Effects of multimedia with printed nursing guide in education on self-efficacy and functional activity and hospitalization in patients with hip replacement

Abstract

This study aimed to examine the effects of multimedia with printed nursing guides in patient education on the improvement of self-efficacy, functional activity and length of hospitalization in patients with hip replacement. A quasi-experimental design was used. Control group received a routine care, whereas experimental group was given the multimedia with printed nursing guides. In the multimedia, CD is a collection of nursing instructions in the format of multimedia such as video and audio recorded into a CD. The result showed there are statistically different between experimental and control groups on self-efficacy (t = −7.93, P < 0.001), functional activities (t = 4.33, P < 0.001), and length of hospitalization (t = 2.54, P < 0.05). The findings indicated experimental group achieved higher self-efficacy with the help of multimedia with printed nursing guides. Control group needed more assistance in performing functional activities. Length of hospitalization was significantly shorter in experimental group than in control group. To better adapt to continual human resource reduction and to improve nursing service quality, wider applications of multimedia with printed nursing guides in patient education may be worthwhile.

Introduction

Hip arthroplasty, also named hip replacement, is one of the most successful medical and surgical interventions of the 20th century for patients with hip arthritis [1], which, if untreated, can lead to increasing disability. Reports have been shown more than 120,000 patients annually, an increase by 64% in 1990s compared to the number of 1980s, in the USA, underwent the hip replacement [2]. Since the 1990s, hip replacement has been successfully applied to a wider range of patients with different ages than usual. It is possible to extend for patients older than 75 years or younger than 60 years to undergo hip replacement [3]. In Taiwan, south branch of the Bureau of National Health Insurance has documented 2825 cases of hip replacement from 1995 to 1998, and the annual growth rate for such cases is 20% for 1997 and 14% for 1998 [4]. One investigation on 2558 cases of hip replacement from 98 hospitals in Taiwan found that the steady increase in the number of patients with hip replacement is due to population aging and relaxation of the age restriction for such surgery because of technological improvement [5]. With the technological improvement in artificial hip joint, patients after hip replacement suffer less pain and can regain almost full mobility [6]. However, there still exists a 2–3% chance of dislocation after the surgery, and higher risk of dislocation is observed for women, elderly, or revision patients [7]. Loosening, another common complication for hip replacement mostly happened on the second year after surgery is generally associated with chronic infections. In Taiwan, hip replacement patients had higher rate not only in dislocation and post-surgical infection but also in 30-day readmission than those in other countries [4].

The increasing number of patients with hip replacement is an economic burden for the whole society. With the increasing medical expenses, changes in insurance reimbursement, and the implementation of case payment scheme, the length of insurance-covered hospitalization shortens. It is therefore important, nowadays, to give patients proper pre-admission education and rehabilitation. Nursing professionals, in this regard, are obliged to understand the factors that can influence the rehabilitation process since they play vital role in helping the patients to regain health, to improve quality of life, and to reduce the social costs incurred. Many studies demonstrated clear evidences that given proper nursing education, the length of hospitalization shortens [8], [9], [10], [11]. In addition, various evidences have been presented to demonstrate that health education can effectively increase patients’ and their families’ satisfaction [10], [12], reduce the dosage of painkiller [8], [10], lower the chance of dislocation [13], [14], [15], help the patient’s rehabilitation [16], [17], and facilitate functional activity [13], [14], [15], [19]. According to the literature, health education can effectively improve self-efficacy to regain health and facilitate the rehabilitation after [12], [19], [20], [21], [22].

Nursing professionals, therefore, can play essential roles in cost reduction by educating patients with appropriate knowledge of preventing complications associated with hip replacement such as post-operative infection and dislocation. A printed nursing guide for hip replacement commonly consists of joint anatomic structure, post-surgical rehabilitation and exercise, prevention of infections and complications, cautions to be taken about changing position, standing, sitting, lying down, climbing upstairs and downstairs [13], [14], [15]. In addition to using the common way of printed nursing guide, it is also possible to utilize multimedia CD containing text, animation, graphics, video and audio as a media for health education to improve patients’ self-efficacy and functional activity [12], [23], [24], [25], [26]. It is well recognized that multimedia presentation is a good technique to draw users’ attention and hence enhance its learning effectiveness [23]. Considering the limited nursing professional human resources, and the constraints of time and space to conduct health education, multimedia CD can be very cost-effective compared to instructor-led health education. Therefore, using multimedia as an aide to teaching and training can enhance comprehension, boots learning effect and interests, and improves self-care ability and behavior.

The purpose of this study was to explore effects of multimedia CD with printed nursing guides in patient education on the improvement of self-efficacy, functional activity, and length of hospitalization in patients with hip replacement.