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 outcome in patients with cleft lip and palate who underwent operation: follow-up cases.

BACKGROUND: Cleft lip and cleft palate are the most common craniofacial anomalies affecting approximately 2.5 of every 1,000 children born in North East of Thailand. Srinagarind Hospital has 150-200 cases of cleft lip and palate each year. The lengthy treatment process of care, requires continuity of care involving a multidisciplinary team. The holistic and interdisciplinary care is very important to patients, family, health care professionals and the health care system. After operation patients stay in hospital about 2-3 days, during this time they will receive information regarding how to take care of the wound,feeding and details about activities to avoid. Before patients leave hospital the nurse will confirm if parents can take care of patients wound, feeding, know about avoiding activities. The Nurses or health care professional can check patients progress again when they come back to hospital for follow-up. OBJECTIVE: To promote continuity care and resolve any problems for developing quality of care. MATERIAL AND METHOD: The present study is retrospective descriptive study. Data was collected from follow-up case forms using 205 medical records of patients with cleft lip and palate who were admitted in 3c ward Srinagarind Hospital between June 2010 to May 2011. The records were purposively selected for the study and recorded with a data collection form. RESULTS: 95.12% of patients with cleft lip and palate came back for follow-up. 2.44% of patients had wound infection. 7.69% of patients have flap separation. The authors also found that some care givers could not take care of the patients correctly and were not concerned about follow-up. CONCLUSION: To contracts the patients and family when they visit hospital for follow-up can make health care professional ensure the patients understand what they need to know and do, also can find any uncomfortable points/problem of patients/ family then can develop the strategies or system to solve the problem.

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.