BANGALORE – KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
BELSIE J
1St year M.Sc (Nursing)
MASTER IN MEDICAL-SURGICAL NURSING
YEAR 2009-2010
CAUVERY COLLEGE OF NURSING
# 42/2B, 2C, TERESIAN CIRCLE
SIDDARTHA LAYOUT
MYSORE.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE
BANGALORE - KARNATAKA
ANNEXURE – I
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Mrs. BELSIEI st YEAR M.Sc. NURSING,
CAUVERY COLLEGE OF NURSING,
SUBASH NAGAR,
MYSORE – 570007.
2 / NAME OF THE INSTITUTION / CAUVERY COLLEGE OF NURSING,
MYSORE – 570007.
3 / COURSE OF STUDY AND SUBJECT / MASTER IN NURSING
MEDICAL-SURGICAL NURSING
4 / DATE OF ADMISSION TO THE COURSE / 15-06-2009
5.1 / TITLE OF THE STUDY / “EFFECTIVENESS OF PLANNED TEACHING PROGRAM ON DIABETIC MANAGEMENT IN TERMS OF KNOWLEDGE AND PRACTICE”.
5.2 / STATEMENT OF THE PROBLEM / A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAM ON DIABETIC MANAGEMENT IN TERMS OF KNOWLEDGE AND PRACTICE AMONG PATIENTS WITH DIABETES MELLITUS IN SELECTED HOSPITAL AT MYSORE.
6. BRIEF RESUME OF THE INTENDED WORK
6.1 - INTRODUCTION
Diabetes mellitus poses a wide range of problems for patients and their family members. These problems include pain, hospitalization, change in the lifestyle and vocation, physical disability and threatened survival. Direct psychological consequence can arise from any one of the factors, making it harder for patients to treat their diabetes and live productive enjoyable lives (Joy M. Block, 1997).
Expert committee on the Diagnosis and classification of Diabetes Mellitus (1998) Diabetes mellitus is the group of metabolic disorder characterized by elevated blood level of glucose in blood (Hyperglycemia) resulting from defects in insulin secretion, insulin action or both.
Patients with insulin dependent diabetes mellitus diagnosed before age five and older patients with Non-insulin dependent diabetes mellitus may have associated alteration in cognitive or intellectual functioning. The patho- physiology of those cognitive changes is not well understood in the young patients those cognitive changes may be linked to recurring episodes of severe hypoglycemia. In the older patients both micro vascular and atherosclerosis disease are possible factors for complication.
The Centre for disease Control and Prevention (2003): There are currently more than 194 million people with Diabetes Mellitus world wide. If nothing is done to growth epidemic the number will exceed 300 million by the year 2025.
National Institute of Diabetes mellitus & Kidney disease (2003): Diabetes Mellitus is the fifth leading cause of deaths in United State killing 150,000/Year. Prevalence of Diabetes Mellitus among the people aged 70 years 18 million, aged 60 years 8.6 million, men 8.7 million and women 4.3 million. In 2003 the five countries which the largest number of persons with Diabetes Mellitus where India (35.5 Million), China (23.5), United State (16 Million), Russia (9.7 Million) and Japan (6.7 Million). 50% of peoples are unaware about their conditions.
The World Health Organization (WHO) estimated that by the year 2025 India alone would have 60 Million people with Diabetes Mellitus. India is alarming, every fifth individual with Diabetes Mellitus.
National Institute of Diabetes mellitus & Kidney disease (2003): Diabetes Mellitus occurs in the age group most likely at 40 in India when compared to the other countries where it develops only at 50 – 60 Years at age. The most common form of Diabetes in Type – 2 about 90 – 93% of people Type 2 Diabetes Mellitus. Old age, Obesity, family history of Diabetes Mellitus, previous history of gestational Diabetes mellitus, and Physical inactivity and hereditary about 80% of people with type 2 Diabetes mellitus, one over weight.
6.2-NEED FOR THE STUDY
In 2000, according to the World Health Organization (WHO), at least 171 million people worldwide suffer from diabetes. Its incidence increasing rapidly and it is estimated that by the year 2030 this number will be double. Diabetes mellitus occurs throughout the world, but is more common (Especially type 2) in the more developed countries. The greatest increase in prevalence is, however expected to occur in Asia and Africa where most patients likely be found by 2030. The increase in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes, perhaps most importantly a “Western style” diet. This has suggested environmental effects, but there is little understanding of the mechanism at present through there is much speculation, some of it most compellingly presented. It is well known that the prevalence of Diabetes mellitus is more in India.
Dietary management is an essential component of management of both Type 1 and 2 diabetes mellitus. Approximately 30% people with diabetes (Type2) are treated with dietary measures only. Meal planning is intended to ensure a reasonably consistent food intake and a nutritionally adequate diet. (Joyce M. Block (1997).
Diabetes mellitus is a serious health problem throughout the world. In the United States an estimated 17 million people, or 6.2% of the population, have diabetes. About one third of the people with diabetes mellitus are not diagnosed, and these individuals are unaware that they have the disease. Diabetes mellitus is the fifth leading cause of death in the United States, with 210,000 deaths annually. Nearly 29% of people over age 65 years have diabetes. The incidence of diabetes is expected to increase 165% in the next years. (Lewis 2004)
The most important tool in the management of diabetes after diet and medication is regular exercise. Exercise for diabetics should be light and proportional to their fitness. Regular exercise also helps to prevent weight gain and plays a part in increasing personal well by reducing stress, Anxiety and depression. Dr. Neelam Makol, Dr. A.M. Elizabeth (2005)
By 2010 three million people could be living with diabetes, and the majority of them, will have Type2. More than 10,000 people are diagnosed with Type2 diabetes in UK annually. This is due to in part to the rising number of obese and over weight people and on going population. (Gwan hall 2006)
6.3 - STATEMENT OF THE PROBLEM:
“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAM ON DIABETIC MANAGEMENT IN TERMS OF KNOWLEDGE AND PRACTICE AMONG PATIENTS WITH DIABETES MELLITUS IN SELECTED HOSPITAL AT MYSORE”.
6.4 - OBJECTIVES OF THE STUDY:
Ø To assess the knowledge and practice regarding diabetic management among the patients with diabetes mellitus.
Ø To evaluate the effectiveness of planned teaching program on diabetic management.
Ø To find out the relationship between knowledge and practice with their selected demographic variables such as age, sex, education, occupation, income, duration of illness, type of treatment.
Ø To determine the association between knowledge and practice score with the selected demographic variables such as age, sex, education, occupation, income, duration of illness, type of treatment.
6.5 - HYPOTHESIS:
Ø There will be a significant difference between pre test and post test knowledge and practice scores regarding diabetic management among patients with Diabetes mellitus.
Ø There will be a significant relationship between knowledge and practice of patients with diabetes mellitus on diabetic management
Ø There will be significant association between pre test knowledge and practice scores on diabetic management and selected demographic variables such as age, sex, education, occupation, income, type of diabetes mellitus, duration of illness, type of treatment.
Ø There will be significant association between post test knowledge and practice scores on diabetic management and selected demographic variables such as age, sex, education, occupation, income, type of diabetes mellitus, duration of illness, type of treatment.
6.6 - OPERATIONAL DEFINITIONS:
Ø Effectiveness
It is the outcome measures of an action through planned teaching program regarding diabetic management gained by the patients with diabetes mellitus.
Ø Knowledge
Knowledge is defined as a verbal response about management of Diabetes Mellitus. It is measured by structured interview questionnaire.
Ø Practice
It is an action or behavior gained by training on follow up, dietary management, self glucose monitoring, exercise and self insulin administration. It is measured by structured practice questionnaire
Ø Planned Teaching Program
It is systematic information given to patients with type-II diabetes mellitus regarding dietary management, exercise, self glucose monitoring, insulin therapy and prevention of complications.
Ø Diabetes mellitus
Diabetes mellitus is the group of metabolic disorder characterized by elevated blood glucose level (Hyperglycemia) resulting from defects in insulin secretion, insulin action or both. Hereafter Diabetes mellitus is referred as DM.
Ø Patient with Diabetes Mellitus
Patients who are diagnosed to have type-II diabetes mellitus by the diabetologist
6.7 - ASSUMPTION:
● The diabetic patients may have some knowledge regarding diabetic managements.
● Planned teaching program helps to improve knowledge and practice on diabetic management.
· Nurses can play a major role in educating the diabetic patients
6.8 - DELIMITATIONS:
o The study is limited to conduct in selected hospital, Mysore.
o The study is limited to the patients with type II diabetes mellitus .
o The sample size is limited to 60 Sample.
6.9 –CONCEPTIONAL FRAMEWORK
“HEALTH PROMOTION MODEL”
6.10 - REVIEW OF LITERATURE
The review of literature is a broad, comprehensive, in depth systemic and critical review of scholarly publication, unpublished scholarly print materials, AV materials and personal communications.
A literature review is a written summary of the existing knowledge on a research problem. The task of reviewing research literature involves the identification, selection, critical analysis and written description of existing information on a topic (Polit and Hungler 2003).
The review of literature in this study is organized under the following
headings.
