RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE : Mr. NAGARAJA SWAMY
AND ADDRESS 1ST YEAR M.Sc.NURSING.
GOVERNMENT COLLEGE OF
NURSING, FORT, BANGALORE-02.
2. NAME OF THE : GOVERNMENT COLLEGE OF
INSTITUTION NURSING, FORT, BANGALORE-02.
3. COURSE OF STUDY : 1ST YEAR M.Sc.NURSING.
SUBJECT PSYCHIATRIC NURSING.
4. DATE OF ADMISSION : 31-05-2008.
5. TITLE OF THE STUDY : “A STUDY TO ASSESS THE COPING ABILITIES AMONG THE PARENTS
OF ORGANOPHOSPHOROUS
POISONING PATIENTS AT
SELECTED HOSPITALS,
BANGALORE WITH A VIEW TO
DEVELOP AN INFORMATION GUIDE SHEET”.
6. BRIEF RESUME OF THE INTENDED WORK
“Those who have control over their minds are masters’
those who are controlled by their minds are slaves,
those who have lost control over their minds are lunatics”.
6.1 Need for the study:
“Poisoning is an exposure to an amount of substances likely to produce untoward effect in an individual”.1
India is a predominantly agricultural country with about 74% of rural population, pesticides are routinely used by them for advanced farming. These Organic insecticides are common agents of accidental and suicidal poisoning due to their ready availability and easy accessibility.4 Hundreds of people are loosing their lives prematurely from pesticide poisoning. Organo phosphorous poisoning and other forms of Suicide is more common these days in our Society and has become a social evil.2
South India is rightly called as suicidal Capital of the world, as it accounts for the world's largest number of suicides by young people. It is estimated that, over 1,50,000 suicidal deaths takes place in India every year. Where South India alone contributes 1/3 of the total suicidal deaths in India.3
Two years back, the ‘ National Crime Records Bureau’ noted that, in this country, approximately one death takes place in every 15 minutes, one among such 3 deaths, is by a youth between age group 15 and 29, middle aged i.e. between the age group 30 and 44 are aimed at repeated suicidal thoughts. In Pondicherry, at least 15 youths die of suicide every month. In 2003 the largest number of farmers around 175 committed suicide in Andhra Pradesh.3 Organophosphate poisoning is the most common suicides in India, accounting for almost half of the hospital admissions.3
Organophosphates are extremely toxic chemicals used by farmers in sub-lethal doses. Commonly four types of Pesticides used in India, in household and agricultural situations. They are organophosphates, organocarbamates, organochlorides and organic pyrathroides, of the four classes of organic insecticides, the organophosphates are popular Insecticides are frequently ingested accidentally or intentionally. 4
Organophosphorous Compounds inhibit acetyl cholinesterase at neuromuscular junction, in autonomic and central nervous system resulting in accumulation of acetylcholine (ACh) and over stimulation of ACh receptors resulting in acute cholinergic crisis, which is characterized by bradycardia, bronchorrhoea, respiratory depression, miosis, sweating, salivation, lacrimation, defecation, urination and hypotension. In addition, there occurs muscle weakness and fasciculation. The Central nervous system involvement results in altered sensorium and seizures.5
Following resolution of cholinergic crisis, some patients may develop intermediate syndrome i.e. cranial nerve palsies, proximal muscle weakness, respiratory muscle weakness. Some may develop peripheral neuropathy at a later stage. changes have been reported on high dose exposure. Psychosis, delirium, aggression, hallucination and depression may also be seen during recovery from the cholinergic syndrome are seen amongst people exposed to low dose of organophosphorous compounds for prolonged periods.5
The management of these patients involves washing of skin and induction of vomiting or gastric lavage to remove Organophosphorous Compounds from stomach, administration of activated charcoal, atropine, glycopyrrolate, oximes and some newer compounds like Sodium bicarbonate, Clonidine, in addition to ventilatory support which they may require. Benzodiazepines is the standard treatment for organophosphorous induced seizures.5
A major complication associated with Organo Phosphorous poisoning includes acute severe pancreatitis, Respiratory failure, Cardiac arrhythmias, cranial nerve palsies and death.5
Mohanty and Patnaik conducted a study at selected hospitals in Bhopal, to evaluate the pattern of acute organophosphorous poisoning cases including death. Males outnumbered females and most OP poisoning occurred in the 21-30 year age group. In 68 cases the motive was suicide and more than 80% were from rural areas. Married females and unmarried males were most frequently affected. Most of the married females were housewives and the males were students or farmers. Twenty-nine out of 66 admitted OP poisoning cases were fatal. There is a high incidence of OP poisoning with mortality in this region.6
The Researcher understands the stress and panic anxiety among the parents which is associated with hospitalization, life threatening complications, treatment, follow up care, and prevention of future Suicidal attempts by the patients. This study helps the Investigator to assess the Coping abilities among the Parents of Organo Phosphorous Poisoning Patients, providing an Information guide sheet will improve the coping abilities among the parents.
6.2 REVIEW OF LITERATURE:
Paudyal BP.(2008) conducted “study to analyze all poisoning cases admitted in medical and pediatric wards of Patan Hospital”. A total of 154 cases were admitted. Females outnumbered males and almost two-thirds patients were young adults (15-34 years). whereas kerosene was the most frequent poisoning in pediatric age group. Intensive care unit (ICU) service was required in 17% of patients; and almost 25% developed complications. Aspiration pneumonia and respiratory failure were the most frequently observed complications. Ninety four percent of admitted patients recovered completely; leaving a mortality rate of 5%.7
Yurumez Y, Durukan P, Yavuz Y, Ikizceli I, Avsarogullari , Ozkan S, et al. (2007) conducted the study to evaluate the “Type of Organophosphorous poisoning exposure among the patients”, admitted to the emergency department. Kocatepe University., During the study period, 220 patients who had organophosphate poisoning with a known agent were admitted to the Emergency Department. There were 131 female and 89 male patients. The most affected age group was 15-24 years in both sexes. Oral ingestion was found to be the most common route of poisoning. The most frequent reason for poisoning was attempted suicide. The most common organophosphate compounds exposed were dichlorvos, diazinon and parathion-methyl. The most frequent clinical signs were miosis, respiratory system findings, tachycardia, loss of consciousness, and hypertension. Twenty patients died due to sudden respiratory and cardiac arrest, respiratory failure, CNS depression and septic shock.8
Ozer C, Kuvandik G, Gokel Y, Duru M, Helvaci MR. (2007) conducted study to evaluate the “Demographic, causative, and biologic characteristics of patients with organophosphate (OP) poisoning” who were admitted to tertiary teaching and research hospitals at 2 different universities. The study group consisted of subjects in the second decade of life; the female-to-male ratio was 2.2:1. In all, 27 of 43 females and 16 of 20 males were married. Most of the patients were graduated; 3 were illiterate and 5 were highly educated. A total of 36 subjects belonged to lower socioeconomic groups. Fifty-three patients intended to commit suicide, and 10 cases were accidental. A total of 19 subjects were intubated, and 4 died. A total of 59 patients recovered completely. The mortality depended on various factors such as OP compound consumed, amount ingested, time interval before hospitalization, and patients' general health.9
Singh B, Unnikrishnan B. (2006) conducted study to “Characterize the poisoning cases admitted to the Government Wenlock Hospital” (a teaching hospital of Kasturba Medical College) Mangalore, India. All cases admitted to the emergency department of the hospital evaluated retrospectively. Of the total 33,207 patients admitted in the hospital for treatment, 325 patients were for to acute poisoning. This was 1% of all emergency admissions. Of these 70% were males and 30% females. The majority cases were from age group of 21-30 years. Most poisonings were intentional and only 27% were unintentional. The most important agents of acute poisoning were agrochemical pesticides, 48 patients died. The poisons responsible for most of the mortality were organophosphate pesticides and aluminum phosphide.10
Bhattarai N, Rauniyar A, Chaudhary D, Jaiswal S, Banthia P, Rana BB. (2006) conducted study to evaluate “Pattern of patients of organophosphorous (OP) poisoning attending Kathmandu Medical College”. This is a retrospective study of OP poisoning from hospital records were analyzed meticulously and data extracted. A total of 47 patients of OP poisoning 22 cases were male and 25 were female. The maximum numbers of patients were between the ages of 20-40. Married patients outnumbered the unmarried. The most common motive for poisoning was suicidal, 41 cases. Metacid (methyl-parathion) was the most commonly used OP compounds in 32 patients. Overall mortality occurred in 3 cases.11
Munidasa UA, Gawarammana IB, Kularatne SA, Kumarasiri PV, Goonasekera CD. (2006) conducted “Retrospective study to evaluate the outcomes and predictors of mortality in patients with acute OP poisoning requiring intensive therapy” at a regional center in Sri Lanka. During the study period, 126 subjects were admitted to the ICU with acute OP poisoning. All the remaining 71 patients (59 male) had required endotracheal intubation and mechanical ventilation. Of these 71 patients, 36 (28 male) had died.12
Seydaoglu G, Satar S, Alparslan N. (2002) conducted study to evaluate “The data on acute adult poisoning, to identify the risk factors of mortality”. In this survey, data were collected from 2,229 adult patients admitted to the Emergency Department, Of all emergency admissions Of the total poisoning cases, 725 were males and 1,504 were females. A majority of the cases were attempted suicides. The attempted suicide ratio is higher for women (gender ratio: 2.4/1) and youths. Drugs were the most frequent cause of poisoning and pesticides were the second. Gender, age, season, clinical status, initial emergency care and type of substance were significant risk factors for mortality.13
Statement of the problem:
“A Study to assess the coping abilities among the parents of Organophosphorous poisoning patients at selected Hospitals, Bangalore with a view to develop an information guide sheet”.
