..->
-
""'·h
,..,.-·~~•""-"'"••-·~~~~~-~--~
--••·"-•-
""
>' -'-~•-•"
- - - . • ~-.
-·~•·-
"0••>'·-.-~~ •-•~,- ~~~-~~-c -~-~""·••--n---•·--"-··-~·~•---~~-~~·-~~'--0~~~--.u--~ ---~-~--
.l
_.,_......,..___,,_.,._,_1
l
i
CALIFORNIA S'I'ATE UNIVERSI'l'Y 1 NOR'I'HRIDGE
EVALUATION OF A PATIENT-TEZ\.CHII:.JG GUIDE
,.
A thesis submi·tted in partial sa·tisfaction of i:he
re=J:uiremer..ts for the degree of I<laster of Public Real th
by
Priscilla Anne Jew
~
Janua:r:r r 19 75
The thesis of PJ::-iscilla Anne ,Jew is approved:
Cmmnittec Chairman
CaJ.:Lforn1.a Stat:e University, Northridge
Decerrber r
...
"
............
J.9 7 4
r-------
----------------~~-------------------~-------------"'·--1
I
.
I
!
.ACKNOWLEDGMENTS
I
I
I
The writer would like to sincerely ·thank
·nr .. Len Glass for his assistance and sustained encourat;ement throughout
th~
prepara"cion of this thesis.
•ro Dr. Krishnamurty, I wish to extend Iny appreciat:.ion
for his guidance in the st.at.istical analysis phase of
·this study.
In addition, I am grateful to Lucile Wood for her ,
ass2.sta1"'J.ce and su(j'gestions in the initial planning stages
of
~:his
study.
I
would also like to e:xpr.s2s my gratituO.e
i..:o Amy f~herrard for her willing help in coordinating this
I
study at the S:Lm.i VaJ..l::::y Adventist. IIospi tal.
I
1
!.
Finally, to Paul, a Si.Jecial thank-you for keeping
my spirits up during the writing of this thesis.
i
L~-~-·-, -~-- --···- -····- . ---~·----- ---- ·-<~ -~~~-~--.·~·-~~-·-·-·--·---~--- --··--·-·-·~·"
. .
'
.l.J
-~
.• - ·- --
------.
--~-- ·-·· -~~- ·-·· ·-· -~-
-
---··-- -· -
~-- ~-·-
r-·-------·--·-----·--"-·"'"-----------------~--------·--·-
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.
_________ _, ___
.c_ _ _ _ _ _ _ _ _ _ _ - - - - · - - - ·---------·--~
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TABLE OF CONTENTS
i
Page
ACKNOWLEDGMENTS
iii
•
vi
LIST OF Tl.BLES
I
vii
ABSTRACT
i
Chapter
1.
2.
1.
IN'l'RODUCTION •
Statement of the Problem
3
Limitations of t:he Study
4
Assumptions of the Study
4
Definition o·E Terms
5
,-
REVIEW OF THE LI'I'ERArf'ORE
0
Improving Conrrnu.nicaticns .
8
ReclL'.cing 1'-unde+:.y •
11
Motivat:L:1.g the Po.t:ient .
13
Preopc.cative :Preparation •
17
Su:m.m2.ry
23
25
Sa.'llple and Se·ttin•J
25
UCLA Iiospital
26
27
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UCLA Control. Group •
28
Si.IJi. Valle}-' .Adventist Hospital
28
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~-~· -·---~..- .. --~ ·--·-·' ....
Approval for Resea-;:·cJ:.,
.30
.
iv
~·-~
~--·--
--·
i
-- ...J'
,--·---------~------···---------·-··-····--------·-·-~·--·----·---·-·~·-·--·--.----------~'·---------
1
f"'h
._.
Page
lI
Patient-'I'eaching Guide •
31
·
Questionnaire
32
Data Collection
34
Statistical Treatment of the Data
36
•
apter
1
1
I
i
l
4.
P~SULTS
AND DISCUSSION
37
•
Individual Test Results
39
Comparison of Pretest to Posttest
41
Comparison of Pretest Scores .
41
Comparison of Posttest Scores
Discussion
50
SU!Y'.J.:lARY,
•
..
•
CONCLUSIONS AND RECOivl!.V!ENDATIONS
Recommendations
50
.
52
"
*
56
•
Sampl,:; of the Questionnaire Used
56
at the UCLA Hospital .
B.
Sac-r,ple of the Questio:nnaire Used a·it.he S.i:mi Valley Adventist Hoepi tal
C.
Pat.:i.e~lt-
'l,eo.ching Guide:
P1:eope:n~:ti ve
PaiL II on
and
Pl.·cparat~icn
Postoperative C&re • •
E.
48
50
1\..P:i?ENDICES
D.
42
Conclusions
BIBLIOGR7\.PHY .
A.
0
Cornpar~son of Responses to Pre-· and PostQuestio:'1.naire IterPs by Individual Experi~
~-1ental Group Pat.i,c~:nts at. UCI,A
67
107
Comparison of RespmJ.ses to J?:r:e·- and Pos·tQu.estion!laix·e lt:erns .t•y InCli ~1·iC.ual
Experimer:tal Grcnp .l?dtient.::; at
Simi Valley
. 109
v
LIST OF TABLES
Page
1.
Cont.ent AJla.lysis of t.he Pre <:ti'ld
Information
Questionnaire . • • • • • • • •
33
Individual Patient. Scores on the Pretest and Posttes·t . . . . . . . . . .
38
Comparison of Mean Scores of the UCLA
Control and Experimental Group on the
Pret8st and Posttest
• . • . " •
42
~ostoperative
2.
3.
4.
. l
!
Comparison of Mean Scores of the Simi
Valley Adventist Hospital Control and
Experimental Group on the Pret.est and
Posttest
. . . .
.....
I
I'
I!
.I
5.
6.
Comparison of RespoEse.s t.o Pre- and
Post-Questionnaire Items by Individual
Experimental Group Patients at UCLA
Comparison of Responses to Pre- and
Post-Ques·tionnai1:"c Items bv Individual
Experimental Group Patients Rt Sirni
~lal.ley
.. . .
~
. .
tJ
•
f)
o!t
..
..
•
44
108
•
110
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)
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L. ----........... ··-" .............. ~ ····--- -··-· . -------------~-- ·-'-.. ·------ ........... - ..-. ·--.. --...,----..·----·.. ··---. ---- ... ___ ,_,____ ,. ___ ..,_. _ _I
vi
r··----.--~----·-·
,___
.
--~--------- ·--~-~-------·---
. ·-----------------
---------~---------~--~--~-------------,
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ABSTR'\CT
I
•
.
EVALUATION OP A PA.TIEN'r-TEACHING GUIDE
I
by
~
Priscilla Anne ,Jew
Haster of Public Hca.l i:h
January, 1975
I
I
The purpose o£ this study was to evaluate
selected sec·tions of a prograrnrned patient-·teaching guide
I
i in adding to the patient's knmvledge abou·t preoperative
i
Ii
I
I
preparation and postoperat.i ve care.
of tJ.1.e patien·t-teaching
~p1ide
1\.l though the author:s
(:',esigned iJc for a learner
population of cholecystectomy p<:-!tients .• the i:1.formation
contained in the f:ecti.ons tested was also applicable to
patieats havir:.g ge.ne:r:al abdominal surgery.
The study Srlmph: cor:sis1:ed of 17 pdtients
scheduled for cholecy'3t.ect.omy at the Uni "'Jersit:y of
scheduled fox genero.l abdnminal surgery at the Simi
Val!.ey Adventi:3t Hospii:c:l ..
The
was used.
pret~est.-·posttest.
control •group study desit;rn
.A Questionnaire '"ras de2igned as the instrument
to measure the amount cf
I<~no,,;ledge
vi 1.
the pa.l.:ients hc.d
------------ ..---------------------------------- __;_l
r--------------~-----~-----------------~--------------_
II separately
1
and no statistical comparisons r.vere made
-
bebveen the two hospital samples.
I ficant
·i
I
.
There were no s.igni-
I
I
l
j
differences revealed between the mean pretest
i
I
!j scores o f
'h e
t:
Ii
.
., groups at elb
. h er
con t ro 1 an d exper1men·ta.1.
UCLA or Simi Valley.
Significa.c'1t differences were shov-m
1
I
to exist at the . 05 level bet\veen the n1:2an pest test. scores:
l
I
!
I
It \vas concluded that the patients vvho read the
I' patient-teaching
i
I
1
of the control and expei·imental groupr; a·t both hospitals.
guide had more knmv-ledge about. pre-
operative preparation and postoperat:ive care tha...'1 the
!
I patients who did not read the teaching guide.
i
i
l
i
It was
further concluded that the programmed patient-··teaching
guide
II about
~ms
an effective method of teachi.n-g· the pa·tients
preoperative preparation an<J.. pcst.operati ve care.
I
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----·- ·----·- -'-----------------·.1
-.:rl
-.: i
v--1.,-.
INTRODUCTION
In this era of rapid advancements in medical
technology and treat..ment of disease, hospitals have
gained prominence for providing expanded services for
more people and for saving more lives.
has increased.
Technological
In a similar fashion there has been in-
creasing interest in research in the area of patient
care.
In recent years more atten·ti.on has been qiven to
efforts to broadening the scope of patient care.
The
·I
i
trend has been to make hospi·::a.J. care mo:re personal a:1d
individualized, particularly in large hospitals.
An L:nportant phase of this t:re:nd t.ov.·ards more
individ'..lalized ca:::e involves ti1e concept o£ ·to·ta.l patient
care.
Hospitals have attempted to extend patient care
beyond treatmer:t o.f the diseas,:;: entity
men·t of the t:ot.al person.
~.tsc1f
to t.re2:.t-
Every ir1divi<:lual perceives
illness and hospitali-zation in his oy,m It-ley.
Once
hospitalized it. is :not 1mlH::.ely that the patient becomes
overwhelme-:1 by new P.Xpe:r:i_ences c-md everything seems unfam.iliar.
he enters
The kinds of experienoes he h::1s from the time
t~he
lwspi tal until he .Leaves rr.ay resu1 t
in the
developro.ent of a positive fT5<£rte cf :reference \vh:J..::::h ';'rould
1
2
~- ··~-~--~··~~··~·-·-~- ----,~-~--~------~-~--~--~~---·--........_-·---....·-~·--··~~-~~~·~--""··-·~- -1
., t:o posit.iv·e a·t·ti tudes, moti vaticns ~ and!
behavior nece.s:
One
for his succc.;!ssful treatment.
nec~~sary
patient education.
(30:83)
ingredient of total patient care is
(43:7)
An incJ:·easing number of heal ~:h
professionals and educators have indicated a strong
concern tha·t today' s patients should have a be tte:r U!lder"standing of illn-=ss and hospi talizat:.ion than t.:hey have had
in the past.
(15:502)
As one segment of patient edu-
cation, preoperative teaching has been a much emphasized
area of nursing responsibility.
(2:1917)
Frequ.ently, due
to the shortage of qualified staff, patient education has
fallen last on the list of nursing priorities.
of rea2ons have been given for fa.ilure to give adec:uate
preoperative
teac~ing.
T'~.•;c
reasons
9'i ven
most oftsn l;y
nurses at a university hospital were lack of time .::tnd.
heavy vvork load.
Co:1sequen·tly, interest has
D88n
gene-
I rated in developing patir;;nt teaching aids, \vhich could be
I uGed by
'
individual patients vdt.hout const.ard:: supe1:vision.
One such teaching aid was evaluated in thia
3tudy.
It
wri_tten .by
\'J2.S
a. };"'):"Og:::-ar.uned
1\~ood ..
R·uccionef
pat.:Lent-teachin~r
DvTorsky anc1.
()cle11~
packet
Tlte
au.tho:::-s stated that t.he !JUrpose cf t.he booklet v1as to:
. lessen the apprehension and fears frequently
demo!1Strated by· -the pn:t:ient facj_nsr t£1.e llnkno,t711 i
to increase acceptance cf the procedures, equipman t! and routines Ly· the patient; 't:') add i:o t.he
pa·tient' s general heaJ. th knm,rled·~re t and to :Lmpro~Je
commu1J.ication beb.;een patient and nurse.
(42: 1)
I
3
r---:·. -
I
-~- ---·-~·-·
··:-
------·~·--·-----~-----~~------·-----
·--.---..·-··-____. . . . . . . .
"··--------------~
--·--·---.. . . . . __. ----------1
cnolecyscectom.y (surglcal removal of the g-allnladder) . ·
j It consisted of easily readable material wit.h pa·tientI
centered illustrations {see Appendix C) • The informa·tion
I
:_·
!
contained in t.he booklet star-b:C: with the diagnosis that
I
I is
made in the doctor's office and ended with the
! hospital discharge plan.
Il Statement
of the__Pro:Ole~
I
I
!
It is questionable as t:o how much helpful
information has actually been given to a patient in the
preoperative period.
Interviews v7ith. nursing personnel
and surgical patien·ts at a university teaching hospital
verified this observation.
1
PhysiciansJ1 nurses and other
:members of the hospital team hc..ve com..,..nented on the need
.I
1I
I
f.or some :rorm
~
Ii
I
!
OI~-
.
-
organ~zea
' . vc -ceac:nng.
.
, ,
preope:r.:·a-~J.
,.. 3 -·r;~
The purpose of t.his study -;,vas to evaluate a.
pat.ient-t.ea:.::hing guide w:d.tten by Wood ,;;t al. for
cholecystectomy patien·ts.
'l'he specific aim of ·this study
was to eval·cate: the e£Zect.i veness of selected sect.io:ns of
the booklet in adding to r.:he patie.:1t 's knowledge about
preoperative preparation <:md post:opGrative care.
The
following hypothesis was te!:.;ted:
The pa·tients reading the teachj:ng guide (experi-
mental group) wil1 sco:r.e the same on the posttest. ;.iliout
preoperative preparation and postoperative care as t.he
patien·t.s not reading the teaching· guide {con:!:rr)l group)
I
I
~--,._~,--· o>c•·-·~ • · • - - ••• ~·~•·
•• • -
--··-~···•- - - - • ·-·--·~•••
I
I
4
r-------------------..---·-···-·-·-------..
T •
. .
t.
~Jl.mJ. -ca J_ons
~
O.L
'
surgery at t-Jle
-------··-------·--·
-·----~---;--.
Il
I
This study was limited to
! pa·tients admitted for gallbladder
tl·!"le
H
·;:)c....L-11'-'-Y
Un~iversity
I
1
.
a 32lected population of
Ii
or: similar abdominal
;.
I
of California Center for the
Health Sciences at Los illlgeles and at the Simi Valley
Adventist Hospital.
The sc...t-nple size \\Tas limited to the
nurober of patients admitted for the specific surgery
between the dates o£ May 22, 1972 and Harch 1, 1973.
The
sample size was further limited to:
1.
Patients who consented to take part in the
s·tudy and 1..Vho completed the pretest and posttest as
2.
Patients who were able to read and write
i English.
.i
l
I
A.ssumptions of the S tt1_~y
For the purpose of this study 1 it was assumed
that:
1.
Th'2 expe:rimental group of patients read the
teachilVJ booklet as direct.ed.
2.
J.'ht~
mc.terial in the t:.eaching booklet was
•...;ritt.en in such a. raanner that the patients underst.ood
what was
writte~J..
3.
•rhe P·.:J.ticmt.3 understood t.he items on the
questionnaire.
4.
':'he patients answe.:red the que.st.ionnaire
cox:scic= n.~!:rtiOllS ly w.i. thout assis·tance from the nursing
___. ··--·-·---... - ____..............._........... --.. -..-----.--·•··-·- _.............- .......... -.. .-.. ---------...-.. ..--.. :. .. -.. . -'.-..,____ i
5
T~tal
patient care.
The concept. of treating the
I
I·i
I
needs.
Treatment.
I for
i
Refers to anything done to a person
purposes of diagnosis, cure, preven·tion of disease
I and/or
the relief of symptoms.
I
!
Patient education.
I
Providing experiences and
I
I information that
l lli'lderstanding of
II
will enable the patif-..mt to have a better
hospital routine, treatments, diagnosis 1
medicines and
Surgical excisi.on. of the gall·bladder.
.A gene~al routine used.
in the t.ospi tal to prepare
Postopera.ti_ye
c<:~.E~·,
.:i
patient for surgery.
A generaL routine of pro-·
cedures used in t:he care of the patient following
surge:ry.
,~---·
,.______"'__.,___,__ -·---..
-------~-
-------------
--------·---------,----------~~---
.....
--~--
···------------ __ , ____ .__,. _____ -_____ , __1
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Chapter 2
i
I
i
REVIEW OF THE LITERATURE
'
!
I
The need for patient educa-tion in thE: hospital
!
I
1
has been discussed in many journal articles.
I
factors have emerged
II
~.vhich
A number of
focus on the role of tl1e
I
in providing patient education.
I hospital
One factor L:;;
I
I
the shift in e:.:nphasis of care £rom acute illnesses t:o
1
II long-term
illnesses and diso.bili ties.
(20)
Formerly,
I the procedural aspects of care Here emphasized rather thani
I
I
I
!
the education of the patients.
i1ow~:~Vt:!r,
concept ·today,
(20: 7)
is cme of enabling the patient to help hims\?.lf
by gi 'lir.g him an understanding of his illness cilld
men t .
( 30 : S 3)
t~:eat.-
According t:o Mi:::o, health education in. the
hospital helps the patient to accept increasing
responsibility for his mvn care.
(30)
Previously the
usually satisfiE:d by his ungueE;tioning fc:.ith in his
elector .
( 3 : 7 6)
Durin·:; the
past~
£ew decades r bmvever 1
the gener:-a.l 1.:::-:!VeJ. of ::r,edical knowledge haro> increased and
through all ch.aron.;;;ls of r::omrrmnication !;he patient has
...... ·11,.;...L,
.,
( .;,~~
3:76)
becomr:: more sophisticat.ed.
A theme vlhich sevaral authors s·tressed was that
patie.n t. ecbc2t.ior: programs should be planned vJi·th certain
1
tJ~nero11s
goals and
\.o--••••-·---•••"-••·· •• '"'"" ·- • •- ""-• • •
. . . . . . . . . . . . . . . . ----
· • • ... "'···-· .... -
6
a:L~ticles- :ct:.t~·ort
. . . . . . . . . . . . .c .......-
·tf1at.
.... --··--------···-·· ......... - - .. - · . . ._ ........... _________
J
: ....
7
r-... -...----·--- .................. -------------------..----------..·-·---··----..
~-
.. ----.. ·--··---·-·----·--·-------·----·----------..···----------·-··
j hospi ta:Ls hav(~ a planned pa·t:ient education prD~-ram.
II
1
(35, 37, 26, 22)
l
In February, 1972 1 institutional
I
l
1
members of the National Hospital Panel Survey were asked
i
j to respond to a special questionnaire concerning patient
~ 'I educatJ'.on. p_rogr~mc.:.
1'. 4)
1
0 n~y
.r.:
• -•
~1tteen
percent o f t .he
institutions or hospitals responded that ·they had such a
program.
The survey defined
1.
plann.Bd patient education
program as:
• 'A program with goals and objectives conceTning
educational experiences planned for the patient by
professional perscr:.nel as a component of his care
and differentiates those experiences from 1.mpla:nned
learning experiences in the-hospital. (4:1025
Haferkorn recorrJnended that a planned
prograrr~
should include assessl'!:en·t of the patient's level. of
·I
iI
percepti01:. as a basis for determining his readiness to
l learn.
(17)
She noted t ..."J.at. data obtained from the
i patient car:. provide meaningful i.nformati..on about his
adaptation to his illnese and its treat...-rnent.
