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“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNOWLEDGE REGARDING
DEMENTIA AMONG NURSING STUDENTS IN SELECTED
NURSING COLLEGES BANGALORE “
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
BHASKAR PHATAK
PSYCHIATRIC NURSING
COLUMBIA COLLEGE OF NURSING
BANASWADI
BANGALORE
2010-2011
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1
NAME OF THE CANDIDATE BHASKAR PHATAK
AND ADDRESS
1STYEAR MSc NURSING
COLUMBIA COLLEGE OF NURSING,
OMBR
LAYOUT,
BANASWADI,
BANGALORE 560043.
2
NAME OF THE INSTITUTION
COLUMBIA COLLEGE OF NURSING,
BANGALORE
3
COURSE OF THE STUDY AND 1st YEAR M.Sc NURSING
SUBJECT
4
DATE OF ADMISSION
MENTAL HEALTH NURSING
04/06/2010
“A
5
TITLE OF THE TOPIC
STUDY
TO
EFFECTIVENESS
TEACHING
OF
ASSESS
STRUCTURED
PROGRAMME
KNOWLEDGE
DEMENTIA
THE
ON
REGARDING
AMONG
NURSING
STUDENTS IN SELECTED NURSING
COLLEGES BANGALORE “
6.0 BRIEF RESUME OF THE INTENDED WORK
6.1. INTRODUCTION
Increase in life expectancy during the twenty first century has produced an
aged population of an unprecedented size and longevity. Ageing leads to several
biological changes that take place over time and results in progressive loss of functional
capacity. The aged have to cope up with many physical and mental health problems with
advancing age requiring constant attention. Depressions, Hypertension, Arthritis,
Dementia, and Alzheimer’s are highly prevalent among the aged.1
Dementia is derived from the Latin word de – “apart, away” and “mens” –
mind. Dementia is a progressive brain dysfunction which result in a restriction of daily
activities and in most cases leads in the long term to the need for care.
Dementia is a non-specific illness syndrome in which affected areas of cognition
may be memory, attention, language, and problem solving. cognitive dysfunction that has
been seen only over shorter times, in particular less than weeks must be termed delirium.
The symptoms of dementia can be classified as either reversible or irreversible depending
upon the etiology of the disease. Less than (10%) of cases of dementia are due to causes
that may presently be reversed with treatment.
Dementia is the most feared and devasting disorder of late life. Current
estimates reveals that there are about 18 million cases of dementia in the world and by
2025, there will be about 34 million suffering from dementia. The overall prevalence of
dementia ranges from 5 percent to 7 percent. Alzheimer’s disease is the most common
dementing disorder accounting for 80 percent of all cases of dementia.2
The causes of dementia depend on the age at which symptoms begin. In the
elderly population (usually over 65 years of age), a large majority of cases of dementia
are caused by Alzheimer's disease, vascular dementia or both. The Hypothyroidism
sometimes causes slowly progressive cognitive impairment as the main symptom, and
this may be fully reversible with treatment. The Fronto-temporal lobar degeneration and
Huntington's disease account for most of the remaining cases.3
Dementia is not merely a problem of memory. It reduces the ability to learn
reason, retain or recall past experience and there is also loss of patterns of thoughts,
feelings and activities. Additional mental and behavioral problems often affect people
who have dementia, and may influence quality of life and the need for
institutionalization. As dementia worsens individuals may neglect themselves and may
become disinhibited, the individual may become incontinent as their condition worsens.
Depression affects (20–30%) of people who have dementia, and about (20%) have
anxiety. Psychosis and agitation/aggression also often accompany dementia.4
As the disease stage progresses to the middle stage, patients might still be able to
perform tasks independently, but may need assistance with more complicated activities.
In the late stage patient will not be able to perform even the simple tasks
independently and will require constant supervision. They may eventually to lose the
ability to swallow food and fluid and this can ultimately lead to death.
There is currently no cure for the disease. Currently available medications offer
relatively small symptomatic benefit for some patient but do not show disease
progression. It helps a little for the memory.5
The sun will continue to show its rays on the world. The waves of the vast ocean
will continue their rush to reach the shore and the wind will continue to blow the leaves
of the tree.
But let us all accept the patient with Dementia and give them a better tomorrow.
6.2 NEED FOR THE STUDY
According to Dr. Harlem “Tomorrow’s elderly people are today’s adult and
Yesterday’s children”. Adulthood is a unique phase of human development. Adults are
the important feature of every society and also a great resource of a nation.
