RAJIVGANDHI UNIVERSITY OF HEALTH

SCIENCES, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

1. Name of the candidate and

address

MS. NEERAJA C.S.,

M.SC NURSING I YEAR,

DR. SYAMALA REDDY COLLEGE

OF NURSING,

# 111/1 SGR MAIN ROAD,

MUNNEKOLALA,

MARATHAHALLI,

BANGALORE-560037.

2. Name of the Institution Dr. Syamala Reddy College of

Nursing.

1

3. Course of study and subject M.Sc Nursing I year,

Medical surgical nursing.

4. Date of admission to course June – 2009

5. Title of the topic A study on assessment of knowledge

and practice of staff nurses regarding

prevention of deep vein thrombosis

among high risk hospitalized clients in

selected hospital at bangalore.

6. BRIEF RESUME OF INTENTED WORK.

2

6.0 INTRODUCTION

“Diseases can rarely be eliminated through early diagnosis or good treatment but

prevention can eliminate disease”

- DENIS BURKITT

A patient is any person who receives medical attention, care or treatment. There are a

number of problems that effect patients who have to spend prolonged periods in bed. This list

is not exhaustive but the most frequently uncounted problems includes muscle spasm,

constipation, pressure ulcer, and Deep vein thrombosis.1,2

The vascular system is vast network of vessels through which blood circulates in the

body. Arteries, arterioles, veins, venules, capillaries and lymphatic constitute the structural

elements of vascular system. Approximately 75% of total blood volume is contained in the

veins. Venous disorders are characterized by stasis, hypercoagulability of the blood and

vessel wall injury.9,10

Deep vein thrombosis (DVT) is a condition in which a blood clot (a blockage) forms

in a deep vein. While these clots most commonly occur in the veins of the leg (the calf or

thigh), they can also develop in other parts of the body. DVT can be very dangerous and is

considered a medical emergency. If the clot (also known as a thrombus) breaks loose and

3

travels through the bloodstream, it can lodge in the lung. This blockage in the lung, called a

pulmonary embolism, can make it difficult to breathe and may even cause death.8,10,11

In the past decade, deep vein thrombosis has increasingly been recognized as an

important and possibly preventable cause of morbidity and mortality in hospitalized patients.

Understanding the natural history of venous thrombosis is important for optimal management

of this condition. Once risk factors are recognized it is possible to avoid these risk factors or

to use active prophylaxis to reduce the A morbidity and mortality.

There are several factors that increase the risk of developing Deep vein thrombosis. It

includes major surgeries, immobility, recent injury, certain chronic medical illness such as

stroke, paraplegia, heart diseases, and cancer, pregnancy, increased estrogen, certain

medications, previous DVT, age, obesity, smoking.3

All hospitalized patients should be assessed for clinical risk factors of DVT . The risk

is in surgical and orthopedic patients .Medical patients are also at high risk and should

receive thromboprophylaxis . Nurses can encourage mobilization and leg exercises in at-risk

patients in order to activate the calf muscle pump. Breathing exercises will also help venous

return. Patients should be advised to observe for signs and symptoms that suggest DVT and

inform nurses if concerned.9,10

Every year Deep vein thrombosis occurs in about 1 in 3000 in those below the age of

40 and 1 in 500 in those over 80years of age. A world wide survey conducted by WHO

4

showed that Deep vein thrombosis is a common disease with an average incidence

rate of more than one per 1000. Deep vein thrombosis is also a lethal disease mostly owing to

Pulmonary embolism. Survivors may experience serious and costly long term

complications.16

An estimated 300,000 individuals are hospitalized annually in the United States for

deep vein thrombosis (DVT) disease. This is especially significant, as up to three quarters of

cases of DVT disease remain silent and do not come to medical attention. The overall

incidence of DVT in the United States is estimated to be 84–150/100,000 annually.

