RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA,

PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION

SANDEEP K RAJU

1ST YEAR M.SC NURSING

CHILD HEALTH NURSING

YEAR 2010-2012

CAUVERY COLLEGE OF NURSING

THERESIAN COLLEGE CIRCLE

SIDDARTHA LAYOUT

MYSORE
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

11 / NAME OF THE CANDIDATE AND ADDRESS / SANDEEP K RAJU
1ST YEAR M.SC NURSING, CAUVERY COLLEGE OF NURSING,
# 42 / 2B, 2C, THERECIAN COLLEGE
SIDDARTHA LAYOUT
MYSORE
22. / NAME OF THE INSTITUTION / CAUVERY COLLEGE OF NURSING,MYSORE
33. / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE INNURSING –CHILD HEALTH NURSING
44. / DATE OF ADMISSION TO THE
COURSE / 01-06-2010
55. / TITLE OF THE TOPIC: / Effectiveness Of Structured Teaching Programme On Knowledge Regarding Prevention And First Aid Management Of Insects Bite In Children Among The Primary School Teachers In Selected Primary Schools At Mysore, Karnataka.
5.1. / STATEMENT OF THE PROBLEM / A Study To Assess The Effectiveness Of Structured Teaching Programme On Knowledge Regarding Prevention And First Aid Management Of Insects Bite In Children Among The Primary School Teachers In Selected Primary Schools At Mysore, Karnataka.

ANNEXURE-II

6. BRIEF RESUME OF THE WORK INTENDED STUDY

6.1 INTRODUCTION

“An ounce of prevention is worth a pound of cure.”

Henry de Bracton

Children are the blessings for today and promises for the days to come! The body of children is the most super sensitive, delicate and susceptible form which can be easily be harmed if not taken care of. Well being of your kid comprises of physical, mental and social well-being.Children can become seriously ill and any sort of infection may be dangerous, so don't take chances because illness at this age requires immediate attention.1

In many parts of the world, widespread introduction of simple, inexpensive interventions have successfully targeted the major killers of infants and children. Highly effective and often “low-tech” solutions, as well as improvements in health delivery systems, have enabled rapid declines in child mortality to occur, even in developing countries.2

Since children playing outdoors are often bitten or stung by Insects, when children are outside and no matter what they are doing, it is important for them to be protected.Knowing how to prevent and treat common Insects bites and stings, and knowing when to not overreact, can help keep your kids safe and healthy.3

The symptoms that can be caused by Insects bites depend on the type of Insects and how sensitive you are to it. Symptoms can vary from mild swelling, pain, itchiness and redness to large blisters or life threatening anaphylactic reactions.3

More serious signs and symptoms of anaphylaxis, a type of life threatening reaction, can include trouble swallowing, throat and chest tightness, low blood pressure (hypotension), diaphoresis (sweating), dizziness, weakness, itching, hives, wheezing and difficulty breathing. These symptoms usually develop fairly quickly and usually within 30 minutes of being stung. we should seek immediate medical attention or activate our local emergency services if your child has these symptoms following an Insects bite or sting. 3

Mosquito bites commonly cause itchy red bumps, which can vary in size from being very small to 1/2 inch. They usually also have a central raised area. Fire ants are notorious for causing severe local reactions, including pustules or pimples and red, swollen, and extremely itchy areas, which may turn into blisters. They often bite multiple times, most commonly on the feet and legs. A large number of bites, more than 10-20, in a young infant can lead to serious reactions and may require medical attention. 3

Bees, wasps, yellow jackets, and hornets usually cause painful red bumps. Honey bees have a barbed stinger and usually leave it behind at the site of the sting. The stinger will usually appear as a black dot inside the bite if it has been left behind. More serious local reactions can cause swelling of an entire limb. Unlike other bites, tick bites are painless and usually don't itch.Bedbugs also usually cause painless bites, which then become itchy. Since bedbugs usually only come out to feed at night, and they feed infrequently (often just weekly), they can be hard to detect. Chiggers or harvest mites also commonly bite children, especially in the southern United States, Chigger bites usually occur on the legs and along the belt line and can appear as small red bumps and are extremely itchy. Flea bites also commonly affect children, causing multiple, grouped red bumps with a central area of crusting. 3

Spider bites cause a lot of fear in parents, but rarely cause serious reactions in children. These spiders can be readily identified by their characteristic markings, including the red or orange hour glass shape on the abdomen of the black widow spider and the violin shaped markings on the back of the brown recluse. These bites are usually painless or cause mild irritation. More serious reactions usually occur quickly and within 3-12 hours and can include muscle pain, diaphoresis , nausea, vomiting, headache and high blood pressure. 3

To prevent the child from getting bitten or stung by Insects, we can:

