RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE Ms. FREEDA. P. THOMAS

AND ADDRESS 1st YEAR, M.Sc. NURSING
BAPUJI COLLEGE OF NURSING,
DAVANGERE.

2. NAME OF THE BAPUJI COLLEGE OF NURSING,

INSTITUTION DAVANGERE.

3. COURSE OF STUDY AND DEGREE OF MASTER OF

SUBJECT NURSING
MEDICAL SURGICAL NURSING

4. DATE OF ADMISSION TO 12th JUNE 2009

COURSE

5. TITLE OF THE TOPIC “EFFECTIVENESS OF SELF

INSTRUCTIONAL MODULE ON
VARICOSE VEIN AND ITS
PREVENTION FOR OPERATION
THEATER NURSES IN
SELECTED HOSPITALS,
DAVANGERE.
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION

As the heart beats, it pumps blood through a system of blood vessels called the
circulatory system. The vessels are elastic tubes that carry blood to every part of the
body. Arteries carry blood away from the heart while veins return it. Vascular disease
includes any condition that affects the circulatory system.1

Many factors predispose human beings to venous disease of the lower extremities,
and this condition affects approximately eighty million Americans. Its manifestations
may appear to be little more than a cosmetic nuisance, yet may be an indication of a
more serious underlying problem undetected by visual inspection. Venous disease is
also capable of producing a plethora of uncomfortable symptoms, and left untreated,
may progress to cutaneous pigmentation, dermatitis, ulceration, hemorrhage, or
superficial thrombophlebitis. Although uncomplicated cases of the disease are more
common, venous disease should not be taken lightly. Steps to retard disease
expression and progression should be implemented whenever possible.2

Varicose vein is the most common type of vascular disease. Varicose veins are
dialated, tortuous, elongated superficial veins that are usually seen in the legs.
Superficial veins (saphenous vein) of the legs are most commonly affected.3

Varicose veins are a very common condition. Women tend to be more affected than
men, with approximately 30% of women developing varicose veins in their lifetime,
compared to 15% of men.4 15 to 20 % of population in India is suffering from
varicose vein.5

6.1 NEED FOR THE STUDY

Recent studies suggest that prolonged standing is associated with development of

varicose vein. Standing in one place for a long time increase venous pressure in the
legs and feet and weakens the blood vessel wall. Occupations that require prolonged
standing (eg: O T nurse) also results increase venous pressure.6 Prevention is a key
factor related to varicose veins.7

Varicose veins are a major vascular disease that affects more than 25 million adults in

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the United States.8 Because of high prevalence, varicose vein of the legs cause
considerable morbidity and loss of labour.9 It is estimated that 41% of all women will
suffer from abnormal leg veins by the time they are in the 50s.10 In a recent study, we
observed that operating theatre nurses, without any sign of CVI, who stand for
>90% of their working time, show high levels of venous pressure of the lower limbs.11

A large Danish population study found that prolonged standing or walking at

work was an independent predictor of the need for varicose vein treatment . 12 A
survey of varicose veins in a rural area of northern New Guinea showed a very low
prevalence in women (0.1 per cent in females aged 20 and over) and a modest
prevalence in men (5.1 per cent in the same age range).13

One large US cohort study found the biannual incidence of varicose veins was 3% in
women and 2% in men. The prevalence of varicose veins in Western populations was
estimated about 25–30% in women and 10–20% in men. A recent Scottish cohort
study has found a higher prevalence of varices of the saphenous trunks and their main
branches in men than in women (40% men v 32% women). Other epidemiological
studies have shown prevalence rates ranging from 1% to 40% in men, and 1% to 73%
in women.14

6.2 REVIEW OF LITERATURE

1. A study was conducted to determine, in subjects with varicose veins, the
characteristics of venous disease and other factors associated with an increased
risk of ulceration. 120 subjects with varicose veins and an open or healed
venous leg ulcers were compared with 120 controls with varicose veins and no
history of venous ulcer on this case control study. Subjects were recruited
from hospital settings and primary care. An increased risk of ulceration was
associated with the severity of clinical venous disease, especially with the
presence of skin changes (P < .0001). Ulceration was associated with reduced
volume of blood displaced as reflected by photoplethysmography and a
limited range of ankle movement(both P < .05).15
2. A study was conducted to assess the early efficacy and complications of
ultrasound-guided foam sclerotherapy (UGFS) in a cohort of patients with

