Nursing And Midwifery Research

Identify a clinical issue and propose a research question about this clinical issue(approx. word count 100)

The identified clinical issue here is “Patient education”. Patient education can be defined as a process in which the health professionals provide information to the patients regarding their health status, medical procedure, and treatment details in order to improve their health status and health outcome by altering their health-related behaviours (Paterick et al., 2017). The research question selected for this literature review would be Does patient education pre operatively impact on patient outcomes? This literature review will be formulated on the basis of the existing evidences by incorporating all the relevant articles that would be able to answer this research question.

Conduct a literature search (using Medline AND CINAHL databases) and identify literature relevant to the research question. Append the search history to the assignment

Write a Literature Review that describes what is already known about your research question(approx. word count 1,500)

Patient satisfaction and the optimal health outcomes of the patient depict an important aspect in order to evaluate the health care services and are the primary goals of health care system. Educating the patient before the commencement of his operation regarding the operation is known pre-operative education. While, educating the patient for their overall concerns such as their care, operative, and treatment process along with patient’s behavior such as his anxiety, fears, insecurities, expected sensation, and the possible outcomes (Paterick et al., 2017). Even though, patient education has been considered as a part of authorization protocols, still there are settings that do not follow this uniformly. Patient’s satisfaction and his successful recovery are directly linked with the management of surgical patient. Surgical patient’s management entails the management of patient’s preoperative anxiety; his prejudiced functional status, along with the post-operative pain control by educating the patient. Educating patient is important as the patients often encounter the fear of the unknown when they are admitted for any surgical procedure, this results the patient in feeling vulnerable (Klaiber et al., 2018). It has been reportedly seen that that patients panics and suffers unnecessarily because of the inadequate pre-operative preparation as well as the lack of information they have regarding their own operative course as specified by the reports of fatigue, unexpected pain, and inability to take care for their own self. Educating the patients regarding their own health status and other procedures has been considerably seen to have a significant positive impact on the outcomes of the surgery as well as it has been also seen as a primary way of managing and meeting patient’s expectations (Iqbal et al., 2018). Patient education is the primary way to manage these expectations. In a study presented by Wongkietkachorn, Wongkietkachorn & Rhunsiri (2018) it has been stated that patient education results in escalating the overall patient satisfaction, tumbling the problem incidence, and has been seen in improving the quality of life of the patient. It has been seen that educating patients reassures the patient with the help of therapeutic communication. The team of health professionals look after for the response from the patient that is suitable to the patient’s psychological and physical health. The components such as relevant information regarding the processes, skills training, and mental support are considered as an important components of the pre-operative patient education or the educational intervention. On comparing the health outcomes of both, the patients who received structured education regarding their health and those who did not it has been seen that the patients that received education showed improved and positive health outcomes. These outcomes were considered to be positive and improved because they were capable of reducing patient anxiety, post-operative complications if there is any. These complications could be atelactasis, fever, and pneumonitis, and reduced need for analgesics (Aust et al., 2016). It is the core duty of the nursing profession to prevention any health and medical complications, several complications can be prevented if the patient has been informed regarding every process. Educating patient prior to their surgical process or before any other intervention that will be given to them has been seen in successful prevention of the potential harms and post-operative complications along with improving the wellbeing of the patient (Aust et al., 2016). Pre-operative education should include all the preoperative procedures along with their rationale such as stopping anticoagulation therapy, fasting, etc. The preparations requisite such as pre-medications, insertion of intravenous cannula, and regarding the sensations that could be felt when inducing anaesthesia. So, educating the patient regarding the post-aneasthetic care unit should also be focussed. The patient must be aware of the results expected postoperatively (Fink et al., 2013). And, any other important information that is specific to the surgery must be given to the patient prior to the surgery (Koutoukidis et al., 2017). Studies have indicating that the stipulation of the good-quality of patient education helps in facilitating the active involvement of the patients in their own care, and in this way they contribute in the overall augmentation of the patient’s satisfaction. Although, a study by Mitchell (2017) have suggested that it depends on the time. The time when the patient was being informed or was getting educating. This could be understood that patient should have been given some time to analyse what has been told to him, there are also some times when the patient was informed about his health status and regarding his surgery before the surgical procedure and this could even worsen the health situation of the patient as he could get panicked and hypertensions along with other potential complications could be faced by the patient. This can worsen the patient’s situation. This is why there is a need for thorough research that can help in identifying the most favorable timing to informing the patient regarding this along with way of delivering the pre-operative information for maximizing the positive effects on the health outcome of the patients that are about to undergo the elective surgery. In an article presented by there was a study conducted by the authors in order to determine whether educating the patients with the help of a structured individualised protocol has any significant effect over the post-operative outcomes of the patients or not. These outcomes were in terms of the pain experienced by the patient post-operative along with the requirement of additional analgesia. From this study it has been seen that the patient recovery along with the overall satisfaction of the patient was directly linked with the patient education (Paterick et al., 2017). Though, educating the patient does not mean informing them about their medical procedures right before they go for the surgery but, it begins right from their admission, admission counter, visit to the out-patient department, pre-operative nursing counselling, and most importantly the pre anesthetic counseling. This overall educating them that begins at the moment patient was being admitted have been potentially resulted in to an associated decrease in the post-operative related pain, this helps the patients in managing better with the hospitalization. Providing education to patients as well as their families is considered to be one of the most important attribute of nursing care. The main objective of the provision of the preoperative education to the patient is to not only just preparing the patient for their surgery, but along with this it is to prepare them with the outcome of the surgery (Tollefson et al., 2012). Thus, the provision of the patient education pre-operatively is seemed to be quite extensive. However, the benefits of the preoperative preparation are so that it enables the patients to have more clear and precise understanding regarding their surgery, to feel more in control, to experience lesser postoperative pain as well as anxiety, and most importantly to have a less length of hospital stay post operation and to have a faster convalescent period (Tollefson et al., 2012). Preoperative education to the patient has been considerably found to give a realistic expectation of surgery to the patient. Along with this, it helps in achieving the high level of satisfaction of the patients regarding the recovery. Overall, impact depends on how the education and the information have been given to the patients that it does not seem daunting to them. Here, nurses play a major as well as powerful role in provision of the pre-operative education to the patient. Nurses play a major role in the provision of patient care as well as patient education. Their therapeutic communication, empathy, and compassion towards the patient are the biggest factor. Nurses spend most of the time with patient from taking care of their medications to everything. So, it is up to the nurses how they spend their time with patients. Amidst of taking care of them, checking up of all the vitals, and preparation for the surgical process they takes this as an opportunity to communicate with the patient and provide them one-on-one patient-centered education. This helps in building up the patient confidence as well as in enhancing the competence in self-care among them. The patient education whether it is about their diagnostic testing, disease process, or regarding their surgical procedure has been seen as a potential factor in directing and influencing the positive patient outcomes (Aust et al., 2016).

