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“A STUDY TO ASSESS THE EFFECTIVENESS OF VEDIO ASSISTED TEACHING
PROGRAMME (VATP) REGARDING
HOMECARE MANAGEMENT OF CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (COPD) ON KNOWLEDGE AMONG
PATIENTS ATTENDING MEDICAL OUT PATIENT DEPARTMENT (OPD) IN
SELECTED
HOSPITAL AT BANGALORE,
KARNATAKA”
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
RENJU DIVAKAR
MEDICAL SURGICAL NURSING
ADARSHA COLLEGE OF NURSING
KACHARAKANAHALLI, BANGALORE
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA.
2010-2011
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1) Name of the candidate
And Address
:
Mr. RENJU DIVAKAR
:
MSc Nursing 1st year
Adarsha College of Nursing
Kacharakanahalli
Bangalore- 560043
2) Name of the Institution
:
Adarsha College of Nursing
Kacharakanahalli
Bangalore- 560043
3) Course of study
:
MSc Nursing 1st year
And subject
:
Medical Surgical Nursing
4) Date of Admission
:
04/06/2010
5) Title of the topic
:
A study to assess the effectiveness of
video assisted teaching programme (VATP) regarding home
care management of chronic obstructive pulmonary disease
(COPD) on knowledge among patients attending medical
OPD in selected hospital at Bangalore, Karnataka.
6.0 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Work joyfully and peacefully, knowing that right thoughts and efforts will inevitably bring
about right results”
“JAMES ALLEN”
Patient education programs to support patient participation in disease management have been proposed as an
important strategy in limiting the growing burden of chronic disease (Lorig and Holman 2003). These
programs have been studied more recently for COPD (Chronic obstructive pulmonary Disease) (Monninkhof)
ef al 2003). Reported success varies between conditions. (warsi et al 2004) so it is important to assess the
effectiveness of programs specifically in COPD..
“LARISSA ARTHA SAMS”
The Lungs or pulmones are the essential organs of respiration. Their main function is to oxygenate blood.
They are situated in the thorax on either side of the middle mediastinum. There is two in number right and
left lung. The right lung has 2 fissures and 3 lobes normally, and heavier about 700 gm. Left lung has one
fissure and 2 lobes normally with weight about 600gm. Blood supply of lungs is through the pulmonary
artery, pulmonary veins and Bronchial Artery. The structural and functional unit of lungs is called respiratory
unit that includes respiratory bronchioles, alveolar ducts, alveolar sacs, antrum, and alveoli. There is a cyclic
process called pulmonary ventilation, by which fresh air enters the lungs and an equal volume of air leaves
the lungs. It is the volume of air moving in and out of lungs per minute in quiet breathing, its normal value is
6000 ML (6 liters)/ minute. In healthy people, who live in a clean environment, the lungs are light pink in
colour but, in people living in polluted area, lungs are dark and mottled due to the accumulation of dust or
carbon particles which become trapped in the phagocytes2..
Chronic Obstructive Pulmonary Disease is defined as chronic airflow obstruction that is progressive and only
partly reversible (Pauwels et al 2001, global initiative for chronic obstructive lung disease 2004) COPD is a
group of chronic lung disorders that results from partial damage of the air-ways and air-sacs (structures in the
lung). Because the air passages and air sacs (alveoli) are damaged, airflow of the lung is blocked. This results
in difficulty breathing1. The two main COPD disorders, that cause respiratory failure, are emphysema and
chronic bronchitis. Emphysema is a disease where the walls between the lungs air sacs become weak and
subsequently collapse. This results in the loss of the lungs elasticity. Chronic Bronchitis is a disease, where in
the air passages swell and produce a lot of mucus leading to coughing, wheezing and infection. when a
person has cough and mucus on a regular basis ( for at least 3 month a year) and in a row (for 2 years) , he/
she is considered to be suffering from chronic bronchitis.COPD occurs where a person breath in any of the
following irritants- Tobacco smoke, Chemicals, Air pollutants, Dusts. The lungs and air way of people are
highly sensitive to the above irritants. When people inhale the above irritants their airways become inflamed
and narrowed. Subsequently the elasticity of the lung is destroyed. This lead to difficulty in breathing in and
out. The Symptoms are Shortness of breath, Chronic coughing, Wheezing, Reduced tolerance to exercise3.
