Download brief resume of intended work

PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
“AN EXPLORATORY STUDY TO ASSESS THE KNOWLEDGE
OF
CAREGIVERS REGARDING THE DRUG COMPLIANCE AND FACTORS
AFFECTING
DRUG
COMPLIANCE AMONG PSYCOTIC PATIENTS
ATTENDING OUT PATIENT DEPARTMENT OF SELECTED HOSPITALS AT
TUMKUR CITY.”
SUBMITTED BY –
MR. YUGAL SWARNKAR
FIRST YEAR M.Sc. NURSING
(MENTAL HEALTH NURSING)
AKSHAYA INSTITUTE OF NURSING SCIENCES
TUMKUR – 02
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE
BANGALORE, KARNATAKA
ANNEXURE – II
SYNOPSIS PERFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MR. YUGAL SWARNKAR
1
NAME OF THE CANDIDATE
AND ADDRESS
FIRST YEAR, M.Sc. NURSING
AKSHAYA INSTITUTE OF NURSING
SCIENCES,
S.I.T. MAIN ROAD,
TUMKUR – 572102
AKSHAYA INSTITUTE OF NURSING
2
3
4
NAME OF INSTITUTE
SCIENCES,
TUMKUR.
COURSE OF STUDY AND
FIRST YEAR, M.Sc. NURSING
SUBJECT
MENTAL HEALTH NURSING
DATE OF ADMISSION TO
COURSE
28/06/2008
“AN EXPLORATORY STUDY TO ASSESS
5
TITLE OF THE STUDY
THE KNOWLEDGE OF CAREGIVERS
REGARDINGTHE DRUG
COMPLIANCEAND FACTORS
AFFECTING DRUG COMPLIANCE
AMONG PSYCOTIC PATIENTS
ATTENDING THE OUT PATIENT
DEPARTMENT OF SELECTED
HOSPITALS AT TUMKUR CITY.”
2
6.BRIEF RESUME OF INTENDED WORK
INTRODUCTION
Mental illness is an age-old problem of mankind. It is recorded in the oldest
literature of all cultures all over the world. Historically mental illness was recorded as
demonic possession, the influence of ancestral spirits, and the result of violating a taboo
or neglecting a cultural ritual leading to spiritual condemnation. A mention of mental
illness has been made in Bible where king Soul during the 4th century B.C. was suffering
from abnormal irritability, great suspiciousness and uncontrollable impulses following
some disturbed behavior early in life.
Apparently he was a case of manic-depressive psychosis. Bhagavat Gita first
recorded the evidence of a situation similar to panic attack and interventions like
psychotherapy, crisis intervention, and counseling and directive psychotherapy.
The celebrated Greek philosopher Plato wrote that mentally disturbed people were
in some “obvious” sense not responsible for their acts and should not receive punishment
in the same way as a normal person. The Greek physician Hippocrates stated that brain
was the central organ of intellectual activity and that mental disorders were due to brain
pathology. He said people should be simply made to pay for the damage and let him be
exempt from other punishments.
Research studies from different part of the country have shown that mental illness
is as common in India as it is elsewhere and is equally common in rural and urban areas.
Mental illness is defined as any disturbance of emotional equilibrium as manifested in
maladaptive behavior and impaired functioning caused by physical, chemical, biological,
psychological, genetic, social or cultural factors. In India the reported rate of mental
illness is 100 per 1000 population.1
It has been estimated that 20%-50% of any patient population is at least partially
complaint and that in patients with schizophrenia and related psychotic disorders rates
run as high as 70%-80%.
3
6.1
NEED FOR THE STUDY
Providing care for a member of the family with mental illness is an exhausting
task for caregivers. They are the people who are always with the patient and their role is
very important. Many a time the immediate blood relatives or those who care for these
patients are unaware of the importance of continuing medications. They are also ignorant
about the side effects of these medications and importance of follow up. Failure to take
prescribed medication is thought to be the biggest cause of subsequent relapse, and this
fact must be made absolutely explicit. The patient’s family members may be helpful in
promoting long-term medication compliance if they are fully informed.2
Lack of active Participation of family and the patient himself is a key problem in
the fight against mental illness. In April 1976, the 1st International congress on patient
counseling devoted a major session to patient’s compliance and drug regimen.
Non-compliance to drug becomes a major problem in chronic illness because it is
the dropout rather than the remainer who in the long run seem to be the typical patient in
the treatment of chronic illness. Families may positively influence adherence to
medication regimens, be the first line of assessment for adverse side effects and supervise
administration of the medication and refill prescriptions. It has been reported that seven
out of 10 people with severe mental illness had family members who could be involved
in their care.3
Compliance to treatment has been poorly understood. Only a few reports have
conceptualized the determinants of non-compliant behavior. On further reviewing of
literature in this area it is found that not many Indian nursing researchers have done a
systematic and scientific study to explore that factors affecting compliance. The
investigator while working in the Psychiatric OPD noticed that majority of patients
(about 90%) who come here had faltered some time or the other in taking medicines.
