Difference between received and expected knowledge of patients undergoing knee or hip replacement in seven European countries

Knowledge about peritoneal dialysis among patients with end-stage kidney disease on hemodialysis: a cross-sectional study

INTRODUCTION

Peritoneal dialysis (PD) is an alternative modality to hemodialysis (HD) for end-stage Kidney disease (ESKD) treatment. However, PD is underutilized, and patients' knowledge about PD is crucial in making an informed decision about the dialysis modality. This study aims to evaluate the knowledge about PD among HD patients and explore the reasons for its underutilization.

MATERIALS AND METHODS

A cross-sectional study of 108 HD patients was conducted from August to November 2023, at Al-Jaber Dialysis Center in Al-Ahsa. They interviewed to assess the knowledge about PD and explore the reasons for its underutilization.

RESULTS

The patients' ages ranged from 20 to 80 years, with a mean age of 44.2 years. Regarding knowledge about PD, 81.5% of the ESKD patients had heard about other renal replacement modalities, with kidney transplant being the most commonly known option. Only 11.1% were aware of both kidney transplants and PD. 60.2% of patients reported that their nephrologists had discussed other treatment options with them. However, overall knowledge about PD among patients was relatively low, with 43.5% having good knowledge and 56.5% having poor knowledge. Lack of information, considering HD as a better method, and fear of complications were the primary reasons for not considering PD as the first treatment option.

CONCLUSION

This study highlights the inadequate knowledge about PD among HD patients and identifies factors contributing to the underutilization of PD. Lack of information, misconceptions about the effectiveness and safety of PD, and preference for HD were significant barriers. Enhancing patient education and addressing misconceptions are crucial in promoting PD as a viable treatment option for ESKD, thereby improving patients' quality of life.

Patient participation in orthopaedic care-a survey on hip surgery patients' preferences for and experiences of engagement in their health and healthcare

INTRODUCTION

Quality in health services is increasingly associated with enabling patients to participate in their own health and healthcare by recognising their resources and needs. Despite a growing recognition as to whether such participation is enabled, little is known regarding opportunities for preference-based patient participation in orthopaedic care.

AIMS

To investigate preference-based participation for patients in orthopaedic care due to hip surgery.

METHODS

Patients across 17 Swedish orthopaedic units who had had hip surgery, due to hip fracture or osteoarthritis, January-April 2021 were invited to complete the validated 4Ps questionnaire. Of 1514 patients, 458 patients returned the questionnaire with reports on their preferences for and experiences of participation. Each of the 4Ps' 12 items were analysed separately using descriptive and comparative statistics.

RESULTS

A complete match in preferences for, and experiences of, participation was achieved with variation between items for 41%-50% of the patients; if almost matches were included, this occurred for 57%-77% of the patients. Less participation than preferred was most common in terms of having had reciprocal communication, opportunities for partaking in planning, and in learning how to manage symptoms/issues. Hip fracture surgery was significantly associated with experiencing lower levels of participation than preferred.

CONCLUSION

Though standardised care promotes efficient hip surgery care, our study suggests a need for more person-centred opportunities to engage. A discrepancy was noted between patients' resources and preparation for their participation in and beyond the hip surgery process, particularly for self-care activities, calling for better use of nursing resources. ID: NCT04700969 with the U.S National Institutes of Health Clinical Registry.

Patients' right to know: A scoping review

AIMS AND OBJECTIVES

To analyse research-based evidence about patients' right to know from their own perspective to promote ethically high-quality nursing and to identify future research areas.

BACKGROUND

Patients' right to know is a fundamental right. Although of topical research interest, the current state of scientific evidence on patients' right to know has not been reviewed.

DESIGN

A scoping review according to the methodological framework by Arksey & O'Malley and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

METHODS

In June 2022, a literature search was conducted in the Ovid Medline, CINAHL and Cochrane Library databases. The inclusion criteria were peer-reviewed, empirical studies on the right to know with samples comprising adult patients. Data were analysed with inductive content analysis, and methodological quality was assessed with Mixed Methods Appraisal Tool.