How well does the existing literature address your research question?

In answering this question consider if your research question has been a) fully answered, b) partially answered, or c) not answered at all.

THEN identify a) what further research could be conducted (and its characteristics such as design, sample, outcome measures) that might provide important information to answer your research question AND b) what are some ethical considerations that apply to these possible research studies (approx. word count 400)

The given literature has fully answered the research question as it can be concluded from the literature that yes, patient education pre-operatively can affect the patient outcomes positively. Though, it depend how and when the patients are being educated because it has been seen that educating the patient regarding their surgical process should be done like the patient gets some time to think about it. The further research on this could be conducted by interviewing the health professionals and nurses in a randomized controlled trial. This will explore the research question well and an extensive research would be done in order to come to the best possible conclusion. The randomized controlled trial is an approach that will be using in conducting the further research as it will help in examining the efficacy of the interventions regarding the pre-operative patient education (Houle, 2015). For conducting the further research the research must be conducted as per the PICO format. After defining the PICO randomization of the participant i.e., patients and nurses will be done. The ethical consideration for this would be first in taking the approval from the authority. An appropriate and effective research project totally depends on how well the research question is focussed. Formulation of the research question has always been considered as a preliminary step to conduct a valuable research. PICO format i.e., Population, Intervention, Comparison, and Outcome would be helpful in the successful facilitation of the literature review. Implication of this framework will make it easy to link with the multiple aspects of the research question altogether to achieve a significant as well as suitable research design (Eldawlatly et al., 2018). Secondly, patient’s consent, his autonomy, and confidentiality should be taken into consideration. However, ethical principles such as autonomy, justice, beneficence, and non-maleficence must be considered. Autonomy is respecting and acknowledging patients’ decisions regarding their care and other interventions. Beneficence highlights the core duty of the health professionals to perform as it benefits the patient. Non- maleficence is causing no harm to the patients ((Jahn, 2011). While, justice must be implemented for making everything fair (Juujarvi, Ronkainen & Silvennoinen, 2019). According to a study presented by Kearney et al. (2011), it has been stated that the patients that have been given preoperative education were reportedly seem to feel better and confidently prepared for their surgery and were able to understand the post-operative measure.

