An assessment of the preoperative information given to patients in the province of Karaman 1

The purpose of this research was to determine the status of information provision for patients in the preoperative period. Two hundred fifty patients undergoing surgery in the Karaman Public Hospital. A questionnaire prepared by the authors based on information in the literature and consisting of questions intended to determine patients’ sociodemographic characteristics and the preoperative provision of information was used as a data collection tool. Data were expressed as number, percentage, mean and standard deviation. Mean age of patients was 45±21.08 years. We determined that 47.2% had been given information concerning preoperative procedures and preoperative preparations, and that 7.6% had been given this information by nurses. In the light of the study findings, we conclude that physicians and nurses need to be more proactive in providing patients with preoperative information and that, considering the forgetfulness factor, such information should also be provided in written form.


Introduction
The provision of information to patients and families in the preoperative period is of the greatest importance, since being scheduled to receive surgical treatment is a frightening, stressful and unfamiliar situation for most patients (Aksoy, 2012).Information provided preoperatively contributes to the patient knowing what will happen at each stage of a surgical procedure, and to improving physical and psychological well-being and also surgical outcomes (Erdil & Elbaş, 2000;Kane, 2000;Yavuz, 2011;Dönmez & Özbayır, 2008;Özbaş, 2011).Guidelines published by the 1 The study was presenten asan poster papers in 7 th National Nursing Edication Congres, 8-10 April 2015 2 Prof. Dr., Karamanoglu Mehmetbey University, Health College, Karaman, alisahin@kmuedu.tr 3 Lecturer, Karamanoglu Mehmetbey University, Health College, Karaman.f.kucuksumbul@gmail.com 4 Lecturer, Karamanoglu Mehmetbey University, Health College, Karaman.hcrsnmzr@gmail.com 5Lecturer, Necmettin Erbakan University, Health Sciences Faculty, Konya, aliye.cyr@gmail.comŞahin, A., Ayhan, F., Öcal, HS., Çayır, A. (2015).An assessment of the preoperative information given to patients in the province of Karaman. International Journal of Human Sciences, 12(2), 1111-1119. doi: 10.14687/ijhs.v12i2.3348Joint Commission on Accreditation of Healthcare Organizations (JCAHO) also contain information and principles related to information to be given to patients and families on the subjects of the operation concerned, the recovery process, sutures, dressings, drains, feeding tubes, pain control and diet.
The European Office of the WHO (World Heath Organization) stresses the importance of health education in 'everyone achieving health targets,' and emphasized that nurses are all health instructors.It also describes the provision of health education for patients and families as one of nurses' health education responsibilities.The nurse assumes primary responsibility for clarifying information given by physicians and the rest of the health team that is necessary for overcoming problems (Taşocak, 2007;Kaya, 2009).Being capable of assisting with providing information, using pamphlets, written recommendations and other materials on the subject and facilitating patient compliance and comprehension all increase the effectiveness of education as the nurse discharges this professional role (Aksoy, 2012).Failure to provide sufficient information in the preoperative period leads to emotional difficulties, such as concerns over the decision to operate and waiting period, anxiety, fear of pain and uncertainty over the future, depression, anger and inability to perform personal functions after surgery.The risk of postoperative complications increases as a result, and lengths of hospital stay are prolonged (Kane, 2000;Özbayır et al, 2003;Oğuzalp et al, 2010;Yavuz, 2011).
Despite the great importance of preoperative education, the number of studies assessing the provision of preoperative information by nurses, in both the Turkish-language and foreign literature, is very low.This research was therefore intended to assess the provision of preoperative information for patients in surgical departments.

Type, place and date of research
The

Data collection form
The study data were collected at face-to-face interviews using a two-part questionnaire prepared in the light of the literature (Bernier et al, 2003, Bulut, 2011, Özbaş, 2011;Yavuz 2011;Carpenito-Moyet, 2012;Aksoy et al., 2012).The first part of the questionnaire contained 8 questions inquiring into patients' health and sociodemographic characteristics, and the second consisted of 35 questions inquiring into receipt of preoperative information.

Data analysis
Data analysis was performed on Statistical Package for the Social Sciences (SPSS) software.
Data were expressed as number, percentage, mean and standard deviation.

