RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU, KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

JABEZ PAUL SAMUEL.N

1ST Year M.Sc. Nursing

Medical Surgical Nursing

Year 2012-2013

BRITE COLLEGE OF NURSING

BENGALURU-91

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU, KARNATAKA.

ANNEXURE-I

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE
& ADDRESS / Mr. JABEZ PAUL SAMUEL.N
1st YEAR M.Sc. NURSING ,
BRITE COLLEGE OF NURSING ,
#69, BWSSB COLONY, CHIKKAGOLLARAHATTI, MAGADI MAIN ROAD,VISHWANEEDAM POST,BENGALURU – 500 091.
2. / NAME OF THE INSTITUTION / BRITE COLLEGE OF NURSING ,
#69, BWSSB COLONY, CHIKKAGOLLARAHATTI, MAGADI MAIN ROAD,VISHWANEEDAM POST,BENGALURU – 500 091.
3. / COURSE OF STUDY & SUBJECT / I YEAR M.Sc. NURSING,
MEDICAL SURGICAL NURSING
4. / DATE OF ADMISSION / 30/06/2012
5. / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE KNOWLEDGE REGARDINGSELFCARE ABILITIES AMONG CEREBROVASCULAR ACCIDENT PATIENTS ADMITTED IN NEUROLOGICAL WARDS IN A VIEW TO DEVELOP INFORMATION GUIDE SHEET IN SELECTED HOSPITALS, BENGALURU.”

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION

Strength does not come from physical capacity. It comes from an indomitable will.

--Mahatma Gandhi

Healthis the level of functional or metabolic efficiency of a living being. Inhumans, it is the general condition of aperson's mind and body, usually meaning to be free fromillness,injuryorpain1.

Personal health depends partially on the active, passive, and assisted cues people observe and adopt about their own health. These include personal actions for preventing or minimizing the effects of a disease, usually a chronic condition, throughintegrative care. They also include personalhygienepractices to prevent infection and illness, such asbathingandwashing handswith soap,brushing and flossing teeth, storing, preparing and handlingfood safely, and many others. The information gleaned from personalobservations of daily living- such as about sleep patterns, exercise behavior, nutritional intake, and environmental features - may be used to inform personal decisions and actions1.

Sorrowtouchesusall,butwecanlearnhowtocallupontheblessings ofgraceandlovingkindnessinourlifeandthelife’sofourlovedones,yes,thereis somethingwecando.Well openourheartandspirittothepossibilitiesthatdwell within us, even at theworst times2.Personal health also depends partially on the social structure of a person's life. The maintenance of strongsocial relationships,volunteering, and other social activities have been linked to positive mental health and even increased longevity1.

Morethan400yearsbeforeChrist,Hippocratesfirstdescribedaclinical syndrome,whichislabeledasapoplexy.InGreekitmeans,“Stuckwithviolenceor paralysis”.Thesynonymsusedforthestrokearecerebrovascularaccident,apoplexy and hemiplegia2.Cerebrovascular disorder is an umbrella term that refers to any functional abnormality of the central nervous systemthat occurs when the normal blood supply to the brain is disrupted.Stroke is the primary cerebrovascular disorder in theUnited states and in the world. Although preventive efforts havebrought about a steady decline in incidence over the last severalyears, stroke is still the third leading cause of death2.

There is no universally accepted definition of 'selfcare' in the wider healthcare field. Indeed, the terms 'self-care', 'self-management' or even 'self-help' tend to be used interchangeably. A couple of decades ago, the term 'self-help' was adopted to describe the mutual support and aid provided by self-help groups, typically in relation to a specific diagnosis such as pain, depression, arthritis. Over time, many self-help or voluntary organizations have responded to the needs of their members by providing more structured support in the form of workshops, seminars and interventions. Indeed, voluntary organizations have played a key role in promoting the development of self-care / self-management support3.

The World Health Organization defines selfcare as "the ability of individuals, families and communities to promote health, prevent disease, and maintain health and to cope with illness and disability with or without the support of a health-care provider". It is clear from the definitions that selfcare can encompass a wide-ranging spectrum of activities that can include simple acts such as brushing one's teeth regularly to prevent dental decay, selfcare has often been used in relation to behavior’s such as a specific exercise regime, managing one's diet, or personal care (e.g. dressing oneself). It is worth noting that most people with disability spend most of their time managing at home on their own with relatively small amounts of contact time with rehabilitation professionals. Selfcare activities are dependent on an individual's needs at a given point in time and may vary over time and with the disease course. However, it is true to say that most conditions have specific selfcare activities. For a person with stroke the main focus of attention is likely to be on managing pain, inflammation, stiffness and fatigue. Selfcare may comprise use of appropriate medication to help control inflammation and pain thus allowing the individual to perform appropriate exercises that will help stiffness and mobility. Broader definitions of selfcare include not only management of symptoms and treatment but also management of psychosocial consequences and lifestyle changes. There is an increasing range of interventions being developed to enhance self-care using cognitive, behavioral, or cognitive-behavioural frameworks. Hence, learning and performing selfcare activities designed to promote well-being and enhance quality of life are vital3.

The area of selfcare encompasses all of the tasks an individual does throughout the day to look after his or herself. It includes activities such as personal care, functional mobility, and community management. Personal care includes such tasks as feeding oneself, bathing, personal hygiene, dressing, and toileting. Activities involved in community management may include driving, taking public transportation, grocery shopping, completing community errands, and managing one's finances4.

Cerebrovascularaccidentistheprimary neurologicalproblemintheworld andranksthirdinthecauseofdeath. Thereare twomillionpeoplesurvivingstrokes and needs assistancewith activities ofdailyliving2. Usuallythequalityand quantityof informationreceivedbystrokepatientsisinadequateorsometimehealthpersonnel failtoimparttheinformationorstrokepatientsmaynot assimilatetheinformation properly. Knowledgeofself-careactivitieshelpscerebrovascularaccidentpatientsto comeoutfromtheirdependencytoalevelofachievementandadjustment. Health&happiness depends on positivethinkingand faith.

6.1NEED FOR THE STUDY

According to the World Health Organization, 15 million people suffer stroke worldwide each year. Of these, five million die and another five million are permanently disabled.High blood pressure contributes to more than 12.7 million strokes worldwide. Europe averages approximately 650,000 stroke deaths each year.In developed countries, the incidence of stroke is declining, largely due to efforts to lower blood pressure and reduce smoking. However, the overall rate of stroke remains high due to the aging of the population5.

Several population-based surveys on stroke were conducted from different parts of India. During thelast decade, the age-adjusted prevalence rate of stroke was between 250-350/100,000. Recent studies showed that the age-adjusted annual incidence rate was 105/100,000 in the urban community of Kolkata and 262/100,000 in a rural community of Bengal. The ratio of cerebral infarct to hemorrhagewas 2.21. Hypertension was the most important risk factor. Stroke represented 1.2% of total deaths in India6.

A longitudinalstudyon predictingmortalityinstrokeamongpatientsadmittedto12-beddedmedicalICUat MahatmaGandhi Institute ofMedicalSciences,Sevagram overa period of 12 months.APACHEIIIscoringsystemwasusedtocalculatethescoreanditwas correlatedwithimmediatein-hospitaloutcomeof thispatients.Thesensitivityand specificityofthisscorewascalculatedatacutoffpointof40. Theresultsrevealed thatseventy-fourpatientswereadmittedwithdiagnosisofstrokeinoneyear.30 patientshad intracerebral hemorrhage (40.5percent) and 44 had infarction (59.5percent).17patientsoutof30inthehemorrhagicgroup(56.6percent)and10 outof44(22.7percent)ininfarctionsgrouphaddied.Theoverallmortalityobserved was34percentinallthepatients. ThesensitivityandspecificityofAPACHEIII scoring systeming predicting mortality was 94.12 percent and 53.85percent respectively inpatientswithhemorrhageand 90percentand73.53percent respectivelyforischemicstrokewhenacutoffpointof40wastaken.Likelihoodof mortalityhadincreasedasthescoreincreased. Thestudyconcludedthatpredicting outcome in strokepatientsisdifficultdueto variabilityinetiologyand pathophysiologyAPACHE IIIscoringsystem was found to be sensitive and reasonably specificin predicting short term, in–hospital outcome ofcritically illpatients havingCerebrovascular accident7.

Cerebrovascularaccidentistheprimaryneurologicalprobleminthe world. Althoughpreventiveeffortshavebroughtasteadydeclineinitsincidence inlastseveralyears, strokeisthethirdrankingcauseofdeath,withanoverall mortalityrateof18percent to 37percent. Thereareapproximatelytwomillion peoplesurvivingstrokesthat need assistancewith activities ofdailyliving2.

Alongitudinalstudyonfollowupofstrokepatientswasconductedinwhich231strokepatientswereselected.After6monthsof discharge when sample werereviewedit was revealed that 34 patients (14.7percent)haddiedand115patients(58percent)wereindependentandliving incommunity.42percentofsampleweredependentandmajorityofthemwerein institutionalcare.29patients(36percent)wereresidingincommunityofwhoma substantialnumberwerenotreceivingphysiotherapy,occupationaltherapyorday care. Thestudyalsorevealedthatpatientswhoweredependentinnursinghomes werelesslikelyto havereceivedphysiotherapy(48:70)oroccupationaltherapy (28:60)comparedtodisabled patientsinhospitalsbasedextendednursingcare. Thestudyconcludedthatmostofthedependentsurvivorsof cerebrovascular accidenthadongoingunmet rehabilitation needs8.

Alongitudinal,descriptiveandcorelationaldesignwasadoptedon self-care self efficacy,qualityoflifeand depressionafterstroke.Thesettingofstudy wasinpatientrehabilitationfacilityat onemonthafterstrokeandhomeatsix monthsafterstrokeamongsampleof sixty-threestrokesurvivors. Mainoutcomemeasured fourinstrumentsusedby people to promote health, quality of life,index strokeversion,centerfor epidemiologicalstudiesdepressionscaleandfunctionalindependencemeasure. Theresultsofthestudyshowedself-care,self-efficacyincreasedafterstrokeand wasstronglycorrelatedwithqualityoflifeanddepressionatoneandsixmonths after stroke. Functional independenceand quality of lifeincreased,while depressiondecreased.Functionalindependencewascorrelatedwithqualityoflife atsixmonthsafterstrokeandthestudyconcludedselfcareselfefficacy,is stronglyrelated to qualityoflife and depression.9

Rehabilitation goalsofself-careenableclients tomove awayfrom aperiod ofdependencytoalevelofachievementandadjustment.Clientmaybeableto groomhimself,includingcleaninghisteeth,washinghisface,combinghishair, dress himself and applyinghismakeup on hisown.

Theabovestudiescreatedaninsightininvestigatorsmindthatthereisa needforthestudy toassessknowledgeonself-careabilitiesamongCerebrovascular accidentpatients, whichwillhelptheinvestigatorinpreparationofaninformative guide sheet in careofCerebrovascular accident patients.

6.2REVIEW OF LITRERATURE

AccordingtoPolitandHunglerliteraturereviewsarecriticalsummariesof whatisknownaboutaparticulartopic,withabackgroundforunderstandingwhathas been alreadylearnedona topic andfacilitates accumulation of knowledge and illuminateswhatthesignificanceofthenewstudyis.Itintegratesabodyofresearch problem in context (or)to identify gapsandweakness in priorstudies soasto justifya new investigation in orderto point thewhyorfurtherknowledge and development10.

Thereview ofliteratureofthestudyis divided into twoheadings:

  • Literaturerelated tooccurrenceofCerebrovascular accident.
  • Literaturerelated to knowledgeofCerebrovascular accident patients on self-careabilities.

LITERATURERELATED TO OCCURRENCEOFCEREBROVASCULAR ACCIDENT.

Astudyconductedonetiologicalfactorsofstrokeamongthepatientsadmittedindepartmentof neurology in Asiaduring 1988to1997revealedthatoutof940patientsadmitted127 (13.5percent) had stroke at youngerage. Ischemic strokehad accountedfor 85.8percent14.2percenthadspontaneousintracerebralhemorrhage.Incasesof cerebral infarction 29.4 percenthadcardioembolic stroke,followedby atheroscleroticocclusivediseasein22percentandnon-atheroscleroticvascular diseasein15.6percentofpatients.Studyconcludedthatthemajorriskfactorsfor strokein youngpatients were hypertension, hypercholesterolemia, hyper triglyceridemiaand smoking.11

Acommunity-based tri-racialcross-sectional survey onPrevalenceratesof stroke werestudied among Singaporeans aged 50andaboveof Chinese,Malay,andIndian origin. A disproportionatestratifiedrandomsamplingbyracewasusedanddatacollectedby face-to-faceinterviewsusingWHOscreeningprotocolforneurologicaldiseases.The studyinvolved14906participants:6734men,8172women, agerange52to106 years,Chinese:Malay:Indianratio3:1:1.Prevalenceratesarosewithageand were higheramongmencomparedwithwomen,4.53%versus2.91%.Ageandgender- standardized ratesamong Chinese,Malays,and Indians were 3.76%, 3.32% and3.62%.12

TheStroke Associationstatesanewsletterpublishedby BBC2004,eachyear.1,30,000peopleinUKsufferfromstroke.Italsohighlightedthatmenwereatmore riskthanwomen. Otherriskgroupsincludedsmokers,peoplewhowereobese,high BP,heartdisease,diabetes,peoplewithageneticlinkfirst-degreerelativewhohad stroke at an earlyage.13

Apopulationbased clustersurvey conducted onstrokedisordersamongtheurbanpopulationofCalcutta.The populationsurveyedwas50,291. Theresultsofthestudyhighlightedthatprevalence ofstrokewas147/ 1,00,000andannualincidencefor1998–1999was36/1,00,000. Womenhadoutnumberedmeninstrokeinallagegroupsexceptin50–69yearage group. Thestudyfound hypertension as most significant risk factor forstroke.14

Acohortstudywas conducted toidentifywhether individualsocio-economicstatus andcommunitysocio-economicstatusat New zealand predictsthe onsetofstrokebothindependentlyandaftercontrollingforindividualriskfactors such as smoking, obesity, hypertension. Theresultssuggestthatindividual incomeasignificantpredictorofsmokingandobesityaresignificantpredictorsofonsetofstrokebothindependentlyandaftercontrollingforbehaviouralandmedical riskfactors,andthatcommunitysocio-economicstatusisasignificantpredictorof strokebothindependentlyandaftercontrollingforbehaviouralandmedical riskfactorsandthatcommunitysocio-economicstatusisasignificantpredictorof heart disease, heavydrinking, diabetes, smokingand obesity.15

A study was conducted to measure knowledge about the symptoms, prevalence and natural history of stroke; the level of concern about having a stroke; understanding of the possibilities for preventing stroke, and the relationship between age, sex, country of origin, educational level, income, self-reported risk factors, and the above factors in Australia. This community-based study demonstrates aspects of public knowledge and perception about stroke. Of 822 respondents, 694 (85.5%) were able to name at least one established stroke symptom. Respondents, in general, overestimated both stroke prevalence in Australia and the chance of full recovery after the stroke. Respondents generally considered the possibility of their having a stroke during their life as being not a matter of serious concern. In a multiple logistic regression model, only one group – those with a higher level education – had better knowledge of established stroke symptoms.16

LITERATURERELATEDTOKNOWLEDGEOF CEREBROVASCULAR ACCIDENTPATIENTSONSELF- CAREABILITIES

Astudywasconductedonfamiliesdealingwithstrokedesireinformationaboutself- careneeds at Australia.Thestudystatesashospitallengthsof stayhavedecreased,opportunitiestoeducatestrokepatientsandfamiliesregarding self-caredecreased.Twenty-fourpeoplerespondedtoasurveythatlisted48self-care needswithinOremsuniversalself-carerequisites. Thetopfiveself-careneedsabout whichinformationwasdesiredwerepreventingfalls,maintainingadequatenutrition, stayingactive, managing stress and dealingwith emotional mood changes.17

Astudywas conducted in onpatientscharacteristicsassociatedwith perceptionsofstrokeeducationin South Korea. It involvedfiftyconsecutivepatientswithacutestroke and88medicalprofessionals(31doctorsand57nurses)workingintheDepartments ofNeurology.They wereadministeredastructuredquestionnaireregardingvariousaspectofpatienteducationconcerningstroke.Resultsshowedtheaveragerankingoftotal itemsforstrokeeducationwashigherinnursesthanindoctorsorpatients(P0.01 foreach).Patientsgavehigherrankingsthandoctorsfor'possibilitytocurewithdrug treatment'(P0.01),'stressmanagement'(P0.01),andmostitemsconcerning'generalmedicalknowledge'and'post-strokedietmanagement,'whereasdoctorsgave higherrankingsthanpatientsformostitemsconcerningriskfactormanagementand treatmentwithsurgery.Itemsconcerning'post-strokedietmanagement'wereranked lowerbymalepatientsthanfemalepatients(P0.005),andwererankedlowerby doctorsthanby patientsornurses(P0.001).Youngerpatientsgavehigherrankings thanolderpatientsforitemsconcerningmedicalknowledgeregardingstroke,'exercise,'and'post-strokesexual activities’.18

Astudy conducted abouttheautonomyofstrokepatientsin rehabilitationwardsinwhichtwenty sevenhealthcareprovidersfromthreenursinghomeswereinterviewed.Thecore category'changingautonomy'wasdeveloped,whichidentifiestheprocessofstroke patientsregainingtheirautonomy(dimensions:self-determination,independenceand self-care),andthefactorsaffectingthisprocess(conditionsandstrategiesofpatients; strategiesofcareprovidersandfamilies;andthenursinghome).Teamwork on increasingpatient autonomyis recommended, whichcan bestimulatedby multidisciplinaryguidelinesandeducation,andbyco-ordinationoftheprocessof changingautonomy.19

A study was conducted at rehabilitationcenters in northern Ohio and southern Michiganto examine the emotional support, physical help, and health of caregivers of stroke survivors,2008.This study was guided byOrem’s (2001)self-care deficit nursing theory, which is based on the concept ofself-care, where individuals perform specific learned activities to maintain health and well-being.The results of this study highlight the importance o dependent care agents, establishing an adequate self-care system that provides emotional support and physical help20.

STATEMENT OF PROBLEM

“ASTUDY TO ASSESS THE KNOWLEDGE REGARDING SELFCARE ABILITIES AMONG CEREBROVASCULAR ACCIDENT PATIENTS ADMITTED IN NEUROLOGICAL WARDS IN A VIEW TO DEVELOP INFORMATION GUIDE SHEET IN SELECTED HOSPITALS,BENGALURU.”

6.3OBJECTIVES

1)To assess the knowledge regardingselfcare abilities among Cerebrovascular accident patients.

2)Toprepare an information guide sheet regarding selfcareabilities among Cerebrovascular accident patients.

3)Tofindassociationbetweenthe knowledge ofCerebrovascular accidentpatients regarding self-careabilities with selected demographic variables.

6.3.1 VARIABLES

  1. Independent variable:Self-care abilities.
  2. Dependent variable:Knowledge regarding self-care abilities.
  3. Demographic variables: Age, gender, religion, education, occupation, family income and source of information.

