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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION.
Mr. THEJES KODINJINAL MATHEW
FIRST YEAR M.Sc NURSING
MEDICAL SURGICAL NURSING
2013-2015
SJB COLLEGE OF NURSING;
BGS HEALTH & EDUCATION CITY
KENGERI,
BANGALORE 560060
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1.
Name of the candidate
Mr. Thejes Kodinjinal Mathew
and address
1st Year M. Sc Nursing
SJB College Of Nursing
BGS Health & Education City
Kengeri, Bangalore - 60.
2.
Name of institution
SJB College Of Nursing,
BGS Health & Education City
Kengeri, Bangalore - 60.
3.
Course of study and
M Sc (Nursing) Medical Surgical Nursing
subject
4.
Date of admission
16 - 07-2013
5.
Title of the topic
"A DESCRIPTIVE STUDY TO ASSESS
THE
KNOWLEDGE
HYPERBARIC
OXYGEN
REGARDING
THERAPY
AMONG STAFF NURSES IN SELECTED
HOSPITALS, BANGALORE WITH A
VIEW TO DEVELOP AN INFORMATION
BOOKLET".
6. BRIEF RESUME OF THE INTENDED WORK:
6.1NEED FOR STUDY
Health is considered to be the wealth for the survival of the fittest. To
maintain health, there are certain elements which should be kept in balanced
measures. Those are food, air, and water which are inter related and absence of any
one element in the human body can lead to disease. This is well said by Maslow's
hierarchy in his first step of basic physiologic need.1
Air is a mixture of gases comprising mainly of nitrogen, oxygen,
and argon which together constitute the major gases of the atmosphere.2 Oxygen is
a chemical
non-metallic
element which
is
a
colourless,
odourless,
tasteless diatomic gas. Oxygen plays a vital role in the breathing processes and in
the metabolism of the living organisms. It not only gives life but also destroys the
harmful bacteria in our bodies without affecting the beneficial bacteria.3 In the
human body, the oxygen is absorbed by the blood streaming in the lungs, which is
then transported to the cells where an oxygenation cycle starts its process. The cells
of the body need energy for all their metabolic activities.4
The average level of oxygen in the blood is approximately 96% and if
this oxygen consumption lowers over time, health can be affected. When cells lack
oxygen they weaken and die. Dr. Richard Lippman, a renowned researcher states
that "A lack of oxygen (hypoxia) is the prime cause of 1.5 million heart attacks
each year."5 The American Heart Association state that over 1.5 million people die
per year from heart conditions and that 70% of the population has some evidence
of heart condition.6 Low oxygen levels are associated with symptoms such as poor
concentration and forgetfulness, easily stressed and anxious, shortness of breath
when walking short distances, cramping of leg muscles, swollen ankles, general
fatigue, recurrent chest infections, blueness of fingertips and lips. These can be
corrected by administering the patients with adequate episodes of oxygen therapy. 7
Oxygen therapy is the administration of oxygen as a medical
intervention for both chronic and acute patient care.It helps to decrease shortness of
breath and fatigue (tiredness), improve sleep in people with sleep-related breathing
disorders, increase the lifespan of some people who have COPD.8 Oxygen is
administered through a nasal cannula, a face mask or through small tube inserted
into the windpipe through the front of the neck (transtracheal oxygen therapy). One
of the recent breakthroughs in the field of oxygen therapy is Hyperbaric Oxygen
Therapy. 9
Hyperbaric
medicine,
also
known
as hyperbaric
oxygen
therapy (HBOT), is the medical use of oxygen at a level higher than pressure, and
is defined as a treatment in which a patient breathes 100% oxygen intermittently
under a pressure of greater than sea level or our atmosphere. It has the capacity to
promote the growth of new blood vessels, decreases swelling and inflammation
deactivates toxins, increases the body's ability to fight infections, clears out toxins
and metabolic waste products, and improve the rate of healing.10 HBOT has been
successfully used as adjunctive therapy for wound healing. Non-healing wounds
such as diabetic and vascular insufficiency ulcers, Clostridal myonecrosis,
necrotising soft tissue infections, Fournier's gangrene, as also for traumatic
wounds, crush injury, compartment syndrome, compromised skin grafts and flaps
and thermal burns.11
Hyperbaric Oxygen Therapy can be carried out in one of two ways.
