A study to assess the effectiveness of planned teaching programme on knowledge regarding Deep Vein Thrombosis among B. Sc. Nursing intern’s working in Jawaharlal Nehru Hospital and Research Centre Bhilai (C.G.)

 

Mr. Rakesh Sahu¹, Mrs. Sindhu Anil Menon², Mrs. Shailaja Anik³, Mrs. Apurva Rai⁴

 

ABSTRACT:

This study was conducted with the objective to formulate planned teaching programme, to assess the pre test and post test knowledge regarding deep vein thrombosis, to assess the effectiveness of planned teaching programme, and to find out the association between knowledge regarding deep vein thrombosis among B.Sc. Nursing Intern’s and selected socio-demographic variables The study design was an pre-experimental, one group pre-test post-test research design. 60 samples of B.Sc. nursing intern’s who fulfill the inclusive criteria were selected based on non-probability purposive sampling, after getting informed consent from the study participant, the planned teaching programme was administered at Jawaharlal Nehru Hospital and research centre Bhilai (C.G.). The study findings reveled that in pre- test score of majority of the B.Sc. nursing intern’s had knowledge score 4 (6.67%) were very good, 55 (91.67%) were good and 1(1.66%) were average, post-test majority 40(66.67%) were very good, 20 (33.33%) were good. pre-test mean score was 16.55 and SD is 2.84 the post-test mean score was 22.11and SD is 2.41. The t-value 2.02 which is highly significant at >0.05 which proves the effectiveness of the planned teaching programme.

 

 

 

INTRODUCTION:

Deep vein thrombosis, or deep venous thrombosis, (DVT) is the formation of a blood clot (thrombus) within a deep vein, predominantly in the legs. Non-specific signs may include pain, swelling, redness, warmness, and engorged superficial veins.

 

Deep vein thrombosis (DVT) is a blood clot in one of the deep veins in the body. Blood clots that develop in a vein are also known as venous thrombosis. DVT usually occurs in a deep leg vein, a larger vein that runs through the muscles of the calf and the thigh. It can cause pain and swelling in the leg and may lead to complications such as pulmonary embolism. This is when a piece of blood clot breaks off into the bloodstream and blocks one of the blood vessels in the lungs.

 

(Health Library _ NHS inform.html):

There are several factors that increase the risk of developing Deep vein thrombosis. It includes major surgeries, immobility, recent injury, certain chronic medical illness such as stroke, paraplegia, heart diseases, and cancer, pregnancy, increased estrogen, certain medications, previous DVT, age, obesity, and smoking.

 

(Wikipedia, the free encyclopedia.html)

Every year Deep vein thrombosis occurs in about 1 in 3000 in those below the age of 40 and 1 in 500 in those over 80years of age. A world wide survey conducted by WHO showed that Deep vein thrombosis is a common disease with an average incidence rate of more than one per 1000.Deep vein thrombosis is also a lethal disease mostly owing to pulmonary embolism. Survivors may experience serious and costly long term complications.

 

(Pushpakala Jagannathan, et al)

All hospitalized patients should be assessed for clinical risk factors of DVT. The risk is in surgical and orthopaedic patients .Medical patients are also at high risk and should receive thromboprophylaxis. Nurses can encourage mobilization and leg exercises in at-risk patients in order to activate the calf muscle pump. Breathing exercises will also help venous return. Patients should be advised to observe for signs and symptoms that suggest DVT and inform nurses if concerned

(Nursing Times.html)

 

NEED FOR THE STUDY:

WHO; 1999 Deep vein thrombosis leads to serious consequences including pulmonary embolism (PE), recurrence of venous thromboembolism (VTE), postthrombotic syndrome and death. Approximately 200,000 individuals die annually as result of PE. Recurrences of VTE account for the minority of causes of deaths. Approximately 25% of DVT patients remain asymptomatic in the long term but severe signs of postthrombotic syndrome (ulceration) are observed in 2-10% of patients 10 years after DVT.

