Topics and structure in preoperative nursing consultations with patients undergoing colorectal cancer surgery

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There is evidence from previous studies that effective communication can make a difference to patient outcomes such as understanding, emotional well‐being and improved psychological adjustment 1. McCance et al. 3 suggest that the nurse–patient relationship must take into account who the patient is as a person and how this impacts on expectations and understanding within that particular relationship. In person‐centred nursing, the idea is that the person is a reflective human being who is capable of making rational choices. However, this capability is dependent on contextual aspects like the conversational frames in the encounters within the health care. These contextual frames are generally controlled by the professionals. Preoperative education is an important part of the surgical nurse's profession in the surgical context, and preoperative consultations may be the starting point of building a partnership that facilitates communication between the patient and the nurse. In order to develop person‐centred communication between nurses and patients, knowledge about the structure and topics in this communication is therefore important.
A challenge in colorectal cancer (CRC) care is to meet patient information needs over time throughout the care process from diagnosis, surgery, postoperative care and recovery 4. In the last decade, the enhanced recovery after surgery (ERAS) protocol 6 has been positively evaluated and proven to be best evidence‐based practice during pre‐ and postoperative CRC care, reducing morbidity, mortality and length of stay in hospital. An essential part of the ERAS programme occurs in the preoperative context where the starting point is to give a structured information regarding all concepts included in the programme, for example nutrition, bowel function, mobilisation, so that the patient feel well informed, know what is expected and can actively participate in their own care 7. An important part of the protocol is to coach the patient throughout the hospital stay to improve recovery 9.
Surgical care is an area in which information transfer and patient learning often has to take place within a short period of time. The preoperative information and education provided by nurses can help patients to relieve their anxiety as well as enhance their self‐care abilities. Patients should also prefer to be given information before admission so that they are prepared for their hospital stay 11.
Identified barriers to nurses implementing effective communication were lack of time and questions raised by patients 12, ward culture, nurses’ lack of knowledge and experience and administrative and resource issues 13. According to Bernier et al. 15, preoperative teaching is an interactive process of providing information and explanations about the surgical process, patient behaviours and provision of psychosocial support that helps to promote the surgical patients’ postoperative recovery. A review article 16 identified the following important areas of preoperative information needs for surgical patients: symptoms, wound care, activity, pain management, postoperative self‐care and psychological issues. Moreover, Fitzpatrick showed that the majority of nurses believed that the knowledge and experience of the individual nurse influenced the standard of education received by patients 17. Failure to help the patient by providing information in such a way that it can be understood and assimilated may mean that the patient is unable to take part in their care 16. According to Oermann et al. 18, nurses are always acting as key educators in the perioperative patient care.
The aim of the study was to describe topics and structure in preoperative nursing consultation with patients undergoing surgery for colorectal cancer. A further aim was to describe whether the topics were documented in the consultations.

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