Download Data will be collected from the Security guards regarding varicose

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1
Ms. LAKSHMI RAO. M
NAME OF THE CANDIDATE AND IST YEAR M.Sc NURSING
ADDRESS
RAJIV GANDHI COLLEGE
NURSING
IIT CAMPUS
NEAR MEENAKSHI TEMPLE
BANNERGHATTA ROAD
BANGALORE 76
2 NAME OF THE INSTITUTION
RAJIV GANDHI COLLEGE
NURSING
IST YEAR M.Sc NURSING
MEDICAL SURGICAL NURSING
3 COURSE OF THE STUDY AND
SUBJECT
4 DATE OF ADMISSION TO THE 30-06-2010
COURSE
5 TITLE OF THE TOPIC
A STUDY TO ASSESS THE
EFFECTIVENESS OF SELF
INSTRUCTIONAL MODULE ON
KNOWLEDGE OF VARICOSE
VEINS AMONG THE SECURITY
GUARDS IN SELECTED
COMPANIES, BANGALORE
1
OF
OF
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Varic is a Latin word which stands for swollen. Varix is meant for an enlarged tortuous vein.
Varicose is the condition where varix is present, which means that it is not a disease by itself but
it can occur in many cases/diseases due to obstruction or other reasons. Varicose veins -- the
most common vein disorder -- are enlarged, twisted veins that are not moving blood effectively.
Veins move blood from your body to your heart. When the one-way valves in your veins
weaken, they may allow blood to flow backward and pool in your veins. Your veins then become
enlarged. Varicose veins usually show up in the legs and feet, because standing and walking
increases the pressure on these veins. They look like bulging, bluish cords beneath the surface of
your skin. Spider veins are similar to varicose veins, but they are smaller and closer to the
surface of your skin. Varicose veins are common, affecting up to 60% of Americans. Women are
more likely to have varicose veins than men are. In many cases, varicose veins are just a
cosmetic problem. But varicose veins can also cause pain and discomfort. In some cases serious
complications, such as phlebitis (inflammation of the veins), skin ulcers, and blood clots, can
occur, 1
Varicose veins develop when your veins stretch and their valves, which prevent blood from
flowing backward, don't work anymore. Primary varicose veins happen when the walls of your
veins become weak. They occur commonly as we age, and also in women during pregnancy.
Secondary varicose veins are most often caused by problems with veins that are deep among the
muscles, which carry about 90% of the blood returning to your heart. These problems include
blood clots and can be serious.1
Blood circulates through your anatomy in a simple, authentic pattern. It leaves your affection
abounding of oxygen and moves through your arteries. From there, it moves into capillaries and
food your organs and tissues with oxygen afore affective into your veins. claret flows through
your veins aback to your heart, which pumps it to your lungs to aces up added oxygen. Then, it
leaves your lungs and your affection to recirculate through your arteries again. Your veins accept
one-way valves aural them that ascendancy the administration in which your claret flows. The
2
valves ensure claret doesn’t breeze in the amiss direction. The botheration is, they can ache
accident for a array of affidavit and become butterfingers of accomplishing their job. As a result,
claret starts pooling, which causes venous billowing and agee in the area. This is accepted as
varicose veins. Below, we’ll board an overview that explores why they occur, affection you may
notice, and how they’re treated. We’ll additionally accord you a few tips for preventing their
onset.2
The veins activate throughout your anatomy may become weakened, and appropriately lose
their pliability. They amplitude and become beneath flexible. In this state, they additionally
anticipate the valve’s flaps from affecting anniversary other. The valves become separated,
which allows claret to breeze in the omission direction. When claret flows astern accomplished
the valves’ afar flaps, the vein swells to board the added volume. Depending on how astringent
the abatement is, the abscess may be significant. There’s bound amplitude abreast the veins, so
they activate to agglomeration up in adjustment to accomplish allowance for the added blood.
