RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE

AND ADDRESS

Ms. ANN MARY VARGHESE

1st YEAR, M.Sc. NURSING

BAPUJI COLLEGE OF NURSING,

DAVANGERE.

2. NAME OF THE

INSTITUTION

BAPUJI COLLEGE OF NURSING,

DAVANGERE

3. COURSE OF STUDY AND

SUBJECT

DEGREE OF MASTER OF

NURSING

MEDICAL SURGICAL NURSING

4. DATE OF ADMISSION TO

COURSE

12th June 2009

5. TITLE OF THE TOPIC “EFFECTIVENESS OF

STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE

REGARDING POST OPERATIVE

EXERCISES OF CLIENTS WHO

ARE UNDERGOING

ABDOMINAL SURGERIES IN

SELECTED HOSPITALS,

DAVANGERE”

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Surgery is the medical speciality that treats diseases,injuries or

other physical conditions.SURGERY came from a greek word cheirourgia,meaning

‘hand work’.In india Sushrutha samhita is also known as by the title ‘Father of

surgery’.1 Billroth is often referred to as “the father of abdominal surgery.2

Having surgery is a major event in any person’s life.Good results of the

surgery depend on careful pre operative evaluation,balancing the risks and benefits of

the surgery,attention to pain management&avoidance of post operative

complications.3 Total number of surgical procedures performed in US was 4.6 million

in that total hysterectomy-5,69000,caesarian section-1.3 million.4

Exercises play an important role in relieving pain &preventing

complications.The application of therapeutic exercises to a patient is a process which

demands an initial examination of patients needs and a constant reassessment of the

situation in the light of progress.5

Pre operative teaching is an important component in the clients operative

experience.3 Teaching about post operative activities is implemented in the pre-

operative phase.Clients need to know about surgical events,how to perform and

exercises necessary to decrease post operative complications and facilitate recovery.6

6.1 NEED FOR THE STUDY

Pre operative teaching is important to ensure a positive

surgical experience for the client.Numerous research studies support the value of pre

operative instructions in reducing both the incidence of post operative complications

and length of stay in the hospital.3 It has been found that the incidence of post

operative complications among patients undergoing major surgery in developing

countries is very high. But the incidence of the same in Western countries account for

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only a very small percentage.The clients undergoing abdominal surgeries are found to

be at risk for developing post operative complications.Knowledge deficit regarding

post operative exercises among the client is noticed.6 Early ambulation is the most

significant general nursing method to prevent post operative complications.7

Post operative pulmonary complication and contribute

equally to morbidity, mortality and length of hospital stay.Use of appropriate lung

expansion techniques and adequate pain management also helps to ameliorate the risk

of pulmonary complications.8 Considering the prevalence of pain after surgical

operations & importance of rapid pain alleviation ,physical exercises is a simple

method for relieving pain.9 Regarding general complications after abdominal

surgeries,respiratory complications are common in post operative patients upto 40%

of all patients develop atelectiasis.6

DEODHAR SD MOHITE JD,SHIRAHATTI RG,JOSHI S on their

study on pulmonary complications of upper abdominal surgery.A prospective study

on 67 patients underwent upper abdominal surgery under general anaesthesia.37

patients had pulmonary complications.development of pulmonary complications

seems to be more in males(61.2%)than in females(30.4%).In conclusion ,it may

indicate the need for prophylactic measures pre-operatively and in the early post

operative period.10

Venous thrombo embolism is considered to be a significant

cause of morbidity & mortality in hospitalized patient,especially in those undergoing

major surgical procedure.In the absence of prophylaxis,VTE rates as high as 25%

have been reported following general surgeries.Six general and colorectal surgical

publications from the region reported an incidence of deep vein thrombosis ranging

from 3%-28%.A study from Singapore showed that out of 227 elective surgeries one

patient developed clinical DVT postoperatively.Only early post operative

mobilization was encouraged for prevention of these complications.11

PIEPER AND KAGER is a careful study from Sweden, estimated a yearly

incidence of 1.33 cases of appendicitis per 1000 of male population and 0.99/1000 of

female population.25% of the patients were younger than 14 yrs and 75% younger

than 33.More recently a population based study examined the outcome of all open

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cholecystectomies performed in 12 month period in 2 states in the US.In this 42,474

patients, representing approximately 8 % of all cholecystectomies performed annually

in that morbidity rate of 14.7% includes all reported complications, including minor

problems such as atelectasis, and other assorted difficulties.12 Some of them have

misconception that a change in position after abdominal surgery may worsen their

health status.The same time it is fact that exercises and early ambulation reduces post

operative complications.6 In our hospital set up among the surgeries are conducting-

abdominal surgeries are most common like appendectomy,cholecystectomy, hernia.

