Rajiv Gandhi University of Health Sciences Bangalore, Karnataka s25
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. NAME OF THE CANDIDATE : HUIDROM GEETANJALI DEVI
AND ADDRESS 1ST YEAR M.Sc. NURSING
APOLLO BGS HOSPITAL
MYSORE. 2. NAME OF THE : BGS COLLEGE OF NURSING
INSTITUTION MYSORE 3. COURSE OF STUDY AND : 1ST YEAR M.Sc. NURSING
SUBJECT MEDICAL SURGICAL NURSING 4. DATE OF ADMISSION OF : 15-06-09
COURSE 5. TITLE OF THE TOPIC : EXPERIENCE OF THE PATIENTS
AND THEIR RELATIVES IN
RELATION TO BEFORE, DURING
AND AFTER ELECTIVE
ABDOMINAL SURGERY 1
BRIEF RESUME OF THE INTENDED WORK
6. Introduction
“ A bad experience or a horrifying incident may scar one's attitude or thinking for a lifetime.”
The branch of medical science that treats disease or injury by operative procedures is called a surgery. It is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function.
Any operation that involves an incision into the abdomen is called the abdominal surgery .Surgery of each abdominal organ is dealt with separately in connection with the description of that organ such as stomach, kidney and liver. Some kinds of abdominal surgery are appendectomy, cholecystectomy, gastrectomy, herniorrhaphy, and laparotomy. The three most common abdominal surgeries are exploratory laparotomy - refers to the opening of the abdominal cavity for direct examination, appendectomy - surgical opening of the abdominal cavity and removal of the appendix and laparoscopy -a minimally invasive approach to abdominal surgery where rigid tubes are inserted through small incisions into the abdominal cavity and the main complication of the abdominal surgery are bleeding, infection, post-surgical adhesions shock, and ileus, or more commonly Paralytic ileus (short- term paralysis of the bowel)1. 2
The entire patient have some reaction before any surgical procedure, be its obvious or hidden, normal or abnormal. For examples , pre operative anxiety may be an anticipatory response to an experience the patient view a threat to his or her customary role in life , body integrity , or life style .Psychological distress directly influence the body functioning . Therefore it is imperative to identify any anxiety the patient is experiencing2. Patients’s emotional state initially reflected their physical condition rather than their disease 3.
Undoubtly, a patient about to undergo surgery is faced with various fears including fear of the unknown of death, anaesthesia, pain, loss of work time, loss of job, increased responsibilities or burden on family member and the threat of permanent in capacity further contribute to the emotional strength created by the prospect of surgery. Less obvious concern may occur because of previous experience with the health care system and people the patient has known with the same condition2.
Part of preoperative anxiety relates to the information and knowledge that the patient has or needs. Miller and Mangan16 studied the way patients cope with the stress of a threatening situation and divided patients into 2 groups—monitors and blunters. Monitors are people who want to know as much as possible to help allay their anxiety. Blunters are those who have no need for information and even try to avoid it as the information may increase their anxiety level 4.
The family is not determining by the blood relationship. A major role of the family is to provide physical and emotional resources to maintain a health and a system of support in the times of crisis, such as in periods of illness.5 Caregiver is 3 words normally used to refer to unpaid relatives or friends who support people with disabilities. The words may be prefixed with "family" "spousal", "child" to distinguish between different care situations.6
When a family member becomes ill, all the members of the family are affected. Depending of the nature of the health problem, family member need to make several adaptation to their existing life style or even restructure their life style.2
Caregiver burnout is more extreme than caregiver burden. Caregiver burnout is described as “a state of physical, emotional and mental exhaustion that may be accompanied by a change in attitude from positive and caring to negative and unconcerned. Burnout can occur when caregivers don’t get the help they need, or do more than they are able either physically or financially. Caregivers who are “burned out” may experience fatigue, stress, anxiety and depression.7
The ultimate aim of the nursing is to keep the patients and their care givers free from above mention constrains as they hospitalised for elective abdominal surgery.
Needs of The study:
Patient- and family-centered care is an approach to health care that recognizes the role of the family in providing medical care; encourages collaboration between the patient, family, and health care professionals; and honours individual and family strengths, cultures, traditions, and expertise. Although there are many opportunities for providing patient- and family-centered care in the emergency department, there are also challenges to doing so.8 4
According to NABH accreditation criteria certain right are concerned for the patient and their family member / relatives on surgical procedure in accordance to any treatment which are information to patients , rights of the patient and family and surgical services i.e. the patients and/or family members are explained about the proposed care, expected outcome , possible complications and expected costs
,personal dignity and privacy during examination, procedures and treatment, documented policies and procedures exist to prevent adverse events, informed consent
Information on how to voice a complaint, access to his / her clinical records, pre- operative assessment, surgeon documents the post-operative plan of care, pre- anaesthesia assessment by a qualified individual. Usually above mentioned rights and information are being negligence by the health care professional while dealing with the patient and their family member who further leads to the humiliation and gave a very bad impact on the experience of the patient and their relatives.9
A phenomenological study was conducted on the need of the family member during the perioperative periods which indicate that the family member are in a need of to be with patient , to known the progress of the patient condition and arrange an area where they can wait and also they felt the need of company of other.20
In another study i.e. on aspect of patient satisfaction with communication in surgical care where it is found that patient expresses the need of proper communication from the care giver side and they express the need of privacy on the public ward. 19 5
Apart from these according to health correspondent of BBC reported patient experience many inconvenient while riding in trolley for surgery because of improper handling by the ward boys as evidenced by the dead of patient during surgery who suffered bleeding to brain and cardiac arrest after the fall given a very unpleasant experience to patient as well as to the relative’s. 10
Patients as well as the relatives of the patient are experiencing many pleasant and unpleasant experiences while patient is admitting for the abdominal surgical procedure during preoperative, intraoperative as well as during the post operative periods which we can’t predict, through depth involvement with them only, we can felt their experiences regarding both the pleasant and unpleasant experiences related to surgery. So further depth enrolment is needed to explore more about the patients and patient’s relatives experience about the elective abdominal surgery in before, during and after surgery. This motivated the investigator to commence a study on experiences of the patients and their relatives regarding elective abdominal surgery.
