NSG2NMR Nursing And Midwifery Research Assignment

ASSESSMENT 3 2018 TEMPLATE
NSG2NMR (2018) Assessment 3: 2,000 individual report
Student First Name:
Student Surname:
Student ID Number:
Facilitator Name:
Site/Clinical School:
TOTAL Word Count: 2,000 +/- 10%
Excludes: reference list, appended search history
Includes: in-text citations
DUE DATE:
Identify a clinical issue and propose a research question about this clinical issue (approx. word
count 100)
[WRITE HERE] The pre-operative period is a very sensitive period for the patient and the nurse. There
are so many uncertainties especially with the patient who expresses concerns about the surgical
procedure and the conclusion of going under total anaesthesia. Pre-operatively patients are prepared
on the surgical procedure they will undergo, the complications that may arise from the procedure, the
possible outcome of the procedure, the medications that will be used and the expected hospital stay
after the procedure.
The outcome of a surgical procedure is determined by many factors, most important question being
Does patient education pre-operatively impact on the patient’s outcome?
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)
[WRITE HERE]Patient education is a very significant strategy used in a health care facility. Educating
patients makes them feel involved in their treatment and disease process. Pre-operative patient
education is a form of health education that is performed by the theatre nurse prior to the actual
procedure. Patients need to be educated step by step about their disease process in patients
scheduled for surgical procedures. Surgical procedures can either be minor or major; however patient
education is a requisite despite the sensitivity of the procedure. A human physiologic mechanism
react differently to many factors; therefore disregarding pre-operative patient education because of
the simplicity of the procedure to be done can be very detrimental to the outcome of the procedure
because of the many uncertainties associated with surgery. Most major surgeries are performed
under general anaesthesia; therefore the client needs to know what general anaesthesia is and its
effects after the procedure together with the outcome of the procedure whether positive or negative.
Alternatively a minor surgery is performed under epidural or local anaesthesia and the patient
undergoing such a procedure should also be given pre-operative patient education about the
expectations of the procedure and the anticipated outcome whether positive or negative. There many
types of surgical procedures performed in a health care facility to different client; therefore each
client is provided with pre-operative education relevant to the procedure they are due for, because
different surgical procedures have different outcomes.
After a surgical procedure so many thing are expected the most expectation being patient
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satisfaction and pain. A study conducted by (Bouchard and Grawe et al,,, 2010) concluded that there
was a remarkable decrease in post-operative pain for patients who had received pre-operation
patient education before the surgical procedure was performed, because these patients had an
overview of the outcome before-hand which made them adopt to the post-operative period
effectively (Bouchard, 2010).
Pre-operative patient education prepares the client on the most likely outcome post-operatively.
Patients are different some recover from anaesthesia calmly while others become very violent post-
operatively when recovering from anaesthesia because of the disorientation associated with the
effects of the anaesthetic drugs. How these patients adapt during the post-operative period is highly
reliant on the patient education provided. Adequate patient education which covers the most
sensitive area such as the possibility of complications, excessive pain, and poor outcome of the
procedure ensures that a patient is well prepared for anything post-operatively (K, 2018).
Pre-operative patient education should be patient-centred. The more individual the education is
the better the outcome post-operatively. When giving pre-operative education the nurse should
ensure that it is patient-centred, this gives the patient the autonomy to make all the decisions
regarding the procedure. Ethical considerations should be put in place and the patient has the final
say, even if the opt out of the procedure hours before it is started their decisions should be respected.
Ethical considerations should be the guiding factor during patient education; Veracity should be
exercised at all times regardless of the situation surrounding the procedure (Oates, 2000). For
instance some procedures are very complex, sensitive and rare for example separating conjoined twin
or transplantation of a major organ such procedures are the type of procedure that bring so much
attention to the hospital and the surgical team. This procedure if performed successfully is able to
boost the rating of the hospital and attract more investors and donors. However such procedures
carry the most and the worst form of complication if they were to go south; therefore patient-centred
pre-operative health education should ignore the attention brought to the hospital and truthfully
educate the client on all the expectations associated with such a procedure and focus on the patient’s
needs (Guo, 2015).
A study conducted by (Gia, 2015) concluded that patient-centred pre-operative education ensures
that a patient’s diversity, beliefs and cultures are respected. During pre-operative patient care, the
client will be educated on everything that will be done to them during the surgical procedure. Some
people belong to cultures that do not allow some procedures to be done, others belong to religions
that do not allow some procedures to be performed on them for instance the Jehovah witnesses do
not belief in blood transfusion. The diversity of patient’s beliefs should be put in place and
alternatives availed to them. This ensures optimal patient outcome and patient satisfaction after the
surgical procedures (L, 2015).
