RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

STATEMENT

A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING

PROGRAM ON KNOWLEDGE REGARDING PREVENTION OF

COMPLICATIONS OF IMMOBILIZATION AMONG ORTHOPEDIC PATIENTS

IN SELECTED HOSPITALS AT KOLAR DISTRICT.

PROFOMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

MOHAN RAJ A.A.E. & C.S. PAVAN COLLEGE OF NURSING, KOLAR

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

PROFOMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.Name of the candidate

and address

Mr. Mohan raj

A.E. & C.S. Pavan College Of

Nursing, Kolar-563101, Karnataka

2. Name of the Institution A.E & C.S. Pavan College Of Nursing

3.Course of the study and

subject

M.Sc. Nursing

Medical and Surgical Nursing

4.Date of admission to

the course

5. Title of topic

A study to evaluate the effectiveness

of planned teaching program on

knowledge regarding prevention of

complications of immobilization

among orthopedic patients in selected

hospitals at Kolar district.

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6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION

“It is better to light a candle

Than to curse the darkness”

Kinesis, a word of Greek origin means motion or to move. The human body is

designed for physical activity and movement. Even at rest, the normal healthy adult

changes position on average every 11.6 minutes during sleep; this physiological

requirement for movement is termed the minimal physiologic mobility

requirements.

“Use It or Lose It-The Hazards of Bed Rest and Inactivity.”

Professional experience and lay wisdom teach us the benefits of exercise and

the hazards of idleness. Yet the myth persists that "bed rest is good for you" when ill

or convalescing. Abundant scientific evidence in the past 50 years has demonstrated

the specific damage done to each of the body's organ systems by inactivity and

immobilization. Both inactivity and immobilization lead to strikingly similar kinds

of deterioration.

Most people take for granted the assumption that rest is beneficial in restoring

the health of an ill or injured person. The bed is the central focus of hospitals and

the standard unit of size for health care facilities. Hospital procedures and

expectations sharply curtail mobility. Even ambulatory patients generally remain

under the sheets, if only for warmth and modesty.

Before the 1940s, strict bed rest was the rule for two weeks after childbirth,

three weeks after herniorrhaphy, and four weeks or more after myocardial

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infarction. The shortages of hospital beds and personnel during World War II led to

the surprise discovery that early mobilization of the sick and injured actually

improved results and lessened complications.

Postwar rehabilitation programs in the Veterans Administration hospitals

taught that the avoidable complications of immobility were often more disabling

than the original injury.

Deitrick and colleagues, in a classic study of immobilized healthy young men

and seriously ill polio patients, documented striking metabolic and neuromuscular

deterioration.

More recent researches by the National Aeronautics and Space Administration

(NASA) produced additional evidence for the damaging effects of prolonged

inactivity and immobility.

Short-term benefits may result from limited rest of individual body parts:

elevating the legs to treat shock, eliminating gravity in peripheral edema, relieving

abdominal wall pressure after laparotomy, or resting traumatized soft tissues or

skeletal structures. The severity of an illness may leave no choice except bed rest,

but the rest itself is rarely beneficial. On the contrary, virtually every organ and

body system promptly and progressively deteriorates when inactivated.

Like muscle, bone is living tissue that responds to exercise by becoming

stronger. Those who exercise regularly generally have greater bone mass (bone

density and strength) than those who do not. Although weight-bearing activities

contribute to the development and maintenance of bone mass, weightlessness and

immobility can result in bone loss.

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Some people can't perform weight-bearing activity. They include, for example,

people who are on prolonged bed rest because of surgery, serious illness, or

complications of pregnancy; and those who are experiencing immobilization of

some part of the body because of stroke, fracture, spinal cord injury, or other

chronic conditions. These people often experience a significant bone loss and are at

high risk for developing complications live deep vein thrombosis, constipation,

osteoporosis, etc. It is suggested that there is a good chance to fully recover the lost

bone if the immobilization period is limited to 5 to 8 weeks.

