RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

|1. |NAME OF THE CANDIDATE AND ADDRESS |Ms. MOUSUMI DEBNATH |

| | |GOUTHAM COLLEGE OF NURSING |

| | |MANJUNATHNAGAR |

| | |WEST OF CHORD ROAD |

| | |RAJAJINAGAR, BANGALORE-560 010 |

|2. |NAME OF THE INSTITUTE |GOUTHAM COLLEGE OF NURSING |

| | |MANJUNATH NAGAR |

| | |WEST OF CHORD ROAD |

| | |RAJAJINAGAR, BANGALORE-560 010 |

|3. |COURSE OF THE STUDY AND SUBJECT |M.Sc. NURSING I YEAR |

| | |MEDICAL SURGICAL NURSING |

|4. |DATE OF ADMISSION TO COURSE |30/5/2007 |

| | | |

| | | |

|5. |TITLE OF THE TOPIC | A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME |

| | |ON IMMEDIATE POSTOPERATIVE SELF CARE AMONG PATIENTS FOLLOWING CATARACT |

| | |SURGERY AT A SELECTED EYE HOSPITAL IN BANGALORE. |

| | | |

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|6. |BRIEF RESUME OF THE INTENDED WORK: |

|6.1 |NEED FOR THE STUDY: |

| | |

| |Cataract is the leading cause of blindness accounting for 55% blindness world wise. It is currently estimated |

| |that there are over 20 million people blind from cataract in the world and it is mostly prevalent in people over |

| |50 years. World Health Organization survey has shown that there is a backlog of over 22 million blindness in |

| |India and 80.1% blindness are due to cataract .The annual incidence of cataract blindness is about 3.8 million. |

| |In Karnataka the prevalence is about 1-1.49% 1 |

| | |

| |Literature reveals that patient education that should begin pre operatively regarding diagnosis, prognosis, |

| |anaesthesia, surgical procedure, risks and benefits, postoperative self-care, required visits are the vital part |

| |of comprehensive management. Re-education is needed regarding numerous misconceptions and misinformation that the|

| |patient has previously attained regarding the diagnosis and surgical procedure.2 Study reveals that patient who |

| |are anxious before surgery experience more postoperative complication and recover in convalescence more slowly |

| |whereas explanation and reassurance at preoperative period dissipates fear, thereby help to promote recovery and|

| |reduce postoperative discomfort.3 |

| | |

| |As we embark upon the 21st century cataract surgery has become one of the most frequent, commonest and safest |

| |procedures performed in ophthalmology department. Phacoemulsification is the most recent innovation and most |

| |frequently used micro incision technique in extracapsular extraction. Phacoemulsification accounts for 98% of |

| |cataract surgery. Study reveals that successful return to useful vision is accomplished by more than 95% of |

| |patients after surgery.4 According to World Health Organization to tackle the rising incidence, 5-6 million |

| |cataract operations annually will have to be performed as against the present rate of 1.7 million per year. India|

| |is undertaking a new long term initiative to expand the capability of cataract surgery and service levels with |

| |financial assistance from the World Bank.1 |

| | |

| |American Academy of Ophthalmology has developed a series of guidelines called preferred practice pattern that |

| |identify characteristics and need for component of quality of self care after ophthalmic surgery.4 It is |

| |recommended that patients should have a sound knowledge regarding immediate post operative self care which will |

| |also help to prevent post operative complications as well as help the patient gaining of feeling of well being. |

| |It has been recommended that patient’s self care after cataract surgery regarding maintaining rigorous aseptic |

| |technique while instilling eye drops will minimize risk of infections, early recognization of complication may |

| |reduce the risk of permanent vision loss, maintaining proper position may decrease the risk of edema at the |

| |operated site, limitation of activities like, coughing, sneezing and strenuous activities may prevent |

| |complication such as vitreal prolapse which may be caused due to increased wound tension.5 |

| | |

| |Following cataract surgery and very short recovery period, patients are normally discharged to their home .The |

| |criteria for discharge include stable vital signs, return to preoperative mental state, absence of nausea and |

| |significant pain, an understanding of the postoperative instructions for the first twenty four hours including |

| |relief of pain, a written review of post operative instructions, a clear understanding of the follow up |

| |appointment schedule for the following days.4 Nurse should recognize the importance of their involvement in |

| |education programme. Some patients receive conflicting guidance from nurses that can affect their compliance with|

| |postoperative follow up, and a qualified nurse described how her mother received no information when she admitted|

| |to a day surgery unit leading to misunderstanding about the aftercare.6 |

| | |

| |The frequency of examination during the postoperative periods is determined by the surgeons experience and the |

| |patient’s need. Postoperative examinations provides the opportunity to provide post operative care as healing |

| |progress, educate and support the patient during the postoperative period, identify diagnose and treat any |

| |complications that may arise after the surgery. The suggested guidelines for normal follow up examinations of the|

| |patients without sign and symptoms of complications is first visit during the first day following surgery, second|

| |visit within first months following surgery, additional visit as necessary throughout the global period. Study |

| |reveals that failure of routine review may result in the failure to detect significant postoperative |

| |complications.4 |

| | |

| |In view of the above and researcher’s clinical experience the researcher is of opinion that patients following |

| |cataract surgery should be well equipped with knowledge and skills to perform self care and keep the patients |

| |independent within their limitations. It has been recommended in various studies that pre operative Structured |

| |Teaching Programme can reduce the fear and anxiety and increase their knowledge regarding post operative self |

| |care to meet activities of daily living. In this respect,nursing personnel are the most responsible persons to |

| |improve the independence of patients by increasing their knowledge so that the goal of surgery is achieved by the|

| |provision of stable improved vision. World Health Organization (WHO) has launched “Vision 2020-the right to |

| |sight”. The researcher has been inspired to take a small step through this research work. Researcher is |

| |interested to take up the study to enhance the knowledge of patients regarding self care who has undergone |

| |surgery to remove any misconception regarding this and there by helping in increasing the quality of life of the |

| |patients. |

|6.2 |REVIEW OF LITERATURE: |

| | |

| |The extensive Review of literature has been done and it is organized according to the following headings: |

| | |

| |Studies related to patient information following cataract surgery during preoperative period: |

| | |

| |A study was conducted on effect of structured preoperative teaching on anxiety levels of patients scheduled for |

| |cataract surgery. It has been found that structured preoperative instructions has clinical significance on |

| |anxiety level and blood pressure. A positive co-relation was also evident between blood pressure and structured |

| |preoperative teaching. Anticipatory planning can reduce the patient’s dependence on others. Items needed for self|

| |care, for example, slippers, pet supplies can be temporarily relocated for easy access. Frail older patients |

| |without strong family or social supports may need a brief admission to an assisted living facility.7 |

| | |

| |A study was conducted to find out whether patients receive adequate information about the concerned surgical |

| |procedure in ophthalmology departments, secondly to learn from patients of their first-hand experiences before, |

| |during and after surgery in order to improve the service provided to the future cataract patients. The main |

| |source of information was Patient Information Leaflet (PIL) for 60% patients, cataract pre assessment clinic 58%,|

| |optometrists 20%, and friend or family 24% patients. Measures undertaken on recommendations of this audit include|

| |revision of PIL, inclusion of PIL in the information package at the preoperative assessment clinic and it’s |

| |distribution to the local general practitioner.8 |

| | |

| |Studies related to postoperative teaching and patient’s self-care following cataract surgery: |

| |A descriptive study was conducted on effectiveness of a post operative teaching programme for cataract patients. |

| |The objective of the study was to assure return of functioning after surgery in the long term. The finding of |

| |the study reveals that effective postoperative management for cataract patient’s places restrictions on every day|

| |activities requires an awareness of symptoms that may require medical intervention and skilled administration of |

| |eye medication. A measure of relevant awareness skill will reflect the degree to which patient’s education needs |

| |have been met. Interunit or time based comparison may help to identify where further improvement in teaching |

| |procedure may be needed .9 |

| | |

| | |

| |A study was conducted regarding unnecessary avoidance of safe post operative behavior to investigate the level of|

| |activity restriction and to test intervention design to improve postoperative activity. Three groups of 50 |

