RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
“A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME ON KNOWLEDGE REGARDING FOOT CARE AMONG DIABETIC PATIENTS IN SELECTED HOSPITALS AT BANGALORE”
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
SUBMITTED BY:
Ms. SIREESHA RANI KOTTALA
I YEAR M.Sc. NURSING
MEDICAL SURGICAL NURSING
SRI SHARADA COLLEGE OF NURSING
BANGALORE- 560061.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATEAND ADDRESS / Ms. SIREESHA RANI KOTTALA
I YEAR M.Sc NURSING,
SRI SHARADA COLLEGE OF NURSING,
BANGALORE-560061.
2 / NAME OF THE INSTITUTION / SRI SHARADA COLLEGE OF NURSING,
UTTARAHALLI MAIN ROAD,
BANGALORE-560061.
3 / COURSE OF STUDY AND SUBJECT / I YEAR
MASTERS DEGREE IN NURSING
MEDICAL SURGICAL NURSING
4 / DATE OF ADMISSION TO COURSE / 25.06.2012
5 / TITLE OF THE STUDY / "A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME REGARDING FOOT CARE AMONG DIABETIC PATIENTS IN SELECTED HOSPITALS AT BANGALORE"
6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
Diabetes Mellitus is a group of metabolic disorders characterized by elevated levels of glucose in the blood (hyperglycemia), resulting from defects in insulin secretion, insulin action or both.American Nurses Association expert committee and classification of diabetes mellitus (2003).1
There are currently 285 million people living in with diabetes worldwide, and the number of affected people is predicted to reach 438 million people by 2030. Because of the rapid increase in diabetes prevalence, the number of diabetes compilation is rising equally quickly. Amputation is one of the most feared of these complication, people with diabetes are at risk for nerve damage and problem with the supply of blood to their feet.2
According to WHO report India today heads the world with over 32 million diabetic patients and this number is projected to increase to 79.4 million by the year 2030. Recent survey indicative the diabetes now affects a staggering 10-16 % of urban population and 5 – 8 % of rural population in India. There is very little data on the level of awareness and prevalence about diabetes in developing countries like India such data is important to plan the public health programme.3 Diabetes foot disease is a major burden for both the individual and health care system.4
High level of blood sugar can damage nerves or blood vessels, nerve damage from diabetes can cause to lose feeling in foot patient may not feel a cut ,a blister, or a sore, feet injuries such as these can cause ulcer and infections. Serious causes may even lead to amputation. Damage to the blood vessels can also mean that feet do not get enough blood and oxygen.5
Diabetes has emerged as one of the world’s biggest health problems and its prevalence is increasing at an alarming rate. People with Diabetes who want to live their lives without limits will need to know a lot about their illness.6
Comprehensive patient education is required to provide the patient with the self management skills necessary to prevent complications. Epidemiologic data indicate that, large number of patients does not receive the proper care or education necessary to develop such self management abilities. In order to convey the importance of patient education, the American Diabetes Association (ADA) has labeled self management education as the corner stone therapy for the patient with Diabetes.6
The National Standards for Diabetes Self-Management Education defined patient education as “an exchange of knowledge, tools, and practices that will address the client’s needs”. These standards state that, Diabetes education results in more informed choices and beneficial changes in behavior which, in turn, improves clinical parameters and reduces the risk of complications associated with Diabetes.7
Diabetic foot problems are the commonest cause of hospital admission with Diabetes-related problem. Despite this, lack of attention to foot-related problems remains an issue in many clinics, and many amputations are potentially avoidable. Management of the Diabetic foot requires knowledge and practical skills in a number of different key areas.8
6.1. NEED FOR THE STUDY:
More than one third (33%) of Diabetic patients were found to be at high risk for future foot ulceration (IWGDF Group 2 & 3). Published evidence shows that diabetes at high risk of foot ulceration. Long term prospective studies to determine out comes for the different risk categories should be carried out locally.9
Foot ulcers due to neuropathy or ischemia, often complicated by infection, are a leading cause of hospitalization and amputation in diabetic patients. Sensory neuropathy, foot abnormality, missing pulses and previous history of ulcers or amputation are risk factor for ulceration. Regular Examination of Feet and protective footwear reduce this risk. Podiatric Services, decreases amputation by up to 85%.10
