RAJIV GANDHI UNIVERSITY OF HEALTH
SCIENCES KARNATAKA, BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF CANDIDATE AND ADDRESS / TERRIN ELIZABETH K VST.JOHN’S COLLEGE OF NURSING
BANGALORE
2. / NAME OF THE INSTITUTION / ST.JOHN’S COLLEGE OF NURSING
3. / COURSE OF STUDY
SUBJECT / M.SC NURSING
MEDICAL-SURGICAL NURSING
4. / DATE OF ADMISSION TO COURSE / 03-05-2010
5. TITLE OF THE TOPIC
EFFECTIVENESS OF VIDEO ASSISSTED TEACHING REGARDING RESPIRATORY EXERCISES ON THE RESPIRATORY OUTCOMES OF POST OPERATIVE PATIENTS.
6. Brief resume of intended work
6.1 Need for the study
In today’s health care arena, the unique holistic perspective of nursing practice mandates that nurses possess the knowledge and skills necessary to educate various audiences in a variety of setting with efficiency and effectiveness1
The responsibility for providing health information is being recognized as fundamental to health care delivery system. Patients always had the need to know and to understand health alterations and preventive health care measures as well as the health care delivery itself. So it indicates that patient teaching is one of the important responsibilities of the nurse2
Preoperative teaching is one of the important areas in patient care. Preoperative teaching and preparation are an essential part of any surgery in order to ensure a positive surgical experience for the client. Numerous research studies have supported the value of preoperative instructions in reducing both the incidence of postoperative complications and the length of stay in the hospital.3
Rapid changes in health care delivery due to economic growth have required nurses to deliver efficient nursing care and thereby develop innovative instructional material for educating patients and families. Educational materials such as video tapes, specifically designed to provide information and promote active participation in treatment decisions can be effective tools for empowering patients.4
The usefulness of videotapes emerges from its flexibility as a tool for instruction. The combination of color, motion, different angles and sound enhances learning through visual as well as auditory senses1.
To help prevent post operative surgical complications, careful preoperative instructions and practice in deep breathing and coughing exercises should be taught and reinforced. Deep breathing exercises, coughing exercises and use of a spirometer promotes alveolar inflation and strengthens respiratory muscles that were weakened during administration of anasthesia3
.
Patients undergoing general anesthesia for surgery are prone to postoperative pulmonary complications. Studies have shown that patients develop pulmonary complications such as atelectasis, respiratory failure, pneumonia and pneumothorax developed as early as 7 days after surgery.5
Thus the above mentioned facts indicate the need for an effective preoperative teaching on postoperative exercises to prevent postoperative pulmonary complications. Though nurses are providing pre operative teaching, it can be made more effective by using the audiovisual effect. Therefore the presence of a videotape to provide pre operative teaching of respiratory exercises will be a tool which can be made available at all time for patient teaching, such a tool does not exist. Hence the investigator felt the need to study the effectiveness of a video assisted teaching on the respiratory outcomes of post operative patients.
6.2 Review of literature
The review of literature can be organized under the following headings.
v Studies related to importance of pre operative teaching.
v Studies related to post operative exercises
v Studies related to video assisted pre operative teaching.
Studies related to importance of preoperative teaching.
