Download 2) Name of the Candidate : MS. ANCY DEENA ALEXANDER

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION
OF SUBJECT FOR DISSERTATION
“A
STUDY TO ASSESS THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE
REGARDING MANAGEMENT AND REHABILITATION OF
SELECTED DEGENERATIVE DISORDERS OF ELDERLY
CLIENTS AMONG FINAL YEAR B.SC NURSING STUDENTS IN
SELECTED NURSING COLLEGES AT DAVANGERE”.
MS. ANCY DEENA ALEXANDER
FIRST YEAR M.Sc. NURSING,
MEDICAL SURGICAL NURSING
KUMUDA INSTITUTE OF NURSING SCIENCES,
DAVANGERE – 577 004.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA, INDIA.
ANNEXURE – II
PROFORMA FOR REGESTRATION OF SUBJECTS FOR
DISSERTATION
1.
NAME OF THE CANDIDATE
Ms. ANCY DEENA ALEXANDER
AND ADDRESS
1 YEAR M.Sc. NURSING
(IN BLOCK LETTERS)
KUMUDA INSTITUTE OF NURSING
SCIENCES,
KUMUDA COLLEGE OF
NURSING, S.NIJALINGAPPA LAYOUT,
DAVANGERE -577004.
2.
NAME OF THE INSTITUTION
KUMUDA INSTITUTE OF NURSING
SCIENCES.
3.
COURSE OF STUDY AND
1 YEAR M.Sc NURSING,
SUBJECT
MEDICAL SURGICAL NURSING.
4.
DATE OF ADMISSION
30-06-2013
5.
TITLE OF THE TOPIC:
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME
ON
REHABILITATION
KNOWLEDGE
OF
SELECTED
REGARDING
MANAGEMENT
DEGENERATIVE
DISORDERS
AND
OF
ELDERLY CLIENTS AMONG FINAL YEAR B.SC NURSING STUDENTS IN
SELECTED NURSING COLLEGES AT DAVANGERE”.
6 BRIEF RESUME OF THE INTENDED WORK:
6.0INTRODUCTION:
“A comfortable old age is the reward of a well-spent youth”
-Maurice Chevalier
Aging, the normal process of time related change begins with birth and continues
throughout life.1 According to the UN, the population of the elderly persons is the fastest
growing around the world and the number of elderly people by 2050 will be close to 2
million. The world health organization has taken the initiative to draw attention to ageing
as this imposes many challenges for individuals and authorities like coping with health
care, employment, social security and other issues concerning the elderly.2
Ageing is an inevitable process and many factors like genes, lifestyles, diet and
environment determine longevity. Though life expectancy has increased in modern times
due to advances in science, technology and medicine, the grinds of daily life takes a heavy
roll in our bodies. For most of us, taking care of our health is the last thing on our mind as
we are too busy. Eventually negligence takes its toll on our body and manifests itself
through a serious illness or in rapid physical deterioration in old age.2
Aging, in simple terms is a continuous process which restricts our normal functions and
makes us more prone to disease. There are several changes in the morphological features
and functions of an aging individual, some of which are reduction in muscle and bone
mass, decline in cognitive and memory functions, decline in sensory perceptions, and an
increased propensity to develop chronic degenerative conditions like multiple sclerosis,
Parkinsonism, Alzheimer’s disease and strokes.3
A degenerative disease is a disease in which the function or structure of the affected
tissues or organs will increasingly deteriorate overtime, whether due to normal bodily wear
or lifestyle choices. The common degenerative disorders associated with aging are multiple
sclerosis, Parkinsonism, Huntington’s disease4
Multiple sclerosis is a chronic, degenerative disorder of the central nervous system
characterized by disseminated demyelination of the brain and spinal cord. Multiple
sclerosis is the commonest progressive neurological disease. The incidence of multiple
sclerosis in India is 0.5 -2 per 100,000 with the onset usually at 20-50 yrs of age. It affects
women more frequently than men. The cause of multiple sclerosis is unknown but research
1
findings suggest that multiple sclerosis is related to infectious (viral), immunologic and
genetic factors.5
Parkinson’s disease is named after James Parkinson who first described the illness.
