RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 /

NAME OF THE CANDIDATE

AND ADDRESS / LIBIN MATHEW
JOSCO COLLEGE OF NURSING
NELAMANGALA
BANGALORE.
2 / NAME OF INSTITUTION / JOSCO COLLEGE OF NURSING
INFANT JESUS BUILDING NO.3590,
CHENNAPPA EXTN., NELAMANGALA
BANGALORE-562123.
3 / COURSE OF THE STUDY AND
SUBJECT / MSc. NURSING I YEAR
PAEDIATRIC NURSING.
4 / DATE OF ADMISSION / 26.10.2009
5 / TITLE OF THE TOPIC / A STUDY TO ASSESS EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON HOME CARE MANAGEMENT OF
ABDOMINAL SURGERY AMONG MOTHERS
OF SCHOOL AGE CHILDREN FOLLOWING
ABDOMINAL SURGERY IN SELECTED HOSPITALS, BANGALORE.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY

Abdominal surgery in school age children is the most challenging thing needed for abdominal problems. The major abdominal problems in childrens are appendicitis, inguinal hernia and intestinal obstruction. Therefore abdominal surgery is performed and determined the outcome after treatment1.

Incidence (annual) of abdominal surgery around the world is 25 per 10,000 for the age group 6 to 12 years. Incidence rate of abdominal surgery is approximately 1 in 319 childrens in India. The incidence rate of abdominal surgery in Karnataka is 1.76% in school age children.2

Acute Appendicitis around the world is 1-2 per 10,000 under the age group of age 10-17. IncidenceRate of AcuteAppendicitis is approximately 1 in 400 or 0.25% or 680,000 childrens in the world3. Incidence of Acute Appendicitis in India is 2,662,676. Population Estimated for Acute Appendicitis in India is 1,065,070,607. The incidence of Acute Appendicitis in Karnataka is 0.34% in school age children4.

IncidenceRate for Inguinalhernia is approximately 1 in 544 or 0.18% or 500,000 children in world. The Incidence of Inguinal hernia in India is 1,957,850. Population Estimated for Inguinal hernia in India is 1,065,070,607. The Incidence rate of inguinal hernia in Karnataka is 0.9% in school age children5.

Incidence rate of intestinal obstruction is approximately 1 in 611 childerns in the world. Incidence rate of intestinal obstruction in India is 1,347,456. Population Estimated for intestinal obstruction in India is 1,742,143,456. Incidence rate of intestinal obstruction in Karnataka is 0.17% in school age children6.

A study conducted on early complications of abdominal surgery for children with intestinal obstruction and appendicitis on 173 childrens in which 16 childrens suffered from early post operative complication including bile leakage (10 patients), wound dehiscence (3 patients) hepatic failure (1 patient), pancreatic juice leakage (1 patient) in post operative intussusceptions (1 patient).12 of the 16 patients recovered but 4 died7.

A study conducted on risk factors for developing intra abdominal abscess following treatment for perforated appendicitis. The morbidity following treatment for perforated appendicitis in children is significant with intra abdominal abscess being one of the most serious complications. Acute appendicitis is the most common reason for emergency abdominal surgery in children. Data were collected on 265 childrens from 4 hospitals, 35 developed intra abdominal abscess post operatively8.

Acute appendicitis is the most common surgical emergency in the study accounting for about 16% of all cases. It is a common cause of abdominal pain in children and the conditions if untreated have several complications like perforations, intra abdominal sepsis and wound infection. Complication rate of acute appendicitis is increase in children due to lack of knowledge and ignorance from the part of parents about the disease condition and delay in reporting the hospital9.

The investigator has observed many school age children who has undergone abdominal surgery. Most of the mothers have lack of knowledge on home care management following abdominal surgery and its complications. Thus it increases the risk for complications following abdominal surgery, so there is a need of necessary information to overcome this situation. By this mothers will have adequate knowledge about the home care management following abdominal surgery and prevent complications so that investigator is interested to assess the knowledge of mother and provide structured teaching programme on home care management.

6.2 REVIEW OF LITERATURE

A review of literature involves a systematic identification, location, securitizations and summary of written materials that containing information on a research problems.

According to Polit and Beck a review of literature is a written summary of existing knowledge on a research problem. Indepth study of any subject involves a systematic review and appraisal of all the relevant scholarly literature and a specific topic.

Literature related to the abdominal surgery has been presented under the following categories

A. Studies related to incidence and prevalence of abdominal surgery.

B studies related to etiology of abdominal surgery.

C. Studies related to home care management following abdominal surgery.

D. Studies related to complication following abdominal surgery

A.  Studies related to incidence and prevalence of abdominal surgery.

A study was conducted on incidence and prevalence of abdominal surgery in India. A total of 4347 children aged 6 to 12 years were involved in the study. Out of this198 children had undergone abdominal surgery due to appendicitis, inguinal hernia, intestinal obstruction and peritonitis. The estimated incidence of abdominal surgery in India is approximately 1 in 319 school age children 10.

A study was conducted on 29 children of age group 6 to 12 years underwent herniorraphy. Operation varied from 45 to 180 minutes and out of 29 children 25 children were discharged on fifth post operative day.26 children return to their normal activities, two children had bleeding and one case with infection11.

B Studies related to etiology of abdominal surgery

A study was conducted on children of age group between 6 to 12 years undergone emergency abdominal surgery. Acute abdominal conditional are a common reason for emergency admission of children.955 childrens were enrolled in the study. The leading causes of surgical abdominal emergencies were typhoid perforations of gastric intestinal tract 68% acute appendicitis 16%, abdominal trauma and intestinal obstructions 4.7% each, irreducible hernia 2.5%, primary peritonitis 1% ball bladder disease and gastric perforation 0.8% each12.

A study was conducted acute abdominal emergencies requiring surgery in children. This study examined the etiologies of acute abdominal emergencies in children. This was a retrospective study of 100 children between the age 6 to 12 years presenting with acute abdominal emergencies requiring operative interventions. The leading causes were appendicitis, intestinal obstruction, inguinal hernia and peritonitis13.

C. Studies related to home care management following abdominal surgery

A study was conducted on care of children after abdominal surgery. 421 childrens were included in the study. The researcher suggested proper diet, medication, assessing the adverse symptoms followed by abdominal surgery and proper follow up. This study concluded that nutritious diet, medication and follow up are more effective for surgical incisional healing14.

A study conducted on immediate postoperative enteral feeding decreases weight loss and improves wound healing after abdominal surgery. Objective of the study was to determine the effect of immediate vs. delayed (72 hrs) postoperative enteral nutritious feeding on weight loss and wound healing after experimental abdominal surgery. Design of the study was Prospective, randomized, controlled study. This study concluded that immediate postoperative enteral feeding results in decreased weight loss and improved wound healing after abdominal surgery15 .

A study examined pain control with low-dose alfentanil in children undergoing abdominal surgery. The aim of this study was to investigate the quality of intra- and postoperative analgesia obtained by alfentanil compared to that produced by peripheral blockade in school age children. This study was concluded that a low-dose, intravenous bolus of alfentanil may be an efficient alternative to peripheral nerve blockade in controlling pain after abdominal surgery16 .

D Studies related to complication following abdominal surgery.

A study was conducted on 207 children undergone laparotomy for intestinal obstruction. Surgical complication found were wound infection 18(14.2%) burst abdomen in 5(3.9%) and fecal fistula in 3(2.3%) children. Intestinal obstruction is associated with considerable morbidity and mortality17.

A study conducted on Portal vein thrombus after pediatric proctocolectomy with ileoanal anastomosis. 296 sample of children were examined the complication of Portal vein thrombus. The researcher recommend that mesenteric/portal venous thrombosis be considered in the differential diagnosis in any child presenting with fever, abdominal pain, and leukocytosis after restorative proctocolectomy with ileal pouch anastomosis and that imaging obtained to evaluate abdominal complaints in this population be directed toward ruling out this complication18.

A study was done on 96 childrens with perforated appendicitis and treated by laparotomy. The post operative complications that specifically seen were wound infections, burst abdomen, hematemesis, intraperitonial abscess, respiratory complication and death 19.

A study conducted on common problems arising after surgery performed under general anesthesia are problems of consciousness, infection of the incision site, discomfort, allergic skin reaction and delayed recovery. When a patient develops post operative complications, it will result into increase in hospital stay as well as economical loss 20 .

STATEMENT OF PROBLEM

"A study to assess the effectiveness of structured teaching programme on home care management of abdominal surgery among mothers of school age children following abdominal surgery in selected hospitals, Bangalore"

6.3 OBJECTIVES OF STUDY

1. Assess the knowledge on home care management of abdominal surgery among mothers of school age children in terms of pretest.

2. Evaluate the effectiveness of structured teaching programme on home care management of abdominal surgery among mothers of school age children by comparing pretest score on post test knowledge score.

3. Find out the association between the pre-test knowledge score and selected demographic variables on abdominal surgery among mothers of school age childrens.

6.4 OPERATIONAL DEFINITIONS

1) Effectiveness: Refers to differences obtained in the post test knowledge score with that of pre test knowledge score regarding home care management of abdominal surgery among the mothers of school going children following abdominal surgery.

2) Structured Teaching Programme: Refers to systematic structured teaching activities designed to provide information on home care management. It is the description of nutritious diet, incisional care, regular checkup, prevention of infection and medication using lecture method assisted with variety of AV aids for duration of one hour.

3) Home care management: Refers to care provided in the home which would be executed 5 areas such as of nutrious diet, incisional care, regular checkup, prevention of infection and medication

4) Mothers of school age children: Refers to the married females with 6 to 12 year children who have undergone abdominal surgery.

5) Abdominal surgery: Refers to surgical opening of the abdomen involving appendicitis, inguinal hernia and intestinal obstruction.

6.5 HYPOTHESIS

H1: There will be significant difference in the knowledge score on home care management following abdominal surgery in the post test knowledge score than the pretest knowledge score among the mothers of school age children undergone abdominal surgery.

H2: There will be significant association between knowledge score on abdominal surgery among mothers of school age children following abdominal surgery and their selected demographic variables. .

6.6 DELIMITATIONS.

1. The study is limited to mothers of school age childrens undergone abdominal surgery.

2. The study evaluates knowledge on once only.

3. The study assess only knowledge scores.

6.7 VARIABLES

Dependent variables: Knowledge of mothers related to home care management.

Independent variables: Structured Teaching Programme.

7. METERIAL AND METHODS

7.1 / Source of data / The data will be collected from the mothers of school aged children following abdominal surgery in selected hospitals in Bangalore.
7.1.2 / Research approach / The research approach adopted for the present study is an evaluative research approach. Evaluations are often the corner stone of an area of research known a policy research.
7.1.3 / Research design / The research design adopted for present study is pre experimental, one group pretest and post test design only..
7.1.4 / Setting of the study / The study will be conducted in post operative ward in selected pediatric hospital, Bangalore.
7.1.5 / Population / The population for the present study comprises of school age children undergone abdominal surgery.
7.1.6 / Sampling technique / The proposed sampling technique adopted for the present study is purposive sampling technique.
7.1.7 / Sample size / The proposed sample size of this study consists of 60 mothers of school age children undergone abdominal surgery.
SAMPLING CRITERIA
7.1.8 / Inclusion criteria / 1. Mothers of children between 6 to 12 years following abdominal surgery.
2. Mothers who are willing to participate
3. mothers who are available during data collection
4. mothers who can read and understand kannada and English only.
7.1.9 / Exclusion criteria / 1. mothers who have attended teaching programme related to home care management
2. Mothers who are not willing to participate.
3. Mothers who are not available during data collection
DATA COLLECTION METHOD
7.2 / Tools for data collection / The tool for the proposed study is self administered structured knowledge questionnaire which would be developed by investigator with the help of extensive literature and experts opinion
7.2.1 / Procedure of data collection / 1. The plan of data collection for the proposed study is as follows:
permission will be obtained from the hospital authorities and respondents
2. Mothers meeting criteria inclusion would be selected using purposive sampling technique and pretest will be conducted using structured knowledge questionnaire Subsequently, Structured Teaching Programme will be given on same day.
3. Pretest will be conducted using structured knowledge questionnaire subsequently structured teaching programme will be given on the same day.
4. On the fifth day post test will be conducted using same structured knowledge questionnaire.
5. Proposed data collection period will be 4 weeks.
7.2.3 / Data analysis method / Data analysis to descriptive and inferential statistics
1. Descriptive statistics: frequency ,means, mean percentage and standard deviation would be used to describe demographic variables
2. Inferential statistics: paired‘t’ test to compare pre and post test knowledge course. chi-square test will be used to find out the association between knowledge scores and demography variables

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE CONDUCTED ON THE PATIENTS, OR OTHER HUMANS OR ANIMALS?

Yes, the structured teaching programme will be administered to mothers on home care management of abdominal surgery.