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 varicose veins. Of 192 consecutive patients referred with varicose veins over
15 months, underwent UGFS treatment. Under ultrasound control via butterfly
or Seldinger cannulation, 1 percent foam was injected into superficial veins
and 3 percent foam into saphenous trunks, up to a total volume of 14 ml. In
163 legs, complete occlusion occurred after one intervention, a further 32 after
a second, and one after a third (overall 91 per cent). All 23 legs with small
saphenous veins had complete occlusion after one intervention compared with
64 of 97 legs with GSV incompetence (p<0.010). Occlusion rates were also
higher when the GSV was cannulated directly: 56 of 70 versus 8 of 27 (p<
0.001).16
3. A study was conducted to evaluate the effectiveness of compression stockings
in the prevention of oxidative stress at work. Venous pressure of the lower
limbs were measured in 55 theatre nurses who stood in the operating theatre
for >6 h, 65 outpatient department nurses. Subjects and controls were
examined on two consecutive days before and after work and with and without
compression stockings. Without compression stockings, lower limb venous
pressure increased significantly after work in all subjects and controls (P <
0.001), while only operating theatre nurses showed significantly higher
mean levels of reactive oxygen species (P < 0.001).11
4. A study was conducted to estimate the prevalence of lower limb chronic
venous disease (CVD) in the UK Asian male population. 100 unselected Asian
men attending a local Mosque were assessed for the evidence of lower limb
CVD, involving the collection of data on history and clinical signs and
objective assessments of venous pathophysiology using lower limb venous
ultrasonography and venous photoplethysmography (PPG). On clinical
examination, 80 limbs (in 50 subjects) had clinical evidence of CVD, the
majority of cases consisting of varicose veins (CEAP C2).17
5. A study was conducted to assess the risk of hospitalization due to varicose
vein in the lower extremities prospectively in workers standing or walking at
least 75% of their time at work. A random sample of 9653 working age adults
was drawn from the central population register of Denmark in 1991. 8664
accepted to be interviewed by telephone (response rate 90%). Respondents
(2939 men and 2708 women) were 20-59 years old and employed in 1990.

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 During 12 years of follow up, 40 hospitalizations due to varicose vein were
observed among the men and 71 among women. For employees with jobs that
require prolonged standing or walking compared to all other employees, the
relative risk was 1.75(95% CI 0.92 to 3.34) for men and 1.82 (95% CI 1.12 to
2.95) for women.18
6. A study was conducted on prevalence, risk factors, and clinical patterns of
chronic venous disorders of lower limbs. Random samples of 2000 subjects
per location were interviewed by telephone, and a sub-sample of subjects
completed medical interviews and underwent physical examination, and the
presence of varicose veins, was recorded. Varicose veins were found in 50.5%
of women versus 30.1% of men (P < .001).19
7. A study was conducted to prove the hypothesis that the development of CVD
might be triggered by exogenous, occupational risk factors. We determined the
prevalence and social relationship of CVD in a wide cross-section of hospital
employees (n=209; medical doctors and nurses) without predocumented
CVD. Prevalence, known endogenous risk factors for CVD and occupational
and environmental risk factor (long periods of standing during work) were
investigated. The restriction in quality of life due to symptoms of CVD was
also evaluated.  CVD was present in a total of 70 employees (34%),
predominantly in women. Standing at work was a predisposing factor. The
study demonstrated that within a representative cross-section of hospital
employees in a University hospital the prevalence of CVD was highest in
women, especially in those working in a standing position.20
8. A study was conducted to determine the inter-relationships between a range of
lifestyle factors and risk of varicose veins. An age-stratified random sample of
1566 subjects (699 men and 867 women) aged 18 to 64 years was selected
from 12 general practices throughout Edinburgh. A detailed self-administered
questionnaire was completed, and a comprehensive physical examination
determined the presence and severity of varicose veins. In both sexes,
increasing height showed a significant relationship with varicose veins (male
OR 1.50, 95% CI 1.18–1.93 and female OR 1.26, 95% CI 1.01–1.58). Among

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 women, body mass index was associated with an increased risk of varicose
veins (OR 1.26, 95% CI 1.02–1.54).21

6.3 STATEMENT OF THE PROBLEM

“Effectiveness of self instructional module on varicose vein and its prevention for
Operation Theater nurses in selected hospitals, Davangere”.

