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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE
AND ADDRESS
: MRS. SUKANYA DEVI .S
1ST YEAR M.SC., NURSING,
GOVERNMENT COLLEGE OF
NURSING, FORT, BANGALORE -02.
2. NAME OF THE
INSTITUTION
3. COURSE OF STUDY &
SPECIALTY
: GOVERNMENT COLLEGE OF
NURSING, FORT, BANGALORE -02
: 1ST YEAR M.SC NURSING,
PSYCHIATRIC NURSING.
4. DATE OF ADMISSION
: 14.06.2010
5. TITLE OF THE STUDY
: A STUDY TO ASSESS THE
PSYCHOSOCIAL PROBLEMS,
AMONG PULMONARY
TUBERCULOSIS PATIENTS AT
SELECTED URBAN DIRECTLY
OBSERVED TREATMENT SHORT
COURSE CENTERS IN
BENGALURU WITH A VIEW TO
DEVELOP AN INFORMATION
GUIDE SHEET.
6. BRIEF RESUME OF THE INTENDED WORK
“Living in a Favorable and Unfavorable Conditions is apart of life. But surviving those
conditions is an art of life”.
INTRODUCTION
Health is a fundamental human right and a world wide social goal. An
understanding of health and disease along with delivery of quality health care is basis for
all health care agencies1.
Tuberculosis is a specific infectious disease caused by Myco-bacterium
tuberculosis, the disease primarily affects lungs and causes pulmonary tuberculosis. It
can also affects intestine, meninges, bones and joints lymph glands, skin and other
tissues of the body. The disease is usually chronic with varying clinical manifestations2.
The
diseases also affects animals like cattle; this is known as “Bovine
Tuberculosis”. Which may some times be communicated to man. Pulmonary
tuberculosis is the most important form of tuberculosis which affects man. Tuberculosis
remains a world wide public health problem despite the fact that the causative organism
was discovered more than hundred years ago and highly effective drugs and vaccine are
available making tuberculosis is preventable and curable disease2.
Tuberculosis control has been accorded a high priority within the health sector as
it is a major health problem. The revised national tuberculosis control programme with
directly observed treatment short course as the strategy was introduced in 19973.
It has been seen that apart from physical symptoms tuberculosis patients face
various problems like psycho social and economical in nature. Therefore, for
comprehensive assessment of patients health status it is essential to consider the overall
impact of tuberculosis on health and patients perception of well being, besides routine
clinical assessment4.
6.1
NEED FOR THE STUDY
According to WHO, Health is defined as a state of complete physical, mental and
social well being and not merely absence of disease or infirmity. Apart from physical
symptoms a patient of tuberculosis, faces several physiological, psychological, financial
and social problems5. These problems have a great impact on the psychosocial aspect of
the patient and impair the quality of life of patient suffering from tuberculosis. It has
been recognized that quality of life indices which focuses on patients own perception of
diseases .provide additional information that cannot be obtained from conventional
clinical and functional measurements6.
Communicable diseases continue to be a major health problem in India.
Tuberculosis is one of the major communicable disease and chronic condition, it requires
continuous medical care. Un-awareness, poverty, under nutrition, poor housing, large
family, and occupation has a major influence on disease prevalence. The suffering is due
to pulmonary tuberculosis is increasing despite excellent treatment available. WHO
estimated that about 9.2 million new cases of tuberculosis occurred in 2006. Of these
cases, 4.1 million where new smear positive cases. There were 14.4 million present
cases. An estimated 1.7 million people died from tuberculosis. It’s estimated that about
one-third of the current global population is infected asymptomatically with tuberculosis,
of whom 5-10% will develop clinical disease during their life time6.
