“A descriptive study on knowledge, practices, burden and problem faced regarding care of

children undergoing treatment for clubfoot deformity among their primary caregivers attending
PediatricOrthopedic OPD, PGIMER, Chandigarh (2023-24).”

SYNOPSIS

Submitted in partial fulfillment of the requirement for the degrees of

Bachelors of Science in Nursing (Post Basic)

Group Members

Nisha Kumari

Salma

Shivani

Sumna Devi

Varsha

National Institute of Nursing Education (NINE)

Post Graduate Institute of Medical Education and Research
(PGIMER) Chandigarh- 160012 (INDIA)
“A descriptive study on knowledge, practices, burden and problem faced regarding care of
children undergoing treatment for clubfoot deformity among their primary caregivers attending
PediatricOrthopedic OPD, PGIMER, Chandigarh (2023-24).”

GUIDE CO-GUIDE

Mrs. Mandeep Kaur Dr G. Nirmal Raj

Tutor Professor
NINE, PGIMER, Dept. of Orthopedics
Chandigarh PGIMER, Chandigarh

Dr. Monika
Tutor
NINE, PGIMER,
Chandigarh

PRINCIPAL
Dr.Sukhpal Kaur
NINE, PGIMER,
Chandigarh
 INDEX
SR. CONTENT PAGE NO.
NO.

Chapter-1
1. Background of the study
• Introduction &Need justification 1-3
• Review of literature 4-7
• Statement of problem
• Objectives 8-9
• Operational definitions

Chapter-2
2. Methodology
• Flow Chart of Research Methodology 10
• Research Approach
• Research Design
• Research setting
• Target population
• Accessible population
• Sample Technique
• Sample size 11-12
• Inclusion criteria
• Exclusion criteria
• Ethical Consideration
• Method of Data Collection
• List of tools of data collection
• Data analysis & Interpretation
• Dissemination of data
Chapter-3 References
3. 13-14
 Chapter-4
4. Annexure-I
• Participant information sheet (English , Hindi, Punjabi)

Annexure-II
• Participants written informed consent form (English, Hindi,
Punjabi)
Annexure-III
• Participants socio-demographic profile
• Demographic profile & Clinical Profile of Child
• Interview Schedule to assess the knowledge and practices
regarding care of child with clubfoot deformity
• Semi structured interview schedule to assess problem faced by
the caregiver of the child
• Modified Caregiver Burden Index to assess Caregiver Burden
CHAPTER-1
 Background of the study

Introduction

Clubfoot is a congenital foot abnormality in which the foot is twisted out of shape or position.
The front of the foot is twisted onward or inward, the arch is increased and the heel is turned
inward. The muscles of calf on the affected side may always be smaller than those the other
side1. Clubfoot can cause more serious problems if left untreated, such as arthritis, poor self
image and, inability to walk normally. The cause of clubfoot is still uncertain but it is believed to
be cause by a combination of genetic and environmental factors. 1 Clubfoot can be corrected with
treatment which consists of two phases: Ponseti serial casting and bracing. The ponseti technique
of serial casting involves careful stretching of the foot and a brace to slowly move the foot into
the right position. Permanently fixing a clubfoot can take several years, but which proper
treatment, a child can have a normal, active life without pain2

The exact etiology of clubfoot is not fully understood but it is believed to be multi factorial
involving genetic and environmental factors. Genetic factors such as family history, polygenic
inheritance (multiple genes may contribute to the development of clubfoot), neurological factors
(such as spina bifida or other spinal cord anomalies). Other factors such as musculoskeletal
factors ( Connective tissue abnormalities affecting the ligaments and tendons around the foot can
also be involved) and intrauterine factors ( such as position in the uterus, crowded position in
utero may affect the proper development of clubfoot) are also responsible for causing clubfoot
deformity2

According to a systematic review and other sources, the Ponseti method is a highly effective
treatment for clubfoot. The Ponseti method is a non-surgical approach that involves a series of
casts to gradually realign the tendons, ligaments, and bones in the foot. The goal is to obtain and
maintain a flexible, plantigrade, and pain-free foot. The method has a success rate of greater than
90% in correcting clubfoot, and results can be seen after one or two weeks of casting. The
Ponseti method has become the gold standard of treatment compared to other interventions, and
it has replaced the previous methods of treating clubfoot, which were a mix of surgical and
conservative techniques. It involves serial casting, Achilles tenotomy, and bracing. 2 Extended
Casting in more severe cases or when initial correction is challenging, additional casting sessions
may be required. Some cases may benefit from using specialized casts, like those with a bar to
assist in abduction or a customized shape to address specific deformities 3. Achilles tenotomy (a
small surgical cut to lengthen the Achilles tendon) may vary based on the child’s response to
casting. It is usually done if the foot does not fully correct with casting or if there’s a significant
residual equinus deformity. The surgical technique for tenotomy may be modified based on the
severity of the equinus deformity and the surgeon’s preference 4. Some cases may benefit from
custom-designed braces, especially if there are unique challenges in maintaining correction 4. If
there are resistant or recurrent deformities, additional interventions such as further casting,
bracing modifications or surgical procedures may be considered. Continuous monitoring and
regular follow-up appointments are essential to assess the foot’s progress and make necessary
modifications to the treatment plan. Treatment modifications in clubfoot require a personalized
and multidisciplinary approach involving orthopedic surgeons, physical therapists, and other
healthcare professionals and parents. Regular communication between the healthcare team and
the family is vital for assessing the child’s progress and making timely adjustments to the
treatment plan5

The ponseti method is the preferred treatment, reducing the need for surgery. Despite its success,
the method involves a lenghthy and challenging process with multiple hospital visits. Parents
play a crucial role in the treatment of clubfoot, including seeking care for the child, providing
support, and ensuring adherence to the treatment plan. During this phase parents may experience
physical and emotional problems, including depression, anxiety, and stress. During this phase
possible reasons for these issues for beliefs, fear, poverty, and lack of awareness. Addressing
parent issues can help improve the effectiveness of clinics by providing education, encouraging
adherence, and offering support to parents.5