Multiplace chambers that are designed to hold 2 or more people. Monoplace
chambers that are designed for single person. Both types are pressurized with air
while patients breathe oxygen via a O2 mask, hood system or tube. The treatment
usually extends from 45 minutes to 60 minutes. It should be used to compliment
conventional therapies and treatments. The treatment is performed by trained
personnel who monitor the patient and adjusts the schedule as required.10 The use
of hyperbaric oxygen therapy is common in Russia for resuscitation in respiratory
failure, for cranial birth injuries, and for haemolytic disease of the newborn. In
cases of respiratory distress, early use led to recovery in 75% of cases. In 1988
Italian physicians started treating small foetus in utero demonstrating a reduction of
cerebral damage. Patients were hospitalized before the 35th week and hyperbaric
treatments were given every 2 weeks for 40 min at 1.5. The fetal biophysical
profile showed a remarkable improvement as soon as the second treatment. HBOT
is also reported to reduce high serum bilirubin levels and prevent development of
neurological disorders. 11
In a
conference "New Horizons for Hyperbaric Oxygenation" in
Orlando, Florida, in 1989, results were presented of HBOT therapy of 230 Cerebral
Palsy patients who had been treated in the early stages since 1985 in Sao Palo,
Brazil (Machado 1989).12 The results were positive changes in balance and
"intelligence with reduced frequency of seizure activity." In India the Hiranandani
Hospital in Powai, Mumbai claimed that HBOT's success rates in treating diabetic
wounds have increased.13
Hyperbaric Oxygen Therapy is a method of administering pure oxygen
at greater than atmospheric pressure to a patient in order to improve or correct
conditions.Since Hyperbaric Oxygen Therapy is a recent innovative technology
which is being practiced in the clinical setting but was not administered in the
Nursing Curriculum thereby, the investigator felt it would be mandatory to impart
the knowledge regarding Hyperbaric Oxygen Therapy among staff nurses. This
knowledge can be used during their practice which will percolate for the clients in
the forthcoming years.
6.2 REVIEW OF LITERATURE
The related literatures are presented in the following sub headings:
1.
Literature related to Hyperbaric Oxygen Therapy
2.
Literature related to knowledge regarding Hyperbaric Oxygen Therapy.
Literature related to Hyperbaric Oxygen Therapy
An experimental study was conducted to assess the effectiveness of Hyperbaric
Oxygen Therapy (HBOT) among 14 diabetics with chronic non healing diabetic
ulcer wounds. The objective of the study was to find the effect of HBOT in ulcer
wounds. In 11 patients there was complete wound healing, while in 1 patient there
was partial response, in 1 minimal response and in 1 a transient response. The
study concluded that in the treatment of diabetic ulcer infection, adjunctive
hyperbaric oxygen therapy seems to be a useful tool to enhance wound healing
provided that there are preserved circulation and controlled infection.14
A systemic review of Chinese literature on clinical effectiveness of treatment with
Hyperbaric Oxygen for neonatal hypoxic ischemic encephalopathy was done to
investigate the clinical effectiveness in Chinese Digital Library 2005. Randomized
and Quasi randomized controlled trials of treatment with Hyperbaric oxygen
compared usual care in term neonates with hypoxic ischemic encephalopathy and
outcomes were evaluated based n the mortality and long term sequelae. The study
concluded that HBOT reduces mortality and neurologic sequalae with hypoxic
ischemic encephalopathy.15
A retrospective study was conducted by Division of Clinical Care research, Boston
USA to determine whether Hyperbaric Oxygen Therapy is an effective adjuvant
treatment for hypoxic wound. The study started from mid 1998 to August 2011.
2000 patients were included with tissue hypoxia. The study results suggest that
Hyperbaric Oxygen may be beneficial as an adjuvant therapy for chronic non healing diabetic wounds, compromised skin grafts, osteo radio necrosis and
gangrene compared with standard wound care alone.16
A prospective study was conducted by the Department of Emergency Medicine,
Karolinska Hospital, Sweden. The purpose of the study was to assess the
effectiveness of HBOT on treatment of diabetic foot ulcers. Thirty eight diabetic
