This document describes a study protocol to evaluate the effectiveness of a planned teaching program for preventing pressure ulcers among fracture patients in a selected hospital in Bangalore. The study aims to provide patients and their family members with health education to improve knowledge on preventing pressure ulcers. A literature review found that pressure ulcer incidence is high for immobile patients like those with orthopedic fractures. Studies show prevention is better than treatment and nurses play a key role in educating patients and monitoring skin integrity. The planned teaching program aims to reduce pressure ulcer rates by empowering patients with knowledge on prevention.

1. A STUDY TO EVALUATE THE EFFECTIVENESS OF
PLANNED TEACHING PROGRAMME ON PREVENTION OF
PRESSURE ULCER AMONG FRACTURE PATIENTS IN
SELECTED HOSPITAL AT BANGALORE.
M.Sc Nursing Dissertation Protocol submitted to
Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka
By
Mrs. PRIYANKA LALAN
M.Sc NURSING 1ST
YEAR
2009-2011
Under the Guidance of
HOD, Department of Medical Surgical Nursing
National College of Nursing
Hegganahalli Cross
Vishwaneedam Post
Magadi Road
Bangalore –91

2. 6. BRIEF RESUME OF THE INTENDED
WORK
INTRODUCTION
“Diseases can rarely be eliminated through early diagnosis
or good treatment, but prevention can eliminate disease”
All around the world people are mobilizing to bring better health
conditions and health care —so that they can have a fighting chance to raise families,
grow communities, find meaningful work, and contribute to society. But often people
take health for granted and do not fully appreciates until it lost the meaning of health is
misunderstood and misinterpreted by many people. This is because of lack of complete
scientific information and poor instructions. It is subjective and abstract. Health
promotion and prevention enables individuals, families and communities to develop their
full health potential.
Maintaining skin integrity is important. A few client populations are
thought to be at greater risk of developing pressure sores because of immobility like
Orthopaedic clients with fractures, the elderly with femoral fractures and client in
nursing settings home settings. Studies in the latter have shown that the incidence of
pressure ulcers increases with length of stay.1
A pressure ulcer is an area of skin that breaks down when the client stays
in one position for too long without shifting the weight. This often happens if he uses, a
wheel chairs or he is bedridden, even for a short period of time (for example after
surgery, an injury). The constant pressure against the skin reduces blood supply to that
area and the affected tissue dies. The most common place for pressure ulcers are over
bong prominence (bone close to the skin) like the elbow, heals, hips, ankles, shoulders,
back and the occiput of the head.2
Pressure sores can develop in unexpected place assess the whole client
when determining pressure sore risk. Therefore in this case patients part is very essential
one and the nurses responsibility is giving health education to patients and his family
members. Research indicates that care giving is associated with biomarkers of chronic
stress. Therefore the investigator recognized the significance of giving a planned
teaching programme for patients to get adequate knowledge to prevent pressure ulcer.

3. Nurses play a major role in prevention of pressure ulcer, as she is the one
who early recognise the signs of pressure ulcer during patients stay in hospitals with
immobility or fracture. She should observe for the adequate integrity of the skin and
should encourage the patient to take all measurements to prevent ulcer with planned
teaching programme.3
6.1 NEED FOR THE STUDY
Pressure sores are common conditions among patients hospitalized in
acute- and chronic-care facilities. Prevention of pressure ulcer is always better than
treating the complication associated with it, with higher expenses. Pressure ulcer occurs
almost exclusively in people with limited mobility, so it is a challenge to prevent the
occurrence of pressure ulcer. When considering pressure ulcer prevalence defined as
number of clients with at least one pressure ulcer who exist in a client population at a
given point in time (WOCN, 2004).More that 1 million individuals develop pressure
ulcer each year (WOCN, 2003).Where there is a risk for pressure ulcer development
preventive interventions such as skin care practices, elimination of shear and positioning
are high priorities.4
The reported incidence of pressure ulcer in aute care facilities ranges from
2.7% to 29.5% and approximately 5-8% annually and 25-85% of these patients develop a
pressure sore at some time. The prevalence in acute care setting ranges from 3.5% to
29.5% and 2.4% to 23% in nursing homes and about 20% at home in people older than
65. Studies have suggested that, at any given time, 3-10% of hospitalized persons have
pressure sores and 2.7% develop new pressure sores.3
Among a selected population, the
incidence rate for the development of a new pressure sore has been demonstrated to be
much higher, with a range of 7.7-26.9%. Once again, the treatment of pressure sores in
this patient population represents a financial challenge, with an average cost per
admission of a patient with a pressure sore of $78,000 at one hospital.5
A study was conducted on pressure ulcer prevalence rates from 2002 to 2008 in German
long-term care facilities. The study group comprised of 18,706 residents in 218 long-
term care facilities (response rate 77.5%). Application of Chi-square tests, chi-square
trend tests and one-way ANOVA to assess differences and trends across the years. The
result shows that regarding gender, age, and pressure ulcer risk, the yearly samples were
comparable. Pressure ulcer prevalence rates decreased from 12.5% (year 2002) to 5.0%
(year 2008) (p<0.001). Prevalence rates, excluding non-blanch able erythema, decreased
from 6.6% (year 2002) to 3.5% (year 2008) (p<0.001).6

4. A study conducted on prevalence of pressure ulcers in hospitalised
patients in a university hospital in India. A total of 445 patients hospitalised in
medical and surgical wards were examined in a single day for the number, site and
grade of pressure ulcers. Haemoglobin, serum albumin and blood sugar levels of
patients with pressure ulcers were recorded. The result was the prevalence of
pressure ulcers was high (4.94%). Anaemia, malnutrition and diabetes were
important risk factors, while morbidity due to pressure ulcers in long-stay wards,
such as neurology, was exceptionally high (40.9%).7
There was a study to determine the quality of protocols for pressure
ulcer prevention in home care in the Netherlands with current pressure ulcer prevention
protocols from 24 home-care agencies were evaluated. A checklist developed and
validated by two pressure ulcer prevention experts was used to assess the quality of the
protocols, and weighted and unweighted quality scores were computed and analysed
using descriptive statistics. The results was 24 pressure ulcer prevention protocols had a
mean weighted quality score of 63.38 points out of a maximum of 100 (sd 5). The
importance of observing the skin at the pressure points at least once a day was
emphasized in 75% of the protocols. Only 42% correctly warned against the use of
materials that were 'less effective or that could potentially cause harm'.8
A study was done to implement and evaluate a heel pressure ulcer prevention
program (HPUPP) for orthopaedic patients in Canada. Program development of HPUPP
involved input from administrators, staff and adult patients on an orthopaedic service in
an academic tertiary care facility, located in a small urban centre in Canada. Prospective
evaluation was conducted. After the program was implemented, the incidence of heel
pressure ulcers was 0%, which was a significant reduction compared with pre-
implementation levels [13.8% (95% confidence interval 8-18%)].9
Pressure sores can develop in unexpected place assess the whole client when
determining pressure sore risk. As a nurse we have a greater role in preventing pressure
ulcer when the patient is hospitalized by giving positioning, checking their nutritional,
maintaining good skin care and cleaning therefore in this case patients part is very
essential one and the nurses responsibility is giving health education to patients and his
family members. Research indicates that care giving is associated with biomarkers of
chronic stress. Therefore the investigator recognized the significance of giving a planned
teaching programme for patients to get adequate knowledge on prevention of pressure
ulcer.10
6.2 REVIEW OF LITERATURE
A literature review is designed to identify related research, to set the
current research project within a conceptual and theoretical context. So that we can find
out that just about any worthwhile idea you will have has been thought of before, at least
to some degree. A literature review can be just a simple summary of the sources, but it
usually has an organizational pattern and combines both summary and synthesis. A

5. summary is a recap of the important information of the source, but a synthesis is a re-
organization, or a reshuffling, of that information. It might give a new interpretation of
old material or combine new with old interpretations. Or it might trace the intellectual
progression of the field, including major debates. And depending on the situation, the
literature review may evaluate the sources and advise the reader on the most pertinent or
relevant.11
The review of literature which support the study are given below:
A study was conducted “To estimate the frequency of use of pressure-
redistributing support surfaces (PRSS) among hip fracture patients and to determine
whether higher pressure ulcer risk is associated with greater PRSS use”. Patients (n =
658) aged >or=65 years who had surgery for hip fracture were examined by research
nurses at baseline and on alternating days for 21 days obtained .The result was a PRSS
was observed at 36.4% of the 5,940 study visits. The odds of PRSS use were lower in the
rehabilitation setting (adjusted odds ratio [OR] 0.4, 95% confidence interval [CI] 0.3-
0.6), in the nursing home (adjusted OR 0.2, 95% CI 0.1-0.3), and during readmission to
the acute setting (adjusted OR 0.6, 95% CI 0.4-0.9) than in the initial acute setting.12
A study had done “To identify care settings associated with greater
pressure ulcer risk in elderly patients with hip fracture in the post fracture period”.
Prospective cohort study was used. The result said that in 658 study participants, the
APU cumulative incidence at 32 days after initial hospital admission was 36.1%
(standard error 2.5%). The adjusted APU incidence rate was highest during the initial
acute hospital stay (relative risk (RR) =2.2, 95% confidence interval (CI) =1.3-3.7) and
during re-admission to the acute hospital (RR=2.2, 95% CI=1.1-4.2). The relative risks
in rehabilitation and nursing home settings were 1.4 (95% CI=0.8-2.3) and 1.3 (95%
CI=0.8-2.1), respectively.13
A study was conducted on “Malnutrition is a risk factor for development of
pressure ulcers (PU)”. Hip-fracture patients (n=103) were included in this double-blind,
randomised, placebo-controlled trial. They received 400 ml daily of a supplement
enriched with protein, arginine, zinc and antioxidants (n=51) or a non-caloric, water-
based placebo supplement (n=52). The result was the incidence of PU was not different
between supplement (55%) and placebo (59%), but incidence of PU stage II showed a
9% difference (difference: 0.091; 95% CI: 0.07-0.25) between supplement (18%) and
placebo (28%). Of patients developing PU 57% developed it by the second day. Time of
onset (days) showed a trend (P=0.090) towards later onset of PU with supplement (3.6+/-
0.9) than placebo (1.6+/-0.9).14
A study was conducted on “Hip fracture and pressure ulcers - the Pan-
European Pressure Ulcer Study - intrinsic and extrinsic risk factors”. Incidence of
between 8.8% and 55% have been reported. Consecutive patients with hip fracture in six
countries, Sweden, Finland, UK (North) and Spain, Italy and Portugal (South), were
included. The patients were followed from Accident and Emergency Department and
until discharge or 7 days. Of the 635 patients, 10% had PU upon arrival and 22% at
discharge (26% North and 16% South). The majority of ulcers were grade 1 and none

