Download 6.2.1 review related to post operative management of heart valve

SYNOPSIS FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
SUBMITTED BY:
Ms. ANUPA SUSAN ABRAHAM
I M.Sc. NURSING
MEDICAL SURGICAL NURSING
(2011-2013 BATCH)
FORTIS INSTITUTE OF NURSING
#20/5, YELACHENAHALLI, KANAKAPURA ROAD
BANGALORE-560078
SYNOPSIS FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
NAME OF THE
Ms. ANUPA SUSAN ABRAHAM,
CANDIDATE AND
1ST YEAR M.Sc. NURSING,
ADDRESS
FORTIS INSTITUTE OF NURSING,
#20/5, YELACHANAHALLI,
KANAKAPURA ROAD,
BANGALORE-560078.
2.
3.
NAME OF THE
FORTIS INSTITUTE OF NURSING,
INSTITUTION
BANGALORE.
COURSE OF STUDY
MASTERS DEGREE IN NURSING,
AND SUBJECT
MEDICAL AND SURGICAL
NURSING.
4.
DATE OF
31st MAY 2011
ADMISSION
5.
TITLE OF THE
A STUDY TO ASSESS THE
TOPIC
EFFECTIVENESS OF VIDEO
ASSISSTED TEACHING
PROGRAMME ON KNOWLEDGE
OF STAFF NURSES REGARDING
POST OPERATIVE
MANAGEMENT OF PATIENTS
WITH VALVE REPLACEMENT
SURGERY AT SELECTED
HOSPITALS, BANGALORE.
1
6.0 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION:
''Cardio vascular nurses and their patients create a tapestry together
and there are no neutral events in nursing.''
Cathie E. L. Babara D.
The heart is a cone shaped organ, and is relatively small, roughly
the same size as a closed fist-about 12cm (5 in) long, 9cm (3.5in) wide at
its broadest point, and 6cm (2.5 in) thick. Its mass average 250g in adult
females and 300g in adult males. The heart lies in the mediastinum, a
mass of tissue that extends from the sternum to the vertebral Colum
between the lungs.1
The valve of the heart control the flow of blood through the heart
into the pulmonary artery and aorta by opening and closing in response to
the blood pressure changes as the heart contracts and relaxes through the
cardiac cycle.2
Valvular dysfunction occurs when the heart valves cannot fully
open and fully close. A stenosed valve may impede the flow of blood
from one chamber to the next; an insufficient (incompetent) valve may
allow blood to regurgitate (flow backward).3
Valvular heart disease can be either stenotic or regurgitant diseased
cardiac valve that restrict the forward flow of blood and unable to open
fully are referred to be as stenotic cardiac valves that close incompetently
and permit the backward flow of blood are referred to be as regurgitate or
incompetent.4
Diseases of the heart valves include a diverse group of acquired
and congenital lesions. Some of these occur in isolation and other occurs
in association with other heart diseases. Deformed cardiac valves may
2
cause disease by two major mechanisms. First, they impose a major
hemodynamic burden on the cardiac chambers by causing obstruction
(stenosis) or regurgitation (incompetence) or sometimes a combination of
two. Second, the abnormal valves are more susceptible to infection and
thus predispose patients to infective endocarditic and its many
complications with the possible exception of infective endocarditic and
carcinoid heart disease, lesions of the tricuspid and pulmonic valves are
much less common. Major causes of acquired heart valve disease include
mitral valve stenosis mitral regurgitation, aortic stenosis or aortic
regurgitation.5
In Asia, there are more than 12 million people are affected by
rheumatic heart diseases and there are more than 40,000 deaths annually.
