Medical and Surgical Nursing Department

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    Pre and post operative Anxiety Among Adult Patients for Elective General Surgery in Three Selected Public Teaching Hospitals In Khartoum State
    ( 2020) Ebtisam Ahmed Elfadel Albasheer ; Mohamed Toum Musa
    Abstract: Background: Anxiety is a big problem that affects the patient responses to surgery and leads to complications that postponed the surgical operation. Objective: The study aimed to assess pre and postoperative anxiety of patients and to identify factors that associated with preoperative anxiety. Methods: Descriptive hospital based study conducted at Ibrahim Malik, Bahri and Omdurman teaching hospitals from November 2019 to February 2020.All patients (230 patients) from elective general surgery at the day before operation and first post-operative visit were included by using convenient sampling technique. The data were collected from using structured questionnaire filled by the researcher. Anxiety was assessed with the Hamilton Anxiety Rating Scale (HAM-A). The data were analyzed by using the Statistical Package for Social Sciences (SPSS) version 25, Chi-square and p value was used to associate between pre and post-operative anxiety levels with selected demographic variables. Results: Finding showed that the levels of preoperative anxiety in surgical patients were highest than postoperative anxiety, (preoperative P.value =0.263, postoperative P.value=0.000).The patient‟s preoperative mean anxiety score (2.58) was statistically significantly higher than their postoperative mean anxiety score (1.03). There were Significance association between patient‟s genders, educational level and preoperative anxiety (p value.000). There was no significance Association between anxiety level and age, Marital Status, Previous surgery, Health insurance and Duration of the stay in the hospital either preoperative or post-operative. The most common factors Responsible for preoperative anxiety were concern about family (80%), fear of complications (79.1%), and postoperative pain (71.7%). Conclusion: The study Conclude that the levels preoperative anxiety in surgical patients was highest than postoperative anxiety. There was significance association between patient‟s genders, educational level and preoperative anxiety. While concerns of family, fear of complications and post-operative pain the most common factors associated with preoperative anxiety. Keywords: Anxiety; Surgery; Preoperative; Postoperative. VI المستخلص: الخلفية: القلق مشكلة كبٌرة تؤثر على استجابة المرٌض للجراحة وتؤدي إلى مضاعفات تؤدي إلى تأجٌل العملٌة الجراحٌة الهدف: هدفت الدراسة إلى تقٌٌم قلق المرضى قبل وبعد الجراحة وتحدٌد العوامل المرتبطة بالقلق قبل الجراحة. المنهجية: تم استخدام دراسة وصفٌة وقد أجرٌت فً مستشفً إبراهٌم مالك وبحري وأم درمان التعلٌمً من نوفمبر 9103 إلى فبراٌر 9191 ، حٌث تم ضمت الدراسة جمٌع مرضى الجراحة العامة للعملٌات الباردة وعددهم )931 مرٌ ًضا( فً الٌوم السابق للعملٌة وأول للمقابلة مابعد العملٌة تم جمع البٌانات باستخدام استبٌا ن مصمم من قبل الباحث و تم تقٌٌم القلق باستخدام مقٌاس تقٌٌم القلق )لهامٌلتون ( تم تحلٌل البٌانات باستخدام الحزمة اإلحصائٌة للعلوم االجتماعٌة )SPSS ( اإلصدار( 92 (واستخدمت قٌمة مربع كاي للربط بٌن مستوٌات القلق قبل وبعد العملٌة مع المتغٌرات الدٌموغرافٌة المحددة. النتائج: أظهرت نتائج الدراسة أن مستوٌات القلق قبل الجراحة لدى المرضى أعلى من القلق ما بعد الجراحة )قٌمة ب قبل الجراحة = 3.9.1 ( )قٌمة ب بعدالجراحة = 111.1) وكان متوسط درجة القلق قبل الجراحة )22.9 )أعلى بكثٌر من متوسط القلق بعد الجراحة )13.0 .) كان هناك ارتباط كبٌرذو داللة احصائٌة بٌن جنس المرٌض والمستوى التعلٌمً والقلق ما قبل العملٌة )ب قٌمة =111.1.) لم ٌكن هناك ارتباط مهم بٌن مستوى القلق ،العمر ،الحالة االجتماعٌة ،الجراحة السابقة ،التأمٌن الصحً اومدة اإلقامة فً المستشفى سواء قبل الجراحة أو بعد الجراحة.كانت العوامل األكثر شٌو ًعا المسؤولة عن القلق قبل الجراحة هً القلق بشأ ن األسرة )421 ، )والخوف من المضاعفا ت )0.413 ، )وآالم ما بعد الجراحة )1.410.)) الخاتمة: خلصت الدراسة إلى أن مستوي القلق قبل الجراحة لدي المرضى أعلى من القلق بعد الجراحة. كان هناك ارتباط كبٌر بٌن جنس المرٌض والمستوى التعلٌمً وقلق ما قبل الجراحة. فً حٌن ان ماٌتعلق األسرة والخوف من المضاعفات وآالم ما بعد الجراحة هً أكثر العوامل المرتبطة بالقلق قبل الجراحة، الكلمات المفتاحية : القلق ؛ جراحة ؛ قبل الجراحة بعد الجراحة.
