RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES



|RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES |

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|SYNOPSIS OF |

|THE M.SC.(N) DISSERTATION |

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|A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAM ON THE KNOWLEDGE OF RESPIRATORY THERAPY AMONG PATIENTS WITH|

|ABDOMINAL SURGERY ADMITTED IN A SELECTED HOSPITAL IN MANGALORE |

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|Submitted By: |

|Mr. Shinto Stephen |

|1st year M.Sc. Nursing student, |

|Srinivas Institute of Nursing Sciences, |

|Valachil Padavu, Arkula, |

|Mangalore – 574 143. |

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|Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. |

|ANNEXURE – II |

|PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION |

|1. |NAME OF THE CANDIDATE |MR. SHINTO STEPHEN |

| |AND ADDRESS |1st YEAR M. Sc. (NURSING) |

| |(IN BLOCK LETTERS) |MEDICAL SURGICAL NURSING |

| | | |

| | |SRINIVAS INSTITUTE OF NURSING SCIENCES, |

| | |VALACHIL PADAVU, ARKULA, |

| | |MANGALORE – 574 143. |

|2. |NAME OF THE INSTITUTION |SRINIVAS INSTITUTE OF NURSING SCIENCES, |

| | |VALACHIL PADAVU, ARKULA, |

| | |MANGALORE – 574 143. |

|3. |COURSE OF STUDY SUBJECT |M.Sc. NURSING |

| | |MEDICAL SURGICAL NURSING |

|4. |DATE OF ADMISSION |31-05-2010 |

|5. |TITLE OF THE TOPIC. |

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| |A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAM ON THE KNOWLEDGE OF RESPIRATORY THERAPY AMONG PATIENTS |

| |WITH ABDOMINAL SURGERY ADMITTED IN A SELECTED HOSPITAL IN MANGALORE |

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|6. |BRIEF RESUME OF INTENDED WORK |

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| |6.1. Introduction |

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| |“In order to experience health ,joy and creative fulfillment we must make systematic application of exercise in our |

| |daily life” |

| |- Swami Vivekananda |

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| |The lungs are the organs of respiration in humans. Our lungs fuel us with oxygen, the body's life-sustaining gas. They |

| |breathe in air, then extract the oxygen and pass it into the bloodstream, where it's rushed off to the tissues and |

| |organs that require it to function. Lung is the essential respiration organ in all human beings. Respiration is the |

| |transport of oxygen from the outside air to the cells within tissues, and the transport of carbon dioxide in the |

| |opposite direction: the metabolic process by which an organism obtains energy by reacting oxygen with |

| |glucose to give water, carbon dioxide and adenosine triphosphate. Respiration includes the inhalation-exhalation |

| |process. In this process, the unwanted gas expelled is mainly carbon dioxide. This is then replaced during the |

| |inhalation breathing phase by the oxygen content within the air inhaled. During this process, via the sacs of the |

| |lungs, an exchange of gases first occurs as the blood exchanges carbon dioxide from the body with fresh oxygen. Oxygen |

| |attaches to the red blood cells in the blood, and later is diffused from the bloodstream into the intercellular spaces,|

| |and eventually diffuses into the cells for use by the cells.1 |

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| |Surgery whether elective or emergency is a stressful complex environment. As lungs are thoracic organs, any surgery |

| |related to thoracic or abdomen can cause pulmonary complications, especially upper abdominal surgical procedures are |

| |known to adversely affect pulmonary function and cause complications. Pulmonary complications among the most common |

| |causes of post operative morbidity and mortality and are estimated to occur after 5% to 7% of all surgeries. The |

| |incidence of complication following upper abdominal and thoracic surgery is between 20% to 40% in patient.2 |

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| |In abdominal surgery the patient may have reduced lung volume and require great efforts to deep breathing and cough. |

| |Decreased cognition has been cited as a risk factor for nosocomial pneumonia due to increased risk for aspiration |

| |because of the inability to cough and manage secretions. Inadequate lung expansion and general anesthesia with |

| |controlled ventilation has a negative effect on respiratory function. In most patients post operative pain, drugs, |

| |immobilization and pre existing lung disease all play a major role in the development of pulmonary complications such |

| |as atelectasis and pneumonia. The post operative patient is at high risk for atelectasis because of the numerous |

| |respiratory changes that may occur. A monotonous low tidal breathing pattern may cause airway closure and alveolar |

| |collapse. This result from the effect of anesthesia supine positioning, splinting chest walls because of pain and |

| |abdominal distension.3 |

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| |Respiratory therapy is an allied health field involved in the assessment and treatment of pulmonary complications after|

| |surgery including chronic lung problems, such as asthma, bronchitis, emphysema, and chronic obstructive pulmonary |

| |disease (COPD), and the respiratory components of acute multisystemic conditions such as heart attacks and stroke.4 |

