RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE & ADDRESS / MR. J. VENKAT REDDYM.Sc. (N) 1st YEAR,
NOOR BUILDING, BHOOPASANDRA MAIN ROAD, RMV II STAGE, BANGALORE – 94
2 / NAME OF THE INSTITUTION / NOOR COLLEGE OF NURSING, No.5, NOOR BUILDING, BHOOPASANDRA MAIN ROAD, RMV II STAGE, BANGALORE – 94
3 / COURSE OF STUDY & SUBJECT / M.Sc. NURSING, 1ST YEAR
COMMUNITY HEALTH NURSING
4 / DATE OF ADMISSION / 01 – 10 - 2010
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING HOME CARE MANAGEMENT OF DIABETES AMONG PATIENTS IN SELECTED URBAN AREA OF BANGALORE.”
BRIEF RESUME OF THE INDENDED WORK
6.1 INTRODUCTION
Diabetes refers to diabetes mellitus (or) less often, to diabetes insipidus. Diabetes Mellitus and diabetes insipidus share the name “diabetes” because they are both condition characterized by excessive urination (polyuria).1
The word “diabetes” is borrowed from the Greek word meaning “a siphon”. The 2nd century A.D. Greek physician, Aretus the Cappadocia named the condition “diabetes”. He has explained the clients with it had polyuria and passed water like a siphon. “kinds health organization defined diabetes mellitus (some time called “sugar diabetes” is a condition that occurs when the body can’t use glucose (a type of sugar) normally.2
WHO defined diabetes is a condition where by the body is not able to regular levels of glucose (a sugar) in the blood, resulting in too much.
Over 200 million people in the us have diabetes, but many cases are preventable and there are important steps we can take to lower our risk. This interactive tool estimates the risk of diabetes and provides personalized tips for prevention any one can used, it but in most accurate for people who have never had any types blood sugar problem.3
According to Psurex conducted research on self monitoring of blood glucose in treatment of type 2 diabetes. Blood glucose measurements are important components of a effective diabetes management. Self monitoring of blood glucose (SMBG) provides. The possibility for collecting information on glucose levels at different time points and facilities patient empowerment. Self monitoring is postulated to have a beneficial effect on metabdic control in type 1 diabetes as it is essential to adjust insulin dose. In type 2 diabetes the efficacy of frequency glucose measurements remain uncertain. This study shows over viewed recent data in the field of self control to evaluate the influence of SMBG on glycaemic control in type 2 diabetes. The result of studies suggest that SMBG can have an important role in improving metabolic control if it is an integral part of a wider educational strategy SMBG can be especially recommended for type 2 diabetic clients with sub optional metabolic control in order to promote dietary and lifestyle changes as well as treatment correction as a response to feed back provided by blood glucose results.
Diabetes has been known for countries as a disease related to sweetness. Diabetes is a heterogeneous group of disorder characterized by an elevation in the level of glucose in the blood. This is a common metabolic disorder characterized by an abnormally elevated level of glucose due to relative lack of insulin or its utilization. Diabetes has been described as “prosperity disease” primarily caused by over eating and consequent obesity.
Diabetes is an important, growing health problem. Currently there are 151 million people worldwide suffering from diabetes, but only 50 million of them are aware of it. WHO estimated that by 2025, the number of diabetics will reach 300 million and every 40 seconds a new case is diagnosed. Out of those 300 million people with diabetes, 76% will be living under developed countries. India had approximately 327 million diabetic patients.
The prevalence of Diabetes is increasing and it is predicted thereby the year 2010, the global population of NIDDM will be 239.3 million and IDDM will be 23.7 million and 1 out of 5 diabetic patients will be an Indian. Among Indians every fourth person is a diabetic and every second Indian is threatened by it. According to endocrinologist G.R Fulcher by 2025, diabetes in India will increase by 59%compared to 42% in other Asian countries.
Diabetes is a syndrome caused by an imbalance between body’s insulin supply and demand. It is characterized by hyperglycemia and is associated with abnormal carbohydrate, fat and protein metabolism. A healthy life style is a combination with healthy eating and regular exercise. Healthy balanced diet combined with regular physical activity helps to keep fit, maintain optimum body weight, improve energy utilization and prevent the early onset of long –term diabetic complications.
Diabetes is primarily a disease of self management .Education in self -management of diabetes can improve many important outcomes, such as diabetes knowledge and self -care behaviors .Diabetes self management and improved self care behaviors are associated with improved metabolic control.
6.2 NEED FOR THE STUDY
In the current health care environment there will be no administrative movement toward improving quality of diabetes care unless there is a related profit incentive (or) a care deficit related penalty. Evidence based improved method and tolls for achieving optional glycemic control are now available. It is ironic that barriers exist simultaneously to prevent the delivery of state-of-the-art diabetes assessment, care and self management education to this population of clients in the most cost-effective care delivery setting the home.
Diabetes is the most common chronic disease among Indian population. It is present in up to 18% of persons older than 65, compromising more than 40% of all persons with Diabetes in United Status. Over 200 million people in the US have diabetes, but many cases are preventable and there are important steps we can take to lower the risk.
It is the seventh leading cause of visit to primary Care physicians where 60% of diabetic patients on Medicare have been estimated to pay 45.5% of office visits for diabetes .The total per capita annual health care expenditure for diabetic patients have been estimated as four times greater than for non diabetic persons.
New research suggested that Indians were genetically predisposed to diabetes. For a given body mass index, Indians have higher amount of fat around the middle as compared to other races .According to Chennai based Diabetes Research center there were 1.02 lakh diabetes related death in India in 1999-2000. In Bangalore 3lakh people are known diabetics. It is estimated that 30 million people in India are affected by diabetes and India is the country with highest rate of diabetes.
A study was conducted to assess the effectiveness of diabetic controlled programme. The aim of the study was to investigate the awareness of diabetes and related factors in diabetes. The study reported that the participants were having inadequate knowledge regarding the risk factors and lack of awareness of diabetes controlled programme.
Diabetes cannot be cured, but can be controlled. Clients with Diabetes must incorporate a complicated regimen of self management in to their lives that is, taking medication, adherence of diet, exercise and also recognition of symptoms associated with glycosuria and hypoglycemia.
Diabetes self management is the corner stone for controlling Diabetes and preventing Diabetes complication. If inadequately treated develop multiple chronic complications leading to irreversible disability and death.
Diabetes can be effectively controlled and complications can be prevented by self care like diet, exercise, medication, self monitoring of blood glucose level, foot and skin care. The client who is knowledgeable about his or her condition and treatment can practice the instruction given to prevent further complications. In order to carry out these functions client must be thoroughly instructed in self care management and their knowledge and practice should be checked periodically.
Hence the investigator felt the need to provide in an acceptable form in order to develop the knowledge of self care management on diet, exercise, self administration of insulin, medications and preventing diabetic complications among Diabetic clients, empower them to make informed choices in their life and keep their personality and optimal health.
6.3 REVIEW OF LITERATURE
The review of literature is defined as a broad, comprehensive in depth, systematic and critical review of scholarly publications, unpublished scholarly print material, audio visuals materials and personal communications. Before any research can be started whether it is a single study or an extended projects, a literature review of previous studies and experience related to the proposed investigations should be done. One of the most satisfying aspects of the literature review is the contribution it makes the new knowledge insight and general scholarship of the researchers. A researcher analyses existing knowledge before dwelling in to a new area of study, while conducting a study, when interpreting the results of the study, and when making a judgments’ about applications of a new knowledge in nursing practice.
A study was conducted among diabetes clients on knowledge attitude, and practice in self care. Observations made that the knowledge attitude and practice of diabetes were less satisfactory in all the areas of self care and none of the patients had any formal education regarding diabetes.
A cross sectional survey was conducted to assess the knowledge in self care practices of diabetes. The study reported that self care is an important component of diabetes control programme. Their knowledge and practice regarding diet, personal hygiene, care of foot, wound complications and medications were assessed. None of the patients on insulin knew about self therapy. Knowledge regarding diabetes complications was not satisfactory. The study suggested that educating diabetes patients about self care is very essential.
A study was conducted to assess the effectiveness of health education program among diabetic clients regarding the risk factors, healthy diet and exercise in diabetes management and common source of diabetic health information. The study result showed that 50% had improved their knowledge after health education.
A survey study was conducted to determine the demand for health education among patients with diabetes by means of evaluating the level of their knowledge .The survey showed that 54.6% of the respondents cannot explain the mechanism of diabetes, while 39.2% of the patients do not know the nature of type 2 diabetes. The survey indicated the increased accessibility and intensity of the educational activities in dialectological health care A study conducted to evaluate group education for patients with non-insulin dependent diabetes. The objective of the study was to identify effective use of hospital resource in relation to staff time and diabetes education; to ensure that all patients have access to a standard level of education; and to maintain and/or improve diabetes control. After group education there was a significant improvement in knowledge of diabetes, blood sugar control and energy balance. This was achieved with a reduction in staff time, when compared with individual education, and more efficient use of hospital resource.Thus, the objectives were realized. it is concluded that diabetes group education is useful in patients
A study conducted to evaluate the effectiveness of the structured group education program on biomedical ,psychosocial and lifestyle measures among type 2 diabetes patient .The intervention group showed significantly positive association between change in perceived personal responsibility and weight loss at 12 months .The conclusion was that the structured education program for patients with type 2 diabetes resulted in greater improvements in weight loss and smoking cessation and positive improvements in belief about illness but no difference in hemoglobin levels up to 12 months after diagnosis.
A retrospective study was conducted to assess the blood glucose measurements are important components of a effective diabetes management. Self monitoring of blood glucose (SMBG) provide the possibility for collecting information on glucose levels at different time points and facilities patient empowerment. The efficacy of SMBG in particular groups of patient is controversial. Self monitoring is postulated to have a beneficial effect on metabolic control in type 1 doses. In type 2 diabetes the efficacy of frequent glucose measurement remain uncertain. The study suggest that SMBG can have an important role in improving metabolic control it is an integral part of a wider educational strategy. SMGB can be especially recommended for type 2 diabetic patients within suboptimal metabolic control in order to promote dietary and lifestyle changes. A study was conducted among diabetic patients and a structured teaching program was given to them. There was a significant increase in overall quality of life (51%), whereas the percentage before education was 41%.The rate of hypoglycemia decreased from 0.15 to 0.06 cases/year and the metabolic control improved significantly. The result shows that education improves the quality of diabetic patients and their metabolic control was significantly reduces the rate of acute complication A study was conducted to evaluate the role of education in the management of diabetes .58% of all patients had inadequate knowledge about diabetes and it was revealed that after the education it was reduced to 40%
A study was conducted to determine the effectiveness of self care management training in type 2 diabetes. The study showed that educational intervention has more effective than diabetes intervention in improving glycaemic control, weight and lipid profiles
A study conducted to understand perception, attitudes and practices. The study result shows that many factor both patient and healthcare provides related influence outcomes of dietary advice have a positive impact on compliance are older age ,shorter duration, nuclear family, good family support less higher health consciousness, advice given by dietician ,diet counseling that is easy to understand and use and includes healthy cooking methods ,practical guidance to deal with lifestyle issue .This study concluded that patients barriers are related to life mostly non-modifiable, most modifiable barriers are related to behavioral aspect and the inability of the health provide individualized diet advice and self management training .Efforts must be made to improve counseling skills. The study was conducted to test the level of knowledge about diabetes mellitus. It was concluded that a formal education program should be integrated into the patients care system in periodical determination of the knowledge of the patient in selected aspect pf self care management