This shows the increased burden of valvular heart disease in Asian
countries.6
In India the prevalence of valvular heart disease varies from
1-5.4/1000. The major cause for this is rheumatic heart disease. A
prevalence of 21/10,000 is the estimated statistical data. The incidence
varies from 0.2 to 0.75 per 1000 per year.7
The incidence of mitral valvular disease is 50-60% of all cases,
aortic valvular disease 10%, pulmonic valvular disease 1% and combined
mitral and aortic valvular diseases are 20% of all cases.8
The total annual mortality due to valve disease in world is
approximately 20,000 patients/year. This mortality is predominantly
related to aortic valve disease i.e. 12,000/year with the remaining related
to mitral valve disease.9
The patients who are undergoing valve replacement surgery require
support from a specialist. Surgery can affect the long term outcome of the
patients, but quality of life and benefits from the surgery is likely to be
enhanced by effective patient education. Nurses are considered as the
3
heart of the health care institution. So they have a major role in the
educating the patients about their condition. Nurse teaches all patients
with valvular heart disease about the diagnosis, the progressive nature of
valvular heart disease, and the treatment plan. The patient is taught that
the infection agent, usually a bacterium, is able to adhere to the diseased
heart valve more readily than to a normal valve. The nurse collaborates
with the patient to develop a medication schedule and teaches about the
name, action, side effects and any drug-drug or drug-food interactions of
the prescribed medications for heart failure, dysrhythmias, angina
pectoris, or other symptoms. The nurse teaches the patient about the
procedures and anticipated recovery.13
6.1 NEED FOR THE STUDY:
The heart contains two atrio-ventricular valves, the mitral and
tricuspid, and two semilunar valves, the aortic and the pulmonic which
are located in four strategic locations to control unidirectional blood flow.
Types of valvular heart disease are defined according to the valve or
valves affected and the two types of functional alteration, stenosis and
regurgitation.10
Valvular heart disease mainly results from rheumatic fever.
Rheumatic fever is a preventable disease, but the combination of a lack of
resources, lack of infrastructure, political, social and economic instability,
poverty, overcrowding, malnutrition and lack of political will contributes
to the persistence of a high burden of rheumatic fever, rheumatic VHDs
and infective endocarditic. 9
Significant valvular heart disease includes mitral or aortic stenosis
severity, moderate or severe mitral regurgitation, moderate or severe
aortic regurgitation and moderate or severe tricuspid regurgitation. Mitral
4
regurgitation and aortic regurgitation are the most frequent valve
diseases. Valvular disease is higher in individuals; with mitral
regurgitation and aortic regurgitation as the most frequent valve disease
(49% and 28% respectively). The left ventricular (LV) dimensions
Function and the presence and severity of heart valvular disease is
evaluated
by
echocardiography.
Aortic
regurgitation
(AR)
is
characterized by diastolic reflux of blood from the aorta into the left
ventricle (LV). Acute AR typically causes severe pulmonary edema and
hypotension and is a surgical emergency. Chronic severe AR causes
combined LV volume and pressure overload. It is accompanied by
systolic hypertension and wide pulse pressure, which account for
peripheral physical findings, such as bounding pulses.9
More than 30,000 patients currently undergo surgery for acquired
valvular heart disease in Germany each year, of whom nearly 17,000
have disease of a single valve, more than 3000 have disease of two or
three valves, and roughly 12,000 undergo a valvular procedure in
combination with an aortocoronary bypass operation. The aortic and
mitral valves are the more commonly affected ones; the pulmonary valve,
in contrast, is affected almost exclusively by congenital diseases, which
will not be discussed in this article. Surgical procedures on the tricuspid
valve are also rare, accounting for only 2.6% of the isolated, single-valve
operations performed in 2007.10
When a prosthetic valve is implanted, close follow-up is required
to assess the hemodynamic status, proper valve function and potential
complication. Close monitoring of
anticoagulant therapy is needed for
mechanical valve cases.11
5
After the implantation of a prosthetic valve, the expected
complications of chronic and uncorrected valve disease are exchanged for
those associated with the prosthetic valve. Complications after valve
replacement include thromboembolic bleeding, ventricular failure,
pulmonic
hypertension,
sudden
death,
arrhythmias
conduction
abnormalities, mechanical complications, and infective endocarditis.
Infections of prosthetic heart valve are a very serious complication (0-1 2.3% per patient year).
