PERCEPTIONS OF PERIOPERATIVE NURSES TOWARDS THE PREOPERATIVE NURSING VISIT IN FEDERAL MEDICAL CENTER KATSINA

1. PERCEPTIONS OF PERIOPERATIVE NURSES TOWARDS THE PREOPERATIVE
NURSING VISIT IN FEDERAL MEDICAL CENTER KATSINA
Author; Nr. Halliru Kabir, Nursing department Federal Medical Center Katsina,
(nursekankara@gmail.com)
Co-author: Nr. Danjuma Aliyu, School of post basic perioperative nursing,
Ahmadu Bello University Teaching Hospital, Tudun Wada, Zaria
(aliyudanjuma19@gmail.com)
ABSTRACT
Background Preoperative visit is important to surgical patients in freeing their anxiety and
post-operative complications. And to perioperative Nurses to enable them to prepare for the
surgery. Objectives to assess the perceptions of perioperative nurses on preoperative visits,
benefits, barriers, and ways to enhance the practice of preoperative visits among the
perioperative nurses in Federal Medical Centre Katsina. Method used was a cross-sectional
design and was conducted among 42 perioperative nurses which only 40 were retrieved and
analyzed. The data were analyzed through the descriptive and inferential statistics models in
SPSS program version 21. The results from the study were presented in pie charts, bar charts,
and frequency tables. Results show that demographically the highest percentage 23(57%) of
the participants were in the age group of 31-35, while 28(70%) of respondents had ND/HND
and BNSC respectively, with 30(90%) of participants received the formal training on a
preoperative visit during their training. The positive perception was identified from the
majority 30(90%) of the participants with a high level of knowledge on the preoperative patient
visit but 30(75%) were poorly practiced preoperative patients visit. The analysis revealed the
significant difference between the practice of preoperative visits and the knowledge because
the respondent has good knowledge of preoperative visits still the practice was very poor. Also,
the majority of the respondents 28(70%) believe it is important and significantly improved
perioperative nursing practice, patients care, and hospital management. The main barriers to
the preoperative visits were lack of time 22(55%), daily workload 32(70%), and shortage of
the perioperative nursing staff 30(57%). Conclusion: This study revealed perioperative nurses
have good knowledge of preoperative visits but the practice is very poor. There is a need to
continue training officially the perioperative nurses in the centre for improving the practices
in the perioperative nursing field.

2. Keywords: Perceptions, perioperative nurses, preoperative visit, surgical patients
1. INTRODUCTION
The notion of the preoperative visit has been in existence since the 1960s and its value and
worth in relation to healthcare delivery has been debated consistently since the term
"preoperative visit" is quite confusing and is usually misunderstood as a nursing interview or
counselling (Danjuma et al., 2015). A preoperative visit by the perioperative nurses should be
planed and get to know the patients and confirm the level of preparedness of the patients and
as well provide physical and psychological support to the patient and the family (Dan, 2015).
Preoperative visit of a patient is of paramount importance to the patients, perioperative nurses,
the entire surgical team members, and the hospital in general (Chi-kong, 2013). The
preoperative visit is carried out by peri-operative nurses before surgery (Edward and
Fitzgerald, 2014). It is seen as an effective instrument to reduce situational anxiety levels,
postoperative pain (Julio, 2015). It reduces surgery cancellation on the day of surgery (Dan,
2015). The aim of the preoperative visit is to mitigate preoperative pressure and anxiety in the
patient, thereby ensuring the success of the surgery and accelerating postoperative recovery
(Dan, and Yingjun, 2015). These visits not only accommodate the standard of modern
medicine but also alter the conventional working pattern of the nurses in operating theatres
(Dan, 2015). The visit was useful and the nursing’ staff thinks that it has certainly benefited
patients who have returned for further surgery (Susan, 2013 p. 67).
Preoperative visit perceptions among the perioperative nurses have been debated to explore
the consistency between the perceptions and the actual practice of preoperative visits and the
factors affecting the actual patient visit compared to the factors affecting the provision of the
visit from the perspective of nurses (Chi-kong, 2013).
Despite the leading role in patient teaching by perioperative nurses, sparse studies have
addressed the consistency between the perioperative nurse's perceptions and their actual
practice of preoperative visits of the Surgical patients (Linda, and Tina, 2014). It is viewed as
important to examine the nurses’ perception of the importance of providing preoperative
information to surgical patients, and factors that might influence their provision of such
information (Susan, 2013 p. 67). Moreover, Language barriers and tight operation schedules