6.4 OBJECTIVES OF THE STUDY

 Assess the existing knowledge of operation theater nurses regarding varicose
vein and its prevention using structured questionnaire.
 Evaluate the effectiveness of self instructional module on varicose vein and its
prevention as evident from gain in knowledge score.

 Determine the association between pretest knowledge score and selected

demographic variables.

6.5 OPERATIONAL DEFINITIONS

 Effectiveness: It refers to determining the extent to which the information in
the self instructional module has achieved the desired effect as expressed by
gain in knowledge score.

 Self instructional module: In this study it refers to provide information on

varicose vein and its prevention.

 Prevention: In this study it refers to reducing future incidence of varicose

vein.

 Operation theater nurses: It refers to nurses those who are working in

Operation Theater.

6.6 ASSUMPTION
The study assume that
1. Operation theater nurses may have some knowledge regarding varicose vein
and its prevention.

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 2. Self instructional module enhances knowledge regarding varicose vein and its
prevention.

3. Operation theater nurses level of knowledge is influenced by demographic

variables.

6.7 RESEARCH HYPOTHESIS

H1: The mean post test of subjects exposed to self instructional module will be greater
than their mean pretest scores as measured by structured questionnaire at 0.05 level of
significance.

H2: There will be a significant association between the knowledge of operation

theater nurses regarding varicose vein and its prevention and selected demographic
variables.

6.8 LIMITATIONS
The study is limited to,
1. Nurses who are working in Operation Theater of selected hospitals.

7. MATERIALS AND METHODS OF THE STUDY

7.1 SOURCE OF DATA

Data will be collected from operation theater nurses of selected hospitals.

7.1.1 RESEARCH DESIGN

Pre experimental one group pre test and post test design.

7.1.2 VARIABLES OF THE STUDY

i. DEPENDENT VARIABLE
Knowledge of Operation Theater nurses regarding varicose vein and
its prevention.
ii. INDEPENDENT VARIABLE
Self Instructional module.

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7.1.3 STUDY SETTINGS
The study will be conducted among operation theater nurses in Bapuji
Hospital and S.S Institute of Medical Science and Research Center,
Davangere.

7.1.4 POPULATION
In this study population refers to nurses those who are working in Operation
Theater.

7.2 THE METHOD OF DATA COLLECTION

7.2.1 SAMPLING TECHNIQUE

Purposive sampling.
7-2.2 SAMPLE SIZE
In this study the sample size will be 50 nurses working in operation theater.

7.2.3 CRITERIA FOR SELECTION OF THE SAMPLE

INCLUSION CRITERIA
1. Nurses who are working in Operation Theater of selected hospitals.
2. Nurses who are available at the time of data collection.

EXCLUSION CRITERIA
1. Nurses who are not willing to participate in the study.

7.2.4 INSTRUMENT
Structured questionnaire. It has two sections:
Section 1: Socio demographic variable.
Section 2: Structured questionnaire will be prepared to assess the knowledge of
nurses regarding varicose vein and its prevention.

7.2.5 METHOD OF DATA ANALYSIS AND PRESENTATION

The data will be analyzed by using appropriate statistical method and will be
presented in the form of figures and tables.

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7.2.5 Descriptive statistics:

Frequency, Mean, Mean percentage and Standard Deviation to describe

demographic variables and to interpret knowledge level.

7.2.6 Inferential statistics:

1. Paired‘t’ test will be used to compare pre test and post test knowledge score.
2. Chi-square test will be used to find out the association between the selected
demographic variables with knowledge score.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE

CONDUCTED ON PATIENTS OR OTHER HUMAN ANIMALS?
Yes, self instructional module will be administered regarding varicose vein and
its prevention to the nurses working in Operation Theater in selected hospitals,
Davangere.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR

INSTITUTION?
Yes, written permission will be obtained from college as well as from selected
hospitals.

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8 LIST OF REFERENCES

1. http://www.medicinenet.com/vascular_disease/article.htm.

2. Johnson MT. Treatment and Prevention of varicose veins.

J Vasclr Nur [abstract] 1997 [cited on 1997 Sept]; 15(3): 97-103.

3. http://www.faqs.org/health/topics/38/Varicose-veins.html.

4. http://www.cks.nhs.uk/patient_information_leaflet/Varicose_Veins.

5. http://www.google.com.

6. Basavanthappa BT: Medical surgical nursing. 1st ed, jaypee brothers medical
publishers (p)Ltd; 2007. p. 433.

7. Lewis SL, HeitkemperMM, Dirksen SR, O’Brien, BucherL: Medical surgical nursing:
Assessment and Management of Clinical problems. 7th ed. Missouri, India: Elsevier;
2007. p. 918.

8. Raffetto JD, Qiao X, Koledova VV, Khalil RA. Potential Implications in varicose
vein. J Vasclr Sur [abstract] 2008 Aug [cited 2008]; 48(2): 447-456.

9. Mashario S. Prolonged Standing Work Aggravates Skin Changes of Varicose

Veins. Japanese J Occup Med Traum [abstract] 2004 [cited on 2004];
52(4):231-234.

10. http://www.wrongdiagnosis.com/v/varicose_veins/prevalence-types.htm.

11. Flore R, Gerardino L, Santoliquido A, Catananti C, Pola P, Tondi P.

Effectiveness of compression stockings in the prevention of oxidative stress at

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 work. Occu Med. [abstract] 2007 [cited 2007]; 57(5): 337-341. Available
from: http://www.occmed.oxfordjournals.org.

12. http://bestpractice.bmj.com/best-practice/evidence/background/0212.html

13. Stanhope JM. Varicose Veins in a Population of Lowland New Guinea. I J

Epidem. [abstract] 1975 [cited on 1975]; 4(3): 221-225. Available from:
http://www.ije.oxfordjournals.org.

14. http://clinicalevidence.bmj.com/ceweb/conditions/cvd/0212/0212_backgroun
d.jsp.

15. Lindsay R, Amanda LJ, Karen G, Jane CS, Christine JE, Brian MH, et al.
Risk factors for chronic ulceration in patients with varicose veins: A case
control study. J Vasclr sur [abstract] 2009 [cited on 2009Jun]; 49(6):1490-
1498. Available from: http://www.jvascsurg.org/article/S0741-
5214(09)00600-4/abstract.

16. Darke SG, Baker SJA. Ultrasound guided foam sclerotherapy. B J sur
[abstract] 2009 [cited 2009 Jun]; 969-974.

17. Sam RC, Hobbs SD, Darvall KAL, Rehman A, Adam DJ, Silverman SH, et al.
Chronic Venous Disease in a Cohort of Healthy UK Asian Men. Ejves
[abstract] 2007 [cited 2007 Jul]; 34(1): 92-96. Available
from:http://www.ejves.com/article/S1078-5884(07)00146-3/abstract .

18. Tuchsen F, Hannerz H, Burr H, Krause N. Prolonged standing at work and

hospitalisation due to varicose veins: a 12 year prospective study of the
Danish population. Occup Environ Med [abstract] 2005 [cited 2005 Dec];
62(12):847-850.Availablefrom:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1740939.

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19. Carpentier PH, Maricq HR, Biro C, Ponçot-Makinen CO, Franco A.
Prevalence, risk factors, and clinical patterns of chronic venous disorders of
lower limbs: A population-based study in France. J Vasc Surg [abstract] 2004
[cited 2004 Oct]; 40(4): 650-659. Available from:
http://www.jvascsurg.org/article/S0741-5214(04)00944-9/abstract.

20. Lee AJ, Evansa CJ, Allanb PL, Ruckleya CV, Fowkesa FGR. Lifestyle
factors and the risk of varicose veins: Edinburgh Vein Study. J Clin Epidem
[abstract] 2003 [cited 2003 Feb]; 56(2): 171-179. Available from:
http://www.sciencedirect.com/science/journal/08954356.

21. Ziegler S, Eckhardt G, Stöger R, Machula J, Rüdiger HW . High prevalence

of chronic venous disease in hospital employees. Wien Klin Wochenschr
[abstract] 2003 [cited 2003 Sep] 15; 115(15-16): 575-9. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/14531170.

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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

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 ETHICAL COMMITTEE CLEARANCE

1. TITLE OF THE DISSERTATION: “EFFECTIVENESS OF SELF INSTRUCTIONAL

MODULE ON VARICOSE VEIN AND ITS
PREVENTION FOR OPERATION THEATER
NURSES IN SELECTED HOSPITALS,
DAVANGERE”.

2. NAME OF THE CANDIDATE: MS. FREEDA P THOMAS,

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.H

Principal and HOD, Head of the Department of
Department of Medical surgical Nursing, Obstetrics and Gynecological Nursing
Bapuji college of Nursing, Bapuji College of Nursing
Davanagere-4 Davanagere

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