الفهرس 
Introduction and Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Thyroidectomy is a surgical removal of all or part of the thyroid gland and one of the most endocrine surgical procedures. After thyroidectomy, patients complain many physical, social, and emotional problems that affect their life style. So the perioperative care given by the nurse should cover the comprehensive needs of the patient, improving the patient’s confidence to face surgery, and return to regular life activities. Thus, the aim of the present study was to evaluate the efficacy of implementing pre- and postoperative protocol of nursing care on postthyroidectomy patients’ clinical outcomes. To fulfill the aim of this study: - The study was carried out in General Surgery Department, Tanta University Education Hospital and Outpatient Surgery Clinic. - A convenience sample of 60 adult patients were selected and divided into 2 equal groups: group 1 Control group: were received their routine nursing care by hospital nursing staff group 2 Study group: they were received their protocol of care which was implemented by the researcher. The subjects of this study were selected according to the following criteria: conscious adult patients, of both sexes, able and willing to communicate and participate in this study, scheduled for thyroidectomy operation whatever the indication, and no previous cervical problems preoperatively. Three tools were used to accomplish the purpose of the study which included: Tool (I) Postthyroidectomy Patients’ Assessment Structured Interview Schedule. This tool was developed by the researcher after reviewing the related literature; it was consisted of 5 parts as follows: Part (1): Bio-socio demographic data Part (2): Patient’s Knowledge Assessment Tool Part (3): The Patient Learning Needs Scale-PLNS Part (4): Thyroidectomy Physiological Parameters Assessment Tool Part (5): Laboratory Investigations Tool (II): Postoperative Thyroidectomy Pain Assessment Tool: It included the following items: - Numerical rating scale developed by Farrar, et al (2001), and was used to assess postoperative pain intensity. Tool (III): Postthyroidectomy Patients’ Clinical Outcomes Assessment Tool: It was constructed by the researcher based on literature review (104). It was used to assess the effect of implementing a protocol of nursing care on clinical outcomes and consisted of four parts as the following: Part (1): Wound Assessment Tool Part (2): Neck Alteration Assessment Tool Part (3) Postthyroidectomy Complications Observation Checklist It was used to assess the presence or absence of signs and symptoms of postoperative complications such as thyroid crisis and hypocalcemia. It consisted of two parts as following: 1- Burch-Wartofsky Point Scale (BWPS) 2- Hypocalcemia Assessment The main result of the present study - The study reveals that near half (46.7%) of the study group, and about one third (33.3%) of the control group were in age group of 40-49 years with MeanSD (40±11.67, 35±25.99) respectively. -As for the sex, majority of the sample (86.7%, 80%) of the control group and the study group were female. In relation to educational level, less than half (40%) of the study group were illiterate, and read & write, while near half (46.7%) of the control group were illiterate. - Concerning the family history of thyroid disorders, it is found that minority (6.7%, 10.0%) of the control group and the study group has family history of thyroid disorders respectively. - In relation to chief complaints, majority (80.0%) of the control group and the study group complaining of neck swelling. - In relation to diagnosis (36.7%, 26.7%) of the control and study group diagnosed with multi nodular goiter. - In relation to type of operation (50.0%, 40.0%) of the control and study group apply total thyroidectomy. - There is statistical significant difference between pre and post- implementation of educational protocol of care since P = 0. 001. - The current study revealed that the total mean score of Patient Learning Needs Scale (PLNS) is high. The current study revealed that the most important subscale need is related to “skin care” with mean score (81.60+8.87) and less important subscale need is related to “feelings related to condition” with mean score (41.11+20.04). - The current study revealed that all vital signs are stable and normal for both the control and study group. - The current study reveals that all (100%) of the control group and study group have normal white blood cell in 4th postoperative day. - The current study revealed that minority of the control group and study group have abnormal serum calcium, Phosphorus, and Parathormone in 2nd morning postoperative day. -There is statistical significant difference were found between the control and study group in 2nd postoperative day in relation to sore throat pain. - There is statistically significant between the study group and control group as at the second postoperative day as p- value equal (0.009) in relation to neck pain and highly statistically significant at third postoperative day, at discharge, and at the time of suture removal as p-value < .001. - There is statistical significant difference were found between the control and study group in relation to neck alteration assessment. Based on the results of the present study, it can be concluded that there was an improvement in patients’ knowledge and less pain level, and less neck dysfunction and discomfort among study group patients than routine nursing hospital care among control group after implementing protocol of nursing care. The recommendations from the present study 1. Recommendation for clinical practice • Protocol of nursing care should be carried out as a routine care for patients undergoing thyroidectomy in the general surgery department. 2. Recommendations for education and training • Develop an in service audiovisual materials training/education about thyroid gland and thyroid disorders and radioactive iodine therapy before, during and after procedure for patients. • The neck range of motion exercises for the patients undergoing thyroidectomy can be included in the nursing curriculum. 3. Recommendations for further research studies:- • Further studies are needed to increase follow up period for postthyroidectomy patients • The study should be replicated on large sample and different hospitals setting in order to generalize the results. •Identification of Patients at High Risk for Postsurgical Hypoparathyroidism. •Assessment of Nurses’ Performance for Patients Undergoing Thyroidectomy. •Assessment of Patients’ Nutritional Needs Post Thyroidectomy. •Effect of Nursing Instructions on Life Style of Patients Receiving Radioactive Iodine Therapy for Thyroid Disorders.