Quite a number of them had relapse or aggravation of symptoms. While interacting with
the caregivers it was also observed that they do not have sound knowledge about the
illness and its treatment.
4
All these observations, experience, curiosity and interest in the field prompted the
researcher to undertake this study.
6.2
REVIEW OF LITERATURE
“The more we search the more
We find there is to know and
As long as human life exists
I believe, it will be so !!”
Albert Einstein
Literature review considered a systematic and critical review of the most
important scholarly literature on a particular topic. The term refers to an extensive,
exhaustive and systematic examination of publications relevant to the research study. The
review helped the investigator in developing a deeper understanding and insight into the
problem under study. It also helped in gaining information on the trends and
developments in this area.
The reviewed literature for the present study is:1. The study was conducted to assess the impact of non adherence and other
factors associated with resource use and costs incurred by people with
schizophrenia. A cross-sectional survey method was used and data was
collected with the help of a structured interview schedule. 658 samples were
studied and it was found that the rate of reported non-adherence was lower in
the sub sample of patients resident in hospital (11.2%) compared with patients
in other types of institution (21.2%).4
2. The study was conducted to evaluate the relationship between during
compliance ad re-hospitalization in a group of schizophrenic patients. An
exploratory survey was done with the help of a structured questionnaire. A
total of 4325 patients were studied. Partially compliant patients with less then
70% compliance had significantly higher rates of hospitalization. There was
an association between measures of partial compliance and risk of
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hospitalization. The lower the level of compliance, the greater the risk of
hospitalization. A gap of 1-10 days (Odds Ratio (OR)=1.98), a gap of 11-30
was associated with an OR of 2.81 and a gap of more than 30 days was
associated with an OR of 3.96. Or in other words partial compliance was
associated with increasing risk of relapse in the long-term treatment of
schizophrenia.5
3. The study was Conducted an exploratory survey of 2507 subjects to find out
their drug compliance. The data collected with the help of a structured
questionnaire revealed that nearly two-thirds (64%) simply forgot to take there
medication with 11% saying that this happened “often” or “very often”. Other
main reasons cited were, to save money (35%) either thought they have no
symptoms or symptoms went away (36%), did not believe that the drug was
effective (33%), painful or frightening side effects (28%) and 25% felt that the
drug did not allow them to do other things they wanted to do.6
4. The study was conducted to identify the factors associated with compliance or
non-compliance to lithium therapy among the patients with bipolar affective
disorder. The research approach adopted was that of a survey and data was
collected with the help of structured knowledge questionnaire. The mean
knowledge score of compliant patient (M=22.7) was significantly higher than
that of their relatives (M=19.3). Males were found to be more compliant than
females.(x2.21, P<0.04). Marital status was also significantly with drug
compliance (x2.81, P<0.05). There was no significant between the compliance
status and disease variables like duration of illness, number of episodes and
number of hospitalizations. It was also found that 88.4% of non compliant
patients stopped lithium for sometime after starting the treatment as they felt
better. About 50% of patients forgot to take medicines and 42% patients felt
taking lithium regularly as a stigma.7
5. The study was conducted to assess the attitudes, knowledge and practices of
family members of clients with mental illness. A descriptive survey design
6
was used and data was collected with the help of a structured questionnaire
with four modules. 78% were able to identify a cause or factor precipitating
the onset of illness; about 97% stated that mental illness is curable with
medication. Almost a third accepted that they used physical restraint to keep
the ill client under control. More than 80% allowed the mentally ill client to
attend the social gatherings or visit public places. 25% of participants objected
to marrying a family member of a mentally ill person. The attitude scores
were associated with education level of family members. The mean attitude
score was statistically higher among those with secondary level of education
(M=16.6, SD= 4.9) in comparison with those with primary level of education
or illiterate (M=13.9, SD=4.5). Family members from urban area scored
significantly higher (M=17.2, SD=4.5) than those from the rural area
(M=14.3, SD=4.8).8
6. The study was conducted to assess how the psychiatric nurses assess &
intervene in issue related to medication adherence. A total of 126 psychiatric
nurses were included in the study. Open ended questionnaire which was to be
self administered were send to the participants. Nurse approaches included
providing medication education (70%) tracking adherences (62%) assessing
medication effectiveness (45%) providing individualized, tailored adherence
intervention(58%) & collaborating with other health care providers(50%) in
medication planning.9
7
6.3
STATEMENT OF THE PROBLEM
“An exploratory study to assess the knowledge of caregivers regarding drug
compliance and factors affecting drug compliance among
psychotic patients
attending the out-patient department of selected hospitals at Tumkur”
6.4
OBJECTIVES OF THE STUDY
1. To identify the level of drug compliance among psychotic patients through
care giver.
2. To assess the level of knowledge among care givers of psychotic patients.
3. To find out the association between knowledge of caregivers and drug
compliance among patients receiving anti psychotic drugs.
4. To find out the association between drug compliance and selected
demographic variables of psychotic patient.
5. To find out the various reasons contributing to drug non-compliance.
6. To prepare information booklet on improving drug compliance among
psychotic patients.
6.5
OPERATIONAL DEFINITIONS
Compliance
The word compliance means following the prescribed treatment or co-operating
with the treatment plan. In this study it refers to the extent to which the patient’s behavior
coincides with the recommendations of the health care providers. It includes following
the prescribed drug regimen, or keeping up the follow-up dates.
Caregivers
In this study the word caregivers refers to a close relative, friend or a paid person
who attend to the immediate needs of the patient.
8
Psychotic patients
In this study the word refers to a person, who is being diagnosed as a case of
schizophrenia, bipolar affective disorder or major depression according to ICD-10
classification and who is receiving antipsychotic drugs
6.6
ASSUMPTIONS
1. The caregivers of psychotic patients will co-operate during the study.
2. Psychotic patients have different levels of drug compliance.
3. The care givers of psychotic patients have some knowledge regarding mental
illness and its treatment.
6.7
HYPOTHESIS
There will be significant association between knowledge of caregivers and level
of drug compliance of psychotic patients.
7 MATERIALS AND METHOS OF THE STUDY
A]
SOURCE OF DATA:
Before proceeding with the main study the written permission will be obtained
from the authorities of the selected hospitals. Information will be obtained from
the respondents who are willing to participate in this study. The data collection
procedure will be carried out for a period of 6 weeks through interview method.
B]
RESEARCH DESIGN:
Exploratory survey design study.
C]
STUDY SETTING:
Sneha manovikas Kendra & O.P.D of District govt. hospital at Tumkur.
9
D]
POPULATION:
The target population of the study will be caregiver of psychotic patient.
E] SAMPLE TECHNIQUE
Purposive sampling technique.
F] SAMPLE SIZE
A sample size of this study is 80 caregivers in Tumkur.
G] CRITERIA FOR SAMPLE SELECTION
INCLUSION CRITERIA
1. Care givers of psychotic patient receiving Antipsychotic drug &
who will follow up in the O.P.D. of selected hospitals at Tumkur.
2. Care givers who are willing to participate in the study.
3. Care givers who can communicate in English/Hindi/kannada.
EXCLUSION CRITERIA
1. Care givers of the patients with , psychiatric as well as medical
problems.
2. Care givers of the patients who are not attending the out-patient
department of selected hospitals at tumkur.
7.2 METHODS OF DATA COLLECTION
Before proceeding with the main study the written permission will be obtained
from the authorities of the selected hospitals. Information will be obtained from the
respondents who are willing to participate in this study. The data collection procedure
will be carried out for a period of 6 weeks through interview method.
10
Description of the tool
1. Socio demographic Performa to collecting demographic data.
2. Structured questionnaire to assess the knowledge of caregivers of
psychotic patients receiving antipsychotic drugs.
7.3Methods of Data analysis and interpretation
Data will be analyzed according to the objectives of the study using descriptive
and inferential statistics and will be presented in the form of tables, graphs and
diagrams.
7.4Duration of the study
: 6 weeks.
7.5Does the study require any investigation or intervention to be conducted on the
patients or other human being or animals? If so please describe briefly.
No
7.6Has Ethical Clearance been obtained from your institution in case of the above?
.
11
8. LIST OF REFERENCES:
1.Gopinathan.P.S., Patients who discontinue day hospitalization.29(3) ed. Indian
journal of Psychiatry. 1999, P.No 197-201.
2.Brooking J .I et al. A Text Book of Psychiatry & mental Health Nursing 1St ed.,
Edinburgchurchill Livingston 1992, P.No 409-410.
3. Johnson. B.S. Psychiatric Mental Health Nursing Adaptation & Growth
4th ed.
Philadelphia: Lippincott 1997,P.No 54-56
4. Knapp M, et al., Non Adherence to Antipsychotic medication regimens
Association With recourses use & costs. British Journal of Psychiatry,2004 , P.No
184
5. Widen P, et al. Partial Compliance and risk of rehospitalization among California
Medicaid Patient with Schizophrenia.55(8)ed.Psychiatric Services 2004, P.No
886-891
6. Break well et al. Expressed emotion affective style lithium compliance and
relapse in resent onset mania. Psychopharmacology Bulletin 2004 P.No 44,628638
7. Bhaduri et al. A study of factor associated with compliance or non compliance to
litihium therapy among the patients with bipolar affective disorder ,The nursing
journal of India .2003 ,vol LXXXXIV(1),P.No 9-11
8. Vimala D Rajan A.K.et al. A study to assess the knowledge, attitude and practice
of
family members of client with mental illness. The Nursing Journals of
India.vol LXXXXIV(10),P.No 223-224
9. Kemppaien. j et al. Psychiatric Nursing & Medication Aadherence.41
(2)ed,Journal of Psychosocial Nursing. 2003. P.No 39-49
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9
Signature of Candidate
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Remarks of Guide
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Name and Designation of (in block letters)
11.1 Name of Guide
11.2 Signature
11.3 Name of Co-Guide (If Any)
11.4 Signature
11.5 Head of the Department
11.6 Signature
12
12.1 Remarks of the Principal
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12.2 Signature
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