Healthcare Facility Website as an Information Source for the Surgical Patient

Introduction

Contemporary information society is characterized by computerization, which means equipping the population and society with information technologies, acquiring computer literacy, transforming public agendas into computer databases, making them accessible via the Internet, and using new information and communication technologies in all areas of social life, bringing more efficient and faster provision of traditional functions and activities, as well as new activities that are only possible with new technology (Sak et al., 2007). These facts also apply to the health sector and also have or may have an impact on more effective provision of information to patients and better education.

Information is defined as a message, notification, or stimulus that enables distinction or a decision between options. Every piece of information is knowledge, therefore it is part of cognitive processes (Hartl, 2004; Hartl, Hartlová, 2010). Strmeň, Raiskup (1998, p. 116) define it as "a notice, message, signal given orally, in writing, or in another way perceivable by the senses."

The Internet is an international computer network enabling the presentation and exchange of information by individuals and institutions on a global scale. It is accessible to anyone who has the appropriate technical equipment and a connection to the network. Within the Internet, the WWW (World Wide Web) system can be used, which allows Internet clients to present and search for various types of information (Průcha, 2017).

"A surgical patient is considered to be a person who suffers from a surgical disease or has sustained an injury and is provided with health care within a surgical department, whether outpatient, inpatient, or a day surgery unit" (Magerčiaková, 2011, p. 51). One of the basic needs of the surgical patient is also the need for information, not only in relation to informed consent. The vast majority of patients are interested in everything concerning their health condition and require information of various kinds from healthcare professionals – information about diagnosis, treatment, diet and exercise regimen, and so on (Kristová, Tomašková, 2002). "Rational guidance, providing timely and adequate information helps the patient's mental adjustment to the surgical condition" (Greisinger, Jobánková et al., 1990, p. 160). From a temporal perspective of hospitalization, information needed by the patient can be divided into information:

• Before admission – this information is provided by the doctor and nurse in the outpatient clinic (reason and necessity of hospitalization and surgical procedure, date of admission and approximate duration of hospitalization, items necessary for hospitalization, and so on).
• Upon patient admission to the ward – it is important to introduce the nurse and welcome the patient, as well as to provide important information concerning the following areas: organizational arrangement of the nursing unit, patient rights and obligations, room number, call system, telephone use, visiting hours, safekeeping of valuables, hospital rules, daily schedule, healthcare team – attending physician, treating doctor, nurses, and so on. Some patients undergo the admission interview multiple times and find it exhausting. In such cases, the interview should focus only on the most important points, especially during acute admissions. Supplementary information may be obtained from medical records, notes from other healthcare professionals, information from paramedics, the admissions office, or the patient's support persons (Workman, Bennett, 2006).
• During hospitalization – provision of information regarding diagnostic, therapeutic, and nursing interventions, including meeting all patient needs.
• Before discharge from the ward – the patient receives information about medical follow-up, method of taking medication, regimen during the convalescence period, and so on (Kristová, Tomašková, 2002).

In support of each of the above categories, patient information provided on the hospital website can also be effective, representing a potential information source. Papík (2011) defines an information source as an information object that contains accessible information corresponding to the user's information needs. "The current era is characterized by a real transition to an information society, i.e., a society in which the ability to obtain quick and easy access to needed information becomes the dominant principle" (Meško et al., 2005, p. 9).

It appears that providing information reduces psychological and emotional distress in surgical patients. In addition to information about the surgical procedure (type of procedure, reason, risks, and possible complications) from the surgeon, and information about the method and possible complications of anesthesia from the anesthesiologist, the patient should also be informed by the nurse about the course of perioperative care (what will happen to them and when) (Zeleníková, 2013). Each patient requires a different scope of information provided; therefore, the nurse, as well as any other healthcare professional, must adopt an individual approach and provide information sensitively with regard to the patient's level of anxiety. Some patients actively seek as much information as possible, while others avoid information and prefer not to know anything. This is related to their coping mechanisms used to deal with the burden. Patients with lower levels of anxiety primarily require information concerning the surgical procedure, while more anxious patients prefer information focused on what feelings and sensations they can expect (Walker, 2002).

The influence of psychological state on obtaining and remembering information can be mitigated precisely by publishing information for the patient on the hospital website, as the patient and their support persons can study this information in the comfort of their own home. Another advantage in this case is that the patient arrives for the surgical procedure informed, and in personal communication with healthcare professionals, only feedback is used to verify the patient's understanding of the information, their ability to follow instructions, and any necessary supplementation of essential information.

Walker (2002) lists the usual methods of providing information:

• individual interview with the patient,
• group education conducted before patient admission,
• information leaflets and brochures,
• video presentations,
• individual or group education during the patient's hospitalization.

An alternative form of providing information to patients before surgery is to offer them leaflets and brochures even before admission for hospitalization. They can read them repeatedly together with family members. The most effective approach is a combination of information provision methods (Zeleníková, 2013). Leaflets and brochures for patients can also be published in electronic form on the hospital website.