Another reason for parental stress can be the problem faced by children with clubfoot. They may
face various challenges, including physical, social, and psychological aspects. Mobility Issues
such as difficulties in walking and weight-bearing, affecting the child’s overall mobility and
ability to participate in physical activities. The abnormal positioning of the foot can result in
muscle imbalances, affecting the development and strength of muscles in the leg and foot.
Untreated or improperly treated clubfoot can result in functional limitations, impacting the
child’s ability to perform daily activities and engage in sports or recreational activities. Clubfoot
can cause an abnormal gait, affecting the child’s walking pattern and posture. If left untreated,
clubfoot may lead to long-term orthopaedic problems such as arthritis, joint stiffness, and foot
deformities. Psychosocial Impact: Children with clubfoot may face social and psychological
challenges due to physical differences. This can affect self-esteem, body image, and interactions
with peers. In some cases, individuals with clubfoot may experience pain or discomfort,
especially if there are complications or residual deformities. The unique shape of the clubfoot
may make it challenging to find suitable footwear, potentially causing discomfort and difficulty
in finding shoes that fit properly.6

Need of the study

Studying clubfoot is crucial for several reasons, encompassing both clinical and research
perspectives. Clubfoot is a congenital deformity that affects 1 in every 1,000 newborns and can
have long-lasting negative effects on the quality of life of patients, especially in the case of
recurrent clubfoot.The ponseti method is the preferred treatment reducing the need for surgery.
Despite its success the method involves a lengthy and challenging process with multiple visits.
Parents play a crucial role in the treatment of clubfoot, including seeking care for the child,
providing support, and ensuring adherence to the treatment plan.7 Research has shown that
caregivers often face significant mental stress, financial burden, and practical challenges in
managing the care of children with clubfoot. Factors such as lack of awareness, family/work
commitments, resistance from family members, and financial constraints can impact the
treatment outcomes and the well-being of both the child and the caregivers. Understanding these
issues is crucial for developing effective support systems and educational interventions programs
to alleviate the burden on the caregivers and improve the overall care and treatment outcomes for
children with clubfoot deformity. Hence, the need was felt to assess the knowledge, practices,
burden and problem faced regarding care of children undergoing treatment for clubfoot
deformity among their primary caregivers attending paediatric orthopaedic OPD, PGIMER,
Chandigarh.
Review of
Literature

Alasbali MSet alconducted a cross sectional study on clubfoot in Saudi Arabia. The objective of

the study is to assess knowledge and awareness on clubfoot among residents of rural areas and

determined the knowledge and attitude of public towards the risk factors and general

consequences of clubfoot. The participants completed a self administered survey on the web. The

questionnaire was pretested in a pilot study to ensure comprehension and ease of administration.

Out of all the people surveyed, about 42% knew the scientific name for clubfoot in their

language, while 39% could identify the condition from a picture. The participants commonly

recognized family history (52.2%), complicated pregnancies (46.5%), and medications (43.4%)

as potential risk factors for clubfoot. Surprisingly, only 8.8% of

them thought that casting was the first treatment for clubfoot.8

Patel SJ et al conducted a retrospective study on the patients at a tertiary care hospital in India

who underwent a ponseti method for clubfoot treatment. Total number of 110 patients

participated in this study that were interviewed at the initiation of the treatment and after each

follow up for the identification of barriers related to the treatment and their correlation to dropout

rate was analyzed .The relation between dropout rates and different parameters was measured by

using the chi-square test. The compliance with treatment is primarily influenced by the presence

of the parent accompanying the patient, when considering the combined impact of all varieties.

The finding of this study can be utilized to develop a strategic approach in enhancing adherence

to the ponseti method for clubfoot in India.9

Saeed H, et alconducted a cross sectional study to determine the efficacy of ponseti technique for

treating clubfoot. For the collection of data all clubfoot patients who were presented to the

orthopedic department were included Among 41 patients, with a mean age of 37 weeks, the

majority presented between 0-6 months. Unilateral involvement was observed in 25 children,

bilateral in 16. The study used the Pirani scoring system, showing a baseline mean Pirani score

of 3.46, which significantly improved to 0.0317 after treatment. On average, 6.29 casts were

needed. Results were excellent in 82%, good in 12%, and fair in 4%, indicating the Ponseti

method's reliability and effectiveness for treating clubfoot.10

Iqbal MS et al conducted a cross sectional, analytical study. The study aimed to assess the

awareness among primary caregivers of children with clubfoot in India, focusing on their

knowledge, beliefs, treatment compliance, and encountered barriers. A standard questionnaire

was prepared in their local language and total 108 respondents were interviewed. Findings

revealed that over half of the participants had no prior knowledge of clubfoot until it occurred in

their family. Superstitions, such as lunar eclipse and punishment from God, were common beliefs

about the deformity's cause. Only a quarter believed in starting treatment immediately after birth.

Satisfaction with doctors' explanations was around 68%, but social stigma (52.77%) and

difficulties adjusting to routine changes (58.33%) were significant obstacles. The study

concludes that the low awareness level among primary caregivers may impact successful

treatment and adherence to clubfoot interventions.11

O Esan et al conducted a cross sectional study over a period of 2 years ( i.e. July 2013 – 2015) to

asses emotional distress and parenting stress among parents ( primary caregivers ) of children

with clubfoot in South Western Nigeria. The study was conducted among 58 parents of children

with clubfoot attending the paediatric clinic. They used demographic data in the form of
questionnaire, The HADS (Hospital Anxiety And Depression Scale) and parenting stress India

short form . The study highlights the experiences of Nigerian parents taking care of clubfoot

children. It emphasizes that healthcare professionals should not only focus on the physical

aspects of treatment but also consider and address

the emotional well being of the parents involved in the care of these children.12

Kazibwe H et al conducted a cross sectional descriptive study at talipes clinic at Mbarara

Regional Hospital and Mulago Hospital in Uganda. There were 167 patients participated in this

study. The aim of the study is to assess the barriers experience by parents of children with

clubfoot deformity. For this study a non structural questionnaire was used which was adopted

from literature. The result of the study found that there is a significant association between

compliance and transport costs, distance travelled and family support. Whereas other barriers

showed that there is need to improve the communication skill between clinicians who provided

treatment to the children affected with talipes

and their parents.13

Alsiddiky A et alconducted a cross sectional survey to assess the public awareness of clubfoot

and knowledge about the importance of the early childhood treatment. The objective of the study

is to assess the public awareness of clubfoot and knowledge regarding the importance of

treatment in early childhood. They conducted a survey with questions about clubfoot, covering

what causes and how it is treated and what might happen. Orthopedics experts helped designing

the survey and they share it online they want responses for everyone regardless of gender age.

