Increasing self-efficacy through empowerment: preoperative education for orthopaedic patients.

PURPOSE: To examine whether patients who received an empowerment model of education for preoperative orthopaedic teaching had improved outcomes compared to patients who received the traditional education. DESIGN: An experimental (empowerment teaching method) group vs. comparison (traditional teaching method) group posttest design. SAMPLE: Seventy-four patients undergoing elective orthopaedic surgery. METHODS: Following the preoperative teaching session, patients in both groups completed a questionnaire designed to measure their perceptions of the teaching (empowerment) and self-efficacy (belief in their ability to carry out perioperative tasks). A chart audit and phone interview was done after discharge to assess length of stay, pain management, complications, and patient perceptions of the ability to complete perioperative tasks. FINDINGS: Patients in the empowerment group felt the educational approach was more empowering and had significantly higher self-efficacy scores than those in the traditional teaching group. There was much less variation in empowerment and self-efficacy scores in the empowerment group. The empowerment group reported feeling greater confidence in performing perioperative tasks. There were no differences in length of stay, complications or pain control. CONCLUSION: Use of an empowerment teaching approach enabled patients to become more confident in their ability to carry out perioperative tasks and become a more integral part of the preoperative teaching process. IMPLICATIONS FOR NURSING RESEARCH: The theoretical model will be used to structure other educational programs and guide research. More sensitive measures of complications and pain control should be considered for future studies.

Parents' knowledge of neonatal screening and response to false-positive cystic fibrosis testing.

Neonatal screening for cystic fibrosis (CF) has become feasible through analyzing dried blood specimens for immunoreactive trypsinogen (IRT), but the benefits and risks of such a screening program remain to be delineated. This study, a survey of the parents of 104 Wisconsin infants with false-positive IRT tests, showed parents had knowledge deficits about neonatal screening in general, misconceptions about test results, and high levels of anxiety. Parenting behaviors were reportedly unchanged during the usual 3-day waiting period between the news of the abnormal screening test and the diagnostic sweat test. Most, but not all, parents were relieved by negative sweat test results subsequent to the abnormal IRT test. Factors associated with continued parental concern included having less than a high school education and/or having an infant with low Apgar scores. Additionally, those contacted by telephone were more likely to have misinformation and lingering concerns about the presence of CF in their child.

Current issues in neonatal screening for cystic fibrosis and implications of the CF gene discovery.

Many questions remain regarding the efficacy, toxicity, and costs of CF neonatal screening. It would be premature, in our opinion, to implement mass population screening of newborns for CF until the benefits and risks have been fully defined, and an adequate and logistically feasible testing system developed and/or highly effective therapy for CF lung disease becomes available. In addition, the ethical issues described herein need to be resolved. This pertains not only to the CF patient but also the heterozygote carrier. These reservations notwithstanding, the discovery of the CF gene should have a favorable impact both directly and indirectly on neonatal screening for the disease. Mutation analysis coupled to IRT testing seems most attractive at this time, at least on a research basis, but primary molecular diagnostic procedures might supervene in the future, particularly if they are financially feasible.

Parental issues in feeding young children with bronchopulmonary dysplasia.

This study examined the feeding issues that parents of 11 children with bronchopulmonary dysplasia (BPD) identified and explored the informational bases or criteria for decisions to initiate, continue, and/or terminate the feeding. An oral feeding by the parents was videotaped and replayed to assist in interviewing the parents regarding the decisions they had made during the feeding. Six types of feeding issues were identified. The smoothness or amenability of the child's feeding behavior was most frequently expressed as important, and about half of the parents mentioned the child's dietary intake as an issue. Most parents consistently tried to maintain the child's eating and to achieve a predetermined amount of nutritional intake. Over half the parents were concerned about adequacy of the child's nutrition, and many were concerned about their child's acceptance of or resistance to food. Parents did not express concern about their child's development but were concerned about their child's somatic growth. Parents' concern about feeding behaviors requires joint problem-solving by nurses and parents. Whether use of decision criteria that refer to the child's behavior rather than a predetermined amount of food is possible for parents and likely to contribute to reduced vomiting and resistive behavior and increased dietary intake needs further study.

Neonatal screening for cystic fibrosis in Wisconsin.

Primary care physicians have been very cooperative in referring screened patients to the two designated CF centers in Wisconsin--the University of Wisconsin Cystic Fibrosis Center, and the center at the Medical College of Wisconsin in Milwaukee--and their help has made this study possible. By 1990, we anticipate that meaningful clinical comparisons between the screened and control groups will be possible, and at that time we can begin to obtain some definitive answers concerning the benefits and potential risks of neonatal screening for cystic fibrosis. At this time, it would be premature to make a decision concerning the efficacy of screening for cystic fibrosis for the State of Wisconsin. It is very important that the study go to completion before making conclusive recommendations. We are eager to meticulously document the natural history of CF by following study patients for a long time. Answers to questions concerning rate of decline of the IRT value in true positives, psychosocial risks of screening to true positives, effect on future reproductive plans, and the cost effectiveness of the screening program will not be available for at least two more years. False positive IRT results seem to be related to perinatal asphyxia. We postulate the mechanism is ischemia in the pancreas related to hypoxia during the perinatal period leading to transient release of trypsin from the pancreas into the bloodstream. Decline of the IRT result over time is of great interest because a repeat blood sampling approach would hopefully eliminate several false positives.(ABSTRACT TRUNCATED AT 250 WORDS)