Rankin et al. (2005) state that the Internet is a vast medium providing unique conditions for communication, information dissemination, and education. Its continued global growth, both in total number of users and frequency of use, also has an impact on healthcare providers. The Internet offers extensive possibilities for searching for information, including health-related topics, within electronic information sources.

Advantages of electronic information sources:

• they are accessible to users at any time and from any place,
• they can be available on the web much sooner than printed versions of documents,
• multiple users can view them simultaneously in real time,
• they save time needed to gain access to a specific document (Majerová, 2006),
• compared to printed versions of documents, they are economically less demanding,
• they can be read repeatedly and returned to,
• it is possible to download the document, save it to a personal computer or portable medium (e.g., USB key), and print it if needed,
• updating data in an electronic document is faster compared to the printed version.

Disadvantages of electronic information sources:

• the quality of their content or information is often uncertain,
• handling an electronic document is less comfortable, it is difficult to go through the document in detail because it is not displayed in full but in parts,
• they contribute little to social interaction,
• technical problems sometimes cause temporary unavailability of electronic information sources (Majerová, 2006),
• their use presupposes information literacy, computer and Internet skills, as well as Internet access.

Aim of the Survey

The aim of the survey was to determine to what extent hospitals use their websites to publish information for surgical patients, or for patients undergoing surgical therapy.

Within the survey, we set the following partial objectives:

• to determine whether hospitals with surgical departments have created and operate their own websites,
• to map whether hospital websites contain a section with information for patients,
• to determine whether hospital websites contain instructions for patients undergoing surgical therapy,
• to verify the content focus of instructions for patients undergoing surgical therapy published on the website of a specific hospital.

Methodology and Sample

The method of content analysis of websites was used for data collection. The survey included 71 inpatient healthcare facilities, or hospitals, out of a total of 126 hospitals and sanatoriums in the Slovak Republic that were searched. The analysis included hospitals that, according to information published on their website, had at least a surgical department or clinic, or a day surgery unit; other hospitals were excluded from the analysis. Also excluded from the list of analyzed hospitals were 8 hospitals that did not have a website, and thus it was not possible to assess whether they operated a surgical department, and they clearly do not publish information for surgical patients on their non-existent web portal. We conducted the analysis using the standard method of searching hospital websites according to a pre-prepared list of hospitals (i.e., the same way a surgical patient or their support persons or legal representatives would search for information on the Internet).

Before starting the survey, we established criteria for the content analysis of hospital websites, within which we searched for published information for surgical patients. We considered as such information instructions for patients undergoing surgical therapy, i.e., preoperative preparation, postoperative regimen, information about anesthesia, information about the surgical disease, its treatment, and regimen measures. Conversely, for the purposes of our analysis, we did not accept published information concerning the characteristics, focus, and staffing of the surgical department, the range of surgical procedures performed, contact information of the department, other information about the department (e.g., parking on the premises, additional services, extra-standard services, smoking ban, and so on), price list of paid services, medical records, provision of information about health status, patient's personal belongings needed for hospitalization, outpatient clinic hours, and so on.

Results

Through analysis, we found that out of the set of 71 hospitals, all hospitals had their own website. Out of this total number, 58 hospital websites contained a section with information for patients. This section has various names on individual hospital portals, which we specify in Table 1.

Table 1 Sections of websites with information for patients

In relation to hospital websites, we also investigated whether their patient section contains instructions for patients undergoing surgical therapy. 16 hospitals have information or instructions addressed to surgical patients on their website in a section for patients or the public (see Table 2).

Table 2 Information for surgical patients on the website

In the case of 16 hospital websites, we further analyzed them in terms of the content focus of instructions for patients undergoing surgical therapy – our findings are presented in Table 3 in the exact wording as they are made available to patients on the Internet (without language editing). The content focus of information for patients is influenced by the fact that some hospitals operated, in addition to surgical inpatient wards and day surgery units, also traumatology, orthopedic, neurosurgical, urological, cardiac surgery departments, departments of vascular surgery, plastic surgery, pediatric surgery, thoracic surgery, oncological surgery, or surgical oncology. Materials addressed to patients from other surgical fields than general surgery were accepted within our survey as materials intended for surgical patients.

Table 3 Content focus of information for surgical patients on the Internet

Regarding the number of documents or materials for surgical patients published on the website of a specific hospital, the highest number of published documents suitable for a surgical patient within one hospital was 10 (see Table 4).

Table 4 Number of documents for surgical patients published on one hospital website

Discussion

Sources of information for the patient undergoing surgical therapy and/or their support persons can be various, including information provided by healthcare professionals, information from written information (educational) materials, from medical records or questionnaires (e.g., questionnaire related to anesthesia), from books and magazines, as well as from the Internet. The volume of information currently available on the Internet is enormous. Almost every organization has a WWW server, and the number of private www pages is also growing. Theoretically, it is possible to find new up-to-date information on any topic on the Internet (Černák, Mašek, 2007).