It is the second most common neurodegenerative disorder. Parkinson’s disease is the
disease of the basal ganglia characterized by slowness in the initiation and execution of
movement, increased muscle tone, tremor at rest and impaired postural reflexes. The
incidence of Parkinson’s disease in India is 1% in adults 65 years or older and 5% in more
than 80 years. India has about 7 million people living with Parkinson’s disease. The
diagnosis of Parkinson’s disease increases with age, with the peak onset in
70’s.6Parkinson’s disease is a multifactorial disease caused by the combination of age,
genetic and environmental factors. Environmental exposures to pesticides, herbicides and
heavy metals play a critical role in the onset and progression of Parkinson’s disease.7
Older adults are at higher risk for Parkinson’s disease and are more common in
men than women. According to the National Parkinson’s foundation, each patient spends
an average of $2500 a year for medications. After factoring in office visits, social security
payments, nursing home expenditures and lost income, the total cost to the nation is
estimated to exceed $5.6 billion annually8. According to O’ Brien et al (2009) estimated
annual burden of Parkinson’s disease in U.S is $21,626 per patient per year.9
6.1 NEED FOR THE STUDY:
Elderly people are at increased risk for developing degenerative disorders. InUnited
States 60,000 Americans are diagnosed with Parkinson's disease each year. Incidence of
Parkinson’s increases with age, but an estimated four percent of people with Parkinson’s
disease are diagnosed before the age of 50. An estimated seven to 10 million people
worldwide are living with Parkinson's disease. The Center for Disease control rated
complications from Parkinson’s disease as the 14th leading cause of death in the United
State.10
Albania has been found to be the country with the world's highest prevalence of
Parkinson's disease. The prevalence figures for Parkinsonism were found to be 800 per
100,000. With prevalence rate of 557 per 100,000 it makes Egypt, the country with the
world's second highest prevalence of Parkinson's disease.11In UK, it is estimated that
around 1 in 500 people are affected by Parkinson’s disease and there are currently 127,000
2
people. The average age for the symptoms to start is around 60; although around 1 in 20
cases first develop in people aged under 50.Men are one-and-half times more likely to get
Parkinson’s disease than women. In England, the ethnic group most likely to develop
Parkinson’s disease is white people. Rates are significantly lower in black and Asian
people.12
In India, the crude age-adjusted prevalence rate of Parkinson’s disease per 100,000
population is 14 in northern India, 27 in the south and 16 in the east,while it is 363 for
paris in Mumbai.13 A study was conducted among 557 patients belonging to both rural and
urban areas of north Karnataka in 2012. Among the study subjects, 90.8% of the patients
were having tremors followed by slowness in activities (32.7%) and dyskinesia (8.1%).14
A national survey sponsored by the national institute of neurological and
communicative disorders and strokes reported 123,000 multiple sclerosis patients in the
conterminous united states (a rate of 58 per 100,000).15 The revised estimate of the
prevalence of multiple sclerosis reported that approximately 250,000 to 350,000 persons
in the united states had physician diagnosed multiple sclerosis.16 According to Gisela
kobelt et al, the estimated annual burden of multiple sclerosis in united states is $47,215
per patient.
Of these 53% were for direct medical and non medical costs, 37% for
production losses, and 10% for informal care.17The first prevalence survey for multiple
sclerosis in India (parsis of Bombay) reported 21/100,000 cases.18
Until a few years back, the physicians in India weresceptical of making a diagnosis
of multiple sclerosis. However, with increasing awareness of medical illnesses, availability
of modern investigative facilities, particularly MRI and expanding neurological services in
our country,more and more cases are being reported from all over India.various studies
have shown that the multiple sclerosis constitutes 2.54% of neurology admissions in
hospitals.19
With the ageing of the population, the prevalence of degenerative disorders is
projected to increase in the years ahead.Thus all health care professionals must be prepared
to provide diagnostic and management strategies for this growing population of
patients.Older patients present with increased medical complexity require a comprehensive
and multidisciplinary approach.understanding the challenges faced by ageing patients can
help the health care providers minimize morbidity and disability associated with
3
degenerative diseases. These challenges neccesitates the need for advanced education of
the health care professionals in the area of management and rehabilitation inorder to
recognize the special needs,and to organize, plan and provide care to meet these needs.20
6.2 REVIEW OF LITERATURE :
Review of literature is a systematic search of published work to gain information
about a research topic. Conducting review of literature is challenging and enlightening
experience. Through the literature reviews, researcher generates a picture of what Is known
about a particular situation and the knowledge gap that exists between the problem
statement and the research subject problems and lays a foundation for the research plan.21
Review of literature provides basis for future investigation, testifies the replication,
throw light on feasibility of the study and constraints of data collection, relates the findings
from the study to another with a hope to establish a comprehensive body of scientific
knowledge in a professional discipline from which valid and pertinent theories may
develop.22
The review of literature was retrived and organized under following headings:
1. Reviews related to effectiveness of structured teaching programme
2. Reviews related to management and rehabilitation of selected degenerative disorders
a) Reviews related to management and rehabilitation of multiple sclerosis
b) Reviews related to management and rehabilitation of Parkinson’s disease.
1. Reviews related to effectiveness of structured teaching programme
A cluster randomized controlled trial study (2008) conducted in UK to assess the
effectiveness of structured teaching program of the diabetes education and self
management for ongoing and newly diagnosed (DESMOND) program for people with
newly diagnosed type 2 diabetes. This study includes 824 adults. The intervention group
had a lower depression score at 12 months: mean difference was −0.50. A positive
association was found between change in perceived personal responsibility and weight loss
at 12 months. A structured group education program for patients with newly diagnosed
type2 diabetes resulted in greater improvements in weight loss and smoking cessation and
positive improvements in beliefs about illness.23
4
A study was conducted to assess the effectiveness of structured teaching
programme on knowledge of polycystic ovarian syndrome among adolescent girls. The
study design adopted was pre experimental one group pre-test post-test design. The
demographic Performa were collected from the adolescent girls by using structured
knowledge questionnaire. Data obtained in these areas were analyzed using descriptive and
inferential statistics. A significant difference between pre-test and post-test knowledge was
found (t79=2.0, p<0.05)The study findings showed that the structured teaching programme
was effective in improving knowledge of adolescent girls regarding polycystic ovarian
syndrome.24
A study was conducted to evaluate the effectiveness of structured teaching
programme on prevention of micro vascular and macro vascular complications among
diabetes mellitus patients. A convenient sampling technique was used to select 50 diabetes
mellitus patients. Structured knowledge questionnaire was used to measure the knowledge
of diabetes mellitus patients before and after structured teaching programme. Structured
teaching programme was administered on the same day of pre-test and assessed its
effectiveness after 7 days. There was a significant difference between pre and post-test
knowledge scores of diabetes mellitus patients with a‘t’ value of 26.52.There was
significant association between the findings and the demographic variables such as age
group, type of family, family income and duration of illness. The study concluded that the
structured teaching programme is effective in increasing the knowledge of diabetes
mellitus patients regarding prevention of micro vascular and macro vascular
complications.25
An experimental study (2005) conducted in Nepal to assess the effectiveness of
structured teaching program in improving knowledge and attitude of school going
adolescents on reproductive health. 200 Adolescent school students were included in this
study and subjects were divided into two groups: experimental and control, each
comprising of two subgroups of 50 boys and 50 girls. Structured teaching program
consisting of information on human reproductive system was used as a tool of
investigation for the experimental group, whereas conventional teaching method was used
for the control group. The mean (±SD) pretest score of the experimental group on
knowledge of reproductive health was 39.83 (± 16.89) and of the control group was
5
39.47(±0.08). The same of experimental group after administration of the structured
teaching program (84.60±10.60) and of the control group with conventional teaching
method (43.93±10.08) was statistically significant (p<0.001).Similarly, the post-test scores
of knowledge of the groups on responsible sexual behavior and their attitude towards
reproductive health were better in the experimental group than in the control group
(p<0.001).26
2. Reviews related to management and rehabilitation of
selected degenerative
disorders
a) Reviews related to management and rehabilitation of multiple sclerosis
A randomized controlled trial study was conducted in USA to investigate the effects of
vestibular rehabilitation programme on multiple sclerosis related fatigue and upright
postural control. Thirty eight patients with MS were randomly assigned to an experimental
group for vestibular rehabilitation, control group for bicycle endurance and stretching
exercises, and wait listed control group received usual medical care for 14 weeks.
