Article Type: Research Article Article Citation: Dr. Eied Saber Al
amine Ali, and Dr. Higazi Mohammed Ahmed Abdallah.
(2020). EFFECT OF PREOPERATIVE PREPARATION ON PATIENTS OUTCOME AMONG PATIENTS
UNDERGOING SURGICAL OPERATIONS AT ALMIK NIMIR HOSPITAL – SUDAN. International
Journal of Research -GRANTHAALAYAH, 8(8), 346-355. https://doi.org/10.29121/granthaalayah.v8.i8.2020.441 Received Date: 15 August 2020 Accepted Date: 31 August 2020 Keywords: Preoperative Patients Elective Surgery Postoperative Satisfaction Preoperative preparations of the patients physically and psychologically are the cornerstone of the good outcomes. This prospective quasi-experimental hospital-based study was conducted in Sudan, Shendi city at Elmek Nimer university hospital to evaluate the impact of preoperative preparation on patients outcome among patients undergoing general surgery. In the period of June 2016 to May 2019. The study was included a hundred patients undergoing general elective surgery, data were collected by interviewing questionnaire, anxiety scale, pain assessment tool, postoperative parameter, and patients satisfaction tool, data were collected in two phases (pre& postoperative). The data were analyzed by the computer software program (SPPS) version 20. The results showed that more than two third (79.4%) of the patient had poor knowledge about the importance of preoperative preparations, but improve after implemented program and this was reflected on patient behavior and outcome in the postoperative phase. (70%) had reported no anxiety to mild in the postoperative phase. in regard of postoperative pain, majority of patients (70%) experienced moderate to severe level of pain in the first 4 hours, this level of pain reduce to mild to no pain level in (82%) of patients in next 12hours. Most of the patients had full to good satisfaction regarding preparations and outcome. The study support and justifies the effectiveness of the preoperative preparations on patient outcomes. The study recommended surgical nurses have to provide proper explanation and teaching for elective surgical patients to be adherence with the care plan to promote good surgical outcome.
1. INTRODUCTION1.1. BACKGROUNDSurgical care is
essential for managing various health conditions such as injuries, malignancy,
infections, and cardiovascular disease. (Meara,
etal.2015).surgery patients at risk for preoperative anxiety due to fear
from unknown, postoperative pain and complications, this negative perception
regarding the what happen after surgery can effect on recovery from anesthesia,
which can lead to poor outcome and longer hospitalization, so is an important
nursing responsibility and care provider in preoperative phase to inform
patient about surgery, pain control, postsurgical explanation. This can promote
recovery and achievement of the optimal goal. (Gerlitz.2017;
Powell.et al.2016). Patients who are
physically and psychologically prepared for surgery tend to have better
surgical outcomes. The patients were capable of managing postoperative pain
more effectively. Patients who are more aware of what to expect after surgery
and who have an opportunity to express their goals and opinions, often cope
better with postoperative pain .so the Preoperative preparation is extremely
essential before any surgical procedure. (Elkalashy
and Masry.2018; Samnani.et al.2014).
Evidence based practice has shown that, preoperative exercise therapy and
information provision is effective on postoperative outcome, in reducing
complication, length of hospital stay and improve patient satisfaction. (Grossweiler.2012 ؛ Thorell,
et al.2016). Education of
surgical patient Preoperative patient education is a key part of nursing
consideration aimed at helping patients to clarify information about their
operation, and what happens after surgery, based on patient need, level of
knowledge and patient condition. (Lobo.2016). Preoperative education has proven
useful in decreasing postoperative complications and duration of stay as well
as positively influencing recovery. Patients who are properly prepared with
specific preoperative preparation deal more effectively with their surgical
treatment and are better prepared to manage their pain and ability to perform
postoperative activities.(Kaur, et al, 2007; Kruzik,
2009).The main purpose of this integrated approach is to reduce the
psychological and physiological stresses associated with surgical illness. (Rizalar and Topcu, 2015). Most
importantly, pre-operative education may reduce anxiety and pain level, study
by (Yeola and Jaipuriya
2016) which
investigated the “effect of
different pre-operative education programs on the anxiety and pain levels
of patients”, the patients in the group
that had received routine care reported the highest level of pain, while
patients on planning preoperative education had a low level of pain and anxiety.
