Download 6.1 Need for Study - Rajiv Gandhi University of Health Sciences

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR THE REGISTRATION OF
SUBJECTS FOR DISSERTATION
SUBMITTED BY:
Mr. BALU G KRISHNAN
I YEAR M.Sc. NURSING
MEDICAL SURGICAL
[2011-2013 BATCH
VARALAKSHMI COLLEGE OF NURSING
NO: 19, KIADB ROAD, CHOKKASANDRA,
T. DASARAHALLI, BANGALORE- 57.
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF
SUBJECTS FOR DISSERTATION.
1
NAME OF THE Mr. BALU G KRISHNAN
CANDIDATE
I ST YEAR M.Sc. NURSING,
AND ADDRESS
VARALAKSHMI COLLEGE OF
NURSING,
NO:19,KIADB ROAD,
CHOKKASANDRA,
T.DASARAHALLI, BANGALORE-57.
2
NAME OF THE
VARALAKSHMI COLLEGE OF
INSTITUTION
NURSING,
NO:19,KIADB ROAD,
CHOKKASANDRA,
T.DASARAHALLI, BANGALORE-57.
3
COURSE OF
M.Sc. NURSING, MEDICAL SURGICAL
THE STUDY
NURSING.
AND SUBJECT
4
DATE OF
ADMISSION OF
15/06/2011
COURSE
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TITLE OF THE
STRUCTURED TEACHING
STUDY
PROGRAMME REGARDING GLOBAL
WARMING AND ITS IMPACT ON
HEALTH.
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6.0 BRIEF RESUME OF THE INTENDED WORK.
INTRODUCTION
“A warmer world already seems to be producing a sicker world; climate affects some of
most important disease affecting the world”
Dairymaid Campell
Global warming is one of the most discussed topics in present world. Global
warming is increasing day by day because of the changing climate and malpractices
against the environment. Global warming causes more deaths in summer because of high
temperature, and also chance for spread of communicable disease and viral infections.
Global warming cause more deaths in summer because of high temperature but these will
not be offset by fewer deaths in milder winters finds an analysis published online ahead
of print in occupational and environment medicine. The world is spinning in a vicious
cycle of demand and supply that is both the cause and effect of global warming. If
situation continues, health hazards will increases.1
Global warming is all about adverse climate change caused by trapping of green
house gases (CO2) in the earth atmosphere that affects biodiversity and causes a serious
health hazards. Counter measures to facilitate living in hotter temperature like air
conditioning and refrigeration will unfortunately consume more electricity from power
plants that burn coal, releasing CO2 .This will further spike global warming and have a
seriously damaging influence on human health. External forces refer to processes external
to the climate system that influence climate. Climate responds to several types of external
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forcing, such as radiative forcing due to changes in atmospheric composition; change in
solar luminosity, volcanic eruption and variation in earth’s orbit around sun2.
The greenhouse effect is the process by which absorption and emission of infrared
radiation by gases occurs in atmosphere and surface. It was proposed by Joseph Fourier
in 1824 and was first investigated quantitatively by Svante Arrhenius in 1896. Naturally
occurring amounts of green house gases have a mean warming effect of about 330C.The
major greenhouse gases are water vapor, which causes about 36 to 70% of the green
house effect; CO2 which causes 9-26% , methane (CH4) which causes 4-9% and
Ozone(O3) which causes 3-7% of greenhouse effect.Cloud also effect the radiation
balance, through cloud forcing similar to green house gases. Human activity since the
industrial revolution has increased the amount of green house gases in atmosphere
leading to increased radiative forces from CO2, Methane, trophospheric ozone ,CFCs and
Nitrous oxide. The concentration of CO2 and Methane have increased by 56% and 148%
respectively since 1750.These values are much higher than at any time during the last
800000 years, the period of which reliable data have been extracted from ice cores. The
fossil fuel burning has produced about three quarters of increase in CO2 from human
activity over the past 20 years.
