Source and content of health information for patients undergoing laparoscopic cholecystectomy

This study, a component of a larger research project examining the effect of pre-admission education on patients' ability and confidence in domiciliary self-care following laparoscopic cholecystectomy, identified the source(s) of specific health- and hospital-related information for patients undergoing this operative procedure. One-hundred laparoscopic cholecystectomy patients were surveyed at pre-admission, following assessment by the pre-admission nurse, anaesthetist and registered medical officer to determine what information had been provided by the pre-admission nurse and/or alternative sources of information provision. The findings showed that laparoscopic cholecystectomy patients received information from multiple sources. Pre-admission clinic nurses were more likely to provide information related to the surgical procedure and hospital length of stay than about postoperative expectations and self-care. Overall, patients perceived that medical practitioners imparted the most information. Printed literature and informal channels of information provision featured strongly, indicating patients' resourcefulness in obtaining information related to their surgery. Informal communication showed the importance of social networks and personal experience in aiding patients' comprehension of the hospital and recovery experience.     

阶段式自我管理教育对动静脉内瘘成形术患者自我护理能力的影响

目的:探讨阶段式自我管理教育对动静脉内瘘成形术患者自我护理能力的影响.方法:对48例动静脉内瘘成形术患者进行阶段式自我管理教育,于出院时、出院后1个月和3个月采用自行设计内瘘自我护理知识掌握情况调查表和自我护理能力实施量表(ESCA)评估患者的自我护理能力.结果:本组患者自我护理知识掌握情况:出院当天掌握13例(27.08%),基本掌握19例(39.58%),未掌握16例(33.33%);出院后1个月掌握31例(64.58%),基本掌握17例(35.42%);出院后3个月掌握46例(95.83%),基本掌握2例(4.17%).患者出院时、出院后1个月和3个月内瘘自我护理知识掌握情况调查表评分及ESCA评分比较差异有统计学意义(P＜0.01).结论:阶段式自我管理教育能有效提高动静脉内瘘成形术患者的自我护理能力,值得临床推广应用.     

Effects of Patient Education and Distraction Approaches Using Virtual Reality on Pre-operative Anxiety and Post-operative Pain in Patients Undergoing Laparoscopic Cholecystectomy

BackgroundFear of post-operative pain often contributes to pre-operative anxiety; accordingly, pain and anxiety are among the most common complications in patients undergoing laparoscopic cholecystectomy (LC).AimThe present study aimed to determine the effects of patient education and distraction using virtual reality (VR) on pre-operative anxiety and post-operative pain in patients undergoing LC.MethodThis randomized clinical trial included 150 patients in the surgery wards of educational hospitals in Mashhad, Iran, in 2020. The participants were randomly assigned to three groups of education, distraction, and control. The education and distraction groups watched two five-minute animations and three 360-degree images of nature using VR glasses 2 hours before and 4 hours after the surgery, respectively. On the other hand, the control group received routine care. Anxiety was measured using Spielberger's State Anxiety Inventory before and half an hour after the intervention. Moreover, the pain was measured using the visual analog scale and McGill Pain Questionnaire.ResultsThe results demonstrated a significant reduction in the two VR groups regarding the pre-operative anxiety mean scores, compared with the control group (p < .001). Furthermore, a significant reduction was observed in post-operative pain scores of patients in the two intervention groups compared with the control group (p = .001).ConclusionsAs evidenced by the results, both VR approaches of patient education and distraction equally decreased pre-operative anxiety and post-operative pain in patients undergoing LC.     

Postoperative Pain Management Discharge Teaching in a Rural Population

With health care increasingly administered on an outpatient and in-home basis, the knowledge and education of any patient population including discharged postoperative patients are essential ingredients to optimal pain management. The purpose of this study was to implement and evaluate in a rural setting a predischarge patient education intervention focused on self pain management of uncomplicated postsurgical patients after being discharged home. A total of 146 patients completed a pretest knowledge and experience questionnaire and then were randomly assigned to the education intervention group (n = 87) or the control group (n = 59). The control group received the usual standards of care. One week after discharge, 68 patients (47%) returned a completed a post-test knowledge and experience questionnaire, Brief Pain Inventory, and a patient pain log used to evaluate the effectiveness of the intervention. Results indicated that although there was no statistically significant difference between the groups regarding knowledge and experience about pain, postoperative pain, and interference of pain with activities of daily living 1 week after discharge, those that received the intervention had lower pain scores and less interference of pain with activities.     

A randomised controlled trial to compare a nurse practitioner to medical staff in the preparation of patients for diagnostic cardiac catheterisation: the study of nursing intervention in practice (SNIP).

BACKGROUND: A number of initiatives have employed nurses in roles traditionally associated with the medical profession but few have been evaluated in prospective randomised studies. This paper reports the results of a randomised controlled trial to assess the performance of a nurse practitioner (NP), trained to prepare patients for diagnostic cardiac catheterisation. METHODS: Eligible and consenting patients were randomised to preparation by either the NP or junior medical staff (JMS). The safety outcome measure was the rate of in-hospital major adverse clinical events including death, myocardial infarction and emergency bypass coronary surgery. Other outcome measures included rate of minor adverse events, cardiologist assessment of case preparation and presentation, patient satisfaction and duration of pre-admission clinic. RESULTS: From April 1997 to May 1998 a series of 355 patients scheduled for elective, day-case, diagnostic cardiac catheterisation were screened. Of these, 345 patients were eligible for the study. A total of 339 patients consented to participate and were randomised. Major adverse clinical events occurred in 0/175 (0%) patients in the NP group and 2/161 (1.2%) patients in the JMS group. (Risk difference = -1.2%, upper boundary of the 95% confidence interval = +2.0%) The cardiologist's evaluation that the patient's preparation was acceptable was high in both groups: NP group 98.3% vs. JMS group 98.8%: P = 1.0). Patient satisfaction, assessed by questionnaire, was greater in the NP group (P = 0.04). The median duration of the pre-admission clinic visit was lower in the NP group 165 min vs. 185 min in the JMS group, P = 0.01). CONCLUSIONS: The preparation of patients for diagnostic cardiac catheterisation can be safely performed by an appropriately trained NP. This approach may be associated with improved patient satisfaction and reduced clinic duration times.     

Homeopathic Arnica montana for post-tonsillectomy analgesia: a randomised placebo control trial

OBJECTIVE: To evaluate the efficacy of Homeopathic Arnica in reducing the morbidity following tonsillectomy. METHODS: Randomised double blind, placebo controlled trial at a tertiary referral centre. 190 patients over the age of 18 undergoing tonsillectomy were randomised into intervention and control groups receiving either Arnica 30c or identical placebo, 2 tablets 6 times in the first post-operative day and then 2 tablets twice a day for the next 7 days. The primary outcome measure was the change in pain scores (visual analogue scale) recorded by the patient on a questionnaire over 14 days post-operatively; Secondary outcome measures were: analgesia consumption, visits to the GP or hospital, antibiotic usage, the day on which their swallowing returned to normal and the day on which they returned to work. RESULTS: 111 (58.4%) completed questionnaires were available for analysis. The Arnica group had a significantly larger drop in pain score from day 1 to day 14 (28.3) compared to the placebo group (23.8) with p < 0.05. The two groups did not differ significantly on analgesic consumption or any of the other secondary outcome measures (number of post-operative visits to GP, use of antibiotics and secondary haemorrhage readmissions). CONCLUSION: The results of this trial suggest that Arnica montana given after tonsillectomy provides a small, but statistically significant, decrease in pain scores compared to placebo.     

Post-operative epidural analgesia: introducing evidence-based guidelines through an education and assessment process

The aim of this project was to re-introduce post-operative epidural analgesi on to two orthopaedic wards using an evidence-based practice approach. This was achieved through the provision of appropriate staff education and information, assessment of staff competence, and provision of relevant and appropriate staff support. An education programme was developed which included study days, ward-based teaching and the assessment of competence. The introduction of guidelines followed an audit cycle in order to measure the success of the education programme. All nursing staff involved in the project were asked to complete a questionnaire which assessed their knowledge of caring for patients with postoperative epidural analgesia. This was completed before and following the education programme. The outcome measures were: (i) successful completion of competence-based assessment; (ii) levels of knowledge as assessed by the knowledge questionnaire; and (iii) participant perceptions of the project. The results of the questionnaire demonstrated significant improvements in knowledge following the education programme. Participants commented on the importance of the ward-based teaching. They also felt that pain was controlled more effectively using this method of analgesia.     

