CHAPTER-I

INTRODUCTION

There are some things, we cannot buy, one of such ‘things is

our childhood….

-Jawaharlal Nehru

Children of today are citizens of tomorrow. As Nehru said “If we do not

look after children today, we will be creating more problems for ourselves in
future”. The health of children and youth is of fundamental value. Health
services for children are a must for building a healthy young India. The Wealth
of a nation is not in its economical and natural resources but it lies in the kind
and quality of the wealth of children and youth. It is they who will be the
creators and shapers of a nation’s tomorrow .

Juvenile diabetes is a general term for heterogeneous disturbances of

metabolism. The cause is either impaired insulin secretion and insulin action or
both. It is mainly divided into two types type–1 diabetes mellitus and type-2
diabetes mellitus

Keeping the above approach, the present study attempted to further explore
the contribution of mothers‟ psychological resources to the adjustment of their
children with IDDM. Specifically, the contribution of the relatively new concept
of mothers' sense of empowerment to the adherence to treatment and metabolic
control of their children with Insulin Dependent Diabetes Mellitus.

Diabetes mellitus has been recognized as a growing worldwide epidemic by

much health's advocacy group Including WHO. The world health organization
has estimated that diabetes will be one of the leading causes of death and
disability with next quarter century. About 10 to 20 percent of all known cases

1
of diabetes are insulin dependent. Although this type may occur at any age, the
peak occurs at puberty (11 to 12 years), with a smaller rise at 5 to 8 years."

Children between 6-12 years of age should have widened their social
horizons beyond the confines of their own name. School age children mostly
affected with some of the endocrine disorders like juvenile diabetes mellitus,
neurological disorders like epilepsy, and other disease. Juvenile Diabetes
mellitus is the most common disorder of the endocrine as beta cells in pancreas
fail to produce adequate insulin. This result in diabetes mellitus as a chronic
disorder in which carbohydrate, protein and lipid metabolism is impaired.”

A diabetic patient has to face the condition in which the amount of glucose
in the blood too high or elevated. This could be due to two reasons. Insufficient
production of insulin by the pancreas or no production of insulin at all or the
cells do not respond effectively to the insulin, produced by the pancreas. This
result in excess of glucose in the blood that eventually passes out of the body
through urine. In spite of plenty of glucose in the blood, the cells are deprived
of it required for energy growth,

The function of insulin is to promote the uptake and use and storage of
amino acids and fat. When insulin is deficient, decreased glucose uptake and
storage as glycogen and fat, abnormal breakdown of glucose takes place, leads
to accumulation of glucose and fat in the blood in the form of fatty acids and
ketone bodies, causes deficiency of insulin, causes kidneys cannot reabsorb all
the filtered glucose, leads to glucose in urine called polyurea.°

Juvenile diabetes mellitus is one of the most common chronic diseases in

childhood. Very little is known about the epidemiology, determinants and
clinical profile of childhood diabetes mellitus In India and a lot more work is
still needed today to improve the health care of these children in our country.

2
 Juvenile Diabetes mellitus is characterized by destruction of pancreatic beta
cells. It is thought that combined genetic, immunologic, and possibly
environmental factors contribute to beta cell destruction. Immune mediated
diabetes commonly develops during childhood and adolescence.

Clinical manifestations of juvenile diabetes mellitus include the three Ps.

Polyuria, polydipsia and polyphagia. Polyuria and polydipsia occur as result of
the excess of fluid associated with osmotic diuresis. Other symptoms include
fatigue, weakness, and loss of weight, tingling or numbness in hands or feet, dry
skin, skin lesions or wounds that are slow to heal and recurrent infection. The
onset of juvenile diabetes mellitus may also be associated with sudden weight
loss or nausea, vomiting of abdominal pain.

An abnormally high blood glucose level is the basic criterion for the
diabetes diagnosis, fasting plasma glucose levels of 120mg/di or more random
plasme glucose levels exceeding 200mg/di on more than one occasion are
diagnostic of diabetes. The main goal of juvenile diabetes mellitus treatment is
to normalize insulin activity and blood glucose levels to reduce the development
of vascular and neuropathic complications. The five components of juvenile
diabetes management are Diet, Glucose monitoring, Exercises, Insulin injection
and Education. For children who require insulin to help control blood glucose
levels, maintaining as much consistency as possible in the amount of calories
and carbohydrates ingested at different meal time is essential. Because the body
loses the ability to produce insulin in juvenile diabetes mellitus,. exogenous
insulin must be administered for life. In many cases, insulin injections are
administered two or more times daily to control the blood glucose level. insulin
may be grouped into several categories based on the onset, peak, and duration
of action.

Efforts to prevent complications of juvenile diabetes mellitus have turned to

a multi-disciplinary approach. The management of this disease includes

3
medical, social, psychological and educational factors. Juvenile diabetes
mellitus is a chronic condition that is typically diagnosed in Children. Among
childhood illnesses, diabetes is unusual because the child and family must take
the primary responsibility for managing the disorder. Due to the duration of
juvenile diabetes mellitus, these children and family must learn to manage their
disorder for a lifetime in addition, the complications associated with poorly
managed diabetes usually manifest themselves later in life making It difficult
for children to conceptualize the consequences of their behaviour, due to their
cognitive developmental level.

It has been shown that compliance with medical treatment significantly

impacts diabetic control in children with juvenile diabetes mellitus, as diabetic
children are better able to manage the daily demands of diabetes treatment
including blood sugar testing, insulin injection, exercises and adherence to their
medical treatment. In addition, children with diabetes mellitus tend to form
adherence problems, shall be directed toward younger children, to prevent
adherence difficulties during adolescence.

Play therapy is developmentally appropriate for young children as ‘children

express themselves more fully and more directly through self-initiated
spontaneous play than they do verbally because they are more comfortable with
play’ than with verbal communication. Children In play therapy learn to cope
with problems through fantasy, and reality testing within and emotionally safe
environment. Play therapy seems to be an appropriate for young diabetic
children as adherence to a medical regimen requires self-responsibility and self-
direction. Intensive play therapy provides both psychological practical benefits
for children

Mother should have the knowledge of the complications of insulin therapy

such as local allergic reaction (redness, swelling, tenderness and in duration)

4
may appear at the site of injection site 1-2hrs after the insulin administration.
Systemic allergic reactions to insulin are rare.

Education is the priority intervention because it will enable children and

family to self-manage this chronic condition. Juvenile Diabetes mellitus is a
lifelong condition that requires regular follow up visits. Children do not want to
be different from their peers, Poor family may not be able to afford appropriate
food, medication, transportation, because of low socio-economic status, & some
religious beliefs, customs. Initial goal of education is for the family to develop
basic management of chronic condition management of complications and
decision-making skills.

Home care management of children with juvenile diabetes mellitus and

their families is very important, Teaching children and their families about
diabetes, includes blood glucose measurement, urine testing regularly, self-
administration of insulin injection, exercises diet control and prevention of
complications. The knowledge regarding home care management of juvenile
diabetes Mellitus is necessary for every child, and family to maintain healthy
life style and to prevent complications.

5
NEED FOR THE STUDY

Approximately 5 percent of children are diagnosed with diabetes. Peak

incidence in children is found around 5 years and about 10 to 12 years. Juvenile
diabetes occurs at younger age. About 25 to 50 percent patients are presenting
before 15 years of age. The incidence of juvenile diabetes may be significantly
altered by changes in geography and lifestyle (Swarna Rekha Bhat, 2009).

Juvenile diabetes can occur from infancy to 30 years, the peak incidence is
between 10 year and 15 years and 75% are diagnosed before 18 years of age.
Diabetes has been more commonly diagnosed in past few decades. Scandinavia
has the highest incidence of diabetes mellitus, with Finland having the incidence
of 35/1,00,000/year. China and Japan have a much lower incidence of 1-
3/1,00,000/year. Indian data suggest an incidence of 10.5/1,00,000/year. India
would have 79 million diabetics by 2030, the highest for any country in the
world (OP Ghai, 2004).

The study was conducted to identify the new cases of juvenile diabetes in
children less than 15 years in the Castilla-Leon of Spain. Samples were selected
by using capture–recapture method. Onset of diabetes mellitus less than 15
years of age were recorded during 2003-2004. Prevalence of all patients
younger than 15 years with juvenile diabetes were identified. The result shows
that 130 children between the age group of 0-14 years were diagnosed with
type-1 diabetes mellitus. Highest incidence was identified in the age group of 5-
12 years. Hence the study concluded that Castilla-Leon appears to have highest
incidence of juvenile diabetes (Bahillo MP, 2007).

According to Indian Journal of Endocrinology and Metabolism, juvenile

diabetes is also an increase like type-2 diabetes mellitus with a trend of

6
3-5%/year. India has three new cases of type-1 diabetes mellitus/1,00,000
children of 0-14 years. Data shows that 17.93/1,00,000 children in Karnataka,
3.2 /1,00,000 children in Chennai and 10.2 /1,00,000 children in Haryana
(Ashok Kumar Das, 2015).

The study was carried out to estimate the prevalence of childhood juvenile
diabetes in Chennai city. Children with newly juvenile diabetes less than 15
years was analysed by retrospective method for a period of 1991-1994. Cases in
the population was calculated by using capture-recapture method. The result
shows that incidence of juvenile diabetes in Chennai city for the period of 4
years was about 10.5/1,00,000/year. Hence the study concluded that the peak
incidents was between 10 to 12 years (Ramachandran A, 1996)

According to various statistics, the researcher observed that prevalence of

juvenile diabetes is high and also the adolescents have less knowledge regarding
juvenile diabetes. If they improve their knowledge, they can maintain good
quality of life. So, the researcher felt that there is a need to providing education
regarding 5 diabetes to the adolescents to improve their quality of life.
Therefore, the present study is aimed to evaluate the effectiveness of the
structured teaching programme on knowledge regarding juvenile diabetes.

7
INCIDENCE

Incidence is as the occurrence of new cases of juvenile diabetes that develop in

a population over specified time

 According the WHO the children with juvenile diabetes are – 1,11,500
 In India 5 to 14 years age group was 24.22/100,000

Global incidence of juvenile diabetes

Name of 2016 2017 2018 2019 2020

thecountry
America 8.0% 8.2% 10.5% 11.7% 22%
Australia 25.0% 25.8% 28% 26% 30%
Russia 18.8% 20.2% 22.4% 23% 24.5%
China 20% 28% 30% 32% 32.4%
Japan 18% 22.2% 22.8% 25% 25%

www.who.org.com
Incidence of Juvenile diabetes in India

States of 2017 2018 2019 2020

India
Karnataka 3.7% 4.0 4.6 3.2
Tamilnadu 3.3% 4.6 6.6 7.2
Telangana 3.0 3.6 4.8 5.6
Kerala 2.22 4 3.0 3.8
www.ncbi.nlm.nih.gov

8
 Incidence of Juvenile diabetes in Telangana

States Osmania Hospital Niloufer Hospital

2016 287 30
2017 290 40
2018 288 35
2019 250 45
www.timesof india.com
PROBLEM STATEMENT

Effectiveness of structured teaching programme on knowledge and practice

of mothers regarding home care management of children with juvenile
diabetes at Niloufer hospital Hyderabad, T.S.

OBJECTIVES
 Assess the knowledge and practice of the mothers regarding home care
management of children with juvenile diabetes
 Plan and conduct structured teaching programme to mothers on home care
management of children with juvenile diabetes.
 Evaluate the effectiveness of structured teaching program on mothers of
children with juvenile diabetes.
 Association between the post level of knowledge and practices among the
mothers regarding home care management of children with juvenile diabetes
with demographic variables

9
OPERATIONAL DEFINITION
Effectiveness: Improvement of post test scores over pre-test scores after
administration of structured teaching programme to the mothers on home care
management of children with juvenile diabetes
Knowledge: It refers to the information that the mothers possess regarding
home care management of children with juvenile diabetes
Practices: the activities of mothers in administration of insulin to the children
with juvenile diabetes.
Mothers: A women with age 21 to 60 years have child with juvenile diabetes
Structured teaching programme on home care management: A well planned
and prepared questionnaires by investigator regarding home care management
of children with juvenile diabetes, which includes: diabetic diet, exercises,

administration of insulin, Record maintenance and importance of follow up

care.

HYPOTHESIS

H1: There will be significant difference between mean pre and mean post-test
knowledge scores at 0.05 level of significance after structed teaching
programme among mothers.

H2: There will be significant difference between mean pre and post test
practice scores at 0.05 level of significance among mothers before and after
structured teaching programme.

H3: There will be significant association between pre and post test knowledge
scores among mothers regarding home care management of children with
juvenile diabetes with selected demographic variables

10
H4: There will be significant association between pre and post test practice
scores among mothers regarding home care management of children with
juvenile diabetes with selected demographic variables.

ASSUMPTIONS

 Most of the mothers of children with juvenile diabetes may have inadequate
knowledge and faulty practices pertaining to juvenile diabetes.
 Structured Teaching Programme will improve the knowledge and practices
regarding juvenile diabetes among the children with juvenile diabetes.
DELIMITATIONS

The study is limited to:

 Mothers of children with juvenile diabetes

 Mothers available during the time of study
CONCEPTUAL FRAMEWORK

A conceptual framework is a network of interrelated concepts that

provides a structure for organizing and describing the phenomena of interest.
The overall purpose is to make scientific findings meaningful and generalizable.
It provides a certain framework of reference for clinical practice, education and
research. It gives direction for relevant questions to practical problems.

“Conceptual framework is a written or visual presentation that explains

the main things to be studied in either graphically form the key factors,
concepts, or variables and the presumed relationships among them” (Miles and
Huberman, 1994).

The study was aimed at assessing the knowledge regarding juvenile

diabetes before and after the Structured Teaching Programme. The conceptual

11
framework in this study based on Modified Weidenbach's Helping Art of
Clinical Nursing (1964). Weidenbach's prescriptive theory is described as a
system of conceptualization invented to some purpose. It directs action towards
an explicit goal. According to Weidenbach's nursing practice, It consists of
central purpose, prescription and reality, which involves three main steps to
identifying patient need for help.

Step I: identification

Step II: ministration

Step III: validation

CENTRAL PURPOSE

According to theorist, practice is those observable nursing actions that are

affected by belief and feeling about meeting the patient’s need for help. These
actions are goal directed and patient centred. Here the central purpose is to
assess the effectiveness of Structured Teaching Programme on knowledge
regarding juvenile diabetes among mothers of children with juvenile diabetes.

Step I : IDENTIFICATION

According to theorist, identification involves viewing the mothers as an

individual with unique experiences and understanding the perception of
procedure. In this study, the identification is involved by individualization of
mothers of the children with juvenile diabetes, which includes demographic
variables and to assess the level of knowledge regarding juvenile diabetes

Step II: MINISTRATION

According to the theorist, ministration refers to provision of help needed to

mothers. In this study, ministration refers to providing Structured Teaching
Programme regarding juvenile diabetes mothers of children with juvenile
According to the theorist, ministering the need for help has two components.

12
a) Prescription

b) Realities

Prescription

Prescription refers to the broad general action that the nurse deems appropriate
to fulfilment of her central purpose the nurse will have thought through the kind
of results to be sought and will take action to obtain these results, accepting
accountability for what she does and for the outcome of her action. In this study,
prescription is plan of care to achieve the purpose which includes providing

Structured Teaching Programme regarding home care management to the

mothers of children with juvenile diabetes

Realities

The realities is the immediate situation that influences the fulfilment of the
central purpose. It consists of all factors–physical, psychological, emotional and
spiritual that are play in a situation in which nursing actions occur at any given
moment.

Step III: VALIDATION

According to theorist, validation is a collection of evidence that shows a

patient’s needs have been met and that his functional ability has been restored
as a direct result of nurse’s actions. In this study, validation refers to the
improvement of knowledge and practices of mothers of children with juvenile
diabetes who have received Structured Teaching Programme regarding juvenile
diabetes

13
 CENTRAL PROCESS

Home care management

regarding juvenile diabetes

IDENTIFICATION MINISTRATION VALIDATION

Demographic
variables Above Preparation of Above average
average Administration
Age, structure Posttest on
teaching Knowledge of
Religion Pretest on Average
Average mothers
Knowledge of programme
Education,
mothers regarding regarding regarding home
Occupation, home care home care care Below average
Family income,
management Below management management
average among
type of family,
mothers
excellent
family history, children with
Pre test on excellent juvenile
insulin administration, Posttest on practices
medical check-up practices of diabetes good
of mothers regarding
mothers good
home care
regarding home
management
care management poor
poor
key :under study :_____________not under study …………… Figure .1 conceptual frame work based on Emestein widen Bach’s theory

14
 Chapter -II

REVIEW OF LITERATURE

Review of literature is an essential component of the research process. It is a

critical examination of publication related to a topic of interest. Review should
be comprehensive and evaluative. It helps to plan and conduct the study in a
systematic and scientific manner.

A review of literature refers to activities involved in identifying and

searching for information on a topic and developing and understanding the state
of knowledge on the topic. This will help in developing a broad conceptual
context in to the research problem.

The review of literature was collected from various information given in

books, journals, abstracts, published and unpublished dissertations, Census and
internet websites.

The literature has been reviewed under the following headings:

1.Review of literature related to care of the families of children with juvenile

diabetes

2. Review of literature related to management of juvenile diabetes mellitus in

promoting self-care behaviour

3.Review of literature related to growth parameters of juvenile diabetes mellitus

4.Review of literature related to self-care management of juvenile diabetes

5. Review of literature related to incidence of juvenile diabetes mellitus

6. Review of literature related to prevalence of insulin dependent diabetes

mellitus

15
7. Studies on knowledge regarding juvenile diabetes among mothers of children
with juvenile diabetes

8. Studies related to effectiveness of Structured Teaching Programme regarding

juvenile diabetes among mothers of children with juvenile diabetes

1.Review of literature related to care of the families of children with

juvenile diabetes.

Mahnaz Sanjari, Hamid Peyrovi and Neda Mehrdad (2018) conducted

qualitative study data was collected through semi-structured interview technique
and was analyzed using Grounded Theory approach. The process of data
collection was carried out by purposeful sampling. The participants included 13
individuals from nine families (11 parents and two children with diabetes). The
research environment was health centres in Iran providing care to the families of
children with diabetes. Data analysis was performed using Corbin and Strauss
approach. Data was analyzed with using MAXQDA software (version 10).
Results The core category of “Entering into the Orbit of Diabetes” addresses the
story of how to keep track of managing children with diabetes within the family
Conclusion The findings of the present study may play an integral part to help
households with practicing appropriate strategies for the management of
children with Participants in this study were families (father, mother, sister,
brother) of children with Type1 Diabetes mellitus and also the children with
diabetes who lived with their parents. Those participants who are willing to
participate in the study were required to have the ability to understand and
speak... In the Children with diabetes, diagnosis must be defined at least more
than one year and without any other chronic diseases. Methods of data
collection, In order to collect demographic information a form was used
including age, sex, education, marital status, economic status and size of the
family. This form also included age, gender, duration of diagnosed diabetes, and
the birth order of the children with diabetes. The semi-structured interview was

16
used to explain the process of managing children with diabetes within the
family. In the process of data collection, nine family were interviewed
encompass in form of family and individual interviews (13 participants)
including 11 parents and also two children with diabetes in the time duration of
40100 min with the mean of 69min. All the interviews were recorded upon the
permission of the participants. The open-ended and semi-structured questions
asked during the interview were focused on how to manage children with
diabetes within the family. Data obtained during each interview determined
questions. In the analysis, 200 open codes in 12 sub categories, three main
categories, and one core category were used to describe the process of
managing children with diabetes in the family. Once in practice, the average age
of children with diabetes and the mean duration of diabetes were reported 11
years and 5.5 years, respectively. As well, the minimum and maximum duration
of diagnosed diabetes were two and 13 years.

2.Review of literature related to management of juvenile diabetes mellitus

in promoting self-care behaviour.

Shyster salehi: soheila shafiei: parvaneh amini: gholamhossein Abdeyazdan

(2017) a study conducted on the management of diabetes mellitus in promoting
self care behaviour, which may help to control children’s blood glucose
appropriately. The first step in DM management is to identify the patient’s self
care needs. The descriptive analysis research was conducted on 99 children and
adolescents with diabetes mellitus who were referred to the endocrinology and
metabolism research institute of Isfahan in the first half of The sample is
convenient sampling. The data were collected using researcher made
questionnaire, the reliability and validity of this questionnaire were examined
and approved before administration to the subjects. The data were analysed
using SPSS. 56.3% of children and 47% of adolescents shows moderate
performance regarding Diabetes Mellitus management. The results showed no

17
significant difference in the mean scores of overall self care performance
between children and adolescents. Identifying the needs of children and
adolescents with type 1 diabetes mellitus in terms of self care and education
may help them to have better performance in management, control, and
prevention of complications.

3.Review of literature related to growth parameters of juvenile diabetes

mellitus.”

Growth status of children and adolescents with type 1 diabetes vamazn V.