 

In view of above the researcher’s opinions that nurses should be well equipped with knowledge and skill to perform good care so that patient will free from complications. It is important for the client with surgeries to live as normal life as possible. Therefore researcher is interested to take up the study to enhance their knowledge on prevention of deep venous thrombosis so that they will take action to prevent deep venous thrombosis which in turn will reduce the incidence of DVT in hospitals and in community there by helping in increasing the quality of life of patient.

 

PROBLEM STATEMENT:

“A study to assess the effectiveness of planned teaching programme on knowledge regarding deep vein thrombosis among B.Sc. Nursing intern’s working in Jawaharlal Nehru hospital and research centre Bhilai (C.G.)”

OBJECTIVES:

1.        To formulate planned teaching programme.

2.        To assess the pre test and post test knowledge regarding deep vein thrombosis among B.Sc. Nursing Interns working in Jawaharlal Nehru hospital and research centre Bhilai (C.G.)

3.        To assess the effectiveness of planned teaching programme on knowledge regarding deep vein thrombosis among B.Sc. Nursing Intern’s working in Jawaharlal Nehru hospital and research centre Bhilai (C.G.)

4.        To find out the association between knowledge regarding deep vein thrombosis among B.Sc. Nursing Intern’s and selected socio-demographic variables.

 

HYPOTHESES:

·         H₁: The mean post test knowledge scores of the B.Sc. nursing intern’s regarding deep vein thrombosis will be significantly higher than their mean pre test knowledge scores at 0.05 level of significance

·         H₂ : There will be association between pre-test knowledge scores of B.Sc. nursing intern’s regarding deep vein thrombosis and selected socio demographic variables at 0.05 level of significance

 

CONCEPTUAL FRAMEWORK:

According to Polit and Hungler (1995) Conceptual framework refers to interrelated concepts of obstruction that are assembled to gather in some rationale scheme by virtue of relevance common theme. They serve as spring board for generation of hypothesis to be tested.

 

Model attempts to represent reality with a minimum use of words. Visual or symbolic representation of theory or conceptual frame work often help to express abstract, ideas in a more readily understandable or precise form than the original conceptualization. The conceptual model in this study is based on Neuman’s system model (1982). It provides guidance for development utilisation and evaluation of planned teaching programme. The conceptual frame work consist of three phases.

 

INPUT:

Refers to the target group i.e. B.Sc. Nursing intern’s and their demographic characteristics i.e. their age, gender, religion, any previous experience on caring DVT patient, present posting. There are indications of characteristics of B.Sc. Nursing intern’s in the study group to assess their back ground data on DVT. The subject characteristics would be serving as a guide in the planned teaching programme for B.Sc. Nursing intern’s on deep vein thrombosis.

 

 

PROCESS:

Refers to the different operational aspects of development and implementation of planned teaching programme given to B.Sc. Nursing intern’s it includes

a.        Assessment of knowledge of B.Sc. Nursing intern’s regarding deep vein thrombosis by structured questionnaire.

b.       Development of planned teaching programme (PTP).

c.        Implementation of planned teaching programme in the B.Sc. Nursing intern’s to determine the effectiveness of planned teaching programme pretest post-test one group design.

 

OUTPUT:

Refers to the evaluation of performance of B.Sc. Nursing intern’s exposed to a planned teaching programme to find out whether there is any evidence of the desire change in knowledge of B.Sc. Nursing intern’s regarding deep vein thrombosis.

 

If B.Sc. Nursing interns acquire adequate knowledge, they will gain confidence and will be able to recognize the signs and symptoms of DVT at the earliest possible time and intervention accordingly and immediately.

If B.Sc. Nursing interns will not acquire adequate knowledge, they will not gain confidence and they will not be able to recognize the signs and symptoms of DVT at the earliest possible time and intervention accordingly and immediately.

 

METHODOLOGY:

Research approach:

quantitative research approach

 

RESEARCH DESIGN:

Pre-experimental, one group pre test –post test research design

 

POPULATION:

Target population:

In present study the target population include B.Sc. Nursing interns.

 

Accessible population:

The population selected for this study is B.Sc. Nursing interns of Jawaharlal Nehru hospital and research centre Bhilai (C.G.)

 

Figure 1: Conceptual Framework Based On Betty Neuman’s System Model Theory (1982)

 

SETTING OF THE STUDY:

The  setting  for  the  present  study  is  Jawaharlal  Nehru Hospital and research centre Bhilai (C.G.)

 

SAMPLE:

The sample of the study comprised of 60 B.Sc. Nursing intern’s of Jawaharlal Nehru hospital and research centre Bhilai (C.G.)

 

SAMPLING TECHNIQUE:

Non probability Purposive sampling technique is used.

 

SAMPLE SIZE:

Total 60 B.Sc. Nursing interns were taken for this study.

 

VARIABLES:

According  to  POLIT  AND  HUNGLER,  variable  is  an attribute of a person or an object that varies, that it takes an different values. Two type of variable are identified in the study. They are dependent variable and independent variables.

 

Dependent variable:

Presumed effect is referred to as the dependent variable according  to  PILOT  AND  HUNGLER.  In  this  study, dependent  variable  is – knowledge  of  B.Sc.  Nursing interns.

 

Independent variable:

According  to  POLIT  AND  HUNGLER  these  are variables which can account for change in the dependent variable.  Independent  variable  in  this  study  is  planned teaching  programme  on  deep  vein  thrombosis  among B.Sc. Nursing interns.

 

SAMPLING CRITERIA:

Inclusion criteria:

·          B.Sc. Nursing interns

·          B.Sc. Nursing interns who are posted in medical and surgical ward, critical care unit.

·          B.Sc. Nursing intern’s working in Jawaharlal Nehru hospital and research centre Bhilai (C.G.)

 

Exclusion criteria:

·          B.Sc. Nursing intern’s not present at the time of data collection.

·          B.Sc. Nursing intern’s who are not willing to participate.

 

DESCRIPTION OF THE TOOLS:

The self structured questionnaires were organized in two sections

 

CRITERION MEASURES:

The question prepared for assessment of knowledge on DVT. The score categorized as:-

§  Very good- 21 to 30 (70-100%)

§  Good - 11to20 (36.66-66.66%)         

§  Average – 1 to10 (33.33%)

 

METHOD OF DATA COLLECTION:

The data collection was done for 4 weeks period. After obtaining informed and willing from the study participants the study was conducted at Jawaharlal Nehru hospital and research centre Bhilai (C.G.). The total of 60 samples data was collected.

 

DATA ANALYSIS AND INTERPRETATION:

Descriptive statistics such as frequency, percentage, mean and slandered deviation was used to assess the knowledge of BSc nursing interns and effectiveness of planed teaching programm regarding deep vein thrombosis

 

Table 4.6 Analysis of pre and post test knowledge score using mean, mean percentage and standard deviation.

Planned teaching programme	Total knowledge score(out of 1800)	Mean	Mean %	SD
Pre-test	993	16.55	55.16	±2.84
Post-test	1327	22.11	73.7	±2.41

 

Table 4.6- Revels that knowledge regarding deep vein thrombosis, planned teaching programme pre-test total knowledge score was 993(1800), mean was 16.55, mean percent was 55.16 and SD is 2.84 where as in post-test total knowledge score 1327(1800), mean was 22.11, mean percent was 73.7 and SD is 2.41.

 

Table 4.7 Analysis of pre-test and post test knowledge score of planned teaching programme according to criteria.

 

 

Table and figure 4.7 :-  Represent that planned teaching programme 4(6.67%) were very good, 55(91.67%) were good and 1(1.66%) were average in pre test and post test majority 40(66.67%) were very good, 20(33.33%) were good.

 

Table 4.8: Effectiveness of pre-test and post-test knowledge score of planned teaching programme.

Planned teaching programme	Mean ±SD	df.	Paired ‘t’ value	Table value
Pre test	16.55±2.84	59	24.06	2.02
Post-test	22.11±2.41

Table 4.8: Represent that there was highly significant difference between the pre-test and post-test knowledge score of planned teaching programme as calculated value 24.06;(df.59) was greater than table value 2.02 at 0.05 level of significance.

 

 

Table 4.9:-Association between pre-test knowledge score and selected socio-demographic variables

 

MAJOR FINDINGS OF STUDY:

The data was collected, analysed and interpreted in term of objectives. Descriptive and inferential statistics were utilized for the data analysis. The level of significance set for testing the hypothesis was, 0.05 using‘t’ test. The major findings of the study were presented under the following.

 

Description of subjects according to socio-demographic variables in frequency and percentage

·         Maximum 54 (90%) belong to the age group 21-25 year and 6(10%) belong to the age group 26-30 year.

·         Majority of subjects 56(93.33%) were female and 4(6.67%) male.

·         Maximum 40 (66.67%) subjects were Hindu, 19 (31.66%) Christian, 1 (1.66%) Muslim and 0(0%) Others.

·         Maximum  35 (58.33%) subjects were       have no any previous experience on caring DVT patient and 25 (41.67%) subjects were have previous experience on caring DVT patient.

·         Present posting of 30(50%) subjects were medical, 12(20%) were surgical, 3(5%), were ICU and 15(25%) others.

 

Table 4.6:- Analysis using mean, mean % and standard deviation.

Revels that knowledge regarding deep vein thrombosis, planned teaching programme pre-test total knowledge score was 993(1800),mean was 16.55, mean percent was 55.16 and SD is 2.84 where as in post-test total knowledge score 1327(1800), mean was 22.11, mean percent was 73.7 and SD is 2.41.

 

Table 4.7:-Criteria wise analysis of knowledge scores between pre test and post test in frequency and percentage.

Represent that planned teaching programme 4(6.67%) were very good, 55(91.67%) were good  and 1(1.66%) were average in pre test and post test majority 40(66.67%) were very good, 20(33.33%) were good  and  0(0%) average.

 

Table 4.8:- t-Test to assess the effectiveness of planned teaching programme on knowledge regarding deep vein thrombosis among B.Sc. Nursing intern’s working in JLN hospital and research centre  Bhilai (C.G.).

Represent that there was highly significant difference between the pre-test and post-test knowledge score of planned teaching programme as calculated value 24.06; (df.59) was greater than table value 2.02 at 0.05 level of significance

 

Table 4.9:- Chi-square analysis for association between pre- test knowledge score of b.sc. Nursing intern’s with selected socio-demographic variables.

Revels that:-

1.        There is no significant association between knowledge and age of subjects as the calculated chi square value is 0.60(df.2) is less than table value 5.99 at 0.05 level of significance.

2.        There is no significant association between knowledge and gender of subjects as the calculated chi square value is 0.39(df.2) is less than table value 5.99 at 0.05 level of significance.

3.        There is no significant association between knowledge and religion of subjects as the calculated chi square value is 4.15(df.4) is less than table value 9.48 at 0.05 level of significance.

4.        There is no significant association between knowledge and any previous experience on caring DVT patient of subjects as the calculated chi square value is 1.25(df.2) is less than table value 5.99 at 0.05 level of significance.

5.        There is significant association between knowledge and present posting of subjects as the calculated chi square value is 23.49(df.6) is greater than table value 12.59 at 0.05 level of significance.

Hence hypothesis H2 is accepted.

 

LIMITATIONS:

The limitations of the present study are –

1.        B.Sc. NuSrsing interns

2.        The study was confined to only 60 B.Sc. Nursing interns which limits the generalization of the findings.

3.        B.Sc. Nursing interns who are posted in medical and surgical ward, critical care unit.

4.        B.Sc. Nursing intern’s working in Jawaharlal Nehru hospital and research centre  Bhilai (C.G.)

 

RECOMMENDATIONS:

1.        The study can be replicated on a large sample to validate the finding and generalization.

2.        A study can be conducted the effectiveness of planned teaching programme with strategies like demonstrator.

3.        A similar study may be conducted on experimental research approach and pre-test, post-test control group design.

4.        A longitudinal study can be conducted to evaluate the impact of deep vein thrombosis

5.        A study can be carried out to identify educational need of B.Sc. Nursing interns with early identification and prevention of deep vein thrombosis.

