Prehospital education: effectiveness with total hip replacement surgery patients

In-hospital education can reduce anxiety, improve coping and shorten hospital stays of surgical patients. However, hospitals are containing costs by shortening pre- and postoperative stays and reducing the time available for in-hospital teaching. This study evaluated prehospital education for total hip replacement (THR) surgery. Half of the patients waiting for admission for THR surgery were randomly selected to receive a THR education booklet in the mail 4–6 weeks before their scheduled THR surgery. Compared to the No-Booklet patients, patients who had received the booklet were less anxious at the time of hospital admission and at discharge, were more likely to have practised physiotherapy exercises prior to hospitalization, and required significantly less occupational therapy and physiotherapy while in hospital. There were no group differences for length of hospital stay.     

Preparing patients for total hip replacement: a randomized controlled trial of a preoperative educational intervention

Previous research indicates that giving appropriate information to patients before surgery yields many benefits. This randomized controlled trial evaluated a pre admission and postadmission intervention comprising a video, booklet and plastic models for patients undergoing total hip replacement. Seventy-eight patients participated in the study and were randomized into control and intervention groups. The intervention was implemented one month before surgery. Over the operative period, patients completed questionnaires including the Hospital Anxiety and Depression Scale, Nottingham Health Profile and Stress Arousal Checklist. Results showed no significant differences between control and intervention groups for the Hospital Anxiety and Depression Scale, Nottingham Health Profile and Stress Arousal Checklist. However, patients from the intervention group were more likely to know as much as they wanted to know before admission (p <.001) and felt less confronted by information on arrival for the hospital stay. In an era when patient satisfaction is of paramount importance, this preoperative intervention has applications in many settings.     

The effect of preoperative education on anxiety of open cardiac surgery patients

The purpose of this experimental study was to evaluate the effect of preoperative teaching method on anxiety levels of the patients. This study consisted of 100 patients having open cardiac surgery. Of 100 patients 50 were placed in the intervention group while the remaining 50 were in the control group. The patients in the intervention group were given a planned teaching according to the patient education booklet. Patients in the control group were informed about pre- and postoperative routines by a nurse by the purpose of comparing anxiety levels of the patients in the intervention and control groups. The anxiety level of the patients in control and intervention groups was measured on the 3rd day after the operation by using the Self-Evaluation Questionnaire for State and Trait Anxiety Inventory. The mean postoperative state and trait anxiety score in the control group was slightly higher than the mean of the patients in the intervention group. There was no statistically significant difference in the state and trait anxiety scores between the groups, and the patients in the intervention group had lower scores than the patients in the control group. In addition, all patients in the intervention group stated that they were satisfied with the preoperative teaching given by the researcher.     

Empowering orthopaedic patients through preadmission education: results from a clinical study

OBJECTIVE: To determine whether it is possible to increase patients' knowledge and certainty about care-related issues, to reach a more empowering learning experience and to exercise a more positive impact on selected clinical outcomes by means of additional preadmission education (education using the concept map method added to standard preadmission education) than by means of standard preadmission education (written educational material with non-systematic oral education). METHODS: Elective hip arthroplasty patients were randomized into group A (n=62), who received preadmission education using the concept map method with written educational material; and group B (n=61), who received the written educational material and non-systematic oral education. Data were collected from both groups 4 weeks prior to hospital admission, at admission and at discharge using questionnaires. RESULTS: In the first post-test at admission, group A had significantly better knowledge and certainty of care-related issues than group B. Group A also reported a significantly more positive learning experience than patients in group B. In the second post-test at discharge, patients in group A still had better knowledge and certainty of care-related issues than patients in group B. CONCLUSION: Preadmission education using the concept map method and written educational material seems to yield better learning results than the use of written educational material with non-systematic oral education. PRACTICE IMPLICATIONS: Empowering preadmission education using the concept map method is beneficial for patients.     

Effects of antidepressive program on verbal behavior

At time of admission 50 hospitalized male patients assigned to one of two groups judged as depressed and nondepressed completed one form of the Depression Adjective Check List (DACL). Depressed patients were placed in a highly specific treatment regime: Antidepressive Program (ADP), which required display of assertive behavior for termination of treatment. After removal from the program ADP patients received an alternate form of the DACL, and 2 weeks postadmission all patients completed a third form of testing. Significant decrease in number of dysphoric mood items selected posttreatment was found for the ADP group as compared with nondepressed patients. Lower depression scores were obtained after ADP across the period studied. Length of time in ADP was related negatively to initial depression scores. Results are interpreted in terms of reinforcement contingencies that sustain depressive verbal behavior.     

