Skills and Practices of European Orthopedic Nurses in Empowering Patient Education.

Purpose: This study provides an overview of the self-defined skills and practices of European orthopedic nurses in empowering patient education. Nurses themselves have highlighted the necessity to enhance their own skills, but possibilities for further education have been limited. Methods: The data (n = 317 nurses) from a structured survey were collected during the years 2009-2012 in seven European countries with an EPNURSE-questionnaire (Empowering Patient Education from the point of view of Nurses). Results: Nurses considered patient education as an important part of their work and evaluated their own skills as good. However, their patient education practices were based more on practices on their ward and their own experience than on further education or evidence-based knowledge. On the other hand, lack of time for patient education and experienced overload were the major barriers experienced by nurses. Implications for Practice: Further education of orthopedic nurses in empowering evidence-based patient education is highly needed. Nurse leaders need to acknowledge the strong need for supporting nurses within clinical practice, improve their evidence-based knowledge and support practices that prioritize patient education within the hospital environment. Further international collaboration in nursing research and health-care organizations is desirable to reach these patient educational goals in clinical nursing practice.

Information and Control Preferences and Their Relationship With the Knowledge Received Among European Joint Arthroplasty Patients.

BACKGROUND: The prevalence of joint arthroplasties is increasing internationally, putting increased emphasis on patient education. PURPOSE: This study describes information and control preferences of patients with joint arthroplasty in seven European countries, and explores their relationships with patients' received knowledge. METHODS: The data (n = 1,446) were collected during 2009-2012 with the Krantz Health Opinion Survey and the Received Knowledge of Hospital Patient scale. RESULTS: European patients with joint arthroplasty had low preferences. Older patients had less information preferences than younger patients (p = .0001). In control preferences there were significant relationships with age (p = .021), employment in healthcare/social services (p = .033), chronic illness (p = .002), and country (p = .0001). Received knowledge of the patients did not have any relationships with information preferences. Instead, higher control preferences were associated with less received knowledge. CONCLUSION: The relationship between European joint arthroplasty patients' preferences and the knowledge they have received requires further research.

Difference between received and expected knowledge of patients undergoing knee or hip replacement in seven European countries.

The purpose of the study was to examine received and expected knowledge of patients with knee/hip arthroplasty in seven European countries. The goal was to obtain information for developing empowering patient education. The data were collected (during 2009-2012) from patients (n = 943) with hip/knee arthroplasty prior to scheduled preoperative education and before discharge with the Received Knowledge of hospital patient scale (RKhp) and Expected Knowledge of hospital patient scale (EKhp). Patients' knowledge expectations were high but the level of received knowledge did not correspond to expectations. The difference between received and expected knowledge was higher in Greece and Sweden compared with Finland (p < .0001, p < .0001), Spain (p < .0001, p = .001), and Lithuania (p = .005, p = .003), respectively. Patients' knowledge expectations are important in tailoring patient education. To achieve high standards in the future, scientific research collaboration on empowering patient education is needed between European countries.

Knowledge expectations of surgical orthopaedic patients: a European survey.

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern (Finland, Iceland, Lithuania and Sweden) and Southern Europe (Cyprus, Greece and Spain). The aim was to analyse associations between expected knowledge and background factors. The data were collected from European arthroplasty patients with the Knowledge Expectations of hospital patients- scale, (KE(hp) - scale), including bio-physiological, functional, experiential, ethical, social and financial dimensions. Patients had essential bio-physiological and functional knowledge expectations. Women expected more than men, employed less than retired, unemployed or who worked at home. Generally, patients in Northern countries expected more than in Southern countries. However, highest expectations were found in Sweden and Greece, lowest in Spain and Cyprus. There are differences in knowledge expectations based on patients' backgrounds. Development of common standards in European patient education needs further research.

The quality of the face-to-face counselling in paediatric ambulatory tonsillectomy: parental point of view.

The objective of this study was to examine parental opinion on the quality of preoperative face-to-face counselling about the child's preoperative fasting. Families, whose child was admitted for ambulatory tonsillectomy were randomly assigned to the study groups (n = 116; 58/58). The intervention group received the information with face-to-face counselling, and the control group in written form. The parents assessed (visual analogue scale) the level of clarity, intelligibility and adequacy of the information, how well they had understood the meaning and the implementation of the child's preoperative fast, as well as their own skills and success to implement the child's fast. The parents in the intervention group felt that the information was significantly clearer, more intelligible and adequate and that they succeeded well. Face-to-face counselling is an effective way to educate the parents.

The effect of preoperative fasting on postoperative thirst, hunger and oral intake in paediatric ambulatory tonsillectomy.

AIMS AND OBJECTIVES: The aim of this prospective study was to examine whether preoperative face-to-face counselling about a child's fasting and active preoperative nutrition have an effect on thirst, hunger and postoperative oral intake in paediatric ambulatory tonsillectomy. Families, whose child was admitted for ambulatory tonsillectomy, participated in the study (n = 116; 58/58). BACKGROUND: Children undergoing tonsillectomy have difficulties in postoperative recovery and nutrition. However, former studies have shown that shorter preoperative fasting seems to promote postoperative well-being and promote the child's postoperative oral intake. DESIGN: A prospective, randomised intervention study. METHODS: The study groups were randomly allocated. The intervention group received the instructions through face-to-face counselling about the child's active preoperative nutrition, the control group received the instructions according to the current practice. The postoperative thirst and hunger were scored during the first postoperative hour and at two, four, eight and 24 hours postoperatively. The first scoring was performed by the nurse on a 0-10 scale. The rest of the estimations were made by the children using a visual analogue scale (VAS), by the parents using a 0-10 scale. RESULTS: In the intervention group, the VAS scores in thirst and hunger were low during the first 24 postoperative hours, whereas in the control group, they increased towards the following morning when the children in the control group, according to the children and the parents, were thirstier (p = 0.051, 0.005, respectively) and significantly hungrier (p = 0.042, 0.005) than those in the intervention group. CONCLUSIONS: Children's perioperative fluid fasting can be decreased with preoperative nutritional face-to-face counselling. Children's perioperative thirst and hunger can be relieved by the limited preoperative fasting. RELEVANCE TO CLINICAL PRACTICE: Clinical practice should take the child's perioperative fasting into account in a more accurate way in preoperative counselling of the parents.

