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RAJIV GANDHI UNIVERSITY OF HEALTH SCEINCES BENGALURU
KARNATAKA.
PROFORMA FOR REGISTRATION OF
1. NAME AND ADDRESS OF THE CANDIDATE
: Mr. SHAFI SHAMSUDIN
I YEAR M.SC NURSING,
GAT CAMPUS,R.R.NAGAR,
BENGALURU-560098
2. NAME AND ADDRESS OF THE COLLEGE
: GLOBAL COLLEGE OF NURSING,
GAT CAMPUS,R.R.NAGAR,
BENGALURU-560098
3. COURSE OF STUDY AND SUBJECT
: I YEAR M.SC.NURSING,
MEDICAL-SURGICAL NURSING.
4 DATE OF ADMISSION 01-06-2011.
5 TITLE OF THE TOPIC
: Effectiveness of Structured Teaching Programme
on Knowledge regarding Autar Scale among staff
Nurses in Selected Hospitals, Bangalore.
6. BRIEF RESUME OF INTENDED WORK
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INTRODUCTION
The goal of medicines is to promote, preserve and restore health. These goals are
embodied in the word prevention. Successful prevention depends upon knowledge of
causation, identification of risk factors, groups, availability of prophylaxis, early detection
and treatment measures. For applying these measures to appropriate persons or groups
continuous evaluation of development of procedures are applied. Early detection and
treatment are the main intervention of disease control.1
Deep vein thrombosis is a condition in which the blood vessel is blocked by the
embolus carried in the blood stream from the site of formation of clot. Thrombosis usually
develops as a result of venous stasis or slow flowing of blood around venous valve sinuses.
Pulmonary embolism can occur when a fragment of blood clot breaks loose from the wall of
vein and migrate from the heart to the lungs, where it blocks a pulmonary artery or one of its
branches. When the clot is large enough to completely block one or more of the vessels that
supply the lungs with blood, it can result in sudden death.2
Each year Deep Vein Thrombosis occurs in about one in 200 people in general
population ranging from less than one in 300 in those below the age of 40 to one in 500 in
those over 80. 2
In United States more people die each year from Deep Vein Thrombosis than
motor vehicle accidents, breast cancer, and AIDS etc. The American College of Chest
Physicians 2002 reported that in United States each year 3,00,000 to 6,00,000 hospitalizations
are associated with Deep Vein Thrombosis. An estimated 2,00,000 patients die from blood
clots that obstruct blood flow to the lungs. In Canada it is reported that pulmonary embolism
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from DVT causes death of more than 1,00,000 patients each year and it remains a leading
cause of death. 4
6.1 NEED FOR THE STUDY
Deep vein thrombosis (DVT) is a silent killer. It is a serious threat to recovery
from surgery and is the third most common vascular disease, after ischemic heart disease and
stroke.
Thrombo embolism remains a major preventable cause of post operative
mortality and morbidity and very little attention has been given among the Indian patients.
Thrombo embolism is a serious post operative complication. After surgery the patient
experiences a period of enforced bed rest and immobility. It is more prevalent in major
orthopedic surgeries especially total hip and knee replacement, traction and plaster cast
because it further reduces post operative movement and these factors lead to venous stasis
and increased likely hood of thrombosis. 5
The incidence of DVT in India as reported is one percent of the adult
population after the age of forty and is 15 to 20 % in hospitalized patients and the risk of
DVT is 50% in patients undergoing orthopedic surgery particularly involving the hip and
knee. It is 40% in those patients undergoing abdominal or thoracic surgery. 1/100 who
develops DVT dies, usually from the blood clot traveling to the lungs - pulmonary embolism.
According to a study done on 60,000 patients in more than 32 countries, almost one
out of every two hospitalized patients in medical and surgical wards worldwide and in India
was at risk of developing DVT. The study revealed that although the risk of DVT was very
high, only 17 per cent of these patients in India received any prophylaxis. 6
3
The Department of Health has made the prevention of DVT a priority across the
NHS. All patients admitted to hospital should be assessed for their risk of developing a blood
clot and, if necessary, given preventative treatment.
