Preoperative Knowledge Retention
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Patients rely on heath care workers to provide information concerning surgical procedures and preoperative education. Preoperative education has been found to reduce both post operative complications and the length of hospital admission times ( Black, Hawks & Keene, 2001). Nursing staff are often left to answer questions from patients who are anxious due to a knowledge deficit. However, due to time constraints and lack of resources this knowledge deficit can often be left unresolved. The use of preoperative patient education and the effectiveness of various approaches has not been extensively studied, as will be discussed. Results from studies would be of great benefit for use within a Coronary Care Unit (CCU) and nursing practice in general.
CCU has many patients scheduled to undergo cardiac procedures and invasive testing. The current practice within most units often involves a brief explanation of the procedure by doctors when obtaining informed consent or when requested by patients. Education provided to patients is often irregular and falls short of patient requirements (Eckert, 2003). The mode and content of information delivery is not strictly enforced nor is a post operative follow- up assessment performed. Current patient education practices amongst staff requires modification in order to reduce the anxiety levels and knowledge gap of patients and their families, before and after intervention.
Literature review
The author has critically analysed two current literature reviews which both relate to the effectiveness of patient education, knowledge retention and post procedure compliance, using several educational methods and tools. After a significant search of relevant topics within the Joanne Briggs and Cochrane databases, two articles were chosen based on their extensive review of research into patient education and knowledge retention. These two articles Eckert (2003) and Stern and Lockwood (2005) discussed the results and their implications to ward practice. The information gained is relevant to daily ward practice within a coronary care environment and can be used to implement change within ward.
A systematic review of literature was instigated by Stern and Lockwood (2005) and Eckert (2003) to evaluate current evidence of the effectiveness of pre-operative education on the knowledge retention of patients. Both Stern and Lockwood (2005) and Eckert (2003) agree that surgical procedures and pre-cardiac intervention can cause much anxiety and distress to patients, therefore, the benefits of preoperative education may be invaluable in reducing anxiety levels and ensuring a more positive post operative outcome. Whilst Stern and Lockwood (2005) studied the aspects of pre-operative education on a larger criteria of patients, Eckert (2003) confined the inclusion criteria to adult patients undergoing cardiac intervention. Moreover, both these studies analysed the timing and methods used for patient education.
Eckert (2003) systematically reviewed five studies, two of which were random control trials (RCT). This was a similar number of studies compared to Stern and Lockwood (2005) who reviewed four RCTs. Stern and Lockwood (2005) investigated the effectiveness of preoperative education and its effects on misconceptions and postoperative care. In addition to this the review sought to ascertain which medium of patient education resulted in the greatest understanding and memory retention. Both reviews methodically analysed various studies which investigated the use of an array of educational tools including pamphlets, videos and the nurse providing information, most at various stages of treatment. The author has found that the most significant research analysed involved the use of pamphlets.
Pamphlets
Both Stern and Lockwood (2005) and Eckert (2003) found evidence that the use of pamphlets is an effective educational tool. Stern & Lockwood (2005) noted that pamphlets were the most common teaching method used in patient education both pre and post operatively and were more successful in post operative rehabilitation, however they did not discuss the optimal time for pamphlet use. Eckert (2003) found that there was no significant change in reducing anxiety levels pre and post operatively when patients were provided with pamphlets/booklets 3-35 days previous to admission for cardiac surgery. Stern and Lockwood (2005) found that pre-admission pamphlets were more effective than as post admission pamphlets combined with verbal instructions. Both Eckert (2003) and Stern and Lockwood (2005) cited that pamphlet use often assumed English comprehension and that no evaluation of this was available in any studies cited both for English as a second language and literacy challenged individuals. Eckert (2003) suggests that supplying patients with a pamphlet during less anxious times, possibly 5-15 days prior to admission, improved knowledge retention and reduced anxiety levels. However none of the studies reviewed demonstrated a change in post operative pain, or length of admission.
Both Stern and Lockwood (2005) and Eckert (2003) have reviewed information related to other types of educational tools. These are discussed as follows.
Other Educational Tools
Recommendations based upon the reviews varied between articles regarding the use of assorted educational tools. The use of visual aids preoperatively, such as video, with a combination of verbal and printed information was sighted as having significant positive effects upon patient knowledge retention (Stern & Lockwood ,2005). Interestingly, Stern and Lockwood (2005) also found that preoperative group instruction was as effective as individual teaching. Both pre and post surgical interventions showed no significant change in improved knowledge or anxiety levels (Eckert, 2003; Stern & Lockwood, 2005). The use of audio-visual aids was considered convenient given time management difficulties and decreased staffing levels (Eckert, 2003). However it was not found to be effective and no reviewed study included an evaluation of its effectiveness alone (Eckert, 2003). Small participant numbers and possibly lack of understanding are cited as possible reasons why this was not explored (Eckert, 2003).
Comparison
Both Eckert (2003) and Stern and Lockwood (2005) had similar research questions, however Eckert (2003) was more specific as it incorporated the effectiveness of preoperative education on reducing hospital admission times, anxiety (pre or post intervention), pain and knowledge retention. Eckert (2003) excluded several studies which she judges to have poor methodological quality,