JSS COLLEGE OF NURSING
1st MAIN SARASWATHIPURAM, MYSORE.
SYNOPSIS SUBMISSION
BY:
Ms. SHILPA. V. JOSE
1st YEAR MSC NURSING
MEDICAL SURGICAL NURSING
JSS COLLEGE OF NURSING
MYSORE
GUIDE:
Mr. CHARAN P. M
ASSOCIATE PROFFESSOR
MEDICAL SURGICAL NURSING
JSS COLLEGE OF NURSING
MYSORE
BATCH: 2011-2013
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Ms. SHILPA V. JOSE1st YEAR MSc (N)
JSS COLLEGE OF NURSING
1st MAIN SARASWATHIPURAM
MYSORE- 570009
2. / NAME OF THE INSTITUTION / JSS COLLEGE OF NURSING
MYSORE
3. / COURSE OF THE STUDY AND SUBJECT / 1st YEAR MSc NURSING
(MEDICAL SURGICAL NURSING)
4. / DATE OF ADMISSION OF COURSE / 21.03.2011
5. / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING MANAGEMENT OF ORGANOPHOSPHORUS POISONING AMONG STAFF NURSES WORKING IN SELECTED HOSPITALS OF MYSORE.”
6. BRIEF RESUME OF THE INTENDED WORK
6.0 INTRODUCTION
Human life is precious, therefore man strives to live healthy and health is an asset that man is blessed with. According to Newman(1990) “ health on a continuum is the degree of clients wellness that exist at any point in time ranging from an optimal wellness condition, with available energy at its maximum, to death which represents total energy depletion[ Potter and Perry 1997].1
The most difficult challenges for environmental health today come not from what is known about the harmful effects of microbial agents; rather they come from what is not known about the toxic and ecologic effects of the use of fossil fuels and synthetic chemicals in modern society
Poisoning both intentional and accidental are significant contributor to mortality and morbidity throughout the world. According to WHO, three million acute poisoning cases with 2, 20,000 deaths occur annually throughout the world. Out of these 90% of poisoning cases belongs to developing countries particularly among agricultural workers.2
An estimated 84% of American households use pesticides, according to a 1990 EPA survey (White more et. al, 1992). Homeowners annually use 5 -10 pounds of pesticides per acre on their lawns and gardens, many times the amount applied by farmers to corn and soybean fields (Robinson et. Al.1994). They also use pesticides in the form of disinfectants, including pine oil cleaners , bathroom cleaning products , and cleaning materials for swimming pools. In addition, structural pest control operators and workers in nurseries, greenhouses and landscaping are also at work related exposures.3
A poison is a chemical that can harm the body .natural or manufactured toxin can be ingested, inhaled, infected, splashed in the eye or absorbed through skin.4
Acute poisoning with agricultural pesticides is an emerging global health problem particularly in developing countries like India. Among the acute poisoning, organophosphorus poisoning is the most common and responsible for majority of deaths.8
Organophosphates are compounds of phosphoric acid with alkyl, alkoxy or alkaylamino side chains. The important members are chlorothion, diazion, isopropylflurophosphate, Malathion, methyl parathion, octa methyl pyrophosphoramide, parathion, tetraethyl pyrophosphate, hexaethyltetraphosphate. They are extensively used as pesticides for protection of vegetables and fruit crops. Toxicity usually results from accidental or intentional ingestion of or exposure to a agricultural pesticide. Accidental poisoning may result from inhalation of spray or absorption through skin. But unsuspected poisoning may result from contaminated clothing and food articles. Accidental poisoning is rare in children but adolescents consume it with suicidal intention.5
The importance of pesticides in India can be understood from the fact that agriculture is a major component of the Indian economy; it contributes 22% of the nations GDP and is the livelihood of nearly 70% of the countries workforce.6