Review of literature:
“A review of literature is an essential aspect of scientific research. It helps the investigators to establish support for the need for the study, select research design, developing tools and data collection technique”
1) Studies Related To Patients Experience On Elective Abdominal Surgery:
A qualitative study was conducted to assimilate individual experiences on satisfaction with each diagnostic test. The sample was the 16 patients. The method of 6 data collection was a semi-structured interview by a health psychologist. Interviews were recorded, responses transcribed and analysis identified three principal themes physical sensations, social interactions and information provision. The studies concluded that social interactions with staff were perceived as very important in colouring the whole experience, information provision was also an important determinant of experience.11
A phenomenological qualitative study was conducted to explore the lived experience of the individual following gastric bypass surgery. Sample was the twelve individuals who had undergone Roux en Y gastric bypass surgery were interviewed.
The overall finding of the study after interpretation of the data analysis was four themes evolved i.e surgery as renewed hope, finding balance, filling the void, and transformation of self-image. The Study concluded that Participants described the post-surgical experience as a time of rapid transformation.13
A phenomenological study on the perianesthesia experience from the patient’s perspective was conducted. The aim of the study was to investigate perianaesthetic experience from the patient perspective. Interpretation was conducted in the part of the research group , sample size was10 in which the 5 were male and 5were female who have undergone anaesthesia for some procedure ranging in age from 23 to 66 years , method used was interviewing using the phenomenological techniques and finding is that each participant relinquished control , lost of control or stove to gain or maintain control during the surgical periods.15 7
A study was conducted on the systematic review of patient subjective experience and satisfaction during the perioperative period in the day surgery setting.
The objective of this review was to present the best available information in relation to how patients experience nursing interventions and care during the perioperative period in the day surgery setting. The samples were adult patients > 18 years of age who have undergone a surgical procedure as a day surgery patient. Data were extracted using the
QARI ‘Data Extraction Instrument (The Qualitative Assessment and Review
Instrument) developed by the Joanna Briggs Institute1 was used to manage, appraise, analyse and synthesize the textual data .Meta-synthesis identified the importance of: pre-admission contact, provision of relevant, specific education and information
,maintaining patient privacy, physical presence of significant others throughout the continuum of care , proactive management of waiting times and, effective communication.. The synthesized findings derived from the metasynthesis were education and information communication and privacy. The study concluded that education , communication and privacy were very much essential on patient’s point of view. 17
A study was conducted on aspects of patient satisfaction with communication in surgical care: confirming qualitative feedback through quantitative methods .The purpose of this paper is to compare the results generated from the interviews and observation with the statistical results of the self completion questionnaire .The sample included 419 elective patients and 280 emergency patients and method used in the qualitative phase was in-depth questioning and observation of surgeons, other members of the surgical team and their patients during a 10- week period across six hospital sites. In quantitative studies questions were included on anxiety level and also 8 any previous hospital stays analysis showed that this experience was viewed overall very positively and therefore not a distinguishing factor in the way in which patients evaluated their current experience , the result of the finding are waiting at the outpatient clinic and information on delays, communication and information, time provided and situation of the outpatient meeting, a second opportunity to communicate, surgeon accessibility and privacy on public wad, the role of printed information in communication, the importance of patient condition.18
Studies Related To Patient’s Relative Experience
A grounded study was conducted to explore the experiences of critical care patients’ families in Greece and the setting was the intensive care units of three general district hospitals in the area of Athens, Greece.. In-depth interviews with 25 relatives of critically ill patients were carried out, and participant and non-participant observation was used to cross-validate the data obtained. Results were the experiences of families revolved around the two core categories of intense emotions and vigilant attendance. Three further categories were also identified, namely caring, dignity and information. 12
A qualitative study was conducted to find those key events in the experience of hospital admission that stand out as meaningful to patients and families.. A purposive convenience sample of 11 patients and five carers was selected across the specialties of emergency care, data collection method was face to face semi structured interviewing and data was analyzed using the Picker domains of experience. The finding of the study were positive dimensions i.e. fast access to reliable healthcare, effective treatment from trustworthy staff, and involvement and support for patients’ 9 families and negative dimensions i.e. a lack of comprehensible information, coordination and continuity of care, and poor attention to physical and environmental needs. The study concluded that Patient stories revealed positive perceptions surrounding access and clinical competence, although participants were often distressed by ineffective communication and coordination of care that failed to focus on the individual.14
A multi cross sectional study on the prognostication during physician-family discussions about limiting life support in intensive care units. The objectives were to determine the types of prognostic information provided to families of critically ill patients when making major end-of-life treatment decisions and to identify factors associated with more physician prognostication. The methodology was audiotape of
51 physician-family conferences were coded to identify the types of prognostic information provided by physicians measurements. The finding were Increasing educational level of the family was independently associated with more prognostic statements by physicians.16
A phenomenological study on need of the family member during the perioperative periods , the purpose of this study was to understand the family member experience during the perioperative periods, the purposive sampling of eight family members of eight patient undergoing extensive surgery and 8 member were the size,.
The method of data collection was the interview method and interview was conducted for those patient .during perioperative and 2 weeks after the surgery the method of data analysis was colaizzi ‘s 1978 , family member own perception of the need where identified, the findings of the study became apparent in five needs , they are 1)to be 10 with an patient or have an option with him /her both preoperatively and post operatively 2)to receive a progressive update about progress of the surgery and patient condition 3) to wait somewhere that is readily accessible and known to the physician and hospital staff 4) to be able to make able decision about when is safe to take a break away from the waiting area 5) to have a company of other19
6 .3 Statement of The Problems
“ A qualitative study on the experience of the patients and their relatives in relation to before, during and after elective abdominal surgery in the selected hospital in Mysore”
6.4Objectives
1) To describe the experience of the patients regarding elective abdominal
surgery.
2) To describe the experience of the patient’s relatives regarding the elective
abdominal surgery.
6.5 Operational Definition :
1. Patient: The individual who is going for the elective abdominal surgery
(Laprotomy) and whose age is above 15 year of age.
2. Relatives : Refer to the patient ‘s care giver who is close one or family
member and whose aged is above 15 year of age
3. Experience : Refer to the pleasant or unpleasant perceptions towards elective
abdominal surgery by the patients and patient’s relatives who is undergoing
the elective abdominal surgery. 11
4. Elective abdominal surgery: An elective abdominal surgery is a planned,
non-emergency abdominal surgical procedure and that is subject to choice
(election). The choice may be made by the patient or doctor.
5. Laparotomy: A surgical procedure that is done by making an incision in the
lower abdomen.
6. Before surgery: Refers to the experience of the patient and their relatives on a
pre operative periods from admission to one day before surgery.
7. During surgery: It is the experience of the patients and their relatives in intra
operative periods from when the patient is transferred to the operating tables to
when he or she is admitted to the post anaesthetic care unit in which data will
be collected after 24 hrs of surgery.
8. After surgery: It is the experience of the patients and their relatives on post
operative periods when the patient got shifted from recovery room to
respective ward.
7. Material And Methods
7.1 Source of Data : Patient undergoing elective abdominal surgery
and their relatives
7.1.1 Research Design : Qualitative phenomenological design
7.1.2 Setting : At the selected hospitals in Mysore.
7.1.3 Population : Patient undergoing the elective abdominal
Surgery and their relatives
7.2 Methods of Data Collection
7.2.1 Sampling Technique : Purposive convenience sampling.
7.2.2 Sample : Patients undergoing the elective 12
abdominal surgery and their relatives at
selected hospital in Mysore.
7.2.3 Sample size : 15 patients and their relatives
7.2.4 Sample criteria
7.2.4.1 Inclusion Criteria:
1. Patient undergoing the elective laprotomy surgery and their relative
2. Both male and female are considers (patients as well as their relatives)
3. Those who known either English, Kannada or Hindi.
7.2.4.2 Exclusion Criteria:
1. Emergency or laparoscopic abdominal surgery
2. Relatives less than 15 year of age
7.2.5 Data Collection Method : Interview and observation technique
Before and after 24 hrs of surgery patients and
their relatives will be interview and will be
recorded.
7.2.5.1 Tool : unstructured interview
7.2.5.2 Duration And Follow up: 20 min to 1 hrs unstructured interview
per patient and their relative 6 week of duration
7.2.6 Data analysis and : The researcher will go for qualitative
interpretation analysis
7.3 Does the study require any intervention on patient, other human or animals? if so please describe briefly:
No. Only it concern with experience of patients and their relatives 13
7.4 Has ethical clearance being obtained from your institution in case of 7.3?
Yes.
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en Y Gastric Bypass Surgery: A Phenomenological Inquiry; 2008 Available at
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9. Signature of Candidate : 16
10. Remarks of the Guide :
11 Name and designation of Guide : Mr. S. Mohan Raju
Principal
11.1 Signature of guide :
11.2 Head of the Department : Mr. S. Mohan Raju
11.3 Signature :
12 Remarks of Principal :
12.1 Signature :