الفهرس 
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Abstract
Gall bladder disease is a common health problem worldwide. It is estimated that 8% to 10% of adults have gallbladder disease. The actual number is not known because many persons are asymptomatic. The incidence of gallbladder disease is higher in women, especially multiparous, and persons over 40 years of age. The major types of gall bladder disease include cholelithiasis and cholecystitis.
Cholelithiasis considers one of the most common digestive tract diseases and constitutes an important health problem in developed countries. Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallstone disease. It is considered one of the most common surgical procedures in the western world.
The educative role of the nurse is an integral part of the care that is essential to patient satisfaction and positive outcomes. The nursing care for LC patients includes physical and broadened psychosocial care. Specific standards are needed to provide efficient pre and post-operative nursing care to patients undergoing laparoscopic cholecystectomy
The purpose of the proposed nursing guidelines for the care of patients undergoing laparoscopic cholecystectomy is effective in inducing improvements in nurses’ related knowledge and practice, which is a better achievement of patients’ needs resulting in decreasing the incidence of complications after surgical care.
The aim of this study:
• Assess nurses’ knowledge regarding the perioperative care of patients with cholelithiasis undergoing laparoscopic cholecystectomy.
• Assess nurses’ practices regarding the peri-operative care of patients with cholelithiasis undergoing laparoscopic cholecystectomy.
• Propose peri-operative care guidelines for patients with cholelithiasis undergoing laparoscopic cholecystectomy.
Material and methods: Research design:
A descriptive exploratory study investigated the actual knowledge and performance of nurses providing care for patients with cholelithiasis undergoing laparoscopic cholecystectomy.
Setting:
This study was conducted in two settings namely; Alexandria Main University Hospital, and Medical Research Institute in the inpatient Hepato-biliary and Pancreatic Surgery Department.
Subjects: The present study subjects were assigned into two groups as follows;
group one: Consisted of all nurses (n=50) who were available at the time of data collection, and assigned to provide direct care for patients with cholelithiasis undergoing laparoscopic cholecystectomy in the above-mentioned settings, twenty from Alexandria Main University Hospital and thirty from Medical Research Institute.
group two (Jury members): A convenient sample of thirty-seven expert members in nursing and education and service was included in the study as follows:
a) Twenty five members of the Medical-Surgical Nursing Department, Faculty of Nursing, University of Alexandria, Ain Shams University, and Assiut University to obtain different points of view. Experts in the field of medical-surgical nursing submitted the proposed peri-operative nursing care guidelines for patients with cholelithiasis undergoing laparoscopic cholecystectomy to assure the content validity, clarity of items, comprehensiveness, appropriateness, and the necessary modification were done.
b) Ten surgeons with more than five years of experience working in the laparoscopic cholecystectomy unit of Alexandria Main University Hospital and Medical Research Institute.
c) Two head nurses with more than five years of experience working in the laparoscopic cholecystectomy unit at the Main University Hospital and Medical Research Institute. Available at the time of data collection in the above-mentioned settings.
Tools of the study:
Three tools were developed by the researcher based on the review of recent related literature to collect the necessary data for this study. This tool was developed to elicit the opinions of the expert group who had experience in the field of the study regarding patients with cholelithiasis undergoing laparoscopic cholecystectomy, basic required nurses’ perioperative care.
Tool I: Nurses’ Knowledge of the Peri-operative Care of Patients with Cholelithiasis undergoing Laparoscopic Cholecystectomy Structured Interview Schedule: This tool included items such as nurses’ socio-demographic characteristics and knowledge regarding the perioperative nursing cares for patients with cholelithiasis undergoing laparoscopic cholecystectomy.
Tool II: Nurses’ Peri-operative Care practices of Patients with
Cholelithiasis Undergoing Laparoscopic Cholecystectomy Observational Checklist: It was used to assess nurses’ practices regarding peri-operative care of patients with cholelithiasis undergoing laparoscopic cholecystectomy, including the following practice domains: Pre-operative preparations, Intra-operative preparations, and post- operative preparations.
Tool III: Basic Nurses’ Peri-operative Care Opinionnaire Sheet for Patients with Cholelithiasis Undergoing Laparoscopic Cholecystectomy.
Method:
The study was accomplished as follows:
Approval of the Ethical Research Committee, Faculty of Nursing, Alexandria University was obtained before conducting the study.
Official permission from the Faculty of Nursing, Alexandria University was obtained and directed to the responsible authorities of the study settings to take their permission to conduct the study after explaining the aims of the study.
Official written permission to conduct the study was obtained from the hospitals’ administrative personnel and directors of the nursing services department of the chosen settings after an explanation of the aims of the study.
Written informed consent of the participants was taken and confidentiality will be ensured.
Three tools were used to collect the data:
Reliability: Tool I, tool II and tool III were tested for reliability using Cronbach’s Alpha test to measure its internal consistency to evaluate how well the questionnaire consistently measures what they are designed to measure. It was estimated r ═ 0.70.
Validity: All developed tools were tested for content validity by every
member of the expert groups to assure their content validity and clarity of items.
Pilot study: A pilot study was carried out on 10% of the study nurses (5 nurses) from the previously mentioned settings who were excluded from the study subjects, to test the clarity and feasibility of the tools (tool II and III), and the necessary modifications were done accordingly. Preparing the proposed guidelines: Testing applicability and feasibility of the proposed guidelines were performed through nurses’ practices assessment throughout the caring of patients undergoing laparoscopic cholecystectomy procedures using tools II and III.
Ethical considerations:
• Witness informed written consent was obtained from the head nurse of the identified study settings
• Written informed consent was obtained from each nurse after the explanation of the purposes of the study.
• Study participants were informed that they have the right to participate in the study voluntarily and have a right to withdraw at any time during the study and that was considered and respected.
• Confidentiality of the collected data for each nurse was assured.
Statistical analysis:
Data were fed to the computer and analyzed using IBM SPSS software package version 25.0. (Armonk, NY: IBM Corp) Qualitative data were described using numbers and percentages. The Kolmogorov-Smirnov test was used to verify the normality of distribution. Quantitative data were described using range minimum and maximum, mean, and standard deviation. The significance of the obtained results was judged at the 5% level. The used statistical tests were: ANOVA, Friedman test, Marginal Homogeneity Test, and Paired t-test
The main result of the study:
Demographic criteria of the studied nurses; 40% were located in the age group 21<30 years, also, the majority of studied nurses88% were females, and more than half of them 60%were married.
96% of the studied nurses had a diploma degree in nursing
concerning nurses’ educational level.
40% of the studied nurses had experienced less than five years, and 100% did not attend any training courses related to the care of patients undergoing laparoscopic cholecystectomy.
All the studied nurses 100% had a fair level of knowledge regarding laparoscopic cholecystectomy, and the Min.–Max. 13.0–
15.0 and the mean± SD overall knowledge regarding laparoscopic cholecystectomy 14.40 ± 0.571.
The mean± SD percent score of overall knowledge regarding laparoscopic cholecystectomy 72%, and there was no statistically significant relation between the nurses’ knowledge level and their age, marital status, level of education, years of experience, and the working hospital p= 0.522, 0.233, 0.363, 0.201, 0.104, 0.485 respectively.
About the pre-operative nursing practices; about 76% of the studied nurses had a fair performance level,
Regarding the intra-operative nursing practices; more than half 64% of the studied nurses had a good performance level, while 36% of them had a fair performance level.
Concerning post-operative nursing practices; 80%of the studied nurses had a fair performance level.
The total practices were fair in 80% of the studied nurses, while 20% had a good performance levels. there was no statistically
significant relation between the nurses’ practices and their age, gender, marital status, level of education, years of experience, and the working hospital p=0.082, 0.192, 0.343, 0.279, 0.203, and
0.470 respectively.
There was no statistically significant relation between the level of
nurses’ practices and their level of knowledge p=0.254.
The age of nursing educators’, the result of the study revealed that more than half 60% of nursing educators were in the age group ≥60 years, while 60% of experts in the medical field were located in the age group 30<40years, also the age of head nurses 100% were located in the age group 40<50 years.
The gender of experts of nursing educators and head nurses 100% were females, while 100% of medical experts were male.
The qualifications of nursing educators, the majority of them 80%were professors, while the qualifications of medical experts 100% were doctoral degrees, and head nurses 100% were bachelor’s degrees.
The years of experience of nursing educators; all of them 100% had 20<30 years of experience, while all medical staff 100% had 10<20 years of experience, and all head nurses 100% had 5<10 years of experience.
All experts agreed 100% about perioperative care guidelines for patients with cholelithiasis undergoing laparoscopic cholecystectomy.
Conclusion:
The results of the present study concluded that more than half of the studied nurses had a fair total level of knowledge regarding patients undergoing cholecystectomy and the majority of the studied nurses had a fair level of practice regarding patients undergoing cholecystectomy.
Recommendations:
The present study point to a great need to focus on the development of nurses’ proposed guidelines for the care of patients with cholelithiasis undergoing laparoscopic cholecystectomy. Efforts should be directed toward enhancing their knowledge and skills, and attitudes through ongoing education and training. Therefore; the following recommendations are deduced and suggested:
Recommendations for nursing staff, supervisors, and head nurses:
• Continuing developing nursing staff competencies in cholelithiasis undergoing laparoscopic cholecystectomy patient care before and after surgery, surgical units should be supplied with a protocol regarding nursing performance for patients undergoing surgical procedures.
• Establishing regular and ongoing educational workshops for continuous updating of their knowledge of cholelithiasis undergoing laparoscopic cholecystectomy.
• Organizing periodic educational training sessions about the comprehensive care of cholelithiasis undergoing laparoscopic cholecystectomy and the role of the nurse.
• Developing and continuing in-service training for nurses to develop their skills in cholelithiasis undergoing laparoscopic cholecystectomy patient care
• Establishing a library containing up-to-date references for nurses inside the unit. The proposed perioperative nursing guidelines for patients with cholelithiasis undergoing laparoscopic cholecystectomy should be distributed and implemented in the laparoscopy units for nurses in all university hospitals, health insurance units, medical institutions and private hospitals.
Recommendations for Further studies
Study the factors affecting nurses’ competence in the care of patients with cholelithiasis undergoing laparoscopic cholecystectomy.
Conducting the study in different settings in Egypt to generalize the results of the study and raise the competence of nursing care given to patients with cholelithiasis undergoing laparoscopic cholecystectomy.
Study the effect of implementing educational training program for nurses on the clinical outcomes of patients with cholelithiasis undergoing laparoscopic cholecystectomy.
Study the impact of educational training programs for nurses on the quality of life of patients with cholelithiasis undergoing laparoscopic cholecystectomy.