PROFORMA FOR REGESTRATION OF SUBJECT FOR DISSERTATION

MR. SYAMPRASAD.R.K

1ST YEAR M.Sc NURSING

MEDICAL SURGICAL NURSING

YEAR 2009-2011

PADMASHREE COLLEGE OF NURSING

GURUKRUPA LAYOUT, NAGARBHAVI

BANGALORE-560072

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS /

Mr. SYAMPRASAD.R.K

I YEAR M.sc. NURSING

GURUKRUPA LAYOUT
NAGARBHAVI
BANGALORE-560072
2 / NAME OF THE INSTITUTE / Padmashree College of Nursing
Bangalore
3 / COURSE OF THE STUDY AND SUBJECT / I Year M.sc Nursing
Medical Surgical Nursing
4 / DATE OF ADMISSION / 10-06-2009
5 / TITLE OF THE TOPIC / A Study to Assess the Knowledge and Attitude of Caregivers Regarding Care of Clients on Traction Admitted in Selected Hospital, Bangalore.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“If you can’t pin it or cast it, the best way is to hang it”

An orthopedic surgeon

Musculoskeletal disorders are the most common cause of severe long-term pain and physical disability affecting hundreds of millions of people around the world. Joint diseases and back pain is the second leading cause of sick leave. With the burden of musculoskeletal disease at the forefront of health care worldwide, the World Health Organization (WHO) declared 2000-2010 the Bone and Joint Decade.1

The musculoskeletal system includes the bones, joints, muscles, tendons, ligaments, and bursae of the body. The common musculoskeletal disorders are musculoskeletal infections, tumors, musculoskeletal trauma and metabolic bone disorders.2Among the musculoskeletal disorders fracture is the most common and important disorder.

Fracture is the (local) separation of an object or material into two or more, pieces under the action of stress. The word fracture is often applied to bones of living creatures. Depending on the part which is fractured, a fracture reduces strength . A bone fracture (sometimes abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a break in the continuity of the bone. Although broken bone and bone break are common colloquialisms for a bone fracture, break is not a formal orthopedic term.3

An article reveals the prevalence and incidence statistics of fracture as follows Incidence (annual) of Fractures: 1.5 million fractures. Incidence Rate: approximately 1 in 181 or 0.55% or 1.5 million people Incidence extrapolations for Fractures: 1,499,999 per year, 124,999 per month, 28,846 per week, 4,109 per day, 171 per hour. Deaths from Fractures: 4.3 per 100,000 cases. In country vice analysis; Incidence extrapolations for Fractures in India is 5,873,551 in 1,065,070,6072 estimated population.4

Traumais the leading cause of death for those aged 1-34 years, and causes more years of lost productivity before age 65 years than coronary artery disease, cancer, and stroke combined.5

Since bone healing is a natural process which will most often occur, fracture treatment aims to ensure the best possible function of the injured part after healing. Bone fractures are typically treated by restoring the fractured pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals. Often, a physician will align the bone, called reduction, in good position and verify the improved alignment with an X-ray. This process is extremely painful without anaesthesia, about as painful as breaking the bone itself.

A fractured limb is usually immobilized with a plaster or fibreglass cast or splint which holds the bones in position and immobilizes the joints above and below the fracture. When the initial post-fracture oedema or swelling goes down, the fracture may be placed in a removable brace or orthosis. If being treated with surgery, surgical nails, screws, plates and wires are used to hold the fractured bone together more directly. Alternatively, fractured bones may be treated by the Illizarov method which is a form of external fixator. Surgical methods of treating fractures have their own risks and benefits, but usually surgery is done only if conservative treatment has failed or is very likely to fail. Occasionally a surgeon uses bone grafting to treat a fracture.6

Orthopaedic surgery or orthopaedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopaedic surgeons use both surgical and non-surgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital conditions.7

Jean-Andre Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. Antonius Mathysen, a Dutch military surgeon, invented the plaster of Paris cast in 1851. Many developments in orthopedic surgery resulted from experiences during wartime. On the battlefields of the Middle Ages the injured were treated with bandages soaked in horses' blood which dried to form a stiff, but unsanitary, splint. Traction and splinting developed during World War I. The use of intramedullary rods to treat fractures of the femur and tibia was pioneered by Gerhard Küntscher of Germany. This made a noticeable difference to the speed of recovery of injured German soldiers during World War II and led to more widespread adoption of intramedullary fixation of fractures in the rest of the world. However, traction was the standard method of treating thigh bone fractures until the late 1970s when the Harborview Medical Center in Seattle group popularized intramedullary fixation without opening up the fracture. External fixation of fractures was refined by American surgeons during the Vietnam War but a major contribution was made by Gavril Abramovich Ilizarov in the USSR. He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia in the 1950s. His Ilizarov apparatus is still used today as one of the distraction osteogenesis methods. Modern orthopaedic surgery and musculoskeletal research has sought to make surgery less invasive and to make implanted components better and more durable.7

In orthopaedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the skeletal system. There are two types of traction: skin traction and skeletal traction.8 Traction can either be applied through the skin (skin traction) or through pins inserted into bones (skeletal traction). Skin traction is generally less desirable due to the fact that skin can be injured when pressure is applied for extend periods of time. Skin traction called Buck's traction is commonly used in patients who have a hip fracture. 9

Skeletal traction (also referred to as distraction), is one of the most ancient (as well as one of the most modern) medical treatments known. The Egyptian papyri (circa 3,000 B.C.), uncovered by Edwin Smith in 1862 identify the use of axial traction for the purpose of reducing spinal fracture dislocations as well as the treatment of many other less serious conditions.10

Skeletal traction requires an invasive procedure in which pins, screws, or wires are surgically installed for use in longer term traction requiring heavier weights. This is the case when the force exerted is more than skin traction can bear, or when skin traction is not appropriate for the body part needing treatment. Weights used in skeletal traction generally range from 25–40 lbs (11–18 kg). It is important to place the pins correctly because they may stay in place for several months, and are the hardware to which weights and pulleys are attached. The pins must be clean to avoid infection. Damage may result if the alignment and weights are not carefully calibrated.

Some of the commonly used tractions in present day orthopaedics are Bryant's traction, Buck's traction, Dunlop's traction, Russell's traction and Milwaukee brace. Traction is used to manage fractures in an effort to realign broken bones; it is most often used as a temporary measure when operative fixation is not available for a period of time. 11

Skeletal traction does have the disadvantage of complications associated with pin insertion, and infections can come from the sites of pin insertion. Proper care is important for patients in traction. Prolonged immobility should be avoided because it may cause bedsores and possible respiratory, urinary, or circulatory problems. Mobile patients may use a trapeze bar, giving them the option of controlling their movements. An exercise program instituted by caregivers will maintain the patient's muscle and joint mobility. Traction equipment should be checked regularly to ensure proper position and exertion of force. With skeletal traction, it is important to check for inflammation of the bone, a sign of foreign matter introduction (potential source of infection at the screw or pin site).12

Family members or caregivers play a very important role in providing a holistic care to the patient with traction and associated complications, therefore the investigator felt a need to conduct a study in caregivers of traction patients.

6.2 NEED FOR THE STUDY

When a limb is painful as a result of a joint or a fracture of one of the bones, the controlling muscles go in to spasm. The antagonistic muscle in a limb are not all equally powerful, with the result that when muscle spasm is present, the action of the more powerful muscle can produce a deformity which may seriously impair the future function of the limb.13

Traction, when applied to an injured limb, can overcome the effect of the original deforming force, and thus can be used to reduce a fracture or a dislocation of a joint. In addition by overcoming muscle spasm and, in certain traction systems, the effect of gravity, traction can relieve pain and allow the limb to be rested in the best functional position. Traction also controls movement of an injured part of the body and thus aids in the healing of bone and soft tissues.14

The purpose of traction is to regain normal length and alignment of involved bone, to reduce and immobilize a fractured bone, to lessen or eliminate muscle spasms. to relieve pressure on nerves, especially spinal, to prevent or reduce skeletal deformities or muscle contractures.15

An experimental study conducted to detect the rate of infection in patient with Illizarov external fixation. In control group the skin around each pin site was cleaned daily with 0.9% saline solution and dry dressing. And in experimental group; daily shower, cleanse with saline, gauze dressing soaked with polyvinylpyrrolidone-iodine. The rate of infection in control group was 66.7% and in experimental group was 47.7%. It indicates that not only the aseptic technique but the cleansing solution is also playing a major role in preventing infection.16

Another study conducted to detect the rate of infection in 20 patients requiring skeletal pins for acute injury from a hospital in Australia. At 72 hours of surgery, participants were randomized to cleansing with normal saline and application of white paraffin ointment daily or twice daily cleansing with normal saline and 10% of povidone iodine solution. The rate of infection in first group is 34.1%and 2nd group is 18.1%17

An article reveals that compartment syndrome is a possible complication for every patient with a fracture, sprain, or orthopaedic surgery. Complete evaluation of the patient is necessary on a continual basis to determine any deviation from the normal range of the neurovascular parameters. Early identification of the symptoms will prompt immediate treatment and prevent the loss of a limb. So the care giver’s knowledge is very important in early identification of symptoms and complications.18

All these statistical studies provide strong support for conducting the present research. The researcher’s own personal experiences while working in the clinical side, has seen that many patients on skeletal traction developed pin site infection and other complications mainly because of lack of knowledge regarding care of traction among caregivers.

All these motivated the researcher to conduct this study to assess the caregiver’s knowledge and attitude regarding care of clients on traction

6.3 STATEMENT OF THE PROBLEM

A Study to Assess the Knowledge and Attitude of Caregivers Regarding Care of Clients on Traction Admitted in Selected Hospital, Bangalore.

6.4 OBJECTIVES

1.  To assess the knowledge of caregivers regarding care of clients on traction.

2.  To assess the attitude of caregivers regarding care of clients on traction

3.  To correlate knowledge and attitude of caregivers regarding care of clients on traction.

4.  To associate the knowledge and attitude of caregiver with their selected demographic variables.

6.5OPERATIONAL DEFINITIONS

1.  Knowledge: Knowledge refers to awareness and understanding of caregiver regarding care of clients on traction such as general information about traction, indication, types, prevention of complication and care of traction including monitoring the skin integrity, hygiene, monitoring for peripheral vascular system, pin site care, neurovascular checks, exercise, pain assessment and management, positioning, monitoring symptoms of infection and monitoring the integrity of traction as measured by structured questionnaire.

2.  Attitude: It refers to opinion, belief or feelings expressed by the caregiver regarding care of clients on traction such as skin care personal hygiene, activities of daily living and complications.

3.  Caregivers: An individual between the age group of 20 to 55 years and who is in close relationship with the client either spouse or children or siblings or in-laws or grand children attending to the needs of the clients who is on traction admitted in orthopedic ward of selected hospitals.

4.  Client: An adult who is admitted in orthopedic wards with skin or skeletal traction

5.  Care: It is the process of looking after the client’s needs by the caregiver who is on traction and preventing further complications.

6.  Traction: It refers to the set of mechanisms for straightening broken bones or relieving pressure on the skeletal system, in which the pulling force is used to treat muscle and skeletal disorders.

i.  Skin traction: It is the application of tape, boots, and splints directly to the skin to maintain alignment, assist in reduction and help diminish muscle spasm.

ii.  Skeletal traction: It is the surgical installation of pins, screws or wires in to the bone, either partially or completely, to align and immobilize body part. In this the weight (11to 18kg) is directly applied to the bone.

6.6 ASSUMPTIONS

1.  Clients on traction may experience major problems or discomforts due to their prolonged immobility where the caregiver or family member play a vital role in meeting their self care needs and alleviating their discomforts.