Developing patient education to enhance recovery after colorectal surgery through action research: a qualitative study.

OBJECTIVES: To understand the role of preoperative education for patients undergoing colorectal surgery by involving patients, carers and staff in: (1) identifying its perceived value and deficits for enhanced recovery; (2) modifying current education practices to address educational deficits; and (3) evaluating these changes for preparing patients to enhance their recovery. DESIGN: Qualitative study of three cycles of action research using mixed methods within a 24-month naturalistic enquiry to identify, implement and evaluate changes through observations, questionnaires, semistructured longitudinal interviews, focus groups and documentation review. SETTING: A UK 1200-bed National Health Service (NHS) hospital providing colorectal surgery in a small city in a rural county. PARTICIPANTS: Ninety-sevenpatients having colorectal surgery, 19 carers and 22 clinical staff. RESULTS: Themes identified were: (1) knowledge and engagement; (2) situated understanding and confidence building; and (3) partnership and proactive involvement in enhancing recovery. All patients articulated needs to prepare mentally and physically to plan for colorectal surgery and rehabilitation. Patients and carers wanted to counter uncertainty about medical procedures: likely bodily changes, recovery timescales and future. They therefore sought as much personalised, relevant information as possible about their disease, planned surgery and recovery. Staff implemented preoperative education to more specifically inform and respond multimodally to individual needs. CONCLUSIONS: Patients wanted to be proactively involved in managing their recovery to re-engage with their everyday lives. Preoperative education supported this through developing patients' situated understanding of hospital and bodily processes related to colorectal surgery. Situated understanding was achieved through educational product to give knowledge and processes promoting engagement. Multimodal, comprehensive and timely preoperative education on the whole patient pathway facilitates active engagement. Situated understanding increased patients' confidence to work in partnership with healthcare professionals and proactively self-manage recovery.

The informational needs of patients with ANCA-associated vasculitis-development of an informational needs questionnaire.

OBJECTIVE: The aim of the study was to compare the informational needs of patients with ANCA-associated vasculitis (AAV). METHODS: We developed a Vasculitis Informational Needs Questionnaire that was distributed to members of Vasculitis UK (VUK) by mail and registrants of the Vasculitis Clinical Research Consortium (VCRC) online registry with self-reported AAV. Patients were asked to use a 5-point scale (1 = not important, 5 = extremely important) to rank aspects of information in the following domains: disease, investigations, medication, disease management and psychosocial care. The source and preferred method of educational delivery were recorded. RESULTS: There were 314 VUK and 273 VCRC respondents. Respondents rated information on diagnosis, prognosis, investigations, treatment and side effects as extremely important. Information on patient support groups and psychosocial care was less important. There was no difference in the ratings of needs based on group, sex, age, disease duration, disease or method of questionnaire delivery. The most-preferred methods of providing information for both groups were by a doctor (with or without written material) or web based; educational courses and compact disc/digital video disc (CD/DVD) were the least-preferred methods. CONCLUSION: This study demonstrates that people with AAV seek specific information concerning their disease, treatment regimes and side effects and the results of investigations. Individuals preferred to receive this information from a doctor. Patients with AAV should be treated in a similar manner to patients with other chronic illnesses in which patient education is a fundamental part of care.

'In one ear and out the other - it's a lot to take in': a qualitative study exploring the informational needs of patients with ANCA-associated vasculitis.

OBJECTIVES: To explore the informational needs of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS: Three focus groups and eight one-to-one interviews were conducted with patients with AAV. A purposeful sample of 15 patients (ten female) [disease: three Churg-Strauss syndrome (CSS); nine granulomatosis with polyangiitis (GPA); one microscopic polyangiitis (MPA); two polyarteritis nodosa (PAN)] participated in the focus groups. Eight (five female) (disease: three CSS; four GPA; one MPA) participated in the one-to-one interviews. A semi-structured interview guide was used to explore patients' experiences of informational needs. The focus groups and interviews were audio-recorded and transcribed verbatim, and analysed using the framework technique. RESULTS: Emergent themes were: reaction to diagnosis, need for information on disease management and access to knowledgeable practitioners. When given the initial diagnosis, all patients described themselves as being too ill to take in information and that they later found it difficult to find information. Most information received at diagnosis was in the form of verbal information given by the hospital doctor. Patients wanted positive but truthful information in the form of a booklet. CONCLUSIONS: Receiving the diagnosis of a rare, potentially life-threatening disease and then dealing with its complex treatment causes anxiety and fear and can impede information retention and recall. Patients want information on diagnosis and treatment but this should be tailored to individual needs, including timing that is appropriate for them. All patients wanted the opportunity to discuss their illness and its management with a knowledgeable healthcare practitioner but also wanted printed forms of information to assimilate at their own pace.

An evaluation of a problem-based learning experience in an occupational therapy curriculum in the UK.

The objectives of the study was to evaluate an adapted approach to problem-based learning (PBL) on a pre-registration Masters course in Occupational Therapy at the University of East Anglia in the UK. The adaptation, named placement PBL, required students to write and select the material based on their placement experiences, for the cohort's learning. The evaluation purpose was to determine the students' views of the efficacy of placement PBL for facilitating their learning in the final 3 months of their pre-registration education. Placement PBL was evaluated using both questionnaires and focus groups, with two cohorts of students for data collection. Placement PBL was seen to provide current, relevant and complex learning scenarios that help students to move from a theoretical understanding to application of theory in the complexity of actual service situations. The authors conclude that placement PBL has the potential to prepare students for the transition from student to qualified practitioner. Both researchers were also the PBL tutors which may have affected the students' honesty in their feedback. Further research is indicated for ongoing evaluations of the effectiveness of PBL in helping students to become confident occupational therapy clinicians, and comparative studies with other learning approaches.

Exploring the use of vignettes: from validity to trustworthiness.

In this article one of the authors presents her experience of using vignettes in an action research case study, with particular emphasis on their trustworthiness. The research was carried out with a group of health care professionals who were working together to improve preoperative education for patients awaiting a hip replacement in one National Health Service Trust in the United Kingdom. The authors describe the exploration of three types of vignette--napshots, portraits, and composites--as a means of collecting, analyzing, and representing data. They provide an example of each and briefly present their evaluative use by the health care professionals. The vignettes were constructed to provide one account of the truth that was representative of events. Within this representation was the writer, researcher, and reader feature. The vignettes stimulated reflection and analysis within the action research cycle and thus contributed to the improvement of practice.