Khadilkar. Lavanya S Parthassrathy. Basavaraj B Mallade. Anuradha V
Khadilkar. Shashi A Chiptonkar and Ashwin B. Borade (2016)

The retrospective cross sectional case control study was conducted at diabetes
clinic for children at tertiary care centre at pune, to study growth parameters f
diabetic children in comparison with age gender matched healthy controls and
evaluate effect of different insulin regimens and age at diagnosis of diabetes on
growth .one twenty five diabetic children (boys 50) and age gender matched
healthy controls were enrolled. All subjects were underwent anthropometric
measurements. Mean height and weight and body mass index for age Z scores
were calculated. Diabetes control was evaluated by measuring glycosylated
haemoglobin (HbAIC). Statistical analysis was done by SPSS version 12.

Mean age of diabetic children and age gender matched controls was 9.7+4.4
years. diabetic children were shorter (128.3+24.3CM VS133.6+24.7cm) and
lighter (29.2kg+15.3v8.31.3+15.4kg) HAZ(-1.1+1.2vs-0.2+0.8) and WAZ(-
1.2+1.3vs0.7+1.3) were significantly lower in diabetic children (P<0.05)
children on both insulin regimens were shorter than control (HAZ-intensiv-
1.0+1.0 conventional -1.3. control - 0.2_0.8.P<0.05), HAZ of children who
were diagnosed at <3years of age was the least (-1.6+1) amongst all diabetic

18
children while those diagnosed after puberty (>14years) were comparable to
healthy controls.

4.Review of literature related to self care management of juvenile diabetes

mellitus.

Maxwell Y Porkka P & shad F (2014) young people with type 1 diabetes
mellitus and self-care. A study is conducted to improve the quality of life of
adults by providing useful information about young people with type 1 diabetes
mellitus, and coping with type 1 diabetes mellitus. Diabetes is predicted to
become the seventh leading cause of death in the world 2030. Total deaths from
diabetes are projected to rise by more than 50% in the next 10 years. A
qualitative descriptive design was followed in the research. In this qualitative
study purposive participants of 58 children and adolescents between the ages of
8-18 years in the diabetes management clinic of major regional hospital in the
western USA. Three types of care: physical care. ambiguous care and emotional
care. Provision of accurate and easy to monitor for domestic use, diabetic
patients have independence and flexibility of checking their glucose level at
time. It has been advocated those enhancements in glycaemic control, blood
pressure, and cholesterol level can moderate a person's hazard for complication.

5.Reviewof literature related to incidence of juvenile diabetes mellitus.”

M Prasanna Kumar (2013) conducted a study on type 1 diabetes mellitus

incidence trends for childhood type 1diabetes in India. It is estimated that India
is housing about 97,700 children with type 1 diabetes mellitus (T1DM). A study
of children in the insulin dependent diabetes with age at diagnosis <15 years.
The peak age of diagnosis was i2years. This was the first population-based
study of prevalence of insulin dependent diabetes in south India. karnal city has
relatively high prevalence of Type 1DM (31.9/100,000). The prevalence of
Type 1DM in children is 1, 11,500 according to a World Health Organization

19
report of the International Diabetes Federation for the South East Asian Region.
India is one of the 11 countries in this report.

6.Review of literature related to prevalence of insulin dependent diabetes

mellitus.

Ramachandran A, Snehalatha C, Abdul Khader OM, Joseph TA. Viswanathan

M. The objective of the study was to estimate the prevalence of insulin
dependent diabetes in children less than or equal to 15 years in an urban area in
south India, by a population study. Three zones from the north-eastern part of
the city demarcated by the Directorate of Census were chosen. Ascertainment of
the cases from these zones was made by collecting data from the major
hospitals and diabetes clinics by Personal visit by questionnaire sent to medical
practitioners in the area and from the chemist and suggests who sell insulin.
Recommendations of the Diabetes Epidemiology Research International
Registry Group were used. Thirty children with insulin dependent diabetes with
age at diagnosis less than or equal to 15 years were identified. The prevalence
was 0.26/1000. The peak age at diagnosis was 12 years. The first population
based study of prevalence of insulin dependent diabetes in south India shows
that insulin dependent diabetes is not rare. It is higher than reported from many
other Asian countries.

7 Studies on Knowledge Regarding Type-1 Diabetes Mellitus Among

Children with Type-1 Diabetes Mellitus.

A cross sectional study was conducted to assess the glycaemic control in

type-1 diabetes mellitus among children and adolescents in Dar es Saloam
Tanzania. The study was carried out over a 6-month period. All children and
adolescents attending the clinic are provided with insulin at no cost, glucose
monitors, strips and diaries for self-monitoring and recording of blood glucose
at home. Glycaemic control was assessed by measuring glycosylated

20
haemoglobin test. The result showed that 75 participants were included in the
study (51% males and 49% female). children aged 14 years old age children.
The researcher concluded that children and adolescents with type-1 diabetes in
Dar es Saloam have poor glycemic control especially the children age between
10-14 years old. Education is needed to the children for regular blood glucose
monitoring and encouraged the caregivers to participate in care of their children
especially the adolescents (Mariam Noorani, 2016).

A descriptive study was conducted to assess the knowledge regarding type-

1 diabetes mellitus among Saudi diabetes children at a governmental Health
Care Center in Riyadh city. A total of 85 samples, age between 10-15 years
were selected by using non- probability convenience sampling technique. A
structured questionnaire was given to collect the data. The result showed that
half of participants have an average knowledge (41%), more than half of the
diabetic children (51.8%) have poor knowledge and only (7%) have very good
knowledge about general aspects of diabetes mellitus. The researcher concluded
that this research is an important first step in identifying areas for continued
interventions needed for children with type-1 diabetes mellitus and their
parents. The children with type-1 diabetes mellitus need more educational
intervention for improving their knowledge (Salma Moawad, 2014).

A descriptive analytical research was conducted to compare the self-care

performance in children and adolescents with type-1 diabetes mellitus in
endocrinology and metabolism research institute of Isfahan. A total of 99
children and adolescents were selected by using convenience sampling method.
The data were collected by using researcher made questionnaire. The result
showed that no significance difference in the mean scores of overall self-care
performance between children and adolescents. However, there was a
significance difference in the mean score of exercise training and glucose self-
monitoring between males and females, which indicated females showed

21
weaker performance than males regarding these two factors. The researcher
concluded that identifying the needs of children and adolescents with type-1
diabetes mellitus in terms of self-care and education may help them to have
better performance in management, control and prevention of complication
(Shayesteh Salehi, 2014).

The cross-sectional study was conducted to find out the various factors
associated with non-adherence to diet, physical activity and insulin among type-
1 diabetes mellitus patient from July 2011 to June 2012 in Baqai Institute of
Diabetology and Endocrinology and Diabetic Association of Pakistan. A total of
194 patients were selected from the diabetes clinics and were diagnosed before
the age of 30 years. The results showed that 114 (58.5%) patients were non-
adherent to dietary advice 82 (42.3) patients' non-adherent to physical activity
(88.1%) responds were non-adherence to their prescribed insulin regimen. The
researcher concluded that the patient with non-adherence to insulin regimen
need to design strategies to understand their treatment regimen in order to
improve their adherence (Musarrat Riaz, 2014).

8. Studies Related To Effectiveness of Structured Teaching Programme

Regarding Type-1 Diabetes Mellitus Among Children With Type-1
Diabetes Mellitus.

A quasi-experimental study was conducted to assess the effectiveness of

structured teaching programme on self- administration of insulin injection
among type-1 diabetes mellitus children in Karvendinagaran.30 samples were
selected by using non probability purposive sampling technique. The results
showed that in pre-test 97% of samples had moderate knowledge and 3% had
inadequate knowledge and none of them had good knowledge. In post-test 28%
had adequate knowledge and 7% had moderate knowledge on self-
administration of insulin injection. The researcher concluded that structured
teaching programme was an effective intervention in improving the knowledge

22
of diabetes children regarding self-administration of insulin injection (P.M.
Prathiba, 2019)

A pre-experimental study was conducted to assess the effectiveness of

educational intervention on knowledge and skill regarding self-administration of
insulin injection among children attending juvenile diabetic clinic in Tirupati
about 50 children was selected by using convenience sampling technique. The
data were collected by using observational checklist on insulin self-
administration technique and 20 structured questionnaires. The results showed
that 48% had moderate knowledge, 30% had inadequate knowledge, and 22%
had adequate knowledge in pre-test. In post-test 32% had moderate knowledge,
68% had adequate knowledge and none of them had inadequate knowledge. The
researcher concluded that the educational intervention is very effective tool for
improving the knowledge regarding self-administration of injection (Kumar
Sandeep, 2017).

Assess the effectiveness of structured teaching programme on Knowledge

and Attitude regarding Prevention of 21 Complications of Diabetes Mellitus
among Children A pre-experimental study was conducted, 60 samples were
selected by using probability convenient sampling technique A Structured
knowledge questionnaire used to gather information before and after
administration of structured teaching programme. The result showed that 56%
had inadequate knowledge, and remaining 44% had moderately adequate
knowledge and none of them had adequate knowledge regarding prevention of
complication. And 80% had un favourable attitude and 20% had favourable
attitude. The researcher concluded that the structured teaching programme is
very effective method to improve the knowledge and attitude regarding
prevention of complication in type-1 diabetes mellitus (M.Malar mohan, 2015)

23
 assess the effectiveness of planned teaching on knowledge and practices of
children with type-1 diabetes mellitus in relation to selected aspects of self-care
in endocrine OPD at B.J Wadia children’s hospital in Mumbai A total of 40
children with type-1 diabetes mellitus with age group of 10–15 years were
selected by using convenience sampling technique. A semi structured
questionnaire and observational check list used to gather information before and
after administration of planned teaching programme The result showed that
there is a significant improvement in overall knowledge after teaching
programme among males the researcher concluded that planned teaching
programme was very effective method to improve self-care management skill
among children with type-1 diabetes mellitus ( Rajshri Bhagat 2014).

Epilogue:
This chapter delt with review of literature which incudes, studies related to
home care management of juvenile diabetes, studies related to prevalence of
juvenile diabetes mellitus, studies, studies related to parental attitudes towards
glucose control in juvenile diabetes.

24
 Chapter-III
Methodology

Research methodology is a way to solve the problem systematically. It

considers the logic behind the methods used in the context of research study
(Polit and Beck, 2000). This chapter includes the research design, setting of the
study, variables, population, sample size, sampling technique, criteria for
sample selection, description of the tool, content validity, reliability, pilot study,
method of data collection and plan for data analysis.

Research methodology deals with the method of investigation to be adopted

by the investigator. It is a set of methods and principles used to perform
particular activity. The selection of research methodology is an important step
in research as it is concerned with overall frame work for conducting the study.”

The methodology of research is how data is gathered in order to answer the

question or analyse the research problem. It includes research approach,
research design, description of variables, setting of the population, sample,
sampling technique, sample criteria, method of data collection, development
and description of the tool for data collection, pilot study and plan for data
analysis and interpretation. In the present study, the investigator aims to study
the, Effectiveness of structured teaching programme on knowledge and practice

25
of mothers regarding home care management of children with juvenile diabetes
at Nilofer hospital Hyderabad, T.S.

Research Approach

The research approach Is the broad-based procedure of studying the

selected problem drawing conclusions. The research approach refers to a
general set of orderly disciplined procedures used to acquire useful information.
The selection of research approach aids the researcher what data to collect and
how to analyze the data. also suggests possible conclusion to be drawn, the data
in view of nature of problem and objectives to be accomplished.”

In the present study Quantitative Research approach was selected to

describe the effectiveness of Structured Teaching programme on knowledge and
practices of mothers regarding home care management of children with juvenile
diabetes , at Niloufer hospital, Hyderabad, Telangana.

Research Design:

Research design is the overall plan for obtaining a research question,

including specifications for enhancing the studies integrity a researcher overall
plan for obtaining answers to the research design.

In the present study the investigator has chosen one group pre-test post-test
pre-experimental design to evaluate the knowledge and practices of mothers
regarding home care management of children with juvenile diabetes. In this

26
design the total sample was taken as one group and pre-test was given. After the
pre-test irrespective of the pre-test results the researcher administered
Structured Teaching programme to the mothers children with juvenile diabetes
mellitus. The effectiveness of independent variable was tested with the help of
post test.

Schematic representation of research design selected for the study is as follows

O1 X O2

O1 - Pre test on knowledge and practice of mothers regarding home care

management of children with juvenile diabetes

X - Structured Teaching Programme regarding home care management of

juvenile diabetes

O2 - Post test on knowledge and practices of mothers regarding home care

management of children with juvenile diabetes

Description of Variables

In the present study the investigator has identified independent variable,

dependent variable and demographic variables which are as fallows.

Independent variable

In the present study the independent variable was structured teaching

programme Regarding Home care management among mothers of children with

Juvenile diabetes.

Dependent variable: knowledge and practice regarding Home care

management among mothers

Demographic Variables

27
 The Demographic Variable which influence the knowledge and practice
scores of care takers age, religion, education, occupation, income, type of
family, family history, insulin administration , frequency of medical check-up
of child.

Setting

The setting selected for the study will be the Nilofer Hospital, Hyderabad
Niloufer hospital for women and children located at Red Hills, Hyderabad. It
was founded by the Princess Niloufer the second daughter in law of Nizam of
Hyderabad in 1949 and started functioning in 1953 as 100 bedded hospital with
a vision to meet the health needs of the mother and child. Today it is a 1000 bed
strength hospital with every day more than 100 women and children were
admitted. Niloufer Hospital approximately 3-5 children with Juvenile diabetes
mellitus attending to outpatient department per day

Population

The total number of people or elements that fit the specific set
specifications of the Study. This is also known as the target population. The
criteria for inclusion or exclusion should be clearly stated.

According to Polit and Beck In

this study, the target population for the present study includes all the mothers of
children with juvenile diabetes.

Sample

Sampling is a process of selecting a portion of the population to represent the

total population and the findings from the sample represent the rest of the group.
The advantage of selecting a sample is that it is that it is less costly and time
saving than collecting information from a large group of respondents. The

28
selected sample should be therefore, have similar characteristics to the
population.

According to Burns& Grove

Sample 50 includes the mothers of Children with juvenile diabetes.

Sample size

There are no hard or fact rules about the sample size but a sample should have
at least30 respondents.”

According to Burns & Grove

The sample in the present study consists of 50 mothers of children with juvenile
diabetes

Sample technique

Purposive Sampling technique was used for the study. it was based on
researcher’s knowledge about the population and its elements was used to hand
pick the mothers of children in the sample. The purposive sampling technique is
a non-probability sampling in which it entails the use of most conveniently
available subjects in the study and is considered as appropriate for the present
study non probability sampling has the advantages of being convenient and
economical.

Criteria for sample selection

The purpose is to control extraneous variable as possible. Hence, the criteria

for sample selection for the study are

Inclusion criteria

Inclusive criteria are the characteristics that the respondents must have in
order to be included in the study.

29
 According to Burns & grove

Mothers of children with juvenile diabetes

Method of Data collection

An interview provides quality data about what people are doing or thinking
about a phenomenon.

According to polit and Beck

For the present study the investigator used a structured questionnaire to assess
the knowledge and practices among mothers regarding home care management
of children with juvenile diabetes by pre-test and post test

The structured questionnaire was most appropriate for the study as the
investigator believed that it was suitable for data collection by interview
method.

The Development and description of tool

The researcher designed the interview schedule that was free from bias and used
the same structured questions for all the respondents to ensure consistency of
responses Questions were prepared to elicit the knowledge of mothers regarding
home care management of children with juvenile diabetes.

The questionnaire were divided into three sections

Part I: Frequency and percentage distribution of sample according to

demographic data

30
Part II: Frequency and percentage distribution of sample according to the
knowledge scores of care mothers regarding home care management of children
with juvenile diabetes.

Part III: Association between knowledge levels of mothers regarding home

care management of juvenile diabetes with selected demographic variables.

Part IV: Frequency and percentage distribution of sample according to the

practices score of mothers regarding home care management of children with
juvenile diabetes.

Part V: Association between practices levels of mothers regarding home care

management of juvenile diabetes with selected demographic variables.

The tool was developed with extensive review of related literature from various
text books, journals, and internet and discussions with experts in the field of
nursing and research. The investigator adopted structured questionnaire with
interview method to assess the knowledge and practices of mothers regarding
home care management of children with juvenile diabetes mellitus and develop
structure teaching programme is planned and developed with lesson plan in
English and Telugu to impart the knowledge and practices to mothers regarding
home care management of children with juvenile diabetes

Validity

Validity is the extent of accuracy of an instrument to Measure the construct

it is supposed to measure in the context of the concepts/variables being studied.

According to Polit and Beck The

questionnaire we and lesson plan were submitted to experts m the field of
nursing and research, The modifications and suggestions of experts were
incorporated m the final preparation of the tool.

Pilot study

31
 A pilot study 1s a small scale preliminary study conducted in order to
evaluate feasibility, time, cost, adverse events, and affect size in an attempt to
predict an appropriate sample size and improve upon the study design prior to
performance of a mam study.

The pilot study was conducted at Osmania General Hospital, Afzalgunj,

Hyderabad, The duration of the study was 07-5-2021 to 10-5-2021.Purposive
sampling technique was used to select five samples, The purpose of the study
was explained to the subjects. Pre test was conducted on mothers regarding
home care management of children with juvenile diabetes. Structured Teaching
regarding home care management of children with juvenile diabetes was
conducted on the same day after administering pre-test. After 72 hours post test
was conducted with the same tool, after interventions assessment scores were
compared with pre test scores to identify the effectiveness of STP.

Reliability

Reliability is the degree of consistency with which an instrument measures the

attributes it is design to measure. In the present study split half method was used
to determine the accuracy of the tool. The calculated t value was 2.776 at 4df,
p<0.01. The tool and STP were found reliable, feasible and practicable.

Data collection procedure

Data collection is the gathering of information needed to address the

research problem. Present study was conducted in Niloufer hospital, Red hills,
Hyderabad. Prior permission was obtained from the Medical Superintendent of
Niloufer Hospital. Hyderabad. The subjects for the study were selected
according to the sample criteria by purposive sampling technique. The

32
investigator gave self-introduction and individual informed prior. The purpose
of the study was explained to the care takers and they were reassured about the
confidentiality.

Data collection was done from 14-06-2021 to 23-6-2021. Data was

collected from Five mothers on an average every day. Pre-test was conducted
by structured questionnaire on knowledge and practices of mothers regarding
home care management of children with juvenile diabetes 30-45 minutes were
spent for each pre-test assessment. On the same day Structured Teaching
programme regarding home care management of children with juvenile diabetes
mellitus was administered for 25 minutes. On third day the post test was
conducted by using the same questionnaire by structured Interview to evaluate
the effectiveness of Structured Teaching. All the care takers were receptive and
co-operative during data collection.

Data analysis

Data analysis is a process of organising and synthesizing data in such a way that
research questions can be answered and hypothesis tested after collecting data,
the investigator analysed the data by using descriptive (Frequency distribution,
Percentage and Mean) and inferential statistics (Standard deviation, S error,
Karl Pearson correlation, Chi square test and t test) computed from the raw
scores obtained in the pre and post-test. The values were compared to assess the
effectiveness of Structured Teaching programme. Data analysis and
interpretation were organized in four parts

Part I: Distribution of demographic data of mothers

Part II: Distribution of knowledge scores and practices score of mothers

regarding home care management of Children with juvenile diabetes.

Part III: Relationship between the knowledge scores of care takers and selected
demographic variables.

33
Part IV: Relationship between the practices scores of care takers and selected
demographic variables

Epilogue

This chapter dealt with the research approach, research design, setting of the
study, population, sample, sampling technique, criteria for sample selection and
method of data collection, development and description of the tool, validity and
reliability of tool, pilot study, data collection procedure and data analysis.

METHODOLOGY
SCHEMATIC PRESENTATION

Research Approach Quantitative approach

One group pretest and post test

Research Design
Design

Setting of the study Niloufer Hospital ,Hyderabad

population Mothers of children with Juvenile

Diabetes
34
 sample Mothers of children with juvenile
diabetes who are attending OPD at
Niloufer Hospital

Sample size 50

Sample Technique Purposive Sampling

Method of data Collection Structured Questionnaire

Data Analysis Descriptive and inferential

statistics

Figure.2 schematic methodology representation

Chapter - IV

Analysis and interpretation

Analysis and interpretation is the most important phase of the research process,
which involves the computation of the certain measures along with searching
for patterns of relationship that exists among data groups. Analysis and
interpretation of data includes compilation, editing, coding, classification, and
presentation of data.

Analysis is defined as ‘the process of systematically applying statistical and

logical techniques to describe, summarize, and compare data’.”

35
 According to Suresh K Sharma

This chapter dealt with analysis and interpretations of data. Data was collected
from fifty care takers of children with juvenile diabetes mellitus at Niloufer
Hyderabad

PROBLEM STATEMENT

Effectiveness of Structured Teaching Programme on Knowledge and

Practices of Mothers Regarding Home Care Management of Children with
Juvenile Diabetes at Niloufer Hospital, Hyderabad, Telangana.

