Research Critiques and PICOT Statement Final Draft
Running head: RESEARCH CRITIQUE ON PREOPERATIVE EDUCATION AND PATIENT OUTCOMES 1
RESEARCH CRITIQUE ON PREOPERATIVE EDUCATION AND PATIENT OUTCOMES 2
Research Critique on Preoperative Education and Patient Outcomes
Preoperative patient education for surgery can be done at different times and by different methods. The purpose of this paper is to critique four research articles that show how different preoperative education methods affect patient outcomes. The first two research articles to be discussed are quantitative research papers Postoperative Instructions Preoperatively-Evaluating Effectiveness of a Teaching Model on Patient Satisfaction Regarding Instructions for Home Care and Preoperative Education Reduces Preoperative Anxiety in Cancer Patients Undergoing Surgery: Usefulness of the Self-Reported Beck Anxiety Inventory. Additionally, two qualitative research studies will be discussed, A Multidisciplinary Preoperative Teaching Session for Women Awaiting Breast Cancer Surgery: A Quality Improvement Initiative. Rehabilitation Process and Outcome and A Qualitative Study of Patient Education Needs for Hip and Knee Replacement. This paper will discuss how these four studies relate to the PICOT question, nursing practice and their ethical considerations. The author will critique the four articles and answer the PICOT statement about preoperative patient education and its effects on patient outcomes.
Nursing Practice Problem and PICOT Statement
Many surgery patients experience fear and anxiety associated with their surgery that results in low patient satisfaction scores and poor postoperative outcomes. Prior research has shown that preoperative teaching that includes postoperative care is effective in reducing fear and anxiety in surgery patients. Surgery can be a difficult experience for many patients with fear of the unknown.
The PICOT statement asks a question related to preoperative patient education. In a 66-year old woman scheduled for hip-replacement surgery, will preoperative patient education as compared to no preoperative patient education improve patient outcomes over a 1-month time frame? The patient in the scenario shares many similarities to a typical surgery patient including a high anxiety level and fear of the unknown due to scant preoperative education. She is unsure of what to expect during the surgery and the postoperative requirements. Analyzing both quantitative and qualitative research articles will help answer the PICOT question.
Background of Study
The first quantitative research article by Hovsepian, McGah & O’Brien (2017) aimed to increase patient satisfaction scores for discharge teaching and improve retention of home care instructions. They were not meeting their goals for patient satisfaction for discharge teaching at their outpatient surgery facility where they serve a diverse patient population in Massachusetts. The researchers felt moving the timing of Post Anesthesia Care Unit (PACU) teaching to the preoperative area and delivering the information via multiple methods would lead to improving these outcomes (Hovsepian, McGah & O’Brien, 2017). The second quantitative study looked at the efficacy of preoperative education in reducing the anxiety of cancer patients undergoing surgical treatment under general anesthesia for endometrial cancer. Researchers conducted the short-term observational study that was conducted at the National Cancer Institute in Brazil (Lemos et al., 2019).
The first qualitative research article also addressed the fear and anxiety for their patients who were scheduled for breast cancer surgery at their facility in Montreal, Canada (Ibrahim et al., 2018). The goal of their study was to assess the introduction of a multidisciplinary approach to preoperative education. The second qualitative research article was performed in a large Canadian orthopedic center which specialized in joint replacement surgeries. The researcher’s purpose was to provide their patients with quality health information that would increase patient engagement and increase self-management while enhancing the healthcare experience by involving the patient’s family. The study aimed to assess their informational needs and delivery preferences (Kennedy et al., 2017).
Method of Study
The first quantitative article aimed to improve postoperative care for surgery patients by creating a multimodality process targeting several approaches to improve how patients get the information needed for discharge such as videos, medication sheets, and creating a designated teaching room (Hovsepian, McGah & O'Brien, 2017). Researchers collected quantitative data for analysis to assess the efficacy of the multimodal postoperative teaching in the preoperative phase program by analyzing the patient satisfaction questionnaire scores. The researchers compared 6 months of results from their patients who responded to the specific patient satisfaction questionnaires. The study included 175 patients who were taught postoperative instructions in the preoperative phase and 257 patients who were taught in the postoperative phase (Hovsepian, McGah & O'Brien, 2017). The research approach was appropriate to this study as it aimed to raise those specific scores. The second quantitative study by Lemos et al. (2019) who conducted a short-term quantitative study to evaluate the effects the preoperative education based on the Beck Anxiety Index (BAI) as well as on hemodynamic values such as heart rate and blood pressure. The study sample included 72 female patients with endometrial cancer who were scheduled to undergo surgical treatment under general anesthesia. The quantitative approach was appropriate as it was intended to evaluate the effects of the preoperative education on the quantitative measures.
The first qualitative study by Ibrahim et al. (2018) assessed the efficacy of the multidisciplinary preoperative teaching program. The preoperative breast cancer education sessions were delivered in group settings. The data was collected through a researcher-developed two item questionnaire administered at two points: before and after teaching sessions to compare the participants anxiety and knowledge levels (Ibrahim et al., 2018). This approach was appropriate to the study as they intended to gain the patient’s perspective typical of phenomenological research. The second qualitative study was conducted to elicit patient experiences for development of effective strategies for education along the care continuum for hip and knee replacement. The study sample was divided into six focus groups and telephone interviews were conducted with 32 participants (Kennedy et al., 2017). The qualitative approach was appropriate as it was intended to view the education from an individual perspective indicative of phenomenological research.
Results of Study
The quantitative research studies were both great examples of evidence-based research that contribute to the knowledge base for improving patient education prior to surgery. The study done in Massachusetts indicated that providing home care instructions before surgery is the optimal time for patient teaching (Hovsepian, McGah & O'Brien, 2017). The researchers concluded that when postoperative teaching is done in the preoperative period before receiving any medication, the patients had higher satisfaction and felt more prepared for discharge home (Hovsepian, McGah & O'Brien, 2017). The key findings of the study done in Brazil were the BAI scores of preoperative cancer patients that were significantly reduced with the preoperative education. Blood pressure and heart rate were also significantly improved when patients received preoperative education (Lemos et al., 2019).
The results of both the qualitative research articles also showed the need for better preoperative education. The researchers in Montreal, Canada collected qualitative data to assess the efficacy of their multidisciplinary preoperative teaching program. The preoperative breast cancer education sessions were delivered in group settings. The facility implemented a preoperative education team from many health care disciplines including nursing, occupational therapy, and physiotherapy (Ibrahim et al., 2018). The Canadian orthopedic research study conducted a qualitative study with a study sample divided into six focus groups and telephone interviews were performed with 32 participants. The study data was coded and organized into four main themes: 1.) Education gaps relating to pain management; 2.) Participant’s validation of existing organizational education materials; 3.) Informal sources of information; and 4.) Interest in new delivery modes for education, such as mobile health applications (Kennedy et al., 2017).
Ethical Considerations
All four of the research articles followed standard and local ethics protocols for research studies. Ethical considerations for the study conducted in Massachusetts were not mentioned but the article did state the facilities Internal Review Boards formal policy does not require review of this type of quality improvement initiative (Hovsepian, McGah & O'Brien, 2017). Lemos et al. (2019) obtained approval from the local Institutional Review Board of the National Cancer Institute in Brazil where the study took place and patients signed an informed consent. Ethical considerations for the study conducted in Montreal were in accordance with the facilities quality improvement activities under the Quality Program. As such, all participants were informed that they were participating; all data collected was kept anonymously to protect patient privacy and all procedures performed in the study involving human subjects in accordance with established ethical standards (Ibrahim et al., 2018). The researchers at the large Canadian orthopedic surgery center did obtain approval from the local research ethics board and all study participants consented to their participation.
Link between Research, Practice Problem, and PICOT
The link between the research, the problem of inadequate preoperative patient education and the PICOT question has been identified. All four studies mentioned the significant benefits of preoperative patient education that includes postoperative teaching has on surgery patients fear, anxiety, patient experience and postoperative outcomes. The research supports a need to make a change in practice where both patients and healthcare organizations will benefit.
The patient in the PICOT scenario would benefit from a more thorough preoperative patient education experience. One that would include PACU teaching as well as the information to be delivered by a multidisciplinary team and with multiple methods tailored to her learning preferences. In this scenario, the preoperative teaching could have been done in the patients preferred method prior to the surgery date in order to minimize anxiety, reduce fear and have better prepared her for discharge home.
Proposed Change of Practice
Successfully preparing patients for a stressful event such as surgery can be done in a more effective manner. It should be proposed to standardize the preoperative patient education process to include PACU teaching prior to surgery. The preoperative education should be offered to the patient at the time of scheduling and in multiple delivery methods such as written, verbal, video and face to face interaction based upon the patient’s preferred learning style. Surgery patients need to know about pain management, physical therapy, diet and physical restrictions as well as have the chance to have their questions answered. This form of preoperative patient education will decrease fear, anxiety and increase patient satisfaction.
Conclusion
In conclusion, a change in practice such as this has many barriers. The evidence presented in the four articles discussed, were great examples of medically ethical and evidence-based research that contributes to the knowledge base for improving patient education prior to surgery. The goal of all healthcare providers should be to serve and care for the patient in the best way possible. Preoperative education is a major component for surgery patients. Preoperative patient education that includes PACU teaching and that is delivered in the patient’s preferred method for learning is paramount for ensuring the best patient experience and improved patient outcomes.
References
Hovsepian, J., Mcgah, C., & Obrien, C. (2017). Postoperative Instructions Preoperatively—Evaluating the Effectiveness of a Teaching Model on Patient Satisfaction Regarding Instructions for Home Care. Journal of PeriAnesthesia Nursing,32(3), 231-237. doi: 10.1016/j.jopan.2015.12.014
Ibrahim, M., Lau, G. J., Smirnow, N., Buono, A. T., Cooke, A., Gartshore, K., . . . Johnson, K. (2018). A Multidisciplinary Preoperative Teaching Session for Women Awaiting Breast Cancer Surgery: A Quality Improvement Initiative. Rehabilitation Process and Outcome, 7, 117957271879093. doi:10.1177/1179572718790937
Kennedy, D., Wainwright, A., Pereira, L., Robarts, S., Dickson, P., Christian, J., & Webster, F. (2017). A qualitative study of patient education needs for hip and knee replacement. BMC Musculoskeletal Disorders, 18, 1–7.
Lemos, M. F., Lemos-Neto, S. V., Barrucand, L., Verçosa, N., & Tibirica, E. (2019). Preoperative education reduces preoperative anxiety in cancer patients undergoing surgery: Usefulness of the self-reported Beck anxiety inventory. Brazilian Journal of Anesthesiology (English Edition), 69(1), 1-6. doi: 10.1016/j.bjane.2018.07.004