Knowledge and Perception of Pre-operative patients about Anesthesia and the Role of Anesthetist in Orrota and Halibert National Referral Hospitals, Asmara, Eritrea, Africa.
Dr. Anthony Raja, Mr. Moses kandula
PhD Scholar, Research Guide, Principal, Unity College of Nursing, Mangalore
Incharge Principal, Welfare Institute of Nursing and Midwifery, Gujarat
*Corresponding Author Email: Karthinsg473@gmail.Com
ABSTRACT:
Background: Most surgical patients do not recognize the role played by anesthetists in the preoperative period because of poor public knowledge of anesthesia as a medical discipline. This study was conducted to determine patients’ knowledge of anesthesia and the role of anesthetists in patient care. Aims: To assess patients’ knowledge and perception regarding anesthesia and the role of anesthetist in Orrota and Halibert referral Hospitals. Method: A total 84 patients scheduled for various surgeries were interviewed on the basis of a questionnaire at the time of preoperative visit. 24 questions were forwarded to know patients’ knowledge and perception regarding the role of anesthetists, different types of anesthesia, concerns were included. After data was collected, it was inserted in to SPSS (statistics package for social sciences) 20th version at 95% CI and visual analogue scale (VAS) used. Patient’s perception and changes were studied with respect to variables like age, sex, educational level and past exposure to surgery. Results: of the study show a poor overall perception with only 40-50 years old (23.81%) which is maximum and the minimum is between 10-20 years old (7%). 44 (52%) were female patients and 40 (48%) were males. Regarding educational level the 22 (26.19%) which is the highest were illiterate, and the lowest was collage graduate (2.38%) those who operated before were 32 (38.1%) and those who are not operated were 50 (59.52%) knowing that anesthetist is the one who gives anesthesia and 36.904% patients knowing that he is a doctor. Patient awareness about types of anesthesia, the type he was going to receive was also poor. Amongst various factors educational level showed a clear-cut influence on patient perception. Conclusion: Patients have poor knowledge of anesthesia and the role of anesthetists in the care of surgical patients. This knowledge deficit should be addressed and made part of the general preoperative care to enable patients to cope better with a view to improve the outcome of surgical procedure.
KEYWORDS: Primitive Anesthesia Arabic Alchemists, Centuries employing techniques.
INTRODUCTION:
Primitive Anesthesia Arabic Alchemists were perhaps some of the most advanced in their beliefs on anesthesia in the 12. And 13. Centuries employing techniques such as the soporific sponge which was a sponge steeped in cannabis, opium and other herbal aromatics. When required for surgery it would be moistened and held over the face inducing a state of unconsciousness. (Barash etal, 2006).
Medieval anesthesia was primitive and barbaric compared to the standards employed today. The most common was probably the use of liberal quantities of alcohol plus or minus opium and a wooden stick to bite down upon. Some of these substances used in this period still hold strong today such as opium derivate and some are even being rediscovered like Cannabis in chronic pain management. (MILER, 2005).
Elective surgery was uncommon prior to Modern Surgical Anesthesia. From 1821 to 1846, the annual reports of Massachusetts General Hospital recorded only 333 surgeries, barely more than one per month. In 1846, opium and alcohol were the only agents generally regarded as having practical value in reducing surgical pain. A 1847 publication on “New Elements of Operative Surgery” listed opium, water of nightshade, hebane, lettuce, hypnosis, strapping, compression of nerve trunks and noise as anesthetics in use. Surgery without adequate pain control seems cruel to the modern reader, yet this was the common practice throughout most of history. While anesthesia is considered a relatively new field, surgery predates recorded human history. Human skull trepanations occurred as early as 10,000 BC, with archaeological evidence of post-procedure bone infection and healing, proving these primitive surgeries were performed on living humans. Juice from coca leaves may have been dribbled onto the scalp wound but the recipient of these procedures was almost certainly awake while a hole was bored into his or her skull with a sharp flake of volcanic glass. This was a unique situation in anesthesia; there are no other instances in which both the operator and his patient share the effects of the same drug. (Eyelade OR et al, 2010).
Systematic anesthesia plans started with the introduction of nitrous oxide by Joseph Priestly and ether by Crawford Long and Morton Williams around 1850. Also Chloroform was introduced and became especially famous as the royal anesthetic as it was used for the Caesarean section of Queen Victoria of England. For the next 50years ether and chloroform dominated the anesthetic scene. Around 1900 the first local anesthetics, cocaine and procaine, were introduced. Finally in 1920 the first endotracheal tube was inserted by Magill and Rowbotham. The first national societies of Anesthesia were established in the UK and the USA, they were headed by Sir Robert MacIntosh and Ralph Waters. This was followed by the introduction of anesthetics still in use like Thiopentone in 1934, Curare derivates in 1942, curved laryngoscope blades 1943, halothane in 1956, Ketamine in 1966. (Jean Lees 2006).
The responsibilities of the anesthetists have widely enlarged. Initially the anesthetist was putting a patient to sleep and woke him up after the operation. nowadays the anesthetist is responsible in clinical anesthesia for the pre-operative assessment and the improvement of the health status, if necessary for anesthesia and surgery, the planning of the anesthesia technique, the intra-operative anesthesia, the recovery period and the management of the patient in the first 24 hours after surgery. This research wants to verify if the public\patient’s knowledge and perception of the role of the anesthetist has changed accordingly or if still the old fashioned view of an unimportant helper of the surgeon is in their minds.
REVIEW OF LITERATURE:
In a prospective cross-sectional study using data obtained in 2007-2008 at a tertiary university hospital involving 518 patients aged 16 years or above were interviewed before and after anesthesia exposure. The study was conducted to evaluate patients' perceptions about anesthesiologists before anesthesia and to identify whether the anesthetic care would change such perceptions: A questionnaire was used to determine patient characteristics and perceptions about anesthesia/anesthesiologists. The majority only attended elementary school (~60%). 79% said that anesthesiologists were specialized physicians, significant changes in knowledge (p<0.05) before and after operation and anesthesia were only found on monitoring and drug administration. The role of the anesthetist outside OR was not investigated. Patients' perceptions of anesthesiologists' roles were judged to be fairly good, but improvements in this relationship would still need to be pursued to achieve better outcomes. (Leite F et al, 2001)
A research team in UK audited patient attitudes to an information leaflet provided at the preadmission clinic as part of standard day-case protocol. The booklet is a simplified version of the booklet Anesthesia and Anesthetists – Information for Patients and Relatives published in London, UK, by the Association of Anesthetists of Great Britain & Ireland. One hundred and three patients
A study was conducted in India in a tertiary care teaching hospital on 150 adult surgical patients posted for elective surgery to assess patient’s knowledge about the role of anesthetists, their preoperative concerns related to anesthesia, post-operative complaints and level of satisfaction regarding anesthesia services. A majority (93%) of patients felt that anesthesia was necessary for surgery, but only 43% knew that it was given by a specialist in anesthesia, in this case an anesthesiologist. Only 27% were aware that monitoring during surgery was part of the anesthetist’s work. Patients had knowledge about anesthesia risks in 15%, about their role in ICU in 7%, about their involvement in pain clinics in 5%. They concluded that sufficient time should be given to educate the patients about anesthesia and the various roles an anesthetist/anesthesiologist plays. Deliberate information during pre-anesthetic visit should be used to fulfill this purpose. (Udita Naithani et al, 2007)
In 2010 a cross-sectional questionnaire survey of 229 consecutive adult patients aged 18years and above, scheduled for elective surgery in Nigeria titled “Patients' perception and knowledge of anaesthesia and anaesthetists—A questionnaire survey” was conducted over a three-month period. Of the 229 patients studied, 90 (39.3%) were males and 139 (60.7%) were females. Ninety-nine (43.2%) had a history of previous anaesthesia and surgery, while 130 (56.8%) had no previous experience of anaesthesia. One-third (33 of 99) of patients who had past experience of anaesthesia knew that anaesthesia is administered by qualified anaesthetists. Among 130 patients without a history of previous anaesthetics, 63 (48.5%) had no idea of what the role of the anaesthetist was, 31 (23.8%) listed putting patients to sleep, monitoring vital signs and offering pain relief, and 25 (19.2%) knew that anaesthetists should administer anaesthetics. Patients who had tertiary education (44.1%) had a significantly higher knowledge of the anaesthetist's role than those with only secondary (33.2%) or primary education (15.7%, p < 0.05). They concluded that patients have poor knowledge of anaesthesia and the role of anaesthetists in the care of surgical patients. This knowledge deficit should be addressed and made part of the general preoperative care to enable patients to cope better with a view to improving the outcome of surgical procedures. (Eyelade O R at al, 2010)
RESEARCH METHODOLOGY:
SETTING OF THE STUDY:
The study was conducted in Orrota and Halibet National Referral Hospitals in Asmara. A pilot study was done before this study in Orrota National Referral Hospital in Asmara.
