Nursing care for patients after abdominal surgeries: Assessment of the patients at surgical ward of ha nam general hospital in 2020

Nội dung text: Nursing care for patients after abdominal surgeries: Assessment of the patients at surgical ward of ha nam general hospital in 2020

1. RESEARCH ARTICLE NURSING CARE FOR PATIENTS AFTER ABDOMINAL SURGERIES: ASSESSMENT OF THE PATIENTS AT SURGICAL WARD OF HA NAM GENERAL HOSPITAL IN 2020 Nguyen Thi Loan1,Trinh Hung Manh2, Le Thanh Tung3, Nguyen Thi Dung3, Mai Thi Yen3 1Ha Nam Medical College 2 Viet Nam National Cancer Hospital 3Nam Dinh University of Nursing ABSTRACT Objective: To describe the nursing treatment support and coordinated doctor’s care for patients after abdominal surgery medical orders reached the highest rate at Surgical Ward in Ha Nam General (87.0%); following by the reception of Hospital in 2020. Method: Descriptive patients (85.4%), Monitoring and evaluation cross - sectional study was conducted to of patients (80.5%). Conclusion: Nursing collect data by interviewing with structured care for patients after abdominal surgery in questionnaires from 123 patients at Ha Nam General Hospital has a rather high Surgical Ward in Ha Nam General Hospital. satisfactory rate. Results: Through the assessment of the Keywords: Nursing care, post-operative patient, most of the nursing care’s contents patients, abdominal. was done well. In particular, providing 1. INTRODUCTION Over the past decade, the number system, pain stimulation, kidney dysfunction, of abdominal surgeries has tended to blood clotting disorder, hypothermia ... due increase. In Europe and America countries, to anesthesia or surgery. The surgery, abdominal surgery was the second whether simple or complex, causes stress position in the ranking of all surgical and anxiety for the patient and the patient’s operations [1]. Viet Nam is similar to other family [3]. Therefore, taking care of the countries in the world, with the statistics patients before, during and after surgery is of over 30453 patients from 2003 to 2007, very important. abdominal surgery accounts for the highest According to the World Health percentage (36.9%) [2]. Abdominal surgery Organization (WHO), the care provided is related to pain, body shape change, fluid by the nurse is one of the core of the disturbances, bleeding during and after healthcare system. Taking care of patients surgery, anesthesia complications ... The at the hospital plays an important role in post-operative stage is the period which treatment, especially for post-operative has many physiological disorded, including: patients. The more complicated surgery, dysfunction of respiratory, circulatory the more affected to the patient’s body [4]. According to a study by Dang Duy Quang on the care needs of patients after surgery at Hue Central Hospital in 2014, Cor. author: Nguyen Thi Loan post-operative patients need medical care, Email: nguyenloanlamsang@gmail.com social care, physical care and mental care Received: Nov 15, 2020 accounted for 85.0%; 79.0%; 43.8%; 47.6% Revised: Nov 22, 2020 [5]. According to a study by Ngo Thi Tuyet Accepted: Mar 05, 2021 et al in 2018, the situation of nursing care Journal of Nursing Science - Vol. 04 - No. 01 15
2. RESEARCH ARTICLE for patients at Thai Nguyen Central General - Z1-α / 2 = 1.96 (Confidence is: 95%) Hospital has showed that there are many - d = 0.1 ( chooses error of 10%) factors that negative affect to nursing care => n = 96 such as: lack of facilities, equipment, human resource, number of patients ... [6] Some - Sampling method: According to the factors can improve the quality of care, limit survey, the average number of patients with complications and ensure safety for patients abdominal surgery at ward is about 15 to such as the nurses’ good knowledge and 20 patients/month. Therefore, convenient skills to care for patients, having enough sampling method was used to chose time [ 7]. patientsfor this study. 123 patients who met In Ha Nam General Hospital, Surgery the criteria were choose to the study. Ward has 21 staff, including 8 doctors and 2.4. Research instruments 13 nurses. Each month, there are about 15- The research instruments which were 20 patients were had abdominal surgery in used in this study was built on Quach Chi this ward. Up to now, there has not been Dong’s research [12]. The questionnaire a complete study on the nursing care in has been modified and used in the pilot this hospita. So that, to answer questions: study with 15 patients. The questionnaire Current situation of nursing care after consists of 2 parts: abdominal surgery? What factors are related Part I: General information of the patient. to nursing care? are practical valuable information to help nurses and managers Part II: Contents of care incuding: to develop an intervention plan to improve Reception of patients; Psychological and quality in the field of occupational disease. spiritual care for patients; Monitoring and evaluation of patients; Providing treatment The study was conducted with the aim: support and coordinate doctor’s medical To describe the nursing care for patients orders after abdominal surgery at Surgical Ward in Ha Nam General Hospital in 2020. 