SYNOPSIS FOR
REGISTRATION OF SUBJECT FOR DISSERTATION
SUBMITTED TO:
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
IN PARTIAL FULFILLMENT
OF
M.Sc (N) IN MEDICAL- SURGICAL NURSING
SUBMITTED BY:
Miss. BINCY MATHEW
I YR M.Sc (N)
UNDER THE GUIDANCE OF:
Mr. P.SIVAMARAN
PRINCIPAL
H.O.D
MEDICAL-SURGICAL NURSING
SHEKHAR COLLEGE OF NURSING,
No. 93, H.D HALLI, BANNERGHATTA MAIN ROAD,
GOTTIGERE POST, BANGALORE - 560 083.
1. / NAME OF THE CANDIDATEAND ADDRESS / Ms. BINCY MATHEW
1st YEAR M. Sc., NURSING,
SHEKHAR COLLEGE OF NURSING, No. 93, H.D HALLI,
BANNERGHATTA MAIN ROAD,
GOTTIGERE POST,
BANGALORE - 560 083.
2. / NAME OF THE INSTITUTION / SHEKHAR COLLEGE OF NURSING,
No. 93, H.D HALLI,
BANNERGHATTA MAIN ROAD,
GOTTIGERE POST,
BANGALORE - 560 083.
3. / COURSE OF STUDY AND
SUBJECT / M. Sc. NURSING
MEDICAL- SURGICAL NURSING.
4. / DATE OF ADMISSION TO THE COURSE / 30:05:2010
5. / TITLE OF THE TOPIC / A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME IN REDUCING ANXIETY OF PATIENTS POSTED FOR ORTHOPEDIC SURGERY IN SELECTED HOSPITALS IN BANGALORE.
6. BRIEF RESUME OF THE INTENDED WORK
6.1: INTRODUCTION
An operation is the medical treatments to cure the abnormalities of some body organs and remove the pathological parts of the body. It is said that an operation is a life - threatening incident for everyone. No matter how major or minor an operation is, it tends to cause a high degree of anxiety to every patient. Although some of the patients know in advance that they are going to be treated by an operation, they cannot help feeling worried, anxious, and nervous about the upcoming surgical treatment.1
The surgical patients had higher anxiety seemed to be increasing no matter major or minor an operation was or whether it was an emergency, a non- emergency, or a prepared operation. It is admitted that an operation can bring about the physical and mental tensions. For example, the reactions to the nervous and endocrine systems can trigger a high degree of anxiety and fear. The level of the anxiety of each person depends upon various factors such as gender, age, level of education, the expense on the medical treatment, and the part of the body where the operation has to be performed.2
The four factors which affected the patient’s anxiety were an individual’s basic personality, a habitual reaction when facing the state of anxiety, an imagination about an operation and being administered anesthesia including an individual’s general mental health.3
The results of the pre- operative anxiety may trigger the problems and obstacles in performing an operation. The patients with a high level of anxiety may have a high risk of unsatisfactory operative result. The high level of the anxiety during the pre-operative period can heighten the stimulation and the reaction of the endocrine gland which lengthens the post- operative recovery state of the patient. At the same time, the body will release Catecholamine which causes some complications from anesthetic administration, and a change of anesthetic potency.4
The pre- operative anxiety may bring about unfavorable systems such as a nausea, a vomit, a urinary retention, a muscle pain, restlessness and a post- operative insomnia The nursing practice that can help the patient to have a rapid recovery state is the practice that responds the needs of the patient by having an interpersonal relationship between the nursing staff and the patients, giving them some information and Knowledge, and encouraging them to encounter the undesirable incidents.5
The proper and sufficient information to the patients can enable them to better adjust themselves in coping with the threatening incidents because an individual is believed to naturally adjust himself to deal with the tension state or the threatening incidents by interpreting the meaning of the situation and considering the guideline to emotionally and behaviorally respond to the encountering incidents based on their existing knowledge and understanding.6
It is believed that giving integrated knowledge, such as the possible conditions occurring before and after the operation, the post- operation feelings and an individual’s practices before and after the operation, is better than giving them only single or one particular item of knowledge. Providing the knowledge to the patients should be made in a program consisting of what they need to know, and what they can practice until it becomes beneficial for their self- improvement.7
The problems in providing the patients some knowledge sometimes arise because the patients waiting for an operation tend to be stressful and ultimately anxious and worried. These causes may irritate their perception and intellectual processes and prevent them from getting complete and accurate information. Therefore, to give the knowledge, the instructing nurses should not rush through the process of giving information, but they have to help the patients to alleviate their stresses and anxiety, and teach them to find a better way to deal with the facing stresses and problems, and to consume the practice knowledge and information. The best way to encourage the patients to lessen their stresses and anxiety is to relax.8
6.2 NEED FOR THE STUDY
The body, mind and spirit are intertwined; distress in one area affects all the others. The nurse who intervenes can help the surgical patients to get through there "dark nights of the soul". A patient who suddenly finds himself disabled has to cope with the loss of what he once was. If the patient was physically active and proud of it, he will probably struggle even more.9
Patient and family members generally, are not familiar and comfortable with clinical knowledge and terminology. So the nurse will have to give clear, simple instructions when teaching various skills and procedures, such as administration of oxygen therapy, applying and changing dressings and making passion change. In the pre operative period the nurse must be able to asses stress in the client and intervene to prevent and reduce complecations.10
The medical personnel give the patients some assistances just based on their current problems and incidents. The information provided to the patients does not cover the necessary medical regimen which will help them then they have to face and solve the problems properly. Giving a systematic advice and information is very rare. There has been no planning in giving information step by step, and it bases on the kind of the information and the individual capability of the medical personnel. Sometime it may confuse the patients and increase their stresses and anxiety. 11
The patients without any stresses and anxiety are believed to recover from their ailment more rapidly than those with stresses and anxiety. When the relaxation techniques are added to health education program, there is a tendency to increase the nursing efficiency and it is expected that these techniques will bring the physical, mental and emotional state of the patients back to normal conditions more rapidly.12
Between 1990-2000, there was nearly a 25% increase in orthopedic surgery worldwide. The peak number of surgery was done for both sexes on the old age and it decreased with the age. By 2050 the number of orthopaedic surgery in men is projected to increase 310% and 240% in women. The highest numbers of hip surgery are seen in Norway, Sweden, Iceland, Denmark and USA. In Switzerland on 2000 there were 62,535 orthopedic surgery were registered. Based on current trends, on 2016 there will be 117,000 orthopedic surgery will be conduct in UK. In Asia it is projected that more than about 50% of all orthopedic surgery will occur by the year 2050.13
The department of anesthesia and perioperative care shows that there are approximately 37 million surgeries performed in the United States each year, with orthopedic surgery accounting for approximately 6% of the total number of procedures. The peak age for admission for orthopedic surgery is 70 years old. The peak age for admission for orthopedic procedure increases with age. Approximately 2, 00,000 hip surgeries are performed each year for degenerative joint diseases.14
Orthopaedic surgery is specially with preservation and restoration of the skeletal system to its articulation and associated structures and it is an event for most patients. Orthopaedic surgery patients frequently described feelings of helplessness and fear of impairment.15
The roles of the nurses/ teachers are to teach the orthopedic client undergoing surgery to follow directions of the physician, perform exercises as prescribed by the physiotherapist, use of recommended device such as walker, cane, crutches for walking, wearing supportive shoes, eliminate safety hazards, eat a nutrious diet, medications and follow-up. The nurses play various roles as a nurse educator, counselor to help overcome the problems. Thus the major role of staff is to improve health status of the patient though planned teaching program and education. Hence the investigator felt there is a need to assess the effectiveness of structured teaching programme for the patient posted for orthopedic surgery regarding reducing anxiety.
6.3: REVIEW OF LITERATURE
SECTION A: Literature review on anxiety among surgical patients.
SECTION B: Literature review on teaching strategie.
SECTION C: Literature review on prevalence of orthopaedic surgery.
SECTION A: Literature review on anxiety among surgical patients.
A study was conducted to assess the level of anxiety in informed and non-informed patients in the pre operative period at the Nini hospital in Tripoli, North Lebanon. By random sampling, 60 patients were selected. 30 patients in groupA2 where un informed. The Spielberger’s step in measuring anxiety was adopted. The result revealed that adopting protocol information booklets and preparative meetings with the patients with the added benefits of valorizing the role of the operating room nurse reduced anxiety.16
A study was conducted on stressors and anxiety in patients undergoing coronary artery bypass surgery to describe the concerns of patients undergoing surgery and its association with higher levels of anxiety. 172 patients were interviewed before surgery, before discharge and 10 days after discharge. Multiple regressions were used to determine the predictors of anxiety. The findings revealed that the anxiety levels remained low to moderate from before to after surgery, and resuming life style where predictors of increased anxiety before surgery. The study concluded that, patient waiting for surgery should be assessed for anxiety before the procedure and interventions to prevent or reduce anxiety should be provided including information for pain management, surgery schedules and resuming life style after the surgery.17
A study was conducted to determine the effect of information giving on pre-operative anxiety level of orthopaedic surgical patients. The research samples consisted of 30 orthopedic surgical patients who were admitted in Pramongkutklao Hospital and assigned into two experimental groups by match paired. The first experimental group received procedure information while the second group received procedure and sensory information. The instruments were the State Anxiety Inventory and anxiety observation scale developed by the researcher. The major findings were as follows: 1 in the first experimental group, there was no significant difference between the mean scores before and after the experiment. 2. In the second experimental group, the mean score of anxiety level after the experiment was significantly lower than before the experiment, at the .05 level. 3. After the experiment, there was no significant difference between the mean scores of the anxiety level of patients in the first and second experimental groups.18
A study to asses effectiveness of self-care manual during pre and post-surgery on patients’ knowledge attitude and anxiety levels. The respondents are 75 samples. It is found that as a result of exposure to self– care manual for pre and post – surgery, the respondents have more favorable knowledge and attitude and vice versa decrease in anxiety significantly. The only demographic characteristic found to be related to knowledge and anxiety level is education of the respondents; no relationship is found to be correlated with increment of favorable attitude level; but it is found that variability of attitude level has some influence on anxiety.19
SECTION B: Literature review on teaching strategies.
A study was conducted by national Health service trust in England to assess the effectiveness of pre operative education possess is beneficial in reducing anxiety for patients awaiting a total hip replacement surgery. Data were collected from observing five pre operative programme, 26 written patient evaluation, 16 interviews with 7 presenters of education, observation of 3 team meeting 20 interviews with 10 patients and documentation pertaining to the program. From the results it seems that patient education can reduce anxiety by making the unknown by familiar.20
A study to assess the effects of educational and relaxation program on postoperative recovery in renal surgical patients who were admitted in male urological and female surgical ward at Buddhachinaraj hospital in September 1995 to March 1996. The samples were selected by purposive sampling: the first 10 samples were control group, the second 10 samples were first experimental group and the third 10 samples were second experimental group. The control group were received the routine nursing care while the first experimental group received the educational & relaxation program. The results of the study revealed that: 1. The renal surgical patients who received educational and relaxation program demonstrated statistically significant higher in physical recovery scores than those who received only the educational program and the routine nursing care (p < .05 and .001), the patients who received the educational program demonstrated statistically significant higher in physical recovery scores the those who received the routine nursing care. (p < .05) 2. The renal surgical patients who received the educational and relaxation program demonstrated statistically significant higher in mental & emotional recovery scores than those who received only the educational program and the routine nursing care (p < .01 and .001), the patients who received the educational program demonstrated statistically significant higher in mental & emotional recovery scores than those who received the routine nursing care. (p < .01).21
A study was conducted to assess the effectiveness of knowledge providing program by McHugh, Chrisman and Johnson, it was found out that giving knowledge about the various feelings that they have to face could make the patients anticipate the future incidents as closely to the reality as possible, and when they confront that incident, they feel confident, and are able to behave decently, and have a participation in taking a better care of themselves after the operation. It also helps rehabilitate the physical, mental and emotional conditions, so the patients can reduce the length of staying in the hospital after the operation. It can reduce the post-operative complications because the patients have more knowledge and skills in the self-practices in order to avoid the coming complication. They have proper behavioral hygiene changes, so no complications occur causing a quicker post-operative recovery. The review of literature relevant to this study is presented as follows.22