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41st international Nurses Conference, Mombasa, Kenya.

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PREPARED BY:

FRANCIS M KENIMAK

PRISCA MAKAU

BEATRICE KHANDEGA

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Abstract:

Pre-operative patient care guidelines (PPCG) have been used to promote good patient outcomes by ensuring that patients undergoing surgeries are prepared physically, socially and emotionally.This prevent post-operative complications and improves individualized safe,quality,surgical outcomes across healthcare settings.

This was an analytical cross sectional study carried out at KNH surgical wards to establish determinants of compliance to PPCG among nurses working in this wards. Both quantitative and qualitative research methods was used with a sample of 103 participants and data analyzed through SPSS version 22.

The results showed that 57.3% of the participants had low compliance to PPCG,shoratge of nursing staff and surgeons support in using PPCG were significantly associated with compliance to PPCG.

Finaly, staff training, recruitement and regular audits measures are required to achieve this objective.

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Background information

  • Compliance to preoperative patient care guidelines(PPCG) remains a challenge (Warner et al., 2017).
  • In developed countries, compliance to PPCG ranges between 90.5%-60.3% while in developing countries the compliance is between 45.5%-60.6%. (Burnside & Snowden et al., 2017).
  • Poor compliance to PPCG results in wrong procedures, wrong site operation, cancellation of procedures, delayed turn around time and wastage of money and other resources (Al-Abri et al., 2014).

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Problem statement

  • Globally, negative effects like surgical errors have been attributed to poor compliance to PPCG.
  • In KNH, surgical errors, cancelled surgeries and delayed turn around time have been reported despite utilization of PPCG.
  • Audits from the quality department reveal that 20% of surgical errors and 10% of cancelled surgeries are due to missing out on some important items in the PPCG checklist.
  • This gap and other possible undocumented errors prompted the researcher to carry out this study.
  • Study justificationSurgeries are common treatment modalities in management of patients.
  • Unavailability of local studies on compliance to PPCG.
  • The results of the study will be utilized to identify factors influencing compliance to PPCG and suggest ways of improving the safety standards during surgery.

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RESEARCH QUESTIONS

1.What is the level of compliance to PPCG among nurses working in surgical wards at KNH?

2.What are the nurse related factors that influence compliance to PPCG among nurses working in surgical wards at KNH?

3.What are the institutional factors that influence compliance to PPCG among nurses working in surgical wards at KNH?

RESEARCH OBJECTIVES:

Main Objective:

To assess the determinants of compliance to PPCG among nurses working in surgical wards at KNH.

Specific objectives

1.To assess the level of compliance to PPCG among nurses working in Surgical wards at KNH.

2.To determine the nurse related factors that influence the compliance to PPCG among nurses working in surgical wards at KNH.

3.To establish the institutional factors that influence compliance to PPCG among nurses working in surgical wards at KNH.

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.Research questions

1. What is the level of compliance to PPCG among nurses working in surgical wards at KNH?

2.What are the nurse related factors that influence compliance to PPCG among nurses working in surgical wards at KNH?

3.What are the institutional factors that influence compliance to PPCG among nurses working in surgical wards at KNH?

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Research design

  • Analytical cross-sectional design.

Study area

  • Surgical units of Kenyatta National Hospitals.

Study population and sample size

  • Population-160 nurses and sample size-125 Nurses .

Sampling technique

  • Census and purposive sampling.

Inclusion criteria:

  • All registered nurses working in the surgical wards at KNH during the study period and those who voluntarily consented to partcipate in the study.

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Exclusion criteria:

  • Nurses who were on orientation, internship, probation and student nurses.

Data collection tools

  • Observational checklist
  • A self-administered questionnaire
  • Key interview guide

Data collection procedure

  • Questionnaires- distributed to participants- Nurse related factors
  • To gather data on compliance to PPCG, nurses were observed as they filled the checklists.
  • Key informant interviews with the unit incharges- institutional related factors

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Multivariate analysis of institution related factors and compliance to PPCG

Variable

Cross tabulation results

AOR

P-value

95% CI for AOR

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High n(%)

Moderate n(%)

Low n(%)

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Lower

Upper

Training of staff on PPCG is a top priority by the institution

Strongly agree

1(1)

4(3.9)

0(0)

Ref.

Agree

3(2.9)

6(5.8)

2(1.9)

1.523

0.734

0.134

17.294

Neutral

0(0)

0(0)

3(2.9)

1

0.999

0.000

.