A Comparison of Diabetes Learning With and Without Interactive Multimedia to Improve Knowledge, Control, and Self-Care Among People With Diabetes in Taiwan

ABSTRACT Objective: Given the increased popularity of complementary and alternative medicine (CAM) and traditional Chinese medicine (TCM), this study aimed to evaluate the effects of interactive media on self-directed learning in patients' knowledge of diabetes and related CAM/TCM strategies, the ability to control blood sugar levels, and self-care in people with diabetes.
Design: An experimental study design was used. The experimental group received patient education through interactive multimedia about diabetes for 3 months, while the control group received a routine 3-month patient education.
Sample: On completion, 60 subjects from Taiwan were evaluated—30 in an experimental group and 30 in a control group.
Measurements: Data were collected from both groups at baseline and at the completion of the patient education. The findings were then compared to evaluate the effects of the intervention on the subjects' knowledge of diabetes, blood sugar control, and self-care.
Results: The experimental group showed greater improvement in understanding diabetes than the control ( t =3.29, p <.001). There was no significant difference in control of blood sugar levels ( t =−1.72, p =.10) and self-care ( F =1.03, p =.32).
Conclusions: The use of an interactive multimedia device to intervene in diabetes self-care was effective only in raising the subjects' knowledge about the disease. Additionally, the subjects may need more time to implement more effective blood sugar control and self-care activities after receiving instruction.     

Low literacy self-care management patient education for a multi-lingual heart failure population: Results of a pilot study

PurposeThe purpose of this pilot study was to test the impact of language-free, low literacy self-care management patient education materials in an ethnically diverse multilingual heart failure (HF) population.MethodsA one group pre-test–post-test design measured changes in self-care, knowledge and health-related quality of life (HRQL) after a 1 month intervention using language-free, low literacy self-care management patient education materials and delivered by a health educator.ResultsThe ethnically diverse sample (n = 21) was predominately male (72%), 48% Black, 42% Hispanic, and 28% marginal/inadequate literacy. There were significant improvements in self-care and knowledge but not HRQL.ConclusionsLanguage-free, low literacy self-care patient education may facilitate improved self-care and knowledge in diverse populations who are at risk for poor HF outcomes.     

Randomized clinical trial of an intensive nursing-based pain education program for cancer outpatients suffering from pain

Introduction  The prevalence of pain in patients with cancer is still too high. Factors relating to ineffective pain treatment fall into three categories: the health care system, professional care providers, and patients. In patients, various barriers lead to noncompliance. Previous educational interventions have increased their knowledge of pain and decreased short-term pain levels. In this randomized controlled trial, the authors investigated how an intensive home-based education program given by nurses affected short-term and long-term pain levels. Materials and methods  One hundred and twenty cancer patients were randomized to receive either the pain education program (PEP) or usual care. Pain, knowledge, quality of life, anxiety, and depression were measured at baseline and after 4 and 8 weeks. In the intervention group, effects on symptom levels were communicated to the treating physician. Results  The level of pain had decreased at 4 weeks, but not at 8 weeks. Significant decreases in pain only persisted in those patients with a high pain score at baseline. Knowledge of pain significantly increased in the intervention group. No correlation was found between increased pain knowledge and decreased pain levels. Conclusions  The PEP given by nurses lowered pain intensity levels in cancer patients and increased their knowledge of pain. More attention should be paid to patient education and to communication between patients and health professionals regarding pain and pain management.     

Assessment of Factors Related to the Understanding of Education and Knowledge of Self-Care among Patients with Diabetes Mellitus: A Cross-Sectional Prospective Study

Introduction

The prevalence of diabetes mellitus is rapidly increasing particularly in developing countries. The aim of this study was to assess the knowledge and self-care practices of diabetes patients and to assess the contribution of the education to this knowledge level and glycemic control.

Methods

We formed patient groups consisting of 15–30 diabetic patients. First, patients were surveyed using a diabetes self-care knowledge questionnaire (DSCKQ-30). Sunsequently, a standard PowerPoint presentation about diabetes self-management was made to the patients who were then surveyed again using DSCKQ-30. All patients were invited to hospital to measure their control glycated hemoglobin (HbA1c) level 3 months later.

Results

Of the total 364 participants, 62.9% were females. Significant increases in the percentage of correct responses were determined in all components between, before and after education. There was a significant decline of 1.1 in HbA1c levels after 3 months of education. Married or active working patients had a better understanding of the education about diabetes and had a greater knowledge of self-care management regardless of their level of education or income.

Conclusion

Education about diabetes can significantly improve knowledge of self-care management and can help in achieving glycemic control. Continuing education about self-care management and complications is crucial and this should be accompanied by a regular assessment of pateients’ diabetic knowledge.

     

The diabetes education study: a controlled trial of the effects of diabetes patient education

The Diabetes Education Study (DIABEDS) was a randomized, controlled trial of the effects of patient and physician education. This article describes a systematic education program for diabetes patients and its effects on patient knowledge, skills, self-care behaviors, and relevant physiologic outcomes. The original sample consisted of 532 diabetes patients from the general medicine clinic at an urban medical center. Patients were predominantly elderly, black women with non-insulin-dependent diabetes mellitus of long duration. Patients randomly assigned to experimental groups (N = 263) were offered up to seven modules of patient education. Each content area module contained didactic instruction (lecture, discussion, audio-visual presentation), skill exercises (demonstration, practice, feedback), and behavioral modification techniques (goal setting, contracting, regular follow-up). Two hundred seventy-five patients remained in the study throughout baseline, intervention, and postintervention periods (August 1978 to July 1982). Despite the requirement that patients demonstrate mastery of educational objectives for each module, postintervention assessment 11-14 mo after instruction showed only rare differences between experimental and control patients in diabetes knowledge. However, statistically significant group differences in self-care skills and compliance behaviors were relatively more numerous. Experimental group patients experienced significantly greater reductions in fasting blood glucose (-27.5 mg/dl versus -2.8 mg/dl, P less than 0.05) and glycosylated hemoglobin (-0.43% versus + 0.35%, P less than 0.05) as compared with control subjects. Patient education also had similar effects on body weight, blood pressure, and serum creatinine. Continued follow-up is planned for DIABEDS patients to determine the longevity of effects and subsequent impact on emergency room visits and hospitalization.     

The Effects of Add-On Self-Care Therapy on Epidural Catheter Analgesia and Pain in Patients after Surgical Stabilization of Multiple Rib Fractures

BackgroundEpidural (EPI) catheter analgesia is frequently prescribed as a regional analgesic technique to patients with multiple rib fractures (MRF) following surgical stabilization of rib fractures (SSRF).AimsWe aimed to study the effect of add-on self-care therapy on recovery and quality of life (QoL) in patients on EPI analgesia after surgical stabilization of rib fractures (SSRF).Design/settings/participants/subjectsA total of 267 eligible patients with MRF who received EPI catheter analgesia after SSRF were recruited, and assigned to one of two groups in a random fashion: intervention group received education on self-care therapy, while the control group did not.MethodsPain scores, incentive spirometry (IS) volumes, oxygen saturation (SpO2), respiratory rate, hospital length of stay (LoS) and QoL were evaluated.ResultsCompared with control group, the intervention group showed significantly improved pain scores, IS volume, respiratory rate, and SpO2. Hospital LoS was shorter for the intervention group than the control group. Overall QoL scores in the intervention group were also significantly better than control patients.ConclusionsEducation on self-care therapy significantly benefited pain management, recovery, and QoL for patients with MRF who received EPI catheter analgesia after SSRF operation.     

护理干预对肿瘤经外周静脉置入中心静脉导管患者自我护理能力和健康行为的影响

目的探讨护理干预对肿瘤经外周静脉置入中心静脉导管（PICC）患者自我护理能力和健康行为的影响,以提高肿瘤PICC患者的生活质量。方法将218例肿瘤PICC患者随机分为干预组107例和对照组111例,对照组采用常规护理,干预组在对照组的基础上由PICC专科护士给予针对性的认知干预,内容包括健康知识水平、自我概念、自护责任感和自我护理技能等4个方面,干预时间为3个月。干预前后进行问卷调查。比较2组的自我护理能力和健康行为水平。结果干预后干预组自我护理能力及健康知识水平显著高对照组。结论有针对性的护理干预能有效地提高门诊肿瘤PICC患者的自我护理能力,改善健康行为。     

The Effectiveness of an Online Mind-Body Intervention for Older Adults With Chronic Pain

The Self-care Pain Management Project assessed the feasibility and efficacy of delivering online mind-body self-care techniques to 78 adults aged 55 and older with chronic pain. To assess feasibility, the study monitored use of the intervention and documented participant satisfaction. A randomized trial with intervention (n = 41) and waiting list comparison groups (n = 37) was used to assess changes in pain intensity, limitations due to pain, pain self-efficacy, depression, anxiety, and awareness of responses to pain from baseline to follow-up at 6 weeks. There were statistically significant results for between-group difference in awareness of responses to pain, improvements in pain intensity and pain interference for both groups, and increases in confidence with using nonmedical self-care techniques to manage pain for the intervention group. Reductions in mean pain scores reported by the intervention group at log on and log off also suggest that the intervention may have an immediate impact on reducing pain. Findings document the feasibility of a relatively short-term, online mind-body pain management intervention that can have benefits for participants. The characteristics of those who volunteered for an online self-care pain management intervention also have implications for identifying target populations for such interventions.PerspectiveThis article documents the outcomes of an Internet-based self-care pain management intervention that focused on mind-body exercises. The study suggests that the Internet can be an efficient mode for delivering self-care education to older adults with chronic pain and has potential benefits that complement clinical care.     

