Nurses’ attitude and competence towards caring for post-operative patients in a government hospital in Aklan

Abstract

This study was conducted to determine nurses’ attitude and competence towards caring for post-operative patients in a government hospital in Aklan. Specifically, this sought to describe the nurses’ selected characteristics in terms of their age, gender, years of experience and trainings and seminars attended for the past five years that are related to surgical or post-operative care; determine nurses’ attitude towards caring postoperative patients; determine nurses’ competence towards caring for post-operative patients; determine if there is a relationship between nurses’ selected characteristics and their attitude towards caring for post-operative patients; determine if there is a relationship between nurses’ selected characteristics and competence towards caring for post-operative patients, and determine if there is a relationship between nurses’ attitude towards caring for post-operative patients and nurses’ competence towards caring for post-operative patients. This is a relational study that is intended to describe relationships among the variables and utilized a one-shot survey design. Data were processed and analyzed using SPSS+PC version 20 wherein Gamma co-efficient and Cramer’s V statistics were employed in determining the significance of the relationship between variables.

Major Findings

The majority of nurses presently assigned in all wards that cater to postoperative patients only in a certain government hospital in Aklan were young (29 years old and below), the majority were females with fewer years of experience (3 years and below) towards caring for post-operative patients and have no proper trainings and seminars attended for the past five years of their professional practice. For nurses' overall attitude, nurses, in general, had a favorable attitude towards caring for post-operative patients. This is shown by the fact that nurses had favorable responses to all of the items regarding nurses’ attitudes. Specifically, a big majority of nurses have favorably agreed that nurses have an important role in the promotion of health maintenance and immediate resumption of activities of daily living in postoperative patients (98.9%); that they have the clinical eye to refer correctly and immediately to the physician any danger signs and symptoms of acute deterioration in any post-operative patients (92.3%); and that with their present knowledge, skills and clinical experience they are confident that they can deliver safe and quality care, active rapid response and correct basic life support in case of an emergency (91.2%). In addition, a little more than four-fifths (82.4%) of nurses favorably agreed that their years of experience are enough alone to consider themselves competent and experts in giving post-operative care. This could be assumed that nurses felt this way because other than their experience towards caring for post-operative patients they felt that there is a need for further updates regarding caring for post-operative patients, as manifested in their answer which said that about six out of seven nurses (85.4%) agreed that trainings and seminars on post-operative care are important and useful in ensuring safe and quality care rendered to post-operative patients. However, despite the current post-operative management on post-surgical pain still, there are nurses who believe that premedications are preferably much better than round-the-clock pain medications (13.2%). It could be assumed that other than pm medications these nurses prefers non pharmaceutical interventions in dealing with post-operative pain, such as acupuncture for post-operative analgesia. Furthermore, it can be assumed that nurses may be concerned that patients may develop a dependency on analgesic medications of which the majority of these medications are highly addictive.

Another notable finding showed that both young (75.5%) and old (86.8%) nurses have a high proportion of favorable attitude, although older nurses tend to have a more favorable attitude towards caring for post-operative patients as compared to young nurses. Similarly, on nurses’ gender, both groups have high proportions of favorable attitude (male nurses 83.9% and female nurses 78.3%). Results also revealed that nurses who have long years of experience (four years and above) and have had no trainings and seminars attended related to their current ward assignment for the past 5 years also have favourable attitude towards caring post-operative patients. For the overall competence of nurses, a high percentage (68.1%) of the nurses were found to be highly competent towards caring for post-operative patients. Specifically, a high proportion of nurses were observed to have high competence in the aspect of the three domains of the overall competence, namely, competence in assessment (69.2%), skill competence (implementation) (79.1%), and competence in monitoring (71.4%). A mean score of 24.90 means that scores of nurses revealed high competence. Furthermore, data revealed a big majority of nurses in terms of their competence in the assessment were observed to excel more in some aspects of assessment such as they make an assessment of patient’s condition after surgery (91.3%) and initiate and make time for patient education and health teaching to ensure that both patient and family are educated on procedures, medications, diet and post-operative activity of daily living (70.3%). In addition, in the area of their skill competence, they also do extremely well in the implementation of care in which they answer patient’s questions and ensure they are kept comfortable (90.3%) as well as they perform intervention duties in cases of postoperative emergencies (e.g. cardiopulmonary resuscitation (85%). Moreover, they are also good in ensuring and monitoring the patient’s condition and in taking vital signs every 15 minutes until a patient is stable and that these nurses report immediately to the doctor any changes, and they document situations and outcomes in an objective and timely manner (90.1%). However, some indicators showed that nurses do poorly in terms of assessing actual situations and use problem-solving skills in responding to critical and ongoing situations (49.5%), changing bandages, dressing the surgical wound, and ensuring that the post-operative space is clean and sanitized (47.3%) and in taking the opportunity to attend seminars and trainings related to surgery or post-operative care of patients (40.3%). Another notable finding is that selected characteristics such as age, gender, years of experience and trainings and seminars attended showed a very or extremely weak relationship with nurses’ attitude towards caring for post-operative patients. The same relationship can also be observed among selected characteristics of nurses and their skill competence and competence in monitoring towards caring post-operative patients of which yielded a very or an extremely weak relationship. Moreover, selected characteristics of nurses in this study showed a weak relationship with nurses’ competence in assessment and nurses’ overall competence towards caring for postoperative patients. A similar relationship was also observed among nurses’ attitude and the three domains of competence which yielded a weak relationship. However, a different notable finding was found between nurses’ attitude and overall competence towards caring for post-operative patients of which Gamma = .709 revealed a strong relationship between the two variables.

This study was conducted to determine nurses’ attitude and competence towards caring for post-operative patients in a government hospital in Aklan. Specifically, this sought to describe the nurses’ selected characteristics in terms of their age, gender, years of experience and trainings and seminars attended for the past five years that are related to surgical or post-operative care; determine nurses’ attitude towards caring postoperative patients; determine nurses’ competence towards caring for post-operative patients; determine if there is a relationship between nurses’ selected characteristics and their attitude towards caring for post-operative patients; determine if there is a relationship between nurses’ selected characteristics and competence towards caring for post-operative patients, and determine if there is a relationship between nurses’ attitude towards caring for post-operative patients and nurses’ competence towards caring for post-operative patients. This is a relational study that is intended to describe relationships among the variables and utilized a one-shot survey design. Data were processed and analyzed using SPSS+PC version 20 wherein Gamma co-efficient and Cramer’s V statistics were employed in determining the significance of the relationship between variables.

Major Findings

The majority of nurses presently assigned in all wards that cater to postoperative patients only in a certain government hospital in Aklan were young (29 years old and below), the majority were females with fewer years of experience (3 years and below) towards caring for post-operative patients and have no proper trainings and seminars attended for the past five years of their professional practice. For nurses' overall attitude, nurses, in general, had a favorable attitude towards caring for post-operative patients. This is shown by the fact that nurses had favorable responses to all of the items regarding nurses’ attitudes. Specifically, a big majority of nurses have favorably agreed that nurses have an important role in the promotion of health maintenance and immediate resumption of activities of daily living in postoperative patients (98.9%); that they have the clinical eye to refer correctly and immediately to the physician any danger signs and symptoms of acute deterioration in any post-operative patients (92.3%); and that with their present knowledge, skills and clinical experience they are confident that they can deliver safe and quality care, active rapid response and correct basic life support in case of an emergency (91.2%).

In addition, a little more than four-fifths (82.4%) of nurses favorably agreed that their years of experience are enough alone to consider themselves competent and experts in giving post-operative care. This could be assumed that nurses felt this way because other than their experience towards caring for post-operative patients they felt that there is a need for further updates regarding caring for post-operative patients, as manifested in their answer which said that about six out of seven nurses (85.4%) agreed that trainings and seminars on post-operative care are important and useful in ensuring safe and quality care rendered to post-operative patients. However, despite the current post-operative management on post-surgical pain still, there are nurses who believe that premedications are preferably much better than round-the-clock pain medications (13.2%). It could be assumed that other than pm medications these nurses prefers nonpharmaceutical interventions in dealing with post-operative pain such as acupuncture for post-operative analgesia. Furthermore, it can be assumed that nurses may be concerned that patients may develop a dependency on analgesic medications of which The majority of these medications are highly addictive. Another notable finding showed that both young (75.5%) and old (86.8%) nurses have a high proportion of favorable attitudes, although older nurses tend to have a more favorable attitude towards caring for post-operative patients as compared to young nurses. Similarly, on nurses’ gender, both groups have high proportions of favorable attitude (male nurses 83.9% and female nurses 78.3%). Results also revealed that nurses who have long years of experience (four years and above) and have had no trainings and seminars attended related to their current ward assignment for the past 5 years also have favourable attitude towards caring post-operative patients.

For the overall competence of nurses, a high percentage (68.1%) of the nurses were found to be highly competent towards caring for post-operative patients. Specifically, a high proportion of nurses were observed to have high competence in the aspect of the three domains of the overall competence, namely, competence in assessment (69.2%), skill competence (implementation) (79.1%), and competence in monitoring (71.4%). A mean score of 24.90 means that scores of nurses revealed high competence. Furthermore, data revealed a big majority of nurses in terms of their competence in the assessment were observed to excel more in some aspects of assessment such as they make an assessment of patient’s condition after surgery (91.3%) and initiate and make time for patient education and health teaching to ensure that both patient and family are educated on procedures, medications, diet and post-operative activity of daily living (70.3%). In addition, in the area of their skill competence, they also do extremely well in the implementation of care of which they answer patient’s questions and ensure they are kept comfortable (90.3%) as well as they perform intervention duties in cases of postoperative emergencies (e.g. cardiopulmonary resuscitation (85%). Moreover, they are also good in ensuring and monitoring the patient’s condition and in taking vital signs every 15 minutes until a patient is stable and that these nurses report immediately to the doctor any changes, and they document situations and outcomes in an objective and timely manner (90.1%). However, some indicators showed that nurses do poorly in terms of assessing actual situations and use problem-solving skills in responding to critical and ongoing situations (49.5%), changing bandages, dressing the surgical wound, and ensuring that the post-operative space is clean and sanitized (47.3%) and in taking the opportunity to attend seminars and training related to surgery or post-operative care of patients (40.3%). Another notable finding is that selected characteristics such as age, gender, years of experience, and trainings and seminars attended showed a very or extremely weak relationship with nurses’ attitude towards caring for post-operative patients. The same relationship can also be observed among selected characteristics of nurses and their skill competence and competence in monitoring towards caring post-operative patients of which yielded a very or an extremely weak relationship. Moreover, selected characteristics of nurses in this study showed a weak relationship with nurses’ competence in assessment and nurses’ overall competence towards caring for postoperative patients. A similar relationship was also observed among nurses’ attitudes and the three domains of competence which yielded a weak relationship. However, a different notable finding was found between nurses’ attitude and overall competence towards caring for post-operative patients, of which Gamma = .709 revealed a strong relationship between the two variables