RESULTS

Out of 2658 identified reports, 12 were selected for analysis. Based on the results, the research on patients' right to know can be classified into two main content categories: (1) expectations of the right and (2) realisation of the right. In the quality assessment, most of the reports did not meet all the quality criteria, the most common deficits being related to instrumentation and risk of bias.

CONCLUSIONS

Research-based evidence on patients' right to know provided a general insight into expectations and realisation of the right to know and not to know. The results indicate a need for continued efforts for novel approaches with high-quality methodological choices in future studies.

RELEVANCE TO CLINICAL PRACTICE

Nurses make constantly ethical decisions: The findings of this study can be useful for their decision-making and understanding of the patient's perspective on knowledge issues, and therefore, support ethically high-quality patient education.

PATIENT OR PUBLIC CONTRIBUTION

No direct patient or public contribution to the review.

Sufficiency of Knowledge Processed in Patient Education in Dialysis Care

PURPOSE

Patient education improves health and treatment adherence of patients with chronic kidney disease. However, evidence about the sufficiency of patients' knowledge processed in patient education is limited. The purpose of this study was to evaluate subjective and objective sufficiency of knowledge processed in patient education in dialysis care and treatment.

PATIENTS AND METHODS

A cross-sectional study design was used. The sample (n=162) comprised patients in predialysis or home dialysis. All eligible patients during the data collection timeframe (2016-2017) in two university hospital districts in Finland were invited to participate. Subjective sufficiency was evaluated with a structured questionnaire having 34 items divided into six dimensions of empowering knowledge (bio-physiological, functional, social, experiential, ethical, and financial) on a Likert scale (1=not sufficient at all, 4=very sufficient). Objective sufficiency was evaluated with a structured knowledge test with 10 items (score range 0-10, correct=1, wrong/no knowledge=0) based on the multidimensional content of patient education emphasizing bio-physiological dimension.

RESULTS

In subjective sufficiency of knowledge, the mean was 3.27 (SD 0.54). The bio-physiological dimension of empowering knowledge was the most sufficient (mean 3.52, SD 0.49) and the experiential the least (mean 2.8, SD 0.88). In objective sufficiency, the means ranged 5.15-5.97 (SD 2.37-2.68) among patients in different modalities of dialysis care and treatment. The least sufficient objective scores were bio-physiological and functional knowledge. The subjective and objective sufficiency did not correlate with each other.

CONCLUSION

Patients' knowledge, either subjective or objective, does not seem to be sufficient. Hence, attention should be paid to supporting patients with more personalized knowledge. Furthermore, the relationship between subjective and objective sufficiency needs future consideration, as their non-correspondence was a new discovery.

Instruments for Patient Education: Psychometric Evaluation of the Expected Knowledge (EKhp) and the Received Knowledge of Hospital Patients (RKhp)

Purpose

In patient education, there is a need for valid and reliable instruments to assess and tailor empowering educational activities. In this study, we summarize the process of producing two parallel instruments for analyzing hospital patients’ expectations (Expected Knowledge of Hospital Patients, EKhp) and received knowledge (Received Knowledge of Hospital Patients, RKhp) and evaluate the psychometrics of the instruments based on international data. In the instruments, six elements of empowering knowledge are included (bio-physiological, functional, experiential, ethical, social, and financial).

Patients and Methods

The original Finnish versions of EKhp and RKhp were tested for the first time in 2003, after which they have been used in several national studies. For international purposes, the instruments were first translated into English, then to languages of the seven participating European countries, using double-checking procedure in each one, and subsequently evaluated and confirmed by local researchers and language experts. International data collection was performed in 2009–2012 with a total sample of 1,595 orthopedic patients. Orthopedic patients were selected due to the increase in their numbers, and need for educational activities. Here we report the psychometrics of the instruments for potential international use and future development.

Results

Content validities were confirmed by each participating country. Confirmatory factor analyses supported the original theoretical, six-dimensional structure of the instruments. For some subscales, however, there is a need for further clarification. The summative factors, based on the dimensions, have a satisfactory internal consistency. The results support the use of the instruments in patient education in orthopedic nursing, and preferably also in other fields of surgical nursing care.

