INTRODUCTION:

Kinesis, a word of Greek origin means motion or to move. The human body is designed for physical activity and movement. Even at rest, the normal healthy adult changes position on average every 11.6 minutes during sleep; this physiological requirement for movement is termed the minimal physiologic mobility requirements. Mobility is an individual’s ability to move about freely. Mobility serves many purposes including expression of emotions, self-defense, attaining basic needs, completing activities of daily living and performing recreational activities, besides assisting in maintaining the body’s normal physiological activities. Immobility is a condition in which a patient is unable to move either due to his disease condition or as part of his treatment, thus jeopardizing all the above activities that mobility helps him achieve.¹

Use It or Lose It-The Hazards of Bed Rest and Inactivity:

Immobility is widely documented in the literature as a cause of increased mortality and complications (Butcher, 2012). The musculoskeletal system is severely affected by immobility and prolonged bed rest (Vollman, 2010). Orthopedic patients will have impairment in immobility results from prescribed restriction of movement in the form of prolonged bed rest, physical restriction of movement or impairment of motor skeletal function (Potter and Perry, 2008). Prolonged bed rest and immobilization inevitably lead to complications. Such complications are much easier to prevent than to treat (Stuempfli, 2007).²

Musculoskeletal complications include loss of muscle strength, contracture and soft tissue changes, osteoporosis and degenerative joint disease. Cardiovascular complications includes an increased heart rate, decreased cardiac reserve, orthostatic hypotension and venous thrombo - embolism. Respiratory complications include decreased ventilation, atelectasis and pneumonia. Genitourinary problem include renal stone and more frequent urinary tract infections. Central system changes includes emotional and behavior changes that can lead to depression. Kurian, (2005) added that sustained pressure from immobilization is the risk factor in developing pressure sore. Orthopedic ward already contain a higher proportion of beds with pressure sore than those of any other specialty. Reports showed 11.9% -19.2 incidences in orthopedic wards against 8.8% in all in patients (Al- Shadedi).³

Patients on the orthopedic service are almost immobilized due to fracture, road traffic accident or surgery either for short duration or for extended period of time which ultimately leads to complications like deep vein thrombosis, orthostatic hypertension, muscle atrophy, osteoporosis, contracture, pulmonary embolism, pneumonia, atelectasis, urinary tract infection, calculi, pressure ulcer and constipation.⁴

It is better to light a candle, than to curse the darkness:

These complications are preventable; it is easy to prevent rather than to treat these complications in terms of escalating cost, health status of the patient and nursing facility. The knowledge regarding prevention of complications of immobilization is on paper yet not effectively implemented in practice. Health is primarily focused on preventive, promotive, and maintaining aspect.

NEED FOR THE STUDY:

According to study of Varghese, An average of approximately 50% of the hospitalized individuals has mobility impairment. Immobilization and inactivity are frequently present in patient with involvement of musculoskeletal and neurological systems and also among critically ill patients.⁵

But patients on the orthopedic service are those who require treatment for fractures, deformities, and diseases or injuries of some part of the musculoskeletal system. Some patients require surgery, immobilization, or both to correct their condition. The majority of patients requires surgical intervention, will be managed by bed rest, immobilization because of traction, fixation, application of plaster cast and rehabilitation. The possible complications arising out of immobilization in orthopedic patients are deep vein thrombosis, pulmonary embolism, pneumonia, orthostatic hypotension, pressure ulcer, calculi, urinary tract infection, osteoporosis, constipation and, muscle atrophy, depression and psychosis.⁶

Among this all complications according to previous study on complications of immobilization, pulmonary embolism is a serious medical complication with life threatening consequences, which form of deep vein thrombosis. Up to 20% of all deaths occurring in hospitals are a result of pulmonary embolism. Pulmonary embolism was shown to be present in 50% of patients who die in hospital; but less than 50% of the patients who died were suspected of having pulmonary embolism prior to death.⁷

National Institute of health (NIH) estimates that deep vein thrombosis (DVT) and pulmonary embolism (PE) are associated with 3,00,000 to 6,00,000 hospitalizations per year, the third leading cause of death from cardiovascular disease. According to Kenneth A. Kudask ‘s study 38 of 39 immobilized trauma patients at bed rest for 10 days or longer had venographic study for their lower extremities to evaluate for the present of silent deep vein thrombosis. 60 % of patients had silent DVT with thrombi extending above the knee in half the patients with clot. DVT was documented in 67% of patients with major lower extremity fractures and 59% of patients without major fractures. Initially 80% DVT and PE occur without symptoms. Mortality from untreated pulmonary embolism is 20% to 35%.⁸

