Download Material and Methods of Study

Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore
ANNEXURE 1
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1
Name of candidate and Miss ASHWINI SATHYA.
address
I YEAR M.Sc. NURSING,
SRI H.D.DEVEGOWDA CO-OPERATIVE
COLLEGE OF NURSING, MANICHANAHALLY
GATE, BELUR ROAD, HASSAN, 573201
2
Name of the Institution
SRI H.D.DEVEGOWDA CO-OPERATIVE
COLLEGE OF NURSING, MANICHANAHALLY
GATE, BELUR ROAD, HASSAN, KARNATAKA.
3
Course of study and MASTER OF SCIENCE IN NURSING,
subject
4
Date of admission to the
MEDICAL SURGICAL NURSING
01/06/2011
course
5
Title Of The Topic :
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNOWLEDGE REGARDING THE
IMPORTANCE OF CARDIO PROTECTIVE DIET IN PREVENTION OF
CARDIAC DISEASES IN HIGH RISK GROUP AMONG III YEAR B.SC.,
NURSING STUDENTS IN SELECTED NURSING COLLEGES AT
HASSAN”.
1
6
Brief Resume of Intended Work
6.1 Introduction
“An ounce of prevention is worth a pound of cure”
-Henry De Bracton.1
Cardiac diets are widely prescribed in the hospital setting for patients with
heart disease, hypertension, myocardial infarction and disorders of lipid
metabolism. A cardiac diet can be part of a plan for either treatment or prevention
of cardiovascular disease. It is suggested by the American Heart Association that
a person with a history of heart disease should consume an overall healthy diet.
The hypertension and heart disease are related. The most important
nutrients involved in blood pressure levels are sodium and potassium. Ideally,
sodium intake should be under 2300mg a day. If a person already suffers from
hypertension, the sodium content of the diet is usually controlled at 1500mg a day
or below. It is advised to avoid adding salt to your food, as 1 tsp. salt contains
2300mg of sodium. An important electrolyte that aids in the reduction of blood
pressure is potassium. The recommended dietary intake for all adults is 4700mg a
day. In some individuals, dietary potassium can blunt the effect of salt, thus
lowering blood pressure. Good food sources of potassium are potatoes, lima
beans, spinach, prunes, sweet potatoes, bananas, yogurt, cantaloupe and orange
juice.
Cholesterol, saturated fats and trans fatty acids are other nutrients that
should be reduced when following a cardiac diet. The American Heart
Association recommends that those suffering from heart disease limit their
saturated fat intake to less than 7 percent of total calories, trans fats to less than 1
2
percent and cholesterol to less than 300mg daily. Dietary cholesterol and saturated
fats are mostly found in foods that are derived from animals such as meat, poultry
and dairy products. Trans fats are found in processed, ready-made foods and
should be avoided.
According to the American Heart Association and the National Institutes of
Health, consuming 2g per day of plant sterols/stanols can be therapeutic for heart
disease sufferers. They are believed to block cholesterol absorption sites in the
human intestine, thus helping to reduce cholesterol and lower LDL levels.
Although plant sterols are found in food, the amount needed requires
supplementation from fortified foods sources and/or supplements. Some food
sources are corn oil, nuts, seeds, wheat germ and soybean oil. There are a few
margarine type spreads on the market today that are fortified with plant sterols.
The cardiac diet is a diet that anyone can follow. It should be rich in fruits,
vegetables, whole grains, lean meats and low-fat dairy products. If weight loss is
required then portion sizes should be monitored. Not all fat has to be avoided.
Fats to include in your diet are omega-3 fatty acids and monounsaturated and
polyunsaturated fats. Monounsaturated and polyunsaturated fats are plant based.
Examples are olive oil, safflower oil, nuts and avocados.Omega-3 fatty acids are
essential fats that are not made by the body and need to be supplied by the diet.
Health benefits of omega-3 fatty acids include decreasing LDLs, increasing
HDLs, and decreasing triglyceride levels. The American Heart Association
recommends consuming fish, a good source of omega-3 fatty acids.2
6.2 Need for Study:
“Care is an absolute, prevention is the ideal”
-Christopher Howson.1
Largest-ever study of deaths shows heart ailments have replaced
3
communicable diseases as the biggest killer in rural & urban India. Heart diseases
have emerged as the number one killer in both urban and rural areas of the
country. Preliminary results from the largest study, yet to find out the exact causes
of mortality in India, have revealed that heart ailments take most lives in both
urban and rural areas. The results are surprising because they indicate a reversal in
disease patterns in the country from communicable diseases to non-communicable
or lifestyle diseases.
