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Perioperative communication from the perspective of patients undergoing bariatric surgery

Authors:

Abstract

This was a qualitative and descriptive study that aimed to determine how patients understand instructions provided by a multidisciplinary team during perioperative periods of bariatric surgery. Data were collected through three individual interviews. Six patients admitted to a surgical unit of a university hospital in southern Brazil, in April and May 2012, participated in the study. Thematic analysis revealed three categories: communication in the perioperative period of bariatric surgery; quality of life and postsurgical care following bariatric surgery; and communication in the work process of the multidisciplinary team. The results showed satisfaction with the information received, but problems in the communication process and apprehension about life after surgery were highlighted. Furthermore, the absence of outpatient nursing care was demonstrated.
Original Article
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Text Context Nursing, Florianópolis, 2014 Abr-Jun; 23(2): 347-55.
PERIOPERATIVE COMMUNICATION FROM THE PERSPECTIVE OF
PATIENTS UNDERGOING BARIATRIC SURGERY
Caroline Lemes Pozza Morales
1
, Jenefer Garcez Alexandre², Suzana Prim³, Lúcia Nazareth Amante
4
1
RN. Master’s student, Nursing Graduate Program, Federal University of Santa Catarina, Santa Catarina, Brazil. Email:
carolpozz@gmail.com.
2
RN. Tutor, Specialization in Family Health, Federal University of Santa Catarina, Santa Catarina, Brazil. Email: jenefergarcez@
hotmail.com.
3
RN. Municipal government of Antônio Carlos, Santa Catarina, Brazil. Email: suzana_tuty@hotmail.com.
4
Ph.D in Nursing. Assistant Professor, Department of Nursing, Federal University of Santa Catarina, Santa Catarina, Brazil.
Email: luciamante@gmail.com.
ABSTRACT: This was a qualitative and descriptive study that aimed to determine how patients understand instructions provided by
a multidisciplinary team during perioperative periods of bariatric surgery. Data were collected through three individual interviews.
Six patients admitted to a surgical unit of a university hospital in southern Brazil, in April and May 2012, participated in the study.
Thematic analysis revealed three categories: communication in the perioperative period of bariatric surgery; quality of life and post-
surgical care following bariatric surgery; and communication in the work process of the multidisciplinary team. The results showed
satisfaction with the information received, but problems in the communication process and apprehension about life after surgery were
highlighted. Furthermore, the absence of outpatient nursing care was demonstrated.
KEYWORDS: Morbid obesity, bariatric surgery, health communication, perioperative nursing.
A COMUNICAÇÃO NO PERÍODO PERIOPERATÓRIO SOB A ÓTICA DOS
PACIENTES SUBMETIDOS À CIRURGIA BARIÁTRICA
RESUMO: Pesquisa qualitativa e descritiva, cujo objetivo foi vericar como o paciente compreende as orientações realizadas pela equipe
multiprossional durante o seu período perioperatório de cirurgia bariátrica. Os dados foram coletados por meio de três entrevistas
individuais. Participaram seis pacientes internados em uma unidade cirúrgica de um Hospital Universitário do Sul do Brasil, em
abril e maio de 2012. A análise temática evidenciou três categorias: A comunicação no período perioperatório de cirurgia bariátrica;
Qualidade de vida e cuidados pós-cirúrgicos de cirurgia bariátrica e comunicação no processo de trabalho da equipe multiprossional.
Os resultados mostraram satisfação com as informações recebidas, porém foram apontados problemas no processo comunicacional,
uma apreensão acerca de como será a vida após a cirurgia e evidenciado a ausência do acompanhamento ambulatorial da enfermeira.
PALAVRAS CHAVE: Obesidade mórbida. Cirurgia bariátrica. Comunicação em saúde. Enfermagem perioperatória.
