Volume 9 Number 3 July-September 2017

International Journal of Nursing Education

Editor-in-Chief
Amarjeet Kaur Sandhu
Principal & Professor, Ambika College of Nursing, Mohali, Punjab
E-mail: [email protected]

INTERNATIONAL EDITORIAL ADVISORY BOARD NATIONAL EDITORIAL ADVISORY BOARD

1. Leodoro Jabien Labrague (Associate Dean) 4. Fatima D’Silva (Principal)
Samar State University,College of Nursing and Health Nitte Usha Institute of nursing sciences, Karnataka
Sciences, Philippines
5. G.Malarvizhi Ravichandran
2. Dr. Arnel Banaga Salgado (Asst. Professor) PSG College of Nursing, Coimbatore, Tamil Nadu
Psychology and Psychiatric Nursing, Center for Educational
6. S. Baby (Professor) (PSG College of Nursing, Coimbatore,
Development and Research (CEDAR) member, Coordinator,
Tamil Nadu, Ministry of Health, New Delhi
RAKCON Student Affairs Committee,RAK Medical and
Health Sciences University, Ras Al Khaimah, United Arab 7. Dr. Elsa Sanatombi Devi (Professor and Head)
Emirates Meidcal Surgical Nursing, Manipal Collge of nursing, Manipal
3. Elissa Ladd (Associate Professor) 8. Dr. Baljit Kaur (Prof. and Principal)
MGH Institute of Health Professions Boston, USA Kular College of Nursing, Ludhiana, Punjab
4. Roymons H. Simamora (Vice Dean Academic) 9. Mrs. Josephine Jacquline Mary.N.I (Professor Cum
Jember University Nursing School, PSIK Universitas Jember, Principal) Si-Met College of Nursing, Udma, Kerala
Jalan Kalimantan No 37. Jember, Jawa Timur, Indonesia
10. Dr. Sukhpal Kaur (Lecturer) National Institute of Nursing
5. Saleema Allana (Assistant Professor) Education, PGIMER, Chandigarh
AKUSONAM, The Aga Khan University, School of Nursing
11. Dr. L. Eilean Victoria (Professor) Dept. of Medical Surgical
and Midwifery, Stadium Road, Karachi Pakistan
Nursing at Sri Ramachandra College
6. Ms. Priyalatha (Senior lecturer) RAK Medical & Health of Nursing, Chennai, Tamil Nadu
Sciences University, Ras Al Khaimah,UAE
12. Dr. Mary Mathews N (Professor and Principal)
7. Mrs. Olonisakin Bolatito Toyin (Senior Nurse Tutor) Mahatma Gandhi Mission College of Nursing, Kamothe, Navi
School of Nursing, University College Hospital, Ibadan, Oyo Mumbai, PIN-410209,Cell No.: 09821294166
State, Nigeria
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School of Nursing, Sacred Heart Hospital,
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Lantoro,Abeokuta,Ogun State, Nigeria
Nursing, HIHT University, Dehradun, Uttarakhand
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15. Pramilaa R (Professor and Principal)
Nursing University of Indonesia
Josco College of Nursing, Bangalore
10. Dr. Abeer Eswi (Associate Prof and Head of Maternal
16. Babu D (Associate Professor/HOD)
and Newborn Health Nursing) Faculty of Nursing, Cairo
Yenepoya Nursing College, Yenepoya University, Mangalore
University, Egypt
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11. Jayasree R (Senior Teacher, Instructor H)
Principal) Laxmi Memorial college of Nursing, A. J. Towers,
Salalah Nursing Institute, Oman
Balmatta, Mangalore, Karnataka
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18. Madhavi Verma (Professor) Amity College of Nursing, Amity
Associate Professor, Aga Khan University School of Nursing,
University Haryana
Karachi, Pakistan
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13. Mrs. Ashalata Devi (Assist. Prof.)
Indirani College of Nursing,Ariyur,Puducherry
MCOMS (Nursing Programme), Pokhara, Nepal
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14. Sedigheh Iranmanesh (PhD)
MKSSS College of Nursing for Women, Nagpur
Razi Faculty of Nursing and Midwifery, Kerman Medical
University, Kerman, Iran 21. Sangeeta N. Kharde (Professor) Dept. of OBG Nursing
KLES’s Institute of Nursing Sciences, Belgaum
15. Billie M. Severtsen (PhD, Associate Professor) Washington
State University College of Nursing, USA International 22. Dr. Suresh K. Sharma (Professor)
Journal of Nursing Education (Nursing) College of Nursing, All India Institute of Medical
Sciences, Rishikesh (UK) 249201
16. Dr Nahla Shaaban Khalil (Assist Professor)
Critical Care and Emergency Nursing, Faculty of 23. Sudha Annasaheb Raddi (Principal & Professor)
Nursing Cairo University Dept of OBG Nursing, KLEU’s Institute of Nursing Sciences,
Belgaum
NATIONAL EDITORIAL ADVISORY BOARD
24. Rentala Sreevani (Professor & HOD)
1. Dr. G. Radhakrishnan (PhD, Principal) Dept. of Psychiatric Nursing,Sri.Devaraj Urs College of
PD Bharatesh College of Nursing, Halaga, Belgaum, Nursing, Kolar, Karnataka
karnataka, India-590003
25. Accamma Oommen (Associate Professor and Head)
2. Dr Manju Vatsa (Principal, College of Nursing) Department, Child Health Nursing, Sree Gokulam Nursing
AIIMS, New Delhi. College, Trivandrum, Kerala, India
3. Dr Sandhya Gupta (Lecturer) College of Nursing, AIIMS,
New Delhi
 International Journal of Nursing Education
NATIONAL EDITORIAL ADVISORY BOARD SCIENTIFIC COMMITTEE
26. Shinde Mahadeo Bhimrao (Professor) 1. Padmavathi Nagarajan (Lecturer)
Krishna Institute Of Nursing Sciences Karad Tal-Karad Dist College of Nursing, JIPMER, Pudhucherry
Satara Mahashtra State 2. Mrs. Rosamma Tomy (Associate Professor)
27. Dr. Judith A Noronha (Professor and HOD) MGM College of Nursing, Kamothe, Navi Mumbai
Department of Obstetrics and Gynaecological Nursing, 3. T. Sivabalan (Associate Professor)
Manipal University Pravara Institute of Medical Sciences (DU), College of
28. Prof. Balasubramanian N (Head) Nursing, Loni, Maharashtra
Psychiatric Nursing, Shree Devi College of Nursing, 4. Ms Daisy J Lobo (Associate Professor)
Mangalore MCON, Manipal, Karnataka
29. Mrs. Harmeet Kaur (Principal) Chitkara School of Health 5. Sanjay Gupta (Assistant Professor)
Sciences, Chitkara University, Punjab. M.M. College of Nursing, Mullana (Haryana)
30. Mrs. Chinnadevi M (Principal) Kamakshi Institute of Nursing, 6. Prashanth PV (Nursing Supervisor) M.O.S.C Medical
Bassa wazira, Bhugnara Post, The Nurpur, Dist Kangra, HP, College Hospital, Kerala
31. Dr. Linu Sara George (Professor and Head) 7. V. Sathish (Academic Officer)
Department of Fundamentals of Nursing, Manipal College of Allied Health Sciences, National Institute of Open Schooling,
Nursing Manipal Ministry of Human Resource, Development, Government of
32. Juliet Sylvia (Professor and H.O.D) India
Community Health Nursing, Sacred Heart Nursing College, 8. Dr. Suman Bala Sharma (Associate Professor)
Madurai Govt. Medical College and Hospital (GMCH)
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Department of Medical Surgical Nursing,Sahyadri College of Rufaida College of Nursing, Faculty of Nursing, Hamdard
Nursing,Mangalore-575007 University,New Delhi-110062
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PSG College of Nursing, Coimbatore. Tamil Nadu 35. SGRD CON(SGRDISMR),Vallah Amritsar Punjab
35. Anitha C Rao, Professor and Principal, Canara College of 11. Baskaran. M (Assistant Professor)
Nursing, Kundapur, Karnataka PSG College of Nursing, Coimbatore, Tamil Nadu,
36. Dr. N.Gayathripriya (Professor) Obstetrics and 12. Mr. Kishanth (Olive.Sister Tutor)
Gynaecological Nursing, Sri Ramachandra Department of Psychiatric Nursing,College of Nursing,
University, Chennai JIPMER, Pondicherry - 06
37. Vijayaraddi B Vandali, Principal 13. Mr. Mahendra Kumar (Associate Professor)
Surendera Nursing Training Institute, Savitribai Phule College of Nursing, Kolhapur
Sri Ganganagar, Rajasthan
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38. T Siva Jeya Anand, Vice Principal, Chitra College of Psychiatric Nursing, Mar Baselios college of Nursing,
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Nursing CHARUSAT-Changa INE, Guru Teg Bahadur Sahib (C) Hospital,
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Kerala INE,G.T.B.S.(C) Hospital, Ludhiana (Punjab)
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 I

International Journal of Nursing Education

www.ijone.org

CONTENTS

Volume 9, Number 3 July-September 2017

1. A Study to Assess the Effectiveness of Planned Teaching Programme on Knowledge ......................... 1

Regarding Selected Breast Related Problems and their Management among Postnatal
Women at Selected Hospital, Vadodara
Dipika Rathod, Rita Thapa, Ravindra H N, Vruti Patel, Poonam Gadiya

2. Effectiveness of E-learning Module on First Aid: A Study on Student Nurses....................................... 6

Alka Mishra, Seema Rani, Urmila D Bhardwaj

3. Effectiveness of Standard Operating Procedure Regarding Knowledge, Attitude and..........................11

Practice of Biomedical Waste Disposal among Nursing Staff Working in Selected
Hospital, Vadodara
Dinesh Patidar, Ravindra H N, Kevin Christian

4. Community Mental Health in India: Current Scenario..........................................................................15

Hanuman Ram Bishnoi, Asif Khan, Rishi Dutt Avasthi, Sataveer

5. Awareness on Prevention of Cardiovascular Health Problems among Students of Higher...................17

Secondary Schools of Chandannath Municipality, Nepal, 2015
Shyam Lamsal

6. Prevalence of High Risk Pregnancy in the Dalit Community of Chandannath.................................... 21

Municipality, Jumla
Shyam Lamsal

7. A Research Critique on Lived-in Experiences of Significant Others of Patients Admitted.................. 23

in Emergency Department at Selected Hospitals
P Ester Mary, Hamad Salem Al Grad

8. Effectiveness of Back Massage versus Ambulation During First Stage of Labour among................... 28
Primigravida Mothers in Terms of Pain and Anxiety Accessory Ridge: A Nonmetric Trait
Indu Bala, Molly Babu, Sharda Rastogi

9. A Study to Assess the Level of Stress and Coping Strategies Adopted by Higher Primary.................. 33
School Teachers in Selected Schools at Mangalore
Susaimari A, Alphonsa Ancheril

10. Effectiveness of Video Assisted Teaching on CPR (Cardiopulmonary Resuscitation) for....................37

Children among Student Nurses
Waikhom Ranjana Devi
 II

11. Factors Influencing Headache Severity in Patients with Chronic Tension Type Headache.................. 43
attending Tertiary Health Care Facility
Gopichandran L, Kanniammal C, Valli G, Jaideep M, Srivastava A, Vanamail P, Dhandapani M

12. A Descriptive Study to Identify the Breastfeeding Problems among Postnatal Mothers in.................. 50
Justice K.S. Hegde Hospital, Mangalore
Sunanda B, Sabitha Nayak

13. Effectiveness of Individually Packed Sterile Guaze versus Drum Packed Gauze on the......................55
Incidence of Surgical Site Infection (SSI) in Surgical Ward AIIMS, New Delhi
Nemkholam Chongloi, Anurag Srivastava

14. Effect of Nutritional Intervention among Children with Protein Energy Malnutrition......................... 58
Soja S L, N Udaya Kiran, Darly Saramma Mammen

15. Preparedness and Practice of Forensic Nursing in Kenya..................................................................... 64

Irene G Mageto, Grace Omoni, Nancy B Cabelus, Justus Okeo Inyega

16. Effect of Selected Muscle Stretching Exercises on Primary Dysmenorrhoea among........................... 69

Student Nurses
Jaibunnisha, Gomathi B, Upma Goerge

17. Assess the Effectiveness of an Interventional Package on Level of Stress among Mothers................. 75
of Baby Admitted in NICU
Franny Joel Emmanuel, Rajesh P, Nirmal Raj E V

18. A Study to Assess the Utilization Regarding Integrated Child Development Services (ICDS)............ 80
among Women in Ernakulam District, Kerala
Preethy Jawahar, Sudha A Raddi

19. Effectiveness of Healthy Eating and Active Lifestyle Intervention Program (Healip) on.....................84
Physiological and Biochemical Parameters among Children with Obesity at Selected
Schools in Chennai – A Pilot Study Report
P Ester Mary, Nalini Sirala Jagadesh, R Vijayaraghavan

20. Prevalence of Psychological Morbidity among Medically Ill Patients..................................................90

R. Sathish, E Devakirubhai

21. A Study on the Relationship between Blood Glucose Level and Depressive Symptoms .................... 95
among the Antenatal Women in the Selected Hospitals at Mangalore
Joyce D’souza, Nalini M

22. A Descriptive Study to Assess the Adequacy of Nursing Measures Carried Out to .............................99
Minimize the Pressure Ulcers During Peri-operative Period
Thenmozhi N, Valliammal Babu, Anita Kiruba Jeyakumar

23. Current Status of End Stage Renal Disease in India – A Narrative Review........................................ 103
Daisy Josphine Lobo, Ravindra Prabhu, Asha Kamath, Viutha Bhat
 III

24. Analysis of Multiple Choice Questions: Item Difficulty, Discrimination Index and.......................... 109
Distractor Efficiency
Juliana Linnette D’Sa, Maria Liza Visbal-Dionaldo

25. Prevalence of Low Back Pain among Nursing Students Compared to Physical Therapy, ................. 115
and Engineering Students in the United States
Asha Solomon, Sara Wilson, Mary Meyer, Neena Sharma

26. Writing the Hypothesis in Research.................................................................................................... 122

Simer Preet Kaur

27. Effectiveness of Care Bundle Approach on Level of Chemotherapy Induced Peripheral...................126

Neuropathy and Quality of Life among Patients Receiving Chemotherapy
S Kavitha, Rajeswari Vaidyanathan, Gopi

28. To Assess the Effectiveness of Planned Teaching Programme on Knowledge and Practices............. 132
Regarding Menstrual Hygiene among the Adolescent Girls in Selected Govt. School of Delhi
Grewal Savita, D’Souza Ranjitha
 DOI Number: 10.5958/0974-9357.2017.00059.9

A Study to Assess the Effectiveness of Planned Teaching

Programme on Knowledge Regarding Selected Breast Related
Problems and their Management among Postnatal Women at
Selected Hospital, Vadodara

Dipika Rathod1, Rita Thapa2, Ravindra H N3, Vruti Patel4, Poonam Gadiya5
Second Year MSc Nursing Student, Sumandeep Nursing College, 2Associate Professor, Dept of Obstetrics &
1

Gynecological Nursing, 3Professor & Principal, 4Assistant Professor, Dept of Obstetrics & Gynecological Nursing,
5
Assistant Professor, Dept of Obstetrics & Gynecological Nursing, Sumandeep Nursing College, Sumandeep
Vidyapeeth, Piparia, Vadodara, Gujarat, India

ABSTRACT

Background: “Mother the most beautiful word on the lips of mankind” The post-partum period which
can last up to 6 months after delivery. Changes during this phase are extremely gradual and pathology is
rare. Several common problems that may arise during the breast feeding period, such as breast engorgement,
plugged milk duct, breast infection and insufficient milk supply, originate from conditions that lead the
mother to inadequately empty the breasts. WHO study shows that 60% of women between age 40 and 69
years come to the breast problems over 10 years periods

Aims and objectives: The aim of the study is to assess the effectiveness of planned teaching programme
on knowledge regarding selected breast related problems and their management among postnatal women at
selected hospital, Vadodara.

Material and method: The research design Pre-experimental-one group pre-test post-test design. The
research approach is a Evaluative Approach with a view to assess the level of knowledge by pre-test on
breast related problems among postnatal women. In the present study 40 postnatal women from selected
hospitals were selected using Simple random sampling technique.

Results: Mean percentage of pretest was 34.84 % with SD was 1.61 whereas, the mean knowledge of
posttest was 18.98 and SD was 4.07 respectively. Further the effectiveness of mean knowledge was
found to be 28.43 % from the pretest to posttest. The statistical pair T test was found to be 12.69*, that
reflects significant effectiveness of knowledge score from pretest to posttest at P<0.05 significant level,
revealing the effectiveness of planned teaching on selected breast problems. The knowledge of postnatal
women regarding the selected breast related problems among the postnatal women’s was poor before the
administration of planned teaching.

Conclusion: The planned teaching was effective in all knowledge aspect in posttest. So the hypothesis
(RH1) is accepted and research hypothesis (RH2) is partially accepted.

Keyword: Assess Effectiveness, Knowledge, Planned Teaching, Postnatal women.

INTRODUCTION Pregnancy is a very special time in a women’s life.

Pregnancy is the state of carrying a developing fetus
“Mother the most beautiful word on the lips of (baby) within the female’s body. This condition can be
mankind” indicated by positive results on an over-the-counter urine
-Khalil Gibran test, & confirmed through a blood test, Ultrasonography,
 2 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

detection of fetal Heartbeat. Pregnancy lasts for about a backup of the milk. The woman usually notice a
nine months, measured from the state of the women’s sore, redden hard lump in one area of her breast. The
last menstrual period. It is conventionally divided into woman should be taught to continue nursing, take
three trimesters, each roughly three month’s long.1 acetaminophen, apply warm compresses and massage
the sites, nurse in different positions, including on her
The word “post natal” comes from Latin words:
knees to facilitate drainage of the breast and to avoid
“post” which means “after” and “natal” is means
constricting clothing or bra, including underwear bras. If
“birth” .It is the period beginning immediately after
the site does not improve within a few days, she should
the birth of a child and extending for about six weeks.
contact her health care provider. 5
The post-partum period which can last up to 6 months
after delivery. Changes during this phase are extremely Mastitis is an infection of the breast tissue. It
gradual and pathology is rare. Several common problems is caused by organisms acquired from the infants
that may arise during the breast feeding period, such as nasopharyngeal or umbilical areas, which harbors
breast engorgement, plugged milk duct, breast infection colonies of the staphylococci or streptococci that develop
and insufficient milk supply, originate from conditions within a few days of birth. It occurs at the end of the first
that lead the mother to inadequately empty the breasts. week following birth. The mother develops a fever and
Incorrect techniques, not frequent breast feeding and a tender, red, firm to hard areas are felt in one of the
breast feeding on scheduled times, pacifiers and food breasts. Treatment consists of analgesics and antibiotics.
suppliers are important risk factors that can predispose If it is not too painful, the mother should be emptied
to lactation problems. The adequate management of after a feed, as incomplete emptying leaves stagnant of
those conditions is fundamental, as if not treated they milk in the system, which may become infected. 3
frequently lead to early weaning. These problems can be
Breast abscess, the infection usually enters through
prevented if the mother empties her breast effectively.
a break in the skin. It is usually confined to one quadrant
If they occur, they should be carefully and adequately
of the breast. The most common organism identified is
approached, thus avoiding the early weaning resultant
staphylococcus aureus, mostly from the infant’s nose or
from painful and stressing situations the mother may
throat. The infant is usually infected from the nursery
face.2
personnel. The mother will have raised temperature,
Breast engorgement is one of the potential problems tachycardia, erythematous segment of the breast, even
that may arise due to the initiation of breast feeding and fluctuation. It can be managed by using broad spectrum
usually starts from 3rd to 6th post natal day. It refers antibiotic coverage; cloxacillin, cephalexin, cefuroxime,
to the sense of breast fullness experienced by mothers adequate supportive brassiere, continue breastfeeding
which is characterized by swelling, tenderness, warmth, from the normal breast empty the affected breast by
throbbing pain, low grade fever, hardness of breast means of a breast pump. Surgical management is done
tissue and heaviness.3 under anesthesia by making circular incision over the
areola followed by drainage.5
Cracked nipples or sore nipples are due to aggressive
suckling by the baby particularly if the nipple is not OBJECTIVES OF THE STUDY
well attached with the infant’s mouth during feeding.
1. To assess the existing level of knowledge of
If cracking is severe the baby should not be fed from
post natal women regarding breast problems.
the affected breast, which should be emptied manually
or by using a breast pump. Sore nipples are probably 2. To assess the effectiveness of planned teaching
the most common complain after child birth. They are programme on knowledge regarding breast problems.
generally reported by the 2nd day after delivery but can
be improve within 5 days, by taking proper care beyond 3. To determine association between the pretest
the 1st week.4 knowledge scores with selected socio-demographic
variables.
Plugged milk ducts are a common problem,
encountered during the nursing period. This happens
when one of the milk ducts becomes obstructed, causing
 International Journal of Nursing Education, July-September, Vol.9, No. 3 3

HYPOTHESIS

H1: There will be significant difference between the pre-test knowledge score and post-test knowledge score
regarding management of the breast problems among the postnatal women.

H2: There will be significant association between pre-test knowledge score regarding management of the breast
problems among the postnatal women with their selected demographic variables.

RESEARCH METHODOLOGY

Research Approach Evaluatory Research Approach

Research Design Pre Experimental Research Design

Dependent–Knowledge of postnatal women regarding selected breast related problems

Variables
Independent- planned teaching programme regarding management of breast related problems.

Setting Selected Hospitals, Vadodara

Population Postnatal Women

Samples 40 Postnatal Women

Sampling technique Simple random Sampling Technique

Section 1: Socio-demographic variables
Tool-development
Section 2 : Self-administered knowledge questionnaire

Suggestion from various experts i.e. Master in the field of Obstetrics & Gynecological Nursing,
Content validity
the Asst. Prof. -7, M.A (English) – 1, MA (Gujarati) – 1, Statistician – 1

Using Karl’s Person’s correlation coefficient formula and the r value was 0.98 thus the tool is
Reliability
reliable.
Pilot study was conducted on 7th September 2016 to find out the feasibility of the study . The
Pilot study pilot study was conducted in Selected Hospitals, Vadodara. The data for pilot study was collected
from 04 internship students.
The investigator selected 40 sample for the inclusion criteria for the data collection .the
investigator explain the purpose of the study, then the given Pretest after 7 Days of the planned
Data collection procedure
teaching on selected breast related problems & their management. Postest was conducted by
using the same structured knowledge questionnaire.

Consolidated and organized the collected data in a master sheet Frequency and percentage for
the analysis of demographic characteristics of the sample respondents. Mean for the overall
Analysis of data
scores. Association between knowledge & pretest score and demographic variables by using
paired t test & chi square.

ANALYSIS AND INTERPRETATION

Table 1: Frequency and percentage distribution in pre-test and post-test level of knowledge

Pre test Post test

Knowledge N % N %
Poor 24 60 % 2 5%
Average 16 40 % 26 65 %
Good 0 0% 12 30 %
Total 40 100 % 40 100 %

Table 1 shows about 60 % of the Postnatal Women were having poor knowledge followed by 40 % were having
 4 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

average knowledge in pretest data. About 65% of the Postnatal Women were having average knowledge followed
by 30% were having good knowledge and 5 % were having poor knowledge in post test data.

Table 2: Association of pretest knowledge regarding breast related problems in post natal women
with selected demographic variables

Knowledge Level

Average Poor 2
x P Value
Characteristics Category Sample N % N % Value

20 - 24 Years 34 12 35.29% 22 64.71%

25 - 29 years 6 4 66.67% 2 33.33%

30 - 34 years 0 0 0.00% 0 0.00% 2.092

Age NS (1DF=3.84) P > 0.05
More than 35 years 0 0 0.00% 0 0.00%

Hindu 32 11 34.38% 21 65.63%

Muslim 8 5 62.50% 3 37.50%

2.109
Christian 0 0 0.00% 0 0.00% NS
Religion P > 0.05
(1DF=3.84)
Others 0 0 0.00% 0 0.00%

No Formal Education 0 0 0.00% 0 0.00%

Primary Education 31 11 35.48% 20 64.52%

Secondary Education 7 3 42.86% 4 57.14% 3.857

Education S (2DF=5.99) P < 0.05
Higher Secondary Education 2 2 100.00% 0 0.00%

Housewife 40 16 40.00% 24 60.00%

Medical Profession 0 0 0.00% 0 0.00%

Farmer 0 0 0.00% 0 0.00% Variable is Variable is

Occupation Constant Constant
Others 0 0 0.00% 0 0.00%

Joint Family 13 8 61.54% 5 38.46% 3.723

Type of Family Nuclear Family 27 8 29.63% 19 70.37% S (1DF=3.84) P < 0.05

Below 8000 0 0 0.00% 0 0.00%

8000 – 8999 6 4 66.67% 2 33.33%

Monthly 9000 – 9999 31 10 32.26% 21 67.74% 3.441
Income NS2(DF=5.99) P > 0.05
Above 10000 3 2 66.67% 1 33.33%

Total 40 16 40% 24 60%

Table 2 shows the association between knowledge and demographic variables of Post Natal Women. Significant
demographic variables are Education with χ 2 Value 3.857 (DF=2), Type of family with χ 2 Value 3.723 (DF=
1)

So for these variables research hypothesis (RH1) is accepted.The Non-Significant demographic variable is Age
(years) with χ 2 Value 2.092 (DF=1), Religion with χ 2 Value 2.109 (DF=1), Monthly Income with χ 2 Value 3.441
(DF=2) So for this variables research hypothesis (RH1) is rejected. Hence research hypothesis (RH1) is partially
accepted.
 International Journal of Nursing Education, July-September, Vol.9, No. 3 5

DISCUSSION REFERENCES

The pretest mean knowledge is 10.45 (34.83 1. B T Basvanthappa. “Nursing Research.”2nd edition
%) with standard deviation of 1.61, further posttest Jaypee brothers: Medical publishers (P) Ltd, New
mean knowledge found to be 18.98 (63.27 %) with Delhi;2007. Pp- 12-3.Women’s perception of
standard deviation of 4.07. it indicates that there is postpartum :URL: http://www.pubmed.com
effectiveness of knowledge score of 8.53 (28.43 %) with 2. Basavanthappa BT. Nursing Research: Review of
standard deviation of 4.25. The statistically paired T Literature. New Delhi: Jaypee Brothers medical
test value 12.690 relieving the effectiveness of planned Publisher (P) Ltd. 1998.
teaching on knowledge regarding selected breast related
3. D.C Dutta. Textbook of Obstetrics. New Central
problems and their management among postnatal
Book Agency (P) Ltd: Calcutta; 2004. 438-40.
women. However this study reveals that the planned
teaching on knowledge regarding selected breast related 4. N. Jayne Klossner. Introductory Maternity
problems among postnatal women was effective. Thus Nursing: Philadelphia; Lipincotte Williams and
the analysis reveals that there is significant difference Wilkins; 2006. 326-27.
between pretest and posttest knowledge score of 5. Polit E, Beck T. Nursing Research: Describing
postnatal women on breast related problems. Hence the data through statistics. NewYork: Lippincot
stated research hypothesis (RH1) “there is significant Williams and Wilkins; 2008. P 556-83.
difference between pretest and posttest knowledge 6. Journal Nursing Education and Practice 2016/
score regarding selected breast related problems among Vol-6 / Issue No 9 ISSN-1925-4040/ http://
postnatal women” has been accepted. jnop.sciedupness.com
Sources of Fund: For the research study, researchers 7. Journal of Science / Vol 4 / Issue 10 / 2014 / 620-
own budget will be used. 624/ http:// journalofscience.net
8. Nursing and Midwifery Research Journal/Vol 11 /
Conflict of Interest: No actual, potential or
No 1 / 2013 / 620-624/ http://medind.nic.in
perceived conflicts of interest have been identified.
No behaviors including promoting private or business 9. Clinical & Diagnostic Research Journal/Vol 6 /
interests that place their personal gain ahead of their 2012 / 1215 - 1218/ http:// jcdr.net
professional responsibilities. All egulatory college’s 10. Curr Pediatrics Res 2010; 14(2):119-124, /2010/
bylaws when they advertise or promote professional available from: http:// google.com, cited on:
services or products. 15.11.2010.

Ethical Consideration: Ethical clearance is 11. Cochrane database syst rev/2010/ available from:
obtained from the ethical committee and willingness http://ncbi.nlm.nih.gov/, cited on: 08.09.2010
will be obtained from the subject before data collection. 12. Indian Journal of applied research/2010/ available
from: http:// ncbi.nlm.nih.gov/, cited on:
CONCLUSION 08.09.2010
The finding of the presence study showed that 13. “Breast feeding rates and hospitals breast feeding
Majority 34(85 %) of the postnatal women belongs to practices in Canada: A national survey of women.”
20-24 years. The majority of postnatal women 32 (80 Prism’s Nursing Practice. [online]/2009/ available
%) were Hindu. The majority of postnatal women 31 from: http:// ncbi.nlm.nih.gov/pubmed/19489806
(77.5 %) were primary school education. The majority 14. Treatments for the alleviation of symptoms in
of the postnatal women 40 (100 %) belongs to house breastfeeding women experiencing engorgement.”
wife. The maximum number 27 (67.50 %) of postnatal [online] 2008 [Cited on Oct 11]. Available from:
women belongs to nuclear family. The majority of the http://ncbi.nlm.nih.gov/m/pubmed/11405948
postnatal women 31 (77.50 %) had monthly income Rs,
15. Curr Pediatrics Res 2008; 14(2):146-154, /2008/
9000 - 9999/- In the pre-test mean score was 10.45+1.61
available from: http:// google.com, cited on:
and post-test means score was 18.98+4.07. The post-test
15.11.2008
level of knowledge mean score is significantly graters
than the pre-test knowledge mean score.
 6 International Journal of Nursing Education, July-September 2017,DOI
Vol.9,Number:
No. 3 10.5958/0974-9357.2017.00060.5

Effectiveness of E-learning Module on First Aid: A Study on

Student Nurses

Alka Mishra1, Seema Rani2, Urmila D Bhardwaj3

1
M. Sc. Nursing 2nd Year Student, 2Assistant Professor, 3Associate Professor, Rufaida College of
Nursing Jamia Hamdard, New Delhi

ABSTRACT

Introduction: A study was conducted to evaluate the effectiveness of e-learning module on first aid in terms
of gain in knowledge among student nurses of selected College of Nursing in Delhi.

Method: The research approach selected was quantitative in nature and research design was with one
group pre-test post-test design. Sampling was done using non-probability sampling using total enumeration
sampling technique. The study was conducted in Rufaida College of Nursing, New Delhi. Sample comprised
of 60 pre-licensure nurses studying in final year of course. The tools used for generating necessary data were
e-learning module and structured knowledge questionnaire on first aid.

Results: Sample characteristics revealed that majority of samples (60%) were studying in B. Sc. (N)
course. All the subjects had experience in handling computer/ smart phone. Only 5% subjects had previous
experience of e-learning module. The relevant findings of study were mean post-test knowledge score was
significantly higher than mean pre- test knowledge score, with maximum gain in area of general first aid.
There was significant relationship between knowledge gain and course of study and academic performance
in previous class.

Conclusion: The finding of study revealed that e-learning module was effective in enhancing the knowledge
of the study subjects.

Keywords: nursing, first aid, e-module, effectiveness.

is the first of the “Net Generation”, which has grown up

INTRODUCTION
in a world of instant access through text messaging and
In recent times, e- learning has emerged as a practical the internet. This generation works well in peer-to-peer
solution for learning and education in the hospital situations, as it is a common learning mode; they are
setting. e-Learning, has the potential to transform also skilled multitaskers. Educators are now faced with
education by creating a knowledge management adapting their teaching styles to accommodate this new
environment that improves access to education, while generation of learners.
reducing scheduling restrictions which are inherent with
An Orange Paper from Mather LifeWay By Jon
face-to-face delivery, it also facilitates the tracking of
Woodall2 was published on e-Learning related to
educational initiatives and assists hospitals in meeting
maturing technology brings balance and possibilities
mandatory educational requirements1. The current
to nursing education and it was discussed that non-
population of learners enrolled in educational institute
traditional methods like e-Learning, are needed to
Corresponding author: ensure that nurses can continually develop their
Alka Mishra knowledge and skill set in a time when nursing supply
M. Sc. Nursing 2nd Year Student, Rufaida College of and demand for qualified nurses continue to work
Nursing Jamia Hamdard, New Delhi. against hospital administrators due to the shortage of
E – mail: [email protected] nursing school faculty. Kokal P.3 stated there have been
 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3 7

many changes to pre-registration nurse education in Researcher developed the e learning module on first
terms of the knowledge and skills students are expected aid and it was named as-
to learn before qualification. This has caused some
“First Aid- The Vital Help”. Total nine conditions,
areas of study, including first aid training, to be cut to
general first aid, burn, cardio pulmonary resuscitation,
a minimum. Meeting competencies leaves resources
shock, choking, hemorrhage, snake bite, dog bite and
strained, as cohorts of students are ever increasing and
head injury have been covered under the e-learning
the competencies required before qualification demand
module.
labor- intensive teaching.
Structured knowledge questionnaire was developed
An educational tool such as e-learning could be
by researcher for assessment of knowledge of final year
a valuable tool for improving knowledge about first
DGNM and B. Sc. Nursing students regarding first aid.
aid. e-learning is increasingly used in health care as
a means of educating large groups of professionals4. MATERIAL AND METHOD
A systematic review by Feng Y., Chang Y.T., Chang
H.Y., Erdley W.S., Lin C.H., Chang Y.J.,. 5 has shown The conceptual frame work for the present study was
that the use of e-learning or ‘internet-based education’ based on the Knowledge Translation Model developed
is associated with a positive effect on the knowledge, by the Canadian Institutes of Health Research (2005)6.
skills, and behavior of healthcare professionals, as well The research approach selected was quantitative in
as on patient outcomes. nature and research design was one group pre-test post-
test design. Sampling was done using non-probability
Title: A study to evaluate the effectiveness of e- sampling - total enumeration sampling technique.
learning module on first aid in terms of knowledge
among student nurses of selected College of Nursing A knowledge questionnaire on first aid comprising
in Delhi. of 50 multiple choice questions, and e – learning module
on first aid was developed by researcher, and validated
OBJECTIVES by seven experts from the field of Nursing Practice
Nursing Education, Medical education, Expert from
- To prepare e-learning module on first aid.
National Disaster Management Authority, International
- To assess the pre-test & post-test knowledge NGO involved in dissemination of knowledge &
regarding first aid among student nurses. practice of first aid (St. John Ambulance). Reliability
of Knowledge questionnaire was worked out by Kudar
- To determine effectiveness of e – learning module
Richardson formula (KR.20) and it was found to be 0
- To determine relationship of knowledge with .836 indicating high reliability of the tool.
selected demographic variables i.e. age, course of study,
After obtaining all the necessary ethical and
academic performance in previous class.
administrative approvals and written, informed consent
HYPOTHESIS from study subjects, knowledge questionnaire on first aid
administered online on 78 final year students studying in
H1– The mean post-test knowledge scores of student Diploma in General Nursing & Midwifery, and B. Sc.
Nurses after administration of e- learning module on Nursing course in selected college of nursing in New
First Aid will be significantly different than their mean Delhi. Study subjects were asked to choose the most
pre- test score, as measured by structured knowledge appropriate answer among given options. E- learning
questionnaire, at 0.05 level of significance. module was administered after completion of pre-test.
E-learning module was completed and post-test taken
H2- There will be a significant relationship between
by 60 study subjects on 10th day after administration of
mean post-test knowledge score of student Nurses
e- learning module on first aid.
after going through e- module on first fid and selected
demographic variables i.e. Age, Course of Study, A score of 1 (one) was given for every correct
Performance in previous academic year at 0.05 level of response and 0 (zero) for wrong. Data collected using
significance. knowledge questionnaire was analyzed using SPSS
 8 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Version- 21 for Frequency and percentage distribution Previous exposure to e

to describe sample characteristics. Mean, median, mode, learning module
3 5
range and standard deviation to describe pre & post-test Yes
knowledge of student nurses regarding first aid. Area 57 95
wise mean, mean percentage, and mean percentage gain
No
in knowledge was calculated. Z- value was computed
to find out significance of difference between mean pre- Analysis of data to find out effectiveness of e-
test and post-test knowledge scores of student nurses learning module yielded that all the 60 study subjects
regarding first aid. Chi square and fisher exact test showed a significant gain in level of knowledge.
were computed to find out significance of relationship
between mean post- test knowledge scores and selected
variables.

FINDINGS

Findings related to background of study subjects

in terms of age, sex, course of study, experience in
handling computers, hours spent using computers/ smart
phone and uses of internet, are shown in table – 1.

Table - 1: Frequency and percentage distribution

of sample characteristics of student nurses N= 60

Sample characteristics Frequency percentage

Age in years Fig -1-Bar graph showing the area wise mean
Up to 20 years 18 30 percentage knowledge scores on pre-test and post-
21 to25 years 42 70 test
Sex
Male - -
Data presented in figure -1 shows that there is gain in
Female 60 100 knowledge in every content area of e- learning module.
Maximum gain was reported in the area of hemorrhage
Course of study and minimum in content area of choking.
DGNM 24 40
B. Sc. Nursing 36 60 Z – test was computed to find out statistical
Experience in handling significance of mean post test scores. Mean post test
computer / smart phone scores were significantly higher than mean pre-test
Yes knowledge scores as evident from “Z” value of 4.36,
60 100
No which is greater than tabulated value at 0.05 level of
Experience in handling significance df=59.
computer / smart phone
Less than 5 years 30 50
Scoring key for knowledge test
6 – 10 years 15 25
• Good knowledge- a score of 70% or above
More than 10 years 15 25
Hours spent using • Average knowledge – a score between 69% to
internet daily 60%
7 11.7
<1 • Poor knowledge – a score below 59%
29 48.3
1 to 3
24 40 Before administration of e-learning module, 12
>3 (20%) students had poor knowledge about the topics
covered in e-learning module while 26 (43.33%) had
 International Journal of Nursing Education, July-September, Vol.9, No. 3 9

average knowledge, followed by 22 (36.6%) had good 38.42 % (pre-test score: 11.56/30 ± 2.90) to 66.46 %
knowledge. After administration, of e-learning module, (post-test score: 19.94/30 ± 6.13. In a study conducted
the number of study subjects in poor knowledge group by Mugwe P., Kamau K.J. and NyambakaO.K,10it was
reduced from 12 to 07, in average knowledge group no. found that staff working in emergency department
reduced from 26 to 20, while in the group of subjects had inadequate knowledge on the standard first aid
having good knowledge the no. increased from 22 to 33. measures, which is consistent with the finding of present
There was significant increase of 18.4% recorded in the study. A systematic review was conducted by Salter S.
group of study subjects having good knowledge of the M.11 it was found e-learning to be effective at increasing
topics covered in e-learning module, which signifies its knowledge immediately after training for all topics and
effectiveness. in all contexts.

Inferential statistics were computed using Chi CONCLUSION

square test and fisher exact test, to find relationship of
First aid is one of the basic skills that every person
post -test knowledge scores with selected variables. Age
should have. It is assumed that nurses can judge the
had no significant relationship with post-test knowledge
situation and while calling for help they can provide
score, with p-value 0.834, at 0.05 level of significance.
professional care to the victim, which will help to
Course of study had significant relationship with post-
promote recovery, as well as minimize the chance of
test knowledge score, with p-value 0.004* at 0.05 level
disability and death. Those who have some knowledge
of significance. It was found that academic performance
are expected to give life-saving first aid, student nurses
in previous class had significant relationship with post-
threshold to help in sudden situation will be higher
test knowledge score, with p-value 0.01* at 0.05 level of
because the students will be familiar with the ways to
significance.
help in different situations.
DISCUSSION
Now that affordable e-learning solutions exist
In the present study, results revealed that, students for both computers and internet; it only takes a good
have poor knowledge about, common requiring first e-learning tool for education to be facilitated from
aid as mean pre-test knowledge scores for hemorrhage virtually anywhere. The intervention in form of e-
was 44.33, while for head injury 42.33, mean pre-test learning module on first aid had shown that there had
score for cardiopulmonary resuscitation was 63.8. These been a significant enhancement in the knowledge
finding indicated that students were not having sound of participants, regarding first aid. Hence it can be
knowledge regarding such an important life-saving concluded that e-learning module is an effective mean
procedure. After administration of e-learning module of enhancing the knowledge of student nurses.
on first aid there was significant increase in knowledge
Conflict of Interest – No conflict of interest
regarding first aid among study subjects.
Source of Funding- Self
The findings of current study in relation to knowledge
gain is consistent with the results of study done by Worm Ethical Clearance – Taken from Jamia Hamdard,
S. W. 7on nurses specializing in anaesthesiology using Institutional Ethics Committee, New Delhi.
e-learning module as a medium of education. In a study
conducted by Morgulis Y., Kumar R., Lindeman R., and REFERENCES
Velan G. 8on medical students using e-learning module
1. [Internet]. 2016 [cited 7 March 2016]. Available
on leukaemia, it was found that, there was significant
from: http://www.nursingtimes.net/e-learning-
difference in mean percentage scores between groups for
benefits-nurse-education-and-helps-shape-
the post-test on leukaemia (t (42) = −3.591, P < 0.001).
students-professional-identity/5011215.fullarticle
The finding of the present study is also consistent with
on 01/03/2016
the study done by Gaikwad N.9 on medical student using
e-learning module on endocrinology and found that 2. [Internet]. 2016 [cited 5 March 2016]. Available
there was significant knowledge gain in the knowledge from: http://www.matherlifewaysinstituteona
scores of study subjects increased significantly from ging.com/wp-content/uploads/2012/03/How-
 10 International Journal of Nursing Education, July-September, Vol.9, No. 3

eLearning-Can-Reduce-Expenses-and-Improve- in respiratory phys... - PubMed - NCBI [Internet].

Staff-Performance.pdf Ncbi.nlm.nih.gov. 2016 [cited 5 March 2016].
Available from: http://www.ncbi.nlm.nih.gov/
3. Kokol P H. GEROM – Developing a Contemporary
pubmed/24039917
On-line Master’s Degree Curriculum in
Gerontology. NI 2012: Proceedings of the 11th 8. Morgulis Y, Kumar R, Lindeman R, Velan G.
International Congress on Nursing Informatics Impact on learning of an e-learning module on
[Internet]. 2012 [cited 6 March 2016];2012. leukaemia: a randomised controlled trial. BMC
Available from: http://www.ncbi.nlm.nih.gov/ Medical Education. 2012;12(1):36.
pmc/articles/PMC3799177
9. S G. Interactive E-learning module in
4. Johnson P. First aid training in pre-registration pharmacology: a pilot project at a rural medical
nurse education. Nursing Standard. 2008;22(51): college in India. - PubMed - NCBI [Internet].
42-46. Ncbi.nlm.nih.gov. 2016 [cited 6 March 2016].
Available from: http://www.ncbi.nlm.nih.gov/
5. Feng Y., Chang Y.T., Chang H.Y., Erdley W.S.,
pubmed/24072666
Lin C.H., Chang Y.J., “Systematic review of
effectiveness of situated e-learning on medical and 10. Mugwe P, Kamau K, Nyambaka O. Knowledge,
nursing education,” Worldviews Evidence Based Attitude and Practice in First Aid Management
Nursing, vol. 10, no.3, 2013, pp. 174-83. of Epistaxis by Accident and Emergency Clinical
Staff at Kenyatta National Hospital. East and
6. Knowledge Translation in Health Care: Moving
Central African Journal of Surgery [Internet].
from Evidence to Practice - CIHR [Internet]. Cihr-
2014 [cited 6 march 2016];19(1):17-21. Available
irsc.gc.ca. 2015 [cited 7 March 2016]. Available
from:
from: http://www.cihr-irsc.gc.ca/e/40618.html
11. Salter S, Karia A, Sanfilippo F, Clifford R.
7. Worm S. W. Learning from simple e-books, online
Effectiveness of E-learning in Pharmacy
cases or classroom teaching when acquiring
Education. Am J Pharm Educ. 2014;78(4):83.
complex knowledge. A randomized controlled trial
 DOI Number: 10.5958/0974-9357.2017.00061.7

Effectiveness of Standard Operating Procedure Regarding

Knowledge, Attitude and Practice of Biomedical Waste
Disposal among Nursing Staff Working in
Selected Hospital, Vadodara

Dinesh Patidar1, Ravindra H N2, Kevin Christian3

1
Second Year M.Sc.Nursing Student, 2Principal & HOD of Medical Surgical Nursing, 3Assistant Professor,
Department of Medical Surgical Nursing, Sumandeep Nursing College,
Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat, India

ABSTRACT
Background of the study: Bio-medical waste / health care waste, (the term bio medical waste is used in
India and the health care waste term is used by WHO, both means the same), contains non infectious waste
and infectious waste. Aims & Objectives: 1. Assess the pre-test knowledge, attitude and practice score
regarding biomedical waste disposal among nursing staff in working selected hospital, Vadodara. 2. To
prepare and administer standard operating procedure regarding biomedical waste disposal among nursing
staff working in selected hospital, Vadodara. 3. Find out the effectiveness of standard operating procedure
regarding biomedical waste disposal among nursing staff. 4. Find the association between the pre-test
knowledge, attitude and practice score with selected socio demographic variables. Material and Method:
In this research study an evaluative research approach with pre-experimental design is used. Probability
random sampling is used to select the 150 samples of nursing staff and data collection was done. Data was
analysed by using descriptive and inferential statistics such as standard deviation, chi-square test and paired
‘t’ test. Results: The pre-test depicts that prior to the administration of standard operating procedure, Study
results revealed that the pre test score of knowledge, attitude and practice (Inadequate 56.7%, Moderate
43.3%, Adequate 0.0%: Unfavourable 60.0%, Moderate 40.0%, Favourable 0.0%: Low 65.3%, Moderate
34.7%, High 0.0%). The post-test depicts that after to the administration of standard operating procedure,
the post test score of knowledge, attitude and practice (Inadequate 0.0%, Moderate 39.3%, Adequate 60.7%:
Unfavourable 0.0%, Moderate 35.3%, Favourable 64.7%: Low 0.0%, Moderate 48.0%, High 52.0%)
respectively. Pre and post-tests reveals that post-test level of knowledge, attitude and practice score were
greater than pre-test of the study. Conclusion: The study findings reveals that standard operating procedure
is highly effective in improving the knowledge, attitude and practice of nursing staff regarding Biomedical
waste disposal.

Keywords: Standard operating procedure (SOP), BMW, knowledge, attitude and practice.

etc. As regards to the category wise percentage of waste

INTRODUCTION
generation, non infectious waste is 80% , pathological
In general the bio medical waste / health care waste, and infectious waste 15% , sharps waste 1 % , chemical
(the term bio medical waste is used in India and the or pharmaceutical waste 3 % and others 1 %.2
health care waste term is used by WHO, both means
Epidemiological studies indicate that a person who
the same), contains non infectious waste and infectious
experiences one needle stick injury from a needle used
waste. The infectious waste includes pathological
on an infected source patient has risk of 30%, 1.8%, and
waste, sharps waste, items contaminated with blood
0.3% respectively to become infected with HBV, HCV
and body fluids and chemical, pharmaceutical waste
and HIV. In 2002, the results of a WHO assessment
 12 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

conducted in 22 developing countries showed that the 4. Find the association between the pre-test
proportion of healthcare facilities that do not use proper knowledge, attitude and practice score with selected
waste disposal methods ranges from 18% to 64%.3 socio demographic variables.

Biomedical waste consists of solid, liquid, sharps HYPOTHESES

and laboratory waste that are potentially infectious or
H1: There will be significant difference between pre
dangerous. It differs from other types of hazardous
test and post test knowledge score regarding biomedical
waste such as industrial waste. Common producers
waste disposal among nursing staff.
of bio medical waste are hospitals, health clinics,
nursing homes, medical research laboratories, offices of H2: There will be significant difference between pre
physicians, dentists and veterinarians.5 test and post test attitude score regarding biomedical
waste disposal among nursing staff.
As per Bio- Medical Waste (Management and
Handling) Rules, 1998, and as amended “Bio-medical H3: There will be significant difference between pre
waste” means any waste, which is generated during the test and post test practice score regarding biomedical
diagnosis, treatment or immunization of human beings waste disposal among nursing staff.
or animals or in research activities pertaining thereto or
in the production or testing of biological and including H4: There will be significant association between
categories mentioned in Schedule I. The schedule pretest knowledge, attitude and practice score on
I includes human anatomical waste, animal waste, biomedical waste disposal with selected demographic
microbiology & biotechnology waste, waste sharps, variables.
discarded medicines and cytotoxic drugs, soiled waste,
MATERIALS AND METHOD
solid waste, liquid waste, incineration ash and chemical
waste.5 This quantitative, pre experimental, one group
pretest – posttest study was conducted in nursing staff
Among all health care personnel, Nurses providing
on biomedical waste disposal, working in selected
more and health services in hospitals. It has been
hospital, Vadodara. A total number of 150 nursing staff
proved that the nurses are more victims of hepatitis
were selected using a method of Probability random
B and HIV infection because not handing biomedical
sampling. Both genders who were studying in nursing
waste properly. For the prevention of infection, Nurses
staff and willing to participate were included in the
should take precautions according to the centre for
study. But nursing staff who can’t give an adequate
disease control, prevention with occupational safety and
response were excluded from the study.
healthy administration. Universal precaution refers to an
infection control system which assumes that any direct A demographic data sheet, knowledge assessment
contact with patients particularly their body fluid has the questionnaire which consisted of 35 multiple choice
potential for transmitting the diseases.8 questions with 4 responses and a Liker scale with 10
statements and practice checklist were used to assess
OBJECTIVES
the knowledge, attitude and Practice of nursing staff on
1. Assess the pre-test knowledge, attitude and biomedical waste disposal, which were developed after
practice score regarding biomedical waste disposal thorough review of literature. Validity was established
among nursing staff working in selected hospital, by seeking opinion of 8 experts from the field of nursing
Vadodara. education, medical surgical nursing. A pilot study was
conducted among 15 nursing staff to establish the
2. Prepare and administer standard operating feasibility of study. No modifications were made in the
procedure among nursing staff working in selected tool or study protocol after the pilot study. Nursing staff
hospital, Vadodara. took 20 minutes to complete the tool. Standard operating
procedure of two hours containing information through
3. Find out the effectiveness of standard operating
lecture, education through audiovisual material was
procedure regarding biomedical waste disposal among
conducted and informed verbal consent was obtained
nursing staff.
 International Journal of Nursing Education, July-September, Vol.9, No. 3 13

from the nursing staff. the administration of standard operating procedure

majority >75%(64.7) nursing staff had favourable level
Collected data were analyzed by using descriptive
of Attitude, 51-75%(35.3), nursing staff had Moderate
and inferential statistics at 0.05 level of significance.
level of Attitude and <50%(00) nursing staff had
RESULT Unfavourable level of Attitude.

