Asian Pacific Journal of Cancer Prevention, Vol 17, 20161479 [603987]

Asian Pacific Journal of Cancer Prevention, Vol 17, 20161479
DOI:http://dx.doi.org/10.7314/APJCP .2016.17.3.1479
Determination of Patients’ Learning Needs after ThyroidectomyAsian Pac J Cancer Prev, 17 (3) , 1479-1483
Introduction
Recent advances in technology and medicine have
shortened the length of hospitalization in patients
undergoing surgical procedure and increased tendency
to out-patient surgery. Considering patient safety and
comfort, resource protection and cost-effectiveness,
thyroid surgery is performed as an out-patient procedure
in most centers (Terris et al., 2013; Perera, Patel and
Law, 2014; Rutledge et al., 2014). In the absence of post-
thyroidectomy complications, patients are discharged
from hospital on the same day of surgery or hospitalized
only for one day (Vrabec et al., 2003; Snyder et al., 2010).
Therefore, nurses give priority to technical care and patient
discharge education is poorly or inadequately provided
(Tasocak, 2003; Johansson et al., 2007; Falvo, 2011).
In the lack of optimally efficacious discharge
education, or of provision of appropriate information,
patients experience more anxiety and problems resulting in
unplanned medical visits (Moderchai, Herman, Kerzman
and Irony, 2010; Dag et al., 2014). In addition, it has been
reported that when patients are concerned and inadequately
informed, they feel more dependent. Therefore, nurses
should identify the learning needs and knowledge deficits
of patients (Johansson et al., 2007; Myers and Pellino,
2009; Falvo, 2011). Throughout the discharge process,
nurses are required to assess patient’s condition, and
provide efficient patient-centered information meeting
1Nursing Department, Health Sciences Faculty, Artvin Coruh University , Artvin, 2Surgical Nursing Department, Florence
Nightingale Nursing Faculty, Istanbul University , Istanbul, 3Nursing Department, School of Health Sciences, Mersin University,
Mersin, 4Cerrahpasa Faculty of Medicine, Istanbul University , Istanbul, Turkey *For correspondence: [anonimizat]
The purpose of this study was to determine discharge learning needs of patients undergoing thyroidectomy.
The population of this descriptive study consisted of patients undergoing thyroidectomy in the Endocrine Surgery
Unit of a university hospital between February and December 2013. The study included 251 patients who were
discharged after thyroidectomy. Data obtained using the data collection form and the Patient Leaning Needs
Scale (PLNS) were analyzed by frequency, mean, standard deviation, Kruskal Wallis and student-t tests. The
mean age of the patients was 47.91±13.05 and 76.1% were females. The PLNS total mean score was 208.38±34.91,
with the maximum score of 39.23±6.80 on the subscale of treatment and complications and the minimum score
of 19.45±4.70 on the subscale of feelings related to condition. It was found that the PLNS total score of the
patients was not influenced by age, gender, marital status (p>0.05). This study demonstrated that patients had
high learning needs after thyroidectomy.
Keywords: Thyroidectomy – patient learning needs – nursing – post-discharge educationRESEARCH ARTICLE
Determination of Patient Learning Needs after Thyroidectomy
Zeynep Temiz1, Didem Ozturk2*, Gulay Altun Ugras3, Seher Deniz Oztekin2,
Emel Sengul4
post-operative individual needs of patients (Sendir,
Buyukyılmaz and Musovi, 2003; Johansson et al., 2007;
Falvo, 2011; Galdeano et al., 2014; Krishnatreya et al.,
2014). It has been reported in the literature that patients
obtaining information specific to their health condition
experience an accelerated healing process, show better
compliance to treatment, have increased self-confidence,
satisfaction, coping skills, and quality of life and decreased
anxiety and unplanned medical visits, which in turn
reduces health care costs and increases the quality of
health care (Clark et al., 2005; Mcmurray et al., 2007;
Piredda et al., 2008; Williams, 2008; Myers and Pellino,
2009; Fedai, Cetin and Teke, 2010).
