PROFORMA FOR REGISTRATION OF
SUBJECTS FOR DISSERTATION
DISSERTATION PROPOSAL
PROFORMA FOR REGISTRATION OF
SUBJECTS FOR DISSERTATION
DISSERTATION PROPOSAL
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PULMONARY REHABILITATION IN COPD AMONG STAFF NURSES WORKING IN SELECTED HOSPITALS IN TUMKUR”.
SUBMITTED BY
Mr. ABHILASH.S
1ST YEAR M.Sc.NURSING
MEDICAL SURGICAL NURSING
SRI RAMANA MAHARSHI COLLEGE OF
NURSING
TUMKUR-06
2009-2010
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGLORE,KARNATAKA
Synopsis Proforma for registration of subjects for Dissertation
1. / Name of the Candidate andAddress / MR.ABHILASH.S
1st Year M.Sc., Nursing
SRI RAMANA MAHARSHI COLLEGE OF NURSING
Sira Road
Tumkur
2. / Name of the Institution / SRI RAMANA MAHARSHI COLLEGE OF NURSING
3. / Course Study and Subject / 1st Year M.Sc. Nursing
MEDICAL SURGICAL NURSING
4. / Date of Admission to Course / 01-06-2009
5. / Title of Study / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTERED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PULMONARY REHABILITATION IN COPD AMONG STAFF NURSES WORKING IN SELECTED HOSPITALS IN TUMKUR”.
6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION
Chronic Obsrtuctive Pulmonary Disease(COPD), is a progressive lung disease that affects millions of people each year. COPD is one of the oldest disease. The term COPD was first used by ‘William Briscoc’ in 1965 and it was described in detail by "The Global Initiative For Chronic Obstructive Lung Disease{GOLD}.According to "GOLD", COPD is a disease state characterized by airflow limitation that is not fully reversible.Chronic Bronchitis and Emphysema are common COPDs.
COPD is caused by noxious particle or gas, most commonly from tobacco smoking, which triggers an abnormal inflammatory response in the lung. The inflammatory response in the larger airway isknown as Chronic Bronchitis, which is diagnosed clinically when people regularly cough up sputum .In the alveoli, the inflammatory response cause destruction of the tissues of the lung, a process known as emphysema. The natural course of COPD is characterized by occasional sudden worsening of symptoms called acute excerbations, most of which are caused by infections or air pollution.
The diagnosis of COPD requires Lung Function Test. Important Management strategies are smoking cessation, vaccinaton, rehabilitation and drug therapy{often using inhalers}.Some patient go on to requring long term oxygen therapy or lung transplantation..
Patient and family teaching is an important nursing intervention to enhance Pulmonary Rehabilitation in patient with COPD.
6.1. NEED FOR STUDY
COPD is continuous to be an important cause of morbidity, mortality and healthcare coasts worldwide .Among males tobacco smoking is responsible for more than 80% of patient.
The World health report 2002, listed COPD as the fifth leading cause of death. It is currently ranks number 6 in Global disease impact scale and predicted to rise to number 3 by 20201.
The number of deaths from COPD has increased more than 60% over the last 20 years, and more than 95%of all COPD related deaths occur in people older than age 55.
COPD affects men more than women but men and women die as a result of COPD at about equal rates. COPD is more often fatal in whites than non- whites and in blue-collar workers than white- collar workers.
A study was conducted on COPD prevalence rate in The US. This study shows that 11.4 million people with COPD in The US, including 9.4 million people have Chronic Bronchitis,3.1 million people have emphysema and around 15 million people have undiagnosed case2.
A study was conducted on surveillance of COPD in North India, especially in Industrial population. This study shows that prevalence of Chronic Bronchitis is 12.5% in India between the age group of 17 and 64 years. It is translates into approximately 12 million cases in India alone, and there is need to study the prevalence of COPD, particularly in the rural areas which may be most affected due to their life style3.
So the researchers are decided to conduct a systemic study to assess the structured teaching programme among patient with Chronic Obstructive PulmonaryDisease. This structured teaching programme on management of COPD is very important. Management education which helps the staff nurse to improve their knowledge.
6.2. REVIEW OF LITERATURE
A review of literature relevant to the present study is aimed at identifying knowledge of thestaff nurse regarding pulmonary rehabilitation of COPD patients (Chronic Bronchitis and Emphysema).
Ajay Manal, et al.{2007}conducted a study on COPD: An Indian perspective .In that study shown that the prevalence of COPD in India is 5% in males and 2.7% in females over 30 years of age with male to female ratio of 1.6:1.The incidence and prevalence of COPD increasing as a result of urban ambient air pollution and indoor exposure concentration of particulate of pollution4.
Don-D.Sin, et al. (2007) conducted a study on management of COPD in The US .The objective of this study was to systematically review the impact of long acting bronchodilators, nocturnal non invasive ventillation, pulmonary rehabilitation, domiciliary oxygen therapy, and disease management programme on clinical outcomes in patient with COPD. This study shows that long-acting beta- agonists and anticholinergics {Tiotropium}reduced excerbation rates by approximately 20% to 25% in patient with moderate to severe COPD. Inhaled corticosteroids also reduced excerbation rates by a similar amount. The beneficial effects were most pronounced in trails enrolling patient with FEV1 between 1L and 2L.Combaining a long-acting beta agonists with an inhaled corticosteroids resulted in approximate 30% reduction in excerbations. Pulmonary rehabilitation improved the health status of the patient with moderate to severe disease, but no material effect was observed on long-term survival or hospitalization rates. .Domiciliary oxygen therapy improved survival by approximately 40% in patient withPaO2 lower than 60 MM Hg, but not in those without hypoxia at rest. The data on disease management programmes where heterogeneous ,but overall no effect wasobserved on survival or risk of hospitalization. Non invasive mechanical ventillaton was not associated with improved outcomes5.
Effing T. Maninkhof, et al. (2001) conducted a study on self management education for patient with COPD in The UK. The objective of this study was to assess the setting, methods and efficacy of self management education programme on health outcomes and use of health care services. This study shows that self management education may reduce the risk of hospital admission. This self management education shown to improve the quality of life6.
Jane Reardon, et al.(2005) conducted a study on outcomes of pulmonary rehabilitation for COPD patient in The US. This study shown that the major components of pulmonary rehabilitation such as advice on smoking cessation ,exercize training and patient self management education are beneficial in improving health related quality of life in patient with COPD7.
Robert J. Green,et al. (2007) conducted a study on effective outcomes of the alternative medicines used for emphysema and COPD in TheUS. This study shows that alternative holistic therapies ranging from herbs to homeopathy offer great promise to relieving COPDs debiliating symptoms8.
Sharma.S, et al. (2006) conducted a study on prophylaxis of the COPD and this study shows that antimicrobial agents be used for management of excerbation of COPD9.
WagenaE .J, et al.( 2001) conducted a study on prevention of COPD in The US. The objective of this study was to systematically review the effects of interventions for smoking cessation in people with COPD. This study shows that cassation of smoking prevent delayed or missed diagnosis of COPD. And this study recommends that Behavioural interventions(Eg.Individual counselling) and Pharmacotherapy(Nicotine replacement therapy and non nicotine replacement therapy such as burpropion) are effective aid to smoking cassation in people with mild to moderate COPD10
6.3. STATEMENT OF THE PROBLEM
A study to assess the effectiveness of structured teaching programme on knowledge regarding pulmonary rehabilitation in COPD among staff nurses working in selected hospitals in Tumkur.
6.4. OBJECTIVES OF STUDY
1. To assess the knowledge ofstaff nurses regarding pulmonary rehabilitation of COPD patients.
2.To evaluate the effectiveness of structured teaching programme on pulmonary reahabilitation in COPD patients.
3. To determine the association between the pretest knowledge score ofstaff nurse regarding pulmonary rehabilitationin COPD and selected demographic variables.
4. To prepare an information booklet regardingpulmonary rehabilitation in COPD patientsand selected demographic variables.
6.5. OPERATIONAL DEFINITIONS
1. Assessment: Its refers to the measurement of knowledge of mothers regarding selected water borne diseases and safe practices.
2.Effectiveness : It refers tothe feedback brought about by the staff nurses after structured teaching programmes. It is measured in terms of significant gains in the post test.
3. Staff Nurses: It refers to nurses who are working in selected hospitals in Tumkur.
4. Structured Teaching Programme: Structured teaching programme refers a written meterial prepared by the researcher and content validated by experts.It is designedto provide information regarding pulmonary rehabilitation ofCOPD patients.
5. Pulmonary Rehabilitation in COPD: It refers to a process of caring in giving advise to the patient with COPD
6.6. RESEARCH HYPOTHESES
H1 : The post test knowledge scores of staff nurses regarding pulmonary rehabilitation in COPD patient is significantly higher than their pretest knowledge scores.
H2 : There is significant association between pretest knowledge scores ofstaff nursesregarding pulmonary rehabilitation of COPD patients and selected demographic variables.
6.7. ASSUMPTIONS
1. Staff nurses may have inadequate knowledge regarding pulmonary rehabilitation in COPD patients.
2.STP provides an opportunity for learning and better understanding regarding pulmonary rehabilitation in COPD.
6.8. PILOT STUDY
Pilot study will be conducted with 6 samples in selected area. The purpose of pilot study is to find out feasibility and reliability of the tool.
6.9. VARIABLES
Research variables are the concepts at various levels of abstraction that are entered manipulated and collected in a study.
· Dependent variable : Knowledge.
·Independent variable : STP
7. MATERIAL AND METHODS
7.1. SOURCE OF DATA
Data will be collected fromstaff nurses working inselected hospitals,Tumkur.
7.1.1. RESEARCH DESIGN
Descriptive research design will be chosen for this study.
7.1.2. RESEARCH SETTING
A study will be conducted in a selected hospitals, Tumkur and are present during the study period.
7.1.3. POPULATION
The population for the study is a staff nurses who is working in selected hospitals at Tumkur.
7.2. METHOD OF DATA COLLECTION
The data collection procedure will be carried out after obtaining permission from the concerned authorities.
At first a good rapport will be established with the samples and the purpose of the study will be explained to them. So as to get the co-operation from them. For procedure of data collection.
A “questionnaire” interview schedule will be used for collection of data.
Part I : Questions related to demographic data.
Part II :
Section A : Consist of questions assessing knowledge regarding COPD .
Section B : Consist of questions assessing knowledge on pulmonary rehabilitation.
7.2.1 sampling procedure :
Convenient sampling method will be used for selection of the samples.
7.2.2 sampling size :
This study consists of 60 samples in selected area, Tumkur.
SAMPLING CRITERIA :
7.2.3 inclusion criteria :
1.Staff nurseswho are willing to participate in the study.
2.Staff nurseswho are available during the period of data collection.
3.Staff nurses who are working in selected hospitals in Tumkur.
7.2.4 Exclusion criteria :
1.Staff nurseswho are not willing to participate in study.
2.Staff nurseswho are not available during the study.
3.Staff nurses who are not working selected hospitals in Tumkur.
7.2.5 Tool for data collection :
The tools will be prepared by the investigators for data collection on demographic profile and self structured questionnaire will be prepared to collect the data regarding knowledge on pulmonary rehablitation in COPD patients.
7.2.6 Data Analysis method:
Descriptive statistics: Frequency, mean, mean percentage and standard deviation, Were used analyzing the Demographic variables and knowledge score.
Inferential statistics:
Chi square were used associate the relationship betweenknowledge and Demographic variables.
7.2.7 Time and Duration:
Time and duration of study will be as per the guidelines of the university..
7.3 Does the study require any intervention to be conducted on patient or other Humans or Animals?
Since the study is descriptive study, interventions are not required.
7.4 Has ethical clearance been obtained from your institution incase of 7.3?
Yes, the pilot study and main study will be conducted after the approval of research committee. Permission will be obtained from the concerned head of the family. The purpose and after details of the study will be explained to the study subjects and assurance will be given regarding confidentiality of data collected
8. LIST OF REFERENCES
1. Brunner and Suddarths .Medical Surgical Nursing. 10 edition. Lippincott-Raven publishers: 2004
2. Christian Gingter. Prevalence and Incidence of COPD in The US :.2008
3. Joshi. R.C. . A Survey for prevalence of Chronic Bronchitis is an industrial population in North India : 2005
4.Ajay Manal et al. : Disease burden in India :2003
5. Don –D. Sin.- et al -Contemporary management of COPD : 2003
6. . Effing T . Maninkhof , et al –Self management education for patient with COPD : 2007
7. Jane Reardon , Richard Casaburi ,Michael Morgan , et al – Pulmonary Rehabilitation for COPD -2005
8. Robert J . Green et al- Natural therapies for emphysema and COPD: Relief and healing for COPD. 2007.
9. Sharma S , et al,-. Role of antimicrobial agents in the management of excerbations of COPD, 2006
10.Wagena E. J., Van Der Meer R , M, ,Ostelo R. J. W. G., et al , Smoking cessation in patient with COPD -2001
9. / Signature of the candidate10. / Remarks of the guide / Can be accepted
11. / Name and designation of (in block letters)
11.1. Guide / Mrs Suneetha.C.J
Prof and HOD
Med-Surg-Nursing
11.2. Signature
11.3. Co-guide (if any)
11.4. Signature
11.5. Head of the Department
11.6. Signature
12. / 12.1. Remarks of the chairman and principal : Can be approved
12.2. Signature
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