Download A study to evaluate the effectiveness of structured teaching

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE
KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSSERTATION
NAME AND ADDRESS MRS.GEESA GEORGE JACOB ,
1. OF
1 YEAR M.Sc NURSING ,
THE CANDIDATE
SOFIA COLLEGE OF NURSING ,
BANGALORE.
2. NAME OF THE
INSTITUTION
SOFIA COLLEGE OF NURSING ,
BANGALORE.
3. COURSE OF STUDY
AND SUBJECT
MASTER OF SCIENCE IN NURSING.
PAEDIATRIC NURSING
4. DATE OF
SUBMISSION
TO THE COURSE
12-06-2010
5. TITLE OF THE TOPIC A STUDY TO EVALUATE THE
EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON
DIABETIC KETO ACIDOSIS (DKA)
AMONG PARENTS OF TYPE-I
DIABETES CHILDREN IN SELECTED
HOSPITALS , BANGALORE.
1
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Children are the world’s most valuable resource and it’s best hope for
the future”
- John Fitzgerald Kennedy
Diabetic Keto Acidosis ( DKA ) is an acute , major , life - threatening complication
of diabetes. DKA mainly occurs in patients with Type-1 diabetes, but it is not
uncommon in some patients with Type-2 diabetes. DKA is a state of absolute or
relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration and
acidosis producing derangements in intermediary metabolism. The most common
causes are underlying infection, disruption of insulin treatment, and new onset of
diabetes. DKA is defined clinically as an acute state of severe uncontrolled diabetes
associated with ketoacidosis that requires emergency treatment with insulin and
intravenous fluids. Biochemically, DKA is defined as an increase in the serum
concentration of ketones greater than 5mEq/L ,a blood glucose level greater than
250 mg/dL and a blood pH less than 7.3Ketonemia and Ketonuria are characteristic
as is a serum bicarbonate level of 18 mEq / L or less.1
Diabetic Keto Acidosis is the condition in which the body has severe
deficiency of insulin. Insulin is a hormone that helps regulate the level of glucose in
the blood. Glucose is the main form of sugar in the body. DKA is s serious but
treatable complication of diabetes. The child who has a DKA has a significant
deficiency of insulin in his or her body. Without insulin, the body is unable to move
glucose from the blood stream to the body cells. This results in high levels of
glucose and acids in the blood.2
2
Diabetic Ketoacidosis is the leading cause of morbidity and mortality in
children with Type I Diabetes Mellitus. Mortality is predominantly related to the
occurrence of cerebral edema, only a minority of deaths in DKA is attributed to
other causes. Cerebral edema occurs in about 0.3 – 1% of all episodes of DKA ,
and its aetiology, pathophysiology, and ideal method of treatment are poorly
understood. There is debate as to whether physicians treating DKA can prevent or
predict the occurrence of cerebral oedema. There is agreement that prevention of
DKA and reduction of its incidence should be a goal in managing children with
diabetes.3
Exact figures for the incidence of Diabetic KetoAcidosis are not available;
however , a multicenter , population – based study reported that around 25% of
new cases of Type-1 diabetes mellitus presented with ketoacidosis , resulting in an
approximate annual incidence of 4 cases per 100,000 children. The youngest
children were at greatest risk , with more than 37% presenting with Diabetic
KetoAcidosis , the rates for children with established diabetes increase with age. As
in the United States, few data are available. A large European multicentre study
showed widely varying rates of diabetic ketoacidosis at diagnosis{26-67%}with
rates inversely related to the overall incidence of childhood diabetes .Diabetic
Ketoacidosis rates in children with established diabetes widely vary; in a United
Kingdom national prospective study, 60% of all cases occurred in patients with
known diabetes.
Diabetic Ketoacidosis at the time of diagnosis is more likely in the most
deprived communities. Despite an increased incidence of diabetes, the incidence of
Ketoacidosis remains high. Diabetic Ketoacidosis is the common cause of diabetes3
related death in childhood. Without insulin therapy, the mortality rate is 100%, but
current mortality rates are around 2-5%. Treatment for diabetic ketoacidosis may
cause life- threatening, predictable, and avoidable acute complications such as
hypokalemia, hyponatremia, and fluid overload.Other complications, such as
cerebral edema, are not as predictable but are very important.Cerebral edema is the
most serious complication of diabetic ketoacidosis. Its causes are not known, but
associated factors include duration and severity of diabetic ketoacidosis before
treatment, overaggressive fluid replacement, the use of sodium bicarbonate to treat
acidosis,too early an introduction of insulin therapy, cerebral anoxia, and degree of
hyperglycemia.Cerebral edema is the most important cause of mortality ad longterm morbidity with diabetic ketoacidosis.4
Diabetic Ketoacidosis is a complication of diabetes that occurs when
compound called ketones build up in the bloodstream. Ketones are produced when
the body breaks down fats instead of sugars, which happens when the body does
not produce enough insulin to process sugar properly. Ketoacidosis generally
develops with Type I Diabetes, a chronic condition in which the pancreas produces
too little or no insulin. It can also happen, although uncommonly, in those with
Type 2 Diabetes, a chronic condition in which the body is either resistant to insulin
or pancreas does not produce enough insulin. Symptoms worsen over time as the
body attempts to use fat instead of sugar for energy. Blood sugar levels generally
increase dramatically during the development of Diabetic Ketoacidosis, as the liver
attempts to compensate for the lack of sugar- derived energy. Diabetic Ketoacidosis
can lead to rapid breathing, flushing, fruity- smelling breath, nausea, vomiting,
pain, fatigue, headache and muscle stiffness. In severe cases, Ketoacidosis can lead
4
to a slowing of mental activity that can progress to coma. The consequences of
Ketoacidosis can be severe, even life threatening, but modern treatments are
usually very effective at preventing serious complications if treatment is obtained
early.5
Diabetic Ketoacidosis treatment attempts to restore insulin, blood glucose,
fluid and electrolyte levels. Treatment may also focus on determining the trigger,
which could be trauma or infection. Most treatment for ketoacidosis require
hospitalization. Treatments for Diabetic Ketoacidosis includes electrolyte
replacement, fluid replacement and insulin administration.6
Girls had DKA more often than boys. Very young children, pubertal
adolescents girls are at a higher risk for DKA at diagnosis. To prevent DKA, earlier
diagnosis of Type 1 diabetes is warranted.7
According to Diabetes statistics by the year 2025, there will be as many as
seven million new diabetic cases in the world. In countries such as India, there are
going to be as many as 80% of all diabetics from the entire world population.
Concentrated there which makes India the Diabetic capital of the world.8
In rural areas, diabetes in children often does not get diagnosed in time. The
reasons for this are manifold – lack of education/ awareness of the symptoms of
this condition, lack of proper care, girl child stigma and poverty. Early diagnosis of
diabetes in children is very poor in rural areas and some of them die because of it,
in the absence of timely diagnosis and / or treatment.9
Every parent should be involved in the care of children and should be familiar with
the warning signs or symptoms of diabetes which could be frequent urination,
excessive thirst, increased hunger, weight loss, tiredness, lack of concentration,
5
blurred vision, vomiting and stomach pain. Every day more than 200 children are
diagnosed with Type 1 diabetes, requiring them to take multiple daily insulin shots
and monitor the glucose levels in their blood. This type of diabetes is increasing
yearly at the rate of 3% amongst children and is rising even faster in pre- school
children at the rate of 5% per year. DKA, a build up of excess acids in the body as a
result of uncontrolled diabetes, is a major cause of death in children with Type 1diabetes. DKA can be prevented with early diagnosis and proper medical care.
About 75,000 children in the low- income and lower- middle income countries are
living with diabetes in desperate circumstances. These children need life- saving
insulin to survive. Many are in need of monitoring equipment, test strips and proper
guidance to manage their condition in order to avoid the life- threatening
complications associated with diabetes. According to the International Diabetes
Federation, In many developing countries and some parts of Asia, life saving
diabetes medication and monitoring equipment is often unavailable or
unaffordable. As a result, many children with diabetes die soon after diagnosis.10
Diabetic KetoAcidosis – DKA – is a common and serious acute
complication of Diabetes caused by relative or absolute lack of insulin. Diabetic
KetoAcidosis is one of the preventable acute complications of diabetes mellitus
through appropriate outpatient diabetes management. Although the management of
DKA has been markedly improved in recent years in association with the general
health care improvement, it is still a health problem in children. DKA is a serious
consequence of insufficient insulin secretion, is the leading cause of acute
morbidity and mortality in children with Type-1 diabetes. The frequency of DKA
at the diagnosis of Paediatric Type-1 Diabetes has been reported to vary from 15 to
6
67% in Europe and North America. Further more , there is substantial variation in
the incidence of Type-1 diabetes between different population and an inverse
correlation between the frequency of DKA and the background incidence of Type1 diabetes has been reported. There are some indication that the frequency of DKA
may be decreasing at the clinical presentation of Type-1 diabetes in children , but
contradictory findings also have been reported. A series of studies have shown that
the incidence of childhood Type-1 diabetes has been increasing over the past
decades , and it has been postulated that increasing medical information and
awareness concurrent with an overall increase in incidence might have resulted in
changes in the clinical presentation at diagnosis in developed countries. In 1983, the
incidence of DKA was reported to be 46 / 10,000 children with Type-1 Diabetes.
During the last two decades the trend of DKA admissions has been increased. Part
of this increased frequency of admissions may be related to the increased
prevalence of Type-1 diabetes. Moreover multiple episodes of DKA have also
contributed to the increase of admissions. But the age adjusted mortality rate has
been improving over the last two decades. In earlier reports, 4% - 25% of cases
followed by non compliance with therapy including discontinuation of insulin and
oral medication and non adherence to diet. The major cause of DKA was
discontinuation of insulin therapy in up to 67% of the cases.
7
6.1 NEED FOR THE STUDY
People living in rural areas have less access to health care than people
living in urban areas. In an emergency situation they are not able to reach the
hospital to avail the best care due to poverty, high levels of illiteracy and limited
access to social services. DKA is typically characterized by hyperglycemia over
300mg/dl, a bicarbonate level less than 15mEq/l, and a pH less than 7.30, with
ketonemia and ketouria DKA is a serious complication of diabetes, which requires
hospitalization for treatment. It is estimated that around 25% to 40% of patients
with newly diagnosed Type 1 diabetes present with this condition particularly those
under 5 years of age. DKA can occur at any age, but it is common in those younger
than 19 years. Studies conducted in India have shown that incidence of
Ketoacidosis in children at the onset of diabetes is around 25%. The prevalence of
diabetes is about 0.4/1000 children with a lower incidence in the rural areas.
Children comprise 3-5% of the total diabetics. A study of 55 pediatric cases of
diabetes mellitus showed that only 40% had ketoacidosis on admission. 18.2% had
onset of illness before 4 years of age. Mortality is due to poverty and relative lack
of health care facilities.11
A retrospective study was done in the Department of paediatrics from
January2002 to November 2006 to determine , clinical features, precipitating
factors and outcome of DKA. 344 diabetic patients were hospitalized . Among them
15.6% had DKA, 51.9% of the patients were newly diagnosed. Amongst
precipitating factors, 28% had missed insulin and 48% have overt infection.
Infections, particularly those of the respiratory tract were the main precipitating
8
cause for the DKA. There was history of both infection and missed insulin
injections in 11.5% of patients. Female and male ratio was 2:1.12
A study was conducted in Ontario for children with diabetes. The main
outcome measure was the frequency of medical encounter before diagnosis in
children presenting with or without DKA. A total of 3947 new cases of diabetes
were identified, 18.6% with DKA. DKA rates were 39.7% for children less than 3
years and 16.3% for children more than 3 years. Children with DKA were less
likely to have had relevant laboratory testing before diagnosis than children with
diabetes without DKA.13
A study was conducted in 1987 in Germany regarding the frequency and the
clinical presentation of Diabetic Ketoacidosis at the onset of Type 1 diabetes
mellitus in children. Hospital records of 2121 children below 15 years of age were
examined retrospectively. DKA was defined as glucose more than 250mg/dl, pH
less than 7.30 or bicarbonate less than 15 mmol/l . Statistical analysis was done
after logarithmic transformation. 26.3%of all patients presented with DKA.