Findings of the study revealed that majority of nursing The pre test depicts that prior to the administration
staff 53(35.3%) of the subjects belongs to age group of of standard operating procedure majority <50%(65.3)
23-26 years, 137 (91.3%) were female respondents, 76 nursing staff had Low level of Practice, 5175%(34.7),
(50.7%) were having clinical experience, 45(30%) of nursing staff had Moderate level of Practice and
ANM education of the nursing staff, 83(55.3%) had in- >75%(00) nursing staff had high level of Practice.
service education of nursing staff. The post test depicts that prior to the administration
of standard operating procedure majority >75%(52)
The pre test depicts that prior to the administration nursing staff had high level of Practice, 51-75%(48),
of standard operating procedure majority nursing staff had Moderate level of Practice and
<50%(56.7) nursing staff had Inadequate level of <50%(00) nursing staff had low level of Practice.
knowledge.5175%(43.3), nursing staff had Moderate
level of knowledge and >75%(00) nursing staff had Table 1 shows the mean pre-test knowledge value
adequate level of knowledge. The post test depicts was 16.66 with S.D 4.8 and in the post-test the mean
that prior to the administration of standard operating was 27.47 with S.D 3.4 & attitude pre-test mean value
procedure majority >75%(60.0) nursing staff had was 24.50 with S.D 5.5 and in the post-test the mean
adequate level of knowledge.51-75%(39.3), nursing was 38.12 with S.D 4.1 and practice pre-test mean value
staff had Moderate level of knowledge and <50%(00) was 9.88 with S.D 2.6 and in the post-test the mean was
nursing staff had Inadequate level of knowledge. 15.37 with S.D 2.0. The calculated Knowledge ‘t’ value
was 54.06 & attitude ‘t’ value was 41.64 and practice ‘t’
The pre test depicts that prior to the administration value was 32.70, which indicates there was high level of
of standard operating procedure majority <50%(60) significance at p<0.001 level between the pre and post-
nursing staff had Unfavourable level of Attitude, test level of knowledge, Attitude and Practice showing
5175%(40) nursing staff had Moderate level of the effectiveness of Standard operating procedure in
Attitude and >75%(00) nursing staff had Favourable increasing the knowledge, attitude and Practice of
level of Attitude. The post test depicts that prior to biomedical waste disposal among nursing staff.

Table 1: - Analysis Effectiveness of SOP regarding knowledge, attitude and practice of biomedical waste
disposal.
Max.
Sr.no. Variables Mean SD Enhancement Paired ‘t’ Test
Score
Post Pre Post
Pre Test Mean SD
Test Test Test

1 Knowledge 35 16.66 27.47 4.8 3.4 10.81 2.5 54.06*

2 Attitude 50 24.50 38.12 5.5 4.1 13.62 4.0 41.64*

3 Practice 20 9.88 15.37 2.6 2.0 5.49 2.1 32.70*

The association of the pre test knowledge score of association between the pre test knowledge score with
the nursing staff with selected demographic variable selected demographic variable was accepted.
such as except age, gender, clinical experience and In-
The association of the pre test attitude score of the
service education. Evidenced that there was statistically
nursing staff with selected demographic variable such
significant association at P < 0.05. Hence the research
as except age, gender, educational qualification and In-
hypothesis H4 stated that there will be significant
 14 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

service education. Evidenced that there was statistically REFERENCES

significant association at P < 0.05. Hence the research
hypothesis H4 stated that there will be significant 1.) Anand R. C and Sidharth Satpathy, Hospital Waste
association between the pre test attitude score with Management: A holistic approach, New Delhi : jay
selected demographic variable was accepted. pee Brothers Medical Publishers (P) LTD., 2003.
P.NO. 118
The association of the pre test practice score of 2.) Bio-Medical Waste (Management and Handling)
the nursing staff with selected demographic variable Rules 1998 and Amendments.
such as except educational qualification and In-service
3.) Pruss A., Giroult E. And Rush Brook D, Safe
education. Evidenced that there was statistically
Management of wastes from Health-care Activities,
significant association at P < 0.05. Hence the research
World Health Organization, Geneva (1999), P.No.
hypothesis H4 stated that there will be significant
30,40
association between the pre test practice score with
selected demographic variable was accepted. 4.) BT Basavanthppa. Foundamental of nursing . 2nd
ed. New delhi: Jaypee brothers; 2009. page no
CONCLUSION 692-693.
The overall pre-test mean knowledge, attitude and 5.) Bio-Medical Waste (Management and Handling)
practice score of the nursing staff was 16.66, 24.50, 9.88 Rules 1998 and Amendments.
and post-test mean knowledge, attitude and practice 6.) VanishMathur, S Dwivedi, M A Hassan and R P
score of the nursing staff was 27.47, 38.12, 15.37. The Misra. Knowledge, attitude and practices about
post-test mean knowledge, attitude and practice score is biomedical waste management among health care
significantly greater than the pre-test mean knowledge, personnel; Alahabad.India.
attitude and practice score. So the Standard operating 7.) Gupta Saurabh, Environmental Education for
procedure was effective. Healthcare Professionals with Reference to
The association of the pre-test knowledge score of Biomedical Waste Management -A Case Study
the nursing staff with selected demographic variables of a Hospital in Lucknow, India, International
such as age, gender, clinical experience, In-service Research Journal of Environment Sciences, Vol. 5,
education. evidenced that there was statistically December (2012) P.No. 69-75.
significant association at p < 0.05. 8.) Pandit, N.A., S.A. Tabish and G.J. Qadri, 2007.
Biomedical Waste Management in a Large
The association of the pre-test attitude score of Teaching Hospital. JK- Practitioner, P.No. 57-59.
the nursing staff with selected demographic variables
9.) Shalini Sharma, Awareness about Bio-Medical
such as age, gender, educational qualification, In-
Waste Management among Health Care Personnel
service education. evidenced that there was statistically
of Some Important Medical Centers in Agra,
significant association at p < 0.05.
International Journal of Environmental Science
The association of the pre-test practice score of and Development, Vol. 1, August 2010,P.No. 3.
the nursing staff with selected demographic variables 10.) Singh R, Kishore J, Mathur R.G, Mandal K. The
such as educational qualification, In-service education. role of an information booklet on biomedical waste
evidenced that there was statistically significant management for nurses. The Nursing Journal of
association at p < 0.05. India.2009, 43:12.
Conflict of Interest: Nil 11.) TNAI. Fundamentals of Nursing. A Procedure
manual. Published by Secretary General. New
Source of Funding: Self Delhi. edition.2009, Page no.98.1.
Ethical Clearance: Yes, ethical clearance is 12.) Barbara Kozier. Fundamentals of Nursing
obtained Concepts, Process and Practice. Seven Editions.
Singapore .Pears on education, Singapore, page
650-655.
 DOI Number: 10.5958/0974-9357.2017.00062.9

Community Mental Health in India: Current Scenario

Hanuman Ram Bishnoi1, Asif Khan1, Rishi Dutt Avasthi1, Sataveer1

1
Tutor/clinical instructor (Nursing), All India Institute of Medical Sciences Jodhpur Basani Jodhpur Rajasthan,

ABSTRACT

Health services in India are with under resources & particularly mental health is suffering more. WHO
estimates that nearly 75% of those affected by mental illnesses do not have access to quality mental health
services due to various reasons. In India there are very few national importance institutes such as NIMHANS
at Bangalore, and Central Institute of Psychiatry at Ranchi, these are mostly accessible by the semi urban and
urban population villagers who require more mental health services are almost deprived. WHO’s estimates,
there are 0.301 psychiatrists per 100,000 population, 0.166 nurses, 0.047 psychologists, and 0.033 mental
health social workers. In India government run only 43 under resourced mental hospitals which are serving
a large population of 1.2 billion. Although availability of mental health services has been increased in India
but there is still a wide gap between existing morbidity and services available.

Keywords: Community, mental health, depression, Indian scenario, mental illness, psychiatric problems,
health services, psychiatrist, mental health nursing.

INTRODUCTION AND BACKGROUND District Mental Health Programme has been in

existence India since 1996
“Health is a state of complete physical, mental
and social well-being and not merely the absence of 1. To provide mental health services to the
disease or infirmity.” W.H.O. community and also integrate these services with other
services.
Health services in India are with under resources
& particularly mental health is suffering more. WHO 2. Early detection and treatment of the patients
estimates that nearly 75% of those affected by mental suffering from mental illness within in the community
illnesses do not have access to quality mental health itself.
services due to various reasons.1
3. Providing services such as hospitals and nursing
Government Initiatives: homes in cities by avoiding people to go long distance
for the treatment.
National Mental Health Programme (NMHP) has
been in existence since 1982 to improve the status of 4. To treat and rehabilitate the patients discharged
mental health in India with following objectives from the mental hospital within the community itself.

1. To ensure the availability and accessibility of 5. To Increase awareness about the mental health
minimum mental healthcare for all in the foreseeable among the people. 3
future, especially to the most vulnerable and
MENTAL HEALTH CARE BILL
underprivileged sections of the population
In October 2014, government of India launched the
2. To encourage the application of mental
first National Mental Health Policy to provide quality
health knowledge in general healthcare and social
psychiatric care to about 20% of population with mental
development
disorders by 2020.3
3. To promote community participation in the
Efforts By The Non Government Organizations
mental health service development and to stimulate
efforts towards self-help in the community 1. NGO’s are identifying people with disabilities
 16 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

by the following ways 5. Upgrade the existing mental hospitals

2. Keeping hospital or institution based clinics 6. Motivate the people on mental health
3. Keeping specialized educational and 7. Organize campaigns on mental health
rehabilitation centers in different parts of the country
CONCLUSION
4. Conducting camps
Currently there has been growth of voluntary
FINDINGS organization and NGO taking interest to deliver mental
Major Contributor To Burden health services to the vulnerable population. Another
growth is of development of private sector in psychiatric
1. Lack of mental health services
services to reduce burden from government. Although
In India there are very few national importance availability of mental health services has been increased
institutes such as NIMHANS at Bangalore, and Central in India but there is still a wide gap between existing
Institute of Psychiatry at Ranchi, these are mostly morbidity and services available.
accessible by the semi urban and urban population
CONFLICT OF INTERESTS
villagers who require more mental health services are
almost deprived. They have to travel more miles to The authors whose names are listed immediately
approach nearest mental health hospitals. After this below certify that they have NO affiliations with or
stigma regarding mental disorders prevents patients and involvement in any organization or entity with any
their families to approach mental health services. financial interest (such as honoraria; educational
grants; participation in speakers’ bureaus; membership,
2. Lack of awareness
employment, consultancies, stock ownership, or other
Population of India is less aware about mental equity interest; and expert testimony or patent-licensing
health disorders till now in most part of the country arrangements), or non-financial interest (such as personal
relatives took the patient to the faith healers first then or professional relationships, affiliations, knowledge or
after worsening of the condition they move to mental beliefs) in the subject matter or materials discussed in
health services as second option & they count mental this manuscript.
disorders as a matter of shame.4
Source of Funding: Self
CURRENT SCENERIO: REALITY CHECK
Ethical Clearance: Obtained
The prevalence of mental disorders in different
REFERENCES
groups is: 0-3 yr old children-13.8%, 4-16 yr old
children-12%, Industrial workers-14-37%. WHO’s 1. http://www.mapsofindia.com/my-india/health/a-
estimates, there are 0.301 psychiatrists per 100,000 reality-check-on-state-of-mental-health-in-india
population, 0.166 nurses, 0.047 psychologists, and 0.033 2. http://healthminds.in/blog/mental-illness-
mental health social workers. In India government run overview-status-in-india/
only 43 under resourced mental hospitals which are
3. R. Sreevani. A guide to mental health & psychiatric
serving a large population of 1.2 billion. 2
nursing. 4th edition, Jaypee brothers:Delhi;2016
RECOMMENDATIONS TO IMPROVE THE 4. Integrating mental health into public health:
MENTAL HEALTH STATUS IN INDIA The community mental health development
project in India. Ng C; Chauhan AP; Chavan BS;
1. Support NGO’s to cover population
Ramasubramanian C; Singh AR; Sagar R; Fraser J;
2. Establish more rehabilitation centers Ryan B; Prasad J; Singh S; Das J; Isaac M. Ovid
MEDLINE(R) Epub Ahead of Print, In-Process &
3. Avoid discrimination on the people who suffer Other Non-Indexed Citations, Ovid MEDLINE(R)
from mental illness specially women and mentally Daily, Ovid MEDLINE and Versions(R) Indian
retarded Journal of Psychiatry. 56(3):215-20, 2014 Jul.
4. Provide mass education about mental illness
 DOI Number: 10.5958/0974-9357.2017.00063.0

Awareness on Prevention of Cardiovascular Health Problems

among Students of Higher Secondary Schools of Chandannath
Municipality, Nepal, 2015

Shyam Lamsal
Associate Professor, B.P. Koirala Institute of Health Sciences Koirala Institute of Health Sciences Dharan, Nepal

ABSTRACT

Background: Cardiovascular disease is a major global health problem, with the majority of the burden
occurring in the developing countries. The World Health organization currently attributes one-third of all
global deaths due to Cardiovascular diseases (CVD). In the South East Asia Region (SEAR) CVD accounts
for 29% of all deaths and 11% of disease burden.

Objective: The study aims at assessing the awareness on prevention of cardiovascular problems among
students of higher secondary schools of Chandannath municipality, Jumla.

Methodology: A descriptive cross-sectional study design was adopted to conduct the study. A total of 200
samples from two government higher secondary schools within the Chandannath municipality were taken
using stratified population proportionate sampling to calculate sample from different streams and systematic
random technique for sample selection. Data were collected using predesigned, pretested and validated self-
administered questionnaire developed by investigator. Data was analysed through SPSS 16 and descriptive
statistics ( frequency, mean, median, IQR, percentage) and inferential statistics ( Chi square test and Mann
Whitney “U” test ).

Result: The findings of the study revealed that 51% of the respondents had adequate awareness regarding
cardiovascular health problems. Around three-fifth of the respondents (63.50%) were from age group (17-
19) years and majority of the respondents (68 %) were female. There was association (p=0.005) between
awareness and family history of cardiovascular diseases. Similarly, there was significant association between
awareness and variables like age (p=0.008), exposure to mass media (p=0.025) and exposure to curricular
content related to CVD (0.008).

Conclusion: The study recommends the need for detailed curriculum-based health education regarding
prevention of CVDs in schools as well as motivation of the children to incorporate healthy lifestyle practices
into their daily lives.

Keywords: Knowledge, practice, attitude, cardiovascular health problems.

INTRODUCTION

Corresponding author- The burden of non-communicable diseases is

Shyam Lamsal emerging as a major public health challenge for
Associate Professor, Department of Community Health the developing countries. The most common and
Nursing, College of Nursing, B.P.Koirala Institute of problematic non-communicable disease conditions are
Health Sciences, Dharan, Nepal
heart diseases3, hypertension and diabetes4. Globally
 18 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

CVDs are the first cause of mortality2. CVDs include Table 1. Socio-demographic profile of the
coronary heart disease, cerebrovascular disease, respondents n=200
peripheral arterial disease, rheumatic heart disease,
congenital heart disease, malformation of heart structure Fre- Percen-
SN Characteristics Categories
existing at birth, deep vein thrombosis and pulmonary quency tage
embolism5.
∠17 28 14.00
In Nepal, it is estimated that 5.6% of people
17-19 127 63.50
living in the mountains, 1.5% of the people from hills 1 Age group
and 5% of the people in the plain regions suffer from 19-21 40 21.00
CVDs6. Five to 20% of adults are reported to suffer >21 5 2.50
from hypertension, with a lower prevalence in rural
areas.(13)The mortality from coronary artery diseases ∠4 8 4.00
(CAD) and the prevalence of CAD risk factors is rising 4-6 112 56.00
Family
rapidly in developing countries7. 2
members
6-8 65 32.50
MATERIALS AND METHOD
>8 15 7.50
A descriptive cross-sectional design among the
Educational Illiterate 42 21.00
students of higher secondaru schools of Jumla consisting 3 status of the
of 1200 students. Stratified population proportionate parents Literate 158 79.00
sampling to calculate sample from different streams and
Farmer 78 35.13
systematic random technique for sample selection was
adopted. Research tools included the socio-demographic Service 36 `16.21
data, assessment of awareness, practice and attitude. Occupation of
4 Labour 21 9.45
Content validity was established through pre-testing in Parents
10% of sample. Data analysis was planned in SPSS 16 Business 65 29.27
version through descriptive statistics ( mean, median,
Other 22 10.00
SD, percentage) and inferential statistics ( Chi square
test and Mann Whiteney ‘U’ test). ∠5000 10 5.00

RESULTS 5000-10000 52 26.00

Monthly
Income 10000-
Majority of the respondents (63.50%) were between 5 56 28.00
(Nepalese 15000
17-19 years with median age 18 and intraquartile range Rupees) 15000-
35 17.50
(IQR) 17-18. Majority (56%) had family size of 4-6 20000
family members. Gender of the respondents was found >20000 47 24.50
to be female 136(68%) and remaining 64 (32%) male.
Eighty percent of the respondents were Hindu and 18% Majority of the respondents (89.00%) have been
were Buddhist and rest (2%) were Christians. exposed to curricular content of CVD, 188 (94.00%)
were exposed to various mass media with the highest
number responding 115 (60.00%) from radio. Only
9.00% of the respondents were having family history of
CVD. At the same time, 74(37.00%) of the respondents’
family used to smoke and 88(44.00%) used to take
alcohol.
 International Journal of Nursing Education, July-September, Vol.9, No. 3 19

Table: 2. Respondents’ view of Risk factors of CVDs. n= 200

Description Frequency (%)

SN
Yes No Don’t know
1 Increasing age 46(23.00) 99(49.50) 55(27.50)
2 Smoking 166(83.00) 16(8.00) 18(9.00)
3 Alcoholism 156(78.00) 35(12.50) 19(9.50)
4 Regular exercise 17(8.50) 150(75.00) 33(16.50)
5 Obesity 126(63.00) 41(20.50) 33(16.50)
6 Diabetes 80(40.00) 77(38.50) 43(21.50)
7 Physical inactivity 87(43.50) 56(28.00) 57(28.50)
8 Regular health checkup 23(11.50) 153(76.50) 24(12.00)
9 Fatty food 134(67.00) 29(14.50) 37(18.50)
10 Junk food 91(45.50) 42(21.00) 67(33.50)
11 High blood pressure 138(69.00) 31(15.50) 31(15.50)
12 Stress 130(65.00) 33(16.50) 37(18.50)
13 Nutritious food 28(14.00) 129(64.50) 43(21.50)
14 Throat infection in children 42(21.00) 47(23.50) 111(55.50)

Regarding the health behaviours as preventive measures of CVDs, respondents expressed that regular exercise,
regular BP monitoring and Cessation of alcohol (81.50%, 81.00% and 80.50%) are important. Majority (72.00%) of
them were aware that CVDs can be treated by medication. At the same time, majority (76.50%) of the respondents
used to do exercise daily and (77.00%) used to play games daily. Food habits of the respondents included of intake
of of junk food (53.50%) and fatty food (55.50%) in more than half of them. Fish and red meet consumption was
among 83.50% and 77.50% respectively. Regular fruit consumption (mainly apple locally available) was consumed
by 54.50% respondents daily.

Table 3. Overall awareness of CVDs among the respondents. n=200

Response
Characteristcs Adequate (≥ (65.95%) Inadequate (∠ 65.95%)
Frequency Percentage Frequency Percentage
Awareness on prevention of CVDs 102 51 98 49
Median percentage of awareness (IQR) = 65.95% (62.25 – 67.44)

Table: 4. Association of awareness of CVDs with sociodemographic variables.

Median Awareness (IQR)/Number

SN Characteristics Categories p-value
Inadequate Adequate
1 Age
2 Income
Illiterate 23 19
3 Education status of head of family 0.401(*)
Literate 75 83
Yes 4 14
4 Family history 0.015(**)
No 94 88
Yes 89 100
5 Exposed to mass media 0.025(**)
No 9 2
Yes 82 97
6 Exposure to curricular content of CVDs 0.008(*)
No 16 5
*Pearson Chi-square test ** Fisher’s Exact Chi-square test *** Mann Whitney “U” test
 20 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

DISCUSSION Source of Funding- Self

Exposure to the knowledge regarding the CVDs Conflict of Interest - Nil

was found in majority (94.00%) of the respondents
REFERENCES
among which radio (60.00%) was the main source. This
has been supported by a study conducted in the cardiac 1. Khuwaja A.K., fatmi Z. Risk factors for
camp of Pokhara, Nepal, where commonest source of cardiovascular disease in school children- a pilot
information were radio and magazines8. Majority of the study. Journal of Pakistan Medical Association
respondents’ (76.00%) did not have family history of (online) 2003; 53:396. Available from : URL: htpp:
CVDs while only (9.00%) had positive family history /www.biomedcentral.com.
which is supported by a study conducted in India9 where
2. WHO fact sheet. Non communicable diseases
the family history was found among 2.90% subjects.
(online) 1996; 106. Available from: URL: htpp:
Family history of smoking was among 74 (37.00%)
/www.who.int/inf-fs/fact106.html.
in this study which supported by a study conducted
in Pakistan1 which had 74(36.00%) family history of 3. Christopher JL, Alam D. The global burden of
smoking. disease (summary), Cambrdge, Mass, Harvard
University Press, 1996.
More than half of the respondents consume junk 4. Coleman R, Gill G, Wilkinson D. Non communicable
food and fatty food (53.50% and 55.50%) which is disease management in resource poor settings: a
supported by a by a study in Pakistan1 where 64.00% of primary care model from rural South Africa. Bull
the subjects consumed junk foods and other high calorie WHO 1998; 76: 633-40.
foods.
5. WHO Cardiovascular disease (online) 2009.
Significant association between the awareness and Available from URL: htpp:/www.who.int.com.
demographic variables was found in the study. The 6. World Health Organization Regional office for South
association between awareness and CVDs (p=0.015) East asia Region. 1998-2000. New Delhi 2002.
was supported by a cross sectional study in Pokhara,
7. Okrainec K, Benerjee DK, Eisenberg MJ. Coronery
Nepal. (19) Similarly there was significant association
artery disease in the developing world. Am Heart J.
between awareness and variables like age (p=0.008),
2004; 148:7-15
exposure to mass media (p=0.025) and exposure to
curricular content of CVds (p=0.008). 8. Shankar PR, Partha P, Shenoy N, Chandrashekhar
TS, Dubey AK. Knowledge about heart attack and
CONCLUSION hypertension among individuals attending cardiac
camp in Pokhara City. Kathmandu University
The study recommends the need for detailed
Medical journal. 2007; 5(2):273-289.
curriculum-based health education regarding prevention
of CVDs in schools as well as motivation of the children 9. Divakaran B, Shalini K. Lifestyle factors of
to incorporate healthy lifestyle practices into their daily communicable diseases: Awareness among school
lives. children. Indian Journal of Cancer. 2010; 47(1):9-
13.
Ethical Clearance- Taken from Executive
Committee of Karnali Academy of Health Sciences,
Jumla, Nepal.
 DOI Number: 10.5958/0974-9357.2017.00064.2

Prevalence of High Risk Pregnancy in the Dalit Community of

Chandannath Municipality, Jumla

Shyam Lamsal
Associate Professor, B.P. Koirala Institute of Health Sciences Koirala Institute of Health Sciences, Dharan, Nepal

ABSTRACT

Introduction: WHO estimates that some 515 000 women die annually from pregnancy-related causes
during the period including pregnancy and the six weeks postpartum, nearly all in the developing world1.
Maternal death is the predominal cause of death amongst women in the 15±44 y age group, and anaemia
in pregnancy is considered one of the major risk factors (Nepal Government =WorldHealth Organization,
1992; Nepal Government, 1996)2. Depending on the type of population and the diagnostic criteria used,
gestational diabetes is said to complicate 1-16% of all pregnancies. Knowledge on possible risk factors may
help reduce the maternal death in Karnali.

Objective: To find out the factors causing high risk pregnancy.

Materials and method: A descriptive cross-sectional study was carried out among the antenatal mothers of
Dalit community residing in Chandannath municipality, Jumla. A total of 100 mothers were selected for the
purpose of the study through snowball technique. Open ended semi-structured antenatal questionnaire was
used as an instrument of study.

Statistics: Descriptive statistics was used.

Result: Majority of them were between the age group of 15-30 (55). Fifty five of the pregnancies were
unplanned and 40 were below the age of 25. More than half (52) were multipara, 72 pregnant attended the
antenatal clinic , 48 women had bad obstretic history (BOH), abortion being the commonest one. Eighty
women had anemia of some degree and 38 had proteinuria.

Conclusion:Unplanned pregnancy, youger age, multiparity and BOH are the major factors for high risk
pregnancy. Eighty and 38 women had anemia and proteinuria respectively.

Keywords: High risk pregnancy, Dalit community.

INTRODUCTION Maternal death is the predominal cause of death

amongst women in the 15±44 y age group, and anaemia
WHO estimates that some 515 000 women
in pregnancy is considered one of the major risk factors
die annually from pregnancy-related causes during
(Nepal Government =WorldHealth Organization,
the period including pregnancy and the six weeks
1992; Nepal Government, 1996)2. Depending on the
postpartum, nearly all in the developing world(1).
type of population and the diagnostic criteria used,
gestational diabetes is said to complicate 1-16% of all
Corresponding author:
pregnancies3.
Shyam Lamsal,
Associate Professor, Department of Community Health Pregnancy and childbearing during adolescence, as
Nursing, College of Nursing, B.P. Koirala Institute of defined by WHO, is the period of life between 10 to 19
Health Sciences, Dharan, Nepal. years of age which carries considerable risk. Girls aged
E-mail: [email protected] 15-19 are twice as likely to die from childbirth as women
 22 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

in their twenties; those under 15 are five times as likely. DISCUSSION

In view of the risks associated with early childbearing,
There is a parallel relationship between the MMR
adolescent fertility rates are alarming high in many
and percent of women with anemia6. Globally, 51% of
countries; in fact 12% of all births each year – total of
pregnant women suffer from anemia. In the developing
15 million births annually – are adolescents. This study
countries, out of 56% of pregnant women with anemia,
efforts to find out the risk factors of pregnancy among
7% suffer from severe anemia5. which supports the
the Dalit women of Jumla where anemia rate among
result of this study.
women between 15-49 years is 33% and maternal
mortality rate is 400 per 100000 population 4 . Grand multi mothers, mothers with the history of
abortion and still birth are also categorized as high risk
RESULTS cases. This study reveals that 25 had history of abortion
Majority of them were between the age group of and 14 had history of still birth.
15-30 (55). Fifty five of the pregnancies were unplanned CONCLUSION
and 40 were below the age of 25.
Unplanned pregnancy, youger age, multiparity and
Table: 1. Distribution of antenatal mothers on BOH are the major factors for high risk pregnancy.
the basis of gravida. n=100 Eighty and 38 women had anemia and proteinuria
respectively.
SN Gravida Frequency
Ethical Clearance- Taken from Executive
1 Primi 26
Committee of Karnali Academy of Health Sciences,
2 Multi 52 Jumla, Nepal.
3 Grandmulti 22
Source of Funding- Self
Table: 2. Bad obstretic history (BOH) of the Conflict of Interest - Nil
women. n=100
REFERENCES
SN BOH Frequency
1. Hill K, AbouZahr C, Wardlaw T. Estimates of
1 Abortion 25
maternal mortality for 1995. Bulletin of the World
2 Still birth 14
Health Organization. 2001;79:182-93
3 Others(IUD,Preterm labour) 9
2. GT Bondevik, B Eskeland, RJ Ulvik, M Ulstein,
Table: 3. Distribution of antenatal mothers on RT Lie, J Schneede and G Kvale. Anaemia in
the basis of anemia. n=100 pregnancy: possible causes and risk factors in
Nepali women. European Journal of Clinical
SN Anaemia Frequency Nutrition (2000) 54, 3-8.
1 Normal 20 20 3. Jimennez MoLeon J, Bueno-Cavanillas A, Luna-
2 Mild 46 Del-Castillo JD, Lardelli-Claret P, Garcia-Martin
3 Moderate 24 80
M,Galvez-Valgas R. Predictive value of screen for
4 Severe 10
GDM, Influence of associated risk factors. Acta
Table: 4. Distribution of antenatal mothers on Obstet Gynecol. 2000;79:991-8.
the basis of urine analysis 4. Source-Jumla-District Health Office, Jumla- 2011-
Nepal-central Bureau of Statistics - 2012- MDG
SN Urine analysis (protein) Frequency
Report, Ministry of health and Population, Nepal
1 Nil 62
– 2013
2 Trace 32
3 +1 6 5. United nations. The world’s women: trends and
4 +2 - statistics 1970-90. New York, 2001.
SN Urine analysis (glucose) Frequency 6. The alan Guttmacher Institute. Issues in brief: risks
1 Nil 92 ans realities of early childbearing worldwide, New
2 Trace 8 York 1997.
3 +1 -
 DOI Number: 10.5958/0974-9357.2017.00065.4

A Research Critique on Lived-in Experiences of Significant

Others of Patients Admitted in Emergency Department at
Selected Hospitals

P Ester Mary1, Hamad Salem Al Grad2

1
M.Sc(N), R.N, R.M, PhD Scholar, Saveetha University, India, 2Assistant Regional Nursing Director,
Najran, Saudi Arabia

ABSTRACT

Aim: This qualitative study explored the experiences of significant others of patients admitted in Emergency
department.

Method and materials: The research approach used in this study was phenomenology approach. Interviews
were conducted with twelve significant others of patients admitted in emergency room. The study was
conducted at selected hospitals at Chennai. The data was analyzed by using the colaizzi’s analysis
method.

Results: The results revealed that significant others of patients admitted in emergency department has lot
of physical, psychological and emotional impacts. It was huge influence on them, the process of coping up
depends on various factors like demographic variables, life experiences, educational status, type of family
etc. There was an association between the socio demographic variables and the lived in experiences of
significant others of patients admitted in emergency department. The significant others of patient’s need
adequate physical and psychological support about their treatment, prognosis and outcomes of the patients.
This study is important for nurses working in the emergency department as it gives them importance to
understand the feelings, emotions significant others of patients and to make the family members to realize
and be aware of their treatment and application of holistic patient care in day to day practice not only to the
patients but also the family members or care givers.

Keywords: Significant others, Phenomenology, lived experiences, Emergency department, colaizzi’

INTRODUCTION
part of an individual’s life is affected by someone or
“PAIN AND PLEASURE LIKE LIGHT AND dependent on others1.
DARKNESS SUCCEED EACH OTHER”
- Lawrence Stone The Experiences of the family members in the
emergency department is a crisis situation for both
The term experience denotes the merging of two the patient and family members, such as a new place,
dimensions, the physical dimensions and psychological new environment, new persons, and new situation. The
dimensions. Experiences are impossible to separate the outcome will be positive or negative depending on their
effects of psychological factors from those of social emotional status of the patient and family members2.
factors of an individual Similarly.
Emergency department /Unit is the place where the
Physical dimensions are interwoven with the emergency treatment is given for all types of emergency
psychological dimension. Experiences of an individual cases. The word casualty/emergency unit engages with
include thoughts, feelings, motivation, mental status, many pictures in one’s mind as a strange place, pivoting
personal strength and weakness. Social experience is a alarms sounds, huge machines, invasive and noninvasive
 24 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

procedures, high alert medications which cause the fear. nurses are concerned about meeting the physical needs
The level of stress varies from person to person, gender of the patient not worrying about the family member’s
to gender and in different situations and different levels. psychological, emotional and spiritual needs due to
technological changes and advancement in the health
The most valuable intervention that can be offered
care domain.
to any patients and their family members by effective
care in various dimensions that includes verbal Nurses , always worry about alleviating physical
expressions of empathy and positive regards, as well as sufferings of the patient’s alone. What is our contribution
psychological and spiritual support.3 address the mental suffering of the family members?
How can this be rectified? Thus the new information
Robert (2006)4 reported that the family members
emerges through exploration of Subjective experiences
experience in the emergency room is a crisis situation
of significance others of patients who were admitted in
for both patient and family members. He classified the
the emergency department .This will enable the nurses
crisis into two types , the first one is biological crisis
to understand and gain insight on the family members /
and the second one is pathological crisis. When
care givers feelings or experiences .This will encourage
the patient enters the casualty, patient is in biological
the nurses to provide support him/her with the use of
crisis. However, family members enter the casualty in
constructive coping strategies.
pathological crisis”.
The investigator strongly believes that the
Weason J.S(2007)5 conducted an experimental
perception of significance of others of patients
study among 28 patients on effects of a brief period of
undergoes must be explored. This realization strongly
counseling on the anxiety of seriously injured patient
motivates the investigator to do this research critique on
in emergency room. The family members and relatives
lived-in experiences of significance of others of patients
were also included .Data was collected by interview
admitted in the emergency department. Through eliciting
method by( using video tape recording method) He
the lived-in experiences, it is possible to identify the
concluded that 17(75%) of the family members/
patient’s family members needs in all dimensions which
relatives physical, emotional and psychological needs
in turn will inspire the nursing care.
were not met by the nurses due to mass causality and
insufficient time. Nursing is a profession 8focused on assisting
individuals, families and communities in attaining,
Holland and Zitton (2011)6 stated that the patients
maintaining, and recovering optimal health and function.
or the family members who enter into the emergency
Modern definitions of nursing define as a science and
unit may bring another cycle of emotional change,
an art that focuses on promoting quality of life to the
such as anger, denial, guilt, depression and acceptance,
persons and families, throughout their life experiences
as well as the impact on other aspects of psychosocial
from birth to care at the end of life. Therefore the nurses
functioning.
play an important role as a supporter, collaborator, and
Hone camp (1995) 7conducted a study on lived motivator in order to help the patient to have an optimal
in experience of a significance of others of patients health and function.
with cardiac problems using the sample size of 32. He
MATERIALS AND METHOD
concluded that the family members expressed that
they were highly stressed and anxious on whatever the Qualitative study design and phenomenological
outcome will be upon emergency admission. approach were adopted for this study. An in- depth
interview was conducted. The significant others of
While working in the hospital, the investigators
patient’s family members, friends, and relatives within
noted that many of the family members were found
the study period, and who fulfilled the inclusion criteria
to be stressed. They were unaware of the triage
were selected with the sample size of 12. Inclusion
system, neither proper information about the patient’s
Criteria were both male and female significant of
health conditions, therapeutic procedures, and cost
others of the patient who were admitted during the
effectiveness of the medications .Most of the time,
time of study period to the emergency room. Prior to
 International Journal of Nursing Education, July-September, Vol.9, No. 3 25

data collection, the necessary permission was obtained of the data, six dimensions and fifty subthemes emerged
from the concerned authorities. Before commencing from the experiences of significant of others of patients
the data collection the investigator got consent from the admitted in the emergency department. The dimensions
study participants. Twelve samples significant of others were physical, physiological, psychological, social
who were admitted in the emergency department were spiritual and economical dimensions and various
chosen for the study. The procedure was explained to suggestions given by the family members.
each participant individually, ensuring comfort and
privacy. Participants were reassured that confidentiality
DISCUSSION
would be maintained and the information would be Physical Dimension
utilized for research purpose only. Informed consent
was obtained, and the interviews were audio-taped. An In physical dimensions, the major themes identified
in- depth interview was done on one-on -one basis. The were insomnia, tiredness, body pain, headache , tiredness
total time was taken for collecting the data from each and inability to perform the day to day activities
participant was 30- 45 minutes. After the completion of
“I feel giddy, tired and I have some head ache
the interview, each participant was given an opportunity
because of prolonged waiting in the outside of
to clarify their doubts.
emergency department”.
RESULTS
The above findings were Consistent with the study
Table 1. Physical dimensions frequency and of M.Claran J.Berglan et al (2000)8 conducted a study
percentage distribution on lived in experience of family members experience
in emergency department . Aqualitative design was
Percentage Frequency used for the study. Patient’s and family members have
Physical dimension S.no
% (n=12) explored their experiences. He concluded that the family
members explored their feelings of pain, tired, fear and
33% 4 Healthy 1
restlessness.
67% 8 Unhealthy 2
Physiological dimension
Table 2. Physiological dimensions frequency and The identified themes were Loss of appetite and
percentage distribution sleep disturbances.
SI Physiological Frequency “I can’t sleep well because my mother-in-law is
Percentage
No. Dimension (n=12) admitted to the emergency department. I don’t know
Not able to sleep what is happening with her”, I have not received any
1. 10 83%
properly
information about her health status from the staff,
2. Unabletoeatproperly 2 17% so I am tensed”.
Table 3. Psychological dimensions frequency and “I don’t feel like eating because I don’t know
percentage distribution what will happen to my father, whether he’ll be
alright or not inside the emergency department”
SI. Frequency Percen-
Psychological dimension
No. (n=12) tage Miott (1992)9 conducted a study on adjustment
1. Sad 4 33% difficulties of family members experiences. The
adjustment problem of the spouses and children of
2. Angry 4 33%
heart disease patients were explored with their defective
3. Emotionally unstable 2 17%
coping mechanism. They were unable to adjust to the
4. Frustration 2 17% situation due to the stressful environment.

Colaizzi’s data analysis framework was used to Psychological dimension

analyze the transcripts in this study. From the analysis
The identified themes were anger, fear, emotional
 26 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

instability, frustration, sadness. social support was received from their peer group than
from their family members
“This is intolerable. It is a sad situation”
Economical dimension
“I am frustrated as I am unable to manage the
household activities burdens” The following themes were based on income, six
(50%) of significant others were low socio-economic
“I often get angry and irritated”
background, four (33%) were from the middle socio-
“I feel troubled of having no one to express my economic background and two (17%) were from the
feelings with frustrations” high socio-economic background.

“It is so sad to see my mom inside the emergency “I don’t have money; I just lend some from my
department” friends”

Marrs (2000)10 conducted a study on identifying “We have collected some amount of money for
the patient’s perception on recovery phase by using our daughter’s wedding but we had spent the money
qualitative techniques of grounded theory. 10 men and for the treatment”
15 women were interviewed, verbatim transcript was
Spiritual dimension
analyzed for major themes. The results revealed that
strengthen the need for patient’s concern and support The identified themes were belief and unbelief
with their psychosocial needs. Nurses must also consider in God among 12 significant of others, ten (83%)
providing support to patients in the pre- admission and significant others expressed that they believed in god,
recovery phase is most essential. two (17%) of them said they don’t have any hope about
the outcome.
White (2001)11 conducted a study on the bio-
physical impact of patient’s partner’s experience’ in “Still I am having a huge amount of belief in
casualty. A phenomenological study was conducted on God. Without him, it would be very difficult”
44 participants and they were interviewed separately,
“I believe in God will give another life to my
Sub- themes were identified from verbatim. He
mom”
concluded that partner’s expressed anger, depression,
and hopelessness, whereas, sadness was observed in the The above findings were supported by Deegan
patients. (2007)13 conducted a study on effects of spiritual
believes among hospitalized patients. The findings
Social Dimension
revealed that the spiritual needs should be met by the
The identified themes were Communications hospital staff to enable the patient to be satisfied in all
problems with the nurses and family members as well the other dimensions
as lack of support . Among 12 significant of others,
G. Satisfaction with Nursing Care:
10(83%) experienced communication problems with the
nurses and 2 (17%) experienced that they don’t have any A Significant number of patients10 (87%) they
communication problems with the nurses. were satisfied with the level of care given by the nurses
in the emergency department .However, the family
“I know I can’t ask the nurses very often about
members were not much considered and fail to give the
my mother’s condition”
information about the prognosis
“I am highly emotional and also worried about
Nurses are like god they took care of me well
my son’s prognosis”
during my illness””
The above study findings coincided with the study
of Elizabeth (2001)12 who studied how the patients and
CONCLUSION
the significant others felt about their social support Therefore the findings of this study are important for
services. The findings revealed that higher level of
 International Journal of Nursing Education, July-September, Vol.9, No. 3 27

nurses working within the emergency department. The 4. Robert,J.,joal…Relationship among the family
investigator was able to find out that each significant of members experiences crisis situation in emergency
patients are unique. Their experience and perception department ,emergency nursing forum,2006.
varied from person to person during the process. The 5. Weason, stress and anxiety and depression among
essential step in the health care system is to elicit the patients admitted in the casuality. World Journal of
significant of others of patients’ experiences to enable Science 2006.45-60.
nurses counsel them about their condition as well as
6. Holland and Zitton ,Psychological sequelae
the prognosis. This will help to reduce their stress and
among women in causality. Journal of Advance
anxiety and more over, also it will help the nurses to gain
Nursing,2011 ;34-39
their cooperation, trust and confidence of patients and
their relatives. 7. Hone camp et al lived in experience of a significance
of others of patients with cardiac problems meta
Nurses need to expand their time not only on the analysis review, the lancet 2005,365.
patient’s needs but also care about their family members
8. M.Claran J.Berglan et al lived in experience
needs. Nurses need to improve their communication
of family members experience in emergency
skills, through staff development programs. Nurses can
department ,Evaluating the quality of care” New
play a vital role in various aspects such as in the area of
York Churchill living stone 2000 ,vol 2 p-22
support, and counseling. They can also act as a guide
to the patients and family members and also strengthen 9.Miott , jaison et al adjustment difficulties of family
their reliance through quality care. members experiences. “Medical and Surgical
Nursing assessment and management of clinical
Conflict of Interest: There is no conflict of problem” 6th Edition Toronto, Mosby 1999.
interest. 10.Marrs , Jerwin Penny et al conducted a study on
Source of Funding: None identifying the patient’s perception on recovery
phase “Emergency and Trauma Care” American
Ethical Clearence: Informed written consent was Journal of Nursing 2000
obtained from the participants who were informed about 11. White , Martin Dorrie conducted a study on the bio-
the purpose and design of the study and assured that physical impact of patient’s partner’s experience’ in
participation was voluntary and confidential. casualty, . “Emergency Care Nursing” 18th Edition
REFRENCES Philadelphia: William and Qilkinson 2001
12. Elizabeth , “Emergency and Trauma Care”
1. David ,S Fisher,Tish Knobt Henry,T.Handbook American Journal of Nursing 2001
of emergency care. 1st edition mosby
13. MLOH S.R. “Adjustment difficulties of patient and
publications.2004.p-143.
family”, South Medical Journal 75, 1992
2. Ajeeta s, neelam Family members experiences and
14. Polit DF, Beck CT, Nursing Research: Principles
their attitude in emergency department .journal
and Methods. 7th Edition, Philadelphia: Williams
emergency nursing 2004 Jan-March.
and Wilkins; 2004.
3. Hall B.Jesse.etal.Principles of emergency care,New
york,McGraw.2004.150-155
 DOI Number: 10.5958/0974-9357.2017.00066.6

Effectiveness of Back Massage versus Ambulation During

First Stage of Labour among Primigravida Mothers in Terms
of Pain and Anxiety

Indu Bala1, Molly Babu2, Sharda Rastogi3

1
Lecturer, Nightingale Institute of Nursing, Sector-62, Noida, UP., 2H.O.D OBG DEPT, RAK College of Nursing,
Lajpat Nagar, New Delhi, 3Senior Tutor, RAK College of Nursing, Lajpat Nagar, New Delhi

ABSTRACT

An experimental study to evaluate the effectiveness of back massage versus ambulation during first stage of
labour among primigravida mothers in terms of pain and anxiety, an experimental research approach with
pretest post test control group design was undertaken on 90 primigravida mothers (30 in each experimental
group1, experimental group 2 and control group). Purposive sampling technique was used to select the
primigravida mothers. There was a significant difference in mean pre-test and post-test labour pain scores
and anxiety scores during first stage of labour among primigravida mothers. There was a positive relationship
between pain and anxiety: as pain increases anxiety also increases and vice versa .It was concluded that back
massage and ambulation was effective to reduce the level of labour pain and anxiety among primigravida
mother during first stage of labour.

Keywords: Back massage, Ambulation, first stage of Labour, level of pain and anxiety, primigravida mothers.

INTRODUCTION group and control group. A Study concluded that there

was a significant reduction of labour pain among
Labour presents a physiological and psychological
experimental group. 2
challenge for women. As labour becomes more
imminent this can be a time of conflicting emotions; An experimental study was conducted in Mangalore,
fear and apprehension can be coupled with excitement the study comprised of 40 primigravida mothers and
and happiness. Tension, anxiety and fear are factors they were grouped as experimental and control through
contributing towards women’s perception of pain and randomization, experimental group received ambulation,
may also affect their labour and birth experience .1 the other group did not. Pain was assessed through Visual
Analog Pain Scale and observational checklist was used
The study was conducted to assess the effectiveness
to assess the outcome of labour there was a significant
of jasmine oil massage on labour pain during first
difference in duration of first stage of labour between
stage of labour among 40 primigravida women. The
the experimental and control group but no significant
study design adopted was true experimental approach
difference in overall outcome of labour. The mean pain
with pre-test - post-test control group design. The
score for experimental group was (6.8) which was less
demographic Performa were collected from the women
than the main pain score of control group. The findings
by interview and Visual Analogue Scale was used to
of the study revealed that ambulation was effective to
measure the level of labour pain in both the groups. Data
reduce the intensity of labour pain among primigravida
obtained in these areas were analyzed by descriptive
mothers. 3
and inferential statistics. A significant difference was
found in the experimental group (t 9.869, p<0.05). A The study aimed to determine the effect of massage
significant difference was found between experimental on pain of labour in nulliparous women admitted to
 International Journal of Nursing Education, July-September, Vol.9, No. 3 29

hospital. This was a single blind clinical trial, random OBJECTIVES

purposive sampling method was used. massage n=32,
30 min of regular massage ,firm and steady at the back The study attempted
of effleurage received in each phase of labour 3-4cm , i) Assess and evaluate the level of pain and
5-7cm ,8-10cm . Pain measured before and after 30 min anxiety during 1st stage of labour among primigravida
intervention by using visual analog pain scale. Mean pain before and after administration of back massage.
intensity in both the groups was significantly different
in three phases of labour and this study indicated that ii) Assess and evaluate the level of pain and
back massage reduces intensity of pain in first stage of anxiety during 1st stage of labour among primigravida
labour.4 before and after ambulation

A study was carried out to evaluate the effect of iii) Find out the relationship between level of labour
massage therapy on relieving pain and its harmful pain & anxiety among primigravida after administration
sequel such as anxiety during labour. Sixty nulliparous of back massage and ambulation
women selected randomly who were expected to have
Hypothesis:-
a normal childbirth in the Jiroft city hospital. Cases
were randomly assigned to experimental (n=30) and H1: There will be a significant difference in mean
control (n=30) groups. The experimental group received pre-test and post-test pain scores of primigravida in
massage intervention. The intensity of pain and anxiety experimental group1 dilatation during 1st stage of labour
between these two groups were compared in the latent after administration of back massage as measured by
phase (cervix dilated 3-4cm), active phase (cervix visual analog scale at 0.05 level of significance at
dilated 5-7cm) and transitional phase (cervix dilated
8-10cm) of labour. Findings suggest that massage is a a) 3-4 cm dilatation
cost effective nursing intervention that can decrease pain b) 5-7cm dilatation
and anxiety during labour and nurse’s intervention to
perform massage could have positive effect on delivery H2: There will be a significant difference in mean
experience. It is suggested that massage is useful for pre-test and post-test anxiety scores of primigravida
decreasing pain and anxiety during labour .5 in experimental group1 during 1st stage of labour after
administration of back massage as measured by C.D
One unique aspect of childbirth is the association Speilberger’s State Anxiety Scale at 0.05 level of
of this physiologic process with pain and discomfort. significance at
However, the experience of pain during labour is not
a simple reflection of the physiologic processes of a) 3-4 cm dilatation
parturition. Instead, labour pain is the result of a complex
b) 5-7 cm dilatation
and subjective interaction of multiple physiologic
and psychological factors on a woman’s individual MATERIAL AND METHOD
interpretation of labour stimuli. An understanding of
labour pain in a multidimensional framework provides An experimental research with pretest posttest
the basis for a woman-centered approach to labour control group design and quantitative approach was
pain management that includes a broad range of selected to carry out the study. The study population
pharmacologic and non pharmacologic intervention comprised of all normal primigravida with selected
strategies. 6 minor disorders who will be admitted in the selected
hospital of Himachal Pradesh. The sample size of the
study was 90 primigravida mothers during the first stage
of labour. The purposive sampling technique was used
with non - random assignment in experimental group 1,
experimental group 2 and control group.
 30 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Table No:1. Schematic presentation of research design

AT 3-4 CM DILATATION AT 5-7 CM DILATATION

DAY-1 DAY-1
GROUP DAY-1 DAY-1
DAY-1 POST TEST DAY-1 POST TEST
PRE TEST ASSESSMENT PRE TEST ASSESSMENT
INTERVENTION INTERVENTION
ASSESSMENT ASSESSMENT

Experimental Level of Back massage for

group- 1 Level of pain Level of pain and Back massage for Level of pain
pain and 30 min at cervical
and anxiety after anxiety before 30 min at cervical , anxiety after
Back massage anxiety before dilatation of
treatment treatment dilatation 5-7 cm treatment
N=30 treatment. 3-4 cm

Ambulation for Ambulation for 30

Experimental 30 min with rest min with rest period
group- 2 Level of pain Level of pain Level of pain and Level of pain,
period of 15 of 15 min after
and anxiety and anxiety after anxiety before anxiety after
Ambulation min after 15 min 15 min walk (at
before treatment treatment treatment treatment
N=30 walk ( at cervical cervical dilatation
dilatation 3-4 cm) 5-7 cm

Control group Level of pain Level of pain and Level of pain and Level of pain ,
----------------- …………………
N=30 and anxiety anxiety anxiety anxiety

Table no: 2. Summary of Data Collection Tools and Techniques Depicted.

S.NO TOOL PURPOSE TECHNIQUE

PART-A Interview Schedule
To collect demographic data data.(history Interviewing
and personal data)
1
PART-B Structured Record For assessment of labour Record analysis
Analysis

2. To assess the intensity of labour pain

Visual Analog Scale among primi gravida mothers during first Observation
stage of labour

3 To assess the anxiety level of primi

CD Speilberger’s State Trait
gravida mothers during first stage of Interviewing
Anxiety Inventory
labour

The tool consists of three sections. In Section-1: secondary education. Majority (80%) of primigravida
(Part –A): Consist of Structured Interview Schedule to mothers were house wives, (87.78%) were booked case,
know demographic data (Part –B): Labour Assessment. (91.11%) had no history of any medical illness, (30%)
In Section-II: Consists of observation schedule for had no previous information about therapies used in
assessing pain. The standard Visual Analog Scale was labour and (62.22%) Of Primigravida mothers Had
used. In Section-III: Consists of interviewing schedule for Nausea during Pregnancy. Majority (57.78%) of sample
assessing the anxiety level of the primigravida mothers were in their 37-38 weeks of period of gestation and
during first stage of labour. The standard anxiety scale (69%) of them onset of labour was spontaneous.
was used. (Speilberger’s State Trait Anxiety Inventory).
The Mean post-test pain scores of experimental
FINDINGS group 1 at 3-4 cm dilatation were (3.96) which was lower
than the pre-test pain scores (6.30) and the obtained
The percentage wise distribution of demographic
mean difference (2.33). The mean post -test pain scores
variables of all primigravida mothers with first stage of
of experimental group 1 at 5-7 cm dilatation was (4.86
labour revealed the highest percentage (65.66%) of the
6) which was lower than the pre-test pain scores (8.03)
sample were in the age group of 20-25years, (95.55%)
and the obtained mean difference (3.166). There is
of them were Hindu, (42.22%) of them had higher
 International Journal of Nursing Education, July-September, Vol.9, No. 3 31

significant difference in mean pre-test and post -test scores of experimental group 2 at 5-7 cm dilatation was
pain scores of experimental group 1. The mean post -test (42.80) which was lower than the pre-test anxiety scores
pain scores of experimental group 2 at 3-4 cm dilatation (64.73) .The obtained mean difference (21.93). This
was (4.033) which was lower than the pre-test pain shows that the intervention ambulation was effective in
scores (6.166) the obtained mean difference (2.133) and reducing the anxiety.
the mean post -test pain scores of experimental group 2
There was a positive correlation at 3-4 cm dilatation
at 5-7 cm dilatation was (5.066) which was lower than
as evident from “r” value (0.613) and 5-7 cm dilatation
the pre-test pain scores (8.033). There is significant
“r” value (0.332) which were found to be statistically
difference in mean pre-test and post -test pain scores of
significant as evident from “r” value for df 28 at
experimental group 2. This shows that the intervention
0.05 level of significance. This shows that there is a
ambulation was effective to reduce the pain.
significant relationship between pain scores and anxiety
Figure no: 1. Intensity of pain scores during first stage of among primigravida mothers in experimental group1.
labour among primigravida mothers at 3-4 cm dilatation in
There was positive correlation at 3-4 cm dilatation
as evident from “r” value (0.501) and 5-7cm dilatation
“r” value (0.468 which were found to be statistically
significant as evident from r value for df (28) at 0.05
level of significance. This shows that there is significant
relationship between pain scores and anxiety among
primigravida mothers in experimental group 2.

The mean post -test pain scores at 3-4 cm dilatation

experimental and control group
in experimental group1 was (3.96) which was lower than
The mean post -test anxiety scores of experimental the post -test pain scores of experimental group 2 (4.03)
group 1 at 3-4 cm dilatation was (40.93) which was and control group (8.06) was found to be statistically
lower than the pre-test anxiety scores (64.90) the significant as evident from the ‘F’ value 187.461 for
obtained mean difference (23.96), and the mean post df (2) at 0.05 level and also the mean post -test pain
-test anxiety scores of experimental group 1 at 5-7 cm scores at 5-7 cm dilatation in experimental group 1 was
dilatation was (42.63) which was lower than the pre- (4.86) which was lower than the post -test pain scores
test anxiety scores (65.3), the obtained mean difference of experimental group 2 (5.06) and control group (8.53)
(22.66), This shows that the intervention back massage was found to be statistically significant as evident from
was effective to reduce the anxiety the ‘F’ value 159.695 for df (2) at 0.05 level. These
Figure no: 2. Intensity of anxiety scores during first stage of are revealed that back massage is more effective than
ambulation to reduce pain among primigravida mothers
during first stage of labour.

The mean post -test anxiety scores at 3-4 cm

dilatation in experimental group1 was (40.9) which was
lower than the post -test pain scores of experimental
group 2 (43.2) and control group (67) was found to be
statistically significant as evident from the ‘F’ value
163.348 for df (2) at 0.05 level. And also the mean post
labour among primigravida mothers at 5- 7 cm dilatation in -test anxiety scores at 5-7 cm dilatation in experimental
experimental and control group. group 1 was (42.63) which was lower than the post -test
The mean post -test anxiety scores of experimental pain scores of experimental group 2 (42.80) and control
group 2 at 3-4 cm dilatation was (43.23) which was group (70) was found to be statistically significant as
lower than the pre-test pain scores (66.43) the obtained evident from the ‘F’ value 485.441 for df (2) at 0.05
mean difference (23.20), and the mean post -test anxiety level. These are revealed that back massage is more
effective than ambulation to reduce anxiety among
 32 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

primigravida mothers during first stage of labour. Primigravida Mothers . Nitte University Journal Of
Health Science.201.,3(4) : 104-107
CONCLUSION
3. Savitha V. Nayak S. Paul S .Effect Of Ambulation
Both back massage and ambulation are effective to During First Stage Of Labour On Labour Pain
reduce the pain and anxiety among primigravida mothers And Outcome Of Labour Among Primigravida
during first stage of labour. But the effectiveness of back Mothers. Journal Of South Asian Federation Of
massage was found to be more. There was a significant Obstetrics And Gynecology .(2013) .5(1) :1-3 .
correlation between pain and anxiety scores of the 4. Abbasi Z. Abedian Z . ismaili H. The Effect Of
primigravida mother of experimental groups 1 and 2. Back Massage On Pain Intensity During The First
Back massage and ambulation can be used as a non Stage Of Labour In Primiparous Women .The
- pharmacological intervention and recommended as a Iranian Journal Of Obstetrics ,Gnaecology And
pain relief measure during first stage of labour. Infertility .2009.11(4) : 39-47.
Conflict of Interest – No Conflict 5. Pilevarzadeh M . Salari S. Shafiei N. Effect Of
Massage On Pain And Anxiety During Labour .
Source of Funding- Self Journal Of Reproduction & Infertility (2002).3(4):
Ethical Clearance – Obtained from Dr. RP 1-12.
Government Medical College, Kangra at Tanda, 6. Lowe. NK. The pain and discomfort of labour and
Himachal Pradesh. Birth .Journal Of Obstetrics Gynecology Neonatal
Nursing.1996. 25(1):82-92
REFERENCES
7. Judie A. Brintha N. N. Touch And Massage On
1. Witoon, Jad Sada, Non pharmacologic labour Pain Perception Among Primiparturient Mothers
pain relief, Journal of The Medical Association of .Research And Review: Journal Of Nursing And
Thailand, 2004:87(3):203-10 Health Sciences. 2015 .1(3) : 48-51
8. Field T. Pregancy And Labour Massage.Expert
2. Joseph R. M . fernandes P .Effectiveness Of Jasmine
Review Of Obstetrics And Gynecology .2010 .5(2)
Oil Massage On Reduction Of Labour Pain Among
:177-181.
 DOI Number: 10.5958/0974-9357.2017.00067.8

A Study to Assess the Level of Stress and Coping Strategies

Adopted by Higher Primary School Teachers in Selected
Schools at Mangalore

Susaimari A1, Alphonsa Ancheril2

1
Lecturer, St.Ignatius Institute of Health Sciences, Honavar, Prabhat Nagar,
2
Vice Principal & HOD of Psychiatric Nursing, Athena College of Nursing, Mangalore

ABSTRACT

Background: Teaching is one of the most significant and visible profession in the world. All other
professions in the society have their bases in the profession of teaching. The experience of work stress can
alter the way the person feels, thinks, and behaves, and can also produce changes in their psychological,
physiological and behavioral functions. Actual sources of work related stress among teachers remain far
from clearly established norms.

Objectives: To assess the level of stress and coping strategies among higher primary school teachers and to
find out the relationship stress and coping.

Methodology: Descriptive survey design was used for the study. The study was conducted in 5 higher
primary schools. Purposive sampling technique was used to select the school and the sample. The sample
consisted of 50 primary school teachers. Data was collected by administering stress rating and coping rating
scale.

Results: The findings showed that 54% of the sample had moderate stress and 90% had good coping and
10% had very good coping. Statistically there is significant negative correlation between the mean stress
score and coping score at 0.05 level of significance as the obtained ‘r’ value (-0.349) is higher than the table
value (0.279). Therefore, it can be inferred that as coping increases stress reduces. Karl Pearson correlation
was used to find out the correlation.

Conclusion: The findings showed that as coping increases stress reduces. There was no significant
association between baseline variables with mean stress core and coping score.

Keywords: Primary school teachers, coping, stress.

INTRODUCTION for human beings to encounter stress both at the work

place as well as at home. More than 70% of the diseases
The new millennium brought with its fast changes
are said to be stress related1.
marked revolution in knowledge, information, explosion
and the associated acceleration of changes in social Today mental disorders stand among the leading
structure, technology, occupations and organizations cause of diseased disability in the world. One in four
making for an increasingly complex living environment, (25%) people in the world will be affected by mental or
placing high demands on an individual’s capacity to neurological disease at some point in their lives. Being
adapt. Thus there is difficulty for individuals to cope ‘stressed’ as a universal phenomena reflecting in each
with the prevailing environment of fast-changing aspect of life cycle, was identified as a major cause of
situation that causes disequilibrium in the body and attrition among all categories of people. Although stress
mind resulting in stressful situations. It is very common affects the biophysical and emotional well being of the
 34 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

people, it varies with age, gender, mental capabilities, 4. To find out the association between stress and
and environmental conditions. Stress has been defined coping with selected demographic variables (gender,
as a process, which causes or precipitates individual to age, religion, marital status, type of family, personal
believe that they are unable to cope up with situation income, education, years of teaching experience, no. of
facing them and the feeling of anxiety, tension, students in the class, and location of the school).
frustration, and anger, which results from the recognition
that they are failing in some ways and situation is getting
MATERIALS AND METHOD
out of control2. A descriptive survey design is adopted for this
study. Purposive sampling technique was used to
Stress affects the body in a variety of ways. For
select the school as the sample. Sample consisted of 50
example stress can reduce enjoyment of occasion,
higher primary school teachers selected from 5 higher
can cause mood changes and can cause severe health
primary schools. The tool consisted of stress rating
problems. Over time stress is related to several chronic
scale and coping rating scale. the tool was prepared
medical conditions such as high blood pressure, migraine
by the investigator and content validity of the tool was
headaches, and a variety of other medical conditions.
established by giving it to experts. Reliability of the
Since everyone has a unique response to stress, there is
tool was found to be 0.77 for stress rating scale and
no “one size fits all” solution to managing it. No single
0.8 for coping scale. The tool was administered to the
method works for everyone or in every situation. So
sample in their respective schools for getting permission
experiment with different techniques and strategies, it
from school authorities and informed consent from the
is helpful to think of the four as Avoid, Alter, Adapt and
participants.
Accept.3

OBJECTIVES RESULTS

Out of the 50 sample 53 (70%) had studied up to

1. To assess the level of stress among higher
B.Ed, 16% D.Ed, 14% were postgraduates. With regard
primary school teachers as measured by a rating scale.
to marital status 72% were married and 28% were
2. To assess the coping strategies adopted by unmarried. More than half (52%) of the sample had
higher primary school teachers using a rating scale. work experience of more than 10 years and only 4% had
less than one year experience.
3. To find out the relationship between stress and
coping strategy of higher primary school teachers.
Table 1: Frequency and percentage distribution of selected demographic variables of higher primary
school teachers n=50

Sl. No. Demographic variables Frequency Percentage

Marital status
a. Married 36 72
b. Unmarried 14 28
1.
c. Any other 0 0
Education
d. D. Ed. 8 16
2. e. B. Ed. 35 70
f. Any other (M.Sc./MA) 7 14
3. Teaching experience
1.
g. Less than 1 year 2 4
1.
h. 1 – 5 years 14 28
i. 6 – 10 years 8 16
j. Over 10 years 26 52
 International Journal of Nursing Education, July-September, Vol.9, No. 3 35

The maximum stress score in the scale was 90. The There was no significant association of demographic
mean stress score of the sample was 32.9 ± 9.834. More variables with mean stress score and coping score.
than half (54%) of the sample had moderate stress and
the score ranged between 30-59, 46% had mild stress.
DISCUSSION

The findings of the present study revealed that 54%

of the sample had moderate stress and 90% of them
had good coping. A study conducted to determine the
job stress among primary school teachers in southwest
Nigeria showed that 73% reported headaches and other
health problems. In order to cope with stress 61.9% of
teachers said they watch TV programmes, 58.9% listen
to music, 53.3% talk with friends, and 51.7% pray to
cope with job stress. The finding was similar to current
study.4
Figure 1: Distribution of sample according to their level of
stress A study was conducted on teachers in Swaziland
showed that teachers were moderately stressed by their
With regard to coping the maximum score in the
work. There was a weak relationship between the level
tool was 60. Majority of the sample (90%) had good
of work-related stress and the demographic variables
coping and 10% had very good coping. The mean score
of gender, marital status, and qualifications. Age had a
was 32.38 ± 4.98.
moderate significant relationship with the level of work-
related stress for the sample.5 In the present study there
was no significant association between demographic
variables and mean stress and coping score.

It is evident from the findings of the present study

and other studies that teaching in higher primary school
is stressful as majority of them experienced moderate
level of stress. Findings also revealed that some type of
coping was present in higher primary school teachers.

Figure 2: Distribution of sample according to their level of CONCLUSION

coping
Teaching profession causes some kind of stress
Relationship between mean stress score and mean
to the teachers as they spent most of the time in the
coping score was tested using Karl Pearson coefficient
school and also have the responsibility of their home.
‘r’ test. It was found that there is a significant negative
The vast changing and advanced technology demands
correlation between stress score and coping score. The
that teachers have to be update in their knowledge. The
obtained value -0.349 was higher than the table value
many subjects and the number of children they have to
(0.279, p ≤ 0.05). This shows that as coping mechanism
deal with make the person stressful. Teachers have to
increases stress decreases.
be encouraged to make use of leisure time activities
Table 2: ‘r’ test showing relationship between and find time for relaxation. Those have good coping
mean stress score and mean coping score mechanism have less stress compared to people those
who do not find time for relaxation. The present study
Variable Median Mean SD r P findings showed that there is a negative relationship
Stress 31.50 32.90 9.834 between mean stress score and mean coping score.
-0.349 0.013 Hence it can be said that as coping level increase, stress
Coping 32.00 32.38 4.981
level will decrease.
r48=0.279, P≤ 0.05 Conflict of Interest – Nil
 36 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Ethical Clearance : Ethical clearance is obtained 3. Bhuvaneswari S. Healthy ways to manage stress.
from the ethical committee of Athena college of Nursing Nightingale Nursing Times 2009 Jun;5(3):33
Mangalore. 4. Angel SW. Mind body exercise upon stress among
Source of Funding : Self special teachers. Journal of Mental Health Nursing
2013;1(2).
REFERENCES 5. Dlamini CC. An empirical study of stressors that
1. Ceasar J. Coping with stress. Health Action 2009 impinge on teachers in secondary schools in
Sep;26. Swaziland. South African Journal of Education
2013;33(1).
2. Prasad VC, Suresh A. The level of stress and coping
mechanisms adopted by 1st year B. Sc. nursing
students. Archives of Medicine and Heath Sciences
2013;1(1).
 DOI Number: 10.5958/0974-9357.2017.00068.X

Effectiveness of Video Assisted Teaching on CPR

(Cardiopulmonary Resuscitation) for Children among
Student Nurses

Waikhom Ranjana Devi

Assistant Professor, HOD of Paediatric Nursing, College of Nursing, SVBP Hospital,
Medical College, Meerut. Uttar Pradesh, India

ABSTRACT

Recent studies have shown that emergencies like asphyxia, shock, respiratory arrest and drowning are
quite common in children. The survival rates of the children who are affected depends on how initial
lifesaving procedures are delivered during the emergencies. CPR is such a measure that can save life in any
emergency.

Materials and method: An evaluative approach was used to assess knowledge regarding CPR for children.
Pre-experimental one group pre-test and post-test research design was used. The sample comprised of 100
student nurses. The sample were selected by purposive sampling technique. Permission was obtained from
the principals and administrators in selected nursing institutions at Tumkur. The data collection process had
done from four selected nursing institutions. On first day, self-administered knowledge questionnaire was
given and knowledge regarding CPR for children was assessed. On the same day video assisted teaching
regarding CPR for children was conducted for a period of one hour after pre-test. Eighth day, the investigator
administered post-test and assessed their knowledge on CPR for children.

Result: The study showed that the student nurses have moderately adequate knowledge regarding CPR for
children. The pre-test mean knowledge score was 15.26 with standard deviation of 3.41. There was a marked
gain in mean knowledge score after administration of video assisted teaching was 33.69 with standard
deviation of 1.96.The difference in mean knowledge score was statistically significant at 0.05 level ‘t’ value
=45.302.There was significant association between the pre-test level of knowledge on CPR for children
with selected socio-demographic variables.

Conclusion: The findings of this study support the need for conducting an awareness programme on CPR
for children to the student nurses. The study proved that the student nurses has improved their knowledge
after administration of video assisted teaching. Such teaching programme can be carried out in the hospital
and community to improve the knowledge of student nurses.

Keywords: Video assisted teaching, CPR for children, student nurses.

INTRODUCTION practice that is actively taught to the general public as

well as medical, nursing, and paramedical personnel.2
CPR is a lifesaving procedure that is performed
when a child’s breathing or heartbeat has stopped, as in CPR procedure is carried out by the doctors,
cases of drowning, suffocation, choking, or injuries. CPR registered nurses, trained nurses and other health
is a combination of rescue breathing, which provides personnels to prevent from the cardiac arrest and
oxygen to a child’s lungs and chest compressions, which respiratory arrest. CPR is important to perform when a
keep the child’s blood circulating.1 Cardiopulmonary child stops breathing or heart stops beating. Performing
resuscitation (CPR) in children is a widely promoted effective CPR keeps the blood oxygenated and keeps the
 38 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

brain supplied with the oxygen it needs to stay alive and Objectives of the study:
avoid damage.3
• To assess the knowledge on CPR
The AHA states that, in the absence of CPR, a (Cardiopulmonary Resuscitation) for children among
victim’s chance of survival drops 7 to 10 percent for student nurses.
every minute that lapses between collapse and medical
• To evaluate the effectiveness of Video assisted
intervention. Every year, there are 294,851 cardiac
teaching on CPR for children among student nurses by
arrests treated outside of the hospital in the United
comparing pre-test and post-test knowledge score.
States. About 80 percent of all cardiac arrests that occur
out of the hospital happen in homes, which emphasize • To find the association between the pre-test
the importance of all capable individuals being trained level of knowledge with selected socio-demographic
to perform CPR in pediatrics.4 variables.
By WHO in India, perinatal asphyxia is one of MATERIALS AND METHOD
the common causes of neonatal mortality. Data from
National Neonatal Perinatal database suggest that An evaluative approach has been used to assess
perinatal asphyxia contributes to almost 20% of neonatal knowledge regarding CPR (Cardiopulmonary
deaths. 5 Resuscitation) for children among student nurses. Pre-
experimental one group pre-test and post-test research
CPR is indicated for any person who is unresponsive design was used. The sample comprised of 100 student
with no breathing or only gasps as breathing as it is most nurses. The sample were selected by purposive sampling
likely that they are in cardiac arrest. If a child still has a technique. Permission was obtained from the principals
pulse, but is not breathing (respiratory arrest), artificial and administrators in selected nursing institutions at
respirations are more appropriate. CPR will restore Tumkur. The data collection process had done from four
breathing and blood circulation of oxygen-rich blood to selected nursing institutions i.e. total 100 student nurses
the brain. Without oxygen, permanent brain damage or who were studying in III GNM course. On first day, self-
death can occur in less than 8 minutes. 6 administered knowledge questionnaire was given to the
student nurses on knowledge regarding CPR for children
CPR for children can be performed by one rescuer
was assessed. On the same day video assisted teaching
and two rescuers. When one rescuer performs CPR, the
regarding CPR for children was conducted for a period
ratio of compressions to ventilations is 30:2 and it is
of one hour after pre-test. Eighth day, the investigator
performed at a rate of 100 compressions per minute.
administered post-test and assessed their knowledge on
Two-rescuer CPR should be performed with one rescuer
CPR for children.
positioned at the chest area and the other positioned
beside the victim’s head. The compression-ventilation FINDINGS
ratio is 5:1, with a pause for ventilation of 1 ½ to 2
seconds consisting primarily of inspiration. 7 Organization of findings:

Hence the investigator felt that there is need to The data collected from the student nurses has been
educate the student nurses regarding CPR for children organized and presented under the following headings:
by administrating video assisted teaching to promote
Section I: Frequency and percentage distribution
knowledge of CPR for children.
of the socio-demographic variables.
Video assisted teaching provides directed learning,
Section II: Analysis of pre-test and post-test
which improves the ability of learning. It enables the
knowledge on CPR for children among student nurses.
participants to understand the topic in easiest way.
So the investigator selected video assisted teaching Section III: Effectiveness of video assisted teaching
programme to impart the knowledge regarding CPR on CPR for children.
(cardiopulmonary resuscitation) for children to the
student nurses. Section IV: Association between the pre-test level of
knowledge with selected socio-demographic variables.
 International Journal of Nursing Education, July-September, Vol.9, No. 3 39

Table 1: Overall knowledge score on CPR (Cardiopulmonary Resuscitation) for children: Pre-test
n=100

Questions Mean SD Mean % of Knowledge

Overall pre-test Knowledge 15.26 3.41 38.15

The above table 1 shows that the overall mean knowledge scores of student nurses are found to be 15.26% with
standard deviation of 3.41.

Table 2: Overall knowledge score on CPR (Cardiopulmonary Resuscitation) for children: Post-test
n=100

Knowledge Mean SD Mean % of Knowledge

Overall post-test Knowledge 33.69 1.96 84.225

The above table shows that the overall mean knowledge scores of student nurses are found to be 33.69% with
standard deviation of 1.96

Table 3: Comparison of pre-test and post-test knowledge score of student nurses on CPR (Cardiopulmonary
Resuscitation) for children. n=100

Pre-test Post-test
Area of Knowledge Paired t-test
Mean SD Mean SD
Definition of CPR 1.06 0.58 2.00 0.00 16.126
Indications of CPR for children 2.50 0.67 5.23 0.47 32.534
Emergency equipment 1.81 0.94 4.37 0.68 21.034
Methods of CPR for children 3.25 0.69 6.07 0.77 25.967
Steps preceding CPR for children 2.32 0.78 4.65 0.69 21.895
Location of CPR compression sites 1.17 0.51 2.47 0.56 18.112
Important points to follow during CPR for children 1.54 0.69 3.21 0.56 18.565
Complications of CPR for children 0.50 0.75 1.8 0.45 19.384
Signs of success of CPR for children 0.30 0.07 0.96 0.15 16.78
After care of the patient 0.81 0.72 2.93 0.29 27.565

S-Significant at 0.05 level of significance, df =99

Table 4: Determination of overall mean knowledge score on pre-test and post-test knowledge score
n = 1 0 0
Knowledge Pre-test Post-test Mean of difference Paired t-test
Overall mean knowledge 4.07
15.26 33.69 45.302*
score (SD=4.07)

*Significant at 0.05 level of significance, df =99

To find the significance difference between pre-test and post-test level of knowledge of student nurses, the
following research hypothesis was stated:
 40 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

• H1- There will be significant difference between pre-test and post-test knowledge score regarding CPR for
children among student nurses.

This hypothesis was tested using paired‘t’ test.

From the above table 4 the overall mean knowledge score of pre-test was15.26 and post-test was 33.69 and mean
difference was 18.43 with standard deviation of 4.07. The obtained’t’value 45.302 is greater than the table value
at 0.05 level of significance. Therefore “t” value is found to be significant. It shows that there will be significant
difference between pre-test and post-test knowledge score of student nurses regarding CPR (Cardiopulmonary
Resuscitation) for children. Therefore the research hypothesis is accepted.

Table 5: Association between pre-test level of knowledge with selected socio-demographic variable.
Variables No. of Level of knowledge P value df Chi-square
student test(χ2)
nurses(n) Below Above
median median
Age 19-20 years 25 16 9 0.557 2 0. 344

21-22 years 75 43 32

23 years and above - - -

Gender Male 8 7 1 0.087 1 2.920

Female 92 52 40

Religion Hindu 46 30 16 0.338 3 2.171

Christian 50 26 24

Muslim 4 3 1

Others - - -

Place of residence Rural 66 37 29 0.405 1 0. 693

Urban 34 22 12

Type of family Nuclear 94 56 38 0.973 2 0. 001

Joint 6 3 3

Extended - - -

Previous knowledge Yes 100 - - - 1 -

regarding CPR for
children No -

Received training on CPR Yes - - - - 1 -

for children
No 100

Source of information Books 94 55 39 1.000 3 0.000

Journals - - -

Internet - - -

Others like T.V, 6 4 2

radio
 International Journal of Nursing Education, July-September, Vol.9, No. 3 41

The above table shows that χ2 value computed maximum mean knowledge score obtained in the post-
between the pre-test level of knowledge of student test by student nurses is found in the area of methods of
nurses regarding CPR for children with selected CPR for children (6.07) with highest standard deviation
socio-demographic variables. Variables of age (χ2=0. of 0.77 and followed by indications of CPR for children
344), gender (χ2=2.920), religion (χ2=2.171), place of (5.23) with standard deviation of 0.47 and least mean
residence (χ2=0.693), type of family (χ2=0.001), previous knowledge score (0.96) is found in the area of signs
knowledge regarding CPR for children (χ2=0.00), of success of CPR for children with lowest standard
received training on CPR for children (χ2=0.00) and deviation of 0.15 and the overall mean knowledge scores
sources of information (χ2=0.000) were significant at of student nurses are found to be 33.69% with standard
0.05 level. Thus it can be interpreted that there is a deviation of 1.96. By comparing the pre-test mean
significant association between the pre-test level of knowledge score and post-test mean knowledge score
knowledge with selected socio-demographic variables was finding effective. So video assisted teaching on
such as age, gender, religion, place of residence, type CPR for children among student nurses was effective.
of family, sources of information on CPR for children.
The overall mean knowledge score of pre-test
Therefore the research hypothesis is accepted.
was15.26 and post-test was 33.69 and mean difference
CONCLUSION was 18.43 with standard deviation of 4.07. The
obtained’t’value 45.302 is greater than the table value at
Majority of the student nurses 75(75%) were in the 0.05 level of significance. Therefore “t” value is found
age of 21-22 years .Majority of the student nurses were to be significant. It shows that there will be significant
92(92%) female and 8(8%) were male. Majority of the difference between pre-test and post-test knowledge
student nurses 50(50%) were Christians, remaining 46 score of student nurses regarding CPR (Cardiopulmonary
(46%) were Hindus and 4 (4%) were Muslims and none Resuscitation) for children. Therefore the research
of them from others. Majority of the student nurses hypothesis is accepted.
66(66%) were residing in rural area and remaining
34(34%) were residing in urban area. Majority of the Association between the pre-test level of knowledge
student nurses 94(94%) were from nuclear family, of student nurses regarding CPR for children with
6(6%) were from joint family and none of were extended selected socio-demographic variables. Variables of age
family. The data shows that the entire student nurses (χ2=0. 344), gender (χ2=2.920), religion (χ2=2.171),
100(100%) were having previous knowledge regarding place of residence (χ2=0.693), type of family (χ2=0.001),
CPR for children. The data depicts that no student previous knowledge regarding CPR for children
nurses 100(100%) were received training on CPR for (χ2=0.00), received training on CPR for children
children before. Among the student nurses majority (χ2=0.00) and sources of information (χ2=0.000) were
of them 94(94%) were having sources of information significant at 0.05 level. Thus it can be interpreted that
from books, 6(6%) from others like T.V, Radio, Heath there is a significant association between the pre-test
personnel and none of the student nurses were having level of knowledge with selected socio-demographic
from journals and internet. variables such as age, gender, religion, place of
residence, type of family, sources of information on
The maximum mean knowledge score obtained
CPR for children. Therefore the research hypothesis is
in the pre-test by student nurses is found in the area
accepted.
of methods of CPR for children (3.25) with standard
deviation of 0.69 and followed by indications of CPR Conflict of Interest: I Waikhom Ranjana Devi,
for children (2.50) with standard deviation of 0.67, confirm that this manuscript is original and has not
steps preceding CPR for children (2.32) with standard been published elsewhere and is not under consideration
deviation of 0.78 and least mean knowledge score by any other journals. I agree with submission to
(0.30) is found in the area of signs of success of CPR International Journal of Nursing Education. I have no
for children with lowest standard deviation of 0.07 and conflict of interest to declare.
the overall mean knowledge scores of student nurses are
Source of Funding: There has been no significant
found to be 15.26% with standard deviation of 3.41.The
of financial support for this work that could have
 42 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

influenced its outcomes. 4. Importance of CPR & FirstAid www.livestrong.com/

article/151859- the importance of-CPR for
Ethical Clearance: Informed consent was obtained
children
from the Administrators/ Principals and Participants of
the respected nursing institutions before conducting the 5. Aggarwal R, Deorari Ak, Paul VK. Post
data collection and maintained the confidentiality and resuscitation management of asphyxiated neonates.
anonymity of the subjects and information gathered. 2001 Dec;68(12);1149-53
6. Indications of Cardiopulmonary resuscitation http:
REFERENCE //en.wikipedia.org/wiki/Cardiopulmonaryresuscita
1. CPR – child (1 to 8 years old) www.nlm.nih.gov/ tion#Indications
medlineplus/ency/article/00012htm 7. Child CPR 2 rescuer Training Summary http:
2. MP Ryan, et.al. Resuscitation attempts in children //www.procpr.org/en/training_video/child-cpr-2-
who cause injury. Emerg Med J 2003;20:10-12 rescuer

3. When to Perform CPR Steps for Children

http://www.buzzle.com/articles/cpr-steps-for-
children.html
 DOI Number: 10.5958/0974-9357.2017.00069.1

Factors Influencing Headache Severity in Patients with

Chronic Tension Type Headache attending Tertiary Health
Care Facility

Gopichandran L1, Kanniammal C2, Valli G3, Jaideep M3, Srivastava A4, Vanamail P5, Dhandapani M6
1
Lecturer, College of Nursing, AIIMS, New Delhi, 2Dean, SRM College of Nursing, SRM University, Chennai,
3
Professor, Meenakshi Ammal Dental College, Meenakshi University, Chennai, 4Professor, Neurology Dept,
AIIMS, New Delhi, 5Associate Professor (Biostat), OBG Dept, AIIMS, New Delhi,
6
Lecturer, NINE, PGIMER, Chandigarh

ABSTRACT

Background: Chronic tension type headache (CTTH) produces disability among children, adolescents and
adults resulting in poor quality of life with adverse socio-economic impact among patients and their family.
Awareness on headache severity and various associated factors is essential for appropriate management.

Objective: To assess the severity of headache and its various influencing factors among patients of CTTH.

Method: A cross sectional study was conducted in a tertiary care center North India to assess the severity
of headache and its associated factors in patients of CTTH. Using consecutive sampling techniques, 169
patients who were diagnosed with CTTH, treated with analgesics or/and betablockers were recruited after
taking informed written consent. Wong Backer Foundation Pain intensity scale was used to assess the
severity of pain.

Results: A pain severity score of six out of ten was reported by 56% of the patients followed by score of
eight by 37% of the patients and the mean pain score reported by the patients was 6.62+1.16. Significantly
more patients of CTTH who are married (p=0.037), had duration of illness less than two years (p<0.001) and
who were treated with only analgesics (p<0.001) reported higher severity of headache.

Conclusion: Patients with CTTH experience moderate to high severity of headache. Higher pain score was
reported by patients who are married, had shorter duration of illness and were treated with only analgesics.
To aid in appropriate pharmacological and non-pharmacological management, it is important for nurses
to monitor the severity of headache in patients with CTTH and identify patients who are at risk for severe
headache.

Keywords: Chronic tension type headache, Pain characteristics, Pain severity, Medication overuse
headache

INTRODUCTION adolescents and adults resulting in poor quality of life

with adverse socio-economic impact among patients
Chronic tension type headache (CTTH) is one of and their family1. Awareness on headache severity
the common cause of hospital visits among adolescents and various associated factors will aid in appropriate
and adults. CTTH produces disability among children, management2-4.

Corresponding author CTTH is affecting 0.5 to 4.8% of the worldwide

Manju Dhandapani, population and is an umbrella term used for a group
Lecturer, NINE, PGIMER, Sector-12, of headache disorders1,5,6. According to International
Chandigarh. 160012, [email protected] Headache Society, CTTH is defined as the occurrence of
 44 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

bilateral tension type headache (TTH) at a frequency of

≥15 days per month with pressing or tightening quality,
mild to moderate intensity, lasting hours to days or
unremitting and not worsening with routine physical
activity but may be associated with mild nausea,
photophobia or phonophobia7. Figure 1: Wong Backer Foundation Pain Intensity Scale

Though it is believed that CTTH is due to the muscle Appropriate descriptive and inferential statistical
tension in head, neck or face, the exact cause of CTTH measures were used for analysis. Chi square test was
is not known and is found to be associated with some used to assess the association between severity of pain
stimulating or precipitating factors like poor vision, and categorical variables of the patients.
stress, hunger etc8,9. CTTH is reported to affect the RESULTS
activities of daily living, increase stress, reduce quality
of sleep and increase medication overuse of the patient Table 1: Distribution of patients with CTTH
and may affect the quality of life of caregivers10,11. based on demographical and clinical variables
Self-medication is common in patients with CTTH
n=169
due to easy availability of over the counter drugs12,13.
Medication overuse may chronify the headache leading Demographic and clinical variables Mean+SD
to medication overuse headache (MOH) with a cycle of of patients or f (%)
intensified analgesic use, its side effects and long-term
Age 45.18+10.93
disability14,15.
Females 96(57)
Gender
The perception of severity of headache by the patient Males 73(43)
must be assessed in patients with CTTH to identify
Unmarried 15(9)
patients at high risk for disability and poor quality of
Married 143(85)
life16. Various factors such as demographic and clinical Marital status
Divorced 5(3)
factors may influence the severity of headache17-19. Widowed 6(4)
Hence present study was conducted with the objective
Nuclear 99(59)
of monitoring the severity of pain and it’s influencing Type of family
Joint 70(41)
factors among patients of CTTH.
Illiterate/ Primary 1(0.6)
MATERIALS AND METHOD Secondary 21(12.4)
Education
Higher-secondary 55(32.5)
A cross sectional study was conducted in a Graduation &above 69(40.8)
tertiary care center North India to assess the severity
Student/unemployed 75(44.4)
of headache and its associated factors in patients of
Unskilled laborer 17(10)
CTTH. Using consecutive sampling techniques, 169 Occupation
Salaried/Self employed 64(38)
patients who were diagnosed with CTTH, treated with Retired/Pensioner 13(7.7)
analgesics or/and betablockers were recruited in the Monthly 10000-15000 30(17.8)
study. Informed written consent was taken from the income (Rs./
month) >15000 139(82.2)
patients. Wong Backer Foundation Pain Intensity Scale
(Figure 1) was used to assess the severity of pain20. The Rural 18(10.7)
Habitat Semi-urban 22(13)
pain scale described as face 0 (doesn’t hurt at all), face 2
Urban 129(76.5)
(hurts just a little bit), face 4 (hurts a little bit more), face
6 (hurts even more), face 8 (hurts a whole lot) and face 6 months-1 year 7(4.1)
Illness >1yr-2yrs 70(41.4)
10 (hurts as much as you can imagine). Patients were
duration >2yrs-3yrs 60(35.5)
asked to report the maximum pain experienced on Wong
>3yrs 32(18.9)
Backer Foundation Pain Intensity Scale during or prior
Analgesics
to one week of assessment. Medications
60(35.5)
Analgesics and 109(64.5)
betablockers
 International Journal of Nursing Education, July-September, Vol.9, No. 3 45

Sociodemographic and clinical profile of patients n=169

with CTTH enrolled in present study is given in table 1.
Mean age of the patients was 45.18+10.93 years ranging
from 18 years to 72 years. Out of 169 CTTH patients
studied, 96(57%) were females, 75(44.4%) were salaried
or self-employed and 82.2% had monthly family income
more than 15,000/-. Approximately half of the patients
i.e. 69(40.8%) were graduate and above graduates and Figure 2: Severity of headache in patients with CTTH
55(32.5%) of them were having education up to higher Headache severity of patients with CTTH during and
secondary. Most of the patients were married (85%) one week prior to assessment is shown in figure 2. The
and urban inhabitants (76.5%). Duration of CTTH mean pain score reported by the patients was 6.62+1.16.
since diagnosis was between one years to two years in with a range of four to eight. A pain severity score of six
70(41.4%) of the patients. Most of the patients (64.5%) out of ten was reported by 56% of the patients followed
were treated with both analgesics and beta blockers and by a score of eight by 37% of the patients and a score of
rest of them (35.5%) were only on analgesics. four by only 7% of the patients.

Table 2: Association of selected factors with headache severity n=169

Pain severity
Variables of patients with CTTH χ2 (p value)
4 6 8
18-40 years 3(5) 41(68) 16(27)
Age 41-60 years 8(8) 46(48) 43(44) 7.73(0.1)
60 years 0(0) 8(67) 4(33)
Females 7(7) 60(63) 29(30)
Gender 4.75(0.09)
Males 4(5.5) 35(48) 34(46.5)
Unmarried 0(0) 13(87) 2(13)
Marital status Married 9(6) 75(52.5) 59(41.5) 10.22(0.037*)
Divorced/ widowed 2(18) 7(64) 2(18)
Nuclear 8(8) 58(59) 33(33)
Type of family 2.14(0.34)
Joint 3(4) 37(53) 30(43)
Illiterate& primary 2(9) 11(50) 9(41)
Education Upto Higher secondary 5(6.5) 40(51) 33(42.5) 2.94(0.57)
Graduation and above 4(6) 44(64) 21(30)
Student/unemployed 5(7) 37(49) 33(44)
Unskilled laborer 1(6) 9(53) 7(41)
Occupation 4.15(0.66)
Salaried/Self employed 4(6) 42(66) 18(28)
Retired/Pensioner 1(8) 7(54) 5(8)
10000-15000 4(13) 13(43.5) 13(43.5)
Monthly Income
4.04(0.13)
(Rs) >15000 7(5) 82(59) 50(36)

6 months-2 year 3(4) 12(16) 62(80)

Illness duration 113.97(<0.001*)
>2yrs 8(9) 83(90) 1(1)
Analgesics 1(2) 6(10) 53(88)
Medications 103.74(<0.001*)
Analgesic and Betablockers 10(9) 89(82) 10(9)
 46 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Association of socio-demographic variables and professionals as the severity of the headache affects the
clinical variables of patients with headache severity is working hours and work efficiency of the patients with
shown in table 2. Headache severity on Wong Backer neurological and neurosurgical diseases1,5,21-24.
Foundation Pain Intensity Scale reported by patients
Several factors influencing severity of headache
with CTTH ranged from four to six. Significantly more
were analyzed in present study. Similar to previous
patients with CTTH who are divorced or widowed i.e.
studies1,5,21, females were found to have more prevalence
18% had reported lower headache severity of four as
of CTTH in present study. Previous literatures show that
compared to 6% of the unmarried or none of the married
headache characteristics including frequency, duration
patients. Significantly more married patients i.e. 41.5%
and severity are similar in both male and female
reported higher headache severity of eight as compared
patients17,18. Similarly, there was no association elicited
to13% patients who are unmarried and 18% divorced or
between gender and severity of headache in our study.
widowed (p=0.017).
Significantly higher headache severity was reported
Higher headache severity of eight was reported by
by patients who were married as compared to patients
significantly more patients with duration of illness less
who were unmarried and divorced. CTTH is however
than two years i.e. 80% as compared to only 1% patient
considered to be a stress related disorder13,25-27 and
with illness duration more than two years (p<0.001).
stress related to meeting role expectation from the
Most of the patients (90%) with illness duration more
family members, stressful interpersonal relationship28,
than two years had reported headache severity of six.
conflicts between family members, poor coping and
When higher headache severity of eight was reported by
lack of time for self-care could explain the reason for
88% of the patients on analgesics, only 9% of patients
higher severity of headache among patients with CTTH
on both analgesics and beta blockers had reported the
who are married. The association between marital status
same (p<0.001). Most of the patients (82%) who are on
and CTTH may be probably related to the occurrence of
both analgesics and beta blockers had reported headache
stressful life events or significant life changes14,21,28.
severity of six.
As reported in literature29,30, significantly higher
Other variables of the patients such as age, gender,
headache severity was reported by patients who had
type of family, education, family income and occupation
duration of illness less than two years. Significantly
did not show any significant influence on pain severity.
higher headache severity was also reported by patients
DISCUSSION who were only on analgesics as compared to patients
who were on both analgesics and beta blockers. On
Present study aimed to assess the severity of
diagnosis of CTTH, pharmacological management is
headache and associated factors among patients with
initiated with analgesics. Efficiency of analgesics such
CTTH. Similar to previous reports1,21, mean age of the
as acetaminophen or NSAIDS in controlling headache
patients in present study was 45.18+10.93, majority of
in patients with CTTH is uncertain12,31. Inefficiency
them were females, married and employed. Though
of these drugs in managing the symptoms leads to
exact causes and mechanism of CTTH is unclear, stress
medication overuse during this period, stress as well
is considered to be one of the primary triggering factor
as disability and may adversely influence the headache
in these patients. Stress could be high among females
severity in patients with CTTH. It is reported that
who are married and employed as they need to balance
frequent self-medication other than the prescribed
professional responsibilities along with family responsi
analgesics is a common practice among patients of
bilities1,5,6,21.
CTTH. This may lead to initiation of betablockers
Headache severity in patients with CTTH in or tricyclic antidepressants to reduce the pain and
literature is reported as moderate to severe22,23. In improve well-being of the patients. Hence, most of the
present study, the patients with CTTH reported moderate patients would be prescribed with any of these drugs for
severity of 6.62+1.16 out of ten. But a headache severity better pain control along with analgesics as the illness
score of eight was reported by 37% of the patients is progresses and become more chronic. Pharmacological
of important concern to the nurses and other health management also should be modified as per the severity
 International Journal of Nursing Education, July-September, Vol.9, No. 3 47

of the pain reported by the patients to avoid medication 2. Bhatia R, Sharma G, Gopichandran L. A
overuse and their side effects29,30,32. Comparative Study to Assess the Knowledge
on Risk Factors, Warning Signs and Immediate
CTTH has its repercussions on the individual, their
Treatment of Stroke among Stroke Survivors
family, work, social relations and activities of daily
and Patients of Cardiovascular Disorders who
living. It also may impair interpersonal relationship
are at risk of Stroke. Asian Journal of Nursing
within family, workplace and society. CTTH is not only
Education and Research 2016; 6(3): 391-6.
affecting the family and social system, but also have an
important consequence in the public health system. High 3. Dhandapani M, Dhandapani S, Agarwal M,
average appointments made in various health facilities Mahapatra AK. Pain perception following
due to CTTH substantially increases the medical different neurosurgical procedures: a quantitative
prescription1,5,17,21. prospective study. Contemporary nurse 2016;
52(4): 477-85.
The findings of the study show the importance 4. Rajan D, Lakshmanan G, Gupta SK,
of pain monitoring in patients of CTTH which can Sivasubramanian R, Saxena A, Juneja R. Effect
be done by nurses using simple and inexpensive of recorded maternal voice on child’s cooperation
techniques. As CTTH is related to stress, patients can during cardiac catheterization–A randomized
be taught about coping strategies to cope with stressors, controlled trial. Indian pediatrics 2017; 3(54):
relaxation techniques, problem solving and conflict 204-7.
management techniques to improve their interpersonal
5. Rao GN, Kulkarni GB, Gururaj G, et al.
relationship23,33.
The burden of headache disorders in India:
CONCLUSION methodology and questionnaire validation for a
community-based survey in Karnataka State. The
The tension type headache is one of the prevalent journal of headache and pain 2012; 13(7): 543-
disabling condition which is proven to have repercussions 50.
on patients’ quality of life and their family roles as well
6. Rasmussen BK, Jensen R, Schroll M, Olesen
as social roles. Patients with CTTH experience moderate
J. Epidemiology of headache in a general
to high severity of headache and was reported more
population--a prevalence study. Journal of clinical
by patients who are married, had shorter duration of
epidemiology 1991; 44(11): 1147-57.
illness and were treated with only analgesics. To aid in
appropriate pharmacological and non-pharmacological 7. The International Classification of Headache
management, it is important for nurses to monitor the Disorders: 2nd edition. Cephalalgia : an
severity of headache in patients with CTTH and identify international journal of headache 2004; 24 Suppl
patients who are at risk for severe headache. 1: 9-160.
8. Lebedeva ER, Kobzeva NR, Gilev DV, Kislyak
Conflict of Interest: There was no conflict of
NV, Olesen J. Psychosocial factors associated
interest.
with migraine and tension-type headache in
Ethical Clearance: Taken from AIIMS (ND) Ethics medical students. Cephalalgia : an international
Committee journal of headache 2016.
9. Zarei MR, Shabani M, Chamani G, Abareghi
Source of Funding: Self  
F, Razavinasab M, Nazeri M. Migraine patients
REFERENCES have a higher prevalence of PTSD symptoms in
comparison to chronic tension-type headache
1. Kulkarni GB, Rao GN, Gururaj G, Stovner LJ, and healthy subjects: a case-control study. Acta
Steiner TJ. Headache disorders and public ill- odontologica Scandinavica 2016: 1-3.
health in India: prevalence estimates in Karnataka
10. Dhandapani M, Gupta S, Sivashanmugam
State. The journal of headache and pain 2015; 16:
Dhandapani PK, et al. Study of factors
67.
determining caregiver burden among primary
 48 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

caregivers of patients with intracranial tumors. 21. Gururaj G, Kulkarni GB, Rao GN, Subbakrishna
Surgical neurology international 2015; 6. DK, Stovner LJ, Steiner TJ. Prevalence and
11. Dhandapani S, Sharma K. Is” en-bloc” excision, sociodemographic correlates of primary headache
an option for select large vascular meningiomas? disorders: results of a population-based survey
Surgical neurology international 2013; 4: 102. from Bangalore, India. Indian journal of public
health 2014; 58(4): 241-8.
12. Koushede V, Holstein BE, Andersen A, Hansen
EH. Stress and medicine use for headache: does 22. Ashina S, Lyngberg A, Jensen R. Headache
sense of coherence modify the association? characteristics and chronification of migraine and
European journal of public health 2011; 21(5): tension-type headache: A population-based study.
656-61. Cephalalgia : an international journal of headache
2010; 30(8): 943-52.
13. Westergaard ML, Glumer C, Hansen EH, Jensen
RH. Medication overuse, healthy lifestyle 23. Castien RF, van der Windt DA, Grooten A, Dekker
behaviour and stress in chronic headache: Results J. Effectiveness of manual therapy for chronic
from a population-based representative survey. tension-type headache: a pragmatic, randomised,
Cephalalgia : an international journal of headache clinical trial. Cephalalgia : an international journal
2016; 36(1): 15-28. of headache 2011; 31(2): 133-43.
14. Westergaard ML, Glumer C, Hansen EH, Jensen 24. Dhandapani S, Singh H, Negm HM, Cohen S,
RH. Prevalence of chronic headache with and Anand VK, Schwartz TH. Cavernous Sinus
without medication overuse: associations with Invasion in Pituitary Adenomas: Systematic
socioeconomic position and physical and mental Review and Pooled Data Meta-Analysis
health status. Pain 2014; 155(10): 2005-13. of Radiologic Criteria and Comparison of
Endoscopic and Microscopic Surgery. World
15. Boe MG, Thortveit E, Vatne A, Mygland A.
neurosurgery 2016; 96: 36-46.
Chronic headache with medication overuse:
Long-term prognosis after withdrawal therapy. 25. Omidi A, Zargar F. Effects of mindfulness-
Cephalalgia : an international journal of headache based stress reduction on perceived stress and
2016. psychological health in patients with tension
headache. Journal of research in medical sciences
16. Sertel M, Simsek TT, Yumin ET. The Effect of
: the official journal of Isfahan University of
Body Awareness Therapy on Pain, Fatigue and
Medical Sciences 2015; 20(11): 1058-63.
Health-related Quality of Life in Female Patients
with Tension Type Headache and Migraine. The 26. Bakhshani NM, Amirani A, Amirifard H,
West Indian medical journal 2016. Shahrakipoor M. The Effectiveness of
Mindfulness-Based Stress Reduction on
17. Marcus DA. Gender differences in chronic
Perceived Pain Intensity and Quality of Life in
headache in a treatment-seeking population. The
Patients With Chronic Headache. Global journal
journal of gender-specific medicine : JGSM : the
of health science 2015; 8(4): 142-51.
official journal of the Partnership for Women’s
Health at Columbia 2000; 3(6): 50-3. 27. Dhandapani S, Sarda AC, Kapoor A, Salunke
P, Mathuriya SN, Mukherjee KK. Validation
18. Marcus DA. Gender differences in treatment-
of a New Clinico-Radiological Grading for
seeking chronic headache sufferers. Headache
Compound Head Injury: Implications on the
2001; 41(7): 698-703.
prognosis and the need for surgical intervention.
19. Smitherman TA, Ward TN. Psychosocial factors of World neurosurgery 2015; 84(5): 1244-50.
relevance to sex and gender studies in headache.
28. Myers TC, Wittrock DA, Foreman GW. Appraisal
Headache 2011; 51(6): 923-31.
of subjective stress in individuals with tension-
20. http://www.olchc.ie/Files-Uploaded/Nursing- type headache: the influence of baseline measures.
Guidelines/Pain-Wong-Baker-Faces-English.pdf. Journal of behavioral medicine 1998; 21(5): 469-
<Pain-Wong-Baker-Faces-English.pdf>. 84.
 International Journal of Nursing Education, July-September, Vol.9, No. 3 49

29. Monteith TS OMT-tHWMOPaCICpahr-. venous fistula: clinico-radiological profile and

<nihms580139.pdf>. outcome following surgical occlusion in an Indian
30. Stephens G, Derry S, Moore RA. Paracetamol neurosurgical center. Neurology India 2013;
(acetaminophen) for acute treatment of episodic 61(4): 406.
tension-type headache in adults. The Cochrane 33. Dhandapani S, Kapoor A, Gaudihalli S,
database of systematic reviews 2016; (6): Dhandapani M, Mukherjee KK, Gupta SK. Study
Cd011889. of trends in anthropometric nutritional indices
31. Krishnan A, Silver N. Headache (chronic tension- and the impact of adiposity among patients of
type). BMJ clinical evidence 2009; 2009. subarachnoid hemorrhage. Neurology India 2015;
63(4): 531.
32. Dhandapani S, Gupta A, Singh J, Sharma B,
Mahapatra A, Mehta V. Spinal dural arterio-
 DOI Number: 10.5958/0974-9357.2017.00070.8

A Descriptive Study to Identify the Breastfeeding Problems

among Postnatal Mothers in Justice K.S. Hegde
Hospital, Mangalore

Sunanda B1, Sabitha Nayak2

1
Lecturer, 2Vice Principal & HOD, Dept. of OBG Nursing, Nitte Usha Institute of Nursing Sciences,
Nitte University, Paneer, Mangalore

ABSTRACT

There are many complications associated with breastfeeding, which include engorgemement, breast
tenderness, sore or painful nipples,plugged ducts and infection of the breast (mastitis). A descriptive study
conducted to identify the breastfeeding problems among 100 postnatal mothers at Mangalore. The purposive
sampling technique was used to select the participants and the study revealed that the majority of them were
hindus between 18-25 years, 72% of them were homemakers, 61% primi mothers, 67% had a normal delivery
and 87% had information about breastfeeding through the parents. There is no significant association
between the breastfeeding problems and demographic variables. There is no significant association between
the breastfeeding problems and demographic variables.

Keywords: Breastfeeding problems, Postnatal mother.

INTRODUCTION Limited information and experience about the

breastfeeding among postnatal mothers is the most
Breastfeeding has been recognized as the best
universal problem7. So investigator interested to initiate
possible sole source of nutrition in Infants by the
the childbirth education to especially primi mothers to
American Academy of Pediatrics. It has many benefits
prevent the breastfeeding complications.
to both infant and mother1.
METHODOLOGY
Breastfeeding problems are common among the
primi mothers and can be very challenging for the Research approach: Quantitative research
mother and infant. The anxiety accompanies primi approach.
mothers breastfeeding in addition to underestimating the
Research design: Descriptive research design was
intensity of newborn care can contribute to breastfeeding
adopted to this study.
difficulties2. There are many complications associated
with breastfeeding, which include engorgement, breast Setting: The study was conducted in Justice
tenderness, sore or painful nipples, plugged ducts, and K.S.Hegde Hospital,Deralakatte.
infection of the breast (mastitis)3.
Population: The population selected for the
study comprises women after delivery admitted in the
postnatal ward
Correspondence:
Mrs. Sunanda B Sample/Sampling techniques: The convenient
Lecturer, Dept. of OBG Nursing, Nitte Usha Institute of sampling technique was adopted to select 100 postnatal
Nursing Sciences, Nitte University, Paneer, Mangalore- mothers.
575018 Mobile: 9482098457,
1. Instrument/method of data collection: a)
E-mail: [email protected]
demographic proforma to analyze the baseline variables.
 International Journal of Nursing Education, July-September, Vol.9, No. 3 51

b) Structured Checklist of breastfeeding problems among postnatal women consists 28 items.

DATA COLLECTION METHOD

To conduct the research study, the investigator obtained formal written consent from the authorities of the
hospital, prior to the data collection and obtained ethical clearance. The investigator assured confidentiality to the
participants to get the cooperation and explained the purpose of the study to the participants.

RESULTS

Table No.1: Distribution of the samples according to demographic characteristics

Demographic variables Frequency Percentage

18-25 51 51
26-35 39 39
Age
36 and above 10 10
Hindu 65 65
Religion Muslim 33 33
Christian 2 2
<10,000/- 81 81
Income(in rupes)
10,000-20,000 19 19
Primary 29 29
Education: Highschool 40 40
PUC 31 31
Cooli 28 28
Occupation:
Home maker 72 72
Primi 61 61
Parity Multiparity 36 36
More than five 3 3
Normal delivary 67 67
Mode of delivery
Caesarean section 33 33
Male 54 54
Sex of the baby
Female 46 46
Good 99 99
Condition of the mother after delivery
Bad 1 1
Good 99 99
Condition of the baby after the birth
Bad 1 1
<2 kg 22 22
2-3 kg 43 43
Birth weight of the baby
3-4 kg 26 26
>4kg 9 9
Friends 1 1
Source of information about
Parents 87 87
breastfeeding
Midwives 12 12
Yes 30 30
Newborn admitted in NICU
No 70 70
Newborn fed with other than Yes 29 29
breastfeeding No 71 71
Within half an hour 65 65
Initiation of Breastfeeding Within one hour 14 14
After one hour 21 21
 52 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

The Frequency, percentage distribution of the combining work and breastfeeding, 80% of the mothers
score on breastfeeding problems among postnatal not felt very tired, 88% of the mothers comfortable in
mothers. positioning the baby, 77% of the mothers have not felt
embarrassed when nursing, 58% of the babies were active
100% of the mothers had no problems of bleeding
during breast feeding, 88% of the mothers had no leaking
nipples, 98% of the mothers had no problems of fissures
breasts, 89% of the babies had no difficulty in latching
in the areola or nipple, 82% of the mothers have no
on, 83% of the mothers had no breast engorgement,
problem of Milk squirts out when baby starts to feed,
99% of the mothers had no breast infection, 97% of the
80% of the mothers had no problem of getting upset at
babies were not reluctant to nurse due to fussiness, 72%
feedings, 74% of the mothers had no feeling pain when
of the babies were not breast fed frequently, 82% of
milk comes in, 97% of the Babies didn’t wants to nurse
the Mothers have not believed that she had inadequate
on one breast, 99% of the mothers had no symptoms
milk, 97% of the mothers family had encouragement,
of flu, 96% of the mothers had no red bumps on breast,
99% of the mothers had no twins, 98% of the mothers
86% of the mothers had good experience of breast
had no breast mass, 95% of the mothers had no nipple
feeding. 88% of the mothers have not felt tensed and
size problems, 88% of the mothers had no big breast and
overwhelmed, 86% of the mothers had no difficulty in
94% of the mothers had no nipple retraction.

Table No: 2: The association between the breastfeeding problems with selected demographic variables
using chi-square test or Fishers exact test.

Demographic variables < median >median Chi-square value ‘p’ value

Age in years : 18-25 29 22 .358

26-35 18 21 2.165
36 and above 7 3
Religion: Hindu 38 27
Muslim 16 17 2.90
.207
Christian 0 2
Monthly income(in rupees):
<10,000/- 42 39 .792
.448
10,000-20,000/- 12 7
Education: Primary 14 15
Highschool 22 18 .605
.743
PUC 18 13
Occupation: Cooli 19 9
3.01
Home maker 35 37 .118

There is no significant association between the breastfeeding problems and demographic variables. There is no
significant association between the breastfeeding problems and demographic variables.
Comparison between primi and multipara indicates that there was no much of differences between primi and
multipara with regards to breast feeding problems.
Table No: 3: Comparison of breastfeeding problems among primi and multipara postnatal mothers chi-
square test or Fishers exact test will be used.

Frequency Mean Standard deviation ‘t’ value P value

Para - 1 61 24.44 3.13 .262
1.128
para - 2 39 25.10 2.65 ‘p’ value >0.05 there is no
difference in parity
Total 100
 International Journal of Nursing Education, July-September, Vol.9, No. 3 53

Comparison between premium and multiplier of the mothers had no nipple size problems, 88% of the
indicates that there was no much of difference between mothers had no big breast and 94% of the mothers had
primary and multipara with regards to breast feeding no retracted nipples.
problems.
The findings were consistent with the observational
DISCUSSION study conducted at the Government Medical College
Hospital, Chandigarh to identify problems of
The study was conducted on 100 postnatal mothers breastfeeding from birth till discharge on 840 mothers
to elicit the breastfeeding problems during first week of and the results were 30.4% mothers had problems related
hospital stay. to breastfeeding during the first week of postnatal period
The study findings were as follows: Majority (51%) and 80% of these were in the first 48 hours of delivery.
of the women were between the age group of 20-25 The problems were more in younger and primiparous
years. Highest percentage (65%) of the respondents mothers. Initiation of feed within the first one hour of
were Hindus, 81% of the women had the family income birth was only seen in 26.1%. None of the mothers who
between Rs.5,000 and Rs.10,000, 40% of the postnatal delivered by caesarean section fed the baby in the first
mothers had high school education, 72% of the mothers one hour, rather 39% mothers fed their babies for the
were home makers, 61% of them were primipara first time after 4 hours of delivery. Problems that were
mothers, 67% of the mothers had normal vaginal encountered during hospital stay were nipple anomaly
delivery, with respect to gender, 54% were male babies. in 26.1% mothers; engorged breast, sore or cracked
43% of the newborn’s birth weight was between 2.5 to nipples in 25% mothers; perception of ‘not enough milk’
3.0 kg, 87% of the mother’s parents were the source of in 37.5% mothers; and multiple problems were faced by
information regarding the breast feeding, and 43% of the 11.3% mothers. Perception of ‘not enough milk’ was
mothers have initiated the breast feeding within half an the most common problem faced by both primi and
hour. multiparous mothers. Engorged breast, sore nipple was
more in first time mothers.
In the findings of the study shows that 100% of the
mothers had no problems of bleeding nipples, 98% of CONCLUSION
the mothers had no problems of fissures in the areola
This study looked at the breastfeeding problems
or nipple, 82% of the mothers have no problem of
among the mothers and newborn during the hospital
Milk squirts out when baby starts to feed, 80% of the
stay. In this study all postnatal mothers who were
mothers had no problem of getting upset at feedings,
admitted during the data collection period were included
74% of the mothers had no feeling pain when milk
in the study and majority of mothers had no breast
comes in, 97% of the mothers were feeding their
feeding problems. This may be due to a good family
babies from both the breasts. 96% of the mothers had
support system in India where most of the mothers are
no red bumps on breast, 86% of the mothers had good
taken care of by their family members especially parents
experience of breast feeding. 88% of the mothers have
and grandparents. However the study was limited
not felt tensed and overwhelmed, 86% of the mothers
to one particular setting and further research can be
had no difficulty in combining work and breastfeeding,
done to generalize the findings. Awareness programs
80% of the mothers were not tired, 88% of the mothers
on postnatal care with emphasis on breastfeeding
were comfortable in positioning the baby, 77% of the
issues will encourage all mothers to detect at the
mothers have not felt embarrassed when nursing, 58%
earliest any breastfeeding problems and to seek advice.
of the babies were active during breast feeding, 88% of
Childbirth education programs will also enhance
the mothers had no leaking breasts, 89% of the babies
exclusive breastfeeding for six months as per WHO
had no difficulty in latching on, 83% of the mothers had
recommendations.
no breast engorgement, 99% of the mothers had no
breast infection, 72% of the babies were breast fed on Conflict of Interest – NIL
demand, 82% of the Mothers have believed that she had
Source of Funding- Self
adequate milk, 97% of the mothers had good family
support. 98% of the mothers had no breast mass, 95%
 54 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Ethical Clearance – Obtained from Institutional in a medical college in Chandigarh. Indian Journal
Ethics Committee, Nitte Usha Institute of Nursing of Public Health 2009 Oct;53(4):264.
Sciences, Nitte University on 16th January 2016. 6. Sithara Suresh, Kamlesh K Sharma, Manju Saksena
REFERENCES et.al Predictors of breastfeeding problems in the
first postnatal week and its effect on exclusive
1. Lowder milk and Perry, “Maternity and women’s breastfeeding rate at six months: experience in
health care” (2007), 9th Edition, Mosby publishers, a tertiary care centre in Northern India : Indian
Missouri, Page No. 755-786. journal of public health:2014(58);270-273
2. Dutta “Text Books of Obstetrics”, (2015), 8th 7. Giugliani, “Common problems during lactation
EDITION, New central book agency Pvt. Ltd and their management”, of the pediatrics CS. Nov
Culcatta. Page No. 438-454. 2004:80 Page No. 147-154.
3. Denise.F.Polit and Beck, “Nursing Research”, 8. Mckinney, “Maternal Child Nursing”, (2000)
(2012) 9th edition, Lippincott William and Wlkins, copyrightl, ,WD saunders company, Philadelphia,
Philadelphia, Page No. 49-50. pAge No. 592-605.
4. Maheshwari Murugesan, “Exclusive Breastfeeding 9. Parmar V.R. “Knowledge attitude and public health
up to 6 moths. Is is Hassel or acceptable?”, regarding breastfeeding”, Indian Journal of public
Nightingale nursing times, April 2005, Page No. health, Vol-XXXXIV, No.4, july 2000, Page No.
21-22. 131-133.
5. Jain S, Parmar VR, Single M, Azad C. Problems of 10. Prabha Ramesh, “Breastfeeding among rural
breastfeeding from birth till discharge- experience mothers of Delhi”, The nursing journal of India,
Aug 1994, Page No. 12-13.
 DOI Number: 10.5958/0974-9357.2017.00071.X

Effectiveness of Individually Packed Sterile Guaze versus

Drum Packed Gauze on the Incidence of Surgical Site Infection
(SSI) in Surgical Ward AIIMS, New Delhi

Nemkholam Chongloi1, Anurag Srivastava2

1
Tutor , College of Nursing , New Delhi, 2Chief and HOD, Surgery Unit, AIIMS, New Delhi

ABSTRACT

Nosocomial infections are a major cause of morbidity and mortality. They are also one of the leading causes
of death. The major cause of nosocomial infections is due to poor quality of health service delivery by the
health care providers.

Hospital-acquired infections increased the burden of disability and emotional stress of the patient and
may reduce the quality of life. The economic costs are considerable because it leads to financial lost as it
increased length of stay for infected patients. Most of the hospital-acquired infections are avoidable and
preventable through proper care

Objectives : To determine the Effectiveness of Individually Packed Sterile Guaze versus Drum Packed
Gauze on the incidence of Surgical Site

Method: During the study period only the individually packed sterile guaze was used for surgical wound
dressings. The incidence of SSI was measured as per the report of Health Care Associated Infection (HCAI)
Rate, Main hospital AIIMS

Findings : The incidence of SSI has been reduced after using the single or individually packs guaze for
caring of the surgical wound.

Conclusion: The results show that there was steady decline in the surgical site infection (SSI) after the
administration of Individually Packed Sterile Guaze.

Keywords: Surgical Site Infection (SSI), Packed Sterile Guaze, Drum Packed Gauze

BACKGROUND guaze is picked up with cheatle forceps. The sterility

of the cheatle forcep is not guaranteed and sometimes
Infection has always been a feature of human life
the lid of the drum in which the sterile guaze are kept,
and sepsis in modern surgery continues to be significant
are left open and even touched by the patients or
problems for healthcare practitioners across the
their relatives with a bared hand which makes them
globe.SSI are a real risk associated with any surgical
unsterilized. The same unsterilized guazed are used for
procedure and represent a significant burden in terms
dressings of the wound which increased the chance of
of patient morbidity and mortality, and cost to health
SSI. The advantage of single-use packaging materials is
services around the world.1
prevention of migration of microorganisms. Single-use
Imperfectly sterilized dressings are a likely cause packaging systems offer maximum safety, sterility and
of unexplained wound infections and epidemic and efficiency, therefore every medical device which needs
sporadic puerperal sepsis.2 to be sterilised has to be packed.3

Surgical wards (D7) of AIIMS are supplied with The used of the cheatle forcep and drum has been
cotton and guaze packed in the drum and the sterile obsolete in many hospitals in India and is replaced by
 56 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

individually packed sterile guaze. If this individually of three different size made by 100 Gsm, craft paper
packed sterile guaze and cotton is used, it could be new 22cmx27 cm ,13 cm x 22cm, 8x10 cm with a quantity
steps towards reduction of SSI as well as HAI in our of 18000 each was indented for the purpose of packing
reputed hospital. Over a period of 4 years, the technical Gamzi, cotton pad and guaze piece respectively. The
sub-committee of The laboratories, Belfast City Hospital, indented items were issued on 31/07/15. Packing of
Belfast, discarded all drums, cheatle forceps resulting in gamzi, cotton pad and guaze piece with the brown
contribution to the prevention of infection4 envelop was started at D7 from august 2015 and
continued till October 2015.
Therefore this study was carried out to find out
whether individually packed guaze for dressing of Traditionally drum packed guaze were used for
wounds will reduce the incidence of SSIs Surgical wound dressing which was replaced by
individually packed guaze. All the staffs were instructed
MATERIAL & METHOD to use only the individually packed sterile guaze for
Preparation and implementation of Individually surgical wound dressings during the study period. The
Packed Sterile Guaze : Self sticking brown envelop incidence of SSI was measured as per the report of
Health Care Associated Infection (HCAI) Rate, Main
hospital AIIMS.

FINDINGS

Table 1: Incidence of SSI before and after Intervention

Total no of SSI
Sl. no Month/ year major surgeries Total no of pathogens isolated
(Unit I) No %

June 2015 79 5 6 Acb(1), PSA(4), MRSA(1)

Before Intervention
(Use of Drum Packed Acb(1), E.coli (4),
Gauze) July 2015 80 6 7.5 MRSA(1),MSSA(1),PSA(1), kleb pneumonaie
(1)

Staphylococcus (1),enterococcus faecalis (1),

August 2015 97 6 6
SCN(1), E.coli (2)

Acb(2),enterobacter(1), E.coli
After Intervention September 2015 71 6 8.4
(2),MSSA(1)staph cog-ve (2)
(Use of Individually
Packed Sterile Guaze) 78 MSSA(2), PSA(1),KLEB OXYTOCA (1),
OCTOBER 2015 3 3.8
Acb(1)

Table 1 show that there was steady decline in the incidence of surgical site infection (SSI) after the administration
of Individually Packed Sterile Guaze.

DISCUSSION Principles of aseptic technique is increasingly

recognized as being integral to all branches of nursing
One important risk factors for Surgical Site
and essential for safe and competent practice9.
Infections (SSI) is asepsis 5, therefore Aseptic technique
is essential for all nurses, regardless of their branch or This study agreed to the importance of using aseptic
field of practice. technique in care of surgical wounds. The present
practice of using cotton and guaze packed in the drum
Aseptic technique is considered most appropriate is against the principle of aseptic technique which states
in acute care hospital settings, for patients at high risk that Sterile object becomes unsterile when touched by
for infection, and for certain procedures such as sharp unsterile objects, Sterile items that are out of vision
instrumental wound debridement.6-8 are considered unsterile and any package that appears
 International Journal of Nursing Education, July-September, Vol.9, No. 3 57

already open is considered unsterile. The cotton and REFERENCES

guaze from the drum is picked up by cheatle forcep
whose sterility is not guaranteed and sometimes the lid 1. Finn Gottrup, Andrew Melling, Dirk A. Hollander,
of the drum in which the sterile guaze are kept ,are left worldwide wound article reprinted in the EWMA
open and even touched by the patients or their relatives journal 2005;5(2): 11-15
with a bared hand which makes them unsterilized. The 2. S.N Hayes .present-day methods of sterilizing
same unsterilized guazed are used for dressings of the dressings, the british medical journal may 1,
wound which increased the chance of SSI. The principle 1937)
of aseptic technique also clearly states that when there is 3. Tim Galekop Sterilization. Past and Future
doubt, throw it out, there should be no compromise on © 2016 IDI • Updated: 24 March 2013, 18:
sterility.10 49 [UTC] http://www.deconidi.ie/html/educ/
educationarticles.
If individually packed sterile guaze and cotton is
used, it could be new steps towards reduction of SSI 4. D. Allison. Hospital Central Sterile Supply
because it is a single use and once the pack is open the Departments. The Laboratories, Belfast City
health care providers know that sterility is compromise Hospital, Belfast https://www.ncbi.nlm.nih.gov/
and discard it. It also enables health care provider to pmc/articles/PMC2098045/pdf/brmedj03041-
check for the expiry date as the expiry dates can be 0058.pdf
written on the outer package. 5. Fighting Surgical Site Infections By Bonnie M.
Barnard, MPH, CIC http://www.infectioncontrol
The present study concludes that there is a reduction
today.com/articles/2002/04/fighting-surgical-site-
in the incidence of SSI after the used of sterile dressing
infections.aspx
in the form of individually packed sterile guaze and
cotton and supports that Aseptic technique and dressings 6. Rowley S, Clare S, Macqueen S, Molyneux R.
have been recommended for post-operative management ANTT v2: an updated practice framework for
of wounds for 24-48 hours. 11 aseptic technique. Br J Nurs. 2010;19:S5–S11.
7. Bates-Jensen BM, Ovington LG. Management
CONCLUSION of exudate and infection. In: Sussman C, Bates-
Based on the present study and our clinical Jensen B, eds. Wound Care: A Collaborative
experience, the incidence of Surgical Site Infections Practice Manual for Physical Therapists and
(SSI) has been reduced after using the single or Nurses. 3rd ed. Philadelphia, PA: Lippincott,
individually packs guaze for caring of the surgical Williams & Wilkins; 2007:215–233.
wound. 8. Ferreira AM, de Andrade D. Integrative review
of the clean and sterile technique, agreement and
Recommendations disagreement in the execution of dressing. Acta
a. Nosocomial infections- implications for Palulista de Enfermagem. 2008;21:117–121.
packaging 9. Nursing and Midwifery Council (2007) Essential
Skills Clusters. NMC Circular 07 Annexe 2. nMC,
Sterile barrier systems materials are a vital part London)
of the medical device for the hospital and industry.
10. Berman Audre .Kozier and Erb’s Fundamentals
Budgeting on packaging materials is the wrong thing
of Nursing: Concepts, Process, and
to do. After all, we are talking about the safety of the
Practice, p 696 https://books.google.co.in/
patient .3
books?isbn=8131715256
Conflict of Interest – none 11.  
Mangram AJ, Horan T, Pearson ML, Silver
BS, Jarvis WR. Guideline for Prevention of
Source of Funding- self
Surgical Site Infection. 1999;20:247–248.
Ethical Clearance – This study was approved by Centers for Disease Control and Prevention.
the ethics committee of AIIMS in New Delhi. http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/
SSI.pdf.
 DOI Number: 10.5958/0974-9357.2017.00084.8

Effect of Nutritional Intervention among Children with

Protein Energy Malnutrition

Soja S L1, N Udaya Kiran2, Darly Saramma Mammen3

1
Assistant Professor, Govt. College of Nursing, Kottayam, Kerala, 2Professor & HOD, Department of Community
Medicine, K.S. Hegde Medical Academy, Mangalore, 3Associate Professor, ICH, Govt. Medical College, Kottayam

ABSTRACT

Protein Energy Malnutrition [PEM] is one of the prime nutritional and health problem in India. The PEM
leads to poor growth and high levels of morality among children under two years, which is a major cause of
30% of death among under five children.

Method:- The research was carried out in two phases ; in first phase cross sectional design and an evaluative
research approach with quasi experimental one group pretest posttest design was used. In second phase
of the study the sample of 520 children attending in selected anganwadies were selected by multistage
sampling technique. The tools used for the data collection were demographic proforma, observation record,
dietary practice assessment questionnaire, questionnaire to find out the factors contributing to PEM and
problem assessment checklist.

Result:- Findings of the study revealed that the mean weight at the time of pretest for Children was 9. 962±
1.288 and was increased to 10.159 ± 1.318 during the posttest 1. The mean weight at post test 2 was 10.57
± 1.298. it revealed a difference in mean weight before and after the intervention (p<0.001). There was
association found between PEM & selected demographic variables like age (χ2 = 10.087, p<0.05), education
of mother (χ2 = 17.476, p<0.05) and occupation of father (χ2 = 12.592, p<0.05)

Conclusion:- The nutritional intervention was effective in gaining the weight among the children. Nurse
educators and administrators should take the responsibilities for conducting the structured teaching program
on prevention and management of PEM among community and anganwadies.

Keywords:- Nutritional intervention program, protein energy malnutrition , children

INTRODUCTION Nutrition forms the most predominant influence on

the development of the growing child. Human survival
Children are priceless resources and if the nation has always dependent upon food and hence nutrition has
neglect there health it could become nation of unhealthy determined his place of living and his way of living.
citizens. Nutrition of under-five children are of Malnutrition accounts for more than fifty percent of all
paramount important because it can lead to long lasting infant mortality in developing countries especially in the
effect on the mental and physical health of children. below five years age group.2
India faces the burden of deceases in which nutritional
deficiencies are most common.1 Protein Energy Malnutrition (PEM) has been
identified as a major health and nutritional problem in
India. It occurs particularly in weaklings and children
in early years of their life. It is not only an important
Corresponding author:
cause of childhood morbidity and mortality but leads
Dr. Soja S.L.
to permanent impairment of physical and possibly
Assistant Professor, Govt. College of Nursing
of mental growth of those who survive.3 The current
Kottayam, Kerala, E-Mail : [email protected]
concept of PEM is that its two forms ; kwashiorkor
 International Journal of Nursing Education, July-September, Vol.9, No. 3 59

and marasmus. PEM found to account for about four variable in this study was the nutritional intervention
million deaths in children. It is still the first killer disease programme to mothers of children attended in selected
(54%) followed by acute respiratory infection (20%) and anganwadis of Kottayam District.
diarrhea (18%) in the global perspective.4
The dependent variable was the nutritional status of
Achieving and maintaining child health is a challenge children as measured by checking the body weight. Data
for parents, care givers, pediatricians, nutritionists and was collected in the respective anganwadis where the
public health specialists and for all those who care for children attended. The following tools viz: demographic
the being of the future generations. A healthy child is proforma, dietary practice assessment questionnaire
not only a child with no clinically apparent illness, but a and observation record were used to collect data from
child with adequate physical development both in terms children. Demographic proforma and dietary practice
of achieved size, acquired motor skills and adequate in assessment questionnaire were administered to all
neurological and emotional development.5 the mothers and the data on demographic variables
of subjects, dietary and factors contributing to PEM
The prevalence of PEM varies across the states
were assessed. Observation record was used by the
and Kerala rates low (27%). This is to be viewed with
investigator to assess the weight of the child as per
serious concerned and necessary steps are to be taken
age. Then the nutritional intervention programme was
to analyze the situation and arrive at feasible solutions.
administered to mothers. After the intervention post test
Understanding the nutritional status of children far
was conducted after 3 months and 6 months to measure
reaching implication for the better development of
the weight of children.
future generations.6
RESULTS
Malnutrition is a curable problem. It is not always
due to shortage of foods, too often there is starvation in Table 1(a): Current dietary practices of children
midst of plenty. The family place an important role in
N=520
shaping the food habits and these habits are passed from
one generation from another. The present study aimed Variables (n=520) Frequency Percentage
to determine the effect of nutritional interventional
Breast milk as first feed 414 79.6
program on children with Protein Energy Malnutrition
Use of artificial feeds 54 49.5
OBJECTIVES Type of artificial feeds used

1. Identify the current dietary practices of Naan 34 48.6

children Lactogen 86 51.4
Exclusive breast feeding 377 72.5
2. Identify the severity of PEM among children
Frequency of feeding
3. Determine the effectiveness of nutritional Hourly 2 0.4
intervention programme to the children with PEM
Every 3 hour 45 8.7
4. Determine the association of severity of PEM Demand feedings 167 32.1
with selected demographic variables. 3 times a day 306 58.8

MATERIALS & METHOD Manage feeding diarrhoea

Stop weaning foods 126 24.2
The research was carried out in two phases. In first
Continue breast feeding 284 54.6
phase survey approach and research design was cross
Consult doctor 110 21.2
sectional design. An evaluative approach with quasi
experimental one group pretest post test design was Initial weaning food
used in second phase of the study. The samples of 520 Cereals 301 57.9
children attending in selected anganwadis were selected Fruit juices 81 15.6
by multistage sampling technique. The independent
Commercially available foods 25 4.8
 60 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Most of the children (79.67) were fed with breast Cont... Table 1(b): Current dietary practices of
milk as their first diet and 49.5% used artificial feeds. children N=520
On an average 51.4% children were fed with lactogen
as their first food. Majority (72.5%) of children were Nuts/oilseeds/eggs/meat 24 04.6
given exclusive breast feeding upto six months. 54.6% All the above 273 52.5
of mothers continued breast feeding even at the time of
weaning diarrhea. 57.9% of children were introduced Cleaning of feeding vessels
with cereals as their initial weaning food Wash with soap and water 204 39.2
Table 1(b): Current dietary practices of children Wash with warm water 177 34.0

N=520 Wash with boiled water 51 9.8

Fre- Percen- Boil the container for ten minutes 88 16.9

Variables (n=520)
quency tage
Washing vegetables before cutting 437 84
Family pattern diet started at
Periodically deworm the child 343 66
<1 year 146 28.1
Walks barefooted outside 237 45.6
1-2 year 297 57.1
Store water in closed vessels 463 89
2-3 year 77 14.8

Meal timings of the family Above data presented majority of children (57.1%)
started family pattern diet at 1-2 years of age. 48.8%
3 times /day 193 37.1
were currently feeding at least three times in a day with
3 times /day with snacks 250 48.1 snacks in between. 39.2% of mothers clean the vessels
used for feeding with soap and water. On an average
4 times /day with snacks 77 14.8 52.5% of children include all food groups in their diet.
Food items in the diet of the child Majority (84%) were used to wash vegetables before
cutting. 66% of children were periodically dewormed.
Cereals/ millets/pulses 126 24.2
On an average 54.4% children used to walk barefooted
Milk/fruits/ green leafy vegetables 97 18.7 outside. Most of the families (89%) stored water in
closed vessels

Table 2: Severity of PEM before and after the intervention

Severity Pretest Posttest 1 Posttest 2

(n=520) f % F % f %

Normal 275 52.88 285 54.81 379 72.88

Grade I 146 28.08 164 31.54 139 26.73

Grade II 97 18.65 70 13.46 2 0.38

Grade III 2 00.38 1 0.19 - -

Before intervention 245 children had PEM. Of these 146 belonged to grade I and 97 belonged to grade II. After
the intervention (after 3 months) the prevalence of PEM was 45.19 (235). Of these 164 were in grade I and 70 were
in grade II. After 6 months the PEM reported among 27.12% of the children
 International Journal of Nursing Education, July-September, Vol.9, No. 3 61

Table 3(a): Multiple comparisons by using Boneferronic adjustment

95% CI for the difference

Observation (n=245) Mean difference Standard error P value
difference

Pretest & posttest 1 0.197 0.02 < 0.001 0.149 to 0.245

Posttest 1 & Posttest 2 0.607 0.03 < 0.001 0.535 to 0.680

Pretest & posttest 2 0.417 0.021 < 0.001 0.3591 to0.461

From the above table it is clear that mean difference in pretest and posttest 1 was 0.197 ± 0.02 and increased
to 0.607 ± 0.03 in posttest 1 and in posttest 2 ,0.41 ± 0.021. The p values are less than 0.05 and hence there is a
difference in weight before and after interventions

Table 4(a): Association between severity of PEM with respect to Age, Gender and Education of parents

Normal Grade 1 Grade II &III

Variable (n=520) χ2 p value
(n=275) (n=146) (n=99)

Age in years

2-3 72 44 42

3-4 140 74 43 10.087 0.039*

4-5 63 28 14
Gender

Male 150 83 59 0.425 0.809

Female 125 63 40
Education of father
Education of father

Illiterate 35 25 14

Primary 91 44 29 3.107 0.795

Secondary 119 57 42

Diploma/ Degree 30 20 14

Education of mother

Illiterate 20 11 5

Primary 108 31 33 17.476 0.008*

Secondary 121 78 46

Diploma /Degree 26 26 15

*significant
The above table it is clear that the obtained chi square value for age (χ2 =10.087, p< 0.05) and education of
mother (χ2 =17.476, P<0.05) were higher than the table value (χ(4)2 =9.488, χ(6)2 =12.592) at 5% level of significance.
Thus the null hypothesis Ho3 with respect to age and education of mother was rejected indicating significant
association between these variables.
 62 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Table 4(b): Association between severity of PEM with respect to Occupation of parents and Monthly
income

Normal Grade I Grade II

Variables (n=520) χ2 p value
(n=245) (n=146) & III (n=99)
Occupation of father
Physical worker 162 87 64
Govt.Job 18 21 12 13.04 0.043*
Private job 62 23 14
Self employed 31 11 07

Occupation of mother

Physical worker 17 12 08
Govt.job 43 23 13 3.281 0.915
Private job 96 46 39
Self employed 36 16 10
Unemployed 83 49 29

Monthly income
10000 -19999 39 13 12 4.491 0.611
5000-9999 29 22 12
2500- 4999 35 22 13
1000- 2499 167 82 60

The data presented above indicated that for malnutrition were 28.087%, 18.65% and 0.38%
occupation of father the obtained chi square value belonged to grade I, grade II and grade III malnutrition
(χ2=13.04) was higher than the table value (χ (6)2=12.592) respectively. In first post test 31.54% had grade I PEM.
at 5% level of significance. Therefore null hypothesis 13.46% had grade II PEM and 0.19% had grade III
H03 was rejected in terms of occupation of father PEM. In second post test. With regard to PEM, 26.73%,
0.38% respectively had grade I and grade II PEM. A
DISCUSSION similar study was conducted by Mukhopadhyay reported
The present study revealed that most of the children that 20% of children had moderate PEM and 15.9% had
(58.8%) currently feeding at least 3 times a day. Majority severe PEM where as 64.1 children were normal.8
of children (56.5%) reported poor dietary practice.
In the present study there was a difference in mean
Regarding the consumption pattern of nutrients 66.3% of
weight for each comparison in pretest and posttest I,
children had inadequate nutrient consumption. A similar
posttest 1 and post test 2 and pretest and post test 2. A
study was conducted on food consumption pattern of
similar study was conducted by Maheswari revealed that
mothers and children were obtained using the food
overall observations showed there was high in weight
consumption score (FCS) based on dietary diversity,
gain for all the age group after 4th observations in
food frequency and the relative nutritional importance of
experimental group.9
nine different food groups. These data reflected that 20%
of children had acceptable food consumption pattern, It was observed from the study that there was
34% children had poor food consumption and 46% had association between severity of PEM and variables like
borderline food consumption pattern.7 age , education of motherland occupation of father. The
finding supported the study conducted by Bhalani and
It was observed that in pretest the grades of
Kotecha in vadodhara city among children of less than
 International Journal of Nursing Education, July-September, Vol.9, No. 3 63

five years reported that prevalence of malnutrition was 3. Reddy V. Textbook of Human Nutrition. 1st edn.
much higher in the lower age groups of 12-35 months.10 Oxford and IBH publishing co. 1996.
4. Bhan M K, Bhandari N, Bhal R. Management of
CONCLUSION
the severely malnourished child: perspective from
As evidenced by this study, the nutritional developing countries. BMJ 2003: 18;326: 146-
status of children can be expected to improve once 151
education on proper nutrition is combined with other 5. Sachdev HPS, Choudhury P. Nutrition in children.
health programmes and delivered through the ICDS Developing country concerns. 1st edn. New Delhi:
programme or the primary care system. Mother’s BI pupblications.2004.
literacy had a much higher impact than father’s literacy
6. Health and nutrition profile of children in rural
on better nutritional status of children. Occupation of
kerala: A call for an action (podcast on the internet)
father also had a beneficial effect in protecting children
Munich personal Re PEC Archive; 2012 (cited
from malnutrition. Age groups have an impact on the
2012 fed 07). Available from: http;// mpra. ub. uni
prevalence of protein energy malnutrition. A Multi-
-muenchen. de/27132
pronged approach like maternal and child health care,
nutrition education and growth monitoring etc. will be 7. Sabbarwal V, Sharma P. Effect of food insecurity
beneficial to combat the problem of malnutrition. on nutritional status of children (6-59 months) – A
study in urbon slum of North Delhi. Ind.J.Nutr.
Conflict of Interest:- None Dietet.2013;50:492-498
Source of Funding:- Self financed by the 8. Mukhopadhyay DK, sinhababu A, Saren AB,
researcher Biswas AB. Association of child feeding practices
with nutritional status of under two slum dwelling
Ethical Clearance:- Ethical approval taken from children: A community based study from West
NITTE University, Mangalore Bengal, India. Indian J public health. 2013; 57 (3):
169-172.
REFERENCE
9. Maheswari K. Effectiveness of home based diet
1. Gopalan. Changing Nutrition Scenario. Indian therapy for malnourished children in the age group
Journal of Medical Research. 2013; 138(3) : 392- of 2-5 years in rural selam,Tamilnadu.International
397. J NsgEdu. 2012;4(2):163-166
2. Park K. A text book of preventive and social 10. Bhalani K D, Kotecha P V . Nutritional status
medicine. 22nd edn. Jabalpur: Banarsidas bhanot and gender differences in the children of less than
publications.2013. five years of age attending ICDS anganwadis in
Vadodara city . Indian J commun Med 2002 ;27(3):
124-129.
 DOI Number:10.5958/0974-9357.2017.00072.1

Preparedness and Practice of Forensic Nursing in Kenya

Irene G Mageto1, Grace Omoni2, Nancy B Cabelus3, Justus Okeo Inyega4

Lecturer, 2Associate Professor, School of Nursing Sciences, University of Nairobi, 3Assistant Professor,
1

Department of Nursing, University of Saint Joseph, USA, 4Senior Lecturer, College of Education and External
Studies, University of Nairobi

ABSTRACT

Forensic nursing has not been adopted in Kenya despite the fact that nurses work in settings requiring this
knowledge. The Nursing Council syllabus calls for lectures in forensic nursing but lectures have neither
been developed nor are there educators prepared to teach the unit. This study evaluated the preparedness
and practice of forensic nursing in Kenya. It adopted a descriptive cross-sectional study design. Self-
administered questionnaires, a focused group discussion and a key informant interview were utilized to
collect data among 116 randomly sampled nurses from three hospitals and ten nurse educators. Quantitative
data was analyzed using the SPSS version 20.0 and results presented using mean, standard deviation, and
frequency distribution. P values of 0.05 or less were considered significant. Qualitative data was analyzed
using thematic analysis. The results indicated majority of the nurses had no training on forensic nursing
science whatsoever even though they handle forensic patients on a daily basis. The nurses perceived
training needs for forensic nursing practice included: advanced health assessment, evidence collection and
documentation, forensic psychiatry, gender violence, legal implications of forensic nursing, theory and
practice in forensic nursing. From these findings it can be concluded that Kenyan nurses lack skills needed
to care for forensic patients and they would like to be trained in forensic nursing.

Keywords: Kenya; forensic nursing; forensic nursing practice; forensic nursing roles

INTRODUCTION AND BACKGROUND recover and preserve evidence from suspects and/or
victims, testifying in court as a fact or expert witness,
Forensic nursing is an essential specialty of nursing and serving as a bridge between healthcare and legal
because it extends the traditional nursing practice systems1. Therefore forensic nurses serve as a bridge
with medical-legal aspects of potential or actual client between the criminal justice system and the healthcare
problems. The International Association of Forensic system.
Nurses defines forensic nursing as the application of
nursing science to public or legal proceedings1. Forensic In 1997 the Joint Commission on the Accreditation
nurses investigate real and potential causes of morbidity of Healthcare Organization, published guidelines that
and mortality in a variety of settings; provide care to requires all staff members be educated to identify
victims, the accused and perpetrators of crime2. Their victims of abuse, violence and neglect, and be able to
responsibilities include conducting forensic assessment, collect and safeguard physical evidence associated with
and photo documentation, knowing how to properly unknown or potential criminal acts.

Consequences of the violence are seen by healthcare

Corresponding author professionals as they render care to the injured in
Dr Irene G. Mageto PhD, MScN, BScN emergency departments (ED), operating theatres, and
Lecturer, School of Nursing Sciences, gynecological wards daily. As nurses are usually the first
University of Nairobi, P.O Box 19676 – 00202 Nairobi, healthcare professionals to see patients, speak with their
Kenya, Email: [email protected] family members, handle personal property and collect
Phone number: +254724205419 laboratory specimens3. Such actions can be extremely
 International Journal of Nursing Education, July-September, Vol.9, No. 3 65

important to the different categories of forensic patients Violence in 2007/2008 often results in the loss and
who are treated in the various healthcare settings destruction of evidence and the lack of successful
worldwide. prosecution of the perpetrators. This consequence
produces a negative outcome: Justice denied for
All nursing roles in the subspecialties of forensic
victims.
nursing are investigative in nature and require specific
knowledge of aspects of the law and expert witness Nurses in Kenya should be aware of the constant
skills. Forensic nurses are involved in investigating the changes occurring in society because these changes
underlying causes of injury or death in many settings. ultimately determine what nursing services must be
Historically, schools of nursing had been less than provided and how they should be provided. These
responsive to the health needs of inmate populations in changes have vast implications on how Kenyan nurses
the education of nurses4. This is an issue that urgently are educated in preparation for their roles as nurse
needs to be addressed in countries where there is no specialists and practitioners.
formal forensic education because it presents many
unique challenges that complicate the work of a forensic
MATERIALS METHOD
nurse who lacks this specialized knowledge. The study adopted a descriptive cross-sectional
research design. The study was carried out in three
Primary care providers are frustrated by what they
purposively selected referral hospitals in Kenya, which
perceive as an “extra” social responsibility, and that
accommodate the vast majority of forensic patients.
they could quickly become overwhelmed in caring
for “non-medical” issues5. Additionally, health care Mathari Teaching and Referral Hospital
providers have expressed concern regarding their
inadequate preparation, uncertainty on how to proceed This is a 700 bed capacity facility located in
if maltreatment is disclosed, and frustration with the Nairobi Kenya. Of the 700 beds 350 are occupied by
inability to ensure positive outcomes for victims6. civil patients and the remaining 350 are occupied by
Thus, the forensic nurse should not be a part of the patients under legal custody. Currently, it is the largest
trauma team, but rather performs a separate task in psychiatric hospital and the main psychiatric referral and
the photo-documentation, recovery, preservation, and teaching hospital in Kenya. The Maximum Security Unit
security of evidence related to the forensic patient of this hospital caters for patients under legal custody.
in coordinated efforts with those who are providing
Kenyatta National Hospital
medical interventions2.
This is an 1800 bed capacity facility with six
There is no documented history of the true
thousand members of staff of whom 1600 are nurses.
beginnings of forensic nursing in Kenya in published
The hospital is the major training facility for health care
literature. Today, forensic nursing across Kenya
personnel in various disciplines both at undergraduate
primarily focuses on working with patients who require
and post-graduate levels. It is the largest referral hospital
mental health services, or are in some way connected
in East and Central Africa.
to the criminal justice system. Kenya needs to consider
the broader aspect of forensic nursing because research Nairobi Women’s Hospital
has indicated that forensic nursing education can be
beneficial for improving forensic patient care7. Forensic This is a 222 bed capacity facility focused in
nursing education is a vital link in the development of women’s and children’s healthcare. A non-profit
clinical acumen required for responding to the forensic organization, the Gender Violence Recovery Centre
circumstances encountered in their daily practice2. (GVRC), is based in the hospital. The Centre provides
Historically, the existence of a significant gap between treatment to survivors of rape and domestic violence
the health and justice systems has been created by the The population of this study consisted of one
absence of forensic knowledge in traditional nursing hundred and sixteen nurses working in the hospitals
education in Kenya. Consequently, the failure to named above, ten nursing lecturers from selected public
recognize forensic situations such as the Post- Election and private universities at the time of study and a key
 66 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

informant from the Nursing Council of Kenya. The findings also revealed that the lecturers involved
in the focused group discussion had little awareness
Multistage sampling technique was utilized and
about forensic nursing. For instance a respondent from
this entailed use of different sampling strategies. In
a public university said that ‘‘…as much as I have had
the first stage the selected hospitals were purposively
heard about forensic nursing through the media I feel
sampled because they are referral hospitals in Kenya,
that I am incompetent in teaching forensic nursing…’’.
which accommodate the largest numbers of forensic
Her sentiments were echoed by another lecturer from
patients and they also handle more problematic and
private university who informed the group that ‘‘…
challenging forensic cases. In the next stage, the sample
anything to do with forensics should be handled by the
was stratified by hospital while the size of strata was
law enforcement officers…’’. This assertion culminated
determined by sampling proportionate to size of the
into a protracted discussion where other group members
hospital. Eventually simple random sampling technique
agreed with another member stating that ‘‘forensic
was utilized to select the participants to be included.
nursing is better practiced in developed countries due to
A self-administered semi-structured questionnaire was
the proper systems in place’’. These findings contravene
used to collect both quantitative and qualitative data
the guidelines on scope and standards of forensic nursing
from 116 respondent nurses. A focus group guide was
practice8 which requires that nurses offering forensic
developed based on the study objectives to determine
nursing education should acquire skills and knowledge
lecturers’ awareness, preparedness in teaching forensic
appropriate to specialty area, practice setting, role, or
nursing and forensic nursing aspects to be included
situation.
in the curriculum formulated by the researcher. A key
informant interview was conducted with the registrar of Overall with regards to training in forensic nursing,
the Nursing Council of Kenya. a significant majority of the practicing nurses had not
received any training on forensic nursing science.
Quantitative data was coded and entered into the
Additionally, the lecturers unanimously reported that
Statistical Package for Social Sciences (SPSS) version
they were inadequately prepared to cover the required
20.0. Qualitative data was analyzed using thematic
22 contact hours on forensic nursing as stipulated in
analysis where themes were identified based on the
the Nursing Council of Kenya syllabus. The concerns
responses of the respondents.
raised by the nurses and lecturers about preparedness
FINDINGS to practice in forensic settings were corroborated by
the key informant who affirmed that the reported lack
This study evaluated the preparedness and practice of preparedness is what prompted the NCK to issue
of forensic nursing in Kenya. The distribution of a directive requiring forensic nursing content to be
respondents per hospital was as follows: Kenyatta included in all BScN curricula in the country.
National Hospital 64.5%(76), Mathari Hospital
25.9%(30) and Nairobi Women’s Hospital 8.6%(10). The aforementioned responses by the study subjects
These three hospitals are referral hospitals, which cater are in agreement with Reid and Glasser6 who articulated
to the majority of forensic patients in Kenya. Majority that health care providers have expressed concern
of the respondents reported that they were unaware of regarding their inadequate preparation, and frustration
forensic nursing specialty even though they handled with the inability to ensure positive outcomes for
forensic patients on a daily basis. This is in agreement victims of violent crimes. This highlights the existence
with the findings of Sugg & Inui who revealed that many of a significant gap that has been created by the absence
healthcare providers feel they lack sufficient knowledge of forensic knowledge in traditional nursing education in
to adequately assist victims of crime5. This could be Kenya. With increased cases of violence being reported
attributed to the fact that forensic nursing was not in Kenya today, the lack of knowledge in forensic
included in nursing curricula until 2011. Therefore the nursing could impact the way forensic patients are
nurses might not have introduced to the specialty while handled negatively.
in training and yet they were posted in clinical settings
The practicing nurses reported that they were
where this knowledge is required.
inadequately prepared in various aspects of forensic
 International Journal of Nursing Education, July-September, Vol.9, No. 3 67

nursing namely: evidence collection, documentation and collection and documentation…” This concern was
caring for victims of different types of violence in general. supported by another respondent who asserted “…I have
A general observation from the respondents was that this never collected any forensic evidence despite working
should be dealt with by the law enforcement officers. The with victims of crime…”. Another added “…I find
lecturers shared similar sentiments as their practicing documenting assessment findings of victims of violence
nurse counterparts. In the focused group discussion challenging....”. Concerning the handling of victims
one lecturer asked ‘‘…How do I teach something that of violence one respondent offered “…Patients whose
I have never been taught before?…’’. This triggered diagnosis have legal implications should be handled by
further discussion within the group and another lecturer the law enforcement officers…” Another area of concern
opined ‘‘…Maybe we should be trained first before was on forensic psychiatry where a respondent asserted
being asked to teach… ’’. This sentiment gained a nod “…I am extremely terrified of mentally ill offenders…”
of approval from the other lecturers who were present and further added “…I wish I could be trained on how to
in the discussion reaffirming inadequate preparedness. care for the mentally ill offenders…”.
This observation contravenes the requirement by the
The aforementioned sentiments offered by
Commission for University Education (CUE) standards
respondents highlight the areas that nurses required
and guidelines. The requirements stipulate that lecturers
training on as follows: advanced health assessment,
teaching undergraduate programmes should be holders
evidence collection and documentation, forensic
of Master’s degree, and lecturers for graduate and post
psychiatry, gender violence, legal implications on
graduate programmes should have doctoral degrees9.
forensic nursing and theory and practice in forensic
In light of the set standards it is clear that the lecturers
nursing. The key informant further indicated that most
tasked with the responsibility of teaching forensic
nurses reported that they were lacking capacity in
nursing at undergraduate level should have acquired
evidence collection and documentation, nursing theory
Masters level training in Forensic Nursing.
and practice and chain of custody of evidence collected.
The practicing nurses expressed concern that the This is in agreement with Lynch11, who asserted that
curriculum was lacking important components that nurses in Kenya require a solid forensic education
they felt would be important in preparing them to as a vital link in the development of clinical acumen
care for forensic patients. A significant majority of required for responding to the forensic circumstances
the respondents indicated that the nursing curriculum encountered in their daily practice.
used in training them is not effective in developing
forensic skills. Owing to the reported unpreparedness
CONCLUSIONS
by the respondents it was evident that most nurses Based on the findings of this study the researcher
had difficulties identifying a forensic patient and were draws the following conclusions,
uncomfortable in dealing with victims of violence.
This is in agreement with Cabelus10 who explains that a 1. Nurses practicing in Forensic settings in Kenya
number of critical issues related to education, training, are not adequately trained to practice in forensic settings
and professional development go unresolved in forensic based on their current training.
nursing. This is an indication that nurses in Kenya are
2. The nurses’perceived training needs included:
posted to work in settings that require knowledge in
advanced health assessment, evidence collection and
forensic nursing even though they have not been trained
documentation, forensic psychiatry, gender violence,
on the same.
forensic pathology, legal implications on forensic
A significant majority of the practicing nurses, nursing, theory and practice in forensic nursing.
the lecturers and key informant indicated that forensic
3. Majority of the nurses had a positive attitude
training is an important aspect in nursing in Kenya.
towards forensic nursing in that they reported that
With regards to aspects of forensic nursing that the
forensic nursing is an integral component in the practice
respondents wish to be trained on, there were varied
of nursing care in Kenya.
areas of interest and some of the responses were as
follows: “…I do not have any training on evidence
 68 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Conflict of Interest: None University of Notre dame Australia, Fremantle WA

Source of Funding: Self 4. Freedberg, P. (2008). Intergrating forensic nursing

into undergraduate nursing curriculum: a solution
Ethical Clearance: Approval to conduct the study for a disconnect. Journal of Nursing Education:
was sought from the University Of Nairobi School 47(5)199-200
Of Nursing Sciences. Clearance to carry out this 5. Sugg, N.K., & Inui T. (1992). Primary care
study was sought from Kenyatta National Hospital/ physicians’ response to domestic violence: Opening
University of Nairobi Ethics and Research Committee Pandora’s box. JAMA. 267(23)3157-3160.
(KNH/UON-ERC). Permission to access and enroll
6. Reid, S.A. & Glaser, M. (1997). Primary Care
the study participants was obtained from the Medical
Physicians’ recognition of attitudes towards
Superintendent/CEOs of the three hospitals. Consent
domestic violence. Acad. Med. 72(1)51-53.
was obtained prior to enrollment by reading the contents
and then signing on the form to approve. Confidentiality 7. Kent-Wilkinson, A. (2011). Forensic Nursing
was ensured by excluding identification details on the educational development: an integrated review of
study tools. literature. Journal of Psychiatric and Mental Health
Nursing 18, 236-246.
REFERENCES
8. American Nurses Association (2015). Evidence-
1. Gorea, R. K. (2009). Development & Future of based Practice. American nurses association, Inc
forensic nursing in India. International Journal of 9. Commission for University Education (2014).
Nursing Education 1(1). Universities Standards and Guidelines
2. Lynch, V. A., & Duval, J. B., (2011). Forensic 10. Cabelus, B. N (2012) Personal communication 27th
Nursing Science (2nd ed) Elsevier Mosby June 2012.
3. Michel, C. M., (2008). Implementing a forensic 11. Lynch, V.A. (2011). Forensic Nursing Science:
educational package for registered nurses in two Global Strategies in Health and Justice. Egyptian
emergency departments in Western Australia. Journal of Forensic Sciences.
 DOI Number: 10.5958/0974-9357.2017.00073.3

Effect of Selected Muscle Stretching Exercises on Primary

Dysmenorrhoea among Student Nurses

Jaibunnisha1, Gomathi B2, Upma Goerge3

Clinical Instructor, 2Assitant Professor, 3Associate Professor, Himalayan College of Nursing SRHU,
1

Dehradun, Uttraakhand India

ABSTRACT

Background: Primary dysmenorrhoea is a painful menstrual flow in the absence of any pelvic pathology.
The scientific evidence display that exercises are helpful to reduce the menstrual pain. Stretching exercise
are being done to improve the elasticity of muscle and achieve comfortable muscle tone and also increase
the thresh hold of pain.1 Objective: To assess the effectiveness of selected muscle stretching exercises on
primary dysmenorrhoea. Material and method: A Quantitative approach with experimental with multiple
time series design was used to assess the effectiveness of selected muscle stretching exercises on primary
dysmenorrhoea. Sixty seven student nurses with primary dysmenorrhoea were selected from Himalayan
College of Nursing by using non probability purposive sampling technique and subjects were randomly
assigned into Experimental group (n=33) and Control group (n=34). Muscle stretching exercises taught to
the experimental group and practiced for 8 weeks (6 days/week, for 10 minutes daily) at hostel. Menstrual
pain intensity was assessed by using Numerical pain rating scale. The post-test was conducted after 8 weeks
of intervention. Result: After 8 weeks of muscles stretching exercises, the intensity of dysmenorrhoea was
reduced from 5.48±1.41 to 4.33±1.31 in the experimental group (p<0.05). In the control group, no significant
reduction of pain was observed at the level of < 0.05. Conclusion: The study concludes that stretching
exercises are effective in reducing pain intensity among student nurses with primary dysmenorrhoea. The
present result suggested that selected muscle stretching exercises can be used as a non pharmacological
method for pain relief in dysmenorrhoea.

Keywords: Primary Dysmenorrhoea, Menstrual health, Muscles stretching exercises.

INTRODUCTION dysmenorrhoea is menstrual pain associated with an

identifiable gynaecological diseases.2
Dysmenorrhoea or painful menstruation is a
common gynaecological problem that affects adolescents The incidence has shown that the prevalence of
and women of reproductive age in their daily activities. dysmenorrhoea worldwide is with rates ranging from
It is the common cause of absenteeism in school and 15.8 to 89.5% with higher prevalence rates reports in
colleges among adolescent girls.1 Dysmenorrhoea is adolescent population. The findings of the study by A
categorized into two types: primary dysmenorrhoea K Agarwal and Anju Agarwal in 2010 showed a high
and secondary dysmenorrhoea. Primary dysmenorrhoea prevalence of dysmenorrhoea, that is, 71.96% among
occurs when there is no pelvic pathology and Secondary adolescent girls of Gwalior.3 In recent times, George
and Bhaduri4 concluded that dysmenorrhoea (87.87%)
Corresponding author: is a common problem in India. In Uttrakhand the
Mrs. Jaibunnisha prevalence of dysmenorrhoea was 65% as reported by
Clinical Instructor, Himalayan College of Nursing, Juyal R, Kandpal. S (2010)5. Dysmenorrhoea has been
SRHU, Jolly Grant, Doiwala (Post) Dehradun, estimated to be the greatest cause of time lost from work
Uttarakhand, India, 248016, and school in the United States.4 One of the easy method
Email: [email protected] that can be used in the prevention of dysmenorrhoea
 70 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

is exercise. Stretching is a form of physical exercise menstrual bleeding. Experimental group was performed
in which a specific muscle or tendon is flexed or muscle stretching exercises for 8 weeks (6 days /week,
stretched to improve the muscle’s felt elasticity and daily for 10 minutes). Stretching exercises included
to achieve comfortable muscle tone. Stretching is also exercises in the abdomen, pelvic and groin region. The
used therapeutically to alleviate cramps. As the health subjects were requested to perform the exercise at hostel
care is moving toward complementary and alternative regularly. Furthermore they were instructed to avoid
therapy in managing of many problems, the researcher performing stretching exercises during the periods.
is interested in studying the effectiveness of muscle Participant’s performance was controlled from time to
stretching exercise on primary dysmenorrhoea, which time by the researcher in hostel and maintaining a diary
is an alternative therapy to reduce menstrual pain and for daily attendance for exercise performance. Control
decrease the absenteeism of the adolescent girls. group was requested not to take part in any exercise
programme up to the end of the study. The muscle
The aim and objectives of the study was to assess
stretching exercises were:
the effectiveness of muscle stretching exercises on
primary dysmenorrhoea among student nurses. 1. Forward bending from the hip joint, duration
for 5 seconds and repetition was 10 times.
MATERIALS AND METHOD
2. Heel raise (bilateral) alternatively and repeats
Quantitative approach with experimental with for 20 times.
multiple time series design was used to assess the
effectiveness of selected muscle stretching exercises on 3. Half squatting position for 5 seconds; then
primary dysmenorrhoea. Data was collected at Himalayan raised body and repeats 10 times.
College of Nursing, Jolly Grant, Dehradun, Uttrakhand
4. Bend and touch left ankle with right hand and
from December 2014- January 2015. 70 female student
right ankle with left hand. Repetition 10 times for each
nurses were selected by using non probability sampling
side.
technique and randomly assigned into two experimental
(35) and control group (35). Student with regular 5. Knee to chest bending and reached to chin,
menstrual cycle with primary dysmenorrhoea were repetition was 10 times.
included. Student nurses with history of any systematic
diseases, traumatic injury, any other gynaecological 6. Abdominal contraction for 10 seconds and
diseases were excluded. Numerical pain rating scale was repeated 10 times.
used to measure the severity of dysmenorrhoea. Before
In the middle of the study, two participants from
data collection participants were explained about the
experimental and one participants from control group
procedure and purpose of the study & written informed
were drop out due to personal problem. Final analysis
consent was obtained. Pre-interventional data was
was done for 67 sample (Experimental group = 33,
collected by using self reporting questionnaire related
Control group = 34). After 8 weeks of intervention data
to socio-demographic characteristics and menstrual
was collected. Descriptive and inferential statistics were
characteristics. Dysmenorrhoea score was assessed
used to describe the results of the study.
by using numerical pain rating scale at the onset of
menstrual bleeding, after six hours and after12 hours of
 International Journal of Nursing Education, July-September, Vol.9, No. 3 71

RESULTS

Table No 1: Frequency and percentage distribution of selected personal variable of student nurses
(n=67)

Experimental Group Control Group “t” ‘ p’

S.N Personal variable
(N=33) (N=34) value value
F % F %
Age (in year)
1.       18- 20 23 69.7 21 61.8
0.83 0.18
21- 23 10 30.3 13 38.2
Height(in cm)
144- 152 11 33.3 9 26.5
2.       0 .59 0.88
153- 161 20 60.6 21 61.8
162-170 2 6.1 4 11.8
Weight(kg)
39- 46 8 24.2 9 26.5
3.       0.9 0.93
47- 54 22 66.7 20 58.8
55- 62 3 9.1 5 14.7
BMI (kg/cm2)
< 18.5 4 12.1 4 11.8
4.       0.06 0.87
18.5- 24.99 27 81.8 29 85.3
> 25 2 6.1 1 2.9
Dietary habits
5.       Vegetarian 7 21.2 11 32.4 - 0.41
Non vegetarian 26 78.8 23 56.6
Age at menarche (in years)
6.       12- 14 26 78.8 27 79.4 1.01 0.3
>14 7 21.2 7 20.6
Length of menstrual Cycle
25- 27 days 2 6.1 3 8.8
7.       0.57 0.56
28- 30 days 31 93.1 29 85.3
>30 days 0 0 2 5.9
Duration of bleeding
8.       3-5   days 30 90.9 34 100 0.92 0.35
>5 days 3 9.1 0 0
Blood loss in each cycle
Scanty (1-2 pads/ day) 13 39.4 10 29.4
9.       - 0.72
Normal (3-4 pads/ day) 18 54.5 21 61.8
Heavy (> 4 pads/ day) 2 6.1 3 8.8
Onset of menstrual pain
Before onset of menstruation 13 39.4 7 20.6
11.    - 0.01
At the onset of menstruation 16 48.5 26 76.5
After onset of menstruation 6 12.1 21 2.9
Duration of pain
1   day 15 45.5 16 47.1
12.    - 0.99
2 days 16 48.5 15 44.1
3 days 2 6.1 3 8.8
H/o of passage of clots
χ2= 0.85
13.    Yes 23 69.7 23 67.6
0.32
No 10 30.3 11 32.4
 72 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Table no. 1 showed the frequency and percentage between 28-30 days and the duration of bleeding was
wise distribution of selected personal variable of student between 3-5 days.
nurses. The result depict that more than half (65.7%) of
Regarding the onset of menstrual pain, more than
the student nurses were in the age group of 18-20 years
half (62.7%) of the student nurses had the onset of pain
followed by those in age group of 21-23 years (34.3%)
with beginning followed by 29.9% student had before
and the mean age of the participants was(19.91±1.17).
onset of menstrual bleeding with 1-2 days of duration.
Majority (83.6%) of sample were categorised under
normal body weight in both experimental and control Homogeneity of the sample was tested by computing
group i.e. between 47- 54 kg. 79.1% students had independent‘t’ test. The p value is significant at p<0.5
attained menarche between 12-14 year of age. Most level. The data showed that both groups are homogenous
of the student nurses in both experimental and control in relation to their personal variable.
group were reported that they had menstrual cycle

Table No. 2: Comparison of pre and post-test level of dysmenorrhoea scores at different times of interval
between experimental and control group n = 67

Mean± SD
n F ‘p’
Time of menstrual pain assessment Pre-test Post test
Value value

Experimental group
6.75±0.26 5.12±0.21
At the onset of menstruation
5.69±0.36 4.51±0.30
After 6 hrs of menstruation 33 160.62 0.001
4.18±0.35 3.42±0.29
After 12 hrs of menstruation

Control group
6.14±0.29 6.08±0.31
At the onset of menstruation
5.70±0.24 5.47±0.25
After 6 hrs of menstruation 34 2.93 0.96
4.11±0.34 4.11±0.31
After 12 hrs of menstruation

Table -2: depict the comparison of pre and post-test level of mean dysmenorrhoea score at three different times
of interval in experimental and control group. Results revealed that there was no significant difference in the mean
with SD in control group at three different times of interval from pre-test to post test (p >0.05). In experimental
group dysmenorrhoea score at the time of menstruation, six hours after menstruation, and 12 hour after menstruation
were significantly reduced from the pre-test to post test (p<0.001).

It was found that after 8 weeks of muscle stretching exercises the mean dysmenorrhoea score with SD was
reduced in experimental group compare to control group.

Table No-3: Effectiveness of muscle stretching exercises by comparing post-test level of dysmenorrhoea
score within the group n=67

Post-interventional dysmenorrhoea
Group GGGGG ‘t’ ‘p’
score
Group n MD Value Value
Mean ±SD

Experimental group 33 4.33±1.31

0.90 3.14
0.002 (s)
Control group 34 5.22±1.01
 International Journal of Nursing Education, July-September, Vol.9, No. 3 73

Table no. 3 shows the significant difference in mean of muscles stretching exercise for the adolescents girls
post-test level of dysmenorrhoea score between the having dysmenorrhoea.
groups at p<0.002 level of significance. It shows the
Based on the findings of this study it can be
effectiveness of muscle stretching exercise on primary
suggested that there is a beneficial impact of stretching
dysmenorrhoea.
exercise on intensity of dysmenorrhoea. According to
DISCUSSION the results of this study, performing 8 weeks of selected
stretching exercises reduces pain intensity, in student
Findings of different studies have shown that
nurses with moderate- to-severe primary dysmenorrhoea
therapeutic exercises and physical activity was related
during the menstruation cycle. Whether or not the effects
with reduced incidence of dysmenorrhoea, whereas in
of exercise could be long-term should be the subjects of
some of studies did not demonstrate such a correlation
further research.
statistically.6, 7,10 The findings are similar to those of
various researcher. Shahnaz Shahr-jerdy et al7 (2012) Acknowledgement- Nil
concluded that stretching exercises are effective in
Ethical Clearance – Taken from Swami Rama
reducing pain intensity, pain duration, and the amount of
Himalayan University.
painkillers used by girls with primary dysmenorrhoea.
Abbaspour et al (2006) also concluded that the exercise Source of Funding – Self
can decrease the duration and severity of dysmenorrhoea
and also use of the sedative tablets in high school girls. Conflict of Interest – Nil
Kristina S Gamit et al conclude that stretching exercises
REFERENCES
are effective in reducing pain in young females with
primary dysmenorrhoea. This improvement may be due 1. Yusoff M Dawood, MD. Advances in primary
to the increase in the blood flow and metabolism of the dysmenorrhoea. Obstet Gynecol. 2006 Aug;
uterus during exercise which may be effective in the 108(2):428-41. (Pub Med)
reduction of dysmenorrhoea symptoms. A study done by 2. Nag RM. Adolescent in India. Calcutta: Medical
Dawood MY (2006) has shown that therapeutic exercise Allied Agency; 1982. pp. 18–26.
can increase the secretion of endorphins from the brain,
3. Agarwal AK, Agarwal A, A study of dysmenorrhoea
and these materials in turn raise the pain threshold of the
during menstruation in adolescent girls. Indian
body. Daley AJ (2009) stated that contracted ligamentous
Journal of Community Medicine [serial online]
bands in the abdominal region were the causative factor
2010 [cited 2014 Oct 4]; 35:159-64
for physical compression of nerve pathways and their
irritation, so the proposed series of stretching exercise 4. Available from: URL: http://www.ijcm.org.in/
was considered very effective. Limitations of the study text.asp?2010/35/1/159/62586
were that investigator has to rely on the participants for 5. George A, Bhaduri A, Dysmenorrhoea among
performing muscle stretching exercises for 8 weeks adolescent girls – symptoms experienced during
at hostel. The impact of muscles stretching exercises menstruation. Health Promotion Education. 2002;
on dysmenorrhoea has not been fully investigated 17:4.
only intensity of dysmenorrhoea was measured after 6. Juyal R, Kandpal SD, Semwal J. Social aspects of
intervention. menstruation related practices in adolescent girls
CONCLUSION of district Dehradun. Indian Journal of Community
Health. 2013;25(3):213-6.9 (pubmed)
Life style plays an important role in remaining healthy.
7. Shahr-jerdy, Shahnaz1, Hosseini, Rahman
Today we are not involved much in physical activities.
Sheikh, Maghsoud Eivazi, “Effects of stretching
Regular muscles stretching exercise play an important
exercises on primary dysmenorrhoea in adolescent
role in reducing the intensity of dysmenorrhoea. Nurses
girls” Biomedical Human Kinetics, December
should acquire thorough knowledge about the problems
2012,Volume 4, Issue -1, Pp-127 – 132,
related to dysmenorrhoea among adolescents girls and
Available from: http://www.degruyter.com/view/j/
should have in-depth knowledge regarding the benefits
 74 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

bhk.2012.4.issue--1/v10101-012-0024-y/v10101- 3 (5): 549-551. Available form: http://dx.doi.org/

012-0024-y.xml) 10.5455/ijmsph.2014.210220142
8. Abbaspour Z,Rostami M,Najjar Sh. The effect of 10. Yusoff M Dawood, MD. Advances in primary
exercise on Primary Dysmenorrhea. J Res Health dysmenorrhoea. Obstet Gynecol. 2006 Aug;
Sci.Nov2008 23:6 (1):26-31. Available from: http: 108(2):428-41. (Pub Med)
//jrhs.umsha.ac.ir/index.php/JRHS/article/view/ 11. Daley A. The role of exercise in the treatment
482 of menstrual disorders: the evidence. Br J Gen
9. Gamit KS, Sheth MS, Vyas NJ. The effect of Pract 2009 Apr 1; 59(561):241–2. Available from:
stretching exercise on primary dysmenorrhoea in URL: http://www.ncbi.nlm.nih.gov/pmc/articles/
adult girls. Int J Med Sci Public Health. (2014), PMC2662100
 DOI Number: 10.5958/0974-9357.2017.00085.X

Assess the Effectiveness of an Interventional Package on Level

of Stress among Mothers of Baby Admitted in NICU

Franny Joel Emmanuel1, Rajesh P2, Nirmal Raj E V3

1
S.Y.M.Sc. Nursing, 2Assistant Professor, 3Assistant Professor, Sumandeep Vidyapeeth,
Sumandeep Nursing College, Whaghodia, Vadodara

ABSTRACT

The aim of this study is to assess the effectiveness of an interventional package on level of stress. Pre
experimental one group pre-test – post-test research design was adopted. 30 mothers of baby admitted
in NICU of Dhiraj Hospital, Vadodara were selected as sample by convenience sampling technique. The
collected data was tabulated and analyzed using descriptive and inferential statistics. In pre-test 13.33% of the
mothers were having moderate Parental stress, 86.67% mothers were having severe Parental stress. Which is
been reduced after administration of an interventional Package so, the result found that 30% of mothers had
mild Parental stress, 63.33% of mothers had moderate Parental stress and only 6.67% of mothers had severe
Parental stress. Researcher has found paired t test value = 34.40 with df : 29 is more than the table value =
1.699at 0.05 level of significance. So it reveals that interventional package is effective Association between
Pre test Parental Stress and demographic variable: age of the mothers, length of hospital stay, education of
mothers are non significant at 0.05 level of significance. Whereas the association between level of NICU,
family type with pre testParental stress score are significant at 0.05 level of significance.

Keywords: Stress; Effectiveness; Interventional Package; Mothers; baby; NICU

BACKGROUND Nearly 27 million babies are born in India each year,

this counts 20% of global births .Out of this 1 million
Children are a gift of GOD, Currently many
die before completing the first four weeks of life. From
countries have given the importance to family cantered
2010 the rate of NICU admission increases day by day,
care where mother or family stays at the child’s bed side
among them about 40% are treated in NICU settings
for the entire time of the hospitalization and participates
and die on the first day of life. NICU has highly stressful
in the process of taking care of the child. Therefore
environment for the mothers, the majority of the mothers
to facilitate this relationship between mother and her
with babies admitted in NICU face possibility of losing
new born in NICU requires high attention. During the
them and causes stress to mothers of baby admitted in
experience of NICU posting, researcher came across
NICU.2
many mothers who had undergone stress and inquiring
about their newborn. The researcher therefore, felt the In this modern world everyone experiences stress at
need to conduct this kind of study. Nurses working in least occasionally in their life. Different ways are there
NICU can impart profound interventions to those needy to conceptualize it. It results in many destructive effects
mothers to cope with such a stressful situation and so among individual, and so it is important to understand its
that they can enjoy motherhood with satisfaction.1 nature to make proper interventions which can mitigate
its effects. This study focuses one of those potentially
Corresponding author: stressful life events: birth of a baby who is then cared
Ms. Franny Joel Emmanuel under Neonatal Intensive Care Unit (NICU).A NICU is a
S.Y.M.Sc. Nursing,1 moonlite apartment, unit of hospital specializing in the care of ill, premature,
Opp. Subaelite Hotel, Fatehgunj main Road, low birth weight newborn or infants. The very first idea
Vadodara- 390001, Co. No. 9173079081 of having a specialized intensive care unit for neonates
 76 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

was successfully implemented in 1960. Since then, among mothers of baby admitted in NICU.
doctors, nursing personals are able to save lives of many
ASSUMPTION
desperately ill newborns. 3
• Stress is common among mothers when their
Parental stress resulting from experience with infant
neonate is admitted to the NICU.
hospitalization in the NICU is well documented. Stress is
emanating from the birth of baby who needs care under • Nursing interventional package may reduce
NICU environment has to receive considerable attention the level of stress among mothers of baby admitted in
and is associated with concurrent parental anxiety and NICU.
stress. notably the NICU experience is connected with
long term parent emotional problem especially for VARIABLES
mothers it matters a lot, though it’s not limited to the
Variable are qualities and quantities, properties, or
period of NICU stay, but can also affect the psychology
characteristic of people things or situation that change:
of mother after getting discharged from hospital. Based
on current knowledge, evaluation of mother is must • Independent variable: Interventional package
during newborn stay of NICU to assess current response
to stress associated with the NICU experience and to • Dependent variable: Level of stress of mothers
manage the stress at early stage.4 of baby admitted in NICU

Therefore it is important to reduce the stressors • Demographic variable: Age of mother,

in mothers of newborn receiving care in NICU. So to Education of mother, Length of Baby’s stay in NICU,
reduce this stress and to boost child care, to enhance Baby’s level in NICU, Family type.
bonding between child and mother, to return her smile Pre experimental one group pre-test – post-test
back, Researcher has planned to assess the level of research design was adopted to achieve the goal of the
stress, with the help of Self-Modified Parental stress study. The tool consists of two parts: First part consists
scale: (PSS:NICU) and developed an interventional demographic data of the sample and second part consists
package consists of wholestic bundle of information of Self Modified Parental Stress Scale. 30mothers of
regarding NICU setup, Counseling of Mothers and baby admitted in NICU of Dhiraj Hospital, Vadodara
demonstration techniques of deep breathing exercise were selected as sample by convenience sampling
which is to be implemented on mothers of newborn technique.
babies admitted in NICU for reduction of stress of
mothers of baby admitted in NICU. THE TOOLS USED IN COLLECTION OF
DATA:
MATERIAL AND METHOD
Data collection was planned through interview
OBJECTIVES OF THE STUDY schedule.
1. Assess the level of stress among mothers of Part 1: Demographic data sheet consists of
baby admitted in NICU by pre test. demographic variables:
2. Assess the effectiveness of an interventional A semi structured questionnaire is planned to collect
package on level of stress among mothers of baby the demographic variables, which includes 5 variables.
admitted in NICU by post test. They are maternal age, Length of baby’s Hospitalization,
3. Find out the association between level of Education of mother, In NICU baby is kept under, Type
stress of mothers of baby admitted in NICU with their of Family
demographic variables. Part 2: Modified parenting stress scale
HYPOTHESIS Modified parental stress scale is prepared for
H1: There will be significant difference between measuring the level of stress of mother of baby admitted
pre interventional and post interventional level of stress in NICU. It consists of 18 items. Items are arranged in
 International Journal of Nursing Education, July-September, Vol.9, No. 3 77

the form of likert type scale, having 5 options for each item.

Scoring for the tool: 1 = Strongly disagree 2 = Disagree 3 = Undecided 4 = Agree 5= Strongly agree. To compute
the negative item’s parental stress score, items 1, 5, 6, 7, 8, 17, and 18 should be reverse scored as follows: (1=5)
(2=4) (3=3) (4=2) (5=1)Classification of score: Mild stress: 18-41,Moderate stress: 42-65, Severe stress: 66-90

FINDINGS

Table I: Frequency and percentage Distribution of demographic variables of mother

1 AGE OF MOTHERS Frequency %

A ) ≤ 20 Years 5 16.67%
B ) 21-25 years 17 56.67%
C ) ≥26 years 8 26.66%

2 LENGTH OF BABY’S STAY IN NICU

A) 0-5 days 16 53.34%
B ) 6-10 days 7 23.33%
C ) 11 days and above 7 23.33%

3 EDUCATION OF MOTHRS
A) No formal education 0 0%
B) Primary education 16 53.34%
C) Secondary education 8 26.66%
D) graduate 6 20 %

4 IN NICU BABY IS KEPT UNDER

A) Level 1 12 40%
B) Level 2 10 33.34%
C) Level 3 8 26.66%

5 TYPES OF FAMILY
A)Nuclear family 4 13.33%
B) Joint family 20 66.67 %
C ) Extended family 6 20 %

Inference: Above mentioned table highlights that 56.67% mothers belong to age group of 21-25 age, 53.34%
mother’s baby are hospitalized in NICU for 0-5 days time period, 53.34% mothers are having education till primary
school, 40% mothers’ baby are in level-1 , 66.67 % mothers live in joint family,

Table 2: Assessment of level of stress of mothers (PRE-TEST)

PARENTAL STRESS SCORE

FREQUENCY PERCENTAGE
Mild stress = 18-41 0 0.0%

Moderate stress= 42-65 4 13.33%

Severe stress=66-90 26 86.67 %

 78 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Inference: Above table presents that 4 mothers ( 13.33%) are having moderate stress and 26 mothers (86.67%)
are having severe stress level and none of them is having mild stress level

Table 3: Assessment of level of stress of mothers (POST-TEST)

PARENTAL STRESS SCORE

FREQUENCY PERCENTAGE
Mild stress = 18-41 9 30 %
Moderate stress= 42-65 19 63.33%
Severe stress=66-90 2 6.67 %

Inference: Above table Represents that 9 mothers ( 30%) sample are having mild stress, 19 mother (63.33%)
sample are having moderate stress and only 2 mothers ( 6.67 %) are having severe stress.

Table 4: Effectiveness of an interventional package on level of stress on mothers of baby admitted in

nicu

Variables Mean Mean difference SD SE t-value significance

Pre-test 76.30
STRESS
SCORE

31.37 0.97
Post-test 44.93 5.31 34.40* S

*t ( 0.05, 29) = 1.699

To test the hypothesis, paired ‘t’ test was used. The
Inference: This table Depicts mean, standard
outputs were depicted in the above table. The table
deviation of pre-test and post-test with the mean
reveals that there is significant difference between pre
difference, SD, SE, paired‘t’ value and p value, df value
interventional test stress score and post interventional
of pre-test and post test stress scores. It indicates that
test stress score test score with 0.05 level of significant
there is significant difference between pre interventional
at df= 29. Calculated ‘t’ (34.40) is greater than the
and post interventional level of stress among mothers.
tabulated ‘t’ (1.699) hence hypothesis is accepted. And
H1: There will be significant difference between an interventional package is effective
pre interventional and post interventional level of stress
among mothers of baby admitted in NICU

Table 5: Association between pre test stress score with demographic variables

Scores which falls Scores which

Level of
S.N Variables at Median and falls below Total X2 df
significance
Above the Median
1 AGE (IN YEARS)
A) ≤ 20 years 1 4 5
B) 21- 25 years 7 10 17
C) ≥26 years 0 8 8
4.85 2 NS
Total 8 22 30

2 LENGTH OF BABY’S STAY

A)0-5 days 8 8 16
B) 6-10 days 3 4 7
C) 11 days and above 0 7 7 NS
Total 11 19 30 5.4 2
 International Journal of Nursing Education, July-September, Vol.9, No. 3 79

Cont... Table 5: Association between pre test stress score with demographic variables

3 EDUCATION OF MOTHER
A) No formal 0 0 0
B) Primary 4 12 16
C)Secondary 3 5 8
D)Higher Secondary 4 2 6 2.9 3 NS
Total 11 19 30

4 IN NICU BABY IS KEPT UNDER

A) level- 1 9 3 12
B) level- 2 2 8 10
C) level-3 0 8 8
13.41 2 S
Total 11 19 30

5 TYPES OF FAMILY
A) Nuclear 0 4 4
B) Joint 8 12 20
C) Extended 3 3 6
13.85 2 S
Total 11 19 30

Inference: The obtained X2 value in age, length of REFRENCES

stay, education of mothers variables are less than the
table value of X2 at 0.05 level of significance. Hence 1. Commodari E. Children staying in hospital: a
the obtained X2 value is non significant. . and the level research on psychological stress of caregivers. Ital
of NICU and family type variables obtained x2 value is J Pediatr.2010
more than the table value at 0.05 level of significant. 2. 4. Orshan AS. Maternity, newborn and women’s
Hence there is significant association between those health nursing. Philadelphia: Lippincott Williams
selected demographic variables and pre-test parental and Wilkins; 2008
stress score of mothers of baby admitted in NICU. 3. Affonso, D. D., Hurst, I., Mayberry, L. J., Haller,
CONCLUSION L., Yost, K., & Lynch, M. E. (1992). Stressors
reported by mothers of hospitalized premature
Pre-test and post-test Parental stress score indicate infants. Neonatal Network, 11, 63-70
that there was reduction in level of stress of mothers 4. Vanderbilt D, Bushley T, Young R, Frank DA.
of baby admitted in NICU, Dhiraj Hospital, Vadodara. Acute posttraumatic stress symptoms among urban
Hence it indicated that an interventional package is mothers with newborns in the neonatal intensive
effective. care unit: a preliminary study. J Dev Behav
Conflict of Interest – There is no conflict of interest. Pediatr. 2009 Feb;30(1):50–5

Source of Funding- self

Ethical Clearance – before starting the research

study the ethical clearance was been taken from the
university committee.
 DOI Number: 10.5958/0974-9357.2017.00086.1

A Study to Assess the Utilization Regarding Integrated Child

Development Services (ICDS) among Women in
Ernakulam District, Kerala

Preethy Jawahar1, Sudha A Raddi2

1
Assistant Professor, MOSC College of Nursing, Kolenchery, Kerala, 2Principal & Dean Faculty of Nursing,
KLEU Institute of Nursing Sciences, Belgaum, Karnataka, India

ABSTRACT

Objective: To assess the utilization regarding Integrated Child Development Services (ICDS) among women.
Study design: Descriptive survey. Materials and method: A sample size of 100 women from Ernakulam
district, Kerala. Statistical analysis used: Frequency and percentage to describe sample characteristics and
utilization of ICDS services. Results: Out of 100 women, 84 % were utilizing any one of the ICDS services
and 16% were not utilizing any ICDS services. Conclusion: Accurate information and encouragement from
health personnel will further help to improve the utilization regarding ICDS services.

Keymessages: An integrated package of services will help in the holistic development of the child.

Keywords: Utilization, health checkup, supplementary nutrition, non-formal education, immunization,

health education, referral services

INTRODUCTION A significant proportion of these children lives

in economic and social environment which impedes
The integrated child development scheme (ICDS) the child’s physical and mental development.1These
was launched in 1975, to provide an integrated package conditions include poverty, poor environmental
of services for the holistic development of the child.1 The sanitation, disease, infection, inadequate access to
beneficiaries are children below 6 years, pregnant and primary health care, inappropriate child caring and
lactating women in the age group of 15 to 45 years.1 The feeding practices etc.1The real shock lies in the fact
scheme aims to improve the nutritional and health status that all these lives could be saved with better child care
of vulnerable groups through providing a package of facilities. Fifty per cent of the total under-five mortality
services including supplementary nutrition, pre-school is due to malnutrition.1
education, immunization, health check-up, referral
services and health education.1ICDS is a multi-sectoral The aim of the study was to identify the utilization
program and involves several government departments. regarding ICDS services among women. This study will
The program services are coordinated at the village, further help in creating awareness among women and to
block, district, state and central government levels. improve the health status and utilization of services
These services are provided through community based
MATERIALS AND METHOD
anganwadi centres.1
The present study was a descriptive survey analysis
India is the home to the largest child population
done among 100 women residing in Ernakulam district,
in the world. “The development of children is the
Kerala. The study used convenient sampling technique.
first priority on the country’s development agenda,
Structured utilization questionnaire was used to collect
not because they are the most vulnerable, but because
data. The content validity of the tools were obtained.
they are our supreme assets and also the future human
Tool was translated to Malayalam and pretesting was
resources of the country”.1
done on 5 women, to determine the clarity of items. The
 International Journal of Nursing Education, July-September, Vol.9, No. 3 81

reliability of the instrument was tested by administering Cont... Table 1: Frequency and percentage
the tool to 10 women. The reliability coefficient of the distribution of samples characteristics (n = 100)
knowledge questionnaire was r = 0.87. Pilot study was 3 Education
conducted among 20 women to assess the feasibility and Uneducated 00 00
practicability. The data was collected after obtaining Up to SSLC 75 75
formal administrative permission from District Medical PUC 16 16
Officer, Child Development Project Officer (CDPO), Diploma/Graduate 06 06
Block Development Officer and Institutional Ethical Post graduate & above 03 03
4 Occupation
Committee. Informed consent were obtained from the
House wife 40 40
participants. The data collection was done in month
Coolie worker 20 20
of October 2016 to February 2017. The obtained data
Unprofessional 16 16
was tabulated and analyzed using the statistical package Professional 24 24
SPSS 17 version for windows. Findings were described 5 Type of family
using frequency and percentages. Nuclear 44 44
Joint 56 56
RESULTS
6 Religion
Section 1: Description of sample characteristics Christian 19 19
Hindu 81 81
Table 1 shows that out of 100 women, 52 % belonged Muslim 00 00
to the age group of 26-30 years and 99% were married
and living with their husbands. 75 % had education upto 7 Monthly income (in
SSLC, 40 % were house wife, 56 % were belonged to rupees) 42 42
joint family, 81% were Hindu’s and 42 % had a monthly Upto 3000 28 28
income between Rs.3001 to 6000. 98 % women were 3001– 6000 20 20
6001 – 9000 10 10
aware about ICDS services and among that 74% houses
More than 9000
were visited by anganwadi teacher.

Table 1: Frequency and percentage distribution 8 Aware about ICDS

of samples characteristics (n = 100) programme 98 98
Yes 02 02
SI. Sample characteristics Frequency Percen-
No
No (f) tage (%)
9 Anganwadi worker
1 Age (in years) visited you 74 74
18-25 37 37 Yes 26 26
26-35 52 52 No
36-45 11 11
2 Marital status
Married 99 99
Widow 01 01 Section 2: Description of utilization of ICDS
Divorced 00 00 services
Living separately 00 00
Data was collected from 100 women by using a
structured questionnaire.
Table 2: Utilization of ICDS services (n=100)

Utilized Not utilized Total

Frequency Percentage Frequency Percentage Frequency Percentage
Category
(f) (%) (f) (%) (f) (%)
Women having
children below 6
years of age 84 84 16 16 100 100
 82 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

The data presented in the table 2: shows that out of 100 women having children below 6 years of age, 84 % were
utilizing any one of the ICDS services and 16% were not utilizing any ICDS services.

Table 3: Utilization of ICDS services by women having children below 6 years of age
(n=100)

Frequency (f) Percentage (%)

Utilization of ICDS services
Yes No Yes No
1. Supplementary nutrition 76 24 76 24
2. Health checkup and referral services 55 35 55 35
3. Immunization 76 24 76 24
4. Non-formal education 72 26 72 26
5. Health education 44 56 44 56

The data presented in table 3 reveals that out of 100 were aged between 20-30 years. 75% of them went for
women reveals that, 76 % were utilized supplementary registration at one of the medical care centers. Around
nutrition, 55 % were utilized health checkup and referral 27.5% of the births were of first birth order and 46% of
services, 72 % were utilized non-formal education, 44 the total live births were 3+ birth order. Every 7th child
% were utilized health education, 76 % were utilized born was the study area belonged to 5+ birth order.
immunization services. Remaining number of children Around 70% of the deliveries took place at homes and
were immunized from private sector, so the percentage 82% of these home deliveries were conducted by village
of utilization of immunization were 100%. trained dais. Mothers who did not register at any of the
medical care centres are mostly illiterate, coming from
DISCUSSION poorer strata of population, below 25 years of age and
A comparative study was conducted to identify bearing 3 or more children. Most of these unregistered
the pattern of utilization of selected maternal and child mothers did not receive iron and folic acid tablets and
health services before and after the commissioning of TT immunization and finally delivered at home.
integrated child development services scheme at Rural
A study was conducted in Tamil Nadu to assess
Project Kathura, Haryana. First survey was conducted
the impact of the preschool education component of
in the year 1976 and repeated survey was conducted
the ICDS on the cognitive development of children in
in 1979. Health check up utilized by children < 6
the age group of 3–5 years. The study design used was
years increased from 28.2% to 92% and in pregnant
case control (ICDS attending children vs Non-ICDS).
and lactating mothers increased from 18.7% to 38%.
Data was collected from 300 children using structured
Supplementary nutrition utilized by children < 6
standardized Home Stimulation Inventory and Hema
years increased from 8% to 50% and in pregnant and
Pandey’s Cognitive Development tests. Results of the
lactating mothers increased from 0% to 25%. There was
study revealed the ICDS Anganwadi attendance had
a marked reduction in prevalence of severe degrees of
positive influence on the cognitive development of
malnutrition in children (below 6 years of age) from
children. The mean cognitive score of the attenders was
17.6 to 8.4 per cent attributable to delivery of a package
40.7 as against a mean score of 30.3 in the case of non-
of services and interventions. Immunization utilized
attenders.
by pregnant mothers increased from 1% to 50%. The
utilization of supplementary nutrition, health check up A study was conducted on awareness and utilization
and immunization increased significantly in pregnant of ICDS services among pregnant (106) and lactating
women, lactating mothers and children. women (177) in Haryana. Awareness of women
regarding services provided by ICDS was mainly for
A cross-sectional study was conducted in East
2 areas viz, nutrition (50%) and immunization (70%).
Delhi to assess the utilization of ante-natal care services
Less than 25% of women were aware of rest of the
among mothers. Data was collected from 276 mothers
services viz, nonformal education and health checkup.
using a semi open ended questionnaire. 75% mothers
 International Journal of Nursing Education, July-September, Vol.9, No. 3 83

The study showed that in subcentre areas beneficiaries 3. Davey A, Datta U. Perception regarding quality
were less aware of location and staff of anganwadi of services in urban ICDS blocks in Delhi. Indian
centre (AWC) and that they visited AWC less often as journal of public health 2008; 52 (3): 156-158.
compared to their counterparts in non-subcentre areas. 4. Devi P, Padmavati T. Effect of nutrition and health
Utilization of services was more in non-subcentre area education to rural women on the awareness,
than subcentre area. practices and nutritional status of ICDS children.
A study was conducted in Delhi among 1243 children Journal of research 2007; 7(15): 132-137.
in the age group of 7–13 years on long term nutritional 5. Saiyed F, Seshadiri S. Impact of the integrated
effects of ICDS. Anganwadi attendance score, age, sex package of nutrition and health services. Indian
of the child and education status of the father showed journal of pediatrics 2000; 67(5): 322-328.
statistically significant association with malnutrition. 6. Vaid S. Nutritional status of ICDS and non- ICDS
Children who attended anganwadis were nutritionally children. Journal of human ecology. 2005 mar;
better than who did not attend anganwadis during their 18(3): 207-212.
childhood, regarding the physical development.
7. Singh A. Utilization of ICDS services by pregnant
Conflict of Interest: Nill and lactating women in subcentre and non-
subcentre villages of Ambala, Haryana. Indian
Source of Funding: Self journal of public health. 1993; 37(4):125-7.
REFERENCES 8. Aggarwal O P, Kumar R, Gupta A. Utilization of
antenatal care services in Delhi. Indian Journal of
1. Integrated Child Development Services [internet] Community Medicine. 1997; 22 (1): 29-32.
2012 may 22. Available from: http://wcd.Nic.In/
9. Pandey H. Impact of preschool education
icds.html
component in ICDS programme on the cognitive
2. Bhasin S, Bhatia V, Kumar P. Long term effects of development of children. Journal of Tropical
ICDS. Indian journal of pediatrics. 2001; 68(3): Pediatrics. 1991; 37 (10):235-219.
211-216.
 DOI Number: 10.5958/0974-9357.2017.00074.5

Effectiveness of Healthy Eating and Active Lifestyle

Intervention Program (Healip) on Physiological and
Biochemical Parameters among Children with Obesity at
Selected Schools in Chennai – A Pilot Study Report

P Ester Mary1 Nalini Sirala Jagadesh2, R Vijayaraghavan3

Ph.D Research Scholar, Department of Nursing, Saveetha University, Chennai, 2M.Sc(N), Professor & Vice
1

Principal, Faculty of Nursing, Sri Ramachandra University, Porur, Chennai, 3Director of Research,
Saveetha University, Thandalam, Chennai

ABSTRACT

Children are the future mankind, healthy children becomes healthy adult. A nation’s health depends on the
health of the children. Ensuring their healthy growth and development is primary concern of the parents.
Childhood obesity is an alarming major public health concern.

Objectives: 1. To assess the Physiological and Bio chemical parameters among children with obesity in
control and experimental group.

2. To evaluate the effectiveness of HEALIP (Healthy Eating and active lifestyle intervention Programme) on
Physiological parameters and Bio chemical among children with obesity in experimental group.

Methodology: True experimental research design with two group pre test post test control group design
was adopted for the study. Children who fulfill the inclusion criteria were selected as a sample. A total of
20 children with obesity were selected and randomly allocated into study and control group. The study
group received HEALIP intervention post test was done for the both groups. Data was analyzed by using
descriptive and inferential statistics.

Results: Child Weight and BMI score respectively reduced from baseline to post-intervention (p<0.01).
There was significantly difference in the physiological parameters, (p<0.05). There was significantly
difference in the biochemical parameters , (p<0.005) . There was significantly improvement in the HEALIP
intervention on maintaining the physiological and biochemical parameters.

Keywords: physiological parameters, biochemical parameters, HEALIP intervention, obesity, School

children.

INTRODUCTION There are certain factors contributing to this

epidemic associated with childhood obesity. Lack of
Obesity has become one of the major issues, not
physical activity, Heredity, family history of obesity
only in developed countries but also in developing
and socioeconomic status. Today’s environment plays
countries. In India it is turning one of the major health
a major role in shaping the habits and perceptions of
problems. A decade back we found very few children
children and adolescents, exposure to sedentary life
were overweight as well as obese in our country, today
style, lack of exercise, increasing indoor game activities,
the scenario has changed to great extent. In India, the
usage of computers are the common trends adopted by
prevalence rate of overweight and obesity among
today’s generation2.
children/ adolescents is markedly increased1.
Obesity affects the general as well as systemic health
 International Journal of Nursing Education, July-September, Vol.9, No. 3 85

of an individual. It increases the risk of subsequent The data was collected by the following phases:
morbidity, with increased prevalence of hypertension,
Phase I: Sample selection based on BMI
type II diabetes mellitus, dyslipidemia, left ventricular
hypertrophy, non-alcoholic steatohepatitis, obstructive On the first day- The children weight, height and
sleep apnea, and orthopedic and psychosocial problems, BMI was measured. The children were instructed to stand
accelerates dental development, and decreases by on bare foot by using the portable electronic weighing
masticatory performance.3,4,5. scale; calibration of the machine was done before it was
used. Height was measured by using the stature meter
Since adult obesity is a key risk factor for lifestyle-
attached to the wall. Each participant were instructed to
related morbidity and mortality,it is important to develop
stand straight, with mass equally distributed between the
effective interventions for treating obesity in childhood6.
feet until the reading was stabilized, then the height was
Various studies done in India from 2002-2012 indicates
measured and recorded. Body Mass Index (BMI) was
a rising trend in the prevalence of overweight and obesity
calculated by the weight in kilograms divided by the
in children and adolescents7,8 . Many interventions has
square of the height in meters (kg/m2).
been followed to treat the childhood obesity hence
HEALIP intervention will supports to maintain their Phase II:
physiological as well as biochemical parameters which
focuses on the diet, physical activity , complication On the next day blood pressure, fasting blood sugar
prevention, and parental involvement The aim of the and post prandial was monitored: Blood pressure was
present study is (1)To assess the Physiological and measured in the left arm to the nearest 1mmHg using an
biochemical parameters among children with obesity in electronic machine . Fasting blood sugar was monitored
control and experimental group. by instructing the sample to avoid coffee , tea and
breakfast on the day of data collection procedure ,made
(2)To evaluate the effectiveness of HEALIP (Healthy the participant to sit in comfortable position, explained
Eating and active lifestyle intervention Programme) on the procedure to the participant, clean the needle prick
both groups. area with alcohol swab and completely made the skin to
dry before prick, after pricking the finger with one drop
MATERIALS AND METHOD
of blood placed on the test strip and recorded the results
Participants: This study was carried out among .Before using the Glucometer the calibration was done and
children with obesity, age group of 12 to 18 years, both verified. Allowed the participant to take over the breakfast
sexes of Chennai city, South India, St,Mary’s school, after 2 hours same method was followed to collect the post
and Nehru school with 20 samples. The samples prandial blood sugar, both values were recorded.
were selected and randomly allocated to study and
Phase III : On the 3rd day, of demographic
control groups based on the inclusion criteria. Informed
variables of age of child, gender educational status,
consent and oral consent was obtained from the mothers
religion, occupation of the parent , type of family ,area
of children for their participation in the study. This
of residence , monthly income, family history of obesity
study was approved by the Institutional Human Ethics
,exposure to secondary diseases, were assessed by self
Committee of Saveetha University .Data collection was
administered questionnaire .
carried out after discussing with the experts
Phase IV: On the 4th day for the experimental
Inclusion and exclusion criteria: Children’s
group children received HEALIP intervention
mothers who agreed to participation of their children
which includes Dietary Objectives, physical activities,
and gave the informed consent were included. Children
complication prevention, and involvement of the
who were absent at the time of data collection, who fail
parents in the child measurement program. Dietary
to fulfill the criteria, who were provided incomplete
Objectives (Healthy Eating Habits) includes positive
data, the child’s BMI reduced due to medical prescribed
encouragement of the children on healthy eating habits,
diet ,and the child who is already in weight reduction
24 hours dietary recall and menu planning was done
progamme , were excluded.
for the each participant based on their recommended
 86 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

dietary allowance. Healthy food habits, tips for eating Phase VII: Parental involvement: On the 2nd
healthy foods, Eating an healthy balanced diet which month, a notification was sent to the parents of the
includes fewer processed foods , regular meals focusing experimental group to make involve themselves in their
on breakfast, concentration on eating fresh meals, child measurement programme. A monthly monitoring
Increasing intake of fruits, vegetables and water, health card regarding child’s progress in physiological
replacing the snacks with healthier alternatives such and biochemical parameters was given to their parents.
as low fat and sugar, to reduce the amount of salt and So that the parents may aware about the Childs health
sugar added in foods and beverages was explained and concern, and also discussed about their involvement
encouraged the children/parents to move positively at home environment such as avoiding the child from
towards healthy eating habits .A diet recording sheet was over eating, oily foods and encouraging the child to do
monitored by the researcher by observing the children’s physical activity regularly . Doubts were clarified to the
intake of food items . parents. With the help of class teacher the children’s were
instructed to bring their parents for regular meetings, in
Phase V : Physical Activity Objectives (Active that way the HEALIP intervention was carried out.
lifestyle intervention programme); encouraged the
children to increase their physical activity like brisk Phase VIII: physiological and biochemical
walking for 30-45 minutes daily, running for 20- parameters were measured by using same procedure for
30minutes, continuous cycling for 20-30 minutes, or control group without HEALIP intervention.
jumping rope exercise for 20-30 minutes . Every day
Phase IX : After 120 days, post test was carried
after school, made the samples to do all these vigorous
out for both experimental and Control groups. Height,
activities for 30- 40 minutes were monitored by the
weight, BMI, blood pressure, fasting and post prandial
researcher and recorded into low, moderate, and high
blood sugar was measured for both group .
physical activity based on their MET values .
Phase X : At the end of the study (after the
Phase VI : on the following week the structured
completion of the experiment)
teaching program was organized on Complication
prevention in obesity by using power point HEALIP intervention for a period one month and
presentation and verbal interaction around 45 minutes the education on complication prevention and detailed
for the experimental children as well as to their parents. intervention booklet was given to the parents as well as
Teaching program and PowerPoint presentation includes the children of the control group.
,meaning of obesity, classification, causes and their
complication such as diabetes, hypertension, coronary Statistics : All the data obtained were tabulated.
heart diseases, liver diseases, dyslipedemia, renal Descriptive and inferential statistics were used to present
diseases, gynecological abnormalities, osteoarthritis, the data and analysis was carried out using Statistical
fatty liver cirrhosis, gall balder diseases, phlebitis, Package for the Social Sciences (SPSS) version 15.
optical disorders, behavioral and learning disabilities
and their preventive measures were enforced for the
children. Intervention description booklet was printed
in Tamil and English and distributed for their future
reference.
 International Journal of Nursing Education, July-September, Vol.9, No. 3 87

RESULTS

Table 1: Effectiveness Of Healthy Eating Active Lifestyle Intervention Program (HEALIP) On Physiological
Parameters (Height,Weight,BMI)Among Control and Experimental Group In pre and Post Test.

Table 1 illustrates Within the Height of experimental group and control group in post- test shows no significant
reduction t=-0.580 and p=0.569 . Weight of experimental group and control group in post- test also had significant
reduction t=-0.427 and p=0.966 value. BMI of experimental group and control group in post- test had significant
changes t=0.696 and p=0.496 value. HEALIP Intervention shows significantly effective in reducing physiological
parameters of p=<0.01in the experimental group.

Table 2: Effectiveness Of Healthy Eating Active Lifestyle Intervention Program(HEALIP) On Physiological

Parameters(Systolic Blood Pressure And Diastolic Blood Pressure ) Among Control And Experimental Group
In pre and Post Test.
 88 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Program(HEALIP) On Physiological Parameters(Systolic Blood Pressure And

Diastolic Blood Pressure ) Among Control And Experimental Group In pre and Post Test.

Table 2: Revealed that within the experimental and control group of systolic and diastolic blood
pressure (Physiological parameters) in post test had significant differences. Systolic blood pressure of
experimental group and control group in post- test had significant differences t=1.758 and p=0.0957
value. Diastolic blood pressure of experimental group and control group in post- test shows t=1.663 and
p=0.114 value. HEALIP Intervention shows significant effectiveness in maintaining the physiological
parameters of p=<0.001.

Table 3: Effectiveness Of Healthy Eating and Active Lifestyle Intervention Program(HEALIP) On Bio
chemical Parameters(Fasting Blood sugar And Post prandial blood sugar) Among Control And Experimental

Group In pre and Post Test.Table 3. Revealed that within the experimental and control group of Fasting and post
prandial blood sugar (Bio chemical parameters)in post test shows significant changes . Fasting blood pressure of
experimental group control group in post- test had significant changes t=6.449 and p=0.045 value . Post prandial
blood sugar of experimental group and control group in post- test had significant changes t=4.569 and p=0.024
value. HEALIP Intervention shows significantly effective in maintaining the bio chemical parameters of p=<0.0.1

Table 4: Physiological (Height, Weight, and BMI )and Bio chemical Parameters (Fasting Blood Sugar And
post prandial Blood Sugar ) Among Control And Experimental Groups In The Pre –Test and Post -Test
 International Journal of Nursing Education, July-September, Vol.9, No. 3 89

DISCUSSION and obesity in Indian adolescent school going

children: Its relationship with socioeconomic
The present study is to evaluate the impact of the status and associated lifestyle factors. J Assoc
HEALIP intervention on physiological and Biochemical Physicians India. 2010;58:1518.
Parameters among children with childhood obesity in
Chennai, India. Childhood overweight and obesity are 2. Story M, Kaphingst KM, Robinson-O’Brien
global problems that are on the rise due to modernization R, Glanz K. Creating healthy food and eating
in lifestyle(dietary habits and physical activity). Height environments: policy and environmental
,weight, BMI, blood pressure and blood glucose level, approaches. Annu Rev Public Health. 2008; 29:
shows significant difference in post test of both groups 253–272.
whereas pre test had no significant changes. 3. Li X, Li S, Ulusoy E, Chen W, Srinivasan SR,
Berenson GS. Childhood adiposity as a predictor
This study was supported by Sonya Jagadesaran et of cardiac mass in adulthood: The Bogalusa heart
al (2015)conducted a study on Prevalence of Overweight study. Circulation 2004;110:3488-92.  
and Obesity among School Children and adolescents in
4. Hilgers KK, Matthew Akridge BA, Scheetz
Chennai.He concluded that the prevalence of obesity was
JP, Kinane DF. Childhood obesity and dental
significantly higher in private compared to government
development. Pediatric Dent 2006;28:18-22.
schools(IOTF criteria)9. And M Watson, Lindsey et
al conducted a study Owen Service evaluation of the 5. Macek MD, Mitola DJ. Exploring the association
GOALS family-based childhood obesity treatment between overweight and dental caries among US
intervention during the first 3 years of implementation children. Pediatr Dent 2006;28:375-80.
.which results in small improvements in child BMI z- 6. Oude Luttikhuis H, Baur L, Jansen H, et al.
score10. Interventions for treating obesity in children
(review): the Cochrane Collaboration. Wiley,
CONCLUSION
2009.
The findings of the study concluded that obesity 7. Chakraborty P, Dey S, Pal R, Kar S, Zaman FA,
children are at risk group for developing diseases like Pal S Obesity in Kolkata children: Magnitude in
diabetes, hypertension, and cardiovascular disease, relationship to hypertension. J Natural Sci Bio
dyslipidemia, obstructive sleep apnea, and orthopedic Med. 2012;2:101-6.
and psychosocial problems11.An integrated program 8. Shah B, Anand K, Joshi P, Mahanta J, Mohan
on HEALIP intervention was effective in maintaining V,Thankappan K, et al. Report of the Surveillance
physiological and bio chemical parameters by promoting of Risk Factors of Non-communicable Diseases
healthy diet, physical activity that helps the muscles (STEPS 1 and 2 From Five Centers in India
to consume excessive glucose stored in the body which – WHO India – ICMR) initiative, New Delhi.
leads to healthy life and encouraging the parents to
9. Sony jagadesan prevalence of overweight and
become good role model by participating in their regular
obesity and obesity among school children
child measurement program.
and adolescents in Chennai, Indian Journal
Conflict of Interest: No Conflict of interest to ofpediatrics.2014 volume 5,1 July 15.p 544-548.
declare. 10. Waston PM, et al Service evaluation of the
GOALS family-based childhood obesity
Funding:None
treatment intervention during the first 3 years of
Ethical Clearance: Obtained from Saveetha implementation BMJ open2015;5page 1-14.
University 11. Sony jagadesan prevalence of overweight and
obesity and obesity among school children
REFERENCES
and adolescents in Chennai, Indian Journal
1. Goyal RK, Shah VN, Saboo BD, Phatak SR, Shah ofpediatrics.2014 voulme 5,1 july 15 p 544-548.
NN, Gohel MC, et al. Prevalence of overweight
 DOI Number: 10.5958/0974-9357.2017.00075.7

Prevalence of Psychological Morbidity among

Medically Ill Patients

R. Sathish1, E Devakirubhai2
Asst Professor, Ved Nursing College, NH – 1: Delhi – Karnal Highway, Panipat,
1

2
Professor, Sacred Heart Nursing College, Madurai

ABSTRACT

Physical and Mental health are two sides of a coin and both are interdependent. A nurse who is responsible
for total health care of a person must take care of the emotional aspect also. Objectives: to determine the
prevalence of psychological morbidities (Distress, Depression, Anxiety and Somatization) among medically
ill patients. Method: A descriptive correlational survey research design was used. Samples were 210
medically ill patients admitted in Rajaji Govt Hospital, Madurai. Sampling technique used was stratified
random sampling technique. Data collection procedure was self-structured interview method and tool used
for data collection was 4DSQ (4 Dimensional Symptom Questionnaire, Terulin et al, 2008) descriptive and
inferential statistics were used for analysing data. Results: 73 % of the samples had low distress. Around
75 % of the samples had low depression; an overwhelming majority of samples 97 % had low anxiety and
samples who had low level somatization were 93 %. There was a significant positive correlation between
distress & depression (r=0.8) distress & anxiety (r = 0.30) distress & somatization (r=0.54) depression &
anxiety (r=0.42) depression & somatization (r=0.57) and anxiety & somatization (r=0.39). Conclusion:
Nurses who works in general health settings must consider the psychological care of medically ill patients
also.

Keywords: Psychological morbidity, Prevalence, Medically ill patients, Distress, Depression, Somatization,
Anxiety.

BACKGROUND OF THE STUDY issue, affecting peoples of all ages and from all cultures
and socio-economic status. Every medical and surgical
“Mental Health in Primary Care: Enhancing
problem is accompanied by some emotional problems2.
Treatment and Promoting Mental Health” forms
The nurse who spends her considerable time with the
the theme of World Mental Health Day 2009. The
patient cannot afford to ignore this aspect of an illness.
objectives seek to recognize the need to integrate
Often patient suffers from psychological problems than
mental healthcare into mainstream healthcare to
actual physical pain, because of the intimate relationship
ensure universal access. This assumes all the more
of the body and mind. It is difficult for anything to affect
importance in the light of the recent prediction made
the body without affecting the mind3. There is a need for
by the World Health Organization, that in the next
complete database for the prevalence of psychological
two decades, Depression is likely to be the number
morbidity among medically ill patients that will help the
one illness affecting millions of people worldwide1. It
care provider to render a holistic care.
stresses the importance of identifying and treating mental
illness in general health settings. Mental health disorders MATERIALS AND METHOD
continue to be a serious and expensive global health
A descriptive correlational survey research design
Corresponding author – was used for the present study. Stratified random
Mr Sathish Rajamani sampling technique was adopted for selecting samples.
Assistant Professor, Prem Institute of Medical Data was collected by means of self-structured interview
Sciences, Badauli. Panipat, Haryana – 132103. method and tool used for data collection was 4DSQ (4
Email: [email protected] Dimensional Symptom Questionnaire, Terulin et al,
 International Journal of Nursing Education, July-September, Vol.9, No. 3 91

2008) descriptive and inferential statistics were used for analysing data.

RESULTS

Table 1: Distribution of samples according to psychological morbidity (n = 210)

Low Moderately High Very High

Variables
f % f % f %

Distress 153 73.00 56 26.50 1 0.50

Depression 157 75.00 48 23.00 5 2.00

Anxiety 203 97.00 6 3.00 0 0.00

Somatization 195 93.00 15 7.00 0 0.00

Table 1: shows the frequency and percentage distribution of samples according to the psychological
morbidity.

A little less than three fourth of the samples 153 (73.00%) had low distress, Three fourth of the total samples 157
(75.00%) had low depression. An overwhelming majority of the total samples 203 (97.00%) had low anxiety and
with regard to somatization majority of the samples 195 (93.00%) had low somatization.

Table 2: Frequency distribution of samples according to diagnosis (n = 210)

Distress Depression Anxiety Somatization

Moder-
Very Moderately Very Moderately Very Moderately
Low ately Low Low Low Very High
High High High High High High
High
17 12 1 15 13 2 29 1 0 25 5 0
Cardiac
(56.60) (40.00) (3.40) (50.00) (43.40) (6.60) (96.70) (3.30) (0,00) (83.40) (16.60) (0.00 )
21 9 0 28 2 0 30 0 0 28 2 0
Respiratory
(70.00) (30.00) (0.00) (93.40) (6.60) (0.00) (100.00) (0.00) (0,00) (93.40) (6.60) (0.00)
24 6 0 24 6 0 30 0 0 30 0 0
Nephrology
(80.00) (20.00) (0.00) (80.00) (20.00) (0.00) (100.00) (0.00) (0.00) (100.00) (0.00) (0.00)
Gastro-Enter 24 6 0 23 6 1 30 0 0 29 1 0
ology (80.00) (20.00) (0.00) (76.70) (20.00) (3.30) (100.00) (0.00) (0.00) (96.70) (3.30) (0.00)
24 4 0 27 3 0 30 0 0 30 0 0
HIV / AIDS
(86.60) (13.40) (0.00) (90.00) (10.00) (0.00) (100.00) (0.00) (0.00) (100.00) (0.00) (0.00)
23 7 0 21 6 3 28 2 0 26 4 0
Neurology
(76.70) (23.30) (0.00) (70.00) (20.00) (10.00) (93.40) (6.60) (0.00) (86.70) (13.30) (0.00)
18 12 0 18 12 0 25 5 0 26 4 0
Endocrinology
(60.00) (40.00) (0.00) (60.00) (40.00) (0.00) (83.40) (16.40) (0.00) (86.70) (13.30) (0.00)

Table 2: explains the distribution of samples according to psychological morbidity and medical diagnosis.

• With regard to patients who have cardiac disorders an overwhelming majority of samples 29 (96.70%) had
low anxiety and next to it were low somatization 25 (83.40%).. one half of the total samples with cardiac disorders
had low depression 15 (50.00%). Low distress was • Among those samples who suffer from renal
present in 17 (56.60%) of the samples. disorders low anxiety and low somatization were
common psychological problems in all samples 30
• In Samples who had respiratory disorders, all the
(100%). Low distress and low depression was seen in 24
samples were suffering from low anxiety 15 (30.00%).
(80.00%) of total samples.
Samples with low depression and low somatization were
28 (93.40 %). Low anxiety was seen in 21 (70.00%) • Psychological morbidity among patients with
samples. gastroenterology related disorders shows that all samples
 92 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

had low anxiety 30 (100%). Low somatization was next common in the general hospital. Studies show that up to
major problem in 29 (96.70%). Low distress was found 65 % of medical inpatient have psychiatric disorders5.
in 24 (80.00%) of samples and low depression was 23
Kunal Kumar, Abhinit Kumar, Prakash Chandra,
(76.70%).
and Hari Mohan Kansal (2016) conducted a study
• Low anxiety and low somatization were seen in to determine the point prevalence of depression and
all samples with HIV / AIDS 30 (100%). Next to it was anxiety in patients suffering from tuberculosis. Total of
low depression 27 (90.00%). Samples with low distress 100 consecutive cases were included who were already
were 24 (86.60%). diagnosed with tuberculosis after applying inclusion
and exclusion criteria. Tools used were General
• Low Anxiety was the most common
Health Questionnaire 12 (GHQ-12), Beck Depression
psychological entity 28 (93.40 %). Samples with low
Inventory (BDI-II) and Hamilton Anxiety Rating Scale
somatization were 26 (86.70%). Little above one third
(HARS). Out of 100 cases, 74 cases found to be having
of total samples 23 (76.70%) had low distress and 21
psychiatric symptoms, in which 35 cases were suffering
(70.00%) of total samples had low depression.
from depression and 39 were suffering from anxiety6.
• An overwhelming majority of total samples
Haverkamp GL, Torensma B, Vergouwen AC and
with endocrinology disorders have low somatization
Honiq A (2015) Prevalence of psychological distress w
problems 26 (86.70%). Next to it was 25 (83.40%)
as assessed using the extended Kessler-10 (EK-10) in
samples with low anxiety. Low distress and low
904 patients in a Dutch general teaching hospital. Of
somatization was seen in 18 (60.00%) of total samples.
904 patients, 585 were native Dutch patients and 319
Table 3: Correlation between the variables of were immigrant patients. The prevalence of psychologic
psychological morbidity among medically ill patient al distress in native compared to immigrant patients was
54% and 66% respectively, with especially
(n = 210) high prevalences among Turkish and Moroccan
immigrant patients. The crude OR for prevalence of
Variables ‘r’ value ‘p’ value
psychological distress for immigrant patients versus
Distress & Depression 0.82 0.000 native patients was 1.7 (95% CI 1.2-2.2) and for first
versus second generation immigrant patients 2.1 (95%
Distress & Anxiety 0.30 0.000
CI 1.2-3.5). After full adjustment ORs were 1.7 (95% CI
Distress & 1.2-2.3) and 2.2 (95% CI 1.2-4.1) respectively7.
0.54 0.000
Somatization
Depression & Anxiety 0.42 0.000 Anthony W. McGuire, Emanuela Ahearn, and Lynn V.
Doering (2015) reviewed the current literature regarding
Depression &
Somatization
0.57 0.000 psychological distress in patients with cardiovascular
disease (CVD). Relevant and current (2005–2015)
Anxiety & Somatization 0.39 0.000
studies were retrieved by a series of searches conducted
in the PubMed and PsychINFO databases using Boolean
The above table reveals the Correlation between the terms/phrases along with manual extraction from the
variables of psychological morbidity among medically reference lists of pertinent studies. Narrative and tabular
ill patients. There was a statistically significant summaries of the findings are reported. Results show
correlation between all variables under the study. It was there is a vast literature on psychological distress and
noted that high correlation was present between distress CVD. Depression is the most common disorder studied
& depression (‘r’ = 0.82, ‘p’ value 0.000). followed by anxiety and posttraumatic stress disorder.
DISCUSSION Physiologic mechanisms linking psychological distress
to CVD are well theorized. Screening for psychological
Medical and surgical inpatients often have psychiatric distress in CVD is recommended8.
conditions that require psychiatric consultations4. it
is now widely accepted that psychiatric disorders are Solomon H. Tesfaye and Girma T. Bune (2014)
cross-sectional study was conducted. Interviews were
 International Journal of Nursing Education, July-September, Vol.9, No. 3 93

conducted with 500 patients initiating ART at Dilla Grandi S (2010) cross-sectional study was to done assess
Referral Hospital. Generalized psychological distress the prevalence and characteristics of anxiety disorders
was measured using the Hospital Anxiety and Depression in the medically ill. A sample of 1,660 medical
Scale (HADS). The prevalence of generalized patients was recruited from different medical settings
psychological distress among the population of this in different periods from 1996 to 2007. All patients
study was 11.2% (HADS≥19). Factors independently underwent detailed semistructured interviews with the
associated with generalized psychological distress were Structured Clinical Interview for DSM-IV (SCID) and
moderate stress (OR=6.87, 95% CI 2.27–20.81), low the Structured Interview for Diagnostic Criteria for
social support (OR=10.17, 95% CI 2.85–36.29), number Psychosomatic Research (DCPR). Results revealed
of negative life events of six and above (OR=3.99, 95% Generalized anxiety disorder was the most frequent
CI 1.77–8.99), not disclosing HIV status (OR=5.24, anxiety disturbance (10.3%) and was associated with
95% CI 1.33–20.62), and CD4 cell count of <200 cells/ DCPR somatization syndromes, Type A behavior, and
mm3 (OR=1.98, 95% CI 0.45–0.83) and 200–499 cells/ irritable mood. Panic disorder with agoraphobia and
mm3(OR=3.53, 95% CI 1.62–7.73)9. agoraphobia without history of panic disorder had
almost identical prevalence (about 4.5%), but differed
ZG Rukundo, S Musisi,and N Nakasujja (2013)
in some patterns of somatization. Agoraphobia without
done a study to determine the prevalence, types and
panic attacks was related to illness denial, persistent
associations of psychiatric morbidity as seen among
somatization, anniversary reactions, and demoralization.
adult in-patients on medical and surgical wards of
Much lower prevalence rates were reported for social
Mbarara Regional Referral hospital as a prototype
phobia and obsessive-compulsive disorder12.
Ugandan regional referral hospital. This was a cross
sectional descriptive study. Psychiatric diagnosis was CONCLUSION
arrived at by administering the Mini International
The current study serves as an eye opener for the
Neuropsychiatric Interview (MINI) as the diagnostic
nursing professionals to include psychological aspects
instrument. Of the 258 participants in this study, 109
of assessment and care in the general health settings.
(42%) met criteria for at least one DSM IV psychiatric
Nurses who care the medically ill patients should be
diagnosis. Only 6% of all the psychiatrically diagnosed
well equipped to carry out mental status examination
patients were recognized by their treating doctors as
and diagnose the common mental morbidities and
having mental illness10.
they should refer it immediately for further psychiatric
Rodrigue M L’akoa. Jean Jacques N N. Yixin F, treatments.
Félicien E N and Christopher K (2013) Interviews
Conflict of Interest – Nil
were conducted with 100 newly diagnosed HIV-
infected patients at three referral hospitals of Yaoundé. Source of Funding – Self
Depression was assessed using the nine-item Patient
Health Questionnaire (PHQ-9). A positive depression Ethical Clearance – Before the conduction of main
screen was defined as PHQ-9 score greater than 9. The study. Ethical permission was obtained from the Ethical
overall prevalence of depressive symptoms was 63% Committee of Sacred Heart Nursing College, Madurai.
(95% CI: 53.2 to 71.8), the majority having symptoms Tamil Nadu.
corresponding to moderate depression. Multiple logistic
REFERENCES
regression analysis showed that probable depressed
patients were more likely than those who were not 1. Savitha C M. World Mental Health Day 2009 –
depressed to have had experience of alcohol abuse “Mental Health in Primary Care. [Internet]. [Place
(OR: 19.03, 95% CI 3.11-375.85; p = 0.0083), and a 100 Unknown]: [updated 2009 Oct 9; cited 2009 Oct
CD4 cells/mm3 fewer was associated with a 2.9 times 9] Available from: http://www.medindia.net/news/
increase of the odds of probable depression (95% CI healthinfocus/world-mental-health-day-2009-
1.88-4.84; p < 0.0001)11. mental-health-in-primary-care-59168-1.htm

Fava GA, Porcelli P, Rafanelli C, Mangelli L, and 2. Moffic HS, Peykel ES. Depression in medical ill
 94 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

patients. Br J Psychiatry 1975; 126:346-53. Disease. 2015, Sep; 22 (9): 421 – 32.
3. Kaplan HI, Sadock BJ. Synopsis of psychiatry. 8. Solomon H, Tesfaye and Grima T, Bune.
Philadelphia, Pa: Lippincott Williams &Wilkins; Generalized Psychological Distress among HIV
2003. – Infected Patients. Global Health Action 2014,
4. Mayou R, Hawton K. Psychiatric disorders in the May 7 (1): 81 – 89.
general hospital. Br J Psychiatry 1986;149:172- 9. Rukundo ZG, Musis S, Nukasujja N. Psychiatric
190. Morbidity among Physically ill patients in a
5. Kunal K, Abhini K, Prakash C and Hari M K. A Ugandan Regional Referral Hospital. African
Study of Prevalence of Depression and Anxiety Health Sciences 2013: 13 (1) 87 – 93.
in Patients Suffering from Tuberculosis. J Family 10. L’akoa et al. Prevalence and correlates of
Medicine & Primary Care. 2017, Mar; 5 (1): 142 depressive symptoms in HIV positive Patients.
– 63. BMC Psychiatry 2013; Sep 13 (1) 64 – 71.
6. Haverkamp GLG, Tarensma B, Vergouwen 11. Fava GA, Porcelli P, Rafannelli C, Mangelli l and
ACM and Hunig A. Psychological Distress in the Grandi S, The Spectrum of Anxiety Disorders in
Hospital Setting: A Comparison Between Native the Medically Ill. J Clin Psychiatry. 2010; Jul 71
Dutch and Immigrant Patients. PLOS ONE 11(7): (7) 910 – 14.
14 – 21.
7. Anthony W Mc Gurie, Emanuela A, Lynn V
D. Psychological Distress and Cardiovascular
 DOI Number: 10.5958/0974-9357.2017.00076.9

A Study on the Relationship between Blood Glucose Level and

Depressive Symptoms among the Antenatal Women in the
Selected Hospitals at Mangalore

Joyce D’souza1, Nalini M2

1
Lecturer, 2Associate Professor, Mental Health Nursing Nitte Usha Institute of Nursing Sciences, Nitte University

ABSTRACT

Introduction: Antenatal period is a maturational milestone in women .The physical as well as emotional
changes that occur during pregnancy can lead to mood swings. Where the antenatal woman is not able to
cope up with the changes and these can lead to depressive symptoms. National institute of mental health
reported that 10-15 % of woman have depression worldwide . International diabetes federation reported that
15% of women are diagnosed as gestational diabetes [1].

Objective: The aim of the study was to find the relationship between the blood glucose level and depressive
symptoms among antenatal women.

Materials and method: A Cross sectional design was adopted with 100 study participants. The data was
analysed by using Chi square and Fishers Exact test to assess the association and Pearson co relation was
used to assess the relationship between blood glucose level and depressive symptoms.

Results: The study results revealed that 76% of the study participants had mild depressive symptoms and
13% of them had moderate depressive symptoms. There was a weak linear negative relationship between
overall depressive scores and blood glucose level among antenatal woman (r=-.381). However the fishers
exact test results shows that there was a significant association between depressive symptoms and blood
glucose level (p=>0.0001). The study findings conclude that there is a significant association between
depressive symptoms and blood glucose level.

Conclusion: Antenatal period is a crucial period so it is necessary to differentiate the normal phenomenon
and depressive symptoms to reduce the risk of mental disability

Keywords: Blood glucose level, Depressive symptoms, gestational diabetes, and Antenatal depression

INTRODUCTION 41.9% woman are having depressive disorder. Studies

also estimated that 7 to 20% of antenatal women are
Major depressive disorder (MDD) is projected
affected by antenatal depression.[2] Indians are among
to be one of the leading contributors to burden of
the world’s most depressed according to a World Health
disease globally by 2020[2]. 350 million people
Organization-sponsored study, results revealed that 9%
live with depression and it is the leading causes of
of people in India have extended period of depression
disability worldwide. Global studies revealed that
and around 36% of the people suffer from Major
Depressive Episode (MDE).[3]
Corresponding author information-
Mrs Joyce D’souza, So the investigator has investigated about the
Nitte Usha Institute of Nursing Sciences, Paneer Beeri prevalence of depressive symptoms among antenatal
Road, Deralakatte, Mangalore -575018 women and relationship between depressive symptoms
E-mail id- [email protected], Mob.: 9620113603 and GCT results is discussed in order to investigate the
 96 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

scientific base. H3: There will be a significant association between

depressive symptoms and selected demographic
NEED OF THE STUDY variables.
Antenatal period is a maturational milestone in
ASSUMPTIONS
women .The physical as well as emotional changes
that occur during pregnancy can lead to mood swings. This study assumes that
Where the antenatal woman is not able to cope up
1. There may be a relationship between depressive
with the changes and these can lead to depressive
symptoms and GCT
symptoms unfortunately the antenatal woman fails to
identify the symptoms. The depressive symptom which DELIMITATIONS
is experienced by antenatal women also has influence
on family and the society A cross-sectional study was 1. This study is delimited to the subjects who have
conducted in turkey to examine the association between been reported in hospitals at Mangalore.
blood glucose level and depression among 177 women
RESEARCH METHODOLOGY
with gestational ages ranging from 24 to 28 weeks.
The subjects were screened with the 50 g oral glucose Research approach – Quantitative approach
challenge test. Beck Depression Inventory was used to
assess the depressive symptoms among the subjects. Research design- Descriptive/cross sectional
The study revealed that depression level was higher in Setting of the study-The study was conducted in
women with abnormal glucose results (44.3%) than in selected hospitals at Mangalore
women with normal glucose results (21.7%). The study
finding concludes that depression may be associated Population- Antenatal woman between 24-28
with blood glucose tolerance in pregnant women. [4] weeks with GCT results
There are research evidence supporting the relationship
Sampling technique- Non probability sampling
between depressive symptoms and blood glucose level.
Hence the present study aims to explore the relationship Sample size-100 Antenatal woman between 24-28
between blood glucose level and depressive symptoms weeks with GCT results in selected hospital Mangalore
among antenatal women.
CRITERIA FOR SAMPLE SELECTION
OBJECTIVES
Inclusion criteria
1. To assess the blood glucose level and depressive
symptoms among antenatal women of gestational period Antenatal mothers who are
between 24 to 28 weeks.
Age between 20 to 35 years
2. To find the relationship between blood glucose
Primi and multi Para mothers.
level and depressive symptoms among antenatal women
of gestational age between 24 to 28 weeks. Gestational week between 24 to 28 weeks

3. To find the association between Blood glucose Exclusion criteria

level, depressive symptoms of the antenatal woman with
selected demographic variables Antenatal mother who have

HYPOTHESIS Complicated pregnancy like hypertension,

antepartum haemorrhage
H1: There will be a significant relationship between
GCT and depressive symptoms Diagnosed case of other psychiatric and medical
illness
H2: There will be a significant association between
GCT and selected demographic variables
 International Journal of Nursing Education, July-September, Vol.9, No. 3 97

DATA COLLECTION INSTRUMENTS years and 22 women was more than 5 years

Part 1- Demographic proforma • About 25 women had normal BMI, 45 women

were overweight and 35 women were obese.
Part 2- Rating scale to assess depressive symptoms
among antenatal mothers DISTRIBUTION OF DEPRESSIVE SYMPTOMS
AND GCT RESULTS
DATA COLLECTION PROCEDURE
• The distribution of depressive symptoms among
Data were collected from 15/10/2015 to 30/12/
the 100 mothers i.e. 11 was asymptomatic and 89 were
2015. To conduct the study a formal written permission
symptomatic. Of which76 showed mild symptom and
was obtained from the selected Hospital Mangalore.
remaining were moderately symptomatic. None of the
Subjects who met the inclusion criteria were selected
mother had severe depressive symptoms
by purposive sampling technique and then Informed
Consent was obtained from the study participants • About 84 mothers had normal GCT results and
Confidentiality was maintained .Subjects were explained 16 mothers had abnormal GCT results.
about the objectives and purpose of the study.
RELATIONSHIP BETWEEN DEPRESSIVE
RESULTS SYMPTOMS AND GCT RESULTS

SAMPLE CHARACTERISTICS The relationship between depressive symptoms

and GCT results were analysed by Pearson correlation
• Among 100 antenatal women 54 women are
and the “r” value was -0.381 and the p value = < 0.001.
between age group 20-25 years, 3 women are between
Hence there was a negative linear relationship between
26-30 years, 12 women are between 31-35 years, and 2
depressive symptoms and GCT results at the 5% level
women are between 36-40 years.
of significance. These results reveal that there is a weak
• Educational qualification of 19 women had relationship between depressive symptoms and GCT
primary education, 42 women had high school education, results.(r is near to 0)
25 had women PUC education, and 14 women were
ASSOCIATION BETWEEN THE GCT
graduates and above.
RESULTS AND SELECTED DEMOGRAPHIC
• 32 women belong to Hindu religion, 53 women VARIABLES.
belong to Muslims religion and 15 women belong to
Association between the GCT results and selected
Christian’s religion.
demographic variables were analysed by using Chi-
• Majority of women were house wife i.e. 85 square and Fishers exact test. The P value of Income (p
women and others were employed i.e. about 11 women. = 0.001) ,Weight (p= 0.004) and BMI ( p = 0.009) is less
than 0.05 And hence these variables are associated with
• About 51 women belong to nuclear family, 40 GCT results at the 5% level of significance.
women belong to joint family and 9 women belong to
extended family. ASSOCIATION BETWEEN THE DEPRESSIVE
SYMPTOMS AND SELECTED DEMOGRAPHIC
• About 17 women had less than Rupees 5000 VARIABLES.
annual income, 55 women had between Rupees 5001-
10,000, 23 women between Rupees 10,001-15,000, 4 Association between the depressive symptoms
women between Rupees15,001-20,000 and 1 woman and selected demographic variables was analysed by
had more than Rupees 20,001. using Chi-square and Fishers exact test. The P value of
Religion(p=0.032) Income(p=0.039) is less than 0.05
• 56 women were from rural area and 44 women And hence these variables are associated with depressive
were from urban area symptoms at the 5% level of significance.
• 88 woman duration of marriage was less than 5
 98 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

ASSOCIATION BETWEEN DEPRESSIVE CONCLUSION

SYMPTOMS AND GCT RESULTS
Antenatal depression as well as gestational diabetes
The association between depressive symptoms and mellitus is been affecting the physical and psychological
GCT results were analysed by using fishers exact test health of the woman which are contributing to burden
(p=<0.0001) which is less than 0.05 and hence these of disease. Since these both are the leading cause for
variables are associated at the 5% level of significance. disability among women of child bearing age.it is
necessary to take essential steps to prevent as well as to
LIMITATIONS OF THE STUDY
find the cause for their occurrence in women.
• The study was limited to only 100 antenatal
Source of Funding: Self
women in selected hospitals.
Conflict of Interest: Nil
• Gravida of the mothers was not considered.
Since it was not the objective of the study to compare Ethical Clearance: Ethical clearance obtained from
the gravida Nitte Usha institute of nursing sciences institutional
ethics committee
• Pre pregnancy weight of the mothers was not
assessed REFERENCES

• The data collection instrument were not 1. Ann P. “Depression and mental health by the
standardized but it was prepared by the investigator, Numbers, Facts, Statistics and You”. Health line
validity and reliability was established 2015 Jan.[cited on 10 October 2015].Available from
www.health.com>depression
RECOMMENDATIONS
2. Katon JG, Russo J, Gavin AR, Melville JL, Katon
• A cross sectional study can be conducted on a WJ. Diabetes and depression in pregnancy: is there
larger sample for generalization of the findings. an association? Journal of Women’s Health. 2011 Jul
1; 20(7):983-9.
• A comparative study can be conducted for primi
and multi gravida mothers 3. Sinha K. “Indians is Depressed lot.” Times of India.
[Cited on 10 October 2015] Available from. www.
• An interventional study can be conducted for times of india.idiatimes.com>articles show2011.
antenatal women with abnormal GCT results. 4. Gezginç K, Þahingöz M, Uguz F, Yazýcý F. Is
Depression Associated With Glucose Tolerance
Abnormality in Pregnant Women? A Cross-Sectonal
Study. Archives of psychiatric nursing. 2013 Oct
31;27(5):219-22.
 DOI Number: 10.5958/0974-9357.2017.00077.0

A Descriptive Study to Assess the Adequacy of Nursing

Measures Carried Out to Minimize the Pressure
Ulcers During Peri-operative Period

Thenmozhi N1, Valliammal Babu2, Anita Kiruba Jeyakumar3

1
Lecturer, 2Professor, 3Lecturer, College of Nursing, Christian Medical College, Vellore

ABSTRACT

Peri- operative period is a crucial period for the patients undergoing surgeries. patient safety is important
to prevent intra-operative complications. Medical personnel are challenged with preventing skin injury in
the perioperative environment due to prolonged periods of patient immobility, compromised circulatory
function under anesthesia, and preexisting conditions of many surgical patient populations. While great
strides have been made in protecting the patient from skin injury, it is an issue that still needs to be addressed.
These skin injuries may result in extended hospital stay, increased medical costs and prolonged morbidity.
The healthcare facility may also incur financial and legal ramifications from these injuries. A descriptive
study was conducted to identify the adequacy of nursinig measures carried out to minimize the pressure
sores during peri-operative period. A total of 40 staff were selected for the study by convenient sampling
technique.the overall adequacy of the nursing measures carried out by nurses to minimize the pressure ulcer
was ( 84.97%) which is good.

Keywords: Nursing Measures, Pressure Ulcers, Peri- operative Period.

INTRODUCTION Medical personnel are challenged with preventing

skin injury in the perioperative environment due to
Prevention is better than cure. prolonged periods of patient immobility, compromised
‘Perioperative’ refers to the total surgical experience circulatory function under anesthesia, and preexisting
and includes pre-, intra- and postoperative phases of the conditions of many surgical patient populations. While
patient’s surgical journey (Phillips, 2004). Turner et al great strides have been made in protecting the patient
(2000) identified that the perioperative environment from skin injury, it is an issue that still needs to be
is potentially one of the most hazardous of all clinical addressed. These skin injuries may result in extended
environments. Patient and staff safety is paramount hospital stay, increased medical costs and prolonged
throughout the perioperative environment and a morbidity. The healthcare facility may also incur
proactive clinical risk management strategy involves financial and legal ramifications from these injuries
assessing, identifying, controlling, monitoring, reducing Margareta Lindgren, Mitra Unosson, Ann-margret
and evaluating risks to improve the quality of care krantz, an Anna-christina ek, (june 2005)(5) in their study
delivered (Wilson, 2000). Within the intra operative on pressure ulcer risk factors in patients undergoing
phase, the patient is vulnerable and totally reliant on surgery mentioned that the patients undergoing surgery
peri-operative nurses and other members of the team to are immobile and unable to change position. They
ensure that they come to no harm. cannot feel the discomfort prolonged pressure will
causebecause of the sedation and anaesthesia. They may
Corresponding author: thus be at high risk of developing pressure ulcers (Kemp
Valliammal Babu et al. 1990) During surgical procedures, the surgical
Professor, College of Nursing, Christian Medical team is responsible for positioning the patient in a way
College, Vellore. that optimizes surgical exposure while still protecting the
 100 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

patient from harm. Poor surgical positioning of patients observational check list prepared by the investigator
and misuse of positioning devices and equipment which consists of 10 questions was used to observe the
pose serious risks to patient safety; these include skin nursing practice. Each aspect which was done was given
breakdown, irreparable nerve damage, ischemia, and 1 mark and item which was not done was given 0 mark
even, in some instances, death. Surgical staff must respectively. The data was collected from Monday to
understand the physiologic effects of positioning and Friday from 7.30 am to 4.30 pm. First week the data was
know how to use positioning devices and equipment. collected in General surgery OR, 2nd week orthopedic
Steps that must be taken include preoperatively and trauma OR, and 3week in urology OR. Each aspect
assessing the patient to identify patient factors that may which was done is given 1 mark and items which is not
affect his or her response to positioning, conducting an done was given 0 mark respectively.
evaluation of the chosen position, ensuring consistent
90 %to 100% - very good
documentation, and performing a postoperative
patient evaluation. Surgical staff must understand the 70% to 90% - - good
physiologic effects of positioning and know how to use
positioning devices and equipment. < 70% - average

Statement of the problem: Validity and reliability of the tool:

A descriptive study to assess the adequacy of The validity of the instrument was established with
nursing measures carried out to minimize the the guidance and opinions of experts in Nursing field.
pressure ulcers during peri operative period by the The instrument is constructed in English only.
OR nurses of CMC, VELLORE.
Data collection procedure:
OBJECTIVE OF THE STUDY
The data was collected for 3 weeks starting
1. To assess adequacy of the nursing measures from 2.7.14 to 23.7.14 for 5 days a week, 8hrs a day. The
carried out by nurses to prevent the pressure ulcers first week from Monday to Friday 7.30 am to 4.40pm
during peri-operative period. the investigator went to the general surgery operating
rooms , the 2nd week the orthopedic and trauma OR was
Hypothesis: selected, and the 3rd week the urology surgery operating
room was selected. The investigator observed in a non-
1. Adequacy of nursing measures will minimize the
participatory method.
occurrences of pressure ulcers.

METHOD RESULTS

A Descriptive design was chosen to assess the

nursing practices by nursing personnel to prevent the
pressure ulcer during the peri-operative period. The
study was conducted in the Main operation theatre of
Christian Medical College, Vellore, a multi specialty,
tertiary medical care centre which has got 24 operating
rooms , where 70 to 80 surgeries are being performed
everyday. All the nursing personnel working in the OR
was the population. Nursing staff who are working in
main operating room who fulfilled the inclusion criteria Figure 1: shows that 84.97% had carried out the nursing
was selected as samples. The convenient sampling measures to prevent the pressure ulcers and 15.03% had not
carried out the nursing measures.
technique was used to select the sample. The investigator
identified the staff who was circulating for the surgery DISCUSSION
who fulfills the inclusion criteria. Forty samples were
A total of 40 staff were selected for the study by
collected. The tool used for data collection was an
convenient sampling technique. Majority of the staff
 International Journal of Nursing Education, July-September, Vol.9, No. 3 101

31(77.5%) were more than 2 years of experience, measures carried out by nurses to minimize the pressure
97.5% were GNM. Aronovitch, Sharon (1)did the ulcer was ( 84.97%) which is good.
study nationally on introperatively acquired pressure
ulcerprevalence with 1128 patients found that Forty
CONCLUSION
percent of those surveyed underwent a procedure lasting Positioning the patient correctly to enable easy
approximately 3 hours and 33% underwent surgery surgical access requires coordination and cooperation
lasting more than 5 hours. As the length of surgery from the whole team. Manual handling regulations
increased, so did the percentage of patients with pressure recommend that the team involved undertake a risk
ulcers. Most patients had at least 1 co-morbid condition assessment for the moving and positioning of each
(78%). The risk of intra-operative ulcerations increases individual patient, and that relevant aids and methods are
as surgical time increases. used to reduce patient movement and potential injury to
both staff and patients (Turner et al, 2000). An assessment
Mary Beth O’Connor(3) in her article nursing
will include the physical condition of the patient, nature
interventions among surgical patients illustrated that
of the intervention and individual patient needs (NATN,
the Use of devices to reduce risk OR nurses use
1998). When positioning patients, consideration should
a static-free, non-shearing transfer board to prevent skin
be given to avoiding nerve and joint injury, avoiding
damage as the patient moves from the gurney to the
mechanical trauma such as shearing, friction burns and
surgical table, and back to the gurney at the end of the
damage to soft tissue, and ensuring that at all times the
procedure. Once the patient has been transferred to the
anaesthetized patient is physically well supported.
surgical table, the OR nurse redistributes and optimizes
pressure by placing positioning devices—which offer Nerve injuries are an outcome of poor positioning,
support, diminish pressure, and avoid friction and with direct pressure resulting in ischemia to that area:
shearing—beneath and around the patient. Positioning e.g. radial nerve injury can occur if the arm is left
devices may include pressure redistribution mattresses, hanging over the edge of the operating table; ulna nerve
a fluid immersion surgical surface (used for patients with injury due to compression by an inappropriately placed
extremely poor skin integrity), gel pads and positions, arm support; and fibular nerve injury due to compression
conforming (“memory”) foam, and wedges. For patients when using the lithotomy poles. Perioperative nurses
expected to lose a lot of blood, the nurse places moisture must therefore ensure that mechanical aids and supports
absorption pads under the patient. When prepping the are padded and used appropriately (Stoker, 2002).
patient with antiseptic solution, the nurse ensures that
no fluid or moisture reaches the bedding. In this study When positioning patients, consideration should
the use of adequate position articles used (100%), and be given to avoiding nerve and joint injury, avoiding
also used rollers to transfer the patients (100%). mechanical trauma such as shearing, friction burns and
damage to soft tissue, and ensuring that at all times the
Kelly Cristina Scarlatti et al (2) in their study on anaesthetized patient is physically well supported. Peri-
Pressure ulcers in surgery patients incidence and operative nurses must therefore ensure that mechanical
associated factors found that there was an association aids and supports are padded and used appropriately
between the ventral position and a greater number of (Stoker, 2002). Shearing forces can occur when moving
PUs, adding up to 37 (50%) ulcers, with most occurring the patient on the operating table, resulting in tissue
on the chest (9 – 12.1%), eyelids (6 – 8.1%), breasts and damage, which may go undetected. The use of gel
knees (4 cases [5.4%] each). Among the lesions that mattresses or similar pressure-relieving adjuncts can
occurred in this position , 27 (36.4%) were stage I; nine redistribute the pressure across a wider area (O’Reilly,
(12.2%), were stage II, and one (1.4%) was stage III. In 2001). Total operating room time was also a significant
this study also only 14 (35.0%) staff had assisted while predictor of pressure ulcers. Specifically, a 1-hour
positioning the patient. increase in time in the operating room increased the
risk for pressure ulcers by 1.07 (OR, 1.07; 95% CI,
Assisting in positioning the patient is an important
1.03-1.11; P < .001). In addition, patients who received
factor to prevent the pressure ulcers.
vasopressors during their hospital stay were 33% more
In this study the overall adequacy of the nursing likely to acquire a pressure ulcer than were patients who
 102 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

did not receive vasopressors. Patients who had a history REFERENCE

of diabetes were 49% more likely to acquire a pressure
ulcer than were patients without such a history. 1. Aronovitch, sharon, (May 1999) intraoperatively
acquired pressure ulcer prevalence: a national study,
According to patina s. Walton-Geer,(4) Positioning Journal of Wound, Ostomy & Continence Nursing:
is a crucial component of surgical care. A patient’s 2. Kelly Cristina Scarlatti et al , (2011) Pressure ulcers
body must be positioned adequately on an OR bed in surgery patients: incidence and associated factors,
and proper body align -ment must be maintained to Rev Esc Enferm US ; 45(6):1369-75
lessen the potential risk of skin injuries Hence the staff
3. Mary beth o’connor, (1999) innovator disclosures
should assists in positioning the patient, ensure that the
nursing interventions among surgical patients
mattress is in good condition, adequate and appropriate
eliminate stage 3 and 4 pressure ulcers and reduce
positioning articles are used, care has to be taken to the
incidence of other pressure ulcers, Journal of
pressure areas with well padding, and ensure that the
Wound, Ostomy & Continence Nursing:
skin is dry after the skin preparation.
4. Patina s. walton-geer, ( 2009) Prevention of Pressure
Ethical Consideration: permission obtained from Ulcers in the Surgical Patient AORN JOURNAL •
college and from the Head of the department VOL 89, NO 3
Conflict of Interest: Nil 5. Margareta Lindgren ,Mitra Unosson , Ann-margret
krantz ,an Anna-christina ek, (june 2005),pressure
Source of Funding: Self ulcer risk factors in patients undergoing surgery,
Journal of advanced nursing volume 50, issue 6,
605–612.
6. Ajcc american journal of critical care, march 2012,
volume 21, no. 2.
 DOI Number: 10.5958/0974-9357.2017.00078.2

Current Status of End Stage Renal Disease in

India – A Narrative Review

Daisy Josphine Lobo1, Ravindra Prabhu2, Asha Kamath3, Viutha Bhat4

1
Associate Professor, Manipal College of Nursing Manipal, Manipal University Manipal India, 2Professor &
HOD, Department of Nephrology, Kasturbha Hospital, Manipal, 3Professor, Community Health Medicine
Department, Kasturbha Medical College Manipal, 4Associate Professor, Department of Biochemistry,
Kasturbha Hospital, Manipal

ABSTRACT

End-stage kidney disease (ESRD)is the widely prevalent non communicable disease in India. It also
contribute to the major cause of loss of life. Objective: This narrative review aimed at to find the
current status of ESRD in India. Methodology: An elaborative literature search was conducted among
peer reviewed and indexed journals with different terminologies in the different data bases like CIHAL,
MEDLINE, PUBMED. Study surveyed about 316 studies and the findings were concluded from 11 survey
studies. Results: Three of the 11 studies reported diabetes mellitus and hypertension are the major cause of
ESRD. Early identification and treatment can prevent this complication. The exact magnitude of the burden
of chronic kidney disease or end-stage kidney disease is not known because of lack of accurate registries’
and failure of reporting systems. One of the population-based study the incidence of ESRD would be 152
per million population. Conclusion: Prevalence of ESRD is rapidly increasing in India due to the hike in the
counterpart contribution of diabetes and hypertension.

Keywords: End-stage kidney disease, current status, Non communicable disease.

INTRODUCTION MATERIALS AND METHOD

The burden of non-communicable disease (NCD) This was a narrative review aimed at to assess
has increased in recent years and it is estimated that over the current status of ESRD in Indian population. An
40% of all deaths are due to NCD. The exact magnitude extensive literature search on ESRD related studies as
of the burden of chronic kidney disease or end-stage an outcome of diabetes and hypertension was reviewed.
kidney disease is not known. An Indian population-based Review was conducted in the data base of CINHAL,
study determined the crude and age-adjusted ESRD PUBMED and MEDLINE using the MeSH words
incidence rates at 151 and 232 per million population, ESRD,CKD, chronic kidney disease, outcome of ESRD,
respectively. It would mean that about 220,000–275,000 Etiology of ESRD.
new patients need dialysis every year. It is estimated
that there are about 55,000 patients on dialysis at any
one point of time in India, and the dialysis population is
growing at the rate of 10–20% annually.

Corresponding author:
Daisy Josphine Lobo
Associate Professor, Manipal College of Nursing
Manipal, Manipal University Manipal India 576104.
 104 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Fig No:1 Prisma Chart showing Review Article Process

Sampling Criteria:

1. Study participants with 18 years and above.

2. Only survey designs

3. Indian survey studies

RESULTS

Preliminary search retrieved a total of 318 articles. Finally only eleven studies were included for the data
synthesis according to the art eligibility criteria. Details are described in table no.1
 International Journal of Nursing Education, July-September, Vol.9, No. 3 105

Table No.1 Characteristics of Review Articles.

Author/Year Design/ Materials Objective/ Sample Population Results
Variable size
P. P. Varma Cross sectional CKD 3396 Healthy government Population was relatively younger
2015 survey to assess prevalence employees of Delhi. (35.64 ± 8.72 years) but diverse age
microalbuminuria in group. 13–15% were diagnosed to have
early stages of CKD undiagnosed hypertension and 1.53%
and calculated GFR by diabetes. Prevalence of CKD as 13–
MDRD and CKD-EPI 15.04% with stage 1, 2 and 3 as 6.62%,
equations. Prevalence of 5.40% and 3.02% respectively.
chronic kidney disease
in India - Where are we
heading?

Hargovind T. Estimated glomerular ESRD 2350 semi-urban CKD was found in 20.93% and eGFR
et.al filtration rate (eGFR) prevalence population of Gujarat <60 mL/min/1.73 m2 was noted in
was calculated by and associated 8.29% of participants. The prevalence
MDRD formula. eGFR factors of CKD peaked after the seventh decade
of life in both genders. There was no
significant difference in the prevalence
of CKD between coastal and non-coastal
regions, however, obesity, hypertension
and diabetes were more common in the
coastal belt, whereas stone burden was
greater in the non-coastal region.
R.Rajesh et.al Cross-sectional, CKD 3043 Nationwide, multi- The mean age was 53.4 (± 11.9) years,
observational study prevalence centric study with a mean body mass index of 27.3
with Glomerular (± 4.8) kg/m2. Both micro and macro
filtration rate [GFR] vascular complications were reported.
<60 ml/min/1.73 m2or In the studied population with T2DM,
albumin creatinine ratio 47.8% had mildly decreased, 15.1% had
[ACR] ≥ 30 mg/g or ≥ mild to moderately decreased, and 1.8%
3 mg/mmol or both). had severely decreased GFR respectively.
The blood/plasma and As per ACR categorization, 61.3% had
urine samples, were normal to mildly increased ACR, 25.6%
collected for estimation with moderately increased and 7.2%
of hemoglobin A1c, with severely increased ACR were seen.
microalbuminuria, 48.4% prevalence of CKD in T2DM
serum creatinine, urine patients.
creatinine

SR Gedela, Cross sectional study Prevalence of 2075 Industrial population The mean age of the population was
Ratna Estimation of urinalysis, ESRD and its at Visakhapatnam found to be 50.31 yrs with SD 7.62.
Mahendru, hematological and indicators l Smokers constituted 26.26% of the
Sougat Ray biochemical parameters population. Historically only 19.7%
2014 including Se Creatinine. of the people had past history of
Glomerular Filtration hypertension, 12.87% had diabetes
Rate was estimated by mellitus, and only 0.72% had any history
MDRD formula of renal disease. 12.4% of the population
were found to be having diabetes and
49.7% found to be having hypertension.
Proteinuria was found in 12.5% of the
population. Anemia was found in 4.1%
of the population. As per the estimated
GFR, 6% of the population were found to
be having CKD (GFR < 60%).

Sheela P. Cross sectional survey Prevalence 735 Vettathoor Panchayat The prevalence of any stage of chronic
Haveri, BMI, BP, Blood of ESRD and adults rural population in renal failure was 4.8% and renal
Sebastian NM parameters associated above the northern Kerala failure was 3.6% of adult population.
, Jesha M M , factors and age of 20 Hypertension and diabetes which
Arya S. Nath burden of it. increases the risk for chronic renal
2014 disease are present in most of the cases
and the risk was many times more when
both were present (adjusted odds ratio
= 22.3)
 106 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Y. J. Anupama Cross sectional survey ESRD 2091 Rural Mean age was 39.88 ± 15.87 years. The
and G. Uma Anthropometric prevalence population subjects were predominantly young with
measurement Fasting and to find the in the south more than 70% aged below 40 years. There
2014
blood sugar serum association with interior part was a female preponderance with females
creatinine Glomerular risk factors of Karnataka, constituting (54.43%) of the population.
filtration rate was India The prevalence of diabetes in this study was
estimated (eGFR) 3.82%. Of the 80 subjects found to have
(MDRD) formula (eGFR) diabetes, only 34 (42.5%) were aware of
and the Cockcroft-Gault their diabetic status. Forty-six were newly
(CG) equation corrected detected to have diabetes. Hypertension
to the body surface area was seen in 702 (33.62%) subjects of
(BSA). whom only 106 (15.07%) subjects gave
a history of hypertension indicating that
nearly 84.93%% were unaware of their
hypertensive status. Prevalence of CKD
taking both decreased GFR and proteinuria
into consideration was found to be 6.3% by
MDRD criteria and 16.69% by CG-BSA
method.

GK Modi and Prevalence 572 029 36 of the 56 Total of 346 new ESRD patients were
V Jha Cross sectional survey. of ESRD and wards of the diagnosed during the study period. Average
2014 ESRD incidence was related factors city of Bhopal. crude and age-adjusted incidence rates
estimated for four were 151 and 232 per million population,
consecutive calendar respectively. The mean age was 47 years,
years (2002–2005) and 58% were males. Diabetic nephropathy
by assessing was the commonest (44%) cause of ESRD.
haemoglobin, blood urea, This study highlights the emergence of
creatinine,BMI, diabetic nephropathy as the major cause of
ESRD in India.

Singh et.al 2013 Cross sectional survey CKD 6120 Adults of The overall prevalence of CKD in the
Demographic details, prevalence and North India, SEEK-India cohort was 17.2% with a mean
Anthropometric details, related risk North west eGFR of 84.27 ± 76.46 versus 116.94 ± 44.65
Urine albumin, serum factors India, Central mL/min/1.73 m2 in non-CKD group while
creatinine and sugar. India,Western 79.5% in the CKD group had proteinuria.
India, South CKD was higher in males across all stages
west India, of CKD Prevalence of CKD stages 1, 2,
South east 3, 4 and 5 was 7%, 4.3%, 4.3%, 0.8% and
India. 0.8%, respectively. The highest prevalence
of CKD was observed in Visakhapatnam,
Andhra Pradesh (46.8%), Kanpur, Uttar
Pradesh (41.7%) and Delhi (41%). The
lowest prevalence was observed in Mysore
and Bangalore in Karnataka state (4.2%
and 4%, respectively). The most common
risk factors and other characteristics among
the subjects diagnosed with CKD were
hypertension (64.5%), anemia (40.7%) and
diabetes (31.6%).

Galemi M.et.al Cross sectional survey ESRD 2535 south area of Dipstick proteinuria was positive in 7.7%
2013 BMI, Serum creatinin prevalence and Kolkata of subjects. In a subsample of high risk
and Urine albumin related factors subjects with hypertension or urine dipstick
proteinuria ≥1+, albumin-creatinine ratio
(ACR) of 30–300 and ≥300 mg/g in 23.5%
and 2.1%, respectively. Lower prevalence
of CKD stages 3 to 5 and 4.1% in total
prevalence.
 International Journal of Nursing Education, July-September, Vol.9, No. 3 107

Rajapurkar Cross sectional survey. CKD 52,273 Adult patients Of the 52,273 adult patients, 35.5%, 27.9%,
M.M,et. Al The data collected prevalence South, North, 25.6% and 11% patients came from South,
2012. included etiology of and etiological West and East North, West and East zones respectively.
CKD, anthropometric factors zones . The mean age was 50.1 ± 14.6 years, with
data, serum creatinine, M:F ratio of 70:30. Patients from North
presence of diabetes, Zone were younger and those from the
hypertension and East Zone older. Diabetic nephropathy was
cardiovascular disease, the commonest cause (31%), followed by
history CKD of undetermined etiology (16%),
chronic glomerulonephritis (14%) and
of indigenous medication
hypertensive nephrosclerosis (13%). About
use and management
48% cases presented in Stage V; they
details at the time of
were younger than those in Stages III-IV.
reporting.
Diabetic nephropathy patients were older,
more likely to present in earlier stages of
CKD and had a higher frequency of males;
whereas those with CKD of unexplained
etiology were younger population.

Agarwal Prevalence of chronic renal failure 4972 Delhi A serum creatinine >1.8
SK, Dash Cross sectional survey. Adopted in adults in Delhi, India mg% defined renal failure.
SC, Irshad multi-stage cluster sampling method A repeat test for serum
M, Raju in the South Zones of Delhi. The creatinine was done after
S, Singh individuals contacted responded to 8-12 weeks to confirm
R, Pandey RM. a detailed questionnaire, and had chronicity of renal failure.
2009 a physical examination, a dipstick If it was >1.8 mg% after 3
urine test for albumin and sugar and months in the absence of
a blood test for serum creatinine. reversible factors, CRF was
diagnosed. heir mean age
was 42+/-13 years; 56%
were males. the prevalence
of CRF in that adult
population was 0.785% or
7852/million.

Conflicts of Interest: Nil rural community in South India: Results from the
kidney disease screening (KIDS) project. Indian J
Ethical Permission: Institutional Research Nephrol, 24(4): 214–221.
Committee permission obtained 4. Gallieni, M., Angela, A., Benedetta, T., Valeria, S.,
Funding: Self-funded Sujit, K., Brahmochary, M. , Anna, D., Simonetta,
G..(2014) The Burden of Hypertension and Kidney
REFERENCES Disease in Northeast India. Scientific World
Journal1-16.
1. Agarwa,l S.K., & Dash S.C., Irshad, M., Raju,
S., Singh,. R., Pande,y R.M., (2005). Prevalence 5. Hargovind Trivedi, Aruna Vanikar, Himanshu
of chronic renal failure in adults in Delhi, India. Patel, Kamal Kanodia, Vivek Kute3 Lovelesh
Nephrol Dial Transplant, 20(8):1638-42. Nigam, Kamlesh Suthar, Umang Thakkar, Harsh
Sutariya and Shruti GandhiBurden of Renal failure
2. Anjana, R.M., Pradeepa, R., Deepa, M., Datta, M.,
among adults in Rural Kerala: A community based
Sudha, V., & Unnikrishnan, R., (2011). Prevalence
study. Clinical Kidney Journal, 2016, vol. 9, no. 3,
of diabetes a.nd prediabetes (impaired fasting
438–443.
glucose and/or impaired glucose tolerance in
urban and rural India: Phase I results of the Indian 6. Modi, G., & Jha V.. (2011).Incidence of ESRD in
Council of Medical Research-INdia DIABetes India. Kidney Int, 79, 573.
(ICMR-INDIAB) study. Diabetologia, 54, 3022– 7. Modi, G.K., & Jha V., (2006)The incidence of
27. end-stage renal disease in India: a population-
3. Anupama, Y.J., & Uma,,G.,(2014). Prevalence based study. Kidney Int, 70, 2131–2133.
of chronic kidney disease among adults in a 8. Sheela P. Haveri, Sebastian NM , Jesha MM ,
 108 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Arya S. Nath. (2016) .Burden of Renal failure 11. Verma, P.P., (2015). Prevalence of chronic kidney
among adults in Rural Kerala: A community based disease in India - Where are we heading? Indian J
study. Indian Journal of Forensic and Community Nephro, 25(3): 133–135.
Medicine, 3(4):288-291. 12. Tsukamoto, Y., Jha, V., Becker, G., Chen, H.C.,
9. Singh, A.K., Farag, Y.M., Mittal, B.V., Perkovic, V., Prodjosudjadi,. W, Tungsanga,
Subramanian, K.K., Reddy, S.R., & Acharya, K., Wang, H., Morad, Z.,(2011). A challenge to
V.N., (2013). Epidemiology and risk factors of chronic kidney disease in Asia: The report of the
chronic kidney disease in India - results from the second Asian Forum of Chronic Kidney Disease
SEEK (Screening and Early Evaluation of Kidney Initiative. Nephrology. 15(2):248-252.
Disease) study. BMC Nephrol ,14,114. 13. Yach, D., Stuckler, D., Brownell, K.D,.(2006).
10. Singh NP, Ingle GK, Saini VK, Jami A, Beniwal Epidemiologic and economic consequences of the
P, Lal M, et al. Prevalence of low glomerular global epidemics of obesity and diabetes. Nat Med.
filtration rate, proteinuria and associated risk 12(1):62-66.
factors in North India using Cockcroft-Gault and
Modification of Diet in Renal Disease equation:
An observational, cross-sectional study. BMC
Nephrol. 2009;10:4.
 DOI Number: 10.5958/0974-9357.2017.00079.4

Analysis of Multiple Choice Questions: Item Difficulty,

Discrimination Index and Distractor Efficiency

Juliana Linnette D’Sa1, Maria Liza Visbal- Dionaldo2

1
Professor, Maternal and Child Health Nursing Department, 2Assistant Professor, Community and Mental Health
Nursing, College of Nursing, King Saud University, Riyadh, Kingdom of Saudi Arabia

ABSTRACT

Background: The quality of the multiple-choice questions (MCQs) used in educational measurement
depends on their difficulty index (DIF I), discrimination index (DI) and distractor efficiency (DE).

Aim: The study is aimed at analyzing the single response MCQs of an Anatomy course in an undergraduate
nursing program and finding the relationship between the DIF I and DI.

Material and method: The 48 MCQs and 144 distractors used in a summative exam after completion of 15
credit hours of an Anatomy course, attended by 56 students in a College of Nursing in Saudi Arabia, were
analyzed.

Results: Twenty-four out of 48 MCQs had average DIF I (30-70%), 29 items (60.40%) had excellent DI
(>0.35) and 10 (20.83%) were good items (DI=0.25-0.34). When the two indices were combined, there were
23 ‘ideal’ questions. The mean DIF I and DI were 67.50 and 0.44 respectively. There were 107 (74.30%)
functional distractors in all. The proportion of items having 0,1,2 and 3 non-functional distractors (NFDs)
were 50%, 27.08%, 18.75% & 4.17% respectively, with a mean DE of 74.30%. There was a significant
negative correlation between the DIF I and DI (r=-0.721; p<0.01), showing that with increasing difficulty
index, the ability to discriminate between the high and low achievers decreased.

Conclusion: Generating high-quality items is an important aspect of the educational assessment. Analyzing
items and banking them for future use will enhance the quality of assessment. The results of the study will
provide an opportunity to change the way MCQs are developed and used in educational assessment.

Keywords: Item analysis, Difficulty Index, Discrimination Index, Distractor Efficiency, Nonfunctional
Distractors

INTRODUCTION Carefully constructed tests by educators will enhance

educational functions. Increasingly multiple choice
Appropriate use of assessment strategies is a
questions (MCQs) are used for assessing students’
challenge to educators. Assessment, integral to learning
performance. Therefore, there is a growing concern about
involves an appraisal of student learning and feedback
the quality of the tests that are used for assessment.
for improving teaching-learning experiences. It is
commonly known that assessment drives learning(1). A wide range of content and objectives on a large
number of students are assessed through MCQs (2). Not
Corresponding author: all educators agree with the use of this format. Few
Juliana Linnette D’Sa concede that it is time-consuming and challenging
Professor, Maternal and Child Health Nursing to develop MCQs for measuring higher cognitive
Department, College of Nursing, King Saud University skills (3). Others are of the opinion that MCQs focus
Riyadh, Kingdom of Saudi Arabia on recall rather than comprehension, application and
E-mail: [email protected] analysis of course-related information(4). Unfortunately,
 110 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

examination items testing factual and conceptual items of the descriptive analysis were 1) to identify the quality
are reported to be high in medical and nursing settings. of the test items by determining the difficulty index
In a baccalaureate nursing program, over 91 % of all (DIF I), discriminating index (DI) and the distractor
MCQs used for educational assessment were of recall efficiency (DE); and 2) to find the relationship between
/comprehension level types (5). For tests to be valid, they DIF I and DI.
must be well-constructed, reflect the desired cognitive
functions to be assessed and be devoid of flaws.
MATERIALS AND METHOD

The descriptive, analytical study was conducted

Flawed items are unsuitable for assessing the
in a College of Nursing of a Governmental University
intended domains and consequently affect the quality of
in Saudi Arabia. The 48 single answer MCQs of an
the test. Further, the performance of high – achieving
Anatomy exam conducted in the year 2015 were
students are not appropriately reflected in comparison
analysed. The 15- credits Anatomy course spanned
to the borderline students when the items are flawed (2).
over a semester in the second year of the Baccalaureate
Teachers can reduce item flaws and improve the quality
Nursing program. The exam answered by 56 students,
of items by following the principles of item- writing and
included other forms of objective items also. Each MCQ
analysis of the item’s performance.
comprised of a stem and four options: one key and three
Effective MCQs possess appropriate difficulty level distractors. The correct answer was awarded one score,
and the ability to discriminate between performers and and the incorrect response or un-attempted item was
non- performers (5). An item analysis enables identifying given zero, with no negative marking. The score ranged
the quality of MCQs based on difficulty index (DIF I), from 0-48 which was aggregated when computing the
discriminating index (DI) and distractor efficiency (DE). final score.
Clues and errors influence the ease or difficulty of an
Data Collection and Analysis
item. Sayyah et al in an assessment of 37 exams (1793
items) of the faculty of Nursing and Midwifery, reported Permission to conduct the study was obtained from
17.7% of exams had item difficulty less than 0.30 the Vice Dean of the College of Nursing. Because the
and 25.9% were over 0.70 (6). Average item difficulty study was not done on human subjects, Institutional
lies between 30 and 70 %. Those items with a DI of Review Board approval was not sought. All 56 answer
>0.24 have good to excellent discrimination ability (7). scripts were retrieved in February 2017 and coded. A
According to Haladyna, more than half the test items total of 48 MCQs and 192 options (48 correct answers
that educators develop do not produce the intended and 144 distractors) were assessed, to identify the DIF I,
results(8). Items on teacher generated - tests therefore DI and DE.
need to be studied. (9); poorly and ineffectively answered
items can be removed from further use thereby making The high and low group comprised of 27% of
the test more effective (2). students in each group. The DIF I was computed using
the formula H+L/Nx100, where H and L are the correct
Examining distractor performance in teacher- responses in the high and the low groups, and N is
generated tests is of interest. High-quality MCQs require the total number of examinees in both groups. Values
well-written options, with effective distractors. To be between 30% and 70% are acceptable, with lower values
efficient, these options should be based on common reflecting the higher difficulty and vice versa. The DI
misconceptions (10). Functional or efficient distractors computed using the formula DI=H-LX2/N expresses the
are chosen by more than 5% of examinees(11,12). Placing power of the item to differentiate between the high and
implausible distractors are of little use. Therefore the low achievers, and ranges between 0 and 1. Greater
framing plausible distractors and reducing the number values indicate higher discrimination power. An item
of non-functional distractors (NFDs) improves the test with a DI>0.35 is considered to be ‘excellent’, 0.25-0.34,
quality. to be ‘good’, 0.15 – 0.24, to be ‘marginal’ and <0.15 to
be ‘poor’ (7). A negative DI (less than zero) indicate
Since teacher-generated tests are widely used for
that low achievers answer the item more correctly than
assessment, it is important to determine the quality of
high achievers. This is possibly due to item flaws or
test items, and bank high-quality items. The objectives
 International Journal of Nursing Education, July-September, Vol.9, No. 3 111

inefficient distractors. obtained in the exam ranged from 8-47. The mean and
standard deviation (SD) of the DIF I (%), DI and DE
Distractor efficiency (DE) is calculated on the basis
(%) were 67.50 ±14.33, 0.44 ± 0.19 and 74.30 ±30.16
of the number of NFDs in an item and ranges from 0-
respectively.
100%. NFDs are those options other than the key when
selected infrequently by the respondents (<5%), and do Difficulty and Discrimination Indices: Of the 48
not perform their function. An item with no NFDs has a items, 24 items (50%) were good and had average
DE of 100%. When the item has one, two or three NFDs, difficulty (DIF I=30-70%). When the DI was assessed,
the DE will be 66.66%, 33.33% and 0% respectively. most items were either excellent (n= 29; 60.40%) or
good (n=10; 20.83%) with DI above 0.24. Items with a
RESULTS
DI below 0.25 were either marginal or poor. (Table 1).
Total 48 MCQs and 192 options (48 correct Only one item had a negative DI.
answers and 144 distractors) were analyzed. The scores

Table 1: Distribution of Items in relation to DIF I and DI

Parameters Items Percentage Interpretation Mean SD

Difficulty index (DIF I) 67.50 (±14.33)

>70 24 50 Easy

30-70 24 50 Good

<30 0 0 Difficult

Discrimination Index (DI) 0.44 (± 0.19)

>0.35 29 60.40 Excellent

0.25-0.34 10 20.83 Good

0.15-0.24 3 6.25 Marginal

<0.15 6 12.50 Poor

To be acceptable, an item should have an average had 0% DE. (Table 2). The overall mean and SD of the
difficulty of 30-70 and a discrimination index of not less DE was 74.30 and 30±0.16 respectively.
than 0.25. When the two indices were combined, there
Table 2: Distractor Analysis: Distribution of
were 23 (47.91%) ‘ideal’ items.
Items and Non functional Distractors
Distractor Analysis: Almost three fourth of the
144 distractors (n=107; 74.30%), were functional with Distractor Number of
NFDs Percentage
a choice frequency of >5%. The remaining (n=37; Efficiency items
25.70%) were NFDs.
0 NFDs DE=100% 24 50.00
Distractor efficiency varied among the items.
Overall out of 48 items, 24 items had functional 1 NFD DE=66.66% 13 27.08
distractors (DE = 100%). The DE for the remaining 2 NFDs DE=33.33% 9 18.75
24 items varied between 0% and 66.66%. A little over
one-fourth of 48 items i.e.13(27.08%) had one NFD 3 NFDs DE=0% 2 4.17
(DE=66.66%), and nine items (18.75%) had two NFDs
(DE=33.33%). A very small proportion of items (4.17%)
 112 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Correlation between Discrimination index and of ideal items in comparison with other studies that
difficulty index reported only 15 ideal items out of 50 items (13).We found
a larger number of items appropriate for item banking.
Pearson’s correlation between DIF I and DI
showed a significant negative correlation (r= -0.721; p Overall, we found nearly three-fourth of all
< 0.01); two-tailed. This indicates that with increasing distractors (74.30%) had 100% DE and were functioning.
difficulty value (easier the item), the power of the item The remaining over one-fourth (25.70%) were NFDs.
to discriminate between high and low achievers is Similar to our study findings, medical education settings
decreased. have reported 75.8% to 89.6% of functional distractors.

DISCUSSION Distractors are analyzed to determine their

usefulness in tests. When distractors do not perform as
The item analysis of 48 MCQs of an Anatomy
expected, they must be removed from the test. Our study
examination was conducted, to determine the DIF I,
found a low percentage (25.70%) of NFDs. Haladyna
DI and DE. Item analysis enables test paper setters
and Downing reported higher percentage (over 38%)
to identify the quality of the items used for student
of NFDs that subsequently required elimination (16)
assessment. Further, identifying ideal questions and
Contrary to our findings, only 11.4% NFDs were
developing an item bank for future assessment will
reported among 50 MCQs and 150 distractors in a
enhance the quality of the assessment in education.
medical setting (13). In an assessment of seven test papers
The DIF I of an item depicts the ease or difficulty of undergraduate nursing students, that had 514 items
of an item. Fifty percent of items (24 items) had and 1542 distractors, Tarrant found only 52.25% of
average difficulty. Similar findings were reported in distractors were functioning (11).
a Community Medicine examination wherein, 24 out
Item-wise distribution showed that only 50% of
of 50 items had good to excellent DIF I (13). The mean
all items had functioning distractors or a DE of 100%.
DIF I in our study was 67.50 (±14.33), well within
A higher percentage of items (70%) with NFDs were
the acceptable range of 30-70. Mitra reported the
reported in a medical setting (13) Kolte reported 47.5%
mean difficulty of multidisciplinary summative exams
items had 100% DE in a Physiology exam of first years
between 64% and 89%(14). As the complexity of exams
MBBS students (15). On the contrary, lower percentage of
increases, the difficulty level of the items also increases.
items (19.3%) with 100% DE was reported by Sayyah
Our exam measured factual content in Anatomy, which
et al. (6)
might explain why 50% of the items were easy. The
remaining 50% of items in our study had average Of concern in our study is the high proportion of
difficulty; a higher percentage of (65%) was reported in items (50%) with NFDs. It was not surprising to have
a physiology exam in a medical setting (15) a large number of items with NFDs in an examination
where training of faculty in item generating is required.
The mean DI (0.44) was acceptable; collectively,
One must expect 50% of the items for teacher- generated
more than 80% of the items were either excellent or
tests (8). Faculty often use implausible distractors when
good; only one item had negative DI. In a Physiology
they find it difficult to develop good distractors.
exam for medical students, 62% of items were reported
to have excellent DI(12). Discrimination ability is an When we have a large number of implausible items
important index that provides information on the ability in a test, it is worth examining the number of distractors
of the item to discriminate between the high and the to be used in future assessments. Flaws in MCQs affect
low performers. Items that discriminate poorly must be the performance of the students.
examined for possible deficiencies and may either be
modified or discarded. Our study found a significant negative correlation
between the DIF I and DI, signifying that with increasing
A combination of the two indices in our study ease of an item, the discriminating power of the item
revealed 23 ‘ideal’ items that constituted almost 50% decreases. Items with lower DI should be assessed
of the test items. Our study found a higher proportion for ambiguity, clues and even wrong keys. Our items
 International Journal of Nursing Education, July-September, Vol.9, No. 3 113

had four options: one correct answer (key) and three REFERENCES
distractors. For improving any test, it is not the number 1. Drew S. Perceptions of what helps learn and
of distractors, but the plausibility of the distractors that develop in education. Teach High Educ. 2001;6(3):
need focus. Evidence supports the use of three options. A 309–31.
meta-analysis of multiple questions with three options,
2. Tarrant M, Ware J. A framework for improving
over 80 years of research, shows that three options are
the quality of multiple-choice assessments. Nurse
appropriate(17). One can examine if there is a need to
Educ. 2012;37(3):98–104.
increase or decrease the number of distractors. Teachers
must use evidence to improve the quality of tests they 3. Vyas R, Supe A. Multiple choice questions: a
construct. literature review on the optimal number of options.
Natl Med J India .2016;21(3):130–3.
Strength and Limitations
4. Walsh CM, Seldomridge LA. Measuring critical
To the best of our knowledge, this is the first study thinking. Nurse Educ. 2006 ;31(4):159–62.
conducted in the basic sciences course of the Nursing 5. Tarrant M, Knierim A, Hayes SK, Ware J. The
program in Saudi Arabia, to analyse items of a faculty- frequency of item writing flaws in multiple-choice
generated exam. The number of examinees on whom questions used in high stakes nursing assessments.
the test was administered was small in number. Further Nurse Educ Today. 2006;26(8):662–71.
studies on larger student population will help to improve 6. Sayyah M, Vakili Z, Masoudi Alavi N, Bigdeli M,
the assessment strategies in the undergraduate Nursing Soleymani A, Assarian M, et al. An item analysis
curriculum. The outcomes observed in this study is of written multiple-choice questions: Kashan
limited to one exam in one course and does not reflect university of medical sciences. Nurs Midwifery
other academic courses. Since we have not randomly Stud. 2012;1(2):83–7.
selected the test, there is an element of sampling bias.
7. Guilbert JJ. Educational handbook for health
Results from this study highlight the importance of
personnel. Revised edition. WHO Offset Publ.
analysing items after test administration and using the
1981;(35):330 p.
results to develop test banks.
8. Haladyna TM. Developing and validating
CONCLUSION multiple-choice test items. 3rd Edition. Mahawah,
Generating high-quality items and developing NJ: Lawrence Erlbaum 2004.
test banks is an important activity in the educational 9. Owen S V., Froman RD. What’s wrong with three-
assessment. Analysing the items, to identify quality option multiple choice items? Educ Psychol Meas.
MCQs and banking them will enhance the assessment 1987;47(2):513–22.
techniques. Items that fail to discriminate students need 10. Haladyna TM, Downing SM, Rodriguez MC. A
to be modified. Distractors that do not serve the purpose review of multiple-choice item-writing guidelines
must be discarded. Faculty training in item generation for classroom assessment. Appl Meas Educ.
will enhance the quality of the test items. The results 2002;15(3):309–33.
of this study will help to change the way MCQs are
11. Tarrant M, Ware J, Mohammed A. An assessment
developed and used in the educational assessment. It
of functioning and non-functioning distractors in
will provide the basis for modifying the assessment
multiple-choice questions: A descriptive analysis.
strategy in the curriculum.
BMC Med Educ. 2009;9:40.
Conflict of Interest: None declared 12. Hingorjo MR, Jaleel F. Analysis of one-best
MCQs: The difficulty index, discrimination
Source of Funding: Self
index and distractor efficiency. J Pak Med Assoc.
Ethical Clearance: Institutional Review Board 2012;62(2):142–7.
approval was not sought because the study did not deal 13. Gajjar S, Sharma R, Kumar P, Rana M. Item
with human subjects. and test analysis to identify quality multiple
choice questions (MCQs) from an assessment of
 114 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

medical students of Ahmedabad, Gujarat. Indian J Appl Med Res 2015; 4(4):320–6.
Community Med. 2014;39(1):17–20. 16. Haladyna TM, Downing SM. How many options
14. Mitra N, Nagaraja H, Ponnudurai G, Judson J. is enough for a multiple-choice test item? Educ
The levels of difficulty and discrimination indices Psychol Meas. 1993;53(4):999–1010.
in type a multiple choice questions of pre-clinical 17. Rodriguez MC. Three options are optimal for
semester 1 multidisciplinary summative tests. Int multiple-choice items: a meta- analysis of 80 years
e-Journal Sci Med Educ. 2009;3(1):2–7. of research Educ means issue pract.2005,24,(2)
15. Kolte V. Item analysis of multiple choice questions ,3-13,10.1111/j.1745-3992,2005.00006.X.
in physiology examination. Int Journ Basic and
 DOI Number: 10.5958/0974-9357.2017.00080.0

Prevalence of Low Back Pain among Nursing Students

Compared to Physical Therapy, and Engineering Students in
the United States

Asha Solomon1, Sara Wilson2, Mary Meyer3, Neena Sharma4

1
Associate Professor, College of Nursing, Christian Medical College, Vellore, 2Associate Professor, School of
Engineering, University of Kansas, Kansas, USA, 3Clinical Associate Professor, School of Nursing,
4
Associate Professor, School of Health Professions, University of Kansas, Medical Center, Kansas, USA

ABSTRACT

The study aimed to determine the prevalence of low back pain (LBP) among nursing students at various
recall time points and compare the rates with physiotherapy (PT) and engineering students. Data were
collected from 214 undergraduate and graduate students using a prevalence questionnaire via REDCap. LBP
prevalence rates were found to be high at all recall time points in all the three disciplines. Nursing students
had similar 12-month, 30-day and 7-day LBP prevalence rates as the PT students while the engineering
students had the lowest prevalence rates at all the time points. Students from all three disciplines attributed
the majority of their LBP to prolonged sitting. In addition, lifting patients and sports activities were also
listed as other major causes for their LBP. Lack of awareness of correct sitting posture (p<.01) and Body
Mass Index (BMI) (p<.01) were the significant predictors of LBP among students. These results suggest that
prevalence of LBP is high among professional students and LBP was more prevalent among the nursing and
PT students.

Keywords: Engineering; Low back pain; Nursing; Physical therapy; Prevalence; Students

INTRODUCTION disciplines namely, physiotherapy (PT; another

professional involved in direct patient care and lifting
Low back disorders continue to be one of the major patients) and engineering with no direct patient care
work-related hazards facing nurses and a number of responsibilities to gain an understanding of difference in
research studies have examined prevalence of low LBP prevalence among different students.
back pain (LBP) among registered nurses1,2. However,
information on LBP prevalence among nursing students AIMS & OBJECTIVES
is limited to few studies 3-6 and no studies have been The aim of this survey was to determine the LBP
reported among nursing students in the United States. prevalence of nursing students and compare with LBP
Also, limited literature report is available comparing the prevalence among PT and engineering students. The
LBP prevalence between nursing students and students study also aimed to assess the characteristics of LBP and
from other disciplines. Therefore, it is important to its association with awareness about body mechanics.
determine the prevalence of LBP for nursing students We hypothesized that LBP prevalence will be higher
in the US and compare it with students from other in nursing students compared to PT and engineering
students, and LBP will be associated with lack of
Corresponding author: awareness about proper body mechanics.
Neena K Sharma
METHOD
Assistant Professor, School of Health Professions,
University of Kansas Medical Center, Kansas City, Design, Setting and Sample
USA, E-mail: [email protected]
The convenience sample was derived from third and
 116 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

fourth year nursing students, fourth year engineering compare various variables. Hierarchial multivariate
students and all three years of PT students in a university logistic regression analysis was used to determine
in Midwest United States. Students needed to be aged potential predicting variables for LBP. We used an alpha
between 18-35 years to be included in the study. The level of .05 for all statistical tests.
exclusion criteria included a history of spinal or
orthopedic surgeries, spinal trauma or fractures of large
FINDINGS
joints within the last one-year. A total of 214 students from Nursing, PT, and
Engineering disciplines participated in the study. About
Instruments
34% of the sample was constituted by nursing students
Information was collected on demographics, LBP (n=73), 41% by the PT students (n=87) and 25% by the
characteristics, participants’ previous work experience engineering students (n=54).
and current job status. The LBP prevalence was assessed
Student characteristics and work experience
using prevalence questionnaire, based on methods
from similar prevalence studies3-5. It included items on The majority of participants were female (56%).
anticipated cause, intensity, duration, radiation of pain The differences in gender distribution across the
and LBP experiences at various time points to capture disciplines were significant (χ² = 66.7, d.f. = 2, p<.001),
the 7-day, 1-month, 12-month, and lifetime prevalence. with predominance of females in nursing, almost
We also inquired about participant’s knowledge of equal distribution in PT and predominance of males
proper sitting, standing and lifting/patient care. The in engineering disciplines (Table 1). Mean age of the
Oswestry Disability Index (version 2.0) was used to students was 22.9 ± 2.46. Despite reaching statistical
assess the disability due to LBP. Data was collected via significance (p<.05), the actual difference in mean age
online survey using REDCap7, which is a secure web among the groups was quite small.
application for building and managing online surveys
and databases. A majority of students (89.3%) had previous work
experience within the last five years and 55.2% of
Data management & statistical analyses them currently had other jobs.The three groups differed
significantly in the type of their previous work (manual
Statistical analysis was completed using SPSS,
work-heavy/moderate/light or sedentary) (p<.001) and
version 23.0. Chi-square test & ANOVA were used to
their current job status (p<.05) (Table 1).

Table 1: Student Characteristics and Work Experience

Total Nursing PT Engineering

Student groups F / χ²value p-value
[n=214] [n=73] [n=87] [n=54]

Age 2.01
22.9 ± 2.46 22 ± 2.55 24.1 ± 1.94 22.1 ± 2.34 .018*
[mean ± SD] (df-14)

Gender
Male 95 (44.4%) 8 (11%) 42 (48.3%) 45 (83.3%) 66.75
p<.001*
Female 119 (55.6%) 65 (89%) 45 (51.7%) 9 (16.7%) (df-2)

1.19
BMI [mean ± SD] 23.8 ± 3.50 22.6 ± 3.29 24.3 ± 3.20 24.7 ± 3.86 .182
(df-94)

Previous work
experience (last 5 yrs)
Yes
191 (89.3%) 67 (91.8%) 74 (85.1%) 50 (92.6%) 2.71
No .258
23 (10.7%) 6 (8.2%) 13 (14.9%) 4 (7.4%) (df-2)
 International Journal of Nursing Education, July-September, Vol.9, No. 3 117

Cont... Table 1: Student Characteristics and Work Experience

Type of previous work

experience
Heavy manual 21 (11%) 8 (11.9%) 4 (5.4%) 9 (18%)
Moderate manual 91 (47.6%) 46 (68.7%) 33 (44.6%) 12 (24%)
44.37
Light manual 50 (26.2%) 12 (17.9%) 27 (36.5%) 11 (22%) .001*
(df-6)
Sedentary 29 (15.2%) 1 (1.5%) 10 (13.5%) 18 (36%)

Current job status***

Yes
116 (55.2%) 45 (64.3%) 49 (56.3%) 22 (41.5%) 6.39
No .041**
94 (44.8%) 25 (35.7%) 38 (43.7%) 31 (58.5%) (df-2)

*p<.001 **p<.05 ***n=210

Awareness of principles of body mechanics

The three student groups differed significantly in awareness about the selected aspects of correct body mechanics,
namely, sitting posture, standing posture, mechanism of lifting objects and transferring patients. In comparison to
nursing and engineering students, a higher proportion of PT students were aware of correct standing & sitting posture
(p<.001), back strengthening exercises (p<.001) and correct mechanism of lifting objects (p<.01). However, there
was no significant difference in awareness of the correct mechanism of transferring patients between the nursing and
PT students (Table 2).

Table 2: Student Awareness of Body Mechanics

Nursing PT Engineering
Selected aspects of body mechanics χ² value p value
n(%) n(%) n(%)

Correct standing posture 47(64.4%) 85(97.7%) 35(64.8%) 33.07(2) p<.001*

Correct sitting posture 65(89%) 87(100%) 45(83.3%) 14.03(2) .001*

At least 2 back strengthening

27(37%) 86(98.9%) 32(59.3%) 71.92(2) p<.001*
exercises

Correct patient transferring

71(97.3%) 87(100%) *** 2.41(1) .120
techniques

Correct mechanism of lifting objects 73(100%) 87(100%) 51(94.4%) 9.01 (2) .011**

*p<.001 **p<.05 ***Not applicable

To determine if knowledge about various aspects of body mechanics is associated with LBP, chi- square tests
were performed. Lack of knowledge of proper sitting posture was the only aspect that was significantly associated
with LBP (χ² = 7.690, d.f. = 1, p=.006).

LBP prevalence

The LBP prevalence rates of the nursing students were high; lifetime (70%), 12-month (68.4%), 30-day (46.5%)
and 7-day (31.5%) (Fig.1). With the exception of the lifetime prevalence, nursing and PT students had equal LBP
prevalence rates for 12 months and 30 days. Engineering students had the lowest LBP prevalence rates at all time
points. The prevalence rates across the groups were not statistically significant: lifetime (χ² = 2.68, d.f. = 2, p= .262),
12-month (χ² = 1.42, d.f. = 2, p= .492), 30-day (χ² = 2.75, d.f = 2, p= .252) or 7-day (χ² = 1.34, d.f. = 2, p= .51).
 118 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

(64%), PT (50%) and engineering (47%) - reported that

they had more than three episodes of LBP over the last
year. Among the student sample, the majority of students
across all disciplines experienced mild to moderate pain
and did not experience radiating pain. Almost half of
nursing students (48%) required analgesics whereas
lesser proportion of PT (20.3%) and engineering
(28.1%) students used analgesics for pain control.
This difference across the disciplines was found to be
statistically significant (χ² = 9.803, d.f = 2, p=.007).
Fig 1: Lifetime, 12-month, 30-day and 7-day LBP Prevalence Nursing students reported higher disability due to their
Among Student Groups LBP than the other two groups (p=.02).
LBP: Characteristics impact & causes
Sitting for prolonged periods of time was reported
Students who reported having LBP within the last 12 as the most common cause for LBP (Fig. 2). Nursing
months were asked about the details of LBP episodes in students reported sports activities, lifting patients, and
terms of duration, frequency, characteristics and causes excessive bending (including prolonged standing) as the
(N=141). Majority of the students - nursing (42%), PT other causes. Engineering students also reported sports
(52.5%) and engineering (47%) - reported that within activities second to prolonged sitting as the cause of
the last 12 months, their worst episode of LBP lasted < LBP. PT students reported prolonged sitting and sports
one-week. A large proportion of the students - nursing activities equally causing LBP.

Fig 2: Causes of LBP within 12 Months

Causes of LBP reported by nursing (A), physiotherapy (B), and engineering students (C)

Predictors of LBP

Hierarchical multivariate logistic regression showed that BMI > 25kg/m2 (p=.002) and lack of awareness about
proper sitting posture (p<.001) were significant predictors of LBP among the students (Table 3). The model explained
between 14.2 % to 20.6% of the variability in LBP prevalence (model χ² = 28.61, d.f. = 7, p<.001).

Table 3: Hierarchical Multivariate Logistic Regression

Included Odds Ratio 95% CI p value

Previous work experience 0.84 0.25-2.81 .782
Current job status 0.58 0.28-1.18 .134
BMI >25 kg/m2 4.74 1.77-12.65 .002*
 International Journal of Nursing Education, July-September, Vol.9, No. 3 119

Cont... Table 3: Hierarchical Multivariate Logistic Regression

Study program:
Nursing Reference Reference Reference
PT 1.37 0.53-3.54 .504
Engineering 0.76 0.30-1.87 .553
Lack of awareness: proper lifting mechanisms 0.54 0.01-23.94 .753
Lack of awareness: proper sitting 10.26 2.69-39.10 p<.001**
Lack of awareness: proper standing 1.01 0.40-2.56 .977
Lack of awareness: back exercises 0.48 0.20-1.15 .102

R2 = .142 (Cox& Snell), .206 (Nagelkerke)

*p<.01 **p < .001

Regression was done using statistically and clinically significant predicting variables after controlling previous
and current work status

DISCUSSION to compare the prevalence rates of nursing students

with another group of health professional students
This was the first study to report LBP prevalence (PT) where patient lifting is common and with non-
among nursing, PT, and engineering students in the health professional students (engineering). Although
United States. statistically insignificant, higher LBP prevalence rates
LBP prevalence, causes and severity among among nursing students as compared to other disciplines
nursing students warrant future in-depth studies.

The study showed that the LBP prevalence is high Another important finding was that sitting was self-
among professional students in the United States, with reported as number one cause of LBP followed by sports
well over half of the students reporting LBP in the past activities. Further, the majority of the nursing students
year. Nursing and PT students had similar 12-month and perceived lifting patients as a variable associated with
30-day LBP prevalence while lifetime prevalence was LBP. Considering that 40% of the nursing students
highest in PT students and 7-day prevalence was highest experienced more than four episodes of LBP during
in nursing students. The engineering students had lowest the 12-month period and 60% of them required medical
LBP prevalence at all-time points. Comparison of these advice or analgesics for their LBP, further exploration
results with other studies could not be systematically into the activity levels of nursing students along with
done because of differences in survey methodology their awareness and practice of body mechanics are of
(particularly recall time and level of nursing students). paramount significance.
The 12-month LBP prevalence rate of the nursing The impact of LBP on students was determined by
students (68.4%) in our study cohort was higher than the data on LBP severity and requirement of analgesics
LBP prevalence rates reported from Hong Kong (18%)3 and medical advice. Around 32% of the respondents
but closer to Australia (71%)4. The lifetime prevalence with LBP in the last 12 months required analgesics for
rate of LBP (69.9%) in our study was found to be almost their back pain and around 16% sought medical advice.
similar to that of nursing students in Australia (79%)4 The significantly higher disability score of nursing
but considerably higher than in Pakistan (41%)5. students suggest a negative impact of LBP among them
Comparisons of LBP between nursing and other as compared to both healthcare students (PT) and non-
disciplines have not been extensively reported. The healthcare students (Engineering).
lifetime LBP prevalence of nursing was reported to be Aspects of body mechanics
lower than medical students in one study in Pakistan5.
To the best of our knowledge, this is the first study Higher proportion of PT students reported awareness
 120 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

about selected aspects of body mechanics than nursing to generalize the findings as our study is limited to one
and engineering students. These differences among the university and may not represent other regions in the US.
three disciplines were statistically significant. When Since it is a cross-sectional survey, there is a potential
compared to nursing and engineering, PT students for recall bias and survey responders to overestimate
have extensive exposure to body mechanics in their their LBP symptoms.
curriculum. Although both nursing and PT students
Conflict of Interest: None
are involved in patient care and perform direct patient
transferring and lifting, the focus on body mechanics in Source of Funding: Self
nursing curriculum is disproportionately limited.
Ethical Clearance: The ethical approval for the
BMI and LBP study was obtained through the University Institutional
Review Board and consent was obtained from all
Another significant predictor of LBP among students
participants.
was being overweight (BMI > 25kg/m2) (p<.001). This
finding was in contrast to other published studies that REFERENCES
reported no association between BMI and LBP among
students8. However, a recent study has reported an 1. Dawson, AP, McLennan, SN, Schiller, SD,
increase in lumbosacral angles in individuals with raised Jull, GA, Hodges, PW & Stewart, S. (2007).
BMI, which might result in biomechanical changes in the Interventions to prevent back pain and back injury
lumbosacral spine and increase the incidence of LBP9. A in nurses: a systematic review. Occupational and
BMI of more than 25 kg/m2 in combination with lack of Environmental Medicine, 64, 642–650. Retrieved
awareness regarding correct sitting posture, were found from http://www.ncbi.nlm.nih.gov/pmc/articles/
to be significant predictors of LBP among students, as PMC2078392/
explained by our logistic regression model. 2. Davis, K.G., Kotowski, S.E. (2015). Prevalence of
musculoskeletal disorders for nurses in hospitals,
CONCLUSION
long term care facilities, and home health care:
The study aimed to determine the prevalence of A comprehensive review. Human Factors, 57(5),
LBP among nursing students at different recall time- 754-792. doi: 10.1177/0018720815581933
points and compare them with PT and engineering 3. Cheung, K. (2010). The incidence of low back
students. Very high prevalence rates were reported by problems among nursing students in Hong Kong.
nursing students with lifetime prevalence of 70% and Journal of Clinical Nursing, 19, 2355–2362
12-month prevalence of 68.4%. Nursing and engineering
4. Mitchell, T., O’Sullivan, P., Burnett, A., Straker, L.,
students were less aware about selected aspects of
& Rudd, C. (2008). Low back pain characteristics
body mechanics than the PT students but compliance
from undergraduate student to working nurse in
to these aspects was self-reported as poor among all
Australia: A cross-sectional survey, International
three disciplines. The most frequent cause reported,
Journal of Nursing Studies, 45, 1636–1644.
for the LBP, across the disciplines, was prolonged
sitting followed by sports activities. BMI > 25kg/m2 5. Hafeez, K., Memon, A., Jawaid M., Usman, S.,
and lack of awareness about proper sitting techniques Usman, S., & Haroon S. (2013). Back Pain – Are
were significant independent predictors of LBP among Health Care Undergraduates At Risk? Iranian
the students. Further exploration into awareness and Journal of Public Health. 42(8), 819-825.
practice of body mechanics among nursing students are 6. Klaber M, Hughes G, Griffiths P. (1993). A
of paramount significance. longitudinal study of low back pain in student
nurses. International Journal of Nursing Studies,
LIMITATIONS 30(3):197-212.
A potential bias remains if there are different back 7. Harris, P., Taylor, R., Thielke, R., Payne, J.,
pain characteristics in students who did not volunteer to Gonzalez, N. & Conde, J. (2009). Research
participate. A certain degree of caution should be taken electronic data capture (REDCap) - A metadata-
 International Journal of Nursing Education, July-September, Vol.9, No. 3 121

driven methodology and workflow process for 9. Onyemaechi, NO., Anyanwu, GE., Obikili,
providing translational research informatics EN., Onwuasoigwe, O., & Nwankwo, OE.
support, J Biomed Inform, 42, 377-381. (2016). Impact of overweight and obesity on the
8. Feyer AM., Herbison, P., Williamson, A., De Silva, musculoskeletal system using lumbosacral angles.
I., Mandryk, J., Hendrie, L., & Hely, M. (2000). Patient Preference and Adherence, 10, 291-296.
The role of physical and psychological factors in doi: 10.2147/PPA.S90967
occupational low back pain: a prospective cohort
study. Occupational Environment Medicine, 57,
116–120.
 DOI Number: 10.5958/0974-9357.2017.00081.2

Writing the Hypothesis in Research

Simer Preet Kaur

Lecturer, U.P.RIMS & R, Nursing College, Saifai, U.P.

ABSTRACT

In our everyday life we often make guesses, as to why certain things or events happen. Some of these guesses
may be influenced by our beliefs, observations and experiences. We also try to relate these events to find a
conclusion. What we do is, we make hypothesis, but we don’t name it as hypothesis. When we do research
we too have to relate our variables under study. These relationships are all predictions because we are still
searching and nothing is clear. But to have a direction in the study we have to generate hypothesis by relating
variables under study. What does Hypothesis mean? Hypothesis state the expected relationship between the
independent variable (the presumed cause or antecedent) and the dependent variable (the presumed effect or
outcome) within a population. Hypothesis, ideally, should be based on sound, justifiable rationales because
if prediction does not express an anticipated relationship, it cannot be tested.

Keyword: Hypothesis, Types of hypothesis, Testing hypothesis.

INTRODUCTION inspiration for inductive hypothesis” (Polit and Beck,

“It’s a formal statement of the expected relationships 2004)2. Whereas in deductive reasoning we deduce
between two or more variables in a specified population” from generalizations for attaining specific observations.
(Nancy and Grove, 2007)1. “It’s a prediction about the Theories play an important role here. As theories cannot
relationship between two or more variables” (Polit and be tested directly, “through deductive reasoning, a
Beck, 2004)2. It’s what the researcher believes will researcher can develop hypothesis based on general
happen in their research study. theoretical principles. Deductive hypothesis have as
starting point theories that are applied to particular
When a relatively new area is being investigated, situations” (Polit and Beck, 2004)2. For example, all
the researcher may have to turn to logical reasoning girls in the world are honest, so Sunita is a girl, and
or personal experience to justify the predictions. Thus so she will be honest. Thus by above process one can
hypothesis furnishes proof that the researcher has develop a hypothesis to be empirically tested.
sufficient background knowledge to enable him/her to
make suggestions in order to extend existing knowledge. The use of hypothesis in quantitative studies tends
It also gives direction to an investigation. It structures the to induce critical thinking and to facilitate understanding
next phase in the investigation and therefore furnishes and interpretation of the data. In qualitative studies,
continuity to the examination of the problem. It can be researchers do not begin with a hypothesis in part,
tested verifiable or falsifiable. It is considered valuable because there is usually too little known about the topic
even if proven false. to justify a hypothesis. Qualitative researchers want
the inquiry to be guided by observations and in depth
How to develop hypothesis? From where does it interviews, to know the participants’ viewpoints rather
comes? Two basic types of logical reasoning’s, inductive than by their own.
and deductive help researchers to derive hypotheses.
Inductive reasoning is going from specific observation WORDING OF HYPOTHESES
towards generalizations. For example, Sunita is a A good hypothesis is worded in simple, clear,
girl, she is honest, so all girls in this world will be and concise language. It is cumbersome to include
honest. “Qualitative studies are an important source of conceptual or operational definitions of terms directly
 International Journal of Nursing Education, July-September, Vol.9, No. 3 123

in the hypothesis statement; it should be specific enough DESCRIPTIVE HYPOTHESiS:

so that readers understand what the variables are and
Directional hypothesis are one that specifies not
whom researchers will be studying. “A clearly stated
only the existence but the expected direction of the
hypothesis includes the variables to be manipulated or
relationship between variables. The use of terms such as
measured, identifies the population to be examined and
positive, negative, less, more, greater, decrease, higher
indicates the proposed outcome of the study” (Nancy
etc. indicates the direction of the relationship between
and Grove, 2007)1. “Hypothesis should be worded in
the variables. Directional hypothesis are never phrased
the present tense” (Polit and Beck, 2004)2. Researchers
as a question, but always as a statement. Directional
make predictions about relationships that exist in the
hypothesis always express the effect of an independent
population. The relational aspect of the prediction is
on a dependent variable. For example, there will be
embodied in the phrases such as more than, less than,
significant difference between height and weight of a
greater than, difference, related to, associated with, or
person. So difference exists between height and weight.
something similar.
It can be either, as the height increases weight increases
Before formulating your research hypothesis, read or as the height increases weight decreases. So we have
about the topic of interest to you. From your reading, a direction.
which may include articles, books and/or cases, you
A non directional hypothesis is one, where the
should gain sufficient information about your topic that
relationship between the variables is present but does
will enable you to narrow or limit it and express it as a
not predicts the nature of direction. It happens when
research question. The research question flows from the
the researcher doesn’t have any evidence to show
topic that you are considering. Research question is what
relationship between the variables. Non directional
For example:
hypothesis ask a specific question regarding some
“There will be significant difference in labour phenomenon or predicting something. For example,
outcome in upright position and dorsal recumbent we might want to study this research question: what
position among second para mothers during second are the social and economic factors of children’s with
stage of labour”. obesity? Non directional hypothesis are always phrased
in the form of a question regarding some aspect of the
Above hypothesis is from a study to assess the research. Let us have an example in table II:
effectiveness of upright position over dorsal recumbent
position on labour outcome during labour among second For example:
para mothers. Thus because of the word ‘difference’ one
“Post-test mean score of nurses after undergoing
will get a clear idea that because of different positioning
planned teaching programme will be higher than those of
during labour (cause) labour outcome (effect) is being
their mean pre-test knowledge score”.(Chandramani.B.N,
affected.
2003 )7
When you write in a form of sentence showing the
The above hypothesis is from a study to
relationship between variables becomes your hypothesis.
assess the nursing care needs of the patients with
Let us have some examples of hypothesis in table I:
organophosphorous poisoning admitted in selected
Table I hospitals with a view to develop and evaluate the
effectiveness of planned teaching programme for nurses
on care of patients with OP poisoning. Above hypothesis
is showing a direction that if there will be planned
teaching programme than post-test mean score is going
to increase. Thus researcher can plan an effective
planned teaching programme keeping in mind that it has
TYPES OF HYPOTHESES: to increase the samples knowledge.

DIRECTIONAL AND NON DIRECTIONAL OR

 124 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

Table II Research hypothesis (also referred to as substantive,

declarative, or scientific hypothesis) are statements
of expected relationships between independent and
dependent variables. Null hypothesis (or statistical
hypotheses) state that there is no relationship between
the independent and dependent variables. “If the null
hypothesis is not stated, it is implied, because it is the
converse of the research hypothesis” (Kelinger and Lee,
SIMPLE AND COMPLEX HYPOTHESES 2000)4. “Null hypothesis becomes important because the
sampling distribution and statistic can be only computed
For example:
when the hypothesis is in null form” (Bhaduri and Farrel,
“There will be significant difference in labour 1979)6. It also states that all samples are random samples
outcome in upright position and dorsal recumbent from a single population. And you are attempting to
position among second para mothers during second negate that statement. For example, no significant
stage of labour”(Mekwan.Sudha.V, 2010)8. difference in pregnancy outcome will be demonstrated
for auxiliary nurse midwives exposed to one month
Above hypotheses is from a study to assess the training and those not exposed to one month training.
effectiveness of upright position over dorsal recumbent For the above study we have randomly selected the
position on labour outcome during labour among second two different groups of samples from same population
para mothers. We can see that researcher wants to study and after the training we hope that our samples are still
two different positions during labour upright position random. If the group exposed to the training has not
(IV) and dorsal recumbent (IV) position which are changed, our null hypothesis will be accepted and if
going to have effect on labour outcome (ID) is being change has occurred it shows that our samples are not
affected. Thus we have two independent variables and random anymore and we reject the null
one dependent variable under study.
H1:”There will be significant difference in labour
Simple hypothesis is a hypothesis that expresses outcome in upright position and dorsal recumbent
an expected relationship between one independent position among second para mothers during second
and one dependent variable. A complex hypothesis as stage of labour”.
the name suggest is complex in nature i.e. prediction
of a relationship between two (or more) independent H0: It symbolizes null hypotheses. If above
variables and/or two (or more) dependent variables. hypothesis is our experimental hypothesis than our null
Complex hypotheses some-times are referred to as hypotheses will be:
multivariate hypothesis because they involve multiple
H0: There will be ‘no’ significant difference in labour
variables. Let us have an example in table III:
outcome in upright position and dorsal recumbent
Table III position among second para mothers during second
stage of labour”.

Thus because of the word ‘no’ significant difference

one will get a clear idea that because of different
positioning during labour (cause) labour outcome
(effect) is not being affected. This has to be proved by
statistical testing.
NULL AND RESEARCH HYPOTHESIS
hypothesis. Let’s have another example in table
Hypothesis are sometimes classified as being IV:
either research hypothesis or null hypothesis.
 International Journal of Nursing Education, July-September, Vol.9, No. 3 125

Table IV accepted, all must be determined in advance, before the

observations are collected or inspected. If these criteria
are determined later, when the data to be tested is already
known, the test is invalid.

Acknowledgement: Nil

Conflict of Interest: I have no conflict of interest

to declare.
TESTING HYPOTHESIS
Source of Funding: It’s a self funded study.
Testable hypotheses are one that contains variables
Ethical Clearance: It’s a review article.
that are measurable or able to be manipulated. Hypothesis
are formally tested through statistical procedures; REFERENCES
researchers seek to determine through statistics whether
their hypothesis have a high probability of being correct. 1. Nancy Burns, Grove Susan.K. Understanding
Researcher should know which test of significance is Nursing research. 4th edition. Missouri: Elsevier
appropriate to the data. Selection of test always depends Publication; 2007. p 118-124.
upon type of data available, nature of population, 2. Polit Denise F., Beck CT. Nursing Research,
sampling technique, sample size and the hypothesis to be Principles and Methods. 7th edition. Pliladephia:
tested. “Hypothesis are never proved through hypothesis LippincottWilliams & Wilkins; 2004. p 77-84.
testing; rather, they are accepted or supported” (Polit and 3. Earl Babbie. The Practice of Social Research.
Beck, 2004)2. Findings are always tentative. If we are 3rd edition. Belmont: Wadsworth publishing
able to generalize the findings, then greater confidence Company; 1983.p 37.
can be placed in the conclusions.
4. Kerlinger Fred N, Lee H B. Foundation of
For an example, suppose we hypothesized that Behavioral Research. 4th edition. U.S.A: Holt,
short mothers’ are more prone to have obstructed labour Rinehart and Winston, Inc; 2000.
than tall mothers’. By chance, researcher drew sample 5. Kerlinger Fred N. Foundation of Behavioral
of mothers’ in which short mothers’ had more cases of Research. 2nd edition. U.S.A: Holt, Rinehart and
obstructed labour than tall mothers. Could researcher Winston, Inc; 1983. p 18-19.
able to conclude, that definitively height is related
6. Aparna Bhaduri, Marie Farrell. Health Research:
to labour? This example illustrates the difficulty of
A community - based approach. WHO: Regional
using observations from limited samples to generalize
office for South East Asia. Series No 12 .
to a population. Other issues, such as the accuracy of
the measures, the effects of uncontrolled extraneous 7. Wikipedia: Hilborn, Ray; Mangel, Marc. The
variables, and the validity of underlying assumptions ecological detective: confronting models with
prevent researchers from concluding with finality that data. 1997. Princeton University Press. p. 24.
hypothesis are proved. ISBN 978-0-691-03497-3. Retrieved 22 August
2011.
For testing hypothesis it is necessary to set the 8. Chandramani.B.N. A study to assess the nursing
level of significance. Level of significance means care needs of the patients with organophosphorous
the maximum risk of error a researcher willing to poisoning admitted in selected hospitals with a
run to accept or reject the hypothesis. Conventional view to develop and evaluate the effectiveness of
significance levels for testing the hypotheses are .05, planned teaching programme for nurses on care of
or .01. After setting the level, researcher applies the patients with OP poisoning. September 2003.
statistical test and obtains results. It’s now compared
9. Mekwan.Sudha.V. a study to assess the
with the table value. If the test result falls above the table
effectiveness of upright position over dorsal
value we accept the research hypothesis and if it falls
recumbent position on labour outcome during
below we reject the research hypothesis. Whether the
labour among second para mothers. April 2010.
null hypothesis is rejected or the research hypothesis is
 DOI Number: 10.5958/0974-9357.2017.00082.4

Effectiveness of Care Bundle Approach on Level of

Chemotherapy Induced Peripheral Neuropathy and Quality of
Life among Patients Receiving Chemotherapy

S Kavitha1, Rajeswari Vaidyanathan2, Gopi3

1
Reader, Department of Medical Surgical Nursing, Saveetha University, Chennai, 2Principal, Department of
Community Health Nursing, Ramachandra University, Porur, 3Biostatician, Department of Research ,
Saveetha University, Chennai

ABSTRACT

Chemotherapy-induced peripheral neuropathy (CIPN) is a significant, debilitating symptom directly related

to the administration of neurotoxin chemotherapy for the treatment of cancer. CIPN compromises quality of
life and results in pain or discomfort. Peripheral neuropathy is the end result of peripheral, motor, sensory,
and autonomic neuron damage secondary to neurotoxic chemotherapy agents. Thus, the purpose of this
investigation was to examine the outcomes of a care bundle approach such as structured, supervised exercise
program, massage therapy and health education on home safety measure in reducing symptoms of CIPN and
improving overall QOL. A total of 20 individuals actively in chemotherapy treatment participated in this
investigation. The EORTC QOL and Leeds Assessment of Neuropathic Symptoms and Signs questionnaires,
followed by a CTCAEV scale evaluation were administered both before and after the intervention. Results
revealed that care bundle approach helped attenuate symptoms of CIPN. Overall QOL was significantly
improved, and troublesome symptoms related to CIPN significantly decreased (p<0.05). Thus we assert that
exercise is an effective tool in managing symptoms of CIPN.

Keywords: Neuropathy; Chemotherapy; Exercise programs; Neuropathic symptoms

INTRODUCTION activities, including walking, sleep, and work 3,4.

The most common neurological side effect of Because the exact mechanism of CIPN is not
chemotherapy is chemotherapy-induced peripheral fully understood, pharmacological treatments are
neuropathy (CIPN), which occurs when the peripheral largely ineffective5. Some therapies provide modest
nervous system is damaged 1. This effect appears to be improvements in neurological function. However,
dose and duration dependent, and is most often caused in most instances, these agents are associated with
by the chemotherapy agents Docetaxel, Paclitaxel, or additional negative side effects for cancer patients, such as
Vinorelbine. Damage to the peripheral nervous system cardiac conduction defects and increased chemotherapy
pathways results in neuropathic pain2, producing resistance 6-8. Thus, other interventions that address the
symptoms described as stabbing, burning, or electric symptoms of CIPN should be investigated.
shock-like sensations, leading to impairments in daily
One intervention that has produced promising
results in populations with diabetic peripheral
Corresponding author: neuropathy is exercise rehabilitation 9-11. Exercise
S Kavitha appears to support nerve health, producing both acute
Associate Professor, Department of Medical Surgical and long term benefits. Short-term exercise stimulates
Nursing, Saveetha University, Chennai endothelium-dependent vasodilatation and endoneurial
email: [email protected] blood flow 12. Likewise, the shear stress that results from
Telephone: 9962374729 long term increased blood flow increases vasodilation
 International Journal of Nursing Education, July-September, Vol.9, No. 3 127

12.
In a previous investigation, our lab surveyed the 2. To assess the effectiveness of care bundle
current exercise behaviors of individuals experiencing approach on chemotherapy induced peripheral
symptoms of CIPN. Only 15% of patients surveyed neuropathy and quality of life among patient receiving
were currently meeting the recommended levels of chemotherapy.
physical activity. Yet, these physically active patients
3. To associate the selected demographic variables
reported a significantly higher quality of life (QOL) and
with posttest level of chemotherapy induced peripheral
experienced less pain than their sedentary counterparts
neuropathy and quality of life among patient receiving
13,
lending some credibility to the hypothesis that an
chemotherapy drug.
exercise intervention would be beneficial in attenuating
symptoms of CIPN and improving the overall QOL HYPOTHESIS
of cancer patients. However, it was unknown if the
sedentary patients refrained from exercise because of H1: There is a significant reduction in the level
the symptoms of CIPN or some other factor.. Thus, of chemotherapy induced peripheral neuropathy score
the purpose of this investigation was to examine the among patients receiving chemotherapy in Experimental
outcomes of a structured, supervised exercise program group after receiving care bundle approach.
in reducing symptoms of CIPN and improving physical
H2: There is a significant improvement in the
fitness and overall QOL.
quality of life among patients receiving chemotherapy
OBJECTIVES in Experimental group after receiving care bundle
approach.
1. To assess the level of chemotherapy induced
peripheral neuropathy among patient receiving
chemotherapy.

RESEARCH METHODOLGY

Research Design :Quantitative approach – True Experimental Research Design

Samples Group Pretest Intervention Post test

End of 1st End of 2nd End of 3rd

X
month month month

Randomisation Experimental Care bundle

O1 O2 O3 O4
Group Approach

Control Group O5 Routine care O6 O7 O8

VARIABLES chemotherapy as their treatment.

Independent variable: Care bundle approach Sample: Patients receiving chemotherapy who
admitted in Medical chemotherapy ward at Guru
Dependent variable: Level of chemotherapy
Hospital Madurai and who meets inclusion criteria was
induced peripheral Neuropathy.
selected as a sample for the study
Setting: The study will be conducted at Guru
Sampling technique:
Hospital, Madurai. It is a 100 bedded hospital.
Approximately 50-60 out patients are attending the Simple random sampling technique
OPD. It has general ward ,specialward,ICU.It has 30
inpatient chemotherapy beds. Sample size:The sample size was 10 in experimental
group and 10 in control group
Population: All cancer patients receiving
 128 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

CRITERIA FOR SELECTION OF SAMPLE and improve the quality life of patients receiving
chemotherapy,the three care bundles areStrength and
Inclusion criteria:
Balance training exercises ,Massage therapy ,Health
• Patients who will be medically diagnosed as education on protective Home safety measures.
cancer.
• Dependent variable: The level of
• Both male and female patients Chemotherapy Induced Peripheral Neuropathy
and improve the quality life of patients receiving
• Patients with the age group of 20 years – 75 chemotherapy.
years
(b)Attribute variable: Socio-demographic
• Patients receiving chemotherapeutic agents variables which include age, Gender, marital status,
which cause neurotoxic effects like taxanes (paclitaxel, education, family income, Residence, Occupation
docetaxel), the vinca alkaloids (vinorelbine), the status,etc.,
platinum analogues (cisplatin, carboplatin), and the
antimetabolites (capecitabine). (c) Clinical variable Performa: To assess the
clinical variable such Body BMI, cancer type, cancer
• Patient receiving chemotherapy cycle per week stage, status of chemotherapy, purpose of chemotherapy,
for atleastone hour duration. surgery, DM, Non-pharmacologicalinterventions,
chemotherapeutic agent.
• Patient receiving treatment weekly and every 3
weeks (ie 7 and 21 days) for at least 16 – 24 weeks ie 6 Description of the tool
courses.
A.DemographicVaribles
• Patient with grade level of I, II & III.
B.CTCAE Neuropathy Assessment Scale
Exclusion criteria:
C.LANSS(Leed Assessment of Neuropathic Signs
• Patients who are not willing to participate in the and symptoms) pain scale
study
D.Knowledge questionnaire on Home safety
• Patients who are not able to perform basic Measures.
activities of daily living such as walking
E.EORQTC Quality of life Scale
• Patients who show cognitive disorders or severe
emotional instability Ethical consideration:Ethical approval was
obtained from the Scientific Review board and
• Patients who are physically challenged Institutional ethical committee of Saveetha University.
Informed consent was obtained from the Director of
• Patient with acutely ill
Guru Hospital and also written assent was obtained from
• Patient with co-morbid diseases that might the patients.
hamper physical exercise (e.g. heart failure, chronic
Pilot Study Data Collection
obstructive pulmonary disease (COPD), orthopaedic
conditions and neurological disorders like Cerebro • The pilot study was conducted after approved
vascular accident and diabetes mellitus. from Institutional Ehtical committee member
from September 2016 to November 2016 at Guru
• VARIABLES:
Hospital,Madurai.
(a)Study variable:
• Prior permission was got from director of the
• Independent variable: Care Bundle Guru Hospital,atMadurai,for conducting the pilot study.
Approachwhich is performed collectively to reduce the
• The informed consent received from
level of Chemotherapy Induced Peripheral Neuropathy
 International Journal of Nursing Education, July-September, Vol.9, No. 3 129

the patients. patients to do the 7 type of exercises which is done for

25-35 minutes twice a day i.e. (with a frequency of four
• Totally 10 patients who were receiving
sets of 10 repetitions) such as finger roll, finger taps,
chemotherapy and met the other inclusion criteria were
ankle circle, standing heel to toe, standing side leg, calf
selected as sample for the study and among them 10
rise, calf stretch and movement performed in elimination
samples for experimental group and 10 samples were
gravity, movement performed in against gravity,
control group were selected by random allocation.
movement performed in minimal resistance, movement
• The researcher obtained demographic and performed in maximum resistance with against gravity
clinical variables. for 3 months during the entire course of chemotherapy.

• Baseline clinical Evaluation was done, based • Massage therapy was given for 10 minutes
on base line demographicdataandbase line physical twice a day for 3 months during the entire course
examination was done. of chemotherapy using the method of kneading and
efflurage in the feet and the palm of patients receiving
• Administered the chemotherapy to the patient. chemotherapy.
• Assessed for emerging or worsening neuropathy • Health education was given with the use of
during and after administration of chemotherapy and the ppt on protective household modification for 10 minutes
pretest evaluation was done by assessing the peripheral starting from the first cycle of chemotherapy and
neuropathy by CTCAE Neuropathy Assessment Scale thereafter positive reinforcement will be given up to the
based on criteria such as touch, vibration in the hands/ end of the six courses of chemotherapy.
feet, muscle strength of the upper/lower extremities and
tendon reflexes before chemotherapy • Control group patient received the routine care.

• The patient with the grade level of I,II and IIIrd • The post test level of CIPN, Quality of life,
was selected for the study. NeuropathicPain and knowledge of patient about home
safety measures was done at the end of each cycle of
• Neuropathic pain was assessed by LANSS chemotherapy (ie last day of each cycle of every week(
Scale and quality of life by using EORQTC Quality 1st ,3rd ,7th ,11th week )the level of CIPN was assessed
of life Scale and assessment of knowledge by by NCI-CTCAEV Neuropathy scale, Neuropathic
knowledge questionnaire on protective house hold pain by LANSS scale, Knowledge on Home Safety
recommendations. Measures by Knowledge Questionnaire and quality of
life by EORQTC Quality of life scale and assessment of
• The interventions was started for the
knowledge by knowledge for experimental and control
experimental group on that same day and asked the
group.

Data Analysis and Statistical Methods Used

S.No Data Analysis Method Remarks

To describe the demographic variables, level of CIPN and quality
1. Descriptive Mean and standard deviation
of life
To compare the level of CIPN and quality of life between the
Independent t test
treatment group and control group
To determine the effectiveness of CBA on the level of CIPN and
Paired t Test
quality of life within the group
Mann – Whitney U test To compare the groups by percentage changes in the variables
To associate the selected demographic variables with the level of
Chi-Square test
CIPN and quality of life

Comparison of sensory symptoms and motor symptoms in theth

2. Inferential th th
ANOVA Test intervention group and control group at the end of 4 , 8 & 12
week
 130 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

DISCUSSION an attention control group.

The aim of the study is to assess the effectiveness The outcome of the present investigation which was
of Care Bundle Approach in reducing the effect shown in Table 10 – 19 supports the results of earlier
of CIPN and improving the QOL among cancer studies of James .A. Bovaird (21014) demonstrating
patients receiving chemotherapy at selected hospital, that exercise enhances quality of life in persons with
Madurai. cancer and improves sensory function in persons with
chemotherapy peripheral neuropathy .
The onset, severity, characteristics and duration of
clinical manifestation of CIPN are highly variable, but In light of the findings and the literature review
are typically characterized by a glove – and – stocking surrounding this topic , it seems feasible to assume that a
distribution and sensory loss in the hand and the foot and supervised exercise program would provide a beneficial
in some cases motor and autonomic dysfunction.These effect on QOL and pain associated with CIPN.
symptoms are difficult to treat and significantly impact
the Quality of life and functional ability in patients.
SUMMARY AND CONCLUSION

Twelve weeks of supervised exercise training

The investigator findings that unpleasant skin
attenuated symptoms of CIPN, significantly improved
sensations and sensitivity related to neuropathic pain,
overall QOL, and decreased troublesome symptoms
inadequate knowledge on protective household activities,
related to CIPN (p<0.05).Although this investigation
low level of well being, statistically shown in the Table
produced promising results for individuals with CIPN
: 2,3,4,5,6,7,8,9 were consistent with the previous
,it was not with limitations. Namely there was a low
investigation work of wonders KY (2014) examining the
adherence rate. Also noteworthy that adherence rates
severity of neuropathic signs and sympyoms, assessing
were similar to that of healthy population. Future
the knowledge on Household protective mechanism and
study in this fitness parameter with a large sample
QOL .
should also be done.While the underlying mechanism
Thus primary findings of this investigation , is unknown, theories center around the expression of
that strength and balance training exercises,massage cytokines should be further explored. Since neuropathic
therapy and health education on home safety measures pain associated with CIPN is one of the more difficult
positively impact the neurological symptoms is clinically types of pain to treat, and in light of the findings that
significant. pharmacological treatments often bring about unwanted
side effects, we assert that exercise is an effective tool in
With neuropathy, muscle mass atrophies and leads managing symptoms of CIPN.
to significant decrease in muscular strength.It also
appears to affect distal muscle groups more so than Conflict of Interest: Nil
proximal muscles. Researchers have reported
Source of Funding: Self
Improvement in muscle strength following moderate
resistance exercise program,massage therapy in turn it
REFERENCES
improves the Quality of Life. 1. Quasthoff S, Hartung HP (2002) Chemotherapy-
induced peripheral neuropathy. J Neurol 249: 9-17.
Though the study involved a small sample, it is the
first exercise intervention focused on the amelioration 2. Horowitz SH (2007) The diagnostic workup of
of CIPN. This pilot data provides preliminary patients with neuropathic pain. Med Clin North Am
evidence that persons who engaged in a home-based 91: 21-30.
strength training exercise program ,massage therapy 3. Tölle T, Xu X, Sadosky AB (2006) Painful diabetic
and education intervention on protective household neuropathy: a cross-sectional survey of health state
modifications following chemotherapy for cancer may impairment and treatment patterns. J Diabetes
experience fewer neuropathic symptoms, better physical Complications 20: 26-33.
functioning , and experience improved quality of life
4. Zelman D, Core M, Dukes E, Tai K, Brandenburg
after the completion of therapy, as compared to those in
 International Journal of Nursing Education, July-September, Vol.9, No. 3 131

N (2005) Validation of a modified version of the extracellular superoxide dismutase by nitric oxide
brief pain inventory for painful diabetic peripheral and exercise training. J Clin Invest 105: 1631-
neuropathy. J Pain Symptom Manage 29: 401-10. 1639.
5. Kaley TJ, Deangelis LM (2009) Therapy of 13. Wonders KY, Drury DG (2012) Current exercise
chemotherapy-induced peripheral neuropathy. Br J behaviors of breast cancer patients diagnosed with
Haematol 145: 3-14. chemotherapy-induced peripheral neuropathy. J
6. Goodman LS, Limbird LE, Milinoff PB (1996) IntegrOncol 1: 103-107.
Goodman and Gilman’s: The pharmacological 14. Wonders KY, Whisler G, Loy H, Holt B, Bohachek
basis of therapeutics. (25thedn), McGraw-Hill K, et al. (2013) Ten weeks of home-based exercise
Professional, New York, USA. attenuates symptoms of chemotherapy-induced
7. Rao RD, Michalak JC, Sloan JA, Loprinzi CL, peripheral neuropathy in breast cancer patients.
Soori GS, et al. (2007) Efficacy of gabapentin in the Health Psychology Research 1: 149-152.
management of chemotherapy-induced peripheral 15. Yu-Wen Chen, Yung-Tsung Li, Yu Chung Chen,
neuropathy: a phase 3 randomized, double-blind, Zong-Ying Li, Ching-Hsia Hung (2012) Exercise
placebo-controlled, crossover trial (N00C3). Cancer Training Attenuates Neuropathic Pain and Cytokine
110: 2110-2118. Expression after Chronic Constriction Injury of Rat
8. Suzuki T, Nishio K, Tanabe S (2001) The MRP Sciatic Nerve. AnesthAnalg 114: 1330-1337.
family and anticancer drug metabolism. Curr Drug 16. Tesfaye S, Harris ND, Wilson RM, Ward JD (1992)
Metab 2: 367-377. Exercise-induced conduction velocity increment: a
9. Balducci S, Iacobellis G, Parisi L, Di Biase N, marker of impaired peripheral nerve blood flow in
Calandriello E, et al. (2006) Exercise training can diabetic neuropathy. Diabetologia 35: 155-159.
modify the natural history of diabetic peripheral 17. Casellini CM, Vinik AI (2007) Clinical
neuropathy. J Diabetes Complications 20: 216-223. manifestations and current treatment options for
10. Richardson JK, Sandman D, Vela S (2001) A diabetic neuropathies. EndocrPract 13: 550-566.
focused exercise regimen improves clinical 18. Huonker M, Halle M, Keul J (1996) Structural and
measures of balance in patients with peripheral functional adaptations of the cardiovascular system
neuropathy. Arch Phys Med Rehabil 82: 205-209. by training. Int J Sports Med 17 Suppl 3: S164-
11. Tesfaye S, Harris ND, Wilson RM, Ward JD (1992) 172.
Exercise-induced conduction velocity increment: a 19. Levy BI, Schiffrin EL, Mourad JJ, Agostini D,
marker of impaired peripheral nerve blood flow in Vicaut E, et al. (2008) Impaired tissue perfusion:
diabetic neuropathy. Diabetologia 35: 155-159. a pathology common to hypertension, obesity, and
12. Fukai T, Siegfried MR, Ushio-Fukai M, Cheng Y, diabetes mellitus. Circulation 118: 968-976..
Kojda G, et al. (2000) Regulation of the vascular
 DOI Number: 10.5958/0974-9357.2017.00083.6

To Assess the Effectiveness of Planned Teaching Programme

on Knowledge and Practices Regarding Menstrual Hygiene
among the Adolescent Girls in Selected Govt. School of Delhi

Grewal Savita1, D’Souza Ranjitha2

1
Msc. (CHN Nursing) Student, 2HOD CHN Nursing, Kailash Institute of Nursing and
Paramedical Science, Knowledge Park-3, Greater Noida

ABSTRACT

Onset of menstruation is one of the most important changes occurring among the girls during the
adolescence. In existing Indian culture\milieu, there are several traditions, myths, misconceptions, mystery
and superstition prevailing about menstruation these issues need to be managed at an early age. A study to
assess the effectiveness of planned teaching programme on knowledge and practices regarding menstrual
hygiene among the adolescent girls. The aim of the study: 1) to assess the knowledge and practice regarding
menstrual hygiene among the adolescent girls before and after the structured teaching programme. 2) To
determine the association of pre-test knowledge with the selected demographic variable. Research approach
was evaluatory and descriptive; research design was pre-test and post-test. A sample of 100 adolescent girls
was selected using purposive sample technique. A semi structured questionnaire tools were used to evaluate
the knowledge and practice. Descriptive and inferential statistic in term of mean, standard deviation and
paired‘t’, Karl Pearson ® and one way ANOVAs test were used for analyzing the data. The finding revealed
that the mean difference of post intervention showed a significant difference in knowledge and practice
regarding menstrual hygiene (t=13.92,p<0.05and t=17.40,p<0.05 respectively). Over all knowledge score
is increased from 8% to 55% and practice score also increased from 20% to 58%. Majority of girls received
information from the mother. Hence the study concluded that structured teaching programme on knowledge
and practices’ regarding menstrual hygiene among the adolescent girls is very effective.

Keywords: Assess; Effectiveness; Planned Teaching Programme; Knowledge; Practices; adolescent girls;
Menstrual Hygiene.

INTRODUCTION years, late adolescent age 17-20 years. A woman goes

through several developmental milestones that greatly
Onset of menstruation is one of the most important
influence her reproductive health. Puberty is a period of
changes occurring among the girls during the
transition between childhood and adulthood, a time of
adolescence. The first menstruation occurs between 11-
profound biologic, intellectual, psychosocial and sexual
15 years with a mean age of 13 year. Girls reach physical
maturity2.
maturity earlier at 9 to 10 years of age, in existing Indian
culture\milieu, there are several traditions, myths, There are many contributing factors that make up
misconceptions, mystery and superstition prevailing personal hygiene with the main ones being bathing,
about menstruation that appear to be a major hurdle for oral care, hair care, nail care, wound care, cleansing
advancement of the knowledge of the subject1. of personal utensils, menstrual hygiene in women is
preventing to infection. Personal hygiene as it says is
WHO defined adolescence as the age group
personal. Everybody has their own habits and standards
of 10-19 years; it is approximately one fifth of the
that they have been taught or that they have learnt from
world’s population. It can be distinguished as early
others. It is essentially the promotion and continuance of
adolescence 10-13 years; middle adolescence age 14-16
good health.3
 International Journal of Nursing Education, July-September, Vol.9, No. 3 133

NEED FOR THE STUDY Thus investigator felt the need to take up a study
to access the effectiveness of structured teaching
In order to grow as women, girls have to live programme on knowledge and practice regarding
healthy, productive and dignified lives. Good practices knowledge and practice regarding menstrual hygiene.
are essential that they are able to manage menstrual
bleeding effectively. This requires access to appropriate STATEMENT OF THE PROBLEM
water, sanitation and hygiene services, including clean
“A Quasi-Experimental study to assess the
water for washing clothes used to absorb menstrual
effectiveness of planned teaching program on knowledge
bleed and having a place to dry them, having somewhere
and practice regarding menstrual hygiene among the
private place to change clothes or disposable sanitary
adolescent girls in selected Govt. School of Delhi”.
pads, facilities to dispose of used clothes and pads
access to information to understand the menstrual cycle OBJECTIVES
and how to manage menstruation hygienically4.
• To assess the knowledge and practice regarding
J. Annamma 2008 in the olden days, menstruation menstrual hygiene among the adolescent girls before
was perceived as unclean or embarrassing, extending and after the structured teaching program.
even to the mention of menstruation both in public and
in the private. Different cultures viewed menstruation • To find the co-relationship between pre-test
differently. Menstruation and menstrual practices were knowledge and pre-test practice regarding menstrual
clouded by taboos and socio-cultural restrictions. The hygiene among adolescent girls.
taboo was so great that not only the woman herself
• To determine the association of pre-test
suffered uncleanness, but anyone who touched her was
knowledge and practice with the selected demographic
considered to be unclean. A woman was not allowed to
variables.
offer prayer or to perform other religious activities like
fasting, going to temples/mosques/churches, light the HYPOTHESES
holy lamps or incense sticks, offer food to Brahmins/
Priests, etc. Sexual intercourse with husband was strictly The following hypotheses will be tested at 0.05
prohibited during menstrual periods. Menstruating level of significance
women in the past were given a period of rest from H1: There will be difference in knowledge and
all household activities, was physically and socially practice regarding menstrual hygiene among the
isolated and forbidden to prepare food. 5 adolescent girls before and after structured teaching
Nowadays, girls are having menarche at an early program.
age as compared to previous times. The customs and H2: There is a relationship between the knowledge
practices of the past are not followed these days. and practice regarding menstrual hygiene among the
Women are not confined to their homes nor are they adolescent girls.
restricted to work. They move out of the house for
education, jobs, and travel a lot. They are allowed to H3: There is an association of pre-test knowledge
do everything normally, including taking daily baths or and practice with selected demographic variables.
showers; exercising, dancing and playing sports are all
REVIEW OF LITERATURE
fine. Women are always on the move, are more beauty
conscious and they looking for more convenient means Literature related to:
to provide them comfort during menstrual periods.
Hence, they need more education on hygienic health • Knowledge of reproductive system, puberty
practices. Menstruation and menstrual practices are and menstruation
still clouded by taboos and socio-cultural restrictions
• Menstruation hygiene and practice
resulting in adolescent girls remaining ignorant of the
scientific facts and hygienic health practices, which • Social taboos related to menstrual hygiene.
sometimes result into adverse health outcomes.6
Knowledge of reproductive system, puberty and
 134 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

menstruation RESEARCH METHODOLOGY

A study was conducted on knowledge regarding • Population: Adolescent girls in the age of
puberty and menstruation among adolescent girls in 10 - 13 years (early adolescent girls) who attained
U.P. 504 samples were selected and structured teaching menarche.
questionnaire was administered. The result showed that
half of the girls did not know that menstruation blood • Sample: Girls studying in 6th to 8th who age is
comes from uterus or vagina. 84.9% of girls stated that 10-13 years standard who attain menarche.
it is dangerous to swim or run during this period. Out Sample criteria:
of 462 girls who had attained their menarche, 64.9%
stated that their first source of information related to • Inclusion criteria:
menstruation was their mother.7
• Adolescent girls in the age group of 10-
Related to knowledge and practices regarding 13years.
menstrual hygiene:
• Adolescent girls who can read English/Hindi.
Adhikari P et al (2007)A study was found that
• Adolescent girls who have attained menarche
they were not properly maintaining the menstrual
hygiene. Only 6.0% of girls knew that menstruation is • Adolescent girls who are willing to participate
a physiologic process, 36.7% knew that it is caused by in the research study.
hormones 94% percentages of them use the pads during
the period but only 11.3% dispose it. Overall knowledge • Adolescent girls who are available at the time of
and practice were 40.6% and 12.9% respectively.8 time of data collection.

Literature related to menstrual hygiene practices Exclusion criteria:

J. Keerti, Y. Pravin, (July-Sept; 2013) A study was • Adolescent girls who have not attained
conducted at centre of Katuri Medical College and menarche.
Hospital, Guntur, Andhra Pradesh and sample were 360 • Adolescent girls who are not willing to
adolescent girls. Age of attainment of menarche ranged participate in the research study.
from eleven to sixteen years. Only 36.19% girls were
aware regarding menstruation prior to the attainment of • Adolescent girls who are not available at the
menarche. Mother was found to be the first source of time of time of data collection.
information regarding menstruation in 61.29% of girls.
Sample size:
34.63% girls reported use of old cloth for protection
during menses.10 • 100 adolescent girls.
Ramchandra C. Goyal (2010). The study was • Sampling technique: Purposive Sampling
conducted byRamchandraConcluded that majority of the Technique
girls received the information regarding menstruation
from their mothers (41%), followed by Media (24%) and • Independent variable: structured teaching
friends (19%). Of the girls who developed genital tract program.
infections, 66% used cloth. 37% girls do not disclose
• Dependent variable: knowledge and practice
about their menstruation. Cleanliness of external genitalia
of adolescent school girls regarding menstrual hygiene.
was unsatisfactory. Hence it is important to educate the
girls with scientific knowledge and dispelling their Data collection process
myths and misconceptions thereby encouraging safe and
hygienic practices for safeguarding themselves against • Step i. Investigator introduced herself to
various infections.11 student.
 International Journal of Nursing Education, July-September, Vol.9, No. 3 135

• Step ii. Administration of pre-test by giving knowledge and practice regarding menstrual hygiene.
questionnaire on knowledge and practice.
ANALYSIS AND INTERPRETATION
• Step iii. Administration of structured teaching
Section 1: Distribution of adolescent girls based on
program regarding menstrual hygiene and practice.
socio demographic variable.
• Step iv. Administration of post test on
Table: n=100

S.no.1 Religion Frequency Percentage

Hindu 82 82
Muslim 14 14
Christian 4 4
Other 0 0

S.no.2 Education Status Of Mother Frequency Percentage

Illiterates 41 41
Primary 31 31
Secondary 10 10

S. no.3 Type Of Family Frequency Percentage

nuclear family 62 62
joint family 38 38
extended family 0 0

S.no.4 Monthly Income Of Family Frequency Percentage

Rs.5000 71 71
Rs.5001 to Rs.10000 20 20
Rs.10001 to Rs.15000 6 6

S.no.5 Age Of Menarche Frequency Percentage

8 to 9 yrs 6 6
10 to 11 yrs 22 22
12 to 13 yrs 55 55

S. no.6 Received Information On Menstruation Frequency Percentage

mass media (TV, newspaper, magazines ) 6 6

health personal 8 8
Mother 76 76
other ( school, teacher, sister, relatives) 10 10

This table shows:

• Distribution based on religion shows that 82% of the adolescent were Hindu, 14% of the adolescent were
Muslim and 4% of the adolescent were Christian
• Distribution based on Mother’s education of • Type of family distribution shows that 62%
adolescent girls was 41% illiterate, primary education of adolescent girls live in nuclear family and 38% of
31% had completed secondary education 10% had adolescent girls live in joint family.
completed and high school education was 18% had
• Family income distribution shows that 71%
completed.
adolescent girls had Rs.5000 monthly income and 3%
 136 International Journal of Nursing Education, July-September 2017, Vol.9, No. 3

adolescent girls had above Rs. 15001monthly income. using paired‘t’ test.
• Menarche age distribution Shows those 55% Significant difference in pre-test and post-test
adolescent girls had menarche 12 to 13 years of age and knowledge sores. n=100
6% of adolescent girls had menarche 8 to 9years of
age. Knowledge Mean SD Df T p

• Distribution of adolescent girls based on Pre 7.89 2.85 99 19.879**

Received Information on Menstruation shows that 76% 0.05
girls received information from and 6% from mass Post 13.92 1.43
media.
Section 11 A in order to test the effect of the Table revealed that the mean pre-test score is
planned teaching on knowledge, the hypotheses’ H1’ 10.10± 3.74 SD and the mean of post-test score is
‘There will be significant difference in knowledge 17.40± 2.22 SD, which shows that there is difference
regarding menstrual hygiene of adolescent girls before in the mean practice core. In order to test the
and after structure teaching program. Is stated and tested hypothesis paired‘t’ test was done. The calculated
value t= 17.115 and tabulated value t= 1.98 Degree of freedom is 99 and p value is 0.05 the tabulated value is
greater than tabulated value hence research H2 is accepted. Thus teaching programme is effective regarding
menstrual

SECTION 111 B Analysis of practice of adolescent girls based on over all practice regarding menstrual
hygiene before and after planned teaching programme. n=100
Practice distribution of adolescent
Pre test Post test

Frequency Percentage Frequency Percentage

Poor 42 42 16 16
Average 38 38 26 26
Good 20 20 58 58

Table shows that in pre- test the 42% adolescents had poor practice, 38% had average practice, and 20% had
good practice regarding menstrual hygiene among adolescent girls. The post-test shows that 16% had poor practice,
26% had average practice and 58% had good practice and regarding menstrual hygiene among adolescent girls.
SECTION 1V in order to test the co-relationship between the knowledge and practices regarding menstrual
hygiene among the adolescent girls. The hypothesis H3 ‘There is a relationship between knowledge and practice
regarding menstrual hygiene that is analyze by Karl person correlation (r)

CORRELATIONS BETWEEN KNOWLEDGE AND PRACTICE

Knowledge Practice
Pearson Correlation 1 .065
KNOWLEDGE Sig. (2-tailed) .524
N 100 100
Pearson Correlation .065 1
Sig. (2-tailed) .524
PRACTICE

N 100 100
P <0.05

SECTION 1V in order to test the co-relationship between the knowledge and practices regarding menstrual
hygiene among the adolescent girls. The hypothesis H3 ‘There is a relationship between knowledge and practice
 International Journal of Nursing Education, July-September, Vol.9, No. 3 137

regarding menstrual hygiene that is analyze by Karl REFERENCES

person correlation (r). Table reveal that knowledge
score is r = .065 and practice score is r = .524 that 1. Johnson, Fernandez. “A Study on awareness
shows Karl Pearson coefficient test ‘r” value is positive. regarding safe and hygienic Practices amongst
When r value is found between (+.4 to +.6) that means school going adolescent girls, Wardha district,
positive co relationship between knowledge and practice India. Vol: 2, October 2010.
regarding Menstrual hygiene. Hence H3 is accepted. 2. Who 2002 Reproductive Health and Hygiene
among Adolescents in India.
DISCUSSION 3. Jimmy Wales, “Menstrual Taboo”, Wikipedia
The study finding reveals that the mean post- Encyclopedia, 2010 Oct; en.wikepedia.org/wiki/
test knowledge score is13.92± 1.43 SD was higher than Menstrual taboo.
their mean pre-test knowledge scored is 7.89± 2.85 SD. 4. Drakshayani Devi K, et al, “A study on menstrual
The calculated’ value (t= 19. 879) at 0.05 level was hygiene among rural adolescent girls”, Indian
greater than the table value (T=1.98). The practice score Journal of Medical Sciences, 1994 June, Revised
is17.40± 2.22 SD was higher than their mean pre-test 2004 Nov, 48:139-43.
practice scored is 10.10± 3.74 SD. It was indicating 5. Annamma Jacob, “A Comprehensive Textbook of
that the gain in knowledge was not by chance and Midwifery”, 2nd Edition, 2008, Jaypee Publications,
there is significant gain in knowledge and practices of New Delhi, Page 63.
adolescent’s girl through planned teaching programme 6. Therese Mohan, Maria Fernandez “Menstrual
regarding menstrual hygiene. Out of 100 adolescent Hygiene In South Asia” Nepal 2009.
girl’s knowledge was increased from 8% to the 55% 7. Drakshayani Devi K, et al, “A study on menstrual
regarding menstrual hygiene, and practices were also hygiene among rural adolescent girls”, Indian
increased from 20% to the 58% regarding menstrual Journal of Medical Sciences, 1994 June, Revised
hygiene. 2004 Nov, 48:139-43.
CONCLUSION 8. Adhikari, P. Kadel,B. Dhungel, S. Mandal, A.
Knowledge and practice regarding menstrual
The main Conclusion drawn from this present hygiene in rural adolescent girls of Nepal.
study is that before teaching programme most of Kathmandu University Medical Journal (2007),
the adolescent girls had an inadequate knowledge Vol. 5, No.3, Issue 19, 382-386
regarding menstrual hygiene. After giving Structured
9. Gupta J, Gupta H. Adolescent and Menstruation.
Teaching Programme, majority of the adolescent girls
The Journal of Family Welfare. Vol.47, No. 1, April
had gain adequate knowledge and practice regarding
2001; 113
menstrual hygiene. It is reveals that Structured Teaching
10. Keerti Jogdand,* Pravin Yerpude*, A community
Programme regarding menstrual hygiene will surely
based study on menstrual hygiene among
change the knowledge and practice of adolescent girls
adolescent girls, Indian Journal of Maternal and
and can reduce the incidence of reproductive and urinary
Child Health,2011 Jul – Sep;13(3)
tract infections. Therefore, adolescent girls should have
sound knowledge on menstrual hygiene that improves 11. C Ramachandra, Goyal (2010) Problems related
their menstrual hygiene practice. to menstruation and their effect on daily routine of
students of a Medical Collage in Delhli, India.
Ethical Clearance: - Taken from Kailash Institute
of Nursing and Paramedical Science, Knowledge Park-
3, Greater Noida
Source of Funding: Self.
Conflict of Interest: No
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