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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE
AND ADDRESS
Ms. ANN MARY VARGHESE
1st YEAR, M.Sc. NURSING
BAPUJI COLLEGE OF NURSING,
DAVANGERE.
2. NAME OF THE
INSTITUTION
BAPUJI COLLEGE OF NURSING,
DAVANGERE
3. COURSE OF STUDY AND
SUBJECT
DEGREE OF MASTER OF
NURSING
MEDICAL SURGICAL NURSING
4. DATE OF ADMISSION TO
COURSE
12th June 2009
5. TITLE OF THE TOPIC “EFFECTIVENESS OF
STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE
REGARDING POST OPERATIVE
EXERCISES OF CLIENTS WHO
ARE UNDERGOING
ABDOMINAL SURGERIES IN
SELECTED HOSPITALS,
DAVANGERE”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Surgery is the medical speciality that treats diseases,injuries or
other physical conditions.SURGERY came from a greek word cheirourgia,meaning
‘hand work’.In india Sushrutha samhita is also known as by the title ‘Father of
surgery’.1 Billroth is often referred to as “the father of abdominal surgery.2
Having surgery is a major event in any person’s life.Good results of the
surgery depend on careful pre operative evaluation,balancing the risks and benefits of
the surgery,attention to pain management&avoidance of post operative
complications.3 Total number of surgical procedures performed in US was 4.6 million
in that total hysterectomy-5,69000,caesarian section-1.3 million.4
Exercises play an important role in relieving pain &preventing
complications.The application of therapeutic exercises to a patient is a process which
demands an initial examination of patients needs and a constant reassessment of the
situation in the light of progress.5
Pre operative teaching is an important component in the clients operative
experience.3 Teaching about post operative activities is implemented in the pre-
operative phase.Clients need to know about surgical events,how to perform and
exercises necessary to decrease post operative complications and facilitate recovery.6
6.1 NEED FOR THE STUDY
Pre operative teaching is important to ensure a positive
surgical experience for the client.Numerous research studies support the value of pre
operative instructions in reducing both the incidence of post operative complications
and length of stay in the hospital.3 It has been found that the incidence of post
operative complications among patients undergoing major surgery in developing
countries is very high. But the incidence of the same in Western countries account for
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only a very small percentage.The clients undergoing abdominal surgeries are found to
be at risk for developing post operative complications.Knowledge deficit regarding
post operative exercises among the client is noticed.6 Early ambulation is the most
significant general nursing method to prevent post operative complications.7
Post operative pulmonary complication and contribute
equally to morbidity, mortality and length of hospital stay.Use of appropriate lung
expansion techniques and adequate pain management also helps to ameliorate the risk
of pulmonary complications.8 Considering the prevalence of pain after surgical
operations & importance of rapid pain alleviation ,physical exercises is a simple
method for relieving pain.9 Regarding general complications after abdominal
surgeries,respiratory complications are common in post operative patients upto 40%
of all patients develop atelectiasis.6
DEODHAR SD MOHITE JD,SHIRAHATTI RG,JOSHI S on their
study on pulmonary complications of upper abdominal surgery.A prospective study
on 67 patients underwent upper abdominal surgery under general anaesthesia.37
patients had pulmonary complications.development of pulmonary complications
seems to be more in males(61.2%)than in females(30.4%).In conclusion ,it may
indicate the need for prophylactic measures pre-operatively and in the early post
operative period.10
Venous thrombo embolism is considered to be a significant
cause of morbidity & mortality in hospitalized patient,especially in those undergoing
major surgical procedure.In the absence of prophylaxis,VTE rates as high as 25%
have been reported following general surgeries.Six general and colorectal surgical
publications from the region reported an incidence of deep vein thrombosis ranging
from 3%-28%.A study from Singapore showed that out of 227 elective surgeries one
patient developed clinical DVT postoperatively.Only early post operative
mobilization was encouraged for prevention of these complications.11
PIEPER AND KAGER is a careful study from Sweden, estimated a yearly
incidence of 1.33 cases of appendicitis per 1000 of male population and 0.99/1000 of
female population.25% of the patients were younger than 14 yrs and 75% younger
than 33.More recently a population based study examined the outcome of all open
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cholecystectomies performed in 12 month period in 2 states in the US.In this 42,474
patients, representing approximately 8 % of all cholecystectomies performed annually
in that morbidity rate of 14.7% includes all reported complications, including minor
problems such as atelectasis, and other assorted difficulties.12 Some of them have
misconception that a change in position after abdominal surgery may worsen their
health status.The same time it is fact that exercises and early ambulation reduces post
operative complications.6 In our hospital set up among the surgeries are conducting-
abdominal surgeries are most common like appendectomy,cholecystectomy, hernia.
