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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Ms. PINKY GEROGEI YEAR M.SC. NURSING
2. / NAME OF THE
INSTITUTION / BHARATHI COLLEGE
OF NURSING
4TH CROSS,
K.R.EXTENSION,
TUMKUR- 572102
3. / COURSE OF STUDY AND SUBJECT / DEGREE OF MASTER
OF NURSING
OBSTETRICS AND GYNAECOLOGICAL
NURSING
4. / DATE OF ADMISSION
TO COURSE / 30-06-2008
5. / TITLE OF THE TOPIC / A STUDY TO ASSESS
THE KNOWLEDGE REGARDING SELF CARE MANAGEMENT
OF GESTATIONAL DIABETES MELLITUS AMONG MOTHERS IN
SELECTED HOSPITALS
AT TUMKUR, KARNATAKA.
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Diabetes mellitus is estimated to complicate approximately 2.5% of all pregnancies of which 90% are gestational diabetes while the rest are overt or pre gestational diabetes. Gestational diabetes mellitus is defined as glucose intolerance of variable degree with its onset or first recognition during the present pregnancy. Women are considered at high risk for gestational diabetes if they are markedly obese, have a personal history of gestational diabetes, have a strong family history of diabetes or have glycosuria. Risk assessment is essential in determining whether a women should be screened or tested for gestational diabetes.
The mother with gestational diabetes mellitus is a high risk of hypertension, preeclampsia, hydramnios, urinary tract infections, caesariansection and future diabetes mellitus, and some of the foetal complications are macrosomia, hypoglycemia, prematurity and congenital anomalies. The aim of management of gestational diabetes mellitus is to control blood glucose levels to avoid maternal and foetal complications. Components of management include diet therapy, exercise, insulin therapy and diabetic education1.
6.1. NEED FOR THE STUDY
“Knowledge is the key to a healthier life, and education is powerful medicine” K. Park
Diabetes is the most common medical condition to affect pregnancy and occurs in 4 per 1000 pregnancies, of which 90% are gestational diabetes mellitus. Traditional management approaches for gestational diabetes mellitus is a combination of diet, exercise, insulin therapy and self monitored blood glucose determination. The main aim of management is to maintain the blood glucose level during pregnancy, labour, delivery and postpartum period, inorder to prevent the maternal and foetal complications. So the mothers with gestational diabetes mellitus need to have adequate knowledge of self care activities. They need to clear their doubts related to selfcare activities such as diet, exercise, self glucose monitoring, insulin therapy and follow up care 2
The role of midwife is to educate the mothers regarding dietary interventions to regulate carbohydrate intake and restrict fat and sugar, importance of exercise, cessation of smoking, regular glucose monitoring throughout the pregnancies, insulin therapy and follow up care.
6.2 REVIEW OF LITERATURE
Review of literature for the present study has been organized under the following headings.
6.2.1. STUDIES RELATED TO NUTRITIONAL MANAGEMENT
6.2.2. STUDIES RELATED TO EXERCISE
6.2.3. STUDIES RELATED TO MEDICATIONS
OR INSULIN ADMINISTATATION
6.2.4. STUDIES RELATED TO SELF MONITORING
OF BLOOD GLUCOSE
6.2.5. STUDIES RELATED TO CARE OF WOMEN
WITH GESTATIONAL DIABETES MELLITUS.
TO REDUCE LONGTERM RISK.
6.2.1. STUDIES RELATED TO NUTRITIONAL MANAGEMENT
A Review of nutritional management of gestational Diabetes Mellitus was conducted inU.K. The aim of the review was to examine the scientific evidence of the optimal nutritional management of gestational diabetes mellitus. Medline search of all English papers published between 1995 and 2005 was cross referenced, gestational diabetes mellitus with diet was undertaken. Overall current evidence points to the effectiveness of dietary advice as a means of improving maternal hyperglycemia and reducing the risk of accelerated foetal growth 3.
An article in medical nutrition therapy addresses that excellent glucose control is as foundational as appropriate weight gain and adequate nutrient intake in a pregnancy complicated by gestational diabetes mellitus. If a balance between nutrient needs and glucose cannot be achieved, the concurrent medication therapy is needed to assist in reducing insulin resistance. Medical nutrition therapy is a self management therapy. Education, support and follow up are required to assist the women to make life style changes essential to successful nutrition therapy 4.
6.2.2. STUDIES RELATED TO EXERCISE
An evidence based guidelines indicate that regular prenatal exercise is an important component of a healthy pregnancy. In addition to monitoring physical fitness exercise may be beneficial in preventing or treating maternal foetal disease. Women who are the most physically active have lowest prevalence of gestational diabetes and prevention of gestational diabetes mellitus may decreases the incidence of obesity and type 2 diabetes in both mother and offspring 5 .
An article on gestational diabetes and exercise addresses that pregnancy is a diabetogenic event which could develop into gestational diabetes mellitus up to 12% of pregnant women. Gestational diabetes mellitus is a carbohydrate intolerance of variable severity with onset or first recognition during pregnancy, involves a relative resistance to insulin. Exercise becomes a logical intervention, only recently offered as an adjunctive therapy to pregnant diabetes. This articles reviews out current understanding of the role of exercise in the management of gestational diabetes mellitus.6
A Study was conducted among randomly assigned 32 gestational diabetes mellitus mothers to examine the effects of circuit type resistance training on the need for insulin. Group-I Was treated with diet alone and group-II was treated with diet plus resistance exercise. The number of women whose condition required insulin therapy was the same regardless of treatment. Women in the diet plus exercise group were prescribed less insulin and should a longer delay from diagnosis to the initiation of insulin therapy. This study revealed that resistance training may helps to avoid insulin therapy for women with gestational diabetes mellitus 7.
6.2.3. STUDIES RELATED TO MEDICATIONS OR INSULIN ADMINISTATATION
A review of use of insulin pump in pregnancy complicated by gestational diabetes mellitus was conducted in a single hospital at South Auckland and diabetes cases were reviewed from 1991 through 1994. This study revealed that insulin pump therapy was safe and effective for maintaining glycemic control in pregnancies complicated by gestational diabetes mellitus and type 2 diabetes 8.
6.2.4. STUDIES RELATED TO SELF MONITORING OF BLOOD GLUCOSE
A Study was carried out by Family Federation in Finland. Women’s at 22-34 gestational weeks had at least two abnormal high values out of three in oral glucose tolerance test were randomly allocated to have continuous glucose monitoring system (CGMS) or self monitoring (SM). Patients tested their plasma glucose 5 time per day. Need of antidiabetic treatment was determined using the following cut off values. Fasting glucose > 5.5m mol/L twice and postprandial value > 7.8m mol/L. In 11 out of 36 patients (31%) monitored with continuous glucose monitoring system antihyperglycemic drug therapy was introduced, where as only 3 out of 37 patients (8%) in the self monitoring group were drug treated. This study revealed that continuous glucose monitoring system detects a markedly higher proportion of gestational diabetes mellitus mothers needing antihyperglycemic medication compared with self monitoring of plasma glucose.9
6.2.5. STUDIES RELATED TO CARE OF WOMEN WITH GESTATIONAL DIABETES MELLITUS TO REDUCE LONG TERM RISK.
An article on improving the care of women with gestational diabetes mellitus addresses that gestational diabetes mellitus affects approximately 7% of all pregnant womens. Women are considered at high risk for gestational diabetes if they are markedly obese, have a personal history of gestational diabetes, have a strong family history of diabetes or have glycosuria. Risk assessment is essential in determining whether a women should be screened or tested for gestational diabetes. Women who have had gestational diabetes should have comprehensive preconception care prior to a subsequent pregnancy to ascertain appropriate weight, nutrition, exercise and signs of gestational diabetes mellitus. 10
An article on post partum management to reduce long term risks addresses that women with gestational diabetes mellitus are at increased risk for developing overt diabetes later in life. In addition their offspring exposed to the diabetes environment in utero are also at increased risk for developing obesity, glucose intolerance and type 2 diabetes later in life This article reviews the roles of medical nutrition therapy, physical activity and pharmacotherapy in preventing type – 2 diabetes in women with a gestational diabetes mellitus history.11
STATEMENT OF THE PROBLEM
A Study to assess the knowledge regarding self care management of gestational diabetes mellitus among mothers in selected hospitals at Tumkur.
6.3. OBJECTIVES OF THE STUDY
6.3.1. To assess the knowledge of diabetes mothers on self care by pretest knowledge score.
6.3.2. To develop and administer structured teaching programme on self care among mothers with gestational diabetes mellitus.
6.3.3. To assess the effectiveness of structured teaching programme regarding self care among mothers with gestational diabetes mellitus by post test knowledge score.
6.3.4. To find out the association between the women’s knowledge score with selected demographic variables.
6.4. RESEARCH HYPOTHESIS
H1 The post test knowledge score of mothers exposed to structured teaching programme on self care management of gestational diabetes mellitus will be significantly higher than their pre-test knowledge score.
VARIABLES UNDER STUDY
· Independent variable :
Structured teaching programme on self care management of gestationl diabetes mellitus.
· Dependent variable:
Knowledge score of mothers on self care management of gestational diabetes mellitus.
6.5. OPERATIONAL DEFINITIONS
1. ASSESSMENT: In this study it is an organized systematic and continuous process of collecting data from a gestational diabetic mothers regarding self care.
2. KNOWLEDGE: In this study, it refers to the correct response from the respondent (gestational diabetes mellitus mothers) on self care management of gestational diabetes mellitus as elicited through structured teaching programme.
