SUBMITTED BY –

MR.KUNJ BIHARI GAUTTAM

1ST YEAR M.Sc NURSING

MEDICAL-SURGICAL NURSING

2007-2009 BATCH

SARVODAYA COLLEGE OF NURSING-

BANGALOR–79.

PROFORMA FOR REGISTRATION OFSUBJECT FOR DISSERTATION

RAJIV GANDHI UNIVERSITY OF HEALTHSCIENCE, KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION1.

NAME OF THE CANDIDATE AND ADDRESS

MR. KUNJ BIHARI GAUTTAMI YEAR M.SC. NURSING SARVODAYA COLLEGE OF NURSING,# 11/2, MAGADI MAIN ROAD,AGRAHARA DASRAHALLI, BANGALORE-560079.

2. NAME OF THE INSTITUTE SARVODAYA COLLEGE OF NURSING AGRAHARA DASRAHALLI, BANGALORE-560079.

3. COURSE OF STUDY AND SUBJECT I YEAR M.SC NURSING MEDICAL AND SURGICAL NURSING.

4. DATA OF ADMISSION OF THE COURSE 01/06/2007

5. TITLE OF THE TOPIC “A Study To Evaluate The Effectiveness Of Structured Teaching Programme On Use Of Braden Scale Among Nurses In Selected Hospitals Bangalore.”

6. BRIEF RESUME OF INTENDED WORK 6.1 INTRODUCTION6.2 NEED OF STUDY6.3 STATEMENT OF THE PROBLEM6.4 OBJECTIVE OF THE STUDY6.5 OPERATIONAL DEFINITION 6.6 INCLUSION CRITERIA AND EXCLUSION CRITERIA 6.7 HYPOTHESIS6.8 REVIEW OF THE LITERATURE

ENCLOSEDENCLOSEDENCLOSEDENCLOSEDENCLOSEDENCLOSEDENCLOSEDENCLOSED

7. MATERIAL AND METHODS7.1 SOURCE OF DATA: Staff Nurses7.2 METHOD OF DATA COLLECTION: Self administered questionnaire &

observation 7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON THE PATIENTS OR OTHER HUMAN BEINGS OR ANIMALS ?

No.7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION.Yes.

Ethical committee’s report is here with enclosed

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,KARNATAKA, BANGALORE

:PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION:

1. NAME OF THE CANDIDATE AND ADDRESS

MR. KUNJ BIHARI GAUTTAM,1ST YEAR M.SC. (NURSING) SARVODAYA COLLEGE OF NURSING NO.11/2 MAGADI ROAD, AGRAHARA, DASARALLI, BANGALORE.

2. NAME OF THE INSTITUTION SARVODAYA COLLEGE OF NURSING AGRAHARA DASARALLI, BANGALORE

3. COURSE OF STUDY AND SUBJECT 1ST YEAR M.SC NURSING MEDICAL-SURGICAL NURSING

4. DATA OF ADMISSION OF THE COURSE

01/06/2007

5. TITLE OF THE TOPIC “A Study To Evaluate The Effectiveness Of Structured Teaching Programme On Use Of Braden Scale Among Nurses In Selected Hospitals Bangalore.”

6. Brief Resume of the intended work: 6.1 Introduction

An estimated 1.7 million patients develop pressure ulcers annually. Both prevention

and treatment of pressure ulcers are costly in term of health care dollars and quality of life for

patients at risk because the cost in term of pain and suffering for a person with pressure ulcer

can’t be quantified, the old saying “an ounce of prevention is worth a pound of cure” is

particularly applicable to pressure ulcers.( Brunner and suddarth 2004)1

Pressure sores are health problems which has impact on health of Nation. In UK the

treatment of pressure sore imposes a large financial and manpower burden.