If the implanted cardiac valve doesn't work well for whatever
reason, the clinical situation is termed dysfunction (malfunction) of the
implanted valve. Dysfunctions include mechanical dysfunctions of the
implanted valve due to defects and wear of material or failure of valve
mechanism. The mechanical dysfunction can occur due to extrinsic or
intrinsic factors. So close monitoring of the hemodynamic status is
essential during the post operative period.12
The health care nurse has a key role in teaching, assessing and
caring for patients who are in the post- operative period she familiarizes.
The client and family with the critical care environment and demonstrates
them how to splint the chest incision, cough, deep breath and perform
exercise.9
Nursing care continues as for most post- operative patients
including incision care, the patient teaching including diet, activity
medications and self care. The nurse educates the patient about long term
anticoagulant therapy, explaining the need for frequent follow up
appointments and blood laboratory studies and provides teaching about
prescribed medications.13
6
It is felt that a structured teaching programme can be more useful
to improve the knowledge of nurses regarding the post- operative
management of patient with heart valve replacement surgery.
A study was conducted by Massha Anees, about the management
of heart valvular disease, and the total number of samples selected are 45
patients hospitalized at Punjab institute of cardiology, Lahore were
studied during the month of June, 2010, results: About 37.85% of patients
are diagnosed with VHD and accounts for 60% of total patient
population. It reveals that most of the patients are diagnosed during the
age of 21-40 years (37.8%), 28.90% of upto 20 years and 33.30% were
diagnosed at age above 40 years and 60% of patients diagnosed are male.
It depicts that in most of the valve replacement cases, Mechanical valve
(91.1%) is used. The valve which is mostly at risk is mitral valve (46.7%)
followed by DVR 28.9% aortic valve (22.22%) and tricuspid valve
(2.22%) Around 40% of patients with Rheumatic heart disease suffer
from VHD whereas infective endocarditis affects 11.1% of patients, MVP
4.4% and congenital cases admitted to hospital are 2.2%.9
Learning is better when more sense organs are utilized. Video is a
versatile education vehicle which stimulates and reinforces ideas beliefs
and tendencies through sight and sound together which makes the
experience real, concrete and immediate.14
This implies the effectiveness of video assisted teaching in
imparting the knowledge. So it is felt that video assisted teaching
programme regarding the post- operative management of heart valve
replacement surgery will improve their knowledge so that they can render
high quality nursing care to the patient after heart valve replacement
surgery.
7
Further during the clinical experience, the investigator observed
that due to inadequate care, the patients after heart valve replacement
surgery developed post -operative complications and had prolonged
hospital stay. Hence the investigator felt the need to develop a video
assisted teaching programme regarding the post operative management of
patient with heart valve replacement surgery to improve the knowledge of
staff nurses.
8
6.2 REVIEW OF LITERATURE
A review of literature on the research topic makes the researcher
familiar with the existing studies and provides information which helps to
focus on a particular problem, lays a foundation upon which to base new
knowledge. It creates accurate picture of the information found on the
subject.
6.2.1
Review related to post operative management of heart valve
replacement surgery.
6.2.2
6.2.1
Review related video assisted teaching.
REVIEW
RELATED
TO
POST
OPERATIVE
MANAGEMENT OF HEART VALVE REPLACEMENT
SURGERY.
A study conducted by Edward M B and Taylor K M on valve
replacement surgery in the UK (1986 -1997) by UK heart valve Registry.
The UKHVR is a computerized data based collecting prospective data on
VR surgery in all UK cardiac units and all patients are tracked by natural
agencies who registry all death of UK .Results showed that from January
1st to December 31st 1997,a total of 58,195 patients underwent first time
valve replacement surgery and received 63.649 valves . Mean age at
operation in 1986 was 58.7 years (range 18 – 87 years) and this rose to
64.7 years (range 18 - 94years) in 1997. Majority of patient received a
mechanical valve within this group the number of
bileaflet valve
implants increase since 1986 and there is a reversal in the down ward
trend in pericardial valves implanted in 1993.Follow up was 96.1%
complete, with a total of 342.993 patients – years. Mortality (30 days) fell
from 6.9% in 1995 but increase to 6.7% in the 2 years to 1997. Actuarial
survival at 1, 5 and 10 years was 89.5%, 78.85% and 61.8% respectively,
9
confidence intervals of 0.5% reflects the enormity of the data base and
quality of the data.20
A retrospective study was conducted on cardiothoracic surgeon
regarding management of post operative cardiac critical care at John
Hopkins hospital, from January 2007, to Feb 2009. The results were
compared using a 2 sample't' test and 2-tiled fisher exact test. And the
cardio thoracic surgeons provides postoperative critical care led to a mean
(SD) decrease in hospital length of stay from 13.4 (0.9) to 11.2(0.04) days
(P<0.0001). These improvements occurred without losing benefits in
other quality measures.