6.1 NEED FOR THE STUDY
“Chose always the way that seems the best, however rough it may be, custom will render it easy
and agreeable”
‘PYTHOGORAS’
Home care management of
COPD
includes education of patients about, Following
pharmacotherapy including using inhaler (metered dose Inhaler) and medications, smoking cessation, exercise
(Respiratory muscle exercise, upper extremity and lower extremity exercise, relaxation techniques), breathing
training and bronchial hygiene techniques ,medication, nutrition and diet, self care activities, follow up4.
COPD is a systemic disease with major impact worldwide. In the treatment of COPD a holistic
approach should be taken. Pulmonary rehabilitation programs may improve quality of life by reducing
shortness of breath, increasing exercise tolerance, promoting a sense of well - being and to a lesser extend
decreasing the number of hospitalizations5.
In this year COPD day has took place on November 17 around the theme “2010- the year at the
lung, measure your lung health-ask your doctor about a simple breathing test called spirometry.” In 1990, a
study by the world Bank and WHO ranked 12th as a burden of disease, by 2010, it is estimated that COPD will
be ranked 5th.
According to the WHO, passive smoking carries serious risks, especially for children and those
chronically exposed. The WHO estimates that passive smoking is associated with a 10 to 43 percentage
increase in risk of COPD in adults. The WHO estimated that in 2000, 2.74 million people died of COPD
world wide. The WHO states that 5.4 million people die each year from causes directly due to COPD, in this
2.4 million people die each year directly attribute to air pollution, with 1.5 million of these attributable to
indoor air pollution6.
A survey performed in 2008 at various centers of the country reveals that there were over 40
million COPD patients in India. The research study report of the Indian chest Society (ICS) and chest research
foundations (CRF) study reveals that COPD is one of the main cause of death in INDIA- more than 5.50
lakhs people every year. The rate of hospital admission of cases with COPD showed a rate of 47.8 / 10,00,000
persons at the community level and 57.28 percentage of between the age group of 18 - 64 and 54. 6 percentage
above 65 years. The other major findings of the study are, 57. 4 percentage of the disease are chronic cases,
Only 16 percentage are mild form, The remaining 26.6 percentage are in moderate category, The male –
female ratio is 2.6:1, There is an association exist between tobacco smoking and the occurrence of COPD, it is
the second largest cause of COPD in INDIA7.
The smoker non smoker ratio is 1.25:10.2 in INDIA 29.4 percentage males and 2.5 percentage
of females are current smokers. In India 75 percentage of the homes uses a biomass like wood, crop residue
and dung cakes or kerosene exposing 700 million people to high risk of indoor air pollution, affecting women
and young children. Indoor air pollution and not smoking is the most important cause of COPD in India, says
a prevalence study conducted by Pune based “Chest Research Foundation” (CRF) in collaboration with the
KEM hospital, Pune , and the Imperial college, London. The CRF study found that the prevalence of the
respiratory disease was 6.9 percentage in Indian population, among COPD suffers 7 percentage only were
smoker and 93 percentage non smokers7.
Smoking is the major cause of COPD. Approximately 80-90% of COPD cases are caused due to smoking.
According to American Cancer Society, men who smoke have 12 times more probability of dying from
COPD. Women who smoke have 13 times more probability of dying form COPD. 15 to 20 percentage of
long-term smokers have the tendency to develop COPD because long term tobacco use cause swelling in the
lungs and destroys the air passages and the air sacs in the lungs. Second hand exposure smoke (smoke in the
air from other people smoking cigarette) also cause COPD.
In Asia COPD prevalence in 12 Asia Pacific Countries and regions a Projection based on the COPD
prevalence estimation model and the results shows the total number at moderate to server COPD cases in the
12 countries of this regions, as projected by the model, is 56.6 million with an overall prevalence rate of
6.3%. The COPD prevalence rate for the individual countries range from 3.5 percentage (Hong Kong and
Singapore) to 6.7 percentage (Vietnam) .