Like~Jise,
Hausch maintained that the first o£ sev·eral areas of
challenge t.he hospital must. face to provide effec·ti'\Te
llec..lt!1 teacl"dng is t:he
pat.:ient:. 1 ~:3
limited
e.ct.iviU. . es that are related to health.
knows and Rssumes becomes the baseline.
perspectj_~,le
(28:2.{)
of
W..J.at he
:R-sparre: agreed
that an orgcmized patient education program is one t..ha.t
includes a systematic effort to assess the patient's
knm-1ledge about his illness and its t.reatment
car~
be
de le:terio•J.S i:o recovery since the pa·t.ient. ma.y unknov:ingly
.-------·--·-·------------·--·
-··-----~·-·--------· --'-·-----~"-·----~·-,
l do himself harm.
l1 patient
(17:199)
For example,
t~e diabetic
.
i
l
.
i
I
I
is poorly equipped to handle his disease if he
l
II
II
lacks knmvledge of the fundamental principles of t11e
disease or how to properly manage it.
Reader and Schwartz believed that ideally each
patient: should have his knowledge of heal-th assessed as a
h.is~tory r
part of his rhed.ical
I
so that an education plan
l
i
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I
1
I
i
ll
not only his present illness bu·t also job hazards,
deleterious habits, and proper diet and exercise.
I
I
could be tailored to fit his particular needs, covering
I According to ·these
IIi
....
( .,..;J:;J.
1~~)'
l..l.
!
I
authors the inforrnation obtained from
an assessment plan can be valuable in providing cri-teria.
for planning object:ives in patient teaching.
i
·I
l
Improving Cmmm.mic:at:ions
Research has indicated that patient teaching is an.
effective means of improving the quality of cornmunications.
(3, 39r 10)
Patients often complain about t.he
lack of information t.hey receive from
~?hysicians
and
nurses regarding their conditions, their care, and their
treatment.
appreciates
(14:87)
kr~.m'lling
Copp has w.ri tten that the patient
what. tests or treatrnent.s are planned
for him, ho\'7 long they wiLL take, and in whai.: v.Te.ys he can
cooperate to ensure best results.
(10)
She says the
patient: often learns about these test.s in unfortunat.e
'va.ys and d8sc:r:ibes an insta.nce when a
pat~_ent
was asked
9
,·---·---··--..-·-·---···--·
! replied,
!I
·-·----·---~·---- --~
..
-.. -·--- .......---··-··--"'''""''----··-··..···-·----..
·
-~
...---·-- ...-·--·----· ___.,
·-~
"Well they carne in at 2 A.M. and ·took my
:
drinking \va ter away--so I knew then that somet.hing was
I going to happen to me!"
I
I
I1 to
have more things explained rather than be left
I dangling
in uncertainty.
(3)
A study focusing on what
I the patient wanted to knoW and not what he
l
· was
'
·,~;
cor.du~ted
(3, 27)
should know
at Beverly (Massachusetts) Hospital.
The study was promp·ted by a recogni·tion over a
long period of time that patients were increasingly un-
' happy because they were uninformed.
Over an eight mont.h
period patients were interviewed at the time of discharge
from the hospital to ascertain ·t.he ques·tions they had at
the time of admission and those still un.anslivered at t.he
time of discharge.
Data \.Yere obt:ained from 450 pat.ierit:.s,
consisting of 130 medical patients 1 250 surgical patients,
52 obstetrical patients, and 18 specialty patien·ts.
The
study revealed that the patients disliked the casual
responses and evasions of t:heir questions by doctors,
nurs~~.:.
i
intex:ns, ;;:;.nd
1. ·
,
to them and v1hy.
II analysis
I had
1
what vms done·
about half of the patients
disch.:-u:-~re
that were un-
(questions were more nurr.erous from surgical
patients} i 65 percent said they 'li/ere given no specific
I instructions
I
~'.:now
Some o£ the major findings aft.er
one or more questions at
!• ans·:r7ered
!
They \.Yanted ·to
of the daJca vlere:
.
about t.heir care after discha:t:ge; 64 pr2rcent~
~~-..,...•-~~· ~-~~~-~~--~~··• ---·--··-~·•·-·- ··--~ ·-~-~•
.
·- ~~--. .... ~-~--••-• -•·--•- ~
·-•·~~~·-~··-•<-
i
I
I
(10: 481)
Jl_lt also stated that the hospital patient wants
1
I
"•-· ·- , _ _ ,, •"•-• ··~ -. ·•»•---v•----•»~
~~·-~··•·--"•~••
;
·
I·
II
i
10
'
i~ ---~---------~-----·--- ··--·--·-···----····~--------·------·
I said
I
I
time of discharge.
I.
!
Some responded saying they did
ask or hm..r to ask.
n
Others responded
he vdll tell me before I leave."
can you get hold of them to ask?"
I quickly.
"They come and go so
It seems to be evident from this study
{3:77)
that patient.s wished to improve the quality of communi-
' cations
1
I
51 percent of the patients inb;r\tievmd had no questions
II not know what to
I TJlith: "I assume
I·
i
1
It was interesting to note in t.his study that
I· at the
·',~1
.
they ..:.vere given no time for instruCtion.
II
i
··----·-·--·-· ...~-----~-·- ..------·-----~---..'--..~
::t:n::~: :::::r:o::c:::s::·a large private
urban hospital, Skipper stud.:i.ed communication between
I
i
i patients o'md physicians and pat:i.en·ts and nurses. ( 39)
I seroist.ruci.:ured
,.;as used ·to
allo'~!i
patients to express fully the range of
The sample consis·t.ed of 86 men Ztnd
women 1 betr,v-een ages 40-GO, and with previous hospital
'l"\vo maj'")r disease
categorie~~
car('J.i.o'\lo.scular- and gastrointestinal.
cor~ducted
were included:
Interviews r,Jere
on the iifth da:z;· of hospitalization.
discovered that
s•i ving
1 L '<vas
a "poor e:xplanatic.n" was ·the most
cri tic.:Lzed <7u::pec:t of medic;"ll care.
Patien.·ts desi:red more
infcrmat:ion fror0 bot.h doctors and nurses about the nature
and extent: of ttteir illness, technical medical procedures 1 and the general organization of the hospital.·
·~vhe:n
!
!
and pat.ient-orient.ed intervievl technique
t."leir experiences.
experience.
i
·thi";; info:;::-:mation was received it t:eDded to allevia i:e
1 ..
-.J.
~~----·-------------·----------------------·-------------------~·------··--·--------------------·-----
1
1 patients'
I
1
1
1
ll
fear and anxiety about their illness and what
I
'li'las going to happen to them, and helped them to define
Ij and
I
..-
L
I
adapt to the expectations of hospital personnel.
•
/
I
•
!
Reduc1ng A..YJ.xlety
l
1
!
According to Storlie patients are disturbed by
., unfamiliar objects, procedures, or persons which they
I
do not understand.
( 40)
'rheir disco::nfort ranges from
I mild anxiety to near hys-teria.
l to
She says it mal:;:es sense
1
use teaching as a means of lessening such fears.
I
noted by Skipper in the above study, when patients re-
I
ceived information about their illness and medical pro-
I
As
I
i ceduresf it tended to alleviate their fear and anxiety
l
about their illness and what was going ·to happen to ·them.
I
(39)
Skipper hypothesized that "the great:er the patient 1 s,
I
!
fear and anxiety about the nature and extent of his ill-
ness, the
gn~atex:
the probability ·that th:l.s fear and
anxiet.y will not be reduced when such information is not
He said a degree of fear
I
-and anxiety over cr1e' s illness is qui·te nor:mal, however
I
cornr.nmicatE:!d to him." { 39; 79)
1
I
t.:.:.'le situat.ion cannot be relieved by ignoring· the patient; s!
interest and desire for information.
Evidence from the
study indicated ·that it: is more likely that. not in-·
forming the patient may have the effect of accentuating
_his fear
ar~d
anxiety.
Janis carried out an ext:ensive investigation of
!
psycho.logical st:x:ess- in surgical pat.ient.s.
(19)
He
:
t_,, ... _,,_ ____ .--------------------------- ... ,....,........ ··---- -- ..... . :-----........ - ··----------.. :----.. --............... _______ --- ·---- ... ------- ------...._, __1
12
r
·----~-----------------·-
I s:tudied
·---·-···-·----..
----···--··-~--------·-----------~------------·-~---------·--··--~~------~-----·-......;.,
a large number: of surgical patients through
!
/ interviews, case study observations, and survey
I
l questionnaires.
1
:
The survey results showed that the
I
occurrence of acute emotional disturbances during exposurej
i
to stressful circumstances depends partly upon ¥<'hether or l
not the person was exposed to preparatory information
It appeared that those who vrere told practi-
beforehand.
cally nothing about the unpleasant aspects of the operation beforehand
~1ere
more inclined than others to
display in te.nse ange:c reactions on the day of the
operation, to develop unfavorabls at·titudes toward the
surgeon and to experience sustained emotional
disturbances.
( 19: 35 8)
From case study observations,
Janis proposed that weird and unfamiliar medical pheno-
mena sorne·timeE' evoke acute fright react:ions, whj <::h might.
be much h:ss severe i£ the patient. were given sufficient
inforl7tatio:n to enable him to work through the dis·tressing
occurrences
bE"~ fore
they materialize.
He belie,res the
patient could at. least be· told in advancE c.J:.,out all those
pains, discou.l:u::..·"Cs, dnd ur1pleasant treatments which invariably do occ1.:o:·.
Egbert,. Eat tit, Turndorf, and Beecher compared
the ;;alue of t.he preoperative visit by an anesthetist to
the effect of pent:obarbital sodium (nembul.:al)
e.nesi:hetic medication.
( 16)
for pre-
The psychologic condition
I
I
i
of <149 patients •.vas evaluated.
L. ·---· - - . . . . ..·- .----- ·---------·---- -
--~~--
-~~~---••• a~~,-~-
~--
Two hund:<:ed e:Lgh·teen
--
~---·-
____
,,....._.,._...._.A~-~~~
•-
~---·------·--·~-~,~~~.
j
13
;-·---·---··---·----·-·----------~------~··-·---·-----·----·---·---~---·-
!
patient.s received pentobarbital sodium and 231 patients
l
received a preoperative visit from the anesthetis·t.
!i
I
II,
I
I,:
Data j
I
collected showed statistically significant differences
:::::::r:::a:f::::~~ t::t:::::e::::::i::s::n:::a:::tal
one hour before an operation became drowsy, bu·t it could
, not be sh.ovm that they became
1
1
!I
calm~
Patients who re-
ceived a preoperative visit by an anesthetis-t vJho in-
! formed them about the events which v.rere to occur on the
day of t.he opera'cion and about t.he anesthetic ·to be
administered were not drowsy, bu·t were more
likel~'
to be
calm.
Ent:t~ring
the hospital, whether for medical or
surgical. reasonsr can be an anxiety-producing situation
for almost anyone, but ·the shock can be lessened by preparing t:he patients for it.
(35, 29)
Header and Sch.war·tz
i
suggested that prehospitalization instruction could help
I
many patients better prepare for the experience of
I
hospitalization.
(35)
JY!c·ti vatinq the Patient
II
I
A.Yl impor·t.ant goal o.f patient. education is helping :
!
to motivate tbe patient to be an active participant in
his treatment and assis'c
~1im
to achieve independence in
hie health care, once he has been
hospital.
from the
I·t has been shovm that one of the most
t~reatment
caJ.lses o£ ine.:::fecti ve
'"
discha:r~g-ed
is the
i
·-·--- -·-·· ..--······· --~· .............__ . -···--··· ·-··-----··---···-··-·- ,.. ... ----~·----~·-·--- -----·--- --· ·-·--·----~ -'-·- ______...]
,.
r-·----------------·---------~--------~--------------------·-··----------·--------·------------·-
--
l' patients' noncompliance with regimens ..prescribed
I
I
. j
physician.::
'
'· ~ •
(22 ·• 9 I
77)
·-------------~------l
by
their
.
I
Often this is because of .in~
!!
I
i adequate knowledge and understanding of their illness and
j
treatment.
Researchers in the field of health education
have given increasing attention to testing the effectiveness of various teachi.ng approaches designed to gi-ve the
pa.tient ·the inforrr.ation and understandinc.; he needs to
assi.lme an active role in his care.
Cross and Parsons used t.he personal approach of
patient teaching to motivate change in food selection
behavior of hospitalized patients.
I
1
!
(11)
They compared
the effects of teaching and goal-directed teaching
l (defined as setting of specific performance goals in
I!
I
. !
I
i
l
ths
teaching situation) . Fcrty·-fiv~: orthopedic patients were
I assigned
received diet
to one of three groaps,
teachiag; the second received diet
te;;~.chinq
and t;oa.l
direction; the third received neither teaching nor goal
dirr:.:ct:ion.
The experimental groups were ta·ught by an
assigned research nurss according to the standardized
teaching- plan fo1.· each ·stroup.
Tr.·.ro"~way
communication ;;-vas
used wi tl1 both experimental groups ·to involve the lca:rner
and to personalize the info::cmation t.aught.
All patients
v-.rho received diet teaching by the nm.:se showed a signi-
ficant change toward a more consistent selection of foods
(high ir1 Vitamin .C and protein content) necessary for
rapid bone healing.
The results did not support the
II
'
j
15
..
r-~-,......._----·-------~·....-.------·-~--~-~-~--
1
I
I
----,---·~~--·.,.--,,~-~---------------~---~~.__..__,
hypothesis that setting performance goals within the
I
teachinq situation would enhance the effec·ts of the
I
.
I
I
I
! teaching,
!
resulting in a greater behavior change.
!'
I
.
I
Teaching the diabetic pa·tient is the area of
I patient
education in which there has been the most
experiment.ation.
The Nedical Foundation Incorporated of
Boston, conducted a pilot. test. of progr2.mmed instruction
as a means of teaching diabetics.,
study
~vas
(21 f
The field
38, 43)
conducted for the Diabetes and Arthritis
Program, Division of Chronic Diseases.
Skiff emphasized
t.hat the. purpose of the s·t.udy was ·to determine whether
progra.'11TI1ed instruction was a "useful mean.s by
~111hich
diabetic patients can learn about their disease,"
arid to test the adaptability of the teaching
I
r
1I'· machine as a teaching tool in the hea.l t.h field.
sa.mple of 184 diabetic patients, including those newly
diagnosed as ·.vell as long ·term diabetics were in vi ted to
I take part uhat
in the study.
I
'
test
All were given a pretest to
t...hey already knevJ about diabet.es; a pos·t-
(s,;;.::ne ae thE pre\.:.est} on co:npletL·.;; t:.he course;
Il attitude
an
in·ter:;rie¥7; an IQ indL·::&t.or; a readin<; test; and
a biograpb.ical interview.
106 pab.ents.
Ti:~.e
The progr·am was completed by
results shoH.sd that. 77 percent of
those vJho completed the program acqu,ired ne;.v information
about d.:i.abetes and self-care.
F-.bout 75 pe.r·cent of these
who di.d not show new learning v..rere from a clinic vd th an
16
~--------··
I
1
--·---·---l
intensive patient t.eaching program and had signifi-
I can
I
.~-------··-------······----···'"··-··-·····---·~.---·---··-·
t1 y higher pre teet score •
Ninety-five percent of the
1
1
participants expressed pos:Ltive.feelings about the
i
I teaching machine and would recommend it to other
I1
I!
'
Skiff concluded that the teaching machine
patients.
should not be expect.ed to take the place of full indi1.ridual teaching or satj_sfy
thE:~
need for personal support.!
i
Rather, it should be used as a part of a total planned
Il program of patient education.
In a more recent study of progi·ammed instruc·tion,
Clark and Bayley developed programined instruction booklets to be used as a teaching tool by patients vrho vlere
to be discharged from the hospi t.al on long-term anticoagulant (Warfarin) therapy.
{9)
Forty-five voluntary
participants discharged on Warfarin t.herapy co::r.prised
·the sample.
groups.
lets.
The subjects vvere ·assigned to one of three
Group I received programmed instruction book·-
Group II received a two-page handout
taining the same factual content
prog·ra.'11111ed booklets.
contaim~d
s~eet
con~
in ·t..'he
Group III recei V•3C. no specific
printed or verbal ins·truct:.ions from t:hs investigators
(control).
Experimental group pa,t.ients who completed
the fifty-frame progra. :auned inst.::::-uction booklet en
Warfarin scored significantly higher on an objective
·test of their understanding of Warfarin therapy than
con t.:Y:ol gToup pat:i.enb.J l:Jho n;cei ved no structured
I
!
17
. -------..----..·----·----..----..·-.-·-'-------------------·-·--·1
investigators. The experimental group l
r~------·--------·-·----·----------
j teaching from t:he
1
1 also scored significantly higher than patients who read a
I
two·-page handout
1
I
inL~:::mation
sheet..
Fourteen cf the
i
!
Ij
I
I
fifteen experimental .subjects said they lllould recorrrrr..end
I
Il the prograr1m1ed instruction bookle-t to others on antiI1
I coagulant therapy. The results indica.tecl that programmed I
I
I.
I instru~tion
is an effec·tive methcc1 for b~aching patients
i
i about the action, indications and effects of Warfarin
I
I anti-coagulant ·therapy.
Ij Preoperative Preparation
Janis has shown that poorly prepared surgical
)
/. patients exhibited a greater degree of stress before a.'1d
I after
surgery than those who had a clearer Uilderstanding
·I of what to expect. {19} The ];lostoperative course a.nd
!
i rehabilitative progress of ·the surgical patient is often
!
I
I
direct.ly related to t.:he t.ype and aruo·t.:mt of preoperative
j preparation.
l:
1
!
i
(23:26)
Most of the nurses on a general and thoracic
surgery un1.•t at. a p:romineni: university hospital felt.
there was a need for better preoperative preparat.ion of
the surgical
patient~s.
(32)
They commented that nc·t all
presurgical pat:.il=::nts were receiving 'Nhat t.hey considered
to be pertinent
in.f,')rm.:~.t.ion
t::l.be>ut preoperative pr:e-
para:tion and postopera.t..ive care, and, that. some patients
did no·t receive any information.
they received bit.s of
i.n.forrr~at.ion
Patients
remar::.~ed
that
from tl:e doctors and
18
r----·-···-~-~----··--·-··---
"·---- ---··'---·----·--·-----·"-·
·---··-"------·~·····--··-·----·---"",..;.
_____,
1 nurses caring for t.;hem, and from fellow patients, but
i
I
!
I
--
I
I
i they could not recall receiving any organized form of
I1
teaching.
1
formation to open-heart. surgery patient:s.
Most emphasis was placed on providing inThe clinical
specialist (usually assigned the responsibility of
patient teaching) estimated that only one-third of the
pre-surgical patients received adequate preoperative
preparation.
(5)
In many hospital settings, nursing personnel are
expected to do preoperative teaching without a definitive
statement of t.vhat preoperative teaching includes.
The
individual nurse, there fore, teaches what she in tui ti •1e 1 y
feels is adequate and correct.
(24=320)
I.Jindeman
observed that- teachir.. g- often reserobeld "telling" rather
tha."l "teaching" and ccnsis·ted of general vague s·tatements
rather than specific instructions.
(24)
Evaluat.ion of the effect of teaching on the
operat.ive .::ourse of patients has been the goal of a
number of studies.
Linde1'ilo.n conduct8d a cornpara·tive
in:vestigatio"n oi ·the structured and UlH:>·tructured pre-
I'
!-
operative teaching of deep breathing, coughing, and bed
exercises upon pos·toperat:ive ventilatory function, length
of hospi t.al stay 1 and need for analgesics.
(2 4}
The
research project was implemented at t./fartin Luther
Hospital, Eau Claire, Wisconsin.
The st.udy was stirnulat.ed
by an incident in a staff developm.e:nt. cl;iss in which
i
!
