Download (sim) on knowledge regarding the life style modifications among the

RAJIV GANDHI UNIVERSITY OF HEALTH
SCIENCES, BENGALURU, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
MR. FINNY PATHICKAL BENNY
MEDICAL- SURGICAL NURSING
I YEAR MSC NURSING
YEAR 2011-2012
SJB COLLEGE OF NURSING
BENGALURU-560060.
0
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BENGALURU, KARNATAKA.
ANNEXURE-1
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
1. NAME OF THE
Mr FINNY PATHICKAL BENNY
CANDIDATE AND
1ST YEAR M.Sc. ( NURSING ),
ADDRESS
SJB COLLEGE OF NURSING,
BGS HEALTH AND EDUCATION CITY
KENGERI,
BENGALURU – 500 060.
2. NAME OF THE
INSTITUTION
SJB COLLEGE OF NURSING,
BGS HEALTH AND EDUCATION CITY
KENGERI, BENGALURU-60.
3.
COURSE OF STUDY AND
1ST YEAR M.Sc. NURSING
SUBJECT
MEDICAL-SURGICAL NURSING
4. DATE OF ADMISSION TO
COURSE
24-10- 2011
“A
5. TITLE OF TOPIC
STUDY
TO
EVALUATE
EFFECTIVENESS
OF
THE
SELF
INSTRUTIONAL MODULE (SIM) ON
KNOWLEDGE REGARDING THE LIFE
STYLE MODIFICATIONS AMONG THE
PATIENTS
WITH
VALVULAR
DISORDERS WHO HAVE UNDERGONE
VALVE REPLACEMENT SURGERY IN
SELECTED
CRADIAC
HOSPITALS,
BENGALURU.”
1
6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION
“I believe every person has a heart, and if you can reach it,
you can make a difference”.
By Uli Derickson
The normal heart valve performs an amazing mechanical function. The
activity starts when the foetus is barely 6 to 8 weeks old and works last till the end
of the life. Opening and closing with each beat of the heart, about 40 million times
per year and for a life time that is over 2.5 billion times generally without a failure.
Sometimes there may be a chance that heart valves may not work properly. 1
In today’s world, most deaths in the developing and developed countries
are attributable to non-communicable diseases and just over half of these are the
result of cardiovascular diseases. More than one third of deaths occur in middle
aged adults. In India an estimated 2.27 million people died due to cardio vascular
disease during 1990 and the projection of deaths due to increase of heart disease
from 1.17 million to 1.59 million in 2000 and 2.30 million by 2010 .The
prevalence of coronary valve disease is reported to be 2 to 3 times higher in urban
population than in rural population and it is estimated as 96.7 percentage in 1000
adult population in urban and 27.1 percentage in rural population.2 The American
heart association reported a statistics in the basis of 2007 mortality rate which
shows that, there was more than 2200 deaths occurring due to CVD in America in
each day.3
In India, it has become a major health issue with deaths due to CVD
expected to double during 1985 to 2015. Mortality estimates due to CVD vary
widely by state, ranging from 10% in Meghalaya (49%) in Punjab (49%), Goa
(42%) Tamil Nadu (36%) & Andrapradesh (31%) have the highest CVD related
mortality estimates.4 Some diseases, such as rheumatic fever, endocarditis,
2
streptococcal infections, and calcification are capable of causing damage the
valves that will eventually need to be repaired or replaced.5
Valvular heart disease ranks well below coronary heart disease in
worldwide. Stroke, hypertension, obesity, and diabetes as major threats to the
public health, nevertheless, it is the source of significant morbidity and mortality
rates. Cardiac disease prevalence has been estimated to range from as low as 1 per
100,000 school-age children in Costa Rica to as high as 150 per 100,000 in China.
Prevalence and mortality rates vary among communities even within the same
country as a function of crowding, the availability of medical resources and
population-wide programs for detection and treatment.5
When a valve is getting malfunction, four abnormalities may happen. The
valve does not open at all, or there is narrowing of the pathway thereby restricting
the forward flow of blood which is called as stenosis. Another type is that the
valve does not close properly and allow the blood to flow backwards that is called
as regurgitation or insufficiency. Next type is the abnormal protrusion or intrusion
of valve, generally called as valve prolapse and finally the valve neither opens nor
closes properly, causing a combination of above problems. Often clients with early
or mild forms of valve disease live with a fairly normal life without any treatment.