COPD is the leading cause of hospitalization in the US. Statistics reveal that it occurs in 4.1 percentages
above the age of 30 years with male to female ratio 1.56:1. Occurrence in Bidi smokers is 8.2 percentage and
Cigarette smokers 5.9 percentage. Risk factors is higher among men, elderly, poor, and urban residents.
Non communicable/ chronic respiratory aliments like COPD and Asthma account for nearly 1.5 percentage
of total disease burden in the country. There are currently 15 million cases of COPD and 25 million cases of
asthma which are expected to grow by 50 percentage by 2015. According to WHO estimates, chronic COPD
will elevate to 3rd amongst top 10 killers in 1990. Close to 90 percentage of COPD cases can be attributed to
tobacco smoke.
Investigator himself during his service period as a staff nurse in medical ward, dealed with management of
many patients with COPD exacerbation. Most of the patients is readmitted to hospital because of the
exposure to unaware risk factors. So it is important to make the people aware about the cause, risk factor
prevention and management of the COPD. Then only we can effectively control this disease.
6.2 REVIEW OF LITERATURE
The review of literature is an integral component of any research. It enhances the depth
of knowledge and provides a clear understanding regarding t topic. It refers to an extensive, exhaustive and
systematic examination of publications relevant to the research project. This chapter presents a review of
selected literature relevant to the study.
A study on the effects of additional care by a pulmonary nurse for asthma and COPD
patients at a respiratory outpatient clinic in 2008 February. A double blind randomized clinical trial. Ninetyseven patients were randomized into the additional care group and 94 into the control group, of which 157
had a complete dataset.(Un) adjusted analyses did not show differences between treatment groups in terms of
knowledge, inhalation technique, self-management, health-related quality of life, and satisfaction with care.
Multivariate logistic regression adjusting for baseline covariates showed a significant treatment effect with
regard to exacerbation rate (odds ratio-0.35l; 95% confidence limits: 0.13/0.94, p=0.04). With the exception
of exacerbation rate, we could not demonstrate efficacy of additional nursing care in a broad range of
outcome parameters8.
A study conducted on Long term effects of out patient rehabilitation of COPD. To
examine the short and long term effect of an out patient pulmonary rehabilitation. Programme for COPD
patent on dyspnea, exercise, health related quality of life and rehabilitation rate. in Secondary care
respiratory clinic in Barcelona where a randomized controlled trial with blinding of out come assessment
and follow up of 3, 6, 9, 12, 18 and 24 months. Sixty patient with moderate to severe COPD (age 65  7
years, FEV1 35  14%) were recruited Thirty patients randomized to rehabilitation received 3 month of out
patient breathing retraining and chest physiotherapy 3 month of daily supervised exercise and 6 month of
weekly supervised breathing exercise. Thirty patients randomized to the control group received standard care
and the result shows that there was a significant differences, between groups in perception of dyspnea ( P <
0.0001) is 6 minute walking test distance (P< 0.0001) and in day to day dyspnea fatigue and emotional
function measured by the chronic respiratory Questionnaire (P< 0.01). The improvements were evident at
the 3rd month and continued with some what diminished magnitude in the second year of follow-up. The PR
group experienced a significant (P < 0.0001) reduction exacerbation, but not the numbers of hospitalization.
Out Patient rehabilitation programme can achieve worth while benefits that persist for period of 2 years9.
A study on Self- management education for patients with chronic obstructive
pulmonary disease (Review)in August 2007. There is great interest in chronic obstructive pulmonary
disease (COPD) and the associated large burden of disease. COPD is characterized by frequent day by day
fluctuations, and repetitive clinical exacerbations are typical. The objective of this review was to assess the
settings, methods and efficacy of COPD self-management education programme on health outcomes and use
of health care services. Selection criteria is Controlled trials (randomized and non-randomized) of self
management education in patients with COPD, studies focusing mainly on pulmonary rehabilitation and
studies without usual care as a control group were excluded. The result shows the broad-spectrum of
interventions and health outcomes with different follow-up times. Meta-analyses could often not
appropriately be performed because of heterogeneity among studies. The studies showed a significant
reduction in the probability of at least one hospital admission among patients receiving self-management
education compared to those receiving usual care (OR 0.64; 95% CI (0.47 to 89). This translates into a one
year NNT ranging from 10 (6 to 35) for patients with a 51% risk of exacerbation, to an NNT of 24 (16 to 80)
for patients with a 13% risk of exacerbation. On the disease specific SGRQ, differences reached statistical
significance at the 5% level on the total score (WMD – 2 58. 95 percentage CI (-5.14 to 0.02) and impact
domain (WMD- 2 83; 95% CI (-565 5o 0.02) but these difference did not reach the clinically10.
