Download INTRODUCTION

1
SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECT
FOR
DISSERTATION
MR. SYAM KUMAR.S
FIRST YEAR M.SC (NURSING)
MEDICAL SURGICAL NURSING
YEAR 2011-2013
ADITYA COLLEGE OF NURSING
# 12, KOGILU MAIN ROAD, YELAHANKA
BANGALORE – 560 064
2
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECT
FOR
DISSERTATION
1.
2.
3.
4.
5.
Mr. SYAM KUMAR .S
NAME OF THE CANDIDATE AND 1ST YEAR M.Sc. (NURSING)
ADITYA
COLLEGE
OF
ADDRES
NURSING,
#12 KOGILU MAIN ROAD,
YELAHANKA, BANGALORE –
560 064
ADITYA
COLLEGE
OF
NAME OF THE INSTITUTION
NURSING,
BANGALORE560064
COURSE OF THE STUDY AND 1ST YEAR M.Sc. (NURSING),
MEDICAL SURGICAL
SUBJECT
NURSING
DATE OF ADMISSION TO THE
15/06/2011
COURSE
TITLE OF THE STUDY
“A STUDY TO ASSESS THE
EFFECTIVENESS
OF
STRUCTURED
TEACHING
PROGRAMME ON KNOWLEDGE
REGARDING
PULMONARY
REHABILITATION
AMONG
PATIENT
WITH
CHRONIC
OBSTRUCTIVE
PULMONARY
DISEASE (COPD) IN SELECTED
HOSPITALS, BANGALORE”
3
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Chronic Obstructive Pulmonary Disease refers to several disorders that affect the
movement of air in and out of the Lungs although, the most important of these
obstructive, bronchitis, emphysema, and asthma-may occur in pure form, they most
commonly coexist, with overlapping clinical manifestations. The term COPD is
commonly used, but some pulmonologist think it is not completely accurate and the term
chronic air flow limitations may be used in it place.1
COPD can occurs as a result of increased airway resistance secondary to
bronchial mucosal edema or smooth muscle contraction. It may also be a result of
decreased elastic recoil, as seen in emphysema. Elastic recoil, similar to the recoil of a
stretched rubber band, is the force. Used in passively to deflate the lung and eschale,
decreased, elastic recoil results in a decreased driving force to empty the lung.2
COPD Modern and effective pulmonary rehabilitation programs are global,
multidisciplinary, individualized and use comprehensive approach acting on the patient
as a whole and not only on the pulmonary component of the disease. In the last two
decades interest for pulmonary rehabilitation is on the rise and a growing literature
including several guidelines is now available. This review addresses the recent
developments in the broad area of pulmonary rehabilitation as well as new methods to
consider in the development of future and better programs. Modern literature for
rationale, physiopathological basis, structure, exercise training as well challenges for
pulmonary rehabilitation programs are addressed. Among the main challenges of
pulmonary rehabilitation, efforts have to be devoted to improve accessibility to early
4
rehabilitation strategies, not only to patients with COPD but to those with other chronic
respiratory diseases.3
COPD mainly occurs due to environmental pollution, industrialization, smoking
tobacco, mining and mill dust exposure, overcrowding. Allisan and Susans (1999)
describes that the chronic nature of the illness lead an individual to lose control over his
own life and they become dependent and experience low esteem and social isolation
which affects their quality of life.4
Exercise improves the oxygen utilization, work capacity and state of mind of
COPD patients. Some patients may also benefit from exercise programs that target upper
body and are designed to increase strength of the respiratory muscles. Several methods
have been investigated, standardized, and prescribed for respiratory exercise. Deep
breathing is considered as one such method. Breathing exercise help the patient during
rest and activity, and it reduces the respiratory muscle fatigue and decrease dyspnea,
anxiety, panic attacks and enable the patient to better cope up with life. The main type of
breathing exercise is pursed lip breathing and diaphragmatic breathing exercise. As a
sum, breathing exercises improve the sense of well being of patients.1
Chronic Pulmonary Disease poses enormous burdens to society both in terms of
direct cost of health care services and indirect costs to society through loss of
productivity. The exact prevalence of Bronchial Asthma is difficult to determine because
of problems with definition and coding. Despite the high prevalence and enormous cost
to health care and society. Bronchial Asthma is thought of as a self inflicted disease and
affects more elderly people. Bronchial Asthma is not such an obvious killer like lung
cancer therefore receives a less emotive response.5
5
Among the respiratory diseases COPD is the common test disease. Chronic
obstructive lung disease is a general term that refers to number of chronic pulmonary
condition, the main disease include chronic bronchitis, bronchial asthma and emphysema.
Bronchial Asthma encompasses chronic obstructive bronchitis with obstruction of small
airways, with enlargement of air spaces and destruction of lung parenchyma, loss of lung
elasticity and closure of small airways, Black M Joyce (2001).6
Incentive Spiro meter also known as sustained maximal inspiration (SMI) is a
component of bronchial hygiene therapy. Incentive Spiro meter is designed to mimic
natural sighing or yawning and it also helps the patient to take long, slow deep breaths.
This is accomplished by using a device that provides patients with visual or other positive
feedback the patient inhale at a flow rate or volume and sustains the inflation for a
maximum of 3 seconds.7
Exercises has emerged as a primary modality for improving quality of life of
COPD patients, Since COPD is characterized by loss of elastic tissues the 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 gets tired in conditions like
COPD. To bring back the muscle tone respiratory muscle training become the Golden
Standard for Patients with COPD.8
6
6.1 NEED FOR THE STUDY
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.
World Wide Information
 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.
 In 1990, a study by the World Bank and WHO ranked COPD 12th as a burden of
disease; by 2020, 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 percent increase in risk of COPD in adults.
 Although cigarette smoking is the primary cause of COPD, the WHO estimates
that there are 400,000 deaths per year from exposure to biomass fuels.
 In Algeria, the prevalence of tuberculosis and acute respiratory infection has
decreased since 1965, but an increase in chronic respiratory diseases (asthma and
COPD) has been observed in the last decade.
 COPD is estimated to be 6.2 percent in 11 Asian countries surveyed by the Asian
Pacific Society of respiratory diseases.
7
Indian Information
 COPD is the fourth leading cause of death in the India and is projected to be the
third leading cause of death for both males and females by the year 2020.
 The NHBLI reports 12.1 million adults 25 and older were diagnosed in 2001.
 It is estimated that there may be currently be 16 million people in the India
currently diagnosed with COPD.
 It is estimated that there may as many as an additional 14 million or more in the
India still undiagnosed, as they are in the beginning stages and have little to
minimal symptoms and have not sought health care yet.
 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
 People over the age of 50 are more likely to be considered disabled, however, the
damage started years before
 About 1.5 million emergency department visits by adults 25 and older were made
for COPD in 2000.
 More emergency department visits for COPD were made by adult females than
adult males (898,000 vs. 651,000).
 About 726,000 hospitalizations for COPD occurred in 2000. More females than
males were hospitalized for COPD (404,000 vs. 322,000).
Carlin B.W(2009), State that department of internal medicine, allegheny general
hospital, Drexel university school of medicine, USA. Pulmonary rehabilitation is a core
component of the management of a patient with chronic lung disease. The respiratory
8
therapist plays a vital role in pulmonary rehabilitation. Identifying patients who are
eligible for pulmonary rehabilitation, assessing the individual patient prior to entry into
the program, providing education regarding the patient's disease, and actively
participating in the exercise and training programs are just few of the ways that the
respiratory therapist can participate in this very important activity for patients with
chronic lung disease.9
Sugawara K (2009), Status that department of Rehabilitation Medicine, School of
Medicine, Japan. Effective home-based pulmonary rehabilitation in patients with
restrictive lung diseases. Patients with chronic obstructive pulmonary disease (COPD) are
commonly referred for pulmonary rehabilitation (PR), but the use of PR is not common
for patients with restrictive lung disease, neuromuscular diseases, and those who have
sustained a severe respiratory illness or undergone thoracic surgery. We investigated the
effects of PR in patients with restrictive lung diseases in comparison with COPD patients
using a home-based setting. Twenty-six restrictive lung diseases patients and 40 COPD
patients who had a Medical Research Council (MRC) dyspnea score >or= 2, a clinically
stable condition, and who had completed 6-months PR program, were enrolled in the
present study.10
Vagaggini B, et.al (2009), Cardio-Thoracic and Vascular Department, University of
Pisa, Italy. Clinical predictors of the efficacy of a pulmonary rehabilitation programme in
patients with COPD. After PRP there was a significant improvement in exercise tolerance
