Nursing Outcome in Patients with Craniofacial
Anomalies Who Underwent Operation
Background: The Northeast of Thailand has patients with craniofacial anomalies about 2.5: 1,000 children birth. Ward 3C Srinagarind Hospital has about 150-200 cases of patients with craniofacial anomalies each year. Some of them have an operation about 10 times. When the patients go to hospital to undergo operation, patients and families experience fear and anxiety. They need information about their disease, operation, feeding and wound care. Nurses who work continuously and closely with the patients need to have ability to support patients needs by using nursing process. Nursing outcome will help nurses to measure the quality of nursing care.
Objective: To study nursing outcome in the patients with craniofacial anomalies who were admitted in 3C ward.
Material and Method: The present study is retrospective descriptive study. Data was collected from medical records of 27 patients with craniofacial anomalies who were admitted in 3C ward Srinagarind Hospital between June 2010 to May 2011. Medical records were purposively selected for the study and recorded with a data collection form.
Results: The authors found that 2.36% of patients had wound infection. 100% of parents received information about disease,medication, self care but some information was not received or was received but not understand. 1 case of patients unplanned readmit. Length of stay of patient 2.74 days. Parents satisfaction is 91.81%.
Conclusion: Patients had wound infection when back home because care giver cannot clean patients wound correctly,parents and care giver did not receive enough information or did not understand all information.
Keywords: Nursing outcome, Craniofacial anomalies, Patients who underwent operation
Cleft lip and cleft palate are the most common craniofacial anomalies, affecting approximately 2.49 of every 1,000 children born in North East Thailand(1). Srinagarind Hospital has 100-150 cases of cleft lip and palate each year(2). Unexpected birth of infants with cleft lip and cleft palate has psychological effects for parents and some parents feel nervous with their child and also can have marriage problems(3). The process for cleft lip and palate care requires continuity of care involving a multidisciplinary team(4).
The patients with cleft lip and palate have problems with feeding, swallowing difficulties and delayed development. When they go to hospital to receive surgery, the pain, limited activity and food are very different from normal life. When going to school, children will separate from other friends. They have speech articulation problems, suffer from shyness, social isolation and loneliness(5). When becoming teenagers they have low self esteem and self image(6). Complete rehabilitation by holistic and interdisciplinary care is very important to patients and family. During pre and post operative care nurses who work continuously and closely with the patients require knowledge, experience and ability to take excellent care of their patients and families to prevent illness, duplicate rehabilitation and promote quality of life and respond well to patients needs(7). It can prevent complications and help their decision process, decrease parental stress and encourage better co-operation. Nurses need to have ability to support patients needs by using nursing process. Nursing outcome will help nurses to measure the quality of nursing care.
Objective
To study nursing outcome in patients with craniofacial anomalies who were admitted in 3C ward Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen Thailand.
Nursing care
Nursing care is the method where nurses use their nursing ability to adjust the balance between self care ability and self care demand. Starting by searching the problem or needs then developing patient or clients ability for self care. Nursing care is a dynamic system depending on patients or clients needs(7). To develop nursing care needs integrated quality management and risk management together. Nursing care comprises(8):
1. Outcome-based nursing service. This is specific nursing care to each health problem.
2. Holistic care: integrated physical, mental, emotional, social and spiritual care together. All of nursing activity focused on the science of caring.
3. Family-based nursing practice: its focus on family centre to solve health problem.
4. Management view: This is the management system for nursing quality. Using nursing process, nursing conference, nursing rounds, nursing modalities, and nursing documentation.
Nursing care has to integrate 4 dimensions of service thus: treatment, health promotion, prevention of illness and rehabilitation as well as concern about holistic care(7). Nurses provide nursing care to all people to solve health problems, so need to have knowledge, ability to prevent illness, duplicate rehabilitation and promote quality of life. Nurses use Care MAPs and nursing care plan to guide nursing implementation in response to patients needs(9).
Nursing outcome
Nursing outcome is the end results of nursing care. The International Classification for Nursing Practice (ICNP) defines a nursing outcome as the measure of a nursing process after nursing intervention(10). Many aspects can affect the outcomes such as disease, diagnosis, sign and symptom severity, socio-economic factors, family support, age and gender, quality of nursing care and professional care team.
Nursing outcome indicators
Nursing outcome indicators are related between nursing intervention that patients have received and their resulting health status. They are the measurement of nursing care by measuring patient outcomes. The patient outcomes usually use measuring nursing outcome thus: Patient complications such as infections, pressure sore, pneumonia and deep vein thrombosis/pulmonary embolism, failure to response to patients condition, patients length of stay, patients functional status, knowledge of condition and treatment, patient satisfaction with care, unplanned emergency department visits, unplanned read missions(11). These outcome will help nurses to measure the quality of nursing care. In the present study, the authors used wound infection, patients’ information receiving, patients’ satisfaction, unplanned readmission and length of stay to measure nursing outcome.
Material and Method
The present study is retrospective descriptive study. The data was collected from medical records of 127 patients with craniofacial anomalies who were admitted for operation in 3C ward Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Medical records were purposively selected for the study and recorded with a data collection form.
Sample population
Medical records of the patients with craniofacial anomalies who underwent operation between June 2010 to May 2011. Medical records of the patients were purposively selected for the study according to the following criteria:
Inclusion criteria
Patients with craniofacial anomalies who undergoing operation.
Age from 2 months-15 years old.
Exclusion criteria
Patients with craniofacial anomalies and another anomalies.
Fig. 1 Conceptual fram work of the study
Data collection
127 medical records of patients with craniofacial anomalies who underwent operation and
admitted in 3C ward, Srinagarind Hospital between June 2010 to May 2011 were recorded with data collection form by nurse.
Data analysis
There are two main parts of analysis, describing characteristics of the patients and analysis
for answering the research question. Categorical data: age, sex, diagnosis, type of surgery, economic status,
wound infection, information, unplanned readmit were presented by number and percentage. Continuous data:length of stay, patients satisfaction were presented by mean and standard deviation.
Measurement of the outcome
1. Demographic data, data collecting form selected for study were age, sex, diagnosis, type of
surgery, economic status.
2. Nursing outcome: the present study focused on 5 outcome thus: wound infection, receiving
information, patients satisfaction, unplanned readmit and length of stay.
The present study was approved by The Ethics Committee for Human Research, Khon Kaen
University, Thailand.
Results
1. Demographic data: From 127 medical record of patients 74 cases were male (58.3%) , age was between 2 month-13 years, average 17 months. 27 cases (21.3%) were patients with cleft lip, 26 cases (20.5%) were patients with cleft palate, 72 cases (56.7%) were patients with cleft lip and palate,
1 case (0.8%) was patient with microtia and 1 case (0.8%) was patient with hemifacial microsomia, 118 cases (92.9%) of medical treatment was subsidized by the government. 50 cases (39.4%) were cheiloplasty and 58 cases (45.7%) were palatoplasty. 9 cases (7.1%) were repair fistula. 10 cases (7.9%) were lip and nose correction.
2. Nursing outcome
2.1. Wound infection 3 cases (2.36%) of patients have wound infection including 1 case of cheiloplasty had stitch abscess and 2 cases of correction.
2.2. Receiving information 100% of patients/care giver get information about disease, treatment medicine and self care but some points couldn’t be understand as Table 1.
2.3. Patients/parents satisfaction Percent of satisfaction is 55-100 average 91.8% as Table 2.
2.4. Length of stay Patients stayed in hospital 2-7 days, average 2.74 days.
2.5. Unplanned readmission 1 case had flap necrosis after 2 flap palatoplasty.
Discussion and Conclusion
The present study answers the research question about nursing outcome into 5 items as follows:
1. Wound infection rate: the authors found 2.36% of patients had wound infection, 1 of these
patients got cheiloplasty, in this case, after the operation the care giver can not dress their child wound correctly because in hospital nurse gave information and demonstration