Critique of Article about Adult Nursing - Coursework Example

Introduction Background preoperative education for patients is becoming a routine feature for the preoperative preparation in most surgical procedures. It is expected that this will provide beneficial outcomes for the patient (Stern & Lockwood C, 2005). Many studies have evaluated the effectiveness of different methods to impart the information, and the effect that this has on a variety of patient outcomes (Stern & Lockwood C, 2005). While some studies point out that there is enough evidence that pre-operative information can reduce patients anxiety regarding surgery (Hughes, 2002) others feel that although preoperative educational interventions increased patients’ knowledge levels, it had limited effects on reducing their anxiety (Johansson et al. 2005). The paper under consideration studies the effect of preadmission information on patients, following laparoscopic cholecystectomy (LC). A brief summary of the report is followed by a critique of the paper, how the findings of the paper be integrated into practice, what has personally been learnt from this appraisal and the conclusion. Summary of the report Blay & Donoghue, 2006 studied the effect of preadmission information on patients in a domiciliary self-care in Sydney, Australia, between June 2000 and February 2002, for laparoscopic cholecystectomy (LC). The study involved 100 patients (79 male patients and 21 female patients) who were surveyed at preadmission, following an assessment by the preadmission nurse, anaesthetist, and a resident medical officer. A preoperative questionnaire was used to know about patient knowledge of LC surgery, postoperative recovery and the source of this knowledge. The questions included facts about LC surgery, length of hospital stay, return to normal lifestyle, postoperative pain expectations and pain management, postoperative nausea and vomiting, postoperative diet and postoperative complications. The sources of information provided included printed literature and informal channels of information. The study had 2 main objectives: first, to determine what information the preadmission nurses provided to patients scheduled to undergo a LC, and secondly to determine what additional information was provided to the LC patients and what the sources of information were. About 86% of patients reported having received some information about the procedure, while 14% said that they did not receive any information. About 47% of patients received verbal and written information, while 7% received only written information. The results indicated that the majority of patients (67%) expected to remain in the hospital for 1-2 days. Most patients (52%) felt that they would manage pain by analgesic medication, mainly paracetamol or paracetamol- codeine preparations. About 19% said they would contact their GP for assistance. Advice on nausea was provided to 5% and 2% received advice on vomiting. As much as 83% were not given advice on postoperative diet. Only about 43% of patients were informed about complications. Overall 73% were satisfied about the information that was received. The results indicated that the patient’s received information from multiple sources. When compared to other sources of information, it was found that the preadmission clinic nurses were more likely to provide information related to both the surgical procedure as well as the and length of hospital stay after laparoscopic cholecystectomy than about postoperative expectations and self care. The patients felt that in general it was the medical practioners who provide the most information. More specifically, 34% indicated their surgeon as the source of information; 33% indicated the surgical registrar/resident medical officer as the source of information; 23% indicated their general practioners as the source of information and 14% indicated their anaesthetist as the source of information. Strengths and weakness of the paper The study has shown the diversity of sources of information provision to patients scheduled for LC surgery, and in particular, the patient’s resourcefulness in obtaining information particular to their needs. The results show that preadmission nurses are more likely to give patients information regarding their surgery and hospital length of stay. This finding is similar to other studies. The study also reveals that patients considered their medical practioners to having given more information. These are the strengths of this study. The same authors in another study (Blay & Donoghue, 2005), primarily aimed to evaluate whether patient education before admission would help in reducing the pain intensity scores, increase domiciliary self-care capacity and lessen the post-operative symptoms following laparoscopic cholecystectomy (LC), in comparison to patients who received a standard pre-admission program (SP). The secondary objectives were to determine patient recall of provided information (Blay & Donoghue 2005.) The study found that in the post-operative period, patients who received education intervention (EI) experienced lower levels of pain, better domiciliary recovery and a better recall of provided information, when compared to patients who received a standard preadmission program (SP) (Blay & Donoghue 2005). However, the two groups did not show any difference with regard to domiciliary self-care (Blay & Donoghue 2005.) Group teaching has the advantages of being very effective, providing support and allowing questions to be asked; and involves the use of videotapes, CDs or DVDs (Freda 2004). Other methods of patient education involve the use of computer and Internet technology, and written information in the form of pamphlets (Freda, 2004). However, the sources of information provided to patients in this study were only printed literature and informal channels of information. Other sources of patient education were not considered. Therefore, not considering other sources of patient of information, is a definite weakness of the study. This paper also has not considered that there could be non-English patients who would not benefit from a pamphlet in English. According to a study by Stern & Lockwood 2005, although information pamphlets are the most common method of patient education, there is a need for pamphlets in people with limited English skills (Stern & Lockwood 2005). The authors also point out that there is also a need for more studies regarding this (Stern & Lockwood 2005). There are certain methodological flaws in the study. The study involved only 100 patients. A large sample size is needed to provide a representative group size and also enables to compare the efficacy of two or more treatment methods. Small numbers may have an impact on the power of statistical analysis (Polgar & Thomas, 2000). Well-designed randomised controlled trials (RCTs), confirming the same hypothesis, have, for many years, been recognized as providing the strongest level of evidence of the treatment effect of therapeutic interventions (Green & Byar, 1984). There is no mention in any study about a control group. Without a control group, it is not possible to assess if the effects observed were due to the treatment or due to other factors (Polgar & Thomas, 2000). There is no mention about the inclusion and exclusion criteria of patients selected for any of the studies. Appropriate identification of participants for a study enhances the quality of research and ensures accuracy of a