Evaluation of Pediatric Preparation Program for Short-Stay Surgical Patients

The effectiveness of a multicomponent preadmission preparationprogram for same-day surgical patients was evaluated. Participantswere 50 children, ages 4 to 7, admitted to a Short Stay RecoveryUnit for elective surgery. Twenty-five of these children andtheir parents had attended the preparation program and the other25 had not. Measures administered to the children and behavioralratings by parents and anesthetists were used to assess children'sanxiety and adjustment. Results suggested that children whoattended the program knew more about hospitalization and surgeryat the time of admission and were less upset at the time ofanesthesia induction than children who did not attend. Children'sself-reported fears about the hospital were not significantlydifferent for the two groups nor were parents' ratings of children'sbehavior following hospitalization.     

Effectiveness of aromatherapy with inhaled lavender essential oil and breathing exercises on ECT-related anxiety in depressed patients

Background and aims Electroconvulsive therapy (ECT) is considered a safe, effective, and significant treatment in patients suffering from a major depressive disorder. Anxiety caused by this invasive treatment may impose several side effects on patients. The purpose of this study was to evaluate the effectiveness of aromatherapy with inhaled lavender essential oil and breathing exercises on ECT-related anxiety in depressed patients.Methods In this randomized controlled clinical trial, 90 depressed patients were selected and divided into three groups: aromatherapy, breathing exercise, and routine care using a random allocation method. Before undergoing ECT, the aromatherapy group was exposed to the inhaled lavender essential oil (n = 30), the breathing exercise group performed the breathing exercises (n = 30), and the routine care group received routine care (n = 30). Before (20 min) and after the intervention (30 min later), patients' anxiety was assessed using Beck Anxiety Inventory.Results After the intervention, the results revealed that anxiety score changes were statistically significant among the three groups (p < 0.001). In addition, it was found that the patients’ mean anxiety scores significantly decreased in the aromatherapy and breathing exercise groups compared to with the pre-intervention scores (p < 0.001).Conclusion Aromatherapy with inhaled lavender essential oil and breathing exercises can be considered by clinical nurses as simple, applicable, and effective interventions to reduce ECT-related anxiety in depressed patients.     

SF-36 Health Profiles of Recently Discharged Hospital Patients in Australia

This study investigated the characteristics and validity of the SF-36 (Australian version) health profile and summary scores for recently discharged hospital patients and compared this with US and Australian community samples with minor and serious medical conditions. Adult medical, surgical, obstetric and gynaecological patients from a large teaching hospital in NSW, Australia, completed a postal survey 1 week after discharge. The SF- 36 discriminated well among patient groups and performed well on most validity tests. Scale and summary scores varied by age, gender, seriousness of condition on admission, prior health status and hospital group. The findings highlight the potential of the SF-36 in monitoring the health status of Australian hospital patients and assessing the health-related support needed on discharge.     

Self help programme for anxiety in general practice: controlled trial of an anxiety management booklet.

Behavioural methods of treating anxiety have been shown to be highly effective but are not widely available in general practice where most people suffering from anxiety are treated. This study reports a development in service delivery which is simple, inexpensive and does not make great time demands on general practitioners or require them to extend their training and expertise. The study shows that for patients suffering from panic disorder or generalized anxiety disorder the use of an anxiety management booklet in addition to their usual treatment from their general practitioner produces clinically and statistically significant improvements. Of particular importance is the speed of response to the booklet. Within the first two weeks those patients who received the booklet were significantly less anxious than the controls. The booklet was acceptable to patients and recommendations are made about how to incorporate it into clinical practice.     

The effect of information and behavioural training on endoscopy patients' clinical outcomes

This study was designed to examine the effects of preparatory information and behavioural training on patients about to undergo an endoscopy procedure. Forty-five first-time endoscopy patients (aged 20-70 years), were randomly assigned to one of three groups (cognitive, cognitive/behavioural and control group). The cognitive group received a 12 min preparation with sensory and procedural information relating to the sensations and sequence of events associated with the endoscopy procedure. The cognitive/behavioural group received, in addition, instruction in deep breathing exercises, tongue depressor task and swallowing technique. Results indicated that patients in the two experimental conditions experienced significantly fewer signs of behavioural distress during endoscopy. The cognitive group required a significantly shorter time to induce the scope. There were no statistical differences between the groups however, for mood, physiological and anxiety measures, although a positive trend was evident for the two intervention groups.     

Factors affecting the use of self-instructional material by patients with ischemic heart disease

This study addressed three questions concerning the feasibility of self-instruction by patients with ischemic heart disease in an acute-care teaching hospital. (1) Do patients complete a linear self-instructional booklet under conditions normally prevailing on a hospital ward? (2) Do patients perceive that activity in the ward environment and symptoms of illness affect use? (3) What aspects of activity and symptoms do patients report affect use? One hundred patients, 60 men and 40 women with an average age of 59 years, hospitalized with ischemic heart disease (acute myocardial infarction or unstable angina) were interviewed an average of six days after distribution of a self-instructional booklet as a component of a standard teaching program. Three subjects claimed not to have received the booklet; nine made no use of it; 73 made partial use of it; and 15 made complete use of it. Fifteen subjects claimed activity in the ward environment and 25 subjects claimed symptoms of illness affected use. Interruption, a noisy, busy atmosphere on the ward, and physical symptoms of ischemic heart disease were reported most frequently as factors affecting use. Results of the study suggest that a small percentage of patients will complete a selfinstructional booklet. In addition to activity in the environment and symptoms of illness, factors not identified in this study also appear to influence the use of self-instructional material.     