A study conducted on Management of chronic obstructive pulmonary disease (COPD)
in primary care: a questionnaire survey in western Sweden. It aims to assess the primary care management of
COPD disease in relation to COPS guidelines. A postal questionnaire was sent out to all Primary Health
Care Centers (PBCCs) in western Sweden (n=232). The response rate was 75%. The result shows a majority
of the PHCCs has a nurse and physician responsible for COPD care. They used spirometry equipment
regularly, but only 50% reported that they calibrated it at least weekly. Less than 30% of the PHCCs
reported access to a dietician, Occupational therapist or physiotherapist. There was a structured smoking
cessation program in 50% of the PHCCs. Larger PHCCs were more likely to use spirometry equipment
regularly and to have specific personnel for COPD care. There is a need to establish structured programs for
COPD care including smoking cessation programs for COPDs patients with special trained staff. Larger
PHCCs have a batter infrastructure for providing guideline-defined COPD care11.
A study conducted on Efficacy of education program in patients with chronic
obstructive pulmonary disease assessed by the lung information needs questionnaire. The aim is to study the
efficacy of an education program in COPD patients assessed by the Lung information Needs questionnaire (
LINQ, 2005, Hyland et al) Two hundred ten COPD patients without cognitive impairment were enrolled. All
subjects received pulmonary function tests (PFT,) MRC scale, St. George Respiratory Questionnaire and
Moral scale for assessing depression t the beginning. Patients received educational interventions including
the six components in LINQ: disease knowledge, smoking cessation, exercise, medication, nutrition, and the
avoidance of exacerbation with leaflets, for 30-60 minute at every visit by a trained nurse. The results shows
the subjects (age 70. 7 yrs, FEV1/FVC 63. 4% on average) composed of 40” at risk.” 22 stage, 1,22 “II” 80,
III and 52 IV”. The number of visits differed significantly among the severity groups: at risk (5.0  1.6) 1
(5.5 1.8), II (5.8 1.5)III (6.6 1.4) and IV (6.3  1.4) total LINQ score significantly improved by the end
of 6 months only in stages III and IV (p < 0.0). the MRC and Morale scales were significantly related to
improvement of LINQ score (p=0.03. 0.02. Respectively)12.
A study conducted on Long term Outcome of pulmonary rehabilitation in patients with
COPD (Chest 1997). This Study investigates the long –term benefits of pulmonary rehabilitation in terms of
health–related quality of life (HRQL.) . Such information is of particular importance in developing strategies
for aftercare at home. HRQL was assessed by the St. George Respiratory Questionnaire and the component
“well being” from the Medical Psychological Questionnaire for Lung Diseases. Patient characteristics
included lung function parameters such as FEV, the diffusion capacity for carbon monoxide and maximal
inspiratory month pressure, age socioeconomic variables, and exercise tolerance evaluated by a 12 min
walking test. The result shows a Complete data sets were obtained from 77 patients. Two groups of cases
were clustered. Patient characteristics were essentially the same in both groups. Group analysis revealed that
patients in group 1 (n=44) had “moderate” scores on HRQL on admission, a significant improvement
between admission and discharge, followed by a significant deterioration of HRQL at follow-up. Group 2 (n33) had “severely” impaired HRQL on admission, little improvement after rehabilitation, and remained in
fairly table condition 9 months post discharge13.
A study conducted on early discharge care with ongoing follow – up support may
reduce hospital readmissions in COPD, April 15th 2009. Early discharge care and self –management
education, although effective in the management of COPD is the back ground.
Early discharge care
followed by continued rapid-access out –patient support would reduce the need for hospital readmission in
these patients. Two hundred and forty six patients, acutely admitted with exacerbations of COPD, were
recruited to the respiratory outreach programme. The result shows that frequency of both emergency
department presentations and hospital admissions was significantly reduced after participation in the
programme. The provision of the respiratory outreach service that includes early discharge care followed by
education, support and ongoing rapid access to out patient clinics is associated with reduced readmission
rates in COPD patients14.