6.1 NEED FOR STUDY.
Pesticide self poisoning is a major clinical problem in many parts of world. Although most death occur in rural areas of developing world, pesticide poisoning is also a problem in industrialized countries, where it may account for significant proportion of death from self poisoning that do occur. The case fatality of self poisoning in the developing world is commonly 10-20%, but for particular pesticides it may be as high50-70%. The causes of high fatality are multi factorial but includes high toxicity of locally available poisons , difficulty in transporting patents to long distance, the paucity of health workers compared with large number of patients and lack of facilities, antidotes and training for management of pesticide poisoned patients.7
Agriculture accounts for 76% of the conventional pesticides used each year (US EPA, 1999b). Pesticide handlers and agricultural workers appear to be at greatest risk for acute pesticide poisoning. Based on states with required reporting of pesticide-related health concerns, EPA estimates there are approximately 250-500 physician-diagnosed cases occur per 100,000 agricultural workers (including pesticide handlers) (Blondell, 1997). Migrant and seasonal farm workers are especially at high risk since they often work and live in areas where pesticide exposures can be significant.3
The World Health Organization estimates that globally three million intentional and unintentional pesticide poisoning episodes occur annually and, of these, a minimum of 300 000 die, with 99%of the cases being from low- and middle- income countries .These figures, if extrapolated to the South East Asia (SEA) Region where approximately one fourth of humanity lives and assuming an even per capita distribution, would mean 750 000 pesticide poisoning cases and 75 000 deaths annually. The corresponding figures for India would be an estimated 600 000 cases and 60 000fatal outcomes occurring annually. 6
According to a WHO estimate, 18% of the pesticide poisonings reported in the SEA Region are work-related, 14% are accidental and68% are intentional (self-harm or criminal attempts). Between 20%and 55% of self-harm attempts in SEAR countries are carried out by ingestion of pesticides. The most vulnerable groups consist of children, women, workers in the informal sector, and poor farmers. 6
Only a small professional pool of experts in toxicology works in the area of case management in the Region. Their commitment is often based on individual choice; doing a lot with little, they have saved hundreds of lives. But the challenges remain tremendous not only in terms of treating, but also in preventing poisonings. Furthermore, none of the existing poison centers works 24 hours a day and 7 days a week. A substantial number of people in the United States are at risk of acute pesticide poisoning from nonagricultural uses. Data collected from Poison Control Centers found that in 1996, more than 40,000 adults were sufficiently exposed to various types of pesticides to warrant a call to their local Poison Control Center. Because of poor data, and, therefore, lack of evidence, there is little awareness about the magnitude of the problem. As a consequence, there is also low political attention given and resources are insufficient to ensure at least one poison information centre in every state / province with the necessary skilled staff. The few engaged toxicologists barely obtain to participate at international meetings or conferences where they could advocate for support.6
A survey of environmental medicine content in US medical schools found that 75% of medical schools require only about seven hours of study in environmental medicine over four years (Schenk et al, 1996). Furthermore, once in practice, health care providers’ awareness and understanding of pesticide-related illness may or may not ever expand. Because of the widespread use of pesticides and the potential for related adverse health effects, primary care providers need to be prepared to recognize, manage, and prevent pesticide-related health conditions in their patients and communities. The current lack of adequate environmental education for health care providers sounds an alarm for leaders in the health care community, whose professionals are not prepared to deal with pesticide-related illnesses as they are presented. Primary care providers are on the frontline of health care and therefore can play a key role in identifying, treating and preventing potential pesticide poisonings and exposure. 3
Basic pharmacology and normal work suggest that early antagonism of pesticide toxicity should be associated with better outcomes. Although there are few studies in this subject, there is some evidence that patients in developing world die soon after admission .The rapid and effective stabilization and treatment of pesticide poisoned patients on their admission should reduce the number of early death, improve the prognosis for surviving patients over the next few days and reduce number and severity of long term sequeliae.7
Organophosphorus pesticide poisoning is a serious condition that needs rapid diagnosis and treatment. Since respiratory failure is the major reason for mortality, careful monitoring, appropriate management and early recognition of this complication may decrease mortality rate in these patients. We should implement a well programmed emerging medical system that we currently do not have, and education of the general practioners regarding intoxication needs to be improved.
Through effective education and training, health care professionals can build on their existing skills in toxicology. Pharmacology, history taking and risk to communication to provide much needed guidance to patients on pesticide related health condition
.6.2 REVIEW OF LITTERATURE
Literature review is a critical summary of research on a, topic of interest, often prepared to put a research problem in context. The literature review for present study is organized under following headings.
