DISSERTATION PROTOCOL



DISSERTATION PROTOCOL

|1. |NAME OF THE CANDIDATE AND ADDRESS | ANITHA THANKACHAN. K. |

| | |D/O. K.M. THANKACHAN, |

| | |KARIMBADAKUZHIYIL (HOUSE), |

| | |CHEEYAMBAM, P.O. |

| | |PULPALLY, WAYANAD DIST |

| | |KERALA |

|2. |NAME OF THE INSTITUTION |HINA COLLEGE OF NURSING |

| | |YELAHANKA NEW TOWN, |

| | |BANGALORE-560 064 |

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

| | |(MEDICAL – SURGICAL NURSING) |

|4. |DATE OF ADMISSION TO COURSE |05/ 06/ 2009. |

|5. |TITLE OF THE TOPIC: |

| |“ASSESS THE EFFECTIVENESS OF SELF-INSTRUCTIONAL MODULE ON KNOWLEDGE AND PRACTICE REGARDING CHEST PHYSIOTHERAPY AMONG |

| |STAFF-NURSES WORKING IN POST-OPERATIVE WARDS IN SELECTED HOSPITALS AT BANGALORE”. |

6: BRIEF RESUME OF THE INTENDED WORK:-

6.1: NEED FOR THE STUDY:-

Chest physiotherapy is the term for a group of treatments designed to improve respiratory efficiency, promote expansion of lungs, strengthen respiratory muscle, eliminate secretions from the respiratory system and help the patient to breathe more freely and to get more oxygen into the body. The various methods of chest physiotherapy includes postural drainage, chest percussion, chest vibration, turning exercise, deep breathing exercise and coughing exercise. All these usually done in conjunction with other treatments such as suctioning, nebulizer treatments and administration of expectorant drugs.7

The study reported that chest physiotherapy is effective in patient with excessive bronchial secretions, evidence of retained secretions, lobar atelectasis and who produce greater than 30ml of sputum/day.17

A retrospective study conducted to assess anesthetic and surgical complication in 219cases, in this overall frequency of complication was 18/219. In this complications16/18 that is 88.88% were pulmonary complications. The investigator suggested, careful monitoring during early post-operative period, protection of upper airways, chest physiotherapy and incentive spirometry are mandatory in all post- operative patients.10

The author aimed to find-out the effectiveness of chest physiotherapy for preventing post-operative pulmonary and shoulder complications. The study conducted in 184 patients. In this 92 patients (Treatment group) receiving post-operative physiotherapy, and a control group (92 patients) receiving standard nursing care, medical intervention but no chest physiotherapy. The out come measured on the basis of (1) Incidence of post- operative pulmonary complication (2) Length of hospital stay and severity of pain. This study proved the effectiveness of chest physiotherapy for the patients in the ICU, and thus provides a frame work for evidence based practice for health care providers in the ICU.8

The study revealed that pulmonary complication is most frequent and significant contributor to morbidity, mortality and costs associated with surgery. Early recognition, diagnosis and management of these problems vary widely based on the knowledge and practice of care givers in the critical care unit. A sample of 150 registered nurses surveyed. Analysis indicated that the majority of respondent were ignorant about management of respiratory infection.9

The study revealed that about 70% of caregivers were ignorant regarding actual management of post- operative pulmonary complications. The investigator found that there is lack of knowledge and skill in the nursing practice and suggested the need for educational programmed for improving post operative out come.5

A study assessed that how nurses keep informed about the development related to the care of patient with post- operative pulmonary complication. The data were collected survey method and result of the study revealed that knowledge deficit in a selected group of nurses. And nurse managers are encouraged to identify educational needs in this area and to have in-service education to provide the best care for client with pulmonary complications.4

The author reported that the nurse should be aware of the patient’s diagnosis, the cardiac status and any structural deformities of the chest wall and spine. The nurse wants to assess the patient’s physical status, understanding of the treatment plan and compliance with the recommended therapy, as well as effectiveness of therapy. It is important to reports the patient’s physicians regarding any deterioration in the patient’s physical status and inability to clear secretion.1

The study described that the chest physiotherapy is treatment programmed that attempt to compensate for impaired mucocilliary clearing by removing mucopurulent secretion, it reduced airway obstruction and health care provider’s needs adequate knowledge regarding chest physiotherapy.20

Hence the investigator plan to develop self instructional module on knowledge and practice regarding chest physiotherapy among staff nurses working in post operative ward to the benefit of patient care.

