ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATIONS
1. / Name of the Candidate and Address
(In Block Letters) / SHEBA S. BABU
1st year M.Sc. (Nursing)
SrinivasA Institute of Nursing Sciences,Valachil, ManGalore,
PIN – 574 143
2. / Name of the Institution / SrinivasA INstitute of Nursing Sciences, Valachil PADAVU, ARKULA,
fARANGIPETE pOST,
Mangalore – 574 143.
3. / Course of study
subject / M.Sc. Nursing
Medical Surgical Nursing
4. / Date of Admission / 14.06.2008
5. / Title of the Topic
A CLINICAL STUDY ON KNOWLEDGE AND PRACTICEOF DIABETIC PATIENTS ATTENDING OUTPATIENT DEPARTMENT IN A SELECTED HOSPITAL IN MANGALORE.
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7.
8.
/ Brief Resume of intended work
6.1 Need for the Study
Glucose is a simple sugar found in food. Glucose is an essential nutrient that provides energy for the proper functioning of the body cells. Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose level elevates, insulin is released from the pancreas to normalize the glucose level. In patient with diabetes the absence or insufficient production of insulin causes hyperglycemia.
According to WHO,“Diabetes Mellitus” is characterized by hyperglycemia and disturbance of carbohydrate, fat and protein metabolism, that are associated with absolute or relative deficiencies of insulin action or secretion.
According to WHO (2007), diabetes causes about 5% of all deaths globally each year. 80% of people with diabetes live in low and middle income countries. According to American Diabetes Association (2008),there are 23.6 million people in the United States or 8% of the population who have diabetes. The total prevalence of diabetes increased 13.5% from 2005-2007. According to Indian health statistics (2008),the number of cases diabetes in Indiais 31.7 million and estimated number of diabetes cases in India for 2030 is 79.4 million.
American Diabetes Association (2003)classified the diabetes mellitus into Type 1 and Type 2 diabetes. Diabetes Mellitus is a chronic disease having an insidious onset, which can be controlled by diet, drug and exercises. According toBlack JM et.al (2007),acute complications of diabetes mellitus are diabetic ketoacidosis, hypoglycemia, hyperglycemic and hyperosmolar non ketotic syndrome. The chronic complications include macro vascular complications such as cerebrovascular disease, coronary heart disease, peripheral vascular disease, hypertension and micro vascular disorders like diabetic retinopathy, nephropathy and neuropathy.
According to SmeltzerSC (2008)diabetes mellitus is a chronic illness requiring a lifetime of special self management behaviour.Because diet, physical activity, physical and emotional stress affect diabetic control, patients must learn to balance a multitude of factors. They must learn daily self care skills to prevent acute fluctuations in blood glucose, and they must also incorporate into their life style many preventive behaviours for avoidance of long term diabetic complications. Diabetic patients must become knowledgeable about nutrition, medication, exercise, disease progression, prevention strategies, blood glucose monitoring technique and medication adjustment.
Pace et.al (2006) had conducted a descriptive study on knowledge on diabetes mellitus in the self care process at endocrinology and diabetology outpatient clinic in Brazil. The objective of the study was to verify diabetes mellitus patient’s knowledge about the disease, causes and complications and highlighting the importance in self care. The sample consisted of 659 diabetes mellitus patients. Data were collected through interviews and data analyzed through descriptive statistics. The result showed that only 28.6% of the participants gave correct answers to “What is diabetes and what are its causes”. The researcher found out that, little knowledge about the disease, its causes and symptoms, the prevention, early diagnosis and its complications.
Helna M (2000)had conducted a cross-sectional study on diabetes self care knowledge among outpatients with type 1 or type 2 diabetes mellitus at the VAANN Arbor Health Care System. The objective of the study was to assess the outpatient’s general understanding about self care knowledge on diabetes mellitus. Samples of 500 patients were selected and data were collected through structured questionnaire. The result showed that 62% of the patients did not have adequate knowledge regarding diet, blood glucose monitoring, foot care, insulin therapy and disease complications. So the researcher emphasized a profound need for health education related to self care management of diabetes mellitus.
6.2 Review of literature
Arslantas et.al (2008) had conducted a descriptive survey on knowledge of diabetic patient about diabetes at the primary stage at Eskiser inTurkey. A sample of 495patients were interviewed.The result showed that majority of the patients had a positive familyhistory, hypertensionand obesity.Only 14.5% of the patients who were able to check their plasma glucose levels by themselves.None of the patients had HbA1c level results in their follow up files. In addition, they were unaware of what HbA1c signifies or what it entails and 21.9% of the diabetic patients developed complications.
