A Study to Assess the Knowledge of Nurses in Early Identification of Deep Vein Thrombosis among Post-Operative Patients

@ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 51 Global Journal of Research in Medical Sciences ISSN: 2583-3960 (Online) Volume 05 | Issue 05 | Sept.-Oct. | 2025 Journal homepage: https://gjrpublication.com/gjrms/ Research Article A Study to Assess the Knowledge of Nurses in Early Identification of Deep Vein Thrombosis among Post-Operative Patients Harini 1, Thaslima 2, *Gayathri. I. V 3, Vinuthna 4, Sunita Mitchel Domingo 5, Mini Jose 6, Maryline Flinsi 7 1,2 Registered nurse, Apollo hospital jubilee hills 3 Deputy clinical nursing lead, Apollo hospital jubilee hills 4 Oncology in charge, Apollo hospital jubilee hills 5 Regional nursing director Apollo Telangana region 6 Nursing Superintendent, Apollo hospital jubilee hills 7 Principal Apollo school of nursing Delhi *Corresponding author: Gayathri. I. V Deputy clinical nursing lead, Apollo hospital jubilee hills ORCID ID: 0009-0001-8526-603X Introduction: Venous thromboembolism (VTE) constitutes a significant risk factor for the majority of hospitalised individuals. Annually, six European nations report 500,000 occurrences of DVT and 300,000 cases of PE. The national database of the USA indicates 7.1 DVT cases per 1,000.2. Korean postoperative patients have 20.9 occurrences of VTE per 1,000.3 individuals. Regional trauma, hypercoagulability, and lower extremity vascular wall constriction cause deep vein thrombosis. Local pain, swelling, discolouration, and warm skin are symptoms of DVT, although USG and venography Abstract Background: Deep Vein Thrombosis (DVT) is a frequent and potentially life-threatening postoperative complication that can lead to pulmonary embolism and long-term morbidity. Nurses play a critical role in the early identification, prevention, and management of DVT. Objectives: This study aimed to assess the baseline knowledge of nurses regarding the early identification of DVT among postoperative patients and to evaluate the effectiveness of a structured educational intervention. Methods: A prospective observational study was conducted among 100 nurses from oncology and general wards of a tertiary care hospital between March and September 2025. A validated questionnaire with 20 multiple-choice questions was used to assess knowledge of DVT risk factors, signs, and prevention strategies. Knowledge levels were categorized as Poor (1–6), Average (7–13), and Good (14–20). Nurses scoring ≤13 underwent a 10-minute educational session, followed by reassessment. Data were analysed using descriptive statistics, ANOVA, and paired t-tests. Results: At baseline, 76% of nurses demonstrated good knowledge, while 24% scored in the average range. None scored poorly. Nurses with average scores showed significant improvement after the educational intervention (mean score pre-test: 14.83 ± 2.61 vs. post-test: 17.75 ± 1.25, p < 0.05). Knowledge improvement was consistent across demographic variables including age, experience, and department. Conclusion: While most nurses demonstrated good baseline knowledge, gaps remained in risk assessment tools and preventive strategies. A brief structured educational session significantly improved knowledge, underscoring the importance of continuous professional development. Integrating DVT training into undergraduate nursing curricula and in-service education programs is recommended to enhance patient outcomes. Keywords: Deep Vein Thrombosis (DVT), Venous Thromboembolism (VTE), Postoperative care, Nursing education, Knowledge assessment. Global J Res Med Sci. 2025; 5(5), 51-58 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 52 should diagnose it. DVT can produce long-term posttraumatic syndrome or chronic venous insufficiency, lowering quality of life and raising health costs4,5. DVT risk factors include age, stroke or paralysis, immobility, cancer therapy, obesity, heart dysfunction, varicose veins, a central venous catheter, inflammatory bowel disease, pregnancy, oestrogen use, and nephrotic syndrome. Lower extremity DVT is usually caused by major surgery (hip, leg, pelvic fracture, etc.)6,7. DVT risk should be reduced by starting pharmacological and mechanical prophylaxis 24 hours before surgery8. Early mobility and anti-embolism stockings are recommended for low-risk patients postoperatively. Patients at moderate risk should also get intermittent pneumatic compression (IPC) and anticoagulants. High-risk patients need medication6. Surgical nurses are crucial to DVT prevention9,10,11. DVT risk factors should be identified and treatment given upon arrival. The Operating Room Safe Surgery Checklist determines if DVT prophylaxis is needed “before the surgical incision”12. After surgery, nurses monitor DVT symptoms, let patients move, teach them deep breathing and coughing movements, and educate them how to use elastic compression stockings and IPC devices13.Since DVT is a common surgical