6.2: REVIEW OF LITERATURE:-

The study reported that effect of deep breathing exercises, coughing exercise, and chest percussion on pulmonary function and arterial blood gas level after coronary artery bypass grafting surgery. In a postoperative random trial the patients performing these exercises (n=48) were compared to a control group (n=42) not performing any exercises. Patient performing exercises after coronary artery bypass grafting surgery had significantly smaller atelectasis areas and better pulmonary function on the fourth post -operative day compared to the control group. The study reveals deep breathing and respiratory therapy are effective modalities for reducing complication in post- operative units.19

The study stated that upper abdominal surgical procedures are known to adversely affect pulmonary complication and these pulmonary complications are the most frequent cause for post operatively pulmonary morbidity. Early assessment and post-operative management is essential for preventing these complications. Various techniques of physiotherapy includes chest physiotherapy, incentive spirometry are the most practical methods available for decreasing secretion13.

The study revealed that nearly 85% hospital inpatients who experiences pulmonary complication. Early identification of patient at risk can enable early intervention. It is therefore essential that the healthcare provider has a comprehensive working knowledge of how different organs interact. Respiratory care nurse requires a good understanding of anatomy physiology and pathology enable to take an effective clinical reasoning approach to problem management and treatment14.

A study reported that Nurse’s play a important role in managing patient with pulmonary complications, maintenance of airway secretion clearance or airway hygiene, prevention of respiratory tract infection are including in nurses role. This study suggest the effectiveness of physical method (Physical therapy and respiratory therapy) augment airway clearance are can be used in ICU for patient with pulmonary complications12.

The study reported that there is a lack of up-to-date literature for the nurses to refer. This study examines the nursing role in chest management, chest infection management by applying various modalities of management. And also found that there is deficit in knowledge and evidenced –based nursing care. It create a general uncertainty regarding care of patient with chest drain. Nursing managers are encouraged to identify educational needs in these fields.15

The study pointed that thoracic and upper abdominal surgery often leads to pulmonary complications. The chest physiotherapy should be performed before and after surgery for reducing the severity of these pulmonary complications and reduce the number of hospital stay. The author stated that the nursing staffs play a vital role in the provision of chest physiotherapy. But the actual therapies provided vary depending upon the provider knowledge and practice. While strong evidence for chest physiotherapy procedure shows that the nurses have lack of knowledge regarding the actual therapies. And the author suggested that it is an ideal setting for under taking clinical research.6

The study evaluated the effectiveness of chest physiotherapy for the prevention of post operative pulmonary complications. The study conducted in 874 patients undergoing abdominal surgery and reported that clinical benefits of prophylactic chest care and chest physiotherapy in post-operative wards to reduce pulmonary problems. And found that the background of knowledge, skill and intuition which guides the nursing practice. The study necessitates the importance of nursing practice education for improving post -operative outcomes.18

The study revealed the effectiveness of self instructional module (SIM) in terms of gained knowledge regarding nursing management of patient having chest tube drainage. In this quasi-experimental study the investigator systematically and randomly selected 100 staff nurses and single group pre-test, post test design was used to assess the existing knowledge and their improvement in the knowledge after introduction of SIM with in an interval of 7-10 days on individual basis. The information given through SIM proved beneficial in improving the knowledge and skill of 100 study subjects. SIM available with the subject could provide reinforcement in their day to day clinical knowledge and skill, which eventually improved the quality of care.11

STATEMENT OF PROBLEM:-

“Assess the effectiveness of self instructional module on knowledge and practice regarding chest physiotherapy among staff nurses working in post operative wards in selected hospitals, at Bangalore”.

6.3: OBJECTIVES OF THE STUDY:-

• To assess the knowledge of staff nurses regarding chest physiotherapy.

• To assess level of practice among staff nurses regarding chest physiotherapy.

