A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING SELF CARE ACTIVITIES
AMONG PATIENTS WITH DIABETES MELLITUS IN A SELECTED PHC OF TUMKUR.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
Mr. Santosh Indi
COMMUNITY HEALTH NURSING
Akshaya College of Nursing,
Tumkur, Karnataka.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the Candidate : Mr. Santosh Indi
And address M.Sc Nursing, 1st Year
Akshaya College of Nursing,
Tumkur, Karnataka.
2. Name of the Institution : Akshaya College of Nursing
3. Course of Study : M.Sc. Nursing 1st year,
And Subject COMMUNITY HEALTH NURSING
4. Date of Admission to :05-06-2009
Course
5. Title of the Topic : A study to assess the effectiveness of structured teaching programme on knowledge regarding self care activities among patients with diabetes mellitus in a selected PHC of Tumkur.
6. INTRODUCTION
“NO FASTING: NO FEASTING”
Diabetes mellitus is a multisystem disease related to abnormal insulin production, impaired insulin utilization or both. Diabetes mellitus is a serious health problem through out the world1.
Diabetes mellitus is not modern disease. In 1500 B.C. Papyreus of ancient Egyptians recorded a number of remedies for passing urine. In 1000 B.C. itself Indian physician sushurutha diagnosed diabetes. In 1798, J.Jhon, the Greek physician found diabetes is associated with excess of glucose in blood. Discovery of insulin by Banting and Best in 1921 is a land mark in diabetes history2.
World diabetes day is the major global awareness campaign for patient with diabetes mellitus through out the world. World diabetes day was introduce in 1991, celebrated on 14 November each year, to co-inside with the birthday of Fredrick Banting who, along with Charles best first conceived the idea that lead to the discovery of insulin3.
The slogan chosen for world diabetes day 2004 is “Fight obesity, prevent diabetes”, to highlight the impact lifestyle on health and how to prevent or lessen the effect of diabetes. A healthy lifestyle is the combination of healthy eating and regular exercise withy regular physical activity3.
In obese patient with type-2diabetes, the association of hyperglycemia, hyperinsulinaemia, dyslipidaemia and hypertension, which leads to coronary artery disease and stroke, may result from a exaggerated by obesity3.
With the IT era drastically changing the lifestyle of young people around the world, Indians, with their strong IT capability and genetic susceptibility to type 2 diabetes, are more prone to developing this disorder below 30 years and even below the age of 15 years. Obesity, wrong food habits and lack of exercise playa major role in the causation of type 2 diabetes in the young3.
Diabetes is an “Iceberg” disease. All through increase in both the prevalence and incidence of type 2 diabetes have occurred globally, they have been especially dramatic in societies in economic transition, in newly industrialized countries and developing countries. Currently the number causes of diabetes world wide is estimated to be around 150 million. This number is predicted to double by 2025, with the greatest number of cases being expected in China and India4.
The racing prevalence of diabetes in developing countries is closely associated with industrialization and socio economic development. It is estimated that 20% of the current global diabetic population resides in the south East Asian region. The number of a diabetic person in the countries of the Region is likely to triple by the year 2025, increasing from the present estimates of about 30 million to 80 million4.
The population in India as an increased susceptibility to diabetes mellitus. The prevalence of diabetes in adults was found to be 2.4% in rural and 4.0-11.6% in urban dwellers. High frequencies of impaired glucose tolerance, shown by those studies, ranging from 3.6-9.1% indicates the potential for further rise in prevalence of diabetes mellitus in the coming decades4.
An analysis of age specific prevalence rates of diabetes mellitus consistently showed and increase in prevalence with increasing age. In the Region, the proportion of people in the age group 30 years and above will increase from 37.2% in 1995-41.9% in 2025. There will be a corresponding increase in the proportion of diabetes in old age group. The percentage of diabetes case crusading in urban areas is projected to increase participation in moderate exercise4.
6.1.NEED FOR THE STUDY
Diabetes mellitus is a chronic disease, with which the patient must live his life. To achieve a state of health and acceptable level of function, patient with diabetes mellitus needs to have adequate knowledge and attitude of self-care activities. They need to clear their doubts related to self care activities such as diet, exercise, medication, self administration of insulin, food care and follow-up. To lead an independent life, the individual diabetes should be a controller of his own life5.
Educating the young people of our country on good nutrition, regular physical exercise and healthy games is therefore of utmost important and should start at the pre school and school level as a national programme.
A nurse researcher from the intercollegiate college of nursing at Washington state university conducted a study of 40 home healthcare patients with type two diabetes and found that an individualized educational intervention led to improved food care knowledge, self care practices and confidence performing food related self care6.
Diabetes is treated by insulin, and by diet and exercise alone or in combination with insulin. Nurse have role in diabetes care as specialists or as part of general care. Screening for complications and referral of patients to relevant agencies when necessary or important aspects of their work, as it offering health promotion advice7.
The age adjusted mortality rates among people with diabetes are 1.5. to 2.5, times higher than the general population. In Caucasian population, much of the excess mortality is attributable to cardiovascular disease especially coronary heart disease; amongst to Asian and American Indian population, renal disease is a major contributor where as in some developing countries infections are an important cause of death. WHO estimates that disease burden in India will increase from the present 30 million to 80 million by 20304.
Diabetes patients must become knowledge about nutrition, medication effects and side effects, exercise, disease progression, prevention strategies, blood glucose monitoring techniques and medication adjustments. An appreciate for the knowledge and skills that diabetic patients must acquire can help the nurse in the providing effective patient education and counseling8.
A crucial element in secondary prevention is self-care. That is the diabetic should take a major responsibility for his own care with medical guidance.
It is estimated 30 millions people in India are affected by diabetes and India is the country with highest rate of diabetes. The WHO estimated that India would be the home for 57 million diabetes by 20259.
The investigator during his clinical experiences identified that the diagnosis of diabetes created anxiety and doubts among diabetics on how to adjust with the restrictions imposed on them to control diabetes, also the investigator identified lack of knowledge in Preventing complications of diabetes mellitus and to make the patient to adhere with right self care activities.
6.2.REVIEW OF LITERATURE
According to Polit and Hungler the activities involved in identifying and searching for information on a topic and developing a comprehensive picture of a state of knowledge and attitude on the topic is called of literature10.
A cross sectional study was conducted on samples of 52 Chinese with diabetes type 2 were studied through the structured interview schedule based on validated sales assessing diabetes knowledge compliance behaviors, and demographic data. The findings indicate that there was no association between what patients were taught, and what they were actually during. Most of the patients were aware of factual knowledge on diabetes but were unaware on the application of knowledge to their real life situation. Strategies are suggested to close the knowledge action gap and increase patient’s motivation and comply with health regimen11.
A study was conducted to assess the effect of adult self-regulation of diabetes on quality of life out come, in Columbia. The study findings indicated that individuals level of under standing of diabetes and their perceptions of control over diabetes were the most significant predictors of out comes. However, diabetes specific health behaviors were related to an increased sense of burden that was negatively associated with quality of life12.
A study was conducted to determined and compares the knowledge, belief and practice of diabetes receiving free medical care and those paid for medical care in Tamilnadu, India. A questionnaire was administered to elicit diabetic patients knowledge regarding diet, exercise, adverse effects, habits, and other matters: their belief above diabetes: and there practice regarding diet, medication and self monitoring. The results showed a large gap between knowledge and action in both groups and need for increased efforts towards patients eructation regarding diabetic mellitus13.
A study was conducted to examine the relationship between diabetes specific family support and other psychological factors with regard to diet and exercise self care among older Mexican American with type 2 diseases. 138 Adult age 55 years and olden who are type 2 diabetes completed a survey to access family support specific to diabetes, barriers to self management, self efficiency and diabetes self care activities. The study result shows that, higher level of perceived family support and greater self efficiency were associated with higher reported levels of diet and exercise self care. The research concluded that, family behavior is associated diet and exercise self care14.