Also it was suggested that an annual reduction of 5-10% in their incidence would be a

reasonable target, justified by the belief that “are largely preventable”. Numerous reports

have been published on the prevalence and incidence of pressure sore due to the large groups

of the patients, it is impossible to determine how many of the reported one could have been

prevented.2

Pressure sores are called pressure-ulcers, friction burn, Decubites ulcers as well as bed

sores. How serious they are depends on the amount of damage to skin and tissue. A pressure

sore (or Bed-sore) is an injury to the skin and tissue under it, and caused usually by

unrelieved pressure , constant pressure against the skin which reduces the blood supplies to

that area and the affected tissue will be necrosed. A pressure ulcer starts as reddened skin but

gets progressively worse, forming a blister, then an open sore and finally a crater. 3

95% of all pressure ulcers occurs over the bony prominences, primarily pelvic girdle.

The pressure ulcers are graded or staged according to their degree of tissue damaged by the

National Pressure Ulcer Advisory Panel (NPUAP). They have recommended the staging

system from stage I-to-stage IV according to their depth.4

The reported incidence (Number of new cases per year) of pressure ulcers in acute

care facilities ranges from 2.7% - 29.5%. The prevalence (Number of cases at one point in

time) in acute care setting ranges from 3.5% -29.5% several populations are at increased risk.

Quadriplegic clients, older adults with femoral fracture (#), and clients in critical care units

have the highest risk. These risk factor can be determined by assessing sensory perception,

moisture, activity, mobility, nutrition, friction & shear.5

The Braden scale for predicting pressure sore risk was developed to foster early

identification of patients at risk for forming pressure sores. The scale is composed of six

subscales that reflect sensory perception, skin moisture, activity, mobility, friction and shear

and nutrition status. Two prospective studies of predictive validity were completed to

determine the scale’s sensitivity & specificity. 6

Daideri G, Berthier F, Brocker P, had a survey to determine the prevalence of

pressure sore in university hospital and to assess the risk of developing pressure sore. The

Braden scale was used to measure the patients risk for the development of pressure ulcers.

The total prevalence was 16.6%, 95% critically ill, (14.9-18.6), the Braden scale score less

than or equal to 15 was found in 29.1% of hospitalized patients.7

6.2 Need for study

An Average of approximately 50% of the hospitalized individuals have mobility

impairment. Immobilization and inactivity are frequently present in patients with

involvement of musculoskeletal, neurological system and also among critically ill patients.

An immobilized individual is at a greater risk of developing pressure sore. 1

Reid & Morrison (1994) mentioned in their studies that pressure ulcers are present in

6-14% of all the patients in acute care setting and up to 25% in residential nursing care. A

prevalence of 40% has been reported in adult intensive care unit. Two-third of pressure ulcers

occurs in patients over the age of 70. Pressure ulcer may complicate the individual at any

age.8

According to Agatha (1994) prolonged low pressure is a greater risk than short term

high pressure. Bereck (1978) cited five conditions that contribute to pressure sore. They are

poor nutrition, aging process, motor paralysis, superficial sensory loss with absence of

subjective awareness of pain and pressure. He suggested that decrease of pressure level

under the resisting body is important in prevention of skin breakdown.

Pressure sores not only cost money but also cause other problems like add the length

of stay at hospital and leads to loss in many ways. Initially, recovery and rehabilitation of

patients who develop pressure ulcer is delayed secondly, feeling of failure, disappointment

and guilt is engendered in the nursing staff. When a pressure sore develops it often carries the

connate of neglect and mismanagement in the nursing care of patients. Thirdly untreated

pressure sore will lead to systemic complications and nosocomial infection. Finally the

country is affected in that, this phenomena prevents another citizen from using the hospital

bed and delays potential tax payers return to his job.

It is therefore imperative that the most vulnerable or high risk patients are recognized

and the preventive plan is implemented immediately. “Prevention is better than cure”. The

present National Health care to every individual, participation to the full extent and

awareness of the health problem is needed. Prevention is a vital option which is

recommended for tackling health problems.

The Investigator observed during his experience at various hospitals in the

neurological, neurosurgical wards and ICU have most of the patients admitted with Brain

injury and sensory motor deficiencies. They are at risk of developing pressure sores due to

the length of stay and improper nursing care.

An informal enquiry related to pressure sores revealed that an average of 2-3 patients

might develop pressure sores in these wards per month. It is also found that some patients

comes to these wards have already developed pressure sores either from home, or from other

institutions. 5

Since pressure ulcer is a common problem, the investigator felt that it is one of the

need to study the knowledge of the nurse because he/she is playing a major role in preventing

pressure ulcer among immobilized individuals.

So the present study is an attempt to use the concept of preventive care, by giving

structured teaching programme on use of Braden scale for predicting pressure sore risk

factors in hospitalized patients among staff nurses.

6.3 Statement of the problem

“A Study To Evaluate The Effectiveness Of Structured Teaching Programme On Use

Of Braden Scale Among Nurses In Selected Hospitals Bangalore.”

6.4 Objectives of the study

1. To assess the knowledge of staff nurses on the use of Braden Scale before and

after structure teaching program.

2. To evaluate the effectiveness of STP on the use of Braden Scale among staff

nurses.

3. To find out association between the knowledge regarding use of Braden scale

among staff Nurses and selected variables.

6.5 Operational definitions

1. Pressure sore: - It refers to any lesion caused by unrelieved pressure

resulting in damage to underlying tissues .

2. Braden Scale: - It is a tool which is clinically validated that allows Nurses

and other health care providers to acquire reliable scores in Clients to asses

the risk for developing pressure sore.

3. Effectiveness: - Refers to the significant gain in knowledge scores and

practice of Braden scale among the nurses.

4. STP: - Refers to the systematically organized, individualized, instructions,

demonstrations, and discussions on the use of Braden scale among nurses.

6.6 Inclusion Criteria

1. All the nurses working in selected Hospitals.

2. Nurses who are willing to participate in study.

Exclusion criteria 1. Nurses who are not willing to participate.

2. Auxiliary nurse midwife.

6.7 Hypothesis :

There will be a significant increase in the knowledge of staff nurses regarding Braden scale

use followed by STP.

6.8 REVIEW OF LITERATURE

This chapter deals with review of published research studies literature related to the present

study.

Bed Sores, decubiti, pressure ulcers no matter what we call them, these lesions present

one of the most serious problems in health care today [Louise 1986]. The National Pressure

Ulcer Advisory Panel [1987] at USA defines pressure ulcer as an area of unrelieved pressure

over a defined area, usually over a bony prominence, resulting in ischemia, cell death and

tissue necrosis.

Daideri G, Bertjoer F, Brocker P, Darmon MJ, Miqnalet F, Quarahta J F. et. al.

conducted a survey to determine the prevalence of bed sores. They found that pressure sores

are still an important problem in hospital, occurrence must be considered as an iatrogenic

events and management is required in a multidisciplinary approach. 7

Carlson E V, Kemp MG, and Shott S. Conducted a study by using the Braden Scale to

assess repeatedly 136 adult patients with out pressure ulcers in a Medical intensive care unit,

surgical intensive care unit, and a noninvasive respiratory care unit, and the patients skin was

inspected routinely for pressure ulcers. A total of 36 pressure ulcers, most commonly on the

sacrum or coccyx and the heels, developed in 17 patients (12%), In 14(82%) of the ulcer

developed in 72 Hours of admission to the intensive care units. This risk pressure ulcer

increased as the mean sensory perception and the mean total Braden scores decreased. They

concluded in intensive care units the critically ill patients are have an increased risk for

pressure ulcers. 9

Bergstrom N, Braden BJ. Conducted a study to evaluate the usefulness of an instrument for

predicting pressure sore risk in AICU. The Braden scale for predicting pressure sore risk was

described. Method for measuring predictive validity and for calculating sensitivity,

specificity, and percent predictive value of positive & negative test were discussed, Sixty (60)

consecutive admitted AICU patients who were pressure sore free were rated to pressure sore

risk with in 24 to 72 Hours after admission. The skin condition is assessed. 24 subjects

developed pressure sore during study period. They finally concluded that Braden scale is

favorably a sensitive scale. 10

Lyder CH, Yu C, Emerling J, Mangat R, Stevenson D, Empleo-Frazier O. et. al.

