O FOOD BELIEF AND PRACTICES DURING

POSTOPERATIVE PERIOD AMONG POST OPERATIVE

PATIENT

By

Binita Acharya

binitabibisa@gmail.com

Cell no:9779849758084

A Research Report Submitted To The Faculty Of Tribhuvan University

Institute Of Medicine In Partial Fulfillment Of The Requirement For

The Degree Of Post Basic Bachelor Of Nursing (Hospital Major)

Lalitpur Nursing Campus

2013

ENDORSEMENT

The research on “Food Belief And Practices During Postoperative Period Among

Post Operative Patient” is my bonafide work at Lalitpur Nursing Campus and is

submitted for approval as a partial requirement for the degree of post basic bachelor of

nursing from Tribhuvan University, Institute of medicine.

Candidate (Signature) ……………………………

Name: Binita Acharya

The Research committee accepts this research for examination and approval. The

research on Food Belief And Practices During Post Operative Period Among

Postoperative Patient has been examined and is approved/ not approved by the research

committee.

Name: Ms Khagi Maya Pun(Signature) …….……………………

Research Advisor

Date:

Name: Ms Radha Devi Bangdel (Signature) ………………………

Campus Chief

Date:

ACKNOWLEDGEMENT

Research is a continuous process which requires support, guidance and help from

different people to conduct successfully. So I would like to extend my heartily gratitude

thanks to many well- wishers for their valuable supports , suggestions, guidance, time,

and cooperation for conducting this small scale study.

First of all, I would like to express my gratitude and thanks to Tribhuvan University,

Institute of Medicine , Lalitpur Nursing Campus for providing me an opportunity to

conduct this study as a partial fulfillment of Post Basic Bachelor degree in major in

Hospital Nursing.

I wish to express my sincere gratitude to the Campus Chief Mrs. Radha Devi Bangdel

and the Assistant Campus Chief Mrs. Sarala K.C of Lalitpur Nursing Camus for their

valuable suggestions during the whole research study.

I would like to express my deep sense of gratitude and appreciation to my research

advisor Mrs. Khagi Maya pun for her constant guidance, valuable suggestions and

enthusiastic support during my study period. I would like to give my sincere thanks to our

co-coordinator mam Mrs. Priscilla Samson and research teacher Mrs. Ranjana Shrestha

and Mr. Rohn Happ and all B.N faculty members for their valuable suggestions during

the course of the study.

I would like to express my thanks to the LNC librarian Mrs. Rajani Shrestha, Pravash

Pokhrel for their valuable help and cooperation to collect related literature and the

materials for the study.

I wish to express my sincere thanks to the chief of clinical administratior of TUTH Ram

Bikram Adhikari for giving me permission to conduct this research. My special and deep

thanks goes to all of the respondents (post operative patient) without whom the research

could not be conducted.

Binita Acharya

ABSTRACT

A study on Food Belief and Practices during Postoperative period Among Post Operative

Patient attending at surgical ward, gynae ward and surgical referral clinic of TUTH

Maharajgunj was done as the partial fulfillment of the requirement for the B.N. The main

purpose of this study was to assess food belief and practice of post operative patients.

Methodology: A small scale descriptive study was used for the study. This study was

conducted among 50 respondents using a non probability purposive sampling technique.

The time period of this study was 5 weeks. Interview technique which composed of

questionnaire related to demographic information and the questionnaire related to belief

and practice was used for data collection.

Findings: The findings of the study showed that, among 50 respondents (49) 98%

respondents had post operative food belief. This finding indicates that a high percentage

of post operative patients had food belief. Potato, meat, fish, egg, ginger, garlic, onion,

pulses are the foods mostly avoided by the surgical patients. 68% of post operative

patient belief that protein containing diet like meat, fish, egg, pulses develop pus at

surgical site . 80% of the respondent belief citrus fruit should not be taken after

surgery. 68.0% of the respondents belief that lentils and pulses should not be taken , but

94.0 % of the respondents had belief that fiber containing food like green vegetables is

needed after surgery to prevent constipation. 70.0% respondents had restriction on dairy

product and majority of the respondent 66% had practiced food belief as it was followed

from the ancient time.