and quality of life, which correlated with baseline FEV(1)/VC, PaO(2), SpO(2), 6MWT
and SGRQ. SGRQ significantly decreased and 6MWT significantly increased after PRP
in all subgroups, except for patients with CV comorbidities. Both univariate and
9
multivariate
logistic
regression
analyses
showed
that
BMI>25
and
resting
PaO(2)<60mmHg were independent predictors of PRP efficacy in terms of improvement
of 6MWT, but not of SGRQ scores. Clinical and functional baseline findings do not
predict the response to PRP in COPD. The greater efficacy in patients with BMI>25 or
with PaO(2)<60mmHg may be due to a greater deconditioning in overweight patients,
and to larger room for improvement in hypoxemic patients.8
WHO (2001) predicts that by 2020, COPD will rise to be fifth most prevalent disease
worldwide and third most common cause of death. In India COPD is equally, prevalent in
rural and urban areas. Males are more affected than females Sainan G.S, (1992).7
Gerald (2000) states that pursed lip breathing improves ventilation, decreases air
trapping in the lungs, decreases the work of breathing, improves breathing pattern
prolongs exhalation, slows down the breathing rate, keeps the airways open longer,
improves the movement of old air out of the lungs and allows for more new air to get into
the lungs.11
Orfanos (1999) evaluated the effect of deep breathing exercises, the results proved
that there was significant improvement in the pulmonary function. 12
A review of available literature indicates that studies effective pulmonary
rehabilitation is need for the COPD patient. The nurse as health team members has the
responsibility of educating the patient about disease process, avoiding triggers, breathing
exercise, inhaler therapy, diet, medication and home care management for the COPD.
10
6.2 REVIEW OF LITERATURE
INTRODUCTION:
COPD during recent year, COPD hospitalizations rates have markedly increased. The
high morbidity rates related to COPD may be attributed to limited access to health care,
an inaccurate assessment of disease severely a delay in seeking help inadequate medical
treatment and non-adherence to prescribed therapy, studies have proved that this could be
overcome by educational programmes emphasizing the importance of self management at
home. Nurses are in the best position to achieve this aim of COPD management therapy
preventing the recurrent. This chapter is discussed under the following headings.
1. Literature related to pulmonary rehabilitation with COPD
2. Literature related to prevalence of COPD
3. Literature related to effectiveness of structured teaching programme on
rehabilitation of COPD.
1. LITERATURE RELATED TO PULMONARY REHABILITATION WITH
COPD.
Evans RA (2009), Dept of Respiratory Medicine, Allergy and Thoracic Surgery,
University Hospitals of Leicester, United Kingdom. The objective of the study is to
assess the effect of pulmonary rehabilitation stratified by the MRC dyspnoea scale in
patients with COPD. This is a retrospective, observational study of data collected from
450 consecutive patients with COPD attending outpatient PR: 247 male, mean (SD) age
69.5 (8.9) yrs and FEV(1) 44.6 (19.7)% predicted. Patients with COPD, of all MRC
dyspnoea grades, benefit comparably from pulmonary rehabilitation achieving both
11
statistically and clinically meaningful improvements in exercise performance. MRC
grade should therefore not be used to exclude patients from pulmonary rehabilitation.13
Hartl S (2009), Department of Respiratory and Critical Care Medicine, Austria. The
study was to determine the effect of one year of pulmonary rehabilitation (PR) on
functional parameters and exacerbation rates in patients with chronic obstructive
pulmonary disease (COPD). A total of 100 patients were enrolled in a multidisciplinary
PR program. PR included endurance, resistance and respiratory muscle training. We
performed spiroergometry, a modified Bruce Test and measurements of upper and lower
limb contractility as well as inspiratory muscle strength before, six and 12 months after
beginning rehabilitation. Additionally, we assessed the quality of life and the number of
exacerbations and exacerbation days one year before and after starting rehabilitation. One
year of outpatient pulmonary rehabilitation is an effective intervention leading to a
significant improvement in exercise tolerance and quality of life in patients with COPD
also reducing COPD exacerbation rates and hospitalizations.14
Martino F (2009), Cardio-Thoracic and Vascular Department, University of Pisa,
Italy. After PRP there was a significant improvement in exercise tolerance and quality of
life, which correlated with baseline FEV(1)/VC, PaO(2), SpO(2), 6MWT and SGRQ.
SGRQ significantly decreased and 6MWT significantly increased after PRP in all
subgroups, except for patients with CV comorbidities. Both univariate and multivariate
logistic regression analyses showed that BMI>25 and resting PaO(2)<60mmHg were
independent predictors of PRP efficacy in terms of improvement of 6MWT, but not of
SGRQ scores. Clinical and functional baseline findings do not predict the response to
PRP in COPD. The greater efficacy in patients with BMI>25 or with PaO(2)<60mmHg
12
may be due to a greater deconditioning in overweight patients, and to a larger room for
improvement in hypoxemic patients.15
Troosters T et al., (2009), Epidemiology, Johns Hopkins School of Public
Health, USA. Pulmonary rehabilitation has become a cornerstone in the management of
patients with stable Chronic Obstructive Pulmonary Disease (COPD). Systematic reviews
have shown large and important clinical effects of pulmonary rehabilitation in these
patients. In unstable COPD patients who have suffered from an exacerbation recently,
however, the effects of pulmonary rehabilitation are less established.16
Weinberg RL et al., (2009), Capital Hospice and Palliative Care Consultants,
USA. Although pulmonary rehabilitation has reproducibly improved dyspnea and quality
of life indices in patients with Chronic Obstructive Pulmonary Disease (COPD), its
suitability to the palliative-care setting is not well established. Evolutions in exercise
design, self-monitored home-based programs, and understanding of the patient
populations that may benefit are rendering pulmonary rehabilitation more feasible for
patients with significant impairment. In this review, we focus on the recent developments
that translate most successfully into the palliative-care setting. Recent innovations in
pulmonary rehabilitation interventions and setting allow the flexibility to facilitate its
incorporation into an individualized palliative plan of care. Appropriately tailored,
pulmonary rehabilitation may provide additional opportunities to optimize functional
capacity and reduce symptom burden.17
F. Lötters (2002), conducted a study to assess the effectiveness of pulmonary
rehabilitation on COPD. The purpose of this meta-analysis is to review studies
investigating the efficacy of pulmonary rehabilitation in chronic obstructive pulmonary
13
disease (COPD) patients. A systematic literature search was performed using the Medline
and Embase databases. On the basis of a methodological framework, a critical review
was performed and summary effect-sizes were calculated by applying fixed and random
effects models. This study concluded that pulmonary rehabilitation programme directed
at chronic obstructive pulmonary disease patients with inspiratory muscle weakness.18
James Patrick Finnerty, (2001) conducted a study to assess the effectiveness of
Outpatient Pulmonary Rehabilitation in Chronic Lung Disease. They undertook a
randomized, prospective, parallel-group controlled study of an outpatient rehabilitation
program in 65 patients with COPD (44 men and 21 women; mean age, 69.5 years [SD,
9.2 years]; FEV1, 41% predicted [SD, 18.5%]). The active group (n = 36) took part in a 6week program of education (2 h weekly) and exercise (1 h weekly). The control group (n
= 29) were reviewed routinely as medical outpatients. A 6-week outpatient-based
program significantly improved quality of life in patients with moderate-to-severe
COPD.19
2. Literature related to prevalence of COPD
Ana Maria B Menezes, (2002), conducted a study to assess the prevalence of
COPD in five Latin American cities (the PLATINO study). The aim of the PLATINO
study, launched in 2002, was to describe the epidemiology of COPD in five major Latin
American cities: São Paulo (Brazil), Santiago (Chile), Mexico City (Mexico),
Montevideo (Uruguay), and Caracas (Venezuela). A two-stage sampling strategy was
used in the five areas to obtain probability samples of adults aged 40 years or older.
These individuals were invited to answer a questionnaire and undergo anthropometry,
followed by prebronchodilator and postbronchodilator spirometry. These results suggest
14
that COPD is a greater health problem in Latin America than previously realised. Altitude
may explain part of the difference in prevalence. Given the high rates of tobacco use in
the region, increasing public awareness of the burden of COPD is important.20
A Sonia Buist, (2007) conducted a study to assess the International variation in
the prevalence of COPD (The BOLD Study). The objective of the study is to measure the
prevalence of COPD and its risk factors and investigate variation across countries by age,
sex, and smoking status. Participants from 12 sites (n=9425) completed post
bronchodilator spirometry testing plus questionnaires about respiratory symptoms, health
status, and exposure to COPD risk factors. This worldwide study showed the prevalence
of stage II or higher COPD was 10·1% (SE 4·8) overall, 11·8% (7·9) for men, and 8·5%
(5·8) for women. The ORs for 10-year age increments were much the same across sites
and for women and men. The overall pooled estimate was 1·94 (95% CI 1·80–2·10) per
10-year increment. Site-specific pack-year ORs varied significantly in women (pooled
OR=1·28, 95% CI 1·15–1·42, p=0·012), but not in men (1·16, 1·12–1·21, p=0·743).21
R. J. Halbert, (2003), conducted a study to assess the prevalence of COPD. The
objective of the study was to summarize the available data on COPD prevalence and
assess reasons for conflicting prevalence estimates in the published literature. Thirty-two
sources of COPD prevalence rates, representing 17 countries and eight World Health
Organization-classified regions, were identified and reviewed. There is considerable
variation in the reported prevalence of COPD. The overall prevalence in adults appears to
lie between 4% and 10% in countries where it has been rigorously measured.22
David M Mannino, (2007), conducted a study to assess the Global burden of
COPD: risk factors, prevalence, and future trends. The objective of the study is to
15
evaluate risk factor, prevalence and trends of COPD. Prevalence estimates of the disorder
show considerable variability across populations, suggesting that risk factors can affect
populations differently. Other advances in our understanding of COPD are increased
recognition of the importance of comorbid disease, identification of different COPD
phenotypes, and understanding how factors other than lung function affect outcome in
our patients. The challenge we will all face in the next few years will be implementation
of cost-effective prevention and management strategies to stem the tide of this disease
and its cost.23
Victor Sobradillo, (2000), conducted a study to assess the Geographic Variations
in Prevalence and Underdiagnosed of COPD. The objective of the study is to ascertain
the prevalence, diagnostic level, and treatment of COPD in Spain through a multicenter
study comprising seven different geographic areas. A total of 4,035 men and women (age
range, 40 to 69 years) who were randomly selected from a target population of 236,412
subjects participated in the study. The result showed that COPD is a very frequent disease
in Spain, and presents significant geographic variations and a very low level of previous
diagnosis and treatment, even in the most advanced cases.24
Andrés Caballero, (2007), conducted a study to assess the Prevalence of COPD
in Five Colombian Cities. This study aimed to investigate COPD prevalence in five
Colombian cities and measure the association between COPD and altitude. A crosssectional design and a random, multistage, cluster-sampling strategy were used to provide
representative samples of adults aged ≥ 40 years. The study concluded that COPD is an
important health burden in Colombia. Additional studies are needed to establish the real
influence of altitude on COPD prevalence.25
16
3. Literature related to effectiveness of structured teaching programme on
rehabilitation of COPD.
Anna Migliore Norweg, (2005), conducted a study to assess the effectiveness of
teaching programme on pulmonary rehabilitation. The objective of the study is to assess
the short-term and long-term effects of pulmonary rehabilitation on quality of life. They
selected Forty-three outpatients with COPD. Patients were randomized to one of three
treatment groups: exercise training alone, exercise training plus activity training, and
exercise training plus a lecture series. The mean treatment period was 10 weeks. The
study concluded that teaching programme with exercise training was effective in
improving the knowledge of pulmonary rehabilitation among patient with COPD.26
Y. Dhein, (2004), conducted a study on education programme can modify the
behavior in the management of COPD. The active participation of COPD-patients in the
management of their disease may reduce the burden of the disease. Self-management of
chronic obstructive pulmonary disease (COPD) includes sufficient coping behaviour,
compliance with inhaled medication, attention to changes in the severity of the disease,
adequate inhalation technique, and self-adjustment of the medication in case of
exacerbations. In contrast to the conflicting results of the current literature, the evaluation
of our structured education programme for patients with mild to moderate COPD
revealed a significant improvement of inhalation technique and self-control of the disease
as well as a significant reduction of exacerbations. Therefore, it may be concluded that
education may modify the behavior of patients in the management of COPD by
improving self-control and self-management of the disease and thus reducing
morbidity.27
17
Dr. P Sudre, (2009), conducted a study to assess the effectiveness of teaching
programme on rehabilitation in COPD. The objectives of this paper are to describe
COPD education programmes and assess their variability.
This study concluded
that Insufficient documentation of COPD education programmes for adults precludes
their replication. This, together with excessive variability, reduces the possibility of
identifying their most effective components. A more systematic description of asthma
training programmes should be promoted.28
Frode Gallefoss, (2004), conducted a study to assess The effects of patient
education in COPD in a 1-year follow-up randomized, controlled trial. The objectives
were to explore the effects and health economic consequences of patient education in
patients with COPD in a 12-month follow-up. Sixty-two patients with mild to moderate
Chronic Obstructive Pulmonary Disease. The intervention group participated in a 4 h
group patient education, followed by one to two individual nurse- and physiotherapistsessions. Self-management was emphasized following a stepwise treatment plan.
