RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE- II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / Name of the candidate and address / Mr. ROBIN VARGHESE
1ST YEAR M.Sc NURSING
LAXMI MEMORIAL COLLEGE OF NURSING
A.J. TOWERS, BALMATTA,
MANGALORE- 2
2. / Name of the institution / LAXMI MEMORIAL COLLEGE OF NURSING
3. / Course of study and subject / M.Sc NURSING, PSYCHIATRIC NURSING
4. / Date of admission to the course / 31-05-2010
5. / Title of the topic:
“EFFECTIVENESS OF STRUCTURED TEACHING PGROGRAMME (STP) ON KNOWLEDGE OF NURSES REGARDING MENTAL STATUS EXAMINATION IN A SELECTED HOSPITAL AT MANGALORE”
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8. / BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
In this really hectic world, quite a number of people are exposed to situations where mental stress is unavoidable. This leads to people having all kinds of mental health problems that eventually may turn to chronic mental disorders. People with mental health problems normally have the tendency of not admitting their health problems because of the stigma attached to these kinds of illnesses. Most of them are in denial state, and this situation may cause very serious social problems since people with mental problems will develop some kind of mental disorders, and as a result, they might be harmful to others around them. People with mental health problems must receive proper treatments and medications. If their mental status can be assessed and examined easily, then most probably their mental problems can be detected at a very early stage, and can be easily controlled and cured1.
Prevalence of mental illness in general medical settings showed wide variation in various surveys. It was revealed that 30% of patients in general medical settings had psychiatric disorders. Delirium was detected in 10% of all medical in-patients,2/3rd of patients who are high users of medical care had a psychiatric disturbance; 23% had depression, 22% had anxiety, 20% had somationzation. Epidemiological studies had established that mental disorders are twice as common in the outpatient general setting and depression is the common psychiatric disorder.2
Psychiatric assessment provides a systematic framework for the delivery of quality care to the patient. It fulfils the requirements for a scientific methodology in order to be consider as a profession.3
The history and Mental Status Examination (MSE) are the most important diagnostic tools a psychiatrist has to obtain information to make an accurate diagnosis. Although these important tools have been standardized in their own right, they remain primarily subjective measures that begin the moment the patient enters the office. The clinician must pay close attention to the patient's presentation, including personal appearance, social interaction with office staff and others in the waiting area, and whether the patient is accompanied by someone (i.e., to help determine if the patient has social support). These first few observations can provide important information about the patient that may not otherwise be revealed through interviewing or one-on-one conversation.4
The mental status examination is a core skill of psychiatrists, nurses and other qualified mental health providers. It is a key part of the initial psychiatric assessment in an out-patient or psychiatric hospital setting. It is a systematic collection of data based on observation of the patient's behaviour while the patient is in the clinician’s view during the interview. The purpose is to obtain evidence of symptoms and signs of mental disorders, including danger to self and others, that are present at the time of the interview. Further, information on the patient's insight, judgment, and capacity for abstract reasoning is used to inform decisions about treatment strategy and the choice of an appropriate treatment setting.5
National Institute of Mental Health and Neuroscience (NIMHANS), Bangalore reported that as mental illness was an age old problem of mankind and as people have their own fear about mental hospitals, many of them seek help from mental hospital as a last resort and get admitted to the general hospitals. Therefore staff nurses and other health staffs of general hospitals have the primary responsibility of delivering basic mental health care along with the general health care. Since the mental status examination plays a vital role to rule out the underlying pathology, the nurses should have an essential knowledge regarding psychiatric assessment to identify the people with mental illness coming to the general hospital.6
A quasi-experimental study was conducted to assess the effectiveness of structured teaching module on the level of knowledge about psychiatric assessment procedure among the trainee nurses. A purposive sampling technique was used to select sample of 30 trainee nurses from different wards at NIMHANS in Bangalore. Assessment tool for collecting data was a questionnaire regarding psychiatric assessment. Pre- test was administered to the respondents and PTP was given. Post- test was conducted using the same tool. The results showed that the total mean pre- test score was 17.33 and post test score was 23.97 with a change in knowledge of 6.64, which was found to be highly significant. The researcher concluded that increasing the knowledge of staff nurses about psychiatric assessment could help them to identify patient’s needs and problems and can provide prompt nursing care.7
Nursing staff are in the front line in caring of psychiatric patients. However, their skill and knowledge pertaining to mental health problems is not fully assessed. As the investigator’s personal experience as staff nurse worked in general hospital and faced difficulty in assessing mental problems of patients. Hence researcher felt the need for improving the knowledge of the nurses working in general hospital regarding psychiatric assessment especially mental status examination through structured teaching programme (STP) as it is an accepted teaching method to improve the knowledge of staff nurses.
