RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Name of the candidate and address
(in block letters) : / MR. SUBIN KURIAN
I YEARM.Sc NURSING
SHRI H.D.DEVEGOWDA CO-OPERATIVECOLLEGE OF NURSING,MANICHINAHALLY GATE. BELUR ROAD,HASSAN.
Name of the Institution : / SHRI H.D.DEVEGOWDA CO-OPERATIVECOLLEGE OF NURSING,HASSAN.
Course of Study :
Subject : / M. Sc NURSING
MEDICAL SURGICAL NURSING
Date of Admission to the course : / 01.06.2011
Title of the Topic : “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF VARICOSE VEIN AMONG I YEAR B.SC NURSING STUDENTS IN SELECTED NURSING COLLEGES AT HASSAN, KARNATAKA”.
Brief resume of intended work
6.1. Introducion
Varicose veins are swollen, twisted, and sometimes painful veins that have filled with an abnormal collection of blood. In normal veins, valves in the vein keep blood moving forward toward the heart. With varicose veins, the valves do not function properly, allowing blood to remain in the vein. Pooling of blood in a vein causes it to enlarge. This process usually occurs in the veins of the legs, although it may occur elsewhere. Varicose veins are common, affecting mostly women.
In normal veins, valves in the vein keep blood moving forward toward the heart. With varicose veins, the valves do not function properly, allowing blood to remain in the vein. Pooling of blood in a vein causes it to enlarge. This process usually occurs in the veins of the legs, although it may occur elsewhere. Varicose veins are common, affecting mostly women.
The causes include defective valves from birth (congenitally defective valves), Pregnancy, Thrombophlebitis. Standing for a long time and having increased pressure in the abdomen may more likely to develop varicose veins, or may make the condition worse. Primary varicose veins occur because of congenitally defective valves, or without a known cause. Secondary varicose veins occur because of another condition, such as when a pregnant woman develops varicose vein.
6.2.Need for the study
Varicose veinsareveinsthat have become enlarged and tortuous. Veins have leaflet valves to prevent blood from flowing backwards. Leg muscles pump the veins to return blood to the heart, against the effects of gravity. When veins become varicose, the leaflets of the valves no longer meet properly, and the valves do not work. This allows blood to flow backwards and they enlarge even more. Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing. Besides cosmetic problems, varicose veins are often painful, especially when standing or walking.
Excess weight, heavy lifting, and pregnancy also increase the likelihood of developing varicose veins as they all put increased pressure on the body. Increasing age, menopause, genetic weaknesses in the vein walls or in their valves, excessive pressure within the veins due to a low fiber diet which causes an increase in straining during bowel movements, and damage to the veins or to their valves resulting from inflammation also increase the risk of developing varicose veins.Varicose veins may or may not be accompanied by symptoms such as fatigue, aching discomfort, feelings of heaviness or pain in the legs, fluid retention, swelling and pain in the feet and ankles, and discoloration. These dilated and often painful veins affect 50% of middle-aged adults and are twice as common in women as in men. Non-surgical treatments includesclerotherapy, elastic stockings, elevating the legs, and exercise. The traditional surgical treatment has beenvein strippingto remove the affected veins. Alternative techniques, such as ultrasound-guided foamsclerotherapy,radiofrequency ablationandendovenous laser treatment, are available as well. Because most of the blood in the legs is returned by the deep veins, thesuperficial veins, which return only about 10 per cent of the total blood of the legs, can usually be removed or ablated without serious harm.1
The epidemiology of varicose veins was examined in 3,822 adults in the Framingham Study. Findings indicate that the incidence of varicose veins is higher among women than men, with no clear age differences. Compared to women without varicose veins, women with varicose veins were more often obese (p less than .01), had lower levels of physical activity (p less than .001) and higher systolic blood pressure (p less than .001), and were older at menopause (p less than .001). Women who reported spending eight or more hours in an average day in sedentary activities (sitting or standing) also had a significantly higher incidence of varicose veins than those who spent four or fewer hours a day in such activities (p less than .05). For men, varicose veins coexisted with lower levels of physical activity (p less than .05) and higher smoking rates (p less than .05). While men and women with varicose veins had a higher incidence of atherosclerotic cardiovascular disease than those without varicose veins, only the excess risk of coronary heart disease in women was statistically significant (p less than .05). However, this finding was not significant after controlling for body mass and systolic blood pressure. These results suggest that increased physical activity and weight control may help prevent varicose veins among adults at high risk, and reduce the overall risk of atherosclerotic cardiovascular disease as well.2
Many factors predispose human beings to venous disease of the lower extremities, and this condition affects approximately eighty million Americans. Its manifestations may appear to be little more than a cosmetic nuisance, yet may be an indication of a more serious underlying problem undetected by visual inspection. Venous disease is also capable of producing a plethora of uncomfortable symptoms, and left untreated, may progress to cutaneous pigmentation, dermatitis, ulceration, hemorrhage, or superficial thrombophlebitis. The purpose of this article is to aid the nurse in providing accurate information to patients about the disease process, treatment options, and interventions for its prevention.3
Maysa conducted a study to examine the effects of walking on the strength of legs muscles and velocity of blood flaw in legs veins and their diameters to prevent varicose veins in pregnant women.The research sample was divided into two groups, an experimental group consisting of 8 pregnant women and control group consisting of 7 pregnant women using the pre-and post tests. Homogeneity and equality were considered for both groups in age, tallness, weight, muscular strength, diameters of legs veins velocity of blood flow in legs veins. The program has been applied to the experimental group for 3 months with the rate of 3 training units weekly with a total of 36 training units. The researcher used the echo -Doppler Instrument to examine blood vessels and the Dynamometer instrument to measure muscular strength. Results showed improvement in both of legs muscular strength and velocity of blood flow in legs veins and did not show an enlargement in the diameters of legs veins and the protection of them in the experimental group comparing with the control group. The researcher recommends following systematic sport activity to activate blood circulation, such as walking to prevent vulnerability of pregnant women to varicose veins risk4
Health care professionals especially nurses are more prone to get varicose vein. A wide range of literature suggests that nursing students has a very little knowledge regarding prevention of varicose vein. The researcher from her own experience, discussions with experts and casual talk understood that detailed information has to be given to improve the knowledge of nursing students. So the researcher was interested to take this problem.
6.3.Review of literature
Review of literature is the writings of recognized authorities and of previous research which provides the evidence that the researcher is familiar with what is already known and what is still unknown. Citing studies that show substantial agreement and those that seem to prevent conflicting conclusions helps to sharpen and define understanding of the existing knowledge in the problem area, provides background for the research project and makes the reader aware of the status of the issue.5
Evans conducted a cross sectional survey to determine the prevelance of varicose vein and chronic venous insufficiency in the generl population. Men and women aged 18-64 years selected randomly from age-sex registers of 12 general practices.In 1566 subjects examined, the age adjusted prevalence of trunk varices was 40% in men and 32% in women (p<or = 0.01). This sex difference was mostly a result of higher prevalence of mild trunk varices in men. More than 80% of all subjects had mild hyphenweb and reticular varices. The age adjusted prevalence of CVI was 9% in men and 7% in women (p<or = 0.05). The prevalence of all categories of varices and of CVI increased with age (p<or = 0.001). No relation was found with social class. The conclusion of the study was approximately one third of men and women aged 18-64 years had trunk varices. In contrast with the findings in most previous studies, mainly conducted in the 1960s and 1970s, chronic venous insufficiency and mild varicose veins were more common in men than women. No evidence of bias in the study was found to account for this sex difference. Changes in lifestyle or other factors might be contributing to an alteration in the epidemiology of venous disease.6
Malhotra conducted a survey to determine the prevalence of varicose veins among railwaymen of identical socio-economic status and doing identical work of sweepers in the North and South of India . The survey included 323 men from Madras in the South and 354 men from Ajmer in the North of India. While constipation, body weight, smoking, posture and tight undergarments do not appear to contribute to the causation of varicose veins, the role of heredity could not be examined in this study. Big differences were present in blood-clotting time and in clot-lysis between these two populations, the respective values for clotting time being 6 minutes in South Indians and 8 minutes 40 seconds for North Indians (P ⋞ 0.001), and for clot-lysis being 3.7 per cent in South Indians and 25 per cent in North Indians. In order to test the cause-and-effect relationship of these haematological indices 24 North Indians and 81 South Indians with varicose veins were compared with 24 healthy North Indian controls and 81 South Indian controls with no varicose veins. Clot-lysis was markedly higher in those with no varicose veins than in those with varicose veins, but the mean blood clotting times were not significantly different between these two. Since such differences are known to be diet related, this study suggests that, in the prevalence of varicose veins, patterns of diet and eating may play an important part. Therefore, there would seem to be hope that this disease may be prevented.7
Laurikka conducted a study to discover the main determinants for the prevalence of varicose veins in a general population, and to assess the possibilities for prevention of this common surgical disease. Varicose veins were evaluated in three defined cohorts of 3284 men and 3590 women aged 40, 50, and 60 years by using a validated questionnaire. The response rate was 75% among men and 86% among women, and varicose veins were determined by self-assessment. Increasing age, female sex, childbirths, standing posture at work, higher weight or height, and positive family history were significantly associated with varicose veins in a univariate analysis. These factors were further taken into a multivariate logistic regression analysis, and female gender (adjusted odds ratio, OR 2.2), increasing age (OR 2.2-2.8), a reported positive family history for varicose veins (OR 4.9), increasing number of births (OR 1.2-2.8), standing posture at work (OR 1.6), and higher weight (OR 1.2) and height (OR 1.4) were found to independent and significant risk indicators of varicose veins. Increasing age, positive family history of varicose veins, and child-births in women were the most important factors in terms of population etiologic fractions. Familial predisposition and pregnancy-related factors bear important associations with varicose veins. Thus prevention of varicose veins appears to be difficult. Varicose veins are nonlethal and, therefore, higher age is related to higher prevalence.8
Chronic venous disease of the legs occurs commonly in the general population in the Western world. Estimates of the prevalence of varicose veins vary widely from 2–56% in men and from 1–60% in women. These variations reflect differences in variability of study populations including age, race and gender, methods of measurement and disease definition. Definitions of chronic venous disease may rely on reports of varicose veins by study participants, based on self-diagnosis or recall of a diagnosis, or on a standardized physical examination. Venous ulceration is less common, affecting approximately 0.3% of the adult population. Age and pregnancy have been established as risk factors for developing varicose veins. Prolonged standing has been proposed, but results of studies should be interpreted with caution given the difficulty in measuring levels of posture. Obesity has been suggested as a risk factor in women, but appears to be an aggravating factor rather than a primary cause.9
Amanda conducted a study to determine the inter-relationships between a range of lifestyle factors and risk of varicose veins to identify which factors may be implicated in the etiology. An age-stratified random sample of 1566 subjects (699 men and 867 women) aged 18 to 64 years was selected from 12 general practices throughout Edinburgh. A detailed self-administered questionnaire was completed, and a comprehensive physical examination determined the presence and severity of varicose veins. The slightly higher age-adjusted prevalence of varicose veins in men than in women (39.7% versus 32.2%) was not explained by adjustment for an extensive range of lifestyle risk factors (male odds ratio [OR] 2.11, 95% confidence interval [CI] 1.51–2.96). In both sexes, increasing height showed a significant relationship with varicose veins (male OR 1.50, 95% CI 1.18–1.93 and female OR 1.26, 95% CI 1.01–1.58). Among women, body mass index was associated with an increased risk of varicose veins (OR 1.26, 95% CI 1.02–1.54). The current study casts doubt as to whether varicose veins occur predominantly in women. In addition, no consistent relationship with any lifestyle factor was shown. Self-reported evidence suggested a familial susceptibility, thereby warranting future genetic studies.10
6.4.Statement of the problem
A study to assess the effectiveness of structured teaching programme on knowledge regarding prevention of varicose vein among I year B.Sc Nursing students in selected nursing colleges at Hassan, Karnataka.
6.5. Objectives of the study
  1. To determine the mean pre-test and post-test level of knowledge regarding prevention of varicose vein among I year B.Sc Nursing students in selected nursing colleges at Hassan, Karnataka.
  2. To evaluate the effectiveness of the structured teaching programme regarding prevention of varicose vein among I year B.Sc Nursing students in terms of gain in the mean post-test knowledge score.
  3. To find the association between the mean pre-test knowledge score and the selected demographic variables (age, family history, duration of standing and break time in ward).

6.6. Operational definitions
1. Knowledge: According to Oxford dictionary knowledge refers to a person’s range of information.
In the present study knowledge refers to the correct responses obtained from I year B.Sc Nursing students regarding prevention of varicose vein as measured by a structured self administered questionnaire.
2. Effectiveness: According to Oxford dictionary effectiveness refers to producing the intended result.
In the present study effectiveness refers to the extent to which the structured teaching programme will achieve the desired effect in improving the knowledge ofI year B.Sc Nursing students regarding prevention of varicose vein.
  1. Structured teaching programme: In this study, structured teaching programme refers tosystematically organized structured questionnaire with teaching aids to improve knowledge regarding prevention of varicose vein among I year B.Sc Nursing students.
  2. Prevention: It refers to the precautionary measures taken to avoid the occurrence of varicose veins.
  3. Varicose vein: Varicose veins are blood vessels just beneath the skin that have widened and twisted due to a defect in the valves within the veins themselves.

6.7. Assumptions
  1. I year B.Sc Nursing students possess some knowledge regarding prevention of varicose vein.
  2. Structured teaching programme is an accepted strategy to improve knowledge regarding prevention of varicose vein.

6.8.Delimitations
  1. The study will be restricted to 50 students of I year B.Sc Nursing in selected Nursing colleges at Hassan.
  2. The study is limited to I year B.Sc Nursing students of selected Nursing colleges at Hassan.