Effectiveness was expressed in terms of number of general practitioner (GP)
consultations, proportions in need of GP consultations, utilization of rescue medication
and patient satisfaction. This study concluded that Patient education reduced the need for
GP visits with 85% (from 3.4 to 0.5, P<0.001) and kept a greater proportion independent
of their GP during the 12-month follow-up, compared with no education (73% versus
15%, respectively). Patient education reduced the need for reliever medication from 290
to 125 Defined Daily Dosages (DDD), and improved patient satisfaction with overall
handling of their disease at GP.29
18
E. Crisafulli, (2010), conducted Learning impact of education during Pulmonary
Rehabilitation program. An observational short-term cohort study. The learning effect
was prospectively evaluated by a specific questionnaire (ESQ) in 285 COPD patients
(age 69±8 years, FEV1 53±14 % pred), then grouped into those who have completed
(ES) Educational Session(Completers group, n=226) or who did not (mean 2±1 ES)
(Control group, n=59). This study showed that Attending educational sessions produces a
specific short-term learning effect during rehabilitation of COPD patients.30
Claus Runge, (2006), conducted a study to assess the effectiveness of WebBased Patient Education Program for COPD Children and Adolescents. The objective of
the study is to determined whether a continuous Internet-based education program (IEP)
as an add-on to a standardized patient management program (SPMP) improves health
outcomes of COPD patients. A total of 438 asthmatic patients aged 8 to 16 years in 36
study centers were enrolled during a 6-month period. Study participants were assigned to
a control group and two intervention groups. Patients in both intervention groups
participated in an SPMP. Additionally, patients in one intervention group received the
IEP. This study concluded that the web-based patient education helped them to improve
the health status of patient with COPD.31
19
6.3(A) STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of structured teaching programme on
knowledge regarding pulmonary rehabilitation among patient with Chronic Obstructive
Pulmonary Disease in selected hospitals at Bangalore.
6.4(B) OBJECTIVES OF THE STUDY
 To assess the pre-test knowledge on pulmonary rehabilitation among patient with
chronic obstructive pulmonary disease
 To
evaluate
the
structured
teaching
programme
regarding
pulmonary
rehabilitation among patient with chronic obstructive pulmonary disease.
 To find out association between knowledge of pulmonary rehabilitation and
selected demographic variables.
6.5(C )OPERATIONAL DEFINITION
Effectiveness:
It refers to the extent to which the teaching programme had brought about the
result intended and measured in terms of significant knowledge gained in posttest.
Structured Teaching Programme
The arrangement and relation between the parts or element, something complex
It refers to the systematically developed and designed information to teach pulmonary
rehabilitation.
Knowledge:
Facts, information and skills acquired by a person through experience (or)
education
20
Pulmonary Rehabilitation
It is the process of restoring the patient with chronic obstructive pulmonary
disease.
6.6(D) RESEARCH HYPOTHESIS
H1: There is significant difference between pre-test and post test knowledge of
pulmonary rehabilitation.
H2: There is a significant association between knowledge of pulmonary rehabilitation
with selected demographic variables.
6.7(E) LIMITATION
 The study was limited to 6 weeks period only
 The study was not generalized
 The study was conducted in selected hospital only.
6.8 ASSUMPTIONS
 Patient have inadequate knowledge on pulmonary rehabilitation measures
 Structured teaching programme will enhance the knowledge of new patient on
pulmonary rehabilitation.
 This will help them to apply the knowledge in life
21
7. MATERIALS AND METHODS
This chapter gives a description of the research approach, research design,
variables, the setting of the study, population, sampling, research tool, methods of data
collection and plan for data analysis.
7.1 Sources of data
Data will be collected from patient with Chronic Obstructive Pulmonary Disease
admitted in selected hospitals at Bangalore.
7.2 Methods of data collection
I.
Research design
Quasi experimental method
II.
Research approach
Pre-test Post-test approach.
III.
Research variables
a. Independent variables
Independent variables are the variable that stand alive and is not dependent on any
other variables Structure teaching programme regarding pulmonary rehabilitation for
chronic obstructive pulmonary disease
b. Dependent variables
In this study the dependent variable refers to knowledge of pulmonary rehabilitation
of patient with chronic obstructive pulmonary disease.
c. Demographic variables
Characteristics of mothers such as Age, educational status, socioeconomic status
and income.
22
IV.
Setting
Study is planned to conduct in selected hospitals at Bangalore.
V.
Population
The patient with Chronic Obstructive Pulmonary Disease admitted in selected
hospitals at Bangalore
VI.
Sample
The patient with Chronic Obstructive Pulmonary Disease admitted in selected
hospitals at Bangalore. For pilot study sample size will be 6. For main study the sample
size will be 60.
VII.
criteria for sample selection
a) Inclusion criteria
 Patient with Chronic Obstructive Pulmonary Disease admitted in select hospitals
at Bangalore.
 Patient with Chronic Obstructive Pulmonary Disease who can communicate
freely in Kannada or English.
b) Exclusion criteria
 Patient who are not willing to participate in the study
 The patient who are under processes of diagnosis.
 The patient who are under the age of 15 years
VIII.
Sampling Technique
Non probability convenience sampling technique.
IX.
Tool for data collection
The structured questionnaire schedule consists of following sections.
23
SECTION I
Demographic Data
It includes items for obtaining information regarding age, sex, marital status,
occupation, income, education, duration of illness for pulmonary rehabilitation for
chronic obstructive pulmonary disease.
SECTION II
Structured Questions on knowledge on Pulmonary Rehabilitation for Chronic
Obstructive Pulmonary Disease.
X.
Methods of data collection
After obtaining permission from concerned authority an informed consent from
samples, the researcher will collect data from samples.
Phase 1
Pretest will be conducted to assess knowledge of patients with COPD on
Pulmonary Rehabilitation by using a self administered questionnaire.
Phase 2
STP on Pulmonary Rehabilitation will be administered to the patients with COPD
Phase 3
After 1 week post test will be administered to assess the level of knowledge on
Pulmonary Rehabilitation to the same subject with the help of same questionnaire.
Duration of the study will be 4 weeks.
XI.
Plan for data analysis
The data will be analyzed by means of descriptive and inferential statistics.
24
a) Descriptive statistics
Mean, median, mode, standard deviation, percentage distribution, will be used to
assess he knowledge of patients on Pulmonary Rehabilitation.
b) Inferential statistics
Chi-square test will be used to associate knowledge of patients with selected
demographic variables.
XII.
Projected outcomes
After the study, the investigator will able to know the knowledge of patients with
COPD on Pulmonary Rehabilitation, based on the findings STP will be administered to
the patients. It will help them to practice pulmonary rehabilitation to reduce the effect of
COPD.
7.3 Does the study requires any investigation or intervention to the patient or other
human being or animal ?
No
7.4 Has ethical clearance been obtained from the concerned authority to conduct the
study ?
Yes
a)
Permission will be obtained from the Director of In selected hospitals at
Bangalore.
b)
Informed consent will be obtained from the patient with Chronic Obstructive
Pulmonary Disease admitted In selected hospitals at Bangalore.” to participate in
the study with their own knowledge.
25
8. LIST OF REFERENCES
1. Brunner and Suddhanths (2004), “Text Book Of Medical Surgical Nursing”,
10th edition, Lippincott Williams and wilkins, Pp.: 416-465.
2.
Craig L, Scanion, Charles B, Spearman, Richard L. Sheldon (1990) “Egan’s
Fundamentals of Respiratory Care” (6thedition) North Calefornia. Mosby
Company. .Pp: 21-45
3. David H.E, Roger C & Bone, (1995) “Comprehensive Respiratory Care, A
learning System” The 856 illustration, U.S.A. The Vc Mosby company.
4. Dr. David Bellary, (2004), “COPD Primary care”, 3rd edition, British Library,
Pp: 220-235
5. Hodgkin E.J. Celli, R.B. Connors L.G., (2000) “Pulmonary Rehabilitation
Guide lines to success” (3redition,)Philadelphia; Lippincott Willians & Wilkins
company.Pp;34-48 Hodgkin J.E, Connors G L & Bell C.W. (1993) “Pulmonary
Rehabilitation guidelines to success” (2ndedition,) Philadelphia Lippincott
company. 86
6. James, (2005), “Principles of exercise testing”, 4th edition, Library of congress
cataloging, Pp: 585, 230.
7.
JOCE M. BLACK, (2005), “Medical Surgical Nursing”, 7th edition, Elsevier
publications, India Pp: 1691-1704.
8. John.R., (1996), “Pulmonary Rehabilitation”, 1st edition, Philadelphia Mosby
Company, Pp: 173.
