RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.
ANNEXURE-II
SYNOPSIS PROFORMA FOR REGISTRATION OF SUJECTS FOR DISSERTATION.
1 / NAME OF THE CANDIDATE AND ADDRESS / Mr. CHIDANAND K. PATILIst YEAR M.Sc. NURSING STUDENT,
RAJEEV COLLEGE OF NURSING
K.R. PURAM, GOVT. HOSPITAL ROAD HASSAN, KARNATAKA.
2 / NAME OF THE INSTITUTION / RAJEEV COLLEGE OF NURSING, K. R. PURAM HASSAN, KARNATAKA.
3 / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
(MEDICAL SURGICAL NURSING)
4 / DATE OF ADMISSION TO THE COURSE / 31ST MAY 2008.
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE EFFECTIVENESS OF COMPREHENSIVE NURSING INTRERVENTION PACKAGE THROUGH PLANNED TEACHING PROGRAMME FOR PATIENTS WITH FRACTURE OF LOWER LIMB ADDMITTED IN ORTHOPAEDIC WARDS IN SELECTED HOSPITALS AT HASSAN, KARNATAKA.”
6. BRIEF RESUME OF THE INTENDED STUDY:
6.1) INTRODUCTION
“THE ONLY THING MORE EXPENSIVE THAN EDUCATION IS IGNORANCE”
Bone is the hardest tissue in the body and when it is fully developed it is composed of water, organic, and inorganic materials. Inorganic mainly constitutes mineral salts, i.e. calcium and phosphorus. 1
The bones provide framework to the body, gives attachment to muscle and tendons, provide movement, forms the boundaries and protect the cranial thoracic and pelvic cavities, produce blood cells and reserve calcium, phosphorus and fat. 1
Bones are classified into two types that are compact and cancellous. Compact bone is the hard structure while cancellous bone looks spongy. The compact bone consists of a central haversian canal, containing blood and lymph vessel and nerve, surrounded by concentric plates of bone (lamellae). Between these there are lacunae of spaces, containing lymph and osteocytes. Canaliculli link the lacunae with the lymph vessels in the Haversian canal and the osteocytes obtain nourishment from the lymph. Bones are almost completely covered by vascular fibrous membranes which are called periosteum. The periosteum mainly maintains the shape of bone and gives attachment to muscles and tendons and protects the bone from injury. 1
The bones are also classified as long, short, irregular, flat and sesamoid. The long bones have a diaphysis or shaft and two epiphyses or extremities. The shaft is composed of compact bone with a central medullary canal, containing fatty yellow bone marrow. The epiphyses consist of an outer covering of compact bone with cancellous bone inside. 1
If any disruption occurs in the normal continuity of bone it is called as fracture. The fracture is mainly classified as; simple, compound, & pathological. When fracture occurs, surrounding soft tissues, blood vessels, several nerves and ligaments rupture may complicate client’s recovery. 1
The fracture mainly results from mechanical overload on the bone, osteoporosis, direct force and powerful muscle contraction. This leads to clinical manifestation like deformity/ swelling bruising, muscle spasm, pain, tenderness, loss of function, neurovascular changes and even these may lead to shock. 2
The fractures are treated by reduction or by applying traction. The radial or ulnar fracture may heal in 3 months. But fracture in tibia or femur may require 6 months or more to heal. 2
The short term complications after fracture includes nerve injury, compartment syndrome, Volkmann’s contractures, fat embolism syndrome, deep vain thrombosis and pulmonary embolism, infection, cast syndrome. But the long term complication which occurs is joint stiffness or post traumatic arthritis, a vascular necrosis, non functional union after a fracture or complex regional pain syndrome. 3
The most of patients with fractures stay for long period in hospital. In which most of them land into several complications such as Infection and deformities. This increases the length of stay. As most of patients are youngsters and old agers they suffer lot of economic and mental distress. This also increases burden on countries GDP. 2
By seeing above factors the investigator strongly felt that simple planned teaching to clients admitted in wards may reduce stay in hospital, complication and also increases cooperation from patients during nursing care and hence decreases economic burden on patient and country. By this study investigator will give planned teaching programme to prevent complications, health teaching, and guidance and counseling with proper diet, exercise, and precautions.
6.2) NEED FOR THE STUDY:
As per the previous experience of investigator most of the patients who are staying for longer time in wards are orthopedics and that most of them are with fracture of lower limb. These patients have longer period of hospitalization due to process of the healing and the complications they develop during there stay in hospital. The nursing care is required to tackle the problems related to proper nutrition, control of infection, prevention of deformities and reducing mental distress associated with various factors during there hospitalization.
Studies have shown that most of the people who got fracture are either youngster or the old agers. Both these age group are of greater importance to society. Youngsters are the independent age groups who are the back bone of society. Old agers are living with life insurance policies and with minimum income. They form the dependent population.
Youngsters are mainly affected by job loss, becoming burden to family and society to which they have to support. Old agers who lived their lives with full dignity of supporting family and society they feel they have become burden to them. The old age is also accompanied with other stressors like loss of spouse, loss of job, and other chronic diseases like Diabetes Mellitus, hypertension etc.
Bone has a capability to repair itself when it is fractured. But due to unawareness among patients about infection control, proper diet, mobilization, exercise and proper weight bearing, most of the patients land into several complications. This will cause economic loss among them by extending hospital stay. And in some of the cases there requires longer time to heal which will cause increased psychological stress among patients.
A study was conducted in between May 2001 and May 2005, where all 8834 adults admitted to hospital with fractures to the lower limbs and pelvis were prospectively entered onto a database. Neck of femur fractures accounted for 32% of admissions. Younger patients were more likely to be male and older patients more likely to be female. Overall 30-day and 1-year mortalities were 4.5 and 13%, respectively. Increased mortality was associated with age, male gender and fractures of the femur or pelvis.4
Fractures have a tremendous impact on a quality of life. According to the study, 80% of women older than 75years preferred death to a bad femur fracture that resulted in nursing home placement. Not surprisingly, fracture can have a negative impact on self esteem, body image and mood, which may lead to psychological consequences. Fear, anxiety and depression are frequently reported in women with established fracture. Other quality of life issues include increased difficulty in activities of daily life, including losing the ability to walk, stand up, or dress.
People who have had a fracture may become immobilized by a fear of falling and suffering. Fifth percentage of those people experiencing a femur fracture will be unable to walk without assistance, only one third of the patients regain their full pre-fracture abilities and another one-third require nursing home placement. Many people are forced to move sometimes temporarily, but often permanent from independent living to assisted care or a nursing home as a result of the fracture. Because an individual’s functional status can be significantly compromised, resulting in loss of independence, financial instability and negative emotional consequences, family care givers bear a great deal of burden assisting individuals in need.5
India has highest incidence of road traffic accidents (RTA) the highest number of victims of RTA (29.4%) was between the age group of 20-29years. The people of the third decade are more commonly involved in traffic injuries. 64.9%of the victim were between15-44yrs age group. Similar observation was reported by WHO in the injury chartbook. This shows that the people of the most active and productive age groups are involved in road traffic injuries, which adds a serious economical loss to the community. The males to female ratio were 4.6%. It was observed that 80% of victims were males. The gender difference probably related to both exposure and risk taking behaviors’. Among the fractures, lower limbs (46.3%) were the commonest site for fracture, followed by fracture of upper limbs (24.7%) and skull (13.2%) 6
Road traffic injuries result in death of more than 100,000 people and hospitalization of 1.5 million people in India resulting in an estimated economic loss of 3% of GDP for the country. 3
Individuals who have fracture are at risk for medical complications such as pressure sores, pneumonia and urinary tract infections.
Fracture can be preventable with the proper intervention, low bone mass is detectable and correctable for most people. In just a few simple steps, we can reduce fracture rates. The alert health care professional can detect declining bone mass early through easy assessments and can implement simple preventive measures.
Health care professionals can be encouraged to do more to proactively assess, diagnose and treat those patients with fracture while at the same time be reminded to help themselves maintain good bone health in their everyday lives. They need to understand that with appropriate nutrition, including adequate calcium and vita D and physical activity throughout their lives.
There are also many studies and literature in support of this study, which show’s a good comprehensively developed nursing care package will bring awareness and induce knowledge among patients. This will help them to cooperate with health team in their hospitalization and procedures for quick recovery and cost effective care. The investigator strongly felt to develop and implementing comprehensive nursing packages for those people who are with long stay and suffering with psychological stress.