26.3%of all patients presented with DKA. Those aged 0-4 yr suffered most
frequently from ketoacidosis. 23.3% of all patients with DKA presented with an
altered level of consciousness. The proportion of ketoacidosis does not increase
concurrently with the number of diabetes manifestations in winter.14
A study was conducted in Canadian Institute for Health Information with
15,872 diabetes related hospital admissions in children younger than 19 years from
1991 to 1999. Of these 5,008 were because of DKA and 10,864 admissions were
because of Non-DKA. During the study period Non- DKA admissions decreased
by 29%, whereas DKA admissions remained stable. Due to the increased care
9
efforts for children with Type 1 Diabetes, the rate of Non- DKA admissions have
successfully reduced. However, DKA admission have remained the same.15
A study was conducted to observe the frequency, demographic data and
outcome of Diabetic Ketoacidosis in children with established Type 1 Diabetes and
newly diagnosed diabetes. From 2008 to 2009. Those who were diagnosed with
DKA were reviewed, and who did not fulfill the criteria were excluded. .Out of 124
cases, 117 were included which fulfilled the criteria of DKA. Out of 117 children,
42.7% had established Type 1 diabetes, and 57.2% Children had newly diagnosed
diabetes. The commonest presenting complaints in both groups were respiratory
distress with 87.1% and vomiting with 77.7%.The symptoms of polyuria,
Polydypesia and nocturia were more among the newly diagnosed children as
compared to those with established diabetes. More studies on a larger scale are
needed to assess the prevalence/ incidence of DKA and also more emphasis with
educational programmes on prevention of recurrent attacks of DKA.16
A study was carried out to estimate the incidence of childhood insulin
dependant diabetes mellitus in an urban southern Indian population. A registry
form has been set up in the city of Chennai, South India. Details of newly
diagnosed Diabetic children, aged less than 15 years were analysed retrospectively.
The peak incidence was between 10 and 12 years. This is the first population based
incidence data from India and showed that the incidence of Type 1 Diabetes is not
low in urban children.17
10
6.2 REVIEW OF LITERATURE
Review of Literature is a key step in research process. It is body of text
that aims to review the critical points of current knowledge including substantive
findings as well as theoretical and methodological contributions to a particular
topic. A well structured literature review is characterized by a logical flow of ideas,
current and relevant references with consistent, appropriate referencing style,
proper use of terminology and an unbiased and comprehensive view of the
research. A literature review is designed to identify related research, to set the
current project within a conceptual and theoretical context. The purpose of a review
is to analyze critically, a segment of a published body of knowledge through
summary classifications, comparison of prior research studies, review of literature
and theoretical articles.
A study was conducted to prevent recurrent Diabetic Ketoacidosis,
based on the assumption that diabetes education in conjunction with appropriate
use of and adherence to insulin therapy should eliminate all Recurrent DKA. A
hierarchical set of medical, educational, and psychosocial interventions was used
The rate of Recurrent DKA was lower after initiation of the program even though
patients seen during this period came from lower socioeconomic and more oneparent families than patients seen prior to intervention. In 44 patients with a history
of Recurrent DKA, insulin omission was documented in 31, inadequate education
in 13. Overall, then rate of Recurrent DKA decreased from a pre referral mean of
25.2 episodes to a post referral mean of 2.6 episodes per 100 patients. Metabolic
control improved after intervention and Recurrent DKA ceased. Although
Recurrent DKA is casually related to a variety of social, economic, and family
11
dysfunctions, its prevention requires recognition that its proximate cause is
omission of insulin and assurance that a support system exists to ensure
adherence.18
A study was done on the clinical presentation and initial management on
230 patients with Type 1 Diabetes. Clinical details from the time of diagnosis were
available on 219 patients. 16% were in severe ketoacidosis with pH less than 7.10
or plasma bicarbonate less than 10 mmol/l, and 10% had mild to moderate
ketoacidosis with pH 7.10-7.35 or plasma bicarbonate 10- 21 mmol/l. Presentation
in severe ketoacidosis was most common in children under age 5 years, and
ketoacidosis of any degree was less frequent in older children and those with a
parent or sibling with diabetes. A second cohort study was done in 1990. The rate
of admissions at diagnosis was 79%, severe ketoacidosis 13% and mild to moderate
13%. Despite recent developments in diabetes management and a high level of
clinical ommitment, Ketoacidosis remains a common presentation of childhood
diabetes, and hypoglycaemia is unacceptably frequent in the years following
diagnosis. Greater public and medical awareness of the presenting feature of
diabetes in young children is needed to reduce the frequency of ketoacidosis at
presentation, while hypoglycaemia remains a major obstacle to good glycaemic
control.19