References for Impact of Preoperative Patient Education

Aust H., Rusch D., Schuster M., Sturm T., Brehm F., Nestoriuc Y. (2016). Coping strategies in anxious surgical patients. BMC Health Services Research, 16, 250. http://doi.org/10.1186/s12913-016-1492-5

Eldawlatly, A., Alshehri, H., Alqahtani, A., Ahmad, A., Al-Dammas, F., & Marzouk A. (2018). Appearance of Population, Intervention, Comparison, and Outcome as research question in the title of articles of three different anesthesia journals: A pilot study. Saudi Journal of Anaesthesia, 12(2), 283-286. doi:10.4103/sja.SJA_767_17

Fink, C., Diener, M. K., Bruckner, T., Müller, G., Paulsen, L., Keller, M., Büchler, M. W., & Knebel, P. (2013). Impact of preoperative patient education on prevention of postoperative complications after major visceral surgery: Study protocol for a randomized controlled trial (PEDUCAT trial). Trials, 14, 271. https://doi.org/10.1186/1745-6215-14-271

Houle S. (2015). An introduction to the fundamentals of randomized controlled trials in pharmacy research. The Canadian Journal of Hospital Pharmacy, 68(1), 28–32. https://doi.org/10.4212/cjhp.v68i1.1422

Iqbal, U., Green, J. B., Patel, S., Tong, Y., Zebrower, M., Kaye, A. D., Urman, R. D., Eng, M. R., Cornett, E. M., & Liu, H. (2019). Preoperative patient preparation in enhanced recovery pathways. Journal of anaesthesiology, Clinical Pharmacology, 35(Suppl 1), S14–S23. https://doi.org/10.4103/joacp.JOACP_54_18

Juujarvi, S., Ronkainen, K., & Silvennoinen, P. (2019). The ethics of care and justice in primary nursing of older patients. Clinical Ethics, 14(4), 187–194. https://doi.org/10.1177/1477750919876250

Kearney, M., Jennrich, M. K., Lyons, S., Robinson, R., & Berger, B. (2011). Effects of preoperative education on patient outcomes after joint replacement surgery. Orthopedic Nursing, 30(6), 391–396. https://doi.org/10.1097/NOR.0b013e31823710ea

Klaiber, U., Stephan-Paulsen, L. M., Bruckner, T., Müller, G., Auer, S., Farrenkopf, I., Fink, C., Dörr-Harim, C., Diener, M. K., Büchler, M. W., & Knebel, P. (2018). Impact of preoperative patient education on the prevention of postoperative complications after major visceral surgery: The cluster randomized controlled PEDUCAT trial. Trials, 19(1), 288. https://doi.org/10.1186/s13063-018-2676-6

Koutoukidis, G, Stainton, K & Hughson, J. (2017). Tabbner’s Nursing Care: Theory and Practice, 7th edn. Elsevier, Chatswood.

Mitchell M. (2017). Day surgery nurses' selection of patient preoperative information. Journal of Clinical Nursing, 26(1-2), 225–237. https://doi.org/10.1111/jocn.13375

Paterick, T. E., Patel, N., Tajik, A. J., & Chandrasekaran, K. (2017). Improving health outcomes through patient education and partnerships with patients. Proceedings (Baylor University. Medical Center), 30(1), 112–113. https://doi.org/10.1080/08998280.2017.11929552

Tollefson, J, Bishop, T, Jelly, E, Watson, G & Tambree, K. (2012). Essential Clinical Skills, 2nd edn. Cengage Learning, South Melbourne.

Wongkietkachorn, A., Wongkietkachorn, N., & Rhunsiri, P. (2018). Preoperative needs-based education to reduce anxiety, increase satisfaction, and decrease time spent in day surgery: A randomized controlled trial. World Journal of Surgery, 42(3), 666–674.

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