RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA
SYNPOSIS PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION

1. NAME OF THE MR.ANUSH K.J

SRI LAKSHMI COLLEGE OF
CANDIDATE AND
NURSING,
ADDRESS
NO. 127/1, SRI GANDADAKAVAL,
MAGADI MAIN ROAD,
SUNKADAKATTE,
BANGALORE – 560 091.

2. NAME OF THE SRI LAKSHMI COLLEGE OF

NURSING,
INSTITUTION
SUNKADAKATTE,
BANGALORE – 560 091.
3. COURSE OF STUDY AND M. Sc NURSING ,1ST YEAR ,

SUBJECT MEDICAL SURGICAL NURSING.

4. DATE OF ADMISSION TO
COURSE 01-06-2011
5. TITLE OF THE TOPIC A STUDY TO ASSESS THE
KNOWLEDGE AND PRACTICE OF
STAFF NURSES REGARDING POST
OPERATIVE CARDIAC CARE IN
SELECTED HOSPITALS AT
BANGALORE WITH A VIEW TO
DEVELOP INFORMATION
BOOKLET.
 BRIEF RESUME OF THE INTENDED WORK
6
INTRODUCION
“No other surgery affects people in quite this way. For it is unthinkable,
finally that one’s heart should be cut open. It is the one unthinkable cut.”
- Martha Weinmann Lear.
Cardiovascular disease is the world’s leading killer, accounting
for 16.7 million or 29.2% of total global death. India will carry 60% of the
world’s heart disease burden, nearly four times more than its share of the
global population, according to a study. Adding to the burden is a higher
incidence of the types of heart disease resulting in serious illness and
mortality, and the fact that these conditions strike at an earlier age, says the
study. Death rates are especially high among the country’s poorest residents,
unable to get to hospital quickly in an emergency, or to afford routine
treatments and surgery.1
Cardiovascular disease is a broad term that encompasses such
varied illnesses as coronary artery disease, peripheral arterial disease,
cerebrovascular disease, rhythmic disorders, rheumatic heart disease,
congenital heart disease, and congestive heart failure. Numerous diseases and
conditions may necessitate the need for cardiac surgery. The most common
reasons for an adult to undergo cardiac surgery is myocardial revascularization
and Coronary Artery Bypass Graft. In addition, Patients undergo cardiac
surgery for valve repair or replacement, repair of structural defects;
acquired or congenital, implantation of devices and cardiac
transplantation.2
Since the introduction of cardiopulmonary bypass in 1953
and the open heart surgery technique of Favalaro in 1967, modifications
and technical improvements in the operating room and in the peri-
operative patient care have abounded. According to Kevin M Spiequel ‘’an
emphasis has been placed on cardiac care because the medium age of residents
is increasing, and more people are showing up with symptoms of heart
diseases”. The science and art of cardiac surgery continue to evolve at
an unprecedented rate. Rapid and diverse development in technology and
pharmacology have led to this continued expansion of procedures
available to patients of all ages suffering from cardiac diseases. In spite
of being able to offer a wider spectrum of procedures to older and
sicker patients, to patients with more advanced stages of cardiac disease,
and to patients with a wider spectrum of non cardiac multisystem co
morbidity, the morbidity and mortality after cardiac surgery continue to
remain at a stable level or to fall.3
Changes in the technology have produced a myriad of new
devices and exposure techniques, and have redefined our concepts of the
role for cardiac surgeries. Parallel to these procedures and advanced
technologies has been an expansion of the knowledge of the early and
late complications following the procedures. Pre operative patient- specific
risk factors as well as perioperative process related factors are profiling
the spectrum of morbidity and mortality of patients after cardiac surgery.
Care of the person undergoing cardiac surgery involves multidisciplinary
team approach utilizing the skills of variety of health care professionals.
It includes pre operative, intra-operative and post operative care. The nursing
personnel play an important role in improving the postoperative outcome of
patients. Each patient is taught as an individual, with consideration of
unique anxieties, needs and hopes. A Programme of instruction based on
the individual’s needs is planned and implemented at the proper time.
Therefore the study is planned to evaluate the effectiveness of pre-
operative information booklet on post operative self care and recovery of
patients undergoing cardiac surgery.3
Postoperative care is the management of a patient after surgery.
This includes care given during the immediate postoperative period, both in
the operating room and post-anesthesia care unit (PACU), as well as during
the days following surgery. The goal of postoperative care is to prevent
complications such as infection, to promote healing of the surgical incision,
and to return the patient to a state of health. Postoperative care involves
assessment, diagnosis, planning, intervention, and outcome evaluation. The
extent of postoperative care required depends on the individual's pre-surgical
health status, type of surgery, and whether the surgery was performed in a day-
 surgery setting or in the hospital. Patients who have procedures done in a day-
surgery center usually require only a few hours of care by health care
professionals before they are discharged to go home. If post anesthesia or
postoperative complications occur within these hours, the patient must be
admitted to the hospital. Patients who are admitted to the hospital may require
days or weeks of postoperative care by hospital staff before they are
discharged.3
Nursing is built on a body of knowledge discreetly synthesized
from physical, biological, and social science and uniquely applied as a
humanistic discipline of caring for people wherever they are recognizing the
health care needs of patients. Nurses must incorporate scientific knowledge
and technical advances into their practice to assist the patients in remaining
well and functioning at the maximum level. In the community setting, nurses
as health workers have a major role in educating and identifying the risk
groups. In ICU’s, the nurses working round the clock have a major
responsibility in caring the patients with cardiac disorders in general.
Cardiovascular Nurses play a key role in the evaluation of Cardiovascular
status, monitoring the Hemodynamic functions and Disease Management.
Nurse-led Cardiovascular procedures like Subclavian CVC placement and
Percutaneous Coronary interventions have been found safe and effective.4

