Effect of Evidence-based Clinical Practice Guidelines for Promotion of Postoperative Nausea and Vomiting of Patients with Laparoscopic Hysterectomy

Sung-Hee Lee; Sung-Jung Hong; Hwa Sun Kim; Younghoon Jeon

doi:10.7469/kjan.2015.27.5.481

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Lee, Hong, Kim, and Jeon: Effect of Evidence-based Clinical Practice Guidelines for Promotion of Postoperative Nausea and Vomiting of Patients with Laparoscopic Hysterectomy

Original Article

Korean J Adult Nurs 2015;27(5):481-492.

Published online: October 2015

DOI: https://doi.org/10.7469/kjan.2015.27.5.481

Effect of Evidence-based Clinical Practice Guidelines for Promotion of Postoperative Nausea and Vomiting of Patients with Laparoscopic Hysterectomy

Sung-Hee Lee¹, Sung-Jung Hong^2,, Hwa Sun Kim³, Younghoon Jeon⁴

^¹College of Nursing, Kyungpook National University, Daegu

^²Department of Nursing, Semyung University, Jecheon

^³Department of Faculty of Medical Industry Convergence, Daegu Haany University, Gyeongsan

^⁴Department of Anesthesiology and Pain Medicine School of Dentistry, Kyungpook National University, Daegu, Korea

Corresponding author: Hong, Sung-Jung Department of Nursing, Semyung University, 65 Semyung-ro, Jecheon 390-711, Korea. Tel: +82-43-649-1587, Fax: +82-43-649-1235, E-mail: ag3927@naver.com

Received 27 February 20158 June 2015 Accepted 10 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to examine the effects of the evidence-based clinical practice guidelines on Postoperative Nausea and Vomiting (PONV).

Methods

The research design was a non-equivalent control group with a non-synchronized design. The participants were the patients undergoing gynecologic laparoscopy. Data were collected from July, 2014 through January, 2015. The participants in the experimental group (n=35) received an assessment of risk factors of PONV, aroma therapy, and P6 acupressure method as recommended in the guidelines. Those in the control group (n=35) received usual nursing care. Data were analyzed by mean, standard deviation, t-test, x²-test using SPSS/WIN 19.0 program.

Results

The occurrence of nausea and vomiting, the level of nausea and vomiting, and the need for antiemetic medicine in the experimental group were significantly less than those in the control group after surgery. The levels of postoperative pain and the amounts of time for nursing activities in the experimental group were significantly reduced than those in the control group after surgery. The levels of satisfaction were significantly higher in the experiment group than that of the control group.

Conclusion

The evidence-based guidelines is recommended for nursing practice as a guidance for managing PONV and helping the recovery of patients after laparoscopic surgery.

Keywords: Postoperative nausea and vomiting, Postoperative pain, Satisfaction

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Figure 1.

Recommendation of evidence-based practice in postoperative nausea and vomiting.

Table 1.

Homogeneity Test on the Characteristics of the Participants related to Postoperative Nausea and Vomiting (N=65)

Variables	Categories	Exp. (n=30)	Cont. (n=35)	x² or t	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Age (year)		43.37±11.10	38.43±11.11	1.862	.067
Weight (kg)		57.74±7.33	57.06±8.70	0.357	.722
Height (cm)		158.31±4.84	157.71±7.49	0.398	.692
Number of risk factors^†	2	1 (2.9)	2 (5.7)	0.470	.790
	3	21 (60.0)	19 (54.3)
	4	13 (37.1)	14 (40.0)
Duration of anesthetic (min)		145.43±50.75	142.57±48.84
Duration of operating (min)		112.71±47.91	106.14±47.99	-0.249	.804
Total fluid		1,337.14±601.02	1,154.29±446.12	-1.445	.153
Blood loss		154.71±186.34	106.14±169.83	1.140	.258
ASA	Class I	21 (60.0)	19 (54.3)	0.233	.809
ASA	Class II	14 (40.0)	16 (45.7)

Exp.=experimental group: Cont.=control group; ASA=American Society of Anesthesiology;

^† Non smoking, PONV (postoperative nausea and vomiting), morning sickness, motion sickness.

Table 2.

Comparison of the Levels of Postoperative Nausea and Vomiting (N=70)

Variables	Categories	Exp. (n=35)	Cont. (n=35)	x² or t	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
0~2 hours	Occurrence of nausea	7 (20.0)	18 (51.4)	7.529	.012
	Level of nausea	1.08±0.45	3.56±1.28	10.814	＜.001
	Occurrence of vomiting	2 (5.7)	12 (34.3)	8.929	＜.001
	Times of vomiting	0.32±0.12	0.78±0.32	16.036	＜.001
	Rescue antiemetic	1 (2.9)	8 (22.9)	6.248	.028
2~24 hours	Occurrence of nausea	6 (22.9)	23 (65.7)	13.027	.001
	Level of nausea	0.10±0.08	0.62±0.21	13.690	＜.001
	Occurrence of vomiting	2 (5.7)	10 (28.6)	6.437	.023
	Times of vomiting	0.13±0.10	0.32±0.18	5.458	＜.001
	Rescue antiemetic	1 (2.9)	9 (25.7)	7.467	.013

Exp.=experimental group: Cont.=control group.

Table 3.

Comparisons of VAS Score and Postoperative Side Effects between the Groups (N=70)

Variables	Categories	Exp. (n=35)	Cont. (n=35)	t	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	t	p
VAS score	2 hours post operation	5.66±1.33	6.46±1.74	2.164	.034
	6 hours post operation	4.13±1.08	4.77±1.02	2.548	.013
	24 hours post operation	3.09±1.04	3.68±1.09	2.317	.024
Dose of PCA	2 hours post operation	7.29±4.66	5.80±2.85	1.610	.112
	6 hours post operation	16.20±8.12	11.66±7.84	2.382	.020
	24 hours post operation	26.06±16.22	18.51±12.53	2.178	.033
Additional analgesic	2 hours post operation	1 (2.9)	4 (11.4)	5.138	.077
	6 hours post operation	0 (0.0)	6 (17.1)	6.563	.025
	24 hours post operation	4 (11.4)	13 (37.1)	6.293	.024

Exp.=experimental group: Cont.=control group.

Table 4.

The Total Amount of Time of Nursing Activities for PONV (N=60)

Variables	Exp. (n=30)	Con. (n=30)	t	p
Variables	M±SD	M±SD	t	p
Observation	3.91±1.60	4.26±2.95	-0.604	.548
Communication	3.97±2.41	4.62±3.53	-0.908	.367
Documentation	3.60±2.54	3.85±2.04	-0.466	.643
Administration	4.65±2.81	7.26±4.45	2.921	.005
Total (min)	16.14±5.93	20.00±8.98	-2.120	.038

Exp.=experimental group: Cont.=control group.

Table 5.

Comparisons of Postoperative Patients' Satisfaction (N=60)

Variables	Exp. (n=30)	Con. (n=30)	t	p
Variables	M±SD	M±SD	t	p
Patients' satisfaction	8.45±2.09	7.12±2.45	2.443	.017

Exp.=experimental group: Cont.=control group.

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