Among these most of them need more than 6 days of hospitalization.Pre operative
teaching allays anxiety & encourages clients to participate actively in their own care.3
Because of the above mentioned reasons the investigator identified the need
for giving a structured teaching programme for clients who are posted for abdominal
surgeries on post operative exercises will avoid post operative complications and to
facilitate recovery.
6.2 REVIEW OF LITERATURE
“Literature review is a critical summary of research on a topic of interest often
prepared to put a research problem in the context or as the basis for an
implementation project”
- Polit and Hungler
1. A study was conducted on chest physiotherapy with positive expiratory
pressure breathing after abdominal and thoracic surgery at Linköping
University Hospital,Sweden. Breathing techniques with a positive expiratory
pressure (PEP) are used to increase airway pressure and improve pulmonary
function. The purpose of this systematic review was to determine the effect of
PEP breathing after an open upper abdominal or thoracic surgery.Randomised-
controlled trials (RCT) was performed in five databases. We selected six RCT
evaluating the PEP technique performed with a mechanical device in
spontaneously breathing adult patients after abdominal or thoracic surgery.
Only one of the included trials showed any positive effects of PEP compared
to other breathing techniques. Today, there is scarce scientific evidence that
PEP treatment is better than other physiotherapy breathing techniques in
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patients undergoing abdominal or thoracic surgery. There is a lack of studies
investigating the effect of PEP over no physiotherapy treatment. 13
2. A study on duration of anaesthesia , type of surgery, respiratory co-
morbidity, predicted VO2max and smoking predict postoperative
pulmonary complications after upper abdominal surgery. Prospective
observational study. 268 consecutive patients undergoing elective upper
abdominal surgery who received standardised pre- and postoperative.
prophylactic respiratory physiotherapy.The results are 35 participants (13%)
developed postoperative pulmonary complications. Five risk factors predicted
postoperative pulmonary complications: duration of anaesthesia; surgical
category;current smoking; respiratory co-morbidity; and predicted maximal
oxygen uptake. A clinical rule for predicting the development of postoperative
pulmonary complications predicted 82% of participants who developed
complications. The odds of high risk participants developing pulmonary
complications were 8.4 times that of low risk participants.They concluded that
clinical rule for predicting the risk of developing postoperative pulmonary
complications from five risk factors may prove useful in prioritising
postoperative respiratory physiotherapy. 14
3. A study to discuss the recent literature concerning the significance of
respiratory complications as a determining factor in post operative
complications after major surgery in San Giovanni Battista Hospital, Italy.
Here,examine the diagnosis, contributing factors, consequences, and early
treatment of respiratory complications. The findings are general anesthesia and
surgery are the main causes of postoperative respiratory complications.
Atelectasis, a common respiratory complication, may contribute to pneumonia
and acute respiratory failure. Recently, it has been shown that activation of
abdominal muscles during the induction of anesthesia contributes to a
reduction of lung capacity, leading to a higher degree of atelectasis.
Additionally, long-term mortality at 5 and 10 years has recently been shown to
remain significantly increased in patients with respiratory complications.
