RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1. / Name of the candidate and address / ANN BARNESFIRST YEAR M. Sc. NURSING
ST. ANN’S COLLEGE OF NURSING
MULKI
MANGALORE – 574 154.
2. / Name of the Institution / ST. ANN’S COLLEGE OF NURSING
MULKI
MANGALORE – 574 154.
3. / Course of study and subject / M. Sc. NURSING,
MEDICAL SURGICAL NURSING
4. / Date of admission to the course / 22-07-2011
5. / Title of the study
EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE (SIM) ON KNOWLEDGE REGARDING THE PREVENTION AND MANAGEMENT OF VARICOSE VEINS AMONG TEACHERS IN SELECTED SCHOOLS OF UDUPI.
6. / Brief resume of the intended work
6.1 Need for the study
Millions of workers spend majority of the working day on their feet and many hours in static positions. Standing uses 20% more energy than sitting and because human bodies are not designed to stand at work, prolonged standing, can lead to tiredness, loss of concentration and increased health risks. These risks include the swelling of feet and legs, feet and joint damage, varicose veins, heart and circulatory disorders, lower back problems and pregnancy complications. Severe varicose veins can have an impact on the lives of the people who work on their feet especially the teachers, nursing staffs, flight attendants, dental staff, traffic and bar workers, postal workers, construction workers and bank staff.1
The teachers are the main pillars of a sound and progressive society. They bear the weight and responsibility of the teaching and apart from parents, are the main source of knowledge and values for children. There are a lot of problems faced by the teachers standing most of the working day and it has a great effect on the lower limbs that is it can damage the joints, make muscles ache and major condition affecting is ‘varicose veins.’ The term “varicose” is derived from Latin “varix” (pleural varices) meaning bent. Varicose veins are tortuous, distended and bulging veins (varicosities) beneath the skin of the legs. They are most often swollen, gnarled veins that most frequently occur in the legs, ankles and feet. 2
Varicose veins have been recognized as chronic disorder since ancient times. Hippocrates discussed them 2500 years ago. With increasing population, increased lifespan and changes in lifestyle and occupation it involves at least 1 out of 5 in the world. It is in developed countries where attire reveals more than it conceals; patients turn up for treatment because of cosmetic records. But in our Indian scenario it is complications not cosmetics reasons bring patient to doctor that is reason why, though common, varicose veins remain iceberg phenomenon.3
The recent statistics shows that about 25% of the women and 18% of men suffer from varicose veins. 60% of the leg ulcers are due to varicose veins. Almost
2, 00,000 reports lower limb symptoms caused or made worse by job. The Health and Safety Executive’s (HSE) latest estimates of the extent of occupational ill- health in the teachers in UK show musculoskeletal disorders are the most common causes of teacher’s related ill-health and that 17 percent of these disorders affected lower limbs. It is been estimated that not only the teachers nearly 1,92,000 people in UK are suffering occupational lower limb disorders caused or made worse by their work.1 According to the World Health Organization statistical information system nearly 177 deaths per year occurred in US, 152 deaths per year in Germany due to varicose veins. If left untreated, 50% of the patients will eventually experience complications such as chronic venous insufficiency, thrombophlebitis and cellulitis.4
A twelve year prospective study was conducted to assess the risk of hospitalization due to varicose veins in the lower extremities prospectively in workers standing or walking at least 75% of their time at work.A representative random sample of 9653 working age adults was drawn from the Central Population Register of Denmark in 1991. Of these, 8664 accepted to be interviewed by telephone (response rate 90%). Respondents (2939 men and 2708 women) were 20–59 years old and employed in 1990. During 12 year follow up, 40 hospitalizations due to varicose veins were observed among men and 71 among women. This prospective study confirms that prolonged standing at work constitutes an excess risk of varicose veins and that it accounts for more than one fifth of all cases of working age.5
A cohort study was done to assess the prevalence and extent of treatment of varicose veins in a Finnish population by using mailed questionnaires. In 1989 a questionnaire was mailed to every resident born in 1929, 1939 and 1949 living in Tampere, a second largest town in Finland. The population comprised of 3284 men and 3590 women. The result found was the life time prevalence of varicose veins which was 18% for men and 32% for women. 25% of men and 41% of women who reported varicose vein had received treatment. Thus the researcher concluded that prevalence of varicose veins was high in the population studied and that preventive measures were required because treatment alone seems to be inadequate in control of varicose veins.6
From the above studies and statistics it is clear that varicose veins are increasing worldwide. Since the teachers spend most of the time standing they are prone to get lower limb symptoms like itchiness, cramps, burning sensation, pain especially when standing. They result in superficial swollen veins, which later develop to varicose veins. So there is a need to educate the teachers regarding this condition in order to prevent it. This urged the investigator to take up the present study with an intention to provide Self Instructional Module regarding prevention and management of varicose veins.