A study on the effects of structured preoperative teaching on occurrence of post operative complications in patients undergoing abdominal hysterectomy was conducted at RAK CON in 1991.Patients were randomly assigned to control and experimental group, 8 in each group. The study concluded, as is evident from the findings, that recovery among patients exposed to structured teaching programme were found to be superior.6
A study was conducted in gynecological ward of SJMCH with a sample size of 30 women undergoing abdominal hysterectomy to find the effectiveness of a preoperative structured teaching programme on knowledge of postoperative care. There was a significant difference between the mean posttest knowledge (20.7+_1.90) and pre test knowledge (11.7+-3.06) of the patients.2
A comparative study was conducted to examine whether patients who received an empowerment model of education for preoperative orthopaedic teaching had improved outcomes compared to patients who received the traditional education. The result showed that use of an empowerment teaching approach enabled patients to become more confident in their ability to carry out perioperative tasks and become a more integral part of the preoperative teaching process.7
Studies related to postoperative exercises
A Meta analysis study was conducted to find out whether incentive spirometry, intermittent positive pressure breathing and deep breathing exercises were effective in the prevention of postoperative pulmonary complications after upper abdominal surgeries. The study concluded that incentive spirometry and deep breathing exercises appear to be more effective than no physical therapy intervention in the prevention of postoperative pulmonary complications.8
In New Delhi a study was conducted on the effect of deep breathing exercises and incentive spirometry in the prevention of postoperative pulmonary complications in patients of cancer esophagus undergoing esophagectomy.Three groups of patients were made keeping 10 patients in each group. Group 1 patients were given deep breathing exercises manually; group 2 patients were asked to do incentive spirometry only and group 3 was control group. It was found that deep breathing exercises and incentive spirometry are more effective than no chest physiotherapy.9
Another study was conducted on effect of a short term intensive pre operative exercise program for elderly patients scheduled for elective abdominal oncological surgery. 42 elderly patients above 60 years were the subjects. The study concluded that the intensive therapeutic exercise program was feasible and improved the respiratory functioning of patients due to undergo elective abdominal surgery compared with home based exercise advice.10
Studies related to video assisted pre operative teaching
A study on the effects of developing and implementing a preoperative instructional digital video disc on patients’ level of knowledge, preparedness and perceived ability to participate in postoperative care activities was conducted at Los Angeles, USA. The instructional media product was found to be effective in increasing pre-operative knowledge and preparedness of patients and their families.11
Preoperative computer assisted video imaging was performed on 50 consecutive rhinoplasty candidates, along with routine preoperative photographs and assessment. Responses indicated that most patients felt, that video imaging increased patient confidence in surgery and enhanced the patient physician relationship.12
A quasi experimental study was conducted to develop a multimedia compact disc of patient controlled analgesia and test its effects on pain knowledge and pain relief in patients receiving surgery. The study concluded that the clinical application of the multimedia compact disc of a patient controlled analgesia could help patients improve knowledge on pain, learn how to use patient controlled analgesia devices, achieve proper pain relief and increase effectiveness of recovery activities.13
A study published in Acta Anaesthesiol,Taiwan was designed to evaluate the difference of satisfaction between patients who joined in small group video teaching at anesthesiologist-directed anesthetic preoperative evaluation clinic(APEC) and patients who paid a traditional pre operative visit in the waiting area using questionnaire for evaluation. The results indicated that APEC with group video teaching could not only make patients more satisfied with process of anesthesia in elective surgery but also reduced the expenditure of hospitalization.14
In the department of neurosurgery, state hospital Switzerland, a study was conducted on pre operative web based audiovisual patient information system. Patients scheduled for an elective lumbar disc operation were asked to use a web based audiovisual patient information system. A combination of pictures, test, tone and video about the planned surgical intervention was installed on a tablet personal computer presented the day before surgery. 84% of all participants found that the audiovisual patient information system led to a better understanding of the forthcoming operation and experienced contentment.15
A systematic review on knowledge retention from pre operative patient information was conducted under the guidance of a panel of experts in Australia. Author quotes that the use of videos as a preoperative instruction tool has not been adequately evaluated. The findings of this review support the use of pamphlets to inform patients and to improve their skill. However existing studies suggests that videos may have a role as a component of a larger teaching method.1
6.3 Problem Statement
A study to assess the effectiveness of video assisted teaching regarding respiratory exercises on selected respiratory outcomes of patients undergoing abdominal surgeries in selected hospital, Bangalore.
6.4 Objectives of the study
v To compare the effectiveness of video assisted teaching regarding respiratory exercises on selected respiratory outcomes among control and experimental group.
v To determine the association in respiratory outcomes with selected baseline variables.
6.5 Operational Definition
v Respiratory outcome: In this study it refers to chest expansion in centimeters, single breath count, oxygen saturation as measured in pulse oxymetry, performance of incentive spirometry and breath sounds on auscultation.
v Patient: It refers to a person who is ill or is undergoing treatment for disease (Bailliere’s nursing dictionary)
In this study it refers to an individual aged 18-50 years admitted to surgical unit for elective abdominal surgery.
v Abdominal surgeries: The term abdominal surgery broadly covers surgical procedures that involve opening abdomen. [wikepedia.]
