course materials

1. PREOPERATIVE EDUCATION USING ONE-ON-ONE COUNSELING ESSAY
EXAMPLE
PREOPERATIVE EDUCATION USING ONE-ON-ONE COUNSELING ESSAY EXAMPLEORDER
NOW FOR COMPREHENSIVE SOLUTION PAPERS ON PREOPERATIVE EDUCATION USING
ONE-ON-ONE COUNSELING ESSAY EXAMPLEPREOPERATIVE EDUCATION USING ONE-ON-
ONE COUNSELINGbyAnnie Daniel, MSN NP-BC Capstone Paper submitted in partial
fulfillment of therequirements for the degree of Doctor of Nursing Practice Chatham
University Date
Signature Faculty
Reader Date
Signature Program
Director Date AcknowledgmentsI would like to first acknowledge GOD
for his grace, mercy, and blessings. I know that without GOD I would not have or be able to
accomplish anything. I would like to acknowledge my faithful family and friends that were
patient with me during this journey. To my beloved husband Daniel and my kids Rhema,
Rebecca and Ryan, thank you all for being understanding of my tight time constraints due to
school and work obligations. I would like to acknowledge my mom and dad for praying for
me everyday and encouraging me all the time. I would like to acknowledge Dr. Sandra, for
taking the time to precept me and always being available to meet and talk with me during
this journey. Thank you, Chatham University staff, for being do helpful and willing to give
me your time so I can truly understand the process. PREOPERATIVE EDUCATION USING
ONE-ON-ONE COUNSELING ESSAY EXAMPLE Abstract Start typing here…. Key
words: ORDER NOW FOR COMPREHENSIVE SOLUTION PAPERSTable of
ContentsAcknowledgments………………………………………………………………………………………………
………………………
XDedication………………………………………………………………………………………………………………………
XAbstract………………………………………………………………………………………………………………………
XChapter One: Overview of the Problem of
Interest………………………………………………………………………………………………………………………
XBackground
Information………………………………………………………………………………………………………………………
XSignificance of the
Problem………………………………………………………………………………………………………………………

2. XQuestion Guiding Inquiry
(PICO)………………………………………………………………………………………………………………………
XVariables of the PICO
question……………………………………………………………………………………………………………
XSummary………………………………………………………………………………………………………………………
XChapter Two: Review of the
Literature/Evidence…………………………………………………………………………………………………………
……………
XMethodology……………………………………………………………………………………………………………………
… XSampling
strategies……………………………………………………………………………………………………………
XInclusion/Exclusion
criteria…………………………………………………………………………………………………………… XLiterature
Review
Findings………………………………………………………………………………………………………………………
XDiscussion………………………………………………………………………………………………………………………
XLimitation of literature
review…………………………………………………………………………………………………………….
XConclusions of
findings…………………………………………………………………………………………………………… XPotential
practice change……………………………………………………………………………………………………………
XSummary………………………………………………………………………………………………………………………
XChapter Three: Theory and Model for Evidence-based
Practice………………………………………………………………………………………………………………………
XTheory………………………………………………………………………………………………………………………
XApplication to practice
change…………………………………………………………………………………………………………… XModel for
Evidence-Based Practice
………………………………………………………………………………………………………………………
XApplication to practice
change……………………………………………………………………………………………………………
XSummary………………………………………………………………………………………………………………………
XChapter Four: Pre-implementation
Plan………………………………………………………………………………………………………………………
XProject
Purpose………………………………………………………………………………………………………………………
XProject
Management……………………………………………………………………………………………………………………
… XOrganizational readiness for
change…………………………………………………………………………………………………………… XInter-
professional
collaboration…………………………………………………………………………………………………………… XRisk
management

3. assessment……………………………………………………………………………………………………………
XOrganizational approval
process…………………………………………………………………………………………………………… XUse of
information
technology……………………………………………………………………………………………………………
XMaterials Needed for
Project………………………………………………………………………………………………………………………
XPlans for Institutional Review Board
Approval………………………………………………………………………………………………………………………
XPlan for Project
Evaluation………………………………………………………………………………………………………………………
XPlan for demographic data
collection…………………………………………………………………………………………………………… XPlan for
outcome data collection and
measurement……………………………………………………………………………………………………………
XPlan for evaluation
tool……………………………………………………………………………………………………………………… XPlan
for data
analysis………………………………………………………………………………………………………………………
XPlan for data
management……………………………………………………………………………………………………………
XSummary………………………………………………………………………………………………………………………
XChapter Five: Implementation
Process………………………………………………………………………………………………………………………
XSetting………………………………………………………………………………………………………………………
XParticipants……………………………………………………………………………………………………………………
…
XRecruitment……………………………………………………………………………………………………………………
… XImplementation
Process………………………………………………………………………………………………………………………
XPlan
Variation………………………………………………………………………………………………………………………
XSummary………………………………………………………………………………………………………………………
XChapter Six: Evaluation and Outcomes of the Practice
Change………………………………………………………………………………………………………………………
XParticipant
Demographics……………………………………………………………………………………………………………………
… XTable or Figure
X……………………………………………………………………………………………………………………… XTable or
Figure X………………………………………………………………………………………………………………………
XOutcome
Findings………………………………………………………………………………………………………………………
XOutcome

4. One……………………………………………………………………………………………………………………… XTable
or Figure X………………………………………………………………………………………………………………………
XTable or Figure
X………………………………………………………………………………………………………………………
XSummary………………………………………………………………………………………………………………………
XChapter
Seven: Discussion……………………………………………………………………………………………………………
………… XRecommendations for Site to Sustain
Change………………………………………………………………………………………………………………………
XPlans for Dissemination of
Project………………………………………………………………………………………………………………………
XProject Links to Health Promotion/Population
Health………………………………………………………………………………………………………………………
XRole of DNP-Prepared Nurse Leader in
EBP……………………………………………………………………………………………………………………… XFuture
Projects Related to
Problem………………………………………………………………………………………………………………………
XImplications for Policy and Advocacy at All
Levels………………………………………………………………………………………………………………………
XSummary………………………………………………………………………………………………………………………
XChapter Eight: Final
Conclusion………………………………………………………………………………………………………………………
XClinical
Problem………………………………………………………………………………………………………………………
XEvidence
Base………………………………………………………………………………………………………………………
XTheory and Model for Evidence-based
Practice………………………………………………………………………………………………………………………
XProject
Management……………………………………………………………………………………………………………………
… XProject
Implementation…………………………………………………………………………………………………………………
…… XOutcome
Findings………………………………………………………………………………………………………………………
XDiscussion
Summary………………………………………………………………………………………………………………………
XFinal
Conclusions………………………………………………………………………………………………………………………
XReferences………………………………………………………………………………………………………………………
XAppendix
A: XXXXXX………………………………………………………………………………………………………………………
XAppendix
B: XXXXXX………………………………………………………………………………………………………………………

5. XAppendix
C: XXXXXX………………………………………………………………………………………………………………………
XAppendix
D: XXXXXX………………………………………………………………………………………………………………………
XAppendix
E: XXXXXX………………………………………………………………………………………………………………………
XAppendix
F: XXXXXX………………………………………………………………………………………………………………………
XAppendix
G: XXXXXX………………………………………………………………………………………………………………………
XPREOPERATIVE EDUCATION USING ONE-ON-ONE COUNSELING ESSAY EXAMPLEChapter
One: Overview of the Problem of InterestSurgery is an important event in an individual’s
life, impairing physical functioning thereby fear, anxiety and depression may be
experienced by the patient (Ramesh et al., 2017), In 2008, more than 22 million surgeries
were performed over 5,000 Ambulatory Surgery Centers in the United States. Surgery can
be a significant and potential danger to the patient’s health and may cause psychological
