RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR RESGITRATION OF SUBJECTS FOR
DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MRS.BILCY.P.B1ST YEAR M.SC NURSING
SUSHRUTHA COLLEGE OF NURSING
#23, PAPAIAH GARDEN DIAGONAL ROAD,
CHENNAMANAKERE, BSK 3RD STAGE ,
BANGALORE - 560085
2. / NAME OF THE INSTITUTION / SUSHRUTHA COLLEGE OF NURSING
3. / COURSE OF THE STUDY AND SUBJECT / DEGREE OF MASTER SCIENCE IN NURSING,
MEDICAL SURGICAL NURSING
4. / DATE OF ADMISSION TO COURSE / 07/06/2010
5. / TITLE OF THE TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME ON KNOWLEDGE REGARDING RISK FACTORS AND PREVENTION OF VOICE DISORDERS AMONG TEACHERS IN SELECTED SCHOOLS AT BANGALORE
6. BRIEF RESUME OF THE INTEDED WORK
INTRODUCTION
“The human voice is the organ of the soul.”
Henry Wadsworth Longfellow
Voice is a reflection of an individual’s persona and physical well-being. It is a dynamic instrument capable of producing many complex and intricate sounds. Each person’s voice is highly personalized by the melodic, emotional and colorful qualities inherent it. We rely on our voices to inform persuade and connect with other people.
Many people use their voices all day long, day in and day out. Singers, teachers, doctors, lawyers, nurses, sales people, and public speakers are among who make great demands on their voices. These individuals are most prone to experiencing voice problems. It is believed tha5t 7.5million people have diseases or disorders of voice. Some of these disorders can be avoided by taking care of voice.1
Causes of vocal problems may include upper respiratory infections, inflammation caused by acid reflux, vocal misuse and abuse, vocal nodules or laryngeal papillomatosis (growths), laryngeal cancer, neuromuscular diseases and psychogenic conditions due to psychological trauma. Keep in mind that most voices problems are reversible and can be successfully treated when diagnosed early.1
Vocal abuse is any behavior or occurrence that strains or injures the vocal folds. This may include excessive talking, throat clearing, inhaling irritants, smoking, screaming or gelling. Vocal misuse is improper voice usage such as speaking too loudly or at an abnormally high or low pitch. Frequent vocal abuse and misuse can damage the vocal folds and cause temporary or permanent changes in vocal function, voice quality, and possible loss of voice.2
Voice management being an emerging field in India, voice therapy, voice analysis, voice culture and vocal dynamics are extensively studied by medical experts to correct speech disorders in patients and also enhances delivery style and voice projection among professional voice users.3
The best preventive care for voice users is training. Along with voice lessons, proper aerobic exercises, and exercise of the abdominal and back muscles for voice support, training includes the proper care of the body by giving it sufficient water, nutrition and sleep. Be sensitive to your own voice and if you notice anything unusual, go on complete vocal rest.4
6.1 NEED FOR THE STUDY:
Voice is one of the most important instruments for expression and communication in humans. The most common consequences of voice problems are missing work, affecting job performance, social activities and emotions.
A teacher with a vocal polyp, who cannot speak loudly this shows teaching is displaying a form of limitation in the teaching activity. If the teacher has to change careers due to the inability to speak loudly, their restriction in participating in the teaching position brings about economical consequences.
Screaming, shouting and loud speaking over a period of time may produce edema of the vocal cords and the formation of nodules or polyps.5 The factors causing voice problems are inappropriate breathing, insufficient rest, inefficient student discipline and noisy environment.
A study conducted by Yui (2002) teachers would like to learn more about voice care and voice production and think that vocal hygiene strategies would help to prevent voice problems. As content for vocal hygiene program teachers suggested voice care strategies, breathing exercises and proper voice production methods. As for the most common strategies to avoid voice problems, mentioned speaking softly, hydration, speaking less and the use of amplifiers.6
Lack of basic knowledge related to voice, its incorrect use and a defective vocal model can lead teachers to develop occupational dysphonia. This affect teacher’s ability to function in the classroom and prevent them form developing effective working relationships with others staff and students.
Vocal hygiene education is an effective method to create awareness, reduce vocal abuse and prevent acquisition and progression of voice problems among teachers.
This motivated to know whether teachers are having adequate knowledge on risk factors and prevention of voice disorders. So planned to make a study on “STRUCTURED TEACHING PROGRAMME REGARDING RISK FACTORS AND PREVENTION OF VOICE DISORDERS AMONG TEACHERS IN SELECTED SCHOOLS AT BANGALORE”.
6.2 REVIEW OF LITERATURE
The review of literature is defined as a broad, comprehensive, in depth, systematic and critical review of scholarly publications unpublished scholar print materials and personal communications. Review of literature is the study of the prevalent materials related to the research. This helps the researcher to get a clear idea about the particular filed. It is important for the researcher to carryout the research successfully. A critical summary of research on a topic of interest. Often prepared to put a research problem in context.
Good vocal health of general interest to everyone, is a vital concern to the professional voice user. The voice is a precious commodity which cannot be replaced when worn out or damaged.
Voice is produced by vibration of the vocal folds. They are located in the larynx or voice box. To produce voice, the brain precisely coordinates a series of events. First, the folds come together in a firm but relaxed way. Once the folds are closed, air from the lungs passes through them, causing vibration and thus making sound. The sound from this vibration then travels through the throat, nose and mouth. The size and shape of these cavities, along with the size and shape of the vocal folds, help to determine voice quality.2
Disorders of vocal abuse and misuse are the most prevalent and preventable of the types of voice disorders. Anyone from infants to the elderly, who uses his or her voice excessively, may develop a disorder related to vocal abuse. Generally, people in voice-intensive professions, such as singers, teachers, call center employees, actors, lawyers, clergy, cheerleaders.7
Primary school teachers are particularly at risk as they have little opportunity for vocal rest during the working day. A study conducted in Dublin by Caitriona M and Day Kinsella (2007) on the Prevalence and impact of voice problems in primary school teachers, suggest that 27% suffered from a voice problem, 53% an intermittent voice problem.8
Practicing a few tips will conserve the voice. The following are the tips maximize rest, maintain adequate hydration, avoid provocative factors like breathing polluted air, chalk dust, avoid tobacco or marijuana alcohol or drugs, avoid loud speaking (sporting event, bar, airports), do no vocalize while yawning, avoid constant throat clearing, excessive whispering, modifying natural speaking voice, excessive voice use during laryngitis, avoid spicy foods, avoid exacerbating medications like corticosteroids and drying medications.9
The most common disorders resulting form vocal abuse and misuse are laryngitis, vocal nodules, vocal polyps, acid reflux, laryngeal papillomatosis (growths), neuromuscular diseases and psychogenic conditions due to psychological trauma.1
Other voice disorders include, According to
· Intensity: (a) Aphonia (b) Dysphonia
· Pitch: High Pitch, Low Pitch, Pitch Breaks
· Resonance: Hypernasality, Hyponasality
· Phonation: Harshness, Hoarseness from functional or organic origin.10
Teacher’s voice problems are widely recognized as consequence of their work. A cross – sectional study conducted by Bermudez De Alvear (2010) on school teachers vocal use, risk factors and voice disorder prevalence. It revealed 81.5% of teachers reported some degree of vocal effort, more than 60% of subjects evidenced frequent throat Paresthesias or vocal fatigue at the end of a working day and about 55% reported hoarseness. Voice disorder prevalence was 59%. Voice disorders affected most teachers and had a multi factorial nature.11
Subjects in the voice disorder group(VD group) had significantly greater effects in changing overall job opinions, reduction of overall communicative ability, decreasing phone calls, reduction of overall social ability, influence on overall emotional state and the frequency of being upset than subjects in the Non voice disorder group(NVD group). A study conducted by Chen SH, Chiang SC (2010) to investigate risk factors of voice problems for Taiwanese teachers with voice disorders. A prospective study was designed for this research. Subjects in the VD group were at significantly higher risk of using a loud voice in teaching than the need for a preventive voice care program for teachers.12
Teaching is an occupation with a high incidence of voice problems. A study conducted by Daniel E. Phillips (2003) on voice problems of classroom teachers Incidence, symptoms and associated factors. He identified 47% of teachers experienced problems with their voice. Elementary teachers 40% were most likely to experience voice problems, followed by secondary teachers 27%. Teachers who complain of sinus problems, throat problems, have vocal activities outside the classroom are more likely to develop problems.13
Voice disorders have an impact on teacher’s personal and professional life and imply a major financial burden for society. Van Houtte E, Claeys (2010) et al conducted a experimental study on the impact of voice disorders among teachers. Findings were teachers reported significantly more voice problems than the control population 51.2% vs. 27.4%. Teachers 25.4% sought medical care and eventually 20.6% had missed at least 1 day of work because of voice problems. This study strongly recommends the implementation of vocal education during the training of teacher students to prepare the vocal professional user.14
Literature review on the behavioral treatment of voice disorders in teachers a study conducted by Ziegler A (2010) voice amplification demonstrates promise as a beneficial type of indirect therapy and vocal function exercises as well as resonant voice therapy show benefits as direct therapies.15
Increased vocal fold hydration is a popular target in the prevention and management of voice disorders. A study was conducted by Sivasankar and Leydon (2010) on the role of hydration in vocal fold physiology. Findings revealed that systemic and superficial dehydration are detrimental to vocal fold physiology.16
Prevalence of voice disorders among teaching personnel in Spain a study conducted by Carmen, Julian and Sudhakar (2004). The prevalence of vocal pathology was 57.6% with the following distribution, Bengin vocal fold lesions 13.7%, chronic laryngitis 2.9%, functional disorders vocal over exertion 18.2%, hyper functional disphonia 7. 6%.17
STATEMENT OF THE PROBLEM
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME ON KNOWLEDGE REGARDING RISK FACTORS AND PREVENTION OF VOICE DISORDERS AMONG TEACHERS IN SELECTED SCHOOL AT BANGALORE.
6.3 OBJECTIVES OF THE STUDY
Ø To assess the knowledge regarding the risk factors of voice problems among teachers.
Ø To assess the knowledge regarding the prevention of voice problems among teachers.
Ø To evaluate the effectiveness of structured teaching programme on risk factors of voice problems among teachers.
Ø To evaluate the effectiveness of structured teaching programme on prevention of voice problems among teachers.
Ø To find out association between the pretest knowledge with selected demographic variables such as age, sex, working experience, level of education.
6.4 HYPOTHESES
Ø There will be no significant difference between the pre test and post test score on risk factors among teachers.
Ø There will be no significant difference between the pre test and post test on prevention of voice disorders.
Ø There will be no association between the selected demographic variables and the knowledge of teachers.
6.5 RESEARCH VARIABLES
INDEPENDENT VARIABLE
Structure teaching programme on risk factors and prevention of voice disorders.
DEPENDENT VARIABLE
Knowledge regarding the risk factors and prevention of voice disorders.
DEMOGRAPHIC VARIABLES
Selected demographic variable age, sex, working experience, level of education etc.
6.6 OPERATIONAL DEFINITIONS
Ø ASSESS
It refers to appraisal or judgment of teacher’s knowledge of risk factors and prevention of voice disorders.
Ø EFFECTIVENESS
Effectiveness is the desired change brought about by the teaching program and is measured in terms of significant gain in the posttest knowledge.
Ø STRUCTURED TEACHING PROGRAMME
It refers to the systematically planned teaching to provide information’s on risk factors and prevention of voice disorders.
Ø KNOWLEDGE
Knowledge refers to the understanding and awareness regarding risk factors and prevention of voice disorders.
Ø RISK FACTORS
Risk factors are the threat paused on voice production of an individual.
Ø PREVENTION
It is measure that is designed to prevent voice disorders.
Ø VOICE DISORDERS
It is a state of disturbance in voice production or deviation found from normal voice that usually interferes with oral communication.
Ø TEACHERS
Teacher is a person who is qualified and employed to teach prescribed curriculum from 1st to 10th Standard in a selected schools.
6.7 ASSUMPTION
Ø Education is a source of knowledge of teachers on risk factors and prevention of voice disorders.
Ø Teachers may have some knowledge about risk factors and prevention of voice disorders.
Ø All teachers may not know the importance of voice.
6.8 LIMITATION
Ø The study is limited only to the teachers.
Ø The study is limited to selected schools.
7 MATERIALS AND METHODS
7.1 SOURCES OF DATA
The data will be collected from teachers at selected schools at Bangalore.
7.2 METHOD OF COLLECTION OF DATA
Data will be collected through self administered questionnaire.
7.2.1 RESEARCH DESIGN
Quasi Experimental Research Design:
The research design used in this study is one group pre - test and post – test design. The knowledge of teachers regarding risk factors and prevention of voice disorders was assessed before providing educational programme (Pre - Test). After a period of 5 to 7 days of structured teaching programme the knowledge of teachers was reassessed (Post - Test). The pre – test score was used to compare the post – test score.
Experimental research design will be used.
O1 X O2