Place: Bellary
Date: 09.12.2010
From,
Bharathi .M
Ist year M.Sc. Nursing Student,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
To,
The Principal,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
THROUGH PROPER CHANNEL
Respected Sir/Madam,
Sub: Submission and forwarding of synopsis for registration of dissertation topic.
***
In accordance with the subject cited above, I the undersigned studying in Ist year M.Sc. Nursing in Obstetrics and Gynaecology have been allotted the dissertation topic “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME REGARDING KNOWLEDGE ON UNIVERSAL PRECAUTIONS TO PREVENT HIV/AIDS AT LABOUR ROOM AMONG STAFF NURSES IN SELECTED HOSPITALS IN BELLARY”. Under the guidance of MRS. SARVAMANGALA, Prof.,Dept. of OBG, Sharabeshwara College of Nursing Bellary.
I request you to kindly forward the dissertation topic in the prescribed form to the registrar Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka for Approval.
Thanking you,
Signature of Guide: Yours faithfully,
MRS. SARVAMANGALA. S, PhD (BHARATHI .M)
Professor and Head,
Place: Bellary
Date: 09.12.2010
From,
The Prof. & Head,
Dept. of OBG,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
To,
The Registrar,
Rajiv Gandhi University of Health Sciences,
Bangalore, Karnataka.
THROUGH PROPER CHANNEL
Respected Sir/Madam,
As per the regulations of the University of Registration of Dessertation topic, the following Ist year M.Sc. Nursing student in Obstetric and Gynaecology has been allotted the dissertation topic as follows by the official registration committee of all qualified and eligible guides of the department of Obstetric and Gynaecology.
Name / Topic / GuideBHARATHI .M
Ist Year M.Sc. Nursing student, Sharabeshwara College of Nursing,
Guggarahatti, Bellary. / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME REGARDING KNOWLEDGE ON UNIVERSAL PRECAUTIONS TO PREVENT HIV/AIDS AT LABOUR ROOM AMONG STAFF NURSES IN SELECTED HOSPITALS IN BELLARY”. / Prof. Sarva Mangala. S, PhD Dept. of Obstetrics & Gynaecology, Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to the PG student at an early date.
Thanking you,
Yours faithfully,
MRS. SARVA MANGALA. S PhD.
Professor,
Dept. of Obstetrics & Gynecology.
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE
PROFORMA FOR REGISTRATION OF SUBJECT FOR DESSERTATION
1. / Name of the Candidate and Address / BHARATHI .MM.Sc. Nursing Ist year student,
Sharabeshwara College of Nursing, Bellary.
2. / Name of the Institute / Sharabeshwara College of Nursing, Guggarahatti, Bellary.
3. / Course of Study and Subject / I year MSc. Nursing
Obstetrics and Gynaecology-1.
4. / Date of Admission / 30-06-2010
5. / Title of the Topic / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME REGARDING KNOWLEDGE ON UNIVERSAL PRECAUTIONS TO PREVENT HIV/AIDS AT LABOUR ROOM AMONG STAFF NURSES IN SELECTED HOSPITALS IN BELLARY”.
6 BRIEF RESUME OF THE INTENDED WORK.
6.1 NEED FOR STUDY
By December 1997, perinatal HIV infection is estimated to have killed 1.7 million children under the age of 15 world wide, and an estimated 8.2 million children have been orphaned by infection with HIV/AIDS. More than 90% of the 16,000 infections in all ages occurring daily are in developing countries and 1,600 of there infections occur in young people between the age of 15 and 24 years.
Mothers to child transmission of HIV during gestation labour, and delivery, or by breast feeding is responsible for the vast majority of HIV infections in children, with an estimated 40-90% of transmission occurring around the time of birth.
Each day an estimated 1600 children born an HIV infected mothers become infected, 1500 of whom are in sub Saharan Africa. Mother to child transmission can occur before, during and after delivery. Overall rates of MTCT range from 15-35% risk factors for MTCT include maternal viral load levels vaginal delivery, pre maturity and breastfeeding.