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| |Pre operative teaching is an important component in the client’s operative experience. Certain factors may predispose |

| |the patient to post operative complications depending upon the type of surgery they undergo. Among these complications |

| |the pulmonary complications are most frequent and serious problems that confront the surgical team Nurses have long |

| |recognized and value of pre operative instruction. The program of instruction should be based on the individual |

| |learning needs. Multiple teaching strategies should be used depending of the patients need and abilities. Pre operative|

| |teaching should start in the physician’s office and continue until the patient arrives in the operating room.3 |

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| |6.2. Need For The Study |

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| |The pulmonary problems continue to constitute to most frequent post operative complications particularly after |

| |abdominal surgery. Pneumonia and atelectasis is the most common of all post operative complications. The mayo clinical |

| |report on surgery of the stomach and deuodenum noted that 25% of hospital deaths were due to pneumonia and atelectasis |

| |in 10% of operations of thorax or upper part of abdomen .The pulmonary changes occurs in 41.9% of patients with gall |

| |bladder after elective surgery at least 2 wks preoperatively exercises emphasizing deep abdominal diaphragmatic breaths|

| |and productive coughing is most rewarding.2 |

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| |A study reported that the patient mastering of exercises behavior pre operatively for use of post operatively. after |

| |studying 130 presurgical cholecystectomy and hernioraphy patients results showed that patient those received specific |

| |exercises instructions performed significantly better than those received non-specific exercise instruction.5 |

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| |A prospective study evaluates the pulmonary complications after upper abdominal surgery. After studying 67 upper |

| |abdominal surgical patients 37 (54.3%) had pulmonary complications forming the single largest cause of morbidity and |

| |mortality in post operative period. Hence study suggested the need for prophylactic measures pre operatively and in |

| |the early post operative period.6 |

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| |The General anesthesia and surgery are the main causes of postoperative respiratory complications. Atelectasis, a |

| |common respiratory complication, may contribute to pneumonia and acute respiratory failure. Recently, it has been shown|

| |that activation of abdominal muscles during the induction of anesthesia contributes to a reduction of lung capacity, |

| |leading to a higher degree of atelectasis. Additionally, long-term mortality at 5 and 10 years has recently been shown |

| |to remain significantly increased in patients with respiratory complications. Prevention or early respiratory therapy |

| |of respiratory complications may, therefore, be beneficial in improving outcome in postoperative patients.7 |

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| |In a study, it showed that total 1,055 consecutive patients who attended the University of Alberta Pre-Admission Clinic|

| |between June 2001 and October 2003. The mean age was 55 years, 531 (50%) were men, and 28(2.7%) suffered a pulmonary |

| |complication within 7 days of surgery: 13 developed respiratory failure requiring ventilatory support, 9 postoperative |

| |pneumonia, 5 atelectasis requiring bronchoscopic intervention, 1 pneumothorax requiring intervention. One of the |

| |patients who developed postoperative pneumonia subsequently died. Lengths of stay were substantially prolonged for |

| |those patients who developed pulmonary complications within 7 days of surgery.8 |

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| |A Study was done on the Prevention of respiratory complications after abdominal surgery: a randomized clinical trial |

| |to evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of |

| |incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive |

| |spirometry plus physiotherapy for high risk patients was done on 456 patients undergoing abdominal surgery showed |

| |that, the most efficient regimen of prophylaxis against respiratory complications after abdominal surgery is deep |

| |breathing exercises for low risk patients and incentive spirometry for high risk patients.9 |