Among these most of them need more than 6 days of hospitalization.Pre operative

teaching allays anxiety & encourages clients to participate actively in their own care.3

Because of the above mentioned reasons the investigator identified the need

for giving a structured teaching programme for clients who are posted for abdominal

surgeries on post operative exercises will avoid post operative complications and to

facilitate recovery.

6.2 REVIEW OF LITERATURE

“Literature review is a critical summary of research on a topic of interest often

prepared to put a research problem in the context or as the basis for an

implementation project”

- Polit and Hungler

1. A study was conducted on chest physiotherapy with positive expiratory

pressure breathing after abdominal and thoracic surgery at Linköping

University Hospital,Sweden. Breathing techniques with a positive expiratory

pressure (PEP) are used to increase airway pressure and improve pulmonary

function. The purpose of this systematic review was to determine the effect of

PEP breathing after an open upper abdominal or thoracic surgery.Randomised-

controlled trials (RCT) was performed in five databases. We selected six RCT

evaluating the PEP technique performed with a mechanical device in

spontaneously breathing adult patients after abdominal or thoracic surgery.

Only one of the included trials showed any positive effects of PEP compared

to other breathing techniques. Today, there is scarce scientific evidence that

PEP treatment is better than other physiotherapy breathing techniques in

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patients undergoing abdominal or thoracic surgery. There is a lack of studies

investigating the effect of PEP over no physiotherapy treatment. 13

2. A study on duration of anaesthesia , type of surgery, respiratory co-

morbidity, predicted VO2max and smoking predict postoperative

pulmonary complications after upper abdominal surgery. Prospective

observational study. 268 consecutive patients undergoing elective upper

abdominal surgery who received standardised pre- and postoperative.

prophylactic respiratory physiotherapy.The results are 35 participants (13%)

developed postoperative pulmonary complications. Five risk factors predicted

postoperative pulmonary complications: duration of anaesthesia; surgical

category;current smoking; respiratory co-morbidity; and predicted maximal

oxygen uptake. A clinical rule for predicting the development of postoperative

pulmonary complications predicted 82% of participants who developed

complications. The odds of high risk participants developing pulmonary

complications were 8.4 times that of low risk participants.They concluded that

clinical rule for predicting the risk of developing postoperative pulmonary

complications from five risk factors may prove useful in prioritising

postoperative respiratory physiotherapy. 14

3. A study to discuss the recent literature concerning the significance of

respiratory complications as a determining factor in post operative

complications after major surgery in San Giovanni Battista Hospital, Italy.

Here,examine the diagnosis, contributing factors, consequences, and early

treatment of respiratory complications. The findings are general anesthesia and

surgery are the main causes of postoperative respiratory complications.

Atelectasis, a common respiratory complication, may contribute to pneumonia

and acute respiratory failure. Recently, it has been shown that activation of

abdominal muscles during the induction of anesthesia contributes to a

reduction of lung capacity, leading to a higher degree of atelectasis.

Additionally, long-term mortality at 5 and 10 years has recently been shown to

remain significantly increased in patients with respiratory complications.

Prevention or early therapy of respiratory complications may be beneficial in

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improving outcome in postoperative patients. Developing early treatment

strategies will likely provide improved benefits. To date, early treatment with

prophylactic or therapeutic continuous positive airway pressure has proved

beneficial in an abdominal surgical patient population.15

4. A study on randomized controlled pilot study comparing physiotherapy

techniques of breathing and mobility after abdominal surgery at Concord

hospital , Sydney, Australia. Results from this study may provide evidence

which can be applied to post operative physiotherapy practice.44 subjects

undergoing open abdominal surgeries at high risk of developing post

pulmonary complications (PPC) were recruited,Subjects were randomly

assigned to three groups.Group A only received physiotherapy directed early

mobility.Group B in addition to early mobility received deep breathing and

coughing.Group C received deep breathing and coughing.but were only

mobilized by the physiotherapist on day 3.The PPC rates were 25%,42% and

10% and the day restoration of independent mobility were 5.6, 11.6, 9.11 for

group A,B,C.Post Pulmonary complications develops in high risk patients

after abdominal surgery and physiotherapy techniques of an addition of deep

breathing to an early mobility or mobilizing on day three is equally effective

in improving recovery.16

5. A study on respiratory physiotherapy to prevent pulmonary

complications after abdominal surgery: a systematic review in Geneva

University Hospitals,Switzerland. Randomized trials were included if they

investigated prophylactic respiratory physiotherapy and pulmonary outcomes,

and if the follow-up was at least 2 days. The results are 35 trials tested

respiratory physiotherapy treatments. Of 13 trials with a "no intervention"

control group, 9 studies (n = 883) did not report on significant differences, and

