1. INTRODUCTION:

“Intelligent, consciousness, pre operative nursing contributes much to have the patient achieve an optimum condition that favors a satisfactory postoperative progress and minimizes the possibility of complication’’-Kanto et.al. 1990¹ Surgery, surgeons and nurses have changed considerably in a century, but the plea for relief from suffering has remained essentially the same. Every patient is a man, woman or child, living and working in different surrounding and different spheres of activity.

They are all different in outlook, different in character, different in their reaction to same disease. Appreciation of the importance of this individual variation is a fundamental principle.⁴ Any type of surgery is a stress to the patient. It becomes even more stressful when the vital organs are involved. Having surgery is a major event in any person’s life. Some of the patients may respond with expression of helplessness, insecurity and isolation due to discomfort, pain and fear of breaking stitches. These feeling can be minimized with pre operative teaching about post operative practice related to activities, nutrition, medication and ambulation about post operative practice related to activities, nutrition, medication and ambulation.²

Pre operative care is the preparation and management of patient prior to surgery. It includes both physical and psychological preparation. The patients who are physically and psychologically prepared for surgery tend to have better surgical outcome³. Pre-operative teaching must be individualized for each patient. Some patient wants 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 with 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.⁴

Respiratory (pulmonary) complications are the second most common reason for unexpected death. Post operative pulmonary complications are common and a major cause of overall post operative morbidity and mortality. The most common complications are pneumonia, atelectasis, pneumothorax, respiratory failure, pleural effusion, pulmonary embolism, bronchitis, and bronchospasm.⁷ Prevention of post operative pulmonary complications needs further investigation and nurses are well positioned to have an effect on reducing their incidence⁵.

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 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 in identifying and reducing risk of patient complications.⁶

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 delivered. When considering the health constraints such as economy, manpower current system insists the need and advantage of patient education. This proved to be the easiest and cheapest way by which patient well being is placed in their own hands.⁵ Pre operative teaching is important to ensure a positive surgical experience for the client. Numerous research studies support the value of pre operative instructions in reducing both the incidence of post operative complications and length of stay in the hospital⁷.

It has been found that the incidence of post operative complications among patients undergoing major surgery in developing countries is very high. But the incidence of the same in Western countries account for only a very small percentage. The clients undergoing abdominal surgeries are found to be at risk for developing post operative complications. Knowledge deficit regarding post operative exercises among the client is noticed Post operative pulmonary complications contribute equally to morbidity, mortality and length of hospital stay. Use of appropriate lung expansion techniques and adequate pain management also helps to reduce the risk of pulmonary complications. Considering the prevalence of pain after surgical operations and importance of rapid pain alleviation, physical exercises has an important role in relieving pain. Regarding general complications after abdominal surgeries, respiratory complications are common in post operative patients and 40% of patients developed atelectasis.⁸

The complication rate for upper abdominal surgery ranges from 17% to 76%, for lower abdominal surgery, the rate is 0- 5% and for thoracic surgery, the rate is 19-59%. Patients undergoing procedures lasting longer than 3-4 hours have a higher incidence rate of pulmonary complications (40%) compared with those undergoing surgeries lasting shorter than 2 hours (8%). Pulmonary Complication of major abdominal surgery may be increasing in America. The number of pulmonary complications after major abdominal surgery increased in the United States between 1989-2004. In this period the number of major abdominal operations performed was 12,897,800, post operative pulmonary complications which occurred after surgery was listed as 3, 88,400 in men (7.8percent) and 4, 52, 800 in women (5.7percent).⁹

A study was conducted on knowledge retention from pre operative patient information. This review considered all studies that included adults in a hospital setting, either as inpatients or same day surgical patients, and who received some form of information and instructions before an operative procedure. The findings of the study support the use of pamphlets to inform patients and to improve their skills. The data suggested that by the instructional method, the act of educating a patient by delivering for actions is useful for improving patient’s knowledge of their treatment and ability to perform and comply with required exercises.¹⁰ Immediate post operative stage means 1-4 hours after surgery. The important responsibility of the nurse is to monitor the airway patency and monitor for secretion. The main complications after general anesthesia is pulmonary complications, it can be alleviated with positioning of the client after surgery. The important thing is to avoid the pulmonary complication by preoperative teaching about deep breathing coughing and positioning.¹¹

2. REVIEW OF LITERATURE:

Post operative pulmonary complications were common after surgery. A study was conducted in Civil Hospital Karachi Pakistan. 501 patients were admitted during the study period in which 411 surgeries were performed - 258 (62.8percent) elective and 153 (37.2percent) emergency procedures. Complications were documented in 122 (29.6percent) patients. The most common complications observed were post operative pyrexia in 75 (18.2percent) patients, post operative nausea, vomiting in 48 (11.6percent)patients, wound infection in 47 (11.4percent)patients and respiratory tract infection in 29 (7.0percent).¹²