The rest of this increase is caused mostly by change in land use, particularly
deforestation. 20% of the global warming is caused by deforestation. When trees breathe
in CO2 from the air, trees absorb and sequester carbon and they slowly exhale oxygen
that all animals breathe. So when trees are killed, either chopped down for wood or
burned for land, the carbon in the trees is released back into the atmosphere. The loss of
entire forest for these purposes is called deforestation. Having too much carbon in the
atmosphere has been proved by most scientists and researchers to cause global warming.2
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By the end of this century according to TIME magazine sea level could rise by
more than four feet .This means that in less than 100 years the global warming will most
likely result in most of the coastal cities in the world to be significantly under water.
6.1 Need for Study
Global warming is one of the most discussed topic in present world. Global
warming is increasing day by day because of the changing climate and human
malpractices against the environment. Global warming will cause more deaths in summer
because of high temperature and also chance for spread of communicable diseases and
viral infections. Global warming controversially refers to a variety of disputes,
significantly more pronounced in the popular media than in the scientific literature,
regarding the nature, causes and consequences of global warming. The disputed issues
involve the cause of increased global average air temperature, especially since the mid
20th century, whether such a warming trend is unprecedented or within normal climate
variations. Whether mankind has contributed significantly to it, and whether the increase
is wholly or partially an artifact of poor measurements.3
There are to be various long term effects of global warming expected. Most
discussion and research including that by the inter governmental panel on climate change
(IPCC) reports, concentrate on the effects of global warming up to 2010, with only an
outline of the effects beyond this. The long term effects happen over thousands, not
hundreds of years. Early work with a simplified model suggested that the global warming
could cause a shutdown of thermohaline circulation. This effect is not replicated in more
sophisticated couple ocean atmosphere, global climate models which do not shut down
but do display varying degrees of slow down. This may take a considerable time to occur,
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as Knutti and Stocker found, again from a simplified model when “thermohaline
shutdown can occur thousands of years after the warming has stopped”.4 Another long
term effect is ocean anoxia. One study suggests that the amount of oxygen dissolved in
the oceans may decline, with adverse consequences of ocean life. This effects were
determined a model run of 100000 years. The clathrate decomposition also called
methane hydrate, is a form of water ice that contains a large amount of methane within its
crystal structure. Extremely large deposits of methane death rate have been found under
sediments on ocean floor of earth.5
One of the short term effects of global warming is sun stroke. It is a life
threatening condition caused by over exposure to extreme heat. Sun stroke some times
called heat stroke, occurs when the bodies heat control system fails and it cannot lose the
excessive heat. High temperature can causes the bodies major organ to fail. There are a
large Varity of symptoms presented with the onset of sun stroke. In the early stage the
skin will become both hot and dry. Sweating usually stops, and breathing becomes rapid
enough to bring an hypertension. The body temperature along with the pulse begins to
rise rapidly. Other symptom includes muscle cramps and head aches. There may also be
some mental and verbal confusion, speech may be unintelligible or incoherent and violent
behavior may appear.6
The causes of sun stroke are usually lengthy exposure to high temperature.
Sunstroke can also be caused by heat exhaustion to people who work outside and people
who exercise for long period of time without proper fluid intakes .Global warming may
have chance to lead hyperthermia increasing body heat. Global warming also cause
disease conditions like malaria and dengue fever.
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In Kenya, Research shows that even a seemingly small rise in temperature can
produce a 10 fold increase in mosquitoes’ populations. Solomon M Nzioka a Kenyan
health ministry consultant said that “High malaria seems to be on the increase in the rainy
season and when temperature is high”. Global warming is not only a threat to our
future health but it also contributes to more than 150000 deaths and 5 million illness
annually according the
team of health and climate scientists at the World Health
Organization and the University of Wisconsin at Madison, and those numbers could
double at 2030.The research data published in the journal nature shows that global
warming may affect human health in surprising number of ways; spreading of infectious
disease such as malaria and dengue fever become more faster; creating conditions that
leads to potentially fatal malnutrition and diarrhea and increasing the likelihood of heat
waves and floods. According to scientists the data shows that global warming affect
different region in very different ways. Global warming particularly hard on the people in
poor countries, which is ironic because that have contributed the least to global warming
are most vulnerable to death and disease higher temperature can bring.
“Those least able to cope and least responsible for the green house gases that
causes global warming are most affected”, said lead author Jonathan Pats, a professor at
UW, Madison Gaylord Nelson Institute of Environmental Studies.”Many of the most
important diseases in poor countries, from malaria to diarrhea, malnutrition are highly
sensitive to climate” said co-author Diarmid Campell-Lendrum of WHO. The health
sector is already struggling to control these disease and climate changes threatens to
undermine these efforts.
Global warming also increases the chance of air pollution. Higher temperature,
increases ozone concentrations, the major component of “smog” changing weather
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pattern may also result premature mortality and cardio pulmonary diseases. Ozone is a
particular concern because of its association with the following even for short exposure,
they are air way irritation, coughing, reduction in lung function, aggravation of asthma
and worsening of emphysema and bronchitis. Prolonged exposure may lead to permanent
structural and cellular damage to the respiratory tract. Airborne allergy may also be
significantly influenced by climate change, for example it has shown pollen counts rise
with increasing temperature. High level of CO2 and warmer temperatures increases pollen
production of allergy, such as ragweed worsening seasonal allergies and asthma. Global
warming increases risk for infectious disease. The many organisms that cannot regulate
their own body temperature such as insects, bacteria, viruses and parasites will develop
more quickly with warmer temperature and over milder winter. As global climate change
extends warm weather seasons. Many diseases- carrying insects have time for additional
reproductive cycles and have become more efficient at spreading diseases. The changing
precipitation patterns associated with climate change will also affect traditional pattern of
diseases. Global climate change may give emerging and re-emerging infectious disease
advantages, but strong public health infrastructure will helps detect out breaks of disease
earlier and facilitate control.
Here the researcher would like to assess the knowledge of staff nurses regarding
global warming and its impact on health using structured questionnaire .A structured
teaching program will be conducted to increase knowledge on global warming and its
impact on health. If the staff nurses gain adequate knowledge regarding global warming,
they will be able to teach patients and their relatives in hospitals.
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6.2 REVIEW OF LITERATURE
Review of literature is defined as broad, comprehensive in depth systematic and
critical review of scholarly publications unpublished scholarly print materials,
audiovisual materials and personal communications. Review of literature is a key step in
research process. Review of literature refers to an extensive, exhaustive and systemic
examination of publications relevant to research project.7
Sokolow S conducted a study regarding effects of a changing climate on the
dynamics of coral infectious disease; a close examination of the coral disease literature
reveals many hypothesized mechanisms for how coral disease may be linked to climate
change. However, evidence has been largely circumstantial, and much uncertainty
remains. The published evidence supports the hypothesis that coral infectious diseases are
emerging and demonstrates that coral disease research has been exponentially expanding
over the last few decades. Current research suggests that environmental factors, such as
ocean warming, altered rainfall, increased storm frequency, sea level rise, altered
circulation, and ocean acidification may play a role in coral disease. These climate
variables likely alter coral epidemiology through effects on pathogen growth rates,
transmission, virulence, and susceptibility. In a rapidly changing global environment, the
consequences of increasing coral disease may be severe, leading to elevated extinction
risk and loss of critical reef habitat. Current evidence is still preliminary but is
increasingly suggestive that mitigating the effects of climate change may help reduce the
emergence of disease and improve the health of coral reef ecosystems.8
A study was conducted in California by D.C.Donaldson and W.R.Keatinge
regarding impact of global warming on health and mortality; the initial concern about the
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possible effects of global warming on infectious has declined with the realization that the
spread of tropical disease is likely to be limited and controllable. However the direct
effect of heat already causes substantial number of deaths among vulnerable people in the
summer. Action to prevent these deaths from rising is the most obvious medical
challenge presented by a global rise in temperature.9
Laurie Michaelis conducted a study regarding Global warming and its impact of
transport and the study shows global warming is expected to occur due to carbon dioxide
and other gases emitted in the course of human activities due to uncertainties about
atmospheric chemistry; few attempts have been made to quantify the impact of emission
of noxi, non methane hydrocarbon and carbon dioxide.10
M.Hishida from the atomic energy research institute, Japan conducted a study
regarding nuclear energy conversion systems for arresting global warming and the study
shows that presently the global warming by CO2 emission from fossil fuel burning is
becoming a serious issue. Especially coal is the worst fossil fuel because it emits the
largest amount of CO2 per unit amount of heat generation. These seems to be two ways of
reducing substantial CO2 emission rate of coal, they are reforming coal to synthesize fuel
with less CO2 emission and removing CO2 from fuel gas of coal fired power station after
burning coal.11
Shao Min Yan of the department of Biomedical and Environmental science,
National Engineering Research Centre for Non-Food Bio Refinery, Guangxi Academy of
Science, conducted a research of possible impact of global warming on the evolution of
Hem agglutinins from influenza A viruses. The objectives of the study was to determine
if global warming has an impact on the evaluation of hem agglutinins from influenza A
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viruses because of both global warming and influenza pandemics epidemics threaten the
world. In the study 4706 hem agglutinins from influenza A viruses sampled from 1956 to
2009 were converted to time series to show their evolutionary process and compared with
the global northern hemisphere and southern hemisphere temperature, to determine if
their trends run in similar or opposite directions. Point to point comparisons between
temperature quantified hem agglutinins was performed for all species and for the major
prevailing species. The study results shows that the trends for both hem agglutinin
evolution and temperature change run in similar direction.After the study the global
warming has a consistent and progressive impact on the hem agglutinin evolution of
influenza A viruses. This study was supported in part by Guangxi Science foundation.12
Martiello MA, in division of public health, university of Siena, Italy conducted a
study regarding “High temperature and health outcomes”. The aim of the study was to
analysis the relationship between high temperature and population health impacts, in
terms of mortality and morbidity. A literature search was conducted using midline to
collect data from studies on heat waves temperature health impacts curves, risk factors
and preventive measures. All the date collected was published in English. The result of
the study showed an increase in deaths may related that a forward shift of deaths may
only explain a very quantity of the excess mortality observed during major heat waves.
Moreover, the results seem to exclude that ozone acts as a confounding variable, whilst it
remains a potential effect modifier.13
Mr.Wassel JJ Novant health concord North Carolina, USA; conducted study
regarding “Public health preparedness for the impact of global warming on human
health” ;Objectives of the study was to asses the changes in weather and weather
associated disturbances related to global warming. The impact on human health of these
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changes; and the public health preparedness mandated by this impact. In this study they
reviewed sixty-seven journal articles and concluded that the projections and signs of
Global environmental changes are worrisome, and there are reasons to believe that
related information may have been conservatively interpreted and presented in the resent
past. We must begin “GREENING” our own lives and clinical practice and start talking
about these issues with patients. As we build walk able neighborhoods, change methods
of energy production and make water use and food production and distribution more
sustainable, the benefits to improved air quality, a stabilized climate, social support and
individual and community health will be dramatic.14
The centre for health and the global environment, Hayward Medical School, USA
conducted a study regarding “Is global warming harmful to health?”In that study there
was a projection from computer models predict that global warming will expand the
incidence and distribution of many serious medical disorders. Global warming aside from
directly causing death by drawing or starvation, promotes by various means by
emergence, resurgence and spread of infection diseases. This article addresses the health
effect of global warming and disrupted climate patterns in detail. Among the greatest
health concerns are diseases transmitted by mosquitoes such as malaria, dengue fever,
yellow fever and several kinds of encephalitis. Such disorders are projected to become
increasingly prevalent because their insect carriers are very sensitive to meteorological
conditions. In addition floods and droughts resulting from global warming can each help
trigger out breaks by creating breeding grounds for insects whose desiccated eggs remain
viable and hatch in still water .Other effects of global warming on health include the
growth of opportunist populations and the increase of the incidence of water borne
diseases because of lack of clean water.15
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Emch M, conducted a study regarding Seasonality of cholera from 1974-2005.
The seasonality of cholera is described in various study areas throughout the world. In
this study Cholera data are compiled from 1974 to 2005 from the World Health
Organization Weekly Epidemiological Reports, a database that includes all reported
cholera cases in 140 countries. The data are analyzed to measure whether season, latitude,
and their interaction are significantly associated with the country-level number of
outbreaks in each of the 12 preceding months using separate negative binomial regression
models for northern, southern, and combined hemispheres. The results suggest that
cholera outbreaks demonstrate seasonal patterns in higher absolute latitudes, but closer to
the equator, cholera outbreaks do not follow a clear seasonal pattern. He findings suggest
that environmental and climatic factors partially control the temporal variability of
cholera. These results also indirectly contribute to the growing debate about the effects of
climate change and global warming. As climate change threatens to increase global
temperature, resulting rises in sea levels and temperatures may influence the temporal
fluctuations of cholera, potentially increasing the frequency and duration of cholera
outbreaks.
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Romero V, conducted a study regarding Kidney stone; global picture of
prevalence, incidence, and associated risk factors. The prevalence and incidence of
nephrolithiasis is reported to be increasing across the world. In this study they review
information regarding stone incidence and prevalence from a global perspective. Data
were collected from the identified literature and sorted by demographic factors and time
period. A total of 75 articles were identified containing kidney stone-related incidence or
prevalence data from 20 countries; 34 provided suitable information for review. Data
regarding overall prevalence or incidence for more than a single time period were found
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for 7 countries (incidence data for 4 countries; prevalence data for 5 countries). The body
of evidence suggests that the incidence and prevalence of kidney stones is increasing
globally. These increases are seen across sex, race, and age. Changes in dietary practices
may be a key driving force. In addition, global warming may influence these trends.17
6.3 STATEMENT OF PROBLEM
Effectiveness of a Structured Teaching Programme on Knowledge regarding
Global Warming and its Impact on Health among the Staff nurses in selected
hospital, Bangalore.
6.4 OBJECTIVES OF THE STUDY
1. To assess the existing knowledge regarding Global warming and its impact on
health among the staff nurses.
2. To assess the post test knowledge regarding global warming and its impact on
health among the staff nurses.
3. To assess the effectiveness of a structured teaching programme on Global
warming and its impact on health among the staff nurses.
4. To associate the pretest knowledge regarding Global warming and its impact on
health with demographic variables.
6.5 HYPOTHESIS
H1. There will be a significant difference between the mean pre test and post test
knowledge regarding Global warming and its impact on health among the staff nurses
in selected hospitals.
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H2. There will be a significant association between level of pretest knowledge
regarding Global warming and its impact on health among the staff nurses in selected
hospitals with their selected demographic variables.
6.6 OPERATIONAL DEFINITIONS
1. Effectiveness:
It refers to the way by which an action produces an intended or desired outcome.
In this study it refers to an extent to which the structured teaching programme
regarding global warming and its impact on health has achieved the desired effect and
improves the knowledge of staff nurses in selected hospitals.
2. Structured Teaching programme:
It refers to a systematically developed instructional aids designed to impart
knowledge regarding Global warming and its impact on health.
3. Global warming:
Global warming is all about adverse climate change. Global warming is an
increase in the earth’s average atmospheric temperature that causes corresponding
changes in climate and that may results from the green house effect.
4. Knowledge:
It refers the response and level of understanding of staff nurses regarding global
warming and its impact on health.
5. Impact:
A high force or a shock over a short time or a long time periods.
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6. Staff Nurse:
A nurse is a healthcare professional who, in collaboration with other members
of a health care team, is responsible for: treatment.
6.7 ASSUMPTIONS
1. Staff nurses in selected hospitals may have inadequate knowledge regarding
Global warming and its impact on health.
2. Knowledge regarding Global warming and its impact on health can be measured
by questionnaire.
3. Knowledge regarding Global warming and its impact on health will be enhanced
among staff nurses in selected hospitals after conduction of structured teaching
programme.
7.0 MATERIALS AND METHODS
7.1 Sources of data
The data will be collected from the staff nurses in selected hospitals, Bangalore.
7.2 Method of collection of data
Structured Questionnaire.
7.2.1 Research design
Quasi experimental-one group pretest posttest design.
7.2.2 Research approach
An evaluative research approach.
7.2.3 Setting of the study
The study will be conducted among staff nurses in selected hospitals, Bangalore.
7.2.4 Population
The population of the present study comprises of all staff nurses in Bangalore.
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7.2.5 Sample size
The sample size will be 60 staff nurses.
7.2.6 Sampling technique
Non-probability convenience sampling technique will be used.
7.2.7 Sampling Criteria
Inclusive criteria
The study includes:
1. All male and female staff nurses working in medical ward and OPD in selected
hospitals.
