Brynja Ingadottir

Difference Between Received and Expected Knowledge of Patients Undergoing Knee or Hip Replacement in Seven European Countries

The purpose of the study was to examine received and expected knowledge of patients with knee/hip arthroplasty in seven European countries. The goal was to obtain information for developing empowering patient education. The data were collected (during 2009-2012) from patients (n = 943) with hip/knee arthroplasty prior to scheduled preoperative education and before discharge with the Received Knowledge of hospital patient scale (RKhp) and Expected Knowledge of hospital patient scale (EKhp). Patients’ knowledge expectations were high but the level of received knowledge did not correspond to expectations. The difference between received and expected knowledge was higher in Greece and Sweden compared with Finland (p < .0001, p < .0001), Spain (p < .0001, p = .001), and Lithuania (p = .005, p = .003), respectively. Patients’ knowledge expectations are important in tailoring patient education. To achieve high standards in the future, scientific research collaboration on empowering patient education is needed between European countries.

Predictors of psychological distress in patients at home following cardiac surgery: an explorative panel study.

Background: Knowledge is lacking on what predicts psychological distress in cardiac surgery patients. Aim: To describe the post-operative symptoms of anxiety and depression in cardiac surgery patients; to detect associations between those symptoms and patient’s experiences of illness and hospitalisation and also their family and social situations; and identify experiences and situations that predict symptoms of anxiety and depression at home when measured at least four weeks after hospital discharge. Method: In this prospective explorative panel study all eligible cardiac surgery patients over a six month period in 2007 were invited to participate. Data was collected at the hospital and at home. Two questionnaires were developed and included the Hospital Anxiety and Depression Scale (HADS), questions on family and social issues, patient’s experience of illness, hospitalisation and family and social situations. Results: Of the 66 participants few had symptoms of anxiety and depression at hospital or at home. Significant associations were found between symptoms of anxiety and depression measured at home and the same symptoms at hospital; pain and general post-operative symptoms; satisfaction with discharge education; self-assessed post-operative recovery and quality of sleep at home. Post-operative anxiety was predicted by depression at the hospital, not feeling rested upon awakening and presence of pain at home. Post-operative depression was predicted by depression at the hospital and not feeling rested upon awakening. Conclusion: Signs of patients’ anxiety and depression should be assessed before surgery and appropriate intervention planned accordingly in order to support patients at risk of post-operative psychological distress.

Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation

Purpose To describe what knowledge heart failure patients expect to acquire in relation to their upcoming cardiac resynchronization therapy (CRT) device implantation, to describe their self-care and health complaints, and to explore the relationship between knowledge expectations and self-care, health complaints, and background factors. Patients and methods Cross-sectional multicenter study with 104 patients scheduled for a first-time, elective CRT implantation in Swedish and Icelandic hospitals. Data were collected with the Knowledge Expectations of hospital patient Scale, European Heart Failure Self-care Behavior Scale, and Adjusted Postoperative Recovery Profile. Results Patients expected most knowledge related to their disease and its treatment (median 4.0, interquartile range 0.13) and least on social issues (median 3.5, interquartile range 0.83). Their self-care was average (standardized mean 51.0±19.6) before the procedure. Patients had on average 8.2 (±4.7) health complaints and rated fatigue and sexual problems as the most severe. Age was independently associated with knowledge expectations (Expβ 0.049, P=0.033). Conclusion Heart failure patients waiting for a CRT device implantation have high expectations for multiple aspects of knowledge, including self-care issues, before their procedure. These expectations are similar to those of other surgical patients and they increase with age.

Development, Usability, and Efficacy of a Serious Game to Help Patients Learn About Pain Management After Surgery: An Evaluation Study

Background Postoperative pain is a persistent problem after surgery and can delay recovery and develop into chronic pain. Better patient education has been proposed to improve pain management of patients. Serious games have not been previously developed to help patients to learn how to manage their postoperative pain. Objective The aim of this study was to describe the development of a computer-based game for surgical patients to learn about postoperative pain management and to evaluate the usability, user experience, and efficacy of the game. Methods A computer game was developed by an interdisciplinary team following a structured approach. The usability, user experience, and efficacy of the game were evaluated using self-reported questionnaires (AttrakDiff2, Postoperative Pain Management Game Survey, Patient Knowledge About Postoperative Pain Management questionnaire), semi-structured interviews, and direct observation in one session with 20 participants recruited from the general public via Facebook (mean age 48 [SD 14]; 11 women). Adjusted Barriers Questionnaire II and 3 questions on health literacy were used to collect background information. Results Theories of self-care and adult learning, evidence for the educational needs of patients about pain management, and principles of gamification were used to develop the computer game. Ease of use and usefulness received a median score between 2.00 (IQR 1.00) and 5.00 (IQR 2.00) (possible scores 0-5; IQR, interquartile range), and ease of use was further confirmed by observation. Participants expressed satisfaction with this novel method of learning, despite some technological challenges. The attributes of the game, measured with AttrakDiff2, received a median score above 0 in all dimensions; highest for attraction (median 1.43, IQR 0.93) followed by pragmatic quality (median 1.31, IQR 1.04), hedonic quality interaction (median 1.00, IQR 1.04), and hedonic quality stimulation (median 0.57, IQR 0.68). Knowledge of pain medication and pain management strategies improved after playing the game (P=.001). Conclusions A computer game can be an efficient method of learning about pain management; it has the potential to improve knowledge and is appreciated by users. To assess the game’s usability and efficacy in the context of preparation for surgery, an evaluation with a larger sample, including surgical patients and older people, is required.

