Jinekolojik cerrahide ameliyat öncesi ve sonrası kanıta dayalı bakım uygulamaları

Yıl 2019, Cilt: 6 Sayı: 2, 114 - 121, 30.06.2019

Dilek Bilgiç , Hande Yağcan , Buse Güler , Nuran Nur Aypar

Öz

Giriş ve amaç: Ameliyat öncesi ve sonrası kanıta dayalı uygulamalar, organları koruyarak strese verilen tepkiyi azaltıp iyileşme sürecini hızlandırmakta ve erken taburculuğu sağlamaktadır. Bu nedenle çalışmamızın amacı hemşirelere jinekolojik cerrahide kanıta dayalı uygulamalar hakkında bilgi vermek, hemşirelik literatürüne katkıda bulunmak ve güncel kanıtları hasta bakımında kullanmalarını teşvik etmektir.

Gereç ve yöntem: Derlemede ameliyat öncesi bakımda kanıta dayalı uygulamalar kapsamında hasta danışmanlığı ve eğitimi, ameliyat öncesi optimizasyon, tromboemboli profilaksisi, barsak hazırlığı, beslenme, premedikasyon, antimikrobiyal profilaksi ve cilt hazırlığı; ameliyat sonrası kanıta dayalı uygulamalar kapsamında ameliyat sonrası yaşam bulguları takibi, tromboemboli profilaksisi, spirometre kullanımı, sıvı tedavisi, beslenme, ileusun önlenmesi, glikoz kontrolü, analjezi, üriner drenaj, erken mobilizasyon ve antibiyotik profilaksisi başlıkları tartışılmıştır.

Sonuç: Kanıta dayalı uygulamalara ilişkin literatür incelendiğinde, kolerektal cerrahi geçiren hastalarda yapılan çalışmaların fazla olduğu ancak jinekolojik cerrahi geçiren hastaları içeren çalışmaların sınırlı olduğu görülmektedir. Ayrıca ülkemizdeki hemşirelik çalışmalarına bakıldığında uygulamada kanıtların kullanılmadığı ve hemşirelerin bu sürecin ve ekibin dışında kaldığı göze çarpmaktadır. Hemşireler, ameliyat öncesi ve sonrası dönemde hasta bakımını geleneksel uygulamalar yerine maliyeti, hastanede kalış süresini, komplikasyon ve morbidite oranlarını azaltan, güvenli, etkili ve hasta memnuniyetini arttıran kaliteli bir bakıma dayandırmalıdır.

Anahtar Kelimeler

jinekoloji, kanıta dayalı uygulamalar, hemşirelik

Preoperative and postoperative evidence based practices in gynecologic surgery

Öz

Introduction and objective: Pre-operative and post-operative evidence-based applications protect the organs, reduce the response to stress, speed up the healing process and provide early discharge. Therefore, the aim of our study is to provide nurses information about evidence-based practices in gynecologic surgery, contribute to nursing literature and encourage them to use current evidence in patient care.

Material and method: In the review within the scope of pre-operative care evidence-based practices, it was discussed that patient counseling and training, preoperative optimization, thromboembolism prophylaxis, bowel preparation, nutrition, premedication, antimicrobial prophylaxis and skin preparation. And it was examined that follow-up of post-operative life findings as part of post-operative evidence-based practices, thromboembolism prophylaxis, use of spirometry, fluid therapy, nutrition, prevention of ileus, glucose control, analgesia, urinary drainage, early mobilization and antibiotic prophylaxis.

Conclucion: When the literature on evidence-based applications was examined, it is seen that studies conducted in patients undergoing surgery have been more common but studies involving patients undergoing gynecologic surgery were limited. In addition, when the nursing studies in our country were examined, it was observed that the evidence is not used in practice and the nurses remain outside this process and the team. Nurses should base patient care before and after surgery that safe, effective and high-quality care that increases patient satisfaction and reduces cost, hospital stay, complication and morbidity rates, instead of traditional practices.

Anahtar Kelimeler

Nursing, evidence based practice, gynecology

Kaynakça

• Stetler, C.B., Brunell, M., Giuliano, K.K., Morsi, D., Prince, L., & Newell-Stokes, V., (1998), Evidence-Based Practice and the Role of Nursing Leadership. J Nurs Adm, 28(7/8): 45-53.
• Kocaman, G., (2003), Hemşirelikte Kanıta Dayalı Uygulama. Hemşirelikte Araştırma Geliştirme Dergisi, 2; 61-69.
• Aksoy, A., Vefikuluçay Yılmaz. D., (2018), Jinekolojik Cerrahide Kanıta Dayalı Uygulamalarda Yeni Bir Yaklaşım: Eras Protokolü ve Hemşirelik. Turkiye Klinikleri J Nurs Sci, 10(1):49-58.
• Çilingir, D., Candaş, B., (2017), Cerrahi Sonrası Hızlandırılmış İyileşme Protokolü ve Hemşirenin Rolü. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi, 20(2): 137-143.
• Kehlet, H., Wilmore, D.W., (2008), Evidence based surgical care and the evolution of fast track surgery. Annals of Surgery, 248(2): 189-198.
• Abdikarim, I., Cao, X.Y., Li, S.Z., Zhao, Y.Q., Taupyk, Y., & Wang, Q., (2015), Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas. World J Gastroenterol, 21(47):13339-44.
• Miller, T.E., Thacker, J.K., White, W.D., Mantyh, C., Migaly, J., Jin, J. et al., (2014), Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg, 118(5): 1052-61.
• Neville, A., Lee, L., Antonescu, I., Mayo, N.E., Vassiliou, M.C., Fried, G.M. et al., (2014), Systematic review of outcomes used to evaluate enhanced recovery after surgery. Br J Surg, 101(3):159-70.
• Stowers, M.D.J., Lemanu, D.P., Hill, A.G., (2015), Health economics in enhanced recovery after surgery programmes. Canadian Anesthesiologists Society Journal, 62:219-230.
• Thiele, R.H., Rea, K., Friel, C.M., Hassinger, T.E., Mcmurray, T.L., Goundreau, B.J. et al., (2015), Standardization of care: impact of an ERAS protocol on length of stay, complications and direct costs after colerectal surgery. Journal of American College of Surgeons, 220(5):986.
• Karaöz, S., (2000), Cerrahi Hemşireliği ve Etik. C.Ü. Hemşirelik Yüksekokulu Dergisi, 4(1): 9-15.
• Angioli, R., Plotti, F., Capriglione, S., Aloisi, A., Aloisi, M.E., Luvero, D., Miranda, A., Montera, R., Gulino, M., & Frati, P., (2014), The effects of giving patients verbal or written pre-operative information in gynecologic oncology surgery: a randomized study and the medical-legal point of view. Eur J Obstet Gynecol Reprod Biol, 177:67-71.
• Nelson, G., Altman, A.D., Nick, A., Meyer, L.A., Ramirez, P.T., Achtari, C. et al., (2016), Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part I. Gynecol Oncol, 140: 313-322. a
• American College of Obstetricians and Gynecologists (ACOG)., (2007), Prevention of deep vein thrombosis and pulmonary embolism, 84.
• ERAS Türkiye Derneği. ERAS protokolünün temel öğeleri. http://eras.org.tr/page.php?id=10&saglikCalisani=true E.T.: 14.02.2019.
• American College of Obstetricians and Gynecologists (ACOG), (2018), Perioperative Pathways: Enhanced Recovery After Surgery, 132 (3): 120-130.
• Barber, E.L., Clarke-Pearson, D.L., (2017), Prevention of venous thromboembolism in gynecologic oncology surgery. Gynecol Oncol, 144(2):420-427.
• Card, R., Sawyer, M., Degnan, B., Harder, K., Kemper, J., Marshall, M. et al., (2014), Perioperative protocol. Health care protocol. National Guideline Clearinghouse.
• Kristen, A.B., Joseph, P.M., Christine, L., Brian, G.H., Eric, H.J., Donald, E.F., Kamal, M.F.I. et al., (2016), American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines. Update.
• American Society of Anesthesiologists Committee, (2011), Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures, 114(3): 495-511.
• Bratzler, D.W., Dellinger, E.P., Olsen, K.M., Perl, T.M., Auwaerter, P.G., Bolon, M.K. et al., (2013), Clinical practice guidelines for antimicrobial prophylaxis in surgery. National Guideline Clearinghouse, 70(3):195-283.
• Nelson, G., Altman, A.D., Nick, A., Meyer, L.A., Ramirez, P.T., Achtari, C. et al., (2016), Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations — Part II. Gynecol Oncol, 140: 323-332.b
• Eltorai, A.E.M., Szabo, A.L., Antoci, V. Jr., Ventetuolo, C.E., Elias, J.A., Daniels,.A.H. et al., (2018), Clinical Effectiveness of Incentive Spirometry for the Prevention of Postoperative Pulmonary Complications. Respir Care, 63(3):347-352.
• do Nascimento Junior, P., Módolo, N.S., Andrade, S., Guimarães, M.M., Braz, L.G., El Dib, R., (2014), Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev, 8(2): CD006058.
• Özalevli, S., (2015), Preoperatif ve postoperatif pulmoner rehabilitasyon. Toraks Cerrahisi Bülteni, 6: 16-25.
• Johnson, K., Razo, S., Smith, J., Cain, A., & Soper, K. (2019), Optimize patient outcomes among females undergoing gynecological surgery: A randomized controlled trial. Applied Nursing Research, 45: 39-44.
• Park, S., & Choi, M., (2018), Meta-analysis of the effect of gum chewing after gynecologic surgery. Journal of Obstetrics, Gynecologic and Neonatal Nursing, 47(3), 362–370.
• Chuamor, K., & Thongdonjuy, J., (2014), Effectiveness of standard nursing care with gum chewing to reduce bowel ileus in post-operative gynecologic patients: Randomized controlled trials. Siriraj Medizinhistorisches Journal, 66, 33–38.
• Kao, L.S., Meeks, D., Moyer, V.A., & Lally, K.P., (2009), Peri-operative glycaemic control regimens for preventing surgical site infections in adults. Cochrane Database Syst Rev, 8;(3):CD006806.
• Castelino, T., Fiore, J. F., Niculiseanu, P., Landry, T., Augustin, B., & Feldman, L. S., (2016), The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A systematic review. Surgery, 159(4), 991–1003.
• Fiore, J. F., Castelino, T., Pecorelli, N., Niculiseanu, P., Balvardi, S., Hershorn, O., & Feldman, L., (2017), Ensuring early mobilization within an enhanced recovery program for colorectal surgery: A randomized controlled trial. Annals of Surgery, 266(2), 223–231.
• Doshani, A., Shafi, M.I., (2003), Pre- and post-operative care in gynaecology. Current Obstetrics & Gynaecology, 13: 151-158.