TABLE OF CONTENTS

CONTENTS

Endorsement i

Acknowledgement ii

Abstract iii

Table of contents iv

List of tables vii

List of figures viii

Abbreviations ix

CHAPTER- I

Introduction

1.1 Background of the study 1

1.2 Rational of the study 4

1.3 Statement of the problem 5

1.4 Objectives of the study 5

1.5 Research Question 5

1.6 Operational definition 6

CHAPTER -II

2.1 Review of related Literature 7

2.2 Summary of literature review 13

CHAPTER -III

RESEARCH METHODOLOGY

3.1 Research Design 14

3.2 Research Area 14

3.3 Population of the study 14

3.4 Sample Size of the study 14

3.5 Sampling technique 14

3.6 Inclusion Criteria 14

3.7 Variables of the study 15

3.8 Data gathering tool 15

3.9 Data gathering procedure 15

3.10 Validity and Reliability of instrument 16

3.11 Pre-test 16

3.11 Ethical Consideration 16

3.12 Data analysis procedure 17

CHAPTER IV

DATA ANALYSIS AND INTERPRETATION

Part I Demographic related information 19

Part II Belief related information 21

Part III Practice related information 39

CHAPTER V

SUMMARY, CONCLUSION AND RECOMMENDATION

5.1 Summary of the findings 42

5.2 Conclusion 45

5.3 Implication of the study 46

5.4 Recommendation for the further study 46

5.5 Strength of the study 46

5.6 limitations of the study 47

5.7 Budget and time schedule 47

5.8 Plan for dissemination 47

REFERENCE 48

APPENDICES

Questionnaire in English version 55

Questionnaire in Nepali version 62

Consent form 71

Time Schedule

Permission letter

LIST OF TABLES

Table Contents Page.No

1 Distribution of the Respondents According to their Demographic Information 19

2 Distribution of the Respondents According to their Demographic Information 20

3

Distribution of Respondents According to Their Belief Regarding Restriction

of food after surgery

21

4

Distribution of Respondents Belief Regarding Food which should not be

taken during Post Operative Period

22

5

Distribution of Respondents Belief Regarding Food which is must

appropriate during Post Operative Period

23

6

Distribution of Respondents Belief Regarding Foods which are Necessary for

Wound Healing

24

7

Distribution of Respondent’s Belief Regarding Types of Fruits which are not

taken after Surgery

25

8

Distribution of respondent’s belief regarding harm caused by these fruits after

Surgery

26

9

Distribution of Respondents According to Their food Belief Regarding lentils

and pulses after surgery

27

10

Distribution of Respondents According to Their Belief Regarding Reason for

taking lentils and pulses

28

11

Distribution of Respondents According to Their Belief Regarding restriction

of fiber containing food ( green vegetables) after surgery

30

12 Distribution of Respondent’s belief regarding fiber containing food ( green 31

Table Contents Page.No

vegetables) after surgery

13 Distribution of respondents according to their belief regarding dairy product 32

14 Distribution of respondent’s belief for taking dairy product after surgery 33

15

Distribution of Respondents Belief for Avoiding Dairy Products After

Surgery

34

16 Distribution of Respondent Belief Regarding Hot Food Concept 35

17

Distribution of Respondents Belief on Food which are Hot (Garmi) After

Surgery

36

18

Distribution of respondents belief regarding reason for avoiding hot food

after surgery

37

19

Distribution of respondents belief regarding food which develop pus at

surgical wound.

38

20

Distribution of Respondent’s Practices regarding Choice of Normal Diet

After Surgery

39

21 Distribution of Respondent’s Food Practice After Surgery 40

22 Distribution of Respondent’s Reason for practicing food Beliefs 41

LIST OF FIGURES

1

Distribution of Respondent’s Belief Regarding not taking Pulses and lentils

after surgery

29

ABBREVIATIONS

TUTH Tribhuvan University Teaching Hospital

SRC Surgical Referral Clinic

SPSS Statistical Package for the Social Sciences

CHAPTER I

INTRODUCTION

1.1 Background of the study

Concepts of foods belief originate from old Greek or Ayurvedic system of medicine.

Consequently Greek concepts and classification of food and diseases are prevalent and

deeply rooted among general population. ( S. Q. Nizami et al. 2008)

The theory of hot and cold food belief during any disease and illness is practiced by

almost all people in society. These food beliefs are not a concept solely seen in the less

educated, lay man but it is seen in homeopaths and qualified doctors too. Faith and belief

on hot and cold effects of food is prevalent in all most all parts of the world mostly deep

rooted in Indian, Malay, Korean, Sinhalese and Mexican cultures and is found in varying

degrees in Latin American, North American, European and African countries as well.

The root of this theory emerges as early as the 5th

century BC in the work of Hippocrates

and in India these belief appears as early as 2nd

century BC. ( N.B. Inam, S Siddiqui, K

Qureshi , 2003)

Specific belief about what food can be consumed and what can’t be consumed remain

in most of the religious people. While restrictions on the eating of certain foods, such as

eggs, dairy products, and meats, were devised for safety reasons not to spoil them easily.

Many Buddhists are vegetarians. Most do not eat meat. Many Hindus are strict

vegetarian. (Victor B Meyer, Rochow 2009)

In Florida and in California, people recovering from major surgery in cancer are given

white bread, canned soups and canned fruits as they belief that these foods are easiest to

digest. But many nutritionists after surgery suggest meals and snacks that include lean

animal meats and proteins such as fish, chicken, eggs (especially the whites), and other

great foods such as brown rice, walnuts, almonds, and sunflower seeds as they belief that

these food helps wounds heal faster. (Dr Nancy, 2012)

After the treatment of cancer in America such as operation, chemotherapy, radiation

therapy, most of the patient think about using more vitamins and minerals supplement

with the belief that they will recover soon and the cancer will not reoccur later but the

physician do not agree on their use, many dietary supplements contains level that are

higher than the amount found in food and some may contains substances that may affect

some chemotherapy drugs. (American Cancer society, 2012)

The food, habits , practices and beliefs are closely related to the particular group of

people or culture. There is an accepted practice of avoiding, or including, some foods

during illness. Most patients will diligently follow these food beliefs .The foods that are

supposed to be “hot” are avoided. Foods like pulses (an annual leguminous crop) are

particularly avoided especially after a surgery because of the belief that they cause the

development of "pus” at surgical sites or wounds. (Dr Palat, 2012)

In an exploratory study based on a literature review and interview with housewives

from rural areas of Kathmandu and Patan and teachers of a women’s college reported on

the food beliefs of the people. The study found that the people hold the beliefs about pure

and impure food; hot, cold, and neutral foods; beneficial or harmful foods; or curative

foods. Such beliefs seem to be carried unapparent without any logic . ( Shakya M.,

2006)

1.2 Rational Of The Study

All surgery is an attack or wound on the body. Recovering from wounds always requires

extra nutrients and diet. The proper diet can help strengthen the body and significantly

reduce the risk of infection due to surgery.(Lawrence Wilson, 2013)

Protocols in modern surgical practices led to most patients eat regular without any

restriction on food within 1 to 3 days. But people have traditional feeding practices such

as taking only clear liquids for 1-3 days after surgery as they have belief that food

immediately after surgery will cause vomiting which frequently contribute to

malnutrition . (Nancy L. Kondracki, MS, RD, LDN, 2012)

Ideally client should have an optimal nutritional status during the surgery and post

operative period to enable them to withstand the stress of surgery and the short term

starvation. Good nutritional status can speed recovery time and have a lower incidence

of infection complication and postoperative mortality and also shorten the time of

hospitalization . (Weiser TG, Regenbogen SE et al 2008)

As many people follow traditional way of feeding during post operative period. Such

belief may cause under nutrition which results in increase post operative infection,

impaired wound healing, increased length of stay, probability of re-admission and

increase the morbidity rate of surgical patient. So researcher is interested to know the

belief and practice of postoperative patient in postoperative food intake.

1.3 Statement of the Problem

Dietary advice by physicians and consumption of food by the patients are often based

upon their hot and cold concepts, cultural and religious belief rather than on scientific

basis. In Africa and Asia, 80 percent of the population still uses traditional remedies,

plant food and herbs as medicines. Metabolic rate is typically increased by about 10%

postoperatively, due to hyper metabolism, hyper catabolism and wound healing but If

adequate nutritional support is not taken at this stage due to this belief it may result

delay in post operative recovery and nutrition depleted patients are at risk from infectious

complications and cardiorespiratory impairment .

Keeping this view in mind research study is prepared on the food belief and practices

during post operative period among post operative patient.

