الفهرس 
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Abstract
Summary
Various non-pharmacological treatments have been identified and are widely believed to address the needs of individuals. The non-pharmacological strategies include the use of education, relaxation techniques, breathing exercises, massage, position changes, and early mobilization (Jones et al., 2012& Anarado et al., 2015).
When non-pharmacological interventions are used as a coping strategy before surgery, it can improve patient’s outcomes and it can lessen a patient’s pre-operative anxiety, reduce post-operative surgical pain, narcotic use, and length of hospital stay for inpatient surgical procedures (Gonzales et al., 2010).
Post-operative complications can be due to anesthesia or surgery or a reaction to the anxiety of surgery itself. Common complications include fever, chest infection, pneumonia, wound infection, bleeding or deep vein thrombosis. Most of the complications manifests after the first few days of surgery, usually 1 to 3 days (WHO, 2013).
The aim of present study was to evaluate the effect of non-pharmacological nursing interventions on outcomes of patients with abdominal surgeries, through:
1- Assessment of patient’s condition and needs.
2- Developing and implementing non-pharmacological nursing interventions and booklet for study group based on patient’s needs.
3- Evaluating the effects of non-pharmacological nursing interventions on the outcome of patients with abdominal surgeries.
To meet the aim of the study, Quasi experimental design was applied and conducted at general surgery wards (5, 7, 10 and 13) at El-Demerdash hospital, Ain Shams University, Egypt.
The study was carried out on 140 adult patients who were scheduled for the abdominal surgery and had the ability to communicate and read. A sample of (140) adult patients undergoing abdominal surgeries were included in the study divided into study and control groups.
Two tools were used for data collection; the first tool was patients’ assessment structured questionnaire sheet, which consisted of five parts. The 1st part concerned with personal and clinical data of patients under study, 2nd part concerned with vital signs measurement for the patients pre and post the operation, and 3rd part was a anxiety inventory scale which included 20 items to assess patients anxiety pre and post-operation
The 4th part was numerical rating pain intensity assessment scale to assess post-operative pain intensity level, and 5th part concerned with postoperative analgesic intake. The second tool was postoperative patients’ complications observational checklist to assess the patients’ complications which may state after the surgery for both groups. The observational checklist in the current study consisted of two options: yes or no option.
The data collected and analyzed by the appropriate statistical tests. The main findings of the study were as follow:-
There were non statistically significance difference between both control and study groups regarding demographic and clinical data, P-value>0.05. More than half of patients were males for both groups (57.14%), patients aged from 28-37 years were 34.29% of control group and the same percentage with the patients aged more than 49 years old in the same group, while patients aged more than 49 years were 37.14% of study group.
Regarding the marital status, the study revealed that married patient were 68.57% and 81.43% of control and study groups, respectively. As regard to educational level was 42.86% and 45.71% in control and study groups, respectively had primary school education. As regard to types of surgery, 44.29% of patients in control group underwent herniotomy, while 45.71% of study group underwent cholecystectomy
It is evident from the present study that 90% of study group stayed in hospital less than 5 days with highly statistically significant difference regarding length of hospital stay between both groups, p<0.001. It is evident from the present study that 10% of patients in study group used analgesic for severe pain versus 47.14% of the patient in control group with highly statistically significant difference, p<0.001.
It is evident from the present study that there was non-statistically significant difference between study and control groups regarding anxiety level in the day pre the operation and night of operation, p-value>0.05. 25.71% of patients in study group had no anxiety in the night of operation versus 15.71% of patients in control group, that the same in 1st day post the operation. In 2nd day post the operation, present study revealed that 44.29% of patients in study group had no anxiety versus 15.71% of patients in control group with statistically significant difference between both groups p-value<0.05 .
As regard of post-operative pain intensity level, this finding revealed that 60% of study group had severe pain in 1st day post the operation versus 88.57% of patients in control group. In the 2nd day post the operation 10% of study group had severe pain versus 47.14% of patients in control group with highly statistically significance difference, p<0.001.
The present study demonstrated that, there was no statistically significance difference between both groups in the day pre the operation regarding patients’ vital signs, and there was a statistically significant difference between both groups in 2nd day post the operation regarding patients’ vital signs, p<0.05.
Regarding patients’ outcome related to post-operative complications, this finding illustrated that, 50% of control group had post-operative complications versus 10% of study group with statistically significant difference between both groups, p<0.005.
There was a highly statistically significant relation between total anxiety mean score level and demographic characteristics (gender, age, marital status, and occupational status) and types of surgery among the patients in study group, p-value<0.001**. On other hand, there was no statistically significant relation between total anxiety mean score level and educational level among the patients in study group, p-value>0.05.
Moreover, there was a highly statistical significant relation between postoperative pain intensity mean score level and demographic characteristics (gender, age, marital status, and occupational status) and types of surgery among the patients in study group, p<0.001. On the other hand, there was no statistically significant relation between post-operative pain intensity mean score level and educational level among the patients in study group, p>0.05.
There was a highly statistically significant relation between total anxiety mean score level and length of hospital stay and analgesic intake among the patients in study group, p-value<0.001**. Also, there was a highly statistically significant relation between postoperative pain intensity mean score level and length of hospital stay and analgesic intake among the patients in study group p-value<0.001**.
Also, there was highly statistically significant correlation between length of hospital stay, anxiety level, postoperative pain intensity level, and postoperative complications rate among the patients in study group P < 0.001**.
Based on the present study finding, it can be concluded that: -
The non-pharmacological nursing interventions had a statistical significant positive effect on the patient’s outcomes after abdominal surgeries. There was improvement in the outcomes of patients in the study group regarding vital signs, anxiety level, postoperative pain intensity level, analgesic intake, postoperative complications rate, and length of hospital stay versus the patients in the control group.
Based on the present study findings, the following is recommended.
1. Rigorous formal pre-operative educational guides, using structured knowledge about non-pharmacological interventions should be mandatory in nursing care practice at the general surgical wards, and their effectiveness is to be evaluated.
2. There is a need for continuous educational programs for patients with abdominal surgeries about the benefits and techniques of using non-pharmacological interventions for improving their outcomes postoperatively.
3. Perspective follow up studies are needed to evaluate the effectiveness of the non-pharmacological intervention on the outcome of patients including; pain, analgesics, anxiety, and postoperative complications in addition to their self-care management and quality of life.
4. Further studies are required to assess the factors affecting outcomes of patients with abdominal surgeries to take into consideration to raise the efficiency of nursing intervention given to such group of patients to enhance their outcomes.
5. The use of non-pharmacological interventions in addition to pharmacological intervention is recommended for all patients suffering from acute and chronic pain in different settings to enhance their outcomes.
6. Replication of study on a larger probability sample selected from different geographical areas in Egypt is recommended to figure out the main aspects of this problem and generalize the finding of this study.