Effectiveness of Clinical Pathway for Patients Undergoing Hysterectomy upon the Knowledge and Practice of Nurses and Patient’s Outcome

Jenifar Monisha, A (2012) Effectiveness of Clinical Pathway for Patients Undergoing Hysterectomy upon the Knowledge and Practice of Nurses and Patient’s 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 hysterectomy upon the knowledge and Practice of Nurses and Patient Outcomes at Apollo hospitals, Chennai. OBJECTIVES: 1. To assess the pre and post test level of knowledge and practice of nurses regarding clinical pathway for patients undergoing hysterectomy. 2. To evaluate the effectiveness of clinical pathway for patients undergoing hysterectomy upon the knowledge and practice of nurses. 3. To assess and compare the patients outcome in control and experimental group of patients undergoing hysterectomy. 4. To assess and compare the level of satisfaction upon nursing care for hysterectomy in the control and experimental group of hysterectomy patients. 5. To determine the association between the selected demographic variables of nurses with their pre and post test level of knowledge regarding clinical pathway for patients undergoing hysterectomy. 6. To determine the association between the selected demographic variables with patients outcome and level of satisfaction in control and experimental group of patients undergoing hysterectomy. 7. To determine the association between the selected clinical variables with patients outcome and level of satisfaction in control and experimental groups of patients undergoing hysterectomy. The conceptual framework of the study was developed on the basis of Roy’s adaptation model. The study variables were the knowledge and practice. Null hypotheses were formulated. The level of significance selected was P < 0.001. An extensive review was made based on the opinions of the experts. A Quasi experimental study of one group pre-test and post-test design for nurses, control and experimental group of hysterectomy patients were used. The study included 30 nurses and 70 hysterectomy patients with purposive sampling technique. The study was conducted at Apollo main Hospitals, Chennai. The researcher used demographic variable proforma for nurses and patients, clinical variable proforma for patients undergoing hysterectomy, structured knowledge questionnaire for nurses regarding clinical pathway for patients undergoing hysterectomy, practice check list for patients undergoing hysterectomy, clinical pathway for patients undergoing hysterectomy, rating scale for patients satisfaction and outcome check list for patients undergoing hysterectomy for data collection. Structured knowledge questionnaire and practice checklist was used for the nurses. The rating scale on level of satisfaction and the patient’s outcome checklist were used for the hysterectomy patients. Pre test knowledge questionnaire regarding clinical pathway for patients undergoing hysterectomy was administered to the nurses and observed with the existing nursing practice. Patient’s outcome and their level of satisfaction were checked out with existing nursing practice through rating scale. Then the clinical pathway was taught to the nurses and implemented after which the post test questionnaire was administered to the same nurses. The practice of nurses and patients outcome was assessed and patient’s satisfaction regarding clinical pathway was obtained. The data were analyzed by descriptive and inferential statistics. MAJOR FINDINGS OF THE STUDY: ❖ Majority of the nurses were unmarried (90%), between the age group of 22 to 26 years (80%), had 0 to 2 years of experience (86. 67%), and had no previous information about clinical pathway (86.67%). Most of them were in the educational status of B.Sc (N) (66.67) and belong to the Christianity (50%). ❖ Most of the patients in the control group and experimental group were in the age group of 41 to 50 years (50%, 57.50%) respectively and majority of patients had undergone normal vaginal delivery (80%, 70%) with co morbid illness (80%, 60%). ❖ Majority of the patients in the control and experimental group had BMI between19 to 24.9 (93.33%, 95%) and regular pattern of menstrual flow (83.33%, 70%). Most of them had the history of fibroid uterus (66.7%, 60%), and the presence of comorbidity (60%, 60%) respectively. ❖ Most of the nurses in pre-test had inadequate knowledge (50%) whereas majority of the nurses had adequate knowledge (93.33%) after the post-test. ❖ Most of the nurses practice in control group in the pre op day, day 2 and day 3 was partially compliant (60%, 70% and 66.67%) and compliant at day 0 and day 1 (96.67%, 73.33%) whereas the practice of all the nurses in experimental group was compliant on all days (100%). ❖ All of them had positive outcome (100%, 100%) and were highly satisfied with nursing care (56.67%, 100%) in control and experimental group respectively. ❖ Mean and standard deviation of level of knowledge of nurses were low in the pretest (M=15.30, SD=3.46) in comparison to the post-test (M=26.87, SD=1.52). The difference was statistically proved at 99.9% level of confidence and it shows that effectiveness of clinical pathway upon the nurses. Hence the null hypothesis Ho1was rejected. ❖ Mean and standard deviation of Knowledge on clinical pathway was low in pre test in all aspects of care and high in the post test. This shows that the knowledge of the nurses improved after implementation of clinical pathway that is Clinical pathway (M=0.32, SD=0.80; M=1.25, SD=1.2), Pre op and post op care (M=0.46, SD=0.90; M=1.66, SD=2.32), oxygen administration (M=0.4, SD=0.97; M=1.08, SD=1.70), Nutrition (M=0.60, SD=0.920; M=1.8, SD=2.35), position and