COMUNICACIÓN EN EL PERIODO PERIOPERATORIO DESDE
LA PERSPECTIVA DE LOS PACIENTES SOMETIDOS A CIRUGÍA
BARIÁTRICA
RESUMEN: Investigación cualitativa y descriptiva, con objetivo de vericar como el paciente comprende las orientaciones realizadas por
el equipo multiprofesional durante el período perioperatorio de la cirugía bariátrica. Los datos fueron recolectados a través de entrevistas
individuales. Participaron seis pacientes admitidos en una Unidad de Internamiento Quirúrgica de un Hospital Universitario al Sur de
Brasil, entre abril y mayo de 2012; todos rmaron el Instrumento de Consentimiento Libre e Informado. El análisis temático reveló la
existencia de tres categorías: La Comunicación en el Periodo Perioperatorio de la Cirugía Bariátrica; Calidad de vida y Cuidado Post-
operatorio en la Cirugía Bariátrica; y Comunicación en el Trabajo del Equipo Multidisciplinario. Los resultados mostraron satisfacción
con la información recibida, sin embargo señalaron problemas en el proceso de comunicación, una aprensión relacionado con el cómo
sería la vida después de la cirugía y demostraron la ausencia de la enfermera ambulatoria.
PALABRAS CLAVE: Obesidad mórbida. Cirugía bariátrica. Comunicación en salud. Enfermería perioperatoria
347
http://dx.doi.org/10.1590/0104-07072014003150012
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Text Context Nursing, Florianópolis, 2014 Abr-Jun; 23(2): 347-55.
Morales CLP, Alexandro JG, Prim S, Amante LN
INTRODUCTION
All surgical procedures require interaction
between the health care team and patients and
their families, to promote health through educa-
tion about the various stages, procedures and
results of surgery. From the preoperative period
until hospital discharge, guidance and care are
performed using human skills including commu-
nication.
1
Obesity is a chronic disease character-
ized by the excessive accumulation of adipose tis-
sue in the body, being listed by the World Health
Organization (WHO) as the 5th leading cause of
death in the world. With the exponential growth
of obesity, the number of patients undergoing
bariatric surgery has increased in recent years.
2
According to the Brazilian Society of En-
docrinology and Metabolism (SBEM) and the
Brazilian Society of Internal Medicine (SBCM),
the etiology of obesity is complex and multifac-
torial, and its treatment needs various types of
approaches such as dietary counseling, physical
activity scheduling, the use of anti-obesity drugs,
and when a more effective intervention in the
clinical management of severely obese patients
is needed, bariatric operations. Bariatric surgery
reduces the stomach capacity or alters gastro-
intestinal transit in order to reduce the signs of
hunger and increase satiety signals, producing a
controllable state of malnutrition.
3
Patients are candidates for surgical treat-
ment when their body mass index (BMI) is greater
than 40 kg/m
2
, or greater than 35 kg/m
2
when
associated with: sleep apnea, type 2 diabetes
mellitus, hypertension, dyslipidemia, locomotion
problems, and others that are difcult to clinically
manage. Patient selection requires a minimum
of ve years evolution of obesity with failure of
conventional treatment methods carried out by
qualied professionals. Surgery is not recom-
mended for patients with severe lung disease,
renal insufciency, severe myocardial damage,
and cirrhosis. Some authors cite psychiatric
contraindications, which are still a source of con-
troversy and a subject of debate. Furthermore,
a BMI greater than 35kg/m
2
, pregnancy, chronic
diseases unrelated to obesity, Prader-Willi syn-
drome, alcoholism and drug addiction are also
contraindicate for bariatric surgery.
3
The control of obesity may be accomplished
by three types of surgical procedures: restrictive
only; mixed (restrictive and malabsorptive) and
purely malabsorptive (no longer used as bariatric
surgery).
3
Among the different surgical tech-
niques, the Roux-En-Y Gastric Bypass or Fobbi-
Capella surgery is considered the gold standard,
and is currently the most frequently performed
due to signicant results: long-term weight loss
with less recidivism of obesity, as well as accept-
able levels of morbimortality.
3
Obesity surgery is a therapeutic tool for
sustained weight reduction and improvement
of diseases associated with morbid obesity, but
adherence to treatment by patients and their
families is critical to its safety and good results.
4
This procedure improves quality of life and
self-esteem, but the life changes that occur and
possible complications should be reported while
the patients are candidates for surgery, so that
they are aware of the processes that they will
undergo, and their role as active agents in their
treatment.