2.5. Data collection. 2. RESEARCH METHOD All data were collected by interviewing with structured questionnaires . 2.1. Research subjects Patients who meet the criteria were Patients had surgery at the Surgery selected and explained about the study, Ward at Ha Nam General Hospital during the period from January 2020 to July 2020. ethical issues, data collection procedures and invited them to participate in the 2.2. Research design research. After that, patients answered the Cross-sectional descriptive study questions. It took patients about 10 - 15 2.3. Sample size and sampling method minutes to finish. - Sample size After having all necessary information, Applying formula data collecting forms were checked for completeness and prepared for analysis. p x (1- p) 2 n = Z 1-α/2 x 2.6. Data analysis 2 d - The data were synthesized by using Inside: SPSS 20.0 software. - n: Sample size required - Descriptive statistical including mean, - p: percentage of patients evaluating percentage, standard deviation were used that good nursing performance is estimated to describe the general information of at 50% subjects, the nursing care for the patients. 16 Journal of Nursing Science - Vol. 04 - No. 01
3. RESEARCH ARTICLE 3. RESUTS Table 1. Demographic factors of subjects (n =123) Contents Number Percentage ≤ 30 8 6.5 Age 31 – 59 59 48 ≥ 60 56 45.5 Male 108 87.8 Gender Female 15 12.2 Primary school 10 8.1 Secondary school 31 25.2 Education level High school 45 36.6 and above 37 30.1 Urban 42 34.1 Accommodation Rural 81 65.9 According to research results: The patient who was youngest was 17 years old and who was oldest was 85 years old. The majority of the subjects was group 31–59 years old (48%). More than a half of the patients living in the rural (65.9%) Table 2. Reception of patients (n =123) Contents Number Percentage The nurses was performed with Fully perform 114 92.7 an attitude of warmth, sympathy Perform but not fully 9 7.3 and bed-folding as soon as the patient entered the ward Not perform 0 0.0 Fully perform 113 91.9 Implement instructions on administrative procedures when Perform but not fully 10 8.1 the patient entered the ward Not perform 0 0.0 Informing patients about their Fully perform 112 91.1 rights and obligations, internal Perform but not fully 11 8.9 rules, and other regulations while being treated in the ward. Not perform 0 0.0 More than 90% of patients indicated that activities of reception of patients was fully perform. In details, the nurses was performed with an attitude of warmth, sympathy and bed-folding as soon as the patient entered the ward (92.7%), Implement instructions on administrative procedures when the patient entered the ward (91.9%), Informing patients about their rights and obligations, internal rules, and other regulations while being treated in the ward (91.1%). Journal of Nursing Science - Vol. 04 - No. 01 17
4. RESEARCH ARTICLE Table 3. Psychological and spiritual care for patients (n = 123) Contents Number Percentage Care, share, and ask about Fully perform 107 87 the health of the patient in the Perform but not fully 16 13 course of care and treatment Not perform 0 0.0 Encourage the patient to feel Fully perform 105 85.4 secure in treatment during Perform but not fully 18 16.4 the process of care and procedures. Not perform 0 0.0 Promptly respond to concerns Fully perform 107 87 and questions of patients in the Perform but not fully 13 10.6 treatment and care process Not perform 3 2.4 Attitude, behavior, verbal Fully perform 113 91.9 communication and behavior Perform but not fully 10 9.1 with patients. Not perform 0 0.0 Psychological and spiritual care for patients are highly appreciated by the patient. Through patients’ evaluating, nurses implemeted fully perform activities with the percentage as follow: Care, share, and ask about the health of the patient in the course of care and treatment (87%); Encourage the patient to feel secure in treatment during the process of care and procedures (85.4%); Promptly respond to concerns and questions of patients in the treatment and care process (87%); Attitude, behavior, verbal communication and behavior with patients (91.9%). Table 4. Monitoring and evaluation of patients (n = 123) Contents Number Percentage Nurses performed daily Fully perform 104 84.6 measurements of pulse, temperature, blood pressure Perform but not fully 19 15.4 for patients during hospital Not perform 0 0 stay Nurses monitor progress, ask Fully perform 112 91.1 questions about the patient’s Perform but not fully 11 8.9 illness every day during the hospital stay Not perform 0 0 Nurses come immediately Fully perform 109 88.6 and treat promptly when the Perform but not fully 14 11.4 patient has abnormal signs. Not perform 0 0 Mainly of the patients indicated that nurses were fully perform monitoring and evaluation of patients with the percentage as follow: Nurses performed daily measurements of pulse, temperature, blood pressure for patients during hospital stay (84.6%); nurses monitor progress, ask questions about the patient’s illness every day during the hospital stay (91.1%); nurses come immediately and treat promptly when the patient has abnormal signs (88.6%) 18 Journal of Nursing Science - Vol. 04 - No. 01
5. RESEARCH ARTICLE Table 5. Providing treatment support and coordinate doctor’s medical orders (n =123) Contents Number Percentage Nurses make informed, Fully perform 105 85.4 explain the work was going Perform but not fully 18 14.6 to do before making medical doctor’s orders Not perform 0 0 Nurses check the name and Fully perform 112 91.1 age of the patient, fully explain Perform but not fully 11 8.9 before each medical order to the patient.. Not perform 0 0 Nurses clearly announced the Fully perform 108 87.8 name of the drug, the quantity of the drug, and publicly Perform but not fully 15 12.2 announced the drug used in the day to the patients. Not perform 0 0 Fully perform 105 85.4 Nurses perform oral medicines for patients in bed, in the Perform but not fully 18 14.6 presence of the nurse Not perform 0 0 Nurses encourage and explain Fully perform 113 91.9 clearly before each injection, Perform but not fully 10 8.9 infusion, dressing change ... to the patients Not perform 0 0 Fully perform 109 88.6 Nurses instruct the patient what to prepare before each Perform but not fully 14 11.4 test and scan. Not perform 0 0 Fully perform 107 87 The nurses brought patients to the place for testing and Perform but not fully 16 13 screening. Not perform 0 0 The results showed that most of the contents assessed by the patients were fully perform with the percentage as follow: Nurses make informed, explain the work was going to do before making medical doctor’s orders (85.4%); Nurses check the name and age of the patient, fully explain before each medical order to the patient (91.1%); Nurses clearly announced the name of the drug, the quantity of the drug, and publicly announced the drug used in the day to the patients (87.8%); Nurses perform oral medicines for patients in bed, in the presence of the nurse (85.4%); Nurses encourage and explain clearly before each injection, infusion, dressing change ... to the patients (91.9%); Nurses instruct the patient what to prepare before each test and scan (88.6%); The nurses brought the patients to the place for testing and screening (87%). Journal of Nursing Science - Vol. 04 - No. 01 19
6. RESEARCH ARTICLE 4. DISCUSSION of care and treatment (87%); Encourage the patient to feel secure in treatment 4.1. Reception of patients during the process of care and procedures The research results showed that: (85.4%); Promptly respond to concerns 92.7% of the patients said the nurses was and questions of patients in the treatment performed with an attitude of warmth, and care process (87%); Attitude, behavior, sympathy and bed-folding as soon as verbal communication and behavior with the patient entered the ward, Implement patients (91.9%). Besides, there are still instructions on administrative procedures 10.6% of patients who believe that nurses when the patient entered the ward (91.9%), have not done well in answering their Informing patients about their rights and concerns and questions during treatment obligations, internal rules, and other and care. The rate of general Psychological regulations while being treated in the ward and spiritual care for patients was 79.7%. (91.1%). Satisfactory rate overall for the This finding is lower than the study of reception of patients was 85.4%. This Duong Thi Binh Minh in 2012 (94.9%) finding is lower than some researches [9]; the study of Chu Thi Hai Yen in 2013 such as: study of Quach Chi Dong in 2018 (94.7%) [10]; Dao Duc Hanh in 2015 (93%) [8], study of Duong Thi Binh Minh (94.8%) [13]. However, this finding is higher in 2012 (95.8%) [9] and study of Chu Thi than the study of Nguyen Thi Bich Nga in Hai Yen (97.2%) [10]. The results may 2015 (78.8%) [12] . The explanation for the be that the patients at Huu Nghi Hospital differences in results of the authors may be is a senior central officer of the Party and due to geographic characteristics as well as State, is a policy object, so the patients the different scope of research (at the ward, are more attentive when receiving. The at the hospital, and at the provincial level). . implementation of the patient care model 4.3. Monitoring and evaluation of and the specificity of the Emergency Ward so the proportion of nurses in charge of patients caring for a patient is higher than in other According to results, mainly of the ward, so it is possible that factors that patients indicated that nurses were fully help the reception of patients in the study perform monitoring and evaluation of of Chu Thi Hai Yen had a higher rate. The patients with the percentage as follow: satisfactory rate in our study is lower than Nurses performed daily measurements that in the study of Nguyen Thuy Chau in of pulse, temperature, blood pressure 2014 at Khanh Hoa General Hospital with for patients during hospital stay (84.6%); 88% of the patients being well received nurses monitor progress, ask questions when entering the hospital [11]. The above about the patient’s illness every day during results are due to the hospital’s good the hospital stay (91.1%); nurses come implementation of “Renewing the service immediately and treat promptly when the style and attitude of health workers towards patient has abnormal signs (88.6%). The patient satisfaction”. rate of general monitoring and evaluation 4.2. Psychological and spiritual care of patients was 80.5%. This finding is still for patients lower than some studies such as: the study of Duong Thi Binh Minh in 2012 Patients evaluate that nurses perform (94%) [9], the study of Chu Thi Hai Yen well activities such as: care, share, and ask in 2013 at the Department of Emergency about the health of the patient in the course Resuscitation of the Agricultural Hospital 20 Journal of Nursing Science - Vol. 04 - No. 01
7. RESEARCH ARTICLE (96.1%), the study of Nguyen Thi Bich Nga instruct the patient what to prepare before in 2015 at the Central Lung Hospital (85%) each test and scan (88.6%); The nurses [12]. In general, Monitoring and evaluation brought the patients to the place for testing of patients is highly appreciated by the and screening (87%). patients, but still 19.5% of the patients believe that nurses have not done well in The general rate of providing treatment support and coordinate doctor’s medical monitoring their disease progress. This orders was 83%.This result is higher than shows that it is necessary to have more study of Nguyen Thuy Chau in 2014 (79,3%) regular inspection, supervision and urge [11], the research of Nguyen Thi Bich by the ward leadership team, the dean of Nga in 2015 at the Central Lung Hospital the ward in the strict implementation of the (81.2%). The reasons for this finding professional regulations. was the Hospital has done a good job in 4.4. Providing treatment support and inspecting, monitoring and urging nursing coordinate doctor’s medical orders and especially successfully implemented Circular 07/2011/TT-BYT on guiding the Nurses perform oral medicines for taking care of patients in hospitals. patients in bed, in the presence of the nurse (85.4%) is one of the most important 5. CONCLUSION task of nurses. This finding is higher than The status of the nursing care for patients some studies such as: the study by Nguyen after abdominal surgery at Hanam General Thuy Chau in 2014 at Khanh Hoa General Hospital through the view of the patient has Hospital (61%) [11], the study of Bui Anh Tu a rather high satisfactory rate: in 2015 at the Military Institute of Traditional Medicine (13.5%) [14]. However, this + 85.4% of the patients assessment finding is lower than study of Chu Thi Hai nurses fully perform recepted of patients Yen in 2013 at the Emergency Recovery Department of Agricultural Hospital (99.3%) + 80.5% of the patients assessed nurses fully perform monitored and evaluated for [10]. patients. According to the results of this study, most + 79.7% of the patients assessed nurses of the contents assessed by the patients fully perform psychological and spiritual were fully perform with the percentage as care for patients was follow: Nurses make informed, explain the work was going to do before making + 83% of the patients assessment nurses medical doctor’s orders (85.4%); Nurses fully perform provided treatment support check the name and age of the patient, fully and coordinated doctor’s medical orders explain before each medical order to the patient (91.1%); Nurses clearly announced REFERENCES the name of the drug, the quantity of the 1 Aneurin Bevan Health Board (2012). drug, and publicly announced the drug used Nursing Strategy 2012 - 1016 “Vision and in the day to the patients (87.8%); Nurses Voice - Making the Shift”, NSH Wales. perform oral medicines for patients in bed, in the presence of the nurse (85.4%); 2. Long Nguyen Hoang (2010). Nurses encourage and explain clearly Factors related to postoperative symptoms before each injection, infusion, dressing among patients undergoing abdominal change ... to the patients (91.9%); Nurses surgery, Master’s thesis, Faculty of Nursing, Journal of Nursing Science - Vol. 04 - No. 01 21
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