Elizabeth C. Devine

Effects of psychoeducational care for adult surgical patients: A meta-analysis of 191 studies

A quantitative review of the literature (meta-analysis) was conducted with 191 studies of the effects of psychoeducational care on the recovery, postsurgical pain and psychological distress of adult surgical patients. Studies issued between 1963 and 1989 were included in the review. Statistically reliable, small to moderate sized beneficial effects were found on recovery, postoperative pain and psychological distress. In further analyses it was shown that these beneficial effects were not an artifact of the biases associated with the decision whether to publish a paper, low internal validity, measurement subjectivity, or a Hawthorne effect. The overall efficacy of psychoeducational care provided to adult surgical patients has been reconfirmed with this larger sample of studies. It is particularly noteworthy that these findings are of more than strictly historical interest. Despite changes in health care delivery, beneficial effects continue even in studies issued between 1985 and 1989. Implications for clinical practice are drawn.

The Nursing Minimum Data Set: abstraction tool for standardized, comparable, essential data.

The Nursing Minimum Data Set (NMDS) represents the first attempt to standardize the collection of essential nursing data. These minimum core data, used on a regular basis by the majority of nurses in the delivery of care across settings, can provide an accurate description of nursing diagnoses, nursing care, and nursing resources used. Collected on an ongoing basis, a standardized nursing data base will enable nurses to compare data across populations, settings, geographic areas, and time. Public health nurses will be able to evaluate and compare services. The purpose of this article is to discuss briefly the following aspects of the NMDS: background including definition, purposes, and elements; availability and reliability of the data; benefits; implications of the NMDS with emphasis on nursing research; and health policy decision making.

Meta-analysis of the effects of psychoeducational care in adults with chronic obstructive pulmonary disease

Meta-analysis, a quantitative research review, was conducted on 65 studies of the effect of education, exercise and/or psychosocial support (hereafter called psychoeducational care) in adults with chronic obstructive pulmonary disease (COPD). Studies ranged in publication date from 1954 to 1994. Only 34% of studies had subjects that were randomly assigned to treatment condition, and only 15% of studies had a placebo-type control group. Analyses by type of treatment showed that pulmonary rehabilitation (large muscle exercise and education plus a variety of psychosocial or behavioral interventions) had statistically significant beneficial effects on psychological well-being (d+ = 0.58, n = 13), endurance (d+ = 0.77, n = 13), functional status (d+ = 0.63, n = 8), VO2 (d+ = 0.56, n = 5), dyspnea (d+ = 0.71, n = 10), and adherence (d+ = 1.76, n = 2). A statistically significant beneficial effect of pulmonary rehabilitation was not found on Forced Expiratory Volume at 1 s. Across 7 outcomes examined, treatments including education-alone had significant beneficial effect on the accuracy of performing inhaler skills (d+ = 1.27, n = 7). Based on a very small sample of studies, a non-significant but small or medium sized effect of education-alone was evident on health care utilization (d+ = 0.26, n = 3) and on adherence to treatment regimen (d+ = 0.50, n = 2). Such results are inconclusive, suggesting that further research may be indicated. Relaxation-alone had statistically significant beneficial effects on both dyspnea (d+ = 0.91, n = 3) and psychological well-being (d+ = 0.39, n = 6). The research base has methodological weaknesses that should be rectified in future research. Nonetheless, based on the best evidence available to date, identified types of psychoeducational care have been shown to improve the functioning and well-being of adults with COPD.

A META-ANALYSIS OF THE EFFECTS OF PSYCHOEDUCATIONAL CARE IN ADULTS WITH HYPERTENSION

A meta-analysis of 102 studies was conducted to determine the effects of psychoeducational care on blood pressure (n = 89), knowledge about hypertension (n = 30), medication compliance (n = 23), weight (n = 16), compliance with health cam appointments (n = 11), and anxiety (n = 6). Small- to medium-sized statistically significant beneficial effects were found on blood pressure for several types of psychoeducational care (education only, behavioral monitoring only, and relaxation). However, in the better controlled studies, the effect of relaxation on blood pressure was much smaller and not statistically significant. Statistically significant large treatment effects were obtained on knowledge, medication compliance, and compliance with health caw appointments. Threats to validity limited conclusions about the effects of psychoeducational care on the weight and anxiety of adults with hypertension.

Meta-analysis of the effects of psychoeducational care in adults with asthma.