The participants of the study were, prepared for pre-operative assessment before the surgery.
The study was a descriptive cross-sectional study.
No = Z2 * P (1-P
e2
Z= 95 % confidence interval of 0.05 confidence interval = 1.96 (table)
P = proportion of maximum 0.5
e = precision level =10%
Total sample size = 84
The researchers used cluster probable random sampling with proportional allocation in Orrota and Halibert Referral Hospitals in Asmara.
· All patients scheduled for operation in Orrota and Halibet National Referral Hospitals during November and December 2016
· All patients who agree to participate in the study after informed written consent
· Patient’s between ages of 18 to 75 years
· Patients in critical condition or mentally not able to answer the questions
· Patients who had language barrier
The ethical issue was dealt first by obtaining a permission letter from ACHS to EEC of MOH. Permission was inquired from MOH and medical director of the research areas and the patients. A written consent was attached on the questionnaire which was given and explained to each participant of the study. The patients were informed about the nature and objective of the study. They were given brief introduction and explanations about the planed study and informed consent from the study participants was received. They felt comfortable with the decision regarding the study participation. They were assured that any information about the participants of the research would be kept confidential through the use of coded transcriptions.
The responders’ right to refuse or withdraw from the study was respected and no disadvantages raised from withdraw or refusal.
The investigators conducted that study by approaching to patients who were scheduled for operation and willing to receive informed consent to participate in the study.
The research team used face–to-face interview with patients to collect the data using a structured questionnaire which was prepared in English and 84 patients were interviewed in the day before the operation. The interview was done with an average of 25-30 minutes for every patient. The investigators explained and translated the English questions in Tigrigna verbally to the patients during the interview.
The data was collected from beginning of November to the end of December, 2016 in the Orrota and Halibet National Referral Hospitals in the surgical wards.
Before data collection was carried out, a pre-test was done to check the consistency, validity and acceptability of the test procedure for inpatient cases. The validity of the questionnaire was tested by expert and the reliability was tested by a pilot study (r=0.78)
After data was collected, it was inserted in to SPSS (statistics package for social sciences) 20th version at 95% CI and visual analogue scale (VAS) used. It was analyzed using descriptive statistics including frequency and percentage. The data was presented in terms of frequency distribution tables and graphs. In the visual analogue scale (VAS) as Meretoja and Koponen used in their similar previous study a division scales for descriptive purposes is a rating of 0-2.5 as weak, 2.5-5.0 as moderate, 5.0-7.5 as good, and 7.5-10 as excellent perception (Meretoja and Koponen, 2011: Salonen, 2007).
Knowledge
|
One-Sample Statistics |
||||
|
|
N |
Mean |
Std. Deviation |
Std. Error Mean |
|
Knowledge |
84 |
6.27 |
1.813 |
.198 |
|
One-Sample Test |
||||||
|
|
Test Value = 0 |
|||||
|
T |
df |
Sig. (2-tailed) |
Mean Difference |
95% Confidence Interval of the Difference |
||
|
Lower |
Upper |
|||||
|
Knowledge |
31.677 |
83 |
.000 |
6.267 |
5.87 |
6.66 |
The mean of the knowledge of the respondent are 6.27(with standard deviation of 1.813). If we consider 95% confidence interval the range of the knowledge of respondents lies between 5.87 and 6.66.
|
Perception rate |
Scale |
Frequency |
Percentage |
|
Excellent |
[7.5-10] |
0 |
0 |
|
Good |
[5.0-7.5) |
19 |
22.62% |
|
Moderate |
[2.5-5.0) |
59 |
70.24% |
|
Weak |
[0-2.5) |
6 |
7.14% |
|
Total |
|
84 |
100% |
Correlation between knowledge and perception:
|
Correlations |
|||
|
|
Knowledge |
Perception |
|
|
Knowledge |
Pearson Correlation |
1 |
.187 |
|
Sig. (2-tailed) |
|
.089 |
|
|
N |
84 |
84 |
|
|
Perception |
Pearson Correlation |
.187 |
1 |
|
Sig. (2-tailed) |
.089 |
|
|
|
N |
84 |
84 |
|
There exist a very weak correlation (0.187) between knowledge and perception and the correlation is not significant with p-value of 0.089.
DISCUSSION:
In our study included 84 pre- operative patients under the categories of age, sex, educational level and those who operated before to discovered their knowledge and perception on the role of anesthetist and aesthesia. In regard to age the participant were greater than 18 and <75 years of age. The majority of the respondents were between the age of 40-50 years old, which is 23.81%.Regarding sex 52.38% were females, the educational level of the respondents which is 26,19% were illiterate .Those who have previous surgery were 38.1% and those who have not previous surgery were 59.52% and the higher level of perception rate was moderate with 70.24%.
There exist a very weak correlation (0.187) between knowledge and perception of pre –operative pateints and the correlation is not significant with p-value of 0.089.
There exist a significant association between knowledge and age with p-value of 0.040.
There exist a significant association between knowledge and Educational level (p=0.016<0.05). Educational level is one of the factor which affect the knowledge of the respondent.
Considering educational level, Secondary has highest knowledge comparing the remaining groups with mean of 8.065(sd=2.354) and the lowest group was illiterate with mean 5.481(SD=1.504)
There exist a significant association between knowledge and Operated before (p=0.000<0.05).
This study revealed that the importance of preoperative and postoperative visits. A close anesthetist-patient contact prior to surgery is a fundamental component of high standard of practice and this can only be achieved by spending adequate time with patients. Anesthetist who fails to visit his patient pre and postoperatively, brings disgrace to our specialty and undermines hard work of those who are attempting to safeguard our interests
The available data suggest that specialty of anesthesia has not done all that it can to educate the patients in particular and the public at large about the role of anesthetist. The educational efforts made during pre-operative visits may be supplemented through broader avenues such as news items in newspapers, magazines, radio, and TV.
LIMITATION:
1) The study was confined to specific Hospitals (Orrota and Halibet referral hospitals).
2) There was limitations to use reference data as base line.
The results of this study is not very encouraging. There is a desperate need for improving the situation. This is of crucial importance in our situation.
· This can be done in several ways, both individual and institutional efforts are needed. Individual efforts can be made through positive media attention to the role of the anesthetist.
· Department should emphasize more contact between patient and anesthetist at the pre-operative period. The available data suggest that specialty of anesthesia has not done all that it can to educate the patients in particular and the public at large about the role of anesthetist.
· Use of booklets, video films, documentaries on television and articles in newspapers can be made to improve perception of genal population about anesthesia. And of coursasthisstudy clearly shows influence of education on patient perception, literacy rate in Eritrea must improve.
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Received on 12.07.2019 Modified on 10.08.2019
Accepted on 12.09.2019 ©A&V Publications All right reserved
Asian J. Nursing Education and Research. 2019; 9(4):525-529.
DOI: 10.5958/2349-2996.2019.00112.5