1.4 Objective of the Study

General

To find out food belief and practices during post operative period among post operative

patient.

Specific

To find belief on post operative diet among the post operative patients .

To find out the practice of post operative diet among the post operative patient.

1.5 Research Question

What food belief and practices do the post operative patient have during post operative

period?

1.6 Operational Definition of Terms:-

Food Belief

An opinion , conviction or faith of the patient towards certain food, either it is good or

bad for health during their post operative hospitalization period.

Practice

Accepting diet pattern that is used by the post operative patient and has been followed

from generation to generation.

Post operative period

The period that extends from the time the patient leaves the operating room until the last

follow up visit with the surgeon. This may be as one week .

Post operative patient

Patient following a surgical procedure till the surgeon releases the patient from their care

or the patient is fully recovered or until the last follow up visit with the surgeon.

CHAPTER -II

Review of Literature

2.1 Review of Related Literature

Review of literature is an essential part of all studies. It is a way to discovering what

other research in the area of our problem has uncovered. It is also concerned with review

of previous studies related to our topic which cannot be ignored because they provide the

foundation to our present study. The review of literature will be focused on food belief

and practices during post operative period among post operative period.

45% - 50% of surgical clients are malnourished due to disease related symptoms

experienced during surgery such as anorexia, nausea, vomiting, fever, malabsorption

and due to inadequate food intake. Nutritional depletion has been demonstrated to be a

major determinant of the development of post-operative complications. (Nicola Ward,

2003)

Undernutrition is common in patients admitted for surgery. The complex physiological

responses to surgery puts patients at high nutritional risk. There are clear prospective

associations between inadequate nutritional status and the risk of poorer outcomes for

surgical patients, including infection, complications and length of stay. However,

practically the nutritional interventions can significantly reduce these poor outcomes of

surgery (Lynne Daniels, 2013).

If someone is having surgery, the food he eats can make a great impact on his recovery

and on how quickly wound heals. One of the best things to improve nutritional status

when recovering from surgery, is to focus on whole foods. But food consumed by post-

surgical patients is dependent primarily on their previous home intake. (Wiley Job

Network, 2012)

Traditional remedies for wound care, such as cayenne pepper, coconut oil, or honey are

used by the patient in post surgery as they belief that it will help close wounds faster and

reduce the risk of scars. (Retrieved from http://www.earthclinic.com/Remedies/post-

op.html,Natural Remedies to Improve Post-Operative Healing)

In a 1-year prospective cohort study in 183 patients in “ Dietary beliefs of people on

post surgery and their effect on nutrient intake” 63% held dietary believe, that many

foods are harmful or helpful and that they modify their intake accordingly. (Jowett SL et

al, 2004)

The Times Of India, “Myths and facts about Caesarean -section” Most mothers and

mothers-in-law have dietary restrictions like avoiding milk, ghee, rice in post caesarean

section as this can impair healing of scars. (Bennett, Coleman, 2013)

In the postoperative recovery period after abdominal surgery, The authors conducted a

randomized trial study comparing two group of patient in dietary practice in post

operative period, which shows that consumption of a normal diet was delayed in the

restricted food intake group, as they belief that it is good for health and the hospital stay

would be short. (Han-Geurts IJ, Hop WCJ, Kok NFM, et al. 2008)

In a descriptive survey used for the patient who had an ostomy and were living at home,

about food choices/avoidances that occurred because of their ostomy. Among 604 patient

the majority of respondents (88.4%) stated that they were not following a special diet;

11.8% (n = 69) stated that they had modified their diet. More than half of the participants

had received dietary instructions. The foods avoided because of the ostomy included

fresh fruits, nuts, coconut, and vegetables such as corn, popcorn, cabbage, beans, and

onions. (Floruta, Crina V et al 2004)

In a study of post operative food preferences in 145 patients who were allowed to eat

within 24 hours after colorectal surgery in first post operative , the most commonly

preferred foods and beverages included: fruit juice (75%); broth (73%); fresh fruit (73%);

coffee/tea (64%) (Kawamura et al 2010)

Mushrooms, onions, fresh vegetables, meat were considered as taboo in ostomy patient.

But today these old food taboos need not to be necessarily apply. (United Ostomy

Association Of Chicago, 2004)

In China associated with a variety of traditional beliefs and practices in post operative

postpartum woman, in Fujian Province 36 family members were interviewed. All

families believed in eating "hot" food as meat and eggs and ginger and wine are also

added in the food . These food, was thought to enrich the blood. (H Raven Joanna et al ,

2007)

Dairy products are an excellent source of protein, which is essential to healing after

surgery but many people, belief that consuming dairy products can lead to constipation,

increase secretions in the lungs and cause chronic cough after surgery. Red meat is not

recommended in surgery because it can trigger constipation. (Lynne Daniels, 2003)

Nutrition is paramount in surgery, an enzyme derived from pineapple is helpful after

surgery because it can reduce postsurgical inflammation and may help with digestion.(

Amy Baugh Meyer, 2000)

Egyptian in early days used honey and used to take bath with wine in surgical wound as

they had belief that honey and wine prevents wounds becoming infected and that it is a

natural antiseptic. In the 16th century surgeons used to poure hot oil onto wounds. They

also use a mixture of egg yolk, rose oil as they belief that it will heal the wound soon.(

Tim Lambert, 2012)

In 2006, a review of 22 clinical trials involving more than 2,000 people found that honey

had antibacterial and anti inflammatory properties and could stimulate the growth of new

tissue. (Wong Cathy, 2013)

Appendicitis Surgery and Food Taboos shows that fiber-containing foods such as celery,

cabbage, parsley, garlic, Chinese chives, Chinese toon, bamboo shoots, are not given by

the people after surgery as they belief that undigested crude fiber cause friction on the

wound. (Iscovery Traditional Chinese Medicine, Yellow Page, 2012)

The reasons why people choose special diets range from religious practices, ideological

beliefs to allergies, special diets and food sensitive. Many Jewish people practice some or

all of these restrictions of food in various degrees. (Lacretia Hardy, 2011)

There is food belief that people who are undergoing surgery should stop taking garlic

during surgery , as garlic may prolong bleeding time and suffer from a bleeding disorder,

or gastrointestinal problems (Steven Foster 2006).