 

CONCLUSION:

Deep vein thrombosis, or deep venous thrombosis, (DVT) is the formation of a blood clot (thrombus) within a deep vein, predominantly in the legs. Non-specific signs may include pain, swelling, redness, warmness, and engorged superficial veins. Pulmonary embolism, a potentially life-threatening complication, is caused by the detachment (embolization) of a clot that travels to the lungs. Together, DVT and pulmonary embolism constitute a single disease process known as venous thromboembolism. that nurses should be well equipped with knowledge and skill to perform good care so that patient will free from complications. It is important for the client with surgeries to live as normal life as possible. And to enhance their knowledge on prevention of deep venous thrombosis so that they will take action to prevent deep venous thrombosis which in turn will reduce the incidence of DVT in hospitals and in community there by helping in increasing the quality of life of patient.

 

In this study, Comparison of overall knowledge score between pre test and post test by frequency and percentage. Hence it can be concluded that the teaching programme was found good method for achieving knowledge on DVT and its prevention.

 

REFRENCE:

LIST OF BOOK:

1.        Black M Joyce, “Medical Surgical Nursing”, volume I, 7^th edition, 2005, Philadelphia, page no.1540-1542

2.        Brunner  and  Suddarth’s “Textbook of Medical Surgical Nursing”, volume I, 11^th edition, 2008, Lippincott Williams  and  Wilkins, page no.1005-1016.

3.        Donna D et.al, “Textbook of Medical Surgical Nursing”, volume I, 2^nd edition, Philadelphia, page no.955-959

4.        Lewis S.M et.al, “Medical Surgical Nursing”, 6^th edition, 2004, Mosby’s publisher’s, USA, page no.912-944; 927-933

5.        Suzanee C.S, Brenda G.B, “Textbook of Medical Surgical Nursing”, 10^th edition, 2005, Lippincott publication, St. Louis, page no. 819-820;842-845

6.        Basavanthappa B.T. “Nursing Research” 2^nd edition, jaypee publication, kundli, 2007.

 

JOURNAL:

1.        Autar, R .Deep Vein Thrombosis: The Silent Killer. Quay Books. Mark Allen Publishing, Wiltshire

2.        Anands SS, Wells PS, Hunt D, et al. (1998) Does the patient have deep vein thrombosis? Journal of the American Medical Association,279(14): 1094–1099

3.        Tortora, G.J.,  and  Derrickson, B., (2006). Principles of anatomy and physiology. Hoboken, NJ: Wiley.

4.        Turpie, AGG .(1997) ,Low molecular weight heparin: from the bench to the orthopaedic patients.Orthopedics (February): 10–13

5.        Collier,M. Anti-embolic stockings for prevention and treatment of deep vein thrombosis.Br J Nurs , 1998,(1): 44-49

6.        Goldman, L.,  and  Ausiello, D. Cecil medicine (23r ed.). Philadelphia, PA: Saunders Elsevier.

7.        Surendra, K. A prospective study of risk factor profile  and  incidence of deep venous thrombosis among medically-ill hospitalized patients at a tertiary care hospital in northern India. Indian J Med Res 30 (3), 2009, ,726-730 .

8.        Markel, A. Valvular reflux after deep vein thrombosis: incidence and time of occurrence. J.vas.nsg.1992 Feb; 15(2):377-82

 

WEBSITES-

1.        http://www.iosrjournals.org

2.        http://www.en.wikipedia.com.org deep vein thrombosis

3.        http://www.books.google.co.in,

4.        http//www.MedlinePlus

5.        Medical Encyclopedia.html

6.        http://www.cdc.gov/features/thrombosis/

7.        http://www.ncbi.nih.gov/pubmed/14715365

8.        http://www.medicalnewstoday.com/articles/B1624.php

9.        http://www.medicalnewstoday.com/articles/10872.php

10.     http://content.karger.com/produckte

11.     http://www.healthline.com/health/deep-venous-thrombosis 

 

 

 

 

Received on 12.01.2017          Modified on 08.05.2017

Accepted on 16.06.2017         © A&V Publications all right reserved