Some surgical procedures may not turn out as expected, some outcomes may be worse than the
present state for example a kidney transplant that results with the recipient rejecting the organ
resulting in a serious chronic condition that the patient ends in an intensive care unit, transparency
about the possibility of the clients body rejecting the organ helps a lot in such an outcome, because
the patient was psychologically prepared for such an outcome.
Pre-operative patient education plays a very important role in ensuring that the client is
psychologically prepared for the pain that is associated with surgical procedures and the coping
mechanisms for reducing the pain. The most effective pain reduction strategies is pharmacologic
intervention the patient should be made aware of such options and the side effects of the
medications used in pain management. This form of detailed education ensures that the client makes
an informed choice it also gives the client the autonomy to choose the surgeon performing the
procedur (Rothrock, 2014).
As I said earlier the human body is very diverse and it reacts differently to medications used
during surgical procedures. Most of the anaesthetic drugs make the recipient drowsy and disoriented
after the procedure, such details should not be left out, the patient should know what to expect as a
result of the medication used. Sharing information about the mode of action and the different
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anaesthetic drugs that will be used during the procedure impacts positively on the patient outcome
post-operatively.
Pre-operative education ensures that the client feels comfortable before total anaesthesia is
achieved, this will positively impact the period of recovery from anaesthesia, and during pre-operative
education the client has the chance to meet the whole surgical team; therefore promoting patient’s
confidence which enhances a positive outcome postoperatively.
In a study by (Lubbeke and Perneger, 2015) “about influence of pre-operative patient education on
the risk of hip dislocation after primary total hip arthroplasty” the study concluded that patient
education is very relevant in reducing the occurrence of complications after the surgical procedure
was done. This applies to all surgical procedure performed on clients. Surgical procedure whether
minor or major possess the risk of developing complications, some complications may arise minutes
to hours to days after the procedure others may arise months to years after the procedure, all of the
possible complications should be discussed with the patient pre-operatively, because it provides the
patient with psychological preparedness in case of any complication s after a surgical procedure is
performed (A, 2009).
Preparing a patient pre-operative ensures that they are psychologically prepared for the outcome
good or bad. Pre-operatively patient education applies to all surgical procedures from major ones to
minor ones such as dental procedures. Such preparation enhances positive recovery period despite
the outcome. It ensures that a patient makes decision autonomously without coercion. It also helps
relieve anxiety which can really complicate the procedure if a client is not relaxed physically and
psychologically.
Extensive research has been conducted supporting the relevance of pre-operative patient education
and its impact across various surgical procedures performed in the hospital. Some of the subjects
studied express their gratitude to pre-operation education which they attribute to the success of the
procedure and the coping mechanisms used especially in patients who have undergone amputation
procedures, they say they are able to adapt to their present condition because of the pre-operative
education they received.
This education helps the client adapt better to the changes that occur in their bodies; therefore pre-
operative patient education is advocated for and taught in nursing schools in order to enhance service
provision to clients. The main aim for pre-operative patient education is ensuring that the client is
well informed and ensuring that the client make autonomous choices about their health. It should be
patient-centred addressing the differing needs of every patient. Nurses should be well versed with the
best strategies for offering patient education, nurses should be able to listen and allay all patients’
anxiety regarding any procedure to be performed.
Over the years the efficacy of pre-operative patient education has increased tremendously enabling
and promoting a better patient outcome and impacting positively on their health. Currently a patient-
centred approach is being adopted because of the diversity of clients in order to achieve the objective
and goals of health care which is provision of safe and quality care. Nowadays patient are actively
involved in the surgical choices and overall health choices. Gone are the days when information was
withheld from the client, now the client is given all the information associated with the surgical
procedures they are undergoing and the expected outcome.
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)
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[WRITE HERE]According to the literature review conducted from Medline and CINAHL sources my
question is fully answered from the extensive research conducted on pre-operative patient education.
The question answered is pre-operative patient education positively influences the outcome and
patient’s impact on the surgical procedures performed. Patient are able to appreciate the effort put in
place to ensure that they are the centre for attention, which is what should be in any health care
setting.
Research should be further conducted to analyse the effectiveness of simulation involvement in
ensuring a patient has a glimpse of what will happen to their bodies during the procedure. Simulation
involvement entails an artificial real life scenario that the patient can be showed to and explained
step by step by the lead surgeon on what will happen and the reason for the many complications that
may be associated with the surgical procedures. This sounds scary especially in people who do not
understand the human body; it can however be done as an option whereby the client can request to
be shown a simulation of what will happen. In my opinion this will help the clients understand more
about their condition and the reason for the surgical procedure.
