Download 6.6.4. Patients with bronchial asthma

RAJIVGANDHI UNIVERSITY OF THE HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
01
NAME OF THE CANDIDATE AND
ADDRESS
Mr. SABIN VARGHESE
02
NAME OF THE INSTITUTION
DIANA COLLEGE OF NURSING,
BANGALORE
03
COURSE OF THE STUDY AND
SUBJECT
M.Sc. NURSING 1st YEAR
MEDICAL SURGICAL NURSING
04
DATE OF ADMISSION TO COURSE
5.
STATEMENT OF THE PROBLEM
EFFECTIVENESS
OF BREATHING
EXERCISES
AMONG PATIENTS
WITH BRONCHIAL ASTHMA AT
SELECTED
MULTI
SPECIALITY
HOSPITAL, BANGALORE
6. BRIEF RESUME OF INTENDED WORK
6.1. INTRODUCTION:
“He who breathes most air lives most life.”
All living organism needs air for the survival. It’s one of the basic psychological
needs of the human beings. The psychological need of the human body is maintained by
the respiratory system. Our body needs a constant supply of oxygen to support the
metabolic need.
The respiratory system brings oxygen through the airways of the lungs into the
alveoli where it diffuses, into the blood for transport to the tissues. This process is so vital
that difficulty in breathing is experienced as a threat of life itself. (Black 2001)
In developing countries like India air pollution is common due to
industrialization. Air pollution is common causes for the respiratory problems. Chronic
respiratory problems include asthma, chronic bronchitis, emphysema and cystic fibrosis.
Asthma is the most common lung disease for which pulmonary rehabilitation is needed.
(WHO 2000)
Asthma is a chronic inflammation of the airway that causes air way
hyperresponsiveness, mucosal oedema and mucous production. The inflammation
ultimately leads to recurrent episodes of asthma, symptoms of cough, chest tightness,
wheezing and dyspnoea (Brunner and Siddharth 2001)
According to national asthma campaign audit in 1998, there was 1621 deaths due
to asthma and 1, 10,475 hospital admissions for asthma. (Payne 1999)
Pulmonary rehabilitation is effective to improve the respiratory status and reduces
the episodes of asthma attacks. (Acharya 2003)
The beteyko therapy would help to lessen the symptoms of bronchial asthma.
(Holloway 2001)
6.2. NEED FOR THE STUDY:
According to WHO (2000) Incidence of Asthma suffers between 100-150 million
people around globe. Worldwide deaths from conditions have reached over 18,00,00
annually. In India rough estimates indicates prevalence between 10- 15% in 15-11 years
of age children.
Chowgule (1998) conducted a study on prevalence of adult on asthma in Mumbai.
The sample were selected from metropolitan population over 17 million and reported that
the prevalence of asthma was 3.5 by physicians diagnosis and 17% was with the
symptoms of bronchial hyperactivity.
The study was conducted by Vedanthan regarding the therapeutic effect of
Breathing exercise upon asthma in the year 1998. 17 Adults asthmatic patients were
selected between the age group of 19-52 years. Groups random by assigned into two
groups experimental group was taught by breathing exercise and relaxation techniques
for three times per week, for total of 16 weeks. Pulmonary function was evaluated by
spirometry and peak flow meter. It was reported that the breathing exercise improves
exercise tolerance, decreased use of beta-adrenergic inhalers enhanced relaxation and
significant variation in pulmonary function.
Bronchial Asthma is a chronic disease it is very essential for active participation
in its management. Tough medications are used to control the symptoms of bronchial
asthma but it will not give permanent cure. Performing the breathing exercise reduces the
frequent asthma attacks and improves relaxation and pulmonary function.
During investigator’s clinical experience in medical ward he found that the
pulmonary rehabilitation for asthma patients were the neglected aspect of patient care,
which motivated the investigator to do a study on the effectiveness of breathing exercise
on respiratory status of patient with bronchial asthma.
6.3. STATEMENT OF PROBLEM:
“THE EFFECTIVENESS OF BREATHING EXERCISE ON RESPIRATORY STATUS
OF PATIENT WITH BRONCHIAL ASTHMA WILL BE CARRIED OUT IN KTG
MULTISPECIALTY HOSPITAL, BANGLORE, KARNATAKA.’
6.4. OBJECTIVES:
1. To assess the respiratory status of the patients with bronchial asthma in
experimental and control group.
2. To provide breathing exercise to bronchial asthma patients
3. To reassess the respiratory status of patients with bronchial asthma
4. To compare the post- test respiratory status of the patients with bronchial asthma
between experimental and control group.