Shortened hospital stay enhances the importance of
effective use of hospitalization time in terms of discharge
education (Tasocak, 2003; Johansson et al., 2007; Falvo,
2011; Sendir, Buyukyılmaz and Musovi, 2013). One of
the causes of ineffective use of time has been reported in
the literature to be the difference between the patients’
perceptions of that which is important information and
that of the nurses providing the education. In this context,
the time allocated for patient education is wasted with the
issues that are perceived as important by nurses and those
that patients deem to be important are ignored (Bailey,
2004; Kızıl, 2008). For the appropriate identification of
patients’ educational needs and priorities at discharge,
learning needs should be assessed using appropriate tools.
The provision of discharge information specific to patients’

Zeynep Temiz et al
Asian Pacific Journal of Cancer Prevention, Vol 17, 20161480learning needs can help reduce the number of patients
presenting to hospital with concern and anxiety about
home care and complications. In the light of these data,
this study aimed to identify discharge information needs
of patients undergoing thyroidectomy and to contribute
to preparation of nurses’ discharge education planning on
patients’ needs.
Materials and Methods
Setting and Sample
This descriptive study aimed at identifying discharge
learning needs of patients undergoing thyroidectomy
at the Endocrine Surgery Unit of Istanbul University,
Cerrahpasa Faculty of Medicine. The population of this
study consisted of 251 patients undergoing thyroidectomy
at the Endocrine Surgery Unit between February and
December 2013, who met the study criteria.
The sample size was ensured to be as five-fold of the
number of scale items (50 items) in validity and reliability
studies. The inclusion criteria were the patients who had
been scheduled to be discharged after thyroidectomy, who
were oriented to person, place and time and had the ability
to speak Turkish, and consented to participate in the study.
Instrument
The instrument developed by the researchers consisted
of two sections. Section one included questions related
to patients’ characteristics. In section two, “The Patient
Learning Needs Scale-PLNS” was used to identify patients’
discharge learning needs. This scale was developed by
Bubela, Galloway, McCay, McKibbon, Nagle, Pringle,
Ross & Shamian in 1990, with a Cronbach’s alpha
coefficient of 0.95 (Bubela et al., 1990). In this study,
Cronbach’s alpha coefficient for the PLNS was 0.95 and
that for the subscales ranged between 0.74 and 0.89. The
validity and reliability study was carried out by Catal and
Dicle in Turkey in 2008 (Catal and Dicle, 2008).
The PLNS is a 50-item Likert-type scale with 7
subscales. The scale items are scored on a Likert-type
scale with, 1: not important 2: less important 3: fairly
important 4: very important and 5: extremely important.
Accordingly, patients are asked to choose the response that
best describes their learning needs and priorities. Result
analysis includes assessment of each subscale and total
scale scores. The scores obtained from the scale range
between 50 and 250 (Bubela et al., 1990).
Procedures
Data were collected by face-to-face interview
technique between February 2013 and December 2013.
The scale was administered to patients undergoing
thyroidectomy 24-48 hours before discharge. All questions
that patients had difficulty in understanding/ interpreting
were explained by the researcher who accompanied the
patient throughout data collection process. Patients who
had difficulty reading questions or marking the responses
were assisted by the researcher; the questions were read to
the patients and they were given time to understand and
choose the response and their responses were marked by
the researcher.Data analysis
Data were analyzed using “SPSS for Windows
21.0 (IBM Corp., Armonk, New York)”. The data were
analyzed statistically using frequency, percentage, mean,
standard deviation. The Kruskal-Wallis and Student t test
were used for the comparison of the groups. A p value
of <0.05 was considered statistically significant, with a
confidence interval of 95%.
Ethical Review
Prior to the study, a written consent was obtained
from the Endocrine Surgery unit of Istanbul University,
Cerrahpasa Faculty of Medicine and the study was
approved by the Clinical Research Ethics Committee
of Istanbul University Cerrahpasa Faculty of Medicine.
Before the administration of data collection tools,
patients were informed about the purpose and content of
the study. The patients were ensured that their privacy
would be kept, their responses were to remain completely
confidential and to be only used for scientific purposes by
the researcher. A written and verbal consent was obtained
from each patient.
Results
The mean age of the patients enrolled in this study
(n:251) was 47.91±13.05. Of all patients, 76% were
females, 82.5% were married, 34.7% had primary
education level, and 15.9% had concerns about home care.
Table 1 presents the PLNS mean scores of the
patients. The PLNS total mean score of the patients was
208.38±34.91. The highest mean score was obtained
for “treatment and complications” (39.23±6.80) and the
lowest mean score was obtained for “feelings related to
condition” (19.45±4.70) (Table 1).
Table 2 presents the most important five learning needs
of the patients after thyroidectomy. The patients ranked
Table 1. Patients’ Learning Needs Subscales Mean
Scores (n=251)
Subscales Number of items Mean SD
Medications 8 34.41 5.45
Activities of living 9 37.13 6.96
Community and follow-up 6 23.80 5.01
Feelings related to condition 5 19.45 4.70
Treatment and complications 9 39.23 6.80
Enhancing quality of life 8 34.27 5.60
Skin care 5 20.06 4.13
TOTAL 50 208.38 34.91
Table 2. Rank Order of 5 Most Important Learning
Needs of Patients’(n=251)
Learning Need Mean score
X±SD
How to care of cut/incision? 4.51±0.77
How this illness will affect my life? 4.49±0.90
How to take each medication? 4.49±0.80
What complications might occur from my illness? 4.49±0.74
What to do if I have a reaction to the medication? 4.47±0.80

Asian Pacific Journal of Cancer Prevention, Vol 17, 20161481
DOI:http://dx.doi.org/10.7314/APJCP .2016.17.3.1479
Determination of Patients’ Learning Needs after Thyroidectomytheir most important information needs to be “How to
care of cut/ incision?” (4.51±0.77), “How this illness will
affect my life?” (4.49±0.90), “When to stop taking each
medication” (4.49±0.80), “What complications might
occur from my illness” (4.49±0.74) and “What to do if I
have a reaction to the medication?” (4.47±0.80) (Table 2).
Table 3 presents some characteristics of patients and
the comparison of the mean scores of the patients on
the PLNS subscales. The PLNS total mean score of the
patients aged between 20 and 35 years was 202.17±40.54,
that of the patients aged between 36 and 50 years was
213.62±29.60, that of the patients aged between 51 and 65
years was 204.72±38.42 and that of those aged 66 years
or older was 210.29±30.29. There was no statistically
significant difference between the PLNS mean scores and
age of patients (p>0.05). The PLNS mean score of female
patients was 209.92±35.82 and that of male patients was
203.48±31.64. No statistically significant difference was
found between the PLNS total mean scores and gender
of patients (p>0.05), whereas, a statistically significant
difference was noted in the “activities of living” subscale
(p<0.05). The PLNS and subscales mean scores of married patients were higher (208.76±33.78) whereas no
significant difference was found between marital status
and the scale and subscales mean scores (p>0.05). There
was no statistically significant difference between level
of education and the PLNS and subscales total mean
scores (p>0.05), whereas, the patients with secondary
education level had higher mean scores (214.26±24.44).
It was found that the PLNS mean score of patients who
had concerns about home-care at discharge was higher
(216.67±28.44) and the difference between the PLNS
mean score and the mean score for the subscale of
“treatment and complications” was statistically significant
(p<0.05) (Table 3).
