Download “A STUDY TO EVALUATE THE EFFECTIVENESS OF

“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNOWLEDGE REGARDING HOME
CARE MANAGEMENT OF ARTHRITIS AMONG RHEUMATOID
ARTHRITIS PATIENTS ATTENDING OUT-PATIENT DEPARTMENT
AT SELECTED HOSPITAL, NELAMANGALA.”
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
2011-2013
SUBMITTED BY,
SUBMITTED TO,
Ms. TEENA MELVIN DAS
MR. T. VIJAYKUMAR
1st YEAR M.Sc NURSING
PRINCIPAL
MEDICAL SURGICAL NURSING
HARSHA COLLEGE OF NURSING
HARSHA COLLEGE OF NURSING
NH - 4, NELAMANGALA
NH-4, NELAMANGALA,
BANGALORE.
BANGALORE.
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF
SUBJECTS FOR DISSERTATION
Ms. TEENA MELVIN DAS
1
NAME OF THE CANDIDATE
1ST YEAR M.SC. NURSING,
HARSHA COLLEGE OF NURSING,
AND ADDRESS
NELAMANGALA,
BANGALORE.
HARSHA COLLEGE OF NURSING,
2
NAME OF THE INSTITUTION NELAMANGALA,
BANGALORE
3
4
COURSE OF THE STUDY
1st YEAR M.Sc NURSING
MEDICAL SURGICAL NURSING
AND SUBJECT
DATE OF ADMISSION TO
05-09-2011
THE COURSE
TITLE OF THE TOPIC
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED
5
TEACHING PROGRAMME ON KNOWLEDGE REGARDING THE HOME
CARE MANAGEMENT OF ARTHRITIS AMONG
RHEUMATOID
ARTHRITIS PATIENTS ATTENDING OUT-PATIENT DEPARTMENT AT
SELECTED HOSPITAL, NELAMANGALA”
2
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Time And health are two precious assets that we don’t recognize and appreciate
until they have been depleted.” ~Denis Waitley
A disease or medical condition is an abnormal condition of an organism that
impairs bodily function associated with specific symptoms and signs. It may be caused by
external factors, such as infectious disease or it may be caused by internal dysfunctions
such as auto immune diseases. Illness and sickness are generally used as synonyms for
disease .However the term occasionally used to refer specifically to the patient’s personal
experience of his or her disease1.
Diffuse connective tissue diseases refer to a group of disorders that are chronic in
nature and characterized by diffuse inflammation and degeneration in the connective tissue.
The diffuse connective tissue diseases have unknown causes and are thought to be the result
of immunological abnormalities, they include RA, SLE, scleroderma2.
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect
many tissues & organs but principally attacks the joints produce an inflammatory synovitis
that often progresses to destruction of articular cartilage and ankylosis of the joints. It also
produces diffuse inflammation in lungs, pericardium, pleura & sclera. About 1% of the
world’s population is afflicted by rheumatoid arthritis, women three times more often than
men. Onset is more frequent between the ages of 40 and 50.It can be disabling and painful,
which can lead to substantial loss of functioning and mobility.2
Rheumatoid arthritis affects the quality of the life. The complications of Rheumatoid
arthritis include joint distraction, heart failure, lung disease, low or high platelets, spine
instability etc. Affected joints may worsen the ordinary tasks of the day to day life.
Rheumatoid arthritis complications of this disease may shorten survival in some individuals.3
3
Although there is no known cure for most forms of arthritis, treatment
designed for individual patient can reduce/eliminate symptoms and limit functional
impairment. The goals of contemporary management of arthritis extend beyond pain control
to the enhancement of patients’ functional status and health-related quality of life. Patient
education regarding joint protection and avoidance of excessive joint loading is important for
this patient. Physical measures like hot pack, paraffin bath or occupational therapies may be
helpful.4
6.1
NEED FOR THE STUDY:
The increasing number of older people in Indian society has been well
perceived. Proportion of older people is growing faster than of any other age group. While
population ageing is a success story of socioeconomic development and good public health
practice, it has also lead to economic and social crisis due to crumbling support system, with
increased demand for health and welfare services. The elderly (people above the age of 60
years) comprise 7.5 percent of India’s total population, and by 2021 that number will be 137
million and making health care available and accessible to them is one of the health priorities
of the country.5
India now has the second largest aged population in the world. The small-family norm
means that fewer working, younger individuals are called upon to care for an increasing
number of economically unproductive, elderly persons 75% population living in the rural
areas. According to the findings of the 60th NSSO Round, the proportion of aged persons who
cannot move and are confined to their bed or home ranges from 77 per 1000 in urban areas to
84 per 1000 in rural areas.6
The prevalence of rheumatoid arthritis was studied in the adult Indian population. As
the first step, a house-to-house survey of a rural population near Delhi was conducted by two
4
trained health workers. The target population comprised 44,551 adults (over 16 years old).
The health workers identified the possible cases of rheumatoid arthritis (RA) using a
questionnaire. These cases were then further evaluated by the authors using the 1987 revised
ARA criteria for the diagnosis of RA. A response rate of 89.5% was obtained and 3393
persons were listed as possible cases of RA by the health workers. Of these, 299 satisfied the
revised ARA criteria for the diagnosis of RA, giving a prevalence of 0.75%. Projected to the
whole population, this would give a total of about seven million patients in India. 7
In India, the prevalence of rheumatoid arthritis (0.75%) is similar to that in the West.
In China, Indonesia, and the Philippines, in contrast, rheumatoid arthritis appears rare
(prevalence below 0.4%), in both urban and rural settings. The rarity of rheumatoid arthritis
in rural Africa contrasts with the high prevalence of the disease in Jamaica, where over 2% of
the adult population are affected. In a study in Latin America, rheumatoid arthritis was the
reason for seeking medical advice in 22% of rheumatology clinic patients. These differences
probably reflect variations in the interactions between genetic and environmental factors.8
Scientists estimate that about 2.1 million people, or 1 percent of the U.S. adult
population, have rheumatoid arthritis. About 1 percent of the U.S. population (about 2.1
million people) has rheumatoid arthritis. 2.5 million Americans (NWHIC); 1% of US
population (NIAMS) has rheumatoid arthritis. What causes the chronic inflammation
characteristic of RA isn’t known, but various theories point to infectious, genetic, and
endocrine factors. Currently, it’s believed that a genetically susceptible individual develops
abnormal or altered immunoglobulin (Ig) G antibodies when exposed to an antigen. This
altered IgG antibody isn’t recognized as “self,” and the individual forms an antibody against
it — an antibody known as RF. By aggregating into complexes, RF generates inflammation.
Eventually, cartilage damage by inflammation triggers additional immune responses,
including activation of complement. This in turn attracts polymorphonuclear leukocytes and
stimulates release of inflammatory mediators, which enhance joint destruction.9
The Accredited Social Health Activist (ASHA) will be trained in geriatric care and the
out-patient medical service which serves as the base for home health service will be
5
enhanced. One of the aspects of home health service for the geriatrics is health education
about the home remedies.10
Although health care professionals can prescribe or recommend treatments to help
patients manage their rheumatoid arthritis, the real key to living well with the disease are the
patients themselves. Research shows that people who take part in their own care report less
pain and make fewer doctor visits. They also enjoy a better quality of life.Patient education
and arthritis self-management programs, as well as support groups, help people to become
better informed and to participate in their own care. An example of a self-management
program is the Arthritis Self-Help Course offered by the Arthritis Foundation and developed
at a NIAMS-supported Multipurpose Arthritis and Musculoskeletal Diseases Center. (See the
Arthritis Foundation listing in “For More Information.”) Self-management programs teach
about rheumatoid arthritis and its treatments, exercise and relaxation approaches,
communication between patients and health care providers, and problem solving. Research on
these programs has shown that they help people:
▪
understand the disease
▪
reduce their pain while remaining active
▪
cope physically, emotionally, and mentally
▪
feel greater control over the disease and build a sense of confidence in the ability to
function and lead full, active, and independent lives.11
The investigator herself came across many people suffering from arthritis and who are
reluctant to know about home remedies for rheumatoid arthritis in outpatient department in
her clinical experience. Investigator had also seen her grandmother suffering from rheumatoid
arthritis. As there are many elderly people in the society and at least one person is seen in
6
each family, the attention given to them is less. So, the elderly people need to be educated on
the home remedies for rheumatoid arthritis. The investigator felt the need of education and
has taken up the present study to create awareness among rheumatoid arthritis patients
regarding rheumatoid arthritis.
6.2 REVIEW OF LITERATURE
The review of literature is traditionally considered as a systematic critical review of
the most important published scholarly literature on a particular topic. A through literature
review
focuses
on
prior
research,
provides
a
foundation
on
which
to
base knowledge. According to Polit and Hungler (1999) “Review of literature is a critical
summary of research on a topic of interest generally prepared to put a research problem in
context to identify gaps and weakness in prior studies so as to justify a new
investigation”. There are three sections included in Review of Literature. They are
SECTION A – Review on knowledge regarding Joints
SECTION B – Review on knowledge regarding Rheumatoid arthritis
SECTION C – Review on Home remedies of Rheumatoid Arthritis and prevention of its
complications.
SECTION D - Review on effectiveness of Structured Teaching Programme
SECTION A – Review on Knowledge regarding Joints
The musculoskeletal system provides an important function of our body. It provides
form, stability and movement to the body. A main part of the musculoskeletal system is the
joint. The word joint is used to describe how bones are connected to other bones and muscle
fibres' using connective tissue such as tendons and ligaments.12
7
Joints consist of bones, muscles, cartilage, tendons, ligaments and other connective
tissue. Muscles keep the bones in place and also through contraction or extension help move
the bones. Cartilage prevents the bone ends from rubbing directly on to each other. Cartilage
is not as hard and rigid as bone, but is stiffer and less flexible than muscle. Tendons are bands
of fibrous tissue that connect muscles to bones. Ligaments are bands of fibrous tissue that
connect the ends of bones together to form a joint.12
Most joints in the human body are freely movable and have much more complex
structures than the immovable or even the slightly movable types. The articular (adjoining)
ends of bones in a freely movable joint are covered with a thin layer of "articular cartilage,"
which is resistant to wear and produces a minimum of friction when it is compressed as the
joint is moved. Joint bones are held together by a tubular "joint capsule" that has two distinct
layers. The outer layer consists mostly of dense, white, fibrous connective tissue, the fibers of
which are attached to the periosteum around the outside ring of each bone of the joint near its
articular end. The outer fibrous layer of the capsule, therefore, completely encloses the other
parts of the joint. It is flexible enough, though, to allow movement and strong enough to help
prevent the articular surfaces from being pulled apart. Bundles of strong, tough collagenous
fibers called "ligaments" reinforce the joint capsule and help to bind the articular ends of the
bones together. Some ligaments appear as bulges in the fibrous layer of the capsule, while
others are "accessory structures" located outside the capsule. In either case, these structures
also prevent too much movement at the joint, because the ligament is relatively inelastic and
becomes tightly drawn whenever a normal limit of movement has been achieved in the
joint. 13
The inner layer of the joint capsule consists of a shiny, vascular lining of loose
connective tissue called "synovial membrane." The membrane covers all of the surfaces
within the joint capsule, except the areas which are covered by cartilage. Some freely
movable joints are partially or completely divided into two compartments by disks of
fibrocartilage called "menisci" located between the articular surfaces. Such a disk is attached
to the fibrous layer of the joint capsule at the sides, and its free surface projects into the joint
cavity. Certain freely movable joints also have closed, fluid-filled sacs called "bursae"
associated with them. Each bursa has an inner lining of synovial membrane, which may be
continuous with the synovial membrane of a nearby joint cavity. Bursae act as cushions and
aid the movement of tendons which glide over such bony parts or over other tendons. The
8
names of the bursae indicate their locations; for example, a "suprapatellar bursa," a
"prepatellar bursa," and a "infrapatellar bursa".13
There are two major types of joints: synarthroses and diarthroses. Synarthroses are
joints connected by fibrous tissue. Diarthroses are synovial joints, where two bones are bound
together by a joint capsule, forming a joint cavity. In synovial joints, there is a nourishing
lubricating fluid called synovial fluid.14
There are two types of synarthroses: fibrous joints and cartilaginous joints. In fibrous
joints, bones are united by fibrous tissue. There are three types of fibrous joints: gomphosis,
suture, and syndesmosis. A gomphosis joint occurs where one bone fits into another bone.
The articulating edges are bound together by connective tissue, and the bony surfaces in the
articulation are close together A syndesmosis joint connects two bones through connective
tissue and is found throughout the human body.14
In cartilaginous joints, bones are connected by either fibrocartilage or hyaline
cartilage. There are two types of cartilaginous joints: symphyses and synchondroses. A
symphysis is a cartilaginous joint where the connecting entity is fibrocartilage. The
symphysis is stable but it allows limited motion. A synchondrosis is a joint where the
articulating surfaces are close together, yet are bound by hyaline cartilage.14
A diarthroses has a synovial component. The bones are connected to a joint capsule
that surrounds the bones and creates a joint cavity. Ligaments also attach bone-to-bone
stabilizing the joint and making the diarthrotic joint stable, yet mobile. . Making the
diarthroses even more unique from the synarthroses is the addition of synovial fluid. The
synovial fluid provides lubrication within the joint Synovial-type joints can be further
classified into three categories: uniaxial, biaxial, and triaxial. In summary, the diarthroses is
complex, with ligaments and capsule providing stability, disks or menisci aiding in
congruency, and synovial fluid providing lubrication.14
9
SECTION B – Review on knowledge regarding Rheumatoid arthritis
T.Makelainen.et.al.(2008) conducted a study to describe RA patients understanding
of their disease and its treatments. The study included 252 RA patients participated in the
survey. The knowledge level of the patients and their physical functioning were measured
using self reported Questionnaire and the datas were analyzed using descriptive and nonparametrical statistical method. The results obtained that the total score of patient knowledge
Questionnaire ranged from 2 to 29.The patient’s were knowledgeable regarding the etiology,
signs and symptoms, blood test, physical exercise ,facts relating to joint protection, how to
use Anti rheumatic drugs and non steroidal non inflammatory drugs. Among them the young
patients, women with long disease duration knew the most. Thus the study concluded stating
that RA patients knowledge of their disease & its treatment varied from poor to good.15
Elly M Van Der Wardt.et.al. (2000) conducted a study to gain insight into the
general public's knowledge and perceptions regarding rheumatic diseases in the Netherlands.
A questionnaire was sent by mail to a random sample of 1800 Dutch homes; the response was
658. Questions mainly focused on knowledge, attitudes, behavioural intentions and use of the
mass media with regard to rheumatic diseases. The respondents gave the right answer to a
mean of 8.2 statements out of 17 true/false statements regarding factual knowledge of
rheumatic diseases. Respondents particularly underestimated the prevalence of rheumatic
diseases and were unaware of several rheumatic disorders. Thus the study concluded that the
public in general do not know very much about rheumatic diseases, but they do have a
moderate desire for more information about them.16
Barlow
JH
.et.al. (1998)
conducted
a
study
to
assess
the
knowledge in patients with rheumatoid arthritis: a longer term follow-up of a randomized
controlled study of patient education leaflets. Despite the wide availability of disease-related
leaflets, their impact on patients' knowledge and well-being has rarely been evaluated. A
randomized
controlled study of
a
'Rheumatoid
Arthritis'
leaflet
revealed
increased knowledge among the intervention group after 3 weeks. In addition, the leaflet was
viewed as a source of reassurance. The purpose of the follow-up study was to determine
whether the increase in knowledge was maintained in the longer term and to examine
10
psychological well-being. Eighty-four patients (42 intervention and 42 control) completed the
6 month follow-up. There were no significant changes (P > 0.01) in mean outcome measures
over the period 3 weeks-6 months for either the intervention or control groups.Patients in the
intervention group retained the increase in knowledge observed at 3 weeks.17
SECTION C – Review on Home remedies of Rheumatoid Arthritis and prevention of its
complications.
