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Original Article

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

Sung-Hee Lee1, Sung-Jung Hong2, Hwa Sun Kim3, Younghoon Jeon4
Korean Journal of Adult Nursing 2015;27(5):481-492.
Published online: October 31, 2015

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: February 27, 2015   • Accepted: June 10, 2015

Copyright © 2015 Korean Society of Adult Nursing

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.

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  • 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.
  • Key Words: Postoperative nausea and vomiting; Postoperative pain; Satisfaction
Figure 1.
Recommendation of evidence-based practice in postoperative nausea and vomiting.
kjan-27-481f1.jpg
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
n (%) or M±SD n (%) or M±SD
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
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
n (%) or M±SD n (%) or M±SD
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
n (%) or M±SD n (%) or M±SD
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
M±SD M±SD
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
M±SD M±SD
Patients' satisfaction 8.45±2.09 7.12±2.45 2.443 .017

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

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      Effect of Evidence-based Clinical Practice Guidelines for Promotion of Postoperative Nausea and Vomiting of Patients with Laparoscopic Hysterectomy
      Korean J Adult Nurs. 2015;27(5):481-492.   Published online October 31, 2015
      DOI: https://doi.org/10.7475/kjan.2015.27.5.481
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      Effect of Evidence-based Clinical Practice Guidelines for Promotion of Postoperative Nausea and Vomiting of Patients with Laparoscopic Hysterectomy
      Korean J Adult Nurs. 2015;27(5):481-492.   Published online October 31, 2015
      DOI: https://doi.org/10.7475/kjan.2015.27.5.481
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      Effect of Evidence-based Clinical Practice Guidelines for Promotion of Postoperative Nausea and Vomiting of Patients with Laparoscopic Hysterectomy
      Image
      Figure 1. Recommendation of evidence-based practice in postoperative nausea and vomiting.

      Figure 1.

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

      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
      n (%) or M±SD n (%) or M±SD
      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
      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.

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

      Variables Categories Exp. (n=35) Cont. (n=35) x2 or t p
      n (%) or M±SD n (%) or M±SD
      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.

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

      Variables Categories Exp. (n=35) Cont. (n=35) t p
      n (%) or M±SD n (%) or M±SD
      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.

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

      Variables Exp. (n=30)　 Con. (n=30) t p
      M±SD M±SD
      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.

      Comparisons of Postoperative Patients' Satisfaction (N=60)

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

      Exp.=experimental group: Cont.=control group.
      Table 1. Homogeneity Test on the Characteristics of the Participants related to Postoperative Nausea and Vomiting (N=65)

      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)

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

      Table 3. Comparisons of VAS Score and Postoperative Side Effects between the Groups (N=70)

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

      Table 4. The Total Amount of Time of Nursing Activities for PONV (N=60)

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

      Table 5. Comparisons of Postoperative Patients' Satisfaction (N=60)

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

      Table 1.

      Table 2.

      Table 3.

      Table 4.

      Table 5.

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