5. To associate the respiratory status of the patients with bronchial asthma with
selected demographic variables.
6.5. HYPOTHESIS:
6.5.1. Null hypothesis:
The Deep Breathing exercises have no significant effect in improving the respiratory
status of patients with bronchial asthma.
6.5.2. Alternate hypothesis:
The Deep Breathing exercises have significant effect in improving the respiratory status
of patients with bronchial asthma.
6.6. OPERATIONAL DEFINITIONS:
6.6.1. Effectiveness:
It refers the desired change in the respiratory status of the patients with bronchial asthma
as a result of breathing exercise.
6.6.2. Breathing exercise:
It is work out to the muscle of respiration to improve the gas exchange and oxygenation.
It includes Diaphragmatic Breathing exercises, Pursed Lip Breathing exercise and
Respiratory muscles exercises.
6.6.3. Respiratory status:
Respiratory status denotes the condition of the respiratory system, it is assessed by using
respiratory parameters such as maximum inspiratory reserve volume, peak expiratory
flow rate, chest expansion, breathe holding time, respiratory rate and oxygen saturation.
6.6.4. Patients with bronchial asthma:
The individual who is diagnose to have bronchial asthma and coming to the hospital as
inpatient and outpatient.
6.7. ASSUMPTIONS:
1.
Breathing exercises improve the respiratory status.
2.
Breathing exercises increases muscle strength and endurance.
6.8. CONCEPTUAL FRAMEWORK:
A concept is an abstract idea or a mental image of phenomenon or reality. (Kogier
1987). Conceptualization is a process of forming ideas, which utilized and forms
conceptual framework for development of research design. (Charter 1975)
A framework is basic model structure supporting anything, a conceptual
framework and model is a basic structure or outline of abstract ideas or images that
represent reality. (Kogier 1997)
Conceptual framework is group of mental images or concepts that are related but
the relationship is not explicit. Polit and Hungler (1989)
The conceptual framework for the study is based on Von Bertalantty (1968) the
general system theory .A system consists of a set of interacting components with in a
boundary that filters the type and rate of exchange with the environment. All living
systems are open in and then there is a continual exchange of matters, energy and
information. In open system there are varying degrees of interactions with the
environment from which the system receives input and gives back output in the form of
matter, energy and information.
The present study aims at assessing the effectiveness of breathing exercises on
respiratory status of patients with bronchial asthma.
6.8.1. Input:
Input consists of characteristics and conditions of the patients .In this study input
refers to demographic variables like age, sex, education, occupation, personel history,
intake of medications, family history and assessment of respiratory status by respiratory
parameters such as maximum reserve volume, peak expiratory flow rate, chest expansion,
breath holding time, respiratory rate and oxygen saturation.
6.8.2. Process:
Process refers to the live demonstrations of exercises such as diaphragmatic
breathing, pursed lip breathing and respiratory muscle exercise- inspiratory muscle
exercise with the help of audio-visual aids (CD).
6.8.3. Output:
In this study out put refers to attaining the normal respiratory status and it si
measured by the respiratory parameters
6.8.4. Feedback:
The feedback is the process where by the output of the system is re directed as
part of the input of the same system. If there is no improvement in the respiratory status,
the condition is re assessed and redirected and the process is continued. Thus it is a
continuous process, which takes place in the system.
Through put
Input
Output
Breathing
Demographic
data
Assessment of
Respiratory
status by
parameters
Improve
Exercise
Diaphr
Pursed
gmatic
Lip
Breathing Breathing
Effectiveness
in
Respiratory
Status
Respiratory muscle
exercise
Inspiratory
Expiratory
Feed back
Figure. 1. Conceptual framework based on general system theory
Vonbertalathy, 1968
No
Improve
7. REVIEW OF LITERATURE
Bronchial asthma is a common condition occurring at all ages. The most research
suggests that one of the main features of asthma is bronchial hyper activity. It cannot be
cured but could be controlled by avoiding the contact with allergens.
Review of literature is discussed under following headings:
1.
Literature related to Bronchial asthma and its effects
2.
Literature related to Effect of breathing exercise in bronchial asthma
3.
Literature related to Breathing exercise and it s respiratory effectiveness.
7.1. Literature related to bronchial asthma and its effect:
Asthma has been recognized as a disease. Since the time of Hippocrates and yet
remains a frightening and potentially dangerous condition. Every year 2000 people die
from Asthma. It could be avoided by better recognition, better management, patient
education and prompt treatment of emergency condition (Barnes 1998)
Carrol (2001) stated that Asthma is a restrictive airway disease. It is a complex
disorder involving Biochemical, Immunological, Endocrine infections, Autonomic and
psychological factors.