Incidence of organophosphorus poisoning
A prospective study was conducted in October 2010 at Manipal for evaluation of incidence, clinical features and management of organophosphorus poisoning .Study was conducted with organophosphorus poisoning patients admitted in emergency department between January 2008 and 2009. Information regarding the age, sex, occupation, type of agent, route of poisoning, clinical, laboratory findings, type of management and subsequent outcomes were recorded from the patient medical records. The most predominant of the affected age groups was 21-30 years (60.5%). The most common reason for poisoning was attempted suicide (98%). The total mortality rate of the study population was found to be 25%. There was always correlation with type of compound, pre-hospitalization period and the type of management may be useful for preventing the mortality rate in developing countries like India.8
A study was conducted to assess the socio demographic profile of the organophosphorus poisoning cases in south India. OP poisoning cases who were admitted to the emergency department of S.N .Medical College, Bagalkot, north Karnataka during the period of one year from Jan 1st to Dec 31st 2010 were studied.148 cases of OP poisoning were studied out of a total of 232 poison cases.. The OP compounds were readily available at low costs in the market. A time of stress and lead to their use as a common poison to commit suicide with.9
A five year study was conducted to assess organophosphorus poisoning in Gulbarga region. The study group comprised 923 poisoning cases admitted to Government hospital Gulbarga. Organophosphorus poisoning cases constituted 65.65% of total cases. Maximum number of organophosphorus poisoning cases was between the ages of 21-30 years of lower socioeconomic status. Males were more affected than female. 66.63% of the cases were from rural area. In most of the cases, route of poisoning was oral. Name of the poison remained unknown in most of the cases, however amongst known Tick-20 was the commonest.10
A three year study was conducted to know the profile of organophosphorus poisoning in 2007 .This study aims to evaluate the certain factors which are very significant in relation to outcome of Organophosphorus compound poisoning like age, sex, SE status, marital status, reason of committing suicide, etc. And attempt to know its prevalence in society and try to plan for future preventive strategy. .The study was carried out on 288 cases of Organophosphorus compound poisoning which come to Maharani Hospital. Majority of the cases were in age group of 21-30 yrs includes 128 cases (44.44%). Higher proportion of cases from lower class of society 141 cases (48.95%), from rural area 237 cases (82.29%), due to lack of education in affected community. Suicidal intent to consume the compound was the commonest - 250 cases (86.80%).2
A WHO sponsored study carried out in India showed data collected from July 1999 to June 2000 from hospitals in Andhra Pradesh, Haryana, Punjab and Karnataka and one Poison Information Centre in Ahmedabad, Gujarat. A total of 1531 cases of pesticide poisoning were recorded during this one-year period. The poison Information Centre, Ahmedabad reported 206 cases. In Haryana, information was collected from five hospitals. Two were located in Faridabad and one each in Rohtak, Sirsa and Ballabgarh. There were 673 cases in these five hospitals. In Karnataka, two hospitals located in Gulbarga reported 389 cases. Two hospitals in Punjab (Bhatinda and Faridkot) reported 61 cases. Out of the 1531 cases, 609 were due to organophosphorus pesticides. Monocrotophos was involved in 86 cases, the largest number of poisonings due to an insecticide.8
A study was conducted in Manipal, Karnataka to assess incidence of organophosphorus poisoning Vikram in 2005 reported on a two-year study on the spectrum of poisonings in Manipal; 153 cases admitted to Kasturba Hospital Manipal between January 2001 and December 2002 were organophosphorus poisonings. The most common reason for poisoning was attempted self harm (98.7%). The most common age group involved was 21 30 years (36.6%) and 75.1% were males. Out of 153 cases, methyl parathion was the most common compound consumed (58 cases).8
Nurses knowledge regarding management of organophosphorus poisoning
A cross sectional was conducted to assess the acute pesticide poisonings among small-scale farmers in Copenhagen. The main objectives of the thesis is to 1) evaluate classes of pesticides used, 2) evaluate acute Health impacts on the farmers, 3) identify risk factors for occupational poisonings, and 4) describe the ability of the health systems to diagnose and treat the acute pesticide poisonings. It was found that health providers have less knowledge in caring organophosphorus patients. The knowledge of the health professionals about pesticide diagnosis and the treatment of poisonings could be improved by including this theme in refresher courses offered by the Bolivian health authorities regularly to their health personnel, and often financed by UN-organizations. Amore permanent solution would be to include this topic in the curriculum of health sciences at university level which does not seem to be overkill due to the magnitude of the problem and the size of the farming population in Bolivia.11