But symptoms such as dizziness, fatigue, shortness of breath and chest pain etc,
become significant enough to affect the daily life before and after the surgery.
Today valve surgery can correct these problems and restore the function of
diseased valves .6 The support by the nurse with health education will restore the
optimal health of clients who has undergone valve replacement surgery.7
3
6.1 NEED FOR THE STUDY
Cardio Vascular disease (CVD) has become a major killer of mankind. It
accounts for over one million deaths each year, with a yearly death of more than
400,000 Americans.8
In India, CVD has become a major health issue and expected to be double
during 1985 to 2015. Mortality estimates due to CVD vary widely by state, ranging
from 10% in Meghalaya (49%) in Punjab (49%), Goa (42%) Tamil Nadu (36%) &
Andrapradesh (31%) have the highest CVD related mortality estimates.4
The WHO estimated that 60% of the World’s cardiac patient was Indian by
2010. Recent studies showed that Valvular heart disease is a leading cause of
morbidity and mortality in India.9 Significant valvular heart disease has a national
prevalence of 2.5% and affects 13% of patients with 75 years old.10
The nurse must be aware of cardio-vascular disease risk factors and be alert
for opportunities to teach health promotions measures to the patients with valve
replacement surgery and their families. Clinical nurse needs necessary knowledge
to provide a health teaching to acquire client’s normal daily life activities which
eventually will leads the heart to its normal function.
A comparative study was conducted from January 2003 to December 2008
by New Delhi University on a short term mortality and morbidity of mechanical
and bio prosthetic heart valves in the Indian population. A total sample of 503
patients who had undergone cardiac valve replacement surgery was retrospectively
analysed. Clients with both mechanical and biological valves were selected. The
study concluded that, patients with Mechanical valves (n=257) are associated with
a significantly higher complication rate compared with patients having biological
valves (n=246). The study reveals that after the surgery secondary complications
will be associated in both mechanical and biological valve replacement clients.
4
The complications include secondary myocardial infraction, ischemia, and
abnormal rhythm etc.11
A study was conducted on 2007 and published on Annals of thoracic
surgery regarding the quality of life after the valve replacement surgery. Sample
sizes of 184 patients with mitral valve prolapse or regurgitation were selected for
control and experimental group with Nottingham Health Profile quality-of-life
analysis. The average interval between surgery and administration of the Quality
of Life techniques was approximately 7.5 years in both groups. The study reveals
that the factors for death were preoperative unstable angina pectoris (relative risk
ratio, 4.4; 95% confidence interval, 2.2 to 8.8), use of mitral prosthesis (relative
risk ratio, 2.7; 95% confidence interval, 1.4 to 5.3), preoperative renal
insufficiency (relative risk ratio, 1.0; 95% confidence interval, 1.0 to 1.007), and
preoperative cerebrovascular disorder (relative risk ratio, 2.7; 95% confidence
interval, 1.0 to 5.3). The study revealed that the quality of life after the surgery had
altered and was thought to trigger the secondary cardiac disease. Subjects who had
positive attitudes and activities in their lifestyles showed lesser cardiac risk
factors.12
There are some noted essential lifestyle changes needed for the client after
valve replacement surgery. For most clients, after surgery enhanced functional
capacity leads to a greater ability to perform the activities of daily living. Older
clients who undergo heart valve surgery have longer hospital stays and more
complications. Turning back to the cardiac normal function after surgery in
hospital and home care is also an opportunity to the health care personals to
evaluate medical management and to educate clients about the safety of increasing
physical activity, procedures outcome, reducing the risk factors and monitoring
warning signs and symptoms .13
5
Nurses have the responsibility to bring back the client to a better quality of
life by several methods such as health awareness program, health profile screening,
and health educations. Proper teaching and guidance will leads the clients to a
better competent life. Here the investigator felt the need of educate the client who
has undergone surgery for valvular repair, which will improve the client daily
activities and the heart functioning after the surgery.