Põlluste K.et.al. (2012) conducted a study on assistive devices, home adjustments
and external help in rheumatoid arthritis. To explain the determinants of adaptation
with disease and self-management of patients with rheumatoid arthritis (RA) in Estonia,
focusing on the use of assistive devices, home adjustments and the need for external help. A
random sample (n = 1259) of adult Estonian RA patients was selected from the Estonian
Health Insurance Fund Database. The patients completed a self-administered questionnaire,
which included information about their socio-demographic and disease characteristics, the
costs of care, quality of life, use of assistive devices, home adjustments and the need for
external help. Regression analysis was used to analyze the predictors of patient's adaptation
with disease and self-management. Twenty-six percent of the respondents used assistive
devices, 20% had made home adjustments and 37% needed external help. The study
concluded that disability and physical impairment are the most important determinants of the
use of various technical aids and home adjustments. These factors, along with the female
gender and single status of the patient, predict help-dependence.18
Hewlett
S.et.al. (2011)
conducted
a
study
on
self-management of
fatigue
in rheumatoid arthritis: a randomized controlled trial of group cognitive-behavioral therapy to
investigate the effect of group cognitive behavioral therapy (CBT) for fatigue selfmanagement, compared with groups receiving fatigue information alone, on fatigue impact
among people with rheumatoid arthritis (RA).Two-arm, parallel randomised controlled trial
in adults with RA, fatigue ≥ 6/10 (Visual Analogue Scale (VAS) 0-10, high bad) and no
recent change in RA medication. Group CBT for fatigue self-management comprised six
(weekly) 2 h sessions, and consolidation session (week 14). Control participants received
11
fatigue self-management information in a 1 h didactic group session. Primary outcome at 18
weeks was the impact of fatigue measured using two methods (Multi-dimensional
Assessment of Fatigue (MAF) 0-50; VAS 0-10), analysed using intention-to-treat analysis of
covariance with multivariable regression models. Of 168 participants randomised, 41
withdrew before entry and 127 participated. There were no major baseline differences
between the 65 CBT and 62 control participants. At 18 weeks CBT participants reported
better scores than control participants for fatigue impact: MAF 28.99 versus 23.99 (adjusted
difference -5.48, 95% CI -9.50 to -1.46, p=0.008); VAS 5.99 versus 4.26 (adjusted difference
-1.95, 95% CI -2.99 to -0.90, p<0.001). Standardised effect sizes for fatigue impact were
MAF 0.59 (95% CI 0.15 to 1.03) and VAS 0.77 (95% CI 0.33 to 1.21), both in favour of
CBT. Secondary outcomes of perceived fatigue severity, coping, disability, depression,
helplessness, self-efficacy and sleep were also better in CBT participants. Thus the study
concluded that the Group CBT for fatigue self-management in RA improves fatigue impact,
coping and perceived severity, and well-being.19
Home D.et.al. (2009) conducted a study on the role of early intervention and selfmanagement of Rheumatoid Arthritis The National Institute of Health and Clinical
Excellence issued guidance on the management of RA in adults while the King's Fund and
National Audit Office have reported on the services that are available for people with RA.
This paper will provide an overview of these reports and their implications for primary care.
The role of early identification, referral and diagnosis will be explained as well as the
treatment options available. The role of self-management and how community nurses can
facilitate self-management will be discussed.20
Chiou AF.et.al. (2009) conducted a cross-sectional study on Disability and
pain management methods of Taiwanese arthritic older patients to investigate the prevalence
of disability, factors influencing disability and pain self-management techniques employed by
older arthritis patients in Taiwan. Disability was found in 11% of Taiwanese individuals
diagnosed with either rheumatoid arthritis or osteoarthritis. Those in disability reported more
severe disease activity, pain, depression and lower life satisfaction. Hierarchical multiple
regression analysis revealed that 31-46% of the total variance of disability could be explained
by age, gender, marriage, joint pain score, diagnosis, disease activity, depression and pain
management.
Patients
with rheumatoid
arthritis had
significantly higher
levels
of
disability, disease activity during the preceding six months, more depression and less life
12
satisfaction than patients with osteoarthritis. Thus the study concluded that higher disability
was explained by older age, female, unmarried, diagnosed with rheumatoid arthritis, more
joint
pain,
more disease
severity,
more
depression
and
more
use
of
pain management strategies in arthritis patients.21
SECTION D - Review on effectiveness of Structured Teaching Programme
Fati Abourazzak.et.al. (2009) conducted a study on Long-term effects of therapeutic
education for patients with rheumatoid arthritis. 39 RA patients participated in a 3 day
educational programme. Effects were evaluated after 3 yrs in 33 patients comparatively to the
baseline based on variables: knowledge of RA, Disease activity(DAS28),functional
impairment (HAQ) and quality of life ,Arthritis impact measurement scale 2 (AIMS2),also
compared patient knowledge in educational programme participants and in 38 controls with
RA. The results stated that patient knowledge was significantly improved compared to
baseline than in controls. DAS28 was lower in educational group after 3 yrs than at baseline
with no change in HAQ,AIMS2.Thus the study concluded that the educational programme
can produce lasting improvement in knowledge of disease and may help to control the
activity of RA.22
T.Uhlig.et.al. (2008) conducted a study to determine whether there was a secular
change from 1994-2004 among patients within the setting of Oslo Rheumatoid Arthritis
Register(ORAR).The Datas were collected from all living patient in the ORAR by giving a
postal questionnaire in 1994,1996,2001& 2004,including the modified Health Assessment
Questionnaire(MHAQ),Arthritis Impact Measurement scale2 (AIMS2) and Visual analogues
scale for the assessment of disease severity, pain & fatigue. Mixed model approach was used
for longitudinal analysis adjusting for age, sex, and co-morbidity& disease duration. The
results were that the health status in the population with RA was consistently improved in all
dimensions of health. Thus the study concluded that health status in RA improved from 1994
to 2004, due to better &more aggressive treatment.23
13
T.M.Spigell.et.al. (1987) conducted a study to evaluate an inpatient RA patient
education program to determine whether patient knowledge improved and whether the
improvement persisted after discharge. The patient’s knowledge was assessed by a multiple
choice and true false test given upon admission, after education and 4 months following
discharge. The result was obtained that the treatment group increased their knowledge by 40
%( p<.05) on post intervention Questionnaire where as control group had no significant
improvement in knowledge. Thus the study concluded that inpatients demonstrated increase
in knowledge of physical therapy even they were involved in numerous diagnostic &
therapeutic interventions that could have distracted from educational programme.24
6.3 STATEMENT OF THE PROBLEM:
A study to assess the effectiveness of structured teaching programme on knowledge
regarding home care management of arthritis among rheumatoid arthritis patients attending
outpatient department at selected hospital, Nelamangala.
6.4 OBJECTIVES OF THE STUDY
1.
To assess the knowledge regarding the home care management among rheumatoid
arthritis patients by conducting a pre-test.
2.
To evaluate the effectiveness of structured teaching programme
on rheumatoid
arthiritis and home care management among the rheumatoid arthritis patients attending the
outpatient department by comparing the pre test and post test knowledge scores.
3.
To
find out the association between pre test knowledge of rheumatoid arthritis
patients regarding the home care management with selected demographic variables.
4.
To evaluate the post test knowledge regarding home care management of rheumatoid
among rheumatoid arthritis patients after structured teaching programme.
14
6.5 OPERATIONAL DEFINITIONS
Evaluate: Refers to significance of systematic determination of merit, worth,
significance of structured teaching programme on rheumatoid arthritis.
Effectiveness: Refers to the extent to which the structured teaching programmes on
rheumatoid arthritis has achieved the desired effect in improving the knowledge of
adults as assessed by structured questionnaire.
Structured Teaching Programme: Refers to systematically planned group instructions
by lecture cum discussion method designed to provide information regarding rheumatoid
arthritis such as meaning, causes, signs and symptoms, and home care management.
Knowledge: It is the understanding of information about a subject that has been obtained
by experience or study. In the present study, knowledge refers to understanding of
information about home care management of rheumatoid arthritis in adults which has
been measured by structured knowledge questionnaire.
Home remedies for rheumatoid arthritis: It refers to selected set of prophylactic
measures one can readily make in the home environment to reduce the pain and
problems related to arthritis. For example application of garlic paste on the affected area,
hot application to the joints and rubbing sandalwood paste etc.
Rheumatoid arthritis: Rheumatoid arthritis (RA) is an inflammatory disease that causes
pain, swelling, stiffness, and loss of function in the joints. It occurs when the immune
system, which normally defends the body from invading organisms, turns its attack
against the membrane lining the joints.
Variable: Variable is an entity or characteristics which will vary during the observations.
6.6 ASSUMPTIONS
1. The researcher assumes that the patients undergoing screening, lack knowledge
regarding self care and home care management of rheumatoid arthritis.
2. The structured teaching programme will improve the knowledge on home care
management among patients.