Pulmonary embolism is estimated to be responsible for about 150,000 deaths per year

representing 5% of all perioperative mortality. DVT is thought to be the source of 90% of

acute pulmonary emboli. In Canada, it is reported that Pulmonary embolism from Deep vein

thrombosis causes death of more than 1,00,000 patients each year. It remains a leading

causes of death in hospital.

Deep vein thrombosis and pulmonary embolism are the major health problems with

two possible serious outcomes. Pulmonary embolism can be fatal. Deep vein thrombosis can

lead to chronic venous insufficiency and affect the ‘Quality of life’ and at the same time

increase the cost of patient’s management. Epidemiological data indicate that annual

frequency in general population is approximately 160 per 100,000 for Deep vein thrombosis

and 20 per 100,000 for the symptomatic nonfatal pulmonary embolism.18,19

Deep vein thrombosis is a common preventable cause of death; especially who are

considered as high risk for Deep vein thrombosis like Orthopedic, Stroke, Cardiology

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patients are identified and preventive measures are instituted without delay.

Systematic assessment, early detection, physical and pharmacological prophylaxis are some

ways of preventing Deep vein thrombosis.14,15

Nursing is a balanced art of compassion and science of concern .When science gives

up the art takes over the disease. Nurses should focus on prevention by the early recognition

and adequate prophylaxis of those at increased risk. Patients should be actively involved in

their care wherever possible. An awareness of diagnostic and treatment strategies will enable

nurses to inform patients. This will help to improve both concordance with treatment and

disease outcome. The nurse can observe and assess how the patient is managing her or his

treatment and adapting to lifestyle changes, leading to an improved quality of life.12,13

The goals of this study are to promote health, to preserve health, to minimize

suffering and distress of the high risk patients. These goals are embodied in the word

‘prevention’. Successful prevention of risk factors and risk group, availability of

prophylactic or early detection and treatment are the main intervention of disease control.

6.1 NEED FOR THE STUDY

Deep vein thrombosis is more serious because it presents a greater risk for

pulmonary embolism. Immobility predisposes a person to thrombosis. Many patients in

hospital are at increased risk of DVT, and it is therefore important for nurses to

understand the condition and how to recognize it.10,18

6

High risk for developing deep vein thrombosis is found in patients with the

condition such as stroke(59-100%), orthopedic surgery(17-84%),elective surgery(3-70%)

and trauma (40-60%). The five most frequent co-morbidities were hypertention

(50%),surgery within 3months(38%),immobility within 30 days (34%),cancer(32%) and

obesity(27%).4,18

Deep vein thrombosis leads to serious consequences including pulmonary

embolism (PE), recurrence of venous thromboembolism (VTE), post-thrombotic

syndrome and death. Approximately 200,000 individuals die annually as result of PE.

Recurrences of VTE account for the minority of causes of deaths. Approximately 25% of

DVT patients remain asymptomatic in the long term but severe signs of post-thrombotic

syndrome (ulceration) are observed in 2-10% of patients 10 years after DVT.5,6,7

All-Party Parliamentary Thrombosis Group (APPTG) (Nov 2008) report which

showed that 70% of acute hospital trusts are now taking steps to risk assess patients for

hospital-acquired Deep vein thrombosis-compared with only 32% in their 2007 report.

These finding demonstrate that more hospitals are now bringing their practices in line.

The majority (74%) of hospital-acquired Deep vein thrombosis cause symptoms after the

patient has left hospital. Hospital-acquired Deep vein thrombosis occur in up to 50% of

patients undergoing major orthopedic surgery who do not receive preventive care.17

World statistics revealed that 25% to 40% of patients over the age of

40years,operated for one or more hours develop Deep vein thrombosis. Therefore

7

practice of preventive measures is needed. Deep vein thrombosis is a complication and

major source of morbidity and mortality in healthy patients above 40years of age

undergoing extensive elective surgery like arthroplasty and cardiac surgeries and cardiac

surgeries and immobility

Many healthcare providers are under the false impression that this life-

threatening illness is not a problem in their hospital or among their patients. While it is

true that an individual doctor will normally see relatively few patients with this disease, it

is clear that DVT is an important public health problem. Each year, 600,000 patients

experience venous thromboembolism. Each year, at least 50,000 and perhaps as many as