The research design should be a qualitative analysis by use of a questionnaire whereby all patients
who are confirmed candidates for surgical procedures. The question should entail be about how they
would feel if they were to be shown a simulation of what will happen during the surgery and what
would happen complications are experienced. This analysis is used to determine the effectiveness of
pre-operative simulation education. It would the set the pace for implementation of such a program
or not.
Some of the ethical considerations related to such research studies are confidentiality, autonomy,
veracity, confidentiality. The clients have to know the truth about the study and their confidentiality
should be maintained, they also should be able to make choices whether to participate or not. Ethical
consideration is very important aspect of research, because it enables the researcher to practice
professionalism and protect the rights of the study subjects. Conducting research on any subject
requires the subjects to be voluntarily involved without coercion and that is the purpose of ethics in
research to ensure that rights of people are not violated.
References
[INCLUDED REFERENCES HERE]
References
A, L. (2009). Influence of preoperative patient education on the risk of dislocation after primary total
hip arthroplasty. Athritis Rheuamtism:Pubmed, 4(61), 552-8.
Bouchard, R. (2010). [Impact of preoperative patient education on postoperative pain in
consideration of the individual coping style]. Articles in German:Pubmed, 6(24), 575-86.
Guo, P. (2015). Preoperative education interventions to reduce anxiety and improve recovery among
cardiac surgery patients: a review of randomised controlled trials. Journal of clinical nursing,,
1-2(24), 34-46.
K, L. A. (2018). Immediate preoperative outcomes of pain neuroscience for patients undergoing total
knee arthroplasty. A case series . Physiotherapy Theory & Practice, 1-11.
L, G. (2015). Preoperative Education: A Patient-Centered Care Approach. USF Scholarship: a digital
repository @ Gleeson Library |, 2-10.
Oates, J. W. (2000). The impact of patient-centered care on outcomes. Fam Pract,, 9(49), 796-804.
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Rothrock, J. C. (2014). Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences.
APPENDIX A: Search History of BOTH Medline & CINAHL
CINAHL
Search History/Alerts
 Print Search History
 Retrieve Searches
 Retrieve Alerts
 Save Searches / Alerts
Select / deselect all
Search
ID# Search Terms Search Options Actions
S9 S5 AND S6 AND S8 Search modes - Boolean/Phrase View Results (92)
View Details
Edit
S8 S6 AND S7 Search modes - Boolean/Phrase View Results (1,773)
View Details
Edit
S7 pain OR outcome OR preoperative OR
education
Search modes - Boolean/Phrase View Results (948,396)
View Details
Edit
S6 S3 AND S4 Search modes - Boolean/Phrase View Results (1,773)
View Details
Edit
S5 S1 AND S4 Search modes - Boolean/Phrase View Results (105)
View Details
Edit
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Search w ith AND Search w ith OR Delete Searches Submit

S4 ethics OR preoperative education Search modes - Boolean/Phrase View Results (43,011)
View Details
Edit
S3 patient outcome OR preoperative
education
Search modes - Boolean/Phrase View Results (62,763)
View Details
Edit
S2 anxiety OR preoperative education Search modes - Boolean/Phrase View Results (48,601)
View Details
Edit
S1 preoperative education for hip or knee
replacement
Search modes - Boolean/Phrase View Results (7,267)
View Details
Edit
MEDLINE
1 (preoperative patient edcutaion or impact of patient outcome).mp. [mp=title, abstract, original title,
name of
substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare
disease
supplementary concept word, unique identifier, synonyms] (401)
2 limit 1 to (english language and full text and medline and last 5 years) (24)
3 (preoperative education or pain reduction).mp. [mp=title, abstract, original title, name of substance
word,
subject heading word, keyword heading word, protocol supplementary concept word, rare disease
supplementary concept
word, unique identifier, synonyms] (4481)
4 (reduced anxiety or preoperative education).mp. [mp=title, abstract, original title, name of substance
word,
subject heading word, keyword heading word, protocol supplementary concept word, rare disease
supplementary concept
word, unique identifier, synonyms] (1426)
5 (positive patient outcome or preoperative education).mp. [mp=title, abstract, original title, name of
substance
word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease
supplementary
concept word, unique identifier, synonyms] (302)
6 3 and 5 (254)
7 2 and 4 (0)
8 3 and 4 (257)
[APPEND SEARCH HISTORY HERE. CAN BE EITHER COPY & PASTED FROM WORD DOCUMENT OR A
PRINTSCREEN IMAGE OF SEARCH]
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