CONVOCATORIA DE PLAZAS Y AYUDAS

Preoperative education has been used in an attempt to improve patients’ experiences by providing relevant information about health care and coping skills (Kruzik, 2009, Scott, 2004). Several meta-analyses (Hathaway, 1986, Devine and Cook, 1986, Devine, 1992) and reviews (Shuldham, 1999b, Oshodi, 2007) of preoperative information provision have been conducted. All of these have shown that compared with usual care, preoperative information is generally beneficial to adult surgical patients.

Hathaway (1986) reviewed 68 experimental studies and concluded that patients having some form of preoperative instruction, particularly those receiving instruction containing psychological and mixed forms of content, helped to improve adult surgical patients’ welfare and postoperative outcomes. The meta-analysis found that the greatest effects were achieved with patients who had high levels of fear and anxiety. The meta-analysis of Devine and Cook (1986) included 102 studies and found a positive effect of psycho-educational interventions on pain, psychological well-being and satisfaction with care outcomes. Subsequently, Devine’s updated review (1992) synthesised 191 studies of any form of psycho-educational care, of which 69% used random assignment to treatment condition. This meta- analysis confirmed earlier findings but also found pre-surgical psycho-

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educational interventions produced small to medium effects on length of hospital stay, medical complications, respiratory function and resumption of activities. Devine stated that the overall efficacy of psycho-educational care provided to adult surgical patients found in this review was reliable and could not be attributed to the biases associated with the decision to publish, low internal validity, measurement subjectivity, or Hawthorne effects.

However, the latest meta-analysis above is now nearly twenty years old and surgical practices, patterns of hospitalisation and nursing as well as patients’ knowledge and expectations have changed substantially. Shuldham (1999b) reviewed more recent studies in this field and demonstrated that preoperative education for patients about what to expect before major surgery had a beneficial impact on a variety of patient outcomes. These included objective measures such as length of hospital stay as well as subjective measures such as anxiety, pain, and satisfaction. Although many questions remain unanswered about the effect of preoperative information on patients’ outcomes, none of the meta-analyses and reviews raised concerns that the information itself increased anxiety.

The effects of preoperative education may differ according to type of surgery. With reference to patients undergoing orthopedic surgery, the meta-analysis of Johansson et al. (2005) found that preoperative education can improve patients’ anxiety and knowledge. A Cochrane review undertaken by McDonald et al. (2004) concluded that there was evidence of a modest beneficial effect of preoperative education on preoperative anxiety among patients undergoing hip or knee replacement surgery. But little evidence was found to support the effect of preoperative education on postoperative outcomes, such as pain, functioning and length of hospital

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stay. These reviewers suggested that there might be beneficial effects when preoperative education was tailored according to anxiety, or targeted at those most in need of support (e.g. those who are particularly disabled, or have limited social support structures).

Some trials or quasi-experimental studies have shown that preoperative information of various types and in different forms appear to have positive effects on the ability of patients to cope with and recover physically and psychologically from their planned surgery (Wong et al., 2010). A randomised controlled trial (Pager, 2005) demonstrated that preoperative information by the use of video-tapes showing patients what to expect from cataract surgery resulted in less anxiety, and greater understanding of, and satisfaction with, their treatment. This finding was supported by Zieren et al.’s trial (2007) showing that an informative video before inguinal hernia surgical repair can lead to better quality of life postoperatively.

Another randomised controlled trial conducted by Lin and Wang in Taiwan (2005) found that a preoperative nursing intervention for pain through oral explanation had a positive effect on anxiety and pain for patients undergoing abdominal surgery. In Blay and Donoghue’s trial (2005), pre- admission education intervention with the use of verbal and written information on pain management, wound care, diet and elimination helped reduce pain following laparoscopic cholecystectomy and significantly increased patients’ knowledge of self-care and complication management.

Studies of preoperative education are characterised by poor design in terms of patient assignment, blinding of participants and researchers, follow-up procedures and statistical analyses (Shuldham, 1999a). There is

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considerable space for improvement in trial design as a basis for promoting evidence based nursing. In addition although there are a relatively large number of studies on preoperative education and some evidence to show its value on patients undergoing minor surgeries, for some major areas of health care such as heart disease, sufficient evidence does not yet exist to enable firm conclusions to be drawn (Shuldham, 1999b).

More specifically, there is a lack of information on the needs of patients who are undergoing cardiac surgery. It has been observed that cardiac surgery can cause more anxiety and can create negative physiological, psychological, and social health changes in patients as compared to other minor surgeries (Fitzsimons et al., 2003, Screeche-Powell and Owen, 2003). This group may therefore be in greater need of information to support their understanding about their health and preoperative preparation. Evidence of the effectiveness of preoperative education interventions for patients undergoing general surgery may not be transferable to those who are undergoing cardiac surgery.