Evidence-informed policymaking: Modelling nurses' career pathway from registered nurse to advanced practice nurse.

AIM: To formulate, validate, and disseminate policy, modelling nurses' career pathway from registered to advanced practice nurse. METHOD: The evidence-informed policy and practice pathway framework was utilized. Multiple methods were used, including scoping review of literature, consultation of key informants, survey study, and expert group round-table discussions during 5-year project between 2013 and 2018. RESULTS: Through (a) sourcing, (b) using, and (c) implementing the evidence, the expert group worked systematically to formulate a policy on a career pathway from registered to advanced practice nurse. The formulated career pathway includes three competence levels: registered nurse, specialized nurse, and advanced practice nurse, which includes the roles of nurse practitioner and clinical nurse specialist. In addition, validation and dissemination of the policy, as well as its effective implementation and the process of integrating it into practice, were examined. CONCLUSION: Evidence-informed policymaking is an effective, interactive way to work collaboratively in achieving consensus and translating knowledge into practice. The formulated policy will contribute to the increased awareness, acknowledgement, and implementation of the registered nurses' traditional and new roles within health care environments. Implementing and integrating the policy in national health care policy, legislation, education, and organizations across the country is a work in progress.

Ambulatory orthopaedic surgery patients' emotions when using different patient education methods.

A randomised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients' emotions during internet-based patient education or face-to-face education with a nurse. The internet-based patient education was designed for this study and patients used websites individually based on their needs. Patients in the control group participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit. The theoretical basis for both types of education was the same. Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process, though their scores also changed during the surgical process. Emotion scores did not decrease after patient education. No differences in patients' emotions were found to result from either of the two different patient education methods.

Ambulatory orthopaedic surgery patients' knowledge with internet-based education.

BACKGROUND: There is a growing need for patient education and an evaluation of its outcomes. OBJECTIVES: The aim of this study was to compare ambulatory orthopaedic surgery patients' knowledge with Internet-based education and face-to-face education with a nurse. The following hypothesis was proposed: Internet-based patient education (experiment) is as effective as face-to-face education with a nurse (control) in increasing patients' level of knowledge and sufficiency of knowledge. In addition, the correlations of demographic variables were tested. METHODS: The patients were randomized to either an experiment group (n = 72) or a control group (n = 75). Empirical data were collected with two instruments. RESULTS: Patients in both groups showed improvement in their knowledge during their care. Patients in the experiment group improved their knowledge level significantly more in total than those patients in the control group. There were no differences in patients' sufficiency of knowledge between the groups. Knowledge was correlated especially with patients' age, gender and earlier ambulatory surgeries. CONCLUSIONS: As a conclusion, positive results concerning patients' knowledge could be achieved with the Internet-based education. The Internet is a viable method in ambulatory care.

Ambulatory orthopaedic surgery patient education and cost of care.

PURPOSE: To describe and compare ambulatory orthopaedic surgery patients' reported cost of care (out-of-pocket costs, use of time, and consultations with healthcare organizations) and nurses' cost of care (use of time and consultations with other professionals such as other nurses, physicians, and anesthesiologists) when patients receive 2 different types of patient education (Internet-based or face-to-face). METHOD: Pretest/posttest design. SAMPLE: Random assignment of all ambulatory orthopaedic surgery patients in a university hospital in Finland. INTERVENTION: The experimental group received Web-based patient education and the control group received face-to-face patient education. OUTCOMES OF INTEREST: Financial and time costs. FINDINGS: Pre-, intra-, and postoperative costs did not differ between the groups. However, Internet-based education was more time-consuming for the patient and face-to-face education was more time-consuming for the nurse. There were no differences between the groups in patients' use of consultations of healthcare professionals. Nurses' consultations were few and did not differ between the groups. The small number of patients' and nurses' consultations indicates that patients in both education methods had enough knowledge to deal with the surgery.

Ambulatory orthopaedic surgery patients knowledge with Internet-based education.

There is a growing need for patient education and evaluation of the outcomes of it. The aim of this study was to compare the ambulatory orthopaedic surgery patients' knowledge with Internet-based education and face to face education with a nurse. The following hypothesis was set: Internet-based patient education (experiment) is as effective as face to face education with a nurse (control) in increasing patients' level of knowledge and sufficiency of knowledge. In addition the correlations of demographic variables were tested. The patients were randomised to either the experiment (n=72) or to a control group (n=75). Empirical data were collected with two instruments. Patients in both groups showed improvement in their knowledge during their care. Patients in experiment group improved their knowledge level significantly more in total than those patients in control group. There were no differences in patients' sufficiency of knowledge between the groups. Knowledge was correlated especially with patients' age, gender and earlier ambulatory surgery. As a conclusion, with the Internet-based education could achieve positive results on patients' knowledge. Internet is usable method in ambulatory care.

The creation and evaluation of an ambulatory orthopedic surgical patient education web site to support empowerment.

The use and evaluation of Web sites in ambulatory surgery patients' education are rare; hence, innovative approaches to educate these patients should be adopted and evaluated. The aim of this study was to describe the creation of and evaluate the utility and usability of an ambulatory orthopedic surgical patient education Web site. A descriptive study design was used. The evaluators were 72 ambulatory orthopedic surgery patients receiving education through a Web site. The data were collected after education preoperatively and 2 weeks postoperatively. Two instruments were used: "Patients' Evaluation of Education" and "Diary of the Use of the Website." Web site evaluators' scores for utility of the Web site ranged from 57.56 to 87.87 of 100. Utility of the Web site evaluations was significantly higher (P < .05) 2 weeks postoperatively than immediately after the operation. Web site evaluators' scores for usability of the Web site ranged from 85.69 to 88.32. The use of this program as educational material for orthopedic surgery patients was supported by the patients' opinions of the usability and utility of the Web site.

How do patients evaluate their education? - a comparison of two education methods.

A Randomized controlled trial was used to compare the ambulatory orthopaedic surgery patients' evaluations of Internet-based education (experiment) and face to face education with a nurse (control). Patients in the control group evaluated their education to meet their needs better than patients in the experiment group. Both groups evaluated the education quite positively.

Preference for information and behavioral control among adult ambulatory surgical patients.

This empirical study aimed to describe the ambulatory surgical patients' information and control preferences with reference to received knowledge. The results indicate that patients' information preferences and behavioral preferences are not very high, and they seem to receive most knowledge in the biophysiological domain. The most important finding is that patients with higher preferences seem to receive less knowledge than those with lower preferences. The results suggest the need to further study nurses in the ambulatory surgery setting and the extent to which the information expectations of patients are met.

A comparison of two educational interventions for the cognitive empowerment of ambulatory orthopaedic surgery patients.

OBJECTIVE: The aim of this study was to compare the cognitive empowerment of ambulatory orthopaedic surgery patients when using Internet-based education (experiment) in contrast to face to face education conducted by a nurse (control). METHODS: Elective ambulatory orthopaedic surgery patients were randomized to either an experiment group (n = 72) receiving Internet-based education, or to a control group (n = 75) receiving face-to-face education with a nurse. The data were collected at three different time points: before the preoperative education session, after preoperative education and 2 weeks after the operation. Three structured instruments were used: the Knowledge Test, the Sufficiency of Knowledge and the Orthopaedic Patient Knowledge Instrument. RESULTS: Patients in both groups showed improvement in their knowledge. However, patients who received Internet-based education improved their knowledge level significantly more in the ethical (p = 0.005) and functional (p = 0.023) dimensions and also in total (p = 0.033) than those patients who underwent face-to-face education with a nurse. In addition, patients in the experiment group had higher scores in sufficiency of knowledge in the experiential (p = 0.050) and financial (p = 0.048) dimensions and, moreover, their scores in sufficiency of knowledge in the ethical dimension improved significantly more (p = 0.008) during the study period than patients in the control group. CONCLUSION: Improvements in the patients' level and sufficiency of knowledge within both groups indicates an increase in patients' cognitive empowerment. PRACTICE IMPLICATIONS: Internet-based education can be used in ambulatory orthopaedic surgery patient education for increasing patients' cognitive empowerment.

Health-related quality of life of day-case surgery patients: a pre/posttest survey using the EuroQoL-5D.

AIM: This paper describes and compares the perceived health-related quality of life (HRQoL) of day-case surgery patients before and after their procedures and examines some associated patient-related factors. METHOD: A pre/posttest survey design was employed to collect data from Finnish adult day-case surgery patients using participant-completed EuroQoL 5-Dimensional Classification Component Scores (EQ-5D) questionnaires given 2 weeks presurgery (n = 131) and 2 weeks postsurgery (n = 131) in 2004. RESULTS: No noticeable change after minor surgery was found using the EQ-5D. Using the EQ-5D index, patients perceived their HRQoL as high before and after surgery. Almost one fifth (17%) reported no pain or discomfort before the procedure compared with 40% after it. As measured by the EuroQol visual analogue scale (EQ(VAS)), those patients who reported chronic illness before the operation had a lower perception of their HRQoL compared with those who did not. It was also found that self-care and usual activities were more disturbed after surgery. CONCLUSIONS: Although there were increases and decreases within items of the EQ-5D, overall, there was no improvement on EQ-5D scores. More research is needed to explore the sensitivity and responsiveness of the EQ-5D measure in day-case surgery patients.

Ambulatory orthopaedic surgery patients' knowledge expectations and perceptions of received knowledge.

AIM: This paper is a report of a study to compare orthopaedic ambulatory surgery patients' knowledge expectations before admission and their perceptions of received knowledge 2 weeks after discharge. BACKGROUND: Advances in technology and population ageing are driving up the number of ambulatory orthopaedic surgical procedures. Shorter hospital stays present a major challenge for patient education. METHODS: A descriptive comparative cross-sectional study (pre- and post-test) design was adopted. The data were collected from 120 consecutive patients in 2004, using the Hospital Patient's Knowledge Expectations Scale and Hospital Patient's Received Knowledge Scale. All patients participated in a preoperative education session given by a nurse. RESULTS: Patients expected more knowledge than they actually perceived that they received on all dimensions except the bio-physiological. They perceived that they received least knowledge about experiential, ethical, social and financial dimensions of knowledge. Knowledge expectations correlated with age and professional education. Perceptions of received knowledge correlated with earlier ambulatory surgery, and both expected knowledge and perceptions of received knowledge were related to the level of basic education. CONCLUSION: Patients' knowledge expectations are greater than the knowledge they perceived that they receive, and they cannot become empowered if they lack important knowledge. Further research is needed to learn about meeting patients' knowledge expectations.

Expectations and received knowledge by surgical patients.

OBJECTIVE: Here, the aim is to compare surgical patients' knowledge expectations at admission with the knowledge they received during their hospital stay. DESIGN: The study used a descriptive and comparative design. SETTING: The study was conducted on surgical wards at one randomly selected university hospital in Finland. PARTICIPANTS: The sample (n = 237) consisted of surgical patients (traumatological, gastroenterological, urological and heart and thorax surgery) admitted to hospital during a 2-month period in 2003. METHODS: The data were collected by two specially developed, parallel questionnaires: Hospital Patients' Knowledge Expectations and Hospital Patients' Received Knowledge. These 40-item instruments used a four-tier response scale and made a distinction between the bio-physiological, functional, experiential, ethical, social and financial dimensions of knowledge. The data were analysed statistically. RESULTS: Surgical patients received less knowledge than they felt they expected on the bio-physiological, functional, experiential, ethical, social and financial dimensions. Their knowledge expectations and the knowledge they received were related to age, gender and level of basic education. CONCLUSIONS: The results highlighted the need for improved patient education. Surgical patients expect to receive more knowledge than they actually receive on all dimensions. The most problematic areas in the education of surgical patients are the experiential, ethical, social and financial dimensions of knowledge. In particular, younger patients, female patients and patients with a higher level of education require more attention.

How to structure an empowering patient education program for internet.

There is a lot of health related information in the Internet. However a little is known about the quality of that. The purpose of this study is to analyze the structure and the applicability of the empowering internet based ambulatory surgery patients' education program. The education material was created and tested for this study. The structure is evaluated with structure analysis and applicability with AWStats-counter program and a survey. The evaluation of the program's structure and applicability, gives feedback about the usability of the program and helps to create criteria for a useable structure of the patients' education program.

Prostatectomy patients' postoperative pain assessment in the recovery room.

AIM: This paper reports a study to assess the usability and use of different pain assessment tools and to compare patients' and nurses' pain assessments in the recovery room after prostatectomy. BACKGROUND: Pain assessment is the first step towards providing adequate pain relief but poses problems because of the subjective nature of the pain experience and the lack of quantifiable measurements. Pain tools have been tested in several clinical settings, but not in the recovery room. METHODS: Data were collected in the recovery room from 45 consecutive patients who had undergone prostatectomy by asking them to evaluate their pain intensity using visual analogue scale, numeric rating scale and verbal expressions. One of two research nurses measured patients' pain at regular intervals and at the same time as the patients. Physiological parameters were also evaluated. Data were analysed as frequencies and percentages. Sum variables were formed and results were analysed using Spearman's rank correlation, Pearson's correlation and with multiple regression analysis. RESULTS: Patients varied in their ability to assess the intensity of their pain using different tools, but assessments were correlated with each other and with nurses' estimations. Nurses and patients obtained similar assessments, but nurses both underestimated and overestimated patients' pain. Patients' verbal assessments varied widely. Patients' and nurses' pain assessments showed no association with patients' pulse or mean arterial blood pressure. CONCLUSIONS: According to our results, it is not totally clear whether pain tools are usable in the recovery room. This issue calls for further research.