Patients' knowledge of perioperative care

Patient perceptions about anesthesia and anesthesiologists before and after surgical procedures

CONTEXT AND OBJECTIVE

Anesthesiologist-patient relationships are established preoperatively and intraoperatively. These are opportunities for providing correct information about anesthesia/anesthesiologists, thereby improving outcomes. The aim here was to evaluate patients' perceptions about anesthesiologists before anesthesia and to identify whether the anesthetic care would change such perceptions.

DESIGN AND SETTING

Prospective cross-sectional study using data obtained in 2007-2008, at a tertiary university hospital.

METHODS

518 patients aged 16 years or over were interviewed before and after anesthesia exposure. A questionnaire was used to determine patient characteristics and perceptions of anesthesia/anesthesiologists.

RESULTS

The patients were 16-89 years of age and 59.8% had attended elementary school. 79.1% said that anesthesiologists were specialized physicians. Anesthesiologists' roles were associated with loss of consciousness (35.5% pre-anesthesia; 43.5% post-anesthesia), pain relief (29.7% pre-anesthesia, 31.7% post-anesthesia), vital sign monitoring (17.6% pre-anesthesia, 35% post-anesthesia; P < 0.05); and drug administration (10.8% pre-anesthesia, 43.9% post-anesthesia; P < 0.05). The level of confidence in the physician was rated high (82.2% and 89.8% pre- and post-anesthesia, respectively; P < 0.05) or intermediate (5.8% and 6.6% pre- and post-anesthesia, respectively; P < 0.05). The care provided by anesthesiologists was classified as: elucidating (52.8%), encouraging (52.6%), neutral (10.2%) and careless (0.8%).

CONCLUSION

Patients' perceptions of anesthesiologists' roles were fairly good, but improvements in this relationship still need to be pursued, to achieve better outcomes. Anesthetic care was important in providing information, confidence and reassurance among patients, regarding their perceptions. Anesthesiologists should not miss opportunities to provide excellent professional care for patients, thereby improving anesthesia outcomes and their image.

Barriers to effective pain management

In this article my sole aim is to engage the reader to think about the management of pain in a different way. I have deliberately taken a less formal style but provided references if you are interested in following up. The management of pain has often been assumed to be a routine part of care, in fact in the perioperative arena it is the second most common nursing intervention (Juntilla et al 2005). Despite this activity, pain after surgery has been reported to be a consistent problem which has spanned several decades (Marks & Sachar 1973, Wu et al 2002, Ekstein et al 2006). The reasons for this are well documented and include: patient barriers, inadequate knowledge of healthcare professionals, lack of assessment and organisational practices which impede the administration of analgesics and non-pharmacological interventions. Despite this knowledge the changes required in practice are not necessarily forthcoming. The purpose of this paper is to explore the patient, professional and organisational barriers which affect the optimal management of pain in the perioperative period, and provide some practical solutions to help you think about and manage pain more effectively.

Discharge Knowledge and Concerns of Patients Going Home With a Wound

PURPOSE

To examine patients' wound care knowledge and concerns prior to discharge from an acute care hospital.

DESIGN

Comparative descriptive study of patients with wounds.

SETTING AND SUBJECTS

Participants (N = 76) included 17 men and 59 women who were African American (n = 33, 43.4%) or Caucasian (n = 43, 56.6%) and ranged in age from 20 to 83 years (M = 48, SD = 13). There were 67 persons with acute wounds and 9 with chronic wounds. All were scheduled to be discharged home from a large urban acute care hospital.

INSTRUMENTS

The questionnaire for this study included the following sections: Demographic, Admission and Discharge, Health, Wound Care, Beliefs about Wounds and their Care, Pain and Wounds, Literacy and Learning, and Discharge Concerns.

RESULTS

Participants' greatest concerns about going home were: (1) how active to be at home, (2) wound pain, (3) looking for wound complications, and (4) watching for wound infection. Many participants did not know the dressing (38.2%) or solution to cleanse the wound (58.7%) at home. Most had taken care of a wound before (67.1%), could see (68.4%) and reach (69.7%) the wound, and had looked at it (64.5%) during the hospitalization. Patients with acute and chronic wounds did not differ significantly in their concerns about their wound or their fear of taking care of their wound. Participants generally had appropriate knowledge about wounds and hand washing, nutrition, going out of the home, and cigarette smoking. They had incorrect information about drying out wounds and leaving them open to breathe the air. The majority of patients with chronic wounds preferred getting answers to questions about their wound and its care from their physician followed by their clinic and family/friends. Patients with acute wounds overwhelmingly chose their physician as a source of information about their wound and its care, followed by calling a nurse at the hospital and using the Internet.

