RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
PRELIMINARY SYNOPSIS ON THE M.Sc.(N) DISSERTATION
A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE AND PRACTICE OF HOME CARE MANAGEMENT OF TUBERCULOSIS AMONG TUBERCULOSIS PATIENTS IN SELECTED HOSPITALS IN MANGALORE
Submitted By:
Ms. Bhavya
1st year M.Sc.(N)
Srinivas Institute of Nursing Sciences,
Farangipete Post,
Arkula, Valachil Padavu,
Mangalore – 574143.
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE
AND ADDRESS
(IN BLOCK LETTERS) / Ms. BHAVYA
1st YEAR M.Sc.(N)
MEDICAL. SURGICAL NURSING
SRINIVAS INSTITUTE OF NURSING SCIENCES
VALACHIL, MANGALORE - 574143
2. / NAME OF THE INSTITUTION / SRINIVAS INSTITUTE OF NURSING SCIENCES,
VALACHIL, PADAVU, ARKULA,
FARANGIPETE POST,
MANGALORE – 574143.
3. / COURSE OF STUDY SUBJECT / M.Sc. NURSING
MEDICAL SURGICAL NURSING
4. / DATE OF ADMISSION / 16-06-2009
5. / TITLE OF THE TOPIC.
A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE AND PRACTICE OF HOME CARE MANAGEMENT OF TUBERCULOSIS AMONG TUBERCULOSIS PATIENTS IN SELECTED HOSPITALS IN MANGALORE
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7.
8. / BRIEF RESUME OF THE INTENDED WORK
Introduction:
“Knowing is not enough, we must apply.
Willing is not enough, we must do”
-Goethe
A disease or medical condition is an abnormal condition of an organism that impairs bodily functions, associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune diseases. A cure is the end of a medical condition or a treatment that is very likely to end it.
Ravindran GD (2005)1 reported that since the dawn of humankind, diseases have been playing havoc. We have waged a relentless a struggle against diseases. As civilization and travel progressed, diseases seen in one regions spread to other regions of the world. In the last three hundred years, microbes have been identified as the cause of many of these diseases. These diseases spread from person to person or between animals and human. These diseases are known as communicable diseases.
The World Health Organization(WHO) (2009)2 defined communicable disease is “an illness due to a specific infectious agent or its toxic products capable of being directly or indirectly transmitted from man to man, animal to animal or from environment to man or animal.” These diseases are completely preventable and most of them are curable.
Meenakshi M (2005)3 reported that most diseases are not communicable during the early incubation period or after full recovery. In diseases such as tuberculosis (TB), syphilis and gonorrhea are in communicable state may exist at any time over a long and sometimes intermittent period when unhealed lesions permit the discharge of infectious agent from the surface of the skin or through any of the body orifices.
Pulmonary Tuberculosis is a major cause of illness and death world wide. It is an contagious bacterial infection caused by Mycobacterium tuberculosis. The lungs are primarily involved, but the infection can spread to other organs of the bodies by blood or lymph system. It is mainly results from feeble immunity, caused by poor nutrition, the offspring of poverty.
WHO (2009)2 reported that the incidence of TB estimated 9.27 million in 2007. This is an increase from 9.24million cases in 2006, 8.3million cases in 2000 and 6.6 million cases in 1990.
Pulmonary Tuberculosis has been known to be a major public health disease in our country for a long time. India accounts for one fifth of the global Pulmonary Tuberculosis incident cases. Majority of the diseases occur among middle-aged and elderly male and female population. Each year over 1.9 million people in India develop TB, of which around 0.87 million are infectious cases. It is estimated that annually around 3,25, 000 Indians die due to TB.
Pulmonary Tuberculosis remains a world wide public health problem despite the fact that the causative organism was discovered more than 100 years ago and highly effective drugs, vaccines are available making pulmonary tuberculosis a preventable and curable disease. Along with this Home care management of pulmonary tuberculosis also plays an vital role in treatment regimen, which mainly focuses on taking the medications correctly to reduce the risk of developing multidrug - resistant TB , keeping all the medical appointments, taking medications as prescribed, and reporting any side effects of the medications especially vision problem and continuing the treatment
6.1. Need for the study:
Lewis et.al (2004)4 reported that Tuberculosis is a specific infectious disease caused by Mycobacterium tuberculosis. The disease primarily affects lungs and causes pulmonary tuberculosis. It can also affect intestine, meninges, bones and joints, lymphnodes, skin and other tissues of the body.
