الفهرس 
Laparoscopic hysterectomyOnly 14 pages are availabe for public view
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Abstract
Laparoscopy is a well-established technique that visualizes the abdominal cavity after insufflation via ports inserted through small incisions. This allowed for the introduction of the laparoscope and other instruments for visualization and intervention. Many advanced surgeries are now performed via this approach (Afzal et al., 2021). Fathy et al. (2020) pointed out that laparoscopy as a minimal tool can accurately and quickly confirm the diagnosis and reduce both the delay in diagnosis and the non-therapeutic laparotomy rate. The rapidly increasing npopularity of laparoscopy may be attributed to several factors, including its applicability, high diagnostic yield, therapeutic management in the same sitting, ability to manage most coexisting conditions, low patients morbidity, and reduced hospital stay and expenditure. Li & Li, (2021) stated that the pain after laparoscopic surgery has not been completely eliminated. Many patients may feel shoulder pain, which is more traditional laparotomy. Because most patients think shoulder pain has nothing to do with surgery, it makes them more anxious. This may lead to discomfort and poor quality of life after laparoscopic surgery, and greatly reduce patient satisfaction. Pain management is recognized as an important indicator of standards of accreditation in health and quality of health care. For this reason, it cannot neglect the importance of pain management quality in postoperative care. Quality development includes an assessment of the quality of care at regular intervals (Köse Tamer & Sucu Dağ, 2020 The nurse role is responsible for providing effective patient care including pain management using non-pharmacological techniques. Among non- pharmacological pain management methods are heat pads and massage (Sinha 2019). Heating therapy involves the use of heat to relax the muscles, facilitate blood circulation, and promote metabolism, thus relieving pain. It is inexpensive, saves time, and requires no special training or skill. Furthermore, heating therapy elicits a sympathetic reaction that increases blood circulation in areas other than those directly in contact with heat (Suk et al., 2022). Massage influences the soft tissues of the body. It is used to help relax muscles and to help calm people. There are different massage techniques that may help to reduce pain such as lower back massage, smooth strokes, also called effleurage, counter pressure, and hip squeezes. Massage stimulates our body to release endorphins, the natural pain-killing, mood-lifting chemicals produced in the brain (Choudhary et al., 2021). Effleurage should be performed at regular and continuous intervals, as the pain tends to increase when the massage is stopped because the nervous system is already accustomed to the stimulus. Hence, repetition of slow, steady speed and ccomfortable pressure are keys that make effleurage massage more effective in pain management. Moreover, effleurage is appropriate to be used by an effleurage maternity nurse because it is a simple, and easy procedure to be applied (Youssef and Abd- Ella ., 2018 The purpose of the present study was to investigate the efficacy of heat pad versus effleurage massage in reducing shoulder pain after gynecological laparoscopic operations. A quasi-experimental design (non-equivalent group design) (case & control) was utilized in implementing this study. It was conducted at the Obstetrics and Gynecology departments of two settings in Menoufia governorate: University Hospital and Shebin El-Koom Teaching Hospital. The sample type in this study was a convenience sample of ninty women after a gynecological laparoscopic operation. The participants included ninty women who fulfilled the inclusion criteria. Women’s age should range from 25-55 years. Immediately within 24 hours (after gynecological laparoscopic operations), women should have no medical disorders. Throughout the course of the current study, data was collected using threeinstruments. Instruments for data collection will be: Instrument I: A semi-structured interviewing questionnaire. It was developed by the researcher afterreviewing related literature to collect the necessary data about participants. It will include the following parts: Socio-demographic data (age, residence, occupation, and level of education), menstrual history (age, frequency, amount, duration, and interval), Obstetric history (gravidity, parity, and abortion), Basal characteristics of the current Gynecological laparoscopic operation (purpose and duration). Baseline characteristics of shoulder pain (pain location, aggravating factors, and relieving factors Instrument II: Physiologic and behavioral response to pain sheet (PBRPS). It was adopted by Deborah, (1984) and Walsh (2001) to measure physiological and behavioral pain responses. It included two parts 100 Part 1-Physiological response:- It was used to measure the physiological response to pain. It includes: 1) Vital signs (blood pressure, temperature and pulse) 2) Gastro-intestinal tract response such as nausea and vomiting. 3) Skin response such as: flushing rash and diaphoresis Part 2-Behavioral response: It was used to measure the behavioral response to pain. It includes four dimensions: posture, gross motor activity, facial expression, and verbalization. For each of these four major behavioral responses, one of three alternative choices is offered. The scoring system: For each of the 12 alternatives, each was scored as either absent (0), (1) for mild or (2) for severe. For posture, the choice is between relaxed (0) or guarded (1), or tense posture (2). For gross motor activity, the choice is between quiet (0), slightly restless (1) and restless (2). For facial expression, the choice is between no frowning (0), some frowning (1), and constant frowning or grimacing (2 Finally, for verbalization, the choice is between normal no sound (0), groans and moans (1), and cries (2). Instrument III: Numerical pain rating scale It was adopted from Williamson & Hoggart (2005) and was used to assess pain intensity. The scoring system of the scale Women were instructed to choose a number from 1 to 10 that best describes their pain. The scale score is as follows: There is no pain (0), mild pain (1-3), moderate (4-7), and sever pain (8-10 101 Approaches to ensuring ethics were considered in the study regarding confidentiality and informed consent. Confidentiality was achieved by the use of closed sheets with the names of the participating women replaced by numbers. All women were informed that the information they provided during the study would be kept confidential and used only for statistical purposes after finishing the study. The findings would be presented as a group data with no personal participant’s information remaining. Regarding the findings of the current study, there was highly significant improvement in each item of physiological and behavioral response among the heat pad groups. The intensity of pain before and after heat pad intervention was highly significant and this answered hypothesis one. (I): Women who used heat pads after gynecological laparoscopic operations had less shoulder pain than those who don’t. There was highly significant improvement in each item of physiological and behavioral response among the effleurage massage group. The intensity of pain before and after effleurage massage intervention was highly significant, and this answered hypothesis two. Women who used effleurage massage after gynecological laparoscopic operations had less shoulder pain than those who don’t Effleurage massage had a higher efficacy than both heat pad and control groups in post intervention and the difference was highly significant statistically; and this answered hypothesis three. Women who used effleurage massage after a 102 gynecological laparoscopic operation had less shoulder pain than women who use heat pads. The following recommendations suggested the nursing education curriculum should be updated to include non-pharmacological management of shoulder pain after a laparoscopic operation. Effleurage massage and heat pads should be recommended in the hospital routine. Training programs should be provided to maternity nurses regarding the implementation