They know someone with Clubfoot. The results reveal a significant lack of public understanding

about clubfoot, possibly due to a death of awareness initiatives. They propose amplifying

awareness through social media and public campaigns in strategic locations like shopping mall,
aiming to promote early treatment- seeking behavior. This is imperative because prompt

management of clubfoot, involving less invasive methods and consistent follow-up, contributes

to enhanced patients outcomes.14

Pietrucin-Materek M et alconducted a qualitative study aimed to explore the impact of a child's

medical condition, specifically Congenital Talipes Equinovarus (CTEV), on the social

environment and family life. Through in-depth interviews with 15 families in the UK,

comprising both joint and single interviews, three major themes emerged: (a) the emotions and

perceptions linked to the diagnosis of CTEV; (b) the challenges of parenting a child with CTEV;

and (c) the concerns parents expressed regarding the child's future. The findings reveal that

participants encountered a spectrum of negative emotions comparable to those faced by parents

dealing with conditions traditionally viewed as more

disabling.15
Problem statement: - "A Descriptive study on knowledge, practices, burden and problem faced
regarding care of children undergoing treatment for clubfoot deformity among their primary
caregivers attending Pediatric Orthopedic OPD, PGIMER, Chandigarh.”

Objectives:-

• To assess the knowledge and practices regarding care of children undergoing treatment
for clubfoot deformity among their primary caregivers attending Paediatric Orthopaedic
OPD of PGIMER, Chandigarh.
• To assess the burden and problem faced regarding care of children undergoing treatment
for clubfoot deformity among their primary caregivers attending Paediatric Orthopaedic
OPD of PGIMER, Chandigarh.

Operational Definitions

• Knowledge- Level of awareness of primary caregivers regarding care (feeding,

medications, hygiene, cast care) of child with clubfoot deformity. It will be assessed
through a structured knowledge questionnaire and knowledge will be categorised as
good, average and poor level of knowledge.
• Practices-It refers to the daily care of a clubfoot child and will include aspect such as
diet, bathing, clothing, taking child to hospital, and medication of child. It will be
assessed by using checklist on practice of caregiver regarding care of child with clubfoot .
• Caregiver’s burden: -Caregiver burden is the perception of persistent problems and a
feeling of decreased well being that results from clubfoot deformity for the child. It will
be assessed across five major domains: Financial, Physical, Psychological, Social and
Personal by using Modified Caregiver Strain Index.
• Problem faced- Typically refers to challenges, difficulties or obstacles encountered in
various situations such as travelling, financial, follow up, cast care, medications, feeding
 practices, transportation issues. It will be assessed by semi structured questionnaire on
care of child with clubfoot deformity.
• Clubfoot Deformity: -Any child diagnosed with clubfoot deformity and undergoing
treatment for the same at Paediatric Orthopaedic OPD, PGIMER, Chandigarh.

• Primary caregivers: -Primary caregivers are the person who provides most of the care or
guardianship and accompanying the child with CTEV (Congenital Talipes Equinovarus)
in the Hospital.
CHAPTER-2
 Research Methodology

Research approach:- Quantitative study

Research design: Descriptive

Research setting:-Paediatric Orthopaedic OPD, PGIMER, Chandigarh

Target population :-Primary Caregivers of Child with Clubfoot Deformity (CTEV)

Accessible population:-Primary Caregivers of Child with Clubfoot Deformity (CTEV), Attending Paediatric Orthopaedic OPD,
PGIMER, Chandigarh

Inclusion criteria: Primary caregiver of clubfoot child

• ≥ 18 years Exclusion criteria: Not able to understand
• Willing to participate in study the Hindi language.
and present at the time of data
collection.

Sampling technique: -Total Enumeration Technique

Sample size:-approx. 50

Method of data collection: Interview

Tools for data collection: -

Part A- Socio Demographic profile of the caregiver& child
Part B- Clinical profile of child
Part C- Questionnaire to assess knowledge of parents.
Part D- Checklist to assess practices regarding care of child with clubfoot deformity.
Part E- Semi structured interview schedule to assess problem faced by the caregivers
of the child

Ethical considerations: -

• This study may help to understand existing knowledge, practices, burden and problems faced regarding care of children with
clubfoot deformity among their primary caregivers and further help to plan strategies to improve knowledge and practices and
reduce caregiver burden.
• Ethical approval will be obtained from Institutes Ethics Committee of NINE PGIMER, Chandigarh
• Permission will be obtained from Head of The Department of Orthopaedics PGIMER, Chandigarh
• Written Informed Consent will be obtained from the subjects.
• Confidentiality of data will be maintained.

Data analysis& Interpretation: - Descriptive and inferential statistics

Dissemination of findings: - Report writing and

publication
Research approach: -Quantitative research is the process of collecting and analyzing data. It can
be used to find patterns and averages, make predictions, test causal relationships and generalize
results to wider populations.

Research design: -Research design of the study will be descriptive. Different fields of research
use descriptive studies. Descriptive studies are often the first step in the research process & can
involve methods like surveys, observations, or content analysis to gather data for description and
analysis.

Research setting:-This study will be conducted in the Pediatric Orthopedic OPD, PGIMER,
Chandigarh, where children with clubfoot deformity receiving medical care.

Target population:-Target population will include caregivers of children with clubfoot

deformity (CTEV), attending Pediatric Orthopedic OPD, PGIMER, Chandigarh.

Accessible population: - Primary caregivers of children with clubfoot deformity (CTEV),

attending PediatricOrthopedic OPD, PGIMER, Chandigarh during period of data collection.

Inclusion criteria:

• ≥ 18 yrs

• Patients who are willing to participate.

Exclusion criteria: - Participants who are not able to understand the Hindi language.

Sampling technique:-Total enumeration technique will be used to select the subject of the study.

Sample size:-Sample size will be approximately 50 primary caregivers, which is calculated by a

portion of the primary caregivers attending Pediatric Orthopedic, OPD.

Ethical considerations: -

Benefits to participate
• This study may help to understand existing knowledge, practices, burden and problem
faced regarding care of children with clubfoot deformity among their primary caregivers
and may help to plan strategies to improve knowledge and practices and reduce caregiver
strain.
• Ethical approval will be obtained from Ethical Committee NINE, PGIMER, Chandigarh.
 Permission from Head of The Department of Orthopaedics, PGIMER, Chandigarh
 Written Informed Consent will be obtained from the subjects.
 Confidentiality of data will be maintained.
Method of data collection: Interview

Tools for data collection: -

1. Socio demographic profile of the caregiver and child- Demographic profile such as
Name, Age, Sex, Education, Ethnicity & Migration, History, Religion, Marital status.
2. Clinical profile of the child- Clinical profile of the child includes Name, Age, Sex, birth
history , growth and development history, Vaccination Status, present complaints,
treatment plan and gait analysis.
3. Questionnaire- To assess knowledge and checklist to assess practices regarding care of
child with clubfoot deformity
4. Semi structure interview schedule to assess problem faced by the caregivers of the
child.
5. Modified Caregiver strain Index to assess the level of strain or stress experienced by
caregivers who provide most of the care or guardianship and accompanying the child
with CTEV in the Hospital.

