Proceedings of the international nursing conference on Chronic Disease

Management Pekalongan, Indonesia, August, 7-8, 2019

Early Mobilization Increases Wound Healing On Post Laparatomy Patients

Yuliana1 , Andrew Johan2, Nana Rochana3

1
Departemen Perawat, Fakultas Kedokteran, Universitas Diponegoro, Semarang, Indonesia
3
Fakultas Kedokteran, Universitas Diponegoro, Semarang, Indonesia
Coresponding author: nanarochana@lecturer.undip.ic.id, nsyuliana2885@gmail.com

Abstract
Introduction: post laparatomy is a care providen to patients to reduce complication and to speed wound healing.
Early mobilization is a pant of post laparatomy care aims to accelerate the process of wound healing. objective : To
systematically review the effect of early mobilization on wound healing in post laparatomy patients. Method: The
literature search was done througl CINAHL, Scientdirect, Pubmed, Google Scholar dan MEDLINE, Portal Garuda,
from 2008 to 2018 in English and Indonesian using keywords: early mobilization, wound healing, laparotomy
surgery. A total of 128 articles have been identified but after the selection process, the criteria only 8 articles.The
inclusion criteria of this review are, quasi experimental studies, adult patients as samples, post laparatomy patients;
while the exclusion criteria are patients with diabetic disease. Results: Early mobilization the affect on wound
healing in post laparotomy patients Conclusion : Early mobilization the affect wound healing in post Laparatomi
patients. Early mobilization is done in patients 2 hours, 6 hours, or 8 hours after surgery. this becomes a
consideration when the right and safe time for early mobilization.

Keywords : early mobilization, woung healing, laparatomy surgery

Introduction to go to bed as quickly as possible, this is

Laparatomy is one of the major surgical
procedures by making cuts on the lining of the
abdominal wall to get parts of the abdominal
organs that are experiencing problems, such as
cancer, bleeding, obstruction, and
perforation.1 Data World Health Organization
(WHO) menununjukkan number of patients with
surgery has increased from 140 to 148 million
people in the world from 2011 to 2012.
Indonesia In 2012, surgery reached 1,2 million
people and an estimated 32% of it is surgery
laparotomy.2
Treatment of post laparotomy is a form of
care given to patients who have undergone
abdominal surgery. The goals of post-
Laparatomy care include reducing complications
due to surgery, accelerating healing, restoring the
patient's function to the maximum extent
possible before surgery, maintaining the patient's
self-concept and preparing the patient home. One
of the postoperative care procedures for
Laparatomi is to carefully manage and move the
patient's position. Restoration of physical
function is done immediately after surgery with
breathing exercises, effective coughing and early
mobilization exercises.3
Early mobilization is the process of
activities carried out after the operation starts
from light exercise on the bed until you can get
out of bed, walk to the bathroom and walk out of
the room. Most surgical patients are encouraged
determined by the stability of the cardiovascular
system, neuromuscular patients, the patient's
usual level of activity and the nature of the
surgery performed. The advantage of early
mobilization is that it reduces the incidence of
post operative complications such as, reducing
abdominal distension, accelerating recovery of
abdominal wounds, reducing pain in surgical
wounds and restoring certain activities so that
patients can return to normal and or be able to
meet daily motion requirements.4
After surgery on laparotomy if you do not
get maximum treatment can slow the healing
process, for example the incidence
of wound infection usually appears 36-46 hours
after surgery.5 The incidence of surgical wound
infections in hospitals in Indonesia is between
2% -18%.6 WHO survey shows that the
incidence of surgical site infection in the world
ranges from 5% -34%.7 Infection results in
dehisend and eviseration.4 The incidence
of wound dehiscence in the world around 0,4 % -
3.5%.2
Kusumayanti Research8 one of the factors
that influence the duration of treatment in post
operative Laparatomi patients in inpatient
installations is early mobilization with a sig
value of 0.033. Arifin9 the patients
with early mobilization of hospitalization < 7
days compared to patients who did not mobilize
early with hospitalization ≥7 days. The success

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 Proceedings of the international nursing conference on Chronic Disease
Management Pekalongan, Indonesia, August, 7-8, 2019

of early mobilization in accelerating wound Padang

healing after surgery has been proven by several
research journals, namely the Indarmein netty Relations analyt Accidenta Chi-
results of Gusti research,1 0 Netty,11 Nur 2012 hip of ic l sampling Square test
early observa technique obtained a P
Rahma,12 Sumarah,13 Sumartinah,14 mobilizati tional 42 value of
Ditya,15 Susanti,16 Simangungso.17 on with with respondents 0.028
post cross
operative sectiona
Method cesarea l
The research method uses a journal search wound approac
healing in h
method with a systematic review. literature the obser
search CINAHL, Scientdirect, Pubmed, Google combined vation
Scholar and MEDLINE, Garuda midwifery sheet
ward of
Portal. keywords from 2008-2018 with the H. Abdul
English-language and Indonesian: early Manap
mobilization, wound healing, laparotomy Hospital
Jambi
surgery, mobilisasi dini, penyembuhan luka, Nur The Analy Accidenta Chi-
laparatomi. Many as 128 articles were identified, Rahm 2013 relationshi tical l sampling Square
but after a process of selection, only eight p of early survey technique test obtained
mobilizati with a 32 a P value
articles that meet the criteria. With the inclusion on to cross- respondents of 0.005
criteria of research methods, analytic wound sectiona
healing in l
surveys, experiments, adult patients, patients cesarean approac
post operative laparotomy. Selected articles sectio h
are carried out systematically using PICO patients in
the SCC Obser
(population, intervention, comparison, and fatimah vation
results) Makassar sheet
mother
and child
Results RSKD
Table. 1 Based on the results of statistical Sumarah 2013 The Quasi Randomiz The
effect of experim ation treatment
tests of some of the research journal shows the early ental wi 25 group was
difference in meaning an tar a respondent who mobilizati th respondent 100%
mobilized with no mobilization (P <0.05) . on on post the post control injured
sectio test app 25 The
Table. 2 The results of the gusty study caesarean roach intervention control
showed a significant increase (5) in the major wound only respondents group 88%
surgery group and minor surgery group (5.1) healing in with injured well
Sleman control
Table. 3 research results from 7 articles District group
found an average ( 45.58% ) wound healing Hospital design.
more on respondents with mobilization Sumartinah The Corre 36 Chi-
2013 relationshi lational respondents Square test
compared with not mobilization. p of early analytic P value of
The table . 1 Extra Data mobilizati survey 0.004 was
Researcher Researc Meth Sumpling Research on and with obtained
h title od/ / sample result hemoglob cross
Instr ulin levels sectiona
ument to wound l design
Reni Prima The effect Quasi Quota mann healing in
Gusty 201 1 of early experim Sampling whitney test sectio
mobilizati ental technique a p value of caesaria
on of with the 20 0.001 was surgery in
patients posttest Respondents obtained Semarang
after control control Wira ditya The analyt Consecuti chi-square
abdominal group 20 interventi 2014 relationshi ic ve sampling test
surgery on design on p between observa technique P value of
wound approac respondents early tional 31 0.003 is
healing h mobilizati cross- respondents obtained
and on and sectiona
respirator wound l study
y function healing in design
of M. post- early
Djamil Laparato mobiliz
hospital in my ation
patients in questio
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 Proceedings of the international nursing conference on Chronic Disease
Management Pekalongan, Indonesia, August, 7-8, 2019

the male nnaire Early mobilization

and observa
female tion Early mobilization that can be done
surgical sheet includes Range of motion (ROM), deep
ward of wound breathing and also effective cough.1 8
the healing
General process Early mobilization procedure in Netty research11
Hospital. 1) Breathing exercises done while sleeping on
Dr.M.Dja
mil
your back as early as possible after fully
padang conscious
Ika Yuni Early Analy Concecuti T-test 2) Move the arms, fingers and toes in the first 6
Susant i 2015 mobilizati tical ve sampling P value of
on against Survey 85 0,000 was
hours after cesarean section surgery
eds e mbu with Cr respondents obtained 3) Tilt left and right starting 6-10 hours after
han post- oss- surgery
cesarean sectiona
wound in l 4) Mother sits after 8-12 hours postoperative
hospital cesarean section
general Early mobilization procedure in Sumartinah
Wahidin
Sudiro research14
Husodo 1) Done 2-6 hours after surgery: move the arms
Mojokerto
Rimayanti The Analy Accidenta Fisher
and hands, move the tips of the fingers and rotate
Simangunson 20 relationshi tic l sampling Test the ankles, lift the heels, bend and shift the legs,
17 p of early Survey 30 P value of tilt right and tilt left
mobilizati with Cr respondents 0.001 was
on with ossectio obtained
2) After 24 hours of surgery: semi-fowler or
the nal fowler sitting exercises, the mother can sit for
process of more than 5 minutes
healing
post- 3) After 36 hours of operation: the mother starts
sectio learning to walk, doing independent activities
caesarea such as toiletting and caring for herself
at GMIM
General
Hospital Discussion
radiating
love
Effect of mobilization on wound healing
Research
Table.2 The Effect on Mobilization of Increased Rahma,12 Susanti,16 Simangungso17 used a
Wound Healing sample with inclusion criteria for postoperative
The mean Increased cesarean section, with good wound
Author Group
Intervention Control the mean healing research between 77.3%-96%. Susanti
Reni Prima Major 10 5 5 Research16 categories of early mobilization if
Gusty 2010 surgeon
Surgical 10 4.9 5.1 mobilizing 6 hours after surgery.
minor Netty's study11 used a sample with inclusion
criteria in postoperative cesarean
Table.3 The Effect of Mobilization of Increased women and exclusion criteria were mothers with
Wound Healing symptoms of anemia, diabetes mellitus, obesity,
a long history
WoundofHealed
parturition. The results of the
Category Mobilization immobilization
Author
Total study 90% good wound healing Difference
in mothers who
sample %
Mobilization
Im do Fearly % mobilization.
F
The%
category of early
mobilization mobilization if the sample mobilizes 6 hours
Indarmein netty 2012 42 33 9 30 90.9 5 55.6 35.3%
postoperatively. Sumartinah14 used a sample
Nur Rahm 2013 32 22 10 with17inclusion
77.3 criteria
2 in 20.2
postoperative
57.1% mothers
Sumarah 2013 50 25 25 with caesarean
100 section, mothers
88 aged 25-35
12%
Sumartinah 2013 36 22 14 years,
17 did77.3not suffer
4 from diabetes48.7%
28.6 mellitus and
Wira ditya 2014 31 18 13 14 77.8 3 23.1 54.7%
exclusion criteria for labor complications. The
Ika Yuni Susanti 2015 51 31 20 28 90.3 11 55 35.3%
Rimayan ti Simangunsong 30 25 5
results
24
of good
96
wound
1
healing
20
research
76%
77.3% in
2017 mothers with early mobilization. Early
Average mobilization category if mobilizing 45.58% 2-6 hours
postoperatively.

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Proceedings of the international nursing conference on Chronic Disease
Management Pekalongan, Indonesia, August, 7-8, 2019
Ditya15 conducted a study with inclusion
criteria in Laparatomi patients, stable condition,
general
anesthesia and exclusion criteria, namely patients
with complications of Laparatomy, malnutrition,
diabetics with diabetes, history of
chemotheraphy. The results empirically wound
healing both 77.8%.
Sumarah13 developed a quasi-
experimental study that divided the
control group and the intervention group in
postoperative cesarean women. Kriteria inclusion
in this sample do not have contraindications,
early mobilization, Hb ≥10gr/ dl, arm circum
ference ≥ 23.5 and exclusion criteria, namely the
disease Diabetesmellitus. The results of the study
100% experienced good wound healing.
Research Gusty13 using samples of patient
inclusion criteria laparotomy 6 to10 hours post-
surgery, did not experience any nutritional
deficiencies, disorder breathing, no abdominal
distress, co-morbidities such as : HIV, diabetes,
sepsis and cancer. The results showed an
increase in wound healing in the minor surgery
group (5.1) and major surgery (5).
The results of several studies10 - 17 get early
mobilization speed wound healing
process. Consists of variations in research
methods, inclusion or exclusion criteria, and the
time of commencement of the mobilization
procedure. Does not describe a significant
difference from the results of the study.
Of several journals, researchers late, using
procedural steps mobilization of
different starting with the time range of 2-10
hours post operative. in terms of the condition of
the patient with surgical wound pain, weakness,
or loss of consciousness, there is great doubt
about the patient's ability to follow all stages of
the mobilization procedure. It is recommended to
use a mobilization procedure that understands the
patient's condition.
Early ambulation should not exceed patient
tolerance. The patient's condition must be a
determining factor in the progress of the patient
mobilization step. Nursing support and
encouragement and with safety being the main
concern, care must be taken not to make the
patient tired, the duration of the first
ambulatory period varies depending on the
physical condition.19
Handayani Research 20 used the mobility
progress protocol, starting the procedure 8 hours
postoperatively. Mobility progression is a
249
mobilization protocol based
on Timmerman (2007) and the American
Association of Critical Care Nurses (2009).
Mobilization starts with safety screening to
ensure the physical condition of the patient .
The Conceicao21 study explained that from
a variety of systematic reviews, it was found that
patients were safe to mobilize if they met the
criteria of cardiovascular, respiratory,
neurological, orthpedic, and other
assessments. In conclusion mobilization can
begin as soon as possible if the patient meets the
criteria.
This was reinforced by the research of Aleef
and Labib22 which used the early mobilization
protocol of Ahmad Hospital in Doha Qatar . The
protocol starts mobilization based on the results
of the safety screening assessment on
patients. Assessment results determine the stages
of mobilization based on intolerance of patient
activity
Conclusion
The results of several studies10 - 17 get early
mobilization deep wound healing process. Early
mobilization procedures used in the Sumartinah
and Netty studies have not yet provided specific
explanations for indications and
contraindications in the use of these mobilization
procedures.
Mobility progress is a mobilization protocol
based on Timmerman (2007) and the American
Associationof Critical Care Nurses (2009). The
mobilization begins with safety screening to
ensure the physical condition of the patient.
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