RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
ANNEXURE-II
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.
1 / NAME OF THE CANDIDATE AND ADDRESS / Mr. VINCE VARGHESEIst YEAR M.Sc. NURSING STUDENT,
N.D.R.K. COLLEGE OF NURSING
B.M. ROAD, HASSAN-573201, KARNATAKA.
2 / NAME OF THE INSTITUTION / N.D.R.K. COLLEGE OF NURSING, B.M. ROAD
HASSAN, KARNATAKA.
3 / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
(CHILD HEALTH NURSING)
4 / DATE OF ADMISSION TO THE COURSE / 6th MAY 2008
5 / TITLE OF THE TOPIC / “EFFECTIVENESS OF INFORMATION BOOKLET ON KNOWLEDGE AND SKILL OF SECOND YEAR B.Sc NURSING STUDENTS ON DRUG COMPLIANCE FOR UNDER-FIVE CHILDREN WITH BRONCHIAL ASTHMA ADMITTED IN THE PEDIATRIC UNIT AT S.C HOSPITAL, HASSAN, KARNATAKA.”
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION BOOKLET ON KNOWLEDGE AND SKILL OF SECOND YEAR B.Sc NURSING STUDENTS ON DRUG COMPLIANCE FOR UNDER-FIVE CHILDREN WITH BRONCHIAL ASTHMA ADMITTED IN THE PEDIATRIC UNIT AT S.C HOSPITAL, HASSAN, KARNATAKA.”
6. BRIEF RESUME OF WORK INTENDED
6.1 INTRODUCTION
“ Ultimately it is human being that counts and if the human being counts, well he counts much more as a child than as a grown group”
- JAWAHARLAL NEHRU
Asthma affects an estimated 78 million children world-wide. Poor compliance with the prescribed medication leads to increased mortality and morbidity. According to the study of Baudine in March 2000, Victoria, U.K. Asthma is a chronic illness that affects 1 in 4 children, and 1 in 7 adults. Effective control of asthma requires a good level of knowledge and self- management. Current literature supports the promises that education is a vital ingredient of self- management.
As a chronic disease, asthma requires a continued treatment and possess the problem of compliance with medication. Low rates of compliance with medication poses a major challenge to the effective management.
Asthma is a chronic inflammatory disorders of the airways in which many cells (mast cells, eosinophil and T-lymphocytes) may play a role. In susceptible children inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough especially at night or in the early morning. These asthma episodes are associated with airflow limitations or obstruction that is reversible either spontaneously or with treatment. The inflammation also causes increase in bronchial hypersensitiveness to a variety of stimulates ( National asthma education and prevention programme, 1997).1
The incidence, severity and mortality associated with asthma is increasing. This increase may result from increasing air pollution, poor access to medical care, under diagnosis and under treatment. Asthma is the most common chronic disease of childhood is the primary cause of school absentism. 10 million absence from school are attributed by asthma (velser-friedrich and srof 2000), responsible for a major proportion of pediatric admission to emergency departments and hospitals.
The onset of asthma usually occurs during the first five years of life. Boys are affected twice as often as girls until adolescence, when the incidence is approximately equal. Morbidity associated with asthma transcends the physical, intellectual and social growth and development of children affected with this disorder. Among its many effects are, impaired physical activity and exercise, academic under achievement, poor self-concept and disruption of family functioning. There is often a family history of asthma or other allergic condition.
Most of the patients fail to comply with asthma medication for a variety of reasons. These range from physical inability to use an inhaler, through simple forgetfulness, to a conscious decision not to use medication as prescribed due to internal or cultural health beliefs or socio-economic factors ( i.e. factors of which patients have limited awareness) can affect compliance. poor doctor-patient communication can be the cause in many other individuals.2
6.2. NEED FOR THE STUDY
The study of asthma trends, hospitalized and non- hospitalized cases. There is now clear evidence that asthma prevalence increases significantly, especially in developed countries. Recent reports from the U.S and U.K suggest that asthma prevalence may have plateau in 1995 and the first few years of the present century. This stabilization, and even some decrease in asthma prevalence, especially in countries with high baseline rates, was confirmed by the international study of Asthma and Allergies in Children. Almost 70% of cases were in the under-five age group and the male to female ratio was 1.3:1. The increasing trend in steroid use was observed (r = 0.693, p= 0.026), while the use of antibiotics was unchanged (r= 0.068, p=0.852). The percentage of admissions began to decline in 1989 when the aerosolized beta-2 agonists were introduced in the hospital and declined further in 1991 when increased use of aerosolized therapy and prophylactic drugs was observed. 3
Asthma can strike at any age, half of all cases first occur in children younger than the age of 10 years. In this age group asthma affects twice as many males than females. Nearly 1 in 13 children have asthma, and which is increasing world-wide. Emergency department visits hospitalizations and mortality from asthma have been increasing for more than 20 years. Especially among children and blacks, asthma affects 14 – 16% of children in Australia. 6.4 (12.2%) million children were recognized with asthma and 4.1 million children had asthma attack in the past year in U.S (2002). The cost of the asthma treatment is approximately $ 3 billion annualy . Every year asthma affects 5 million children, and is the leading cause of pediatric admission in hospitals.4
In America, the incidence rate of asthma is 26% higher in African-Americans than whites.( World Health Organization 2004).