6.3) STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF COMPREHENSIVE NURSING INTRERVENTION PACKAGE THROUGH PLANNED TEACHING PROGRAMME FOR PATIENTS WITH FRACTURE OF LOWER LIMB ADDMITTED IN ORTHOPAEDIC WARDS IN SELECTED HOSPITALS AT HASSAN, KARNATAKA.”
6.4) OBJECTIVES OF THE STUDY IS:
1 To identify the existing knowledge of clients regarding self care of lower limb fracture who are admitted in selected Hospitals Hassan, during pre- test.
2 To develop and implement the comprehensive nursing intervention package for lower limb fracture patients.
3 To determine the knowledge of clients with lower limb fracture regarding self care of fracture after the post-test.
4 To associate the knowledge gain of clients with lower limb fracture regarding self care of fracture with their selected socio-demographic variable.
6.5) HYPOTHESIS
There is significant difference between pretest and post test knowledge scores of clients with lower limb fracture regarding self care management of lower limb bone fracture.
6.6) ASSUMPTION
1 Patients and their relatives have limited knowledge regarding self care of fracture of lower limb.
2 There will be significant increase in knowledge after the administration of comprehensive nursing package to patients.
3 Anxiety and psychological stress of the patients will reduce after administering comprehensive nursing package.
6.7) OPERATIONAL DEFINITION
1 Assess: - To estimate the outcome of the planned teaching programme on clients with long bone fracture.
2 Effectiveness: - Expected increase in knowledge score after administration of comprehensive nursing package.
3 Lower limb fracture: - In this study client with long bone fracture refer to the fracture of the femur, tibia and fibula.
4 Comprehensive nursing intervention package:- Means complete care to prevent deformity, infection and mental distress.
5 Planned Teaching Programme: - It refers to systematically planned teaching programme designed to provide information to prevent deformity, infection and mental distress.
6 Selected hospital: - Orthopedic hospitals in Hassan.
6.8) CRITERIA FOR SELECTION OF SAMPLE
· INCLUSION CRITERIA
1 Male and female clients with lower limb fracture of lower limb admitted in selected hospital Hassan.
2 Present during the period of data collection
3 Clients with lower limb fracture who are willing to participate.
· EXCLUSION CRITERIA
Clients who are not willing to participate.
6.9) LIMITATION
1 Clients admitted in orthopedic ward of selected hospital, Hassan with long bone fracture of lower limb.
2 For period of 4 to 6 weeks
6.10) Significance Of Study
Provide comprehensive knowledge to adopt a positive attitude towards self care and prevent complication and encourages confidence.
6.11) CONCEPTUAL FRAME WORK
This study is based on “general system theory”.
6.12) REVIEW OF LITERATURE.
Review of literature is a key step in the research process. It refers to an extensive, exhaustive and systematic examination of publications relevant to research. A literature review helps to lay the foundation for a study and can also inspire new research ideas. It can help with orientation to what is known and not known about an area of inquiry, to ascertain what research can best make a contribution to the existing base of evidence.7
The reviews of literatures are divided into following categories:-
1 Literatures related to length of stay in hospital.
2 Literatures related to infections.
3 Literatures related to deformities
Ø Literatures related to length of stay in hospital.
A retrospective study was conducted on proximal femur fractures in the elderly to know mortality, and length of hospital stay. The postoperative hospital mortality decreased from 8.1% in 1991 to 5.6% in 2004, in 2004 as compared to 1991, 2.5 times as many patients were discharged to a nursing home. The study was concluded that in the proximal femur fractures that was closely related to the ageing. It is estimated that the decreasing hospital mortality and the decrease in the length of hospitalization will increase the need for nursing-home care for this category of patients. 8
A 6-month, randomized, double-blind, placebo-controlled trial with a 6-month post-treatment follow-up study was conducted on Protein supplements increase serum insulin-like growth factor-I levels. There were n= 82 patients with recent osteoporotic proximal femur fracture. The study result shows that patients who received protein supplements had significantly greater increases in serum levels of insulin-like growth factor-I. P = 0.003 and an attenuation of the decrease in proximal femur bone mineral density P = 0.029. Median stay in rehabilitation wards was shorter for patients who received protein supplements than for controls P = 0.018. The study was concluded that supplementation of protein will help in attenuation of proximal femur bone loss, and shorter stay in rehabilitation hospitals. 9