NEED FOR THE STUDY:

6.1
Cardiovascular diseases exert a burden on individual and society
which is the single most common cause of death. The population based
surveys conducted in India shows that there is an increase in the prevalence
rate of Ischemic heart disease from 1-4% to 10%. According to the hospital
statistics in 1980 Coronary Artery Bypass Grafting (CABG) accounted for less
than 10% of all cardiac surgeries. Today, it accounts for more than 62%. Every
year 25,000 coronary bypass operations and 12,000 Percutaneous coronary
Angioplasties (PTCAs) are carried out.4
Cardiovascular disease accounting for 16.7 million or 29.2% of
total global death. With modernization, a large proportion of Asians are
trading health traditional diets for fatty foods, physical jobs for deskbound
sloth, the relative calm of the countryside for the stressful city. Heart attack
victims are just the first wave of a swelling population of Asians with heart
problems. While deaths from heart attacks have declined more than 50% since
the 1960s in many industrialized countries, 80% of global cardiovascular
diseases related deaths now occur in low and middle income nations, which
cover most countries in Asia. Nearly 50% of cardiovascular disease related
deaths in India occur below the age of 70, compared with just 22% in
the West.5
Worldwide, roughly 50 million deaths occur annually, with
cardiovascular diseases and stroke causing about one quarter of these deaths.
Of the 50 million, about 32 million deaths are registered in the developing
world,7 million in the group of the least developed countries, 6.8 million in the
developed market economies, and 4.2 million in Eastern Europe. Rheumatic
heart disease is also a major public health problem in younger age group.3
The most recent statistics released by the American heart
association shows that heart diseases is at the top of the list of the country’s
most serious health problem and it is the leading cause of death In U S A.
According to American heart association, at least 64 million people in this
country suffer from some form of heart disease. This includes high blood
pressure- 50 million; coronary heart disease – 13.2 million; stroke – 4.8
million; congenital cardiovascular defects – 1 million; and congestive heart
failure – 4.5 million. More than 2,600 American die of cardiovascular disease
each day, an average of one death every 34 seconds.6
Nurses must incorporate scientific knowledge and technical
advances into their practice to assist the patients in remaining well and
functioning at the maximum level. Especially in critical care units of hospitals,
with the advancing science and technology on par with doctors, the nurses
should upgrade their knowledge. They must be able to identify life threatening
situations and to perform emergency measures if necessary without the aid of
the doctor on standing orders. The nurses specialized in the care of the patients
in cardiac and intensive care units have truly become a significant and
responsible figure in the total field of health care. She meets the demands of
patients and at the same time rehabilitates in such a way that the patient fits in
the society. Teaching about post-operative care and activities are essential and
is the main responsibility of nurses. This allays anxiety and encourages
clients to participate actively in their own care. Clients and families need
to know about surgical events, and sensations, how to manage pain and
how to perform physical activities necessary to decrease post operative
complications and facilitate recovery.7
A study was conducted on Nurse’s knowledge and practice on
Management and Outcome of patient with Permanent Pacemaker and
Implantable Cardioverter-Defibrillator Infections, California. Data collection
was done through questionnaire and observation check list. They result
showed that lack of knowledge and timely management by the nurse
practitioner on patient with any implantable cardiac device lead to certain
complications.8
Swindale states that the nurse who informs the patient about the
ensuing upcoming surgery process must have a clear perception of his or her
role, duties, and professional responsibility within the clinical setting to
perform the best. Promoting accurate information during this period can
effectively reduce the stress. Additionally guidance and instruction given by
the nursing staff during the pre-surgical preparation can assist the patient
during recovery and reduce post surgical complications.9
A recent study report of rising rate of cardiac device infection, US
reveals the infection rates vary between 2% and 8%. Treatment typically
involves the removal of all implanted hardware, in addition to long-term
antibiotic therapy. They concluded that beyond the highly specialized role of a
pacemaker nurse, any nurse working in a primary health care setting should be
familiar with at least some general aspects of the implanted cardiac device
patients follow up care and provide counseling to this patient population. Staff
nurses’ play a major role in hospital and long-term care will ensure an
uneventful procedure and a safe discharge as well as early detection of device
malfunction and late complications. Taking care of a rapidly growing patient
population constitutes a challenge for all health care providers working in a
cardiology ward, operating room or primary care practice. Nurses among them
have a unique role by being the most appropriate persons to provide in-hospital
and long term health care, education and psychological support to these
patients 10.
A descriptive study was done to assess the knowledge regarding
ventricular arrhythmias among the nurses working in intensive coronary care
units in Twin cities, A.P. A sample of 100 nurses was selected randomly. A
structure questionnaire was used for data collection, which consisted items
regarding causes signs and symptoms and management of patients with
ventricular arrhythmias. The results of studies showed that 70% nurses had
below average knowledge, 28% of nurses had average knowledge & 2% of
nurses had above average knowledge. The study concluded by saying that the
nurses needs to improve their knowledge regarding ventricular arrthythmias.11
A comparative study was conducted to determine the feasibility
and efficiency between the nurse-led clinic and resident-led clinic for stable
patient recovery from recent Myocardial Infarction in Alkmaar. Samples of
200 patients were selected and the patients were randomized on transfer from
the coronary-care unit to the cardiology ward. Subsequently, these patients
were treated by a registered nurse practitioner (n=97) or by a resident (n-103)
both of whom were under the direct supervision of the attending cardiologist.
Degree of satisfaction was scored by the patients on a 0-10 point scale. The
study results reported that no significant differences were found between the
groups. However, patients treated by the nurse practitioners expressed a
significantly higher score in the satisfaction rates. The study concluded by
saying the treatment of stable post Myocardial Infarction patient in nurse-led
clinic was found to be feasible and effective with a significantly higher level of
patient’s satisfaction.12
Bangalore Orbit Blogs says that the Bangalore is the top
destination of India for cardiac surgery. This is world center for cardiac
surgery treatment. Compared to other city like Delhi and Mumbai,
Bangalore emerged as a top city in India for Angioplasty surgery.13
Even though the cardiac surgery is a major surgery,
advances in anesthesia and surgical techniques allow client to recover
quickly from surgery and return home to productive lives. Careful
preparation of clients undergoing surgery during the pre-operative period
 reduces the operative risk and promotes post operative recovery. Nurses
are the frontline health personnel who provide comprehensive care to the
patients to recover fast and minimize hospitalization. Care of person
undergoing cardiac surgery involves multidisciplinary team approach
utilizing the skills of a variety of health care professionals including
nurses, physicians, nutritionists and others. The nurse caring for the
cardiac surgery patients provides individualized care that is appropriate
for the patient’s medical condition, health history and psychosocial
history.3
From the above informations, it is clear that nurses have a key
role with the post operative cardiac patients ,in their recovery as well as in the
prevention of complications. Hence, the researcher felt that there is a need to
assess the knowledge and practice of staff nurses regarding the postoperative
cardiac care in selected cardiac hospital at Bangalore, Karnataka.

REVIEW OF LITERATURE:
The review of literature is defined as a broad, comprehensive in
6.2
depth, systematic and critical review of scholarly publications, unpublished
scholarly print materials, audiovisual materials and personal communications.
The review of literature in a research report is a summary of current
knowledge about a particular practice problem and included what is known
and not known about the problem.14
The sources to obtain information on the topic were books,
journals, abstracts, medline, unpublished dissertations and internet. For the
purpose of logical sequence, the chapter is divided into sections.
The literature reviewed has been presented under the following categories:
I. Reviews related to knowledge of staff nurses.
II. Reviews related to practices of staff nurses.
III. Reviews related to cardiac conditions.
IV. Reviews related to post operative care.

REVIEWS RELATED TO KNOWLEDGE OF STAFF NURSE

A descriptive study was conducted to assess the
6.2.1 knowledge of nursing personals regarding immediate post operative care of
cardiac surgery patients on ventilator in cardio thoracic intensive care unit
(CTICU) in selected hospitals of Hyderabad.30 nurses working in CTICU with
at least 6 months experience were selected by purposive sampling method.
Data was collected by observation check list and questionnaire. The study
revealed that majority of nurses had below average knowledge and more than
one third of nurses had above average knowledge. The study concluded that
the nurses had a low knowledge regarding immediate post operative care of
cardiac patients on ventilators and hence educational programmes to be
organized to improve their knowledge or practices in caring the patients in
ICU’s.15
A comparative study was conducted to assess the knowledge
regarding electrocardiogram among degree and diploma staff nurses in
Madurai. A Sample of 60 nurses were selected by using random sampling
technique in which 30 graduate staff nurses and 30 diploma staff nurses were
there. Data were collected by using structured questionnaire. The results
showed that mean score of degree nurses in the following areas were: 38.24 in
introduction, 29.73 in procedure, 33.81 in interpretation, 31.52 in identification
of cardiovascular disorders. The mean score of diploma nurses were 36.93 in
introduction, 41.64 in procedure, 21.76 in interpretation and 19.45 in
identification of cardiovascular disorders. The study concluded that the degree
staff nurses had more knowledge on electrocardiogram as compared to the
diploma staff nurses.11
A descriptive study was conducted to assess the knowledge
regarding risk factors, life habits and personal beliefs among nurses and
nursing students about cardiovascular prevention in Italy. A sample of 182
nurses were selected by using random sampling technique in which 98
students attending the last year course in School of Nursing, and 84 nurses
working in a cardiovascular department were there. Data were collected by
using questionnaire. The results showed that among heritable risk factors,
hypertension ranked first in the awareness of both students and nurses. The
risk inherent in a family history of Myocardial Infarction was recognized only
by 36% of subjects, 15% of staff nurses and 30% of students recognized that 5
 to 10 of cigarettes per day are not harmful respectively. The knowledge of
upper normal limits for blood pressure, plasma cholesterol and triglycerides
was often poor in both the cohorts. The study concluded by saying that
majority of the staff nurses and student nurses life style was a credible model
for patients. 14
A study was conducted on knowledge regarding nursing care for
patients with implantable defibrillators among nurses, Delhi. A teaching
protocol given to 400 nurses by convenience sampling method, study period
was one year. The result showed there is doubtless change among nurses in
their knowledge and assisting patients to assume the role of being their own
most important healthcare manager.16
A survey was designed by Mr Tagney J, using a purposive
sample of 152 nurses from cardiology areas in four large teaching hospitals
and a 28-point postal questionnaire to explore knowledge of the device and its
impact. The result showed that Knowledge of the device and its effects
appeared poorly understood by all nurses, irrespective of additional
qualifications, length of time since qualifying or area of work. They concluded
that most subjects were not confident in their abilities to prepare patients for
implant or life at home after implant and Lack of understanding may impair
preparation of patients for implantation of or for living with an implantable
cardioverter defibrillator.17
A study was conducted on effectiveness of teaching programme
on knowledge regarding care of patient with cardiac assist devices among
nurses, Columbia. They teach device care during the annual skills fair. The
result showed that nurse’s knowledge level was high as compare to pre test.
They concluded that patients are the beneficiaries of professional, competent
nursing care by providing teaching programme.18
REVIEWS RELATED TO PRACTICES OF STAFF NURSE:
A study was conducted to assess the nurses’ knowledge and
6.2.2 practice regarding post operative care, following cardiac device implantation,
London. They found that certain aspects of established practice are based on
tradition rather than evidence. Nurses are lacking in some aspects of
knowledge in giving care. They concluded that nurses should play a key role in
identifying and addressing research questions that lead to improved patient
outcome.19
A study was conducted on effectiveness of nursing education
regarding knowledge and practice of post operative care of patient with a
permanent cardiac anti arrhythmic devices among nursing professionals,
Chicago. This study was conducted over three year period. They observed a
high Cardiac Device infections rate associated with substantial morbidity in
the beginning in their practice due to lack of knowledge. The result showed
that there is significant difference in their knowledge and practice level after
implementing the nursing education program. They concluded that the nursing
education measures had an impact on CDI in prevention they also suggests that
implementation of a comprehensive teaching program is feasible and
efficacious among nurses.9
A study was conducted on Nurses knowledge and practice on
Management and Outcome of patient with Permanent Pacemaker and
Implantable Cardioverter-Defibrillator Infections, California. Data collection
was done through questionnaire and observation check list. They result
showed that lack of knowledge and timely management by the nurse
practitioner on patient with any implantable cardiac device lead to certain
complications.20
A study was conducted to assess the nurses’ knowledge and practice
regarding post operative care, following cardiac device implantation, London.
They found that certain aspects of established practice are based on tradition
rather than evidence. Nurses are lacking in some aspects of knowledge in
giving care. They concluded that nurses should play a key role in identifying
and addressing research questions that lead to improved patient outcome.19
A pre-experimental study was done by Sanne E. Hoeks to assess
the effectiveness of protocol on knowledge and practice among nursing
personnel regarding pre and post operative nursing management of patients
undergoing cardiac surgery was carried out in selected hospital of Central
India in 2007. 20 nursing personnel were selected as subjects by using
purposive sampling. A structured knowledge questionnaire and an observation
checklist was used to observe the knowledge and practices of nursing
 personnel regarding pre and post operative nursing management of patients
undergoing cardiac surgery. The experts validated both the tools. The protocol
was administered after pretest and the posttest was taken after 7 days. Findings
indicated that the protocol was effective in increasing knowledge and
improving practices regarding pre and post operative nursing management of
patients undergoing cardiac surgery among nursing personnel.21
REVIEWS RELATED TO CARDIAC DISORDERS :
A study was conducted on prevalence rates of cardio vascular
disease in India. The result showed that the Challenge of Cardiovascular
6.2.3 Disease 13.5% in India about 50% of related deaths occur among people
younger than 70. They concluded that, the prevalence rates among younger
adults (age group of 40 years and above) are also likely to increase.22
A study was conducted to assess the knowledge of nursing
personnel’s on first 24 hours care of the patients with Myocardial Infarction in
Osmania General Hospital, Hyderabad. 50 nursing personnel’s were randomly
selected and structured questionnaire was used for data collection. The results
of the study showed that 26% of nursing personnel’s had below average
knowledge, 44% had average level of knowledge, and 30% had above average
knowledge. The study concluded by saying that the nurses need to be given
special training in caring the cardiac patients in ordered to improve their
knowledge.23
An explorative study was conducted on knowledge regarding
importance of emergency identification scheme on patient with implanted
cardiac devices among 190 senior nurses. Standardized questionnaires were
sent to senior representatives. The result showed that majority 59% of the
personnel not aware of the identification of symptoms during emergency. They
concluded that it is vital that all staff routinely search patients for any
abnormality with sufficient knowledge.24
A study was done by Asilioglu.K, celik SS in 2004, evaluation of
the effectiveness of pre operative education on anxiety of open cardiac surgery
patients in Gulhane Mililaty Medical of Academy, Ankara, Turkey. This study
consisted of 100 patients having open cardiac surgery. Of 100 patients, 50
were placed in the intervention group while the remaining 50 were in the
 control group. The patients in the intervention group were given a planned
teaching according to the patient education booklet. Patients in the control
group were informed about pre and post operative routines by a nurse by the
purpose of comparing anxiety levels of the patients in control and intervention
groups. The anxiety levels of both groups were measured on the third day after
the operation by using the self evaluation questionnaire for state and trait
anxiety inventory. The mean post operative state and trait anxiety score in the
control group was slightly higher than the mean of patients in the intervention
group. In addition, all patients in the intervention group stated that they were
satisfied with the pre-operative teaching given by the researcher.25
A study from Alkmaar shows that the care of patients who have
recently had a myocardial infarction, which is normally done by a
resident/physician-in-training, can also be carried out by a nurse practitioner,
when working within the limits of well-defined protocol, and under the
supervision of a staff cardiologist. Although no difference in clinical endpoints
was found during the follow-up period, the study shows that patients who were
under the care of the nurse practitioner were overall more satisfied with the
information that was provided to them, than those under the care of the
resident. These findings are important and need confirmation in larger studies
and in other patient populations.26
REVIEWS RELATED TO POST OPERATIVE CARE :
A study was conducted on 2008 on late complications of cardiac
surgery.215 consecutive open heart patients were followed preoperatively and
6.2.4 post operatively with questionnaires to assess changes in quality of life. 80%
patients documented improvement. Pre operative patient characteristics play
an important role in post operative improvement.529 patients were followed at
six months after elective bypass surgery for physical and mental health
improvement. Of these, 73.2% had improvement in physical health and 41.6%
in mental health.27
A study was conducted by Leegard M. et al in 2008 on post
operative pain and self management: woman’s experience after cardiac surgery
in Institute of Nursing and Health Science, University of Oslo, Norway. Semi-
structured interviews were conducted with 10 women 1-2 weeks after
discharge from their first elective cardiac surgery. Qualitative content analysis
was used to identify recurring themes. Pain dairies were used to record post
operative pain experiences. The findings showed that post operative pain
experience varied from no pain to pain all the time. Pain experience depended
on what women’s expectations of pain after cardiac surgery. This study shows
that patients need more individualized and gender specific information before
surgery to improve self- management.28
A study was conducted on postoperative care of a heart transplant
recipient, states that early postoperative care of a heart transplant recipient
remains challenging, even in experienced centers with a long tradition of
excellence. Approximately 10% to 20% of heart transplant recipients
experience potentially life-threatening right ventricular dysfunction intra-
operatively and early postoperatively due to an elevated pulmonary vascular
resistance. In addition, heart transplant recipients experience a high risk of
peri-operative hemorrhage, as well as opportunistic infection and rejection.
The authors describe a case of severe right ventricular dysfunction in a 46-
year-old male several hours after heart transplantation for a dilated
cardiomyopathy. This patient was salvaged by judicious multimodality therapy
including the use of adrenergic agents, phosphordiesterase inhibitors, inhaled
nitric oxide, and extracorporeal membrane oxygenation. The risk factors for
the development of early graft failure after heart transplantation are reviewed,
along with the principles of appropriate management of this complication.29
A descriptive study was carried out in 1998 “To assess the
knowledge and practices of nursing personal regarding immediate post
operative care of cardiac surgery client on ventilator in Cardio Thoracic
Intensive Care Unit in selected Hospitals of Hyderabad”. 30 nurses working in
CTICU with at least 6 months experience were selected by purposive
sampling. Data was collected by observational checklist and questionnaire.
The study revealed that majority of nurses had below average knowledge and
practices and more than one third of nurses had above average knowledge and
practices.
A study was conducted to evaluate post operative pain
management by Jeffrey .L. Apfelbaum. Relief of postoperative pain is major
topic of public health and has been repeatedly shown to be inadequate. The
present study describes specific results for the 178 French health care
institutions surveyed and 345 questionnaires collected. Preoperative patient
information is given on a regular basis for 84% of respondents. Multimodal
analgesia is used after major surgery in 87% of cases and prescribed on a
regular basis for 84% of respondents. Written protocols are available in 36%
of responding institutions. Pain scores are measured several times a day in
65% of institutions. An acute pain service is found in 52% of institutions.
Regular onsite training courses on pain control are delivered to 30% of
anesthesiologists, to 6% of surgeons, to 57% of recovery-room nurses and to
63% of ward nurses. Overall, the study suggests an improvement efforts
remain to be done, particularly in the field of initial and continuous education
of all healthcare categories as this is believed to be the only real way to obtain
long-term results in pain management.30
A study was done by Kotrotsious E, et al on 2004 on pre surgical
instruction and guidance conducted in Greek general hospital that more
attention to the patient in the pre-operative period can lead to a faster post
operative recovery. This study suggests that patients should be informed about
the surgery and the immediate post operative period, and should receive
information about the importance of respiratory exercises and the early
ambulation that will be performed33.

STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF
STAFF NURSES REGARDING POST-OPERATIVE CARDIAC CARE
IN SELECTED HOSPITALS AT BANGALORE WITH A VIEW TO
DEVELOP INFORMATION BOOKLET.

OBJECTIVES
The objectives of the study are
 To assess the knowledge regarding post operative cardiac care among
6.3 nurses.
 To assess the practices of nurses working in postoperative cardiac ward.
 To determine the association between knowledge and practice of staff
nurses with the selected demographic variables.
 To correlate the knowledge and practice of staff nurses regarding post
operative
cardiac care.
 To develop an informational booklet on post operative cardiac care.

OPERATIONAL DEFINITIONS:
 Assess: Evaluate or estimate the nature, value or quality of knowledge and
practice of staff nurses regarding post operative cardiac care.
6.4  Knowledge: It is the information and skills acquired through experience and
education. In this study it refers to correct reaction of nurses to the
questionnaires given.
 Practice: It is the application of theoretical science or knowledge. In this
study it refers to the way staff nurses providing care to the patients.
 Staff nurses: In this study staff nurses refer to professionals who are
formally trained and registered and are working in a health setups.
 Postoperative cardiac care: Postoperative cardiac care is the management
of patients after cardiac surgery who are admitted in the cardiac postoperative
ward.
 Information booklet: Self learning information furnished in simple and
illustrated way prepared in English regarding the post operative cardiac care
to improve the knowledge and practice of staff nurses.

HYPOTHESIS:
H1: There will be significant association between knowledge and practice of
the staff nurses regarding post operative cardiac care.
6.5 H2: There will be significant association between the selected demographical
variables and knowledge and practice of the staff nurse regarding post
operative cardiac care.
 ASSUMPTIONS:
1. The staff nurses may have some knowledge regarding postoperative cardiac
care.
2. The staff nurses may not have adequate practice on post operative cardiac
6.6 care.

DELIMITATIONS:
This study is limited to nurses working in selected cardiac hospitals at
Bangalore, Karnataka.

6.7
MATERIALS AND METHODS:
SOURCE OF DATA
Data will be collected from the staff nurses working in selected cardiac
hospitals, Bangalore, Karnataka.

METHOD OF COLLECTION OF DATA

7
Self administered structured questionnaire and observation check list will be
7.1
using.

RESEARCH DESIGN
Non experimental descriptive design is adopted for the study. Single group
7.2
will be selected for the study.

RESEARCH APPROACH
In this study descriptive survey approach is used.
7.2.1
SETTING
The setting of the study will be the postoperative wards in selected cardiac
hospitals, Bangalore, Karnataka.
7.2.2

VARIABLE UNDER STUDY

7.2.3
 DEPENDENT VARIABLE
Dependent variables-knowledge and practice of staff nurses regarding post
operative cardiac care.
  EXTRANEOUS VARIABLE

7.2.4 Age, sex, education, religion, total work experience, experience in post
operative cardiac ward.

POPULATION
The target population of this study is the Staff nurses those who are working in
selected cardiac hospitals in Bangalore, Karnataka. The assessable population
of the study is the staff nurses working in the postoperative cardiac wards in
the time of study in selected cardiac hospitals in Bangalore, Karnataka.

SAMPLE
7.2.5
Staff nurses who are working in selected cardiac hospitals, Bangalore,
Karnataka.

SAMPLE SIZE
For this study a sample of 60 staff nurses will be considered.

7.2.6 SAMPLING TECHNIQUE

The Non probability purposive sampling technique will be adopted to select
the sample.

7.2.7 SAMPLING CRITERIA:

INCLUSION CRITERIA

7.2.8  Staff nurses,

1. Who are willing to participate in the study.
2. Who are working in cardiac hospitals.

7.2.9 3. Who are available during the data collection.

4. Both male and female nurses.
EXCLUSION CRITERIA
 Staff nurses
1. Who are not willing to participate in the study
2. Who are ANMs.
3. Who are newly appointed.

TOOLS FOR DATA COLLECTION:

The tool for the proposed study is self administered structured questionnaire
 and observation check list.

DATA COLLECTION PROCEDURE:

The plan of data collection for the proposed study is as follows ;
7.2.10 ~ Permission will be obtained from the hospital authorities and the
respondents.
~ Data will be collected using the structured questionnaire and observation
7.2.11 check list.
~ Proposed period for data collection will be 4 weeks.

METHODS OF DATA ANALYSIS AND PRESENTATION:

Data analysis will be through descriptive and inferential statistics.
*Descriptive statistics:
 Selected demographic variables are to be analyzed in terms of frequency
and percentage.
7.2.12  Knowledge and practice of staff nurses are to be presented in the form of
mean, median and standard deviation.
*Inferential statistics:
X2 test will be using to determine the association between selected
demographic variables such as age, sex, education, religion, years of
experience.
 Karl Pearson’s co-efficient of correlation will be used to determine the
relationship between knowledge and practice of staff nurses regarding post
operative cardiac care.

DURATION OF DATA COLLECTION:

Duration of data collection will be 4 weeks.

PROJECTED OUTCOME:
The results of the study will through light on the knowledge of nurses
regarding care of patient undergone cardiac surgery and also help the future
7.2.13 researchers to have in-depth studies regarding the practice of staff nurses.

DOES THE STUDY REQUIRE ANY INVESTIGATION OR

7.2.14 INTERVENTION TO BE CONDUCTED ON PATIENTS OR
OTHER HUMANS OR ANIMALS? IF SO PLEASE
 DESCRIBE BRIEFLY.
Hence this is a descriptive study, no investigations and interventions are
7.3 required.

HAS ETHICAL CLEARANCE BEEN OBTAINED FROM

YOUR INSTITUTION?
 Yes, ethical clearance will be obtained from the research committee of the
Srilakshmi College of Nursing, Bangalore, Karnataka.
 Ethical clearance will be obtained from the authorities of selected hospitals
having cardiac specialty, Bangalore, Karnataka..
7.4  Informed consent will be obtained from the staff nurses who are willing to
participate in the study.

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