complication, nurses should utilise several scales to identify risk factors also to identify the patients who are not on DVT prophylaxis post-surgery. This study was done to assess nurses' knowledge of early DVT detection in post-operative patients and to evaluate the effectiveness of a structured educational intervention. Aims and Objectives 1. To assess the baseline knowledge of nurses regarding DVT identification 2. To evaluate the effectiveness of a structured educational session on improving DVT knowledge among nurses. Materials and Methods: This prospective observational study was conducted at Apollo Hospitals, Jubilee Hills, from March to September 2025. The study was done after approval from Institutional Ethics Committee with approval number. A total of 100 nurses working in departments such as Oncology, Regency wards, and general wards were selected using purposive sampling. The study aimed to assess and enhance the knowledge of nurses regarding the early identification of Deep Vein Thrombosis (DVT) in post-operative patients, a group recognized to be at increased risk of thromboembolic events. Early detection of DVT in these patients is critical for timely prophylaxis and management. A self-structured and validated questionnaire comprising 20 multiple-choice questions was developed to evaluate the knowledge of nurses on DVT risk factors, signs, and prevention strategies. Each correct response was awarded one point, and based on the total score, knowledge levels were categorized as Poor (1–6), Average (7–13), and Good (14–20). Participants scoring 13 or below underwent a 10-minute educational session led by the principal investigator, focusing on key aspects of DVT recognition and prevention. These participants were subsequently re-evaluated using the same questionnaire to assess knowledge improvement. Both descriptive and inferential statistics were employed to analyse the data, including mean scores, standard deviation, ANOVA, and paired t-tests. Results: A total of 100 nurses working in departments such as Oncology, Regency wards, and general wards were included in the study. The demographic results showed 96% were females, and 76% of them belong to the age group less than 25years. All Nurses held a minimum educational qualification of BsC Nursing degree. Amongst the study group, 44% of them had a minimum of one year experience. 32% of them are having less than one year experience. 18% of them having 3 years experience. And 6% of them having more than 3 years of nursing experience. In our hospital there is no special postoperative ward that isolates all post surgical patients. So, we have tested the nurses working different ward areas to understand their knowledge better. Amongst the study group 25% of them are working in oncology area. 75% of them are working in general ward areas distributed in 1st, 2nd & 3rd floors. Table 1: demonstrates distribution of nurses according to their sociodemographic parameters Sociodemographic Parameters N (n =100) % Age in years 20-25 76 76% 25-30 24 24% >30 0 Gender Female 96 96% Male 4 4% Global J Res Med Sci. 2025; 5(5), 51-58 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 53 Educational qualification BSC nursing 100 100% Year of experience <1 year 32 32% 1 year 44 44% 3 years 18 18% >3 years 6 6% Department Oncology 25 25% Ward-Regency 23 23% Ward-1st floor 23 23% Ward-2nd floor 29 29% We have assessed the nurses responses to a structured and validated questionnaire comprising of 20 questions. The responses were analysed accordingly. Table 2: Gives the nurses responses to the questionnaire about DVT risk factors and prevention. Questions % of study population with correct answer 1. Which of the following is likely in massive DVT? 72 2. Which of the following suggests a small pulmonary embolism? 65 3. Levels of D-dimer increase in? 71 4. What Is Deep Vein Thrombosis? 73 5. Which vein is most commonly effected by DVT? 74 6. Which of the following is not a common risk factor for DVT? 76 7. Which of the following is NOT a common risk factor for DVT? 81 8. Which medical condition increases the risk of DVT? 79 9. What is the most common symptom of DVT? 77 10. Which of the following symptoms might indicate a serious complication of DVT (pulmonary embolism)? 77 11. Which diagnostic test is commonly used to detect DVT? 77 12. Which of the following is NOT a common symptom of DVT? 72 13. DVT primarily affects which type of blood vessels? 87 14. What is the most serious complication of DVT? 86 15. Which of the following is a risk factor for developing DVT? 84 16. What is the primary treatment for DVT? 79 17. Which imaging test is commonly used to diagnose DVT? 72 18. What does the term "thrombus" refer to in the context of DVT? 72 19. What is the primary goal of treating DVT? 72 20. Where does the Ddimer test measure? 71 Each correct response was awarded one point, and based on the total score, knowledge levels were categorized as Poor (1–6), Average (7–13), and Good (14–20). Global J Res Med Sci. 2025; 5(5), 51-58 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 54 Table 3: Represents the distribution of responses of study group on their level of understanding. Pre-test N Percentage Poor 0 0% Average 24 24% Good 76 76% Total 100 76% of them scored well with score 14-20 showing good knowledge, 24% of them scored average with score ranging 713. Participants with this average scoring 13 or below underwent a 10-minute educational session led by the principal investigator, focusing on key aspects of DVT recognition and prevention. We have also compared the sociodemographic profile of study participants in both the groups of assessment (Good & Average Knowledge respectively). Table 4: Depicts the sociodemographic profile of study participants in both the groups of assessment. The sociodemographic profile of study participants in both the groups is comparable. Sociodemographic Parameters Good Knowledge (N=76) % Average Knowledge (N=24) % Age in yrs. 20-25 55 72% 21 88% 25-30 21 28% 3 13% >30 0 0% 0 0% Gender Female 73 96% 23 96% Male 3 4% 1 4% Educational qualification BSC nursing 76 100% 24 100% Year of experience <1 year 33 43% 11 46% 1 year 22 29% 6 25% 3 years 15 20% 4 17% >3 years 6 8% 3 13% Department Oncology 17 22% 10 42% Ward-Regency 17 22% 9 38% Ward-1st floor 19 25% 2 8% Ward-2nd floor 23 30% 3 13% The participants with average scoring less than 13 were subjected to educational intervention and they were subsequently re-evaluated using the same questionnaire to assess knowledge improvement. We have compared the sociodemographic profiles of study participants in the pre-test and post-test evaluation and there is no significant difference between the pre and post-test group. Global J Res Med Sci. 2025; 5(5), 51-58 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 55 Table 5: depicts the sociodemographic profiles of study participants in the pre-test and posttest groups. Pre-test Post-test Age Mean ± SD P-value Mean ± SD P-value 20-25 14.87 ± 2.81 P = 0.0987 18.11±1.23 P=0.26 25-30 15.95±2.62 17.33±1.96 Gender Female 15.20±2.77 P = 0.7527 17.95±1.46 N.A. Male 14.75±3.40 17 Year of experience <1 year 15.09±2.76 P=0.4912 18±1.7 P=0.9256 1 year 15.21 ± 3.03 17.66±1.36 3 years 14.83 ±2.61 17.75±1.25 >3 years 16.83 ± 1.94 18.33±0.57 Department Oncology 14.48±3.09 P=0.1911 18.1 ±1.37 P=0.41 Ward-Regency 14.91±3.07 17.33±1.5 Ward-1st floor 15.13±2.43 19 ± 1.41 Ward-2nd floor 16.06±2.40 18.33 ± 1.52 We have compared the experience of study participants pre and post-test and Department of study participants pre and post-test and we have found no statistically significant difference between the groups in terms of experience and department of working before and after intervention. Table 6: depicts the comparison of experience and department of study participants pre and post test Pre-test Post-test Year of experience <1 year 15.09±2.76 P=0.4912 18±1.7 P=0.9256 1 year 15.21 ± 3.03 17.66±1.36 3 years 14.83 ±2.61 17.75±1.25 >3 years 16.83 ± 1.94 18.33±0.57 Department Oncology 14.48±3.09 P=0.1911 18.1 ±1.37 P=0.41 Ward-Regency 14.91±3.07 17.33±1.5 Ward-1st floor 15.13±2.43 19 ± 1.41 Ward-2nd floor 16.06±2.40 18.33 ± 1.52 Discussion: This study found that nurses demonstrated modest baseline knowledge, favourable attitudes, and proactive behaviours in managing DVT, with significant interrelationships between these domains. Although attitudes and practices reflected awareness of DVT prevention and care, intermediate knowledge scores revealed notable gaps in understanding essential conceptsparticularly the use of risk assessment tools, staging, and evidence-based procedures. Prior research has shown that insufficient knowledge can hinder the adoption of clinical recommendations despite positive attitudes toward patient care14,15. Such limitations may result in suboptimal adherence to DVT prevention measures and poorer patient outcomes, as also documented in other clinical contexts16,17. Global J Res Med Sci. 2025; 5(5), 51-58 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 56 The knowledge scores in our cohort are consistent with findings from other regions, where healthcare workers often display limited familiarity with contemporary diagnostic tools and preventive strategies for DVT. Studies have reported that even after training, many nurses remain unfamiliar with validated risk assessment instruments such as the Caprini and Wells scoring systems a finding mirrored in this study, where nearly half of respondents could not identify them18,19. Similarly, knowledge gaps in DVT staging and chronic complications appear to be a universal challenge in nursing education. These gaps are significant because delayed recognition of high-risk patients may lead to severe complications, including pulmonary embolism. Our results also showed favourable attitudes, consistent with earlier studies where nurses recognised DVT as a serious complication and emphasised preventive measures20,21. However, a substantial proportion perceived patient compliance as a barrier reflecting findings from prior work where limited patient awareness and poor adherence hindered effective DVT management22,23. Knowledge, attitudes, and practice scores were significantly influenced by education level, professional role, prior training, and direct experience in DVT care. Nurses with higher qualifications, senior positions, or prior DVT training scored better across all parameters, as confirmed by multivariate logistic regression and SEM analysis. This aligns with existing evidence that structured training improves both theoretical understanding and clinical application24,25. Workshops focusing on risk assessment and anticoagulation management have been shown to boost nurses’ confidence and adherence to evidence-based care26,27. Direct clinical exposure also enhanced performance, underlining the importance of experiential learning. Conversely, nurses in non-teaching or lower-tier institutions scored lower across all domainslikely due to systemic disparities in resources, professional development opportunities, and emphasis on continuing education. Studies have similarly noted that nurses in low-resource settings often miss advanced training opportunities, limiting guideline implementation28,29. Specific knowledge deficits included poor recognition of DVT phases, limited use of risk assessment tools, and lack of familiarity with certain preventive interventions such as lower limb elevation and antithrombotic stockings consistent with other reports linking these gaps to insufficient emphasis on standardised evaluation tools during training30,31 and underutilisation of procedural guidelines in practice32,33. To address these gaps, multifaceted and context-specific interventions are essential. Hospitals should implement mandatory training programs on high-priority topics—particularly risk stratification, staging, and guideline-based prevention and management. These programs should integrate case-based learning to contextualise theory and enhance practical skills. For resource-limited facilities, online interactive modules and virtual reality simulations offer accessible alternatives34,35. Overcoming attitudinal and behavioural barriers is equally important. Embedding motivational interviewing techniques in nurse–patient communication training could help address compliance issues. A mentorship model, pairing senior nurses with substantial DVT experience with junior staff, could strengthen confidence and practice standards. Hospitals should also incorporate quality improvement initiatives, such as patient outcome audits and feedback systems, to continuously refine practice. Our findings also reinforce the need for early integration of DVT education into nursing curricula, supplemented by ongoing professional development. Providing culturally tailored educational materials can empower patients and families to participate actively in care, alleviating nurses’ concerns about adherence. Forming multidisciplinary DVT teams including nurses, physicians, and patient educators can further improve prevention and management36,37. The strong correlations between knowledge, attitudes, and practices observed here confirm the interconnectedness of these elements, consistent with prior healthcare research38,39. SEM analysis indicated that improving knowledge can positively influence attitudes and actions supporting the rationale for prioritising knowledge enhancement in interventions. Limitations of this study include its cross-sectional design, which restricts causal inferences; reliance on self-reported data, which may introduce social desirability bias; and confinement to a single province (Zhejiang), potentially limiting generalisability to other settings with differing resources and policies. Future research should consider longitudinal designs and larger, multi-centre samples. Global J Res Med Sci. 2025; 5(5), 51-58 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 57 Conclusion: This study highlights that while nurses demonstrated positive attitudes and practices toward DVT management, notable gaps remain in the use of risk assessment tools and practical application. Training, institutional support, and direct patient care exposure significantly influenced KAP scores. A brief 10-minute educational session effectively improved knowledge across all demographics, underscoring the value of focused microlearning. To translate knowledge into consistent practice, ongoing education should be coupled with reinforcement of guidelinebased care, particularly the ACCP recommendations. Future initiatives should prioritise integrating DVT prevention into undergraduate curricula, expanding in-service training, leveraging digital learning for accessibility, and evaluating longterm retention and clinical outcomes through multi-centre, longitudinal studies. References: 1. 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