Citric fruits such as Grapes, lime and oranges are not taken on the very day of the

surgery. Especially in case of ENT surgeries, as the people have belief that their

sharpness may sting during swallow and delay healing post-surgery . The other hand,

Carbonic acid, which comes from sodas, colas and carbonated beverages, weakens

stitches of wound ( Gehi Reema, 2012 ) .

Grapefruit and plenty of fresh fruit with lemon juice, carrots, beetroot or any other

vegetable are taken by the patient in the surgery as they belief that, in the case of

operations involving a general anesthetic, the liver is the organ that takes the hardest

knock from the drugs so these food will very effectively detoxify the liver. (Orchards

Nutrition Centre 2008-2013)

It is important to include fiber in the diet while recovering from surgery, fiber plays a

major role in preventing constipation, a common complication after surgery.such as

White bread , Fruits , Vegetables , Cereal . ( Heisler Jennifer, , 2011)

Arnica, Bellis perennis, Ferrum phosphoricum( flowers) are plant food taken by the

people after surgery mostly in China as they think that these herbs will help reduce

soreness, bruising, tissue damage, trauma of deep internal tissue and bleeding related to

surgical procedure involving the abdomen, breasts, or trunk. (Truesta 2013)

Associate Professor at the Keio University School of Medicine in Japan, he had proved

that ginger, and Timur will relieve constipation in children and in adults suffering from

post-operative ileus and reduce inflammation, edema and difficulty in having a bowel

movement. (Hidekazu Suzuki, 2007)

While assessing the prognostic value of nutritional assessment techniques in determining

outcome after major abdominal surgery . Higher death rates were found in the

malnourished groups. The risk of complication was increased in malnourished than in the

well nourished group.( Hülya Sungurtekin, MD, Uğur Sungurtekin et al. 2004)

Brahmins never handle any meat, fish, or eggs . Furthermore, many Brahmins abstain

from cooking or eating onion and garlic as they are believed to increase passions like

anger and sex drive. (Victor B Meyer-Rochow ,2009)

Chinese people belief that all fibrous food such as Goose, bamboo shoot, all shellfish

causes pus or swelling in wound. (Lee MM, Shen JM, 2013)

Arnica, Aconitum is a Homeopathic remedies usually used by the patient to reduce pain

after surgery.( Dana Ullman, 2013)

Aconitum, Arnica, Calendula, are the homeopathic remedies most commonly used by

the people of India for fast healing of wounds and to reduce gastric disorders like nausea

and vomiting after the surgery. (Dr Banergi P, 2008 )

In a cross sectional study in a Community Health Center (CHC), The Aga Khan

university Hospital, Karachi,400 adult female respondents were interviewed to find out

belief regarding food items. The percentage of respondents saying that certain foods were

hot, cold and badi were 71%, 55%, and 88% respectively. (Ali NS, Azam SL, Noor R

2008)

2.2 Summary of Review of Literature

Different books ,articles, national and international journal related to food beliefs were

constituted for review literature. Most of the review of literature revealed that majority

of the post operative patient held dietary believe.

In a prospective cohort study in 183 patients, about Beliefs of people on post surgery

and their effect on nutrient intake, 63% had held dietary believe.

Faith and belief on hot and cold effects of food, harmful and helpful food is prevalent in

all most all parts of the world. Most people have belief that food like pulses, meat, dairy

product are harmful in post operative period as they develop pus in the wound and trigger

constipation.

The most commonly preferred foods and beverages during post surgery included: fruit

juice, broth(soup), fresh fruit, coffee/tea .

CHAPTER III

RESEARCH METHODOLOGY AND DESIGN

This chapter deals with the research design and procedure used in this study. It contains

the research design, study area, population and sample, sampling technique, instrument,

ethical consideration and statistical tools used for data analysis.

3.1 Research Designs

A simple descriptive research design was used to find out the patient’s belief and practice

regarding post operative diet.

3.2 Research area

TUTH Maharajgunj is 444 beded hospital . The study was conducted in surgery ward,

gynae ward, SRC in Maharajgunj Teaching Hospital.

3.3 Population of the study

All the post operative patient who had done major surgeries from the 3rd post operative

day to last follow up visit to surgeon.

3.4 Sample size

50 respondent was included for the study .

3.5 Sampling Technique

Non probability purposive sampling technique was used.

3.6 Inclusion Criteria

Patients undergoing major surgeries.

Both male and female .

Aged 15 years and above.

Those who are willing to participate.

literate and illiterate will be included in this study .

3.7 Variables of the Study

Dependent Variable

Food belief and practice during post operative period .

Independent Variables:

Sociocultural factors

Age

Education

Past experience

Family status

Geographical location

3.8. Data gathering Tool

A structured questionnaire was prepared on the basis of research Question .The tool was

prepared in three parts;

Part I – Socio-Demographic information

Part II- Questions related to belief of post operative diet.

Part III – Questions related to practice of post operative diet.

3.9. Data gathering Procedure

Verbal and written permission was taken from each respondent.

Purpose of the study was explained to each respondent.

Data was collected through interview.

3.10 Validity and reliability

Validity

Validity of instrument was established by reviewing literatures, consulting with

concerned teachers, advisor, subject expert, research expert and extensive discussion with

friends in the beginning and throughout the study period.

Reliability

Reliability of the instrument was maintained by pre-testing the instrument in 10% of the

population. Necessary modification was made according to the pilot study.

3.11. Pretesting of the Instrument:

Before conducting the actual data , the instrument was pretested in 10% (5 respondents)

of the total sample in the similar setting . Then the tool was modified and finalized on the

basis of respondent’s response and suggestion of advisor.

3.12. Ethical consideration

Written permission was taken from the concerned authority of the organization by

providing official letter from Lalitpur Nursing Campus.

Privacy and confidentiality of the respondents was maintained.

Verbal consent was taken from each respondent.

Objective of the study was clearly explained to the respondents prior to interview along

with a written permission.

Nobody was forced to participate in the study.

Respondents were free to withdraw participation at any point during the interview

3.13. Data analysis procedure

The collected data was checked and organized.

Data was entered in Microsoft Excel Software and analysis was performed using SPSS

version 17.

The collected data was analyzed and interpreted by using descriptive statistical method in

terms of the frequency and percentage.

After analysis of the data, the findings was presented in different tables.