\ ._. - - ···-····--·-.-~- ........- - . - - · · · ' - - - -
......... --~-------------·-. ·-----··-- ··--·--··-·
:
i
·---···'·---···-···-~~-·--·· - - --· ···- ........ c •••• --~-----l
19
·-··-·----·- .....------·-~--·~-·-"-····--·-···-··"-"" -· ~------~-----·------··-·-·-·
~ t 3. 'h . .
t'
d'
.
l
eva..~..ua· ~ec. 1: eJ.J:: prac .J.Ce regar J.llg preoperatl ve
,-···-------.·~·-···-·····
., nurses
1· teaching
1
of deep breat.hing, coughing, and bed exercises.
They found tha·t ·teaching varied from nurse to nurse and
Il 'i,vas
r.roo, some patients did not rec•3ive
preopera·ti ve ·teaching.
A static group pretest-posttest
Il
The control group consis·ted of 135
was used.
su~rgical pa:d.ents
(admitted in l"iay and ~T·I.ll1e T 19 70) \vho
receivec1 unstructured preoperative teaching.
The
(a.dmitted in Noverrber, 1970) who received struct:ured
teaching
Unstructured teaching referred to the nurse
i~-7hat
she felt was adequate and correct:.
In
addition, there was no coordination as to how and when
t.he teaching was ·to take place.
Structured teaching
refe:rred to an approach standardized for content and
rae:thod.
1\nalysis of the data showed significantly higher
scores achieved by the experimental group on tests of
ventilatory function.
The degree of improvement varied
with the site of incision which indicat-ea that learning
was ad,ie:tsely affected by. incisional pa.in.
preope.ra"...:i7e. preparation.
'-----~c.-.....--~-~-~--- -·-··~ --~-
I
--
'l'her:e was a
It ;,.;as concluded t.hat this
~-- -¥-~"- -----~---·----'--~- ----~----~-~-
II
I
i
!
I
l
l
experimental group Consisted of 126 surgical patients
teaching.
I
I
-.
inoffective
~-...
I design
r
l
·-· ---~---~---~----~------~·--·J
I
!
II
I
I.
I
I
I
20
cedure and co;:ltent: v1as followed for both groups of
patients, except that the individual teaching group re-
I
cei ved instruction in their own hospi-tal rooms.
Patients
were pretested the evening before surgery a.nd before they
received preoperat:ive teaching.
They were posttested 24
j
hours after the time. listed as the start of their surgery.:
after a significantly shorter length of .lea.r:n.ing time
than those who had individual teaching.
Thus,
~_:_.rroup
teaching v1as more efficient than individui.il ·teaching·.There t.vas no evidence that nursing personnf,!l found cne
teaching method more effective than the ot.her.
A preoperative ·teaching and information program
was inst.i·tuted at the Montefiore Hospital in New York.
(23)
The goals of the program
1.
~1ere
to:
Lessen pa·t:ient: a.nd :family fears.
- ..-
r·------------~---
2.
---------··--------·-·--..---·-·---·-·---------l
Assure the patient's accep·tance of pro-
1
!
1
_ cedures cmd equipment used in his care.
1
3.
Improve patient cooperation.
Patients were visited 1-2 days before surgery.
I
I
They received the pamphlet. 1
Recovery Room--Surgical ICU for Patients and Their
Relatives."
I explanation
I
Included in the pamphlet
I
~vas
a brief
of the purpose 1 procedures, a.'Yld equipmcn t
the recovery room--·ICU.
I
"Information Regarding the
treated individuall~.
of
The patients were evaluated and
The degree of information given-to
I
the patient was dependent on the patient's ability and
desire to comprehend what was told to him.
i
Evaluation of '
I'
the program proved it to be very beneficial to ·the
patients.
I
They vvere foimd t.o be more accepting of pro-
cedures used in their care and more cooperative
a·
The Montreal General Hospital ini tia·ted a preadmission patient t.eaching clinic to provide information
to groups of patien·ts about to have similar abdominal
surgery.
(29)
· t
+..:o acqua1.n
One of the specific aims of the clinic
·•
·c.ne
pa t.J.ern:.:·
w1· tn
c
•
t·1·1e
::-.s
W~
~
purpos(:, a.nu..::! na t ure 01:
activities carriE:d out pre- and pos·toperatively in any
type of surgery.
Patients were invited to at·tend the
class on the day ·they ca...-rne to the hospi t.al for ·their
.'.i
I
22
,-----~--·-------------·--~--·------~----------------··----· -·-·-·-···"-·--·-··---···--··--···----~---
I
I
1
staff.
Postoperatively, the staff encouraged and
assisted the patient to carry out the activities neces-
Il program,
I data
I
The
gaaiered showed that patients remernber:ed the acti-
v·ities taught them and in most cases pract3.ced them after
There was a positive response to the clinic and
a general reaction of lowered anxiety.
I
I
To determine the effects o=-=f--=t=-=h:::..:.e=-·---+-----
a follow-up was made of selected patients.
II surgery.
I
I
instructions in ·the clinic which ·were reinforced by the
' sary to his recovery.
I'
----···-1
{29:39)
Because of their concern about the need for wellprepared pat.ient teaching proqrams, Wood, Rucci one,
I)r.,..:orsky and Odell developed a patient teaching guide for
cholecystectomy pa tien'i::s.
(42)
I
Tha con·i:ent of Hte bookle·t:
I
!
\vas developed by the authors from job experiences ar.d
obse:r.va. t:i.ons, a search of the li tera·ture and various pro··cedure books, and consultation v.:r.'i.th physicians and nurses
to determine specific con·tent.
The booklet ':ll)'as designed
tc provide a cor.sis·tent, systematic, cmd concise presenta·tion cf fac·ts abou·t the disease, -the procedures, and
the
the~cap~~ut:ic
care.
There we.re three parts of t:he
cb.o.h:c:yst.ectomy teaching bookle·t:
Ofii.ce:
.r1aking the Diagnosis,
{1) In the Physician's
(2) Preoperative Pre-
paration and Postoperat..i.ve Care, and (3) Discharge Plan.
'I'he authors took considerable
the guide.
of
d11::;
Several re'irisions
·;Td de was
test~ed
~-1ere
~
in preparing·
completed.
Each part
indi vidu.ally wi.1:.h non-patients.
i
'
tirr.E.~
i
.
J
'··-·-..·--·-··---··----··--·-·--.... -··· ........._... --·c·--·- ---· - ..·.---··- --·- ..... ···-·------ ..• ·-·~----· -- ·-··---·-·- ---·--·-· ---·---·------...... J
23
r·~-'-~------·-·-----------------~-------·-:-·---·--------··---·--------------~~---'-
l
. --
I Further testing vlith the actual gallbladder patients \vas
I
!
I also carried out to ascertain whether the material was
II written
I
I evaluate
I
I
in such a manner that the patient understood what
I was written.
i
I
1
(42:4)
It was the purpose of this study to
the effectiveness of
selectE:~d
sections of the
booklet in adding to i::he pat.ient' s knowledge about preoperative prepara-tion and postoperative care.
1
Summary
I
Many health p-rofessionals have indicated tha·t a
patient needs to be oriented and iEstructed abou.t vlha·t
I experiences
I
I
might entail in the hospital.
~islI
Unfortunately
li
research indicates tha·t many hospitals have failed to meet;
I this
I
.
1
need.
(4~
26)
i
t
Generally authors have stressed tha·t
I
I patient education programs should be planned .wid:. certain
I goals and objectives to help the patient understand and
I participate in his treat.ment ar..d care3
Research in patient education has shown that
I patie!lt teaching is an effective means of:
.. Improving ccrrmmnications bebveen the patient
I
.i...•
j
I
I
and th.e · pa.tien t-ca.re team.
f
I
2.
Relieving some of the anxiety and fear of the
3.
Hotivating the patient to be an active parti-
unk.now11..
cipant in his treatm.ent and care.
i
i
!I
4.
Providing t.he patient with general health
.
kno·;,.,;ledae.
!
L.. ----------·· ···--.. ---~: ________ -- ---···-------- -~-' ·---------- ------..----····----·· ~----··-- --·-···--·· -- -- .... ---~- ---·-··------------- ----- _______ _j
i
24
r·---.--·--·--"-..--. ---···- ·--"-·---·--------·--·--··-·-----·-··-·--..·-·----
I
---···-----·-----~----
. -·
··-·--·-----~
l
Specific studies indicated that patients wanted
I
I
!I
1
I
to be more informed about their illness and treatmen·t.
A
I
I;
variety of teaching approaches ~ver:e found to be effective '
as a m2ans of educating the patient.
Medical as v;rell as
surgical patients responded positively to patient
teaching.
Chapter 3
HE'I'HODOLOGY
The purpose of this 'study was to determine if
selected sections of a patient-teaching guide for
cholecystectomy patient.s added to the patient's knmvledge
about preoperati,re preparation and ?OStoperati ve care.
The following hypothesis was tested:
The patients reading the teaching guide (experi-
Eenta.l group) wi:l.l score the same on the post.test a.bOl.:t
preopera.ti ve
prepara~cion
and post:operat:.ive can'!, as the
p.:e,tients not reading the teachi.!1g guide (cont.rol group).
In order to test t.l:10 above hypo·t.hes:Ls, an· experiI
ment v.ra.s designed 1.1sir..g the pretest·-post.test control o·rour:)l
-,
met.hod.
A hetero-geneCltS sa.r:lplr;; of I_)a.t.ie:at.s participa·ted
in ·the s"t'.ldy ..
1'l.tese
pat~ents
ilY(:e-rvie·~ved
were
using the i.ns·tr'l...mtents and ·techniques described
.::md tested
.
J.. l1
,
'
t.f! l. s
S?......Ttt:ple ·ar!.d. S-ai:tJ.r ,:J
·---·
---------------=-
The sampls for ·this study
according to
th~~
CO'..lld
not be chosen
·i
sta.ndard met.hoas fo:r:· sr2lectinq a random
sample, hur,,rever it .-1as not selected
a~cording
1:o any
precono:;.p-clons on ·the part of the researcher as to vib.o
could or could
I10t
J.earn.
The subjec·ts werE: initially
'·---~~·••--•
I
-•••• -~---c "-• • -•~J
26
r·-·-..
II
··-·---~--·-··-
· -·-·-···--· ·--·-· · · ··-··--- -------:----··-·-·-·· ·····-··.
--------------------~-----------'-~
selected by a review of the daily suroe:cy" admission
.
j schedule
I!
~
vih.ich listed each ne;;v admission, their age 6
sex,
diagnosis and doctor.
I
The patients were selected as
candidates for the st.udy on the basis of t.heir diagnosis
and expected surgical procedure.
The study was carried
on at a church-owned qenerB-1 hospital and at a large
teaching hospital.
Similar methods of patient selection
were used at both hospitals.
UCLA HO~J2i tal.
One group of subjects \vere selected from the
University of California Hospital at the Center for th8
II Health
i
I
I
Sciences, Los Angeles
(UCL~.
Hospital).
The
hospital is situated on the ca"11?US of the University of
I
Cali fon-da.
j
l
oriented hospital and admits patients from a broad range
I
of socioeconomic and cultural backgrounds.
i
I
!
It. .i_s p1.·imarily a teaching and research
I
'
•
1
'l'w<:mty-five patients admitted for a cn.o_,_e-
!
'
I
lI
cystectomy
"~"ere
selected from the general surgery uni·t of
i
i
I
I
I
II
to obtain verbal consent to participate in the study.
t..~e
average r one. or
t:~v-o
pat:ients
bladder surgery each week.
i
'l;\7
eeks passed without
bladder surgery.
i"l.
~verr:~
On
admi t·ted for gall-
Ckcasionally 1
t\.'TO
to three
scl:eduled admission for gall-
Every ai::.tempt was made to see each
patient admit-ted for a chclecyst:ectmny over the period in
i
I
i
~
~Arhici1
l._,..- ~-~--·-•--••--
•-·-n
the cesez..:rch wa.s
•-··~·-~ , -·--- ·-·---.. ,.._ __ •·~-·~~---·-
C:.)lldllCt.ed ~
Pa:tier..ts admit.ted
27
.
r·---·--"-------·--··--~-·------··----~---·-----:---·~----·--·----·········-·--· ~-·---·------·-------------··
I
:
!
..-------"-·-,
·through the emergency room, those who were seriously ill
/
I
at the time of admission and patient.s having complications/
i
I
II were not approached to participate in the study.
I
I
I
Of the
tvlenty-five patients interviewed ·there were seven patients!
li
I
I
I
who did not participate due to various reasons.
l .Hexican.·-1\merica:n patients had a
T:,.;ro
limited ability to read
ii English, th:::ee pa'cients had t_heir surgery cancelled, and
I
j ·two patients did not conser~t. to take part in the study.
The patients were alte.rnately ass:Lgned to the.
l:
l
experimental and control groups.
All of the patients had
/ a diagnosis of either cholelithiasis {gallstones) or
I
cholecys-titis (inflam:ma·tion of the gallbladder) and sub-
I
Nine patients were
sequentiy underwent a cholecystectomy.
I assigned to the experimental group and nine 'l'lere
II
I
assigned
I
.I
i
One individual from the control
to the control 9roup.
group decided to drop out of the study, w·hich reduced the
II size of.+-hat
group tc eight patients.
I
.I
I
UCLA
Experi~~~al Grou~-
I
In
b~s
exp.3rlmental group, the ::-o.nge in age itJas
from 26 to 61 years.
The experimental. group vvas pre-
dominantly female, with 7 females and 2 males.
It con-
sis ted of an ethnic mix of 5 Anglo-l:..mericans, 3 Hexica.nAmericans and 1 Englis:b.womr:m.
Educational. achievement
ranged from grade 10 to 4 years of collsge.
~a~--:c,n"'-c
1:'
__ .._._, .,L-~-'
rrm,.-,1e-'-e~
·''-''P ..... ·'- . .__.
h~\...,.h
-'-:3 ~
"'C'X'Or-,1
o::>
•.. .:. '-'-
.<":J
- •. na"~
]._
·
Da!-l.P'_'lt
,_
~'-
1111 but 2
re.C•'"'l,~l'~r.~.
~
·--·
a
' ••
1-.
• • ' d•·>
u
-~t• 0.1..
. f: ·l•"h
~· 4•
~
t"h
1; .Oo.cca
..
aUrt!at.3
.....:axee.
""10.::>.
....., e ·--·
pa ·~... lc:n
•• s _,_n
...e
.
L-·--····-·· ..... --·--··-- ---·-·----...-............. . _::_____ -·-·---··--· ··- ------·- ---......... -···- ·----~-·-·- -- -~··· - -------·----~ --···-· -·------ ··---·--·----'
A
0
28
r---------------·---~--··-·--·---
! experimen t.al
l
---=------ ----·---···--
--------------··---~----
group had been hospi ta1ized previously.
I
I
The
number of previous hospitalizations ranged from 0-4.
l
Neither of the 2 male patients had experienced previous
hospitalizations or surgeries.
Only 2 of the female
patients had experienced surgery before.
1
UCLA Cont.rol Group
I
l!
There l.vere 8 patients assigned t.o ·the control
group.
was predomirtan tly female, with 7 females and 1 male.
I ranged· from
II' American
I grade t.o
I! completed
I
I
I
II
from 1-3.
one year of post-graduate studies.
from 0-3.
I . Simi
Two patients
ll~ll
patients experienced at least 1 previous
'I'he number of past surgeries ranged
Hal£ of the patients did not have past
selected from the
Valley P. . dventist Hospi·tal in Sired. Valley, CaliIt is a church-owned general hospital which
dra:;,vs primarily middle class income pa·t.ients from the
I
I
Previous hospitalizations ra..'"lged
A second group of patients
fornia.
j
!
2 years of college and l patient was comple·ting
hospitalization.
l
Six l'_nglo-AlP.ericans, 1 Chinese- -
Educational. achievement ranged from the tenth
his Master 1 s Deqree •
I
!
22 to 6 3.
i
Aaes 1
and 1 Israeli student made up the ethnic mix of
t.'l-J.e g-roup •
I
Ii
Like the experimental group, the control group
Shai Valley area.
II
l
~
L-----·---·--·-----···----- ................. -- -------.. _........... ________ . _·----------·--·-------------·- ..... --------··--···---............____________ ..............!
29
..
r·-~- -··~----,-~-----.-~A·~------·--·--, ----~·:_----·---~~----·-~·~-- -.,·~-~-r· ··~----~~~-~~~~--~~-~--~--~00<-·•.......-o~
A limited number of patients ~Tere admitted for
1
I
j
i
lI gallbladder surgery, so it was necessary to include
I
l abdominal surgery patients in order to ob·tain a repre-
I sentative
I
I
sample.
I
was written for a learner population of cholecystectomy
in the
sections tested ;ms also app.licable to patients having
j general abdominal surgery.
'I"N'o
minor modifications ';-.,·ere
j necessary to adapt the booklet for use
by abdominal
I
surgery patients (see Appendix C).
I
used in the study was also adapted accordingly by
I omitting the question pertaining to
!
I
examination.
!
:general abdominal surgery.
l
I
Ij
The teaching booklet used in this study!
I patients, however the information cont.ained
I
II
The questionnaire
gallbladde:r: x-ray
All other questions -.;.·1ere applicable to
Nineteen general abdominal surgery patients
consented to participate in the study.
Verbal consent
/ was obtained by Mrs. Amy Sherrard, Health Services
1
Representative of the hospital.
The patients were
!!
I
divided into cont.rol and experimental groups.
!
patients were assigned to t:·;.e sxperimm1t.al group and 8
I
patients to the control group.
Eleven
'I'he experimental group
i
i
consisted of 3 males and 8 females.
I
consist.;d of 1 male and 7 females.
I1
informa'i:.ion was not obtained.
1
f
i
i
The control group
Specific O.emogra.phic
A.ges of the patients ranged
i
.r.
~rom
·
·
1 ate s1.x·t1.es.
·
·
the ear 1 y t h'1.rt:tes
to ·tne
.
.1
l
I
II
L------·~-·~-----·--. ·-·"'". - ...-.......-.,.............. ---.............. ---·-··---·-·· ______,,,,_,_______......... --------- ...~.- ..........,_______ ··---......Jl
30
j--~~-;~;:~--~~--~~s~a!ch ·--~--
I
~
_________..._ ___ _
A.<'1 interview \•Tas held with the head nurses of the
7 East general surgery unit at the UCLA Hospital to re··
quest approval to use the unit to do research.
I
purpose of the study was discussed in detail.
I vi.ev.red
The
She re-
the pat.ien t··teaching guide ancl questionnaire to be
i
used in the study and agreed to the use of her unit.
Ii
research proposal ;,vas also approved by the supervisor of
I
the surgical units.
The
Final approval to.do research had to
be obtained from the Director of Nursing Service, the
Director of Staff Development, and the UCLA Hospital
I
I
Ii
I
II
I
1
Research Comrni ttee.
Duplicate letters formally requesting;
j
the use of the 7 East clinical facility for research were
sent to the Director of Nursing Service and ·to the
Di.recto~
of Staff De.velopment.
The UCLA Hospital Research COl(ll'fiit-tee requested a
copy of the
re~search
proposal including the questionnaire
a.nd patien·t-teaching- booklet.
The proposal,
i
I
I
II
!
questimtnaire and teaching booklet
~-Jerr~
:r..·eviewed by t.J1.e
Research CornmL. . 'l:ee a.nd were appr.oved. as vJ.:ci t:·ten.
process o£
obtai.n:L1~g
final approval tc do research took
approxima-tely six weeks including the fir3t interview
'lrvi t...~ the head nurse.
After the study was approved, a
1
I
meeting· was held 'l.vi th a Research Cornmi ttee Representative
to coordinate the s-tudy wi t...lJ. the UCLA staff .
.rm appo.int:nK:!nt: h7 aS made wi-th Mrs. Aro.y Sher:rardv
l
il.
31
/;eal~;;;, r~i.:--:--~e~r~~~~~a t~~;of -~-;;-~--;;~,;:--Va~ 1~;------,
I Adventist: Hospital,
1
I
I
to inquire about the possibility of
using 'che hospital facility for research.