Eventually, they alpha to aberration adjoin anniversary other.This action can arise for a cardinal
of reasons, including obesity, pregnancy, and sitting or continuing in one abode for abiding
periods. The ataxia is prevalent, amid both men and women.3
If the valves within the veins fail to work properly, blood can flow backwards in the veins
and pool in the legs. The pooled blood can increase pressure in the veins. This can cause
problems that are mild (leg heaviness, aching, dilated or unsightly veins) or severe (swelling,
skin color changes, rashes on the legs, recurrent skin infections and chronic ulcers). People who
develop these symptoms are said to have chronic venous insufficiency. Varicose veins tend to
develop due to inherited characteristics (genetics) and the aging process. Any vein in the body
can become varicose, however it is more prevalent in the legs due to pressure from walking and
prolonged standing.4 A survey conducted in know the prevalence of varicosities and it was found
to be 47,928,1275
3
6.1 NEED FOR THE STUDY
A study was conducted in Dharwad among 3402 patients, and were examined for oral and
other varices. Oral varices were much more common than varicosities of other veins. Varices
were found to increase with age. Overall prevalence rate was 59.3 per 1000. This rate was
highest in the about 60 years age group being 329.94 per 1000.6
The prevalence and risk factors of varicose veins in Japan were investigated in 541 Japanese
women. Varicose veins were defined as any dilated, tortuous, and elongated veins of the lower
extremity and classified into four types. The total prevalence rate was 45%. Saphenous type was
observed in 22%, segment type in 35%, reticular type in 28%, and web type in 16%. Varicose
veins in Japan seem to be less common than in the United States and Europe but more prevalent
than in Africa. Concerning risk factors for varices, age, sex, heredity, and childbirth were related
to the incidence of varicosities, as reported by others. However, these risk factors were shown to
differ according to type of varicose veins.7
According to U. Vasudeva Rao of Manipal Hospital, varicose veins are another common
vascular disease, which affects 20 to 30 per cent of the population. Though varicose veins are not
life threatening problems, they can cause significant morbidity.Early detection and treatment
with proper stockings would prevent progression of the disease. “Unfortunately, many patients
are already in an advanced stage nursing swollen legs and ulcers. However, even at this stage
they can be treated with relatively simple surgery or laser procedures. The Vascular Society of
India has thus taken up a massive programme to create awareness about vascular diseases in the
country. A team of vascular surgeons from Bangalore at a press conference here on Thursday
explained the incidence of vascular disease, its causes and treatment. In Bangalore, smokers,
diabetics and those aged above 50 are at the risk of developing vascular diseases. Peripheral
vascular disease mainly affects the legs. The problem initially causes pain the calf muscles while
walking and the walking distance progressively reduces. If ignored, it results in severe pain in
the toes even at rest and can eventually lead to gangrene of the toes and foot, which might
4
necessitate amputation. Leg attack was dangerous as it could endanger the limb and life of the
patient. Blocked arteries in the leg mirror the rest of the body. When a patient has blocked
arteries in the heart (which causes heart attack) it indicates that there is 30 per cent chance of the
patient having vascular disease in other parts of the body. But a blocked artery in the leg
indicates that there could be a 60 to 70 per cent chance of vascular disease in other parts of the
body.8
The following statistics relate to the prevalence of Varicose veins:
41% women have abnormal leg veins by 50's, 60% of all American women and men suffer from
some form of vein disorder, 2.3% of population self-reported having varicose veins in Australia
1.1% of male population self-reported having varicose veins in Australia 2001 ,3.5% of female
population self-reported having varicose veins in Australia 2001, 440,000 people self-reported
having varicose veins in Australia 2001,98,000 men self-reported having varicose veins in
Australia 2001,342,000 women self-reported having varicose veins in Australia 2001 5
varicose veins are common in the adult population occurring in up to 40%of men and 33%of
women in the western world because the skin and tissue of elderly people is so fragile, they are
more likely to sustain minor leg injuries and ulcers which can then lead to ruptured veins.9
The incidence and prevalence of varicose veins has been studied in a number of crosssectional studies. In 1973, the United States Tecumseh community health study estimated that
about 40 million persons (26 million females) in the US were affected. In 1994, a review by
Callam found half of the adult population have minor stigmata of venous disease (women 5055%; men 40-50%) and fewer than half have visible varicose veins (women 20-25%; men 1015%). In 2004, these finding were also seen in a French cross-sectional study that found the odds
ratio per year for varicose veins were 1.04 for women and 1.05 for men. Age and gender have
been the only consistently identified risk factors for varicose veins.10
Individuals spending most of the day on their feet every working day are at greater risk of
health problems including varicose veins, poor circulation and swelling in the feet and legs, foot
problems, joint damage, heart and circulatory problems and pregnancy difficulties. A Hazards
survey of UK union health and safety officers found widespread problems from standing at
5
work. Unions representing shopworkers, teachers, library staff, production line workers, bank
workers, warehouse staff, museum workers, school supervisors, train drivers, printers, hospitality
and casino workers and engineers all reported standing-related health problems experienced by
their members. Workers in lower status jobs are far more likely to be required to stand for long
periods. Workers in higher status jobs are much less likely to be required to stand for long
periods without access to a chair.11
Even though varicosity can occur anywhere in the body, the commonest part that often
suffers is the leg (calf muscle area). This is because gravitational force endures more pressure in
the veins of legs due to the erect posture of the human being. Varicosity occurs on two
occasions, one, due to lack of muscular pump, and another, due to valve imcompetency/damage
due to diseases. As blood tend to pool in veins, veins get enlarged to become varicose veins.