Life expectancy has gone up from 20 years at the beginning of the 20th century
to 62 years today. India has a large segment of older people in the population. This
segment is growing fast with the rapid increase of the grey population in India.6
Indian aged population is currently the second largest in the world. By 2020,
of the countries with the largest elderly population in the world, five will be in
developing world, China 230 million, India 142 million, Indonesia 29 million, Brazil 27
million, and Pakistan 18 million.
Very little is known about the prevalence of dementia outside the more
developed countries. The idea that illness like Alzheimer’s a disease of a rich developed
nation is a myth. Alzheimer’s disease can occur to any adult at any age. Women are three
times more likely to be affected than men.
An estimated 4.5 million Americans are afflicted with Alzheimer’s disease
and other 20 million families must care for them. There are currently 800,000 people
living with dementia in United Kingdom today, a number expected to double within
twenty years. The number of people with dementia in the Asia Pacific region will rise
from about 14 million today to 65 million by 2050.7
In Indian context prevalence of Alzheimer’s disease is one in every five elderly
Citizens suffer from Alzheimer’s. In Kolkata there are about 46,000 patients with
Alzheimer’s. In Delhi it accounts for about 50,000 Alzheimer’s patient and in Bangalore
there are 30,000 elderly patients suffering from Alzheimer’s disease. Today in India
32,00,000 people are affected by dementia. The figure is expected to double every 20
Years.8
A descriptive study was conducted to systematic review and partial meta-analysis of
physical activity interventions in people with dementia in United Kingdom. The sample
size was 896 participants. The information was collected by searching eight databases for
English language papers and reference lists of relevant papers. Included studies reported
a physical activity intervention lasting at least 12 weeks in which participants were older
and had a diagnosis of dementia. Studies compared the intervention with a non-active or
a no-intervention control and reported at least one outcome related to physical function,
quality of life or depression. The results revealed that three of six trials that reported
walking as an outcome found an improvement, as did four of the five trials reporting
timed get up and go tests. Only one of the four trials that reported depression as an
outcome found a positive effect. Both trials that reported quality of life found an
improvement.9
A descriptive survey was carried out to investigate knowledge and fear of
developing Alzheimer’s disease in a sample of healthy adults. The sample size was 127
young adult and 118 older adults. The data was collected by using knowledge
questionnaire; Younger adults obtained a score of (54 %) while older adults obtained
(58%) on knowledge test. Knowledge and fear scores were not significantly correlated
with having a family member or knowing someone with Alzheimer’s disease. (Laforce R
Jr. McLean S).10
A study was carried out to assess the knowledge on Alzheimer’s disease in
four ethnic groups of older adults. The sample size was 96 Anglo, 37 Latino, 30
Asian and 30 African American older adults. The survey method was used to collect the
information. The result suggested that certain minority groups do not have sufficient
information about Alzheimer’s disease, and this may explain the lack of Alzheimer’s
disease service use by minorities. (Ayalon L. Arean PA).11
The investigator during his clinical posting and his interactions with the nursing
students in the clinical setting and community setting has observed that students have the
lacunae in their knowledge bank on dementia.
Nurses are vital sources in educating the public on various health related issues.
Hence the investigator is interested to assess the knowledge of student nurses regarding
Dementia. Furthermore, the study of this kind will serve as guidelines for future nurses to
provide comprehensive care for Dementia.
Keeping above facts in view the researcher is keen to assess the knowledge of
Student nurses regarding dementia.
6.3 REVIEW OF LITETATURE
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.12
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.13
A study conducted on meeting the need for public education about dementia.
Research continues to advance the knowledge of pathophysiology and development of
effective methods for treating patients with Alzheimer disease and other dementias.
Dissemination of information is likely to be slowest among the general population, who
may be the first to recognize dementia symptoms but may also be reticent to discuss
concerns because of fear, embarrassment, and inadequate knowledge. Public interest in
this service and willingness to use this technology is evaluated from 1 month study
conducted in a predominantly rural upper Midwest county population of 102,565.
Concern for a parent or grandparent was the most frequent reason 50.6percent given for
the call. Self-concern was indicated by 24.7 percent of the callers. Callers provided
positive feedback.14
A dementia quiz was developed to assess carers' and professionals knowledge
about dementia, services needed by dementia sufferers and their families, and methods of
coping with some of the problems presented by people with dementia. The quiz was
compared with a United Kingdom version of Dieckmann, Zarit, Zarit & Gatz's.