Shilubanc HN et.al (2007) had conducted a quantitative survey on patients and familymemers knowledge and views regarding diabetes mellitus and its treatment. The objective of the study was to identify diabetic patients and family member’s knowledge about diabetes mellitus. A convenient sample of 32 diabetic patient and 32 family members who attended 2 health care facilities in the Mopani district. The data were collected by using 2 similar questionnaires, one for each group respectively. Findings revealed that the diabetic patients and family members lack adequate knowledge on diabetes and its treatment. Therefore, the researcher emphasized the importance of health education regarding diabetes mellitus to the patients and family members.
Tuks et. al (2006) had conducted an experimental study on Diabetes self care knowledge, behaviors and metabolic control of older adults, the effect of post educational follow up programme. The objective of the study was to increase the self care knowledge, improve metabolic control and reduce self care behavioral deficit. A sample of 27 hospitalized elderly patients with diabetes, who had completed an inpatient education programme were recruited and randomized into experimental (n=18) and controlled (n=12) groups. A post test on HbA1c and diabetes self care knowledge was administered to all subjects and self care behavioral deficits were measured. A 4 week follow up intervention via telephone contact was administered to the experimental subjects. The result revealed that there was no significant difference observed in diabetes self care knowledge and HbA1c values. A significant differences was achieved in reduction of self care deficit(p<0.05-0.01). It was concluded that post educational follow up is necessary for enhancing self care adherence and ensuring safe practice at home for elderly patients with diabetes.
Michele et.al (2005) had conducted a cross-sectional survey on the relationship between knowledge of recent HbA1c values and diabetes care understanding and self management. A sample of 686 USA adults with Type2 diabetes mellitus in 5 health systems was selected. The objective of the study was to examine bivariate and multivariate associations between each variable and the respondence knowledge of their last HbA1c values and assessed whether knowledge of HbA1c was associated with diabetes care, attitudes and behaviours. The result showed that 66% of patients did not know their last HbA1c values and only 25% accurately reported that value. The respondents who knew their last HbA1c value had higher odds of accurately assessing their diabetes control and better reported self management behaviours.
Kruger S et.al (2004) had conducted a descriptive study on knowledge and practice of foot care in people with diabetes. The objective of the study was to determine the knowledge and practice of foot care in people with diabetes. A sample of 80 patients admitted in middle brough, South Tees at U.K. The data were collected through questionnaire and knowledge score was calculated and current practice determined, practices that put patient at risk developing foot ulcers and barriers to good practice were identified. The result revealed that there was positive correlation between knowledge score and having received advice on foot care (6.9 versus 5.4, p=0.001). Deficiencies in knowledge included the inability to sense minor injury to the feet (47.3%), proneness to ulceration (52.4%), effect of smoking on the circulation (44.5%), 24.6% never visited chiropodist, 18.5% fail to inspect their feet and 83% did not have their feet measured when they last purchased shoes. The results highlighted the areas where refers to improve knowledge and practice may contribute to the prevention of foot ulcers and amputation.
6.3 Problem Statement
A clinical study on knowledge and practice of diabetic patients attending outpatient department in a selected hospital in Mangalore.
6.4 Objectives of the Study
1. To assess the knowledge and practice of diabetic patient.
2. To determine the relationship between knowledge and practice of diabetic patients
and selected demographic variables.
6.5 Operational Definitions
1. Knowledge:
Refers to the knowledge expressed by the diabetic patients about the diabetes mellitus including meaning, etiology, clinical features, treatment and complications.
2. Practice:
Refers to the activities of the diabetic patients regarding drug administration, wound dressings, foot care, exercise, diet etc.
3. Diabetic Patients:
In this study diabetic patient refers, patients who are diagnosed as having both type 1 and type 2 diabetes mellitus and are attending outpatient department of selected hospital.
6.6 Assumptions
1. Diabetic patients knowledge can be assessed.
2. In most diabetic patients there is a deficit in knowledge about their illness.
3. There is a relationship between knowledge and practice of diabetic patient.
4. Knowledge and practice of diabetic patients are influenced by variables such as educational status, duration of illness, family history.
