Staff come together on joint unit to teach
Teaching integral part of interdisciplinary team
Education is an integral part of an orthopedic patient’s hospital stay when he or she is on the total joint replacement unit at Arlington (VA) Hospital. It’s an ongoing process, and much of routine care is considered an opportunity for a lesson. For example, when the nurses help patients transfer from the bed to a chair, they explain the steps each time they do it so patients will remember the correct way once they are discharged.
"By post-op day two, we encourage the patient to get up out of bed instead of using a bed pan every single time they need to go to the bathroom. It is more opportunity to educate because they practice getting in and out of bed over and over and over," says Therese Frank, BSN, RN, head nurse for the total joint replacement center at Arlington, which opened in July 1999.
Benefits of education varied
To make sure nurses have the time to teach, the unit has eight beds dedicated to elective joint replacement surgery and a four-to-one patient-to-nurse ratio. However, it isn’t just time that makes teaching more favorable. It’s also the fact that there is only one patient type. On the regular orthopedic surgical floor, nurses have several types of patients to teach, such as those who have a fractured hip. The focus at the center is total joint replacement, explains Frank.
A third factor favorable to education is the preliminary teaching that takes place. Patients have the option of attending a seminar that is held the first Thursday of each month at 2:30 p.m. This hour-long session is taught by nursing staff, a physical and occupational therapist, and a social worker. (For details on the teaching that takes place at the presurgery seminar, see article, p. 129.)
Patients also have access to an interactive, touch-screen computer program that provides information about their joint replacement sur gery. The program, Orthopedic Shared Choice System by Evanston, IL-based InLight, is available to use when patients come to the hospital for pre-op screening. (For more information on the computer system, see source list at the end of this article.)
The important elements of the computer program also were transferred to a videotape that patients can take home and view with their families. They are given the tape when they come to the seminar. "In that way, they are not constricted with time. They can rewind the tape to view portions they want to see repeatedly or fast-forward it through parts they don’t feel they need to see again," says Frank.
A second reason for creating a videotape was the fact that most patients having hip or knee joint replacement surgery are over 65 years old. This age group is not always computer-literate.
The education that takes place before patients enter the hospital reduces anxiety and fear and incorporates patients as key players in their recovery. "We want patients to be part of our team, and the only way to make them part of our team is to teach them what they can do for themselves and what we will be doing for them, so we can all work together and be on the same page," explains Frank.
Before the classes began, for example, patients didn’t know they would get out of bed the first day following surgery. As a result, they were very resistant and needed a lot of reassurance from the nurse before they would participate. Now that they obtain this information in the class, they have plenty of time to prepare mentally and are better able to learn, says Frank.
While nursing educates the joint replacement patients from pre-op through discharge, teaching is an interdisciplinary affair. The physical therapist sees the patient the first day after surgery and continues to work with him or her throughout the entire hospital stay. The occupational therapist sees the patient the second day following surgery and has two or three follow-up visits. The social worker helps the patient learn about discharge options.
All disciplines follow a critical pathway to ensure that patient education is completed in an appropriate time frame. It is up to the nurse on duty each day to check the care pathway to make sure all disciplines completed their teaching. Edu cation is documented on a computerized interdisciplinary patient record.
To help promote patient readiness for learning, physical therapy gives nursing a list of scheduled patient therapy sessions. In that way, nursing can give pain medication to the patients in a timely manner so they are ready for their physical therapy. For best results, pain medication must be balanced, with enough provided for pain control without making the patient too drowsy to learn.
In addition to pain, other barriers to education on the joint replacement unit are anxiety, not being able to speak fluent English, or hearing problems. "The biggest barrier is anxiety," says Frank. "So we make sure patients are ready to learn by keeping them calm and relaxed. We use family members to help reduce anxiety. Sometimes having people you know and care about nearby reduces anxiety."
Family members not only are used to foster good education, they are encouraged to take part in the educational sessions. If a family member plans to visit the hospital during his or her lunch break, nurses wait to teach the patient or review the information again with the family members when they arrive at the hospital.
The special unit for joint replacement surgery patients was created at the prompting of a few orthopedic physicians who thought a specialized floor would result in better patient outcomes. "It allows us more time to meet the specific needs of the total joint replacement patients," says Frank.
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