https://www.ausmed.

com/articles/preoperative-education/

AUSMED EDUCATION PTY LTD (AU) Sally Moyle 10th Jul 17 diakses pada tgl 17/10/18

Providing education to patients and their families is one of the most important aspects of
nursing care.

This can be education about practically anything but most commonly; pain management,
bowel management, physical restrictions, medication side effects… the list goes on. I have
also on occasion provided education on the best shows to watch on Netflix as well as the
best coffee to be found within a 100m vicinity of the hospital.

Education is essential to the patient and, as you can see, it can vary quite dramatically
depending on patient needs.

In terms of the surgical patient, some of the most important education we give them is the
education before surgery, their preoperative education.

The goal of preoperative education is to not only prepare the patient for their surgery, but
also to prepare them for what to expect following the surgery. Therefore it can be quite
extensive! We’ll look at some of the common areas of preoperative education in this article.

Preoperative preparation allows patients to:

 Have more understanding of their surgery

 Feel more in control

 Experience decreased postoperative pain and anxiety

 Have a decreased length of hospital stay

 Have a quicker recuperative period

 (Tollefson et al. 2012)

Information should be provided not only to the individual undergoing the surgery but also to
their family and relatives if required.

Each member of the surgical team will focus on different components of information. For
example, the surgeon will discuss and gain consent for the surgery, the anaesthetist will
discuss their role and what to expect with the anaesthetic experience, and the nurse will
discuss nursing aspects of care and education such as deep breathing and coughing
exercises.

Why is Providing Information Important?

Knowledge and understanding of what is occurring and why promotes feelings

of a sense of control that also helps to allay any anxiety.

Information may also need to be repeated at times. Because, as you may

know, anxiety can result in the individual having difficulty retaining information.
The individual should also be assessed on their prior knowledge so that the
information we give them is appropriate and it should also be presented to the
individual in language that they understand.

Sometimes written information can be used that will also be help the individual
to retention of information (Koutoukidis, Stainton & Hughson 2017).

Information should include:

 Preoperative procedures and the rationale for these procedures such as
fasting, stopping anticoagulation therapy, etc.

 Preparations required such as insertion of intravenous cannula, pre-

medications and what sensations may be felt when the anaesthesia is
induced

 Information regarding the post-aneasthetic care unit

 What to expect postoperatively; for example IV fluids and wound drains

 Postoperative activities the patient will be expected to do, such as deep

breathing and coughing, and early mobilisation

 Pain management

 Any other information specific to the surgery they are undergoing or relevant
to the individual

(Koutoukidis, Stainton & Hughson 2017)

Preoperative Education

Preoperative education is not only important to reduce the risk of

postoperative complications from occurring, it also allows the individual to take
an active role in their recovery and can help them gain a sense of control
during a time when they may feel events are out of their control (Koutoukidis,
Stainton & Hughson 2017).
Any preoperative teaching should occur over a prolonged period of time in
order to give the patient the opportunity to ask questions and ensure
information is assimilated. Therefore, ideally this teaching and education isn’t
done on the day of surgery but is an ongoing process which begins during
their pre-admission visit (Farrell & Dempsey 2013).

Deep Breathing and Coughing

Preoperative education to the patient will include instructions on completing

deep breathing and coughing exercises postoperatively.

Deep breathing and coughing improves blood oxygenation and promotes lung
expansion as well as helps to facilitate gas exchange and expectorate any
accumulated mucus in the lungs. This is a significant exercise for patients to
complete during their post-operative period to help decrease the risk of
respiratory complications including pneumonia from occurring (Farrell &
Dempsey 2013; Koutoukidis, Stainton & Hughson 2017).

During this exercise, the individual is told to take several deep breaths,
followed by a short breath and cough. If they have any wounds, they will also
be educated on how to protect and support them with their hands or a pillow
during these exercises (Koutoukidis, Stainton & Hughson 2017).
Deep Vein Thrombosis (DVT) Risk Reduction

Patients will also be educated on performing bed leg exercises and the
benefits of early mobilisation (if able) following the surgery in order to
decrease the risk of DVT formation. Exercises and mobilisation helps
stimulate blood circulation and increase venous return which then decreases
the risk of blood clot formation from venous stasis. They may also be informed
of the use of compression devices such as TED stockings which can also be
used to help prevent DVTs (Koutoukidis, Stainton & Hughson 2017).

Promote Activity and Exercise

Not only does early mobilisation help protect patients against clot formation, it
also helps to promote optimal respiratory function and the return of bowel
peristalsis. However, pain and the fear of causing harm to themselves can
impede on the patient’s participation in early mobilisation.

Therefore, preoperative teaching needs to also address the expectations of

performing activities and mobilising post operatively as well as reassurance
and strategies such as splinting incisions to make this task measurable for the
patient (Farrell & Dempsey 2013; Tollefson et al. 2012).
 Sometimes it can be difficult for the individual to participate in movement
exercise postoperatively due to pain, nausea or dizziness. The nurse must
ensure these factors are controlled to promote early mobilisation.

Key benefits of early ambulation include:

 Prevention of respiratory complications due to deep breathing which promotes

lung expansion

 Prevention of vascular complications due to the stimulating effect ambulation

has in the circulatory system

 Improves muscle tone and strength

 Helps with elimination

 Reduces the risk of pressure injury formation

 Improves the morale of the individual

(Farrell & Dempsey 2013; Koutoukidis, Stainton & Hughson 2017)

Promoting exercise and activity is one of the most important aspects of

preoperative education and postoperative care because in order for the
patient to be safely discharged home, they need to be independent and safe
with activities such as toileting and transfers, as well as ambulate a functional
distance safely and independently (Farrell & Dempsey 2013).
Pressure Injuries

Patients should also be preoperatively educated on their risk of developing

pressure injuries and how to decrease this risk by performing regular position
changes. If the patient is unable to do so independently, then the nurse will
need to assist the patient postoperatively or educate the patient on techniques
to facilitate movement (Duggin 2017).

Pain Management

Patients should also be educated on pain management and what to expect

following this surgery. Often patients will be worried about their postoperative
pain, therefore it is important that preoperative teaching involves giving the
patient reassurance as well as education on pain management.

It is also important that the patient is education on pain rating scales which will
be used during their postoperative period. This is especially important if the
patient will be using a patient controlled analgesia device (Farrell & Dempsey
2013; Tollefson et al. 2012).
Elimination

One of the most common complications following surgery is constipation.

Therefore education on strategies to relieve and prevent constipation is
essential.

The patient should be encouraged to mobilise early and to ensure that once
they can tolerate diet and fluids, they maintain an adequate fluid intake and
eat foods high in fibre (Koutoukidis, Stainton & Hughson 2017).

As you can see, preoperative education can involve many areas including
these mentioned but it is important to remember that all education is
individualised to the patient and their information needs.