4 studies (n = 528) did: in 1 study, the incidence of pneumonia was decreased

from 37.3 to 13.7% with deep breathing, directed cough, and postural drainage

; in 1 study, the incidence of atelectasis was decreased from 39 to 15% with

deep breathing and directed cough ; in 1 study, the incidence of atelectasis was

decreased from 77 to 59% with deep breathing, directed cough, and postural

5

drainage; in 1 study, the incidence of unspecified pulmonary complications

was decreased from 47.7% to 21.4 to 22.2% with intermittent positive pressure

breathing, or incentive spirometry, or deep breathing with directed cough.

They concluded that are only a few trials that support the usefulness of

prophylactic respiratory physiotherapy. 17

6. A study on knowledge retention from pre operative patient information.This

review considered all studies that included adults in a hospital setting,either as

inpatients or same day surgical patients,and who received some form of

information and or instruction before an operative procedure.Interventions

were the methods of pre operative patient education,instruction or

teaching,and included evaluations of the effectiveness of different

presentations such as written information , a.v aids,computer assisted

instructions etc. The findings of the study support the use of pamphlets to

inform patients and to improve their skills.The data suggested that the

instructional method,the act of educating a patient by delivering for actions is

useful for improving patients knowledge of their treatment andability to

perform and comply with required exercises.If teaching is to be done after

admission,using a group format has been shown to be equally as effective as

individual instruction. 18

7. A study on Preoperative Teaching and Hysterectomy Outcomes. This study

used a theoretical model to determine whether an efficacy-enhancing teaching

protocol was effective in improving immediate postoperative behaviors and

selected short- and long-term health outcomes in women who underwent

abdominal hysterectomies.One hundred eight patients in a 486-bed teaching

hospital in the Midwest who underwent hysterectomies participated. The

participation rate was 85% during the six-month study. The major finding was

that participants in the efficacy-enhancing teaching group ambulated

significantly longer than participants in the usual care group. This is an

important finding because the most prevalent postoperative complications

after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein

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thrombosis, and postoperative ambulation has been shown to decrease or

prevent all of these complications.19

8. A study in on physiotherapy outcomes and staffing resources in open

abdominal surgery patients in Australia.This study investigated at two

hospitals.The Abdominal Surgery Physiotherapy Outcomes Data

Sheet,designed for this study .The 30 subjects at each of the 2 hospitals were

comparable in all pre operative and peri operative variables.Wide variations in

the amount of physiotherapy resources were found between the two

hospitals..Number of physiotherapy treatments was found to be co related with

pre operative ASA score,days of mechanical ventillation and post operative

length of stay.Rates of restoration of mobility varied significantly,with

hospital B subjects sitting out of bed earlier and able to mobilise

independently earlier after surgery compared to hospital A .Over all rate of

post operative complications rates was 43.3%.Development of clinical

outcome measures in this area of physiotherapy is urgently needed in order to

review clinical practices and and inform priorities for future research

direction.20

9. A study to exam the effects of preoperative nursing intervention for pain on

abdominal surgery preoperative anxiety and attitude to pain, and postoperative

pain. In a randomized controlled study conducted between January and August

2001, patients undergoing abdominal surgery in a medical center in southern

Taiwan were randomly assigned to an experimental (n = 32) or control group

(n = 30). The experimental group received routine care and preoperative

nursing intervention for pain, while the control group received routine care

only.. Perceived pain interference during position changes, deep

breathing/coughing, and moments of emotion in the experimental group was

statistically significantly lower than that of the control group in the same

situations. The experimental group also started out-of-bed activities 1·5 days

earlier. They conclude that  Preoperative nursing intervention for pain has

positive effects for patients undergoing abdominal surgery. 21

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10. A study conducted on the effect of exercise on post caesarian section pain.

This clinical study was performed on 40 volunteer patients for caesarian

section at Aytollah Kashani hospital in Jiroft 2000 .The subjects were

randomly divided into 2 groups of 20:Case and control groups .Physical

exercises were taught to the case group including proper deep

breathing ,effective coughing ,limb movement, changing position in bed and

leaving bed ,but they were not demonstrated to the control group. .Results

showed that the cases had significantly lower pain magnitude and receptive

after operations especially on the 1st,2nd, and 3rd days after operation. They

concluded that physical exercises after abdominal surgeries is recommended

as a simple non-medical and non invasive method for relieving pain.9

6.3 STATEMENT OF THE PROBLEM

“A study to evaluate the effectiveness of structured teaching programme on

knowledge regarding post operative exercises of clients who are undergoing

abdominal surgeries in selected hospitals, Davangere ”.

6.4 OBJECTIVES OF THE STUDY

1. Assess the existing knowledge regarding post operative exercises of clients

who are undergoing abdominal surgeries .

2. Evaluate the effectiveness of structured teaching programme as evident from

gain in post knowledge score.

3. Determine the association between pretest knowledge score and

sociodemographic variables.

6.5 OPERATIONAL DEFINITIONS

EVALUATE

In this study, it refers to determine amount of outcome of knowledge among pre

operative clients by structured teaching programme.

EFFECTIVENESS :

It refers to determining the extent to which the information in the structured

teaching programme has achieved the desired effect as expressed by gain in

knowledge score.

8

STRUCTURED TEACHING PROGRAMME :

It refers to systematically planned teaching programme designed to provide

informations which is prepared by researcher.

KNOWLEDGE:

In this study, it refers to amount of information collected by the researcher

from the subjects by administering structured questionnaire.

POST OPERATIVE EXERCISE :

In this study it refers to the exercises which are to be performed after abdominal

surgeries.

ABDOMINAL SURGERIES :

In this study it broadly covers surgical procedures that involve opening the abdomen

includes appendicectomy,cholecystectomy,incisional hernia,abdominal

hysterectomy,intestinal obstruction.

CLIENT :

In this study it refers to the client who are posted for abdominal surgeries.

6.6 ASSUMPTION

The study assume that

1. Clients who are posted for abdominal surgeries may have some knowledge

regarding post operative exercises after abdominal surgery.

2. Structured teaching programme enhances knowledge regarding post operative

exercises.

3. Clients level of knowledge is influenced by demographic variables.

6.7 RESEARCH HYPOTHESIS

H1 – The mean post test of subjects exposed to structured teaching programme

will be greater than their mean pretest scores as measured by structured knowledge

questionnaire at 0.05 level of significance.

H2 - There will be significant association between selected demographic

variables and the knowledge of pre operative clients.

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6.8 LIMITATIONS

The study is limited to the clients who are posted for the elective abdominal

surgeries like appendicectomy,cholecystectomy ,incisional hernia, abdominal

hysterectomy.

Clients in pre and post operative wards of selected hospital Davangere.

Pre operative clients who are available at the time of data collection.

Clients who can read and write Kannada.

7. MATERIALS AND METHODS OF THE STUDY

7.1 SOURCE OF DATA

Pre operative clients who are available in the hospital at the time of data

collection.

7.1.1 RESEARCH DESIGN

Pre-experimental research design with one group pretest post test.

7.1.2 VARIABLES OF THE STUDY

i. DEPENDENT VARIABLE

Knowledge gained by the pre operative client.

ii. INDEPENDENT VARIABLE

Structured teaching programme on knowledge regarding post operative

exercises.

7.1.3 STUDY SETTINGS

The study will be conducted in the selected hospitals includes S.S.Institute of Medical

Sciences&Research centre, C.G.Hospital Davangere.

7.1.4 POPULATION

The population of the present study will be comprised of pre operative

clients who are posted for elective abdominal surgeries-

appendicectomy,cholecystectomy,incisionalhernia,abdominal hysterectomy in

selected hospitals, Davangere.

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7.2 THE METHOD OF DATA COLLECTION

Data will be collected by using self administered questionnaire after obtaining

prior permission from the hospital

7.2.1 SAMPLING TECHNIQUE

Purposive sampling technique is used to select the sample of pre operative

clients.

7.2.2 SAMPLE SIZE

Sample for the study are 45 pre operative clients posted for abdominal

surgeries.