reactions such as anxiety (Gezer & Arslan, 2019). With thousands of patients having elective
surgery on a daily basis, it is essential that these patients are adequately prepared prior to
their surgery (Kruzik, 2009). Preoperative education is widely used by health-care
professionals all over the world to help patients prepare for their impending surgery and
postoperative needs (Spalding, 2004). Preoperative education is a key element of the
Enhanced Recovery After Surgery (ERAS) protocols and guidelines (Foss,
2011). Preoperative education leads to significant improvements in patient satisfaction,
surgical outcomes, and reduction in patient’s anxiety.Background InformationEach year, an
estimated 234 million major surgical procedures are conducted worldwide (Fink et al.,
2013). Evidence suggests that postsurgical complications occur in at least seven million
cases annually, resulting in up to one million deaths. These figures illustrate the tremendous
socio-economic burden associated with postoperative morbidity and mortality (Fink et al.,
2013). Patients suffer needlessly due to inadequate preoperative preparation and lack of
information regarding their postoperative course as indicated by reports of unexpected
pain, fatigue, and the inability to care for themselves (Fink et al., 2013). The prevention of
these postoperative complications is of the highest medical interest and importance. The
impact of well drafted standardized preoperative patient education will result in positive
postoperative outcomes (Fink et al., 2013). This suggests that there is a need for improved
efforts from all healthcare providers to step up and design preoperative educational
interventions for better patient preparedness, reduce their anxiety and post-operative
complications.In late 2016, the American College of Surgeons (ACS) became the national
home for Strong for Surgery which is a pre-surgical health optimization program (American
College of Surgeons, 2016). The ACS has begun administering and promoting STRONG as a
quality initiative aimed at identifying and evaluating evidence-based practices to prepare
and optimize the health of patients before their operations. Strong for Surgery was
developed by surgeons and empowers hospitals and clinics to integrate checklists into the
preoperative phase of clinical practice for elective operations. These checklists are used to

6. screen patients for potential risk factors that can lead to surgical complications, and to
provide appropriate interventions to ensure better surgical outcomes (American College of
Surgeons, 2016). PREOPERATIVE EDUCATION USING ONE-ON-ONE COUNSELING ESSAY
EXAMPLEThe project implementer’s clinical practice site is an inpatient facility which
conducts approximately 40 surgeries a day, including same-day surgery and inpatients. In
the project implementer’s clinical practice site only about 50 % of the patients are told by
their surgeons to come to the pre-surgical testing area prior to their elective surgery. The
preoperative surgical patients either come 1 to 2 days before their surgery, but the majority
of them arrive on the day of their surgery. As a result, these patients are not be given the
adequate preoperative counseling. Even if they receive preoperative counseling, there is
less time for them to be prepared; for example, proper preoperative diet, exercise,
medication management, smoking cessation, and co-morbidities such as diabetes and
hypertension to be under control.The key principles of the ERAS protocol include
preoperative counseling, preoperative nutrition, avoidance of perioperative fasting and
clear liquids up to 2 hours preop. But according to traditional surgical doctrine patients are
instructed to take nothing by mouth (NPO) from mid night by the surgeons to avoid
pulmonary aspiration after elective surgery; however, there is no evidence to support this.