OBJECTIVES

 Assess the knowledge and practice of the mothers regarding home care
management of children with juvenile diabetes
 Plan and conduct structured teaching programme on knowledge and
practices of mothers regarding home care management of children with
juvenile diabetes.
 Evaluate the effectiveness of structured teaching program on mothers of
children with juvenile diabetes.
 Find the association between knowledge and practice of the mothers
regarding home care management of children with juvenile diabetes.
 Association between the post-test level of knowledge and practices
among the mothers regarding home care management of children with
juvenile diabetes with demographic variables

HYPOTHESIS

H1: There will be significant difference between mean pre and post test
knowledge score <0.05 after structed teaching programme among mothers.

36
H2: There will be significant difference in the practices scores among mothers
before and after structured teaching programme
H3 : mothers who are receive structured teaching programme regarding
Juvenile diabetes will show a significant improvement in the level of knowledge
and practices.
H4: There will be significant association between knowledge scores and
practices score of mothers regarding home care management of children with
juvenile diabetes.

METHOD OF DATA COLLECTION

Investigator plan for structured questionnaire to obtain demographic data and
Knowledge of mothers and observational check list on practices of home care
management
DEVELOPMENT AND DESCRIPTION OF TOOLS
The structured questionnaire consist and divided in to Part-A, Part-B & Part-
Part-A Deals with demographic data
Part -B Deals with knowledge of mothers and practices, further divided into
Section- I Deals with questionnaire regarding Anatomy and physiology of
pancreas
Section -II Deals with Questionnaire regarding meaning, causes, signs &
symptoms of juvenile diabetes
Section-III Deals with Questionnaires regarding diagnostics tests &
management
Section-IV Deals with Questionnaire regarding home care management &
complications of juvenile diabetes
Part - C Deals with observational check list on practices at home care
management.

37
 PART-I
Table-4
Frequency and percentage Distribution of samples
according to age in years
N=50
Age ( in years) frequency percentage
21-20 years 15 30
31-40 years 22 44
41-50 years 13 26
51-60 years 00 00
Total 50 100
_____________________________________________________________

38
Table-1 above one shows out of 50 mothers 15(30%) belongs to age group of
below 21-30 years, 22 (44%)belongs to 31 – 40 years,13(26%) belongs to 41-
50 years,0(0%) belongs to 51-60 year. the highest majority shows 22(44%)
mothers belongs to 31-40 years and lowest majority 13(26%) mothers belongs
to 41-50 years

44.0
45.0

40.0

35.0 30.0
30.0 26.0

25.0

20.0

15.0

10.0

5.0 0.0
0.0
21 years to 30 years 31 years to 40 years 41 years to 50 years 51 years to 60 years

Figure.1 Frequency and percentage distribution of sample according to age

39
 Table -5
frequency and percentage distribution of sample according to Religion

N=50
_____________________________________________________________
Religion Frequency percentage
a) Hindu 28 56
b) Muslim 15 30
c) Christian 7 14
d) Others 0 0
Total 50 100

Above Table 2 shows that out of 50 mothers 28(56%) are Hindu, 15(30%) are
Muslim, 7(14%) are Christian and 0(0%) are others. The highest majority scores
28(56%) belongs to Hindu & the lowest majority shows 7 (14%) are belongs to
Christian.

40
 56.0
60.0

50.0

40.0
30.0
30.0

20.0 14.0

10.0
0.0
0.0
Hindu Muslim Christian Others

Fig.2 Frequency and distribution according to religion

41
 Table -6
frequency and percentage distribution of sample according to education

N=50

_____________________________________________________________
Education Frequency Percentage

a) Illiterate 18 36
b) Primary school 19 38
c) Secondary school 10 20

d) Inter and above 3 6

Total 50 100
____________________________________________________________

Above Table 3 shows that out of 50 mothers 18(36%) are illiterate,19(38%) are
primary school, 10( 20%) are high education, 3(6%) are inter and above .the
highest majority shows 19(38%) belongs to illiterate, the lowest majority shows
3(6%) belongs to inter and above.

42
 20% 6%
36%

Illiterate
Primary school
High school
Inter and above

38%

Figure.3 Frequency and percentage distribution according to education of

mother

43
 Table -7
frequency and percentage distribution of sample according to occupation
N=50
_____________________________________________________________
occupation Frequency Percentage

a) Home maker 10 20

b) Labourer 8 16

c) private employee 32 62

d) government employee 00 00

Total 50 100

Above Table.4 shows out of 50 mothers ,10(20%) mothers are home

makers,8(16%) mothers are labourer,32(62%) are private employee and 0(0%)
are government employee, the highest majority employee are 32(62%) private
employee, the lowest majority are labourer 8(16%)

44
 64.0
70.0

60.0

50.0

40.0

30.0 20.0
16.0
20.0

10.0
0.0
0.0
Home maker Labour Private employee Govrnment
Employee

Figure.4 Frequency and percentage distribution according to occupation

45
 Table -8
frequency and percentage distribution of sample according to monthly
income

N=50

_____________________________________________________________
monthly income Frequency Percentage

a) >199,862 00 00

b) 999,932-199,861 00 00

c) 74,756-99,930 00 00

d) 49,962-74,755 00 00

e) 29,973-49,961 16 32

f)10,002-29,972 22 44

g) < 10,001 12 24

Total 50 100

Above Table-5 denotes that out 50 samples,16 (32%) are from income group of
29,973-49,961,22(44%) are from income group of 10,002-29,972,12(24%) are
from income group of < 10,001,the highest majority belongs to 22(44%) are
10,002-29,972 & the lowest majority belongs to 12(24%) ) < 10,001

46
 44.0
45.0

40.0

35.0 32.0

30.0
24.0
25.0

20.0

15.0

10.0

5.0
0.0 0.0 0.0 0.0
0.0
>199,862 99,932- 74,756- 49,6962- 29,973- 10,002- < 10,001
199,861 99,931 74,755 49,961 29,972

Figures.5 Frequency and percentage distribution according to monthly income

47
 Table -9
frequency and percentage distribution of sample according to type of
family

N=50

Family type Frequency percentage

a) Nuclear family 26 52
b) Joint family 14 28
c) Extended 0 0
d) Single parent 10 20
Total 50 100

Above table.6 denotes that out of 50 sample,26(52%) of nuclear family,

14(28%) of joint family, 0(0%) of extended family,10(20) single parent family.

The highest majority belongs 26(52%) nuclear family, the lowest majority
belongs to 10(20%) single parent

48
60.0
52.0

50.0

40.0

28.0
30.0
20.0
20.0

10.0
0.0
0.0

Figure. 6 Frequency and percentage distribution according to type of family

49
 Table -10

Frequency and percentage distribution of sample according to history of

juvenile diabetes

N=50

Variables Frequency percentage

a) Yes 9 18
b) No 41 82
Total 50 100

Above Table.7 denotes out of 50 sample,9(18%) had family history of juvenile

diabetes, 41(82%) had no family history of juvenile diabetes. the highest
majority belongs to 41(82%) No, the lowest majority belongs to 9(18%) yes

50
 18%

Yes
No

82%

Figure.7 Frequency and percentage distribution according to family history of

juvenile diabetes

51
 Table -11

Frequency and percentage distribution of sample according to insulin

administration

N=50

Variables Frequency percentage

a)Yes 31 62

b)No 19 38

Total 50 100

Above Table.8 denotes that out of 50 samples, 31(62%),had know about insulin
administration,19(38%) had no history of insulin administration,the highest
score belongs to 31(62%) yes ,the lowest scores belongs to 19(38%) No

52
 38%

Yes
No

62%

Figure.8 Frequency and percentage distribution regarding about insulin

administration

53
 Table -12

Frequency and percentage distribution of sample according to medical

check-up

Variables Frequency percentage

a) weekly 15 30
b) monthly 35 70
c) quarterly 0 0
d) yearly 0 0
Total 50 100
Above table-9 denotes that out of 50 sample, 15(30%) had medical check up
weekly,35(70%) had medical checkup monthly. The highest majority 35(70%)
belongs to monthly check up, lowest majority belongs to 15(30%) are weekly
medical check up.

54
 70.0
70.0

60.0

50.0

40.0
30.0
30.0

20.0

10.0
0.0 0.0
0.0
Weekly Monthly Quaterly Yearly

Figure.9 Frequency and percentage distribution about monthly medical

check-up

55
 Part -II

It dealt with the analysis of knowledge scores in pre and post test regarding care
takers on home care management of children with juvenile diabetes of sample
into three groups. below average, average, above average based on the
knowledge scores obtained on the pretest and posttest. The effectiveness of
structured Teaching Programme was estimated with the help of paired t test
significance.

Table-13

Frequency and percentage distribution of the pretest and post test

Knowledge scores among mothers

N=50

Level of Knowledge Pre-test post test

f p f p

Below average 32 64% 0 0

(<33.3%)

Average 18 36% 22 44%

(33.34%-66.6%)

Above average 0 0 28 56%

Total 50 100% 50 100

56
Table-10 shows that in post test ,22(44%) of care takers had average level of
knowledge, 28(56%) of care takers had above average level of knowledge. the
obtained t value was -17.589, which is greater than the table value at 2.02 at
49df at 0.05 level of significance which shows the effectiveness of structured
teaching.

70.0% 64.0%

56.0%
60.0%

50.0% 44.0%

36.0% Below Avg(<=33.33%)

40.0%
Avg(33.34%-66.66%)
30.0% Above Avg(>66.67%)

20.0%

10.0%
0.0% 0.0%
0.0%
Pre Test Post Test
.

Figure.10 Frequency and percentage distribution of pre test and post test
knowledge scores among care takers

57
 Table-14

Cumulative scores of pretest and post test

N=50

Categories pretest post test

Mean 8.7400 19.2000

Standard deviation 3.56748 2.79212

Standard error .50452 .39486

‘t ‘Test -17.589

Table 11 shows that mean of post test scores is 19.2000. standard deviation
scores of post test scores is 2.79212 standard error scores of post test scores
is .39486. t test value is -17.589 which is greater than table value 2.02 with 0.05
level of significance and 49 df. It shows there is significant difference in post
test. Knowledge scores of mothers regarding home care management of
children with juvenile diabetes. Hence research hypothesis was accepted. This
indicates the effectiveness of structured teaching programme.

58
 80.0%
80.0% 70.0% 72.0%
66.0%
58.0%
60.0% 50.0%
42.0% 44.0%
44.0% 42.0%
38.0%
40.0% 32.0%
26.0% 28.0% 28.0%
24.0%
18.0%
20.0% 12.0% 12.0%
6.0% 6.0%
2.0% 0.0% 0.0%
0.0%
Pre Test

Pre Test

Pre Test

Pre Test
Post Test

Post Test

Post Test

Post Test
Knowledge Level Knowledge level re- KnowledgeLevel Knowledge Level
regarding garding meaning, regarding diagnos- regarding home care
Anatomy& physiol- causes, signs & symp- tics tests & manage- management & com-
ogy of pancreas toms of juvenile dia- ment plications of juvenile
betes diabetes

Figure.11 cumulative knowledge score pre and post test

59
 19.200
20.000

18.000

16.000

14.000

12.000 Mean
10.000 8.740 Std. Deviation
Std. Error Mean
8.000

6.000
3.567
2.792
4.000

2.000 0.505 0.395

0.000
pre test post test

Figure.12 over all knowledge score pre and post test

60
 PART -III

Table-15

Association between knowledge and Age

N=50

Pre test post test

Age in years

Below Average Above Below Average Above

Average Average Average Average

f % f % f % f % f % f %

21-30 8 53.3 7 46.7 0 0 0 0 4 26.7 11 73.3

31-40 17 77.3 5 22.7 0 0 0 0 14 63.6 8 36.4

41-50 7 53.1 6 46.2 0 0 0 0 4 30.8 9 69.2

51-60 0 0 0 0 0 0 0 0 0 0 0 0

Characteristics chi square df table value inference

Post-test 6.195 2 5.991 significance

Table 12 shows that there was significant association between the age and post
scores of knowledges of mothers on home care management of children with
juvenile diabetes since the obtained chi-square value for posttest 6.195 is greater
than the table value 5.991 at df 2 and 0.05 level of significance.

61
 77.3%
80.0% 73.3%
69.2%
70.0% 63.6%

60.0% 53.3% 53.8%

46.7% 46.2%
50.0%
36.4%
40.0%
30.8% Below Avg(<=33.33%)
26.7% Avg(33.34%-66.66%)
30.0% 22.7%
Above Avg(>66.67%)
20.0%

10.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
0.0%
21 years 31 years 41 years 21 years 31 years 41 years
to 30 to 40 to 50 to 30 to 40 to 50
years years years years years years
Pre Test Post Test

Figure.13 association between knowledge and age of mother in year

62
 Table 16

Association between knowledge and Religion

N=50

Pre test post test

Religion Below Average Above Below Average Above

Average Average Average Average

f % f % f % f % f % f %

Hindu 15 53.6 13 46.4 0 0 0 0 12 42,9 6 57.1

Muslim 12 80.0 3 20.0 0 0 0 0 7 46.7 8 53.3

Christian 5 71.4 2 28.6 0 0 0 0 3 42.9 4 57.1

Others 0 0 0 0 0 0 0 0 0 0 0 0

Characteristics chi square df table value Inference

Post-test .062 2 5.991 no significance

Table 13 shows that there was not significant association between the religion
and post scores of knowledges of mothers on home care management of
children with juvenile diabetes since the obtained chi-square value for
posttest .062 is less than the table value 5.991 at df 2 and 0.05 level of
significance.

Figure.14 Association between knowledge and Religion

63
 80.0%
80.0% 71.4%
70.0%
57.1% 57.1%
60.0% 53.6% 53.3%
46.4% 46.7%
50.0% 42.9% 42.9%
40.0%
28.6%
Axis Title 30.0% Below Avg(<=33.33%)
20.0%
20.0% Avg(33.34%-66.66%)
Above Avg(>66.67%)
10.0%
0.0% 0.0% 0.0%0.0% 0.0% 0.0%
0.0%
Hindu

Hindu
Muslim

Muslim
Christian

Christian
Pre Test Post Test
Axis Title

Table 17

64
 Association between knowledge and Education

N=50

Pre test post test

Below Average Above Below Average Above

Average Average Average Average

f % f % f % f % f % f %

Illiterate 17 94.4 1 5.6 0 0 0 0 11 61.1 7 38.9

Primary

School 12 63.2 7 36.8 0 0 0 0 10 52.6 9 47.4

High

School 2 20.2 8 80.0 0 0 0 0 1 10.0 9 90.0

Inter and

Above 1 33.3 2 66.7 0 0 0 0 0 0 3 100.0

Characteristics chi square df table value Inference

Post-test 9.762 3 7.815 significance

Table 14 shows that there was significant association between the education
and post scores of knowledge of mothers on home care management of
children with juvenile diabetes since the obtained chi-square value for post-
test .9.762 is greater than the table value 7.815 at df 3 and 0.05 level of
significance.

65
 100.0%
94.4%
100.0% 90.0%
90.0% 80.0%
80.0%
66.7%
70.0% 63.2% 61.1%
60.0% 52.6%
47.4%
50.0% 38.9%
36.8%
40.0% 33.3%
Below Avg(<=33.33%)
30.0% 20.0% Avg(33.34%-66.66%)
20.0% 10.0% Above Avg(>66.67%)
5.6%
10.0% 0.0% 0.0% 0.0% 0.0%0.0% 0.0% 0.0% 0.0%
0.0%
0.0%
Illiterate

Illiterate
High school

High school
Primary school

Primary school
Inter and above

Inter and above

Pre Test Post Test

Figure.15 Association between knowledge and education of mother

66
 Table 18

Association between knowledge and occupation

N=50

Pre test post test

Occupation

Below Average Above Below Average Above

Average Average Average Average

f % f % f % f % f % f %

Home 9 90.0 1 10.0 0 0 0 0 6 60.0 4 40.0

makers

Laborer 7 87.5 1 12.5 0 0 0 0 2 25.0 6 75.0

Private

Employee 16 50.0 16 50.0 0 0 0 0 14 43.8 18 56.3

Government

Employee 0 0 0 0 0 0 0 0 0 0 0 0

Characteristics chi square df table value Inference

Post-test 2.212 2 5.991 no significance

Table 15 shows that there was no significant association between the occupation
and post scores of knowledge of mothers on home care management of children
with juvenile diabetes since the obtained chi-square value for posttest 2.212 is
less than the table value 5.991 at df 2 and 0.05 level of significance.

67
 90.0%
87.5%
90.0%

80.0% 75.0%

70.0%
60.0%
56.3%
60.0%
50.0%
50.0%
50.0% 43.8%
40.0% Below Avg(<=33.33%)
40.0% Avg(33.34%-66.66%)
30.0% 25.0% Above Avg(>66.67%)

20.0% 12.5%
10.0%
10.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
0.0%
Home Labour Private Home Labour Private
maker employee maker employee
Pre Test Post Test

Figure.16 association between knowledge level and occupation

Table 19

68
 Association between knowledge and monthly income

N=50

Pre test post test

Income Below Average Above Below Average Above

Average Average Average Average

f % f % f % f % f % f %

29,973-

49,961 5 31.3 11 68.8 0 0 0 0 3 18.8 13 81.3

10,002-

29,972 16 72.7 6 27.3 0 0 0 0 12 54.5 10 45.5

<10.000 11 91.7 1 8.3 0 0 0 0 7 58.3 5 41.7

Characteristics chi square df table value Inference

Post-test 6.133 2 5.991 significance

Table 16 shows that there was significant association between the monthly
income and post scores of knowledge of mothers on home care management of
children with juvenile diabetes since the obtained chi-square value for post-test
6.133 is greater than the table value 5.991 at df 2 and 0.05 level of significance.

69
 100.0% 91.7%
90.0% 81.3%
80.0% 72.7%
68.8%
70.0%
58.3%
54.5%
60.0%
45.5%
50.0% 41.7% Below Avg(<=33.33%)
Avg(33.34%-66.66%)
40.0% 31.3%
27.3% Above Avg(>66.67%)
30.0%
18.8%
20.0%
8.3%
10.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
0.0%
29,973- 10,002- < 10,001 29,973- 10,002- < 10,001
49,961 29,972 49,961 29,972
Pre Test Post Test

Figure.17 association between knowledge level and family income

70
 Table 20

Association between knowledge and type of family

N=50

Pre test post test

Type of Below Average Above Below Average Above

family Average Average Average Average

f % f % f % f % f % f %

Nuclear 15 57.7 11 42.3 0 0 0 0 10 38.5 16 61.0

joint family 10 71.4 4 28.6 0 0 0 0 7 50.0 7 50.0

Extended f 0 0 0 0 0 0 0 0 0 0 0 0

Single parent 7 70.0 3 30 0 0 0 0 5 50.0 5 50.0

Characteristics chi square df table value Inference

Post-test .674 2 5.991 no significance

Table 17 shows that there was no significant association between the type of
family and post scores of knowledge of mothers on home care management of
children with juvenile diabetes since the obtained chi-square value for
posttest .674 is less than the table value 5.991 at df 2 and 0.05 level of
significance.

71
 80.00%
70.0% 71.4%
70.00%
61.1%
58.3%
60.00%
50.0%
50.0% 50.0%
50.0%
50.00%
41.7%
38.9%
40.00%
30.0% Below Avg(<=33.33%)
28.6%
30.00% Avg(33.34%-66.66%)
Above Avg(>66.67%)
20.00%

10.00%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
0.00%
Nuclear Joint Single Nuclear Joint Single
family Family parent family Family parent
family family
Pre Test Post Test

Figure.18 association between knowledge level and type of family

72
 Table 21

Association between knowledge and family history of juvenile diabetes

N=50

Pre test post test

family Below Average Above Below Average Above

history Average Average Average Average

f % f % f % f % f % f %

yes 2 22.2 7 77.8 0 0 0 0 1 11.1 8 88.9

No 30 73.2 11 26.8 0 0 0 0 21 51.2 20 48.8

Characteristics chi square df table value Inference

Post-test 4.818 1 3.841 significance

Table 18 shows that there was significant association between the family history
of juvenile diabetes and post scores of knowledge of mothers on home care
management of children with juvenile diabetes since the obtained chi-square
value for posttest 4.818 is greater than the table value 3.841 at df 1 and 0.05
level of significance.

73
 88.9%
90.0%
77.8%
80.0% 73.2%

70.0%

60.0% 51.2%
48.8%
50.0%
Below Avg(<=33.33%)
40.0% Avg(33.34%-66.66%)
26.8% Above Avg(>66.67%)
30.0% 22.2%

20.0% 11.1%

10.0%
0.0% 0.0% 0.0% 0.0%
0.0%
Yes No Yes No
Pre Test Post Test

Figure.19 association between knowledge level and family history

74
 Table 22

Association between knowledge and regarding about insulin administration

N=50

Pre test post test

insulin Below Average Above Below Average Above

Average Average Average Average

f % f % f % f % f % f %

yes 19 61.3 12 38.7 0 0 0 0 15 48.4 16 51.6

No 13 68.4 6 31.6 0 0 0 0 7 36.8 12 63.2

Characteristics chi square df table value Inference

Post-test .637 1 3.841 no significance

Table 19 shows that there was no significant association between regarding

about insulin administration and post scores of knowledge of mothers on home
care management of children with juvenile diabetes since the obtained chi-
square value for post-test .637 is less than the table value 3.841 at df 1 and 0.05
level of significance.

