RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Mr. MALLANAGOUDA L.KI YEAR M.SC. NURSING STUDENT, B.M.ROAD.HASSAN,KARNATAKA
2 / NAME OF THE INSTITUTION / N.D.R.K. COLLEGE OF NURSING, HASSAN, KARNATAKA
3 / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
(MEDICAL SURGICAL NURSING.)
4 / DATE OF ADMISSION TO THE COURSE / 12TH MAY 2007
5 / TITLE OF THE TOPIC / “THE EFFECTIVNESS OF STRUCTURED TEACHING PROGRAMME ON HOME CARE MANAGEMENT OF BRONCHIAL ASTHMA AMONG PATIENTS ATTENDING MEDICAL O.P.D IN SELECTED HOSPITALS, HASSAN, KARNATAKA.”
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO ASSESS THE EFFECTIVNESS OF STUCTURED TEACHING PROGRAMME (STP) ON HOME CARE MANAGEMENT OF BRONCHIAL ASTHMA REGARDING KNOWLEDGE AMONG BRONCHIAL ASTHMA PATIENTS ATTENDING MEDICAL O.P.D IN SELECTED HOSPITALS, HASSAN, KARNATAKA.”
6. BRIEF RESUME OF THE INTENDED STUDY
6.1 INTRODUCTION
The secrete of national health lies in the home of the people.
K. PARK
Asthma is known from the period of Hippocrates (430-330 BC) the father of modern medicine. The word asthma derived from aazcin means to pant or exhale with open mouth1.
The cells of body need energy for the chemical activity that maintains homeostasis most of energy derived from chemical reaction. Which can only take place in the presence of oxygen. The main waste product of this reaction is carbon dioxide the respiratory system provides the route. Breathing is a regular inflation and deflation of the lung. Which maintains a steady concentration of atmospheric gases. In the alveoli that is the constant intake of oxygen and out put of carbon dioxide2. The lungs one of the pair of conical organs of the respiratory system. Consisting of an arrangement of air tubes (bronchi and bronchioles)terminating in air space(alveoli) they occupy most of the thoracic cavity the lung supply the blood with oxygen inhaled from the out side air and they dispose of waste carbon dioxide in the exhaled air as apart of the process known as respiration.3
Respiration is a process of gaseous exchange between an organism and its environment this includes external and internal respiration which involves breathing2.
Asthma is a disease characterized by recurrent attacks of breathlessness and wheezing which vary in severity, and frequency from person to person symptoms may occurs several time in a day or week in a affected individuals and some people became worse during physical activity or at night .During an asthma attack the lining of bronchial tubes swell causing the air way to narrow and sleeplessness day time fatigue reduced activity levels and school and work absenteeism.4
Asthma is a inflammatory disease of air way resulting in air way hyperresponsipeness mucosal edema and mucus production. This inflammation leads to recurrent episodes of asthma symptoms. Allergy is strongest predisposing factor for the development of asthma. Chronic exposer to air way irritants or allergens also increases the risk for developing asthma. Common allergens can be seasonal example Grass, Tree and weed pollens, Mold dust, Roaches or animal. Common triggers for asthma include air way irritants Example Cold, Heat, Air pollutants, Weather changes. Strong odors, Perfumes, Smoke, Stress or Emotional upset. Most people who have asthma are sensitive to a variety of triggers5.
If persons is diagnosed with asthma. It is very important to reduce and prevent the symptoms preventive measures include, having a healthy diet and nutrition, exercise and managing environment , to eliminate triggers .This would help the patient to maximize lung function. So home care management of bronchial asthma is health education of awareness of the disease and its management it includes life style modification ,diet management, breathing exercise, follow-up care, preventive measures like avoidance of allergens exposure and air- pollution,. These are the information, To improve the patient knowledge to control their asthma attacks and predicit their signs and symptoms of bronchial asthma in home setting.
6.2NEED FOR STUDY
Live a healthier life ….. Starting today!
Asthma is a common disease worldwide with significant ethnic and regional variation. And increasing morbidity and mortality as well as health care burden from asthma has been recognized lately. There has been a change in the epidemiology and clinical spectrum of asthma with an apparent increase in overall prevalence along with raise in incidence of difficult to treat case. Atopy the production of abnormal amounts of IgE antibodies in response to common environmental allergens is the strongest identifiable predisposing factors for developing asthma7.
Asthma is not just public health problem for high income countries . It occurs in all countries regardless of level of development over 80% of asthma deaths occurs in low and lower middle income countries. Asthma is under diagnosed and under treated creating a substantial burden to individual activities for a life time.8
About 42% of increase of asthma among males between 1982 and 1994. Incidence of asthma cause is projected to double by 2010 predicits the American Lung Association. Asthma is a 9th leading cause of hospitalization .Death from asthma was up over 200% from 1979 to 1997 from 2596 deaths to 5434 deaths. According to WHO estimates 300 million people suffer from asthma and 255000 people died of asthma in 2005.Asthma death will increase by almost 20% in the next 10 years if urgent action is not taken. In India have been estimated 15 to 20 million persons of asthmatic. In India low literacy rate and low socio economic status is prevailing which also can affect the patient with asthma, so they are not able to afford treatment8. In south Karnataka state has the first position in the incidence of asthma that is 3.849 in 29.5% among total population (5.27.33.950) this may due to climate with cold air humidity and rainfall 9
A study was conducted on to determine the level of practical knowledge of self management of acute asthma. The sample were 80 patient which moderate and severe asthma were interviewer administered questionnaire the result shows lack of knowledge about treatment and self management to reduce asthma mortality and morbidities10
A study was conducted on factors influencing development of asthma in Hariyana
state they were screened for the presence of symptoms of asthma using questionnaire
suggested by international study of asthma and allergy it was found that passive smoking,
pets at home, absence of windows in living rooms., family history of asthma, history of
worm infestation fuel used for cooking, location of cooking and food allergy associated
with symptoms of asthma.11
A study was conducted on to evaluate self care efficacy in asthmatic patient the result shows minority of the patient had satisfactory level of the knowledge the patient attitude towards medication were negative a practical implication of study findings is that asthma self management focus on developing spefic knowledge and skills in the self treatment of asthma attack12
A nutritional supplement that may be helpful .Being overweight increases the risk of asthma. Obeys people with asthma may improve their lung function symptoms and overall health status by engaging in a weight loss programme .A control study found that weight loss resulted in significant decrease in episodes of shortness of breath increases in overall breathing capacity and decrease in the need for medication to control symptoms13. In those who are having asthma the planned teaching programme may helpful to reduce the prognosis of disease and increasing their knowledge about home care management and improving their health status to lead there life and family survival and build up a healthy family , healthy community and healthy nation.
When the investigator came to Hassan and posted in clinical, on a communication with patient and professional experience of investigator, found that the patient had lack of health awareness on self management of asthma episodes. And Hassan environment is cold dust and heavy rain fall these are the risk factors which exacerbate the disease condition. Hence this information made, to take this study among bronchial asthma patient with health education in the form of planned teaching programme .There is satisfactory evidence in number of patient attending medical out patient unit at selected hospitals Hassan Karnataka.
6.3 PROBLEM STATEMENT
“A study to assess the effectiveness of structured teaching programme on home care management of bronchial asthma regarding knowledge among bronchial asthma patient attending medical O.P.D in selected hospitals, Hassan, Karnataka”.
6.4 OBJECTIVES OF THE STUDY
1) To assess the Knowledge of bronchial asthma patient regarding home care
management of bronchial asthma before and after implementation of structured
teaching programme in control and experimental group.
2) To compare the knowledge of bronchial asthma patient between before and after
implementation of structure teaching programme in control and experimental
group.
3) To find out the association between the knowledge of bronchial asthma patient on
home Care management of bronchial asthma with there selected demographic
Variables in control and experimental group.
6.5 HYPOTHESES :-
H1 :- There will be significant difference between pre-test and post-test knowledge. scores of bronchial asthma patient regarding home care management of bronchial asthma.
H2 :- There will be significant association between the post-test score of Knowledge of bronchial asthma patients with selected demographic variables.
6.6 ASSUMPTIONS:-
1) The patient has some knowledge regarding home care management of bronchial
asthma.
2) The patient are willing to participate in teaching programme to enhance their
knowledge regarding home care management of bronchial asthma.
3) Teaching programme is an effective method of imparting knowledge
of patient regarding home care management of bronchial asthma .
6.7OPERATIONAL DEFINITIONS
1) Assess: - It is statistical measurement of knowledge of patient regarding home care management of bronchial asthma observed by structured interview schedule.
2) Effectiveness:-It is a significant gain in the difference between pre-test and post-test knowledge scores.
3) Structure teaching programme: - It is method of teaching with organized and sequential representation of information regarding home care management of bronchial asthma with some aid’s.
4) Knowledge: - It refers to correct responses of bronchial asthma patient to the knowledge items in the close ended questionnaire regarding home care management of bronchial asthma.
5) Bronchial asthma patient: - In this study bronchial asthma patient refers to the persons who are 20 years and above diagnosed as bronchial asthma attending medical O.P.D for follow-up.
6) Home care management; Home care management is a self care measures taken by bronchial asthma patients to control and eliminate triggering factors by prediciting signs and symptoms of bronchial asthma in home setting by adopting life modification which includes healthy diet and nutrition, proper exercise and maintenance of healthy environment .
6.8 INCLUSION AND EXCLUSION CRITERIA
Inclusion criteria
1) Irrespective of gender
2) Diagnosed as having bronchial asthma.
3) Present during the period of data collection.
4) In the age group of 20years and above.
Exclusion criteria
Patients who are:-
1) Not willing to participate in the study.
2) Developed secondary complication.
6.9 DELIMITATIONS OF THE STUDY
1) Prescribed data collection period is only 4-6 weeks
2) Sample size is limited to 60 patients.
3) Study design is limited to Quasi-experimental design.
6.10 SIGNIFICANCE OF THE STUDY
This study signifies the importance of structured teaching programme to enhance
the knowledge of patients on home care management of bronchial asthma.
6.11) CONCEPTUAL FRAME WORK:-
Based on the “General system Theory”.
6.12 REVIEW OF LITERATURES
Review of literature is a key step in the research process. It refers to an extensive, exhaustive and systematic examination of publications relevant to the research. A literature review helps to lay the foundation for a study and can also inspire new research ideas. It can help with orientation to what is known and not known about an area of inquiry, to ascertain what research can best make a contribution to the existing base of evidence.14
A study was conducted on to determine the effectiveness of providing return health information in addition to verbal information on knowledge and satisfaction for patient or significant other being discharged from hospital setting to home. Were slected randomized control trials included 197 patients in United states and 123 in Canada .The result showed provision of verbal and written health information significantly increased knowledge and satisfaction scores. The study concluded that the use of verbal and written health information which appears to improve knowledge and satisfaction15.
A study was conducted on to determine the efficacy of fish oil supplementation on exercise induced bronchi constriction the result showed that the fish oil diet improved pulmonary function with a concurrent reduction in bronchodilator use the study concluded that fish oil supplementation may represents a potentially beneficial for asthmatic subjects with EIB16.
A placebo controlled double blind cross over trial study was conducted on to determine the effect of ascorbic acid supplementation on pulmonary and EIB on asthmatic clients the study finding showed that the ascorbic acid diet significantly reduced the maximum fall in post exercise compared to usual and placebo diet asthma symptom scores significantly improved the study concluded that ascorbic acid supplementation provides a protective effect against exercise induced air way narrowing in asthmatic subjects.17
A randomized controlled trial study to asses the effect of grass pollen immunotherapy on asthmatic symptoms, bronchial hyper responsiveness and quality of life in seasonal rhinitis and asthma .The study concluded that grass pollen immunotherapy improves quality of life on seasonal allergic rhinitis and reduces seasonal asthma symptoms and bronchial hyper responsiveness.18
A study conducted to determine the effectiveness of physiotherapy based breathing retraining for patient with asthma on 33 adult patients with diagnosed and currently treated with asthma the result concluded that the patient who have symptoms of dysfunctional breathing shows a clinically relevant improvement in quality of life following with physiotherapy based breathing intervention19.
A study conducted on effect of two type breathing exercise 90 patient with asthma taking inhaled corticosteroid were randomized after one two week run in period to buteyko and pranayama exercise. The result showed that breathing exercise technique improves respiratory function and reduce the use of bronchodilator20