Preoperative teaching has been administered in various methods including
written materials, audio-visual presentations, oral information in the form of
one-to-one counseling or group discussion, or combinations of some or all of
these. Previous studies have shown that each approach has both advantages and
limitations. Additionally, due to an increasing trend toward shorter times
between hospital admission and surgery, there has been a limited time that
nurses can spend with patients before surgery. Thus, reliance on verbal
information giving alone may not always be effective. The use of media such as
booklet and videos can help to deliver information in a potentially more
efficient and interesting way. A systematic review of randomized controlled
trials concluded that the use of video and printed information for preoperative
education has a positive impact on anxiety and knowledge. (Guo et al,2012; Sousa,
et al, 2015.) 2. PROBLEM STATEMENTApproximately 312.9
million surgical procedure are performed worldwide yearly (Weiser, et al.2015;
Esquivel, et al.2015). The incidence rate of major complications following
inpatient surgical procedures has been reported as up to 22% with a mortality
of up to 0.8%. and about seven million patients yearly will experience serious
problems as a result of surgical procedure and around one million patients can
pass away as a result of complications after surgery. (Glaysher
and Cresswell.2017) Regarding the surgery outcome in Africa, the previous
studies from 25 countries for all in-patient surgeries reported that one in
five surgical patients in Africa developed a perioperative complication, and
one in ten patients died. (Biccard, et al.2018).
Sudan considered under low economical counters, so it suffers from a lack of
development of the health system, especially in the surgical approaches, the
patient's problem in surgical treatment may be lack of adequate preoperative
preparations which is the effect on patient physiologically and emotionally.
And also effect on postoperative patient's outcome and incidence rate of mortality. 3. METHODOLOGYDesign: Prospective quasi-experimental
hospital-based study conducted to evaluate the effectiveness of the
preoperative preparation on patient outcome among patients undergoing elective
surgical operations done during the period which extended from June 2016 to May
2019. Study area: The study was carried out at Shendi town which is 176km north to Khartoum and 110 km
south to Elddamer, the capital of River Nile State; Shendi town is lies on the eastern bank of the River Nile
with a total area of about 14596 Km2. The total population of Shendi locality is estimated at about 197589 of whom 116713
live in rural areas and 80876 in urban areas, most of them are farmers. Shendi city now is one of the rich cities in health care
facilities and education institution, it contains four main hospitals which are
Elmak Nemir University
hospital; Shendi teaching hospital and military
hospital, and also there are Hosh bannaga
hospital and Elmiseiktab hospital. Setting: This study was carried out at Elmeck Nimer University hospital. This hospital
was established since 2002. And it’s the second university hospital in Sudan. The hospital provides most
types of medical services (medicine, surgery, Obs/Gyne, and pediatric). Besides these there is cardiac, renal
center). In the hospital, there is a big two-theater complex in which most type
of general operations. The hospital system for work, for nursing staff,
morning shift for 8 hours in duration, and 16 hours, and is the distribution of
nursing staff according to need of hospital departments, nurses rotate
frequently without fixed intervals according to the need. The surgery
department within the hospital is divided into two sections. include
preoperative and postoperative ward occupying 17 beds and 20 nurses rotated
according to hospital policy, they work shift morning; afternoon night shift
per day. The general elective
surgical procedures were done according to department schedule in fixed two
days per week (Sunday; Tuesday), by rate of (8-10) surgical procedure\day.
