Perioperative patient education and nursing
What is perioperative care? Its textbook definition refers to the patient experience before, during and after surgery. According to Elizabeth A. Villavicencio, RN, MSN Ed., a perioperative educator at Chandler Regional Medical Center in Chandler, Ariz., “in the health care setting, perioperative usually means the actual operative experience.”
Patients facing surgery can feel intimidated and frightened of the unknown. That’s where nurses like Elizabeth Villavicencio can come in. Nurses who provide perioperative patient education frequently also have direct experience as operating room nurses. “I have worked in surgery for six years in a variety of settings, from trauma hospital to small community hospitals,” says Villavicencio. “The knowledge I gained through experience during this time provide me with great insight into many aspects of nursing and medical care. I can use that insight to improve education for nurses and patients.”
Villavicencio draws directly on her experience as a surgical nurse when helping prepare patients for surgery. “Just like every nurse learns in an individual manner based on previous experience, so do patients,” she explains. “Some patients have only a few direct questions for the RN preparing them for surgery, while others are very anxious and need some extra attention.”
The information and support Villavicencio typically provides her patients ranges from hard facts about the surgical procedure itself to compassion and moral support. “We reassure the patient that our primary function during surgery is patient care needs, and that we will be present 100% of the time,” she says. “Our first priority is the advocacy of the patient. We also educate the patient about the procedure itself, the physical experience during the operative process, and help set expectations for pain sensation, pain control and general recovery.”
Kathleen Prost, RN , BSN, MSN, is Director of Medical Surgical Services at Chandler Regional Medical Center and works closely with Villavicencio on perioperative patient education, and she has also developed a specialized education program targeted at patients undergoing elective orthopaedic surgery procedures. “We use a multidisciplinary approach, one that involves the nursing staff as well as our Social Work/Case Management departments and Physical Therapy,” says Prost. “More importantly, we establish the patient relationship across all of these staff stakeholders, and that’s by far the biggest benefit of the program.”
This specialized perioperative education program familiarizes surgical patients and their loved ones with every aspect of the surgical process, as well as postoperative care and ambulatory services such as postoperative physical therapy. “Patients receive a booklet that describes everything about their procedure,” says Prost. “The patient’s loved ones also get a patient tracker device that allows them to follow their loved one virtually throughout preop, surgery and recovery, as well as track vital signs and pain management needs in real time.” The participation of hospital case management and social work staff enables the patient education program to continue after hospital discharge throughout the recovery process, whether at home or at a short-term nursing care facility.
According to Prost, the launch of the orthopaedic perioperative education program at Chandler Regional Medical Center has resulted in improved patient outcomes, as well as some patient-directed changes in care procedures. “We set up an Orthopaedic Advisory Board with input from some of the patients who participated in the perioperative education program,” she says. “Based on some of the feedback we got from patients, we were able to modify some of our in-room procedures. Having the patient education class has helped us make our care procedures more patient-centered.”
Other benefits of the program include reports of better patient compliance with recovery instructions, as well as better continuity of care, which has even resulted in prevention of some potentially serious medication errors. In addition, the program’s multidisciplinary approach resulted in better staff cooperation between various departments within the hospital. “The collaboration across multiple departments—nursing, case management, social work and physical therapy—helped reduce tension between the various stakeholders, and helped get those teams working well together in ways they weren’t before,” says Prost.
The success of the orthopaedic perioperative education program has led Chandler Regional Medical Center to develop a similar one for ostomy patients (ostomy patients have undergone complete or partial removal of their lower digestive system). “The goal of the postoperative ostomy workshop is to help prevent shut-ins, since ostomy is such a dramatic procedure,” says Prost. “The confidence I gained as we developed the orthopaedic program drove me to do the same for ostomy patients, who are undergoing such radical changes in their bodily functions after surgery. The first program’s success drives me to do more for our patients."
With perioperative patient education programs achieving broad successes for both patients and staff, we can expect to see them become more widespread—and nurses will be leading the way.
