SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
HIMA K.B.
IST YEAR M.Sc. NURSING
MEDICAL SURGICAL NURSING.
YEAR 2011-2012.
VSS COLLEGE OF NURSING,
NAGADEVANAHALLI, BANGALORE, KARNATAKA.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / HIMA K.B.IST YEAR M.Sc. NURSING
VSS COLLEGE OF NURSING,
BANGALORE, KARNATAKA.
2 / NAME OF THE INSTITUTE / VSS COLLEGE OF NURSING,
BANGALORE, KARNATAKA.
3 / COURSE OF THE STUDY AND SUBJECT / IST YEAR M.Sc. NURSING,
MEDICAL SURGICAL NURSING.
4 / DATE OF ADMISSION TO THE COURSE / 13- AUGUST – 2011
5 / TITLE OF THE STUDY / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING ANTIBIOTICS AMONG THE PATIENTS ATTENDING THE OPD IN SELECTED HOSPITAL, BANGALORE”.
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
And while we are on the subject of medication you always need to look at risk versus benefit.1
~Temple Grandin
Antibiotics are among the most frequently prescribed medications in modern medicine. The world becomes a smaller place with viruses, bacteria and other pathogens travelling with great ease which lead us to be more exposed to challenges to our health. They exist all around us and can be transmitted from person to person by direct contact, inhalation of infected air and consumption of contaminated food or water. It may causes infectious disease when the body invaded by microbes and the body having little or no natural immunity to the invading microorganism, or the number of invading microbes is too great for the body’s immune system to overcome. They mostly treated by using antibiotics.
Antibiotics are a class of drugs used to treat bacterial infection where they destroy bacteria (bactericidal) or prevent bacteria from multiplying (bacteriostatic). Antibiotics are vital in today's medical practice, even though as with all medications, there may be some side effects which overall, are outweighed by the benefits. However, we now have come to understand that overuse or misuse of antibiotics can result in bacteria developing ways of resisting the effect of the antibiotics on them. Knowledge on antibiotics Chemical structure, Mechanism of action, Type of organism against which primarily active, Spectrum of activity, Origin of antibiotics plays an important role among health care professional in the better management of patients condition. Doctors try to prevent the development of antibiotic resistance by selecting the drug most likely to eliminate the bacteria present in each individual case as quickly and as thoroughly as possible. Failure to complete a course of antibiotics that has been prescribed by doctor increases the likelihood that the infection will recur in a resistant form.2
Antibiotic resistance has been described by the World Health Organization as a major global health problem that needs urgent action. This is largely due to inappropriate use and overuse of antibiotics. A number of studies have found gaps in public knowledge about antibiotics. These misunderstandings may contribute to inappropriate prescribing, as patients’ expectations create a major pressure on prescribers to provide antibiotics inappropriately.
As a consequence, calls to reduce antibiotic use and thereby control the development of resistance often include public education and information campaigns. Some authors have suggested that people need to be educated about antibiotics and education programs have been developed. The most efficient way to organize such education would be in hospitals. Currently, staff nurses may contribute to forming their patient’s knowledge, beliefs and expectations about antibiotics in their health teaching, and in interaction with individuals who are taking antibiotics. Hospitals are both places where people get treatment and places where they learn about health, medicines and diseases.3
Antibiotics are powerful medicines that fight bacterial infections. If used properly, antibiotics can save lives. They either kill bacteria or keep them from reproducing. If a virus is making you sick, taking antibiotics may do more harm than good. Each time of take, the body could get or spread an infection that those antibiotics cannot cure.2
6.1. NEED FOR THE STUDY
Overuse of antibiotics has led to the creation of drug-resistant bacteria — so-called superbugs, like methicillin-resistant staphylococcus aureus. But now some researchers are exploring an equally unsettling possibility: Antibiotic abuse may also be contributing to the increasing incidence of obesity, as well as allergies, inflammatory bowel disease, asthma and gastroesophageal reflux. Antibiotics are permanently altering microbial flora of the human body with serious health consequences.4
Antimicrobial resistance is a rapidly increasing problem in India and worldwide. A well-documented risk factor for infection or colonization with resistant bacterial pathogens is recent antibiotic use, particularly within 4 weeks or 1 month before exposure. As a result, one of the primary strategies to prevent and control the emergence and spread of resistant organisms is to reduce the selective pressure of overuse and misuse of antibiotics in human medicine .5
We already have evidence of the effects of antibiotic resistance in India. A 2009 World Health Organization study found that 58.7 percent of pathogenic E.coli samples in Delhi were resistant to the common antibiotic ciprofloxacin1. In intensive care units in India, the rate of vancomycin-resistant enterococcus (VRE), a hospital acquired infection, is five times the world average. When treatment with first-line antibiotics fails, patients have to turn to more powerful, more expensive drugs. In addition, sometimes these drugs fail, too. Antibiotic resistance leads to higher treatment costs, longer hospital stays, and in some cases, death. For example, our rough estimate is that 119,000 of the one million children who die each year in India within the first four weeks of life die from sepsis, or a bacterial infection that overwhelms the blood stream. Of these sepsis deaths, over 30% are attributable to antibiotic resistance. Resistance is driven by antibiotic use, and antibiotic overuse speeds its development. In India, we see numerous examples of such overuse. India is behind many other countries in regulating the use of antibiotics in livestock, as there are currently no laws prohibiting the use of antibiotics in food animals. Additionally, people often take antibiotics when they are not needed. Between 45 and 80 percent (depending on where they live and the type of practitioner they visit) of patients in India with symptoms of acute respiratory infections and diarrhoea are likely to receive an antibiotic, even though it will not be effective if they have a viral illness.
