RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1.

NAME OF THE

CANDIDATE AND

ADDRESS

Mr. SUDEEPA S.R.

1st YEAR MSc. NURSING STUDENT

NISARGA COLLEGE OF NURSING

#18, KIADB INDUSTRIAL AREA, B.KATIHALLI

B.M. ROAD HASSAN, KARNATAKA.

2.NAME OF THE

INSTITUTION

NISARGA COLLEGE OF NURSING, HASSAN,

KARNATAKA.

3.COURSE OF STUDY

AND SUBJECT

MASTER OF SCIENCE IN NURSING

MEDICAL-SURGICAL NURSING

4.DATE OF ADMISSION

TO THE COURSE01/07/2011

5. TITLE OF THE TOPIC

THE EFFECTIVENESS OF VIDEO ASSISSTED TEACHING

(VAT) ON KNOWLEDGE REGARDING CARE OF SKIN

GRAFTING AMONG INTERNSHIP NURSING STUDENTS.

5.1STATEMENT OF THE

PROBLEM

“A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO

ASSISTED TEACHING (VAT) ON KNOWLEDGE

REGARDING CARE OF SKIN GRAFTING AMONG

INTERNSHIP NURSING STUDENTS IN SELECTED

NURSING SCHOOLS AT HASSAN”.

6. BRIEF RESUME OF THE INTENDED WORK

6.1. INTRODUCTION

1

"Take care of your body. It's the only place you have to live."

-- Jim Rohn

Skin is the largest organ of the human body, representing approximately 16% of

the total body weight. Skin grafting are promotion of accelerated healing of burns and

other wounds, reduction of scar contracture, skin also has important metabolic functions

in protein and vitamin D metabolism. The human body produces the greatest amount of

vitamin D in the epidermal layer of the skin.1

The evolution of skin grafts dates back thousands of years, with its history

beginning in ancient India where Sanskrit texts document transplants performed by

Hindi proto surgeons in 3000—2500 BC. Within the last 50 years, the use of skin grafts

has become a popular method in facilitating wound closure, especially in burn, crushed

wound, open fracture, amputation, diabetic foot ulcer, diabetic gangrene units. The most

frequently utilized skin graft include autografts.2

A skin graft is used to permanently replace damaged or missing skin or to

provide a temporary wound covering. This covering is necessary because the skin

protects the body from fluid loss, aids in temperature regulation, and helps prevent

disease- causing bacteria or viruses from entering the body. Skin that is damaged

extensively by burns or non-healing wounds can compromise the health and well-

being of the patient.2

Over the years, full-thickness skin grafts (FTSGs) have been widely used for a

variety of applications in reconstructive surgery. They consist of both the epidermis and

entire dermis compared with split thickness skin grafts (STSGs) which consist of the

2

epidermis and a variable amount of dermis. FTSGs are believed to be superior to

STSGs in functional and cosmetic aspects. They have less secondary contraction; they

are more durable and are more resistant to trauma. In addition they have better final

sensation, better texture and better colour matching with less pigmentary problems. Use

of Lower Abdominal Full-Thickness Skin Grafts for Coverage of Large Skin Defects.3

Injuries represent one of the most important public health problems faced by

both developing and industrialized nations today. Injuries may be intentional or non-

intentional but intent is sometimes difficult to determine for injuries such as burns.4

Burns represent an extremely stressful experience for both the burn victims as

well as their families. An extensive burn profoundly affects the patient's physique,

psyche, financial situation and family. Patients who suffer from extensive burn injuries

frequently die, while others suffer from painful physical recovery. In addition to their

dramatic physical effects, burn injuries frequently cause deleterious psychological

complications.4

The majority of burn injuries i.e. more than 85% occurred at home. The sex of

the victim was significantly associated with the site of accident. The vast majority of

occupational and street burns occurred among males while more than half the females

were because of domestic reasons. Cooking was most often responsible for burn in

domestic setup. Flames represented the most common agent of burn injuries (75.1%)

and showed a tendency to affect more females. Among the flame burns, kerosene stoves

were the most common source affecting 55.2% females and 40.4% males. Chimney and

LPG burns rank the second most common source of flame injuries accounting for 29%

males and 27.1% females in chimney and 15.8% males and 32.5% females in LPG

3

cases. The occurrences of scalds, chemical and electrical burns were 8.2%, 9% and

20.5% in males and 6.6%, 0.4% and 5.1% females respectively, Out of total burn

patients 67.7% were accidental, which was the most common cause, while the rest of

them were homicidal (13.4%) and suicidal (18.9%). In terms of sex distribution, 72.1%,

7.5%, 20.4% males and 65.8%, 15.9%, 18.3% females suffered from accidental,

homicidal and suicidal burns respectively.4

A retrospective cohort study was conducted in Heidelberg, among 38 diabetic

patients. The aim of this study was to analyse the outcome of plastic surgical treatment

for soft tissue defect coverage of the diabetic foot ulcer. "Diabetic foot" are increasing

in incidence and pose a challenging medical and financial problems. Interdisciplinary

teams have been formed to prevent and treat these problems, consisting of diabetic

nurses and physicians, nutritionists, podiatrists, specialist shoemakers, general,

orthopaedic and vascular surgeons. The result revealed that success rate of defect

coverage decreased with increasing co-morbidity. Whereas 71 % of the defects were

covered. This study concludes that provide justification for plastic and reconstructive

surgery being in any case part of an interdisciplinary treatment approach of the diabetic

ulcer.5

6.2 NEED FOR THE STUDY

"Health has its science, as well as disease." – (Elizabeth Blackwell)

4

According to the American Burn Association, there are more than 1 million

burn injuries in the United States each year that require medical attention.

Approximately one-half of these require hospitalization, and roughly 25,000 of those

burn patients are admitted to a specialized burn unit. About 4,500 people die from burns

each year in the United States.4

Among 16 million patients with diabetes in the United States, there are an

estimated 1200 amputations performed each week, 84% of which are preceded by a foot

ulcer. Limb amputation in patients with diabetes is associated with an increased risk for

further amputation, which has a 5-year, mortality rate of 39% to 68%.5

In the United States, someone dies in a fire nearly every two hours, on average,

and another person is injured every 23 minutes. Approximately half the deaths occur in

homes without smoke alarms. In addition to deaths resulting directly from burns, as

many as 10,000 Americans die every year of burn-related infections, pneumonia being

the most common infectious complication among hospitalized burn patients.6

The use of skin grafts has become a popular method in facilitating wound

closure, especially in burn, crushed wound, open fracture, amputation, diabetic foot

ulcer, diabetic gangrene units. The most frequently utilized skin graft includes auto

grafts.2

The average size of a burn injury in a patient admitted to a burn centre is

approximately 14% of the total body surface area. Smaller burns covering 10% of the

total body area or less account for 54% of burn centre admissions, while larger burns

covering 60% or more account for 4% of admissions. About 6% of patients admitted to

burn centre’s do not survive, mostly as a result of having suffered severe inhalation

5

injuries in a fire. Treatment for severe burns has improved dramatically in the past 20

years. Today, patients can survive with burns covering up to about 90% of the body,

although they often face permanent physical impairment.6

Diabetes mellitus is a disease known for chronic complications. Among them

diabetic foot infection is one of the devastating complications. In addition to causing

severe morbidities, they now account for the largest number. More than 50% of all

non-traumatic lower limb amputations taking place every year are performed on

diabetics.7

Diabetes is the leading cause of non traumatic lower extremity amputations,

today, more than 85% of lower extremity amputations in patients with diabetes

are preceded by foot ulcers. Among patients who have a lower extremity

amputation, more than half will have a contra lateral amputation within 5 years and half

of those who undergo amputation will die within 3 years. Diabetes is a fairly

common disease seen in India with a prevalence of almost 12% - 17% in the Indian

urban population as per a study and with a prevalence of 2.5% in the rural population