Psychological Preparation as a Method of Reducing the Stress of Surgery

Abstract

Studies of the preparation of adult patients for surgery are reviewed. While many show that preparation reduces stress, the studies are criticized for methodological and conceptual inadequacies. In particular, studies often fail to measure a range of stress responses, and also fail to provide measures over a sufficient time span to fully assess the effect of preparation on stress responses which are known to have differing rates of responsiveness. The experimental study was specifically designed to overcome these problems. Eighty patients undergoing a minor gynecological operation (laparoscopy for sterilization or infertility investigation) were allocated to one of three groups: routine care only (Control 1); routine care plus a minimally informative preparatory booklet (Control 2); or routine care plus a maximally informative preparatory booklet (Experimental group). Patients in the special preparation condition showed lower stress responses on measures of preoperative fear and anxiety, heart rate and blood pressure, and postoperative anxiety. At both one-and six-week follow ups they showed reduced state anxiety and elevated postdischarge vigor scores. They also showed less pain after surgery and recovered faster in hospital and in the first six days after going home. They returned to normal activities faster than patients in the two control groups. There were no differences on measures of postoperative symptoms, medication use, or reported time to return to normal health. The results are discussed in terms of previous studies of psychological preparation, and current concepts of stress. Suggestions for the design of preparatory interventions are made which match the type and timing of the intervention to the target stress response.     

How informed is consent? Use of an information booklet in patients undergoing total hip replacement

For informed consent, patients must understand the risks and benefits of the proposed procedure. Fifty patients undergoing total hip replacement (THR) participated in an evaluation of a newly devised information booklet. Patients' understanding of the risks and benefits of THR was assessed using a questionnaire before and after they had read the booklet. Pre-booklet patients knew on average 2 benefits of THR, compared with 3 afterwards. Twenty-two patients initially identified no alternative treatment to THR. Those who knew an alternative stated on average 1 treatment compared with 2 in the post-booklet group. Fifteen patients identified no risks of THR initially, compared with two after reading the booklet. Initially patients reported 1 risk, versus 3 after reading the booklet. Forty-eight patients thought that the booklet increased their understanding of THR and its risks. Fourteen found it upsetting, but acceptable. Forty-six patients wished to keep the booklet.     

心理支持干预对稽留流产患者焦虑和抑郁的改善作用

目的:探讨心理支持干预对稽留流产患者精神焦虑和抑郁的改善作用。方法:选取2014年2月—2016年2月因稽留流产于我院治疗的患者共150例,随机分干预组和对照组,每组75例,干预组采用心理支持干预,对照组采用常规的护理,在干预前后采用焦虑自评量表(SAS)、抑郁自评量表(SDS)患者进行疗效评价。结果:两组患者入院时的SAS和SDS评分比较差异无统计学意义,出院时两组患者的SAS和SDS评分均较入院时有所下降(P0.05),干预组患者显著低于对照组,差异具有统计学意义(t=8.161,P0.001),两组患者入院前的焦虑和抑郁人数比例差异均无统计学意义(χ~2=0.110,P=0.740;χ~2=1.000,P=0.317),而出院时出院时干预组患者的无或轻度焦虑和抑郁人数比例显著高于对照组,差异具有统计学意义(χ~2=7.535,7.985;P0.01)。结论:心理支持干预有助于缓解稽留流产患者的焦虑和抑郁情绪,值得临床推广。     

Randomized controlled trial of an educational booklet for patients presenting with back pain in general practice.

A randomized controlled trial was used to evaluate an educational booklet on back pain for patients presenting to five group practices during one calendar year. The booklet had no immediate effect on consultations for back pain, but in the period from two weeks to one year after presentation significantly fewer patients in the group receiving the booklet consulted with back pain (35.6%) than in the control group (42.2%) (P less than 0.05). There were no significant differences between the booklet and control groups in certified absence from work owing to back pain. Referral to hospital, referral to physiotherapy, admissions to hospital and laminectomies were all less common in the booklet group. The reduction in the combined referral rate to physiotherapy and hospital, and the reduction in laminectomy rate almost reached statistical significance at the 5% level. In replying to a questionnaire sent one year after entry to the study 94.1% of respondents in the booklet group said that they had read the book, 84.0% said that they found it useful, and 68.0% said that they still had a copy. Scores on a 15-item test of knowledge about back pain were significantly higher in the group of patients who had received the booklet than in the control group. The results suggest that the booklet had some effect in altering both the knowledge and behaviour of patients with back pain. The provision of an educational booklet was a method of giving information which was appreciated by both patients and doctors.     