About 25 per cent of deaths in the age group of 25- 69 years occur because
of heart diseases. In urban areas, 32.8 per cent deaths occur because of heart
ailments, while this percentage in rural areas is 22.9.If all age groups are included,
heart diseases account for about 19 per cent of all deaths. It is the leading cause of
death among males as well as females. It is also the leading cause of death in all
regions though the numbers vary. The proportion of deaths caused by heart
disease is the highest in south India (25 per cent) and lowest - 12 per cent - in the
central region. In rural areas of poorer states like Uttar Pradesh and Bihar, the
leading cause of death among middle aged males is cardiovascular disease.
Heart attacks are killing people not just in urban areas," said Dr Prabhat
Jha, Director of the Centre for Global Health Research at the University of
Toronto and lead researcher of the study. The study is being carried out in
collaboration with the Registrar General of India and the Indian Council of
Medical Research. The data forms part of the first set of results from the study,
dubbed the 'Million Deaths Study' because it aims to investigate one million
deaths by 2014.The preliminary results relate to an analysis of 1,30,000 deaths
that occurred between 2001 and 2003. Data relating to another 270,000 deaths is
being analysed currently.4
A study conducted in Department of Food Science, North Carolina State
University reported that tomatoes are a rich source of lycopene, beta-carotene,
folate, potassium, vitamin C, flavonoids, and vitamin E. The processing of
tomatoes may significantly affect the bioavailability of these nutrients. Many of
4
the nutrients may function individually, or in concert, to protect lipoproteins and
vascular cells from oxidation, the most widely accepted theory for the genesis of
atherosclerosis. This hypothesis has been supported by in vitro, limited in vivo,
and many epidemiological studies that associate reduced cardiovascular risk with
consumption of antioxidant-rich foods Other cardio protective functions provided
by the nutrients in tomatoes may include the reduction of low-density lipoprotein
(LDL) cholesterol, homocysteine, platelet aggregation, and blood pressure.
Because tomatoes include several nutrients associated with theoretical or proven
effects and are widely consumed year round, they are considered a valuable
component of a cardio protective diet.5
A study conducted in Institute of Public Health, University of Cambridge,
UK. Studies of diet, reported on fresh fruit and vegetables or a nutrient which
could serve as a proxy were included. For coronary heart disease nine of ten
ecological studies, two of three case-control studies and six of 16 cohort studies
found a significant protective association with consumption of fruit and
vegetables or surrogate nutrients. For total circulatory disease, one of two cohort
studies reported a significant protective association.6
The cardiovascular disorders are caused by several risk factors including
modifiable and non-modifiable factors. Among modifiable risk factors, nowadays
dietary modification requires special attention due to the introduction of various
life style changes and fast food culture. This necessitates the need for further
research focused on this topic.4
6.3 Review of Literature
Review of literature is a key step in research process. Review of literature
refers to an extensive, exhaustive and systematic examination of publications
relevant to the research project. Before any research can be started whether it is
a single study or an extended project, literature reviews of previous studies and
5
experiences related to proposed investigations should be done. One of the most
satisfying aspects of the literature review is the contribution it makes to the new
knowledge, insight and general scholarship of the researcher.7
Lyon Diet Heart Study was conducted in France about secondary
prevention trial testing the protective effects of diet and, to analyze their relations
with the associated drug treatments and to gain insights into the possible
mechanisms underlying the beneficial effects of certain nutriments. A total of 605
patients (303 control subjects and 302 study patients) were studied over a mean
period of 27 months. When major primary and secondary end points were
combined, there were 59 events in control subjects and 14 events in the study
patients, showing a risk reduction of 76% (p < 0.0001). When these end points
were combined with the minor end points, there were 104 events in control
subjects and 68 events in the study patients, giving a risk reduction of 37% (p <
0.005). By observational analysis, only aspirin among the medications appeared to
be significantly protective (risk ratio after adjustment for prognosis factors 0.45;
95% confidence interval 0.25 to 0.80).researcher concluded that certain
nutriments characteristic of the Mediterranean diet (omega-3 fatty acids, oleic
acid, antioxidant vitamins) have specific cardio protective effects.8
A study was conducted in Latin America to determine the visual, spatial,
and or statistical relationships between dietary patterns and cardiovascular disease
in Latin America and the Caribbean. The analyses included 32 LAC countries
with sufficient data (15 of 47 had been excluded for incomplete data). Pearson's
correlations (r) were used to determine relationships between diet and CVD
mortality, and multiple linear regression analysis was conducted to identify
predictors of mortality. Statistically significant, positive correlations were found
between oil-crops (r = 0.680, P = 0.000) and fish and seafood (r = 0.411, P =
0.019) and CVD mortality. Regression analysis revealed that high kilocalorie
availability was a predictor of low CVD mortality (P = 0.020). High oil-crop
availability was a predictor of high CVD mortality (P = 0.000). Maps constructed
6
show visual relationships between availability of fish and seafood, kilocalories,
and oil-crops, and CVD mortality. Researcher concluded that fish and seafood,
kilocalorie, and oil-crop availability appear to be related to CVD mortality.9
A comparative study was conducted in Medical Hospital and Research
Centre, Moradabad to test whether a fat reduced diet rich in soluble dietary fibre,
antioxidant vitamins, and minerals reduces complications and mortality after
acute myocardial infarction. They selected randomized, single blind, controlled
trial. They selected 505 patients with suspected acute myocardial infarction.