3. were perceived as top factors affecting the provision of preoperative visits (Danjuma et al.,
2015).
Relevance to clinical practice Nurses’ perceptions and satisfaction towards preoperative visits
can be compared with those of the patients in further studies so that the insights for developing
an effective preoperative visit programme can be more comprehensive (Chi-kong, 2013).
A preoperative visit is an important aspect in improving the health outcomes of patients
undergoing surgeries and could be a multi-disciplinary approach that requires harmonization
of knowledge or information between nurses, surgeons, anaesthesiologists, dieticians, and
physiotherapists to coordinate care for patients (Musa and Ali, 2018). The general components
of the preoperative teaching include client education and preparation, reducing surgical stress
response, maintaining the postoperative physiological function, minimizing pain and
discomfort, and promotion of patient autonomy (Gerlitz, 2010).
Preoperative teaching has been used to improve patients' experiences by providing health care
relevant information, coping skills, and psychosocial support prior to surgery thereby
promoting positive postoperative outcomes, mitigating patients’ post-operative complications
for surgical patients across the healthcare settings (Guo, 2012). Furthermore, as preoperative
visits tend to reduce postoperative complications, it consequently decreases the costs of
hospitalization which would increase savings (Jonathan, 2014).
The three most favourite teaching methods were the oral explanation, pamphlets, and oral
explanation with pictures and to a lesser extent Internet and videotapes (Chi-Kong and Iris,
2012). The teaching involves nurses providing knowledge that includes expectations of the
surgical procedure, education on food restrictions before the surgical procedure, as well as
providing instructions for aftercare postoperatively (Grossweiler, 2012). Despite the
universally acknowledged importance of preoperative teaching, its implementation especially
in developing countries and or specifically secondary health institutions is low. This is largely
associated with unawareness, inadequate knowledge among perioperative nurses on the
concept of preoperative teaching, nurses' shortage in the hospitals, lack of time, work overload,
fear of passing wrong information to the patients (Danjuma et al. 2015).
The provision of adequate preoperative teaching is vital to the quality of perioperative nursing
care. Although there are still gaps in the aspect of delivering sufficient preoperative
information (Musa & Ali, 2018).

4. This study was objectified to identify the perceptions of perioperative nurses towards the
preoperative visit as well as its benefits, barriers, and ways to enhance its practice. For
establishing it as the first stage in the assistance systematization of perioperative nursing. The
visit represents a valuable instrument, allowing perioperative nurses to assist patients
individually, systemically, and continuously. All nurses had considered the visit important and
as one of their attributions, however, a significant number did not carry it out, due to
innumerable difficulties.
1.1 Objectives of the Study
● To assess the perception of perioperative nurses towards the preoperative visit.
● To determine the perceived benefits of the preoperative visits.
● To identify barriers to the preoperative visits.
● To identify perceived ways to enhance the practice of preoperative.
1.2 Research Questions
● What are the perceptions of perioperative nurses towards the preoperative visit to
surgical patients?
● What are the perceived benefits of a preoperative visit to a surgical patient, nurses,
other surgical team members, and the hospitals?
● What are the barriers to preoperative visits?
● What are the perceived ways to enhance the practice of preoperative visits among
perioperative nurses?
2. Methods
2.1 Study Area
Is located at Murtala Muh'd way, Jibia bypass, Katsina, Katsina state. The Federal Medical
Centre, Katsina, was initially built by the State Government to serve as a Specialist Hospital
in 1986. In line with the Federal Government of Nigeria's policy to establish Tertiary Health
institutions in each state, the State Government released it to the Federal Government in 1996
and take up in 1999. The main functions of the Centre are Medical care, training, and research.
As a specialized consultative institution, it provides Healthcare services based on a referral
from primary and secondary healthcare centers for advanced medical investigation and
treatment. The health care services provided are almost in all the complex medical and surgical
interventions in almost all aspects of medical and surgical specialties as it is now competing

5. with almost all the federal teaching hospitals in Nigeria. As it keeps on changing and
expanding to serve the patients and make the medical practice better to the best international
standard, it has about 600 bed capacity with (7) seven operating theatres which includes a
standard modular theater, Performing about but not exact (20-25) twenty to twenty-five
emergency surgeries and (40-45) Fourty to fourty five planned/booked surgeries weekly,
across all the specialties.
The Federal Medical Centre is the first to start using Electronic Health Records in Northern
Nigeria and currently, all patients and staff's data can only be documented and accessed
electronically, which eases documentation and reduces data loss. That also makes online
Appointment possible for patient wishes to make an online appointment, can book an
appointment online with the top Hospital Consultant. And get the best medical consultation
& treatment with the best doctors @ www.fmckatsina.gov.ng
2.2 Study Design
A cross-sectional descriptive study was used to assess the perceptions of perioperative nurses
towards the preoperative nursing visit.
2.3 Study Population
The population of this study is strictly perioperative nurses working in the Federal Medical
Centre Katsina
2.4 Sampling Technique
A simple random sampling technique was used to select all eligible perioperative nurses.
2.5 Inclusion Criteria Are:
• Must be certified, registered, and licensed to practice as perioperative nurses in
Federal Medical Center Katsina.
• Consented to participate in the study.
• Availability at the time of data collection
2.6 Exclusion Criteria Are:
• Person, who is not certified, registered, and license to practice as a perioperative
nurse.
• Perioperative nurses not working in Federal Medical Centre Katsina.
• Those on leaves or vacations
2.7 Data Collection

6. Already-developed self-administered questionnaire used in a similar study was adapted for
data collection. which was redesigned into multiple choice and five Likert Scale on tabular
format questions, necessary corrections were made to suit the objectives of this study. Which
were administered to all the Perioperative nurses during the morning and call duty hours for 2
weeks to ensure that all the eligible perioperative nurses were included in the study. The filled
questionnaires were retrieved.
2.8 Data Analysis.
Data collected were analyzed using SPSS version 21. Descriptive and inferential statistics,
Frequency and distribution tables, bar charts, and pie charts were used to present the results.
2.9 Ethical Consideration.
Ethical approval for the study was sought from the Federal Medical Centre Katsina ethical
committee. The research proposal was sent to the committee which read through the work
before approval.
Informed consent was obtained from the participants on the goals and objectives of the study,
and their absolute confidentiality was assured.
3. Result
3.1 Socio-Demographic data
Sex

7. Figure 1 shows the sex of the respondents, results show that 30(75%) are males while 10(25%) are
females. The majority of the respondents are males.
Age (in years)
Figure
2, shows the majority of the respondents 23(57%) were between age 31 – 35, followed by an age
range of 25 – 30 with 8(20%) then 36-40 are 6(14%) with only 2(5%) between the age of 41-45
and the least represented age group was age 46 - 50 with 1(3%).
Marital status

8. Figure
3, Illustrating the marital status that shows most of the respondents are married 30(75%), followed
by single 6(15%). The least represented age group was divorced with 4(10%).
Professional qualification
Figure
4 shows that 14 (35%) of the respondents possessed ND/HND. While 14(35%) have BNSC,
10(25%) possess MSc, while 2(5%) remain silent on it.
Years of experience as Reg. Nurse:

9. VARIABLES FREQUENCY PERCENTAGE
≤ 5 years 0 0%
6-10 year 12 30%
11-15 years 13 32.5%
16-20years 8 20%
21-25 years 5 12.5%
26-30years 2 5%
35years and above 0 0%
TOTAL 40 100%
Table 1 shows the years of experience, 12(30%) respondents had worked for between 6- 10 years.
13(32.5%) worked for between 11- 15 years. 8(20%) worked for between 16 and 20 years.
5(12.5%) worked for between 21-25 years. The rest of the respondents 2(5%) had worked for
between 26-30 years.
Years of experience as Reg. PON:
YEARS FREQUENCY PERCENTAGE
≤ 5 years 15 37.5%
6-10 years 15 37.5%
11-15 years 6 15%
16-20years 3 7.5%
21-25years 1 2.5%
26-30years 0 0%
35years and above 0 0%

10. TOTAL 40 100%
Table 2; Shows the results of years of experience as perioperative nurses [PONs], among the
respondents 15(37.5%%) had worked as perioperative nurses for less than 5 years. 15 respondents
(37.5%) worked as PONs for between 6-10 years. 6(15%) worked as PONs for between 11 and 15
years. 3(7.5%) worked as PONs for between 16 -20 years. And only 1(2.5%) worked as PON for
between 26-30 years.
Professional Rank:
Figure 5; Shows the professional qualification of the respondent, which shows most of the
respondents are SNO with 12(30%) and PNO 10(25%), followed by 8(20%) as CNO and 6(15%)
then 1(2.5%) as ADNS and 1(2.5%) as DDNS.
3.2 Participants Perceptions of preoperative visit
TABLE 3; PERCEPTION OF PERIOPERATIVE NURSES ON PREOPERATIVE VISIT
VARIABLES OPTION FREQUENCY PERCENTAGE
Do know what a preoperative visit
is all about?
Yes 36 90%
No 4 10%

11. TOTAL 40 100%
If yes, how important is the
practice of preoperative visits to
the perioperative nurses and the
patient?
Very important 28 70%
Important 10 25%
Not important 2 5%
TOTAL 40 100%
Were you taught on the
preoperative patient visit in your
training school?
Yes 30 75%
No 6 15%
Unsure 2 5%
TOTAL 40 100%
Did you practice preoperative
patient visits during your
clinical/practical posting as a
perioperative nurse student?
Yes 30 75%
No 10 25%
TOTAL 40 100%
Do you carry out preoperative
patient visits at your present place
of work?
Yes 14 35%
No 26 65%
I don’t know 0 0%
TOTAL 40 100%
If you answered yes in Q12, how
often do you practice it?
Always 3 21%
Occasional 11 79%

12. Not at all 0 0%
TOTAL 14 100%
If not on Q12, would you like to
practice it in your facility?
Yes 26 100%
No 0 0%
TOTAL 26 100%
Do you normally document your
actions/findings during
preoperative visits?
Yes 12 86%
No 2 14%
TOTAL 14 100%
Who do you think should carry out
preoperative visits among the
perioperative nurses?
Theatre/suite
managers
6 15%
experienced
perioperative
nurse
8 20%
Any
perioperative
nurse
26 26%
TOTAL 40 100%
How do you think the preoperative
visit should be done?
Individually 26 65%
team of
perioperative
nurses
12 30%

13. with the team of
surgeons and
anaesthetics
2 5%
TOTAL 40 100%
Table 3 is illustrating the respondent's perception of the preoperative visit, which shows, the
majority 36(90%) have full knowledge of what a preoperative visit is all about, while only 4(10%)
say they have no knowledge of the preoperative visit. On how important is the practice of
preoperative visits to the perioperative nurses and the patient the majority 28(70%) says it is very
important while 10(25%) says it is important but only 2(5%) believes it is not important. On the
aspect of whether been taught on the preoperative patient visit in the training school, the majority
of the respondents were taught 30(75%) with 6(15%) were not taught and only 2(5%) not sure on
either being taught or not. Also, the majority of the respondents 30(75%) do practice preoperative
patient visits during your clinical/practical posting as a perioperative nurse student while only
10(25%) say they did not. But the majority of the respondents 26(65%) say they don’t carry out
preoperative patient visits at their present place of work with only 14(35%) that say they practice
the visit. While out of the 14 that practice the visit 9(64.5%) majority say they often do it, while
3(27.5%) always practice the visit with only 2(14%) that are rarely doing it. While out of the 26
that are not practicing it 20(77%) like to practice it in their facility, with only 6(23%) that say they
don’t. Also, 12(86%) out of those visiting the patients say they do document their actions/findings
while only 2(14%) say they don't normally document their actions/findings during preoperative
visits. The majority of the respondent 26(65%) says the visit should be carried out every
perioperative nurse while 8(20%) says experienced perioperative nurses should carry out the visit
and only 6(15%) agreed the preoperative visit should be done by the perioperative nurses'
managers. Then the majority 26(65%) agree the preoperative visit should be done individually by
perioperative nurses and 12(30%) say it should be done in a team of perioperative nurses while
only 2(5%) agree to be done in a team together with other surgical team members.
3.3 Participants perceived benefits of preoperative visit
TABLE 4; PERCEIVE BENEFIT OF PREOPERATIVE VISIT
VARIABLES Strongl Agreed Not Disagre Strong TOTA

14. y
Agreed
sure e ly
Disagr
ee
L
To lessen the anxieties that the
patient has towards his operation
22
(55%)
8 (20%) 4 (10%) 4 (10%) 2 (5%) 40
(100%)
To improve patient care by knowing
the patient and his problems before
the operation
30
(75%)
4 (10%) 1
(2.5%)
4 (10%) 1
(2.5%)
40
(100%)
Aid recovery of post-operative
patients
18
(45%)
10
(25%)
6 (15%) 3
(7.5%)
3
(7.5%)
40
(100%)
Allow patients the opportunity to
express concerns and fears about the
impending surgery
20
(50%)
6 (16%) 5
(12.5%)
7
(17.5%)
3
(7.5%)
40
(100%)
Allows perioperative nurses to learn
about their patients
16
(40%)
8 (20%) 8 (20%) 4 (10%) 4
(10%)
40(100
%)
Establish good rapport 28
(70%)
4 (10%) 2 (5%) 4 (10%) 2 (5%) 40(100
%)
Develop a plan of care before the
patient arrives in the operating
department.
30
(75%)
4 (10%) 0 2 (5%) 4
(10%)
40
(100%)
To collect data involve perioperative
nurses more with total patient care
and to encourage them to keep up to
date with new procedures and ideals
the patient, to understand the
20(50%
)
6(15%) 8(20%) 4(10%) 2(5%) 40

15. procedures and the equipment that
will be used in the surgery.
To improve patient care by knowing
the patient and his problems before
the operation
16
(40%)
8 (20%) 2 (5%) 8 (20%) 6
(15%)
40
(100%)
To enable the perioperative nurse to
anticipate types of equipment that
may be needed for patients care
16
(40%)
8 (20%) 2 (5%) 8 (20%) 6
(15%)
40
(100%)
To re-enforce information that the
patient has already been given by
ward nurses and surgeons
28
(70%)
8 (20%) 1
(2.5%)
2 (5%( 1
(2.5%)
40
(100%)
To involve perioperative nurse more
with total patient care and to
encourage her to keep up to date
with new procedures and ideals
20
(50%)
6 (15%) 8 (20%) `4
(10%)
2 (5%) 40
(100%)
Table 4 will elicit the benefit of preoperative visit, majority of respondents 22(55%) strongly agree
it lessens the anxieties that the patient has towards his operation, while 8(20%) agree while 4(10%)
and 2(5%) disagree and strongly disagree with 4(10%) that are neutral. While 30(75%) and 4(10%)
of the respondents strongly agree and agree that it improves patient care by knowing the patient
and his problems before operation while 4(10%) and 1(2.5%) strongly disagreed and disagree with
only 1(2.5%) that remain neutral on that. But 18(45%) and 10(25%) strongly agree and agree that
it aids the recovery of post-operative patients while 3(7.5%) strongly disagree and disagree while
6(15%) remain neutral. The majority 20(50%) and 6(16%) strongly agree and disagree, it allows
patients the opportunity to express concerns and fears about the impending surgery, and 7(17.5%)
and 3(7.5%) strongly disagree and disagree and 5(12.5%) are neutral. Also, 16(40%) and 8(20%)
strongly agree and agree that it allows perioperative nurses to learn about their patients while
4(10%) strongly disagree and agree with 8(20%) as neutral. Meanwhile, the majority 28(70%) and
4(10%) strongly agreed and agreed it helps establish good rapport in which 4(40%) and 2(5%)

16. strongly disagree and disagree and 2(5%) remain neutral. Furthermore, the majority of the
respondents 30(75%) and 4(10%) strongly agree and agree it helps develop a plan of care before
the patient arrives in the operating department and 2(5%) and 4(10%) strongly disagree and
disagree respectively. Likewise, most of the respondents 20(50%) and 6(15%) strongly agree and
agree it helps to collect data involving perioperative nurses more with total patient care and to
encourage them to keep up to date with new procedures and ideals the patient, to understand the
procedures and the equipment that will be used in the surgery meanwhile 8(10%) are neutral and
4(10%) and 2(5%) agree and strongly disagree with the above. The majority of the respondent also
16(40%) and 8(20%) strongly agree and agree with 8(10%) and 6(15%) strongly disagree and
disagree with only 2(5%) as neutral that, preoperative visit helps to improve patient care by
knowing the patient and his problems before operation. While largely about 32(80%) and 6(15%)
strongly agree and agree it enables the perioperative nurse to anticipate types of equipment that
may be needed for patients care which only 2(5%) strongly disagree. Likewise 28(70%) of the
respondents further strongly agree and 8(20%) agree that it helps to reinforce the information that
the patient has already been given by ward nurses and surgeons and 2(5%) strongly disagree with
1(2.5%) disagree and neutral. while on the involvement of perioperative nurses more with total
patient care and to encourage them to keep up to date with new procedures and ideals, half of the
respondents 20(50%) strongly agree and half-quarter of the respondents 6(15%) agree to help on
the above while up to 8(20%) of the respondent are neutral on the above with only 4(10%) and
2(5%) that strongly disagree and disagree with the above respectively.
3.4 Participants perceived barriers of the preoperative visit
TABLE 5; THE BARRIERS TO PREOPERATIVE VISIT
VARIABLES Strongly
Agreed
Agreed Not
sure
Disagre
e
Strongl
y
Disagre
e
TOTAL
Resistance from perioperative
nurses due to limited staffing
25
(62.5%)
7
(17.5%)
0 7
(17.5%)
1
(2.5%)
40
(100%)

17. Timing of the visits/ lack of
time
22 (55%) 6 (15%) 1
(2.5%)
3 (7.5%) 8 (20%) 40
(100%)
Inadequate knowledge among
perioperative nurses on the
concept of the preoperative
visit to patients
10 (25%) 8 (20%) 4 (10%) 2 (5%) 16
(40%)
40
(100%)
Shortage of perioperative
nurses in the hospital.
30 (75%) 4 (10%) 0 4 (10%) 2 (5%) 40 (100)
Fear of passing wrong
information to the patient
8 (20%) 3
(7.5%)
1
(2.5%)
23
(57.5%)
5 (10%) 40
(100%)
Reluctance by the surgeons
and anaesthetists to allow the
perioperative nurses to
conduct a standalone visit to
surgical patients
3 (7.5%) 4 (10%) 1
(2.5%)
7
(17.5%)
25
(62.5%)
40
(100%)
Fear of information overload
to the patients
6 (15%) 4 (10%) 4 (10%) 12
(30%)
14
(35%)
40
(100%)
Work overload 32 (80%) 8 (20%) 0 0 0 40
(100%)
Lack of Hospital policy on the
preoperative visit
30(70%) 4 (10%) 0 0 6 (15%) 40
(100%)

18. Lack of relevance to the
preoperative visit
3(7.5%) 6 (15%) 1(2.5%) 5
(12.5%)
24
(60%)
40
(100%)
Lack of mentorship by senior
perioperative nurses
33(82.5%) 4 (10%) 0 1
(2.5%)
1
(2.5%)
40
(100%)
Reluctance by the surgeon to
allow perioperative nurses to
carry out a stand-alone visit to
the surgical patient
8(20%) 4 (10%) 0 20
(50%)
8
(20%)
40
(100%)
The poor motivation of
perioperative nurses by the
hospital management
32 (80%) 5
(12.5%)
0 3
(7.5%)
0 40
(100%)
Table 5 is showing the distribution of the respondents based on the barriers of preoperative visit
in which the majority 25(65.5%) strongly agree and 7(17.5%) agree on the Resistance from
perioperative nurses due to limited staffing is a barrier while 7(17.5%) and 1(2.5%) disagree and
strongly disagree with the above as barrier. Also, the majority 22(55%) and 6(15%) says Timing
of the visits/ lack of time is a barrier while 8(10%) and 3(7.5%) disagree and strongly disagree
with it as a barrier with only 1(2.5%) that is neutral. While the majority 16(40%) and 2(5%)
strongly disagree and disagree with Inadequate knowledge among perioperative nurses on the
concept of the preoperative visit to patients as a barrier but 10(25%) and 8(20%) strongly agree
and agree with this as a barrier with only 4(10%) that remain neutral. Also, the majority 30(75%)
and 4(10%) strongly and agree with the Shortage of perioperative nurses in the hospital as a barrier
while 4(10%) and 2(5%) disagree and strongly disagree with the above. Meanwhile, the majority
23(57%) and 5(12.5%) strongly disagree and disagree with the language barrier/Fear of passing
wrong information to the patient as one of the barriers, and 8(20%) and 3(7.5%) strongly agree
and agree it is a barrier while one 1(2.5%) remain neutral. Also, Reluctance by the surgeons and
anaesthetists to allow the perioperative nurses to conduct a standalone visit to surgical patients
strongly disagree and disagree by 25(62.5%) and 7(17.5%) as part of the barrier while 3(7.5%)
and 4(10%) strongly agree and agree to be part of the barriers with only 1(2.5%) as neutral. Also,
the majority 14(35%) and 12(30%) strongly disagree and disagree with Fear of information

19. overload to the patients as a barrier while 6(15%) and 4(10%) strongly agree and agree it is and
1(2.5%) is neutral. On other hand larger majority 32(80%) and strongly agree and 8(20%) agree
with Work overload as a barrier to preoperative visits. Also, the majority 30(75%) strongly agree
and 4(10%) agree on the Lack of Hospital policy on the preoperative visit as a barrier while only
6(15%) strongly disagree with it as a barrier. More so, the majority of the respondent 24(60%)
strongly disagree and 5(12.5%) disagree with the Lack of relevance to the preoperative visit as a
barrier while 6(15%) and 3(7.5%) agree and strongly agree it is with 2(5%) respondents as neutral.
Also, the Lack of mentorship by senior perioperative nurses was strongly agreed as a barrier by
majority 33(82.5%) and 4(10%) agree with 2(5%) and 1(2.5%) strongly disagree and disagree with
it as a barrier. Also, the majority 20(50%) and 8(20%) strongly disagree and disagree with
Reluctance by the surgeon to allow perioperative nurses to carry out a stand-alone visit to the
surgical patient as a barrier while 8(20%) and 4(10%) strongly agree and agree it is a barrier. The
last majority 32(80%) and 5(12.5%) strongly agree and agree with the Poor motivation of
perioperative nurses by the hospital management as a barrier with only 3(7.55%) disagreeing with
it as a barrier.
3.5 Participants perceived ways to enhance the practice of preoperative visit
TABLE 6; THE PERCEIVED WAYS TO ENHANCE THE PRACTICE OF PREOPERATIVE
VISIT
VARIABLES Stron
gly
Agree
d
Agree
d
Not
sure
Disagre
e
Strongl
y
Disagre
e
TOTAL
Attending Workshop/conferences 36
(90%)
2 (5%) 0 1
(2.5%)
1
(2.5%)
40
(100%)
Adhering to the standard of
perioperative nursing practice
32
(90%)
3
(7.5%)
1
(2.5%
)
2
(5%)
2
(5%)
40
(100%)
Utilization of hospital policy 28
(70%)
6
(15%)
0 4 (10%) 2
(5%)
40
(100%)

20. Enforcement of the practice by
training schools
32
(80%)
4
(10%)
0 3
(7.5%)
1
(2.5%)
40100%
Awards and incentives to
outstanding perioperative nurses
(motivation)
30(75
%)
4
(10%)
3
(7.5%
)
3(7.5%) 0 40(100
%)
Table 6 is showing the distribution of the respondent on the ways of enhancing the practice of
preoperative visits in which the majority of the respondents 36(90%) and 2(5%) strongly agree
and agree with attending workshops/conferences will assist to enhance to the practice while
1(2.5%) and also 1(2.5%) disagree and strongly disagree. It also strongly agree and agree by a
larger majority of the respondents 32(80%) and 3(7.5%) that adhering to the standard of
perioperative nursing practice will enhance the practice while 2(5%) disagree and 2(5%) strongly
disagree it will, with 1(2.5%) that is neutral. It is also strongly agreed by the majority 28(70%)
and, agree by 6(15%) that utilization of hospital policy will enhance preoperative visit while
4(10%) disagree with only 2(5%) that strongly disagree. The majority of the respondents further
strongly agree with 32(80%) and 4(10%) agree that enforcement of the practice by training schools
will help to enhance its practice while minority 3(7.5%) and 1(2.5%) disagree and strongly
disagree. On the other hand, the majority of the respondents strongly agreed with 30(75%) and
4(10%) agreeing that awards and incentives to outstanding perioperative nurses (motivation) and
3(7.5%) disagree with only 3(7.5%) that are neutral on the enforcement of hospital policy on the
preoperative visit.
4. Discussion of findings
Socio-Demographic characteristics of Respondent in this study shows the majority 23(57%)
were between the age 31 – 35, Which correlate with a study by (Dative, 2019) that revealed
among 74 participants, the highest percentages 32 (43.2%) of the participants were in the age
group of 35-44. This is contrary to the study by (Aliyu. et al, 2015) in Nigeria that showed that
the majority (65.8%) of participants in their study were fifty years old, and that of (Blomberg,
Bisholt, and Lindwall, 2018) that revealed that the participants of their study were in the age
group of 34–60 years. This also is contrary to the report by (Dhakal et al, 2016) that revealed
that the highest 67.9 % of respondents were in age below 25 years. The sex of the majority of
the participants, the results show 30(75%) are males while 10(25%) are females. The majority

21. of the respondents are males which is contrary to a study by (Dative, 2019) which reveals
46(62.2%) of the study were female, and (Aliyu et al, 2015) revealed that the major part of
participants was female (76.19%) and (Dakhal et al. 2016) that shows 79(54.1%) of the
participants were females respectively. This shows that there is a rapid change in the fact that
historically there are more females than males in the nursing profession worldwide. This study
shows the majority of the respondent 14(35%) has ND/HND also 14(35%) has BNSC in
nursing, this is in line with the finding by Dative (2019) that, the finding of the study revealed
that half 37(50%) of respondents had an advanced diploma in nursing. This is in line with the
study by (Blomberg, Bisholt, and Lindwall, 2018) that showed that the participants in their
study were Registered nurses with different educational backgrounds and the study by
(Oyetunde and Akinmeye, 2015) showed that 34 (17.7%) of respondents had bachelor‟s
degree in nursing, while others have postgraduate degrees such as masters. This can be due to
the change in the structure of the nursing programs in the country that has included a review
of nursing curriculum and mode of training to meet up with the population need and country
context. This study shows the majority 25(62.5%) has between 11-20 years of working
experience as registered general nurses, this is contrary to the study by Dative (2019) that
highlighted that the participants 38(51.4%) had working experience as registered nurses
between 3-5 years only. It also reveals that 30(75%) has between 1-10 years of working
experience as perioperative nurses, this is similar to the studies by (Mitchell, 2016) and
(Dhakal et al, 2016) which showed that 46 (34%) of respondents employed in the theatre
setting for 1–5 years and most of the respondents 75% had working experience of five years
and below respectively. This finding is contrary to the study by (Mohan et al., 2018) showed
that the majority of participants in their study had up to 6 years of working experience in the
operating theatre.
This study proves positive perceptions of perioperative nurses concerning the knowledge of
preoperative visits, the majority 36(90) agreed they have full knowledge of preoperative visits,
this is contrary to the study by Dative (2019) that shows 58 (78.4%) received the informal
training thereby making them less knowledgeable. In this study, the majority 67(93.0%) of
participants had a high level of knowledge on a preoperative patient visit. This is supported by
the study of (Aliyu et al, 2015) among Nigerian perioperative nurses that showed that the

22. nurses have correct knowledge about the preoperative visit to patients before undergoing a
surgical operation. Another similar study by (Oyetunde and Akinmeye, 2015) indicated that
nurses have good knowledge and a positive attitude toward patients teaching before surgery,
this study proves the majority were taught about the preoperative visit during their training,
this is in line with the study by (Aliyu et al, 2015) that (97.3%) of participants acquired the
formal training in perioperative nursing visit right from the school. This is in relation to the
official training of specialist perioperative nurses in Nigeria was established far for decades.
This study shows how important the visit is? With 28(70%) participants, the findings show it
is very important, which is in line with the study by Dative (2019) which showed the highest
score of participants 77% say it is very important. This study found the majority 26(60%) don’t
practice the visit, this is contrary to the results by Dative (2019) of her study showing that the
highest practiced the visit with a total score of participants of 69%. This is in line with the
study by (Musa and Ali, 2018) which the result also shows that 72(97.3%) of participants had
poor practice of preoperative patient teaching. The majority of the respondents 26(65%) of this
study says the preoperative visit is the responsibility of every perioperative nurse and should
be done individually at a time, this is contrary to the study by Dative (2019) that says the big
number 38(51.4%) of participants in this study disagreed that the preoperative patients are the
responsibility of perioperative nurses. This is also contrary to the studies by (Alawadi et al.,
2016) that revealed that there is confusion about the duty to deliver information to clients and
about 60% of nurses thought that doctors were primarily responsible to provide pre-operative
information to patients before surgery. This is in line with the study by Ali, Lalani, and Malik,
(2015) that revealed the preoperative patient visit is the important duty of health care providers
and that perioperative nurses work as a teacher in charge of teaching the clients before
experiencing surgical operation for preventing the associated risks. In this study majority of
the participants 38(95%) agreed that preoperative patient visits should be given to surgical
patients by perioperative nurses individually, this finding is contrary to the study by
(Papanastassiou et al., 2015) that reported that preoperative teaching is to be done in a team
with the surgeons and other team members.
This study fund as perceived benefits of preoperative visit, the majority 22(55%) agreed it
lessen the preoperative anxiety, this is line with a study of Dative (2019) that says the majority

23. 47(63.5%) of the participant of the study agreed that preoperative teaching can prevent the
preoperative anxiety among patients undergo surgery. This study further proves the majority
30(75%) says it helps to plan for the care and develop new knowledge, this is in line with the
study by Aliyu et al, (2015) that says the 34(45.9%) agreed that preoperative patients visit
helps the perioperative nurses to build up an idea of what to expect after surgery. In this finding
also 34(45.9%) strongly agreed that preoperative teaching facilitates the patients undergoing
surgery to follow post-operative instructions. This study also shows the majority 28(70%) says
it helps to develop rapport with the patients which is in line with the study by Aliyu et al.
(2015). Also further agree by 32(80%) that it helps perioperative nurses to prepare for the
surgery before the day of surgery, this is supported by a study by Danjuma et al. (2015) which
revealed 57% and the majority of the respondent agree on that.
This study proves as barriers to preoperative visits, the majority 25(62.2%) disagreed that
reluctance by surgeons or anaesthetists as a barrier which is contrary to a similar study by (Lee
& Lee, 2016) in China Hong Kong that showed that there is conflicting matter in carrying out
preoperative patients teaching among nurses and the surgeons. Also, the study proves by the
majority 32(80%) says work overlord and lack of timing This is also supported by the studies
of (Aliyu, et al.,2015; Oyetunde And Akinmeye, 2015) that revealed the majority 65% agreed
with it as a barrier. The findings show the shortage of perioperative nursing by the majority
30(75%) of the respondents. In addition to these similarities, the researcher found that this
poor practice of preoperative patients teaching can be due to the shortage of perioperative
nursing staff in theatre and to their low level of education because most of them have advanced
diplomas in nursing. As supported by a study of Danjuma et.al, (2015) 48(64.9%) of
participants strongly agreed that preoperative patients teaching is affected by a heavy daily
workload of nursing staff in operating theatre; 53(71.6%) strongly agreed that the lack of time
among nursing staff of operating theatre can affect the delivery of preoperative teaching to
patients undergoing surgery; 57(77%) strongly agreed that the shortage of perioperative
nursing staff is a factor affecting the practice of preoperative patient visit; 35(47.3%) agreed
that the lack of experience among nursing staff is a factor affecting the preoperative teaching
to patients undergoing surgery; 45(60.8%) strongly agreed that the preoperative patients
teaching can be affected by the tight operations scheduled daily in operating theatre; These

24. findings above are similar to the study by(Lee& Lee, 2015) that revealed that the top factors
affecting the practice of preoperative visit were time availability, language barriers, close-
fighting operation programs, professional trainings and daily workload in the clinical setting.
In addition to this, the other study by (Oyetunde and Akinmeye, 2015) indicated that chief
factors that influence the practice of client teaching were the nurses‟ experiences, culture,
workplace, lack of time, heavy workload, insufficient staffing, limited teaching aids and the
complexity of clients‟ status.
This finding stated as means to enhance the practice of preoperative visits by the majority
36(90%) that attending workshops to update knowledge and 32(80%) says adhering to the
perioperative standard will enhance the visit, this is supported by a study of Dative (2019)
which says it does by 65% and 52% respectively. It also further revealed 28(70%) of the
respondents agree utilization of the hospital policy will too improve the practice this is contrary
to the study by Lalani et al. (2015) which says 56% of the respondent that hospital policy
always contradicts its practice by nurses. And finally, the majority 32(80%) and 30(75%)
agreed that enforcement of the practice in the training school and motivation of perioperative
nurses through awards and incentives to outstanding perioperative nurses will enhance the
practice respectively.
Conclusion
This study determined the perceptions of perioperative nurses towards preoperative visits. The
findings will contribute to the growth of the body of knowledge and practices towards the
preoperative patient's visit. This study finds that the population of males perioperative nurses
is seriously increasing against the fact that it says nursing is a female profession, evidenced by
the highest number of the respondents being males. This research finds that the majority of the
respondent has full knowledge of preoperative visit and were formally trained during their
training but only a few practiced it with the majority interested to practice it in the future. Also,
it proved as major benefits of the preoperative visit are; alleviating patient’s anxiety, helping
the perioperative nurses to prepare for surgery before the surgery day thus improving the
quality of patient’s care, and improving hospital economy by proper utilization of hospital
equipment/instrument which prevents spoiling of such equipment/instrument. It also finds,
shortage of perioperative nurses, lack of time, work overload, lack of the hospital policy, lack

25. of motivation, and mentorship as major barriers to preoperative visits. It was further stated that
adhering to the standard of perioperative practice, utilizing hospital policy, staff motivation,
enforcement of the practice in the training, and updating of knowledge of the already graduated
perioperative nurses will help to improve the practice.
Recommendations
There is a need to further study the relationship between gender, age, experience, rank, and the
environment with the poor preoperative visit practice.
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