Thesis (M.S.)--Boston University / Anxiety is a common reponse in patients undergoing cardiac surgery. The source of this anxiety is attributed to a multitude of factors. Research findings support the relationship between preoperative preparation and a reduction in anxiety. However, a lack of information exists as to the role of critical care nurses in this process. This purpose of this study was to examine the effect of a structured preoperative education/orientation visit by the critical care nurse on the level of patient anxiety. A sample of 21 patients were drawn from the population of cardiac surgical patients and randomly assigned to the experimental or control group. Subjects in the experimental group received a structured preoperative education/orientation visit by a critical care nurse the evening prior to surgery. Subjects in the control group did not receive the visit. Subjects in both groups completed the State-Trait Anxiety Inventory preoperatively and the A-State Scale plus an additional questionaire postoperatively. Data were analyzed using analysis of covariance on repeated measures and a t-test comparison of mean anxiety scores. Findings revealed no significant differences in postoperative state anxiety scores between the experimental and control group. Results from the second questionaire indicated that subjects in the experimental group felt the preoperative visit was helpful. Furthennore, those patients who had the continuity of the same nurse conducting the preoperative visit and assuming primary care postoperatively in the intensive care unit responded more favorably on the questionaires. There were however, significant pre-existing differences in age and trait anxiety scores between the groups. This fact, in addition to the small sample size limit the ability to evaluate the effectiveness of the experimental intervention. Thus, further research is warranted to determine the effect of a preoperative education/orientation visit by critical care nurses utilizing a larger sample size.

This is a post-test only experimental design using an uncertainty reduction video to alleviate patient uncertainty, desire for information and increase self-concept to improve overall patient satisfaction with health care experience. The subjects were 80 cardiac consultation patients in a cardiology clinic in Northern California. Forty people were randomly assigned to a control group and forty people to the experimental group. A scale was given to each group which measured the patients' level of self-concept, level of uncertainties (medical setting, relational and illness), and desire for information. The experimental group received an uncertainty reduction video prior to filling out the questionnaire. The uncertainty reduction video was designed to debrief the patient on subjects that may be causing uncertainty for the patient. In conclusion, this study found that the uncertainty reduction video significantly reduced the patient's level of medical setting uncertainty. The study showed a relationship between medical setting uncertainty and relational uncertainty and a relationship between relational uncertainty and illness uncertainty. The study also indicated that patients have high levels of uncertainties in all uncertainty areas: illness, relational, and medical setting, and high a desire for information. However, the video did not show an ability to reduce a patient's level of relational or illness uncertainty. The study also did not show a relationship between self-concept and level of uncertainty and desire for information. Future areas of research suggest that for a similar study a series of illness specific videotapes may be more beneficial at reducing illness uncertainty. The patient's level of previous knowledge, its source, depth and credibility was also suggested for future research. Another area suggested for future research would be the correlation between uncertainties and anxieties.

Objective: To systematically scope the reported advice and education in physical therapy management of patients with subacromial shoulder pain, and to define key themes of the advice and education. Design: Scoping review. Literature Search: We searched MEDLINE, Scopus, Web of Science, and CINAHL, with publication dates from 2007 to September 2019. Study Selection Criteria: We included quantitative and qualitative research that reported on physical therapy interventions for subacromial shoulder pain. Data Synthesis: We performed a qualitative synthesis that identified items included in patient advice and education. Results: Of 89 original studies included, there were 61 randomized controlled trials; 5 prospective studies; 16 nonrandomized observational intervention studies or case series; and 7 surveys, audits of physical therapy patient records, and focus groups with physical therapists. We identified 7 key themes for advice and education: exercise intensity and pain response, activity modification advice, posture advice, pain self-management advice, pathoanatomical and diagnosis information, behavioral approaches, and pain biology advice. Conclusion: While advice focused predominantly on the local tissue pathology model, 10% of studies included information about pain neuroscience education, psychosocial factors, motor imagery, or behavior change.

No description available.

Introduction: To improve comprehension of medical care, the Joint Commission recommends that patient education materials (PEMS) be written at a fifth-grade reading level or below. Objectives: The purpose of this study was to evaluate the compliance of commonly used tertiary drug references to Joint Commission standards. Methods: PEMs for the top 100 most prescribed medications in 2017 were obtained from commonly used drug information tertiary references (Lexi-comp patient drug information, Micromedex Care Notes, Micromedex Med Essential Fact Sheets, Medline Plus, and Drugs.com) to evaluate readability. The grade reading level of each medication-related PEM was evaluated using the Flesch-Kincaid Grade Level test and compared with a one-way analysis of variance using correlated samples and Tukey's post-hoc test for significance between groups. Results: The mean grade reading levels of Lexi-comp, Micromedex Care Notes, Micromedex Med Essential Fact Sheets, Medline Plus, and Drugs.com were 4.2, 7.5, 7.8, 9.3, and 10.4, respectively. Lexi-comp achieved a reading level at or below fifth grade for 99% of medications while Micromedex Med Essential Fact sheets was the next highest at 33%. No other reference contained drug information at or below a fifth-grade reading level. Conclusion: Lexi-comp patient drug information consistently met the Joint Commission recommendation for medical information at or below a fifth-grade reading level, whereas Micromedex Med Essential Fact Sheets met this recommendation approximately one-third of the time. When providing drug information resources to patients, health-care providers should be diligent in selecting sources that meet the Joint Commission recommendations.

Background: Adolescents need to develop health literacy skills to participate in making decisions about their health care. Organizational health literacy facilitates patient understanding of health information, care access, and self-management. Methods: A literature review and qualitative case study were conducted to explore adolescent health literacy within an organizational context of an adolescent scoliosis program. Results: Adolescent health literacy is more nuanced than numeracy and reading levels. Yet, little is known about how organizations (including clinicians) support adolescent health literacy. Interviews with health care professionals in a pediatric tertiary hospital related health literacy to scoliosis patient education but did not address other factors associated with adolescents’ ability to navigate health systems. Organizational documents did not adequately support healthcare professionals in promoting the health literacy of adolescent scoliosis patients. Conclusion: Organizational supports are needed to build health literacy capacity amongst adolescents receiving scoliosis care and clinicians need help to leverage the supports that are in place.

Background: Implantable cardioverter defibrillators (ICDs) deliver therapy in the form of an internal shock should a life-threatening arrhythmia occur. Literature suggests that patients have misconceptions regarding ICD therapy and unmet information needs. Purpose: This study assessed the feasibility of delivering a pre-implantation nurse-led educational intervention to ICD candidates. Methods: ICD candidates attending an outpatient preoperative clinic were invited to participate. Consented participants were randomized to standard care or standard care plus an educational intervention. The educational intervention addressing information gaps identified in the ICD literature was delivered during the preoperative visit. The primary outcome was feasibility with the following targeted rates, (1) 80% recruitment; (2) ≥ 95% consent; (3) 90% randomization; (4) ≥ 90% completion of questionnaires; (5) 80% of intervention sessions delivered less than 45 minutes; and (6) 90% of intervention content delivered. At baseline, demographic data and Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety scores were collected. Four weeks post-ICD implantation, participants completed the PROMIS anxiety measure, Florida Patient Acceptance Survey (FPAS), and Florida Shock Anxiety Scale (FSAS). Results: Twenty patients consented to the study (10 standard care/10 standard care plus the educational intervention). Feasibility outcomes achieved were, (1) recruitment rate of 80%; (2) consent rate of 87%; (3) 100% randomization; (4) 80% completion of questionnaires; (5) 100% of intervention sessions completed in less than 45 minutes; and (6) intervention checklist completion rate of 100%. The four-week mean (SD) FPAS scores were 80.0 (13.4) in the intervention group compared to 77.0 (16.5) in standard care. Mean (SE) four-week PROMIS scores were 45.4 (6.4) in the intervention group and 43.7 (8.6) in standard care. Mean FSAS (SD) scores were 14.7 (4.6) in the intervention group and 13.3 (3.9) in standard care. Conclusion: The results demonstrated feasibility of delivering a pre-implantation nurse-led educational intervention in an outpatient clinic setting to ICD candidates. Further studies to evaluate the effectiveness of the intervention on patient-reported outcomes are warranted. / Thesis / Master of Science (MSc) / An ICD is a medical device placed under the skin that can fix a dangerous heart rhythm. It can do so by shocking the patient’s heart if the ICD senses a dangerous heart rhythm. This study was done to determine if it is practical to deliver education to patients before they receive their ICD. Some patients feel they do not receive enough information before getting an ICD. No studies have tested how education before receiving an ICD can impact a patient’s quality of life. In this study, ten people received usual care while ten people received usual care and ICD education from a nurse before ICD implantation. The results of this study determined that it was practical for nurses to deliver ICD teaching before the ICD was implanted. A future study testing the impact of education on the quality of life of ICD patients can and should be completed.

No description available.

Objective We sought to analyze the effect of a structured, dietitian-led education program on patients' general knowledge of phosphate and phosphate binders, and its impact on serum phosphate concentrations in a single-center hemodialysis population. Design We compared subjects before and after intervention. Setting This study involved two dialysis units operated by a single center. Patients One hundred and fifteen hemodialysis patients consented to participate in this study (54% male; mean age, 61.1 years; 32% Asian). Patients acted as their own controls. One hundred and eight patients completed the study. Intervention All patients completed a questionnaire to assess their knowledge of phosphate and phosphate-binder therapy. Small group teaching sessions were then delivered to patients by a single dietitian, with the aid of a hospital interpreter as required. Patients also received information booklets or audio cassettes translated into Urdu. A second identical questionnaire was completed a month later. Main Outcome Measures Outcome measures involved pre-education and posteducation knowledge scores, monthly measurements of serum phosphate, calcium, and mean Kt/V, and parathyroid hormone concentrations every 3 months during the 5 month run-in period and subsequent 5-month study period. Results The education program significantly improved patients' general knowledge of phosphate and of phosphate-binders (P < .001), especially in patients with a low pretest score and those of South Asian origin. This result was associated with a significant reduction in serum phosphate in patients with hyperphosphatemia (P = .032). Conclusions These findings suggest that a combination of educational initiatives is effective in enhancing patients' knowledge of phosphate and phosphate-binders, and consequently in improving serum phosphate levels in patients with hyperphosphatemia.