According to national health survey conducted in 1998 there has been rapid
increase in asthma in recent years in many parts of the world. India 2,468/1,00,000
persons were suffering from asthma. It is high in males than in females. Age are marked
between 14-60 years.
According to WHO (2000) asthma cannot be cured but could be controlled. The
strongest allergens like pet animals, cockroaches and those who have family history of
allergy should avoid contact with allergens.
Bronchial asthma causes recurrent episodes of breathing, breathlessness, chest
tightness and cough at night, in early morning associated with an increase in existing
hyper responsiveness to variety of stimuli. (Berry 2001)
Allergic
Bronchitic
Asthma
is
characterized
by airway inflammation,
development of airway hyperactivity and recurrent airway obstruction caused by the
immune response. (Renz 2002)
The diagnosis asthma includes the history of the patient, spirometric lung function
test; chest X-ray, Blood count occasionally and the peak flow rate is valuable tool in the
objective self-assessment of asthma. (Ashok 2000)
Gyorik and Brutsche 2004 published the alternative medicine in bronchial asthma
studies, which do not support the Homeopathy, Manual Therapy and Acupuncture for
Asthma. Breathing exercise could improve lung functional quality of life in different
study.
Mc Allister 2002 stated that functional impairment often leads to hypercapnic
respiratory fatigue.
7.2 Literature related to breathing exercise and bronchial asthma:
Breathing exercise includes techniques to improve ventilation and oxygenation.
This is deep breathing and coughing exercise, pursed lip breathing, diaphragmatic
breathing and respiratory muscle training.
Russian Prof. Konstantin Buteyko designed breathing techniques in the year 1985
of the asthmatic sufferers. He has insisted that incorrect breathing is the cause of
breathing problem.
Mc Kesson 2005 explained that breathing exercise helps to make use of entire
lung and chest muscle activity, they allow to get more oxygen with each breaths and to
breathe with less effort.
Kisher 1996 stated that breathing exercise are designed to relaxing the muscles of
respiration and to improve the gas exchange and oxygenation.
Hodgkins 1997 emphasis that exercise has merged has primary modality for
improving quality of life for chronic obstructive disease patients.
7.3. Literature related to Breathing exercises and Respiratory effectiveness:
Curge 1995 compared the effects of Breathing exercises or Yoga on the course of
bronchial asthma. They selected 36 subjects with mild disease; three groups randomly
signed patients. At the end of the training lung functions are assessed, there was a
significant improvement in FEV, PEFR, PIFR and Vital Capacity.
Cathelene (1998) described the need for pulmonary function test for asthmatic
patients. She was randomly assigned two groups (30 in each) Respiratory training gives
to experimental group. In experimental group 45% fast improvement was achieved than
control group. Experimental group used limited medications than control group.
Conner 2003 conducted a study about spirometry has become the most widely used
assessment and pulmonary function for diagnostic purposes. The articles reviews
indication of spirometry in persons who have asthma and the parameter measured which
is interpreted to evaluate the person with asthma.
8. METHODOLOGY:
The chapter includes research approaches, research design and setting of the study.
Sample size and sampling technique also includes the development of tools, pilot study,
data collection procedure and plan for data analysis.
8.1. Research Approach:
Experimental approach is the subtype of qualitative approach was used for the
present study. Quasi – experiment involved the manipulation of independent variable that
is the institution of the intervention. The study was aimed at evaluating the effectiveness
of breathing exercise on respiratory status of patient with bronchial asthma.
8.2. Research Design:
The research design adopted for this study was known equivalent control group. Pretest,
Posttest design was adopted for assessing the respiratory status before and after the
breathing exercise.
E
Q1
C
Q1
X
Q2
Q2
where,
E - experimental group
C - control group
Q1 - Assessment of respiratory status by using respiratory parameters before intervention
of breathing exercise.
Q2 - Assessment of respiratory status by using respiratory parameters after intervention of
breathing exercise.
X- Intervention (Demonstration of Breathing exercise)
8.3. Setting of Study:
The study was conducted at K.T.G Hospital. It is 150 bedded multispecialty
hospital. The hospital was well equipped with inpatient and outpatient unit. On an
average 30-40 patients attend out- patient department daily.
8.4. Population:
The population of the study includes the patient diagnosed as bronchial asthma in K.T.G.
Hopital during data collection period of 4 weeks.
8.5. Sample size:
The selected sample size was 40, out of which the first 20 patients were considered as
control group and rest 20 patients as experimental groups.
8.6. Sampling techniques:
Non- probability purposive technique was used for selecting samples. The investigator
got information of samples and the samples met the inclusion criteria, and it included for
the study. The first 20 are considered as control group and rest 20 are considered as
experimental group.
8 .7 Selection Criteria:
Inclusion criteria:
1. Patient who were between the age group of 20 – 60 years.
2. Both male and female with bronchial asthma.
3. Patients who are willing to participate.
4. Patients who knows language either Kannada or English.
Exclusion criteria:
1. Patients with status asthmaticus.
2. Patients with perceptual disorders.
3. Patients who discontinues the exercise.
8.8. Pilot study:
The pilot study was conducted to find whether the tool was capable of eliciting
the responses from the patients, whether they had any difficulty in following the
procedures of the instructions, the feasibility of study and to estimate the time required
for administering.
It was conducted among four patients for a period of one week, two patients each
for a control group and for experimental group. After pilot study no changes were made.
The result of the pilot study found that the tool was capable of assessing the effectiveness
of breathing exercise on respiratory status on patients with bronchial asthma at an
average time of 30 minutes. Finally it proved that the study was feasible.
8.9. Data Collection Procedure:
Formal permission was obtained from the Managing Director of the Hospital to
conduct the study.
The sample were selected on the basis of selection criteria and explained about
the breathing exercise to get their cooperation. Each patient was instructed about how to
perform the exercise. 40 samples were selected and assigned to control group and
experimental group (20 in each) after the general instruction the investigation collected
demographic data.
The patient in control and experimental group were assessed for the respiratory
status before administering the intervention. Then the experimental group underwent the
teaching program of breathing exercise by the help of audio- visual aids. After this
session the pamphlets are given to the patients. The patients were requested to practice
the exercise daily two times for seven days. After seven days both group were assessed
for the respiratory status.
8.10. Plan for data analysis:
The investigator adopted the descriptive and interventional statistics to analyze
the data. The demographic variables were analysed by using frequency and percentage.
The effectiveness of breathing exercise were analysed by using student and test
9. BIBLIOGRAPHY:
9.1. Books:
1. Basavanthappa.B.T (2003), Medical Surgical Nursing (1st edition) New Delhi; JP
Brothers Medical Publishers.
2. Beare and Myres (1998), Adult Health Nursing (3rd edition) Philadelphia; Mosby
Company.
3. Black J.M and Jacobs. EM (1997), Medical Surgical Nursing, Clinical
Management of Continuity care (5th edition) Philadelphia; WB Saunders
Company.
4. Golwalla (1994) Medicine for students (16th edition) Bombay. S.V Limaye, India
Printing House.
5. Gupta S.P., (2004), Statistical Method (32nd edition) New Delhi; Sulthanchand
and Sons education Publishers.
6. Pilot DF and Hungler, BP (1999) Nursing Research – Principles and Method
(6th edition) Philadelphia; Lippincort.
7. Thompsons. A and Alison (1995) Tidy’s Physiotherapy (12th edition) Mumbai;
Varghese Publishing House.
8. Wyn Garden J.B; Smith, LH and Bennett JC (1992) Cecil Textbook of Medicine
(19th edition) Philadelphia; WB Saunders Company.
9.2. Journals:
1. Acharya SM (2003) Asthma not a disease; Just weakness of the body; Health
Action; Vol 16; Pg: 4
2. Ashok K (2000) The Diagnosis of Asthma; Department Chest Disease at Govt.
Medical College and Hospital; Sector 32; Chandigarh, India.
3. Karoro (2000) A study to investigate the effectiveness of pulmonary program for
asthma patients, www.bmn.com
4. K Smith Sins (2001) Hospital Acquired Respiratory tract infection; American
Journal of Nursing; Vol 101; No.1
5. Khanam (1996) Effectiveness of Yoga training to investigate the pulmonary
function improvement. www.bmn.com
6. Kisher (1996) Bronchial Asthma; Nursing times; 21 (8); Pg:78-81
10
Signature of the candidate
11
Remarks of the guide
Found suitable
12
Name and designation
13.1
Guide
13.2
Signature
13.3
Head of the Department
13.4
Signature
14
Remarks of the Principal
14.1
Signature
Prof. Vasantha Chitra
Head of the Department
Medical Surgical Nursing
Prof. Vasantha Chitra
Head of the Department
Medical Surgical Nursing
The study is significant and
relevant.