Following interventions, the experimental group had greater improvements in fatigue,
balance and disability compared with the control group.27
A study was conducted in Germany on the effectiveness of daclizumab in patients
with relapsing- remitting multiple sclerosis. The study used a randomized controlled trial
with 821 patients were randomly assigned to receive subcutaneous injections of
daclizumab high yield process (HYP) 150 mg, 300 mg and placebo every 4 weeks for 52
weeks. Subcutaneous daclizumab administered every four weeks led to clinically important
effects 150mg (81%), 300mg (80%) in relapsing-remitting disease than patient in placebo
group (64%).28
A randomized controlled trial study was done in Turkey to evaluate the effects of
cycling progressive resistance training for people with multiple sclerosis. Forty five
patients were randomly assigned into exercise training groups for progressive resistance
training on a bicycle ergo meter and balance exercise and a control group for home-based
lower limb strengthening and balance exercise for 8 weeks. The outcome measures
duration of exercise, tolerated maximum workload, timed up and go test, falls efficacy
scale and fatigue severity scale. Following interventions, improvements in outcome
measures of training group patients were significantly higher (p< 0.05) and showed
6
statistically significant improvement in physical functioning than those in other groups
(p>0.05).29
A pilot study was conducted to evaluate the efficacy of desmopressin therapy in the
symptomatic treatment of nocturia in patients with multiple sclerosis and neurogenic
detrusor over activity. A set of 20 women with multiple sclerosis and detrusor over activity
was enrolled in two groups, those with large bladder capacity (> 250ml), and small bladder
capacity (<250ml) measured by urodynamic evaluation. Desmopressin 20mg was
administered before bedtime to both the groups and night time voiding diaries were
maintained for 6 weeks. The mean volume of nocturnal incontinence decreased
significantly (p<0.005) and the average number of episodes of nocturia per night decreased
from 2.35 to 0.89.The study concluded that desmopressin is effective in the symptomatic
management of nocturia and detrusor over activity in patients with multiple sclerosis.30
A randomized controlled trial was conducted to assess the efficacy of a stress
management program in reducing neuroimaging markers of multiple sclerosis disease
activity. 121 patients with relapsing forms of multiple sclerosis were randomly assigned to
receive stress management therapy for 24 weeks, followed by a 24 week post treatment
follow-up. The primary outcome was the cumulative number of new Gadoliniumenhancing (Gd+) brain lesions on MRI at 8, 16, 24 weeks. Following interventions there
was a reduction in cumulative Gd+ lesions (p=0.04) and greater number of participants
remained free of Gd+ lesions during the treatment.31
b) Reviews related to management and rehabilitation of Parkinson’s disease
A study (2012) conducted in Brazil to assess the motor learning benefits of selfcontrolled practice in persons with Parkinson's disease. Twenty-eight individuals with
Parkinson’s disease were randomly assigned to one of two groups, self-control and a yoked
(control) group. The self-control group demonstrated more effective learning of the task
than the yoked group. Questionnaire results indicated that self-control participants were
more motivated to learn the task, were less nervous, and less concerned about their body
movements relative to yoked participants.32
A study was conducted to evaluate the efficacy of neurostimulation in reducing motor
disability in patients with advanced Parkinson’s disease who have severe levodopainduced motor complications.251 patients with early motor complications were randomly
7
