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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