Asthma that results from sensitivity to specific external allergens is known as extrinsic. Extrinsic (atopic) asthma usually begins in childhood and is accompanied by other manifestations of atopic (type 1, immunoglobulin (1g) E-mediated allergy) such as eczema and allergic rhinitis. In intrinsic asthma, no extrinsic allergens can be identified. In many asthmatics intrinsic and extrinsic asthma co-exist. Several drugs and chemicals may provoke as asthma attack without using the IgE pathway. (eg. Aspirin) 5
Bronchial asthma is the attacks of dyspnoea in which there is wheezing and difficulty in expiration due to muscular spasm of the bronchi. The attacks may be precipitated by hypersensitivity to foreign substances, air pollution, exertion of infection or associated with emotional upsets. There is a family history of asthma or other allergic conditions. Treatment is with bronchodilators, with or without corticosteroids, usually as aerosol or a powder inhaler.
The annual attack rate (episode) per child was more in urban area than in rural area (acute respiratory disease survey in Tripura). Monthly incidence was 23% in urban area and 17.65% in rural area. The overall incidence of asthma is 20%. Air pollution of the urban area had stronger relation for bronchial asthma. Acute respiratory infections was decreased as percapita income increased. Lower socio- economic status had the greater risk. An increase in magnitude of asthma was observed with the decrease in literacy rate. 6
This study is to assess the knowledge and skill of second year Bsc nursing students, on drug compliance of under-five children with bronchial asthma. Because in future they will become nurses as well as the care-giver and they should know, what are the problems of children and how to provide sufficient care. In future they may see many children with bronchial asthma, if they are aware about the drug compliance, they can provide a comprehensive care.
6.3 STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of the information booklet on knowledge and skill of second year B.Sc nursing students on drug compliance for under-five children with bronchial asthma admitted in the pediatric unit at S.C. Hospital, Hassan, Karnataka"
6.4 OBJECTIVES OF THE STUDY: Is to:-
1) Identify the knowledge of second year B.Sc Nursing students regarding drug compliance for under-five children during the pre-test.
2) Evaluate the knowledge and skill of the Second year B.Sc Nursing students, regarding the drug compliance for under-five children after the information booklet and demonstration.
3) Determine the knowledge and skill of Second year B.Sc Nursing students regarding Drug compliance for under-five children after the post - test.
4) Correlate between the Post-test knowledge and skill scores after the information booklet and demonstration.
5) Associate the knowledge and skill gain score of second year B.Sc Nursing students with selected socio-demographic data.
6.5 RESEARCH HYPOTHESIS
There will be significant difference in the knowledge and skill of second year B.Sc Nursing students who have received the information booklet regarding drug compliance for under-five children with bronchial asthma.
6.6 ASSUMPTION: This study will:-
1. Improve the knowledge and skill of second year B.Sc Nursing students regarding the provision of promotive and preventive pediatric nursing care on drug compliance for under-five children with bronchial asthma.
2. Enhance the knowledge and skill of second year B.Sc Nursing students regarding drug compliance for under-five children with bronchial asthma.
6.7 OPERATIONAL DEFINITION
Assess: Assess is defined as the value or the quality of the study regarding drug compliance for under-five children with bronchial asthma.
Effectiveness: Effectiveness is defined as a significant increase in the level of knowledge regarding drug compliance for under-five children with bronchial asthma.
Information booklet: Knowledge regarding drug compliance of under-five children with bronchial asthma gathered in a small book with a paper cover.