India is the highest tuberculosis burden country in the world and accounts for
nearly one-fifth (20%) of global burden of tuberculosis. Every year approximately 1.8
million persons develop tuberculosis of which about 0.8 million are new smear positive
highly infectious cases. Two out of every five Indians are infected with tuberculosis
bacillus. Every day about 5,000 people develop the disease. Patients with infectious
pulmonary tuberculosis disease can infect 10-15 persons in a year. In India almost 0.37
million people die every year6.
Tuberculosis is a protean disease that involves lung as well as other organs, is
considered a social stigma in India. It has been a common observation that patients of
pulmonary tuberculosis even after completion of chemotherapy and reassurance,
continue to attend the hospital with one or the other respiratory complaint7. Hence
“Perceptions of tuberculosis patients about their physical, mental and social well-being”
reported that stigma remained unchanged even after completion of treatment. Secondly
tuberculosis create multiple burdens for patients, including the necessity to deal with
pain, suffering, reduced quality of life, premature mortality, financial costs and familial
emotional trauma8.
Pulmonary tuberculosis has both medical and social dimensions characterized by
its close relation to poor socioeconomic conditions. Previous studies indicate that the
stigma associated with tuberculosis adds to the burden of disease for both men and
women particularly if they are of marriageable age8.
A survey carried out in India in 1997, before implementation of directly observed
treatment shortcourse strategy, estimated that 100,000 women were rejected by their
families each year because of their Tuberculosis disease8.
A study was conducted on 980 tuberculosis patients, to assess the psychosocial
problems through structured interview. The study reveals that the psychosocial problems
faced by the patients were low self esteem, ashamed to cough in front of others,
occupational disturbances, reduced quality of life and change of behaviour of
community. To conclude that the disease creates multiple burdens among the
tuberculosis patient9.
A Study was conducted to examine the perceived and enacted stigma experienced
by tuberculosis patient and community perception on stigma related to tuberculosis. An
interview was carried out on 276 tuberculosis patients who are registered for directly
observed treatment short course in South India. Data was collected using semi structure
interview schedule. The study reveals that social and perceived stigma was higher in
both the gender. One of the recognized barriers to tuberculosis treatment is stigma
associated with the disease.
The study concluded that considering the social and
emotional impact of the disease, it is essential to adopt support strategies to enhance
acceptance and for successful health programme10.
The above studies clearly demonstrates the importance of such researches for the
better psychosocial adjustments of the patients, In order to gain further insight into the
issue, the present study was taken by the researcher to examine the perceived and
enacted stigma and psycho social problems experienced by tuberculosis patients which
will help to develop and provide an information guide sheet will further help in
improving the psychosocial adjustments of tuberculosis patients.
6.2
REVIEW OF LITERATURE:
A prospective longitudinal study was conducted on 1,000 tuberculosis patients
newly enrolled to directly observed treatment short course centers at Chandigarh to
evaluate health related quality of life by using structured questionnaire. Study suggests
that, quality of life is markedly impaired across all domains in patients of pulmonary
tuberculosis11.
A study was conducted among 90 tuberculosis patients on their quality of life who
are registered at directly observed treatment – short course centers by using structured
interview schedule. The study revealed that tuberculosis is a disease with social
implications due to the stigma attached to it the study concluded that tuberculosis has
adverse effect on patients psychological and social role functioning12.
A study was conducted among tuberculosis patients on men and women patients in
rural Bangladesh to assess and compare stigma in 50 women and in 52 men by using
semi structured interview schedule. The study showed six indicators of tuberculosis
related stigma were more prominent in women and were isolated from the families.
Hence, the impact of tuberculosis on women had an adverse effect on their quality of
life13.
A study was conducted with 60 tuberculosis patients and 60 non tuberculosis
patients by using structured questionnaire schedule. The study result shows that
tendency for psychological disorders like depression and psychopathic deviation in
personality profile of tuberculosis patients of those were higher risk for depression and
psychopathic deviations14.
A study was conducted to assess the misconceptions and quality of life among
tuberculosis patients in Punjab. A total of 1,129 inhabitants aged about 15 - 45 years
old were interviewed through telephone and field surveys. Analysis showed that the
strongest predictors of misconceptions were older age and an urban type of settlement. A
total of 33.9% of respondents could not identify any sign of tuberculosis and 86.6% of
respondents were having negative attitude towards tuberculosis study revealed that the
quality of life remained significantly worse than in the general population in Punjab15.
A Study was conducted to evaluate the impact of the National Tuberculosis
Programme's health education on patient’s knowledge and stigma associated with the
disease of tuberculosis patients. New pulmonary tuberculosis patients who had received
tuberculosis treatment for a minimum of 1 month were interviewed using a structured
questionnaire and health education. The study revealed that 93% of respondents reported
that they are receiving tuberculosis information from the health staffs. Apart from health
education many patients reported that tuberculosis information from medias. The study
concluded that, ultimately the society must bear the negative impact of the social
consequences and stigma associated with the disease created by the combined effects of
tuberculosis on patients and their families16.
A study was conducted on 205 respondents from 210 selected houses to ascertain
the psychosocial problem of
tuberculosis patients. An interview with standardized
questionnaire is used to collect the data. Generally the knowledge about tuberculosis was
poor. The study revealed that, although more than 90% of the respondents considered
tuberculosis is a socially acceptable within their family and community. A large
proportion (41%) expressed that getting tuberculosis was embarrassing, 4% said it was a
disgrace to the family, and 16% said that it was too sensitive to discuss about it17.
A study was conducted among tuberculosis patients of their
health related
psychosocial stigma. A systemic literature search from 1981 to 2008 was performed. The
result shows that tuberculosis had a substantial and encompassing impact on patient’s
quality of life. Tuberculosis treatment had a positive effect on improving patients
quality of life and their physical health tend to recover more quickly than the mental
wellbeing. The study concluded that tuberculosis has substantial adverse effect on
patient’s quality of life18.
A descriptive cross sectional study was conducted to explore the psychosocial
consequences among
tuberculosis patients and their families. Totally 203 patients
interviewed by using structured questionnaire. Nearly about 82% knew that tuberculosis
is contagious and 78% were aware that lungs are commonly affected. Almost half knew
that it spreads by droplets and causes the cough and that treatment is long and costly. The
study revealed that with regards to commonly affected age and sex, however,
respectively only 23% had the correct knowledge 40% had negative attitude and
practices towards tuberculosis. All most considered tuberculosis is a social stigma19.
A study was conducted to understanding the attitude and social consequences of
tuberculosis in Addis Ababa, Ethiopia on 703 participants, comprising 326 males and
377 females were interviewed using the written questionnaire. The study reveals that of
the total, 69.0% feel that tuberculosis patients are not accepted in the community and
78.3% fear of physical contact with tuberculosis patients. Most participants agreed that
tuberculosis is a very dangerous, contagious but curable disease, but the community has
a generally negative attitude towards them. These attitudes have social consequences
particularly the stigmatization and social isolation of tuberculosis patients. The study
concluded that perception by most respondents was that tuberculosis is incurable,
transmittable and associated with HIV/AIDS, led to the understanding that tuberculosis
is a very dangerous disease. This, in turn, contributes to social avoidance and the worse
consequences in tuberculosis patients20.
A preliminary survey was conducted on 200 tuberculosis patients to evaluate the
attitude and psychological reaction of tuberculosis patients. The sample comprised of
employed persons from Firland sanatorium U.S.A. The study revealed that many of the
employers who become ill did so in a situation of stress which would be conducive
towards resistance. The study concludes that the postulation of psychosocial crisis is one
of the precipitant cause is tenable21.
STATEMENT OF THE PROBLEM
A STUDY TO ASSESS THE PSYCHOSOCIAL PROBLEMS AMONG
PULMONARY
DIRECTLY
TUBERCULOSIS
OBSERVED
PATIENTS
TREATMENT
AT
SHORT
SELECTED
COURSE
URBAN
CENTERS
BENGALURU, WITH A VIEW TO DEVELOP AN INFORMATION GUIDE
SHEET.