assigned with mean age of 52 yrs to undergo neurostimulation plus medical therapy or
medical therapy alone. The quality of life was assessed with the use of Parkinson’s disease
questionnaire (PDQ), and Parkinson’s disease rating scale. The mean score for
neurostimulation was improved (7.8%) than medical therapy group(0.2%).the study
concluded that neurostimulation was superior to medical therapy with respect to motor
disability(p<0.001), and activities of daily living(p<0.001), levodopa-induced motor
complications(p<0.001) with good mobility and no dyskinesia (p=0.01).33
A randomized controlled trial study was conducted in Turkey to detect the
effectiveness of incremental speed-dependent treadmill training on postural instability,and
fear of falling in patients with idiopathic Parkinson’s disease.21 patients were randomly
assigned to participate in an 8 week exercise programme using incremental speed
dependent treadmill training. The postural instability was assessed using Unified
Parkinson’s Disease Rating Scale(UPDRS), Dynamic Gait Index, and Falls Efficacy Scale.
Following interventions, the Dynamic Gait Index and Falls Efficacy Scale scores of
training groups were improved significantly after the training programme(p<0.01) and the
initial total walking distance was increased from 266.45+/-82.14m to 726.36+/-93
(p<0.001) than the control group(p>0.05).34
An article (2007) reported in Spanish
regarding detection and management of
non-motor symptoms in Parkinson's disease: impact on their prevalence. The study
included 60patients with Parkinson's disease. The presence of non-motor symptoms was
determined by the non-motor symptom questionnaire. The non-motor symptoms that
showed statistically significant differences in frequency between baseline and the final
assessment, were constipation (p = 0.04), urinary urgency (p = 0.02), hallucinations (p =
0.04), dizziness (p = 0.02) and vivid dreams (p = 0.04). The change in specific symptoms
is probably related to adjustments in dopaminergic management.35
6.2.1STATEMENT OF THE PROBLEM.
“A Study to assess the effectiveness of structured teaching programme on knowledge
regarding management and rehabilitation of selected degenerative disorders of elderly
clients among final year b.sc nursing students in selected colleges at davangere.”
8
6.3 OBJECTIVES OF THE STUDY
1. To assess the knowledge of final year B.sc nursing students regarding management and
rehabilitation of selected degenerative disorders of elderly clients during pre and post test.
2. To evaluate the effectiveness of structured teaching programmer by comparing pre and
posttest knowledge scores.
3. To identify the association between selected sociodemographic variables with the pretest
level of knowledge regarding management and rehabilitation of selected degenerative
disorders.
6.3.1
OPERATIONAL DEFINITIONS:
1. Assessment - It refers to measuring the impact of structured teaching programme
on knowledge of final year B.sc nursing students followed by structured teaching
programme.
2. Effectiveness – It refers to changes in the knowledge of final year B.sc nursing
students regarding management and rehabilitation of selected degenerative
disorders of elderly clients followed by structured teaching progamme.
3. Structured teaching programme – It refers to planned education programme for
the duration of 1 hour by using lecture cum discussion method and computer
assisted AV aids to impart the knowledge regarding meaning, etiology,
pathophysiology, signs and symptoms, management and steps of rehabilitation
related to multiple sclerosis and Parkinson’s disease in class room settings of
selected colleges.
4. Knowledge – It refers to awareness of final year B.sc nursing students regarding
meaning, etiology, pathophysiology, signs and symptoms, management and
rehabilitation of selected degenerative disorders such as multiple sclerosis and
Parkinson’s disease.
5. Final year B.sc nursing students – It refers to regular nursing students studying in
4th year B.sc nursing programme at selected colleges of Davangere who fulfills
following inclusive and Exclusive criteria.
6. Management - Management refers to a process whereby an efficient treatment
plan formulated and implemented to produce the most cost-effective outcomes. In
this study it refers to management of multiple sclerosis and Parkinson’s disease.
9
7. Rehabilitation - Rehabilitation
is the process of restoring the individual to the
fullest physical, mental, social, vocational and economic capacity of which he or
she is capable.
8. Degenerative disorders - The term degenerative disorder is used to refer to
neurological disorders in which there is a premature aging of nerve cells which is
caused by suspected metabolic disturbances or for which the cause is unknown.
9. Selected degenerative disorders -. In this study, selected degenerative disorder
refers to multiple sclerosis and Parkinson’s disease.
10. Elderly clients – It refers to individuals over 65yrs who have functional
impairements.
6.3.2. ASSUMPTIONS
1. Final year B.sc nursing students have some knowledge regarding management and
rehabilitation of selected degenerative disorders of elderly clients.
2. Self-administered questionnaire can measure the knowledge of final year B.sc
nursing students regarding selected degenerative disorders.
6.3.3. HYPOTHESIS
H1-There will be significant difference between pre and post test scores after
administration of structured teaching programme.
H2-There will be significant association between the pretest knowledge scores with the
selected demographic variables.
6.3.4. SAMPLING CRITERIA
a) Inclusion criteria
 Final year B.sc nursing students who are willing to participate in the study.
 Final year B.sc nursing students who are available during the period of data
collection.
b) Exclusion Criteria
 Final year B.sc nursing students who are not available at the time of study.

Final year B.sc nursing students who are not willing to participate in the study.
6.3.5. LIMITATION OF THE STUDY:
 The sample size was delimited to final year B.sc nursing students
 The study was delimited to final year B.sc nursing students present during the
study.
10
7. MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
Data will be collected from Final year B.sc nursing students of Selected nursing
colleges, Davanagere.
7.2 METHOD OF DATA COLLECTION:-
1. Research Design:-Single group pre and posttest design
2. Research Setting: - Selected nursing colleges, Davangere
3. Population: -Final year B.sc nursing students of Selected nursing colleges, Davangere.
4. Sample Size:- 60
5. Sampling Technique: -Simple Random sampling for the selection of subjects will be
followed.
6. Collection of Data:- Questionnaire method is planned for Collection of data by using
structured questionnaires.
7. Tools for data collection:Part 1- Socio demographic data sheets consisting of demographic variables
Part 2-Structured knowledge questionnaire to assess knowledge of final year B.sc
nursing students regarding management and rehabilitation of selected degenerative
disorders of elderly clients.
8. Plan for Data Analysis :Descriptive Statistics:
The descriptive statistics analysis includes percentage,
Frequency, Mean, Standard Deviation for the final year B.sc nursing students regarding
management and rehabilitation of selected degenerative disorders of elderly clients.
Inferential Statistics:
1. Paired t-test will be used to compare the pre-test and post-test knowledge scores.
2. The association between the interpretive scores and the selected variables will be
done using Chi-square test.
9. Duration of study:-16 months
Duration of intervention
: 1 months
Duration of data collection: 6 weeks
10.Variables Under Study:
Independent variable:
11
Effectiveness of Structured teaching program regarding the management
and
rehabilitation of selected degenerative disorders.
Dependent variable:
Knowledge of final year B.sc nursing students regarding the management and
rehabilitation of selected degenerative disorders.
11.PILOT STUDY:10% of the population is planned for the pilot study.
12.ETHICAL CONSIDERATION:
1. Informed Concern:- Informed concerned will be obtained from chosen sample.
2. Ethical Consideration:- It is already obtained from the authority.
7.3. Does the study require any investigations or interventions to be conducted on
patients or other humans or animals?
Yes, the study requires intervention to be conducted in the form of structured teaching
programme which will not have any harmful effects.
7.4. Has ethical clearance been obtained from your institution?
Yes informed consent will be taken from concerned authority of the institution prior to the
study. Privacy, confidentiality and anonymity will be guarded. Scientific objectivity of the
study will be maintained with honesty and impartiality.
12
8. BIBLIOGRAPHY:1. Brunner and suddarth’s, “Textbook of medical surgical nursing”, Lippincott William
and wilkins publications,12th edition ,page no:201
2. Common diseases in old age; Available from http://zeenews.india.com/exclusive
/common-diseases- in-old-age.
3.
Sridhar Nadamuni; Neurological Disorders in the Elderly/Livestrong.com; Nov
18,2009; Available Form: www.livestrong.com/article/9224-need-neurologicaldisorders-elderly.
4. Degenerative disorders; Available from http://en.wikipedia.org/wiki/degenerative
disorders.
5. Lewis’s “Medical Surgical Nursing ; Elsevier, Mosby publications; page no:1508.
6. Lewis’s “Medical Surgical Nursing ; Elsevier, Mosby publications; page no:1514.
7. S.Patel, A.Sinha, D.Parmar, M.P.Singh; An update on the role of environmental
factors in Parkinson’s disease; volume:12; Number: 4 (2005).
8. Parkinson’s Disease –Introduction; Available form:
http://seniorhealth.about.com/library/parkinsons/blpdintro.htm
9. Judith A, O’Brien; Economic Burden Associated With Parkinson Disease;18 July
2009;volume:21; No:6.
10. Parkinson’s Disease Statistics; Available Form: http://www.sactrust.org/pd_stats.ht.
11. Prevalence of Parkinson’s Disease; Available form:
http://viartis.net/parkinsons.disease/prevalence.htm
12. Maximillian; Parkinson’s disease-NHS Choices: England; 10 may 2012; Available
Form: http://www.nhs.uk/conditional/parkinsons disease/pages/introduction.aspx.
13. AshaKrishnakumar, Prof.N.H.Wadia; Dissecting Parkinson’s Disease-frontline; May
12,2002; Vol:19; Issue:9.
14. Kadakol G.S, Suyamindra S Kulkarani, Baskar L.V.K.S, et al; Parkinson’s Disease
in North Karnataka-An epidemiological perspective; Vol:8; number 1; 2012.
15. The incidence and prevalence of reported multiple sclerosis; Available from
http://onlinelibrary.wiley.com/doi/10.1002/ana.410100504/abstract.
16. Revised estimate of the prevalence of multiple sclerosis in the United States;
Available from http://onlinelibrary. wiley.com/doi/10.1002/ana.410310317/abstract.
13
17. Costs and quality of life in multiple sclerosis; Available from
http://www.neurology.org/content/66/11/1696.short.
18. Prevalence of multiple sclerosis in the Parsis of Bombay; Available from
http://www.neurology.org/content/38/5/727.short.
6
19. Clinical profile of multiple sclerosis in north-west India; Available from
http://www.neurologyindia.com/article.aspZ?issn=0028-3886.
20. Treating neurodegenerative diseases; Available at
http://www.bmj.com/content/324/7352/1466.
21. Kirlinger F.N “Foundation of behavioural research,2nd edition,London;Mc.Millan
company,1986, page no:50.
22. TreeceW.TreeceTW.”Elements of research in nursing”, 3rd edition,St.Louis.C.V.
Mosby Company,1998, page no:43.
23. M J Davies, Sheller, T.C Skinner et al; A study to assess the effectiveness of
structured teaching program of the diabetes education and self-management for
ongoing and newly diagnosed (DESMOND) program for people with newly
diagnosed type 2 diabetes; UK (2008);http://dx.doi.org/10.1136/bmj.39474.922025.
24. Sowmya M.A & Philomena Fernandes; Effectiveness of structured Teaching
Programme on knowledge of polycystic ovarian syndrome among adolescent girls;
Nitte university journal of health science; sept 2013; volume 3; ISSN 2249-7110.
