There have been giant strides in technological and scientific developments in surgical treatment and postoperative care minimize the risk of surgical treatments, improve the treatment and care of patients, and increase the quality of life [1]. Globally an estimated 234 million surgeries are performed annually, making surgical care an essential part of healthcare [2].  Nurses play significant role in the care and management of patients at different stages of the surgical process. The surgical process includes preoperative preparation, intra-operative care or interventions and post-operative management and care interventions for the patient's recovery after surgery. Intraoperative care is a process that begins when the patient has being taken to the operating room and continues until they leave the operating room [2].

The postoperative period commences from post-anesthesia care unit (PACU). The most frequent disturbances during the immediate postoperative period in PACU are acute pain, nausea and vomiting, delirium, shivering, dry mouth, and hunger [3]. Postoperative care in early recovery should involve airway management and oxygen therapy, vital signs monitoring, postoperative pain management, postoperative nausea and vomiting treatment, treating post anesthesia shivering, and monitoring surgical sites for complications such as bleeding, discharge, swelling, hematoma, wound healing, and infection [3].

Nursing care is significant in PACU to improve the quality of recovery of patients and to prevent complications that may occur. Nurses must be highly qualified and have knowledge and skills in the treatment and care of patients from different surgeries of varying complexity that require specialized and individualized care [1]. Nursing care in the recovery room is focused on the patient’s condition after surgical intervention with its main purpose of providing direct and continuous patient observation in emergence from general or regional anesthesia. In the absence of professional assistance, patients can develop complications that can lead them into shock or death [4].

The use of Alderete’s score chart has provided use of a standardized tool that provides consistency in monitoring thus reducing errors that may occur after anesthesia. In countries where the tool has been in use, it has been effective in detection of any deviation from the normal parameters leading to effective and prompt thus preventing post anesthesia complications and subsequent deaths [5]. Alderete’s scoring system includes assessing a patient’s responsiveness, activity or movement of limbs, respiration, blood pressure and oxygen saturation level as determined by pulse oximetry. A score of 0 to 2 is given for each of the five categories assessed and a score of 8 to 10 is considered adequate for discharge of the patient from the post anesthesia care unit to the post-surgical ward. A patient with a score of less than 8 is considered not ready for discharge and has to be monitored until a desired score is achieved.

A descriptive cross-sectional design was used to determine the level of knowledge, perceived attitude and reported utilization of alderete’s scale in post anaesthesia care unit management of patients among theatre personnel’s of UDUTH. UDUTH Sokoto is a tertiary health institution serving as a referral centre to all primary and secondary health facilities in its catchment area which consist of Sokoto, Kebbi, Zamfara, Katsina and Niger states. It commenced operation in 1989 and is a 650 bed hospital with various specialties. The population for the study is a total of 43 nurses who work in the main operating theatre the hospital. Using existing strata, a stratified random sampling technique was used to select 43 nurses.

The instrument for data collection is a questionnaire designed by the researcher covering objective 1, 2 and 3. The questionnaire comprised of 37 items in English, including 6 demographic questions, 11 knowledge questions, and the interviewees were asked to reply in two ways: 1 = Yes; 0 = No, with a total range of “0-10”; they were asked to answer 7 attitude questions according to five-point Liker scales: from “strongly agree = 5” to “strongly disagree = 1”; they were asked to answer 6 practice questions according to five-point Liker scales: from “always = 5” to  “less often =  1” with a total score range of “6-30”; and they were asked to choose from 8 barriers questions that applies to them. Answers were evaluated considering the extent to which they are compatible with pain therapy standards commonly acknowledged by the international pain management guidelines. A knowledge score of 0-5 means poor knowledge and 6-11 means good knowledge.

The questionnaire was designed using Google form and link shared with the theatre personnel using their contact numbers and this lasted for two weeks. Therefore two weeks was used for data collection. Data obtained through the questionnaire was appropriately cleaned to ensure accuracy and consistency. The data collected was analyzed using the Statistical package for social science version 23. The respondents’ demographics, alderete’s assessment tool-related knowledge, attitude, and practice were analysed using frequencies and percentages.

All information about the study was explained to the participants for them to understand the purpose of the study which is academic and therefore informed Participants are informed that participation is voluntary and they can withdraw at anytime.

A total of 51 self-administered questionnaires was sent electronically to the respondents out of which 43 (84.3%) responded and were completely filled and 4 did not respond and 4 incompletely filled. The analysis was based on the 43 completely filled questionnaires retrieved.

Table 1: Socio-demographic characteristics of respondents N=43.

Source: Field data 2024

Table 1 displays socio – demographic characteristics of nurses who participated in the study. The Study covered age group, gender, educational attainment, Position/rank, duration in the position (in years), number of years as registered nurse Majority of the nurses are within the age brackets of 34-39 representing 41.9%. Male nurses are almost double of female nurses representing 65.1%. Most of the respondents are registered perioperative nurses representing 67.4% while 11.5% hold Bachelor’s degree in Nursing.  Most of the respondents are Senior Nursing Officers representing 34.9%, and other ranks (assistant director and deputy director) represented 11.7% of the respondents. The duration in the position (years) by nurses was mostly  majority of nurses was less than 3 years representing 72.1% and those with 10 years and above representing 4.7%. 34.9% of the respondents have 11-15 years’ experience while those with 21 years and above are 16.3%.

Table 2: Level of Nurses’ Knowledge about alderate tool/scale Patient Management (N=43).

Source: Field data 2024

From the table 2 above it shows that 81.4% of the respondents have good knowledge about the modified alderate tool while 16.8% of them have poor knowledge about modified alderate tool/scale.

Table 3: Attitude of Theatre Personnel on the Use of Modified Alderate Scale in patient management.

Source: Field data 2024

From the table 3 above it shows that 95.3% of the respondents have good attitude about the modified alderate tool while 4.7% of them have negative attitude knowledge about modified alderate tool/scale.

Table 4: Use of Modified Alderate Scale in patient management in PACU.

The table above depicts that participants indicate the leading frequency of items on usage of modified alderate assessment scale in the management of patients that “Modified alderete chart always tell the true state about the patient” with 69.77%, “Prior to admitting patient I ensure all monitors are functioning” with 65.12% and “Patients to be discharged must have a score greater than 8” with 53.49%. Those who use Modified Alderete scale in monitoring all patients in PACU both often and frequently are 13.95% and 4.65% totally 18.6%.

Table 5: Factors Affecting the Use of Modified Alderate Scale in patient management.

Source: Field data, 2024

Table 5 shows factors affecting the use of modified alderate tool/scale The theater personnel reveal that three leading factors affecting the use of modified alderate scale: “Poor documentation as a result of non-availability of charts” representing 86%, “Shortage of nurses hinders the use of Alderete's chart in the hospital” representing 83.7% and “High patients to Personnel’s ratio in Post Anaesthesia Care Unit making the use of scoring system impossible” representing 74.4%.

Table 6: Relationship between knowledge and Utilization alderate scale in patient management (N=43).

Table 6 shows that at 0.05 level of significance, there was no significant relationship between knowledge and reported practice of the use of modified alderate assessment scale in PACU  management of patients in UDUTH with r=0.199, p<0.05. Now, this suggests that knowledge and usage of modified alderate scale are independent and not related with each other.

Findings in the study shows 81.4% of theatre personnel had good knowledge about the modified alderate tool. This finding was consistent with a study conducted by [5], which revealed that 93%% of staff had knowledge about Alderete tool. Staffs that have the required knowledge and skills will be better placed to use the Alderete’s score chart more effectively.

The study also showed that 4.7% of the respondents have negative attitude about the modified alderate tool this is far less than to that conducted in kenya which revealed that 29% of nurses had negative attitude towards the use of Alderete’ chat in monitoring patients. The reason to the afore mention as reported in 55.8% of theatre personnel was that the chat been cumbersome and time wasting which is also similar to that conducted in kenya with 66% of nurses reported the use of Alderete's score chart in monitoring Post anesthesia patients that is was cumbersome [5].

The study also revealed that three leading factors affecting the use of modified alderate scale: “Poor documentation as a result of non-availability of charts” representing 86%, “Shortage of nurses hinders the use of Alderete's chart in the hospital” representing 83.7% and “High patients to Personnel’s ratio in Post Anaesthesia Care Unit making the use of scoring system impossible” representing 74.4% affected the use of alderete tool in patients management which is similar to a study conducted by [6] which revealed that Staff factors that have affected utilization of the monitoring tool include knowledge, skills and attitude towards the use of the chart. Institutional factors have also affected the utilization of monitoring tool and these are policies governing the use of the tool and supply of resources necessary for the utilization of the scoring tool. This is also similar to the study conducted by [7] in which it was observed that shortage of nurses affected the delivery of health care.

The study revealed that at 0.05 level of significance, there was no significant relationship between knowledge and reported practice of the use of modified alderate assessment scale in PACU  management of patients in UDUTH with r=0.199, p<0.05. Now, this suggests that knowledge and usage of modified alderate scale are independent and not related with each other

Limitation

Firstly, the study was carried out in UDUTH it is pertinent to note that the results cannot be generalized for the entire nurses in the state. However, the study can be extended to cover the entire state in Northern Nigeria. Secondly, the study assessed reported utilization of alderete scales in post anaesthesia care unit management of patients among theatre personnel. Observation on the use of alderete scales among theatre personnel would have been more appropriate. Finally, factors identified to have impinged on the use of alderete scale in post anaesthesia care unit management of patients are skewed negatively as it was only on the staff without noting what the management has to say.

On the basis of the findings of this study, the following conclusions were drawn:

It was seen that theatre personnel had good knowledge about alderete scale in post anaesthesia care unit management of patient and their knowledge is consistent with nurses in other parts of the world. Furthermore, the study revealed that patient’s workload and lack of assessment protocols were the two leading factors militating against the use of alderete scale in post anaesthesia care unit management of patient. Also, there was no significant relationship between knowledge and reported practice of the use of modified alderete assessment scale in PACU management of patients of UDUTH, Sokoto.

Conflict of interest

There is no conflict of interest in this paper.

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