International Journal of Nursing Education

EDITOR
Prof. R K Sharma
Formerly at All India Institute of Medical Sciences, New Delhi
E-mail: [email protected]

INTERNATIONAL EDITORIAL ADVISORY BOARD NATIONAL EDITORIAL ADVISORY BOARD

1. Leodoro Jabien Labrague (Associate Dean) 4. Fatima D’Silva (Principal)
Samar State University,College of Nursing and Health Nitte Usha Institute of nursing sciences, Karnataka
Sciences, Philippines
5. G.Malarvizhi Ravichandran
2. Dr. Arnel Banaga Salgado (Asst. Professor) PSG College of Nursing, Coimbatore, Tamil Nadu
Psychology and Psychiatric Nursing, Center for
6. S. Baby (Professor) (PSG College of Nursing,
Educational Development and Research (CEDAR)
Coimbatore, Tamil Nadu, Ministry of Health, New Delhi
member, Coordinator, RAKCON Student Affairs
Committee,RAK Medical and Health Sciences University, 7. Dr. Elsa Sanatombi Devi (Professor and Head)
Ras Al Khaimah, United Arab Emirates Meidcal Surgical Nursing, Manipal Collge of nursing,
Manipal
3. Elissa Ladd (Associate Professor)
MGH Institute of Health Professions Boston, USA 8. Dr. Baljit Kaur (Prof. and Principal)
Kular College of Nursing, Ludhiana, Punjab
4. Roymons H. Simamora (Vice Dean Academic)
Jember University Nursing School, PSIK Universitas 9. Mrs. Josephine Jacquline Mary.N.I (Professor Cum
Jember, Jalan Kalimantan No 37. Jember, Jawa Timur, Principal) Si-Met College of Nursing, Udma, Kerala
Indonesia 10. Dr. Sukhpal Kaur (Lecturer) National Institute of Nursing
5. Saleema Allana (Assistant Professor) Education, PGIMER, Chandigarh
AKUSONAM, The Aga Khan University, School of 11. Dr. L. Eilean Victoria (Professor) Dept. of Medical
Nursing and Midwifery, Stadium Road, Karachi Pakistan Surgical Nursing at Sri Ramachandra College
6. Ms. Priyalatha (Senior lecturer) RAK Medical & Health of Nursing, Chennai, Tamil Nadu
Sciences University, Ras Al Khaimah,UAE 12. Dr. Mary Mathews N (Professor and Principal)
7. Mrs. Olonisakin Bolatito Toyin (Senior Nurse Tutor) Mahatma Gandhi Mission College of Nursing, Kamothe,
School of Nursing, University College Hospital, Ibadan, Navi Mumbai, PIN-410209,Cell No.: 09821294166
Oyo State, Nigeria 13. Dr. Mala Thayumanavan (Dean)
8. Mr. Fatona Emmanuel Adedayo (Nurse Tutor) Manipal College of Nursing, Bangalore
School of Nursing, Sacred Heart Hospital, 14. Dr. Ratna Prakash (Professor) Himalayan College of
Lantoro,Abeokuta,Ogun State, Nigeria Nursing, HIHT University, Dehradun, Uttarakhand
9. Prof Budi Anna Keliat, Department of Mental Health 15. Pramilaa R (Professor and Principal)
Nursing University of Indonesia Josco College of Nursing, Bangalore
10. Dr. Abeer Eswi (Associate Prof and Head of Maternal 16. Babu D (Associate Professor/HOD)
and Newborn Health Nursing) Faculty of Nursing, Cairo Yenepoya Nursing College, Yenepoya University,
University, Egypt Mangalore
11. Jayasree R (Senior Teacher, Instructor H) 17. Dr. Theresa Leonilda Mendonca (Professor and Vice
Salalah Nursing Institute, Oman Principal) Laxmi Memorial college of Nursing, A. J.
12. Dr. Khurshid Zulfiqar Ali Khowaja Towers, Balmatta, Mangalore, Karnataka
Associate Professor, Aga Khan University School of 18. Madhavi Verma (Professor) Amity College of Nursing,
Nursing, Karachi, Pakistan Amity University Haryana
13. Mrs. Ashalata Devi (Assist. Prof.) 19. LathaSrikanth (Vice Principal)
MCOMS (Nursing Programme), Pokhara, Nepal Indirani College of Nursing,Ariyur,Puducherry
14. Sedigheh Iranmanesh (PhD) 20. Rupa Verma (Principal)
Razi Faculty of Nursing and Midwifery, Kerman Medical MKSSS College of Nursing for Women, Nagpur
University, Kerman, Iran
21. Sangeeta N. Kharde (Professor) Dept. of OBG Nursing
15. Billie M. Severtsen (PhD, Associate Professor) KLES’s Institute of Nursing Sciences, Belgaum
Washington State University College of Nursing, USA
International Journal of Nursing Education 22. Dr. Suresh K. Sharma (Professor)
(Nursing) College of Nursing, All India Institute of Medical
NATIONAL EDITORIAL ADVISORY BOARD Sciences, Rishikesh (UK) 249201
1. Dr. G. Radhakrishnan (PhD, Principal) 23. Sudha Annasaheb Raddi (Principal & Professor)
PD Bharatesh College of Nursing, Halaga, Belgaum, Dept of OBG Nursing, KLEU’s Institute of Nursing
karnataka, India-590003 Sciences, Belgaum
2. Dr Manju Vatsa (Principal, College of Nursing) 24. Rentala Sreevani (Professor & HOD)
AIIMS, New Delhi. Dept. of Psychiatric Nursing,Sri.Devaraj Urs College of
3. Dr Sandhya Gupta (Lecturer) College of Nursing, AIIMS, Nursing, Kolar, Karnataka
New Delhi
 International Journal of Nursing Education
NATIONAL EDITORIAL ADVISORY BOARD SCIENTIFIC COMMITTEE
25. Accamma Oommen (Associate Professor and Head) 1. Padmavathi Nagarajan (Lecturer)
