In Defense of Defensive Nursing Practice

Abstract

The practice of defensive medicine is a much debated topic today. The economist wail about the unwanted
cost thrust upon the consumer, i.e., the patient. The health administrators bemoan that it causes
unnecessary burden on the limited resources which would otherwise be used judiciously. What everyone
turns a blind eye to is a drastic overhaul in the perception of seekers of health care. Health providers
have assumed death-defying culture. The litigious society going for "swapping the fly by a hammer"
has become intolerant. Gone are the days when the medical profession was considered noble. Now this
nobility is found only in lectures and text books. Beyond all this commotion undoubtedly accelerated
by 'lawyers chasing doctors' people have forgotten the fact that defensive is not only protecting the
flanks but providing provision for additional service as well, particularly in the context of nursing care.
This is what is discussed in this paper.

Full text

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I
INTERNATIONAL JOURNAL OF
NURSING CARE
www.ijonc.com
Volume 2 Number 02 July-December 2014
1. Indian School Children can learn Basic Life Support Skills ..................................................................................................... 01
Anurag Bhai Patidar, Asha Sharma
2. The Customs and Cultural Practices on Premature Baby Care among Tribal ...................................................................... 06
Women of Ahmednagar District, Maharashtra a Qualitative Study
Bhasura Chandrachood, P A Chandekar
3. In Defense of Defensive Nursing Practice ................................................................................................................................... 11
Farha Azmi, Munawwar Husain, Suman Vashist, Jawed A Usmani
4. A Study to assess the effect of Structured Teaching Programme on Knowledge ................................................................ 14
Regarding Behavioral Problems in Children among Mothers
Pawan Sharma, Jagjeet Kaur
5. Awareness Regarding Adverse effects of Chemotherapy among Parents of ....................................................................... 20
Children Attending Oncology Units of AIMS
P Chitra, Vishnu Priya M B
6. Women 'S Educational Needs about Emergency Contraception Method ............................................................................. 27
Sameti Sedigheh, Goudarzi Mitra, Razani Mohsen, Falsafi Fariba
7. A Study to assess the Needs of the Family Members of Patients Admitted in Intensive ................................................... 31
Care Unit and to Compare these with the Nurses' Perception in Selected
Hospitals of Karnataka State
Tsering Paldon, Elsa Sanatombi Devi, Flavia Castelino
8. A Study to assess the effectiveness of Interactive Bibliotherapy on Reduction of .............................................................. 36
Body Image Dissatisfaction among High School Girls (13-16 Years)
in Selected Schools, Mysore
Riji C Philip, Ambika K, Sheela Williams
9. Factors Responsible for Stress among Family Caregivers of Hospitalised ........................................................................... 42
Patients in Abeokuta, Nigeria
FATONA, Emmanuel Adedayo, OSENI, Rukayat Ejide, ADEBAYO,
Catherine Olubunmi, ADEGBITE, Nasimot Omolola
10. Effect of Yoga as Nursing Intervention on Stress, Anxiety and Quality of Life among ..................................................... 48
Cervical Cancer Patients
M Jayalakshmi
Contents
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II
11. A Study to assess the effectiveness of Self-Instructional Module on Third Space............................................................... 52
Fluid Shift and its Management among Critical Care Nurses at Selected
Hospitals in Mysore
Keerthi Rao, Aswathy Devi M K, Sheela Williams
12. A Study to assess the effectiveness of Demonstration Programme on Cardio Pulmonary ............................................... 57
Resuscitation on the Knowledge and Skill of KSRTC Workers in Selected KSRTC
Depots of Mysore
Manju Kurian, Usha M Thomas, Sheela Williams
13. Stress among Antenatal Women in India .................................................................................................................................... 63
Maria Pais, Murlidhar V Pai, Asha Kamath, Anice George, Judith A Noronhna, Baby S Nayak,
Jayaram Nambiar, Ganapathi Joisa H
14. A Study to assess the Physical Growth in Children of Working and Non-Working Mothers........................................... 68
Rimple Sharma, Poonam Sharma, Sunita Saini
15. Cervical Cancer Screening Practices among Rural Indian Women ........................................................................................ 73
S B Thovarayi, J A Noronha, S Nayak
16. A Study to assess the Knowledge and Practice of Staff Nurses Regarding Prevention of ................................................. 78
Surgical Site Infection among Selected Hospital in Udaipur City
Rakesh Joshi
17. Effectiveness of Mindfulness based Stress Reduction (MBSR) on Stress and Anxiety ....................................................... 81
among Elderly Residing in Residential Homes
Sasi Kumar, Kasturi Ramesh Adiga, Anice George
18. A Study to assess the Stress among Juvenile Delinquent Boys of Long Term Stay in a ..................................................... 86
Selected Institutions at Bangalore
Jenifer J
19. Effectiveness of Garlic Intake on Blood Pressure among Hypertensive Patients in a ........................................................ 91
Selected Community at Mangalore
Sherin James
20. A Study to assess the Level of Stress and Coping among Female Workers in ..................................................................... 98
Selected Apparel at Bangalore with a View to Develop an Information Booklet
Aspin R
21. A Study to assess the effectiveness of Awareness Programme on Knowledge and .......................................................... 103
Knowledge of Practice Regarding Prevention and Management of Rabies among
Rural Adults in Selected Rural Areas of Mysore District
Sreekutty Divakaran, Nisha P Nair, Sheela Williams, Jetty Elizabeth Jose, Vinay Kumar G
22. A Study to assess the Level of Satisfaction and Explore the Factors Influencing .............................................................. 109
Extent of Utilization of Reproductive and Child Health Services among Mothers
Attending Selected Primary Health Centre's of Mysore District
Vinay Kumar G, Sheela Williams, Nisha P Nair
Content Final.pmd 9/5/2014, 8:52 AM2

III
23. Long-term Outcomes of Pediatric Burn Injury : A Review .................................................................................................... 115
Vinitha Ravindran, Gwen Rempel, Linda Ogilvie
24. Health Locus of Control and Compliance in Diabetic Patients............................................................................................. 120
Sripriya Gopalkrishnan
25. Patient Satisfaction: A Key to Quality Nursing Care............................................................................................................... 124
Ashalata W Devi, Sandhya Shrestha, Harikala Soti
26. A Study to assess the Impact of Health Education Regarding Common Childhood ....................................................... 128
Ophthalmic Ailments and their Self Care Management among Rural School
Children at Chitradurga
Sunil Kumar Dular
27. A Study to Identify the Prevalence of Co-Morbidity among Chronic Obstructive Pulmonary...................................... 134
Disease Patients Seeking Treatment in Outpatient Department of Bhopal Memorial Hospital
& Research Centre, Bhopal
Radha K, Chinchumol Abraham, Jyoti Pandey, Neha Maurya, Rambha Kumari, Shweta Singh
Content Final.pmd 9/5/2014, 8:52 AM3

International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 1
DOI Number: 10.5958/j.2320-8651.2.1.001
Indian School Children can learn Basic Life Support
Skills
Anurag Bhai Patidar1, Asha Sharma2
1Lecturer, Bhopal Nursing College, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh,
2Ex- Principal, Raj Kumari Amrit Kaur, College of Nursing, New Delhi
ABSTRACT
Introduction: Training school children in CPR has been strongly advocated by European Resuscitation
Council, AHA & American Academy of Pediatrics. The present study was aimed to assess the effectiveness
of BLS training programme among 9th graders of selected schools of Ludhiana, Punjab.
Material and Method: We recruited 281 ninth graders from five conveniently selected schools of
Ludhiana, Punjab. Instructor led BLS training session was organized for the students in the experimental
group. BLS Knowledge was assessed using 30 items questionnaire and 10 items checklist was used to
assess BLS practice. Data was collected one day before and 7th day after BLS training.
Results: Both the groups were comparable with regard to age. Male outnumbered female in experimental
(57.06%) as well as control group (59.34%). The experimental group knowledge and practice score was
significantly (p<0.0001) higher than the control group in post-experimental test. Furthermore, age and
gender were not significantly associated with knowledge and practice score in both the groups. Slightly
more than 70% of the students achieved corrected compression rate and depth in the first cycle of CPR,
however nearly 40% of the students were not able to provide rescue breath neither in first cycle nor in
second cycle of CPR.
Conclusion: 9th graders can acquire BL S knowledge and practice; therefore it can be included in their
curriculum.
Keywords: Basic Life Support, Knowledge, Practice, School Students
INTRODUCTION
The risk of coronary artery disease in Indians is 3-4
times higher than White Americans, 6-times higher than
Chinese, and 20-times higher than Japanese1. It was
estimated2 that nearly 30 million Indians had
cardiovascular disease in 2003, which represented a
prevalence of 8–10% among urban Indians. Another
side of the coin is that Indians are prone as a community
to CAD at a much younger age3-4. In the Western
population, incidence of CAD in the young is up to 5%
as compared to 12-16% in Indians5-6.
In some studies from India, the percentage of patients
below the age of 45 years suffering from acute
myocardial infarction is reported as high as 25-40%7-8.
Most sudden death events in the community are due to
cardiac causes, most commonly secondary to CAD
which may include ventricular tachyarrhythmia either
ventricular tachycardia or ventricular fibrillation.
Approximately 4280 out of every one lakh people
die every year from SCA in India alone9. Most of the
SCD events occurs out-of-hospital before any contact
with health professionals. It’s estimated that more than
70% of ventricular fibrillation victims die before
reaching the hospital10.
Basic life support or cardiopulmonary resuscitation
performed by bystanders improves outcomes in cardio
respiratory collapse, yet less than 1% of the general
population can perform it effectively. It has been
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2International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
estimated that if 15-20% of the population could perform
basic life support, out of hospital mortality could be
curtailed significantly. However, bystanders attempt
CPR in only 32% of cases11 mostly because lack of
training and fear of causing damage, contracting an
infectious disease, and not being able to provide
adequate resuscitation12.
The ideal situation would be to train the whole
population, but it seems impossible to train the whole
population in a resources limited country like India.
Moreover, the scarcity of resources usually requires that
training be targeted to certain groups. In an attempt to
maximize the number of potential BLS lay providers in
the community, several societies and organizations
have suggested that a BLS programme should be
included in the school curriculum within the mandatory
schooling period.
In the year 2003, the International Liaison Committee
on Resuscitation recommended CPR training in
schools13 and in 2010 the American Heart Association
suggested CPR to be a requirement for high school
graduation.14
Parnell MM et al15 reported that most high-school
students are willing and motivated to learn CPR.
Similarly, Naqvi S et al (2011)16 conducted a quasi-
experimental study in Pakistan to evaluate results of
BLS training to school students. The study reported
significant improvement in knowledge after CPR
training and retention of knowledge and skills of CPR
after 3 months period. In India, there is paucity of work
which explores the effectiveness of BLS training among
school children. The present study is aimed to assess
the knowledge and practice of Basic Life Support among
9th graders in selected schools of Ludhiana, Punjab.
MATERIAL AND METHOD
In this experimental pretest posttest study we
recruited 281 ninth graders from five conveniently
selected schools of Ludhiana, Punjab. The students
studying in a selected school were randomly assigned
to either experimental (191 students) or control group
(90 students) through tossing a coin. Sample size was
calculated based on available literature using the
sample size and power analysis software PS
version3.0.4317 for power 0.80. Data was collected using
Structured Knowledge Questionnaire (SKQ) and
Checklist. SKQ consists of two parts: part one contained
background information and part II contained 30 MCQs
to assess BLS knowledge. Checklist was used to assess
BLS practice. It consists of 10 items depicting the steps
used to complete 2 cycles of CPR as per AHA 2010 single
rescuer BLS guidelines for adult cardiac arrest victim.
Content validity of the tools was established from
experts in the field of Resuscitation, Medicine, Surgery
and Nursing. Necessary modifications were done as
per experts’ opinions. Internal consistency of the
structured knowledge questionnaire was established
by split half method (r=0.918). Inter observer reliability
was established for observation checklist (r=0.9).
Keeping in view the background of the 9th class school
students it was decided that the readability
(grammatical complexities and sentences length) of the
SKQ should be adjusted at their level. Therefore,
readability formulas18 were applied to calculate the
average grade level, reading age and text difficulty of
the SKQ.
Flesch Reading Ease score19 was calculated and it
was found to be 81.2 (text scale) which means the
content of the tool was easy to read. The Gunning Fog20
index score was 6.3 (text scale) which means the content
of tool is fairly easy to read. The SMOG Index21 was 5.3
which mean the fifth grade students can read the content
of the tool. Readability consensus was checked based
on 8 readability formulas3 and the text of the tool was
scored as easy to read and it was found to be appropriate
for reader’s age 8-9 years (fourth and fifth graders).
Intervention
BLS training programme was prepared based on
the latest American Heart Association Guidelines,
201022 for “Adult cardiac arrest victim, single rescuer
Basic Life Support”. It was an instructor led training
session which consists of knowledge, demonstration
and attitude training of 9th graders for BLS. The content
of the training programme was validated by ten experts
in the field of resuscitation. Power point slide show
was used as an audiovisual aid which included total
48 slides.
Instructor (researcher) delivered theoretical content
as well as demonstrated the step of BLS for adult cardiac
arrest victim on Little Anne® CPR Training Manikin
following the delivery of theoretical content of every
step and at last all the steps were demonstrated on Little
Anne® CPR Training Manikin in one go (hands on).
Following the lecture cum demonstration session
students were divided into groups (each group consist
of 10 students) and allowed to practice on manikin in
the presence of AHA certified instructors. Return
demonstration was taken from each student. It was
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 3
ensured that every student should perform all the steps
correctly at least once.
Participants were given full disclosure of the study
and written informed consent was obtained from each
participant. Written permission for data collection was
obtained from the concerned school principals. SKQ
was distributed to the students in the classroom and
they filled the required information at their own. BLS
Skill test was taken on Little Anne® and researcher
observed the students performance in a separate room.
Pre-experimental data was collected day before the
intervention and post-experimental data was collected
7th day after the intervention from both the groups.
RESULT
Mean age in the experimental group was
14.29±0.794 (95% C.I. 14.19 to 14.41) whereas it was
14.24±0.852 (95% C.I. 14.066 to 14.423) in the control
group. Both the groups were comparable (p=0.604) with
regard to age. Male outnumbered female in
experimental (57.06%) as well as control group
(59.34%). More than half of the students (53.40%) in
the experimental group were Hindu followed by Sikh
(45.03%). However, in control group slightly more than
3/4th was Sikh followed by Hindu (22.22%). In both the
groups, majority of the students were urban (82.2%,
79.13% in experimental and control group respectively).
All the students in both groups were studying in
Central Board of Secondary Education affiliated
schools.
Table 1: Pre and Post-experimental BLS Knowledge
score in Experimental v/s Control group.
N=281
Knowledge Score P value
Independent
t test
Experimental Control
Groupn=191 Group n=90
Score % Score %
Pre-experimental 32.53% 30.77% P >0.05
Post-experimental 71.15% 31.25% P<0.0001
P value dependent t test P<0.0001 P >0.05
As depicted in table 1 there was no significant
difference (p>0.05) in pre-experimental BLS knowledge
score in the experimental and control group. The
experimental group, scored significantly (p<0.0001)
higher than the control group in the post-experimental
test. The knowledge score in the experimental group
increased significantly (p<0.0001) after the BLS training
as compared to baseline knowledge score
Table 2: Pre and Post-experimental Practice score of
BLS in Experimental v/s Control group.
N=281
Practice Score P value
Independent
t test
Experimental Control
Groupn=191 Group n=90
Score % Score %
Pre-experimental 2.35% 2.11% P >0.05
Post-experimental 74.71% 2.66% P<0.0001
P value dependent t test P<0.0001 P >0.05
There was no significant difference (p>0.05) in pre-
experimental practice score in both groups. The
experimental group scored significantly (p<0.0001)
higher than the control group in post-experimental test
indicating the effectiveness of BLS training programme.
The practice score in the experimental group increased
significantly (p<0.0001) at post-experiment as
compared to baseline practice score. Age and gender
were not significantly (p>0.05) correlated with pre and
post-experimental practice and knowledge score in the
experimental as well as in the control group. Nearly 3/
4th of the students in the experimental group located
CPR hand position correctly and slightly more than
70% of the students achieved corrected compression
rate and depth in the first cycle of CPR, however nearly
40% of the students were not able to provide rescue
breath neither in first cycle nor in the second cycle of
CPR. Similarly 28.27% of the students were not able to
complete second cycle of chest compressions correctly.
Nearly 1/4th of the students forget to call emergency
response system and 12.04% missed the assessment of
responsiveness of the victim.
DISCUSSION
The sample of the present study consisted of 9th
graders school students. Male outnumbered the female
in the study sample. Almost similar sample
characteristics have been reported by previous
studies 15,16.
The present study revealed significant increase in
knowledge and skills of BLS among school students
following the training session. Connolly M et al also
reported that children instructed in CPR showed a
highly significant increase in level of knowledge
following the training session23. The results of the
present study clearly indicate that vast majority of 9th
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4International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
graders acquired the knowledge and learned BLS skills.
It was also revealed that age and gender were not
significantly correlated with knowledge and practice
score in the experimental as well as control group.
Similar results had been reported by previous studies24.
With the rate of more than 8% of cardiac arrests
witnessed by students16, proven psychological and
physical readiness of 13-14 years school students by
numerous research studies worldwide25 positive
correlations between BLS training and willingness to
apply it, and positive attitude of school students
towards Basic Life Support26 we believe that
compulsory BLS training should be implemented in
secondary schools in India. It is noteworthy, that the
European Resuscitation Council, the American Heart
Association, and the American Academy of Paediatrics
have all recommended that resuscitation be taught to
school children.
School environment can be considered the most
suitable platform for CPR training, as it provides
opportunity to repeat BLS training every year or half
yearly on same group of students to enhance the
retention of knowledge and skills. Furthermore, with
the development of nationwide network of EMS in India,
the impact of BLS training will be maximized in terms
of improved survival after out of hospital cardiac arrest.
A limitation of our study is that sample recruitment
was not random, and it only included students in
public schools of one city (Ludhiana) in the Punjab.
These schools generally contain high achiever students
who are more interested in learning new skills.
Therefore, it is possible that a larger or more diverse
sample could have yielded different results. This study
does not give us adequate insight about the approach
and capabilities of Government schools students. The
present study was carried out on manikins while in
real life there could be emotional stress and fear to do
harm to the victim that could affect the performance.
On the basis of this study, it is recommended that
children of all schools should be provided training of
BLS skills.
Nursing implications: Community health nurse
and School health nurse should plan and implement
Basic life Support techniques training to secondary
school children in the light of their proven capability to
acquire knowledge and skills of BLS.
CONCLUSION
Indian children as young as 13 years, can learn BLS
skills through training they would acquire physical
endurance to perform adequate chest compressions.
Central Board of Secondary Education and other state
secondary education boards need to include basic life
support training in to mandatory school period as well
as make it a mandate to get qualified for secondary
school certificate.
Conflict of Interest: None
Acknowledgement: None
Ethical Clearance: Permission to conduct study was
obtained from head of the institution where study was
conducted (DMCH Nursing College). INC consortium
research committee approved the study protocols.
Source of Funding: Self
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Gregory A, Hazinski MF, et al. Importance and
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J 2006;23;899-902.
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6International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
The Customs and Cultural Practices on Premature Baby
Care among Tribal Women of Ahmednagar District,
Maharashtra a Qualitative Study
Bhasura Chandrachood1, P A Chandekar1
1Vice Principal, and Principal, Pravara Institute of Medical Sciences (DU), College of Nursing, Loni (BK), Tal. Rahata,
Ahmednagar Dist., Maharashtra
ABSTRACT
Background: Child birth and neonatal period are culturally important times, during which there is a
strong adherence to traditional practices among tribal population. The prevailing and the dominant
understanding reveal that they are unchanging and resistant to newer innovations. They are perceived
as an inhibitor to the so called modernizing process. The present study is aimed at exploring the
traditional practices and customs related to premature baby care among tribal community.
Materials and Method: A qualitative research, ethnographic study was conducted among the women
at two tribal villages at Ahmednagar district, to understand the customs and traditional practices
related to care of premature infants among the tribal community. Data was collected from 30 tribal
women, two Anganwadi workers, two Dais, two ANMs which throws light on amazing customs and
cultural practices related to premature baby care. A self prepared and pre tested unstructured interview
schedule was used for data collection. The descriptive and inferential statistics were applied wherever
required.
Results: The findings of study show that, though the tribal did not had concept clarity of prematurity,
they give importance to maintain the temperature of newborn baby irrespective of their gestational
maturity. Interestingly, it was noted that tribal's did not feed the baby with colostrums, believing that
it's a dirty milk, instead used sugar/jaggery water or honey. Bathed the baby immediately after birth,
with oil massage, instils oil in ears, and putting oil and 'kumkum' at cord stump. It was found and
validated that the tribal's used kajol marking, tied black threads and puts metal ear rings etc to drive
away evil spirit, further they firmly believed in the effect of block eye on the newborn.
Conclusion: The results revealed a many traditional practices and customs related to newborn care
practised by the tribal's has significant impact on health and wellness. The awareness imports the
change in health seeking behaviours and may control the overwhelmed risk of illness and other life
issues. It's a need of the hour to educate tribals on healthy ways for care of premature baby care with
humanised way.
Keywords: Customs, Cultural Practices, Premature Baby Care and Tribal Community
INTRODUCTION
Infants are unique in their physiology and the health
problems that they experience. It’s a period of transition
from intrauterine life to extra uterine life; when they
born prematurely, the transition become more critical.
Premature infants are those newborn, born before 37
weeks of gestation1. Every year 27 million babies were
Corresponding author:
Bhasura Chandrachood
Professor cum Vice Principal
Pravara Institute of Medical Sciences (DU), College of
Nursing, Loni (Bk), Tal. Rahata, Ahmednagar Dist,
Maharashtra, Pin: 413736.
Mob: 08301032815
Email: sivavimal.guru@gmail.com
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 7
born in India of which 3.6 million are born prematurely,
out of which 303,600 babies does not survive due to the
complications related to prematurity, unhealthy
practices, early bathing, delayed breastfeeding etc.
Alongside the data show that 65.4% of all births and
75.3% of births in rural area occur at home 2.
The family and its cultural aspects play an
important role in child rearing practices. For many
families, the traditional practices and beliefs are an
integral part of their daily living3. Interestingly, some
cultures view evil influence such as voodoo, witch craft
or evil spirit falls on newborns and children. Due to
immature development the premature infants are
vulnerable to the gaze of evil eye which they rationalise
as the cause of illness. It was believed that the religious
relics like wearing amulets, metals and other practices
protects the child as well as facilitate healing4.
The prevailing and dominant understanding
perceived that these cultural beliefs are unchanging and
resistant to innovations. As health care professional,
the nurse encounters people of many racial and ethnical
origins in the process of meeting the health needs of
children and family. The scientific evidences also
highlights that the harmful newborn care practices that
contribute to neonatal mortality and morbidity5.
The health care workers should be aware of these
customs and cultural values (especially in rural and
tribal areas) where it has direct influence on the health.
Therefore, it is important to recognize these beliefs,
customs and values, and explore the nursing
implications6. Nurses can be more effective when
operating from a trans-cultural perceptive, where she
uses the appropriate aspects of each cultural orientation
under consideration to develop culturally acceptable
and safe health care intervention.
OBJECTIVES
(1) To explore the customs and traditional practices
related to premature baby care among tribal
community and
(2) To analyse the harmful practices which serve as a
guideline to promote healthy practices.
MATERIAL AND METHOD
The qualitative, ethnographic study was carried out
in tribal villages – Panjre and Bhandardara at
Ahmednagar dist, Maharashtra. The total population
of the villages were 2956, while nearly 25% of birth
takes place in the home. Approval by institutional ethics
committee of Pravara Institute of Medical Sciences (DU)
was obtained. 30 tribal women who were above 18
years of age, 02 Anganwadi workers, 02 Dais and 02
ANMs were studied. To consider sampling with
maximum diversity, women from younger age, middle
age and old age (20 to 80 years) were selected. The
subjects were selected through non probability;
convenient sampling technique and home visit were
made for the survey.
The data collected was validated with Anganwadi
workers, Dais, and ANM s of that area (who are aware
of the customs and cultural practices prevailing in the
village). The legal permission was obtained from the
Sarpanch of tribal village and informed consent was
taken from the participants before the conducting the
unstructured interview as data collection method. The
tool consists of a) 03 demographic characteristics of
participants and b) 12 open ended questions related to
premature baby care. The response was voluntary and
it was jotted down by the researcher in diary. Along
with descriptive statistics, the qualitative thematic
content analysis was used for the data analysis.
RESULTS
Socio demographic characteristics: The mean age
of the women was 39 years, among the participants
higher percent (36%) of women was belonged to 20 – 25
years of age, followed by (30%) was 75 – 80 years of age.
Majority 83% of participants under study was illiterates,
while (89%) was belong to low socio economic class
respectively. (Table. 1)
Table.1: Socio demographic characteristics of subjects
(n=36)
SN Variables Number Percentage
1 Age in years (women)
20 – 25 11 36
40 – 45 05 17
46 – 50 05 17
75 – 80 09 30
2 Category of participants
Women 30 82
Anganwadi worker 02 06
Dai 02 06
ANM 02 06
3 Education
Illiterate 30 83
Primary 0 4 11
Secondary 02 06
4 Economic status
Low class 32 89
Middle class 04 11
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8International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Themes generated from the results
Assessing the participants verbatim through
qualitative thematic content analysis, the following
themes were generated like 1) Maintenance of thermo-
regulation, 2) Breast feeding practice, 3) Practice related
to care of new born (premature or normal) babies and 4)
Customs in child rearing.
Theme: One – Maintenance of thermo regulation
On interviewing the women, it was evident that they
give importance to maintain temperature of premature
baby, but methods are widely different. Almost all the
women said that they keep the baby wrapped in cotton/
flannel cloths to maintain temperature.
“My baby is very small, and will be affected by cold
atmosphere. So we keep the baby wrapped up in old
cotton or woolen pieces of cloth”. [25 year old women]
It was noted from interview that some of the practices
related to providing warmth to the premature babies
are dangerous too. To quote, Few elderly women
verbalized the practices like making baby and mother
sleep near fireplace, make the mother sit with the baby
near the fireplace, Keeping coal/dry cow-dung litten
container under the cot where the mother and baby
sleeps.
Theme: Two – Breast Feeding practices
Early initiation of breast feeding improves the
neonatal survival and protective against morbidity and
mortality among premature babies. All of the women
reported that they breast feed the baby, but they do not
feed colostrum/breast milk for 3 – 5 days after birth, as
the women believed it is not good for the baby.
It was expressed that, when breast milk is not given
as per custom or if the babies not able to suck well; we
usually dip a piece of cotton cloth in honey, sugar water
or jaggery water and feed the baby
“We strongly believe that the initial milk is
contaminated one, and not good for the babies health.
We start feed the baby when breast milk flow is
established well” [45 years old Mother – in law of a
postnatal mother]
Theme: Three – Practices related to care of premature
Most of the mothers expressed the salient practices
followed for the care of premature baby. The statements
below was unanimously echoed by majority of women,
like
1. Give bath immediately after birth, as it was believed
that the baby needs to be cleaned of secretions and
vernix sticking to the body.
2. Bath the baby daily (twice a day).
3. Massage the baby with oil, which is a good custom
followed by the mothers. It was firmly believed that
Massaging helps to increase the strength of the
baby.
The unhealthy practices followed was
1. Instill the oil in ears
2. Keep oil, kumkum or rakh (ash of cow dung) at cord
stump
“Keeping oil at cord stump prevents early drying of
cord and thereby it prevents entry of air in the
stomach” [70 years old elderly]
Theme: Four – Customs related to Child rearing
Some of the cultures view evil influences such as
witchcraft and evil spirit cause illness/diseases. Data
collected from tribal women also narrates the similar
customs like,
• Making hole in the ear and wearing metal earring
on 12 th day. It was trusted by the tribal women that
“Metal ear rings will help in driving away the evil
spirit” [50 years old woman]
• Putting kajol in the eye and kajol marks on the body,
and tying black threads as anklets and bracelet. It
was credited that “It will help to remove the black
spirit and protect the child from evil eyes”. [21 year
old mother]
• Not taking the baby out of house for three months.
Interestingly it was emphasized by a elderly that
“If you take the child out of the house, black eye
will fall on the child and people will do black magic
on the child “ [75 years elderly]
• They don’t take the child out especially on “no-
moon” day which is most inauspicious day. When
there is ‘eclipse’, they don’t even feed the baby
during the eclipse duration. It was rationalized by
a 80 year old elderly that “During eclipse time the
feeds are poisonous, so we don’t feed the baby till
the eclipse duration is gets over”
• Most of babies were immunised completely based
on immunisation schedule, because of ANMs visits
in the village.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 9
The above mentioned verbatim and information’s
related to customs and practices on child care was
validated from data’s collected from the ANM,
Anganwadi workers and Trained Dais. Understanding
the customs and beliefs of tribal women enables nurses
to devise appropriate strategies to improve their
awareness on premature baby care to provide better
care and support for survival.
DISCUSSION
The present study finding highlights the harmful
practices related to the premature baby care like delayed
initiation of breast feed and early bathing etc. These
findings was consistent with a study conducted by
Kesterton AJ and Cleland J who also noted the delayed
feeding and early bathing of premature babies 5.
Alongside Gupta P, Shrivastava VK, Kumar V and Jain
S found in the study that majority 79% of mother’s
practices baby bath immediately after delivery and only
36.6% of them do initiate breast feeding within 1 st hour
of delivery7.
The results revealed an interesting customs like
putting bracelets on child’s leg, putting earring to drive
out evil spirit, and tying black thread to protect from
evil spirit/evil eyes. These findings was well supported
by Dinesh Shah B and Dwivedi L who found a similar
practices of tying black threads and putting metal ear
rings among tribal women8.
It was documented that the women needs awareness
and support for the care of newborn i.e. a need of the
hour. Baquin AH, Williams EK and Damstaldt M
highlighted the significant role of imparting awareness
related to good care practices, like maintaining
temperature and breast feeding immediately following
delivery in saving newborns life9.
Several low cost interventions that are potentially
effective measures which can be practiced to reduce
neonatal mortality in settings of Basic health care
delivery system 10. Example: Practice of Kangaroo
Mother Care promotes warmth and comfort, breast
feeding and bonding, which is a humanised way of
caring premature babies, superior to sophisticated
technologies.
CONCLUSION
A nurse encounters people of many racial and ethical
origins in the process of meeting health needs of
children and families. For many families the traditional
practices and beliefs are an integral part of daily living.
Child birth and neonatal period are culturally important
times during which there is a strong adherence to
traditional practices among tribal population. Many
unhealthy practices and customs related to newborn/
premature newborn care exists among the tribal
community.
Some of the practices are even dangerous and
injurious to newborns mainly the premature babies. The
study throws light on an urgent need for discouraging
unhealthy practices through health education.
Understanding of routine newborn care at home is
necessary in order to design and prioritise interventions
to reduce neonatal morbidity and mortality. It is
important for the public health professionals to
understand the dynamics of maternal and child health
for future strategies.
ACKNOWLEDGEMENT
We are highly obliged to the Director of Primary
Health Centre and the Sarpanch of Village for granting
permission to conduct the study. Our sincere gratitude
to Mr. Bhavare for his help in introducing us to the
community people and helping in understanding their
language while collecting information We are thankful
to the ANMs, Anganwadi workers, Dais for their co-
operation in collecting information from the women as
well as validating the data gathered from them.
Conflict of Interest: Nil
Source of Funding: None
REFERENCES
1. Park K. Text Book of Preventive and Social
Medicine. 22 edition, M/s Bhanarsdidas Bharot
publishers, Jabalpur.
2. Born Too Soon: The Global Action Report on Pre-
term Birth’ ...Related news. The Hindu, New
Delhi, May 2, 2012. Available in Updated: May
2, 2012 23:29 IST http://www.thehindu.com/
news/national/india-has-the-highest-
premature-baby-deaths- report/article
3377531.ece accessed on October 2013.
3. Wilson WH and Lowdermilk P. Maternal and
Child Health Nursing Care. 3 edition, Mosby
Publication, Elsievier.
4. Parthasarathy A, Menon PS, Guptha P, Nair MK,
Agarwal R and Sukumaran TU. IAP Textbook of
Paediatric.8 edition, National Publication House.
Gwalior.
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10 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
5. Kesterton AJ and Cleland J. Neonatal Care in Rural
Karnataka, healthy and harmful practices – the
potential for change. BMC Pregnancy and Child
Birth. 2009: 9(1); 25 – 28
6. Susan Scott, Ricci, Terry Kyle and Susan Carman.
Maternity and Paediatric Nursing. 2 edition,
Mosby Elsevier publication.
7. Gupta P, Shrivastava VK, Kumar V and Jain S. A
cross sectional study related to newborn care in
urban slums of Luknow City, Indian Journal of
Community Medicine, 2010: 35 (1); 47 – 52
8. Dinesh Shah B and Dwivedi L. Causes of Neonatal
Death among Tribal women in Gujarat, India.
Population research and Policy review. 2011: 30(4);
163 – 67
9. Baquin AH, Williams EK and Damstaldt M.
Newborn care in Rural UP, Indian Journal of
Paediatrics. 2011: 74 (1); 84 – 89.
10. Udani RH and Nanavati R. Training Manual on
Kangaroo Mother Care. Department of
Neonatology. KEM Hospital and GS Medical
College, Mumbai.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 11
DOI Number: 10.5958/j.2320-8651.2.1.001
In Defense of Defensive Nursing Practice
Farha Azmi1, Munawwar Husain2, Suman Vashist3, Jawed A Usmani4
1Lecturer, Govt. College of Nursing, Kanpur, 2Professor & Fmr Principal, Department of Forensic Medicine, J N Medical
College, AMU, Aligarh, 3Assisstant Professor, Saraswati Nursing Institute, Kurali, Punjab, Mohali, 4Professor and
Chairman, Department of Forensic Medicine, Department of Forensic Medicine, J N Medical College, AMU, Aligarh
ABSTRACT
The practice of defensive medicine is a much debated topic today. The economist wail about the unwanted
cost thrust upon the consumer, i.e., the patient. The health administrators bemoan that it causes
unnecessary burden on the limited resources which would otherwise be used judiciously. What everyone
turns a blind eye to is a drastic overhaul in the perception of seekers of health care. Health providers
have assumed death-defying culture. The litigious society going for "swapping the fly by a hammer"
has become intolerant. Gone are the days when the medical profession was considered noble. Now this
nobility is found only in lectures and text books. Beyond all this commotion undoubtedly accelerated
by 'lawyers chasing doctors' people have forgotten the fact that defensive is not only protecting the
flanks but providing provision for additional service as well, particularly in the context of nursing care.
This is what is discussed in this paper.
Keywords: Defensive Nursing Practice, Health Provider, Liability-Effectiveness, Defensive Medicine, Nursimeter
INTRODUCTION
After reading a short composition on defensive
forensic medicine penned by certain authors 1 in which
defensive forensic medicine is claimed to acquire a halo
of arbitrary arguments the current authors did some
research to formulate the concept of defensive practice
in relation to nursing care and practice. The authors of
the current write-up have been successful in believing
and thus propagating the idea that defensive attitude
can be worn by the nurses without compromising the
economic cost or discomfort to the patient. It can be
legally and medico-morally applicable to nursing care
and practice without having to assume a defensive
posture. For this purpose a word ‘nursimeter’ is coined
to elucidate the concept because that provides an easy-
to-understand canvas.
Corresponding author:
Farha Azmi
Nursing Tutor
c/o Prof Munawwar Husain
Department of Forensic Medicine, J N Medical College,
AMU, Aligarh 202 002 (UP)
Mobile No.: +919058917022 / +919045287341/
+919410026330
MATERIAL AND METHOD
Assessment tool: ‘Nursimeter’: a case in point
“Nursimeter” it may be defined as an instrument to
measure the activity of a nurse in terms of nursing
approach – both subjective and objective - and care
pertaining to specific health care. Its objective and
relevance can be gauged by observing nuances in
stepwise approach to prescribed procedures.
An easy example is cited to lucidly spread the point.
• All primi para mothers should be watched for
development and growth of breast commensurate
to the trimester as a matter of rule.
• Health hygiene and cleanliness of breasts must be
emphasized during the first and subsequent visits.
• In the advanced third trimester, the breasts must be
observed for the following:
• Nipples – whether normal/retracted/cracked
• Engorgement of breasts
• Any evidences of cellulitis or reddening around the
areolae
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12 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
• Whether the breasts are bilaterally and
symmetrically engorged with milk.
In the light of the above the nurse advises the patient
whether lending support to the breasts is required by
pregnant lady. It is proposed that ‘nursimeter’ should
be able to record the examining behavior of the nurse in
the light of the above mentioned points. However, any
deviation would render the examining nurse
susceptible to allegation of neglect by omission more so
if the patient develops complication later directly
attributable to lack of advice.
The charge against the nurse would only stick, if
omission leads to damage - howsoever trivial in scale -
to the mother or the newborn.
To strengthen their defenses, the nursing care
provider shall examine the breast in detail following
the above mentioned guidelines in multi gravida too,
even though it may not be required because they are
“old timers”. The primi gravida and mothers carrying
precious pregnancy are to be examined in detail.
It is an established fact that some of the problems
are related to primi only, even then as a measure of
defensive nursing care the nurse shall practice the same
in multi gravida too.
DISCUSSION
Admittedly no financial implication is involved on
the part of the patient, therefore, the term defensive
nursing care may not be nefariously sustainable strictly
going by the accepted term “defensive medicine”
defined as “which occurs when doctors order tests,
procedures or visits, or avoid high-risk patients or
procedures, primarily (but not necessarily or solely) to
reduce their exposure to malpractice liability, they are
practicing defensive medicine; when they avoid certain
patients or procedures, they are practicing negative
defensive medicine” 2. Either way the cost is passed on
to the patient.
But the authors contend that in this instance
defensive practices are followed which may not be
required in case of multi gravida, therefore, it can be
assumed that this would come under ambit of defensive
nursing care. The authors believe that since it is a no-
lose and all-win situation hence such type of practice
may be encouraged.
The regular nursing audit shall take care of all the
aspects of negligence and over-boarding of nursing care
in contravention to the established practices. The
‘nursimeter’ shall only be effective if proper audit is
done leaving no parameter undermined. The parameters
may very well include the behavior and attitude of the
nurse towards the patient, gentleness in conducting
the procedure, motherly touch while comforting the
patient, doing what is ethically, and morally
permissible, and of course following scrupulously all
the principles enunciated in the code of Nursing Care 3.
Not the least she must pay attention towards what she
wears because studies have established that the nurse’s
dress do influence the recuperating graph 4. The nursing
audit shall be done by a team similar to clinical audit in
medical practice. The Hospital Ethics Committee shall
have a prominent role to play.
CONCLUSION
Inferential derivation regarding root cause for
defensive nursing practice and care
Nursing care is a multifarious activity where any
situation can be a challenging health care confrontation
in which a nurse at times may experience moral distress,
whereas some situations may offer moral courage 5. One
morally distressing situation paraphrased repetitively
is when demand exceeds infrastructural support. The
nurse is expected to provide all care at an exceedingly
finesse level. The availability of necessary equipments
and comfort level conducive environment may not be
available. In distress the nurse gets all the blame because
she happens to occupy the lowest position in the
hierarchy of health providers. She may succumb or
depending on her cultural background and personally
cultivated stoicism she would respond differently. One
approach for her would be to borrow confrontation at
every level thereby creating hostile patients at every step
thus leading to “denigration of nursing role” 6. The other
and much promising way would be to act defensive.
Invariably the nurse as care giver would try to expand
her sphere of nursing and would try to enroll as many
carers as possible hoping that the sum factors in
denomination may not lead to lessening the sum of
total. The liability-effectiveness model may prove it.
Acknowledgement: Not required
Conflict of Interest: None to declare
Funding: None from any source
Informed Consent: Not required
Ethical Clearance: Not required
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 13
REFERENCES
1. Husain M, Anjum A, Usmani MA, Alshraim M,
Usmani JA: In defense of defensive forensic
medicine. J Forens Legal Med; Available online
02 February 2013. Accessed at http://dx.doi.org/
10.1016/j.jflm.2013.03.032
2. Manner PA. Practicing defensive medicine –Not
good for patients or physicians. AAOS; 2014; 8(3);
Available at http://www.aaos.org/news/
bulletin/
3. Code of Ethics for Nurses with Interpretive
Statements. Accessed at: http//I//STATHOME/
WEBPAGE/ethics/CODE/
nwcoe1115htm[11.15.2010 3:15:58 PM]
4. Windel L, Halbert K, Dumont C, Tagnesi K,
Johnson K. An evidence based approach to
creating a new nursing dress code; Am Nurse
Today. Available at:http://
www.americannursetoday.com/
article.aspx?id=4438HYPERLINK “http://
www.americannursetoday.com/
article.aspx?id=4438&fid=4422”&HYPERLINK
“http://www.americannursetoday.com/
article.aspx?id=4438&fid=4422”fid=4422
5. Gallagher A. Moral distress and moral courage in
everyday nursing practice. The Online J Issues
Nursing; 2011. Available at: http://
www.nursingworld.org/MainMenuCategories/
EthicsStandard
6. Calcott L. We have allowed the nursing role to be
denigrated. Available at http://
www.nursingtimes.net/home/francis-report
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14 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to assess the effect of Structured Teaching
Programme on Knowledge Regarding Behavioral
Problems in Children among Mothers
Pawan Sharma1, Jagjeet Kaur2
1Associate Professor & Head of Department of Psychiatric Nursing, 2Msc (N) 2nd Year Student, Institute of Nursing
Education Guru Teg Bahadur Sahib (C) Hospital, Ludhiana, Punjab, India
ABSTRACT
The term behavior refers to the way a person responds to ascertain situation or experience. Most of the
Behavioral problems in school children occur due to lack of parental knowledge, inconsistent discipline,
over criticizing, neglect, problem between parents, sibling rivalry, and bad habit of mothers during
pregnancy. This study was conducted to assess the effect of structured teaching programme on
knowledge regarding behavioral problems in children among mothers. A Quantitative approach and a
Quasi-Experimental research design were used to assess the effect of structured teaching programme
regarding behavioral problems in children among mothers. The target population of study was mothers
of school age children residing in village Paddi, Ludhiana, Punjab. Sample of 60 mothers chosen by
purposive sampling technique. 30 mothers were kept in experimental group & 30 in control group.
Data was collected by self structured multiple choice questionnaire. Data collection was done in March,
2014.
Findings revealed that majority of mothers (50%) in both control and experimental group had average
pre test knowledge regarding behavioral problems in children. Maximum mothers (66.66%) obtained
below average post test knowledge score in control group whereas maximum mothers (93.33%) obtained
excellent post test knowledge score in experimental group. The mean post test knowledge score of
mothers in experimental group regarding behavioral problems in children was significantly higher
than the post test knowledge score of mothers in control group. Education and type of family were
found to be significantly related with knowledge of mothers regarding behavioral problems in children
Keywords: Assess, Effect, Structured Teaching Programme, Knowledge, Behavioral Problems, Children, and
Mothers
INTRODUCTION
The term behavior refers to the way a person
responds to ascertain situation or experience. Most of
the Behavioral problems in school children occur due
to lack of parental knowledge, inconsistent discipline,
over criticizing, neglect, problem between parents,
sibling rivalry, and bad habit of mothers during
pregnancy. This study was conducted to assess the
effect of structured teaching programme on knowledge
regarding behavioral problems in children among
mothers. A Quantitative approach and a Quasi-
Experimental research design were used to assess the
effect of structured teaching programme regarding
behavioral problems in children among mothers. The
target population of study was mothers of school age
children residing in village Paddi, Ludhiana, Punjab.
Sample of 60 mothers chosen by purposive sampling
technique. 30 mothers were kept in experimental group
& 30 in control group. Data was collected by self
structured multiple choice questionnaire. Data
collection was done in March, 2014.
Findings revealed that majority of mothers (50%) in
both control and experimental group had average pre
test knowledge regarding behavioral problems in
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 15
children. Maximum mothers (66.66%) obtained below
average post test knowledge score in control group
whereas maximum mothers (93.33%) obtained excellent
post test knowledge score in experimental group. The
mean post test knowledge score of mothers in
experimental group regarding behavioral problems in
children was significantly higher than the post test
knowledge score of mothers in control group. Education
and type of family were found to be significantly related
with knowledge of mothers regarding behavioral
problems in children
BACKGROUND OF STUDY
The term behavior refers to the way a person
responds to ascertain situation or experience. Early
childhood is the critical period of behavior formation.
The school period is an exciting period of transition,
from limited language ability, primarily sensory motor
engagement with the surrounding environment to
mastery of communication, a high degree of motor
activity, and a significant competence in self regulation,
expanding cognitive, behavior and emotional changes
and a heightened ability to empathies with others.
Behavior or distressed emotions, which are common or
normal in children at some stage of development, may
become abnormal by virtue of their frequency or severity,
or their inappropriateness for a particular child’s age
compared to the majority of ordinary children.1
Most of the Behavioral problems in school children
occur due to lack of parental knowledge, inconsistent
discipline, over criticizing, neglect, problem between
parents, sibling rivalry, and bad habit of mothers during
pregnancy. The most common behavioral problems
during preschool period include shyness,
oversensitive, nail biting, aggressiveness, refusal to
food, negativism, and specific fears and temper tantrum
etc.2
OBJECTIVES
The objectives of the study were
• To assess the pre-test knowledge regarding
behavioral problems in children among mothers in
control and experimental group.
• To assess the post-test knowledge regarding
behavioral problems in children among mothers
in control and experimental group.
• To compare pre-test and post-test knowledge
regarding behavioral problems in children among
mothers in control and experimental group.
• To find out the relationship of pre-test and post-test
knowledge regarding behavioral problems in
children among mothers in control and
experimental group with selected variables like Age,
Education, Type of family, Number of children,
Occupation and family income.
MATERIAL AND METHOD
A Quantitative approach and a Quasi-Experimental
research design were used to assess the effect of
structured teaching programme regarding behavioral
problems in children among mothers. The conceptual
framework for this study was based on General Systems
theory given by Ludwig Von Bertalanffy.
Hypothesis framed in this study was as follows
H1: The post-test mean knowledge score regarding
behavioral problems in children among mothers in
experimental group will be significantly higher than
the post-test mean knowledge score of mothers in
control group as measured by self structured
questionnaire at p<0.05 level.
H0: There will be no significant difference between
mean post-test knowledge score regarding behavioral
problems in children among mothers in experimental
and control group as measured by self structured
questionnaire at p<0.05 level.
The target population of study was mothers of school
age children residing in village Paddi, Ludhiana,
Punjab. A sample of 60 mothers was chosen by
purposive sampling technique. 30 mothers were kept
in experimental group & 30 in control group. Data was
collected by self structured multiple choice
questionnaire.The tool consisted of the following parts:-
Section 1: Demographic characteristics
This part included 6 items to obtain information
from the sample regarding Age, Education, Type of
family, Number of children, Occupation and Family
income.
Section 2: Multiple Choice Questionnaire
This part consists of 30 self structured multiple
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16 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
choice questions to assess the knowledge of mothers
regarding Behavioral problems in school age children.
The total items of questionnaire were as follows:-
Criterion Measure
S.No Category Percentage Marks
1 Excellent >70 % > 21
2 Good 51-70 % 15-21
3 Average 30-50 14-Sep
4 Below average < 30% < 9
Maximum score =30
Minimum score =0
After obtaining written permission from the Ethical
and Research committee of Institute of Nursing
Education GTBS(C) Hospital, Ludhiana, Punjab and
from the Senior Medical Officer of Community Health
Centre, Dehlon,, distt Ludhiana, Punjab pilot study was
done on 1/10th of the sample to assess reliability of the
tool and feasibility of the study. The reliability of the
tool was calculated by applying Split half method using
Karl Pearson Coefficient of Correlation and Spearman
Brown’s Prophecy formula and reliability was found
to be 0.83.
For the main study, using Purposive sampling
technique a sample of 60 mothers was selected and
divided into 2 groups- 30 in experimental group and
30 in control group. Matching of sample was done by
matching demographic variables. Pre-test was taken
from both the experimental and control group.
Thereafter structured teaching programme was
administered to experimental group with the help of
lesson plan and Audio Visual aids. The investigator
spent 45 minutes to complete the teaching programme.
After one week of teaching post test was taken from
both the groups i.e. is experimental and control group.
The data collected was analysed by using descriptive
and inferential statistics i.e. mean, mean percentage,
standard deviation, ‘t’ test, and ‘F’ test was calculated
to find out the effect of structured teaching programme.
RESULTS
The analysis of data was done in accordance with
objectives of the study. The data was organized and
presented under the following sections:
Section 1: Demographic characteristics of sample
Section 2: Finding related to mean pre and post test
knowledge score regarding Behaviour problems in
children among mothers in control and experimental
group.
Section 3: Finding related to comparision of mean
pre and post test knowledge score regarding Behaviour
problems in children among mothers in control and
experimental group.
Section 4:Findings related to relationship of mean
pre and post test knowledge scores regarding Behaviour
problems in children among mothers in control and
experimental group with selected variables.
Table 1: Mean pre and post test knowledge score regarding behavioral problems in children among mothers in
control and experimental group
N=60
Group Pre & Post Test Knowledge Score
Pre Test n=30 Post Test n=30
N Mean Mean % Mean Mean %
Control group 30 8.60 28.66 7.47 24.9
Experimental group 30 8.87 29.56 24.47 81.56
Maximum score=30
Minimum score=0
Table 1 shows mean pre and post test knowledge
score regarding behavioral problems in children among
mothers in control and experimental group. The mean
pre test knowledge score of mothers in Control group
was 8.60 and mean post test knowledge score was 7.47
.Among mothers in experimental group the mean pre
test knowledge score was 8.87 and mean post test
knowledge score was 24.47.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 17
Table 2: Comparison of mean pre and post test knowledge score regarding behavioral problems in children among
mothers in control and experimental group
N=60
Group Pre &Post Test Knowledge Score
Pre Test Post Test ‘t’
N Mean S.D Mean S.D df
Control group 30 a8.60 3.01 c7.47 2.50 29 2.13*
Experimental group 30 b8.87 2.52 d24.47 2.39 29 24.41**
a+b Df t c+d df t
58 0.38NS 58 26.92**
Maximum score=30 NS= non significant at p<0.05 level
Minimum score=0 *=significant at p<0.05 level
**=significant at p<0.01 level
Table 2 shows comparison of mean pre and post
test knowledge regarding behavioral problems in
children among mothers in control and experimental
group. In Control group, the mean Pre test knowledge
score is 8.60 and post test knowledge score is 7.47. The
difference between mean pre and post test knowledge
score of control group is statistically significant at p <
0.05 level .In experimental group the mean pre test
knowledge score is 8.87 and mean post test knowledge
score is 24.47. The difference between mean pre and
post test knowledge score of experimental group is
statistically significant at p < 0.01 level. The difference
between pre test knowledge score of control and
experiment group is statistically non significant at p
<0.05 level but the difference between post test
knowledge score of both groups is statistically
significant at p<0.01 level. Hence, it was concluded that
the Structured Teaching Programme is an effective tool
in improving the knowledge of mothers regarding
behavioral problems in children.
DISCUSSION
Based upon findings from analysis of data and
review of literature discussion was done according to
the objective:
The first objective of the study was to assess the pre-
test knowledge regarding behavioral problems in
children among mothers in control and experiment
group. The mean pre test knowledge score is 8.60 of
control group and 8.87 in experimental group. Majority
of mothers (50%) have average pre test knowledge
regarding behavioral problems in children in both
control and experimental group. Above findings are
similar in the study conducted by Priyaesh Benwara
(1996)3 on knowledge of mothers regarding behavioral
problems, who found that majority of mothers 45% has
no previous knowledge regarding behavioral problems
in children.
Second objective of the study was to assess the post-
test knowledge regarding behavioral problems in
children among mothers in control and experimental
group. The mean post test knowledge score of control
group is 7.47 and experimental group is 24.47. Majority
of mothers (66.66%) obtained below average post test
knowledge score in control group and Majority of
mothers (93.33%) obtained excellent post test
knowledge score in experimental group. Above stated
findings are similar in the study conducted by Barbara
J, Hoofdakker VD, Sytema S, Paul MG (2007)4 on to
investigate the effectiveness of behavioral parent
training who found that after structured teaching
programme the knowledge of mothers are improved.
Analysis of third objective of the study i.e. to compare
pre-test and post-test knowledge regarding behavioral
problems in children among mothers in control and
experimental group reveals that the difference between
pre test knowledge score of both control and
experimental group is statistically non significant at
p<0.05 level. However the difference in post test
knowledge score of both control and experimental
group was statistically significant at p<0.01 level.
Hence research hypothesis is accepted that post test
knowledge score of experimental group will be
significantly higher than knowledge score of control
group. The above findings were similar to those stated
by Ruth R., (1997)5 Tung W.C and Lee I.F., (2006)6 and
Verma P., (2003)7 conducted a study to assess the
effectiveness of structured teaching programe who
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18 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
reported that post test knowledge score of experimental
group is significantly higher than that of control group
due to structured teaching programme.
Analysis of fourth objective of the study i.e. To find
out the relationship of pre-test and post-test knowledge
regarding behavioral problems in children among
mothers in control and experimental group with
selected variables like Age, Education, Type of family,
Number of children, Occupation and family income.
Analysis of findings related to age show that Highest
mean pre test knowledge score is obtained by mothers
in age group of 41 years and above (9.50) and mean
post test knowledge score is obtained by mothers in age
group of 36-40 years (9.67) in control group. Highest
mean pre test knowledge score is obtained by mothers
in age group of <30 years (9.10) and mean post test
knowledge score is obtained by mothers in age group
of 36-40 years in experimental group. Age is found to
have no impact on knowledge score of mothers. These
findings are in conformity with the findings of study
conducted by Sarna K., (1993)8 who conducted a study
to assess the effect of structured teaching programme
and reported that age has no effect on knowledge of
mothers regarding acute respiratory infection.
Analysis of findings in relation to education show
that Highest pre and post test knowledge score is
obtained by mothers who are educated up to graduate
and above (9.50, 8.83,13.00, 26.00) in both control and
experimental group. It has concluded that education
has definite impact on knowledge level of mothers
regarding behavioral problems in children. Similar
findings has been reported by Yadav S.D., (1993)9 who
found that both pre and post test knowledge score was
highest in subjects who were graduates.
Analysis of findings in relation to number of
children reveals that Highest mean pre and post test
knowledge score is obtained by mothers having one
child (12.00, 9.33) in control group. Highest mean pre
test knowledge score is obtained by mothers having
more than three children (9.25) and highest mean post
test knowledge score is obtained by mothers having 3
children in experimental group. It inferred that number
of children has no effect on knowledge of mothers
regarding behavioral problems. Similarly Subbiah N.,
(2006)10 conducted a study to assess the knowledge of
mothers on prevention of childhood accidents. The
study results shows that number of children has no
effect on knowledge of mothers.
Analysis of findings in relation to occupation
reveals that Highest mean pre and post test knowledge
score is obtained by mothers who are working (8.92,
8.00) in control group and Highest mean pre and post
test knowledge score is obtained by mothers who are
nonworking (9.20, 24.93) in experimental group. It is
found that occupation has no impact on knowledge of
mothers regarding behavioral problems in children.
Analysis of findings in relation to type of family
reveals that Highest mean pre and post test knowledge
score is obtained by mothers belonging to joint family
(9.14, 8.25, 9.29, 25.44) and followed by nuclear family
in both control and experimental group. It concluded
that type of family has impact on knowledge of mothers
regarding behavioral problems in children. On the
contrary Subbiah N., (2006)10 conducted a study to
assess the knowledge of mothers on prevention of
childhood accidents. The study results showed stated
that type of family had no effect on knowledge of
mothers regarding prevention of childhood accidents.
Analysis of findings in relation to family income
per month reveals that highest mean pre and post test
knowledge score is obtained by mothers having income
5001-10000/- per month (10.00, 8.86) in control group.
Highest mean pre and post test knowledge core is
obtained by mothers having income eH20,001/- per
month (9.25, 25.50) in experimental group. It concluded
that family income has no effect on knowledge of
mothers regarding behavioral problems in children
CONCLUSION
• The difference between pre test knowledge score of
control and experiment group is statistically non
significant at p <0.05 level but the difference
between post test knowledge score of both groups
are statistically highly significant at p<0.01 level.
Thus structured teaching programme is significantly
effective in raising the knowledge level of
experimental group regarding behavioral problems
in children among mothers.
• There is statistically significant effect of education
and type of family on knowledge regarding
behavioral problems in children among mothers.
• There was no statistically significant effect of age,
number of children, occupation and monthly
income on knowledge regarding behavioral
problems in children among mothers.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 19
RECOMMENDATION
Structured teaching Programmes must be conducted
in community to educate mothers regarding
behavioural problems in children for the purpose to
reduce prevalence of behavioural problems and its
complications.
Conflict of Interest: None
Source of Funding: This was a self funded study.
REFERENCES
1. Manoj Y. Behavioral problems. [Homepage on the
Internet]. 2011 [cited 2011 Nov 31]. Available from:
http://http://pv_books@yahoo.com
2. Anitha J, Jayasudha A, Kalaiselvi. Behavioural
problem among preschool children. Nightingale
Nursing Times 2010 Jul 8;6(4):33-5.
3. PriyaeshBenwara. Knowledge of mothers
regarding behavior problems. Indian journal of
prevention and social medicine.1996;2:75.
4. Barbara J, Hoofdakker VD, Sytema S, Paul MG.
Effectiveness of behavioural parent training for
children with ADHD in routine clinical practice. J
Am Acad Child Adolesc Psychiatry 2007
Oct;46(10):1263-70.
5. Ruth R. planned health teaching on cardio
pulmonary resuscitation. The nursing journal of
india 1997;88:273.
6. Tung W.C., Lee I.F.K., Effect of an osteoporosis
educational programme for men. Innovations in
nursing practice 2006; 10 (11): 26-29.
7. Verma P. A quasi experimental study to assess the
effect of structured teaching programme on
knowledge and performance ability of breast self
examination among women in selected urban
communities of Ludhiana, Punjab. Unpublished
master of nursing thesis, Baba Farid University of
Health Sciences, 2003.
8. Sarna K. A comparative study to assess the
maternal knowledge and practices regarding
acute respiratory infections in children in urban
areas of Ludhiana city, Punjab. Unpublished
master of nursing thesis, Punjab university, 1993.
9. Yadav S.D. an experimental study to assess the
effect of structured teaching about CSSM
programme on knowledge of MPHWs (female) in
Ludhiana health centers, Punjab. Unpublished
master of nursing thesis, Punjab university, 1993.
10. Subbiah N. Knowledge of mothers on prevention
of childhood accidents- a study with particular
reference of selected area of New Delhi. The
nursing journal of India 2006;97 (10):229-231.
4. Jagjeet kaur--14--.pmd 9/5/2014, 8:50 AM19

20 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
Awareness Regarding Adverse effects of Chemotherapy
among Parents of Children Attending Oncology Units of
AIMS
P Chitra2, Vishnu Priya M B2
1 Professor, 2Year MSc Nursing, Child Health Nursing, Amrita College of Nursing, Amrita Institute of Medical Sciences,
Kochi, Kerala
ABSTRACT
Introduction: Cancer remains the most frequent medical cause of death among the children.
Method: The approach used for the study was quantitative approach using descriptive research design.
The study was conducted among 60 parents of children who met with the eligibility criteria following
non probability convenience sampling technique.
Findings: Regarding the CAE, 4 (6.7%) of the subjects had very poor knowledge, 41(68.3%) had
inadequate knowledge and 15 (25%) had adequate knowledge. The highest occurrence of adverse
effects was vomiting and the next was alopecia. The other adverse effects reported were fatigue 10(16.7%),
diarrhea 6(10%), color change in nails 5(8.3%), fever 3(5%), constipation 2(3.3%) respectively. Regarding
awareness of cancer and its treatment 27(45%) had inadequate knowledge.
Conclusion: The researchers investigated the awareness of CAE among parents, 41(68%) were not
aware about the CAE and its management. Regarding Myths and Facts 25% of the subjects had wrong
beliefs and 75% of them aware about the facts regarding CAE.
Keywords: CAE- Chemotherapy Adverse Effects, ALL- Acute Lymphocytic Leukemia, AML- Acute Myeloid
Leukemia, NHL- Non Hodgkin's Lymphoma
INTRODUCTION
Cancer remains the most arrogant, independent,
uncontrolled, highly destructive and proliferative,
tissue invasive, hardly inevitable, renegade, apparently
immortal population of body’s own cells with the
potentiality to metastasize and pollute the system with
a fatal terminal.1 Chemotherapy is the use of
antineoplastic agent to destroy the tumor cells by
interfering with cellular functions and reproduction.2
Common CAE are nausea, vomiting, fatigue, injection
Corresponding author:
P Chitra
Amrita College of Nursing, Amrita Institute of Medical
sciences, Kochi-682041, Kerala
Mobile No. 09645740256
E-mail id prof.pchitra@gmail.com
pchitra@aims.amrita.edu
site reaction, insomnia, anemia, neutropenia,
thrombocytopenia, diarrhea, constipation, oral
mucositis, and alopecia.
MATERIALS AND METHOD
Quantitative approach using descriptive design was
adopted for the present study. The setting was Amrita
institute of medical sciences, Kochi which is a 1500
bedded super speciality hospital. The subjects for the
study were parents of children who have undergone
chemotherapy treatment regimen, attending oncology
units of Amrita institute of medical sciences, Kochi who
were selected for the present study. Non probability
convenience sampling technique was used for the
selection of subjects. Sixty parents were selected from
oncology departments of AIMS who met with the
inclusion criteria. Data collection period was 5 weeks
from 13-11-2013 to 06-12-2013.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 21
The data collection instrument include semi
structured questionnaire to assess the socio-
demographic and clinical data. The socio demographic
data of the parents consists of 10 items which includes
age of parent, sex, marital status, religion, educational
status, monthly income, occupation, residential area,
family history of cancer and source of information about
chemotherapy adverse effects. Socio-demographic
profile and clinical data of the child consists of 12 items
which includes age of the child, sex, type of cancer,
duration of illness, total number of chemotherapy
cycles, antiemetic medications, adverse effects of
chemotherapy drugs, history of co-morbidity, modality
of treatment after diagnosing cancer, medication, use of
alternative therapy and specific food practices.
Structured questionnaire to assess the awareness
regarding adverse effects of chemotherapy includes 20
items. It was categorized into 2 headings. The first
category includes 4 items regarding cancer and its
treatment. The second category includes 16 items
regarding adverse effects of chemotherapy such as
nausea, vomiting, fatigue, injection site reaction,
insomnia, anemia, neutropenia, thrombocytopenia,
diarrhea, constipation, oral mucositis, and alopecia.
The alternative response questionnaire (true or false) to
explore the myths (beliefs) and facts (truth) about cancer
and chemotherapy treatment which includes 10
statements given regarding hair re-growth,
discoloration of skin, taste alteration, cancer prognosis,
causes of cancer, immunity, food pattern, nature and
function of chemotherapy drugs. The collected data was
analyzed using descriptive and inferential statistics.
FINDINGS
The first objective of the study was to determine the
awareness regarding CAE among parents
(n=60)
The above findings were supported by Geiger F, et
al. (2013), which suggests that the most typical side
effects of chemotherapy were nausea and vomiting.3
Fig. 1. Distribution of experiences of CAE among children
Fig. 2. Distribution of subjects based on knowledge regarding
CAE
The current study result was supported by the study
conducted by Hassan, SS et al. (2011) who assessed the
homecare management for caregiver’s having leukemic
adolescent patients in Erbil city. This study indicate
the fact that the caregivers who are having adolescent
leukemic patients had deficit knowledge and low
practice regarding homecare management.4
The second objective of the study was to explore the
myths and facts about cancer and chemotherapy
treatment
True Statement Myth(Beliefs) Fact(Truth)
f%f%
Hair re-growth occur 4 6.7 56 93.3
after chemotherapy
treatment
Chemotherapy drugs 19 31.7 41 68.3
cause dark discoloration
of skin
Cancer prognosis is good 7 11.7 5 3 88.3
among children
Smoking causes cancer 26 43.3 34 56.7
among children
Immunity is poor among 2 3.3 5 8 96.7
cancer patients
Pomegranate is good 0 0 6 0 10 0
for cancer patients
Chemotherapy drugs are 2 8 46.7 32 53.3
toxic in nature
Cancer is not a 1 1.7 5 9 98.3
communicable
disease
Chemotherapy drugs 28 46.7 32 53.3
kills kills both cancer
and normal cells
Chemotherapy drugs 5 8.3 5 5 91.7
cause taste alteration
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22 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Table 1: Distribution of Myths and Facts about cancer and
chemotherapy treatment
(n=60)
A study was conducted by Adhami, V.M., et al. (2009),
on cancer chemoprevention by pomegranate. Result
shows that pomegranate extracts selectively inhibit the
growth of breast, prostate, colon and lung cancer cells.8
Gavidia, R., et al. (2012), had conducted a study on
sepsis and infectious death in pediatric fever states that
infection remains the most common cause of death from
drug toxicity in children with cancer. Of the 251 children
enrolled, 47 (17.5%) patients developed sepsis and 7
(2.6%) died of infection. 9
The present study was supported by the Cancer
research in UK which states that non-communicable
diseases such as cancer is the ‘leading global killer’.10
Batchelor, D. (2003) conducted a study on the optimal
management of hair loss among children which states
that hair shedding usually begins from 1 to 3 weeks
and is complete from 1 to 2 months after initiation of
chemotherapy. Chemotherapy induced alopecia
usually is reversible, since hair re-growth typically
occurring after a delay of 3 to 6 months.11
A study conducted by Husti, K., et al. (2006) on
altered food intake and taste perception among children
with cancer after the start of chemotherapy. The study
states that the altered taste was the predominant cause
of the eating problem.12
The third objective was to find the association
between the awareness regarding CAE with selected
demographic variables
Fig. 3. Distribution of subjects based on myths and facts
regarding CAE
The above study findings were opposed by the cross
sectional study conducted by Chen .W, et al. (2007) on
nail color changes associated with chemotherapy
among children. The study concluded with the fact that
one third of the children with cancer developed nail
color changes associated with chemotherapy.5
The study conducted by Connor, T. H., et al. (2007)
on cytotoxic drugs states that chemotherapy drugs are
highly toxic even in minute quantities, and they pose
risks to those who handle them. Typically, cytotoxic
drugs do not distinguish between normal and
cancerous cells.6
Pavithran, K. (2013) cleared the myth that
chemotherapy drugs kills actively dividing cancer cells.
Along with cancer cells the normal cells were also
destroyed. The side effects are caused by the destruction
of normal cells along with the cancer cells.7
Table 2: Distribution of socio-demographic characteristics of children undergoing chemotherapy
(n=60)
Variables Category Frequency(f) Percentage (%)
Age of the child birth-3years 15 25
4-7years 25 41.6
8-11years 7 11.7
12-16years 13 21.7
SexBoy 41 68.3
Girl 19 31.7
Family history of cancer
Yes 1 0 1 7
No 50 83
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 23
The present study also shows that there was,
statistically significant association (÷2 =3.936) at 0.05
level of significance between the residential area and
knowledge score.
Fourth objective of the study was to prepare a care
guideline for improving awareness regarding CAE
Careguideline for Chemotherapy Adverse Effects
Chemotherapy is a drug treatment that uses powerful
chemicals to kill fast-growing cells in the body. It kills
normal cells as well as cancer cells. CAE are caused
due to the destruction of normal cells along with cancer
cells. CAE are of three types acute (occur within 24
hours), delayed (occur within 24-72 hours), long term
(months to years after treatment). The parents can follow
the care guideline listed below
Nausea and vomiting
• Stay away from cooking smells
• Eat soft and salty foods kept cold or at room
temperature
• Eat a light meal before treatment (e.g. soup, dry
biscuits)
• Drink as much fluid as possible
• Eat small and frequent feeds
• Avoid reclining immediately after eating
• Drink ginger ale
• Chew food well for better digestion.
• Add food rich in potassium (eg: banana, tomato,
cereals)
• Eat or drink high calorie (eg. rice, wheat, chappathi,
nuts), high protein foods (eg. milk, pulses, cereals)
when feeling well.
• Administer antiemetic medications 30-60 minutes
before foods
• Wear loose cotton clothes
• Room should be well ventilated
• Breath deeply and slowly when feeling nauseated
• Avoid the sight and smell of foods when not eating
• Avoid favorite foods when nauseated(ice-cream,
chocolate) to avoid aversion later
Anorexia
• Eat foods that is best tolerated
• Serve food in an attractive manner
• Avoid fried foods, gas forming vegetables (eg.
cabbage, corn, peas, beans)
• Clean the mouth after each meals
• Exercise for 10-15 minutes, half an hour before
meals.
Injection site reaction
• Immediately inform the staff if there is pain or
swelling at the injection site
• Stop the drug and elevate the affected extremity
• Apply cold compress (for Inj. Adriamycine) and
warm compress (for Inj. Vincristine) over
infiltration site.
Oral mucositis
• Take care of dental problems before starting
treatment
• If brushing is too painful use a soft-bristled tooth
brush.
• Gently floss the teeth if there is no bleeding from
gums.
• After brushing and flossing rinse the mouth for 30
seconds
Fig. 4. Distribution of types of cancer among children
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24 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
• Apply lip lubricant to avoid dryness.
• Avoid citrus juices (eg: orange, lemon)
• Inspect mouth daily and inform the doctor if there
is any painful mouth sores, white patches, difficulty
eating or swallowing, bleeding gums, or swelling
of the lips or tongue.
• Avoid breathing through mouth to prevent dryness.
• Use oral mouth wash (eg: chlorhexidine mouth
wash, saline water)
• Apply honey over the mouth ulcer
Fatigue
• Assess the causes of fatigue (e.g. dehydration,
electrolyte imbalance, and anemia).
• Do mild exercise.
• Drink plenty of water during the day time
• Eat well balanced diet
• Avoid caffeine in the evening
• Get up slowly to prevent dizziness
Neutropenia/fever
• The first sign of infection is fever, so a thermometer
should be kept ready.
• If temperature is >1000 F (37.7 0C) inform the doctor
and follow medical care immediately
• Wipe the body with luke warm water.
Infection
The symptoms of infection are:
• Fever of 100 °F or more
• Chills
• Sweating
• Loose stools
• Burning sensation during urination
• Cough or sore throat
• Redness, swelling, or tenderness, especially around
a wound, pimple, IV site or central venous catheter.
• Abdominal pain
Prevention
• Wash hands especially before eating and after using
the bathroom.
• Stay away from crowd
• Stay away from people with diseases such as cold,
flu, measles, or chicken pox
• Do not take any immunization without consulting
the doctor
• Stay away from people who have recently been
immunized, such as a vaccine for chicken pox or
small pox
• Clean the rectal area very well but gently after each
bowel movement
• Don’t squeeze or scratch pimples
• Take bath or sponge bath every day
• Use lotion or oil to soften and heal the skin if it
becomes dry and cracked
Constipation
• Provide fiber rich food (eg: green leafy vegetables)
• Serve plenty of liquids, except at mealtime.
• Practice regular bowel habits
• Use stool softeners if approved by physician
• Respond immediately for the urge to defecate
Diarrhea
• Serve plenty of food and fluids that contain sodium
(eg: salt, bengal gram) and potassium (eg. mashed
potatoes, coconut water).
• Avoid food that contains fat (eg. ghee, butter)
• Assess the signs and symptoms of dehydration
such as dryness of skin and mouth, decreased urine
volume and sunken eyes.
• Keep the perineal area clean by washing with mild
soap and water
• Give Oral rehydration solution (ORS)
Alopecia
• Keep the hair clean and wash it gently with mild
shampoos
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 25
• Use soft-bristle hair brushes
• Cut short the hair
• If considering a wig, see a wig stylish before the
treatment begins
• Use a sunscreen lotion, hat or scarf to protect from
the sun
• Use a cotton pillowcase to avoid friction between
hair and scalp
Protection during and for 48 hours after chemotherapy
treatment
• Sit on the toilet and use, to avoid splashing
• Flush the toilet twice after use
• Put the lid down before flushing to avoid splashing
• Wear gloves to clean the toilet seat after each use
• Always wash hands with warm water and soap
after using the toilet
• If the child vomits into the toilet, clean off all
splashes and flush twice
• If the child vomits into a basin, carefully empty it
into the toilet without splashing the contents and
flush twice. Wash out the basin with hot, soapy
water and rinse it, emptying the wash and rinse
water into the toilet, then flush.
• Caregivers should wear two pairs of throw-away
gloves if they need to touch the body fluids of child.
• If using throw-away diapers or under pads, seal
them in two plastic bags and properly dispose.13,14
CONCLUSION
Awareness regarding CAE is very essential in
managing the acute and delayed adverse effects. CAE
affect both the physical, physiological and
psychological perspectives of the child. There were
certain myths existing among the parents so researchers
in future can undertake the study to explore the myths
and facts existing in the parents of children.
Acknowledgement: Dr. Pavithran K, MD, DM, FICP,
ECMO Professor & Head , Department of Medical
Oncology, Amrita Institute of Medical Sciences , AIMS,
Kochi 682041 Kerala . He has recommended to develop
care guideline for pediatrics population based on need.
Conflict of Interest: Nil
Source of Funding: Self
Ethical Clearance: Ethical Clearance obtained from the
thesis review committee of Amrita Institute of Medical
Sciences, Kochi , Kerala
REFERENCES
1. SenR. Principles and management of cancer. 1st
ed. NewDelhi: BI Publications and Pvt Ltd; 2004.
p.1,84
2. Smeltzer SC, Bare B. The textbook of medical
surgical nursing. 10th ed. Philadelphia: Lippicott
Williams and Wilkins publications; 2004.p. 329
3. Geiger F, Wolfgram L. Overshadowing as
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randomized controlled trial states that typical side
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Trials journal [serial online] 2013 Apr 20; 14(103):
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4. Hasan SS, Hussein KA, Hashim M. Assessment
of home care management for caregiver’s having
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pubmed /17243953
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7. Pavithran K. Novel features of chemotherapy.
Manorama health weekly. June 2013.p.112-113
8. Adhami VM, Khan N, Mukhtar H. Cancer chemo
prevention by pomegranate: laboratory and
clinical evidence. Nutr Cancer [serial online] Nov
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 27
DOI Number: 10.5958/j.2320-8651.2.1.001
Women 'S Educational Needs about Emergency
Contraception Method
Sameti Sedigheh1, Goudarzi Mitra1, Razani Mohsen1, Falsafi Fariba1
1 Academic Member of Islamic Azad University, Nursing Department, Borujerd Branch, Iran
ABSTRACT
Introduction and Goal: Emergency contraception (EC) method, is a way that women can use it when
they didn't use any sure method for prevention of pregnancy, or every case that has probability of
unwanted pregnancy(2),(8). They can use this method for 3 days (or 72 hours) (5).The aim of this research
was investigation of women's educational needs about EC and its details.
Materials and Method: We did this research for investigation of women's educational needs about EC,
in 250 women between 15-45 years old, that came to health centers in Boroujerd. We use nonrandom-
continual way for selection of samples. The instrument of gathering information was questionnaire,
and we gathered information by interview. Information was analyzed with SPSS16 software.
Findings: The information showed that 85.3% of women have moderate knowledge about EC method,
13.6% had knowledge about all details of EC. 32.5% had knowledge about EC side-effects. 85.3% had
knowledge about EC contradiction's, 53.6% didn't have knowledge about starting time and how to use
this method, 90% didn't have knowledge about caring points during use of EC.
Conclusions: According to results, women have needs for education about all details of EC , we must
plan for them in health centers to achieve this aim. Physicians, nurses and midwifes can educate
women through books, pamphlets, films in this matter. Because with exact planning for having healthy
women we would have healthy community, after that women and her children would be happy and
healthy ,too, and it 's principal aim of our researches.
Keywords: Educational Needs, Emergency Contraception, Women
INTRODUCTION
The family planning policy refers to a set of plans
allowing families have desired number of children
through different ways (3) . Family planning is a plan
and action that its general objective at the family scale
is to establish a balance between economic facilities
and the number of children, and at the society level its
Corresponding author:
Sameti Sedigheh
Academic Member of Islamic Azad University,
Iran, Borujerd. Safa st. Shahid Ruzbahani alley, Baharan
apt. No 103/5. Unit 1. Postal Code 6916711111
Emails: sametisetareh@yahoo.com ,
sametis103@yahoo.com
objective is to establish a balance between population
and production (7),(1).
The most important objectives of family planning
that are accordance with objectives of WHO are:
decreasing malnutrition among mothers and infants
fatality rate, preventing malnutrition among mothers
and infants by putting intervals between birth,
providing suitable background for physical and mental
health for whole of the family, preventing from
undesired pregnancies and increasing the rate of
population growth and coordinating with economic,
social and cultural development (4),(3).
Medical society has provided useful methods for
family planning. Every method has a number of side
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28 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
effects (8). Therefore there is no fully reliable method
that is without any side effects for preventing pregnancy,
but not using these methods is even more dangerous.
One of these methods is EC (6).
If serial intercourse is done without prevention
methods or for example if the condom is toured or
something like this happens we can use EC. This
method is immune for majority of women (1).
Effectiveness of EC method with using
levonorgestrole pills, is 99% and using compound pills,
is about 97% . The shorter interval between sexual
intercourse and beginning of usage EC is more effective
(2) . Main side effects of this method include vomiting,
menstruation disorders, headache and vertigo. In some
cases it is forbidden to use Levonorgestrole including
active severe Porphyria, liver active and severe disease,
pregnancy and unusual and undiagnosed bleedings
in reproduction system. In some other cases it is
forbidden to use compound pills (not being allowed to
use estrogen) including pregnancy, classic migraine
and DVT (5),(7).
The best time for using EC method is the initial hours
after susceptive sexual intercourse until 72 hours later
(8). This method includes taking Levonogestrole pills
or LD or HD or three physic pills at special times. One
Levonogestrole pill as soon as possible and one another
pill 12 hours later –two HD pills as soon as possible
and 2 other pills 12 hours later -4 LD pills as soon as
possible and 4 other LD pills 12 hours later, 4 white 3-
phasic pills as soon as possible and 4 other white pills
12 hours late. It is better to take this pills while the
stomach is empty (2),(4). In the case of vomiting until 2
hours, pills should be retaken again. This method
should be used just once in a period (cycle) (1).
In the case of using barbiturates and vitamins the
effectiveness of this method would be decreased (4). This
method is not teratogen for fetus (3).
This study revealed that, this method is used less
than other methods for preventing pregnancy, according
to general objectives of family planning and also the
necessity of having complete knowledge about different
methods for women, this research was done with aim
to reviewing women’s educational needs about EC
method (6).
MATERIALS AND METHOD
This is a periodic research performed on a 250 –
samples of women (15 to 45 years old) referring to
Borujerd’s heath care centers. The sample was collected
by nonrandom-continual method. The data collecting
tool was a questionnaire containing 45 questions in
three parts. The first part (15 questions) was about
subjects personal information , the second part (10
questions) was about their knowledge of when and how
to do EC and the third part (15 questions) was about
forbidden usage cases, side effects and some points
regarding sexual intercourse when using EC. For
determining educational needs, if the subjects answered
more than 75% of questions correctly their educational
needs are estimated low and if the answered 50% to
75% of questions correctly , their educational needs are
estimated medium , and in other cases their educational
needs are estimated high. Scientific validity of the
questionnaire was determined by contents validity
method and the reliability was determined which is a
method based on internal homogeneity (r=0.91).
Questionnaires were completed using the interview
method under similar conditions for all of the subjects.
The collected data were categorized in three classes
namely high educational needs, medium educational
needs and low educational needs according to the
acquired scores. The data were analyzed using SPSS16
software, descriptive statistic test (relative frequency,
mean, standard deviation) , K square test and fisher
accurate test.
FINDINGS
The results showed that 47/3% of women aged 22
to 35 years old, 42% of them had diploma degree, 84/
6% having only one child and 63/2% of them had
received no education about EC . The results also
showed that majority of subjects having enough
information about EC had expressed their information
resources, other than health care groups, newspapers,
and scientific journals.
Generally speaking, 85/3% of subjects had medium
educational needs and 7/35% had low educational
needs. Also, the majority of subject women (85/3%)
were not informed about forbidden cases of using EC .
Majority of them (87.6%) had medium educational
needs about EC method. 82/8% of women said that the
reason of unsuccessfulness of this method is taking the
pills in the first 25 hours after suspected sexual
intercourse, and 17/2% of them said it is because of
taking LD pills (because of weakness). 63.3% of subjects
answered correctly about vomiting after using EC
method, and 60% of them answered correctly about
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 29
experiencing headache and vertigo after using EC
method .
Only 10% of them said that, they have had
menstruation disorders resulting from EC. 93/7% of
them were not able to name the conditions that EC
method can be used or were not able to tell who can use
the EC method.
Findings showed that only 13/6% of subjects were
informed about different aspects of EC method, and only
32/5% of them were correctly informed about its said
effects. 80% of subject women answered “yes” to this
question “Do you use EC method even if after using it,
you are still susceptive about pregnancy?” majority of
studied women (37%) have just taken either LD pills or
HD pills but only 3 people (1/2%) have taken
Levonorgestrole.
About when and how to do EC method, although
96% of them were informed about presence of a correct
EC method, but 53/6% of them were not exactly
informed about when and how to do EC method.
Findings of the research regarding how to deal with
the said effects of EC method showed that only 3/6% of
the studied women were informed about presence of
an anti-vomiting drug (plasil) after taking contraceptive
pills in EC. 90% of studied women were not informed
about important points of sexual intercourse while
using EC method. The K square test showed there is a
significant relationship between education level and
decrease in educational needs (p=<0.006). Also fisher
test showed that, there is a significant relationship
between women’s employment (p<0.0007), experience
of receiving education (p=0.004), and decrease in their
educational needs. There is no significant relationship
between educational needs and age, number of children
and place of life.
DISCUSSION
The medical society has present effective methods
for pregnancy planning but , no one if them is
completely accurate and symptomless ( without any
side effects).
Aghajanian says; if all of pregnancy prevention
methods are taught separately and exactly to people,
using them correctly lead to decreasing side effects and
a better effectiveness (2).
The current study also showed that 63.2% of studied
women had no experience of receiving education about
EC lonely. Etemad also writes “mass media (TV,
newspaper, etc.) provide ambiguous information
because their addresses are not women and men of the
society only (3). Whereas 82.6% of studied women with
relatively enough information about EC have expressed
that they had received their information from people
other than heath care groups, newspapers and scientific
journals.
Pouransary writes”: time of beginning of EC method
(initial hour after susceptive sexual intercourse) is very
influential in success rate, whereas 82/8% of women
have mentioned that the reason of method’s
unsuccessfulness is taking pills during the first 24
hours after susceptive sexual intercourse (4). Asadifard
also in her studies reported that majority of women have
complained about vomiting, headache and vertigo after
taking OCP (1). Also in this research, 63/7% answered
positively about headache and 60% about vertigo after
EC.
Taghavi also reported that forbidden usage cases of
OCP should be educated to women in pregnancy age
according to taken pills and methods (5), whereas even
in this current research 85/3% of studied women were
not informed about forbidden usage cases.
Javanshir reports that “ women went to stop
undesirable pregnancies, therefore they insist on using
those methods, they think would help them in reaching
this goal, whereas if the menstruation delay after EC is
more than 7 days, it is necessary to perform B-HCG test
(6). Also in this research, 80% of women said that if they
doubt about pregnancy they would repeat this method.
Shahriari also reported that we can recommend
women to use medicine with no or low side effects while
they are being educated about pregnancy prevention
methods and their side effects (7), whereas only 3/6% of
studied women were informed about using an anti-
vomiting medicine (plasil). Javanshir says that one of
the reasons of EC failure is not considering some point
(taking while stomach is empty, repeating the method
in the case of vomiting, using EC with other medicine,
etc.) while using EC method (6). Findings of the present
research also showed that 90% of studied women were
not informed about important points of protection while
using EC method.
CONCLUSION:
Findings of the research showed that only a few
number of studied women were informed about EC
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30 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
method and majority of them need information and
education about side effects of this method (EC), cases
of forbidden usage, how to do and when to do this
method and also points of protection while using EC.
People with acceptable level of knowledge about EC
claimed that they have received this information from
the media (newspapers, scientific journals, etc.).
In addition, subjects of this research have not
acquired useful information and education about EC
lonely.
Therefore considering these results, providing
useful and planned educations in heath care centers
by health care groups (nurses, doctors, midwives)
through suitable methods such as group discussion,
educative pamphlets, presenting educative films, etc.
is a necessity.
This study revealed that there is a significant
relationship between women’s education and
employment status and their knowledge. Therefore it is
suggested that, provide more planned training for
people with low literacy in this field and use teaching
aids such as educative pamphlets and handbooks to
make it more effective. We can be much sure about
effectiveness of given training, through educative
pamphlets and handbooks. It would be better to say
repeatedly that having a health child with exact
planning is the all women’s absolute right and it plays
an important role in mother and children’s physical
and mental health.
Acknowledgments: I thank all the subjects cooperated
patiently in this research. Also I thank all partners in
Borujerd’s health care centers who friendly cooperated
with the researcher throughout this study and we them
good luck.
Conflict of Interest and source of support: There isn’t
any conflict of interest in my article, and Islamic Azad
University of Borujerd, Iran is our sponsor for doing
this project.
Ethical Clearances: They were agree that their
responses being used for education and research and
privacy was respected. They understood that they are
under no obligation to take part in this project. They
understood they have the right to withdraw from this
project at any stage.
REFERENCES
1. Asadifard Farahnaz. (2009) . a new concept in
eatable pregnancy prevention treatment. Family
health magazine, Tehran: Islamic republic of Iran
family planning agency. 4th year, number 15, fall.
2. Aghajanian et al. (2011). activities regarding
fertility programs, using prevention tools and
family planning in islamic republic of iran. Family
health magazine. Tehran:Islamic republic of iran
family planning agency. 4th year, number 15, fall.
3. Etemad Maryam .(2011). recent news of family
planning. Family health magazine. Tehran:
Islamic republic of iran family planning agency.
4th year, number 16, winther.
4. Pouransary L., zaher-naseri Ali .(2010). Fertility
and population. University publication center.
Tehran.
5. Taghavi Nemat. (2009). Poplation and family
planning. Ravanpooya publication. Tehran.
6. Javanshir Sima. (2012).Emergency pregnancy
prevention. Family Health news. Family health
magazine. Tehran: Islamic republic of iran family
planning agency. 2nd year. Number 12 winter.
7. Shahriari Afsar, Saffye-Delavar, Bahram .(2011).
Fertility Health News. Family Health magazine.
Tehran: Islamic republic of iran family planning
agency.4th year. Number 16. winter.
8. Shakerinejad Masoume. (2010). Population,
fertility and family planning. Jamenegar
publications. Tehran.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 31
DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to assess the Needs of the Family Members of
Patients Admitted in Intensive Care Unit and to Compare
these with the Nurses' Perception in Selected Hospitals of
Karnataka State
Tsering Paldon1, Elsa Sanatombi Devi2, Flavia Castelino3
1 Staff Nurse, Medanta, the Medicity, Gurgaon, Haryana, 2Associate Professor, MCON, Manipal, 3Assistant Professor,
MCON, Manipal
ABSTRACT
The admission of a patient into a Intensive Care Unit is often a frightening and stressful experience for
the family members. The purpose of this study was to assess the needs of the family members of ICU
patients and the nurses' perception of these needs. A descriptive survey was undertaken and data was
collected using structured questionnaires from a sample of 75 family members of ICU patients and 75
nurses working in ICUs of Kasturba Hospital, Manipal. The top five needs of the family members
identified were: to be assured that the best care is given to my patient, to receive information about the
patient's progress, to know exactly what is being done for the patient, to know the expected outcome
and to have questions answered honestly. The family members identified the Cognitive needs as the
most important needs followed by Emotional needs. They gave the least preference to their own Personal
or Practical needs. The nurses were able to perceive that the Cognitive needs were the most important
to the family members followed by the Emotional needs. The nurses were able to identify 4 out of the top
5 needs of family members. However the mean score of the nurses' perception of the family members
needs were lower than that of the family members needs score (22.91 vs 28.09). Hence it is of crucial
importance that the nurses identify the needs of the family members accurately in order to meet these
needs.
Keywords: Needs of Family Members, Nurses' Perception, Intensive Care Unit
INTRODUCTION
Critically ill patients provoke a great deal of stress
in family members. Family members try to maintain
equilibrium by adopting numerous coping behaviors.
The family’s perception of a critical illness is a subjective
experience based on coping strategies, past experiences
with illness, family traditions, and the patient’s role in
the family.1
Studies in American hospitals have shown anxiety
symptoms in 10-42% and depressive symptoms in 16-
35% of relatives of critically ill patients. A higher
prevalence was found in a French study with 73%
anxiety symptoms and 35% with depression symptoms.
Nearly 5 million patients are admitted to an ICU in
India every year, yet studies exploring its psychological
impact on their relatives are scant.2
Attending to the critical, unstable condition of
patients who require intensive care often takes priority
over addressing the psychological turmoil experienced
by their relatives. Addressing this psychological
distress nonetheless remains an integral part of a
comprehensive critical care approach. Family members
often play an important role in promoting the
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32 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
psychological well-being of the critically ill patient
through their familiar and caring presence, meaningful
interaction with the patient, and collaboration with the
treating team in planning care.
Nurses are usually the first line care providers that
the family encounters on admission. They are
responsible for the patient’s day to day care and
involved in meeting the patient’s and family’s
immediate needs. Thus, to promote optimal outcomes
for both the patient and the family, a vital responsibility
of the nurse is to address the needs and concerns of
family members during ICU hospitalization.3
Before critical care nurses can effectively intervene
with the critically ill patients’ family, knowledge of the
family’s’ needs is essential.
RESEARCH METHODOLOGY
Descriptive survey design was used for this study.
The present study was conducted in Medical ICUs,
Surgical ICU and Cardiology ICUs of Kasturba
Hospital, Manipal. The sample consisting of 75 family
members and 75 nurses working in ICUs of Kasturba
Hospital, Manipal was selected using purposive
sampling.
The conceptual model adopted for this study was
developed by the researcher by using the concepts of
Imogene King goal attainment model (1981).
Inclusion criteria
Family members
• Family members with a patient in ICU for a
minimum of 2 days.
• Family members who can read & communicate in
English, Hindi or Kannada.
Nurses: Nurses who have worked in ICU for 1 year or
more.
MATERIALS
Tool 1: Background Proforma of family members and
nurses
Tool 2: A Structured Rating Scale on Needs of Family
Members of ICU Patients.
The tool was developed by the researcher to assess
the needs of family members of ICU patients. It consisted
of 20 items. The content areas covered were Cognitive
needs, Emotional needs, Social needs and Practical
needs. Each item was scored on a three point Likert
Scale to indicate the importance of the needs as felt by
the family members: Very Important (2), Important (1)
and Not Important (0). The scores were arbitrarily
classified as Low level needs (1-13), Moderate level
needs (14-26) and High level needs (27-40).
Tool 3: Rating scale to assess the nurses’ perception of
the needs of family members.
The tool was developed by the researcher to assess
the nurses’ perception of the needs of the family
members of ICU patients. It consisted of 20 items. The
content areas covered were Cognitive needs, Emotional
needs, Social needs and Practical needs. The nurses
were asked to rate the needs as felt by the family
members. Each item was scored on a three point Likert
Scale to indicate the importance of the needs as felt by
the family members: Very Important (2), Important (1)
and Not Important (0). The scores were arbitrarily
classified as: Low level needs (1-13), Moderate level
needs (14-26) and High level needs (27-40).
The validity of the tools was established by experts
from different specialties i.e Psychiatry, Medical Surgical
Nursing, Pediatric Nursing and Psychiatric Nursing.
Reliability of the tools was determined by Cronbach’s
alpha.
Data collection procedure
The investigator approached the study subjects,
explained the purpose of the study and obtained their
consent after assuring them of the confidentiality of the
data. Data was collected using the structured
questionnaires. The family members in the ICU waiting
rooms and the nurses working in their respective ICUs
were approached for the study.
Data analysis
Descriptive and inferential statistics using SPSS
windows 16.0 version was used to analyze the study
findings.
Findings of the study
Sample characteristics
Family members: Majority of the family members
of ICU patients (62.7%) were males; between the age
group of 31-40 years (30.7%) and were the children of
the patients (29.3%). Only 8% of the family members
were illiterate, while most of them (37.3%) belonged to
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 33
the unskilled workers category and had a family income
of d” Rs 5,000 (45.3%).
Nurses: Most of the nurses (41.3%) were of the age group
26-30 years and were females (65.3%). Most of them
(60%) were from medical ICU and majority of the nurses
(74.7%) had a work experience of 1-5 years.
Needs of the family members of ICU patients
The top five needs of the family members were
identified as: to be assured that the best care is given to
my patient, to receive information about the patient’s
progress, to know exactly what is being done for the
patient, to know the expected outcome and to have
questions answered honestly.
The least five needs of the family members were: to
have explanation about ICU environment, to have
someone nearby for my support, to have explanation of
the routines, policies and procedures of the hospital, to
have a place to pray and to be assured that it is alright
to leave the hospital for a while.
The total score of the needs of family members
ranged from 18-37 with a mean of 28. Majority of the
family members (72%) had high level of needs while
none of them reported low level of needs.
The mean percentage for the domains of the needs
of the family members was calculated. The family
members viewed the Cognitive needs (76.68%) and
Emotional needs (75.5%) as the most important needs.
The Practical needs or Personal needs were given the
lowest priority by the family members.
Nurses perception of the needs of the family members
The top five needs as perceived by the nurses were:
to be assured that the best care is being given, to know
the expected outcome, to have questions answered
honestly, to know exactly what is being done for the
patient and to be involved in decision making in
patients’ care
The least five needs of family members as perceived
by nurses included: to have a place to pray, to have
someone nearby for support, to see the patient frequently,
to be assured that it is alright to leave the hospital for a
while and to involve in patients’ care.
The total score of the needs of the family members as
perceived by the nurses ranged from 17-29 with mean-
22.91 and SD-2.326. Majority of the nurses 73 (97.3%)
perceived moderate level of needs while none of them
perceived low needs level.
By computing the mean percentage of the domains
of the needs, it was found that the nurses perceived the
Cognitive needs (66.37%) and Emotional needs (64.37%)
as the most important to the family members while
Social needs (26.67%) were perceived as the least
important needs.
Table 1: Comparison of the top 5 needs of the family members and needs of family members as perceived
by the nurses
Top 5 needs of the family members Rank Top 5 needs of family members as perceived by the
nurses
To be assured that the best care is given to the patient 1 To be assured that the best care is given to the patient
To get information about the patient’s progress 2 To know the expected outcome
To know what is being done for the patient 3 To have questions answered honestly
To know the expected outcome 4 To know what is being done for the patient
To have questions answered honestly 5 To be involved in decision making
The nurses were able to identify 4 out top 5 needs of
family members. However the mean total score of the
nurses’ perception of the family members needs were
lower than that of the family members needs (22.91 vs
28.09).
Difference in needs of the family members and as
perceived by the nurses
Independent t-test was used and it was found that
the scores of the needs between the family members
and nurses were statistically different (t= 10.376,
p=0.000), demonstrating the difference in perceptions
of the needs between the two groups with the nurses
underestimating the needs of the family members.
Association between needs of family members and
selected demographic variables
There was association between needs of family
members with age (f= 2.663, p=0.041) and gender
(t=2.242, p=0.028), with males having more needs.
However there was no association between needs of
family members and other demographic variables.
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34 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Association between nurses perception of family
members needs and selected demographic variables
There was significant association between nurses’
perception of the needs of the family members with age
(f=10.623, p=0.000), professional qualification (f=9.912,
p=0.000) and work experience in ICU (f= 4.614,
p=0.013). However there was no association with
gender (t=0.371, p= 0.712).
Limitations
The purposive sampling technique used may limit
the generalization of findings.
The present study was confined to a sample selected
from a single hospital.
CONCLUSION
1. The family members identified the Cognitive needs
as the most important needs followed by emotional
needs. Cognitive needs include the need for
information and knowledge about the patient’s
condition and progress. Emotional needs include
need for hope and reassurance. The need for
accurate, understandable information is important,
as is the provision of psychological support and
guidance to the family members during this time.
2. The least importance was given to the Practical
needs. These include the needs for comforts for the
family members themselves. This finding shows
that the family members prefer the ICU staffs’
attention to be focused on the patients’ care and
give absolute priority to everything that concerns
the patient. With the admission of patient in ICU,
the family members set aside their own personal
needs and concentrate all their energy on the
patient.
3. The nurses were able to perceive the Cognitive
needs as the most important needs of the family
members, followed by the Emotional needs. The
nurses were able to identify 4 out of the top 5 family
members needs.
4. The nurses rating of the family members needs
(mean score) were lower than that of the family
members needs (22.91 vs 28.09). It may be due to the
fact that nurses are more concerned about the
acutely ill patients (patient focused) and hence are
not able to accurately perceive the needs of the
family members.
