https://doi.org/10.15218/ejnm.2024.12 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov, 2024 Original Article Assessing the Performance of Statistical Tools for Postoperative Nursing Care Quality of Patients with Laparoscopic Cholecystectomy in Teaching Hospitals at Erbil City ABSTRACT Background and Objectives: Laparoscopic Cholecystectomy is a minimally invasive surgery for or conducting gallbladder removal, providing faster recovery times and fewer complications compared to conventional open surgery. This study aims to evaluate and compare the standard of post-operative nursing care provided to patients who undergo Laparoscopic Cholecystectomy procedures in surgical units at teaching hospitals and understand statistical tools' performance in evaluating care quality. Methods: A cross-sectional descriptive study design, involving fifty nurses via non- probability (purposive) sampling technique, who had been working in the surgical unit. The data were collected through the use of the observational checklist, which consisted of two parts; the first part includes information about the socio-demographic characteristics of respondents, and the second part is about the assessment of Postoperative nurses' care items consisting of five main domains. The data were collected from October -2023 to February -2024 after approval of the proposal by the Ethical Committee, using statisti- cal tools to analyze the data. Result: The finding of the study showed that most study items responding to the ques- tionnaire showed significant differences and that there is insufficient provision of high- quality postoperative nurse interventions for patients undergoing Laparoscopic cholecys- tectomy at surgical wards at Erbil City teaching hospitals. Conclusion: This study concludes that several demographic factors, such as age, marital status, and level of education, among nursing staff significantly correlate with the quality of nursing care provided in surgical wards. Despite their educational background, many nurses lacked adequate professional skills and training in postoperative nursing interven- tions for care. Keywords: Assessment; Postoperative Nursing Care; Laparoscopic Cholecystectomy; Statistical Tools. Yahya Zakarya Shakir; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. (Correspondence: yahya.shakir@hmu.edu.krd). Burhan Izzaddin Sabir; Department of Nursing, College of Nursing, Hawler Medical University, Kurdistan Region, Erbil, Iraq. Paree khan Abdulla Omer; Department of Statistics and Informatics, College of Administration and Economics, Sala- haddin University, Erbil, Kurdistan Region, Iraq. Ali Taher Mohammedameen; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq 127 Received: 31/03/2024 Accepted: 26/05/2024 Published: 30/11/2024 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. mailto:yahya.shakir@hmu.edu.krd) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.12 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov, 2024 Original Article The liver, gallbladder, and pancreas work together to secrete enzymes and other substances that aid in the digestion of food in the stomach and small intestine. If these organs are not functioning correctly, it can lead to digestive problems, which can re- sult in poor nutrition. Collaborative care for patients with biliary system problems should include enhanced nutrition to sup- port healthy cellular function (AbdElgilil et al., 2020). Laparoscopic cholecystectomy (LC) is a minimally invasive surgery for per- forming gallbladder removal, providing faster recovery times and fewer complica- tions compared to conventional open sur- gery (Aziret et al., 2019; Farhangmehr & Menzies, 2020). However, despite its bene- fits, postoperative nursing care plays a criti- cal role in ensuring optimal patient out- comes and quality of care delivery. Postop- erative nurses need to understand the im- portance of the procedure, potential risk factors, and know the signs of complica- tions. Precise nursing assessment, as well as intervention is essential to support pa- tients in quickly and safely regaining opti- mal function. Nursing attention is concen- trated on restoring the patient's physiologi- cal equilibrium to prevent or identify post- surgery complications promptly. Moreover, timely nursing implementation is necessary for checking vital signs, alleviating pain lev- els, managing nausea and vomiting, pro- moting wound healing, and minimizing drainage. Nurses should intervene prompt- ly to ensure adequate ventilation, alleviate pain, preserve skin integrity, provide opti- mal nutrition, and implement measures to minimize patient discomfort during recov- ery. Furthermore, nurses should educate patients on essential information for post- operative recovery and after discharge (Edwards et al., 2019; EL-Shatby & El- Monem, 2020; Salime & shakweer, 2021). Assessing the performance of statistical tools within this context aids in gauging the effectiveness of postoperative nursing interventions. Patients expect the use of effective and safe interventions and avoidance of unnecessary or inappropriate therapies. Post-operatively, the proficiency and application of healthcare professionals are crucial factors in managing patients' care. Lack of information persists regarding the pre and postoperative nursing care quality for patients undergoing LC in Erbil City. Despite some available data indicating substandard levels of care in various cities across Iraq, such as Kirkuk (Hussein & Khudair, 2019), Al-Najaf (Kareem et al., 2022), and Al-Nasiriya (Ibrahim & Muhamad, 2021), Sulaymaniyah City stands out for its commendable proficiency in both knowledge acquisition and practical application. (Hassan & Saeed, 2023) In teaching hospitals across Erbil City, the efficacy of postoperative nursing care for patients undergoing LC is paramount, necessitating a comprehensive evaluation of the statistical tools employed to assess care quality. Aim of the study: The current study aims to evaluate and compare the standard of post-operative nursing care provided to patients who undergo laparoscopic cholecystectomy procedures in surgical units at teaching hospitals and understand statistical tools' performance in evaluating care quality. A cross-sectional descriptive study was conducted about the post-operative quality of nurse care at a teaching hospital. A non-randomly purposeful sample of fifty nurses was selected, who has been working in surgical wards, from teaching hospitals (Hawler Teaching Hospital, Rizgary Teaching Hospital, and Rojhalat Emergency Hospital) including both genders. The duration of the study, which 128 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.12 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov, 2024 Original Article administrative personnel, as well as head nurses/supervisors of surgical depart- ments. Participation in the study entails no inherent risks. Information is anonymized to protect the confidentiality of partici- pants, thereby fostering maximal coopera- tion from study samples. Data were coded and analyzed utilizing Microsoft Office Ex- cel 2016, in addition to the software statis- tical package for the social sciences (SPSS version 27). Here used the useful test called the chi-square test, and is a non- parametric test that is specifically used for two tasks: (a) Testing the hypothesis that two or more groups, populations. (b) Cal- culating the probability that the observed data distribution fits the expected distribu- tion (i.e., evaluating goodness of fit). It is meant to evaluate categorical data, such as patients who are male or female, smok- ers or not (Rana & Singhal, 2015), (ELsayed, 2022). The expected count de- ducted from the observed count is to de- termine the difference between them. Then, the square of the difference is com- puted, to eliminate the negative values because the squares of (2 and 2) are natu- rally both four. The hypothesis of null and alternative for this test will be (Rana & Singhal, 2015): H0: no association between two categorical variables. H1: an associa- tion between two categorical variables. The binomial distribution used in statistics and probability theory, which generally offers only two possible outcomes for any experiment: such as gender (male or fe- male) and (success or failure). Similarly, there are only two possible outcomes while taking a test: pass or fail , yes or No (Phillips, 2006). was conducted during the period of 15, Sep. 2023 to April. 2024. The data were collected from Oct. 2023 to Feb. 2024 after approving the proposal. The data were col- lected through the use of a standard post- operative observation checklist, by the re- searchers after a strong review of the rele- vant literature (AbdElhafiez et al., 2021; Brenner & Kautz, 2015) which consisted of two parts; the first part includes infor- mation about the socio-demographic char- acteristics of respondents such as (age, gender, marital state, level of education, years of experience, number of years of experience in surgical unit, training course on post-operative nursing care for patients undergoing laparoscopic cholecystectomy). The second part is about the assessment of Postoperative Nurses' care items con- sisting of five main domains. First: Nurses' practices concerning monitoring and man- aging potential complications included 8 items. Second: Nurses' practices concern- ing improving respiratory status included 6 