This study assesses the effect of preoperative patient education intervention to reduce stress and anxiety in patients undergoing cross-linking surgery. The substantial research shows, the factors which contributes to anxiety during pre-operative period includes loss of vision, pain, impact of surgery, loss of independence, fear of problems during surgery and poor recovery (Mulugeta et al., 2019). Therefore, pre-operative patient education is the way to decrease anxiety which can improve patient’s self-efficacy and outcome (Burgess, Arundel and Wainwright, 2018). In this study we will examine the impact of the pre-operative education on the patient perceptions and understanding of the cross-linking surgery.
The method of research will be carried out in two groups, the first group, which will attend nurse lead patient education session and the second group will not be provided education session. Two questionnaires will be provided and completed before and after the surgery by both groups. The education session will be approximately an hour either in person or telephone during this Covid crisis. The education session in person will be delivered before the surgery in the allocated room. One open ended question will be asked to assess perceptions of the education session.
Keratoconus affects the cornea. It causes severe vision loss, irregular astigmatism, blurred vision, near-sightedness, glares and extreme light sensitivity. Since, keratoconus starts from puberty, young children find difficulty in their studies which contributes to low self-esteem. It’s quite important to treat in early stages.
Corneal crosslinking has grown from an interesting concept to its introduction in clinical practice in the late 1990s when it radically modified conservative management of progressive corneal ectasia with the possibility of strengthening corneal tissue. The primary aim of corneal crosslinking is to stop the progression of corneal ectasia/ Keratoconus.
The research shows that good clear understanding of surgery can enables patients to fully participate in the management decisions and care planning of their condition. The nurse-led pre-operative education to the patients undergoing cross-linking may prove to decrease anxiety and enable patient engagement with their care being able to retain and recall instructions which can impact the recovery and decrease infection rates and increase patient satisfaction. It also helps to reduce cancellations which has adverse impact on hospital finances, waste of resources and affect patients psychologically.
During nurse-led education session, the nurse can assess the patient’s risk factors for procedure, understanding and knowledge/perception of the cross-linking procedure, expectations of intra and post-operative care, stress/anxiety level, cultural or religious beliefs, socio-economic status and support from the family. By keeping the patients at the centre of the pre-operative processes, which can develop confidence, rapport and the confidence in the perception of their care which will aid the educating nurse to develop best plan of care for the individual patient. The education session should be individualised to assess mental and physiological status.
It is the paramount to use the pre-operative patient educational clinic effectively to identify and foresight the patients concerns which can help to minimise disrupted theatre time and it also help for discharge planning of the patients. The patient education session can provide good understanding of the journey ahead, quality care, reduce pre-operative anxiety of patients and families. It also provides holistic needs, support at every step, safe and compassionate care, it also helps to reduce cancellations which has adverse impact on hospital finances, waste of resources and prepare patient psychologically to increase their resilience to cope with stress and anxiety so that patient can achieve satisfactory outcome of the surgery.
In the clinic, the information about cross linking surgery is imparted to the patient in the clinic through a discussion with the clinician or distributing information leaflet about the surgery and management or a combination of both. Sometimes the information leaflet provided is ignored by the patient or do not understand the information. It might be because of poor communication, stress, limited time, limited education, anxiety, perceptive abilities. The patient comes for surgery with anxiety or fear of possible loss of vision or visual impairment which can affect their self-esteem. Stress could affect patient’s cooperation intraoperatively, by increasing the risk of complication in uncooperative, stress or fearful patients. It is important to improve pre-operative patient education.
According to my experience generally, the information provided to patients in the clinic does not help to enhance their understanding of the crosslinking surgery. I experienced that when patient comes for cross-linking surgery they forget or misunderstand the information about the surgery which was provided to them at the clinic appointment. Even though at clinic, the clinicians provide leaflets and explain to the patient about surgery, still most of the time they fail to retain the information maybe because of a wide gap in time between the day of surgery and the clinic appointment (referred clinic), moreover, the patients attend surgery directly without any preassessment. As a result, there are cancellation or patient don’t attend the surgery or the patient has anxiety prior to surgery.
Hence, the preoperative education maybe the right time to re-educate patient about the various stages, procedures and results of surgery. The lack of patient engagement, poor understanding of surgery and the poor communication before surgery may also lead to non-adherence of regimes post-operatively care. The appropriate and clear information, empathic, two-way communication and regard for patients’ concerns gives patients the ability to make informed decisions and thus, have more control over their care.
The purpose of this study is to analyse factors which can enhance patient knowledge/understanding of cross-linking procedure and reduce stress and anxiety. To analyse nurse-led pre-operative patient education is helpful including feelings of preparedness, confidence and the satisfaction of patients undergoing surgery
Research Hypothesis:
The research hypothesis that was derived for this proposal is: By introducing Nurse led patient education session, which can enhance and improve Patient understanding of the procedure, preoperative satisfaction, experience and information undergoing cross-linking procedure, hence reducing stress and anxiety. It will also help to reduce cancellation which furthermore help to optimize theatre resources.
