PROFORMA FOR REGISTRATION OF
SUBJECTS FOR DISSERTATION
DISSERTATION PROPOSAL
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING KNOWLEDGE ON GESTATIONAL DIABITES MELLITUS, AMONG GESTATIONAL DIABETICS IN SELECTED HOSPITALS AT TUMKUR”.
SUBMITTED BY
HEMALATHA B.
1ST Year M.Sc., (Nursing)
Obstetric and Gynocological Nursing
Shridevi College of Nursing
Tumkur-06
2007-08
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGLORE,KARNATAKA
Annexure II
Synopsis Proforma for registration of subjects for Dissertation
1. / Name of the Candidate andAddress / HEMALATHA B.
1st Year M.Sc., Nursing
Shridevi College of Nursing
Lingapura, Sira Road
Tumkur
2. / Name of the Institution / Shridevi College of Nursing
3. / Course Study and Subject / 1st Year M.Sc., Nursing
Obstetric and Gynaecological Nursing
4. / Date of Admission to Course / 09-06-07
5. / Title of Study / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING KNOWLEDGE ON GESTATIONAL DIABITES MELLETUS, AMONG GESTATIONAL DIABETICS IN SELECTED HOSPITALS AT TUMKUR”.
6. BRIEF RESUME OF THE INTENTED WORK
Introduction:
“Mother of all diseases – Diabetics”
- W.H.O
Diabetes mellitus is a chronic systemic disease characterized by either a deficiency of insulin or a decreased ability of the body to use insulin. Diabetes mellitus is sometimes referred to as “high sugar” by both clients and care providers.
Diabetes mellitus consists of 3 types
1. Type I- Previously called insulin dependent mellitus.
2. Type II- Previously called Non-insulin dependent diabetes.
3. Gestational diabetes mellitus.1
The country has already achieved the “dubious distinction” of being called the diabetes capital of the world with well over 33 million people suffering from it. According to who figures over 170 million people ax diabetic all over the world. It could well be about 370 million in another 20-25 years gestational diabetes mellitus [GDM] is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.2
The definition applies weather insulin or only diet modification is used for treatment is weather or not the condition persist after pregnancy. It does not exclude possibility that UN recognized glucose intolerance may has antedated or debug concomitantly with the pregnancy.2
Approximately 7% of all pregnancy are complicated by gestational diabetes; resulting in more than 200.000 annually. The prevalence may range from 1 to 14% of all pregnancies depending on the population studied and the diagnostic tests compleyed.2
Diabetes in pregnancy is of 2 types:
Gestational
Pre gestational
Gestational diabetic generally occurs in the latter half of pregnancy (3rd Trimister) and symptomatic. It disappears after delivery as the hormonal levels revert back to normal. If it fails to disappear it suggests that there may be overt diabetes which may have antedated or begun concomitantly with the pregnancy.3
Pregnancy in a diabetogenic state is due to impaired insulin sensitivity. It worsens diabetes and some women may experience symptoms similar to those seen with type diabetes while poorly controlled diabetes result in fetal, antenatal, maternal complications, such as hypoglycemia, hypertropic cardiomyopathy, pre-eclampcia, preterm etc.3
Diabetes mellitus is a common medical disorder encountered in pregnancy in certain population such as Asians particularly Indians, the prevalence of diabetes is high. Obesity and advanced maternal age other risk factors for diabetes.3
Gestational diabetes mellitus can harm the mother and fetus, early treatment is crucial. The aims of diabetic control in pregnancy are to maintain normal blood sugar level. The treatment includes early detection, screening, diet and exercise, medication therapy. Improving self care activities and also prevention of complications.4
6.1 NEED FOR STUDY.
“INDIA THE DIABETES CAPITAL OF THE WORLD”
WHO.
1. The united states recent reports have shown high rates for Gestational Diabetes in various parts of the country including:
Ø Washington D.C. where in 2003 the GDM prevalence rate Hispanic women was 12% close to the highest rate of 14% seen in some American Indian women.
Ø In New York city, the prevalence rate increased 46% from 1990 to 2002 with the highest increase found among Asian women.
Ø In Colorado, GDM prevalence rate increased 95% from 1994 to 2002 with the highest among Hipanic women .
Ø In Northern California the no. of new cases each year increased 35% from 1991 to 2000. So these regional GDM prevalence rates raise concern that the increase may reflect the on going pattern of increasing obesity and contribute to the up surge in cases of diabetes in the united states.5
2. The nurse has an important role in controlling and managing to diabetes in pregnancy. Pre existing maternal diabetes and gestational diabetes create challenges for health care provide to avoid complications such as macrosomia as well as other prenatal mortality. Hence it is essential for the nurse to have indepth knowledge towards Gestational diabetes.6
3. Diabetes mellitus complicates 3-5% of all pregnancy and is a major cause of prenatal morbidity and mortality. The availability of a variety of new insulin’s, insulin pumps, and self monitoring of blood glucose have revolutionized the case of the pregnancy complicated by diabetes mellitus. To have successful control of disease and to have happy mother hood before and after the delivery, It is most important that the mothers should possess some knowledge regarding disease, treatment and prevention of possible complication.7
4. As obesity increases in this country and our population becomes more diversified, the rate of GDM will rise. There is agreement that excellent blood glucose control, with diet and exercise, by changing life styles. This study provide excellent knowledge about Gestational diabetes and also helps to improve good perintal out come.7
5. Gestational diabetes effects on pregnancy. It effects various organs of the body, such as Kidney, Heart, Brain and it leads to complications. Such diabetic nephropathy and retinopathy. So it becomes much necessary for the gestational mothers to have knowledge about gestational diabetes complications.8
6. Now a days more gestational diabetes cases found in rural and urban. Where the mothers develop leg ulcers rapidly due to improper care, this can leads to physiological stress for women during pregnancy and delivery. Hence diabetes mothers need more information about successful control of disease. So I would like to give Structured Teaching Programme on Gestational diabetes mellitus and assess knowledge about it among the gestational diabetes and planned to distribute the Pam plates to improve the knowledge about Gestational diabetes mellitus.
6.2 REVIEW OF LITERATURE.
The review of literature is defined as a broad comprehensive in depth systematic & critical review of scholarly publications, unpublished scholarly print materials, audio visual material and personal communication.
The purpose of this study is to identify the effectiveness of structured teaching programme on Gestational diabetes mellitus among Gestational diabetics through structured questionnaires, also the purpose of review of literature is to obtained comprehensive knowledge base and in-depth of information from previous studies.
1. Evans et al (2005), conducted study on gestational diabetes: The meaning of an at risk pregnancy in Brock university, Canada. In their study, they stated that, being diagnosed with gestational diabetes (GDM) is coupled with the implication that the women and her fetus are at risk. In this study, the authors use a hermeneutic phenomenological approach to gain an in depth understanding of Gestational diabetes mellitus as pregnant women meaningfully experience it. They conducted conversation interviews with 12 women who were diagnosed with and being treated for diabetes in pregnancy. Data analysis involved a reflective process consistent with the guide lines of thematic analysis. Four themes identified as characteristic of the women pregnancy experience were living a controlled pregnancy, balancing, being a responsible mother and being transformed. The findings challenge health care professionals to discuss openly reassess their present models of care for pregnant women and their families.9
2. Bartaskva et,al., (2002), conducted study on diagnosis and therapy of Gestational diabetes mellitus, in 1999-2000 at the medical clinic motol faculty hospital. The main objective of the study was find out diagnosis, prevalence, frequency morbidity, presence of risk factors and prevent mortality of Gestational diabetes. The study provided evidence that Gestational diabetes is not detected at the earliest as possible due to in adequate screening which ultimately results in competition. So, appropriate screening and early detection is very essential. 10
3. Joseph et, al., (2007), as done a study on socio economic status and perinatal outcomes in a setting with universal access to essential health care services, in Canada. In this study they stated that, perinatal outcomes also influencing by the socio economic status and also they stated lower family income is associated with increased rates of Gestational diabetes, small for gestational-age live birth and post neonatal death despite healthcare service being widely available at no out-of-pocket expence.11
4. Bottalico J.N., (2007) Investigated study on recurrent diabetes mellitus in this study, the researcher stated that Gestational diabetes mellitus (GDM) should be regarded as a sentinel event in a woman’s, life, that presents challenges and disease prevention opportunities to all providers of healthcare for woman of reproductive age. And also reported, pre-diabetic risk factors of rising in prevalence and include dietary and life style habits, resulting rising prevalence type 2 diabetes and Gestational diabetes mellitus. Gestational diabetes mellitus in on index pregnancy increases the risk of recurrent Gestational diabetes mellitus in subsequent pregnancies and recurrence rates of up to 70% have been reported, there rates are influenced by maternal characteristics and past pregnancies history. He concluded in his statement, the risk of later metabolic syndrome and type 2 diabetes is increased in woman with a history of Gestational diabetes mellitus.12
5. Khatun et,al., (2005) explored a study on pregnancy associated complications of Gestational diabetes mothers. Their study was comparative study. The purpose of study was to compare the outcomes of Gestational diabetics with normal (non-diabetic mother) pregnant woman with a view of reducing a competition. In their study they concluded Gestational diabetic mothers had a higher risk of complications, like pre-eclampsia, Hypertension, urinary tract infection and caesarean section.13
6. Kim et, al(2007) conducted study on preventive counseling among woman with histories of Gestational diabetes mellitus, in Michigean University. In their study, the stated that woman with histories of Gestational diabetes mellitus who recalled advice regarding post partum glucose testing and received laboratory slips were significantly more likely to report having had post partum diabetes screening.14
7. Malinowska et, al, (2003) conducted study on pregnancy and delivery course in patients with Gestational diabetes mellitus, in Warsaw medical University in 1997 to 2001 years. The patients ages, post obstetric experience, Gestational age of Gestational diabetes mellitus diagnosis, pregnancy compactions delivery course and neonatal outcomes were the main parameters. In their study stated many complication among infants such as intranatal and neonatal deaths, congenital defects, hypoglycemia etc. the study also provided early diagnosis of gestational diabetes mellitus and specialist obstetric surveillance prevent of pregnancy complications and perinatal mortality.15
8. Symons Downs et,al,(2006) conducted study on Gestational diabetes patients about exercise beliefs and behaviors to assessing their self-reported exercise beliefs. In their study they concluded that exercise during pregnancy was controlling blood glucose and in post partum it was controlling weight. And also the study provided, through increase exercise behaviour, we can be reduced the type 2 diabetes mellitus in woman with Gestational diabetes mellitus. 16
STATEMENT OF THE PROBLEM
“ A STUDY TO ASSESS OF THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING KNOWLEDGE ON GESTATIONAL DIABETES MELLITUS AMONG GESTATIONAL DIABETICS IN SELECTED HOSPITALS, TUMKUR.”
6.3. OBJECTIVES OF THE STUDY.
6.3.1. To determine the existing knowledge of diabetic mothers regarding Gestational diabetes mellitus.
6.3.2. To administered structured teaching programme on Gestational diabetes mellitus among Gestational diabetics.
6.3.3. To assess the effectiveness of structured teaching programme on Gestational diabetes mellitus among the diabetic mothers by comparing pre and post test knowledge.
6.3.4. To associate the knowledge on Gestational diabetes mellitus with selected demographic variables.
6.4. OPERATIOANL DEFINITIONS.
Ø ASSESSMENT: Refers to the organized systematic variables of collecting information about pre and post test knowledge from Gestational diabetics regarding Gestational diabetes mellitus.
Ø EFFECTIVENESS: Refers to the extent to which the planned teaching programme on Gestational diabetes mellitus to improve their knowledge among Gestational Diabetics.
Ø STRUCTURED TEACHING PROGRAMME: Refers to well planned systematically developed and organized teaching strategy on knowledge regarding Gestational diabetes mellitus developed by the investigator.
Ø KNOWLEDGE: Refers to correct response of Gestational diabetic mothers in the study elicited through self interview schedule on Gestational diabetics.
Ø GESTATIONAL DIABETES MELLITUS: Refers to glucose intolerance of variable severity that start or is first recognized during pregnancy.
Ø GESTATIONAL DIABETICS: Refers to patients who are diagnosed as suffering from gestational diabetes mellitus and diagnosed by physician.
6.5. HYPOTHESIS OF THE STUDY.
Research Hypothesis.
H1: There will be significant difference between the pre and post test knowledge scores of Gestational diabetics regarding Gestational diabetes mellitus.
6.6. ASSUMPTIONS.
The patients with Gestational diabetes may have deficit of knowledge on Gestational diabetes mellitus.
6.7. DEMILITATIONS.
1. The study is limited to the Gestational Diabetics.
2. The study is limited to Gestational diabetics who are attending antenatal checkups regularly.
3. Sample size is limited to fifty Gestational diabetics.
6.8. PILOT STUDY.
Pilot study will be conducted with 5 samples, the purpose of pilot study is to find out the feasibility of conducting study and design on plan of statistical analyses.
6.9. VARIABLES.
Research variables are the concepts at variables levels of abstractions, that are entered manipulated and collected in a study.
v Independent Variables - Structured Teaching programme.
v Dependent Variables – Knowledge.
7.0. MATERIAL AND METHODS (METHODOLOGY).
The study is designed to assess the effectiveness of structured teaching programme on Gestational diabetes mellitus, among Gestational diabetics selected hospitals, in Tumkur.
7.1. SOUR CE OF DATA.
Gestational diabetes patients at selected hospitals in Tumkur.