Clinical Pathways of Postoperative Nursing Care for Women Undergoing Gynecological Operations at Port Said Hospitals | ||
| Port Said Scientific Journal of Nursing | ||
| Article 13, Volume 6, Issue 3, December 2019, Pages 221-248 PDF (629.02 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/pssjn.2019.68002 | ||
| Authors | ||
| Manar Fathy Heeba1; Elsayda Hamdy Nasr1; Hanan mohamed Ali Abou Elsadat* 2 | ||
| 1Maternity, Obstetric and Gynecological Nursing, Faculty of Nursing - Port said University | ||
| 2Maternity, Obstetric and Gynecological Nursing | ||
| Abstract | ||
| Background:The aim of the present study is to investigate the effect of clinical pathways of postoperative nursing care for patients undergoing gynecologic operations on the postoperative outcome.Subjects and Methods: the study was conducted at Obstetric and Gynecologic Department. A total of 112 women undergoing gynecological operation (56 study group who received pre and postoperative care of clinical pathway, and 56 control group who received pre and postoperative routine care of the hospital).Results: The current study shows that patients underwent gynecological operation in the study group were significantly more likely to have no vomiting compared to those in the control group. Thus less than one fifth of them were in need to antiemetic compared to almost half in the control group. Concerning the level of pain experienced by patients during the postoperative period, the present result reveals that women in the study group experience less mean score compared to those in the control group, thus they showed lesser need for analgesia. Significant differences in the early oral intake, postoperative bowel mobility, hours to remove catheters and drains and length of stay were observed between present study and the control groups. Women’s satisfaction related to the care provided was assessed in the present study group. The score given was mostly very good and excellent. Conclusion: Clinical pathway was effective in improving postoperative outcomes related to early ambulation, early oral intake, bowel mobility, hours to remove catheters and drains, short length of stay and patient satisfaction. Recommendations: The concept of clinical pathways should be applied in gynecologic operations to improve patient outcome and reduce postoperative complications. | ||
| Keywords | ||
| Gynecological operations; clinical pathway nursing management | ||
| References | ||
|
Adamina M, Kehelt H, Tomlinson GA, Senagore AJ, Delaney CP. (2011): Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery; 149:830-40.
Al-Ghareeb S A, Ahmad R E, Ahmad H. (2013): Effect of Early Oral Hydration on Post Cesarean Outcomes. Journal of American Science; 9(8).
Apfelbaum JL, Chen C, Mehta SS and Gan TJ. (2003): Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg; 97:534-40.
Barber E, Van L. (2016): enhanced recovery pathways in gynecology and gynecologic oncology. PMC; 70(12): 780-792.
Bell A, Relph S, Sivashanmugarajan V, Yoong W. (2013): Enhanced recovery programs: do these have a role in gynecology? Journal of obstetrics and gynecology: the journal of the institute of obstetrics and gynecology; 33(6): 539-541.
Chulay M, Brown J, Summer W. (1982) Effect of postoperative immobilization after coronary artery bypass surgery. Crit Care Med ; 10:176–179.
Crowe PJ, Dennison A, Royle GT. (1984) The effect of pre-operative glucose loading on postoperative nitrogen metabolism. Br J Surg; 71:635–7.
De Groot JJ, Van ES LE, Maessen JM, Dejong CH, Kruitwagen RF, Slangen BF. (2014): Diffusion of Enhanced Recovery Principles in Gynecologic Oncology surgery: is active implementation still necessary? Gynecologic Oncology; 134(3):570-575.
Dickson E, Argenta PA, Reichert JA. (2012) Results of introducing a rapid recovery program for total abdominal hysterectomy. Gynecol Obstet Investig; 73:21-25.
Eberhart LHJ, Koch T, Ploger B, Wagner U, Wulf H, Zwiorek L, et al. (2008): enhanced recovery after major gynecological surgery for ovarian cancer-an objective and patient based assessment of a traditional versus a multimodal fast track rehabilitation programme.;49:180-94.
Eva M, Smith M, Ahmed S. (2016) Implementation of enhanced recovery after surgery (ERAS) in gynecological oncology; Arch Gynecol Obstet; 294:137-143.
Gerardi MA, Santillan A, Meisner B, et al. (2008): a clinical pathway for patients undergoing primary cytoreductive surgery with rectosigmoid colectomy for advanced ovarian and primary peritoneal cancers. Gynecologic oncology; 108(2): 282-286. [PubMed: 18023851].
Gillinov AM, Davis EA, Alberg AJ, Rykiel M, Gardner TJ, Cameron DE. (1992) pulmonary embolism in the cardiac surgical patient. Ann Thorac Surg; 53:988–991.
Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. (2014): Enhanced recovery program in colorectal surgery: a meta- analysis of randomized controlled trials. World journal of surgery; 38(6): 1531-1541.
Joshi GP and Ogunnaike Bo. (2005) Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North America; 23:21-36.
