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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| | |
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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. |
| | | |
| | | |
| | | |
| | | |
| |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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