28 Patient education and care of the perianesthesia patient
Affective Learning: Relates to attitude and includes the ability to receive, respond, value, and organize a personal value system and internalize the value system.
Cognitive Learning: The human processing of information; application of knowledge.
Continuous Positive-Pressure Airway (CPAP): Delivers air into the patient’s airway and creates enough pressure to keep the airway open during inhalation.
Intermittent Mandatory Ventilation (IMV): Allows patients to breathe on their own as often and as deeply as they like and ensures that a set tidal volume is delivered at a predetermined back-up rate.
Patient Education: Useful information that helps patients and their families or companions become more informed about the medical and nursing care they receive before, during, and after surgical and diagnostic procedures.
Positive End-Expiratory Pressure (PEEP): A technique that can be used to help prevent collapse of the alveoli during the expiratory phase of ventilation, to increase the lung’s functional residual capacity, and to reduce the amount of physiologic shunting.
Stir-Up Regimen: Consists of five major activities as the patient is recovering from anesthesia: deep-breathing exercises, coughing, positioning, mobilization, and pain management.
Sustained Maximal Inspiratory (SMI) Maneuver: The patient inhales as close to total lung capacity as possible and, at the peak of inspiration, holds that volume of air in the lungs for 3 to 5 seconds before exhaling.
Synchronous Intermittent Mandatory Ventilation (SIMV): Allows the patient to control the inspiratory time and the size of the spontaneous tidal volumes.
Patient education concepts and perianesthesia care
The purpose of preoperative education is to empower patients, give them greater decision-making authority related to their care, and enable them to better manage their health. The patient benefits from learning before the surgery with decreased preoperative fear and anxiety, postoperative complications, recovery time, and postoperative pain.1,2 Education also increases patient compliance with instructions and improves coping mechanisms for the patient and preparation. Preoperative education is for the patient and the family or companion and is a responsibility of the professional registered nurse.
Before providing education for patients, perianesthesia nurses complete a self-assessment that reflects on strengths and weaknesses such as knowledge base, understanding of the information to teach, and whether they like or dislike teaching. Consideration should be given to personal biases: does the nurse react negatively to patients with a history of alcohol use or who are obese? Does the nurse dislike children or the elderly? Do the religious or ethnic preferences of the nurse conflict with the patient population served? Sensitivity to diversity and cultural awareness of patients improve the professional registered nurse’s ability to provide appropriate education for the patients and families or companions. The nurse may need to work on improving knowledge and teaching skills while preventing biases from affecting the duty to provide patient education.
Learning environment and learning needs
Methods for identifying learning needs of the patient and the family or companions include asking open-ended questions, directly observing the patient and family, and hearing the verbal cues that indicate learning and knowledge. Nonverbal cues are also observed and noted. The patient’s and family’s or companion’s current knowledge level can be identified through questionnaires, telephone conversations, observation, or interview. Patient education is more effective when the content and methods are individualized for the patient and family; the nurse should determine what the patient and family or companion want and need to know and teach them accordingly.1
Types of learners
When a child is the patient, the parents often begin education at home, depending on the age of the child and the preparation needed. Therefore parent preparation is essential and requires knowledge of adult learning characteristics by the nurse. Typically the younger the child, the closer to the day of the procedure the education occurs. Parents’ and caregivers’ understanding of the child’s behavior and developmental stage should guide the nurse in choosing appropriate teaching tools and techniques. Even with preparation, separation anxiety for both child and parent occurs and may be especially difficult for the 1- to 5-year-old child. See also Chapter 49 for specific information about caring for the pediatric patient.
The older adult may have had less formal education, and comprehension may be limited. However, the learning challenges of older patients may be related to sensory deficiencies that can interfere with the ability to learn, and not educational level or intellect. Chapter 50 reviews the care of the geriatric patient and the specific challenges of this population.
Influences on learning
Physiologic, emotional, cultural, and environmental barriers can hinder the learning process for all ages and developmental levels.1 Language barriers can decrease the patient’s ability to understand instructions and limit compliance with instructions because of a lack of comprehension. Inadequate or poor teaching can also be a barrier to the learning process, and the professional registered nurse works on improving knowledge and skills of teaching and learning for the patient populations encountered. Another consideration is evaluation of the learner’s present knowledge, previous experience, prior education, perceptions, expectations, and potential misinformation. The patient’s health beliefs, attitudes, level of stress, coping skills, anxiety, and social support also influence learning.
Teaching characteristics and planning
The professional registered nurse needs to have knowledge of teaching-learning principles, to recognize that anxiety and pain impede learning, and to value reinforcement of learning. Common language, not medical terminology, should be used. Knowledge of the teaching tools available and the content to teach is essential for successful patient education.
Content of teaching plan
The teaching plan includes generic content, with general information about preoperative preparation, day of surgery activities, and postoperative issues. The environment is described, as is the usual sequence of events. Individualized content is also integrated into the teaching plan to meet needs identified by the nurse’s assessment of learning, review of the patient’s history, and information requested by the patient or family.1
Discussion related to possible alterations in comfort helps to prepare the patient for what to expect after surgery. Common concerns include pain, sore throat, nausea, and vomiting. The patient’s past experience may influence expectations. Descriptions of strategies for pain reduction, including request of pain medication and use of positioning, ice, or other techniques, may ease the patient’s concerns about pain and discomfort. Postoperative nausea and vomiting may be minimized or controlled with medications, aromatherapy, hydration, and slow movements. Additional information on pain management can be found in Chapter 31; nausea and vomiting are discussed in Chapter 29.
Teaching strategies
The nurse’s primary objectives when teaching are establishing a rapport to reduce anxiety and fear, assessing patient and family knowledge and expectations for learning, and assessing patient and family learning style to enhance the learning process. These objectives can apply to teaching before the day of surgery in a structured setting, patient education that occurs at the bedside while the patient is in the postanesthesia care unit (PACU), or teaching during preparation for discharge. The level of detail provided should be based on these assessments, with the education tailored specifically to the patient and family or companion. Teaching should be directed to the patient, but the family decision-maker or primary caregiver should also be considered as important to educational success. Ample opportunity for the patient and family to voice concerns and ask questions should be provided. If language is a barrier, interpreter services can assist in the teaching process. Short simple explanations are best, with the importance of the instructions and expected benefits of compliance with the instructions stressed. Jargon should be avoided and all terms should be clarified. Teachable moments should be used to take advantage of times when the patient and family are most likely to accept new information (e.g., symptoms are present).
Documentation
Patient education completed by the nurse is documented as a record of education provided to the patient. Forms vary by institution and may be paper or electronic. Standardized care plans include documentation of individualized education. Checklists or flow sheets may be used. Whatever the form, teaching should be documented to support the work of the nurse and record what the patient was told and the response to the educational information. This documentation protects the patient, the nurse, and the facility should concerns arise over educational content and patient preparation. Additional information on documentation can be found in Chapter 7.
