Increasing Ophthalmic Nurses’ Self-Confidence in Performing Postoperative Phone Follow-Up by Implementing a Standardized Guideline

By Kelvin K.H. LI, RN, CRNO, CNS (Oph), MNurs, BNurs (Hons)

Purpose

The purpose of this rapid-cycle small test of change was to increase the self-confidence of nurses in conducting postoperative phone follow-up (PFU) by using a novel standardized evidence-based approach.

Background

Nurses provide postoperative PFU to ensure continuity of care for surgical patients in the Department of Ophthalmology. However, few structured guidelines are available. As a result, discrepancies exist in the phone calls provided. It has been difficult for nursing staff to gauge whether their advice has been appropriate or if they have conducted the PFU properly. Self-confidence of nurses, especially for less experienced staff, may be negatively impacted and patients may not receive self-care advice or referral appropriately through the PFU.

Methods

All nurses in the Department of Ophthalmology were recruited and categorized according to their years of experience in ophthalmology. The baseline level of self-confidence in performing postoperative PFU was assessed via a questionnaire. Literature search was conducted and the standardized postoperative PFU guideline and relevant tools were structured after extracting and consolidating the evidence collected. A small test of change was carried out by implementing the standardized guideline. Post intervention data collection was conducted to evaluate the potential effect of the change by using the same questionnaire as the baseline.

Results

Twenty-six nurses adopted the guideline and tools to conduct the postoperative PFU for 325 post-cataract and 249 post-LASIK patients. The results indicated that there was an increase in self-confidence of nurses in conducting the PFU, giving the post-op advice appropriately, recognizing the signs and symptoms of postoperative complication and answering patients’questions after implementing the standardized guideline. This improvement was independent of the amount of ophthalmology nursing experience.

Discussion

The small test of change by implementing the standardized guideline was accomplished and the result indicated that the guideline increased both less experienced and more experienced nurses’ self-confidence in performing PFU. The standardized guideline and tools were deemed useful for the ophthalmic nurses to perform postoperative PFU. 

Implications/Conclusion

 This project utilized the evidence-based practice approach which positively impacted ophthalmic nurses’ self-confidence in performing postoperative PFU to ophthalmic patients. The current nursing practice can be further improved and optimized. Regular audits will be conducted to ensure adequate utilization and sustainability. Evidence will be regularly evaluated and implemented in the guideline to keep it current. Consideration may be made to adopt the guideline to the other procedure such as vitrectomy in the future.