Download SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECT FOR

SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECT
FOR
DISSERTATION
SAVITHA KUMARI. M
Msc NURSING FIRST YEAR
INDIAN ACADEMY COLLEGE OF NURSING
YEAR 2012-2014
INDIAN ACADEMYCOLLEGE OF NURSING,
HENNUR CROSS,
BANGALORE-560043
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
MS. SAVITHA KUMARI. M
1.
2.
3.
4.
NAME OF THE CANDIDATE AND 1ST YEAR M.SC. (NURSING)
ADDRESS
INDIAN
ACADEMY
COLLEGE
NURSING
HENNUR CROSS
BANGALORE
INDIAN
ACADEMY
COLLEGE
NURSING
HENNUR CROSS
BANGALORE - 560043
COURSE OF THE STUDY AND 1ST YEAR M.Sc. (NURSING),
MEDICAL SURGICAL NURSING
SUBJECT
NAME OF THE INSTITUTION
DATE OF ADMISSION TO THE
COURSE
TITLE OF THE STUDY
OF
11/06/2012
‘EFFECTIVENESS
5.
OF
OF STRUCTURED
TEACHING PROGRAMME REGARDING
SELF-CARE MANAGEMENT IN TERMS OF
KNOWLEDGE AND PRACTICE AMONG
PATIENTS WITH CHRONIC
OBSTRUCTIVE PULMONARY DISEASE
(COPD) IN SELECTED HOSPITAL,
BANGALORE.’
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“When you can’t breathe, nothing else matters”
-American Lung Association.1
Never before in the history of the world was there so much wealth, and never before so
much poverty; never before so much power, and never before so little peace; never before so
much education and never before so little coming to the knowledge of truth. We live in a time
when the value of human life is under attack. At the very least, the value of human life appears to
have been significantly diminished. Today we measure our value and the value of others in terms
of material possessions, wealth, power, position, title, education, houses, cars, pleasures and
health.2
If life to maintain health it is important to maintain the different system in our body
health and out of it the most important is the respiratory system and once it worsen it brings lots
of complication to the health of the people and in that 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. These programs have been studied more
recently for COPD. Reported success varies between conditions, so it is important to assess the
effectiveness of programs specifically in COPD.3
Chronic obstructive pulmonary disease (COPD), is the occurrence of chronic
bronchitis or emphysema, a pair of commonly co-existing diseases of the lungs in which
the airways narrow over time. This limits airflow to and from the lungs, causing shortness of
breath (dyspnea). In clinical practice, COPD is defined by its characteristically low airflow
on lung function tests. In contrast to asthma, this limitation is poorly reversible and usually gets
progressively worse over time. COPD is caused by noxious particles or gas, most commonly
from tobacco smoking, which triggers an abnormal inflammatory response in the lung.4
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 irritantsTobacco 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
In COPD self care management is a best treatment structured for ill patients with
chronic respiratory problems. It is also for patients who remain symptomatic, even if their
pulmonary function has not decreased after other medical treatment. An example of somebody
who could qualify for self care management are who come into this criteria of a program of
exercise, disease management and counseling coordinated to benefit the individual.3 Self care
has been shown to improve shortness of breath, exercise capacity and helps in the improvement
of quality of life of the patients. It has also been shown to improve the sense of control a patient
has over their disease as well as their emotions.4
Education and practice is the most important aspects of COPD managements. Patients
with new onset of COPD require extensive education for their self care management and
practice of it regularly to manage their disease safely and effectively reduce the complications.