6.2 Review of literature
A cross sectional population study which was conducted in Edinburgh to examine the relation between age, sex, lower limb symptoms, the presence and severity of varicose veins by administering a questionnaire. It consisted of random sample of 1566 people (699 men and 867 women) aged 18-64 selected from the computerized age sex registers. The results showed that women were significantly more likely to report lower limb symptoms such as heaviness or tension (54.7%), swelling (24.6%), aching (63.1%), restless legs (49.6%), cramps (45.5%), and itching (38%). The prevalence of symptoms tended to increase with age in both sexes. In men, itching was significantly related to the presence and severity of varicose veins. The researcher concluded that varicose vein was a major problem in growing population. 7
An epidemiological study was done to determine the prevalence of varicose veins among railway men of identical socio-economic status and doing identical work of sweepers in North and South of India. It showed that the overall prevalence was significantly higher among South Indian sweepers (25.08%) than North Indian sweepers (6.8%). The survey included 323 men from Madras in South and 354 men from Ajmer in North India. A big difference was present in blood-clotting time and clot in lysis between these two populations. In order to test the cause-and-effect relationship of these hematological indices 24 North Indians and 81 South Indians with varicose veins were compared with 24 healthy North Indian controls and 81 South Indian controls with no varicose veins. Clot-lysis was markedly higher in those with no varicose veins than in those with varicose veins, but the mean blood clotting times
were not significantly different between these two. Since such differences are known to be diet related, this study concluded that, in the prevalence of varicose veins, patterns of diet and occupation may play an important part. Therefore, there would seem to be hope that this disease may be prevented.8
An epidemiological study was conducted in England and Egypt. Prevalence of varicose veins was studied among 504 women cotton workers in England and 467 in Egypt, by standardized questionnaire and specially developed method of examination. The English women who worked standing had high prevalence of varicose veins than Egyptian population who also performed spinning and weaving. The study concluded that prevalence of varicose veins was related to age, parity, body weight and occupation that is whether or not they stood at their work.9
A cross sectional study was conducted among teachers in 12 schools in Ahmedabad which revealed that 77% of the 138 teachers suffered from varicosity or enlargement of the veins of legs. Among these 107 nearly 84 people suffered from spider webs, the first stage of varicose veins. While 23 had severely established varicose veins which means they suffered from severe aches, swelling and heaviness in the legs. This study concluded that varicose veins is a condition that makes walking and standing extremely difficult and painful and if treated early at the stage of spider veins they are preventable.10
A cross sectional study was done to assess the prevalence of varicose veins, risk factors and the complications of varicose veins among school teachers. Samples of 100 teachers were taken in Thiruvananthapuram. The study showed the prevalence of varicose vein was 19% among the school teachers. Among those affected with varicose veins, 89.5% had history of standing for long duration. Ratio of 26.3% had complications from this disease. Thus conclusion was made that standing for long hours was a major risk factor as compared to other known risk factors. Hence it is very much essential to prevent the occurrence of these risk factors. 11
6.3 Statement of the problem
Effectiveness of Self Instructional Module (SIM) on knowledge regarding the prevention and management of varicose veins among teachers in selected schools of Udupi.
6.4 Objectives of the study
Objectives of study are:
6.4.1 To determine the level of knowledge on prevention and management of varicose veins among teachers using structured knowledge questionnaires.
6.4.2 To evaluate the effectiveness of self instructional module on prevention and management of varicose veins among teachers in terms of gain in knowledge scores.
6.4.3 To find the association with pre-test knowledge scores and selected baseline characteristics (age, gender, educational qualification, marital status, years of experience, source of information).
6.5 Operational definitions
6.5.1 Effectiveness: In this study it refers to the extent to which the SIM on prevention and management of varicose veins has achieved desired effect in terms of gain in knowledge scores by teachers as measured by structured knowledge questionnaire.
6.5.2 Self Instructional Module (SIM) on prevention and management: It refers to systematically developed and validated learning material designed by the investigator for teachers on prevention and management of varicose veins. It includes information regarding definition, causes, signs and symptoms, early detection, measures taken to prevent varicose veins and treatment of varicose veins.
6.5.3 Knowledge: In this study it refers to correct responses given by teachers for knowledge items in the structured questionnaire regarding prevention and management of varicose veins and is expressed in terms of knowledge scores.
6.5.4 Varicose veins: In this study it refers to bluish or purplish enlarged or dilated veins that are superficial and most commonly seen in the legs, feet and thighs. They are often painful when standing or walking.
6.5.5 Teachers: In this study it refers to the male and female teachers teaching in primary and high schools in Udupi.
6.5.6 School: In this study it refers to the primary and high schools which run the program from 1st to 10th standard (English or Kannada medium) in Udupi.
6.6 Assumptions
The study assumes that
6.6.1 The school teachers have some knowledge regarding the management and prevention of varicose veins.
6.6.2 Any educational program would increase the knowledge.
6.7 Delimitations
The study is delimited to
6.7.1 The primary and high school teachers of selected schools in Udupi.
6.8 Hypotheses
The following hypotheses will be tested at 0.05 level of significance.
6.8.1 H1: There will be significant difference between mean pre and post test knowledge scores of teachers on prevention and management of varicose veins.
6.8.2 H2: There will be a significant association between the pre-test knowledge scores of teachers and selected baseline characteristics (age, gender, marital status, educational qualification, years of experience, source of information).
7. / Material and methods
7.1 Sources of data
The data will be collected from primary and high school teachers who fulfil the inclusion criteria, working in selected primary and high schools of Udupi.
7.1.1 Research design
The research design used in this study will be based on pre-experimental (one group pre-test post-test) design.
7.1.2 Setting
The study will be undertaken in the selected primary and high schools which are situated in Udupi. Schools which run program from 1st – 10th standard (English or Kannada medium)
The investigator will be taking four different schools situated in area of Udupi. Each school is situated 25-30 km away from Mulki and has 15-16 teachers.
7.1.3 Population
In this study the population consists of all the teachers of primary and high schools of Udupi.
7.2 Method of data collection
7.2.1 Sampling procedure
In view of the nature of problem and to accomplish the objectives of the study purposive sampling will be used to select participants.
7.2.2 Sample size
In the study the sample consists of 60 primary and high school teachers.
7.2.3 Inclusion criteria
· Teachers working in the primary and high schools.
· Male and female teachers.
· Teachers who are willing to participate in the study.
7.2.4 Exclusion criteria
· Teachers who are not available at the time of data collection.
· Teachers who have been diagnosed and under the treatment for varicose vein.
· Teachers who have attended any type of education program on varicose vein.
7.2.5 Instruments intended to be used
The instrument intended to use in this study is structured questionnaire which includes
Part-1-Baseline characteristics
Part-2- Structured knowledge questionnaire regarding prevention and management of varicose veins.
7.2.6 Data collection method
· The investigator will obtain formal written permission from the concerned authorities of selected primary and high schools.
· The investigator will introduce herself to the participants.
· The purpose of the study and method of data collection will be explained to the participants.
· The informed consent will be obtained from the participants.
· On the first day pre-test knowledge will be measured by administering structured knowledge questionnaire followed by administering Self Instructional Module.
· Post test will be conducted by administering the same structured knowledge questionnaire after seven days.
7.2.7 Data analysis plan
· Collected data will be analyzed using descriptive (mean, median, standard deviation) and inferential statistics (chi-square and‘t’-test).
· The data will be analyzed for significance of difference between the pre-test and post test scores using paired‘t’ tests.
· The data will be presented in the form of tables and graphs.
7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals?
Yes, the investigator needs to assess the knowledge of teachers on prevention and management of varicose veins and also to administer SIM after getting the informed consent from them.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance is obtained.
8. / List of references
1. Neill R. Standing problem. Hazards Magazine [online]. 2005 Aug 10 [cited 2011 Oct 24]; Available from: URL:http://www.hazards.org/standing/index.htm.
2. Bailey H, Love NRJ. Short practice of surgery. 23rd ed. London: Hodder Arnold; 1991:235-45.
3. Mukunda NK. Clinical evaluation and management of lower limb varicose veins: a study at KIMS. Unpublished doctoral dissertation submitted to Rajiv Gandhi University of Health Sciences; 2006.
4. Morality statistics- varicose vein of lower extremity [online]. 2004 Jan 1 [updated 2005 Jan 1; cited 2011 Oct 24]. Available from: URL:http://www.nationmaster.com/index.
5. Tuchsen F, Hannerz H, Burr H, Krause N. Prolonged standing at work and hospitalization due to varicose veins: a 12 year prospective study of the Danish population. Occup Environ Med 2011 Oct 23;62(12):847-50.
6. Laurikka J, Sisto T, Auvinen O, Tarkka M, Hakama M. Varicose vein in Finnish population aged 40-60. J Epidemiol Community Health 2011 Oct 26]; 47(2):355-7.
7. Bradbury A, Evans C, Allan P, Lee A, Ruckley CV, Fowkes FGR. Edinburgh vein study cross sectional population survey. BMJ 1999 Jun 15;318(6):318-53.
8. Malhotra SL. An epidemiological study of varicose veins in Indian railroad workers from the south and north of India with special reference to causation and prevention of varicose veins. Int J Epid 2011 Oct 23;1(2):177-83.
9. Mekky S, Schiling RSF, Walford J. Varicose veins in women cotton workers: an epidemiological study in England and Egypt. Br Med J 2011 Oct 7;2(5657):591-5.
10. Sharma R. New worry for teachers: varicose veins. The Times of India. [Internet]. 2010 Nov 29 [cited 2011 Oct 24]; Available from: URL:http://epaper.timesofindiacom/repository/ml.
11. Jacob DA, Shruthy M. Prevalence of varicosities among people whose work demands standing for long hours; paper presented at: The National conference on student’s medical research, Thriruvanthapuram, India; 2008 Apr 11-12.
9. / Signature of the candidate
10. / Remarks of the guide
11. / Name and designation of (in block letters)
11.1 Guide / SR. LUCY RODRIGUES
PROFESSOR, MEDICAL SURGICAL NURSING
ST. ANN’S COLLEGE OF NURSING
MULKI
MANGALORE
11.2 Signature
11.3 Co-guide (if any)
11.4 Signature
11.5 Head of the department / MRS. LANET SMITHA
ASSOCIATE PROFESSOR, MEDICAL SURGICAL NURSING
ST. ANN’S COLLEGE OF NURSING
MULKI
MANGALORE
11.6 Signature
12. / 12.1 Remarks of the Chairman and Principal
12.2 Signature
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