exercise (M=0.60, SD=0.82; M=1.55, SD=1.80), wound care (M=0.72, SD= 1; M=1.46, SD=1.72) and patient education (M=0.7, SD=0.87; M=1.43, SD=1.61) respectively. The difference was statistically proved at 99.9% level of confidence and it was attributed to the effectiveness of clinical pathway upon the nurses in various aspects of care. ❖ Mean and standard deviation of practice scores of nurses were high in after the clinical pathway administration (M=322.02, SD=5.63) in comparison to the before clinical pathway administration (M=260.56, SD=2.8). The difference was statistically proved at 99.9% level of confidence and it shows the effectiveness of clinical pathway upon the nurses on patients undergoing hysterectomy. Hence the null hypothesis Ho1 was rejected. ❖ Mean and standard deviation of practice of nurses in control group were less compared to the experimental group of patients undergoing hysterectomy. This shows the practice of the nurses in pre op in control and experimental group (M=121.6, SD=5.34; M=154, SD=1.1), day 0 (M=118.3, SD=2.1; M=134.3, SD=1.36), day 1 (M=83.2, SD=2.3; M=98.6, SD=1.28), day 2 (M=67.2, SD=7.18; M=86.5, SD=1.54), day 3 (M=123.2, SD=6.27; M=155.2, SD=1.4) respectively. The difference was statistically proved at 99% level of confidence and it was concluded that the practice of nurses in clinical pathway for patients undergoing hysterectomy was effective in experimental group. ❖ The mean and standard deviation of outcome of hysterectomy patients in the control group (M=2.97, SD=3.61) were greater when compared to the experimental group (M=0.52, SD= 1.32). This indicates the experimental group of patients did not developed complications. The difference was statistically proved at 99.9% level of confidence and it shows that effectiveness of clinical pathway upon the patients outcome of the hysterectomy patients. Hence the null hypothesis Ho2 was rejected. ❖ The mean and standard deviation of satisfaction in the control group (M=121.93, SD= 9.52) were less when compared to the experimental group of patients undergoing hysterectomy (M=147.2, SD=9.62), which indicates that the experimental group of patients are highly satisfied. The level of confidence was 99.9% and it shows that effectiveness of clinical pathway upon the patients satisfaction. Hence the null hypothesis Ho2was rejected. ❖ Mean and standard deviation of satisfaction (M=17.33, SD=3.22), (M= 17.06, SD=2.81), (M=14.7, SD=2.57), (M=14.35, SD=2.52) in control group of patients components was less compared to the experimental group (M=19.62, SD=0.74), (M=19.52, SD=1.012), (M=18.25, SD=1.48) (M=18.05, SD=1.66) of patients undergoing hysterectomy. This shows that significant difference was found in spiritual needs, communication, family involvement, education, discharge plan. The difference was statistically proved at 99.9% level of confidence and can be attributed to the effectiveness of clinical pathway upon patient’s satisfaction of the hysterectomy. ❖ There is no association between the age, educational qualification, marital status and years of experience, religion, previous information in the level of knowledge for the nurses in the pre & post-test. It has proven that there no is association between the selected demographic variables and level of knowledge. Hence the null hypothesis Ho3 was retained with regard to age, educational qualification, marital status and years of experience, religion, previous information. ❖ There was association between demographic variables and level of satisfaction in the control group of patients undergoing hysterectomy. Hence the null hypotheses Ho4 was rejected with regard to education and occupation. ❖ There was no association between demographic variable and outcome of patients undergoing hysterectomy in control group and experimental group. No statistics could be applied to find the association between demographic variables and the patient outcome. Hence the null hypothesis Ho4 was retained. ❖ There was significant association between clinical variables and level of satisfaction of patients in control group. Hence the null hypothesis Ho4 was rejected with regard to the co morbidity. ❖ There was no association between clinical variable and outcome of patients undergoing hysterectomy in control group and experimental group. No statistics could be applied to find the association between clinical variables and the patient outcome. Hence the null hypothesis Ho5 was retained. The above findings reveal that clinical pathway for patients undergoing hysterectomy Improves the knowledge and practice of nurses and patients satisfaction and outcome. Which showed that the clinical pathway provided by the researcher was effective. RECOMMENDATIONS: ❖ A similar study can be conducted in different settings. ❖ A comparative study between two clinical settings can also be conducted. ❖ The same study can be conducted with larger number of samples of hysterectomy patients. ❖ A similar study can be conducted by using prospective study and retrospective study design. ❖ A comparative study can be conducted for different clinical pathway to evaluate the best practices. ❖ A study can be conducted among nursing personnel for each of their nursing activities. ❖ A study can be conducted for other clinical conditions.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Effectiveness, Clinical Pathway, Patients Undergoing Hysterectomy, Knowledge, Practice, Nurses and Patient’s Outcome.
Subjects: NURSING > Obstetrics and Gynaecology Nursing
Depositing User: Subramani R
Date Deposited: 22 Aug 2020 19:24
Last Modified: 22 Aug 2020 19:24
URI: http://repository-tnmgrmu.ac.in/id/eprint/12957

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