EFFECTIVENESS OF PREOPERATIVE PLANNED TEACHING PROGRAMME ON PREVENTION OF POST OPERATIVE PULMONARY COMPLICATIONS AMONG

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1 Asia Pacific Journal of Research Vol: I Issue XX, December ISSN: -, E-ISSN--9 EFFECTIVENESS OF PREOPERATIVE PLANNED TEACHING PROGRAMME ON PREVENTION OF POST OPERATIVE PULMONARY COMPLICATIONS AMONG PATIENTS UNDERGOING ELECTIVE ABDOMINAL SURGERIES IN SELECTED HOSPITAL OF UDUPI DISTRICT Bijoy Thomas, Immalaraju Sujani, Sunitha Reji John, Dane Rogers, Savitha *, Anil Raj * Manipal College of Nursing Manipal, Manipal University, Manipal-(Karnataka) India ABSTRACT Background: Intelligent, consciousness, pre-operative nursing contributes much to having the patient to achieve an optimum condition that favours a satisfactory postoperative progress and minimizes the possibility of complications. Objectives: This study was aimed at finding the effectiveness of preoperative planned teaching programme on prevention of postoperative pulmonary complications among patients undergoing elective abdominal surgeries. Settings and Design: The study was conducted in Kasturba Hospital, Manipal, using true experimental post test only control group design. Methods and Materials: Purposive sampling technique was used to collect the data. Sample size comprised of subjects, each in experimental and control group. The data was collected using demographic proforma, structured observational and morbidity checklists. Content validity and reliability of the tool were established. Results: Majority of the subjects % in experimental group and % subjects in the control group were in age group of - years. Thirty percentages (%) of subjects in the control group have undergone hernia repairs, whereas in experimental group, majority of the subjects (%) have undergone other surgeries than hernia repair such as cholecystectomy, appendicectomy, laparotomy etc. The study showed that pre-operative planned teaching programme was effective in terms of appropriate postoperative practices and prevention of post-operative pulmonary complications. Significant association was found between duration of surgery and post-operative practice score ( =., p=.8) among experimental group and type of the surgery and postoperative score among control group ( =.8, p=.). The study concluded that planned teaching programme was found more effective in experimental group. Keywords: Abdominal surgery, Planned teaching programme, Post-operative pulmonary complications Page

2 Asia Pacific Journal of Research Vol: I Issue XX, December ISSN: -, E-ISSN--9 Introduction: Surgery is one of the most ancient arts in the world. Any type of surgery is stress to the patient. It becomes even more stressful when the vital organs are involved in the surgery. Some of the patient may respond with expression of helplessness, security and isolation due to discomfort, pain and fear of breaking stitches (Watson, ). Pre-operative care is a preparation and management of patient prior to surgery. It includes physical, psychological and legal preparation. The patients who are physically and psychologically prepared for surgery tend to have better surgical outcome. (KG., October). Pre-operative teaching must be individualized for each patient and some patients want as much information as possible, while others prefer only minimal information because too much knowledge may increase their anxiety. Patients have different abilities to comprehend medical procedure; some prefer printed information, while other learns more from oral presentation. It is important for the patient to ask questions during preoperative teaching sessions (SK,, July). Global incidence of post operative respiratory complications were. percent, global mortality in surgical patient ranges from seven to eight percent and out of all cases, pneumonia contributes to 8 percent. In United States, elective abdominal surgery were, the incidence of respiratory complications were. percent most frequent is pneumonia (. percent), overall mortality due to the respiratory complication were seven and half percent and.8 percent morbidity related to respiratory complications. (Lawrence VA, 99), (Pedersen T., 99). In India the incidence of respiratory complications following upper abdominal surgery is - percent and following lower abdominal surgery five to percent (Deodhar SD, Aug). Post-operative pulmonary complications are common and a major cause of overall peri-operative morbidity and mortality. The most common complications are pneumonia, atelectasis, pneumothorax, respiratory failure, pleural effusion, pulmonary embolism, bronchitis, and bronchospasm. The prevention of post-operative pulmonary complications needs further investigation and nurses are well positioned to have an effect on re-educating their incidence. (Barclay., May). Previous studies have suggested that between % and 88% of people having surgery to the upper abdomen will suffer complications that affect their lungs after the operation (post-operative pulmonary complication). These complications can be made less likely and less severe with the careful use of treatments designed to increase the volume of the lungs, as these volume tends to fall after surgery (Patrick Pasauina, n.d.) Patient education is known to have many positive effects on patients with life threatening illness including increased knowledge retention, improved pain management, decreased length of hospitalization and improved patient adherence to the medical regimen. Preoperative teaching is defined by Devine and Cook (98), as provided to the patient with health related information, psychosocial support and the opportunity to learn selected skills in preparation for surgery. Patient education is one of the most important aspects of quality nursing care. (Kanat F, 9). Material and Methods: The study adopted evaluatory approach and true experimental post test only control group design. Study was conducted in Kasturba Hospital, Manipal, using purposive sampling technique. Sample size comprised of subjects, each in experimental and control group who met the inclusion criteria were included in the study. Patients who are undergoing elective abdominal surgeries for the first time under general anaestheia and those clients between the age group of 8- years were included in this study. Page

3 Asia Pacific Journal of Research Vol: I Issue XX, December ISSN: -, E-ISSN--9 Tools on demographic proforma, Observational checklist on post-operative practices and Morbidity checklist on pulmonary complications were used to collect data. Items were pooled from literature reviews. Observational checklist on post-operative practices consisted of items related to various postoperative practices after abdominal surgery. Each item was coded on a point scale Yes-, No-, with minimum score of and maximum score of. Morbidity checklist on pulmonary complications consisted of items on various symptoms predisposing to pulmonary complications after abdominal surgery. Each item was coded on point scale Yes-, No- with minimum score of and maximum score of. Content validity was established by giving to five experts in the field of medical surgical nursing, surgery, and anesthesia departments. Reliability of the tools were obtained by administering the tools to samples and was calculated by Rater-Inter rater reliability The reliability of the observational checklist was calculated using split half method (r=.8) and self- reported practice rating scale using Cronbach s alpha (r=.9). Administrative permission was obtained by the Dean Manipal College of Nursing and Heads of department of surgery. The study was approved by the Institutional Ethical Committee. Written informed consent was obtained from all participants. Results Data on sample characteristics were analyzed with frequency and percentage. The information on demographic characteristics is given in (Table ). The mean post-operative practice scores (.9±.) of experimental group is higher than the mean post-operative scores (8. ±.) of the control group. The calculated t value (t=.) was greater than table value and was found to be significant at. level of significance. This indicates that preoperative planned teaching programme was effective in terms of appropriate post-operative practices (Table ). The mean post operative morbidity scores (x=.) of experimental group is lower than the mean post operative morbidity score (x=.) of the control group. The calculated t value (t= 9.) is greater than table value and was found to be significant at. level of significance. This indicates that pre-operative planned teaching programme was effective in terms of prevention of post-operative pulmonary complications. There was significant association was found between duration of surgery and post-operative practice score ( =., p=.8) among experimental group and type of the surgery and postoperative score among control group (( =.8, p=.). Other variables were independent to the postoperative practice score. Discussion: The study findings showed that the mean post-operative practice score (x=.9) of experimental group was higher than the mean post-operative practice score (x=8.) of the control group. The mean postoperative morbidity scores (x=.) of experimental group was lower than the mean post-operative morbidity score (x=.) of the control group. It was concluded that planned teaching programme was effective in terms of appropriate post-operative practices (t=., p=.) and prevention of postoperative pulmonary complications (t=9., p=.) among the patients who are undergoing abdominal surgeries. These findings are supported by a study conducted by Kandaswamy et al found that there was a non-significant difference of pre-test performance score between the two groups (p>.) before the implementation of planned pre-operative teaching on early ambulation. There was statistically significant difference (p<.) found between the post-test performance scores of experimental and control group, when analysed by unpaired t test (Kandaswamy A, 8 Aug). Page

4 Asia Pacific Journal of Research Vol: I Issue XX, December ISSN: -, E-ISSN--9 A descriptive retrospective study was conducted by Masood J, Zubia M, and Syed AI to find out postoperative complications during hospital stay of patients in a general surgical ward at tertiary care teaching hospital of Karachi. A total of patients were selected, in which surgeries were performed. 8 (.8%) were elective and (.%) were emergency procedures. Complications were documented in (9.%) patients; the most common complications observed as post-operative pyrexia (8.%), post-operative nausea vomiting 8 (.%), wound infection (.%), and respiratory tract infection in 9 (.%) patients (Masood J, April June). Single-blind randomized controlled study was done by Dronkers J Veldman A, Hoberg E, van der Waal C, van Meeteren N in Netherlands with an objective to find the effects of preoperative teaching and inspiratory muscle training on the incidence of post-operative pulmonary complications after upper abdominal surgeries. Twenty high-risk patients undergoing elective abdominal surgery were randomly selected. The study results showed that eight patients in the control group and three in the intervention group developed atelectasis (p =.). The median duration of atelectasis was days in the intervention group and. days in the control group (p =.). Study concluded that preoperative teaching and inspiratory muscle training was a good tool in preparation for surgery (Dronkers J, 8 Feb). Conclusion: In health care today, the ability to predict and prevent adverse events such as post-operative pulmonary complications has become increasingly important as a measure of the safety and quality of care within the constraints of current health care system economics, workforce shortages and increasing patient care complexity means. Nurses must take proactive approach to identifying and reducing risk of patient complication. Acknowledgement: We are grateful to The Dean, Manipal College of Nursing Manipal, Medical Superintendent and Head of Dept of General Surgery, Kasturba Hospital, Manipal for granting the permission to undertake this investigation. We also acknowledge the study subjects for their willingness and cooperation. Table : Frequency and percentage distribution of subjects with reference to sample characteristics Demographic variables Experimental group n=+= Control group (f) (%) (f) (%) Age in years A) 8 to B) to C) to Gender A) Male B ) Female 8 Marital Status A) Married B) Unmarried Page

5 Asia Pacific Journal of Research Vol: I Issue XX, December ISSN: -, E-ISSN--9 Educational Status A) Illiterate B) Primary school (-) C) High school (8-) D) Pre University (-) E) Degree and above Occupation A) Unemployed B) Employed C) Retired 8 9 Body weight in kg. A) - B) - C) Above Family history of any abdominal surgery A) Yes B) No Types of surgery A) Cholecystectomy B) Appendecectomy C) Laprotomy D) Herina repair E) others Duration of surgery A)- hours B) - hours C) Above hours Page 8

6 Asia Pacific Journal of Research Vol: I Issue XX, December ISSN: -, E-ISSN--9 Table : Mean, standard deviation, mean difference and t value of post-operative practice score among the experimental and control group n=+= Post-operative practice Groups score Mean SD Mean percentage Mean difference t value p value Experimental group * Control group 8... *=significance at. level. Table : Chi square showing the association between post-operative practice scores of subjects and selected demographic variables of experimental group. n= Demographic variables Age in years a) - b) - Gender a) Male b) Female Marital status a) Married b) Unmarried Educational status a) Less than high school b) High school and above Occupation a) Employee b) Unemployee Type of surgery a) Cholecystectomy b) Appendicectomy c) others Body weight in kg. a) Below b) and above Duration of surgery a) Below hrs b) Above hrs F 8 df p value Inference.8. NS..98 NS.9. NS..88 NS.88. NS..8 NS.9.8 NS..8* S Page 9

7 Asia Pacific Journal of Research Vol: I Issue XX, December ISSN: -, E-ISSN--9 History of habits a) Alcoholism b) Smoking c) None Family history of abdominal surgery a) Yes b) No *= Significance at. level NS.8. NS *Author for Correspondence: Savitha, Asst. Professor, Manipal College of Nursing Manipal-Manipal University, (Karnataka) India Cell: 98 savitha.umesh@manipal.edu References. Barclay., L., May. Pulmonary complications of major abdominal surgery may be increasing in us.. Hospital Medicine, Volume 9, pp. -.. Deodhar SD, M. J. S. R. J. S., Aug. Pulmonary complications of upper abdominal surgery.j Postgrad Med, ( ), p Dronkers J, V. A. H. E. V. M. N., 8 Feb. Prevention of pulmonary complications after upper abdominal surgery by preoperative teaching and intensive inspiratory muscle training: a randomized controlled pilot study. Clin Rehabil., (), pp. -.. Kanat F, G. A.,. T. T.,. G. C., 9. Risk factors for postoperative pulmonary complications in upper abdominal Surgery.. ANZ Journal of Surgery., (), pp. -.. Kandaswamy A, C. S. D. G., 8 Aug. 9.doc.. [Online] [Accessed July ].. KG., P., October. Identifying risk factors for postoperative pulmonary complications. AORN Journal.. Lawrence VA, H. S. M. C. D. R. S. J. P. C., 99. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. J Gen Intern Med, (), pp Masood J, Z. M. S. A., April June. Postoperative complications in a general surgical ward of a teaching hospital. Pakistan Journal of Medical Science, Volume, pp Patrick Pasauina, M. R. J. M. B. W., n.d. [Online] [Accessed July ].. Pedersen T., 99. Complications and death following anaesthesia. A prospective study with special reference to the influence of patient, anaesthesia, and surgery-related risk factors.. Dan Med Bull, (), pp SK, M.,, July. Preoperative Evaluation. American Family physician, Volume, pp Watson,. Clinical nursing and Related science Milk wash publications, th edition:. P.No Page