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”
Although COPD affects people of all ages and over all, the incidence of
COPD in women than in men and higher industrialized sectors and nations. From 1980 to 2000,
the death rate from COPD for women rose from 20.1 deaths per 100,000 women to 56.7 deaths
per 100,000 women; while for men, the rate grew from 73.0 deaths per 100,000 men to 82.6
deaths per 100,000 men.5
In 2010, almost 24 million adults over the age of 40 in India had COPD. Data
monitor expects this number to increase 34% to approximately 32 million by 2020. COPD is
predominately a disease of men and only 40% of cases in India occur in women. Over the
forecast period, the growth in the number of total prevalent cases of COPD will be primarily
driven by demographic changes.6
The World Health Organization (WHO) estimates that COPD as a single
cause of death shares 4th and 5th places with HIV/AIDS (after coronary heart disease,
cerebrovascular disease and acute respiratory infection). The WHO estimates that in 2000, 2.74
million people died of COPD worldwide. 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 percent increase in risk of COPD in adults.7
COPD is the fourth leading cause of death in the U.S. and is projected to
be the third leading cause of death for both males and females by the year 2020. It is estimated
that there may be currently be 16 million people in the United States currently diagnosed with
COPD. 8
Men are 7 times more likely to be diagnosed with emphysema then
women, though the prevalence in women is on a steady increase and this number is lowering
with each year.9
More than 13 million Indians are victims of Chronic Obstructive Pulmonary
Disease (COPD), where the patients’ airways are blocked.10 The prevalence rate of COPD in
Indian males is 5% and in women is 2.7%, male to female ratio being 1.6:1.10
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 up.11
COPD is a systemic disease with major impact worldwide. In the treatment of
COPD a holistic approach should be taken. Home care management 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 hospitalizations12.
In this year COPD day has took place on November 17 around the theme
“2011- 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 2012, it is estimated that COPD will be ranked 5th. 13
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 worldwide. 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
pollution.14
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 causes 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 percentages 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 INDIA.15
The smoker non smoker ratio is 1.25:10.2 in INDIA 29.4 percentage males and 2.5
percentages 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 percentages in Indian population, among COPD suffers 7
percentages only were smoker and 93 percentage non smokers16.
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 percentages 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.17
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).
18
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 are higher
among men, elderly, poor, and urban residents. 19
Non communicable/ chronic respiratory ailments 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
percentages 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. 20
Investigator himself during his service period as a staff nurse in medical ward, dealed
with management of many patients with COP 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
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.21
The review of literature is traditionally considered as a systematic critical review of the
most important published scholarly literature on a particular topic.
For the present study the review of literature is organized under the following headings.
1. Reviews related to prevalence and incidence of COPD
2. General reviews related to COPD
3. Reviews related to home care management.
Reviews related to prevalence and incidence of COPD
Information on the prevalence of COPD was obtained from vital statistics, health
interview surveys, hospital charge records, national publications, and the World Health
Organization (WHO). These data indicate that COPD is a common disease with
implications for global health. In the United States, morbidity caused by COPD is 4%,
making COPD the fourth leading cause of death, exceeded only by heart attacks, cancer,
and stroke. Internationally, there is substantial variation in death rates possibly reflecting
smoking behavior, type and processing of tobacco, pollution, climate, respiratory
management, and genetic factors. The Global Obstructive Lung Disease Initiative,
initiated by the National Heart, Lung, and Blood Institute and the WHO, aims to raise
awareness of the increasing burden of COPD, decrease morbidity and mortality, promote
further study of the condition, and implement programs to prevent COPD.22
Silvi J (2009) conducted a study on incidence of COPD those who are all are at
a risk of different complications. Primary prevention is the home care management is
investigated. Investigators although recommended that chronic bronchitis prevalence was
higher than the other two others factors. During follow up many cases were identified and
adverse effect was found.23
Loveman E (2011) conducted a study on factors influencing the outcomes of
patients with COPD. Currently 20 million adults have had diagnosed of COPD, with
estimates that an additional 9% of the total US population will be diagnosed with COPD.
Currently the annual cost of health care is too high for the people to afford. So the COPD
clients are taught about the home care management. 24
R. J. Hopkins, & R. P. Young, chronic obstructive pulmonary disease (COPD) is
a common co morbid disease in lung cancer, estimated to affect 40–70% of lung cancer
patients, depending on diagnostic criteria. As smoking exposure is found in 85–90% of
those diagnosed with either COPD or lung cancer, coexisting disease could merely reflect
a shared smoking exposure. Potential confounding by age, sex and pack-yr smoking
history, and/or by the possible effects of lung cancer on spirometry, may result in overdiagnosis of COPD prevalence. In the present study, the prevalence of COPD (prebronchodilator Global Initiative for Chronic Obstructive Lung Disease 2+ criteria) in
patients diagnosed with lung cancer was 50% compared with 8% in a randomly recruited
community control group, matched for age, sex and pack-yr smoking exposure.
In a subgroup analysis of those with lung cancer and lung function measured prior to the
diagnosis of lung cancer (n = 127), we found a no significant increase in COPD prevalence
following diagnosis (56–61%; p = 0.45). After controlling for important variables, the prevalence
of COPD in newly diagnosed lung cancer cases was six-fold greater than in matched smokers;
this is much greater than previously reported. The studies conclude that COPD is both a common
and important independent risk factor for lung cancer.25
P Lange, the percentage of men with normal lung function ranged from 96% of never
smokers to 59% of continuous smokers; for women the proportions were 91% and 69%,
respectively. The 25 year incidence of moderate and severe COPD was 20.7% and 3.6%,
respectively, with no apparent difference between men and women. Smoking cessation,
especially early in the follow up period, decreased the risk of developing COPD substantially
compared with continuous smoking. During the follow up period there were 2912 deaths, 109 of
which were from COPD. 92% of the COPD deaths occurred in subjects who were current
smokers at the beginning of the follow up period. The study concludes that the absolute risk of
developing COPD among continuous smokers is at least 25%, which is larger than was
previously estimated.26
GENERAL REVIEWS RELATED TO COPD
The World Health Organization, According to WHO estimates, 80 million people have
moderate to severe chronic obstructive pulmonary disease (COPD). More than 3 million people
died of COPD in 2005, which corresponds to 5% of all deaths globally. Even in those countries,
accurate epidemiologic data on COPD are difficult and expensive to collect. It is known that
almost 90% of COPD deaths occur in low- and middle-income countries. At one time, COPD
was more common in men, but because of increased tobacco use among women in high-income
countries and the higher risk of exposure to indoor air pollution (such as biomass fuel used for
cooking and heating) in low-income countries, the disease now affects men and women almost
equally. In 2002 COPD was the fifth leading cause of death. Total deaths from COPD are
projected to increase by more than 30% in the next 10 years unless urgent action is taken to
reduce the underlying risk factors, especially tobacco use. Estimates show that COPD becomes
in 2030 the third leading cause of death worldwide.27
Lewis (2000) in COPD patient’s chest expansion is limited and patients
use the accessory muscles for respiration clinically respiratory muscle fatigue is the common
feature of COPD patients. The accessory muscles are not designed for long term use so it easily
get tired. To bring back the muscle tone respiratory muscle training becomes the central part of
concern. The patient with COPD develops an increased respiratory rate with a prolonged
expiration to compensate for the obstruction to airflow resulting in dyspnea. In addition, the
accessory muscles of breathing in the neck and upper part of the chest are used excessively to
promote chest wall movement.28
REVIEWS RELATED TO HOME CARE MANAGEMENT.
Rootmensen, Et,(2009) 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. Ninety-seven 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 parameters.29.
Rose Guell, MD, Pere Casan, Et Al (2011) ,a study conducted on
Long term effects of outpatient rehabilitation of COPD. To examine the short and long term
effect of an outpatient home care management. 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 outcome 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 outpatient 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 somewhat 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 worthwhile benefits that persist for period of 2 years.30
Effing T, Monninkhof EM, et al (2009), 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 home care management 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 clinically31.
Jorgen Thron, Maria Norrhall (2011) ,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 care.32
Kozui Kida,Ritsuko Vakabayashi,et al,(2010) 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) 33.
Corry A.J.Ketelaars,et, et (2011) a study conducted on Long term
Outcome of home care management in patients with COPD (Chest 1997). This Study
investigates the long –term benefits of home care management 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 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 (n-33) had “severely” impaired
HRQL on admission, little improvement after rehabilitation, and remained in fairly stable
condition 9 months post discharge34.
Lawlor Maria, Kealy Sinead, et al (2010) 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
outpatient clinics is associated with reduced readmission rates in COPD patients35.
Marry L Carison et al(2010) a comparative descriptive study to examine the
perceived learning needs and preferred learning styles of patients with COPD, August 2006.
Patient’s education for COPD. Patient’s education is a criteria component of COPD
management and fundamental to sing a patient’s ability to self manages 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 was 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%) 36.
Elaine Mackay, et al (2009) a study on the value of maintenance home
care management 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 home care management 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) been performed at baseline, after 8 weeks of
rehabilitation and after a year. The result shows the 120 patients who completed home care
management, 67 opted for maintenance classes and 53 declined. There was 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 classes37.
