RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
PROFORMA FOR THE REGISTRATION OF THE SUBJECT FOR THE DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MS.DORATHY ROSELINED/O MESHAK.S.
METHODIST CHURCH,
MISSION COMPOUND,
KOLAR-563101.
2. / NAME OF THE INSTITUTION / SRI DEVARAJ URS COLLEGE OF NURSING, TAMAKA, KOLAR-563101. KARNATAKA.
3. / COURSE OF THE STUDY AND SUBJECT / I YEAR MSC. NURSING
MEDICAL – SURGICAL NURSING SPECIALITY
4 / DATE OF ADMISSION TO COURSE / 15TH JUNE 2009
5. / TITLE OF THE TOPIC / A study TO assess the Effectiveness of Patient
Teaching on Knowledge and
Practice regarding Self-Administration of Insulin
Injection among patients with Diabetes Mellitus admitted in a selected Hospital, Kolar with a view to develop Information Pamphlet.
6 / BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION :
Human body consists of various systems to co-ordinate its functions. The nervous system and the endocrine system are the two important systems that act together to co-ordinate the functions of all body systems. Their means to control are different. The nervous system acts through nerve impulses, where as endocrine system controls body activities by releasing mediators called hormones. 1
Hormone is a mediator molecule that is released in one part of the body but regulates the activity of cells in other parts of the body. The islets of langerhans of the pancreas regulate blood sugar levels by producing a hormone called insulin. 1
Insulin is the principle regulator of the metabolism and storage of ingested carbohydrates and proteins. An increased blood glucose level is the major stimulus for insulin synthesis and secretion. 2
The insulin alterations result in disordered metabolism of carbohydrates, fat the proteins and causes hyperglycemia and finally leading to a condition called as Diabetes mellitus. 2
According to Joyce.M.Black, the overall term Diabetes mellitus includes four subclasses:
a. Insulin dependent Diabetes Mellitus
b .Non-Insulin dependent Diabetes Mellitus
c. Secondary Diabetes Mellitus
d.Malnutrition related Diabetes Mellitus.3
The exogenous insulin is needed in Diabetes Mellitus when a patient has inadequate insulin to meet specific metabolic needs.3
Diabetes is difficult to manage as it imposes life long demands on people with diabetes and their families. People with diabetes might need insulin injection either because they don’t produce enough insulin in their bodies or they cannot properly use the insulin that they do produce or both.3
Successful self management in Diabetes helps the patient feel
better. Education is an important aspect of self-management, teaching the client on self administration of insulin helps the patient helps to build self confidence and pride of contribution in their management.4
The nurse has an important role to play in the management of Diabetes. The nurse has the responsibility of teaching the self injection of Insulin to the patient and the family members or significant others and she has to begin this as soon as the need for the insulin has been established and use written or verbal instructions and demonstration techniques for teaching the patients.4
6.1. / NEED FOR THE STUDY
“Education is of the essence in preventing
Diabetes complication”
Diabetes has emerged as a major health care problem everywhere. Currently the number of cases of diabetes worldwide is estimated to be around 150 million. This number is predicted to double by 2025.5
According to the National Diabetes Information Clearing House. In 2007, the five countries with the largest number of people with Diabetes Mellitus in India (40.9 Million), China (39.8 Million), the United States (19.2 Million), Russia (9.6 Million) and Germany (7.4 Million). By 2025, largest increases in diabetes prevalence take place in developing countries.5
Rapid urbanization and industrialization have produced advancement on the social and economic front in developing countries,such as India which have resulted in dramatic lifestyle
related diseases. The transition has occurred in the last 15 years and the prevalence has risen from 2.4% to6.4%. It is estimated that
by 2025, every fifth person with diabetes will be an Indian. 5
In India, the lack of proper healthcare infrastructure ,rampant ignorance and absence of clear cut guidelines mean that approach to the management of Diabetes is ad hoc. 5
In India the recent study done in Chennai shows that 25% of the population studied were unaware of a condition called diabetes. Only 40% of the participants felt that prevalence of diabetes was increasing and only 22% of the population felt that diabetes could be prevented.5
In a Diabcare Asia study in 1998, it was observed that of all the patients with diabetes taking treatment from specialized centres, more than 50% of the patients had poor control of diabetes. The study showed that 4% of patients were on diet therapy alone, 53.9%, were receiving oral anti-diabetic agents, 22% of the patients were taking insulin and another 19% were on both
insulin and oral drugs. This study confirmed that diabetes care in India leaves much to be desired.5
A cross sectional survey was done on prevalence of Diabetes Mellitus and impaired fasting blood glucose among rural population of Mysore was conducted from J.S.S. Medical College, Mysore. Blood samples were collected with a minimum of eight hour fasting. The results showed that the prevalence rate (percent) of diabetes mellitus above the age of 25 years was 3.77%. The prevalence in males was 4.58% and in females it was 2.66% and impaired fasting glucose was 2.82% in male and 2.78% in females.5
In the year 2006, 4620 Diabetic patients reported to the OPD at R.L.Jalappa Hospital and 433 were patients admitted to Diabetic ward.