| |patients answered a questionnaire regarding limiting their activities after routine cataract surgery on their |

| |first eye for 3 weeks. The first group received the current discharge instructions telling that they can continue|

| |all daily activities, the second group received an additional written sheet specifying that the tested activities|

| |were all safe, the third group received a sheet with photographs of people performing safe activities. The |

| |finding of the study reveals that 64% of the patients unnecessarily avoid safe behavior after surgery; additional|

| |written instruction didn’t significantly improve this figure while a photo sheet significantly reduced the figure|

| |to 30%.10 |

| | |

| |Studies related to postoperative outcomes following cataract surgery: |

| |A study was conducted on preoperative functional expectations and postoperative outcomes among patients |

| |undergoing first eye cataract surgery. Results reveal that patient’s preoperative expectations regarding the |

| |impact of cataract surgery were very high and were unrelated to their demographic or ocular characteristics. |

| |Sixty one percent of patients achieved their expected level of postoperative functioning. In selected cases more |

| |comprehensive counseling may reduce the discrepancy between expectation and actual outcomes of cataract |

| |surgery.11 |

| | |

| |A study was conducted to asses the patients quality of life and overall visual function after phacoemulsification|

| |with intraocular lens implantation in an urban Indian population. Study comprises 300 patients with a mean age of|

| |60-80 years. Findings reveal that 40% resume their daily activities within 1 week, 55% within 1 month. More than |

| |42% resumed professional activities within 1 week after surgery, 53% took 1 week to 1 month. Eighty six percent |

| |were full satisfied with the results of cataract surgery, Overall 88% reported that visual function and quality |

| |of life were “a lot better” and 10% responded little, they were “little better” after surgery. It is recommended |

| |that the speed of visual acuity recovery after phacoemulsification matched the improvement across health related |

| |quality of life functions, resulting in rapid recovery of the patient’s functional independence and health |

| |status.12 |

| | |

| |A study was done to describe the implementation of a nurse practitioner led preoperative cataract assessment and |

| |postoperative care clinic and to assess the safety, efficacy and outcomes involving 185 public patients. |

| |Concordance between nurse practitioner and ophthalmologist regarding assessment, waiting times for first clinical|

| |appointment and surgery, visual acuity, degree of visual disability and patient’s satisfactions has been |

| |measured. It has been found that implementing a nurse led cataract assessment clinic improved access to care for |

| |public patients with cataract. The safety and efficacy of the programme and the excellent visual and |

| |patient-centered outcomes commend that it can be adapted and implemented to other ophthalmology departments.13 |

| | |

| |Study related to postoperative complication following cataract surgery: |

| |A study was conducted on early complication of cataract surgery and necessity of routine review of patients 1 |

| |week after cataract extraction to define the nature and frequency of complications present 1 week after cataract |

| |surgery, to determine whether these complications are predictable, and to ascertain if patients undergoing |

| |cataract surgery require routine review at this time. At the routine 1 week visit, postoperative complication |

| |were observed in 4.1% of patients, Out of this 19% were symptomatic, 95% required a change to their |

| |postoperative management. The study provides an overview of modern cataract surgery in a large teaching hospital |

| |and indicates that abandonment of routine one week review may result in the failure to detect significant |

| |postoperative complications.14 |

|6.3 |STATEMENT OF THE PROBLEM: |

| | |

| |A study to assess the effectiveness of Structured Teaching Programme on immediate postoperative self care among |

| |patients following cataract surgery at a selected eye hospital in Bangalore. |

|6.4 |OBJECTIVES OF THE STUDY: |

| | |

| |Assess the effectiveness of Structured Teaching Programme using observational check list by post test in the |

| |experimental group. |

| |Compare the effectiveness of Structured Teaching Programme by observational checklist between experimental and |

| |control group. |

| |Associate the effectiveness of Structured Teaching Programme with selected demographic variables. |

|6.5 |OPERATIONAL DEFINITIONS: |

| | |

| |Effectiveness: - Refers to the differences of scores obtained by the subjects measured by the observational |

| |checklist between experimental and control group. |

| |Structured Teaching Programme (STP) :- Refers to systematically organized teaching strategy which provides |

