Decreasing Readmission Rates in Patients With Immune-Mediated Toxicities Using an APRN-Led Discharge Teaching Program.

Patients with cancer are at increased risk for readmission, which can be associated with increased healthcare costs and poor patient outcomes, because of the nature of the disease, treatment complexity, and symptom management.

Comparison of Nurses' and Patients' Readiness for Hospital Discharge: A Multicenter Study.

Decision to discharge is often based solely on clinical criteria but readiness for discharge is multifactorial and perceived differently by patients, families, nurses, and physicians. This is an analytical cross-sectional study aimed to compare perceptions of readiness to discharge 452 patients and their assigned nurses on the day of hospital discharge. To compare perceptions of readiness to discharge patients and their assigned nurses on the day of hospital discharge via readiness for hospital discharge (RHD) self-reported questionnaire. The biggest difference between nurses and patients' perception scores was in the knowledge subscale. The results of linear regression model showed that patients' gender, education, occupation, ward, nurse's age, and marital status predict the difference between nurses and patients' perception of readiness. Hospitalization in ear, nose, and throat (ENT) department with increasing difference and the older age of nurses is associated with a decrease in the difference between the perception. Assessment of nurse's self-readiness can help with the development of care and education planning tailored to patients' needs before discharge.

Multimedia in preoperative patient education for adults undergoing cancer surgery: A systematic review.

PURPOSE: The purpose of this systematic review was to determine whether adequate research evidence exists to support utilizing multimedia technology in the preoperative education of adult cancer patients. METHODS: A systematic search of Medline, CINAHL, Web of Science, and PsycINFO databases from 2010 through September 24, 2020, was performed. The review included quantitative studies that examined whether education delivered by multimedia impacted levels of anxiety, knowledge acquisition, satisfaction, and compliance. The research quality was evaluated using the Joanna Briggs Institute Critical Appraisal Tool specific to the study design. RESULTS: The database search identified 529 scientific articles, of these nine studies met the eligibility criteria (n = 5 randomized controlled trials; n = 4 quasi-experimental studies). The education interventions included a variety of researcher-developed, multimedia modalities, consisting of video (n = 7), a computer program (n = 1), and a tablet application (n = 1). The methodological rigor varied among these studies. Multimedia patient education resulted in decreased anxiety and improved knowledge acquisition within groups; however, there was no significant difference when compared to traditional methods. Patients were also similarly satisfied and compliant with both education methods. CONCLUSIONS: In all studies, the healthcare provider played a prominent role in both multimedia and traditional interventions, revealing the strong influence of the interpersonal connection in the delivery of preoperative education. Future research is needed to investigate whether more interactive technology could improve patient outcomes.

The effect of reinforcing an educational programme using telephone follow-up on health-related quality of life of individuals using warfarin: A randomised controlled trial.

OBJECTIVES: To evaluate the effect of reinforcing an educational programme through telephone follow-up on health-related quality of life and anxiety and depression symptoms in individuals starting warfarin therapy. BACKGROUND: Educational interventions have improved quality of life in individuals using warfarin. Few studies have examined the addition of telephone follow-up to enhance educational interventions. DESIGN: Randomised controlled trial in outpatient setting. METHODS: Hospitalised adults starting warfarin therapy who agreed to participate received an educational programme about the warfarin treatment. At discharge, they were randomised to receive either five telephone follow-up calls (intervention) or no telephone calls (controls). Both groups were evaluated for health-related quality of life (using Duke Anticoagulation Satisfaction Scale) and symptoms of anxiety and depression (using Hospital Anxiety and Depression Scale) at three and six months post-discharge. Groups were compared at each time by independent-samples t test, and over time by repeated-measures analysis of variance, with time (three and six months), groups (intervention and control) and an interaction between time and group as factors. Level of significance was set at 0.05. The Consolidated Standards of Reporting Trials was used for reporting. RESULTS: Fifty-two individuals (26 per group) completed the study. There were no statistical differences between groups in health-related quality of life, anxiety and depression symptoms, at both times post-discharge. Participants who received follow-up telephone calls reported better positive psychological impact (a subscale of quality of life) than controls. CONCLUSIONS: Reinforcing an educational programme with telephone follow-ups did not have an overall effect on health-related quality of life of individuals using warfarin but promoted positive psychological impact. RELEVANCE TO CLINICAL PRACTICE: The low cost of reinforcing educational programmes with telephone calls and the improvement in positive psychological aspects indicate that this type of intervention is still a promising intervention that could be further investigated and improved.

Postsurgical Follow-Up Phone Calls: Worth the Investment?

PURPOSE: To analyze differences in health confidence levels regarding discharge instructions between two groups of same-day surgery patients. DESIGN: Comparative and descriptive design. METHODS: Phone surveys to two groups: those who received follow-up phone calls from a registered nurse (RN) and those who received standard care instructions at discharge only. FINDINGS: In 74 same-day surgery patients (n = 37 per group), all participants expressed high health confidence in implementing discharge instructions. Results revealed no higher health confidence levels in patients who received RN follow-up phone calls, no difference between groups attending postoperative appointments, and no relationships between subject demographics, health confidence level, and postoperative complications between groups. CONCLUSIONS: The use of specialized RNs to conduct postoperative phone calls may not be cost effective. When RNs provide excellent instructions to patients in person, it may lead to sufficient patient health confidence. Personal and nurse-provided education should be considered a standard, and the outcomes of costly follow-up phone calls should be examined.

Excellence in Patient Education: Evidence-Based Education that "Sticks" and Improves Patient Outcomes.

The patient education process has 4 equal components to be addressed by the nurse: assessment, planning, implement, and evaluation. Excellent patient education is an "art" and "science" using nuances and evidence-based strategies to effectively educate. The assessment and evaluation components often use nuanced approaches (motivational interviewing, teach back) to engage the patient/caregiver respectfully, whereas planning and implementation rely more on evidence-based strategies such as the Patient Education Assessment of Materials. Nurses should provide education that is simple, patient centered, and multimodal to meet the health literacy needs of patients/caregivers.

Using simulated patients as a learning strategy to support undergraduate nurses to develop patient-teaching skills.

BACKGROUND: An increase in the number of patients with long-term conditions has required a greater focus on nurse-led educational interventions to enable patients to develop self-management strategies. However, patient education is frequently taken for granted, and nurses sometimes consider that their undergraduate training does not prepare them to participate in effective patient teaching. AIM: The study aimed to formatively evaluate a simulated role-play scenario facilitated with third-year nursing students to support the development of patient-teaching skills. METHOD: The study combined two approaches to simulation, using high-fidelity and mid-fidelity simulation scenarios sequentially. This enabled students (n=20) to apply the communication strategies learnt to both a skills-based procedural situation and a patient-teaching simulation. A five-item pro forma with four open questions and one closed question was used for formative evaluation. FINDINGS: The results indicated that using a simulated patient to practise patient-teaching skills was perceived by the students to be a valuable method of learning that they could transfer to clinical practice. CONCLUSION: The findings suggested that facilitating learning with a simulated patient is useful in replicating authentic verbal and practical interactions with a patient in practice.

Discussing sexuality in health care: A systematic review.

AIMS AND OBJECTIVES: Using the PRISMA guidelines, a systematic literature review was conducted to explore current and relevant evidence regarding factors that influence nurses' provision of sexual healthcare education to patients. BACKGROUND: The World Health Organization and Healthy People 2020 emphasise the importance of sexual health care. Although the nursing profession has the ability to develop a competent level of sexuality education, sexual health care is often ignored in nursing care and education. Many nurses are failing to engage in meaningful conversations about sexual health with patients, and this could lead to negative health events. However, patients would like reliable and nonjudgmental access to education about sexual health. DESIGN: Electronic databases were searched for articles published between 2012-2017. Studies of nurses providing sexual health education in healthcare settings were included. The Melnyk and Fineout-Overholt (2015, Evidence-based practice in nursing & healthcare, Philadelphia, PA: Walters Kluwer) quality assessment framework was used. The researchers independently reviewed 532 studies and agreed upon ten to include in this review. RESULTS: Findings from this systematic review suggest that nurses' provision of sexual health education to patients is influenced by four factors: (a) a lack of knowledge about sexual health, (b) nurses' attitudes and beliefs that sexual health care is private and not a priority, (c) nurses' comfort discussing sexual health, and (d) perceived barriers related to time, responsibility and organisational support. CONCLUSION: The ten articles reviewed were all Level VI descriptive and qualitative studies, as defined by Melnyk and Fineout-Overholt (2015). It is evident that sexual healthcare information is not being widely addressed. To reduce stigma, the positive aspects of sexual health care must be promoted on multiple levels. RELEVANCE TO CLINICAL PRACTICE: Leaders in professional and community-based organizations should be on the forefront of making recommendations for nurses and practitioners, so they could improve their ability to provide sexual healthcare information to their patients.

Optimizing patient education of oncology medications: A descriptive survey of pharmacist-provided patient education in Canada.

BACKGROUND: The incidence of cancer is increasing in Canada due to an aging and growing population. This frequently necessitates chemotherapy, which is a high-risk treatment, often given as a part of a complex regimen with serious side effects. A review of the evidence of pharmacy-provided patient education initiatives targeted to oncology patients revealed that minimal is known about this service. OBJECTIVE: The objective of this study was to determine the different models of patient education of oncology medications delivered by pharmacists to adult oncology patients in a hospital or cancer center in Canada. METHODS: The study design was a descriptive online survey developed by the investigation team and was distributed to pharmacists who provided patient education to adult oncology patients. The primary outcome of this research project was to describe self-reported pharmacist-provided patient education of oncology medications across Canada. The survey data was analyzed quantitatively with Opinio survey software. RESULTS: Sixty-four pharmacists completed the survey. Key findings of the study were that approximately 50% of pharmacists spend up to 25% of their time providing direct patient care and that not all adult oncology patients are receiving education by a pharmacist. CONCLUSIONS: Pharmacists provide patient education at the first treatment, change in therapy, and on request of another healthcare professional. Most cover administration, side effects, their prevention and management, and drug-interactions. Frequently used teaching methods include structured patient education delivery process, customized teaching for each patient, and repetition of key educational points.

Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement.

BACKGROUND: Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6]. OBJECTIVE: To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement. SETTING: Participants were recruited from a university hospital-based WMC in Pennsylvania. METHODS: This qualitative descriptive study used purposive sampling and inductive content analysis. RESULTS: A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming. CONCLUSION: Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's education requirement (standard 5.1). Future educational research could help develop best practices in WLS patient education and assess associations between education and clinical outcomes.

Challenges in everyday life among recently diagnosed and more experienced adults with type 2 diabetes: A multistage focus group study.

AIMS AND OBJECTIVES: To identify perceived challenges related to self-management among recently diagnosed adults and those with longer experience of type 2 diabetes as a foundation for the future development of a person-centred information and communication technology service. BACKGROUND: Learning self-management of type 2 diabetes includes mastering the skills required to complete complex emotional and physical tasks. A service developed with the participation of stakeholders may be an alternative way to meet rising needs for self-management. DESIGN: Qualitative descriptive design influenced by a participatory approach. METHODS: Multistage focus group interviews among one group of recently diagnosed (≤3 years, n = 4) adults and one group with longer experience (≥5 years, n = 7) of type 2 diabetes. RESULTS: Challenges in self-management in everyday life with type 2 diabetes were identified: understanding; developing skills and abilities; and mobilising personal strengths. Both groups described challenges in understanding the causes of fluctuating blood glucose and in developing and mobilising skills for choosing healthful food and eating regularly. The recently diagnosed group was more challenged by learning to accept the diagnosis and becoming motivated to change habits while the experienced group was mainly challenged by issues about complications and medications. CONCLUSION: Adults with diabetes have different needs for support during different phases of the disease. From a person-centred perspective, it would be desirable to meet individual needs for self-management on peoples' own terms through a technological service that could reach and connect to a large number of people. RELEVANCE TO CLINICAL PRACTICE: Diabetes nurses need to address the knowledge needs of patients with diabetes and support them in developing self-management skills. Consistent with person-centred care, practitioners should also encourage patients' abilities to mobilise their own personal strengths to maintain self-management.

Parent/guardian knowledge regarding implanted shunt type, setting, and symptoms of malfunction/infection.

OBJECTIVE Patients with shunts often interact with providers distant from their primary hospital, making it important that the parent(s)/guardian(s) is well versed in the type of shunt implanted and symptoms of malfunction/infection. This is particularly important with magnetic-sensitive programmable valves, as the use of MRI becomes more prevalent. METHODS Over a 6-month period, primary caregivers of 148 consecutive patients who received shunts were prospectively administered questionnaires at clinic visits. Caregivers were asked to do the following: 1) identify shunt valve name, type, and setting if applicable; 2) list symptoms of shunt malfunction/infection; and 3) indicate whether they had access to references regarding shunt type/setting, booklets from the Hydrocephalus Association, and quick reference cards with symptoms of shunt malfunction/infection. One cohort of caregivers (n = 75) was asked to carry informational cards with shunt valve/setting information (group I); this cohort was compared with another subgroup of caregivers (n = 73) not carrying cards (group II). RESULTS The mean (± SD) age of patients at implantation/revision was 3.71 ± 4.91 years, and the age at follow-up was 6.12 ± 5.4 years. The average time from surgery to administration of the questionnaire was 2.38 ± 3.22 years. There were 86 new shunt insertions and 62 revisions. One hundred twenty-eight caregivers (87%) could identify the type of valve (programmable vs nonprogrammable). On the other hand, only 72 caregivers (49%) could identify the valve name. Fifty-four of 73 (74%) caregivers of patients who had shunts with programmable valves could correctly identify the valve setting. One hundred caregivers (68%) had a copy of the Hydrocephalus Association booklet, and 103 (70%) had quick reference cards. Eighty caregivers (54%) had references on shunt type/setting. Most caregivers (127 [86%]) could name ≥ 3 signs/symptoms of shunt malfunction, with vomiting (61%), headache (49%), and sleeps more/lethargic (35%) most frequently reported. Caregivers of patients in group I were more likely to have cards with symptoms of shunt infection or malfunction (p = 0.015); have information cards regarding shunt type/setting (p < 0.001); and correctly identify valve type (p = 0.001), name (p < 0.001), and setting if programmable (p = 0.0016). There were no differences in ability to list symptoms of shunt malfunction or infection (p = 0.8812) or in access to Hydrocephalus Association booklets (p = 0.1288). There were no significant demographic differences between the groups, except that group I patients had a shorter time from surgery to last follow-up (1.66 vs 3.17 years; p = 0.0001). CONCLUSIONS Education regarding the care of patients with shunts by providing written cards with shunt type/setting and access to reference materials seems to be effective. Developing plans for guided instruction with assessment in the clinic setting of a caregiver's knowledge is important for patient safety.

Understanding patients and spouses experiences of patient education following a cardiac event and eliciting attitudes and preferences towards incorporating cardiopulmonary resuscitation training: A qualitative study.

AIM: The aim of this study was to gain a comprehensive perspective about the experience of patient and spousal education following an acute cardiac event. The second objective was to elicit an understanding of patient and spousal attitudes, preferences and intentions towards future cardiopulmonary resuscitation training. BACKGROUND: Patients with cardiovascular disease require comprehensive patient and family education to ensure adequate long-term disease management. As cardiac patients are at risk of future cardiac events, including out-of-hospital cardiac arrest, providing cardiopulmonary resuscitation training to patients and family members has long been advocated. DESIGN: We conducted a qualitative study underpinned by phenomenology and the Theory of Planned Behaviour. METHODS: Semi-structured interviews were conducted with cardiac patients and their spouses (N = 12 patient-spouse pairs) between March 2015-April 2016 purposively sampled from a cardiology ward. Interviews were transcribed verbatim and thematic analysis undertaken. FINDINGS: Nine male and three female patients and their spouses were recruited. Ages ranged from 47-75 years. Four strongly interrelated themes emerged: the emotional response to the event, information, control and responsibility. There was evidence of positive attitudes and intentions from the TPB towards undertaking cardiopulmonary resuscitation training in the future. Only the eldest patient spouse pair were not interested in undertaking training. CONCLUSIONS: Findings suggest cardiac patients and spouses have unmet education needs following an acute cardiac event. Information increased control and decreased negative emotions associated with diagnosis. Participants' preferences were for inclusion of cardiopulmonary resuscitation training in cardiac rehabilitation programs.

Nursing students' perceptions of preparation to engage in patient education.

Patient teaching is a key component of graduate nursing practice. Nurses sometimes believe that their undergraduate teaching does not prepare them to engage in effective patient teaching. In addition, nursing students often do not use teaching resources when engaging in patient teaching. The aim of this focused ethnographic study was to determine if students in a CBL/PBL based learning undergraduate nursing program engage in patient teaching when they are in the clinical area. Focus groups and shorter individual interviews were used to ensure in-depth data collection. Data saturation was reached with a sample of 28 undergraduate students. Emerging themes included: Whose responsibility? When patient teaching does happen, when patient teaching does not happen and improving the culture of patient teaching in the teaching setting. It was clear that students in this context-based learning nursing teaching program valued and were engaged in patient teaching. However, they did not necessarily feel that they had been taught the skills necessary for engaging in effective patient teaching. They also expressed concern that workplace conditions for nurses were not always conducive to patient teaching.

Searching for a written patient feedback instrument for patient-medical student consultations.

OBJECTIVE: The Patient Teaching Associate (PTA) program at Eastern Health Clinical School uses volunteer patients with chronic illnesses in consultation-based medical student education. The PTA program aims to develop students' patient-centeredness and associated skills. Our study aims, 1) to identify key desirable characteristics of written patient feedback to doctors and/or students that focuses on patient-centeredness in consultations, and 2) to critically evaluate existing instruments to identify any suitable instrument for use for medical student teaching. METHODS: We reviewed our experience with the PTA program and explored the literature on patient-centeredness and patient feedback to identify desirable characteristics of written feedback for our program. A systematic search was conducted to identify existing patient feedback instruments. These were then evaluated in light of criteria based on desirable characteristics. RESULTS: Eight instruments met the inclusion criteria. While all were designed for patient use, none were ideal for the PTA program. The Doctors' Interpersonal Skills Questionnaire (DISQ), while not used with medical students, is the closest fit to criteria. CONCLUSION: The lack of instruments specifically designed for written patient feedback to medical students highlights a gap in the current literature. PRACTICE IMPLICATIONS: The DISQ provides a good basis for developing a new feedback instrument focused on patient-centeredness in medical students.

La enseñanza a pacientes con diabetes: significado para profesionales de enfermería / Teaching to diabetes patients: Meaning for the professionals of Nursing / O ensino a pacientes com diabetes: significado para profissionais de enfermagem

Objetivo: Describir el significado que para profesionales de enfermería tiene la enseñanza a pacientes diabéticos hospitalizados sobre su cuidado en el hogar. Método: Estudio cualitativo, fenomenológico, descriptivo, desarrollado en un hospital de Culiacán, Sinaloa. Selección de participantes con base a muestreo teórico: fueron enfermeras que laboran en servicios de medicina interna y cirugía. Número de entrevistas con base en la saturación de datos. En aspectos éticos, han sido considerados los principios de beneficencia, confidencialidad y respeto a la intimidad, así como la autorización de los participantes mediante consentimiento informado. Para recolección de datos se utilizó entrevista a profundidad. Instrumentos: guía de preguntas semiestructurada y notas de campo. El análisis y la interpretación de los datos fueron de acuerdo a la propuesta de De Sousa Minayo, basada en el análisis temático, que incluye: organización de datos, clasificación de temas y análisis final. Resultados: Se realizaron 7 entrevistas. El análisis inicial identificó que la relación intersubjetiva de la enfermera con el paciente y su familia se puede realizar en cualquier espacio de enseñanza. Se generaron dos categorías; en este manuscrito solo se referirá la categoría información que proporciona la enfermera, que incluyó tres subcategorías: información que proporciona al paciente, a la familia y momentos para enseñar. Conclusión: Los hallazgos evidencian la necesidad de redefinir el papel de la (del) enfermera(o) en la enseñanza a pacientes diabéticos y considerar la importancia del contexto en desarrollo de esta función; estos tienen utilidad en planteamiento de propuestas educativas efectivas que contribuyan a potencializar la enseñanza a estos pacientes.

Objective: To describe the meaning which Nursing professionals have about their teaching to hospitalized patients with diabetes regarding their home care. Method: This is a qualitative, phenomenological and descriptive study conducted in a Hospital in Culiacan, Sinaloa. The participants were selected on the basis of theoretical sampling and included nurses working in the services of internal medicine and surgery. Interviews were conducted until data saturation was reached. Regarding the ethical aspects, the principles of beneficence, confidentiality, and respect to the intimacy were considered as well as the participants' authorization through their informed consent. Data were collected through interviews with semi-structured questions and field notes. The analysis and interpretation was conducted following the De Sousa Minayo proposal which is based on thematic analysis, and includes: organization of data, classification of themes, and final analysis. Results: Seven interviews were conducted. In the initial analysis, it was identified that the inter-subjective relation between the nurse and the patient and family can take place in any teaching space. Two categories emerged, one of these being information which the nurse provides which included tree sub-categories: information provided to the patient, information provided to the family, and the moments to do the teaching. Conclusion: The findings suggest that there exists a necessity to re-define the role of the nurses regarding their teaching to diabetic patients, and also to consider the importance of the context in the development of this function; all these in order to generate effective educational proposals which can contribute to the improvement of their teaching to these patients.

Objetivo: Descrever o significado que tem o ensino a pacientes diabéticos hospitalizados sobre o cuidado no lar para profissionais de enfermagem. Método: estudo qualitativo, fenomenológico, descritivo, desenvolvido em um hospital de Culiacán, Sinaloa, seleção de participantes com base na amostragem teórica, foram enfermeiras que lavoram em serviços de medicina interna e cirurgia, número de entrevistas com base na saturação de dados. Em aspectos éticos têm sido considerados os princípios de beneficência, confidencialidade e respeito à intimidade, bem como a autorização de participantes através de consentimento informado. Para a coleta de dados utilizou-se entrevista a profundidade, instrumentos: guia de perguntas semiestruturada e notas de campo. A análise e interpretação de dados foi conforme à proposta de De Sousa Minayo, baseada na análise temática, que inclui: organização de dados, classificação de temas e análise final. Resultados: Realizaram-se 7 entrevistas. Análise inicial identificou que a relação intersubjetiva da enfermeira com o paciente e sua família, pode se realizar em qualquer espaço de ensino. Geraram-se duas categorias, neste manuscrito, só se referirá a categoria informação que proporciona a enfermeira que incluiu três subcategorias: informação que proporciona ao paciente, à família e momentos para ensinar. Conclusão: Os achados evidenciam a necessidade de redefinir o papel da enfermeira (o) no ensino a pacientes diabéticos e considerar a importância do contexto no desenvolvimento desta função, estes têm utilidade na abordagem de propostas educativas efetivas, que contribuem a potencializar o ensino a estes pacientes.

Systematic review of patient education practices in weight loss surgery.

BACKGROUND: Education plays a key role in adherence to lifestyle modifications after weight loss surgery (WLS). Education given before and after surgery may decrease weight recidivism rates and improve outcomes. OBJECTIVE: The purpose of this systematic review was to analyze educational practices in bariatric centers. METHODS: The Cumulative Index to Nursing and Allied Health and PubMed databases were searched in May 2016 for English-language, peer-reviewed studies about WLS patient education practices from 1999 to 2016. Publications were: (1) rated with the Advancing Research and Clinical Practice through Close Collaboration levels of evidence hierarchy (see Melnyk's pryamid [http://guides.lib.umich.edu/c.php?g=282802&p=1888246]) and (2) analyzed according to surgical phase, curriculum, program delivery, and educator. RESULTS: Twenty-four publications met the study criteria. Evidence ratings for preoperative (n = 16) and postoperative studies (n = 8) were levels I to III (n = 5) and IV to VII (n = 17). Two publications were not ratable. Preoperative and postoperative education programs varied in curriculum, teaching methods, and educator. Topics varied in depth. Commonalities were surgical procedure, nutrition, activity, and psychosocial behaviors. Preoperative education was mostly provided in small groups, whereas individual sessions were used postoperatively. Lecture and discussion provided by myriad of healthcare experts from multiple disciplines were typical in both phases. Written or web-based aides supported learning needs in both phases. CONCLUSION: WLS patient education varied by curriculum and dose and commonly used passive learning methods (e.g., traditional lecture style instruction with minimal engagement from learners). Results shared can inform future bariatric education programs and accreditation standard development (e.g., Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program patient education standards). Additional study is needed, but existing evidence can guide improvements in high-quality, cost-effective, and patient-centered educational programs.