Patients on the orthopedic service are almost immobilized due to fracture,

RTA, or surgery either for short duration or for extended period of time which

ultimately leads to complication like deep vein thrombosis, PE, pneumonia, calculi,

and pressure ulcer. These complications are preventable; it is easy to prevent rather

than to treat these complications in terms of escalating cost, health status of the

patient, and nursing facility. The knowledge regarding prevention of complication

of immobilization is on paper yet not effectively implemented in practice. Health is

primarily focused on preventive, promotive, and maintaining aspect. As per the

definition the first level of nursing care is prevention which can be entirely full

filled and achieved by educating the patient.

The main purpose of this study is to prevent complications arising out of

immobilization by educating the patient and the family, the researcher chose

orthopedic as area of speciality to conduct the study because orthopedic patients are

more necessitated and vulnerable to immobilization due to health and disease

condition and long-term immobilization is most common among orthopedic

patients. Most of the immobilization complications are noted among the orthopedic

patients; if these patients are educated the outcome would be beneficial to the

patient and the rehabilitation would be still easier without any complications.

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6.1. NEED FOR THE STUDY

An average of approximately 50% of the hospitalized individuals has mobility

impairment. Immobilization and inactivity are frequently present in patient with

involvement of musculoskeletal and neurological systems and also among critically

ill patients. An immobilized individual is at a greater risk of developing

complications.

Patients on the orthopedic service are those who require treatment for fractures,

deformities, and diseases or injuries of some part of the musculoskeletal system.

Some patients will require surgery, immobilization, or both to correct their condition.

The majority of patients not requiring surgical intervention will be managed by bed

rest, immobilization, and rehabilitation.

Prolonged bed rest and immobilization inevitably lead to complications. Such

complications are much easier to prevent than to treat. Research studies in relation

to complication of immobilization are conducted more often in Western countries,

but have not gained importance as a major health problem in India.

The complications arising out of immobilization in orthopedic patients are

deep vein thrombosis, pulmonary embolism, pneumonia, orthostatic hypotension,

pressure ulcer, calculi, urinary tract infection, anemia, osteoporosis, constipation and

fecal impaction, muscle atrophy, glucose intolerance, negative nitrogen balance,

depression and psychosis.

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Deep vein thrombosis occurs in atleast 5% of all immobilized patient. Most

deep venous thrombi occur in the calf and mainly originate in the soleus sinus.

Researchers believe that 80% of the clots lyse before reaching the level of the knee.

The incidence of pulmonary embolism is reported in 4 to 7% patient after emergency

hip surgery and in 0.34 to 1.7% of patients after elective hip replacement. Patients

with proven deep venous thrombi involving the popliteal or more proximal leg veins

have a 50% chance of developing pulmonary emboli.44 Mortality from untreated

pulmonary embolism is 20% to 35%.

Pneumonia is estimated to occur in 0.5% to 1% of all hospitalized patients and

15% to 20% of intensive care patients. Orthostatic hypotension is third major effect

of immobility on cardiovascular function in orthostatic hypotension. Pressure ulcer

develops in 25% to 80% of all patients with immobilization. The triad of

hypercalciuria, urinary stasis and urinary tract infection often causes stones to form in

the kidneys or bladder. One series showed that urolithasis developed in more than

50% patients due to immobilization.

Urinary tract infections are the second most common bacterial disease. The

causes of infection are indwelling catheter and stasis of urine secondary to

immobilization. Anemia is not a specific disease; it is a manifestation of the

pathologic process. Osteoporosis is the most common bone disease which becomes

severe on immobilization. Constipation and fecal impaction are common in

immobilized patients, results from decreases peristalsis and constrictive sphincters.

Fecal impaction is a fairly common complication of long-term constipation in the

elderly and bedridden occurring in about 30% of all nursing home residents.

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A statistical study conducted by a research center in Delhi and NCR gave a

statistical data of bedridden patients of Delhi & NCR and their problems and

complications. For the survey a representative sample of 1000 Bedridden Patients,

caregivers and family members was interviewed spread across Delhi & NCR

It was found that percentage of bedridden men patients (67.5%) is higher than

bedridden women patients (32.5%) among total bedridden patients of Delhi & NCR.