6.7 Delimitations
The study is limited to
-Those who are attending outpatient department in a selected hospital.
-Diabetes mellitus patients
-Only 50 outpatients
-The patients who are willing to participate
-Patients age between 20yrs and 70 yrs
6.8 Hypothesis
Statistical Hypothesis:
-Ho: There is no significant relationship between the knowledge and practice of diabetic patients and selected demographic variables
Research Hypothesis/Alternative Hypothesis:
- H1: There is significant relationship between the knowledge and practice of diabetic patients and selected demographic variables
MATERIALS AND METHODS
7.1 Source of Data
The data will be collected from the diabetic patients who fulfill the inclusion criteria.
7.1.1. Research Design
The research design selected for this study is descriptive in nature.
Analysis
Frequency and percentage Mean, Standard deviation and Chisquare
of socio demographic variables percentage of knowledge and test for
practice about diabetes relationship
between
knowledge score
and socio
demographic
variables
Findings and Conclusion
7.1.2. Setting
The study will be undertaken in a outpatient department of a selected hospital in Mangalore
7.1.3. Population
In the present study, the population consists of all diabetic patients who are attending outpatient department of a selected hospital in Mangalore
7.2Method of Data Collection
7.2.1Sampling Procedure
In view of the nature of the problem and to accomplish the objective of the study, purposive sampling procedure will be used to select 50 diabetic patients from theoutpatient department of a selected hospital in Mangalore.
7.2.2 Sampling Size
The data will be collected from 50 diabetic mellitus patients.
7.2.3 Inclusion Criteria for Sampling
- Patients who are willing to participate in the study
- Patients who are diagnosed to have diabetes mellitus
- Both male and female patients
- Who are attending outpatient department in a selected hospital.
- Patients who are able to read and speak Kannada or English.
7.2.4 Exclusion criteria for sampling
- Diabetic Patients who are not willing to participate in the study
- Patients who cannot read and speak Kannada or English
- Patients who are very weak
7.2.5 Instrument Used
A structured interview schedule.
7.2.6 Data collection method
Data will be collected after getting permission from the concerned authority of the selected hospital. The objectives of the study will be explained to the participants and formal written consent will be taken from the subjects. Investigator will introduce herself to the participants and later will conduct an interview by using a semi structure interview schedule.
7.2.7 Data Analysis Plan
- By using frequency, percentage, ratio, standard deviation, mean, chi-square etc.
- The knowledge scores will be calculated and represented on tables, diagrams and graphs.
7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animal? If so please describe briefly.
Medical interventions like injections or medications etc. are not required on human beings or animals.
7.3Has ethical clearance been obtained from your institution in case of 7.3
Consent letter from college and hospital will be obtained.
References
Books
- Black JM, Hokanson JH. Medical Surgical Nursing. 7th Ed. St. Louis (Missouri): Saunders; 2007
- Lewis SM, Heitkemper MM, Dirksen SR. Medical Surgical Nursing. 6th Ed. Missouri : Mosby Elsevier publications; 2004.
- Smeltzer CS, Bare GB, Hinkle LJ, Chaeever HK. Text book of Medical Surgical Nursing. 11th Ed. Philadelphia: Lippincott Williams and Wilkins; 2008.
1. Helena M. Diabetes self care knowledge among outpatients. American journal of
health system pharmacy 2002; 59(9): 99-102.
2. Kruger S, Guthrine D. knowledge and practice of foot care in people with diabetes.
Diabetes research and clinical practice 2004; 64 (2): 117-122.
3. Michele H, John PD, Spencer N. The relationship between knowledge of recent
HbA1c values and diabetes care understanding and self management.
Diabetes care 2005; 28 (4): 816-22.
4. Tuks, Gay JT. Diabetes self care knowledge, behaviours and metabolic control of
older adults, the effect of post educational follow up programme.
Diabetes education 2006 January – February; 19 (1): 25-30
Online Sources
1. Arslantas D, Unsal A, Mefintas S. Knowledge of diabetic patients about diabetic at
the primary stage in Eskischir, Turkey(online). 2008; Available from:
URL:
2. Pace AE, Ochoa KV, Helena M, Paula A. Knowledge on diabetes mellitus in the
self care process(online).2006; Available from:
URL:
3.Shilubane HN, Potgieter E. Patients and family members knowledge and views
regarding diabetes mellitus and its treatment (online). 2007; Available from:
URL:
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