临床观摩式护理干预与下颌阻生牙拔除患者的焦虑状况

目的:下颌阻生牙拔除患者通常存在围手术期的焦虑症状,本研究探讨临床观摩式的护理干预对门诊拔除阻生牙患者焦虑情况的影响。方法:238例患者随机分为实验组和对照组,两组患者均接受常规的健康宣教和临床资料收集。实验组采用临床观摩式护理干预,患者观摩临床阻生牙拔除的全过程。两组于手术前、后行HAMA量表检测患者的焦虑状况。结果:实验组和对照组术后的HAMA值有显著性差异(P<0.05),而术前无统计学意义。结论:临床观摩式的护理干预有助于下颌阻生牙拔除患者降低患者的焦虑状况。     

Assessing the acquisition of core clinical skills through the use of serial standardized patient assessments.

PURPOSE: Students in many medical schools now undergo multiple standardized-patient-based assessments. In this study, the authors examine the ability of such serial assessments to detect interval learning. METHOD: Twenty-one students from the University of California, Irvine, College of Medicine, class of 1999, underwent a clinical skills appraisal after three months of their third-year instruction. After nine months, all 89 members of that class completed an OSCE. Subsequently, all 87 students in the class of 2000 also completed clinical skills assessments after their third and ninth months of third-year instruction. All of these exercises included identical or similar stations measuring history, physical examination, and communication skills. Communication skills were measured somewhat differently during some of the exercises, using checklists that were either "content-" or "process-"oriented. The authors compared the performances for all groups. RESULTS: Both classes demonstrated significant improvement in physical examination performance, while their history performances remained unchanged. According to the assessments, their communication skills deteriorated over the course of their third-year instruction. Repeated exposures to similar or identical cases on the serial assessments did not impact the students' performances. Both content- and process-oriented measures of communication skills yielded highly similar results. CONCLUSIONS: Serial assessments using standardized patients can detect interval changes in performance that are independent of repeated exposures to similar or identical cases. Changes detected using this approach may have important curricular implications.     

认知干预对脊柱侧弯矫形术患者焦虑的影响

目的探讨认知干预对脊柱侧弯矫形术患者焦虑心理的影响。方法选取我院2010年1月-2013年3月行脊柱侧弯矫形术患者68例,随机分为对照组和干预组各34例。对照组实施常规护理;干预组在常规护理基础上实施认知干预。运用焦虑自评量表(SAS)对两组患者于入院时、术前1天、术后2天及术后2周进行焦虑状态评估。结果对照组术前1天和术后2天SAS得分均较入院时明显升高(t=5.79,6.36;P0.05),2周后患者SAS得分较术前1天和术后2天显著下降(t=-6.61,-7.17;P0.05)。而干预组术前1天和术后2天SAS得分较入院时无显著差异(t=1.85,1.61;P0.05)。入院时干预组和对照组SAS得分无显著差异(t=-0.31,P0.05),而干预组术前1天、术后2天以及术后2周SAS得分均较对照组明显降低(t=-3.60,-4.26,-2.77;P0.05)。结论脊柱侧弯矫形术患者围手术期存在明显的焦虑,积极有效的认知干预可明显减轻患者围手术期的焦虑状态。     

Children of a cohort of depressed patients 25 years later: psychopathology and relationships

BACKGROUND: While many studies have examined cross-sectional or short-term effects of parental depression on children, few have studied such children many years later when they reach adulthood. It was hypothesised that children of patients hospitalised for depression 25 years ago would have more psychological morbidity and relationship difficulties than children of a surgical comparison group. METHOD: Children (n=94) of depressed patients and a surgical control group (n=31) admitted to a teaching hospital 25 years ago were compared on measures of psychiatric morbidity, personality, marital and family relationships. RESULTS: Compared with control children, children of depressed patients demonstrated trends for higher rates of non-phobic anxiety and substance disorders, but neither psychological morbidity overall nor affective disorder specifically. Compared with control children, children of depressed patients rated their relationships with fathers who were spouses of female patients more negatively. Having consciously tried to make their own intimate relationships different from that of their parents, children of depressed patients and their partners reported significantly more caring in their relationships compared with control children and their partners. CONCLUSION: In this study of the effects of parental depression on children 25 years on, adult children of depressed patients demonstrated significant resilience as evidenced by similar rates of overall psychiatric morbidity and quality of intimate relationships to controls. They may be at risk for specific disorders such as anxiety and substance disorder and have problematic relationships with the "well" spouses of depressed patients particularly if the "well" spouse is their father.