Aim. The overall aims of this study were to develop a tailor-made educational intervention and to examine its effectiveness on short- and longer-term outcomes among Chinese patients with traumatic limb fractures who had undergone surgery. / Background. Fracture limb and undergoing surgery is the common problem after injury. It is the most common source of pain and anxiety and research continues to demonstrate a high prevalence of unrelieved pain in injured patients who have undergone surgery. Patient's belief in pain is the major barrier in pain management. Strategies directed to have appropriate educational interventions are urgently needed to improve patient outcomes for those suffering acute pain after surgery for traumatic limb fracture. / Conclusion. The C-BEI was effective in terms of reducing the pain barrier, providing post-operative pain relief, reducing anxiety, and improving sleep satisfaction in patients with fractured limbs during their first week of hospitalization after surgery. This study has generated evidence supporting the use of a C-BEI in acute pain management. / Method. The study was conducted in the orthopaedic wards of two regional hospitals in Hong Kong and comprised two phases. In phase one, qualitative interviews were conducted with twenty-six Chinese patients who had traumatic limb fractures and were undergoing surgery regarding their experiences of and beliefs about pain management. Ten orthopaedic nurses were also interviewed about their perceived pain management practices and the barriers that prevented better pain control among patients. The findings from these qualitative interviews were used to develop a cognitive behavioural approach educational intervention (C-BEI). C-BEI was used to enhance knowledge of pain, modify their beliefs about pain management and promote positive coping thoughts and behaviour. The C-BEI consisted of two sessions. The first was a 30-minute session comprised a combination of patient education and breathing relaxation exercise and conducted at T0 (1 day before surgery). A 30-minute reinforcement session was conducted at day 7 after surgery (T3). / Results. A total of 125 participants completed the study, with 62 in the experimental group and 63 in the control group. The participants were homogenous in terms of demographic data (P > 0.05) and baseline clinical characteristics (p > 0.05). The short-term outcomes (from T0 to T3) for the participants in the experimental group were a statistically significant with lower pain barrier (p = .003), lower level of pain (p = .003), lower level of anxiety (p &lt; .001), and better sleep satisfaction (p = .001) than the control group. The experimental group had a significantly higher frequency of analgesic use at T2 (p &lt; .001) and better self-efficacy in pain management at T3 (p = .011) than the control group. There were no statistically significant differences in the total length of stay in hospital, although the mean length of stay was shorter in the experimental group than in the control group (8.1 day VS 10.1 days). For longer-term effects, the C-BEI was effective at the post-operative stage in anxiety reduction ( p = .002) and sleep satisfaction improvement (p = .002). There were no statistically significant differences for the VAS pain level, GSE scores, physical health summary component (PCS) and mental health summary component (MCS) of the SF36 between two groups over three months, although the experimental group had better scores in the mental health dimension. Findings of the process evaluation showed that most participants perceived the C-BEI as effective in enhancing their knowledge on pain management and the use of analgesics, and helping them to cope with pain, the could sleep better and regain self-control. / The main study was conducted in phase II which consisted of outcomes and process evaluation. A quasi-experimental design of two groups' pre-test and post-test between subjects was employed for the outcomes evaluation. All participants in the experimental group received the C-BEI and usual care, whereas those in the control group received usual care only. The short-term outcomes were treated as primary outcomes and evaluated in terms of the participants' pain barrier score, pain level (Visual Analogue Pain Scale: VAS, anxiety level (State-Trait Anxiety Inventory:STAI), sleep satisfaction, self-efficacy in pain management (General Self Efficacy Scale: GSE), and frequency of analgesic use. All of which were measured at T0, T1 (day 2), T2 (day 4), and T3 (day 7) after surgery. The total length of stay in hospital of the two groups was also compared. Longer-term outcomes were further evaluated over three months at T4 (1 month) and T5 (3 months), and included the VAS pain level, STAI, sleep satisfaction, GSE and health-related quality of life (SF36).The intention-to-treat method was adopted. The process evaluation involved a qualitative study using telephone interviews. / Wong, Mi Ling, Eliza. / Adviser: Sally Chan. / Source: Dissertation Abstracts International, Volume: 71-01, Section: B, page: 0231. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 256-278). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese.