The primary focus of this paper is to create, implement, and review a teaching plan to be provided to a patient who has recently undergone surgery and subsequently entered the recovery phase. The patient subject of this paper, who will be referred to as ‘GW’, is a 48-year-old male who has recently undergone major spinal surgery; an anterior cervical disk fusion as well as a cervical vertebrectomy. Postoperative recovery is a multifaceted process, a major component of which is reaching a reasonable level of functionality. This teaching plan will emphasize recovery of mobility through physical therapy, coping mechanisms, and nurse interventions. This paper begins with the topic and why this particular plan was chosen for this patient, provide a detailed assessment of the patient’s situation and why education is needed, followed by the implementation and tools used to carry out the plan, and finally an evaluation of the plan after the fact.
Topic for educational need
For an adult to function in day-to-day life, mobility is a necessity. When mobility is compromised due to trauma, surgical or otherwise, day-to-day functionality suffers greatly. The patient, GW, is having a difficult time with his recovery after spinal surgery, both physically and emotionally, and if things don’t improve, activities of daily living such as walking to the kitchen to prepare a meal, bathing, or going to the store will be incredibly difficult tasks for GW upon discharge. That being said, recovering as much mobility as possible, as soon as possible, should be a primary focus of the patient and healthcare staff alike. When mobility is impaired during surgical recovery, staff should emphasize the importance of a progressive increase in movement, daily physical therapy, and coping methods for barriers that arise. Pain, hopelessness, alterations in self-image, and depression can be significant barriers to a return to functionality after surgery. GW has himself made statements regarding a lack of hope for the situation. Beliefs that he will again end up in the hospital soon after his discharge and that his recovery will be too long and difficult were expressed. The student nurse decided that education needed to take place in order to show the patient both the benefits from early, continued mobilization, and the negative effects of staying in bed. Deep vein thrombosis, pulmonary embolism, higher risk for falls, pneumonia, and longer hospital stays are all concerns that nurses should consider and educate patients on when they hear patients refusing to ambulate (Rebar, Ignatavicius, & Workman, 2017).
Assessment of patient
Upon first contact between GW and the student nurse, the student learned GW had been admitted to the hospital following a severe bout of pain, and was subsequently diagnosed with Degenerative Disk Disease, cervicalgia, upper right extremity radiculitis, and neck compression. GW had been suffering with chronic pain for some time and was using a single-point cane at home to ambulate, however, he began to experience increasingly potent symptoms that decreased his mobility further and forced him to switch to using a walker. After seeking help, GW underwent surgery; ACDF with vertebrectomy, which was aimed at alleviating his pain and increasing his mobility. The student nurse met with GW one day after surgery, where GW expressed to the student that while he was initially hopeful the surgery would help him, he felt it may not have helped him at all. The student nurse asked GW why he felt that way, to which he responded “I just keep ending up in here.” Based on these statements, it would seem that GW suffers from hopelessness and is having difficulty coping with his current state, both of which are significant barriers to recovery. During the first half of the day, GW worked with the staff and student to ambulate around the nurse’s station and made an effort to participate in his scheduled care. However, throughout second half of the day the student nurse observed GW becoming agitated with staff when asked to use an incentive spirometer, and again when encouraged to walk around the unit again, followed by isolating himself in his room while asking not to be disturbed. Because of the severity and recency of his surgery, GW may merely need time to properly cope with his situation, but time is short.
Method of implementation
For many recovering patients, the sooner they mobilize, the better. In the case of this patient, the student nurse strongly believes the teaching plan needed to be implemented immediately. A paper published by the Physician-Patient Alliance for Health and Safety stated that “given the well-documented positive effects on patient care, it makes sense that ambulation should be a clinical priority” (PPAHS, 2017). Ambulation and regaining mobility is not a “wait and see” part of recovery, it requires immediate action from the staff and patient alike. Participation and willingness from the patient are crucial, as even skilled staff cannot force recovery. In the case of GW, the student nurse felt that one of the best ways to reach the patient would be to start simply by conversing and build from there. The student nurse started by asking basic questions to identify barriers, past experiences, coping mechanisms used, and goals the patient could set for himself. Afterwards, the patient was willing to walk around the unit with the student and PT, making several trips around the nurse’s station. Upon returning to his room, and given some time to rest, the student nurse continued to speak with GW about his condition, and encouraged him to continue to ambulate as much as he could, with resting periods between, so long as his physician and primary nurse agreed.
Beyond conversation and formulation of coping strategies, the student nurse believes that media, written information, and medical studies that the patient can relate to are all important tools. There has been extensive study into the effects of progressively increasing mobility soon after surgery and the benefits that come with it. There is no small number of online articles quoting or based on these studies, many of which contain advice from qualified physicians and physical therapists. Helping GW access and read through some of them may very well help educate him on the benefits of early mobilization, and detrimental effects of being sedentary after surgery. One such article states that “therapeutic exercise before and after surgery might augment the postoperative outcomes by improving functional status and reducing the complication and mortality rate” and “postoperative exercise should be initiated as soon as possible after surgery according to fast-track or enhanced recovery after surgery principles” (Hoogeboom, Dronkers, Hulzebos, & Meeteren, 2014).
Over the course of the teaching plan, several techniques were used in order to educate and see improvements in the patient’s overall understanding and willingness to work on the mobility aspect of his recovery. During a question-and-answer phase, the student nurse asked several questions in an effort to better get to know the patient’s feelings. The student nurse asked why GW felt the way he did, to which GW responded that he was “tired of coming back to the hospital” and that “if I’m just going to end up back here then I don’t know what the point of all this is.” The student nurse took this as an opportunity to explain how not partaking in physical activity at intervals recommended by the physician and ignoring components of recovery could easily prolong a hospital stay and quite possibly land someone back into the hospital soon after discharge from something such as a fall at home or deep vein thrombosis due to prolonged sitting. Next, the student nurse worked with the patient to identify coping strategies that he can use to provide outlets and respite from the difficult time ahead of him. Spending time with his wife, watching TV, going to a local sports bar with his friends to watch a game, and going to visit his daughter were all healthy opportunities to relieve stress and focus on something else. The student nurse also suggested simple breathing exercises, positive thinking, and rewards for progress as additional methods to cope. Finally, the student nurse asked GW for a verbal return demonstration of several of the things they had gone over that day. In the end, if this plan was to be revised, the inclusion of more teaching aids (i.e. brochures and prepared articles), a longer preparation time, and more time spent getting to know the patient would very likely be included. One of the largest hurdles when carrying out this plan was not knowing the patient well enough and, due to the limited amount of time, there wasn’t much of an opportunity to remedy this. The last thing the student nurse would consider changing is the level of patient involvement during the education phase. Because education is individualized, it would be beneficial to have the patient tell the student nurse what their most effective medium for learning is, be it visual, auditory, or physical. Strong positive reinforcement, educational information, teaching aids, and forming effective coping strategies are all part of effectively educating a patient for the good of their continued recovery.
Rebar, C., Ignatavicius, D., Workman, M. L. (2017).
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Patient ambulation a key metric to improved health.
Retrieved from http://www.ppahs.org/wp-content/uploads/2017/02/PPAHS-Patient-Ambulation-a-Key-Metric.pdf
Hoogeboom, T., Dronkers, J., Hulzebos, E., Meeteren, N. (2014).
Merits of exercise therapy before and after major surgery
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