200,000 patients die from blood clots that obstruct blood flow to their lungs (pulmonary

embolism). The most of these problems could be avoided by simple, cost-effective

measures. Use of modern methods of DVT prophylaxis will reduce the incidence of DVT

during the postoperative period by two-thirds and will prevent death from pulmonary

embolism in 1 patient out of every 200 major operations.18

Incidence of deep vein thrombosis in US 100/100000-500/100000 at 80years of

age, in UK 1 in 2000, in China 17.1/100000;8.1/100000>66years of age, in Singapore

388 cases between 1996-97,Asian countries 6-75%. Epidemiology indicates that DVT or

PE may occur in almost 2 in 1,000 people each year, with up to 25% of those having a

recurrence. Around 5-15% of people with untreated DVT may die from PE. Male: female

ratio = 1.2 to 1. When not pregnant or using oral contraceptives or HRT, women have a

lower risk than men. Two thirds of patients with proven PE have no symptoms of DVT

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and, in one third of cases, it is impossible to find the original site of a DVT without an

autopsy. Autopsy studies demonstrate that approximately 80% of all cases of DVT and

PE remain undiagnosed, even when they are the immediate cause of death.14

Prognosis indicates there may well be recurrence of DVT. Recurrence after the

first event can be as high as 60% but halved by compression stockings. Death occurs in

approximately 6% of DVT cases and 12% of PE cases within 1 month of diagnosis.

Incidences of DVT in South India (Vellore) revealed that post operative DVT is a well

recognized complication. The reported incidence ranges from 45% to 85% in patients who

have had no prophylaxis. DVT was determined in 50% of patient aged 50years and more. In

patients with malignancy the incidence was 47.6%; 10% had an infusion in to ankle during

operation and three of them developed venous thrombosis in the same day.20

About 80 cases per 100,000 persons annually diagnosed as deep vein thrombosis in world

wide. 600,000 hospitalizations for deep vein thrombosis occur annually in the United States.

200,000 deaths annually in the United States due to pulmonary embolism attributed by deep

vein thrombosis. 80% of pulmonary embolism occurs without signs. 2/3 rd of deaths occur

within 30 minutes due to pulmonary embolism. Variable incidences (20 – 70%) of deep

venous thrombosis in hospitalized patients. Venous alteration and venous insufficiency of the

lower leg, which are long term complications of DVT, affect 0.5% of the entire population.

The cost of management of DVT increases by at least Rs.10,000/- for every

patient in hospital. If the patient develop complication of DVT, then the cost of

9

management steeply increases. Venous ulcers develop in at least 300 per 100,000

populations and the proportion due to DVT is approximately 25%.

Deep vein thrombosis is more prevalent in major orthopedic surgeries and

injuries, traction and plaster cast reduces movement and enforce rest and immobility. All

these factors lead to venous stasis and an increased likelihood of thrombosis. It was

suggested that appropriate educational sessions regarding thrombo-prophylaxis especially

costless measures (physical exercise ), use of pneumatic compression and compression

stocking., would enable the patient to prevent development of Deep vein thrombosis.12,13

Deep vein thrombosis is a serious problem that affects millions of people annually.