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    Knowledge and Practice of Nurses Regarding Transfer of Critically Ill Surgical Patients in Three University Hospitals in Khartoum State 2017
    (University of Khartoum, 2020) Massaged AbdalrheemSaeedEdrise
    Abstract Background The nurses play an important role in transfer of critically ill surgical patients. The transport process itself is associated with a risk of physiological deterioration and adverse events. Critically ill surgical patients in particular commonly require such transfers and are at high risk of complications. This process needs accurate nurses knowledge and skills. Objective: to assess the nurses’ knowledge and practice regarding Transfer of critically ill surgical patients in three university hospitals in Khartoum State, 2017. Methods: This is a descriptive cross sectional hospital-based study. The study sample involved one hundred and seventy-three nurses in three university hospitals in Khartoum state in the year 2017.The study sample was analyzed successfully surveyed using both a questionnaire and check list. Data was using descriptive statistic of central tendency and Statistical Packages for Social Sciences (Version 23). Results: knowledge level of the participants was poor in the majority of them (63.6%), and good in (36.4%). The practice level of the participants was poor in the majority of them (72.6%), good in (27.4%).The overall correct knowledge of the nurses about transfer of critically ill surgical patients was found to be significantly associated with higher qualifications, and training (P value=0.002,0.001respectively). Conclusion and recommendation: The study concluded that the level of knowledge was poor among the studied group resulting in improper practice. The study recommended that there should be an in-service training and special educational programstargeting nurses to improve nurse’s knowledge and practices ملخص البحث خلفية:يلعب الممرضين دورًا مهمًا في نقل مرضى الجراحة ذوي الحالات الحرجة. ترتبط عملية النقل نفسها بخطر التدهور الفسيولوجي والأحداث السلبية. عادة ما يحتاج مرضى الجراحة الحرجة بشكل خاص إلى مثل هذه التحويلات وهم معرضون بشدة لخطر حدوث مضاعفات. تحتاج هذة العملية الي معرفة ومهارات ممرضين دقيقة. هدفا الدراسة: تقييم معرفة والممارسة العملية للممرضين فيما يتعلق بنقل مرضى الجراحة ذوي الحالات الحرجة في ثلاثة مستشفيات جامعية في ولاية الخرطوم، 2017. المنهجية: هذه دراسة وصفية مقطعية قائمة على المستشفى. اشتملت عينة الدراسة على مائة وثلاثة وسبعين ممرضاً في ثلاث مستشفيات جامعية بولاية الخرطوم في عام 2017. تم المسح بنجاح باستخدام كل من الاستبيان والقائمة المرجعية(الملاحظات). تم إجراء البيانات باستخدام الإحصاء الوصفي النزعة المركزيةوتحليلها باستخدام الحزم الإحصائية للعلوم الاجتماعية (الإصدار 23) النتائج: كان مستوى المعرفة لدى المشاركين ضعيفاً في غالبيتهم (63.6٪) وجيد في (36.4٪). كان مستوى الممارسة العمليةللمشاركين ضعيفًا في غالبيتهم (72.6٪)، وجيد في (27.4٪). وُجد أن المعرفة الصحيحة العامة للممرضين حول نقل مرضى الجراحة الحرجة مرتبطة بشكل كبير بالمؤهلات العليا.، والتدريب (قيمة P = 0.002،0.001 على التوالي) الخاتمة والتوصيات: خلصت الدراسة إلى أن مستوى المعرفة كان ضعيفًا بين المجموعة التي أجريت فيها الدراسة مما أدى إلى ممارسة عملية ضعيفه. أوصت الدراسة بضرورة وجود تدريب أثناء الخدمة وبرامج تعليمية خاصة تستهدف الممرضات لتحسين معرفة الممرضينوالممارسات العملية.
