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A Pre-Experimental Study to Evaluate the Effect of ICU Prophylaxis Program in Improving the Knowledge, Practices Related to Pressure Ulcers and Deep Vein Thrombosis in Spinal Cord Injury Patients and its Acceptability by the Nurses in a Tertiary Care Facility

Good nursing care is a key factor in reducing the most common complications related to immobility like pressure ulcers (PU), deep vein thrombosis (DVT) in spinal cord injury (SCI) patients. Materials and methods: The study was conducted using a pre-experimental, time series design on 52 nurses and 73 patients with SCI (30 before and 43 after the intervention) enrolled by universal sampling technique in a trauma ICU of a tertiary care facility to evaluate the effectiveness of ICU Prophylaxis Programme (IPP) in terms of knowledge, practices related to PU and DVT in SCI patients and its acceptability by the nurses. Pretested and validated tools were used to collect the data. Occurrence of the PU and DVT were assessed among the admitted SCI patients during the study period as secondary outcome. Results: There was signifi cant improvement in knowledge scores of nurses (in post-test 1) following the implementation of IPP in PU (12.87 ± 2.37 vs. 16.23 ± 1.60, p < 0.001) and DVT (12.90 ± 2.30 vs. 17.08 ± 1.49, p < 0.001), however slight reduction in knowledge scores was observed on 15th day (post -test 2) in PU (15.77 ± 1.88, p ≥ 0.269) and DVT (16.29 ± 1.80, p ≥ 0.219) as compared to post-test 1. There was also signifi cant improvement in practice scores of nurses following the implementation of IPP in PU (6.23 ± 1.57 vs. 8.44 ± 1.046, p < 0.001) and in DVT (1.55 ± 1.17 vs. 8.21 ± 1.28, p < 0.001) on 15th day. Majority of nurses (84.6%) expressed moderate acceptability towards the IPP. The occurrence of the PU reduced from 16.6% to 4.6% after IPP and the use of mechanical prophylaxis for the prevention of DVT increased. Conclusion: IPP improved the knowledge and practice scores of the nurses in PU and DVT and reduced the occurrence of PU among SCI patients and increased the use of mechanical prophylaxis for prevention of DVT among admitted SCI patients. Research Article A Pre-Experimental Study to Evaluate the Effect of ICU Prophylaxis Program in Improving the Knowledge, Practices Related to Pressure Ulcers and Deep Vein Thrombosis in Spinal Cord Injury Patients and its Acceptability by the Nurses in a Tertiary Care Facility Toseef M RN1, Joshi P RN2* and Sinha S3 1Nursing Offi cer, Department of Cardiology and Cardiothoracic Sciences Centre, India 2Lecturer, College of Nursing, All India Institute of Medical Sciences, New Delhi, India 3Professor, Department of Neurosurgery, India Dates: Received: 08 March, 2017; Accepted: 22 March, 2017; Published: 23 March, 2017 *Corresponding author: Poonam Joshi, Doctor, Lecturer, College of Nursing, All India Institute of Medical Sciences, New Delhi, India, Tel: +91-11-2659 4457; Fax: +91-112658 8663; 2658 8641; E-mail:

Some available research studies suggested the effi cacy of the clinical educational programme and workshops [1][2][3], in enhancing the knowledge and practices of nurses and reduced the occurrence of PU and DVT among trauma patients, thus improved the outcome of critically ill patients [4][5][6][7][8][9].
Therefore the present study was conceptualized to evaluate the effectiveness of IPP in terms of knowledge, practices, and acceptability of the nurses and occurrence of PU and DVT among patients with SCI.

Methodology
In a pre-experimental (one group pre-test post-test),time series design, effectiveness of IPP was assessed among 52 nurses in terms of knowledge scores before, immediately after and on 15th day following the IPP. Practice scores of the nurses were assessed as baseline and on 15th day following the intervention. Acceptability of IPP by nurses was assessed at the end of the programme. As secondary outcome, development and severity of PU and DVT was assessed in patients with SCI.
Ethical clearance was obtained from the institute ethics committee. Written informed consent was taken from the nurses and the relatives of the patients with SCI admitted in TICU after ensuring them about the confi dentiality of the obtained information. Total seventy three patients with SCI [30 before (group I) and 43 after (group II) IPP], having age more than 18 years, hemo-dynamically stable and having stay in ICU for more than 48 hours were included. Patients with SCI with poly-trauma were excluded. Total 52 available nurses during the study were enrolled using universal sampling technique.

Data analysis
All the data were coded and entered in the Microsoft excel 2013 and all the entries were checked for any errors. SPSS 16 and STATA 12.1 were used for statistical analysis. Data were analysed using descriptive and inferential statistics.    (Table 4). The IPP was moderately acceptable to majority of nurses (84%) ( Table 5).

Discussion
Major fi ndings of the study revealed that majority of nurses working in TICU did not attend any in-service education Present study is one of its kind in which IPP was taught to the nurses in a small group, and their doubts were cleared.   Supervision and reinforcement of the IPP was ensured in the unit by the researcher with the ward in-charge. Our study has certain limitations. The small sample size, single center study and absence of control group of nurses limit the generalizability of the fi ndings. There is need to assess the long term effect of the IPP in terms of reduction in occurrence of PU and DVT.
The study can be replicated using large sample size in different setting and the effectiveness of IPP can be tried on bedridden unconscious with head injury, stroke, encephalopathy patients etc. The developed IPP for patients with SCI can be used to teach the nurses at pre-service and in-service level so that they could perform risk assessment, practice preventive measures and manage PU and DVT in a systematic manner.

Conclusion
IPP improved the knowledge and practice scores of the nurses in PU and DVT and reduced the occurrence of PU among SCI patients and the use of mechanical prophylaxis by the nurses on patients with SCI for preventing DVT increased.