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| |Health promotion activities during the pre operative phase focus on prevention of complications. |

| |Health maintenance and support of possible rehabilitation needs post operatively. Pre operative |

| |teaching is most useful when started the week before admission and reinforced immediately before surgery. Every |

| |operative teaching program include explanation and demonstration of the five post operative |

| |exercises such as Diaphragmatic breathing, incentive spirometry , controlled coughing turning and leg |

| |exercises.10 |

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| |Patient education support patients to live the best possible quality of life. It instills patient’s self confidence to |

| |help them carry out behavior necessary to reach a desired goal. The selected exercises are simple and economical in the|

| |sense that they do not need any expensive devices. The exercises are practical in terms of practice and administration.|

| |There is no recent study on effect of respiratory therapy among abdominal surgical patients in Mangalore region and |

| |also in this population. The investigator would like to under take the present study to evaluate abdominal surgical |

| |patients who are admitted in selected hospitals in Mangalore, to improve their knowledge and practice on respiratory |

| |therapy by administering a structured teaching programe. Hence the study is relevant to this area, to this population, |

| |and to this period. |

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| |6.3. Review of Literature |

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| |6.3.1 Review of literature on post operative pulmonary complications |

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| |A study was conducted to see the extent of respiratory morbidity in the general surgical unit of a tertiary care |

| |hospital and look for probable factors that were responsible for them. The findings of the study reveals that 13.9% of |

| |the patients developed respiratory complications out of which pneumonia was the most common complication (68%) with |

| |respect to the type of surgery performed. Patient who underwent upper abdominal surgery either elective or emergency |

| |had a huge rate of complications.11 |

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| |A study reported that post operative atelectasis generally occurs within 48 hours. It is an extremely common post |

| |operative complication with some degree of pulmonary collapse occurring after almost every abdominal or trans thoracic |

| |procedure. Mucus is retained in the bronchial tree, blocking the finer bronchi and the alveolar air is then reabsorbed |

| |with collapse of the supplied lung segments usually the basal lobes. The collapsed lung may become secondarily infected|

| |by inhaled organisms.12 |

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| |6.3.2 Review of literature on preventive measures of post operative |

| |pulmonary complications |

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| |A study reported that bronchial hygiene therapy is used to describe various airway clearance techniques chest |

| |physiotherapy (with consist of postural drainage, percussion, vibration, coughing and suctioning) breathing exercise |

| |(such as huffing and diaphragmatic) and manual hyperventilation. The purpose of bronchial hygienic therapy is to |

| |improve the clearance of secretion, thereby decreasing airway obstruction, enhancing ventilation and gas exchange.13 |

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| |A study was done on Prevention of respiratory complications after abdominal surgery stated that Preoperative therapy |

| |for elective surgery with training in cough and lung expansion techniques should begin at least 24 to 48 hours |

| |preoperatively. Postoperative therapy should be continued for 3 to 5 days. Usually, anesthesia is responsible for early|

| |complications, whereas surgical procedures are often associated with delayed morbidity. Regional anesthesia is given as|

| |having less adverse effects on pulmonary function than general anesthesia. The various techniques of physiotherapy |

| |(chest physiotherapy, incentive spirometry, continuous positive airway pressure breathing) seem to be equivalent in |

| |efficacy. Chest physiotherapy and incentive spirometry are the most practical methods available for decreasing |

| |secretion contents of airways, whereas continuous positive airway pressure breathing is efficient on atelectasis.14 |

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| |A study was done to quantitatively assess the conflicting body of literature concerning the efficacy of incentive |

| |spirometry (IS), intermittent positive pressure breathing (IPPB), and deep breathing exercises (DBEX) in the prevention|

| |of postoperative pulmonary complications in patients undergoing upper abdominal surgery reported that  Incentive |

| |spirometry and DBEX appear to be more effective than no physical therapy intervention in the prevention of |

| |postoperative pulmonary complications.15 |

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| |6.3.3 Review of literature on effectiveness of pre operative teaching |

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| |A study was conducted on 49 patients admitted for undergoing abdominal surgeries. Structured pre operative teaching was|

| |given on deep breathing exercise and coughing exercise. An observational checklist was used to indicate that the |

| |patient could perform deep breathing and coughing exercise structured pre operative preparations significantly improved|

| |the ability of patient’s deep breathing and coughing post operatively as measured by pulmonary function test (PFT). |

| |Structured teaching programe improved their knowledge, decrease pulmonary complication and reduced the mean length of |

| |hospital stay.16 |

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| |An experimental study at a community health centre in California. The sample was 50 adults scheduled for open|

| |abdominal surgery. The findings were the preoperative patients who received pre admission structured education had |

| |improved knowledge. Clinical outcomes are more satisfied and more likely to meet the targeted discharge date and return|

| |to prior functional stay sooner.16 |

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| |6.3.4 Review of literature on knowledge and practice |

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| |A study was done on the evaluation of nurses and student nurses knowledge of incentive spirometry. The purpose of this |

| |study was to evaluate nurses? And student nurses? Knowledge of incentive spirometry. This is important because nurses |

| |are taking more responsibility in the education and teaching of incentive spirometry to patients. There were 137 |

| |respondents. Scores on the 12-point questionnaire ranged from 4 to 12, with a mean score of 8.52. The study |

| |demonstrated that the nurses and student nurses have adequate knowledge of the indications for using incentive |

| |spirometry and on proper technique. However, they lack knowledge concerning the goals and effectiveness of incentive |

| |spirometry.17 |

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| |A study on the Evaluation of Current Knowledge, Awareness and Practice of Spirometry among Hospital -based Nigerian |

| |Doctors. The aim of this study was to evaluate the current knowledge, awareness and practice of spirometry among |

| |hospital-based Nigerian doctors. 321 doctors that participated, Irrespective of access to a spirometer or the type of |

| |hospital they were employed in, doctors reported that unavailability of a spirometer was the greatest barrier to its |

| |use (62.5%) followed by lack of awareness about its usefulness (17.2%). The knowledge and practice of |

| |spirometry were poor among hospital-based Nigerian doctors because of unavailability of spirometers in most hospitals. |

| |These findings have implications for further evaluation, planning and management of patient care in respiratory |

| |disease.18 |

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| |6.3.5 Review of literature on related studies |

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| |A study was done on incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications |

| |after abdominal surgery. It was done on 876 patients into a clinical trial aimed at preventing pulmonary complications |

| |after abdominal surgery. Patients either received conventional chest physiotherapy or were encouraged to perform |

| |maximal inspiratory manoeuvres for 5 min during each hour while awake, using an incentive spirometer. The incidence of |

| |pulmonary complication did not differ significantly between the groups incentive spirometry 68 of 431 (15.8%) and chest|

| |physiotherapy 68 of 445 (15.3%). It concluded that prophylactic incentive spirometry and chest physiotherapy are of |

| |equivalent clinical efficacy in the general management of patients undergoing abdominal surgery.19 |

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| |A study was done on the Strategies To Reduce Postoperative Pulmonary Complications after Noncardiothoracic Surgery to |

| |systematically review the literature on interventions to prevent postoperative pulmonary complications after |

| |noncardiothoracic surgery.  The authors qualitatively synthesized, without meta-analysis, evidence from eligible |

| |studies. Evidence (2 systematic reviews, |

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| |5 additional RCTs) indicates that lung expansion interventions (for example, incentive spirometry, deep breathing |

| |exercises, and continuous positive airway pressure) reduce pulmonary risk. The evidence is conflicting or insufficient |

| |for preoperative smoking cessation (1 RCT), epidural anesthesia (2 meta-analyses), epidural analgesia (6 RCTs, 1 |

| |meta-analysis), and laparoscopic (vs. open) operations (1 systematic review, 1 meta-analysis, 2 additional RCTs), |

| |although laparoscopic operations reduce pain and pulmonary compromise as measured by spirometry. Interventions have |

| |been shown to clearly or possibly reduce postoperative pulmonary complications.20 |

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| |6.4 Statement of the Problem |

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| |A study to assess the effectiveness of structured teaching program on the knowledge of respiratory therapy among |

| |patients with abdominal surgery admitted in a selected hospital in Mangalore. |

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| |6.5. Objectives of the Study |

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| |objectives of the study are to |

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| |Assess the pretest level of knowledge of respiratory therapy among the patients in the pre operative period. |

| |Develop and administer structured teaching program on respiratory therapy to the patients during the pre operative |

| |period and evaluate the effectiveness of S T P on knowledge of respiratory therapy among the patients during the post |

| |operative period. |

| |Assess the effectiveness of structured teaching program on knowledge of patients regarding respiratory therapy. |

| |Find out the association between pretest knowledge and selected demographic variables among the patients. |

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| |6.6. Operational Definitions |

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| |Effectiveness:- In this study effectiveness refers to the extend to which the S T P delivered has achieved the |

| |desired improvement as assessed by gain in knowledge of patients on respiratory therapy. |

| |Structured teaching program:- It refers to the structured learning material to improve the knowledge of patients |

| |regarding meaning, purpose and importance of respiratory therapy after abdominal surgery. |

| |Knowledge :- In this study knowledge refers to the correct responses to the items to the questionnaire on respiratory |

| |therapy which is measured by structured knowledge questionnaire and the content area include meaning, purpose, |

| |importance, steps and procedure associated with respiratory therapy after surgery. |

| |Respiratory therapy:- Respiratory therapy is an allied health field  involved in the assessment and treatment of |

| |breathing disorders including chronic lung problems (asthma, bronchitis, emphysema, and  COPD), and the respiratory |

| |components of acute multisystemic conditions (heart attack and stroke) by breathing exercise, coughing techniques |

| |,incentive spirometer, chest physiotherapy, turning exercise and ambulation. |

| |Patients: - In this study patients refer to the persons undergoing abdominal surgery. |

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| |6.7. Assumptions |

| |The post operative patients may not have adequate knowledge regarding respiratory therapy. |

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| |S T P can improve knowledge of patients regarding respiratory therapy. |

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| |6.8. Delimitations |

| |The study will be limited only |

| |Admitted in selected hospitals of Mangalore. |

| |Who have abdominal surgery. |

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| |6.9. Hypotheses |

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| |Research hypotheses |

| |H1-The mean post-test knowledge score of post operative patients will be significantly higher than the mean pre-test |

| |knowledge score. |

| |H2-There will be a significant association between pre-test knowledge and selected demographic variables such as age,|

| |sex, education, occupation, socio economic status, previous exposure to information. |

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| |MATERIALS AND METHODS |

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| |7.1 Source of Data |

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| |Data will be collected from pre and post operative patients undergoing abdominal surgery admitted in selected hospitals|

| |at Mangalore who fulfill the inclusion criteria. |

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| |7.2 Research Design |

| |One group pre test post test pre experimental design. |

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| |O1 X O2 |

| |(DAY1) (DAY 1) (DAY 7) |

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| |O1 – Pre Test |

| |O2 – Post Test |

| |X - Administration of STP |

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| |7.2.1 SCHEMATIC OUTLINE OF RESEARCH DESIGN |

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| |7.3 Setting |

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| |Study will be conducted in a selected hospital in Mangalore. |

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| |7.4 Population |

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| |The population selected for the study will be all the preoperative and post operative patients with thoracic or |

| |abdominal surgery who are admitted in a selected hospital in Mangalore. |

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| |7.5. Method of Data Collection |

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| |A written permission will be obtained from the concerned authority of selected hospitals by explaining the purpose of |

| |study. The objectives of the study will be explained to the participants and informed consent will be obtained from the|

| |subjects. The investigator will introduce him self to the participants and the tool is administered pre operatively. |

| |The questionnaire will be collected back and on the same day a well designed teaching program on respiratory therapy |

| |will be given among the participants with proper explanation. After seven days a post test will be conducted by using |

| |same questionnaire and checklist post operatively. |

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| |7.5.1. Sampling Procedure |

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| |The sampling technique will be non probability purposive sampling. |

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| |7.5.2. Sample Size |

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| |The data will be collected from 40 patients who meet the inclusion criteria. |

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| |7.5.3. Inclusion Criteria for Sampling |

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| |Pre and post operative patients with abdominal surgery who are admitted in selected hospitals. |

| |Patients who are present on the day of data collection and willing to participate. |

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| |7.5.4. Exclusion Criteria for Sampling |

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| |Patients who cannot read and write Kannada/English. |

| |Patients who cannot perform self care. |

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| |7.5.5. Instrument Used |

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| |A self administered structured questionnaire to asses the knowledge of patients on respiratory therapy. The instrument|

| |consists of Two sections. |

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| |Section A: Demographic variables consist of base line information of patients regarding age, sex, education, |

| |occupation, socio economic condition, previous exposure to information. |

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| |Section B: Structured questionnaire consisting items regarding knowledge on respiratory therapy such as |

| |Meaning of respiratory therapy |

| |Types of respiratory therapy |

|7. |Importance of respiratory therapy after surgery |

| |Steps & procedures of therapy |

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| |7.6 Data Analysis Plan |

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| |The data will be analyzed using descriptive and inferential statistics. |

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| |By using frequency, percentage, ratio, standard deviation, mean, paired “t “test Correlation &Chi-square. |

| |The knowledge scores will be calculated &represented on tables, diagrams &graphs. |

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| |7.7. Does the study require any investigation or intervention to be conducted on patient or other human or animals? If |

| |it so please describe briefly. |

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| |No ‘this study does not require any investigation or interventions to be conducted on patients or animals. |

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| |7.8. Has ethical clearance been obtained from your institution in case of 7.3? |