In this sense, patients undergoing this
type of surgery should receive support and
monitoring from an interdisciplinary team. The
entire team should speak the same language
as the patient. Each professional of this team is
responsible for a part of the treatment, making
the care more intensive and the results more
rapid.
2-3
Communication in the surgical process
of bariatric surgery is one of the tools through
which it is sought to make the patient and family
feel safe, and motivated to modify habits and face
the changes resulting from the surgical process,
which in this case will be for the rest of the pa-
tient’s life.
4
However, there is a lack of studies
focused on the communication process which
is essential for both the patient and members of
the professional multidisciplinary team. Health
care professionals must make sure that patients
understand and adhere to the treatment in the
perioperative and late postoperative periods, and
the patients need to understand the directions
being provided so that they understand and are
willing to adhere to the new condition resulting
from bariatric surgery.
Thus, our goal was to determine how pa-
tients understand the instructions given by the
professionals of the multidisciplinary team dur-
ing their perioperative period of bariatric surgery.
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Perioperative communication from the perspective of patients...
METHOD
This was a qualitative
5-6
and descriptive
study conducted in April and May 2012, through
semi-structured individual interviews which
were recorded in order to ensure the reliability
of the data collected. Six patients who were
hospitalized in a surgical unit of a university
hospital in southern Brazil were interviewed
and identied as PAT 1, PAT 2, PAT 3, PAT 4,
PAT 5 and PAT 6. Inclusion criteria were: be-
ing at least 24 hours in preoperative bariatric
surgery, over 18 years old, of either sex, with
the ability to communicate, and would not be
required to spend the postoperative period in
the intensive care unit. The interviews took place
in the shift change room of this surgical unit in
three stages: in the rst 24 hours of admission, at
hospital discharge, and seven days after surgery,
when the patients returned to the hospital for
tube removal and to receive nutritional guid-
ance. Among the six patients, ve were female
and one male. Their ages ranged from 28 to 48
years. Their Body Mass Index (BMI) ranged from
39.09 to 47 kg/m². The study was approved by
the Ethics Committee on Human Research of
the institution (Protocol 23.910). The thematic
analysis,
6
which enabled the development of
three categories, was conducted in three stages:
1) Pre-analysis, in which documents were cho-
sen and prepared through the initial reading
of the text, and indicators were developed that
represented the homogeneity and relevance of
the categories; 2) Exploration of the material,
which included phase coding of the data and
transforming the data related to the objectives
into values that comprise the table of results;
3) Treatment and interpretation of the results
obtained: relevant information was grouped
into units that allowed inferences and interpre-
tations, and categorization of raw data formed
a representation of the content.
RESULTS AND DISCUSSION
The categories resulting from the thematic
analysis were: “Communication in the periopera-
tive period of bariatric surgery”; Quality of life
and post-surgical care after bariatric surgery”;
and “Communication in the work process of the
multidisciplinary team”.
Communication in the perioperative period
of bariatric surgery
Communication between health profes-
sionals, patients and families aims to identify
and attend to the health needs of these people,
contribute to the improvement of care, and pro-
mote faster and more efcient recovery.
7
People
about to undergo surgery have many fears that
can alter their balance. Thus, explanation about
the surgical procedure and recovery may reduce
fears, insecurities and apprehensions, especially
when professionals are available for dialogue.
8-9
It was noted that the patients received guidance
in the preoperative period: I think I was well
informed. They are always willing to respond to us,
provide guidance (PAT 4); [...] [...] The nutritionist
explained everything to me, drawing a picture and
showing how the surgery would be done [...] she also
told me about the dietary changes [...] she knew ev-
erything. She just didn’t know about the anesthesia.
I was pretty scared of the surgery center. That part
was the hardest [...]. It was terrifying [...] I thought I
would not get back to normal. It was the worst part.
They also didn’t talk about the drain that we would
go home with it (PAT 1).
Although most patients afrmed having
received information, PAT 1 cited a lack of infor-
mation and that he felt fear and ignorance about
what would happen. The lack of individualized
guidance may cause the patients to have some
doubts, since the information is provided in
a very similar way to all, without taking into
account their values, experiences and expecta-
tions.
10
The preoperative period is the proper time
to establish interpersonal relationships with
patients, and it is essential to have prior contact
with them to explain about the procedures to be
performed. Fear of anesthesia, lack of knowledge
of preoperative preparation, the surgical proce-
dure and recovery issues cause anxiety that can
be avoided through embracement of clear and
honest communication with patients and their
families.
8-9
The patients demonstrated knowledge
about the procedures that should be performed
in the preoperative period: perform medical exams,
see the doctor, cardiologist, nutritionist, psychologist.
Perform a blood test. Lose a little weight (PAT 2);
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Morales CLP, Alexandro JG, Prim S, Amante LN
[...] Diet, take a bath, wash the stomach with a green
soap, fast and stay very calm [...], do not wash your
hair and wear the clothes that they provide (PAT 3).
Patients were aware of what they should
do in the preoperative period, revealing effec-
tive communication by the multidisciplinary
team. The guidance for nutritional care should
be initiated prior to bariatric surgery, to clarify
the evolution of diet in the postoperative period.
Orientation on dietary changes must be given
according to the patient’s timing, to avoid confu-
sion and complications such as nausea, vomit-
ing, dumping syndrome, diarrhea, constipation,
gastric obstruction, food intolerance, insufcient
weight loss, weight gain after the procedure,
rupture of the staple line, and deciency of some
specic micronutrients, such as folic acid, iron
and vitamin B12.
11
That guidance on these issues
was provided to the patients is proven by the fol-
lowing statements: I’ll learn how to eat. Eat more
fruit. I’ll eat less, however, I am already eating. I have
already lost 5 kilos. I started eating only liquids, now
I can eat some baby food and mashed fruits. I thought
it would be more difcult to get used to these dietary
changes, but I’m managing. When I see someone eat-
ing something, of course I feel like eating, but I put it
in my head that I can’t and that’s it (PAT 1); [...] For
now I just have a little cup of coffee, juice or tea. I don’t
know what the next stage of the diet is. The nutritionist
said that I should return on Wednesday, even though
I don’t have a drain to remove, to understand about
the continuation of the diet. [...] I could get confused if
she gives all the information now, because the change
is really radical (PAT 6).
In order to ensure that the guidance is un-
derstood, the professionals use communication
skills (spoken or written), particularly verbal
communication.
3-12
Patients receive numerous
directions in the perioperative period of bariat-
ric surgery, the majority of which are delivered
orally, and thus important information is often
forgotten or confused. To avoid such consequenc-
es, these directions should also be delivered in
writing, as suggested by the patients: [...] Since I
left sort of ‘groggy’, I didn’t remember the directions
correctly, so I would get the paper and read (PAT 3);
[...] To receive something in writing would be good,
because we always forget something, some detail. [...]
An information sheet is good to take a look, to not get
confused or forget information (PAT 4).
Communication involves interpersonal re-
lationships, and sometimes problems, difculties
and restrictions can occur so that the message is
not properly understood. Thus, when they relate
to patients, health care professionals should try
to speak slowly, focusing on the main ideas,
repeating them and verifying that they were
understood, because sometimes the patient has
trouble grasping and understanding the infor-
mation provided.
13
A lack in the communication
process between the multidisciplinary health care
team, or forgetfulness/difculty in understand-
ing by the patient, is observed in the following
statements: How many days do I have to use heparin?
(PAT 1 ); [...] The nutritionist didn’t say anything to
me, I’m unsure about the change in diet [...] (PAT 5);
[...] Do I have to buy the heparin that I have to continue
using? Do they give the prescription? (PAT 6).
Clarifying doubts allows the patient to un-
derstand certain situations and seek alternatives
that minimize their anxiety.
8
Perioperative care
includes several procedures that may be initiated
during consultation, including the various stages
of hospitalization and return home.