Conclusion

EKhp and RKhp have potential for international use in the evaluation of empowering patient education. In the future, testing of the structure is needed, and validation in other fields of clinical care besides surgical nursing is especially warranted.

Health related quality of life in patients having total knee replacement and associations with symptoms, recovery, and patient education: A six month follow up study

AIM

To describe the symptoms, recovery, patient education, and health related quality of life (HRQOL) of patients having total knee replacements at three time points and to detect experiences and situations that predict HRQOL six weeks and six months post-surgery.

METHOD

A prospective exploratory two-site study assessing 123 patients, while in hospital (T1), at six weeks (T2), and at six months (T3) post-discharge. HRQOL was measured using the SF-36v2 and symptoms were measured with the Hospital and Anxiety Scale. Two questions considered pain and two considered movement and tiredness while two questions addressed recovery and patient education. Linear regression models were used to calculate predictors of mental and physical HRQOL at T2 and T3.

RESULTS

HRQOL improved from T1 to T3. The main predictors of higher physical scores at T2 were; being older, fewer symptoms of depression and little distress related to movement. At T3 the main predictors were; having resumed work, finding patient education very useful, experiencing no pain in the last 24 h and fewer symptoms of depression. The main predictors of higher mental scores at T2 were fewer symptoms of anxiety and depression and little distress related to movement while at T3 these were fewer symptoms of anxiety and depression and experiencing no pain last 24 h.

CONCLUSION

Apart from pain, function and resumption of activities, the symptoms of anxiety and depression influence HRQOL. These symptoms should be assessed during the hospital stay.

Impact of technology-based patient education on modifiable cardiovascular risk factors of people with coronary heart disease: A systematic review

OBJECTIVE

To collect evidence on what types of technology and content are most effective in helping people with coronary heart disease (CHD) to change their modifiable cardiovascular risk factors.

METHODS

A literature search was performed to find relevant studies published between 1 January 2008 and 31 December 2018 in PubMed, CINAHL, PROQUEST and Scopus databases. Selected outcomes were risk factors (exercise, diet, blood pressure, blood sugar, cholesterol, body mass index, tobacco use). The quality of the studies was evaluated according to Joanna Briggs Institute Reviewers Manual Checklists for risk for bias, TIDieR for quality of interventions, and PRISMA statement for presenting results.

RESULTS

Eighteen quantitative (17 RCT´s and one quasi-experimental) studies were included. Patient education delivered through telephone, text messaging, webpages, and smartphone applications resulted in significant changes in some risk factors of people with CHD. Sufficient descriptions of the content and intervention methods were lacking.

CONCLUSION

Patient education delivered with technology can help people with CHD to modify their risk factors. There is a need for better descriptions of the content and delivery of educational interventions in studies.

PRACTICE IMPLICATIONS

Patient education needs to be delivered with technological solutions that best support the multidimensional needs of CHD patients.

The role of health literacy in orthopaedic rehabilitation after total knee and hip arthroplasty: A scoping review

BACKGROUND

Health literacy (HL) is a key aspect in empowering patient education as part of orthopaedic rehabilitation after total knee or hip arthroplasty (TKA/THA).

OBJECTIVES

This scoping review aims to demonstrate the prevalence of patient-related outcome measures in studies on the effectiveness of orthopaedic rehabilitation of older people after TKA/THA. The review also focuses on the identification of outcome measures that assess patients' HL or HL-related aspects.

METHODS

A scoping literature search was conducted using the JBI methodology for scoping reviews. The databases MEDLINE (PubMed), CINAHL Complete, The Cochrane Library, Academic Search Elite, and ERIC were searched with keywords and phrases to find relevant literature. Identified outcome measures were conceptually analysed in a peer reviewed procedure. Those with suspected HL-related content were analysed at item level. Text analyses were performed using MAXQDA.

RESULTS

117 papers were included in this review. 45 patient-related outcome measures could be found, 2 of which assess HL-related aspects. No paper could be found that assessed patients' HL in orthopaedic rehabilitation after TKA/THA.

CONCLUSIONS

HL has hitherto been of limited importance in orthopaedic rehabilitation. Health professionals are responsible for assessing patients' health literacy and developing appropriate strategies for patient education in the context of orthopaedic rehabilitation.