Conducted a study to examine the predictive validity of Braden scale in predicting pressure

sore risk and to determine the physiological and non- physiological variables associated with

prediction of pressure ulcers in Black and Latin/Hispanic elder’s A prospective clinical

design was used to conduct study. Among 74 patients aged 60 years or older, 24 patients

(32%) developed pressure ulcers. Black elders had a higher incidence rate (21%) than Latino

(11%). Sensitive was 81% and specificity was 100%.11

Vanderwee K, Clark M, Dealey C, Gunningberg L, Defloor T. Have done a study as

pressure ulcers prevalence aimed to develop an uniform data collection instruments and

methodology to measure the pressure sore prevalence across different patient groups in

Europe. 5974 patients were surveyed in 25 Hospital in Five European countries. The pressure

ulcers prevalence was 18.1% (grade 1-4). The sacrum & heels most of affected location only

9.7% of patients is Need of prevention received fully adequate preventive care. They

concluded that the pressure ulcers prevalence were higher than expected and relatively few

patients received adequate prevention. This indicates that more attention to prevention is

needed in Europe.12

Grous C A, Reilly NJ, Gift MJ. Conducted a descriptive study to identify risk factors

contributing to pressure ulcer development in patients undergoing scheduled, prolonged-

operative procedures. The Braden Scale was used for predicting pressure sore risk. Among

the 33 patients studied, 15(45%) were found to acquire stage I or stage II pressure ulcers with

in 48 Hours after procedure. 13

Karadag M, Gumuskaya N. Were conducted a study for the purpose of determining the

incidence of surgery related pressure sore formation.. They concluded the finding obtained

showed that 54.8% patients were observed to have stage I pressure ulcers. A total of 41.3% of

patients had pressure ulcers in more than one regions and 56.5% of there were of the

erythema type. During six-day postoperative monitoring 97.9%. of the pressure ulcers were

observed in the first three days. So they concluded that surgery related pressure ulcers were

the important problem.14

Lewicki LJ, Mion LC, Secis M. Conducted a study to find out the Braden scale usage for

predicting pressure ulcers risk in a cardiac surgical population 337 pressure ulcer free patients

undergoing cardiothoracic surgery at a large Midwestern national referral centre were

enrolled in the study. Skin assessment & Braden scale assessment done on post-operative

days 1,3 and 5. Sixteen patients (4.7%) developed a total of 22 pressure ulcers. Scores

correctly classified 67% of the pressure ulcer positive patients on post-operative day 1,57%

on postoperative day 3 and 50% on post-operative day 5. Their results illustrated that

optimum prediction of pressure ulcers risk can only be accomplished with reassessment and

determination of the Braden cut-off score or scores that are reflective of the patients changing

clinical condition throughout the hospitalization.15

7. MATERIAL AND METHOD

7.1 Source of Data :- Data will be collected from Staff nurses

7.2 Method of data collection

i. Research Design :- Quasi experimental

ii. Setting :- Selected Hospitals at Bangalore.

iii. Sample Size :- 50.

iv. Sample techniques :- Simple Random sampling

v. Method of Data collection :- Self administered questionnaire.

vi. Tool for Data collection :- Structured questionnaire.

vii. Duration of study :- 4 weeks.

viii. method of data analysis and interpretation :-

The researcher will use appropriate statistical technique for data analysis. The data Will be

analyzed by using experimental statistics.

ix. Research variables

Dependent variable :-Knowledge of Nurses

Independent variable : - Braden scale and demographic variables.

x. Projected outcome: - this study help the nurses to acquire optimal knowledge on use of

Braden scale thereby help the nurses to identify the risk factors for developing pressure sores

and its prevention

7.3 Does the study require any investigation or intervention to be conducted on patients

or other human or Animal?

No.

7.4 Has ethical clearance been obtained from institution

Yes

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