  • Make sure to keep as much of their skin covered with clothing as possible, including a long sleeve shirt, long pants, socks, and a hat.
  • Wear light colored clothing, so as not to attract bugs.
  • Avoid using any scented soaps or other products , since the fragrances can also attract Insects.
  • Use aninsects repellent regularly. Commonly used Insects repellents that can usually be safely used in children include those with less than 10% DEET, or others with citronella or soybean oil.
  • Apply Insects repellents to clothing instead of to skin so that it won't be absorbed.
  • Wash off Insects repellents as soon as possible.
  • Follow the instructions, including age restrictions on any Insects repellent you are considering using.
  • Do daily tick checks of our child's body when he has a possible exposure, especially when camping or hiking, so as to prevent tick borne diseases, such as Lyme disease.
  • Remember that Insects repellents do not protect against most stinging Insects, including wasps, bees and fire ants.
  • Use window and door screens to prevent Insects from getting inside your house. 3

First aid is the provision of initial care for an illness or injury. It is usually performed by a non-expert person to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care past the first aid intervention. It generally consists of a series of simple and in some cases, potentially life-saving techniques that an individual can be trained to perform with minimal equipment.4

Some of the first aid measures for Insects bite are

  1. Stay Safe! Follow universal precautions and wear personal protective equipment if you have it. If a stinger is present, follow the directions for treating bee stings.
  2. Apply an ice pack to the site of the sting. Alternate on and off to prevent tissue damage - usually 20 minutes on and 20 minutes off.
  3. If the victim exhibits any of the following, consider the possibility of anaphylaxis:
  4. itching
  5. swelling (other than the site of the sting)
  6. shortness of breath
  7. heart palpitations
  8. chest pain
  9. hives or redness
  10. Try to identify the bug. If the bug is dead, scoop it up and take it with you to the emergency department. Be careful, even dead bugs have venom.
  11. For pain relief, try sting swabs (compare prices). Acetaminophen and ibuprofen are also good for pain. 5

Keeping the same as the reference, the present study was planned to assess the knowledge level of the school teachers regarding prevention and first aid management of Insects bite in children.

6.2 NEED FOR THE STUDY

Insect’s bites and stings are very common in children, especially during the spring and summer months. Among the arthropods that often bite and sting are spiders, ticks, mites, mosquitoes, flies, fleas, ants, bees, and wasps. While most Insects bites only result in mild local reactions, they can cause more serious conditions, such as anaphylactic reactions and Lyme disease. Knowing how to prevent and treat common Insects bites and stings, and knowing when to not overreact, can help keep the kids safe and healthy.6

In the United States, the American Association of Poison Control Centers reported 42,620 cases of exposures to Insects in 2007. Just more than 200 of these were listed as resulting in moderate or major reactions. A moderate reaction is defined as signs or symptoms that were more pronounced or systemic, whereas a major reaction is life-threatening or lead to significant residual disability. Fatalities among these exposures are rarely reported to poison centers and usually result from allergic reactions to Hymenoptera stings. Because of underreporting, these numbers are only a glimpse as to what is actually occurring.7

A study in tropical Zimbabwe, where biting Insects are common, found that 1.5% of hospital admissions were related to Insects exposure, including both bites and stings. A vast majority of these were arachnid or Hymenoptera related.7

Estimates of mortality from Insects-provoked anaphylaxis in the United States range from 50-150 persons annually. In Arizona, for example, death from reduviid-associated anaphylaxis has been reported as a leading cause of death from Insects exposure. Worldwide, the greatest morbidity and mortality associated with Insects bites are due to Anopheles species mosquito bites resulting in infection with malaria. Incidence and prevalence of sting 9.3 million people yearly. Other Hymenoptera account for more than 1 million stings annually. Estimates of mortality from Insects-provoked anaphylaxis in the US range from 50 to 150 individuals annually (Fernandez). Mortality from spider bites occur mostly in very young children and the elderly, and deaths has been attributed to presumed brown recluse envenomation. Many potentially dangerous scorpions inhabit the underdeveloped or developing world. Consequently, numerous envenomations go unreported, and the true incidence is unknown. The highest reported mortality data for scorpion envenomation is from Mexico, with estimates as high as 1,000 deaths in 1 year.8

A study of 750 definite spider bites in Australia indicated that 6% of spider bites cause significant effects, the vast majority of these being red back spider bites causing significant pain lasting more than 24 hours.9

The jumping spider is probably the most common biting spider in the United States, the main species being Phidippus audax. Bites from a jumping spider are usually painful, itchy and cause redness and significant swelling. The spiders of most concern in the United States, however, are brown recluse spiders and black widow spiders. Most recluse spider bites are minor with little or no necrosis. However, a small number of bites produce severe dermonecrotic lesions, and, sometimes, severe systemic symptoms, including organ damage. Rarely the bite may also produce the systemic condition with occasional fatalities.9

Allergic reactions to bee and Insects stings are potentially fatal. Bee, wasp, and Insects stings cause more deaths in the United States than any other kind of envenomation. Wasps and bees cause 30 to 120 deaths each year in the U.S. Most deaths occur in people 35-45 years of age. Fifty percent of deaths occur within 30 minutes of the sting. Stinging Insects are most active during the summer and early fall. Yellow jackets cause over 95% of the

allergic insectsstings in this country.10

A study was conducted on “Acute immune thrombocytopenic purpura triggered by Insects bite.” The report shows that acute thrombocytopenic purpura is most commonly seen in young children, with a sudden onset, following aInsects bite and viral illness. The report is a rare case of ITP, which was triggered by a honey-bee bite and caused continuous intermittent bleeding from the gingival sulcular region of the maxillary left permanent first molar, and ecchymotic spots on the forehead, scalp, and lower limbs. A complete hemogram revealed severe thrombocytopenia with platelet count as low as 15,000/mm3. The patient was immediately hospitalized and administered platelet replacement and medication. With this report, the authors, as dentists, emphasize the significance of recognition, early diagnosis, and referral of such patients with bleeding disorders to specialized centers, for prompt treatment.11

A retrospective analysis was conducted in Belgaum, Karnataka, India. Among the cases of all childhood poisonings in District Hospital, over 5 years in the 1 to 15 years age group were studied with respect to age, sex, type of poison and outcome. A total of 116 cases were studied. The study showed male predominance. Amongst 116 cases of poisoning, 40 cases were due Insects bites. Maximum number of cases observed was in the age group 4 and 12 years. The study showed male predominance than females. Maximum number of Insects bites occurred in rainy and summer season. All the cases were accidental in nature. The investigator recommends that access prevention and massive health education campaign should be instituted to reduce the incidence of accidental poisoning in children.12

The investigator felt the need to conduct a study on Prevention and first aid management of Insects bite in children as it is assumed that school teachers spend most of their time with children in schools next to parents. Teaching preventive and first aid measures on Insects bite helps to prevent and save children from harmful effects of Insects bite such as anaphylaxis reaction or preventing a deadly disease such as malaria.Therefore, the study aims at improving the level of knowledge about preventive and first aid measures ofInsects bite in children, which also helps the school teachers in communicating this information to others with whom they come in contact.

6.3. STATEMENT OF THE PROBLEM

A Study To Assess The Effectiveness Of Structured Teaching Programme On Knowledge Regarding Prevention And First Aid Management Of InsectsBite In Children Among The Primary School Teachers In Selected Primary Schools At Mysore, Karnataka.

6.4. OBJECTIVES

1. To assess the knowledge of Primary school teachers regarding the Prevention and firstaid management of Insects bite in children before the administration of STP.

2. To develop and administer STP regarding Prevention and firstaid management of Insects bite in children.

3. To assess the knowledge of Primary school teachers regarding the Prevention and firstaid management of Insects bites in children after the administration of STP.

4. To evaluate the effectiveness of STP by comparing pre and post test knowledge scores regarding Prevention and first aid management of Insects bites in children among the Primary school teachers

5.To find out the association between the pre-test knowledge scores and the selected socio demographic variables.

6.5. HYPOTHESIS

H1:- There will be a significant difference between the pre and post test knowledge scores of Primary school teachers regarding Prevention and firstaid management of Insects bite in children.

H2:- There will be a significant association between pre test knowledge scores of Primary school teachers and selected demographic variables.

6.6. ASSUMPTION

1. The Primary school teachers may have some knowledge regarding Prevention and firstaid management of Insects bite in children prior to the administration of STP.

2. Administration of STP may promote the knowledge of Primary school teachers regarding Prevention and firstaid management of Insects bite in children.

6.7. OPERATIONAL DEFINITIONS

  • Assess

It refers to an activity to estimate the knowledge of Primary school teachers regarding Prevention and first aid management of Insects bite in children before and after the STP as revealed by suitable knowledge questionnaire.

  • Effectiveness

It refers to significant increase in the level of knowledge of Primary school teachers regarding Prevention and first aid management of Insects bite in children which is measured from the response of pre-test, STP and post test.

  • Structured teaching programme (S.T.P)

It refers to systematically organized instruction on Prevention and firstaid management of Insects bite in children for the Primary school teachers of selected primary schools at Mysore.

  • Knowledge

It refers to the understanding and awareness of Primary school teachers regarding Prevention and first aid management of Insects bite in children as expressed to the response of knowledge questionnaire

  • Prevention

In this studythe term prevention is refers to those interventions that are carried out to save the children from Insects bite.

  • First aid management

In this studythe term First aid management is refers to the provision of initial care of children for an Insects bite. It is usually performed by primary school teachers to a sick or injured child until definitive medical treatment can be accessed.

  • Insectsbite

In this study it refers to when an Insects is agitated and seeks to defend itself through its natural defense mechanisms, or when an Insects seeks to feed off the bitten person. The selected Insects in this study are fire ants, bees, wasps, hornetsmosquitoes, fleas, and mites.

  • Primary school teachers

In this study they refer to persons who provide schooling for pupils and students (1st -4th standard) in selected primary schools of Mysore.

6.8. DELIMITATION OF THE STUDY

  1. The study is limited to the Primary school teachers who are working at selected Primary schools at Mysore.
  1. Study period is limited to 4-6 weeks of duration.
  1. Sample size is limited to 60 Primary school teachers
  1. The study design is limited to Pre-experimental (Single group pre-test post- test) design.

6.9. CONCEPTUAL FRAME WORK

Conceptual frame work is based on the General System Theory {Ludwig Von Bertanlanffy system theory-1968}

6.10. REVIEW OF LITERATURE