The purpose of ·
i
the s·tudy "ras discussed and the patien·t-t.eaching guide andi
l questl'or1na~.re
..:.
were reviewed by Mrs. Sherrard.
The study
1!
I
met with her approval and arrangements were made to meet
~lith
the Hospital Administrator.
The research proposal was discussed with the
Hospital A.&ninistrator.
He examined the ques-tionnaire
and patien·t-teaching guide and :cequested two minor
I
I'
;
additions to the teaching guide in t.he sections on
doctor 1 s orders and general hospital surg·ical routine.
Neither of these additions altered the context of the
teaching guide.
Before giving his final approval to the
study 1 the Hospj tal Adminis tra·tor requested copies of the
teaching booklet and questionnaire, sc that they could be
I approved
the staff physicians.
I
The use- of the Simi Valley Advent.ist Hospital was
by
I
I
I
I
I
n.epresentative -;;._;orc-:inate the adminj st.rat:Lon of the
questionnaires c1.nd teaching guides t.o tr£ patients ..
I
I
!
!
l
Patient.-'rea·:::!hincr
Guide
-~...,..·-------,.,._-.·----~----
:
I
'
The patient-teaching guide evaluated in this
s·t~J.dy
;va.s
-;;~T.ritte.n
t.eachin9 :s)rog·rams.
I
I
I
I
I
by Wood et al. because of their concern i
abcnxt the lack of well-planne<l, V'7ell-prepa.red pat:i(:::n·tI
I
I
approved with the provi:::dcm that the Health Services
The learne.r population
~i/C..S
I
described.
l
~-~-- ··~-~--·--• •••••-·- . .-~ • --•··-·• "-~• -•·•--·-·~- ''"·"--·~~-·- ·-··•••----~b-••----•••n-,,,. ____ -·-··~-~---·- '' -~---~---•·-••·• -~ •--·----~~·-a~ -~~-·~-~ •-~
.3 ...'1
,--·--·-·-···---·-·-·-···--·---·--·----· -··-- -----------·-----·-··-····-..·---.. ···-- -----·-------- _,_ ...___ , ___1
I as English-speaking adult candidates
1
for
i
chol~cystectomy.
l
The authors chose gallbladder surgery as a subject for a
I
i
·teaching guide because i t is a cormnon procedure, usually
;
i
I
uncomplicated, and with a general routine followed by
physicians in the care of the patiente
(42:1)
I
J
•rhe ouroose!
·'•
i
I
of the booklet was to lessen ·the apprehension and fears
I
!
frequently demonstro.ted by the patient facing the un-
I
known; to increase accep·tance of the procedures, equip-
I
I
ment, and routines by the pat.ienti to add to the pa·tient' s!
I
I
general health knowledge; and to improve communication
j bet\veen patient
I
I
and nu::::·se.
(42:1)
For the purpose of th:i.s study, the sec·tion dealing:
with preoperative prepa.ration and postoperative care was
I evaluated.
.I
I with
I pare
I
Infm:."TO.at:ion con·tained in this section dealt
the general .:coutine used in moBt hospitals to pre·tl'1e pat.ient for surgery and dle care he will receive
after the operation.
_f\
<p.lestions
qu.esLLonnaix-e of
twenty~four
mul·tiple choice
to measure thB amoun·t of knm·dedge
the pati.en·ts had atK/ut: preoperat:L ve preparcttion and post.O.ne questi.onnai:L"e v-;a.s used to p:eetest and;
posttest. bo"'ctJ. ·the control and the experiment.aJ. group of
pat.:ient:.s ~
'l'he content: of t.he questions vJas taken from
the in.fo:cmad.on qi ven in the beaching- bookle·L
Each item
c•')nsisted of a st;a:tement. follovmd by four. choices.,
:
L •.--·-----·--·--· .............- ........... ------··.. -·---- .............~-·· ....... - ............ ---- ···- "·--------·---- ··-·-·-----·------ ........ -
j
......... -·---..........)
33
,--------
-·---·--···------·-··---·---------··--·---··1
I
I
Table 1
A Content Analysis of the Pre and Postoperative
Information Questionnaire
!
-
Situation (procedures)
Doctor's orde.rs ...........
~
...
I
Il
Item Nt:rrnber
w.
a
••••
$
••••
8
•••••
General hospital surgical routine .. ..........
e
••
1...,.6
7-9
Personal care immediately before surgery ••.•.•. lO
I After
I
I
l
surgery ...............•.•.••...•••.••.•.. 11-14
What vdll be happening to me? ••.••.••••••...... 15,16,22
i
I
-Hew will I
feel? ..
* ...
o-
lol
••••••••
~ ~ o. ~ ••• ..,.
I'J
•••
..,
.17--..2J.
j
I
As I get better
"i
•
•
•
•
""
e
•
e
•
•
e
·~ ~ ~
o
a o
o .,
I
I
I'
&
e
,
~
•
•
~
•
"' e
•
231 24
I
l!
I
~
,.
!
--------------··---------------
I
I
I
i
I
I
!
I
.34
,----------..----·-------------
I
.I
I
!
1
Data Collection
At UCLA each prospective subject v.;ras approached
/.;
1
011
.
I
I
the day of admission and was asked to participate in a
I
study on preoperative teaching.
lI
If the patien·t
I
I
consent;ed to take part in the study, then pertinent back-
I ground
I
I
I'·
the four choices following each statement.
I research
I
·--.-..,
..
Instructions were given to circle the best choice from
I
I
----------·.-·----~---·--·····-----------
information was obtained regardlng past hospital
or surgical experiences.
I was
!
administered.
Next, the pretest questionnaire I
I
Each pai:ient v;as instructed to ans-vqer
!
I
J every question choosing what he thought was the best
answer.
The questionnaire too};:: most patients :from 10 t.o
15 minutes to complete.
1
I
It was collected as soon as
l
j
i
completed"
I
I cations
!
i'
concerning tho study.
The experimental group was I'
given L;.e pa.t.:i.ent-teaching guide on preoperative pre-
I!
parat.ion and postoperative care.
read
i::.~e
I
be
I would
They
I
I
The control group received no further communi-
4
They 'tvere ins·tructed to
booklet before surgery p and were told that it
could. help ·them with some of t:hei1: questions about what
i
happening to them be:Eore c:md aft. er surgery.
were told to keep thu booklets throughout their
I
I
hospital stay and to refer to it. as they would like.
The posttest \vas adrn.inist.ered to both groups of
patient:s n.o sooner than £:Lve days postopera·tively.
was admin:L:-;tered
"3..8
close to the Clay of
di~;charge
-~
.....
.l ....
as
I
I
I
35
r-----------------------~----------·---------
j possible.
. --..·-----..
------------------·---------··-----~
The experirnental group patients were not
!
j allowed to use the information booklet at any time w·hile
.I
taking the post test.
The patients were asked not to seek
help :from the nursing staff or fellow patients in
I
!
i
j
I
I
a..11swering the qu.est.ionnaire.
i
The posttests were collected
-
i
as soon as completed and corrected in the presence of the
l
patient so that the patient could see the correc·t ar1s'(,ve1:-s ••I
At. t..he Simi Valley Adventist. Hospi-tal,
the Health
Services Representative administered the questionnaires
and collec·ted the data.
Since patients were admitted in
the evening and went t:o surgery at 6 A.M. the nex-t
morning, it was not possible for the Health Services
Representative to intervie<;.v them or have them answer th,;=
The informat.i.on booklet
quest.ionnaires preoperati.vcly.
was given to each of the
~xperirr.eE tal
group patients
post.operat:ivelx to read and refer to as ·they needed
during their hospitalization.
The questionnaire· \vas
administered t.o each patient before being discharged
from t.he hospital .
Patients in the e:xperimente.l group
received ins·tru.cticns to mark an
11
X"
for wha·t
I ·thoucrl:ct:
-----~--~-,.---=-'-·!--.-..
Instructions ·to the control group were to mark a.."l "x" for
mark an
surqerv.
11
0
11
t. ---===-·-·---~--- -·· ---~-- -----------------------·--- - - - ·--------------------------·-·--. _____________j
I
1
36
r---··-·--·--·-------·--·--·----·---------------·--·----------·-------·--·--·----·-.. -·-----·-··-··- -----·-----·--------------·----! Stat;istical 'l'.reatment
!I
l
of the Data
I
j
The da-ta were analyzed on ·the basis of nUinber of
I correct r.ssponses
scored by each of the individuals in-
j vol ved in the s·tudy.
! were
!
Data collected from each hospital
treated separately and no statistical comparisons
I
I
I
·were made between the tv1o hospital samples.
I were
computed for each of the groups.
Mean scores
'L'he standard
l deviation and standard error of each mean was also
II
calculated.
The significance of the difference in t.he
I mean scores (;~,~~established
I_
by using the t
test at the
5 percent le'ilel of significance.
I
!
I
I
I
I
I
Ii
II
)
j
i
''i
!
I
!
I
i
I
j
I
I
.
r-·----~·~-~-··------------·---------------·-·-·--·-·--·-~----- ·--·-··---·-··-·---~------~------·--------------,
l
I
Chapter 4
RESULTS
N~D
I
DISCUSSION
I
I
This study att.empt.ed to evaluate the effectiveness!
! of
I
j
I
selec·ted sections of a -patient-·teaching packet in
I
adding to. the patient 1 s knowledge <:1bout preoperative
I
!
preparation and postoperat.i ve care.
i
Although the· packet
was wri·tten for a learner populat.ion of cholecystectomy
I
I
I
patients, the information contained in the sec·tions ·tested!
was also applicable to patients having general abdominal
surgery.
The hypothesis tested in t.his study was that the
patien·ts reading the teaching guide will score the same
on the :pQsttest as the patients not reading the teaching
guide.
The patients who pa:cticipated in this study ·were
selected en the basis o£ their d.iagnosis and planned
surgical procedure.
The sa.r.:ple studied consisted of 17
patients scheduled for cholecyst.ectomy at. the University
of California
Ho~">pital
at Los Angeles and 19 patients
scheduled £or aJ)dominal surgery a.t the S:Lmi Valley
Adventist Hospital.
Specific background information
about the subjects was discussed in Chap·ter 3,
~r:ere
.
alternately assigned to the c,:mtrol and
xnental
L ... __ ,_ ........
tha.t there wex:e 9 patients
Patients
~xpen.-
~''""~~- '~"--·----~---~~-·-,
--
. .
"""•~·•~•-'---••-·---,.--~-" ~~- -·----~~- ·--·-~---"~·--·-•·---
--·· •·
v---------------·-·~-
·----·--····--·-·---·------·-------·----.
i
Table 2
Ind.ividual Patient Sco:res on the Pretest and Posttest
_____
_____ ______
_
--- __-..--·----·------ --·--·-
..·--·---,-_,_.,_.
.....
....
...
.,,
..
.
'"'I A I:ro··· · : .... -.-1
~::_-::_.._·l_::-:E::.~_:!-·_
·u·
Control
-·------ _._..
f.:~
16
14
*
Simi Valley __!.{o~ital**
Experimental
____ _______·----·-·----··--- ---·
..
post:
Ere_
17
13
20
19
:~6
17
18
19
16
20
17
18
16
19
15
22
19
20
19
13
20
Control
Experimen·tal
20
.•
()
l.O
:;ost
r_... _
'
20
23
23
20
23
19
24
22
22
rre
16
19
Hi
13
20
16
19
16
PC!_St
17
19
16
13
20
16
19
15
-ore
17
17
17
16
18
10
21
18
16
21
16
mean
16.8
t
·---------------------------·-----------·
17.6
·•ue2.48** *
Vcl~
18.4
21.8
16.9
post
23
23
22
20
20
17
'"'?
L.o.
21
19
22
15
·--------------·· ...-- ..
16.9
17.0
no difference
5.77***
* ~:'he maximum possible score on ·the UCIJA questionnaire was 24.
** The maximum ponsible score on the Simi Valley questionnaire was 23.
**'h t scores significant at .05.
··---~-
.._: ij •
4.48***
·'l
I
I
!
I
1
l
-·-·--· -·---,-·--- _____,____..___ ··-· --·-.. --- ------" - ..----·-----·- __ j.
vJ
C(l
39
i
fromj
!
the questionnaire used at the Simi Valley Hospital, so
that the highest possible score was 23.
I
Comparison o£ the individual scores revealed that
!
all. of the patient.s in th€ UCLA experimental group scored
bet.ter on the postte.st by l to 7 points.
I·patient in the UCLA control grm1p
j
I
l
I
All but one
equalled. or bettered
their pretest score b.Y 1 to 2 points.
One patient scored
one point less on the posttest.
j
I
I
The Simi Valley Hospital scores showed t...."'lat alJ.
but one of t.'le patients in t:he experimental group scored
on the
I better
exception vvas
post test.
posttest by 1 to 7 points.
a. patient '1vh0 scored one.:! point less on ·the
Out of the 8 pa·tients in the control group 6
of t.he patients equalled
patic~nt
'l:he one
t....~eir
p::::etest score; one
scored one point better on the posttest; and one
patient scored one point less on the posttest.
I
4C
r-·"'-·-··-----·-----------~----·-----
~
·-·--·-~
Tables 5 and 6 in the appendix show respons.:=s to
1
I
. . .-.-.. .--·-·-----·-··--··-----.. . . -----.. . . ---.. ___........... -··-· ·--.. . _____ . --··- ---·
individual questionnaire items by the patients who read
I
the information booklet.
l
was no section of quest:ions wit.h which the patients con-
'
i
I
As the tables indicate, there
i
I sistently had difficulty.
I doctor's
orders; question 10 on personal care im:rnec1iately
before goin(t:,) to surgery, and question 18 in the section
on "how I will feel."
i sections
I
I
(See A.ppendix A. )
II
I
li
I
!I
There were three;
I
in which the patients reading the booklet showed I
i
the most gain in knowledge.
I hospital surgical routine,
i
I,.
The pa·tient:s :had the most in-
! correct responses to q11estion nur::tber 2 in Uw section en
l
I
They were:
(1)
general
(2) what will be happening
after surgery, and (3) how will I
feel~
Mean scoi"es on the pre·test ann postte:st
calculated for the control <?nd experin2ntal groups at
both hospitals.
The mean scores were analyzed as follows:!
(1) comparison of the mean pretest score ·to the mean
I
j
post te.st score for each of the groups at UCLA and Simi
Valleyi
(2 ~
comparison of the mean pretest scores of t.he
DCLA cont:col ar~C. <..::"i;.pe:d.mental g:roups;
(3} comparison of
·t.,.">te mean p.re·tes·t. s8o:res of the Simi Vallye,· control e.nd
experimental grr::mps:
(4)
comparison of the mean post.test
scores of the two UCLA groups,
(.5)
comparison of the mean
post test scores of the t\:vo Simi Valley groups.
test at the . 05 level of significance
i'
L--·-····-·---------·----~·-·-- ......... ·---·
~Has
The t
used to cmnpare
...... .,------·--···-------....--.- ........ _ ......... _. ___..................... ---...... -·--.. ---..----- ................-· ... .
I
i
r;~~~p~~~-~~~-- of -;re~es-~-- to Pos~~~-s-t
I
--------------L---------------1
In order to determine if there was any gain in
!knowledge about preoperative preparation and posti
j operative care, the pretest
IThe
I
i
I
.l...
~Jere compared.
UCLA. control group had a mean score of 16.7 on the
I pretest
1,-o-r::
and posttest
post~ tes-t.
and 17.6 on the
There was a diffe-rence
-
•
1
9 po~"'·',-'='
,.,,,h-lch
"''ac:.
,~t-,:>-!--.;s~-l·,...,a.
a-ign-:.c;,....,.-.1-·t
~-i- t"ne
...L.J..L_.-J
'{J.L..
.....
....
.. '1"
-.-...
...
Gtt..a..;
~'
.
~
~l.~.oo..J-
\..~
~.._
1..~-Y
..,..,......_.J.....J.-o"""">.,;~.-
-
~
I
I .05 level.
II of
I
The UCLA experimental group had a mean score
18.4 on the pretest and 21.8 on the post.:test.
•
1 dJ..fference
The
•
was 3. 4 po1nts which also was statistically
Isign.ifi-.:::ant
at t.he .05 level.
For the Simi Valley control
~ group t.here was no difference in mean scores on the pre-
! test
I
I The
!
and pos·ttest.
The mean score was 16.9 on both ·tests.
Simi Valley e.xperirne:r1 7.:.c..l ~;-:to,_2p had a mean score of
i 17.0 on the pretest a:1d 20 "4 on the pcstt.est.
1
The dif-
ference in means was . 3. 4 poin.-ts aJ:"1d -;,v-as st.atist.ically
j significant at the • 0 5 le·vel (Table 2) •
lI
Comoarison of Pre·test Sc:o:r:es
----------------------The UCLA cont:cnl group had a mean scor:G o.f 16.7 on
UCJ~JI~
the pretest as coL>:tpared to the
which hnd a mean . score of 18. 4.
tl1.e means o_f'
experimental group,
'I;he difference betv-1een
groups was 1. 7 poin·ts.
This did
not turn ·out. to be a st:a.tisticaJ ly significant difference
(Table 3) .
The Simi Va11ay control group had a mean
~.'7hile
score of 16.9 on t.hs pretest.,
the Simi Valley
j expe:r·imer.. tal group l:ad a. xnea.r:.. score
~~~""-•~·"'~'-~- -· ~>-~•--• .. c·-~- ·-~·- ---~--·-
--·•---•, •~·· •-·- , ,,, b~
_.,, ••• .,, - . , · • • - ""
,
.,. ' •
•
-·
'"~"-·-
••
~~··-~
•-.
•
--··~-
·---·--
--~- -·~~••o- - - - - • -••••--~--~ ... --···-··~---·-~H
r-··------·---·. --.-·---.. .---.. -·---.. ----.. .---· ·-·- .
······~--·-··-·-
. ·-------..--·-:·---· --.. . ------------------------------..
·-----------~
l
'
'I' all le 3
I
Comparison of Hean Scores of the UCLA Control and
I
I
!'
Experimen t:.al Group on the P.ret.est and Post·tast
l'
I
i
·--·--~
Difference
Betvveen
Jvlean
i
l
'
l
'
1
'I'est
-----~------·----
Cont..rol
.I
Scores
Groups
..--·
Means
-·
-
i
...
Standard
Standard
Deviation
B::cror of
Mean
Obtained
t·-value
--------·--2.49
16.7
.88
1.33**
1.7
Pretest
Experiment.al
18.4
2.60
.87
Control
17.6
1.76
.62
4.19*
4.2
Postt.est
I
Exp~::ri·­
mental
!l
1.72
21.8
• 57
I
i
I
I
i
""' f5tat. .i.stically siguificcmt at • 05 level
**
in favor of the experimental group.
No·t st:atis·tically significant.
-··-----·--,..-~- - - - - ' • • · - - - "''w•--•• - - - -
!'
l
I
!
-·-··-·--"--·· ---------..--·-·----·-" --·-..-----~·--·- . ···---·-------_!
.t~
1-J
43
[
..
-"--"--~-----------~------""--·-~----~----- ---------·--------------~--
----------,
difference of .1 ooints was not siqnifica.nt
(Table 4) .
~
~
!I
l
j •rhe standard deviation and standard error of the mean are j
· listed in Table 3 for the UCLA groups and 'l'able 4 for the :
Simi Valley groups.
I
iI
I Comparison of Posttest Scores
Il
I
!
I
1
The acceptance of-the hypothesi3 that the P "'-'-ient<~
'...
;.::, j
-~
reading the teaching guide vli ll score ·the same on the
posttest as the patients not reading the teaching guide
I v;as
dependent on -the results of the comparison of the
I posttest mean scores. The mean scores on the
I the UCLA control and experimental groups were
I
I
21.8 respectively.
The t
I
17.6 and
There wa2 a difference of 4 • 2 poin i.:s.
hypotl1esis is rejected for ·the UCLA. sctn1ple
The Simi Valley cont..1:·ol group had a posttest. mean
of 16.9 while the experimental group had a mean score of
The difference
I tained
~as.3.5
points.
