CHAPTER ONE

GENERAL INTRODUCTION

1.1 Background to the study

Postoperative care is the care a patient receives after a surgical procedure. The type of postoperative care provided depends on the type of surgery performed, as well as health history. Postoperative care includes pain management and wound care.(1) Postoperative care begins immediately after surgery.

It lasts for the duration of a patient’s stay in the hospital and may continue after patients have been discharged. As part of postoperative care, Nurses should educate patients about the potential side effects and complications of the procedure (1). The aim of post-operative care is to ensure the patient has a quick, painless, and safe recovery from surgery as possible.

There are three phases of post-operative care: immediate (post-anesthetic-Phase 1), intermediate (Hospital stay-phase 2), convalescent (After discharge to full recovery). The aim of phase 1&2  is to ensure homeostasis, treatment of pain and prevention, and early detection of complications(2)

The recovery from major surgery can be divided into three phases: an immediate, or post-anesthetic, and phase;(3) The intermediate phase, encompassing the hospitalization period; and a convalescent phase. During the first two phases, care is principally directed at maintenance of homeostasis, treatment of pain, and prevention and early detection and management of complications.

The convalescent phase is a transition period from the time of hospital discharge to full recovery. The trend toward earlier postoperative discharge after major surgery has shifted the venue of this period. We often say “postop starts preop,” which essentially means that the postoperative plan should be considered and discussed before surgery to set expectations for the patient and their family (2). The surgeon is responsible for the operative site and all other aspects of the care not directly related to the effects of anesthesia (3).

Before patients have surgery, nurses need to ask their doctor what the postoperative care will involve. This will give them time to prepare beforehand. However, doctors may revise some of their instructions after surgery, based on how the surgery went and how well the patient is recovering (1).

This postoperative care relationship has been deemed the “essence” (4); “crux”(5) “core” (6) and the “heart” of the discipline. It’s a professional and interaction form of relationship which guarantees that the patients’ needs are placed on the priority, where the nurse takes the responsibility for the establishment and the maintenance of the boundaries with the patients, irrespective of how the patients behave(6).

It is a helping relationship between a nurse and a patient based on mutual trust and respect, empowering of faith and hope with a positive attitude and care in assisting the patient meet his/her gratification needs physically, emotional,ly and spiritually. It is geared towards enhancing patient’s well-being.

Nurses are not the only healthcare providers who are responsible for relieving patients’ pain(7) but they also play a key role in managing patients’ pain(8) This is attributed to the fact that the nurses are in a central position between the responsible doctor and their patients(9) This study assess nurses’ knowledge and practices on immediate post-operative care of patients and will be carried out from March 2021 to April 2021 in Limbe Regional hospital and Buea Regional hospital which is found in the South-west region, Fako division of Cameroon.

Using nurses working in the Regional Hospital, data will be collected using a self-administered questionnaire by the researcher herself with objectives to investigate the nurses’ knowledge of practice on the immediate post-operative care of patients

1.2 Statement of Problem

The following problems were identified in this study

1. Ineffective or inappropriate post-operative care management: Studies conducted among Jordanian nurses indicated that nurses provide inadequate pain management during post operative care. Daibes (10) found that nurses did not perform pain management for their patients. In particularly, Daibes’s findings revealed that nurses in Jordan’s hospitals provide inadequate intervention to relieve patients’ pain and did not undertake any immediate action to manage the patients’ pain(10).
2. Another problem study is Negligence and lack of focus. Negligence from nurses in charge of post-operative care after a wound surgery can cause discomfort and make the patient contract a disease as a result of that Comparing the study conduct in some regions in sub-Saharan Africa by A. K. Karani et al 2013, described some sort of negligence some nurses portray in response to the patients’ ability. It was noted that most patients stay with their family members in the ward who take care of most of their physical/non-medical needs while the nurses only handle the medical or professional part of care.

• Poor and inadequate medical management by nurses after the operation. Medical management is very important in the post-operative care of patients, however, nurses’ practices on medical management are inadequate. This could be because they have other patients to attend to, and in the course of being fast, they tend to give inadequate medical attention to patients

1. Lack of well-trained nurses on post-operative care of patients
2. Improper management of post-operative acute pain. This can contribute to medical complications including pneumonia, deep vein thrombosis, infection, and delayed healing(11)

1.3. Justification of the Study

The researcher’s motivation to research on nurses’ knowledge and practice on the immediate post-operative care of patients in the Limbe regional hospital is based on the fact that it is an obligation of nurses to take care of patients after a surgery

• To identify the learning needs of nurses related to immediate post-operative care of patients considering that, studying the practice of related immediate post-operative care of patients will help improve on training as areas of deficiency and factors hindering compliance to its practice in Cameroon.
• In developing countries with limited standard guidelines for immediate post-operative care of patients, there is a limited up-to-date knowledge on the practice of immediate post-operative care of patients. Infection control is a very challenging problem to the public health sector in Cameroon with corresponding(12) . More so, an important aspect of nursing care is to improve patient care by minimizing infection and ensuring patient wellbeing. This can be achieved by applying the guidelines on the immediate post-operative care of patients
• The increasing growth of technology and globalization is another important reason for the study because it is important to understand if the nurses in the Limbe and Buea regional hospital actually adhere to guidelines of immediate post-operative care

1.3.1   Significance of Study

The findings of this study will be widely used.

Results from this research will help updating aseptic handling of materials during post-operative care. The results will also educate nurses on the necessity of practicing effective post-operative care. This study will provide information on nurses’ knowledge and practice on the immediate post-operative care of patients in the Limbe and Buea Regional hospital. The findings will also serve as a research baseline measurement for other researchers.

1.4. Aim

The aim of this study is to investigate nurses’ knowledge and practice on the immediate post-operative care of patients in the Limbe Regional hospitals.

1.4.1 General Objectives

The general objective of this study is to assess nurses’ knowledge and practice on the immediate post-operative care of patients in the Limbe and Buea regional hospital

1.4.2 Specific Objectives

1. To assess the percentage of nurses who are knowledgeable on post-operative care
2. To examine the percentage of nurses who practice adequate and standard post-operative care
3. To identify barriers to adequate post-operative care of patients