Meta-analysis was conducted with 31 studies published between 1972 to 1993 on the effect of psychoeducational care (education, behavioral skill development, cognitive therapy, and/or nonbehavioral support/counseling) in adults with asthma. Fifty-eight percent of studies had subjects that were randomly assigned to treatment condition. Statistically significant beneficial effects were obtained on the occurance of asthmatic attacks (d+ = .56, n = 11), dynamic respiratory volume (d+ = .34, n = 10), peak expiratory flow rate (d+ = .29, n = 6), functional status (d+ = .46, n = 4), adherence to treatment regime (d+ = .78, n = 7), utilization of health care (d+ = .29, n = 10), use of PRN medications (d+ = .62, n = 8), psychological well-being (d+ = .53, n = 6), and psychomotor knowledge of inhaler use (d+ = 1.02, n = 4). Methodological weaknesses were identified that should be rectified in future research. Nonetheless, based on the best evidence available to date, both education and relaxation-based behavioral interventions have been shown to improve important clinical outcomes in adults with asthma.

AHCPR clinical practice guideline on surgical pain management: adoption and outcomes.

Pain management practices and short-term patient outcomes in nine acute care hospitals in Milwaukee, Wisconsin, were studied at two points in time. One-and-a-half years after the Agency for Health Care Policy and Researchs (AHCPR) Clinical Practice Guideline on Acute Pain Management was published, data from 330 adult surgical patients were collected (Time I). These data were contrasted with data from 373 adult surgical patients collected 2 years later (Time II). There were significant increases in the percentage of patients who reported being taught how to report pain using a pain rating scale and about setting a pain goal preoperatively; in the percentage of patient hospital records with at least one documented numeric pain rating; and in the percentage of patients who received analgesics by intravenous administration. However, pain management practices continued to differ from recommendations in the AHCPR guideline. No significant improvement was noted in the short-term outcomes of patient-rated pain or patient satisfaction with pain management. Availability of well-published guidelines alone may be insufficient to ensure comprehensive adoption of guidelines that are multidimensional in nature and to obtain improvements in patient outcome.

Clinical and financial effects of psychoeducational care provided by staff nurses to adult surgical patients in the post-DRG environment.

A three-hour, two-stage workshop for staff nurses on providing patient education and psychosocial support was evaluated in terms of its effects on patient welfare and recovery. Subjects were 148 persons who had either a cholecystectomy, other abdominal surgery, or transurethral resection of the prostate (TURP). Two hundred and six additional control subjects were obtained from a nearby hospital. Both hospitals were owned by the same corporation and had many of the same surgeons. After the workshop, experimental subjects used fewer sedatives or antiemetics, fewer hypnotics, and were discharged from the hospital on the average half a day sooner.

Nurse Practitioner Student Prescriptive Patterns

ABSTRACT As employment of nurse practitioners (NPs) increases in health care systems, there is a need to have current data on their prescribing practices and patterns, and to implement a system for updating such data. This study reports prescriptive data based upon 10,421 primary care visits conducted by 55 family NP students over a 15‐month period in 1997 and 1998. Numbers of over‐the‐counter drugs taken regularly, prescription drugs currently prescribed and prescription drugs prescribed or refilled at the visit were recorded in addition to types of drugs, compliance issues, diagnoses rendered and socio‐demographic information. Individual student data were aggregated and analyzed using Epi Info (Epidimiology Program Office of the Centers for Disease Control) and SPSS‐PC®. Results identified that: 1) the majority of patient visits involved the prescription of 1‐2 drugs (88%); 2) major compliance issues included financial concerns, knowledge deficits, and complexity/demands of treatment; 3) commonly rendered diagnoses at drug visits for chronic conditions were hypertension and diabetes; for acute conditions, otitis sinusitis and upper respiratory infections; 4) anti‐microbial agents, drugs used for relief of pain, and cardiovascular drugs account for 60% of drug mentions; and 5) the numbers of drugs prescribed or refilled at visits were similar by type of preceptor, except fewer single drugs were prescribed or refilled at visits supervised by nurse preceptors. Findings are discussed relative to deepening the understanding of advanced practice nursing education and the prescribing practices of NP students and their preceptors.

Nursing Minimum Data Set: An Abstraction Tool for Computerized Nursing Services Data

The Nursing Minimum Data Set (NMDS) is an initial effort to establish uniform standards for the collection of minimum essential nursing data. It draws on the documentation of the nursing process that is performed when nurses take care of people in any setting. This establishment of uniform standards is crucial as data in the health care field become computerized and retrievable. These standards are the bases for collecting comparable data locally, regionally, and nationally.