3. STRUCTURED TEACHING PROGRAMME: It refers to systematically planned teaching programme designed to provide information regarding self care management of gestational diabetes mellitus .
4. SELF CARE MANAGEMENT: Activities carried out by the mothers with gestational diabetes mellitus regarding diet, exercise, self monitoring of blood sugar and self administration of insulin.
6.6. ASSUMPTIONS
· Mothers with gestational diabetes mellitus may have deficit knowledge regarding self care management.
· Structured teaching programme will enhance the knowledge regarding self care among mother with gestational diabetes mellitus.
6.7. DELIMITATIONS
· Gestational diabetes mothers who are attending the antenatal clinic in selected hospitals at Tumkur during the period of study.
· Gestational diabetes mellitus mothers who are willing to participate in the study
7. MATERIALS AND METHODS:
7.1 SOURCE OF DATA
Date will be collected from gestational diabetes mellitus mothers who are attending the antenatal clinic in selected hospitals at Tumkur.
7.2. METHODS OF DATA COLLECTION
7.2.1 RESEARCH APPROACH
Quasi – Experimental research approach
7.2.2 RESEARCH DESIGN
One group pre and post test design.
7.2.3 RESEARCH SETTINGS
Study will be conducted in selected hospitals, Tumkur.
7.2.4 POPULATION:
The population consists of gestational diabetes mellitus mothers attending the antenatal clinic in selected hospitals, Tumkur.
7.2.5 SAMPLE SIZE:
The population consists of 60 gestational diabetes mellitus mothers attending the antenatal clinic in selected hospitals, Tumkur.
7.2.6. SAMPLING TECHNIQUE
Convenience sampling technique.
7.2.7 SAMPLING CRITERIA
(A) INCLUSION CRITERIA
· Gestational diabetes mellitus mothers who are willing to participate in the study.
· Gestational diabetes mellitus mothers who can understand English and Kannada.
(B) EXCLUSION CRITERIA
· Gestational diabetes mellitus mothers who are not willing to participate in the study.
· Gestational diabetes mellitus mothers who are not able to understand English and Kannada.
7.2.8. DATA COLLECTION TOOL.
Structured questionnaire.
7.2.9. DATA ANALYSIS METHOD
Data analysis will be through descriptive and inferential statistics.
Descriptive statistics: Frequency, percentage, mean, median and standard deviation.
Inferential statistics: Non parametric chi-square test to determine the association between knowledge and the selected variables.
7.3 DOES THE STUDY REQUIRE ANY OR OTHER INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?
Yes, the study require data collection through structured questionnaire on knowledge of gestational diabetes mellitus mothers regarding self care management of gestational diabetes mellitus.
7.4 HAS THE ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION?
Yes, Ethical clearance will be obtained from,
· The research committee of Bharathi college of Nursing Tumkur.
· The authorities of selected hospitals, Tumkur.
· The informed consent from the candidates willing to participate in the study.
8. LISTS OF REFERENCES
1. Dhanwal Dinesh, Mukkhopadhay surabhi; gestational diabetes mellitus and pregnancy, Obs.. & Gynae. today; January 1999; 4(1); 22-24.
2. Myles, Textbook for midwives fourteenth edition; London; Elsevier science Ltd, 2003; 345-346.
3. Dornhorst, G. Frost, the principles of dietary management of gestational diabetes reflection on current evidence , Journal of Human Nutrition and Dietetics; April – 2002; 15(2); 145-156.
4. Reader DM, Medical nutrition therapy and life style interventions, diabetes care, July – 2007; 30 (2); 188-193.
5.Weissgerber TL, wolfe LA, Davies GA, Mottola M.F, Exercise in the prevention and treatment of maternal foetal disease; Applied physiology, nutrition and metabolism; December 2006; 31 (6); 661 – 674.
6. Bung P. Artal R, Gestational diabetes and exercise; Semin perinatol; Aug – 1996; 20(4); 328-333.
7. Reader D, Splett P, Gunderson EP, management of gestational diabetes mellitus, Journal of American diet association; Sept 2006; 106-109.
8. Simmons D, Thompson CF, Conroy C, Scott DJ, use of insulin pump in pregnancies complicated by gestational diabetes mellitus and type – 2 diabetes mellitus; Diabetes care; December 2001; 24(12); 2078-2083.
9. Kestilla KK, Ekbald UU, Ronnema T, Self monitoring of blood glucose in the treatment of gestational diabetes mellitus; diabetes research and clinical practice, Aug. 2007; 77(2); 174-179.
10. Farell M, Improving the care of women with gestational diabetes, American journal of maternity and child health nursing; Sept. 2003; 28 (5); 301-305.
11. Khandelwal M; post partum management to reduce long term risks; current diabetes reports; Aug. 2008; 8(4); 287-293.