Also, the surgical department it contains outpatient clinic with a dressing
room and laboratory. Study population: This study includes all patient`s admitted
in Elmak Nimer university
hospital for elective surgery during the time of the study. While Excluded Psychiatric & emergency surgical Patients. Sampling method: All
patients whom admitted to the hospital for elective general surgery were
enrolled. (112) patients were admitted to the hospital for elective surgery for
three months and were met the inclusion and agreed to participate. seven
patients were discarded because of cancelation in the day of surgery, and
however, five patients refused to follow participations. (100) patients were
included in the study using simplified formula for determine sample size "
the yamane formula " (Israel, 1992) as follow: 𝑛 =𝑁1+𝑁 (𝑒)2 = 8801+880 (0.1)2 = 89 n = the sample size N = the population
size e = the level of
confidence So, the minimum
sample size for patients = 89 patients Data collection
tools: Four tools were used:
I. Structured questionnaire. II. State Anxiety Inventory form (Akinsulore et al,2015; Jafar and
Khan 2009). III. Universal pain assessment tool (Menabde,
etal.2017). 1.V. Satisfaction scale form (Karen instrument form) (Andersson and
Lindgren,201) Pilot test: The data
collection tools were pilot tested using (12) patient undergoing general
surgery at the hospital by the researcher to test the applicability of the
tools of data collection and find out unclear or ambiguous questions, and to
estimate the time required for filling each form. Data from the pilot study has
been analyzed and we found that 10% of the questions need to be modified in
accordance with patients understandings. The Cronbach,s alpha of study tools
was ( 0.88) Data collection
technique: The data was
collected in two phases of surgery pre& postoperative phases. In preoperative
phase data was collected after consenting for the surgery by patient or
relative, enough verbal explanation was given after describing the study
objectives, then written consent was taken. demographic and health profile data
were collected, then section two from a questionnaire filled to assess patient
knowledge regarding important of preoperative preparation, postoperative
exercise. And preoperative anxiety was assessed using the State Anxiety
Inventory Scale. After this, each patient had been interviewed separately and
given full preoperative teaching program by using (booklet, boosters, videos)
and demonstrating postoperative exercise (deep breathing, cough exercise, and
leg exercise, turning and lifting) by using the observational checklist as
guidance to steps of each exercise. The preoperative
preparation program: Planned
preoperative education has been designed by researcher based on preoperative
nursing preparation and strategies of enhancing postoperative recovery in light
on literature review. The preparation
program has been established in simple Arabic language to facilitate patient
understanding and cover the patient question and need in all phases of surgery
(pre\intra\and postoperative) also others teaching methods such as
demonstration, short videos, booster have been used. The preparation program
has consisted of preparations related to the preoperative phase as
physiological assessment, bowel, bladder, skin, and preoperative fasting.
Addition to the information about the environment of the theater room and
sterilization technique. The final part of
preparation included information about postoperative phase as preparation the
patient for postoperative exercise, instruction about the wound of operation,
adaptation for pain control and information related to discharge from hospital.
The program has been implemented in the day before the surgery, each patient
was interviewed separately through 40 -45 minutes and given sufficient
information and then the patient was trained on postoperative exercises. In
Postoperative phase (post I) after patient returned from surgery to
postoperative ward, vital sign parameters (blood pressure, pulse, respiratory,
temperature) was evaluated immediately and the pain was assessed by using the
numerical rating scale after 4hours.During the postoperative phase, the
patients were encouraged to execute deep breathing and couching, early
mobilization and leg exercise post-II Then after patient fully recovering from
anesthesia the postoperative anxiety was assessed by using the same tool. Vital
sign parameter was recorded and the pain was assessed by using the same tool
after 8hours later. After that, during follow up phase the patient had been
evaluated for any complication present. Post III was conducted on discharge
day, satisfaction level regarding preparation and outcomes was evaluated by
using the "Karen instrument”, and length of hospital stay was recorded. Ethical
considerations: The study
was approved by the ethical committee of the college and the institutional
research board of the university. Before conducting the study, permission was
taken from the hospital general manager. Before obtaining the patients'
consent, they were informed about the purpose and nature of the study. The
researcher assured them that the data collected from the questionnaire and
other tools will remain confidential and it’s not allowed for any
person to identify it.
Responders were explained that they could refuse to participate in the study,
and withdraw from it at any time. with no effect on their care. Clarification
of the aim of the study to each of the patients had been explained verbally,
and then written consent has been taken. Data management
(Statistical design): After
the data was collected, then transferred into a specially designed format so as
to be suitable for computer feeding, following data entry, checking and
verification process was carried out to avoid any errors during data entry.
Frequency analysis, correlation, cross tabulation, and manual revision were all
used to detect any errors and through SPSS program version 20. 4. RESULTSTable 1: Demographic characteristic of the study group Table 2: Clinical characteristics of the study group Table 3: mean of patients anxiety level pre-&
post-operative: Table 4: level of pain 4hr and 12hr postoperatively Table 5: Distribution of study group according to the length of postoperative
hospital stay: Table 6: Correlation between level of postoperative exercise benefits gained and
"level of preoperative instructions benefits, Knowledge
regarding the importance of exercise Table 7: Correlation between level of satisfaction and preoperative
instructions benefits degree gained from preoperative instructions: Figure 1: Distribution of study group according to the knowledge regarding the
importance of preoperative preparation. 5. DISCUSSIONPreoperative
education empowers patients to decrease postoperative complication, increase
patient satisfaction, reduce anxiety, and shorten the length of
hospitalization. (Adogwa et
al,2017).The Study was included (100) patient, more
than half (57%) of them were females and 43% were meals, more than half (57%)
of the age above the fifty years, and less than half 43% below fifty years. Most
of them were married (74 %). One third 32% of them were illiterate, a majority
(77%) of them were prepared for major surgery. The present study reflected that
majority 79% of patients had no bad habits effect on anesthesia, more than half
65% of patients had no disease that needs special preparations. The evaluation
of patient physiological status is essential to determine the need for special
preparation mainly patient how to have the chronic disease. The study reflected
that varying anxiety level on preoperative phase which found that 69% of
patient had reported moderate to high level of anxiety, and significant
reduction on anxiety level was shown in postoperative phase, which found more
than two-thirds 70% had reported no to mild anxiety. This reduction on anxiety
level indicates that preoperative information provided had a significant impact
to reassure and support patient psychologically. This finding is agreed with
the line of conclusions of studies was conducted in Nigeria and India by (Akinsulore et al, 2015; Lobo.2016) concluded to the
provision of adequately information help patient to reducing anxiety. In
addition to that, this study revealed that, significant negative correlation
between postoperative anxiety and level of education, (sig = 0.03) the
explanation, patients who receive little chance of education confront
difficulty for understanding and adherence with preoperative instruction and
perform the exercise. the findings consistent of a study conducted by (Nigussie et al 2014). on
other hand, our study finding contradicted with the result of the study in
Pakistan by (Jafar and Khan 2009) "mentioned that
positive correlation between anxiety and high level of education" .The
study reflected that, more than two thirds (79.4%) of patients had poor
knowledge about important of preoperative preparation such as fasting, bowel,
bladder, skin, and exercise in the postoperative phase; this has a connection
with the lake of experience of previous surgery and illiteracy state. In
addition to that, the present study finding shown a significant negative weak
association between benefited gained from postoperative exercise and patients
knowledge; preoperative education content had improved patients awareness and
skills on postoperative exercise; this finding agree with a line of result
study by (Priya, et al.2017) reported; the preoperative instruction gains
patient knowledge and improve the performance of the postoperative exercise.