Melnyk, Casey, Black and Koupparis (2011) stated that, preoperative fasting actually
increases the metabolic stress, hyperglycemia and insulin resistance, which the body is
already prone to during the surgical process. Despite the significant body of evidence
indicating that ERAS protocols lead to improved outcomes, the ERAS protocols challenge
traditional surgical doctrine, and as a result, their implementation has been slow (Melnyk,
Casey, Black and Koupparis, 2011). PREOPERATIVE EDUCATION USING ONE-ON-ONE
COUNSELING ESSAY EXAMPLEORDER NOW FOR COMPREHENSIVE SOLUTION
PAPERSSignificance of Clinical ProblemPatients must be appropriately educated before any
surgical procedure to ensure they understand the complete process and to improve surgical
outcomes (Wunderle, Bena & McClelland, 2017). When patients are not adequately
prepared for surgery, there is a high chance that their surgery can be canceled on the day of
surgery. Surgery cancelations on the operative day cause a huge impact on the
organizational effectiveness and the patient satisfaction.Further, preoperative education
plays a major role in prevention of post operative complications. Complications such as
Surgical Site Infection (SSI) increase the length of the patient’s stay. The Center for Disease
Control (CDC) health care – associated infection (HAI) prevalence survey found that there
were an estimated 157,500 surgical site infections (1.9%) in 2008 among the inpatient
surgical patients (CDC, 2018). Surgical site infections remain a substantial cause of
morbidity, prolonged hospitalization and mortality of the patients. The implementer’s
clinical practice site’s SSI task force data showed that the SSI rates among surgical patients
was 2.2% in 2017. The preoperative education provides information to patients regarding
the measures that can be used to prevent post-operative complications. A well-designed
preoperative education with emphasis on SSI prevention measures such as usage of
Hibiclens showering prior to surgery, hand hygiene and wound care may result in decrease
rate of SSIs.Other postoperative complications such as venous thromboembolism (VTE)
including deep vein thrombosis (DVT) and pulmonary embolism (PE) affects an estimated

7. 300,000-600,000 individuals in the U.S each year causing significant mortality and
morbidity (Beckman et al., 2010). VTE is a leading cause of preventable hospital death in the
Unites Stated (CDC, 2015). VTE is the fifth most frequent reason for unplanned hospital
readmissions after surgery (CDC, 2015). A recent study of almost 500,000 surgeries
performed at Department of Affairs (VA) hospitals found that about 4 in 10 patients
developed VTE after surgery while they were still in hospital and approximately 6 in 10
surgical patients developed VTE up to 90 days after discharge from hospital (CDC, 2015).
The implementer’s clinical practice site performance improvement (PI) data reported a
significant increase in VTE rates in 2017. Preoperative education plays a major role in
educating patients in prevention of such complications. Preoperative education regarding
the early ambulation after surgery helps the patient to be more compliant, thereby reducing
the risk of VTE.In addition, Oshodi (2007) suggested that preoperative information about
surgical procedures and outcomes alleviates patient anxieties, lessens the need for
postoperative analgesia, and allows the patient to be discharged earlier. The patients when
educated before surgery know what to expect after their procedure, such as pain. Through
preoperative education, the capability of patients to take care of themselves improves
through meeting their postoperative self-care needs at home (Oshodi, 2007). For example,
information about appropriate behavior after discharge (mobility, exercise, relaxation,
appropriate diet or adequate pain control) will facilitate full recovery and prevents
postoperative complications.Question guiding inquiry (PICO). A clinical question needs to
be relevant to the patient or problem in the current practice, it should facilitate the search
for the solution. PICO makes the search process easier. The formulation of a question used
to challenge a current practice and provide evidence for new practice change is called a
“PICO” question. The “P” stands for patient or problem, “I” for intervention, “C” for
control/comparison and “O” for outcome. (Melnyk & Fineout-Overholt, 2015). The PICO
question that guided a literature inquiry for the problem of surgical patients is: In pre-
surgical patients, does individualized one-on-one pre-operative counseling decrease the
post-operative complications?Variables of the PICO questionPopulation. The population of
interest was individuals eighteen years of age and older located in New Jersey. Patients
who participated were scheduled for ortho-spine procedures and was not limited by
gender, education, nationality, religion, ethnicity, or race. The targeted population of
interest that participated in the EBP change project were 18 years of age and
older. PREOPERATIVE EDUCATION USING ONE-ON-ONE COUNSELING ESSAY
EXAMPLEIntervention. The intervention for this project was the implementation of
individualized one-on-one pre-operative counseling. Educational materials and a question
and answer session were offered during the educational session.Comparison. There was no
comparison group, but a comparison was made to assess the fear and anxiety of pre-
surgical patients. There was a pre-test given before the start of the educational session.
Immediately after the educational session, the participant was given a surgical fear post-
test to determine if there were a decrease in fear and anxiety.Outcomes. Knowledge is the
first step of prevention; therefore, the intended outcome of the EBP change project is to
reveal if an increase in knowledge and decrease in fear occurred by comparing the pre-test
and post-test scores after the educational sessions.SummaryPreoperative education

8. provides the surgical patients with the pertinent information concerning the surgical
process and the intended surgical procedures, as well as anticipated patient behaviors (e.g.,
anxiety, fear); expected sensations; and probable surgical outcomes (Kruzik, 2009).