'I' he t
score ob-
\vas significan.t at: i:h.e .C5 level, therefore t:he
I hypothesis
was also rejected for the Sird Valley sample
Discussion
wnen comparing the pretest to the posttest for
"·
the TJCI
~
U'3.
,~ontro~i
_, ~. ··....
gro'lP
~
'
1
"'t w:::.s fo'md thaT
< -
.J..
•
.....
•
'
.
-·
~!--~.E:
-
t"ii
--- fferer:.t"!e
-
between tl"l.e mean scores i:Tas s·tatistically significant at
th.e .OS leve.1"
I
L~-----·~~----
Since the difference in means was only
-·- ~-- ~-- - -----·~--------·~- ~-~-~-~ ~--·- . --.. -----. ··-· ·------· ...~- ---~-~
~-·
I
l
I
'
I
post test for'
score obtained \'<Tas significant at th<:? .05 level,
I therefore the
I (Table 3) •
I
.... -----··· .. ~-~··-·· -~ . ~····· ~- ~ -· ....~. ~- ~--~~~-· -······ ~· ....... -........... -
I
r--- - ·- ------
------------------------------------------------------·----··-------------------------------------,·----------------------~
Table 4
!
Comparison of Mean Scores of the Simi Valley Advent.ist Hospital
Control and Experiment.al Group_ on the
Pretest and Posttest
~~e i:'n
'l'est
Grou.ps
Cont.rol
Sc~ores
16.9
r·1ean
0.10**
17.0
2.93
.88
Ccntrol
16.9
2.36
.83
3.09*
3.5
Experimental
20.4
Obta.ined
t-value
.81
Experimental
Postt.es·t
**
2.29
Standard
Error of
0.1
Pretest
*
Difference
Beb·Jeen
Standard
Means
Deviation
2.54
.77
·-----------------------------Statistically
si~rnificant
at the . 05 level in favor of ·the experimental group.
Not statistically siqnificant.
!I
I
i
!
l!
... ·--- ~--·· ---------------------------------·-- ·--------------------- --~------------------ ---------·------ . . . . ---··-·--------------·-·-------------------------------------------------_J
~
,::,
45
by sensi·tizing the patients to kno•ftl "l.vhat kinds of
questions to ask.
In addition, it is possible that
o~~er
extraneous variables left uncontrolled, such as unplanned
It was noted that the Simi Valley control group
to administer the questionnaire.
•rhe patients at the
! Simi Valley Hospital did :':lot actually answer the
I questionnaire
II
I·
periods of time.
for what
I they
thouglYl: a
t:hey
J
I
I
.
as a pretest. and posttest at dlfferent
Rather, they vJere asked to place an
t~hought
before surgery and an "0 11 for what
fevJ' da.ys after having surgery,
It is
i
! doubtful -c-_hat:. tl1e patient' could accurat.ely recall what
I
,
.
I
I
if he ha.d t:tkr::n U:e quest:1.cnnalre i
i' an mv e :cs \~ould
I
I
i
II the day of .adJ.nission to the hospital.
I
I
!
I
Botb. Simi Valley and UChA experimen·tal groups
scored signific&ntly better on the posttest.
It was
probably a coincidence that. both groups had the same mean
difference of 3. 4 points betv,reen the pretest and post-
I
46
r-----------------,.--------------------·--·--------------l
I
!I
-1
The pretest was administered Jco determine the
i
II
general level of knowledge about preoperative preparation .
I and postoperat.ive care of the patients who participated
I in this study. There were .no singificant differences
I between the mean pre·test scores of ei t.her the
or
i
UCLA
l,l
Simi Valley groups, \.Vhich suggests that all t.l-J.e patients
.
had about the same level of k.nmvledge when they entered
l
I
I1
the hospital.
The difference in the posttest mean scores
between the control and experimental groups at both
II. hospitals
was significant at the .05 level, therefore the
hypothesis that the patients reading the teaching guide
I
I
'Vlill score the same on the posttest as the patien·ts not
!
I
reading- the te~hcing guide was rejected_.
!
I
Pat.ients :responded favorably· to
tl~f~
patient-
l
teaching guide.
1
readability of the prograrn.:ned £'ormat.
!
sponse of one pa·tient at UCLA was,
I
bladder' booklet helpful, informative a.tul comforting--
'They were particularly impressed by the
11
I
The a.ctual refound
~{our
1
Gall-
I
I
i
tJ"'.ank you!
a
(
3 4)
A
patient at tile Simi Valley Hospital
stated the booklet \vas "really great" in l":.elping to reduce fears.
P...nothsr patient in the Simi Valley cor.trol
I
i
I
group conu:nented that all v.;as still confusing after 7 days!
I
in the hos-oital·--"A booklet t..vith ·the correct
j
I
I
sounds great i" ( 33)
I
ans~~rers
None of the patients read.ing the
booklet. felt that. it had macta them more fearful of having·.
L_______________ _'----------
---·-· -·----
___ ___________..____ - ------·- -------· --- ·---------·
._
··•···
----- --------· --·---------------. ------------------ __ __]
47
I
I
I
I
I
I
I
I
I
!
I
I
I
I.
I
I
I
II
i
Il
I
I
l
'
L-----·-·-----·--···-~--······ ...---·---·--- .. ------·-------·--·-- --------· ----- -·-·--- __...._________.__. ______.____.._ _j
r---·-··-------------·---~------·------------------
1
I
l
Chapter 5
I
I'
· SUr1-L!,IARY, CONCLUSIONS liND
I1 selected
I writ ten
RECOHJYIENDJ!~TIONS
The purpose. of this study was t.o evaluate
sec·tions of a programmed patient-teaching quide
The hypothesis tested was t..:hat
by Wood e ·t al .
the patients reading the teaching guide
I
I group)
!i
I
(experimental
will score the same on the posttest about pre-
operative preparation a.nd postoperative care as the
!'
j patients not reading the teaching guide (cont.rol group)
II
A review of ·the literature indicated that patientsi
I
i
I wan·ted t:o
II A vari8ty
I
l
be inforrned abou·t their illness and "l:reatment.
of b::.a.ching approaches T1Jere found to
effective as a. rneans of educating the patient.
No other
tb.e recent l.i.t.erature on the
I
studies vve:re
I
effectiveness of programmt.!::l instrnctio:1 i:r;. teaching
I!
I
patient about p:;:-eopera:tive preparation and postoperative
ca"?::"eN
There Kere h•To
st~udies
supported t.he effectiveness of
teaching
'
1.:n
...
o-cher
areas of
i.n t.he literat~ure which
progra.rnrat~d
p~1t.ien t
car~~.
patien·t-
In 19613, Skiff
reported the results of a pilot test c:: programmed
instru.ct.ion as a mea:1s of teaching
rGsul ts sho-;.1ed
t;.h~t.
"o,..-
...-.--•~"•••-~v-~-·•-·--
-· •o
<• • • -
-.~-~
, _,.,
~-•·
~~-~
•-•
,u.-•
(13)
77 perce!i.t of the patient.s who
C'Jmp1eted the program acqui:l':ed
!
dia~)etics.
••·--·-~,,
•
>•"•--•
48
ne~·:
in :formation about
The
~ C~~rk-:nd B-ay~l~y ~e;elop€~d- a--pr~~;~a~Ine-~-lnstrt;~~~--·--·-··-1
,
I
booklet to be used as a teaching tool by patients who
1.·
'tlere to be discharged from the hospital on long-term
! anticoagulant therapy.
!
I
I
1 .
l
I
I
I
The results of the stud;{
(22)
i
indicated that progra:rnmed inst:ruction is an effective
method fer teaching patients about Warfarin anticoagulant '
therapy.
For this study a questionnaire of twenty-four
I
I
l
multiple choice questions >-vas designed to measure the
I
amount of knowledge the patients had about preoperative
I
preparation and postopera·tive care.
The content of the
questionnaire was taken directl.y from i:he infm:mation
given in the teaching booklet.
The questionnaire was
used as the pretest. and the post test.
Both ·the control
and experimental groups a;1swered the questionnaire as
instructed.
'l'he experimental group received the
patient-teaching guide a.:nd were asked to read the
booklet th.oroughl:J and refer to it as they needed
throughout.: their hospital s·tay.
The cc·ntrol group re!
ceived :c1o ocher materic:.l cr corrmmnicat..ions about the
study. un·til the pos'ctest
~,..ras
I-
I
ad..-ninistered.
Data collected from each hospital \¥ere ·treated
separately an1.J. no statist.ical comparisons were made
between the t1.vo hospital .samples.
Mean scores on -the
prf.:.tes·t and posttest were calculated fer the control and
1
t
l
i
i
experimental groups at both hosp.i i:als and v.rere
t. ~~---------~-- '"~-~-----~~ -~--~--~-- -~~---~~·- -·~-·-~~-~ --·----~-·--- ·-
~~-~-
-·. -~~----
~-~---~ ---~~~ -··-·--·-··-·----·--·~---~-~---~-·-·
..
-~--~
50
~-;tC:ti;:ti'~-~iiy·-;;~p-~~-~d ·-~~--,£-;;ii;~,;~-:~ --(i)--~~.;~_;-·:pr~t~~t------1
I' score
II
to the mean posttest score for each of the groups
at UCLA and Simi Valley:
!
(2) mean pretest scores between
the control and experimental groups a:t each hospital; and
II
I
I
I
I
I
I
(3)
UCI,A and at Simi Valley.
I
Conclusions
Based on the number of correct responses on the
1.
II
!
I
II
Patients who read the patient-teaching guide
I
had more knov;ledge about preoperative preparo.tion and
·,
I
l
care than the patients VJho did not read the !
teaching guide.
2.
I
I
I
groups, the following conclusions were reached:
I
I!
I
I
pretest and posttest by the control and experimental
I postoperative
l
I
comparison of the mean posttest. of the two g·roups at
The programmed patien·t-t:eaching guide \.'la.s an
effec·tive method of teaching t.he patients about pre·opera·ti ve preparation and postoperative care.
:Recommendations
On
t1lE~
_!·)a. s 1.. G of: th:l.s study 1 s
findings the
follmving recom-rr•endat.ions are made;
1.
F·arther. studies should be done to test the
i
efficac:"
of
th.if..l method of patient-t.eaching as compared
i
!
wi tl1 other n1e·thods •
2.
Using the patient-teaching guide evaluated in'
this study as a prototype, :more prograrr.Lrned materials
51
r------~---··-------·--·
i
-----·~··-·-
should be developed and made available for patient use
1
in other areas of patient care.
!
l
I
I
---·-------·;;·-----··--···-··-···---··-··------- -"1
I
I
I
I
I
l
I
l
I
i
i
I
I
I
II
i
I
I
I
Ii
I
I
I
I
i
I
BIBLIOGRAPHY
l.
II I
4
( 1966)
t
36-44.
.Aiken, L .E.
"Pat:.Lent Problems a.rc Prc.blems l . -,-..~·
Lear.rnng 1 II Amer-ican JClJXTlt~L c.f' Nuxs ing r 70:1916191 fh Sep-ten·;n e.r:-;-19-?o:--------------
"?atient Education Program
AnS'de:rs ~1any Un.cm.ST,vered Questions, " Hc:_spi t:.?:_ls_,
40~76·-78, November 16r J966o
3.
Al.tt Richard E., t·1.D.
4.
IV niA Research
}\mer.i<:=an B,:,.;spi tal ~-ssociatio:r1 ..
Capsules--No. 7," Hospitals, ~6:102, December 1,
1972.
Bo'tm1an, June .
6.
Bro~·rn,
7~
Br·uegal,
Personal Interview, July 26, 1972.
Est:he:r I..uci.le. Ne\•Yer Di:mensio!lS of Pa.tic:::J.t.
Care:
Pa.ti<:.n ts .:-.:s f·c::ople--:--P'ar-E:--3.-.--~:~e\~---.,-io".rk:··Russeli sag;E .f,:)li~1:i"&T:I.-..:;!;::--l5 s 4.
.r':ar:~l
.i\r1n..
.
1
~Relat:!..or~sh.Lp
of
?r.eopera.t.!L~v.s
A..""lxiety to Pe:cception of Pr.stoperative Pain,
r1ursi~1; TI.t.;~38ar~:::~-:p
11
20:26 . -30*'
8.
Ca..."'Upbell~
9.
Clark, Ccn!;:;t.:;mce. and EJ:Lzabr;th Bayley.
''Eva.lu.a·tion
of ·tl1e TJst~ () .f Procr:t::·a IDitlCC1 Ir: s t.r·u (!T:~iC.'.rl ~fc) r P i:t i:.i.E~r.l t ..f3
10 Af!1l'!:rican ;ro1..1..r·y13.l
tJ1air.ta1 ne•1 on WaTf;;,.rin The:ranv,
- ,..
__
---a_._
f 'P '"b '! .: ., ":r
1 1- 1. .-:: ? . 1 1 ":l !.:; •.,. 1 ~ -:: q
-. '.,..11 ,.. ,_
~ q '7 '1
0---:.....::.---=.::::...~.~
.....:..::~:::~..:.:-_:-.:::./
., ._, • .-.~. ~
~~·.
h \..;.. ;:. - ~ ~· II
11
Donald T.
I"a.ctors ?..el.e1.•ar.t to t.he
Va,lidity cf Experiments in Socia}_ Set.t:.ings i"
Ps·yc1l91~gj.c~l_:3~;_le~:!:in, 34:297-3:.2, ,Ttme~ 1957.
,_,.,---~--·--,--.,.,_a
0
.,J
.10
~
C~opp,
I;a'tJ:t·t~l.
;~
..
19~481--183,
11.
,.,...,.,.~--·~
"
.-.'"""'
n'The \.Vaitina :«oOJ:iL
July~·
19 'j:i_.
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..J.. , ,
,.
w
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I
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NT~r.si:o.cr O<~i:louk r
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Cross, .Joc.nne E.,- a11d Car0J R. .::-c:u::sons.
"N·u:;:-se,..,
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.:.:::l
rl G~oa·
.-..~ ,..~.......... t:ed
;>.,-t,lr~.:.n:::
.. c ...-ml
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• 1 ·-L'.,;...~;;:;:._
.l"'·'-- E~ac,h,;
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t1oti ""lat:e C~har:ge in Fbocl ~::lelec·til)t1 Be"t::.<lvi.o.r o£
U ~ .... ·1' ·t
1 ; ,...,. e rTI a f- ~ e· r· 4- c..-r .. 1" n·rr' -p·Ci c: :~ <~ ··r·.-.l;
r..~·St-~- a ........ ., a ;:
-·" l t ·-·, n "l\T1,
~~_,;L_::;;:.::::~:::.::-..::·_~:::..:.•·
20 ~ 454-45 8, Se.pte:mbe:r:-October, 19? 1.
'Y"
52
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53
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o
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o
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··--------·--·- ________ .......... ·--·------------.------,
"'
1
12.
De La Vega, Margr:.eri te .
"Nevt Focus· on the Hospital
as a Health Education Center," Hospitals, 40:78,
16~
July
13.
1966.
i
·
l
Dixon, Wilfrid J., and Frank J. Massey, Jr.
"Introduction to St.atlstical h1~al vsis .
2d ed.
Ne~1 York: McravT-Hlll-Book ·company;--Ers 7.
I
i
Dodge, Joan S.
"Nurses' Sense of Adequacy and
Attitudes Toward Keeping Patients Info:t.lited 1 n
Jcurnal of Health EJ.nd HU:.'!,an Behav.ior 1 2: 213·-216,
19
2.5.
6~---------------------
---~--"Factors Related to
-f= Tl11"'1~
('r."'-rli
T:,re,:-.,llc.
0 .1.... - .. -... .J..
--".:1- ...... ...1_.·i-,ro
\! · .·l
..... '-A.;:J 1 "
Pa.tien·ts 1 Percept.ions
1'1t'I·ll.,~"'.:.,.lq
~ .._,.J...;;,
_
T'pr..::ea--r·'h
. . .\. ..... -· · L -.t g
18:502-.513, November-December, 1969.
i
I
j
I
I
16.
I
Egbert, La':ri·rcnce D., Iv!.D., and others.
"'The Value of'
i
the Preopera·ti ve Visit by an Z:'mesthe·t.ist, n
Jou:r.:na~l of ·the American r~edical Association 1
... ~ ~;c:·. . ~-s- ·5 1 A11g'-,~-~1-.., f _l96':l
·---...18 _:; "..,.~ - l . . ) - ...J
.,
v~
L..
17.
...J •
Haferkorn ~ Virginia.
n Assessing I!1di vidual Learning
Needs as a Basis fo:r Patient Teaching,"
Nursin9 Clinics of North A.rnerica, 6! 199-209 Y
£-·I arch 1
18.
. J
i
9 7 i-~-----·---
Healy, Kathryn M.
"Do(?.:2 Preoper:3.ti-;/c. Instruct.ion
!Jlake c. Dif£crer1ce, 11 Amer.ican Jo•J.rD.al of Nursinq,
68:62-67, ,J.=-.tn1Jary 1 1968.
19.
20.
21.
Janis r lrving I,.
PE::_ychoJ:::igi_cal__~l!::.:¥2...:.~.:
Joftr... f''t:tl.y ar1d Sor1.s, In.c., 1958, Pf:·,.
Nevl York:
352~-375
..
Kasey 1 Elizaoeth, a.-.:1d Elizabeth ~1cK~.ha·n
11
Educat:i0n as 2 i".Ji ving Process 7 " Hc~alt:..h. Educar.io;;l. in thG Eosr:d. tal, Ci1icaqo ~ -i1_rii8r1ca.n
t.l"'~-.-.;.;:··.:;1-·-;--:::;-;;-::-r~.:. -·- ~~--,:.--~ 9 (' o:;
.a; •....,~._;.p...~. . . . v....-k,
.i.~s~:-CJ ......~~B~\.....~~o.b.~, t
.1. "'J-' ..
o
K.cysan 1 Gerrr.ai!.;-3 S.
n.i?ro~~-rar,mted Self-InrrL:r:;lction-Its Use ir. Pat:ient Educab.. on, '' 1-!.NA Clinical
C::c> c.• ... -1 L··•rJ
~T,, '.l.r<-; .....
·,•}c· ••
A,...-~
..·1 c.·•-,.,-..- __ ,-.;;-!.; i-··1·•-y-•""';..-o-4f"
R_·:::.S... fl
!:..·.-::
J.. ...... i::),
1967.
' - ' ' - i:)l::\.1.~
·_:,_-.1_
--\V'
-
.-~,;.,.I..... .;J..'>
_. .......l,. .... !,.,..
.,&...
'\..~..t..
Fat.i.ent as 2. Health
44:75-80, March 16, 1970.
23.
Levine:, D;.1.le C"' an:1 ,:ru..n.e P. Fiedler.
~'.FGars, Pacts
and Fantasies Abo·,xt Pre and. Pos toperat. .:L ve Care 1 ~~
Nl..1Y-"sir:o Out.lcoi.-:,. I8:26·-28, F,ebru-3.:L"Yt 19?0.
·--·------..._
~-:o\0:.. -~--------
I
54
;-----·---------------·-·---------·------------------------.-----------:....---------------------------------------11
1
-~
24.
rf e~-t:Lveness.
·
'1 _E ff 1~1ency
· ·
•
LJ.ndemar:.,
Caro .,. . A: . " E.:~
anu.
of
Group and IndlvlduaL ~reoperatlve ~eachlng-- ,-..1-,ase
I I 1!- Nu·rs·J·
'"'g RP"'e·a--v·ch-••I 20
• "'..t, 9-3")'1
.C-1.J--••
•...)
"
Auaust 1 1971.
I~
w.~
!1
~~!,.
•
-•'":,');
,.~
J.
.JL.. I
i
ulv-
J
I 25.
i
•
"Nursing Intervention VTith the Presurgicali
----Pat1ent," Nursing Res_earcl!., 21~196-210, May-June,·
1972.
