INTRODUCTION:
General
surgery, despite its name, is a surgical specialty that focuses on
abdominal
organs,e.g., intestines
including esophagus, stomach,smallbowel, colon, liver, pancreas, gallbladder and bile ducts, and often
the thyroid gland
(depending on the availability of head and neck surgery specialists). They also
deal with diseases involving the skin, breast, soft tissue, and hernias.
The earliest form of surgery was trephining, which involved cutting a
small round hole in the head. It was practised as early as the Neolithic
period, for reasons that remain a mystery.
There are many theories about the reasons behind this
practice. The only thing known for sure is that some patients survived the
procedure, and sometimes even had more than one performed. Later, the Egyptians
practised trephining in an effort to cure migraines - the idea was to ‘let out’
the illness that was causing the headaches.
As the 1900s progressed, surgery became more complex. Transplant
and replacement surgery become
relatively common. Elective surgery i.e non-life-saving procedures were performed
regularly and some surgery has been developed principally for cosmetic
purposes. Keyhole surgery and microsurgery are used increasingly to minimize
exposure to infection and reduce the shock of surgery. While surgery has become
safer, it remains a risky business.
Exercise is an important component of the healing process
post-surgery. It improves muscle tone and increases blood flow to the area,
facilitating healing. Abdominal surgery is no different. When muscles are
severed, patient have weakness and loss of tone. Once the doctor gives the
green light, patient can choose from several abdominal exercises that he can
perform post-surgery to restore strength and balance to his abdomen.
Exercise
advice in the days and week or two after the operation is best sort form the
individual surgical team and may change with local policies and techniques,
after that period. Deep breathing and coughing
help prevent pneumonia after surgery. Take a slow, deep breath and hold for a
second or two, then push the air out of your lungs with a deep strong cough.
For abdominal or chest surgeries, place a pillow over incision and apply gentle
pressure to this area as cough. This helps to splint or support the incision
and lessen discomfort. Use an incentive spirometer. This is a small plastic
device that encourages to breathe effectively. Nurse will instruct to use of
the spirometer if indicated for surgery. Walking will help recover faster and
return to normal. Take help the first few times when to get out of bed and
begin walking. Don’t overdo it. Gradually increase the activity.
So
the researcher is interested in assessing the level of pain and activity
tolerance by using the numerical pain rating scale and activity tolerance
scale.
This
will help the patient to recover soon and in a better way after abdominal
surgery.
OBJECTIVES:
1 To assess
the level of pain and activity tolerance among abdominal surgery patients
before implementation of selected nursing interventions in experimental and
control group.
2 To assess
the level of pain and activity tolerance among abdominal surgery patients after
implementation of selected nursing interventions in experimental and control
group.
3 To assess
the effectiveness of selected nursing interventions on the level of pain and
activity tolerance among abdominal surgery patients in experimental and control
group.
4 To find
out association between the post test level of pain and activity tolerance with
selected demographic variables in experimental and control group.
5 To find
out association between the pre test level of pain and activity tolerance with
selected demographic variables in experimental group.
HYPOTHESIS:
H1 There will be a significant
difference in the pre test and post test level of pain and activity tolerance
among abdominal surgery patients.
H2 There will be a significant
association between post test level of pain and activity tolerance with
selected demographic variables in experimental and control group.
H3 There will be a significant
association between pretest level of pain and activity tolerance with selected
demographic variables in experimental group.
RESEARCH METODOLOGY:
Quantitative approach
Pretest and post test design with control
group
Surgery Ward of Herbertpur Christian
Hospital
Abdominal surgery patients
Abdominal surgery patients in surgery ward
of Herbertpur Christian Hospital
Purposive sampling
60 abdominal surgery patients
Pain rating scale and activity tolerance
rating scale
Experimental group
Control group
Pretest
Pretest
Selected
nursing
interventions given
Post-
test Post -test
DESCRIPTION OF THE TOOL:
A Pain Rating Scale and Activity Tolerance
Scale is use to measure the level of pain and activity tolerance among
abdominal surgery patients in in surgery ward of Herbertpur Christian Hospital,
Dehradun, Uttrakhand.
Part-A: questionnaire related to
demographic variables to associate the pretest and post-test knowledge with
certain demographic variables. It consists of age, gender etc.
Part-B:Pain Rating Scale &Activity
tolerance Scale to assess the level of pain and activity tolerance among
abdominal surgery patients.
The components of the instrument:
This consists of 2 standardized
scales, i. e the Pain Rating Scale & the Activity Tolerance scale. Pain
Scale is divided into 4 Categories-none (0), mild (1-3), moderate(4-6) &
severe(7-10).Patient has to select the number according to the level of pain he
is suffering after abdominal surgery. Activity tolerance Scale consist of 6
categories-Bathing, Dressing, Toileting, Transferring, continence &
Feeding. Instructions were clearly written to choose that activity only that
he/she performing after abdominal surgery. Each correct item was scored as “1”.
Data collection procedure:
The duration of the data collection for the
main study was one month. The study was conducted in Herbertpur Christian
Hospital, Dehradun, Uttrakhand, after obtaining permission from the academic
section and Medical superintendent. 60 patients who were admitted in the male
surgery ward, female surgery ward and ICU after abdominal surgery were included
in the study. Standardized tools were used for collection of data. Patients were
explained about the purpose of the study and got a written consent from them
and purposive sampling technique was used .Numerical pain rating scale &
activity tolerance scale were given to them to get information about their
baseline data. After this, post-operative exercises (selected nursing
interventions) were taught to the experimental grouponly with the help of
flash cards up to seven days and post tests
were conducted on the 7th day of pre-test
for both ,the experimental group and control group.
RESULTS:
The effectiveness of selected nursing has
been seen on the level of pain and activity tolerance among abdominal surgery
patients by finding out the difference between the mean percentage of the pre
test and post test and the t-value in experimental group. For the level of pain
,the t-value of experimental group is 15.12 and the mean percentage difference
between the pretest and post test of experimental group is 43%,which is more
than the control group ,that indicates the effectiveness of selected nursing
interventions.
For the level of activity tolerance ,the
t-value of experimental group is 12.46 and the mean percentage difference
between the pretest and post test of experimental group is 35% ,which is more
than the control group ,that indicates the effectiveness of selected nursing
interventions.
CONCLUSION:
The present study was aimed to assess the
effectiveness of selected nursing interventions(post operative exercises) on
the level of pain and activity tolerance among abdominal surgery patients and
the result showed that after giving selected nursing interventions i.e the post
operative exercises to the patients of abdominal surgery in experimental group
their pain reduced and activity was improved.
RECOMMENDATIONS:
·
Similar
study can be conducted on a larger population for generalization.
·
A study can
be conducted to know the effectiveness of post operative exercises in reducing
the post operative complications in abdominal surgery patients.
·
A study can
be conducted to know the side-effects of post operative pain in recovery of a
abdominal surgery patient.
·
A study can
be conducted to assess the knowledge of surgery ward nurses regarding care of
abdominal surgery patients.
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