Discussion
Today, in the absence of any complications, a long
hospitalization is not contemplated in patients undergoing
thyroidectomy and the patients are discharged in a short
time. The tendency for short-stay thyroidectomy deters
nurses from spending enough time with patients to provide
discharge education. In this context, learning needs should Table 3. Comparison of Patients’ Learning Needs Subscales Mean Scores According to Patients’ Characteristics
(n=251)
Patients’ Learning Needs Subscales
Characteristics MedicationsActivities of
livingCommunity
and follow-upFeelings
related to
conditionTreatment and
complicationsEnhancing
quality of lifeSkin care TOTAL
Age*
20-35 33.28±6.53 69.20±14.92 22.48±5.77 18.26±5.44 38.33±7.19 34.02±6.69 34.15±8.18 202.17±40.54
36-50 35.18±4.20 71.69±11.30 24.45±4.42 20.17±4.29 40.24±7.19 34.76±4.87 37.31±6.40 213.62±29.60
51-65 34.06±6.28 68.18±14.63 23.49±5.29 18.91±4.84 38.64±6.47 33.83±6.10 35.37±7.90 204.72±38.42
≥66 34.45±4.62 70.58±11.24 24.58±4.54 20.41±3.83 38.70±5.12 34.16±4.58 36.91±7.13 210.29±30.29
KW:2.302 KW:2.546 KW:4.345 KW:5.580 KW:1.618 KW:1.164 KW:5.904 KW:2.830
p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05
Gender**
Female 34.50±5.72 70.93±13.25 23.94±5.20 19.69±4.75 39.28±6.03 34.51±5.70 36.57±7.59 209.92±35.82
Male 34.11±4.50 67.06±12.43 23.35±4.36 18.66±4.48 39.08±8.90 33.51±5.25 34.53±6.46 203.48±31.64
t:0.484 t:1.999 t:0.805 t: 1.484 t:0.203 t:1.202 t:1.876 t:1.247
p>0.05 p<0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05
Marital status**
Married 34.39±5.35 70.10±12.83 23.88±4.92 19.59±4.51 39.27±6.75 34.32±5.37 36.16±7.28 208.76±33.78
Single 34.50±5.95 69.56±14.64 23.40±5.45 18.75±5.49 39.09±7.11 34.04±6.65 35.70±7.85 206.56±40.21
t:0.115 t:-0.244 t:-0.576 t:-0.958 t:-0.159 t:-0.299 t:-0.375 t:-0.379
p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05
Education level*
Illiterate 32.90±7.54 67.85±16.84 23.33±6.12 19.95±5.24 37.57±8.62 33.14±7.17 35.66±9.52 202.85±46.64
Primary school 34.27±5.77 69.82±13.52 24.24±5.19 19.73±4.54 39.54±7.98 34.39±5.68 36.14±7.87 209.31±36.01
Secondary school
High school
and higher34.81±3.63 72.65±8.73 24.71±3.68 20.55±4.07 39.73±3.80 34.81±4.67 37.86±5.20 214.26±24.44
34.73±5.18 69.60±13.35 23.08±4.99 18.59±4.88 39.09±5.94 34.18±5.52 35.39±7.03 206.26±34.53
KW:.687 KW:.682 KW:4.721 KW:6.088 KW:.150 KW:1.014 KW:3.072 KW:1.470
p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05
Concern status about home-care **
Yes 35.60±3.96 38.40±6.63 24.97±4.42 20.50±4.03 40.87±4.36 35.45±4.43 20.87±3.31 216.67±28.44
No 34.18±5.66 36.89±7.01 23.58±5.09 19.25±4.79 38.92±7.14 34.05±5.78 19.91±4.26 206.81±35.85
t:1.504 t:1.258 t:1.615 t:1.545 t:2.297 t:1.450 t:1.349 t:1.923
p>0.05 p>0.05 p>0.05 p>0.05 p<0.05 p>0.05 p>0.05 p<0.05
*Kruskal Wallis and **Student-t tests were used

Zeynep Temiz et al
Asian Pacific Journal of Cancer Prevention, Vol 17, 20161482be assessed using correct tools for the correct identification
of patients’ discharge learning needs and priorities. This
study demonstrated patients’ high information needs using
the PLNS scale (Table 1). Previous studies using the PLNS
scale (Tasdemir et al., 2010; Demirkıran and Uzun, 2012;
Erdogan, 2012; Dag et al., 2014) also reported that patients
had high information needs prior to discharge, which is
also consistent with our findings. On the other hand, a
study of 45 surgical patients by Jacobs (2000) reported
a PLNS total mean score of 106.2±48.6 and a study of
cardiac catheterization patients by Carew (1999) reported
a PLNS total mean score of 111.53 ±38.81, which both
are lower than that found in this study (Carew, 1999;
Jacobs, 2000). The higher mean score on the PLNS in
this study compared to those in the latter two studies
can be attributed to differences in patients’ demographic
characteristics, types of surgical procedures, patient
education policies in the countries and institutions the
studies were conducted in.