Prophylaxis against DVT can save lives. Proper application of the prophylactic regimen by

nursing and the interdisciplinary team can be a major key in affecting the outcome of the

high risk patient. To obtain successful outcome, the educational needs of each individual in

interdisciplinary team must be met, also the practice pattern and implementing individual

preferences for preventing DVT.15

A study conducted among patients on practice of DVT prophylaxis in teaching

hospitals of Tabria. The result revealed that highest rate of DVT prevention was related to

cardiology unit(63.4%) and lowest rate to thoracic surgery unit(27%).Appropriate prevention

methods were related to cardiology(73.1%),pulmonary ICU (51.4%),and

Gynecology(42.3%).inappropriate methods were related to neurology ICU, and orthopedic

wards(0%).21

10

A descriptive study was conducted among 159 registered nurses to evaluate the

knowledge level of registered nurse on DVT. The result revealed that there was a significant

relationship between longer years of work experience and the RNs' level of DVT knowledge

(p = 0.001). However, the relationships of RNs' level of knowledge between educational

levels and area of specialized and non-specialized trained RNs' were found to be

insignificant.22

A multi-factored approach to prevention of thromboembolism on 529 cases was

conducted which revealed that morbidity and incidence of thromboembolic complications

could be reduced by patient awareness and nursing staff concern with exercise, post-

operative circle-bed turning and use of the Trendelenburg position form the foundation of

prophylaxis of DVT.18

Preventions is better than cure –Having identified patients at high risk of DVT, the

nurses select the most appropriate prophylactic measures. Early mobilization of patients, as

soon as possible after surgery is to reduce the chance of DVT. Graded compression stocking

have been shown to be effective introducing post operative venous thrombosis. Hospital-

acquired deep vein thrombosis (DVT) and pulmonary embolisms (PE) are preventable

problems that can increase mortality. Early assessment and recognition of risk as well as

initiating appropriate prevention measures can prevent DVT and PE.

Nurses are the professionals who deals with patients round the clock and have

adequate knowledge and skill to be competent. DVT is an early preventable but not

negligible complication among prolonged bedridden patients by considering especially on

ortho and neuron patients. By concentrating on the above statistics and factors the

11

investigator decided to conduct study on assessment of knowledge and practice of staff

nurses regarding prevention of Deep vein thrombosis among high risk hospitalized client.

6.2 THE RELATED REVIEW OF LITERATURE IS ARRANGED AND

PRESENTED IN THE FOLLOWING ORDER:-

1.Meaning of deep vein thrombosis

2.Etiological factors of deep vein thrombosis

3.Risk factors for deep vein thrombosis

4.Clinical manifestations of deep vein thrombosis

5.Diagnostic studies of deep vein thrombosis

6.Prevention and prophylaxis of deep vein thrombosis

7.Management of deep vein thrombosis

8.Complications of deep vein thrombosis

9.Studies related to knowledge and practice of staff nurses regarding prevention of

deep vein thrombosis

MEANING OF DEEP VEIN THROMBOSIS:-

Deep vein thrombosis(DVT) is a disorder involving a thrombus in a deep vein,most

commonly the iliac and femoral veins.

DVT is a blood cloat that develop in a deep vein usually in the leg.

ETIOLOGICAL FACTORS OF DVT:-

Venous stasis

Damage of the endothelium

Hyper coagulability of the blood

12

RISK FACTORS FOR DEEP VEIN THROMBOSIS:-

1)VENOUS STASIS

Advanced age

Atrial fibrillation

Chronic heart failure

Obesity

Orthopedic surgery

Postpartum period

Pregnancy

Prolonged immobility such as bed rest, fractured leg or hip, long trips without adequate

exercise and spinal cord injuary

Stroke

Varicose vein

2)ENDOTHELIAL DAMAGE

Abdominal and pelvic surgery

Fractures of the pelvis, hip or leg

Intra venous drug abuse

Indwelling femoral vein catheter

History of previous DVT

3)HYPERCOAGULABILITY OF BLOOD

Antiphospholipid antibody syndrome

Antithrombin III deficiency

13

Cigarette smoking

Dehydration or malnutrition

Hormone replacement therapy

Nephrotic syndrome

Malignancies

Oral contraceptives

Pregnancy

Sepsis

Protein C and S deficiency

CLINICAL MANIFESTATION:-

Unilateral leg edema

Extrimity pain

Warm skin

Erythema

Systemic temperature < 100.4 degree F

Tenderness on palpation

Positive Homan`s sign

DIAGNOSTIC STUDIES:-

Blood laboratory studies include ACT, a PTT ,bleeding time, Hb, INR ,platelet count,