patients were investigated in the study in which 29 patients were healed with intact
skin. The study concluded that adjunctive HBOT can be valuable for treating
selected cases of diabetic foot ulcers.19
Literature related to knowledge regarding HBOT
A study was conducted by Canadian Agency for Drugs and Technologies in Health
(CADTH) among primary care physicians at one of the largest annual medical
conferences in the country. The purpose of this study is to explore the prevailing
knowledge base and attitude trends regarding HBOT. After the survey it was found
that the knowledge regarding Hyperbaric Oxygen Therapy was low. The study
concluded that there, discovery of knowledge gaps and negative attitude predictors
will help to identify physicians who would benefit most from future educational
efforts. If physicians’ knowledge of and attitudes toward HBOT are improved,
patients will be more likely to receive optimal care and avoid devastating lower
limb amputation.17
A survey was conducted to evaluate the knowledge and attitudes of the military
and civilian nurse practitioners at the royal medical Service in the kingdom of
Bahrain with regards to the clinical application of hyperbaric oxygen therapy. The
survey consisted of a questionnaire and a semi-structured interview in which a total
of 90 nurse practitioners were included. After the survey it was found that the
knowledge of nurse practitioners in Bahrain regarding hyperbaric oxygen therapy
was low. A large proportion of the participants had a positive attitude towards the
use of hyperbaric oxygen therapy, felt that it is a valid treatment modality and they
would refer their patients for such treatment. They would like to receive more
information on hyperbaric oxygen therapy. Educational interventions to address the
knowledge gap would likely be effective, since most participants have a positive
attitude towards the therapy and believe that it is cost-effective.18
A survey was conducted to evaluate the physicians knowledge of and attitude
towards Hyperbaric Oxygen Therapy at Primary Care Today Conference in
Toronto, Ontario. The survey consisted of a 24 item questionnaire in which a total
313 physicians attended. After the survey it was found that less than 10% of
respondents had a good knowledge of HBOT and 57%had a good attitude towards
HBOT. The survey concluded that educating physicians with HBOT might
encourage future use of HBOT.17
PROBLEM STATEMENT
"A descriptive study to assess the knowledge regarding Hyperbaric Oxygen
Therapy among staff nurses in selected hospitals, Bangalore with a view to
develop an information booklet".
6.3 OBJECTIVES:
1.
To assess the knowledge of staff nurses regarding Hyperbaric Oxygen
Therapy in selected hospitals, Bangalore.
2.
To find association between knowledge scores with selected demographic
variables.
3.
To provide information booklet regarding Hyperbaric Oxygen Therapy
among staff nurses in selected hospitals, Bangalore.
6.3.1 VARIABLES
1.
Demographic Variables: Gender, Age, Previous exposure to Hyperbaric
Oxygen Therapy.
6.4 OPERATIONAL DEFINITIONS
1.
Knowledge: It refers to correct responses towards the items of the knowledge
questionnaire regarding Hyperbaric Oxygen Therapy.
2.
Hyperbaric Oxygen Therapy: It is defined as a treatment in which a patient
breathes 100% oxygen intermittently under a pressure of greater than sea
level
3.
or our atmosphere.
Staff Nurses: Staff Nurses are qualified nurses working in hospital with
either
G.N.M/B.Sc/M.Sc certification, recognised by INC and registered in
Karnataka Nursing Council, and are involved in direct care of the patient.
4.
Information Booklet: Information Booklet is a brief comprehensive
systematically arranged information material regarding Hyperbaric Oxygen
Therapy prepared by the investigator and validated by experts.
6.5 ASSUMPTIONS
1.
Staff Nurses may have knowledge regarding Hyperbaric Oxygen Therapy.
2.
The information booklet is a method to impart knowledge.
6.6 DELIMITATION
This study is limited only to asses knowledge.
7. MATERIALS AND METHODS:
7.1 Source of data
: Staff Nurses.
7.1.1 Research approach
: Descriptive Approach
7.1.2 Research Design
: Descriptive design
7.1.3 Setting
7.1.4 Sample and sample siz
: Selected Hospitals, Bangalore
e
7.1.5 Duration of the Data Collection
: 100 staff nurses
: Four weeks.
7.1.6 Inclusion criteria:
Staff nurses who are

present at the time of Data Collection.

willing to participate in the study.
7.1.7 Exclusion criteria:
Staff nurses who are

working in Operation Theatre.

not involved in Direct patient care
7.2 METHOD OF COLLECTION OF DATA
7.2.1 Sampling Technique: Non probability convenience sampling technique.
7.2.2 Tool of Research: Structured Questionnaire
It will be constructed in two parts:
Part I-Demographic data
Part II-Knowledge Questionnaire regarding Hyperbaric Oxygen Therapy
7.2.3 Collection of Data

The formal permission will be obtained from hospital authority.

Investigator introduces himself to subjects and notifies about his objectives
and steps of study.

Investigator collects data from the staff nurses through self administered
structured questionnaire followed by distribution of informational booklet
regarding Hyperbaric Oxygen Therapy
7.2.4 Method Of Data Analysis And Presentation
1.
The investigator uses descriptive and inferential statistical technique for data
analysis
a.
Descriptive Statistics:

Frequency and percentage distribution will be used to describe the
demographic variable of staff nurses.

Mean, Median, Mean percentage range, and standard deviation will be used
describe the knowledge regarding Hyperbaric oxygen therapy among staff nurses.
b.
Inferential Statistics:

Chi square test to find the association between knowledge and selected
demographic variables will be used
2.
Analysed data will be presented in the form of tables, diagrams and graphs
based on findings]
7.3 Does the study require any investigation or intervention to be conducted on
human beings animal? If so describe briefly.
No
7.4 Has ethical clearance been obtained from your institution?
 Yes, consent will be obtained from concerned subjects and authority of
institution.
 Privacy, Confidentiality and Anonymity will be maintained
 Scientific objectivity of the study will be maintained with honesty and
impartiality.
8. LIST OF REFERENCES
1.
Barber C. Health Management in Health Care Environments. BJN 2012 March
8;21(5): 299 - 302.
2.
Waugh A, Grant A. Ross and Wilson Anatomy and Phyisiology in Health and
Illness. 11th ed. Churchill Livingstone Elsevier; 2010. p. 250-1.
3.
The Importance of Oxygen. [Online]. 2013[ cited 2013 October 21]; Available
from: URL:http://www.naturalcleansingtechniques.com/oxygen.html
4.
Biological Action. [Online]. 2013[ cited 2013 October 21]; Available from:
URL: http://nautilus.fis.uc.pt/st2.5/scenes-e/elem/e00840.html
5.
Debra Ross. The Importance of Oxygen. [Online]. 2008 [cited 2013 October
21]; Available from :
URL: http://www.fitorbit.com/fitness-articles/102-
health-wellness-article-the-importance-of-oxygen?video_id=32095
6.
Optimal Breathing. [Online]. 1997 [cited 2013 October 21]; Available from:
URL:http://www.breathing.com/articles/oxygen.htm
7.
Understanding Oxygen. [Online]. 2004 [cited 2013 October 27]; Available
from: URL:http://www.healthoxygen.com/understanding-oxygen/
8.
What is Oxygen Therapy. [Online]. 2012 February 24 [ cited 2013 October
27];
Available
from:
URL:http://www.nhlbi.nih.gov/health/health-
topics/topics/oxt/
9.
Potter Patricia A, Perry Anne Griffin. Fundamentals of Nursing. 6th ed.
Elsevier; 2008. p. 1123-5.
10. Hyperbaric Oxygen Therapy. [Online]. [cited 2013 October 27]; Available
from: URL: http://www.icddelhi.org/Hyperbaric_oxygen_therapy.html
11. Hyperbaric Oxygen and wound Healing. [Online]. 2012 May [cited October
21]; Available from: URL:http://www.ncbi.nlm.nih.gov/pubmed/23162231
12. Virginia Neubauer, Richard Neubauer, Paul Harch. Hyperbaric Oxygen
Therapy in the Management of Cerebral Palsy. [Online]. 2011 November 05
[cited
2013
October
27];
Available
from:
URL:http://www.hbot.com/blog/infinitee/hyperbaric-oxygen-therapymanagement-cerebral-palsy
13. Sumitra Deb Roy. Non-Invasive treatment for Diabetic Mumbaikars facing
amputation Threat. [Online]. 2013 March 11 [cited 2013 October 22];
Available
from:
URL:http://articles.timesofindia.indiatimes.com/2013-03-
11/science/37622743_1_hbot-hyperbaric-diabetic-wounds
14. Diabetic Ulcer wounds And HBOT. [Online]. 2009 [cited 2013 October 27];
Available
from:
URL:http://www.hyperbaric-oxygen-info.com/diabetic-
ulcer.html
15. Zlaulian Liu, Tengbin Xiong, Catherine Meads. Clinical Effectiveness of
treatment
with
hyperbaric
oxygen
for
neonatal
hypoxic-ischaemic
encephalopathy: systemic review of literature. [Online]. 2005 September 27
[cited
2013
October
27];
Available
from:
URL:http://www.bmj.com/content/333/7564/374
16. Wang C, Schwaitzberg S, BerlinerE, Zarin DA, Lau. Hyperbaric oxygen for
treating wounds: a systemic review of literature. [Online]. 2003 March [cited
2013
October
22];
Available
from:
URL:http://www.ncbi.nlm.nih.gov/pubmed/12611573
17. Wayne Evans, Richard Gill, Ted S. Sosaik. Hyperbaric Oxygen Therapy and
Diabetic Full ulsers. [Online]. 2009 [cited 2013 October 22]; Available from:
URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868617/
18. Abdulaal. A survey of the knowlegde of the miitary and civilian nurses.
[Online]; 2012 March [cited
2013 October 22]; Available from:
URL:http://scholar.sun.ac.za/handle/10019.1/20049
19. Kalani M, Jorneskog G, Naderi N, Lind F. Hyperbaric Therapy in Treatment
of Diabetic Foot Ulcers. Long term Follow up. [Online]; 2012 March [cited
2013
October
22];
Available
http://www.ncbi.nlm.nih.gov/pubmed/12039398
from:
URL:
9.
Signature of the
candidate
Remarks
10.
of
the
The study is feasible and of genuine
guide
interest of the student.
11.
Name
and
designation of
11.1. Guide
Mrs. Manimozhi R
Professor,
HOD, Medical and Surgical nursing
SJB College Of Nursing,
Kengeri, Bangalore-60.
11.2. Signature
11.3. Co-guide
Ms. Lakshmy T.V
Lecturer,
SJB College Of Nursing,
Kengeri, Bangalore-60.
11.4. Signature
11.5. Head of the
Mrs. Manimozhi R
department.
Professor,
HOD, Medical and Surgical Nursing
SJB College Of Nursing,
Kengeri, Bangalore-60.
11.6. Signature
12
12.1. Remarks Of
This topic was discussed with the
The Principal
members of research committee and
finalized. He is permitted to conduct
the study.
12.2. Signature