Assess the effectiveness of preoperative education on postoperative outcome among the patients undergoing major Gynecological surgery admitted at Pravara Rural Hospital, Loni (Bk)
Ms. Swapnali Kapase, Mrs. Bharti Weljale
Pravara Institute of Medical Sciences, College of Nursing Loni Bk. Dist: Ahmednagar (M.S.) India.413736.
*Corresponding Author E-mail: sswapnaliaher@gmail.com
ABSTRACT:
Background: As per WHO data base in 2016, an estimated 15, 40000 women underwent hysterectomy in the world, Hysterectomy is most commonly performed on women between 40 to 45 years of age and by age 65 approximately 37% to 39% of women have under gone this procedure. The aim of the study was to generate baseline data for indications of gynecological surgeries, and to assess route of surgery and histopathology correlation in women undergoing major gynecological surgery in a rural tertiary level teaching hospital in India. The present study was conducted to determine the effectiveness of preoperative education on postoperative outcome undergoing major gynaecological surgery. Material and methods: A Quasi experimental study, posttest design only with control group approach was undertaken in Pravara Rural Hospital Loni. The Data were collected from 60 (30 in experimental group and in control group) gynecological surgery who are selected by non-probability method purposive sampling technique met the inclusion criteria. The nurse investigator provided 5-10 minutes range of motion exercise daily, nutrition diet and psychological support. Assessment of effectiveness was performed by evaluating the level of stress (DASS Rating scale) and (observational checklist). The data was analyzed with descriptive statistics frequency and percentage of demographic variables and inferential statistics SD and Mean. Results: It was found that range of motion exercise significantly reduced the level of stress, depression and anxiety. A statistical difference was found between the group awareness (t= 0.05), anxiety (t=1.10), depression (t=0.03) and emotional distress (t=0.02) at p<0.05 level. There was significant association found between stress with socio demographic variables like age (X2 0.6), education qualification (X2 0.43), presence of co-morbid illness (X2 3.33), indication of gynecological surgery (X2 0.00), duration of illness (X2 0.04), previous history of surgery (X2 3.58) at p< 0.05 level. Conclusion: The study outcome revealed that range of motion exercise was found to be effectiveness in reducing the level of stress undergoing major gynecological surgery. Hence it should be emphasized that relaxation therapy should be practiced for vulnerable undergoing major gynaecological surgery.
KEYWORDS: Effectiveness, preoperative education, postoperative outcome, gynecological surgery.
INTRODUCTION:
As per WHO data base in 2016, an estimated 15,40000 women underwent hysterectomy in the world, making hysterectomy the most common non-pregnancy related major surgery performed on women.1 The present study was conducted to determine the effectiveness of preoperative education on postoperative outcome undergoing major gynaecological surgery.2
“A condition in which body health is impaired, a departure from a state of health, an alteration of the human body interrupting the performance of vital functions.”3 A disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury.4 Creating awareness regarding these complications in terms of management and preventive measures helps in reducing the severity of the problems experienced. Preoperative teaching is an effective way of communicating information on identified patient’s need, there by rendering care on these areas which aid in relief from postoperative problems, quick recovery and improve fitness.5 Preparing the women undergoing hysterectomy preoperatively is beneficial in improving their self-care activities following surgery which may in turn improve their post-operative outcome. The purpose of the present study is to evaluate the effectiveness preoperative teaching on women undergoing hysterectomy.6
STATEMENT OF PROBLEMS:
Assess the effectiveness of preoperative education on postoperative outcome undergoing major gynaecological surgery admitted at Pravara Rural Hospital, Loni BK
OBJECTIVES:
1. Assess the clinical profile of patient undergoing major gynecological surgery.
2. To determine the effectiveness of Pre-operative education and post-operative outcome on major gynecological surgery.
3. To correlate the postoperative outcome with selected sociodemographic clinical characteristics.
HYPOTHESES:
H1 There is significant difference between mean pre-test and post-test of gynecological surgery.