"Audiovisuals Orient. Patie::1ts,
----47': 129-130, Narch 1, 1973.
26
•"·~
,.._' .•'
-
~
11
Hospitals
11
Linehan, Dorothy T.
\'Vha.t Does the Patient Want to
11
Kno•,v?
American Journal of Nur-sina, 66:1066------------"'1075, MaY,- 1966.
2 8.
Hausch, Hans 0. , Ph.D.
''Paradoxes in Hospital Carf:;
and Ec:u.cation 1 " Heal·th Edt:cation in the
Hospital.
Chicago: Arr\erice:m Hc)sp.ital
Associ~~tion, 1965.
29.
HcCcne, Carol.
30.
"Preadmission Patient Teaching
Nurse, 69:39, f3epternber 1
Tb.e~~~~.dian
Clinj_c,."
1973.
Mico, Paul R.
Hospitals
for Health Education in
Heal·th Education in !V1edica1 Ca!:'e:
"I:mpl:Lc&.tic~n
f"
Needs and Opportunities .~-Berkeley!-un.:CversTty
o:C Cai:i.T6i·n.Di--Scho-of-o£ Pll1.'11ic Health, 19 62.
31.
11
Nield, Narga.rei.: Ann.
The Effect of Health Teaching
qn t~he AnxiGty Le\781 of Pa·ti.en ts :,•Ji th Chronic
11
Obs·tru.~tive Lung DiseaDe,
Nursing Research,
20 ~ 537-54J., November-December, -i-;71, ·
32.
Nurses.
Personal Interviews,
J~ly
17, 1972.
?er.sonc.1 1i'7ri.tten St2t.eme.nt., r!Jay,
33.
Pe..tient.
Personal Interview,
Octohe~
1973.
15, 1972.
35.
Header r Geor<JB G.
a7!.1 Doris Sch\vartz.
"Develcpin.g
Patient.s' Knm·?ledgr.'.:! of Heal·th ,. " l'iosp_:i-t:_als_,
47:111-ll4r March 1, 1973.
36.
Redman? Barbara :(. Process of Patiet1t Teachi.na .in
Nur.sina.
St. Louis:
C. V. M.:Jsby· Co., 19 6 8.
j
- • s _ _ _ _ ::;.
Sch1.esinger. rr David A.
4.7:1.37-140: April
'
~.~_.,.,_ -• •-c~~~·-~·~-u~-~~ ·~-·• ··~··--•-~ •·--a·-·-· -~·•- ·---•
••>"·--•••
---~- -~··
--~-
·--·•·---
·---~··••
.,. o•r• •••
·•-~·---
•-
0-0~H~·-·--•-• '"-"'•-·~-•-•••-'•••••----·--•••-•·•••- ••-•-•'-•' -~·~·-~
0'•
55
~--··
!
l
··---·-·--··-·----···-·-·--·----------·-·--------·--·----
38.
Skif:f., Anna.
--·---··--·----·--·----·-------~
"Programmed Instruction and Patient
~·eaching, :• Arrierican Journal of Public Health I
55:409-415, -i1arch;J:"-~rE55.
1
----
39..
Skipper, -James K.
"Communication and the
Hospitalized Patient,n Social Interaction and
Patient Care, eds.
J.K. Sklpper and R.C.
Leonard·-.-Philadelphia: J. B. I.ippincot·t
Company, 196.5, pp. 61-92.
'~
Storlie, Francis.
"A Philosophy of Patient
Tea9hing,~ Nursing Outlookr 19:387-389,
Jun~, 1971.
...f',,; .-
~
.;t]..
Et.cuffer, Sa.muel A.
"Some Obse:;:.·vations on Study
Design," zunerican Journal of Socio1og_y 1
55:355-361, January, 1950.
42.
Wood, Lucile,. and others.
"How Well Do You Teach
Your Patients?" Los A.Ylgeles:
Unpublished Paper,
Septembe:c 22, 1971.
(Xeroxed.}
43 .•
Young¥ Harjorie A. C. _;13~vJE"::t!_Q..~ Rese~.rch ang_ __§.:~-~.::1~~~Re.la·t.ed t.o Health .Education Practice (1961-·
r966l-=--~Paticnt-Edu.caticr1-:·--ilealt:hEducatl.on
} ( ; - srf:· (owe ll. S , Levin o
New·
Socie·c.y of Public He<:::.l th Educators, Inc.,
Nconogiapli·s 1 NG.
York •
1968.
i
:
'
APPENDIX A
QUESTIONNAIRE USED AT UCLA HOSPITAL
56
57
PRE AND POST-OPERA'.I'IVE INFC:l:u'1i\'.I'ION QUESTIONNAIP.E
CIRCLE THE BEST ANSWER FROM THE FOUR CI-IOICES FOLLOWTNG
E:l\CH S'l'ATEMENT •.
1.
The blood tests ordered by the doctor before surgery
will help him better understand
@
b.
c.
d.
2.
Your general health.
If your kidneys are working properly.
If you need blood transfusions.
If your gallbladder is working properly.
A urine test is usually ordered before surgery to
indicate
a.
b.
•~c·
\:..
•J
d.
3.
The amount o£ fluid your body uses.
Your general health.
The general health of kidney function.
Any present illness.
If an x-ray exam of the gallbladder is ordered for you
in the morning, you sh0uld not eat anything or take
fluids after
a.
b.
6:00 P.M.
8:00 P.M.
10:00 P.Iv:t.
12:00 midnight.
4.
When you sign the surgica1 consent 1 you are indicating
that
a.
You are r•2ady to go to surgery.
Your dcctor may perf0r:m the specific surgica,l
c.
d.
You are satisfi0d with the results of your surgery.
You hzcve not. had any !Tl.~lre food o:.::· fluids to e::1.t.
@
5.
opera~ion
expl~in?d
to you.
\AJ'hen the r1u1.. se t~:.lls yot~. tl1a.t:
midnight, this means th<J.t
a~
b.
c.
(<.'
f:\
~-.:;;
y~.:>tl
.are
·~1.P.,O
..
a.fter
You cannot (:;at or drink anything for 24 hours
tefore your surgery is scheduled.
You can drink anything after midnight.
You can eat anything after midnight.
You ca.nno·t eat or drink anything after midn.ir;h t.
58
6.
Ih the pre·-operative prepa.rat1on {"prep") of the
operative site, the hair on the skin's surface is
shaved
a.
c.
d.
7.
It is reconrrnended that the family
a.
b.
d.
8.
.......
d.
@)
Tell him your allergies, if you have any.
Ask questions about your surgery.
Ask questions, if you have any, about the
anesthetic to be used.
l'"l.ll of the above.
Personal care immediately before going to the
operating room shou~Lcl include ?ll b~~!
.,
0.,
@
c.
d.
11.
Doctors are nearby in surgery if needed.
You need to sleep.
It is easier for the nurses •
Your room needs to be cleaned.
When the doctor visits you to review your personal
history, it is impor~cant ·to
a.
b.
c.
10.
Stay away from the hospital until surgery is
completed.
·
Call the hospital frequently to check on the
patient.
Be available in the waiting room before and
during surgery.
Wait at home until called by ·the hospital.
You are taken to a recovery room instead of your
own room after surgery because
vb.
9.
Because i t will make the operative site more
visible.
Because germs cling to the hair.
To make the skin smooth.
To draw the skin tight.
B~cushinq b:.ce th. and removing chewing gum •
Fixing you~ hair in place.
Removal of artificial objects, as dentures,
contact lenses and wigs.
Removal of maJ::e·-up and nail poli.sh, if any.
As ~ou wake up from surgery you will notice a
soft tube coming out of your nose, which
a.
b.
c.
6'1
~
Is used for feeding.
Is used for medication.
Helps you. to breathe easier undt:~r th<~ anesthetic.
Mildly sucks out digestiv~ juices to give your
stomach a rest..
59
12.
After surgery you will notice a I.V. with tubing and
a needle going into an arm vein.
You
~
b.
c.
d.
13.
You may have a cat.heter (soft tube) temporarily
inserted into your urinary bladder
a.
@
c.
d.
14.
a.
~
b.
c.
@)
Drink plenty of fluids to flush the anesthetic out
of your system.
Put your call light on for the nurse.
Try to empty your urinary bladder.
Cough and deep breathe to prevent the accumulation
of fluid in the lungs.
Keep your muscles working.
Help the nurse.
Make feeding easier.
Make the medicines work better.
The best way to help your body regain strength after
surgery is by
a.
b.
<Q)
d.
18.
Change i t as often as necessary.
Keep the bedsheets from touching i~.
Tell the nurse if it feels damp.
Try to avoid lying on ·that side.
After surgery your doctor will want you to start
moving around to
c.
d.
17.
stop the urine from flowing out.
that the urine will flow Ollt: automatically.
allow medication to be given.
train you to urinate.
As soon as possible after you wake up from the anesthetic, you should
a.
16.
•ro
So
To
To
After surgery you may find a dressing over the
incision.
You should
b.
15.
Should keep your ann as still as possible.
move your arm freely since it is well padded
and bandaged.
·will have to be flat until the I. V. is removed.
Should not wiggle your fingers.
~lay
Getting as m'..lch sleep as po..:;sible.
Lying quietly ~ithout much moving around.
Cornbining rest and sleep '>'ii t~1 exercise.
Not tiring yourself too much t,vi th visi·to:r-s.
•rhe amount of pain you will feel after surgery is
directly related to
60
a.
b.
c.
@
19.
If you should have severe pains in the incision after
surgery, you should
a.
b.
~
20.
®
®
c ..
d.
b.
By taking a pain medication.
'rhrough body movement and exercise.
By lying quietly.
·rhrough surgery.
Nove fingers, hands, arms,
t.oes 1 feet and legs
(unless restrained by I.V. apparatus).
Feed yourself.
Bathe yourself.
All of the above.
As you get better, your digestive system begins to
work aq.J.in and
b.
c.
('(i)
'-.-/
24~
An indication that your body needs food.
Not a normal thing.
An indica·tion that your digestive system neeas
rest.
A normal sign of recovery.
Aft.er ·the operat.ion, you will be allowed t.o
a·.
23.
and bear it.
a •,.:hile to see if the pains go away.
your nurse right away.
your farnily.
The best way to relieve gas pain is
a.
22.
Grin
Wait
Tell
Tell
Gas pains may occur following abdominal surgery such
as yours.
This is
a.
b.
c.
21.
Your fears of surgery.
Your fears of sickness.
Your worries of hospitals in general.
All of the above.
You can order v.;hatever you like to eat.
You wiJ.l begin 8ating solid foods.
You will remain N.P.O. to aid in healing.
You will begin eating clear fluids as ordered
by the doctor.
\"lhen th.e urinary catheter is removed
a.
@
<.
C•
d.
It is not normal for your urine to be reddish
when you .first urinate.
You \.vil1 be able to u.rina·te on your own now.
You should drink less fluids.
Your u:r::Lne won't need to be measured and checked
anymore.
APPENDIX B
QUES'l'IONNAIRE USED I\.T
SHU VALLEY ADVEN'riS'l' HOSPITAL
61
62
PRE
.A~JD
POST-OPERATIVE INFO:P..MATION QUES'riONNAIRE
INSTRUCTIONS:
1.
Please mark an "x" for what I thought when I
first came int9~~e hospital.
2.
Hark an non for wha"\:_!__thought a few days after
~1av j_ng surgery.
3.
If you received an information booklet, mark an
qO" for what I thought after reading the bookl.et.
63
1.
The blood tests ordered by the doctor before surgery
will help him better understand
a.
b.
c.
d.
2.
A urine test is usually ordered before surgery to
indicate
a.
b.
c.
d.
3.
c.
d.
b.
c.
d.
You cannot eat or drink anything for 24 hours
before your surgery is scheduled.
You can drink anything after midnight.
You can eat anything after midnight.
You cannot eat or drink anything after midnight.
In the pre-operative preparation ("prep") of the
operative site, the hair on the skin's surface is
shaved
a~
b.
c.
d.
6.
You are ready to go to surgery.
Your doctor may perform the specific surgical
operation explained to you.
You are satisfied with the results of your surgery.
You have not had any more food or fl11ids to ea:t.
When the nurse tells you that you are N.P.O. after
midnight, this means that
a~
5.
'J:he amount of fluid your body uses.
Your general health.
The general health of kidney function.
Any present illness.
When you sign the surgical consent., you are indicating
that
a.
b.
4.
Your ge~eral health.
If your kidneys are working properly.
If you need blood transfusions.
If your gallbladder is working properly.
Because it will make the opera·tive site more
visible.
Because germ~ cling to the hair.
To make the skin smooth.
To dl:aw -t:l1e skin tight.
It is recommended t.hat the family
a.
b.
c.
d.
Stay away from the hospi ta.l un+..:.il surgery is
completed.
Call the hospital frequently to check on the
patient.
Be available in the waiting roorr:. before and during
surgery.
Wait at home until called by the hospitaL
64
7.
Yo·u are taken to a recov·ery room ins·tead of yotlr ov:n
room after surgery because
a.
b.
c.
d.
B.
When the doctor visits you to review your personal
history, i t is important to
a.
b.
c.
d.
9.
d.
Is used for feeding.
Is used for medications.
Helps you to breathe easier under the anesthetic.
I-lildly sucks ouoc digestive juices to give your
stomach a rest.
After surgery you will notice an I.V. with tubing and
a needle going into an arm vein.
Y8u
a.
Should keep your arm as still as possible.
b.
May move your arm freely since it is well padded
c.
and bandaged.
·
Will have to be flat until ·the I. V. is removed.
Should not wiggle your fingers.
d.
12.
Brushing teeth and removing chewing gll!-n.
Fixing your hair in place.
Removal of artificial objects, as dentures,
contact lenses and wigs.
Removal of make~up and nail polish, if any.
As you wake up from surgery you will notice a soft
tube coming out of yon:r: nose, which
a.
b.
c.
d.
11.
Tell him your allergies, if you have any.
Ask questions about your surgery.
Ask questions, if.you have any, about the
anesthetic to be used.
All of the above.
Personal care immediately before going to the operating
room should include all but
a.
b.
c.
10.
Doctors are nearby in surgery if needed.
You need to sleep.
It is easier for the nurses.
Your room needs to be cleaned.
You may have a ca.·theter
{soft tube) t.emporarily
inserted into your urinary bladder
a.
b.
c.
d.
To
So
To
To
stop the urine from flowing out.
that the urine will flow out automatically.
allow medication to be given.
train you to urinate.
65
13.
After surgery you may find a dressing over t.he
incision.
You should
a.
b.
c.
d.
14.
As soon as possible after you wake up from the
anesthetic you should
a.
b.
c.
d.
15.
you:c muscles working.
the nurse.
feeding easier.
t.he medicines work bett.er.
Getting a.s much sleep as possible.
Lying quietly without much moving around.
Combining rest and sleep with exercise.
Not tiring yourself too much with visitors.
The amount of pain you will feel after surgery is
directly related to
a.
b.
c.
d.
18.
Keep
Help
Make
Make
The best way to help your body regain strength after
surgery is by
a.
b.
c.
d.
17.
Drink plenty of fluids to flush the anesthetic
out of your system.
Put your call light on for the nurse.
Try to empty your urinary bladder.
Cough and deep breathe to prevent the accumulation
of fluid in the lungs.
After surgery your doctor will want you to start
moving around to
a.
b.
c.
d.
16.
Change i t as often as necessary.
Keep the bedsheets from touching it.
Tell ·the nurse if i t feels damp.
Try to avoid lying on that side.
Your fears of surgery.
Your fears of sickness.
Your wo~ries of hospitals 1n gelieral.
All of the <::bmre.
If you have severe pains in the incision after
surgery, you should
a.
b.
c.
d.
Grin and bear it.
Wait a while to see if the pains go away.
Tell your nurse right away.
Tell your family.
€6
19.
Gas pains may occur following abdominal surgery such
as yours.
This is
a.
An indication that your body needs food.
b.
c.
Not a normal thing.
An indication that your digestive system needs
rest.
A normal sign of recovery.
d.
20.
The best way to relieve gas pain is
a~
b.
r<
-·
d.
21.
After the operation, you will be allowed to
a.
b.
c.
d.
22.
Move fingers, hands, arms, toes, feet and legs
(unless restrained by I.V. apparatus).
Feed yourself.
Bathe yourself.
All of the above.
As you get be"cter, your digestive system :begins to
work again and
a.
b.
c,
d.
23.
By taking a pain medication.
Through body movement and exercise.
B·:l';l·
na
e{-ly
.};
..1
-·:J ,.,"l.
~:l.u.
_._.
•
Through suzgery.
You can order whatever you like to eat.
You will begin eating solid foods.
You will remain N.P.O. to aid in healing.
You will begin e~ting clear fluids as ordered
by the doctor.
When the urinary catheter is removed
a.
b.
c.
d.
It is not normal for your urine to be reddish
when you first ur ina·te.
You will be able to urinate on your ovm now.
You should drink less fluids.
Yom.: urine \·Jcn' t need to be measured and. checked
anymore.
APPENDIX C
PATIEN~r-'rEACHING
GUIDE:
CHOLECYST'ECTOHY
P]),P.T II:
FRS-OPERATIVE PP.EPARl"\TICN AND
POS'l'-OPEHNI'TVE CARE
67
PAR'l' II:
l?RE-OPEHATIVE PREPAR.:'\'l'ION AND POST-OPERATIVE
-
·-"-·-----~--
Cl~H?.::
-
YOU HAVE BEEN l'iDHI'l''l'ED iJ.'O rl'HE HOSPI'I'AJ... TO HAVE
SURGERY.
HELP ANSWER SOf.'lE OF 'l'HE QUESTIOW3 YOU HAVE ABOU'I' YOUR SURGERY.
THESE CARDS MAY
A GENERI\.L ROUTINE IS USED
IN THE HOSPITAL TO PREPARE YOU FOR THE SURGERY AND ·rHE CARE YOU \IHI,L RECEIVE AF'l'ER THE
OPERA'T'ION.
(YOUR DOCTOR MAY CHANGE 'I'IIEi'1 ACCORDING TO YOUR NEEDS OR 'I'HE HOSPITAL POLICY.)
;1'0 HELP YOU UNDERSTAND '..:::'HE PROCEDURES, THEilt PURPOSE, AND WHA'.r YOU WILL BE EXPEC'l'ED TO
[;() 1
'I'HE FOLLOHING CA.HDS Hl~VE BEEN PREPARED.
WILL BE GLAD
•ro
YOUR NURSE
ANS'irER l1.NY QUES'l'IONS OR CT... P~RIFY ANY POIN'I'S WHICH YOU DO NOT GNDERSTl"\.ND.
YOU CAN PROCEED
PUT ON YOUR CAIJL
UPON COMPLE'riON OF 'l'EE CARDS,
~::'HHOUGH
LIC~HT
THE CARDS IN ANY ORDER.
\vHEN YOU HAVE F'INISHED THE CARDS,
AND ASK FOR YOUR NURSE,
<S'i
00
LI[3'l'ED DEijOW A!·(E
{A)
CO~l!-10N
'J:HEY ARE; BEING DONE.: AND
(C)
PROCEDURES WHICH WILL BE DONE FOR YOU~
(B)
WHP.T ACTIONS WIL.r... BE EXPECTED FROM YOU.
THE REASONS vJIIY
AT THE COMPLETION
OF 'l'HE CARDS YOU SHOT..JI,D BE l\BLE 'I'O LOCJ>..TE 'I'HE CORRECT RESPONSE FROM 'I'HE · CARDS WHEN YOO
.Aim QUES'riONED
SI'I:'UATION
l~BOUT
THE SITUATION OR WHEN THE SITUATION AC'rUALLY OCCURS.
(PP.OCEDURE)
H.EASON
EXPECTED ACTION FROM YOU
--~--~,------------·--
I •
DOCTOR' S ORDERS
JL
LABORATORY TESTS
1.
2.
BLOOD--Cm.-!PI,ETE BLOOD
COUN'l' (CBC) ;
HEMOGLOBIN (HBG) ;
HENA'I'OCRIT (HC'l')
URINE
GIVE A BLOOD SAMPLE TO THE
INDICA'T'Q3:{S OF
GENERA.I... HEAL'l'H
LABORATORY TECHNICIAN.
S~MPLE
IS USUALLY TAKEN FROM VEIN IN
ARM.
INDICATION OF
GIVE A URINE SAMPLE TO THE
GENEf'.JI.L HEAL'l'E
NURSE.
OF KIDNEY
FUNCTION.
a.
"'
SITUATION (PROCEDURE)
B.
EXPEC'l'ED ACTION FROM YOU
REASON
X-RAY EXA.r-iiNA'riON
l.
2•
CHEST
GALLBI,I..DDER ( OPTIONAL:
THIS TES'I'
HAY HAVE BY:::EN DONE
ON AN OU'.r-Pl\.TIENT
BASIS BEFORE
AD!JliSSIO!J 'l'O THE
HOSPITAL}
INDIC.P<.TOR OF' HEALTH
YOU \AHLL GO TO THE X-RAY
OF LUNGS
DEPARTMENT FOR X-RAY 'I'O BE
TAKEN
DEMONSTRA'I'ES CURRENT
FUNCTION AND SIZE OF
1. WILL EAT A SPECIAL FAT-·FREE
DIET, 5 TO 6 P.M.
(P.M.
BEFORE TEST, NO OTHER FOODS
SHOULD BE TAKEN)
GALLBLADDER
2. TAKE 6 GALLBLADDER DYE PILLS
(SO GALLBLADDER WILL SHOW
ON X-RAY)
3.
5 :tvliNUTES APART
EA'r NO BREl':>.KFAST THE
MORNING OF THE TEST
4. TAKE NO FLUIDS OR WATER
AFTEfo.:.-12 MIDNIGHT, AND NO'r
UNTIL X-RAYS ARE T.P<.KEN
RE.MEMBER!
FOODS OR FLUIDS TAKEN AF'l'ER MIDNIGHT CAN SPOIL THE X-F.A.Y PICTURES!
-..1
0
REVISION:
CT"'('fA·'fiO"~
~_::_!_._:...
. L'J
B.
THIS PAGE USED A.T SIMI VAJ... LEY
J.
EXPECTED
.
. ACTION FROM YOU
EXl~HINA'X'ION
CHES'l'
{IF' ORDERED
B''l 1)1-JV<)Ir'T'·'-,1)
J:
.J.. t-....
INDICATOR OF HEALTH OF
LUNGS
GAI~LBLADDER
DEMONSTRATES CUP-RENT
J.
2•
ONLY
REl-..SON
('T>RO"'E'T"'"UP''?)
I
•
\..•__::___:::;_~
X-RAY
HOSPITAI~
\.,;~
B.E TAKEN
tlL.~
(OP'TI0~1AL::
'F'OR
GALLBLACD:t:E Sl.!RGERY :P.ATIEN'.f'S--
YOU WILL GO TO THE X-RAY
DEPARTMENT FOR X-RAY 'I'O
l.
FUNCTION AND SIZE O:B'
GA!..LBLADDER
~HLL
EA'r Z... SPECIA.L J?A'r-FREE
DIET; .5 TO 6 P.M. (P.M.
BEFORE TEST, NO OTHER FOOD
SHOULD BE TAKEN)
'J'HJ.:S TEST M2\Y
HAVE BEEN DONE
ON AN ,)UT·-P.!\'TIEN'J:
AnMISSION TO l'HE
B.ASIS BEFOl{8
2.
TAI~E
6 G.ALLBLADDER DYE
(SO GALLBLADDER WIIJL
SHOW ON X-PAY) 5 MINUTES
APAR'.r
PILLS
HOS PI 'f'AL)
3. El\'I' NO BREAKFAST rrEE
~10RNING OF THE TES'l'
4. TAKE NO FOOD OR FLUIDS
.i\F'I'ER 12 MIDNIGHT, AND
NOT UN'J'IL X RAYS 'l'AKEN
REf-1EMBER!
FOODS OR FLUIDS TAKEN AFTER MIDNIGHT CAN SPOIL 'rHE X-RAY PICTURES!
·...J
J-1
Sl'l'UA'l'ION
C.
(PROCEDURE)
SIGN SURGICAL CONSENT
REASON
EXPEC'rED ACTION FROM YOU
1. PROVIDES AN OPPORTUN'ITY TO EXPLAIN THE
SURGICAL PROCEDURE
TO BE PERFORMED
1. READ THE CONDITIONS ON THE
CONSENT FORM CAREFULLY
2. TO OBTAIN YOUR
WRITTEN CONSENT FOR
YOUR DOCTOR TO PERFOR1'1 THE SPECIFIC
SURGICAL OPEP..ATION
2. SIGN CONSENT IN PRESENCE OF
AU'l'HORIZED WI'l'NESS (USUP..LLY
A NURSE OR DOCTOR)
.._J
N
S I:£g{~~~ ON J.P ~.QCED~"RE)
D.
PRELIMINARY PREPARlJ.'.riON
OP OPERATIVE ;3I'l'E
( CO~.J-10NL Y CALLED A
II
n·q·•·•p
.1::" !\J:;
REASON
1. HAIR SHAVED ON SKIN
SURFACB-·--GEID-18 CLING
•.ro HAIR
li)
EXPEC'IED AC'riON FROM YOU
1. PERMI'I' NURSING PERSONNEL TO
SHAVE PRESCRIBED AREA.
2. CLEANSE SKIN WI'rH
2. FOLLOW ADDITIONAL ORDERS FOR
SURGICl\.L SOAP AND
CLEANSING IF GIVEN r E. G.,
AN'I'ISEP'riCS TO MAKE
SHOWER AND SHAHPOO WITH
SKIN AS FREE OF GERMS
ANTISEPTIC SOAP
AVOIDS
1\S POSSIBLE.
G:E'I'TING AN HlFECTION
IN 'l'HE SFRGICAL WOUND
(COT) •
E.
NOTHING
BY J:-10UTH
(PREQUi~N'l'LY STATED
N. P. 0.)
AS
AFTER :t--1IDNIGHT
l.
•ro PREVEN'r LIQUIDS
AND FOOD IN S'rOMACH
DURING AND APTER
SURGERY
1. AVOID TAKING ANY LIQUIDS OR
FOOD SUBSTANCES AFTER PRESCRIBED HOUR, E.G., AFTER
!vliDNIGHT IF' SURGERY IS
SCHEDULED THE NEXT A.M.
2. 'rUE AITSSTHETIC SOMETIMES CAUSES VOMITING
AF'l'ER SURGERY.
IF
F'OOD OR FLUIDS ARE IN
S'l'OJv"JA.CH, 'rHEY r.mY BE
ASPIRA'I'ED (SUCKED)
IN'l'O LUNGS I C.AUSING
ONE TYPE OF PNEUMONIA.
-....l
(_.,_,
§._!_TUl:TION
II.
(PROCEDURE)
REASON
EXPEC'I'ED ACTION FROM YOU
GENERAL HOSPITAL SURGICAL
ROU'IINE
A.
DOCTOR VISITS
1. TO TAKE A BRIEF
PERSONAL HISTORY
1. TELL HIM YOUR A.LLERGIES I
IF ANY
2. TO PRESCRIBE A
SLEEPING PILL AT
2. ASK QUESTIONS IE' YOU HAVE
1UN ABOUT THE ANESTHETIC
BED'riME.
I'r IS
GOOD TO GET A GOOD
:LGGH'l' OF REST.
3. TO PRESCP.IBE PRE-OP
MEDICINE IN A.M.
BEFOHE SURGERY SO
THAT YOU WILL BE
Dl<OVJSY
A.i~JD
3. TAKE MEDICATION AS PRESCRIBED AT BEDTIME OR IN
A.M.
RELP,XED
IN ORDER TO GET THE
MOS'r m~~NEFI'l' FROM
·rrm
Jl.NE~3THESIA
4. fESet.mS 'l'HE ANESTHETIC
HE EXPECTS 'I'O USE
4. RELl\.X AFTER T.AKING ~1EDICINE
TO GET MOST BENEFIT
~J
.!:»
RJ:i":VISION:
SITUATION
ll.
'riiiS PAGE USED AT THE SIMI VALLEY HOSPITAL ONLY
(PROCEDURE)
REhSON
EXPECTED
ACTION FROH
YOU
.
.
GENERZ\L HOSPITAL
SURGICAL ROUTINE
A. DOCTOR VISITS
YOU MAY BE SEEN
BY SURGEON
l'iNESTHESIOLOGIS'l'
CONSUI....'I'ANTS
1. TO 'TAKE A BRIEF
PEHSOW'-_L HIS'I·ORY
2. TO PRESCRIBE A SLEEPING PILL .i\'1' BEDTIHE.
IT IS GOOD 'T'O GET A
GOOD NIGHT OF REST.
3. TO PRESCH.:::BE PRE-OF
MEDICINE IN A.M. BEFORE
SUR.GERY SO ~l'HAT YOU WIIJL
BE DRO\VSY AND HELl\XED IN
1. TELL HH1 YOUR ALLERGIES
IF 1-Ji!Y
F
2. ASK OUESTIONS IF YOU HAVE
J>.NY ABOUT 'THE ANESTHETIC
3. TAKE MEDICATION AS PRESCRIBED AT BEDTH1E OR IN
A.M.
ORDER TO GET TI-IE HOST
EENEFI'l.' F:R.Oiv1. THE ANES'l·I{ES Il\
4. DISCUSS 'l'HE ANESTHE'I'IC
HE EXPECTS TO USE
4. RELAX AFTER TAKING MEDlCINE 'I'O GET HOST BENEFIT
~...}
tn
SI'rUA'riON
B.
(PROCEDURE)
-REASON
EXPEC·rED 1\CTION FROI•1 YOU
----
VISITING HOURS FOR FAMILY
1. '1'0 HAVE FAMILY NEARBY
1. INPORM FAMII,Y THEY CAN BE
WHEN YOU OR 'l.'HE DOC'rOR
'I'HEH.E THROUGHOUT THE DAY
ON DAY OF SURGERY, USUALLY
AT LEAST 2 HOURS BEFORE
NBED THEM
SCHEDULED AND JI.S NEEDED
'rHROUGHOT.JT DAY J>_ND NIGHT
2. TO HAVE THEM AVAILABLE 2. THEY SHOULD A.RRIVE 1~ TO 2
FOR CONSULTATION
HOURS BEFORE SURGERY Sil'·lCE
YOU WILL BE EXPECTED TO
REST AFTER YOU RECEIVE
YOUR MEDICINE (USUALLY
ABOUT 30 to 60 MINUTES
BEFORE GOING TO SURGERY)
C. FAMII,Y Y.JAI'riNG ROO~~
.AND REGULATIONS
1. PROVIDE COMFORT AND
PRIVACY WHILE YOU.
ARE I'N SURGERY AND
RECOVERY ROOM
2. PROVIDES A CEN'l'RA.L
LOCA.TII)N SO 'l'HNL'
DOCTORS AND NURSES
CAN l<~IND YOUR FAMILY
IF NEEDED 'J:O REPORT
YOUR PROGRESS
1. TELL YOUR FAMILY THE
LOCATION
2.
REQUEST 'l'HAT THEY REHJUN
IN 'rHE WAITING ROOM. UNTIL
'J'HEY HAVE SEEN THE DOC'I'OR
AFTER SURGERY IS FINISHED
·....J
(1;
§liTt0~}:0N
(PRO<:_::EDURE)
D. TRANSFER FRON SHF.GEFY
TO RECOVERY ROOM
RJ.!!ASON
1.
USUALLY NEAR '.rHE
OPERATING ROOM:.
LITTLE TIME IS LOST
IN
EXPECTED ACTION ..:B ROM YOU
1
1. KNOW WHERE YOU WILT... BE
GOING
TRANSPOR~RION
2. DOCTORS ARE NEARBY
IN SURGERY IF
~EEDEn
2. INFORM J:i'AMILY YOU WILL
REMAIN IN THE RECOVERY
ROOH UNTIL YOU WAKE UP
3. DO NOT BE FRIGHTENED WHEN
YOU WAKE UP IN STRANGE
SURROUNDINGS WITH ~ANY
DOC'rORS AND NURSES .A. ROUND
4. KNOW THAT YOU WILL RETURN
TO YOUR ROOM vJHEN YOUR
CONDITION PERHITS. THEN
YOUR FMHLY CAN SEE YOU.
....J
...,j
§IT~~~I9N
III.
(PROCEDUR~)
.EXPECTED ACTION FROM YOU
REASON
"
PERSONAL CARE
H1lYI.EDIATELY BEFORE
GOING •ro OPERA'l'ING
ROOH
(0. R.)
.A. PERSONAL CLEANLINESS
1. DECREASE POSSIBILITY
OF' DIR'I' AND GEm1.S
ENTERING 'I'HE SURGICAL
WOUND (INCISION)
1.
'I'AKE CLEANING SHOw"ER AND/
OR SHAMPOO AS ORDERED IN
P.M. OR EARLY A.l'-1. BEFORE
YOU RECEIVE YOUR SLEEPING-
HEDICINE.
2.
YOU WILL NOT BE PHYSICALLY ABLE 'I'O SHOWER
AND SHAJYIF·OO IIVIMEDINl,ELY
A.FTER SUHGERY
.......i
"'
SI'I'UATION (PROCIEDURE}
---
B.
REMOVAL
OIIF
!-lAKE-· UP
EXPECTED AC'riON l?ROM YOU
REASON
AND
NAIL POLISH
SO THAT COI.OR CHli.NGES CAN
REI-iOv"'E MAKE-UP AND NAIL
BE EASILY OBSERVED BY
POLISH
ANESTHESIOLOGIS'I' DURING
SURGERY OR B"1{ ~rHE NURSE
IN REC. RM.
COLOR CHANGES
Ri\Y INDICATE CHANGE IN
GENERAL CONDITION
C.
ORl\I. HYG~ENE {BRUSH
TEETH) A~D REHOVE
CHEWING GUM
TO CJ.JEJ.i.NSE MOUTH TO REHOVE
ALL FOREIGN PARTICLES WHICH
COULD BE SUCKED INTO LUNGS
WHILE RECOVERING FROivl
ANESTHESIA
1.
BRUSH TEETH
2. USE MOUTHWASH, IF DESIRED
3. SPIT OUT GUM
-...1
;.,.c;
SI'J:U.l~.·riON
D.
(PRCCEDURE)
P..El>!OVAL OF ARTIFICIAIJ
OBJECTS (DENTURES,
BRIDGES, CONTl~C'r
REASON
1. TO AVOID LOSS OR
BREAKAGE WHILE IN
OPERA'I'ING H.OOM OP.
f
1. REI\10VE OB,JECTS AND GIVE TO
FAMILY FOR SAFEKEEPING, OR
RECOVERY ROOM
LENSES; WIGS, ARTIFICIAL LIMBS
EXPECTED AC'riON
FROM
•.
. YOU
E:rc. ) AND
VALUABLES, E.G., RINGS
AND WArrCHES
2.
THE ABOVE 'rWO DEPARTMEN'I'S DO NO'J~ HAVE
2. GIVE TO NURSING PERSONNEL
'I'O STORE IN AGENCY SAFE
STORAGE AP.Ei\S FOR
YOUR PERSONAL ITEHS
E. PUT ON HOSPITAL G0v-JN
1. TO lWCID LOSS 1 SOILING
OR 'l'EARING OF YOUR
GARHENT WHILE IN
SURGERY
1. REMOVE' GOWN OR PAJAMAS
2. AGl':..IN, NO STORAGE
AREA. AVAILABLE IN
SURGERY
2. PUT ON HOSPITAL GOWN
00
0
83.
H
0
Q
>
H
r
~'"""'\
V:JU.P. RNH'I
b ·-=t
OPERATIIIC. ROOM
·.·\
~1/
\~r~ I
~------··--r
I p:1,f.l
/
l
YOU 1 I .. L STIW HERE ABOU'r
2 OR 3 HOURS UNTIL
YOUR SURGERY IS FINISHED.
~
L ______j
"( I._ Jtl
t~ili'j-t II /
I
/
- t
__
I"
//
./
If.
r---------·-""
lL
YOU'LL STAY !IER~ ~~ HC2_~.:~ Q_~ TV.JO_, WITH SPECIALLY-TRJI.INED PEOPLE KEEPING A CLOSE WATCH
OVER YOU, UNTIL YOUE BLOOD PRESSURE AND PULSE ARE STRONG, AND YOU WAKE UP ENOUGH TO
RESPOND 'I'O YOUR NAHE AND KNOW WHERE YOU liRE.
en
!-.;
83
H
H
{OPTIONAL PAGE)
AS YOU WAKE UP, YOU HAY NOTICE
A SOF'r, PI. Il'.l3LE NASOGAS't'RIC TUBE
{OR N/G TUBE) ••• - - - - - - - - -
Nose
---:
(na.so-)
ft)--·'.
~\\
It/·\_
N
I.
•
~(~'
~~ t~s~
(_\Sf!
J (l
\
\l
( 11.--t·, .
It'
1
\
\
(l
}/
II J
Stomach
" ' (·-gastric)
'
G
\
IT 'tVILJ... PROBABLY BE
~rAPED
TO YOUR NOSE OR CHEEK'rO
KEEPIT INPI.JAC·E-.- - - -
ro
...
~rf·
( OPTION.l:.I. PAGE)
AS YOU BEGIN '1'0 HEA.L FROH SURGERY, YOUR STOf.ffi.CH NEEDS lo,. REST.
SO, :FOR A DAY OR TWO, YOU'LL BE "NPO" (HAVE NOTHING BY MOUTH).
AND 'l'HE
!:J/Q
'l't~E ••••••••• WILL BE CONNECTED TO •••••••••• A SUCTION MACHINE.
"------....._
~-
~~~/
l
6
Jf,
/'f-
THE TUBE MAY FEEL A LITTLE
UNCOMFOR'I'ABLE, BUT IT NEl,1JS
LESS IRRI'I'.i\'riCN FOR YOUR
R."ETs'i~
r FiG s ·I"75.i-1A"c!f. - - --·-
6
\r;<,;t:P'\'
/
_,/
~
.
G\ N
~J
t.~'J I
I~
/
THIS 1'1ILDLY 'iSUCKS OUT" THE
DIGES'I'IVE JUICES YOUR STO:tviACH
KEEPS .M.AKING EVEN THOUGH YOU
ARE NO'r EA'riNG.
I
YOU PROBl'.BLY WON 1 'I' EVEN FEEL
THE SCCTIONING.
C.
YOU MAY DISCOVER AN I.V.
BOTTLE
I.V.
ST~rv . .r
To.&~~J-~\.
\ I
n c_>-_:_~e,
:'r>/--J"!_,, "'---·-' .,
) ....
,.
H
I
!i
.
1
.
rmt:r
=
intra venous
(in the) (vein)
IT'S VERY IHPORTANT 'I'HA'r 'rHIS NEEDLE STAY
IN PLACE, SINCE THIS IS 'l'HE WAY YOUR. BODY
WILL BE NOURISHED UN'l'IL y·ou ARE NO LONGER
---- --·
.
NPO.
SO YOUR ARM MAY BE HELD STABLE BY
A PIECE OF ~vELL-PADDED BOARD AND SOME
'rAPE.
YOU SHOULD TRY TO KEEP THIS ARM
AS S'l'ILL AS POSSIBIJE--·BUT YOU- CAN~\'"rGGI,E
YOUR FINGERS IF THEY BEGIN •ro FEEL S'riFF.
AND YOU SHOULD TELL YOUR NURSE IF' YOUR
ARM HURTS OR FEELS ..SWOLLEN":--
~~
-
.~-~
00
(";"\
D.
WHAT ELSE rHGI-I'l' YOU NOTICE.?
YOD f.tt...~~Y HAVE A • • •
WELL, FOR ONE THING,
't-~;1]_4
•A l.
~
CA'I'HETER
.\ i
a
-•""\1,r ... ('.,
----........ . .
~-~
II:
!J
l
-TIIPI!
= -
-
(A SOFT TUBE) INSERTED INTO
YOUR URINA~Y ,BLA~DER TO
TEHPORARILx. EMPTY YOUR BLADDER.
I
.
. I
r--~,-r--:::J~~~-i
I 4~~1
r~~-=-,c_
1
L_----
PRA.IiliA.Gs~
\
_; /.. / 4 --ru.etNG
(::
I~
_____
_____II
Jr---;-
I
WHILE I'l' IS IN PLACE, IT MAY
MAKE YOU FEEL THE URGE TO ___
URINATE; BUT Y51r"ncm 1-T NEED
TO--'I'HE UHINE IS DRAINING
OUT AUTOivLZ\.TTCl'~LLY.
!\
~~
B"'~ _ . , ~JLlRtt.Jt
.1:\o-rrLi; OR
co
~.J
E.
YOU .MJ\.Y FIND A
DRE~SING_
OVER
~OUR
INCISION,
PRO'l'ECTING IT SO 'rHAT l'l' CAN HEAL.
(SOME DOCTORS t-:!AY USE A PROTECTIVE
SPRAY COATING INS'rEAD OF A DRESSING.)
BECAUSE SOME DRAINAGE FROM YOUR
INCISION WILL BE ABSORBED BY THIS
DRJ~SSING,
YOU SHOULD BE SURE •ro
'-rELL YOUR NURSE IF IT FEEI,S DANP--·
SO IT CAN BE REINFORCED
~VITH
.r.10RE
GAUZE.
TE:F; VERY FIRST
DR:E~SSI~JG
CHANGE r-1AY BE DONE BY YOUR DOCTOR, SO 'J:HA1' HE CAN PERSONALLY
CHECK YOUR INCISION--·!\F'fER 'L'H2\'I' ~ THE DRESSING WILL BE CHANGED A.S OFTEN AS NECESSli.RY
BY YOUR NURSE.
OJ
(X)
.
i>
lL
FIRST 1 AS SOON AS POSSIBLE, YOUR DOCTOR WIIJL WANT YOU TO TURN, ~~OUG!_!, AND
DEEP BREATHE A.'l' LEAST EVERY TWO HOURS
/"~~
t .
\._:J
•
/<1---r..
A ~
~~
t: " .)
\.~y
• • • OF COURSE, THE NURSE WILL HELP YOU.
TEE IDEA IS TO KEEP ':PEE AIR PASSAGES CI,E:AR A'ND
PREVENT THE ACCUHUL.ATION OF FLUID IN' 'I'HE LUNGS
WHICH COULD I.EAD TO PNEUMONIA.
'1.!:1
0
P.~;
YOU COUGH AND DEEP BREATHE, YOU MAY BE UNCOHFORTABLE, ESPECIALLY l!..T FIRST.
SO,
I'r
.H£\Y HELP IF THE NURSE, OR PERHAPS EVEN YOU, USE 'rEE HANDS •ro SUPPOR'I' THE INCISIOl'! WHEN
YOU COUGH OR DEEP BREA'!:'HE.
YOUR NURSE CAN SHOW YOU HOW.
NONE OF THESE ACTIVITIES WILL
OPEN THE INCISION, THOUGH!
'(
~.JJJ~
I.
. "Y
l----
SUPPOR'riNG THE INCISION
MERELY HELPS TO PP.EVEN'I'
YOUR DISCOMFORT.
0
,..,'.0
B.
YOUR DOCTOR WILL J\LSO WANT YOU TO I-:!OVE AROUND.
THIS IS BECAUSE EXERCISING HELPS
YOUR CIRCULA'l'ION AND DEEP BREATHING-·- SO YOU GET WELL SOONER.
E·~='~~
_·
~.~--."~
~~
"
I
~
.
•;;. !
-l
'
b
SO r HHIIJE IN BED, YOU SHOULD
P..E.MEMBER TO MOVE YOUR FINGERS,
HANDS, AND ARMS (UNLESS
RESTRAINED BY 'l'HE I. V. ) r TOES,
F'EE'I', AND LEGS , ll~ND HEAD
PERIODICALLY 'rO KEEP -~{OUR.
:MUSCLES WORKING.
WITHIN A DAY .l\F'rER SURGERY,
YOU'LL BE HELPED TO SIT ON
THE EDGE OF YOUR BED--WE
CALL THIS DANGLING.
NEXT, YOU'LL PROGRESS TO
GETTING OUT OF BED AND
INTO .A CHAIR, AND lu."\TER
AMBULJI~TING (WALKING) IN
'I'HE HALL.
~0
N
C.
AFTER SURGERY YOU MAY BATHE IN BED.
(.:~
r-c:.~~··
__ ~"
.
~
~\
I J ...J.
l='J/I.t.~
.
r---rJr
n
·b
I
6
I·--L~-
~~
---
?--
Bl1.THING AND FEEDING YOURSELF HELPS YOU EXERCISB
SO THAT YOU GET STRONGER--AND BY THE TIME YOU
GO H0!-1E, IT'LL BE EASIER FOR YOU TO TAKE CARE
OF YOURSELF'.
\..I')
w
94
H
,...,.
::;;:
H
H
'A.
YOU'LL PN.OBABLY FEEL PRE'l'TY SLEEPY MUCH OF THE TIME--SO 'rAKE 1\DVANTAGE .AND RE:LAX!
IN FACT, 'l'HE l-10RE RELAXED YOU ARE··; THE HORE REST AND SLEEP YOU'LL BE ABLE TO GE'I'.
1- 1.- t.. ~
1.-
~--~)~1
\. -- ,.
·,·----=--1
1
-~
YOUR DOCTOR WILl. LEAVE INS~P.RUC­
TIONS WITH YOUR NURSE SO THAT
YOU CAN HAVE MEDICINE TO HELP
YOU SLEEP AT NIGHT • • •
SH1PLY ASK YOUR NURSE.
{)
'l'HA.T 1 S BECAUSE RES'r AND SLEEP -
Yfi!ITH EXERCISE -
IS WHAT YOUR BODY NEEDS TO REGAIN STRENGTH.
1.0
U1
----
B.
---~~------·--·
PAIN?
Hm'V' Jl.iUCH YOU FEEL PAIN DEPENDS ON YOUR SURGERY, BU'l' r·r ALSO DEPENDS ON YOU.
RIGH'r •
•
• A LOT OF Pl!,IN IS
\:~'!
KNm~m
'l'O
RESUL'1~
A-?t~
•Jj~~ . ['J·· vt'
,¥t?---B .~Ef.@ //!
'I
:,/_J
A!---w:
'\1
v
FROI4 YOUR OWN 'rENSIONS:
(~.
11
.
THA'r' S
---
i
J
-~.NXIE'riES
WHICH YOU EXPERIENCE
ARISING FROI-·I YOUR FEARS • • • OF
SICKNESS, SURGERYr AND HOSPITALS
Il..J GENERl\L.
AND SO, IT'S 1'0 YOUR BENEFIT TO RELAX AS MUCH AS POSSIBLE AND TALK THESE THINGS OUT
'iHTH YOUR NURSE AND DOCTOR.
I.D
C''l
C.
OF COURSE, YOUR
DOC~t'OR
WILL ORDER MJ<;DICINE FOf{ ANY PAIN RESULTING FROr-1 YOUR INCISION ••
• . . AND THE NURSE WILJ_, GIVE IT
TO YOU WHEN YOU NEED IT.
!r
\·
SO~
SHOULD YOU HAVE PAIN IN THE AREA OF YOUR INCISION, DON'T HESITATE TO TELL YOUR
NURSE--IN FACT, THE SOONER, THE BETTER.
SHE'LL FOLLOW YOUR DOCTOR'S ORDERS.
1.0
-l
D.
NOW, THERE 1 S ANO'J?HER 'l'YPE OF PAIN YOU SHOULD I<NOV>i' ABOU'l' OCCUR FOLLO'(IHNG ABDOMINAL SURGERY SUCH .AS YOURS.
GAS PAIN -· WHICH :t-iAY
-- ---
II\,
··---.~-7'·'~,.~-Q
I~;.~ \"-. ~·
r
r-~-=
~
'l
(gJ~ \
) \1 \
/'!'1
//
/
GAS PAIN
IS i\N INDIC.A'l'ION TIIA'l' YOUR DIGgSTIVE SYS.l'EM-·-vmiCH HAS BEEN RESTING
SINCE YOUR OPERATIUN--IS BEGINNING TO WORK AGAIN.
AND,
DESPITE YOUR DISCOMFORT, YOU SHOULD KEEP IN MIND THAT IT 1 S REALJ~Y A SIGN QF
RECOVERY.
SO 1
IT'S A NORI-il\L THING: NOTHING TO BE
E~-1.BARRASSED
ABOUT.
THE BES'l' ~'Jl\Y
TO REIJIEVE GAS PAIN IS ·THROUGH BODY MOVEMEWl' AND EXERCISE.
\.C'
00
99
H
H
>
]:,,
l::..S "fOU PROGRESS, YOUR DIGESTIVE SYSTEt-1 BEGINS •ro WORK AGl1IN.
~I
r-r----.11?'. ~~1-~
I.
..·
~ ("\
.
@r
··~~
~l
MlH
.
t.-?'/
-~--~~--L_____,
r)
c<~
~~
/-- .... ~
;;--~
THEN YOU 1 LI~ BEGIN ENriNG:
YOUR DIET WILL GRADUALLY BE
l\T FIRS'r ·JUST A. LIT'l'I.E I
Il\JCREASED; A..T\ID WHEN YOUR DOCTOR
:£1.10STI..Y CLEAR FLUIDS SUCH
IS SURE YOU CAN TOLERP.TE FOOD 1
AS CLEl\R SOUP AND .TEA.
YOU'LL BEGIN EATING SOLIDS AND
THE I.V. USUALLY WILL BE
DISCONNECTED.
!-.A
0
(_::)
v~H.EN YOU NO LONGER Hl\VE AN I. V. ,
YOU SHOULD ~rH.Y 'ro
DlUNK A FULL GLASS Of' LIQUID EVERY HOUR
J.I~Im
~JHILE
AWAKE TO HELP YOU UR.INATE EASILY, OR -
YOU
IF' YOU
HAVE A CATHETER ·- 'I'O KEEP THE CNniETER "FLUSHED OUT"
AND WORKING vJEI.L.
ffi(9r·~.~.
v~
Lr'- -. 1_...:...--~
../~-------r
1
r~
I-'
0
!-•
YOU !'1.t"\Y NOT FEEL HUCH LIKE EATING
A'r
FIHS'I' f
BU'r YOUR APPE'l'ITE WILI. HOST LIKEI.oY RE'I'URN
vvD:'HIN A .F'EVv DAYS AFTER SURGERY •
AND 'rHEN EA'riNG WILL BE GOOD
---- -·-- FOR YOU FOR TWO REASONS:
---
B.
( 1)
IT CAN HELP PREVEN'l' OR
RELIEVE GAS PAIN, SINCE
Hl\.VING SOMETHING IN YOUR
STOI4ACH AND INTESTINES
S'riMUL.ATES THEM TO MOVE.
(2)
YOU'LL NEED THE NUTRIENTS
FOUND IN FOODS FROM THE
FOUR BASIC FOOD GROUPS
FOR ENERGY AND TO AID IN
HEALING.
NOW, IF YOUR DOCTOR WANTS YOU TO REivlAIN ON A SPECIAL DIET FOR SOME TH1E, THE
DIETICIAN AND 'l'HE NURSE CAN HELP YOU TO ANSWER ANY QUES'I'IONS YOU MAY HAVE ABOUT
THE DIET.
!-'
0
t'-.l
C"
IE' YOU HAVE A C.ATHE'l'ER,
J?LUIDS BY MOU'r~-.- .-
IT WILL USUALLY BE REMOVED AT ABOUT rrHE TIME YOU CAN TAKE
---
REMEN!BER TO KEEP DRINKING LOTS OF'
FLUID WHEN THE CATHETER IS REMOVED
SO YOU'LL BE ABLE TO URINA'.I'E EASILY
~-~"").!
~
- - ct~.c:--=:.1
,-1-----··-. . y=
J:l
~
~
A
u
/~
(~.:\
~>"
-
1
....- -...- - ·
ON YOUR OWN.
. )rTosJ.;fl.t1
r.
. ~ 01~
JJ1
D.
ii-1
m
--~~"'
YOUR NURSB WILL PROBABI,Y INS'I'RUCT YOU •ro SAVE A SPECIMEN OF YOUR PIRST VOIDING
(URINATION} SO IT CAN Bg MEASURED AND CHECKED.
YOU :tvlAY FEEL SLIGH'I' DISCOHFORT
l~ND NO'.I'ICE SOME REDDISH URINE THE FIRST FEW TH1ES YOU VOID--THIS IS NOIDi'.t.AL, TOO,
l\ND WILI. GO AWlW AS YOU DRINK MORE LIQUID.
!-'
t:::,
:,·d
E.
MOST OF YOUR SU~rDRES--THE "S'I'PfCHES" USED TO HOLD YOUR INCISION 1'0GETHER UNTIL I'l!
HEAT.S--WILI, USUALLY.BE REMOVED WITHIN A WEEK OR SO AFTER SURGERY.
,..---\
1
rl~?'
r(~/
\,(·~ ~I
~-·
K\ 1\.\.
'." ~·
~, j_).!'"";
~·-. -
r
'-1-
~=~-
~===---
~-nri
6t~~~
l
6
~:RAV ~·
F'.
YOUR DOC'l'OR J!l!J.', Y .P•. LSO ORDER .AN X·- PlW
CALLED A CHOLANGIOC'RP';M •ro BE TAKEN
BEForm you G"6--aokur·~-.r.o ·cEECK 'I'HE A.HEA
WHERB YOUR Gl>o.loLBLADDER WAS REMOVED.
.....
0
.;:...
105
H
H
H
H
:>
1~.
HELJ..,, WE 1 VE DISCUSSED SOME OF THE THINGS YOU 1 I..L NO'riCE AND PEEL AFTER SURGERY, AS
WELL AS THE 'rHINGS 'l'HA'r WILL BE HAPPENING ~'1'0 YOU • • • BUT IT IS II>!POR'.rANT TO KEEP
IN MIND THA'r • • •
YOU ARE THE CENTER OF THE HEALTH TEAM •
----·----
~
~
~if . .,
( ) '\
, \ ~~
\ / ~\I -"" '-./,
~-
-~~;l~
....
\
\
~'
.....
'l .(~
V I
I
··,·,,
' .
·,,
'
/~
'\I
._/
\
'""'-
\ //
\~\, -::'"" j
\
'
t :;;..!J' /
1-)
,..--~
//
(•
\
L,.· .
(-"~
.,.,.. .-r.a.\
tw~·
l
}'"'"j?
\-~/
........,..
/
..
/"
\...
WITH ALL M.EMBERS OF THE TEAM
WORKING TO MAKE YOU WELL AGAIN.
SO YOUR K~OWLEDGE.:..-PLUS YOUR
COOPERl\.'riON AND INVOLVEMENT
:'[}~ YOUR OV\"N CARE--CAW- GO_A_
LONG WAY TOi.VARD Ml\KING YOUH
RECOVERY EASIER AND MUCH FASTER.
I-'
0
O"l
APPENDIX D
107
108
Table 5
Comparison of responses to pre- and postquestionnaire items by individual
experimental group patient.s at UCLA
Patients
1
tion
#
p
1. I+ +
+
2. !+
1
3. f .... +
4.
-+ ,-+'
5.
7:
6
8.
9.
10.
11.
l2.
ll-l-
I='
+
I-
1+ +
t..L
.1'
~q
4
p p
+
+
+
+
+
+
+
+
+
+
.1..
I~ ~
+
= ++
13.
14.
15. l +
16. 1I ·!-.
17.
18.
.L. •
I
3
Tp p p p
I~ ~ ~ ~ I ~ ; L~ ~
L=-L~~L-~ t
Ip
I
Ques--
2
+
-'•
1: :
20. i+ +
21. l·- +
22. i1
23. I+ +
+
24. L~I
+ +
+ :+ +
+
+ +
+ +
+ +
+ +
!'
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
•. +
+
+ +
+ +
+ +
+ +
+ +
+
+
+
+
+
+
+
+
+
+ +
+ +
+ +
+
+ +
..~- +
+ +
+ -r
+
+ +
-!
+
+ +
... +
+
+ +
+ +
6
7
,---p-p-,--p p
I~ ~
8
+ +
+ +
+ +
+ +
.J... +
+ +
+ +
+ +
-· +
+ +
+
+ +
,_ +
+ +
+ +
+ +
+
+ +
+ +
+ +
+ +
+
+ +
+ indicates a correct response
indicates an incorrect response
9
I p p ---rPP [- p Pi
~ ~ ~ ~ I~ ~ ~ ~
ll
t __.____:.;.._t_....___t _
-:- -+
+ +
+ +
+ +
+ +
+ +
-;- +
- +
+
5
+ +
+
+ +
+ +
+ +
+ +
+ +
-t-
+
+
·+
.j..
+
+
+
+
+
+
+
..L
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ +
+ +
+
+ +
+
+ +
+ +
+ +
+ +
+ +
- +
+ +
-t· +
+ +
+ +
+ +
+
+
+
+
+
+
+
+
_t
+ +
+
+
+
+
+
+
+
+
+
+
·
=~
+ +
+
+
+
+
+
+
+
+
+
+ +
+
+ +
+ +
+ +
+ +
+ +
+ +
+ +
+ +
+ +
+ +
-r
+
+ +
+
+
+
+
+ +
+ +
+ +
+ +
+ +
+
+ +
+ +
+
+ +
+ +
+
+
+
+
+
+ +
P.FPENDIX E
J.. 09
110
Table 6
Comparison of responses to pre- a.nd post.questionnaire items by individual experimental
group patients at Simi Valley
Patients
Question
#
IP
1
2
3
PIP p p
4
5
PIP PIP PIP
6
7
8
9
] 0 11
PIP p p PIP p p p!p
;I
~~~~~I~~~~~~~~~~~~~ ~i~ ~~~ ~.~ ~~~;_;I
~
+ + + + + +
+ + + + + + T + + + + + +
+ + + + - + - + + + + + + + + + - + + + - +_I!
3. + + + + + + + + + +
+ + + - +
+ + +
4.
- + + + + + + + + + - - + + + + + + + + + +
++++++++++
++:r-++++++++1
6. +++++++++++++++++++++·!+!'.
7.1+-'-++-+····;'++·+++++
++++
8. II++· +
+ + + + + + + - + + + + + + + + + +
9.
+ + + + + + - + + + + +
+ + + +
1.
2.
II - : ! : : - - ~ : : : ! :
10.
11.
12.
+ + +
13. + + + +
14. + + - +
15. + + + +
16. - + + +
17. 1+ +
+
18. I + + + +
19.
+ + +
20. + + + +
21.
I
,1+
22.
+ + - + +
- +
+ + +
+ + +
+ + +
+ + +
+ + +
+ + +
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ + +
+ - + +
+ +
+
+ +
+- -· +
+ - - +
+ + + +
+ +- +
+ + + +
+
+
+
+
+
+
+
+
+
~ ~
+ :
:
: ++ +
+ + + + + +
T
+ + + + + + - +
+ + +
+
+ + + + + +
++++++--I
+ + - - + + + +
+ T + + + + +
+ + + + + + + +
+ + + + + + + +
1+:+ ~+:::+ +~. +~ := ~ :h;- ~
23. I++++
++++++++++++++++
+ indicates a correct response
- indicates an incorrect response