Preliminary effects of a preoperative nursing consultation for patients undergoing hip or knee replacement surgery: A pre-experimental study / Effets préliminaires d'une consultation préopératoire infirmière auprès des patients devant subir une arthroplastie de la hanche ou du genou : une étude préexpérimentale

Introduction: A large proportion of patients undergoing hip or knee replacement surgery experience preoperative anxiety, a predictor of postoperative pain. Objective: To evaluate the preliminary effects of a preoperative nursing consultation incorporating therapeutic education with relaxation on pre- and postoperative anxiety and postoperative pain in patients undergoing hip or knee replacement surgery. Method: Pre-experimental study conducted with a single group and several measurement times: before and after the consultation with a nurse; the day before surgery; and during the hospital stay. Results: A total of 92 people participated in the study. There was a significant and progressive decrease in levels of pain and anxiety. The reduction in anxiety levels before/after the consultation (T0-T1) correlated with anxiety levels the day before surgery (T2), anxiety levels during the hospital stay (T3), and postoperative pain. Discussion: This preoperative nursing consultation appears to have been effective in reducing levels of pre- and postoperative anxiety, as well as postoperative pain, in the patients studied. Conclusion: This randomized clinical trial demonstrates the relevance of continuing to study this combined therapeutic approach in the management of pre- and postoperative anxiety and pain.

Introduction: Une grande proportion de personnes devant subir une arthroplastie de la hanche ou du genou éprouvent de l'anxiété préopératoire, prédictive de douleur postopératoire. Objectif: Évaluer les effets préliminaires d'une consultation infirmière préopératoire intégrant de l'éducation thérapeutique avec de la relaxation sur l'anxiété pré- et postopératoire et la douleur postopératoire dans cette population. Méthode: Devis préexpérimental avec un seul groupe en plusieurs temps de mesure, avant et après la consultation infirmière, la veille de la chirurgie et durant le séjour hospitalier. Résultats: Au total, 92 personnes ont participé à l'étude. Il y a une diminution significative et progressive de l'anxiété et de la douleur. La diminution de l'anxiété avant/après la consultation (T0-T1) est corrélée à l'anxiété la veille de la chirurgie (T2), l'anxiété pendant le séjour (T3) et la douleur postopératoire. Discussion: Cette consultation infirmière en préopératoire semble efficace pour diminuer l'anxiété pré- et postopératoire et la douleur postopératoire dans cette population. Conclusion: Cette étude démontre la pertinence de continuer à étudier cette combinaison thérapeutique dans la gestion de l'anxiété et la douleur pré- et postopératoire dans un essai clinique à répartition aléatoire.

Pain Assessment Clinical Practice Improvement: An Educational Approach in the Home Healthcare Setting.

In the 2 decades since The Joint Commission on Accreditation of Healthcare Organizations designated pain as the fifth vital sign, practitioners have become increasingly aware of the numerous challenges associated with the assessment and management of pain in older adults. Comprehensive pain assessment relies not only on the availability of assessment tools, but also on a clinician's knowledge, training, prior experience, and keen awareness of their own implicit bias and how it may influence their assessment and decisions. The purpose of this project was to develop, implement, and evaluate outcomes of a two-part online learning module on home healthcare clinicians' knowledge of pain. A quasi-experimental, one-group pretest posttest design was used. Of the 94 clinicians who volunteered, 54 participants completed all modules and surveys. Mean posttest scores (58.7%) were significantly higher than pretest scores (50.7%; n = 54, T = 3.08, p-value = 0.003). The strongest gains in learning occurred for those with lower pretest scores. The mean difference between posttest and pretest scores did not vary among job titles. There was no significant difference in posttest scores among job titles. A higher mean pretest score was associated with greater years of clinical experience, but did not significantly affect mean posttest scores. These findings suggest elearning is an effective educational approach to improve home healthcare clinicians' pain knowledge, particularly those who lack a sufficient knowledge base at the outset.