PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Ms.GOWRI.R
Ist yr M.Sc (Nursing)
Oriental College Of Nursing,
2nd main, west of chord road,
Bangalore-44.
2. / NAME OF THE INSTITUTION / Oriental College of Nursing, Bangalore-44.
3. / COURSE OF STUDY AND SUBJECT / 1st Year M.Sc nursing,
Medical Surgical Nursing,
4. / DATE OF ADMISSION TO COURSE / 10-06-2009
5. / TITLE OF THE TOPIC / ‘‘A STUDY TO ASSESS THE KNOWLEDGE REGARDING GLAUCOMA AND ITS MANAGEMENT AMONG CLIENTS IN SELECTED HOSPITALS AT BANGALORE, WITH A VIEW TO DEVELOP AN INFORMATION GUIDE SHEET’’.
6. / BRIEF RESUME OF THE WORK
6.0 Introduction
6.1 Need for the study
6.1.1 Statement of the problem
6.2 Review of related literature
6.3 Objectives of the study
6.3.1 Operational definitions
6.3.2 Assumption
6.3.3 Hypothesis
6.3.4 Sampling criteria
(i) Inclusion criteria
(ii) Exclusion criteria / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7. / MATERIALS AND METHODS:
7.1 Sources of data: Data will be collected from clients suffering with glaucoma in selected hospitals at Bangalore.
7.2 Method of data collection: Structured interview schedule.
7.3 Does the study require any investigations of interventions to be conducted on the patients or other human being or animals?
No.
7.4 Has ethical clearance been obtained from your institution?
YES. Ethical committee’s report is here with enclosed.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
M.Sc (Nursing) First Year
Oriental College of Nursing,
2nd main, west of chord road,
Bangalore – 44.
2. / NAME OF THE INSTITUTION / Oriental College of Nursing
3. / COURSE OF THE STUDY AND SUBJECT / M. Sc (Nursing),
Medical Surgical Nursing.
4. / DATE OF ADMISSION TO THE COURSE / 10.06. 2009
5. / TITLE OF THE STUDY / A study to assess the knoweldge regarding glaucoma and its management among clients in selected hospitals at bangalore with a view to develop an information guide sheet
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
BRIEF RESUME OF THE INTENDED WORK:
6.0 INTRODUCTION
“For I dipped into the future, far as human eye could see, saw the vision of the world, and all the wonder that would be”
The ability to see the world clearly can easily be taken for granted. The eye is highly specialized sense organ. Impaired vision affects an individual’s independence in self care, work and life style choices, safety, inability to interact with society and the environment, and overall quality of life.1
Glaucoma is the term used for a diverse group of eye diseases, all of which involve progressive damage to the optic nerve. Glaucoma is usually accompanied by high intraocular (internal) fluid pressure. Glaucoma has been nicknamed as "sneak thief of sight" because the loss of vision normally occurs gradually over a long period of time and is often only recognized when the disease is quite advanced. Once lost, this damaged visual field can never be recovered.2
Glaucoma is the second leading cause of blindness. Worldwide, it is estimated that about 66.8 million people have visual impairment from glaucoma, with 6.7 million suffering from blindness. The prevalence of glaucoma increases with age. Two percent of the population older than 40 years of age and five to nine percent of those older than 65 years have glaucoma. It is estimated that there will be 60.5 million people with open angle glaucoma and angle closure glaucoma in 2010, which will increase to 79.6 million by 2020. Of these, 74% will have open angle glaucoma. From 2010 to 2020, the most detectable change in glaucoma worldwide will be an increase of the incidence of glaucoma in India.3
According to World Health Organization estimates, about 314 million people around the world have impaired vision, either due to various eye diseases or due to need for glasses (uncorrected refractive errors). Of these, 45 million people are blind. More than 82 per cent of all blind are 50 years of age and above, and more than 90 per cent of the world’s visually impaired people live in developing countries like India. Top five causes of blindness are cataract, refractive errors, glaucoma, age-related macular degeneration and diabetic retinopathy.4
A study was conducted on Glaucoma in a rural population of southern India. Total of 5150 subjects aged 40 years and older from 50 years were participated from three southern districts of Tamil Nadu in southern India. All participants had a comprehensive eye examination. The results of the study was the prevalence (95% confidence interval) of any glaucoma was 2.6% (2.2, 3.0), in that primary open angle glaucoma was 1.7% (1.3, 2.1), and primary angle closer glaucoma was 0.5% (0.3, 0.7), and secondary glaucoma was 0.3% (0.2,0.5). . After best correction, 18 persons (20.9%) with primary open angle glaucoma were blind in either eye because of glaucoma, including 6 who were bilaterally blind and an additional 12 persons with unilateral blindness because of glaucomatous optic neuropathy in that eye. Of those identified with primary open angle glaucoma, 93.0% had not been previously diagnosed with primary open angle glaucoma.5
The modern goals of glaucoma management are to avoid glaucomatous damage, preserve visual field and total quality of life for patients with minimal side effects. These require appropriate diagnostic techniques and follow up examinations and judicious selection of treatments for the individual patient. Although intraocular pressure is the only major risk factors for glaucoma, lowering it via various pharmaceuticals techniques is currently the mainstay of glaucoma treatment. Pharmacological therapeutic strategies including nutritional compounds; some of which may be regarded by clinicians as safe for use now, while others are on trial.6
Glaucoma is a chronic, potentially blinding disease with a variable rate of progression and severity in individual patients. Advances in diagnosis and therapy give us the ability for earlier diagnosis and better therapy that is less likely to affect the quality of life of the patient. World over the need for surgical therapy is probably decreasing, economic and compliance issues, the financial burden made drug therapy a choice of treatment. 7
6.1 NEED FOR THE STUDY
Glaucoma is a very serious eye disease that can lead to blindness if not treated early. More than 6.5 million people in the worldbecame blind due to glaucoma. Glaucoma affects 1 in 200 people aged fifty and younger, and 1 in 10 over the age of eighty. And it is a very misunderstood disease. Often, people don’t realize the severity of the disease. If the condition is detected early enough it is possible to arrest the development or slow the progression with medical and surgical means.8
A survey was conducted on assess patient-reported problems and adherence to glaucoma medications. The purpose of the study was to describe the different types of problems reported by the patients in India when taking their glaucoma medications and examine the relationship between patient-reported problems in taking their glaucoma medications and patient adherence to treatment. The study found that Forty-two percent of patients reported one or more problems in using their glaucoma medications like difficulty in squeezing the bottle (Fisher's exact test, P = 0.04), and difficulty in opening the bottle. Younger patients were significantly more likely to report having difficulty paying for their medication and getting their drops in their eyes than older patient. Approximately 6% of patients reported being less than 100% adherent to their glaucoma medications.
This survey have estimated that by 2010 approximately 8.2 million people in India will have open-angle glaucoma and 3.7 million will have angle closure glaucoma, which translates to approximately 18.4% and 23.7% of the world's open-angle glaucoma and angle closure glaucoma, respectively. And glaucoma was found to be responsible for 10.2% of bilateral blindness.9
With early diagnosis and treatment, most patients with glaucoma can have their vision restored and enjoy a healthy life. The wide variety of topical effective antiglaucoma drugs that are available today, and a few others that are in the development stage, represent significant advancement in ocular therapeutics. Though these topical ophthalmic preparations have reduced the risk of systemic toxicity to quite an extent, their long-term use causes systemic as well as ocular toxicity.10
The ocular patients increase the risk of treatment nonadherence by an imbalance between their perceived need for medication and their concerns about taking it. Patient-centered communication education techniques can encourage the patient in shared decision making about medication, thereby redefining the good patient as someone who works with his or her health care provider to address adherence barriers. Those barriers can be explored with open-ended questions designed to elicit the patient's understanding and concerns, to provide information, and to assess change in the patient's understanding and attitudes. Communication will be more effective if it is based on the patient's stage of readiness to adopt adherent self-management/medication practices.11
Eye patients often attempt to treat conditions that require ophthalmologic emergency care by self-medicating with homemade or manufactured products. The most widely used products include boric acid, normal saline, leaf infusions and breast milk. This behavior occurs independently of educational level, gender, age or the nature of the ocular condition. Self-medication is a culturally driven practice that is used even in cases of acute ocular injuries.12
According to survey of world health organization, glaucoma is the second largest cause of low vision in Qatar after cataract, as a survey conducted on over 3,000 people aged 40 and above reveals some 50 (16 percent) of them suffered from this problem. Of the 3,149 people surveyed, at least 115 (41 percent) were found to have cataract, a condition which is fully curable. Some 40 of them were found to be completely blind and in 39 percent cases glaucoma was the main cause of blindness, followed by corneal pathology (21 percent) and cataract (18 percent). People with seriously impaired vision numbered 52 out of a total of 3,149 covered by the survey. The WHO identified eye problems in 1999 as one of the mightiest challenges facing the world and launched an initiative entitled Vision 2020 to help combat this problem. Joining the global initiative, Qatar set up the national panel for preventing blindness in 2004 and ever since it has enhanced efforts dedicated to identifying and curing eye problems. It aims to bring down total blindness to 0.7 percent by the year 2015 during the five-year plan.
The survey was conducted by the National Committee for Prevention of Blindness and the World Health Organization (WHO) comprising six eye specialists, five nurses and 10 assistants covered nationals as well as expatriates of both genders aged 40 and above..The aim of the survey was to assess the extent of the eye problems prevalent locally; especially low vision and their causes .The survey urges people to get their eyes checked periodically at primary health centers. Students can avail this facility at school clinics. "Most of the eye problems can either be avoided or treated," the recommendations suggested. There are an estimated 45 million blind people in the world and 161 million people suffering from various eye problems.13
Glaucoma management may be extremely challenging, especially in elderly patients who have a variety of systemic diseases and take multiple medications. The investigator obtained a comprehensive medical history in patients with primary open-angle glaucoma to determine which systemic diseases are most prevalent and which systemic medications are most commonly used. The study has also reviewed the literature that addresses how these concomitant diseases and medical treatments influence the management of glaucoma. Knowledge of systemic diseases and potential drug interactions, especially between various systemic and glaucoma medications, is important for the safe management of glaucoma patients.14
Nurse in all setting encounter patient with glaucoma. Glaucoma is a lifelong disease involving a possible loss of sight as psychological, physical, social and vocational ramification. The primary role of nursing management is patient education about proper use of glaucoma medications. Since glaucoma medications can cause adverse effects if used inappropriately.
From the above findings of literature, the investigator would like to study the knowledge of clients regarding glaucoma and its management. Moreover, the investigator mother is known case of diabetic mellitus and she developed glaucoma. She is not aware about her eye disease and its management. Hence the investigator felt there is a need to assess the knowledge regarding glaucoma and its management.
6.1.1 STATEMENT OF THE PROBLEM
“A Study To Assess The Knowledge Regarding Glaucoma And Its Management Among Clients in Selected Hospitals At Bangalore With A View To Develop An Information Guide Sheet”.
6.2 REVIEW OF LITERATURE
Review of literature is a key step in research process. This refers to the activities involved in searching for information on a topic and developing a comprehensive picture of the state of knowledge on that topic. The literature review classified under the following headings.
1. Review related to incidence of glaucoma.
2. Review related to common obstacles in utilization of eye care services.
3 .Review related to effectiveness of topical antiglaucoma medication.
1. Review related to incidence of glaucoma
A nationwide population-based survey was conducted on prevalence of major eye diseases and causes of visual impairment in the adult Finnish population. The main purpose of the study was to estimate the prevalence of cataract, glaucoma, age-related maculopathy and diabetic retinopathy. There are 7979 eligible people were enrolled in this study. The result shows that the estimated total prevalence of cataract, glaucoma, age-related maculopathy and diabetic retinopathy in the study population were 10%, 5%, 4% and 1%, respectively. All these chronic eye diseases increased with age (p < 0.001). The corresponding prevalences for persons aged 65 and older were 34%, 13%, 12% and 2%, respectively. Cataract and glaucoma were more common in women than in men [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.26-1.91; OR 1.57, 95% CI 1.24-1.98, respectively]. The most prevalent eye diseases in people with visual impairment (VA </= 0.25) were age related macular degeneration (37%), unoperated cataract (27%), glaucoma (22%) and diabetic retinopathy (7%).15