| |information regarding immediate post operative self care by the patient who has undergone cataract surgery.The |

| |teaching will be involved with variety of audiovisual aids for duration of one hour. |

| |Immediate postoperative period:- Refers to first 24hrs following the cataract surgery for the patients who has |

| |admitted in a selected eye hospital,Bangalore. |

| |Self Care:- Refers to areas like meeting the activities of daily living in the post operative period smoothly, |

| |maintaining proper position by the patient himself, recognizing sign and symptoms of complication and to call for|

| |assistance of health care provider as needed, instilling eye drop in correct technique. |

| |Cataract Surgery:- It is a surgical procedure by which removal of a clouded lens and replacing it with |

| |artificial lens is done. |

|6.6 |HYPOTHESIS: |

| | |

| |H1:There will be significant difference between the scores of observational checklist among subjects exposed to |

| |Structured Teaching Programme than the subjects not exposed to Structured Teaching Programme. |

| |ASSUMPTIONS: |

| |Patients following cataract surgery will have knowledge deficit regarding self care. |

| | |

|6.7 |DELIMITATION: |

| |The effectiveness of the Structured Teaching Programme is measured by single observation only using observational|

| |check list. |

| | |

| |PROJECTED OUTCOME: |

| |The structured teaching programme prepared for this study can be dissipated to all patients with cataract in the |

|6.8 |preoperative period which aids in practicing evidenced based nursing |

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|6.9 | |

|7. |MATERIAL AND METHODS |

|7.1 |SOURCE OF DATA |The source of data will be the patients with cataract in |

| | |a pre operative care unit at a selected eye hospital, |

| | |Bangalore. |

|7.2 |METHODS OF DATA COLLECTION |

|7.2.1 |SAMPLE CRITERIA | |

| |INCLUSION CRITERIA |Patients who are admitted to undergo cataract surgery. |

| | |Patients who are interested to participate in the |

| | |teaching programme by giving consent. |

| | |Patients who can understand Hindi or English. |

| | |Patients who are in between the age group 50-70 years. |

| | | |

| | |Postoperative cataract patients. |

| | |Patients who can not hear or understand or having |

| | |disorientation. |

| | |Patient who has not given consent to join in the teaching|

| | |programme. |

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| | | |

| |EXCLUSION CRITERIA | |

|7.2.2 |RESEARCH DESIGN |The research design adopted for this study is Quasi |

| | |Experimental Study using Post Test control only method as|

| | |a research design. |

| | | |

|7.2.3 |VARIABLES | |

| | | |

| |INDEPENDENT VARIABLES |Structured Teaching Programme. |

| | | |

| |DEPENDENT VARIABLES |Knowledge regarding immediate post operative self care in|

| | |cataract patient. |

|7.2.4 |SETTING OF THE STUDY |The study will be conducted at a selected eye hospital in|

| | |Bangalore. |

|7.2.5 |SAMPLING TECHNIQUE |Investigator will use convenience sampling technique to |

| | |draw the sample for the study. |

|7.2.6 |SAMPLE SIZE |Total of Forty (40) samples will be taken for the study. |

| | |Out of them Twenty (20) will be taken as experimental |

| | |group and another as control group. |

|7.2.7 |TOOLS FOR THE RESEARCH |Observational checklist based on self care will be |

| | |developed by the researcher with the help of literature |

| | |and expert’s opinion to evaluate the effectiveness of |

| | |Structured Teaching Programme. |

|7.2.8 |COLLECTION OF DATA |Preoperative STP will be given to experimental group in |

| | |the pre operative period and the effectiveness of STP |

| | |will be measured by using observational checklist post |

| | |operatively. Observational checklist will be used to |

| | |assess the post test in the experimental and control |

| | |group. The findings will be associated with selected |

| | |demographic variables. The duration of the study will be |

| | |30 days. |

|7.2.9 |METHODS OF DATA ANALYSIS AND INTERPRETATION |The investigator will use data analysis in terms of the |