Oshana Hermiz, et al (2010) a study to conducted a “randomized
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 management38.
Vittorio Cardaci, et al,(2010) 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 home care management (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 Scale, 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 COPD39.
METHODOLOGY
6.3. STATEMENT OF THE PROBLEM: A study to assess the effectiveness of structured
teaching programme regarding self – care management in terms of knowledge and practice
among patients with chronic obstructive pulmonary disease (COPD) in selected hospital,
Bangalore.
6.4. OBJECTIVES
1)
To assess the pre existing knowledge and practice regarding home care management
among patient with chronic obstructive pulmonary disease.
2). To evaluate the effectiveness of structured teaching programme regarding home care
management patient with chronic obstructive pulmonary disease.
3). To find the association between knowledge and practice score with selected socio
demographic variables
6.5. HYPOTHESIS
H1: There will be significant difference between pre-test and post test knowledge of home
care management .
H2: There will be a significant association between knowledge and practice with selected socio
demographic variables
.
6.6 OPERATIONAL DEFINITION
Assess:- It refers to the measurement of knowledge by using appropriate tool developed
by the investigator.
Effectiveness:- It refers to significant gain in difference between pre-test and post-test.
Structured teaching programme: Refers to systematized organized teaching strategies to
the COPD clients with audio visual aids.
Practice: It is the frequently repeated customary action related home care
management.
Knowledge:- It refers to the correct responses given by the patients attending regarding
Home care management of COPD which is elicited through structured Multiple choice
questionnaire.
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.
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.
Patients: - Individuals who are admitted in hospital with COPD.
6.7 ASSUMPTION
 An information booklet helps to improve or enhance the knowledge levels of COPD
clients regarding the home care management.

Socio demographic variables will have an influence on the knowledge level of COPD
clients regarding the home management.
6.8 LIMITATIONS OF THE STUDY
1. This study is limited to patients who are attending medical opd and inpatient of
selected hospital at Bangalore.
2. The duration of the study is limited for four weeks only.
3. Sample size is limited to 30 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 and IPD 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
I.
Research variables
a. Independent variables: In present study the independent variable is structured
teaching programme.
b) Dependent variables: In this study the dependent variables is home care
management of COPD patients.
b. Socio-Demographic variables
Characteristics of patients such as age, gender, educational status, experience,
type of pneumonia effected, marital status, religion, type of family, socioeconomic status and
income.
II.
Setting
Study is planned to conduct in selected hospitals at Bangalore..
III.
Population
The patient with COPD admitted in selected hospitals at Bangalore.
IV.
Sample
The patient with COPD clients admitted in selected hospitals at Bangalore.. For pilot study
sample size will be 3. For main study the sample size will be 30.
7.2.1 CRITERIA FOR SELECTION OF SAMPLE
(a) Inclusion Criteria:Patients of both sexes who will be,
1) Attending medical OPD and IPD 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 sexes 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 > Socio- 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- STP 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- thoracic nursing, medical surgical nursing, education and
bio-statistics. Reliability of the tool will be established by test re-test method.
METHOD OF DATA COLLECTION:
After obtaining permission from concerned authority, researcher will take an
informed consent from samples and will collect the data.
Phase 1
Pre-test will be conducted to assess the knowledge of diabetic clients on prevention
of coronary artery disease using an interview schedule.
Phase 2
Information booklet on prevention of coronary artery disease will be distributed to
the diabetic clients.
Phase 3: After 1 week post-test will be administered to evaluate the level of knowledge on
prevention of coronary artery disease with the help of interview schedule. Duration of the
study is 4 weeks
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 Management of
COPD.
(b) Inferential statistics: Chi-square test and T –test will be used to associate the
knowledge of patients with selected socio 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?
NO
7.4
Has ethical clearance been obtained from your institution in case of the above?
NO
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.
PROJECTED OUTCOMES
After the study, the investigator will able to know the knowledge of diabetic
clients on prevention of coronary artery disease, based on the findings information
booklets will be given to the subjects. It will help them to be aware of the common
actions to prevent coronary artery disease.
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9.
10.
Signature of the Candidate
Remarks of the guide
11.
11.1
Name and designation of
Guide
11.2
Signature
Head of department
11.3
11.4
Signature
12
Remarks of Principal
12.1
Signature