Research conducted by the GARP-India working group shows that there is much that India can do to address antibiotic resistance. Recommendations include limiting the use of antibiotics in livestock, strengthening hospital infection control, and educating health practitioners and the public about the dangers of antibiotic misuse.6
Several studies have identified and examined specific causes of the misuse of antibiotics, including unnecessary prescribing and patient demand. Factors contributing to inappropriate prescribing practices have been elucidated. In particular, numerous studies of adults have shown that patients’ expectations or physicians’ perceptions of those expectations affect the physicians’ prescribing behaviour.
To solve the problem of antibiotic misuse, a more thorough understanding of what influences the development and expression of patients’ expectations must be gained. Understanding patients’ knowledge, attitude, and practices may facilitate more effective communication between the clinician and patient, as well as aid in the development of strategies to educate patients and the public. Several lines of evidence suggest educational interventions directed at patients and clinicians can increase patients’ knowledge and awareness, as well as reduce the frequency with which clinicians prescribe antibiotics inappropriately.
Few studies have examined patients knowledge regarding antibiotic. The current study is an attempt to promote knowledge and awareness among patients regarding antibiotic by means of a structured teaching programme. The information obtained from this study will provide further insight for the development and evaluation of health education and prevention strategies.5
6.2. REVIEW OF LITERATURE
Review of literature is a systematic search of published work to gain information about a research topic. Through the literature review researcher generates a picture of what is known about a particular situation and the knowledge gap that exists between the problem statement and the research subject problems and lays a foundation for the research plan.7
Here the review of literature of the present study has been divided under the following areas.
1. Literature related to knowledge regarding antibiotics.
2. Literature related to effectiveness of educational programme on knowledge regarding antibiotics.
3. Literature related to Effectiveness of the structured teaching programme
1. Literature related to knowledge regarding antibiotics
Maria M Azevedo, Céline Pinheiro, John Yaphe and Fátima Baltazar (2009) conducted a cross-sectional study on Portuguese students' knowledge of antibiotics: in secondary school and university students in Braga. In this cross-sectional study, a questionnaire about antibiotic use was given to a sample of students in the 9th and 12th grades of secondary school and in the first year of university in the north of Portugal. 349 students returned completed questionnaires. Deficits were found in the students' knowledge of antibiotics and their correct use. Only 4% of 9th grade students, 14% of 12th grade students and 29% of first-year university students were aware that antibiotics are used to treat bacteria only. Fewer students were aware that antibiotics are used to treat tuberculosis. There were deficiencies in the knowledge of timing and duration of therapy. However close to 70% of these students are aware that inappropriate use of antibiotics can contribute to resistance to these drugs. This study has observed a lack of general knowledge on correct antibiotic use in Portugal, as has been found in other countries. Since this may be due to a lack of formal education on this subject, they concluded that a teaching unit on infectious diseases should be included in the in all curricular areas. In addition, education on the correct use of medications may need to begin at much earlier ages. 8
Neeta Parimi, Lexley MP Pereira and P Prabhakar (2004) conducted a cross-sectional study on Caregivers' practices, knowledge and beliefs of antibiotics in pediatric upper respiratory tract infections in Trinidad and Tobago. Children's adult caregivers gave a telephone interview and were scored on an antibiotic knowledge test and divided based on their score. Differences between those with high and low scores were compared using the chi-square test. Of the 417 caregivers, 249 (60%) respondents scored high (≥ 12) on antibiotic knowledge and 149 (34%) had used antibiotics in the preceding year. More caregivers with a high knowledge score had private health insurance (33%), (p < 0.02), high school education (57%) (p < 0.002), and had used antibiotics in the preceding year (p < 0.008) and within the last 30 days (p < 0.05). Caregivers with high scores were less likely to demand antibiotics (p < 0.05) or keep them at home (p < 0.001), but more likely to self-treat with antibiotics (p < 0.001). Caregivers administered antibiotics in 241/288 (84%) self-assessed severe episodes of infection (p < 0.001) and in 59/126 (43%) cough and cold episodes without visiting a health clinic or private physician (p < 0.05). the study concluded that caregivers scoring low on antibiotic knowledge have erroneous beliefs and use antibiotics inappropriately.9
Moni Rani Saha, Shammy Sarwar, Manik Chandra Shill and Mohammad Shahriar. (20110) conducted a cross-sectional Study on patients' knowledge and awareness towards use of antibiotics in Bangladesh to find out possible reasons of irrational use of antibiotics on 350 subjects. It was found from the study that the general knowledge of the patients about the indication of antibiotics was very poor. Only 26% respondents answered correctly that antibiotics are indicated for bacterial infections. In addition, 38.97% of them also did not know that an antibiotic is a prescription drug and should not be used without doctor’s prescription. The awareness about the patients towards use of antibiotics was also poor. A very high percentage of the patients (51.71%) answered that they do not complete the full course of therapy. 39.14% of the patients replied that they stop antibiotics when the symptoms disappear and remarkably 14.29% just make the dose double if they forget to take due dose. On the other hand, 28.86% of the patients said that they do not maintain dosing schedule during the course of therapy. Moreover, prevalence of self-medication with antibiotics in cold and fever was also extremely high (60.86%). This study indicates that there is an urgent need of health education for the community to increase knowledge and awareness about use of antibiotics to decrease the self-medication and inappropriate use of antibiotics.10
Jacqueline Lule Nambatya, Sarah Nyairo, Micheal Bironse, Samantha Kacwiya et al. (2010) conducted a study to evaluate the knowledge, attitude and behaviour of antibiotic usage in two student groups at Makerere University in Uganda. 1000 were asked to participate by filling a self administered questionnaire. The sampling group was divided into Group A which included students from the College of health sciences and Group B made of students of other faculties. The use of antibiotics to avoid illness was reported by 24.0% in Group A and 31.8% in Group B (P< 0.05). When asked the course of action if they felt the antibiotic being used was not helpful, 35.1% in group A and 50.6% in B said they would go back to the same health care worker for advice while 1.4% and 9.9% respectively would switch health care provider. The most common symptoms reported as the primary reason for antibiotic use was cough at 16%, followed by sore throat at 7.1% and common cold at 6.1%. They concluded that the high reliance on health care personnel for prescription was rather encouraging and it gives health workers a window of opportunity to promote rational antibiotic use when prescribing to patients. However, for this to materialize the health workers must be aware of antibiotic resistance and ways to combat it. Therefore constant training and encouragement must be given to the health care workers and the public.11
Osborne, D. and Sinclair, H. (2006) conducted a study on Public knowledge, attitudes and behaviour regarding antibiotics: does five years make a difference? to compare patient knowledge, attitudes and behaviour regarding antibiotic use between 2000 and 2005.Postal survey method was used to gather the data from 400 patients. There was a 64% response rate; the results showed that 90% had experience of antibiotic use and 96% were happy to take antibiotics when necessary; 75% felt we should be more careful about how we use antibiotics. Compared to 2000, fewer patients indicated that most infections clear up by themselves without the need for antibiotics (48% versus 59%, P = 0.031). Fewer patients now agreed that telephone helplines for advice is a good idea (42% versus 54%, P = 0.009), while more felt that people should make more use of their local pharmacist for advice on treatments for RTI and that they, themselves, would consult a pharmacist. On advice (from doctors, pharmacists or advertisements) on the management of RTI. More patients cited: self-medicate (non-paracetamol) (32% versus 15%, P = 0.004); let infection run its course (11% versus 5%, P = 0.027). Conclusions from the study was that antibiotic use remains a concern for many patients. 12