Data analysis: - Descriptive and inferential statistics. Data analysis will help us to understand

the existing knowledge, practices, burden and problem faced regarding care of children with

clubfoot deformity among their primary caregivers attending pediatricorthopedic OPD,

Chandigarh. Dissemination of findings:-Report writing and publication

CHAPTER-3
 REFERENCES

References:-

1. Clubfoot - Symptoms and causes [Internet]. Mayo Clinic. [cited 2024 Jan 20]. Available
from: https://www.mayoclinic.org/diseases-conditions/clubfoot/symptoms-causes/syc-
20350860

2. Clubfoot Treatment Options | HSS Lerner Children’s Pavilion [Internet]. [cited 2024 Jan
20]. Available from: https://www.hss.edu/condition-list_clubfoot.asp

3. The Ponseti Method for Clubfoot Correction | HSS Pediatrics [Internet]. Hospital for
Special Surgery. [cited 2024 Jan 20]. Available from: https://www.hss.edu/conditions_the-
ponsetimethod-for-clubfoot-correction.asp

4. Ponseti Method for Clubfoot in Children [Internet]. [cited 2024 Jan 20]. Available from:
https://nyulangone.org/conditions/clubfoot-in-children/treatments/ponseti-method-for-
clubfoot-inchildren

5. What are the problems suffering from by parents in clubfoot explain in detailtal [Internet].
[cited 2024 Jan 20]. Available from: https://www.perplexity.ai/search/bc53c9b3-1c3a-40e3-
900dc7926eff9c8a

6. Lööf E. Additional challenges in children with idiopathic clubfoot: is it just the foot? J
Child Orthop. 2019 Jun 1;13(3):245–51.

7. What are the problems suffering from by parents in clubfoot explain in detailtal [Internet].
Perplexity AI. [cited 2024 Jan 20]. Available from:
https://www.perplexity.ai/search/bc53c9b31c3a-40e3-900d-c7926eff9c8a

8. Alasbali MS, Altammami AF, Alharbi AA, Aljurfi MM, Alhumaidan AI, AlKhudhair MR, et
al. Assessing awareness and knowledge level of clubfoot among a rural city population in
Saudi Arabixsa: A cross-sectional study. J Fam Med Prim Care. 2023 Jan;12(1):55–61.

9. Patel SJ, Shah MV, Mistry M, Zala R, Panchal H, Prabhakar M, et al. Quantitative Analysis
of Barriers to Clubfoot Treatment Experienced at a Tertiary Care Institute in India. Cureus.
2022 Jun;14(6):e25782.

10. Saeed H, Manzoor B, Sarwar M, Rasheed N, Manzoor I, Elahi M. Treatment of club foot
with serial casting by ponsetti technique. Prof Med J. 2022 May 31;29:802–6.

11. Iqbal MS, Dubey R, Thakur K, Katiyar S, Prasad M. Assessment of awareness and barriers
to clubfoot treatment in the Indian scenario. J Fam Med Prim Care. 2021 Nov;10(11):4229–
35.
12. Assessment of emotional distress and parenting stress among parents of children with
clubfoot in south-western Nigeria [Internet]. [cited 2024 Jan 19]. Available from:
http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2017000200003

13. Kazibwe H, Struthers P. Barriers experienced by parents of children with clubfoot

deformity attending specialised clinics in Uganda. Trop Doct. 2009 Jan;39(1):15–8.

14. Alsiddiky A, Alrwibaah S, Alqahtani A, Alnujidi A, Alhomaidhi A, Almasoud A, et al.

Assessing public awareness of clubfoot and knowledge about the importance of early
childhood treatment: a cross-sectional survey. BMC Pediatr. 2019 Oct 17;19(1):358.

15. Pietrucin-Materek M, van Teijlingen ER, Barker S, Forrest Keenan K, Miedzybrodzka Z.

Parenting a child with clubfoot: A qualitative study. Int J Orthop Trauma Nurs. 2011 Nov
1;15(4):176–84.
CHAPTER-4
Annexure-I
Participant Information Sheet (PIS)
Protocol No:
Sponsor:
Principal Investigator:
Name of Participant: Post Basic Bsc. Nursing 2nd year (Group 8)
Title: “A Descriptive study on knowledge practices, burden and problem faced regarding care of
children undergoing treatment for clubfoot deformity among their primary caregivers attending
Pediatric Orthopedic OPD, PGIMER, Chandigarh (2023-24).”
You are invited to take part in this research study. The information in this document is meant to
help you decide whether or not to take part. Please feel free to ask if you have any queries or
concerns.
1. What is your expected duration of the participation?

Your participation in this study will be 1 day.

2. What procedures will be followed during this study?

Data will be collected through interview schedule.

3. What are the risks and discomforts to you?

There will be no risk and discomfort to participant.

4. What benefits are expected from this research?

The study may be beneficial for patients comes in neurosurgery OPD

5. What are the alternatives available to you?

If the participants do not wish to participate, you have the alternative to not doing so.
6. Are the data/records of the participant kept confidential?

Yes all the data and records of participants will be kept confidential
7. What will be the treatment schedule(s)?

No there will be no treatment schedule for the patient.

 8. What compensation and/or treatment(s) are available to the Participant in the event of a
trial related injury?

No payment will be there for participants in the research study. Approximately 200 patients
will be enrolled in the study.
9. Are the participants paid to take part in this study?

No the participants will not be paid to take part in the study.

