A Proposed Health Information Leaflet in Waray-Waray Dialect for the Patient Undergoing Cataract Extraction at Eastern Visayas Regional Medical Center of Tacloban City

RATIONALE:Sight is a magnificent gift of God. The beauty of things is well appreciated through ones sense of sight and losing such endowment would cause distress among the afflicted that affects ones attitude. Cataract is define as clouding of the eye lens that reduces the amount of incoming light and results in deteriorating of vision. Cataract is often described as being similar to looking through a waterfall or waxed paper.

cataract occurs when proteins of the nucleus (center) degenerate and darken, causing light to scatter. In the Philippines 80% of blindness is caused by cataract (CMC; 2008) Locally, cataract surgery is one of the most common procedures performed in Eastern Visayas Regional Medical Center (EVRMC). It is done twice a week and scheduled as an elective operation during Mondays and Thursdays.

According to the EVRMC-OR census as of 2011, there were 609 cataract surgeries done. 81.3% of the patients are from 50 to 80 years old, followed by less than 50 years of age. 60% were indigent. With the number of patients undergoing surgery, it is imperative that health teaching provision is needed.

Other factors which influenced the statistics is the disproportionate nurse-patient ratio due to limited number of staff nurses, illiteracy of patients and unavailability of IEC materials which will be utilized by the patients.

Undergoing a surgery is the most anxiety-provoking event in a patients life. The primary role of the nurse is to explore ways to provide better patient outcomes and the most effective way of delivering them is through health education, to improve the patients confidence in self-management and at the same increase the level of independence of families. (Tan; 2011)

It is essential to conduct pre-operative education among patients undergoing surgery since this would prepare the patient psychologically and physically. This would also meet the patients needs in terms of what to expect during and after the surgery and at the same time patients input of goals and objectives are also elicited. (Wojahn;2002)

GEOGRAPHICAL LOCATION

Eastern Visayas encompasses the two large islands of Leyte and Samar, the province of Biliran and several minor islands. This region is the eastern boundary of the Philippines. As of August 1, 2007, the total population of the region was 3,912,936

Eastern Visayas Regional Medical Center (EVRMC) is a government Teaching Training Hospital in Region VIII which accommodates whole region as its catchment area. At present, it has two affiliating medical schools namely, Remedios Trinidad Romualdez Medical Foundation and the University of the Philippines- School of Health Sciences. There are eight colleges of nursing affiliating in the hospital.

The Operating Room of Eastern Visayas Regional Medical Center presently has four existing O.R. suites but construction of three additional theatres were initiated last February, thereby a total of seven suites will be available soon.

Objectives of the Study

This study aims to provide health information to the Cataract Patients Undergoing Cataract Extraction at Eastern Visayas Regional Medical Center, utilizing a handy leaflet translated in waray-waray dialect. It is the main purpose of the research utilization. The value of the leaflet will be measured its ability to:

Provide comprehensive information regarding health management to patient who will be undergoing cataract extraction that includes:

- Information about cataract, its signs and symptoms; - Information regarding who are at risk in developing cataract; - Pre-operative preparation; Preparation during the day of surgery; Post-operative care; - Expected signs and symptoms after surgery; symptoms that need immediate follow up check-up; - Prevention of complication and Personal hygiene.

Ability to be understood completely by the client.To reduce the anxiety of the patients who will undergo cataract surgery and significant others on the post-op management of cataract.Its ability to serves as a useful aide in health teaching responsibility.

REVIEW OF RELATED LITERATUREInformed consent for cataract surgery: Patient understanding of verbal, written, and videotaped information ScanlanD, SiddiquiF, PerryG, HutnikCML. J Cataract Refract Surg.2003; 29:19041912 Vol. 38 Issue 1 pp. 80-84.Summary:In an academic setting, a verbal consent alone is difficult to standardize among residents and patients. The goal of this study was to explore how current practices of resident verbal consent at the VA Boston Healthcare System compare with more standardized practices of educating patients on the surgical procedure, benefits, risks, and alternatives to surgery. Written brochures at a second-grade and eighth-grade reading level were created to specifically determine effects of readability. surgery.

REVIEW OF RELATED LITERATUREThe AAO video was also used to analyze how a standard video providing audio and visual information translated into understanding the risks of, benefits of, and alternatives to cataract. Dhingra etal. found that patient retention of verbal and written information on cataract surgery complications was poor on the day of surgery.

In future studies, it would be beneficial to test patients at the VA Boston Healthcare System on the preoperative visit and on the day of surgery to determine how quickly information is forgotten. This would highlight the importance of repeating the informed consent with written and video tools if necessary. It would also be interesting to determine whether verbal consent combined with second grade-print and video presentation further enhance a patients understanding and retention of the informed-consent process.

Based on our results, we conclude that concise informed-consent information sheets at a second-grade reading level or videotape presentations optimize patient understanding of the risks of, benefits of, and treatment alternatives to cataract surgery in our academic tertiary referral center. Critique:

Adequate informed consent is imperative to a patients overall feeling of success of any procedure. It is anticipated that with increased focus by the surgeon on the informed consent process, with simplified written information sheets or videotape presentation, patients may be more willing to defer elective cataract surgery.