Mostly, no one goes for medical treatment in the beginning unless cramps or pain develop. If the
problem is cosmetic, they will proceed for treatment even in the initial period. Also, as many of
the sufferer are reluctant to use stockings continuously (due to cosmetic concern or discomfort),
they opt for other methods.12
6.2 REVIEW OF LITERATURE
Review of related literature is an integral component of a study or research project. It
enhances the depth of knowledge and inspires a clear view into the crux of the problem,
literature review throws a light on the studies and their findings reported about the problem
under study
The review of work conducted in an area of interest can help in the formulation or
classification of a research problem. A scrutinizing of previous work acquaints the researcher
with what has been done in a field, thereby minimizing the possibility of an international
duplication and increasing the possibility that a new study will make a distinctive contribution to
knowledge. It will help the investigator to find the comparative data that could be used for
supporting the present findings to draw conclusion.
6
The investigator did an extensive review of the research and non-research literature related
to the present study and made an attempt through (MEDLINE), standard medical literature
analysis and retrieval system online search , which contributed new knowledge.
For review of subject matter

Description about varicose vein

Related studies about varicose vein
Description about varicose vein
A descriptive study was conducted in Khober, on Role of saphenous vein wall in the
pathogenesis of primary varicose veins, and it was conducted among 70 specimens of long
saphenous veins from 35 patients (24 with varicose and 11 with normal veins). Two specimens
were taken from each vein approximately 3-4 cm from the saphenofemoral junction. Vein
specimens were processed for histological and electron microscopic studies. Both qualitative and
quantitative analyses were performed to assess the degree of wall changes. Using the image
analyzer, contents of collagen, elastin and smooth muscle cells, in addition to intimal and medial
thickness, were measured, and result was found that Light microscopy revealed significant
increase in intimal and medial thickness and collagen content of media and significant decrease
in elastin content in varicose veins compared with normal veins. There was no statistical
significant difference between varicose veins with and without saphenofemoral valve
incompetence. Electron microscopy showed marked degenerative changes in intima and media
of varicose veins.13
A descriptive study was conducted in USA to find out Mechanisms of varicose vein
formation valve dysfunction and wall dilation. Varicose veins are a common venous disease of
the lower extremity. Although the mechanisms and determinants in the development of
varicosities are not clearly defined, recent clinical studies and basic science research have cast
some light on possible mechanisms of the disease. In varicose veins, there are reflux and
incompetent valves as well as vein wall dilation. Primary structural changes in the valves may
make them 'leaky', with progressive reflux causing secondary changes in the vein wall.
Alternatively, or concurrently, the valves may become incompetent secondary to structural
7
abnormalities and focal dilation in vein wall segments near the valve junctions, and the reflux
ensues as an epiphenomenon. The increase in venous pressure causes structural and functional
changes in the vein wall that leads to further venous dilation. Increase in vein wall tension
augments the expression/activity of matrix metalloproteinases (MMPs), which induces
degradation of the extracellular matrix proteins and affect the structural integrity of the vein wall.
Recent evidence also suggests an effect of MMPs on the endothelium and smooth muscle
components of the vein wall and thereby causing changes in the venous constriction/relaxation
properties. Endothelial cell injury also triggers leukocyte infiltration, activation and
inflammation, which lead to further vein wall damage. Thus, vein wall dilation appears to
precede valve dysfunction, and the MMP activation and superimposed inflammation and fibrosis
would then lead to chronic and progressive venous insufficiency and varicose vein formation.14
A descriptive study was conducted in Belgium know whether Hypoxia-induced activation of
endothelial cells as a possible cause of venous diseases, Blood stasis in leg veins is a situation
commonly linked to the development of venous diseases such as varicoses. Such a stasis will
provoke an ischemia, thus decreasing oxygen availability to tissues. Owing to its localization
between blood and tissue, endothelium is the first target of this insult. The authors develop here a
hypothesis in which the effect of oxygen deprivation on the functional state of the endothelium is
the starting point of a cascade of events leading to the disorganization of the vessel wall typical
of these pathologies. When venous human endothelial cells obtained from umbilical cords
(HUVEC) are exposed to hypoxic conditions they become activated without change in their
viability. The synthesis of a proinflammatory molecule (PAF, platelet-activating factor) and the
adhesion of human polymorphonuclear neutrophils (PMN) on HUVEC are markedly increased
during hypoxia incubation. These two processes are related to a calcium-dependent activation of
endothelial cells due to a decrease of adenosine triphosphate (ATP) availability during hypoxia.
Adherence of neutrophils to endothelial cells is the first step of diapedesis, which leads to the
infiltration of these cells in the media of the veins, where they affect the smooth muscle cells and
the connective tissue, leading to tissue alterations typical of the venous pathologies. The authors
propose that this sequential process which originates from a reduction in oxygen availability and
which involves different cell type as one main cause of the venous disorders, in addition to
genetic, hormonal, and mechanical factors.15
8
A comparative study was conducted in London to explain the cause of varicose veins, citing
three different factors as the primary cause valvular incompetence, a weakness of the vein wall,
and increased arterial inflow associated with multiple arteriovenous communications. This study
was designed to determine the cause of varicose veins with respect to these three factors. Duplex
scanning techniques were used to assess the venous valves, and simultaneous measurements of
calf volume (strain-gauge plethysmography) and venous pressure made during venous occlusion
plethysmography were used to determine the elasticity of the venous wall and the rate of arterial
inflow. Fifty-one control legs and 36 legs with superficial venous insufficiency were examined.
Risk factors were used to divide the control legs into two groups: low risk or normal (23 legs)
and high risk (28 legs). The results obtained in the high-risk limbs demonstrated a significantly
reduced vein wall elasticity (p less than 0.001) and increased arterial inflow (p less than 0.005)
compared with the normal limbs, with no corresponding increase in the incidence of valvular
incompetence. These results clearly suggest that the role of the venous valves in the development
of varicose veins is secondary to changes in the elastic properties of the vein wall and the rate of
arterial inflow.16
Related studies about varicose vein
A study was conducted in Finland to assess the prevalence and the extent of treatment of
varicose veins, a structured questionnaire was mailed to the respondents. The response rate was
75% in men and 86% in women. Both the sensitivity and specificity of the self assessed
diagnosis were 0.92. The life time prevalence of varicose veins was 18% for men and 32% for
women, with an increasing prevalence in relation to age. 25% of the men and 41% of the women
who reported varicose veins had received treatment. The prevalence of varicose veins was high
in the population studied, and the disease is more common in women than men. Moreover, the
prevalence increased with age. The results are comparable with other western populations.