The survey showed that 66.5% of the total bedridden patients were confined to bed

for a short period (less than 12 months) while 33.5% of the total contacted bedridden

patients were long-term patients. Almost 76.5% were partially affected while 23.5%

bedridden patients were severely affected.

Approximately 13.9% of the respondents approached by interviewers were

affected by different kinds of mental/psychological problems. When information

collected from survey was analyzed, it was also found that older persons (60+)

constitute major part of bedridden patients. Approx. 65% of the bedridden patients

were reported from older person category.

It was found that bedridden patients were facing different types of practical

problems. Their major problems include non-availability of caregivers,

depression/nervousness, cleanliness & hygiene, bedsores, etc.

The researcher also observed the same during clinical posting that education

regarding complications of immobilization among orthopedic patients is important

one while planning care. Many orthopedic patients were found to have inadequate

knowledge regarding prevention of complications of immobilization and most of

them suffer with complications. The present study is an attempt to give knowledge to

orthopedic patients regarding prevention of complications of immobilization, the

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cause for it, signs and symptoms and how to manage or prevent the complications by

planned teaching programme. Thus, the patients will be more aware of complications

and will try to prevent it. Hence, the study becomes more apt to the situation and

more relevant. This motivated me to undertake this study to evaluate the effectiveness

of planned teaching programme on knowledge regarding prevention of complications

of immobilization among orthopedic patients admitted in selected hospitals at Kolar.

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6.2. REVIEW OF LITERATURE

The review of literature in a research report is a summary of current knowledge

about a particular problem, to provide a basis for conducting the study.

Literature review is one of the major components of the research process.

According to Polit & Hungler (1999), literature review to the activities involved in

identifying & searching for information.

It provides essential information to assist in critiquing the literature review

section. An extensive review was done to gain insight into the selected problem.

The related literature for the project is divided under 3 headings:

I. Studies related to complications of immobilization among orthopedic

patients.

II. Studies related to prevalence of complications due to immobilization among

orthopedic patients.

III. Studies related to prevention of complications of immobilization among

orthopedic patients: Preventive and curative aspect.

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I. STUDIES RELATED TO COMPLICATIONS OF IMMOBILIZATION

AMONG ORTHOPEDIC PATIENTS.

A study was conducted to identify silent deep vein thrombosis in immobilized

multiple trauma patients at Memphis in Tennessee, U.S.A. Thirty-eight of 39

immobilized trauma patients at bed rest for 10 days or longer had venographic study

of their lower extremities to evaluate for the presence of silent deep vein thrombosis.

Sixty percent of patients had silent deep vein thrombosis, with thrombi extending

above the knee in half of the patients with clot. Deep vein thrombosis was

documented in 67% of patients with major lower extremity fractures and 59% of

patients without major fractures. Deep vein thrombosis increased with increasing age

but not with injury severity score.

A case was reported with pulmonary emboli complication, who was an

outpatient, after the leg immobilization for 36 hours. The patient is a 56-year-old

woman with the chief complaint of left knee arthralgia. A woman comes in

ambulatory due to knee arthralgia and had medical examination. Gypsum fixation

was done. She has come again after 36 hours for medical examination. She

complained thorax discomfort and dyspnea afterwards and she was carried to the

emergency center. Blood pressure and pulse had been stabilized and partial oxygen

pressure had lowered obviously. Chest X-ray, CT were underwent and embolism

occurred frequently in the pulmonary artery was observed. She was diagnosed as

pulmonary embolism. Anticoagulation by urokinase and thrombolytic therapy by

warfarin and heparin are performed. Plaster bandage on the leg may be a risk factor.

A study was conducted in University of Western Ontario, London, to assess the

complications of immobilization and bed rest that revealed prolonged immobilization

affects almost every organ system. Respiratory complications include decreased

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ventilation, atelectasis, and pneumonia. Decreased basal metabolic rate, increased

diuresis, natriuresis, and nitrogen and calcium depletion affect metabolism.

Genitourinary problems include renal stones and more frequent urinary tract

infections. Glucose intolerance, anorexia, constipation, and pressure sores might

develop. Central nervous system changes could affect balance and coordination and

lead to increasing dependence on caregivers.

A research study was conducted to outline the predisposing factors in the

development of pressure ulcer complication among immobilized orthopedic patients.

The study revealed that immobilized orthopedic patients are prone to develop

pressure ulcers because there are no sufficient staffs to provide pressure relief to

rotate the patient every 2 hours in a hospital setting, with the exception of the

intensive care unit. The cost of caring for these preventable pressure ulcers may now

be as high as 60,000 dollars per patient

A study to assess the relation of prolonged immobilization and urinary tract

infection to renal calculus formation among orthopedic patients was published in

Australian and New Zealand Journal of surgery. The literature on the subject of

prolonged immobilization in relation to renal calculus formation was reviewed and

six illustrative cases were reported. The study revealed that prolonged immobilization

may interfere with the drainage from the pelvis and calyces as a result of the position

occupied by the kidneys, may provide sufficient time for the deposition of crystals

which would otherwise not have been deposited till the urine had been voided, and

cause these crystals to be retained, thus leading to calculus formation which would

otherwise never have developed.

A research study was done to prove that what happens to bones without

weight-bearing activity which was observed among space travelers. When there is no

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gravity putting pressure on the bone, astronauts will lose bone mass even though they

exercise in space. Studies show that immobility for more than 6 months for any

reason is a risk factor for osteoporosis.

A study was done to determine alterations in skeletal muscle related to

impaired physical mobility among orthopedic patients. An animal model was used to

study morphological adaptations of the soleus and plantaris muscles to decreased

loading induced by hind-limb suspension of an adult rat for 7, 14, and 28 consecutive

days. Alterations in weight, skeletal muscle growth, and changes in fiber type

composition were studied in synergistic plantar flexors of the rat hind limb. Body

weight and the soleus muscle mass to body mass ratio demonstrated significant

progressive atrophy over the 28-day experimental period with the most significant

changes occurring in the first 7 days of hind limb suspension. Hind-limb suspension

produced atrophy of Type I and Type II muscle fibers as demonstrated by significant

decrease in fiber cross-sectional area (micron 2). These latter changes account for the

loss of contractile force production reported in the rat following hind-limb unloading.

II. STUDIES RELATED TO PREVALENCE OF COMPLICATIONS DUE TO

IMMOBILIZATION AMONG ORTHOPEDIC PATIENTS.

A study regarding deep vein thrombosis after cast immobilization of the lower

limb among Malaysian population and should thromboprophylaxis be recommended?

Forty patients were enrolled in this study. They presented to our hospital with lower

limb injury requiring cast immobilization. Patients who were on anti-coagulant

medication, anti-thrombotic agents or their derivatives and patients who could not

comply with instructions were not enrolled. The casts were worn for 6 weeks.

Patients who complained of pain suggestive of deep vein thrombosis during the 6-

week period of cast immobilization had the cast removed and were examined for

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deep vein thrombosis by color Doppler ultrasonography. Of the 40 patients who

were enrolled in this study, eight (20%) had clinical signs suggestive of deep vein

thrombosis; however, only one patient (2.5%) had positive evidence of deep vein

thrombosis on Doppler ultrasonography.

A survey was conducted in 148 hospitals and found a prevalence of pressure

ulcers of 9.2 percent in the most extensive study of acute care facilities.

A survey report gave an incidence of 66% pressure ulcer in elderly patients

admitted for femoral fracture. Orthopedic patients may be at greater risk for pressure

ulcer development because of immobility; orthopedic patients with fractures appear

to be at greater risk than patients admitted for elective orthopedic procedures.

A descriptive study was conducted to determine the incidence of pressure ulcer

and its risk factors among immobilized patients at orthopedic wards in Tehran, Iran.

