SUBMITTED BY:

MS. PARVATHY MOHAN

1ST YEAR M.SC. NURSING

MEDICAL SURGICAL NURSING

2009-2011 BATCH.

SARVODAYA COLLEGE OF NURSING.

BANGALORE.

RAJIV GANDHI UNIVERSITY OF SCIENCES, BANGALORE,
KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / Name of the Candidate and Address / MS.PARVATHY MOHAN
11/2, MAGADI ROAD, AGRAHARA DASARAHALLI, BANGALORE, PIN-560079
2. / Name of the Institution / Sarvodaya College Of Nursing,
Bangalore-79
3. / Course of Study and Subject / 1st year M.Sc Nursing,
Medical surgical nursing
4. / Date of Admission of the Course / 04.04. 2009
5. / Title of the Study / “A Study To Evaluate The Effectiveness Of Structured Teaching Program On Narcotic policy among staff nurses in selected hospitals at Bangalore.”
6. / Brief Resume of the Work
6.0 Introduction
6.1 Need for the Study
6.1.1 Statement of the Problem
6.2 Review of Literature
6.3 Objectives of the Study
6.3.1 Operational Definitions
6.3.2 Assumptions
6.3.3 Research Hypothesis
6.3.4 Sampling Criteria
(i) Inclusion Criteria
(ii) Exclusion Criteria / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7. / Materials and Methods
7.1 Sources of Data: Data will be collected from the staff nurses in selected hospitals at Bangalore.
7.2 Method of Data Collection: Self administered questionnaire.
7.3 Does the study require any investigations of interventions to be conducted on the
patients or other human being or animals? Yes.
7.4 Has ethical clearance been obtained from your institution?
Yes. ethical committee’s report is here with enclosed.
8.0 List of References : Enclosed

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION:

1. / NAME OF THE CANDIDATE AND ADDRESS / MS. PARVATHY MOHAN
1ST YEAR M.SC. (NURSING) SARVODAYA COLLEGE OF NURSING, MAGADI MAIN ROAD, BESIDE RAHEJA PARK, AGRAHARA DASAR HALLI BANGALORE 79
2. / NAME OF THE INSTITUTION / SARVODAYA COLLEGE OF NURSING, BANGALORE
3. / COURSE OF STUDY AND SUBJECT / 1ST YEAR M.SC. MEDICAL SURGICAL NURSING
4. / DATA OF ADMISSION OF THE COURSE / 04/04/2009
5. / TITLE OF THE TOPIC / “A study to evaluate the effectiveness of structured teaching programme on Narcotic policy among staff nurses in selected hospitals at Bangalore.”

6.BRIEF RESUME OF THE INTENDED WORK

6. 0 Introduction

“A STRONG POSITIVE MENTAL ATTITUDE WILL CREATE MIRACLE THAN ANY WONDER DRUG”

The term“narcotics” derived from the Greek "narke" that means "numbness or torpor. Narcoticsmeanany drug that produces sleep or stupor relieves pain, due to its depressant effect on the central nervous system. Usually in medical terms called as opium or opium derivatives, opium till today is the best known source for relieving pain. The word ‘opium’ is derived from the Greek word “opion”in Sanskrit known as Aahipen”. The opium poppy belongs to the family papaveraceae is an annual medicinal herb contains many alkaloids that are frequently used as an analgesic, anti tussive, and anti spasmodic in modern medicine .It was used by ancient Greek physicians such as Galen and Hippocrates for benumbing or paralyzing the area with the use of poppy juice and mandrake roots1.

A 2002 National House hold survey on drug abuse reported approximately 15,000,000 people in U.S.A illicit drugs and about 1% of population abuses narcotics. The number of treatment admissions for all drugs of abuse has been steadily declining since 2002 with the exception of non-heroin opiates, for which admissions increased 26.1%.The DAWN report in 2003shows narcotic analgesics were involved in 16% oftotal drug abuse related admissions.2

The National Survey on Drug Use and Health (NSDUH) sponsored by the Substance Abuse and Mental health Services Administration (SAMHSA) provides data that graphically illustrate the increase in prescription of opioid and abuse in the last decade Between 1999 and 2006, the number of persons aged 12 and older illicitly using prescription pain relievers in the month prior to being surveyed increased from 2.6 million in 1999 to 5.2 million in 2006.In 2006, 5.2 million surveyed persons had used prescription pain relievers illicitly in the past month, compared with 0.3 million people who had used heroin.3

