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Learning as a patient: What and how individuals want to learn when preparing for surgery, and the potential use of serious games in their education
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Surgical patients need knowledge to participate in their own care and to engage in self-care behaviour in the perioperative period which is important for their recovery. Patient education facilitates such knowledge acquisition and several methods can be used to facilitate it, for example, face-to-face education and brochures or using information technology such as website or computer games. Healthcare professionals have been slow to seize the possibilities that information technology has to offer within the field, including the use of serious games. To optimise patient education, the information is needed on the patients’ needs and preferences and what they think about the idea of using a serious game to learn about self-care.

Aim: The overall aims of this thesis were to describe the knowledge expectations of surgical patients, to describe how surgical patients want to learn, and to explore the potential use of serious games in patient education.

Methods: This thesis includes four studies that used both quantitative and qualitative data to describe aspects of patient learning in relation to surgery. Study I has a prospective and comparative design with survey data collected before surgery and before hospital discharge from 290 patients with osteoarthritis undergoing knee arthroplasty. Data was collected on fulfilment of knowledge expectations and related factors. Study II is a cross-­‐sectional study in 104 patients with heart failure who had been scheduled for cardiac resynchronisation therapy (CRT) device implantation. Data was collected on knowledge expectations and related factors. In Study III the perceptions of 13 surgical patients towards novel and traditional methods to learn about post-operative pain management are explored in a qualitative interview study using content analysis. Study IV describes the development and evaluation of a serious game to learn about pain management with the participation of 20 persons recruited from the public. The game was developed by an interdisciplinary team following a structured approach. Data on the efficacy and usability of the game was collected in one session with questionnaires, observations and interviews.

Results: Participants reported high knowledge expectations. Knowledge expectations were highest within the bio-physiological knowledge dimension on disease, treatment and complications and the functional dimension on how daily activities are affected, both of which include items on self-care. Most participants wanted to know about the possible complications related to the surgery procedure. In none of the knowledge dimensions the expectations of participants were fulfilled. Participants received most knowledge on the physical and functional issues and received least on the financial and social aspects of their illness. The main predictor of fulfilment of knowledge expectations was having access to knowledge in the hospital from doctors and nurses. Trust in the information source and own motivation to learn shaped how the participants thought about different learning methods. Although the participants were open to using novel learning methods such as websites or games they were also doubtful about their use and called for advice by healthcare professionals. To develop a serious game with the goal to learn about pain management, theories of self-care and adult learning, evidence on the educational needs of patients about pain management and principles of gamification were found useful. The game character is a surgical patient just discharged home from hospital who needs to attend to daily activities while simultaneously managing post-operative pain with different strategies. Participants who evaluated a first version of the serious game improved their knowledge and described usability of the game as high. They were positive towards this new learning method and found it suitable for learning about pain management after surgery in spite of some technical obstacles.

Conclusions: Surgical patients have high knowledge expectations about all aspects of their upcoming surgery and although they prefer direct communication with healthcare professionals as a source for knowledge they might be open to try using more novel methods such as games. Preliminary short-­‐term results demonstrate that a serious game can help individuals to learn about pain management, and has the potential to improve knowledge. A careful introduction, recommendation, and support from healthcare professionals is needed for implementation of such a novel method in patient education.

Abstract [is]

Fræðsla gerir sjúklingum betur kleift að taka þátt í umönnun sinni sem er mikilvægt fyrir bata eftir skurðaðgerð. Sjúklingafræðslu má veita með ýmsum aðferðum, til dæmis munnlega, með bæklingum eða með því að nota upplýsingatækni á formi vefsíðna eða kennslutölvuleikja. Heilbrigðisstarfsfólk hefur verið lengi að tileinka sér möguleika upplýsingatækninnar í sjúklingafræðslu, þar með talið notkun kennslutölvuleikja. Þörf er á meiri þekkingu um fræðsluþarfir skurðsjúklinga en jafnframt um viðhorf sjúklinga til nýrra námsaðferða. Kennslutölvuleikir eru ein leið sem gæti gagnast sjúklingum en notagildi þeirra hefur lítið verið rannsakað.

Meginmarkmið þessarar ritgerðar var að lýsa væntingum skurðsjúklinga til fræðslu, lýsa því hvernig þeir vilja læra og að kanna möguleika kennslutölvuleikja í sjúklingafræðslu.

Ritgerðin samanstendur af fjórum rannsóknargreinum. Notuð vorumegindleg og eigindleg rannsóknargögn til að lýsa ýmsum hliðum náms einstaklinga sem fara í skurðaðgerð. Rannsókn I er framsýn samanburðarrannsókn sem gerð var á 290 sjúklingum með slitgigt sem gengust undir hnéliðskipti. Gögnum var safnað með spurningalistum fyrir skurðaðgerð og fyrir útskrift af sjúkrahúsi um uppfyllingu væntinga til fræðslu og tengda þætti. Rannsókn II er þversniðsrannsókn með þátttöku 104 sjúklinga með hjartabilun sem voru á leið í aðgerð til að fá ígræddan sérstakan hjartagangráð (e. cardiac resynchronisation therapy (CRT)). Gögnum var safnað með spurningalistum, fyrir ígræðsluna, um væntingar til fræðslu og tengda þætti. Rannsókn III er eigindleg rannsókn með þátttöku 13 sjúklinga sem nýlega höfðu farið í liðskiptaaðgerð eða hjartaskurðaðgerð. Gögnum var safnað með viðtölum þar sem sjúklingar lýstu viðhorfum sínum til nýrra og hefðbundinna aðferða til að læra um verkjameðferð eftir  skurðaðgerð. Gögnin voru greind með innihaldsgreiningu. Rannsókn IV lýsir þróun og mati á kennslutölvuleik til að læra um verkjameðferð eftir skurðaðgerð, með þátttöku 20 sjálfboðaliða. Leikurinn var þróaður af þverfaglegum hópi hjúkrunarfræðinga og tölvunarfræðinga. Gagnsemi og notagildi leiksins voru metin með spurningalistum, áhorfi og viðtölum.

Þátttakendur höfðu miklar væntingar til fræðslu. Væntingar voru mestar á sviði lífeðlisfræði um atriði er sneru að sjúkdómi, meðferð og fylgikvillum og á sviði færni um áhrif veikinda á daglegar athafnir. Bæði sviðin fela í sér atriði um sjálfsumönnun. Flestir þátttakendur vildu fá fræðslu um mögulega fylgikvilla skurðaðgerðar. Væntingar voru ekki uppfylltar á neinu þekkingarsviði þó best á sviði lífeðlisfræði og færni en síst er vörðuðu fjárhag og félagslegan stuðning í tengslum við veikindi. Væntingar voru best uppfylltar meðal þeirra sem höfðu góðan aðgang að fræðslu á spítalanum frá hjúkrunarfræðingum og læknum.

Viðhorf þátttakenda til mismunandi námsaðferða mótaðist af trausti á fræðslumiðli og eigin áhugahvöt. Þátttakendur voru opnir fyrir notkun nýjunga á borð við vefsíður og kennslutölvuleiki en jafnframt nokkuð tortryggnir og töldu mikilvægt að fá ráðleggingar og aðstoð heilbrigðisstarfsfólks við slíka notkun.

Kenningar um sjálfsumönnun og nám fullorðinna, aðferðir leikjahönnunar og tiltæk þekking á fræðsluþörfum sjúklinga um verkjameðferð voru notaðar til grundvallar við hönnun kennslutölvuleiksins. Persóna leiksins er nýlega útskrifuð af sjúkrahúsi eftir skurðaðgerð og þarf að sinna daglegum athöfnum jafnframt því að meðhöndla verki sína. Þátttakendur rannsóknarinnar sem lögðu mat á kennsluleikinn bættu þekkingu sína og töldu nothæfni leiksins mikla. Þeir voru jákvæðir gagnvart þessari nýju námsaðferð og fannst hún henta vel til að læra um verkjameðferð eftir skurðaðgerð þrátt fyrir nokkra  tæknilega örðugleika.