Many diabetic patients were not offered adequate foot specific information during group lectures, even those with education in foot care practices is important, and systems of networked multidisciplinary professionals are believed to be needed, particularly in delivering customized interventions to at risk patients based on the initial evaluation.11
Although several organizations have emphasized the need to increase awareness of this problem and called health care providers to action on decreases the incidence of ulceration and amputation, there is limited evidence regarding what interventions are best suited to accomplish this goal. 12
In a study found One third of diabetic patients had poor knowledge about foot care and only very few patients had good practices for foot care. Literacy has significant association with the knowledge and practices related to foot care in diabetic patients. In the present setting the OPD / in patient had lack of knowledge regarding diabetes and diabetic Foot care, Foot Ulceration and Amputation. 12
A study regarding the incidence of foot ulceration and amputation in diabetes shows that the incidence of foot ulcers range from 1.0% to 4.1% and lower extremity amputation range from 2..1 to 13.7 per 1000.13 To reduce these complications several preventive strategies have been devised for reducing risk factors, improving treatment and management and providing teaching programme for to Educate diabetic clients.13
Diabetes self management education (DSME) has gained in importance over the past decade as research has documented the benefits of such interventions in improving glucose control and reducing Diabetes related complications. Unless education is imparted and awareness is created among people it is difficult to control the epidemic of Diabetes. Diabetes education, awareness and improving motivation for self care not only enhance care and reduce the burden of complications but also indirectly reduce the overall economic costs of Diabetes. The evidence on the impact of education on people with Diabetes is found to be very much effective. 14
Foot problems in a person with Diabetes are one of the most common complications seen in India. The morbidity, and sometimes, the mortality, associated with these complications are immense not only from the purely medical viewpoint, but also from the socioeconomic and psychological aspects. In fact, it has been shown that after accidents, Diabetes associated foot problems are the second most common cause of lower limb amputations in India.15
The various studies also suggest that the educational programs had a long term effect on the patients which is reflected in their overall disease management. Patient himself, who needs to be empowered to take the responsibility for his/her own health care rather than relying on others.16
6.2. REVIEW OF LITERATURE:
A Study conducted in Altair’s medical center, examined the causal pathway for lower extremity amputation in patients with diabetes has identified the most common sequence of events 73% of the amputation in the study subjects were result of the causal sequence of minor trauma, cutaneous ulceration, and wound healing failure. 86% of amputations were attributed to initial minor trauma causing tissue injury. And also the study noted above foot trauma was caused by shoe-related repetitive pressure leading to cutaneous ulceration in 36% of all causes, accidental cuts or wounds in 8% thermal trauma in 8% and decubitus ulceration in 8%.13
A study result showed that primary care physicians in the intervention group conducted more examinations of lower extremities for to identify the person at risk for and referred them for podiatric care. Patients in the intervention group received more patient education made more changes in appropriate self care behaviors and had fewer shot term foot problems than patients in the control group.17
Study findings showed that 43% of patient with a history of foot ulcer could not reach and remove simulated lesions on their toes, over 50% of the older subjects reported difficulty trimming their toe nails and only 14% had sufficient joint flexibility to allow inspection of the plantar aspect of foot. The investigator concluded that elderly people who care of the feet would benefit more from regular feet care given by others then from intensive education Exercise.18
A study shows physicians do not provide adequate care to the feet of their diabetic patient irrespective of the presence for diabetic foot ulceration and amputation. So continuing medical education to health care providers emphasizing adequate “care of the foot” of the diabetic patient also will reduce loss of limb due to diabetes.19
A study was conducted among 148 persons with type 2 diabetes to know their knowledge about foot care and their personal foot care behavior by using a 32 item designed structured interview questionnaire.Each participant in the study received a single 20 min face to face individual education session. The study result shown that the applied educational intervention has improved their knowledge and practice about diabetic foot care. And also the knowledge and practice scores were increased significantly after the education in the lean group (BMI< or =25) rather than the obese ones.20
A study was conducted to evaluate the medium-term effectiveness of a group educational intervention in primary care aimed at improving attitudes and skills in self-care of the feet among 76 patients with type 2 Diabetes, and to determine the optimal time for Re intervention. They performed a two group education sessions with a 24-month follow-up. The mean age was 66 years and 51% were men. Skills performance before-after (8 months) the intervention were as follows: correct hygiene 41%-86%, good-medium hydration 80%-97%, daily foot washing 42%-68%, proper tools use 41%-79%, proper shoes 9%-33%, proper nails 26%-74% (all differences with p < 0.001). The intervention improved all the skills studied. Group education favors skills improvement. They suggested repeating the intervention every 24 months will be effective.21
A study to assess the effectiveness of patient education on the prevention of foot ulcers in patients with Diabetes Mellitus was conducted. Nine Randomized control trials were included. Four trials compared the effect of intensive with brief educational interventions; two of these reported clinical endpoints. One study involving high-risk patients reported a reduction in ulcer incidence [Peto OR: 0.28 (95% CI 0.13 to 0.59)] and amputation rate [Peto OR: 0.32 (95% CI 0.14 to 0.71)] after one year. Participant’s foot care knowledge significantly improved with education in two trials. Evidence suggests that patient education may reduce foot ulceration and amputations, especially in high-risk patients. Foot care knowledge and behavior of patients seem positively influenced by patient education in the short term.22
STATEMENT OF THE PROBLEM:
“A study to assess the effectiveness of video assisted teaching programme on knowledge regarding foot care among diabetic patients in selected hospitals at Bangalore”
6.3. OBJECTIVES OF THE STUDY
1. To Assess the Level of Knowledge about Foot care among Diabetic patients.
2. To evaluate the effectiveness of video assisted teaching programme by comparing the
Pretest and post test knowledge.
3. To associate the pre test knowledge score of diabetes Patients about foot care with their selected socio demographic variables.
OPERATIONAL DEFINITIONS:
1. Assess: Measure the level of knowledge about the Foot care among diabetic patients.
2. Effectiveness: Increase in knowledge scores of participants after a video assisted teaching programme regarding foot care.
3. Video assisted teaching programme: It is a planned teaching programme about foot care by using the video assisted techniques to educate the diabetic patients which was prepared by the investigator.
4. Knowledge: It’s the information regarding the foot Care for diabetic patients.
5. Foot care: Special care given to the foot of diabetic client to prevent the occurrence of foot ulcer.
HYPOTHESIS:
H1: There will be a significant difference between pre and post test knowledge scores of diabetic patients regarding the foot Care.
H2: There will be a significant association between the levels of knowledge regarding foot care
of diabetic patients with their selected Socio- demographic variables.
ASSUMPTIONS:
1. Diabetic patients may have less knowledge regarding foot care.
2. Appropriate health education will help to increase the knowledge regarding foot care.
RESEARCH VARIABLES:
Independent Variable: Video assisted teaching Programme regarding foot Care.
Dependent Variable: knowledge regarding Foot care of diabetic patients.
Selected Demographic variables: socio demographic variables such as age, sex, educational qualification, marital status, type of diabetes mellitus, duration of illness, source of information, etc..,
DELIMITATIONS:
1. The study will be conducted only in the diabetes patients attending
OPD or admitted in selected hospitals at Bangalore.
2. The size of the sample was only 50 subjects.
3. Individual foot care for the participants will not be done by the investigator.
7. MATERIALS AND METHODS:
7.1. SOURCE OF DATA:
Data will be collected from the diabetic patients in selected hospitals at Bangalore.
7.2. METHOD OF COLLECTION OF DATA
Research Approach:
Evaluative approach.
Research Design:
Quasi experimental One group pretest posttest design.
Study Setting:
The study will be conducted in selected hospitals at Bangalore.
Population:
Diabetic patients of selected hospitals at Bangalore.
Sample:
Diabetic patients attending OPD or admitted in selected hospitals at Bangalore.
Sample Size:
The sample consists of 50 diabetic patients.
Sampling Technique:
Non-probability convenient sampling technique will be used.