10. No any invasive procedure will be done.

Any other pertinent information

Contact persons:
For further information / questions, you can contact us at the following address:
Principal Investigator: Nisha Kumari, Salma, Shivani, Sumna Devi, Varsha(Post Basic 2 nd year)
National Institute of Nursing Education, Post Graduate Institute of Medical Education and
Research
Chandigarh 160012(India)
Co-Investigator
Guide:-Mrs. Mandeep Kaur,Tutor, NINE PGIMER Chandigarh
Co-Guide:-Dr.G. Nirmal Raj, Professor, Department of Orthopedics, PGIMER
Chandigarh
Dr Monika Tutor, NINE PGIMER Chandigarh
 अनुबंध- I

प्रतिभागी सूचना पत्रक (पीआईएस)

प्रोटोकॉल संख्या:

प्रायोजक:

प्रमुख अन्वेषक:

प्रतिभागी का नाम: पोस्ट बेसिक बीएससी। नर्सिंग द्वितीय वर्ष (समूह 8)

शीर्षक: "पीडियाट्रिक ऑर्थोपेडिक ओपीडी, पीजीआईएमईआर, चंडीगढ़ (2023-24) में भाग लेने वाले
प्राथमिक देखभालकर्ताओं के बीच क्लबफु ट विकृ ति के इलाज के दौर से गुजर रहे बच्चों की
देखभाल के संबंध में ज्ञान प्रथाओं, बोझ और समस्या पर एक वर्णनात्मक अध्ययन।"

आपको इस शोध अध्ययन में भाग लेने के लिए आमंत्रित किया जाता है। इस दस्तावेज़ में दी
गई जानकारी आपको यह तय करने में मदद करने के लिए है कि भाग लेना है या नहीं। यदि
आपका कोई प्रश्न या चिंता हो तो कृ पया बेझिझक पूछें ।

1. आपकी भागीदारी की अपेक्षित अवधि क्या है?

इस अध्ययन में आपकी भागीदारी 1 दिन की होगी.

2. इस अध्ययन के दौरान किन प्रक्रियाओं का पालन किया जाएगा?

साक्षात्कार अनुसूची के माध्यम से डेटा एकत्र किया जाएगा।

3. आपके लिए जोखिम और असुविधाएँ क्या हैं?

प्रतिभागी को कोई जोखिम और असुविधा नहीं होगी।

4. इस शोध से क्या लाभ की उम्मीद है?

न्यूरोसर्जरी ओपीडी में आने वाले मरीजों के लिए यह अध्ययन फायदेमंद हो सकता है

5. आपके लिए क्या विकल्प उपलब्ध हैं?

यदि प्रतिभागी भाग नहीं लेना चाहते हैं, तो आपके पास ऐसा न करने का विकल्प है।

6. क्या प्रतिभागी का डेटा/रिकॉर्ड गोपनीय रखा गया है?

हां, प्रतिभागियों के सभी डेटा और रिकॉर्ड गोपनीय रखे जाएंगे

7. उपचार कार्यक्रम क्या होगा?

नहीं, रोगी के लिए कोई उपचार कार्यक्रम नहीं होगा।

8. परीक्षण-संबंधी चोट की स्थिति में प्रतिभागी को क्या मुआवजा और/या उपचार उपलब्ध हैं?

शोध अध्ययन में भाग लेने वालों के लिए कोई भुगतान नहीं होगा। अध्ययन में लगभग 200

रोगियों को नामांकित किया जाएगा।

9. क्या प्रतिभागियों को इस अध्ययन में भाग लेने के लिए भुगतान किया गया है?

नहीं, प्रतिभागियों को अध्ययन में भाग लेने के लिए भुगतान नहीं किया जाएगा।

10. कोई भी आक्रामक प्रक्रिया नहीं की जाएगी.

कोई अन्य प्रासंगिक जानकारी

संपर्क करें:

अधिक जानकारी/प्रश्नों के लिए, आप हमसे निम्नलिखित पते पर संपर्क कर सकते हैं:

प्रधान अन्वेषक: निशा कु मारी, सलमा, शिवानी, सुमना देवी, वर्षा (पोस्ट बेसिक द्वितीय वर्ष)

नेशनल इंस्टीट्यूट ऑफ नर्सिंग एजुके शन, पोस्ट ग्रेजुएट इंस्टीट्यूट ऑफ मेडिकल एजुके शन एंड
रिसर्च

चंडीगढ़ 160012(भारत)

सह अन्वेषक

मार्गदर्शक:-श्रीमती. मनदीप कौर, ट्यूटर, नाइन पीजीआईएमईआर चंडीगढ़

सह-मार्गदर्शक:-डॉ.जी. निर्मल राज, प्रोफे सर, हड्डी रोग विभाग, पीजीआईएमईआर चंडीगढ़

डॉ मोनिका ट्यूटर, नाइन पीजीआईएमईआर चंडीगढ़

 ਅਨੁਬੰ ਧ-I

ਭਾਗੀਦਾਰ ਜਾਣਕਾਰੀ ਸ਼ੀਟ (ਪੀ.ਆਈ.ਐਸ )

ਪ੍ਰੋਟੋਕੋਲ ਨੰ :

ਸਪਾਂਸਰ:

ਪ੍ਰਮੁੱ ਖ ਜਾਂਚਕਰਤਾ:

ਭਾਗੀਦਾਰ ਦਾ ਨਾਮ: ਪੋਸਟ ਬੇਸਿਕ ਬੀ.ਐਸ.ਸੀ. ਨਰਸਿੰ ਗ ਦੂਜਾ ਸਾਲ (ਗਰੁੱ ਪ 8)

ਸਿਰਲੇਖ: "ਪਿਡੀਆਟ੍ਰਿਕ ਆਰਥੋਪੀਡਿਕ ਓਪੀਡੀ, ਪੀਜੀਆਈਐਮਈਆਰ, ਚੰ ਡੀਗੜ੍ਹ (2023-24) ਵਿੱ ਚ ਹਾਜ਼ਰ ਹੋਣ
ਵਾਲੇ ਉਨ੍ਹਾਂ ਦੇ ਪ੍ਰਾਇਮਰੀ ਕੇਅਰਗਿਵਰਾਂ ਵਿੱ ਚ ਕਲੱ ਬਫੁੱ ਟ ਦੀ ਵਿਗਾੜ ਲਈ ਇਲਾਜ ਕਰ ਰਹੇ ਬੱ ਚਿਆਂ ਦੀ ਦੇਖਭਾਲ ਦੇ
ਸਬੰ ਧ ਵਿੱ ਚ ਗਿਆਨ ਅਭਿਆਸਾਂ, ਬੋਝ ਅਤੇ ਸਮੱ ਸਿਆਵਾਂ ਬਾਰੇ ਇੱ ਕ ਵਰਣਨਯੋਗ ਅਧਿਐਨ।"

ਤੁਹਾਨੂੰ ਇਸ ਖੋਜ ਅਧਿਐਨ ਵਿੱ ਚ ਹਿੱ ਸਾ ਲੈਣ ਲਈ ਸੱ ਦਾ ਦਿੱ ਤਾ ਜਾਂਦਾ ਹੈ। ਇਸ ਦਸਤਾਵੇਜ਼ ਵਿੱ ਚ ਦਿੱ ਤੀ ਜਾਣਕਾਰੀ ਦਾ
ਮਤਲਬ ਇਹ ਫੈਸਲਾ ਕਰਨ ਵਿੱ ਚ ਤੁਹਾਡੀ ਮਦਦ ਕਰਨਾ ਹੈ ਕਿ ਹਿੱ ਸਾ ਲੈਣਾ ਹੈ ਜਾਂ ਨਹੀਂ। ਕਿਰਪਾ ਕਰਕੇ ਬੇਝਿਜਕ
ਪੁੱ ਛੋ ਕਿ ਕੀ ਤੁਹਾਡੇ ਕੋਈ ਸਵਾਲ ਜਾਂ ਚਿੰ ਤਾਵਾਂ ਹਨ।

1. ਤੁਹਾਡੀ ਭਾਗੀਦਾਰੀ ਦੀ ਸੰ ਭਾਵਿਤ ਮਿਆਦ ਕੀ ਹੈ?

ਇਸ ਅਧਿਐਨ ਵਿੱ ਚ ਤੁਹਾਡੀ ਭਾਗੀਦਾਰੀ 1 ਦਿਨ ਦੀ ਹੋਵੇਗੀ।

2. ਇਸ ਅਧਿਐਨ ਦੌਰਾਨ ਕਿਹੜੀਆਂ ਪ੍ਰਕਿਰਿਆਵਾਂ ਦਾ ਪਾਲਣ ਕੀਤਾ ਜਾਵੇਗਾ?

ਇੰ ਟਰਵਿਊ ਸ਼ਡਿਊਲ ਰਾਹੀਂ ਡਾਟਾ ਇਕੱ ਠਾ ਕੀਤਾ ਜਾਵੇਗਾ।

3. ਤੁਹਾਡੇ ਲਈ ਖਤਰੇ ਅਤੇ ਬੇਅਰਾਮੀ ਕੀ ਹਨ?

ਭਾਗੀਦਾਰ ਨੂੰ ਕੋਈ ਖਤਰਾ ਅਤੇ ਬੇਅਰਾਮੀ ਨਹੀਂ ਹੋਵੇਗੀ।

4. ਇਸ ਖੋਜ ਤੋਂ ਕਿਹੜੇ ਲਾਭਾਂ ਦੀ ਉਮੀਦ ਕੀਤੀ ਜਾਂਦੀ ਹੈ?

ਨਿਊਰੋਸਰਜਰੀ ਓਪੀਡੀ ਵਿੱ ਚ ਆਉਣ ਵਾਲੇ ਮਰੀਜ਼ਾਂ ਲਈ ਅਧਿਐਨ ਲਾਭਦਾਇਕ ਹੋ ਸਕਦਾ ਹੈ

5. ਤੁਹਾਡੇ ਲਈ ਕਿਹੜੇ ਵਿਕਲਪ ਉਪਲਬਧ ਹਨ?

ਜੇਕਰ ਭਾਗੀਦਾਰ ਹਿੱ ਸਾ ਨਹੀਂ ਲੈਣਾ ਚਾਹੁੰ ਦੇ, ਤਾਂ ਤੁਹਾਡੇ ਕੋਲ ਅਜਿਹਾ ਨਾ ਕਰਨ ਦਾ ਵਿਕਲਪ ਹੈ।

6. ਕੀ ਭਾਗੀਦਾਰ ਦੇ ਡੇਟਾ/ਰਿਕਾਰਡ ਨੂੰ ਗੁਪਤ ਰੱ ਖਿਆ ਜਾਂਦਾ ਹੈ?

 ਹਾਂ ਭਾਗੀਦਾਰਾਂ ਦੇ ਸਾਰੇ ਡੇਟਾ ਅਤੇ ਰਿਕਾਰਡ ਨੂੰ ਗੁਪਤ ਰੱ ਖਿਆ ਜਾਵੇਗਾ

7. ਇਲਾਜ ਦੀ ਸਮਾਂ-ਸਾਰਣੀ ਕੀ ਹੋਵੇਗੀ?

ਨਹੀਂ ਮਰੀਜ਼ ਲਈ ਕੋਈ ਇਲਾਜ ਅਨੁਸੂਚੀ ਨਹੀਂ ਹੋਵੇਗੀ।

8. ਅਜ਼ਮਾਇਸ਼ ਨਾਲ ਸਬੰ ਧਤ ਸੱ ਟ ਲੱ ਗਣ ਦੀ ਸੂਰਤ ਵਿੱ ਚ ਭਾਗੀਦਾਰ ਨੂੰ ਕੀ ਮੁਆਵਜ਼ਾ ਅਤੇ/ਜਾਂ ਇਲਾਜ ਉਪਲਬਧ
ਹਨ?

ਖੋਜ ਅਧਿਐਨ ਵਿੱ ਚ ਭਾਗ ਲੈਣ ਵਾਲਿਆਂ ਲਈ ਕੋਈ ਭੁਗਤਾਨ ਨਹੀਂ ਹੋਵੇਗਾ। ਅਧਿਐਨ ਵਿੱ ਚ ਲਗਭਗ 200 ਮਰੀਜ਼ਾਂ ਨੂੰ
ਸ਼ਾਮਲ ਕੀਤਾ ਜਾਵੇਗਾ।

9. ਕੀ ਭਾਗੀਦਾਰਾਂ ਨੂੰ ਇਸ ਅਧਿਐਨ ਵਿੱ ਚ ਹਿੱ ਸਾ ਲੈਣ ਲਈ ਭੁਗਤਾਨ ਕੀਤਾ ਜਾਂਦਾ ਹੈ?

ਨਹੀਂ, ਭਾਗੀਦਾਰਾਂ ਨੂੰ ਅਧਿਐਨ ਵਿੱ ਚ ਹਿੱ ਸਾ ਲੈਣ ਲਈ ਭੁਗਤਾਨ ਨਹੀਂ ਕੀਤਾ ਜਾਵੇਗਾ।

10. ਕੋਈ ਵੀ ਹਮਲਾਵਰ ਪ੍ਰਕਿਰਿਆ ਨਹੀਂ ਕੀਤੀ ਜਾਵੇਗੀ।

ਕੋਈ ਹੋਰ ਢੁਕਵੀਂ ਜਾਣਕਾਰੀ

ਸੰ ਪਰਕ ਵਿਅਕਤੀ:

ਹੋਰ ਜਾਣਕਾਰੀ / ਸਵਾਲਾਂ ਲਈ, ਤੁਸੀਂ ਸਾਡੇ ਨਾਲ ਹੇਠਾਂ ਦਿੱ ਤੇ ਪਤੇ 'ਤੇ ਸੰ ਪਰਕ ਕਰ ਸਕਦੇ ਹੋ:

ਪ੍ਰਿੰ ਸੀਪਲ ਇਨਵੈਸਟੀਗੇਟਰ: ਨਿਸ਼ਾ ਕੁਮਾਰੀ, ਸਲਮਾ, ਸ਼ਿਵਾਨੀ (ਐਸ.ਪੀ.), ਸੁਮਨਾ ਦੇਵੀ, ਵਰਸ਼ਾ (ਪੋਸਟ ਬੇਸਿਕ ਦੂਜਾ
ਸਾਲ) ਨੈ ਸ਼ਨਲ ਇੰ ਸਟੀਚਿਊਟ ਆਫ਼ ਨਰਸਿੰ ਗ ਐਜੂਕੇਸ਼ਨ, ਪੋਸਟ ਗ੍ਰੈਜੂਏਟ ਇੰ ਸਟੀਚਿਊਟ ਆਫ਼ ਮੈਡੀਕਲ ਐਜੂਕੇਸ਼ਨ
ਐਂਡ ਰਿਸਰਚ ਚੰ ਡੀਗੜ੍ਹ 160012 (ਭਾਰਤ)

ਸਹਿ-ਜਾਂਚਕਾਰ

ਗਾਈਡ:-ਸ਼੍ਰੀਮਤੀ ਮਨਦੀਪ ਕੌਰ, ਟਿਊਟਰ, ਨੌਂ ਪੀਜੀਆਈਐਮਆਰ ਚੰ ਡੀਗੜ੍ਹ

ਸਹਿ-ਗਾਈਡ:-ਡਾ.ਜੀ. ਨਿਰਮਲ ਰਾਜ, ਪ੍ਰੋਫੈਸਰ, ਆਰਥੋਪੈਡਿਕਸ ਵਿਭਾਗ, ਪੀਜੀਆਈਐਮਈਆਰ ਚੰ ਡੀਗੜ੍ਹ

ਡਾ: ਮੋਨਿਕਾ ਟਿਊਟਰ, ਨੌਂ ਪੀਜੀਆਈਐਮਆਰ ਚੰ ਡੀਗੜ੍ਹ

 Annexure-II
Informed Consent Form (ICF)
Study Title: “A Descriptive study on knowledge practices, burden and problem faced regarding
care of children undergoing treatment for clubfoot deformity among their primary caregivers
attending Pediatric Orthopedic OPD, PGIMER, Chandigarh (2023-24).”

Subject’s Initials: _______________

Subject’s Name: _____________
Date of Birth / Age: _________________
Participant's initial
I confirm that I have read and understood the information sheet dated____ _______ for the above
study and have had the opportunity to ask questions.
I understand that my participation in the study is voluntary and that I am free to withdraw at any
time, without giving any reason, without my medical care or legal rights being affected.
I understand that the Sponsor of the clinical trial, others working on the
Sponsor’s behalf, the Ethics Committee and the regulatory authorities will not need my
permission to look at my health records both in respect of the current study and any further
research that may be conducted in relation to it, even if I withdraw from the trial. I agree to this
access. However, I understand that my identity will not be revealed in any information released
to third parties or published.
I agree not to restrict the use of any data or results that arise from this study provided such a use
is only for scientific purpose(s)
I agree to take part in the above study
Signature (or Thumb impression) of the Subject/Legally Acceptable
Representative : _________
Date: _____/_____/______
Signatory’s Name: ________________________________________
Signature of the Investigator: ____________________________
Date: _____/_____/______
Study Investigator’s Name: _________________________
 Annexure-III

Part(A)

Demographic Profile of child:-

1. Name of the patient …………………….

2. Age……………………………..

3. Gender
Male Female Other

4. CR Number ………. 5.Date………………..

6. Time……………….
7. Diagnosis……………
8. Height……………..
9. Weight…………….
10. BMI………………
11. First Medical Facility Visited……

12. Religion

Hindu Muslim Sikh Others

13. Number of family members

A)More than two……. B) More than four…….

14. Problem having

A) One leg……..B) both leg……………

Clinical Profile Of Child

1. Name of the patient …………………….

2. Age……………………………..
3. Gender
(a) Male. (b) Female. (c)Other.
4. CR Number ……….
5. Date………………..
6. Time……………….
7. Diagnosis……………
8. Height……………..
9. Weight…………….
10. BMI………………
11. First Medical Facility Visited……
12. Date of birth……
13 Type of delivery.
(a) NVD (b) C-section
14. Clubfoot is present in .
(a) One leg. (b) Both leg .
15. Date of surgery.
16.Type of cast .
17. Duration of casting.
 Part (B)
Demographic Data of the caregiver
Instructions:
Thank you for participation in this interview. This interview will help to assess the knowledge,
practices, burden and problems faced by the caregiver while attending the OPD for the treatment
of clubfoot. Your responses to the following questions are very important to us. Please answer
each question carefully and correctly. Your all given information will be kept confidential.
Participants name………………………………..

Age of the participant…………………….………….

What’s your gender?

Male Female Others

Relationship with child

Father Mother Other

1. Marital status

Married Divorced Widow

Unmarried Separated

2. Education status

High school Graduated

Secondary Others

3. Occupation
 Professional Unskilled
worker

Skilled worker Housewife

Specify any other

4. Religion

Hindu Muslim
Sikh
Other

5. Area of residence

Urban

Semi urban

Rural

6. Address _____________________ Mobile no. ___________

7. Type of family

Nuclear Extended Joint

8. Total number of family member?

9. Income (B.G.Prasad 2022)

Upper Class (8220 & Above)

Upper Middle Class (4110-8219)
Middle Class (2465-4509)
Lower Middle Class (1230-2464)
Lover Class<1230
 Part-C

Questionnaire to assess the knowledge regarding care of children undergoing

treatment for clubfoot deformity among their primary caregivers attending
Paediatric Orthopaedic OPD, PGIMER, Chandigarh

Q. Have you ever heard or read about club foot before it can be diagnosed in
your child?
Yes ☐ No☐
Heard from relative or friends.☐
Read in book/article.☐

Q. When did you come to know about that your child is affected from club
foot?
During pregnancy/ ANC visit.☐
After delivery☐
During first month of life☐

Q. To the best of your knowledge, what is the first line of treatment for club
foot?
Cast ☐Physiotherapy☐ Shoes☐
Surgery ☐ Splint ☐I don’t know☐

Q. To the best of your knowledge when clubfoot treatment be initiated?

Don’t know☐
Birth to first six months☐
First 6-12 months☐
1-4 years☐

Q. What do you think if this condition left untreated, can lead to which of
the following conditions?
Normal foot ☐ Painful foot ☐
Abnormal foot ☐ Unable to walk ☐

Q. Do you think that this condition is an isolated phenomenon or is

accompanied by other conditions? Isolated ☐
Accompanied by other conditions☐
I don’t know☐

Q. Does anyone in your family already have clubfoot or any other type of
congenital deformity?
Yes ☐ No☐
st
1 degree relative ☐ 2nd or 3rd degree relative.☐

Q. Do you think that this disease can be cured?

Yes ☐No☐
Don’t know ☐ Maybe.☐

Q. Do you think this disease is the result of some kind of bad deeds?
Yes ☐ No☐
Maybe ☐ Don’t know.☐

Q. Do you think your child is being treated properly or not?

Yes ☐
No☐ I think so ☐
Maybe☐
 Part: D

Checklist to assess the practice care of children undergoing treatment for clubfoot deformity
among their primary caregivers attending Paediatric Orthopaedic OPD, PGIMER, Chandigarh

Q. Change the position of the baby after 2 hours?

Yes.☐ No.☐

Q. Maintain baby hygiene?

Yes. ☐No.☐

Q. Care for cast?

Yes. ☐No.☐

Q. Problem faced in bathing the baby?

Yes. ☐No.☐

Q. You breastfeed your baby from time to time?

Yes.☐ No.☐

Q. Change your baby's diaper on time?

Yes. ☐ No.☐

Q.After the cast is applied, you put a pillow under the child's leg?
Yes.☐No.☐

Q. When the child is crying continuously for a long time, then you give him pain medication?
Yes.☐No☐

Q. check the color and temperature of the toes of the casted leg frequently?
Yes.☐No☐

Q. Do you face difficulty while changing your child's clothes?

Yes.☐ No☐

Part-E
 Modified Caregiver Strain Index to assess caregiver burden

MODIFIED CAREGIVER STRAIN INDEX

Directions: Here is a list of things that other caregivers have found to be difficult. Please put a
checkmark in the columns that apply to you. We have included some examples that are common
caregiver experiences to help you think about each item. Your situation may be slightly different,
but the item could still apply.

Yes, On a Yes, No=0

Regular Basis-2 Sometimes
=1

My sleep is disturbed
(For example: the person I care for is in and
out of Bedor wanders around at night)

Caregiving is inconvenient
(For example: helping takes so much time
or it's a long drive over to help)

Caregiving is a physical strain (For

example: lifting in or out of a chair;
effort or concentration is required)

Caregiving is confining
(For example: helping restricts free time
or I cannot go visiting)
There have been family adjustments
(For example: helping has disrupted
my routine; there is no privacy)
There have been changes in personal plans
(For example: I had to turn down a job; I could
not go on vacation)

There have been other demands on my time

(For example: other family members need me)
There have been emotional adjustments
(For example: severe arguments
about caregiving)

Some behavior is upsetting

(For example: incontinence; the person cared
for has trouble remembering things; or the
person I care for accuses people of taking
things)

It is upsetting to find the person I care for

has changed so much from his/her
former self (For example: he/she is a
different person than he/she used to be)

There have been work adjustments

(For example: I have to take time off for
caregiving duties)

Caregiving is a financial strain

I feel completely overwhelmed
(For example: I worry about the person I care
for; I have concerns about how I will manage)

Total Score =

[Sum responses for "Yes, on a regular basis" (2 pts each) and "yes, sometimes" (1 pt each)]

Through Proper Channel

To
The Convenor
Ethics Committee,
NINE, PGIEMR, Chandigarh.
Subject: Request for Ethical Clearance.
Sir,

With due respect, we the students of B.Sc. Nursing (post basic) 2 nd year, NINE, PGIMER,
Chandigarh arerequired to conduct a research study as per the syllabus requirement. The title of
our study is“A descriptive study on knowledge, practices, burden and problem faced
regarding care of children undergoing treatment for clubfoot deformity among their
primary caregivers attending Paediatric Orthopaedic OPD, PGIMER, Chandigarh
(202324)” The study shall be conducted in a group of five students(Nisha Kumari, Salma,
Shivani, Sumna, Varsha), Our guide is Mrs. Mandeep Kaur Tutor NINE PGIMER Chandigarh
and Co-guide is Dr Monika Tutor NINE PGIMER Chandigarh and Dr. G. Nirmal Raj Professor
Department of Orthopaedic PGIMER Chandigarh Kindly give us ethical clearance for the
research study. The protocol is attached herewith.

Yours faithfully
Nisha Kumari
Salma
Shivani
Sumna Devi
Varsha
B.Sc. Nursing (Post basic) 2nd year, NINE, PGIMER, Chandigarh.

32

Through proper channel

The Principal
National Institute of Nursing Education PGIMER,
Chandigarh.
Subject: Requesting Permission to conduct research study.

Madam

This is for your kind notice that we the students of B.Sc. Nursing (post basic) 2 nd year have
planned to conduct a research study entitled“A descriptive study on knowledge, practices,
burden and problem faced regarding care of children undergoing treatment for clubfoot
deformity among their primary caregivers attending PaediatricOrthopaedic OPD,
PGIMER, Chandigarh (2023-24)” for partial fulfilment of the degree of B.Sc. Nursing (Post
Basic). The study shall be conducted in a group of five students (Nisha Kumari, Salma, Shivani,
Sumna, Varsha), Our guide is Dr. Mrs. Mandeep Kaur Tutor NINE PGIMER Chandigarh and
Co-guide is Dr Monika Tutor NINE PGIMER Chandigarh and Dr. G. Nirmal Raj Professor
Department of Orthopaedic. The study will be conducted in the month of February 2024 and the
main data will be collected from……..This study will not hinder the patients care in any way and
will not cause any harm to the patient.
We humbly request you to kindly allow us to conduct the above mentioned study. Submitted for
your kind approval. Thanking you

Yours sincerely,
Nisha Kumari
Salma
Shivani
Sumna Devi
Varsha
B.Sc. Nursing (Post basic) 2nd year, NINE, PGIMER, Chandigarh.