6.9.Hypotheses
All hypotheses will be tested at 0.05 level of significance.
H1: The mean post-test knowledge score of I year B.Sc Nursing studentswill be significantly higher than the mean pre-test knowledge score.
H2: There will be significant association between the mean pre-test knowledge score of I year B.Sc Nursing students and selected demographic variables.
7. / Material and methods
7.1. Source of data
The data will be collected from I year B.Sc Nursing students of selected Nursing colleges at Hassan.
7.1.1. Research design
Quasi experimental one group pre-test post-test design will be used for the study.
7.1.2. Setting
The study will be conducted in selected Nursing colleges at Hassan, Karnataka (H.D Devegowda college of Nursing, Rajeev college of Nursing, NDRK college of Nursing). 15 to 20 samples will be selected from each college.
7.1.3 Population
The population of the study would consist of I year B.Sc Nursing students of selected Nursing colleges at Hassan (H.D Devegowda college of Nursing, Rajeev college of Nursing, NDRK college of Nursing) .In an academic year average student admission rate of I year B.Sc Nursing is 200 ( 3 colleges).
7.2. Method of data collection
7.2.1. Sampling procedure
Simple random sampling technique will be used to collect data.
7.2.2.Sample Size
The sample for the present study would consist of 50I year B.Sc Nursing students in selected nursing colleges at Hassan.
7.2.3. Inclusion criteria for sampling
1. Students studying I year B.Sc Nursing.
2. Students who are willing to participate in the study.
7.2.4. Exclusion Criteria for sampling
1.Students who are not willing to participate.
7.2.5Instruments Used
The tool will have two sections:
1.Section I: Demographic proforma
2.Section II: Structured knowledge questionnaire for assessing the knowledge of of I year B.Sc Nursing students regarding prevention of varicose vein.
7.2.6. Data collection method
Permission will be obtained from the concerned authorities. Using simple random samplingmethod 50 samples will be selected. The purpose of the study will be explained and informed consent will be obtained from the selected samples. Data will be collected using structured self administered questionairre. After collecting data,group structured teaching programme will be given. On seventh day after the structured teaching programme, post-test will be conducted using the same method of pre-test. Data collection will last for 2 weeks. Confidentiality will be assured.
7.2.7. Plan for data analysis
Descriptive and inferential statistics will be used to analyse the data. The findings will be presented in the form of tables and figures.
Demographic data will be presented in frequencypercentage, mean and standard deviation.
The significant difference between the mean pre-test and post-test knowledge score will be analysedby‘t’ test.
The association between selected demographic variables and mean pre-test knowledge score regarding prevention of varicose vein will be analysed by Chi-square test.
7.3. Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
No intervention or investigation will be conducted on the sample. However, group structured teaching programme will be given to the samples.
7.4.Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance will be obtained from the ethical committee of the college of nursing prior to the conduction of the study. Administrative permission will be obtained from the concerned authorities. Written consent will be obtained from the sample and confidentiality will be assured.
8. / List of References
1.Suzaanne C S, Brenda G B, Janice L H, kerry Hcheever. Brunner and Suddarth's Text book of medical surgical nursing. 11th ed. India: Wolters kluwer Pvt.Ltd; 2008. p. 380-420.
2. Brand F.N. The epidemiology of varicose vein. American journal of preventive medicine. 2009;4(2):96.
3. Mary T.J. Treatment and Prevention of varicose vein. Journal of vascular nursing. 2007;15(3):97-103.
4. Maysa M.R. Effect of Walking Intervention Program on Varicose Veins among Pregnant Women. World Journal of Sport Sciences.2010;3: 942-946.
5.Basavanthappa B.T. Nursing research.1st edition.New Delhi:Jaypee brothers' medical publishers; 2003.
6. Evans C.J. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study.J Epidemiol Community Health. 1999;53(3):149.

7. Malhotra S.L. An Epidemiological Study of Varicose Veins in Indian Railroad Workers from the South and North of India, with Special Reference to the Causation and Prevention of Varicose Veins. Journal of epidemiology.1972;1 : 177–183.

8. Laurikka J.O. Risk indicators for varicose veins in forty- to sixty-year-olds in the Tampere varicose vein study. Journal of surgery. 2002; 26(6):648-51.

9.Robertson L. Epidemiology of chronic venous disease. Journal of epidemiology.2008;23(3):103-113.

10. Amanda J.L.Lifestyle factors and the risk of varicose veins.Journal of epidemiology.2003;.56(2):171-173.

Signature of the Candidate. / 9.
Remarks of the Guide. / 10.10
Mrs.DeepaAnuThomas,Asso.Professor & Head of the Department.,
Dept. Of Medical Surgical Nursing,
Shri H.D.DevegowdaCo-OperativeCollege Of Nursing,Manichinahally Gate,Belur Road ,Hassan.
Mrs.Deepa Anu Thomas / Name and Designation of
11.1 Guide
11.2. Signature
11.3. Co-Guide
11.4. Signature
11.5 Head of the Department
11.6. Signature. / 11.
12.1 Remarks of the Chairman &
Principal
.12.2 Signature. / .12

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