Comparison of Hysterectomy Clients\u27 and Nurses\u27 Perceptions of Preoperative Teaching

Recent changes in the health care environment have influenced the practice of nursing. Reimbursement for hospitalization based on diagnosis related groups has shortened the length of inpatient stays, thus reducing the time nurses have for preoperative teaching (Recker, 1994). The purpose of this study was to determine if there was congruence between what hysterectomy clients wanted to learn about surgery and what nurses believed was important to teach. Orem’s (1980) supportive-educative nursing system and Knowles’s (1980) teaching-learning theory, along with the preoperative teaching process, guided this investigation. The investigation used a descriptive, exploratory design. The research questions explored the difference between hysterectomy clients’ perceptions and nurses’ perceptions of preoperative teaching. For this investigation, preoperative teaching was defined as being composed of five dimensions: (a) situational information, (b) sensation information, (c) client role information, (d) psychosocial support and (e) skills training. Nurse and client preoperative teaching questionnaires developed by Yount and Schoessler (1991) served as the data collection tools. Convenience samples of 32 nurses and 30 hysterectomy clients were recruited from a Midwestern, rural, regional referral acute care medical center. The nurses and clients ranked the five dimensions of preoperative teaching in the same order of importance; however, a significant difference was noted between hysterectomy clients’ and nurses’ perceptions of the importance of two preoperative teaching dimensions: sensation information (F=8.71, p=.005) and skills training (F=29.51, p=.000). Clients (M=63.00, SD=13.20) rated sensation information significantly higher than did nurses (M=50.34, SD=16.45), but clients (M=31.13, SD=8.34) rated the need for skills training significantly lower than did nurses (M=42.59, SD=7.01). There were no significant differences in the overall time preference for receiving preoperative teaching between the nurse and client groups. A significant difference (chi-square = (2, N=62) = 10.203, p\u3c.05), was noted between nurses (M=1.56) and clients (M=1.96) frequencies concerning one of the questions related to time i.e., (The care nurses give before surgery) and the time preferences for the teaching to occur (before admission to the hospital or after admission to the hospital but before surgery. More nurses (44%) than clients (10%) preferred the teaching to occur before admission to the hospital but the majority of nurses (56%) and clients (83%) preferred teaching to occur after admission to the hospital but before surgery concerning one of the questions related to time. Sensation information and skills training were the two dimensions of preoperative teaching the majority of hysterectomy clients reported as not receiving preoperatively from a nurse. The results of this investigation have implications for nursing research and practice. Recommendations for further research include research studies to explore different methods of delivering preoperative teaching and how these methods affect postoperative outcomes. Future studies need to incorporate the current practice of admitting clients the morning of surgery. Development of a program, such as a continuing nursing education workshop, to enhance nurses teaching methods may be beneficial. Based on this investigation, nurses involved with preoperative teaching may find that a necessary prerequisite for effective preoperative teaching is gaining a better understanding of what nurses believe is important to teach preoperatively and what clients believe is important to learn preoperatively from a nurse. In order to provide effective preoperative teaching, nurses need to consider all five dimensions of preoperative teaching. Nurses need to emphasize sensation information and skills training in order to best meet the perceived needs of the client population