Alzheimer's Disease Knowledge Test, one of only two published tests assessing
knowledge about dementia. Both measures were given to samples of carers and
professionals who were either members or non-members of Alzheimer's disease Society.
The responses were analysed to determine the reliability and validity of the new
Dementia Quiz. The results were encouraging and the quiz should prove useful in
teaching, clinical and research settings.15
A study carried out on withdrawn support for carers of people with Alzheimer's
type dementia. All randomised trials in which primary carers of people with Alzheimer's
disease are allocated to intervention or non-intervention, control groups and where the
intervention was provided by healthcare and social services. Data was extracted by both
reviewers and was found to be unsuitable for quantitative synthesis. Weighted Mean
Differences for each outcome and its subcategories are also presented. The results of the
review are inconclusive.16
A study conducted on providing education about Alzheimer's disease. Improving
carers' knowledge of Alzheimer's disease has been associated with benefits for carer wellbeing. This has led to recognition of the need to systematically evaluate dementia
education tools. In this study dementia knowledge was measured before and after
interventions designed to improve knowledge in a sample of 100 undergraduate students.
Dementia education materials were selected from existing resources that are readily
accessible and are recommended for use in clinical settings. Subjects were allocated to
one of four conditions, including a control group. Subjects allocated to education
conditions were asked to view a video on Alzheimer's disease, read written information
about the disease or do both. Results showed that education improved Knowledge of
Alzheimer's disease, as measured by increased scores on a dementia knowledge
questionnaire. This study has important implications for public education about dementia
and resource allocation for service providers.17
A study conducted on skilled carers' ways of understanding people with
Alzheimer's disease. Five carers in a group dwelling for people with dementia were
observed and interviewed concerning their interactions with five residents with
Alzheimer's disease. The tape-recorded and transcribed data were analyzed as text. The
carers' personal ways of achieving understanding were refined as, affect atonement and
completing a puzzle through explanatory connections of observation, knowledge about
the residents' life histories and behaviour at the group dwelling; and affect atonement
within the context of caring as an intrinsic end. Personal experience from childhood and
motherhood, knowledge about the residents' life history and the nature of the disease, and
personal talent seemed to form these carers' ways of achieving understanding.18
A study conducted on carers' knowledge of dementia and their expressed
concerns. The investigator wished to determine how much carers from different settings
caring for patients with dementia knew about the disorder and elicit their main concerns
about the disease. A survey questionnaire was administered to 136 carers. Two old age
psychiatric services and an Alzheimer's support group in urban areas of the United
Kingdom. The carers came from one of three categories one was from carers with no
prior contact with elderly mental health services pre assessment group; second carers who
had been in contact with mental health care professionals post assessment group; third
carers in contact with an Alzheimer's Disease Society support group. A questionnaire on
the subject of dementia. Carers' worries about the disorder were also recorded. Carers in
contact with an Alzheimer's support group were the most knowledgeable and carers in the
pre assessment group were the least knowledgeable on the subject of dementia. While
carers in the post assessment group had a level of knowledge above that of the pre
assessment group, this difference failed to reach statistical significance. The study
highlights the need for elderly mental health teams to evaluate their methods of
dissemination of knowledge to carers, develop educational packages for carers and
evaluate their effectiveness.19
A study conducted on the multi nodal strategies for caregivers of persons with
dementia. The researcher divided 139 caregivers in 3 groups: 62 in educational support;
19 – Alzheimer’s Association support group and 58 did not receive any treatment.
Outcome measures coping styles, burden, caregivers concerns and symptoms profile in
caregivers. Results revealed that the distress increased in educational support group after
intervention; high participant satisfaction with groups; support group members reported
higher distress and life impact and lower anxiety. Control group had lowest distress and
lower care giving satisfaction.20
A study conducted on the improvement in agitation and anxiety in dementia after
psycho educational group intervention with their caregivers. The study examined effect
of psycho educative group intervention on the behavioral and psychological symptoms of
the dementia patients in a 3 month; expert based and conceptualized group intervention
with caregivers relatives of dementia patients. The 3 month group intervention yielded a
significant improvement in agitation and anxiety of the dementia patients.21
With the older population growing, there is likely to be an increase in the numbers
of people with dementia on acute hospital wards. This article presents some of the
findings from a Masters study (Ballard 2005) that explored the knowledge, understanding
and implications for care of adult nurses working with patients who present with
dementia in general hospital wards. Kitwood's 'malignant social psychology' and 'personcentred approach' were used as the theoretical framework to develop a questionnaire
distributed to nurses. The findings about nurses' knowledge and understanding of personcentred dementia care and gaps in this area are discussed, and implications for future
education and training of nurses presented.22
6.4 STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of structured teaching programme on
knowledge regarding Dementia among nursing students in selected nursing colleges
Bangalore.”
6.5 OBJECTIVES OF THE STUDY
1. To assess the knowledge of nursing students regarding Dementia.
2. To assess the effectiveness of structured teaching programme regarding dementia
among nursing students
3. To find out the association between knowledge of nursing students regarding
dementia and selected demographic variables.
6.6 OPERATIONAL DEFINITIONS
1) Knowledge: Refers to correct responses given by nursing students regarding dementia
as measured by knowledge questionnaire.
2) Nursing Students: Refers to students studying 4th year B. Sc nursing in selected
nursing institution
3) Nursing College: refers to the educational institutions training the B. Sc Nursing
students, which are recognized by Indian Nursing council and affiliated to Rajiv Gandhi
University of Health Sciences Bangalore.
4) Dementia: Refers to a progressive brain dysfunction which results in a serious loss of
cognitive ability in a previously unimpaired person, beyond what might be expected from
normal aging and restriction of daily activities.
5) Structured teaching Programme: Refers to organized group teaching in the form of
lecture cum discussion to impart knowledge for nursing students regarding dementia.
6.7.1 HYPOTHESIS
H1: There will be significant increase in knowledge level regarding dementia after
structured teaching programme among nursing students
H2: There will be significant the association between knowledge of nursing students
regarding dementia and selected demographic variables.
6.8 DELIMITATION
1. The data collection period is limited to 6 weeks
6.9. VARIABLES
6.9.1 Independent variable: of this study is knowledge of nursing students regarding
Dementia
6.9.2 Demographic variables: of this study are Age, Sex, Religion, previous exposure
to teaching on dementia and Source of information on dementia.
7. MATERIALS AND METHODS
The study is designed to assess the effectiveness of structured teaching programme
regarding dementia among nursing students
7.1. SOURCE OF DATA
Data will be collected from 4th year B. Sc Nursing students of selected nursing colleges,
Bangalore.
7.1.1. RESEARCH DESIGN
Research design adopted for the present study quasi experimental research design.
7.1.2. RESEARCH APPROACH
The research approach used in this study is evaluative approach.
7.1.3. SETTING OF THE STUDY
Selected nursing colleges, Bangalore
7.1.4. POPULATION
4th year B. Sc Nursing Students
7.1.5. SAMPLE SIZE
The proposed sample size of the study is 50 nursing students.
7.1.6. SAMPLING TECHNIQUE
Sampling technique using in this study is simple random Sampling Technique.
7.1.7 SAMPLING CRITERIA
7.1.7. 1 Inclusion criteria
1. Who are willing to participate in this study.
2. Who are present during the period of data collection
7.1.7.2 Exclusion criteria
1. Those who are on long leave
7.2. METHOD OF DATA COLLECTION
7.2.1. Tool for data collection
Structured questionnaire
7.2.2. Method of data Collection
Method used is self administered pretest and post test
7.2.3. Procedure for data collection
The data will be collected with the prescribed period from selected nursing colleges at
Bangalore.
 Permission will be obtained from higher authorities.
 Written consent will be taken from the respondents.
 Purpose of the study will b explained to the respondents.
 Knowledge of nursing students on dementia will be assessed by using self
administered questionnaire
 Planned teaching programme on dementia will be conducted.
 On the 8th day post-test will be conducted.
7.2.4. DATA ANALYSIS METHOD
7.2.4.1 Descriptive statistics: Frequency, mean, mean percentage, and standard
deviation of described demographic variables.
7.2.4.2 Inferential statistics:
 Paired t’ test to assess the effectiveness of planned teaching programme on
dementia
 Chi square test will be used to find out association between selected variables.
7.3.
DOES
THE
CONDUCTED
STUDY
REQUIRE
ANY
INVESTIGATION
ON THE PATIENT OR OTHER HUMAN
ANIMALS?
Yes
7.4. HAS ETHICAL CLEARENCE OBTAINED?
YES, ethical clearance certificate is enclosed.
TO
BEINGS
BE
OR
8. LIST OF REFERENCES
1. Kaplan and Sadock. Comprehensive Textbook of Psychiatry. 5th ed. USA:
Lippincott Williams; 2000. P.3045.
2. Dementia statistics worldwide. URL: http://www.google.com [cited on 2007 Oct
6].
3. World Health Organisation. Alzheimer’s Disease Help for Caregivers.
Alzheimer’s Disease International. Geneva: 1999. P.1-5.
4. Johnson BS. Adaptation and Growth Psychiatric Mental Health Nursing. Second
ed. USA: JB Lippincott Company. 1999. P.618-21.
5. Andrew Pollack: Advances in diagnosing Alzheimer’s Disease. The Hindu. 2007
Oct 17. P.18.
6. Life expecting in India URL:http:www.google.com [cited on 2007. Sep. 20].
7. Alzheimer’s Disease statistics worldwide.URL:http: www.google.com [cited on
2007 Oct. 7].
8.
Arnals Ganaguly: Struck by Alzheimer’s elders left to struggle. The Times of
India. 2006. Sep.22; Sect.A:3 (vol 1).
9. Potter R, Ellard D, Rees K, Thorogood M. A systematic review of the effects of
physical activity on physical functioning, quality of life and depression in older
people with dementia.Int J Geriatric Psychiatry. 2011 Jan 6; 73:61-3.
10. Laforce R Jr., McLean S. Knowledge and fear of developing Alzheimer’s Disease
in a sample of healthy adults. Psychol P.2005, Feb; 96(1): P. 204-6.
11. Ayalon L, Arean PA. Knowledge of Alzheimer’s Disease in four ethnic groups of
older adults. International journal of Geriatric Psychiatry 2004: Jan; 19(1): P. 51-7
12. Kirlinger FN. Foundation of Behavioral Research, 2nd ed. London: Mc.Millan
Company; 1986. P.50.
13. Treece W, Treece TW. Elements of Research in Nursing. 3rd ed. St. Louis: C.V.
Mosby Company; 1998. P.43.
14. Mundt JC, Kaplan DA, Greist JH. Meeting the need for public education about
dementia research support. 2000 Sep 25; 142 (39): P. 40-1.
15. Gilleard C. Grom F. A study of two dementia quizzes. British Journal of clinical
psychology. 1994 Nov; 33(4): P. 529-34.
16. Thompson C. Spilsbury K. Withdrawn support for carers of people with
Alzheimer’s type dementia. American Journal of Psychiatric Nursing. 2001 May;
42(4): P. 439-48.
17. Sullivan K. Providing education about Alzheimer’s Disease on caregivers British
Journal of Psychiatric Nursing. 2001 Feb; 5(1): P.5-13.
18. Haggstrom TM, Jansson L, Norberg A. Skilled carer’s ways of understanding
people with Alzheimer’s Disease. International Journal of Geriatric Psychiatry.
1998 Sept; 12(3): P.239-66.
19. Graham C, Ballard C, Sham P. Carer’s Knowledge of dementia and thus
expressed concerns, International Journal of Geriatric Psychiatry. 1997 Apr;
12(4): P.470-3.
20. Faran C, Keane H. Multimodal intervention strategies for caregivers of persons.
International Journal of Geriatric Psychiatry. 2000 Mar; 13(2): P. 220-4.
21. Haupt, Karger A, Janner. Improvement in agitation and anxiety in dementia
patients after psycho educational group intervention with caregivers. International
Journal of Geriatric Psychiatry. 2000 Jun; 15(2); P.1125-9.
22. Fessey V. Patients who present with dementia: exploring the knowledge of
hospital nurses. Nurs Older People. 2007 Dec; 19(10):29-33.
9
Signature of candidate
10
Remarks of the guide
11
Name and designation
The topic selected for the study is relevant
(in block MRS.VIMALA
letters
PROFESSOR
HEAD OF DEPARTMENT
PSYCHIATRIC
NURSING,
COLUMBIA
COLLEGE OF NURSING,
#84/1, 5TH MAIN ROAD, OMBR LAYOUT,
BANASWADI, BANGALORE-43
11.1 Guide
MRS.VIMALA
11.2 Signature
11.3 Co-guide (if any)
-------
11.4 Signature
12
12.1 Head of the Department
MRS.VIMALA
12.2 Signature
13
13.1 Remarks of the Chairman or
Principal
13.2 Signature
Relevant