Prevention or early therapy of respiratory complications may be beneficial in
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improving outcome in postoperative patients. Developing early treatment
strategies will likely provide improved benefits. To date, early treatment with
prophylactic or therapeutic continuous positive airway pressure has proved
beneficial in an abdominal surgical patient population.15
4. A study on randomized controlled pilot study comparing physiotherapy
techniques of breathing and mobility after abdominal surgery at Concord
hospital , Sydney, Australia. Results from this study may provide evidence
which can be applied to post operative physiotherapy practice.44 subjects
undergoing open abdominal surgeries at high risk of developing post
pulmonary complications (PPC) were recruited,Subjects were randomly
assigned to three groups.Group A only received physiotherapy directed early
mobility.Group B in addition to early mobility received deep breathing and
coughing.Group C received deep breathing and coughing.but were only
mobilized by the physiotherapist on day 3.The PPC rates were 25%,42% and
10% and the day restoration of independent mobility were 5.6, 11.6, 9.11 for
group A,B,C.Post Pulmonary complications develops in high risk patients
after abdominal surgery and physiotherapy techniques of an addition of deep
breathing to an early mobility or mobilizing on day three is equally effective
in improving recovery.16
5. A study on respiratory physiotherapy to prevent pulmonary
complications after abdominal surgery: a systematic review in Geneva
University Hospitals,Switzerland. Randomized trials were included if they
investigated prophylactic respiratory physiotherapy and pulmonary outcomes,
and if the follow-up was at least 2 days. The results are 35 trials tested
respiratory physiotherapy treatments. Of 13 trials with a "no intervention"
control group, 9 studies (n = 883) did not report on significant differences, and
4 studies (n = 528) did: in 1 study, the incidence of pneumonia was decreased
from 37.3 to 13.7% with deep breathing, directed cough, and postural drainage
; in 1 study, the incidence of atelectasis was decreased from 39 to 15% with
deep breathing and directed cough ; in 1 study, the incidence of atelectasis was
decreased from 77 to 59% with deep breathing, directed cough, and postural
5
drainage; in 1 study, the incidence of unspecified pulmonary complications
was decreased from 47.7% to 21.4 to 22.2% with intermittent positive pressure
breathing, or incentive spirometry, or deep breathing with directed cough.
They concluded that are only a few trials that support the usefulness of
prophylactic respiratory physiotherapy. 17
6. A study on knowledge retention from pre operative patient information.This
review considered all studies that included adults in a hospital setting,either as
inpatients or same day surgical patients,and who received some form of
information and or instruction before an operative procedure.Interventions
were the methods of pre operative patient education,instruction or
teaching,and included evaluations of the effectiveness of different
presentations such as written information , a.v aids,computer assisted
instructions etc. The findings of the study support the use of pamphlets to
inform patients and to improve their skills.The data suggested that the
instructional method,the act of educating a patient by delivering for actions is
useful for improving patients knowledge of their treatment andability to
perform and comply with required exercises.If teaching is to be done after
admission,using a group format has been shown to be equally as effective as
individual instruction. 18
7. A study on Preoperative Teaching and Hysterectomy Outcomes. This study
used a theoretical model to determine whether an efficacy-enhancing teaching
protocol was effective in improving immediate postoperative behaviors and
selected short- and long-term health outcomes in women who underwent
abdominal hysterectomies.One hundred eight patients in a 486-bed teaching
hospital in the Midwest who underwent hysterectomies participated. The
participation rate was 85% during the six-month study. The major finding was
that participants in the efficacy-enhancing teaching group ambulated
significantly longer than participants in the usual care group. This is an
important finding because the most prevalent postoperative complications
after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein
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thrombosis, and postoperative ambulation has been shown to decrease or
prevent all of these complications.19
8. A study in on physiotherapy outcomes and staffing resources in open
abdominal surgery patients in Australia.This study investigated at two
hospitals.The Abdominal Surgery Physiotherapy Outcomes Data
Sheet,designed for this study .The 30 subjects at each of the 2 hospitals were
comparable in all pre operative and peri operative variables.Wide variations in
the amount of physiotherapy resources were found between the two
hospitals..Number of physiotherapy treatments was found to be co related with
pre operative ASA score,days of mechanical ventillation and post operative
length of stay.Rates of restoration of mobility varied significantly,with
hospital B subjects sitting out of bed earlier and able to mobilise
independently earlier after surgery compared to hospital A .Over all rate of
post operative complications rates was 43.3%.Development of clinical
outcome measures in this area of physiotherapy is urgently needed in order to
review clinical practices and and inform priorities for future research
direction.20
9. A study to exam the effects of preoperative nursing intervention for pain on
abdominal surgery preoperative anxiety and attitude to pain, and postoperative
pain. In a randomized controlled study conducted between January and August
2001, patients undergoing abdominal surgery in a medical center in southern
Taiwan were randomly assigned to an experimental (n = 32) or control group
(n = 30). The experimental group received routine care and preoperative
nursing intervention for pain, while the control group received routine care
only.. Perceived pain interference during position changes, deep
breathing/coughing, and moments of emotion in the experimental group was
statistically significantly lower than that of the control group in the same
situations. The experimental group also started out-of-bed activities 1·5 days
earlier. They conclude that Preoperative nursing intervention for pain has
positive effects for patients undergoing abdominal surgery. 21
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10. A study conducted on the effect of exercise on post caesarian section pain.