Knowledge: A range of information about drug compliance in under-five children with bronchial asthma.
Skill: Ability to do something well or expertise on drug compliance for under-five children.
Second Year B.Sc Nursing: Students who are studying in second year B.Sc Nursing perform at N.D.R.K College of nursing, B.M Road, Hassan.
Drug: Drug is defined as any substance which is used to provide care, make a diagnosis or to prevent a disease.
Compliance: `Obedience to a request or command regarding the drug regimen of bronchial asthma and bronchodilators. Eg: Salbutamol
Under-five Children: The group of children aged below five years who are suffering from bronchial asthma.
Bronchial asthma: Attacks of dyspnoea in which there is wheezing and difficulty in expiration due to muscular spasm of the bronchi. The attacks may be precipitated by hypersensitivity to foreign substance air pollution, exertion or infection or associated with emotional upsets. There is often a family history of asthma or other allergic condition.
Pediatric Unit: It is the unit which is only for treating and caring for the children. Pediatric unit is a group or a smallest, component of the general medicine of child hood. At S.C Hospital there are two pediatrics units, I & II having fifteen beds each, with a total of 30 bedded pediatric unit. And the facilities available here are centralized oxygen supply, suction apparatus, nebulizer , restraints, infantometer etc.
S.C Hospital: Sri. Chamarajendra Hospital was established in the year 1928. It is the district government hospital, which is situated in between district court and the government school, which are in the heart of the city, Hassan. Sri. Chamarajendra Hospital is a 1000 bedded multi-specialty hospital attached with a medical college and nursing college.
6.8 CRITERIA FOR SAMPLE SLECTION
Inclusion Criteria:
· Male and female students studying in the second year B.Sc Nursing at N.D.R.K college of Nursing B.M Road, Hassan.
· Students who know to read, write and speak, in Kannada and English.
· Second year B.Sc Nursing students who are willing to participate.
· Under-five children who are suffering from bronchial asthma and are treated with drug therapy.
Exclusion Criteria:
Second year male and female B.Sc Nursing students not willing to participate.
6.9 LIMITATIONS OF THE STUDY
This study is limited to:
· 64 Second year B.Sc Nursing students of N.D.R.K College of Nursing, Hassan.
· A period of 4 weeks.
· Under-five children with bronchial asthma admitted in the pediatric unit of S.C.Hospital, Hassan for drug therapy.
6.10 SIGNIFICANCE OF THE STUDY
This study will :
· Increase the knowledge and clinical skill of second year B.Sc Nursing students in the provision of drug compliance of under-five children with bronchial asthma.
· Pave the way for second year B.Sc Nursing students to render evidence based nursing practice.
6.11 CONCEPTUAL FRAME WORK
Based on:
· Peplau’s inter personal theory ( 1952 )
6.12. REVIEW OF LITERATURE
The objective of the study was to investigate how parents use bronchodilator treatment for asthmatic pre-school children. Research design was commercial-electromechanical timers device was attached to a large volume spacer to record the time and data of each use of bronchodilator over two months. The study was conducted in a large pediatric teaching hospital in Glasgow. The subjects included were 29 pre-school children with moderately severe asthma attending a specialist pediatric asthma clinic. The results include satisfactory data obtained from 22 out of 29 children. The conclusion of the study is that the frequency of parental administration of bronchodilator treatment was varied and not closely related to the parent’s record of symptom severity. Parents often recorded symptoms in their children but did not treat them.7
The objective of the study was to compare effects of nebulized budesonide inhalations suspension and Cromolyn Sodium nebulized solution in young children with asthma. A randomized parallel group research design adopted for the study was conducted in allergy and immunology associates of Ann Arbor, Michigan, U.S.A 335 pre-school children were included in the study. 287 children (86%) completed the study. The result of budesonide group had a mean asthma rate of 1.23 per year compared with 2.41 per year for the cromolyn group. The conclusion of the study was budesoide inhalation suspension was more effective than nebulized Cromolyn sodium in young children with persistent Asthma.8
The aim of the study was maintenance of treatment with nebulized budesnsonide in young children with asthma. Blind parallel, groups design adopted for the study .102 children were included in the study, conducted in the department of Pediatrics, Ostra Hospital, Goteborg, Sweden. The patients were reviewed once in every 3 weeks. The result of the study was that, symptom control had been achieved when the dose was reduced and the clinical effect was very good. The conclusion of the study was that no significant side – effects were seen. 9