A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF HOT COMPRESSION VERSUS COLD COMPRESSION IN TERMS OF REDUCING PHLEBITIS DUE TO INTRAVENOUS INFILTRATION AMONG PATIENTS, IN THE MEDICAL AND SURGICAL WARD OF SELECTED HOSPITAL GURUGRAM.

(1)

113

International Journal in Management and Social Science http://ijmr.net.in, Email: [email protected] A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF HOT COMPRESSION VERSUS COLD COMPRESSION IN TERMS OF REDUCING PHLEBITIS

DUE TO INTRAVENOUS INFILTRATION AMONG PATIENTS, IN THE MEDICAL AND SURGICAL WARD OF SELECTED HOSPITAL GURUGRAM.

Ms. Sonika Chauhan , Prof.Sheuli Sen, Dr. Bhartendra Sharma

M.Sc.nursing 2nd year (Medical Surgical Nursing) Professor, Associate professor

Abstract

The purpose was to explore the effectiveness of hot compression versus cold compression and compare the effectiveness on phlebitis.A quasi-experimental equivalent time series design was used for the study .Conceptual framework of the study was Ladwig Von Bertanlanlaffy System Model. The population was 20-50 years of age of sick adults getting intravenous medicine at medical and surgical ward in Civil Hospital Gurugram .Non probability purposive sampling technique was used for selected subject. The sample comprised of 60 sick adults 20-50 years of age getting intravenous medication with phlebitis. The tool used were record analysis of selected variable and standardized phlebitis grading scale of Infusion nurses society standard practice 2011 .Data were collected through interview schedule and assessment method.

Major findings of the study:

(2)

114

International Journal in Management and Social Science http://ijmr.net.in, Email: [email protected]

in that study group I, the post test mean score and SD of hot compression and cold compression (.8677±.628 ;.3000± .534).This was compared by independent t test which project t value is 1.672 which was statically significant at p>o.oo1 level. The computed t value shows that there was a significant decrease in level grade of phlebitis score after the application of cold compression

Conclusion: Hot compression and cold compression are both effective but cold compression is highly effective to reduce phlebitis. By practicing this technique routinely nurses can contribute to improve patients comfort level by reducing the intervention phlebitis.

Key words; Effectiveness, Hot compression, cold compression, phlebitis.

Background of the study:

Peripheral endovenous (I.V.) cannulisation is associate invasive procedure that predisposes the patient to associate accrued risk of native and general infection from micro-organisms introduced either at the time of insertion or when in situ. Peripheral I.V. cannula related infections are associated with increased morbidity, prolonged hospitalization and increased costs. Infections are most commonly caused by Staphylococci. The predominant source of these micro-organisms is likely to be from the patient’s endogenous flora colonizing the skin or from the hands of the health care practitioner.

PURPOSE OF THE STUDY:. The purpose was to explore the effectiveness of hot compression versus cold compression and compare the effectiveness on phlebitis

OBJECTIVES OF THE STUDY:

1) To determine the severity of phlebitis among the adult measured by phlebitis grading scale.

2) To determine the effect of hot compression on the phlebitis.

3) To assess the effect of cold compression on the phlebitis.

4) To compare the effectiveness of hot compression versus cold compression on phlebitis due

To intravenous infiltration among patients receiving intravenous infusion.

ASSUMPTIONS:

1) Patient’s receiving intravenous fluid infusion are at risk to develop intravenous infiltration.

2) Peripheral infusion may cause phlebitis due to mechanical as well as chemical interference

VARIABLES:

(3)

115

Dependent Variable: Presumed effect is the dependable variable; in this study dependent variable is phlebitis in term of pain, edema, and erythema palpable venous cord and streak formation.

Extraneous Variables: Age of the patient ,Type of Intravenous fluid infusion ,Duration of intravenous cannulation, Type of intravenous fluid

HYPOTHESES:

All the Hypotheses were tested at 0.05 level of significance

H1: There will be significant difference in reduction of mean phlebitis assessment score in experimental group I after the application of hot compression.

H2: There is significant difference in reduction of mean phlebitis assessment score in experimental group II after the application of cold compression.

H3: There will be a significant difference in the effectiveness of hot compression versus cold compression in reducing the signs and symptoms of intravenous cannulation induced phlebitis among the patients.

CONCEPTUAL FRAMEWORK:

DELIMITATION OF THE STUDY:

Male and female in the age group of 25- 50 years of age having phlebitis

(4)

116

Those who have phlebitis

RESEARCH METHODOLY

Fig 2: Flow chart of Research Methodology:

SYMBOLIC REPRESENTATION OF RESEARCH DESIGN

0 hour 12th hour 24th hour 36 the hour 48th hour 60th hour 72 the hour

EXP-I O1X1.1 O2x1.2 O3X1.4 O4X1.4 O5x1.5 O6X1.6 O7X1.7

EXP-II O1X2.1 O2x2.2 O3X2.4 O4X2.4 O5x2.5 O6X2.6 O7X2.7

Fig3: Schematic Representation of Research design

Interpretation of the symbol

O1,O2,O3,O4,O5,O6 Observation of phlebitis at 0 hour,12th hour,24th hours ,36th hours.48th hour,60th hour,72th hour respectively

XI-Treatment with hot compression at 0 hour,12th hour,24th hours ,36th hours.48th hour,60th hour,72th hour respectively

X2- Treatment with hot compression at 0 hour,12th hour,24th hours ,36th hours.48th hour,60th hour,72th hour respectively

Experimental X1-Hot compression

Experimental X2-Cold compression

Research APPROACH –Quasi Experimental

Research design –Time series Design

Setting of the study- Medical and surgical ward of Civil hospital Gurugram

Population of the study –adult from 20-50 years of age

Sampling Technique –Purposive sampling technique

(5)

117

Tool Number Name of the tool Variables Techniques

Tool-I(A) Structured Interview

Schedule for obtaining demographic data

Demographic Variable

Questioning and analysis

Tool-I (B) Interview Schedule on

selected variable

Selected Variable Record Analysis

Tool-II Standardized Phlebitis

grading Scale

Status of the phlebitis

Observation and Assessment (Infusion Nurses Society)

Methods of data collection:

The necessary approval has been obtained .

Ethical permission from the respective Hospital.

Informed consent has been obtained from every subject based on the inclusion criteria who be included in the study after explaining the aim of the study and assuring them of the confidentiality of collected data .

A pilot study will be conducted on (10) each for experimental groups to test the tools for its clarity ,organization ,applicability and to determine the length of time needed to collected data.

FINDINGS OF THE STUDY:

Section 1: Description of the sample characteristics by frequency percentage

0 0.1 0.2 0.3 0.4 0.5 0.6

AGE 20-25 26-30 31-35 36-40 41-45 46-50

23% 28%

14% 17%

6% 12%

23%

33%

12% 17%

6% 12%

cold compression

(6)

118

Fig 4: Pyramid diagram showing percentage distribution of age of the sick adults with phlebitis.

Fig 5: Bar diagram showing percentage distribution of sex of the sick adults with phlebitis in group-I and group –II

0% 20% 40% 60% 80%

hot compression cold compression

43%

0%

37%

57% 63%

male

Female

40%

27% 33%

0% 24%

13%

3%

27%

0 0.1 0.2 0.3 0.4 0.5

Duration of hospital

staying

1-3 days 4-6 days 7-9 days 10 above

hot compression

(7)

119

Fig 6:Bar diagram showing percentage distribution of duration of hospital staying among sick adults with phlebitis in group-I and group –II

Fig 7:Pyramid diagram showing percentage distribution cause of hospitalization among sick adults with phlebitis in group-I and group –II

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7

3% 37%

30%

30% 27%

16% _33% _23%

cold compression

hot compression

0 0.1 0.2 0.3 0.4

40%

23% _20% _17%

40% 40%

20% 0%

hot compression

(8)

120

Fig 8:Cylindrical diagram showing percentage distribution type of fluid among sick adults with phlebitis in group-I and group –II

Fig 9:Cylindrical diagram showing percentage distribution duration of fluid among sick adults with phlebitis in group-I and group –II

Section-2: Evaluation of severity of phlebitis as measured by phlebitis grading scale

0 0.1 0.2 0.3 0.4 0.5 0.6

Duration of IV fluid

1-4 hours 5-8 hours 9-12 hours Abve 12 hours 7%

23%

57%

13% 10%

57%

13% 20% Hot compression

cold compression

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

0%

30%

43%

23%

0% 0%

23%

43%

33%

0%

pre hot compression

(9)

121

Figure 10: Bar diagram showing that before receiving hot compression 13(43%) adult had grade 2 phlebitis. Whereas before receiving the cold compression 13(43%) of adult have

grade 1 phlebitis

Figure 11 : This bar diagram showing that after receiving of hot compression 18(60%) of adult have grade 1 phlebitis ,whereas after receiving the cold compression 22(74%) of adult have grade 1 phlebitis

Section 3: Findings related to determine effect of hot compression on grade of phlebitis and pain score among adult patient before and after receiving of hot compression.

N=30

Group

Mean ± SD

Mean difference

Standard error mean

Paired ‘t’

df P value Table ’t’ value

Pre hot compression

2.1±.758

1.23 0.78 15.7 29 .00 1.69

Post Hot

compression

.8677±.628

**Significant at .001 level, ’t’ (29) =1.69 ,p≤.00 level

Table depicts that comparison of mean of post test of grade of phlebitis score is lower then the pretest score .This was compared by using paired t test which project t value is 1.69 .Which was statically significant at p<.001 level .The computed t value shows that there was a significant decrease in level of phlebitis score after the application of hot compression.

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8

0 0%

13%

60%

26%

0% 0% 3%

23% 74%

Post Hot Compression

(10)

122

Section 4: Findings related to determine effect of cold compression on grade of phlebitis and pain score among adult patient before and after receiving of cold compression

N=30

Group Mean±S D

Mean difference

Standard Error mean

Paired ‘t’

df P value Table ‘t’ value

Pre cold

Compression

1.9±.758 1.60 .189 8.44 29 .000 1.69

Post cold compression

.300±.53 4

**Significant at 0.0001 level ’t’ (29) =1.69 ,p≤.000 level

Table depicts that comparison of mean of post test of grade of phlebitis score is lower than the pretest score .This was compared by using paired t test which project t value is 1.69 .Which was statically significant at p≤ .00 levels. The computed t value shows that there was a significant decrease in level of phlebitis score after the application of hot compression.

Section 5: Findings related to compare the effectiveness of hot and cold compression on grade of phlebitis and pain score among adult patient before and after receiving of hot compression.

N=60

Group Mean±SD Mean difference

Standard Error

Mean

Paired ‘t’

D f

P val ue

Table ‘t’ value

Post hot compression

.8677±.628 .566 .157 3.75 5

8

.00 1.67

Post cold compression

.3000±.534

(11)

123

Table signifies that comparison of mean, SD, of post –test phlebitis score between both groups1 and II who received hot compression and cold compression. Data depicts in that study group I, the post test mean score and SD of hot compression and cold compression (.8677±.628 ;.3000± .534).This was compared by independent t test which project t value is 1.672 which was statically significant at p>o.oo1 level. The computed t value shows that there was a significant decrease in level grade of phlebitis score after the application of cold compression.

Conclusion: In study both hot compression and cold compression are both effective but cold compression is more effective in reduce phlebitis.

Limitation: 1)The study was confined to a specific geographical area which imposes limit for generalization.

2) Limit sample size.

Recommendation:

1) The same study can be conducted on a larger sample over a longer period of time to increase the generalizability.

2) The same study can be conducted in different settings such as nursing homes, community centers.

3) The same study can be conducted in pediatrics and old age people.

4) A study can be conducted to find out the long term effects of painful.

REFERENCES:

1. Chowdhary Roy SS. Textbook of Nursing Research Methods and Application 7th Edition

.JB Lippincott Company. 2004: 293-298.

2. Polit DF, Hungler B.P Essential of Nursing Research –Method and application.7th

edition. JB Lippincott Company; 2004:290-291.

3. Burns N, Groove SK.The practice of Nursing Research, 3rd Edition W.B Saunders

Company 1997: 34.

4. Indryan A. Basic Methods of Medical Research .3rd edition AITBAS Publishers, India;

2013: 370-390.

5. Polit DF, Beck TC. Nursing analysis generating and Assessing proof for nursing observe.

8th Edition. Wolter Kluwer (India) pvt .ltd. 2011:340.

6. Burns N, Groove SK. The practice of Nursing Research.3rd Edit W.B Company 1997: