JENEFA RESEARCH PROPOSAL-3.pptx for msc nursing 1st year

For msc

1. Research Proposal NAME OF THE INVESTIGATOR M.JENEFA SHINY Msc Nursing 1 ST YEAR

2. : . RESEARCH GUIDE : Mrs. Sophia Vijayananthan Professor College of nursing CMC, vellore CO-GUIDE : Mrs. Sheeba Rani Nelson Professor College of nursing CMC, vellore MEDICAL GUIDE : DR . Rohin M ittal Surgery II CMC vellore STATISTICIAN: DR . Grace R ebekha Dept.of statistics

3. Title of the study Effectiveness of virtual reality therapy on stress and pain among patients undergoing gastrointestinal surgeries.

4. INTRODUCTION The postoperative period is a crucial phase in the surgical continuum, beginning immediately after surgery and continuing until the patient has sufficiently recovered. It is generally presumed that the presence of post operative pain and stress adversely influences the patients experience of the perioperative period and negatively impacts the perioperative satisfaction

5. INTRODUCTION With the continuous development of technology virtual reality therapy serves as an emerging non- pharmacological treatment of pain relief (Ding et al., 2020). Virtual reality displays a simulation of a beautiful natural environment and can provide a non pharmacological analgesic effect( Maryo Yonatan Sengkeh & Chayati , 2021).

6. INTRODUCTION There are now multiple types of virtual kits available in the world of technology and affordable for anybody, though the costly types also exist. With the advancement of modern technology the various applications are now easily downloadable from play stores (Google play store, i-playstore ) and can be uploaded in a mobile or a computer system (laptop, desktop, tablet) which people can use as relaxation therapy sitting in the room even while resting on bed .

7. INTRODUCTION In this study semi immersive VR headset with android mobile inserted and used as non pharmacological adjuvant therapy to reduce post operative pain and stress experienced by patients.

8. SIGNIFICANCE of THE STUDY The global burden of abdominal surgeries is significant, with millions of procedures performed annually to address various medical conditions such as colorectal cancer, appendicitis, gallbladder diseases, and hernias. These surgeries, while often life-saving or essential for improving quality of life, are frequently associated with substantial postoperative pain and stress, which can impact patient recovery and overall outcomes.

9. SIGNIFICANCE of THE STUDY Ineffective pain and stress management can result increase in number of hospital stays, increased readmission rates, and higher healthcare costs. Moreover , poorly managed acute postoperative pain can transit into chronic pain creating long term challenges and significantly affect patients quality of life. Virtual Reality (VR) therapy represents a groundbreaking approach in the field of postoperative care, offering a non-invasive, drug-free alternative to traditional pain management techniques. This study aims to evaluate the efficacy of VR therapy in reducing postoperative pain and stress, contributing to the growing body of evidence supporting its use in clinical settings.

10. OBJECTIVES To assess pain and stress between experimental and control group of post operative patients who underwent gastrointestinal surgeries. To determine the effectiveness of virtual reality therapy by comparing the pre test post test scores of pain and stress with experimental and control group of post operative patients To determine the co-relation between pain and stress scores in the experimental and control group of post operative patients. To find the association between selected demographic variables and level of pain and stress in the control and experimental group of post operative patients. To find the association between selected clinical variables and level of pain and stress in the control and experimental group of post operative patients.

11. OPERATIONAL DEFINITION PAIN : It is a highly unpleasant sensory experience caused by a surgical procedure. It is assessed by Standardized Numerical Rating Scale. STRESS: It is a feeling of mental strain and pressure or any unpleasant emotion or feeling.It affects the well being of a person and the recovery process. It is assessed by Standardized Perceived S tress Scale .

12. Virtual Reality T herapy : It refers to generating a virtual environment or projection to create a realistic experience but does not exist in reality In this study: Semi Immersive Virtual Reality (only visual experience without physical movements ) is provided using a headset VR box. The therapy is given for 3 days for 15 to 20 minutes. Gastrointestinal Surgeries : Gastrointestinal surgeries encompasses surgical procedures that involve the gastrointestinal tract including the esophagus, stomach, smallintestine , large intestine and rectum.

13. HYPOTHESIS

14. ASSUMPTIONS Patients undergoing surgery not only have physical pain, but also have social and mental agony . Unmanaged Pain and stress can lead to post operative complications. Medications can provide relief ,but may be associated with undesirable side effects.

15. LIMITATIONS Study is confined to only patients undergoing gastrointestinal surgeries. Study period is limited to 6 weeks.

16. PROJECTED OUTCOME VR Therapy will lead to significant reduction in pain score and levels of stress in patients undergoing gastrointestinal surgeries. Patients receiving virtual reality therapy will report higher satisfaction with their Postperative care.

17. CONCEPUAL FRAMEWORK Callista Roy’s adaptation model

18. Input Throughput Output Focal stimuli Postoperative pain and stress Contextual stimuli Socio-demographic variables:- age ,gender, education ,occupation, support system avalaible . Clinical variables:- co-morbid illness, previous relaxation therapy, type of surgery, type of anesthesis , past relaxation therapies, previous hospitalization Residual stimuli Life experience, post operative complication . No reduction in pain and stress Reduction in pain and stress Self concept Physiological mode Role function Interdependence mode Virtual reality therapy Pretest to assess pain and stress Intervention group control group Posttest to assess pain and stress Feed back

19. AUTHOR YEAR PLACE STUDY TITLE RESEARCH DESIGN/ SAMPLE SIZE OUTCOME Apfelbaum et al 2014 US Postoperative Pain Experience: Results from a National Survey Suggest Postoperative Pain Continues to Be Undermanaged SURVEY METHOD using 250 samples Approximately 80% of patients experienced pain after surgery most of these patients had moderate, severe, or extreme which causes severe discomfort in the postoperative period

20. AUTHOR YEAR PLACE STUDY TITLE RESEARCH DESIGN/ SAMPLE SIZE OUTCOME Ugras et.al 2023 turkey The Effects of Virtual Reality on Preoperative Anxiety in Patients Undergoing Colorectal and Abdominal Wall Surgery. RCT with Eighty six patients were divided into the control group (n = 43) and in the experimental group (n = 43).  The VR application reduced Preoperative anxiety levels in the experimental group  (P < .001)  and changes in the SBP  (P < .001) , DBP ( P < .001 ), HR  (P < .001),  RR  (P = .041)  compared to the levels in the control group. VR applications can reduce psychological and physiological responses to PA in patients undergoing colorectal and abdominal wall surgery.

21. AUTHOR YEAR PLACE STUDY TITLE RESEARCH DESIGN/ SAMPLE SIZE OUTCOME Thippabathuni et al. 2023 India Effectiveness of Virtual Reality Environment for Post-Operative Pain Management Hospital based interventional study with 25 samples in each experimental and control group In the interventional group, the NRS scores showed a significant reduction after the VR session as compared to the pre-session scores. Also, majority of patients expressed their satisfaction in the VR session in terms of its relation and engagement. Majority expressed their willingness to undergo VR sessions in future. Thus, VR confers a clinical window for pain alleviation in post-operative patients.

22. AUTHOR YEAR PLACE STUDY TITLE RESEARCH DESIGN OUTCOME Jos luis et al. 2014 Belgium Virtual Reality for Pain Management in Cardiac Surgery Not clear Done with 67 patients Overall, the results of the therapy were positive Of the (88%) reported a decreased level of pain experienced post-therapy. The mean change in the Likert scale was 3.75, which corresponds to a decrease from ‘‘severe’’ to ‘‘moderate’’ or ‘‘moderate’’ to ‘‘light.’’ Physiologically, 25 patients (37.3%) experienced reduced heart rates, 35 (52.2%) experienced reduced mean arterial pressure, and 14 (64%) of 22 patients tested for respiratory rate experienced a reduction.

23. METHODOLOGY APPROACH Quantitative approach DESIGN True Experimental study SETTING The study will be conducted in selected surgical wards P1 ,P2,P3,06 East of CMC, Vellore. TARGET POPULATION Target population comprises patients who undergo gastrointestinal surgeries. ACCESSIBLE POPULATION In this study the accessible population is the group of patients who underwent GI surgeries at CMC, vellore and admitted in selected surgical wards P1, P2,P3,06 East.

24. SAMPLE patients who underwent GI surgeries at CMC, vellore and admitted in selected surgical wards (P1, P2,P3,06 east) and meet the inclusion criteria. SAMPLING TECHNIQUE Consecutive sampling technique

25. SAMPLE SIZE Sample size was calculated using the study done by Thippabathuni et al. Two Means - Hypothesis testing for two means Standard deviation in group I (Control Group) 0.866 Standard deviation in group II (Intervention group) 0.085 Mean difference 0.24 Effect size 0.504732 Alpha error (%) 5 Power (1- beta) % 80 1 or 2 sided Required sample size per group 103 Hence we need to study 103 Intervention group and 103 control group

26. SAMPLING CRITERIA Inclusion Criteria Patients who undergo GI surgeries Hospital stay of minimum 3 days following surgery Ability to understand and follow instructions Exclusion Criteria Prior sensitivity to VR technology Patient who has motion sickness,vertigo,active nausea and vomitting Hearing and visual impairments. Patients with claustrophobia Facial wounds at the site of application. Cognitive dysfunction that might impede the understanding of the study requirements Patients who have co-morbidity of seizure and epilepsy

27. Selection & Development of Study Instruments The instruments that used in the study are- SECTION A: A Structured performa to elicit the Demographic variables and clinical variables. SECTION B: Standardized numerical rating scale to assess pain SECTION C: Standardized perceived stress scale to assess stress

28. Demographic Variable Proforma In this study demographic variable proforma consisted of information relating to patient’s age, gender and education level, occupation ,support system available. Clinical Variable Proforma The Proforma consisted of information of participants regarding number of hospitalization, history of any medical illness, medications used for any major illness, duration of present illness, type of treatment undergoing presently, type of surgery, relaxation therapy used before etc.

29. Cohen et al’s Perceived Stress Scale It is a standardized tool for assessing the level of stress of patients. The instrument consists of 10 items to be answered by the participants on a rating scale form (scores =4, 3, 2, 1, 0). The responses include- never, never almost, sometimes, fairly often, very often. Score Interpretation <13 low stress 13-19 average stress >20 high stress

30. McCaffery Beebe Pain Rating Scale It is a numeric pain rating scale that indicates the intensity of current, best, and worst pain levels on a scale of 0 (no pain) to 10 (worst pain imaginable).

31. DATA COLLECTION PROCEDURE The investigator will first identify the patients who fulfil the inclusion criteria using consecutive sampling technique Establish a good rapport, explain the purpose of the study and get written informed consent Virtual reality therapy will be introduced in the preoperative period for the experimental group Using lottery method experimental and control group will be selected(List of 4 wards will be written in the lots- 2 for each group) to avoid contamination.

32. Intervention will be given for 3 days for 15 -20 minutes for the experimental group along with the standard care Post test will be obtained each day for both experimental and control group using McCaffery Beebe pain rating scale and Cohen et al’s Perceived stress scale and mean average will be calculated. Postoperatively once patient becomes hemodynamically stable Pre test will be conducted among patients in experimental and control group using Demographic variable proforma, Clinical variable proforma McCaffery Beebe pain rating scale and Cohen et al’s Perceived stress scale by self report questionnaire .

33. Data analysis All statistical analysis will be done using SPSS 21 VERSION Frequency and percentage distribution of demographic variables among the control and experimental group of Postoperative patients. Frequency and percentage distributions of clinical variables in control and experimental group of post operative patients. Frequency and percentage distributions of pain and stress scores in experimental group of postoperative patients before and after the VR therapy.

34. Data analysis Comparison of mean and standard deviation of pretest and posttest score of pain and stress in control and experimental group of postoperative patients Correlation between pain and stress in control and experimental group of postoperative patients after the VR therapy. Association between selected demographic variables and levels of pain and stress in control and experimental group of postoperative patients. Association between selected clinical variables and levels of pain and stress in control and experimental group of postoperative patients .

35. Pilot study Pilot study will be conducted for a period of one week to assess the feasibility of the study The pilot study will be done with 10% patients of each control and experimental group in postoperative wards of cmc vellore Based on the findings modifications will be made in the methodology

36. Ethical consideration The study will be conducted after the approval by the IRB and Research Committee, College Of Nursing CMC Vellore. A written informed consent will be obtained from the subjects. Data obtained from the subject will be kept confidential

37. Nursing implications NURSING PRACTICE Nurses can use VR as a relaxation techniques and pain relieving measures other than the usual pharmacological approach . Training programme can be arranged for the staff in hospital settings to improve awareness of the use of high technology like Virtual Reality in patient care module. In addition, the nurse as a team leader can plan, organize and coordinate activities for the patients, so that the physical and mental stress can be reduced and the complicated treatment will be easily adaptable for the patient

38. Budget plan For printing -2000 For dissertation paper-3000 Virtual reality kit-2500