9.
Kothari.C.R., (2002), “Research Methodology methods and technique”, 3rd
edition, K.K. Gupta of Newage International (P) Ltd Publication, Pp: 277-299.
26
10. Krausel, (2000), “Food, nutrition and diet therapy”, W.B.Saunders company
Publisher, Pp:815-832.
11. Lewis, S.M. Heit Kemper M.L. & Derikson, S.R. (2000) “Medical Surgical
Nursing, Assessment and Management of Clinical problems” ( 5th edition)
Philadelphia Mosby Company.
12. Madama C & Viincnet (1998) “Pulmonary Function Testing and Cardio
Pulmonary stress testing”, (2nd. edition,) Washington : Thomson publishing
company.Pp 845-856
13. Evans RA (2009), The Effectiveness of Incentive Spirometer and Deep Breathing
exercises in improving Pulmonary function. The Indian Journal of Nursing and
Midwifery 1 (1) 57 - 59.
14. Hartl S (2009), Exercise and Chronic Obstructive Pulmonary Disease Modest
fitness gains Canadian Medical Association Journal 25 (11) 122 - 127.
15. Martino F (2009), “Exercise Limitation in Patients with COPD”, Journal of
Respiration, Volume: 14 (5), Page No: 23-26
16. Troosters T (2009), Respiratory muscle edurance Training in Chronic obstructive
pulmonary disease, Impact on exercises capacity Dysponea an quality of life.
American Journal of Critical Care Medicine 162 (5) 1709 - 1714.
17. Weiner P et. al. (1997) The effect of Incentive Spiro meter and Inspriatory Muscle
Training on Pulmonary Function after Lung Resection. Journal of Thoracic
Cardio Vasular Surgery 103 (3) 550 - 557.
18. F. Lötters (2002), European Respiratory Journal, volume: 20, Page No: 570577, http://www.ersj.org.uk/content/20/3/570.short
27
19. James Patrick Finnerty, (2001), Chest Journal, Volume:119, Page No : 17051710, http://chestjournal.chestpubs.org/content/119/6/1705.short
20. Ana Maria B Menezes, (2002), Journal of The Lancet, Volume 366, Pages
1875-1881, http://www.sciencedirect.com/science/article/pii/S0140673605676325
21. A Sonia Buist, (2007), Journal of The Lancet, Volume 370, Pages 741-750,
http://www.sciencedirect.com/science/article/pii/S0140673607613774
22. R. J. Halbert, (2003), chest journal, Volume 123, Pages 1684-1692,
http://chestjournal.chestpubs.org/content/123/5/1684.short
23. David M Mannino, (2007), Journal of The Lancet, Volume 370, Pages 765-773,
http://www.sciencedirect.com/science/article/pii/S0140673607613804
24. Victor Sobradillo, (2000), chest journal, Volume 118, Pages 981-989,
http://chestjournal.chestpubs.org/content/118/4/981.short
25. Andrés Caballero, (2007), chest journal, Volume 133, Pages 343-349,
http://chestjournal.chestpubs.org/content/133/2/343.short
26. Anna Migliore Norweg, (2005), chest journal, Volume 128, Pages 442-443,
http://chestjournal.chestpubs.org/content/128/2/663.short
27. Y. Dhein, (2004), Journal of Patient Education and Counseling, Volume 52, Pages
267-270, http://www.sciencedirect.com/science/article/pii/S0738399103001010
28. Dr P Sudre, (2009),
An International Journal of Respiratory Medicine,
Volume 23, Page No 34-36, http://thorax.bmj.com/content/54/8/681.abstract
29. Frode Gallefoss, (2004), Journal of Patient Education and Counseling,
Volume 52, Pages 38-40,
http://www.sciencedirect.com/science/article/pii/S0738399103001009
28
30. E. Crisafulli, (2010), Journal of Chest Diseases, Volume 43, Pages 224-228,
http://www.archest.fsm.it/pne/pdf/73/02/pne73-2_02_crisafulli.pdf
31. Claus
Runge, (2006),
chest
journal,
Volume
http://chestjournal.chestpubs.org/content/129/3/581.short
73,
Pages
876-879,
29
9. Signature of the candidate
:
10. Remarks of the guide
:
11. Name and designation of
:
11.1 Guide
:
11.2 Signature
:
11.3 Co-guide
:
11.4 Signature
:
11.5 Head of the department
:
11.6 Signature
:
12. Remarks of the Principal
:
12.1 Signature
: