“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMMEON KNOWLEDGE REGARDING THE LIFE STYLE MODIFICATION FOR PREVENTION OFMYOCARDIAL INFARCTION AMONG CARDIAC PATIENTS IN SELECTED HOSPITAL AT TUMKUR.”

PROFORMA FOR REGISTRATION OF SUBJECT FOR THE DISSERTATION

SUBMITTED BY

MS. ASWATHY KUTTAPPAN

FIRST YEAR M.Sc (NURSING)

MEDICAL AND SURGICAL NURSING

SRI SIDDHARTHA COLLEGE OF NURSING

AGALAKOTE, B. H. ROAD

TUMKUR

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / MS. ASWATHY KUTTAPPAN
I YEAR M.Sc.NURSING
SRI SIDDHARTHA
COLLEGE OF NURSING,
AGALAKOTE,TUMKUR.
2. / NAME OF THE INSTITUTION / SRI SIDDHARTHA COLLEGE OF NURSING, B.H.ROAD,
TUMKUR
3. / COURSE OF THE STUDY AND SUBJECT / DEGREE OF MASTER OF NURSING

MEDICAL AND SURGICAL NURSING

4. / DATE OF ADMISSION / 8TH JUNE 2009
5. / TITLE OF THE TOPIC / “A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING THE LIFE STYLE MODIFICATION FOR PREVENTION OF MYOCARDIAL INFARCTION AMONG CARDIAC PATIENTS IN SELECTED HOSPITAL AT TUMKUR.”

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Without health life is not life it is only a state of languor and suffering an image of death.”

- Buddha.

Heart disease is responsible for more deaths and disability among both male and female, than any other killer and it is quickly establishing itself as the leading cause of death and disability. Furthermore the incidence of heart disease is spreading worldwide. Asian countries adopt a more sedentary westernized life style, together with high fat, high salt diet and processed foods that have come to be associated with technological offence, researchers are noticing that western disease are becoming more prevalent causes of death in Asia.1

The first stages of heart disease begin in childhood and it progresses silently for decades until in millions of people, it results in a heart attacks or even sudden death. The majority of deaths occur before the person reaches the hospital. 1

Ischemic heart disease and stroke are two most common cause of death world wide over 80 percent of death and 85 percent of disability from cardiovascular disease (CVD) occurs in low and middle income countries the Indian subcontinent (including India, Pakistan, Bangladesh, SriLanka and Nepal) is home to 20 percent of the worlds population and may be one of the region with highest burden of Cardio Vascular Disease in the world.2

Cardiovascular disease is the leading cause of death in the all regions of India with the highest proportion in southern region. (25% and lowest in central region (12%). In 2003, the prevalence of CHD in India was estimated to be 3-4 percent in rural areas (two-fold higher compared with 40 yrs ago) and, 8-10 percent in urban areas

(six-fold higher compared with 40 yrs ago) with a total of 29.8 million affected (14.1 million in urban areas and 15.7 million in rural areas) according to population based cross-sectional surveys.2,3

There have been significant improvements in managing acute myocardial infarction. This has resulted in considerable reduction in death rates if treatment is initiated early. However in spite of these developments more than half of the patients die suddenly within one hour of the onset of chest pain before they can even seek medical help. It is scientifically proven fact that the mean age of our population, which gets myocardial infarction, is at least 10years younger than what is seen in the developed countries.4

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Life style practices and behaviors can have positive or negative effects on health. The life style risk factors have gained increased attention because it is known that many of the leading cause of death are related to life style patterns or habits. This also represents huge impact on the economics of health care system. Therefore it is important to understand the impact of lifestyle behaviors on health status.5

Identifying risk factors is the first step in health promotion, wellness education and illness prevention activities. Risk factor modification, health promotion or illness prevention activities or any programme that attempts to change unhealthy life style behaviors can be considered a wellness strategy.5

Hence it is clear that myocardial infarction can be preventable by life style modification.

6.1 NEED FOR THE STUDY

Live sensibly- among a thousand people, only one dies a natural death; the rest succumb to irrational modes of living”

-Maimonides.