2. Staff nurses who can understand English.
Exclusive criteria
The study excludes:
1. Staff nurses who are not willing to participate.
2. Staff nurses who are working in critical care areas.
7.2.8 Tool for data collection
The tool consists of the following sections:
Section A- Demographic variables
Section B- Structured questionnaire to assess the knowledge of staff nurses
regarding Global warming and its impact on health.
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7.2.9 Plan for data analysis
The data collected will be analyses by using descriptive and inferential statistics.
Descriptive statistics
Frequency, percentage distribution mean and standard deviation will be used to
analyze the knowledge regarding global warming and its impact in health among
the staff nurses in selected hospitals.
Inferential statistics
Paired t test will used to compare the pre and post test knowledge regarding
global warming and its impact in health. Chi-square test will be used to analyze
association between pre test knowledge among staff nurses in selected hospitals
with selected demographic variables.
7.3 Does the study require any investigations or interventions to be conducted on
patients or other human or animals…?
Yes, structured teaching programme will be administration for staff nurse.
7.4 Has ethical clearance been obtained from your situation…?
1. Permission will be obtained from the research committee of Varalakshmi
College of nursing, Bangalore.
2. Permission will be obtained from the concerned authorities of the hospitals.
3. Informed consent will be taken from the samples, confidentiality and privacy of
data will be maintained.
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8.0 LIST OF REFERENCES
1. Introduction of Global warming available from:
URL:http://www.medindia.net
2. Climate changes available from:
URL:http://www.en.wikipedia.org
3. Boykoff M. Balance as bias, global warming and the as prestige press. Global
environmental change part A 14th edition 2004.p125-136.
4. Schmitter A Stocker TF. The stability of the thermo line circulations in global warming
experiments. Journal of climate.1994 August; 12(4); 1117-33.
5. Knutti R Stocker TF. Limited predictability of the future thermo line circulations close
to as instability threshold. Journal of climate.2002April; 15 (2); 179-86.
6. Study about Sun stroke available from:
URL: http: //www.wisegeek.com
7. BT Basavanthappa. Nursing research: Review of literature. New Delhi: Jaypee
brothers; 2003. p48.
8. Sokolow S. Effects of a changing climate on the dynamics of coral infectious disease. Journal
for Health care Quality.2009 Nov; 14(3); p5-18
9. W R Keatinge.
Impact of global warming on health and mortality. South med
Journals.2004, 97(11).p494-582.
10. Global warming impact in transporting available from:
URL:http//www.sciencedirect.com
11. M.Hishada. Japan Atomic energy research institute. Tokai-mura. Ibaraki-ken
publications: Japan; 2008 Feb; 24(5): p319.
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12. Shaomin Yan.Biomedical and environmental science. Journal of America. 2011
February; 24(1); p62-67.
13. Martiello MA. Scand J public health .Oxford Journals. 2010 December; 38(8): p 826837
14. Wassal JJ.Public health preparedness of the impact of global warming on human
health. Disaster medical journal.2009 July; 4(4); p217-225.
15. Study about is Global warming harmful to health available from:
URL: http://www.ncbi.nlm.nih.gov
16. Emch M. Seasonality of cholera from 1974 to 2005: a review of global patterns. International
journal for health Geographics.2008 june20 (7); 30-31.
17. Romero V. Kidney stone; global picture of prevalence, incidence, and associated risk factors.
A journal of review on Urology.2010, 12(2-3)86-96.
18. Denise F Polit, Cherly Tatano Back. Nursing research Data analysis and
interpretation. Williams and Willkims publications: New Delhi; 2008. p506-642.
19. Barbara Hazard Munro. Statistical methods for health care research: Inferential and
descriptive statistics. Philadelphia: Lippincott; 3rdedition. p73.
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9. SIGNATURE OF THE STUDENT
:
10. REMARKS OF THE GUIDE
:
11. NAME AND DESIGNATION OF
:
11.1. GUIDE
: Mrs.Thresa.A
Professor
Varalakshmi College of
nursing
11.2. SIGNATURE
:
11.3. HEAD OF THE DEPARTMENMT
: Mrs.Thresa.A
Professor
Varalakshmi College of
nursing
11.4. SIGNATURE OF HOD
:
12. REMARKS OF THE PRINCIPAL
:
12.1. SIGNATURE OF PRINCIPAL
:
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