Make pre-surgery teaching flexible

When schedules vary, assess and track teaching

Q. What is the best method for providing preoperative education to surgical patients who are scheduled for surgery with anywhere from a one-day to a one-week notice? These are patients who are scheduled for surgery in the hospital setting and are due to be admitted after surgery.

A: To determine the best method, you have to look at how your facility is structured, says Simone Hughes, RN, MSN, clinical nurse specialist and educator at Good Samaritan Health Systems in Kearney, NE. Is there enough staff to conduct preoperative education classes or telephone patients to answer questions the night before the surgery? It’s best to find hospitals similar to yours and ask how they conduct their preoperative teaching. Following are several suggestions from Hughes and other experts:

Provide a setting for preadmission teaching.

At Mercy Center for Healthcare Services in Aurora, IL, patients are sent to the Ambulatory Care Center for preoperative teaching. "Any patient that is coming to Mercy Center for any type of surgical procedure can come for preoperative teaching from two weeks until a day before their surgery," says Rita Smith, MSN, RN, education coordinator at Mercy. A nurse in the center is available to teach patients during the day.

Educate with information sheets and materials.

At Good Samaritan, people are given a single sheet with the need-to-know information. "There are lots of things we would like them to know so they would be more prepared when they come in, but people only want to know what they have to know. For example, the NPO after midnight is important, but they don’t need to know what they can eat after surgery," says Hughes.

Never simply hand a patient information. A nurse should go over the sheet when the patient receives it or, if it is mailed, the patient should receive a follow-up call, advises Hughes.

Mercy Center has several procedure-specific booklets that are given to patients at the time of the preoperative teaching. "The nurse briefly goes over the material before handing it to the patient to take home and read. There is a phone number on the booklet so the patient can call the nurse if he or she has any questions about information in the booklet," says Smith. Although these booklets cover post-operative care, the information is only touched on during pre-operative education sessions.

Track teaching with a flow sheet.

Preoperative patient education is usually initiated in the medical clinics at Fairview-University Medical Center in Minneapolis, MN. The flow sheet covers what needs to be taught before surgery and meets hospital standards. For example, before surgery the patient should be able to:

— describe any food and fluid restrictions;

— state which medications can or cannot be taken prior to the procedure;

— state the importance of informing the nurse of any unusual sensations such as chest pain, numbness or tingling, and nausea after the procedure.

The flow sheet follows the patient to the inpatient setting, so health care workers can see what the patient has and has not been taught. "It has become a teaching tool for the staff. It is a record of what the patient has accomplished so each person who works with the patient will know where to start the education process," says Nancy Goldstein, MPH, patient education program manager at the medical center. (See example of procedure-teaching flow sheet, as well as an abbreviated version, inserted in this issue.)

Use videos to teach patients what to expect.

Patients at Fairview-University Medical Center are shown a video of patients describing their surgery experiences. They view the tape on the hospital’s closed circuit TV system or in the clinic when they come for their preadmission visit. "The video is designed to relieve the patient’s anxiety about surgery. The patients on the tape describe in their own words what worried them before surgery, their experience with pain, and how their recovery went," says Goldstein.

She eventually hopes to have a library of preoperative video tapes to send to patients before their surgery so they could watch it in their own home. "People watching at home might learn a little more because they would be more relaxed," explains Goldstein.

Always assess what has been taught.

Many physicians who operate on patients at Mercy Center do a good job at preoperative education, yet some don’t. Because all do not have the same standard of patient education, a preadmission assessment is conducted at the Ambulatory Care Center before any teaching takes place. That way, the nurse can determine how much the patient knows and what needs to be taught, explains Smith. The assessment covers such topics as advance directives, allergies, and risk factors.

[Editor’s note: Do you have a question about patient education? Patient Education Management can provide you with specific expert advice gathered from your peers. Write: Patient Education Management, Susan Cort Johnson, P.O. Box 740056, Atlanta, GA 30374. Telephone: (916) 489-3769. Fax: 404-262-7837. E-mail:]