H2 There is significant association of gynecological surgery with their selected demographic variables (Age, occupation, Education, Religion, Family income, Type of diet).
MATERIAL AND METHODS:
Research design and approach:
Quantitative evaluatory approach.
Research design:
Pretest Post Control group design
Research variables
Independent variable:
Pre-operative education
Dependent variable:
Awareness, Anxiety, depression, Emotional distress
Extraneous variables:
Age, educational status, occupation, religion, type of family, family income, Residence
Clinical characteristics:
Weight of mother, Presence of co-morbid illness, Indication for gynecological surgery, Present clinical symptoms, Duration of illness, previous history of surgery.
Setting of the study:
PIMS Loni (BK), Ahmednagar.
Population:
Primi gravida mothers with minor aliment of pregnancy attending Antenatal clinics
Target Population:
Patients undergoing major gynecological surgery
Sample Size: 60
Criteria for selection of sample:
Inclusion criteria:
Pre-operative clients who are
1. Posted for the major gynaecological surgeries like vaginal hysterectomy, vaginal hysterectomy with cystocele repair, abdominal hysterectomy.
2. Present at the time of data collection.
3. Can read and write Marathi.
Exclusion criteria:
Pre-operative clients who are
· Not willing to participate in study
· not available during data collection
Method of data collection:
Observational checklist
Reliability:
The tool was found to be reliable with the r value for the anxiety (r = 0.94)
Analysis and Interpretation of Study Findings:
This chapter deals with the analysis and interpretation of data collected from 60 patients undergoing major gynecological surgery in Pravara Rural Hospital Loni. The study was designed to evaluate effectiveness of pre-operative education and post-operative outcome on major gynecological surgery. The data was collected, coded and analyzed as per the objectives and categorized under following heading.
Section I
Part I: Description of socio demographic data of undergoing major gynecolological surgery:
Patients undergoing major gynecological surgery according to their age show that in experimental and control group one third (33%) of them were ≤ 35 year of age. However in both group 60% of the patients were between 36-55 years of age. Patients education show that in experimental group higher percentage (37%) had no formal education whereas in control group (30%) of them had primary and secondary school education respectively and similar % of patients in experimental group has the same. Patients income of family/month show that in experimental and control group most (47% and 43% respectively had income more than 3001-6000 and 6001-9000. Type of family show that in experimental group half (53%) of them were belongs to joint family whereas in control group (63%) were from the same type of family. However in both groups (47% and 37% respectively) were belongs to nuclear family. Religion show that in both group majority (90% and 70% respectively) of them were Hindu religion whereas the remaining patients were from Christian and Muslim religion. Residence show that in both group majority (97% and 73% respectively) of them were residence at rural areas whereas the remaining patients were from urban and semi urban residence. Presence of co-morbid illness show that in both group majority of mothers (47% and 7%) had any other, and the remaining percent of mothers had anemia, diabeteus mellitus, hypertension and congenital anomalies. Indication of gynaecological surgery show that in both group majority of mothers (66% and 46%) had any other, and the remaining percent of mothers had fibroid uterus, uterine prolapse, ovarian tumor and endometriosis. clinical symptoms show that in both group majority of mothers (47% and 40%) had any other, and the remaining percent of mothers had chronic pelvic pain, painful bowel movement, heavy uterine bleeding, dymenorrhoea and pelvic pressure. previous history of surgery show that in both group (63% and 37%) of them had previous history of surgery. duration of illness show that in both group (50% and 46%) of them had less than one month of duration of gynaecological surgery, while a significant percent ( 50% and 54%) had duration of illness between ≥ 6 months.
Part II: Item wise comparison of pretest and posttest correct knowledge response (%) of patients undergoing major gynaecological surgery.
Item wise comparison of pretest and posttest correct knowledge response of undergoing major gynaecological surgery shows that during posttest highest percentage (30%) of them responded whereas in pretest (22%) of the responded correctly to the same item and the effectiveness was (30%) during posttest the lowest percentage (8%) responded (16%) of them responded correctly to the same item and the effectiveness was (13%). Thus the overall effectiveness of health education in relation to introduction about gynaecological surgery from 3% to 13%. It shows that health education was effective in gynaecological surgery.
Comparison of level of patient undergoing major gynaecological surgery with their selected socio demographic variables both group:
1. Comparison of mean and SD of level of patients undergoing major gynaecological surgery after implementing the intervention in experimental group according to their age:
The preoperative education was more effective on patients of 36-40 years had good awareness (mean was 8.12), in relation to anxiety and depression 46-50 years of age patients had better effectiveness , and the mean score was (8.5 and 7) respectively, it interprets that preoperative education was more effective on awareness aspects for 36-40 years of age and 46-50 years of age for anxiety and depression.The above table depicts that, the preoperative education was more effective for patients who had congenital heart disease had good awareness (mean was 8.5), in relation to anxiety and depression congenital heart disease more effective for patients had better effectiveness them other, and the mean score was (7.5 and 13.5) respectively, it interprets that the preoperative education was more effective on awareness aspects for congenital heart disease for anxiety and depression. The preoperative education was more effective for patients who had endometriosis had good awareness (mean was 8.5), in relation to anxiety and depression fibroid uterus more effective for patients had better effectiveness them other, and the mean score was (7.45 and 10.5) respectively, it interprets that the preoperative education was more effective on awareness aspects for endometriosis and fibroid uterus for anxiety and depression.The preoperative education was more effective for patients who had ≤ 6 months had good awareness (mean was 7.53), in relation to anxiety and depression ≥ 6 months more effective for patients had better effectiveness them other, and the mean score was (7.86 and 9.4) respectively, it interprets that the preoperative education was more effective on awareness aspects for ≤ 6 months and ≥ 6 months for anxiety and depression.Previous history of surgery the gynaecological surgery patients had improve awareness then others in relation to other aspects like anxiety, depression, patients who had previous history had less mean score indicates no anxiety and depression. It interprets that the patient with previous history of surgery had better effectiveness than other. The preoperative education was more effective on patients of 36-40 years had good awareness ( mean was 8.12), in relation to anxiety and depression 46-50 years of age patients had better effectiveness the others, and the mean score was (8.5 and 7) respectively, it interprets that preoperative education was more effective on awareness aspects for 36-40 years of age and 46-50 years of age for anxiety and depression .The preoperative education was more effective for patients who had secondary education had good awareness (mean was 8.2), in relation to anxiety depression more effective for patients who did not had no formal education and the mean score was (7.36 and 10.36) respectively, it interprets that the preoperative education was more effective on awareness aspects for secondary education and no formal education for anxiety and depression.The preoperative education was more effective for patients who had congenital heart disease had good awareness (mean was 8.5), in relation to anxiety and depression congenital heart disease more effective for patients had better effectiveness them other, and the mean score was (7.5 and 13.5) respectively, it interprets that the preoperative education was more effective on awareness aspects for congenital heart disease for anxiety and depression. The preoperative education was more effective for patients who had endometriosis had good awareness (mean was 8.5), in relation to anxiety and depression fibroid uterus more effective for patients had better effectiveness them other, and the mean score was (7.45 and 10.5) respectively, it interprets that the preoperative education was more effective on awareness aspects for endometriosis and fibroid uterus for anxiety and depression.The preoperative education was more effective for patients who had ≤ 6 months had good awareness (mean was 7.53), in relation to anxiety and depression ≥ 6 months more effective for patients had better effectiveness them other, and the mean score was (7.86 and 9.4) respectively, it interprets that the preoperative education was more effective on awareness aspects for ≤ 6 months and ≥ 6 months for anxiety and depression.Irrespective of previous history of surgery the gynaecological surgery patients had improve awareness then others in relation to other aspects like anxiety, depression, patients who had previous history had less mean score indicates no anxiety and depression. It interprets that the patient with previous history of surgery had better effectiveness than other.
Testing of hypotheses:
H01- There is no significant difference in awareness, anxiety, depression and emotional distress undergoing major gynaecological surgery in experimental and control group.
Paired’ value of posttest on awareness, anxiety, depression and emotional distress in experimental and control group
Table No: 01 n=60
Sr. No. |
Area |
‘t’ value |
Level of significant |
1 |
Awareness |
0.05 |
Not Significant |
2 |
Anxiety |
1.10 |
Not Significant |
3 |
Depression |
0.03 |
Not significant |
4 |
Emotional distress |
0.02 |
Not significant |
at 0.05 level of significance
Paired ‘t’ test was calculated to analyze the difference in awareness, anxiety, depression and emotional distress among the experimental group (i.e. after implementation of undergoing major gynaecological surgery) and control group (i.e without intervention). significant difference was found between the awareness, anxiety, depression and emotional distress between the two groups at P< 0.05 level. Hence the stated null hypothesis (H01) rejected and alternative hypothesis (H1) was accepted, as it was interpreted that there was highly significant difference existed between posttest level of awareness, anxiety, depression and emotional distress. Thus the difference observed in the study variables in experimental and control group were true difference and not by chance.
Association between the awareness, anxiety, depression, and emotional distress of experimental group of mothers undergoing major gynaecological surgery with their selected socio-demographics variables
Table No: 02 n=60
Sr. No. |
Variables |
Aware ness |
Anxi ety |
Depres sion |
Emotio nal distress |
1 |
Age |
0.27 |
1.69 |
1.07 |
0.6 |
2 |
Educational Qualification |
4.73* |
0.07 |
0.21 |
0.43 |
3 |
Presence of co-morbid illness |
0.53 |
1.77 |
0.31 |
3.33 |
4 |
Indication for gynaecological surgery |
1.09 |
4.22* |
2.30 |
0.00 |
5 |
Duration of illness |
0.53 |
0.13 |
0.55 |
0.04 |
6 |
Previous history of surgery |
4.73* |
0.01 |
1.21 |
3.58* |
Chi–square values were calculated to find out association between awareness, anxiety, depression, and emotional distress with their selected socio demographic variables of the experimental group mothers undergoing major gynaecological surgery. Finding reveled that there was a significant association between the awareness and the demographic variables like educational qualification, previous history of surgery of mothers undergoing major gynaecological surgery. Anxiety had statically significant association with indication for gynecological surgery of mothers undergoing major gynecological surgery. However, there was significant association between the emotional distresses with their demographic variables like previous history of surgery of mothers undergoing major gynecological surgery. hence, the stated null hypothesis (H02) was rejected and alternative hypothesis (H2) was accepted.
Relationship between anxiety and depression undergoing major gynecological surgery
Table No: 02 n=60
Sr. No. |
Areas |
Values |
1 |
Anxiety and Depression |
0.40 |
2 |
Depression and Emotional distress |
0.16 |
3 |
Awareness and Anxiety |
0.21 |
The calculated r value for anxiety and depression (0.40), depression and emotional distress (0.16), awareness and anxiety (0.21) indicates positive correlation.
CONCLUSION:
The conclusion drown from this study is that the effectiveness of preoperative education on postoperative outcome undergoing major gynecological surgery. The result highlight that the relaxation therapy was effective in reducing the stress and undergoing major gynecological surgery which was statically significant. It was evident that there was significant positive relationship was excited between the depression, anxiety and stress. It was emphasized that the compliance with intervention to reduce to reduce the level of stress.
DISCUSSION:
Level of anxiety, depression and emotional distress among patients undergoing major gynecological surgery before implementation of interventions in experimental and control group:
The study finding noted that the undergoing major gynaecological surgery under study during pretest score on anxiety and depression shows that, in both group the mean score was (10.8±2.65) and (7.96±2.25) respectively indicates “mild anxiety‘’ of anxiety similarly in relation to depression the undergoing major gynaecological surgery had mean ( 11.86±2.46) And (10.36±2.94) respectively indicate ‘moderate level of depression however the stress score was (15.53±3.37) and (12.23±2.48) indicates moderate level stress. the finding was consistent with the study done by Tankan U also found that before the nursing intervention on anxiety, depression and stress among the patients undergoing major gynaecological surgery shows that mothers in the experimental group had significantly higher anxiety and lower depression and stress score when compared to the control group.72
Comparison of pretest and posttest awareness of mothers of undergoing major gynecological surgery:
The present study revealed that the mean and standard deviation of post-test knowledge score of mothers in experimental group (7.66±1.41) was much greater than pretest value (5.8±1.65). it was consistent with the study conducted by Abed EF, Elmoneim, Gehan E. Ghonemy, Hassan NI who also observed highest score of posttest mean and SD (23.8±3.2) greater than pretest (25.3± 4.1).73
Effectiveness of patients undergoing major gynaecological surgery on awareness, anxiety, depression and emotional distress:
The study findings that the patients of experimental group had mean score (7.6±1.4) for awareness which was more than the control group score indicates patients had improved awareness after preoperative education in line with anxiety and depression the experimental group patients had mean score (7.6±2.25) and (10.3±2.9) respectively which was lower than the control group. However in both group, the patients did not had any changes in emotional distress. It interprets that the preoperative education was effectiveness in improved the awareness, and reduces the anxiety and depression. This study findings was consistent with the study was done by Elweley MZ, also found that after the nursing intervention on anxiety, depression and stress among patients undergoing major gynaecological surgery shows that mothers in the experimental group had significantly lower anxiety, depression and stress scores when compared to the control group.74
Association effectiveness of educational intervention on undergoing major gynecological surgery Chi square test with socio demographic variables among patients undergoing major gynecological surgery:
The finding of present study show that description of Chi square values were calculated to find out association of educational interventions on undergoing major gynecological surgery of study group.finding revealed that there was significant association found between undergoing major gynecological surgery and demographic variables like Age, education, occupation, type of family 0.05 level as there was significant hence there is effectiveness of teaching on undergoing major gynecological surgery and its management.
NURSING IMPLICATIONS:
The researcher has drawn the following implications from the study, which vital concern of nursing practice, nursing education and nursing research.
Nursing practice:
· As emphasized through the study findings practicing the interventions (exercise, relaxation therapy, education) reduce the level of stress and undergoing major gynaecological surgery.
· It is an important role of nurse to make awareness on nursing intervention through education and training in simple way to enhance the patient’s knowledge and practice skill.
Nursing Education:
· In service education should be established to update the nurses knowledge in various type of relaxation therapies used for controlling stress undergoing major gynaecological surgery.
· The relaxation therapy is an independent intervention which can be used by nurse according to the needs of the client.
Nursing Research:
· Nurse researcher to know about anxiety level, depression level, and reduce stress of mothers before implementation of interventions and well known about effectiveness of preoperative education after posttest.
RECOMMENDATIONS:
On the basis of the findings of the study, the following recommendations were made,
· A similar study can be replicated on a large sample using non probability sampling techniques.
· A similar study can be replicated in another setting.
· A study can be conducted with different teaching methods including more variables like knowledge and satisfaction level.
· More studies are needed to evaluate effectiveness of long-term follow up of preoperative teaching on health outcome.
ACKNOWLEDGEMENT:
The authors are grateful to the authorities of Pravara Medical Trust’s, College of Nursing Loni, Bk. District: Ahmednagar (MH) India.413736
CONFLICT OF INTEREST:
The authors declare no conflict of interest.
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Received on 15.04.2020 Modified on 17.07.2020
Accepted on 25.09.2020 ©A&V Publications All right reserved
Int. J. of Advances in Nur. Management. 2021; 9(2):121-126.
DOI: 10.5958/2454-2652.2021.00030.5