.TYPE II diabetes is the commonest form of diabetes constituting a b o u t 9 0 % o f

t h e d i a b e t i c p o p u l a t i o n i n I n d i a .7

The World Health Organization has predicted that the major burden of diabetic

patients will occur in the developing countries. A 42% increase from 51 to 72 million in

the developed countries and 170% increase from 84 to 228 million, in the developing

countries, is predicted by 2025. The countries with the largest number of diabetic

people are, and will be India, China and United States in 2025. In 2025, every 4th

person will be a diabetic.7

6

A retrospective study was conducted in China, among 10 cases of exceptionally

large area burns, to investigate the clinical effect of meek technique skin graft. The burn

area was 82.6% +/- 3.1% of total body surface area (TBSA), including 5 cases of flame

burns, 2 cases of hot liquid burns, and 3 cases of gunpowder explosion injury. The

results revealed that in meek group survival rate was 91.23% and in particle group was

78.65%. Showing the significant differences between 2 group’s (p<0.05>). These

findings showed that meek technique skin graft has good effect than particle skin

grafting.8

A study was conducted in China on 15 patients with skin and soft tissue defects

of lower limbs, to explore the feasibility, indications, and effects of vacuum sealing

drainage (VSD) combined with flaps for repairing skin and soft tissue. The defects of

lower limbs were treated with VSD combined with flaps (VSD group, n = 5) and only

flaps (non-VSD group, n = 10).There were significant differences between 2 groups (P

< 0.05). The results revealed that all flaps were good in colour, texture, and wear

ability. The findings showed that VSD combined with proper flap to repair skin and soft

tissue defects of lower limbs, is more effective, it cut down the down infection rate,

improve blood supply, shorten the pre-operative hospitalization days, and facilitate

healing.9

A study was conducted in china, among 11 patients with large skin defect of the

forearm and the hand, Among the 11 cases, 5 were caused by carding machine and 4 by

traffic accident and 2 cases suffered from late stage of burn injury. The size of skin

defect ranged from 42 cm x 12 cm to 60 cm x 16 cm. The flaps harvested during

operation were 45.0 cm x 10.5 cm - 62.0 cm x 18.0 cm in size. The results revealed that

all incisions healed by first intention and also all flaps survived. The findings showed

7

that excellent and good rate was 81.8% .Among 11 patients 7 cases were graded as

excellent, 2 as good, 2 as poor.10

A study was conducted in Taiwan, on 73 critical diabetic cases, to assess the

Skin grafting as a salvage procedure in diabetic foot reconstruction to avoid major limb

amputation. The results revealed that wound healing was achieved within 4 weeks in 54

cases. The complete wound healing rate was 74% in 1 month and 86.3% in 2 months.

These findings showed that skin grafting is more suitable than major amputation, in

order to preserve the feet among critical and unstable diabetic patients.11

As a post graduate student in medical surgical nursing department, Researcher

in his personal experience saw many diabetic, burns, fracture cases in all the age groups

and that was end up in amputation of body parts or extremities in case of diabetic

gangrene or foot, severe burns and in severe fracture and also ends up in death. So the

researcher felt to give some awareness on skin grafting through VAT. The VAT will

give enough knowledge to the internship nursing students in skin grafting, that in turns

useful to surrounding and future generations also.

6.3 STATEMENT OF PROBLEM

‘‘A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED

TEACHING (VAT) ON KNOWLEDGE REGARDING CARE OF SKIN

GRAFTING AMONG INTERNSHIP NURSING STUDENTS IN SELECTED

NURSING SCHOOLS AT HASSAN’'.

6.4 OBJECTIVES OF THE STUDY

8

1) To assess the pre test knowledge regarding care of skin grafting among

internship nursing students in selected nursing schools at Hassan.

2) To develop and administer video assisted teaching regarding care of skin

grafting.

3) To evaluate the effectiveness of video assisted teaching regarding care of skin

grafting in terms of post test knowledge scores among internship nursing students in

selected nursing schools at Hassan.

4) To find out the association between post-test knowledge score with their

selected socio-demographic variables.

6.5 HYPOTHESIS

Research hypothesis:

H1: There will be a significant difference between pre-test and post-test

knowledge scores among internship nursing students regarding care of skin

grafting.

H2: There will be a significant association between post test knowledge score

and with their selected socio-demographic variables.

6.6 ASSUMPTIONS

This study assumed that:-

The internship-nursing Students may have some basic knowledge regarding care

of skin grafting.

Video assisted teaching programme is an accepted teaching strategy in

improving knowledge of internship nursing Students.

9

6.7 OPERATIONAL DEFINITIONS

Assess: - It refers to determine the knowledge of internship nursing

students, regarding care of skin grafting.

Effectiveness: In this study it refers to the extent to which the video

assisted teaching on care of skin grafting has achieved the desired

effect in improving the knowledge of Internship nursing students as

assessed by structured questionnaire.

Video assisted teaching (VAT): Refers to systematically planned group

instructions by means of video shooting with narration of the topic

designed to provide information regarding care of skin grafting.

Knowledge: - It refers to the written correct response of internship

nursing students to items in knowledge questionnaire regarding

care of skin grafting.

Skin grafting: - A surgical graft of healthy skin from one part of the

body to another in order to replace damaged skin.

Internship nursing students: In this study it refers to the students who

completed 3-years Diploma in Nursing and were eligible for Internship

period in selected nursing schools, Hassan.

Selected Nursing Schools: - It refers to selected nursing schools

which were having GNM courses at Hassan.

6.8 CRITERIA FOR SAMPLE SELECTION

10

Inclusion criteria

The internship nursing Students who are studying in selected nursing schools at

Hassan.

The internship nursing students who are willing to participate in the study.

Who are present during the period of data collection.

Exclusion criteria

The internship nursing students those who are not willing to participate in the

study.

The internship-nursing students those who are absent or on leave at the time of

data collection.

6.9 LIMITATIONS OF THE STUDY

This study is limited to

60 internship nursing Students studying in selected nursing schools at Hassan.

Data will be collected in 4-6 weeks of period.

6.10 SIGNIFICANCE OF THE STUDY

This study will evaluate the effectiveness of VAT regarding care of skin grafting

on the knowledge of internship nursing Students.

The increased knowledge of internship nursing Students regarding care of skin

grafting imparts an efficient skill by treating patients with skin grafting.

Thus improve the outcome of care of patients those who are undergoing skin

grafting.

11

6.11 CONCEPTUAL FRAME WORK

This study based on “General system theory”.(Modified Ludwig von Bertalanffy

General system Theory 1968).

6.12 REVIEW OF LITERATURE

Review of literature is divided into four divisions:

1) Reviews related to Introduction of skin grafting.

2) Reviews related to Reason for skin grafting.

3) Reviews related to Reason of care of skin grafting among nursing students.

4) Reviews related to Role of nurse regarding care of skin grafting.

1) Reviews related to Introduction of skin grafting.

A study was conducted in USA among 510 burns patients. The goals of this

study are to acquire burn patient’s demographics for eastern province, Zambia. There

were 191(37.4%) patients who underwent 410 surgical procedures; there were

138(33.7%) sloughectomics, 118(28.7%) skin grafts, 39(9.5%) amputations and

115(28.1%) other procedures. The results revealed that there has been a statistically

significant improvement in their conditions. The finding showed that skin grafting was

improved the condition of burn patients.12

A single centre retrospective study was conducted in France among 63 patients

with massive burns; patients were treated with cultured epithelial auto graft (CEA) for

massive burn patients. The results revealed that the success rate was 65 +/_ 19%. These

finding showed that CEAs could be used with reasonable success and satisfying

survival results for treatment of massive burns.13

12

A Study was conducted in Brazil among 295 patients with scalp burns to

describe the incidence of complications on scalp from which a thin skin graft was

harvested (0.005-0.007 in) in children and adult burn victim. The results revealed that

295 patients whose scalps were used as donor site, 274 were followed from 6 months to

10 years after procedure (median 18.2 months) 21 patients were last to follow-up in the

first 6 months no hypertrophic scarring on the donor site was observed. These finding

showed that thinner split graft from scalp is a safe procedure. 14

2) Reviews related to Reason for skin grafting.

A study was conducted in China among 63 severely burned patients, to treat the

burns patients by micro skin grafting over 70% of total body surface area (TBSA).

Their burn size ranged from 70% to 98% of TBSA with a mean of 84.9%. The results

revealed that micro skin auto grafting yielded on overall survival rates was 63.5%.

These findings showed that using of micro skin auto grafting technique was very

effective in covering of extensive burns.15

A study was conducted in Japan among 38 patients with chronic wound

caused by diabetes mellitus to determine whether exposure of bone marrow cells

and subsequent grafting of epidermal sheets accelerates healing and reduce the

need of amputation, each patients were grafted on to the diabetic foot ulcer

without exposed bones (n=10), the exposed bone were treated with standard

procedure (n=9) and with a newly developed experimental procedure (n=11). The

results revealed that epidermal skin grafting significantly accelerated, the healing

of diabetic ulcer (p=0.042). These finding showed that epidermal skin grafting

improves healing of ulcer and reduce the rate of amputation.16

13

A study was conducted in china, among 20 patients with 25 non healing

wounds, to observe the feasibility of repairing non-healing wound with artificial dermis

and autologous skin graft. They were divided into chronic ulcer group (9 patients with

11 ulcerating scars after trauma and burn), and bone exposing group (11 patients with

14 wounds with exposed bone). The results revealed that in chronic ulcer group 9 of the

11 wounds healed well and in the bone exposing group, 12 of the 14 wounds healed

well. These findings showed that artificial dermis combined with autologus skin graft

healed .Non healing with high quality and it provides a new choice for repairing non

healing wound.17

A study was conducted in Hyland, among 2 groups that is group ‘O’ contains

patients were treated by skin grafting and group ‘C’ contains patients were treated by

conservative means. They were influence of large chronic leg ulcer. The results

revealed that at the end of the study pain was decreased only in patients of ‘O’ group

(p<0.05>), while in ‘C’ group pain practically remained same. These findings showed

that skin grafting positively influences the quality of patients lives significantly

(p<0.05).skin grafting has decreased the limitation of functions.18

A study was conducted in USA, among 88 patients with large burn wounds to

assess the coverage of large burns wounds with cultured epithelial auto grafts. (CEAs)

using of the CEAs in 88 patients (20 children and 68 adults) with age range of 6 months

to 73 years. The results revealed that the final graft take of 72.7% with a 91% overall

survival rate. These finding showed that CEAs was excellent to treat critically burned

patients and large burn wounds.19

A study was conducted in China among 123 patients with 128 devastating

wounds, to study the safety and effects of free composite tissue flaps in repairing of

devastating wounds. The type of flaps used in the surgery include 58 latissmusdorsi

14

muscular flaps, 32 anterolateral flaps, 21 circumflex scapular flaps, 6 dorsalispedis

composite flaps, 3 big toe nail skin flaps, 3 forearm flaps and 1 lateral thoracic flaps.

The results revealed that total survival rate of transplanted flaps and composite tissue

flaps was 95.3% (122/128). These finding showed free composite tissue transplantation

reduces amputation rate, good appearance, shortens length of hospital stay, reduces

complication and treatment cost.20

A study was conducted in Russian, among 31 patients with post burn face and

neck to reconstructive operations for post-burn face and neck. The triangle and

trapeziform skin facial flap plasty was performed in 24 patients, 7 patients were treated

by using vascularised tissue flap transplantation. The results revealed the survival rate

was 96.8 %. These finding showed using of triangle and trapeziform skin flap and

vascularized tissue flap transplantation is a safe procedure for reconstruction of burns

area in neck and face.21

The study was conducted in China, among 19 cases with soft tissue defects to

explore repair method of skin and soft tissue defects in lower extremities. The results

revealed that all wounds were healed primarily, the size of the flap range from 18 cm X

8cm to 40cm X 18cm. These finding showed that latissimusdorsi flap in various forms

can be satisfactory for repair of large skin and soft tissue defects in lower extremities.22

3) Reviews related to Knowledge of care of skin grafting among nursing students.

A study was conducted on Education and Empowerment of the Nursing

Assistant: Validating Their Important Role in Skin Care and Pressure Ulcer Prevention,

and Demonstrating Productivity Enhancement and cost saving. The educational

program included instruction on time-saving methods for increasing productivity in

15

bathing and incontinence care, and effectively promoted the importance of proper skin

care and pressure ulcer prevention techniques. The article is divided into 2 parts: A and

B parts, The result revealed that (certified nursing assistants) CNAs/( nursing

assistants)NAs were empowered in their integral caregiver roles. This program was part

of a larger, major process improvement initiative, but the rate of acquired pressure

ulcers declined from 2.17% in 2002 to 1.71% in 2003.The study concluded that this

educational program was considered a contributor to the improved patient outcomes.23

A retrograde study was conducted in African, on 108 patients, Harvesting Split

Thickness Skin in Areas of Scarcity, The aim of this study was to evaluate the outcome

split thickness skin graft harvested using sterile razor blade in an areas of scarcity.

The result revealed that The harvests were adequate in quantity and quality to cover the

desired areas to be covered. The grafts were well taken by the recipient areas and

technically there was no danger of deep bite. The study concluded that Split thickness

skin can be harvested using sterile razorblade in areas of scarcity.24

A study was conducted in China on 83; to cases evaluate the application of skin

and soft tissue expansion in the treatment of deformity due to extensive severe burn

injury and repair of severe deep electrical burned scalp and skull with fresh wound. The

result revealed that all of the cases were successfully treated with little pain and

minimized infection. The finding showed that skin and soft tissue expansion in a safe

and reliable measure in the treatment of deformity in extensive severe burn.25

A study was conducted in Austria, on 45 patients to the need for flaps in burn

surgery the aim of this study is to give more detailed information about the need for

flaps in burn surgery, they received 53 flaps. In 53% the cause of accident was flame, in

22% scald and in 24% electrical burn. The results revealed that all the cases reached

16

good results. These findings showed that Limb salvage was the dominant indication for

primary reconstruction compared to the improvement of function and aesthetics for

secondary reconstruction.26

A study was conducted in China, among 24 patients with extensive deep burns

to evaluate the economic significance of meek skin grafting and auto micro grafting

divided in to two groups that is meek skin grafting group and auto micro grafting group.

In each group with 12 patients the results revealed that wound healing time,

consumption of each special dressing, total cost of hospitalization and rehabilitation

cost of meek skin grafting group was (14.4+/-1.9) d, yen (16590+/- 521), yen (421

628+/- 145), yen (39571+/- 225), and in micro grafting group was (25.6+/-4.2)d, yen

(136441+/- 356), yen (539 526+/- 686), yen (55853+/- 794), the statistical difference

between each group was (p<0.01). These finding showed that meek skin grafting has a

lower therapeutic cost and better therapeutic effects as compared with auto micro

grafting.27

A study was conducted in Brazil. On 779 of the 1001 students from the Medical

School, Federal University of Bahia, Brazil, and Knowledge about transplantation and

attitudes toward organ donation, a survey among medical students knowledge about

transplantation issues, and willingness to donate organs that is 47.7% skin donation. The

results revealed that study support a greater emphasis on providing information

regarding transplantation in medical schools to improve the knowledge of future heath

care professionals about transplantation and organ donation issues.28

4) Reviews related to Role of nurse regarding care of skin grafting.

A study was conducted in India, all burn cases (n=412) admitted to the burns

unit of M. Y. Hospital, the study was done to investigate the epidemiology of various

17

causations and their outcomes in terms of morbidity and mortality. Also, the effect of

social stigma and cultural issues associated with burns on the victim and his family was

assessed.The result revealed that Burns were found more commonly in middle-aged

groups. The incidence was more in females as an absolute number (70.3%) as well as

when stratified by age. Most burns were domestic, with cooking being the most

prevalent activity. Flame (80.3%) was the most common agent. Most of the cases of

burn were accidental (67.7%).This study concluded that series provides an overview of

the most important aspects of burn injuries for hospital and non-hospital healthcare

workers.29

7. MATERIAL AND METHODS OF STUDY

7.1 SOURCES OF DATA

The data will be collected from internship nursing Students of selected nursing schools

at Hassan.

7.2 METHOD OF DATA COLLECTION

7.2.1 Research design:

Pre-experimental study with single group pre-test post-test design.

Schematic plan of the study

Group Pre-test Intervention Post-test

Single group 01 X 02

Key:

O -₁ Pretest knowledge of internship nursing students.

X - Video assisted Teaching on care of skin grafting.

18

O₂ - Posttest knowledge of internship nursing students.

7.2.2 Research setting:

The study will be conducted in selected nursing schools at Hassan.

7.2.3 Population:

The internship nursing students

Target population: All the Internship nursing students of nursing schools,

Hassan.

Accessible population: Internship nursing students of selected nursing schools,

Hassan.