The world health organization (WHO) report, “Preventing chronic diseases a vital investment” says global action to prevent chronic disease could save the lives of 36 million people who would otherwise be dead by 2015. Currently, chronic diseases are by far the leading cause of death in the world and this impact is steadily growing. The report projects that approximately 17 million people die prematurely each year as a result of global epidemic of chronic diseases.6

Faced with the prospect of millions of people dying prematurely and suffering needlessly from heart disease, stroke, cancer and diabetes, WHO says the global epidemic of chronic disease must be stopped. The epidemic is worst in low and middle-income countries where 80% of all chronic disease death occurs. In Southeast Asia region, 54% of all deaths due to chronic diseases, and 89 million people in south east Asia are likely to die of such a disease in the next 10 years. 60 million such deaths are likely to occurs in India alone.6

Heart disease is the leading cause of death for both women and men in the United States. In 2005, 652,091 people died of heart disease (50.5% of them women). This was 27.1% of all U.S deaths. The age-adjusted death rate was 222 per 100,000 populations. In 2009, heart disease is projected to cost more than $304.6 billion including health care services, medications and lost productivity.7

On the basis of data from the Framingham study, about 45% of all acute myocardial infractions occur in people younger than 65yrs and 5% in those younger than the age of 40years.8

The world health organization estimates that in 1990, 1.2 million Indians died from heart disease and predicts that this number will more than double by 2020, giving India the greatest cardiovascular disease burden of any nation by that year. In the same 30-year period, the death rate from heart disease will rise by just 15% in US. By 2010, the WHO states, 100 million Indians will have heart disease. In fact more than 25% of all cardiac patients in the world will be Indian.1

A major study found that the prevalence of heart disease in New Delhi and Chennai both in India was 10% and 11% respectively. Over the past three decades, heart disease rates in the nation of India have doubled in rural areas and tripled in urban areas.1

Despite higher rates of smoking in rural India, the heart disease rate among rural dwellers is about half that among urban Indians. City dwelling Indians have traded in the cleanse air, lower-fat diet and natural physical exercise of rural areas for an urban life marked by greater pollution richer food; sedentary desk. Jobs, and home lives spent in front of the TV. In the last three decades, heart disease rates in urban. India, particularly south India, have risen by more than three times from 3% to 11%.1

In Western countries where Cardio Vascular Death is considered a disease of the aged, 23 percent of Cardio Vascular Disease deaths occur below the age of 70, this compares with 52% of Cardio Vascular Disease deaths occurring among people under 70yrs of age in India. As a result the Indian subcontinent suffers from tremendous loss of productive working years due to Cardio Vascular Disease deaths; an estimated 9.2 million productive years of life were lost in India in 2000, with an expected increase to 17.9 million years in 2030(almost ten times the projected loss of productive life in united states)2

Indians develop heart disease about ten years earlier than other population and young Indians often have heart disease as severe as older Indians. In west 15% of men and 12% of women who die from heart disease die before reaching 65years. In India the figure is 35%- More than double the figure for Europeans and Americans still, heart disease is most common cause of premature death in both Europe and US, but it is primarily a disease of senior citizen with more than 60% of heart attacks and bypass surgeries in the US occurring in people older than 65years of age. The median age of first heart attacks among Europeans is 59 years and 60 years among Chinese. Among people from Indian subcontinent, it is 50years fully 10 years earlier.1

In the Southeast Asia region a 2% annual reduction in death due to chronic disease could save over 8 million lives in the next 10years. In India, a similar reduction of chronic disease death rate at the national level would also result in an economic gain of USD 15 billion over the next ten years. In order to achieve the goal by WHO, all sectors from government, private industry, civil society and communities will have to works together.” More and more people are dying too early and suffering too long from chronic diseases” said Dr. Catherine le Gales-Camus. Assistant Director General of non communicable disease and mental health; WHO: “We know what to do and so we must do it now”.6

