Providing education to patients and their families is one of the most important aspects of nursing care.
This can be education about practically anything but most commonly; pain management, bowel management, physical restrictions, medication side effects… the list goes on. I have also on occasion provided education on the best shows to watch on Netflix as well as the best coffee to be found within a 100m vicinity of the hospital.
Education is essential to the patient and, as you can see, it can vary quite dramatically depending on patient needs.
In terms of the surgical patient, some of the most important education we give them is the education before surgery, their preoperative education.
The goal of preoperative education is to not only prepare the patient for their surgery, but also to prepare them for what to expect following the surgery. Therefore it can be quite extensive! We’ll look at some of the common areas of preoperative education in this article.
Preoperative preparation allows patients to:
- Have more understanding of their surgery
- Feel more in control
- Experience decreased postoperative pain and anxiety
- Have a decreased length of hospital stay
- Have a quicker recuperative period
(Tollefson et al. 2012)
Information should be provided not only to the individual undergoing the surgery but also to their family and relatives if required.
Each member of the surgical team will focus on different components of information. For example, the surgeon will discuss and gain consent for the surgery, the anaesthetist will discuss their role and what to expect with the anaesthetic experience, and the nurse will discuss nursing aspects of care and education such as deep breathing and coughing exercises.
Why is Providing Information Important?
Knowledge and understanding of what is occurring and why promotes feelings of a sense of control that also helps to allay any anxiety.
Information may also need to be repeated at times. Because, as you may know, anxiety can result in the individual having difficulty retaining information. The individual should also be assessed on their prior knowledge so that the information we give them is appropriate and it should also be presented to the individual in language that they understand.
Sometimes written information can be used that will also be help the individual to retention of information (Koutoukidis, Stainton & Hughson 2017).
Information should include:
- Preoperative procedures and the rationale for these procedures such as fasting, stopping anticoagulation therapy, etc.
- Preparations required such as insertion of intravenous cannula, pre-medications and what sensations may be felt when the anaesthesia is induced
- Information regarding the post-aneasthetic care unit
- What to expect postoperatively; for example IV fluids and wound drains
- Postoperative activities the patient will be expected to do, such as deep breathing and coughing, and early mobilisation
- Pain management
- Any other information specific to the surgery they are undergoing or relevant to the individual
(Koutoukidis, Stainton & Hughson 2017)
Preoperative education is not only important to reduce the risk of postoperative complications from occurring, it also allows the individual to take an active role in their recovery and can help them gain a sense of control during a time when they may feel events are out of their control (Koutoukidis, Stainton & Hughson 2017).
Any preoperative teaching should occur over a prolonged period of time in order to give the patient the opportunity to ask questions and ensure information is assimilated. Therefore, ideally this teaching and education isn’t done on the day of surgery but is an ongoing process which begins during their pre-admission visit (Farrell & Dempsey 2013).
Deep Breathing and Coughing
Preoperative education to the patient will include instructions on completing deep breathing and coughing exercises postoperatively.
Deep breathing and coughing improves blood oxygenation and promotes lung expansion as well as helps to facilitate gas exchange and expectorate any accumulated mucus in the lungs. This is a significant exercise for patients to complete during their post-operative period to help decrease the risk of respiratory complications including pneumonia from occurring (Farrell & Dempsey 2013; Koutoukidis, Stainton & Hughson 2017).
During this exercise, the individual is told to take several deep breaths, followed by a short breath and cough. If they have any wounds, they will also be educated on how to protect and support them with their hands or a pillow during these exercises (Koutoukidis, Stainton & Hughson 2017).
Deep Vein Thrombosis (DVT) Risk Reduction
Patients will also be educated on performing bed leg exercises and the benefits of early mobilisation (if able) following the surgery in order to decrease the risk of DVT formation. Exercises and mobilisation helps stimulate blood circulation and increase venous return which then decreases the risk of blood clot formation from venous stasis. They may also be informed of the use of compression devices such as TED stockings which can also be used to help prevent DVTs (Koutoukidis, Stainton & Hughson 2017).
Promote Activity and Exercise
Not only does early mobilisation help protect patients against clot formation, it also helps to promote optimal respiratory function and the return of bowel peristalsis. However, pain and the fear of causing harm to themselves can impede on the patient’s participation in early mobilisation.
Therefore, preoperative teaching needs to also address the expectations of performing activities and mobilising post operatively as well as reassurance and strategies such as splinting incisions to make this task measurable for the patient (Farrell & Dempsey 2013; Tollefson et al. 2012).
Sometimes it can be difficult for the individual to participate in movement exercise postoperatively due to pain, nausea or dizziness. The nurse must ensure these factors are controlled to promote early mobilisation.
Key benefits of early ambulation include:
- Prevention of respiratory complications due to deep breathing which promotes lung expansion
- Prevention of vascular complications due to the stimulating effect ambulation has in the circulatory system
- Improves muscle tone and strength
- Helps with elimination
- Reduces the risk of pressure injury formation
- Improves the morale of the individual
(Farrell & Dempsey 2013; Koutoukidis, Stainton & Hughson 2017)
Promoting exercise and activity is one of the most important aspects of preoperative education and postoperative care because in order for the patient to be safely discharged home, they need to be independent and safe with activities such as toileting and transfers, as well as ambulate a functional distance safely and independently (Farrell & Dempsey 2013).
Patients should also be preoperatively educated on their risk of developing pressure injuries and how to decrease this risk by performing regular position changes. If the patient is unable to do so independently, then the nurse will need to assist the patient postoperatively or educate the patient on techniques to facilitate movement (Duggin 2017).
Patients should also be educated on pain management and what to expect following this surgery. Often patients will be worried about their postoperative pain, therefore it is important that preoperative teaching involves giving the patient reassurance as well as education on pain management.
It is also important that the patient is education on pain rating scales which will be used during their postoperative period. This is especially important if the patient will be using a patient controlled analgesia device (Farrell & Dempsey 2013; Tollefson et al. 2012).
One of the most common complications following surgery is constipation. Therefore education on strategies to relieve and prevent constipation is essential.
The patient should be encouraged to mobilise early and to ensure that once they can tolerate diet and fluids, they maintain an adequate fluid intake and eat foods high in fibre (Koutoukidis, Stainton & Hughson 2017).
As you can see, preoperative education can involve many areas including these mentioned but it is important to remember that all education is individualised to the patient and their information needs.
- Duggin, J 2017, ‘Nursing in the perioperative care environment’, in Koutoukidis, G & Stainton, K (eds), Essential Enrolled Nursing Skills For Person-Centered Care, Elsevier, Chatswood
- Farrell, M & Dempsey, J 2013, Smeltzer and Bare’s Textbook of Medical-Surgical Nursing, 3rd edn, Lippincott Williams & Wilkins, Broadway
- Koutoukidis, G, Stainton, K & Hughson, J (eds) 2017, Tabbner’s Nursing Care: Theory and Practice, 7th edn, Elsevier, Chatswood
- Tollefson, J, Bishop, T, Jelly, E, Watson, G & Tambree, K (eds) 2012 Essential Clinical Skills, 2nd edn, Cengage Learning, South Melbourne