Nurses are supposed to develop new strategies to
provide an effective discharge education directed at
patients’ educational needs. In the process of developing
these strategies, it is of great importance to identify
patients’ priorities and primary information needs. In this
study, patients ranked the most important five information
needs to be “ How to care of cut/ incision ?”, “ How this
illness will affect my life ?”, “ When to stop taking each
medication ”, “What complications might occur from
my illness ” and “ What to do if I have a reaction to the
medication ?” (Table 2).
A study of neurosurgery patients by Tasdemir et al.
(2010) reported that the most important five learning
needs of the patients were “ What the possible side effects
of my treatment are ”, “How to manage the symptoms I
have ”, “How this illness will affect my life ” “How this
illness will affect my future ” and “ When to stop medicine ”
(Tasdemir et al., 2010). A study of 212 patients undergoing
hip arthroplasty by Johansson et al. (2002) reported that
the most important information for the patients was
“how to recognize complications ” (Johansson, Huplı and
Salantera, 2002).
In a study by Clark and Lan (2004), the most important
learning need of patients was reported to be “ what are the
signs and symptoms of complications that may develop
after discharge ” (Clark and Lan, 2004). The results
of this and similar studies suggest that nurses should
focus particularly on issues related to treatment and
complications and medications in the process of planning
and providing discharge education to patients undergoing
a surgical procedure.
It was found that patients’ age, gender, and marital
status had no effect on patients’ learning needs, however,
female patients identified the area of “ activities of living ”
more important as a learning need and those who had
concerns about home care had higher information need
in the domain of” treatment and complications” (Table 3).
The result of this study is consistent with those previously
reported in other studies (Suhonen et al., 2005; Erdogan,
2012; Tan et al., 2013), which might have resulted from
the fact that female patients perceived home care after
discharge as a more important learning need as compared to male patients. Postoperatively, patients can experience
concerns about possible complications after treatment and
discharge and how to manage them. After thyroidectomy,
an impaired cosmetic appearance due to visible surgical
incision, concerns about loss of voice or impaired voice
quality (Cutclife and Herth, 2002), as well as, patients’
and families’ lack of knowledge on home care can drive
patients into concerns and fears about everything that have
been said and done previously (Toksal, 2005). The results
of this study suggest that patients experience concerns
and anxiety about post-discharge complications after
thyroidectomy and these concerns may be promoted by the
inability of provision of appropriate discharge education,
which are also consistent with the literature.
One of the limitations of this study is that it included
patients undergoing thyroidectomy in the Endocrine
Surgery unit of only one university hospital. Therefore the
results of this research represent only the mentioned unit.
One of the other limitations is that the data were collected
based on self-reporting.
In conclusion, It is important to determine patients’
learning needs in terms of their priority through the use
of appropriate measurements to provide patients with
effective education and enhance the quality of their care.
This study demonstrated that the patients, in the unit the
study had been conducted, had high information needs
and had greater concerns and anxiety particularly about
treatment and complications. Nurses should recognize and
evaluate the learning needs of their patients. These results
are also important to nurses who work in practical fields.
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