A Study to assess the Effectiveness of Structured Teaching Programme on Knowledge and Practice Regarding Prevention of Selected Complications of Immobilization among the Patients with Orthopedic Disorders in RMMCH, Chidambaram

 

Mrs. Bhavani. A.¹ , Dr. Mrs. Sara. B²

¹Nursing Tutor, Rani Meyyammai College of Nursing, Annamalai University, Chidambaram, Cuddalore district, Tamil Nadu

²Reader in Nursing, Rani Meyyammai College of Nursing, Annamalai University, Chidambaram, Cuddalore District, Tamil Nadu.

 

ABSTRACT:

Patients on the orthopedic service are almost immobilized which may lead to complication. These complications are easy to prevent rather than to treat. The objectives were (i) to assess the existing knowledge and practice, (ii) to evaluate the effectiveness of Structured Teaching Programme on knowledge and practice and (iii) to find the association between the pretest knowledge and practice regarding the prevention of complications of immobilization with the selected demographic variables. The study was conducted among 50 immobilized patients with orthopedic disorders in RMMCH, Chidambaram chosen by convenient sampling technique. The data was collected using structured-interview schedule regarding knowledge and observational checklist for practice on prevention of selected complications of immobilization. The intervention was given as STP on pressure ulcer, deep vein thrombosis, contracture and constipation by using power point. One week later a posttest was conducted by using the same structured-interview questionnaire and observation checklist. The study revealed that in the pretest 12 patients (24%) had moderately adequate knowledge, 38 patients (76%) had inadequate knowledge all the patients 50 (100%) had poor level of practice and after STP regarding prevention of selected complications all the patients 50 (100%) had adequate knowledge and good level of practice. There was significant association between the clinical variable surgery with existing level of knowledge (p=0.013) and practice (p=0.037) regarding prevention of selected complications. The effectiveness of STP was statistically tested by paired ‘t’ value and the results were found to be significant at P<0.001 level.

 

 

 

INTRODUCTION:

Patients on the orthopedic service are those who require treatment for fractures, deformities, and diseases or injuries of some part of the musculoskeletal system. Some patients will require surgery, immobilization, or both to correct their condition. Prolonged bed rest and immobilization inevitably lead to complications such as deep vein thrombosis, contracture, pulmonary embolism, pneumonia, pressure ulcer, calculi, urinary tract infection, osteoporosis, constipation, muscle atrophy, depression and psychosis. These complications are much easier to prevent than to treat; if these patients are educated the outcome would be beneficial to the patient and the rehabilitation would be still easier without any complications. The knowledge regarding prevention of the complication of immobilization as concept, yet not effectively implemented in practice. The first level of nursing care is the prevention which can be entirely fulfilled and achieved by educating the patient (Phillip Parr, 2012).

 

METHOD:

Pre-experimental design was used to assess the effectiveness of Structured-Teaching Programme on knowledge and practice regarding prevention of selected complications of immobilization among 50 immobilized patients with orthopedic disorders in RMMCH, Chidambaram selected using convenience sampling technique. The study was conducted after obtaining permission from the Medical Superintendent of the selected hospital. The participants were informed of the study, and a written consent was obtained from each of the participant. The pretest was conducted by using structured-interview questionnaire consisting of four sections. Section I assessed demographic variables, Section II assessed clinical variables, Section III knowledge questionnaire with Multiple Choice patterns to assess the Knowledge and its preventive aspects of Pressure Ulcer, Deep Vein Thrombosis, Contracture, Constipation and the total score was 35. Section IV Observation Check List consisted of sixteen items on four point rating scale. The preventive care practices followed by the patients were observed.  The response was rated as Always, Sometimes, Rarely and Never. Total score of practice was 48. The structured Teaching was given on complications of Immobilization and prevention. One week later a posttest was conducted by using the same structured-interview questionnaire and observation checklist for practice.

 

RESULTS:

The descriptive and inferential statistics were used to compute the data. The statistical analysis showed the following results.

 

Table 1- Distribution of Level of Knowledge Regarding Prevention of Selected Complications among the Immobilized Patients with Orthopedic Disorders in Pretest and Posttest                                                                                                                                                             N= 50

 

Table 1 shows that in pretest 12 patients (24%) had moderately adequate knowledge, 38 patients (76%) had inadequate knowledge and in the posttest all the patients 50 (100%) had adequate knowledge regarding prevention of selected complications of immobilization.

