RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Mrs. EZHILARASI .RSRI LAKSHMI COLLEGE OF NURSING,
# 127/1, SRI GANDADAKAVAL, MAGADI MAIN ROAD, VISHWANEEDAM POST, SUNKADAKATTE, BANGALORE-91.
2 / NAME OF THE INSTITUTION / SRI LAKSHMI COLLEGE OF NURSING,
# 127/1, SRI GANDADAKAVAL, MAGADI MAIN ROAD, VISHWANEEDAM POST, SUNKADAKATTE,
BANGALORE-91.
3 / COURSE OF STUDY AND SUBJECT /
M.Sc., NURSING I YEAR
COMMUNITY HEALTH NURSING.
4 / DATE OF ADMISSION TO COURSE / 13-06-2009
5 / TITLE OF THE TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON SELF ADMINISTRATION OF INSULIN INJECTION AMONG DIABETIC CLIENTS IN A SELECTED PRIMARY HEALTH CENTRE AT BANGALORE.
6 / BRIEF RESUME OF THE INTENDED WORK
6.1 / NEED FOR THE STUDY:
“The financial basic of quality of life involves functioning reciprocal interaction, between persons and their practice”
Alexander Williams (1981).
The term diabetes mellitus is derived from a Greek word which means to go through or a siphon and the word Mellitus is derived from a Latin word Me (honey) describes the sweet odour of the urine. Diabetes Mellitus is a silent disease and now recognized as one of the fastest growing threat to public health in almost all countries of the World. It is also called the disease of prosperities. Prevention is better than cure and is less expensive. 1
Around 150 Million peoples suffered from diabetes in the World, out of that above 35 million are Indians are the highest in the world, so it is called Diabetic capital of world. Every fifth person who suffer from diabetes in the world today is an Indian. By 2030 Indian will have 79.4 Million diabetic projects of WHO (World Health Organization) that’s more than twice the current number over 35 million cases. No wonder India is the “Diabetic Capital of the World”.7
The self administration of insulin injection for the diabetic clients on the assumption that an intelligent co-operative clients partially restored on health can be promoted for part of long term illness at home to his ultimate benefit.
The success of National Diabetes Prevention and Control Programme would be the resultant of multiple components (health education, supportive health system, family support, prevalence of risk factor etc) acting is concern to support and enable clients to complete therapy. Community contribution of effective diabetes care has the potential to overcome the limitation resulting is more wide spread implementation and effective of resources which has been brought out through the pilot programme on 4th Jan 2008 in 7 states with on district each from Assam (district – Kamrup), Punjab (district – Jalandhar), Rajasthan (district – Bhilwala), Karnataka (district – Shimoga), Tamilnadu (kancheepuram),Kerala (Thiruvananthapuram) and Andrapradesh (Nellore) 1.
Diabetes is an “Ice Berg” disease. According to recent estimates Prevalence of Diabetes Mellitus in adults was around 4% worldwide and it means that over 143 million persons are newly affected.6 The population in India has an increase in adults was found to be 2.47 in rural and 4.0-11.6 in urban dwellers. High frequencies of impaired glucose tolerance show by studies ranging form 3.6 to 9.17 indicates the potential for further rise in prevalence of diabetes mellitus in the coming decades. It is projected that the disease prevalence will 5.4% by the year 2025, with Global diabetic population reaching 300 million, of this close to 77% of the Global burden of disease was projected to occur in the developing countries. The important differences are observed in the age structure of diabetic population between developed and developing countries. Whereas, in the developed World, the majority of diabetics are ages 65 years and above, it was 45 to 64 Years in the developing country. An estimated 30 million persons in the South-East Asian region are affected at present. It is estimated that by the year 2025 there will be nearly 30 million diabetics in the region. The prevalence of Diabetes Mellitus in countries of the South – East Asia region ranges between 2.1-4from this 1% in adult populations. In major urban agglomerates, the prevalence was shown to be much higher: 6 to 12%. 7
It is estimated that in India during 1997 about 102,000 persons died due to Diabetes Mellitus, with about 1,981.000 daily lost. Earlier it was called as Richman’s Mellitus. So the investigator thought that it is important for the community to know about Diabetes and its prevention. Diabetes also alters the immune system. Thus increasing the body’s ability to fight infection. Small infection can rapidly progress to death of the skin and outer tissues (Necrosis), which may lead to complications of the various systems of the body. Thus saving the life of the Community.2, 3 The researcher through the review of literature, references and through their previous experiences felt that there is a need to conduct the study. Earlier it was called as a “Richman’s Disease”, were as now it is seen even among the “slum dwellers”. Hence the researcher felt that there is need to prepare booklet in order to create awareness among the general public both in urban & a rural areas.
The burden of diabetes for the year 2005 was estimated to be 53 percent of death and annual links estimated up to 70 million by 2005. Now India becomes diabetic capital of the world. The percentage of diabetic to increase 54% in 1995 to 73 percent.9
While India is around 40million diabetes the highest in any country, the lack of awareness level is people who has diabetic is high 63.4% according the first national survey conducted on diabetes. The prevalence of diabetes is 3.37% in Indians 25 years and above, with as much 3.35% in male and 3.41% in female. The 40-49 years of age groups have highest prevalence followed by 50-59%, 30-39years of age groups with 3.41% - 2.86% respectively. An unexplained observation in there survey was annual incidence of about 40 million per 1027 billion population growth.10
In 1998 diabcare Asia study observed patients with diabetes from specialized centers, the 50% had poor control of diabetes as per criteria of American Diabetes Association, showed 4% patient were on diet therapy alone, 53% were receiving oral anti diabetic agents 22% taking insulin another 19% were an both insulin and drugs. 21
In addition to non-insulin dependent diabetes which is either silent, chronic, often unidentified killer most among adult population, the Insulin Dependent Diabetic Mellitus (IDDM) makes as even more diabetic appearance in affected children. They develop symptoms of keto acidosis and often die, since the majority do not have access and adequate medical care, and science insulin is not available or to expense. It is estimated that the prevalence of type 1 diabetes in Asia is relatively low, according to 9.7% of all diabetes mellitus cases in the region. The insulin dependent diabetes registry at Chennai (India) reported an incidence of 10.5 per 100,000 children in the age group of 10-12 years.13
In 2006, study was conducted by oxford university press on behalf of the British Geriatrics society during 6 months period. In elderly patients with diabetes were <60 years, previous self administrator of insulin. We evaluated by the predictive value of an easily available and short performance test – times testing money counting to identify adequate resources for a successful self management of insulin administration.11
According to Indian press (2004) Hyderabad and Chennai are the diabetes capital of India. Hyderabad tops the metropolitan Cities in the prevalence of diabetes (16.6%). Followed by Chennai (13.%), Bangalore (12.4%), Kolkata (11.75%), New Delhi (11.6%) and Mumbai (9.3%). The most important aspect of diabetes is the occurrence of complications that increases the cost of management. 25
In 2008 study was conducted by Hospitals, Brazil aimed to compare the insulin administration followed by 169 (62.8%) self administration individual verses non self administration 100 (37.2%) individual by selected 269 patients with 37 simple random sampling in urban area of municipality 90% reported needing assistance in the insulin administration process at home, 75% reported assistance from the family members, this study encouraging them to adopt and develop self administration of insulin injection at home .29
In 2009, the study was conducted by Nursing professor in Brazil, aimed to correct and incorrect self administration technique for insulin disposable syringes by 169 patients with 37 simple random sampling, it favours the development of interventions focused on the needs of stimulating self care.34
Some studies have demonstrated that self administration insulin injection can meet the urgent needs for diabetic clients. A diabetic prevention and control programme was inaugurated at set on hospital 2008 to meet the urgent need for the diabetes. It was soon realized, however, that the programme in management of diabetes patients in equal importance of that occupational therapy, rehabilitation, psychotherapy, physiotherapy and social service departments of the hospital.32
The self administration of insulin injection programme for the diabetic client test on the assumption that an intelligent, co-operative clients daily restored to health can be treated for part of his long-term illness at home to his ultimate benefit. The self administration insulin injection has been found most useful patients undergoing diabetes mellitus. After clients are able to spend part of the time at home convalescing, a period otherwise spent in the institution. To a lesson extent the self administration insulin injection is suited for familial hereditary autoimmune diseases, and obesity with effective symptoms of the diabetes mellitus and with spontaneously regressive diabetes in whom there is a reasonable expectation that in time the disease will become develop. Two basic criteria are utilized in the conduct of the self administration insulin injection. First the condition of the client must sufficiently to permit continued treatment at home, secondly home condition must be adequate. 13,18
The investigator had exposure to many clients with diabetes mellitus with symptoms of increase blood glucose, polyuria, polyphagia, polydipsia, weight gain, malaise, kusmal smell. The investigator also find that family health nurse to giving more importance in self administration of insulin injection relevant articles on diabetes mellitus for this reason the investigator felt that there is a need for conducting a study to assess the effectiveness of Structured Teaching Programme on self administration of insulin injection among diabetic clients.
6.2
6.2.1
6.2.2
6.2.3
6.2.4
6.2.1
6.2.2
6.2.3
6.2.4 / REVIEW OF LITERATURE:
The review of literature is defined as a broad, comprehensive in depth, systematic and critical review of scholarly publications unpublished by scholarly print materials, audiovisuals materials, and personal communications. Literature reviews throws uncover a new practice intervention. Hence the investigator intending to review the literature available to assess the effectiveness of structured teaching programme on self administration of insulin injection among diabetic clients by using research and non -research materials.23
The received related literature has been organized under the following headings.
Studies related to diabetes mellitus.
Studies related to self administration of insulin injection.
Studies related to knowledge regarding self administration of insulin injection.
Studies related to effectiveness of structured teaching programme.
Studies Related To Diabetes Mellitus.
The study was conducted on “Evaluation of awareness of diabetes mellitus and associated factors”, to investigate the awareness of diabetes mellitus and related factors in Diabetes Cross Sectional Study was conducted in four health centers area of Ankar. The result of the home follow up insists were 2136 (62.5%) diagnosed patient with diabetes (334) participated in the study in which face to face interview was conducted to fill the questionnaire followed by fasting blood glucose level testing. The statistical analysis has shown the mean age of respondents was 57.4 years and majority were female 67.9% and older onset DM (96.6 %) Means duration of DM was 7.8 years. The analysis show that knowledge about diabetes increases with increasing educational level. The association between Socio-economic Status and health is well known and many determinants of these health in equalities have been studied.27
A study was conducted on “Incidence of type 1 and type 2 diabetes mellitus in children aged 0-14 years,” (1996 census risk population 832,000) who met the criteria for diagnosis of diabetes from 1 January 1999 to 31 December 2000 were included. There were 315 valid reports of new cases of diabetes of these, 298 (94.6%) had type 1 diabetes, 12(3.8%) had type 2 diabetes and five had other specified type of diabetes. The average annual incidence of type 1 diabetes was 17.9/100,000 (95 % CI: 15-9-20/100,000) Children in the South island had a 1.5-fold higher incidence than children in the North island, Which was largely accounted for by the Variation in incidence with ethnicity, in that the European rate was 4.5 times highest than the Maori rate average annual incidence of type 2 diabetes was 0.84/100,000 (95%.CI: 0.37 – 1.26/100,000). Estimated care ascertainment rate was 95.2%. Type 1 diabetes incidence has doubled over the post there decades. The geographical differences previously described have persisted, and are largely explained by the ethnic variation in incidence.
The Study was conducted on “Treatment of diabetes mellitus, in rural health centre”, and to reduce the long term complications of diabetes include macro vascular change, coronary heart disease and stroke. The result of the study is that the average age of person in the sample was 69 years. Males were slight majority (59%) and the average weight was 97% amongst the period of investigations the long term blood glucose mean value, HAD/C, dropped significantly from 7.46 at the onset of period 6.53 at the termination of period. 29
The study was conducted on “awareness and knowledge of diabetes in Chennai,” the Chennai urban rural epidemiology study. A structured questionnaire administered to 26.001 individual and the result shows that only 75% (19642/26001) of the whole population reported that they know about a condition called of the participants and 76.7% (1173/1529) of the self reported diabetic subjects know that the prevalence of diabetes was increasing in India. Only 22.27 (627/26001) of the whole population and 41.0% (627/1529) of the known diabetic subject were aware that diabetes could be prevented. The awareness and knowledge regarding self management of is still grossly in adequate in India, massive diabetes self management programmes are urgently needed both urban and rural India. 30,31