Preoperative teaching plays a vital role in preoperative, intraoperative and postoperative
management of patient. The preoperative education can help patients to be prepared for
surgery, to decrease post-operative pain, reduce length of stay, decrease anxiety and
increase patient satisfaction (Garretson, 2004). Lack of preoperative education can lead to
postoperative complications such as DVT, SSI. Chapter Two: Review of the
LiteraturePreoperative education includes instruction about the preoperative period, the
surgery itself, and the postoperative period. Patients who undergo surgical procedures
experience a high level of stress and anxiety, which could have negative consequences on
post-operative outcomes. Patient education appears to be effective in improving knowledge
and reducing days of stay at the hospital (Chevillon, Hellyar, Madani, Kerr and Chae, 2015).
The goal of preoperative education is to not only prepare the patient for their surgery, but
also to prepare them for what to expect following the surgery. Patient preparedness for
surgery has important implications for patient satisfaction and the perception of
improvement after surgery (Greene et al., 2017). PREOPERATIVE EDUCATION USING ONE-
ON-ONE COUNSELING ESSAY EXAMPLEAnxiety has been noted among patients who have
been waiting for scheduled procedures ( Harkness, Morrow, Smith, Kiczula, and Arthur,
2003). Nurse-initiated preoperational education and counseling was associated with a
reduced rate of perioperative complications and a reduced level of anxiety following
surgery (Ji et al., 2012). Therefore, it is crucial that the patients are adequately educated and
prepared for their surgery. To this end, various types of preoperative education have been
evaluated to help reduce patient’s anxiety and complications after surgery. The purpose of
this paper is to provide an overview of the literature regarding preoperative education. This
chapter will review the literature regarding specific interventions utilized in preoperative
education.MethodologyIn order to study the concept of preoperative education and its
importance in patient preparedness, a comprehensive literature review was performed.
After considering the concept and perusing several articles through the online library and
databases, the decision was made on the possible search terms that will be covered to find
scholarly articles on preoperative education and its importance in preparing the patients.
The selection of the literature was based on the level of evidence and the relevancy to the
EBP change project.Sampling strategies. The databases searched for the literature review
were as follows: ProMED , CINAHL Complete, the allied and complementary medicine
database (AMED), EBSCO Host, PyscINFO, the Cochrane Database of Systematic Reviews on
preoperative education. The key terms included preoperative teaching, preoperative
education, preoperative preparation, surgery preparedness, preoperative teaching and
anxiety, preoperative education and surgery, preoperative teaching and surgical site
infection, preoperative education and postoperative complications using the Boolean
operator AND. Google scholar search was also performed to include possible additional
literature. Please see Appendix A for the Literature Search Strategy Log.Inclusion
/Exclusion Criteria. After performing a literature review, titles were reviewed for relevance.
If the title was unclear, the abstract was reviewed. Articles were included for further review

9. if they related to preoperative education and preoperative teaching. Exclusion criteria
included articles not in English and published prior to 2012.A hierarchical rating system for
evaluation of strength of the evidence was used in evaluating articles for inclusion or
exclusion. As part of the EBP process, assessing individual articles for strength of the
evidence is appropriate to ensure that findings are “best evidence” (Melnyk & Fineout-
Overholt, 2015, p. 11). Articles were ranked according to the following Rating System for
the Hierarchy of Evidence for Intervention/Treatment Questions:Level I: Evidence from a
systematic review or meta-analysis of all relevant RCTsLevel II: Evidence from well-
designed RCTsLevel III: Evidence obtained from well-designed controlled trials without
randomizationLevel IV: Evidence from well-designed case-control and cohort studiesLevel
V: Evidence from systematic reviews of descriptive and qualitative studiesLevel VI:
Evidence from single descriptive or qualitative studiesLevel VII: Evidence from the opinion
of authorities and/or reports of expert committees(Melnyk & Fineout-Overholt, 2015, p.
11).Articles from Level I through Level VI were considered for inclusion. The total number
of articles reviewed was 695. Of those, the total number kept for inclusion was
30.Literature Review FindingsIn many institutions, when a patient is scheduled for surgery,
the patient is contacted before the procedure and given instructions as to how to prepare
for the surgery. Preoperative anxiety is a common occurrence leading up to procedures in a
hospital setting, owing to fear of the unknown and loss of control, and may cause an array of
detrimental physiological effects (Chevillon, Hellyar, Madani, Kerr, and Son Chae,
2015).Preoperative education may be done by staff from the surgeon’s office or staff at the
institution where the surgery will be performed. Some institutions also send written
instructions. Often the patient is anxious and may have difficulty understanding or
remembering the instructions. It has been repeatedly proven a well instituted preoperative
education reduces anxiety, and post-operative complications (Greene et al., 2017). It is
essential in helping pre-surgical patients cope with these changes and to recover quickly
after surgery. Surgical patients who perceive they did not receive proper
preoperative education experience more dissatisfaction after surgery and have greater
difficulty understanding the changes they face (Guo, 2015).According to Chevillion et
al. (2015) patient education appeared to be effective in improving knowledge and reducing
days of mechanical ventilation. Preoperative pain neuroscience education (NE) for lumbar
radiculopathy resulted in significant behavior change. Despite a similar pain and functional
trajectory during the 1-year trial, patients with LS who received NE viewed their surgical
experience more favorably and used less health care facility in the form of medical tests and
treatments (Louw, Diener, Landers and Puentedura 2014)Preoperative education is a broad
term that encompasses many modalities. Common preoperative teaching techniques
include a) instructional printed material, b)one-on-one sessions, c) group classes, d)
seminars, e) counseling, f) video tapes, g) picture guides, h) online apps, and i)YouTube
videos. The amount of pre-surgical information and education to which a patient is exposed
has shown to improve the patient’s overall anxiety and stress levels (Gadler, 2016;
Liebner 2015). It also highlights the need for incorporating education into all phases of the
perioperative process, beginning in the preoperative period. Perioperative educators
should address all learning styles that provide education in a simple and cost-effective way

10. to appeal to all patients and help to reduce postoperative complications and increase
patient satisfaction. PREOPERATIVE EDUCATION USING ONE-ON-ONE COUNSELING ESSAY
EXAMPLEOne-on-one education and individual teaching can decrease their anxiety and gain
reassurance while allowing patients to obtain specific information more pertinent to
them.According to Kalogianni et al. (2016), preoperative education delivered by the nurses
reduced anxiety and postoperative complications of patients undergoing surgery. By
providing preoperative education by inpatient urology RN decreased patients’ anxiety,
answered their questions, and introduced the urinary catheter and leg bag. This helps
patients develop confidence and autonomy after hospital discharge (Delano,
2017).According to Guo et al. (2012) Chinese patients undergoing cardiac surgery who
received preoperative education experienced a greater decrease in anxiety score (mean
difference ?3.6 points, 95% confidence interval ?4.62 to ?2.57; P <0.001) and a greater
decrease in depression score (mean difference ?2.1 points, 95% CI ?3.19 to ?0.92; P <0.001)
compared with those who did not. There was no difference between groups in average pain,
current pain, and interference in general activity, mood and walking ability. Patients
randomized to the preoperative education group reported less interference from pain in
sleeping (mean difference ?0.9 points, 95% CI ?1.63 to ?0.16; P =0.02).Chevillon et al.
(2015) evaluated the impact of multifaceted preoperative patient education on
postoperative delirium, anxiety, and knowledge and to explore predictors of postoperative
delirium, days of mechanical ventilation, and days in the intensive care unit (ICU) among
patients undergoing pulmonary thromboendarterectomy. A prospective, randomized
controlled trial was conducted on consented patients from October 2011 to April 2013.
