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Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
Evidence based practice share
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Evidence based practice share

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  • Chest PTTed Hose / SCDAmbulationDietBowel / UrineDischarge
    3.8753.2543.7543.75
  • Chest PTTed Hose / SCDAmbulationDietBowel / UrineDischarge
    3.8753.2543.7543.75
  • Transcript

    • 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
    • 2. Clinical Practice Problem
    • 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.
    • 5. Baseline Pre-operative Teaching 100% 90% 80% 70% % Patients 60% n=25 50% Pre-Intervention 40% 30% 20% 10% 0% Yes, No, Pre-op Pre-op Teaching 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?
    • 10. Interventions
    • 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.
    • 12. 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
    • 13. 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.
    • 15. Outcomes
    • 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.
    • 17. RN Survey Results
    • 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
    • 25. Results: Overall Patient Knowledge & Patient/Family Engagement Reported by Nurses 4 3 2 1 Overall Knowledge Patient Engagement Family Engagement
    • 26. Patient Survey Results
    • 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
    • 32. Results: Overall Effectiveness of DVD Reported by Patient 4 3 2 1 Prepared Patient Prepared Family Overall
    • 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
    • 37. Questions

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