Research article - Vol. 07 - No.

02 (2024)

Journal of Nursing Science

Journal homepage: www.jns.vn

Post-operative nursing care for patients receiving abdominal hysterectomy

at the Obstetrics and Gynecology Department of Bach Mai Hospital in 2023

Nguyen Thu Dung1, Pham Viet Ha1, Vuong Thi Hoa2, Pham Van Thanh3,
Nguyen Thi Thanh Hoa3, Ha Thi Thuan3, Pham Quoc Sy4
Bach Mai Hospital; 2Thang Long University
1

3
Vinmec Times City International General Hospital; 4Tam Anh General Hospital

ABSTRACT
Objective: To describe post-operative nursing care for patients receiving abdominal
hysterectomy at the Obstetrics and Gynecology Department of Bach Mai Hospital in 2023.
Method: A Cross-sectional descriptive study was conducted using an instrument developed
based on 12 professional tasks of patient care prescribed in Circular 31/2021/TT-BYT by
the Ministry of Health. The study included 119 patients who had undergone abdominal
hysterectomy to assess the care outcomes. Results: Among the participants, 69.7% had
undergone their first surgery, while 30.3% had undergone surgery two or more times. Most
patients (94.1%) had undergone a complete hysterectomy. Post-operative complications,
including wound bleeding, urinary retention and drug allergies, were reported in 5% of
the participants. The percentage of patients receiving good nursing care after abdominal
hysterectomy was 74.8%. Conclusion: The study found that 5% of patients experienced
post-operative complications following abdominal hysterectomy. Additionally, 74.8% of
patients received good nursing care, while 25.2% received average care.
Keywords: Nursing care, abdominal hysterectomy, Bach Mai Hospital

INTRODUCTION hysterectomy annually 2. Over 70% of

Hysterectomy is a surgical procedure hysterectomies are performed for benign
to remove the uterus through an incision surgical indications, including menorrhagia,
in the lower abdomen, laparoscopy, or the uterine fibroids, pelvic pain, and uterine
vagina 1. Hysterectomy directly affects the prolapse 3.
lives, health and psychological well-being Each year, the Department of Obstetrics
of women. Uterine diseases such as uterine and Gynecology at Bach Mai Hospital
fibroids, endometriosis, genital prolapse... handles about 200 cases of patients with
directly affect patients’ health and quality indications for hysterectomy. However,
of life. Around 600,000 women in the US there is a lack of comprehensive studies on
and 100,000 women in the UK undergo nursing care for partients after abdominal
Cor. author: Nguyen Thu Dung Received: Jan 05, 2024
Email: [email protected] Accepted: Mar 04, 2024
DOI: 10.54436/jns.2024.02.778 Published: Mar 05, 2024
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 Research article - Vol. 07 - No. 02 (2024)

hysterectomy. Post-operative care for Sample size and sample selection: The
patients receiving hysterectomy plays formula was applied to calculate Sample
an important role in facilitating a speedy size as follows:
recovery and minimizing complications. 𝑝𝑝(1 − 𝑝𝑝)
2
𝑛𝑛 = 𝑍𝑍1−𝛼𝛼/2
In addition, nurses need to provide 𝑑𝑑 2
specialized care plans for patients post-
abdominal hysterectomy to reduce risks In which:
and complications, enabling patients p was the proportion of patients receiving
to resume normal activities promptly. good care. In the study, p = 0.8 was chosen
Research related to patient healthcare (referenced from research by Le Kim Yen 4)
post-abdominal hysterectomy serves as
the foundation for nurses to develop a d was the absolute error; d = 0.05 was
complete care plan, ultimately enhancing selected.
the quality of comprehensive care provided Substituting these values into the
to patients after surgery. Therefore, the formula, the sample size was calculated as n
study aims to describe the post-operative = 110, with a margin of error of 8%.
nursing care for patients undergoing Therefore, the final sample size included
abdominal hysterectomy at the Obstetrics in the analysis was n = 119 patients.
and Gynecology Department of Bach Mai
Hospital. Measurement and data collection:
PARTICIPANTS AND METHODS A questionnaire was developed based
on the 12 professional tasks of patient care
Participants: Patients who underwent outlined in Circular 31/2021/TT-BYT 5.
abdominal hysterectomy and was treated at The questionnaire was divided into four
the Obstetrics and Gynecology Department parts: General information, pathology
of Bach Mai Hospital, Hanoi information, clinical and paraclinical
Inclusion criteria: Patients who symptoms, and post-operative patient care
underwent abdominal hysterectomy, had activities.
standardized medical records as per hospital Data collection: Information was
protocols and agreed to participate in the gathered by assessing and categorizing the
study patients’ condition upon admission to the
Exclusion criteria: Patients who did surgical department, at 6 hours, 24 hours,
not meet the mental health requirements and three days post-surgery, and at the time
to participate in the research or were in an of discharge from the hospital. An initial
emergency condition. assessment, along with data from medical
records, was conducted upon the patient’s
Research design: A cross-sectional
admission to the department within the
descriptive study was conducted.
first 6 hours post-surgery. Interviews based
Research time and location: The on the questionnaire were conducted at 24
study was conducted at the Department hours post-surgery, 3 days post-surgery, and
of Obstetrics and Gynecology, Bach Mai upon discharge from the hospital to collect
Hospital, from April 2023 to August 2023. information.
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 Research article - Vol. 07 - No. 02 (2024)

