Empowering orthopaedic patients through preadmission education: Results from a clinical study
Introduction
Patient education has gained ever greater importance in surgical practice, especially with the trend towards shorter hospital stays. In industrial countries the average hospital stay for surgical patients has dropped clearly in the past 10 years [1], [2], [3]. Given this trend it is important that new and innovative ideas for patient education are constantly encouraged in terms of timing, content and methods, as surgical patients today have to take ever greater responsibility for their care from advance preparation through to rehabilitation [4], [5], [6], [7], [8], [9].
The benefits of preoperative education are widely recognized [4], [5], [6], [7], [8], [9], but there is no single universal content and method that can be applied to all conditions and diseases [5], [10]. According to orthopaedic patients themselves, their greatest knowledge needs and expectations are in the areas of biophysiological and functional issues, such as complications and medications [11] and postoperative and recovery related issues [12]. Generally patients are considered to be empowered when they have knowledge that meets their needs, expectations or preferences and when they are in the position to make good use of this knowledge [9], [13], [14], [15]. The knowledge that is needed to manage with a certain health problem does not, however, necessarily translate into the relevant practical skills of knowing-how. Patient education must therefore go beyond the simple provision of information [16], [17], [18].
To gain a sense of confidence and certainty about one's knowledge and knowing-how, it is important for patients to adopt an active role in the learning process. One way to achieve this might be through the empowerment approach [13]. Becoming empowered is an outcome of a process in individuals that can be intentionally facilitated [19], [20]. Empowering education aims at engendering a sense of control and at facilitating the patient's involvement in decision-making and self-management. For this to succeed it is essential to know what the patient already knows so that we can proceed to top up that knowledge [9], [17], [20], [21]. There is some evidence from clinical studies on empowering education and its benefits and impacts for patients’ knowledge, capability or skills, certainty [9], [13], [18], [22] and activity [23] related to their care, but there remains a scarcity of research into empowering educational interventions among orthopaedic patients.
Empowering education can be defined as consisting of an individually tailored amount of knowledge about biophysiological (e.g. symptoms and signs), functional (e.g. activities of daily living), experiential (e.g. feeling, experiences), social (e.g. social network), ethical (e.g. individual rights) and financial (e.g. payments and benefits) issues [14], [15], [24] covering the preoperative phase at home via the pre- and postoperative phases at hospital to the postoperative phase at home [9]. Different teaching and learning methods have been used when implementing empowering education, and it seems that methods that can activate patients are the most suitable [9], [13], [18], [23]. The concept map method has been reported to be suitable for learning [25], [26], [27], [28], but this method has not yet been widely studied among patients.
It seems that empowering education has beneficial impacts, but there is still need for a more focused research effort. This study aims 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 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).
We set out to test two hypotheses and to address one research question:
- 1.
Patients are more knowledgeable and certain about care-related issues, and
- 2.
Patients have a more empowering learning experience. If their education has made use of the concept map method and has included written educational material than patients educated with written educational material without systematic oral education.
- 3.
Do these two groups differ in terms of selected clinical outcomes (length of patient’ admission discussion, length of patient's hospital stay and patient's need for further care)?
Section snippets
Study design and implementation
A randomized two-group pre-test post-test design was used to compare voluntary, adult and elective orthopaedic patients from a surgical ward at one university hospital in Finland during a period of about 1 year. The study design is described in Fig. 1.
Education in groups A and B
Preadmission patient education in both groups (group A received written educational materials plus education using the concept map method, group B received written educational materials) was based on the idea of empowering through education [9],
Patient characteristics
The sample consisted of 123 hip arthroplasty patients divided into group A (n = 62) and group B (n = 61). The patients’ sociodemographic characteristics are shown in Table 1. On average, patients in group B were 5 years older than those in group A (p < 0.03). In addition, patients in group B were more often retired than patients in group A (p < 0.04). These two baseline factors were used as covariates to strengthen the validity of the comparison between the total scores of groups A and B.
Patients’ knowledge and certainty about care-related issues
At baseline
Discussion and conclusion
We begin this discussion by outlining the results and looking at the validity and reliability. We then move on to outline our conclusions and finally discuss the practical implications of our study.
Acknowledgement
We wish to thank Mr. David Kivinen for his help with the English language.
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