel/Urine Discharge

Results: Patient Knowledge of Post-operative Activities Reported by Nurses

Results: Engagement Levels of Patients in Post-operative Activities Reported by Nurses

• The following slides report the mean results of RN responses on a Likert scale of 1 to 4, in the pre-intervention survey.

1= not engaged2= somewhat engaged3= engaged4= very engaged

• How ENGAGED do you feel your thoracic surgical patients were about each of the following important aspects of post-operative care?

1

2

3

4

PainManagement

IncentiveSpirometer

Cough/ DeepBreathe

Ted hose/SCD Ambulation Diet Discharge

Results: Engagement Levels of Patients in Post-operative Activities Reported by Nurses

Results: Overall Patient Knowledge & Patient/Family Engagement Reported by Nurses

1

2

3

4

Overall Knowledge Patient Engagement Family Engagement

Patient SurveyPatient SurveyResultsResults

Results: Understanding and Participation in Post-operative Activities Reported by Patients

• The following slides report the mean results of Patients responses on a Likert scale of 1 to 4, in the post-intervention survey.

1= I do not understand2= I understand a little3= I understand4= I understand very well

Results: Level of Understanding Post-DVD Reported by Patients

• How much do you UNDERSTAND about each of the following after viewing the pre-operative DVD?

1

2

3

4

PainManagement

SurgicalDrainages

Vital Signs IncentiveSpirometer

Cough/ DeepBreathe

• How much do you UNDERSTAND about each of the following after viewing the pre-operative DVD?

1

2

3

4

Chest PT Ted Hose /SCD

Ambulation Diet Bowel /Urine

Discharge

Results: Level of Understanding Post-DVD Reported by Patients

Results: Ability to Participate in Post-operative Activities Reported by Patients

• The following slides report the mean results of Patient responses on a Likert scale of 1 to 4, in the post-intervention survey.

1= not participate2= participate somewhat3= participate4= participate a great deal

• To what extent do you feel you will be able to PARTICIPATE in your post-operative care in each of these following areas after viewing the pre-operative DVD?

1

2

3

4

PainManagement

IncentiveSpirometer

Cough/ DeepBreathe

Ted Hose /SCD

Ambulation Diet Discharge

Results: Ability to Participate in Post-operative Activities Reported by Patients

Results: Overall Effectiveness of DVD Reported by Patient

1

2

3

4

Prepared Patient Prepared Family Overall

Lessons Learned

• Creating system changes continues to be a challenge.– The clinic, which is located off-

site, lacks an infrastructure to ensure the distribution of pre-operative teaching and educational materials.

Conclusions

• “The goal of patient teaching is to improve patients’ understanding of their disease process and the operation that they are about to experience with the goal of enlisting their active participation in the healing process.”

Whyte & Grant ,2005

• Nurses reported low levels of knowledge and patient/family engagement related to post-operative activities.

• A quality instructional media product was developed and determined to be effective in increasing pre-operative knowledge and preparedness for patients and their families.

Future Plans

• Obtain post-intervention surveys from nurses caring for thoracic surgical patients.

• Disseminate results to MOU Staff and Thoracic Surgical Physicians.

• Continue to work to facilitate patients and families consistently receiving Pre-operative DVD instructions.

• Disseminate results at Nursing Department Educational Forums: – Grand Rounds– PI– EBP Conference

• Consider submitting abstracts to conferences and publications.

Acknowledgements

• RR UCLA Medical Center• MOU Patients who

participated in the video• MOU Staff

– Penny De La Camara• Renee Appleby, RN

– Unit Director and Mentor• Thoracic surgeons

– Dr. Cameron– Dr. Lee– Dr. Maish– Dr. Maharaja

• UCLA Women’s Auxillary

• DVD Production Crew– Nancy Williams– Brian

• Thoracic Clinic Staff– Becky Allegretto, RN, MBA– Martha Martinez

• Heidi Crooks, RN, MN– Chief Nurse Executive

• Dr. Cathy Ward, RN, DNSc– Director, Inpatient Nursing

• Dr. Anna Gawlinski, RN, DNSc– Director, Evidence-Based Practice

Questions