Evaluation standards:

No Work content Satisfactory Unsatisfactory

1 Measure vital signs Fully implemented and when Not fully tested
patients had abnormalities
2 Establish a close and Comfortable, understand the Patients are worried about
friendly relationship illness well, not worried, their health, treatment
with patients satisfied with the care results methods during and after
discharge from the hospital,
and were not satisfied with the
care results.
3 Pain relief (based on Little or no pain A lot of pain
VAS scale)
4 Nutritional care Eat all the ration with a good Loss of appetite, could not eat
appetite all the ration
5 Mobility care Move gently around the bed Lying in bed without moving
or being sedentary
6 Sleep care The patient got sufficient and Patients slept little, difficulty
deep sleep falling asleep or frequent
awakenings during the night.
7 Monitor the condition of The incision site was dry and The incision was saturated
the incision did not saturate fluid or blood with fluid, swollen, and
after changing the bandage bleeding
8 Personal hygiene Patients resolved personal Patients were unable to resolve
issues independently without personal issues independently
requiring support. and still required support.
9 Performance of Use medication as prescribed Using drugs without publicity
medication orders and had their medications or having reactions
made public
10 Performance of a Change the bandage on the Delay on changing the
dressing change right day, the bandage was bandage, seepage of fluid and
dry blood into the bandage
11 Monitor complications There were no postoperative There were one or more
complications. postoperative complications.
12 Health education Patients understood Patients did not clearly
the regulations and understand regulations and
administrative procedures administrative procedures

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 Research article - Vol. 07 - No. 02 (2024)

Each care criterion being satisfactory got 1 point. The following calculation formula
was applied:
Percentage of care results (%) = (Total number of satisfactory care results)/ (Total
number of care activities) x 100
Patient care results were considered good when the score was 80% or higher 3. Patient
care results were average when score was below 80%
Data processing methods: Data were entered by using Epidata 3.1 software; coded
and analyzed using SPSS 25.0 software. Descriptive statistics was utilized to present and
analyze the table of quantity distribution, percentage (for qualitative variables), mean value,
and mean standard deviation of variables (for quantitative variables).
Ethics in research: The study was approved by the Ethics Committee of Thang Long
University and got the permission of the Board of Management of the hospital.
RESULTS
Table 1. General information about participants (n = 119)
Patients with hysterectomy n %
Career Workers and Employees 39 32.8
Farmer 27 22.7
Others 53 44.5
Living area Urban 42 35.3
Rural 68 57.1
Mountainous 9 7.6
Education level Primary school 39 32.5
Middle School & High School 49 40.8
College - University - postgraduate 32 26.7
Insurance Have 109 91.6
Do not have 10 8.4
BMI Underweight 10 8.4
Normal 49 41.2
Overweight, obese 60 50.4
Age group > 45 years old 90 75.6
< 45 years old 29 24.4
Table 1 presented that 32.8% of the participants were civil servants, 22.7% of them were
farmers, and 44.5% were in other occupations (housewives, freelancers, unemployed). Most
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of the patients lived in rural areas (57.1%). Regarding education level, the proportion of
the participants with secondary school and high school degrees were the highest (40.8%),
followed by the proportion of patients with primary school degree (32.5%), and the lowest
proportion had college-undergraduate-postgraduate degrees (26.7%). Most patients had
health insurance (91.6%). More than half of the patients were overweight and obese
(50.4%). The majority of the patients were 45 years old or older (75.6%), with an average
age of 49 ± 8.77 years old.
Table 2. Classification of the patients according to times of births
and surgical characteristics (n = 119)

Content n %
Number of children < 2 Children 88 73.9
3 Children 31 26.1
Times of surgery <2 83 69.7
>2 36 30.3
Surgical method Complete hysterectomy 112 94.1
Partial hysterectomy 7 5.9
The results indicated that the majority of the participants had no moretham two children
(accounting for 73.9%), while the participants had 3 children accounted for 26.1%.
Regarding the times of surgeries, the percentage of the patients who had surgery at the first
time was higher than the percentage of the patients who had surgery 2 times or more (69.7%
versus 30.3%). Most of the participants were prescribed complete hysterectomy (94.1%).
Table 3. Condition of the incision and the patient’s urination, defecation
and fart status at the time of follow-up (n = 119)

Follow-up time

Index First 6 hours 24 hours 3 days Discharge

n % n % n % n %
Abdominal incision
Dry 101 84.9 118 99.2 119 100 119 100
Swelling, fluid seepage/Bleeding 18 15.1 1 0.8 0 0 0 0
Drainage incision
Do not have 114 6 114 96 114 96 119 100
Dry 3 2.5 5 4.2 5 4.2 0 0
Swelling, fluid seepage/bleeding 2 1.7 3 2.5 1 0.8 0 0

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Follow-up time
Index First 6 hours 24 hours 3 days Discharge
n % n % n % n %
Urinary catheter status
After removal of urinary catheter 1 0.8 20 16.8 114 95.8 118 99.2
Before removal of urinary 118 99.2 99 83.2 5 4.2 1 0.8
catheter
Fart status
Farted 1 0.8 30 25.2 93 78.2 119 100
Not farted yet 118 99.2 89 74.8 26 21.8 0 0
Defecation status
Defecated 0 0 0 0 24 20.2 119 100
Not defecated yet 119 100 119 100 95 79.8 0 0
The results presented that the patient’s condition improved gradually post-surgery.
There were 15.1% of the patients whose incisions were saturated with fluid after 6 hours
of surgery, which decreased to 0.8% after 24 hours. By discharge, all incisions were
completely dry and waterproof (100%). There were 5 patients who had to have drainage
placed after surgery. The condition of the drained tube being seeped with fluid accounted
for 1.7% and 0.8% of the participants. Three days after surgery, the drained tube was still
seeped with fluid. There was 1 patient who had to keep a urinary catheter upon discharge
due to a surgical condition. The percentage of patients unable to pass gas within 6 hours
post-surgery was 99.2%, dropping to 74.8% after 24 hours and further decreasing to 21.8%
by the third day, and all patients were able to pass gas before leaving the hospital (100%).
The percentage of patients unable to defecate within the first 24 hours after surgery was
100%, decreasing to 79.8% by the third day.
6 (5%)

114 (95%)

Have Do not have

Figure 1. Percentage of patients with complications after surgery(n=119)

Figure 1 indicated that among 119 patients with abdominal hysterectomy, 6 patients
(accounting for 5%) had post-operative complications such as surgical wound bleeding,
drug allergy, urinary retention and incision infection.
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Table 4. Post – operative nursing care activities for the patients (n = 119)
Nursing consultation
Activites
n %
Visit and answer questions Satisfactory 114 95.8
Unsatisfactory 5 4.2
Disclosure of medicine Satisfactory 118 99.2
Unsatisfactory 1 0.8
Incision care Satisfactory 118 99.2
Unsatisfactory 1 0.8
Pain relief Satisfactory 117 98.3
Unsatisfactory 2 1.7
Measure vital signs Satisfactory 118 99.2
Unsatisfactory 1 0.8
Get advice on movement Satisfactory 107 89.9
Unsatisfactory 12 10.1
Get advice on nutrition Satisfactory 111 93.3
Unsatisfactory 8 6.7
Get advice on sleep Satisfactory 105 88.2
Unsatisfactory 14 11.8
Get advice on complications Satisfactory 93 78.2
Unsatisfactory 26 21.8
Receive care for other needs according to Satisfactory 96 80.7
comorbidities Unsatisfactory 23 19.3
Total 119 100
The results in table 4 demonstrated that the activities of disclosing medicine, caring for
incisions and measuring vital signs were the highest percentage (99.2%), while activities of
consulting on complications and taking care of other needs according to comorbidities only
were 78.2% and 80.7%, respectively.