7.2.4 Sample:

The internship-nursing students of selected nursing schools at Hassan, who fulfil the

inclusion criteria.

7.2.5 Sample size:

It consists of 60 internship-nursing students.

7.2.6 Sample technique:

Probability simple random sampling.

7.2.7 Collection of data:

Collection of data is done by using semi- structured questionnaires.

7.2.8 Selection tool:

Structured questionnaire consists of two sections

Section A- socio-demographic Data.

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Section B- Semi- Structured knowledge questionnaire on care of skin grafting.

7.3. Research approach: Evaluative approach.

8. VARIABLES

Independent variable: VAT on care of skin grafting.

Dependent variable: Knowledge of internship nursing students.

Extraneous variables: Socio demographic variables such as age, sex,

educational qualification, previous exposure to OT, mass media exposure on

skin grafting, Source of health information regarding care of Skin grafting.

9. PLAN FOR DATA ANALYSIS

Descriptive analysis: -The descriptive statistical analysis includes frequencies,

percentages, means, and Standard deviation.

Inferential statistics: - Chi square test will be used to calculate and analyses the

relationship between scores with selected variables. The paired‘t’ test will be

used to find out the significant difference between pre-test and post-test scores.

10. PILOT STUDY

The pilot study is planned with 10% of the population, which will be conducted during

the time of study and that will be excluded in the main study.

11. ETHICAL CONSIDERATION

Does the study require any interventions to be conducted on Human population?

20

Yes. Study requires any interventions to be conducted on Human population.

Has ethical clearance being obtained from your institution?

Yes. Ethical clearance has being obtained from Research committee of Nisarga

College of nursing Hassan.

HAS THE ETHICAL CLEARANCE TAKEN FROM THE HEAD OF THE

SELECTED NURSING SCHOOLS HASSAN?

Yes. The ethical consideration taken from the head of the selected nursing schools

Hassan.

12. LIST OF REFERENCES (VANCOUVER STYLE

1) Benjamin C Wood, MD; Chief Editor: Gregory Caputy, Skin Grafts ,Updated:

Jan 4, 2011, http://emedicine.medscape.com/article/1295109-overview.

2) M Anthony Rosales, Merri Bruntz, David G Armstrong. Gamma-irradiated

human skin allograft: a potential treatment modality for lower extremity ulcers

Blackwell Publishing Ltd and Medicalhelplines.com Inc 2004 .

International Wound Journal . Vol1No3, http://www.armstrong@usa.com.

3) Samir K. Jabaiti. Use of Lower Abdominal Full-Thickness Skin Grafts

forCoverage of Large Skin Defects, European Journal of Scientific Research

ISSN 1450-216X Vol.39 No.1 (2010), pp.134-142, © EuroJournals

Publishing, Inc. 2010. available from

http://www.eurojournals.com/ejsr.htm.

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4) Jaiswal AK, Aggarwal H, Solanki P, Lubana PS, Mathur RK, Odiya S.

Epidemiological and socio-cultural study of burn patients in M. Y. Hospital,

Indore, India. Indian J Plast Surg [serial online] 2007 [cited 2011 Dec

3];40:158-63. Available from: http://www.ijps.org/text.asp?

2007/40/2/158/33426.

5) Baumeister S, Dragu A, Jester A, Germann G, Menke H. The role of plastic and

reconstructive surgery within an interdisciplinary treatment concept for diabetic

ulcers of the foot. Klinik für Hand-, Plastische und Rekonstruktive Chirurgie,

Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Plastische und

Handchirurgie der Universität Heidelberg in German. Dtsch Med

Wochenschr. 2004 Mar 26;129(13):676-80. Available from:

http://www.ncbi.nlm.nih.gov/pubmed/PMID:15026963.

6) Available from: http://www.surgeryencyclopedia.com/Pa-St/Skin-Grafting.html.

7) Pendsey S . Peripheral vascular disease and diabetic foot syndrome. In: Anuja

MMS, Tripathy BB, Moses SGP , Chandalia , Das AK, Rao

PV,MadhuSU,editors. RSSDI Textbook of Diabetes Mellitus. 1st ed.

Hyderabad: RSSDI;2002.p.559-570, available from:

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