An experimental study was conducted on the prevention of post operative pulmonary complications through respiratory rehabilitation. Aim was to investigate the efficacy of respiratory rehabilitation in preventing post operative pulmonary complication. Out of 81 study subjects, rehabilitation group (n=40) received breathing exercise and there was one control group (n=41). Result suggested that incidence of post operative pulmonary complication was 7.5percent in rehabilitation group and 19.5percent in control group. They concluded that respiratory rehabilitation prevents post-operative pulmonary complication¹³.

3. MATERIALS AND METHODS:

Inorder to accomplish the objectives a pre-test post-test control group design was used. The study was conducted in two hospitals at Tumkur District, Sri Siddhartha Medical College and Research Center and District Government Hospital, Tumkur. Both hospitals were admitting sufficient number of surgical patients. Sree Siddhartha Medical College and District Government Hospital have 40-50 surgical patients who were consulting in causality and surgical Outpatient Department in a day. Every day 20-35 patients got admitted in surgical ward and around 35-55 patients were undergoing different surgeries in a week. Control group and experimental groups were selected from both hospitals. The population of this study was pre operative patients in Sree Siddhartha Medical College and Research Center and District Government Hospital, Tumkur, who were admitted for elective surgery in surgical wards. The total 60 samples, PTP was given for 30 patients and the rest 30 patients were kept as control group. The sampling technique adopted for the study is Purposive sampling technique . Here the units are selected at the discretion of the researcher. Such samples use human judgment in selecting units and have no theoretical basis for estimating population characteristics. This method is used because of accessible persons or objects as subject in this study. The subjects are convenient and accessible to the researcher

1. Socio demographic data sheet to collect basic data of subjects like age, gender, year of experience etc.

2. Knowledge assessment questionnaire which consists of 30 multiple choice questions to assess the knowledge on prevention of post operative pulmonary complications. A score value of one was allotted to each correct response. A total knowledge score was 30. A split half method was used to establish the reliability of the structured questionnaire. The reliability coefficient of the structured questionnaire was found to be r=0.83. Content validity for this study, the structured questionnaires and planned teaching programme content was given to experts in the field of medicine and nursing for the content validity. Items were modified based on the suggestion of experts.

3.1 Data collection procedure:

Researcher obtained written permission from the ethical committee of selected hospitals. A structured questionnaire was administered after admission of patient to the hospital and before the surgery on knowledge regarding prevention of post operative pulmonary complications among surgical patients. Written consent was obtained from each subject. The number of subjects varied each day. The investigator maintained good interpersonal relationship with the subjects and explained about the study. If they are willing to participate in the study, PTP was conducted for a period of half an hour and researcher was to explained about exercises, early ambulation etc .LCD and charts were used as visual aids to facilitate easy understanding. Post test was conducted on 5th day after the implementation of the PTP with similar structured questionnaire on effectiveness of planned teaching programme to assess the knowledge regarding prevention of post operative pulmonary complications among surgical patients. The data collection period for this study was from 01-07-2010 to 31-07-2010.

4. RESULTS:

4.1 Description of sample characteristics:

In the experimental group 93.33% were found from 31-40yrs of age, in control group 20% of patients were from 21-30 yrs of age, 80% were found from 31-40 yrs of age. Both in experimental group and control group 50% were males and 50% were females. In the experimental group 96.67% were Hindus. In experimental group 20.00% had non formal education and the remaining 80.0% had primary school education. None of them had higher secondary, collegiate education, degree and above. Where as in control group 36.67% had non formal education and the remaining 63.33% had primary education.

4.2 Effect of PTP on prevention of pulmonary complication among experimental and control groups Mean, SD and Mean % and paired ‘t’ test value of pre-test and post-test knowledge. In experimental group the pre test mean is12.16 SD is 2.53 and mean % 40.53, post test mean is 21.83 SD is 2.78 and mean % is 72.77. enhancement mean is 9.67, SD is 2.39 and mean % is 32.23 .Paired t test value 22.16 is significant at p < 0.001 level. In control group pretest mean is13.63 SD is 2.98 and mean % 45.43, post test mean is 13.89 SD is 2.93 and mean % is 46.30.enhancement mean is 0.26, SD is 1.1 and mean% is 0.87 .Paired t test value 0.59 which is not significantat p < 0.001 level.

Table 1: Comparison between experimental and control group after PTP n = 30

Domain	Mean	SD	Mean%	Unpaired ‘t’test
Post test Experimental group	21.83	2.78	72.77	14.24**
Post test control group	13.89	2.93	46.30

* P<0.01 level.

4.3 Association between pre-test knowledge level and selected demographic variables:

Chi square test was used to determine the association with selected demographic variables of experimental group surgical patients such as Age, Sex, Religion, Income, Education, Occupation, and Source of information regarding prevention of postoperative pulmonary complication. Of these variables the, age (χ ²=8.57, df=1), Sex (χ ²=7.5, df=1), Education (χ ²=4.21 df=1), were significant at 5% level. Rests of the socio-demographic variables were not significantly associated with knowledge.

The association between knowledge and selected socio- demographic variables of control group surgical patients. Only the education variable (χ ²=5.28, df=1) is significant at 5% level. Rest of the socio-demographic variables was not significantly associated with knowledge.

5. DISCUSSION:

The present study there is a significant difference between mean pre-test and post-test score. in experimental group the posttest mean is 21.83, SD is 2.78 and mean % is 72.77 and in the control group the posttest mean is 13.89, SD is 2.93 and the mean % is 46.30.The unpaired ‘t’ test value after PTP is 14.24, which is significant to P<0.01 level.

Hence the research hypothesis H1 was accepted. PTP is found to having role in significant improvement in level of knowledge regarding prevention of post operative pulmonary complications among surgical patients. On analysis it was clear that there is a significant association between age ,sex and education with pre-test knowledge level in experiment group and in controlled group only variable education had association with pre-test knowledge level .no other socio demographic variables had any sort of association with pre- test knowledge level.

A study was conducted on the effect of structured preoperative teaching on pre operative exercises and their management of pain. 256 patients were selected and they are divided in to experimental and control group. The experimental group received a written pamphlet and structured preoperative teaching on pre operative exercises to manage their pain. The control group received the usual preoperative preparation normally provided by the physician. The result suggested that there was statistically significant evidence that the experimental group's knowledge was different from that of the control group. There was significant evidence that the experimental group managed their pain better. They concluded that the experimental group managed their pain better¹⁴

6. FUTURE SCOPE:

6.1 Nursing education and practice:

The nurses will be able to prevent the pulmonary complications in surgical patients with the effective administration of planned teaching programme like deep breathing, coughing, periodical position, early ambulation exercise.The nurses can reduce the morbidity and mortality due to pulmonary complications in surgical patients with prompt administration of planned teaching programme such as deep breathing, coughing, periodical positioning and early ambulation. The evidence based practice will give an inspiration for the nurses to work hard and get a sense to direct others for applying these interventions to prevent most post operative pulmonary complications in surgical patients.

The nurses can improve their knowledge regarding the effectiveness of exercise, periodical position changing and early ambulation to prevent the post operative pulmonary complications.The application of this knowledge will helps the nursing staffs to improve the quality of life of surgical patients through preventing the pulmonary complications.

6.2 Nursing service and administration:

These findings will help the administrators to encourage the nurses to practice this knowledge in surgical wards. These findings will make the administrators aware about the cost effective management of post operative patients to prevent the pulmonary complications. Through the prevention of complications the nurses can reduce the length of hospital stay and will helps the patient to go back to their functional status as soon as possible. This effort will increase the credit of nursing administration

6.3 Nursing research:

The ultimate goal of any profession is to provide its clients with maximum, effective, and efficient services. A profession seeking to improve the practice of its members and to enhance its professional stature strives for the continual development of a relevant body of knowledge. The present study throws light on prevention of post operative pulmonary complications. Nurses need to engage in multidisciplinary research so that it will help to improve the knowledge and by applying it, health problems can be solved. Extensive nursing research in exploring the effectiveness of planned teaching programme on prevention of post operative pulmonary complications is needed, so that mortality and morbidity could be reduced. The need of the pre operative patients has to be explored to prepare effective teaching methods there by contributing to effective and quality nursing care. This study proved that the nursing interventions such as deep breathing and coughing exercises, periodical position changing and early ambulation were helpful to prevent post operative pulmonary complications. Further studies can be done to find out the alternatives to prevent these complications.

7. LIMITATIONS:

The study was limited to surgical patients who are free from respiratory complications. Hence the result of the study cannot be applied to all patients. The study was limited to find out the effectiveness of planned teaching programme to prevent post operative pulmonary complications among surgical patients. The study was limited to Sri Siddhartha Medical College and research centre and District Government Hospital, Tumkur.

8. REFERENCES:

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Received on 28.01.2022 Modified on 16.02.2022

Int. J. Nur. Edu. and Research. 2022; 10(2):117-121.

DOI: 10.52711/2454-2660.2022.00027