25. Dr.Bhushanam YC, Dr.Ravi CM, KiranNagaraju et al; Effectiveness of structured
teschingprogramme on prevention of microvascular and macrovascular
complications among diabetes mellitus patients;ISSN 2321-2748.
26. Dhital AD, Badu BP , Paddle RK , Uprety DL, Effectiveness of structured teaching
program in improving knowledge and attitude of school going adolescent on
reproductive health ,Katmandu University medical journal (2005),vol-3,no-4,issue12,p:380-383.
27. Hebert JR, Corboy JR, Manago MM, Schenkman M et al : Effects of vestibular
rehabilitation on multiple sclerosis-related fatigue and upright postural control:
USA:PMID:21680771.
28. Gold R, Giovannoni G, Selmaj K, Havrdova E, et al; Daclizumab high yield process
in relapsing-remitting multiple sclerosis; Germany; PMID: 23562009.
14
29. Cakt BD, Nacir B, Genc H, Saracoglu M, et al; Cycling progressive resistance
training for people with multiple sclerosis; Turkey; PMID: 20216060.
30. Zahariou A, Karamouti M, Karagiannis G,et al; Maximaal bladder capacity is a
positive predictor of response to desmopressin treatment in multiple sclerosis;
PMID: 17610036.
31. Mohr DC, Lovera J, Brown T,et al; Stress management for the prevention of new
brain lesions in multiple sclerosis; PMID: 22786596.
32. Chiviacowsky S, Wulf G, Lewthwaite R et al; Motor learning benefits of selfcontrolled practice in persons with Parkinson’s disease; Brazil (2012); PMID:
22209649.
33. Schuepbach WM, Rau J, Knudsen K, Volkmann J, et al; Neurostimulation for
Parkinson’s disease with early motor complications; PMID: 23406026.
34. CakitBD,Saracoglu M, Genc H, Erdem HR et al; Incremental speed-dependent
treadmill training on postural instability and fear of falling in Parkinson’s
disease;Turkey; PMID: 1784606.
35. Rodriguez-Violante M, Cervantes-Arriaga A; “ Detection and management of nonmotor symptoms in Parkinson’s disease”,Spanish (2011); PMID: 22215333.
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9
SIGNATURE OF THE CANDIDATE
10
REMARKS OF THE GUIDE
11. NAME & DESIGNATION OF
(IN BLOCK LETTERS)
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE (IF ANY)
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT
11.6 11.6 SIGNATURE
12. 12.1 REMARKS OF PRINCIPAL
12. 2 SIGNATURE
ETHICAL COMMITTEE CLEARANCE
“A STUDY TO ASSESS THE
1) TITLE OF THE DISSERTATION:
EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON
KNOWLEDGE REGARDING
MANAGEMENT AND
REHABILITATION OF SELECTED
DEGENERATIVE DISORDERS OF
ELDERLY CLIENTS AMONG FINAL
YEAR B.SC NURSING STUDENTS
IN SELECTED NURSING
COLLEGES AT DAVANGERE”.
2) NAME OF THE CANDIDATE
:
MS. ANCY DEENA ALEXANDER
1st Year M.Sc., Nursing
Kumuda Institute of Nursing Sciences,
Kumuda College of Nursing,
S. Nijalingappa Layout,
Davangere- 577 004.
3)
SUBJECT
:
MEDICAL SURGICAL NURSING
4)
NAME OF THE GUIDE
:
Mr. Shymon K.M.Sc., (Nursing)
HOD of medical surgical Nursing dept,
Kumuda Institute of Nursing Sciences,
Davangere – 577 004.
5)
APPROVED / NOT APPROVED:
(If not approved, suggestion)
Mr. Shymon K.
Principal,
HOD of Medical Surgical Nursingdept,
KumudaCollege of Nursing,
S. Nijalingappa Layout,
Davangere – 577 004.