1. Review literature related to diabetic management.
2. Review literature related to exercise
3. Review literature related to diet
4. Review literature related to Glucose monitoring
5. Review literature related to Medications & Insulin
6. Review literature related to prevention of complications of diabetes mellitus.
LITERATURE RELATED TO DIABETIC MANAGEMENT
Diabetic management is a measure taken to control or maintain the blood glucose level in the body. It includes maintaining proper weight, diet, exercise, monitoring blood glucose and medication (insulin therapy) and prevention of complication.
Deakin TA, Cade JE, Williams R, Greenwood DC. Nutrition & Dietetic Department, urnley, Pendle & Rossendale Primary Care Trust, East Lancashire, UK (2006) conducted a study To develop a patient-centred, group-based self-management program (X-PERT), based on theories of empowerment and discovery learning, and to assess the effectiveness of the programme on clinical, lifestyle and psychosocial outcomes. METHODS: Adults with Type 2 diabetes (n = 314), living in Burnley, Pendle or Rossendale, Lancashire, UK were randomized to either individual appointments (control group) (n = 157) or the X-PERT Programme (n = 157). X-PERT patients were invited to attend six 2-h group sessions of self-management education. Outcomes were assessed at baseline, 4 and 14 months. RESULTS: One hundred and forty-nine participants (95%) attended the X-PERT Programme, with 128 (82%) attending four or more sessions. By 14 months the X-PERT group compared with the control group showed significant improvements in the mean HbA1c (- 0.6% vs. + 0.1%, repeated measures anova, P < 0.001). The number needed to treat (NNT) for preventing diabetes medication increase was 4 [95% confidence interval (CI) 3, 7] and NNT for reducing diabetes medication was 7 (95% CI 5, 11). Statistically significant improvements were also shown in the X-PERT patients compared with the control patients for body weight, body mass index (BMI), waist circumference, total cholesterol, self-empowerment, diabetes knowledge, physical activity levels, foot care, fruit and vegetable intake, enjoyment of food and treatment satisfaction. CONCLUSIONS: Participation in the X-PERT Program by adults with Type 2 diabetes was shown at 14 months to have led to improved glycaemic control, reduced total cholesterol level, body weight, BMI and waist circumference, reduced requirement for diabetes medication, increased consumption of fruit and vegetables, enjoyment of food, knowledge of diabetes, self-empowerment, self-management skills and treatment satisfaction.
Chang HC, Chang YC, Lee SM, Chen MF, Huang MC, Peng CL, Yan CY. Division Community Medicine Department, Li Shin Hospital. (2007) conducted a study to design, implement and evaluate disease outcomes at a regional hospital- based case management program of care for patients with type 2 diabetes. A medical team and practice guidelines were established in line with the health insurance strategy of Taiwan's Bureau of National Health Insurance (BNHI) and American Diabetes Association (ADA) Standards of Care for Diabetes (2003 edition). Also, a set of self-care booklets was designed suitable for use by the subject group. The study was prospective and followed the patients from enrollment to one year. Patient outcomes were determined based on laboratory examinations and recorded self-care behavior. Data were collected at enrollment and over 4 follow-up times within a one year period. Generalized Estimating Equation (GEE) multiple linear regression and logistic regression were used for repeated measurements and adjustments of the effects of specific prognostic factors. Sixty subjects diagnosed with type 2 diabetes (mean duration 3.25 years) were recruited. All participants were married with a mean age of 52.5 years. A majority (58.3%) was male and 65% were ethnic Hakka. Self-care knowledge and behavior accomplishment rates were: taking medications by oneself, 91.3% (knowing medicines, 25.4%); hypoglycemia management, 23.3%; monitoring blood sugar, 46.7%; exercise, 35.8%; diet management, 51.7% and foot care, 92.8%. Significantly improved ADA diabetes care standard items included HbA1C (p< .0001), fasting glucose (p< .01) and triglycerides (p< .05). The study incorporated evidence-based guidelines, public health insurance strategies and self-care booklets into a protocol to provide comprehensive care. The implemented diabetes program achieved diabetes care goals and improved patient self-care.
LITRETURE RELATED TO DIET
Lois Jovanovich and colleagues, (1998) conducted a study to find whether a decrease in Carbohydrate and calorie restricted diet can help people with type 2 diabetes mellitus to get their blood sugar under control. After eight weeks on a diet with 25% of calories from Carbohydrate, type 2 diabetes mellitus had a significant improvement in blood sugar level compared to those seen with a diet of 55% calories from carbohydrate.
Willimas (2000) conducted a study on two groups of patient’s in their homes, in order to estimate the degree which prescribed, diet were being followed. In the first study, 60 populations gave a 24 hour recall of the food item. In the second of the pattern of food intake was studied on 17 clients over a 7 days period. The studies indicate a high frequency of failure by these diabetic patient’s in taking the prescribed diet.