Specific Aims

“How can I manage the pain of the surgical site? Is the health condition I am having now considered
normal for post-operative recovery? When can I start having some food, and what kind of food to begin with?
When is the appropriate time to start the rehabilitation? I feel terrible pain, and I cannot even move my legs,
should I go to see the provider?” These are examples of questions asked by 56% of patients who underwent
ambulatory surgical procedures and felt that healthcare providers failed to provide them adequate education
regarding their post-operative instructions and post-operative issues (Atchison et al., 2005; Rajala et al., 2018).
This problem calls into action healthcare providers to pay more attention to health education for this particular
group of patients since the number of ambulatory surgical patients is predicted to be rising every year. Recent
reports show 28.6 million visits and 48.3 million surgical and nonsurgical procedures were performed in 2010
(Hall, 2017). These statistics indicate the shifting of healthcare delivery from inpatient to the outpatient setting.
To achieve the optimum outcomes of ambulatory surgery, discharge instruction plays an essential role since
the nursing care provided by the nurse is now carried out by patients and/or their caregivers. However,
previous studies report that adequate patient education was rarely provided due to the limited communication
and time for education in ambulatory surgery settings (Gilmartin, 2007; Varghaei-Paidar et al., 2017).
Microlearning-based education--a small piece of education in the form of video presented via digital
technology, accessible at the learner’s preferred time and place (Corbeil et al., 2021; Thillainadesan et al.,
2022)-- is a new pedagogy used in the healthcare field. It has been used to deliver patient education in several
areas of healthcare settings and has yielded favorable outcomes. It has been found to be a practical
educational approach to enhancing learners’ knowledge retention in previous studies (Chongpornchai et al.,
2021; Parisod et al., 2018; Sarker et al., 2022). However, this educational approach has never been studied in
ambulatory surgery patients. In addition, there is a lack of an education-focused theoretical framework used in
previous studies to guide the study design. Therefore, in this study, the human information processing model
and the cognitive load theory will be used to guide the development of the study design. These theories explain
how new information received by humans is processed and transformed into long-term memory. They also
demonstrate how to enhance the encoding of long-term information and minimize the cognitive load to
increase learning ability (Atkinson & Shiffrin, 1968; Bouchrika, 2022; Çeliköz et al., 2019). Another gap in the
literature is that the tools used to evaluate the educational outcome of patient knowledge retention have shown
poor reliability and validity in all prior studies. For the proposed study, the “Received Knowledge of Hospital
Patients (RKhp)” will be used. The instrument was developed to measure patient knowledge received at the
end or after their hospital stay, and demonstrated reliability and validity for the purpose of evaluating patient
knowledge retention (Leino-Kilpi et al., 2020). Therefore, the purpose of the study will be to test the effect of a
micro-learning intervention on patient received knowledge retention within 24 hours post-ambulatory procedure
discharge. The research question is: Is there a difference in patient received knowledge retention 24 hours
post-ambulatory procedure between patients who receive discharge information using a micro-learning
strategy versus those who receive discharge information using standard practice?
The significance of this study includes being the first study to examine the effects of microlearning-
based education on knowledge retention of ambulatory surgery patients, being the first study that utilizes an
education-focused theoretical framework as a guidance of the study design development, and be the first study
to use a psychometrically sound instrument in evaluating patient knowledge retention. Findings from this
study could advance the scientific knowledge of patient education and support the idea that microlearning-
based patient education may have the potential to mitigate the barriers of the time constraint in providing
adequate health education in an ambulatory surgery setting since it can deliver a minimal-time-consuming
education session yet make high-quality educational outcomes. It could also benefit nurses in ambulatory
surgery settings in terms of using the study as an evidence-based practice to enhance the outcome of patient
education, which is patient knowledge retention. The benefit of this study in research is that it serves as the
foundation for higher-level research to examine the use of microlearning-based patient education and its
outcomes on patient knowledge retention. It also stimulates research questions for patient education studies in
another different context, whether this educational approach could increase patient knowledge retention in that
particular population.