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| |The proposal has been accepted and recommended by the institutional ethical committees. |

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| |REFERENCES |

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| |Maton, Anthea, Jean Hopkins, Charles William McLaughlin, Susan Johnson, Maryannaquon Warner, David Lahars. Human |

| |biology and health. 3rd Ed. Englewood cliffs : Newjersey USA ; 1993. |

| |Curitis James. Management of surgical complications. 3rd Ed. Philadelphia, w b saunders ; 1975. |

| |Smeltzer C, Bare G, Editors. Brunner’s and Suddarths text book of medical surgical nursing. 10th rev Ed. Philadelphia, |

| |Lippincott Williams and Wilkens ; 2004. |

| |Drasin G. Respiratory care. Am j respire crit care med 2009 ; 36 (2) : available from |

| | |

| |Brunner Scoltis, Suddarth Smith. Text book of medical surgical nursing. 6th Ed. Philadelphia, j d Lippincott ; 1988. |

| |Deodhar SD, Mohiti JD, Sgirahatti RG, Joshi S. Pulmonary complications of upper abdominal surgery. Postgrade med. 1991 |

| |; 13 (7) : 88-92. |

| |Chinn S. Statistics for the European respiratory journal. Eur respir j. 2001 Aug 18 ; 18 : 393-401. |

| |Finlay A. McAlister, Kimberly Bertsch, Jeremy Man, John Bradley and Michael Jacka. Incidence of and risk factors for |

| |pulmonary complications after non thoracic surgery. Amj respire crit care med. 2005 ; 171 (1) : 514-517. |

| |John C Hall, Richard A Tarala, Jeff Tapper, Jane L Hall. Complications after abdominal surgery: a randomized clinical |

| |trial.bmj. 1996 Jan 20 ; 312 (7024) : 148-52. |

| |Potter and Perry G. Basic nursing. 5th Ed. New Delhi : Mosby publication ; 2004. |

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| |Litwack K. Post operative pulmonary complication. Respir Care Clin N Am. 1997 March ; 3 (1) : 77-80. |

| |Casey JM. Post operative atelectasis. Br j surg. 2004 oct ; 55 : 85-91. |

| |Lynda Thomas. Bronchial hygiene therapy. Am j of nurs. 2002 jan ; 102 (1) : 37-42. |

| |Rezaiguia S, Jayr C. Prevention of respiratory complications after abdominal surgery. Ann fr anesth Reanim. 1996 ; 15 |

| |(5) : 623-46. |

| |Thomas JA, McIntosh JM. Effectiveness of prevention of respiratory therapy after abdominal surgery, physiother res |

| |int. 1994 Jan ; 74 (1) : 3-10. |

| |D’souzakiranasha. Evaluation of protocols on pre operative and immediate post operative nursing care of general |

| |abdominal surgical patients (dissertation) Rajiv Gandhi University of Health Science ; 1998. |

| |Amber Mattsey, Alena Graddy. Respiratory care, respire care clin N Am. 2001nov ; 113 : 17-23. available from |

| |. |

| |Ruppel G, Spirometry, Ann thorac med. 2008 Apr 3 ; (2) : 2-6 available from |

| |. |

| |Hall John, J Tapper, R Tarala. Incentive spirimetry versus routine chest physiotherapy for prevention of pulmonary |

| |complications after abdominal surgery. Lancet 1991 ; 337 : 953-56. |

| |A Valerie, E John, W Gerald. Strategies to reduce post operative pulmonary complications after noncardiothoracic |

| |surgery, Ann intern med. 2006 Apr ; 18:8 (144) : 596-608. |

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ANALYSIS

ATTRIBUTES

Age, sex, education, occupation, socio economic status, previous exposure to information.

INDEPENDENT

STP

DEPENDENT

Knowledge on respiratory therapy

VARIABLES

Paired “t” test for significance of difference between the pretest and the post test score, Chi square test for association between pretest and socio demographic variables.

Mean, standard deviation and

Percentage of knowledge

and practice on respiratory therapy

Frequency and percentage distribution of socio demographic variables

TOOL

Knowledge questionnaire

STUDY SETTING

Selected hospitals in Mangalore

STUDY SAMPLE

40 patients

FINDING, DISCUSSION AND CONCLUSION

SAMPLE TECHNIQUE

Non- random Purposive Sampling

POPULATION

Preoperative patients those who are undergoing abdominal surgery

DESIGN

One group pre-test post –test pre experimental study design

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