• To evaluate the effectiveness of self instructional module among staff nurses regarding chest physiotherapy.

• To compare the knowledge and practices of nurses regarding chest physiotherapy with their demographic variables.

6.4: HYPOTHESIS:

H0:-There will be no difference between the pretest and post test score of the knowledge and practice of staff nurses.

H1:-There will be a significant difference between the level of knowledge and practice of staff nurses with the demographic variables.

6.5: OPERATIONAL DEFINITIONS:-

ASSESS:-

Statistical measurement of knowledge and practice score among staff nurses regarding chest physiotherapy.

EFFECTIVENESS:-

In this study it refers to the extent to which the self instructional module on chest physiotherapy achieves the desired effect in improving the knowledge and practices of staff nurses in post operative wards

SELF INSTRUCTIONAL MODULE:-

It is self instructional booklet which is planned and prepares that allows qualified staff nurses to learn by themselves regarding knowledge and practice regarding chest physiotherapy for preventing post- operative pulmonary complication.

KNOWLEDGE:-

It refers to the amount of information or awareness of staff nurses regarding the chest physiotherapy which is explored by the score of knowledge questionnaires.

PRACTICE:-

It refers to the verbal response of the doing of something rather than theories about it. That means doing of chest physiotherapy rather than theory about it.

CHEST PHYSIOTHERAPY:-

It is a group of therapies used to mobilize pulmonary secretions. These therapies include postural drainage, chest percussion, vibrations deep breathing exercise and coughing exercise.

STAFF NURSE:-

The male or female individuals who provide professional nursing care to the patients.

POST OPERATIVE WARDS:-

It refers to the highly equipped place especially for care of patient’s undergone surgery.

6.6: ASSUMPTIONS:-

• Staff Nurses will have some knowledge on chest physiotherapy.

• The knowledge of staff nurses influences the practice of chest physiotherapy.

7: MATERIALS AND METHODS:-

7.1: SOURCE OF DATA:-

Staff nurses working post -operative wards in selected hospitals at

Bangalore.

7.2: METHODS OF COLLECTION OF DATA:-

Data will be collected by investigator herself using structured closed

ended questionnaire and check list:- 7.2.1: RESEARCH DESIGN AND APPROCH:-

The research design adopted for this study will be quasi-

experimental design and one group pre and post test approach with

out a control group.

7.2.2: SETTING:-

This study will be conducted in post- operative wards of selected

hospitals at Bangalore.

7.2.3: POPULATION:-

The population of the present study will be the staff nurses

working in the post- operative wards of selected hospitals at

Bangalore.

7.2.4: SAMPLE SIZE:-

The sample size will be around 100.

7.2.5: SAMPLING TECHNIQUE:-

Purposive sampling technique will be used to select the samples for

the study

7.2.6: SAMPLING CRITERIA:-

INCLUSIVE CRITERIA:-

Staff nurses who are,

➢ working in post operative wards.

➢ available during data collection

➢ willing to participate in this study

➢ able to read and write Kannada and English.

EXCLUSIVE CRITERIA:-

Staff nurses who are,

not working in post operative wards

➢ not available during the period of data collection.

➢ not willing to participate in this study.

➢ not able to read and write Kannada and English.

7.2.7: DATA COLLECTION TOOL:-

• Structured closed ended questionnaire will be prepare and used for knowledge.

• Check list will be prepare and used for practice. Period of data collection:- The period of data collection will be from September/October 2010.

7.2.8: DATA ANALYSIS METHODS:-

• Appropriate descriptive and inferential statistics will be used for data analysis and presented in the form of tables, graphs and figures etc.

• The effectiveness of pre test post- test score of knowledge and practice will be analyzed by paired ‘T’ test.

• The significance of relation ship between the selected demographic variable and knowledge and practice score will be analyzed by using chi-square test.

7.3: DOES THE STUDY REQURE ANY INVESTIGATIONS OR INTERVENTION TO BE CONDUCTED ON OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.

-NO-

7.4: HAS THE ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?

Required ethical clearance will be obtained from the concerned authority before the main study.

8: LIST OF REFERENCES:-

BOOKS:-

1. Brunner & Suddarth’s, “Text book of medical surgical nursing”; 10thedition; (2003); Lippincott Company, Philadelphia; Page no:-605-08.

2. Patricia A potter ,“Fundamentals of nursing”; 6th edition; (2005); published by Elsevier; New Delhi; page no- 1030-40.

3. Sharon L Lewis “medical surgical nursing”, 7th Edition; (2008); Mosby Elsevier publication; New Delhi; Page no-646-649.

JOURNALS:-

4. Daniela Lehwldt, (2007); “The need for nurses to have to in-service education to provide best care for client with chest drains”; journal of nursing management; 15(2) 142-48.

5. Duff B, (2007); “the impact of surgical ward nurses practicing respiratory assessment on positive patient out come”; Physio therapy in intensive care; 24(4),52-6.

6. Gass E, (2009); “Patterns of chest physiotherapy in Australian intensive care units”; Journal of critical care; 19(3),145-151.

7. Jennifer trust for information sheet; N0-013, (2009); “chest physiotherapy in SMA-Physio therapy –theory and practice”; Critical care; 195(4),451-54..

8. Kristine Nicol,(2008); “does physiotherapy reduce the incidence of post

operative complication?”; Journal of cardio thoracic surgery, 48(3) ;30-2.

9. Mishoe S.C),(2001); “Critical thinking in respiratory care-a problem based

learning approach”; The Jennifer trust medical publications, 18(7),12.

10. Matheu J,(1997); “Anesthetic and surgical complications”, Aron on line

article, 20(1) 64-7.

11. Nancy A,(2002); “Impact of self instructional module for the nurses on

nursing management of the patient having chest tube drainage” Nursing

journal of India vol-2; 27/9.

12. Peres.A,(2009); “The nurses role in managing bronchiectasis” Nursing

Times,,4(2),105-13

13. Rezaiguia S, (1996), “Prevention of respiratory complication after

abdominal surgery ”; Ann Fr Anesth eanim, France,15(5), 623-46.

14. Routh Morley, (2007), “Respiratory physiotherapy”;British journal of surgery, 98(12),58-63.

15. Sullivan B, (2008); “nursing management of patient with a chest drain”; British journal for critical care nursing, London 17(6) 388-93.

16. S.Labeau, (2007) “ critical care nurses knowledge of evidence based guideline for preventing ventilated associated pneumonia”; AJCC American journal of critical care; vol-16(1),371-777.

17. Teik E, (2009); “chest physiotherapy in the intensive care unit”; published by Elsevier; vol -7, 39-47.

18. Telfer, (2007); “nursing perspectives in the management of infants and children requiring thoracic surgery”; Prog peditr –online; 27(2);30-2.

19. .Westerdhal. E,(2009); “chest physiotherapy with positive expiratory pressure breathing after abdominal and thoracic surgery”; Published by Elsveir;64(7),683-9.

20. .Zach MS,(1987); “chest physiotherapy-the mechanical approach to anti-infective therapy in cystic fibrosis”; Indexed for mediine; 15(5), 381-84.

| 9: |SIGNATURE OF THE STUDENT:- | |

|10: |REMARKS OF THE GUIDE: |

| |The study is useful for improving the knowledge and practice of staff nurses regarding chest physiotherapy. The need for study |

| |explained is appropriate; methodology is as per the statement of problem. Hence can be approved for undertaking this study. |

|11: |NAME AND DESIGNATION :- | |

|11.1: |GUIDE:- |Mrs. FAIROZA.M Associate Professor& HOD |

| | |Medical-surgical Nursing |

| | |Hina college of Nursing, Bangalore. |

|11.2: |SIGNATURE:- | |

| | |Mrs. FAIROZA.M |

|11.3: |HEAD OF THE DEPARTMENT:- |Associate Professor & HOD |

| | |Medical-surgical Nursing Henna college |

| | |of Nursing, Bangalore. |

|11.4: |SIGNATURE: | |

|12.1: |REMARKS OF THE CHAIRMAN AND PRINCIPAL:- |

| |The study is based on newer approach and approved by the research committee. Hence the study can be conducted. |

|12.2: |SIGNATURE:- | |

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