Communication Preferences in Total Joint Arthroplasty: Exploring the Patient Experience Through Generative Research

BACKGROUND

Improving communication and information services for people receiving a total joint (knee or hip) arthroplasty (TJA) depends on the differences in patient communication needs and personal characteristics.

PURPOSE

The purpose of this study was to further examine individual differences in TJA patient preferences regarding communication and information provision.

METHODS

Nineteen patients participated in generative research, which meant they actively reflected on their TJA experiences and communication preferences through creative exercises (e.g., collage making). Audio transcripts of their shared reflections were qualitatively analyzed through an inductive approach.

RESULTS

Some participants wanted detailed health education, others did not. Participants also reported different support needs (e.g., at hospital discharge or during rehabilitation). Moreover, participant preferences for social connections with care providers differed.

CONCLUSIONS

An individual patient's mindset, his or her social support needs, physical condition, and medical history should guide the provision of tailored services.

Emotions of Orthopaedic Arthroplasty Patients: A European Survey

METHODS

This was a pre/post-observational study examining patients' emotions before and during elective knee or hip replacement surgery for osteoarthritis in seven European Union countries to identify factors related to better emotional status at discharge.

INSTRUMENTS

In addition to demographic data, information was collected on quality of life (EuroQoL five-dimension questionnaire), hospital expectations (Knowledge Expectations of Hospital Patients Scale), symptoms, and experienced emotions.

ANALYSIS

Total negative emotions scores at baseline and discharge were transformed into median values. Multivariate analysis identified the baseline factors related to better emotional status at discharge.

RESULTS

Patients (n = 1,590), mean age 66.7 years (SD = 10.6), had a significant reduction in the frequency of total negative emotions at discharge as compared with baseline. The multivariate model showed better health status (odds ratio [OR] = 1.012; p = .004), better emotional status at baseline (≥24 points), and shorter duration of hospital stay (OR = 0.960; p = .011) as independent factors associated with better emotional status at discharge (OR = 4.297; p = .001).

CONCLUSIONS

Patients undergoing elective knee or hip replacement surgery for osteoarthritis improve their emotional status during hospitalization, with fewer negative emotions at discharge. Good emotional status, feeling of higher health status at baseline, and shorter hospitalization were independently associated with better emotional status at discharge.

Relationship between sufficiency and usefulness of patient education: A cross-sectional study of patients with chronic kidney disease

The aim of this descriptive study was to analyze the relationship between the sufficiency and usefulness of patient education from the perspective of people with chronic kidney disease. The goal was to discover whether both sufficiency and usefulness need to be analyzed in the quality evaluation of patient education. Patients undergoing predialysis or home dialysis care in Finland (N = 162) evaluated both the sufficiency and usefulness of patient education provided by nephrology nurses by using parallel structured questionnaires. A strong relationship was found between the sufficiency and usefulness of patient education. The relationship was significant across all dimensions of empowering knowledge, but no systematic association was found between the sufficiency-usefulness relationship and background variables. Depending on the purpose of evaluating patient education, either aspect, that is, sufficiency or usefulness, can be used, but it is not necessary to use both due to their strong inter-correlation. In terms of implications for practice, consideration of both sufficiency and usefulness is important when providing empowering patient education for people undergoing pre- or home dialysis, but only one aspect needs to be evaluated.

Patients are expecting to learn more: A longitudinal study of patients with heart failure undergoing device implantation

OBJECTIVE

To explore the educational expectations and experiences of patients with heart failure in relation to device implantation.

METHODS

In this longitudinal study, patients at six Swedish and Icelandic hospitals answered instruments about their knowledge expectations, before the device implantation, and about the knowledge they had received at two weeks, six months and 12 months after the procedure. Predictors for fulfillment of knowledge expectations were assessed with linear mixed model analysis.

RESULTS

Patients (N = 133, mean age 69.8 (±9.7) years, 80 % men) had high knowledge expectations, which for 83 % of them were unfulfilled. Predictors for fulfillment of knowledge expectations were access to knowledge from healthcare professionals (β 0.74, 95 % CI: 0.42-1.10), educational level (β -0.30, 95 % CI: -0.52 to -0.07) and knowledge expectations (β -1.03, 95 % CI: -1.30 to -0.80). Healthcare professionals were the main information source (89 %), 74 % of patients received written information, and 19 % had used the Internet.

CONCLUSIONS

Patients receive less knowledge than they expect, and individual factors and communication with healthcare professionals are related to their experience. Face-to-face is the most common method of delivering education.

PRACTICE IMPLICATIONS

Healthcare professionals should assess patients' expectations for information and consider implementing more diversity in their educational practices.

Expectations of patients with colorectal cancer towards nursing care- a thematic analysis

PURPOSE

The purpose of this study was to explore comprehensively expectations of patients with colorectal cancer towards nursing care in the chemotherapy context.

METHODS

A purposive sample of patients with colorectal cancer (n = 15) was interviewed individually at the outpatient clinic in one university hospital chemotherapy unit. The data were analysed with thematic analysis.

RESULTS

Three main themes were identified in the data. Firstly, patients expected to be empowered with knowledge of disease process, side effects and their self-management and peer support. Secondly, patients expected to be humanely encountered, which included being encountered with support, compassion and hope. Thirdly, patients expected to be skillfully cared for with systematic assessment, expertise, continuity and advocacy.

CONCLUSIONS

Besides reliable knowledge of cancer treatment and care, patients expected the sympathetic presence of a nurse whose professional skills they can trust. The results may be utilised in intervention development by focusing on themes significant to these patients. The results may help nurses to enhance person-centred care as well as to encounter patients according to their expectations.

Exploring patient empowerment

Purpose

The purpose of this paper is to develop a research framework for exploring and improving patient empowerment through the analysis of the effects produced by a satisfying physician relationship on patient involvement in the healthcare process.

Design/methodology/approach

The authors begin with a literature review of patient empowerment in healthcare, useful to highlight the importance of relational aspects. Then, the authors tested the hypotheses of the research through the analysis of 450 questionnaires. The results are analyzed through covariance-based structural equation modeling.

Findings

This paper highlights how empowerment is a more complex phenomenon, needing many dimensions to be investigated. The hypotheses were tested, and correlations computed, highlighting a medium-strong positive correlation between physician relationship and patient involvement determining satisfying patient empowerment.

Research limitations/implications

The considerations conducted in the paper are restricted to physician relationship and needs further research aimed to analyze and evaluate the changes in the patient behaviors influenced by empowerment.

Practical implications

The research points offer new insight into patient empowerment and allow the healthcare provider to create new opportunities for promoting patient empowerment through the development of quality relationship for effective patient involvement.

Originality/value

The study developed contributes new insight about patient empowerment in the healthcare management literature, proving the key role of satisfying physician relationship useful for future researches.

Experiences of pre- and postoperative information among patients undergoing knee arthroplasty: a systematic review and narrative synthesis

Purpose: The aim of this review was to identify and synthesize knowledge of how patients undergoing knee arthroplasty experience pre- and postoperative information provided by healthcare professionals.Materials and methods: A systematic review and narrative synthesis was conducted in accordance with Popay et al.'s guidelines which involve 1) developing a preliminary synthesis; 2) exploring relationships; and 3) assessing the robustness of the synthesis. Qualitative and quantitative studies were considered for inclusion, and a systematic, extensive search was conducted in scientific databases.Results: A total of 31 studies were included in this review. The analysis resulted in five synthesized themes: 1) Support in the decision to undergo surgery; 2) Confidence versus uncertainty in the preparation for surgery; 3) Prerequisites for feeling secure before discharge; 4) Struggling through rehabilitation at home; and 5) Unmet expectations and endeavoring to accept realities.Conclusions: The findings illustrate the complexities of patients' experiences of information from healthcare professionals and its significance for how they manage challenges throughout the surgical care pathway. Information from healthcare professionals influences patients' knowledge, skills and confidence in the journey through knee arthroplasty. Therefore, it is important that healthcare professionals recognize patients' support requirements and adapt information to their individual needs.Implications for rehabilitationHealthcare professionals should encourage more dialog with patients and adapt information to their individual circumstances and needs throughout the surgical care pathway.It is important that healthcare professionals provide ongoing information and repeat information throughout the entire surgical care pathway in order to facilitate predictability and improve patients' ability to comprehend and assimilate information.Improved access to information and advice from healthcare professionals following knee arthroplasty will offer patients reassurance and increase their confidence in managing postoperatively at home.Patients who require enhanced information and guidance from healthcare professionals need to be identified in order to support their progress and achieve the best possible postoperative outcomes.

Perceived quality of nursing care and patient education: a cross-sectional study of hospitalised surgical patients in Finland

OBJECTIVES

This study aims to analyse the relationship between patient education and the quality of surgical nursing care as perceived by patients. The background of the study lies in the importance of a patient-centred approach for both patient education and quality evaluation.

DESIGN

This was a cross-sectional descriptive correlational study with surgical patients.

SETTING

Data were collected in 2013 in one hospital district in Finland.

PARTICIPANTS

480 hospitalised surgical patients.

METHODS

The data were collected using two structured instruments: one measuring the perceived quality of nursing care experienced by patients (Good Nursing Care Scale) and one measuring the received knowledge of hospital patients (RKhp). Data were analysed statistically using descriptive and inferential statistics to describe the sample and study variables. Pearson's correlation coefficients were used to analyse the association between the scales.

RESULTS

Surgical hospital patients evaluated the level of the quality of nursing care as high; this was especially true with reference to the environment and staff characteristics, but not to collaboration with family members. Most (85%) of the patients had received sufficient knowledge preoperatively and they were familiar with the proceeding of their care and treatment after discharge; in particular, they had received bio-physiological knowledge, consisting of knowledge of the disease, symptoms and the physiological elements of care. The positive correlation between the perceived quality of surgical nursing care and received knowledge was strong, suggesting a positive relationship between patient education and improvement of the quality of nursing care.

CONCLUSIONS

Based on the results, the quality of nursing care and patient education are interconnected. Thus, by improving patient education, the quality of nursing care can also be improved. It is particularly important to improve collaboration with family members and patients' own management strategies as well as the multidimensionality of educational knowledge.

Knowledge expectations of orthopaedic patients

AIM

To describe and compare knowledge expectations and received knowledge in elective orthopaedic surgery patients.

BACKGROUND

Population aging, increasing incidence of osteoarthritis, the growing number of surgical procedures, and reduced clinical stays underline the need for a new approach to patient education.

DESIGN

This study has a descriptive, comparative design.

METHODS

Data were collected from 263 patients who had total hip and knee replacement elective surgery during 3 years (2009-2012) in 5 public hospitals in Spain. The Knowledge Expectation of Hospital Patients and the Received Knowledge of Hospital Patients Scales were used to collect data. The questionnaires were filled before hospital admission, at discharge and at follow-up 6 to 7 months later.

RESULTS

Surgical patients received less knowledge than they expected. Patients' expectations were only met in the functional dimension. At follow-up, patients reported that they perceived having acquired more knowledge during their hospital stay than they reported at the time of discharge. Knowledge expectations and knowledge received were related to employment status, gender, and previous contact experience with the hospital.

CONCLUSION

Knowledge expectations were not met, and results showed the need to improve education for orthopaedic patients throughout the perioperative process, not only during hospitalization.

Development of post hip replacement comfort scale

AIM

To develop and psychometrically test the Post Hip Replacement Comfort Scale (PHRCS).

BACKGROUND

Evaluation of the patient comfort after hip replacement surgery is highly important in order to increase the quality of patient care. The review of the relevant literature shows that a scale that specifically measures the patient comfort after hip replacement surgery is absent.

DESIGN

Methodological design was used. This study included the development of the scale and tested the psychometric properties of the scale.

METHOD

180 patients who had been hip replacement surgery recruited from three education and research hospitals' orthopedic and trauma departments from January 2014 to December 2015. The study was conducted in three phases. In phase 1, scale items were developed based on the literature review and other comfort scales. In phase 2, the trial was applied with data collection forms. Phase 3 was conducted to evaluate the reliability and validity of the finalized inventory using item analysis.