The rapid increase in magnitude of complications needs the attention of health
professionals. Hence in order to reduce the immediate and long term dangers of DVT the
researcher feels that early detection and prevention is very necessary.
The Autar DVT risk assessment scale was developed to separate risk into no risk,
low, moderate and high risk categories. It is recommended that staff nurses using the Autar
DVT scale should evaluate for themselves the best cut-off score to avoid misinterpretations
and to achieve maximum predictive accuracy15
Though many risk assessment scales are available, Autar scale was found to be more
valid and reliable in the case of deep vein thrombosis. So The investigator planned to
administer structured teaching programme to increase the knowledge level of staff nurses
which will help them in to understand more about deep vein thrombosis and to identify the
highly risk patients to deep vein thrombosis.
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6.2 REVIEW OF LITRATURE
Review of literature is a systematic identification, location, scrutiny and summary of
written materials that contain information on research problems. 8
The literature related to the topic are organized and presented under the following
headings.
1. Incidence and prevalence of Deep Vein Thrombosis.
2. Validity and Reliability Assessment of Autar DVT Scale.
3. Knowledge regarding Deep Vein Thrombosis.
The incidence and prevalence of Deep Vein Thrombosis.
A prospective study conducted on incidence of post operative Venous Thrombo
Embolism in Indian patients who have undergone major lower limb surgery. A total of 104
adult patients were enrolled. Venous Thrombosis was observed in 35.6 percent of the patients
who underwent total hip arthroplasty, 46 percent with total knee arthroplasty and 18.3
percent with fracture fixation involving the proximal femur. In this group 52 percent showed
venographic evidence of Venous Thrombosis. The study has shown that post operative
Venous Thrombo Embolism is common in Indian patients. 5
A prospective study was conducted on risk factor and incidence of Deep Vein
Thrombosis among medically-ill hospitalized patients in northern India. Because of the high
risk of missed diagnosis, only a few studies exist on surgical patients. A study was conducted
on medically ill patient both from medical wards and ICU. A total of 163 patients were
studied. None of the patient had prior history of DVT and was at risk of developing DVT.
None of these patients received anticoagulants prior to the development of DVT. The study
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revealed the risk of DVT was clearly elevated in hospitalized patient than in non-
hospitalized patient. However a large autopsy based study from India revealed a high
prevalence (16 percent) of pulmonary embolism at autopsy in patients dying of a medical
illness. 9
A study conducted in Father Muller Hospital, Kanganadi, Mangalore to determine
the incidence of deep vein thrombosis (DVT) in postoperative patients after major abdominal,
orthopedics and neurosurgical procedures, which require long term postoperative hospital
stay and to identify the risk factors for DVT in these patients. A total number of one hundred
patients were studied. Out of them, 60 were males and 40 were females. In this study, the
incidence of deep vein thrombosis in postoperative patients was found to be 14 %. The
incidence of DVT in our study (14%) is significant enough to advocate prophylactic
anticoagulant therapy to those who have to undergo major surgical procedures and those who
have risk factors. 10
Validity and Reliability Assessment of Autar DVT Scale
A prospective study was conducted in Ain Shams University (EGYPT) aimed to
assess the validity & reliability of "Autar DVT risk scale". The Autar DVT scale was
developed as a predictive index to assess patients' risk and enable the application of the most
effective prophylaxis. The DVT scale was evaluated through data gathered on 35 patients at
vascular surgery to evaluate its validity, reliability and sensitivity as a screening (or
diagnostic test) and prognostic index. This was carried out between May and October 2008 in
Ain Shams Specialized Hospital using the action research technique. The study showed
agreement between duplex and Autar D.V.T scale, at moderate risk it achieved 60%
sensitivity and 40% specificity while 46.6% and 75% at high risk category respectively. The
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results of this study have provided some interesting data and insight into an effective risk
assessment of DVT patients and guiding decision making. 12
The Autar DVT risk assessment scale was developed by Autar (1994; 1996).
Founded on Virchow’s triad in the genesis of DVT and comprising seven subscales of
thrombogenic risk factors, the DVT risk calculator was validated on a small orthopedic
population. Although positive outcomes were reported, the small yet well formed study did
not permit generalisability of findings and wider application across the boundaries of
practice. Further to revalidate the DVT scale for its universal application and finding and
generalisability by Ricky Autar, Principal Lecturer of De Montfort University, England, 150
patients were randomly recruited from Orthopedic, Surgical and Medical specialties. Data
from two patients, who could not be followed up, were excluded for evaluation of the
predictive accuracy of the DVT scale. Overall, 115 patients out of the 148 (78%) were
correctly classified and predicted. This predictive accuracy of the DVT risk calculator was an
underestimation of its efficacy as it was masked by the administration of prophylaxis to a
large number of high risk patients. As a result of the findings and the availability of new and
compelling research evidence, the Autar DVT scale was revisited and revised for
maximization of its predictive validity. 3
A study was conducted in College of Nursing, USA to test the validity and reliability
of the Autar Scale. Hospital-acquired deep vein thrombosis (DVT) and pulmonary embolisms
(PE) are preventable problems that can increase mortality. Three phases were undertaken in
developing and testing the DVT risk assessment tool. Investigation and clarification of risk
and predisposing factors for DVT were identified from the literature, expert nursing
knowledge, and medical staff input. Second, item development and weighting
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were undertaken. Third, parametric testing for content validity measured the differences in
mean assessment tool scores between a group of patients who developed DVT in the hospital
and a demographically similar group who did not develop DVT. Interrater reliability was
measured by having three different nurses score each patient and compare the differences in
scores among the three. The DVT group had significantly higher scores on the DVT
assessment scale than did those who did not experience DVT. Interrater reliability showed a
strong correlation among the scores of the three nurses. Providing a valid and reliable tool for
measuring the risk for DVT or PE in hospitalized patients will enable nurses to intervene
early in patients at risk. Basing DVT risk assessment on the evidence provided in this study
will assist nurses in becoming more confident in recognizing the necessity for interventions
in hospitalized patients and decreasing risk. Nurses can now evaluate patients at risk for DVT
or PE using the risk assessment tool. 13
Knowledge regarding Deep Vein Thrombosis
Deep vein thrombosis (DVT) constitutes a serious threat to patients' general recovery.
The Autar DVT risk assessment scale was developed to separate risk into no risk, low,
moderate and high risk categories. Founded on Virchow's triad in the genesis of DVT, the
scale is composed of seven categories of risk factors. When the scale was tested on a
trauma/orthopaedic unit a cut-off score of 16 yielded 100% sensitivity, 81% specificity and a
correlation coefficient of 0.98. The DVT scale is designed to allow application in diverse
clinical specialties. It is recommended that staff nurses using the Autar DVT scale should
evaluate for themselves the best cut-off score to achieve maximum predictive accuracy15.
8
A quantitative, cross-sectional survey design was used, and 48 participants
receiving pharmacological thromboprophylaxis participated. Most hospitalized patients
(83%) were aware that were receiving injections to prevent blood clots and 81.2% reported
hearing of either DVT, PE or both conditions. Of the participants who had heard of DVT
and/or PE, 74.2% knew immobility was a risk factor but had limited knowledge of symptoms
and prevention modalities. Participants reported hearing about VTE more frequently from
friends, family or the media than from healthcare providers, including nurses. Participants
were satisfied with pharmacological thromboprophylaxis but were less satisfied with the
information received on VTE. Findings suggest that patients require further information on
VTE during their hospitalization to enhance their involvement in VTE prevention and
recognition, and that the provision of written, patient-directed information could begin to
address that lack of involvement. This study also highlights the need to strengthen the
nurses' role in providing patient education about VTE.16
STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of Structured Teaching Programme on
Knowledge regarding Autar Scale among staff nurses in Selected Hospitals,
Bangalore”.
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6.3. OBJECTIVES OF THE STUDY
1. To assess the regarding Autar Scale among staff nurses in Selected Hospitals,
Bangalore.
2. To evaluate the effectiveness of structured teaching programme on Autar scale
among staff nurses by comparing the pre & post test score.
3. To find out the association between knowledge on Autar scale among the staff
nurses with their selected demographic variables.
6.4 Hypothesis:
H1 – There will be significant difference in knowledge regarding Autar scale among
staff nurses before and after administration of STP.
H2 – There will be significant relationship between knowledge on autar scale among
staff nurses and their selected demographic variables.
6.5 OPERATIONAL DEFINITIO
Evaluate: It refers to assess the structured questionnaire regarding autar scale among
staff nurses
Effectiveness: It determines the extent to which structured teaching programme has
improved the knowledge regarding Autar scale among stuff nurses as assessed by
structured questionnaire.
Structured Teaching Programme: It refers to the systematically organized group
instructions and discussions on use of Autar scale
Autar scale : Autar scale is using to assess and identify the patients those who are prone
to develop deep vein thrombosis. The Autar scale (1994) comprised seven subscales:
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increasing age, build and body mass index (BMI), immobility, special DVT risk, trauma,
surgery and high risk disease. The score of Autar scale in DVT is as follows: 1) <6 = No
risk, (2) >10 = Low risk (<10 per cent),(3) 11-14 = Moderate risk (11-40 per cent),(4)
>15 = High risk (>41 per cent).
DVT (deep vein thrombosis): Blood clotting in the veins of the inner thigh or leg. Blood
clots can break off (as emboli) and makes their way to the lung where they have the
potential of causing respiratory distress and respiratory failure
Knowledge: it refers to response of staff nurses to the questionnaire regarding autar scale.
Staff Nurses: Nurses who have completed Basic B.Sc nursing or diploma in nursing and
presently working in the selected hospitals, Bangalore.
7. MATERIALS AND METHODS:
7.1 Sources of data:
The staff nurses who are working in selected hospitals, Bangalore.
7.2 Method of Data Collection: Data will be collected by using structured questionnaire.
7.2.1 Definition of the study subject: Staff nurses in a selected hospitals of Bangalore.
7.2.2 Inclusion & Exclusion Criteria:
a) Inclusion criteria:
Nurses who are,
1. willing to participate in the study.
2. present at the time of the study.
b) Exclusion Criteria:
1. Nurses who have previously attended seminar or work shop on Autar scale.
7.2.3Research Design : Pre experimental, one group pre- test
post –test design.
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7.2.4. Setting : Selected hospitals in Bangalore.
7.2.5. Sampling technique : Convenient sampling technique.
7.2.6
a) Sample Size : 60 Staff Nurses
b) Duration of study : 4 weeks
c)
7.2.7. Tools for Research : The investigator will collect the data by using
structured questionnaire. It consists of two parts.
Part A : Socio Demographic Variables
Part B : Assess the knowledge regarding autar scale.
7.2.8. Collection of data : The investigator himself will collect data
from staff nurses by using structured
questionnaire.
7.2.9 Method Of Data analysis:
1. The researcher will use descriptive and in
ferential statistics to analyse the data.
2. The analysed data will be presented in the form
of tables, figures and graphs wherever necessary.
7.3 Does the study require any investigations or interventions to be conducted on
patients or other humans or animals? If so, please describe briefly.
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No
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes, permission has been obtained from the concerned authorities and
subject.
