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EDUCATION TO IMPROVE PATIENT
SATISFACTION AND OUTCOMES IN THE
NEUROSURGICAL PATIENT
Tara Orgon Stamper CRNP DNP Conference 2017 New Orleans, LA
INTRODUCTION
Satisfaction Outside health care Within health care
Knowledge Role in health care
Connection to outcomes
Outcomes Used in health care today
Relevance to satisfaction
INTRODUCTION
Neuroscience Complex system Patient/family anxiety and fear
Limited number of studies
BACKGROUND
Patient satisfaction indicator of care quality
Impacts patient outcomes
Education influences satisfaction
DEFINITIONS
Patient satisfaction satisfaction with care delivered
Patient knowledge knowledge of disease process and surgical care
30 day readmission readmitted to inpatient setting prior to thirty days from discharge
Post-operative complications presence of surgical site infection, neurological change resulting in admission
Demographic factors age, gender, ethnicity, comorbidities, past medical and social histories
PURPOSE
Implement a neurosurgery perioperative education bundle with patients undergoing a craniotomy to improve patient knowledge, satisfaction and outcomes
PICOT
In the cranial neurosurgery patient (P), how does a cohesive, structured perioperative neurosurgery education bundle (I) compared with the non-structured standard education (C) affect patient satisfaction, knowledge and outcomes (O) over an eight week timeframe (T)?
CLINICAL QUESTIONS
What demographic factors are associated with improved patient knowledge and improved patient satisfaction?
What demographic factors are associated with an improvement in post-operative complications and 30-day readmissions?
CLINICAL QUESTIONS
What effect does a perioperative neurosurgery patient education bundle have on the level of patient satisfaction and patient knowledge of the bundle’s information?
What effect does a perioperative neurosurgery patient education bundle have on post-operative complications and 30 day readmissions?
FEASIBILITY & NEEDS
Need for the project Limited patient education, Low HCAPHS scores
Project expenses Minimal printing expenses incurred by PI
Implementation issues PI has access to sample, no need for technology modifications, no legal concerns
Organizational congruence Project supports organizational values
SUBJECT IMPACT
Benefit Immediate – individual satisfaction and knowledge Long term – departmental culture change
Confidentiality Coded master list linking study subjects to designated number, including paper surveys,
locked in cabinet Study data not stored with master list Study data stored in password protected database Research data maintained for six years Data relayed in congregate
Risk No psychological, physical, social or legal harm to participant May withdraw from study at anytime
Financial Participant not billed any additional services for education bundle
REVIEW OF LITERATURE
Patient Education Randomized clinical trial of 66 patients receiving post-MI education, support and
counseling
Intervention group with higher scores on Myocardial Infarction Self Care Ability Questionnaire (p<0.0001)
Oral anticoagulation therapy patient and family education program
Nurses delivering program found information able to be tailored to individual needs Insufficient knowledge jeopardizes a health care regimen4
REVIEW OF LITERATURE
Patient Education 70 ankylosing spondylitis (AS) patients received structured teaching program (STP) Author created knowledge questionnaire
Positive differences in knowledge pre and post education STP implementation
REVIEW OF LITERATURE
Patient Satisfaction Discharge class (n=53) and traditional discharge (n=51) given to postpartum mothers
when leaving hospital
Individualized teaching more satisfying than discharge classes as measured by the Modified Client Satisfaction Tool (p=.0312)
Orthopedic patients receiving structured discharge education (n=47) were more satisfied than those receiving the standard model (n=48) (p<0.0001)
Satisfaction with nurse-patient communication, fewer pain complaints, functional status higher in structured discharge education group
REVIEW OF LITERATURE
Patient Satisfaction 122 patients equally randomly assigned to intervention group receiving education
sessional on pain education and control group receiving no specific education
Cancer patients receiving an educational session on pain education were more satisfied than those receiving conventional education; when second week compared to control group (p<0.001)
Intervention group (n=150) watched a video module on lung resection surgery; control group (n=150) received standard surgery preparation
Video module group stated better surgical preparation (p=0.006), less anxiety regarding surgery (p=0.0001) and overall satisfaction with their surgery (p=0.02)
REVIEW OF LITERATURE
Patient Outcomes Concept Care group (n=62) received preoperative education plus written materials
whereas only written materials was the control group (n=61)
Concept Care Method delivered to orthopedic patients two weeks preoperatively decreased significantly (p<0.001) admissions discussions (13.25 min, 33.36 min, respectively)
35 active patients against 115 historical control Enrolled patients received pharmacy based counseling on medications and
importance; discharge medication list
Pharmacist initiated HF discharge education program decreased 30-day all-cause readmissions (p=0.02) and HF-related readmissions (p=.11)
SYNTHESIS OF EVIDENCE Limitations Scarce literature on postoperative neurosurgical patient No mode of education delivery is supported over others
Education delivered at different times along the health care continuum
SYNTHESIS OF EVIDENCE Strengths Despite lack of generalizability to neurosurgery, evidence exists that shows education
impacts outcomes Outcomes = satisfaction, knowledge, postoperative complications, 30-day readmissions
METHODOLOGY
IRB Roadblocks Allegheny Health Network (AHN) approval BEFORE Georgia College and State
University approval
AHN Nursing Research Council input/question session/presentation prior to AHN approval
Informed Consent verbiage Four surgeons needing to be co-investigators
Utilizing clinic/hospital personnel to help deliver intervention Question regarding necessary study sample given average cases/month Patient knowledge survey length, time to complete
METHODOLOGY
Subjects and Recruitment Purposive sampling Inclusion Criteria
> 18 years of age
undergoing a cranial surgery
Proficient in English
Non-emergent
Exclusion Criteria < 18 years of age
Not proficient in English
No POA (if cognitively impaired)
METHODOLOGY
Subjects and Recruitment Informed consent obtained by PI in person Power analysis = 102 participants
Complete survey = bundle + $5 VISA gift card No complete survey = bundle but no gift card IRB approval from Georgia College and State University and Allegheny Health
Network
METHODOLOGY
Setting Academic level one trauma center Four cranial neurosurgeons
Perioperative implementation Once decision for surgery is made
Postoperative implementation At hospital discharge
Postimplementation assessment At first postoperative visit
METHODOLOGY
Measurement Tools Strength evaluated by validity and reliability Validity External Content
Reliability Test-retest Interrater reliability Internal consistency
Related to current study No patient population specific tools pertaining to knowledge and satisfaction
ascertained
METHODOLOGY
Measurement Tools Demographic Questionnaire
Developed by PI
Validity, reliability not a concern
General demographics
Age
Gender
Ethnicity
Current height and weight
Where do you live
Co-morbidities
METHODOLOGY
Preoperative Teaching Interview Guide (PTIG) 32 item questionnaire; scored Likert scale Cronbach’s alpha = 0.83 Contains five distinct subscales situational/procedural information related to the procedure itself
sensation/discomfort information related to sensations and pain the patient may feel before, during and after the procedure
patient role information related to the expected behavior of patients as participants in their health care goals
skills training related to postoperative care such as wound care and dressing changes
psychosocial support defined as “the interaction between patients and providers which is aimed at helping patients deal with anxiety, concerns and fears” about their upcoming surgery and care
METHODOLOGY
Client Satisfaction Questionnaire 8 (CSQ-8) Abbreviated version of Client Satisfaction Questionnaire
Originally implemented in mental health practice 8 item questionnaire (abbreviated from 18) Cronbach’s alpha = 0.83 – 0.93 Copyrighted
$.55 per use Questions focus on overall satisfaction, meeting patient’s needs, did services help you
with your problems, recommend services, did you get the type of services you wanted
METHODOLOGY
Measurement Tools Strengths Established validity and reliability (CSQ-8) Generalizability
Limitations Not neuroscience specific Little established validity and reliability
INTERVENTION TOOL
Perioperative Implementation One on one counseling session
Ten minutes, in a private clinic room Going over written materials personalized to patient Verbal and visual materials Allows adequate time for questions and answers
INTERVENTION TOOL
Discharge Implementation Study material incorporated as standard of care Cranial Discharge Education Instructions
One on one counseling session as standard of care using study materials Registered nurse going over materials specific to patient’s course Verbal and visual materials
DATA ANALYSIS
What demographic factors correlate with the level of patient satisfaction and patient knowledge after implementation of a neurosurgery perioperative education bundle?
What demographic factors correlate with the effect a perioperative neurosurgery education bundle has on 30-day readmissions and postoperative complications?
DATA ANALYSIS
To explore these two clinical questions, demographic factors will be collected at the time of admission into the study.
Level of patient knowledge and satisfaction will be collected at the postoperative visit.
Data will be analyzed for correlations between demographic factors and the level of patient knowledge and satisfaction
DISCUSSION
Expectations Sufficiently answer clinical questions Positive feedback
Patient
Department
Network-wide implementation Continue to monitor for long term impact
DISCUSSION
Lessons Learned Appropriate research protocols should be vetted and vetted AGAIN! Have an IRB expert/resource on speed dial!
Build a study team with professionals of similar interest
Practice Implications Positivity is contagious! Overcoming obstacles to nursing research
REFERENCES
Ben-Morderchai, B., Herman, A., Kerzman, H. & Irony, A. (2010). Structured discharge education improves early outcome in orthopedic patients. International Journal of Orthopaedic and Trauma Nursing 14, 66-74
Bernier, M., Sanares, D., Owen, D. & Newhouse, P. (2003). Preoperative teaching received and valued in a day surgery setting. Association of Operating Room Nurses Journal 77(3), 563-582
Chou, P. & Lin, C. (2011). A pain education program to improve patient satisfaction with cancer pain management: A randomized control trial. Journal of Clinical Nursing 20, 1858-1869
Crabtree, T., Puri, V., Bell, J., Bontumasi, N., Patterson, G., Kreisel, D., Krupnick, A. & Meyers, B. (2012). Outcomes and perception of lung surgery with implementation of a patient video education module: A prospective cohort study. Journal of the American College of Surgeons 214(5), 816-821e2
REFERENCES
Jisha, J., Suneetha, C. & Skandhan, K. (2016). The effect of structured teaching program among patients with ankylosing spondylitis. International Journal of Nursing Education 8(2), 50-54
Johansson, K., Salantera, S. & Katajisto, J. (2006). Empowering orthopaedic patients through preadmission education: Results from a clinical study. Patient Education and Counseling 66, 84-91
Larsen, D., Attkisson, C., Hargreaves, W., Nguyen, T. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning 2, 197-207
Mohammadpour, A., Sharghi, N., Khosravan, S., Alami, A. & Akhond, M. (2015). The effect of a supportive educational intervention developed based on the Orem’s self-care theory on the self-care ability of patients with myocardial infarction: A randomized controlled trial. Journal of Clinical Nursing 24, 1686-1692
REFERENCES
Shaha, M., Wiithrich, E., Stauffer, Y., Herczeg, F., Fattinger, K., Hirter, K., Papalini, M. & Herrmann, L. (2015). Implementing evidence-based patient and family education on oral anticoagulation therapy: A community-based participatory project. Journal of Clinical Nursing 24, 1534-1545
Wagner, D. & Washington, C. (2016). Patient satisfaction with postpartum teaching methods. The Journal of Perinatal Education 25(2), 129-136
Warden, B., Freels, J., Furuno, J. & Mackay, J. (2014). Pharmacy-managed program for providing education and discharge instructions for patients with heart failure. American Journal of Health System Pharmacy 71, 134-139