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Evidence based practice share
1. Effect of a
Pre-operative Instructional DVD
on Patient Knowledge and Preparedness
for Engaging in
Post-operative Care Activities
Joe Ong, RN, MSN
Staff Nurse Evidence-based Practice Fellow
July 2007
3. 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.
4. 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.
6. 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).
7. 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.
8. 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.
9. 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?
11. 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.
14. 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.
16. 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.
18. Demographic Characteristics of
the Sample for Pre-intervention RN Survey
Variable
( n= 35)
No.
%
Gender
Female
Male
28
7
80
20
Clinical Ladder
CNI
CNII
CNIII
1
33
1
2.9
94.3
2.9
19. Demographic Characteristics of
the Sample for Pre-intervention RN Survey
Var iable
Shif t days
Days
Nights
Rotate
Year s of RN Ex per ience
Less than 1 year
1-5 years
6-10 years
> 10 years
No.
%
1
3
31
2.9
8.6
88.6
4
30
0
1
11.4
85.7
0
2.9
6
28
1
0
17.1
80.0
2.9
0
Wor k in Unit
Less than 1 year
1-5 years
6-10 years
> 10 years
20. 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 knowledgeable
2= somewhat knowledgeable
3= knowledgeable
4= very knowledgeable
21. 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?
4
3
2
1
Pain
Management
Surgical
Drainages
Vital Signs
Incentive
Spirometer
Cough &
Deep Breathe
Chest PT
22. 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?
4
3
2
1
Ted hose /SCD
Ambulation
Diet
Bowel/Urine
Discharge
23. 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 engaged
2= somewhat engaged
3= engaged
4= very engaged
24. Results: Engagement Levels of Patients in
Post-operative Activities Reported by Nurses
• How ENGAGED do you feel your thoracic
surgical patients were about each of the following
important aspects of post-operative care?
4
3
2
1
Pain
Management
Incentive
Spirometer
Cough/ Deep Ted hose/SCD
Breathe
Ambulation
Diet
Discharge
27. 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 understand
2= I understand a little
3= I understand
4= I understand very well
28. 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?
4
3
2
1
Pain
Management
Surgical
Drainages
Vital Signs
Incentive
Spirometer
Cough/ Deep
Breathe
29. 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?
4
3
2
1
Chest PT
Ted Hose / Ambulation
SCD
Diet
Bowel /
Urine
Discharge
30. 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 participate
2= participate somewhat
3= participate
4= participate a great deal
31. Results: Ability to Participate in
Post-operative Activities Reported by
Patients
• 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?
4
3
2
1
Pain
Management
Incentive
Spirometer
Cough/ Deep
Breathe
Ted Hose /
SCD
Ambulation
Diet
Discharge
33. Lessons Learned
• Creating system changes
continues to be a challenge.
– The clinic, which is located offsite, lacks an infrastructure to
ensure the distribution of preoperative teaching and
educational materials.
34. 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.
35. 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.
36. 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