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    Fourth Year Nursing Students’ Perception of Safety in Clinical Settings in Governmental Universities - Khartoum state (2018).
    (University of Khartoum, ) Ibrahim, Sahar Ahmed Mohammed ; Mohamed Toum Musa Mohamed ; Medical and Surgical Nursing Department
    Background: The goal of nursing education is the preparation of students who are able to enter the workforce and function safely and competently as new graduates. The ability to fulfill this function is dependent on a clinical learning environment that is supportive of student learning and as we know nurses are committed through the code of ethics to provide safe, competent and ethical care, this study aimed to explore fourth year nursing students’ perception of safety in clinical settings. Methodology : This is a descriptive exploratory cross-sectional study conducted in Khartoum state at five recognized governmental universities, total coverage sampling method was used, included 470 nursing students in the 4th year 2017-2018 that met selection criteria, data collected by the researcher using published self administered survey then the collected data were analyzed included 470 respondents. Results: Among 519 nursing students included, a total of 470 students responded at a rate of 90.5% and responses showed that almost near half of them 204(43.4%) revealed that safety is their focus during their clinical shift. In addition, half of them 240(51.1%) strongly agree that there are safety problems on the clinical settings, furthermore respondents stressed that the clinical nurse by 138(29.4%) and nurse students by 167(35.5%) feel that mistakes are held against them. Also 133(28.3%) agree that our policies and procedures are not good at preventing errors from happening and one third of them 171(36.4% feel that they provide safe care. Although one third of them 162(34.5%) reported that students and nurses in the clinical settings sometimes discuss ways to prevent errors from happening while, 153(32.6%) never feel free to speak up if they see something that may negatively affect the patient safety and 164(34.9%) perceived that nurses were not appear free to speak up if they see something that may negatively affect the patient safety. Hence near to half 232(49.4%) stressed that clinical instructor never discuss patient safety including the use of reporting tools, moreover the majority 391(83.2%) of respondents reported that they did not complete a hospital incident report when an error is made and 401(85.3%) reported that they never complete nursing school specific error report. Hence 362(77%) replied that they never report near miss errors and 270(57.4%) reveled they never report errors that made potential harm to the patient. Conclusion: The study concluded that safety is the focus of the students. There are safety problems on the clinical settings. Students are concerned with errors. Our policies and procedures are not good at preventing errors from happening. The safety-reporting tool is not available to be completed. Hence under reporting of the errors and near miss errors and barriers exist for the nursing student to repot errors and near miss errors.