6.3 Objectives of the problem:
1. To assess the coping abilities among the parents of Organophosphorous patients.
2. To find the association between the level of coping abilities among the parents
of Organo Phosphorous clients and selected Socio Demographic Variables.
3. To develop an information guide Sheet about coping strategies.
6.3.1 Assumptions:
1. Parents of Organo Phosphorous poisoning patients may have some knowledge about
Organo Phosphorous Poisoning.
2. Parents of Organo Phosphorous Poisoning patients may have little coping abilities.
3. There may be a significant association between level of coping abilities with
Selected demographic variables.
6.4 Operational definitions:
1. Assess: Refers to the process used to Identify, analyze and evaluate coping
abilities among the parents of Organo Phosphorous Poisoning clients.
2. Coping: Refers to the abilities of an Individual to adjust with Situational
Crisis.
3. Organo Phosphorous poison: Refers to the Pesticide which is extremely toxic
chemical substance Containing Carbon and Phosphorous.
4. Information Guide Sheet: It refers to concised and comprehensive information
Material, containing coping techniques on reducing the stress.
7.0 MATERIALS AND METHODS
7.1 Source of data : Parents of Organophosphorous poisoning
patients who are admitted in Emergency,
Causality, ICUs, and Medical wards, at
selected Hospitals, Bangalore.
7.2.1 Definition of the study : Parents of the Organo Phosphorous poisoning
Subject patients at selected Hospitals, Bangalore.
7.2.2 Inclusion and Exclusion criteria:
a) Inclusion criteria: : 1. Parents of Organophosphorous Poisoning
patient admitted in Emergency, Causality,
ICU and medical wards.
2. Parents of Organophosphorous Poisoning
patients who are willing to participate in the
study.
3. Parents of OP poisoning patients who
Understand Kannada or English.
b) Exclusion criteria : 1. Parents of clients attempted suicide by
means, other than OP consumption.
7.2.3 Research Design : Descriptive Design.
7.2.4 Settings : Selected Government Hospitals, Bangalore.
7.2.5 Sampling technique : Non probability sampling technique, -
Purposive sampling technique.
7.2.6 A) Sampling size : 50 Parents of Organophosphorous Poisoning
patients.
B) Duration of the study : 30 days.
7.2.7 Tools of research : Tool of the research will be constructed in
Two parts:
Part I-Selected socio demographic variables
Such as Age, Sex, Occupation, Income,
Education, Type of family, and residential
area .
Part II-Structured Interview Schedule on
Coping abilities among the parents of
Organophosphorous Poisoning patients.
7.2.8 Collection of data : 1. The investigator himself collects the data
from parents of Organophosphorous
Poisoning patients regarding their coping
abilities using Structured Interview
Schedule.
7.2.9 Method of Data Analysis : 1. The investigator will use
and Presentation descriptive statistical techniques like mean,
mode, median and standard deviation and
inferential statistical techniques and other
relevant statistical methods will be used.
2. The analyzed data will be presented in
the form of tables, diagrams and graphs.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY?
Yes, study will be conducted on selected parents of Organo Phosphorous poisoning patients regarding their coping abilities.
7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
· Yes, permission will be obtained from the concerned person and authority of the institution before the study.
· Privacy, confidentiality and anonymity will be guarded.
· Scientific objectivity of the study will be maintained with honesty and impartiality.
8) Bibliography:
1. Jaya Kuruvilla, Essentials of Critical care nursing. New Delhi: Jaypee
Brothers Medical Publishers; 2007. p. 281-88.
2. Bawaskar HS, Joshi RS. Organo Phosphorous poisoning in Agricultural India [serial online]; 2005. [cited on 2008 Nov 10];422(24). 53-56. Available from: URL: http://www.google.com.
3. Kuckian Uday. South India World’s suicidal capital? Med Res Coun Bull [serial online]; 2004 April 15 [cited on 2008 Nov10]; 12(2):12-14. Available from: URL: http://www.google.com.
4. Arun M, Vikram Palimar. Neurological manifestations in Organophosphorous
Toxicity. J Indian Acad ForensicMed [serial online]; 2006 Jan 1. [cited on 2008 Nov
12];30(1):29. Available from: URL: http://www.google.com.
5. Dr. Singh S. Organo Phosphorous Poisoning: an Evidence based approach,