A study was conducted to assess the relationship between diabetes related attitudes and patients self reported adherence. This study involved 1202 patients who were placed into low adherence or higher adherence groups based on their answer to questionnaire. Member at the high adherence group strongly supported the need for special training for health care professionals who treat diabetes, favored team care, accepted the importance of patients compliance. The research concluded that difference in attitudes between high and low adherence groups were more prevalent for difficult adherence areas, example, diet and exercise, than for easy adherence areas, example, carrying sweets or diabetic identification. An understanding of patients’ attitude can help diabetes educators and patients develop realistic and relevant self care plans15.
A descriptive study was conducted on 100 samples on type 2 diabetic patients’ knowledge and attitude on self care activities were accessed by using interview schedule and Likert’s scale. The result shows that 48% at the patients had inadequate knowledge, 35% of the patients had moderately adequate knowledge and 17% of patients had adequate knowledge. Regarding attitude, 72% of patients had undesirable attitude, 16% patients had desirable attitude and 12% of patients had most desirable attitude on self care activities. The researcher concluded that, most of the patients were inadequate knowledge and attitude about diabetes mellitus. So proper health education can improve the patients knowledge and attitude on self care activities. (un publish research)16.
A study was conducted to determine whether an increased dietary protein to carbohydrate ratio as an effect, independent of energy restriction, on weight loss and insulin resistance. A clinical intervention study of 12 weeks of energy restriction and 4 weeks of energy balance comparing 2 groups of obese, hyper insulinemic subjects (14 males and 43 females), randomly assigned to either a high protein (HP) diet or standard protein (SP) diet. Data were analyzed by 2 ways ANOVA. After16 week the decrees in weight, total fact and abdominal fat was similar in the HP and SP diet. At both base line and week 16, the plasma glucose response was significantly less and insulin responses similar following HP compare to the SP meal, plasma triglyceride level decreased more on the HP compare to the SP diet (10%). The researchers concluded that, in obese subjects with hyper insulinemia (i) energy restriction is the major determent of weight loss, and (ii) an increase in the Protein to carbohydrate ration is associated with lower postprandial glucose and decreased plasma triglyceride concentrations17.
A study was conducted to compare a simple meal plan emphasizing healthy food choices with a traditional exchange based meal plan in reducing HbA (Ic) levels in urban African Americans with type 2 diabetes. A total of 648 type 2 diabetic patients were randomized to received instructions in either a healthy food choices meal plan (HFC) or a exchange based meal plan (ExCH) to compare the impact on glycemic control Weight loss, serum lipids, and blood pressure at 6 months of follow up. The study results showed that improvements glycemic control over 6 months were significant but similar in both groups: improvement in HDL cholesterol and triglycerides were comparable in both groups, where as other lipids and blood pressure were not altered. The researchers were concluded that, medical nutrition therapy is effective in urban African American with type 2 diabetes18.
A study was conducted to compare the effect of simple dietary education on food intake, nutritional components and glycemic control with conventional dietary education. A randomly allocated 30 new elderly diabetic outpatients and 38 out patients who had been visiting the clinic for a long time to the simile education group and the conventional educating group. Before and 2 or 3 months after simple or conventional education, they assessed food in take nutritional components for a week. The study results showed that, in the new diabetic patients, simple conventional nutritional education similarly reduced HbA Ic levels as well as intakes of total energy, sweets and fruits after the education. However, patents who had been visiting for a long time had no significant differences in total energy in take and HbA Ic level between before and after education in both the simple and conventional groups. The results suggest that simple dietary education is useful and effective for elderly diabetic patients on their first visit19.
A study was conducted to determine if registered direction (RD) and registered nurse (RL) Certified diabetes educators provide similar recommendations regarding carbohydrates and dietary supplements to individuals with diabetes. The service sample consisted of 336 certified diabetes educators: 207 were RNs and 159 were RDs. The study results showed that, no statically significant differences were found between RNs were RDs in typical carbohydrate recommendation for treatment of diabetes. However RDs were more likely than RDs to recommend consuming a carbohydrate sources sources with protein to treat hypoglycemia. They were concluded that, although some difference existed, RDs and RNs are making similar overall recommendations in the treatment of individuals with diabetes20.