14
This care
includes directions for hospital discharge made
by the multi-professional team and/or by the
nurse. In most cases, these directions are only
made at the time of discharge from the hospital,
and patients receive many directions at the same
time, making it difcult for them to understand,
and increasing the risk of forgetting and misun-
derstandings.
15
This explanation would account
for doubts, as shown by the comments above of
PAT 1, PAT 5 and PAT 6.
Given that surgery for treatment of morbid
obesity involves physical, psychological and
nutritional aspects, among others, the patient
should receive support and guidance from a
multidisciplinary team. For this, the entire team
should speak the same language with patients
stressing that successful treatment depends
not only on their commitment, but also on the
absence of clinical, psychological and psychiat-
ric complications, which can arise even after a
long time has elapsed since the surgery. Thus,
information and guidance to patients and their
families should be offered from the moment
the decision for surgery is made through the
postoperative period, so that they understand
the surgical process and know how to deal with
the post-surgical changes. In the case of bariatric
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Perioperative communication from the perspective of patients...
surgery, there are many changes that will last
for the rest of the patients’ lives.
2-3
Although the patients reported that com-
munication with the multidisciplinary team was
satisfactory, communication failures still oc-
curred. Thus, health care professionals need to
reect on the way that they communicate with
patients and their families.
Quality of life and post-surgical care of
bariatric surgery
Obesity is a problem that limits various as-
pects of life. It is a predisposing factor for many
chronic diseases such as diabetes mellitus and car-
diovascular disease, in addition to osteoarthritis,
gastric reux, respiratory disorders, sleep apnea
and premature death.
3
By involving multiple fac-
tors such as inadequate diets and psychological,
genetic, demographic, social and environmental
aspects, among others, many obese patients are
not successful in reducing weight with nutri-
tional guidance, physical exercise and antiobesity
medications.
3
Thus, bariatric surgery provides the
patient with the opportunity to perform self-care,
which is closely linked to quality of life and can
be dened as the relationship between what is de-
sired and what is achieved or achievable. Among
obese people, there is a decrease in quality of life
related to health, especially in physical capacity,
psychological well-being and social function-
ing.
15
Bariatric surgery benets the obese patient
because it can improve life expectancy, decrease
mortality, and improve the pathologies associ-
ated with obesity, contributing to the general
improvement of life for these patients.
16
One of the concerns that frequently ap-
peared in the statements of the interviewees was
on life after bariatric surgery, highlighting care
of the wound and drain, and post-surgery diet,
which was the greatest concern that generated
the most questions. The patients interviewed
revealed hope for improved quality of life, health
and self-esteem, as the following statements re-
veal: I hope for a new life, with better health, better
quality of life (PAT 4); I hope that my health improves
because now I feel an agony, the heavy body, I hope
this gets better (PAT 5); everything better. Health,
self-esteem [...] (PAT 2).
On the other hand, the objective of the pa-
tients undergoing bariatric surgery is not only
to eliminate or alleviate diseases associated with
obesity, but also to promote the improvement in
the performance of daily activities, interpersonal
affectivity and social life, as it allows for a return
to social activities.
17
Obese people also seek to
t into the current standards of beauty, as they
suffer prejudice and discrimination due to their
physical appearance. Finding clothes that t well
and proper sizes is also a challenge for these pa-
tients.
16
The consolidation of bariatric surgery is
a way to return to living and starting a new life,
without feeling different from others, as shown
in the following statement: new life: to be able to
walk, dress better, exercise, eat better, dance again, in
short, get back to living! [...] Before the clothes were
horrible, many years ago I stopped doing a lot (PAT
3); it will be like a new phase of my life, a new begin-
ning. I turned a page, hopefully I can turn this page
and I’ll write a new diary (PAT 6).
Other aspects, usually reasons for doubts
on the part of bariatric patients, are related to
postoperative care, especially with the wound
and tubular drain.
13
Thus, effort by the multidis-
ciplinary team is essential to clarifying these ques-
tions, and interaction between the professionals
and patients in preparation for surgery will lead
to satisfactory recovery.