6.2REVIEW OF LITERATURE

  1. A descriptive study conducted to establish a comprehensive multi-disciplinary cardiac prevention and rehabilitation programme for patients with coronary artery disease in order to achieve life style modification risk factor control and optimal use of proven cardioprotacttive medication. Results showed that of 537 patients, 9.2% were non-smokers, mean BMI was 27.2kg/m2, 76% achieved their BP target, and 87% achieved target fasting total cholesterol. They concluded the study that a multi disciplinary cardiac prevention programme can achieve and sustain effective secondary prevention.9
  1. A randomized controlled study trial over 24 months, to evaluate the effectiveness of an individually tailored multifactor lifestyle intervention in primary care for individuals at high risk for cardiovascular disease 1050 adults with existing cardiovascular disease or multiple risk factors were studied the results of the study showed that the cardiovascular risk score decreased by 28% in intervention group and body weight decreased by 3.7%; total cholesterol decreased by 10.8% while time engaged in exercise by 39%. The concluded the study that cardiovascular risk level of high-risk individuals decreased in both intervention and control group. Primary case prevention should be targeted to high-risk persons.10
  1. An experimental control study conducted to assess the effect of home based cardiac rehabilitation progress on quality of life in low and moderate risk patients with coronary artery disease in rural Indian population. Sample size was 60. The result should that there was a significant improvement in the quality of life smokers in all domains of experimental group. But there was no significant improvement in the quality of life scores in any domains in the control group was noted. They concluded the study that home based cardiac rehabilitation proved to be effective in improving quality of life in coronary artery disease patients.11
  1. A randomized and quasi experimental study conducted to determine the effect of brief structured intervention on risk factor modification in patients with coronary heart disease. Seventeen trails involving a total of 4725 participants were included in the final review. Three trials compared the effect of brief structured interventions on diet modification, seven on smoking cessation and seven on multiple risk factors. The results showed that there is suggestive but inconclusive evidence from the trials of a benefit in the use of brief interventions for risk factor medication in patients with coronary heart disease.12
  1. A study conducted to assess the level of knowledge of cardiovascular risk factors and recommended life style changes in patients rehabilitated after an acute coronary syndrome with a simple size of 31 patients. The result showed that after rehabilitation programme the subjects had significant improvement regarding knowledge on recommended lifestyle changes and cardiovascular risk factors. They concluded the study that the patients after acute coronary syndrome have poor knowledge of cardiovascular risk factors and recommended life style modifications. The level of knowledge improves after short term, stationery cardiac rehabilitation.13
  1. A cross sectional study conducted to assess the knowledge of modifiable risk factors of heart disease among patients with acute myocardial infarction among 720 subjects. Results showed that the mean age was 54 years and mere 42% had good level of knowledge. They concluded the study that the lack of good level of knowledge of modifiable risk factors for heart disease among subjects admitted with acute myocardial infarction. There is a urgent need for aggressive and targeted educational strategies in that population. 14
  1. A cross sectional study conducted to assess the knowledge of modifiable risk factors of coronary atherosclerotic heart disease in New Delhi among 217 patients. The result showed that 41% of them had good knowledge. 68%, 72%, 73% and 57% of population identified smoking obesity, hypertension and high cholesterol correctively, respectively. They concluded that an Indian population in a hospital setting shows a lack of knowledge pertaining to modifiable risk factors of coronary atherosclerotic heart disease. Educational interventions can be effectively targeted and implemented as primary and secondary prevention strategies to reduce the burden of coronary atherosclerotic heart disease in India.15
  1. A descriptive study conducted to assess the level of knowledge regarding modifiable risk factors of myocardial infarctions among 50 Coronary heart disease patients at Chennai. The result showed that 82% had inadequate knowledge, 12% had moderately adequate and 6% had adequate knowledge regarding modifiable risk factors of myocardial infarction. The study concluded that there is an immense need of educational programmes in related fileds.16

6.3 STATEMENT OF THE PROBLEM

“A Study To Evaluate The Effectiveness Of Structured Teaching Programme On Knowledge Regarding The Life Style Modification For Prevention OfMyocardial Infarction Among Cardiac Patients In Selected Hospital At Tumkur.”

