Preoperative education on postoperative delirium, anxiety, and knowledge in pulmonary thromboendarterectomy patients.
BACKGROUND
Delirium is the most common postoperative psychiatric condition in intensive care settings and can lead to increased complications and costs.


OBJECTIVE
To evaluate the impact of multifaceted preoperative patient education on postoperative delirium, anxiety, and knowledge and to explore predictors of postoperative delirium, days of mechanical ventilation, and days in the intensive care unit (ICU) in patients undergoing pulmonary thromboendarterectomy.


METHODS
A prospective, randomized controlled trial was conducted on consented patients from October 2011 to April 2013. Patients were randomized in a 1 to 1 ratio to receive either an individualized 45-minute multifaceted preoperative education (experimental group, n = 63) or standard education (control group, n = 66). Participants completed the State-Trait Anxiety Inventory and Knowledge Test before and after the education. Data on incidence of delirium, days of mechanical ventilation, ICU days, and cardiopulmonary parameters were collected.


RESULTS
The experimental group had significantly more knowledge about postoperative care (P< .001) and fewer days of mechanical ventilation (P = .04) than the control group. The 2 groups did not differ significantly in anxiety, incidence of delirium, or ICU days. In exploratory multivariate analyses, hearing impairment was a positive predictor for days of delirium (P = .009), days of mechanical ventilation (P< .001), and ICU days (P= .049), whereas the posttest knowledge was a negative predictor for days of mechanical ventilation (P = .02).


CONCLUSIONS
The patient education appeared to be effective in improving knowledge and reducing days of mechanical ventilation. Hearing impairment was an unexpected predictor of adverse outcomes for patients but may be amenable to nursing intervention.
Cassia Chevillon is a clinical nurse specialist in the intensive care unit at Thornton Hospital and the Sulpizio Cardiovascular Center, University of California San Diego Health System, La Jolla. Mary Hellyar is manager of the intensive care unit at Thornton Hospital, University of California San Diego Health System. Catherina Madani is a clinical nurse at the University of California San Diego Health System. Kim Kerr is a clinical professor of medicine at the University of California San Diego Health System. Son Chae Kim is a professor at St David's School of Nursing, Texas State University, Round Rock, Texas. cchevillon@ucsd.edu.
Cassia
C
Chevillon
Cassia Chevillon is a clinical nurse specialist in the intensive care unit at Thornton Hospital and the Sulpizio Cardiovascular Center, University of California San Diego Health System, La Jolla. Mary Hellyar is manager of the intensive care unit at Thornton Hospital, University of California San Diego Health System. Catherina Madani is a clinical nurse at the University of California San Diego Health System. Kim Kerr is a clinical professor of medicine at the University of California San Diego Health System. Son Chae Kim is a professor at St David's School of Nursing, Texas State University, Round Rock, Texas.
Mary
M
Hellyar
Cassia Chevillon is a clinical nurse specialist in the intensive care unit at Thornton Hospital and the Sulpizio Cardiovascular Center, University of California San Diego Health System, La Jolla. Mary Hellyar is manager of the intensive care unit at Thornton Hospital, University of California San Diego Health System. Catherina Madani is a clinical nurse at the University of California San Diego Health System. Kim Kerr is a clinical professor of medicine at the University of California San Diego Health System. Son Chae Kim is a professor at St David's School of Nursing, Texas State University, Round Rock, Texas.
Catherina
C
Madani
Cassia Chevillon is a clinical nurse specialist in the intensive care unit at Thornton Hospital and the Sulpizio Cardiovascular Center, University of California San Diego Health System, La Jolla. Mary Hellyar is manager of the intensive care unit at Thornton Hospital, University of California San Diego Health System. Catherina Madani is a clinical nurse at the University of California San Diego Health System. Kim Kerr is a clinical professor of medicine at the University of California San Diego Health System. Son Chae Kim is a professor at St David's School of Nursing, Texas State University, Round Rock, Texas.
Kim
K
Kerr
Cassia Chevillon is a clinical nurse specialist in the intensive care unit at Thornton Hospital and the Sulpizio Cardiovascular Center, University of California San Diego Health System, La Jolla. Mary Hellyar is manager of the intensive care unit at Thornton Hospital, University of California San Diego Health System. Catherina Madani is a clinical nurse at the University of California San Diego Health System. Kim Kerr is a clinical professor of medicine at the University of California San Diego Health System. Son Chae Kim is a professor at St David's School of Nursing, Texas State University, Round Rock, Texas.
Son Chae
SC
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology*; D003693:Delirium / Q000208:ethnology / Q000209:etiology*; D003863:Depression / Q000453:epidemiology; D004691:Endarterectomy / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D034381:Hearing Loss / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011655:Pulmonary Embolism / Q000601:surgery; D011669:Pulmonary Wedge Pressure; D012121:Respiration, Artificial; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult