RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1) NAME OF THE CANDIDATE
AND ADDRESS: SHAIK HUSSAIN.
1ST YEAR M.Sc NURSING H.K.E.S
COLLEGE OF NURSING BASVESHWAR
HOSPITAL CAMPUS GULBARGA, KARNATAKA
2) NAME OF THE INSTITUTION: H.K.E.S. COLLEGE OF NURSING GULBARGA.
3) COURSE OF STUDY AND
SUBJECT: M.Sc. NURSING I YEAR.
MEDICAL SURGICAL NURSING.
4) DATE OF ADMISSION TO .
COURSE: 25.06.2009.
5) TITLE OF THE TOPIC: “A STUDY TO DETERMIND THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON
KNOWLEDGE REGARDING PREVENTION OF PRESSURE
ULCER AMONG IMMOBILISED ORTHOPAEDIC
PATIENTS IN SELECTED HOSPITALS AT GULBARGA”
6.0 BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
“He, who has health, has hope; and he who has hope has everything”
The health and proper functioning of the musculoskeletal system are interdependent with that of other body systems. The musculoskeletal system consists of the bones, cartilage, muscles, ligaments, and tendons. The bony skeleton provides a study framework to support body structure. Shape and form for our bodies in addition to supporting, protecting, allowing bodily movement, producing blood for the body, and storing minerals. 1
A joint is a part of the skeleton in which two or more bones meets joints holds the bones together while allowing the body to move. There are 206 bones in the human body divided into 4 categories long bones, short bones, flat bones, irregular bones. 1
A Fracture is break in the continuity of bone. Fracture occurs when the bone is subjected to stress greater than it can absorb. When the bone is broken adjacent structure are also affected, resulting in soft tissue edema, hemorrhage into the muscles and joints, joints dislocations, ruptured tendons, severed nerves, and damage blood vessels. 1
According to survey report, percentage of frequency of injuries sustained are as follows: Knee 23.5%, Back 16.5%, Ankle 14%, Arm 30.5%, Leg 10%, Thigh 9%, Groin/Hip 5.5%, wrist/hand 4%, Neck 1.5%, Foot 5%, and Trunk 1%. The data clearly shows that 63.3% of the injuries are of the lower limb that leads to immobility.2
A mobile person generally turns approximately once every 10-12 minutes while sleeping. This action provides for healthy blood circulation, stimulation of body organs and movement of body fluids. When a person becomes temporarily or permanently immobilized, however, the blood supply to that part of the body that is under pressure is restricted. If that pressure is not regularly relieved, and the blood supply restored, the affected tissue dies and sloughs off. Pressure ulcer most often involve motion deficits when a person is immobile and inactive, pressure is exerted on the skin and subcutaneous tissue. The development of pressure ulcers is directly related to the duration of immobility. If pressure continues long enough, small vessel thrombosis and tissue necrosis occur, resulting in a pressure ulcer. Weight bearing bony prominences is most susceptible to pressure ulcer development. These prominences are covered by skin and small amount of subcutaneous tissue. Susceptible areas include Occiput, Ear, Scapula, Elbow, Sacrum, Ischial tuberasities, Greater trochanter, Medial condyle of tibia, Fibular head, medial Malleolus, Lateral malleolus, Heel.1
Immobilization is prescribed by physician for therapeutic reasons, which may be due to use of external devices like cast, skeletal tractions. But normal individuals on bed rest loose muscle strength from baseline levels at a rate of 3% a day. Immobilization is also associated with changes in musculoskeletal, cardiovascular, gastro-intestinal, respiratory genitourinary and integument systems. 3
6.1 NEED FOR THE STUDY:
“Prevention is better than cure”
“According to World Health Organization (WHO) health is a state of complete physical mental and social wellbeing and not merely an absence of disease or infirmity” So healthy person can be more productive and enjoy all aspects of life comparing to ill person. In order to promote health body needs to function optimally. For this, the musculoskeletal system plays an important role.4
Mobility refers to a person’s ability to move about freely and immobility refers to the inability to move about freely. There are various complications due to immobility. Immobility related problems include pressure ulcers, pneumonia, constipation, loss of appetite, urinary stasis, urinary tract infection and venous stasis or deep vein thrombosis. 4
A pressure ulcer is any lesion on the skin caused by unrelieved pressure and resulting in damage to underlying tissue. Pressure ulcer occurs commonly in areas subjected to high pressure from body weight on bony prominences. Pressure ulcer also called as decubitus ulcers. The word decubitus comes from Latin which means to lie-down. Pressure ulcer develops when soft issue (skin, subcutaneous tissue and muscle) are compressed between a bony prominence and a firm surface for a prolonged period of time. There for immobility and inactivity is major risk factor pressure ulcer more than 95% of all pressure ulcers occur over a bony prominence only. Pressure ulcer remains as one of the neglected aspects of health care provision in India. The cost of pressure ulcer treatment is much greater than the cost of prevention. Treating a pressure ulcer incurs considerable cost to the patient and hospital, especially if the pressure ulcer has advanced beyond stage one. 5
During the immobilization phase, simple basic patient care is extremely important like skin care, active-passive exercises, changing position, etc. These cares not only contribute to the patient’s physical but also psychological well being. Lengthy periods of immobilization are emotionally stressful for patients. Hence when the complications due to immobilization are prevented it helps an individual to be physically, emotionally and psychologically sound. 6
Pressure ulcers adversely affect the quality of life of many patients and cause anxiety and distress for their families. A study was conducted by Moore Z. (Adelaide and Meath Hospital Incorporating the National Children's Hospital, Tallaght, Dublin) regarding effective pressure ulcer management, and it was found that there was improvement in pressure ulcer prevention through education. Therefore this article stresses the need of educating patients in order to prevent complications due to immobility. 7
During the investigator’s clinical training period, the patients in the orthopaedic wards were long term immobilised orthopaedic patients, and they developed complications like pressure ulcer, foot drop, constipation and pneumonia. Based on these facts the investigator feels the need to develop and administer a (STP) Structured Teaching Programme in order to prevent pressure ulcer.
6.2 REVIEW OF LITERATURE:
The review of literature will be subdivided and presented under the following headings
1) Literature related to incidence and prevalence of orthopaedic trauma
2) Literature related to complications of pressure ulcers
3) Literature related to prevention of pressure ulcers among immobilised orthopaedic patients
4) Literature related to effectiveness of structure teaching programme
1) Literature related to incidence and prevalence of orthopaedic trauma
A descriptive study was conducted in two hospital of eastern Nepal. To find out the statistical data of Road Traffic Accidents (RATs) reported by victims during one year of period. Result revealed that the highest (28.6%) of victims were in the mean age grope of 22-29 years and Labours groups had highest (27.6%) number of Road Traffic Accidents (RTAs) followed by students (24.1%). The study report also revealed that highest number of (126, 14.5%) Road Traffic Accidents (RATs) had been reported in the month of July followed by January. Where as regarding days, highest accidents (30.5%) occurred on Sunday followed by Friday (20%) respectively. In the present study, 16.9% drivers were found to have consumed alcohol 2-3 hours prior to the accident. Buses (31.4%), trucks (12.3%) and bicycles (11.3%) were the common vehicles involved in Road Traffic Accidents (RTAs)8
A survey was conducted in India to determine the relationship between epidemiological factors and road traffic accidents in one year of period. Total 726 road traffic victims enrolled, the study selected variables like characteristic of victims, time, day, months of accidents, type of accidents and vehicle in accidents. Result revealed that the highest (83%) were male and lowest (17%) were female accidents victims. Labourers were highest (29.9%). The study also revealed that in the month of January highest (12.9%) number of accidents reported, where as on Sunday (17.1%). Among the groups, occupants group constituted large number (45%) of victims and motorized vehicles two wheelers drivers were more (31.1%) involved in accidents.9
2) Literature related to complications of pressure ulcers
A cross sectional study was conducted in Varanasi, India to find out the prevalence of pressure ulcer among immobilized patients and predisposing factors for ulceration. A total of 445 patients were included from medical and surgical wards. The hospitalized patients examined for site, number, grade of pressure ulcer, Haemoglobin, serum albumin and blood sugar levels of these patients were also reported. Result showed that, the prevalence pressure ulcer was high (4.94%) among these hospitalized patient. The study identified the risk factors for ulceration such as anaemia, malnutrition and diabetes. Morbidity was reported among prolonged hospitalized patients (40.9%), especially in neurological wards.10
A prospective comparative study was conducted among 530 adult patients from medical and surgical wards to identify risk factors associated with pressure ulcer development. Data was collected by register nurse using Risk Assessment Pressure Sore (RAPS) once a week for up to 12 weeks. Result revealed that more (11.7%) number of patients developed pressure ulcer were significantly older, and prolonged hospitalized. The study identified immobility, prolonged hospitalization, age, surgical treatment and weight were found to be risk factors for the development of pressure ulcer.11
3) Literature related to prevention of pressure ulcers among immobilised orthopaedic patients
An experimental study was conducted on prevention of pressure ulcer among immobilized orthopedic patients. The aim of this study was to improve the quality of care and patient safety with a hip fracture. A total of 478 patients with a hip fracture were included between April 2003 and March 2004. A clinical pathway was introduced on 1-10 2003. The results from the of first 210 patients in the control group and the last 210 patients in the experimental group were revealed. The study shows, experimental group, acquired pressure ulcers decreased by 50% (p0.007). It is possible to reduce the development of hospital acquired pressure ulcers among elderly patients with a hip fracture even though it is not possible to eliminate the effect of factors such as increased age and the patients’ medical status.12
This article is not included in your organization's subscription. However, you may be able to access this article under your organization's agreement with Elsevier.