Patients were randomized in a 1 to 1 ratio to receive either an individualized 45-minute
multifaceted preoperative education (experimental group, n = 63) or standard education
(control group, n = 66). Participants completed the State-Trait Anxiety Inventory and
Knowledge Test before and after the education. Data on incidence of delirium, days of
mechanical ventilation, ICU days, and cardiopulmonary parameters were collected. The
experimental group had significantly more knowledge about postoperative care (P< .001)
and fewer days of mechanical ventilation (P= .04) than the control group. The patient
education appeared to be effective in improving knowledge and reducing days of
mechanical ventilation.Wunderle, Bena, & McClelland ( 2017) in their systematic review of
the sample patient’s EMR found that patients who were given tailored preoperative
education felt empowered than the general group of patients. Tailored preoperative
education increased patients’ comfort and willingness to contact providers, which may have
resulted in improved outcomes. Preoperative education offers patient undergoing surgery
with relevant information regarding their surgery and thereby minimize their worry and
anxiety (Ramesh et al., 2017).Zhang et al. (2012) conducted prospective and randomized
trial, 40 patients were divided into the study and control groups. All patients received
standard preoperative and postoperative care, but the study group patients also completed
a structured education and counseling course supervised by designated nurses before
surgery. Anxiety symptoms were assessed by Zung’s self-rating anxiety scale (SAS) on the
day of admission and at three days after the surgery. Following surgery, the rate of
complications such as lower extremity edema, urinary retention, constipation, respiratory

11. infection, and deep venous thrombosis in the study group was lower than in the control
group (P < .05). The mean postoperative SAS scores in the study group was lower than in
the control group (40.1 [SD, 6.5] vs 48.9 [SD, 7.3]; P = .01), and the proportion of patients
with a SAS score greater than 40 in the study group was also lower than in the control
group (15% vs 45%, P = .041). Nurse-initiated preoperational education and counseling
were associated with a reduced rate of perioperative complications and a reduced level of
anxiety following CABG.Kalogianni and Brokalaki (2016) conducted randomized controlled
trials, the sample consisted of 395 patients (intervention group: 205, control group: 190).
Patients in the intervention group received preoperative education by specially trained
nurses and the control group received the standard information. The state of anxiety on the
day before surgery decreased only in the intervention group (34.0 (8.4) versus 36.9 (10.7);
P=0.001). The mean decrease in state score during the follow-up period was greater in the
intervention group (P=0.001). Lower proportions of chest infection were found in the
intervention group (10 (5.3) versus 1 (0.5); P=0.004). Preoperative education delivered by
nurses reduced anxiety and postoperative complications of patients undergoing cardiac
surgery.O’Donnell (2015) stated that patients who received the preoperative education
intervention reported less severe pain during the first 24 hours postoperatively,
experienced less pain medication and fewer side effects, returned to normal activities
sooner, and used more non pharmacologic pain management methods postoperatively
compared with those who did not receive the education.Printed education material can be
presented prior to surgery, during the hospital stay and/or after surgery, and post-
discharge. Studies discussed below show that preoperative teaching has a beneficial effect
on postoperative outcomes for patients. Based on the SAM methodology, printed dietary
guidelines may increase in suitability by emphasizing aspects related to health literacy and
accommodating the needs of different food cultures within a population (Garnweidner-
Holme, Dolvik, Frisvold and Mosdol 2016).According to Jacob et al (2016) the reading level
and understandability of many written patient education materials do not align with the
literacy and health literacy skills of the general population Patient education materials
should be created or revised that allow individuals with low literacy and physically
challenged to understand their condition. Sayin & Aksoy (2012) stated that the patients and
their family members wanted to be given more information about the surgical process than
they had received. Patients wanted more information about the intraoperative period,
whereas their family members wanted more information about the postoperative period.A
preoperative education class for patients undergoing prostatectomy and their caregivers
significantly reduced anxiety and increased confidence in the immediate postoperative
period. The group education class also increased patient satisfaction regarding at-home
urinary catheter care and post-discharge instructions (Bisbey, 2017). Gadler (2016)
demonstrated that take-home video education can improve patient knowledge retention
and reduce anxiety. Patients were satisfied with the deliv