As a clinical nurse in the surgical short stay unit at Cleveland Clinic’s Glickman Urological Institute, Julie Green, RN, is accustomed to providing patients with a lot of education in a short amount of time since patients on the unit are released the day after surgery. “We teach them about prescriptions they will take at home, give them discharge instructions, and warn them about blood clots, among many other things they need to know,” says Green. “Receiving so much information can be overwhelming to patients.” She is particularly concerned that patients obtain and retain life-saving information about venous thromboembolism (VTE).
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As part of a quality improvement project, Green created educational tools on postoperative VTE, a major complication of surgery with anesthesia, which can be deadly. The tools included a pamphlet and video featuring knowledge about VTE signs and symptoms, prevention methods and what to do if it is suspected.
The quality project blossomed into a research study. “I wanted to find out if patients who received multiple educational tools – rather than just a handout – retained new information better than those receiving a handout alone,” says Green. She partnered with Esther Bernhofer, PhD, RN-BC, CPE, Nurse Scientist II in Cleveland Clinic’s Office of Nursing Research and Innovation, on a randomized controlled trial.
Study purpose and methods
The study aimed to compare knowledge retained regarding VTE risk and prevention. The experimental group received a multimethod education plan that included a video, pamphlet and verbal instructions, while the control group received usual care written instructions. Green and Dr. Bernhofer were guided by three primary research questions:
- Prior to receiving any pre-discharge VTE education, what was participants’ knowledge regarding VTE prevention and the level of importance they place on it?
- Within groups, were there differences in the level of importance, pre-education knowledge and basic survival knowledge of VTE prevention 10 ± 4 days after hospital discharge, based on age, gender, race, surgery type, length of hospital stay and prior history of VTE?
- Was there a between-group difference in survival skill knowledge and level of importance that participants placed on VTE prevention?
A random sample involved 66 adults who were recovering on general surgery nursing units. All participants received a knowledge test immediately before instruction. Two weeks following discharge, a member of the research team called participants to complete the post-instruction test.
Both tests included six knowledge-based questions about VTEs. The post-instruction test also asked participants if they had used any prevention methods on which they were instructed to prevent VTEs, and, if so, which ones.
“All of the tools were short and to the point because I didn’t want to give patients too much information that they did not need,” says Green. “I wanted them to get life-sustaining information about VTEs.”
Study results and implications for practice
By group, there were no statistically significant differences in age, gender, race, length of stay, surgery and history of VTE among participants. There also was no statistically significant difference in post instruction scores between groups. However, numerically, experimental group participants had higher knowledge scores than control group participants, 73.5 percent versus 38.2 percent, respectively.
Of the six questions, one question was answered correctly by all experimental group participants: If you suspect you have a VTE, what is the first thing you should do? “Although this one test item does not represent all instructions received, it was a very important question to answer correctly,” says Dr. Bernhofer. “And when assessing differences between groups on the individual knowledge items, that item scored significantly higher in the experimental group.”
The study reinforces the value of patient education regarding postoperative VTE. “Nurses need to realize how important it is to educate patients on three aspects of VTE – signs and symptoms, what patients need to do when they go home to prevent blood clots, and what they need to do if they think they have a VTE,” says Green.
Dr. Bernhofer adds that it’s important to utilize several methods to teach patients, rather than rely solely on written care instructions. “Use multiple methods to get the point across – especially those points that are life-saving,” she says.
Results of the study were published earlier this year in the Journal of Clinical Nursing.