Fasta á undan skurðaðgerð: Leiðbeiningar til sjúklinga og lengd föstu – framskyggn könnun

INTRODUCTION Fasting is an important safety precaution for patients before surgery but studies indicate that excessive fasting is common. Explanations for this, including patient education related factors, are not well known. The aim of this study was to explore how long patients fast before surgery and what instructions they received, one year after the introduction of new guidelines for patients and professionals. MATERIAL AND METHODS This descriptive study was undertaken in a national, 660-bed university hospital in 2011. Data was collected from patient records and with questionnaires. Included were adult surgical patients having anaesthesia during a 5day period. RESULTS The sample consisted of 193 patients: 83% were scheduled for elective surgery and 86% returned questionnaires. Average fasting time was 13,6 (±3.0) hours for solid food and 8,8 (±4.5) hours for clear fluids. A quarter (27%) had received instructions according to guidelines and 45% were instructed to fast from midnight. Information was either written (18%), verbal (37%) or both (45%) and 46% of patients received information on the importance of fasting. Patients scheduled for morning surgery fasted for a shorter time than afternoon patients (p<0.05). Patients who received both verbal and written information fasted shorter on clear fluids (p<0.001) than others. CONCLUSIONS The fasting of surgical patients before their operation is unnecessarily long and they do not get uniform instructions. This warrants further exploration. There is a need for staff to coordinate instructional practices, to involve patients more in their own care with consistent information and comprehensive education and assist them in reducing fasting on clear fluids after hospital admission. KEY WORDS preoperative fasting, patient education, surgery, surgical patients. Correspondence: Brynja Ingadottir, brynjain@landspitali.is.

Effects of web-based interventions on cancer patients’ symptoms: review of randomized trials

PurposeSymptom management is of high priority in cancer care. Information and communication technology allows interventions to be provided through the internet to enhance the delivery of care. This study aimed to review the effects of web-based interventions on cancer patients’ symptoms.MethodsMEDLINE, PSychINFO, PubMed, CINAHL, and Cochrane databases were systematically searched. Included were randomized controlled trials (RCTs), pilot RCTs, or quasi-experimental (QE) studies focusing on web-based interventions in adult cancer patients with at least one outcome primary or secondary, in terms of symptoms, treatment side effects, or distress. Data were analyzed study by study.ResultsTwenty studies were identified. All web interventions included information, 16 included self-management support, 14 included self-monitoring, 13 included feedback/tailored information, 12 used communication with health-care professionals, and eight used communication with other patients. Overall, 13 studies reported positive symptom outcomes. Psychological distress was reported in eight studies with positive intervention effects in three. Symptoms of anxiety/depression were reported in ten studies with positive intervention effects in five. Somatic symptom severity was reported in ten studies with intervention effects found in six, and symptom distress was reported in six studies with intervention effects found in all.ConclusionsThis review shows the promising potential of web-based interventions for cancer symptom management, although it was limited by considerable heterogeneity in the interventions tested and targeted outcomes. The multidimensional nature of symptoms was partly addressed; only one study was guided by a comprehensive theoretical model of cancer symptom management. It can only be speculated which web elements are important for effective symptom outcomes. Further testing is needed for web-based cancer symptom management.

Self-reported health and quality of life outcomes of heart failure patients in the aftermath of a national economic crisis: a cross-sectional study: Self-reported outcomes of HF patients

There are indications that economic crises can affect public health. The aim of this study was to describe characteristics, health status, and socio‐economic status of outpatient heart failure (HF) patients several years after a national economic crisis and to assess whether socio‐economic factors were associated with patient‐reported outcome measures (PROMs).

Content of Orthopedic Patient Education Provided by Nurses in Seven European Countries

Patients’ and their significant others’ education during the perioperative phase is an important and challenging aspect of care. This study explored the content of education provided by nurses to arthroplasty patients and their significant others. Data were collected with the Education of Patients–NURSE content (EPNURSE-Content), Received Knowledge of Hospital Patient (RKhp), and Received Knowledge of Significant Other (RKso) scales. The results showed that the content of education emphasized biophysiological and functional needs, differed between countries, and was related to how physically demanding nurses found their job to be and the amount of education provided. There is congruence between the received knowledge of patients and their significant others in relation to the content of education provided by nurses. The findings can support nurses in developing aid material for patients and significant others explaining the nature of education and advising them what to expect and how to optimize their participation in the process.

The potential use of a serious game to help patients learn about post-operative pain management – An evaluation study

Abstract Aims To describe the evaluation of a serious computer game designed for patients to learn about post-operative pain management. Methods This was a usability and evaluation study. The sample consisted of 20 people, recruited from the public. The computer game was developed by an interdisciplinary team. In the game, the player controls the actions of a virtual human character who has been discharged home after surgery. The player needs to make decisions about the character’s daily activities, such as common household tasks and self-care, including pain management. The player observes how his decisions influence the character’s recovery. The usability and efficacy of the game were evaluated in one session with semi-structured interviews and questionnaires on knowledge acquisition and usability. The playing session was video recorded to assess if technical problems arose and how often the player needed assistance. Results The mean age of participants was 48 years (SD = 14), 11 were women. Participants described the usability of the game as high (range 3–5 on a 0–5 scale) and expressed satisfaction with this novel method of learning, despite some technological challenges. Ease of use was confirmed by observation. Knowledge of pain medications and pain management strategies improved after playing the game. The number of correct answers increased from 54%, before playing, to 71% after playing the game (p = 0.001). Conclusions Playing an educational computer came has the potential to improve knowledge regarding post-operative pain management. The game was well received by participants. Serious computer games can be a useful tool in enhancing patient education. The game needs to be tested with surgical patients.