Ethical issues
Written approval for the study was granted by the Karaman Public Hospitals Union, and verbal consent was obtained from patients.All patients agreeing to take part and their families were informed about the aim of the study, the methodology and its expected benefits.
Examination of the information provided in the preoperative period and the mode of provision revealed that 94.4% of patients had received verbal information about the type of surgery to be performed, 92.8% about preoperative fasting, 89.2% about preoperative intestinal preparation, 88.4% about preoperative tests, 86.4% about preoperative treatments, and 84.8% about permission for surgery (Table 3).A further 88.4% of patients had received written information about preoperative tests and 39.6% about the operating theater.

Discussion
Patients who do not receive adequate preoperative information experience various emotional difficulties both before and after surgery.These include problems such as anxiety, fear of pain, fear of the unknown and the future, depression, anger and inability to perform personal functions after surgery.Preoperative education is therefore an important marker of the quality of surgical patient care.Nurses' being in possession of up-to-date information on the subject of patient education, the presence of sufficient infrastructure in institutions, awareness of the importance of the subject and planned patient education all increase the quality of care.The findings from this study are discussed below in order to determine the provision of preoperative information to patients in that context.
Both physicians and nurses provided information for 60% patients concerning preoperative procedures and preparations.Similarly, Dolgun and Dönmez (2010) reported that 42% of patients received information from both physicians and nurses, while Gürlek and Yavuz (2013) cited a figure of 61.9%.Özbayır et al. (2003) reported that 59.15% of patients received information about surgery from physicians only, while Aygül and Ulupınar (2012) cited a figure of 72.3% and Kutlu and Çetinkaya (2004) reported that 'the majority' of patients received information from doctors alone.When nurses attach importance to and perform patient instruction, patients then assume responsibility for health care and are able to share anxieties and better comprehend the information provided.The levels of information provision in this research and other studies therefore apears to be insufficient.
Informed preoperative consent has to be obtained from patients by law in order to protect their rights, autonomy and privacy.The nurse's ethical responsibility within the context of informed consent, acting as the patient's protector, permits the patient to understand information and take autonomous decisions.We determined that 84.8% of patients received information about consent forms for surgery (Table 3).
In this study, 64.4% of patients received information about where they would be taken after surgery (Table 3).Gürlek and Yavuz (2013) reported that 58.7% of patients were given such information, while Dolgun and Dönmez (2010) cited 55.1%.In addition, 69.6% of patients in this study were given information concerning postoperative nutrition and diet (Table 3).Similarly, Dolgun and Dönmez (2010) reported that 66.7% of patients received such information, with Gürlek and Yavuz (2013) citing 60%.
Our study showed that 53.6% of patients received information about postoperative deep respiration coughing exercises (Table 3).Kutlu and Çetinkaya (2004) reported that 9.3% of nurses taught patients deep respiration coughing exercises in the preoperative period, while Dolgun and Dönmez (2010) reported that 31.9% of patients received such information while Gürlek and Yavuz (2013) reported a figure of 22.2%.Although our findings for respiration and coughing exercises were higher than those of other studies, considering the potential complications that may develop if these activities are not performed after surgery, we think that the level is still low.

Conclusion
Studies have revealed deficiencies in preoperative information provision.Physicians and nurses need to be more proactive in information provision, and since written information is more permanent that verbal information, we think that both verbal and written information need to be given.We recommend that pre-and postoperative information provision be adjusted to the patient's requirements, readiness, age and level of education and that effective information can be provided with the development of educational materials for patients (such as pamphlets and videos).Şahin, A., Ayhan, F., Öcal, HS., Çayır, A. (2015).An assessment of the preoperative information given to patients in the province of Karaman.
study population of the descriptive and cross-sectional study consisted of patients undergoing surgery in Karaman Public Hospitals Union General Surgery, Urology, Orthopedic, Ear, Nose and Throat and Gynecology departments.The research sample consisted of patients meeting the inclusion criteria between 1 March and 30 May, 2013.The inclusion criteria were;  Age 18-65,  No diagnosis of mental or psychological disease and not using drugs for such reasons,  Surgery being elective,  Willingness to participate in the study.