Department, Child Health Nursing, Sree Gokulam Nursing College of Nursing, JIPMER, Pudhucherry
College, Trivandrum, Kerala, India 2. Mrs. Rosamma Tomy (Associate Professor)
26. Shinde Mahadeo Bhimrao (Professor) MGM College of Nursing, Kamothe, Navi Mumbai
Krishna Institute Of Nursing Sciences Karad Tal-Karad 3. T. Sivabalan (Associate Professor)
Dist Satara Mahashtra State Pravara Institute of Medical Sciences (DU), College of
27. Dr. Judith A Noronha (Professor and HOD) Nursing, Loni, Maharashtra
Department of Obstetrics and Gynaecological Nursing, 4. Ms Daisy J Lobo (Associate Professor)
Manipal University MCON, Manipal, Karnataka
28. Prof. Balasubramanian N (Head) 5. Sanjay Gupta (Assistant Professor)
Psychiatric Nursing, Shree Devi College of Nursing, M.M. College of Nursing, Mullana (Haryana)
Mangalore
6. Prashanth PV (Nursing Supervisor) M.O.S.C Medical
29. Mrs. Harmeet Kaur (Principal) Chitkara School of Health College Hospital, Kerala
Sciences, Chitkara University, Punjab.
7. V. Sathish (Academic Officer)
30. Mrs. Chinnadevi M (Principal) Kamakshi Institute of Allied Health Sciences, National Institute of Open
Nursing, Bassa wazira, Bhugnara Post, The Nurpur, Dist Schooling, Ministry of Human Resource, Development,
Kangra, HP, Government of India
31. Dr. Linu Sara George (Professor and Head) 8. Dr. Suman Bala Sharma (Associate Professor)
Department of Fundamentals of Nursing, Manipal College Govt. Medical College and Hospital (GMCH)
of Nursing Manipal
9. Smriti Arora (Assistant Professor)
32. Juliet Sylvia (Professor and H.O.D) Rufaida College of Nursing, Faculty of Nursing, Hamdard
Community Health Nursing, Sacred Heart Nursing University,New Delhi-110062
College, Madurai
10. Rajesh Kumar (Asst. Professor)
33. Dr. (Prof). Raja A (Professor & HOD) SGRD CON(SGRDISMR),Vallah Amritsar Punjab
Department of Medical Surgical Nursing,Sahyadri College
11. Baskaran. M (Assistant Professor)
of Nursing,Mangalore-575007
PSG College of Nursing, Coimbatore, Tamil Nadu,
34. Beena Chako (Professor)
12. Mr. Kishanth (Olive.Sister Tutor)
PSG College of Nursing, Coimbatore. Tamil Nadu 35.
Department of Psychiatric Nursing,College of Nursing,
35. Anitha C Rao, Professor and Principal, Canara College JIPMER, Pondicherry - 06
of Nursing, Kundapur, Karnataka
13. Mr. Mahendra Kumar (Associate Professor)
36. Dr. N.Gayathripriya (Professor) Obstetrics and Savitribai Phule College of Nursing, Kolhapur
Gynaecological Nursing, Sri Ramachandra
14. Bivin Jose (Lecturer)
University, Chennai
Psychiatric Nursing, Mar Baselios college of Nursing,
37. Vijayaraddi B Vandali, Principal Kothamangalam, Kerala
Surendera Nursing Training Institute,
15. Poonam Sharma (Assistant Professor)
Sri Ganganagar, Rajasthan
INE, Guru Teg Bahadur Sahib (C) Hospital,
38. T Siva Jeya Anand, Vice Principal, Chitra College of Ludhiana, Punjab
Nursing, Pandalam, Pathanamthitta Dist, Kerala
16. Kapil Sharma (Associate Professor)
39. Anil Sharma, Principal, Manikaka Topawala Institute of INE,G.T.B.S.(C) Hospital, Ludhiana (Punjab)
Nursing CHARUSAT-Changa
17. Simer Preet Kaur (Lecturer), U.P R.I.M.S N R,
40. Vasudevan N.J, Associate Professor, Chitra College of Saifai, Nursing College
Nursing, M.C Road, Pandalam. Pathanamthitta District,
Kerala
41. Col. Jayalakshmi Namasivayam Pillai, Principal & Print-ISSN: 0974-9349, Electronic - ISSN: 0974-9357,
Director Symbiosis College of Nursing Pune, Maharashtra Frequency: Quarterly (Four issues in a year)
42. Mrs Ashia Qureshi, Dean Cum Principal Prakash www.ijone.org
Institute of Nursing, Physiothrepy and Rehabilitation &
Allied Medical Sciences Editor
Dr. R.K. Sharma
International Journal of Nursing Education is an international peer reviewed Institute of Medico-legal Publications
journal. It publishes articles related to nursing and midwifery. The purpose of the journal is to 4th Floor, Statesman House Building, Barakhamba Road,
bring advancement in nursing education. The journal publishes articles related to specialities Connaught Place, New Delhi-110 001
of nursing education, care and practice. The journal has been assigned international standard
serial numbers 0974-9349 (print) and 0974-9357 (electronic). The journal is covered by Index Printed, published and owned by
Copernicus, Poland and is included in many international databases. We have pleasure to Dr. R.K. Sharma
inform you that IJONE is a double blind peer reviewed indexed international journal and is Institute of Medico-legal Publications
now covered by EMBASE ( Scopus), Indian citation index, GOOGLE SCHOLAR, INDEX 4 Floor, Statesman House Building, Barakhamba Road,
th

