Patients learn about joint replacement process
Going back to school
Each week, Therese Frank, BSN, RN, head nurse for the Total Joint Replacement Center at Arlington (VA) Hospital, reviews the operating room (OR) schedule to determine which patients are having joint replacement surgery. These patients are contacted so they can enroll in the presurgery seminar that takes place the first Thursday of each month. Because surgeries are scheduled six weeks in advance, most patients are enrolled two to four weeks prior to surgery.
"A lot of what we teach in this class, we used to teach one-on-one in pre-op screening. We decided we could be more time-effective if we did several people at once," says Frank. Those who cannot come to the class are still taught in pre-op screening.
The seminar is taught by five people, each taking about 10 to 15 minutes, and is taught in order of educational need. The first to teach is the pre-op nurse, who discusses what paperwork and information patients need to bring to the pre-op screening, including insurance forms and a list of medications they currently take. They also learn about the lab work they will undergo, the interviews they will have with a nurse and anesthesiologist, and information on what to expect on the day of surgery.
Frank teaches next, covering four areas of information. She discusses how rehabilitation is begun promptly by getting the patient out of bed the first day after surgery, and she provides exercises patients can do in bed. She also discusses pain management including medications, distraction methods, ice packs, repositioning, and relaxation exercises. The third component of her teaching is care of the wound, and the fourth component is exercises that will reduce the risk for infection or blood clots.
Physical therapy and preoperative therapy teach exercises patients can do before surgery, as well as what kinds of rehabilitation activities will take place following the joint replacement.
The design of the Joint Replacement Center includes a gym and an occupational kitchen. Patients become more independent because they walk from their room to the gym, explains Frank. In the kitchen, they are able to evaluate their needs for a safe home. If they have trouble reaching pots and pans on the bottom shelf and their kitchen at home is arranged the same way, they are prompted to consider moving the equipment.
Social work teaches what to expect for discharge planning. This is the shortest portion of the teaching, because it is difficult to tell before surgery if the patient will need extended care. "We individualize the teaching when they arrive on the hospital floor. At that time, we will know if they need extra help with one or another issue we can focus on. However, preoperatively, the teaching is generalized," says Frank.
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