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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 5 TITLE OF THE STRUCTURED TEACHING STUDY PROGRAMME REGARDING GLOBAL WARMING AND ITS IMPACT ON HEALTH. 2 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 3 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 4 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, 5 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. 6 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 7 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. 8 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 9 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 10 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 11 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 12 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. 16 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 13 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. 14 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. 15 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. 16 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. 17 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. 18 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. 19 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. 20 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 : 21