| | |objectives using statistical methods. |

| | |Assessing effectiveness of Structured Teaching Programme |

| | |among patients will be interpreted by descriptive |

| | |statistics such as ‘Mean’. |

| | |Comparing the effectiveness of STP between experimental |

| | |and control group will be analyzed by ‘t test’. |

| | |Association of the effectiveness of STP with selected |

| | |demographic variables by χ2 (Chi Square). |

| | |The investigator will represent the analyzed data in the |

| | |forms of tables, diagrams, and graphs. |

|7.3. |DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR |

| |OTHER HUMEN OR ANIMALS, IF SO PLEASE DESCRIBE BRIRFLY. |

| |Yes, the study will be conducted on patients who will undergo cataract surgery. |

|7.4. |HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR |

| |INSTITUTION IN CASE OF 7.3 ? |

| |Yes, informed consent will be obtained from the institution, authorities and subjects. Privacy and |

| |confidentiality and anonymity will be grounded. Scientific objectivity of the study will be maintained with |

| |honesty and impartially. |

|8. |LIST OF REFERENCES: |

| |Annual Reviewers. Blindness due to Cataract: Epidemiology and Prevention. [online]. Available from: URL: |

| | |

| |Smithson B. Setting a day unit in ophthalmology. Nursing Standard. 2005 July; 1:25. |

| |Roland M, Dixon M. Randomised control trial of an educational booklet for patients undergoing cataract surgery. |

| |Journal of the Royal College of General Practice. 39:244-46. |

| |American Academy of Ophthalmology. Guidelines for Cataract Surgery. [online].Available from:URL: |

| |. |

| |Brunner and Suddarth’s Textbook of Medical Surgical Nursing. 8th ed. Philadelphia: Lippincott; 1996. p. 1666-17. |

| |Evason E, Whittington D. Patients satisfaction studies : Problem and |

| |implication explored in a pilot study in North Ireland. Health |

| |education journal. 2001;1:73-77. |

| | |

| |Murrel G . Effects of structured pre operative teaching on anxiety levels of patients scheduled for cataract |

| |surgery. The Insight. 26(3):4-9. |

| |A C Wadood, A Laing, J Robertson & B B Dhillon. Audit of the patient information process through cataract |

| |journey. [ serial online]. Available from: URL: . |

| |Allen M, Knight C, and StrangV. Effectiveness of a postoperative teaching Programme for cataract patient. Journal|

| |of advanced Nursing. 2000;17:303-309. |

| |J J Koshy, M R Wilkins, W Abdullah,T Fayers, Moorfields. Unnecessary avoidance of safe post operative behaviour. |

| |[serial online]. Available from:URL: http/Elsevier. |

| |J M Tielsch, E P Steinberg, S D Cassard, O D, Sachein, J C Javitt, M W Lergo et al. Pre operative functional |

| |expectations and post operative outcomes among patients undergoing first eye cataract surgery. [serial online]. |

| |Available from: URL: http//archopt.cgi/content/abstract/113/10/1312 |

| |Mamidipuri P R,Vasavada A R, Merchant S V, Namboodiri V, Ravilla T D. Quality- of- life and visual function |

| |assessment after phacoemulcification. [serial online]. Available from: URL: |

| |http//ncbi.nlm.sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermT |

| |Kirkwood B J, Pesudovs K, Latimer P, Coster D J. The efficacy of a Nurse-led preoperative cataract assessment a |

| |postoperative care clinic. [serial online]. Available from: URL: |

| |http//ncbi.nlm.sites/entrez?Db=pubmed&Cmd=ShowDetailView&Ter |

| | |

| |Malcolm John, Mc Kellar, Mark John Elde. The early complication of cataract Surgery. Ophthalmology periodicals.|

| |2001 May;108(5):930-35. |

| |Lewis, Darksen, Heitkemper. Medical surgical Nursing Assessment and Management of clinical problems. 6th ed. USA:|

| |Mosby; 2000. p. 449-52. |

| |Phipps Medical Surgical Nursing Health and illness perspective. 8th ed. Canada: 2007. p. 1823-26. |

| |Basavanthappa B T. Nursing Research. 2nd ed. New Delhi (India): Jaypee brothers; 2007 p. 92,148,188,278,363. |

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