A comparative descriptive study to examine the perceived learning needs and preferred
learning styles of patients with COPD, August 2006. Patients education for COPD. Patients education is a
criteria component of COPD management and fundamental to sing a patients ability to self manage the
disease (Bourbeau, Nault and Dany tan, 2004, Gold 2005) is the back ground. The purpose of those
comparative descriptive study were to (a) describe the perceived learning needs of patients with COPD (b)
describe to preferred learning style of patients with COPD (c) describe the educational topics care provides
believe are important for COPD patients (d) compare the educational topic of category rankings of patients
and providers. A Non experimental, comparative descriptive study design utilizing written survey
instruments was used to answer the research questions. A convenience sample if 83 patients and 65 provides
participated in this study. The result shows that the sample of 202 potential patients identified and
approached regarding the study, 115 agreed to participate. Eighty three surveys were returned (72% response
rate) the mean age of the respondents was 07.8 years and 57 % were men. Most participants had completed
high school and had some college and education. The majority of participates ad been aware
of their diagnoses more than 6 years. electronic survey were emailed to 119 providers, and 65 surveys were
returned (55% response rate). The sample consisted of 27 registered nurses (42%) 123 physicians (35%) and
15 respiratory therapists (23%)15.
A study on The Value of Maintenance pulmonary rehabilitation classes in COPD . The
value of maintenance classes following the initial course is not clear. It assessed whether maintenance
rehabilitation classes improved endurance shuttle walk test (ESWT), Borg score, quality of life, anxiety and
depression in COPD. All patients who successfully completed 8 weeks of pulmonary rehabilitation were
offered maintenance classes for the rest of the year is the method used. An ESWT, O2 saturation, modified
Borg score, Chronic Respiratory Questionnaire (CRQ-SR), hospital anxiety and depression scale (HAD)
were performed at baseline, after 8 weeks of rehabilitation and after a year. The result shows the 120 patients
who completed pulmonary rehabilitation, 67 opted for maintenance classes and 53 declined. There were no
significant baseline difference, except a higher CRQ fatigue score in the maintenance group. At the end of
the year, the maintenance group had a improvement in the ESWT, compared to the group who did not attend
maintenance classes16.
A study to conducted a “Randomised controlled trial of home based care of patients
with Chronic Obstructive Pulmonary disease”. Objective is to evaluate usefulness of limited community
based care for patients with Chronic obstructive pulmonary disease after discharge from Hospital. in
Liverpool Health service and Macarthur Health service on outer metropolitan Sydney between September
1999 and July 2000. 177 patients randomized into an intervention group (84 patients) a control group (93
patients) which received current usual care. The result shows Intervention & cultural groups showed no
differences in presentation or admission to hospital or in overall functional status. However, the intervention
group improved their activity scores and the control group worsened their symptom scores. While
intervention group patients received more visits from community nurses and were more satisfied with their
care, involvement of general practioners was much less (with only 31% (22) remembering receiving a care
plan) patients in the intervention group had higher knowledge scores and were more satisfied. There were no
differences in guard practitioner visits or management17.
A study to Conducted a study on Effects of respiratory rehabilitation in patients with
different stages of COPD severity. This study was design to identify the possible benefits of pulmonary
rehabilitation (PR) on lung function, exercise tolerance, dyspnea, and quality of life in patient with different
stages of COPD. 110 patients with stable COPD were enrolled in this study, Patients were subdivided for
the first point according to the GOLD guidelines: 36 moderate, 36 severe and 38 very severe. All patients
perform a respiratory rehabilitation programme for 4 weeks. Assessments included anthropometric
measurements, pulmonary function tests, MRC and Borg scale, BODE index , 6 minute walking test
(6MWT) and St. George’s Respiratory Questionnaire (SGRO). All these parameters were taken before and
after the rehabilitation programme.The result shows that Comparing
with pre-rehabilitation value, a
significant improvement (p<0.05) of Borg Sclae, BODe index, MRC Scale and SGRQ was observed in all
the stages of the diseases, with no differences between patient with or without lung failure. FEV1 value was
increased only in moderate and in patients with no respiratory failure. In our study we observed that
respiratory rehabilitation programme improves exercise performance and quality of life in patients with any
stages of COPD18.
6.3. STATEMENT OF THE PROBLEM
A study to assess the effectiveness of video assisted structured teaching programme
(VATP) regarding home care management of chronic obstructive pulmonary disease (COPD) on knowledge
among patient attending medical OPD in selected Hospital, Bangalore, Karnataka.
6.4. OBJECTIVES
1)
To assess the knowledge of patients attending medical OPD regarding home care management
of COPD. Before implementation of VATP
2)
To assess the effectiveness of video assisted teaching programme
on Home Care Management of COPD
3)
To find out the association between knowledge regarding home care management of COPD
among patients attending medical OPD with selected demographic variables.
6.5. HYPOTHESIS
H1 : The mean post-test knowledge score of patients attending medical OPD regarding Home care
management of COPD will be significantly higher than the pre-test knowledge score
H2: There will be a significant association between the selected demographic variables and the mean
knowledge score of patients attending medical OPD regarding homecare management of COPD.
6.6 OPERATIONAL DEFINITION
(1) Assess:It refers to the measurement of knowledge by using appropriate tool developed by the investigator.
(2) Effectiveness:It refers to significant gain in difference between pre-test and post-test.
(3) Video assisted structured teaching programme:
It refers to significantly organized instructions regarding home care management of COPD which will
be played through CD in the Television.
(4) Knowledge:It refers to the correct responses given by the patients attending Medical OPD regarding Home care
management of COPD which is elicited through structured Multiple choice questionnaire.
(5) Home Care Management:It refers to the practice of using inhaler, smoking cession, exercise, breathing training and Bronchial
hygiene techniques, nutrition and diet, self care activity and follow-up by the patients in home.
(6) COPD (Chronic Obstructive Pulmonary Diseases):It refers to the lung disease in which airway (wind pipe or bronchi) and lung substances (air sacs or
alveoli) are affected due to harmful particle or gases.
(7) Medical OPD( Out Patient Department) :It refers to an out patient department in hospitals were Doctor consults and treat the Medical condition
of patient.
6.7 ASSUMPTION
1) Clients attending Medical OPD will have some knowledge about home care management of COPD.
2) Knowledge regarding home care of COPD varies from clients to clients.
3) VATP is a effective way to improve the knowledge among patients attending Medical OPD
regarding Home Care Management of COPD.
6.8 LIMITATIONS OF THE STUDY
1.
This study is limited to patients who is attending Medical OPD of selected hospital at Bangalore.
2. The duration of the study is limited for four weeks only.
3. Sample size is limited to 50 only.
4. The study is limited only to those who can read and write Kannada.
7. MATERIALS AND METHODS
7.1 Source of Data:The data will be collected from patients who will be attending medical OPD in selected hospital in
Bangalore.
7.2 Methods of Data Collection:i)
Research Approach :Quasi experimental and evaluative approach.
ii)
Research Design:One group pre-test, post-test design.
iii)
Sample Technique:Non Probability convenience sampling technique.
iv)
Sampling size:50 patients attending Medical OPD to get treatment for COPD at Chaya and Sathya Hospital,
Bangalore.
v)
Setting of Study:The Study will be conducted in Chaya and Sathya Hospital, Bangalore.
7.2.1 CRITERIA FOR SELECTION OF SAMPLE
(a) Inclusion Criteria:Patients of both sex who will be,
1) attending medical OPD to get treatment for COPD.
2) able to read and write kannada.
3) available during the period of data-collection.
4) willing to participate in the study.
(b) Exclusion criteria:Patient of both sex who will not be,
1) attending medical OPD to get treatment for COPD.
2)
able to read and write kannada.
3)
available during the period of data collection.
4)
willing to participate in the study.
7.2.2 DATA COLLECTION TOOL
Section 1 > Demographic Performa, it include sample number, age, sex, educational status, occupation,
income, socioeconomic status and information obtained about Home Care Management of COPD
Section 2 > Structured questionnaire to assess the knowledge of patients attending medical OPD
regarding homecare management of COPD.