In relation to our study, construction of health information leaflet would also help the patient overcome fear of such operation or rather the fear of the unknown. They will thoroughly understand the preparation, the procedure and the expected outcome after cataract extraction.

Importance of Leaflets, International Medical Journal pp. 45-46 Family Practice 1998 vol. 14 no. 5

The article reviews the usefulness and importance of written information, specifically leaflets being given to patients. It is well known that patient forget of or misunderstand, much of what is discussed during a consultation. One study showed that, on average, patients had forgotten half of what the health care provider had told them within 5 minutes after instruction (moron 471).

The primary role of the nurse is to explore ways to provide better patient outcomes and the most effective way of delivering them is through health education, to improve the patients confidence in self-management and at the same increase the level of independence of families (Tan; 2011).

Critique:The researcher utilizes the health information leaflet because it will help the patients understand and learn how to manage on their own. It will reinforce communication between institutions health personnel and the patients. As part of the health team, nurses have the opportunity and responsibility to educate, motivate patients and significant others to be involve in the post-op care of the patient.

CATARACT: CAUSES AND RISK FACTORS SOURCE:www.nei.nih.gov.health/ cataract facts, asp.

Summary:A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging so they are very common in older people. It can occur in either or both eyes but cannot spread from one eye to the other. As the person age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Overtime, the cataract may grow larger and cloud more of the lens, making it harder to see. Researchers suspect that there are several causes of cataract, such as smoking and diabetes. Or, it may be that the protein in the lens just changes from wear and tear it takes over the eyes.

Critique:Cataract is the major cause of blindness in the word and the most prevalent ocular diseases. In the United States, cataract are the most frequently cited self-reported cause of visual impairment and the third leading cause of preventable blindness.Knowing the causes and other facts about cataract is necessary in explaining to the client the nature of the disease. Educations of clients help them to understand and accept the needed management and care.

Research ModelResearch utilization refers to the use of some aspect of scientific investigation in a clinical application unrelated to the original research. The ultimate responsibility for research utilization rests within the entire nursing community. There is tremendous potential for the utilization of research throughout the nursing process (Polit & Hungler, 1999).

TheConduct and Utilization of Research in Nursing (CURN) project. Developed in 1975-1980 by the Michigan State Nurses Association with 34 hospitals participating. This model exemplifies a structure, formal organizational process that requires organizational commitment, resources, and research expertise.

Assumptions: Organization must be committed Visible, potent, enduring mechanisms vital Substantial resources necessary Planned change is essential Two or more studies are required to support change

STEPSSystematic Problem Identification.Assessment of ResearchConduct of Clinical and Trial Evaluation.Decision Making: rejection,adoption, modification.Plan for diffusion of innovation.Mechanism for maintenance.Evaluating and intergrating studies for the research base.

Systematic problem identification

Assessment of research

Conduct of clinical trial and evaluation Decision MakingAdoptionRejectionModificationPlan for diffusion of innovation and Mechanism of maintenance.

Evaluating and integrating studies for the research baseFigure 1:CURN MODEL: CONDUCT & UTILIZATION OF RESEARCH IN NURSING

Recognized need for Health Information Leaflet in Waray-waray dialect for Patients undergoing Cataract Extraction in Eastern Visayas Regional Medical Center in Tacloban City

Assessment of Research Review the existing practices in cataract surgery. Related studies and research regarding Cataract Surgery, reliability of health information leaflet

Adaptation/design of practice innovation

No health Information leaflet about cataract surgery in EVRMC

Cataract Extraction done twice a week on regular basis and are willing to go through with the studyLimited time spend for discharge instruction to patient undergoing cataract surgery due to lack of nurse staff.

Conduct of clinical trial and evaluationComplete a health information leaflet based on the review of literature.Gets the consensus of the administration regarding the content of the leaflet.Devise a survey tool for the evaluation of the leaflet.Conduct a survey tool with the approval letter from the administration

Distribution of Health Information leaflet and evaluation tool among the 10 nurses and medical personnel, and 15 cataract patients at Eastern Visayas Regional Medical Center

Decision MakingIf the Health Information leaflet will be beneficial, then it will be adopted by the OR department for its utilization as per approval by the administration.

If certain portion of the Health Information leaflet need to be Modified, applied necessary changes then it will be adopted by the administration.

If the Health Information Leaflet considered not helpful to the cataract patients and health Personnel, then re-assessment will be applied for its problem.

Possibility to extend the utilized health information leaflet with the Optha-Team through its medical mission on other municipalities and the entire institution of Eastern Visayas Regl Medical Center of Tacloban City

Figure 2: RESEARCH FLOW

*In spite of less number of patients having post operative complication, it is important that patients must be aware that these complications may occur. Providing them adequate and accurate information that is easy to understand will give them confidence and reassurance as they go through the surgery.

*The importance of patient health teaching should not be discounted for since this is the most salient part of the nurses role in the patients recovery. The varied facets of education make it even more challenging part of patient advocacy