Objective: To assess Nurses' Knowledge about Nursing Management for Patients with Bariatric Surgery, and to find out relationship between Nurses' Knowledge about Nursing Management for Patients with Bariatric Surgery and their socio-demographic characteristic. Methodology: A descriptive analytic study is carried out to assess Nurses' Knowledge about Nursing Management for Patients with bariatric Surgery. A purposive "non-probability" sample consisted of (50) participants , Nurses should have at least one year of experience or more to participants at study. The study was conducted in the Surgical Teaching Hospital, second floor of surgical ward at Al-Sulaymaniyah Health Directorate in Al- Sulaymaniyah City. Results: The result show in all domain that the nurses have little Knowledge about Nursing Management for Patients with Bariatric Surgery, Where the item related to nurses’ general knowledge about bariatric surgery; the total percentage of nurses’ correct answer refer to 23.5% correct responses, Item related to nurses’ knowledge about pre-bariatric surgery nursing management; the total percentage of nurses’ correct answer refer to 15.1%, item related to nurses’ general knowledge about post-bariatric surgery nursing management; the total percentage of nurses’ correct answer refer to 25.8% , and there is no significant association between nurses’ knowledge and their socio demographic characteristics. Conclusion: Nurses' knowledge about Nursing Management for Patients with bariatric Surgery Was little, and there is no significant association between nurses’ knowledge about Nursing Management for Patients with bariatric Surgery and their socio demographic characteristics. Recommendations More efforts should be done to educate nurses’ about the bariatric surgery, and it is important to encourage nurses to teach patients with with bariatric Surgery during the pre and post period about the bariatric surgery.
The global obesity epidemic continues unabated, wreaking havoc on global health and the economy [1].
People with significant obesity have the worst health implications, including a shorter life expectancy [2]. Obesity surgeries have become the best solution for people's unable to stick to a permanent diet, especially since these operations have undergone significant medical and technological advancement [3].
Bariatric surgery (BS) is now the most effective treatment for extreme obesity, resulting in significant long-term weight loss, better obesity-related comorbidities, and lower mortality [4]. According to a meta-analysis, bariatric surgery reduces the risk of heart attack by nearly half and the risk of stroke by more than half [5].
Weight reduction is achieved by restricting the amount of food, inducing nutrient malabsorption, or by a combination of both gastric restriction and malabsorption [6].
Hormonal alterations are also a most common after bariatric surgery [7]. The role of nurses in caring for and educating people with pre and post bariatric surgery has dramatically increased in scope and scale with the worldwide increase in the prevalence of obesity. Pre and post bariatric surgery self-management requires dietary management, adherence to diet restriction. Patients’ outcomes have been demonstrated to improve when patients receive up-to-date, complete and accurate information about bariatric surgery and its care and management [8].
Malabsorption, or by a combination of both gastric restriction and malabsorption. Hormonal alterations are common after bariatric surgery. The majority of today's weight-loss operations are conducted using minimally invasive methods (laparoscopic surgery) [6].
Design of the Study
A descriptive analytic study is carried out to assess Nurses' Knowledge about Nursing Management for Patients with bariatric Surgery.
Sample of the Study
A purposive "non-probability" sample consisted of (50) participants , Nurses should have at least one year of experience or more to participants at study
Setting of the study: The study was conducted in the Surgical Teaching Hospital, second floor of surgical ward at Al-Sulaymaniyah Health Directorate in Al- Sulaymaniyah City
Data collection and Study Instruments
Data were collected by self-administrative method was used to fill out the constructed questionnaire for nurse's knowledge and their demographic data ,each nurse took 20-25 minutes to fill out the questionnaire, and the Study Instruments the present study consist of two part and page of nurses agreement to participate in a study which as:
Part One: Consist of 5 variables’ which as Age, Gender, Level of Education, Training Courses and Years of Experiences
Part Two: Consist of three subdomain (Assessment of Nurses’ General Knowledge about Bariatric Surgery consist of 16 items, Assessment of Nurses’ Knowledge about Pre-Bariatric Surgery Management consist of 19 items, and Assessment of Nurses’ Knowledge about Post-Bariatric Surgery Management consist of 17 items)
Statistical Analysis
Descriptive and inferential statistics were used to analyze the results of the study using the Statistical Package of Social Sciences (SPSS) version 25 and Microsoft Excel (2010) test the participants' knowledge. The questionnaire aims for study purposes and involves relevant topics to the study subject.
The participants were fully acquainted with the current study and its aims and then voluntary verbal consent was obtained in order to participate in the study. ethical approval was obtained from the ethical committee of research in the Faculty of Nursing/University of Baghdad regarding confidentiality and anonymity of participants.
The descriptive data in this table shows that the highest percentage of nurses associated with age group 45≤ year (46%).The gender variable refers that (54%) of nurses are female. Regarding years of employment, the highest percentages are associated with 21≤ years of employment (50%. Concerning the nursing qualification, 54% of nurses are graduated from nursing institute with diploma degree. Related to participation in training sessions about bariatric surgery, only 18% of nurses participated in one national training session (Table 1).
The Table 2 presents the item related to nurses’ general knowledge about bariatric surgery; the total percentage of nurses’ correct answer refer to 23.5% correct responses, While 76.5% o incorrect answer.
The Table 3 presents the item related to nurses’ knowledge about pre-bariatric surgery nursing management; the total percentage of nurses’ correct answer refer to 15.1%, While 84.9% incorrect answer.
The Table 4 presents the item related to nurses’ general knowledge about post-bariatric surgery nursing management; the total percentage of nurses’ correct answer refer to 25.8%, While 74.2% incorrect answer.
Table 1: Distribution of the Sample According to their Socio-demographic Characteristics
List | Characteristics |
| F | % |
1 | Age | 20- less than 25 year | 5 | 10 |
25-less than 30 year | 1 | 2 | ||
30-less than 35 year | 2 | 4 | ||
35-less than 40 year | 5 | 10 | ||
40-less than 45 year | 14 | 28 | ||
45 and more | 23 | 46 | ||
Total | 50 | 100 | ||
2 | Gender | Male | 23 | 46 |
Female | 27 | 54 | ||
Total | 50 | 100 | ||
3 | Years of employment | 1-less than 6 | 5 | 10 |
6-less than 11 | 4 | 8 | ||
11-less than 16 | 8 | 16 | ||
16-less than 21 | 9 | 18 | ||
21and more | 25 | 50 | ||
Total | 50 | 100 | ||
4 | Nursing qualification | Nursing School | 7 | 14 |
Nursing High School | 13 | 26 | ||
Nursing Institute | 27 | 54 | ||
Nursing College | 3 | 6 | ||
Total | 50 | 100 | ||
5 | Participation in training sessions about bariatric surgery | Yes | 9 | 18 |
No | 41 | 82 | ||
Total | 50 | 100 |
f: Frequency, %: Percentage
Table 2: Assessment of Nurses’ General Knowledge about Bariatric Surgery
| List | Item | Correct | Incorrect | |||
F | % | f | % | M.S | ||
1 | Bariatric surgery status mean weight-loss surgeries | 20 | 40 | 30 | 60 | 1.4 |
2 | Bariatric Surgery: Change the personality | 15 | 30 | 35 | 70 | 1.3 |
3 | Bariatric surgery is very painful | 13 | 26 | 37 | 76 | 1.26 |
4 | Weight loss surgery has proven to be effective cure for obesity | 10 | 20 | 40 | 80 | 1.2 |
5 | Bariatric surgery make felling full sooner by Allowing to eat and drink less at one time | 14 | 28 | 36 | 72 | 1.28 |
6 | The least complications of bariatric surgery is sleeve | 12 | 24 | 38 | 76 | 1.24 |
7 | Benefits for bariatric surgery: Rapid, sustained weight loss | 19 | 38 | 31 | 62 | 1.38 |
8 | Most common bariatric surgeries are Sleeve Gastrectomy | 8 | 16 | 42 | 84 | 1.16 |
9 | One of the three warning signs of a gastric leak Worsening abdominal pain and abdominal distention | 8 | 16 | 42 | 48 | 1.16 |
10 | Possible complication associated with bariatric surgery is hernia | 5 | 10 | 45 | 90 | 1.1 |
11 | The best describes how you feel about bariatric surgery: Bariatric surgery improves the quality of life for all obese patients who are compliant with postoperative instructions and diet | 7 | 14 | 43 | 86 | 1.14 |
12 | BMI indicator for evaluating the level obesity | 9 | 18 | 41 | 82 | 1.18 |
13 | A phenotype of obese individuals (Sick Fat) in the bariatric surgery metabolically unhealthy obese or “at risk” obese | 8 | 16 | 42 | 84 | 1.16 |
14 | Obesity is mainly related to genetic | 9 | 18 | 41 | 82 | 1.18 |
15 | The weigh to be considered for bariatric surgery is BMI of 40 over ideal body weight and having | 9 | 18 | 41 | 82 | 1.18 |
16 | There are many contraindication of bariatric surgery is Severe heart failure | 22 | 44 | 28 | 56 | 1.44 |
Total percentage | 23.5% | 76.5% |
| |||
f: Frequency, %: Percentage ,M.S=mean of score
Table 3: Assessment of Nurses’ Knowledge about Pre-Bariatric Surgery Management
List | Item | Correct | Incorrect | M.S | ||
F | % | F | % | |||
1 | Preoperative evaluation should be holistic, integral, and include Dieticians | 9 | 18 | 41 | 82 | 1.38 |
2 | One of the past and present evolution of medical history include Detailed history | 9 | 18 | 41 | 82 | 1.18 |
3 | Evaluation for psychological preparation include Depression | 7 | 14 | 43 | 86 | 1.14 |
4 | Nutritional assessment and patient education will help guide the patient towards dietary modifications that are necessary Before surgery | 7 | 14 | 43 | 86 | 1.14 |
5 | Start complete liquid diet Two days before surgery | 5 | 10 | 45 | 90 | 1.1 |
6 | Preoperative fasting important for Prevented Prolong recovery | 6 | 12 | 44 | 88 | 1.12 |
7 | A guided weight loss plan is Necessary for bariatric surgery | 4 | 8 | 46 | 92 | 1.08 |
8 | The weight loss plan should include Nutritional assessment | 11 | 22 | 39 | 78 | 1.22 |
9 | pre-operative laboratory tests for the patient is Important | 8 | 16 | 42 | 84 | 1.16 |
10 | Pre-operative required Medical and Surgical Screening for Bariatric Surgery Abdominal ultrasound | 10 | 20 | 40 | 80 | 1.2 |
11 | Bowel preparation is important before surgery for Prevent obstruction | 7 | 14 | 43 | 86 | 1.14 |
12 | The bladder preparation (emptying\ catheterization) is important before surgery to Prevent trauma to the bladder | 7 | 14 | 43 | 86 | 1.14 |
13 | The skin preparations in the surgery day include Bathing by antiseptic solution | 6 | 12 | 44 | 88 | 1.12 |
14 | Preoperative of body wash by antimicrobial solution for bariatric surgery To avoid infections | 10 | 20 | 40 | 20 | 1.2 |
15 | Preoperative Exercise include Turning and lifting | 9 | 18 | 41 | 42 | 1.18 |
16 | The importance of preoperative Instructions regarding benefits for bariatric surgery is to Reduce Pain | 10 | 20 | 40 | 80 | 1.2 |
17 | Sleep study important to Pre-operative sleep test (polysomnography) to check for the condition | 5 | 10 | 44 | 88 | 1.08 |
18 | Preoperative H. pylori eradication versus standard care in patients undergoing bariatric surgery Done before surgery | 5 | 10 | 45 | 90 | 1.1 |
19 | The steps in pre-operative preparations for bariatric surgery are Creating awareness of the risks | 9 | 18 | 41 | 82 | 1.18 |
Total percentage | 15.1% | 84.9% |
| |||
f: Frequency, %: Percentage, M.S=mean of score
This Table 5 indicates that there is no significant association between nurses’ knowledge and their socio demographic characteristics.
Discussion of Socio-Demographic Characteristics Table
The Age: The study result shows the highest percentage of nurses in the are associated with age group 45≤ year (46%). These results agreed with the study which find the majority of the nurses' age was between (35-55) years old and represent (40.8%) and 59.2% respectively [9]
Gender: The result shows the gender variable refers that 54% of nurses are female. This result is agreeing with study which reveals that the majority of respondents were female [7]
Years of Employment: Regarding years of employment, the highest percentages are associated with 21≤ years of employment (50%). Explanation of this result refers to most of the nurses works in bariatric surgery need for good experience there for we find most of them have 21 years of employment.
Nursing qualification Concerning: The nursing qualification, 54% of nurses are graduated from nursing institute with diploma degree. The result is disagree with the result that find most of participant were nurses had a bachelor and associate degree, 19.6% , 13.5% respectively [9]
Table 4: Assessment of Nurses’ Knowledge about Post-Bariatric Surgery Management
| List | Item | Correct | Incorrect | M.S | ||
F | % | F | % | |||
1 | A catheter is passed in to the bladder to collect urine When the patient is asleep in the operating room | 23 | 46 | 27 | 54 | 1.46 |
2 | The benefit of tube through the skin into the operated part of the stomach Check leak in to the abdomen from the surgical site | 14 | 28 | 36 | 72 | 1.28 |
3 | Bariatric patients can take for Pain relievers that are Acetaminophen-based, such as Tylenol | 17 | 34 | 33 | 66 | 1.34 |
4 | Tests After Surgery EGD | 19 | 38 | 31 | 62 | 1.38 |
5 | The eat and drink slowly Avoid dumping syndrome | 11 | 22 | 39 | 78 | 1.22 |
6 | The foods cannot be eaten after bariatric surgery Food with Empty Calories and High-Fat Food | 10 | 20 | 40 | 80 | 1.2 |
7 | Patients can return to work Within two to six weeks | 10 | 20 | 40 | 80 | 1.2 |
8 | Breathing exercises (Incentive Spirometer) after bariatric surgery important to Prevent pneumonia | 9 | 18 | 41 | 82 | 1.18 |
9 | Patients can start do heavy lifting First six weeks after surgery, do not lift any more than 15 lbs | 3 | 6 | 47 | 94 | 1.06 |
10 | Patients can Resume Driving After Weight Loss Surgery Week after bariatric surgery | 6 | 12 | 44 | 88 | 1.12 |
11 | Patients can take a bath or shower 48 hours after surgery | 19 | 38 | 31 | 62 | 1.38 |
12 | Inform the doctor if the patients develop a fever after bariatric surgery | 23 | 46 | 27 | 54 | 1.46 |
13 | Expectation after bariatric surgery is to improve type 2 diabetes or sleep apnea | 12 | 24 | 38 | 76 | 1.24 |
14 | Gastric bypass Cannot increase or decrease life span | 15 | 30 | 35 | 70 | 1.3 |
15 | Patient’s follow-up visits for recognize Iron deficiencies | 13 | 26 | 37 | 74 | 1.26 |
16 | Schedule of Postoperative Visits 1-2 weeks after bariatric surgery | 6 | 12 | 44 | 88 | 1.32 |
17 | Support group meetings for bariatric surgery leads to Allow patients to surround themselves with people who understand and support their goals | 10 | 20 | 40 | 80 | 1.2 |
Total percentage | 25.8% | 74.2% |
| |||
f: Frequency, %: Percentage ,M.S=mean of score
Table 5: Association between Nurses’ Knowledge and their Socio-demographic Characteristics among Study Group
Characteristic | Poor | Fair | Good | Total | Significance | |
Gender | Male | 12 | 0 | 0 | 12 | X -=13.515 df= 2 Sig= .408 NS |
Female | 13 | 0 | 0 | 13 | ||
Total | 25 | 0 | 0 | 25 | ||
Age group | 20-less than 25 year | 2 | 0 | 0 | 2 | X -=55.119 df= 10 Sig= .508 NS
|
25-less than 30 year | 1 | 0 | 0 | 1 | ||
30-less than 35 year | 3 | 0 | 0 | 3 | ||
35-less than 40 year | 7 | 0 | 0 | 7 | ||
40-less than 45 year | 12 | 0 | 0 | 12 | ||
45 and more | 0 | 0 | 0 | 0 | ||
Total | 25 | 0 | 0 | 25 | ||
Nursing Qualification | Nursing School | 4 | 0 | 0 | 4 | X -=40.675 df= 6 Sig= .529
NS |
Nursing High School | 6 | 0 | 0 | 6 | ||
Nursing Institute | 14 | 0 | 0 | 14 | ||
Nursing College | 1 | 0 | 0 | 1 | ||
Total | 25 | 0 | 0 | 25 | ||
Years of employment | 1-less than 6 | 3 | 0 | 0 | 3 | X -=54.592 df= 8 Sig= .528
NS |
6-less than 11 | 2 | 0 | 0 | 2 | ||
11-less than 16 | 4 | 0 | 0 | 4 | ||
16-less than 21 | 5 | 0 | 0 | 5 | ||
21-and more | 11 | 0 | 0 | 11 | ||
Total | 25 | 0 | 0 | 25 | ||
Training | No | 4 | 0 | 0 | 4 | X -=14.087 df= 2 Sig= .443 |
Yes | 21 | 0 | 0 | 21 | ||
Total | 25 | 0 | 0 | 25 | ||
X -: Chi-square, df: Degree of freedoms Sig: Significance
Participation in training sessions Related to participation in training sessions about bariatric surgery, only 18% of nurses are participated in one national training session. As a result of lacking of experience, nurses experience, nurses may insufficiently care for patients, with all respect to these range of few years of experience in bariatric surgery among nurses participating in the study gives indication that continually many nurses were moved from these wards, which have a negative consequence on the quality of care provided to the patients regarding bariatric surgery.
The study result of nurse’s knowledge about bariatric surgery; the total percentage of nurses’ correct answer refer to (23.5%,15.1%, and 25.8% in table 4-2,4-3,4-4- respectively). This result is agreement with a Swiss study by Bucher et al showed that the reason why some doctors and nurses did not have knowledge and skills bariatric surgery is due to a lack of guidelines of bariatric surgery and lifestyle [10].
Concerning the result related to associations between nurses knowledge and demographical data. The present study reveals that there is no significant association between nurses' knowledge, and demographic data (age, gender, Marital status, and years of experience). The results of the present study are supported by other studies that indicated no significant difference between demographic data and nurses' knowledge [11].
According to the Items of the questionnaire, it was found that the nurses' knowledge about Nursing Management for Patients with bariatric Surgery Was little.
There is no significant association between nurses’ knowledge about Nursing Management for Patients with bariatric Surgery and their socio demographic characteristics.
Recommendations
More efforts should be done to educate nurses’ about the bariatric surgery.
It is important to encourage nurses to teach patients with BS during the pre and post period about the bariatric surgery.
Establishing, and implementing gastric rehabilitation program in all bariatric centers. Therefore, all BS nurses should be involved in such program as soon as their health condition was stable.
Thomas, E.L. et al. “Whole body fat: content and distribution.” Progress in Nuclear Magnetic Resonance Spectroscopy, vol. 73, 2013, pp. 56–80.
Agha, M. and Agha, R. “The rising prevalence of obesity: Part A: impact on public health.” International Journal of Surgery Oncology, vol. 2, no. 7, 2017, pp. e17.
Nguyen, N.T. and Varela, J.E. “Bariatric surgery for obesity and metabolic disorders: State of the art.” Nature Reviews Gastroenterology & Hepatology, vol. 14, no. 3, 2017, pp. 160–169.
Pucci, A. and Batterham, R. “Mechanisms underlying the weight loss effects of RYGB and SG: Similar, yet different.” Journal of Endocrinological Investigation, vol. 42, no. 2, 2019, pp. 117–128.
Al Khalifa, K. and Al Ansari, A. “Quality of life, food tolerance, and eating disorder behavior after laparoscopic gastric banding and sleeve gastrectomy: Results from a Middle Eastern center of excellence.” BMC Obesity, vol. 5, no. 1, 2018, pp. 1–6.
Ionut, V. et al. “Gastrointestinal hormones and bariatric surgery-induced weight loss.” Obesity, vol. 21, no. 6, 2013, pp. 1093–1103.
Dimitriadis, G.K. et al. “Potential hormone mechanisms of bariatric surgery.” Current Obesity Reports, vol. 6, no. 3, 2017, pp. 253–265.
Magallares, A. and Schomerus, G. “Mental and physical health-related quality of life in obese patients before and after bariatric surgery: A meta-analysis.” Psychology, Health & Medicine, vol. 20, no. 2, 2015, pp. 165–176.
Fan, M. et al. “Knowledge and attitudes towards obesity and bariatric surgery in Chinese nurses.” Obesity Surgery, vol. 30, no. 2, 2020, pp. 618–629.
Bucher, S. et al. “Knowledge, attitudes, representations and declared practices of nurses and physicians about obesity in a university hospital: Training is essential.” Clinical Obesity, vol. 8, no. 2, 2018, pp. 122–130.
Wadi Al-Azawi, H.A. and Hameed, D.M. “Assessment of nurses’ knowledge toward sleeve gastrectomy in surgical unit at Al-Najaf Al-Ashraf Governorate.” Indian Journal of Forensic Medicine & Toxicology, vol. 15, no. 2, 2021, pp. 612–627.
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