CONCLUSIONS

Patients were able to verbalize their concerns about going home with a wound. Concerns about discharge may help to direct patient teaching in preparation for discharge. Teaching literature could include the most common concerns, as well as ways to avoid misinformation about wound care. Discharge teaching needs to begin early so that patients feel they have adequate time to learn and ask questions. Further research is needed about patients' wound care knowledge and discharge concerns.

Remaining experiences of living kidney donors more than 3 yr after early recipient graft loss

Living kidney donor programs, based on willingness among family members and close relatives to donate, have made it possible to perform a satisfactory number of kidney transplantations. Early graft loss in the recipient may occur and it is not known if such an event will result mainly in acute, rather transient, emotional reactions or if long-lasting reactions may be evoked in the living kidney donor. The aim of the present study was to assess and describe the remaining experiences of donors (n = 10) more than 3 yr after early recipient graft loss or death of the recipient. A phenomenographic, interview-based research approach was used. Five different fields or domains were identified: (i) the decision to donate; (ii) the information provided; (iii) care received at the time of donation; (iv) responses at graft failure; and (v) concerns remaining at the time of the interview. All donors expressed that they had volunteered to donate and that no stress had been put on them. The information given prior to and in connection with the donation procedure was deemed insufficient but all donors were satisfied with the medical care provided in connection with the nephrectomy and in the immediate post-operative period. Graft failure was immediately accepted on the intellectual level by nine of 10 donors but still evoked emotional reactions and responses included a wish that continuing contact with the transplant staff had been provided. The present interview-based study shows that it is of importance that the donor is thoroughly informed about all donor as well as recipient-related factors including the potential risk of recipient graft failure. In case of graft failure, or the death of the recipient, the transplant unit staff members should offer contact for discussions of medical matters as well as for psychosocial support. In individual cases it may be necessary to maintain such a supportive contact channel for a prolonged period of time.

The work, duties and prestige of Finnish anesthesiologists: patients' view

BACKGROUND

Patients' awareness of the medical qualifications and duties of anesthesiologists outside the operating theatres may be limited. How are anesthesiologists ranked with regard to prestige and academic qualifications among other hospital employees?

METHODS

One hundred and sixty operative patients were interviewed in one tertiary care center and another secondary care center in Finland.

RESULTS

Nearly all (90%) of the patients knew that anesthesiologists are medical doctors and that they work in operation theatres (87%). Many patients thought that anesthesiologists do not work in pain clinics (41%), obstetric departments (36%) and in the departments of radiology (68%), in ambulances (58%) and in research work (46%). Anesthesiologists were ranked second after surgeons with regard to prestige among health service professionals.

CONCLUSIONS

Patients knew the medical qualification of anesthesiologists very well. The work of anesthesiologists was highly appreciated, but the duties outside the operation theatres were poorly known.

Postoperative pain management on surgical wards--do quality assurance strategies result in long-term effects on staff member attitudes and clinical outcomes?

Postoperative pain management (POPM) remains suboptimal on surgical wards in many countries despite the availability of effective analgesics, new technologies for drug administration, and clinical practice guidelines for pain management. The aim of the present study was to assess remaining long-term effects on pain management routines, patient experiences, and staff member attitudes in surgical wards more than 3 years after introduction of a quality assurance program for POPM and compare the findings to those of an organization where a corresponding systematic, entire hospital, quality assurance program had not been completed. A descriptive and comparative design, based on survey data from both patients (N = 110) and staff members (N = 51) on urologic surgery wards, was used. Significant (p <.05 to p <.0002) overall relationships were observed for identified shortages in pain management routines (lack of preoperative information, inadequate preoperative discussions on pain management, wait for pain killer) and reported experience of pain, nausea, or vomiting in the postoperative period. The quality assurance program, anesthesia-based pain services using a nurse-based anesthesiologist-supervised model, resulted in more adequate pain management routines, better patient satisfaction with POPM, and increased confidence in pain management among nurses on the surgical wards. On the basis of the present study it may be concluded that more than 3 years after the introduction of a quality assurance program for POPM in surgical wards, the pain management routines, patient experiences, and staff member attitudes have remained markedly improved and in accordance with the aims of accepted clinical practice guidelines for surgical pain management.