6.4 OBJECTIVES

  1. To assess pretest knowledge regarding lifestyle modification for the prevention of myocardial infarction.
  1. To administer the structured teaching programme among cardiac patients
  1. To assess the post test knowledge regarding life style modification for prevention of myocardial infarction.
  1. To assess the effectiveness of structured teaching programme by comparing pre and post test score.
  1. To determine the association between knowledge and selected demographic variable of cardiac patients.

6.5 OPERATIONAL DEFINITIONS

1)Effectiveness:

It refers to the extent to which the structured teaching programme is helpful in gaining the knowledge regarding life style modification for prevention of myocardial infarction

2)Structured teaching programme:

It is planned and purposeful teaching programme which can be given to

cardiac patients on life style modification for prevention of myocardial infarction.

3)Knowledge:

It is the awareness of cardiac patients regarding lifestyle modification.

4)Life style modification :

It refers to any activity or any programme that attempts to change unhealthy life

style behaviours.

5)Prevention:

It refers toavoidance of myocardial infarction in future.

6)Myocardial infarction:

It refers to a life threatening condition characterized by formation of

localized necrotic areas within the myocardium.

6.6 ASSUMPTIONS:

The study assumes that-

  1. The cardiac patients may have inadequate knowledge regarding lifestyle modification to prevent myocardial infarction.
  1. The structured teaching programme will improve the knowledge regarding life style modification to prevent myocardial infarction.
  1. The knowledge on life style modification may have relation with demographic variables of cardiac patients.

6.7 RESEARCH HYPOTHESIS

H1 : The mean post test knowledge regarding life style modifications for prevention of myocardial infarction will be significantly more than the mean pre-test knowledge among cardiac patients

H2: There will be significant association between knowledge regarding lifestyle modification for prevention of myocardial infarction and selected demographic variable of cardiac patients.

6.8 DELIMITAIONS:

Study is limited to patients who had experienced any of the acute coronary syndromes of angina and acute myocardial infarction.

7. MATERIALS AND METHODS OF THE STUDY:

7.1SOURCE OF DATA

Known cardiac patients admitted in selected hospital at Tumkur

7.1.1RESEARCH DESIGN

One group pre and post test experimental design is chosen for the study

7.1.2VARIABLES OF THE STUDY

i. DEPENDENT VARIABLE:

Knowledge level of cardiac patients regarding life style modification for prevention of myocardial infarction

ii. INDEPENDENT VARIABLE:

Structured teaching programme for the cardiac patients

iii. ATTRIBUTING VARIABLE:

Age, Sex, Occupation, Education and income are the attributing variable

7.1.3STUDY SETTING

The study will be conducted at Sri Siddhartha Medical College hospital and District Hospital at Tumkur.

7.1.4POPULATION

Population of the present study will be cardiac patients admitted in selected hospital at Tumkur

7.2METHOD OF DATA COLLECTION

Structured questionnaire will be used for collecting data regarding life style modification for prevention of myocardial infarction among cardiac patients.

7.2.1SAMPLING TECHNIQUE

Non random sampling procedure of convenient sampling technique is used to select the sample of cardiac patients

7.2.2SAMPLE SIZE

Sample consist of 60 cardiac patients (n=60) for the study

7.2.3 CRITERIA FOR SELECTION OF THE SAMPLE

  • INCLUSION CRITERIA
  1. Cardiac patients who experienced the symptoms of acute coronary syndromes once in their life.
  2. Cardiac patients both male and female.
  3. Patients who are hospitalized.
  • EXCLUSION CRITERIA
  1. Cardiac patients with any other complications
  2. Cardiac patients who are not willing to participate in the study
  3. Cardiac patients who can’t able to reed and speak Kannada or English.

7.2.4 INSTRUMENT

A structured questionnaire will be prepared in such a way it will consist two parts.

Part I:

It consists of demographic profile of cardiac patients.

Part II: