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- PublicationWhat characterizes 'the usual' preoperative education in clinical contexts?The literature on preoperative education is dominated by studies that employ experimental designs to measure the effects of structured programs on patient outcomes. These studies predominantly compare structured preoperative educational interventions with the usual care that patients receive. However, the notion of what the “usual” care comprises is largely elusive and unexplored. This study aimed to understand how the usual preoperative education is practiced in a number of surgical clinical units at one particular hospital in Ireland. Twelve experienced surgical nurses were interviewed in depth. A qualitative strategy resembling grounded theory was employed to analyze the data. The findings indicated that the content and quality of the preoperative education that patients received depended largely upon the individual nurse caring for the patient. Although there was a generic content of preoperative education that all participants identified as important, this related to physical and technical issues, and to the transmission of administrative or procedural information. Perspectives on the process of delivering preoperative education were diverse. The vast majority did not relate to the formal language of the discourses of teaching and learning; nonetheless, their descriptions of engaging in their work indicated the application of some elements of educational theory. The data suggested that the use of teaching tools was inconsistent, depending on their availability and the practices of individual nurses. On the whole, the usual care as described by participants in our study may be characterized as uneven, variable, and mutable. We conclude by raising some methodological issues relating to the use of the usual care in control groups in experimental studies on preoperative education.
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- PublicationNurse-related factors in the delivery of preoperative patient educationAims and objectives. This article aimed to explore the factors relating to nurses themselves that influence the delivery of preoperative patient education in everyday surgical clinical contexts at one large general adult teaching hospital in Ireland. Background. As landmark studies of preoperative education undertaken in the UK in the 1970s identified the superiority of structured programmes of patient education over and above ‘regular’ preoperative care, there have been many intervention/outcome experimental studies carried out in this area. However, there has been little interpretative work conducted that explores the regular, or ‘usual’ preoperative education given to patients in everyday surgical units. Methods. A sample of 12 experienced surgical nurses was selected and each participant was interviewed in depth. Data were analysed using a qualitative strategy resembling grounded theory. Results. Findings indicate that preoperative education was variously interpreted by participants, and participants’ accounts suggested that different understandings and practices by nurses resulted in patients receiving different levels of care. In addition, diverse levels of knowledge and experience of individual nurses resulted in unevenness in the type of preoperative education that patients received. A number of participants advocated a more formal method of preparation for nurses in the area of preoperative education. Finally, in some surgical areas, specialist nurses worked side-by-side with regular ward nurses and their input in preoperative education was largely seen by participants in a positive way, particularly in view of the structural constraints that ward nurses faced. Conclusions. We conclude that nurse-related factors in preoperative education do not arise in a vacuum, but rather are related to the wider organizational practices and culture. The difficulties with preoperative education identified in data may be addressed through organizational investment in preoperative education. Relevance to clinical practice. This paper produces evidence for nurses and clinical nurse managers about how nurse-related factors impede preoperative education, and may provide a starting point for how to begin to address obstacles to better preoperative care.
Scopus© Citations 22 3684