Psychometrical evaluation of an instrument to measure the nurses’ knowledge about early mobilization among post laparotomy patients

Jaata, Jikrun; Syam, Yuliana; Irwan, Andi Masyitha; Syahrul, Syahrul
doi:10.1016/j.enfcli.2021.07.027
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A laparotomy is a surgical procedure to gain access to the peritoneal cavity by making a significant cut in the midline along the linea alba&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> In the United States&#44; there were nearly 10 million patients discharges related to laparotomy between 2009 and 2013&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> While in the UK&#44; 30&#44;000&#8211;50&#44;000 surgical procedures were performed annually&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> In Indonesia&#44; there were 1&#46;2 million surgeries per year&#44; and it was estimated that 32&#37; of them are laparotomy&#46; The morbidity rates from surgical complications range from 3&#37; to 16&#37;&#59; meanwhile&#44; the mortality rates range from 0&#46;4&#37; to 0&#46;8&#37; in a developed country and 5&#37; to 10&#37; in developing countries&#46; For this reason&#44; adequate intervention is needed in order to reduce post-operative complication&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Complications that may occur after surgery are Post-operative Ileus &#40;POI&#41;&#44; Deep Vein Thrombosis &#40;DVT&#41;&#44; muscle weakness&#44; pulmonary disease&#44; intra-abdominal infection&#44; wound dehiscence&#44; and urogenital infections&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> Those complications should be treated immediately&#44; one of which is through early mobilization intervention&#46; According to clinical practice guidelines from the American Society of Colon and Rectal Surgeons &#40;ASCRS&#41; and Society of American Gastrointestinal and Endoscopic Surgeons &#40;SAGES&#41;&#44; the management of post-operative intervention on early mobilization can minimize some negative impacts caused by surgeries on organ functions&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">However&#44; early mobilization intervention is less commonly performed by nurses&#46; According to the study on the nurses in hospitals in Washington&#44; DC&#44; mobilization became the intervention with the highest percentage of Missed Nursing Care Task of 53&#37; by medical&#8211;surgical nurses&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> This is in line with the result of a study administered to 344 nurses from Australian Hospitals that early mobilization is the most reported missed nursing care component &#40;43&#46;3&#37;&#41; due to inadequate knowledge and skills as well as inability to evaluate the intervention area given&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The lack of knowledge and skills tends to make nurses do not carry out the intervention to patients&#59; it will undoubtedly affect the quality of nursing care&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">7</span></a> Therefore&#44; we need a standardized instrument to assess the nurse&#39;s knowledge of performing the early mobilization intervention to post laparotomy surgery&#46; In the meantime&#44; there is no standardized instrument assessing nurse&#39;s knowledge of the early mobilization steps&#44; appropriate timing for the intervention&#44; as well as its benefits and resulting impacts&#46; The previous instruments&#44; however&#44; lack some components that make it necessary to develop an instrument in accordance with the evidence-based practice in order to be used as a measurement tool in research&#46; Thus&#44; the development of an instrument assessing nurse&#39;s knowledge in providing nursing care services to post-laparotomy surgical patients is essential&#46; This study aims at assessing the validity and reliability of an instrument measuring nurse&#39;s knowledge in performing early mobilization intervention to post-laparotomy surgical patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Design and samples</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study is a cross-sectional pilot study with a non-probability sampling technique using total sampling by selecting all those that fulfill the inclusion and exclusion criteria&#46; The instrument developed in this study involved all 13 Intensive Care Unit &#40;ICU&#41; nurses of Makassar General Hospital&#46; The inclusion criteria are having minimum education requirement of Diploma III &#40;three&#41; of Health Education and one year plus of experience in ICU while the exclusion criteria are the nurses in the period of leave or got illness during the study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Procedures and data analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">The instrument assessing nurse&#39;s knowledge regarding early mobilization intervention was in the form of a questionnaire consisting of 20 multiple-choice questions&#46; The questions were compiled based on evidence-based literature&#46; Then&#44; the questionnaire went through the expert judgment consisting of three expert panels to evaluate each item in terms of its relevance&#44; clarity&#44; simplicity&#44; and ambiguity using a four-point rating&#58; 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8216;not relevant&#8217;&#44; 2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8216;somewhat relevant&#8217;&#44; 3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8216;quite relevant&#8217;&#44; and 4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8216;highly relevant&#8217;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> Instrument test results from the three expert panels were calculated using the Content Validity Index &#40;CVI&#41;&#46; CVI is used to check the content validity of an instrument and is categorized as very good if the content validity<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;80&#46; Meanwhile&#44; a reliability test was carried out using Internal Consistency Reliability to determine if the items measure the right concepts of Cronbach&#39;s Alpha&#46; It was analyzed using IBM SPSS Statistics for Windows&#44; version 22&#46;0&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Ethical consideration</span><p id="par0035" class="elsevierStylePara elsevierViewall">Ethics approval for this study was obtained from the Health Research Ethics Commission of Health Polytechnic Makassar no&#46; No&#58; 1135&#47;KEPK-PTKMKS&#47;X&#47;2019 then forwarded to the Hospital Education and Training Center to get permission to conduct the research&#46; The respondents signed the informed consent after receiving the information regarding the objectives and requirements of the study&#44; just in case the respondents quit this study without notice&#46; The items of the questionnaire are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The mean age of the participants was 30 years old&#44; ranging from 27 to 36 years&#46; Most of the participants were female &#40;71&#46;4&#37;&#41;&#46; 78&#46;6&#37; of participants are Registered Nurse &#40;RN&#41; with an average of 7 years of work experience ranging from the minimum length of work of 1 year to the maximum length of work of 15 years&#46;</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Validity test</span><p id="par0045" class="elsevierStylePara elsevierViewall">In order to assess the instrument that will be used as a measurement tool&#44; the validity test in this study was conducted through the judgment by expert quantitatively using the CVI method&#46; The experts consist of 3 people with a doctoral degree and have a basic knowledge of medical-surgical nursing with more than 15 years of work experience in the field of education&#46; The experts were asked to rate the content of each item in the questionnaire with the choices of scores 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8216;not relevant&#8217;&#44; 2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8216;somewhat relevant&#8217;&#44; 3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8216;quite relevant&#8217;&#44; and 4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8216;highly relevant&#8217;&#46; From the total score calculated from the three experts&#44; it was concluded that all items in the questionnaire met the relevant criteria with CVI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;80&#44; showing that the questionnaire had a good content validity&#46; Based on the expert judgment&#44; the CVI value was 0&#46;96&#44; with a total I-CVI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#46;5&#46; This showed that all items in the questionnaire are valid and can be used as a measurement tool&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Reliability test</span><p id="par0050" class="elsevierStylePara elsevierViewall">The reliability test for the instrument was carried out using internal consistency reliability in order to see whether the questionnaire items measure the same underlying concepts with the Cronbach&#39;s Alpha&#46; This is the most accurate approach to measure internal consistency reliability&#46; At this stage&#44; the information was presented in the form of Cronbach&#39;s Alpha &#40;0&#46;734&#41;&#46; The following table is the Cronbach&#39;s Alpha value for each item in the questionnaire&#46; The items of the questionnaire are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The four answer options are also displayed in the parentheses&#46; The answer options are separated with a slash&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Early mobilization procedure performed to the post laparotomy surgical patients contributes to reduce hospital length of stay&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a> reduce the risk of complications&#44; as well as to reduce morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> Thus&#44; early mobilization is strongly recommended by Enhanced Recovery After Surgery Society &#40;ERAS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> Therefore&#44; the nurse&#39;s knowledge in providing nursing care services to post-laparotomy surgical patients is important&#46; An evidence-based instrument is needed in measuring nurse&#39;s knowledge in providing nursing care since the evidence-based instrument is considered as having high validity&#46; Moreover&#44; the questionnaire is the most practical instrument to use&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> Early mobilization instruments can be developed following policy formulation and programmed orientation&#44; and the development of the program has a positive impact on nurses&#8217; understanding related to the risks of immobilization and the benefits of mobilization in patients&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> Thus&#44; an evidence-based instrument is needed in order to assess the competence of the nurse&#39;s knowledge&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In developing an instrument&#44; a test for validity and reliability is necessary since they are the most essential and fundamental features in evaluating every measurement tool&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> Validity concerns with what an instrument measures and how well it measures&#46; In contrast&#44; reliability concerns one&#39;s faith in the instrument in obtaining the data&#44; the degree to which a measuring tool can control the random errors&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">12&#44;14&#44;15</span></a> The research findings showed the CVI of 0&#46;96 with an I-CVI total value of 19&#46;5&#44; which indicates an excellent content validity &#40;CVI value<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;80&#41;&#46; The average content validity index for the questionnaire was 0&#46;93&#44; where all items had a score higher than 0&#46;79 with 18 question items&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> Another research result by reviewing 20 question items by seven experts obtained a scale content validity index of 0&#46;94 then tested among 200 undergraduate nursing students used to evaluate EBP knowledge&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Another study by Spurlock and Wonder &#40;2015&#41; showed minimum CVI and maximum CVI of 0&#46;83 and 1&#44; respectively&#44; from 20 item questions&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> This showed strong psychometric properties for an instrument and was available for use in research and educational contexts&#46; Next&#44; the results of the study by Pezeshki et al&#46; &#40;2017&#41; designing 25 items with seven subscales showed CVI of 0&#46;99&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a> The results of another study&#44; a draft questionnaire composed of 35 items related to knowledge about musculoskeletal disorders and its risk factors validated by nine experts&#44; yielded a 0&#46;98 overall CVI&#46; Hence&#44; it can be concluded that high CVI value from the item questions indicates its availability for use in researches&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The reliability test results of this study using internal consistency reliability indicate the value of Cronbach&#39;s Alpha 0&#46;734&#46; This indicated that the instrument developed is reliable to be used&#46; A previous study conducted also showed Cronbach&#39;s alpha value of 0&#46;90&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a> Other studies by developing and validating psychometric scales to prevent early diarrhea in children obtained Cronbach&#39;s alpha &#40;0&#46;84&#41;&#44; which shows that the scale is reliable&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> Coefficient results for items between 0&#46;63 and 0&#46;95 with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 indicating high internal reliability with Cronbach&#39;s alpha values varying between 0&#46;63 and 0&#46;85 and 0&#46;89 so they can be used as instruments&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The instrument on the knowledge of the early mobilization intervention steps on post laparotomy surgical patients can be used as a standardized instrument assessing nurse&#39;s knowledge regarding early mobilization intervention&#46; Its implication can be used as a Standard Operational Procedure &#40;SOP&#41; in assessing the quality of nurses in providing nursing care services&#46; In addition&#44; this instrument can be used to assess the quality of nurses in providing nursing care services in terms of early mobilization interventions to the post-laparotomy surgical patients based on evidence-based practice&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        0 => array:3 [
          "identificador" => "xres1635808"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
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            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
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            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
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            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1459229"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Design and samples"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Procedures and data analysis"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Ethical consideration"
            ]
          ]
        ]
        4 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Results"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Validity test"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Reliability test"
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Discussion"
        ]
        6 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conclusion"
        ]
        7 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflict of interest"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2021-01-04"
    "fechaAceptado" => "2021-07-19"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1459229"
          "palabras" => array:5 [
            0 => "Early mobilization"
            1 => "Validity and reliability"
            2 => "Instrument development"
            3 => "Knowledge"
            4 => "Laparotomy"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aims to assess the validity and reliability of an instrument regarding the nurse&#39;s knowledge in performing early mobilization intervention on the post laparotomy patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This cross-sectional study involved 13 nurses in the Intensive Care Unit &#40;ICU&#41; in Makassar General Hospital&#46; The data were analyzed using Expert Judgment with Content Validity Index &#40;CVI&#41;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;80 and Internal Consistency Reliability with the value of Cronbach&#39;s Alpha<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The research finding showed that the CVI of 0&#46;96 with I-CVI total value of 19&#46;5 and the value of Cronbach&#39;s Alpha of 0&#46;375 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The Instrument on the knowledge of the early mobilization intervention steps on the post laparotomy surgical patients can be used as a standardized instrument&#46; Its implication can be used as a Standard Operational Procedure &#40;SOP&#41; in assessing the quality of nurses in providing nursing care services&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review process of the 3rd International Nursing &#38; Health Sciences Students &#38; Health Care Professionals Conference &#40;INHSP&#41; 2019 is under the responsibility of the scientific committee of the 3rd International Nursing &#38; Health Sciences Students &#38; Health Care Professionals Conference &#40;INHSP&#41;&#46; Full-text and the content of it is under the responsibility of authors of the article&#46;</p>"
      ]
    ]
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      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "mostrarDisplay" => false
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          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Questions and Answers Options&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cronbach&#39;s Alpha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">An action performed on a post-operative laparotomy patient by doing passive ROM exercises left and right tilted position&#44; sitting position&#44; until helping to walk the understanding of &#40;active ROM&#47;passive ROM&#47;mobilization&#47;immobilization&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;712&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early mobilization in post-operative laparotomy patients by training the flexibility and strength of muscles and joints by actively using their muscles is called &#40;active ROM&#47;passive ROM&#47;functional motion&#47;activity intolerance&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;706&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early mobilization interventions is carried out &#40;before surgery&#47;after 6<span class="elsevierStyleHsp" style=""></span>h post-surgery&#47;immediately after surgery&#47;after 24<span class="elsevierStyleHsp" style=""></span>h post-surgery&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;751&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stages of early mobilization consist of &#40;2 stages&#47;3 stages&#47;4 stages&#47;5 stages&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;713&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The purpose of early mobilization is &#40;reducing bleeding&#47;increase the risk of pressure sores&#47;streamlining blood circulation&#47;increase pulmonary complications&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;713&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early mobilization activities to help post-operative laparotomy patients in performing passive ROM such as helping patients move their shoulders&#44; elbow movements&#44; wrist movements&#44; hip and knee movements&#44; foot and ankle movements performed on &#40;stage 1&#47;stage 2&#47;stage 3&#47;stage 4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;763&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Assist post-operative laparotomy patients to change their left and right slanted position&#44; the position of semi fowler to fowler &#40;30<span class="elsevierStyleSup">0</span> to 90<span class="elsevierStyleSup">0</span>&#41; is done on &#40;stage 1&#47;stage 2&#47;stage 3&#47;stage 4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;752&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early mobilization of the first phase is carried out on &#40;8<span class="elsevierStyleHsp" style=""></span>h before surgery&#47;at 6&#8211;24<span class="elsevierStyleHsp" style=""></span>h post-surgery&#47;shortly after surgery&#47;after 24<span class="elsevierStyleHsp" style=""></span>h post-surgery&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;722&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Activities carried out at the fourth stage of early mobilization are &#40;helping patients lean in bed&#47;help the patient in a sitting position without leaning&#47;helping patients sit on the edge of the bed initiated&#47;helps patients stand and be active in wheelchairs until they walk&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;706&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Activities carried out at the third stage in early mobilization are &#40;help the patient in a sitting position without leaning&#47;helps patients tilt right-left tilt&#47;helping patients sit on the edge of the bed initiated&#47;helping patients walk 2&#8211;3 steps beside the bed to get to the bathroom&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;740&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Activities carried out in the second stage in early mobilization are &#40;help the patient in a sitting position without leaning&#47;helps patients tilt right-left tilt&#47;helping patients sit on the edge of the bed initiated&#47;helping patients walk 2&#8211;3 steps beside the bed to get to the bathroom&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;730&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The second phase of early mobilization is carried out on &#40;less than 12<span class="elsevierStyleHsp" style=""></span>h before surgery&#47;12&#8211;24<span class="elsevierStyleHsp" style=""></span>h post-surgery&#47;less than 12<span class="elsevierStyleHsp" style=""></span>h after surgery&#47;24&#8211;48<span class="elsevierStyleHsp" style=""></span>h post-surgery&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;746&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Assisting post-operative laparotomy patients to sit in bed as much as &#40;1 time per day for 30<span class="elsevierStyleHsp" style=""></span>min&#47;2 times per day for 30<span class="elsevierStyleHsp" style=""></span>min in 1 session&#47;at least two times per day for 5&#8211;15<span class="elsevierStyleHsp" style=""></span>min in 1 session&#47;minimum of 2&#8211;3 times per day for 1<span class="elsevierStyleHsp" style=""></span>h in 1 session&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;687&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Benefits of early mobilization in post-operative laparotomy patients &#40;Increase complications of post-operative surgery&#47;increases the risk of deep venous thrombosis&#47;Speed up the process of intestinal peristalsis&#47;Increases the risk of pulmonary complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;713&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complications caused when no early mobilization is carried out in post-operative laparotomy patients &#40;Reducing fatigue&#47;Extend the length of stay&#47;Reducing surgical complications&#47;Speed up the wound healing process&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;723&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contraindications to early mobilization in post-operative laparotomy patients &#40;post-operative patients with hypertension&#47;post-operative patients with DM&#47;post-operative patient with a history of pulmonary TB&#47;post-operative patients with a history of vertigo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;734&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complications caused by immobilization in post-operative laparotomy patients &#40;risk of fracture&#47;risk of muscle hypertrophy&#47;risk of decubitus&#47;risk of urinary tract infections&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;692&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Things to consider before doing early mobilization in post-operative patients laparotomy &#40;measuring intestinal peristalsis&#47;wound condition&#47;measuring vital signs&#47;measuring brachial ankle index&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;713&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Things that must be considered in patients when conducting early mobilization in post-operative laparotomy patients &#40;old bed rest&#47;medical devices installed in the patient&#39;s body&#44; so they are not interested&#47;muscle weakness&#47;reduction in surgical complications&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">Early mobilization not carried out according to the procedure can cause &#40;risk of muscle atrophy&#47;risk of infection in wounds&#47;risk of injury to patients and caregivers&#47;risk of deep venous thrombosis&#41;&nbsp;\t\t\t\t\t\t\n
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