The abuse and misuse of legal drugs without prescription ends up with death or addiction. Global drug control system has formulated an International agreement for the regulation of psycho active drugs. The current International frame work came in to force in 1961 with the agreement of United Nations single conventions on Narcotic drugs. Since then the control system has grown in scope with the establishment of agencies like International Narcotics Control Board, United Nations office on Drugs and Crime.4

A survey conducted by the Ministry of Social Welfare and United Nations International Drug Control Programme in Chandigarh reveals that at 3.4 per cent, the consumption of opiates in the region is three times the national average As per the survey, the prevalence of drug and alcohol abuse among females was 45.6 per cent and 54.4 per cent males out of a sample size of 3000 more than in other individuals .5

.
People abuse drugs for various reasons. These may range from curiosity, availability and previous drug use to emotional and social pressures. Drug use and abuse as a habit unfortunately could begin quite early in life as part of culture in some societies. The common drugs that are abused and which have attracted both local and international concern include tobacco, marijuana, heroin, cocaine, valium and ecstasy. Young injecting drug users are at high risk for a number of negative health outcomes such as hepatitis B, and HumanImmune Deficiency infection.6

The physician or nurse who uses narcotics over a period of time in treating patients with pain may lead to addiction or dependence. The narcotics are abused due to its peculiar featuresto produce euphoria and also reduces sensitivity to physical and psychological stimuli. Administration of narcotics plays a vital role in managing pain without developing physical dependence.1


According to information from Post Graduate Institute’s de-addiction centre, around 500 new patients come every year. And more than 5,000 patients who are already treated for addiction. Doctors say the number of such cases is consistently increasing by around 10 per cent a year. As many as 40 per cent of the total cases at the Post Graduate Institute’sCentre are related to addiction to opiates, including opium, smacks, heroin, injectables, synthetics and tablets. Region drug abuse statistics shows it’s ahead of national average.7

The use of narcotic analgesic is normally controlled by various regulations and procedures to prevent misuse and to comply with International conventions termed as Narcotic policy. It is the policy of the hospital that all controlled substances shall be counted at the beginning of every shift by off going& oncoming licensed staff nurses. A narcotic record shall be maintained, if patient has an order for narcotics nurse should receive a written order from physician, and fromtime of taking narcotics till administration and documentation carried out withan eye witness and get signature from two licensed nurses ie: the one who have administered and witnessed. Thenurse manager is responsiblefor the collection, documentation and record keeping, if any manipulation or misuse of narcotics needs to be inquired and clarified.8

6.1 NEED FOR THE STUDY

A narcotic is drugs, which are very efficient in controlling pain and provides the patient a sense of wellbeing. Misuse or improper dosage, and lack of knowledge regarding narcotic policy among health professionals especially nurses may lead to under estimation of patients pain orlead to physical dependence in patients.9

A study on narcotic addiction in patients with chronic pain, who is attending pain relief unit in U.K reveals 130 patients were taking narcotic analgesic in which 74 were suffering from cancer, 56 had chronic pain 9 patients were addicted to narcotic analgesics.10A study on analysis of opium use by students of Medical sciences revealed that 3.9% of the students were admitted using opium once or more during their lives.2% were occasional opium users. These findings can be consideredfor the clinical practice for the detection of opioid abuse.11

According to United Nations Office on Drugs and Crime, estimates that, substance use are also more prevalent among young people than in older age groups. 2.7 % of the total global population and 3.9 % adolescents of 15 years and above had used cannabis at least once in their life.12The report published by Dr. Hussein A. Gezairy from World Health Organization emphasized that the countries of the Eastern Mediterranean Region faced a growing problem of substance use and dependence and there was a urgent need to intervene. Substance use and dependence and its consequences constitute a major public health threat globally and in the region. This requires an urgent response. Available evidence in countries points to increasing production of drugs like opium as well as increasing consumption of drugs.13

A study was done on nurses knowledge regarding opioid analgesic dose and psychological dependence among 200 nurses byusing a questionnairereveals that only 45% of staff nurses are aware of opioid analgesic and its relation with physical dependence, suggests there is an urgent need for basic education on opioid analgesic in correlation with pain management.14A Nursing study reveals nurses know pain but not narcotics; they tend to have unrealistic fears about the risks of addiction. This lead to under treat pain in patients who needs narcotic pain killer most and they seem to have less knowledge about narcotics and its side effects.15.

A study to evaluate the knowledge and attitudes amonghealth professionals regarding pain issues such as addiction, the assessment of pain, scheduling, use of analgesics, Additionally, to determine whether differences exist based on hospital setting, years of service, clinical practice area, and country of origin: A total of 686 nurses, physicians, pharmacists, and medical/nursing students from three hospitals completed a 17-item survey evaluating knowledge and beliefs about pain. Nurses scored significantly less concordantly than physicians on 11 of the 17 items. Unwarranted fear of addiction is a misunderstood and important concept that needs to be addressed.16

The investigator had a felt need to do the study among nurses on narcotic policy because when she was working as a staff nurse, she noticed that many of the staff nurses are unaware about the importance of handling narcotics and has misconceptions about addiction and most of the hospitals are not aware of the significance of narcotic policy. This made her to think on educating nurses about narcotic policy.

6.1.1 STATEMENT OF THE PROBLEM

“A study to evaluatethe effectiveness of structured teaching programme on Narcotic policy among staff nurses in selected hospitals at Bangalore”.

6.2 REVIEW OF LITERATURE

Review of literature provides the basis for future investigations, justifies the need for replication, throws light up on feasibility of the study, and indicates constraints of data collection and help to relate findings of one another.

Review of literature is categorized under the following headings:

1. Review related to incidence about narcotic addiction

2. Review related to nurses knowledge

3. Review related to narcotic policy

4. Review related to effectiveness of STP.
Review related to statistics about narcotic addiction

The incidence of opioid addiction in physicians has been estimated by the U.S commissioner of Narcotics about 1 addict among every 100 physicians in contrast to rate of 1 in 3000 general population. According to Federal Bureau of Narcotics1, 012 physicians were reported as opioid drug abusers.17

A study shows the prevalence of substance abuse in the nurse population is believed to parallel that in the general population. The American Nurses Association reports that up to 20 percent of nurses may have substance abuse issues. They are in danger of harming patients, the nursing profession, and themselves. The consequences of not reporting concerns can be far worse than those of reporting the issue.18

The constant increase in the quantity of various drugs seized worldwide indicates the increase in the number of addicts. With a turnover of around $500 billion, it is the third largest business in the world, next to petroleum and arms trade. About 190 million people all over the world consume one drug or the other. 5% of the world population consumed illicit drugs at least once in the last 12 months it no longer is an individual or a social problem, but a politico-economic one with the facet of narco terrorism.19

Review related to nurses knowledgeon narcotics

A Studywas conducted in NIMHANS India, to determine the extent to which nurses are able to correctly identify drugs as narcotics and to ascertain their perception of the addiction potential of opiates when used for pain management. A questionnaire was administered to 86 nurses who attended palliative care workshops in India. Only morphine (95%) heroin (71%) and codeine (75%) were correctly identified as narcotics by the majority of participants. Imipramine (34%), diazepam (20%) and phenobarbitone (39%) were wrongly classified as narcotics by many nurses. Dextropropoxyphene (11%) , pentazocine (21%), buprenorphine (15%) were correctly classified as narcotics by fewer than half the participants. Only 14% knew that that the frequency of psychological dependence due to use of morphine for cancer pain was less than 1%.20

A study to assess theknowledge of opioid analgesic drugs and the incidence of psychological dependence among staff nurses the data obtained from 27 workshops on pain across 14 states (2,459 nurses) to determine current nursing knowledge of pharmacological management of pain. Results indicate that nurses lack knowledge in classification of opioids ranging from 23 to 98% correct response across seven analgesic drugs. Less than 25% of nurses correctly identified the frequency of psychological dependence. Further analysis revealed significant differences in basic versus advanced learners and geographical differences in knowledge. Implications are made for nursing education and practice.21

The purpose of this study was to determine areas of emergency nurses' knowledge deficit regarding pain management, and to identify barriers to pain management as perceived by emergency nurses. Data were collected anonymously in a mail survey using a 52-item knowledgequestionnaire addressing pain management principles and asking emergency nurses. A significant deficit existed on 2 domains of knowledge: understanding of the terms "addiction," "tolerance," and "dependence"; and knowledge of various pharmacologic analgesic principles. Nurses with a master's degree or higher, or those who attended a 1-day seminar on pain management, achieved statistically significantly higher scores. The data indicate that emergency nurses may not have a good understanding of the management of pain with drugs, or of such issues with the risk of addiction.22