In this study it refers to elective surgeries of upper and lower abdomen including laparoscopic surgery under general anesthesia.
v Respiratory exercise: Is a physical therapy intervention on the post operative period encompassing a broad range of activities designed to restore or improve cardiopulmonary function. [wikepedia]
In this study it refers to deep breathing exercise, coughing exercise and incentive spirometry, which will be performed by the patients on the 1st and 2nd postoperative days.
v Effectiveness: A change that something causes in something else; a result. [Oxford English Dictionary]
It refers to the difference in respiratory outcome among control and experimental group which will be assessed using an observational checklist on 1st and 2nd post-operative day.
v Video assisted teaching: It refers to a pre recorded video demonstration of respiratory exercises with a running commentary of its description, which will be projected to the patient using a laptop one day prior to surgery as a teaching method.
v Selected baseline variable: In this study it refers to the age of patient, sex of the patient, educational status of the patient and patient’s previous experience with surgery under general anesthesia and type of surgery.
6.6 Assumption
A video teaching device may be a good source of information for patients.
6.7 Delimitation
This study is going to be conducted only on patients undergoing elective abdominal surgeries in the surgical unit of SJMCH.
6.8 Projected outcome
The findings of the study will reveal information regarding the effectiveness of video assisted teaching on preoperative patient preparation. This information will help to implement the intervention in the clinical setting.
Hypothesis
There will be a significant difference in respiratory outcome between experimental group and control group at 0.05 level of significance.
MATERIAL AND METHOD
7.1 SOURCE OF DATA
7.1.1 Research design
Quasi experimental study. Post test only design.
7.1.2 Setting
The study will be conducted in the surgical unit SJMCH Bangalore. The surgical unit includes 2 male surgical wards, 1 female surgical ward and 1 surgical ITU.
· Total bed strength of male surgical ward A-31
· Total bed strength of male surgical ward B- 33
· Total bed strength of female surgical ward- 39
· Total bed strength of surgical ITU-9
Average number of abdominal surgeries per month:
Laprotomy-19 Appendicectomy-3
Splenectomy-4 Cholesystectomy-5
Hemicolectomy-1 Whipples procedure-1
7.1.3 Population
The target population for the study will include patients admitted in surgical unit of SJMCH for elective abdominal surgeries.
7.2 METHOD OF DATA COLLECTION
7.2.1 Sampling procedure
Purposive sampling of patients admitted in surgical unit.
7.2.2 Sampling size
The sample size consists of 88 patients undergoing abdominal surgeries under general anesthesia in the surgical unit of SJMCH. [S-I S-II, S-III, S-IV]
7.2.3 Inclusion criteria for sampling
v Patients admitted in surgical unit of SJMCH for elective abdominal surgeries under general anesthesia.
v Patients under age group of 18-50 years
v Patients who are willing to participate in the study.
7.2.4 Exclusion criteria for sampling
v Patients who are critically ill and unconscious.
v Patients with severe respiratory disorder.
7.2.5 Instrument used
Section 1- Proforma to elicit baseline data.
Section 2- Observational checklist to assess the practice of postoperative exercises among patients
7.2.6 Data collection method
After obtaining formal administrative permission the data will be collected.
By using purposive sampling technique, pre operative patients for abdominal surgery will be selected and randomly assigned to control and experimental group. The control group will receive the usual pre operative teaching. The experimental group will receive a video assisted teaching regarding respiratory exercises in addition to the usual pre operative teaching, one day before surgery. The video assisted teaching will be administered by the investigator on a one to one basis in a separate room. Post operatively the respiratory outcome among the control and experimental group will be assessed with the help of an observational checklist. This assessment of respiratory outcomes will be done on 1st and 2nd post operative days.
7.2.7 Data analysis plan
Data obtained will be analyzed based on objectives of the study using descriptive and inferential statistics method.
7.3 Does the study require any investigation or intervention or intervention to be conducted on patients or other humans or animals? If so please describe briefly.
The study includes administration of video assisted teaching on post operative exercises.
7.4 Has ethical clearance been obtained from your institution?
Yes. Administrative permission and ethical clearance has been obtained from scientific and ethical review committee, St. Johns College of Nursing Bangalore.
List of References
1. Bastable SB. Nurse as educator. 2 rd ed. Boston: Jones and Bert let publishers; 2003. p. xii-xiv.