Park K (2002)5 reported that the primary infectious agent, Mycobacterium tuberculosis, is an acid-fast anaerobic bacilli that grows slowly and is sensitive to heat and ultraviolet light.
Smeltzer CS (2004)6 reported that Pulmonary Tuberculosis is a worldwide public health problem and the mortality and morbidity rates continue to rise. TB kills most people world wide than any other infectious diseases. It is estimated that between 19% and 43% of the world’s population is infected with Mycobacterium tuberculosis.
WHO (2009)2 estimates that more than 8 million new cases of TB occur each year, & approximately 3 million people die from the disease.
Bond et.al (2005)7 conducted a study on the widening role of home-based care organizations in the management of tuberculosis patients in Lusaka, zambia. The sample of 8 home-based care organizations and 1 hospice in Lusaka, 142 TB patients under home-based care organizations, 54 care givers, 42 TB patients not under home–based care organizations and 9 managers were interviewed. The result shown that at least 50% of TB patients are cared for by home-based care organizations and the majority of the TB patients said that their situation improved under home-based care management. The study concluded that, home-based care organizations have become a key partner in TB control and the quality of their management of TB and their partnership with government need to improve.
Kaona FA et.al (2004)8 conducted a study about an assessment of factors contributing to treatment adherence and knowledge of TB. A total 736 patients were interviewed using a pre-tested structured questionnaire, consisting of socio-demographic characteristics, socio-economic factors, knowledge about TB transmission and prevention, TB treatment practices at house hold level. The result shown that there were 39.1% of the females and 33.9% of the males, stopped taking their medication within the first 2 month of commencing treatment. Overall 29.8% of the patients stopped taking their medication. There was a significant difference in TB knowledge, with more males than females. This study established that 29.8% of
TB patients failed to comply with TB drug taking regimen once they started feeling better.
The Pulmonary Tuberculosis develops in the minority of people whose immune system does not successfully destroy the primary infection. The risk of contracting Pulmonary Tuberculosis increases with the frequency of contact with people who have the diseases and with crowded or unsanitary living conditions and poor nutrition. In order to control the patient contacts, they can be treated at home or ambulatory. The improper treatment of Pulmonary Tuberculosis patients which increases the mortality rate. There is no recent study on Tuberculosis in Mangalore region and also in this population. The investigator would like to under take the present study to evaluate the Pulmonary Tuberculosis patients who are admitted in a selected hospital in Mangalore, to improve their knowledge and practice on homecare Management of tuberculosis by administering a self-instructional module. Hence this study is relevant to this area, to this population and to this period.
6.2.Review of Literature
Review of Literature related to knowledge
Savicevic JA et.al (2009)9 conducted a study on tuberculosis knowledge among patients in out –patient sittings in Split, Croatia. The study comprised a structured questionnaire survey of 386 subjects aged more than or equal to 18 years. The result had shown that, there was no statistically significant differences were observed between females and males with respect to age, educational background or contact with TB patients. The mean TB knowledge score was 9.4+/-1.98 and a low score was associated with the youngest age group 18-29 yrs. (P=0.018) and with less than 12 years of education (P= 0.002). This study concluded that educational background and age groups of respondents were important determinants of TB knowledge.
Lertmaharit S et.al (2005)10 conducted a cross-sectional descriptive study on factors associated with compliance among tuberculosis patients in Thailand, to study the levels of compliance and associated factors among tuberculosis patients. A total of 487 adult newly diagnosed TB patients with positive sputum smear at the study location and they were interviewed by trained health personnel with structured questionnaire. Level of compliance classified into excellent (punctuality), good (missing less than or equal to 2 consecutive weeks) and poor (missing more than 2 consecutive weeks). The result shown that, the excellent compliance rate of the TB patients was 65.7%, while good and poor compliance were 22.8% and 11.5% respectively. The study concluded that compliance is one of the potential factors to increase the cure rate in TB patients. Finding the significant factors will pave the way to improve the effective treatment of tuberculosis.