During the clinical experience of the investigator in the diabetic ward of R.L. Jalappa Hospital, she observed that most of the patients receiving Insulin Injection were not aware of the correct techniques and were dependent on the nurses in the ward . When they were discharged they depended on the nurses in the Nursing homes . Patients taking self injection of insulin have come
with the Bruises and Abscess as the complication of taking the
Injection. Therefore patient teaching on self-administration of insulin injection will prevent the complications.
Based on the Review of literature and personal experience the investigator is interested to explore the effects of Patient teaching on self administration of Insulin injection on the patients knowledge and practice .this will make a significant contribution to the field of nursing.
6.2 / REVIEW OF LITERATURE
Review of Literature refers to the activities involved in identifying or searching for information on a topic and developing an understanding of the state of knowledge of the topic (polit and Hungler) 1993.
The Review of literature for the study on effectiveness of patient teaching on self -administration of insulin is a follows
1. Changing role of a nurse as a health educator
2. Patient education on insulin therapy.
3. Barrier in self care of insulin requiring diabetic patient
4.Self-administration of insulin
I.Changing role of a nurse as a health educator
Health promotion and disease prevention are a growing concern and focus of the healthcare delivery system. Educating clients about diseases ,prevention ,nutrition and healthy behaviours is essential .Education is involved in all nursing activities .
II. Patient education on Insulin Therapy
A prospective study done in Bethanien Hospital at the university of Heidelberg to assess the effects of metabolic control patient education and initiation on insulin therapy on the quality of life of patients with type I Diabetes mellitus was conducte on 71 consecutively recruited patients with insulin treated diabetes assessed before and 6 months after participation in DTTP showed that only patients switched on insulin therapy showed significant improvement in diabetes. 6
A experimental study among 34 insulin-dependent diabetes patients the effects of a more intensive treatment done in Michigan by three regular specialist were examined on comparing with a matched control group (n=34), the results showed that the intensively treated group had a better metabolic control and that there were no differences found regarding the satisfaction about the patient education.7
The controlled trial on the effects of patient education in
the treatment of insulin dependent diabetes done at university of
Sao Paulo on 77 subjects randomized in to two groups. Intensive patient education given by group from team of physician, teaching nurses and a dietitian. The results demonstrated that the effects of educational programme are of limited value they do not lead to permanent changes in attitude and motivation.8
A descriptive study to assess the self–management support for insulin therapy in type–2 diabetes was conducted in Michigan with a purpose to describe the self–manage support that can be provided by diabetes educators for type–2 diabetes patients who are transitioning from therapy with oral hypoglycaemic agents to insulin the results show that education and ongoing self–management support are needed for informed decision making and the initiation and maintenance of insulin therapy.9
A multicentre controlled randomized education study was performed in Netherland to evaluate an education programme for insulin treated diabetic patients. Fifteen randomly recruited hospitals (558 Patients) were equally divided into 3 groups two
experimental and a control group. The patients in the
experimental group were evaluated four times and those is control group twice for 6 to 7 months. The results showed no significant effect of education an anyone of these varieties could be found.10
III.Barriers in self care of insulin requiring diabetic patients
A Cross–sectional study was conducted in Amsterdam to assess the perceived barriers in self-care of insulin requiring diabetic patients by using a “Barrier in diabetes Questionnaire consisting of 3 sub scales for 240 patients with type I and type II. Diabetes mellitus. Result showed a significant negative correlation was found between the patients subjective evaluation of their health status and their barrier in diabetes questionnaire scores11
A Cross–sectional study was done in Amsterdam to asses the psychological functioning and self management
behaviors of adult patients with insulin requiring Diabetes
