الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 176 |  |  |
| | | from | 176 | | |
Abstract
A thyroidectomy is the common surgery that performed as definitive treatment for thyrotoxicosis and for malignancy. Also, it performed for benign conditions such as goiters or Graves’ disease. A goiter, which is an abnormal enlargement of the thyroid, may grow large enough to interfere with the airway or cause difficulty swallowing. Other indications of thyroidectomy include hoarseness and a noticeable increase in neck size; it may be partial, total or subtotal thyroidectomy.
The patient undergoing thyroidectomy needs more precise pre-operative nursing interventions to avoid series of post-operative complications. The common post thyroidectomy complications are hypocalcaemia, swallowing disorders, hematoma, neck pain and stiffness, hemorrhage, wound infection, RLN injury, and hypothyroidism. So, implementation of nursing interventions for patients undergoing thyroidectomy by providing them with knowledge about pre and post thyroidectomy care, promoting compliance with treatment regimens, decreasing occurrence of post thyroidectomy complications which improve health outcomes for those patients.
The aim of this study was:
Determine the effect of nursing interventions on patients’ health outcomes post thyroidectomy.
Materials and method:
Research design: quasi experimental research design was utilized to fulfill the aim of this study.
Setting: this study was conducted at the head and neck surgery unit of the Alexandria Main University Hospital which present in the third floor of surgical building. The postoperative follow up after discharge was conducted at the head and neck surgery outpatient clinic at the Alexandria Main University Hospital, which receive patients on Saturday and Tuesday every week from 8.30 am to 12 pm. Subjects of this study were a convenience sample of 60 patients undergoing thyroidectomy. They were sequentially divided into two equal groups the first was the study group and comprised 30 patients and they received the nursing interventions. The second was the control group which comprised 30 patients and exposed to routine hospital care only.
Tools of the study:-
Three tools were used for data collection:
Tool I: Patients’ Bio-socio demographic data
This tool was developed by the researcher and included two parts:
Part 1: Socio-demographic data: included age, gender and level of education, area of residence, marital status, occupation and monthly income.
Part 2: Clinical data: included family history about thyroid gland diseases, patients’ past medical history and presence of chronic diseases, previous hospitalization, previous surgeries, duration of thyroid enlargement, symptoms, laboratory investigations and prescribed medications.
Tool II: Thyroidectomy patient’s knowledge structured interview schedule
This tool was developed by the researcher based on review of relevant recent literature (Shomon, 2019; Reiberg, 2019; Gaetan, 2017; Arnaud 2017) to assess patients’ knowledge related to thyroidectomy. It included 7 structured list questions about: function of thyroid gland, causes of thyroidectomy, different types of thyroidectomy, side effects of thyroidectomy, preoperative preparations, duration of operation, and post-operative management.
Tool III: Health outcomes for post thyroidectomy patient assessment sheet; it included three parts:
Part 1: Post-operative neck pain assessment sheet, it included two sections. Section 1: using Indiana Polyclinic Combined Pain Scale (IPCPS); it was adopted from Dimitry Arbuck & Amber Fleming 2001 to assess the severity of neck pain.
Section 2: developed by the researcher after review of relevant literature (Audrey, Snyder, &Frandsen, 2016) to assess neck pain frequency, duration, aggravating and relieving factors and associated signs and symptoms.
Part 2: Neck Disability Index (NDI) questionnaire; this tool was adapted from Vernon & Mior (1991), to measure neck-specific disability and to evaluate how neck pain affects ability to manage activities of daily living.
Part 3: Post thyroidectomy complications observational checklist.
This part was be developed by researcher after reviewing the related literature ((Michael & Adrian 2017; Jesus, Aledo, Alonso &Lopez, 2015; Ali &Hassan, 2020) to assess the presence of complications post thyroidectomy.
Method:
The study was carried out as follows:
Ethical approval from the Ethical Committee of Faculty of Nursing, Alexandria University for carrying out this study was obtained.
The reliability of the developed and adapted tools was tested by using Cronbach’s Alpha test, and pilot study was applied on 6 patients who excluded after that from the study.
Sixty patients were assigned and divided attentively into two equal groups, a control group& study group, each of them comprised of 30 patients.
Patients selection was according to the following criteria:
Age group from 18 to 60 years of both sexes.
Able to communicate verbally and to follow the instructions.
Planned for thyroidectomy; total or partial surgery.
Assessment was carried out for both control and study group pre-operative to collect the needed data, clinical data, and to assess existing knowledge related to thyroid gland and nursing care post-surgery.
Every patient of both control and study group was assessed four times; during zero day, before discharge, after one week, and after three weeks postoperatively.
Control group was exposed only to routine hospital care.
For the study group, based on assessment of every patient’s knowledge deficit by using tool II, the nursing interventions was formulated based on the relevant recent literatures (Kuwait Cancer Control Center, 2014; Mater Private Hospital Redland, 2017; United State National Library of Medicine, 2019; Akhtar et al., 2013; Hashem et al., 2018).The content was
organized according to a feasible learning sequence ”from easy to difficult” to enhance patients’ understanding.
Nursing interventions were implemented through 2 sessions preoperative using educational colored booklet that prepared by the researcher. The first session was provided theoretical information about thyroid gland, thyroidectomy, and its complications, the second session for practical part including neck, shoulder and breathing exercises. Each session continued about 30-45 minutes.
Comparisons between the control and study groups were carried out using appropriate Chi-square test, t-test to evaluate the effect of the nursing interventions on health outcomes among patients post thyroidectomy.
The main results of the study were:
Around (50%) of study group and (40%) of control group were in aged group from 40 to less than 50 years old, sixty percentages of study group and 53.3% of control group were females.
Forty percentages of study group and 50% of control group had primary education, and the majority of both study and control group were married.
Near half (46.7%) of the study group and 36.7% of control group were housewives, the majority of study and control group live in rural area, 66.7% of study group and 63.3% of control group did not have enough income per month, from patient’s point of view.
The highest percentage of both study and control group had family history of thyroid disease.
The vast majority of study group and control group (90%, 83.3%) respectively had chronic diseases, 36.7% of study group had hypertension while 40% of the control group had diabetes mellitus.
Less than half (46.7%) of study group suffered from thyroid disease from 6 to 12 months and 36.7% of control group suffered from thyroid disease from 3 to 6 months. Less than one third (30%) of both groups suffered from thyroid disease from more than one year.
The majority of both groups suffered from nervousness, 76.7% of study group and 90% of control group suffered from neck swelling. More than three fifths (63.3%) of study group and 73.3% of control group suffered from difficulty of swallowing, 53.3% of study group and 76.7% of control group suffered from hoarseness. The majority (80%) of the study group suffered from palpitation and 90%of control group suffered from increasing appetite.
Less than three quarters of study group and more than three quarters of control group (70%, 76.7%) respectively had incorrect answer or don’t know regarding the causes of thyroidectomy. The vast majority (90%, 86.7%) of both groups had incorrect answer or didn’t know the function of thyroid gland.
More than three fifths (63.3%) of study group and 56.7% of control group had correct and incomplete answer about the types of thyroidectomy, 66.7% of study group and 76.7% of control group had incorrect answers or didn’t know about side effects of thyroidectomy. More than half (56.7%) of study group and 66.7%of control group had incorrect answer or didn’t know about the preoperative preparation.
More than two thirds (73.3%, 66.7%) of both study and control group respectively had incorrect answer or didn’t know regarding the duration of thyroidectomy. Highest percentage (80%) of study group and 76.7% of control group had incorrect answers or didn’t know regarding post-operative management.
It was found that 66.7% of study group and 70% control group had a poor level of knowledge with no statistically significant difference.
Regarding the frequency of neck pain, the difference was highly statistically significant between both groups in favor of the study group at zero day, before discharge, 1st and 3rd week (p1=0.002*, p2=0.000*, p3=0.009*, p4=0.000*) respectively.
Regarding duration of neck pain, the difference was highly statistically significant in the study group over the control before discharge, 1st and 3rd week post operatively (p2=0.000*, p3=0.000*, p4=0.000*) respectively.
Concerning aggravating factors of neck pain, the difference was statistically significant between both groups at 1st and 3rd week post implementation of nursing interventions (p3=0.000*, p4=0.006*) respectively.
According to relieving factors of neck pain, the difference was highly statistically significant between both groups in favor of the study group at zero day, before discharge, 1st and 3rd week post implementation of nursing interventions (p1= 0.003*, p2=0.001*, p3=0.000*, p4=0.000*) respectively.
In relation to associated manifestation with pain, the difference was highly statistically significant between both groups at zero day, before discharge, 1st and 3rd week post implementation of nursing interventions (p1=0.005*, p2=0.005*, p3=0.001*, p4=0.002*) respectively.
As regard to severity of pain, the difference was statistically significant between both groups at zero day, before discharge, 1st and 3rd week post implementation of nursing interventions (p1=0.007*, p2=0.001*, p3=0.000*, p4=0.000*) respectively.
Regarding the personal care postoperatively, the difference was highly statistically significant between both group patients after 1st and 3rd week post implementation of nursing interventions (p2= 0.000*, p3=0.000*) respectively.
In relation to lifting, the difference was highly statistically significant between both group patients after 1st and 3rd week post implementation of nursing interventions (p2= 0.009*, p3=0.000*) respectively. Concerning reading, the difference was highly statistically significant between both group patients after 1st and 3rd week post implementation of nursing interventions (p2= 0.000*, p3=0.000*) respectively.
According to headache, the difference was highly statistically significant between both groups before discharge, after 1st and 3rd week post implementation of nursing interventions (p1= 0.000*, p2= 0.000*, p3=0.000*) respectively. According to concentration, the difference was statistically significant between both groups before discharge, after 1st and 3rd week post implementation of nursing interventions (p1= 0.039*, p2= 0.002*, p3=0.000*) respectively. In relation to work, the difference was highly statistically significant between both group patients after 1st and 3rd week post implementation of nursing interventions (p2= 0.000*, p3= 0.000*) respectively.
Regarding driving, the difference was highly statistically significant between both groups in favor of the study group after 1st and 3rd week post implementation of nursing interventions (p2= 0.000*, p3= 0.000*) respectively. Concerning sleeping, the difference was highly statistically significant in the study group over the control before discharge, after 1st and 3rd week post implementation of nursing interventions (p1= 0.000*, p2= 0.000*, p3= 0.000*) respectively. According to recreation, the difference was not significant between both groups after 1st and 3rd week post implementation of nursing interventions (p2= 0.083, p3= 0.083) respectively. According to the level of neck disability, the difference was highly statistically significant between both groups after 1st and 3rd week post implementation of nursing interventions (P2= 0.000*, P3= 0.000*) respectively.
The occurrence of complications with in study group was satisfactory at zero day, before discharge, after one week, and after three weeks as the mean less than two (0.96, 0.90, 1.83, 0.90) respectively. Within control group, the occurrence of complications was satisfactory at zero day, before discharge, after three weeks (mean=1.23, 1.23, 1.80) respectively. After one week, the occurrence of complications within control group was unsatisfactory as mean equal 2.700.
Conclusion: post thyroidectomy patients who receive nursing interventions exhibit improvement of neck pain, neck disability and decreasing postoperative complications.
Recommendations:
A colored illustrated educational booklet about nursing interventions for thyroid patients undergoing surgery should be available and distributed to each patient undergoing thyroidectomy in the hospital.
In service training program should be carried out for nurses working in head and neck surgery department about complete care for patients pre and post thyroidectomy.
Facilitate opportunities for nurses to attend continuing educational program about thyroid gland diseases and care of patients undergoing thyroidectomy.
update standards of care for patients undergoing thyroidectomy according to international guidelines.
Further research is needed to be conducted on larger sample size to attain more generalized results.