Sjúklingar hafa miklar væntingar til fræðslu fyrir skurðaðgerð. Þeir kjósa helst að leita þekkingar hjá heilbrigðisstarfsfólki en eru þó opnir fyrir að prófa nýjungar eins og kennslutölvuleiki. Fyrstu niðurstöður sýndu að kennslutölvuleikur getur hjálpað einstaklingum að læra um verkjameðferð. Við innleiðingu nýjunga innan sjúklingafræðslu er vönduð kynning, meðmæli og stuðningur af hálfu heilbrigðisstarfsfólks mikilvægur fyrir viðtökur sjúklinga.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. , 112 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1528
Keyword [en]
Education, knowledge expectations, learning, serious game, surgical patients
Keyword [is]
Kennslutölvuleikur, nám, sjúklingafræðsla, skurðsjúklingar, væntingar til fræðslu
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy Social and Clinical Pharmacy Other Health Sciences Learning
Identifiers
URN: urn:nbn:se:liu:diva-132387DOI: 10.3384/diss.diva-132387ISBN: 9789176857144 (Print)OAI: oai:DiVA.org:liu-132387DiVA: diva2:1044837
Public defence
2016-11-24, K3, Kåkenhus, Campus Norrköping, Norrköping, 13:00 (English)
Opponent
Supervisors
Note

The online version is a corrected version of the printed thesis. Download the errata list in order to see thecorrections.

Available from: 2016-11-07 Created: 2016-11-07 Last updated: 2016-12-02Bibliographically approved
List of papers
1. The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective
Open this publication in new window or tab >>The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective
Show others...
2014 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, 2896-2908 p.Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To describe the possible differences between knowledge expectations and received knowledge of patients undergoing elective knee arthroplasty in Iceland, Sweden and Finland and also to determine the relationship between such a difference and both background factors and patient satisfaction with care.

BACKGROUND: Knee arthroplasty is a fast-growing and a successful treatment for patients with osteoarthritis. Patient education can improve surgery outcomes, but it remains unknown what knowledge patients expect to receive and actually acquire during the perioperative period and what factors are related to that experience.

DESIGN: Descriptive, prospective survey.

METHODS: In total, 290 patients answered questionnaires about their expectations (Knowledge Expectations of hospital patients - scale) before surgery and about received knowledge (Received Knowledge of hospital patients - scale) and satisfaction with hospital care (Patient Satisfaction Scale) at discharge. Sociodemographics, clinical information, accessibility to knowledge from healthcare providers (Access to Knowledge Scale), and preferences for information and behavioural control (Krantz Health Opinion Survey) were collected as background data.

RESULTS: Patients` knowledge expectations were higher (mean 3·6, SD 0·4) than their perception of received knowledge (mean 3·0, SD 0·7). Multiple linear regression analysis showed that access to knowledge, information preferences and work experience within health- or social care explained 33% (R²) of the variation in the difference between received and expected knowledge. Patients reported high satisfaction with their care except regarding how their family was involved.

CONCLUSION: Patients undergoing knee arthroplasty receive less knowledge than they expect, and individual factors and communication with healthcare providers during hospitalisation are related to their experience. The content of patient education and family involvement should be considered in future care.

RELEVANCE TO CLINICAL PRACTICE: The results strengthen the knowledge base on the educational needs of knee arthroplasty patients and can be used to develop and test new interventions.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keyword
Knee arthroplasty, osteoarthritis, patient education, patient expectations, patient satisfaction, surgery
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-105225 (URN)10.1111/jocn.12552 (DOI)000343857700020 ()24476393 (PubMedID)
Projects
EEPO
Available from: 2014-03-13 Created: 2014-03-13 Last updated: 2016-11-07Bibliographically approved
2. Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation
Open this publication in new window or tab >>Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation
2015 (English)In: Patient Preference and Adherence, ISSN 1177-889X, Vol. 9, 913-921 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To describe what knowledge heart failure patients expect to acquire in relation to their upcoming cardiac resynchronization therapy (CRT) device implantation, to describe their self-care and health complaints, and to explore the relationship between knowledge expectations and self-care, health complaints, and background factors. Patients and methods: Cross-sectional multicenter study with 104 patients scheduled for a first-time, elective CRT implantation in Swedish and Icelandic hospitals. Data were collected with the Knowledge Expectations of hospital patient Scale, European Heart Failure Self-care Behavior Scale, and Adjusted Postoperative Recovery Profile. Results: Patients expected most knowledge related to their disease and its treatment (median 4.0, interquartile range 0.13) and least on social issues (median 3.5, interquartile range 0.83). Their self-care was average (standardized mean 51.0 +/- 19.6) before the procedure. Patients had on average 8.2 (+/- 4.7) health complaints and rated fatigue and sexual problems as the most severe. Age was independently associated with knowledge expectations (Exp beta 0.049, P= 0.033). Conclusion: Heart failure patients waiting for a CRT device implantation have high expectations for multiple aspects of knowledge, including self-care issues, before their procedure. These expectations are similar to those of other surgical patients and they increase with age.

Place, publisher, year, edition, pages
Dove Medical Press, 2015
Keyword
cardiac devices; CRT treatment; patient education
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-120368 (URN)10.2147/PPA.S83069 (DOI)000357535000001 ()26170641 (PubMedID)
Note

Funding Agencies|Landspitali University Hospital Research Fund, Landspitali - The National University Hospital of Iceland; Icelandic Nurses Association Research Fund; Ingibjorg Magnusdottir in Iceland; Medtronic-Vingmed AB; St. Jude Medical Sweden AB in Sweden

Available from: 2015-07-31 Created: 2015-07-31 Last updated: 2016-11-07
3. Perceptions about traditional and novel methods to learn about post-operative pain management: - a qualitative study.
Open this publication in new window or tab >>Perceptions about traditional and novel methods to learn about post-operative pain management: - a qualitative study.
2016 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 11, 2672-2683 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To explore the perceptions of surgical patients about traditional and novel methods to learn about post-operative pain management.Background: Patient education is an important part of post-operative care. Contemporary technology offers new ways for patients to learn about self-care, although face-to-face discussions and brochures are the most common methods of delivering education in nursing practice.Design: A qualitative design with a vignette and semi-structured interviews used for data collection.Methods: A purposeful sample of 13 post-surgical patients, who had been discharged from hospital, was recruited during 2013 - 2014. The patients were given a vignette about anticipated hospital discharge after surgery with four different options for communication (face-to-face, brochure, website, serious game) to learn about post-operative pain management. They were asked to rank their preferred method of learning and thereafter to reflect on their choices. Data were analysed using an inductive content analysis approach.Findings: Patients preferred face-to-face education with a nurse, followed by brochures and websites, while games were least preferred. Two categories, each with two sub-categories, emerged from the data. These conceptualised the factors affecting patients' perceptions: 1) 'Trusting the source', sub-categorised into 'Being familiar with the method' and 'Having own prejudgments'; and 2) 'Being motivated to learn' sub-categorised into 'Managing an impaired cognition' and 'Aspiring for increased knowledge'.Conclusion: In order to implement successfully novel educational methods into post-operative care, healthcare professionals need to be aware of the factors influencing patients' perceptions abouthow to learn, such as trust and motivation.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keyword
Content analysis; educational methods; nursing; patient education; patient learning; post-operative self-care; vignettes
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-129199 (URN)10.1111/jan.13021 (DOI)000386079500010 ()27205900 (PubMedID)
Note

Funding agencies: Landspitali University Hospital Research Fund; Icelandic Nurses Association Research Fund

Available from: 2016-06-13 Created: 2016-06-13 Last updated: 2016-11-21

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