Hence it is a vital responsibility of the nurse to
address the needs and concerns of the family members
of the ICU patients. The nurse must acknowledge the
important role the family members play in patient care
and embrace their participation.
Acknowledgement: I would like to extend my sincere
thanks to all the Heads of the Departments, nurses,
patients, my teachers and my classmates for their help
in completing my study.
Conflict of Interest: None
Source of Support: Self
Ethical clearance:
• Administrative permission was taken from the
Dean, Manipal College of Nursing, Manipal
University.
• Permission was taken from the HODs of Department
of Medicine, Department of Surgery and
Department of Cardiology, Kasturba Hospital,
Manipal.
• Permission was taken from Medical
Superintendent, Kasturba Hospital, Manipal.
• Institutional Ethics Committee approval from
Kasturba Hospital, Manipal.
• Informed consent from the participants.
REFERENCES
1. Hardicre J. Meeting the needs of families of
patients in intensive care units. Nursing Times.
2003 July; 99(27): 26-27.
2. Kulkarni HS, Kulkarni KR, Mallampalli A, Parkar
SR, Karnad DR, Guntupalli KK. Comparison of
anxiety, depression and post traumatic stress
symptoms in relatives of ICU patients in an
American and an Indian public hospital. Indian
Journal of critical Care Medicine. 2011 July-
Sep;15(3) :147-155.
3. Bailey JJ, Sabbagh M, Loiselle CG, Boileau J, McVey
L. Supporting families in the ICU: A descriptive
correlational study of informational support,
anxiety, and satisfaction with care. Intensive and
Critical Care Nursing.2010 Dec; 26:114-122.
Available at: URL:http://www.pubmed.com.
4. Lee IYM, Chien WT, Mackenzie AE. Needs of
families with a relative in critical care unit in Hong
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 35
Kong. Journal of Clinical Nursing. 2000; 9: 46-54.
Available from: http://www.sciencedirect.com.
5. Paparrigopoulos T, Melissaki A, Efthymiou
A, Tsekou H, Vadala C, Kribeni G, Pavlou
E, Soldatos C. Short-term psychological impact on
family members of intensive care unit patients. J
Psychosom Res. 2006 Nov;61(5):719-722.
Available at URL:http:// www.pubmed.com.
6. Azoulay E, Pochard F, Cherret S, Lemaire F,
Mokhtari M, Gall JRL et al. Meeting the needs of
Intensive Care Unit Patient Families: A multi-
center study. Am J Respir Crit Care Med. 2001.
16:135-139.
7. Verhaeghe S, Defloor T, Van Zuuren F, Duijnstee
M and Grypdonck M. The needs and experiences
of family members of adult patients in an intensive
care unit: A review of the literature. Journal of
Clinical Nursing .2005 Apr;14(4):501-509.
8. Maghsoudi J, Soltani F,Pahlavanzade S and
Tavakol K. Family experiences of patients admitted
in intensive care unit .Iranian Journal of Nursing
and Midwifery Research. 2007 November;
12(4):139-145. Available at URL:http://
www.pubmed.com.
9. Pillai L et al. Can we predict intensive care relatives
at risk for posttraumatic stress disorder? Indian J
Crit Care Med. 2010 April-June; 14(2): 83–87.
Available from http://www.pubmed.com.
10. Heyland DK et al. Family satisfaction with care in
the intensive care unit: Results of a multiple center
study. Crit Care Med. 2002; 30(7):1413-1418.
11. Davidson JE et al. Clinical practice guidelines for
support of the family in the patient-centered
intensive care unit: American College of Critical
Care Medicine Task Force 2004–2005. Crit Care
Med.2007; 35(2): 605-621.
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36 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to assess the effectiveness of Interactive
Bibliotherapy on Reduction of Body Image Dissatisfaction
among High School Girls (13-16 Years) in Selected
Schools, Mysore
Riji C Philip1, Ambika K2, Sheela Williams3
1M.Sc Nursing, Dept. of Pediatric Nursing, 2Assistant Professor, Dept. of Pediatric Nursing, 3Prof.Sheela Williams,
Principal cum Professor & HOD, JSS College of Nursing, Mysore
ABSTRACT
Background: The enormous influence of the media toward urban population regarding woman's ideal
body image causes women especially the adolescent girls to experience body image dissatisfaction.
Studies have revealed that body image dissatisfaction could lead to serious problems such as low self-
esteem, depression, and eating disorders that even might lead to death. Therefore, some solution to
cope with this problem is needed, one of which is bibliotherapy, a kind of therapy using an activity of
reading selected literatures or materials to promote mental health.
Aim: The aim of the study was to assess the effectiveness of interactive bibliotherapy on reduction of
body image dissatisfaction among high school girls (13-16 years) in selected schools, Mysore.
Method: True experimental pre- test post- test only design, was adopted for the study. Simple random
sampling technique was adopted to select the high school girls, 30 each in experimental and control
group. The level of body image dissatisfaction was assessed by using self-administered body image
dissatisfaction scale. Bibliotherapy was given to high school girls regarding reduction of body image
dissatisfaction.
Results: The analysis of the findings revealed that there was a significant difference between the mean
pre - test and post- test body image dissatisfaction scores which was statistically tested using paired 't'
test (t(29)=6.10; p<0.05) and was found to be significant at 0.05 level of significance. The significance of
difference between the post-test knowledge scores among experimental and control group was
statistically tested using independent 't' test (t(58)= 5.74; p< 0.05) and was found to be significant at
0.05 level of significance and inferred that bibliotherapy was effective in reducing body image
dissatisfaction among high school girls. The results of the study also revealed that the level of body
image dissatisfaction among high school girls had no significant association with their selected personal
variables.
Conclusion: Therefore, the study concluded that interactive bibliotherapy was effective in reducing the
level of body image dissatisfaction among high school girls. Hence, the school authority should give
importance to reading in improving the mental health of the girls and thereby enabling them to be a
fruitful and a healthy citizen and also improvement in academic performances.
Keywords: Interactive Bibliotherapy, Body Image Dissatisfaction, High School Girls
INTRODUCTION
Adolescence, the transitional stage from childhood
to adulthood is a delicate phase of life.1 The never-ending
sequence of physical and psychological adaptations of
adolescents has a remarkable influence on the social
and behavioral aspects of their lives.2 Body image is
about feeling good about yourself and your appearance
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 37
and also about how a person believes the outside world
views their body fits with social norms.3 Body image
dissatisfaction at moderate levels can be a normative
experience for many women of current culture.
However, women whose body dissatisfaction exceeds
moderate levels are vulnerable to developing an eating
disorder. Empirical findings show body dissatisfaction
predicts low self-esteem, depression, and overall poor
quality of life.4
More recently, educators and medical health
professionals have relied on powerful tales and the
concept of “bibliotherapy” to help younger students
who are struggling with personal experiences that
distract them from their educational pursuits.
Bibliotherapy is “a projective indirect intervention that
uses literature for personal growth.”5 Bibliotherapy has
a long history and it is often defined as “healing through
books”. It is an activity which utilizes the strength of
literature for the purposes of understanding, insight
and self- growth. The reader identifies with the
characters in a book and realizes that they are not alone
with the problems they experience in their lives.6
A cross sectional survey was done to examine the
prevalence of body weight dissatisfaction, difficulty in
communication with the parents and the relationship
between communication with the parents and
adolescents dissatisfaction with their body weight and
the data was collected from adolescents in 24 countries.
The results showed that body weight dissatisfaction
was highly prevalent and more common among girls
than boys, among overweight than non-overweight and
among older adolescents than younger adolescents.
Difficulty in talking to father was more common than
difficulty in talking to mother in all countries and it
was greater among girls than among boys and
increased with age.7
A study was conducted to evaluate the effectiveness
of bibliotherapy in reducing the body image
dissatisfaction among high school girls. The study was
conducted among 45 girls from three different high
schools. The body image dissatisfaction of each
participant was measured at pre- treatment; post
treatment and one month follow up. The research
findings revealed that the group who got interactive
bibliotherapy had gone through a significant mean
decrease of body image dissatisfaction before and after
the training. The mean of body image dissatisfaction
before the training (60.60) that was in moderate category
decreased into 47.20 after the training and it was
classified into low category. Thus the results showed
that, the interactive and reading bibliotherapy was
effective in reducing body image dissatisfaction among
high school girls.8
OBJECTIVES
The objectives of the study were
1. To assess the level of body image dissatisfaction
among high school girls in experimental and control
group.
2. To determine the effectiveness of interactive
bibliotherapy on reduction of body image
dissatisfaction among high school girls in
experimental group.
3. To find out the association between level of body
image dissatisfaction among high school girls and
their selected personal variables.
HYPOTHESES
H1:The mean post- test body image dissatisfaction
scores of high school girls who have undergone
interactive bibliotherapy will be significantly lesser than
their mean pre-test scores
H2: The mean post- test body image dissatisfaction
scores of high school girls who have undergone
interactive bibliotherapy will be significantly lesser than
mean post test scores of high school girls who have not
undergone interactive bibliotherapy.
H3: There will be significant association of body
image dissatisfaction scores of high school girls with
their selected personal variables.
METHODOLOGY
Research design selected for this study is True
experimental, pre-test post-test only design.
In this design, subjects are randomly assigned to
either the experimental group or control group. The true
experimental design is characterized by manipulation,
control and randomization.
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38 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
The symbolic representation of the present study was
as follows
E: O1 X1 X2 O2
C: O1 O2
KEYS:
E – Experimental group
C – Control group
X1 – Session 1
X2 – Session 2
O1 – Pre-test
O2- Post- test
In the present study, population comprises high
school girls in the age group of 13- 16 years. The sample
of the present study comprises of high school girls (13-
16 years) in selected schools of Mysore and sixty high
school girls were selected for the present study, thirty
each in experimental and control group. Simple random
sampling technique was used in the present study. Data
collection was based on
Proforma for selected personal variables.
The proforma for selected personal variables
contains the basic information about the high school
girls viz. age, type of family, education of participants,
family income (per month), area of residence, hobby,
source of information regarding body image.
Self – administered Body Image Dissatisfaction Scale.
It includes 30 items which are categorized into
following areas like dissatisfaction related to self-
perception which includes 10 items, dissatisfaction
related to physical development which include 3 items,
dissatisfaction related to eating habits with 4 items, and
dissatisfaction related to appearance with 13 items.
There were 5 alternative response columns: not at all,
once in a while, occasionally, most of the times and
always. It was scored as 1 for not at all, 2 for once in a
while, 3 for occasionally, 4 for most of the times and 5
for always. The total score ranges from 30- 150. This
was further divided arbitrarily as follows: Satisfied (30-
60), Just satisfied (61-90), Dissatisfied (91-120), Very
dissatisfied (121- 150).
The schematic representation of the research design
GROUP DAY 1 DAY 7 DAY 14
Experimental group Pre-test : Self-administered body Intervention: Interactive Post - test : Self-
image dissatisfaction scale Bibliotherapy(IB) administered body image
Session -2 dissatisfaction scale
Intervention: Interactive
Bibliotherapy ( IB) Session- 1
Control Group Pre- test : Self-administered body - Post - test : Self- administered
image dissatisfaction scale body image dissatisfaction scale
Fig 1. Schematic representation of the research design
FINDINGS
SECTION 1
Description of Selected Personal Variables of Study
Subjects:
1. Frequency and percentage distribution of high
school girls in the experimental and control group
according to their selected personal variables.
The study sample comprised of 60 students, 30 each
in experimental and control group. The selected
personal variables were described under the sub
headings viz. age, education, type of family, family
income (per month), area of residence, hobby, source of
information regarding body image as shown in
Table 1.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 39
Table 1: Frequency and percentage distribution of high school girls according to their selected personal variables in
experimental and control group
n=60
Sl.No Sample characteristics Experimental Control Total
Groupn=30 Groupn=30 n=60
f % f% f%
1 Age in years
a) 13 -14 14 46.67 19 63.33 33 55
b) 15 – 16 16 53.33 11 36.67 27 45
2 Education
a) 8th standard 3 1 0 12 40 15 25
b) 9th standard 11 36.67 8 26.67 19 31.67
c) 10th standard 16 53.33 10 33.33 26 43.33
3 Type of family
a) Nuclear family 20 66.67 20 66.67 40 66.67
b) Joint family 7 23.33 6 20 13 21.67
c) Extended family 3 1 0 4 13.33 7 11.66
4 Family income ( per month)
a) < Rs. 5000/- 4 13.33 8 26.67 12 20
b) Rs. 5001 /-10000/- 6 20 10 33.33 16 26.67
c) Rs. >10000 20 66.67 12 40 32 53.33
5 Area of residence
a) Urban 29 96.67 15 50 44 73.33
b) Rural 1 3.33 15 50 16 26.67
6 Hobby
a) Reading 8 26.67 9 30 17 28.33
b) Watching TV 6 2 0 8 26.66 14 23.33
c) Dancing 3 10 7 23.33 10 16.67
d) Singing 7 23.33 2 6.67 9 15
e) Drawing 4 13.33 2 6.67 6 10
f) Painting 2 6.67 2 6.67 4 6.67
7 Source of information regarding body image
a) Media 9 3 0 1 2 40 21 35
b) Magazines 14 46.67 13 43.33 27 45
c) Peers 7 23.33 5 16.67 12 20
Section ii: effectiveness of interactive bibliotherapy
1. Frequency and percentage distribution of level of
body image dissatisfaction among high school girls.
The data showed that (53.33%) of the high school
girls were satisfied about their body image among
experimental group in pre-test, 36.67% were just
satisfied, 6.67% were dissatisfied and 3.33% were
very dissatisfied with their body image. In the post-
test all 30 (100%) samples belonged to the satisfied
level. In the control group, during pre-test majority
60% of the samples were just satisfied, 20% were
satisfied, 16.67% were dissatisfied and 3.33% were
very dissatisfied with their body image and during
post- test majority 56.67% were satisfied, 26.67%
were just satisfied and 16.67% were dissatisfied
with their body image.
2. Description of pre-test and post-test body image
dissatisfaction scores of high school girls in
experimental and control group.
The pre-test scores ranged 36-125 in experimental
group and 34-123 in control group. The post-test
scores ranged 31-58 in experimental group and 32-
125 in control group. The mean pre-test body image
dissatisfaction scores of experimental group is 62.1
with SD ±18 and 63.7 with SD ±18.9 in control
group. The mean post- test body image
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40 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
dissatisfaction score of experimental group is 42
with SD ±7.28 and is 63.5 with SD ±19.2 in control
group.
3. Significance of difference between pre- test body
image dissatisfaction scores of high school girls in
experimental and control group:
The mean difference between the body image
dissatisfaction scores of experimental and control group
is 1.6. To find the significance of difference in mean
body image dissatisfaction scores, an independent ‘t’
test was computed and obtained value of independent
‘t’ = 0.33 (p>0.05) was found to be not significant.
Hence, it is inferred that there is no significant difference
between mean pre- test body image dissatisfaction
scores of high school girls among experimental and
control group and both the group were from the
equivalent base line.
4. Reduction in body image dissatisfaction:
comparing pre-test and post-test scores
i. Significance of difference between pre-test and post-
test body image dissatisfaction scores of high school
girls among experimental and control group
The mean difference between the pre-test and post-
test in experimental group was 20.1. It indicates that
there was reduction in the body image dissatisfaction
scores of high school girls in experimental group. To
find the significant reduction in body image
dissatisfaction scores the paired t test was computed
and was found to be 6.10 (p< 0.05) and was found to be
significant at 0.05 level of significance.
In control group, the mean difference between the
mean pre- test and mean post test score was 0.42. To
find the significant reduction in body image
dissatisfaction scores the paired t test was computed
and was found to be 0.42 (p> 0.050 and was found to be
not significant at 0.05 level of significance.
ii. Significance of difference between post-test body
image dissatisfaction scores of high school girls
among experimental and control group
The mean difference between the body image
dissatisfaction scores of pre-test and post- test of
experimental and control group is 21.5. This indicates
the reduction in body image dissatisfaction scores in
experimental group after the interactive bibliotherapy.
To find the significance of reduction in body image
dissatisfaction, an independent ‘t’ value was computed
and was found to be 5.74 (p< 0.05) and was found to be
significant at 0.05 level of significance.
It was inferred that the mean post- test body image
dissatisfaction scores of high school girls who have
undergone interactive bibliotherapy was significantly
lesser than the mean post- test body image
dissatisfaction scores of high school girls who have
not undergone interactive bibliotherapy. Interactive
bibliotherapy was effective in reducing body image
dissatisfaction among high school girls.
SECTION III
Findings related to the association of the level of
body image dissatisfaction of high school girls with
their selected personal variables.
The computed Chi-square value for association
between level of body image dissatisfaction and
selected personal variables were found to be not
significant at 0.05 level of significance. It was inferred
that there was no significant association between the
body image dissatisfaction with their selected personal
variables viz. age, education, family income (per month),
area of residence, hobby and source of information
regarding body image.
CONCLUSION
The present study was focused to assess the
effectiveness of interactive bibliotherapy on reduction
of body image dissatisfaction among high school girls
in selected schools. The findings revealed that, there
was a significant reduction in the mean body image
dissatisfaction scores of high school girls in
experimental group compared to control group. Thus,
it was concluded that, interactive bibliotherapy is
helpful in reducing body image dissatisfaction among
high school girls. Therefore, the study reinforces to give
importance to reading which sensitizes the young girls
to have a positive attitude towards their body, their
behavior and healthy life styles. Thus, the dangers of
the risk of developing emotional and physical
disturbances in early life can be prevented there by
enabling them to be a fruitful and a healthy citizen and
also improvement in academic performances.
ACKNOWLEDGEMENT
We express our thanks to all high school girls who
participated in the study and the authorities who
provided permission to conduct the study.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 41
Conflict of Interest
Nurses play a vital and major role in health care
delivery system in taking measures to prevent
psychological problems. Early identification and
intervention prevents many physical and psychological
problems. Bibliotherapy is a cost-effective intervention
in order to reduce many psychological problems faced
by the children. Nursing personnel working in school
settings need to take the responsibility to develop
healthy life styles and to reduce their dissatisfaction to
their body thereby improving their academic activities
and making them a psychologically and physically
fruitful citizenry by providing appropriate reading
material of people who lived a successful life in spite of
their deformity
Ethical Clearance: Ethical clearance was obtained from
the ethical committee of the college.
Funding Sources: Not obtained any funds from any
sources.
REFERENCES
1. Swati Y Bhave. Adolescent body image-
Perspectives, Impact and Management. New
Delhi: Jaypee brothers; 2006.
2. Swati Dixit U, Agarwal GG et al. A study on
consciousness of adolescent girls about their body
image. [serial on the Internet]. 2011 [cited 2012 Oct
2]. Available from: http://www.ijcm.org.in/
article.asp?issn=09700218;year=2011; volume=
36;issue=3;page=197;epage=202;aulast=Dixit
3. Kids Help. Body Image. [homepage on the Internet].
2009 [cited 2013 Sep 4]. Available from: http://
www.kidshelp.com.au/grownups/news-
research/hot-topics/body-image.php
4. Stefanie Teri Greenberg. An investigation of body
image dissatisfaction among Jewish American
females:an application of tripartite influence
model. [homepage on the Internet]. 2009 [cited
2012 Oct 7]. Available from: http://ir.uiowa.edu/
etd/368
5. Michael Rozalski, Angela Stewart, Jason Miller
W. Bibliotherapy: Helping children cope with life’s
challenges. [homepage on the Internet]. 2010 [cited
2012 Oct 17]. Available from: http://http://
www.kdp.org/publications/pdf/record/fall10/
Record_Fall_2010_Rozalski.pdf
6. Lilian Mitchell. The application of bibliotherapy
with primary school children living in a violent
society. [homepage on the Internet]. 2002 [cited
2012 Oct 19]. Available from: http://http://
etd.uwc.ac.za/usrfiles/modules/etd/docs/
etd_init_1080_1176817672.pdf
7. Haleema Al Sabbha D, CareenaVereecken A. Body
weight dissatisfaction and communication with
parents among adolescents in 24 countries:
international cross-sectional survey. [homepage
on the Internet]. 2008 [cited 2012 Oct 14]. Available
from: http://www.biomedcentral.com/1471-
2458/9/52
8. Monique Elizabeth Sukamato. The effectiveness
of bibliotherapy in reducing body image
dissatisfaction among high school girls.
Indonesian Psychological Journal [serial on the
Internet]. 2008 [cited 2012 Oct 18].; 24(1) Available
from: http://ssisjd.pdii.lipi.go.id/admin/jurnal/
241083337.pdf
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42 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
Factors Responsible for Stress among Family Caregivers of
Hospitalised Patients in Abeokuta, Nigeria
Fatona, Emmanuel Adedayo1, Oseni, Rukayat Ejide2, Adebayo, Catherine Olubunmi3,
Adegbite Nasimot Omolola4
1Nurse Educator, 2Chief Nurse, 3Chief Midwife Educator, 4Nursing Officer, Sacred Heart Hospital, Lantoro, Abeokuta,
Ogun State, Nigeria
ABSTRACT
The study is designed to; evaluate the factors contributing to stress among caregivers, identify the
effects of stress among family caregivers of hospitalized patients, to suggest useful coping strategies in
dealing with stress during hospitalisation. Family caregiver implies family member, spouse, friend, or
neighbour who provides care to an individual during hospitalization. The research design adopted for
this study was descriptive survey approach. Purposive sampling technique was used to select the
sample of 200 family caregivers. Data was collected using questionnaire. Analysis was done descriptively
and inferentially. Care recipient’s behaviour and required attention towards siblings do not significantly
contribute to stress in family caregivers of hospitalised patients. X2< critical value (P<0.05).Emotional
problems are the major effects of caregiver stress. Thorough understanding of patient’s medical situation,
Stress management and self-efficacy techniques are the useful coping strategies. Therefore, patients
and caregivers should be well-informed.
Keywords: Effects, Family Caregivers, Hospitalised patients, Nigeria, stress
INTRODUCTION
Caregivers can be seen as individual(s) who during
the course of treatment are most closely involved in
caring for the patient and helping the patient cope with
and manage his illness, short term or long term.
According to Fatona1, the concept of Nursing reflects
an open system which responds to the society of which
it is a part. As an open system, nursing involves
simultaneous interaction with social system. As a
profession, nursing addresses the responses/needs of
the individual and families to actual or at risk health
problems in a humanistic and holistic manner.
Healthcare professionals especially nurses, as
members of the social system most times work, and will
continue to work with patient relatives (caregivers) in
order to promote effectiveness of care and to prevent
complications through home-based continuity where
necessary. At the same time, family caregivers of
hospitalized patients perceive high levels of stress and
anxiety due to length of hospitalisation, economic status,
hospital policies and care receiver’s behaviour/attitude.
This brings out the need to evaluate the factors
responsible for stress in caregivers of hospitalised
patients in State General Hospital and Sacred Heart
hospital, Abeokuta.
Most patients have families that are providing some
level of care and support. In the case of older adults
and people with chronic disabilities of all ages, this
“informal care” can be substantial in scope, intensity,
and duration. Family care giving raises safety issues in
two ways that should concern nurses in all settings.
First, caregivers are sometimes referred to as “secondary
patients,” who need and deserve protection and
guidance. Research supporting this caregiver-as-client
perspective focuses on ways to protect family caregivers’
health and safety, because their care giving demands
place them at high risk for injury and adverse events.
Second, family caregivers are unpaid providers who
often need help to learn how to become competent, safe
volunteer workers who can better protect their family
members (i.e., the care recipients) from harm.
The term caregiver refers to a family member, spouse,
friend, or neighbour who provides care to an individual
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 43
having an acute or chronic condition and needs
assistance to manage a variety of tasks, from bathing,
dressing, and taking medications to tube feeding and
ventilator care.
According to Reinhard et al2, recent surveys estimate
there are 44 million caregivers over the age of 18 years
(approximately one in every five adults). The economic
value of their unpaid work has been estimated at $257
billion dollars. Most caregivers are women who handle
time-consuming and difficult tasks like personal care.
But at least 40 percent of caregivers are men, a growing
trend demonstrated by a 50 percent increase in male
caregivers between 1984 and 1994. These male
caregivers are becoming more involved in complex tasks
like managing finances and arranging care, as well as
direct assistance with more personal care. Nurses are
likely to see many of these caregivers, although many
of them will not identify themselves as a caregiver.
Having a child hospitalized is a stressful event for
parents. Previous studies have found increased stress
in families with children affected by different kinds of
pathologies, and analyzed disease related objective
variables producing stress. However, most of these
studies recruited caregivers of children with chronic or
serious illnesses, and focused on evaluation of objective
environmental stressors and did not consider subjective
“perception” of stress.
Present data showed that caregivers of hospitalized
children perceived high levels of stress and anxiety.
Perception of stress was influenced by the degree of
kindred with patients, length of hospitalization, and,
notably, participation in some of the activities offered
to children, mainly school services.3
Bhattacharjee M, et al 4submitted Caregiver factors
responsible for major stress are long care giving hours,
anxiety, disturbed night sleep, financial stress, younger
age and Caregivers being daughter-in-law.
Raina et al 5in their study “The health and well-
being of caregivers of children with cerebral palsy”,
stated that the psychological and physical health of
caregivers is strongly influenced by child behavior and
care giving demands. Child behavior problems are an
important predictor of caregiver psychological well-
being, both directly and indirectly, through their effect
on self-perception and family function. The practical
day-to-day needs of the child create challenges for
parents. The influence of social support provided by
extended family, friends, and neighbors on health
outcomes is secondary to that of the immediate family
working closely together. Family function affects health
directly and also mediates the effects of self-perception,
social support, and stress management. In terms of
prevention, providing parents with cognitive and
behavioral strategies to manage their child’s behaviors
may have the potential to change caregiver health
outcomes.
Stress is a reaction to changes that require
adjustments or responses and our stress level will
depend upon how we respond to these adjustments.
Early in care giving experience, increased stress will be
noticed.
Requirements for caregiver role include
Choice, perceived obligation, attachment or
relationship to the sick, ability to deal with the situation,
perceived responsibility, and a child hospitalized based
on illness(es), or born with a birth defect. A difficult
relationship may be strengthened or further
disintegration may take place, causing regrets and
resentments. If the quality of the relationship is poor,
the assistance of a professional may help. Relationships
can be strengthened through much effort, compromise
and willingness to sacrifice.
Caregiver stress can be caused by any of the
following: Care receiver’s behavior and attitude,
physical and emotional components of care, adjusting
to work and care giving, care receiver’s financial
problems, adjustments of care giving within the family.
Warning signs that may indicate high stress include
Physical: Headaches, appetite feeling tired all the
time, changes in sleep habits, muscle aches, getting sick
often, stooped posture, sweaty palms, neck pain, weight
gain or loss.
Emotional; Anger, sadness or crying spells,
irritability or short temper, worry or anxiety,
discouragement, trouble relaxing, emptiness or loss of
direction, looking for magic solutions, inability to
concentrate, frequent mood swings.
Behavioral; Increased use of drugs or alcohol, trouble
concentrating, avoiding decisions, low productivity,
forgetfulness, boredom, over-reacting, acting on
impulse, changing jobs often.
Relationships; Problems with marriage or children,
intolerance of others, fewer contact with friends,
nagging, lowered sex drive, loneliness, resentment.
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44 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Healthy choices for dealing with stress may include:
exercise, getting enough sleep, eating proper food, taking
time for hobbies, asking for support from family
members, friends, or community resources, taking care
of physical appearance, accepting that there are events
one cannot control, cessation of harmful habits like
smoking, setting realistic goals and expectations,
having a forgiving spirit, communicating feelings.6
In the presence of stress and burnout, the caregiver’s
health is at risk, it affects the ability to provide care. It
hurts both the caregiver and the person receiving care.
The key point is that caregivers need care too. Managing
the stress levels in life is just as important as making
sure the family member (care recipient) gets to his
doctor’s appointment or takes medication on time.7
Family caregivers are also at increased risk for
depression and excessive use of alcohol, tobacco and
other drugs. Care giving can be an emotional roller
coaster. Studies show that an estimated 46 percent to
59 percent of caregivers are clinically depressed.8
Garro9 suggested that it is important to provide a
variety of resources to families of children with chronic
feeding problems during their children’s
hospitalizations, including access to support and
information groups. Also, it is beneficial for these
families to acquire a thorough understanding of their
child’s medical situation because this understanding
seems to help them in their ability to cope. According to
Raina et al 5, Strategies for optimizing caregiver physical
and psychological health include supports for
behavioral management and daily functional activities
as well as stress management and self-efficacy
techniques.
Tang and Chen10in their study, Health promotion
behaviors in Chinese family caregivers of patients with
stroke, affirmed that social support is the strongest
positive predictor of caregiver’s health promotion
behaviors, which suggests that social support is
important to caregiver’s health promotion behaviors.
MATERIAL AND METHOD
The research design adopted for this study was
descriptive survey approach. Purposive sampling
technique was used to select the sample of 200 family
caregivers, {100 each from the two (2) hospitals}.
Participation was based on the fact that they were the
most relevant group under study. They were also
selected based on presence, and readiness to participate
in the study.
Inclusion criteria; Family member, spouse, friend, or
neighbour who provides care to an individual during
hospitalisation in State Hospital and Sacred Heart
Hospital, Abeokuta, Ogun State, Nigeria.
Exclusion criteria; Family member, spouse, friend, or
neighbour who only visits the patient occasionally
during hospitalization, healthcare professionals taking
care of patients. Data was collected using questionnaire.
Data collected from the respondents were analysed
descriptively through the use of tables followed by
interpretation derived from the data presented, and
inferentially using the Chi-Square.
FINDINGS
Table I: Socio-demographic Characteristics of
Respondents
N=200
S/No Demographic Frequency Percentage
Characteristics (%)
1 Age (years)
15-24 56 28
25-34 70 35
35-44 49 24.5
45 and above 25 12.5
2 Gender
Male 79 39.5
Female 121 60.5
3 Marital Status
Single(never 73 36.5
ever married)
Married 118 5 9
Separated/divorced 4 2
Widowed 5 2.5
4 Religion
Christianity 118 5 9
Islam 71 35.5
Traditional 11 5.5
5 Occupation
Trading 76 38
Farming 1 5 7.5
Civil servant 4 6 23
Unemployed 2 2 11
Student 26 13
self-employed 15 7.5
6 Educational level
Tertiary 86 4 3
Secondary 56 28
Primary 24 12
None 3 4 17
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 45
Table II: Contingency table for factors contributing to stress among family caregivers of hospitalized patients
SA A D SD X2 df P-value
Length of hospitalization contribute to 7 0 93 29 8 1.632 12 21.03
stress among caregivers
Care recipient behavior give rise 7 4 71 37 1 8
to stress in caregivers
Caregivers encounter stress due to work and 68 10 8 1 7 7
care giving adjustments
Care giving demands weakens caregiver 61 88 4 0 11
Required attention towards siblings creates 48 9 9 39 1 4
more stress for the caregiver
Column Total 32 1 45 9 162 58
Note:
*SA- Strongly agree, A- Agree, D- Disagree, SD- Strongly disagree.
Level of significance á= 0.05
Degree of freedom df = 12
X2 value =1.632
Table (Critical) value = 21.03.
Hypothesis ; Care recipient behaviour and required attention towards siblings do significantly contribute to
stress in family caregivers of hospitalised patients.
X2< critical value, therefore hypothesis is rejected.
Outcome; Care recipient behaviour and required attention towards siblings do not significantly contribute to
stress in family caregivers of hospitalised patients.
Table III: Effects of stress among caregivers
Effects of stress among caregivers S A A SA+A SA+A(%) D SD
Emotional problems e.g. anger, irritability or short temper, 6 0 95 155 26.8 29 16
discouragement, inability to concentrate,
frequent mood swings.
Increased use of drugs or alcohol and low productivity 3 9 98 137 23.7 42 21
intolerance of others and fewer contact with friends 51 9 6 147 25.4 39 14
Reduced ability to provide care. 60 79 139 24.0 44 17
Column Total 21 0 368 578 10 0 154 68
Table IV: Coping strategies/measures to reduce stress in caregivers
Coping strategies/measures to reduce stress in caregivers SA A SA+A % D SD
Providing access to support and information groups 86 8 3 1 69 24.6 28 3
Supports for behavioral management and daily 80 90 170 24.7 25 5
functional activities
Stress management and self-efficacy techniques. 88 86 174 25.3 22 4
Thorough understanding of patient’s medical situation 7 9 95 1 74 25.3 23 3
Column Total 33 3 354 687 10 0 98 15
DISCUSSION
Respondents of ages 25-34 years constitute the
highest percentage (35%), Most of them are females
(60.5%), Majority (59%) of them are married. 59% of the
respondents are Christians, traders constitute 38% and
43% are educated up to tertiary level.
Care recipient’s behaviour and required attention
towards siblings do not significantly contribute to stress
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46 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
in family caregivers of hospitalised patients. X2< critical
value (P<0.05).
Emotional problems e.g. anger, irritability or short
temper, discouragement, inability to concentrate,
frequent mood swings (26.8%) are the major effects of
caregiver stress, followed by intolerance of others and
fewer contact with friends (25.4%). This supports the
submission of Family caregiver alliance8 who stated
that care giving can be an emotional roller coaster.
Studies show that an estimated 46 percent to 59 percent
of caregivers are clinically depressed. At the same time,
disagrees with Smith and Kemp 7who affirmed that, in
the presence of stress and burnout, the caregiver’s
health is at risk, it affects the ability to provide care.
Most respondents fully agreed that; Stress
management and self-efficacy techniques (25.3%),
thorough understanding of patient’s medical situation
(25.3%), will reduce stress among caregivers, followed
by Supports for behavioral management and daily
functional activities (24.7%) and Providing access to
support and information groups (24.6%). This implies
that thorough understanding of patient’s medical
situation, Stress management and self-efficacy
techniques are the useful coping strategies. This
corroborates the submission of Garro9 in that; it is
beneficial for families of hospitalized children with
chronic feeding problems to acquire a thorough
understanding of the medical situation because this
understanding seems to help them in their ability to
cope. Disagrees with Tang and Chen 10 who stated that
social support is the strongest positive predictor of
caregiver’s health promotion behaviors.
CONCLUSION
Patient relatives are involved in caregiver role(s) in
order to promote effectiveness of care and to prevent
complications through home-based continuity where
necessary. They sometimes perceive high levels of stress
and anxiety due to several reasons. Findings show that
care recipient’s behaviour and required attention
towards siblings do not significantly contribute to stress
in family caregivers of hospitalised patients. Stress
management and self-efficacy techniques, thorough
understanding of patient’s medical situation and
providing access to support/information groups will
reduce stress among caregivers.
Acknowledgement: The authors are grateful to the
participants (for taking part in the study). The Chief
Matron, management and staff of Sacred Heart Hospital
for their approval and support. We are equally grateful
to the Research Ethics Committee, management and staff
of State General Hospital, Abeokuta, Nigeria.
Conflict of Interest: None.
Source of Funding: Self.
Ethical Clearance: Following notification, ethical
permission was obtained from the Chief Matron of
Sacred Heart Hospital and Research Ethics Committee
of State General Hospital, Abeokuta, Ogun State,
Nigeria.
REFERENCES
1. Fatona E.A. Awareness of nurses about the nature
and practice of collaborative care in Sacred Heart
Hospital, Abeokuta, Nigeria. International Journal
of Nursing Care (IJONC) July-December 2013;1 (2),
25-30. DOI Number: 10.5958/j.2320-8651.1.2.026
2. Reinhard S. C., Given B, Petlick N.H. and Bemis
A. Supporting Family Caregivers in Providing
Care Patient Safety and Quality: An Evidence-
Based Handbook for Nurses, Chapter 14. Edited
by Hughes RG. 2008. Available from: http://
www.ncbi.nlm.nih.gov/books/NBK2665/
Accessed 31 August 2013.
3. Commodari E. Children staying in hospital: a
research on psychological stress of caregivers.
Italian Journal of Pediatrics 2010; 36:40. Available
from: http://www.ijponline.net/content/36/1/
40.Accessed 31 August 2013.
4. Bhattacharjee M, Vairale J, Gawali K and Dalal P.
Factors affecting burden on caregivers of stroke
survivors: Population-based study in Mumbai
(India). Ann Indian Acad Neurol. 2012 Apr-Jun;
15(2): 113–119. doi: 10.4103/0972-2327.94994.
PMCID: PMC3345587. Available from:http://
www.ncbi.nlm.nih.gov/pmc/articles/
PMC3345587/Accessed 27 February 2014.
5. Raina P, O’Donnell M, Rosenbaum P, Brehaut J,
Walter SD, Russell D, Swinton M, Zhu B, and
Wood E. The health and well-being of caregivers
of children with cerebral palsy. Pediatrics 2005;
Jun;115(6):e626-36. Available from: http://
www.ncbi.nlm.nih.gov/pubmed/15930188.
Accessed 31 August 2013.
6. Narum L andTranstrom N. CAREGIVER STRESS
& COPING. The Journey Through
Caregiving.2003; Available from: http://
www.ndsu.edu/ndsu/aging/caregiver/pdf/
stress/manual.pdf. Accessed 31 August 2013.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 47
7. Smith M and Kemp G. Caregiver Stress & Burnout
Tips for Recharging and Finding Balance.2013;
Available from; http://www.helpguide.org/
elder/caregiver_stress_burnout.htm. Accessed 31
August 2013.
8. Family caregiver alliance. Taking Care of YOU:
Self-Care for Family Caregivers. 2012; Available
from: https://www.caregiver.org/caregiver/jsp/
content_node.jsp?nodeid=847. Accessed 27
February 2014.
9. Garro A. Coping patterns in mothers/caregivers
of children with chronic feeding problems.J
Pediatr Health Care. 2004; 18(3):138-44. Available
from: http://www.ncbi.nlm.nih.gov/pubmed/
15129214. Accessed 31 August 2013.
10. Tang Y and Chen S. Health promotion behaviors
in Chinese family caregivers of patients with
stroke. Health Promot. Int. 2002; 17 (4): 329-339.
doi: 10.1093/heapro/17.4.329. Available
from:http://heapro.oxfordjournals.org/content/
17/4/329.full. Accessed 27 February 2014.
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48 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
Effect of Yoga as Nursing Intervention on Stress, Anxiety
and Quality of Life among Cervical Cancer Patients
M Jayalakshmi
Principal, Shri Vinoba Bhave College of Nursing, Silvassa, DNH
ABSTRACT
The experience of cancer can have a significant impact on patient's quality of life. Using suitable
alternative medicine like yoga helps to provide a holistic approach to cancer care. Clinical and anecdotal
reports of yoga for cancer patients suggest physical and psychological benefits and an increased sense
of participation in the treatment and recovery process. By using a combination of therapies, self care
and life style based interventions can contribute to improve their quality of life. The specific objective of
this study was to determine the effect of supportive therapy for women with cervical cancer on the non
physiologic parameters. A convenience sample of women with cervical cancer (stages 1 to 3), newly
diagnosed patients participated in the study. A total of 24 patients were enrolled in the experimental
and in the control group. Demographic information and a baseline assessment of Stress, Anxiety and
Quality of life were done before the intervention. The intervention consisted of 3 week duration of 30
minute duration 5 days a week yoga session. Participants participated in the yoga session under the
supervision of a nurse trained in the Yoga practice. Majority of the participants were illiterate or
functionally literate and belonged to the low income group. The mean anxiety score in both the
experimental and control group was 48 ( high medium anxiety ) and the mean score for stress was 22
in both the groups. Both the groups had average quality of life with a mean score of 128 in the experimental
and control group. Yoga can be integrated into the nursing practice as a supportive therapy for women
with cervical cancers . Mind body therapies enhances the mind's ability to control bodily functions
thus improving the end result of a longer and higher quality life for many cancer patients.
Keywords: Cervival cancer, Yoga , Stress, Anxiety, Quality of life
INTRODUCTION
Cervical cancer is the fifth most common cancer
among women, the second most common cancer in
women worldwide. It accounts for 80% of the global
burden of the disease and over 80% of the global
mortality. Latin America and the Asia-Pacific region
account for about 60% of cervical cancer cases
worldwide. It is also the most common cancer cause of
death in the developing countries including India.
There are 50 million new cervical cancer cases detected
each year - WHO (2011)1, with approximately 288,000
deaths worldwide, 88 per cent of which occurred in
developing countries and 159,800 in Asia out of which
India accounts nearly 73000 out of the reported 132000
cases. Cervical cancer ranks as the most frequent cancer
among women in India. An estimated 2,05,496 new
cases and 1,19,097 deaths due to cervical cancer will
occur in India by 2020, contributing to 29% and 30%
respectively of the global burden of cervical cancer cases
and mortality.2 Over 33,000 women, mostly in rural
areas, died of cervical cancer in the country in 2010. A
report from the HPV Information Center, WHO-India
reveals that India has a population of 366.58 million
women aged 15 years or older and who are at risk of
developing cervical cancer3. Current estimates indicate
that 132,082 women are diagnosed with cervical cancer
every year. Research shows that cervical cancer patients
reported for treatment having both psychological and
physical symptoms at all time points of their cancer
journey. Shock, fear, self-blame, power-lessness, and
anger are the most common emotions experienced by
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 49
women who receive bnormal Pap test results.4 Common
psychological problem being anxiety and stress affect
a patient’s ability to cope with a cancer diagnosis or
treatment. Patients may have anxiety while being
screened for a possible cancer, pain- both mental and
physical, financial strain, loss of family support after
receiving cancer diagnosis, and while being treated for
a cancer, worrying that cancer cannot be cured
completely and having fear that it may also recur.
Anxiety may increase pain, affect sleep, loss of appetite,
nausea, vomiting and may also even affect quality of
life. Women with gynecological cancer are at risk of
having poor relationship with their spouse results in
quality of life outcomes5.
MATERIAL AND METHOD
Research Approach - Quantitative approach was in
nature.
Research Design – Quasi Experimental Design.Pre –
test and Post test control group design was followed.
Setting – The study was conducted at Cancer Institute
(WIA), Adyar, Chennai
Population – The study included patients between 20
to 60 yrs of age admitted with cervical cancers.
Sample Size – Convenient sampling technique was
adopted .A total of 48 patients participated in the study
( 24 patients in the control group and 24 patients in the
experimental group) who fulfilled the criteria for sample
selection .
Inclusive criteria
• Inpatients admitted with cervical cancers
• Patients who are undergoing chemotherapy /
radiotherapy
• Patients who are ambulatory
• Patients whose hospital stay is of at least 3 -4 weeks
Exclusive criteria
• patients who are extremely fatigued and cachexic
• Patients who are unable to perform daily living
activities
• Patients who have incordinated movements /
neurological impairment
•Patients who are severely anemic
Sampling Technique: Purposive sampling technique
was followed.
Tools for Data Collection
S.No Tool name Author / Year
1 State Anxiety Inventory for Adults Spielberger,1999
2 Perceived Stress Scale Sheldon Cohen,1983
3 CI –QoL Version II Dr E Vidhubala Quality of Life
4 Structured questionnaire for demographic data of subjects Investigator
Intervention
Lecture cum demonstration on Yoga in cancer
followed by Daily Yoga session (Asanas, Pranayama
and Meditation) 30 min duration for 6 days a week for
3 -4 weeks along with standard ( personal hygiene, self
care management during radiation and chemotherapy)
HYPOTHESIS
•H
0There is no difference in the Post intervention
level of Stress, Anxiety and Quality of life between
the experimental and control group at 5 % level of
significance in experimental group.
•H
1The Post intervention level of Stress score is
lesser than that of Pre intervention level stress score
among women with cervical cancers at 5 % level of
significance in experimental group.
•H
2The Post intervention level of anxiety score is
lesser than that of Pre intervention level anxiety
score among women with cervical cancers at 5 %
level of significance in experimental group.
•H
3Post intervention level of Quality of life score is
higher than that of Pre intervention level Quality of
life score among women with cervical cancers at 5
% level of significance in experimental group.
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50 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
RESULTS AND DISCUSSION
• Mean age of the participants was 47.
• Majority of the participants (80%) were illiterate
and have done elementary schooling except one
participant who had passed 10th std.
• All participants belonged to the low income group.
• Stage II cancer was commonly seen (80%).
• All participants underwent radiation therapy and
chemotherapy.
• None of the participants had practiced yoga before.
The pre intervention mean anxiety score in both the
experimental and control group was 49 and the mean
pre intervention score for stress was 22 in both the
groups as seen in Table :1.
Table 1: Mean and SD values of Pre and Post intervention Scores of Participants
Mean Mean SD SD
Exp Group Cont Group Exp Group Cont Group
Stress
Pre Yoga 22.25 21.58 3.74 3.23
Post Yoga 17.70 22.50
Anxiety
Pre Yoga 48.53 48.75 6.49 4.30
Post Yoga 43.29 48.91
QoL
Pre Yoga 128.33 128.58 12.66 10.98
Post Yoga 139.12 128.87
The pre and post intervention mean Quality of life score was 129 in the control group while there was a
significant difference in the pre and post intervention mean scores of Quality of Life among the experimental
group and was highly significant ( p < .001) as depicted in Table 2.
Table 2: Mean, SD and ‘t’ values of Experimental and control group participants.
Pre yogaMean Post YogaMean SD ‘t’ value(paired) P value
Stress 22.25 17.70 3.74 1.33 NS
Anxiety 48.53 43.29 6.49 0.95 NSP > .05
Qol 128.33 139.12 12.66 5.52* SP<.001
Though in the post intervention only 4% had high
anxiety scores ( fig 1)when compared to pre intervention
where 17 % had high anxiety scores, there was no
significant difference in the mean values between the
experimental and control groups ( p > .05) .
Fig. 1. Comparison of Pre and Post Intervention Anxiety
scores
The quality of life was graded into very low,low,
average , high and very high based on the level of scores
obtained. In the pre intervention only 4 % had high
quality of life while in the post intervention 21 % had
Fig. 2. Comparison of pre and post intervention Quality of
life scores among Experimental group
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 51
high level of quality of life.( fig 2) . Majority of the
participants had average quality of life scores in both
the pre and post intervention group among the
experimental group.
CONCLUSION
Yoga can be integrated into the nursing practice as
a supportive therapy for women with cervical cancers .
Mind body therapies enhances the mind’s ability to
control bodily functions thus improving the end result
of a longer and higher quality life for many cancer
patients.As as a part of holistic care approach, Yoga is
a practice that can be used safely with guidance and
respect for its tradition. Integrating yoga in nursing
intervention, could result in positive outcomes in
cervical cancer patients helping them to live to their
fullest.
Acknowledgement: Dept of Radiation Oncology ,
Adyar Cancer Institute ,Chennai
Conflict of Interest: No competing financial interests
exist. The author report no conflict of interest in this
work.
Source of Funding: The project was a self financed.
Ethical Clearance: The research proposal was
approved by Ethical committee of the Institute where
research was conducted.
REFERENCES
1. Susan H,Eileen D, Mona S,Elizabeth U, Lauri
M.Manual for the Surveillance of Vaccine-
Preventable Diseases. Atlanta : Centre for Disease
Conterol and Prevention, 2011.
2. Shastri Surendra S . Cervical cancer screening and
vaccination in India.Indian Journal of Medical
Ethics.2010 ;7(1) : 41.
3. Bruni L, Barrionuevo-Rosas L, Serrano B, et al. ICO
Information Centre on HPV and Cancer (HPV
Information Centre). Human Papil-lomavirus and
Related Diseases in India. Summary Report.
2014.3.17.
[ Data accessed]
4. Christine Baze , Bradley J. Monk , Thomas J.
Herzog .The impact of cervical cancer on quality
of life: A personal account.Gynecologic Oncology.
2008 ;109 : S12 – S14.
5. Jolyn Hersch. Psychosocial interventions and
quality of life ingynaecological cancer patients: a
systematic review Psycho-Oncology . 2009;18:
795–810.
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52 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to assess the effectiveness of Self-Instructional
Module on Third Space Fluid Shift and its Management
among Critical Care Nurses at Selected Hospitals in
Mysore
Keerthi Rao1, Aswathy Devi M K2, Sheela Williams3
1M.Sc Nursing, 2Associate Professor, Medical Surgical Nursing, 3Principal cum Professor & HOD (MSN), JSS College of
Nursing, Mysore
ABSTRACT
Background of the study: In a healthy adult, nearly all fluid is contained in the intracellular, intravascular,
or interstitial spaces, with the intracellular space holding about two-thirds of total body water. Body
fluids are distributed between the intracellular and extracellular fluid compartments. Abnormal changes
in the distribution of these fluids lead to health problems. Thus being a nurse it's a necessity to understand
these health issues.
Aim: The aim of the study was to assess the effectiveness of self-instructional module on third space
fluid shift and its management among critical care nurses at selected hospitals in Mysore.
Method: In the study, quasi experimental non-equivalent control group pre test post test design was
used and a non-probability convenient sampling technique was adopted to select 60 critical care
nurses', 30 in experimental and 30 in control group. Pilot study was conducted, the tool and study
design were found to be feasible. The knowledge level was measured by using structured knowledge
questionnaire. The tool was validated by experts and reliability was established using split half method.
Self-instructional module was administered to experimental group. The data was collected and analyzed
using descriptive and inferential statistics.
Results: Results of the study revealed that, there was significant difference between the mean pre test
and post test knowledge scores which was statistically tested using paired 't' test ('t'(29)=11.564; p<0.05)
was found to be significant at 0.05 level of significance. The significance of difference between the post
test knowledge scores among experimental and control group was statistically tested using independent
't' test ('t'(58) =1.67. p< 0.05) was found to be significant at 0.05 level of significance and inferred that the
self-instructional module was effective in improving the knowledge level among critical care nurses.
The results of the study also revealed that the knowledge level of the critical care nurses had no
significant association with their selected personal variables.
Conclusion: Therefore, the study concluded that self-instructional module was effective in improving
the knowledge level among critical care nurses. Hence the hospitals/ institutions should give importance
to staff development programs and thereby improve the knowledge level among critical care nurses'.
Keywords: Self-Instructional Module, Knowledge, Effectiveness, Critical Care Nurses'
INTRODUCTION
The human body is the entire structure of
a human organism and comprises a head, neck, torso,
two arms and two legs. The human body is a
sophisticated and highly technical machine. It is
composed of number of systems that are
interdependent. The interdependent function of these
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 53
systems helps in maintaining a healthy human being.
Each of these systems is composed of different levels of
structural organizations and complexities1
The human organism consists of trillions of cells all
working together for the maintenance of the entire
organism. The varied processes by which the body
regulates its internal environment are collectively
referred to as homeostasis. Homeostasis in a general
sense refers to stability, balance or equilibrium. It is the
body’s attempt to maintain a constant internal
environment. Maintaining a stable internal
environment requires constant monitoring and
adjustments as conditions change. This adjusting of
physiological systems within the body is
called homeostatic regulation2.
Fluid volume, pressure and levels of sodium and
albumin are the keys to maintain the fluid balance
between intracellular and extracellular space.
Physiologically, the first space and second space are
the intravascular and the extravascular space
respectively. When there is an increase in the fluid
volume or disruption in the process of diffusion and
osmosis, the fluid shifts into a ‘third space’, which is not
perfused for fluids2.
Major examples of third spaces include peritoneal
cavity, pleural cavity and lumen of the gastro-intestinal
tract. The term ‘third space fluid shift’ is physiological
concept where body fluids accumulate in the third
space3. The statistical data also reveals that 50:10,000
people of United States develop third space fluid shift
and 40% of the patients admitted in INDIA develop
complications due to fluid shift. This fluid shift is also
found fatal to human being and in most of the patients
it is left undiagnosed leading to complications. The
complications include peritonitis, edema, pyometritis
and pleural effusion3.
OBJECTIVES
Objectives of the study were
1. To assess the knowledge of critical care nurses’
regarding third space fluid shift and its
management through structured knowledge
questionnaire before and after administration of self-
instructional module.
2. To determine the effectiveness of self-instructional
module on third space fluid shift and its
management in terms of gain in knowledge scores
of critical care nurses’.
3. To find the association of critical care nurses’
knowledge regarding third space fluid shift and its
management with their selected personal variables.
HYPOTHESES
H1: There will be significant difference between the mean
post-test and pre-test knowledge scores of critical care
nurses’ among experimental and control group.
H2: The mean post-test knowledge scores of critical care
nurses’ who have received self-instructional module
will be significantly higher than the mean post-test
knowledge scores of critical care nurses’ who have not
received the self-instructional module on third space
fluid shift and its management.
H3: There will be significant association between critical
care nurses’ knowledge scores regarding third space
fluid shift and its management and their selected
personal variables.
METHODOLOGY
Research design selected for this study is quasi
experimental non-equivalent pretest post-test control
group design.
Quasi experimental approach for an intervention
study is the one in which the subjects are not randomly
assigned to treat condition, but the researcher exercise
some control to enhance the study’s internal validity.
The symbolic representation of the present study was
as follows
E - O1XO
2
C - O1- O
2
Keys
E – Experimental group
C – Control group
O1– Pretest
X – Intervention
O2– Post-test
In the present study, population comprises of critical
care nurses . The sample of the present study comprises
of critical care nurses who are working in JSS Hospital
and BGS Apollo Hospital, Mysore. Sixty (60) critical
care nurses were selected for the present study, 30 each
in experimental and control group.
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54 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Description of tool
1. Description of proforma for selected personal
variables:
This section contains the basic information about
the age, gender, professional education, number of
years of experience and in-service education.
2. Description of structured knowledge questionnaire:
The structured knowledge questionnaire was
prepared for the study includes 38 items. There were
4 alternative responses. The total score ranges from
0 to 38. This was further divided arbitrarily as
follows: poor knowledge (0-18), average knowledge
(19-28), good knowledge (29- 38).
The schematic representation of the research design
Group Pre-testDay 1 InterventionDay 1 Post testDay 8
Experimental Group SKQ to assess knowledge of Self-instructional SKQ to assess knowledge
critical care nurses’ on third module administration of critical care nurses’ on
space fluid shift and its third space fluid shift and
management its management
ControlGroup SKQ to assess knowledge of - SKQ to assess knowledge of
critical care nurses’ on third critical care nurses’ on third
space fluid shift and its space fluid shift and its
management management
FINDINGS
Section 1: Description of selected personal variables
of study subjects
• Frequency and percentage distribution of rural
adults in experimental and control group according
to their selected personal variables.
Study sample composed of 60 critical care nurses’,
30 in experimental and 30 in control group. The
selected personal variables are described under sub
headings viz. Age, gender, education qualification,
experience in critical care units and in-service
education as shown in Table 1.
Table 1: Frequency and percentage distribution of critical care nurses according to their selected personal variables
in experimental and control group
n=60
Sample characteristics Experimental Control Total
Group n=30 Group n=30 n=60
f% f%f%
Age in years
a) 21-25 yrs 4 13.33 6 20 1 0 16.67
b) 25-30 yrs 13 43.33 14 46.66 27 45
c) >30 yrs 13 43.33 10 33.33 23 38.33
Sex
a) Male 5 16.66 12 40 17 28.33
b) Female 25 83.33 18 60 43 71.67
Educational qualification
a) GNM 25 83.33 7 23.33 32 53.33
b) B.Sc. Nursing 2 6.66 10 33.33 12 20
c) P.B. BSc. Nursing 3 1 0 9 30 12 2 0
d) M.Sc. Nursing - - 4 13.33 4 6.67
Number of years of experience working as staff nurse in critical care areas
a) Less than 3 yrs - - 11 36.66 11 18.33
b) >3 - <6 yrs 8 26.66 11 36.66 19 32.67
c) >6 - <9 yrs 9 30 5 16.66 14 23.33
d) >9 yrs 13 43.33 3 10 16 26.67
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 55
Section 2: Effectiveness of self-instructional module
a. Frequency and percentage distribution of level of
knowledge among critical care nurses’ in
experimental and control group.
The total knowledge scores ranged from 0-38. The
knowledge scores were arbitrarily divided as poor
knowledge (0-18), average knowledge (19-28) and
good knowledge (29-38).
Mean, Median, Range Standard deviation of pre
test and post test knowledge scores of rural adults
in experimental and control group.
The pre test knowledge scores ranged from 08-31 in
experimental group and 05-33 in control group. The
mean pre test knowledge score was 16.57 with a
standard deviation of ±8.461 in experimental group
and 15.27 with a standard deviation of ±6.28 in
control group. The post test knowledge scores
ranged from 24-38 in experimental group and 05-
32 in control group. The mean post test knowledge
score is 30.3 with a standard deviation ±3.317 in
experimental group and 13.5 with a standard
deviation ±5.645 in control group.
b. Significance of difference between mean pre test
knowledge scores of critical care nurses’ in
experimental and control group.
The mean difference between the pre test knowledge
scores of critical care nurses’ among the
experimental and control group was 1.3. To find
the significance of difference in mean pre test
knowledge scores among experimental and control
group, an independent ‘t’ value was computed and
the obtained value of independent ‘t’(58)=0.793,
p>0.05 was found to be not significant. Hence it is
inferred that there is no significance of difference
between pre test knowledge scores of critical care
nurses’ among experimental and control group and
both the group were started from equivalent base
line.
c. Gain in knowledge: comparing pre test and post
test scores
i. Significance of difference between pre test and post
test knowledge scores of critical care nurses’ among
experimental and control group.
The mean difference between the mean pre test and
mean post test scores of experimental group was
13.73. This indicates that the self instructional
module had helped to increase the level of
knowledge in experimental group. To find the
significant gain in knowledge scores the paired ‘t’
value was computed and the obtained value of t(29)
= 2.045 was found to be significant at 0.05 level of
significance. Hence it was inferred that there is a
significant difference in the mean pre test and post
test knowledge scores of critical care nurses’ among
experimental group. Thus, it was concluded that
self instructional module was effective in increasing
the knowledge of critical care nurses’ regarding
third space fluid shift and its management.
The control group mean difference between pre test
and post test knowledge scores was 1.1. To find the
significance of difference of mean knowledge scores,
the paired ‘t’ test was computed and obtained t(29) =
2was found to be not significant at 0.05 level of
significance. Hence it is inferred that there is no
significant difference between pre test and post test
knowledge scores of critical care nurses’ among
control group.
ii. Significance of difference between gain in post test
knowledge scores of critical care nurses’ among
experimental and control group.
The mean difference between the mean post test
knowledge scores of experimental and control
group is 16.13. To find the significance of difference
in mean post test knowledge scores independent ‘t’
value was computed and obtained t(58) = 9.601 was
found to be significant at 0.05 level of significance.
Section 3: Findings related to association between
level of knowledge scores with their selected personal
variables of critical care nurses’.
The knowledge of critical care nurses’ had no
significant association with their selected personal
variables.
CONCLUSION
The pre test was conducted to identify the
knowledge scores among critical care nurses’, result
showed that the critical care nurses’ had very little
knowledge. The analysis of the findings revealed that,
there was a significant improvement in mean
knowledge scores of critical care nurses’ in
experimental group compared to control group.
The self instructional module was effective in
improving the level of knowledge the experimental
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56 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
group as the paired t(29) =11.564, was significant at 0.05
level of significance. The results also revealed that, there
was no association found between the pre test
knowledge scores with their selected personal
variables.
Thus, it was concluded that, self instructional
module is helpful in improving the level of knowledge
among critical care nurses’. Hence the hospitals should
give importance to improving the level of knowledge
among critical care nurses’.
Acknowldgement: We express our thanks to all critical
care nurses’ who participated in the study and the
authorities who provided permission to conduct the
study.
Conflict of Interest: Nil
Ethical Clearance: Ethical clearance was obtained from
the ethical committee of the college.
Funding Sources: Not obtained any funds from any
sources.
REFERENCES
1. Anthony S & Dennis L. Fluid Challenges. In editor.
Harrison’s Principles of Internal Medicine, 18th
Edition. America: McGraw-Hill ISBN; 2012.
pp.1200-1205
2. Harsh Mohan, Derangement of Homeostasis and
Hemodynamics. In editor. Textbook of Pathology :
Jaypee publishers; 2010.
3. Chintamani E, Fluid, Electrolyte and Acid-Base
Balance, 7th edition. In editor. Lewis’s Medical-
Surgical Nursing. Haryana, INDIA: Elsevier; 2011.
pp.303-333
4. George M, Fluid and Electrolyte Imbalance. In
editor. Essentials Of Critical Care Medicine, 2nd
edition. New Delhi, INDIA: Elsevier; 2012.
pp.25-38
5. Wikipedia. Fluid Compartment. [homepage on the
Internet]. 2004 [cited 2012 Oct 4]. Available from:
http://en.wikipedia.org/wiki/
fluid_compartments.
6. Swank C, Christianson CA, Prows CA.
Effectiveness of a genetics self-instructional
module for nurses’’ involved in egg donor
screening. [homepage on the Internet]. 2004 [cited
2012 Oct 5]. Available from: http://
www.ncbi.nlm.nih.gov/pubmed/11724197.
7. Rank J.M. The effect of a self-instructional module
on rabies for staff nurses’’. [homepage on the
Internet]. 1990 [cited 2014 Jan 5]. Available from:
http://circle.ubc.ca/handle/2429/214498.
8. John, Julie C. Effectiveness of self-instructional
module on aseptic wound dressing practices
among staff nurses’’ in selected hospitals at
Mangalore. [homepage on the Internet]. 1994 [cited
2012 Oct 4]. Available from: http://
119.82.96.198:8080/jspui/handle/123456789/
1352.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 57
DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to assess the effectiveness of Demonstration
Programme on Cardio Pulmonary Resuscitation on the
Knowledge and Skill of KSRTC Workers in Selected
KSRTC Depots of Mysore
Manju Kurian1, Usha M Thomas2, Sheela Williams3
1M.Sc Nursing, 2Associate Professor, Dept. of Medical Surgical Nursing, 3Prof.Sheela Williams, Principal cum Professor
& HOD, JSS College of Nursing, Mysore
ABSTRACT
Background: Cardiac arrest also known as cardio pulmonary arrest or circulatory arrest is the cessation
of normal circulation of the blood due to failure of heart to contract effectively. Cardio pulmonary
resuscitation is a vital link in the chain of survival that supports the victim until more advanced help
is available. Rapid intervention is the key to success and is critical in preventing biologic death or the
death of brain cells. The chance of survival of a cardiac arrest victim during these critical first few
minutes depends very much on the proficiency of bystander cardio pulmonary resuscitation.
Aim: The aim of the study was to assess the effectiveness of demonstration programme on Cardio
Pulmonary Resuscitation on the knowledge and skill of KSRTC workers in selected KSRTC depots of
Mysore.
Method: Pre-experimental; one group pre test- post test design was adopted for the study. Convenience
sampling technique was adopted to select 60 KSRTC workers. Data collection tools consists a structured
knowledge questionnaire to assess the knowledge of KSRTC workers regarding CPR and observational
checklist to assess the skill of KSRTC workers on CPR. Tools were validated by subject experts. Split
half technique was used to assess the reliability of structured knowledge questionnaire and interrater
method was used to assess reliability of checklist. All the KSRTC workers were exposed to a
demonstration programme on CPR followed by the knowledge and skill assessment.
Results: The analysis of the findings revealed that, the KSRTC workers had poor knowledge and skill
on CPR. Findings also revealed that demonstration programme on CPR was an effective strategy to
increase the knowledge and skill of KSRTC workers as indicated by the computed 't' value which was
statistically significant at 0.05 level of significance (t(59)=18.72; p<0.05) and (t(59)=41.86; p<0.05).
Study findings also revealed that there is no significant association between the knowledge and skill of
KSRTC workers regarding CPR and their selected personal variables.
Conclusion: Demonstration programme was effective in enhancing the knowledge and skill of KSRTC
workers regarding Cardio Pulmonary Resuscitation. The study findings stress the increasing
responsibility of health professionals in planning and implementing various educational strategies to
improve the knowledge and skill of public regarding Cardio Pulmonary Resuscitation.
Keywords: Sudden Cardiac Arrest, Cardio Pulmonary Resuscitation, Demonstration Programme
INTRODUCTION
Cardiac arrest also known as cardio pulmonary
arrest or circulatory arrest is the cessation of normal
circulation of the blood due to failure of heart to contract
effectively1. When the heart stops pumping, blood flow
and spontaneous breathing stop, resulting in
cardiopulmonary arrest and a complete lack of oxygen
delivery to vital organs. 2 Prompt intervention can
usually reverse a cardiac arrest, but without such
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58 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
intervention, it will almost always lead to death.
Chances of survival reduce by 7-10% with every passing
minute3. Cardio Pulmonary Resuscitation (CPR) is an
emergency procedure which is performed in an effort
to manually preserve intact brain function until further
measures are taken to restore spontaneous blood
circulation and breathing in a person in cardiac arrest4.
Out-of-hospital cardiac arrest is a leading cause of
death among adults. India is one of the top countries
for cardiac arrest5. In the first few minutes following
out- of- hospital cardiac arrest, five critical actions by
bystanders or emergency medical service providers
comprise the chain of survival, which substantially
increase the chance of survival from out- of- hospital
cardiac arrest6. The 2010 impact goal of American Heart
Association to reduce death rate from heart disease
emphasizes the need for timely delivery of effective pre
hospital emergency care7.
People tend to be panic and freeze when they
encounter someone in cardiac arrest, and they need to
know that cardio pulmonary resuscitation is easier than
many realize8. AHA has emphasized that everyone
must have to learn cardio pulmonary resuscitation9.
Many research studies have documented the importance
of bystander cardio pulmonary resuscitation in
increasing the survival chance of victims of cardiac
arrest10.
The value of bystander cardiopulmonary
resuscitation (CPR) has been well defined by studies in
many countries and communities. Even in countries or
areas where emergency services are well developed,
most victims of cardiac arrest do not receive bystander
CPR, and when it is given, the quality is generally far
from ideal. The need, therefore, is not only for more CPR
but also for better-quality CPR11.
In most countries, little effort has been given to
making CPR a universal skill.12 Overall survival rate
for out-of-hospital cardiac arrest rarely exceeds 5%.
Bystander cardiopulmonary resuscitation is associated
with increased survival: a victim is almost 4 times more
likely to survive a cardiac arrest event when receiving
CPR from a bystander. Unfortunately, bystander CPR
rates have remained low over the past decade, rarely
exceeding 20%13.
OBJECTIVES
The objectives of the study are
1. To assess the knowledge of KSRTC workers
regarding Cardio Pulmonary Resuscitation.
2. To assess the skill of KSRTC workers on Cardio
Pulmonary Resuscitation.
3. To evaluate the effectiveness of demonstration
programme on Cardio Pulmonary Resuscitation in
terms of gain in knowledge & skill of KSRTC
workers.
4. To determine the association of knowledge and skill
of KSRTC workers regarding Cardio Pulmonary
Resuscitation with their selected personal variables.
HYPOTHESES
H1:The mean post test knowledge and skill scores of
KSRTC workers regarding Cardio Pulmonary
Resuscitation will be significantly higher than their
mean pretest knowledge and skill scores.
H2:There will be significant association between the
knowledge and skill of KSRTC workers regarding
Cardio Pulmonary Resuscitation and their selected
personal variables.
METHODOLOGY
Pre-experimental; One group pre test- post test design
was adopted for the study. The population comprised
of KSRTC workers deputed for training at
Bannimantapa KSRTC Depots of Mysore. . Convenience
sampling technique was used for selecting 60 KSRTC
workers for the present study. Instrument in a research
study is the device used to collect data. Based on the
review of literature the following tools are developed
by the researcher.
1. Personal proforma to assess the selected personal
variables of KSRTC workers.
2. Structured knowledge questionnaire to assess the
knowledge of KSRTC workers regarding Cardio
Pulmonary Resuscitation.
3. Observational check list to assess the skill of KSRTC
workers on Cardio Pulmonary Resuscitation.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 59
Description of Profoma for personal variables
This section includes the basic information about
the KSRTC workers viz. age, gender, educational
qualification, designation, number of years of
experience, and number of in-service educational
programmes attended regarding Cardio Pulmonary
Resuscitation.
Description of structured knowledge questionnaire
Structured knowledge questionnaire prepared for
the study includes 32 items to assess the knowledge of
KSRTC workers regarding CPR. Total score ranges from
0 to 32. This was further divided arbitrarily as follows:
• 0-15: Poor knowledge
• 16-23: Average knowledge
• 24-32: Good knowledge
Description of Observational check list
The observational checklist consists of a total of 21
items. Each item in the check list has 2 responses (Yes/
No). The total score ranges from 0 to 21. Higher score
indicates good skill on CPR. This was further divided
arbitrarily as follows:
• 0-10: Poor
• 11-15: Average
• 16-21: Good
Development of demonstration programme on CPR
The demonstration programme include
introduction about cardiac arrest, definition of cardiac
arrest, risk factors of cardiac arrest, causes of cardiac
arrest, signs and symptoms of cardiac arrest, definition
of CPR, indications of CPR, and demonstration of steps
of adult CPR on a manikin.
FINDINGS
Section I: Description of selected personal variables of
study subjects
The study sample consisted of 60 KSRTC workers
deputed for training at the Bannimantapa, KSRTC,
Depot, Mysore. The selected personal variables of
KSRTC workers are described under the sub headings
viz. Age in years, gender, education qualification,
designation, duration of work experience and previous
exposure to in-service education programme regarding
CPR as shown in Table 1
Table 1: Frequency and percentage distribution of
KSRTC workers according to their selected personal
variables
n=60
Sl. No. Sample Frequency (f) %
characteristics
1 Age in years
a) 21-25 yrs 13 21.6
b) 25-30yrs 27 45
c) >30 yrs. 20 33.3
2 Gender
a) Male 56 93.3
b) Female 4 6.6
3 Educational qualification
a) SSLC 8 13.3
b) PUC 47 78.3
c) Degree and above
58.3
4 Designation
a) Driver 2 1 3 5
b) conductor 39 65
5 Number of years of experience
a) Less than 3 yrs 13 21.6
b) 3years - 9 yrs 33 55
c) Above 9 years 1 4 23.3
6 Previous exposure to in-service educational
programmes regarding CPR.
a) Yes 0 0
b) No 60 100
Section 2: Effectiveness of demonstration programme
on Cardio pulmonary resuscitation
Part-A: Description of knowledge scores of KSRTC
workers regarding CPR.
I. Frequency and percentage distribution of
knowledge scores of KSRTC workers according
to their pre test and post test knowledge scores.
Knowledge of KSRTC workers regarding CPR was
assessed using structured knowledge
questionnaire. Total knowledge scores ranged from
0-32. The study findings revealed that, all the
KSRTC workers (100%) had poor knowledge
regarding cardio pulmonary resuscitation in the
pre test. Data also revealed that in the post test, there
was an increase in the knowledge level of KSRTC
workers. i.e. 20% of them have scored good
knowledge and 76.66% have scored average level
of knowledge regarding CPR.
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60 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
II Mean, median, range and standard deviation of
knowledge scores
Mean, Median, Standard deviation and Range of
the scores were computed. The pre-test knowledge
score ranged from 3-15 and the post-test knowledge
score ranged from 12-27. The mean pre test
knowledge score was 10.13 with standard deviation
of ±2.62 and the mean post-test knowledge score
was 19.86 with the standard deviation of ±2.62. This
indicates that there was an increase in knowledge
scores of KSRTC workers after the demonstration
programme on CPR.
III. Significance of difference between the pre test
and post test knowledge scores of KSRTC workers
on cardio pulmonary resuscitation.
To determine the significance of difference between
the mean pre-test and post-test knowledge scores
of KSRTC workers regarding CPR, paired ‘t’ test
was computed. The mean difference between the
pre test and post test knowledge scores of KSRTC
workers is 9.73. To find the significance of difference
in knowledge, paired ‘t’ test was computed and
obtained value of paired ‘t’= 18.72, p<0.05 is found
to be significant. Hence it is inferred that there is
statistically significant difference between the mean
pre test and post test knowledge scores of KSRTC
workers regarding CPR.
Part B: Description of skill scores of KSRTC workers
regarding CPR:
I. Frequency and percentage distribution of skill
scores of KSRTC workers.
An observational check list was used by the
researcher to assess the skill of KSRTC workers on
CPR. Total score ranged from 0-21. All the KSRTC
workers (100%) had poor skill on cardio pulmonary
resuscitation in the pre test. Data also revealed that
in the post test, majority of subjects (66.66%) had
good level of skill in performing CPR and only
33.33% have scored average level of skill on CPR.
II. Mean, median, range and standard deviation of
skill scores.
The findings shows that, the pre-test skill score
ranged from 0-5 and the post-test skill score ranged
from 11-21. The mean pre test skill score was 1. 83
with standard deviation of ±1.04 and the mean post-
test skill score was 15.46 with the standard deviation
of ± 2.46. This indicates that there was an increase
in the skill scores of KSRTC workers after the
demonstration programme on CPR.
III. Significance of difference between the pre test
and post test skill scores of KSRTC workers on
cardio pulmonary resuscitation.
To determine the significance of difference in the
mean pre-test and post-test skill scores of KSRTC
workers, paired ‘t’ test was computed. The study
findings shows that the mean difference between
the pre test and post test skill scores of KSRTC
workers on CPR is 13.63. To find the significance of
difference between the pre test and post test skill
scores, paired ‘t’ test was computed and obtained
value of paired ‘t’= 41.86, p<0.05 is found to be
significant at 0.05 level of significance. Hence it is
inferred that there is statistically significant
difference between the mean pre test and post test
skill scores of KSRTC workers on CPR.
Section 3: Association between the knowledge and skill
of ksrtc workers regarding cardio pulmonary
resuscitation and their selected personal variables.
To find out the association between the pre-test
knowledge and skill levels of KSRTC workers and their
selected personal variables, chi square was computed.
A. Chi-square values between the level of knowledge
of KSRTC workers regarding CPR and their
selected personal variables.
All the KSRTC workers (100%) have scored poor
knowledge (<15) in the pre test knowledge
assessment. Hence the chi square is computed based
on the median level of knowledge scores. The study
findings revealed that, there is no significant
association between the knowledge of KSRTC
workers regarding CPR and their selected personal
variables.
B. Association between the skill of KSRTC workers
on CPR and their selected personal variables.
Chi square was computed to determine the
association between the skill of KSRTC workers on
CPR and their selected personal variables. The
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 61
study findings revealed that, there is no significant
association found between the skill of KSRTC
workers on CPR and their selected personal
variables.
CONCLUSION
The present study focused to determine the
effectiveness of demonstration programme on Cardio
Pulmonary Resuscitation on the knowledge and skill
of KSRTC workers in selected KSRTC depots of
Mysore.Data was collected from 60 KSRTC workers.
Collected data was analyzed by using descriptive and
inferential statistics and presented in the form of tables
and graphs. Analysis of findings revealed that all the
KSRTC workers (100%) had poor knowledge and skill
in Cardio Pulmonary Resuscitation. The findings also
revealed that demonstration programme was effective
in increasing the knowledge and skill of KSRTC workers
regarding Cardio Pulmonary Resuscitation as
evidenced by computed ‘t’ test which was significant
at 0.05 level of significance.
Acknowledgement: We express our thanks to the
subjects for giving their consent to be a part of this study
and the authorities who provided permission to
conduct the study.
Conflict of Interest: Study findings stresses the
increasing responsibility of health professionals in
planning and implementing various educational
strategies to improve the knowledge and skill of public
regarding Cardio Pulmonary Resuscitation which in
turn help to reduce the mortality rate associated with
sudden cardiac arrest especially in case of out - of
hospital cardiac arrest.
Ethical Clearance: Ethical clearance was obtained from
the ethical committee of the college.
Funding Sources: Not obtained any funds from any
sources.
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knowledge of first year students at the University
of Maribor. [homepage on the Internet]. 2011 [cited
2012 Nov 6]. Available from: http://
www.intjem.com/content/4/1/16.
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62 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
11. Douglas A, Chamberlain, Mary Fran Hazinski.
Education in resuscitation. [Homepage on the
Internet]. 2011 [cited 2012 Nov 6]. Available from:
http://www.intjem.com/content/4/1/16.
12. Dr. Wissenberg. Widespread CPR training saves
lives. [Homepage on the Internet]. 2012 [cited 2012
Nov 11]. Available from:
http://medicalxpress.com/news/2012-03-
widespread-cpr.html#jCp.
13. Christian Vaillancourt. Understanding and
improving low bystander CPR rates: A systemic
review of the literature. [homepage on the Internet].
2008 [cited 2012 Nov 16]. Available from: http://
medicalxpress.com/news/2012-03-widespread-
cpr.html#jCp.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 63
DOI Number: 10.5958/j.2320-8651.2.1.001
Stress among Antenatal Women in India
Maria Pais1, Murlidhar V Pai2, Asha Kamath3, Anice George4, Judith A Noronhna5, Baby S Nayak6,
Jayaram Nambiar 7, Ganapathi Joisa H8
1Assistant Professor, MCON, Manipal University, 2Professor Kasturba Hospital, 3Selection Grade Lecturer, Department of
Community Medicine, Kasturba Medical College Manipal, 4Dean, MCON, Manipal, 5Associate Dean MCON, Manipal,
6Professor, MCON, 7Associate Professor, Kasturba Hospital, 8Department of Yoga Kasturba Hospital. Manipal University
ABSTRACT
Introduction: Pregnancy is a special time for a woman and her family. It is a time of many changes in a
pregnant woman's body and emotions. Stress during pregnancy may lead to several problems to the
mother and unborn child. Stress reacts physically, mentally and emotionally to the various conditions.
The purpose of the present study was to investigate stress in antenatal women and its association with
selected factors among antenatal women.
Study Design: A descriptive survey design was used to identify the stress and its associated factors
among (160) antenatal women aged 20-45 years.
Results: The present study reveals no or mild stress level among antenatal women 107(66.9) and
moderate to severe stress in 53(33.3%) of them. A statistically significant association was observed for
gravida, education and monthly family income of antenatal women.
Conclusions: Stress during antenatal period was observed among more than half the women. Stress
was significantly associated with gravida, educational status and monthly family income.
Keywords: Stress, Stress Pathways, Pregnancy
INTRODUCTION
Stress is a complex genetically determined pattern
of response of the human physiology to a demanding
situation. The element of perception indicates that
human stress responses reflect differences in
personality, as well as differences in physical strength
or general health. A woman’s experience of pregnancy
and childbirth is most likely affecting her role as a
mother. Any stress and emotional changes during
pregnancy can have long-term adverse effect on herself
and her child, and it may interfere with mother-infant
attachment and child development. The maternal stress
during antenatal period can have specific effect on
cognitive and brain development outcome of the fetus1.
Stress during antenatal period varies from life events
and other factors like financial and social problems.
During exposure to a stressor, the whole system of stress
regulation, that is the hypothalamus pituitary adrenal
cortex system (HPA axis) and the sympathetic nervous
system-adrenal medulla system, is activated. Various
hormones, including corticotropin-releasing hormone
(CRH), adrenocorticotropin-releasing hormone
(ACTH), cortisol and (nor) adrenaline, are released in
large quantities to the blood. However individuals may
respond differently to an identical stressful stimulus.
The degree of stress response depends also on genetic
factors, personality characteristics, and previous
experience, support from the social environment and
the way of coping with stress. This applies to pregnant
women because they are also confronted with all
possible stress factors.2
The complex situation of stress during antenatal
period affects the physical and psychological health in
many ways in antenatal women; one of them is
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64 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
genetically determined pattern of response to a
demanding situation of the human physiology. The four
key concepts related to stress are homeostasis, stressor,
stress and adaptive response. And the coping situation
adopted to maintain a complex dynamic equilibrium/
homeostasis, is challenged by the internal and external
forces, which may threaten the state of equilibrium.3
The present study aimed to identify the stress level
among antenatal women of a selected hospital in Udupi
District at second trimester i.e. 18 to 22 weeks of
gestation. A thorough understanding of the stress level
among antenatal women in India and its severity is
essential for the provision for effective heath care service
for the antenatal women.
MATERIALS AND METHOD
A descriptive survey study was carried out to
determine the stress level among 160 antenatal women
in a selected tertiary care hospital of Udupi District.
The inclusion criteria were, antenatal women between
18 to 22 weeks of gestation, who were willing to
participate after obtaining informed consent. Women
with multiple pregnancy, maternal physical
abnormality, psychiatric illness and fetal abnormality
on ultrasound scan were excluded from the study. A
study was conducted after obtaining institutional
ethical committee clearance and written informed
consent was obtained from the participants.
TOOL DESCRIPTION
Demographic Proforma
A demographic tool was constructed to collect the
sample characteristics. The tool consisted of nine items
like age, educational status, occupation, type of family,
gravida and monthly family income. There was no
scoring for the sample characteristics.
Stress scale
The stress scale used for the study was a modified
version of standardized scale developed by the A Kazi
et.al4 with their permission. It contained 20 statements.
The statements were scored from 1 to 4, in a four point
scale (1= never, 2= rarely, 3= sometimes and 4= always),
the minimum and maximum range was 20-80. The
stress scale was modified and validated as per the
expert’s opinion. Reliability was checked, Cronbach’s
alpha of the stress tool was r=0.84. The stress was
classified into two levels no or mild stress (0-40) and
moderate to severe stress (41-80). The data obtained
were analysed and interpreted based on the study
objectives using descriptive and inferential statistics
by using SPSS (Ver. 15)
RESULTS AND DISCUSSION:
Sample Characteristics
The mean age of the women was 27.5±3.3 years.
Sixty three (39.4%) were graduates, 132 (82.6%) were
housewives, 100 (63.1%) belonged to joint family, 70
(43.8%) women had family monthly income of rupees,
5,001-10,000 and 104 (65.0%) were primigravid women.
The mean gestational period was 20.8±1.6 weeks.
(Table 1)
Table 1: Frequency and percentage distribution of
antenatal women
n=160
Variables Frequency (f) Percentage (%)
Age (Mean±SD) 27.5±3.57
Education status
Primary 1 2 7.5
Secondary 60 37.5
Graduate 63 39.4
Postgraduate 2 5 15.6
Occupation
House wife 132 82.6
Service 12 7.2
Business 5 3.2
Professional 11 7.0
Type of family
Nuclear 60 37.5
Joint 10 0 62.5
Monthly family Income
Rs.3,000-5,000 55 34.3
5,001-10,000 70 43.8
>10,000 35 21.9
Gravida
Primi 10 3 64.4
Multi 57 35.5
Severity of the stress
The antenatal women stress level assessed at 18 to
20 weeks of gestation. Out of 160 antenatal women 107
(66.9%) had no or mild stress and 53 (33.1%) had
moderate to severe stress. (Fig:1 )
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 65
Association between Stress and selected variables among antenatal women
Table 2: Association between antenatal stress and selected variables:
n=160
Variable Frequency No or Mild Moderate to p-value
stress Level Severe stress
Level
Education status
Primary 12 7 (66.7) 4 (33.3)
Secondary 60 32 (53.3) 28 (46.7) 0.034
Graduate 63 49 (73.1) 18 (26.9)
Postgraduate 25 19 (86.4) 3 (13.6)
Occupation
House wife 132 90 (68.2) 42 (31.8)
Service 1 2 7 (58.3) 5 (41.7) 0.809
Business 5 3 (60) 2 (40.0)
Professional 11 7 (68.2) 4 (40.0)
Type of family
Nuclear 60 41(68.3) 19 (31.7) 0.761
Joint 10 0 66 (66.0) 34 (34.0)
Monthly family Income
Rs.3,000-5,000 56 36 (32.4) 20 (40.8)
5,001-10,000 65 45 (40.5) 20 (40.8) 0.024
>10,000 39 30 (27.0) 9 (18.4)
Gravida
Primi 10 3 78 (75.7) 25 (24.3) 0.002
Multi 57 29 (50.9) 28 (49.1)
Fig. 1. Pie chart on the stress levels of antenatal women.
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66 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Association between antenatal stress and selected
variables
Data in table 2 shows that there was significant
association between the level of antenatal stress and
gravida (p = 0.002), educational status (p=0.034) and
monthly family income (p=0.024). However no
association was found between antenatal stress and
selected variables like occupation and type of family.
Therefore it can be stated that gravida, educational
status and monthly family income has a direct influence
on the stress experienced by antenatal women.
DISCUSSION
The present study reveals that 53 out of 160 (33.1%)
antenatal women, had moderate to severe stress. This
study supports the study conducted in USA among 59
pregnant women (mean age = 22 years) were structured
clinical interviews and maternal self-report were
utilized to assess maternal psychosocial distress at mid
trimester (26-28 weeks) and the result revealed that the
perceived mean stress was 23.31±7.315. A study
conducted by Fisal Curry A, on antenatal anxiety and
depression among 432 antenatal women in Osaco,
revealed that the anxiety and depression level was
59.5% and 45.3% respectively. 6 During antenatal period
the behaviour of the women often confronted with
situations that demand adaptation. Maternal stress
affects maternal feelings, continuity of which may
potentially lead to child development or subsequently
affect the maternal psychopathology, bolstering the idea
of prenatal environmental transmission of risk for later
distress in life. Another observational cross sectional
study conducted in urban maternity centre in Northern
Ireland among 263 healthy low risk pregnant women,
to determine the level of pregnancy related stress by
administering self-reported questionnaire. The result
of this study revealed that the mean prenatal distress
score was 15.1 (SD= 7.4, range 0-46) 7.
The study also revealed that there was a significant
association between antenatal stress and gravida and
educational status and monthly family income this
study similar to the study conducted among 720
Bangladesh in women in which the result revealed that
the anxiety symptoms was 29% and associated factors
were illiteracy and poor household economy8.
Antenatal stress may be more logical as it occurs
through stress hormones, it may lead to reduction in
blood flow to the uterus and foetus and it may lead to
intra uterine growth restriction. The initial screening
and identification of antenatal stress by subjective and
objective assessment are beneficial for the antenatal
women, because this can support further therapeutic
management in order to inhibit further complication
and adverse outcome.
CONCLUSION
This study brings to light the stress levels among
the antenatal women. The current antenatal care
situations is ill-equipped to identify the pregnant
women who are suffering from different levels of
antenatal stress; yet a growing body of research
evidence links severe stress with adverse pregnancy
outcomes. By initial assessment of stress among
antenatal women using stress measurement tool will
provide information on the stress level of pregnant
women. The health care providers may recognize the
symptoms of stress and understand the negative impact
on the health of the mother and infant. They can provide
valuable educational material as well as conduct and
coordinate strategies for health care plans to improve
the maternal and infant health and initiate healthy
therapeutic measurements for all pregnant women.
ACKNOWLEDGEMENT
We extent our gratitude to Dr. Parvathi Bhat, Medical
Superitendent TMA Pai Hospital, for giving us the
administrative permission to conduct the study and
for valuable support and suggestion.
We extent our genuine gratitude to Anice George,
Dean, Manipal College of Nursing for granting
permission to conduct the study.
Conflicts of Interest: Nil
Source of Funding: Nil
REFERENCE:
1. K.M Abel. et.al (2014) Severe Bereavement stresses
during the prenatal and childhood periods and
risk of psychosis in later life; Population based
cohort study, British Medical Journal. 348 May.
2. Christine Denkel Schetter & Laura M. Glynn.
(2008). Stress in Pregnancy: Empirical Evidence
and theoretical issues to Guide Interdisciplinary
research, Stress in Pregnancy: May 3
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 67
3. Barbara Plytycz and Rolf Seljelid; (2002). Stress
and Immunity: Minireview, Folia Biologica
(karkow), Vol.50. Page 181-189.
4. Kazi A., Z. Fatmi, J. Hatcher, U.Niaz and A. Aziz
(2009) Development of a Stress scale for preganant
women in the South Asian context: the A-Z Stress
Scale. Eastern Mediterranen Health Journal. Vol
(15) 2: 353-361.
5. El. Kady, Dina MD: Gilber, William M. MD: Xing,
Guibo (2005). Maternal and Neonatal outcomes
of Assaults during pregnancy: Obstetrics &
Gynaecology; Vol 105.(2). 357-363.
6. Faisal C, Rossi M., Prevalence of anxiety and
depression during pregnancy in a private setting
scale. Achieves of women’s Mental Health (Sereial
online) 2006 Jan 3 (cited 2010 October 10) 10 (1)
page 25-32.
7. Parcells D.A (2010). Women’s mental health
nursing; depression, anxiety and stress during
pregnancy. Journal of Psychiatric and Mental
Health Nursing. (17): 831-820.
8. Nasreen H.E, Kabir Z.N, Fossell Y. Ednborg M.
Prevalence and associated factors of depressive
and anxiety sympots during pregnancy: A
population based study in rural Bangladesh: BMC
Women’s Health (Serial Online) 2011; 11 (22).
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68 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to assess the Physical Growth in Children of
Working and Non-Working Mothers
Rimple Sharma1, Poonam Sharma2, Sunita Saini3
1Associate Professor, 2Assistant Professor, 3M.Sc.(N), Institute of Nursing Education, Guru Teg Bhadur Sahib ©Hospital,
Ludhiana, Punjab, India
ABSTRACT
Children of today are the citizens of tomorrow. Childhood is the period of rapid change in developmental,
social, emotional, cognitive and linguistic abilities of the child. The mother continues to be the main
person who cares for children. Employment of women has created number of problems for the
development of children. A comparative study was conducted to assess the physical growth in children
of working and non- working mothers in a selected community, Ludhiana, Punjab with objectives: To
assess the physical growth in children of working and non- working mothers, To compare the physical
growth in children of working and non-working mothers, To assess and compare the relationship of
physical growth in children of working and non-working mothers with selected demographic variables
and to prepare pamphlets. A non-experimental, comparative study was conducted in selected
community of Ludhiana. The target population was children (3-5 years) of working and non- working
mothers. 60 children were selected by purposive sampling technique. Data was collected by using self
structured proforma. Data was analyzed by using descriptive and inferential statistics and presented
through tables and figures. Findings revealed that majority of children of Non- working mothers had
normal physical growth as compared to children of working mothers. While comparing the physical
growth in children of working and non-working mothers three parameters of physical growth that is
weight for age, height for age and mid arm circumference were found statistically significant and body
mass index was found statistically non significant. In demographic variables mother's age, child's
gender, birth order, and Type of Family had an impact on Weight for age, birth order had some impact
on height for age. Family income had an effect on mid arm circumference and mother's age had impact
on body mass index of children.
Keywords: Physical Growth, Children, Working Mothers, Non-Working Mothers
INTRODUCTION
The child is God’s gift for a family1. The investment
on our children will help to reap rich individuals in
future. As said by Karl Augustus Menninger “what is
done to the children, they will do to the society”2. Child
grows and gains skills at his or her own pace. Mothers
Knowledge regarding what is normal for children this
Corresponding author:
Poonam Sharma
Assistant Professor
House No.-136 Basanti Baag, Baddi, Teh: Baddi, Dist.:
Solan, Himachal Pardesh, PIN-173205
Ph. 09915985080
Email- poonam.sharma331@gmail.com
age can help her to spot problems early or feel better
about how their child is doing which fuels the growth
and development3. Physical growth in children takes
into account height and weight as well. Parents,
caregivers and teachers have numerous tools available
to them for assessing various stages of physical growth
and development4. The age of 3 to 5 years is often called
preschool year. A child develops in these main areas
such as physical, cognitive, emotional and language,
sensory and motor development5. Anthropometric
examination is an almost mandatory tool in any
research to assess health and nutritional condition in
childhood. Physical measurements like body weight,
height, circumference of arm and calf, triceps skin fold
of children have been extensively used to define health
and nutritional status of communities6.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 69
The mother continues to be the main person who
cares for children. However, her role varies a great deal
according to the age of the child7. During preschool
period child is mostly dependent on mother for all his
nutritional needs. Hence, it is argued that the mother
being the major care provider for the child during
preschool period8. The increasing number of women in
the work force has created a number of problems for the
children. The women who are in full time jobs are
staying away from their family for long hours during
day, which creates disturbances for their children9.
OBJECTIVES
1. To assess physical growth in children of working
and non-working mothers.
2. To compare physical growth in children of working
and non-working mothers.
3. To find out relationship of physical growth in
children of working and non-working mothers with
selected demographic variables.
4. To compare the relationship of physical growth in
children of working and non-working mothers with
selected demographic variables.
5. To prepare pamphlets for enhancing mother’s
knowledge regarding promotion of physical
growth in children.
MATERIAL AND METHOD
The present study was conducted to compare the
Physical Growth in Children of Working and Non-
Working Mothers in a selected Urban Community,
Ludhiana, Punjab . A Quantitative approach and non-
experimental, comparative research design was used
in the present study. The target population was children
(3-5 years) of working and non- working mothers. 60
children were selected by purposive sampling
technique. Data was collected by using self structured
proforma. Literature related to comparison of physical
growth of children of working and non-working
mothers was retrieved. Tool was prepared and pretested
for validity and reliability. Pilot study was conducted
to check feasibility and practicability of study.
Descriptive and Inferential statistics were employed to
analyze the data. Analyzed data was presented through
tables and figures.
RESULTS
Findings related to assessment of the physical growth
in children of working and non-working mothers.
• According to Weight for age, in children of working
mothers majority of children 15 (50%) had 1st degree
malnutrition, with mean of weight for age
percentage 73.22 and children 30 (100%) of non-
working mothers had normal nutritional status,
with mean of 90.13.
• According to Height for age, in children of working
mothers majority of children 20 (66.77%) had short
height, with mean height for age percentage 89.39
and children of non- working mothers 30(100%)
had normal height with mean 96.46.
• According to Mid arm circumference, in children of
working and non workingmothers majority of
children 17 (56.7%), 14 (46.7%) had moderate
malnutrition with mean 12.85, 12.60.
• According to Body mass index, in children of
working mothers, majority of children 23 (76.7%)
had malnutrition with mean Body Mass Index of
13.93 and in children of non – working mothers
majority 19 (63.3%) of children had normal
nutritional status with mean Body Mass Index of
15.53.
Findings related to comparison of physical growth in
children of working and non- working mothers.
• The difference in mean weight for age percentage,
in children of working and non- working mothers
who were having normal nutritional status was
found to be statistically significant at p < 0.05.
• The difference in mean height for age percentage,
in children of working and non- working mothers
who were having normal height for age was found
to be statistically significant at p < 0.01 level.
• The difference in mean of mid arm circumference
among children of working and non- working
mothers who were having normal mid arm
circumference was found to be statistically highly
significant at p < 0.001 level.
• The difference in mean of Body Mass Index among
children of working and non- working mother was
found to be statistically non-significant.
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70 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Table 1. Comparison of Physical growth in children of working and non- working mothers according to the Weight
for age, Height for age, Mid arm circumference and Body mass index.
N=60
Weight for age Children of Children of non- df ‘t’
working Mothers working Mothers
n Mean SD N Mean SD
Normal 11 85.89 3.55 30 90.13 4.78 39 2.67*
1st degree malnutrition 15 73.22 2.19 — — — — —
2nd degree malnutrition 0 4 65.32 2.39 — — — — —
3rd degree malnutrition — — — — — — — —
4th degree malnutrition — — — — — — — —
Height for age
Giant — — — — — — — —
Normal 10 94.64 1.23 30 96.46 1.87 38 2.86**
Short 20 89.39 1.78 — — — — —
Dwarf — — — — — — — —
Mid arm circumference
Normal 17 12.85 0.42 13 13.52 0.42 28 4.5***
Moderate nutrition — — — 14 12.60 0.34 — —
Severe nutrition 1 3 11.73 0.33 03 12.00 0.00 14 1.3NS
Body mass index
Normal 7 15.88 0.80 19 15.53 0.37 24 1.55NS
Malnutrition 23 13.93 0.77 11 14.43 0.50 32 1.95NS
* = significant at p <0.05, ** = significant at p <0.01, *** = significant at p <0.001, NS= Non-significant
Findinds realted to assessment of the relationship and
comparison of physical growth in children of working
and non- working mothers with selected demographic
variables.
• According to Weight for age (Mother’s age), in
children of working mothers mean weight for age
of 21-25 years old mother was highest (79.79) and
in children of non- working mothers mean weight
for age of 26-30 years old mother was highest (90.52).
Mother’s age and occupational status had an
impact on physical growth (weight for age) of
children.
• According to Weight for age (Child’s gender), in
children of working mothers mean weight for age
of male children was higher (78.81) and in children
of non- working mothers mean weight for age of
female children was higher (90.33). Child’s gender
had no impact but occupational status of mother
had an impact on physical growth (weight for age)
of children.
• According to Weight for age (Birth order), in
children of working mother with birth order 4thmean
weight for age was highest (87.03) and in children
of non- working mothers mean weight for age was
highest (92.79) for 2nd birth order. Birth order and
occupational status of mother had some impact on
physical growth (weight for age) of children.
• According to Weight for age (Dietary Habits), in
children of working and non-working mothers
mean weight for age for those who were vegetarian
was (76.81), (90.13). Occupational status of mother
had no impact on physical growth (weight for age)
of children.
• According to Weight for age (Type of family) in
children of working and non- working mothers
mean weight for age of children who belonged to
nuclear family was highest (77.81) (91.01). type of
family had some impact but occupational status
had an impact on physical growth (weight for age)
of children.
• According to Weight for age (Family income), in
children of working and non- working mothers
mean weight for age of children in family income
group d” 5,000/- was highest (78.39), (91.66).
Family income had no impact but occupational
status of mother had an impact on physical growth
(weight for age) of children.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 71
• According to Height for age (Mother’s age), in
children of working and non- working mothers in
the age of 26-30 years mean height for age was
highest (92.15), (96.68). Mother’s age and
occupational status had an impact on physical
growth (height for age) of children.
• According to Height for age (Child’s gender), in
children of working mothers mean height for age
of male children was higher (91.77) and in children
of non- working mothers mean height for age of
female children was higher (96.73). Child’s gender
had no impact but occupational status of mother
had an impact on physical growth (height for age)
of children.
• According to Height for age (Birth order), in
children of working mothers mean height for age of
children with birth order 4 was highest (94.07) and
in children of non- working mothers mean height
for age was highest (97.14) for 2nd birth order. Birth
order had no impact but occupational status of
mother had an impact on physical growth (height
for age) of children.
• According to Height for age (Dietary Habits), in
children of working and non- working mothers
mean Height for age for those who were vegetarian
was (91.14), (96.46).Occupational status of mother
had an impact on physical growth (height for age)
of children.
• According to Height for age (Type of family) in
children of working mothers mean height for age
was highest (91.77) among those belonging to
nuclear family and among children of non-working
mothers it was highest (96.73) for those belonging
to joint family.
• According to Height for age (Family income), in
children of working mothers mean height for age of
children belonging to income group e”10,001/- was
highest (91.89) and in children of non- working
mothers mean height for was highest (96.87) for
those belonging to income group of 5001- 10,000/-
. Family income had no impact but occupational
status of mother had an impact on physical growth
(height for age) of children..
• According to Mid arm circumference (Mother’s age),
in children of working and non- working mothers
in the age of >31 years mean mid arm circumference
was highest (12.47), (13.0).Mother’s age had no
impact but occupational status had an impact on
physical growth (mid arm circumference) in
children.
• According to Mid arm circumference (Child’s
gender), in children of working mothers mean Mid
arm circumference of male children was higher
(12.41) and in children of non- working mothers
mean mid arm circumference of female children was
higher (13.04). Child’s gender had no impact but
occupational status of mother had an impact on
physical growth (mid arm circumference) of
children.
• According to Mid arm circumference (Birth order),
in children of working and non- working mothers
mean mid arm circumference of children with birth
order 4th was highest (13.00), (13.50). Birth order
had no impact but occupational status of mother
had some impact on physical growth (mid arm
circumference) of children.
• According to Mid arm circumference (Dietary
Habits), in children of working and non- working
mothers mean mid arm circumference for those who
werevegetarian was (12.36), (12.90).Occupational
status of mother had an impact on physical growth
(mid arm circumference) of children.
• According to Mid arm circumference (Type of
family) in children of working and non- working
mothers mean mid arm circumference of was
highest (12.10, 13.00) for those belonging to joint
family.
• According to Mid arm circumference (Family
income), in children of working and non- working
mothers mean mid arm circumference of was
highest (13.0), (13.78) among children belonging to
income group of e”10,001/-. Family income and
occupational status of mother had an impact on
physical growth (mid arm circumference) of
children.
• According to Body mass index (Mother’s age) mean
body mass index of children of working mothers in
the age group of 21-25 years was highest (14.94)
and in children of non- working mothers mean body
mass index of children of mothers in the age of 26-
30 years was highest (15.19). Mother’s age and
occupational status had some impact on physical
growth (body mass index) in children.
• According to Body mass index (Child’s gender), in
children of working and non- working mothers
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72 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
mean Body mass index of male children was higher
(14.54), (15.20).Child’s gender had no impact but
occupational status of mother had some impact on
physical growth (body mass index) of children
• According to Body mass index (Birth order), in
children of working and non- working mothers
mean body mass index of children with birth order
4th was highest (15.45), (15.45). Birth order and
occupational status of mother had some impact on
physical growth (body mass index) of children.
• According to Body mass index (Dietary Habits), in
children of working and non- working mothers
mean body mass index for those who were
vegetarian was (14.38), (15.13).Occupational status
of mother had an impact on physical growth (body
mass index) of children.
• According to Body mass index (Type of family) in
children of working and non- working mothers
mean body mass index of children was highest
(17.54, 15.20) for those belonging to nuclear family.
• According to Body mass index (Family income), in
children of working and non- working mothers
mean body mass index of children was highest
(14.56), (15.55) among those belonging to e”10,001.
Family income had some impact and occupational
status of mother had some impact on physical
growth (body mass index) of children.
CONCLUSION
In the study ,majority of children of Non- working
mothers had normal physical growth as compared to
children of working mothers. While comparing the
physical growth in children of working and non-
working mothers three parameters of physical growth
that is weight for age, height for age and mid arm
circumference were found statistically significant and
body mass index was found statistically non
significant. In demographic variables mothers age,
child’s gender, birth order, and Type of Family had an
impact on Weight for age, birth order had some impact
on height for age. Family income had an effect on mid
arm circumference and mother’s age had impact on
body mass index of children.
Ethical Consideration
Formal written permission was taken from Ethical
Research Committee and Principal of I.N.E., G.T.B.S.(C)
Hospital, Ludhiana, Punjab. Informed verbal consent
was taken from mothers of children regarding their
participation in study. Anonymity of subjects and
confidentiality of the information was maintained.
ACKNOWLEDGEMENT
Our heartfelt thanks to all those who supported us
in any respect during the completion of the study.
Conflict of Interest: None
Source of Funding: No special source of funding.
Research study was completed by the researchers’ own
funds.
REFERENCES
1. World health organization. Definition of health.
Preamble to the constitution of the world health
organisation as adapted by the international
health conference, new York, p- 19-22. June 1946.
2. Soetijiningsih. Study guide block growth and
development udhiana University faculity of
medicine, 2007. Study – guide growth and
development/ www.slideshare net.
3. Gautamhazarika and basudevkhasnobis. Guha.
Women status and children food security in
Pakistan. Unb-wider. Discussion paper number-
2006-03.
4. Weiss RS attachement in children life in c.m.
papers &j.stevenson-hinde, the place of
attachement in human behaviour new York; p-171-
184.
5. Hock. E mcbride, s: &genzdam. Maternal
separation from the maternal prespective. Child
development, 2004 .p-793-802.
6. Anderson MP, buchter. F.k,Levine. B. P maternal
employment and childhood obesity : 2000.
7. Bhartisusmitha. Pal M, bharti p, determinants of
nutritional stautus of preschool children in
india,2001, journal biosocial science volume. 40 {
6} , p-801-14.
8. Sharma, R. A comperative study of the children of
working and non working mothers pH.d
education, m.sukh . university.
9. WHO .measuring changes in nutritional status:
guidelines for assessing the nutritional impact of
supplementary feeding programme for vulnerable
groups. Genava. p-12-14.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 73
DOI Number: 10.5958/j.2320-8651.2.1.001
Cervical Cancer Screening Practices among Rural Indian
Women
S B Thovarayi1, J A Noronha2, S Nayak3
1M Sc Nursing, 2Professor and HOD, 3Lecturer, Department of Obstetric and Gynaecological Nursing, Manipal College
Of Nursing, Manipal University, Manipal, India
ABSTRACT
Background: Cervical cancer is a major health problem in India. The aim of this paper was to find the
cervical cancer screening practices among rural Indian women.
Method: This cross- sectional study was carried out in 3 villages of Udupi, India among 407 married
women in the aged 221- 65 years. Data was collected using interviewer administered questionnaires.
Results: The mean age of the women who participated in the study was 43.17 ± 13.43 with the age
range from 21- 65 years. It was determined that more than half of the women (68.3 %) were Hindu.
37.1% had completed primary school education. Majority of the participants (40%) had monthly income
less than 5000 rupees. 98% were living with their spouse. Most of them (77.3 %) were married within
18-25 years. Majority of the women belonged to joint family (53.6 %). It was found that none of the 407
participants had ever had a Pap test in their lifetime and only 6.1 % were aware of the Pap test as a
screening modality for cervical cancer. Lack of awareness was cited by more than half of the women as
the reason for not undergoing cervical cancer screening.
Conclusion: From this it can be inferred that lack of awareness is a major barrier for not undergoing
screening. An organized health education programme focusing on women with the participation of
health care workers is sorely needed.
Keywords: Barriers, Cervical Cancer, Cervical Cancer Screening, Indian Women, Pap Test, Utilization
INTRODUCTION
Cervical cancer is a huge health problem in
developing countries. Though the incidence of cervical
cancer has declined in developed countries, in
developing countries like India where women do not
undergo routine cervical cancer screening it is still a
major problem. Cervical cancer is the fifth most common
cause of cancer death in the world and the second
largest cause of cancer mortality in India. Currently
India accounts for 1/4th of the global cervical cancer
burden1
Cervical cancer is a disease which is largely
asymptomatic in its early stages, so regular screening
is needed to identify it in its early precancerous stage.
Cervical cancer screening using the Papanicolaou (Pap)
test prevents the development of cervical cancer by
recognizing a precancerous state in the cervix and
allows 90% of cervical cancers to be identified, treated
and cured before it can spread. Pap smears have been
shown to detect early cervical cellular abnormalities,
thereby reducing morbidity and mortality from cervical
cancer.2 Successfully organized, population-based
cervical cancer screening programmes have not yet been
implemented in most developing countries, despite the
greatest burden of cervical cancer in these countries
which is largely related to poverty, lack of resources
and infrastructure and disenfranchisement of women3
India has a population of 366.58 million women
aged 15 years and older who are at risk of developing
cervical cancer. Current estimates indicate that every
year 134,420 Indian women are diagnosed with cervical
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74 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
cancer with the figure for new cervical cases projected
to reach 203,757 by 2025. It is estimated that at present
approximately 72,825 women die due to cancer of the
cervix. By 2025, this number is projected to rise to
115,1714
A study done among women in a rural population
of Kerala, India to identify current knowledge and
practice regarding cervical cancer screening showed
that the reasons for not getting the screening test done
in spite of a desire to do so were mainly no awareness,
no disease or symptoms, not knowing where to go, no
one is doing it and never thought of it. Lack of knowledge
about the disease and absence of the concept of
preventive behaviour were found important factors5.
Another study done among 192 women in Pakistan
also reported that the most common reason cited for
not having received a Pap test was the lack of
information and the Pakistani population studied
demonstrated a very low coverage of the Pap test and a
poor knowledge regarding its utility.6
The aim of this study was to find the utilization of
cervical cancer screening among women in three
villages of Udupi, India and to identify the barriers for
utilization.
MATERIALS AND METHOD
Methodology
A cross sectional survey design was used for this
study. This study was conducted in rural areas of Udupi
taluk, India. Udupi taluk has a rural population of
158651 females. There are 22 primary health centre
(PHCs) in Udupi taluk. Out of these, the PHC
Moodebettu was selected conveniently. The reason for
selecting this particular PHC was that the population
characteristics were similar and economy of time and
ease of access. Under this PHC there are 5 villagesout
of which 3 villages were selected randomly namely
Moodebettu, Kote and Yenegudde.
Participants
The research was conducted among 407 married
women in the age group of 21- 65 years residing in the
previously mentioned villages. 157 women from
Moodebettu, 150 from Yenegudde and 100 from Kote
were selected through house to house survey. Women
who had undergone total hysterectomy were excluded.
Data collection
Semistructured questionnaires were used to collect
the data. The first questionnaire focused on
demographic data. The second consisted of 5 questions
related to awareness, utilization or future plans to
utilize cervical cancer screening. It consisted of Yes or
No questions (categorical) and open ended (descriptive)
response. The third questionnaire was a 4-point Likert
scale which focused on barriers for utilization of cervical
cancer screening. It had 21 items and an open ended
question at the end. The questionnaire was pretested
using 7 women and was examined by experts for content
validity. The questionnaire was then administered to
20 different women. Reliability calculated using test
retest method and Cronbach’s alpha was found to be
significant at 0.05 levels. The questionnaires were
interviewer administered to the participants during
January to February 2013.
Data Analysis
Statistical Package for Social Sciences (version 11.0)
was used to compute frequency and descriptive
statistics related to demographic data. Statistical
methods included the chi-square test. A level of p < 0.05
was considered statistically significant.
Ethical Considerations
Ethical clearance was provided by the Ethics
Committee. A written informed consent was obtained
from each of the participants. Anonymity of the subjects
and confidentiality of the data were maintained.
RESULTS
The data presented in Table 1 shows that the mean
age of the women in the study population was 43.17 ±
13.43 with the age range from 21- 65 years. A majority
(151, 37.1 %) have high school education. Majority of
the subjects (207, 40%) have monthly income less than
5000 rupees. Most of them (315, 77.3 %) were married
within 18-25 years. Majority of the women belong to
joint family (218, 53.6 %).
Data presented in Table 2 shows that women who
had had 2 pregnancies comprised 42.8% (174) of the
study population. Majority of the subjects (45%) had 2
children with most of them (305, 76.1 %) having the
first child between the ages of 18-25 years. Majority of
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 75
the subjects (337, 82.8%) had no history of abortions/
MTPs. Majority of them (406, 99.8 %) had only a single
sexual partner and majority (227, 55.7%) had their first
sexual experience within 13-20 years. Only 2 (0.5 %)
had a history of smoking or tobacco chewing. There
was no family or personal history of cervical cancer or
STDs. 2 (0.5%) of the women reported a history of sexual
abuse.
Data presented in Table 3 shows that the source of
health related information for 91.4% (372) of the
participants was family members, 5.2% (21) from media
and only 2.5% (10) from health personnel.
Data presented in table 4 shows that only 6.1 % (25)
of the samples are aware of the existence of the Pap
smear test for cervical cancer screening. None of the
samples have ever had a Pap test and 3.9% (16) plan to
get a Pap test done in the future.
As seen in Fig. 1, among the 407 samples, 25 were
aware of the Pap smear test. Out of these, 9 got their
information from books, 9 from media, 4 from health
professionals and 3 due to their profession.
Data presented in Table 5 shows that of those
planning to undergo cervical cancer screening in the
future 6.25 % (1) plan to get it done in the next 6 months
and 93.76 % (15) plan to do it in the next year.
Table 6 shows that the major barrier (60.7 %, 247) for
not undergoing cervical cancer screening was lack of
awareness of the Pap smear test. The next major barrier
was (56.2 %, 229) having no symptoms. Doctor not
recommending was a barrier for 3.9% (16). For 3.4 %
(14) cost was a barrier. 3% (12) believed that they were
not at risk of cervical cancer. 1.7% (7) mentioned
embarrassment as the reason for not getting a Pap test.
0.7% (3) have not undergone the test due to lack of
time.0.5% (2) have not had a Pap test because of
inadequate explanation by doctor or nurse. 0.5% (2) felt
that it is not useful. 0.5% (2) cited fear of pain as a barrier.
0.2% (1) cited fear of the result as a reason for not
undergoing the test.
DISCUSSION
The major findings in this study were that none of
the women in this study had ever undergone cervical
cancer screening and 94 % of them had no previous
knowledge of cervical screening tests. These findings
are similar to those of other studies done in developing
countries7,8,6 (Mupepi et al.,2011; Nwankwo et al., 2011;
Imam et al., 2008). The most important finding from
this study is that none of the women irrespective of age,
education, income and access to health care had
undergone screening even once.
In this study the major reason for not undergoing
screening was lack of awareness followed by lack of
symptoms. This is corroborated by findings of another
study in which the reasons for not getting the screening
test done in spite of a desire to do so were mainly no
awareness, no disease or symptoms, do not know where
to go, no one is doing it and never thought of it. Thus,
knowledge factors accounted for 50 per cent of the self
reported factors. Lack of knowledge about the disease,
absence of the concept of preventive behaviour appear
to be important factors.5 Another study done in Pakistan
also reported that the most common reason cited for
not having received a Pap test was the lack of
information and the Pakistani population studied
demonstrated a very low coverage of the Pap test and a
poor knowledge regarding its utility6.
In a qualitative study which assessed influencing
factors for cervix cancer screening in Iran, low
knowledge, shyness and fear of examination and
diagnosis of cancer and financial barriers were
mentioned as effective negative factors. These findings
support the findings of the present study9.
Table 1. Socio-demographic characteristics
N=407
Sample characteristics Frequency(n) Percentage(%)
Age in years
21-30 85 20.9
31-40 103 25.3
41-50 94 23
51-65 125 30.7
Education
Nonliterate 56 13.8
Primary 151 42.7
High school 17 4 14.5
Undergraduate 23 5.7
Postgraduate 3 0.7
Income :per month in rupees
Less than 5000 20 7 50.9
5001-15000 188 46.2
>15001 12 2.9
Age at marriage
<18 42 10.3
18-25 315 77.3
26-35 50 12.2
Type of family
Nuclear 189 46.4
Joint 21 8 53.6
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76 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Table 2: Frequency and percentage distribution of
biological variables
Sample characteristics Frequency Percentage
Number of pregnancies
None 6 1.5
16917
2 174 42.8
3 109 26.8
>3 49 26.8
Age during first child birth
<18 20 5
18-25 305 76.1
26-35 75 18.7
>35 1 0.2
Number of living children
None 7 1.7
1 84 20.6
2 178 43.7
3 108 26.5
>3 30 7.4
Number of MTPs/abortions
None 33 7 82.8
1 43 10.6
≥2276.6
Age at first sexual experience
13-20 227 55.7
21- 32 180 44.2
Number of sexual partners
1 406 99.8
210.2
History of smoking/tobacco chewing
No 405 99.5
Ye s 2 0 . 5
Table 3: Frequency and percentage distribution of source
of information and health care
Sample characteristics Frequency Percentage
Source of health related information
Family members 37 2 91.4
Health personnel 10 2.5
Media 2 1 5.2
Other 4 1
Table 4: Frequency and percentage distribution of
utilization of cervical cancer screening
Utilization Yes No
Frequency Percentage Frequency Percentage
Aware of the 25 6.1 382 93.9
Pap smear test
Had a Pap test at 0 0 40 7 1 00
least once
Plan to get a Pap test 16 3.9 3 91 96.1
in the future
Table 5: Frequency and percentage distribution of
future plan for cervical cancer screening
n=407
Plan to get a Pap test Frequency Percentage
Next 6 months 1 6.25
Next year 15 93.76
Table 6: Frequency and percentage distribution of
barriers
n=407
Barriers Frequency Percentage
Fear of pain 2 0 .5
Embarrassment 7 1.7
Cost 14 3.4
Lack of adequate 2 0.5
explanation by
doctor/nurse
Lack of time 3 0.7
Doctor didn’t recommend 16 3.9
Not at risk 12 3
Not useful 2 0.5
No symptoms 229 56.2
Fear of the result 1 0.2
Unaware of it 247 60.7
CONCLUSION
This study showed that awareness and utilization
of cervical cancer screening is very low among rural
Indian women. Thus there is a critical need to intensify
mass education on the role of regular cervical screening
in rural areas. Organized health education programmes
focusing on women is needed to create awareness which
will help in increasing utilization of cervical cancer
screening.
This study was conducted in villages of a primary
health centre that was conveniently selected. The data
is based on self-reported information that was not
validated. Some women may not be able to distinguish
between Pap smears, pelvic examinations and vaginal
swab tests for infection. It will be beneficial to plan
studies with samples selected randomly from more
settings.
Acknowledgement: I wholeheartedly acknowledge
the women who participated in the study and
administrators for giving permission to conduct the
study.
Conflict of Interest: Nil
Funding: Self funding
n=407
n=407
n=407
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 77
REFERENCES
1. Basu P, Chowdhury D.Cervical cancer screening
and HPV vaccination: a comprehensive approach
to cervical cancer control. Indian J of Med Res,
2009.130, 241-6.
2. Bhatla N.Ending cervical cancer in Asia: regional
burden of disease. Cervical Cancer Action
“Champions” Webinar. 2012.
3. Denny L, Quinn M, Sankaranarayanan
R.Screening for cervical cancer in developing
countries. Vaccine, 2006. 24S3 S3/71–S3/77.
(Available from www.sciencedirect.com).
4. Tamil Nadu Systems Project. Department of Health
and Family Welfare. Screening for cervical and
Breast Cancer. Government of Tamil Nadu. 2005.
(Available from http://www.tnhsp.org/
screening-cervical-cancer-and-breast-cancer).
5. Aswathy S, Quereshi MA, Kurian B, Leelamoni
K.Cervical cancer screening: Current knowledge
and practice among women in a rural population
of Kerala, India. Indian J of Med Res, 2012.136,
205-10.
6. Imam SZ, Rehman F, Zeeshan MM, Maqsood B, et
al. Perceptions and practices of a Pakistani
population regarding cervical cancer screening.
Asian Pac J Cancer Prev, 200810, 42-4.
7. Mupepi SC, Sampselle CM, Timothy RB, Johnson.
Knowledge, attitudes, and demographic factors
influencing cervical cancer screening behavior of
Zimbabwean women. Journal of Women’s Health,
2011. 20, 943-51.
8. Nwankwo K.C, Aniebue U, Aguwa E.N, Anarado
AN, Agunwah E. Knowledge attitudes and
practices of cervical cancer screening among urban
and rural Nigerian women: a call for education
and mass screening. Eur J Cancer Care,2011. 20,
362–7.
9. Keshavarz Z, Simbar M, Ramezankhani A, Factors
for performing breast and cervix cancer screening
by Iranian female workers: A Qualitative-model
Study. Asian Pac J Cancer Prev, 2011.12, 1517-22.
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78 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to assess the Knowledge and Practice of Staff
Nurses Regarding Prevention of Surgical Site Infection
among Selected Hospital in Udaipur City
Rakesh Joshi
Vice Principal, Arihant Nursing Institute, Udaipur
ABSTRACT
Objectives:
1) To identify existing knowledge of staff Nurses regarding prevention of surgical site infection.
2) To identify the practice of staff Nurses regarding prevention of surgical site infection.
3) To assess the pre & post- test knowledge and practice score of the staff Nurses with selected
demographic variables.
Material and Method: This descriptive, correlation study was to identify the nurses' knowledge and
practice at GBH American Hospital, Udaipur and examine the relationship between them. One hundred
and twenty surgical nurses participated in the study (96% response rate). The instrument used for data
collection was a questionnaire which is composed of three parts: Demographic characteristics, Nurses'
knowledge questionnaire, and Nurses' practice questionnaire.
Result: The results revealed that the nurses had low level of knowledge (M = 69.67%, SD = 8.53) and
high level of practice (M = 89.95%, SD = 4.06). There was a weak, significantly negative correlation
between knowledge and practice regarding prevention of SSI (r = -.18, p = .04).
Conclusion: This study showed that the knowledge and practice of staff nurses regarding prevention
of surgical site Infection was satisfactory whereas they had knowledge regarding causes and sign and
symptoms. Some area of practice regarding assessment patient's body mass index, preoperative and
post-operative practice. Thus structured pre-test and post-test brought out improvement in the knowledge
and practice regarding the prevention of surgical site infection.
Keywords: Surgical Site Infection, Knowledge, Practice, Staff Nurses
INTRODUCTION
Surgical site infection is a type of healthcare-
associated infection in which a wound infection occurs
after an invasive (surgical) procedure. Other types of
healthcare-associated infections that mainly affect
surgical patients are postoperative respiratory and
urinary tract infections, bacteraemias (including
methicillin-resistant Staphylococcus aureus infections
and intravascular cannula infections) and antibiotic-
related diarrhoeas (particularly Clostridium difficile
enteritis). Surgical site infections have been shown to
compose up to 20% of all of healthcare-associated
infections. At least 5% of patients undergoing a surgical
procedure develop a surgical site infection.
A surgical site infection may range from a
spontaneously limited wound discharge within 7–10
days of an operation to a life-threatening postoperative
complication, such as a sternal infection after open heart
surgery. Most surgical site infections are caused by
contamination of an incision with microorganisms from
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 79
the patient’s own body during surgery. Infection caused
by microorganisms from an outside source following
surgery is less common. The majority of surgical site
infections are preventable. Measures can be taken in
the pre-, intra- and postoperative phases of care to
reduce risk of infection. Surgical site infections can have
a significant effect on quality of life for the patient. They
are associated with considerable morbidity and
extended hospital stay. In addition, surgical site
infections result in a considerable financial burden to
healthcare providers. Advances in surgery and
anaesthesia have resulted in patients who are at greater
risk of surgical site infections being considered for
surgery. In addition, increased numbers of infections
are now being seen in primary care because patients
are allowed home earlier following day case and fast-
track surgery.
Incidence of SSI may vary from hospital to hospital
in different countries. Developed countries, such as the
USA, the United Kingdom (UK), and Sweden have the
lower incidence of SSIs ranging from 2% to 6.4%. In
developing countries, such as India, Pakistan, Nepal,
Turkey, and Iran, the incidence of SSI is higher ranging
from 5.5% to 25%. SSI is a significant clinical problem
leading to morbidity and mortality.
SSI caused pain, misery, and possible deformity. SSI
also added to functional disability and emotional stress
to the patients and in some cases disabling condition
led to reduce quality of life Furthermore, SSI might
require that the patient undergoes additional surgical
procedures or it may result in death Patients with SSI
had 2 to11 times higher risk of death compared to
patients without SSI The Institute of Medicine reported
that SSI caused death in 44,000 to 98,000 patients per
year in the USA.
SSI also causes unnecessary increased health care
cost resulting in financial constraints to both patients
and health care system as a whole. In the USA, a study
revealed that SSI caused prolonged hospitalization 14
extra days. SSI has a significant impact on quality of
life and economic status. SSI patients spent significantly
more time in out-patient department visits, emergency
room visits, investigation services, readmission in
hospital, and other health care services than patients
without SSI.
Intrinsic and extrinsic risk factors were related to
the development of SSIs. Intrinsic factors include
advanced age, malnutrition, metabolic diseases,
smoking, obesity, hypoxia, immunosuppressant, and
length of pre-operative stay. Extrinsic factors include
duration and application of skin antiseptics,
preoperative shaving, antibiotic prophylaxis, pre-
operative skin preparation, inadequate sterilization of
instruments, surgical drains, surgical technique,
surgical hand scrub, and dressing technique.
Prevention of SSI is the result of a complex interaction
among the patient, wound related factors and nurses’
evidence-based knowledge and practice of infection
prevention (Hollinworth et al., 2008). Application of
current knowledge and practices by nurses can help
prevent SSI, reduce patients’ and hospitals’ expenditure
and improve patients’ quality of life. The incidence of
SSI is very high in Udaipur. Information about standard
nursing practice guidelines in prevention of SSI are
lacking in Udaipur. Currently, infection control training
program for nurses is existed, but no special training
program on prevention of SSI has yet been conducted
in Udaipur. Nurses have a lot of roles to play in
prevention of SSI, thus, there is a need to examine their
state of knowledge and practice. The examination of
nurses’ knowledge and practices regarding the
prevention of SSI has not been conducted in Udaipur.
MATERIAL AND METHOD
Type of study: A survey study.
Place of study: GBH American Hospital, Udaipur.
Duration of the Study: July 2013.
Study Population: One hundred and twenty staff nurses
working in the surgical ward in all three shifts of GBH
American Hospital, Udaipur.
Study tool: Demographics data, Knowledge
questionnaire.
Study design: Descriptive study.
RESULT
Subjects’ Demographic Characteristics
The majority of the subjects were female (90.8%). The
average age was 40.86 years old (SD =6.47), ranging
from 28 to 55 years old. The majority of the subjects
(95.8%) were married. More than one-fourth (27.5%)
worked in the male (17.5%) and female (10%) surgical
wards. The average years of working experiences in
the surgical wards was 3.77 years (SD =1.29), ranging
from 1 to 16 years. Most of them (93.3%) completed
diploma in nursing.
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80 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Knowledge Regarding Prevention of SSI
The results have shown that the level of total
knowledge regarding SSI prevention in this group of
subjects was at the low level (marginal to moderate
level) (M = 69.67%, SD = 8.53%) with the minimal scores
of 48% and the maximum scores of 92%. Fifty three
subjects (44.2%) had knowledge of SSI prevention at
the low level and forty three subjects (35.8%) had
knowledge of SSI prevention at the moderate level
followed by a very low and high level (Table 3).
Considering each sub-dimension of the knowledge of
SSI, the pre-operative knowledge of SSI was at the low
level with the mean of 66.66% and the post-operative
knowledge of SSI was at the moderate level with the
mean of 74.16%.
Practice Regarding Prevention of SSI
The results revealed that nurses’ practice of SSI was
at high level (M = 89.95%, SD = 4.06) with the minimum
scores of 80% and the maximum scores of 96 %. More
than half of the subjects (51.70%) reported that their
practices regarding prevention of SSI were at a very
high level Considering each sub-dimension of the
practice of SSI, the pre-operative practice of SSI was at a
high level with the mean score of 85.92% and post-
operative practice of SSI was at a very high level with
the mean score of 96 %.
CONCLUSIONS
A descriptive, co relational design was used to
examine the nurses’ knowledge and practice regarding
prevention of SSI at GBH American Hospital, Udaipur
and to examine the relationship between their
knowledge and practice.. The instrument for data
collection was a questionnaire which composed of three
parts: Demographic characteristics of the subjects,
Knowledge regarding prevention of SSI questionnaire
and practice regarding prevention of SSI.
ACKNOWLEDGEMENT
I acknowledgement my deep sense of gratitude to
Mr.Manish Sharma, HOD of Medical Surgical Nursing
Department of GMCH Udaipur. I special thank to all
my faculty colleagues for their kind support, valuable
suggestion to carry out this study.
Source of Funding: None
Ethical Clearance: To conduct the study, ethical
committee permission was obtained from the
institutional ethics committee of GMCH .Administrative
permission from the Dean, HOD, and Principal and
written inform consent from the participant were taken.
REFERENCE
1. Jean-Luc Pagani, Phillippe Eggiman, ‘’
Management of Catheter- Related infection’’, 2008.
2. Amam EL Kholy, Hospital acquired infection,
“The Centre of disease control and prevention”,
2007.
3. Mary Lou Morritt, Anne Senner, et.al, ‘’ Nursing
practice development unit’’, Journal of geriatric
critical care, vol-19, 2006, page-220.
4. Gita Srinivasan, Medha Y. Rao, ‘’ Centre for
nosocomial disease control and prevention’’, 2005.
5. Ramanathan P, et.al, ‘’ Intravascular Catheter
Related infection’’.
6. Grant V. Bochicchio, et.al, ‘’Nosocomial infections
in elderly trauma patients’’, 2002.
7. Elsevier B.V. “ Hand hygiene and simple aseptic
techniques”, 2009
8. Chawla K. Shetty Anoop, ‘’ A journal of Deduction
of Methillicin Resistant Staphylococcus Aureus’’,
vol 5.
9. Greg E. Martin MD, ‘’ Selective decontamination
for the prevention of nosocomial respiratory
infection in ICU patients’’, 2009.
10. Evaluation of aseptic techniques, ‘’ Journal of
infection control’’.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 81
DOI Number: 10.5958/j.2320-8651.2.1.001
Effectiveness of Mindfulness based Stress Reduction
(MBSR) on Stress and Anxiety among Elderly Residing in
Residential Homes
Sasi Kumar1, Kasturi Ramesh Adiga2, Anice George3
1Professor, Vydehi Institute of Nursing Science and Research Centre, Bangalore, Karnataka, 2Principal, Manipal School of
Nursing, Manipal University, Manipal, Karnataka, 3Dean& Director of Nursing Education, Manipal College of
Nursing, Manipal University, Manipal, Karnataka
ABSTRACT
With the increasing life expectancy stress and anxiety is a public health issue worldwide. It also
associated with morbidity as well as disability among the elderly. Screening the elderly for stress and
anxiety is mandatory to improve their quality of life. Mindfulness meditation is a powerful tool to help
seniors successfully manage the physical and psychological challenges of aging in a manner that
reduces stress and anxiety and promotes health related quality of life. The present study was conducted
among elderly residing in residential homes, Bangalore, to assess the effectiveness of Mindfulness
Based Stress Reduction (MBSR) on stress and anxiety. An evaluative approach with a quasi experimental
research design was used. There were two groups in the study each group consisting of 30 samples,
selected by non-probability convenience sampling technique. Experimental group participants were
provided intervention on Mindfulness Based Stress Reduction (MBSR). The study findings shows that
there was significant reduction in stress (p<0.001) and anxiety (p<0.001) among elderly in the
experimental group who received Mindfulness Based Stress Reduction.
Keywords: Effectiveness, Mindfulness Based Stress Reduction, Stress, Anxiety, and Elderly
INTRODUCTION
The life expectancy, in more than twenty developing
countries is 72 years and above. Approximately 600
million of elderly, that is, 60 years and above live in the
world, in that around two thirds of the world elderly
are living in the developing countries. Old age is a period
that people need physical, emotional and psychological
support. With the growth of ageing population in the
community, mental health problems among elderly are
receiving more attention.1- 2 A pivotal development tasks
in older adulthood is the cultivation of emotion
regulation strategies to influence the experience and
expression of emotions.3 An Initiative of Ministry of
Science and Technology (Govt. of India) suggests that
anxiety disorders are real and are relatively common
problems among elderly.4
By increasing psychological disorders in the elderly,
it is estimated that their prevalence will increase four
folds by 2030 compared with the past 30 years.5 The
diminishing joint family system in India and the various
other social factors have created a boom in emergence
of old age homes, especially in cities. Old age homes
are places for the elderly to reside, rest, be taken care of
and live. Most of the residents had at least one symptom
of psychological disorders and most frequent symptoms
were depression, anxiety and phobic anxiety etc. Since
prevalence of psychological disorders is higher among
old women compared with old men.2-6
For the promotion of a positive mindset and to create
a feeling of wellbeing for the older adult, meditation,
prayer and relaxation are important.7 MBSR is a
therapeutic intervention that improves emotion
Corresponding author:
Sasikumar S
Professor
Vydehi Institute of Nursing Sciences and Research
Centre, 82, E.P.I.P Area, Whitefield, Bangalore-560066
Karnataka
Mob:+919620410946
Email: sashwya@rediffmail.com
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82 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
regulation by increasing mindfulness attention or non-
judgmental awareness and acceptance of emotion as
they arise at any given moment.8-9 There are very few
research studies that are conducted in India and other
countries on effectiveness of Mindfulness Based Stress
Reduction on stress and anxiety among elderly. Hence
the researcher conducted a study on outcome of MBSR
on stress and anxiety for elderly living in a residential
home. Moreover helping the elderly learn these
techniques is cost effective, has no side effects and
would be a helpful tool to reduce stress, and anxiety.
OBJECTIVES
Objectives of the study were to
1. Find the stress level of the elderly residing in
residential homes
2. Assess the anxiety level of the elderly residing in
residential homes
3. Determine the effectiveness of Mindfulness Based
Stress Reduction (MBSR) in terms of reduction of
stress and anxiety
4. Find the association between
• stress score and selected baseline characteristics.
• anxiety score and selected baseline characteristics.
Hypotheses
All hypotheses were tested at 0.05 level of significance
H1: The mean posttest stress scores of elderly in the
experimental group will be significantly lesser than
mean posttest stress scores of elderly in the control
group.
H2: The mean posttest stress scores of elderly will be
significantly lesser than mean pretest stress scores of
elderly in the experimental group.
H3: The mean posttest anxiety scores of elderly in the
experimental group will be significantly lesser than
mean posttest anxiety scores of elderly in the control
group.
H4: The mean posttest anxiety scores of elderly will be
significantly lesser than mean pretest anxiety scores of
elderly in the experimental group.
H5: There will be significant association between stress
and selected demographic variables.
H6: There will be significant association between
anxiety and selected demographic variables.
METHODOLOGY
The conceptual framework for this study was based
on Theory of comfort by Katharine Kolcaba.10 An
evaluative approach with a quasi experimental pretest
and posttest control group design was used. The study
was conducted among elderly residing in residential
homes, Bangalore. There were two groups in the study
(experimental and control group) and each group
consisted of 30 elderly, selected from different residential
homes by non probability convenience sampling
technique. The sample size was calculated by use of
power analysis with 80% of statistical power and 5%
level of significance.
The criteria for selecting the sample was elderly aged
between 60 - 85years. Data were collected using
interview. The data collection tools included socio
demographic proforma, Perceived Stress Scale (r=.90),
Geriatric Anxiety Inventory(r=.90). Content and
language validity of the tools were established. The pilot
study was conducted on 10 elderly in each group and
it revealed the study to be feasible. Experimental group
participants were provided intervention on MBSR,
which was 5 weeks programme, (5 sessions beginning
with observation of breathing, body scan, mindfulness
of sound and thoughts and feelings). SPSS (16.0 version)
was used for statistical analysis of the data.
FINDINGS
Description of demographic data
The data presented in Table 1 depicts frequency and
percentage distribution of socio demographic
characteristics of elderly.
Effectiveness of Mindfulness Based Stress Reduction
(MBSR) on stress and anxiety:
Experimental group mean posttest stress score
(M=11.033, SD=3.358) was lower than the control group
mean posttest stress score (M=14.8, SD= 3.488). It shows
that there was reduction in stress among elderly in the
experimental group [t (58) =10.632, p<0.001)]. In
experimental group mean posttest stress score
(M=11.033, SD=3.358) was lower than mean pretest
stress score (M=15.333, SD=3.507). It was indicating a
statistically significant reduction in stress after MBSR
[t (58) =13.202, p<0.001)] (refer table 2 and 3).
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 83
With regards to reduction of anxiety the
experimental group mean posttest anxiety score
(M=4.833, SD=1.464) was lower than control group
mean posttest anxiety score (M=6.467, SD=1.502). There
was a significant reduction in anxiety [t (58) =7.284,
p<0.001)] among elderly in the experimental group. In
experimental group mean posttest anxiety score
(M=4.833, SD=1.464) was lower than mean pretest
anxiety score (M=6.8, SD=1.864). It was indicating a
statistically significant reduction in anxiety after MBSR
[t (58) =10.103, p<0.001)] (refer table 4 and 5). The above
findings showed that the MBSR was effective in
reducing stress as well as anxiety among elderly.
Association between stress and anxiety score and
selected demographic variables
Stress was significantly associated with age
(p=0.036), practice of yoga (p=0.013) and anxiety also
was associated with gender (p=0.027), practice of yoga
(p=0.003).
Table 1: Frequency and percentage distribution of socio demographic characteristics elderly
Socio demographic characteristics Experimental group Control group
f%f %
Age (in years)
60-64 22 73.33 17 56.67
65-69 5 16.67 7 23.33
70-74 3 10 5 16.67
75&above 0 0 1 3.33
Gender
Male 16 53.33 18 60
Female 14 46.67 12 40
Marital status
Married 27 9 0 27 90
Widowed 3 10 3 10
Religion
Christian 20 66.67 23 76.67
Hindu 9 30 7 23.33
Muslim 1 3.33 0 0
Education
Primary 7 23.33 6 20
Secondary 14 46.67 17 56.67
Higher secondary 8 26.67 6 20
Undergraduate 1 3.33 1 3.33
Previous Occupation
Male
Govt. employee 6 37.5 6 33.33
Private employee 2 12.5 4 22.22
Self employed 8 5 0 8 44.44
Female
Govt. employee 2 14.28 1 8.33
Private employee 2 14.28 1 8.33
House wife 10 71.42 10 83.33
Financial status
Elderly aid 1 4 46.67 16 53.33
Retirement organization 8 26.67 7 23.33
Other financial sources 8 26.67 7 23.33
Length of stay
Less than two year 15 50 22 73.33
More than two year 15 5 0 8 26.67
Regular practice of yoga
Less than one year 4 13.33 4 13.33
More than one year 2 6.67 0 0
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84 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Table 2: Mean, SD, MD, and‘t’ value computed between the posttest stress scores of elderly in experimental and
control group
Group N Mean SD MD t value p-value
Experimental Group 30 11.033 3.358 3.767 10.632 0.001
Control Group 30 14.8 3.488
df= 58, p=0.001
Table 3: Mean, SD, MD, and‘t’ value computed between the pretest and posttest stress scores of elderly in
experimental group
Group Test N Mean SD MD t value p-value
Experimental group Pretest 3 0 15.333 3.507 4.3 13.202 0.001
Posttest 11.033 3.358
df= 58, p=0.001
Table 4: Mean, SD, MD, and‘t’ value computed between the posttest anxiety scores of elderly in experimental and
control group
Group N Mean SD MD t value p-value
Experimental Group 30 4.833 1.464 1.634 7.284 0.001
Control Group 30 6.467 1.502
df= 58, p=0.001
Table 5: Mean, SD, MD, and‘t’ value computed between the pretest and posttest anxiety scores of elderly in
experimental group
Group Test N Mean SD MD t value p-value
Experimental group Pretest 3 0 6.8 1.864 1.967 10.103 0.001
Posttest 4.833 1.464
df= 58, p=0.001
DISCUSSION
This study examined the effectiveness of
Mindfulness Based Stress Reduction (MBSR) on stress
and anxiety among elderly residing in residential
homes. The results of the study showed that MBSR had
demonstrable effects on reduction of stress and anxiety
of elderly. The present study findings reported that
perceived stress score and anxiety score was high
among elderly residing in residential home. The
findings of the present study are consistent with study
done by Etemadi & Ahmadi2 who reported that anxiety
is more prevalent in elderly living at geriatric homes
than those at their own homes and going to geriatric
clubs regularly. Fahey11 et al found that about 62 percent
of the residents of old age home had at least one
symptom of psychological disorders. The findings of
the present study reveal that there was significant
reduction in stress and anxiety of elderly in the
experimental group who received MBSR. Smith12
reported that mindfulness training is a meditation based
approach can effectively important on several
therapeutic targets such as depression, anxiety etc and
it is useful to older people. Young & Baime13 also
reported that MBSR was an effective intervention for
decreasing psychological distress like depression, stress
and anxiety in older adults.
CONCLUSION
The study findings concluded that MBSR was an
effective intervention for reduction of stress and anxiety
among elderly. Mindfulness is a simple way of relating
to all experience that can reduce suffering and set the
stage for positive personal information. Mindfulness
based stress reduction practice may improve ability to
tolerate negative emotional state and cope with them
effectively. This practice might be a useful approach for
stress, anxiety reduction and alleviate suffering of the
elderly thus improving their quality of life.
Acknowledgement: My sincere thank to Mr. Mustafa
Nadeem Kirmani, Clinical psychologist, who trained
me in Mindfulness Based Stress Reduction (MBSR)
therapy. I am deeply indebted to management and
trustee of residential homes for permitted me to conduct
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 85
the study. I gratefully acknowledge all participants and
also for their kind cooperation.
Ethical Clearance: Obtained from concerned authorities
and after brief self introduction, the researcher
explained the purpose of the study to participants and
informed consent was obtained.
Conflict of Interest: None
Sources of Funding: Self
REFERENCES
1. Sherina MS, Nor Afiah MZ, Shamsul AS. Factors
associated with depression among elderly patients
attending primary health care clinic. Asia Pacific
Family Medicine, 2003 Apr: 2: 148-152.
2. Etemadi A, Ahmadi K. Psychological disorders of
elderly home residents. Journal of Applied
sciences, 2009 Feb: 9(3): 549-554.
3. Gross JJ, Barrett LF. Emotion regulation: one or two
depends on your point of view. Emotion review,
2011 Jan: 3(1): 8-16.
4. Akhand CJ. Old age solution: portal on technology,
solution for elderly. An initiative of Ministry of
Science and Technology (Govt. of India) 2009.
5. Waerna ME, Rubinowitz, Wilnelmsonb. Predictors
of suicide in old elderly. Gerontology, 2003: 49:
328-334.
6. Suresh NK. The old age problems and care of
senior citizens. Nursing journal of India. 2002 Oct:
93(10): 225-226.
7. Shauna L, Shapiro M. Effect of Mindfulness Based
Stress Reduction. Journal of Behaviuor medicine.
2010: 12 (1): 28-40.
8. Goldin PR, Gross JJ. Effects of MBSR on emotion
regulation in social anxiety disorders. Emotion,
2010 Feb: 10(1): 83- 91.
9. Kabat-Zinn J, Lipworth L, Burney R. The clinical
use of mindfulness meditation. J Behav. Med 1985:
8:163–190.
10. Kolcaba. Comfort theory and practice: a vision for
holistic health care and research, New York:
Springer Publishing Company, 2003.
11. Fahey T, Montgomery AA, Barnes J, Protheroe J.
Elderly people living at home residents: controlled
and observational study. BMJ, 2003 Mar: 326
(7389):580.
12. Smith A. Clinical use of meditation training for
older people. Behavioral Cognitive Psychotherapy,
2004: 423-430.
13. Young AL, Baime JM. Mindfulness-Based Stress
Reduction: Effect on Emotional Distress in Older
Adults. Journal of Evidence-Based
Complementary & Alternative Medicine, 2010 Apr:
85:891-903.
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86 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to assess the Stress among Juvenile Delinquent
Boys of Long Term Stay in a Selected Institutions at
Bangalore
Jenifer J
PhD (N) Pursuing, Mental Health Nursing, Department, Shri U S B College of Nursing, Abu Road, Rajasthan
ABSTRACT
Introduction: Stress is the most unpleasant event it is caused by experiencing severe psychic trauma.
The stressors could be markedly distressing to anyone experiencing intense fear, terror, and helplessness.
Excess stress manifest itself in a variety of emotional, behavioral and even physical symptoms, and the
symptoms of stress vary enormously among different individuals.
Objectives of the study: 1) To assess the level of stress among the juvenile delinquent boys of long term
stay. 2) To find the association between the stress and the selected demographic
Variables among the juvenile delinquent boys of long term stay.
HYPOTHESES: H1: There will be a significant level of stress among the juvenile delinquent boys of
long term stay.H2: There will be an association between the stress and the selected demographic
variables among the juvenile delinquent boys of long term stay.
Research Approach: The quantitative research approach was used to collect data.
Research Design: The descriptive survey design was used.
Target Population: The juvenile delinquent boys of long term stay in selected institutions at Bangalore.
Sample Size: The sample of the present study 60 Juvenile delinquent boys.
Sampling technique: Purposive sampling technique was used.
Tools: It consist of two parts: part A- It consists of demographic variables age education, religion,
duration of stay in institution, residence, family type, living status of father & mother ,education of
father and mother, occupation, size of the family, number of siblings, educational qualification ,habit of
smoking or alcohol drugs.
Part B-The structured interview schedule it consist of 6 stressors i.e change in life style, environmental
factor, educational factor, social factor, homesickness, personal factor there are 50 items in this scale .A
5 point scale was applied to measure the stress from No stress 1,to extreme stress score 5.This range of
scores from 1-250 higher score indicate high work stress.
Findings: Majority 95% of the juvenile delinquent boys had severe level of stress, and 5% samples had
moderate level of stress. The data obtained was analyzed by using both descriptive and inferential
statistics. A "p" value of < 0.05 was considered as statistically significant level.
Conclusion: It reveals that juvenile delinquent boys had significant level of stress. There was a significant
association between the level of stress among juvenile delinquent boys with the age, duration of stay in
the current institution, transfer from other institution, age of entry, living status of mother, number of
siblings, level of current education.
Keywords: Juvenile Delinquency, Stress, Institutions
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 87
INTRODUCTION
Cohen(2010)1 Institutionalization of adults may
trigger out additional life events ,thus generate immense
experience of stress, which often warrants better coping
strategies and consistent effort to deal with the
Adolescents. This group is a vulnerable group to both
physical and emotional stress.
Theresiamma (1998)2 children’s institution is
defined as a twenty four hour residential facility in
which a group of unrelated children together ,in the
care of a group of unrelated adults the number of
institutions for children in need of care and protection
has increased considerably over the years. It is estimated
that there are about 32 million destitute children in India.
A large number of them are in institutions .The
institutions for children in conflict with law host about
40,000.
Marium P (2010)3 The focus on the impact of
institutionalization on children begun during the
1930’s and 1940’s.There is an established consenus
generated by a large number of studies and experts
declared that institutionalization in undesirable for
children development. Institutional care is mean to
substitute family care, but turns out to be mass care by
group on unrelated adults with little or no emotional
bonds.
The Karnataka state council for child welfare reveals
that nearly there are 2,00,000 children in Karnataka are
in institution or residency care. Juvenile justice act 2006
provides provisions for the establishment of children’s
homes, for the care, treatment, and protection, of
neglected and abandoned children. The number of
institutions for children in need of care, and protection,
has increased considerably over the years.3
NEED OF THE STUDY AND LITERATURE
REVIEW
Children home means an institution established by
state government or by voluntary organization and
certified by government for the reception of children in
need of care and protection during pendency of any
inquiry and subsequently for their care, treatment,
education, training, development and rehabilitation. 2
A study detecting stress disorders in juvenile
detainees:1999 randomly selected juvenile detainees
were interviewed by interview schedule for children
and related functional impairment using the child
global assessment scale, among them 154 received
treatment by care disposition 6 months ,the study
recommended that provide innovative and effective
treatments to juvenile detainees beyond the reach of
traditional services.4
Krohn5 A study assessed that in their longtitutional
study among youths assessing variables that moderate
the influence of stress and learnt that family stability
and organizations and family cohesion served to
promote competent functioning under stress, family
variables found to have critical influences on the
adjustment of inner city youths. In a study of 144 urban
ninth grade students were assessed.Luther has found
that social skills and internal focus of control served to
protects youths from the effects of life stress.
Henderricken.G (2001)6 in a study conducted on the
stress and related problem of teens in the city of
Baltimore showed that the following g figures. Social
work 78%, parents 78%, romantic relationships 64 %
problems with friends 64% siblings 64 %.A study found
that, besides poverty and illiteracy, parental factors, lack
of guidance and care, indirect encouragement parents
towards deviant activities /habits of one or both the
parents, stressful situation nor certain crisis in their
family, environments factors and or influence of peer
group anti social they found to be very influential
leading innocent children to deviant activities.
Kasi.Nataraja M (2001)7 the study on street
“children of Bangalore” revealed that 96.91 % of the
street children had been institutionalized for any
deviant act. Of those who had been
institutionalized,27.78 % were institutionalized twice
and 14.81 % thrice .There is in sited for being
institutionalized in 81.48 % of the street children theft,
two thrice children sample reported that they had
occasional fights with their companies while 8.43%
fought regularly. Aganist the opinion of general public
that the street children are mostly anti-social delinquent
and thieves.7
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88 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Section: 1 Sociodemographic characteristics of the
juvenile delinquent boys in state run boys home.
• Regarding age, 36.7 % of the samples were between
the age of 14-16 years, 33.3 % of them were under
the category of 10-13 years of age, and the remaining
30 % were in the category of 17-19 years of age.
• According to place of birth, 51.7 of the juvenile
delinquent boys were residing in the area of urban,
and the remaining 48.3 % were in rural area.
• 51.7 % of the respondent’s mothers were speaks
Non kannada, and the remaining 48.3% speaks
only Kannada.
• With regard to the religion, 48.3 % of them were
Hindus, followed by 33.4 % were Christian, and
the remaining 18.3 % were Muslims.
• On the basis of duration of stay in the institution,
majority 81.7% of the samples were staying in the
current institution for 3-4 years, 8.3 % were staying
bellow in 2-3 years, and the remaining 10 % above
4 years.
• Majority 81.7% of samples were transferred from
other institution, and the remaining 18.3% were
from the same institution.
• With regard to the age of entry, majority 56.7 % of
the respondent’s age of entry into institution were
14-16 years, and followed by 25 % were below 10-
13 years, and the remaining 18 % were entered in
the age of above 17-19 years.
• Majority 61.7 % of the respondents residence before
institution were rural, and remaining 38.3 % were
urban.
• 50 % of the respondents were belonged to joint
family, and 33.3 % of them were belonged to nuclear
family, and the remaining 16.7 % were from broken
family.
• 70 % of the respondent’s fathers were living, and
the remaining 30 of their fathers were non living.
• 66.7 % of the respondent’s mothers were living, and
the remaining 33.3 % of their mothers were non
living.
• 45% of respondent’s fathers were studied up to PUC
level, 30 % were under below high school, 23.3 %
were SSLC level, remaining 1.7 % were
postgraduates.
• 56.7% of the respondent’s mothers were studied up
to SSLC level,25 % were studied below high school
, 15% were studied PUC level, and remaining 3.3%
were studied up to degree.
• Regarding to family size,75 % of the respondents
family size were 4-6, 15 % were living with 3
members, and the remaining 10 % were above six
members in their family.
• According to the number of siblings,46.7 % of the
samples had one sibling, 40 % had two siblings,
followed by 8.3 % had 3 siblings, and the remaining
5 % had no siblings.
• With regard on birth order,48.3 % of the respondents
were first born in their family, 41.7% in second order,
8.3% of the were in third order, and the remaining
1.7 were in fourth order.
• On the basis of level of current education, 63.3 % of
the respondents were average, 20% were poor, and
the remaining 16.7% of them were good.
• Majority 83.3% of the respondents were not using
smoking or drugs before coming to the institution,
and the remaining 16.7 % of the respondents were
having the habit of smoking or using drugs /
alcohol.
Section: 2 Findings related to stress among the juvenile
delinquent boys in State run boys home.
Majority 95 % of the respondents were under the
severe level of stress score 151- 200, and the remaining
3% were under the moderate level of stress score101-
150, over all mean stress score is 64.6% with S.D 2.35,
the above findings were supported by the similar study
concluded, among Street youth of 228 which detained
in the juvenile justice system, stress and help to
independent main effects and as interactive risk factors
in relation to depressive symptoms. The detained youth
has higher stress level. The high stress level causes due
to mental illness and low bone mass. The study shows
that stress can aggravate swelling.8
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 89
Table 1: Association between the stress and the selected demographic variables among the Juvenile delinquent boys
of long term stay.
S.No Demographic variables Calculated chi- Degree of “P” value
square value freedom
1. Age 8.333 2 0.001
2. Religion 8.100 2 0.017
3. Duration of stay 23.333 2 0.000
4. Transfer from other institution 24.067 1 0.000
5. Age of entry 7.467 2 0.002
6. Living status offather 9.600 1 0.002
7. Living status of mother 6.667 1 0.010
8. Father education 23.333 3 0.000
9. Mother education 37.733 3 0.000
10 . Number of siblings 32.933 3 0.000
11. Level of current education 23.200 2 0.002
There is a significant association between the stress
and the selected demographic variables such as age,
religion, duration of stay in the current institution,
transfer from the other institution, age of entry
institution, living status of the father, living status of
the mother, father education, mother education, number
of siblings, level of current education among the juvenile
delinquent boys of long term stay.
Table 2: Overall and area wise mean stress of juvenile delinquent boys of long term stay.
No Stress areas wise Statements MaxScore Respondents
Mean S.d
I. Change life style 4 2 0 10.58 1.65
II. Environmental 8 40 26.87 2.205
III. Educational 6 3 0 19.12 2.308
IV. Social 12 60 40.45 3.219
V. Homesickness 9 45 30.40 2.637
VI. Personal 11 55 34.15 3.308
VII. Total 50 250 161.57 5.864
In the present study, there is a significant association
between the stress and the selected demographic
variables such as age, place of birth, mother tongue,
religion, duration of stay in the current institution,
transfer from the other institution, age of entry
institution, Residence before institution, type of family,
living status of the father, living status of the mother,
father education, mother education, number of siblings,
level of education. Hence, the stated Hypotheses is
accepted. The result of the study shows the majority of
the juvenile delinquent boys experience moderate and
serve level of stress.
Nursing Practice
Nurses are the key person of the health team, he
plays a vital role in the promotion and maintenance of
health. They can provide adequate counseling. Nursing
interventions can be planed to minimize stress and
effectiveness of these interventions can be
recommended for better implementation in practice.
RECOMMENTATIONS
1. A similar study can be replicated on a large sample
to generalize the findings.
2. An experimental study can be undertaken with
control group for effective comparison with stress
management techniques and guidance services.
CONCLUSION
The study concluded that most of the juvenile
delinquent boys had severe stress due to various
stressors.
ACKNOWLEDGEMENT
The author is thankful to almighty for showering
his blessings and prof. DR.K.R.Srinivas M.Sc, PhD
principal, Sneha College of Nursing, for his support
and further guidance in all my endeavors.
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90 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
A special thanks to my husband Mr. Nelson Prabhu
Migael, and my son N. Jenel stuart for their unbeatable
encouragement. My heartful thanks to my M.Sc friends
Mr. Aspin, Mrs. Stella Gracy for their support.
Conflict of Interest: There was no such issue.
Source of Funding: Funding was by self finance
Ethical Clearance Permission taken from child health
and family welfare department, Bangalore, before data
collection written consent was taken from all the
participants.
REFERENCES
1. Cohen .S.strategies for measuring stress in studies
of psychiatric and physical disorders. 2010;
12.(27)1-17.
2. Theresiamma J.A.comparative study on the felling
of inferiority and aggression in orphans and
children.youth society.1998(32):14-20.
3. Marium P stress among children in
institutionalization .2010.june4(1)61-67.
4. Garmezy.J studies os stress resistant
children.journal of child
development.1998.34(5)12-20.
5. Krohn.the measurement of family process
variables:the effect of adolescent and parent
perceptions of family life on delinquent behavior
.32(5):287-315.
6. Henderricken.G.confronting teen stress.meeting
the challenge in Baltimore city.2001.200(24)19-22.
7. Kasi.nataraja M.a study on adolescent problems
and resources.M-phil dissertation
(2001).NIMHANS.bangalore.
8. The impact of punishment and rehabilitation
views on organizational commitment among
correctional staff: A preliminary study. American
journal of criminal justice.2008.33(1)85-98.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 91
DOI Number: 10.5958/j.2320-8651.2.1.001
Effectiveness of Garlic Intake on Blood Pressure among
Hypertensive Patients in a Selected Community at
Mangalore
Sherin James
MSc Nursing Student, Laxmi Memorial College of Nursing, Mangalore
ABSTRACT
Hypertension is a disease of vascular regulation in which the mechanisms that control arterial pressure
within the normal range are altered. Hypertension is typically defined as having a systolic blood
pressure (SBP) ≥140 mm Hg and a diastolic blood pressure (DBP) ≥ 100 mm Hg. The present study was
undertaken to assess the effectiveness of garlic intake on blood pressure among hypertensive patients
in a selected community at Mangalore.
The research approach used for the study was the experimental research approach. The conceptual
framework was based on the Theory of Imogene King’s. A quasi experimental research design was
used to study 40 hypertensive patients. The samples were selected by the purposive sampling technique.
The data was collected by using demographic proforma, compliance diary and blood pressure
monitoring chart. The data collected was analyzed to achieve the objectives of the study and to test the
research hypotheses using descriptive and inferential statistics.
Result showed that the mean systolic blood pressure in post-test 1 (136.1±7.23) and post-test 2
(122.8±3.07) of the experimental group was significantly lower than the mean post-test 1 (141.1±7.55),
post-test 2 (141±7.49) in control group, i.e., t38=2.14, t38=10.04 at 0.05 level of significance respectively.
The mean diastolic blood pressure in post-test 1 (87.7±4.86), post-test 2 (80.8±1.76) of the experimental
group was significantly lower than the mean post-test 1 (80.8±1.76), post-test 2 (91.5±5.10) in control
group i.e., t38=2.8, t38=13.01s at 0.05 level of significance respectively. This shows that garlic was effective
in reducing blood pressure in experimental group. The findings of the study proved that there was
reduction in the blood pressure due to garlic administration. Garlic is used as an alternative method for
the control of blood pressure among hypertensive clients. The main advantage is that garlic is cheap,
easily available and has no side effect.
Keywords: Effectiveness, Garlic, Blood Pressure
INTRODUCTION
In the modern world each and every individual’s
life has become stressful. This stressful life is directly
affecting a common person. There is no other gift greater
than the gift of health1. WHO has defined as health is a
state of physical, mental, emotional and spiritual
wellbeing not merely the absence of disease or infirmity.
If there is balance in the physical, mental, emotional
and spiritual dimensions, then a person enjoys the total
health.2 Modern living with stresses and strains,
mounting tensions and pressure in everyday life.
Chronic diseases are of long duration and generally
slow progression. Chronic diseases such as heart
disease, stroke, cancer, chronic respiratory diseases and
diabetes, are by far the leading cause of mortality in the
world, representing 60% of all deaths. Based on current
trends, it is expected that non-communicable diseases
(NCD) will account for 73% of deaths and 60% of the
global disease burden by 2020, and will account for a
major proportion of disease and deaths in India.3
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92 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Hypertension is the one of the most common chronic
disease affecting humans. Hypertension is the most
important modifiable risk for coronary heart disease.
Hypertension is a sustained elevation of Blood Pressure.
In adults, hypertension exists when systolic blood
pressure (SBP) is equal to or greater than 140 mm Hg or
diastolic blood pressure (DBP) is equal to or greater
than 90 mm Hg for extended periods of time. It is the
prime duty of the therapist to help a person understand
all about the problem and non-pharmacological
method going on to medication.4
Garlic also has a history of use in Ayurvedic
medicine. Garlic has higher nutritive value than other
bulb crops. It is rich in proteins, phosphorous,
potassium, calcium, magnesium and carbohydrates.
The garlic cloves are used as seed, for consumption
(raw or cooked), and for medicinal purposes such as to
prevent and control tumours and cancer, lowering blood
sugar cure cerebrovascular disease, protect liver
function and reduces hypertension.5-8 Recently, science
has begun to confirm many of garlic’s long-standing
medicinal uses. Garlic has been shown to lower blood
cholesterol, blood pressure and blood sugar in studies
and clinical trials. Garlic has also demonstrated anti-
cancer, antibacterial, anti-fungal and anti-oxidant
effects. Garlic has many healing properties, but the most
research has been done on its potential to help reduce
heart disease. Garlic has also been shown to reduce
pain and other symptoms in people with rheumatoid
arthritis. And it reduces the size of some cancerous
tumours and helps prevent some cancers, particularly
those in the intestines.9
In the ICMR study in 1994 involving 5537
individuals (3050 urban residents and 2487 rural
residents) demonstrated 25% and 29% prevalence of
hypertension (criteria ≥ 140/90 mm of Hg) among males
and females respectively in urban Delhi and 13% and
10% in rural Haryana.10 Garlic may be useful in addition
to medication to treat high blood pressure, a study
suggests. A study was carried out to assess the
effectiveness of garlic on blood pressure among
hypertensive patients in Kaduthuruthy co-operative
hospital, Kottayam. The analysis revealed that the mean
post-test systolic blood pressure 139.15 was less than
the mean pre-test systolic blood pressure 157.3. Mean
post-test diastolic blood pressure 86.65 was less than
the pre-test diastolic blood pressure 94.7. There was a
significant reduction in the mean systolic blood pressure
after garlic administration among hypertensive patients
in the experimental group t=7.179 (p=0.001). There was
a significant reduction in mean diastolic blood pressure
after garlic administration among hypertensive patients
in experimental group t=7.11 (p=0.001).11
The incidence of hypertension is increasing in
developing countries due to the lack of awareness of
the risk factors; improper distribution or allocation of
resources irrelevant and inappropriate healthcare
strategies societal changes due to industrialization
leading to life style changes of people socio political
negligence and interference, leading to a standstill
situation in the health sector.
Hence the present study was undertaken to assess
the effectiveness of garlic intake on blood pressure
among the hypertensive patients in a selected
community at Mangalore.
OBJECTIVES OF THE STUDY
1. To assess the blood pressure of both experimental
and control group by sphygmomanometer readings.
2. To find the effectiveness of garlic intake on blood
pressure in the experimental group.
3. To compare the mean difference in blood pressure
among hypertensive patients in experimental group
and control group.
4. To find the association of mean blood pressure
readings with selected factors like age, sex,
occupation, nature of work, type of family, duration
of illness, regularity of taking medications, sleeping
hours and exercise among the hypertensive
patients.
MATERIAL AND METHOD
Quasi-experimental (Time series design) design is
adopted for to determine the effectiveness of garlic intake
in reducing the hypertension among hypertensive
patients in selected community at Mangalore. Sample
comprises of 40 hypertensive patients who were
selected from Devinagar area, Mangalore based on
those who maintain the inclusion criteria. Among 40
hypertensive patients, 20 were in experimental group
and 20 were in control group. Patients who are having
hypertension are purposively selected as sample from
the Devinagar community for the study.
The study was approved by the ethical committee of
A.J Medical college and the informed writtern consent
was obtained from all the participants.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 93
Pilot study was conducted in selected Urban area of
Mangalore. A written permission was obtained from
the concerned authority prior to the study. Purposive
sampling technique was used to select 10 samples. The
comparison of post-test systolic blood pressure score of
experimental group (mean=142) and the control group
(mean=147.6) showed that mean post-test in
experimental group was significantly lower than
control group in systolic blood pressure of the
samples.The comparison of post-test diastolic blood
pressure score of experimental group (mean=88.4) and
the control group (mean=92.4) showed that mean post-
test in experimental group was significantly lower than
control group in diastolic blood pressure of the samples.
The data collection period is from 01-04-2013 to 30-
4-2013. Prior to data collection, permission was
obtained from the concerned authority to conduct the
study. Samples were selected according to the selection
criteria of the study. Before administering the garlic,
self- introduction and the purpose of the data collection
was to the samples. On the first day the investigator
checked the blood pressure of both experimental and
control group and administered heated garlic of 3 cloves
in the morning after breakfast and in the night after the
meals. The blood pressure were checked on 15th and
30th day for both the experimental and control group.
The systolic blood pressure before and after
administration of garlic would be calculated by using
mean, median and standard deviation.
The significant difference between the mean pre-test
and post-test score of systolic and diastolic blood
pressure of experimental group would be calculated
using F test. The significant difference between the mean
systolic and diastolic blood pressure in experimental
group and control group would be calculated using
independent t test. The association of the hypertensive
patients with selected demographic variables was
computed by using Chi square formula.
Section 1: Description of demographic variables
The majority of the sample in the experimental group
(50%) and in control group (55%) belonged to the age
group of 55- 60 years. Majority of the samples in the
experimental group (85%) and in the control group
(95%) were males. All the samples in the experimental
group and control group were married. Majority of the
samples in the experimental group (50%) and control
group (40%) were completed primary education.
Highest percentage of the samples in the experimental
group (65%) and control group (60%) were
unemployed. Majority of the samples in the
experimental group (85%) and control group (90%) were
from the joint family. Highest percentage of the samples
in the experimental group (75%) and control group
(65%) were did walking as an exercise regularly.
Majority of the samples were non-vegetarian both in
the experimental group (95%) and control group (90%).
Highest percentage of samples in the experimental
group (30%) having increased blood sugar and in
control group (40%) were not having any other diseases
except hypertension. Majority of the samples in the
experimental group (75%) and control group (55%) were
on anti-hypertensive medications. Highest percent of
the samples in experimental group (55%) were having
duration of disease since 1-2 years and for control group
(45%) were having disease since 3-6 years.
Table 1: Frequency, percentage and cumulative frequency of systolic blood pressure scores before and after garlic
administration in experimental group
N=20
Range Pre-test Post-test 1 Post-test 2
f cf cf% f cf cf% f Cf cf%
115-120 - - - - - - 5 5 25
121-125 - - - 1 1 5 11 16 80
126-130 - - - 4 5 25 4 20 100
131-135 3 3 15 4 9 45
136-140 2 5 25 6 15 75
141-145 4 9 45 2 17 85
146-150 6 15 75 3 20 100
151-155 4 19 95
156-160 1 20 100
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94 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Table 2: Frequency, Percentage and Cumulative frequency of diastolic blood pressure scores before and after garlic
administration in the experimental group
N=20
Range Pre-test Post-test 1 Post-test 2
f cf cf% f cf cf% f Cf cf%
75-80 - - - - - - 15 15 75
81-85 - - - 1 1 5 4 19 95
86-90 6 6 30 7 8 40 1 20 100
91-95 3 9 45 4 3 65
96-100 9 18 90 4 17 85
101-105 2 20 100 3 20 100
Section 2: Effectiveness of garlic intake in reducing the blood pressure in experimental and control group
To test the significant difference in pre and post-test score in experimental group nulls hypotheses H01 was
stated.
Table 3: ANOVA test to find out the significance of difference between pre-test and post-test blood pressure of the
experimental group
N=20
Variance Sum square df Mean F P value
square
Systolic blood pressure
Between group 4507.10 2 849.50 14.54 3.15
Within group 58.03 57 58.03
Total 12822.20 60 907.03
Diastolic blood pressure
Between group 389.53 2 9.99 8.46 3.15
Within group 134.93 57 11.24
Total 533.80 60 106.23
The calculated ‘F’ value (14.54) for the SBP was greater than the tabled value (F(2,57) =3.15) at 0.05 level of
significance. The calculated ‘F’ value (8.46) for the DBP was also greater than the tabled value (F(2,57) =3.15) at
0.05 level of significance. Hence null hypotheses H01 was rejected.
Comparisons of post-test blood pressure scores in the experimental and control group
Table 4: Mean, SD, Mean Difference and ‘t’ value of systolic blood pressure in the experimental group and control
group
N1=20, N2=20
Mean SD Mean difference ‘t’ value
SBP-Post 1 Experimental 136.1 7.23 2.33 2.14*
Control 141.1 7.5
SBP-Post 2 Experimental 122.8 3.07 1.81 10.04*
Control 141.0 7.49
t38=2.49, p<0.05 *Significant
This shows that garlic was effective in reducing blood pressure in experimental group.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 95
Table 5: Mean, SD, Mean Difference and‘t’ value of diastolic blood pressure in the experimental group and control
group
N1=20, N2=20
Mean SD Mean difference ‘t’ value
SBP-Post 1 Experimental 87.7 4.86 1.50 2.80*
Control 92.0 4.76
SBP-Post 2 Experimental 80.8 1.76 0.82 13.01*
Control 91.5 5.10
t38=2.49, p<0.05 *Significant
This shows that garlic was effective in reducing blood pressure in experimental group.
Association of blood pressure score with selected demographic variables.
Chi-square was used to determine the association of blood pressure and the selected demographic variables. T
o test the significant association the following null hypotheses H03 was stated.
Table 6: Association of blood pressure score of control and experimental group with selected demographic
variables
N=20+20
Variables Chi-square p-value Inference
1. Age
a. SBP 2.28 >0.05 Not significant
b. DBP 0.58 >0.05 Not significant
2. Sex
a. SBP 0.83 >0.05 Not significant
b. DBP 0.17 >0.05 Not significant
3. Occupation
a. SBP 0.60 >0.05 Not significant
b. DBP 0.87 >0.05 Not significant
4. Work and activity
a. SBP 3.05 >0.05 Not significant
b. DBP 1.24 >0.05 Not significant
5. Type of family
a. SBP 0.76 >0.05 Not significant
b. DBP 0.14 >0.05 Not significant
6. Medication
a. SBP 13.7 <0.05 Significant
b. DBP 12.7 <0.05 Significant
Table value: χ2=3.84, p<0.05
DISCUSSION
Hypertension is a common, chronic and silent killer
disease seen all over the world since many years.
Hypertension is described as an elevated blood pressure
level both. Blood pressure control depends on the proper
interaction of the five components of hypertension
management. These are diet, medication, exercise or
physical activity, health education and monitoring of
blood pressure level. In addition to drug therapy and
dietary control the nurse may take the opportunity to
educate the hypertensive patients about many other
available therapies and supportive measures for
control of hypertension.
Effectiveness of garlic intake in terms of reduction
in blood pressure readings in the experimental group.
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96 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Systolic blood pressure
• The mean post-test score of systolic blood pressure
in the experimental group were lower than their
previous post-test score.
• The mean pre-test score of systolic blood pressure
in the experimental group (145±7.03) was more than
the post-test 1(136.1±7.23) and post-test 2
(122.8±3.07) scores of the experimental group.
• In the control group pre-test score (141.7±7.40) was
similar to post-test 1 (141.1±7.55) and post-test 2
(141±7.49) score of the control group.
• The mean post-test score is lower than the mean
pre-test scores in experimental group F(2,57)=14.54,
p>0.05.
• The mean systolic blood pressure in post-test 1 score
(136.1±7.23), post-test 2 (122.8±3.07) of the
experimental group was significantly lower than
the mean post-test 1 (141.1±7.55), post-test
2(141±7.49) in control group ie, t38=2.14, t38=10.04
at 0.05 level of significance respectively.
Diastolic blood pressure
• The mean post-test score of diastolic blood pressure
in the experimental group were lower than their
previous post-test score.
• The mean pre-test score of diastolic blood pressure
in the experimental group (95.1±5.16) was more
than the post-test 1(87.7±4.86) and post-test
2(87.7±1.76) scores of the experimental group.
• In the control group pre-test (92.4±4.96) was more
than the post-test 1 (92±4.76) and post-test 2
(91.5±5.10) of the control group.
• The mean post-test score is lower than the mean
pre-test scores in experimental group F(2,57)=8.462,
p>0.05.
• The mean diastolic blood pressure in post-test
1(87.7±4.86), post-test 2(80.8±1.76) of the
experimental group was significantly lower than
the mean post-test 1 (80.8±1.76), post-test
2(91.5±5.10) in control group i.e., t38=2.8, t38=13.01s
at 0.05 level of significance respectively.
Association of blood pressure score with selected
demographic variables.
There was a significant association of level of blood
pressure with medication SBP χ2=13.7, p<0.05 and DBP
χ2=12.7, p<0.05.
CONCLUSION
The main purpose of the study was to assess the
effectiveness of garlic intake on blood pressure among
the hypertensive patients. Most of the hypertensive
patient’s knowledge regarding the effectiveness of garlic
intake on blood pressure was poor before the
administration of garlic. By administering the garlic to
the patients they learn the effectiveness of garlic in
reducing the blood pressure. Garlic is effective in the
reduction of the blood pressure. Garlic is effective, non-
invasive, cost effective non-pharmacological alternative
in the treatment of hypertension. Garlic not only helps
to control blood pressure but also helps to control
cholesterol.
Acknowledgement: Sincere thanks to my madam Mrs.
Jenifer D’souza and to my husband and all the
participants of my study.
Source of Funding: Self
Conflict of Interest: None
Ethical Clearance: Ethical committee of A.J. Medical
college
REFERENCE
1. Panda PC. Yoga therapy for healthcare.
Naturopathy 2005 Jul.
2. Narendra HR, Nagarathna R. Yoga for
Hypertension and heart diseases. 2nd ed.
Bangalore: Swami Vivekanada Yoga Prakashana;
2006.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 97
3. Satsharma. Hypertension. E-medicine. [online].
Available from: URL:http://www.emdicine.com
4. Bhat V. Introduction to Yoga. Indolink-health and
fitness. [online]. Available from: URL:http://
indolink.com.
5. Plant people possibilities. Plant culture exploring
plants and peoples. [online]. Available from:
URL:http://www.kew.org/plant-cultures/
plants/garlic_history.html.
6. Meyers M. Garlic - Herb Society of America Guide.
[online]. Available from: URL:http://
www.herbsociety.org/factsheets/
Garlic%20Guide.pdf.
7. Garlic. [online]. Available from: URL:http://
www.nhrdf.com/htmlfiles/Garlic/
gar_intro.htm.
8. A brief introduction of garlic. [online]. Available
from: URL:http://pubarticle.com/a-brief-
introduction-of-1246612239,1721.html.
9. Hornick B, Yarnell E. Medical uses for garlic.
[online]. Available from: URL:http://
health.howstuffworks.com/wellness/natural-
medicine/alternative/medical-uses-for-garlic-
ga.htm.
10. Yang K. A review of yoga programmes for four
leading risk factors of chronic diseases. Oxford
Journal 2003 Oct 27;(4):487-91.
11. Paulose A. Hypertension and Garlic
administration. The Nurse 2011 Nov- Dec;3(6):
3-4.
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98 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to assess the Level of Stress and Coping among
Female Workers in Selected Apparel at Bangalore with a
View to Develop an Information Booklet
Aspin R
SCPM College of Nursing and Paramedical Sciences, Gonda. UP
ABSTRACT
Work-related stress is a pattern of physiological, emotional, cognitive and behavioral reactions to some
extremely taxing aspects of work content, work organization and work Environment. When people
experience work-related stress, they often feel tense and distressed and feel they cannot cope.
Objectives of the study: 1) To assess the level of job related stress among female workers in apparel.
2) To assess the level of coping strategies among female workers in apparel. 3) To associate the socio-
demographic variables with the level of stress among the female workers in apparel. 4) To associate the
socio-demographic variables with the level of cope among the female workers in apparel. 5) To find out
correlation between stress and coping of female workers in apparel.
Research hypothesis: H1: There will be significant amount of stress on female apparel workers.
H2: There is a significant relationship between experience of stress and effective coping skills the
workers possesses.
Research design: A descriptive survey design was selected for the study.
Sample Size: 50 female apparel workers
Sampling technique: A non-probability purposive sampling technique was used to select the
respondents for the study.
Data collection tool: Demographic data sheet, The Work Stress Scale (WSS, 1990) and Brief COPE
(Carver, C.S, 1997) scale were used to collect data from the subject.
Findings: Majority 80% of the respondents were experiencing moderate level of stress, 16% of them
having high level of stress, 4% of them having low level of stress. Overall mean stress score was found
to be 68.1% with S. D 9.16%. The highest mean stress score was noticed in the area of performance
pressure (16.74). It was observed that in the present study, 64 % of them had moderate level of coping
and 36% of them had high level of coping to overcome the stress. Overall mean coping score is found to
be 54.64% with S.D 6.55%. The highest mean coping score was noticed in the area of Religion (6.36).
Keywords: Stress, Coping, Female Workers, Apparel Workers
INTRODUCTION
Kumar R (2007) A study examining stress in India,
denotes Stress is inevitable in life, and with increasing
complexities, aspirations and uncertainties associated
with socioeconomic, political and cultural upheavals,
stress is only likely to increase. In work situations,
organizational stress due to longer working hours,
greater workloads, multitasking, lack of job stability and
a host of other factors have motivated researchers to
explore the causes and consequences of stress and the
possible remedial measures.1
Ahluwalia A (2010) A study on Job stress and
women explains stress at work is a relatively new
phenomenon of modern lifestyles. The nature of work
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 99
has gone through drastic changes over the last century
and it is still changing at whirlwind speed5. They have
touched almost all professions, starting from an artist
to a surgeon, or a commercial pilot to a sales executive.
With change comes stress, inevitably. Professional stress
or job stress poses a threat to physical health. Work
related stress in the life of organized workers,
consequently, affects the health of organizations.2
Need for the study
Ahluwalia A (2010) A study on Job stress and
women explains women may suffer from mental and
physical harassment at workplaces, apart from the
common job stress. Women may suffer from tremendous
stress such as ‘hostile work environment harassment’.
This can consist of unwelcome verbal or physical
conduct. These can be a constant source of tension for
women in job sectors. Also, subtle discriminations at
workplaces, family pressure and societal demands add
to these stress factors.2
Sri lanka’s news portal (2010) A garment worker to
earn little amount they sacrifice their health. They skip
meals to save time. They drink less water to avoid going
to the toilet. The result is that their health is worse than
that of women of the same age group in the general
population. According to the Srilanka government’s
labour gazette, 56 percent of the garment workers were
facing health problem. The body mass index of garment
workers showed that 34.2 percent were suffering from
some form of chronic malnutrition. 3
Beccary (2009) A study on garment workers
mentioned that the garment workers were working
inhumanly from morning to evening, doing overtime to
meet their two square a meal, There had been demand
from these workers to increase their wages to a level so
that they can lead a better life; so far all their demands
have gone unheeded.4
The investigator therefore felt the need to assess the
level of stress and coping among female workers in
selected apparel at Bangalore with a view to develop
an information booklet.
Review of literature
Machado T (2013) In a study 38% of the sample had
significant psychological distress, found through the
General Health Questionnaire (GHQ-28; Goldberg and
Hillier, 1979). The vulnerable groups were women,
permanent employees, data processors, and those
employed for 6 months or longer. The reported levels of
burnout were low and the employees reported a fairly
large repertoire of coping behaviors. 5
Chaudhuri P (2007) A exploratory study was
undertaken among 135 women health workers on
experiences of sexual harassment in four hospitals in
Kolkata. Four types of experiences were reported by the
77 women: verbal harassment (41), psychological
harassment (45), sexual gestures and exposure (15), and
unwanted touch (27). None of the women reported rape,
attempted rape or forced sex, but a number of them knew
of other women health workers who had experienced
these. The women who had experienced harassment
were reluctant to complain, fearing for their jobs or being
stigmatized. 6
JinkyLeilanie Lu (2005) An investigation of the
impact of organizational factors on perceived job stress
among women workers in the garment in the
Philippines was undertaken. The sample included 23
establishments with 630 women respondents.
Questionnaires, walk-through surveys of the
industries, and interviews were done. Chi-square
analysis showed that there were interactions among
the organizational factors (P = 0.05 and 10). The result
shows that the workers experienced moderate level of
job stress (P = .05) when they were subjected to low job
autonomy, poor work quality, close monitoring, and
hazardous work pressure.7
Li CY, Chen KR (2010) A cross-sectional study
analyzed the frequency and severity of work stressors
and job satisfaction at workplaces in relation to work-
related non-fatal injuries amongst a sample of
petrochemical workers in Taiwan. The study
participants consisted of 568 cases injured on the job,
and 954 injury-free controls matched to cases on
frequencies of age, sex and work site. After adjusting
for potential confounders, we found that cases were
more likely than controls to report stressors with a
higher frequency [odds ratio (OR) = 1.4, 95% confidence
interval (CI) = 0.9–2.0] and a more severe reaction (OR
= 1.3, 95% CI = 0.9–1.8). The dose–response analyses
further indicated that the OR of injury was
monotonically associated with stress reaction only (P
for test for trend of ORs = 0.02). The results tend to
suggest that the severity of stress reaction is more
associated with occupational non-fatal injury than is
the frequency of stress or job dissatisfaction.8
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100 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Sociodemographic characteristics of the female
apparel workers.
1. Regarding distribution of age, 48% of the
respondents were in the age group of 30-40 years,
42% of them were in the age below 30 years and the
remaining 10% of them in the age above 40years.
2. The study findings demonstrated that the 62% of
the respondent had middle school education
followed by 30% of them had secondary education
and the remaining 8% of them studied primary
education.
3. Regarding marital status, majority (62%) of the
respondents were married, followed by 20% of them
were single, 16% were widow and the remaining
2% of them were divorced.
4. Almost half (44%) of the female workers belonged
to the joint family, followed by 40% belonged to
nuclear family and remaining 16% were belonged
to extended family.
5. Findings shows 34% of the respondent were
Hindus, 26% were Muslims and 28% of them
Christians, remaining 12% of them were belonged
to other religion.
6. Majority (74%) of the female workers were belonged
to semi urban and remaining 26% of the female
workers were belonged to urban.
7. Majority (76%) of the respondent’s family annual
income was Rs.50000- Rs.100000, 12% of them
having the family annual income of below Rs.50000
and the equal distribution was observed in above
Rs.100000.
8. Majority (66%) of the respondent were with less than
5 members in their family and remaining 34% of
the them with more than 5 members in their family.
9. Majority (84%) of the female workers were not using
any substance, 2% of them were using alcohol and
14% of the female workers were using tobacco.
10. All female workers were belonged to local standard
of organization.
11. Majority (90%) of the respondent were temporary
workers and the remaining 10% of them permanent
workers.
12. Majority (78%) of respondents were having less than
2 years of experience in the apparel, 20% of them
were having 2-5 years of experience and the
remaining 2% of them were having above 10 years
of experience in the apparel.
13. From the study findings, 52% of the respondents
were having distance between 2 km-5km from their
workplace, 32% were having less than 2km from
their work place and the remaining 16% of them
were having distance between 5km-15km from their
work place.
Findings related to occupational stress of female
apparel workers.
In the present study it was found that majority (80%)
of the respondents experiencing moderate level of stress.
16% of them experiencing high level of stress, remaining
4% of the respondent experiencing low level of stress.
Hence the “H1- There will be significant amount of stress
on female apparel workers” is accepted. The overall
mean stress score was found to be 68.10%. The highest
mean stress score was noticed in the area of performance
pressure (16.74%) followed by Bureaucratic constraints
(16.72% ), Poor relations with colleagues (16.72%), Work
family conflict (14.60%), Poor relations with superiors
(14.18%), and Poor job prospectus(13.66%).
Findings related to coping strategies among female
apparel workers.
The finding of the present study shows that 64 % of
them had moderate level of coping to overcome the
stress. 36% of them had high level of coping to overcome
the stress. The overall mean coping score was found to
be 54.64%. The highest mean coping score was noticed
in the area of Religion (6.36%).
Correlation between mean stress and coping scores
of female apparel workers.
The findings of the study shows that there is a
positive relationship between perceived stress and
coping strategies with the obtained (r) value (0.709)
which is less than the table value (1.96) with 48df at
0.05 level of significance. It shows that there is a
significant relationship between experiences of stress
and effective coping skills of the employee possesses at
the 0.05 level of significance. Hence the H2 is accepted.
Association between stress and coping and selected
sociodemographic variables.
There is a statistically significant association was
found between the stress and the demographic variables
like age, education, income, religion, and marital status,
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 101
number of persons, and type of family, year of experience
and distance work place.
A statistically significant association was found
between the coping and demographic variables like age,
education, income, religion, and marital status, number
of persons, and type of family, year of experience and
distance work place.
Table 1: Association between demographic variables with stress on female workers
Demographic variables Calculated Degree of “P”Value Level of
Chi-squarevalue freedom significance
Age 12.52 2 0.002 **
Education 22.12 2 0.000 **
Marital status 40.080 3 0.000 **
Family 6.88 2 0.032 **
Religion 5.20 3 0.158 **
Income 40.96 2 0.000 **
Number of persons 5.12 2 0.000 **
Working status 32.00 1 0.000 **
Years of experience 47.32 2 0.000 **
Distance of workplace 9.76 2 0.008 **
P <0.05 =**Significant and P>0.05=* Significant .There is a significant association between the stress and the demographic variables
such as age, education, income, religion, and marital status, number of persons, and type of family, year of experience and distance
from work place.
Table 2: Association between demographic variables and the level of coping among female workers in the apparels
Demographic variables Calculated Degree of “P”Value Level of
Chi-squarevalue freedom significance
Age 11.03 2 0.002 **
Education 19.45 2 0.000 **
Marital status 39.04 3 0.000 **
Family 4.67 2 0.032 *
Religion 6.23 3 0.160 *
Income 37.04 2 0.000 **
Number of persons 6.08 2 0.000 **
Working status 31.04 1 0.000 **
Years of experience 42.06 2 0.000 **
Distance of workplace 10.42 2 0.008 **
P <0.05 =**Significant and P>0.05=* Significant
There is a significant association between the coping and the demographic variables such as age, education, income, religion, and
marital status, number of persons, and type of family, year of experience and distance from work place.
Table 3: Significant relationship between experience of stress and effective coping skills the workers possesses.
S.No. Varaibles Statements Max.score Mean Mean(%) SD (%)
1 Stress 3 4 136 92.62 68.10 9.16
2 Coping 28 112 61.20 54.64 6.55
Coefficientcorrelation(r) 0.709
There is a significant relationship between experiences of stress and effective coping skills of the workers possesses at the 0.05 level
of significance.
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102 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Nursing Practice
Nurses are playing a vital role in the promotion and
maintenance of health. They should help the female
workers to reduce job stress and to cope up adequately
with it. Psychiatric Nurses play a definite role to help
the female workers to cope with the job stress. They are
in the unique position to educate and prepare the female
workers to accept the changes during their work. They
can provide adequate counseling and this would help
the workers to manage and cope up better with stress.
CONCLUSION
It concludes that there is a significant relationship
between experiences of stress and effective coping skills
of the workers.
ACKNOWLEDGEMENT
The author is thankful to almighty for showering
his blessings and prof. DR.K.R.Srinivas M.Sc, PhD
principal, Sneha College of Nursing, Bangalore., for his
support and further guidance in all my endeavors.
A special thanks to my wife Mrs. Monisha, and my
son Juan Aspin for their heartly encouragement. My
heartful thanks to my M.Sc friends Mrs. Jenifer, Mrs.
Beena Jimmy, Mrs.Shiyamala Boominathanand,
Mr.Kiran G.V for their support.
Conflict of Interest: There was no such issue.
Source of Funding: Funding was by self-finance.
Ethical clearance
• Permission taken from D.C Garments, Bangalore,
• Written consent was taken from all the participants.
REFERENCES
1. Kumar R et al. Examining role stress among
technical students in India. Springer Netherlands.
2007; 10: 77-91.
2. AhluwaliaA et al. Life positive stress and the
workplace. Job stress and women. 2010.
3. Sri lanka’s news portal. Women workers shy away
from garment industry - labour union leader. 2010
July 19.
4. Beccary. Women garment workers. May 4, 2009
5. Machado T, Sathyanarayanan V, Bhola P, et al.
Psychological vulnerability, burnout, and coping
among employees of a business process
outsourcing organization. Ind Psychiatry J. 2013
Jan; 22(1):26-31.
6. Chaudhuri P. Experiences of sexual harassment
of women health workers in four hospitals in
Kolkata, India. Reprod Health Matters. 2007;
15(30):221-9.
7. JinkyLeilanie Lu. Human Factors and Ergonomics
in Manufacturing & Service Industries.
2005.15(3):275–291.
8. Li CY1, Chen KR, Wu CH, Sung FC. Job stress and
dissatisfaction in association with non-fatal
injuries on the job in a cross-sectional sample of
petrochemical workers. Occup Med. 2001
Feb;51(1):50-5.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 103
DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to assess the effectiveness of Awareness
Programme on Knowledge and Knowledge of Practice
Regarding Prevention and Management of Rabies among
Rural Adults in Selected Rural Areas of Mysore District
Sreekutty Divakaran1, Nisha P Nair2, Sheela Williams3, Jetty Elizabeth Jose1, Vinay Kumar G4
1M.Sc Nursing, 2Assistant Professor cum HOD, Community Health Nursing, 3Prof.Sheela Williams, Principal cum
Professor & HOD, 4Assistant Professor, Community Health Nursing, JSS College of Nursing, Mysore
ABSTRACT
Background: In this present scenario, rabies represents a serious threat to the health of people and
animals. Rabies is a dangerous virus that is transmitted through the saliva of animals. The dog has
been and still is the main reservoir of rabies in India1. More than 90% of all rabid animals reported to
CDC each year occur in wildlife.
Aim: The aim of the study was to assess the effectiveness of awareness programme on knowledge and
knowledge of practice regarding prevention and management of rabies among rural adults in selected
rural areas of Mysore District".
Method: A quasi experimental non equivalent pre-test and post-test control group design was adopted
for the study. The samples were selected by non-probability convenience sampling technique. Eighty
rural adults were selected for the study, 40 each in experimental and control group. The tools used for
the data collection were proforma for selected personal variables, structured knowledge questionnaire
and structured knowledge of practice questionnaire.
Results: The data analyses were done by using both descriptive and inferential statistics. Findings of
the study revealed that, there was significant difference between the mean pre-test and post-test
knowledge and knowledge of practice scores which was statistically tested using paired 't' test
(t(39)=35.1633; P<0.05 and t(39)=25.42; P<0.05 for knowledge and knowledge of practice respectively)
was found to be significant at 0.05 level of significance. The significance of difference between mean
post-test knowledge and knowledge of practice scores among experimental and control group was
statistically tested using independent 't' test (t(78)=32.9149; P<0.05 and t(78)=24.74; P<0.05 for
knowledge and knowledge of practice respectively) was found to be significant at 0.05 level of
significance . The results of the study also revealed that knowledge and knowledge of practice of rural
adults had no significant association with their selected personal variables except age in years with
level of knowledge.
Conclusion: It was concluded that awareness programme was effective in increasing the knowledge
and knowledge of practice of rural adults regarding prevention and management of rabies. Therefore
the study recommends that, it is the need of this hour to organize health campaigns and awareness
programme to sensitize rural adults to enhance the knowledge and knowledge of practice regarding
prevention and management of rabies thereby reducing the mortality associated with rabies.
Keywords: Rabies, Effectiveness, Rural adults, Knowledge, Knowledge of Practice
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104 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
INTRODUCTION
Rabies is the 10th biggest cause of death due to
infectious disease worldwide and it occurs in above
150 countries and territories. Across Asia the annual
expenditure due to rabies is estimated to be reaching
563 million1. More than 55000 people die of rabies every
year mostly in Asia and Africa2. The annual estimated
number of dog bites in India is 17.4 million, leading to
estimated 18,000– 20,000 cases of human rabies per
year. Rabies is a fatal condition with no cure, but there
are preventive interventions to reduce its burden, but
they are not well adopted in India. As a result, India
has the largest contribution to worldwide rabies
mortality1. As yet another family mourns the death of
its child owing to dog attack in Bangalore (2007). While
this is one of the first reported cases of rabies death in
the past few years, it brings to focus the fact that
incidence of rabies in dogs has remained constant in
the last 10 years3.
About 40% of people who are bitten by suspect rabid
animals are children under 15 years of age. Between
35% to 50% of rabies mortalities occur in children less
than 15 years of age. Wound cleansing and
immunization within a few hours after contact with a
suspect rabid animal can prevent the onset of rabies
and death. Every year, more than 15 million people
worldwide receive a post-exposure vaccination to
prevent the disease this is estimated to prevent hundreds
of thousands of rabies deaths annually. There is no
treatment available globally after the diseases develop4.
After exposure, rabies takes between 4 and 6 weeks
to incubate and once you develop symptoms, death is
inevitable. However, exposure to rabies can be treated.
Vaccines given shortly after exposure may stop the onset
of the disease. Rabies is the most deadly infectious
disease on earth; it kills hundreds of people and animals
every day5. Most of the deaths are due to ignorance and
lack of access to affordable services6.
OBJECTIVES
The objectives of the study were
1. To assess the knowledge and knowledge of practice
regarding prevention and management of rabies
among rural adults in experimental and control
group before and after administration of awareness
programme.
2. To determine the effectiveness of awareness
programme on knowledge and knowledge of
practice regarding prevention and management of
rabies among rural adults in experimental and
control group.
3. To determine the association of knowledge and
knowledge of practice regarding prevention and
management of rabies among rural adults with their
selected personal variables.
HYPOTHESES
H1: The mean post-test knowledge and knowledge of
practice scores of rural adults regarding prevention and
management of rabies will be significantly higher than
mean pre-test knowledge scores and knowledge of
practice scores among experimental group.
H2: The mean post-test knowledge and knowledge of
practice scores of experimental group will be
significantly higher than the mean post knowledge and
knowledge of practice scores of the control group.
H3: There will be significant association between the
knowledge and knowledge of practice scores regarding
prevention and management of rabies among rural
adults and their selected personnel variables.
METHODOLOGY
Research design selected for this study is quasi
experimental non equivalent pre-test post-test control
group design.
The symbolic representation of the present study was
as follows
E - O1XO
2
C - O1-O
2
Keys
E – Experimental group
C – Control group
O1– Pre-test
X – Intervention
O2– Post-test
In the present study, population comprises of rural
adults between the age group of 18 years to 64 years.
The sample of the present study comprises of rural adults
who are residing in selected villages in Suttur. Eighty
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 105
(80) rural adults were selected for the present study, 40
each in experimental and control group.
Description of tool
1. Description of proforma for selected personal
variables
It includes the basic information about the rural
adult’s viz. age, gender, type of family, educational
status, occupation, religion, average monthly
income, history of dog bite and attended formal
awareness programme regarding prevention and
management of rabies.
2. Description of structured knowledge and
knowledge of practice questionnaire
In the present study the structured knowledge
questionnaire was used to assess the knowledge and
structured knowledge of practice questionnaire to
assess the knowledge of practice of rural adults
regarding prevention and management of rabies.
The structured questionnaires consist of 25 and 23
items respectively to measure the respondents’ level of
knowledge and knowledge of practice regarding
prevention and management of rabies. The score were
further divided arbitrarily as follows: poor, average, and
good.
The Schematic Representation of the Research Design
Group Day 1Pre test Day 2Intervention Day 7Post test
Experimental group Structured knowledge Awareness programme Structured knowledge
questionnaire and on rabies questionnaire and
structured knowledge of structured knowledge of
practice questionnaire. practice questionnaire
Control group Structured knowledge No intervention Structured knowledge
questionnaire and
questionnaire and structured
structured knowledge of knowledge of practice
practice questionnaire uestionnaire
Fig. 1: Schematic representation of the research design
FINDINGS
Section 1: Description of selected personal variables of study subjects
• Frequency and percentage distribution of rural adults in experimental and control group according to their
selected personal variables.
The data related to frequency and percentage distribution of sample according to their selected personal
variable is presented in Table 1.
Table 1: Frequency and percentage distribution of rural adults according to their selected personal variables in
experimental and control group
n=80
Sample characteristics Experimental Control
Group n=40 Group n=40
f% f%
1 Age in years
a) 18- 31 yrs 17 42.5 20 50
b) 32-45 yrs 1 7 42.5 15 37.5
c) 46-59 yrs 6 15 5 12.5
2 Gender
a) Male 14 35 18 45
b) Female 26 65 22 55
3 Type of family
a) Nuclear 22 55 17 42.5
b) Joint 15 37.5 17 42.5
c) Extended 3 7.5 6 15
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106 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Table 1: Frequency and percentage distribution of rural adults according to their selected personal variables in
experimental and control group (Contd.)
n=80
Sample characteristics Experimental Control
Group n=40 Group n=40
f% f%
4 Education
a) Primary 17 42.5 19 47.5
b) Secondary 15 37.5 14 35
c) Higher secondary 7 17.5 6 15
d) PUC and above 1 2. 5 1 2.5
5 Occupation
a) Coolie 12 30 9 22.5
b) Agricultural 6 15 6 15
c) House wife 14 3 5 1 8 45
c) Government employee 5 12.5 3 7.5
d) Private employee 3 7.5 4 1 0
6 Religion
a) Hindu 34 85 34 85
b) Christian 1 2.5 5 12.5
c) Muslim 5 12.5 1 2.5
7 Average monthly income.
a) Below 5000 25 62.5 29 72.5
b) 5001 to 10,000 7 17.5 9 22.5
c) Above 10,000 8 2 0 2 5
8 Do you have any history of animal bite?
a) Yes 37.5 37.5
b) No 37 92.5 37 92.5
9 Have you ever attended any formal awareness programmes regarding prevention and management of rabies?
a) Yes 12.5 0 0
b) No 39 97.5 40 100
Section 2: Effectiveness of awareness programme
Part-A:
a) Description of knowledge of rural adults regarding
prevention and management of rabies.
In pre-test all 40(100%) sample had poor knowledge
scores both in experimental and control group,
whereas in post-test majority 23(57.5%) of samples
attained good knowledge and 17(42.5%) attained
average knowledge in experimental group, while
all 40(100%) of the samples in the control group
remained at poor knowledge.
Mean Median, Range, SD of pre-test and post-test
knowledge scores of rural adults in experimental
and control group.
In the pre-tests and post-test mean knowledge scores
among experimental group was 2.85 with SD ±1.902
and 17.25with SD ±2.169 respectively; whereas,
among control group the pre-test and post-test mean
knowledge score was 2.3with SD ±1.856 and
2.45with SD ±1.839 respectively. The pre-test
median was 2.3 in experimental group and 2 in
control group, and the post-test median was 17 in
experimental group and 2 in control group.
b) Significance of difference between pre-test
knowledge scores of rural adults in experimental
and control group.
The mean difference between pre-test knowledge
scores of rural adults among experimental and
control group is 0.55. The obtained independent
t(78) = 1.3087; Pe”0.05 was found to be not significant.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 107
c) Gain in knowledge: comparing pre-test and post-
test knowledge scores
• Significance of difference between pre-test and post-
test knowledge scores of rural adults regarding
prevention and management of rabies among
experimental and control group.
Among experimental group the mean difference
between pre-test and post-test score was 14.4. This
indicates that the awareness programme had
helped to increase the level of knowledge in the
experimental group. The obtained value of paired
t(39)= 35.1633 was found to be significant at 0.05
level of significance.
Among control group the mean difference between
per-test and post-test score was 0.15. The obtained
paired t(39) = 1. 778 were found to be not significant
at 0.05 level of significance.
d) Significance of difference between gain in post-
test knowledge scores of rural adults among
experimental and control group.
The mean difference in post-test score among
experimental and control group is 14.8. The
independent ‘t’ value was computed and the
obtained t(78)= 32.9149 was found to be significant
at 0.05 level of significance.
Part -B:
a) Description of knowledge of practice of rural
adult’s regarding prevention and management of
rabies.
In pre-test all 40(100%) sample had poor knowledge
of practice scores both in experimental and control
group, whereas in post test maximum number
31(77.5%) of samples attained good knowledge of
practice and 9(22.5%) attained average knowledge
of practice in experimental group, while all
40(100%) samples in the control group remained at
poor level of knowledge of practice.
Mean, Median, Range, SD of pre-test and post-test
knowledge of practice scores of rural adults in
experimental and control group.
The pre-tests and post-test mean knowledge of
practice scores among experimental group was 3.5
with SD±1.484967 and 3.4 with SD±1.905458
respectively; whereas, among control group the pre-
test and post-test mean knowledge of practice score
was 3.4 with SD±1.905458 and 3 with SD±1.81005
respectively. The pre-test median was 4 in
experimental group and 3 in control group and the
post-test median was 14 in experimental group and
3 in control group.
b) Significance of difference between pre-test
knowledge of practice scores of rural adults in
experimental and control group.
The mean difference between pre-test knowledge of
practice scores of rural adults among experimental
and control group is 0.1. The obtained independent
t(78) = 0.261; Pe”0.05 was found to be not significant.
c) Gain in knowledge of practice: comparing pre-test
and post-test knowledge of practice scores.
• Significance of difference between pre-test and post-
test knowledge of practice scores of rural adults
regarding prevention and management of rabies
among experimental and control group.
Among experimental group the mean difference
between pre-test and post-test score was 11.25. This
indicates that the awareness programme had
helped to increase the level of knowledge of practice
in the experimental group. The obtained value of
paired t(39)= 25.42 was found to be significant at
0.05 level of significance.
Among control group the mean difference between
per-test and post-test score was 0.075. The paired
‘t’ test was computed and the obtained paired t(39)=
1.38 were found to be not significant at 0.05 level of
significance.
d) Significance of difference between gain in post-
test knowledge of practice scores of rural adults
among experimental and control group.
The mean difference in post-test score among
experimental and control group is 11.575. The
independent ‘t’ value was computed and the
obtained t(78)= 24.74 was found to be significant at
0.05 level of significance.
Section 3: Findings related to association of the level
of knowledge and knowledge of practice of rural
adults regarding prevention and management of
rabies with their selected personal variables.
The knowledge and knowledge of practice of rural
adults had no significant association with their
selected personal variables except age in years with
level of knowledge.
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108 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
CONCLUSION
The analysis of the study revealed that in pre-
test most of the rural adults had poor knowledge and
knowledge of practice regarding prevention and
management of rabies. The awareness program was
effective in increasing the knowledge and knowledge
of practice regarding prevention and management of
rabies as the computed ‘t’ (t(78)=1.99) 32.9149 value for
knowledge and 24.74 value for knowledge of practice
was found to be significant at 0.05 level of significance.
There was no significant association between both the
pre-test levels of knowledge and knowledge of practice
of rural adults with their selected personal variables
except age in years in the pre-test levels of knowledge.
Thus, it was concluded that, the awareness program
was effective in enhancing knowledge and knowledge
of practice regarding prevention and management of
rabies. Therefore, the study reinforces the need to
organize health campaigns and awareness programs
which sensitize the adults to enhance the knowledge
and knowledge of practice regarding prevention and
management of rabies.
ACKNOWLDGEMENT: We express our thanks to all
rural adults who participated in the study and the
authorities who provided permission to conduct the
study.
Conflict of Interest: Continuing nursing education
enables the learner to keep abreast of changes and
development in his/her field of specialty. Nursing
administrators are the key persons to plan, organize
and conduct in-service education programme to
nursing personnel. Nurse administrators working in
hospital and community setting can plan for health
campaigns, mobile health clinics organize and CNE
for community level health personnel and awareness
programmes for rural adults regarding prevention and
management of rabies.
Ethical Clearance: Ethical clearance was obtained from
the ethical committee of the college.
Funding Sources: Not obtained any funds from any
sources.
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/www.who.int
5. What is rabies? And 12 facts [Internet]. [updated
2012 Mar 23; cited 2012 Aug 24] Available from:
http://www.rabiescontrol.net
6. Agarvval N, Reddaiah VP. Knowledge, Attitude
and Practice Following Dog: a Community-based
Epidemiological Study. [homepage On the
Internet]. 2003 [cited 2013 Dec 12]. Available From:
http://nihfw.org
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 109
DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to assess the Level of Satisfaction and Explore the
Factors Influencing Extent of Utilization of Reproductive
and Child Health Services among Mothers Attending
Selected Primary Health Centre's of Mysore District
Vinay Kumar G1, Sheela Williams2, Nisha P Nair3
1Assistant Lecturer, Dept. of Community Health Nursing, 2Principal, 3Assistant Professor, Dept. of Community Health
Nursing, JSS College of Nursing, Mysore
ABSTRACT
Introduction: Consumer evaluation of health care services is an important component in assessing
accessibility and quality of care. Information about community perception with a thorough
understanding of the needs and expectations of the community about health care services can help in
better delivery and higher utilization of health services.
Aims and objectives: The study aim to find the level of satisfaction and the factors influencing utilization
pattern among beneficiaries regarding RCH services.
Approach and design: In the study exploratory descriptive cross sectional design was used. Sample
and sampling criteria: non probability purposive sampling technique was adopted to select to select
the mothers attending the PHC.
Tools and techniques: Structured interview method was adopted to collect the data. The data were
collected and analyzed using descriptive and inferential statistics.
Results: Result revealed that, that among all the mothers 93.5% are highly satisfied and 6.5% are
moderately satisfied. It was also evident that availability (100%), accessibility(100%), providers
attitude(100%), motivation of the family members(100%) are the most influencing factors in the
utilization of RCH services among mothers attending PHC. Majority of the mothers reported that
rendering service at right place (96%) , counselling about RCH services(89%), accompany of family
members (82%), transportation facility(82%), appropriate referral services(82%), are the other factors
which influence the utilization of RCH services among mothers attending PHC, whereas the work of
anganwadi workers (25%), ASHA workers (32%) and health education activities (nil) are the least
influencing factors in the utilization of RCH services among mothers attending PHC.Chi square analysis
revealed that the level of satisfaction of mothers attending PHC had no significant association with
their selected personal variables except education. Therefore it is evident that lower the level of education
higher the level of satisfaction.
Conclusion: It was concluded that the education had main role in the level of satisfaction and also infer
that the education activities to be improved in the rural areas.
Keywords: Reproductive and Child Health Services, Level of Satisfaction, Utilization, Primary Health Centre
INTRODUCTION
“Feeling fat lasts nine months but the joy of
becoming a mom lasts forever.”
Nikki Dalton
The rapidly growing population has become a major
concern for health planners and administrators in India
since independence. As a result there was launching of
several programmes related to maternal and child
health from time to time and updates its strategies in
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110 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
order to improve health status of women and children
and fulfil the unmet need of the Maternal Child health
care throughout the country 1.
Consumer evaluation of health care services is an
important component in assessing accessibility and
quality of care. Information about community
perception with a thorough understanding of the needs
and expectations of the community about health care
services can help in better delivery and higher
utilization of health services3. According to United
Nation for Population Association the average maternal
mortality rate all over the world is 265 but the average
in developed countries is 18 where as in the less
developing countries is 293 and in least developing
countries is 597. The maternal mortality rate in India is
230 per one lakh live birth, whereas in developed
countries like Sweden 5, Ireland 3, and Israel 7 and in
developing countries like, Pakistan 260, South Africa
410 and Sudan 750 per one lakh live birth 6.
According to NFHS-3(2005-06) the utilization of
reproductive and child health services in India with
regard to antenatal service i.e. atleast three antenatal
checkups was 50.7%, institutional delivery was 40.8%
and the children’s who are fully immunised in the first
year are 43.5%.the highest utilization of RCH services
in India is by the kerala state and low utilization is
found to be in the northern states like Punjab, Haryana
and Rajasthan 7.
In Karnataka, according to DLHS-3 report the
utilization of reproductive and child health service with
regard to antenatal service i.e. atleast three antenatal
checkups was 90%, institutional delivery was 65% and
children’s who are fully immunised in the first year are
77%. Also koppal district is the low performing district
and highest in Bangalore district. Majority of women
54.8% had received the service from a private health
facility and 49.2% had received the service from a
government health facility 7.
Hence the researcher with his personal and
professional experience geared interest towards
assessing the level of satisfaction and explore the factors
influencing extent of utilization of RCH services which
would help the health professionals to improve the plan
and provision of RCH services in the community. This
in turn will contribute in the effective coverage of RCH
services thus reducing the maternal and child mortality.
Keeping this in view, this study was planned in
order to find level of satisfaction and the factors
influencing utilization pattern among beneficiaries
regarding RCH services.
OBJECTIVES
1. To assess the level of satisfaction regarding
Reproductive and Child Health Services among
mothers attending selected Primary Health Centre’s
of Mysore District.
2. To assess the factors influencing extent of
utilization of Reproductive and Child Health
services among mothers attending selected Primary
Health Centre’s of Mysore District.
3. To find the association between the level of
satisfaction regarding Reproductive and Child
Health Services among mothers attending selected
Primary Health Centre’s of Mysore District with
their selected personal variables.
METHODOLOGY
Research Approach/Design
Descriptive exploratory survey approach.
Inclusion Criteria
Mothers who are
• Having children below 5years of age.
• Attending selected PHCs for RCH services
• Willing to participate in the study
Sampling Technique
• Purposive sampling technique was used in the
present study .Sample size comprises of 200
mothers. (n=200)
Variables of the study were
• Research variables: Level of satisfaction and Factors
influencing extent of utilization of RCH services.
• Personal variables: Age, religion, education,
occupation, type of family, family income, number
of children and source of information about RCH
services.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 111
OBSERVATION AND DISCUSSION
Table 1: Frequency and percentage distribution of mothers according to their personal variable
n=200
Sl No Sample characteristics Frequency(f) Percentage(%)
1 Age in years
a) 20- 24yrs 120 60
b) 25-29yrs 72 36
c) 30-34yrs 84
2 Religion
a) Hindu 192 96
b) Muslim 84
3 Education
a) No formal education 34 1 7
b) Up to SSLC 141 70.5
c) PUC 15 7.5
d) Graduate and above 1 0 5
4 Occupation
a) House wife 177 88.5
b) Coolie 21 10.5
c) Self employed 10.5
d) Others 10.5
5 Type of family.
a) Joint 142 71
b) Nuclear 58 29
6 Family income per month
a) <3000 86 43
b) 3001-6000 88 44
c) 6001 and Above 26 1 3
7 Number of children’s
a) 1 111 55.5
b) 2 85 42.5
c) 3 and above 42
8 Source of information
a) Health person 71 35.5
b) Neighbours/friends/relatives 12 9 64.5
c) Electronic media - -
Table 2: Level of satisfaction regarding various RCH services among mothers attending selected Primary Health
Centre of Mysore District.
n=200
Level of satisfaction
Services Highly satisfied Moderately satisfied Low satisfied
f%f%F%
Antenatal services 15 9 79.5 41 20.5 0 0
Intra-natal services 12 6 6 3 7 0 35 04 02
Immunisation services 1 91 95.5 09 4.5 0 0
Family planning services 176 88 2 4 12 0 0
Physical environment 184 9 2 16 08 0 0
Services provided 1 66 83 3 4 17 0 0
Communication 195 97.5 05 2.5 0 0
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112 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
The data presented in the table 2 shows that most of
the mothers 79.5% are highly satisfied about the
antenatal service and 20.5% are moderately satisfied.
About the intranatal services 63% mothers are highly
satisfied, 35% are moderately satisfied and 2% are low
satisfied whereas in immunisation services 95.5 %
mothers are highly satisfied and 4.5% are moderately
satisfied. Also about the family planning services 88%
mothers are highly satisfied and 12% are moderately
satisfied. Then about the physical environment of the
health centre mothers are 92% highly satisfied and 8%
were moderately satisfied and about the services
provides 83% are highly satisfied and 17% were
moderately satisfied and about the communication
pattern 97.5% mothers were highly satisfied and 2.5%
were moderately satisfied.
Table 3: Mean, Median, Standard deviation, Range score of mothers regarding various level of satisfaction about
RCH services at PHC
n=200
Services Mean Median Standard Range
deviation
Antenatal services 25.45 26 ± 3.42 16-30
Intranatal services 22.14 22 ± 3.452 12-30
Immunisation services 18.44 19 ± 1.798 12-20
Family planning services 13.24 14 ± 1.876 8-15
Physical environment 30.75 31 ± 3.692 17-35
Services provided 28.40 28 ± 3.460 19-35
Communication 27.16 28 ± 2.642 18-30
The data presented in the table 3 shows mean score
with antenatal services is 25.45 with SD ±3.42, ranged
from 16-30 with median 26. For intranatal services mean
score is 22.14, median 22 with SD ±3.45 ranged from
12-30 for immunisation services mean score is
18.44,median 19 with SD ±1.799 ranged from 12-20, for
family planning services mean score is 13.24 ,median
value is 14 with SD ±1.876 ranged from 8-15,about the
physical environment mean score is 30.75, median
value is 31 with SD ±3.692 ranged from 17-35, with
services provided mean score is 28.40, median value is
28 with SD ±3.460 ranged from 19-35 and about the
communication mean score 27.16,median value is 28
with SD ±2.642 ranged from 18-30.
Table 4: Level of Satisfaction with the overall RCH services
n= 200
Level of satisfaction Frequency(f) Percentage (%)
a) Highly satisfied 187 93.5
b) Moderately satisfied 13 6.5
c) Low satisfied 00 00
The data presented in the table 4 shows that among all the mothers 187(93.5%) are highly satisfied and 13(6.5%)
are moderately satisfied.
Table 5: Mean, Median, Standard deviation, Range score of mothers regarding overall level of satisfaction about
RCH services at PHC
n=200
Services Mean Median Standard Range
deviation
Overall level of satisfaction about RCH services at PHC 165.58 167 ±12.26 120-195
The data presented in the table 5 shows that mean scores of mothers regarding level of satisfaction about RCH
services at PHC is 165.58; with median 167 and SD ±12.26 ranged from 120-195
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 113
Table 6: Factors influencing extent of utilization of RCH services
n = 200
Sl No Factors Never Sometimes Always
f%f%f%
1 Availability - - - - 200 100
2 Accessibility - - - - 20 0 100
3 Transportation facility - - 0 5 2.5 195 97.5
4 Encouragement words of staff 02 01 3 2 16 166 83
5 Appropriate referral services 01 0. 5 3 1 15.5 168 82
6 Counselling about RCH services - - 2 2 11 178 8 9
7 Providers attitude towards client - - 10 0 5 19 0 100
8 Rendering of service at right place - - 08 0 4 192 96
9 Availability of ASHA workers 5 2 2 6 84 4 2 64 32
10 Availability of Anganwadi workers 3 0 1 5 120 6 0 5 0 2 5
11 Attended any health talks 170 8 5 30 1 5 - -
12 Motivation from family members - - - - 2 00 10 0
13 Accompany of family members - - 30 1 5 170 85
Table 7: Association between the level of satisfaction of mothers regarding RCH services with their personal
variables
n=200
Variables Highly Satisfied Moderately satisfied Chi square
1. Age in years
a) 20-24 years 111 09 0.859‘“
b) 25-29 years 6 8 0 4
c) 30-34 years 0 8 0 0
2. Religion
a) Hindu 180 12 0.494
b) Muslim 0 7 0 1
3. Education
a) No formal education 31 0 3 5.622* ‘“
b) Up to SSLC 135 06
c) PUC /diploma 13 0 2
d) Degree 08 0 2
4. Occupation
a) House wife 165 1 2 0.198‘“
b) Coolie 20 0 1
c) Self employed 0 1 0 0
d) Other 01 0 0
5. Family type
a) Joint family 132 10 0.237
b) Nuclear 55 03
6. Family Income
a) Less than Rs. 3000 77 09 1.00‘“
b) 3001-6000 87 01
c) More than Rs.6001 2 3 03
7. Number of children
a) One 106 05 1.634‘“
b) Two 78 07
c) Three and above 03 0 1
8. Source of information
a) Health Personnel 6 8 0 3 0.937
b) Neighbours/Friends/Relatives 119 1 0
χ2 (1) =3.84, χ2 (2) = 5.99, χ2 (3) = 7.82, χ2 (4) = 9.49 p>0.05; p< 0.05 ‘“ Yates correction *Significant
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114 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
The data in the table shows that there is a significant
association between level of satisfaction and education
status of mother. But there is no association with other
personal variables such as age, religion, occupation,
type of family, no of children’s, family income and source
of information.
CONCLUSION
Thus study concludes that mothers should attend
the educational programme which enhances the
utilisation of RCH services. Hence health care health
care professionals should give importance to provide
information regarding availability and need of RCH
services. Also the continuous sincere efforts of ASHA
and anganwadi workers help in the utilisation of RCH
services which will indirectly influence in reducing
maternal mortality and achieving the millennium
development goal 3.
Acknowldgement: We express our thanks to Medical
officer of PHC who provided permission to conduct the
study
Conflict of Interest: Primary health centres play a vital
role in providing RCH services in the rural areas. So
this study has attempted to evaluate the level of
satisfaction of the mothers those who rendered services
from the primary health centres.
No source of funding for this study
BIBLIOGRAPHY
1. Park. K, Textbook of preventive and social
medicine, 21st ed. Jabalpur (India): Banarsidas
publishers, 2011: p.408
2. Gulani. K.K, Textbook of Community Health
Nursing. 1sted. New Delhi: Kumar publications,
2009: p.419-26
3. Takalkar.A.A, Salprasad. G. Y, Client satisfaction
regarding RCH services provided: a study from
outpatient department of rural health training
centre. Indian journal of maternal and child health.
2010; 12(03):2-10.
4. Maternal mortality rates. [Homepage on the
Internet]. 2010 april 12 [cited 2011 Nov 9].
Available from: http://www.guardian.co.uk
5. Neelanjana. P, Perceived barriers to utilization of
maternal heath child health services: qualitative
insights from rural Uttar Pradesh India.
[Homepage on the Internet]. 2009 [cited 2011 Nov
17]. Available from: http://paa2011.princeton.edu
6. Status of world population. [Homepage on the
Internet]. No date [cited 2011 Nov 23]. Available
from: WWW.UNFPA.ORG
7. District Level Health Survey-3(2007-08),
International institute for Population Sciences for
Population Sciences, Mumbai, India.
8. Beck and polit, Nursing research: principles and
methods. 7th ed. Philadelphia (USA): Lippincott
Williams and Wilkins phildelphia, USA. Page
no:213-215
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 115
DOI Number: 10.5958/j.2320-8651.2.1.001
Long-term Outcomes of Pediatric Burn Injury : A Review
Vinitha Ravindran1, Gwen Rempel2, Linda Ogilvie3
1Professor, College of Nursing, Christian Medical College, Vellore, India, 2Associate Professor, Faculty of Health
Disciplines University of Athabasca, Canada, 3Professor, Faculty of Nursing, Co-Director, Prairie Metropolis Centre,
University of Alberta, Edmonton, Canada
ABSTRACT
Background: Burn injury is one of the worst trauma that can happen to a child. As more children are
surviving even severe burns the outcome indicator for burns has shifted from survival to long term
quality of life.
Aim: The aim of this article is to present the synthesized data on long-term outcomes in burn injured
children from the literature so as to improve practice and identify gaps in the literature that could be
addressed through future research.
Method: A comprehensive literature search was done through databases MEDLINE, CINAHL, EMBASE,
and PsycINFO using the search terms "child", "burns", "rehabilitation", and "outcomes."
Result: There is a dearth of information on long-term burn outcomes in children in low and middle-
income countries (LMIC). In High income countries (HIC) the burn outcomes have been reported as
good on standard measurements. Little is known about subjective experiences of a burn child's recovery
or parents' caregiving.
Conclusion: Studies addressing long term pediatric burn outcomes in LMICs and contextually relevant
family and child support interventions are needed to help establish creative and flexible follow-up
services for the pediatric burn population.
Keywords: Burns, Child, Outcomes Assessment, Review
INTRODUCTION
Burn injury is one of the most traumatic injuries
children experience and often results in long-term
hospitalization, painful procedures and protracted
rehabilitation. As acute care has advanced, burn
mortality in children has declined, more dramatically
in high-income countries (HICs) than in low and
middle-income countries (LMICs).1-3 Most patients with
burns are now regarded as candidates for survival. This
has led to a paradigm shift in the predictors of outcome
in burn care,4 with quality of life gaining importance
over mortality as an outcome measure. Quality of life in
burned individuals refers to their ability to resume
normal physical, emotional and family functions,
reintegrate into the community, and participate in social
activities.5 Contractures, scarring, disfigurement, and
psychological problems are burn outcomes that could
affect quality of life. As disability associated with scars
and contractures occurs over time,6 rehabilitation is a
significant phase of burn care.
It is imperative that health care professionals know
the burn outcomes in the pediatric population to plan
and implement interventions that optimize positive
outcomes and quality of life. The need is greater in
LMICs where there is dearth of follow-up services.
METHOD
The burn literature was comprehensively searched
through data bases such as MEDLINE, CINAHL,
EMBASE, and PsycINFO and the published data were
analyzed and synthesized to understand the long term
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116 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
pediatric burn outcomes in the HICs and LMICs and is
presented in this paper. Implications for research,
practice and policies are discussed.
RESULTS: PEDIATRIC BURN INJURY
Approximately one third of burn unit admissions
are children under 15 years and about one third of all
burn deaths involve children.9 Over half a million
children are admitted with burn injuries per year
globally, with the majority occurring in LMICs in Asia
and Africa.8
Type of burn, age, and gender distribution in relation
to pediatric burn injury are similar worldwide. Burns
occur widely in children less than four years of age and
predominantly in males. Scalds, the most common type
of burn injury in this age group, most often occur at
home.9,10,11 Advances in acute care have reduced
mortality in children with burns. In HICs the burn
mortality in the pediatric population decreased from
9% in the 1960s and 1% in the 1980s 12, 13 to 0.5% in
2009.14 Similar reports of reduction in mortality are not
available from LMICs. Although the mortality related
to pediatric burns is declining,1 it remains
comparatively higher in LMICs; for example 0.49% to
9.08% in China,15 5.6% in Turkey,3 6.4% in Iran,16 8.2 %
in Korea9 and 10 to 20% in India.14,17 Burn mortality
and morbidity differ from center to center in LMICs
depending on the acuity level of patients and the
availability of specialized professionals and facilities.
In some LMICs, burns are a major cause of childhood
morbidity, disability, and death. Burn morbidity ranks
third after acute respiratory infections and diarrhoeal
diseases in children between one to four years in
Bangladesh.18
BURN OUTCOMES
Physical and physiological outcomes. The
regeneration of nerve endings in deep burns causes
discomfort due to varying sensations. Itching can persist
for weeks to months in the post-burn period.19 Impaired
tanning, diminished tactile sensibility, and increased
reddening of the grafted and regenerated areas of skin
were identified as long-term functional sequelae in
another pediatric burn population.20 A thickened scar
may form two to six months after major burns and may
contribute to the development of contractures.21 Such
contractures limit range of motion of joints in children
with major burns22 compared to children with less than
20% burns.23
In the literature on burn outcomes in children from
HICs, presence or absence of hypertrophic scarring and
contractures in burned children is reported in only a
few studies.21, 24 In contrast, observation reports from
LMICs such as Ghana and India have reported high
incidence of scars, keloids (overgrowth of scar),
contractures, and loss of body parts even when
comparatively less body surface area (BSA) is
involved.13,25
Psychological outcomes. Research reveals mixed
results concerning psychological reactions of children
after burn injury. Some studies of North American
adolescents and young adults (13-28 years) who
sustained an average of 30 % burns as children suggest
that the burn survivors’ emotional adjustment, anxiety,
and self worth are equal to their reference norm on
standardized measures.24,26,27 However, one study from
the same North American setting that measured
psychological adjustment in persons above 12 years
who were severely burned (> 40%) as children showed
that while 50% were well adjusted, the others harboured
thoughts of hopelessness, and had suicide ideation,
negative self-evaluation and hostility.28
In studies and clinical observations from both HICs
and LMICs that included younger children with burn
injury (1 to 17 years, 15-80% burned), a wide range of
psychological sequelae such as nightmares, bedwetting,
sleep walking,29excessive fear, neurosis, regression,30
anxiety, depression, PTSD,25,31 withdrawal from
activities, social isolation, aggressiveness, and drug
addiction25 were reported. The majority of these results
were based on case studies, clinical observations, and/
or parent and child interviews and comparison groups
were not involved. Denver Developmental Screening
tests over one year post-burn revealed developmental
delay, specifically delay in language development in
children aged six months to six years.23 In three reports,
however, young children and adolescents did not have
significant psychological sequelae when their mean
scores of post burn adjustment measured by the CBCL
were compared to scores of control groups of acutely ill
children, children with fractures, non-ill non-injured
children,32 a norm group,33 or a matched control of non-
burned children.34
Psychological outcomes in children appear to differ
depending on the age when the burn injury occurred,
time since injury, and the measurement tools. Also,
psychological sequelae may lessen over time.34 Studies
that had comparison groups and/or used standardized
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 117
scales generally reported none or less difference in the
mean scores of psychological outcome measures both
in the young adults (13-28years) and the children (1-
17years) groups. Similar conclusions were made by
Tarnowski et al. (1991)34 in their review of psychosocial
outcomes in burn injured children. In some instances,
although standardized instruments identified
psychological functioning as within normal limits,
subjective assessments revealed anxiety, struggles with
body image, and self-esteem issues in adolescents and
young adults burned as children.26,27 Such variation in
results calls for researchers’ attention to assessment and
evaluation methods.
Activities of daily living. The primary goal of post
burn care and rehabilitation is to ensure that affected
children can participate in age-appropriate activities
in their family and community. Dependency on
assistance in activities of daily living and inability to
walk or run were reported in 15 to 50 % of children who
survived more than 70% burns.30,35 In contrast, the
majority of children with less than 30 to 40% burns
were able to function normally.23,26,36 Participation in
physical education classes was affected by tight skin
or joint impairments19 and probably contributed to
adolescents between 13 and 20 years who were burn
injured rating themselves as low in athletic
competence.24 In one study young adults who were
burned as children (mean BSA 28%) manifested
impaired peripheral strength (wrist and grasp), which
affected some self care skills.26
Participation. Evidence related to social functioning
is available from research in HICs. Social functioning
of children who sustain burns is frequently similar to
that of their non-burn counterparts during childhood
or later, 27,35 and sometimes is even higher,24 if mean
scores of standard scales are compared for domains of
self worth/ self esteem, social acceptance, marital life,
job competence, and popularity. The results were based
on self reports from the adolescents or adults who were
burn injured at various ages in their childhood. 33
Another study reported similar results from parents of
children aged five to 17 years. However, negative social
consequences for preschool and school age children,
such as problems in social interaction and integration,
sexual identity,37 establishing relationships or social
initiative,38,39 involvement in intellectual and cultural
events, and in playing with other children19 were
identified by parents or teachers when they completed
inventories such as CBCL or by adolescents themselves
in their self reports in other studies.
Returning to school is a vital reintegration activity
for a child’s post-burn rehabilitation. Issues with
coping with school work were reported by children
aged nine to 13 years and their parents in an Australian
study.19 Concentration problems and externalizing
behaviours, were reported by the teachers in a study in
Sweden.38 Children’s accounts of lack of confidence
because of their appearance41 emphasize the problems
burned children may have related to successful school
re-entry. Although adolescents or adults who were
burned as children overall rate themselves as well
adjusted, they are concerned about their physical
appearance, body image, self-esteem, stigma, and social
isolation even in countries where burn follow up has
been rigorous.24, 28,42 These concerns can be covert and
hinder successful social functioning.
Although research results suggest better adaptation
in children in their post-burn life, the disfigurement
and associated distress can hinder the burn injured
children from developing to their fullest potential.
Therefore, factors that maximize functional outcomes
and quality of life of burn injured children such as
family support need attention.
DISCUSSION
Most of the research evidence on burn outcomes in
children is from HICs, specifically from well-established
burn centers. Little is known about severity of structural
and functional outcomes in children from LMICs after
they are discharged from the hospital. Research
predominantly focuses on adolescents or adults who
have been burned as children. In studies including
children, parental and/or teachers’ perceptions have
been given major consideration. We need to elicit
children’s perceptions of burn outcomes. Further, issues
related to school and community reintegration during
the rehabilitation stage and the role of each family
member in this process need to be explored.
Instead of only using diverse standardized scales 43
Qualitative methods, which encourage participants to
tell their story can be utilized to explicate experiences
of burn injured children and their families.
As burn injury can take a heavy toll on family
resources, prevention of burns should be emphasized
as a part of child safety measures in parental education
sessions in the mass media, especially in LMICs. Burn
prevention should be a part of national health-care
strategies.44 Investment in follow-up services will assist
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118 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
families in giving care, optimize positive outcomes, and
will enable burn injured children to live happy and
productive lives.
CONCLUSION
This literature review has provided a synthesis of
evidence on pediatric burn outcomes highlighting the
lack of empirical evidence from LIMCs. Further research
related to burn care and the outcomes is needed to fill
the gap in evidence from LIMCs.
Acknowledgement: Laura Rogers for her help with the
references
Source of Funding: University of Alberta Graduate
Scholarship
Conflict of Interest: None
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Saunders Elsevier; 2007.
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7. Purdue GF, Hunt JL, Burris AM. Pediatric burn
care. Clin Pediatr Emerg Med. 2002;3(1):76-82.
8. Burd A, Yuen C. A global study of hospitalized
paediatric burn patients. Burns. 2005;31(4):
432-438.
9. Han T, Kim J, Yang M, et al. A retrospective analysis
of 19,157 burns patients: 18-year experience from
Hallym burn center in Seoul, Korea. Burns.
2005;31(4):465-470.
10. Mukerji G, Chamania S, Patidar GP, Gupta S.
Epidemiology of paediatric burns in Indore, India.
Burns. 2001;27(1):33-38.
11. Sakallýoðlu AE, Baþaran Ö, Tarým A, Türk E, Kut
A, Haberal M. Burns in Turkish children and
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2007;33(1):46-51.
12. Tompkins RG, Remensnyder JP, Burke JF,
Tompkins, DM, Hilton, JF, Schoenfeld DA, et al.
Significant reductions in mortality for children
with burn injuries through the use of prompt eschar
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13. Tompkins D, Rossi LA. Care of outpatient burns.
Burns. 2004;30(8):A7-A9.
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Demographics of pediatric burns in Vellore, India.
J Burn Care Res. 2009;30(1):50-54.
15 Kai-Yang L, Zhao-Fan X, Luo-Man Z, et al.
Epidemiology of pediatric burns requiring
hospitalization in China: A literature review of
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142.
16. Maghsoudi H, Samnia N. Etiology and outcome
of pediatric burns in Tabriz, Iran. Burns.
2005;31(6):721-725.
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epidemiological study of 500 pediatric burn
patients in Mubai, India. Indian J Plast Surg.
2008;40(2):153-157.
18. Mashreky SR, Rahman A, Chowdhury SM, et al.
Epidemiology of childhood burn: Yield of largest
community based injury survey in Bangladesh.
Burns. 2008;34(6):856-862.
19. Tyack ZFB, Ziviani JB, Pegg S. The functional
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L, Herndon D. Competence and physical
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24. Robert R, Meyer W, Bishop S, Rosenberg L,
Murphy L, Blakeney P. Disfiguring burn scars and
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Shanker J, Ramachandran P. Paediatric
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in a group of 459 burnt children. Pediatr Rehabil.
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Physical and psychologic rehabilitation outcomes
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MS. Adjustment to visible stigma: The case of the
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27. LeDoux J, Meyer WJ, Blakeney p, Herndon D.
Positive self-regard as a coping mechanism for
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1996;17(5):472-476.
28. Blakeney P, Portman S, Rutan R. Familial values
as factors influencing long-term psychological
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29. Kravitz M, McCoy B, Tompkins D, et al. Sleep
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30. Herndon D, Lemaster J, Beard S, et al. The quality
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31. Stoddard FJ, Ronfeldt H, Kagan J, et al. Young
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32. Kent L, King H, Cochrane R. Maternal and child
psychological sequelae in paediatric burn injuries.
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33. Landolt MA, Grubenmann S, Meuli M. Family
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34. Tarnowski KJ, Rasnake LK, Gavaghan-Jones MP,
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term outcome of children surviving massive burns.
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120 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
Health Locus of Control and Compliance in Diabetic
Patients
Sripriya Gopalkrishnan
Officiating Principal, Sadhu Vaswani College of Nursing, Pune
ABSTRACT
For treatment of Diabetes to be successful patient compliance with therapeutic regimens is very essential.
This descriptive study was conducted to examine the relationship between the health locus of control
(HLC) orientation and Self-reported compliance with diabetic treatment regimens. The convenience
sample of 100 diabetic patients was obtained from a diabetic clinic in Maharashtra. A Demographic
Questionnaire, the Multidimensional Health Locus of Control (MHLC) Scale, and self-reported
Compliance questionnaire were used to collect the data. The average overall rate of self-reported
compliance with therapeutic regimen was 39 %. Examining the compliance measures it was found that
patients were most compliant in following dietary advice, taking medications and follow-up. A
significant correlations between the three subscales of the multidimensional health locus of control
(MHLC) and overall compliance measures were found in this study (p < 0.01). The study suggests that
the locus of control has a positive relationship with the compliance practices of diabetic patients.
Implications of findings for nursing practice, nursing education, community practice and research are
discussed.
Keywords: Health Locus of Control, Self-Reported Compliance, Diabetes
INTRODUCTION
Currently India is home to over 62.4 million
diabetics and this number is expected to cross the 100
million mark by 2030. Diabetes is also the largest
contributor of mortality with 983,000 deaths in 2011
due to diabetes. International diabetes federation says
that India’s prevalence of diabetes among 20-79 year
olds is 9.2%. India is only second to China, which has
90 million diabetics (2011). Bariatric surgeon Dr. Raman
Goel says ‘One person is dying from diabetes every seven
seconds and approximately three new cases are added
every 10 seconds or almost 10 million per year1. It is
even more worrying that in India type2 diabetes is
affecting the younger population and poses a greater
threat of health problems in these individuals. The
epidemic of diabetes is further complicated by an
increased prevalence of its complications, which
accounts for premature mortality and morbidity2. The
presence of multiple chronic conditions increases the
burden of disease and negatively influences health
status beyond the sum of the effects of each single
condition. The importance of managing co-existing
chronic conditions in people of all ages is critical to
slow progression, prevent further disease and reduce
the risk of duplicated, incompatible or conflicting
treatments that adversely affect health outcomes3.
The diabetes treatment regimen is extremely complex
and it is generally accepted that adherence with a
complex regimen is usually poor. According to the
World Health Organization, non-compliance with long-
term medication for conditions such as hypertension,
dyslipidaemia and diabetes is a common problem that
leads to compromised health benefits and serious
economic consequences in terms of wasted time, money
and uncured disease. 4 Diabetic individuals need to
follow a strict regimen of life style modification, dietary
modifications, exercise and medications. This requires
self regulation and adherence to the treatment regimen.
Kavanagh suggests that in order to increase
adherence to the diabetes regimen, it is important to
determine what predicts an individual’s ability to
maintain the treatment objectives after the initial
diabetes education program5. Determining reliable
predictors of adherence may allow for a better
understanding of how to improve adherence to this
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 121
regimen. Locus of control is the patient’s belief in the
location of the control over results of his/her behavior,
that is to say a method or a strategy that patients use in
order to attribute the cause of their own disease. An
individual who thinks that he/she can determine events
in his/her environment by his/her own actions is said
to have an internally oriented Locus of control. The
contrary orientation is referred as externality of Locus
of control. Internal Locus of control in fact correlates
with volitional perception, an idea of a controllable (and
curable) disease, while external Locus of control reflects
the patient’s impression of an incurable illness and a
denial of its symptoms, which often leads to refusing
care and rehabilitation6. Health Psychology suggests
several models that help to understand the factors that
influence an individual’s adherence to a medical
regime. Leventhal’ s self-regulatory model (SRM),
suggests that health locus of control factors influence a
range of illness coping behaviors and outcomes among
sick people7. Self-care is the key to success with long
term diabetic therapeutic regimen. To maintain optimum
health and prevent complications compliance with
regimen is most essential. Compliance is a very personal
characteristic and depends heavily on the person’s
attitude, perception of illness and ability to feel control
over the health and treatment. The Rotter’s theory of
Locus of control is based on the belief the behavior is
dependent on consequence. A patient’s perception of
personal ability to control health acts as a predictor of
compliance with treatment recommendations9
According to Rodin, an individual with high perceived
control may have better health because he or she is more
likely to take health-enhancing actions. In particular,
individuals with diabetes may adhere more closely to
their regimen if they experience an increase in perceived
or internal locus of control.9 O’ Hea et al assessed an
interaction between locus of control, self-efficacy and
outcome expectancy in predicting the glycosylated
hemoglobin and found that an interaction of all three
factors was a good predictor of HbA1C10. A study by
Obeje and Nebo investigated the influence of locus of
control on adherence to a treatment regimen among
hypertensive patients and found that Internally-
oriented patients adhered more to their treatment
regimen than externally oriented patients, F(1.98) = 18.2
(P , 0.01).11
The conceptual framework used for this study was
the Wallston’s Health locus of control theory. Health
Locus of Control (HLC) has been defined as the degree
to which individuals believe that their health is
controlled by internal or external Factors. Whether a
person is internal or external is assessed on the basis of
a series of statements. The statements are scored and
summed to determine whether the individual has
internal or external health beliefs. This descriptive
exploratory research was done to identify the
relationship between health locus of control and self-
reported compliance among diabetic patients attending
outpatient department of diabetic clinics.
MATERIALS AND METHOD
Participants
In this descriptive exploratory study 100 diabetic
patients were selected from those attended the diabetic
clinic. Patients who were newly diagnosed and
seriously ill were excluded. Only patients who were
diagnosed as diabetics for more than 1 year and older
than 50 years of age were included.
Measures: A self-report assessment tool consisting
of Demographic information, Multidimensional Health
locus of control Scale and compliance questionnaire
was administered to all the participants while they
were waiting to see their physician. The
Multidimensional health locus of control scale had
three items that strongly defined each dimension of the
locus of control. The compliance questionnaire had
items on each aspect of treatment namely oral
hypoglycemic, exercise, diet, self -monitoring of blood
glucose or urine testing for sugar, foot care and followup.
Ethical clearance was obtained from the institutional
review committee and the hospital review committee.
Participation was voluntary. The purpose of the study
was explained to the respondents and written
permission was obtained from them
FINDINGS
The data collected was tabulated and analyzed
using the SPSS vs 19. 100 patients who qualified for the
study were selected from those attending a diabetic clinic
of a reputed hospital in Maharashtra.
Socio-demographic data of the participants
Majority (59) % of the subjects of them belonged to
the age group 50 – 60 years, and only 9 % in 70 – 80
years. Most of the respondents (68%) were females and
married (74%). Majority of the respondents (72%) did
not have any formal education and could only read
and write while 18(18%) had secondary education. A
large number (8%) were unskilled labourers. Chronicity
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122 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
of the disease ranged from 1 – 10 years (74%), 11 – 20
(22%) and more than 20 years (4%). Most (53%) of the
patients had been admitted with complications at least
1 – 5 times and the overall self-reported compliance
was poor among 60% of the subjects.
Overall compliance among participants
Table 1 shows the overall compliance scores of the
participants in various aspects of self-care. It was found
that compliance was greatest with dietary advice (Mean
score – 3.29, S D – 1.87) as well as oral hypoglycemic
intake (Mean Score - 3.42, SD – 1.64). Compliance was
lowest in areas of exercise, foot care and self-
administration of insulin. Of the Participants who were
on insulin only 40 % rotated the sites regularly. With
regards to dietary practices, many participants had
either lost or misplaced the diet sheets and had not
understood food exchanges.
With regards to following dietary advice subjects
reported that they did not understand food exchanges
and were not able to alter food intake according to the
need. A significant number (42%) of patients were
skipping meals for various reasons like religious
fasting, loss of appetite etc. Considering the fact that
selfmonitoring of blood glucose is not affordable to poor
people, urine testing for glucose is equally effective and
reflects glycemic control but only (10%) a small number
of subjects followed this at home.
Table1: Distribution of overall compliance scores
Dimension of Self- Max Score Mean S D
reported compliance
Dietary advice 5 3.29 1.87
Self-monitoring of 4 1.07 0.52
blood glucose/self-
monitoring of urine sugar
Regular follow-up 4 2.71 2.49
Oral hypoglycemic 5 3.42 1.64
Insulin 5 0.53 1.43
Foot care 5 2.39 2.09
Exercises regularly 6 0.63 1.19
Other directives 4 2.73 0.9
An assessment of the compliance with foot care
practices revealed that only 17(17%) of the subjects
observed their feet daily for injuries and 24(24%)
exercise daily.
Relationship between Health Locus of Control and
Compliance
Table 2 shows the relationship between health locus
of control and self-reported compliance of the
participants. A significant relationship was noted
between health locus of control and overall compliance
(χ²= 17.30, p < 0.01)
Table 2: Distribution of Health Locus of Control and
Self Reported Compliance
Locus of Control Overall Compliance
Poor Satisfactory Good
%% %
Internal 38 5 7 5
Internal with BP Control 5 8 42 0
External 78 22 0
External with BP control 6 7 33 0
Compliance practices were satisfactory in people
with internal locus of control (57.2%) and internals with
benevolent powerful others (41.9%). Very poor
compliance was observed among subjects with external
locus of control (77.8 %). It was surprising to note that
only one participant had very good compliance.
OTHER FINDINGS
Maximum (66.7 %) participants above 70 years of
age had poor compliance. Also female (65%) were found
to be less compliant than males. A significant
relationship between educational qualification and self-
reported compliance was seen (χ2=1 1.05, p<0.01).
Women participants often did not follow dietary advice
since cooking separately for them was not possible A
significant relationship between health locus of control
and gender was observed (χ2=1 1.1, p<0.01), with
females being more externally controlled and males
being internally control with benevolent powerful
others. While Brides V et al found that respondents’
dietary choices have been influenced by the Diabetes
Mellitus, resulting to a shift towards a healthier eating
behavior. Physical activity like exercise is weighed in
terms of its health benefits against the risk of trauma12.
Thus the respondents displayed positive attitudes
towards their medication Brooks and Matson suggests
that Locus of control may be linked to gender, and
females were likely to have an internal Locus of control
than males13
CONCLUSION
The study suggests a relationship between health
locus of control and self-reported compliance. While
Mohammed Ali 14 reported that Men revealed more
internal locus of control and women revealed more
chance locus of control. The attributions of external locus
of control increased by age, while the internal locus of
control increased by education level and chance locus
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 123
of control decreased by education level. A positive
association between internal locus of control and
adherence to diabetes regimen was found and there
was a negative association between chance locus of
control and adherence to diabetes regimen. Similarly
Roya Mansoor et al15 showed that there was no
significant relationship between patients’ knowledge,
health belief and locus of control with their glycosylated
hemoglobin level, number of referrals and self-
management. It is suggested by the present survey that
locus of control, health belief and knowledge of patients
are not found to have no practical effect upon diabetic
self-management behavior or outcomes, according to
the variables used and care for the diabetic patients
must be tailored to individual requirements. The present
survey has suggested a relationship between locus of
control and compliance but objective measurements like
HbA1c would be beneficial in authenticating this
relationship. The findings of this study are limited
because of the small sample size and measurement error
caused by the self-report method of data collection. It
has been found that there are several factors hindering
compliance practices and individualized nursing plans
are required to help patients cope with the effects of the
illness and its therapeutic regimen. The study has
highlighted the continuing education and
reinforcement of teaching is very essential to enhance
adherence with treatment regimen. Education helps in
developing the patient’s self confidence and may thus
alter the health locus of control and illness perception
of diabetic individuals. Nurses in the outpatient setup
play a vital role in improving patient compliance by
providing teaching and assisting patients to
understand their disease and its management better.
Further studies using objective measures to analyze
compliance and associate with health locus of control
would be useful. Also it is recommended that methods
to change the health locus of control should be identified
and their effectiveness should be studied.
Acknowledgement: No acknowledgements
Conflict of Interest: No conflict of Interest
Source of Funding: Self
Ethical Clearance: Ethical clearance was taken from
the hospital review board and institutional review
board.
REFERENCES
1. Kounteya Sinha “India’s diabetes burden to cross
100 million by 2030" TOI, Dec 14, 2011
2. Mohan V, Anbalagan V P. Expanding role of the
Madras Diabetes Research Foundation – Indian
Diabetes Risk Score in clinical practice. Indian J
Endocr Metab [serial online] 2013 [cited 2013 Sep
20]; 17:31-6. Avbl from http”//www.ijem.in/
text.asp?2013/17/1/31/107825
3. Theofilou P (2011) Non - compliance with medical
regimen in haemodialysis treatment: a case study.
Case Reports in Nephrology 2011:1-4.
4. World Health Organization (WHO) 2003
Adherence to Long Term Therapies: Evidence for
Action. Geneva
5. Kavanagh DJ, Gooley S, Wilson PH. Prediction of
adherence and control in diabetes. J Behav Med.
1993;16:509–22
6. The Gap in the Current Research on the Link
between Health Locus of Control and Multiple
Sclerosis: Lessons and Insights from a Systematic
Review. Multiple Sclerosis International. Feb
2013:1-8
7. Theofilou P, Saborit AR (2012) Health Locus of
Control and Diabetes Adherence. J Psychol
Psychother S3:e002. doi:10.4172/2161-0487.S3-
e002
8. Glasgow RE, McCaul KD, Schafer LC (1986)
Barriers to regimen adherence among persons
with insulin-dependent diabetes. J Behav Med 9:
65-77.
9. Rodin J (1986) Aging and health: effects of the
sense of control. Science 233: 1271-1276.
10. Ohea et al ( 2009)The interaction of locus of control,
self-efûcacy, and outcome expectancy in relation
to HbA1c in medically underserved individuals
with type 2 diabetes , J of Behav Med , 32:106 – 117
11. Omeje and Nebo. Patient adherence and locus of
control. Dove press journal, April, 2011: 141-148
12. Veronica Brides, Joy Ann Marie Rapadas, Winset
Rose Sabella , Adyth Sanchez, Jun Mari
Thelshorette, Lorenzo Tan II (2012) Compliance
of Treatment Management Among Diabetes
Patients, Nur Res J, Jan, 4 : 143 - 167
13. N A Brooks and R R Matson (1992) Socio-
psychological adjustment to Multiple Sclerosis A
Longitudinal study” Social Science and medicine
Vol 16 No 24 pp 2129 – 2135
14. Mohammed Ali Morowatishaerifabad, Seid Saeed
Mazloomy Mahmoodabad et al Relationships
between locus of control and adherence to diabetes
regimen in a sample of Iranians Int J Diabetes Dev
Ctries. 2010 Jan-Mar; 30(1): 27–32.
15. Roya Ali Mansour, Farahnaz Joukar, Fatemeh Soati
and Atefeh Ghanbari Khangha. Association
between knowledge, locus of control and health
belief with self-management, Hb A1c level and
number of attendances in type 1 diabetes mellitus
patients. International Journal of Clinical and
Experimental Medicine. 2013; 6(6)470
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124 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
Patient Satisfaction: A Key to Quality Nursing Care
Ashalata W Devi1, Sandhya Shrestha2, Harikala Soti3
1Assistant Professor, 2Assistant Professor, 3Assistant Lecturer, Manipal College of Medical Sciences (Nursing
Programme), Kathmandu University, Pokhara, Nepal
ABSTRACT
Background: One of the most significant indicators of quality services provided by health care personnel
is patient's satisfaction. Nurses provide care for patients 24 hours in a day and comprise the majority
of health care providers.
Objective: To identify the level of patient satisfaction with nursing care so that necessary measures can
be taken up from the findings to ensure the quality nursing care and quality of life for the patient.
Subjects and methods: An outcome study design with convenient sample consisted of 50 patients; the
study was carried out in a Teaching Hospital of Pokhara- Nepal, in Medical, Surgical, Orthopedic and
OBG ward respectively.
Tool of data collection: An interview with semi structured questionnaire was used to measure the
patient satisfaction regarding nursing care provided in a Teaching Hospital of Pokhara, Nepal.
Results: The result of the current study revealed that majority 74% of the patient were age of 18-45
years, 66% were female, 36% were of intermediate level education, 58% were from rural areas, 30% were
of magar ethnicity, 36% had monthly income of NRs. 11000-20000/-, 40% were in OBG ward and 48%
were hospitalized for first time, 100% of the patients satisfied with statement of nurse answer to the
patient's question politely and 86% were least satisfaction with the statement of nurse orients the
patient about the hospital and ward properly, maximum of the patient 98% were satisfied with the
statement of nurse promotes patient's positive self image and electric facility available in the hospital,
and 52% had least satisfaction with the statement of patient's transport facility available in the hospital,
majority 98% of the client had satisfaction on the statement nurse provides health education as per
needed, and 62% had least satisfaction on nurse communicate with the patient during procedure.
There was no significant association between the patient's satisfactions and selected demographic
variables but there was significant association between the patient's satisfactions with the selected
demographic variables
Conclusion: The findings of the study conclude that there are so many areas lacking where nursing
care has to improve in order to maintain the quality nursing care.
Keywords: Patient's Satisfaction, Quality Nursing Care
INTRODUCTION
The quality in health care is described as levels of
excellence produced in the process of patient care, based
on the best knowledge available and achievable at a
Corresponding author:
Ashalata Devi
Assistant Professor
Manipal College of Medical Sciences (Nursing
Programme) Kathmandu University, Pokhara, Nepal
E-mail: ashman_206@hotmail.com
Mobile No. 977-9804152977
particular facility. The quality is defined as the degree
to which the patient care services increase the
probability of desired outcomes and reduce the
probability of undesired outcomes given the current
state of knowledge. Quality of nursing practice is
achieved when organization’s processes and activities
are designed and implemented to meet the needs and
expectations of the receiver on a competent, consistent
and continuous basis.
A descriptive study conducted to assess Patient
satisfaction in public hospitals in Cyprus aiming to
assess medical and surgical patient satisfaction with
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 125
nursing care and explore its possible correlation with
background factors. The methods used for the study
was an exploratory, descriptive design, with face-to-
face semi-structured interview. The study sample
consisted of 159 medical (49.1%) and 165 surgical
patients (50.9%). The result shows that the majority of
the sample were male (200 - 61.7%) and the mean age
was 57.6 years (SD=17.8 years). Overall, patients
showed enthusiasm with the medical care provided
(Mean=3.97, SD=0.65, R=1-5). Particularly, patients
were more satisfied with the technical aspect of care
(Mean=4.20, SD=0.62) and less satisfied with the
provision of information (Mean=3.71, SD=0.92) and
hospitalization (Mean=3.84, SD=0.70) and most
particularly with food and resting time. There was no
statistically significant difference in relation to the
department (medical or surgical), sex, age, educational
level and residency. 1
A study conducted on patient satisfaction in three
urban hospitals in Guntur district, Andhra Pradesh
with the aim to assess the satisfaction levels of the
patient and to suggest measures to strengthen the
administrative practices that improves patient
satisfaction in hospitals in India. The settings of the
study were the Government General Hospital (GGH),
St. Joseph General Hospital (SJGH) and NRI Hospital
(NRI). The study revealed that patient satisfaction is
high in the case of SJGH and followed by NRI and GGH.
Perceived quality at public facilities was only
marginally favorable, leaving much scope for
improvement. Better staff and physician relations,
interpersonal skills, infrastructure, and availability of
drugs were the largest effect in improving patient
satisfaction.2
A study on Quality nursing care in the words of
nurses 2008 conducted in USA with the aim of to answer
the research question ‘What is the lived meaning of
quality nursing care for practising nurses?’ The data
were collected from twelve nurses practising on medical
or surgical adult units at general or intermediate levels
of care within acute care hospitals in the United States
of America with interview method. Emerging themes
were discovered through empirical and reflective
analysis of audiotapes and transcripts. The study
revealed lived meaning of quality nursing care for
practicing nurses was meeting human needs through
caring, empathetic, respectful interactions within which
responsibility, intentionality and advocacy form an
essential, integral foundation. 3
A literature study conducted in UK, Sweden and
USA aimed to describe the influences on patient
satisfaction with regard to nursing care in the context
of health care. The study revealed that results describe
eight domains that have an influence on patient
satisfaction with nursing care: the socio-demographic
background of the patients, patients’ expectations
regarding nursing care, the physical environment,
communication and information, participation and
involvement, interpersonal relations between nurse and
patient, nurses’ medical-technical competence, and the
influence of the health care organization on both
patients and nurses.4
A study aimed to assess patient satisfaction with
nursing care and related hospital services, and
association between satisfaction and patient
characteristics at the National Hospital of Sri Lanka
(NHSL). Sample of was interviewed on discharge. Data
were collected using a satisfaction instrument among
380 patients warded for three to 90 days in general
surgical/medical units with interviewed on discharge.
The study found that the majority of respondents were
males (61%), aged 35-64 years (70%), educated to GCE
(O/L) and above (61%), and previously hospitalized
(66%). The proportion satisfied with “interpersonal
care” was 81.8%, “efficiency and competency”, 89.7%,
“comfort and environment”, 59.2%, “cleanliness and
sanitation”, 48.7%, and “personalized and general
information”, 37.4%. Males reported higher satisfaction
(OR varied from 2.29-2.87, p < 0.001) than females.
Patients with GCE (A/L) were less satisfied with
“comfort and environment” (OR=0.45, p < 0.05) and
“cleanliness and sanitation” (OR=0.45, p < 0.05)
compared with those educated below grade 5.
Satisfaction with “comfort and environment” was lower
among patients from medical (OR=0.51, p < 0.01) rather
than from surgical units. 5
Statement of the problem: “Patient satisfaction: A key
to quality nursing care”
Objective of the study: To identify the level of patient
satisfaction with nursing care so that necessary
measures can be taken up from the findings to ensure
the quality nursing care and quality of life for the patient.
MATERIAL AND METHOD
A. Research approach: The combination of qualitative
and quantitative research approach.
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126 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Research design: An outcome research design
B. Research setting: The study was conducted at
Medical, Surgical, Orthopedic and OBG ward in a
Teaching Hospital of Pokhara, Nepal.
Research subjects: A convenient sample composed of
50 patients.
Duration of study: from December 2013 to January 2014
Inclusive criteria
• Conscious, oriented, and stable patients.
• Age 18 years old and above.
• Both male and female gender.
• Patients available during data collection
Exclusive criteria
• Critical patients, unconscious and comatose.
• Patients under 18 years old
C. Tool for data collection:
An interview with semi structured questionnaire
was used to assess the patient satisfaction with nursing
care included five parts as the following:
Part 1: Patients’ socio- demographic characteristics as
regards their age in year, gender, level of education, and
residence etc.
Part 2: Questionnaires on patient satisfaction related to
nurses’ communication
Part 3: Questionnaires on patient satisfaction related to
hospital environment
Part 4: Questionnaire on patient satisfaction related to
nurses’ skill & competences
Part 5: Patients’ suggestions for improving the quality
of nursing care
Scoring system: The questionnaire on patient
satisfaction related to nurses’ communication, hospital
environment, and nurses’ skill & competences
comprises of thirty statements together. All statements
were scored on a four points Likert Rating Scale
whereas, (strongly agree = 4, agree = 3, disagree = 2 and
strongly disagree = 1). For analysis patient’s responses
if the patient responses were strongly agree or agree,
categorized as Satisfied, and if the patient responses
were disagree and strongly disagree, categorized as
Dissatisfied.
FINDINGS
The data was collected from December 2013 till
January 2014. The result of the study revealed that
majority 74% of the patient were age of 18-45 years,
66% were female, 36% were of intermediate level
education, 58% were from rural areas, 30% were of
magar ethnicity, 36% had monthly income of NRs.
11000-20000/-, 40% were in OBG ward and 48% were
hospitalized for first time. Qualitative analysis revealed
that 100% of the patients satisfied with statement of
nurse answer to the patient’s question politely and 86%
were least satisfaction with the statement of nurse
orients the patient about the hospital and ward
properly, maximum of the patient 98% were satisfied
with the statement of nurse promotes patient’s positive
self image and electric facility available in the hospital,
and 52% had least satisfaction with the statement of
patient’s transport facility available in the hospital,
majority 98% of the client had satisfaction on the
statement nurse provides health education as per
needed, and 62% had least satisfaction on nurse
communicate with the patient during procedure.
Table 1: Range, Minimum, Maximum, Mean, Median and Standard Deviation of Patient’s satisfaction score:
N=50
Variable Range Min. Score Max. Score Mean Median Standard
Deviation
Patient’s Satisfaction 1 2 3 2.66 3 .479
Maximum possible score for patient satisfaction = 120
Regarding patients’ suggestions for improving the
quality of nursing care, majority 76% of the patients
had suggested to improve nurses about the orientation
of the ward and hospital, listen to patient’s doubt and
complaint carefully and provide adequate information
to the patient. Regarding the hospital environment
suggested that hospital should provide extra bed for
visitors, place to keep pt’s belongings, to keep the toilet
and bathroom clean properly, adequate number of
cleaners, good attitude & politeness of the cleaners to
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 127
the patient and visitors, adequate safe drinking water
facility, availability of nutritious diet, hot water in the
bathroom, transportation facility, control visitors,
security in the evening and not to delay in treatment as
per requirement. Regarding nurses’ skill and
competence suggested that nurses should provide detail
information about the patient’s condition and treatment,
give medicine on time, spend more time with patient,
be skillful and competent in any procedure especially
during vein open, monitor the patient who are with I/
V drip, look after the patients carefully in short interval,
understand the patient’s problem and feel empathy to
the patient, and explain about the diets to the patient.
Quantitative analysis revealed that there was no
significant association between the patient satisfaction
scores and selected demographic variables (where ÷2
(1)
= 3.84, ÷2
(3) = 7.81, p<0.05), but there was significant
relationship between the patient’s satisfaction scores
with the selected demographic variables (where p<0.05
level of significant).
DISCUSSION
The present study finding is similar with the study
conducted at district headquarter hospital Dera Ismail
Khan in 2006, the findings of the study were 90%
patients were not comfortable talking to nurses and 80%
had negative experiences that nurses were not attentive
to their needs, particularly at night and had negative
perception with respect to physical care. Overall the
patients’ expectations were not sufficiently met6.
Another study conducted at a University Hospital in
Turkey supported the present study where the findings
of the study revealed the need for nurses to take steps to
improve patient satisfaction with nursing care in the
areas of tangibles, reliability, responsiveness, assurance
and empathy7.
CONCLUSION
Patient satisfaction is a significant indicator of the
quality of care. Nursing care in the hospital plays
important role to develop patients’ mental and spiritual
strong. Nurses are a key part of any healthcare team,
and the way they perform their jobs has a real impact
on healthcare quality. Effective nursing care creates such
an environment where patients relief their anxiety and
develop confident. Besides it, improvement in hospital
environment is also an important part of quality nursing
care. Considering the findings of the study it requires
urgent attention to enhance patients’ satisfaction and
to improve in the areas having many loopholes in
nursing care, at the same time to ensure quality of
nursing care and quality of life for patient.
Acknowledgement: The authors’ gratitude goes to the
ethical committee of the teaching hospital for their kind
permission to conduct the study and to all my colleagues
of MCOMS (Nursing Programme) for their kind co-
operation to carry out the study.
Conflict of Interest: None
Sources of Funding: Nil
REFERENCES
1. Merkouris A, Andreadou A, Athini E,
Hatzimbalasi M, Rovithis M, Papastavrou E.
Assessment of patient satisfaction in public
hospitals in Cyprus: a descriptive study. Health
Science Journal.2013;7(1):28-40. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/
1490271
2. T Sreenivas, Nethi Suresh Babu. A study on
patient satisfaction in hospitals. International
journal of Management Research & Bussiness
Strategy. 2012 October; Vol.(1). Available from:
http://www.ncbi.nlm.nih.gov/pubmed/
1490271
3. Burhans L.M. & Alligood M.R. Quality nursing
care in the words of nurses. Journal of Advanced
Nursing: 2010; 66(8): 1689–1697. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/
17888547
4. Johansson P, Oléni M, Fridlund B. Patient
satisfaction with nursing care in the context of
health care: a literature study. Scand J Caring Sci.
2002 Dec; 16(4):337-44.
5. Upul Senarath, Nalika S. Gunawardena, Benedict
Sebastiampillai, et.al. Patient satisfaction with
nursing care and related hospital services at the
National Hospital of Sri Lanka, Leadership in
Health Services. 2013; Vol. 26 (1): 63 – 77. Available
from: http://www.emeraldinsight.com/
journals.htm?articleid=17076658
6. Khan MH, Hassan R, Anwar S, Babar TS, Babar S.
Patient Satisfaction with Nursing Care. RMJ.
(2007); 32(1): 28-30. Available from: http://
www.scopemed.org/?mno=7982
7. Uzun, Özge PhD. Patient Satisfaction with
Nursing Care at a University Hospital in Turkey.
Journal of Nursing Care Quality. 2001 October; 16
(1):24-33. Available from: http://
journals.lww.com/jncqjournal/Abstract/2001/
10000/Patient_ Satisfaction_ with_ Nursing_
Care_at_a.4.aspx
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128 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to assess the Impact of Health Education
Regarding Common Childhood Ophthalmic Ailments and
their Self Care Management among Rural School Children
at Chitradurga
Sunil Kumar Dular
Assistant Professor cum Vice Principal, Dashmesh College of Nursing (A Unit of SGT University), Budhera, Gurgaon
(Haryana), India
ABSTRACT
Introduction: Good eye health and clear vision are very important for the development of children.
With proper vision, children gain knowledge and skills which will remain them their entire life. Good
eye sight is every child's birth right. Eye injuries occur frequently and can happen anywhere. In children
eye injuries can occur at home, school or play ground and also during the festivals. Retinal burns can
occur while viewing the solar eclipse without protection. They should always be aware of the best
ways to protect their eye sight. The trend of increased TV and computer exposure has led to an increase
in vision-related problems in children. Very often parents don't realize that their children are suffering
from vision related problems.
Objectives: To assess the level of knowledge of school going children regarding common childhood
ophthalmic ailments and their self care management before and after the implementation of health
education, To compare the pretest and post test knowledge scores of school going children regarding
common childhood ophthalmic ailments and their self care management with their demographic
variables, To find out the association between post test knowledge score of the school going children
regarding common childhood ophthalmic ailments and their self care management and demographic
variables.
Design: One group pre-test post-test Quasi- experimental design
Setting: The study was conducted in Government Higher Primary School, Mallapura, Chitradurga
district, Karnataka.
Participants: 100 school going children residing in rural areas under Chitradurga district, Karnataka.
Measurement and tools: Structured multiple choice questionnaires and a checklist. Descriptive and
inferential statistics were used to analyze the data.
Findings: Majority of subjects 55% belong to the age group of 12-13 years and 45% of them belong to the
age group of 10-11 years. Majority 60% of the subjects were males and remaining 40% of the subjects
were females. The data revealed that The pretest mean is 17.98 and post test mean score is 30.17 and the
't' value was 30.994. The obtained 't' value 30.994 was found to be significant at (df = 99) 0.01 levels of
significance. Overall mean knowledge score obtained by the subjects was 17.98(44.95%) with standard
deviation of 3.21in the pre-test and the overall knowledge obtained score was 30.17 (75.42%) with
standard deviation 4.546 in the post-test. It was evident that there was a statistically significant
association between the knowledge score with demographic variables like age and education at the
probability level of p<0.05.
Conclusion: Ophthalmic ailments are common in children. Eye problem is mostly common in children
due to unhygienic practice. Planned health teaching will improve the knowledge regarding self eye
care.
Keywords: Retinal Burns, Knowledge, School Children
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 129
INTRODUCTION
A child is a precious gift who has lots of potential
within, who can be best resource of the nation if raised
and molded in a good manner. The health of a growing
child is always a matter of great concern to the parents.
The physical health of a child is important because it is
associated with the mental and social development.
Health care aspects of children have been neglected
over years when compared to adults. (Sasikala T, 2008)1
Eye problems affect more than 12 million children
in the United States. This includes 5 percent of
preschoolers and 25 percent of school-aged children,
according to the American Academy of Ophthalmology.
Left untreated, these problems can lead to permanent
vision loss, or to less serious but still substantial
problems such as learning difficulties that may be
attributed to a disability. (Park K) 2
A cross sectional study was conducted to determine
the causes of blindness among children in rural
Malawi. Children were examined by an
ophthalmologist and the cause of blindness
determined. In total 151 children were identified, of
whom 37 (25%) were blind. Among the blind, 21 (60%)
were girls and 16 (40%) were boys. Cataract (congenital/
developmental) was the leading cause of blindness
(35%) followed by corneal conditions (22%). (Kular K,
Patel D)3
According to WHO every minute a child somewhere
in the world goes blind, worldwide approximately there
are 1.5 million blind children. An estimated 127 million
pre-school children are vitamin A deficient, and each
year 350,000 children go blind.9 about 1.1 percent of
population in India suffers from avoidable blindness;
approximately 12 million are blind in country.
Karnataka State has the highest number of people
suffering from avoidable blindness in country It is
estimated that 747 children are suffering from vitamin
A deficiency and 979 children have defective vision in
Bangalore District alone. (Staff Reporter) 4
OBJECTIVES OF THE STUDY
1. To assess the level of knowledge of school going
children regarding common childhood ophthalmic
ailments and their self care management before and
after the implementation of health education.
2. To compare the pretest and post test knowledge
scores of school going children regarding common
childhood ophthalmic ailments and their self care
management with their demographic variables.
3. To find out the association between post test
knowledge score of the school going children
regarding common childhood ophthalmic ailments
and their self care management and demographic
variables.
ASSUMPTION
The study assumed that
1. Ophthalmic ailments are common in children.
2. Eye problem is mostly common in children due to
unhygienic practice
3. Planned health teaching will improve the
knowledge regarding self eye care.
MATERIAL AND METHOD
The research design used in the study one group
pre-test post-test Quasi- experimental design. The
population of the present study comprises of the all
Primary School children from the government higher
school Mallapura, Chitradurga district, Karnataka. I
did the study by own and no source of funding. The
accessible populations are those available at the time
of conducting study. After getting the ethical committee
clearance from government higher school Mallapura,
Chitradurga district, Karnataka. The data was collected
by structured multiple choice questionnaires and a
checklist. The sample of the study comprises all the
primary school children at government higher school
Mallapura, Chitradurga district, Karnataka.and who
fulfill the inclusive criteria that has been included in
the study. Both descriptive and inferential statistics
were used for data analysis.
FINDINGS
Section–I: Demographic profile of children.
Majority of subjects 55% belong to the age group of
12-13 years and 45% of them belong to the age group of
10-11 years. Majority 60% of the subjects were males
and remaining 40% of the subjects were females.
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130 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Majority 80% of the subjects had only one sibling and
least 1% had three siblings. Majority 94% of the subjects
living in nuclear family setting and 85% are having the
family size of 4-6 members. Majority 55% of the subject’s
family income was Rs. 3001-6000. Among the study
participants 83% of the subjects belongs to Hindu
religion In relation to the education 52% were studying
in 5th and 6th standard and 48% studying in 7th
standard. In relation of sources of information 80% of
subjects had no information. Over all mean score of the
subjects in pre test were 17.98, found to be Inadequate.
Over all mean score of the subjects in post test were
30.17, found to be improvement in the knowledge. The
pretest mean is 17.98 and post test mean score is 30.17
and the ‘t’ value was 30.994. The obtained ‘t’ value
30.994 was found to be significant at (df = 99) 0.01 levels
of significance.
SECTION II
Knowledge of children regarding common
childhood ophthalmic ailments in pre test
Table 1: Mean, Mean percentage and standard deviation for the pre test knowledge of School going children
N = 100
Sl. No Knowledge variables Maximum score Mean Mean % Median SD
1 Anatomy & Physiology of Eye 4 1.93 48.25 2 0.685
2 Refractive errors 4 1.70 42.5 1 0.99
3 Conjunctivitis 5 2.29 45.8 3 0.924
4 Blepharitis 5 2.47 49.4 3 0.703
5 Trachoma 4 1.75 43.75 2 0.520
6 Strabismus 5 2.23 44.6 2 0.694
7 Xeropthalmia 6 2.20 36.66 2 0.739
8 Eye Injuries 3 1.48 49.33 2 0.559
9 Foreign Bodies in Eye 4 1.93 48.25 2 0.537
10 Overall knowledge 40 17.98 44.95 17 3.21
The above table shows that the maximum mean
percentage obtained by the sample is found in the aspect
of Blepharitis (49.4%), eye injuries (49.33%), anatomy
and physiology and foreign body in eye (48.25%),
conjunctivitis (45.8%), strabismus (44.6%), Trachoma
(43.75%), refractive errors (42.5%) and least mean
knowledge score (36.66%) found in the aspect of
Xeropthalmia. The overall knowledge scores of
respondents were found to be 44.95% with standard
deviation 3.21.
SECTION III
Post test knowledge scores of school children
regarding common ophthalmic ailments and its self
care
Table 2: Mean, Mean percentage and standard deviation for the post test knowledge of school children regarding
common ophthalmic ailments and its self care
N = 100
Sl. No Knowledge variable Maximum score Mean Mean % Median SD
1 Anatomy & Physiology of Eye 4 3.26 81.5 3 0.676
2 Refractive errors 4 3.07 76.75 3 0.987
3 Conjunctivitis 5 3.68 73.6 4 0.909
4 Blepharitis 5 3.60 72 4 0.995
5 Trachoma 4 3.05 76.25 3 0.833
6 Strabismus 5 3.61 72.2 4 1.043
7 Xeropthalmia 6 4.42 73.66 5 1.165
8 Eye Injuries 3 2.35 78.33 3 0.796
9 Foreign Bodies In Eye 4 3.13 78.25 3 0.825
10 Overall knowledge 40 30.17 75.42 32 4.546
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 131
The above table shows that the maximum mean
percentage obtained by the samples is found in the
aspect of Anatomy and physiology of eye (81.5%)
followed by eye injuries ( 78.33%), foreign body in eye
(78.25%), Refractive errors (76.75%), trachoma (76.25%),
Xeropthalmia (73.66%), conjunctivitis (73.6%), and least
mean knowledge score found in the aspect strabismus
(72.20%) and Blepharitis (72%). The overall knowledge
scores of respondents were found to be 75.42% with
standard deviation 4.546.
SECTION IV
Comparison of pre test and post test knowledge
regarding common childhood ophthalmic ailments.
Table 3: Comparison of pretest and post test knowledge scores among school going children regarding common
childhood ophthalmic ailments
N=100
SLNo Knowledge Variable Pre test Post test t value df Inference
Mean SD Mean SD
1 Anatomy & Physiology Of Eye 1.93 0.685 3.26 0.676 15.372 99 S
2 Refractive errors 1.70 0.99 3.07 0.987 12.586 99 S
3 Conjunctivitis 2.29 0.924 3.68 0.909 12.636 99 S
4 Blepharitis 2.47 0.703 3.60 0.995 10.470 99 S
5 Trachoma 1.75 0.520 3.05 0.833 14.372 99 S
6 Strabismus 2.23 0.694 3.61 1.043 13.493 99 S
7 Xeropthalmia 2.20 0.739 4.42 1.165 19 99 S
8 Eye Injuries 1.48 0.559 2.35 0.796 10.551 99 S
9 Foreign Bodies In Eye 1.93 0.537 3.13 0.825 13.519 99 S
10 Overall knowledge 17.98 3.21 30.17 4.546 30.994 99 S
From the above table it is evident that the obtained
“t” value 30.994 is greater than the table value both at
0.01 and 0.05 level of significance. Therefore, “t” value
is found to be significant. It means there is gain in
knowledge level of school going children regarding
common childhood ophthalmic ailments and its self
care management. This supports that structured
teaching program on common childhood ophthalmic
ailments and its self care management is effective in
increasing the knowledge level of children.
SECTION V
Association of demographic variables of children
with pre test knowledge scores
Table 4: Association of demographic variables of children with pre test knowledge scores
N= 100
Variables Knowledge Chi Square df Inference
Below Median
Median and Above
1. Age
a. 10-11 years 24 2 1 10.669 1 S
b. 12-13 years 12 4 3
2. Sex
a. Male 25 3 5 2.091 1 NS
b. female 11 29
3. Number of Siblings
a. None 3 6 0.662 3 NS
b. One 29 51
c. Two 4 6
d. Three 0 1
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132 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Table 4: Association of demographic variables of children with pre test knowledge scores (Contd.)
N= 100
Variables Knowledge Chi Square df Inference
Below Median
Median and Above
4. Family type
a. Nuclear 33 61 0.543 1 NS
b. Joint 3 3
5. Family Income
a. Less than Rs. 3000 15 1 6 3.845 3 NS
b. Rs. 3001-6000 18 37
c. Rs. 6001-9000 2 9
d. Rs. 9001 and above 1 2
6. Family Size
a. 1-3 members 3 6 0.557 2 NS
b. 4-6 members 30 55
c. Above 6 Members 3 3
7. Education
a. 5th and 6th standard 27 2 5 11.922 1 S
b. 7th standard 9 3 9
8. Religion
a. Hindu 26 57 5.658 2 NS
b. Muslim 9 5
c. Christian 1 2
9. History of ophthalmic ailments
a. Yes 1 8 2.659 1 NS
b. No 35 56
10 . Source of information
a. Mass media 0 1 1.602 3 NS
b. School teacher 1 3
c. Health personnel 4 11
d. No information 3 1 49
The data in table 4 shows ÷2 value computed
between the knowledge scores of school children on
common childhood opthalmic ailments and selected
demographic variables. Variables of age (÷2= 10.669)
and education (÷2= 11.922) were significant both at 0.01
and 0.05 level. But sex (÷2 =2.091), number of siblings
(÷2 =0.662), family type (÷2= 0.543), family income
(÷2=3.845), family size (÷2 =0.557), religion (÷2=5.658),
history of opthalmic ailments (÷2= 2.659) and source of
information (÷2= 1.602) were not significant. Thus it
can be interpreted that there is significant association
between knowledge level of the school children and
selected variables such as age and educational level.
Therefore the research hypothesis is accepted.
CONCLUSION
This chapter presents the conclusions drawn,
implications, limitations, suggestions and
recommendations. Children and young people
represent a country’s future. Their health needs are
vital, and they share an entitlement to good health and
quality health and quality service with the rest of the
community. The focus of this study was to evaluate the
effectiveness of structured teaching program on
knowledge of school children regarding common
childhood ophthalmic ailments and their self care
management at government higher primary school,
Mallapura, Chitradurga district, Karnataka. A quasi-
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 133
experimental design and evaluative approach was
used in the study. The data was collected from 100
samples through Simple random sampling technique.
The data collected was subjected to analysis using
descriptive statistics in terms of frequencies, percentage
and inferential statistics like ‘t’ test and chi square
association.
RECOMMENDATIONS
The study can be replicated in various settings.
ACKNOWLEDGEMENT
I acknowledge my deep sense of gratitude to the Mrs.
Shoba M. Wagmore, Professor for guiding a M.Sc.
Nursing programme and providing a constant support.
I am also thankful to my Wife Mrs. Saroj Gajraj, Nursing
Sister, ESIC Hospital, Gurgon for her help even at odd
hours.
Conflict of Interest: There were no conflicts of interest
reported.
Funding: There was no financial assistance from any
governmental/nongovernmental funding agency.
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Med J. (KUMJ) 2009
13. Ajaiyeoba Al Oluleye TS, “Department of
Ophthalmology”, university college hospital
Ibadan Nigeria, 2005
14. Shirmas, Lewallens, “Kilimanjaro center for
community Ophthalmology”, KCM/College
Tumaini University, Tanzania,
plourtright@kcco.net 2009
15. Isawumi A., “Department of Ophthalmogoy”,
University college hospital, Ibadan Nigeria, 2007
16. Maida Jm, Mathers K, Alley CL, “Cuer Opin,
Opthalmol” Temple university, Philadelphia,
Pemsyluania, USA. 2008
17. Guy R, Nicholson J, Pannu SS, Holdey R. Hospital
NHS Trust Derby UK”. 2003 Sep. UK
rosehlmesguy@hotmail.com
18. Bowman RJ, “CCBRT Disability Hospital”, Dar-
Es-Salaam, Tanzania 2005
19. Sitorus RS, Abidin MS, “Department of
Opthalmology faculty of medicine university of
Indonesia”, Jakarta – 10430 Indonesia 2007
20. Ajaiyeoba A. Childhood eye diseases in Ibadan.
African journal of medical science. 1994 Sep;
23(3):227-31.
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134 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 DOI Number: 10.5958/j.2320-8651.2.1.001
A Study to Identify the Prevalence of Co-Morbidity
among Chronic Obstructive Pulmonary Disease Patients
Seeking Treatment in Outpatient Department of Bhopal
Memorial Hospital & Research Centre, Bhopal
Radha K1, Chinchumol Abraham2, Jyoti Pandey2, Neha Maurya2, Rambha Kumari2, Shweta Singh2
1Vice- Principal, 2Nursing II Year Students, Bhopal Nursing College, (ICMR, Under Dept of Health Research,
MOH&FW, Govt of India, BMHRC, Bhopal
ABSTRACT
"A study to identify the prevalence of co-morbidity among Chronic Obstructive Pulmonary Disease
patients seeking treatment in outpatient department of Bhopal Memorial Hospital & Research Centre,
Bhopal. Objectives:
Methodology: Research approach was quantitative approach and a retrospective and descriptive
research design was used in this study. Bhopal Memorial Hospital and Research Centre (ICMR, Under
Dept. Of Health, Ministry of Health &Family welfare, and Govt. of India) a 350-bedded multi-specialty
tertiary care centre situated at Bhopal, India. Sample sizes were 150 patients with COPD. The data
collection instrument had two parts. Part I- Demographic variables and part-II general assessment of
co-morbidity with COPD.
Analysis: Out of 150, COPD patients 73.3% were male, and 26.6% were females who had co-morbidity
along with COPD. Among 150 COPD patients, 35.33% had hypertension 28% had tuberculosis, cardiac
diseases is 26.7%, respiratory tract infection had 20%, diabetes mellitus had 18.67%, & others were
20%.Chi-square test was computed in order to find the relationship between co-morbidity and
demographic variables like age, gender, income, living condition, BMI, education, history of illness,
occupation and history of smoking were found significant at 0.05 level of significance. conclusion of
this study were the hypertension was associated with age, diabetes mellitus was associated with
occupation ,Cardiac disease associated with age, gender and occupation, tuberculosis associated with
age, gender and occupation, respiratory tract infection associated with history of smoking. Hence there
was significant relationship between co-morbidity of COPD and demographic variables.
Keywords: Chronic Obstructive Pulmonary Disorder, World Health Organization, Co-morbidity, Cardiac
Diseases, Renal Diseases
INTRODUCTION
Chronic Obstructive Pulmonary Disease is a slowly
progressive condition characterized by airflow
limitation which is largely irreversible.1 Chronic
Corresponding author:
Radha K
Vice Principal
Bhopal Nursing College, (ICMR, Under Dept of Health
Research, MOH&FW, Govt of India) Bhopal Memorial
Hospital and Research Centre, Bhopal
Email id: radha.adn@gamil.com
Obstructive Pulmonary Disease affects 6%of the world
population and now it is ranks as the fourth leading
cause of chronic obstructive pulmonary disease in
worldwide and also a leading cause of morbidity and
mortality in worldwide.2
According to WHO: Chronic Obstructive
Pulmonary Disease currently affects 210 million people
worldwide. Roughly, 4-6% of the adult populations have
clinically relevant chronic obstructive pulmonary
disease. Three million deaths are recorded every year,
caused by chronic obstructive pulmonary disease (5%
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 135
of all deaths). It is estimated that by 2020, it shall become
the third cause of mortality in the world and fifth cause
of disability by 2020.2
The disease is usually not diagnosed until the
smoker experiences symptoms (usually shortness of
breath with mild exertion) that interfere with quality of
life. Unfortunately, dyspnoea on mild exertion does not
occur. Until only about half of lung function remains
and COPD has become moderately severe. Experts agree
it would be desirable to have some test or intervention
that would allow early identification of COPD, enabling
earlier treatment or prevention of more severe stages of
the disease. 3,4
Co-morbidity is present in one third of the adult
population and its prevalence increases with age,
eventually affecting 60% of the population aged 55 to
74 years.1 COPD often coexists with other diseases, and
this related co-morbidity is a key prognostic factor of
the consequences of COPD. Some of these diseases occur
regardless of COPD, some are related by virtue of having
a common cause(s), and others share risk factors. For
instance, inflammation brought about by smoking can
be a common route for a series of diseases, such as
Ischemic heart disease, Heart failure, Osteoporosis,
Anaemia, Cancer, Depression and Diabetes. COPD
associated co-morbidity contributes to symptoms
determines the quality of life, increments healthcare
costs and increments the mortality of patients suffering
it.5
Hence the investigators are interested to find the
prevalence of co-morbidity among COPD.
Statement of the Problem
“A study to identify the prevalence of co-morbidity
among Chronic Obstructive Pulmonary Disease
patients seeking treatment in outpatient department of
Bhopal Memorial Hospital & Research Centre, Bhopal.”
OBJECTIVES
• To assess the demographic variables among
Chronic Obstructive Pulmonary Disease patients
• To assess the prevalence of co-morbidity among
Chronic Obstructive Pulmonary Disease patients.
• To find out relationship between demographic
variables and co-morbidity among Chronic
Obstructive Pulmonary Disease patient.
Hypothesis
•H
1= There is a significant association of co-
morbidity among Chronic Obstructive Pulmonary
Disease patients.
Operational Definition
• Prevalence: In this study, prevalence refers to the
population found to have a co-morbid condition
along with COPD.
• Co-morbidity: In this study, co-morbidity refers to
the presence of one or more additional diseases co-
occurring with the COPD.
• Chronic obstructive pulmonary disease: Chronic
Obstructive Pulmonary Disease (COPD) is a lung
disease characterized by chronic obstruction of lung
airflow that interferes with normal breathing and
is not fully reversible.
Review of literature
Claus Vogale &Andreas Von Leopalt (2007)
conducted a study to assess mental disorder in chronic
obstructive pulmonary disease patient in Germany with
20 objects in a selected hospital. The objective of the
study was to identify moderating factors explaining
mental co-morbidities and to compare the results with
a quasi-experimental study. Result showed that
55%patients with chronic obstructive pulmonary
disease received a diagnosis of a mental disorder
compared to 30% control group patients.6
Van Manen and colleagues conducted a study to
identify the prevalence of co-morbidity among COPD
patient in Colombia, and sample size was 1,145 patients
with COPD and they have done descriptive study with
standard questionnaire. They repeated that over 50%
1,145 patients had 3-4 co-morbidities and 6.8% had 5
or more co-morbidities.7
METHODOLOGY
This study adopted a quantitative approach and
retrospective & descriptive research design to
accomplish the main objective of the study. The study
was conducted in pulmonary OPD of Bhopal Memorial
Hospital and Research Centre. It is 350-bedded Super-
specialty Hospital situated at Bhopal, M.P. Sample
selected through convenient sampling technique. The
study was delimited to people who gave consent to
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136 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
participate in the study and adults could identify the
co morbidities of COPD. The conceptual frame work of
this study based on Systematic approach to Health
Improvement model.
Tool-I: demographic variable-The Demographic
Performa included age, sex, education, occupation,
monthly income, etc .Total 11 items were included in
this tool.
Tool –II: General assessment of co-morbidity with
COPD- questionnaire included 15 items. Sample size:
150 and convenient sampling technique was used.
Formal permission and ethical clearance was obtained.
Analysis
The above Pie diagram shows that the socio-
demographic variable regarding age majority of
subjects 36% in the age group of >65 yrs and 56-65
years age ,in age 46-55 having 20% & age 35-45 having
8%.
The data showed that Out of 150, COPD patients
73.3% were male, and 26.6% were females who had co-
morbidity along with COPD.
Table I: Demographic data of patients with COPD and
its co-morbidity by frequency and percentage
N=150
Demographic Variables Frequency %
Education
Illiterate 8 4 56
Primary 40 26.6
Secondary 7 4.67
graduation and above 1 9 12.67
Occupation
daily labour 19 12.67
driver 10 6.67
Business 3 1 20.67
Others 90 60
Monthly income (Rs.)
<5000 77 51.33
5000-10,000 47 31.34
>10,000 26 17.33
Marital status
Married 127 84.67
Unmarried 2 1.34
widow/widower 20 13.34
Separation 1 0.67
Place of living
urban 1 23 8 2
Rural 7 4.67
semi rural 6 4
semi urban 1 4 9.33
History of illness
<1 year 18 12
1-5 years 24 16
5-10years 31 20.67
>10years 7 7 51.33
History of smoking
yes 83 55.33
No 6 7 44.67
Frequency of smoking
3 times 12 14.45
5-10 times 4 3 51.81
>10 times 2 8 33.73
BMI
<18.5 (Malnourished) 3 3 22
18.5-24.9(normal weight) 1 05 7 0
25-29.9(overweight) 1 2 8
>30 (obesity) 0
Table 1 :Regarding education majority of 56%
samples were illiterate, Regarding monthly income
majority were in <5000 per month income .Regarding
marital status married person having co-morbidities
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 137
127(84.67%), widow/widower having (20)13.34%,
unmarried person having (2)1.34%, separated person
having (1)0.67%.Regarding place of living urban people
(123)82%, semi-urban having (14)9.33%, rural people
having (7)4.67%, semi-urban people having (6)4%.
Regarding history of illness >10 yrs suffered COPD
patient having co-morbidities (77)51.33%, Regarding
frequency of smoking, smoker who smoke 5-10 time
having co-morbidities (43)51.81%, who smoke >10 time
having (28)33.73%.Regarding BMI <18.5 -24.9(normal
weight) having co-morbidities (105)70%,
<18.5(malnourished) having (33)22%, 25 -
29.9(overweight) having (12)8%, >30(obesity) having
(10)0.00%.
Table No II: COPD and its co-morbidity by frequency and percentage.
Co-morbidity Frequency %
Hypertension 53 35.33
Diabetes 28 18.67
Tuberculosis 42 28
Cardiac diseases 40 26.7
Respiratory tract infection 30 20
GI tract diseases 10 6.67
Cachexia 15 10
Renal disease 8 5.33
Visual &hearing problems 11 7.33
Others 30 20
Table no. II shows that COPD associated with co-
morbidity in terms of frequency and percentage, in that
hypertension is 35.33%, diabetes is 18.67%,
tuberculosis is 28%, cardiac diseases is 26.7%,
respiratory tract infection is 20%, GI tract diseases is
6.67%, cachexia is 10%, renal disease are 5.33%,
with visual & hearing problems are 7.33% & others are
20%.
Chi square value computed between the demographic variables and COPD co-morbidities.
Table III: Chi square value computed between the demographic variables with Hypertension among COPD
patients
Variables Present Absent df x2P value Significant
at 0.05 level
Age
35-45 3 9 3 10.055 7.82 S*
46-55 4 26
56-65 25 29
>65 21 33
Gender
Male 34 76 1 3.534 3.84 NS
Female 1 9 21
Occupation
daily labor 7 1 2 3 0.146 7.82 NS
Driver 4 6
Business 11 11
Others 3 1 31
Monthly income (Rs.)
<5000 27 50 2 0.42 5.99 NS
5,000-10,000 18 29
>10,000 8 18
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138 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Table III: Chi square value computed between the demographic variables with Hypertension among COPD
patients (Contd.)
Variables Present Absent df x2P value Significant
at 0.05 level
Marital status
Married 45 82 3 1.83 7.82 NS
Unmarried 0 2
widow/widower 8 12
Separation 0 1
Place of living
urban 3 3 90 3 2.59 7.82 NS
Rural 1 6
semi rural 3 3
semi urban 5 9
No. of smoking
Yes 19 64 1 2.405 7.82 NS
No 23 44
NS=Not Significant
S*= Significant
Table No. III COPD with co-morbidity associated with hypertension the age(x2 =10.055,df =3) is significant at 0.05 level of
significance and other gender, occupation, monthly income, marital status, place of living& no. of smoking were not significant.
Table IV: Chi square value computed between the demographic variables with Diabetes mellitus among COPD
patients
Variables Present Absent df X2P value Significance
Age
35-45 3 9 3 0.983 7.82 NS
46-55 4 26
56-65 10 44
>65 11 43
Gender
Male 17 93 1 2.803 3.84 NS
Female 11 29
Occupation
Daily labour 1 5 4 3 98.91 7.82 S*
Driver 9 1
Business 3 2 8
Others 1 8 9
Monthly income (rs.)
<5000 16 61 2 0.495 5.99 NS
5,000-10,000 8 39
>10,000 4 22
Marital status
Married 23 1 04 3 1.243 7.82 NS
Unmarried 0 2
Widow/Widower 5 15
Separation 0 1
Place of living
Urban 2 4 99 3 0.339 7.82 NS
Rural 1 6
Semi Rural 1 5
Semi Urban 2 12
No. of smoking
Yes 11 72 1 3.587 3.84 NS
No 17 50
Table No. IV COPD with co-morbidity associated with diabetes mellitus the occupation(x2= 98.91,df =3) is significant at 0.05 level
of significance and other age, gender, monthly income, marital status, place of living & no. of smoking were not significant.
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 139
Table V: Chi square value computed between the demographic variables with Cardiac disease among COPD patients
Variables Present Absent df X2P value Significance
Age
35-45 1 11 3 16.99 7.82 S*
46-55 5 25
56-65 9 45
>65 25 29
Gender
Male 38 72 1 13.09 3.84 S
Female 2 3 8
Occupation
Daily labour 1 3 6 3 28.94 7.82 S
Driver 6 4
Business 0 3 1
Others 3 4 56
Monthly income (Rs.)
<5000 22 55 2 1.065 5.99 NS**
5,000-10,000 10 37
>10,000 8 18
Marital status
Married 36 91 3 5.05 7.82 NS
Unmarried 0 2
Widow/Widower 3 17
separation 1 0
Place of living
urban 3 6 87 3 3.353 7.82 NS
Rural 1 6
semi rural 0 6
semi urban 3 11
No. of smoking
Yes 19 64 1 1.35 3.84 NS
No 21 46
Table no. V: COPD with co-morbidity associated with cardiac diseases, the age(x2 =16.99,df= 3), gender(x2 =13.09,df =1),
occupation(x2 28.94,df 3) is significant at 0.05 level of significance and other monthly income, marital status, place of living and
no. of smoking were not significant.
Table VI: Chi square value computed between the demographic variables with Tuberculosis among COPD patients
Variables Present Absent df X2P value Significance
Age
35-45 3 9 3 5.995 7.82 S
46-55 11 19
56-65 19 35
>65 9 45
Gender
Male 25 85 1 5.689 3.84 S
Female 1 7 23
Occupation
daily labour 3 16 3 30.7 7.82 S
Driver 9 1
business 1 3 0
Others 2 9 61
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140 International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2
Table VI: Chi square value computed between the demographic variables with Tuberculosis among COPD patients
(Contd.)
Variables Present Absent df X2P value Significance
Monthly income (rs.)
<5000 21 56 2 3.629 5.99 NS
5,000-10,000 17 30
>10,000 4 22
Marital status
Married 33 94 3 2.55 7.82 NS
unmarried 1 1
widow/widower 8 12
separation 0 1
Place of living
urban 3 3 90 3 2.59 7.82 NS
Rural 1 6
semi rural 3 3
semi urban 5 9
No .of smoking
Yes 19 64 1 2.405 7.82 NS
No 23 44
Age, gender(x2 =13.09,df =1), and occupation(x2= 28.94,df= 3) is significant with tuberculosis,
DISCUSSION AND RESULTS
The co-morbidity with COPD are increased with
increasing age and also influenced by their gender,
occupation and frequency of smoking habit. The male
persons were found to have more co-morbidity with
COPD than females.
Holguin and colleagues, co-morbidity was
frequently reported in hospitalized patients with
primary or secondary COPD diagnoses: hypertension
17%, cardiac disease 25%, and diabetes 11%,
pneumonia 12%; all higher than in the control group.8
In another study of 270 hospitalized patients with
COPD, Antonelli Incalzi and coworkers noted
hypertension in 28%, diabetes in 14%, and ischemic
heart disease in 10% .9
In the present study it was found the co-morbidity
with COPD are increased with increasing age and also
influenced by their gender, occupation and frequency
of smoking habit. The male persons were found to have
more co-morbidity with COPD than females and Among
150 COPD patients, hypertension is was 35.33%,
tuberculosis was 28%, cardiac diseases is 26.7%,
respiratory tract infection is 20%, diabetes mellitus is
18.67%, & others are 20%.
Major findings of the study
1. The data showed that Out of 150, COPD patients
73.3% were male, and 26.6% were females who had
co-morbidity along with COPD.
2. Among 150 COPD patients, hypertension is was
35.33%, tuberculosis was 28%, cardiac diseases is
26.7%, respiratory tract infection is 20%, diabetes
mellitus is 18.67%, & others are 20%.
3. Relationship between the co-morbidity and
demographic variables: Chi-square test was
computed in order to find the relationship between
co-morbidity and demographic variables like age,
gender, income, living condition, BMI, education,
history of illness, occupation and history of
smoking were found significant at 0.05 level of
significance
i. Among 150 subjects , hypertension was associated
with age
ii. Diabetes mellitus was associated with occupation
iii. Cardiac disease associated with age, gender and
occupation
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International Journal of Nursing Care. July-December, 2014, Vol.2, No. 2 141
iv. Tuberculosis associated with age,gender and
occupation
v. Respiratory tract infection associated with history
of smoking
Recommendations
1. A similar study can be replicated on large sample.
2. A similar study can be done with structured
teaching programme on life style modification of
COPD patients associated with co-morbidity.
3. A survey can be done to determine the level of
knowledge among nurses in providing care to
COPD patients.
4. A research study can be done to find out association
of COPD and nutritional status.
CONCLUSION
COPD is a progressive obstructive lung disease that
is a major cause of mortality and morbidity in the United
States. In fact, COPD recently became the third leading
cause of death behind heart disease and cancer. This
study mainly focused on COPD and its co-morbidities.
This study will have a defining success if it does
encourage further research activity in the same field.
Conflict of Interest: None
Source of Support: Nil
Ethical clearance: Formally obtained from institution.
Acknowledgement: Principal Investigator and co-
investigators were collaborated together to develop the
final content of the manuscript.
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