The Power of Education: Preoperative Class Reduces Anxiety and Improves Confidence.
Inman and colleagues (2013) found men who received education regarding the urinary catheter before prostatectomy reported less anxiety and higher levels of satisfaction postoperatively. When a patient is not able to attend the preoperative prostatectomy class, considerable time is needed to complete the needed education. Education thus needs to begin before surgery because, after prostatectomy and subsequent discharge from the hospital, the patient has an indwelling urinary catheter that may remain in place for 5-10 days or longer (Mayo Clinic, 2015). He and his caregiver need to know how to manage the urinary catheter and drainage bags.
Project Site and Reason for Change
Mayo Clinic Hospital--Rochester, Methodist Campus (Rochester, MN), a 794-bed health system, was the project site. Hospital leaders recognized the importance of providing empowering education to patients and their families so they can take an active role in their health. This particularly included the value of education for patients undergoing prostatectomy.
Many key factors have a role in patients' safe discharge from the hospital after prostatectomy. Patients must be comfortable with urinary catheter care and demonstrate the ability to change drainage bags. They also must be able to identify potential postoperative complications and understand postoperative restrictions, medications, and follow-up instructions. The registered nurse (RN) who provided education at patient discharge required at least 1 hour to review catheter care and other instructions after prostatectomy. When rating the discharge experience, many patients stated the process was longer than expected and too much information was relayed at the end of their hospitalization. In addition, postoperative nurses observed patients without formal comprehensive education before surgery did not appear as confident in caring for their catheters. Because of the large amount of education needed, nurses on the inpatient surgical unit suggested a preoperative class should be developed.
A preoperative class was developed and taught on a rotating basis by a core group of 10 RNs who worked on the postoperative urology unit. The 90-minute class was held Monday-Friday except on holidays. Following their preoperative appointment, patients were scheduled for the class and received a patient appointment guide. Class objectives include the following: verbalize steps to prepare for the operation, demonstrate care for the indwelling catheter with appropriate bag changes, identify how to manage possible health issues, and discuss when to contact the healthcare provider.
The class also included discussion of possible postoperative complications. Information was provided through written material and pamphlets, video, return demonstration, and open dialogue with the RN. The goal of the class was to increase confidence and decrease anxiety for patients and their caregivers surrounding hospitalization, catheter management, and discharge from the hospital. Healthcare providers in the ambulatory setting electronically ordered the class for a patient and the patient's caregiver. Most providers had the patient attend the class the week of surgery.
Evaluation and Action Plan
A voluntary, anonymous survey was distributed to patients after class. Data from the first 6 months of surveys showed 96 of 101 patient and caregiver respondents (95%) believed the class would help them be more successful in caring for the catheter at home. In addition, 92 (91%) indicated they felt less anxious and better prepared for surgery. An estimated 80% of patients attend the class when it is scheduled. After the first 6 months, the plan was to continue providing the preoperative class to patients scheduled for prostatectomy and their caregivers; the goal was to work with physicians to order the class for each patient going through the surgery.
Survey results, reminders, and updated or changed information are communicated through email. Surveys are collected and compiled quarterly. Results are relayed to the nurse manager and RN lead, who send survey suggestions and comments via email to all educators.
Results and Limitations
Quarterly data were collected in 2015. Of 209 patients who attended the preoperative education class, 196 (94%) believed the class would help them be more successful in catheter care at home (see Table 1). Less than 1% (n=3) did not believe the class would help them care for the catheter (<1% [n=10] gave no response). When asked, "Do you feel less anxious or nervous and better prepared for surgery after the class?" 191 respondents (91%) stated yes and 5 (<1%) stated no; <1% [n=12] gave no response). In addition, unit nurses identified subjective differences between patients who attended the preoperative class and those who were not able to attend. The amount of time spent by nurses in educating patients, fitting the leg bag, and demonstrating how to change and empty the bag appeared to be greater for patients who did not attend the preoperative class.
To assess patient satisfaction more effectively among participants, a survey specifically related to each class time would be helpful. In addition, the survey questions were broad, and the survey had only one catheter-related question. Results thus may not have reflected specific patient learning; rather, the results may have captured the response to the class content and how beneficial the information will be for patients after discharge from the hospital.
Patients typically return for a postoperative follow-up appointment; however, they are seen as outpatients, and only inpatient nurses teach the preoperative class. Additional collaboration across the continuum of care would allow nurses to gain insight about patients' most frequent questions and concerns after surgery. This knowledge could assist educators in assessing and possibly revising the class curriculum.
Lessons Learned/ Nursing Implications
After implementing the project and gathering data, authors determined the survey should have been designed to assess anxiety and confidence quantitatively versus qualitatively. For example, a valid presurvey could have assessed anxiety. Second, a post-survey would have helped measure how effective the class was after patients were discharged home. Third, comparison of discharge time would have been helpful to see the before-and-after impact.
A preoperative education class for patients undergoing prostatectomy and their caregivers significantly reduced anxiety and increased confidence in the immediate postoperative period (Inman et al., 2013). It also increased patient satisfaction regarding at-home urinary catheter care and post-discharge instructions. Of importance, the RN is a pivotal communicator and teacher before and after a patient's prostatectomy. Incorporation of preoperative and postoperative instructions and an indwelling catheter management class should be included in all preoperative education activity for men undergoing this procedure.
* Anticipation of hospital discharge can induce anxiety. However, educational interventions increase patient knowledge and competence on how to cope with pain, incisions, drain care, and the indwelling catheter (Ferreira da Mata, Caldas Ferreira, & Campos de Carvalho, 2013).
* Lee and Lee (2013) examined nurses' perceptions of preoperative patient teaching and found addressing details of anesthesia, information about the operation, and postoperative expectations decreased patient anxiety and stress.
* Inman, Jacobson, Maxson, Wang, and Lohse (2013) found decreased patient anxiety with home urinary catheter care after patients attended a preoperative class. Increased confidence was established in patients' ability to care for the indwelling catheter and adherence to postoperative instructions after preoperative education.
* Specifically, hands-on practice with indwelling catheter equipment is important for patients who undergo prostatectomy (Huber et al., 2012).
Quality Indicator with Operational Definitions & Data Collection Methods
* Registered nurses who provided education at hospital discharge took at least 1 hour to review prostatectomy education, catheter care, and discharge instructions. When rating their discharge experience, many patients stated the discharge process was longer than expected and too much information was relayed at the end of their stay.
* Preoperative survey was used to measure effectiveness. Four quarters of data were collected.
* Decreased discharge time and confidence of patient at discharge were used to determine success of the preoperative class. However, this was identified anecdotally through nurse-to-nurse communication rather than by use of a survey or another tool.
22-bed gynecology/urology postsurgical unit with average daily census of 18 patients
Improve patient confidence and decrease anxiety through use of the preoperative class, in turn decreasing delay in discharge.
Ferreira da Mata, L.R., Caldas Ferreira, T., & Campos de Carvalho, E. (2013). Nursing actions in the perioperative period and in preparing prostatectomy patients for discharge. Investigacion y Educacion En Enfermeria, 31(3), 406-413.
Fink, C., Diener, M.K., Bruckner, T., Muller, G., Paulsen, L., Keller, M..... 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. doi:10.1186/1745-6215-14-271
Huber, J., Ihrig, A., Herzog, W., Huber, C. G., Konyango, B., Loser, E.....Hohenfellner, M. (2012). Patients' view of their preoperative education for radical prostatectomy: Does it change after surgery? Journal of Cancer Education, 27(2), 377-382. doi: 10.1007/s13187-011-0293-0
Inman, D.M., Jacobson, T.M., Maxson, P.M., Wang, H., & Lohse, C.M. (2013). Effects of urinary catheter education for patients undergoing prostatectomy. Urologic Nursing, 33(6), 289-298.
Lee, C.K., & Lee, I.F. (2013). Preoperative patient teaching: The practice and perceptions among surgical ward nurses. Journal of Clinical Nursing, 22(17-18), 2551 -2561. doi:10.1111/j.1365-2702. 2012.04345.x.
Mayo Clinic. (2015). Prostatectomy: What you can expect. Retrieved from http://www. mayoclinic.org/tests-procedures/prostatectomy /basics/what-you-can-expect/ prc-20119420
Nigussie, S., Belachew, T., & Wolancho, W. (2014). Predictors of preoperative anxiety among surgical patients in Jimma University Specialized Teaching Hospital, south western Ethiopia. BMC Surgery, 14, 67. doi:10.1186/1471 -2482-14-67
Cindy C. Bisbey, RN, CMSRN[R], is Preoperative Educator and Staff Nurse, Inpatient Gynecology/Urology Surgical Unit, Mayo Clinic, Rochester, MN.
Tori A. Ristau, RN, is Staff Nurse, Inpatient Gynecology/Urology Surgical Unit, Mayo Clinic, Rochester, MN.
Michelle D. Johnson, RN, CNOR, is Staff Nurse, Inpatient Gynecology/Urology Surgical Unit, Mayo Clinic, Rochester, MN.
Meghan M. Streed, RN, is Preoperative Educator and Staff Nurse, Inpatient Gynecology/Urology Surgical Unit, Mayo Clinic, Rochester, MN.
April A. Bursiek, MSN, RN, is Nurse Manager, Inpatient Gynecology/Urology Surgical Unit, Mayo Clinic, Rochester, MN.
Pamela L. Grubbs, APRN, CNS, is Clinical Nurse Specialist, Department of Nursing, Mayo Clinic, Rochester, MN.
TABLE 1. Responses to Two Survey Questions Quarter 2015 Question Response, % (n) Do you feel this class Do you feel less anxious will help you be more or less nervous and successful in caring better prepared for for your catheter at surgery after the class? home? 1 100 (26/26) 92 (24/26) 2 93 (70/75) 91 (68/75) 3 93 (69/74) 91 (67/74) 4 91 (31/34) 94 (32/34)
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|Title Annotation:||Continuous Quality Improvement|
|Author:||Bisbey, Cindy C.; Ristau, Tori A.; Johnson, Michelle D.; Streed, Meghan M.; Bursiek, April A.; Grubb|
|Date:||Sep 1, 2017|
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