Wong Janice, Mulamira Pius, Arizu Jessica, Nabwire Mariam, Mugabi Dorothy, Nabulime Sarah, Driwaru Dorine, Nankya Esther, Batumba Ritah, Hagara Augustin, Okoth Anthony, Lindan Namugga Jane, Ajeani Judith, Nakisige Carolyn, Ueda Stefanie M, Havrilesky Laura J, Lee Paula S
Duke University School of Medicine, Durham, NC, USA.
Uganda Cancer Institute, Kampala, Uganda.
Gynecol Oncol Rep. 2021 Dec 21;39:100915. doi: 10.1016/j.gore.2021.100915. eCollection 2022 Feb.
In Kampala, Uganda, there is a strong cultural practice for patients to have designated caregivers for the duration of hospitalization. At the same time, nursing support is limited. This quality improvement project aimed to standardize caregiver and nursing perioperative care on the gynecologic oncology wards at the Uganda Cancer Institute and Mulago Specialised Women and Neonatal Hospital.
We developed, implemented, and evaluated a multidisciplinary intervention involving standardization of nursing care, patient education, and family member integration from October 2019 - July 2020. Data were abstracted from medical records and patient interviews pertaining to the following outcomes: 1) pain control; 2) post-operative surgical site infections, urinary tract infections, and pneumonia; 3) nursing documentation of medication administration, pain quality, and vital sign assessments, and 4) patient and caregiver education. Descriptive statistics, Fisher's exact test, and independent samples -test were applied.
Data were collected from 25 patients undergoing major gynecologic procedures. Pre- (N = 14) and post- (N = 11) intervention comparison demonstrated significant increases in preoperative patient education (0% to 80%, p = 0.001) and utilization of a comprehensive postoperative order form (0% to 45.5%, p = 0.009). Increased frequency in nursing documentation of patient checks (3 to 8, p = 0.266) and intraoperative antibiotic administration (9 to 10, p = 0.180) in patient charts did not reach significance. There was no change in infection rate, pain score utilization, caregiver documentation, or preoperative medication acquisition.
Our findings suggest that patient- and family-centered perioperative care can be improved through standardization of nursing care, improved education, and integration of caregivers in a nursing-limited setting.
在乌干达坎帕拉，患者在住院期间由指定护理人员照料是一种盛行的文化习俗。与此同时，护理支持有限。本质量改进项目旨在规范乌干达癌症研究所和穆拉戈专科医院妇女与新生儿科妇科肿瘤病房护理人员对患者及其护理人员的围手术期护理。
我们于2019年10月至2020年7月开展、实施并评估了一项多学科干预措施，内容包括护理标准化、患者教育以及家庭成员参与。数据从医疗记录和患者访谈中提取，涉及以下结果：1）疼痛控制；2）术后手术部位感染、尿路感染和肺炎；3）护理人员对用药、疼痛性质和生命体征评估的记录，以及4）患者和护理人员教育情况。采用描述性统计、费舍尔精确检验和独立样本检验。
收集了25例接受大型妇科手术患者的数据。干预前（N = 14）和干预后（N = 11）的比较显示，术前患者教育显著增加（从0%增至80%，p = 0.001），综合术后医嘱单的使用率显著提高（从0%增至45.5%，p = 0.009）。患者病历中护理人员对患者检查记录的频率增加（从3次增至8次，p = 0.266）以及术中抗生素给药记录增加（从9次增至10次，p = 0.180）未达到显著差异。感染率、疼痛评分使用率、护理人员记录或术前用药获取情况均无变化。
我们的研究结果表明，在护理资源有限的情况下，通过护理标准化、加强教育以及让护理人员参与其中，可以改善以患者和家庭为中心的围手术期护理。