Childhood diabetes is a life- long chronic illness placing complex and daily
demands on the patient and family. Although the role of psychological factors in
diabetes has long been recognized, only recently have investigators begun to
systematically explore the relationship between parent and child knowledge about
12
diabetes, attitudes toward diabetes, compliance or adherence behaviors, and health
status.20
Although the incidence rates of diabetes in children under the age 3 years
is increasing dramatically, no previous studies provide information about the dayto – day experience of caring for these infants and toddlers .Because a young child
with diabetes is dependent on the parent for his /her very existence , the purpose of
this phenomenological study was to gain knowledge and understanding of the
parents experience so that appropriate interventions could be developed and
implemented to support parental care for this unique population. Findings revealed
three distinct phases in the parents experiences the diagnosis and child’s
hospitalization, adjusting to care at home, and long- term adaptation. Within these
phases, parents described inordinate amounts of stress exacerbated by the child’s
young age and the complex, intrusive nature of diabetes management. 21
One in four children with Type 1 diabetes experiences DKA before being
correctly diagnosed with the condition. DKA occurs when blood glucose lvels are
dangerously high. It can cause nausea, vomioting, stomach pain and rapid
breathing, and potentially lead to a coma if left untreated. It is vital that healthcare
professionals, and parents, have the knowledge to be able to detect the signs of
undiagnosed Type 1 diabetes so that vital insulin treatment can begin as quickly as
possible and DKA can be prevented. In a study it shows that one in three of newly
diagnosed children has had at least one related medical visit prior to diagnosis,
suggesting the condition is being missed by doctors. In addition, 35% of children
under 5 have DKA at diagnosis.22
13
A study was done in Southwestern Saudi Arabia with children less than 13
years of age with Type 1 diabetes between January 2000 to December 2006. A total
of 181 children with Type 1 Diabetes were taken for the study. Of these, 27.6%
were children 5 years or less, while 72.4% were more than 5 years of age. The
duration of symptoms was longer in younger .Children compared to older patients.
Diabetic Ketoacidosis was present in 31.4% of the younger children and in 15.3%
of the children more than 5 years old. Most significant differences were in the
younger children’s group and affected the biochemical test results. The present
study showed that more younger children present to the hospital late, and in a state
of Diabetic Ketoacidosis compared to older patients.23
A study was conducted in Bangkok with children age from 11 to 15 years.
The important of patient education program in the management of diabetes has
been widely recognized. A study was conducted in general to find out what the
patients and their parents know about diabetes and their self- care by using a
questionnaire. Then the diabetic education was given by one- to – basis to every
patient. 34 insulin dependent diabetic mellitus children attended the diabetic clinic.
Majority came from low socioeconomic families. 23.5% were separated families,
one patient lived with neither her mother nor father. Only one patient had home
glucose monitoring. 41.2% had been diagnosed as DKA over the past year,
however, there was no statistically significant difference between admission with
DKA and low socioeconomic status. The situation in India is different from that in
the western countries as the patients are low in literacy and socioeconomic status. A
well- planned educational programme is essential to cater to the need to the oriental
patients.24
14
A study done in India from January 2004 to August 2008 to know the
clinical profile and outcome of children with Diabetic Ketoacidosis. 21 children
were analysed for the study, They were managed using a standard protocol
including intravenous fluids and insulin infusion. Blood glucose, serum
electrolytes, blood urea, arterial blood gases and urinary ketones were monitored at
regular intervals. The outcome was assessed. 80% were detected to have diabetes
mellitus at the time of presentation. 57% presented with severe diabetic
ketoacidosis. Polyuria with polydipsia was the commonest clinical presentation. All
of them had elevated HbA1C levels. The outcome of active management of DKA
in children is rewarding. The use of a standard protocol for management was
associated with no complications or mortality.25
A recent study from a major US childhood diabetes centre showed that
children with Type 1 Diabetes remain high risk for DKA with an incidence of 8 per
100 patient- years.Children who are uninsured or underinsured, have psychiatric
disorders, have poorl controlled diabetes,and live in dysfunctional families are most
vulnerable.26
A study was conducted in Germany and Austria with the occurrence of DKA
at the onset of Type 1 Diabetes. DKA was observed in 21.1% of patients.10% had
mild DKA, 5.4% had moderate DKA, and about 6% had severe diabetic
ketoacidosis. The frequency of DKA was particularly striking among children less
than 5 years of age.27
A new study into children with Diabetes has found that many diagnosis of