COPERNICUS (POLAND), EBSCOHOST (USA), and many other international databases. Connaught Place, New Delhi-110 001
© All Rights reserved The views and opinions expressed are of the authors and not Published at
of the International Journal of Nursing Education. The Journal does not guarantee directly or Institute of Medico-legal Publications
indirectly the quality or efficacy of any products or service featured in the advertisement in the
journal, which are purely commercial. 4th Floor, Statesman House Building, Barakhamba Road,
Connaught Place, New Delhi-110 001
 I

International Journal of Nursing Education

www.ijone.org

CONTENTS

Volume 8, Number 2 April-June 2016

1. Effectiveness of Cold Application, Heparinoid Application & Megnesium-sulphate ................................ 01

Application on Superficial Thrombophlebitis- Literature Review
Anil Sharma

2. Process Oriented Guided Inquiry Learning in Nursing Education ............................................................... 03

Jeya Devi Coomarasamy, Yusup Hashim

3. Effectiveness of Teaching Intervention on Knowledge and Practices Regarding Endotracheal ................ 08

Tube Suctioning among Staff Nurses
Kaur Harjot, Saini Hemant Kumar, Gupta Kewal Krishan

4. Parents Influence on Quality of Life of Children with Epilepsy: An Evaluative Survey ............................ 12
Poonam Joshi, Manju VM, Shefali Gulati

5. A Quasi Experimental Study to Assess the Effect of Relaxation Technique on Stress related ................... 17
to Adjustmental Problems among Staff Nurses working in Selected Hospitals of District
Jalandhar, Punjab, 2015
Satvir Kaur, Kishanth Olive

6. Analysis of Health Care Delivery System in Pakistan and Singapore ........................................................... 21

Hina Nizar, Parveen Chagani

7. Outcome of Interventional Programme on Quality of Life of Infertile Women with Polycystic ............... 27
Ovarian Syndrome
Beena MR, Kochuthressiamma Thomas

8. Soothing Crying Babies and Preventing Shaken Baby Syndrome .................................................................. 34

Susamma Thomas

9. Relationship among Nurses Role Overload , Burnout and Managerial Coping Strategies at ................... 39
Intensive Care Units
Fatma Rushdy Mohamed

10. Effectiveness of Structured Teaching Programme on Knowledge and Practice Regarding ....................... 46
Intravenous Cannulation among the Staff Nurses
Naoroibam Jayalaxmi, Mayengbam Benita Devi, Nongmeikapam Monika

11. The Effect of Structured Teaching Programme among Patients with Ankylosing Spondylitis ................. 50
Jisha J, Suneetha CJ, Skandhan KP
 II

12. An Exploratory Study to Assess the Psychosocial Problems Experienced by Migrants Residing ............ 55
in Selected Districts of Punjab, 2015
Kiranpreet Kaur, Kishanth Olive

13. Communication: An Essence to Operating Room Nursing ............................................................................. 59

Sonia P Abraham, Anita Kiruba Jeyakumar, Valliammal Babu

14. Effectiveness of Educational and Selected Exercise Programme to Reduce Back Pain in ........................... 62
Staff Nurses
Rakesh Sharma

15. Cognitive Function among Elderly Residing in Families versus Old Age Homes ...................................... 68
Gishy Vijayakumar, Elsa Sanatombi Devi, Preethy Jawahar

16. Loneliness in Elderly and Non-elderly Residents of Nursing Homes ........................................................... 71

Mohammad Heidari, Mansureh Ghodusi, Mina Shirvani

17. Quality of Life of Adolescents Studying in Schools in Kerala .........................................................................77