Informed written consent will be obtained from the participants prior to
the study
Privacy, Confidentiality & anonymity will be guaranteed.
Scientific objectivity of the study will be maintained with honesty and
impartiality.
LIST OF REFERENCES:
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1. Park J E, Textbook of preventive and social medicine, Jabalpur, Bharat
Publisher 2000. p137-8.
2. Brunner and Suddharth’s text book of Medical Surgical Nursing 10th edition,
Lippincott Philadelphia 2004. Pg 405-7
3. Ricky Autar, The Management of Deep Vein Thrombosis_The Autar DVT Risk
Assessment Scale. Available from URL:
http://bjhltx.com/learning/themanagementofdvt_theautar.pdf
4. American college of chest physicians 2002. Prevention of thrombo embolism
chest108; p312-34.
5. Agarwala S, Bhagwat A.S, Modhe J, Deep Vein Thrombosis in Indian patients
undergoing Major limb surgery India J Surg, 2003.65: p159-62.
6. Avaliable From URL:http://www.expresshealthcare.in/200904/market23.shtml
7. Avaliable from URL
:http://www.nhs.uk/conditions/deep-vein-
thrombosis/Pages/Introduction.aspx
8. Polit and Hangler P. Nursing Research Principles and methods, Philadelphia
Lippincott, 1999. P69-71.
9. Surendra K Sharma, Varun Gupta “A prospective study of risk factor profile
and incidence of deep venous thrombosis among medically ill hospitalized
patients in Northern India” , AIIMS, New Delhi, Feb 20, 2009.
10. George C, Rao BSS Shenoy D H, Hegde B R. “The Incidence of Deep Vein
Thrombosis in post operative patients in a large south Indian tertiary care
centre” Father Muller Hospital, Kanganadi, Mangalore-2.
Vol 4, issues 5, Oct 2010, pg3120- 3127. Available in
URL:http://jcdr.in/article_fulltext.asp?issn=0973
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11. Agarwala S, Bhagwat AS, Wadhwani R. Pre and postoperative DVT in Indian
patients - Efficacy of LMWH as a prophylaxis agent. Indian J Orthop
[serialonline]200524];39:55-8.Available from:
http://www.ijoonline.com/text.asp?2005/39/1/55/36900
12. Dr.SusanM Dosouky, Dr. Eman T Elshamma,Validity and Reliability
Assessment of Autar Scale. Available in URL:
http://www.ijar.lit.az/pdf/3/2010(1-8).pdf
13. Mc Caffrey R, Bishop M, Development and testing of a DVT risk assessment
tool:Providing evidence of Validity and Reliability. Available in URL:
www.ncbi.nlm.nih.gov/pubmed/17355406
14. Awareness of Deep Vein Thrombosis APHA Conference, 1986. Dec. P 105-8
15. Autar, R.Calculating patients' risk of deep vein thrombosis, 17-Oct-
2011,Avaliable from URL: http://hdl.handle.net/10755/170279
16. Stephanie Le Sage , Marianne McGee ,Jessica D. Emed Journal of Vascular
Nursing,Volume 26, Issue 4 , Pages 109-117, December 2008
9 SIGNATURE OF CANDIDATE
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10 REMARKS OF THE GUIDE Study is satisfactory and recommended.
11.1 NAME AND DESIGNATION OF GUIDE Mrs. SUGANTHI. J,
Asst.Prof
Medical Surgical Nursing Dept
11.2 SIGNATURE
11.3 CO-GUIDE ( IF ANY ) Mr. GOPALAKRISHNAN, (HOD),
Assoc.Prof
Medical Surgical Nursing Dept
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT Mr. GOPALAKRISHNAN, (HOD),
Assoc.Prof
Medical surgical Nursing Dept
11.6 SIGNATURE
12.1 REMARKS OF THE PRINCIPAL The topic selected by the researcher is relevant and forwarded
12.2 SIGNATURE
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