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    Effectiveness of Psycho-Educational Programm on Cardiac Surgical Patients in Khartoum State
    (University of Khartoum, ) Ishraga Mohammed Ahmed Elbashier ; Kamil Merghani Ali ; Medical and Surgical Nursing
    Background: The presence of anxiety and depression before cardiac surgery leads to poor surgical outcomes. This study conducted to assess the effectiveness of psycho-educational programme on anxiety and depression, quality of life, and post-operative hospital stay among cardiac surgery patients in cardiac hospitals, Khartoum state. Methods:Fifty seven eligible and consented patients were included in a quasi-experimental study (pre-post) combines focus group discussion,30 patients were allocated to intervention group in Ahmed Gassim cardiac center, and 27 in Sudan heart Institute and Alshaab Teaching Hospital as control group. Fifteen to twenty minutes counseling sessions were given to the intervention group before surgery. Pre test and baseline data were collected on the second day after admission. The effects of the preoperative psycho-education was evaluated, first by measuring the change in the levels of anxiety and depression score on the Hospital Anxiety and Depression Scale (HADS) at the seventh day after the operation, and the second one was SF36v2 health survey for measuring quality of life six month after operation. The length of postoperative hospital stay was evaluatedfrom medical records. A focus group discussion was conducted with five patients from intervention group participants before hospital discharge. Results: The mean scores obtained in both anxiety and depression dimensions were significantly different between the intervention and control groups. P-value 0.000 for anxiety, and .001 for depression. Quality of life improved in intervention group, as 66% of respondents were above average of normal mental level, and 48% were above physical level of general population, while all respondents incontrol group after surgery were below average for both mental and physical normal level of general population. There was significant reduction in length of hospital stay after surgery among intervention group (P-value 0.003). In qualitative findings, the participants admitted having complete benefit from their participation in the study. Conclusion: Psycho-educational program provided for patients undergoing cardiac surgery, improve psychological condition, quality of life, and reduces the length of post-operative hospital stay. The study recommends psycho-educational sessions for heart surgical patients and their families preoperatively, with the help of the booklet focused on managing these patients.
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    Assessment of Effect of Educational Program for Heart Failure Patients on Self Care, Readmission in Alshab Teaching Hospital (Khartoum State)
    (University of Khartoum, 2016-03-22) Fageery, Fageery Mohammed Yassien ; Abdalla Mahmud Abass
    Background: Heart failure (HF) is a major health problem and a challenge facing individuals and the whole society. Literature review has provided evidence that there is considerable misunderstanding about HF among patients. Knowledge about HF and its risk factors is an important pre-requisite for an individual to implement behavioral changes leading to prevention, or reduction of re-admission. Self-care behaviors include medications, regular weight monitoring, and exercise, which play a major role in maintaining physiological stability. Performing these self-care behaviors are central factors in facilitating lifestyle changes. Improvement of individual self-care skills and behaviors are an important outcome of patient education and counseling. The aim of this study was to evaluate the effectiveness of the educational program in improving self-care behavior and controlling hospital re-admission among HF patients. Methods: Quasi-experimental study design was used (pretest and post test). Forty nine participants were conveniently sampled and participated into this study during the period October to November 2013. Patient’s data was collect from the outpatient clinic of Alshaab hospital. Educational program was applied via face-to-face to improve self-care and reduce or prevent re-admission. The duration of intervention was 6-month. Questionnaire was used for the data collection. Results: The data was analyzed to evaluate the educational program on self-care behavior and prevention or reduction of hospital re-admission among heart failure patients. 55.1% of participants were illiterate; 59.3 % of illiterate participants are males and 40.7 % of them are females. Regarding physical exercise 16.3% were practicing it in the pre-test but in post-test period and follow-up, the number increased to 51%. 65.3% participants were hospitalized during the six months of the pre-test but 18.4% were hospitalized in the post-test period and follow-up. I. 12.2% of the participants were taking medications regularly in the pre-test; but only 4.2% were taking medications regularly in the post-test and follow-up. The median behavior of the total scores in the pre-test was 62, either in the post-test and the follow-up was 64. The mean knowledge of the total scores in the post-test (21.41 S.D. = 5.70) and follow-up test (23.80 S.D. = 5.42) were significantly higher than pre-test (17.14 S.D. = 6.57), (p < 0.001). The pre-test scores were significantly different from the post–test scores, at level of p