Hysterectomy is the second most common major surgery performed in the United States. Approximately 665,000 women have hysterectomies each year. Hysterectomy, therefore, represents a serious concern for women's health. The long-term personal, psychological and social costs to women who experience hysterectomy require study. Postoperative, up to 50% of women undergoing hysterectomy, experience one or more complications from the surgery. While preoperative education, in general, has been found to yield better immediate postoperative outcome than no preoperative instruction, the magnitude and consistency of benefits has been small; theoretical linkage between preoperative preparation and outcome measures have rarely been presented. The purpose of this study is to determine if an efficacy enhancing teaching protocol is effective in improving immediate postoperative behaviors and selected short and long-term health outcomes in women who undergo abdominal hysterectomy. The theoretical model for this study is Bandura's self-efficacy theory. The hypotheses for this study are: 1) Patients who receive the efficacy enhancing teaching protocol will have higher scores on the Preoperative Self-Efficacy Scale (PSES) while controlling for pre-intervention self-efficacy than those patients who do not receive the protocol; (2) Patients who receive the efficacy enhancing teaching protocol will have lower preoperative and postoperative scores on the State Anxiety Inventory (SAI) than those patients who do not receive the protocol when controlling for preintervention anxiety, preoperatively, at discharge, at 6 weeks and at 6 months after surgery; (3) Patients who receive the efficacy enhancing teaching protocol will have a higher level of performance of ambulation immediately after surgery than those patients who do not receive the protocol; (4) Patients who receive the efficacy enhancing teaching protocol will have a higher vital capacity immediately after surgery than those patients who do not receive the protocol; (5) Patients who receive the efficacy enhancing teaching protocol will have fewer preventable complications (atelectasis, pneumonia, paralytic ileus, deep vein thrombosis) while hospitalized than those patients who do not receive the protocol; (6) Patients who receive the efficacy enhancing teaching protocol will have shorter hospital stays than those patients who do not receive the protocol; (7) Patients who receive the efficacy enhancing teaching protocol will have higher scores on the Health Status Questionnaire 2.0 (HSQ) at discharge, 6 weeks and 6 months after surgery than those patients who do not receive the protocol; and, (8) Preoperative efficacy expectations, type of preoperative instruction methods, and anxiety are significant predictors of immediate postoperative behaviors (ambulation, vital capacity), preventable complications, and selected health outcomes in women who undergo total abdominal hysterectomy.
| Oetker-Black, Sharon L; Jones, Susan; Estok, Patricia et al. (2003) Preoperative teaching and hysterectomy outcomes. AORN J 77:1215-8, 1221-31 |