Those with definite or possible acute myocardial infarction and unstable angina
based on World Health Organization criteria were assigned to diet A (n = 204) or
diet B (n = 202) within 24-48 hours of infarction. Both groups were advised to
follow a fat reduced diet. Researcher concluded that blood lipoprotein
concentrations and body weight fell significantly in patients in group A compared
with those in group B. The incidence of cardiac events was significantly lower in
group A than group B (50 v 82 patients, p less than 0.001). Group A also had
lower total mortality (21 v 38 died, p less than 0.01). The incidence of cardiac
events was significantly lower in group A than group B. Group A also had lower
total mortality than group B. Comprehensive dietary changes in conjunction with
weight loss immediately after acute myocardial infarction may modulate blood
lipoproteins and significantly reduce complications and mortality after one year.10
A study was conducted, at the Human Nutrition Unit, University of Sydney,
Australia to find out importance of dietary flavonoids. Flavonoids are a group of
polyphenolic compounds, diverse in chemical structure and characteristics, found
ubiquitously in plants. Therefore, flavonoids are part of the human diet. Over
4,000 different flavonoids have been identified within the major flavonoid classes
which include flavonols, flavones, flavanones, catechins, anthocyanidins,
isoflavones, dihydroflavonols, and chalcones. Flavonoids are absorbed from the
gastrointestinal tracts of humans and animals and are excreted either unchanged or
as flavonoid metabolites in the urine and feces. Flavonoids are potent
7
antioxidants, free radical scavengers, and metal chelators and inhibit lipid per
oxidation. Epidemiological studies show an inverse correlation between dietary
flavonoid intake and mortality from coronary heart disease (CHD) which is
explained in part by the inhibition of low density lipoprotein oxidation and
reduced platelet agreeability. Researcher concluded that intake of dietary
flavonoids reduces the chance of CHD significantly.11
A study was conducted From Northwestern Memorial Hospital, Wellness
Institute, Chicago, Illinois. Cardiovascular disease is the number one cause of
death in the United States, and prevention of cardiovascular disease is at the top of
the public health agenda. Evidence shows that reducing the incidence of coronary
heart disease with diet is possible. More than a half century of evidence from
epidemiologic, experimental, and clinical trials pinpoints a positive correlation
between lifestyle and dietary factors as they relate to blood lipids, blood pressure,
and coronary heart disease risk, and a number of evidence-based nutrition
guidelines have emerged. The National Cholesterol Education Program's
Therapeutic Lifestyle Changes diet includes unsaturated fats, fiber, and plant
sterols/stanols. The whole foods approach incorporates increased consumption of
fruits, vegetables, whole grains, and fish; and the American Heart Association
guidelines emphasize functional foods like soy protein, nuts, and alcohol. These
guidelines display the rationale for nutrition intervention as a primary prevention
for cardiovascular disease. This article highlights key nutrients and lifestyle
factors in preventing cardiovascular disease and identifies practical applications
for clinicians.12
6.4 Problem statement:
“A study to evaluate the effectiveness of structured teaching
programme on knowledge regarding the importance of cardio protective
diet in prevention of cardiac diseases in high risk group among III year B.Sc
Nursing students in selected nursing colleges at Hassan”.
8
6.5 Objectives of study:
1. To determine mean pretest and post test level of knowledge of 3rd year B.Sc.
Nursing students regarding the importance of cardio protective diet in prevention
of cardiac diseases in high risk group as measured by a structured knowledge
questionnaire.
2. To find out the association between mean pre test knowledge score with the
selected demographic variables(sex, religion, type of family, monthly income of
family, residence, previous knowledge of cardio protective diet and source of
information).
3.To evaluate the effectiveness of structured teaching programme regarding the
importance of cardio protective diet in prevention of cardiac diseases in high risk
group among 3rd year B.Sc Nursing students in terms of gain in mean post test
knowledge score.
6.6 Operational definition:
1. Evaluate:
In this study it refers to judge the worth of structured teaching programme on
importance of cardio protective diet in prevention of cardiac diseases in high risk
group.
2. Effectiveness:
In this study it refers to the extent to which the structured teaching programme to
improve the knowledge level of 3rd year B.Sc. Nursing students regarding the
importance of cardio protective diet in prevention of cardiac diseases in high risk
group.
3. Structured teaching programme:
In this study it refers to systematically organized information’s provided to 3rd
year B.Sc Nursing students on importance of cardio protective diet in prevention
of cardiac diseases in high risk group to increase their knowledge.
9
4. Knowledge:
In this study it refers to the number of correct responses of the 3rd year B.Sc.
Nursing students of selected nursing colleges at Hassan regarding importance of
cardio protective diet in prevention of cardiac diseases in high risk group.
5. Cardio protective diet:
In this study cardio protective diet means the diet enriched with coronary
supplements and the application of these food items found to prevent risk of
cardiovascular disorders.
6. Cardiac diseases:
In this study cardiovascular disease means any disorders that affect structure and
functions of heart and related vasculature, ultimately result in complications in
human body including death.
7. High risk group:
In this study high risk group means persons who are having a family history of
cardiac disorder, age more than 35 years, attained menopause, habit of smoking,
diabetic mellitus.
8. Nursing students:
In this study they are 3rd year B.Sc. Nursing students studying nursing as a
profession in selected colleges at Hassan.
6.7 Variables under study:
1. Independent variable:
The structured teaching programme for 3rd year B.Sc. Nursing students regarding
the importance of cardio protective diet in preventing cardiac diseases in high risk
group.
2. Dependent variable:
The knowledge of 3rd year B.Sc. Nursing students regarding the importance of
cardio protective diet in prevention of cardiac diseases in high risk group.
3. Extraneous variable:
It includes sex, religion, type of family, monthly income of family, residence,
10
previous knowledge of cardio protective diet, source of information.
6.8 Assumptions:
1. The 3rd year B.Sc Nursing students have some knowledge regarding the
importance of cardio protective diet in prevention of cardiac diseases in high risk
group.
2. Structured teaching programme is an accepted teaching strategy for improving
the knowledge regarding the importance of cardio protective diet in prevention of
cardiac diseases in high risk group.
6.9 Limitations of the Study:
Study will be limited to
1. 60 students from the selected nursing college at Hassan District.
6.10 Research Hypothesis (Projected Outcome)
All hypotheses will be tested at 0.05 level of significance.
H1- The mean post test knowledge score of 3rd year B.Sc. Nursing students
regarding the importance of cardio protective diet in prevention of cardiac
diseases in high risk group will be significantly higher than mean pretest
knowledge score.
H2- There will be significant associations between the mean pretest knowledge
score and selected demographic variables.
7.
Material and Methods of Study:
7.1 Sources of Data:
The data will be collected from 3rd year B.Sc Nursing students of selected
nursing colleges at Hassan district of Karnataka State.
11
7.1.1. Research Design:
Quasi experimental one group pretest-post test design is planned for the
research study. Schematic plan of the study:-
Group
Pretest
Intervention
Posttest
60 third year B.sc
nursing
students
selected
nursing
colleges
at
O1
X
O2
Hassan,
Karnataka.
Key:O1
=
Pretest knowledge of 3rd year B.Sc., nursing
students regarding the importance of cardio
protective diet in prevention of cardiac diseases in
high risk group.
X
=
Structured teaching programme on importance of
Cardio protective diet in prevention of cardiac
diseases in high risk group.
O2
=
Post test knowledge of 3rd year B.Sc Nursing
Students regarding importance of cardio
protective diet in prevention of cardiac diseases in
high risk group.
7.1.2. Research Setting:
The study will be conducted in selected nursing colleges at Hassan district.
7.1.3. Population:
In this study population consist of 80 3rd B.Sc. nursing students studying in
selected nursing colleges at Hassan District.
12
7.2 Method of Data Collection:
7.2.1. Sampling procedure:
Simple random sampling method will be used for the study.
7.2.2. Sample Size:
A group of 60 3rd year B.Sc. nursing students of selected nursing colleges at
Hassan district of Karnataka State.
7.2.3. Inclusion criteria for sampling:
1. 3rd year B.Sc. Nursing students of selected nursing colleges at Hassan
district of Karnataka State.
2. 3rd year B.Sc. Nursing students who are present at the time of data
collection and willing to participate at the time of data collection.
7.2.4. Exclusion criteria for sampling:
1. B.Sc. Nursing students other than 3rd year B.Sc. Nursing students of
selected nursing colleges at Hassan.
2. 3rd year B.Sc. Nursing students who are absent at the time of data collection
and not willing to participate at the time of data collection.
7.2.5 Instruments Used:
Tool consists of :
Section 1
: Demographic Performa.
Section 2
: Structured knowledge questionnaire.
13
7.2.6 Data Collection Method:
Written permission will be obtained from the concerned authority. The
purpose of the study will be explained to the subjects and informed consent will
be taken and should be kept confidential. Pre test will be conducted to assess
the knowledge of students regarding importance of cardio protective diet in
prevention of cardiac diseases using structured knowledge questionnaire. A
structured teaching programme will be given to nursing students. The post test
will be conducted with the same structured knowledge questionnaire after
structured teaching programme.
7.2.7 Plan for Data Analysis :
Descriptive and Inferential statistics will be used for data analysis.
Findings will be presented in the form of tables and figures. Demographic data
will be presented in percentage, frequency, mean and standard deviation.
Effectiveness of structured teaching programme will be analyzed by using
paired‘t’ test. The association of mean pre test knowledge score with selected
socio demographic variables will be analyzed by using chi-square test.
7.3 Does the study require any investigations or interventions to be carried
out on patients or other humans or animals?
No. The study does not require any investigation or intervention.
However a structured teaching programme will be given to the 3rd year B.Sc.
Nursing students regarding the importance of cardio protective diet in
preventing cardiac diseases in high risk group.
7.4. Has ethical clearance been obtained from your institution in case of
7.3?
Yes. Ethical clearance will be obtained from the College of Nursing prior
to conduction of the study. Administrative permission will be obtained from the
subject and confidentiality will be maintained.
14
LIST OF REFFERANCE ( VANCOVER STYLE) :
1. www.thinkexist.com/quotes/with/keyword/prevention (accessed on 06/12/2011)
2. www.livestrong.com/article/79110-cardiacdiet. (accessed on 09/12/2011)
3. www.medscape.com/view article/543854-2.
4. Dinesh C. Sharma, “Heart Disease” India Today, New Delhi, April12,2010.
5. Joye K. Willcox, George L. Catignani and Sheryl Lazarus, “Tomatoes and
Cardiovascular Health”, Critical Reviews in Food Science And Nutrition
2003, Volume 43, Issue: 1, Pp: 1-18.
6. A.R Ness and J.W Powles, “Fruits and Vegetables and Cardiovascular
Disease”, Medical International Journal of Epidemiology, Volume 26,
Issue: 1, Pp; 1-13.
7. Basavanthappa B.T. Nursing research. New Delhi: Jaypee Brothers Medical
Publishers; 2003.
8. Michel De Lorgeril, Patritia Salen, Jean Louis Martin and Nicole Mamella,
“Effect of a Mediterranean type of diet on the rate of cardiovascular
Complications in patients with coronary artery disease insights into the
cardio protective effect of certain nutriments”, Journal of the American college
of cardiology, Volume:28, Issue:5, Pp:1103-1108.
9. Jennifer Mac Donald, Patricia B. Brevard, Robert E. Lee and Tammy Wagner,
“Link between diet and cardiovascular disease in Latin America and The
Caribbean using geographic information system 2009”, Volume:26, Issue:4,
Pp: 1580-1598.
10. S. Gosh, M.A Niaz, “Randomized controlled trial of cardio protective diet in
patients with recent acute myocardial infarction results of one year follow
up”, BMJ 2002, Volume: 304, Issue:1136, Pp:1015-1019.
11. N.C Cook and S.Samman, “Flavonoids- chemistry, metabolism, cardio
protective effects and dietary source 2004”,Volume: 65, Issue:4, Pp:337-353.
12. Victoria Shanta Retenly, Annie Neuendorf and Julie L. Roth, “Nutrition
Protocols for the Prevention of cardiovascular disease 2008”, Volume:23,
Issue: 5, Pp: 5468-5476.
15
8
Signature of the candidate
9
Remarks of the guide
10
Name and designation(in block
MRS.DEEPA ANU THOMAS,ASSOCIATE
letters)
PROFESSOR &H.O.D OF MEDICAL
Guide
SURGICAL NURSING,SRI H. D
DEVEGOWDA CO-OPERATIVE COLLEGE
OF NURSING,MANICHINAHALLY
GATE,BELURROAD.HASSAN.KARNATAKA
Signature
Co-guide(if any)
Signature
11
Head of the department
MRS.DEEPA ANU THOMAS
Signature
12
Remarks of the chairman and
Principal
signature
16
17