This clinical study was performed on 40 volunteer patients for caesarian
section at Aytollah Kashani hospital in Jiroft 2000 .The subjects were
randomly divided into 2 groups of 20:Case and control groups .Physical
exercises were taught to the case group including proper deep
breathing ,effective coughing ,limb movement, changing position in bed and
leaving bed ,but they were not demonstrated to the control group. .Results
showed that the cases had significantly lower pain magnitude and receptive
after operations especially on the 1st,2nd, and 3rd days after operation. They
concluded that physical exercises after abdominal surgeries is recommended
as a simple non-medical and non invasive method for relieving pain.9
6.3 STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of structured teaching programme on
knowledge regarding post operative exercises of clients who are undergoing
abdominal surgeries in selected hospitals, Davangere ”.
6.4 OBJECTIVES OF THE STUDY
1. Assess the existing knowledge regarding post operative exercises of clients
who are undergoing abdominal surgeries .
2. Evaluate the effectiveness of structured teaching programme as evident from
gain in post knowledge score.
3. Determine the association between pretest knowledge score and
sociodemographic variables.
6.5 OPERATIONAL DEFINITIONS
EVALUATE
In this study, it refers to determine amount of outcome of knowledge among pre
operative clients by structured teaching programme.
EFFECTIVENESS :
It refers to determining the extent to which the information in the structured
teaching programme has achieved the desired effect as expressed by gain in
knowledge score.
8
STRUCTURED TEACHING PROGRAMME :
It refers to systematically planned teaching programme designed to provide
informations which is prepared by researcher.
KNOWLEDGE:
In this study, it refers to amount of information collected by the researcher
from the subjects by administering structured questionnaire.
POST OPERATIVE EXERCISE :
In this study it refers to the exercises which are to be performed after abdominal
surgeries.
ABDOMINAL SURGERIES :
In this study it broadly covers surgical procedures that involve opening the abdomen
includes appendicectomy,cholecystectomy,incisional hernia,abdominal
hysterectomy,intestinal obstruction.
CLIENT :
In this study it refers to the client who are posted for abdominal surgeries.
6.6 ASSUMPTION
The study assume that
1. Clients who are posted for abdominal surgeries may have some knowledge
regarding post operative exercises after abdominal surgery.
2. Structured teaching programme enhances knowledge regarding post operative
exercises.
3. Clients level of knowledge is influenced by demographic variables.
6.7 RESEARCH HYPOTHESIS
H1 – The mean post test of subjects exposed to structured teaching programme
will be greater than their mean pretest scores as measured by structured knowledge
questionnaire at 0.05 level of significance.
H2 - There will be significant association between selected demographic
variables and the knowledge of pre operative clients.
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6.8 LIMITATIONS
The study is limited to the clients who are posted for the elective abdominal
surgeries like appendicectomy,cholecystectomy ,incisional hernia, abdominal
hysterectomy.
Clients in pre and post operative wards of selected hospital Davangere.
Pre operative clients who are available at the time of data collection.
Clients who can read and write Kannada.
7. MATERIALS AND METHODS OF THE STUDY
7.1 SOURCE OF DATA
Pre operative clients who are available in the hospital at the time of data
collection.
7.1.1 RESEARCH DESIGN
Pre-experimental research design with one group pretest post test.
7.1.2 VARIABLES OF THE STUDY
i. DEPENDENT VARIABLE
Knowledge gained by the pre operative client.
ii. INDEPENDENT VARIABLE
Structured teaching programme on knowledge regarding post operative
exercises.
7.1.3 STUDY SETTINGS
The study will be conducted in the selected hospitals includes S.S.Institute of Medical
Sciences&Research centre, C.G.Hospital Davangere.
7.1.4 POPULATION
The population of the present study will be comprised of pre operative
clients who are posted for elective abdominal surgeries-
appendicectomy,cholecystectomy,incisionalhernia,abdominal hysterectomy in
selected hospitals, Davangere.
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7.2 THE METHOD OF DATA COLLECTION
Data will be collected by using self administered questionnaire after obtaining
prior permission from the hospital
7.2.1 SAMPLING TECHNIQUE
Purposive sampling technique is used to select the sample of pre operative
clients.
7.2.2 SAMPLE SIZE
Sample for the study are 45 pre operative clients posted for abdominal
surgeries.
7.2.3 CRITERIA FOR SELECTION OF THE SAMPLE
INCLUSION CRITERIA
1. Preoperative clients who are posted for the elective abdominal surgeries
includes appendicectomy,cholecystectomy,incisional hernia,abdominal
hysterectomy.
2. Pre operative clients those are present at the time of data collection
3. Pre operative clients who can read and write Kannada
4. Clients in pre and post operative wards of selected hospitals.
EXCLUSION CRITERIA
1. Pre operative clients other than abdominal surgeries.
2. Pre operative clients who are not willing to participate.
7.2.4 INSTRUMENT
A structured questionnaire will be prepared in such a way it will
consists of two parts.
I The demographic data of the pre operative clients.
II The knowledge of pre operative clients regarding post operative exercise.
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7.2.5 METHOD OF DATA ANALYSIS AND PRESENTATION
The data being collected through structured questionnaire will be
carefully analysed through the following statistical technique.
I Descriptive statistics
i. Frequency and percentage used to describe demographic
characteristics of pre operative clients being studied under research.
ii. Mean and standard deviation will be used to assess knowledge on
post operative exercise .
II Inferential statistics
i. Paired ‘t’ test will be used to compare pretest and post test knowledge
scores.
ii. Chi square test will be used to find out the association between
demographic variables with the level of knowledge on post operative exercise
7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE
CONDUCTED ON PATIENTS OR OTHER HUMAN ANIMALS?
Yes, structured teaching programme will be administered to the pre operative
clients in increasing their knowledge regarding post operative exercises to be
performed after abdominal surgeries.
7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR
INSTITUTION?
Ethical clearance will be obtained from the institutions ethical committee
(IEC).The purposes and details of the study will be explained to the study subject and
informed consent will be obtained from them. Assurance will be given to the study
subject on the confidentiality of the data collected from them. Permission will be
obtained from the hospital for data collection.
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8. Reference:
1. New world encyclopedia contributers, Surgery [internet]. New World
encyclopedia; 2008 Aug 29, 15:46 UTC [cited 2009 Dec 8]. Available from :
http://www.newworldencyclopedia.org/entry/Surgery?oldid=795211
2. MJ,Ashley Zinner SW.Maingot’s abdominal operations. 11thed.United states
of America:Mc Graw Hill;2007. p. 3.
3. Black JM, Hawks JH. Medical surgical nursing: clinical management for
positive outcomes. 7th ed. Missouri, India: Elsevier; 2005. p. (vol 1).
4. Centers for disease control and prevention. Inpatient surgery. 2006. Available
from: URL: http://www.cdc.gov/nchs/FASTATS/insurg.htm.
5. Hollis M.Practical exercise therapy.Oxford:Blackwell scientific;1976. p. 1
6. Shymon K. Effectiveness of preoperative planned teaching programme on post
operative self care activities and recovery of clients undergoing abdominal
surgery, dissertation 2006
7. Lewis SL, Heitkemper MM, Dirksen SR, O’Brien PG, Butcher L:Medical
Surgical Nursing:Assessment and Management of Clinical Problems. 7 th ed.
Missouri, India:Elsevier; 2007. p. 21-35.
8. Relan M, Kancha RK. Peri operative assessment and management of the
patient with pulmonary disease. North east Flore med[abstract] 2008[cited
on2008]; 59(1): 19. Available from: URL:
http://www.dcmsonline.org/jaxmedicine/…/perioperative/pulmonary/pulmona
ryevaluation.pdf.
9. Aetzadeh S. The effect of exercise on post caesarian section pain.J Qazvin
Univ Med Sci[abstract]2000[cited on 2003]; 7(4); Available from:
http://jqums.hbi.ir/browse php?a_code_a_10-1-89&sid=1&sk-lang-en.
10. Deodhar SD, Mohite JD, Shirahatti RG, Joshi S. Pulmonary complications of
upper abdominal surgery. J Postgrad Med [serial online] 1991 [cited 2009 Nov
13
27]; 37: 88-92. Available from : URL:
http://www.jpgmonline.com/text.asp?1991/37/2/88/782.
11. Jawaid M, Masood Z, Iqbal SA. Post operative complications in general
surgical ward of a teaching hospital. Pak J Med Sci [abstract]2006 [cited
on2006];22(2):171.Availablefrom:
http://www.pjms.com.pk/issues/apr.jun06/article/article16.html
12. Zinner MJ, Schwartz IS, Ellis H.Maingot’s abdominal operations. 10th ed.
United states of America:Prentice Hall International;1997.p. 1193,1733.
13. .Orman J, Westerdahl E. Chest physiotherapy with positive expiratory
pressure breathing after abdominal and thoracic surgery: a systematic review.
Act Anaes Scand[abstract] 2009 [cited 2009]. Available from: URL:
http://www.researchgatenet/publication/38056438.
14. Scholes RL, Browning L, Sztender EM, Denehy L. Duration of anesthesia,
type of surgery, respiratory co morbidity,predict poat operative pulmonary
complications after abdominal surgery. Aust J Physio [abstract]2009
[cited2009]; 55(3): 191-198. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/19681741.
15. Ferreyra G, Long Y, Raniera V. Respiratory complications after major
surgery. Curr Opin Crit Care[abstract]2009 Jun 17 [cited on 2009 Aug]; 15(4).
342-348. Available from: http: //journals.lwww.com/co-critical
care/abstract/2009/08000/respiratory_complication_after_major
_surgery.12.aspx.
16. Silva Y, Li F. Randomised controlled pilot study compairing physiotherapy
techniques of breathing and mobility after open abdominal surgery on high
risk patients. Research report platform presentation[abstract] 2007 [cited on
2007 Jun];93(5): 5308. Available from:
http://www.org/abstracts2007/abstract/1030htm?abstractlist.
17. Pasquina P, Tramer RM, Granier JM, Walder B. Respiratory physiotherapy to
prevent pulmonary complications after abdominal surgery: a systematic
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review. Chest[abstract] 2006 Dec [cited on 2006]; 130(6): 1887-99. Available
from: http://chestjournal.chestpubs.org/content/130/6/1887.abstract.
18. Stern C,Lockwood C.Knowledge retention from preoperative patient
information. Intern J Evi based health[abstract]2005 March [cited on 2005];
3(3): 45-63. Available from:
http://www.3interscience.wiley.com/journal/118719400/abstract?CRETRY
=1& S RETRY=0.
19. Sharon L,Black LO, Jones S, Estok P, et al. Pre operative teaching and
hysterectomy outcomes. AORN[abstract]2003 June [cited 2003];77(6): 1215-
1231. Available from: http://www.aornjournal.org/article/50001-
2092(06)60983-6/abstract.
20. Mackay RM, Ellis E. Physiotherapy outcomes and staffing resources in open
abdominal surgery patients. Physio theory & Pra[abstract]2002 [cited on
2002]; 18(2):75-93. Available from:
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CRETRY=1&SRETRY=0.
21. Lee DS, Chein WT. Pre-operative patient teaching in an acute care ward in
Hong Kong: Contemporary Nurse[abstract]2002 [cited on 2002];13(2-3):
Available from : http://www.ncbi.nlm.gov/pub/116116783.
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9. SIGNATURE OF THE CANDIDATE :
10.
REMARKS OF THE GUIDE :
11.
NAME & DESIGNATION OF (IN BLOCK LETTERS)11.1 GUIDE
11.2 SIGNATURE
:
:
11.3 CO-GUIDE (IF ANY)
11.4 SIGNATURE
:
:
11.5 HEAD OF THE DEPARTMENT
11.6 SIGNATURE
:
:
12.
12.1 REMARKS OF CHAIRMAN AND PRINCIPAL
12. 2 SIGNATURE
:
:
16
ETHICAL COMMITTEE CLEARANCE
1. TITLE OF THE DISSERTATION: “EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING
POST OPERATIVE EXERCISES OF CLIENTS WHO ARE UNDERGOING ABDOMINAL SURGERIES IN SELECTED HOSPITALS,
DAVANGERE”
2. NAME OF THE CANDIDATE: MS. ANN MARY VARGHESE, 1st year M.Sc Nursing, Bapuji College Of Nursing.
3. SUBJECT: MEDICAL SURGICAL NURSING 4. NAME OF THE GUIDE : PROF. S.F. BILLALLI , M.Sc. Principal and HOD, Medical surgical Nursing Dept,
Bapuji college of Nursing, Davanagere-4
5. APPROVED/NOT APPROVED: (If not approved, suggestion)
PROF. S.F.BILLALLI, MRS.LEELAVATHY.R.HPrincipal and HOD, Head of the Department of Department of Medical surgical Nursing, Obstetrics and Gynecological NursingBapuji college of Nursing, Bapuji College of NursingDavanagere-4 Davanagere-4.
17