RAJIV GANDHI UNIVERSITY OF HEALTH AND SCIENCES
BANGALORE – KARNATAKA
Performa synopsis for registration of subject for dissertation
SUBMITTED BY:
Mrs.DIVYA.K.A
M.SC. Nursing 1st Year
Medical Surgical Nursing
Sneha College of Nursing
RAJIV GANDHI UNIVERSITY OF HEALTH AND SCIENCES
BANGALORE – KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / Name of the Candidate & Address / Mrs.DIVYA.K.A1st Year M.Sc. (Nursing)
SNEHA COLLEGE OF NURSING
NO.97, 5th Main. I stage, I Block, HBR Layout, Bangalore – 43
2 / Name of the Institution / SNEHA COLLEGE OF NURSING
3 / Course of study and subject / M.Sc. Nursing 1st year
MEDICAL SURGICAL NURSING
4 / Date of admission to course / 01/07/2011
5 / Title of the topic / “A STUDY TO ASSESS THE IMPACT OF SELF INSTRUCTIONAL MODULE (SIM) ON KNOWLEDGE REGARDING THE PREVENTION OF HYPERTENSION AMONG IT( INFORMATION TECHNOLOGY) EMPLOYEES AT SELECTED COMPANY IN BANGLORE”
6 / Brief resume on intended work
6.1: Need for the study
6.2: Review of Literature
6.3: Objectives of the study
6.4: Hypothesis / ENCLOSED
ENCLOSED
ENCLOSED
ENCLOSED
7 / Materials and Methods:
7.1: Sources of Data: Data will be collected from the employees working in
Selected IT company in Bangalore.
7.2: Method of Data Collection: Self administered questionnaire method
7.3: Does the study require any investigation or intervention to be carried out on
the patients or human or animals?
NO
7.4: Has ethical clearance been obtained?
YES
6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
“Awareness of risk factors and the need for screening can go a long way toward early
detection andpreventionof hypertension.”
~Allan Collins.
Hypertension is the commonest cardiovascular disorder and a chronic condition of concern due to its role in the causation of coronary heart disease, stroke and other vascular complication. Hypertension is a disease of vascular regulation in which the mechanisms that control arterial pressure within normal range are altered and why this mechanism fail is not known. The basic explanation is that pressure is elevated when there is increased cardiac output plus increased peripheral vascular resistance.1
Hypertension is an interesting disease entity of its own. It remains silent, being generally asymptomatic during its clinical course. As it is hidden beneath an outwardly asymptomatic appearance, the disease does immense harm to the body in the form of 'Target Organ' damage; hence, the WHO has named it the 'Silent Killer'2.
Worldwide, raised blood pressure is estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths. This accounts for 57 million disability adjusted life years (DALYS) or 3.7% of total DALYS. Raised blood pressure is a major risk factor for coronary heart disease and ischemic as well as hemorrhagic stroke. Blood pressure levels have been shown to be positively and continuously related to the risk for stroke and coronary heart disease.3
Globally, the overall prevalence of raised blood pressure in adults aged 25 and over was around 40% in 2008. The proportion of the world’s population with high blood pressure, or uncontrolled hypertension, fell modestly between 1980 and 2008. However, because of population growth and ageing, the number of people with uncontrolled hypertension rose from 600 million in 1980 to nearly 1 billion in 2008.Across the WHO regions, the prevalence of raised blood pressure was highest in Africa, where it was 46% for both sexes combined. Both men and women have high rates of raised blood pressure in the Africa region, with prevalence rates over 40%. The lowest prevalence of raised blood pressure was in the WHO Region of the Americas at 35% for both sexes. Men in this region had higher prevalence than women (39% for men and 32% for women). In all WHO regions, men have slightly higher prevalence of raised blood pressure than women. This difference was only statistically significant in the Americas and Europe3.