Joshi P, Kulkarni S, Hunter C, Shahrour W, Surana S, Batra V .(2016) Are urologists getting French-fried? Discrepancy between the label advertised and actual sizes of endoscopic urological materials. Indian Journal of Urology, Vol 32, Supplement 1.
Kalogera E, Bakkum-Gamez JN, Jankowski CJ, Trabuco E, Lovely JK, Dhanorker S, et al. (2013): Enhanced Recovery in Gynecologic Surgery. ObstetGynecol; 122: 319-28.
Kehelt H, Wilmore DW. (2008) Evidence based surgical care and the evolution of fast-track surgery. Ann Surg; 248:189-98.
Kehlet H, Wilmore D. (2002): Multimodal strategies to improve surgical outcome. Am J Surg; 183:630–41.
Khan S, Wilson T, Ahmed J, Owais A, Macfie J. (2010) Quality of life and and patient satisfaction with enhanced recovery protocols. Colorectal Dis; 12: 1175-82.
Kinsman L, Rotter T, James E. (2010) what is a clinical pathway? Development of a definition to inform the debate. BMC Med; 8:31.
Kinsman L. (2004) Clinical pathway compliance and quality improvement. Nurs Stand;18:33-5.
Lu D, Wang X, Shi G. (2012): Perioperative enhanced recovery programmes for gynecological cancer patients. The Cochrane database of systematic reviews; 12:CD008239.[Pubmed: 23235656].
Micieli G, Cavallini A, Quaglini S. (2002) Guideline compliance improves stroke outcome a preliminary study in 4 districts in the Italian region of Lombardia. Stroke; 33:1341–7. doi: 10.1161/01.STR.0000013663.27776.DB.
Minig L, Biffi R, Zanagnolo V. (2009): Reduction of postoperative complication rate with the use of early oral feeding in gynecologic oncologic patients undergoing a major surgery: a randomized controlled trial. Annals of surgical oncology; 16(11):3101-3110.
Modesitt Sc, Sarosiek Bm, Trowbridge Er, Redick Dl, Shah Pm, Thiele Rh, Tiouririne M, Hedrick Tl. (2016) Enhanced recovery implementation in major gynecologic surgeries: effect of care standardaization, Obstet Gynecol; 123:457-66.
Pruthi Rs, Chun J, Richman M. (2003). Reducing time to oral diet and hospital discharge in patients undergoing radical cystectomy using a perioperative care plan. Urology; 62:661–5. 65–6. discussion.
Pruthi Rs, Nielsen M, Smith A, Et Al. (2010) Fast track program in patients undergoing radical cystectomy: results in 362 consecutive patients. J Am Coll Surg; 210:93–9.
Rajeswari T (2011): A study to assess patient's satisfaction with quality of nursing care. Diploma diss., Trivandrum.
Rello J, Lorente C, Bodí M, Diaz E, Ricart M, Kollef Mh. (2002) why do physicians not follow evidence-based guidelines for preventing ventilator-associated pneumonia? A survey based on the opinions of an international panel of intensivists. Chest; 122:656–61.
Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J, Et Al. (2010) Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev; 3:3. .
Samama Mm, Dahl Oe, Quinlan Dj, Mismetti P, Rosencher N. (2003) Quantification of risk factors for venous thromboembolism: a preliminary study for the development of a risk assessment tool. Haematologica; 88:1410–1421.
Seehusen Da. (2010) Clinical pathways: effects on practice, outcomes, and costs. Am Fam physician; 82:1338-9.
Smeltzer Sc, Bare Bg, Hinkle Jl, Et Al. (2010) Brunner & Suddarth’s textbook of medical-surgical nursing 12th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
Thiele Rh, Rea Km, Turrentine Fe, Friel Cm, Hassinger Te, Mcmurry Tl, Et Al. (2015): Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J AM CollSurg; 220: 430-43.
Thorell A, Nygren J, Ljungqvist O. (1999) Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care; 2:69–78.
Verheijen Pm, Vdven Awh, Davids Php, Vd Wall Bjm, Pronk A (2012): Feasibility of enhanced recovery program in various patients groups. Int. J. Colorectal Dis; 27:507-11.
Vlug Ms, Bartels Sa, Wind J, Et Al (2012): Which fast track elements predict early recovery after colon cancer surgery? Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland; 14(8):1001-1008. [PubMed: 21985079]
Wang Y. (2013) Effect of clinical pathway in caesarean operation. Med Innovation China; 10:2.
Wijik L, Franzen K, Ljungqvist O, Nilsson K. (2014) Implementing a structured enhanced recovery after surgery (ERAS) protocol reduces length of stay after abdominal hysterectomy. Acta Obstet Gynecol Scand; 93:749-756.
Wisely J, Barclay K. (2016) Effects of an Enhanced Recovery After Surgery programme on emergency surgical patients. ANZ J Surg ;86(11):883-888. | ||
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