Neverthless, critical research questioner as well as public health challenges remain. The U.S centers for disease control and prevention CDC estimates that 280 to 370 HIV infected infants born in the US each year between 1999 and 2001.
New research studies are focusing on the role of post perinatal exposure prophylaxis with anti retroviral drugs administered to the infants and the mother followed by early weaning and prevention of postnatal transmission of HIV.
An urgent task now is to translate promising trial results into an effective global public health response, guided by local input and the will to maximally reduce pediatric HIV infections world wide.
About 3.2 million infants and young children, world wide are infected with HIV and more than 95% of then get the virus from their mother, usually during intrapartum period. The tradition method for preventing mother to child transmission (MTCT). Is voluntary testing during antenatal care and provision of antiretroviral prophylaxis to the HIV infected women and their new bourns.
The WHO estimates that in developing countries 32% of pregnant women give birth with no previous antenatal care. Although universal antenatal HIV testing is standard in the USA, an estimated 40% of HIV transmission in 2000 occurred among mothers whose HIV infection was un recognized.
In settings where many women give birth with unknown HIV status either because of low antenatal attendance or otherwise, HIV testing during the labour provides the last window of opportunity before delivery for interventions to reduce MTCT of HIV.
6.2. REVIEW OF LITERATURE
JT Mutihir, VE Uguru etal 2004:- A retrospective study was conducted from January 1998 to December 2003. The information was obtained from 159 patients records of the labourroom of the JOS University teaching hospital, JOS, Nigeria. The HIV status was already confirmed antenatally. Record of HIV positive patients were retrived and analyzed. The record of staff at risk was also determined. The study showed that from 2 cases reported in 1998, The portion of HIV had been on the increase. The incidence has risen astronomically from 0.1% to the present figure of 1.9% or 32 per 1,673 deliveries in 2003. The age range of the patients was from 18-36 Years with a mean of 26.4 years all patients are married.1
John E Anderson 2006:- The study was conducted by national survey of family growth from 2002 findings measures self reported prenatal HIV testing for all women who had completed pregnancy in 12 months before interview. We estimated the percentage with a prenatal test for categories defined by major Socio-Economic groups.
Results shown 69% of 748 recently pregnant women reported receiving a prenatal HIV test. The percentage tested was significantly higher for women with incomes below 300% of the poverty level 76% and women who reported some degree of HIV risk 82% suggested that prenatal care provides offer and encourage testing based on perceived risk even through universal HIV screening is recommended. Testing was also higher among women with knowledge of intervention to prevent perninatal HIV transmission 74% suggested that more public information on those treatment might be helpful.2
Anne Bryant Borders Rebeccal 2007:-
A retrospective Study was conducted in 137 hospitals. Almost 47% of Illinois birthing hospitals and adequate maternal HIV status documentation on arrival (L&D). 73% documented prenatal HIV results in the L&D chard. 65.7% documented prenatal HIV in the new born chart 38.7% ordered HIV test on L&D if no prenatal HIV status was available and 61.3% had AzT available. Only 17 hospitals 12.4% met requirements for over all readiness to prevent prenatal HIV Transmission, 16 hospitals 11.6% met a minimal level of readiness (perinatal HIV status documentation and AzT availability.3
Mayris P Webber – 2008:-
A study conducted in 2002 January to 2005 January 653 womens who are HIV negative were interviewed postpartum. Results shown 63% of women reported prior HIV testing during the index pregnancy although their results were not available at delivery. Multivariate logistic modeling identified receipt of prenates care and delivery in NYC as being associated with having been affered prenatal HIV testing. In a model restricted to women receiving medical care emergency department use and delivery outside of New York City were associated with not having been affered prenatal testing, acceptance was associated with delivery outside of New York City.4
Sreeraman – 2008:-
In the retrespective analysis 367 live births were reported from 291 Australian women with HIV infection between 1982-2005. During the same period 80 mothers were diagnosed with AIDS and 50 mothers died.5
Anitha Earl, Linda Health -2007:-
The purpose of this study was to describe Nurses concerns, opinions and precautions related to nursing patients infected with HIV of special interest was comparison of responses by nurses who reported exposure to the HIV through broken skin or mucous membranes with the responses of nurses who reported such exposure. The sample included all staff nurses employed in either the ambulatory home health care unit or in one of seven patients critical care unit of a large urban medical center. Of the 323 respondents 64(20%) reported HIV exposure, 77(24%) reported no exposure and 180(56%) reported not knowing of they had been exposed. More HIV exposed nurses than non exposed nurse’s reported.6
J Environ -2010:-
A study was conducted on 409 respondents 66.3% corresponded to the nursing staff, 14.4% doctors and 8.3% laboratory staff. The irregular use of gloves and other protective clothing for risky task and recapping of needles after use were some of the risk factors identified, especially amongst staffnurses.7
Indian Journal of Medical entries 2010
HIV infection is acquired perinatally 5-10% The incidence of such infection will rise or more women get infected children with HIV progress to AIDS related illness more rapidly than do adults. The maximum risk of perinatally transmission is antenatally through the placenta or during labour and delivery when the infant is exposed. To contaminated maternal blood and fluid. A pregnancy women who is HIV positive has a 15-30% chance of giving birth to a child with true infection.8
Cameroon:-
The study was conducted in 4 hospitals in Cameron, laboring women with unknown HIV status were counseled and those who accepted were tested for HIV.
A total of 2413 women were counseled and 2130, 88.3% accepted to be tested for HIV of the 2130 women tested, 214 were HIV positive acceptability of HIV testing during labor was negatively associated with maternal age, parity and number of antenatal visits and level education.9
VR Sreeraman 2010:
The world health organization UNAIDS and the Un Children fund. UNICEF said in a joint report that the target of universal access – defined as access for 80% of the HIV positive population to prevention, treatment and care was with in clear reach for good news of countries.
“Nevertheless this report also demonstrate that on a global scale, target for universal accesses to HIV prevention, treatment and care will not be met by 2010”. The report said.10
Yaounde, Cameron 2010:
The number of people with HIV worldwide continued to grow in 2008, reaching an estimated 33.4 million (31.1 million-35.8 million ) The total number of people living with the virus in 2008 was more than 20% higher than the number in 2000, and the prevalence was roughly therefore higher than in 1990.
During labor and delivery, the baby becomes into contact with her/his mother blood and cervically / vaginal secretions while passing through the cervix and vagina. Research indicates that the majority of babies who pick up HIV infection from their mothers probably acquire the virus during birth process.11
Aids awareness and blood handling practices of health care workers in bags Nigeria. Eur. J. Epidemiol 1995 August 11(4) 425-30.
A questionnaire survey of 260 health care workers from 13 randomly selected health care facilities was undertaken. Their knowledge, attitude, belief and blood handling practices regarding HIV/AIDS were enquired about virtually all (99.0%) respondents had heard about AIDS but only 57.0% had seen an AIDS patients before. Although 83.0% knew that AIDS is caused by a virus a high proportional still confuses mode of transmission with causative agent. Deficient knowledge was exhibited when asked about groups of people who were at a higher risk of contracting HIV and AIDS only 54.6% and 51.5% identified homosexual and I.V during users as being at a high risk. Almost all (97.0%) of our respondents claimed to have been more careful in their blood handling practices of blood and 285% sometimes although as may as 30.4%, 40.4% and 18.1% do not wear gloves for cleaning up blood stained materials, nursing procedures and taking obstetric delivery respectively. It is evident from their responses that not all the health worker knew the correct method for disposing of used blood stained instruments and left over blood samples and neither were they all adhering to the safety guidelines recommended for handing these materials recommended for handing these materials. Education of all health care workers in Nigeria on the universal precautions guidelines issued by the centers for disease control in 1987 regarding blood, body fluids and contaminated instruments handling precautions is urgently recommended.12
6.3 STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME REGARDING KNOWLEDGE ON UNIVERSAL PRECAUTIONS TO PREVENT HIV/AIDS AT LABOUR ROOM AMONG STAFF NURSES IN SELECTED HOSPITALS IN BELLARY”.
6.4 OBJECTIVES OF THE STUDY
1. To assess the knowledge of staff nurses on universal precautions to prevent HIV/AIDS at labour room.
2. To impart structured teaching programme universal precautions to prevent HIV/AIDS.
3. To evaluate the effectiveness of structured teaching programme universal precautions to prevent HIV/AIDS.
4. To determine the association between the knowledge of socio demographic variables.
6.56.6
6.7
6.8
6.9
7.
7.1
7.2.1
7.2.2
7.2.3
7.2.4
7.2.5
7.2.6
7.2.7
7.2.8
7.2.9
7.2.10
7.3
7.4 / VARIABLES UNDER STUDY :
· Independent variables : Structured teaching programme.
· Dependent Variables : Knowledge of the Staff Nurses
OPERATIONAL DEFINATIONS
ASSESSMENT : It refers to measurement of knowledge and practice of universal precautions regarding HIV/AIDS.
PLANNED STRUCTURED TEACHING PROGRAMME:-
A systematically planned / developed instructional teaching aids designed for staff nurses to provide information regarding HIV transmission.
UNIVERSAL PRECAUTIONS:- It is a term used in the medical field that encompasses the steps taken in order to prevent the cross contamination of air and blood borne pathogen.
HIV:- Human immuno deficiency virus that causes AIDS. This virus is passed from one person to another through blood to blood and sexual contact.
AIDS:- Acquired immuno deficiency virus caused by HIV virus.
STAFF NURSE:- is a person who is completed a prescribed period of training course in a INC recognized school/college of nursing and registered in a state nursing council to practice in a state or through out the world.
ASSUMPTIONS:
The study assumes that Staff nurses may have some knowledge regarding HIV/AIDS.
1. Staff nurses are able to practice universal precautions on HIV/AIDS.
2. Staff nurses have interest to know more about universal precautions on HIV/AIDS.
3. Women in labour are at high risk for transmission of HIV.
DELIMITATIONS:
1. The study is delimited to the staff nurses who are working in labour room at Bellary district.
MATERIALS AND METHODS:
SOURCE OF DATA: The data will be collected from the trained staff nurses who are working in labour room at the time of data collection.
METHOD OF DATA COLLECTION:- Through Structured interview schedule.
RESEARCH DESIGN: Quasi experimental design.
RESEARCH APPROACH: An evaluative research approach is used.
RESEARCH SETTING: The study will be conducted on staff nurses who are working in labour room in selected Hospitals at Bellary.
POPULATION: The population included in this study is trained staff nurses working in labour room and who are willing to participate in the study.
SAMPLE SIZE : 50 staff nurses.
SAMPLING TECHNIQUE: Sample Random/purpose Sampling Technique.
SAMPLING CRITERIA:-
1. Inclusive Criteria:-
Staff nurses who are working in a labour room willing to
participate available at the time of data collection.
2. EXCLUSIVE CRITERIA:-
· Staff nurses who are not willing to participate.
· Staff nurses who are not available at the time of data collection.
DATA COLLECTION TOOL:-
A structured interview scheduled is used to assist the knowledge of staff nurses regarding universal precautions of HIV/AIDS.
The tools consist of two sections.
Section – A
Section – B
Section – A:-
Consists of demographic variables such as knowledge of staff nurses.
Section – B:-
Deals with practice of universal precautions. The tools were critically written in English to facilitate data collection through interview the tools was translated in kannada.
COLLECTION OF DATA:-
Prior permission was obtained from the concerned authority to conduct the study. The investigator will collect data by using interview schedule.
DATA ANALYSIS METHODS:-
Data will be analysed applying quasi experimental design mean standard deviation and mean percentage will be used to describe the variables.
Chi - Square test will be used to find out the association between the dependent and independent variable. Analysed data will be presented in the form of tables and graphs.
Does the study require any investigation or intervention to be conducted on patients or other animals? If so please describe briefly.
This study requires no investigations or interventions by the investigator.
Has ethical clearance obtained from your institution.
Ethical clearance obtained from the Sharabeshwara College of Nursing. Permission obtained from consent authority of selected Hospitals in Bellary and also permission taken from the Research Committee of Sharabeshwara College of Nursing Bellary.
8. LIST OF REFERENCES