items. Third: Nurses' practices concerning relieving pain included 4 items. Fourth: Nurses' practices concerning maintaining skin integrity and drainage included 11 items. Fifth: Nurses' practices concerning maintaining nutritional status included 6 items. The checklist was administered through direct observation utilizing the standardized post-operative observational checklist. All nursing personnel actively serving in surgical units at the designated teaching hospitals were encompassed in the study, encompassing both male and female cohorts. Exclusion criteria were ap- plied to individuals declining participation in interviews or facing impediments to study involvement. The ethical aspect of data collection is paramount, with prior approval secured from the Ethics Com- mittee at the Nursing College, University of Hawler Medical. Verbal consent and au- thorization were sought from 129 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.12 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov, 2024 Original Article Table 1 shows that there is a significance among the level of the studied (Y1) Gender variable because (α = 0.05) is greater than (P-Value = 0.033) (α > P-Value). While it reports a highly significant, with (Y2) age groups, (Y3) marital state, (Y4) educational level, (Y5) years of experience in hospitals, (Y6) years of experience in surgical units, and (Y7) training course on post-operative nursing care for patients undergoing LC. The male study participants were 17 (34%); while the female participants were 33 (66%). The majority of the study partici- pants is 29 (58%) between 34 – 45 years old, in addition to that, the mean of the total sample age is (3.88 years) with a standard deviation (1.365 years). Regard- ing the level of education, half of the study samples 25 (50%) had diplomas degree. Regarding the number of years of experi- ence in hospitals, the majority of the sam- ple (36%) having 14 – 18 years of experi- ence. While for number of years of experi- ence in surgical units was 15 (30%) having 6 – 10 years. Concerning the subject of the Training Course on post-operative nursing care for patients undergoing LC, the sam- ples who answered "Yes" were reported only 6 (12%), while who answered ''No" accounted for 44 (88%). 130 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULT Table 1. Socio-demographical characteristics with comparison between all variables and their significances. Variables Groups F. (%) Cumu. Percent P-value Y1 = Gender Male 17 (34) 34 Binomial 0.033 S Female 33 (66) 100 Y2 = Age Groups 22 – 27 2 (4) 4 Χ2 = 25.880 < 0.001 HS 28 – 33 4 (8) 12 34 – 39 15 (30) 42 40 – 45 14 (28) 70 46 – 51 9 (18) 88 52 – 57 4 (8) 96 ≥ 58 2 (4) 100 Mean ± SD 3.88 ± 1.365 Y3 = Marital State Single 9 (18) 18 Χ2 = 20.480 < 0.001 HS Married 41 (82) 100 Divorced 0 (0) 0 Y4 = Level of Education Nursing school 19 (38) 38 Χ2 = 11.320 0.003 HS Diploma 25 (50) 88 Bachelor's 6 (12) 100 Y5 = Number of Years of Experience in Hospitals 4 – 8 5 (10) 10 Χ2 = 22.720 < 0.001 HS 9 – 13 10 (20) 30 14 – 18 18 (36) 66 19 – 23 12 (24) 90 24 – 28 0 (0) 90 29 – 33 3 (6) 96 ≥ 34 2 (4) 100 Y6 = Number of Years of Experience in Surgical Units 1 – 5 11 (22) 22 Χ2 = 22.960 < 0.001 HS 6 – 10 15 (30) 52 11 – 15 14 (28) 80 16 – 20 8 (16) 96 21 – 25 1 (2) 98 26 – 30 0 (0) 98 31 – 35 1 (2) 100 Y7 = Training course on post-operative nursing care for patients undergoing LC Yes 6 (12) 12 Binomial < 0.001 HS No 44 (88) 100 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.12 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov, 2024 Original Article 131 between these items and the quality of post-operative nursing intervention pro- vided by the nurses for patients with cholecystectomy, and (X13, X15, X20, X35) reported significant differences. This means there is a significant relationship between these items and the quality of the nursing intervention. Only five items (X4, X6, X9, X12, X14), reported a non- significant, it means there is a weak as- sessment of postoperative nurse inter- vention. Table 2 displays the majority of the exam- ined elements across the five categories, including monitoring and managing poten- tial complications, enhancing respiratory function, alleviating pain, preserving skin integrity, managing drainage, and optimiz- ing nutritional status (X1, X2, X3, X5, X7, X8, X10, X11, X16, X17, X18, X19, X21, X22, X23, X24, X25, X26, X27, X28, X29, X30, X31, X32, X33, X34) reported highly signifi- cant, It means there is a strong relationship Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2. Assessment of Postoperative nurses’ practices on different items. Postoperative Nurses' Interventions items Responses F. (%) MS P-value 1. Nurses’ practices concerning monitoring and managing potential complications X1 = Monitoring vital sings (T, PR, RR, BP) Achieved 14 (28) 1.72 Binomial 0.003 HS Non achieved 36 (72) X2 = Ensuring the dress is clean, dry, and intact Achieved 42 (84) 1.16 Binomial < 0.001 HS Non achieved 8 (16) X3 = Observing the surgical dressing and any drains Achieved 48 (96) 1.04 Binomial < 0.001 HS Non achieved 2 (4) X4 = Moving patient slightly on bed after 4-6 hrs. Post operatively Achieved 27 (54) 1.46 Binomial 0.672 NS Non achieved 23 (46) X5 = Helping the patient to go out of bed Achieved 11 (22) 1.78 Binomial < 0.001 HS Non achieved 39 (78) X6 = Instructing the patient and family to record any change in the color of the waste (stool) Achieved 21 (42) 1.58 Binomial 0.322 NS Non achieved 29 (58) X7 = Assessing the patient for increased tender- ness rigidity of the abdomen Achieved 11 (22) 1.78 Binomial < 0.001 HS Non achieved 39 (78) X8 = Record the abdominal distention Achieved 4 (8) 1.92 Binomial < 0.001 HS Non achieved 46 (92) 2. Nurses’ practice concerning improving respiratory status X9 = Assessing the rate, depth and sound of breathing Achieved 21 (42) 1.58 Binomial 0.322 NS Non achieved 29 (58) X10 = Recording the rate, depth and sound Achieved 5 (10) 1.90 Binomial < 0.001 HS Non achieved 45 (90) X11 = Raising the head of the patient’s bed Achieved 39 (78) 1.22 Binomial < 0.001 HS Non achieved 11 (22) X12 = Putting the patient in the low fowler’s position Achieved 29 (58) 1.42 Binomial 0.322 NS Non achieved 21 (42) X13 = Encouraging the patient to turn, take deep breaths and cough gradually Achieved 16 (32) 1.68 Binomial 0.015 S Non achieved 34 (68) X14 = Helping patients to walk early by sup- porting the surgical incision site when coughing and walking Achieved 23 (46) 1.54 Binomial 0.672 NS Non achieved 27 (54) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.12 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov, 2024 Original Article 132 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2. Assessment of Postoperative nurses’ practices on different items. Postoperative Nurses' Interventions items Responses F. (%) MS P-value 3. Nurses’ practices concerning relieving pain X15 = Assessing and recording characteristic (location, type and severity) Achieved 33 (66) 1.34 Binomial 0.033 S Non achieved 17 (34) X16 = Helping the patient in a pillow or bind- er over the surgical incision during turn, coughing Achieved 15 (30) 1.70 Binomial 0.007 HS Non achieved 35 (70) X17 = Performing massage to the patient’s back Achieved 4 (8) 1.92 Binomial < 0.001 HS Non achieved 46 (92) X18 = Administering analgesics as prescribed Achieved 48 (96) 1.04 Binomial < 0.001 HS Non achieved 2 (4) 4. Nurses’ practices concerning maintaining skin integrity and drainage X19 = Recording skin status and eye sclera Achieved 5 (10) 1.90 Binomial < 0.001 HS Non achieved 45 (90) X20 = Recording characteristic (color and amount) of wound drainage Achieved 16 (32) 1.68 Binomial 0.025 S Non achieved 34 (68) X21 = Checking the potency of drainage tube Achieved 49 (98) 1.02 Binomial < 0.001 HS Non achieved 1 (2) X22 = Caring of the drainage bag Achieved 49 (98) 1.02 Binomial < 0.001 HS Non achieved 1 (2) X23 = Assess drain insertion site for signs of leakage, redness or signs of ooze Achieved 48 (96) 1.04 Binomial < 0.001 HS Non achieved 2 (4) X24 = Dressing on the drainage tube Achieved 48 (96) 1.04 Binomial < 0.001 HS Non achieved 2 (4) X25 = Assessing if drain is secured with su- ture or tape and document Achieved 42 (84) 1.16 Binomial < 0.001 HS Non achieved 8 (16) X26 = Changing of the outer dressings and protection of the skin from irritation Achieved 37 (74) 1.26 Binomial 0.001 HS Non achieved 13 (26) X27 = Ensuring drain is located below the insertion site and free from kinds or knots Achieved 35 (70) 1.30 Binomial 0.007 HS Non achieved 15 (30) X28 = Recording fluids output and any change in color of urine Achieved 9 (18) 1.82 Binomial < 0.001 HS Non achieved 41 (82) X29 = Encouraging patient mobilized with a drain Achieved 43 (86) 1.14 Binomial < 0.001 HS Non achieved 7 (14) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.12 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov, 2024 Original Article of participants were female and there is a highly significant relationship between providing nursing care and gender. This result is in line with a study on the “Effect of a self-learning package on nurses' knowledge and practices regarding patient care undergoing laparoscopic cholecystec- tomy” in Egypt in 60 samples of nurses, showed that the majority of nurses were female (Salime & shakweer, 2021). Our study shows that the majority of the par- ticipants were married. This result agrees by a study done on “Assessment of Nursing Practices Provided for Patients Post Lapa- roscopic Cholecystectomy” in Egypt in 65 samples of nurses, their findings showed that the majority of nurses were married (EL-Shatby & El-Monem, 2020). Our results show that half of them graduated from the Nursing Institute. This result is supported by (AbdElgilil et al., 2020). Their result con- curred with the study carried out in Sulay- Over the past 50 years, LC has been the preferred method of treating cholelithia- sis. The low cost, quick recovery, minimally invasive procedure, and high success rate were attained with LC to avoid postopera- tive complications and enhance quality of life, nurses play a critical role in the pa- tients’ management following LC by as- sessing, comprehending, and providing the best and appropriate nursing care. (Gao et al., 2021) The majority of nurses are in the age group (34-39) years, there is a signifi- cant relationship between the age of the participant and the quality of nursing care. This study disagrees with the finding of (EL -Shatby & El-Monem, 2020) on the “Assessment of Nursing Practices Provided for Patients Post laparoscopic cholecystec- tomy” In Egypt in 65 samples of nurses, their findings showed that their age group is twenty years to less than thirty years old. Nurses in surgical wards need to be young. Our study shows that the majority 133 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2. Assessment of Postoperative nurses’ practices on different items. Postoperative Nurses' Interventions items Responses F. (%) MS P-value 5. Nurses’ practices concerning improving nutritional status X30 = Administration IV therapy as pre- scribed Achieved 50 (100) 1.00 Binomial < 0.001 HS Non achieved 0 (0) X31 = Monitoring the state of swallowing and bowel sounds Achieved 12 (24) 1.76 Binomial < 0.001 HS Non achieved 38 (76) X32 = Encouraging soft diet after bowel sounds return Achieved 37 (74) 1.26 Binomial < 0.001 HS Non achieved 13 (26) X33 = Recording fluid intake Achieved 14 (28) 1.72 Binomial 0.003 HS Non achieved 36 (72) X34 = Assessing the symptoms of the di- gestive system as nausea and vomiting Achieved 39 (78) 1.22 Binomial < 0.001 HS Non achieved 11 (22) X35 = Assessing the color and consistency of stool Achieved 17 (34) 1.66 Binomial 0.033 S Non achieved 33 (66) DISCUSSION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.12 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov, 2024 Original Article training programs offered both domestical- ly and internationally., by continuing their education for those working in surgical wards, and by using guidelines for postop- erative interventions. These measures will enhance the quality and strength of the nurses' patient care and raise their knowledge about how to prevent compli- cations from LC. Thus, if the nurse is im- pacted by an attitude barrier or lacks suffi- cient knowledge, effective intervention will not be possible. This study concludes that the study identi- fied a significant correlation between the various demographic factors (such as age, age group, Marital State, level of educa- tion, etc.) of nursing staff and the quality of nursing care provided. Nurses in the age group of 34-39 years constituted the ma- jority, suggesting a potential influence of experience and maturity on care delivery. This finding contradicts previous studies emphasizing the necessity of a younger nursing workforce in surgical wards. Inade- quate professional backgrounds and lack of competent skillful practice were ex- pressed by most of the nurses who worked at surgical wards related to their postoper- ative nursing interventions in LC care re- gardless of their educational level and non- satisfactory training background. Most postoperative nurses' assessments were directly correlated with their intervention domains. Additionally, some sociodemo- graphic characteristics affected the assess- ments of postoperative nurses' interven- tion. The study's assessment of postopera- tive nursing interventions revealed both strengths and areas for improvement. While significant progress was noted in various domains, including monitoring vital signs, ensuring clean dressings, and admin- istering analgesics, certain aspects, such Postoperative Nurse Intervention in Pa- tients with Laparoscopic Cholecystectomy at Teaching Hospitals”, which showed most of the nurses had 1-5 years of experi- ence in the surgical unit and half of them did not participate in training courses es- tablished by the teaching hospitals. On the other hand, more than two-thirds of them participated in the training courses for <6 months (Hassan & Saeed, 2023). Regard- ing the practical items of quality of post- operative nurse’s intervention most of the studies items for the five parts reported 30 significant differences except 5 items re- ported non-significance. The result shows that most of the nursing interventions not achieved are related to insufficient struc- tural and continuous education programs by the policy of those hospitals and the Ministry of Health for improve nursing in- tervention, and insufficient nursing re- sources like an advanced nursing electron- ic library. This finding concurs with the study carried out in Baghdad teaching hos- pitals regarding the assessment of the post -operative nursing intervention for pa- tients undergoing LC, showed that most of the studied items reported significant differences, except for items such as “changing the patient's position, raising the head of the patient's bed, install drain- age bag, turn the patient position fre- quently, reads and check patient’s chart immediate after operation carefully to see how the operation takes place to avoid complications in the surgical unit” (Kadhim, 2014). This issue stems from inadequate structural and ongoing educational programs within hospital poli- cies and Ministry of Health initiatives aimed at enhancing nursing interventions, as well as a lack of resources such as ad- vanced nursing electronic libraries. Pro- vides postoperative patients in surgical wards with high-quality nursing interven- tions, nurses should be reinforced by 134 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. CONCLUSION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.12 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov, 2024 Original Article 553-566. DOI. https://doi.org/https:// doi.org/10.1213/ane.0000000000004018 [6] EL-Shatby, A. M., & El-Monem, H. A. A. As- sessment Of Nursing Practices Provided For Patients Post Laparoscopic Cholecystectomy. International Journal of Novel Research in Health Care and Nursing.2020. (1),9(2), 48- 57. DOI. https://www.iosrjournals.org/iosr- jnhs/papers/vol9-issue2/Series-4/ I0902044857.pdf . [7] ELsayed, K. A. Chi-Square Independence Test: to Study the Effect of Chronic Diseases and Recovery from COVID-19. Egyptian Jour- nal of Business Studies. 2022. 46(4), 335- 306. DOI. [8] Farhangmehr, N., & Menzies, D. Laparoscop- ic cholecystectomy: from elective to urgent surgery. Laparoscopic Surgery, 5. (2020). DOI. https://doi.org/http:// dx.doi.org/10.21037/ls-20-4 [9] Gao, Y., Huang, J., Zheng, Y., & Han, J. Effect of comfort nursing on postoperative quality of life, negative emotions and nursing satis- faction in patients undergoing laparoscopic surgery. American journal of translational research, 2021.13(12), 13825-13834. DOI. [10] Hassan, H. D., & Saeed, K. A. Assessment of Postoperative Nurse’s Intervention in Pa- tients with Laparoscopic Cholecystectomy at Teaching Hospitals in Sulaimaniyah, Iraq. Journal of Zankoy Sulaimani. 2023- Part A, 25(1), 11. DOI. https://doi.org/https:// doi.org/10.17656/jzs.10894 [11] Hussein, T. H. S., & Khudair, K. M. Assess- ment Nurse's Knowledge toward Nursing Management for Patients Post Cholecystec- tomy in Kirkuk City Hospitals. Indian Journal of Public Health Research & Development. 2019. 10(10). DOI. https://doi.org/http:// dx.doi.org/10.5958/0976- 5506.2019.03296.0 [12] Ibrahim, B. K., & Muhamad, S. J. Assessment of Nurses Knowledge toward Pre and Post Nursing Interventions Laparoscopic Chole- cystectomy at AL-Imam AL-Hussein Teaching Hospital in AL-Nasiriya City. Kufa Journal for Nursing Sciences. 2021. 11(2), 105-113. DOI. [13] Kadhim, H. Assessment of postoperative nurses' interventions for the patients with laparoscopic cholecystectomy at Baghdad Teaching Hospitals. Iraqi National Journal of Nursing Specialties. 2014. 27(1), 11-22. DOI. [14] Kareem, M. M. A., Shraida, A. A., & Razzaq, M. S. Assessment of Nurses' Knowledge Re- garding Management of Patient's with as recording changes in waste color and assessing breathing depth, showed non- significant results, suggesting areas for en- hancement. Recommendations: To enhance postoper- ative nursing care quality for LC patients in Erbil City's teaching hospitals, several rec- ommendations are proposed. These in- clude ongoing training courses, developing manual guidelines, providing comprehen- sive handbooks, promoting professional development activities, and conducting further research to develop and assess the implementation of an educational pro- gram’s efficacy. [1] AbdElgilil, S. A., Talaat, T., & Mahmoud, B. H. Nurses Performance Regarding Care of Patients Undergoing Laparoscopic Cholecys- tectomy. International Journal of Novel Re- search in Health Care and Nursin. 2020. (1), 1202-1216. DOI. 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