Preventive methods are needed because treatment alone seems to be inadequate in the control of
varicose veins.17
A study was conducted in Finland to know the incidence of varicose veins, the purpose of
this study was to compare such prevalence rates with incidence rates from our longitudinal
9
follow-up study to find out whether there is a difference due to the methodology. A validated
questionnaire was used in 3 middle-aged cohorts (n = 6874) in Tampere, Finland. Positive family
history was more common both in men (prevalence odds ratio 6.6; 95% confidence interval, 4.79.3) and women (4.9; 95% confidence interval, 4.0-6.0) with varicose veins compared to those
without. However, positive family history was linked much less with the incidence of varicose
veins than the prevalence of varicose veins in women (incidence odds ratio 1.8; 95% confidence
interval, 1.1-2.8) and men 1.4 (95% confidence interval, 0.7-2.6). There is likely to be a
hereditary component of varicose veins, but it is substantially less than usually proposed in
literature.18
A study was conducted in Finland to assess whether smoking, alcohol drinking and dietary
factors are linked with varicose veins, A middle-aged general population of 4903 was studied,
and prevalence rates at entry and five-year incidence of varicose veins were assessed. Lifestyle
habits were recorded at entry and at the end of the follow-up.
New varicose veins were
significantly more common in individuals with regular alcohol intake, incidence odds ratio (OR)
1.5 (95% confidence interval [CI]: 1.05-2.3) in a multivariate analysis (of 2202 individuals). The
association was particularly strong in women. Smokers had a higher incidence of varicose veins
compared with non-smokers, OR 1.3 (95% CI: 0.9-1.8), but without statistical significance.
Having daily meals of meat implied less new varicose veins than having 0-2 weekly meals of
meat, and was concluded Alcohol was likely to increase the risk of varicose veins in women and
smoking in both genders. These findings were seen in the follow-up design, but not when the
data of these risk factors were compared with varicose veins prevalent at entry.19
A study was conducted to know the mechanisms of varicose vein formation valve
dysfunction and wall dilation and to define the relations between age, sex, lower limb symptoms,
and the presence of trunk varicose veins on clinical examination. The design of the study is
Cross sectional population study. It was conducted in 12 general practices with catchment areas
geographically and socioeconomically distributed throughout Edinburgh. The participants were
an age stratified random sample of 1566 people (699 men and 867 women) aged 18-64 selected
from the computerised age-sex registers of participating practices. Self administered
questionnaire on the presence of lower limb symptoms and physical examination to determine
the presence and severity of varicose veins. The results were found that tension, swelling, aching,
10
restless legs, cramps, and itching. The prevalence of symptoms tended to increase with age in
both sexes. In men, only itching was significantly related to the presence and severity of trunk
varices (linear test for trend, P=0.011). In women there was a significant relation between trunk
varices and the symptoms of heaviness or tension (P 0.001), aching (P 0.001), and itching (P
0.005). However, the level of agreement between the presence of symptoms and trunk varices
was too low to be of clinical value, especially in men. The results of the study was, vein in the
presence of trunk varices, most lower limb symptoms probably have a non-venous cause.
Surgical extirpation of trunk varices is unlikely to ameliorate such symptoms in most patients20
A study was conducted to know whether arteriovenous shunting involved in the
development of varicosities A study of the intraluminal pressure and oxygen content in varicose
veins. Arteriovenous (AV) shunting has been postulated as the underlying cause of varicose
veins. The aim of this study was to analyse pressure and oxygen content in primary varicose
veins in order to determine evidence of arterial shunting. 39 patients with varicose veins
underwent cannulation of varicosities. The pressure and the blood oxygen content within
varicosities were measured in different positions and during exercise. Similar measurements
were made in the long saphenous veins of 10 control subjects without venous disease. Mean
pressure in varicose veins in the supine position was 12.3 mmHg (Standard deviation [SD] 3.6
mmHg). Control subjects had similar pressures measured in the long saphenous vein. No
pulsatile pressure tracings were obtained. Varicosity pressures in the erect position averaged 66
mmHg (SD 9 mmHg). In all cases, the pressure correlated with the distance of the varicosity
from the heart. Pressure reduction in varicosities after exercise was significantly less than that in
control subjects. Recovery time (RT 90) was also significantly shorter than in the control group.