6.2 REVIEW OF LITERATURE
Review of literature for the present study is explained under the following
headings:
1.Literature related to Lifestyle modification after valve replacement surgery.
2.Literature related to the effectiveness of Self Instructional Module (SIM).
1. Literature related to Lifestyle modification after valve replacement
surgery.
A cross-sectional survey was conducted on Association of Trans fatty acids
and clarified butter intake with higher risk of coronary artery disease in rural and
urban populations with low fat consumption. The survey included a sample 1769
rural and 1806 urban randomly selected subjects between 25-64 years of age from
Moradabad in North India. The survey revealed among urban and rural subjects
consuming moderate to high fat diets and had a significantly higher prevalence of
coronary artery disease. These prevalence was in people who are consuming
clarified butter plus vegetable oils in both rural (9.8, 7.1 vs. 3.0%) and urban (16.2,
13.5 vs. 11.0%), men as well woman as in rural (9.2, 4.5 vs. 1.5%) and urban
(10.7, 8.8 vs. 6.4%). The researcher concluded that it is possible that lower intake
of total visible fat (20 g/day) by decreased intake of milk, increased physical
activity and cessation of smoking may benefit some populations in the prevention
and reduction of coronary artery disease.14
6
A study was conducted by doctors in Karolinska University Hospital,
Sweden in order to assess the quality of life and the mortality rate after the heart
surgery. The study included 4,086 cardiac surgery patients and identified 141
patients who had a postoperative intensive care unit stay of more than 10 days with
the Karnofsky performance scale and the Short Form-36 questionnaire scale .The
data regarding patient’s outcome were collected. The study results concluded that
early mortality was 33%. They found significantly lower physical (39.7 %) and
mental (44.1 %) scores, especially in patients who required dialysis. However,
long-term survival and functional status were encouraging according to the Quality
of life. 15
An experimental study was conducted at Department of Cardiothoracic
Surgery, University Hospital, Sweden from 1998 to 2003. A sample size of 225
clients who underwent primary heart valve surgery were selected, who required 8
days or more of treatment in an intensive care unit with Nottingham health profile
and SF-36 scale were analyzed. A cohort group (n =154) matched for sex, age,
type of procedure, and week of operation, with an uncomplicated postoperative
course (ICU stay of 2 days or less) served as the control group. The study revealed
a 5 year Survivor in the total ICU group was 68%, this group showed quality of
life by lesser physical mobility after heart valve surgery compared with controls
group and 80% patients experienced improvement after surgery in terms of quality
of life.16
A study was conducted on lifestyle changes following acute myocardial
infarction, patient’s perspectives for assessing the impact of life style changes in
heart disease. The study found that the secondary cardiac warning signs taking
responsibility for lifestyle changes.
The study highlights the need for the
development of supports to the patient’s through by providing information to
families to reduce anxiety and fear regarding secondary cardiac diseases after the
surgey.17
7
In 2007 the American college of Cardiology and American heart
association grouped a guideline committee for administering guideline to the
health professionals regarding the importance of life style modifications after the
cardiac surgery on the basis of various studies and statistics. In the committee they
include patients with heart valve surgical repair or replacement for prime aspects
of consideration. The Writing Committee focused its attention on two general
performance measurement sets: Referral of eligible patients to an outpatient
Cardiac rehabilitation (CR) program, and delivery of appropriate CR services by
CR programs. The committee recommends that the guideline should be
implemented in the health care delivery system.18
Several articles were published online regarding the need for the life style
changes after the valve replacement surgery. It was evident that sedentary life style