3. Patients will practice home care management.
15
6.7 HYPOTHESIS
H0–There is no significant difference between the post test knowledge scores and the
pretest knowledge scores regarding the home care management of rheumatoid arthritis
among rheumatoid arthritis patients.
H1-There is a significant difference between post test knowledge and the pre test
knowledge scores of rheumatoid arthritis patients regarding the home care management.
H2-There is a significant association between the pretest knowledge score of rheumatoid
arthritis patients regarding the home care management with selected demographic
variables.
6.8 VARIABLES OF THE RESEARCH
Independent variable: Structured Teaching Programme.
Dependent variable: Knowledge on rheumatoid arthritis.
Demographic variables: Age, education, marital status, socio economic status, source of
information, occupation etc.
6.9 DELIMITATIONS OF THE STUDY
 Small sample size so may not be generalized to larger population with different level of
literacy.
 Lack of follow up on the practice of the home care management as per structured
teaching programme.
 Teaching module is limited to structured teaching programme.
7.0 MATERIALS AND METHODS
Methodology helps researcher to project a blue print of research undertaken. This
includes a series of steps from problem identification to the data collection.
16
7.1 SOURCES OF DATA
The data will be collected from the rheumatoid arthritis patients attending outpatient
department.
 RESEARCH APPROACH
The research approach for the present study is an evaluative research approach.
 RESEARCH DESIGN
The research design adopted for present study is quasi experimental, one group pretest
and post test design.
 SETTING OF THE STUDY
The study will be conducted at selected hospital of Nelamangala.
 POPULATION
Population in the study consists of rheumatoid arthritis patients attending outpatient
department in selected hospital of Nelamangala.
 SAMPLES SIZE
The sample of the study will consist of 60 patients.
 SAMPLING TECHNIQUE
The proposed sampling technique adopted for the present study is simple
non-probability sampling technique.
 SAMPLING CRITERIA
INCLUSION CRITERIA
o Rheumatoid Arthritis patients who are present during data collection.
o Rheumatoid Arthritis patients who are willing to participate in the research.
17
o Rheumatoid Arthritis patients who can understand and communicate in English or
Kannada.
o Age group of 21 - 60
o Patients without disability in seeing and hearing
EXCLUSION CRITERIA
o Rheumatoid Arthritis patients who are not willing to participate in this study.
o Rheumatoid Arthritis patients who are not present during data collection.
o Rheumatoid Arthritis patients who cannot understand and communicate in Kannada or
English.
7.2 METHODS OF DATA COLLECTION
TOOL FOR DATA COLLECTION
The tool for the proposed study is self administered structured questionnaire which
would be developed by researcher with the help of extensive literature and expertise
opinion.
METHOD OF DATA ANALYSIS AND INTERPRETATION
The data collected will be spread into a master sheet for easy statistical analysis.
 Descriptive statistics:
To describe data collected by percentage, mean, mode, median and standard deviation.
 Inferential statistics:
1. Independent (unpaired)‘t’ test to find difference between the mean knowledge scores
of the adults.
2. Chi square test to determine the association between the selected demographic
variables and the knowledge level of Rheumatoid Arthritis patients regarding home care
management of rheumatoid arthritis.
18
DURATION OF THE STUDY
The research is intended to complete within a time frame of 6-8 weeks.
7.3
DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON ADULTS OR OTHER
HUMAN OR ANIMAL?
Yes, educational intervention planned for the study group is enough.
7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM
YOUR INSTITUTION?
.
Yes, Ethical clearance will be obtained
from the respective institution where the data
collection to be done, the hospital.
The informed consent will be obtained from the samples for their willingness to participate in
the study.
Sample’s privacy and self esteem will be respected and maintained throughout the study and
information will not be disclosed or shared with anybody else.
19
8.0 LIST OF REFERENCES
1. Disease
from
wikipedia,
the
free
encyclopedia.CMAJ
136(8):811–3.
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9. Signature of the candidate:
10. Remarks of the guide:
11. Name & Designation
11.1 Guide:
11.2 Signature:
11.3 Co-Guide:
11.4 Signature:
11.5 Head of the Dept:
11.6 Signature:
12.Principal
12.1 Remarks of the Principal:
12.2 Signature:
22