CHAPTER-IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with the analysis and interpretation of the findings from the obtained

data. The obtained data were tallied and tabulated for different views expressed by the

respondents. All data were analyzed and interpreted on the basis of research objectives

and research questions. Findings have been presented in different tables and bar- graphs

separately as in number and percentage.

Analyzed data were grouped into three parts:

• Part I – Socio-Demographic information

• Part II- Questions related to belief of post operative diet.

• Part III – Questions related to practice of post operative diet.

Part -I

Socio- Demographic Information of the Respondents

Table 1

Distribution of the Respondents According to their Demographic

Information.

n=50

Items Frequency Percent

Age

20-29 Years 20.0 40.0

30-39 Years 12.0 24.0

40-49 Years 6.0 12.0

50-59 Years 4.0 8.0

60-69 Years 5.0 10.0

70 and above 3.0 6.0

Sex

Male 11.0 22.0

Female 39.0 78.0

Ethnic group

Brahman 13.0 26.0

Chhetri 15.0 30.0

Newar 14.0 28.0

Rai/limbu 3.0 6.0

Others 5.0 10.0

Table 1 shows that the majority of respondents 20 (40%) were of age group 20-29 years.

Majority of the respondents 39(78%) were female and 15 (30%) of the respondents were

Chhetri ethnicity.

Table 2

Distribution of the Respondents According to their Demographic

Information.

n=50

Items Frequency Percent

Religion

Hindu 35.0 70.0

Buddhist 13.0 26.0

Christian 2.0 4.0

Education

Illiterate 17.0 34.0

Primary 10.0 20.0

Secondary 10.0 20.0

Graduate 12.0 24.0

Master 1.0 2.0

Post operative day

Third day

Fourth day

Fifth day

Sixth day

Seventh day

Fifteenth day

20.0

17.0

8.0

2.0

2.0

1.0

40.0

34.0

16.0

4.0

4.0

2.0

Table 2 shows that the majority of the respondents 35 (70%) were Hindu, 33(66%)

were literate and 17(34%) respondents were illiterate. Majority of the respondents 20

(40%) were of third post operative day. The findings shows that patient from all religious

group and whether literate and illiterate both have post operative food belief .

Part -II

Belief Related Information on Post Operative Food

Table 3

Distribution of Respondents According to Their Belief Regarding

Restriction of food after surgery

n = 50

Yes No

Items Frequency Percent Frequency Percent

Has restriction

about food

49.0 98.0

1.0 2.0

Table 3 shows that 49(98%) of respondents had food restriction after surgery because of

their food belief whereas 1(2% ) of the respondents did not have. This finding indicates

that a high percentage of post operative patients had food belief and had restriction about

food during post operative period.

Table 4

Distribution of Respondents Belief Regarding Food which should not

be taken during Post Operative Period

n=49

Multiple response

Table 4 shows that majority of the respondents 47(96.0%) said black dal should not be

taken during post operative period , 33 (67.0%) respondents said Meat/fish , 32 (65.0%)

respondents said potato and 21 (43.0%) respondents said tomato respectively . Behind

this they had belief that all these food items may cause delay in wound healing.

Items Frequency Percent

Potato 32.0 65.0

Tomato 21.0 43.0

Black Dal

Meat/Fish

47.0

33.0

96.0

67.0

Table 5

Distribution of Respondents Belief Regarding Food which is Most

Appropriate After surgery

n =50

Items Frequency Percent

Only liquid and soup

36.0

72.0

Only soft diet as jaulo

Normal diet

Balance diet with all

nutrient

31.0

5.0

4.0

62.0

10.0

8.0

Multiple response

Table 5 shows that majority of the respondents 36(72%) said only liquid and soup is

appropriate food after surgery, 31(62%) respondents said only soft diet as jaulo , 5(10%)

respondents said normal diet as rice, dal, curry is appropriate where as 4(8%)

respondents said that all the food containing balance diet as protein, vitamin,

carbohydrate, calcium is appropriate after surgery. As shown in the table most of the

patient preferred to take liquid to soft diet after surgery even though doctor suggested to

take normal diet.

Table 6

Distribution of Respondents Belief Regarding Foods which are

Necessary for Wound Healing

n=50

Items Frequency Percent

Diet having Fiber

Diet having protein like meat,

fish, egg

Diet having protein like pulses

31.0

12.0

16.0

62.0

24.0

32.0

Multiple response

Table 6 shows that the majority of respondents 31(62.0%) said diet having fiber like

fruits, green vegetables are necessary for wound healing, 12 (24.0%) respondents said

diet having protein like meat, fish, egg and 16 (32.0%) respondents said diet having

protein like pulses respectively. The finding of research shows that majority of post

operative patient had lack of knowledge about more protein containing diet are required

for fast wound healing.

Table 7

Distribution of Respondent’s Belief Regarding Types of Fruits which are

not taken after Surgery

n=50

Items Frequency Percent

Mango 17.0 34.0

Citrus fruit ( lime, orange, grapes) 40.0 80.0

Banana 5.0 10.0

All fruits can be taken 1.0 2.0

Multiple response

Table 7 shows that majority of the respondents 40 (80.0%) said Citrus fruit like lime,

orange, grapes should not be taken after surgery, 17 (34.0%) respondents said mango, 5

(10.0%) respondents said banana respectively and 1 (2.0%) respondents said that all

fruits can be eaten after surgery. Reason behind this belief was that all these fruits may

causes pus at surgical site, causes abdominal discomfort and stingness in the wound.

From the research it was found that majority of the respondents did not know, citrus fruit

which contains vitamin c is also needed for fast wound healing.

Table 8

Distribution of respondent’s belief regarding harm caused by these fruits

after Surgery

n=50

Items frequency Percent

It causes abdominal discomfort

13

26.0

It causes hot effects on wound

1

2.0

It causes pus at surgical site

28

56.0

It causes stingness in the wound

8

16.0

Table 8 shows that majority of the respondents 28 (56.0%) said that fruits like mango,

lime, orange, grapes, banana causes pus at surgical site,13 (26.0%) respondents said that

these fruits causes abdominal discomfort, 8 (16.0%) respondents said that these fruits

causes stingness in the wound 1 (2.0%) respondents said that these fruits causes hot

effects on wound.

Table 9

Distribution of Respondents According to Their food Belief Regarding

lentils and pulses after surgery

n = 50

Yes No

Items Frequency Percent Frequency Percent

Has food belief

about lentils and

pulses

34.0 68.0

16.0 32.0

Table 9 shows that majority of the respondents 34.0 (68.0%) belief that lentils and pulses

should not be taken after surgery where as 16.0 (32.0%) belief that lentils and pulses can

be taken .