6.2 REVIEW OF LITERATURE
A cross-sectional study was conducted at a health centre in UK to determine the accuracy of the geriatric mental status examination and the Montgomery-As berg Depression Scale and to find out the knowledge of nurses in detecting depression in patients who have recently had a stroke. Twenty-eight patients who were still in hospital in the second week post-stroke were included in the study. The nurses conducted the geriatric mental status examination. The result shows that geriatric mental status examination had a sensitivity of 71%, a specificity of 67%, a positive predictive value of 42%, a negative predictive value of 88% in detecting depression and an overall efficiency of 68%. The Montgomery-As berg depression rating scale had a sensitivity of 100%, a specificity of 65%, a positive predictive value of 54%, and a negative predictive value of 100% and overall efficiency of 75%. Hence it was clear that all nurses could be trained in the use of these instruments like psychiatric history-taking, MSE and a crucial mass of assessment needs to be undertaken every year to maintain competence.8
A study was conducted to determine the impact of clinical teaching of mental status examination on the knowledge of nurses. This study included 40 nurses divided into two groups of 20 each were taken, one as control group and one for training. Pre- assessment of knowledge of nurses in MSE was done using a 50 item multiple choice questionnaires. A post test was also done for both control and experimental group. Data was analyzed by using ‘t’test and Mc Nemer’s test. The difference in pre-test and post-test score of the experimental was significant at the level of 0.005 and p value was found p<0.001. The difference in pre-test and post-test score of control was not significant (t=0.3036). When items of the tools were analyzed to identify the changes in the post test score, the control group had significant changes in the post-test score on 9 items. In the experimental group 20 items were significantly better in the post-test. The study suggested the regular use of clinical teaching as a method to train the nurses working in general hospitals to keep them equipped with the knowledge to give better and comprehensive nursing care to the patients.9
A descriptive study was conducted to evaluate psychiatric morbidity in elderly patients admitted to non-psychiatric wards in a general hospital in Nigeria. All patients aged 60 years and above who were admitted into medical, surgical and gynaecological wards were assessed with a self reporting questionnaire, mini-mental state examination and geriatric mental state schedule. The result showed that diagnosis of mental disorders were made according to the mental morbidity, where 45.3% with depression being commonest. The physician could recognize only 2.8% mental disorder. Hence it showed that health care professionals should have enough knowledge on psychiatric assessments.10
A cross-over study was conducted in UK to assess the impact of psycho-social assessment made by staff nurses working in accident and emergency department. Data was collected from 40 nurses by using simple random sampling. Psychiatric nursing assessment including history taking were completed for each patient seen by the nurse using a rating scale. The results showed that about 1/3rd of patients had presented with mental health problems in accident and emergency department and 90% of nurses were able to assess the patients. Approximately half of the patients (50%) seen by the nurse had a psychiatric history. Hence it can be concluded that nurses who had knowledge in psychiatric assessment can manage patients with mental health problems.11
A study analysis was carried out in London during training of primary care nurses in relation to mental health. Training needs analysis was the part of training strategy where training or learning objectives are established, knowledge regarding psychiatric history and assessment are mapped, gaps are identified and appropriate action was taken to meet the needs. After each session, the 90 participants were given a questionnaire to complete. The analysis found that 73% of sample had no formal mental care experience and 65% had no formal mental healthcare training, a majority (62%) had frequent contact with clients experiencing mental health problems of varying degrees. The preferred modes of teaching were formal sessions (26%), face-to-face sessions in a clinic setting (22%), and group work (16%). The results showed that these types of exercises may become more commonplace as services providers seek to ensure that staff have the skills needed to collect the history of the clients.12
6.3 STATEMENT OF PROBLEM
Effectiveness of Structured Teaching Programme (STP) on knowledge of nurses regarding mental status examination in a selected hospital in Mangalore.
6.4 OBJECTIVES OF THE STUDY
1.  To determine the level of knowledge on mental status examination among nurses as measured by structured knowledge questionnaire.
2.  To evaluate the effectiveness of structured teaching programme (STP) on knowledge of nurses regarding mental status examination in terms of gain in post-test knowledge score.
3.  To find the association of pre-test knowledge scores with selected demographic variables.
6.5 OPERATIONAL DEFINITIONS
EFFECTIVENESS: Refers to that which is capable of producing the desired effect or result.
In this study, it refers to the extent to which the structured teaching programme (STP) programme has achieved its desired objectives in terms of gain in knowledge as measured by structured knowledge questionnaire.
STRUCTURED TEACHING PROGRAMME(STP):
In this study it refers to the teaching programme designed by the investigator for the nurses to improve the knowledge regarding the concept of mental status examination and its application in assessing mental status of a patient through lecture cum demonstration with help of various teaching aids.
MENTAL STATUS EXAMINATION: In this study mental status examination include the assessment of general appearance and behaviour, speech, thought, mood and affect, perception and cognitive functions of a patient.
NURSES: In this study, nurses refers to male and female nurses who are working in a hospital and have more than three months of experience and holds a diploma in nursing.
HOSPITAL: In this study, it refers to the institution which provides medical, surgical, obstetrics, paediatrics and psychiatric health services to the people who are in need.
KNOWLEDGE: In this study, it refers to the score the nurses are able to obtain in response to the questions relating to the concept of mental status examination.
6.6 ASSUMPTIONS
The study assume that :
·  The nurses will have some knowledge on Mental Status examination.
·  Planned teaching programme is an effective strategy to improve knowledge.
·  Demonstration is an appropriate technique for improving knowledge on assessing mental status of a patient.
6.7 DELIMITATIONS
·  This study is delimited to nurses who have been working in a general hospital for not less than three months.
·  This study is delimited to nurse who holds a diploma in nursing.
6.8 HYPOTHESIS
All hypotheses will be tested at .05 level of significance.
H1: The mean post-test knowledge scores of nurses on mental status examination will be significantly higher than that of the mean pre-test knowledge scores.
H2: There will be significant association of pre- test knowledge of nurses regarding mental status examination with selected demographic variable.
MATERIALS AND METHODS
7.1 SOURCE OF DATA:
Nurses working in a general hospital that has more than three months of experience and hold a diploma in nursing.
7.1.1 RESEARCH DESIGN
Pre experimental study design with one group pre-test post test design is adopted.
O1______X______O2
Pre- test Intervention Post- test
(structured teaching programme)
7.1.2 SETTING
This study will be conducted in a selected general hospital in Mangalore.
7.1.3 POPULATION
Nurses who has more than three months of experience and hold a diploma in nursing.
7.2 METHODS OF DATA COLLECTION
7.2.1 SAMPLING PROCEDURE
Simple random sampling
7.2.2 SAMPLE SIZE
In this study sample size will be 50 staff nurses working in a selected general hospital in Mangalore.
7.2.3 INCLUSION CRITERIA FOR SAMPLING
1.  Nurses working in a selected general hospital with more than three months of experience.
2.  Nurses working in a selected general hospital that holds a diploma in nursing.
3.  Nurses who are not exposed any of the teaching programmes on mental status examination.
4.  Nurses who are willing to participate in the study.
7.2.4 EXCLUSION CRITERIA FOR SAMPLING
1.  Nurses with less than three months of experience.
2.  Nurses who are with PcBsc and B.sc degree in nursing.