6.3
OBJECTIVES OF THE PROBLEM
1.
To assess the psychosocial problems among pulmonary tuberculosis
patients.
2.
To find the association between the psychosocial problems among
pulmonary tuberculosis patients and selected socio demographic
variables.
3.
To develop and provide an information guide sheet about improving
psycho-social adjustments.
6.3.1 ASSUMPTIONS
a)
The pulmonary tuberculosis patients may have various psycho-social
problems.
b)
Information guide sheet may help to enhance better psycho-social
adaptation.
VARIABLES
It includes demographic variables such as age sex, family income, occupation,
educational status.
6.3.2 OPERATIONAL DEFINITIONS
1.
Assess:
Refers to identify, analyze and evaluate psycho-social problems of
tuberculosis patients.
2.
Psycho-social problems: It refers to the internalizing feelings of the patient like
depression, and behavioral problems and alcohol abuse, etc. executed by the
patient as a result of his illness.
3.
Directly observed treatment – shorts course: Dots, it is a strategy to ensure
cure by providing the most effective medicine and confirming that it is taken.
4.
Information Guide Sheet: It refers to concise and comprehensive information
material, which enhance better psychosocial adaptation.
7.0
7.1
MATERIALS AND METHODS
Source of Data
: Pulmonary tuberculosis patients receiving
directly observed treatment – short course
centers in Bengaluru.
7.2
Definition of the study subject
: Pulmonary tuberculosis patients receiving
directly observed treatment – short course
centers in Bengaluru.
7.2.2
Inclusion and Exclusion criteria
a) Inclusion criteria
:
1. Pulmonary
tuberculosis
patients
receiving directly observed treatment
– short course centers in Bengaluru.
2. Pulmonary tuberculosis patients who
are willing to participate in the study.
3. Pulmonary tuberculosis patients who
understand Kannada or English
a) Exclusion criteria
:
1. Patients
with
Extra
pulmonary
tuberculosis.
2. Patients who are below the age group
of 15 years.
7.2.2
Research approach
:
Non-experimental approach
7.2.3
Research Design
:
Descriptive design
7.2.4
Settings
:
Selected directly observed treatment –
short course centers in Bengaluru.
7.2.5
Sampling technique
:
Purposive sampling technique.
7.2.6
A) Sampling size
:
50 Pulmonary tuberculosis patients at
selected directly observed treatment –
short course centers in Bengaluru.
7.2.7
B) Duration of the study
:
30 days
Tools of Research
:
Tool of the research will be constructed
in two parts:
Part
I –
Contain,
selected socio
demographic variables such as Gender,
Age, Religion, Occupation, Monthly,
Income, Education, Type of family.
Part II – Structured interview schedule
on assessment of various psychosocial
problems of pulmonary tuberculosis
patients.
7.2.8
Collection of data
:
1. The investigator himself collects the
data from pulmonary tuberculosis
patients receiving treatment at urban
directly observed treatment – short
course Centers in Bengaluru using
structured interview schedule.
7.2.9
:
Method of Data Analysis
1. The investigator will use descriptive
statistical
mode,
technique
median
like
and
mean,
standard
deviation and inferential statistical
techniques like chi square and other
relevant statistical methods will be
used.
2. The Analyzed data will be presented
in the form of tables, diagrams and
graphs.
7.3
DOES
THE
STUDY
REQUIRE
ANY
INVESTIGATION
OR
INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY?
Yes, study will be conducted on selected pulmonary tuberculosis patients.
7.4
HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.3?

Yes, permission will be obtained from the concerned person and authority
of the institution before the study.

Privacy, confidentiality and anonymity will be guarded.

Scientific objectivity of the study will be maintained with honesty and
impartiality.
8. LIST OF REFERENCES
1. Gururaj G, Imai MK.
Information for educational institution. Department of
epidemiology. NIMHANS; 2003. p. 7-8.
2. Harrison’s principles of internal medicine. 10th ed. German: Schwabe and Company
& Pvt. Ltd; 1983. p. 1019-1025.
3. Park K. Text book of preventive and social medicine. 20th ed. Jabalpur: Banarasidas
Bhanot; 2009. p. 159-162.
4. Indian Journal of Community Medicine. [Serial on line] 2007 may [cited on
2010 Nov 23]; 20(3): 222-233. Available from: URL: http://www.pubmed.com.
5. John Gibson. Modern medicine for nurses. 4th ed. London: Black well; 1979. p. 312316.
6. Chakraborthy AK, Epidemiology of tuberculosis current status in India. Indian J Med
Res [serial on line]. 2004 [cited on 2010 Nov 22]; 120: 248-76. Available from URL:
http://www.pub med.com.
7. Brunner & Suddarth‘s Text book of medical and surgical nursing. 11th ed. New
Delhi: Wolters Kluwer India Pvt. Ltd.; 2008. p. 643- 644.
8. Nagpoul DR. Social research in tuberculosis. Indian J TB [serial on line]. 2002 [cited
on 2010 Nov30]; 39(14): 109-111. Available from: http://www.pubmed.com.
9. Rajeshwari R, Muiyandi M, Balasubramanian R, Narayanan PR. Perception of
tuberculosis patients about their physical, mental and social well being. A field report
from South India [serial on line]. 2005 [cited on 2010 Nov 25]; 60(8): 1845-53.
Available from URL: http://Irsitbrd.nic.in.
10. Jaggarajamma K, Rajeshwari R, Nirupa C. Perceived and enacted stigma among
tuberculosis patients. Indian J Tuberc [Serial on line]. 2008 July [Cited on 2010 Nov
21]; 55(3): 179-187. Available from: URL: http://Irsitbrd.nic.in.
11. Guo N, Marra F, Carlo AM. Health and quality of life out comes. [Serial on line].
2009 Feb [cited on 2010 Dec 1]; 7(1) 1477-525. Available from: URL;
http://www.hqlo.com.
12. Weiss MG, Somma D, Karim F.
Cultural epidemiology of tuberculosis with
reference to gender in Bangladesh, India and Malwai. International journal of
tuberculosis and lung diseases. [Serial on line]. 2008 [Cited on 2010 Dec 2]; 12(7):
837-847. Available from: URL: uttp://www.projectcork.org.
13. Tandon AK, Jain SK, Ram Asare. Psychosocial study of tuberculosis patients. Ind J
Tub. [Serial on line]. 2008Oct [cited on 2010 Dec 2]; 28; 172-175. Available from:
URL:http://www.pubmed.com.
14. Dhuria M, Sharma N, Ingle GK. Impact of tuberculosis on the quality of life. Indian J
Community Med [Serial on line]. 2008 [cited on 2010 Dec 4]; 33(2): 58-59.
Available from URL: http://www.pubmed.com.
15. Hawkins NG, Davies R, Holmes TH.
Evidence of psychosocial factors in the
development of pulmonary tuberculosis. Ame Rev Respir Dis. [serial on line]. 2007
May [Cited on 2010 Dec 2004]; 22(3): 222-32. Available from: URL:
http://ntiindia.kar.nic.in.
16. Hoa NP. Knowledge and health seeking behaviours among Vietnamese. Scand J
Public Health [Serial on line]. 2003 Dec [cited on 2010 Nov 28]; 31(6): 59-65.
Available from: URL:http://www.pubmed.com.
17. Avinash CM, Dwarka P. Psychological survey of tuberculosis. Indian J TB [serial on
line]. 2002 [Cited on Dec 3]; 22(1):32-34. Available from:http://ntiindia.kar.nic.in.
18. Kelly P. Isolation and stigma, The experience of patients with active tuberculosis
[serial on line]. 2001 [cited on 2010 Dec 4]; 16; 233-241. Available from; URL:
http://www.pubmed.com.
19. Bhatia MS, Bhasin SK, Dubey KK.
Psychologicaldisfunction in tuberculosis
patients. Indian J Tubec [serial on line]. 2000. [Cited on 2010Dec1]; 54 (5): 171-3.
Available from: URL:http://Irsitbrd.nic.in.
20. Caldon G, A method for evaluating the attitudes of tuberculosis patients. Ame Rev
Respir Dis [serial on line]. 1999 Feb [Cited on 2010Dec3]; 67:722-731, Available
from: URL:http://ntiindia,kar.nic.in.
21. Caldon G. A method for evaluating the attitudes of tuberculosis patients. Ame Rev
Respire Dis [serial on line]. 1999 Feb [Cited on 2010 Dec 3]; 67:722-731, Available
from: URL:http://ntiindia,kar.nic.in.
9.
SIGNATURE OF THE CANDIDATE
:
10
REMARKS OF THE GUIDE
: Relevant
11
NAME AND DESIGNATION OF
: Prof. H H DASEGOWDA
11.1 GUIDE
: HEAD OF THE DEPARTMENT
PSYCHIATRIC NURSING
GOVERNMENT COLLEGE OF NURSING,
FORT, BENGALURU.
11.2 SIGNATURE
:
11.3 CO-GUIDE (IF ANY)
: Mr. GANGADHAR
11.4 SIGNATURE
:
11.5 HEAD OF THE DEPARTMENT
: Prof. H H DASEGOWDA
HEAD OF THE DEPARTMENT
PSYCHIATRIC NURSING
GOVERNMENT COLLEGE OF NURSING,
FORT, BENGALURU
11.6 SIGNATURE
:
12.1 REMARKS OF THE PRINCIPAL
: Topic selected for the study is relevant and
forwarded for needful action.
12.2 SIGNATURE
:
12
ETHICAL COMMITTEE CLEARANCE
1 TITLE OF DISSERTATION
: A STUDY TO ASSESS THE PSYCHOSOCIAL
PROBLEMS
AMONG
PULMONARY
TUBERCULOSIS PATIENTS AT SELECTED
URBAN DOTS CENTERS BENGALURU,
WITH A VIEW TO DEVELOP AN
INFORMATION GUIDE SHEET.
2 NAME OF THE CANDIDATE AND
ADDRESS
: Mrs. SUKANYA DEVI. S
M.Sc (N) 1st Year
Government College of Nursing,
Fort Bengaluru -02
: PSYCHIATRIC NURSING
3 SUBJECT
4 NAME OF THE GUIDE
5 APPROVED / NOT APPROVED
(If not approved, suggestion)
: Prof. H.H. DASEGOWDA
Head of the Department of
psychiatric Nursing,
Government College of Nursing
Fort, Bengaluru -02.
:
Mr. H.H. DASEGOWDA
Head of the Department of
Psychiatric Nursing,
Government College of Nursing,
Fort, Bengaluru -02
Smt. RENUKA .N
Head of the Department of
Pediatric Nursing,
Government College of Nursing,
Fort, Bengaluru -02
Mr. BASVARAJU.G
Head of the Department of Medical
Surgical Nursing,
Government College of Nursing,
Fort, Bengaluru -02
Mr. H.B. PRAKASH
Head of the Department of
Community Health Nursing,
Government College of Nursing,
Fort, Bengaluru -02
Dr. SUWARNA B TALWAR
Head of the Department of Obstetrics
and Gynecological Nursing,
Government College of Nursing,
Fort, Bengaluru -02
Mrs. HEMAVATHY.S
Principal,
Government College of Nursing,
Fort, Bengaluru -02
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