6. was grade 4. Cervical fractures were more common in the North and trochanteric in the
South. Waiting time for surgery and duration of surgery were significantly longer in the
South. Traction was more common in the South and perioperative warming in the North.
Risk factors of statistical significance correlated to PU at discharge were age >or=71 (P
= 0.020), dehydration (P = 0.005), moist skin (P = 0.004) and total Braden score (P =
0.050) as well as sub scores for friction (P = 0.020), nutrition (P = 0.020) and sensory
perception (P = 0.040). Co morbid conditions of statistical significance for development
of PU were diabetes (P = 0.005) and pulmonary disease (P = 0.006).15
A study done ,were to (i) investigate the incidence of pressure ulcers in
1997 and 1999 among patients with hip fracture, (ii) study changes of nursing and
treatment routines during the same period and (iii) to identify predictors of pressure ulcer
development. Comparative study was based partly on data collected in two prospective,
randomized, controlled studies conducted in 1997 and 1999. Patient with hip fracture, >
or = 65 years, admitted without pressure ulcers. Forty-five patents were included in 1997
and 101 in 1999. AS per the result, there was a significant reduction of the overall
incidence of pressure ulcers from 55% in 1997 to 29% in 1999. The nursing notes had
become significantly more informative.16
A study done on “Impact of prevention structures and processes on pressure
ulcer prevalence in nursing homes and acute-care hospitals.”A total of 7377 residents
in 60 nursing homes and 28,102 patients in 82 acute-care hospitals in Germany
participated in annual point prevalence surveys. The result was samples within the
arranged groups showed no clinically relevant demographical differences.
Nosocomial prevalence rates in hospitals dropped from 26.3% in the first year to
11.3% in the last year (nursing homes from 13.7% to 6.4%). The use of pressure
ulcer-related structures remarkably increased during each repetition to more than
90%.17
A study conducted on pressure ulcer prevalence and incidence of acute
care hospital.116 acute care facilities from 34 states participated and the sample of
17,560 patients in hospital –based medical-surgical or intensive care unit. The average
length of stay for the participating facilities was 5 days .The result was pressure ulcer in
7% of the subject (n-383)90% were stage I or II pressure ulcer and 73% occurred in
patients older than 65yrs.The most sites based on both prevalence and incidence
measurements were sacrum and coccyx at 26% and 31% respectively.18
A study done on “prevalence and incidence studies of pressure ulcer in
long term care facilities in Canada”, with 95 resident and other with 92 residents were
selected for study. Data were collected on demography, medication information and
possible contributing factors. The result was pressure of pressure ulcer in the 2 long term
facilities was 36.8% and 53.2% respectively. The incidence of pressure ulcer on the long
term care facilities was 11.7% and 11.6% respectively. The pressure ulcer prevalence is
higher than published figure for the long term care setting .The pressure ulcer incidence

7. of less than 2% in each facility suggests an equal and acceptable level of nursing care in
both facilities.19
A study conducted on “perception of pressure ulcer among young men with
spinal injury” .About 1000 younger people each year suffer a traumatic spinal cord
injuries that leaves them wholly or partly paralysised.The majority of these individuals
are males. The results suggest that there men were knowledgeable about pressure
management and highly motivated to look after themselves but there were an over
reliance on the specialist unit for support.20
An study done to “assess selected factors relation to pressure sores among
immobilized patients of St.John Medical College and hospital Bangalore, with view of
developing standard protocol for its prevention”. Data was obtained from 50
immobilized patients or their care givers who were admitted emergency ward ICU .The
finding of the study revealed that a proportion of 6.75% patients developed pressure
sores during the 40 days of the study. The knowledge and opinion of the immobilized
patient who developed pressure sores and who did not developed pressure sores was not
significant. The knowledge and opinion of the nursing personnel regarding pressure
sores and its prevention were not satisfactory despite the fact that it has been taught to
them during their courses of training. Based on the finding of the study, the major
implication for the study was that knowledge of nursing personnel in relation to pressure
sores need to be refreshed and updated.21
A study done on “reduction of nosocomial pressure ulcer in patients with hip
fracture a quality control programme”. The nursing quality improvement unit of Israel’s
Hadassah mount Scopus medical centre designed and implemented a quality
improvement intervention programme to reduce the incidence of nosocomial pressure
ulcer. Assessing that, it was found that 46.7% of nosocomial pressure ulcer develops in
patients with hip fracture. First intervent programme included providing each with visco-
elastic mattress and a cushion for the elevation of the affected limb. This programme
conducted in orthopaedic ward and in recovery room, pressure ulcer relieving practices
were introduced following the implement of intervention programme, it is revealed in the
incidence of nosocomial pressure ulcer from 12.9% to 9% results of the study reveals the
patients with hip fracture are still at very high risk of developing nosocomial pressure
ulcer , prevention is feasible.22
A study conducted for “evaluation of an evidenced based programme for
pressure sore prevention”. The purpose of the study was to implement and evaluate a
standardised workshop for and two levels of nursing staff. A quasi experimental design
was used. The convenient sample included registered nurses (n=595) and licensed
practioner nurses (n=59) employed in there acute care hospital with a total bed capacity
of 1760. The questionnaire was pilot test, before use pre-test post- test with three month
duration. Data was analysed using descriptive statistics. The result was general
knowledge course for the total groups were significantly higher. The evidence based
pressure ulcer education was effective increasingly in registered nurses and licensed
practical nurses knowledge.23

8. A study done on “knowledge of pressure ulcer by under graduate nursing
students in Brazil”. Third and fourth year undergraduate baccalaureate students at a
public university in a Brazil CN= 38 were asked to provide demographic information,
identify extracurricular activities and complete the pressure ulcer knowledge test.
Students correctly answered 67.71 of the pressure ulcer knowledge list items. The result
was students who participated in extracurricular activities and used the internet had
significant impact on knowledge test score. Generally the students were found to have
low pressure ulcer knowledge.24
A study conducted on “effectiveness of Individual Planned Teaching to the
care givers on prevention of pressure sore in bed ridden patients admitted to Fr Muller
Medical College Hospital, Mangalore”. A quasi experimental approach with one group
pre-test and post-test adopted for study a sample of 30 care givers of 30 bedridden
patients. They were selected by using convenience sampling technique. The result was
most of the caregivers (63%) had no prior experience of staying with the patients in the
hospital. Majority (90%) of caregivers had a very good knowledge scores (81-100%) in
the post test. The mean difference between post-test and pre-test knowledge scores on
prevention of pressure sores which was found to be significantly high (29) =
(p<0.05)92.25
6.3 STATEMENT OF PROBLEM
“A study to evaluate the effectiveness of planned teaching programme on
prevention of pressure ulcer among fracture patients in selected hospital at
Bangalore.”
6.4 OBJECTIVES OF STUDY
• To assess the level of knowledge regarding prevention of pressure ulcer among
fracture patients in selected hospital at Bangalore
• To determine the effectiveness of planned teaching programme regarding
prevention of pressure ulcer among fracture patients in selected hospital at
Bangalore
• To find the association between post test knowledge scores with selected
demographic variables i.e. age, sex, education, occupation, type of diet and place
of residence.
6.5 HYPOTHESIS

9. H1: The mean post-test knowledge score will be significantly higher than
pre-test knowledge score regarding prevention of pressure ulcer among fracture
patients.
H2: There will be significant association between knowledge scores with
selected demographic variables such as age, sex, education, occupation, type of
diet and place of residence.
6.6 OPERATIONAL DEFINITION
Evaluate : The term evaluate refers to assessing the effectiveness of planned
teaching programme regarding pressure ulcer pre-test and post-test.
Effectiveness : it refers the extent to which the of planned teaching programme has
achieved the desire effect as measured by gain in knowledge score.
Planned teaching programme : it refers to information providing pressure ulcer
which includes definition, causes, its sign and symptoms, stages, treatment,
prevention, complication and nurse’s responsibility.
Prevention : includes primary and secondary measures adopted to protect patients
from developing pressure ulcer.
Pressure ulcer : it is localized area of tissues necrosis caused by unrelieved
pressure, tissue layers sliding over other tissue layer, shearing and excessive
moisture.
Fracture: it is the disruptions or break in the continuity of structure of bone.
6.6 ASSUMPTIONS
The study assumes that:
1. Fracture patients need reinforcement of knowledge and practice regarding prevention
of pressure ulcer

10. 2. Planned teaching programme will enhance their knowledge in further.
6.8 DELIMITATIONS
1. Data collection period will be for 4 weeks
2. Sample size is 60
6.9 PROJECTED OUTCOME
Planned teaching programme will improve knowledge and they will practice the
preventive measures such as positioning, skin care, diet and exercises.
7.0 MATERIALS AND METHODS
7.1 SOURCE OF DATA
 Patients who are admitted with fracture.
7.1.1 RESEARCH DESIGN
 Pre-experimental design.
 One group pre-test and post-test.
Research approach
 Evaluative approach will be used for the study.
7.1.2 SETTING OF THE STUDY
 K.C General Hospital at Malleswaram
7.1.3 POPULATION

11.  Patients who have fracture
7.2 METHODS OF COLLECTION OF DATA
• Structured Interview Schedule will be used to assess the knowledge
regarding prevention of pressure ulcer among fracture patients in selected
hospital at Bangalore.
• Interview will be conducted between 9am to 3pm.Data will be collected
from 6 patients per day. The duration of 30 minutes will be spend per each
subject.
• The duration of the study will be 4weeks. In the first 2 weeks pre-test will
be conducted and structured teaching programme will be given and then
for the next 2weeks post-test will be conducted.
7.2.1 SAMPLING TECHNIQUE
 Convenient sampling technique will be used for this study.
7.2.2 SAMPLE SIZE
 The sample size is 60
7.2.3 INCLUSION AND EXCLUSION CRITERIA
INCLUSION CRITERIA:
• Who are having fracture.
• Who are willingly participate in the study
• Those who known English and Kanada
EXCLUSION CRITERIA:
• Patients with complication
• Patients will skull, humerus fracture.

12. • Patients with pressure ulcer.
7.2.4 DATA COLLECTION TOOL
Questionnaire which contains section A and section B
SECTION A: consists of demographic variables like age, sex, education, occupation,
type of diet and place of residence.
SECTION B: Questionnaire will be used to assess the knowledge regarding prevention
of pressure ulcer using 25 questions.
SCORING PROCEDURE
 For correct answer score will be given as 1.
 For incorrect answer score will be given as 0.
* Score 1 will be given for agree
* Score 0 will be given for disagree
Based on the score knowledge level will be classified into:
 75% to 100% - adequate
 50% to 75% - average
 Below 50% - inadequate
7.2.5 DATA COLLECTION METHODS
 Prior permission will be obtained by the significant authorities and from the
subject. The investigator will use questionnaire to assess the knowledge regarding
prevention of pressure ulcer among fractured patients.
 Interview will be conducted between 9am to 3pm.Data will be collected from 8
patients per day. The duration of 30 minutes will be spending with per each
subject.

13.  The duration of the study will be 4weeks. In the first 2 weeks pre-test will be
conducted and structured teaching programme will be given and then for the next
2weeks post-test will be conducted.
7.2.6 PILOT STUDY PLAN
6 samples will be taken and study will be conducted to find out the feasibility.
7.2.7 DATA ANALYSIS METHOD
The data collected from garments where be grouped and by statistical measures in terms
of objectives.
1. Number and %distribution to explain demographic variables and knowledge level.
2. The significance of relationship between the selected demographic variables and
knowledge scores will be analyzed by using chi square
7.3 DOES THE STUDY REQUIRE ANY INTERVENTION TO
BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR
ANIMALS:
 YES
7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED
FROM YOUR INSTITUTION? PERMISSION WILL BE
OBTAINED FROM:
• YES, ethical clearance will be obtained from the research committee of
NATIONAL College of Nursing.
• Consent will be taken from the District Medical Officer and study subjects before
data collection.

14. 8.0 LIST OF REFERENCES
1. Smeltzer.C.Suzanne,Bare Brenda G “Medical Surgical Nursing”, 10th
edition,
2004, Lippincott Williams and Wilkins, pg:175-177.
2. Black.M.Joyce, “Medical Surgical Nursing. Clinical Management For Positive
Outcomes”, 7th
edition, 2005, Elsevier Missouri, pg:1403.
3. Ingnataricius.D.Donna et.al , “Medical Surgical Nursing. A Nursing Process
Approach”, 2nd
edition, 1995, W.B.Saunder Company Philadelphia, 1935-1944.
4. Perry. Potter, “Fundamentals of Nursing”, 7th
edition, 2009, Elsevier Missouri,
pg:1228-1231
5. Bradon J Wilhelmi, “Pressure Ulcers ,Surgical Treatment and
Principles”Southern Illinois University School of Medicine, 2010
6. Lahmann NA, Dassen T, Poehler A, Kottner J, “Pressure ulcer prevalence rates
from 2002 to 2008 in German long-term care facilities”, Department of Nursing
Science, Berlin, Germany, 2010 Apr;22(2):152-6.
7. Chauhan VS, Goel S, Kumar P, Srivastava S, Shukla VK, “The prevalence of
pressure ulcers in hospitalised patients in a university hospital in India”,
Department of General Surgery, Institute of Medical Sciences, Banaras Hindu
University, Varanasi, India,2005Jan;14(1):36-7.
8. Chaves LM, Grypdonck MH, Defloor T, “Protocols for pressure ulcer
prevention: are they evidence-based?”, University Medical Centre Utrecht,
Utrecht University, Utrecht, The Netherlands, 2010 Mar;66(3):562-72.
9. Campbell KE, Woodbury MG, Houghton PE, “Implementation of best practice in
the prevention of heel pressure ulcers in the acute orthopedic population”,
London Health Sciences Center, London, Ontario, Canada, 2010 Feb;7(1):28-40.
10. Nettina, Sandra M. (2001). The Lippincott Manual of Nursing Practice, 7th Ed.
Philadelphia:Lippincott,WilliamsandWilkins.
11. Anson, Chris M. and Robert A. Schwegler, “The Longman Handbook for Writers
and Readers”, Second edition, New York: Longman, 2000.
12.Baumgarten M et.al, “Use of pressure-redistributing support surfaces among
elderly hip fracture patients across the continuum of care: adherence to pressure
ulcer prevention guidelines”, Department of Epidemiology and Preventive
Medicine University of Maryland School of Medicine, USA. 2010
Apr;50(2):253-62.

15. 13.Baumgarten M et.al, “Use of pressure ulcers in elderly patients with hip fracture
across the continuum of care”, Department of Epidemiology and Preventive
Medicine, University of Maryland School ofMedicine, Baltimore, 2009
May;57(5):863-70.
14.Houwing RH et.al “A randomised, double-blind assessment of the effect of
nutritional supplementation on the prevention of pressure ulcers in hip-fracture
patients”, Department of Dermatology, Deventer, The Netherlands. 2003
Aug;22(4):401-5.
15.Lindholm C, et.al “Hip fracture and pressure ulcers - the Pan-European Pressure
Ulcer Study - intrinsic and extrinsic risk factors”, Department of Health Sciences,
KristianstadUniversity,Sweden,2008Jun;5(2):315-28.
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fractures: a 2-year follow-up of quality indicators”, Department of Public Health
and Caring Sciences, Section of Caring Sciences, Uppsala University, Sweden.
2001 Oct;13(5):399-407.
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hospitals”,Department of Nursing Science, Berlin, German. 2010 Feb;16(1):50-6.
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21. Ms.Sara Ommen “Assess selected factors relation to pressure sores among
immobilized patients of St.John Medical College and hospital Bangalore, with
view of developing standard protocol for its prevention”, ( Unpublished Masters
of nursing Dissertation ,Rajiv Gandhi University of Health Science,Bangalore,
Karnataka)2000
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16. 25.Ms.Diana Lobo“effectiveness of Individual Planned Teaching to the care givers
on prevention of pressure sore in bed ridden patients admitted to Fr Muller
Medical College Hospital, Mangalore”( Unpublished Masters of nursing
Dissertation ,Rajiv Gandhi University of Health Science,Bangalore,
Karnataka)2004.
9 SIGNATURE OF THE CANDIDATE
10 REMARKS OF THE GUIDE
11 NAME AND DESIGNATION OF
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.3 SIGNATURE
11.5 HEAD OF THE DEPARTMENT
11.6 SIGNATURE
12 12.1 REMARKS OF THE PRINCIPAL

17. 12.2 SIGNATURE