RESULTS

The Cronbach's alpha coefficient value is 0.758. Test-retest results found positive and meaningful correlation between the scores of the scales, indicating the reliability of the scale. Scope, surface, criterion and construct validity analysis confirmed the validity of the scale. There were 26 items in the final scale. In our study, the average patient comfort score was 3.64±0.43 (from 1 to 5).

CONCLUSION

The PHRCS is recommended for evaluating patients' comfort after hip replacement surgery and examining the effects of nursing interventions on patients' comfort.

Validación de la versión española: Expectativa y conocimiento recibido del paciente hospitalizado

Objetivo: evaluar la validez y la fiabilidad de la versión española del instrumento Expectativas y conocimiento recibido del paciente hospitalizado (ECPH/CRPH) en pacientes con osteoartritis intervenidos de artroplastia total de rodilla. Material y métodos: el proceso de validación siguió las recomendaciones internacionales: validez de contenido, validez de constructo, validez de criterio y fiabilidad. Un total de 248 pacientes que debían intervenirse de artroplastia total de rodilla en 5 hospitales públicos españoles contestaron la ECPH antes de ser hospitalizados y 220 pacientes contestaron el CRPH al darles el alta hospitalaria. Resultados: el análisis factorial confirmó las dimensiones de la escala original para el conocimiento recibido, pero no en la escala para las expectativas. La correlación de las dimensiones de la ECPH con la Escala de Opinión de la Salud de Krantz (KHOS) y la correlación de las dimensiones de la CRPH con la Escala de Acceso a la Información (AKS) indicaron la validez de criterio mostrando unas relaciones positivas. Los resultados señalaron buena fiabilidad con valores de alfa Cronbach elevados. Conclusión: el proceso de validación indica que la versión española del ECPH/CRPH es un instrumento válido y fiable para medir las expectativas y el conocimiento recibido en pacientes quirúrgicos en el contexto español.

Content of Orthopedic Patient Education Provided by Nurses in Seven European Countries

Patients’ and their significant others’ education during the perioperative phase is an important and challenging aspect of care. This study explored the content of education provided by nurses to arthroplasty patients and their significant others. Data were collected with the Education of Patients–NURSE content (EPNURSE-Content), Received Knowledge of Hospital Patient (RKhp), and Received Knowledge of Significant Other (RKso) scales. The results showed that the content of education emphasized biophysiological and functional needs, differed between countries, and was related to how physically demanding nurses found their job to be and the amount of education provided. There is congruence between the received knowledge of patients and their significant others in relation to the content of education provided by nurses. The findings can support nurses in developing aid material for patients and significant others explaining the nature of education and advising them what to expect and how to optimize their participation in the process.

Development, Usability, and Efficacy of a Serious Game to Help Patients Learn About Pain Management After Surgery: An Evaluation Study

Background

Postoperative pain is a persistent problem after surgery and can delay recovery and develop into chronic pain. Better patient education has been proposed to improve pain management of patients. Serious games have not been previously developed to help patients to learn how to manage their postoperative pain.

Objective

The aim of this study was to describe the development of a computer-based game for surgical patients to learn about postoperative pain management and to evaluate the usability, user experience, and efficacy of the game.

Methods

A computer game was developed by an interdisciplinary team following a structured approach. The usability, user experience, and efficacy of the game were evaluated using self-reported questionnaires (AttrakDiff2, Postoperative Pain Management Game Survey, Patient Knowledge About Postoperative Pain Management questionnaire), semi-structured interviews, and direct observation in one session with 20 participants recruited from the general public via Facebook (mean age 48 [SD 14]; 11 women). Adjusted Barriers Questionnaire II and 3 questions on health literacy were used to collect background information.

Results

Theories of self-care and adult learning, evidence for the educational needs of patients about pain management, and principles of gamification were used to develop the computer game. Ease of use and usefulness received a median score between 2.00 (IQR 1.00) and 5.00 (IQR 2.00) (possible scores 0-5; IQR, interquartile range), and ease of use was further confirmed by observation. Participants expressed satisfaction with this novel method of learning, despite some technological challenges. The attributes of the game, measured with AttrakDiff2, received a median score above 0 in all dimensions; highest for attraction (median 1.43, IQR 0.93) followed by pragmatic quality (median 1.31, IQR 1.04), hedonic quality interaction (median 1.00, IQR 1.04), and hedonic quality stimulation (median 0.57, IQR 0.68). Knowledge of pain medication and pain management strategies improved after playing the game (P=.001).

