Development of Information System for Patients with Cleft Lip and Palate undergoing Operation.

BACKGROUND: Srinagarind Hospital has 150-200 patients with cleft lip and palate each year. When patients are admitted to hospital for surgery patients and family feel they are in a crisis of life, they feel fear anxiety and need to know about how to take care of wound, they worry if patient will feel pain, how to feed patients and many things about patients. Information is very important for patients/family to prevent complications and help their decision process, decrease parents stress and encourage better co-operation. OBJECTIVE: To develop information system for patients with cleft lip-palate undergoing operation. MATERIAL AND METHOD: This is an action research divided into 3 phases. Phase 1 Situation review: in this phase we interview, nursing care observation, and review nursing documents about the information giving. Phase 2 Develop information system: focus groups, for discussion about what nurses can do to develop the system to give information to patients/parents. Phase 3 evaluation: by interviewing 61 parents using the structure questionnaire. RESULTS: 100 percent of patients/parents received information but some items were not received. Patients/parents satisfaction was 94.9 percent, no complications. CONCLUSION: The information system development provides optimal care for patients and family with cleft lip and palate, but needs to improve some techniques or tools to give more information and evaluate further the nursing outcome after.

Comparison of wound dehiscence and parent's satisfaction between spoon/syringe feeding and breast/bottle feeding in patients with cleft lip repair.

BACKGROUND: Cleft lip and cleft palate are the most common craniofacial anomalies affecting approximately 2.49 of every 1,000 children born in North-east of Thailand. Srinagarind Hospital has 100-150 cases of cleft lip each year. Children with cleft lip and palate need surgical procedures as soon as possible. After lip repair the normal recommendation is not using bottle or breast feeding for 2 weeks to avoid tension at the sutured area during sucking and possible cause of wound dehiscence. So this is quite complicated for the parents, and patients feel frustrated, cry, and move their head around, because of hunger which cannot easily be satisfied. Previous research found that sucking does not cause wound dehiscence, but mentioned no detail about severity of cleft. OBJECTIVE: Primary objective is to compare surgical wound dehiscence between breast feeding/bottle and spoon/syringe feeding after lip repair. MATERIAL AND METHOD: This is an experimental study: non-inferiority trials study. The population is the patients with cleft lip who underwent lip repair in Inpatient Department 3C, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. The study period is during May 2010-February 2013. The total sample size in the present study is 192 participants, 96 cases breast/bottle feeding, 96 cases spoon/syringe feeding. The wound dehiscence rate was analyzed by Z-test. Parents'satisfaction is a qualitative data and was analyzed through content analysis. RESULTS: No statistical significant diference between breast/bottle and spoon/syringe groups (p-value = 0.320, 95% confidence interval -0.031-0.010). Parents were more satisfied to feed children by breast/bottle and patients were more relaxed with breast/bottle feeding. CONCLUSION: Breast/bottle feeding and syringe/spoon feeding have the same result on the surgical wound. Breast/bottle feeding are not causes of wound dehiscence.

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.

Nursing care system development for patients with cleft lip-palate and craniofacial deformities in Srinagarind Hospital: pre-post operation.

BACKGROUND: Cleft lip and palate are the most common craniofacial anomalies. Srinagarind Hospital has 150-200 cases each year. The operating process of care requires continuity of care involving a multidisciplinary team. When the patients go to hospital to have operation, pain, limited activity and food are very different from normal life. During pre and post operative care nurses who work continuously and closely with the patients should have knowledge, experience and ability to take excellent care of their patients and families. This can prevent complications and help their decision process, decrease parents stress and encourage better co-operation. OBJECTIVE: To develop a nursing care system for patients with cleft lip-palate undergoing operation. MATERIAL AND METHOD: This is an action research divided into 3 phases. Phase 1, situation review: review of nursing care process by interview, focus group, observation and nursing documents. Phase 2, nursing system management: developing guidelines, composing nursing manual, handbook for parents, VCD for patients and family and story telling. Following that announcement and implementation. Phase 3: evaluation. RESULT: The authors found that guidelines, nursing manual, handbook for parents, VCD for patients and family and story telling are appropriate and have good utilization, but the pictures in handbook for parents and storytelling were not clear, too small and not attractive. CONCLUSION: Nursing manual for giving information about pre-post operative care, handbook for parents, story telling and VCD about pre-post operative care provide optimal care for patients and family with cleft lip and palate, but need to evaluate further the nursing outcome after this nursing system development.

Postoperative pain in patients with cleft lip and palate in Srinagarind Hospital.

BACKGROUND: Srinagarind Hospital has about 150-200 cases of patients with cleft lip and cleft palate each year. The operating process requires continuity of care involving a multidisciplinary team. When the patients go to hospital to undergo operation, pain is one of the most important symptoms to try and control effectively. During pre and post operative care nurses who work continuously and closely with the patients are the best persons to assist with pain relief. They need to have knowledge, experience and ability to take excellent care about pain control as well as having to have continuing assessment and selection of pain measurement tool. They can then better help to relieve patients pain, decrease parents stress and encourage better cooperation. OBJECTIVE: To the present study pain score level in patients with cleft lip cleft palate during the 24 hour period after operation. MATERIAL AND METHOD: This is the retrospective descriptive study. Data was collected from medical records. 86 Medical records of the patients with cleft lip cleft palate who were admitted in 3c ward between January to December 2010. Medical Records were purposively selected for the study and recorded with a data collection form. RESULT: 39% of patients after cheiloplasty and 55.6% of patients after palatoplasty received painkillers before leaving operating room, 29.29% of patients after cheilopalsty and 15.50% of patients after palatoplasty had severe pain immediately in ward. 48.8% of patients after cheiloplasty have moderate to severe pain at the 4th hour. Pain score was less when longer time after operation. Only 7.3% have pain after the 16th hour and pain finish after the 20th hour after operation. 51.1% in patients after palatoplasty have moderate to very severe pain at the 4th hour and 15.6% have moderate to very severe pain still occurring until the 24th hour. CONCLUSION: Some of the patients with cleft lip and palate after operation received painkillers before leaving operating room. Pain score immediately at ward is severe to very severe pain. 22.09% of patients after cheiloplasty and palatoplasy have moderate to severe pain at the 4th hour. For patients after cheiloplasty pain will continue until the 16th hour after operation, but patients after palatoplasty pain will continue more than 24 hours.