Hoa N.P. et.al (2004)11 conducted a descriptive study on knowledge about tuberculosis and its treatment among new pulmonary TB patients in the north and central regions of Vietnam. A total of 364 patients were interviewed, using a structured questionnaire. About 93% of respondents reported receiving TB information from the health staff, apart from health education and other patients reported that receiving TB information from the Television. The result shown that average knowledge score was 7.07+ 2.02 (maximum 10). The study concluded that knowledge about TB and its treatment was generally high. Marginalized groups with limited access to media and low education levels may benefits from specially targeted educational interventions.
Wand walo E.R., Morkve.O (2000)12 conducted a study on knowledge of disease and treatment among tuberculosis patients in Mwanza, Tanzania with the objective to determine patients general knowledge of TB and the Management of the disease. The sample of 296 pulmonary tuberculosis patients were consecutively interviewed from 7th may to 7th July 1998. The result had shown that, only 30% of the study population had satisfactory knowledge of disease and treatment. The study findings indicate that, there are factors associated with satisfactory knowledge that could assist in designing health education intervention strategies.
Review of Literature related to practice
Moalosi G et.al (2003)13 conducted a study on Cost-effectiveness of home-based care versus hospital care for chronically ill tuberculosis patients, Francistown, Botswana .Sample of 50 caregivers were included and administered structured questionnaire for them .The characteristics of caregivers and patients were assessed
by using demographic and socio economic data collected during interviews and medical records. The result shown that the home based care reduced the cost per patient treated by 44% compared with hospital based treatment . Study concluded that home based care is more affordable and cost effective than hospital based care for chronically ill TB patients.
Review of Literature related to knowledge & practice:
Chuc N.T et.al (2009)14 conducted a study on knowledge & practices about TB & choice of communication channels in a rural community in Vietnam. A total of 12,143 adults were included. A population based cross-sectional survey was carried out within a demographic surveillance site in a rural district of Vietnam. The result shown that the average knowledge score was 4.3 + 2.1 (maximum=8). Men had a significantly higher knowledge score than women. The study concluded that traditional belief such as a hereditary cause of TB persists in the population despite many years. So access to information should be taken into consideration when choosing methods & channels for health education programme.
Hashim D.S et.al (2003)15 conducted a study on knowledge, attitudes & practices survey among health care workers & tuberculosis patients in Iraq. A cross sectional study was made of 500 patients & 500 health care workers randomly selected from 250 primary health care centers throughout the Iraq, to evaluate knowledge, attitudes and practices towards tuberculosis. Using structured questionnaire interview, the study showed 64.4% of patients had good knowledge, while 54.8% had negative attitudes and practices towards TB. The 2 most important sources of patients information about TB were physician & television. By contrast health care workers practice was poor only 38.2% handled suspected TB cases correctly. The study conclucded that the national TB programme in Iraq has had a good impact on knowledge of TB patients and health care workers.
6.3. Problem statement:
A study to assess the effectiveness of self instructional module on knowledge and practice of home care management of Tuberculosis among Tuberculosis patients in selected hospitals in Mangalore
6.4. Objectives of the study:
The objectives of the study are to:-
1.  assess the knowledge & practice of patients with Pulmonary Tuberculosis regarding home-care management before administering SIM.
2.  design & administer a self instructional module regarding Pulmonary Tuberculosis
3.  evaluate the effectiveness of self-instructional module on knowledge & practice of home care management among patients with Pulmonary Tuberculosis.
4.  compare the knowledge and practice score of patients after administering SIM.
5.  find out the association between knowledge on home-care management of Pulmonary Tuberculosis & selected demographic variables such as education and family history of illness.
6.  find out the association between practice on home-care management of Pulmonary Tuberculosis & selected demographic variables such as education and family history of illness.
6.5. Operational definitions:
1. Effectiveness:
It is the knowledge gain on home-care management of Pulmonary tuberculosis expressed in terms of increase in scores in the post-test.
2.  Self instructional Module:
In this study, SIM refers to an self-explanatory guide on home care management for patients with Pulmonary tuberculosis. It gives information regarding anatomy & physiology of the lungs, causes, signs & symptoms, diagnostic studies, treatment, home care management & prevention of Pulmonary tuberculosis.