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The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. (EEPO)
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. (EEPO)
University of Turku, Finland. (EEPO)
University of Akureyri, Iceland . (EEPO)
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2014 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, 2896-2908 p.Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To describe the possible differences between knowledge expectations and received knowledge of patients undergoing elective knee arthroplasty in Iceland, Sweden and Finland and also to determine the relationship between such a difference and both background factors and patient satisfaction with care.

BACKGROUND: Knee arthroplasty is a fast-growing and a successful treatment for patients with osteoarthritis. Patient education can improve surgery outcomes, but it remains unknown what knowledge patients expect to receive and actually acquire during the perioperative period and what factors are related to that experience.

DESIGN: Descriptive, prospective survey.

METHODS: In total, 290 patients answered questionnaires about their expectations (Knowledge Expectations of hospital patients - scale) before surgery and about received knowledge (Received Knowledge of hospital patients - scale) and satisfaction with hospital care (Patient Satisfaction Scale) at discharge. Sociodemographics, clinical information, accessibility to knowledge from healthcare providers (Access to Knowledge Scale), and preferences for information and behavioural control (Krantz Health Opinion Survey) were collected as background data.

RESULTS: Patients` knowledge expectations were higher (mean 3·6, SD 0·4) than their perception of received knowledge (mean 3·0, SD 0·7). Multiple linear regression analysis showed that access to knowledge, information preferences and work experience within health- or social care explained 33% (R²) of the variation in the difference between received and expected knowledge. Patients reported high satisfaction with their care except regarding how their family was involved.

CONCLUSION: Patients undergoing knee arthroplasty receive less knowledge than they expect, and individual factors and communication with healthcare providers during hospitalisation are related to their experience. The content of patient education and family involvement should be considered in future care.

RELEVANCE TO CLINICAL PRACTICE: The results strengthen the knowledge base on the educational needs of knee arthroplasty patients and can be used to develop and test new interventions.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014. Vol. 23, no 19-20, 2896-2908 p.
Keyword [en]
Knee arthroplasty, osteoarthritis, patient education, patient expectations, patient satisfaction, surgery
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-105225DOI: 10.1111/jocn.12552ISI: 000343857700020PubMedID: 24476393OAI: oai:DiVA.org:liu-105225DiVA: diva2:704924
Projects
EEPO
Available from: 2014-03-13 Created: 2014-03-13 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Empowering knowledge and Quality of Recovery after hip or knee replacement
Open this publication in new window or tab >>Empowering knowledge and Quality of Recovery after hip or knee replacement
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today’s shorter hospital stay may be a challenge for the patients and their spouses. Patient education is linked to and promotes the recovery process and can improve the outcome after elective hip or knee replacement. Fulfilment of knowledge expectations is essential for enabling people to become empowered during the period of recovery.

Aim

The overall aim was to explore the association between empowering knowledge and patients’ quality of recovery after elective hip or knee replacement.

Methods

The design of the four papers was descriptive, prospective and comparative. Consecutively included patients and their spouses from Cyprus, Finland, Greece, Iceland and Sweden answered questionnaires before surgery and at discharge from hospital. Data was collected during the years 2009-2012. Relationships and associations between a number of factors and fulfilment of knowledge expectations, and patients’ quality of recovery were investigated. Comparisons between patients undergoing hip or knee replacement and between patients and their spouses were made.

Results

Patients and their spouses had similar knowledge expectations, and these were not fulfilled during the hospital stay. Spouses had less fulfilled knowledge expectations compared with the patients. Swedish patients and spouses had less fulfilled knowledge expectations compared with the Icelandic and Finnish ones. Patients who experienced the hospital stay as meeting their general expectations had more fulfilled knowledge expectations compared with those who did not.

Access to knowledge was the main predictor of the variance in fulfilment of knowledge expectations. Negative emotions, such as depressive state and impatience, were associated with less fulfilled knowledge expectations. For patients undergoing hip replacement, a higher level of professional education was associated with less fulfilled knowledge expectations. For patients undergoing knee replacement, a history of employment in social services or healthcare was associated with less fulfilled knowledge expectations.

Patients’ experience of greater satisfaction with care was associated with better quality of recovery for both kinds of arthroplasty. Patients with fulfilled knowledge expectations experienced better quality of recovery. The spouserelated factors, namely uncertainty and depressive state, were associated with lower quality of recovery. Factors associated with greater quality of recovery among the patients were spouses with a history of employment in social services or health care, and nurses explaining matters concerning the care and treatment for the spouses.

Conclusion

Patients and their spouses had high knowledge expectations that were not fulfilled during the hospital stay. Patients’ emotional state and their access to knowledge were important for their fulfilment of knowledge expectations. Patients’ and spouses’ emotional state also played an important role in determining the patients’ quality of recovery, and greater satisfaction with care among the patients was associated with better quality of recovery.

These results emphasise the need to detect patients and their spouses in need of support in their preparation and recovery process. It is therefore important to assess patients’ and spouses’ personal knowledge expectations, and adapt to their emotional state while fulfilling them.

The content of patient education should be personalised in future care, and informal caregivers should be seriously taken into account during the period of early recovery. The results of this thesis can be used in the development and testing of person-centred educational interventions for patients undergoing elective hip or knee replacements.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 70 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1496
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-125237 (URN)10.3384/diss.diva-125237 (DOI)978-91-7685-876-9 (ISBN)
Public defence
2016-03-18, K1, Kåkenhus, Campus Norrköping, Norrköping, 13:00 (English)
Opponent
Supervisors
Available from: 2016-02-17 Created: 2016-02-17 Last updated: 2016-02-17Bibliographically approved
2. Learning as a patient: What and how individuals want to learn when preparing for surgery, and the potential use of serious games in their education
Open this publication in new window or tab >>Learning as a patient: What and how individuals want to learn when preparing for surgery, and the potential use of serious games in their education
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Surgical patients need knowledge to participate in their own care and to engage in self-care behaviour in the perioperative period which is important for their recovery. Patient education facilitates such knowledge acquisition and several methods can be used to facilitate it, for example, face-to-face education and brochures or using information technology such as website or computer games. Healthcare professionals have been slow to seize the possibilities that information technology has to offer within the field, including the use of serious games. To optimise patient education, the information is needed on the patients’ needs and preferences and what they think about the idea of using a serious game to learn about self-care.

Aim: The overall aims of this thesis were to describe the knowledge expectations of surgical patients, to describe how surgical patients want to learn, and to explore the potential use of serious games in patient education.

Methods: This thesis includes four studies that used both quantitative and qualitative data to describe aspects of patient learning in relation to surgery. Study I has a prospective and comparative design with survey data collected before surgery and before hospital discharge from 290 patients with osteoarthritis undergoing knee arthroplasty. Data was collected on fulfilment of knowledge expectations and related factors. Study II is a cross-­‐sectional study in 104 patients with heart failure who had been scheduled for cardiac resynchronisation therapy (CRT) device implantation. Data was collected on knowledge expectations and related factors. In Study III the perceptions of 13 surgical patients towards novel and traditional methods to learn about post-operative pain management are explored in a qualitative interview study using content analysis. Study IV describes the development and evaluation of a serious game to learn about pain management with the participation of 20 persons recruited from the public. The game was developed by an interdisciplinary team following a structured approach. Data on the efficacy and usability of the game was collected in one session with questionnaires, observations and interviews.

Results: Participants reported high knowledge expectations. Knowledge expectations were highest within the bio-physiological knowledge dimension on disease, treatment and complications and the functional dimension on how daily activities are affected, both of which include items on self-care. Most participants wanted to know about the possible complications related to the surgery procedure. In none of the knowledge dimensions the expectations of participants were fulfilled. Participants received most knowledge on the physical and functional issues and received least on the financial and social aspects of their illness. The main predictor of fulfilment of knowledge expectations was having access to knowledge in the hospital from doctors and nurses. Trust in the information source and own motivation to learn shaped how the participants thought about different learning methods. Although the participants were open to using novel learning methods such as websites or games they were also doubtful about their use and called for advice by healthcare professionals. To develop a serious game with the goal to learn about pain management, theories of self-care and adult learning, evidence on the educational needs of patients about pain management and principles of gamification were found useful. The game character is a surgical patient just discharged home from hospital who needs to attend to daily activities while simultaneously managing post-operative pain with different strategies. Participants who evaluated a first version of the serious game improved their knowledge and described usability of the game as high. They were positive towards this new learning method and found it suitable for learning about pain management after surgery in spite of some technical obstacles.

Conclusions: Surgical patients have high knowledge expectations about all aspects of their upcoming surgery and although they prefer direct communication with healthcare professionals as a source for knowledge they might be open to try using more novel methods such as games. Preliminary short-­‐term results demonstrate that a serious game can help individuals to learn about pain management, and has the potential to improve knowledge. A careful introduction, recommendation, and support from healthcare professionals is needed for implementation of such a novel method in patient education.

Abstract [is]

Fræðsla gerir sjúklingum betur kleift að taka þátt í umönnun sinni sem er mikilvægt fyrir bata eftir skurðaðgerð. Sjúklingafræðslu má veita með ýmsum aðferðum, til dæmis munnlega, með bæklingum eða með því að nota upplýsingatækni á formi vefsíðna eða kennslutölvuleikja. Heilbrigðisstarfsfólk hefur verið lengi að tileinka sér möguleika upplýsingatækninnar í sjúklingafræðslu, þar með talið notkun kennslutölvuleikja. Þörf er á meiri þekkingu um fræðsluþarfir skurðsjúklinga en jafnframt um viðhorf sjúklinga til nýrra námsaðferða. Kennslutölvuleikir eru ein leið sem gæti gagnast sjúklingum en notagildi þeirra hefur lítið verið rannsakað.

Meginmarkmið þessarar ritgerðar var að lýsa væntingum skurðsjúklinga til fræðslu, lýsa því hvernig þeir vilja læra og að kanna möguleika kennslutölvuleikja í sjúklingafræðslu.

Ritgerðin samanstendur af fjórum rannsóknargreinum. Notuð vorumegindleg og eigindleg rannsóknargögn til að lýsa ýmsum hliðum náms einstaklinga sem fara í skurðaðgerð. Rannsókn I er framsýn samanburðarrannsókn sem gerð var á 290 sjúklingum með slitgigt sem gengust undir hnéliðskipti. Gögnum var safnað með spurningalistum fyrir skurðaðgerð og fyrir útskrift af sjúkrahúsi um uppfyllingu væntinga til fræðslu og tengda þætti. Rannsókn II er þversniðsrannsókn með þátttöku 104 sjúklinga með hjartabilun sem voru á leið í aðgerð til að fá ígræddan sérstakan hjartagangráð (e. cardiac resynchronisation therapy (CRT)). Gögnum var safnað með spurningalistum, fyrir ígræðsluna, um væntingar til fræðslu og tengda þætti. Rannsókn III er eigindleg rannsókn með þátttöku 13 sjúklinga sem nýlega höfðu farið í liðskiptaaðgerð eða hjartaskurðaðgerð. Gögnum var safnað með viðtölum þar sem sjúklingar lýstu viðhorfum sínum til nýrra og hefðbundinna aðferða til að læra um verkjameðferð eftir  skurðaðgerð. Gögnin voru greind með innihaldsgreiningu. Rannsókn IV lýsir þróun og mati á kennslutölvuleik til að læra um verkjameðferð eftir skurðaðgerð, með þátttöku 20 sjálfboðaliða. Leikurinn var þróaður af þverfaglegum hópi hjúkrunarfræðinga og tölvunarfræðinga. Gagnsemi og notagildi leiksins voru metin með spurningalistum, áhorfi og viðtölum.

Þátttakendur höfðu miklar væntingar til fræðslu. Væntingar voru mestar á sviði lífeðlisfræði um atriði er sneru að sjúkdómi, meðferð og fylgikvillum og á sviði færni um áhrif veikinda á daglegar athafnir. Bæði sviðin fela í sér atriði um sjálfsumönnun. Flestir þátttakendur vildu fá fræðslu um mögulega fylgikvilla skurðaðgerðar. Væntingar voru ekki uppfylltar á neinu þekkingarsviði þó best á sviði lífeðlisfræði og færni en síst er vörðuðu fjárhag og félagslegan stuðning í tengslum við veikindi. Væntingar voru best uppfylltar meðal þeirra sem höfðu góðan aðgang að fræðslu á spítalanum frá hjúkrunarfræðingum og læknum.

Viðhorf þátttakenda til mismunandi námsaðferða mótaðist af trausti á fræðslumiðli og eigin áhugahvöt. Þátttakendur voru opnir fyrir notkun nýjunga á borð við vefsíður og kennslutölvuleiki en jafnframt nokkuð tortryggnir og töldu mikilvægt að fá ráðleggingar og aðstoð heilbrigðisstarfsfólks við slíka notkun.

Kenningar um sjálfsumönnun og nám fullorðinna, aðferðir leikjahönnunar og tiltæk þekking á fræðsluþörfum sjúklinga um verkjameðferð voru notaðar til grundvallar við hönnun kennslutölvuleiksins. Persóna leiksins er nýlega útskrifuð af sjúkrahúsi eftir skurðaðgerð og þarf að sinna daglegum athöfnum jafnframt því að meðhöndla verki sína. Þátttakendur rannsóknarinnar sem lögðu mat á kennsluleikinn bættu þekkingu sína og töldu nothæfni leiksins mikla. Þeir voru jákvæðir gagnvart þessari nýju námsaðferð og fannst hún henta vel til að læra um verkjameðferð eftir skurðaðgerð þrátt fyrir nokkra  tæknilega örðugleika.

Sjúklingar hafa miklar væntingar til fræðslu fyrir skurðaðgerð. Þeir kjósa helst að leita þekkingar hjá heilbrigðisstarfsfólki en eru þó opnir fyrir að prófa nýjungar eins og kennslutölvuleiki. Fyrstu niðurstöður sýndu að kennslutölvuleikur getur hjálpað einstaklingum að læra um verkjameðferð. Við innleiðingu nýjunga innan sjúklingafræðslu er vönduð kynning, meðmæli og stuðningur af hálfu heilbrigðisstarfsfólks mikilvægur fyrir viðtökur sjúklinga.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 112 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1528
Keyword
Education, knowledge expectations, learning, serious game, surgical patients, Kennslutölvuleikur, nám, sjúklingafræðsla, skurðsjúklingar, væntingar til fræðslu
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy Social and Clinical Pharmacy Other Health Sciences Learning
Identifiers
urn:nbn:se:liu:diva-132387 (URN)10.3384/diss.diva-132387 (DOI)9789176857144 (ISBN)
Public defence
2016-11-24, K3, Kåkenhus, Campus Norrköping, Norrköping, 13:00 (English)
Opponent
Supervisors
Note

The online version is a corrected version of the printed thesis. Download the errata list in order to see thecorrections.

Available from: 2016-11-07 Created: 2016-11-07 Last updated: 2016-12-02Bibliographically approved

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