children that have Type 1 diabetes can be missed unless there are more obvious
symptoms such as stomach pain, vomiting and rapid breathing. With around 29,000
15
children being diagnosed with this type of Diabetes each year, it was shown that a
quarter of these only found out they had the disease once they had suffered a DKA
attack, which exhibits these symptoms and can sometimes lead to the child falling
into a coma.28
A critical analysis of the evolution during the first 24 hours was undertaken
in 41 children and adolescents treated for diabetic ketoacidosis. Three of 4 children
presented with Ketoacidosis revealing diabetes. One of 4 was less than 6 years of
age. Severe Ketoacidosis {pH less than 7.15} concerned one third of children and
were more frequent in the group of adolescents with already known diabetes. In
these patients, Ketoacidotic decompensation was attributed to psychosocial factors
in most cases. Evolution was favorable in all cases, without complication. Blood
glucose levels decreased from 28.7mmol/l on arrival to 16.2 mmo l / l after 2 hours
of treatment and became stable at 10 mmol / l from the 12th to 24th hours. The
corrected blood sodium levels were stable, showing the adequacy of infusion solute
osmolarities. Blood potassium was maintained at a normal level owing to early
potassium supplementation. Ketoacidosis was corrected after about 12 hours,
without bicarbonate administration when pH
was greater than 7.15. Average
perfused volumes were 3 l/ 24 hours. This study shows the efficacy of a treatment
taking into account the pathophysiology of diabetic ketoacidosis and the knowledge
of the complication risk factors, by forseeing the adjustments to be done with
respect to individual and/ or at risk situations. These precise descripitive data,
collected on a large group of patients, establish a reference basis to follow
evolution in the course of the treatment of diabetic ketoacidosis in children.29
16
6.3 STATEMENT OF PROBLEM
A study to evaluate the effectiveness of structured teaching programme on
Diabetic Keto Acidosis (DKA) among parents of type-I Diabetes children in
selected hospitals , Bangalore.
6.4 OBJECTIVES OF THE STUDY
1. To assess the level of knowledge of DKA among parents of Type 1 Diabetes
children.
2. To determine the differences between the mean pretest and posttest knowledge
scores on DKA among parents of Type 1 Diabetes.
3. To find out the association between the pretest knowledge level with selected
demographic variables.
6.5 HYPOTHESIS
H1 – There will be a significant difference between the mean pretest and posttest
knowledge scores regarding DKA among parents of Type -1 Diabetes.
H2 – There will be a significant association between the pretest knowledge levels
with selected demographic variables.
6.6 OPERATIONAL DEFINITION OF THE TERMS
In this study it refers to
Evaluate: The difference between pretest and posttest knowledge scores of
mothers of type-1 diabetic children regarding DKA based on a structured teaching
programme.
17
Effectiveness: Determining the extent to which the structured teaching programme
has achieved the desired effect as measured in terms of significant gain in the post
test knowledge of mothers of type-1 diabetic children regarding DKA.
Structured Teaching Programme: Systemic organized teaching programme
prepared by the investigator and validated by experts, containing information about
various aspects of DKA.
Diabetic Keto Acidosis:
This is one of the complication of type-1 diabetes
mellitus resulting in acidosis.
Parents: Refers to the mother or fathers who takes care of children.
6.7 ASSUMPTIONS
1. DKA is a major complication in children if it remains undiagnosed, unidentified
and untreated in Type 1 Diabetes.
2. Diabetic Education in conjunction with appropriate use of and adherence to
insulin therapy, and regular glucose monitoring should eliminate all recurrent
DKA.
3. To raise awareness among parents about the life threatening complications of
DKA.
6.8 DELIMITATIONS
This study is limited to
1. Parents of Type 1 Diabetic children.
2. Collection of data from parents of selected hospital at Bangalore.
3. Knowledge of DKA will be assessed only through structured interview
schedule.
18
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA
Parents whose children have Type 1 Diabetes in selected
hospitals in
Bangalore .
7.2 METHODS OF DATA COLLECTION
Research method : Quasi experimental method
Research Design : One group pretest and posttest design.
Sampling Technique : Convenience sampling.
Sample size : 60 parents of children having Type 1 Diabetes.
Setting of the study : Selected hospitals at Bangalore.
7.2.1 CRITERIA FOR THE SELECTION OF SAMPLES
Inclusion criteria
1. Parents whose children have Type 1 Diabetes.
2. Parents who are willing by their own to participate in the study.
3. Parents who can read and understand Kannada.
4. Parents who attend Outpatient Department.
Exclusion criteria
1. Parents whose children are sick.
2. Step Father and Mother
3. Parents already participated in structured teaching programme.
19
7.2.2 DATA COLLECTION PROCEDURE
A structured interview schedule will be prepared to assess the knowledge
regarding DKA among mothers of type-1 diabetes children.A structured teaching
programme will be prepared on DKA. Content validity
of the tool will be
ascertained in consultation with the guide and experts from nursing and medicine.
Reliability of the tool will be established by split half method. Prior to the study
permission will be obtained from concerned authority. Further consen will be taken
from the samples regarding their willingness to participate in the study.
7.2.3 DATA ANALYSIS METHOD
Data analysis will be done by descriptive and inferential statistics. Frequency
and percentage will be done to analyse socio- demographic variables. Mean and
standard deviation will be done to assess the knowledge on DKA . A paired t-test
will be done to evaluate the effectiveness of structured teaching .A chi-square test
will be used to find out the association between the knowledge with selected
demographic variables.
7.3 DOES THE STUDY REQUIRES ANY INTERVENTIONS
OR INVESTIGATIONS TO BE CONDUCTED ON PATIENTS
OR OTHER HUMAN ANIMALS?
No,
Only a structured interview schedule will be used.
No other intervention which cause physical harm will be used for the study.
20
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED?
Yes,
1. A written permission from the concerned authority will be obtained from the
concerned prior to the study.
2. Consent will be obtained from the client before conducting the study.
3. Confidentiality will be maintained.
21
8. LIST OF REFFERENCES
1. Vasudevan A Raghavan. Diabetic Ketoacidosis
2. http://www.uillinoismed.center.org university of Illinois medical center: health library
3. Howard Bauchner , Archives of Disease in Childhood
4. William H Lamb Pediatric Diabetic Ketoacidosis
5. http://www.bettermedicine.com
6. http://care.diabetes.journals.org
7. http://www.ncbi.nlm.nih.gov/pubmed/ 21271502
8. http://health.Savvy.com
9.
Sreeraman Diabetes and children
10. http://dev.worlddiabetesday.org
11. Verma IC The challenge of Childhood Diabetes Mellitus in India
12. http://www.imcbd.ne/files/journals/1261138589
13. The Journal of Pediatrics
14. http://www.ncbi.nlm.nih.gov/pubmed/14655263
15. Medline Abstract for reference 3 of treatment and complications of diabetic
ketoacidosis
16. Journal of Pakistan Medical Association
17. Professor Stephen Colagiuri Diabetes Research and clinical practice pages 79-82
18. Michael P Golden,Alison J Herrold, Donald P.OrrThe Journal of Pediatrics, volume
107,pages 195-200, August 1985
19. Pinkey JH, Bingley PJ, Sawtell PA,Dunger DB, Gale EA, Presentation and Program
of Childhood Diabetes Mellitus: a prospective population based study
20. Suzanne Bennett Johnson knowledge, attitudes and behaviour: correlates of health in
childhood diabetes, volume 4 issue 5 pages 503-524
21. Hattan DL, Canam C, Thorne , Hughes AM Parents Perceptions of caring for an
infant or toddler with diabetes. Pages 569-77
22
22. http://www.diabetes.org.uk
23. Dr Suliman H. The relation of age to the severity of Type 1 diabetes in children.
24. http://www.mcbi.nlm.gov/pubmed/2638697
25. Ganesh R, Arvindkumar R, Vasanth T, Clinical profile and outcome of diabetic
ketoacidosis in children
26. http://www.elsevier.com
27. http://www.endocrinology.com
28. http://www.i-diabetes.com
29. Tubiana-Rufi N, Habita C, Czernichow P Critical study of diabetic ketoacidosis in
children .
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SIGNATURE OF THE
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CANDIDATE
10
THE TOPIC IS RELAVANT
AND IT IS FEASIBLE TO
CONDUCT THE MAIN STUDY.
REMARKS OF THE GUIDE
11
NAME AND DESIGNATION
MR.RAMESHWAR PRASAD
SHARMA,
LECTURER.
11.1 GUIDE
11.2 SIGNATURE
11.3 CO- GUIDE
11.4 SIGNATURE
HEAD OF THE DEPARTMENT
MR.RAMESHWAR PRASAD
SHARMA,
LECTURER.
11.5 NAME
11.6 SIGNATURE
12
12.1 REMARKS OF THE
CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE
24
EARLY INDENTIFICATION
PREVENTS FURTHER
COMPLICATIONS. THIS
STUDY HELPS THE MOTHER
TO INDENTIFY THE
COMPLICATIONS IN TYPE-1
DIABETIC CHILDREN.