Mean venous pO2 in varicosities was 4.5 kPa (SD 1.0) in the supine position dropping to 3.9 kPa
(SD 0.9) on standing; these values were not significantly different to samples from control
subjects. AV shunting is unlikely to be a causative factor in the development of primary
varicose veins.21
A study was conducted in Germany to assess changes in the extracellular matrix of the vein
wall--the cause of primary varicosis. Conflicting theories on the development of primary
varicosis have led to the molecular biological investigation of the vein wall or, more accurately,
of the extracellular matrix. It was the aim of this study to quantify matrix expression and to
11
compare pathological changes in the vein wall with valve-orientated staging of varicosis, in order
to determine indicators of the primary cause of varicosis. Three hundred seventy-two tissue
specimens of greater saphenous veins were obtained from 17 patients with varicosities and
categorised according to Hach stage and procurement site. The specimens were compared with
36 specimens collected from six patients without varicosities, incubated with fluorescencestained antibodies for collagen 4, laminin, fibronectin and tenascin prior to being assessed with
confocal laser scan microscopy. In addition, 22 vein specimens (16 varicose, 6 normal veins)
serving as negative controls were investigated. The results Image analysis and statistical
evaluation showed that compared with normal veins, varicose veins are associated with a
significant increase in matrix protein expression for collagen 4, laminin and tenascin. A trend
towards an increase in matrix expression was further observed for fibronectin. There was,
however, no difference between varicose veins and clinically healthy vein segments inferior to a
varicose segment.22
A study was conducted in Brooklyn to find out the etiology of varicose veins remains
elusive. We hypothesized that abnormal cell cycle events in the vein wall may contribute to
changes in its structural integrity predisposing to varicosity development. Since cell cycle
checkpoint controls are linked to the signaling and execution of apoptotic cascades, possibly
apoptosis is a contributing factor in the pathophysiology of varicosities. The present study was
designed to investigate whether programmed cell death varies in varicosities as compared to
normal veins. Twenty-seven normal greater saphenous vein specimens were obtained from
patients undergoing infrainguinal arterial bypass surgery, and 20 varicose vein specimens were
retrieved from patients undergoing varicose vein excision. Apoptosis was detected by TUNEL
assay. Expression of bcl-2 and cyclin D1 was noted by standard immunohistochemical
techniques. Apoptotic cells were identified in 32 of the 47 specimens. Forty-eight percent of
normal vein specimens displayed >3 apoptotic cells per 100 cells in the adventitia; 15% of the
specimens of the varicose vein group showed such magnitude of apoptosis (p < 0.03). This
increased apoptotic activity was not observed in media or intima of either vein group (p < 0.001).
No significant difference in immunoreactivity to bcl-2 protein was observed in varicose vein
specimens as compared to controls. Varicose vein specimens demonstrated increased nuclear
expression of cyclin D1 whereas its cytoplasmic expression was significantly diminished (p
12
</=0.02). These data show that programmed cell death is inhibited in varicose veins. Differential
expression of cyclin D1 suggests that it may deregulate cell cycle events, thereby leading to
varicosity formation.23
A study was conducted in USA to describe the strategies and costs associated with recruiting
African American and white adults into a randomized controlled pilot trial. "Cryotherapy for
Venous Disorders: A Pilot Study" is a randomized controlled trial designed to determine the
effects of a cool gel wrap and leg elevation intervention versus a leg elevation alone intervention
on skin temperature, skin microcirculation, quality of life, and pain in adults with stages 4 and 5
chronic venous disorders. We sought to recruit 60 participants (21 African Americans, 37 whites,
and 2 Hispanic or Latino) to complete the study. These enrollment targets reflect the
demographic distribution of the community in which the study was conducted (33% African
American, 66% white, and 2% Latino). Proactive and reactive recruitment strategies were
implemented to recruit subjects. Seventy-three individuals (9 African American men, 29 African
American women, 11 white men, 22 white women, 1 Asian woman, and 1 Hispanic woman)
were screened, and of those, 67 were randomized (9 African American men, 25 African
American women, 9 white men, 22 white women, 1 Asian woman, and 1 Hispanic women).
Fifty-eight completed the study, yielding an overall 11% attrition rate. An additional 8 subjects
canceled or did not show up for a first appointment. Reactive recruitment strategies were most
successful for recruiting men, women, African American, and white participants. The 3 most
successful reactive strategies were referrals from providers/clinics (34%), flyers posted in the
hospital elevators (22%), and targeted mailings from a business (16%). Of the healthcare
provider referrals (19), wound care nurses referred 12 completed participants. The amount
budgeted for advertisement was $5,000 (2% of the total grant award). The amount spent on
recruitment including labor was $5,978, which averaged $103 per participant who completed the
study (N = 58). Reactive strategies per participant completer proved more cost-efficient than
proactive strategies ($83 vs $215). However, the time spent by the principal investigator
(approximately 100 hours or 2.5 hours per week x 40 weeks) on recruitment, particularly
maintaining frequent face-to-face contact with providers, increased success in the area of
healthcare provider referrals.24
13
6.3 STATEMENT OF THE PROBLEM
A study to assess the effectiveness of self instructional module on varicose veins among security
guards in selected companies, Bangalore.
6.4 OBJECTIVES OF THE STUDY
1. To assess the knowledge of security guards regarding varicose veins
2. To assess the effectiveness of Self Instructional Module in terms of pre and post test
knowledge of security guards on varicose veins
3. To develop a Self Instructional Module regarding varicose veins
4. To associate the pre and post test score on varicose veins with selected demographic
variables
6.5 OPERATIONAL DEFINITIONS

ASSESS
Refers to the level of knowledge of security guards regarding the varicose veins

EFFECTIVENESS
It refers to the gained knowledge as determined by significant difference in pretest and post test
scores

SELF INSTRUCTIONAL MODULE
In this study SIM refers to a self learning guide designed for the security guards to
understand logically the Meaning, Definition, Risk factors, Causes, Clinical manifestations,
Diagnosis, Treatment and Prevention of Varicose veins.

KNOWLEDGE
14
In this study knowledge refers to the scores obtained by security guards in correct responses to
the questions relating to varicose veins.

VARICOSE VEIN
Varicose veins are dilated tortuous veins occurring in the lower extremity. Some patients with
venous problems have no visible veins, or may present with telangiectasias (chronic dilation of
groups of capillaries causing elevated dark red blotches on the skin) or ulcers.

SECURITY GUARDS
Refers to the person who is working as a security guard in who is above 30 years, with a
minimum of 5 year experience in selected companies Bangalore
6.6 ASSUMPTIONS
1. Security guards have the risk for developing varicose veins
2. Security guards have inadequate knowledge regarding varicose veins
3. Self Instructional module enhance knowledge of varicose vein to security guards
6.7 HYPOTHESIS
H1:
The post test knowledge scores of Security guards regarding varicose veins will be
significantly higher than their pre-test knowledge score.
H2: There will be a significant association with the knowledge score and the selected
demographic variables.
6.8 DELIMITATION
The study is delimited to security guard in selected company Bangalore
15
7. MATERIAL AND METHOD
7.1 Source of data:
Data will be collected from security guards at selected companies in Bangalore
7.1.1 Research design:
The research design selected for this study is pre-experimental (one group pretest post test
design )
7.1.2 Settings
The study will be conducted in the selected companies at Bangalore
7.1.3 Population
All the securities working in the selected companies in Bangalore, who fulfill the inclusion
criteria
7.2 METHODS OF DATA COLLECTION
7.2.1 Sampling procedure
Convenient sampling technique will be used to select the sample for the study
7.2.2 Sample size
The sample size consist of 50 security guards
16
7.2.3 Inclusion criteria
1. Security guards who are aged above 40 years and working as security minimum for 5
years
2. Security guards who are willing to participate in the study
3. Security guards who are in the duty during the period of data collection
4. Male Security guards
7.2.4 Exclusive criteria
1. Security guards who are absent during the period of data collection
2. Security guards who are unable to communicate effective in English
3. Security guards who are females
7.2.5 Instruments intended to be used
Self instructional module
Structured questionnaire questionnaire
7.2.6 Data collection method
Data will be collected from the Security guards regarding varicose veins by administering the
structured knowledge questionnaire regarding varicose veins
7.2.7 Plan for data collection
Descriptive: Mean, median, mode, standard deviation, percentage and co-efficient of correlation
will be calculated
17
Inferential: Chi-square, t-test would be used to find out the effectiveness of Self Instructional
Module on varicose veins
7.3 Does the study require investigation or intervention to be conducted on patient or other
human or animal
Yes, the study will be conducted among the Security guards regarding knowledge of varicose
veins
7.4 Has ethical clearance been obtained from your Institution
Permission will be obtained from research committee of the Rajiv Gandhi College of Nursing
Informed consent will be obtained from security guards of selected companies to participate in
the study
Permission will be obtained from the concerned authority of selected companies Bangalore
18
8. LIST OF REFERENCES
1. Douglas, WS ,Simpson NB. The Guidelines for the management of chronic venous leg
ulceration report of a multidisciplinary workshop. British Association of Dermatologists
and the research unit of the Royal college physicians: 1995;.