 

Table 2- Distribution of Level of Practice Regarding Prevention of Selected Complications among the Immobilized Patients with Orthopedic Disorders in Pretest and Posttest                                                                                                                                                             N= 50

 

Table 2 shows that in pretest all the patients 50 (100%) had poor level of practice and in the posttest all the patients 50 (100%) had good level of practice regarding prevention of selected complications of immobilization.

 

Table 3- Comparison of Mean and Standard Deviation of Knowledge Regarding Prevention of Selected Complications between Pretest and Posttest                                            N= 50

S = Significant

 

Table 3 shows the mean and standard deviation of knowledge between the pretest and the posttest. In the pretest the mean knowledge score is 15.20 and in the posttest the mean is 29.52. It was statistically tested with paired ‘t’ test and the result found to be significant at p< 0.001.

 

Table 4- Comparison of Mean and Standard Deviation of Practice Regarding Prevention of Selected Complications between Pretest and Posttest N= 50

Variables	Mean	SD	Paired ‘t’ test value	‘P’ value
Pretest	19.96	1.57	57.783	<0.001 (S)
Posttest	44.88	2.58

S = Significant

Table 4 shows that the mean and standard deviation of practice at the pretest and the posttest.  In the pretest the mean practice score was 19.96 and in post test the mean was 44.88. It was statistically, tested with paired ‘t’ test and the result found to be significant at p< 0.001.

 

Table 5- Association of Mean and Standard Deviation of Pretest Knowledge with Surgery N=50

S = Significant

 

Table 5 represents the association between the mean and standard deviation of pretest knowledge with surgery. The mean pretest knowledge was higher among patients who have not undergone surgery with the mean value of 16.68.The Mann Whitney U test has been applied and found that knowledge level at pretest has been significant with the ‘p’-value 0.013 and infers that surgery has influence in the knowledge level of the immobilized orthopedic patients.

 

Table 6-Association of Mean and Standard Deviation of Pretest Practice with Surgery N=50

S = Significant

 

Table 6 represents the association between the mean and standard deviation of pretest practice with surgery. The mean pretest practice was higher among patient with who have undergone surgery with the mean value of 20.35, when compared to the patients who have not undergone surgery. The Mann Whitney U test has been applied and found that practice level at pretest has been significant with the p-value 0.037 and infers that surgery has influence in the practice level of the immobilized orthopedic patients. 

 

Table 7 - Correlation of Pretest Knowledge and Practice with Days of Immobilization N=50

 

Table 7 represents the correlation of the pretest knowledge and practice with days of immobilization. The correlation of pretest knowledge with days of immobilization was not significant (P=0.849). Correlation of pretest practice with days of immobilization was significant (P=0.015). Thus coefficient correlation indicates that the duration of immobilization improves practice. 

 

Table 8- ANCOVA Analysis of Pretest and Posttest Level of Practice with Significant Clinical Variables

 

 

Table 8 represents that in the pretest the mean practice score is 19.96 and in posttest the mean is 44.88 significant at p< 0.001. Since the duration of immobilization and those who have undergone orthopedic surgery are significantly associated with pretest practice the two variables are included as covariance in the ANCOVA repeated measures. The p-value for days of immobilization and surgery undergone, infers that the non-significance in the practice score has not been influenced by these two variables. Further, the significant p-value for the assessment infers that, STP is effective in increasing the practice score after controlling the influence of the significant clinical variables. It ensures that increase in practice score is due to the STP. 

