Clinical Corner

Bringing Arthroplasty Patient Education Online

By Andre Vermette, RN, BScN, ONC(C)
Orthopaedic Assessment Clinic, Halifax Infirmary

As technology changes, so too shall nursing. Patient education will always be happening at the bedside, but education in advance of the total joint replacements of knees and hips is now happening at home via the World Wide Web. Traditionally, we would bring patients to an in-person education session in the weeks preceding their operation, but this can now be done in the comfort of their home. This article is being written to explore the creation, the usage and evaluation of using a web-video to deliver education.

The idea to produce an online education class for our patients in Central Zone was conceived several years ago. It took about a year to secure funding for this project, followed by four months to create the script for it. Filming was done through a local company, and while it only took 2 days to film, post production was 2-3 months. The result: A forty minute instructional video to inform patients of what to expect with their hospitalization and recovery (including their activities of daily life) which can be followed by the home exercises patients are expected to do at home following their new joint.

Accessibility: It is available to anyone who has access to a computer that is connected to a high speed internet connection. No login is required and it is located on a pubic portion of our local health district webpage. There is also a link to it if you visit the provincial webpage devoted to Orthopaedic surgery. When patients see the surgeon in our Orthopaedic Assessment Clinic, and consent to their new joint (which can vary from months to several years ahead of their surgery itself), we ask the patients if they have access at home to the internet, and most do. For those without direct access, there are usually alternative options such as a family member's home or their local library. The website is located at: http://www.cdha.nshealth.ca/orthopaedics/patient-educational-videos.

The Positive: We are now able to offer 24-7 access to our information from anywhere in the world (that has internet). Halifax has a wide intake of patients throughout our province and the Maritimes; we are able to save some people from multiple hours of driving and money spent on gas, parking and tolls. The recorded video also allows for a consistent message. If patients wanted to review a component post-op, the site allows for itemized review of smaller sections.

The Critique: Upfront we knew there were a couple of faults. Patients viewing this wouldn't have the added bonus of an open Q & A that typically accompanies an in-person session; sometimes fellow Patients would prompt others to think about issues not considered previously. There are, of course, who don't have internet access at home, or their computer device had software issues and wouldn't play the video. We still offer in-person sessions to those in need, but the number of patients is far less than what is was before the video.

Hindsight and Moving Forward: There were no tools to collect proof which patients are watching this, but we are able to get some stats: For 2015, there has been 1831 different computers access this, with a total view count of 3776 with an average time of 45 minutes. Less frequently people are accessing the post discharge exercises - 396 unique page views with a total of 1186 views. Viewing the glass half full, rather than half empty, this is proof that people are able to go back and reinforce what they have learned, instead of simply relying on their next interaction with a physiotherapist.

On the whole, the video has been quite successful, but to view it as the only implement in our education tool belt would be a mistake. Not everyone has readily available access, and it lacks the personal interaction which helps to confirm successful learning, but we do offer ourselves as ready to accept inquiries following the watching of the video; and we do still offer in person sessions. It has become a valuable mechanism to deliver education with added convenience, but one can't exclusively rely on it.

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