1
Most of the patients
demonstrated an understanding of the basic
care of the surgical wound and the tube drain: I
am washing and drying it well. I’m not coughing in
order to not rip any stitch. I am careful not to bump
it (PAT 1); [...] To disinfect it well, clean it correctly,
dry it well, apply the dressing, hold it when I cough,
apply the injections [heparin]. [...] The drain can’t
be lifted much, or be pulled (PAT 3).
We can see that the multidisciplinary team
provided useful guidance to the patients for care
after hospital discharge, avoiding post-operative
problems and promoting recovery. At this stage,
work by the nursing staff makes the patient feel
safe and motivated, enabling the recovery of
their bio-psycho-socio-spiritual integrity.
18
The
patients were instructed in the hospital regard-
ing the care of the surgical wound and drain
after discharge, and some performed the care on
their own. Others opted for help from a nursing
professional: [...] I take off the dressing, when I take
a shower I wash it well, and leave a soft cloth on top,
because the nurses come to my home every day to put
on the dressing. They wash it with serum, dry it well
and apply the dressing (PAT 5); [...] I do the dressing
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Morales CLP, Alexandro JG, Prim S, Amante LN
with gauze every day, because I have children, and
they don’t touch it, to avoid contamination (PAT 2).
In PAT 2’s statement, we see concern for
infection of the wound, one of the most common
complications that can occur both during hospi-
talization and after discharge. Clear guidance is
needed on how to clean it, and appropriate use
of aseptic technique during the dressing change.
Also related to self-care, diet is one aspect
of the life of bariatric patients that will undergo
the most changes. Nutritional treatment is started
before the surgery and aims to promote initial
weight loss, strengthen the patient’s perception
that it is possible to lose weight, identify eating
disorders and errors, promote realistic expecta-
tions of weight loss, and especially prepare the
patient for postoperative feeding. Moreover,
only after a thorough nutritional assessment
on dietary habits and the nutritional status of
the patient is the recommendation for bariatric
surgery assured.
19
Diet in the postoperative period of bariatric
surgery can vary according to the protocol of
the bariatric team. It is generally agreed that the
diet should allow gastrointestinal rest, aimed
at proper healing and keeping the patient well
hydrated. Food in the rst 15 days of surgery
should be liquid, and pasty/soft for the follow-
ing 15 days. Solid foods will only be allowed in
the second postoperative month, always under
nutritional guidance, as this progression avoids
complications such as vomiting and obstruction.
13
The statements below show what the patients
know about the postoperative diet: start with liq-
uid diet for 15 days, I can drink tea, ‘gatorade’. Then,
the pasty/soft food for 15 days, too. And then normal
food in small quantities, more salads (PAT 2); begin
with liquids, then strained, then pasty. First comes
a liquid amount in ml (not sure how much), then it
increases (PAT 1).
We noticed that the respondents were pro-
vided with guidance about feeding after surgery
with respect to the type of food and the time
span of each stage; however, the amounts to be
ingested were not remembered by any patient.
Other directions were also mentioned, such as
the consumption of fats, zzy drinks and other
foods that were part of patients’ lives before
surgery: I’m already doing it. I took out the fat, re-
duced it. I used to use ve cans of oil, and today I use
two to make lunch and dinner for the entire month. I
switched to extra virgin olive oil. [...]. Fruits, I was not
in the habit of eating fruit, but today I eat ve fruits
per day, ve types of vegetables also (PAT 3). [...] I
want to stop with soft drinks altogether and continue
to eat fruits, salads and vegetables. I’ve always been
a healthy chubby (PAT 4).
Analysis of the discourse of the bariatric
patients regarding quality of life, wound care and
feeding demonstrated a concern with self-care
relating to basic needs. It can be inferred that the
new lifestyle will cause an improvement in the
lives of these patients, with a positive perception
of themselves. On the other hand, the commit-
ment to self-care revealed in the statements is a
basic condition to achieve the improvement of
their overall condition. In this sense, the com-
munication established between the health care
team and patients was positive.
Communication in the work process of the
multidisciplinary team
Each patient should be understood as
unique, with different needs which guide the
health care work process. Thus, knowledge of
the history of the patients (drug or food allergies,
comorbidities associated with the underlying
disease, smoking and alcohol consumption), and
their social networks (family, friends, support
groups), among others, are factors that make
health care and the work process unique. The
work process during the perioperative period
requires organization of the care provided by
members of the health care team, so that the
surgical procedure is performed successfully
and safely.