According to Indian studies it is noted that the prevalence of hypertension has increased by 30 times among the urban population over a period of 55 years and about 10 times among the rural population over a period of 36 years. It is further more common amongst people from upper social class because of the presence of multiple factors such as sedentary jobs, lack of physical activity, rich diet, alcohol intake, smoking, obesity and disease like diabetes mellitus. . In some age groups, the risk of cardiovascular disease doubles for each increment of 20/10 mmHg of blood pressure, starting as low as 115/75 mmHg.2
The problem which lies with the hypertension is that it cannot be cured completely. And its management requires lifelong medication with some life-style modifications. The only way to curb the problem of hypertension is by its prevention. Decreased physical activities coupled with increased mental tension are important contributors of hypertension. They are commonly seen amongst employees of the profession where working is mostly sedentary. Therefore, higher prevalence of hypertension is reported from employees of such profession. Since IT employees work is of sedentary in nature with more of work related tension hence, this present study is planned among IT employees.3
6.1: NEED FOR THE STUDY
Hypertension is an area of concern in public health because the condition has the potential to affect a large segment of the population. Finding effective ways to educate the public about hypertension is one method of preventing or treating the condition4.
A study reported prevalence of hypertension varied around the world, with the lowest prevalence in rural India (3.4% in men and 6.8% in women) and the highest prevalence in Poland (68.9% in men and 72.5% in women). Awareness of hypertension was reported for 46% of the studies and varied from 25.2% in Korea to 75% in Barbados; treatment varied from 10.7% in Mexico to 66% in Barbados and prehypertension varied from 5.4% in Korea to 58% in Barbados. Thus study concluded that hypertension is an important public health challenge in both economically developing and developed countries. Significant numbers of individuals with hypertension are unaware of their condition and, among those with diagnosed hypertension, treatment is frequently inadequate. Measures are required at a population level to prevent the development of hypertension and to improve awareness, treatment and control of hypertension in the community.5
A study in India on 1000 adult in the age group of 20-60 years (Tirupati, A.P) revealed that prevalence of hypertension was found to be 8.6%. Out of the 86 hypertensive’s, 72 (83.7%) were aware of their hypertension; all of those aware were under treatment. Higher prevalence of hypertension was found with history of cerbrovascular/cardiovascular events (50.0%), diabetes mellitus (33.3%), family history of hypertension (23.3%), smoking (22.4%), age more than 50 years (22.2%), alcohol intake (20.0%), lack of physical exercise (15.8%), B.M.I.>25 (14.9%), male sex (9.6), non-vegetarian diet (8.8%) and saturated fat intake (8.8%). Despite treatment, most of the hypertensive’s had not achieved satisfactory control of blood pressure. Health education of the public is needed to control the various risk factors of hypertension.6
A recent survey revealed that there is high prevalence of systolic hypertension at advanced age in India such as from Parsi community in Western India (73% in age group equivalent to 70 years), among Kerallite (51.8%) from South Indiaand Assamese (63.63% for people above 60 years of age) from North eastern India . Thus the survey has recorded a high prevalence of hypertension. Systolic hypertension has been considered to be one of the most important cause of morbidity and mortality leading to cerebrovascular stroke, cardiovascular and renal diseases.7
A research report of University of Miami shows that a total of 841 healthy men and women aged 25 to 49 years, with diastolic blood pressures of 78 to 89 mm Hg, half were randomly assigned to a control treatment group (no Dietary counseling) and rest half with dietary counseling treatment groups (reduced calories, reduced Sodium and increased potassium).All dietary counseling treatment groups had lower mean blood pressures than the control group. And report concluded that the protective effect of dietary counseling include a reduction in the incidence of hypertension and improve the sense of wellbeing of patient and often less expensive.8
A study conducted in France with 397 participants examined the effect of changes in alcohol consumption on blood pressure. Overall, interventions to reduce alcohol consumption caused small but statistically significant reductions in both systolic (3.4 mmHg) and diastolic (3.4 mmHg) blood pressure . And concluded that prevalence and level of hypertensionindicate that these populations may benefit by decreasing the alcohol consumption.9
A study conducted in Surat in 2011 revealed that prevalence of hypertension was significantly higher 35.7% (148) among employees consuming mixed food as compared to those who reported vegetarian food 21.3% (230). Risk of having hypertension was more than twice among employees consuming mixed diet than others. The same study revealed that risk of getting hypertension among smoker was 1.3 times higher than non smoker. Risk of getting hypertension among past smoker was 1.8 times higher than current smoker. Risk of getting hypertension among regular smoker was 1.6 times higher than occasional smoker. Risk of getting hypertension among heavy (≥ 36 cigarette / week) smoker was 1.8 times higher than light (7-35 cigarette / week) smoker. Risk of getting hypertension among employees who were smoking since long duration (> 10 year) was 2.2 times higher than smokers of short duration (≤10 year).10