This article is not included in your organization's subscription. However, you may be able to access this article under your organization's agreement with Elsevier. A study carried out on prevention of pressure ulcers. Fifty-nine RCTs (Randomized Controlled Trials) were selected. Studies were grouped into 3 categories, i.e., those addressing impairments in mobility, nutrition, or skin health. Effective strategies that addressed impaired mobility included the use of support surfaces, mattress overlays on operating tables, and specialized foam and specialized sheepskin overlays. While repositioning is a mainstay in most pressure ulcer prevention protocols, there is insufficient evidence to recommend specific turning regimens for patients with impaired mobility. In patients with nutritional impairments, dietary supplements may be beneficial. The study shows thatrepositioning the patient, optimizing nutritional status, and moisturizing sacral skin are appropriate strategies to prevent pressure ulcers.13
4) Literature related to effectiveness of structure teaching programme
A study was conducted on prevention of pressure ulcer an evaluation of awareness in the families of patients at risk. 62 caregivers (78% family members and 22% non-related) filled out the questionnaire related to the prevention and treatment of pressure sores. The result showed that only 11% knew about the pressure ulcer, 42% of care givers were not aware of the possible pressure ulcer causes, and 54.8% were not able to mention any pressure ulcer risk factors. They concluded that the families and care givers of bedridden patients have insufficient knowledge of pressure ulcer prevention, indicating the need of providing knowledge regarding pressure ulcer prevention.14
6.3 STATEMENT OF THE PROBLEM:
“A study to determine the effectiveness of structured teaching programme on knowledge regarding prevention of pressure ulcer among immobilised orthopaedic patients in selected Hospitals at Gulbarga.”
6.4 OBJECTIVES OF THE STUDY:
(i) To determine the knowledge regarding prevention of Pressure Ulcer among immobilised orthopaedic patients as measured by structured questionnaires.
(ii) To develop and conduct structured teaching programme regarding prevention of Pressure Ulcer among immobilised orthopaedic patients.
(iii) To evaluate the effectiveness of the structured teaching programme regarding prevention of Pressure Ulcer among immobilised orthopaedic patients.
(iv) To find association between post-test knowledge scores with selected demographic variables.
OPERATIONAL DEFINITIONS
Knowledge: It refers to the correct response given by patients regarding prevention of pressure ulcers. Among immobilised orthopaedic patients. As measured by structured questionnaires.
Effectiveness: It refers to gain in knowledge on prevention of pressure ulcers among immobilised orthopaedic patients as determined by significant difference between pre and post test knowledge scores.
Structured teaching programme: It refers to the systematically developed instructional method designed for immobilised orthopaedic patients to provide information regarding prevention of pressure ulcers.
Pressure ulcers: It refers a condition which arise due to constant pressure exerted by
the bed or mattress on tissue which leads molecular death of tissue.
Immobilised orthopaedic patients: It refers to patients affected by orthopaedic
problems resulting in restricted range of motions among immobilised orthopaedic
patients.
7. MATERIALS AND METHODS:
RESEARCH DESIGN: The research design adopted for the present study is one
group Pre- test and post- test design.
Research Variables
1. Independent variable: Structured Teaching Programme (STP) regarding
prevention of pressure ulcers.
2. Dependent variable: Knowledge regarding prevention of pressure ulcers.
Performance in the pre-test, Performance in the
post-test
7.1 SOURCE OF DATA: Immobilised orthopaedic patients in