7.2.3 CRITERIA FOR SELECTION OF THE SAMPLE

INCLUSION CRITERIA

1. Preoperative clients who are posted for the elective abdominal surgeries

includes appendicectomy,cholecystectomy,incisional hernia,abdominal

hysterectomy.

2. Pre operative clients those are present at the time of data collection

3. Pre operative clients who can read and write Kannada

4. Clients in pre and post operative wards of selected hospitals.

EXCLUSION CRITERIA

1. Pre operative clients other than abdominal surgeries.

2. Pre operative clients who are not willing to participate.

7.2.4 INSTRUMENT

A structured questionnaire will be prepared in such a way it will

consists of two parts.

I The demographic data of the pre operative clients.

II The knowledge of pre operative clients regarding post operative exercise.

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7.2.5 METHOD OF DATA ANALYSIS AND PRESENTATION

The data being collected through structured questionnaire will be

carefully analysed through the following statistical technique.

I Descriptive statistics

i. Frequency and percentage used to describe demographic

characteristics of pre operative clients being studied under research.

ii. Mean and standard deviation will be used to assess knowledge on

post operative exercise .

II Inferential statistics

i. Paired ‘t’ test will be used to compare pretest and post test knowledge

scores.

ii. Chi square test will be used to find out the association between

demographic variables with the level of knowledge on post operative exercise

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE

CONDUCTED ON PATIENTS OR OTHER HUMAN ANIMALS?

Yes, structured teaching programme will be administered to the pre operative

clients in increasing their knowledge regarding post operative exercises to be

performed after abdominal surgeries.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR

INSTITUTION?

Ethical clearance will be obtained from the institutions ethical committee

(IEC).The purposes and details of the study will be explained to the study subject and

informed consent will be obtained from them. Assurance will be given to the study

subject on the confidentiality of the data collected from them. Permission will be

obtained from the hospital for data collection.

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8. Reference:

1. New world encyclopedia contributers, Surgery [internet]. New World

encyclopedia; 2008 Aug 29, 15:46 UTC [cited 2009 Dec 8]. Available from :

http://www.newworldencyclopedia.org/entry/Surgery?oldid=795211

2. MJ,Ashley Zinner SW.Maingot’s abdominal operations. 11thed.United states

of America:Mc Graw Hill;2007. p. 3.

3. Black JM, Hawks JH. Medical surgical nursing: clinical management for

positive outcomes. 7th ed. Missouri, India: Elsevier; 2005. p. (vol 1).

4. Centers for disease control and prevention. Inpatient surgery. 2006. Available

from: URL: http://www.cdc.gov/nchs/FASTATS/insurg.htm.

5. Hollis M.Practical exercise therapy.Oxford:Blackwell scientific;1976. p. 1

6. Shymon K. Effectiveness of preoperative planned teaching programme on post

operative self care activities and recovery of clients undergoing abdominal

surgery, dissertation 2006

7. Lewis SL, Heitkemper MM, Dirksen SR, O’Brien PG, Butcher L:Medical

Surgical Nursing:Assessment and Management of Clinical Problems. 7 th ed.

Missouri, India:Elsevier; 2007. p. 21-35.

8. Relan M, Kancha RK. Peri operative assessment and management of the

patient with pulmonary disease. North east Flore med[abstract] 2008[cited

on2008]; 59(1): 19. Available from: URL:

http://www.dcmsonline.org/jaxmedicine/…/perioperative/pulmonary/pulmona

ryevaluation.pdf.

9. Aetzadeh S. The effect of exercise on post caesarian section pain.J Qazvin

Univ Med Sci[abstract]2000[cited on 2003]; 7(4); Available from:

http://jqums.hbi.ir/browse php?a_code_a_10-1-89&sid=1&sk-lang-en.

10. Deodhar SD, Mohite JD, Shirahatti RG, Joshi S. Pulmonary complications of

upper abdominal surgery. J Postgrad Med [serial online] 1991 [cited 2009 Nov

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27]; 37: 88-92. Available from : URL:

http://www.jpgmonline.com/text.asp?1991/37/2/88/782.

11. Jawaid M, Masood Z, Iqbal SA. Post operative complications in general

surgical ward of a teaching hospital. Pak J Med Sci [abstract]2006 [cited

on2006];22(2):171.Availablefrom:

http://www.pjms.com.pk/issues/apr.jun06/article/article16.html

12. Zinner MJ, Schwartz IS, Ellis H.Maingot’s abdominal operations. 10th ed.

United states of America:Prentice Hall International;1997.p. 1193,1733.

13. .Orman J, Westerdahl E. Chest physiotherapy with positive expiratory

pressure breathing after abdominal and thoracic surgery: a systematic review.

Act Anaes Scand[abstract] 2009 [cited 2009]. Available from: URL:

http://www.researchgatenet/publication/38056438.

14. Scholes RL, Browning L, Sztender EM, Denehy L. Duration of anesthesia,

type of surgery, respiratory co morbidity,predict poat operative pulmonary

complications after abdominal surgery. Aust J Physio [abstract]2009

[cited2009]; 55(3): 191-198. Available from:

http://www.ncbi.nlm.nih.gov/pubmed/19681741.

15. Ferreyra G, Long Y, Raniera V. Respiratory complications after major

surgery. Curr Opin Crit Care[abstract]2009 Jun 17 [cited on 2009 Aug]; 15(4).

342-348. Available from: http: //journals.lwww.com/co-critical

care/abstract/2009/08000/respiratory_complication_after_major

_surgery.12.aspx.

16. Silva Y, Li F. Randomised controlled pilot study compairing physiotherapy

techniques of breathing and mobility after open abdominal surgery on high

risk patients. Research report platform presentation[abstract] 2007 [cited on

2007 Jun];93(5): 5308. Available from:

http://www.org/abstracts2007/abstract/1030htm?abstractlist.

17. Pasquina P, Tramer RM, Granier JM, Walder B. Respiratory physiotherapy to

prevent pulmonary complications after abdominal surgery: a systematic

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review. Chest[abstract] 2006 Dec [cited on 2006]; 130(6): 1887-99. Available

from: http://chestjournal.chestpubs.org/content/130/6/1887.abstract.

18. Stern C,Lockwood C.Knowledge retention from preoperative patient

information. Intern J Evi based health[abstract]2005 March [cited on 2005];

3(3): 45-63. Available from:

http://www.3interscience.wiley.com/journal/118719400/abstract?CRETRY

=1& S RETRY=0.

19. Sharon L,Black LO, Jones S, Estok P, et al. Pre operative teaching and

hysterectomy outcomes. AORN[abstract]2003 June [cited 2003];77(6): 1215-

1231. Available from: http://www.aornjournal.org/article/50001-

2092(06)60983-6/abstract.

20. Mackay RM, Ellis E. Physiotherapy outcomes and staffing resources in open

abdominal surgery patients. Physio theory & Pra[abstract]2002 [cited on

2002]; 18(2):75-93. Available from:

http://www.interscience.wiley.com/journal/118698730/abstract?

CRETRY=1&SRETRY=0.

21. Lee DS, Chein WT. Pre-operative patient teaching in an acute care ward in

Hong Kong: Contemporary Nurse[abstract]2002 [cited on 2002];13(2-3):

Available from : http://www.ncbi.nlm.gov/pub/116116783.

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9. SIGNATURE OF THE CANDIDATE :

10.

REMARKS OF THE GUIDE :

11.

NAME & DESIGNATION OF (IN BLOCK LETTERS)11.1 GUIDE

11.2 SIGNATURE

:

:

11.3 CO-GUIDE (IF ANY)

11.4 SIGNATURE

:

:

11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE

:

:

12.

12.1 REMARKS OF CHAIRMAN AND PRINCIPAL

12. 2 SIGNATURE

:

:

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ETHICAL COMMITTEE CLEARANCE

1. TITLE OF THE DISSERTATION: “EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING

POST OPERATIVE EXERCISES OF CLIENTS WHO ARE UNDERGOING ABDOMINAL SURGERIES IN SELECTED HOSPITALS,

DAVANGERE”

2. NAME OF THE CANDIDATE: MS. ANN MARY VARGHESE, 1st year M.Sc Nursing, Bapuji College Of Nursing.

3. SUBJECT: MEDICAL SURGICAL NURSING 4. NAME OF THE GUIDE : PROF. S.F. BILLALLI , M.Sc. Principal and HOD, Medical surgical Nursing Dept,

Bapuji college of Nursing, Davanagere-4

5. APPROVED/NOT APPROVED: (If not approved, suggestion)

PROF. S.F.BILLALLI, MRS.LEELAVATHY.R.HPrincipal and HOD, Head of the Department of Department of Medical surgical Nursing, Obstetrics and Gynecological NursingBapuji college of Nursing, Bapuji College of NursingDavanagere-4 Davanagere-4.

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