6.4 OPERATIONAL DEFINITIONS

a)Selfcare abilities: It refers to the abilityofthe client to meet theactivities of dailylivingsuch as bathing, walking,grooming, dressing, eating and attendingtoilet without help.

b)CerebroVascularAccident:It refers to the rapid loss of brain function due to disturbance in the blood supply to the brain.

c)Patients:It refers to theindividuals who arediagnosedwithCerebrovascularaccident admitted in neurological wards.

d)Information guide sheet: A printed guide sheet which contains information on self care abilitiesofCerebrovascularAccident which will be in self directed nature.

6.5 HYPOTHESIS

H1 There will be significant relationship between the knowledge score on self-care abilities among Cerebrovascular accident patients with their selected demographic variable.

6.6 ASSUMPTIONS:

  • Cerebrovascularaccident patients maydevelop someselfcareabilities forbetterqualityoflife.
  • Cerebrovascular accident patients may gain knowledge through information guide sheet about selfcare abilities.

6.7LIMITATIONS:

  1. Thestudyis limited to age group 40-70years.
  2. Thestudyislimitedtothosewhoarewillingtoparticipateinthestudy
  3. Thestudyislimitedtothosewhodon’t have cognitiveimpairment.

7. MATERIALS AND METHODS

7.1 Sources of Data:Cerebrovascular accident patientsin neurological wards of selected hospital, Bengaluru.

7.1.1 Research Approach: Descriptive research approach.

7.1.2 Research design:Qualitative study design.

7.1.3 Setting:Selectedneurological hospitals atBengaluru.

7.1.4 Sample:Cerebrovascular accident patients.

7.1.5 Population:Patients in neurological wards at selected hospitals, Bengaluru.

7.1.6 Sample size:60 samples.

7.1.7 Inclusion criteria:

Adults who are:

  • Age group between 40-70 years irrespective of gender.
  • Available during the time of data collection.
  • Can communicatein KannadaorEnglish.

7.1.6 Exclusion criteria:

  • Adults those who are not willing to attend the study.
  • Adults those who have cognitive impairment.

7.2 Method of collection of data:

7.2.1 Sampling technique:Purposive sampling.

7.2.2 Duration of study:The study will be conducted in duration of 30 days.

7.2.3Tool of research:Structured knowledge questionnaire.

Structured knowledge questionnaire will be constructed in two parts.

Part I -Demographic data.

Part II- Knowledge based structured questionnaire regarding selfcare abilities among cerebrovascular accident patients.

7.2.3 Collection of data

  1. The investigator himself collects the data from the cerebrovascular accident patients admitted in neurological ward.
  2. Structured knowledge questionnaire will be used to access the knowledge regarding selfcare abilities.

7.2.4 Method of data analysis and data presentation

a)Descriptive statistics

  1. Frequency and percentage distribution will be used to describe the demographic variable of cerebrovascular accident patients.
  2. Mean, median, mean percentage, range standard deviation will be used to describe the knowledge regarding self care abilities.

b)Inferential statistics

  1. Chi-square test will be used to find the association between knowledge of cerebrovascular patients regarding selfcare abilities with selected demographic variables

c)The analyzed data will be presented in the form of tables, diagrams and graphs based on findings.

7.3Does the study require any investigation to be conducted on patients or other human or animals? If so please describe briefly?

Yes, the study is done on cerebrovascular accident patients.

7.4 Has ethical clearance has been obtained from your institution?

  • Yes, Consent will be obtained from concerned authority and subjects.
  • Privacy, confidentiality and anonymity will be guarded.
  • Scientific objectivity of the study will be maintained with honesty and impartiality.

8. LIST OF REFERENCES

  1. Health.Article about human condition [serial online] [cited 2012 Dec 3]; Available from:URl:
  2. SuzanneCS,BrendaGB,BrunnerandSuddarth’s. Text book of Medical Surgical Nursing. 8thed. Lippincott company,Philadelphia.2004.p.1888-90.
  3. Julie Barlow. Selfcare. International Encyclopedia of Rehabilitation. [cited 2012 Dec 3];Availablefrom:

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  1. Occupational Therapy .Self-care Aging, Client, and Bathing. JRank Articles[online][cited 2012 Dec 3]; Available from:

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  1. Stroke statistics. The internet stroke centre. [Online] [cited 2012 Dec 4]; Available from:

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  1. Stroke survey. Neurological journal of south east asia. [Online] 2006[cited 2012 Dec 4]; Available from:

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  1. Bhalla,Gupta.Predictingmortalityin stroke. NeuroIndia. 2004;50:p.279 – 81.
  2. No one et al,“Strokepatients afterhospital discharge”IrMed j. 2004. 94(5): p.151– 2.
  3. Smith,Johnson, Allen.Self-care, self-efficacy, qualityoflifes depressionafterstroke.Arch phys Med Rehab.2003; 81 (4): 460 – 4.
  4. Polit D E, BernadetteP. Hungler.Nursing research and principles and methods. 5th ed.Philadelphia:Lippincot publication.; 2005.
  5. MehndirattaMM.strokeamongyoung adults. Journal ofmedical scienceMonitoring.2004 ;10 (9): p. 535 – 541.
  6. Venketasubramanian N, TanLC, Sahadevan S, ChinJJ, KrishnamoorthyES, HongCY, et.Al.PrevalenceofstrokeamongChinese, Malay, andIndian Singaporeans: a community-based tri-racial cross-sectional survey. Journal of Stroke. 2005 March; 36(3): 551-6.
  7. Frih Ayed M, Chelbel S, Ben HamdaK, Maatoug F.Ischemicstrokeinyoung adults. Tunis Med.2004.Jun;82 (6):506-11.
  8. BanerjeeTK, MukherjeeCS, SarkhelA. Strokein urban population. Journal of association ofphysicans.2003May; 46 (4): 351 –4.
  9. Brown P, GuyM,BroadJ. Individual socio-economicstatus, community socio- economicstatus and strokein NewZealand: a casecontrol study. Soc Sci Med. 2005 Sep; 61(6): 1174-88.
  10. Sung Sug Yoon, Richard F Heller, Christopher Levi, John Wiggers. Knowledge and perception about stroke among an Australian urban population. BMC Public health.[online]7 July 2004 [cited 2012 Dec 5]; Available from:

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  1. Pierce, Gordon, Steiner. Families dealing with strokedesireinformation about Selfcareneeds 2004 .29 (1): 14 – 7
  2. Choi-Kwon S,LeeSK, Park HA, Kwon SU,Ahn JS, KimJS. What stroke patients want to know and what medical professionals think theyshould know about stroke. Journal on Patient Education and Counseling. 2005 Jan;56(1): 85-92.
  3. ProotIM, Abu-Saad HH, Van Oorsouw GG, Stevens JJ.Autonomyin stroke rehabilitation: theperceptions ofcareproviders in nursinghomes. Journal of NursingEthics. 2002 Jan; 9(1): 36-50
  4. Victoria Steiner, Linda Pierce, Sean Drahuschak, Erin Nofziger, Debra Buchman. Emotional Support, Physical Help, and Health of Caregivers of Stroke Survivors. NIH public ascess[online][cited 2008 Feb 4]; Available from:

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9 / Signature of Candidate
10 / Remarks of the Guide
11 / 11.1 Name & Designation Of Guide / Mrs. VIJI.C.
Associate Professor,
Brite college of nursing
Chikkagollarahatti, bengaluru -560091
11.2Signature
11.3Co-Guide / Mrs.Rajashree.S.S.
Lecturer,
Brite college of nursing
Chikkagollarahatti, bengaluru -560091
11.4Signature
11.5 Head of the Department / Mrs. VIJI.C.
Associate Professor,
Brite college of nursing
Chikkagollarahatti, bengaluru -560091
11.6Signature
12 / 12.1Remarks of the Principal
12.2Name and Signature / Prof. H.H.DASEGOWDA

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