 

discussion:

The collected data were analyzed, organized and discussed under the following headings. The first objective of the study was to assess the existing knowledge and practice. It was inferred that, in the pretest 12 patients (24%) had moderately adequate knowledge, 38 patients (76%) had inadequate knowledge and all the patients 50 (100%) had poor level of practice regarding prevention of selected complications due to immobilization. The study findings were similar to the findings of Jeminikurian (2005) conducted a descriptive study to assess the knowledge and practice of immobilized patients and their care givers regarding prevention of complications in St. John’s medical hospital among 40 patients and their care givers. Data were collected using interview schedule. The study findings revealed that there was knowledge deficit and inadequate practice existed among the patients and care givers related to prevention of complications of immobilization.  The second objective of the study was to evaluate the effectiveness of Structured Teaching Programme on knowledge and Practice. It was revealed that the mean posttest knowledge score was 29.52 and mean posttest practice was 44.88. It was statistically tested with paired ‘t’ test and the result found to be significant at p< 0.001. The statistical value supported the research Hypothesis that “The mean posttest knowledge and practice of the subjects after the Structured Teaching Programme in the prevention of complications of the immobilized orthopedic patients is significantly higher than their mean pretest knowledge and practice”. The study findings was similar to the findings of Soroja (2011) conducted a study on effectiveness of Structured Teaching Programme regarding prevention of selected complications among 50 immobilized orthopedic patients  those who had complications of bed sore, constipation, and pneumonia, in Government Rajaji Hospital, Madurai. Quasi-experimental one group pretest posttest design was used and the samples were selected using purposive sampling technique. The study results revealed that there was a considerable improvement of knowledge after the structured teaching programme. The third objective of the study was to find an association between pretest knowledge and practice regarding prevention of complications of immobilization with selected demographic variables and clinical variables. It revealed that there is no significant association between the demographic variables and there is significant association between the clinical variable surgery with existing level of knowledge (p=0.013) and practice (p=0.037) regarding prevention of selected complications of immobilization which was statistically confirmed with Mann Whitney U test and the correlation of pretest practice with days of immobilization was significant (p=0.015). Statistically, coefficient correlation indicates that as the days of immobilization increases the practice also improves. ANCOVA analysis of pretest and posttest level of knowledge and practice with significant clinical variables inferred that, STP was effective in increasing the knowledge score and level of practice. The study findings was similar to the findings of Khalid Fahd Alhosis, et al. (2012) conducted a Quasi-experimental study among 64 adult male and female caregivers of immobilized patients from medical, surgical and orthopedic units of King Fahd and medical and surgical units of king Saud hospitals on Effect of Designed Pressure Ulcer Prevention Program on Caregivers' Knowledge of Immobilized Patients. Two modified tools were used to collect data about socio demographic characteristics and knowledge regarding pressure ulcer prevention which mainly cover four areas: skin care; proper positions; nutrition and Exercises. The results of the present study revealed that a highly statistical significant improvement of mean knowledge score in posttest compared with pretest related to prevention of pressure ulcer through skin care, positions, nutrition and exercises as well as total mean scores of knowledge.

 

conclusion:

The present study assessed the knowledge and practice of patients regarding prevention of selected complications among the immobilized patients and found that the majority of the patients had inadequate knowledge and all had poor practice. After the Structured-Teaching Programme about prevention of complications related to immobilization there was significant improvement in the patient knowledge and practice regarding prevention of complications. At the end of the study it was observed that none of the patient had developed complications. The study revealed that the Structured-Teaching Programme was effective in improving knowledge and practice of patients with orthopedic disorders in preventing selected complications.

 

REFERENCE:

1.     Bare, G., Brenda, Smeltzer, C., and Susanne. (2007). Brunner and Suddarth’s textbook of medical surgical nursing, Philadelphia: Lippincott William and Wilkinson.

2.     Khalid Fahd Alhosis., et al. (2012). Effect of Designed Pressure Ulcer Prevention Program on Caregivers' Knowledge of Immobilized Patients. Journal of American science, 8(12).

3.     Jemini Kurian, (2005). Immobilized orthopedic caregivers Medical Surgical Nursing. Ncbi.

4.     Lewis, S.L., Heittemper, M.C., Dirksen. S.R., Brien, P.G., and Bucher. (2009). Medical surgical nursing. St. Louis: Mosby.

5.     Phillip Parr., (2012). The complete spectrum of musculoskeletal care from prevention and diagnosis to treatment and rehabilitation. JBJS Reviews, 2(5):e3.

6.     Soroja., (2011). Effectiveness of Structured Teaching Programme regarding prevention of selected complications among 50 immobilized orthopedic patients. National journal of community medicine, 2(1).

 

 

Received on 03.10.2016          Modified on 15.10.2016

Accepted on 21.12.2016          © A&V Publications all right reserved