1
SYNOPSIS FOR
REGISTRATION OF SUBJECT FOR
DISSERTATION
SUBMITTED TO:
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
IN PARTIAL FULFILLMENT
OF
M.Sc (N) IN MEDICAL SURGICAL NURSING
SUBMITTED BY:
MISS. BINTU GEORGE
I YR M.Sc(N)
UNDER THE GUIDANCE OF:
Mrs. JESSY JACOB
ASSOCIATE PROFESSOR
MEDICAL SURGICAL NURSING
NARAYANA HRUDAYALAYA COLLEGE OF NURSING
NO: 258/A, BOMMASANDRA INDUSTRIAL AREA
ANEKAL TALUK, BANGALORE-99
1 / Name of the candidate and Address / Ms. BINTU GEORGEI YEAR M.Sc NURSING,
NARAYANA HRUDAYALAYA COLLEGE OF NURSING,
BOMMASANDRA INDUSTRIAL AREA, BANGALORE – 99.
2 / Name of the Institution / NARAYANA HRUDAYALAYA COLLEGE OF NURSING.
3 / Course of study and subject / 1ST YEAR M.Sc NURSING
( MEDICAL SURGICAL NURSING)
4 / Date of admission to Course / 08/06/ 2009
5 / TITLE OF THE TOPIC / EFFECTIVENESS OF A STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HOME CARE AMONG PATIENTS UNDER GOING CATARACT SURGERY .
PROBLEM STATEMENT
A STUDY TO ASSESS THE EFFECTIVENESS OF A STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HOME CARE AMONG PATIENTS UNDER GOING CATARACT SURGERY IN A SELECTED HOSPITAL IN BANGALORE
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Cataract is the clouding of the crystalline lens of the eye, placed at the back of the iris or in its envelop. cataract is very common in older people. There are, many causes for cataract; they are smoking ,diabetes, deterioration in the nutrition of the lens, deposits of acids and salt between lens fibers and disintegrity of lens fibers, use of alcohol and prolonged exposure to sunlight. Age related cataract occurs in 40s and 50s1
Blindness resulting from cataract is a major health problem in the developing world. Out of 41.8 % of blindness reported globally 23.% is contributed by India and of which majority is caused by cataract alone. A major proportion of total blindness in India (81 %) and that of Haryana (79 %) is contributed by cataract. In India 3.8 million people become blind due to cataract every year. It has severe impact on the economy and productivity of country. According to most recent WHO data on blindness, women are 1.5 to 2.2 times more likely to blind than man1.
Fifteen percentage of people with cataracts suffer visiual impairment which requires cataract surgery. Cataract surgery is a common ophthalmic procedure. Cataract surgery can be performed by either phacoemulsification or by extra capsular extraction3.
6.1: NEED FOR THE STUDY
Home care is essential after cataract surgery. Home care includes protection of operated eye with an eye shield, avoiding activities that causes strain on the eyes, such as strenuous work, excessive bending, driving and lifting heavy articles and straining during defecation. Excess pressure on the operated side and rubbing of eyes should be avoided. Patient should be encouraged to use one’s own spectacle and to avoid dirt, water, soap or any other substances to get into the eyes. Proper administration of eye drops is important to avoid post operative infection. Patients and the family are responsible for almost all postoperative care. Instruction regarding homecare is essential. These teaching should include information about postoperative eye care, activity restrictions, medications, follow-up visit schedule and signs and symptoms of possible complications. Patients need to be informed that vision will be blurred for few days and to inform the doctor if they have severe pain in the eyes, fever or the vision become suddenly worse. 2
Though the above mentioned home care seems to be simple, it has a significant impact on the prognosis. Because of shortened hospital stay patients need to be educated regarding care at home . Nurses has a pivotal role in educating the patients. Hence the researcher would like to conduct a study to assess effectiveness of structured teaching programme on knowledge regarding home care among patients under going cataract surgery.2
6.2: REVIEW OF LITERATURE
Based on the objectives of the study the literature from various sources were reviewed and arranged under following categories.
v Section A : Complications after cataract surgery
v Section B : The care to be taken after cataract surgery
v Section C: Effectiveness of teaching programme regarding home care after cataract surgery
SECTION A : Complications after cataract surgery
A study was conducted at cataract and Intra ocular lens research centre , Ahmedabad to evaluate Intra operative performance and long term surgical outcome after Phaco emulsification of age related cataract. One hundred and sixty five patients were studied post operatively. Posterior capsule opacification occurred in 8 eyes, endothelial cell loss was occurred in 7.1% at 3years follow up .6
A Study was conducted to determine the prevalence , primary cause and risk indicators of visual impairment in cataract operated eyes. Two sixty one patients were studied . Out of 261 participants 100 (38%) participants had undergone a unilateral extraction and 161(62%) had undergone bilateral extraction . The prevalence of visual impairments was 41% (n=107).7
A study conducted by Royal college of ophthalmologists on1000 patients who have undergone extra capsular extraction to identify significant postoperative complications.
The study found that on the first postoperative day, complications were observed in 10 % of eyes, of which 88 % was due to raised intra ocular pressure. 3
The national survey most frequently occurring complications within 48 hours after surgery were corneal oedema (9.5%), raised Intra Occular Pressure (7.9 %), and uveitis (5.6 %). Overall, 23.3 % of patients had early postoperative complications ranging from minor to sight threatening conditions. These findings revealed the need for home care management after cataract surgery3
A systematic review was conducted to determine the reported incidence of acute endophthlmitis following cataract extraction. This systematic review indicated that the incidence of endophthlmitis associated with cataract extraction has increased. This upward trend in endophthlmitis frequency coincides temporally with the development of suture less clear corneal incisions8.
SECTION B: The care to be taken after cataract surgery
A study was conducted to determine the experience of relatives caring for a person operated on for cataract. In this study, 8 caregivers who is closest to a patient and plays an important role in caring were interviewed. Care givers lacks the knowledge which would tranquilize both the patients and the carer. This is the situation of day surgery procedures, such as those for cataracts, after which patients (mainly elderly) are sent home a few hours later and cared exclusively by relatives. Although some studies have dealt with patient satisfaction, none have been published dealing with the experience of caring for a person –after day surgery treatment for cataract.4
A study was conducted to determine difficulties of patents at home after cataract surgery Twenty patients were interviewed to investigate their ability to manage eye-care and daily-living routines at home following uncomplicated unilateral cataract extraction without implantation of an artificial lens. A high degree of compliance with the recommendations of health care professionals were reported; however, difficulties were incurred in obtaining medications, reading labels, instilling eye drops, applying the eye shield and providing a safe environment. Performance of daily-living routines presented no problems, if help with shopping and heavy household tasks were available in the first few weeks postoperatively13.
A study was conducted to determine the use of antimicrobials to prevent postoperative infection in patients with cataracts. Despite the high frequency of cataract surgery,there are still no definitive studies on antibiotic prophylaxis against endopthalmitis after cataract surgery ,The results of several recent studies shed additional light on this topic. This review presents some principles of prophylactic treatment and selected literature that addresses the effeciveness of antisepis, topical preoperative antibiotics, subconjunctival antibiotics, systemic antibiotics, and post operative antibiotics. 11
A study was conducted regarding importance of home care for the postoperative cataract patient. Findings revealed that the traditional collaborative practice model sustained a negative impact when cataract surgery became an outpatient procedure. Early discharging of postoperative cataract patients plan for rehabilitative needs. Complications of cataract surgery are a reality and range from minor to catastrophic. The nurse is able to assess the postoperative patient, to collaborate with the ophthalmologist. The nurse act as a vital link between the ophthalmologist and the patient5.
The following information will assist the patient when they are at home after cataract surgery. It has been developed by the section of ophthalmology Greater victoria hospitial society.
Protection
1. The wound will not be completely healed before the sixth week.
2. Protect eyes at bed time and during naps by taping an eye shield with non-allergic tape.
3. Do not rub or exert pressure on the operated eye.
4. Patients are encouraged to use their own glasses.
5. Patients should take extra care to avoid chemicals to get in to the eyes
Activity limitations
1. Light house work is allowed for the first week.
2. Bending down below the waist is not encouraged early in your post operative recovery.
3. Lifting any thing which weighs heavier than 10k is not recommended for the first week.
4. Sexual relations may be resumed in 3 weeks provided care is taken not to strain excessively for up to 6 weeks.
5. Driving a vehicle requires your ophthalmologists approval.
Expectations
• Patients may feel that there is something in their eye. This is due to the stitches. This feeling may last up to six weeks. Vision may be blurred until eye glass prescription is given or changed.9
SECTION C : Effectiveness of teaching programme regarding home care after cataract surgery
A study conducted by faculty of nursing, university of Alperta to determine the effectiveness of pre- operative teaching programme for cataract patients. Findings revealed that teaching programme was effective and resulted in positive benefits. The study suggested that teaching on home care is necessary because of shortened hospital stay . 12
A Study was conducted at Manchest Royal Eye Hospital to determine the effectiveness of teaching regarding instillation of eye drops after cataract surgery. Ten patients who intended to instill eye drops by themselves were interviewed on the ward before discharge and two weeks later at home. The majority had inappropriate expectation of what compliance with treatment would involved. The study concluded need for developing and improving the teaching of drop instillation after cataract surgery to be extend the community10
6.3: OBJECTIVES
The objectives of the study are:
• To assess the knowledge regarding homecare before and after structured teaching programme among patients undergoing cataract surgery
• To identify the association between knowledge regarding homecare and selected demographic variables
• To determine the effectiveness of structured teaching programme on knowledge regarding homecare
6.4: OPERATIONAL DEFINITION
• EFFECTIVENESS: It refers to change in knowledge score as a result of structured teaching programme as measured by a questionnaire.
• STRUCTURED TEACHING PROGRAM ME: It refers to a planned teaching programme intended to improve knowledge regarding homecare. It includes instruction regarding proper instillation of eye drops, activities to be avoided, personal hygiene, early identification and reporting of complication and follow up care.
• KNOWLEDGE: It refers to understanding regarding homecare among patients undergoing cataract surgery.
• CATARACT SURGERY: It refers to a surgical intervention for removing opaque lens from the eye of an adult patient,
• PATIENTS : It refers to adults aged above 40years and are undergoing either phacoemulsification or extra capsular cataract extraction.
• HOME CARE: It refers to the care that the patient has to take at home followed by cataract surgery .
6.5: ASSUMPTIONS
• Home care after cataract surgery is essential for better prognosis.
• Patients are having some knowledge regarding home care after cataract surgery
• The structured teaching programme will improve the knowledge of patients regarding home care after cataract surgery.
6.6;HYPOTHESIS
HI;The mean post test knowledge scores of patients who are receiving structure teaching programme will be significantly higher than their mean pre test knowledge scores at 0.05 level of significance.
H2;There will be a significant positive association between knowledge and selected demographic variables such as age ,gender ,education ,economic status ,occupation,and previeus experience at 0.05 level of significance .
6.7;DELIMITATION
• The study is limited to patients who are undergoing a planned cataract surgery in Narayana Nethrayala.
• The period of data collection is only for 6 weeks
• Generalisation of finding will be delimited to the population studied.
7. MATERIALS & METHODS
7.1 Sources of data
· Patients who are undergoing planned cataract surgery in Narayana Nethralaya .
7.2 METHODOLOGY
7.2.1 Research approach: evaluative
7.2.2 Research design: Pre test-post test design. with control group.
7.2.3 Sample : patients undergoing planned cataract surgery at Narayana
Nethralaya .
7.2.4 Sample size : 60 (30 experimental and 30 controlled group)
7.2.5 Sampling Technique :Simple Random sampling
7.2.6 SAMPLING CRITERIA
Inclusion criteria :
• Patients who are willing to participate in the study
• patients who are undergoing planned cataract surgery at Narayana Nethralaya
• patients who can understand Kannada, or, English, Malayalam ..
Exclusion Criteria
• Patients who are unable to comply with the requirements of the study
7.2.7 VARIABLES
Independent variable; Structured teaching programme.
Dependent variable; Knowledge regarding homecare after cataract surgery.
7.2.8 SETTING
Narayana Nethralaya
7.2.9 Data collection technique
v Obtain formal administrative permission.
v Obtain informed consent from patient.;
v Assign the patients to controlled group or experimental group by randomly.
v Assess the knowledge by using structured questionnaire ( pretest ) in both the groups
v Provide structured teaching programme to the experimental group.
v Reassess the knowledge by using the same structured questionnaire (posttest) in both the groups
DESCRIPTION OF TOOLS:
Section- A
Demographic profoma : age, gender, education, economic status, occupation and previous experience.
Section -B
Structured Questionnaire ; on home care after cataract surgery
7.3 Data Analysis :
v Descriptive Statistics – frequency, percentage, mean, standard deviation,