D-dimer testing

Noninvasive studies includes venous Doppler evaluation and Duplex scanning

14

Venogram

PREVENTION AND PROPHYLAXIS:-

Early mobilization

Positioning

Dorsi flexion of feet

Rotation of ankles

Anti embolism stokings

Intermittent compression devices

MANAGEMENT:-

Anticoagulant

1.Vitamin K antagonist

2.Unfractionated heparin

3.Low -molecular-weight heparin

4.Direct thrombin inhibitors

5.Factor Xa inhibitor

Venous thrombectomy

COMPLICATION:-

Chronic venous insufficiency

Pulmonary embolism

Phlegmasia cerulea dolenss

PTS

15

STUDIES RELATED TO KNOWLEDGE AND PRACTICE OF STAFF NURSES

REGARDING PREVENTION OF DEEP VEIN THROMBOSIS AMONG HIGH

RISK HOSPITALISED CLIENT:-

A descriptive study done prospectively to identifying the factors predisposing to

thrombosis among 50 patients in South India at a tertiary care hospital. The result

revealed that Most of our patients were male (56%), in age group between

20-40 years. Pain with limb swelling (64.5%) were the most common presenting

symptoms in limb DVT and 9 patients (28.1%) had symptoms of PE. 28% patients

presented with recurrence of venous thrombosis. 78% patients with symptomatic

limb .DVT had involvement of the proximal veins. 34% patients had no evidence of

acquired risk factors, while 66% of patients had one or more acquired risk factors. 14 %

had high serum homocysteine (>15µmol/L) and 12% were positive for APLA test.

Among 35 patients, protein C deficiency in 22.9% patients and protein S deficiency in

20% patients were identified. Among 15 patients anti-thrombin III deficiency was present

in 26.7%, Factor V Leiden mutation in 20% patients and high factor VIII level in 6.7%

patients. After 6 month of follow up, repeat Doppler revealed complete recanalisation of

thrombosed vein in 45.8%, and partial recanalisation in 54.11%. There was no correlation

between the outcome, i.e. Doppler normalization Sand the duration of symptoms.23

A study conducted to evaluate the effectiveness of an intervention targeting both

physicians and nurses in improving venous thromboprophylaxis for older patients in

France.The result showed that one department to the intervention targeted at physicians

only and 7 departments allocated to the intervention targeted at both physicians and

nurses dropped out of the study.Compared with the intervention targeted at physicians

16

only (n=497 patients),the intervention targeted at both physicians and nurses (n=315

patients) was associated with a higher rate of mobilization and comparable levels of

elastic stockings and anticoagulant use.The rates of deep vein thrombosis ,bleeding and

thrombocytopenia did not differ between the two group.24

A study conducted on deep vein thrombosis and its risk analysis among 50

patients admitted in a tertiary care hospital at Bangalore. The result revealed that the

mean age of the study group was 34 to 96yrs ranging from 18 to 75yrs.Out of the 50

patients,28 were male and 22 were female .The mean age of male and female was

37.43yrs and 31.25 yrs respectively.38 patients resided in Karnataka,7 patients were

from Tamil Nadu and 5 patients were from Andhra Pradesh.25

A study was conducted on acute-care hospital patients at risk for venous thrombo

embolism in U.S. The result showed that the number of patients who are at risk for

venous thromboembolism and should receive a recommended prophylaxis strategy will

continue to increase in the years to come due to aging of the population, increasing

number of orthopedic procedures performed each year, and increasing prevalence of heart

rate, stroke, and other acute medical illness that place patients at risk for venous thrombo

embolism.26

A study was conducted to determine deep vein thrombosis following ischemic

stroke among Asians. The result revealed that deep vein thrombosis was detected in 30%

of patients at days 7-10 and in 45% of patients at days 25-30.Most thrombosis were

significant associations of age and degree of weakness with the presence of deep vein