changes such as food, activities pattern
control, dietary recommendations, rest
20
19
, reducing cigarette smoking, weight
and Sexual activities adjustment which
improved the quality of life after the surgery. 21
2. Literature related to the effectiveness of Self Instructional Module (SIM).
A
study was conducted on 2009 to assess the effectiveness of Self
Instructional Module regarding quality of
life among patients following
CABG surgeries in the elderly . A total number of 63 patients with 65 years of
age group, both males and females were selected by convenience sampling
technique. A detailed questionnaire was used to collect data about quality of
life and improvement in lifestyle after CABG surgery . The study result showed
that a high proportion of the patients experienced improvement (that is 45
patients) in life style modifications, while a substantial number (that is 15
patients) had exacerbations in cognitive function, lack of confidence and
dependence. The study concluded that an important step is needed to improve the
quality
of
life,
might
be
through
the
institution
of
a
structured
multidisciplinary rehabilitation program, also the life style modification with
focus on emotional support.22
8
A study was conducted to assess the effectiveness of Self Instructional
Module on patient knowledge and compliance of Quality of Life among 30
patients who had underwent valve replacement surgery and 18 patients who had
had coronary artery bypass surgery were included in this study. Among them 25
patients were taught by masters-prepared clinical specialists and 23 by nurses with
less than master’s preparation. Measurements of knowledge and compliance were
obtained preoperatively. The study revealed that the patients who are received
teaching from masters-prepared nurses had significantly higher test scores at
discharge than the teaching received by nurses with less than master’s degree. So
there is an effectiveness of teaching programme by the nurses with masters in
degree regarding Quality of life after valve replacement surgery.23
9
6.3 STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of Self Instructional Module (SIM)
on knowledge regarding the life style modifications among the patients with
valvular disorders who have undergone valve replacement surgery in selected
Cardiac hospitals, Bengaluru.”
6.4 OBJECTIVES
1. To assess the knowledge among patients who have undergone valve
replacement surgery regarding lifestyle modification by pretest knowledge
score.
2. To evaluate the effectiveness of Self Instructional Module on knowledge
regarding lifestyle modification for patients who have undergone valve
replacement surgery by comparing pre and posttest knowledge scores.
3. To find out association of pretest knowledge scores with selected
demographic variables.
6.4.1 HYPOTHESIS
H1: There will be a significant difference between pre-test and post-test
knowledge scores regarding life style modification of patients who have
undergone valvular replacement surgery.
H2: There will be significant association between pretest knowledge scores and
selected demographic variables.
6.4.2 VARIABLES
1. Independent variable: Self Instructional Module on knowledge regarding
lifestyle modification for patient who have undergone valve replacement
surgery.
2. Dependent variable: knowledge of patients regarding lifestyle modification
3. Demographic variables: Age, sex, residing, family history, occupation,
source of information, educational background and working experience of the
patients.
10
6.5 OPERATIONAL DEFINITIONS
1.Evaluate: It refers to systematic determination of merit, worth and
significance of subject’s response to Self Instructional Module (SIM).
2.Effectiveness: It refers to the extent to which the Self Instructional Module
(SIM) has achieved the desired effect in improving the knowledge of patients
as evidenced from gain in knowledge scores on life style modification.
3.Self Instructional Module (SIM): It refers to the systematically developed
instructional method and teaching aids designed for patients to provide
information on lifestyle modifications.
4.Knowledge: It refers to correct responses of patients to the questionnaire on
lifestyle modifications.
5.Lifestyle modification: It refers the change in habits of a client’s including
alcohol Consumption, smoking, physical activity, food habits etc. which
enhance optimal cardiac function after surgery.
6.Valve replacement surgery: It refers to the replacement of impaired heart
valve with the prosthetic valve
6.6 ASSUMPTION
1. Patients, who have undergone the valve replacement surgery, may have
some knowledge regarding lifestyle modifications.
2. Self Instructional Module may improve the knowledge of patients who
have undergone valve replacement surgery regarding lifestyle modifications.
6.7 DELIMITATIONS
1. Study is limited to patients who have undergone valve replacement surgery
in selected hospital, Bengaluru.
2. Study is limited to patients who are willing to participate.
7.
MATERIALS AND METHODS
7.1 Sources of data: patients who have undergone valve replacement surgery in
selected hospital, Bengaluru.
7.1.1 Research Approach: Evaluative approach.
7.1.2 Research design: Pre-experimental one group pre-test and post-test design.
7.1.3 Setting: selected Cardiac hospitals in Bengaluru.
7.1.4 Sample size: 40 patients who has undergone valve replacement surgery at
selected Cardiac hospitals in Bengaluru.
11
7.1.5 Inclusion criteria:

Patients, who have undergone valve replacement surgery, present at the
time of data collection.

Patient who are able to read English and kannada
7.1.6 Exclusion criteria:
 Patients who are not willing to participate in the study.
 Patients who are critically ill, at the time of data collection.
 Pediatric patient.
7.2.
Method of collection of data
7.2.1 Sampling technique : Non- probability purposive sampling technique.
7.2.2 Tool of research
: Self-administer structured questionnaire.
Structured questionnaire consist of two parts:
Part I- Demographic data
Part II-Knowledge based questionnaire regarding lifestyle modification after
valve replacement surgery
7.2.3 Collection of data
The investigator himself collects the data from patients from selected
hospital, Bengaluru.
 Investigator himself collects the data from patients through structured
questionnaire.
 Administers Self Instructional Module to the patients who have undergone
valve replacement surgery.
 Same structured questionnaire is used for post-test to evaluate the
effectiveness of Self Instructional Module.
7.2.4 Duration of the data collection: 4 weeks.
7.2.5 Method of data analysis and presentation
1. The investigator uses descriptive and inferential statistics techniques by
using mean, median, frequency, reliability test, standard deviation, paired t-test
and chi-square test for data analysis.
2. The analyzed data will be presented in the form of tables, diagrams and
graphs based on findings.
12
7.3
Does the study require any investigation to be conducted on human
beings or animal? If so describe briefly?
Yes [Structured questionnaire to patients]
7.4
Has ethical clearance been obtained from your institution?
1. Yes, consent will be obtained from concerned subjects and authority of
institution.
2. Privacy, confidentiality and anonymity will be maintained.
3. Scientific objectivity of the study will be maintained with honesty and
impartiality.
13
8. REFERENCE
1.Willam and Wilkins. Pathophysiology 2 in one reference for nurses. 1st
edition. Pheladelphia: Lipincott Publication: 2005. p.143
2.Park. K. Textbook of preventive and social medicine. 18th ed. Jabalpur: M/s
Banarsidas Bhanot Publishers; 1970. p.13-5, 29,287.
3.Heart Disease and Stroke Statistics—2011 Update A Report from the
American Heart Association. [Online] 2012 Feb8 [cited2012 Feb 6].
Available from: URL:http://circ.ahajournals.org/content/123/4/e18
4.Sharon .L.Lewis, Chintamani, Mrinalini.Mani. Et al. Medical and Surgical
Nursing,7th ed Philadelphia: Mosby Elsiver Publications; 2011. p.745-928.
5.Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, et al, editors. Harrison’s
principles of internal medicine. 14th ed. New York: McGraw Hill, Health
Professions Division; 1998.Vol 2 .p1949
6.Heart Valve Disease. [Online] 2010 Jan16 [cited2011 Nov 10]. Available
from: URL:http://www.onxlti.com/heart-valves/patient-guide/Heart Valve
Disease/
7.What are overweight and obesity? [online] Nov 01 2010 [cited 2012 Feb 11]
URL; http://www.nhlbi.nih.gov/health/health-topics/topics/obe/
8.Katherin.M, Erika.S, Sivarajan.Froelicher. Cardiac nursing.4th ed. Lippincott
Williams and Wilkins publishers: 1997. ch 29,31,35Heart disease on the rise
in India. [online]. 2009 Apr 02 [cited2012 Feb 10]. Available from: URL:
http://articles.cnn.com/2009-04-02/health/india.heart.disease_1_mutationheart-disease-heart-attacks?_s=PM:HELTH
9.Suman Bhandari, K Subramanyam, N Trehan. Valvular Heart Disease:
Diagnosis and Management. JAPI. 2007 Aug 6 ; 55:575-84. Available from:
URL: http://www.japi.org/august2007/U-575.pdf
10. Cases Studies in Valvular Heart Disease: An Evidence-Based, Real-Life
Interactive Experience. [Online] .2011Apr2 [cited2012 Jan10]; Available
from: URL: http://www.mayo.edu/cme/cardiovascular diseases-2011r497-03
14
11. Mandiye Shiv Sagar, Agarwa Saket, Pratap Himanshu, Kumar Singh
Aditya, et al. Comparison over short term mortality and morbidity of
mechanical and bio prosthetic heart valves in the Indian population. Indian
Journals for Thoracic and Cardio vascular Surgery 2010 JUN 24; 26:139–43.
12. Janne J. Jokinen, Mikko J. Hippelainen, Otto A. Pitkänen.Mitral Valve
Replacement versus Repair: Propensity-Adjusted Survival and Quality-of-Life
Analysis. Annals of thoracic surgery 2007 MAR; 84:451-8
13. Questions about heart failure. [Online] 2006 Sep09 [cited2011 Nov 25].
Available from: URL:http://www.abouthf.org/questions_living.htm
14. Singh RB, Niaz MA, Ghosh S, Beegom R, Rastogi V, Sharma JP, Dube
GK. Association of Trans fatty acids and clarified butter intake with higher
risk of coronary artery disease in rural and urban populations with low fat
consumption. Int J Cardiol 1996 Oct 25; 56(3):289-98.
15. Emma Lagercrantz, Dan Lindblom, Ulrik Sartipy. Survival and Quality of
Life in Cardiac Surgery Patients With Prolonged Intensive Care: Annals of
thoracic surgery 2010 Sep :89:490–6
16. Laila Hellgren, Elisabeth Stahle, Quality of Life after Heart Valve Surgery
with Prolonged Intensive Care.Annals of thoracic surgery 2004April
:80:1693-98
17. Parvathi .G. A study to assess the effectiveness of structured teaching
programme on life style modifications of patients with Myocardial Infarction
attending Cardiology outpatient department in selected hospitals of Bellary.
Unpublished Master of nursing Dissertation. Rajiv Gandhi University of
health science. Bangalore. 2008; p. 5-6
18. Randal J. Thomas, Marjorie King, Karen Lui, Neil Oldridge, et al.
AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation
for Referral to and Delivery of Cardiac Rehabilitation/ Secondary Prevention
Services. [Online] [Cited2011 Nov 29]. Available from:
URLhttp://content.onlinejacc.org/cgi/content/full/50/14/1400
15
19. Edward .Winslow, Nancy. Bohannon, Stephen A. Lifestyle Modification:
Weight Control, Exercise, and Smoking Cessation. American journal of
medicine 1996 ; 25-35
20. Heart Disease: Tips for Prevention [Online] 2009 Mar [cited2011 Dec 20].
Available from: URL: http://www.umm.edu/features/tips_prev.htm
21. Resuming Activities and Exercise after Heart Surgery. [Online]
[cited2011dec 25]. Available from: URL: http://www.cts.usc.edu/hpgresumingactivitiesandexerciseafterheartsurgery.html
22. Anastasios Merkouris. Quality of life after coronary artery bypass graft
surgery in the elderly. European Journal of cardio vascular nursing 2009 Mar;
8(1): 74-81.
23. Linde BJ, Janz NM. Effect of a teaching program on knowledge and
compliance of cardiac patients. 1979 Sep; 28(5):282-6
.
16
9.
Signature of Candidate
10.
Remarks of the Guide
The study is feasible and of genuine
interest of the student.
11.
Name & Designation of
11.1
Guide
Mrs C VIJI,M.Sc.(N)
Associate Professor,
HOD, Medical Surgical Nursing
SJB College of Nursing,
Kengeri, Bengaluru-60.
11.2
Signature
11.3
Co-guide
Mrs SARITA BHATTARAI,M.Sc.(N)
Lecturer,
Medical Surgical Nursing
SJB College of Nursing,
Kengeri, Bengaluru-60.
11.4
Signature
11.5
Head of Department
Mrs C VIJI,M.Sc.(N)
Associate Professor,
HOD, Medical Surgical Nursing
SJB College of Nursing,
Kengeri, Bengaluru-60.
12
11.6
Signature
12.1
Remarks of the
Principal
12.2
The topic for the study is relevant and
forwarded for needful action.
Signature
17
18