Immobility can also be devastating to lung function. It can result in a 25-50% decrease in respiratory capacity. Pneumonia is estimated to occur in 0.5% to 1% of all hospitalized patients and 15% to 20% of intensive care patients. A study was done by ZerwerkhJE to evaluate the efficacy of potassium alkali as potassium – magnesium citrate to reducing renal stone renal stone risk during 5 weeks if strict bed rest. The result shows that bed rest promotes the rapid increase in urinary calcium excretion of approximately 50 mg per day in both groups. The triad of hypercalciuria, urinary stasis and urinary tract infection often causes stones to form in the kidneys or bladder. One series showed that urolithasis developed in more than 50% patients due to immobilization. Urinary tract infections are the second most common bacterial disease. The causes of infection are indwelling catheter and stasis of urine secondary to immobilization. Osteoporosis is the most common bone disease which becomes severe on immobilization.⁹

A statistical study conducted by a research center in Delhi and NCR gave a statistical data of bedridden patients of Delhi and NCR and their problems and complications. For the survey a representative sample of 1000 bedridden patients, caregivers and family members was interviewed spread across Delhi and NCR. It was found that percentage of bedridden men patients (67.5%) is higher than bedridden women patients (32.5%) among total bedridden patients of Delhi and NCR. The survey showed that 66.5% of the total bedridden patients were confined to bed for a short period (less than 12 months) while 33.5% of the total contacted bedridden patients were long-term patients. Almost 76.5% were partially affected while 23.5% bedridden patients were severely affected.¹⁰

A study was done by Sara Oomen at a tertiary care centre at Bangalore to assess the knowledge and practice of nursing personal, family members and immobilized patient regarding prevention of pressure sores. It was reported that nurse had adequate knowledge about the prevention of pressure sores, whereas they were inconsistent in their practice. Other complications of immobilization can be treated easily but pulmonary embolism and deep vein thrombosis are very serious and life threatening complications of immobilization. It can lead to death even because they strike silently. So staff nurses must take preventive actions during hospitalization. So the investigator found the need to do research on this topic. So that the staff nurses come to know more about the seriousness of complications of immobilized orthopedic patients and can prevent it by giving adequate nursing care to the orthopedic patients.¹¹

OBJECTIVES OF THE STUDY:

1. To assess the knowledge of staff nurses on prevention of complications of immobilized orthopedic patients before and after administration of planned teaching programme among staff nurses working in orthopedic units of selected hospitals of Ahmedabad city, Gujarat State.

2. To assess the practice of staff nurses on prevention of complications of immobilized orthopedic patients before and after administration of planned teaching programme among staff nurses working in orthopedic units of selected hospitals of Ahmedabad city, Gujarat State.

3. To find out the association of pretest knowledge scores of staff nurses on prevention of complications of immobilized orthopedic patients with selected demographic variables.

4. To find out the association of pretest practice scores of staff nurses on prevention of complications of immobilized orthopedic patients with selected demographic variables.

HYPOTHESIS:

H₁:

The mean post – test knowledge score of staff nurses will be significantly higher than mean pre –test knowledge score after administration of planned teaching programme on prevention of complications of immobilized orthopedic patients as evidenced by structured knowledge questionnaire at 0.05 % level of significance.

H_2:

The mean posttest practice score of staff nurses will be significantly higher than mean pretest practice score after administration of planned teaching programme on prevention of complications of immobilized orthopedic patients as evidenced by structured observational check list at 0.05 level of significance.

H₃:

There will be significant association of pretest knowledge score of staff nurses on prevention of complications of immobilized orthopedic patients with selected demographic variables at 0.05 level of significance.

H₄:

There will be significant association of pretest practice score of staff nurses on prevention of complications of immobilized orthopedic patients with selected demographic variables at 0.05 level of significance.

MATERIAL AND METHODS:

Research approach:

Quantitative approach.

Research design:

Pre experimental one group pretest posttest design.

Target population:

Staff nurses working in orthopedic units of selected hospitals of Ahmedabad city.

Accessible population:

Staff nurses available during the study at the orthopedic units of selected hospitals of Ahmedabad City.

Sampling technique:

Non probability convenient sampling technique.

Sample size:

40 staff nurses.

Data collection tool:

Structured Knowledge Questionnaire and Structured observational check list.

Data analysis:

Descriptive statistics and Inferential statistics.

Criteria measure:

Knowledge and practice

_{MAJOR FINDINGS OF THE STUDY:}

Findings related Percentage distribution of Demographic data of samples:

The study sample 35 (87.5%) were female. The majority of the samples 35 (95%) were from the age group 21 to 30 years. Majority of samples 25(62.5%) had basic qualification of GNM. Majority of the samples 33(82.5%) had < 1 year of working experience.

Findings related to knowledge of Samples regarding prevention of complications of immobilized orthopedic patients:

The mean posttest knowledge score 23.21 was higher than mean Pretest knowledge score 10.16 with the mean difference of 13.05. The mean posttest knowledge score is significantly higher than the mean pretest knowledge score with the mean difference of 13.05 and the calculated t‘value (t = 23.33) was greater than tabulated t‘value (t =2.02) which was statistically proved. And it revealed that the planned teaching programme on prevention of complications of immobilized orthopedic patients was effective in terms of knowledge among the samples.

Findings related to the practice of Samples regarding prevention of complications of immobilized orthopedic patients:

The mean posttest practice score 21.7 was higher than mean pretest practice score 9.44 with the mean difference of 12.26. The mean posttest practice score is significantly higher than the mean pretest practice score with the mean difference of 12.26 and the calculated t‘ value (t = 20.39) was greater than tabulated t‘ value (t =2.02) which was statistically proved. And it revealed that the planned teaching programme on prevention of complications of immobilized orthopedic patients was effective in terms of Practice among the samples.

Findings related to association of pretest knowledge and practice score with selected demographic variables:

Association of pretest knowledge score with demographic variables was tested by chi square test and it was found that there was significant association between pretests knowledge score and selected demographic variables like age.

Association of practice score with demographic variables was tested by chi square test and it was found that there was significant association between pretest practice score and selected demographic variables like gender.

CONCLUSION:

The following conclusions can be drawn from the present study findings:

It was concluded that samples knowledge as well as the skill improved after implementation of planned teaching programme on prevention of complications of immobilized orthopedic patients. It showed that the planned teaching programme was effective in terms of improving knowledge and practice among staff nurses related to on prevention of complications of immobilized orthopedic patients.

ETHICAL CLEARANCE:

Ethical clearance has been taken from individual participants and ethical committee of JG college of nursing and Gujarat University.

SOURCE OF FUNDING:

Self

CONFLICT OF INTEREST:

Nil

REFERENCES:

1 Manju Varghese. A study to assess the practice and knowledge of staff nurses regarding care of immobilized patients. St. John’s College of Nursing Rajiv Gandhi University Bangalore. India. 2008

2. Fathia A. Mersal. caregivers knowledge and practice regarding prevention of immobilization complications in El –Demerdash hospital Cairo Egypt; American Journal of Research Communication.2015; vol 2(3)78-98

3. S. Poudyal, M Neupane, M Lopchan. Knowledge on prevention of complications related to immobility among caregivers of orthopedicpatients of selected hospitals of Chitwan District. Chitwan, Nepal. Journal of Chitwan Medical College.2014;4 (9), 9-12

4. A. Malarvizhi, V. Hemavathy. Knowledge on complications of immobility among the immobilized patients in selected wards of selected hospital. IOSR Journal of Nursing and Health Science. 2012; Vol 4, 49-51

5. Fathia A. Mersal, Caregivers knowledge and practice regarding prevention of immobilization complications in El –Demerdash hospital Cairo Egypt “American Journal of Research Communication. 2014;vol 2(3) 78-98

6. Brunner and Siddhartha's. Text book of medical surgical nursing.11^thEdition. New Delhi. Elsevier publishers; 2012;.2435-2443

7. Sherin Mary Kurian. A study to assess the effectiveness of planned teaching programme on knowledge regarding prevention of deep vein thrombosis among immobilized orthopedic patients in selected hospitals At Tumkur", Rajiv Gandhi University India. 2013

8. Ahsin M. Bhatti, Sadia Ahsin Babur Salim Junaid Mansar. Knowledge, attitude and practice of health care provider towards deep vein thrombosis prophylaxis in five teaching hospitals of Rawalpindi, Pakistan “, J Ayub Med Call Abbottabad. 2012;136-139

9. Vijay Puriba, Himanshu Vyas, Maneesh Kumar Sharma, Devashri Rapture. A study to assess the effectiveness of Planned Teaching Programme on knowledge of staff nurses regarding prevention of urinary tract infection among patients with indwelling catheter, Udaipur, Rajasthan, ” International Journal of Scientific and Research Publications. 2014;Volume 4, (1), 9-12

10. Narbada Khanal. Knowledge and practice among the care takers of bedridden patients on prevention of urinary tract infection Journal of Universal College of Medical Sciences. 2014;vol 2 no; 01(5), 24-29

11. Sara Oommen. A study to assess factors related to pressure sore among immobilized patients Of St. John Medial College And Hospital, Bangalore with view to developing a standard protocol for its prevention University of Bangalore, India. 2009

Received on 09.03.2017 Modified on 28.03.2017

Int. J. Adv. Nur. Management. 2017; 5(3):206-210.

DOI: 10.5958/2454-2652.2017.00044.0