17

thrombosis at days 25-30, but not at days 7-10.Deep vein thrombosis in the 1st month

after stroke was associated with poores outcome at 6month.27

A study was conducted to evaluate the effectiveness of structured teaching

programme on prevention of DVT among 50 orthopedic patients with injuary of the

lower extrimities in selected hospital at Bangalore.The findings revealed that the mean

post test practice score of 24.96 of the mean pre test practice score of 10.66 and was

significant . There exists a significant association between pretest knowledge score and

age,educational status and income.28

A prospective randomized study carried out in 104 Indian patients undergoing

major orthopaedic lower limb surgery in India to determine the incidence of

venographically proved deep vein thrombosis, the distribution of the thrombi and their

significance.The result revealed that Group A consisting of patients treated

prophylactically with LMWH showed a 43.2% incidence of deep vein thrombosis. Group

B consisting of patients without any prophylaxis showed an incidence of 60%

postoperatively. The incidence was high in patients undergoing total knee arthroplasty.

Majority of the thrombi were distal, involving a short segment of the ipsilateral leg.

Clinical signs and symptoms proved unreliable for diagnosing this condition.29

A study was conducted to evaluate effectiveness of self instructional module for

the staff nurses on prevention of venous thrombo embolism(VTE) in post-operative

patients at selected hospital at Mangalore.The finding of the study revealed that the

difference between mean pretest knowledge score(13.2) and mean post test knowledge

18

score (26.98)was found to be statistically significant p<0.001,suggesting that SIM was

effective in increasing the knowledge of staff nurses. 30

A study conducted on deep vein thrombosis is the frequent of morbidity and

mortality in hospital patients.surgical patients are highly susceptible to thromboembolic

events.The route cause of DVTis immobilization.For such immobilized patients,certain

physical prophylaxis can be given to mobilize the muscles and the circulation.One among

such activities is the use of physiotherapy,pneumatic compression and compression

stocking.31

A randomized control study was conducted to evaluate the effect of sequentional

foot compression on prevention of VTE after total knee arthroplasty among 48 patients

in India.The result revealed that lower limb swelling and pain were significantly VTE in

this group.Study emphasized on foot compression therapy as an important prophylactic

method in venous stasis.32

A study stated that Venous thromboembolism is a common disease among

hospitalized patients with an average annual incidence of over one per 1000.These are

10% to 30% of surgical ICU who developed DVT with the 1st week of admission.The

estimated prevalence of DVT in surgical patients is 22% to 35%.The incidence of DVT

in spinal cord injury patients is in the range of 50% to 80%.To improve the survival rate

and prevent complications, the incidence of DVT has to be reduced.33

19

6.3 PROBLEM STATEMENT

A study on assessment of knowledge and practice of staff nurses regarding prevention of

Deep Vein Thrombosis among high risk hospitalized clients in selected hospital at

Bangalore.

6.4 OBJECTIVES

1)To assess the knowledge of staff nurses regarding prevention of DVT among high risk

hospitalized clients.

2)To identify the practice of staff nurses regarding prevention of DVT among high risk

hospitalized clients.

3)To determine relationship between knowledge, practice, and selected socio-

demographic variables.

6.5 HYPOTHESIS

H1:There is a significant relationship between knowledge & practice of staff nurses

regarding prevention of deep vein thrombosis among high risk hospitalized clients.

H2:There is a significant association between knowledge, practice of staff nurses and

selected socio-demographic variable.

6.6 OPERATIONAL DEFINITIONS

20

ASSESSMENT: It is a process of measuring the level of knowledge and

practice of staff nurses regarding prevention of deep vein thrombosis using

structured questionnaire.

KNOWLEDGE: It refers to the information possessed by staff nurses about

prevention of deep vein thrombosis such as what is DVT, causes of DVT,

signs and symptoms of DVT, management of DVT, prevention of DVT,

nurses role in prevention of DVT measured by using structured questionnaire.

PRACTICE: It refers to an action of staff nurses regarding prevention of

deep vein thrombosis elicited verbaly using structured interview technique.

STAFF NURSES: Nurses who have completed Diploma or B.Sc Nursing and

registered in State Nursing Council.

PREVENTION: It refers to the measures adapted to protect high risk

hospitalized clients from developing deep vein thrombosis.

DEEP VEIN THROMBOSIS: It refers to developing blood clot in deep vein.

HIGH RISK HOSPITALIZED CLIENTS: Those admitted in Orthopedic and

Neurological department for prolonged period of time and who are

immobilized.

6.7 ASSUMPTION

Staff nurses will have some knowledge and practice regarding prevention of

deep vein thrombosis.

Level of knowledge and practice of staff nurses regarding prevention of deep

vein thrombosis varies from individual to individual.

21

Level of knowledge of staff nurse varies based on their period of experiences

and area of exposure.

The knowledge regarding prevention of deep vein thrombosis influences the

practice on care of high risk patients.

Socio-demographic factors influence the level of knowledge and practice

regarding prevention of deep vein thrombosis.

7.0 MATERIALS AND METHODS:-

7.1 SOURCE OF DATA: The staff nurses who are working in orthopedic and neurological

department in selected hospital at Bangalore.

7.2 METHOD OF DATA COLLECTION PROCEDURE :-

A descriptive cross-sectional study will be carried out in a selected hospital at

Bangalore. A sample of 50 staff nurses will be selected using convenience sampling

technique.

A self administered structured questionnaire for assessing knowledge and a structured

interview technique for assessing practice will be used to collect data. The duration of the

study will be 4 weeks from the date of study commences.

RESEARCH APPROACH: It is a descriptive cross sectional research design using

structured questionnaire to determine the level of knowledge and practice of staff nurses

regarding prevention of deep vein thrombosis.

22

RESEARCH DESIGN: It is non-experimental descriptive design using structured

questionnaire to find out the level of knowledge and practice of staff nurses regarding

prevention of deep vein thrombosis.

SAMPLING TECHNIQUE: The sample of 50 staff nurses will be selected using non

probability convenience sampling technique. Data will be collected using structured

questionnaire. Verbal consent will be taken from the sample prior to the study.

SAMPLE AND SAMPLE SIZE: The sample of 50 staff nurses in selected hospitals at

Bangalore.

SETTING OF THE STUDY: The descriptive cross sectional study will be conducted in

selected hospital at Bangalore.

7.2.1 SAMPLING CRITERIA:

INCLUSION CRITERIA:

Staff nurses who are working in Orthopedic and neurological department.

Those who are willing to participate.

Staff nurses who are present at the time of data collection.

EXCLUSION CRITERIA:

Staff nurses are not available during data collection.

23

7.2.2 DATA COLLECTION TOOL: A structured questionnaire will be used to determine

the level of knowledge and practice of staff nurses in a selected hospital at Bangalore.

Structured questionnaire will include:

Section A) - Items on socio demographic variables.

Section B) - Items on assessment of the level of knowledge of staff nurses regarding

prevention of DVT.

Section C) - Items on assessment of the practice of staff nurses regarding prevention of

deep vein thrombosis.

VALIDITY: The structured questionnaire will be prepared to assess the level of knowledge

and practice of staff nurse. The validity of the tool will be done in consultation with guide

and other experts from various fields.

7.2.3 DATA ANALYSIS METHODS: Data analysis can be done by descriptive inferential

statistics. The descriptive statistics like frequency distribution, table, mean and standard

deviation to see the association between knowledge and socio demographic variables and

correlation coefficient to see the relationship between knowledge and practice.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE CONDUCTED

ON THE PATIENT/ OTHER HUMAN BEING OR ANIMALS?

No, the study does not require any investigation to be conducted on the patient / other

human being or animals.

24

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED?

Yes, the confidentiality and anonymity of the subject will be maintained. Concern

will be obtained from the adult before conducting the study.

8.0 REFERENCE

1. http://www.en.wikipedia.com.org, prolonged bedridden patient

2. http://www.books.google.co.in, problems related to prolonged bedridden

3. http://www.cdc.gov/features/thrombosis/

4. http://www.ncbi.nih.gov/pubmed/14715365

5. http://www.medicalnewstoday.com/articles/B1624.php

6. http://www.medicalnewstoday.com/articles/10872.php

7. http://content.karger.com/produckte

8. Black M Joyce, “Medical Surgical Nursing”, volume I, 7th edition, 2005,

Philadelphia, page no.1540-1542

9. Donna D et.al, “Textbook of Medical Surgical Nursing”, volume I, 2nd edition,

Philadelphia, page no.955-959

10. Lewis S.M et.al, “Medical Surgical Nursing”, 6th edition, 2004, Mosby’s

publisher’s, USA, page no.912-944; 927-933

25

11. Suzanee C.S, Brenda G.B, “Textbook of Medical Surgical Nursing”, 10th edition,

2005, Lippincott publication, St. Louis, page no. 819-820;842-845

12. http://www.uni-duesseldorf.de/

13. www.thrombosisadviser.com

14. http://chests journal. chest pubs.org/content/124/6-suppl/3575

15. http://www.medscape.com/viewarticles/590272-3

16. http://www.who.int.com

17. 2nd annual report of the All Party Parliamentary Thrombosis Groups (APPTG)

November 2008- www.thrombosis-charity.org.uk/cms/index.php

18. http://www.dvt.org

19. Epidemiology-praxis, 2006, http://www.ncbi.nlm.nih.gov/pubmed/16602219

20. Dr.G.V Shead, Ramjinarayanan incidence of DVT in South India.

http://www.3.interscience.wiley.com/journal/112197402/

21. Aydin Pirzeh et.al, Practice of DVT prophylaxis in teaching hospitals, Tabria,

2003

22. Asma Ahamd et.al, Study on assessment of the knowledge regarding DVT among

Registered nurses, Iran ,2005

23. Vijay Kumar J.R, Assessment of the factors predisposing to thrombosis, South

India, 2008

24. Jose Labarere et.al, Evaluation of the effectiveness of venous thrombo

prophylaxis, France, 2007

25. Dr. Santhosh R, Study on DVT profile of patients in tertiary care hospital and risk

analysis,Bangalore,2007.

26

26. Anderson.F.A et.al, Study on acute- care hospital patients at risk for venous

thromboembolism,U.K ,2007

27. Deidre Anne De Silva et.al, Study on DVT following ischemic stroke,Asia,2006

28. Indumathi .R Effectiveness of structured teaching programme among orthopaedic

client on prevention of DVT,Bangalore, 2005

29. Mrs.Naina Pandita, Assessment of the incidence of the venography proved

DVT,the distribution of thrombi and their significance, 2005

30. Renju Joe, Effectiveness of self instructional module for staff nurses on

prevention of DVT in post-operative patient,Mangalore,2004

31. Nesurker, DVT is the frequent morbidity and mortality in surgical patients,2002.

32. Temir, Evaluation of effect of sequentional foot compression on prevention of

VTE after total knee arthroplasty,India, 2002

33. Mock.C.K, Study on Venous thromboembolism is a common disease among

hospitalized patients , 2001

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9

SIGNATURE OF CANDIDATE

10 REMARKS OF THE GUIDE

11 NAME AND DESIGNATION

11.1 GUIDE

11.2 SIGNATURE

28

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF THE

DEPARTMENT

11.6 SIGNATURE

12 12.1 REMARKS OF THE

CHAIRMAN AND

PRINCIPAL

12.2 SIGNATURE

29

30