The effect of preoperative nutritional face-to-face counseling about child's fasting on parental knowledge, preoperative need-for-information, and anxiety, in pediatric ambulatory tonsillectomy.

OBJECTIVE: The objective of this study was to define how preoperative nutritional face-to-face counseling on child's fasting affects parental knowledge, preoperative need-for-information, and anxiety, in pediatric ambulatory tonsillectomy. METHODS: The participants in the prospective, randomly allocated study were parents (intervention 62/control 62) with children (4-10 years) admitted for ambulatory tonsillectomy. Data were collected by the knowledge test designed for the study and with The Amsterdam preoperative anxiety and information scale (APAIS). The intervention group was invited to a preoperative visit to receive written and verbal face-to-face counseling. They were initiated into the child's active preoperative nutrition. The parents of the control group received current information without face-to-face counseling. RESULTS: The parents followed the instructions. Their knowledge about the child's fast increased (p=0.003), and need-for-information and anxiety decreased (p<0.0001) significantly. CONCLUSION: The preoperative face-to-face counseling with written information improves parental knowledge about the child's fasting and active preoperative nutrition, and relieves their need-for-information and anxiety. PRACTICE IMPLICATIONS: The primary responsibility remains with the health care professionals when the active preoperative nutrition of the child and counseling on it are introduced into nursing practice.

The effect of preoperative fasting on postoperative pain, nausea and vomiting in pediatric ambulatory tonsillectomy.

OBJECTIVE: The aim of this prospective randomized study was to examine whether active counseling and more liberal oral fluid intake decrease postoperative pain, nausea and vomiting in pediatric ambulatory tonsillectomy. METHODS: Families, whose child was admitted for ambulatory tonsillectomy or adenotonsillectomy, were randomly assigned to the study groups (n=116; 58 families in each group). The intervention group received the fasting instructions with face-to-face counseling for the child's active preoperative nutrition, and the control group the fasting instructions according to the hospital's standard procedure. The level of postoperative pain and nausea was scored in the postanesthesia care unit (PACU) during the first postoperative hour, as well as at 2, 4, 8 and 24h postoperatively. The first scoring in PACU was performed by the attending nurse with a 0-10 scale. The rest of the estimations were made independently and simultaneously by the children using a VAS scale, and by the parents using a 0-10 scale. RESULTS: The children in the control group were in more pain in the PACU than the children in the intervention group, and the difference between the groups was statistically significant (p=0.0002). All pain scores, according to the children and the parents, increased after the surgery. In both groups the highest score values were found at home 8h after surgery, and no significant difference was found between the study groups. On the first postoperative morning, the children in the control group were in pain (p=0.047). The children did not have significant nausea in the PACU, but the nausea increased postoperatively. Four hours after surgery the children were most nauseous according to all estimations (60%, n=116). More than half of the children vomited and most vomited clotted blood. Nausea and vomiting decreased during the evening of the surgery, but six children vomited the next morning, four of them vomited blood. The incidence and intensity of postoperative nausea and vomiting between the intervention and control groups were not statistically significant. However, preoperative nutritional counseling and more liberal per oral fluid intake appeared to have a positive effect on the children's well-being and helped them to better tolerate postoperative nausea and vomiting. CONCLUSIONS: The preoperative counseling about active preoperative nutrition significantly reduces the child's pain during the first posttonsillectomy hours and might prepare the child to better tolerate the stress of potential postoperative nausea and vomiting.

Fasting in paediatric ambulatory surgery.

The purpose of this descriptive study was to examine how preoperative fasting and postoperative termination of the fast was experienced in ambulatory surgery by child patients and their mothers. The target group consisted of children (n = 12, age 2-10 years) who had undergone tonsillectomy/adenoidectomy, and their mothers. In the interviews, the mothers were asked to describe the problems connected with their child's preoperative fast and postoperative termination of the fast, as well as the things that went well in the process. Content analysis was carried out inductively. Preoperatively, the children were thirsty and anxious, but understood the fasting situation well. In some cases, there were conflicts between the child and his/her parent if fasting was prolonged. Parents also had doubts about their ability to implement the child's fast. Postoperatively, children had pains in their throats and stomachs, suffered from nausea, and had difficulty taking in nutrition and medication. Parents had worries about their child's home care, such as food intake and administration of pain medication. The possibility of postoperative bleeding and exacerbation of the child's condition was also worrying for the parents. The most evident result of the study was that parents need more information before their child's operation. Preparing the child for the operation by giving him/her nutrition as long as permitted enhances postoperative recovery and improves parents' control over the ambulatory surgical experience. Nurses should take a more active part in children's perioperative fasting and preoperative preparation of children and their parents. In further research, experimental studies should be designed in order to receive more evidence-based information for clinical practice.