30 (25,2%)

89 (74,8%)

Average Good
Figure 2. Results of care for patients with abdominal hysterectomy (n = 119)
The results in figure 2 presented that the proportion of good care results was higher than
average care results (74.8% compared to 25.2%).

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DISCUSSION conducted a study in 2023 which reported

Patient care activities after abdominal that 48.7% of the patients were not clearly
hysterectomy informed about the medicine and 0.8% did
not receive incision care. Additionally, 1.7%
The study indicated that the percentage of patients experienced significant pain
of complications after surgery was not high, without adequate pain management, 10.1%
with no reported cases of complications. did not receive exercise advice, 6.7% did not
Specifically, within the first 24 hours after receive nutrition advice, and 11.8% did not
surgery, one patient experienced incisional receive advice on sleep. This findings were
bleeding, which was bandaged and dried lower than the result of Nguyen Thi Thanh
completely without requiring further Mai 8 in 2023, which reported that 12.6%
intervention. By the time of discharge from of patients did not know about appropriate
the hospital, no additional cases of bleeding
nutrition, 27.6% of the patients did not have
from the incision were reported. This result
the knowledge to take care of their sleep.
was similar to the research by Yimaz2 which
This difference may be due to differences in
documented two cases of post-operative
characteristics of the participants.
bleeding.
Nurses’ health education consultations
Complications of the Urinary Tract
were deemed effective based on patient
Infections were noted in three patients, with
feedback post-surgery. However, 21.8%
instances of urinary retention post-surgery,
and one case with painful urination 3 days of the patients did not clearly understand
after treatment. This result was higher than the possible complications after surgery,
that of Le Kim Yen 4 with 0.1% of urinary indicating a need for enhanced health
tract infections. One limitation was that education efforts to improve patient care
the patient must have a urinary catheter and mitigate future risks.
placed within 24 hours after surgery, which There were 74.8% of the patients
increased the risk of urinary tract infection with good outcome, 25.2% with average
as well as complications after catheter outcome and no patient with poor outcome
placement 6. 7. In case the patient had a during treatment. This result was related to
urinary catheter placed, urinary catheter the type of surgery, which was abdominal
care activities, included instruction to family hysterectomy. The recovery proportion was
members on how to clean the patient’s lower than other forms of surgery such as
genitals, and instructions on how to hang laparoscopy and transvaginal surgery, so the
the urine bag to avoid urine reflux, causing percentage of good care result was lower
upstream infection, it was quite important to compared to limited invasive surgeries.
have urine lines clamped hourly in order to Therefore, it is absolutely necessary to
prevent syndrome of loss of urination reflex strengthen health education counseling so
for patients after removing the urinary that patients can comply and follow the
catheter. instructions of medical staff. This depends
The results indicated that 4.2% of patients largely on the work of the nurse, and on
had not their questions specifically answered, how to raise the patient’s awareness to
and 0.8% of them had not had their drugs improve the patient’s recovery after surgery
clearly disclosed. Nguyen Thi Thanh Mai to produce the best care results.
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CONCLUSION 2021 of the Ministry of Health regulating

Among participants undergoing nursing activities in hospitals. Print:2021.
abdominal hysterectomy, 5% experienced 6. Phung Trong Thuy. Clinical and
post-operative complications. The study paraclinical characteristics and results of
observed good nursing care outcomes in surgical treatment of uterine fibroids at
74.8% of patients, with 25.2% achieving Tuyen Quang Provincial General Hospital.
average care results. Vietnam Medical Journal. 2021;505(1).
RECOMMENDATIONS DOI: https://doi.org/10.51298/vmj.
v505i1.1057.
Strengthen health education consulting
activities and update professional technical 7. Nguyen Le Thanh Truc, Tran Thi
procedures to prevent post-operative Tuong Vy, Nguyen Thi Ngoan, Thach
complications and improve patient care Thi Thanh Thuy. Nutritional status of
results. patients before surgery and some early
complications after gastrointestinal surgery
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