Predictors of Readiness for Hospital Discharge After Birth: Building Evidence for Practice.

BACKGROUND: Preparation for hospital discharge after birth became a global concern when hospitals in many developing countries began implementing shorter lengths of stay for uncomplicated deliveries. A mother's perceived readiness for hospital discharge may be influenced by many factors that can ultimately shape postdischarge outcomes. AIMS: The purpose of this study was to explore the antepartum, intrapartum, and postpartum predictors of discharge readiness, including nursing educational practices that are predictive of postpartum mothers' perceptions of readiness for hospital discharge. METHODS: The Adaptation to Transitions conceptual framework guided the descriptive correlational study design and measures. A purposive sample of 185 English- and Spanish-speaking postpartum mothers who experienced an uneventful vaginal or cesarean birth of a healthy infant completed demographic, quality of discharge teaching, and readiness for hospital discharge questionnaires prior to discharge. RESULTS: Mothers with three or more children, delivery mode, bottle-feeding, the delivery of education, and the difference between educational content received and needed, were significant predictors that accounted for 42% of the variance in readiness for hospital discharge (R2 = 0.42, F[10,174] = 14.52, p < .001). Nurses' skill in teaching and educational content received were significant predictors even with parity, feeding, and delivery mode in the model. LINKING EVIDENCE TO ACTION: The relationship between quality of discharge teaching and discharge readiness provides evidence of the critical role nurses have in the discharge preparation process. Nurse education programs and evidence-based guidelines should be designed to enhance patient education focused on the adequacy and delivery of teaching content.

Managing Symptoms: Enhancing Patients Self-Management Knowledge and Skills for Surgical Recovery.

OBJECTIVES: To review postoperative symptoms experienced by patients following surgery for cancer and discuss focused, evidenced-based methods to teach the patient acute pain and symptom management to include both pharmacological and non-pharmacological strategies. DATA SOURCES: Peer reviewed articles and national guidelines. CONCLUSION: Although significant advances have been made in providing effective acute pain control, pain remains a serious consequence after cancer surgery. Most patients go home after surgery (often the day of their surgery) not taking their pain medications or with inadequate pain medication. Postoperative symptoms such as nausea, constipation, and fatigue, and complications such as blood clots and infection, may present barriers to post-surgical recovery that can affect initiation of adjuvant therapy. IMPLICATIONS FOR NURSING PRACTICE: Nurses who are equipped with successful strategies to support self-management of postoperative symptoms will ensure that patients have a positive surgical experience.

Postoperative pain: knowledge and beliefs of patients and nurses.

AIMS AND OBJECTIVES: To describe patients' and nurses' knowledge and beliefs regarding pain management. Moreover, to explore the effect of information and education on patients' and nurses' knowledge and beliefs regarding pain management. BACKGROUND: In the treatment of postoperative pain, patients' and nurses' inadequate knowledge and erroneous beliefs may hamper the appropriate use of analgesics. DESIGN: A randomised controlled trial and a cross-sectional study. METHODS: In 2013, half of 760 preoperative patients were allocated to the intervention group and received written information about the complications of postoperative pain. The knowledge and beliefs of 1184 nurses were studied in 2014 in a cross-sectional study. All data were collected with the same questionnaires. RESULTS: In the intervention group, patients' knowledge level was significant higher than in the control group, while no differences were found in beliefs. Nurses had higher knowledge and more positive beliefs towards pain management compared with both patient groups. Nurses with additional pain education scored better than nurses without additional pain education. Nurses were also asked what percentage of pain scores matched their impression of the patient's pain, and the mean was found to be 63%. CONCLUSIONS: Written information was effective for increasing patients' knowledge. However, it was not effective for changing beliefs about analgesics and patients and nurses had erroneous beliefs about analgesics. RELEVANCE TO CLINICAL PRACTICE: It is necessary to continue to inform patients and nurses about the need for analgesics after surgery. Such education could also emphasise that a discrepancy between a patient's reported pain score and the nurse's own assessment of the patient's pain should prompt a discussion with the patient about his/her pain.