The impact of a nurse-led clinic on self-care ability, disease-specific knowledge, and home dialysis modality

A nurse-led clinic focusing on education and self-care for patients with advanced renal failure was introduced in a renal outpatient clinic in Sweden. The purpose was to enhance patients' disease-related knowledge, involvement, and self-care ability. This article reports the results of a study comparing patient outcomes with the nurse-led clinic to the previous model of care. The hypothesis was that the nurse-led clinic would increase medical control and self-care outcomes. The participants in the nurse-led clinic chose and started dialysis in a self-care alternative and also had a functioning, permanent dialysis access to a greater extent than the patients in the comparison group. Those choosing home-hemodialysis rated their self-care ability higher. The participants rated self-care and effects of treatment options on family and everyday life as the most important disease-related areas of knowledge.     

Postoperative pain: strategy for improving patient experiences

BACKGROUND: Many patients continue to suffer moderate pain following surgery. Much of this may be unnecessary and could be alleviated with careful strategic pain management. It appears that the knowledge and attitudes of both health care professionals and patients are pivotal to patients' pain experiences. AIM: This paper reports the introduction and evaluation of a nurse-led intervention to improve pain management after surgery. METHODS: The study design was experimental (pretest-post-test), comparing patients' pain scores in a control and an intervention hospital over time. The control hospital was included to assess if temporal effects reduced pain scores during the study period. A convenience patient sample was used, and patients' pain scores were measured in two phases (n = 800). Baseline data were compared with subsequent data collected after the introduction of the nurse-led intervention. The intervention included education for nurses in the form of short pain courses, introduction of regular pain assessment and profiling of pain at hospital level. RESULTS: Introduction of the nurse-led intervention reduced patients' pain scores. This reduction, in the order of 0.73 cm (7.3%) on a visual analogue scale (0-10 cm), was statistically significant for day of surgery and 2 days postsurgery (P < 0.05) in the intervention hospital. A reduction was not seen in the control hospital. CONCLUSION: Improvements in pain management can be made by embracing basic pain management principles.     

Impact of patient education on self-care behaviour in patients with heart failure: a review of the literature

Heart failure is a highly prevalent chronic condition. Nurse-led patient education has been described in the literature as a key component of disease management programs. This literature review investigates the impact of patient education on self-care behaviour in patients with heart failure. Seven randomised controlled trials could be included in the review. Medication taking, daily weighing, salt and fluid restriction and taking action in case of worsening symptoms are cornerstones in patient education programs. All seven studies revealed that interventions comprising patient education were associated with improved self-care behaviour in patients with heart failure. The education has to be individualized and family members should be included. Nurses play an important role in patient education interventions and must be well trained and skilled for example in clinical assessment. To date, the dose and the length of the patient education interventions necessary to improve self-care behaviour and sustain these behaviours remain unclear and need more research.     

老年住院患者护理健康教育需求及实施

目的:探讨老年住院患者对护理健康教育的需求。方法:采用问卷调查法对2004年12月至2005年12月,年龄≥60岁的住院老年患者242例进行问卷调查,问卷由作者自行设计,经过护理专家讨论修改而成。内容包括:患者的一般情况,并发症,希望了解的健康知识,教育形式,进行教育的时间等。结果:患者对自身疾病相关知识有需求者占85.52%,对自我护理知识有需求者占65.25%,对日常保健知识有需求者占75.12%。对双向交流式教育方法有需求者占65.15%,宣讲式教育方法有需求者占34.85%,宣传栏式教育方法有需求者占35.46%。同时具有多方面的知识需求。结论:针对患者需要开展护理健康教育,密切了护士与患者的关系,提高了患者的自我保健能力,激发了护士学习的积极性、主动性。     

护理干预对肿瘤经外周静脉置入中心静脉导管患者自我护理能力和健康行为的影响

目的 探讨护理干预对肿瘤经外周静脉置入中心静脉导管(PICC)患者自我护理能力和健康行为的影响,以提高肿瘤PICC患者的生活质量.方法 将218例肿瘤PICC患者随机分为干预组107例和对照组111例,对照组采用常规护理,干预组在对照组的基础上由PICC专科护士给予针对性的认知干预,内容包括健康知识水平、自我概念、自护责任感和自我护理技能等4个方面,干预时间为3个月.干预前后进行问卷调查.比较2组的自我护理能力和健康行为水平.结果 干预后干预组自我护理能力及健康知识水平显著高对照组.结论 有针对性的护理干预能有效地提高门诊肿瘤PICC患者的自我护理能力,改善健康行为.