Patient’s home good site for pre-surgery teaching
Patient’s home good site for pre-surgery teaching
Comfortable environment enhances learning
Pre-surgery teaching for total joint replacement patients was hectic and haphazard at Jameson Health System in New Castle, PA. Patients received some teaching when they came to the hospital for preadmission testing. Yet, if no one was available to teach, the instruction took place before surgery.
Staff from surgery got together with representatives from the utilization department, home health department, and education services to brainstorm.
"We wanted to determine what the ideal situation would be if we all worked at Utopia General," says Kathi McFerren, RN, BSN, MSN, director of surgical services at Jameson.
Their ideal’ was to do the pre-surgery teaching in the patient’s home. They initiated the program in January 1997. The average length of stay (LOS) for joint replacement surgery before the in-home teaching was 5.8 days. The average LOS for patients admitted for this surgery between January and June 1997 was 5.6 days.
McFerren attributes the drop to the fact that everyone receives comprehensive teaching now. Also, patients are more comfortable learning in their homes, she says. A follow-up survey showed a 98% patient satisfaction rate with the pre-surgery teaching at home.
Here’s how the program works:
• Nurses who are familiar with the surgery teach.
A group of operating room nurses familiar with the surgery do the home teaching. They are nurses from each of the three surgical teams who asked to participate in the project. To learn how to do home visits, the OR nurses from Jameson paired with a nurse from the local Visiting Nurses Association and went to see a few patients.
The nurse who conducts the in-home teaching also is scheduled to work in the operating room the day of the surgery.
"Patients are very happy that the person who comes to see them in their home is the person they meet in the operating room on the day of surgery. That increases their comfort level more than anything else. They feel like they know someone, and that person will take personal care of them," says McFerren.
• A documentation sheet guides the education process.
Each nurse has a packet of information to review with the patient and a documentation sheet to ensure that everything has been covered. Educational services wrote a booklet, in collaboration with all the departments involved in the surgery, that explains what will take place on the day of surgery. (To receive a sample copy of preparation for surgery booklet, contact Kathi McFerren. Contact information listed in source box at end of story.) The nurse reviews this booklet; however, it is the details from the OR nurse doing the teaching that patient’s find invaluable, says Diane Baranski, RN, staff nurse in the OR at Jameson and one of the in-home teachers.
"We know the routines like the back of our hands. We can tell them what the dressing will be like, when they will come out of surgery, what will happen the next day on the floor," she says.
Instructions include what to expect in the recovery room and methods to control pain such as breathing techniques and taking pain medication before physical therapy sessions.
Nurses review papers that patients need to fill out and bring back to the hospital, such as the anesthesia assessment form. Also, the nurse explains advance directives to the family and gives them a booklet on the topic which was created in-house. The physical therapy department created a sheet that covers equipment the patients might be using, such as a walker, and exercises they will be asked to do. The nurse shows patients how to do the exercises and use a walker if their surgery warrants it. The home also is reviewed for safety with an eye on removing throw rugs that might cause a patient to slip and making sure hallways are well lit.
An in-home teaching session takes about an hour.
• Education is made a family affair.
Patients are encouraged to invite as many family members to the teaching session as they want. The OR nurse then can answer any questions they have to ease anxiety in the waiting room the day of surgery, says Baranski. The fact that lots of people can gather in the home for the teaching session, which isn’t always possible in a hospital setting, is one of the benefits of in-home teaching. Other benefits include the comfort level it produces for patients and the opportunity it provides for reviewing the house for safety.
• Home health nurses teach out-of-town patients.
Visiting some patients takes the whole afternoon because the drive to their home is an hour or more, says Baranski. In such cases, a nurse from the Visiting Nurses Association near the patient’s home does the teaching. "If we can’t get to the home, we’ll send a visiting nurse to go over the packet of information. We trained them as they were training us," she explains.
If an in-home visit cannot be arranged, the hospital tries to schedule an OR nurse to meet with the patient at the hospital when he or she comes in for the preadmission testing.
• Home visits are scheduled in advance.
When a patient schedules an appointment for preadmission testing, the nurse in that department sends the information to the program coordinator in the operating room. The coordinator then calls the patient and schedules a home visit.
"When we are doing the surgical staffing schedule, we know who is going to be out of the operating room doing a pre-op home visit at that time," says McFerren.
The OR nurses do the in-home teaching as part of their workday. They are reimbursed for mileage. "When we use to do the pre-op teaching on the day of surgery or the day of their pre-op testing, the patients’ anxiety level was high. Now we are educating them a week or more before surgery in their home where they are comfortable. We think it is a better learning environment," says McFerren.
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