Null Hypothesis:
The patient’s experience, satisfaction and knowledge cannot be improved or enhanced.
Aim:
To enhance patient understanding of the cross-linking by giving information to the patient which is suitable to the understanding of the patient. To create and implement on-site or online or telephone educational class for patients and families to attend prior to crosslinking surgery. To analyse the patient’s perception in the way the educational session will help them to plan for their crosslinking surgery. It will allow the patients and families to ask questions and engage in the educational session.
Background
The perspective area is a critical dimension of care transition. One of the main goals of the perspective assessment is to determine the factors that can pose risk for intraoperative and postoperative complications.
In this digital era, there are many ways to find and access information online Internet and social media, the information which are available on websites are not always monitored by qualified professionals which can be misleading and increase the stress and anxiety in the patient. By starting the preoperative education clinic, it can provide quality patient education which can help to minimize patient’s anxiety levels and well-informed patient can be an effective member of the health care team.
The literature search has been carried out in the PubMed database, Google Scholar, CINHAL, Cochrane database, unable to find relevant research regarding assessment of patient experience preoperative.
Methodology
The Research study would be mixed, conducted using qualitative and quantitative research, which seeks understanding through observation and interviews, both of which provide insight into the research question. Qualitative researchers study phenomena in their natural setting and include everything that may impact that setting by identifying variables and how they impact the outcome.
The qualitative methods employed in nursing research include grounded theory, phenomenology, ethnography, and qualitative description.
In nursing research, the qualitative research can be used as evidence-based nursing practice and it also helps to understand from the patient’s point of view. The quantitative data can be collected by observing behaviour using questionnaire.
The independent Variable involved in this study is the approximately an hour-long session that provides preoperative patient education, the place of counselling/meeting the patient, when to meet the patient, how to meet the patient. The dependant variable is patient satisfaction and appropriate information (pre, intra and post-operative) of cross-linking surgery.
The Timeline for this study is estimated 1 month.
Participants- 30
Design:
The design of the nurse led patient educational program which is used in this study is evidence-based practice. The best practices for patient teaching are gleaned from policies and procedures, additional, covering patient plan of care, safety measures, health promotions and pain management and to provide the environment free from distractions. The teaching session should be more interactive. The literature of the educational intervention is created based on the patient health care literacy in mind, it should be understandable, legible and interactive for participants.
The questionnaire designed to investigate patient’s understanding of the procedure and state of anxiety. Nurse-led pre-operative counselling to patients group discussion could lead to interaction between patients, which can be a learning environment, opportunity to meet patients undergoing same treatment, it can benefit the patient by optimizing decision making and maximizing patient cooperation.
Nurse-led pre-operative patient education could give patient “teachable moments” where patients can positively accept, healthy lifestyle for example smoking cessation, healthy diet, alcohol consumption, physical exercise.
The patients and families are unfamiliar with the theatre department and nature of the surgery, which are sometimes perceived as functioning behind closed doors.
In the pre-operative process, by making a few simple changes, we could hugely improve that experience and exemplary care that is centred around the patient and their family.
The findings of the studies will be used to optimize the patient experience and reduce patient anxiety.
Plan of intervention:
A convenience sample can be used for the research. The inclusion criteria are the listed patients for surgery, are 16 years or older. Gender-Male and Female. All ethnicity and diversity included in the study.
There will be two groups. The verbal consent from the patients before giving questionnaire is must.
Group 1 (15 patients) will have nurse led patient education prior to surgery.
Group 2 (15 patients) will have no nurse led patient education prior to surgery
Appendix 1 and 2- questionnaires to be filled before and after the crosslinking surgery.
The group 1– is supported by a nurse to guide conversation before surgery. To explain the cross-linking surgery (pre, intra, post) operatively procedure, answer their questions, address their concerns and talk about recovery.
The group 2– will go ahead for the cross-linking surgery without prior nurse led patient education.
To study through a simple intervention of the combination of group and questionnaire – it helps to analyse and evaluate the patient anxiety, understanding and retention of clinical information of cross-linking surgery.
On the day of surgery, nurse led cross-linking surgery list is carried out. Before the patient goes for surgery, the selected patients (Group 1) will be invited by the nurse into an allocated room. Prior to the start of the session, participant will be provided verbal information which includes an overview of the study and the purpose of the study. It must be emphasized that no personal information would be collected or shared, then the nurse will provide education related to cross linking surgery to the patient and family which includes, what they could expect in the theatre, answer their questions, address their concerns and talk about recovery, an open-end discussion is conducted for approximately an hour session. Due to the current COVID crisis, telephone method of the group 1 will be considered.
The nurse will give the questionnaire (appendix 1) to both groups 1 and 2, before surgery, then after the surgery followed by appendix 2
The nurse who carried out the nurse led patient education will collect the completed questionnaire from the patient and put it inside the assigned sealed box
2020-10-29-1604003765