A study in India revealed that prevalence of hypertension was lower among employees observing healthy habit like walking, jogging, swimming, sports etc. Prevalence of hypertension found significantly higher among employees who was not having any healthy habit like walking, jogging, exercise; it was found to be 28.7% excluding patient on treatment (P<0.01). Chances of getting hypertension were 1.56 times higher among employees who were not doing any kind of exercise than others.11
The studies advised 420 participants to change their diet so as to restrict their sodium intake to below 70-100 mol/day (4.2 - 6.0g of salt). The Scientific Advisory Committee on Nutrition target for all adults is 6 grams/day. Sodium reduction was associated with a statistically significant reduction in systolic (3.4 mmHg) and diastolic (2.2 mmHg, ) blood pressure. Twenty-three percent of patients who reduced their salt intake were likely to show at least a 10 mmHg reduction in systolic blood pressure. And concluded that it would have a beneficial effect on preventing cardiovascular disease independent of and additive to the effect of salt reduction on blood pressure.12
A study conducted a medical camp for over 2,000 staff of a reputed information technology (IT) company in Pune. The camp found more than 80% of the employees showed symptoms of high blood pressure because of hectic work schedule and sedentary life style. The study revealed that the effect is similar in the other cities like Bangalore, Hyderabad and Chennai, a hub for IT, BPO and education. And concluded that sedentary lifestyles are linked to the metabolic syndrome in its totality, not only to hypertension, which suggests the existence of a common mechanism, such as weight gain13.
Hypertension cannot be cured, but it can be controlled through lifestyle changes and prescriptive medication. While medications to treat hypertension are available, research has shown that modest lifestyle and dietary changes can help treat and often delay or prevent high blood pressure .People trying to control hypertension often are advised to decrease sodium, increase potassium, watch their calories and maintain normal body weight14.
Bangalore is clustered with IT companies and new companies are still sprouting. So here one tenth of total population is IT employees with sedentary life style. Therefore I as a nurse researcher felt that the above studies and regarding factors are pathway for me to select this problem statement. Through this I can assess the impact of knowledge of self-instructional module regarding diet, exercise and lifestyle modification among IT employees which will help them to prevent hypertension and lead to a healthy life.
6.2: REVIEW OF LITERATURE
It is a process of reading, analyzing, evaluating, and summarizing scholarly materials about a specific topic that is prevention of hypertension. Many research studies are under way to understand the prevention of hypertension. Overweight and obesity, sedentary lifestyle, high sodium intake, physical inactivity, heavy alcohol intake, low potassium intake, and a Western-style diet make up the major factors for hypertension. The literature supporting the associations between these factors and hypertension is well established below.
In 2006,the successive reports of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of Hypertension, WHO scientific report on primary prevention of essential hypertension and national High Blood Pressure Education Program's working groups report on primary prevention of hypertension have stressed on the non-drug therapy. Today a busy family physician does not spend enough time to explain to the patient various dietary and lifestyle modifications but straightaway prescribes the drugs. Every patient of hypertension from the stage of pre-hypertension to grade 2 hypertension should follow non-drug therapy. If non-drug therapy is strictly adhered, one can prevent cases of pre-hypertension from progressing to hypertension stage and one can reduce or stop the medications in Grade I (mild) hypertension. We have discussed the role of low salt, high potassium diet, role of caffeine intake, calcium and magnesium supplements, fish oil intake, cigarette smoking, alcohol consumption, role of physical exercise, stress reduction and bio-feedback, yoga, meditation and acupuncture. These recommendations regarding diet and lifestyle modifications should be targeted to population at large through public health authorities, non-government organizations and news media15 .
A similar study conducted by Joint National Committee on Prevention, Detection, Evaluation and Treatment of Hypertension on 135 healthy young adult <40 years of age and out of 73 of sedentary lifestyle adults have hypertension were as 24 adults who are physically active compared to them have normal blood pressure. This study concludes that sedentary individuals are characterized by increase in blood pressure relative to their endurance-trained peers, independent of changes in conventional risk factors for cardiovascular disease. These findings lend further support for the need for regular physical activity in the prevention of hypertension in individuals of all ages.16