75
 68.4%
70.0% 63.2%
61.3%
60.0%
51.6%
48.4%
50.0%
38.7%
36.8%
40.0%
31.6% Below Avg(<=33.33%)
Avg(33.34%-66.66%)
30.0%
Above Avg(>66.67%)

20.0%

10.0%
0.0% 0.0% 0.0% 0.0%
0.0%
Yes No Yes No
Pre Test Post Test

Figure.20 association between knowledge level and insulin administration

76
 Table 23

Association between knowledge and frequency of medical check up

N=50

Pre test post test

Frequency of medical check up

Below Average Above Below Average Above

Average Average Average Average

f % f % f % f % f % f %

weekly 11 73.3 4 26.7 0 0 0 0 3 20.0 12 80

monthly 21 60.0 14 40.0 0 0 0 0 19 54.3 16 45.7
quarterly 0 0 0 0 0 0 0 0 0 0 0 0
yearly 0 0 0 0 0 0 0 0 0 0 0 0
Characteristics chi square df table value Inference

Post-test 5.009 1 3.841 significance

Table 20 shows that there was significant association between frequency of

medical checkup and post -scores of knowledge of mothers on home care
management of children with juvenile diabetes, since the obtained chi-square
value for post-test 5.009 is less than the table value 3.841 at df 1 and 0.05 level
of significance.

77
Figure.21 association between knowledge level and medical check up

78
 Part -IV
It dealt with the analysis of practices scores in pre and post test regarding
mothers on home care management of children with juvenile diabetes of sample
into three groups. below average, average, above average based on the
knowledge scores obtained on the pretest and posttest. The effectiveness of
structured Teaching Programme was estimated with the help of paired t test
significance.

Table-24

Frequency and percentage distribution of the pretest and post test practices
scores among mothers

N=50

Level of practices Pre-test post test

f p f p

Below average 42 84% 0 0

(<33.3%)

Average 8 16% 10 20%

(33.34%-66.6%)

Above average 0 0 40 80%

(>66.6%)

Total 50 100% 50 100

79
Table-21 shows that in post test ,10(20%) of care takers had average level of
practices, 40(80%) of care takers had above average level of practices. the
obtained t value was -19.097, which is greater than the table value at 2.02 at 49
df at 0.05 level of significance which shows the effectiveness of structured
teaching.

90.0% 84.0%
80.0%
80.0%

70.0%

60.0%

50.0% Low(<=33.33%)
Moderate(33.34%-66.66%)
40.0% High(>66.67%)

30.0%
20.0%
16.0%
20.0%

10.0%
0.0% 0.0%
0.0%
Pre Test Post Test

Figure .22 association between practice level pre and post test

80
 Table-25

Association between practices and Age of the mother

N=50

Pre test post test

Age in years

Below Average Above Below Average Above

Average Average Average Average

f % f % f % f % f % f %

21-30 13 86.9 2 13.3 0 0 0 0 2 13.3 13 86.7

31-40 20 90.9 2 9.1 0 0 0 0 6 27.3 16 72.7

41-50 9 69.2 4 30.8 0 0 0 0 2 15.4 11 84.6

51-60 0 0 0 0 0 0 0 0 0 0 0 0

Characteristics chi square df table value inference

Post-test 1.317 2 5.991 no significance

Table 22 shows that there was not significant association between the age and
post scores of practices of mothers on home care management of children with
juvenile diabetes since the obtained chi-square value for posttest 1.317 is less
than the table value 5.991 at df 2 and 0.05 level of significance.

81
 100.0% 90.9%
86.7% 86.7% 84.6%
90.0%
80.0% 72.7%
69.2%
70.0%
60.0%
50.0%
Low(<=33.33%)
40.0% 30.8% Moderate(33.34%-66.66%)
27.3%
30.0% High(>66.67%)

13.3% 13.3% 15.4%

20.0%
9.1%
10.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
0.0%
21 years 31 years 41 years 21 years 31 years 41 years
to 30 to 40 to 50 to 30 to 40 to 50
years years years years years years
Pre Test Post Test

Figure.23 association between practice level age of mothers

82
 Table-26

Association between practices and Religion

N=50

Pre test post test

Religion Below Average Above Below Average Above

Average Average Average Average

f % f % f % f % f % f %

Hindu 24 85.7 4 14.3 0 0 0 0 7 25.0 21 75.0

Muslim 14 93.3 1 6.7 0 0 0 0 2 13.3 31 86.7

Christian 4 57.1 3 42.9 0 0 0 0 1 14.3 6 85.7

Others 0 0 0 0 0 0 0 0 0 0 0 0

Characteristics chi square df table value Inference

Post-test .997 2 5.991 no significance

Table 23 shows that there was no significant association between the religion
and post scores of practices of mothers on home care management of children
with juvenile diabetes since the obtained chi-square value for post-test .997 is
less than the table value 5.991 at df 2 and 0.05 level of significance

83
 100.0%

90.0%

80.0%

70.0%

60.0%

50.0% Low(<=33.33%)
Moderate(33.34%-66.66%)
40.0% High(>66.67%)
30.0%

20.0%

10.0%

0.0%
Hindu Muslim Christian Hindu Muslim Christian
Pre Test Post Test

Figure.24 association between practice level and religion

Table 27
84
 Association between practices and Education

N=50

Pre test post test

Education

Low moderate high Low moderate high

f % f % f % f % f % f %

Illiterate 16 88.9 2 11.1 0 0 0 0 9 50.0 9 50.0

Primary

School 18 94.7 1 5.3 0 0 0 0 1 5.3 18 94.7

High

School 8 80.0 2 20.0 0 0 0 0 0 0 10 100.0

Inter and

Above 0 0 3 100 0 0 0 0 0 0 3 100.0

Characteristics chi square df table value Inference

Post-test 15.954 3 7.815 significance

Table 24 shows that there was significant association between the education and
post scores of mothers on home care management of children with juvenile
diabetes since the obtained chi-square value for post-test 15.954 is greater than
the table value 7.815 at df 3 and 0.05 level of significance.

85
 100.0% 100.0%100.0%
94.7% 94.7%
100.0% 88.9%
90.0% 80.0%
80.0%
70.0%
60.0% 50.0%
50.0%
50.0%
40.0%
Low(<=33.33%)
30.0% 20.0% Moderate(33.34%-66.66%)
20.0% 11.1% High(>66.67%)
5.3% 5.3%
10.0% 0.0% 0.0% 0.0%0.0%
0.0%0.0% 0.0% 0.0%
0.0% 0.0%
0.0%
0.0%
Illiterate

Illiterate
High school

High school
Primary school

Primary school
Inter and above

Pre Test Post Test Inter and above

Figure.25 association between practice level and education of mother

86
 Table 28

Association between practices and occupation

N=50

Pre test post test

occupation

Low moderate High Low Moderate High

f % f % f % f % f % f %

______________________________________________________________________Home
maker 9 90.0 1 10.0 0 0 0 0 3 30.0 7 70.0

Labourer 6 75.0 2 25.0 0 0 0 0 4 50. 4 50.0

Private

Employe 27 84.4 5 15.6 0 0 0 0 3 9.4 29 90.6

Government

Employee 0 0 0 0 0 0 0 0 0 0 0 0

Characteristics chi square df table value Inference

Post-test 7.383 2 5.991 significance

Table 25 shows that there was significant association between the occupation
and post scores of practices of mothers on home care management of children
with juvenile diabetes since the obtained chi-square value for posttest 7.383 is
greater than the table value 5.991 at df 2 and 0.05 level of significance.

87
 100.0% 90.0% 90.6%
84.4%
90.0%
75.0%
80.0% 70.0%
70.0%
60.0% 50.0%
50.0%
50.0%
40.0% 30.0%
25.0% Low(<=33.33%)
30.0%
15.6% Moderate(33.34%-66.66%)
20.0% 10.0% 9.4%
High(>66.67%)
10.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
0.0%
Labour

Labour
Home maker

Home maker
Private employee

Private employee

Pre Test Post Test

Figure.26 association between practice level and occupation

88
 Table 29

Association between practices and monthly income

N=50

Pre test post test

Income low moderate high low moderate high

f % f % f % f % f % f %

_______________________________________________________________________

29,973-

49,961 13 81.3 3 18.8 0 0 0 0 0 0 16 100.0

10,002-

29,972 19 86.4 3 13.6 0 0 0 0 1 4.5 21 95.5

<10.0001 10 83.3 2 16.7 0 0 0 0 9 75.0 3 25.0

Characteristics chi square df table value Inference

Post-test 29.972 2 5.991 significance

Table 26 shows that there was significant association between the monthly
income and post scores of practices of mothers on home care management of
children with juvenile diabetes since the obtained chi-square value for post-test
29.972 is greater than the table value 5.991 at df 2 and 0.05 level of
significance.

89
 100.0%
95.5%
100.0%
86.4%
90.0% 81.3% 83.3%

80.0% 75.0%

70.0%

60.0%

50.0% Low(<=33.33%)
Moderate(33.34%-66.66%)
40.0%
High(>66.67%)
30.0% 25.0%
18.8% 16.7%
20.0% 13.6%

10.0% 4.5%
0.0% 0.0% 0.0% 0.0%
0.0% 0.0% 0.0%
0.0%
29,973- 10,002- < 10,001 29,973- 10,002- < 10,001
49,961 29,972 49,961 29,972
Pre Test Post Test

Figure .27 association between practice level and monthly income

90
 Table 30

Association between practice level and type of family

N=50

Pre test post test

Type of family

Low Moderate High Low Moderate High

f % f % f % f % f % f %

Nuclear 22 84.6 4 15.1 0 0 0 0 5 19.2 21 80.8

joint family 13 92.9 1 7.1 0 0 0 0 2 14.3 12 85. 7

Extended f 0 0 0 0 0 0 0 0 0 0 0 0

Single parent 7 70.0 3 30 0 0 0 0 3 30.0 7 70.0

Characteristics chi square df table value Inference

Post-test .920 2 5.991 no significance

Table 27 shows that there was no significant association between the type of
family and post scores of practices of mothers on home care management of
children with juvenile diabetes since the obtained chi-square value for post-
test .920 is less than the table value 5.991 at df 2 and 0.05 level of significance.

91
 100.0% 92.9%
85.7%
90.0% 80.6% 77.8%
80.0% 70.0%
70.0%
60.0%
50.0%
40.0% 30.0%
30.0% 19.4% 22.2%
14.3% Low(<=33.33%)
20.0% 7.1% Moderate(33.34%-66.66%)
10.0% 0.0% 0.0% 0.0% 0.0% 0.0% High(>66.67%)
0.0%
Joint Family

Joint Family
Nuclear family

Single parent family

Single parent family

Pre Test Post Test

Figure.28 association between practice level and type of family

92
 Table 31

Association between practice level and family history

N=50

Pre test post test

family history

Low Moderate High Low Moderate High

f % f % f % f % f % f %

_______________________________________________________________________

yes 7 77.8 2 22.0 0 0 0 0 0 0.0 9 100.0

No 35 85.4 6 14.6 0 0 0 0 10 24.4 31 75.6

Characteristics chi square df table value Inference

Post-test 2.744 1 3.841 significance

Table 29 shows that there was no significant association between the family
history of juvenile diabetes and post scores of practices of mothers on home
care management of children with juvenile diabetes since the obtained chi-
square value for post-test 2.744 is less than the table value 3.841 at df 1 and
0.05 level of significance.

93
 100.0%
100.0%
85.4%
90.0%
77.8% 75.6%
80.0%

70.0%

60.0%
Low(<=33.33%)
50.0%
Moderate(33.34%-66.66%)
40.0% High(>66.67%)
22.2% 24.4%
30.0%
14.6%
20.0%

10.0%
0.0% 0.0% 0.0%
0.0% 0.0%
0.0%
Yes No Yes No
Pre Test Post Test

Figure.29 association between practice level and family history

94
 Table 32

Association between practices and regarding about insulin administration

N=50

Pre test post test

Insulin administration

Low Moderate High Low Moderate High

f % f % f % f % f % f %

_______________________________________________________________________

yes 25 80.6 6 19.4 0 0 0 0 6 19.4 25 80.6

No 17 89.5 2 10.5 0 0 0 0 4 21.1 15 78.9

Characteristics chi square df table value Inference

Post-test .021 1 3.841 no significance

Table 29 shows that there was no significant association between the family
history of juvenile diabetes and post scores of practices of mothers on home
care management of children with juvenile diabetes since the obtained chi-
square value for post-test .021 is less than the table value 3.841 at df 1 and 0.05
level of significance.

95
 89.5%
90.0%
80.6% 80.6% 78.9%
80.0%

70.0%

60.0%

50.0%
Low(<=33.33%)
40.0% Moderate(33.34%-66.66%)
High(>66.67%)
30.0%
19.4% 19.4% 21.1%
20.0%
10.5%
10.0%
0.0% 0.0% 0.0% 0.0%
0.0%
Yes No Yes No
Pre Test Post Test

Figure.30 association between practice level and insulin administration

96
 Table 33

Association between practices and frequency of medical check up

N=50

Pre test post test

Frequency of medical check up

Low moderate High Low Moderate High

f % f % f % f % f % f %

_______________________________________________________________________

weekly 11 73.3 4 26.7 0 0 0 0 3 20.0 12 80.0

monthly 31 88.6 4 11.4 0 0 0 0 7 20.0 28 80.0
quarterly 0 0 0 0 0 0 0 0 0 0 0 0
yearly 0 0 0 0 0 0 0 0 0 0 0 0
Characteristics chi square df table value Inference

Post-test 0.000 1 3.841 no significance

Table 30 shows that there was no significant association between frequency of

medical checkup and post -scores of practices of mothers on home care
management of children with juvenile diabetes, since the obtained chi-square
value for post-test 0.000 is less than the table value 3.841 at df 1 and 0.05 level
of significance.

97
 88.6%
90.0%
80.0% 80.0%
80.0% 73.3%

70.0%

60.0%

50.0%
Low(<=33.33%)
40.0% Moderate(33.34%-66.66%)
High(>66.67%)
26.7%
30.0%
20.0% 20.0%
20.0% 11.4%
10.0%
0.0% 0.0% 0.0% 0.0%
0.0%
Weekly Monthly Weekly Monthly
Pre Test Post Test

Figure .31 association between practice level and medical check-up

Epilogue: The chapter dealt with analysis and interpretation of the data using

descriptive and inferential statistics and is represented in tabular and

diagrammatic forms. the obtained results had clearly indicated the effective ness

of STP on knowledge and practices of mother

98
 Chapter -v

Summery

This chapter dealt with summary, findings, discussion, Implication and

recommendations. The study was undertaken to assess the effectiveness of
Structured Teaching on knowledge and practices of mothers regarding home
care management of children with juvenile diabetes mellitus at Niloufer
Hospital, Hyderabad, Telangana

Objectives

 Assess the knowledge and practice of the mothers regarding home care
management of children with juvenile diabetes
 Plan and conduct structured teaching programme to mothers on home
care management of children with juvenile diabetes.
 Evaluate the effectiveness of structured teaching program on mothers of
children with juvenile diabetes.
 Find the association between knowledge and practice of mothers
regarding home care management of juvenile diabetes.
 Association between the post level of knowledge and practices among
the mothers regarding home care management of children with juvenile
diabetes with demographic variables

99
OPERATIONAL DEFINITION
Effectiveness: Improvement of post test scores over pre-test scores after
administration of structured teaching programme to the mothers on home care
management of children with juvenile diabetes
Knowledge: It refers to the information that the mothers possess regarding
home care management of children with juvenile diabetes
Practices: the activity of mothers in administration of insulin to the children
with juvenile diabetes.
Mothers: A women have child with juvenile diabetes
Structured teaching programme on home care management: Information
booklet regarding home care management of children with juvenile diabetes
prepared by investigator, which includes: diabetic diet, exercises, administration
of insulin, Record maintains and importance of follow up care.
HYPOTHESIS

H1: There will be significant difference between mean pre and post-test
knowledge score <0.05 after structed teaching programme among mothers.

H2: There will be significant difference in the practices scores among mothers
before and after structured teaching programme

H3: mothers who are receive structured teaching programme regarding Juvenile
diabetes will show a significant improvement in the level of knowledge and
practices

H4: There will be significant association between knowledge scores and

practices score of mothers regarding home care management of children with
juvenile diabetes.

100
The review of literature had helped the investigator to get an insight into present
problem, to gain in depth knowledge of the content, to develop conceptual
frame work and tool for data collection.

The research approach adopted for the present study was quantitative
approach. The research design selected was pre experimental, one group pre test
and post test design. The sample of the present study consisted of fifty mothers
of children with juvenile diabetes mellitus. Purposive Sampling technique was
used to select 50 mothers of children with juvenile diabetes, structured
questionnaire regarding home care management of juvenile diabetes was
prepared by the investigator to assess the knowledge and practices level of the
mothers

The pilot study was conducted at Osmania General Hospital, Afzalgunj,

Hyderabad. The duration of the study was 07-5-2021 to 11-5-2021.Purposive
sampling technique was used to select five samples. The purpose of the study
was explained to the subjects. Pre test was conducted on mothers regarding
home care management of children with juvenile diabetes mellitus. Structured
Teaching regarding home care management of children with juvenile diabetes
was conducted on the same day after administering pre test. After 72 hours post
test was conducted with the same tool. After interventions assessment scores
were compared with pre test scores to identify the effectiveness of Structured
Teaching Programme.

Main study was conducted in Niloufer hospital, Red hills, Hyderabad.

Prior permission was obtained from the Medical Superintendent of Niloufer
Hospital, Hyderabad. The subjects for the study were selected according to the
sample criteria by purposive sampling technique. The investigator gave self
introduction and individual informed prior. The purpose of the study was
explained to the mothers and they were reassured about the confidentiality.

101
 Data collection was done from 14-06-2021 to 23-6-2017. Data was
collected from 5 mothers on an average every day. Pre test was conducted by
Structured questionnaire on knowledge of mothers regarding home care
Management of children with juvenile diabetes mellitus 30-45 minutes were
spent for each pre test assessment. On the same day Structured teaching
programme regarding given to mothers on home care management of children
with juvenile diabetes was administered for 25 mines. On third day the post test
was conducted by using the same questionnaire by structured interview to
evaluate the effectiveness of Structured Teaching programme. All the mothers
were receptive and co operative during data collection Data was collected by
using structured questionnaire from 14 june to 26” june, 2021 and analyzed with
the help of descriptive and inferential statistics and findings were interpreted.

Findings

The effectiveness of Structured Teaching programme was assessed by

descriptive and inferential statistics. There was a significant difference in pre-
test and post-test knowledge of mothers regarding home care management of
children with juvenile diabetes mellitus. The knowledge levels and practices
level were categorised as below average, average and above average

Part I- It dealt with frequency and percentage distribution of demographic data

of the mothers

The analysis with the distribution of demographic data shows in the total
sample of 50 mothers of children with juvenile diabetes majority of mothers
15(30%) belongs to age group of below 21-30 years, 22 (44%)belongs to 31 –
40 years,13(26%) belongs to 41-50 years,0(0%) belongs to 51-60 year , out of
50 mothers 28(56%) are Hindu, 15(30%) are Muslim, 7(14%) are Christian and
0(0%) are others, out of 50 mothers 18(36%) are illiterate,19(38%) are primary
school, 10( 20%) are high education, 3(6%) are inter and above, out 50

102
samples,16 (32%) are from income group of 29,973-49,961,22(44%) are from
income group of 10,002-29,972,12(24%) are from income group of < 10,001 ,
out of 50 sample,26(52%) of nuclear family,

14(28%) of joint family, 0(0%) of extended family,10(20) single parent family,

out of 50 sample,9(18%) had family history of juvenile diabetes, 41(82%) had
no family history of juvenile diabetes, out of 50 samples, 31(62%),had know
about insulin administration,19(38%) had no history of insulin administration,
out of 50 sample, 15(30%) had medical check up weekly,35(70%) had medical
checkup monthly
Part-II; It dealt with comparison scores of mothers before and after STP
regarding home care management of children with juvenile diabetes. 22(44%)
of care takers had average level of knowledge, 28(56%) of care takers had
above average level of knowledge. the obtained t value was -17.589, which is
greater than the table value at 2.02 at 49df at 0.05 level of significance which
shows the effectiveness of structured teaching. that mean of post test scores is
19.2000. standard deviation scores of post test scores is 2.79212 standard error
scores of post test scores is .39486. t test value is -17.589 which is greater than
table value 2.02 with 0.05 level of significance and 49 df. It shows there is
significant difference in post test.

Knowledge scores of mothers regarding home care management of children

with juvenile diabetes. Hence research hypothesis was accepted. This indicates
the effectiveness of structured teaching programme

Part-III it dealt with the association between knowledge of mothers regarding

home care management of children with juvenile diabetes and demographics
variables

there was significant association between the age and post scores of knowledge
of mothers on home care management of children with juvenile diabetes since

103
the obtained chi-square value for posttest 6.195 is greater than the table value
5.991 at df 2 and 0.05 level of significance. there was no significant association
between the religion and post scores of knowledge of mothers on home care
management of children with juvenile diabetes since the obtained chi-square
value for posttest .062 is less than the table value 5.991 at df 2 and 0.05 level of
significance, there was significant association between the education and post
scores of knowledge of mothers on home care management of children with
juvenile diabetes since the obtained chi-square value for post-test .9.762 is
greater than the table value 7.815 at df 3 and 0.05 level of significance. there
was not significant association between the occupation and post scores of
knowledge of mothers on home care management of children with juvenile
diabetes since the obtained chi-square value for posttest 2.212 is less than the
table value 5.991 at df 2 and 0.05 level of significance. there was significant
association between the monthly income and post scores of knowledge of
mothers on home care management of children with juvenile diabetes since the
obtained chi-square value for post-test 6.133 is greater than the table value
5.991 at df 2 and 0.05 level of significance

there was no significant association between the type of family and post scores
of knowledge of mothers on home care management of children with juvenile
diabetes since the obtained chi-square value for posttest .674 is less than the
table value 5.991 at df 2 and 0.05 level of significance, that there was
significant association between the family history of juvenile diabetes and post
scores of knowledge of mothers on home care management of children with
juvenile diabetes since the obtained chi-square value for posttest 4.818 is greater
than the table value 3.841 at df 1 and 0.05 level of significance.

there was no significant association between regarding about insulin

administration and post scores of knowledge of mothers on home care
management of children with juvenile diabetes since the obtained chi-square

104
value for post-test .637 is less than the table value 3.841 at df 1 and 0.05 level
of significance.

there was significant association between frequency of medical checkup

and post -scores of knowledge of mothers on home care management of
children with juvenile diabetes, since the obtained chi-square value for post-test
5.009 is less than the table value 3.841 at df 1 and 0.05 level of significance.

Part-IV. It dealt with the analysis of practices scores in pre and post test
regarding mothers on home care management of children with juvenile diabetes
of sample into three groups. below average, average, above average based on
the knowledge scores obtained on the pretest and posttest. The effectiveness of
structured Teaching Programme was estimated with the help of paired t test
significance. 10(20%) of mothers had average level of practices, 40(80%) of
mothers had above average level of practices. the obtained t value was -19.097,
which is greater than the table value at 2.02 at 49 df at 0.05 level of significance
which shows the effectiveness of structured teaching.

there was not significant association between the age and post scores of
practices of mothers on home care management of children with juvenile
diabetes since the obtained chi-square value for posttest 1.317 is less than the
table value 5.991 at df 2 and 0.05 level of significance. that there was not
significant association between the religion and post scores of practices of
mothers on home care management of children with juvenile diabetes since the
obtained chi-square value for post-test .997 is less than the table value 5.991 at
df 2 and 0.05 level of significance.

there was significant association between the education and post scores of
mothers on home care management of children with juvenile diabetes since the
obtained chi-square value for post-test 15.954 is greater than the table value
7.815 at df 3 and 0.05 level of significance. there was significant association

105
between the occupation and post scores of practices of mothers on home care
management of children with juvenile diabetes since the obtained chi-square
value for posttest 7.383 is greater than the table value 5.991 at df 2 and 0.05
level of significance

there was significant association between the monthly income and post
scores of practices of mothers on home care management of children with
juvenile diabetes since the obtained chi-square value for post-test 29.972 is
greater than the table value 5.991 at df 2 and 0.05 level of significance. there
was no significant association between the type of family and post scores of
practices of mothers on home care management of children with juvenile
diabetes since the obtained chi-square value for post-test .920 is less than the
table value 5.991 at df 2 and 0.05 level of significance.

that there was not significant association between the family history of
juvenile diabetes and post scores of practices of mothers on home care
management of children with juvenile diabetes since the obtained chi-square
value for post-test 2.744 is less than the table value 3.841 at df 1 and 0.05 level
of significance. that there was not significant association between the family
history of juvenile diabetes and post scores of practices of mothers on home
care management of children with juvenile diabetes since the obtained chi-
square value for post-test .021 is less than the table value 3.841 at df 1 and 0.05
level of significance. that there was not significant association between
frequency of medical checkup and post -scores of practices of mothers on home
care management of children with juvenile diabetes, since the obtained chi-
square value for post-test 0.000 is less than the table value 3.841 at df 1 and
0.05 level of significance.

Discussion

106
First objective Assess the knowledge and practice of the mothers regarding
home care management of children with juvenile diabetes

The knowledge of 50 mothers regarding home care management of juvenile

diabetes was assessed by using structured questionnaire. The obtained mean
value in pre test was 8.7400 and standard deviation was 3.56748

Second objective Plan and conduct structured teaching programme to

mothers on home care management of children with juvenile diabetes

Structured teaching programme on home care management among children

with juvenile diabetes was prepared and administered by the investigator to the
mothers of children with juvenile diabetes on the same day pre test.

Third objective Evaluate the effectiveness of structured teaching program

on mothers of children with juvenile diabetes

the knowledge of mothers were assessed by using the same tool after 72 hours
of Structured Teaching . The post test mean score was 19.2000 and standard
deviation was 2.79212.the calculated t value was -17.589. There was significant
difference between the pre test and post test knowledge scores of mothers
regarding home care management of children with juvenile diabetes mellitus
which indicated that the Structured Teaching was effective in improving their
knowledge levels. The inferential statistical analysis showed that the mean level
of pre test and post test were 8.7400 and 19.2000 respectively. The obtained t
value was -17.589showed that significant at 0.05 level. The findings showed
that post test knowledge scores were more than the pre test mean scores.

Fourth objective Find the association between knowledge and practice of

the mothers regarding home care management of children with juvenile
diabetes

107
The analysis of association between the knowledge and practice level and
demographic Variables showed that there was a significant relationship between
knowledge and age, knowledge and religion, knowledge and education,
knowledge and occupation, knowledge and Monthly income, knowledge type of
family, knowledge and family history, knowledge and insulin administration
frequency of medical check up,

The analysis of association between the knowledge and practice level and
demographic Variables showed that there was a significant relationship between
practice and age, practice and religion ,practice and education, practice and
occupation, practice and Monthly income, practice type of family ,practice and
family history ,practice and insulin administration, frequency of medical check
up

conclusion

It is evident from the findings of the study that there was significant difference
between pre test and post test effectiveness of Structured Teaching on
knowledge scores of mothers regarding home care management of children with
juvenile diabetes mellitus. The findings mean value for pre test score was
8.7400 In the post test mean knowledge score was 26.1600.standard deviation
of post test was 19.2000.standard error was0.6063 respectively. The calculated t
value was -17.589 which is higher than the table t value at 49 df with 0.05 level
of significance.in practice level the obtained t value was -19.097, which is
greater than the table value at 2.02 at 49 df at 0.05 level of significance which
shows the effectiveness of structured teaching

Hypothesis

H1: There will be significant difference between mean pre and post-test
knowledge score <0.05 after structed teaching programme among mothers.

108
H2: There will be significant difference in the practices scores among mothers
before and after structured teaching programme

H3: mothers who are receive structured teaching programme regarding Juvenile
diabetes will show a significant improvement in the level of knowledge and
practices with demographic variables. Hence research hypothesis is accepted

H4: There will be significant association between knowledge scores and

practices score of mothers regarding home care management of children with
juvenile diabetes.

Implications

The findings of the study can be implicated in the areas of nursing practice,
administration, education and research.

Nursing practice

Nursing can help the care takers of children with juvenile diabetes mellitus to
improve their knowledge to the healthy life style for the children the remaining
life with optimum physical health and psychological wellbeing and nurse also
can teach the family members regarding the physiological changes symptoms
and care of the chidren with juveni diabetes mellitus there by care takers may
get co-operation from the family members.

Nursing administration

The nurse administrator need to plan staff development programs in the hospital
as well as community on home care management of juvenile diabetes thus the
staff can be informed about the home care management of juvenile diabetes
mellitus. This can help in educating care takers of children with juvenile
diabetes mellitus their family and community as a whole.

109
Nursing research

Research helps nurse to take appropriate decisions on the needs of care takers of
children with juvenile diabetes mellitus regarding home care management.
Evidence based research activities by the nurses in the health care setting will
help to solve the problems, to take right decisions in meeting the needs of the
cafe taker.

Research may be done continuously on knowledge regarding home care

management of juvenile diabetes mellitus Research will provide nurses the
Credibility to influence decision making and to educate staff nurses and student
nurses regarding home care management of juvenile diabetes mellitus.

Nursing education

The nursing education should prepare nurses with the potential for imparting
heath information effectively and assist the people in the community and
hospital settings in the development of self care potential development.

recommendations:

The similar study can be conducted on large sample The analyzed can be
conducted on care takers of children with juvenile diabetes regarding home care
management.

Epilogue

This chapter dealt with findings of the study that is, Effectiveness Structured
Teaching programme on knowledge and practices of mothers regarding home
care management of child with juvenile diabetes mellitus with demographic
variables, t, discussion implications in nursing practice, nursing administration
and nursing research, nursing education limitations encountered during the
study, ‘recommendations for future students.

110
Biblography.

1. Dorothy R Marlow (2012) text book of pediatric nursing 6th edition. Nev
Delhi published by Elsevier, printed and bound in Saurabh printers. 1050-1053

2.Dorothy R Marlow (2012) text book of pediatric nursing 6th edition. New
Delhi published by Elsevier, printed and bound in 1053.

3.Jane W. Ball and Ruth C. Binder (2009), Text book of Paediatric Nursing,
page no 12-13
4.Polit. F.D. and Beck, Essential of Nursing Research, 8 th edition, Philadelphia,
Williams and Wilkins Publishers, page no 196
International journal of health problems and its management, 6 th edition,
Kingsville,
5.Carin F, Engels R, Baumeister RF. Parenting behaviour and adolescent
behavioural and emotional problems: The role of self-control. Int J Behave.
6.Marilyn E. Parker. “ Nursing theories and nursing practice” 2 nd edition
published by Jaypee brothers medical publishers
7.Denise F.Polit and cherlyTatano Beck, (2012) nursing research generating and
assessing evidence for nursing practice, 9" edition. Williams & Wilkins (2012)
3, 50-52, 58, 73-84,274-275,741-742,745,New Delhi: wolters kluer
health/Lippincott

Journals:

1. Journal of Nightingale Nursing times February 2019, vol Xiii No 11 pg.

no:
2. M’CAMM nursing journal, World Population Day Volume: I, August
2009

111
3. The Nursing Journal of India World Cancer Day, February 2018
4. Indian journal of paediatrics march an international journal 2016.
5. Nightingale Nursing Times volume 15 September 2019 page no:31
6. International journal of advance in Nursing Management Volume 04
sept.2016,
7. International journal of health problems and its management, 6th edition,
Kingsville,
8. Collins, Airhihenbuwa (2020), Journal of health promotion practice, page
no:
9. htt-s:/Iwww.ncbi.nim.nih. +» ov/ + mc/articles/PMC4113115/
10.World health organization
11.www.thehansindia.com>sunda -Hans

112
 Appendix.A

Letter for content validity

Hyderabad

Date

To

__________________

__________________

Respected sir/Madam,

Sub; Ms.A.Malleshwari M Sc(N)2nd Year

Student tool validity with request regarding……

I ms.A.Malleshwari M.Sc(N) 2nd year student bring your kind notice that I am
conducting a research on topic ‘‘Effectiveness of Structured Teaching
Programme on Knowledge and Practices of Mothers Regarding Home
Care Management of Children with Juvenile Diabetes at Niloufer Hospital,
Hyderabad, Telangana.’’

For the partial fulfilment of M.sc( Nursing) Programme. I kindly request

you to validate my tool and give me your valuable suggestions.

Thanking you

Yours Obediently,

A.Malleshwari,

113
 M.sc(N)2nd year student,

Govt.collage of Nursing,

Appendix.B

GOVERNMENT COLLEGE OF NURSING

No. ACAD/GCON/2021 Date:

From, To,
Prof. (Mrs.).D.R.Radha Rukmini Medical Superintendent,
Principal, Osmania Hospital,
Government College of Nursing, Afzal Gunj,
Hyderabad, Rajbhavan Road, Hyderabad, T.S.
Hyderabad, T.S.
Sir,
Sub: - Govt.College of Nursing, Hyderabad –M.Sc. (N) 2nd year student - Permission
for pilot study and data collection –Requested – Reg.

I have pleasure in introducing the following Miss.A.Malleshwari, M.Sc. (N) 2 nd year student
of this college who is doing the project study in partial fulfillment of the M.Sc. Nursing
postgraduate course. The topic of project work is furnished below:

Topic: ‘‘Effectiveness of Structured Teaching Programme on Knowledge and Practices

of Mothers Regarding Home Care Management of Children with Juvenile Diabetes at
Niloufer Hospital, Hyderabad, Telangana.’’In this connection, she would like to conduct
pilot study and data collection. I request you to give permission for the same and extend your
guidance and cooperation in this matter.

Thanking you,

Yours sincerely,

114
 PRINCIPAL

Appendix.C

GOVERNMENT OF TELANGANA

No.CON-ACAD/21 Date:

From,

Prof. (Mrs) D.R.Radha Rukmini, To

Principal, The Medical superintendent,

Govt. College of nursing, Niloufer Hospital,

Hyderabad-500082. T.S Redhill’s, Hyderabad, T.S

Sir,

Sub: Govt. College of Nursing, Hyderabad-2nd year M.Sc( Nursing) course

Permission for main study and Data Collection-Requested.

I have Pleasure in Introducing following Miss. A. Malleshwari 2nd year M.sc

(Nursing) student of this college who is doing Project Work for partial
Fulfilment of her M.Sc. (Nursing) Post Graduate Course. Topic of the Project
Work is Furnished Below.

‘‘Effectiveness of Structured Teaching Programme on Knowledge and

Practices of Mothers Regarding Home Care Management of Children with
Juvenile Diabetes at Niloufer Hospital, Hyderabad, Telangana.’’

In this Connection, She need permission for Data Collection in your hospital. I
request you kindly give permission for the same and extent your guidance and
co-operation in this matter

Thanking You,
115
 Your sincerely

PRINCIPAL
Appendix.D

METHOD OF DATA COLLECTION

Investigator plan for structured questionnaire to obtain demographic data and
Knowledge of mothers and observational check list on practices of home care
management
DEVELOPMENT AND DESCRIPTION OF TOOLS
The structured questionnaire consist and divided in to Part-A, Part-B & Part-c
Part-A Deals with demographic data
Part -B Deals with knowledge of mothers and practices, further divided into
Section- I Deals with questionnaire regarding Anatomy and physiology of
pancreas
Section -II Deals with Questionnaire regarding meaning, causes, signs &
symptoms of juvenile diabetes
Section-III Deals with Questionnaires regarding diagnostics tests &
management
Section-IV Deals with Questionnaire regarding home care management &
complications of juvenile diabetes
Part -C Deals with observational check list on practices at home care
management.

116
 PART-A
DEMOGRAPHIC DATA

CODE NO---------- DATE;

1) Age of the mother in years ( )

a) 21 years to 30 years
b) 31 years to 40 years
c) 41 years to 50 years
d) 51years to 60 years
2) Religion ( )
a) Hindu
b) Muslim
c) Christian
d) Others
3) Education of the mother ( )
a) Illiterate
b) Primary school
c) High school
d) Inter and above
4) Occupation of the mother ( )
a) Home maker
b) Labourer
c) Private employee
d) Government employee

117
5) What is the monthly income of the family ? ( )
a) >199,862
b) 999,932-199,861
c) 74,756-99,930
d) 49,962-74,755
e) 29,973-49,961
f)10,002-29,972
g) < 10,001

6) Type of Family ? ( )
a) Nuclear family
b) Joint Family
c) Extended Family
d) single parent family
7)Do you have family history of juvenile diabetes ? ( )
a) yes
b) No
8) Do you have knowledge regarding about insulin administration?
a) Yes
b) No
9) How often do you go for medical check-up? ( )
a) weekly
b) monthly
c) quarterly
d) yearly

118
 PART-B
SECTION-I
Questionnaire regarding Anatomy& physiology of pancreas

1)Which organ secretes the Insulin in the body? ( )

a) Liver
b) Kidneys

c) Pancreas
d) Stomach
2) where the pancreas Located? ( )
a) Right side of stomach
b) Left side of stomach
c) Right side of Intestine
d) Beside the stomach
3) What is the Function of pancreas? ( )
a) Secretion of insulin
b) Secretion of fat
c) Secretion of saliva
d) Secretion of sweat
4) What is the action of insulin in the body? ( )
a) Maintaining the blood glucose level
b) Increases the blood glucose level
c) Decreases the blood urea level
d) Increases the blood urea level

119
 Section -II
Questionnaire regarding meaning, causes, signs & symptoms of juvenile
diabetes
5) What is type 1 diabetes ? ( )
a) Non-insulin dependent diabetes
b) Insulin dependent diabetes
c) Gestational diabetes
d) Onset diabetes
6)How do you identify juvenile diabetes mellitus in the child? ( )
a) Excessive urination, increase hunger
b) Decreased urination, decreased thirst
c) Decreased hunger, wet mouth

d) Weight gain, decrease hunger

7) What are the symptoms of hypoglycemia? ( )
a) Excessive sweating
b) Decrease thirst
c) Decrease hunger
d) Dry mouth
8) How to manage a child with hypoglycemia? ( )
a) Administration of insulin injection
b) Immediately drinking of sugar water
c) Taking of rest
d) Administration of fluid

120
 SECTION -III
Questionnaires regarding diagnostics tests & management

9) What diagnostic tests is preferred for juvenile diabetes?

( )
a) Serum Bilirubin
b) Random Blood Sugar
c) Complete Blood picture
d) Serum creatinine
10) The treatment of Juvenile diabetes should be included with? (
)
a) Exercises, Diet
b) Heparin
c) Antibiotics
d) IV fluids
11) which therapy is to be included in treatment of Juvenile diabetes ? (
)
a) Insulin injection therapy
b) Chemo therapy
c) Antibiotic therapy
d) Fluid therapy
12) How frequently blood sugar level need to be tested? (
)
a) once in week
b) twice in week
c) thrice in week
d) Once in 30 days

121
13) What is the time span of short acting insulin? ( )
a) 1/2 to 1 hours
b) 2 to 3 hours
c) 4 to 5 hours
d) 6 to 7 hours
14) What is the onset of intermittent acting insulin is? ( )
a) 1 to 6 hours
b) 6 to 12 hours
C) 12 to 18 hours
d) 18 to 24 hours
15) What is the time span of long-acting insulin? ( )
a) up to 6 hours
b) 6 to 12 hours
c) 12 to 24 hours
d) 24 to 48hours
16) Which fruits are to be avoided by the child with juvenile diabetic?
( )

a) Apple, guava

b) Sapota, custard apple, banana , ,

c)Papaya, orange

d)grapes, pomegranate

122
17) How do the exercises help the juvenile diabetes patient? (
)
a) Maintain blood glucose level
b) Maintain blood Pressure level
c) Maintain Cholesterol level
d) Maintain potassium level

123
 SECTION-IV
Questionnaire regarding home care management & complications of
juvenile diabetes

18) How frequently the body weight shall be checked? ( )

a) Once in monthly
b) Once in three months
c) Once in six months
d) Once in year
19) which of following The instrument used for blood glucose monitoring

is? a) Glucometer
( )

b) Thermometer

c) Sphygmomanometer

d) stethoscope
20) Which tool/ instrument is used to prick the finger? ( )

a) Lancet (Needle)

b) Blade

c) knife
d) sharp item

124
21)Where should the insulin vials be stored? (
)
a) Microwave oven
b) Refrigerator & Earthen pot
c) Store in box
d) Store in hot box
22) Which precautionary measures should be taken before taking insulin
injection? ( )
a) Hand washing
b) Take food
c) Wear clean clothes
d) Take bath
23) How to clean the skin ? (
)
a) Swab dipped in water
b) Swab dipped in Dettol
c) Sprit swabs
d) Dry cotton
24) Why the insulin vials are to be rolled between Palms before taking
insulin Injection?
( )
a) To make the insulin more cool
b) To make the insulin hot
c) To bring insulin to the room temperature
d) To mix the insulin in the vials

125
25) What is the ideal time to take insulin injection?
( )
a) 1/2 hour after food
b) 1/2 hour before food
c) 1 hour after food
d) 1 hour before food
26) What is the ideal site for administration of insulin injection in the ? (
)

a) Abdomen
b) chest
c) legs

d) buttocks
27) Which types of syringes are preferred for insulin injection ? (
)
a) Disposable syringe with marked units
b) 2ml syringe
c) 5 ml syringe
d) 10 ml syringe
28) While giving insulin injection the angle of the subcutaneous needle
Should be? ( )
a) 30 degrees angle
b) 45 degrees angle
c) 60 degrees angle
d) 90 degrees angle

126
 Appendix E
పార్ట్-ఎ
డెమోగ్రాఫిక్ డేటా

కోడ్ సంఖ్య ---------- తేదీ;

1) సంవత్సరాల్లో తల్లి వయస్సు ( )

ఎ) 21 సంవత్సరాల నుండి 30 సంవత్సరాల వరకు
బి) 31 సంవత్సరాల నుండి 40 సంవత్సరాల వరకు
సి) 41 సంవత్సరాల నుండి 50 సంవత్సరాల వరకు
డీ) 51 సంవత్సరాల నుండి 60 సంవత్సరాల వరకు
3) మతం
( )
ఎ) హిందూ
బి) ముస్లిం
సి) క్రిస్టియన్
డీ) ఇతరులు
3) తల్లి విద్యార్హత
( )
ఎ) నిరక్షరాస్యులు
బి) ప్రాథమిక విద్య
సి) ఉన్నత విద్యా
d) ఇంటర్ మరియు అంతకంటే ఎక్కువ
4) వృత్తి
( )

127
ఎ) ఇంటి తయారీదారు
బి) కార్మికుడు
సి) ప్రైవేట్ ఉద్యోగి
d) ప్రభుత్వ ఉద్యోగి

5) కుటుంబం యొక్క నెలవారీ ఆదాయం ఎంత? ( )

a)> 199,862
బి) 999,932-199,861
సి) 74,756-99,930
d) 49,962-74,755
ఇ) 29,973-49,961
f) 10,002-29,972
g) <10,00
6) కుటుంబ రకం? ( )
ఎ) అణు కుటుంబం
బి) ఉమ్మడి కుటుంబం
సి) విస్తరించిన కుటుంబం
d) ఒకే మాతృ కుటుంబం
7) మీకు బాల్య మధుమేహం యొక్క కుటుంబ చరిత్ర ఉందా? ( )
ఎ) అవును
బి) లేదు
8) ఇన్సులిన్ అవగహన గురించి మీకు ఎలా తెలుసు (
)
ఎ) అవును
బి) లేదు
9) వైద్య పరిక్షల కోసం ఎన్ని రోజులకు ఒకసారి తరచుగా వెళ్తారు ?
( )
ఎ) వారం
బి) నెలవారీ

128
 సి) త్రైమాసికం
డి ) వార్షిక

పార్ట్-బి
విభాగం -1
అనాటమీకి సంబంధించిన ప్రశ్నపత్రం

1) ‌ఇన్సులిన్‌ను ఏ అవయవం స్రవిస్తుంది? ( )

ఎ) కాలేయం

బి) కిడ్నీలు

సి) క్లోమం

డి) కడుపు
2) క్లోమం ఎక్కడ ఉంటుంది ? ( )
a) జీర్ణాశయం యొక్క కుడి వైపు
బి) జీర్ణాశయం యొక్క ఎడమ వైపు
సి) ప్రేగుల యొక్క కుడి వైపు
డి) జీర్ణాశయం వెనుక వైపు
3) క్లోమం యొక్క పని ఏమిటి? ( )
ఎ) ఇన్సులిన్ ఉత్పత్తి చెయడం
బి) కొవ్వు ఉత్పత్తి చెయడం
సి) లాలాజల ఉత్పత్తి చెయడం
డి) చెమట ఉత్పత్తి చెయడం
4) శరీరంలో ఇన్సులిన్ పని ఏమిటి? ( )
ఎ) రక్తంలోఉన్నా గ్లూకోజ్ స్థాయిని అదుపు చేయడం
బి) రక్తంలో గ్లూకోజ్ స్థాయిని పెంచుతుంది
సి) రక్తంలో యూరియా స్థాయిని తగ్గిస్తుంది
డి) రక్తంలో యూరియా స్థాయిని పెంచుతుంది

129
 విభాగం -II
బాల్య మధుమేహం యోక్కా అర్థం, కారణాలు, సంకేతాలకు సంబంధించిన
ప్రశ్నపత్రం

5) టైప్ 1 డయాబెటిస్ అంటే ఏమిటి? ( )

ఎ) ఇన్సులిన్ ఆధారపడని మధుమేహం
బి) ఇన్సులిన్ ఆధారిత మధుమేహం
సి) గర్భధారణ మధుమేహం
డి) మధుమేహం
6) పిల్లలలో జువెనైల్ డయాబెటిస్ మెల్లిటస్‌ను ఎలా గుర్తిస్తారు?
( )
ఎ) అధిక మూత్రవిసర్జన, ఆకలిని పెంచుతుంది
బి) మూత్రవిసర్జన తగ్గింది, దాహం తగ్గుతుంది
సి) ఆకలి, నోరు తడి ఆరిపోవుట
డి) బరువు పెరుగుట, ఆకలి తగ్గుతుంది
7) హైపోగ్లైసీమియా యొక్క లక్షణాలు ఏమిటి? ( )
ఎ) అధిక చెమట
బి) దాహం తగ్గడ o
సి) ఆకలి తగ్గడ o
డి) పొడి నోరు
8) హైపోగ్లైసేమియా ఉన్న పిల్లవాడికి ఎలాంటి చికిత్స అందించాలి?
( )
ఎ) ఇన్సులిన్ ఇంజెక్షన్ ఇవ్వడం ద్వారా
బి) వెంటనే చక్కెర నీరు త్రాగించాలి
సి) విశ్రాంతి తీసుకోవడం ద్వారా
డి) ద్రవాలను ఇవ్వడం ద్వారా

130
 విభాగం -III
విశ్లేషణ పరీక్షలకు సంబంధించిన ప్రశ్నపత్రాలు

9) బాల్య మధుమేహాన్ని నిర్ధారించడానికి కింది వాటిలో ఏ పరీక్షలు

చేయవలసి ఉంటుంది?
( )
ఎ) సీరం బిలిరుబిన్
బి) రాండమ్ బ్లడ్ షుగర్
సి) పూర్తి రక్త చిత్రం
డి) సీరం క్రియాటినిన్
10) జువెనైల్ డయాబెటిస్ చికిత్సలో ఏది ముఖ్యమైనది?
( )
ఎ) వ్యాయామాలు, ఆహారం
బి) హెపారిన్
సి) యాంటీబయాటిక్స్
d) ఇంట్రా వినియస్ ద్రవాలు
11) జువెనైల్ డయాబెటిస్‌కు అందించవలసిన ప్రత్యేక చికిత్స ఏమిటి ? (
)
(ఎ) ఇన్సులిన్ ఇంజెక్షన్ థెరపీ
బి) కీమో థెరపీ
సి) యాంటీబయాటిక్ థెరపీ
డి) ద్రవ చికిత్స
12) రక్తంలో చక్కెర స్థాయిని తరచుగా ఎన్ని రోజులకు ఒకసారి
పరీక్షించాల్సిన అవసరం ఉంది?
( )
ఎ) వారానికి ఒకసారి
బి) వారంలో రెండుసార్లు
సి) వారంలో మూడుసార్లు
డి) నెలకు ఒకసారి

131
13)తక్కువ సమయంలో పనిచేసే ఇన్సులిన్ యొక్క వ్యవధి ఎంత? ( )
ఎ) 1/2 నుండి 1 గంటలు
బి) 2 నుండి 3 గంటలు
సి) 4 నుండి 5 గంటలు
డి) 6 నుండి 7 గంటలు
14)మధ్యస్తంగా పనిచేసే ఇన్సులిన్ యొక్క వ్యవధి ఎంత? (
)
ఎ) 1 నుండి 6 గంటలు
బి) 6 నుండి 12 గంటలు
సి) 12 నుండి 18 గంటలు
డి) 18 నుండి 24 గంటలు
15) దీర్ఘకాలం పనిచేసే ఇన్సులిన్ వ్యవధి ఎంత? (
)
ఎ) 6 గంటల వరకు
బి) 6 నుండి 12 గంటలు
సి) 12 నుండి 24 గంటలు
డి) 24 నుండి 48 గంటలు
16) జువెనైల్ డయాబెటిస్‌క తో ఉన్న పిల్లవాడు ఏ పండ్లను తినకూడదు? (
)

a) ఆపిల్, గువా

బి) సపోటా, కస్టర్డ్ ఆపిల్, అరటి,

సి) బొప్పాయి, నారింజ

డి) ద్రాక్ష, దానిమ్మ

17)బాల్య మధుమేహ పిల్లలకి వ్యాయామాలు ఎలా సహాయపడతాయి? ( )
ఎ) రక్తంలో గ్లూకోజ్ స్థాయిని అదుపు చేయడానికి సహాయపడుతుంది
బి) రక్తపోటును అదుపు చేయడానికి
సి) కొలెస్ట్రాల్ స్థాయిని అదుపు చేయడానికి
డి) పొటాషియం స్థాయిని అదుపు చేయడానికి

132
 విభాగం- IV
బాల్య మధుమేహం యొక్క సమస్యలు ,గృహ సంరక్షణ నిర్వహణకు
సంబంధించిన ప్రశ్నపత్రం

18) శరీర బరువును ఎంత తరచుగా తనిఖీ చేయాలి? (

)
ఎ) నెలవారీ ఒకసారి
బి) మూడు నెలలకు ఒకసారి
సి) ఆరు నెలలకు ఒకసారి
డి) సంవత్సరానికి ఒకసారి
19) రక్తంలో గ్లూకోజ్ స్థాయిని పరీక్షించడానికి ఏ పరికరంను
ఉపయోగించాలి? ( )

ఎ) గ్లూకోమీటర్

బి) థర్మామీటర్

సి) స్పిగ్మోమానొమీటర్

డి) స్టెతస్కోప్

20) వేలును గుచ్చుటకు ఏ పరికరాన్ని ఉపయోగిస్తారు ? (

)

ఎ) లాన్సెట్ (సూది)

బి) బ్లేడ్

సి) కత్తి

డి) పదునైన అంశం

133
21) ఇన్సులిన్ వైల్స్ ఎక్కడ నిల్వ చేయాలి?
( )
ఎ) మైక్రోవేవ్ ఓవెన్
బి) రిఫ్రిజిరేటర్ & మట్టి కుండ
సి) పెట్టెలో నిల్వ చేయండి
డి) హాట్ బాక్స్‌లో నిల్వ చేయండి

22) ఇన్సులిన్ ఇంజెక్షన్ తీసుకునే ముందు ఎలాంటి జాగ్రత్తలు

తీసుకోవాలి? ( )
ఎ) చేతులు కడుక్కోవడం
బి) ఆహారం తీసుకోండి
సి) శుభ్రమైన బట్టలు ధరించండి
డి) స్నానం చెయడం
23) ఇన్సులిన్ ఇంజెక్షన్ తీసుకునే ముందు చర్మాన్ని ఎలా శుభ్రం చేయాలి?
( )
ఎ) నీటిలో ముంచిన దూదితో
బి) డెట్టోల్‌లో ముంచిన దూదితో
సి) స్ప్రిట్ లో ముంచిన దూదితో
డి) పొడి పత్తితో
24) ఇన్సులిన్ ఇంజెక్షన్ తీసుకునే ముందు చేతుల మధ్య ఇన్సులిన్ వైల్స్
లను ఎందుకు రుద్దాలి?
( )
ఎ) ఇన్సులిన్ మరింత చల్లగా ఉండటానికి
బి) ఇన్సులిన్ వేడిగా చేయడానికి
సి) గది ఉష్ణోగ్రతకు ఇన్సులిన్ తీసుకురావడం
డి) సీసాలో ఇన్సులిన్ కలపడానికి
25) ఇన్సులిన్ ఇంజెక్షన్ తీసుకోవడానికి అనువైన సమయం ఏది? ( )
ఎ) ఆహారం తర్వాత 30 నిమిషాలకు
బి) ఆహారానికి ముందు 30 నిమిషాలకు
సి) ఆహారం తిన్న గంట తర్వాత

134
డి) ఆహారానికి గంట ముందు

26) శరీరంలో ఇన్సులిన్ ఇవ్వడానికి సరైన ప్రదేశం ఏది? (

)

ఎ) కడుపు
బి) చాతి

సి) కాళ్లు

డి) పిరుదులు
27) ఇన్సులిన్ ఇంజెక్షన్ కోసం ఏ రకమైన సిరంజిలను ఉపయోగిస్తారు? (
)
ఎ) గుర్తించబడిన యూనిట్లతో పునర్వినియోగపరచలేని సిరంజి
బి) 2 ఎంఎల్ సిరంజి
సి) 5 మి.లీ సిరంజి
డి) 10 మి.లీ సిరంజి
28) ఇన్సులిన్ ఇంజెక్షన్ ఇచ్చేటప్పుడు సబ్స్కు టేనియస్ సూది యొక్క
కోణంఎంత ఉండాలి? ( )
a) 30 డిగ్రీల కోణం
బి) 45 డిగ్రీల కోణం
సి) 60 డిగ్రీల కోణం
డి) 90 డిగ్రీల కోణం

135
 PART -C
Observational check list on practices of homecare management
S.NO QUESTIONS YES NO
1) Wash hands Before administration of insulin

2) Selection of right route for insulin

administration

3) Selection of right dose for insulin

administration

4) Checking glucose level before administering

the insulin

5) Turn on the glucometer and insert the glucose

strip

6) Clean the site with sprit swab

7) Pricking the skin with lancet

8) Wiping and cleaning the remaining blood with

cotton by applying pressure

9) Recording the blood glucose level

10) Administering correct dose of Insulin

11) Wash hands After administration of insulin

12 ) Store Insulin at correct temperature

136
13) Taking food at the right time

14) Following monthly health check up

15) Check monthly body weight

16) Check weekly blood sugar levels

17) Following daily exercises

18) Follow healthy nutritional diet?

137
 LESSON PLAN
ON
JUVENILE DIABETES

Guide-II Guide -I
Mrs.A. Sunitha Mrs. G. Kamala
Lecturer professor
Govt.collage of Nursing Govt.collage of Nursing
138
 Objectives

General Objectives: By the end of the structured teaching programme the group able to know about the juvenile diabetes
and its home care management.

Specific objectives: Group will able to

 Explain the anatomy and physiology of pancreas

 Define Juvenile Diabetes
 Describe the etiology of Juvenile Diabetes
 Discuss the pathophysiology of Juvenile Diabetes
 Enlist the clinical manifestations of Juvenile Diabetes
 Explain the management of Juvenile Diabetes
 Describe the diet management of Juvenile Diabetes
 Explain the glucose monitoring for Juvenile Diabetes
 Describe the exercises done for Juvenile Diabetes
 Discuss the insulin treatment for Juvenile Diabetes

139
 Student profile
Name of the student: A. Malleshwari

Course : MSc(N) II nd year

Topic : Home Care Management of Juvenile Diabetes Mellitus
Group : care takers
Place : Niloufer hospital

Method of teaching : Lecture cum Discussion with structured teaching programme

AV Aids : structured teaching programme

Duration : 20minutes

Guide -I : Mrs. G. Kamala, Professor, Govt college of Nursing,

Hyderabad

Guide-II : Mrs. A. Sunitha, Lecturer, Govt collage of Nursing,

Hyderabad

140
Objectives Time Content Teaching Evaluation
&
learning
activity
Introduction

Children are best hope for the future. Today's children are
1mt citizens of tomorrow. Such an importance is given to children. Structured
lf the children are healthy the nation will be healthy. If the teaching
children are affected with any disease then the whole family programme
will be disturbed. This will affect the future generation.
Approximately 5% of children have a first or degree
relative with Juvenile diabetes mellitus. There is equal
distribution between the genders with the peak incidence
occurring in school age children. Diabetes is a chronic systemic
disease characterized by disorders in the metabolism of insulin,
carbohydrate, protein and fat as well as abnormalities in the
structure and function of blood vessel.

141
Explain the Anatomy and physiology What is
anatomy and The pancreas is, located in the abdominal cavity behind the anatomy and
physiology of stomach. It is an endocrine gland producing several important physiology o
pancreas hormones, including insulin, glucagon, somatisation and pancreas
pancreatic polypeptide which circulate in the blood. The
pancreas is also a digestive organ secreting pancreatic juice
containing digestive enzymes that assist digestion and
absorption of nutrients in the small intestine...
Define juvenile 1mt Definition What is juvenile
diabetes Juvenile diabetes is a metabolic disorder that affects the diabetes ?
carbohydrate, protein, fat metabolism. It is associate with an
List out the Absolute or relative deficiency of insulin secretion or insulin
incidence of action. What is the
juvenile Incidence incidence of
diabetes At present in India 62million individuals are suffering. The juvenile
prevalence of diabetes is predicted to double globally diabetes?
from171million to 366 million in 2030 with a maximum

142
 increase in India. 16.6% in Hyderabad.
Types
1. Juvenile diabetes
2. Diabetes mellitus
1.Juvenile diabetes is also known as insulin dependent diabetes
mellitus or type 1 diabetes mellitus although disease onset can
occur at any age, the peak age for diagnose is 10 to 12years,
type 1 diabetes develops when pancreas is destroyed, that
completely eliminates the production and secretion of insulin.
To survive people with type 1 diabetes insulin delivered by
injection or a pump.
2.Diabetes mellitus is also known as non-insulin dependent
diabetes
mellitus or type 2 diabetes mellitus or adult onset diabetes,
when What is the
1mt pancreas gradually loses the ability to produce sufficient etiology of
Describe the quantities of insulin. juvenile
aetiology of etiology diabetes?

143
juvenile The cause of juvenile diabetes mellitus is unknown, the
diabetes precipitating factors like:
 genetic pattern,
 autoimmune disease,
 viral infections,
 chemicals and drugs

Discuss the 2mts Pathophysiology What is the

pathophysiolog pathophysiology
y  The pathophysiology in juvenile diabetes is a destruction of juvenile
Of juvenile of beta cells in the pancreas, regardless of which risk diabetes ?
diabetes factors or causative entities have been present. What are the
Enlist clinical 2mts Clinical Manifestations clinical
manifestations  The classical symptoms of juvenile diabetes include: manifestation of
of juvenile  Excessive urination: Increased thirst, Dry mouth, juvenile
diabetes  Increased hunger diabetes
 Fatigue, and e Weight loss.

144
 Diagnosis
List the 3mts  Diagnosis of juvenile diabetes done by How to
diagnostic tests  History Diagnose
for juvenile  Physical examination juvenile
diabetes  Blood examination diabetes ?
 Urine examination,
Management
Explain the 2mts  Diet What is the
management of  Exercises management of
juvenile  Glucose monitoring juvenile
diabetes  Insulin therapy diabetes ?

Diet
Describe the 2mnts  Juvenile diabetes children should eat sugar balanced What is the
Dietary healthy diet. Daily should need to take 2000kcals per dietary
management of day. management of
juvenile  Cereals, corn flakes, oats, green leafy vegetables, fruits juvenile

145
diabetes providing easily energy, lots of fibre, vitamins, and diabetes ?
minerals
 Sapota, banana, custard apple should be avoided
because these fruits have more sugar contents
 Avoid fried foods.
 Limit the number of eggs eat to four per week.
 Choose fish and skinless poultry and lean meats. Cooked
oat meal is an inexpensive, healthy cereal.
 Aloe Vera juice, bitter guard juice, menthe seeds will
control the sugar levels in the blood.
 We should provide children diet two times pulka, and
one time rice. When we take balanced diet, we can
minimise the sugar levels in the blood.

146
 Glucose monitoring How to monitor
8mts  Testing blood glucose level once in a week, adjusting glucose levels
Explain the insulin doses according to food intake, exercises, and for juvenile
glucose blood glucose levels. diabetes
monitoring for  Daily urine for sugar test should be done.
juvenile  we should provide diet to child according to diet,
diabetes exercises, blood glucose levels, and insulin dose.
 Daily we can measure the glucose levels with the use of
an instrument called glucometer.
Monitoring glucose levels with glucometer
 A glucometer is a medical tool available for home use
that determine the amount of glucose levels in the blood.
Blood glucose monitoring refers to the ongoing
measurement of blood sugar. Monitoring can be done at
any time using a portable device called glucometer.
Articles needed:
Glucometer — To monitor blood sugar levels.
Test strips — To take sample

147
 Spirit — To prevent cross infection
Cotton swabs — To wipe the area
Lancets — To prick the finger

Procedure
5mnts  Assemble all necessary supplies, make sure that
everything need and that the test strips are not expired
according to expiry date on the package.
 Wash hands with soap and water and rinse thoroughly.
This will reduce the chance of infection at the puncture
site.
 Turn on the glucometer and insert a test strip, according
to their directions on the test strip. One side of the test
strip is meant for blood collection.
 Wipe the fingertip with an alcohol pad and allow to dry.
 Pierce the skin of the fingertip with the lancet. Squeeze
the finger blood drop forms.

148
  Place the edge of the test strip against the blood drop
until strip draws the required amount of blood. The
glucometer will signal that it has obtained the
appropriate amount of blood that testing has begun.

 Wipe away any remaining blood with a cotton and apply

pressure to the site to stop bleeding. If necessary.

 Record the glucose test results, after the test done.

Exercises
What are the
 Exercises play an important role in maintaining blood
5mts exercises to be
glucose
Discuss the done for
levels. we should have more benefits from exercises.
exercises done juvenile
 Exercises minimise the sugar levels in the blood, thereby
for juvenile diabetes
preventing the heart diseases.
diabetes
 Exercises lowering of blood glucose levels
 Improvement in insulin sensitivity
 Burning more calories

149
  Increased strength and flexibility

 improvements in attitude, sense of well-being and

quality of life.

 Exercise for more than 30 minutes, drink water during

the workout. Water is the best fluid replacer
Insulin therapy
How will you
There are four main types of insulin: rapid acting insulin, short
Discuss the 5mts manage juvenile
acting insulin, intermediate acting insulin, and long acting
insulin therapy diabetes with
insulin. The rapid acting insulin is used as a bolus dosage. The
for juvunile insulin therapy?
action onsets in 15 minutes with peak actions in 30 to 90
diabetes
minutes. Short acting insulin
 action onsets within 30 minutes with the peak action
around 2 to 4 hours. Intermediate acting insulin action
onsets within 1 to 2 hours with peak action of 4 to 10
hours’ duration 12 to 28 hours. Long acting insulin is
usually given once per day. The action onset is

150
 roughly 1 to 2 hours with a sustained action of up to
36 hours.
 Insulin should be refrigerated at 1 to 8degrees
centigrade inside the refrigerator. Cloudy Insulin’s
should be thoroughly mixed by gently inverting the
vial or rolling it between the hands before drawing
the solution into a syringe or a pen.

 Syringes must be matched with the insulin

concentration (e.g.: U-100). Currently 3 sizes of U-
100 insulin syringes are available, should use Unit
type disposable.
* 1mi syringes that hold 100units.
* O.5ml syringes that hold 50units.
* 0.3ml syringes that hold 30units.
The ideal time to take insulin injection is half an hour before
food. The four main areas for injection are the abdomen, upper
arms (posterior surface) thighs (anterior surface) and hips.
Insulin is absorbed faster in some areas of the body than

151
decreases progressively in the arm, thigh and hip respectively.
Insulin technique
 Wash hands thoroughly. Take out the vials from the
refrigerator and roll the insulin vials between two
palms to bring them to the room temperature.
 Clean the site of injection with a spirit cotton
 Introducing the equal amount of air into the bottle for
withdrawing the prescribed dosage helps in easy
filling and avoids air bubbles.
 With one hand, stabilize the skin by spreading it or
pinching up large areas.
 Pick up syringe with the other hand and hold it as you
would a pencil, insert needle straight into the skin as
90degrees angle/ for children 45degree angle.
 To inject the insulin, push the plunger all the way in.
 Pull needle straight out of the skin, press cotton ball
over injection site for several seconds.
 Use disposable syringe only once and discard into
hard plastic container such as empty bleach or

152
 detergent container. ,
 Hypoglycemia when the child’s blood glucose level
fails below 60mg/dl. Signs of hypoglycaemia are
nervousness, shakiness, sweating, irritability,
impatience, chills, clamminess, rapid heartbeat,
anxiety, light headedness, and hunger
 Home care management of hypoglycemia includes,
immediately taking / drinking of sugar.
 Elders should take care of the children while they are
playing, to prevent injuries, not to quarrel with other
children while they are playing.
 The child should cut their nails frequently to prevent
infections, nail biting, and injuries,

 It is important to know about the juvenile diabetes

melilites and its management for all the family
members.

153
154
 బాల్య మధుమేహ వ్యాధిగ్రస్తుల
పై పాఠ్య ప్రణాళిక

గైడ్- II గైడ్ -I
శ్రీమతి.ఎ. సునీత శ్రీమతి .జి. కమల
లెక్చరర్ ప్రొఫెసర్
ప్రభుత్వ నర్సింగ్ కళాశాల
ప్రభుత్వ నర్సింగ్ కళాశాల

లక్ష్యాలు

సాధారణ లక్ష్యాలు: నిర్మాణాత్మక బోధనా కార్యక్రమం ముగిసే సమయానికి ఈ బృందం బాల్య మధుమేహం మరియు దాని ఇంటి
సంరక్షణ నిర్వహణ గురించి తెలుసుకోగలదు.
నిర్దిష్ట లక్ష్యాలు: సమూహం చేయగలదు
 ప్యాంక్రియాస్ యొక్క అనాటమీ మరియు ఫిజియాలజీని వివరించండి

155
 జువెనైల్ డయాబెటిస్ నిర్వచించండి
 జువెనైల్ డయాబెటిస్ యొక్క ఎటియాలజీని వివరించండి
 జువెనైల్ డయాబెటిస్ యొక్క పాథోఫిజియాలజీని చర్చించండి
 జువెనైల్ డయాబెటిస్ యొక్క క్లినికల్ వ్యక్తీకరణలను నమోదు చేయండి
 జువెనైల్ డయాబెటిస్ నిర్వహణ గురించి వివరించండి
 జువెనైల్ డయాబెటిస్ యొక్క డైట్ మేనేజ్‌మెంట్ గురించి వివరించండి
 జువెనైల్ డయాబెటిస్ కోసం గ్లూకోజ్ పర్యవేక్షణను వివరించండి
 జువెనైల్ డయాబెటిస్ కోసం చేసిన వ్యాయామాలను వివరించండి
 జువెనైల్ డయాబెటిస్ కోసం ఇన్సులిన్ చికిత్స గురించి చర్చించండి

విద్యార్థుల ప్రొఫైల్

విద్యార్థి పేరు : ఎ. మల్లేశ్వరి

156
 కోర్సు : MSc (N) II nd సంవత్సరం

అంశం ; జువెనైల్ డయాబెటిస్ మెల్లిటస్ యొక్క హోమ్ కేర్ మేనేజ్‌మెంట్

సమూహం : సంరక్షణ తీసుకునేవారు

స్థలం : నీలౌఫర్ ఆసుపత్ర

బోధనా విధానం : ‌టీచింగ్ ప్రోగ్రామ్‌తో లెక్చర్ కమ్ చర్చ

AV ఎయిడ్స్ : నిర్మాణాత్మక బోధనా కార్యక్

వ్యవధి : 20 నిమిషాలు

గైడ్ -I : శ్రీమతి జి. కమల, ప్రొఫెసర్, ప్రభుత్వ కళాశాల

నర్సింగ్, హైదరాబాద్

గైడ్- II : శ్రీమతి ఎ. సునీతా, లెక్చరర్, గవర్నమెంట్ కోల్లెజ్ ఆఫ్

నర్సింగ్, హైదరాబాద్

లక్ష్యాలు సమయం కంటెంట్ బోధన బోధన

పరిచయం

పిల్లలు భవిష్యత్తు కోసం ఉత్తమ ఆశ. నేటి పిల్లలు రేపటి పౌరులు. అలాంటి

157
 1 నిమిసం ప్రాముఖ్యత పిల్లలకు ఇవ్వబడుతుంది. పిల్లలు ఆరోగ్యంగా ఉంటే దేశం
ఆరోగ్యంగా ఉంటుంది. పిల్లలు ఏదైనా వ్యాధితో బాధపడుతుంటే కుటుంబం మొత్తం
చెదిరిపోతుంది. ఇది భవిష్యత్ తరాన్ని ప్రభావితం చేస్తుంది.

సుమారు 5% మంది పిల్లలు జువెనైల్ డయాబెటిస్ మెల్లిటస్‌తో మొదటి

లేదా డిగ్రీ బంధువును కలిగి ఉన్నారు. గరిష్ట సంఘటనలతో లింగాల మధ్య సమాన
పంపిణీ ఉంది

క్లోమం యొక్క నిర్మాణా శరీర

అనాటమీ మరియు ఫిజియాలజీ త్మక
శరీర నిర్మాణ నిర్మాణ
బోధనా
శాస్త్రం మరియు ప్యాంక్రియాస్, కడుపు వెనుక ఉదర కుహరంలో ఉంది. ఇది ఎండోక్రైన్ గ్రంథి, శాస్త్రం
కార్యక్ర
శరీరధర్మ మం మరియు
శాస్త్రాన్ని ఇన్సులిన్, గ్లూకాగాన్, సోమాటైజేషన్ మరియు ప్యాంక్రియాటిక్ శరీరధర్మ
వివరించండి పాలీపెప్టైడ్ వంటి అనేక ముఖ్యమైన హార్మోన్లను ఉత్పత్తి చేస్తుంది, ఇవి శాస్త్రం
అంటే క్లోమం
రక్తంలో తిరుగుతాయి. ప్యాంక్రియాస్ జీర్ణ అవయవం, ఇది జీర్ణ ఎంజైమ్‌లను
కలిగి ఉన్న ప్యాంక్రియాటిక్ రసాన్ని చిన్న పేగులోని జీర్ణక్రియ మరియు
పోషకాలను గ్రహించడానికి సహాయపడుతుంది

బాల్య
మధుమేహాన్ని
నిర్వచించండి

బాల్య
నిర్వచనం
1 నిమిసం మధుమేహం
బాల్య మధుమేహం అంటే ఏమిటి?
జువెనైల్ డయాబెటిస్ అనేది జీవక్రియ రుగ్మత, ఇది కార్బోహైడ్రేట్,

158
యొక్క సంఘటనలను ప్రోటీన్, కొవ్వు జీవక్రియను ప్రభావితం చేస్తుంది. ఇది ఇన్సులిన్
జాబితా చేయండి
స్రావం లేదా ఇన్సులిన్ చర్య యొక్క సంపూర్ణ లేదా సాపేక్ష లోపంతో సంబంధం
కలిగి ఉంటుంది.

సంఘటనలు

ప్రస్తుతం భారతదేశంలో 62 మిలియన్ల మంది ప్రజలు బాధపడుతున్నారు.

భారతదేశంలో గరిష్ట పెరుగుదలతో 2030 లో డయాబెటిస్ ప్రాబల్యం
ప్రపంచవ్యాప్తంగా 171 మిలియన్ నుండి 366 మిలియన్లకు రెట్టింపు
అవుతుందని అంచనా. హైదరాబాద్‌లో 16.6%.
బాల్య
రకాలు
మధుమేహం
సంభవం
1. జువెనైల్ డయాబెటిస్
ఏమిటి?
2. డయాబెటిస్ మెల్లిటస్
బాల్య మధుమేహం
యొక్క 1. జువెనైల్ డయాబెటిస్‌ను ఇన్సులిన్ డిపెండెంట్ డయాబెటిస్ మెల్లిటస్
ఏటియాలజీని లేదా టైప్ 1 డయాబెటిస్ మెల్లిటస్ అని కూడా పిలుస్తారు, అయితే ఏ
వివరించండి
వయసులోనైనా వ్యాధి మొదలవుతుంది, రోగ నిర్ధారణకు గరిష్ట వయస్సు 10 నుండి
12 సంవత్సరాలు, ప్యాంక్రియాస్ నాశనం అయినప్పుడు టైప్ 1 డయాబెటిస్
అభివృద్ధి చెందుతుంది, ఇది ఉత్పత్తిని పూర్తిగా తొలగిస్తుంది మరియు

1 నిమిసం ఇన్సులిన్ స్రావం. ఇంజెక్షన్ లేదా పంప్ ద్వారా పంపిణీ చేయబడిన టైప్ 1
డయాబెటిస్ ఇన్సులిన్ ఉన్నవారిని బతికించడానికి.
పాథోఫిజియాలజీ
ని చర్చించండి ఎటియాలజీ

159
బాల్య మధుమేహం బాల్య డయాబెటిస్ మెల్లిటస్ యొక్క కారణం తెలియదు, వంటి కారకాలు:

• జన్యు నమూనా,

• స్వయం ప్రతిరక్షక వ్యాధి,

బాల్య మధుమేహం
యొక్క
• వైరల్ ఇన్ఫెక్షన్లు,
క్లినికల్
వ్యక్తీకరణలను 1 నిమిసం • రసాయనాలు మరియు మందుల
నమోదు చేయండి

పాథోఫిజియాలజీ

 బాల్య మధుమేహంలోని పాథోఫిజియాలజీ ప్యాంక్రియాస్‌లోని బీటా కణాల

1 నిమిసం నాశనం, ఏ ప్రమాద కారకాలు లేదా కారణ కారకాలు ఉన్నప్పటికీ.

బాల్య మధుమేహం
క్లినికల్ మానిఫెస్టేషన్స్
కోసం
రోగనిర్ధారణ
పరీక్షలను  బాల్య మధుమేహం యొక్క శాస్త్రీయ లక్షణాలు:
జాబితా చేయండి  అధిక మూత్రవిసర్జన: పెరిగిన దాహం, పొడి నోరు,
 పెరిగిన ఆకలి
 అలసట, మరియు బరువు తగ్గడం.
బాల్య మధుమేహం
నిర్వహణ
గురించి
2 నిమిసం
వివరించండి రోగ నిర్ధారణ బాల్య
మధుమేహాన్
 జువెనైల్ డయాబెటిస్ నిర్ధారణ ని ఎలా
గుర్తించా
లి?

160
  చరిత్ర
బాల్య మధుమేహం
 శారీరక పరీక్ష
యొక్క ఆహార
నిర్వహణ  రక్త పరీక్ష
గురించి
 మూత్ర పరీక్ష,
వివరించండి
నిర్వహణ

 ఆహారం బాల్య
 వ్యాయామాలు మధుమేహం
నిర్వహణ
 గ్లూకోజ్ పర్యవేక్షణ ఏమిటి?
 ఇన్సులిన్ థెరపీ
ఆహారం

 జువెనైల్ డయాబెటిస్ పిల్లలు చక్కెర సమతుల్య ఆరోగ్యకరమైన ఆహారం

తినాలి. రోజూ మనం రోజుకు 2000 కిలో కేలరీలు తీసుకోవాలి.
 తృణధాన్యాలు, మొక్కజొన్న రేకులు, వోట్స్, ఆకుకూరలు, తేలికగా బాల్య
శక్తినిచ్చే పండ్లు, చాలా ఫైబర్, విటమిన్లు మరియు ఖనిజాలు మధుమేహం
యొక్క ఆహార
 పండ్లలో చక్కెర పదార్థాలు ఎక్కువగా ఉన్నందున సపోటా, అరటి, నిర్వహణ
కస్టర్డ్ ఆపిల్ మానుకోవాలి ఏమిటి?
 వేయించిన ఆహారాన్ని మానుకోండి.
బాల్య మధుమేహం  తినే గుడ్ల సంఖ్యను వారానికి నాలుగుకు పరిమితం చేయండి.
కోసం గ్లూకోజ్
 చేపలు మరియు చర్మం లేని పౌల్ట్రీ మరియు సన్నని మాంసాలను
పర్యవేక్షణను
వివరించండి ఎంచుకోండి. వండిన వోట్ భోజనం చవకైన, ఆరోగ్యకరమైన తృణధాన్యం.
 కలబంద రసం, చేదు గార్డు రసం, మెంతే విత్తనాలు రక్తంలోని చక్కెర
స్థాయిలను నియంత్రిస్తాయి. పిల్లలకు రెండుసార్లు పుల్కా, మరియు

161
 ఒక సారి బియ్యం ఇవ్వాలి. మేము సమతుల్య ఆహారం తీసుకున్నప్పుడు,
రక్తంలో చక్కెర స్థాయిలను తగ్గించవచ్చు
2 నిమిసం గ్లూకోజ్ పర్యవేక్షణ
 వారానికి ఒకసారి రక్తంలో గ్లూకోజ్ స్థాయిని పరీక్షించడం, ఆహారం
బాల్య
తీసుకోవడం, వ్యాయామాలు మరియు రక్తంలో గ్లూకోజ్ స్థాయిల ప్రకారం మధుమేహం
ఇన్సులిన్ మోతాదులను సర్దుబాటు చేయడం. కోసం
గ్లూకోజ్
 చక్కెర పరీక్ష కోసం రోజువారీ మూత్రం చేయాలి.
స్థాయిలను
 ఆహారం, వ్యాయామాలు, రక్తంలో గ్లూకోజ్ స్థాయిలు మరియు ఇన్సులిన్ ఎలా
మోతాదు ప్రకారం పిల్లలకు ఆహారం అందించాలి. పర్యవేక్
షించాలి
 రోజూ మనం గ్లూకోమీటర్ అనే పరికరాన్ని ఉపయోగించి గ్లూకోజ్
స్థాయిలను కొలవవచ్చు.
‌గ్లూకోజ్ స్థాయిలను పర్యవేక్షిస్తుంది

గ్లూకోమీటర్ అనేది గృహ వినియోగానికి అందుబాటులో ఉన్న ఒక వైద్య సాధనం,

ఇది రక్తంలో గ్లూకోజ్ స్థాయిలను నిర్ణయిస్తుంది. రక్తంలో గ్లూకోజ్
8 నిమిసం
పర్యవేక్షణ రక్తంలో చక్కెర యొక్క కొనసాగుతున్న కొలతను సూచిస్తుంది.
గ్లూకోమీటర్ అనే పోర్టబుల్ పరికరాన్ని ఉపయోగించి ఎప్పుడైనా పర్యవేక్షణ
చేయవచ్చు.

అవసరమైన వ్యాసాలు:

గ్లూకోమీటర్ - రక్తంలో చక్కెర స్థాయిలను పర్యవేక్షించడానికి.

పరీక్ష స్ట్రిప్స్ - నమూనా తీసుకోవడానికి

162
 ఆత్మ - క్రాస్ ఇన్ఫెక్షన్ నివారించడానికి

పత్తి శుభ్రముపరచు - ప్రాంతాన్ని తుడిచిపెట్టడానికి

లాన్సెట్స్ - వేలును కొట్టడానికి

విధానం

 అవసరమైన అన్ని సామాగ్రిని సమీకరించండి, ప్రతిదీ అవసరమని మరియు

ప్యాకేజీపై గడువు తేదీ ప్రకారం పరీక్ష స్ట్రిప్స్ గడువు
ముగియలేదని నిర్ధారించుకోండి.
 సబ్బు మరియు నీటితో చేతులు కడుక్కోండి మరియు బాగా కడగాలి. ఇది
పంక్చర్ సైట్ వద్ద సంక్రమణ అవకాశాన్ని తగ్గిస్తుంది.
 ‌ఆన్ చేసి, ‌‌వారి ఆదేశాల ప్రకారం పరీక్ష స్ట్రిప్‌ను చొప్పించండి.
పరీక్ష స్ట్రిప్ యొక్క ఒక వైపు రక్త సేకరణ కోసం ఉద్దేశించబడింది.
 ‌ప్యాడ్‌తో వేలిముద్రను తుడిచి, ఆరబెట్టడానికి అనుమతించండి.
బాల్య మధుమేహం
 ‌వేలిముద్ర యొక్క చర్మాన్ని కుట్టండి.
కోసం చేసిన
వ్యాయామాల
గురించి  ఫింగర్ బ్లడ్ డ్రాప్ రూపాలను పిండి వేయండి.
చర్చించండి  స్ట్రిప్ అవసరమైన మొత్తంలో రక్తాన్ని తీసుకునే వరకు రక్తపు
చుక్కకు వ్యతిరేకంగా పరీక్ష స్ట్రిప్ యొక్క అంచుని ఉంచండి.
పరీక్ష ప్రారంభమైన తగిన మొత్తంలో రక్తాన్ని పొందారని
గ్లూకోమీటర్ సంకేతం చేస్తుంది.
 మిగిలిన రక్తాన్ని పత్తితో తుడిచివేయండి మరియు రక్తస్రావం
ఆపడానికి సైట్కు ఒత్తిడి చేయండి. ఒక వేళ అవసరం ఐతే

163
  పరీక్ష పూర్తయిన తర్వాత గ్లూకోజ్ పరీక్ష ఫలితాలను రికార్డ్
చేయండి.
వ్యాయామాలు
 ‌గ్లూకోజ్‌ను నిర్వహించడానికి వ్యాయామాలు ముఖ్యమైన పాత్ర
పోషిస్తాయి
జువునిలే స్థాయిలు. మేము వ్యాయామాల నుండి ఎక్కువ ప్రయోజనాలను కలిగి
డయాబెటిస్ కోసం
ఉండాలి.
ఇన్సులిన్
చికిత్స వ్యాయామాలు రక్తంలో చక్కెర స్థాయిలను తగ్గిస్తాయి, తద్వారా గుండె
గురించి
జబ్బులను నివారిస్తుంది.
చర్చించండి
 రక్తంలో గ్లూకోజ్ స్థాయిలను తగ్గించే వ్యాయామాలు
 ఇన్సులిన్ సున్నితత్వంలో మెరుగుదల
 ఎక్కువ కేలరీలు బర్నింగ్
 పెరిగిన బలం మరియు వశ్యత
 వైఖరిలో మెరుగుదలలు, శ్రేయస్సు యొక్క భావం మరియు జీవన
నాణ్యత.
 30 నిమిషాల కంటే ఎక్కువ వ్యాయామం చేయండి, వ్యాయామం
చేసేటప్పుడు నీరు త్రాగాలి.
ఇన్సులిన్ చికిత్స

ఇన్సులిన్ యొక్క నాలుగు ప్రధాన రకాలు ఉన్నాయి: వేగవంతమైన నటన

ఇన్సులిన్, షార్ట్ యాక్టింగ్ ఇన్సులిన్, ఇంటర్మీడియట్ యాక్టింగ్
ఇన్సులిన్ మరియు లాంగ్ యాక్టింగ్ ఇన్సులిన్. వేగంగా పనిచేసే
ఇన్సులిన్ బోలస్ మోతాదుగా ఉపయోగించబడుతుంది. 30 నుండి 90

164
 నిమిషాల్లో గరిష్ట చర్యలతో 15 నిమిషాల్లో చర్య ప్రారంభమవుతుంది.
చిన్న నటన ఇన్సులిన్.
5 నిమిసం ఇన్సులిన్
 ఇన్సులిన్ రిఫ్రిజిరేటర్ లోపల 1 నుండి 8 డిగ్రీల
థెరపీతో
సెంటీగ్రేడ్ వద్ద రిఫ్రిజిరేటెడ్ చేయాలి. ద్రావణాన్ని మీరు బాల్య
సిరంజి లేదా పెన్నులోకి గీయడానికి ముందు మేఘాన్ని మధుమేహాన్
ని ఎలా
ఇన్సులిన్ మెత్తగా విలోమం చేయడం ద్వారా లేదా చేతుల మధ్య నిర్వహిస్
చుట్టడం ద్వారా పూర్తిగా కలపాలి. తారు

 సిరంజిలు తప్పనిసరిగా ఇన్సులిన్ గా ration తతో సరిపోలాలి

(ఉదా .: U-100). ప్రస్తుతం 3 పరిమాణాల U-100 ఇన్సులిన్
సిరంజిలు అందుబాటులో ఉన్నాయి, యూనిట్ రకాన్ని
పునర్వినియోగపరచలేనిదిగా ఉపయోగించాలి.
 1ML ‌ల
ను
కలిగి ఉన్న 1 మి సిరంజిలు.
* 0.5ML ‌కలిగి ఉన్న O.5 ఎంఎల్ సిరంజిలు.
* 0.3ML యూనిట్లు కలిగి ఉన్న 0.3 ఎంఎల్ సిరంజిలు.
* ఇన్సులిన్ ఇంజెక్షన్ తీసుకోవడానికి అనువైన సమయం ఆహారానికి అరగంట
ముందు. ఇంజెక్షన్ కోసం నాలుగు ప్రధాన ప్రాంతాలు ఉదరం, పై చేతులు
(పృష్ఠ ఉపరితలం) తొడలు (పూర్వ ఉపరితలం) మరియు పండ్లు. చేయి, తొడ మరియు
‌క్రమంగా తగ్గడం కంటే శరీరంలోని కొన్ని ప్రాంతాల్లో ఇన్సులిన్
వేగంగా గ్రహించబడుతుంది
ఇన్సులిన్ టెక్నిక్
 చేతులు బాగా కడగాలి. రిఫ్రిజిరేటర్ నుండి కుండలను
తీసివేసి, గది ఉష్ణోగ్రతకు తీసుకురావడానికి రెండు అరచేతుల

165
 మధ్య ఇన్సులిన్ కుండలను చుట్టండి.
 ‌కాటన్‌తో ఇంజెక్షన్ చేసే స్థలాన్ని శుభ్రపరచండి
 బాటిల్ లోకి సమానమైన గాలిని పరిచయం చేస్తోంది సూచించిన
మోతాదును ఉపసంహరించుకోవడం సులభంగా నింపడంలో సహాయపడుతుంది
మరియు గాలి బుడగలు నివారిస్తుంది.
5 నిమిసం
 ఒక చేత్తో, చర్మాన్ని వ్యాప్తి చేయడం ద్వారా లేదా పెద్ద
ప్రాంతాలను చిటికెడు ద్వారా స్థిరీకరించండి.
 మరోవైపు సిరంజిని తీయండి మరియు మీరు పెన్సిల్ లాగా
పట్టుకోండి, సూదిని సూటిగా 90 డిగ్రీల కోణం / పిల్లలకు 45
డిగ్రీ కోణంలో చొప్పించండి.
 ఇన్సులిన్ ఇంజెక్ట్ చేయడానికి, ‌లోపలికి నెట్టండి.
 సూదిని చర్మం నుండి నేరుగా లాగండి, పత్తి బంతిని ఇంజెక్షన్
సైట్ మీద చాలా సెకన్ల పాటు నొక్కండి.
* పునర్వినియోగపరచలేని సిరంజిని ఒక్కసారి మాత్రమే వాడండి మరియు ఖాళీ బ్లీచ్ లేదా
‌కంటైనర్ వంటి కఠినమైన ప్లాస్టిక్ కంటైనర్‌లో విస్మరించండి. ,
* పిల్లల రక్తంలో గ్లూకోజ్ స్థాయి 60mg / dl కన్నా తక్కువ విఫలమైనప్పుడు
హైపోగ్లైకేమియా. హైపోగ్లైకేమియా యొక్క సంకేతాలు భయము, వణుకు, చెమట,
చిరాకు, అసహనం, చలి, చమత్కారం, వేగవంతమైన హృదయ స్పందన, ఆందోళన, తేలికపాటి
తలనొప్పి మరియు ఆకలి

 హైపోగ్లైకేమియా యొక్క గృహ సంరక్షణ నిర్వహణలో, వెంటనే

చక్కెర తీసుకోవడం / త్రాగటం ఉంటుంది.

166
 పిల్లలు ఆడుతున్నప్పుడు పెద్దలు జాగ్రత్తలు తీసుకోవాలి,
గాయాలు రాకుండా ఉండాలి, ఆడుతున్నప్పుడు ఇతర పిల్లలతో గొడవ
పడకూడదు.
 అంటువ్యాధులు, గోరు కొరికే మరియు గాయాలను నివారించడానికి
పిల్లవాడు వారి గోళ్లను తరచుగా కత్తిరించాలి,
జువెనైల్ డయాబెటిస్ మెలిలైట్స్ మరియు కుటుంబ సభ్యులందరికీ
దాని నిర్వహణ గురించి తెలుసుకోవడం చాలా ముఖ్యం.

167
 Appendix F
List of Experts

1.Prof.Mrs.D.R.RadhaRukmini Principal, M.sc(N)

Govt. college of
Nursing,
Hyderabad
2.Dr. Mrs. K.T. Sheeba professor
Govt. college of
Nursing,
Hyderabad
3.Mrs.K.Prashanthi Assistant professor
Govt. college of
Nursing,
Hyderabad
4.Mrs.K.Renuka Assistant professor
Govt. college of
Nursing,
Hyderabad
5.Mrs.Hansli Assistant professor
Govt. college of
Nursing,
Hyderabad

168
6.Mrs.Feeba Faculty
Govt, college of
Nursing,
Hyderabad
7.Mrs.Anitha professor
Yashoda college of
Nursing, Hyderabad
8.Dr.Rakesh kumar sahay professor, HOD
Department of
Endocrinology
OGH, Hyderabad
9.Mr.Laxmi prasad Medical officer
Amber pet
Hyderabad.
10.Mr.Krishna Kishore Assistant professor
Dept. of statistics
Osmania university
Hyderabad.

169
 Appendix G
Key

S.No. Answer S.No. Answer

1) C 26) a
2) A 27) a
3) A 28) d
4) A
5) B
6) A
7) A
8) A
9) B
10) A

11) A

12) A

13) A

14) A

15) B

16) B

17) A

18) A

19) A

20) A

21) B

170
22) A

23) C

24) D

25) A

Appendix H

Photographs of the study

171
172
173
174
175
 Appendix I
Master sheet
Demographic data
S.no D1 D2 D3 D4 D5 D6 D7 D8 D9

1 1 1 1 2 7 4 2 2 2

2 2 2 2 1 6 2 1 1 2

3 1 1 1 1 7 4 2 1 2

4 1 1 4 3 5 4 1 1 2

5 3 2 2 1 5 2 2 2 2

6 1 2 2 3 6 2 1 2 2

7 2 3 3 3 5 4 2 2 1

8 2 1 2 2 7 4 2 1 1

9 2 3 2 1 6 4 2 2 2

10 3 1 1 3 5 4 1 2 2

11 1 1 3 3 5 4 1 1 2

12 1 1 2 3 6 4 2 1 1

13 2 1 2 3 6 4 2 1 2

14 3 1 3 3 5 2 1 1 2

15 1 1 3 3 6 4 1 1 2

16 2 2 1 3 6 2 2 1 2

17 1 1 2 3 5 4 2 1 2

18 1 2 1 1 5 2 2 2 1

176
 19 2 1 2 3 6 4 2 2 2

20 3 3 4 3 5 4 1 2 1

21 2 1 1 2 7 4 2 2 2

22 2 3 1 3 6 2 2 2 1

23 3 3 1 3 5 2 2 2 2

24 2 2 2 2 6 4 2 2 1

25 3 2 2 3 6 4 2 1 2

26 1 1 3 3 5 4 1 1 2

27 3 1 1 1 7 4 2 2 1

28 1 1 2 1 7 2 2 1 2

29 2 1 3 3 5 4 2 1 2

30 2 1 1 2 7 4 2 1 2

S.no D1 D2 D3 D4 D5 D6 D7 D8 D9

31 3 3 4 3 6 4 2 1 1

32 2 2 1 3 7 2 2 1 2

33 3 2 1 1 6 2 2 1 2

34 2 1 2 3 6 4 2 1 2

35 2 1 1 3 5 4 2 1 2

36 2 1 1 1 7 4 2 1 2

37 1 1 2 3 6 4 2 1 2

38 3 3 3 2 6 4 2 1 1

177
39 1 2 3 3 5 2 2 1 2

40 2 1 1 2 7 4 2 1 2

41 3 2 1 2 7 4 2 1 1

42 1 1 2 3 6 4 2 1 1

43 2 2 2 3 6 4 2 1 2

44 2 1 2 3 7 4 2 1 2

45 2 2 1 3 6 4 2 2 1

46 3 1 3 3 5 4 2 2 1

47 3 2 3 3 6 2 2 2 2

48 2 1 2 3 6 4 2 1 2

49 1 2 2 3 5 2 2 2 2

50 2 1 1 1 6 4 2 2 1

178
 PRE TEST SCORES

S.no Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Q13 Q14 Q15 Q16 Q17 Q18 Q19 Q20 Q21 Q22 Q23 Q24 Q25 Q26 Q27 Q28

1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 1 1 0 1 0
2 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 1 0 0
3 1 0 1 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0
4 0 1 0 1 1 1 1 0 1 1 1 1 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0
5 0 0 0 1 0 1 0 0 1 1 0 1 1 0 1 1 0 1 1 0 0 1 0 1 1 0 1 0
6 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 1 1
7 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0
8 0 0 0 0 1 1 0 1 0 0 1 0 1 0 1 0 0 0 1 0 0 0 0 0 0 1 1 0
9 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 1
10 1 0 0 1 0 1 1 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1
11 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 1
12 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0
13 0 0 1 0 1 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0
14 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0
15 0 0 0 0 1 1 1 0 0 0 1 1 0 0 0 1 0 1 1 1 1 0 0 0 1 1 1 0

179
16 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0
17 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0
18 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0
19 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0
20 1 1 0 0 0 1 1 1 1 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 1 1 0 0
21 1 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0
22 1 1 0 1 1 0 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0
23 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 0 1 0 0
24 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0
25 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
26 1 0 0 0 1 1 0 1 1 0 1 0 1 1 1 1 0 1 1 1 1 1 1 1 0 1 0 0
27 1 0 0 0 1 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0
28 0 0 1 0 1 0 1 0 1 0 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0
29 0 0 0 0 0 1 0 1 1 1 0 1 1 1 0 0 0 1 1 1 1 0 0 0 0 1 1 1
30 0 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 1 0
S.no Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Q13 Q14 Q15 Q16 Q17 Q18 Q19 Q20 Q21 Q22 Q23 Q24 Q25 Q26 Q27 Q28

31 0 0 0 0 0 1 1 0 1 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 1 0 0
32 1 1 0 1 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 0
33 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0
34 0 1 0 0 1 1 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1
35 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1 0 0 0

180
36 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0
37 0 0 1 1 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0
38 1 0 0 1 0 1 1 1 1 0 1 0 0 0 1 1 1 0 0 0 0 1 1 0 1 1 1 0
39 0 0 1 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 1 1 0 0 0 0 0 1 1 0
40 0 1 0 0 1 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0
41 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 1 0 0 0
42 0 0 0 1 0 0 0 1 1 1 1 0 1 1 1 0 0 1 1 1 0 0 0 0 1 0 1 0
43 0 1 0 0 1 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0
44 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 0 0 1 1 0 1 0 0 0 1 0 1
45 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0
46 0 0 1 0 0 0 1 0 1 0 0 0 1 1 1 1 0 1 1 0 0 1 1 1 1 1 1 0
47 0 0 0 0 0 1 0 1 0 0 0 1 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0
48 0 0 0 1 0 1 1 1 1 1 1 1 1 0 0 0 0 0 0 1 0 1 0 0 1 0 0 1
49 0 0 1 1 0 0 1 1 0 0 0 0 1 1 0 1 0 0 1 1 0 1 1 0 1 0 1 1
50 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0

181
POST TEST SCORES

182
S.no Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Q13 Q14 Q15 Q16 Q17 Q18 Q19 Q20 Q21 Q22 Q23 Q24 Q25 Q26 Q27 Q28

1 1 1 0 1 0 1 1 0 1 1 1 1 1 0 1 0 1 1 0 0 0 1 1 1 1 1 1 0
2 1 1 1 1 0 0 1 1 0 1 1 1 0 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1
3 1 1 0 1 0 1 0 1 1 0 1 1 1 1 1 0 0 0 0 0 1 1 0 1 1 1 1 1
4 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 0 1 0 1 1 0 0 1 1 0 1
5 1 1 1 1 0 1 0 0 1 0 0 1 0 1 1 1 1 1 0 1 0 0 1 1 1 1 0 1
6 1 1 0 1 1 1 0 0 1 1 0 1 0 1 1 0 1 1 1 1 0 1 1 1 0 1 1 1
7 1 1 1 0 1 1 1 0 1 1 1 1 1 1 0 1 1 1 1 1 0 1 0 1 1 1 1 0
8 1 1 1 0 1 1 0 1 1 1 0 0 1 1 1 0 1 1 0 1 0 1 1 1 1 1 1 1
9 1 1 1 1 0 0 1 1 1 1 0 1 1 1 0 1 1 1 0 0 0 0 1 0 1 1 0 1
10 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 0 1 1 1 1 1 0 1 1 1 1
11 1 1 0 1 0 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 0 1 1
12 1 1 1 0 1 0 1 1 1 0 1 0 0 1 0 1 0 1 0 1 0 1 1 1 1 1 1 1
13 1 1 0 1 1 1 1 0 0 1 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1
14 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1 1 1 1 0 1 1 1 1
15 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 1 0 0 0 0 1 0 1 0 1 1 0 1
16 1 0 1 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 0 1 0 1 1 1 1 1
17 1 1 1 1 0 1 1 1 1 0 1 1 1 1 1 1 1 0 1 1 0 1 1 1 1 1 1 1
18 1 0 0 1 1 1 0 1 0 1 1 1 1 0 1 1 0 1 0 1 1 1 0 1 1 1 1 0
19 1 0 0 1 0 0 1 1 1 1 0 1 1 1 1 1 0 1 1 0 0 1 1 0 1 0 1 1
20 1 1 1 1 1 1 0 1 1 1 1 1 1 1 0 1 1 1 0 1 0 0 1 1 1 1 1 0
21 1 1 1 0 0 0 1 0 1 1 1 1 1 0 1 0 1 1 1 0 1 0 1 0 1 0 1 1
22 1 1 1 0 0 1 0 1 1 0 1 1 0 1 0 0 1 1 1 0 0 1 1 1 0 1 0 1
23 1 1 1 1 1 1 0 1 1 1 1 0 0 1 1 1 0 0 1 0 1 0 0 0 1 1 1 0
24 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 0 1 0 1 0 1 0 1 1 0 0 1
25 1 1 1 0 1 0 0 1 1 0 0 0 0 1 0 0 1 0 0 1 1 1 1 1 1 1 1 1
183
26 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 1 1 1 0 1 0 0 1 1 1 1
27 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 1 1 0 1 0 0 1 1 1 1 0
 Practice Pre test scores
S.no P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13 P14 P15 P16 P17 P18 Total
1 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 3
2 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 2
3 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 2
4 0 0 0 1 0 1 0 1 0 1 1 0 0 1 1 0 0 1 8
5 1 0 0 0 1 0 1 0 0 0 0 1 0 0 0 0 0 0 4
6 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 3
7 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 3
8 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 2
9 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 3
10 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 3
11 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 3
12 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 2
13 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 3

184
 14 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 3
15 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 4
16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1
17 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1
18 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1
19 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 2
20 1 0 0 1 0 1 1 1 1 1 0 0 0 0 1 0 1 0 9
21 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1
22 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 2
23 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 2
24 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 2
25 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1
26 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 3
27 0 1 1 1 0 1 1 0 1 1 1 0 0 0 0 0 0 0 8
28 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1
29 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 3
1
30 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0
S.no P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13 P14 P15 P16 P17 P18 Total
31 1 1 0 0 1 0 0 1 1 0 1 0 1 1 1 1 0 1 11
32 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 2

185
33 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1
34 1 0 0 1 1 1 0 1 1 1 1 1 0 0 0 0 0 1 10
35 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 7
36 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 3
37 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 3
38 1 1 1 1 1 1 0 0 0 0 0 0 0 1 0 1 0 0 8
39 0 1 1 1 1 1 1 1 1 1 0 0 0 1 0 0 0 0 10
40 0 0 1 1 0 0 0 1 1 1 1 0 1 0 1 0 1 0 9
41 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1
42 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 2
43 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 2
44 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 3
45 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 4
46 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 3
47 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 3
48 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
49 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 2
50 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1

186
 Practice Post test scores
S.no P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13 P14 P15 P16 P17 P18 Total
1 0 0 1 0 1 0 1 1 0 0 0 1 0 1 1 1 1 1 10
2 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 17
3 1 1 0 1 0 1 1 0 1 1 0 0 0 0 1 0 0 0 8
4 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 17
5 1 1 1 1 1 0 1 0 1 1 1 1 0 0 0 1 1 1 13
6 1 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 1 14
7 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 16
8 1 1 0 1 1 0 1 1 1 1 1 0 0 1 0 1 1 1 13
9 1 1 1 1 1 0 0 0 1 1 1 0 1 1 1 1 1 1 14
10 1 0 1 0 1 1 1 1 1 1 0 1 1 1 1 1 1 1 15
11 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 17
12 1 1 1 1 1 1 1 0 0 1 1 1 1 0 0 1 1 1 14
13 1 1 1 1 1 1 0 1 1 1 1 0 0 1 1 1 1 1 15

187
 14 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 17
15 1 1 1 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 15
16 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16
17 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 1 1 1 16
18 1 1 1 1 1 1 1 0 1 1 1 0 0 1 1 1 1 1 15
19 1 1 1 1 1 1 1 0 0 1 1 0 0 1 1 1 1 1 14
20 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 17
21 0 1 1 1 1 0 1 1 0 0 1 0 1 1 0 0 1 0 10
22 1 1 1 1 1 0 1 0 1 1 0 1 0 0 0 1 0 0 10
23 1 1 0 1 1 1 1 0 1 1 0 1 1 1 1 1 1 1 15
24 1 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 1 1 15
25 1 1 1 1 1 1 0 0 1 1 1 1 1 0 0 1 1 1 14
26 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 17
27 1 1 0 0 0 1 0 0 1 1 0 1 0 0 1 0 1 0 8
28 1 1 1 1 1 1 1 1 1 0 1 0 1 0 1 0 1 1 14
29 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 16
30 1 0 1 0 1 0 0 0 0 1 1 0 0 0 0 1 0 1 7

S.no P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13 P14 P15 P16 P17 P18 Total
31 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 18
32 1 1 1 1 0 1 1 0 1 0 0 0 0 1 0 0 0 0 8
33 1 0 1 1 1 1 1 0 1 1 1 1 1 0 1 0 1 1 14

188
34 1 1 1 1 1 1 0 1 0 1 1 1 0 0 1 1 1 1 14
35 1 1 1 1 0 1 0 1 1 1 1 1 1 1 0 1 1 0 14
36 1 0 0 1 1 1 0 1 1 0 1 1 0 1 1 1 0 0 11
37 1 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 1 1 15
38 1 1 1 1 1 1 1 1 1 0 0 1 1 1 0 0 1 1 14
39 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 18
40 1 1 0 1 1 1 0 1 1 1 1 1 0 0 1 1 1 0 13
41 1 1 0 1 0 0 1 0 1 1 0 1 1 1 0 0 0 0 9
42 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 17
43 1 1 1 1 1 1 1 1 0 1 1 1 0 1 0 1 1 1 15
44 1 1 0 1 0 1 0 1 0 0 1 1 1 0 0 1 1 0 10
45 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 0 15
46 1 1 1 1 1 1 0 0 0 1 1 1 0 0 1 1 1 1 13
47 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 18
48 1 1 1 1 1 1 1 1 0 1 1 0 1 1 1 1 1 1 16
49 1 1 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 1 16
50 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 18

189
190