The mission of our survey was to map the extent to which hospital websites are used to publish information for surgical patients, or for patients undergoing surgical therapy, which can be considered the most modern source of information. According to the Patient's Charter, the patient also has the right to information. Also, obtaining informed consent from the patient or their legal representative is preceded by information and instruction, and it must be in the interest of healthcare professionals to guide the patient toward the right decision, i.e., a decision in favor of health. Patient information contributes to co-responsibility for their own health and reduction of negative emotions arising from an unfavorable health condition, therapeutic regimen, and so on. Patient information and education are closely related. As Svěráková (2012) states, effective patient education and training leads to reduced healthcare costs: an educated patient usually has a more active approach to treatment, and it can be assumed that treatment will be more successful and convalescence shorter.

As Sak et al. (2007) state, obtaining information, working with it, and communication are activities that are used most frequently and by the largest number of users through computers. Patients also search for information on the Internet to an increasing extent, so why not offer them verified information rather than misinformation on hospital websites. Fox, Duggan (2013) in their study state that 72% of Internet users say they have searched for health information online in the past year, therefore it makes sense to use healthcare facility websites for publishing information for patients. Every patient who is to undergo surgical therapy is interested in their condition, as well as in the course and possible complications of the surgical procedure, preoperative preparation and postoperative regimen, limitations, and other areas related to surgical therapy, and they search for information on the Internet, but often also unverified information from various laypersons. It is an indisputable fact that the outcome of any treatment, including surgical treatment, is influenced by the patient's approach to the treatment process. An active patient approach, where the patient is informed about the nature of their disease, the principles of overcoming it, the essence of the surgery and its accompanying discomforts, the importance of early and intensive rehabilitation, and has trust in the doctor and in their own recovery, is irreplaceable in the algorithm of treatment steps (Zeman et al., 2011). Given the legislatively guaranteed free choice of both doctor and healthcare facility, the patient wants to know not only the healthcare facility where they will undergo surgical therapy, but also specific information concerning their surgical procedure. For this reason as well, we investigated whether hospitals with surgical departments have created and operate their own websites. The survey included 71 inpatient healthcare facilities that, according to information published on their website, had at least a surgical department or clinic, or a day surgery unit. Out of the set of 71 hospital websites, 58 contained a section with information for patients. Of this number, only 16 hospitals have information or instructions addressed to surgical patients on their website in a section for patients or the public. However, some information is published on websites under a specific document name, which appears rather cryptic and is difficult to access for the lay public – patients, therefore it is more appropriate to place them on the main page navigation bar of the hospital, for example as information for patients. The vast majority of information was characterized by careless language and inappropriate formal formatting of the published documents.

The content focus of information for patients on websites is also determined by the fact that some hospitals operated, in addition to surgical inpatient wards and day surgery units, various departments in other surgical fields (traumatology, orthopedics, neurosurgery, and so on). Information for patients in a separate tab is published on their websites rather by private healthcare facilities that provide healthcare services also beyond the scope of care covered by health insurance companies. Written educational materials in electronic form can also be part of the information for patients on healthcare facility websites. Mansour and Dowse (2003) point out that patients remember 20% of what they hear. Written educational materials in particular can help improve patient knowledge and skills, patient participation in decision-making processes concerning their health condition and treatment, cooperation between the patient and healthcare professionals, efficiency of time devoted to education, comprehensiveness of education, management of the disease by the patient themselves, and can shorten the length of hospitalization or possibly reduce patient readmissions (Čáp, Gurková, 2009 In Bašková et al., 2009).

Conclusion

Information and communication technologies (ICT) and the Internet are an integral part of provided healthcare. They are also a tool for promoting healthcare facilities and an opportunity to make information accessible to the broad lay public, including potential patients. For the effective use of ICT and the Internet in these areas, the continuous development of staff skills integrating information technologies into daily practice routines is essential (Rankin et al., 2005). A prerequisite for improving the provision of information to surgical patients via the Internet is computer literacy not only of healthcare professionals but also of patients. Computer literacy is generally understood as the competence to operate and use a personal computer (Sak et al., 2007). An adequate material and technical equipment of healthcare facilities and Internet access are also necessities for the publication and updating of information for patients on hospital websites. If patients are recommended information from various electronic sources, it should be subjected to critical analysis and currently considered valid (Pokorná, 2010 In Nemcová, Hlinková et al., 2010). The same applies to professional assessment of the suitability and timeliness of information provided to patients and their support persons through the hospital website. The publication of information for patients should necessarily be preceded by language proofreading and graphic design.

Author: PhDr. Mgr. Mariana Magerčiaková, PhD Katolícka univerzita v Ružomberku, Fakulta zdravotníctva, Katedra ošetrovateľstva

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