1
DISSERTATION PROTOCOL
1. / NAME OF THECNADIDATE AND ADDRESS / Ms. ARUNADEVI .A
MSc. NURSING STUDENT
D/O C.ACHIKANDAR
MELAPALAPPATTI,
PALAPPATTI ( PO)
P.VELUR (TK)
NAMAKKL(DT)
2. / NAME OF THE INSTITUTION / S.B COLLEGE OF NURSING,
YELAHANKA NEW TOWN,
BANGALORE.
3 / COURSE OF STUDY AND SUBJECT / M.SC NURSING
(MEDICAL AND SURGICAL NURSING
4. / DATE OF ADMISSION TO COURSE / 25.06.2008
TITLE OF THE TOPIC
EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE AND PRACTICE OF FOOT CARE AMONG DIABETIC PATIENTS IN SELECTED HOSPITALS, BANGALORE.
BRIEF RESUME OF INTENDED WORK:
6.1 NEED FOR THE STUDY:
The diabetic foot is one of the main complications of diabetes
mellitus (DM) of high social economic impact, characterized by foot
lesions resulting from neuropathy, Ischemia and infection. To
verify the knowledge of preventive measures for the diabetic foot
wear evaluated regarding their clinical – epidemiological history,
demographic attitudes toward diabetes mellitus(DM) control and
preventive care of the feet, before and after attending an
informative educational, programme. There was a significant
improvement of knowledge of preventive measures for the diabetic
fool after the programme (P<0.0001), as well as for the attitudes
towards DM control (P<0.0001). It concluded that the population
sample evaluated is unaware of preventive measures for the diabetic
foot and related to foot care.(Arg Bras Endocrinol)
Foot infection was common among Indian diabetic patients (52 %). A lesser prevalence of peripheral vascular disease (13%) among Indians was noted when compared with those in western countries (48 %) smoking increases the risk by reducing blood circulation in the legs and reducing sensation in the feet. (Vijay Viswanathan 2004).
The prevalence abnormal footfindingswas peripheral neuropathy 9.7 %, peripheral arterial disease14.8% (absent dorsalis pedis), 12.4 % (absent tibia is Posterior)acute diabetic foot ulcer 0.8 % amputations of lower extremities1.5% and amputations limited to toes 0.5%. The prevalence of the Diabetic Foot Syndrome at the primary care level in Germany is 2.9 %. Common risk factors such as hyperkeratosis sis and poor glycemic control can be modified (Shaman A, et.al, 2008).
`Foot ulcers and amputations are a major cause of morbidity,disability, as well as emotional and physical costs for people with diabetes. Early recognition and management of independent risk factors for ulcers and amputations can prevent or delay the onset of adverse outcomes.This position statement provides recommendations for people who currently have no foot ulcers and outlines the best means to indentify and manage risk factors before a foot ulcer occurs or an amputation becomes imminent. (Janisse D, et.al., 1998).
The diabetic foot care management includes
Keep bloodsugar levels, under control
Wash our feet daily,and dry them carefully especially in
between the toes
Cut toe nails straight across and file the edges gently
Check the insides of your shoes daily and make sure that the
People with one or more high risk foot conditions should be
seam (or) stitches of the shoes has not come.
evaluated more frequently.
Nurse’s role is to increase awareness of foot care among the diabetic patients.People with diabetes can develop a variety of foot complaints are the leading cause of hospitalization. It is estimated that 15% of all diabetes will develop a serious foot complaints. Tow hundred and fifty three people were recruited. There were 40 deaths (15.8%) 36 amputations (15.5%) and 99 recurrences (43.2%) at 18 months our main findings were that being older (hazard Ratio (HR) 1.07, 95%CI 1.04, 1.11). (West Journal Nursing Research 2008 AP 30(3)).
Health education has become the most important tool in community health today to change practices and shift behavior toward healthier life (Rajamma M 1999). Hence it is felt that preparation, validation and reliability of an audiovisual aid can be more useful as it permits both observing and listening and facilitates learning at their own space. Self instructional module is a learning, package planed and prepared form the beginning till end with an aim to facilitate self learning. It is self explanatory, self sufficient, Self-directed, self motivating and self evaluating and also less time consuming, appropriate for the target audience and more effective than lecture method (Sankaranariyanan 2006).
Further,investigator while working in the hospital observed that the diabetic patients have not given proper care to their foot. So, the investigator will be planning to develop a self instructional module to improve the knowledge and practices of the diabetic patients regarding foot care.
6.2 REVIEW OF LITERATURE:
Batista. F Pinzur MS( 2005) stated that Patients with diabetes who are at risk for the development of diabetic foot ulcers should receive ongoing foot- specific patient education..
Khamesh ME, et.al. (2007) mentioned that the knowledge and practice of foot care in diabetes. The mean knowledge score was 6.6 out of a possible 16.56% not aware of the effect of smoking, 60% failed to inspect their feet, 42% did not know to trim their toenails, walking bare foot 62%.
Vishwanathan V. et .al., (2005) they stated that to determine whether intensive treatment and education strategies for diabetic patients. With high risk diabetic foot disease helps in preventing foot amputations. The three study groups were subjects with diabetes and neuropathy (group1 in: 2,871). Diabetic neuropathy with deformity (group 2 n=235) and diabetic neuropathy with deformity and foot ulceration (or) peripheral vascular disease (group 3n=1,766). Among the 1,259 group 3 subjects who came for follow up 718(57%). Strictly flowed the advice given and 541(43%) did not subjects who did not follow the advice developed new problems(26%)are required surgical procedures (14%) those who followed the advice (5 and 3%)strategies such as intensive management and foot care education are helpful in preventing newer problems and surgery in diabetic foot disease.
Ostomy wound manage (2002) recommended that the diabetic patient, daily foot care and inspection can prevent the development of foot ulcers. Preventive behaviors focus on not going bare foot, Performing / receiving proper foot care and wearing properly fitting shoes.
John Miller,(2003) mentioned Swelling of the feet or legs can be a sign of underlying inflammation or infection. Bruise, strain, pain, localized warmth can be a sign of infection Drainage of pus from a wound is usually a sign of infection persistent bloody drainage is also a sign of a potentially serious foot problem. Fever or chills, red streaking away from a wound (or) redness spreading out form a wound.
Taylor.et.al.,(2003)mentioned that nurses play a critical role in reducing diabetic complications education. Nurses can prevent diabetes complications in patients by providing diabetes education to newly diagnosed patients, creating a multidisciplinary diabetic control regimen with the patient, nutritionist, and diabetes educator, and calling patients bimonthly to check upon patient’s compliance with diabetes control regimen. During the meetings, the nurse should act as a patient advocate and actively involve the patient in the decision making process once the diabetes control regimen has been implemented ,the nurse can increase patient’s compliance by calling them bimonthly to check their status. Asking a few simple questions such as the patient’s recent glucose levels, recent meals, or last time that the patient exercised, can give a nurse valuable clues about how the patientis doing
STATEMENT OF PROBLEM:
A study to assess the effectiveness of self instructional module on knowledge and practice of foot care among diabetic patients in selected hospital,Bangalore.
6.3 Objectives of study:
To assess the knowledge and practice of foot care among diabetic patients before implementation of self instructional module
To assess the effectiveness of self instructional module on knowledge and practice of foot care among diabetic patients.
To compare the knowledge and practice of diabetic patients on foot care with their demographic variables.
6.4HYPOTHESIS:
Research Hypothesis:
H1: There is no significant difference between knowledge and practice of diabetic patients on foot caret
H2:There will be significant association between the selecteddemographic
variables with knowledge level score of diabetic patients assessed by chi-
square test (X2) AT 0.001 levels
6.5 OPERATIONAL DEFINITIONS:
- EFFECTIVENESS:
It refers to significant gain in knowledge and practice as determine by significant difference in pre and past test course.
- ASSESS:
It refers to measurement of the knowledge and practice on foot care among diabetic patients as observed form the scores based on questionnaire method and check list
- KNOWLEDGE:
It refers to the correct response of diabetic patients to the knowledge items in the structured ,questioner schedule regarding foot care
- SELF- INSTRUCTIONAL MODULE
It refers to a learning package, planned and prepared form the beginning to till end with an aim to facilitate self- learning.
- DIABETIC- FOOT CARE:
It refers to care which is given to the diabetic foot.
- ASSUMPTIONS
Diabetic patients will have some knowledge regarding foot care.
7. MATERIALS AND METHODS:
7.1. SOURCE OF DATA-
The source of data will be diabetes mellitus patients in selected hospital Bangalore.
7.2. METHOD OF COLLECTION:
The data will be collected by the investigator herself using structured questionnaire sections.
7.2.1 RESEARCH DESIGN AND APPROACH
Quasi- experimental design and one group pre and post test approach.
7.2.2 SETTING:
Study will be conducted in the selected hospital, Bangalore.
7.2.3 POPULATION:
The population for the present study will bediabetic patients admitted in the selected hospital,Bangalore.
7.2.5SAMPLE SIZE:
The approximate Sample size is 50.
7.2.6 SAMPLING PROCEDURE
The sampling technique will be selected for present study is Purposive
sampling technique.
7.2.7 SAMPLING CRITERIA:
INCLUSION CRITERIA
1). Patients admitted in the selected hospital with diabetes mellitus who
are willing to participate in the study.
2). Patient with diabetes mellitus who are available during data
collection.
3). who were able to read and speak English and Kannada.
EXCLUSION CRITERIA:
1).Patient admitted in the selected hospital with diabetes mellitus who are not willing to participate in the study.
2). Patient with diabetes mellitus who are not available at the time of data
3). who were not able to read and speak English and Kannada.
7.2.8 DATA COLLECTION TOOL:
Structured questionnaire schedule will be prepared for data collection. The questionnaire consists of
Section A: Questions associated with demographic variables.
Section B: Questions related to knowledge on diabetic foot care.
Section C: Questions related to practice on diabetic foot care.
7.2.9 DATA ANALYSIS METHOD:
Appropriate inferential statistics will be used for data analysis and presented in the form of table, graphs and figures etc.
The effectiveness of pre and post test knowledge score will be analyzed by using paired‘t’ test.
The significance of relationship between the selected demographic variables and knowledge scores is by using chi-square test, t-value.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENS OR OTHER HUMANS OR ANIMALS? IF SO DESCRIBE BRIEFLY NO
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
NOT APPLICABLE
8. LIST OF REFERENCES
1). Batista F (2005) “Disease knowledge in patients attending a diabetic
foot Clinic” foot ankle int 26(1)
2). Han and Ezquerro (2002 “Diabetic foot wound care” journal of the
Americanpodiatric medical association 92(6)
3). HauserDE, (1999)“promotion of foot health education” clinical Excell
Nurse practioner 3(4)
4). Khamesh ME, et.al., (2007)“knowledge and practice of foot care in people
with diabetes” Journal Int wound 4(4)
5). Lit Zelman, et.al.m., (1997) “The role of foot wear in the prevention of foot
leions in patients with diabetes mellitus” Diabetes care 20(156)
6).pollock RD,et.al.,(2004)“knowledge and practice of foot care in people with diabetes” Diabetes Res Clinical practice 64(2)
7).Viswanathan v, et. al. ,(1999) “Need for education on foot care diabetic
patients in India” Journal Association of physicians India 47(11)
:9. SIGNATURE OF THE CANDIDATE10. REMARKS OF THE GUIDE:
The study is use full for providing care to the diabetic patients. The need
for study explained is appropriate, methodology is as per the statement
of the Problem. Hence, can be approved for under taking this study.
11. NAME AND DESIGNATION:
11.1 GUIDE: Ms. LATHA P,
Professor and Head of the Department,
MEDICAL SURGICAL NURSING.
S B College of Nursing, Bangalore.
11.2 SIGNATURE:
11.3 HEAD OF THE Ms. LATHA P,
Professor and Head of the Department,
MEDICAL SURGICAL NURSING.
S B College of Nursing, Bangalore.
11.4SIGNATURE:
12.112.1.REMARKS OF THE CHAIRMAN AND PRINCIPAL:This helps to improve the knowledge of diabetic patients and is
approved by the research committee.Hence can be conducted
12.2. SIGNATURE:
.