20
The concern to provide effective and con-
tinuous care is evidenced by way of providing
guidance to patients and families, through con-
sultation with an interdisciplinary team, which
is available to respond to questions, resolve
doubts and provide reassurance to patients un-
dergoing bariatric surgery and their families. The
implementation of care makes the patients trust
the team, bringing them satisfaction and peace
through clarication of the type of surgery and
the stages through which they will pass. The im-
portance given by patients to the care provided
can be seen in reports of satisfaction and improve-
ment in care, as well as through the suggestions
that emerged: [...] it was explained well throughout
the pre-surgical process [...]. I think the hospital staff
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Perioperative communication from the perspective of patients...
is being restructured. They are getting better [...]. I
think the staff are well focused, well directed (PAT 6);
[...] This way is ne. But I think that the psycholo-
gist could speak longer with us [...] a friend of mine
decided not to do it because she was not prepared for
the surgery (PAT 5).
The statements reect the perceptions of
the patients about the need to optimize the care
service provided. This need is due to the aware-
ness of surgical and post-surgical risks, so that
the patients want to receive further information
in different ways for better understanding of the
surgical process. The lack of guidance and con-
tinuous monitoring can lead the patient to refuse
to undergo the surgery, reecting recognition of
the changes which they will undergo without due
preparation, or accept the surgery and suffer the
consequences of a surgical procedure for which
they were not properly prepared.
The nursing staff is directly involved in
patient care, with the aim of reducing anxiety
through multiple actions: preparing the environ-
ment and providing support; promoting proper
nutrition; encouraging the patient to eat foods
that reduce gastric irritation, and in small por-
tions; monitoring uid therapy and drug therapy;
assessing pain; promoting relief and comfort;
conducting orientations and assisting in pre-
surgical preparation (in the bath, administering
pre-anesthetic medication according to medical
prescription); collaborating with the organization
of medical records; delivering and accompany-
ing the patient to the operating room; assisting
and monitoring the onset of postoperative food
intake, predicting and acting on possible compli-
cations; monitoring and preventing the onset of
bleeding, thromboembolism, ulcers, metabolic
imbalances, and surgical site infections, among
others.
13
This nursing care contributes to the pre-
vention of complications in the perioperative
period.
1,13
Based on their general skills (health
care, decision-making, leadership, etc.), the nurse
delegates and supervises the specic activities
of the nursing staff through work planning.
21
Therefore, it is necessary to know the individual
by completing the nursing history and estab-
lishing a trusting relationship. In the process of
bariatric surgery and in the nursing consultations,
nurses collect the data for the health history and
physical examinations, and organize the nursing
interventions to be performed throughout the
perioperative period.
For better patient adherence to treatment,
nurses share responsibility through guidance,
sincerity and respect for the choices the patient
makes. Nursing interventions to be performed in
the perioperative period range from care of skin
and the surgical wound, hygiene and comfort,
drains, medications, exercises to mobilize mem-
bers, as well as psychosocial health, attention to
anxieties related to the surgical procedure, doubts
regarding absenteeism from work and/or the
family, and guidance about the importance of
having a companion.
13
Doubts are clarified during the nursing
consultation, making the patient feel safe regard-
ing the surgery.
1
Of the six patients interviewed,
ve of them showed insecurity, fears and doubts
when they were still in the preoperative period:
They still haven’t talked about this at all [...]. What
scares me is the drain. For me it is a big deal (PAT 4);
[...] They didn’t tell me anything about the wound,
or the dressing. There’s the drain too. I do not know
the care (PAT 5).
We observed that the lack of nursing con-
sultation in the preoperative period can make
the patient insecure and fearful about what may
happen. Anxiety in the preoperative period may
be a factor that hinders patients’ understanding
of the information provided. Thus, an outpatient
nursing orientation would probably offer a more
effective and individualized result.
9
When the
patients spoke about the professionals who per-
formed the orientations, they did not mention the
nurse, as we can see in the following: It was the
nutritionist who provided me with the most informa-
tion; the psychologist taught me to retrain my eating
[...]. The physical therapist [...] taught me breathing;
the endocrinologist guided me during consultations
[...] (PAT 1). The endocrinologist, nutritionist, car-
diologist, social worker, psychologist, physiotherapist,
all of these from the beginning. Today I spoke with the
doctor who ordered tests [...] (PAT 2).
It was observed that after the hospitalization
period, the nurse is remembered by the patients:
The surgeons, the nutritionist and the nursing staff
are always asking if we need anything, if everything’s
okay (PAT 2); the psychologist, nutritionist, surgeon,
nurses, pharmacists (PAT 3).
The presence of nurses as members of
multidisciplinary teams is crucial, however,
- 354 -
Text Context Nursing, Florianópolis, 2014 Abr-Jun; 23(2): 347-55.
Morales CLP, Alexandro JG, Prim S, Amante LN
professional recognition still depends on nurs-
ing, because only those who are present are
recognized. Thus, it is the nurse’s responsibility
to search for a practice in which all of the profes-
sionals on the multidisciplinary team collaborate
on clinical decisions, making the work process
decentralized, and everyone will share responsi-
bility for the decisions, and be committed to the
appropriate care.
FINAL CONSIDERATIONS
This study noted that the patients under-
stand the guidelines provided and that com-
mitment is essential to the therapy; however,
weaknesses were identied in the communica-
tion process established between the multidis-
ciplinary team and the patient/family, such as
lack of information and the use of oral language
only, in addition to the information for hospital
discharge occurring just at the time of discharge
from the hospital, and lack of outpatient nursing
care during the pre-and postoperative periods.
This study may contribute to understanding
what the therapeutic process involves besides the
surgical procedure, such as sustaining of a way
of living life through an effective communication
process, and that the ability to understand the
patient is fundamental to the success of bariatric
surgery. Therefore, it is necessary that profes-
sionals rethink how they are communicating with
patients and their families, and the presence of
nurses is essential throughout the perioperative
period, because this is when a relationship of
trust is established with patients, and nurses can
intervene, reinforcing actions for their safety. Re-
garding the forms of communication, in addition
to the directions delivered orally, it is suggested
that these are also delivered in writing and pro-
vided during the hospitalization and subsequent
visits to the hospital, including by nurses during
the nursing consultation. We believe that the
advancement of nursing knowledge about obese
people and bariatric surgery is based on effective
communication.
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Correspondence: Caroline Lemes Pozza Morales
Rua João Motta Espezim, 859; 201/1A
88045-401 –Florianópolis, SC, Brazil.
E-mail: carolpozz@gmail.com
Received: September 05, 2012
Approved: April 02, 2014
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... [23] Another research found the main doubts and concerns of participants about the care of the surgical wound and drains, and post-surgical diet. [22] These knowledge needs are common to bariatric surgery patients and can guide the formulation of technologies and educational interventions for health promotion focused on what patients have the greatest knowledge deficit and greatest dependence on professional support. Therefore, multiprofessional assistance, especially nursing care, based on behaviors and educational technologies can enable the removal of doubts, provide appropriate guidance aimed at promoting self-efficacy of patients in their self-care and improve the psychological and physical preparation of subjects, enabling better facing and recovery from treatment. ...
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... (5) Professor de Odontologia e do Mestrado Profissional Pesquisa em Saúde do Centro Universitário CESMAC; E-mail: diego_duke@hotmail.com; (6) Doutoranda, Faculdade de Odontologia São Leopoldo Mandic, Campinas, São Paulo; E-mail: sylalbuquerque@hotmail.com; (7) Professor de Odontologia e do Mestrado Profissional Pesquisa em Saúde do Centro Universitário CESMAC; Professor da disciplina de Cariologia da Faculdade de Odontologia da Universidade Federal de Alagoas; E-mail: nbs.odonto@hotmail.com Todo o conteúdo expresso neste artigo é de inteira responsabilidade dos seus autores. ...
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