• Mr. NANDEESHA M.K
• GURUPRASAD T R

ABSTRACT Statement of the Problem: “A study to evaluate the effectiveness of Structured Teaching Programme (STP) regarding Rehabilitative Measures of Lower Limb Amputation among Staff nurses working at selected in hospitals in Bengaluru. Back ground: Most of us are born as whole complete human beings. Mind and body is connected through nerves, muscles and bone. Unfortunately this system is torn apart by disease or accidents 1. . In olden days, people used to cut the body parts as a punishment for crime. Later for some years they were surrendering their body parts as apology. Now cutting a part or organ is used as treatment. Although medical advances in antibiotics, trauma care, vascular surgery and the treatment for neoplasm have improved the prospects for limb salvage, in many cases prolonged attempts to save a limb that should be amputated lead to excessive morbidity or even death. Amputation is one of the oldest operations which refer to the removal of leg, foot, hand, toes, fingers or any body part from the body. In most of the time, the parts removed are lower extremities. Amputation can be done either by surgery or they occur by accident (auto amputation). Reason of having amputation are progressive peripheral vascular disease such as Diabetic foot and Raynauds disease, severe trauma to the limb such as crush injuries, Infection that do not go away or become worse which cannot be controlled or healed like gas gangrene, any tumor of the limb like cancerous bone, soft tissue trauma, severe burns or frostbite, any deformities of digits, Amputation in vitro like amniotic band and others. In some situation it is related to the mistakes done by doctors or other medical professionals including surgical errors, negligence, failure to diagnose or misdiagnosis. Amputation is a major blow to anyone both physically and physiologically. Loss of limb produces a permanent disability that can impact patient’s self image, self care and mobility or it affects all areas of patient’s life. It is like losing a relative and it takes time to adopt for change. In certain situation, patient experience psychological or emotional problems. Nearly 50- 80% of patients experience a phenomenon of phantom limb sensation that is they feel body parts that are no longer there. A phenomenon explains that the portion of brain responsible for processing stimulation from amputated limbs. The common complications after amputation are phantom limb sensation, delayed wound healing, folliculitis, post operative edema, joint contracture and wound breakdown. The severity of effect depends on extent of surgery. If the procedure is minor, then patient adjust to situation without struggle, if it is major, then consequences are severe. Amputation is mainly performed in two ways. In Open or guillotine amputation surgeon does not close the stump with skin flap, but leaves it open allowing the wound to drain freely. In closed or flap amputation surgeon closes or covers the stump with a flap of skin sutured over the end of stump. Other modes of amputation are below knee amputation, above knee amputation, knee bearing amputation, rotationplasty, hip disarticulation, hemi pelvectomy, partial foot amputation and ankle disarticulation. A survey on nature and incidence of major complications after lower limb amputation says that among all admissions 5.4% of patients were undergoing amputation. Out of that 24.8% are facing complications like infection, dehiscence, and non union of leg and wound necrosis. They concluded that patients with amputation can expect a significant number of complications. The success of rehabilitation depends on how many variables including level and type of amputation, degree of any resulting impairment and disabilities, overall health of patient and family support. The goal of rehabilitation after an amputation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life physically, emotionally and socially. Evidence suggests that patients who received acute post operative inpatient rehabilitation compared to those who didn’t get inpatient rehabilitation had an increased likelihood of one year survival and home discharge. Results support that early post operative inpatient rehabilitation following amputation. Rehabilitation teaches the ambulation skills mainly exercises to improve the general condition and balance, to stretch the hip and knee, strengthen extremities and help patient tolerate the prosthesis, because ambulation requires 10-40% increase in energy expenditure after below knee amputation and 60-100% after above knee amputation. It also helps to prevent secondary disabilities. A total of 57 studies were selected to predict walking ability following lower limb amputation. They found cognition, fitness, ability to stand on one leg, independence in activities of daily living and pre operative mobility were important predicting factors of good walking ability. Longer time from surgery to rehabilitation and stump problems were predictors of poor outcome. Among all health professionals, staff nurses are in crucial place and helps in all the respective areas of rehabilitation right from surgical dressing till gait training. Care of stump is a challenging task and patient’s health has to be maintained through holistic approach. Clients stump made to fit with socket of prosthesis device and highly motivated to achieve independence in movements. Once it made ready ambulation training is given with new set up until a skillful automatic gait is developed. When the prosthesis is not worn, turning also requires re-adaptation in body balance. OBJECTIVES OF THE STUDY: 1) To assess the knowledge level of staff nurses about rehabilitative measures of lower limb amputation before the administration of STP. 2) To asses the knowledge level of staff nurses about rehabilitative measures of lower limb amputation after the administration of STP. 3) To evaluate the effectiveness of STP on knowledge level of staff nurses regarding rehabilitative measures of lower limb amputation. 4) To find out the association between knowledge scores of staff nurses with their selected socio demographic variables. HYPOTHESIS: H1 - There will be significant differences between pretest and posttest knowledge scores of staff nurses regarding rehabilitative measures of lower limb amputation after STP. H2 - There will be significant association between the knowledge scores with their selected socio demographic variables. ASSUMPTIONS: 1. The staff nurses may not have adequate knowledge about rehabilitation of lower limb amputation. 2. There will be an improvement in the knowledge level of staff nurses after the STP. 3. Structured Teaching Programme is an effective method of imparting knowledge to the staff nurses. OPERATIONAL DEFINITIONS: 1. Evaluate: It involves ascertain the difference between pretest and posttest scores with appropriate statistical methods. 2. Effectiveness: It refers to statistical measurement of difference between pretest and Posttest knowledge scores. 3. Structured Teaching Programme: It refers to systematically organized teaching strategy for duration of 45 minutes to 1 hour for staff nurses on rehabilitation of lower limb amputation by verbal interaction with the use of power point .It includes rehabilitation lower limb amputation towards limb prosthesis, exercise and prevention of complication 4. Lower limb amputation: It is the removal of a body extremity by trauma or surgery. It includes both above and below knee amputation. 5. Rehabilitative measures: They are the interventions designed to facilitate the process of recovery from an injury or illness to as normal condition as possible. 7. Staff nurses: It refers to nurses working in orthopedic department in selected hospitals, at Bengaluru. CONCEPTUAL FRAMEWORK OF THE STUDY: A concept is an abstract idea or mental image of a phenomena or reality. Conceptualization is a process of forming ideas, which utilized and forms conceptual framework for the development of research design. A framework is a basic structure supporting anything. It gives a clear picture for logical thinking, for systemic observation and interpreting the observed data. Polit and Hungler (1999) describes that a conceptual framework deals with abstractions that are assembled by the virtue of their relevance to a common theme. The most important purpose of theoretical framework is to communicate clearly the relationship of various concepts. It provides certain framework of reference for clinical practice, research and education. A conceptual framework or model is a basic structure or outline of abstract ideas that represents reality. Conceptual framework is a group of mental images or concepts that are related but relationship is not explicit. The conceptual framework for this study is based on “General Systems Theory”. General system theory serves as a model for viewing people as interacting with environment. This theory was first introduced by Ludwig Von Bertanlanffy in 1968. General system theory was meant to provide a common language and a set of common principles, to speak and learn from each other. A system is a set consisting of integrated, interacting parts that function as a whole (e.g. human beings). A system consist a set of interacting components with in a boundary that filters the type and rate of exchange with the environment. A system is a group of elements that interact with one another in order to achieve goal. System is composed of both structural and functional components. . Input Input in general system theory is the term for movement of matter of energy or information from the environment into the system. Input is the data collected during assessment of knowledge regarding Rehabilitative Measures of Lower Limb Amputation and it includes the data about the immediate environment. In this study, the input were characteristics/ socio demographic variables of Staff nurses and assessment of knowledge level Staff nurses on Rehabilitative Measures of Lower Limb Amputation. The knowledge was assessed and measured using questionnaire. Throughput Throughput is the process by which the system transforms, creates and organizes the input, resulting in a reorganization of the input. In this study throughput was preparation and development of tool and STP, content validity of the tool and STP, assessment of pretest on day 1, administration of STP and assessment of posttest on day 8. After the Assessment of knowledge on Rehabilitative Measures of Lower Limb Amputation among staff nurses, the researcher identifies the outcome; planned for research intervention and implementation. Throughput had processed and utilized the STP in the form of matter, energy and information. Output The end product of a system is to improve the knowledge of staff nurses on Rehabilitative Measures of Lower Limb Amputation. The system returns output to the environment in an altered state affecting the environment. Through the posttest, assess the knowledge of staff nurses after administering the STP. Output may be improved knowledge on Rehabilitative Measures of Lower Limb Amputation. If the knowledge level is found inadequate, rectification can be done by strengthening the knowledge through feedback which was not included in the study. Feedback In the present study feedback can be measured by output, which could be either improved knowledge on Rehabilitative Measures of Lower Limb Amputation or not. After the administration of STP on Rehabilitative Measures of Lower Limb Amputation, the developed STP will be considered useful for improving the knowledge of same. If the knowledge of staff nurses was not improved, then a feedback strategy on Rehabilitative Measures of Lower Limb Amputation education can be initiated and improved by the investigator. In this study feedback is not included. DELIMITATIONS: This study is delimited to; 1. 60 staff nurses working Fortis and Panacia hospitals in Bengaluru. 2. Prescribed data collection period was 4 weeks. 3. Pre experimental design (Single group pretest posttest design). SIGNIFICANCE OF THE STUDY: The study signifies the importance of Structured Teaching Programme on rehabilitation of lower limb amputation and it will enhance the knowledge of staff nurses regarding rehabilitative measures. It enables effective care to patients with lower limb amputation. METHODOLOGY Research methodology is a way of systematically solving the research problem. It is a science of studying how research is done scientifically. The methodology of research indicates the general pattern to gather valid and reliable data for the problem under investigation. Research methods are the steps, procedures and strategies for gathering and analyzing the data in research investigation. Research methodology refers to controlled investigations of the way of obtaining, organizing and analyzing the data. This chapter includes the description of research approach, research design, setting of the study, sampling technique, development of the tool, data collection technique and plan for data analysis. Section III: level of knowledge on Rehabilitative Measures of Lower Limb Amputation after the implementation of STP. Posttest knowledge scores on rehabilitative measures of lower limb amputation was analyzed by using mean and standard deviation. Section IV: comparison between the level of knowledge on Rehabilitative Measures of Lower Limb Amputation before and after the implementation of STP. Comparison of pretest and posttest mean knowledge scores was analyzed using student independent‘t’ test. Knowledge wise effectiveness of STP was analyzed using mean percentage. Section V: association between levels of knowledge of Rehabilitative Measures of Lower Limb Amputation with selected socio demographic variables. Association between demographic variables and knowledge gain score was analyzed using chi square test. Testing of hypothesis: Section A: Examining the effectiveness of STP on rehabilitative measures of lower limb amputation. Section B: Association of pretest level of knowledge scores of Staff nurses with selected demographic variables. Interpretation: 1. Distribution of age indicates that 43.3% of the staff nurses were in the age group of 23 years, 43.3% of them were 26 years and 13.3% of them were 24 years of age. 2. Distribution of gender shows that majority of the Nurses (N= 56) were females with 93.3% and 6.7% were males. 3. Distribution of religion reveals that majority of the Nurses (N=45) belongs to Christian religion with 75%, 20% of them were from Hindu religion and 5% of were in Muslim religion. 4. Distribution of place of residence that 51.7% of Nurses were from semi urban area, 30% of them were belongs to urban area and 18.3% of the samples resided in rural areas. 5. Distribution of educational status of father represents 43.3% of fathers got their higher secondary education, 26.7% got secondary school education, 13.3% were illiterate, 10% of fathers were graduates and 6.7% of them completed primary school. 6. Distribution of educational status of mother reveals that 45% of mothers had higher secondary education, 25% of were graduates, 25% of mothers completed secondary school education and 5% of them got only primary education. 7. Distribution of occupation of father depicts that 45% of fathers were agriculturists, 31.7% were depending on business, 13.3% were not having specific work and 10% of them were officials. 8. distribution of previous information about rehabilitation reveals that most of the nurses (N=33) got information in their probationary period with 55% , 40 % of them worked in 1st year,3.3% of nurses got information from other sources and 1.7% of them received information from workshop. 9. Distribution of exposure to mass media regarding rehabilitation shows that 40% of nurses read about rehabilitation in news paper, 38.3% of them didn’t get any exposure regarding the topic, 20% of them seen in television and 1.7% of them heard a programme in radio. 10. Distribution of previous experience explains that most of the nurses (N = 34) didn’t get any experience regarding rehabilitation, 41.7% of them got experience from their neighbors, where as 1.7% of nurses experienced in their family.

χ2:Chi Square test df : Degrees of Freedom ≥ : Greater than or equal to < : Lesser than S : Significant NS : Non-Significant N : Number of subjects P : Probability Value % : Percentage r : Reliability SD : Standard Deviation STP : Structured Teaching Programme

"“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP)REGARDINGREHABILITATIVE MEASURES OFLOWER LIMB AMPUTATION AMONG STAFF NURSES WORKING AT SELECTED HOSPITALS IN BENGALURU.”", International Journal of Emerging Technologies and Innovative Research (www.jetir.org), ISSN:2349-5162, Vol.11, Issue 1, page no.c303-c333, January-2024, Available :http://www.jetir.org/papers/JETIR2401232.pdf

"“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP)REGARDINGREHABILITATIVE MEASURES OFLOWER LIMB AMPUTATION AMONG STAFF NURSES WORKING AT SELECTED HOSPITALS IN BENGALURU.”", International Journal of Emerging Technologies and Innovative Research (www.jetir.org | UGC and issn Approved), ISSN:2349-5162, Vol.11, Issue 1, page no. ppc303-c333, January-2024, Available at : http://www.jetir.org/papers/JETIR2401232.pdf