330 patients with no pressure ulcer at the time of admission, no movement due to

therapeutic interventions or movement only with assisting devices were selected

through convenience sampling at orthopedic wards. The findings of the study

showed that 46 patients (13.9%) developed pressure ulcer of which 76.1%, 21.7%

and 2.2% were at stages 1, 2 and 3 respectively. The most common locations of the

ulcers were in sacrum (34%), ischium (34.8%), heels (17.4%) and both sacrum as

well as heels (10.9%). The related factors included medical diagnosis, type of

therapy, decreased activity and immobility.

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III. STUDIES RELATED TO PREVENTION OF COMPLICATIONS OF

IMMOBILIZATION AMONG ORTHOPEDIC PATIENTS: PREVENTIVE

AND CURATIVE ASPECT.

The study was undertaken to assess the incidence of symptomatic deep vein

thrombosis in orthopedic outpatients who are treated with lower limb casts and were

not on any deep vein thrombosis prophylaxis and to determine should orthopedic

outpatients with lower limb casts be given deep vein thrombosis prophylaxis? It was

retrospectively analyzed the incidence of deep vein thrombosis in a district general

hospital over a 1-year period. There were 381 patients who have had lower limb

casts and treated as outpatients. In all, 7 patients developed deep vein thrombosis

during the period of cast immobilization as outpatients and of these 4 patients were

detected to have an associated pulmonary embolism. The results show that even

though the proven deep vein thrombosis was low, the potential of developing a

pulmonary embolism in these patients is high and should be prevented. Deep vein

thrombosis prophylaxis should be discussed for those orthopedic outpatients who are

at high-risk of developing thrombosis during immobilization and treatment with

lower limb casts.

A study regarding venous thromboembolism following prolonged cast

immobilisation for injury to the tendo Achillis was conducted in New Zealand. An

audit of 208 patients with a mean age of 39 years attending the Orthopaedic

Assessment Unit with an injury of the tendo Achillis requiring immobilisation in a

cast was chosen for the study. Information on assessment of venous

thromboembolism risk, prophylactic measures and venous thromboembolism events

for all patients was obtained from the medical records. A venous thromboembolism

risk factor was documented in the records of three (1%) patients. One of the 208

patients received aspirin prophylaxis; none received low molecular weight heparin. In

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all, 13 patients developed symptomatic venous thromboembolism during

immobilisation in a cast, including six with a distal deep-vein thrombosis, four with a

proximal deep-vein thrombosis, and three with a confirmed pulmonary embolus. This

incidence of symptomatic venous thromboembolism is similar to that reported

following elective hip replacement.

A journal published an article on effect of a rotating bed on the incidence of

pulmonary complications in critically ill patients. The risk of nosocomial pneumonia

and atelectasis is high among critically ill immobilized patients. We hypothesized

that continuous turning on the kinetic treatment table would reduce their incidence.

A study was designed to establish ambulatory norepinephrine treatment of

severe autonomic orthostatic hypotension among bedridden and immobilized

patients. Ambulatory, patient-controlled norepinephrine therapy was initiated in six

patients with orthostatic hypotension due to primary autonomic failure that had been

refractory to conventional treatment. Before this therapy, three patients were

bedridden; one was immobilized in a wheelchair. All had recurrent syncope and

tolerated upright tilt-table testing for less than 15 min despite extensive medical

treatment. Norepinephrine infusion therapy enabled all patients to sit, stay and walk

around for more than 45 min. One patient died after a five-year treatment period,

another after nine months because of nonhemorrhagic brain stem infarctions, both in

the absence of norepinephrine treatment. The remaining four patients are still mobile

after a period of 19, 10, 9 and 7 months, respectively.

A study was conducted to reduce the period of immobilization following

pressure sore: A prospective, randomized trial was used. Each patient was

randomized preoperatively to either 2 or 3 weeks of postoperative immobilization.

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The study summarized that 2 weeks of postoperative immobilization following

surgery is adequate for uncomplicated solitary pressure sores.

A study was conducted on pressure ulcer prevention. The study suggested that

pressure relief program must be individualized for non-weight-bearing individuals as

well as those that can bear weight. For those that can not bear weight and passively

stand, the RENAISSANCE Mattress Replacement System is recommended for the

immobile patient who lies supine on the bed, the stretcher, or operating room table.

This alternating pressure system is unique because it has three separate cells that are

not interconnected. The most recent advance in pressure ulcer prevention is the

development of the seating system. This seating system provides regular periods of

pressure relief and stimulation of blood flow to skin areas while users are seated. By

offering the combination of pressure relief therapy and an increase in blood flow, the

reportedly creates an optimum pressure ulcer healing environment.

A study on reduction of renal stone risk by potassium-magnesium citrate

during 5 weeks of bed rest was performed. This study was performed to evaluate the

efficacy of potassium alkali as potassium-magnesium citrate in reducing renal stone

risk and bone turnover. This study was performed as a double-blind, placebo

controlled trial. We studied 20 normocalciuric subjects randomized to either placebo

or potassium-magnesium citrate before and during 5 weeks of strict bed rest under

controlled dietary regimen. Two 24-hour urine collections were obtained under oil

each week for assessment of stone risk parameters and relative saturation of calcium

oxalate, brushite and undissociated uric acid. Blood was also collected for

determination of serum immunoreactive parathyroid hormone and vitamin D

metabolites. The study result showed that bed rest promoted a rapid increase in

urinary calcium excretion of approximately 50 mg per day in both groups. Despite

this increase subjects treated with potassium-magnesium citrate demonstrated

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significant decrease in the relative saturation of calcium oxalate and in the

concentration of undissociated uric acid compared to placebo. Provision of alkali as

potassium-magnesium citrate is an effective countermeasure for the increased risk of

renal stone disease associated with immobilization.

Journal of Women's Health published an article on osteoporosis in women who

are nonambulatory and with disability. Women with physical disabilities frequently

are nonambulatory and have bone loss due to immobility. They are at high risk for

osteoporosis and osteoporosis-related fractures. Primary care providers and

specialists need to prioritize osteoporosis prevention strategies when taking care of

women with disabilities.

A research study compared the effectiveness of common laxatives in producing

a bowel movement among immobilized orthopedic patients. Fifty patients satisfied

the inclusion criteria. Of the 50 patients, 25 did not have a bowel movement during

the first 96 hours of admission. Patients given a stimulant laxative (senna, bisacodyl)

and/or an osmotic laxative (lactulose, milk of magnesia) were more likely to have a

bowel movement. Opioid intake, expressed as logarithmic morphine equivalents,

was negatively associated with occurrence of a bowel movement. It was concluded

that critically ill patients have a high frequency of constipation, and opioid therapy is

a significant risk factor. Routine administration of stimulant or osmotic laxatives

should be considered for this patient population.

A research study on functional and structural adaptations of skeletal muscle to

microgravity was conducted. The purpose of the study is to summarize the major

effects of space travel on skeletal muscle with particular emphasis on factors that

alter function. The primary deleterious changes are muscle atrophy and the associated

decline in peak force and power. Studies on both rats and humans demonstrate a rapid

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loss of cell mass with microgravity. In rats, a reduction in muscle mass of up to 37%

was observed within 1 week. For both species, the antigravity soleus muscle showed

greater atrophy than the fast-twitch gastrocnemius. However, in the rat, the slow type

I fibers atrophied more than the fast type II fibers, while in humans, the fast type II

fibers were at least as susceptible to space-induced atrophy as the slow fiber type.

Space flight also resulted in a significant decline in peak force. For example, the

maximal voluntary contraction of the human plantar flexor muscles declined by 20-

48% following 6 months in space, while a 21% decline in the peak force of the soleus

type I fibers was observed after a 17-day shuttle flight. The reduced force can be

attributed both to muscle atrophy and to a selective loss of contractile protein. The

former was the primary cause because, when force was expressed per cross-sectional

area. The human fast type II and slow type I fibers of the soleus showed no change

and a 4% decrease in force, respectively. Despite the increase in fiber V(0), peak

power of the slow type I fiber was reduced following space flight. The decreased

power was a direct result of the reduced force caused by the fiber atrophy. In addition

to fiber atrophy and the loss of force and power, weightlessness reduces the ability of

the slow soleus to oxidize fats and increases the utilization of muscle glycogen, at

least in rats. This substrate change leads to an increased rate of fatigue. Finally, with

return to the 1g environment of earth, rat studies have shown an increased occurrence

of eccentric contraction-induced fiber damage. The damage occurs with re-loading

and not in-flight, but the etiology has not been established

A study to examine the effect of immobility stress (IS), and magnesium (Mg)

and/or imipramine (IMI) administration on forced swim test (FST) behavior. The

joint administration of Mg and IMI was effective in both IS and non-stressed animals

in FST. IS did not significantly alter locomotor activity, while IMI or Mg + IMI

treatment in IS mice reduced this activity.

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PROBLEM STATEMENT

A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING

PROGRAM ON KNOWLEDGE REGARDING PREVENTION OF

COMPLICATIONS OF IMMOBILIZATION AMONG ORTHOPEDIC PATIENTS

IN SELECTED HOSPITAL AT KOLAR.

6.3. OBJECTIVES OF THE STUDY

1. To assess the knowledge regarding prevention of complications of

immobilization among orthopedic patients.

2. To determine the effectiveness of planned teaching programme on knowledge

regarding prevention of complications of immobilization among orthopedic

patients.

3. To find association between the post test knowledge and scores with the

selected demographic variables. regarding prevention of complications of

immobilization among orthopedic patients.

6.4. OPERATIONAL DEFINITIONS

1. KNOWLEDGE: The fact and information that a person has acquired through

experiences and education regarding prevention of complications of immobilization

among orthopedic patients.

2. EFFECTIVENESS: Refers to significant improvement in knowledge as

determined by significant difference between pretest and posttest knowledge scores.

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3. PLANNED TEACHING PROGRAMME: It refers to systematically

organized instruction regarding prevention of complications of immobilization

among orthopedic patients.

4. COMPLICATION: It refers to any condition or disease which worsens the

existing one. This study deals with deep vein thrombosis, pulmonary embolism,

pneumonia, orthostatic hypotension, pressure ulcer, calculi, urinary tract infection,

anemia, osteoporosis, constipation and fecal impaction, muscle atrophy, glucose

intolerance, negative nitrogen balance, depression and psychosis.

5. IMMOBILIZATION: It refers to the condition in which a patient is unable to

move independently or is restricted for orthopedic intervention. It is inability to move

around freely.

6. ORTHOPEDIC PATIENTS: It refers to fracture patients (male and female).

It includes fracture of hip, lower limbs, patients immobilized after orthopedic

surgery, on traction, plaster cast or bandage application and who are unable to move

about freely.

6.5. HYPOTHESES

H1 The mean post test knowledge score of the subjects after planned teaching

programme will be significantly higher than their mean pretest knowledge score.

H2 There will be significant relationship between the pretest knowledge score and

selected demographic variables such as age, sex, religion, educational qualification,

occupation, previous exposure to information, duration of hospitalization, type of

diet, method of relaxation and type of treatment.

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6.6. VARIABLES :

DEPENDENT VARIABLES: Knowledge of patients on complication of

immobilization among orthopedic patients.

INDEPENDENT VARIABLES: Planned teaching programme on prevention of

complications of immobilization among orthopedic patients.

ATTRIBUTES: Age, sex, religion, educational qualification, occupation, previous

exposure to information, duration of hospitalization, type of diet, method of

relaxation, and type of treatment.

6.7. ASSUMPTIONS

1. The patients may have inadequate knowledge regarding prevention of

complications of immobilization among orthopedic patients.

2. The planned teaching programme on prevention of complications of

immobilization among orthopedic patients will improve knowledge.

3. The patient’s knowledge on prevention of complications among orthopedic

patients with immobilization will reduce the chance of developing

complication.

4. Knowledge level of orthopedic patient on prevention of complications of

immobilization is influenced by variables such as age, sex, religion, educational

qualification, occupation, previous exposure to information, duration of

hospitalization, type of diet, method of relaxation, and type of treatment.

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7. MATERIALS AND METHODS

7.1. SOURCES OF DATA:

Immobilized patient admitted in orthopedic ward in selected hospitals at Kolar.

7.2. METHODS OF DATA COLLECTION:

7.2.1. RESEARCH DESIGN: Quasi-experimental research design (one group

pretest-posttest design).

7.2.2. RESEARCH APPROACH: The research approach used for this study was

an evaluatory approach. A quasi-experimental approach was used without control

group by manipulating the variables to asses the effectiveness of planned teaching

program regarding prevention of complications of immobilization among orthopedic

patients.

7.2.3. SETTING OF THE STUDY: The study will be conducted in selected

hospitals at Kolar.

7.2.4. POPULATION: All Immobilized patients

7.2.5 SAMPLE: Immobilized patients admitted in orthopedic ward.

7.2.6. SAMPLING TECHNIQUE: Purposive sampling technique.

7.2.7. SAMPLING SIZE: Sample of 60 orthopedic immobilized patients.

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7.2.8. SAMPLING CRITERIA:

Inclusion Criteria

1. Clients who are immobilized in orthopedic ward.

2. Clients who understand Kanada and English.

3. Both male and female who are immobilized in orthopedic ward.

Exclusion Criteria

1. Clients who are having other serious illnesses.

2. Clients who are uncooperative.

7.2.9. TOOLS FOR DATA COLLECTION: A structured interview schedule will

be used to collect the data from immobilized orthopedic patients.

Tools consist of two parts:

SECTION-A: DEMOGRAPHIC DATA: The first part of the tool consists of ten

items of demographic data variables such as age, sex, religion, educational

qualification, occupation, previous exposure to information, duration of

hospitalization, type of diet, method of relaxation and type of treatment.

SECTION-B: KNOWLEDGE QUESTIONNAIRE: Knowledge questionnaire

consists of closed index questions related to complication of immobilization and its

prevention. A teaching plan will be prepared on prevention of complications of

immobilization among orthopedic patients. The content validity of it will be

ascertained with experts and guides in nursing and various fields like medicine and

surgery.

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7.2.10.METHODS OF DATA COLLECTION:

A structured interview schedule will be adapted by the researcher to collect the

data from subjects. The purpose of the study will be explained to involve in the

study. Pre-test to subjects will be conducted and structured teaching program will be

implemented. Post-test assessment will be done after 7 days of implementation of the

structured teaching program. Tentative period of the study will be 6 weeks. The tool

for data collection will be prepared and after validation by the experts, the further

refinement of the tool will be done. The pilot study will be conducted before the

main study.

7.3. DATA ANALYSIS AND INTERPRETATION

The data will be analyzed by using descriptive and inferential statistics such as

frequency, mean, mean percentage, standard deviation, paired t-test, and chi-square.

Chi-square test will be used to find out the association between knowledge score with

selected demographic variables.

7.4. DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE

CONDUCTED ON HUMAN OR ANIMALS? IF SO DESCRIBE BRIEFLY?

Yes. The study require interventions (planned-teaching program on knowledge

regarding prevention of complications of immobilization among orthopedic patients)

to be conducted among immobilized orthopedic patients.

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7.5. HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION?

Yes prior to the study permission will be obtained from the concerned

authorities and the research committee of Pavan College of Nursing, Kolar to conduct

study and the purpose of the study will be explained to the respondents.

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9. Signature of the Candidate

10. Remarks of the Guide

11.

Name and designation of

11.1. Guide

11.2. Signature

11.3. Co-guide

11.4. Signature

11.5. Head of the Department

11.6. Signature

12.

12.1. Remarks of the Principle.

12.2. Signature

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