The present study illustrate that, more than two-third 70% was experienced
moderate to severe pain in first 4huors after surgery, after reassessment in
next eight hours the pain level was reduction marked by most 82% of patients
had reported no pain to mild level of pain and few 18% was reported moderate
pain, moreover majority 87% of patients had pain medication one to two times
during the first 24huors;the preoperative instruction provided on pain control
and compliance of patients with exercise after surgery such as deep breathing
help patients to be able to control pain, this finding was consistent with
findings of studies by (Oshodi,2007; O'donnell,2015;Chou et al,216;Tew,2018,
Youssef and Hassan,2017). "stated the provision information on
preoperative exercise and demonstrated patient about exercise effectiveness on
reducing postoperative pain ". Moreover, the
recovery after surgery is the main nursing aspect, so the monitoring vital signs
are most important during postoperative nursing care, the current study showed
that increase in respiratory rate and blood pressure during the immediate
postoperative phase. anesthesia and surgery may be responsible for this
abnormality. After 8hure later the most of patients had been reported normal
vital signs parameters. May due to pain controlled and the patient is full
recovery from the effect of anesthesia. postoperative complication considered
as an important change in the recovery of the patient, this study showed that
most (93 %) of patients did not develop any postoperative complication. This
finding is a good indicator for the effect of the preoperative information
provided and demonstrating patient on postoperative exercise to reducing the potential
complication. A similar finding was reported in the previous study, conducted
by (Lobo.2016) to investigate the effectiveness of preoperative teaching in
promoting postoperative outcome, which showed most 98.4% of patients did not
develop to postoperative complication. Furthermore, the current study found
that more than half 54% of patients were discharged whiten 3days, and less than
half 46% were discharged on 4 to7 days. This finding agree
with line of studies by (Shenson, et al,2017; Auer et
al.201; Gustafsson et al,2018; Hussein and Taha,2018) reported, preoperative
instruction of patients had reduced the hospital stay after surgery. On another
hand, our study results disagree with study finding by (Kalogianni,
et al,216) indicated "the preoperative teaching minimize the postoperative
complication but did not effectiveness on length" of hospital stay ".
Finally, the findings of our study had explained that half 50% of patients had
full satisfaction, 47% had a good satisfactory level. in addition, most of the
patients had gained a lot of benefits and rest reassured, this finding
justifiable, enough information and explanations provided in the preoperative
phase encouraged patient to be compliance with information. so, the patient has
satisfaction and benefited after surgery. So is an important nursing
responsibility to achievement optimal satisfaction level and benefits. This
finding supported with previous studies (Fasulo et
al.2018; Best, etal,2018; White,2015) suggest to, the provision preoperative
education positively increase patient satisfaction and outcome. On the other
hand, the study stated by (Varghese,2009) reported that "the poor
satisfaction level can prompt poor adherence to treatment with therefore poor
results. Which is not agree with our present study 6. CONCLUSION Majority of patients have poor knowledge about
the importance of preoperative preparation and postoperative exercise. But most
of them were gained a lot of benefit after the educational program. -
preoperative teaching program had a positive effect on reducing the severity of
anxiety level. Preoperative instruction and demonstrating postoperative
exercise effective on reduction postoperative pain - Preoperative preparations
effectiveness on patient satisfaction and Length of hospital
stay after surgery. Most 93% of patients did not develop to postoperative
complication. - A significant statistical negative relationship between
postoperative anxiety and level of education. Significant negative weak
relationship between postoperative mobilization and level of education. 7. RECOMMENDATIONSSurgical nursing
staff should provide proper explanation and counseling to be adherence with the
care plan and promote outcome for elective surgical patient’s.
Hospital administrative should provide a facility for preoperative counseling
and exercise demonstrating by simple methods to improve patient knowledge and behaviors.
The hospital should establish regular conference and training program about
preoperative preparations for surgical nurses to improve quality of nursing
care and patient satisfaction. studies are needed to evaluate the effectiveness
of preoperative education program on specific types of surgery. SOURCES OF FUNDINGThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. CONFLICT OF INTERESTThe author have declared that no competing interests exist. ACKNOWLEDGMENTNone. REFERENCES
[1]
Adogwa, O., Elsamadicy, A.A., Fialkoff, J.,
Cheng, J., Karikari, I.O. and Bagley, C., 2017. Early
ambulation decreases length of hospital stay, perioperative complications and
improves functional outcomes in elderly patients undergoing surgery for
correction of adult degenerative scoliosis. Spine, 42(18), pp.1420-1425.
[2]
Akinsulore,
A.D.E.S.A.N.M.I., Owojuyigbe, A.M., Faponle, A.F. and Fatoye, F.O.,
2015. Assessment of preoperative and postoperative anxiety among elective major
surgery patients in a tertiary hospital in Nigeria. Middle East J Anaesthesiol, 23(2), pp.235-40.
[3]
Biccard, B.M.,
Madiba, T.E., Kluyts, H.L., Munlemvo,
D.M., Madzimbamuto, F.D., Basenero,
A., Gordon, C.S., Youssouf, C., Rakotoarison, S.R., Gobin, V. and Samateh, A.L.,
2018. Perioperative patient outcomes in the African Surgical Outcomes Study: a
7-day prospective observational cohort study. The Lancet, 391(10130),
pp.1589-1598.
[4]
Elkalashy.R.A.Q, Masry. S E. .S.E. 218. The Effect of Preoperative Educational
Intervention on Preoperative Anxiety And Postoperative
Outcomes In Patients Undergoing Open Cholecystectomy. Journal of htt - p://iosrjournals.org/iosr 8 7. u - rsing and Health Science.vol. 7,
no.5, pp. 78 9/J 0705097887.pdf iss - ue5/Version jnhs/ - papers/vol7
[5]
Esquivel,
M.M., Molina, G., Uribe-Leitz, T., Lipsitz, S.R.,
Rose, J., Bickler, S., Gawande, A.A., Haynes, A.B.
and Weiser, T.G., 2015. Proposed minimum rates of surgery to support desirable
health outcomes: an observational study based on three strategies. World
journal of surgery, 39(9), pp.2126-2131.
[6]
Fasulo, S.M.,
Testa, E.J., Lawler, S.M., Fitzgerald, M., Lowe, J.T. and Jawa,
A., 2018. A Preoperative Educational Video Improves Patient Satisfaction and
Perceived Knowledge, but Not Patient Understanding for Total Shoulder
Arthroplasty: A Randomized, Surgeon-Blinded Study. Journal of Shoulder and
Elbow Arthroplasty, 2,p..2471549218792966.
[7]
Gerlitz, R.,
2017. Barriers and faciliators of preoperative
education within Enhanced Recovery after Surgery (ERAS) programs.From http://hdl.handle.net/10133/4934
[8]
Glaysher, M.A.
and Cresswell, A.B., 2017. Management of common
surgical complications. Surgery (Oxford), 35(4), pp.190-194.
[9]
Grossweiler, H.,
2012. Preoperative Education: How Effective Teaching Impacts Knowledge with the
Surgical Patient. Nursing Theses and CapstoneProjects.
119.https://digitalcommons.gardner-webb.edu/nursing_etd/119
[10] Guo, P., East, L. and Arthur, A., 2012. A
preoperative education intervention to reduce anxiety and improve recovery
among Chinese cardiac patients: a randomized controlled trial. International
Journal of Nursing Studies, 49(2), pp.129-137.
[11] Jafar, M.F. and Khan, F.A., 2009. Frequency of
preoperative anxiety in Pakistani surgical patients. Journal of the Pakistan
Medical Association, 59(6), p.359.
[12] Kaur, N., Verma, P. and Rana, S.S., 2007.
Effectiveness of planned pre-operative teaching on self-care activities for
patients undergoing cardiac surgery. Nursing and Midwifery Research, 3(1),
pp.36-42.
[13] Kruzik, N., 2009. Benefits of preoperative
education for adult elective surgery patients. AORN journal, 90(3), pp.381-387.
[14] Lobo, D., 2016. Effectiveness of Preoperative
Teaching in Promoting Postoperative Outcome among Patients Undergoing Abdominal
Surgery in Selected Hospitals of Karnataka.
[15] Meara, J.G., Leather, A.J., Hagander, L., Alkire, B.C.,
Alonso, N., Ameh, E.A., Bickler,
S.W., Conteh, L., Dare, A.J., Davies, J. and Mérisier,
E.D., 2015. Global Surgery 2030: evidence and solutions for achieving health,
welfare, and economic development. The Lancet, 386(9993), pp.569-624
[16] Nigussie, S., Belachew, T.
and Wolancho, W., 2014. Predictors of preoperative
anxiety among surgical patients in Jimma University
specialized teaching hospital, South Western Ethiopia. BMC surgery, 14(1),
p.67.
[17] Oshodi, T.O., 2007. The impact of
preoperative education on postoperative pain. Part 2. British journal of
nursing, 16(13).
[18] Powell, R., Scott, N.W., Manyande,
A., Bruce, J., Vögele, C., Byrne‐
[19] Rizalar, S. and Topcu,
S.Y., 2015. Analysis of Enhanced Recovery after Surgery Applications in
Patients Who Received Surgical Intervention. Open Access Library Journal,
2(10), p.1.
[20] Samnani, S.S., Umer,
M.F., Mehdi, S.H. and Farid, F.N., 2014. Impact of preoperative counselling on
early postoperative mobilization and its role in smooth recovery. International
scholarly research notices, 2014.
[21] Shenson, J.A., Craig, J.N. and Rohde, S.L., 2017.
Effect of preoperative counseling on hospital length of stay and readmissions
after total laryngectomy. Otolaryngology–Head and Neck Surgery, 156(2),
pp.289-298.
[22] Sousa, C.S., Turrini,
R.N.T. and Poveda, V.D.B., 2015. Educational intervention in patients
undergoing orthognathic surgery: Pilot study. Journal of Nursing Education and
Practice, 5(5), p.126.
[23] Thorell, A., MacCormick,
A.D., Awad, S., Reynolds, N., Roulin,
D., Demartines, N., Vignaud,
M., Alvarez, A., Singh, P.M. and Lobo, D.N., 2016. Guidelines for perioperative
care in bariatric surgery: enhanced recovery after surgery (ERAS) society
recommendations. World journal of surgery, 40(9), pp.2065-2083.
[24] Topcu. Y.T, Rizalar.S , and Ünver, S., Önüt.F , Işıklı.
A.G., 2016. Relations between Patients' Breathing Practices and Mobilisation after Lung Resection Surgery. International
Journal of Caring Sciences, 9(2), p.653.
[25] Varghese J. A.,2009. Study to Assess the
Patient Satisfaction with Quality Nursing Care in Neuro Medical Unit, Institute
of Medical Sciences and Technology Medical ollege.;
35(2):422-29.
[26] Weiser, T.G., Haynes, A.B., Molina, G.,
Lipsitz, S.R., Esquivel, M.M., Uribe-Leitz, T., Fu,
R., Azad, T., Chao, T.E., Berry, W.R. and Gawande, A.A., 2015. Estimate of the
global volume of surgery in 2012: an assessment supporting improved health
outcomes. The Lancet, 385, p.S11.
[27] White, J.A., 2015. Improving Patient
Satisfaction after Primary Total Knee Arthroplasty Using Nurse
Practitioner-Driven Preoperative Education, p13.
https://digitalcommons.otterbein.edu/stu_doc/13.
[28] Yeola, M. and Jaipuriya,
P., 2016. Effect of pre-operative counseling on post-operative outcome in
hernia surgery patients. Int J Sci Res (Raipur), 5(7), pp.762-767.
[29] Youssef, N.F. and Hassan, A.D.A., 2017. The
Effect of hand and foot massage on alleviating pain and anxiety of abdominal
post-operative patients at a University Hospital: A randomized control trial.
Journal of Nursing and Health Science (IOSR-JNHS), 6(3), PP 56-65.
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