suffering from extreme fear of self injecting and self testing with 1275 samples. Results showed that people with extreme FSI or FST scores as compared with other patients reported higher levels of trait or state anxiety and depression. 11
IV.Self-administration of insulin
A cross-sectional study undertaken to describe the most common correct and incorrect self-administration techniques for insulin using disposable syringes cared for by family health strategy in Brazil identified errors in steps of self -administration of insulin ,from hand washing to compression on the injection site.12
A Descriptive study done in Newyork to assess the behaviour of people with Diabetes Mellitus in relation to utilization and reutilization of disposable syringes for the administration of insulin at home showed that 98.2% used a disposable syringe for insulin injection and only 5.3% actually disposed it .Among these,94.6% re-used the disposable syringe after application by means of various procedures.13
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7.4 / STATEMENT OF THE PROBLEM
A study to assess the Effectiveness of Patient Teaching on Knowledge and Practice regarding Self-Administration of Insulin Injection among patients with Diabetes Mellitus admitted in a selected Hospital, Kolar with a view to develop Information Pamphlet.
OBJECTIVES OF THE STUDY
1. Assess the Knowledge of Patients with Diabetes mellitus regarding self–administration of insulin injection.
2. Evaluate the effectiveness of patient teaching on self– administration of insulin injection on Knowledge and Practice among patients with Diabetes
3. Determine the association between knowledge and practice of patients with Diabetes Mellitus regarding self-administration of insulin injection.
4. Determine the Association between knowledge and
selected Demographic variables such as Age, Sex,
educational status, number of years on insulin
therapy,number of admissions with Diabetes Mellitus
andfamily history of taking insulin injections.
5. Develop an information pamphlet on self-administration of insulin injection.
ASSUMPTIONS :
1. Patient will have some knowledge regarding self–administration of Insulin injection.
2. Knowledge of Patients about self–administration of Insulin injection will influence their practice.
3. Patient teaching will improve the knowledge and practice of patients with Diabetes Mellitus on self-administration of Insulin injection.
4. Information pamphlet will improve the Knowledge and Practice of Patients regarding self–administration of Insulin injection.
HYPOTHESIS
Ho1 -There will be no significant increase in the knowledge scores of the patient after the patient teaching on self–administration of insulin injection.
Ho2 – There will be no significant association between knowledge and practice of patients with Diabetes Mellitus regarding self-administration of insulin injection.
Ho3- There will be no significant association between knowledge on self–administration of insulin injection and demographic variables.
OPERATIONAL DEFINITION
Effectiveness: In this study Effectiveness refers to the change in the knowledge and practice scores on self–administration of insulin injection obtained by comparing pretest and post-test scores.
Patient Teaching: In this study patient teaching refers to systematically planned education which includes discussion and demonstration on subcutaneous injection of insulin to patient with Diabetes Mellitus ; researcher will conduct the discussion and demonstration herself.
Knowledge : It refers to the correct responses to the questions on self-administration of insulin injection which will be assessed by a structured interview schedule.
Practice : It refers to the method of performing the procedure of self-administration of insulin injection, assessed by using observation check list.
Self-administration of insulin injection: In this study it refers to the method of taking / self injecting insulin by the patient.
Patients :In this study it refers to patients who are admitted to R.L.Jalappa Hospital with Diabetes mellitus and are receiving insulin Injection.
Diabetes mellitus: In this study it refers to the health problem characterized by abnormalities in glucose homeostasis resulting in hyperglycaemia.
Information Pamphlet: In this study it refers to the Pamphlet which provides detailed information on self-administration of insulin injection.
MATERIALS AND METHODS
Source of data
Source of data for this study will be inpatients diagnosed to have Diabetes Mellitus and who are receiving insulin injection.
Research design and approach
Quasi-experimental (one group pre-test post-test design) will be used .