Brindha, M (2012) Effectiveness of Clinical Pathway for Patients undergoing Cholecystectomy upon the Knowledge and Practice of Nurses and Patients Outcome. Masters thesis, Apollo College of Nursing, Chennai.
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Abstract
A Quasi Experimental study to Assess the Effectiveness of Clinical Pathway for Patients Undergoing Cholecystectomy upon the Knowledge and Practice of Nurses and Patients’ Outcome at Apollo Main Hospital, Chennai. OBJECTIVES: 1. To assess the pre and post test level of knowledge and practice of nurses regarding clinical pathway for patients undergoing Laparoscopic cholecystectomy. 2. To assess the patients’ outcome in control and experimental group of patients undergoing laparoscopic cholecystectomy. 3. To evaluate the effectiveness of clinical pathway by comparing the pre and post test level of knowledge and practice of nurses regarding clinical pathway for patients undergoing laparoscopic cholecystectomy. 4. To compare the patients’ outcome in control and experimental group of patients undergoing laparoscopic cholecystectomy. 5. To compare the level of patient satisfaction on nursing care in control and experimental group of patients undergoing laparoscopic cholecystectomy. 6. To determine the association between selected demographic variables of nurses and their pre and post test level of knowledge regarding clinical pathway for patients undergoing laparoscopic cholecystectomy. 7. To determine the association between selected demographic variables of control and experimental group of patients undergoing laparoscopic cholecystectomy and their outcome. 8. To determine the association between selected clinical variables of control and experimental group of patients undergoing laparoscopic cholecystectomy and their outcome. The conceptual framework for the study was developed on the basis of Wiedenbach’s helping art of clinical nursing theory, which was modified for the present study. An intensive review of literature and experts guidance laid the foundation to the development of tools such as demographic variable proforma for nurses and patients, clinical variable proforma for patients, structured knowledge questionnaire for nurses, practice check list, patient satisfaction rating scale and patient outcome check list. In this study, quasi experimental research design was adopted. Since there were a limited number of nurses, one group pre and post test design was adopted for nurses. The present study was conducted at Apollo Main Hospital, Chennai among nurses and laparoscopic cholecystectomy patients. The sample size for the present study was 30 nurses and 60 patients undergoing laparoscopic cholecystectomy. Among the 60 patients, 30 patients were assigned to control group and 30 patients to experimental group who satisfied the inclusion criteria. The investigator used the demographic variable proforma of nurses and patients and clinical variable proforma of patients to obtain the baseline data. Structured questionnaire was used to assess the knowledge of nurses, practice checklist was used to identify whether the patients were receiving the appropriate care, rating scale to assess the level of patient satisfaction on nursing care and checklist to assess the patients’ outcome. The data collection tools were validated and reliability was established. After the pilot study, the data collection of the main study was conducted for a period of 4 weeks. The collected data was tabulated and analyzed by using appropriate descriptive and inferential statistics. MAJOR FINDINGS OF THE STUDY: ❖ Majority of the nurses were in the age group of 21-25 yrs (80%), females (93.3%), having less than 5 years of experience (86.6%), completed diploma nursing (56.6%), studied in private institution (86.6%), working as staff nurses (70%), in private wards (66.6%) and not attended in service education on clinical pathway (70%). ❖ Most of the patients in control group and experimental group undergoing laparoscopic cholecystectomy were males (66.6%,70%), belongs to age group of above 50 years (43.3%, 40%), married (90%, 86%), graduates (36.3%, 46.6%), employed (53.3%, 46.6%), non vegetarians (70%, 70%), indoor place of work (86.6%, 80%), moderate worker (70%, 56.6%), with monthly income of more than 15,000 (73.3%, 70%), and acquired health information about laparoscopic cholecystectomy from health workers ( 63.3%,53.3%) respectively. ❖ Most of the patients in control and experimental group undergoing laparoscopic cholecystectomy were weighing above 70 kgs (46.6%, 50%), had co morbid illness (66.6%,76.6%), on treatment for co morbid illness (50%,76.6%), had no history of trauma ( 90%, 90%), had no rapid history of weight loss (86.6%, 83.3%), suffering from gall bladder disease for less than 3 months (86.6%, 83.3%), had no history of jaundice (83.3%, 86.6%), and had no history of bad habits (63.3%, 46.6%) respectively. ❖ In pre test regarding clinical pathway for laparoscopic cholecystectomy, most of the nurses had inadequate knowledge (70%) and had moderately adequate knowledge (30%). In post test, majority of the nurses had adequate knowledge (76.6%) and significant percentage of nurses had moderately adequate knowledge (23.33%). ❖ Most of the nurses had partially compliant scores on day 1 and day 2 (56.6%, 56.6%) and most of them have non compliant scores on day 3(63.3%) for control group of laparoscopic cholecystectomy patients. Nurses had compliant scores from day 1 to day 3 for experimental group of patients ❖ Majority of the control group patients had moderate positive outcome (86.6%) and majority of experimental group patients had positive outcome (83.3%). ❖ Most of patients in control group were satisfied (56.6%) and significant percentage were dissatisfied (43.3%) with nursing care. Majority of patients in experimental group were highly satisfied (80%) on nursing care provided. ❖ The knowledge of nurses in post test (M=16.5, SD = 1.52) were high in comparison with the pre test (M=9, SD=2.61). The difference was found to be statistically significant at p<0.001 level of confidence. ❖ The mean practice scores for nurses in experimental group of patients were high in comparison with the practice scores in control group of patients. The difference was found to be statistically significant at p<0.001 level of confidence. ❖ The level of satisfaction on nursing care in experimental group of patients (M=33.93, SD=3.677) was high in comparison with the level of satisfaction in control group (M=22.16, SD= 4.099). In the experimental group, the level of satisfaction was improved after implementation of clinical pathway. The difference was found to be statistically significant at p<0.001 level of confidence. ❖ The patients’ outcome in experimental group (M=20.83, SD=2.20) was high in comparison with the patients outcome in control group (M=17.13, SD = 2.31). The difference was found to be statistically significant at p<0.001 level of confidence. ❖ There was no significant association between the selected demographic variables namely age, total years of experience, designation, working area, professional qualification and place of study and pre and post test level knowledge of nurses. ❖ There was no significant association between the selected demographic variables namely age, sex, educational qualification, dietary intake, place of work, nature of work, occupational status, residential area and patients’ outcome in control and experimental group of patients. ❖ There was no significant association between the selected demographic variables namely age, sex, educational qualification, dietary intake, place of work, nature of work occupational status, residential area and level of satisfaction in control group and experimental group of patients. ❖ There was no significant association between the selected clinical variables namely weight, history of co-morbid illness, treatment of co morbid illness, history of trauma, history of rapid weight loss, history of surgeries, history of bad habits and patients outcome in control and experimental group. But there was a significant association between history of surgery and outcome in control group of patients. RECOMMENDATIONS: ❖ The similar study could be undertaken on larger scale for more valid generalization. ❖ This study could be replicated in different settings. ❖ The study could be conducted to analyze the relationship between the use of clinical pathway and time spent by the nurse. ❖ Clinical pathways can be established for major disease conditions and other surgeries.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Effectiveness, Clinical Pathway, Patients undergoing Cholecystectomy, Knowledge, Practice, Nurses and Patients Outcome. |
| Subjects: | NURSING > Medical Surgical Nursing |
| Depositing User: | Subramani R |
| Date Deposited: | 11 Aug 2020 17:04 |
| Last Modified: | 11 Aug 2020 17:04 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/12812 |
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