Date of Award


Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Dr. Loralynn M. Antin

Faculty Reader

Darryl DuVall

Executive Summary

Effectiveness of Online Pediatric Plastic Surgery Preoperative Education via Inside Out Care

Background and Significance

Online patient education improves health outcomes, increases knowledge attainment, and decreases organizational costs (Win et al., 2016). Additionally, effective preoperative patient education shortens recovery times and decreases postoperative complications, costs, as well as patient and guardian anxiety (Brumfield et al., 1996; Herrera-Usagre et al., 2019). In the plastic surgery clinic at a large regional pediatric hospital in Washington state, an online platform for preoperative teaching termed Inside Out Care (IOC) was implemented to optimize patient education. Prior to implementation of the IOC platform, preoperative teaching was completed by the nurse during a preoperative clinic visit with the surgeon, and families were provided with a paper packet of printed instructions.

Problem and Purpose Statement

The institution had not yet formally evaluated the outcomes of the online preoperative teaching process implemented in the plastic surgery clinic. This program evaluation sought to determine the effectiveness of preoperative teaching via the IOC platform as well as understand the patient and guardian experience in order make sound recommendations for improvement and implementation across the organization.


The project was designed as a program evaluation based on the Centers for Disease Control and Prevention (CDC) framework for evaluation in public health and the constructivist model of learning. A survey link was sent by email to 451 patients or guardians who completed online plastic surgery preoperative education via the IOC platform prior to January 2022. Preoperative education was largely completed by guardians, however, patients 18 years and older completed the preoperative education independently. The anonymous, 14-question, mixed-methods survey included 11 quantitative, Likert scale-based questions and three qualitative, open-ended questions. The researcher administered the survey by telephone using certified medial interpreters for patients and guardians who spoke a primary language other than English.


A total of 61 survey responses were collected between January 31 and March 3, 2022. Ninety-eight percent of respondents agreed that the online preoperative instructions via IOC were helpful for understanding pre and post operative care. Over half the respondents logged back into the IOC portal to review information after completing the initial education. All respondents reported feeling at least moderately confident applying the information they learned, and 68% were very or extremely confident applying the information they learned from the online education.

Inductive qualitative content analysis and coding identified positive themes of helpfulness, understandability, completeness, and effectiveness in meeting the needs of participants with multiple learning styles. Negative themes included task confusion, platform issues, language barriers, and scheduling concerns. Spearman’s correlation test found no significant relationship between age and confidence in applying the information provided via IOC, r(29)=.167, p= .368 or between education level and confidence in applying the information, r(29)=.118, p= .527. This speaks to the success of the online education in reaching patients and guardians of all ages and educational backgrounds.


The results from this project confirm previous findings in the literature about the effectiveness of online patient education and provide new and valuable insights regarding patient experience and satisfaction with the online preoperative teaching process. Based on the results of this program evaluation, recommendations were made for optimizing the preoperative teaching process before rollout in other clinic areas. Additionally, the survey tool was shared with clinic nurses for adaptation and use in continual improvement cycles.

Implications for Practice

This project has implications for all clinics that do preoperative teaching. There are many clinics within this particular pediatric hospital including urology and general surgery that utilize a preoperative teaching process that is similar to the plastic surgery clinic’s process prior to IOC implementation. All the ambulatory surgical clinics within the organization could benefit from transitioning to standardized, online education.

Once the platform is optimized based on recommendations from this program evaluation, it can be utilized in other clinics. The same basic structure from IOC can be edited to fit the content of other surgical specialties. This would allow different specialty clinics to implement similar online preoperative teaching processes without building any new content. Programs built within the IOC platform can be seamlessly shared and copied, and the developer is enthusiastic about supporting this ongoing work.


Brumfield, V. C., Kee, C. C., & Johnson, J. Y. (1996). Preoperative patient teaching in ambulatory surgery setting. Association of Perioperative Registered Nurses Journal, 64, 941-946.

Herrera-Usagre M., Santana V., Burgos-Pol R., Oliva J. P., Sabater E., Rita-Acosta M., Casado M. A., Cruces S., Pacheco M., & Solorzano Perez C. (2019). Effect of a mobile app on preoperative patient preparation for major ambulatory surgery: Protocol for a randomized controlled trial. Journal of Medical Internet Research, 8(1).

Win, K. T., Hassan, N. M., Oinas-Kukkonen, H., & Probst, Y. (2016). Online patient education for chronic disease management: consumer perspectives. Journal of Medical Systems, 40(4), 88.

K Lueneburg digital poster 2022.pptx (106 kB)
K Lueneburg digital poster 2022