study (Polgar& Thomas, 2000). The study also does not clearly address the issues of whether there was a perceived benefit from the perioperative patient education. It is not clear whether there was a decrease in postoperative pain scores, nausea, vomiting and other symptoms. This could have been addressed in detail with the use of pain related-surveys. There are very few studies conducted on this aspect. One such study by Watt-Watson et al. 2004, evaluated the use of analgesics and adequacy of post-discharge information in same-day surgery patients. The results indicated that moderate to severe pain was present in all patients and at all time periods. More significantly, most patients had not received information about analgesic use, with consequent inadequate pain relief and/or adverse events (Watt-Watson et al. 2004.) The authors concluded that analgesic use was inadequate in the post-discharge period. They also noted that more research on effective pain interventions and patient education on pain are required for day-surgery patients, following discharge. The study also does not address the patients need for pre-operative and postoperative information. One study by Lithner & Zilling, surveyed fifty patients admitted to open cholecystectomy (37 women and 13 men) with a median age of 49.5 years, ranging from 17-76 years. The patients answered one questionnaire both at admission and at discharge, and it involved answering 48 statements on a five-point, Likert scale. The results indicated that the patients admitted for cholecystectomy desired more information both at admission and at discharge. Specifically, the patients wanted information related to pain and post-operative symptoms after surgery. Thirty per cent of the patients wanted both written and verbal information. Other studies have also found that though preoperative patient education had an effect, the precise nature of the effect is not known (Johansson et al. 2005). Although preoperative educational interventions increased patients’ knowledge levels, it had limited effects on reducing their anxiety (Johansson et al. 2005.) How the findings of the paper be integrated into practice In this study, the patients perceived that it is the medical practioners who provide the most information. This could be because the patient’s perceived the medical practioners as more knowledgeable, and probably do not have enough confidence in the nurses ability to explain such matters. In practice, therefore, nurses could try to increase the confidence level of patients by using various methods of patient education. The emphasis should not be just on information pamphlets but other sources of information like group-teaching and video instructions. Any kind of hospitalisation is bound to provoke anxiety in the patient, and this is especially true if it involves a surgical procedure. An unrecognised, prolonged anxiety state leads to stress, which may harm the patient and delay recovery (Swindale, 1989). A therapeutic nursing intervention should recognize this factor and a preoperative education should be based on current research findings within the framework of a nursing model (Swindale, 1989). In this study, information given about complications like nausea and vomiting, dietary advice and about postoperative complications were not adequate. In practice, specific information about these can be given more frequently. What have I learned from this appraisal From the article it was possible to learn that the preadmission clinic nurses were more likely to provide information related to both the surgical procedure as well as the length of hospital stay after laparoscopic cholecystectomy than about postoperative expectations and self care. The patients also perceived that it was their medical practioners who provided the most information. From the critique, it was possible to learn that only two sources of patient education was used; printed literature and informal channels of information. This is clearly inadequate. Other sources of patient education like group teaching and videos should also be considered. In addition, it is also important to recognize that there might be non-English speaking patients also, and printed literature in English might not be effective in all groups of patents. Therefore, a multilingual information pamphlet must be considered. The importance of preoperative patient education has also been learnt. While there are no definite conclusions to be reached regarding the effectiveness of such a measure, it is worthwhile to actively pursue patient education. Conclusion This study has demonstrated that preadmission clinic nurses were more likely to provide information about the surgical procedure and the length of hospital stay after laparoscopic cholecystectomy than about postoperative expectations and self-care. The patients perceived that the medical practioners was the best source of information. The study has also shown the diversity of sources of information provision to patients scheduled for LC surgery and in particular, the patient’s resourcefulness in obtaining information particular to their needs. Although these are the strengths of the paper, the weakness includes considering only two types of patient information; printed literature and informal channels of information. Numerous other studies have also been conducted regarding the impact of perioperative patient education on outcomes related to patient recovery. However, these studies point out that not enough research has been conducted to evaluate the effect that perioperative education has on patient knowledge and specific skills. While most studies observed a positive impact of perioperative education on patient outcomes, others have not observed a clear positive outcome. It is generally felt that research studies in this topic are not adequate. It is recommended that in the future, more such studies be conducted because this has important implications for nurses and patient recovery post-operatively. References Blay, N, Donoghue, J (2005). The effect of the pre-admission education on domiciliary recovery following laparoscopic cholecystectomy. Australian Journal of Advanced Nursing. 22 (4):14-9. Green, S.B, Byar, D.P (1984). Using observational data from registries to compare treatments: the fallacy of omnimetrics. Statistics in Medicine. 3: 361–370. Hughes, S (2002). The effects of giving patients pre-operative information. Nurs Stand. 2002 Mar 27-Apr 2;16(28):33-7. Johansson, K, Nuutila, l, Virtanen, H, Katajisto, H, Salantera, S (2005). ‘Preoperative education for orthopaedic patients: systematic review’, Journal of Advanced Nursing. 50 (2): 212-23. Freda, M.C (2004). Issues in Patient Education. J Midwifery Womens Health. 49(3): 203-209. Lithner & Zilling (2000). Pre- and postoperative information needs. Patient Educ Couns. 40(1):29-37. Polgar, S, Thomas, SA (2000). Introduction to research in the health sciences.  4th ed. Edinburgh, Churchill Livingstone. Stern C, Lockwood, C (2005). Knowledge retention from preoperative patient information. International Journal of Evidence-Based Healthcare. (3): 45-63. Swindale, J,E (1989 ). The nurses role in giving pre-operative information to reduce anxiety in patients admitted to hospital for elective minor surgery. J Adv Nurs. 14(11):899-905. Watt-Watson J, Chung, F, Chan, VWS, McGillion, M (2004). Pain management following discharge after ambulatory same-day surgery. Journal of Nursing Management. 12 (3): 153-61. Read More