Conclusions

A computer game can be an efficient method of learning about pain management; it has the potential to improve knowledge and is appreciated by users. To assess the game’s usability and efficacy in the context of preparation for surgery, an evaluation with a larger sample, including surgical patients and older people, is required.

Patient Perspectives on Engagement in Recovery after Hip Fracture: A Qualitative Study

Purpose. To understand older adults' engagement in their recovery experience and rehabilitation after a fall-related hip fracture. Method. 50 community-dwelling older adults recovering from a recent (3–12 months) hip fracture (32 women, 18 men) participated in telephone interviews using a semistructured format at 6 and 12 months after recruitment into the study. Interviews were conducted as part of a mixed-methods study designed to test the effect of a postoperative hip fracture management program (B4 Clinic). Results. Three substantive themes were identified in the qualitative data: (1) managing expectations; (2) engaging in physical activity; and (3) there is life after fracture. Participants shared valuable insight into how their expectations for their recovery period compared to their lived experience and the role of physical activity in their ability to return to their prefracture activities. Conclusions. Our findings reflect older adults' expectations for recovery from hip fracture. Encouraging engagement in rehabilitative exercises and addressing expectations prior to hospital discharge may improve patients' adherence to rehabilitation programs, functional outcomes, and postoperative quality of life. Implications for rehabilitation include the necessity for early and ongoing engagement of rehabilitation professionals.

The Knowledge Test Feedback Intervention (KTFI) increases knowledge level of spinal stenosis patients before operation-A randomized controlled follow-up trial

OBJECTIVE

To assess the impact of a preoperative educational intervention on the knowledge level of patients with spinal stenosis.

METHODS

One hundred spinal stenosis patients were randomized into a preoperative educational intervention group (IG, n=50) or a control group (CG, n=50). All the patients received routine preoperative education. In addition, the IG went through an empowering telephone discourse based on a knowledge test performed before admission to hospital. Data on patients' knowledge level were collected at baseline (after the treatment decision), admission to hospital, discharge from hospital and at 3 and 6 months follow-up.

RESULTS

At baseline, there was no difference in the knowledge level of the study groups. At admission, the knowledge level was significantly higher in five of six dimension of empowering knowledge in the IG compared to the CG. During follow-up, the knowledge level within the study groups remained stable.

CONCLUSION

A preoperative KTFI significantly increased the patients' knowledge level in most dimensions of empowering knowledge.

PRACTICE IMPLICATION

KTFI is an effective method of preoperative education in patients with spinal stenosis.

Participation of family members and quality of patient care - the perspective of adult surgical patients

AIMS AND OBJECTIVES

The aim of this study is to describe the participation of family members in the care of Finnish adult surgical patients and the connection of the participation with the quality of patient care as perceived by surgical patients.

BACKGROUND

The family members of adult surgical patients are important. Earlier studies vary concerning the nature of participation, its meaning and the connection of participation with patient-centred quality of care. In this study, we aim to produce new knowledge about adult surgical patients whose family members have participated in their care.

DESIGN

This was a cross-sectional descriptive survey study.

METHODS

The data were collected among adult surgical patients (N = 481) before being discharged home from hospital with two instruments: the Good Nursing Care scale and the Received Knowledge of Hospital Patients.

RESULTS

Based on the results, most adult surgical patients report that family members participate in their care. Participation was connected with received knowledge and preconditions of care, which are components of the quality of patient care.

CONCLUSIONS

In future, testing of different solutions for improving the participation of surgical patients' family members in patient care should be implemented. Furthermore, the preconditions of family members' participation in care and the concept of participation should be analysed to emphasise the active role of family members.

RELEVANCE TO CLINICAL PRACTICE

The results emphasised the importance of family members for the patients in surgical care. Family members' participation is connected with the quality of patient care.