Ayman Sameh Nabawi
Alexandria University - EGYPT
Professor of Surgery and Reconstructive Microsurgery
Chief Head and Neck and Endocrine Surgery Unit Consultant Surgeon, CMO Al-Shatti Hospital, Muscat, Oman.
(April 2001 – April 2003).
General Director, Surgery hospital, Alexandria University Hospitals.
(January 2010 – June 2011)).
Chief Emergency and Casualty Departments, Alexandria Main University Hospitals.
(January 2012 – july 2013).
Chair Head and Neck Surgery Unit, Surgery Dept, Alexandria Main University Hospital. (February 2012 – till present).
Healthy life has become an important factor in health management. Marjorie Gordon introduced a formal framework for assessing functional health patterns (FHPs) under eleven headings in 1982. Surgery on the gastrointestinal tract is always invasive to some degree. Healing a wound is an energy requiring process that often requires adjunctive therapies in addition to wound care products to achieve success. Ultrasound is able to identify dermal structures with improved resolution, thereby offering a potentially more accurate visualization of deep dermal microcirculation and to analyze the tissue patterns of healing wounds. It is important for nurses to know about the various forms of cutaneous techniques (acupressure and TENS), the evidence for and against the use of some of these therapies, and the legal risks posed by patients’ use of these therapies. Using functional health patterns, a method of holistic assessment that provides information from a nursing rather than a medical perspective can provide the patient with a good experience of recovery. The aim of the current study was to compare between two cutaneous stimulation techniques on wound healing, related pain and functional health patterns of patients with abdominal surgery.
This study was conducted on 60 patients who underwent an abdominal surgery at the general surgical wards of Alexandria Main University Hospital. Every patient was assigned randomly into one of three groups (20 patients in each group) as follows:
Group (I): Subjected to routine daily hospital management (control group),
Group (II): Subjected to acupressure (study group I),
Group (III): Subjected to the use of transcutaneous electrical nerve stimulation device (TENS) (study group II).
Three tools were used in this study for data collection in addition to patients' sociodemographic data sheet including personal data and clinical data.
Tool 1. Surgical wound assessment including wound data base sheet, wound healing
follow-up by ultrasound and wound characteristics follow-up sheet.
Tool 2. Holistic pain assessment sheet.
Tool 3. Postoperative functional health patterns structured interview schedule.
The tools were tested for its content validity by a jury of seven experts in the field. As for testing its applicability a pilot study was then carried out on five patients. According to the findings of the pilot study and comments of the jury members, the necessary modifications had been done. The data was collected in a period of fifteen months by the researcher. Functional health patterns assessed using tool 3 before and after sessions' completion (nine sessions of acupressure and TENS). Wound and pain assessment were done using tool 1& 2 before and after each session. Wound healing was assessed on the first and third day post-operative and the tenth day post-operative (either hospitalized or discharged) by using ultrasound with 14MHZ transducer. Dressing was done by the researcher for both study groups, while control group was dressed by the hospital staff according to the hospital routine.
From the findings of the present study, it can be concluded that:
- Ultrasound with 14MHz transducer can report detailed underlying skin structure description for wound healing including the skin layers thickness, presence of subcutaneous edema, site and size of subcutaneous fluid collection, degree of vascularity, and gap filling.
- Patients' functional health patterns are affected by the presence of surgical wound and related pain.
- Acupressure is more effective than TENS in reducing discomfort for patients underwent abdominal surgery in the form of wound pain, holistic pain, and wound tenderness of abdominal surgery patients.
- TENS and acupressure are valuable for improving abdominal wound healing with the superiority for TENS.
- Acupressure and TENS had nearly equal effects for the improvement of functional health patterns for patients with abdominal surgery.
- A group of 60 patients with 60 abdominal wounds was enrolled in this study. 45% of the studied patients were among the age group 20-29 years.
- More than half (66.7%) of the patients were male. Manual work was the most common occupation encountered among the three groups (51.7%).
- Half of the patients underwent hernioplasty operation. All studied patients suffered from wound pain.
- Acupressure group had remarkable reduction of subcutaneous fluid collection size than TENS group for patients with hernioplasty wound. Both study groups (acupressure and TENS) were nearly equal in relation to wound characteristics follow-up.
- Acupressure was superior to TENS in reducing the intensity of wound pain as measured by VAS score since the mean score of VAS following acupressure (0.60±0.754) was significantly lower than that following TENS (0.90±1.021).
- Wound tenderness changed significantly in both, acupressure and TENS groups (FET= 25.619, P = 0.000).
- Regarding holistic pain assessment for abdominal surgery patients, the finding was that total number of patient changed according to the applicability of holistic pain. The mean score of holistic pain VAS had significantly decreased in the control group from 9.00±0.000 to 0.31±0.751, the mean score of VAS had been decreased from 8.57±1.369 to 0.000±0.000 in the acupressure group and from 9.00±0.707 to 0.000±0.000 in the TENS group. These changes were statistically significant (P=0.016).
- The findings of the present study showed that there was a considerable improvement of health perception for both acupressure and TENS group.
- The mean score of dependency for activities of daily living had decreased in the control group comparatively to the study groups (acupressure and TENS). The mean score of activity of daily living had been decreased from 3.80 to 0.60 following acupressure sessions, and from 4.50 to 0.30 following TENS sessions.
- A significant reduction of nutritional problems as reduction of nausea sensation in the acupressure group from 30.0% before sessions to 10% following acupressure sessions. For TENS group, the feeling of nausea had decreased from 45% before TENS sessions to 15% by the end of TENS sessions (P= 0.044).
- Concerning sleep/rest pattern, a significant reduction in sleeping problems for acupressure group from 15.0% before acupressure sessions to 0% after sessions completion and TENS group from 25.0% before TENS to 0% after TENS sessions (P= 0.039).
- With reference to sexuality/reproductive pattern, 40 male patients were changed significantly (P= 0.047) their reporting about effect of wound on sexuality from 75.0% agree to 32.5% after application of treatment modality.
From this study the following recommendations had been suggested:
- Nurses play a vital role in surgical wound assessment approaches through 1-dimension, 2-dimension (ultrasound), and 3-dimension wound assessment techniques.
- Nurses should provide each patient with a simple illustrated booklet including the most important points regarding wound pain and common points, TENS, and acupressure techniques.
- Development of functional health patterns assessment tool for postoperative patients.
- As an efficient method of wound healing, acupressure and TENS courses should be taught to undergraduate nursing students in the Egyptian universities. It should be noted that in this regard, the Faculty of Nursing of Alexandria University has taken the initiative step.