2. Nelson, EA,et al. Compression for preventing recurrence of venous ulcers cohrane data
base Review 2000; 98.
3. Mani, R,et al.. Intermittent pneumatic compression for treating venous leg ulcers.
Cochrane Database Syst Rev 2001;
4. Callam, MJ. Epidemiology of varicose veins. Br J Surg 1994; 81:167.
5. http://www.wrongdiagnosis.com/v/varicose_veins/stats6. Chatopadhya K etal. Department of oral medicine, SDM college and dental science and
hospitals, Dharwad, Karnataka, 1993; 38(3): 37-40
7. Hasafumi Hirai., Department of angiology august 2009;60:487-491
8. The Hindu. April 26, 2008; Saturday
9. Wesley K Lew, Resident, Department of General Surgery, University of Southern
California. Jul 7, 2010.
10. http://www.medindia.net/news/First-Aid-can-Prevent-Death-of-Varicose-Vein-Patients11. Standing problem Hazards 91, August 2005.
12. Chidambaram Article, department of homeopathy, published on July 24, 2006.
13. Elsharawy IA. Et al. “Role of saphaneous wall in pathogenesis of primary varicose vein,
Department of surgery, college medicine, king faisel university, April 2007;6(2):224.
14. Raffetto JD, Khalil RA. “Mechanisms of varicose vein formation valve dysfunction and
wall dilation” 2008; 23(2):85-98.
15. Michiels C,et al, “Hypoxia-induced activation of endothelial cells as a possible cause of
venous diseases: hypothesis” Aug 2003;44(8):639-46
16. Clarke GH,et al. “Venous wall function in the pathogenesis of varicose veins” Apr
1992;111(4) 402-408.
17. .J Laurikka, et al“Varicose veins in a Finnish population aged 40-60”Apr 2010 ;48:212.
19
18. Gherman C, “ Effect of Family History on the Incidence of Varicose Veins: A
Population-Based Follow-Up Study in FinlandANGIOLOGY August 1, 2009; 60: 487491.
19. Ahti TM et al. “Lifestyle factors and varicose veins: does cross-sectional design result in
underestimate of the risk?” 2007 Oct;60(1):50-7.
20. . Mironiuc A et al. “mechanism of varicose vein formation”, 2008; Feb;17(3):350-9.
21. .Murphy MA, Hands L. “Is arteriovenous shunting involved in the development of
varicosities? A study of the intraluminal pressure and oxygen content in varicose veins”
2008;23(3)137-41
22. Kirsch D, et al. “Changes in the extracellular matrix of the vein wall--the cause of
primary varicosis” Aug 2000; 29(3):172-177
23. Ascher et al Programmed cell death (Apoptosis) and its role in the pathogenesis of lower
extremity varicose veins.Jan 2000;(1):24-30
24. Kelechi TJ, et al, “Effectiveness of cryotherapy intervention for a venous leg ulcer
prevention study 2010: 2010; Jan 37(1), 39-45
20
9. Signature of Candidate
10. Remarks of the guide
VARICOSE
VEIN
IS
COMMONLY
OCCURING
DUE
TO
PROLONGED
STANDING. SECURITY GUARDS ARE
THUS AT A HIGHER RISK OF FACING
THIS PROBLEM. THERE IS A NEED TO
MAKE AWARENESS ON THIS ISSUE.
11.1. Name and Designation Mrs. DHANALAKSHMI M. K
Guide
ASSISSTANT PROFESSOR
11.2. Signature
Mrs. DHANALAKSHMI M.K
12.1. Head of the department
12.2. Signature
21
13.1. Remarks of chairman and
This study is feasible to conduct.
principal
13.2. Signature of principal
22