Table 10

Distribution of Respondents According to Their Belief Regarding Reason

for taking lentils and pulses

n =16

Items Frequency Percent

It gives energy to the body

16

100.0

It promotes fast wound healing 1 6.25

It is easy to digest 0.0 0.0

Note: Multiple response

Table 10 shows that majority of the respondents 16 (100.0%) said that lentils and pulses

gives energy to the body whereas the 1 (6.25%) respondents said that it promotes fast wound

healing during and after surgery . This findings shows that most of the patient did not

know advantages of lentils and pulses in post surgery.

Figure 1

Distribution of Respondent’s Belief Regarding not taking Pulses and

lentils after surgery

n=34

Figure1 shows that majority of the respondents 14 (41.0%) said that lentils and pulses

develops pus at surgical site, 11 (32.0%) respondents said it is difficult to digest and 9

(27.0%) respondents said it forms gas in the abdomen .

41%

32%

27%

Develops pus at surgical site Difficult to digest Forms gas in the abdomen

Table 11

Distribution of Respondents According to Their Belief Regarding

restriction of fiber containing food after surgery

n = 50

Yes No

Items Frequency Percent Frequency Percent

Has restriction of fiber

containing food

3.0 6.0

47.0 94.0

Table 11 shows that majority of the respondents 47 (94.0 %) had no restriction of fiber

containing food like green vegetables after surgery where as 3.0 (6.0%) had restriction on it.

Table 12

Distribution of Respondent’s belief regarding fiber containing food

(green vegetables) after surgery

n=50

Items Frequency Percent

It Prevents constipation

36.0

72.0

Other ( It Increases blood in the body)

11.0

22.0

It causes cold effects on the wound 3.0 6.0

Multiple Response

Table 12 shows that majority of the respondents 36 (72.0 %) said that fiber containing

food like green vegetables should be taken as it prevents constipation after surgery,11

(22.0%) respondents said that it increases blood in the body where as 3(6.0%)

respondents said that it should not be taken as it causes cold effects (Sardi) and patient

may have cough, common cold.

Table 13

Table 13 shows that the 35(70.0%) respondents had restriction on dairy product during

and after surgery where as the 15 (30%) of respondents had no restriction . The research

shows that the maximum percentage of the respondents belief that dairy product which

are the excellent source of protein should not be eaten after surgery.

Distribution of respondents according to their belief regarding

dairy product

n=50

Yes No

Items Frequency Percent Frequency Percent

Has restriction

On dairy product

35.0 70.0

15.0 30.0

Multiple response

Table 14 shows that majority of the respondents 12 (80.0%) had belief that dairy product

gives energy and they will be able to get out of bed soon, 11 (73.3%) respondents

believed it helps to build up strong muscles and 8(53.3%) respondents believed it

helps to build up tissues .This findings shows that although they knew the advantages

of dairy product but they did not know that it helps in wound healing.

Table 14

Distribution of respondent’s belief for taking dairy product after surgery

n =15

Items Frequency Percent

It gives energy

Help to build strong muscles

Helps to build up tissues

12.0

80.0

11.0

73.3

8.0 53.3

Promotes wound healing 0.0 0.0

Table 15

Distribution of Respondents Belief for Avoiding Dairy Products

After Surgery

n=35

Items Frequency Percent

Causes constipation

Increases secretion in

the lungs

Formation of gas in

abdomen

29.0 83.0

6.0 17.0

4.0

11.0

It causes diarrhea 0.0 0.0

Multiple responses

Table 15 shows that majority of the respondents 29 (83.0%) had belief dairy product

after surgery causes constipation and hard stool, 6 (17.0%) respondents believe it should

not be taken as it increases secretion in the lungs and develops cough and while coughing

it may develop gap in the stitches, and 4 (11.0%) respondents believe it causes

formation of gas in abdomen and will have fullness of stomach .

Table 16

Distribution of Respondent Belief Regarding Hot Food Concept

n= 50

Yes No

Items Frequency Percent Frequency Percent

Hot food concept

49.0 98.0

1.0 2.0

Table 16 shows that majority of the respondents 49 (98.0%) had belief on hot food

concept and (only 2.0%) had no belief on it. This findings shows that despite of

education people still have superstition and nurses needs to provide education on them.

Table 17

Distribution of Respondents Belief on Food which are Hot (garmi)

After Surgery

n=49

Items Frequency Percent

Honey

Ginger/Garlic

Onion

Meat

22.0

49.0

49.0

40.0

45.0

100.0

100.0

82.0

Multiple response:

Table 17 shows that majority of the respondents 49 (100.0%) had belief Garlic/ Ginger

are hot food, 49 (100.0%) said onion, 40 (82.0%) said meat and 22 (45.0%) respondents

belief honey is hot food and should not be eaten after surgery .

Table 18

Distribution of respondents belief regarding reason for avoiding hot

food after surgery

n =49

Items Frequency Percent

It causes nausea and vomiting

It causes heart burn

It develop pus in wound

It is difficult to digest

2.0

2.0

46.0

5.0

5.0

5.0

94.0

10.0

Multiple response

Table 18 shows that majority of the respondents 46.0 (94.0%) had belief that hot food

will develop pus in the wound, 5.0 (10.0%) had belief that it is difficult to digest, 2.0

(5.0%) belief that it causes nausea and vomiting and another 2.0 (5.0%) belief that it

causes heart burn.

Multiple Response

Table 19 shows that majority of the respondents 36 (72.0 %) had belief ginger and garlic

will develop pus on surgical wound , 31(62.0%) respondents meat and fish , 34(68.0%)

respondents said pulses, respectively . They believe that it makes our whole body hot

where our wound will also get hot and there will be more chance of developing pus in the

wound.

Table 19

Distribution of respondents belief regarding food which develop pus at

surgical wound.

n =50

Items Frequency Percent

Pulses 34.0 68.0

Meat/fish 31.0 62.0

Milk 1.0 2.0

Ginger/Garlic 36.0 72.0

Part III

Practices Related Information

Table 20

Distribution of Respondent’s Practices regarding Choice of Normal

Diet After Surgery

n=50

Items Frequency Percentage

Jaulo

31.0

62.0

Rice, curry and dal

7.0

14.0

Soup with jaulo

31.0

62.0

Multiple response

Table 20 shows that majority of the respondents 31 (62.0%) respondents had taken jaulo

for 6 days to 7 days, 31 (62.0%) had taken soup like vegetable soup, mushroom soup,

mug dal with jaulo as normal diet, 7 (14.0%) respondents had taken rice, curry and dal

The above table shows that maximum percentage of patient had jaulo and liquid in their

diet as normal diet after operation.

Table 21

Distribution of Respondent’s Food Practice After Surgery

n=50

Yes NO

Items Frequency Percent Frequency Percent

Eats ripe fruits, green

Vegetables

43.0 86.0

7.0 14.0

Eats meat, fish and egg

Eats citrus fruit lemon,

orange, mausam

Eats milk and

milk product

Eats ginger and

garlic

3.0 6.0

4.0 8.0

31.0 62.0

1.0 2.0

47.0 94.0

46.0 92.0

19.0 38.0

49.0 98.0

Multiple Response

Table 21 shows that majority of the respondents 43 (86.0%) had taken ripe fruits, green

vegetables in their diet after surgery, 32 (64.0%) had taken pulses , , 4 (8.0%) had taken

citrus fruits like lemon, orange, mausam , 31 (62.0%) respondents had taken milk and

milk product . During the research it was found that greater number of patients were

eating ripe fruits, green vegetables and less number of patients were eating ginger, garlic,

meat, fish, egg, citrus fruit.

Table 22

Distribution of Respondent’s Reason for Practicing these Beliefs

n=50

Items Frequency Percent

Beliefs from the ancient Period

Past experience of family

Members

Fear of delay in wound healing

33.0

10.0

13.0

66.00

20.0

26.0

Multiple response:

Table 22 shows that majority of the respondents 33 (66.0 %) said they were practicing

these food belief due to believe from the ancient period. From their childhood they had

seen their parents, grandparents following the same belief and they are also continuing

the same belief now. 10 (20.0%) had food belief due to past experience of family

members, previously some member of the family had done surgery and they had

experienced delay in wound healing, infection in the wound due to some food so they

avoid such food now also. And 13(26.0%) had food belief due to fear that wound will

not heal properly or wound will get infected, they did not want to take risk of infection in

the wound by some foods. From the research it was found that still the people are not

changing their old concepts, despite of good education.

CHAPTER- V

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

This chapter deals with the findings, discussions, conclusions, implications and

recommendation of the study and the comparison of findings to literature review. Besides

these, strength and limitation of the study, difficulties face during the study, plan for

dessimination have also been included in this chapter.

A descriptive research design was used to assess the belief and practice during post

operative period among post operative patient . The data were collected from 50

Respondents. The collected data were thoroughly analyzed and interpreted in terms of the

findings and stated objectives.

5.1 Summary Of The Findings

This study was conducted to assess food belief and practice of post operative patient at

surgical, gynae ward and surgical referral clinic at Tribhuvan University Teaching

hospital Maharajgunj. The data was collected within 2 weeks from 50 respondents.

Demographic Related Findings:

Majority of the respondents, 20 (40%) were of age group 20-29 years.

Majority of the respondents 39(78%) were female.

Majority of the respondents, 33(66%) were literate and 17(34%) were illiterate..

Majority of the respondents 35 (70%) were from Hindu religion.

Majority 15 (30%) of the respondents were Chhetri ethnicity.

Majority of the respondents 20 (40%) were of third post operative day.

Belief Related Findings:

Regarding belief , among 50 respondents, (49)98% had post operative food belief .

Majority of the respondents 47(96.00%) said black dal should not be taken during post

operative period

Majority of the respondents 36( 72%) belief that liquid and soup is only the appropriate

food after surgery.

Regarding their belief about types of nutrients necessary for wound healing majority of

the respondent 62% said fiber containing diet as green vegetables and minority of the

respondents said diet having protein like meat, fish and egg are necessary.

Regarding the citrus fruit majority 80% of respondents had belief that it should not be

taken as it causes stingness in the wound and develop pus in the wound .

Majority of the respondents 34.0 (68.0%) belief that lentils and pulses should not be

taken after surgery as it causes pus at surgical site.

Regarding fiber containing food like green vegetables after surgery 47 (94.0 %)

respondents had no restriction on it.

Majority of the respondents 35 (70.0%) had restriction on dairy product after surgery.

Majority of the respondents 12 (80.0%) had belief dairy product after surgery increases

secretion in the lungs and develops cough.

Majority of the respondents 49 (98.0%) had belief on hot food like ginger, garlic, onion,

Meat, honey that it should not be taken after surgery.

Majority of the respondents 46 (92.0%) had belief that hot food will develop pus in the

wound.

Majority of the respondents 36 (97.3 %) had belief ginger and garlic will develop pus on

surgical wound .

Practice Related Findings

Majority of the respondents 31 (62.0%) had taken only jaulo as normal diet after 6 to 7

days of surgery .

Majority of the respondents 43 (86.0%) had taken ripe fruits, green vegetables in their

diet after surgery.

Majority of the respondents 33 (67.34 %) said they were practicing these food belief

due to believe from the ancient period.

Discussion

The major findings of this study was discussed in this chapter with comparision with

other findings of the relavent studies, survey reports and other documented literatures

Post operative food belief on post operative patient was 98% . This findings of the study

revealed with Jowett SL et al, 2004 which showed that people with colon surgery and

their effect on nutrient intake” 63% held dietary believe, that many foods are harmful

and that they modify their intake accordingly.

Hot food concepts among post operative patients was 98% . This finding is supported by

the literature of Ali NS, Azam SL, Noor R (2008) where out of 400 respondents 71%

had hot food concepts.

The findings of the study revealed that out of 49 respondents, 49 (100%) had believed

that ginger and garlic are hot food . This findings is supported by the literature of H

Raven Joanna et al , (2007) where out of 36 family members all families believed ginger

are hot food.

Regarding the most appropriate food after surgery 72% of respondents belief that only

liquid diet as fruit juice, soup are only the appropriate food after surgery. This findings

of the study is supported by the literature of Kawamura et al 2010 where out of 145 post

operative patients , the most commonly preferred foods and beverages included, fruit

juice 75%.

Findings of the study shows that majority of the respondents 47 (94.0 %) had no

restriction of fiber containing food like green vegetables after surgery but Iscovery,

(2012) shows that fiber-containing foods such as celery, cabbage, parsley, garlic, Chinese

chives, Chinese toon, bamboo shoots, are not given by the people after surgery as they

belief that undigested crude fiber cause friction on the wound.

Findings of the study shows that majority of respondents 34 (68%) avoid pulses in their

diet after surgery. This findings of the study is supported by the literature of Dr Palat,

2012 which showed that Foods like pulses are particularly avoided especially after a

surgery because of the belief that they cause the development of "pus” at surgical sites or

wounds.

5.2 Conclusion

Concept of food belief is seen in all most all people in both developed and developing

countries, Seen not only in illiterate and layman but also in educated and health workers

too. In this research more than half of the respondent had post operative food belief as

they belief that some food are hot and some are cold, Some food develop pus at surgical

site, some food delays wound healing and some food are difficult to digest.

Food Practices of the respondent were based on their belief . Even though Doctor

suggests to take normal diet within 2 to 3 days after operation the respondents had taken

jaulo, vegetable soup, Canned fruit juices in their diet up to 6 to 7 days of post surgery.

5.3 Implication of the study

Despite the limitation of the small scale study, the study highlighted a number of

implications for the nurses.

The findings of the study helps to plan health teaching for surgical patients regarding

post operative diet.

This study will provide literature to other researcher on related studies in future even

though it is a small scale study.

5.4 Recommendation

This type of study can be conducted in family members of patient whose relatives are

going for surgery.

A comparative study can be done between literate and illiterate respondents using equal

sample size.

Same study can be conducted on large scale which will help in generalizing and

concluding the findings.

5.5 Strengths of the Study

The researcher has gained more knowledge about post operative diet and it’s importance

in fast recovery of wound.

The investigator gained confidence from this study to conduct a large scale research in

future.

The researcher has gained more knowledge on computer work.

5.6 limitation of the study

The study was conducted only on 50 respondent so this study can’t be generalized.

5.7 Budget and time schedule

Budget: self finance

Time: 5weeks

5.8 Plans for Dissemination

After completing this research, the researcher had planned to disseminate the final

research report to the following;

Research advisor

Library of Lalitpur Nursing Campus.

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Tribhuvan University

Institute of Medicine

Lalitpur Nursing Campus

Sanepa

Research Topic: Food belief and practices during post operative period among post

operative patient.

Objective of the Study: To asses food belief and practices during post operative period

among post operative patient.

Date of interview:

Sample no:

Part - I

SOCIO-DEMOGRAPHIC INFORMATION:

1) Age ……………………………..

2) Sex : Male Female

3) Education of respondent:

a) Literate b) Iliterate

4) Level of education if literate

a) Primary b) Secondary c) Graduate d) Postgraduate

5) Religion:

a) Hindu b) Buddhist c)Muslim d) Christian

6) Ethnic group:

a) Brahmin/Chhetri b) Newar c) Tamang/Gurung/Rai/Magar d) other

7) Post operative day:

PART- II

“Questionnaire related to food belief during and after post operative period among post

operative patient”

1. Do you have any restriction about food after surgery?

Yes No

2. If yes which foods do you think that should not be taken after surgery ?

a) Potato b) Tomato

b) Black Dal d) Meat/ fish

e) If other specify

3. Which food do you think that is most appropriate after surgery?

a) Only liquid diet as fruit juice, soup

b) Only soft diet as jaulo

c) Normal diet

d) Balance diet with all nutrient

4. Which foods are necessary for fast wound healing after surgery?

a) Diet having fats.

b) Diet having fiber like fruits, green vegetables.

c) Diet having protein like meat, fish.

d) Diet having protein like pulses .

5. Which fruits do you think is not taken after surgery ?

a) Mango

b) Citrus fruit like lime, orange, grapes

c) Banana

d) All fruits can be taken

6. Why do you think these fruits are not taken after surgery ?

a) It causes abdominal discomfort

b) It causes hot effects on wound

c) It causes pus at surgical site

d) It causes stingness in the wound

7. Do you think pulses and lentils should be taken after surgery?

Yes No

8. If yes why should it be taken?

a) It is easy to digest

b) It gives energy to the body

c) It promotes fast wound healing

9. If no why should it not be taken?

a) It develops pus at surgical site

b) It is difficult to digest

c) It forms gas in the abdomen

10. Do you have any restriction about fiber containing food like green vegetables

after surgery?

Yes No

11. If yes why do you take it after surgery?

a)To prevent constipation

b) To prevent pain at surgical site

c) To prevent itching at surgical site

d) To prevent infection of wound

12. If no why don’t you take it after surgery?

a) It causes diarrhea

b) It causes cold effects

c) It slows wound healing

d) It is difficult to digest

13. Should dairy product be eaten after surgery ?

Yes No

14. If yes why do you take it after surgery?

a) Promotes wound healing

b) It gives energy

c) Help to build strong muscles

d) Helps to build up tissues

15. If no why don’t you take it after surgery ?

a) It causes constipation

b) It causes diarrhoea

c) It increases secreation in the lungs

d) It causes formation of gas in abdomen

16. Do you belief in hot food concepts?

Yes No

17. If yes which of the following are hot food?

a) honey

b) garlic/ginger

c) Onion

d) Meat

e) If any other specify…………………………….

18. If yes why do you think it should be avoided after surgery?

a) It causes nausea and vomiting

b) It causes heart burn

c) It develop pus in wound

d) It is difficult to digest

e) If other specify

19. Which food will cause pus at surgical site?

a) Pulses

b) meat/ fish

c) Milk

d) Ginger/ garlic

e) If other specify

PART- III

“Questionnaire related to food practice during and after post operative period among post

operative patient”

1) Which food did you choose as normal diet after surgery?

2) Did you take fruits and green leafy vegetables in your diet after surgery?

Yes No

3) Did you take pulses in your diet after surgery?

Yes No

4) Did you take meat/fish and egg in your diet after surgery?

Yes No

5) Did you take citrus fruit like lemon, orange, mausam in your diet after surgery?

Yes No

6) Did you take milk and milk product in your diet after surgery?

Yes No

7) Did you take curry with ginger and garlic in your diet after surgery?

Yes No

8) What is the reason that you didn’t take food which is given in above question ?

a) Due to beliefs from the ancient period

b) Due to past experience of family members

c) Due to fear that wound will not heal properly

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