Cardio thoracic surgeons may be clinically
qualified to provide post operative cardiac critical / care in a semi closed
unit.21
A study conducted by department of surgery, university of Virginia
health system USA regarding surgical care improvement –study used
quality improvement measures. In 2006, the surgical care improvement
project (SCIP) developed out of the STP project and its process measures.
The result showed seven of the SCIP initiatives apply to the perioperative period and prophylactic antibiotics should be received within 1
hour prior to surgical incision , be selected for activity against the most
probable antimicrobial contaminants and be discontinued within 24 h
after the surgery end-time .Euglycemia should be maintained, with wellcontrolled morning blood glucose concentrations on the first two postoperative days especially in cardiac Surgery patients, hair at the surgical
site should be removed with clippers or by depilatory methods, not with a
blade ,urinary catheters are to be removed within the first two postoperative days and normothermia should be maintained peri -operatively.
Study concluded there is strong evidence that implementation of
protocols that standardize practices reduce the risk of surgical infection.22
10
Sheffers J M,Schuikers N conducted a study on ambulatory post
operative care of patients following coronary artery bypass and valve
replacement surgery on patients who are seen for medical follow-up after
coronary artery bypass graft (CABG) / valve replacement surgery. This
study as a summary of the comparison of the surgical post operative
problems and potential significant complications. In addition, as an aid to
simplify and direct outpatient post-operative care, they present an
algorithm which addresses the expected clinical features of post-operative
patients, recommended routine follow-up diagnostic tests, signs,
symptoms and appropriate screening procedures for significant postoperative complications and recommendations for rehabilitation and risk
factor management. This approach is designed to enable the practitioner
to address these complex patients with confidence and to assist them with
positive lifestyle adaptations and risk factor reduction and to predict and
prevent significant post-operative complications.23
A study conducted on risk profile and outcomes of aortic valve
replacement in 273 octogenarian that underwent aortic valve replacement
by Sujatha Kesavan. The aim of the study to include the patient,
relationship.The result showed logistic Euro score (LES) was collected to
characterize the predicated operative risk. Two groups were defined LES
≥ 15(n-80) and Les < (n-193) in pts with LES ≥ 15, 30d mortality was
(14%) (95% cl; 7%-23%) compared with 4% (95%cl: 2%-8%) In the LES
< 15 group ( P< 0.007) despite the increase in number of operation from
1996 to 2008, the average LES did not change, only 5% of patients had
prior bypass surgery the LES identified a Low risk qualities of patient
with very low mortality ( 4%,n-8, p<0.007) at 36d. The overall surgical
results for octogenarian were excellent. The low risk group had an
excellent outcome and the high risk had a poor outcome after surgical
11
aortic valve replacement. It may be the treatment with transcatheter aortic
valve implantation.24
6.2.3 REVIEW RELATED TO VIDEO –ASSISSTED TEACHING
Kumar mahendra conducted a study on 60 staff nurses to assess the
effectiveness of video assisted teaching on needle strick injury regarding
knowledge and attitude of staff nurses working in selected hospital in
Hassan on November 2002.The research design is quasi-experiment with
pre test and post test. The result showed the overall post test mean
percentage of knowledge and attitude was higher in experiment group
than in control group and 't' value were knowledge (t=26.67at p<0.001)
after administration of video assisted teaching the scores of knowledge
(88%) and attitude (83.20%) increased significantly. There was no
association between knowledge and attitude level with selected
demographic variables. The Independent‘t’ value (knowledge= 26.67,
attitude= 16.32) was greater than table value at p<0.001 level of
significance. The finding signifies that the video assisted teaching was
effective to enhance the knowledge and to mould attitude of staff nurses
Overall mean knowledge scores (pre test=13.53, post test= 26.66) and
mean attitude scores are (pre test= 43.39, post- test= 74.92). Knowledge
(43.90%) and attitude (54.60%) scores of staff nurses were less before
administration of video assisted teaching.25
6.3 STATEMENT OF THE PROBLEM
A STUDY TO ASSESS THE EFFECTIVENESS OF
VIDEO
ASSISTED TEACHING PROGRAMME ON KNOWLEDGE OF
STAFF NURSES REGARDING POST OPERATIVE MANAGEMENT
OF PATIENTS WITH VALVE REPLACEMENT SURGERY AT
SELECTED HOSPITALS, BANGLORE.
12
6.4 OBJECTIVES OF THE STUDY
1. To assess the demographic profile of staff nurses.
2. To assess the knowledge of staff nurses regarding post operative
management of heart valve replacement surgery.
3. To find out the effectiveness of video assisted teaching programme on
knowledge regarding post operative management of heart valve
replacement surgery.
4. To associate the post test knowledge of score of staff nurses regarding
post operative management of heart valve surgery.
6.5 OPERATIONAL DEFINITION
6.5.1 ASSESS:
In the present study assess refers to,' measure the knowledge of the
staff nurses regarding the post operative management of heart valve
replacement surgery.
6.5.2 EFFECTIVENESS:
In the present study effectiveness Refers to, 'again of knowledge of
staff nurses regarding the post operative management of patients with
heart valve replacement surgery as determined by significant difference
in pre and post test knowledge score.
6.5.3 VIDEO ASSISTED TEACHING PROGRAMME:
A system of recording and reproducing moving visual images
using magnetic tape are used to communicate with and see each other to a
group of people. In this study teaching with video shall be done upon
post operative management of heart valve replacement surgery.
13
6.5.4 KNOWLEDGE:
In the present study, 'the correct response from the staff nurses
regarding the post operative management of patient with heart valve
replacement surgery as
observed from score based on closed ended
questionnaire.
6.5.5 POST OPERATIVE MANAGEMENT:
Defined as the nursing interventions provided by nurses to the
patients after heart valve surgery which involves respiratory care,
hemodynamic monitoring, maintaining fluid –electrolyte, care of chest
drainage, administration of medications, wound care, nutrition, exercise,
prevention of complications and patient education.
6.5.6 HEART VALVE REPLACEMENT SURGERY:
It is defined as the surgical procedure in which the diseased heart
valve (mitral valve, tricuspid valve, aortic valve or pulmonary valve) is
replaced with a prosthetic valve.
6.5.7 STAFF NURSE:
A person who has successfully completed either the diploma or
Baccalaureate programme in nursing and working as a staff nurse.
6.6 HYPOTHESES:
H0: There is no significant difference between pre and post- test
knowledge score of staff nurses regarding post operative
management of heart valve replacement surgery.
H0.1: There is no significant association between the post test knowledge
score of post operative management of heart.
14
H1.1: There is a significant difference between pre and post test
knowledge score of post operative management of heart valve
replacement surgery.
H1.2: There is a significant association between post test knowledge score
of post operative management of heart valve replacement surgery
and selected demographic variables
6.7 VARIABLES IN THE STUDY:
Independent variable:
Video assisted teaching programme regarding the post operative
management of patient with heart valve replacement surgery.
Dependent variable:
Knowledge of staff nurses regarding the post operative
management of patient with heart valve replacement surgery.
Demographic variables:
Age, sex education qualification, income of staff nurses, Years of
professional experience of staff nurses, area of residence, source of
information.
7.0 MATERIALS AND METHODS
7.1.1 Source of data
:
Staff nurses in selected hospitals in
Bangalore
7.1.2Research approach:
An experimental research approach
7.1.3 Research design :
A quasi-experimental design with one
group pre test and post-test.
7.1.4 Research settings :
Selected hospitals, Bangalore.
15
: Population of study includes staff
7.1.5 Population
nurses.
7.1.6 Sampling technique : Purposive sampling technique
: 60
7.1.7 Sample size
7.1.8 Sampling criteria
7.1.9Inclusioncriteria: Staff nurses who are willing to participate
in this study.
: Staff nurses who are available during the
period of data
collection
: Staff nurses who completed in any one of
the formal basic education in nursing.
7.2 Exclusion criteria: Staff nurses who are not available at the
time.
7.2.1 TOOL FOR DATA COLLECTION:
Data collection tool contain items on the following aspects.
PART 1- contains the items of demographic characteristics of staff
nurses comprising of age, sex, education qualification, and income of
staff nurses, years of professional experience of staff nurses, area of
residence, source of information.
PART 2- Knowledge assessment questionnaire regarding post operative
management heart valve replacement surgery
7.2.2 METHOD OF DATA COLLECTION
The data will be collected personally using structured questionnaire
on knowledge of staff nurses regarding post operative management of
heart valve replacement surgery.
16
7.2.3 METHOD OF DATA ANALYSIS:
The investigator will analyse the data obtained, by using
descriptive and inferential statistics. The plan of data analysis as follows.
DESCRIPTIVE STATISTICS:
Mean, mean %, median and standard deviation will be used.
INFERENTIAL STATISTICS:
 Student paired t-test will be used for measuring the significant
mean difference between pre and post-test knowledge.
 Chi square (2) test for measuring association level of knowledge
and selected demographic variables.
7.3
DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTION TO BE CONDUCTED ON OTHER
HUMAN OR ANIMALS?
Yes, the knowledge of staff nurses on post operative management
of heart valve replacement will be assessed by using self
administered questionnaire
7.3.1 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM
THE INSTITUTION
1. The ethical clearance is obtained from the research committee
of Fortis institute of nursing.
2. Written permission will be obtained from concerned authorities
of selected hospitals.
3. Written permission will be obtained from the sample who is
involved in the study before collecting the data.
17
7.3.2 LIST OF REFERENCESES:
1. Tortora,
Grabowski.
Principles
of
anatomy
and
physiology.10th ed.USA: Churchill Livingstone; 2003. P.660.
2. Basavanthappa B T. Medical surgical Nursing. 1st ed. New
Delhi: Japee brother; 2003. P. 409-13.
3. Black Joyce M. Medical surgical nursing. 7th ed. vol 1.
Elsevier; 2005. P.1231-2.
4. Levison G E .Medical surgical nursing.7th ed. Indian: Elsevier;
2011. P.747.
5. Khawaja tahir mahmood, Mashal anees, Ayesha asghar.
Valvular heart disease.2011; 3(1): 315-21. Available at:
URL:Jbsr.pharmainfo.in/document/vol 3issue/2011030163.pdf
6. Ronald .professional guide to heart diseases. 8th ed.
Philadelphia: Lippincott publishers; p 640- 46.
7. WHO statistics (2011)
8. Luckmann J, Sorensen C K. Text book of medical surgical
Nursing.5th ed. Philadelphian: Lippincott publishers; 2003 .p
.412-16.
9. Donaldm, Lloyd jone. Heart disease and stroke statistic.
Journal of the American Heart Association; 2011.
30-36
URL:Circ.ahajournals.org/content/ 123/4/e18.full.pdf
10.Revolts J M.Performance of the lonescu-shiley pericardial
valve in the aortic position: 100 months clinical experience.
The Journal of Thoracic and Cardiovascular surgery.2006.
247-51
11.Gerard. Valvular Heart Diseases. 1st ed. Jones and Barlett;
2005 p 137-41
12. Lord c. Patients with mechanical valve-role of nurse current
perspective. American journal of nursing; 2006. P 64-68
18
13.Suzanne C S, Brenda G B. Text book of medical surgical
nursing. 10th ed. Philadelphia: Lippincott Williams and
Wilkins Company; 2004. P. 533- 48.
14.Neeraja K.P. Text book of nursing Education. 1st ed. New
Delhi: jaypee publishers; 2005.p 196-198
15.Ankur kapoor. Heart valvular replacement. National Bureau of
Health
intelligence;
2007.p198-99
Available
at:
URL:www.heart-valve-surgery.com/surgeon.../surgeon
16.Denise F Polit, Nursing research principles and methods.
7th
ed. Philadelphia: Lippincott; 2004. P 4
17.Berg.W.D. Knowledge of nurses regarding management of
heart valve surgery patient. Journal of Cardio Vascular
Nursing 138(3); 2006.
18.Sung.j, wong.K. Effect of a Teaching program on knowledge
and compliance of cardiac patients, Heart and lungs,
September/October-volume 28-issue 5; 2008. 67-71.
19.Edward M B, Taylor K M. valve replacement surgery in u.k. J
Heart valve Dis, 1999 Nov; 8(6): 697-701. Available at: URL:
www.ncbi.nih.gov/pubmed?term=PMID%3A%2010616250
20.Whitman GJ, Haddad M, Hirose H, Allen JG, Lusardi M,
Murphy
MA.Cardiothoracic
surgeon
management
of
postoperative cardiac critical care. Arch Surg. 2011 Nov; 146
(11):1253-60.available
at:
URL:
www.ncbi.nih.gov/pubmed?term=PMID%3A%2022106316.
21.Rosenbergee L H, Politano A D, Sawyer R G. Surgical care
improvement. Surg Infect (Larchme). 2001 June; 12(3): 163-8.
Available
at:
19
URL:www.ncbi.nlm.nih.gov/pubmed?term=PMID%3A%202
1767148%20%20
22.Sheffers J M,Schuikers N. Ambulatory post operative care of
patients following coronary artery bypass and valve
replacement surgery. Prog Cardiovasc Nurs. 1991 Jan-Mar;
6(1):
3-12.
Available
at:
URL:www.ncbi.nlm.nih.gov/pubmed?term=PMID%3A%201
852755%20%20
23.Kesavan S, Khan Iqbal A, Hutter J, Pike K, Rogers C, Tumer
M, etal,. Risk profile and outcomes of aortic valve
replacement. World J Cardiol. 2011 Nov 26; 3(11):359-66.
Available at URL: www.ncbi.nlm.nih.gov/pubmed?term.
24.Kumar Mahendra. Video assisted teaching on needle stick
injury. International Journal of Nursing Education. 2010 July
1;
2(2):
25-7.
Available
at:
URL:
www.library.nhs.uk/booksandjournalls/details.aspx?t=staff+n
urses&stfo=True&sc=bnj.ovi.bnia,bnj.ebs.cinahl,bnj.ovi.emez
,bnj.ebs.heh,bnj.ovi.hmie.pub.
20
9 SIGNATURE OF
Ms. ANUPA SUSAN ABRAHAM
THE CANDIDATE
10 REMARKS OF
THE GUIDE
Study is feasible; the design structured
teaching program helps to improve the
knowledge of staff nurses regarding
management of patients undergoing valve
replacement surgery.
11 NAME AND
DESIGNATION
OF
11.1 THE GUIDE
11.2 SIGNATURE
Mr. PRABHUSWAMY A C.
ASSOCIATE PROFESSOR
Mr. PRABHUSWAMY A C.
11.3 CO-GUIDE
Prof. SHRIDHAR K V.
11.4 SIGNATURE
Prof. SHRIDHAR K V.
11.5 HEAD OF THE
Prof. SHRIDHAR K V.
DEPARTMENT
11.6 SIGNATURE
REMARKS OF
12 THE PRINCIPAL
Prof. SHRIDHAR K V.
Study is feasible; the design structured
teaching program helps to improve the
knowledge of staff nurses regarding
management of patients undergoing valve
replacement surgery.
12.1 SIGNATURE
Prof. SHRIDHAR K V.
21