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The Effectiveness of three preoperative learning programs on patient recovery and learning Cranstoun, Catherine Jean


The study reported here was a controlled experiment in which three groups of eleven randomly assigned female patients undergoing cholecystectomy were studied for the effectiveness of three different types of preoperative learning programs: 1. a systematic, planned learning program in which learning objectives, strategies and tests were designed to meet individual patient preoperative learning needs; 2. a planned group learning program which involved a class of patients and discussion of a slide-sound presentation and demonstration of exercises; and 3. an unplanned learning program in which patients experienced only incidental learning objectives. Since previous research had not controlled for type of surgery, the major question in this study was whether or not the effectiveness of preoperative learning programs as measured by postoperative recovery measures would be a persistent finding in a more rigidly controlled study. In addition to testing for cognitive achievement in all three learning groups, a variety of physiological measurements of postoperative recovery were made and studied in relation to cognitive achievement. The study also asked patients to validate a series of 50 preoperative learning needs and collected data about their cognitive learning styles in a postoperative patient questionnaire. Contrary to previous research, it was found that the traditional physiological measurements of postoperative recovery used to measure the effectiveness of preoperative learning programs could not be construed as valid, direct measurements of learning. When studied in relation to cognitive achievement scores, these measures did not correlate significantly. Thus, it was concluded that the measures are not valid, indirect measures of effective preoperative learning. There was however, a suggestive finding that the use of analgesic drugs may be a useful indirect measure of effective preoperative learning. There were no significant differences in cognitive achievement among the three groups, but there was a significant difference between the Individualized and the Incidental Learning Group in relation to the number of doses of parenteral drugs administered. Anaesthetic time also correlated negatively and significantly with the cognitive achievement score and there were significant differences between all three learning groups in relation to anaesthetic time. This latter finding is of value in providing appropriate reinforcement of learning postoperatively. It may be that patients that have a long anaesthetic time will need more reinforcement of learning postoperatively.

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