Disagree

0(0)

20(19.4)

53(51.4)

60.7

0.01

5.66

651.835

Strongly disagree

0(0)

10(9.7)

1(1)

4.12

0.264

0.342

49.795

The surgeons support use of PPCG

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Strongly agree

1(1)

15(14.6)

2(1.9)

Ref.

Agree

2(1.9)

5(4.9)

10(9.7)

3.732

0.056

0.968

14.393

Neutral

0(0)

6(5.8)

20(19.4)

15.8

<0.001

3.924

64.262

Disagree

1(1)

10(9.7)

25(24.3)

19.01

<0.001

4.746

76.162

Strongly disagree

0(0)

5(4.9)

2(1.9)

2.29

0.358

0.391

13.409

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Multivariate analysis of institution related factors and compliance to PPCG

Variable

Cross tabulation results

AOR

P-value

95% CI for AOR

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High n(%)

Moderate n(%)

Low n(%)

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Lower

Upper

Training of staff on PPCG is a top priority by the institution

Strongly agree

1(1)

4(3.9)

0(0)

Ref.

Agree

3(2.9)

6(5.8)

2(1.9)

1.523

0.734

0.134

17.294

Neutral

0(0)

0(0)

3(2.9)

1

0.999

0.000

.

Disagree

0(0)

20(19.4)

53(51.4)

60.7

0.01

5.66

651.835

Strongly disagree

0(0)

10(9.7)

1(1)

4.12

0.264

0.342

49.795

The surgeons support use of PPCG

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Strongly agree

1(1)

15(14.6)

2(1.9)

Ref.

Agree

2(1.9)

5(4.9)

10(9.7)

3.732

0.056

0.968

14.393

Neutral

0(0)

6(5.8)

20(19.4)

15.8

<0.001

3.924

64.262

Disagree

1(1)

10(9.7)

25(24.3)

19.01

<0.001

4.746

76.162

Strongly disagree

0(0)

5(4.9)

2(1.9)

2.29

0.358

0.391

13.409

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Qualitative analysis for institution related factors

Theme 1: Shortage of nursing staff

“In this ward we are having a lot of shortage. We have a total of 23 nurses in the unit. In a shift there are 2-3 nurses with an average of 117 patients. This compromises the nursing care alot”.KI 3

Theme 2: Poor teamwork among the staff

“Usually the theatre team, nurse, surgeon and anaesthetist should visit a patient as a team which is not the case here. The theatre nurses never visit, sometimes the lead surgeons don’t see the patient in the wards until they reach theatre. Anaesthetists do come to visit a day before surgery”.KI 8

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Discussion

  • The results show that 57.3% of the participants had low compliance to PPCG. These findings are similar to findings in Sub-saharan African countries where compliance is 45.5%, 47.6%, 53.8% and 55.9% in Chad, South Sudan, Botswana and Senegal respectively.On institution related factors, shoratge of nursing staff and surgeons support in using PPCG were significantly associated with compliance to PPCG. This is similar to a study conducted in Nigeria by Dangyangs et al. 2016 who found that lack of enough staff was attributed to poor compliance to PPCG.

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  • On nurse related factors, years of experience was significantly associated with compliance to PPCG. This is similar to findings by Amaya et al. 2019 in a study in Scotland where she found that nurses who had experience of 15 years or more had better compliance to PPCG.

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Discussion Ct...

  • On institution related factors, shoratge of nursing staff and surgeons support in using PPCG were significantly associated with compliance to PPCG. This is similar to a study conducted in Nigeria by Dangyangs et al. 2016 who found that lack of enough staff was attributed to poor compliance to PPCG.

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Recommendations

1. The nursing education department should:-

  • Prioritise training of staff on PPCG and conduct regular audits to assess the compliance to PPCG by the nursing team.

2. The KNH administration should:-

  • Recruit more nurses to ease the shortage in the surgical units.
  • Sponsor more nurses for specialized nursing training e.g. perioperative nursing.

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References

  • Al-Abri R., & Al-Balushi A. (2014). Patient satisfaction survey as a tool towards quality improvement. Oman medical journal. 29(1), 3-7.
  • Burnside W. S., & Snowden C. (2017). Preoperative assessment and investigation. Surgery - Oxford International Edition. 35(2), 75–80.
  • Anburaj C. (2019). The impact of pre-operative assessment clinics on elective surgical case cancellations. Surgeon. 7(2), 76–78. https://doi.org/10.1016/S1479.

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