Section 3> VATP regarding homecare management of COPD.
Content validity of the tool will be obtained in consultation with guides and experts in the field of
Pulmonology, Cardio- thorasic nursing, medical surgical nursing, education and bio-statistics. Reliability of
the tool will be established by test re-test method. The tentative period of data collection will be from
July to August 2011.
7.2.3 METHOD OF DATA ANALYSIS
Data will be analyzed by means of descriptive and inferential statistics.
(a) Descriptive Statistics: mean, Median, Mode, Standard Deviation, percentage distribution will be used
to assess the knowledge of patient on Home Care Mangement of COPD.
(b) Inferential statistics: Chi-square test and T –test will be used to associate the knowledge of patients
with selected demographic variables.
7.3
Does the study requires any investigation or intervention to be conducted on the patient or other human
being or animals if so please describe briefly?
YES
The study requires specific intervention as VATP on home care management of COPD will be
conducted among patients attending Medical OPD.
7.4
Has ethical clearance been obtained from your institution in case of the above?
YES
Permission will be obtained from the concerned authority of selected hospital’s to conduct the study and
informed consent will be taken from the sample, selected on the basis of selection criteria.
8. LIST OF REFERENCE
1) Joyce M. Black, June Hokanson Hawks, Medical –Surgical Nursing, 8th edition, Clinical management
for positive outcomes, page no:- 1577-1591.
2) Tortora and Grab owski, Principles of Anatomy and physiology,10th edition, page no. 816-818.
3) Suzanne C. Smeltzer, Brenda G. Bare, Janicel, Hinkle, Kerry H. Cheever, “Brunner & Suddarth’sTestbook of Medical Surgical Nursing “ 12th edition, Page No.601-614.
4) Nitingal Nursing Times, a window for health in action, volume 6, No. 1 April 2010. Page No.4-5.
5) Linda.S. willings, Paula D. Hopper, Undertaking Medical Surgical Nursing F.A Davis Company
Publications. 3th edition, Page No. 475-501.
6) Nightingale Nursing Times, A window for health in action, vol 6, No. 3, June 2010, page No.43-45
7) Statistical abstract of the United States, 1994: the national data book. 114th ed. Washington, D.C.:U.S.
Dept. of Commerce, Economics and Statistics Administration, Bureau of the Census, 1994:95.
8) Rootmensen,et al,(Febuary 2008) A study on effects of additional care by a pulmonary nurse for COPD
patients at a respiratory outpatient clinic,70(2),Page no:179-186.
9) Rose Guell,MD,Pere Casan,et al,Chest April 2000,A Study on Long term effects of out patient
rehabilitation of COPD. Vol.117,Page no:976-983.
10) Effing T,Monninkhof EM,et al(august 21st 2007) Conducted a study on self management education for
patient with COPD,PubMed.gov,Vol. 55,Issue 2,page no:177-184.
11) Jorgen Thron, Maria Norrhall, et al, Primary care respiratory journel,General practice airways group
publisher, page no:1475-1534.
12) Kozui Kida,Ritsuko Vakabayashi,et al,(September 2009) Conducted study on efficacy of education
programme in patients with COPD assessed by the lung information needs questionnaire,Page no:820824.
13) Corry A.J.Ketelaars,et al,Chest 2007,A study on long term outcome of pulmonary rehabilitation in
patients with COPD,Vol.112,Page no:363-369.
14) Lawlor Maria,Kealy Sinead,et al(April 2009) A study that early discharge care with ongoing follow-up
support may reduse hospital readmission in COPD,Dove press journal-International journal of COPD
Vol.4,Page no:55-60.
15) Marry L Carison et al,(August 2006),A study to examine the perceived learning needs and preferred
learning styles of patients with COPD, Health publication ,Page no:157-163.
16) Elaine Mackay,et al,September 2009,The value of maintenance pulmonary rehabilitation classes in
COPD,Vol.14,Issue 3,Page no:181-192.
17) Oshana Hermiz,et al,(BMJ 2002 October 26) A study of home care of patients with COPD
,Vol.325,Page no:938-941.
18) Vittorio Cardaci,et al,(September 2009) Astudy on effects of respiratory rehabilitation in patients with
different stages of COPD severity Page no:71-75.