Cicily Joseph, Chellarani Vijayakumar

18. Effectiveness of Structured Teaching Programme on Knowledge Regarding Prevention ......................... 82

and First Aid Management of Insects Bite in Children among the Primary School Teachers of Mysore,
Karnataka
Sandeep K Raju

19. Effectivenes of Awareness Programme on Prevention of Vector Borne Diseases among ........................... 87
School Age Children
Naresh Soni, Dipti Y Sorte, Atul Chaudhari

20. Assessment of Compliance and Factors Influencing Therapeutic Regimen among .................................... 94
Patients with Heart Failure in a Tertiary Care Hospital, Kochi, Kerala, India
Sreeja M S, Laly K George

21. Parental Alcoholism and Psychosocial Problems of Adolescents ................................................................... 99

Chetana, Sanjenbam Emon Chanu, Mahalingam V, Sanchita Pugazhendi

22. Qualitative Data Analysis: Making it Easy for Nurse Researcher ................................................................ 106
Meena Ganapathy

23. A Descriptive Study to Assess the Knowledge Regarding Nosocomial Infections among ...................... 111
the Second Year GNM Students in D. Y. Patil Institute of Nursing Sciences, Kadamwadi,
and Kolhapur, Maharashtra
Kiran Patil, Surekha She�y, Shailesh Sawanth

24. Assessment of Knowledge among Caregivers on Safe Feeding Practice in Infants Admi�ed ................ 115
in Pediatric Medical Ward of a Tertiary Care Hospital
P Sinu, Anitha Zacharias

25. A Quasi Experimental Study to Assess the Effect of Structured Teaching Programme ............................ 119
on Knowledge Regarding Nomophobia among Students of Selected Colleges in District Jalandhar,
Punjab
Priyanka Thakur, Kishanth Olive
 III

26. A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge ........................ 122
and Practice Regarding ET Tube Suctioning among Pediatric ICU Staff Nurses in Selected
Hospital at Bangalore
Vinayaka A M, Sheela Bernet

27. Protein Energy Malnutrition among Children ................................................................................................ 129

Soja S L, N Udaya Kiran

28. A Study to Assess the Knowledge on the Supplementary Feeding among Mothers ........................... 134
with Children age 6-24 Months in Selected Rural Community at Mullana, Ambala
Rohitash Kumar, Eenu, Neetu Dhanda, Sharandeep Kaur

29. Comparison of Patient Safety Measures Related to I.V Infusion and I.V Injection Adopted ................... 139
by Staff Nurses of a Government and a Private Hospital of Delhi
Anjali Kaushik, Manju Chhugani, E L Tamang

30. Level of Satisfaction of Care among Patients .................................................................................................. 146

R Naganandini

31. A Study to Assess the Knowledge of Rural Adults Regarding Selected Central Sponsored ................... 148
Schemes in Selected Rural Community at Mysore
Mamatha G, Murali Mohan A, Munirathna K, Bhavya S V

32. A Comparative Analysis of Academic Performance of Diploma Nursing Students of Public, .............. 151
Private and Faith based Schools in Tanzania
Kija Malale, Elijah Nyangena, Winfred K Kithinji

33. Practice of Female Smoking among Older Females in Rural Areas of U�arakhand ................................. 158
Mahalingam Venkateshan, Ramandeep Kaur Panwar, Priyanka Rawat, Rakhi Rana,
Prateek Diwedi, Priyanka Panwar, Shivani Verma

34. Untold Aspects of Accountability in Curriculum: Social Accountability from the Experiences ........... 163
of Providers and Receivers in the Health System
Masumeh Sanaei, Leili Mosalanejad, Saideh Rahmanian

35 Nursing Student’s Clinical Learning Experiences and the Barriers Faced .................................................. 169
Santa De, Pravina Mahadalkar, Lily Podder Bera

36. Effect of Yoga and Raw Diet on Physiological Variables and Quality of Life of ..................................... 175
Prediabetic Patients
Sr.Tresa Anto, Rajeev Kumar N

37. The Development and Psychometrics of SEAT (Self-Efficacy Assessment Tool) ....................................... 180
Kathleen Garrubba Hopkins, Theresa A Koleck, Dianxu Ren, Alice M Blazeck

38. Biochemical Value among Suicide A�empted Individual ............................................................................. 186

A Arvin Babu, Prasana Baby, R Vijayaraghavan

39. Knowledge and Practices Regarding Prevention of Anaemia in Pregnant Women ............................... 191
S Swarna, M Jayalakshmi
 IV

40. Effect of an Instructional Module Regarding Knowledge and A�itude on Childrearing ........................ 197
Practices among Mothers of Infants in Tribal Areas of Kannavam, Kannur, Kerala
Himamol

41. A Pre Experimental Study to Assess the Effect of Emotional Intelligence Skill Training ......................... 203
on Emotional Intelligence of Undergraduate Nursing Students
Vishavdeep, Sunita Sharma, Karobi Das, Prahbhjot Malhi, Sandhya Ghai

42. Assessment of Adjustment Problems among Adolescents Residing in Orphanage .................................. 209
Anju P Thampi, Sreejamol M G, Febu Elizabeth Joy

43. Assessment of Psychosocial Problems among Parents of Dyslexic Children A�ending ......................... 215
Child Guidance Clinic
P Sinu, Sunil Moothedath

44. A Case Report on Childhood Dysthymia- Low Mood Triggers The End ................................................... 219
Jidhun P, P Chitra
 DOI Number: 10.5958/0974-9357.2016.00036.2

Effectiveness of Cold Application, Heparinoid Application

& Megnesium-sulphate Application on Superficial
Thrombophlebitis- Literature Review

Anil Sharma
Assistant Professor, Manikaka Topawala Institute of Nursing–a constituent of Charotar University of
Science & Technology, Changa, Ta: Petlad, Dist.- Anand, Gujarat, India

ABSTRACT

The current study aims to assess the effectiveness of Cold Application, Heparinoid Application &
Megnesium-sulphate Application on Superficial Thrombophlebitis employing literature review as the
methodology. Multiple databases were searched focusing of three treatment modalities for reducing
pain & distress of Superficial Thrembophlebitis.
It was concluded that to provide quality care it is important that the evidence based practice guideline
should be followed.
Keyword: Cold Application, Heparinoid Application, Megnesium-sulphate Application, Superficial
Thrombophlebitis, Evidence Based Practice, Pain & Distress.

INTRODUCTION MATERIAL, METHODS & FINDINGS

Intravenous infusions are an important aspect of The study is headed in three main areas on based
therapy in both medical & surgical conditions. Over on interventions and these are cold application,
one fourth of hospitalized patients receive intravenous heparinoid application & megnesium-sulphate
therapy for fluid replacement & administration of application.
drugs1. It is also recognized that intravenous therapy
exposes the patient to considerable variety of hazards. Moist ice pack application on the site of superficial
The registered nurse is the only member of the health thrembophlebitis for 5 minutes, twice daily for three
team who can, on a continuous basis assumes the days suggested that pain, bruise & Hematoma relieved
responsibility for regular monitoring of intravenous in much be�er way. A randamadized control study
therapy and prevention of complications 2,3. explicated that, Moist ice pack used for experimental
group were statistically significant in favor of the use
Superficial Thrembophlebitis is defined as an of moist ice pack while comparing the pain, bruise at
inflammation of a vein and thrombus formation subcutaneous injection site6.
related to a chemical or mechanical irritation or both4.
It is characterized by a reddened, warm area around To relieve pain at perineal area in mothers with
the insertion site or along the path of a vein, pain & episiotomy, hot and cold pack used but still cold
tenderness. In this condition, various methods can be application is significantly more effective in relieving
used such as Cold application Heparinoid Application perineal pain and alienating the discomfort. A quasi-
& Megnesium-sulphate Application5. experimental study in which 100 sample of postnatal
mothers with episiotomy selected and randomly
The literature reviewed was obtained through divided for two interventions such as Hot and Cold
different database which includes CINHAL application. The finding of the effectiveness of hot and
(Cumulative Index to Nursing & Allied Health cold application in relieving perineal pain showed
Literature), MEDLINE (Medical Literature Analysis that there is a highly significant difference between
& Retrieval System Online), Pubmed, Science Direct, effect of hot & cold application on time series. Cold
SpringerLink, ProQuest & Google scholar. application is significantly more effective in relieving
perineal pain and alienating the discomfort7.
2 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Heparinoid application is significantly used to Ethical Clearance: Not needed but still, the article
treat sign & symptoms of superficial thrembophlebitis. approved by SN Institutional Review Board.
Similarly a quasi experimental study was conducted REFERENCES
to investigate the curative effect of notoginsy cream
1. Kazier, B.B. Fundamental of Patient Care. 8th
versus heparinoid cream in the treatment of post
ed.. Philadephia and London: W.B.Saunders
infusion thrembophlebitis, where it was statistically
Company.2014
proved that heparinoid cream has good result
comparatively8. 2. Luckman & Sorensen. Medical Surgical Nursing
3rd ed, Philadelphia: W.B. Saunder’s Company
The Essaven gel in thrembophlebitis improves
1987
sign, symptoms & decrease skin temperature faster.
A randomized, placebo controlled study for 4 week 3. Luckman, Saunder’s. Manual of Nursing Care,
study evaluated the average skin temperature & Philadelphia: W.B. Saunder’s Company. 2009
analogue symptomatic score and proves it9. 4. Tortora, G.J.. Principles of Anatomy and
A topical use of diclofenac also can be used as Physiology, 12th ed. Hoboken, NJ: John Wiley &
alternative to treat superficial thrembophlebitis. Sons. 2012
A prospective study was explicated that topical 5. Brunner & Suddarth’s. Medical Surgical
treatment of diclofenac can be recommended as Nursing, 12th ed., Philadelphia: Lippinco�
an alternative, simple, effective & safe therapy for Williams and Wilkins.2011
patients who develop Superficial Thrembophlebitis. 6. Varghese, Chiannamma. Prevention and
In this study 120 sample size with male and female Reduction of Pain, Bruise and Hematoma by
taken & divided in three groups of 40 each with three ‘Moist Ice Pack’ Application on The Site of
category, without treatment, topical diclofenac & oral Subcutaneous Heparin Injection. Nursing and
diclofenac. The favorable answer after result is first, Midwifery Journal. 2 (4) 139-148.2006
second & third group is 20, 70,60% respectively10.
7. Sharma, Purnakala. . Comparative Study on
A comparative study has shown that 44% of Effect of Hot and Cold Application Alternatively
patient treated with 1000 IU/g heparin gel three times for Perineal Pain in Mothers with Episiotomy.
a day were symptom free at 1 week compared with Communicating Nursing Research. 56.2004
26% on placebo11.
8. Zhang Gouping . Notoginseny cream in the
The external use of magnesium sulphate solution treatment of phlebitis. Journal of infusion
to skin it provides heating effect to relieve symptoms. nursing. 26 (1) 49-54.2003
A descriptive study has shown that magnesium
sulphate application helps to reduce pain and distress 9. De Sanctis M.T..Treatment of superficial
much faster comparatively other methods12. thrombophlebitis of the arm with Essaven gel–a
placebo–controlled, randomized study. Journal
CONCLUSION of angiology. 52(3) 63-67. 2001
The treatment modalities for receiving symptoms 10. Becherucci A.. Effects of topical and oral
of superficial thrembophlebitis are widely used as cold diclofenac on superficial thrombophlebitis
application, heparinoid application and magnesium caused by intravenous infusion. Medicine
sulphate application. As evidence based practices clinic. 137 (17), 237-2393.2009
always promote safety & prevent complications.
11. Vilardell M.. Topical heparin for the treatment
Moreover, the knowledge & competence of health
of acute superficial thrombophlebitis secondary
care professional play an important role in enhancing
to indwelling intravenous catheter: A double
safety of the patient.
blind randomized placebo – controlled trial.
Acknowledgement: I would like to acknowledge European journal clinical pharmacology. 54,
nursing division of V.S. Hospital, Ahmadabad & 917-921.1999
CHARUSAT University, Changa, Gujarat, India.
12. Sharma A.K. comparative study of treatment
Conflict of Interest: None modalities for superficial thrembophlebitis.
Source of Funding: No separate funding was International conference souvenir on humanities
received for this study. at AIIMS, New Delhi, 109 2012 Declaration by
the Author.
 DOI Number: 10.5958/0974-9357.2016.00037.4

Process Oriented Guided Inquiry Learning

in Nursing Education

Jeya Devi Coomarasamy1, Yusup Hashim2

PhD Student, School of Education and Cognitive Science. Asia e University, Kuala Lumpur,
1

2
Instructional Designer & Lecturer, School of Education and Cognitive Science, Asia e University, Kuala Lumpur

ABSTRACT

Employers want graduates who have the confidence and ability to make appropriate patient care
decisions. This study was done to determine whether Process Oriented Guided Inquiry Learning
(POGIL), would have an effect on the diploma in nursing students’ academic achievement and
confidence in learning. A convenience sample of students (n=73) were randomly assigned to two
groups. A quasi-experimental study was conducted using pre-test/post-test together with a beginning
/end of semester confidence in learning surveys. To determine the perception of the students towards
the new instructional method, a semi-structured interview was done amongst nine students from the
experimental group. Significant difference was found between the two groups towards confidence
in learning, but not in the post-test scores. Three main categories and nine themes emerged from the
interviews which supported the quantitative findings that POGIL as an instructional method has the
potential to make a significant contribution to nursing education.

Keywords: POGIL, achievement level, confidence in learning.

INTRODUCTION learned in past semesters and during their clinical

Demand for nurses with diploma is high, but practicum to the coursework they are currently
employers in Malaysia are very selective and want learning. In the clinical areas, if there is any deviation
graduates who are commi�ed and able to blend from norm, the students are also found to have
immediately into the working environment. They difficulty applying the concepts learned in classroom.
want nurses who have the confidence to communicate They have to be constantly supervised.
well in writing and orally, source for evidence-based Current instructional methods are teacher-centred
information and think critically to solve and manage with emphasis on imparting discipline content. To
any nursing problems that may arise. replace these methods, innovative methods are being
Majority of the millennials who join the introduced to engage students not only in their own
programme are passive learners. When they are in learning, but develop key skills that would enhance
the final semester, they are expected to have at least their employability and enable them to adapt to any
gained some ability to use the knowledge they had new situations. One such active instructional method
that is gaining much popularity in the field of science
and meeting the needs of new workplace challenges is
Corresponding author:
Process Oriented Guided Inquiry Learning (POGIL).
Jeya Devi Coomarasamy
PhD Student, School of Education and Cognitive LITERATURE REVIEW
Science, Asia e University Kuala Lumpur
31 Jalan 4; Taman Murni, Batu 91/2, 43200 Cheras, Grounded in educational research, POGIL was
Selangor. Malaysia. Tel: 603-90750519 originally developed in the 1990s by educators who
E-mail: [email protected] wanted to replace didactic teaching methods1. Based
on constructivism, the focus of POGIL is on the student
4 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

and the process of learning. The students learn the learning task through their own abilities and efforts 14.
required discipline content and the important skills Confidence in learning is important and reported to
which are relevant for their professional role and have increased with POGIL 2, 7, 15. Despite the benefits,
lifelong learning1. The allocated teaching time is used students used to traditional teaching methods and the
for discussions and guided inquiry activities with authoritative figure of the lecturer in the classroom
minimal or no lecture2. The lecturer acts as a facilitator were found not appreciative of POGIL8. Contributing
rather than imparting information as content expert. factors were cited as unclear explanation given of the
Students are grouped into cooperative learning teams classroom format, expectations from the lecturers,
made up of four members, with each member having inadequate feedback to the students and not listening
a specific role such as manager, presenter, recorder actively to students’ complaints8. This study was done
and strategy analyst. These roles are rotated for each to determine whether POGIL, a constructivist-based
class to enable the students to learn the associated instructional strategy, introduced into a traditional
key skills. The learning activities are designed teacher-centred environment would have an effect
around a three-phase learning cycle derived from on the diploma in nursing students’ achievement
Piaget’s mental functioning model and Vygotsky’s and confidence in learning. In addition, the study
theory of learning3. Each class starts with a briefing investigated the perception of students towards this
of the learning outcomes to be achieved. Worksheets instructional method.
are then distributed with models specific to the
course such as case scenarios and critical thinking
MATERIALS & METHODS
questions2. In the exploration phase, students learn Mixed-methods sequential design was used to
to examine and explore the given model. The given explore the following research questions:
questions stimulate their curiosity and create the
needed cognitive dissonance for critical thinking4. 1. Is there a difference between the post-test
In the concept invention phase, the students learn to scores of nursing students in the POGIL group when
discover new concepts and relate to what they already compared to nursing students in the lecture group?
know1. Finally, in the concept application phase, they
2. Is there a difference in the post-test scores
learn to apply their conceptual understanding to new
between two genders of nursing students in the
learning situations and in the process learn how to
POGIL group when compared to nursing students in
apply the concept learned to similar experiences they
the lecture group?
may encounter in the actual work se�ing. At the end
of each class, learning teams are randomly selected 3. Is there a difference in the post-test scores
to present their answers to the questions through between the different nationalities of nursing
their presenter. The whole class had to come to a students in the POGIL group when compared to
consensus and agree on the right answer to each of nursing students in the lecture group?
the questions. Every team is given the opportunity
to answer a question. The lecturer only intervenes to 4. Is there a difference in the end of semester
give a diagnostic assessment of the responses agreed confidence in learning scores of nursing students in
upon and to use the information to provide a mini the POGIL group when compared to nursing students
summary before ending the class2. in the lecture group?

Successful implementation and effectiveness of 5. What is the perception of nursing students

POGIL in achievement levels and overall satisfaction towards POGIL as an instructional method?
of the students towards the method have been In the quantitative phase convenience sampling
reported in many courses such as chemistry5, 6, 7, was used. Final year students (n=73) registered
engineering8, aviation9, foreign language10, medicinal for the course Communicable Diseases in January
pharmacy11, anatomy and physiology12, biochemistry2 2012 semester were selected. The class was divided
and business marketing13. While academic into control (lecture method) (37 students) and
achievement is important, students need to have a experimental (POGIL) (36 students) groups.
personal feeling of having succeeded in mastering a The course content, syllabus, homework and
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 5

examinations were similar. In the qualitative phase, the two groups, (F [1, 70] =.11, p=.740, partial η2=.002).
purposive sampling of nine students, three with the Only 0.2% of the student gains were related to POGIL
highest scores, three with average scores and three as an instructional method when compared to the
with lowest scores from the experimental group findings of other POGIL specific studies 6, 9. Similar to
were selected based on the final school examination Barthlow6, the effect of group and gender in post-test
results for the course Communicable Diseases and scores was also not significant (F [1, 68] =.007, p=.934).
interviewed using a semi-structured format. In addition, the effect of group and nationality was
not significant (F [2, 61] =.057, p=.945).
Two instruments were administered before and
after the intervention: 1) Pre and post-test made Confidence in learning of both groups at the
up of 30 multiple choice items on Communicable beginning of semester was not significant (p >.05).
Diseases and 2) A three-part confidence in learning However, the computed t-value of independent
survey questionnaire adopted and revised to suit the t-statistic (equal variance assumed) showed a
current course with permission from the authors16. significant difference between the groups in the
The contents of the before and after intervention end of semester confidence in learning (p <.05).
instruments were similar in all aspects except for The experimental group had a higher mean score
tense changes in the end of semester confidence compared to the control group2, 7, 15, 19. De Gale and
in learning survey format. The selected questions Boisselle19 had similar findings in a study done on
for pre and post-test were from the test bank and students of an upper six class of a secondary school.
had undergone item analysis. Two senior lecturers However, their students in the POGIL class were
checked the questions for content and face validity. academically good students compared to the nursing
Similarly, the confidence in learning survey was students who were academically average. Qualitative
validated and piloted twice for test-retest reliability findings further strengthened these findings and
(Cronbach’s alpha .912 and .891). The semi-structured showed the nursing students had benefited in terms
interview format with five open-ended questions was of confidence gained.
also piloted among a similar group of students in
Three main categories emerged from the
July 2011 semester to determine the clarity of the
interview. In the category, learning and teaching
questions, authenticity of the methods used and
environment, four themes emerged: non-threatening
accuracy of findings17.
environment, peer support, learning by doing and
Ethical approval was granted by the university limited time. The students perceived their experience
where the study was done. At all times confidentiality learning in a group and the use of worksheets did not
and anonymity of the students was maintained. hinder their learning. Despite the initial doubts, the
Using SPSSv20, descriptive and inferential statistics psychologically safe environment and the support
were used to analyse quantitative data. Qualitative of peers were appreciated. The students perceived
data was analysed using selective coding methods for learning by doing and the intellectual discourse
themes and categories18. with their peers had benefi�ed them in many ways.
However, the students stated of being stressful due
FINDINGS to limited time in class to complete worksheets and
Majority of the students were female (89%). prepare for each class. Some of the quotes are:
Students were mainly from Malaysia (65.8%). Rest
• “It was fun, learning this way. I just express what
were from Botswana (28.8%) and Nigeria (5.5%). The
I think is right. Not all the time we can be right. We never
mean age of the students was 22.3 years. The grade
really had a problem as a group….so I like that.” (PG8);
point average (GPA) of the students at the end of the
previous semester ranged from 2.48 to 3.65 years with • “At first I thought, no way…I am going to get
a mean of 2.87. used to this kind of learning. What no lecturer. Later it
sort of made sense. By working on it (worksheets) and you
The main effect on post-test scores after controlling
hear other people’s opinion why they think that way about
pre-test scores was not significant statistically between
something you never thought of…made me check it out.”
(PG8).
6 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

• “So frus…stress…if manager or recorder and had teacher-centred environment. There were limitations
to submit what is done next day in time (PG9).” which could not be avoided. True randomisation was
not possible, but a�empts were made to segregate
The second category was personal factors with
gender and nationality before assigning the students
two themes: motivation to learn and self-confidence.
to groups. All possible effort was taken to ensure
From the responses, the students were found to be
both groups were kept as similar as possible to avoid
conscious of their own limitations and aware that
extraneous variables. The small sample may have also
doing the worksheets alone was insufficient. They
contributed to statistical significance.
knew it was important to read on their own. The
students determination and effort put into learning Nevertheless, the findings were encouraging and
was extrinsic and goal oriented, namely to do well indicate that POGIL has the potential to contribute
in the course and ultimately get a good cumulative to nursing education in producing “work ready”
grade point. The constant feedback which is an in- graduates. One of the positive findings was the
built mechanism of POGIL classes was perceived increase in the confidence in learning and how
by the students to have enabled them to self-assess students perceived they had benefi�ed in many
and take the necessary steps to improve further. ways especially in learning important process
Such extremely motivated behaviours appear to skills when compared to lecture classes. Their only
have increased their self-confidence not only in concern was the limited time for preparation and in
examinations, but in the clinical area when giving completing the activities. Through self-assessment,
care to patients20. Some examples of the student they did realise the importance of prior reading
quotes were: and coming prepared for discussions. If POGIL had
been introduced at beginning of the programme, it
• “I like to procrastinate, I never read before class.
would probably have made a significant difference.
With POGIL you have to do it (PG6)”;
A track and trend of achievement scores through the
• “I think the POGIL classes helped me to be more three years and further research will help to establish
sensible about the way to look at things in the ward. I was the effectiveness of POGIL especially in relation to
much more confident when reading patient case notes with retention of knowledge and level of growth in process
hepatitis B. I sort of knew what to look for (PG4).” skills.

The third category was key transferable skills with Conflict of Interest: At no time, we, the authors
three themes: teamwork, communication, critical thinking or our institution received payment or services from
and clinical reasoning. The students perceived the skills a third party.
they had learned in the POGIL class were important and
Source of Funding: There was no outside
difficult to learn in a lecture class where there is no active
funding. It was self-funded.
involvement and participation. Examples of some of the
student quotes were: Ethical Clearance: Approval and clearance
obtained from both universities to conduct the study.
• “I know when I am absent from class, it can affect
Wri�en consent was obtained from the students and
the group. We all have a responsibility and it is not fair if
they were aware of their rights.
one of us do not show up” (PG6);
REFERENCES
• “As a presenter, I learned to express my group’s
ideas in front of the class” (PG3) 1. Hanson DM. Instructor’s guide to process-
oriented-guided-inquiry learning. Lisle, IL:
• “Without the right information we cannot think
Pacific Crest; 2006.
and reason out. Like we get to know not all the answers
2. Minderhout V, Loertscher J. Lecture-free
may be suitable for the particular case” (PG1).
Biochemistry: A Process Oriented Guided
CONCLUSION Inquiry Approach. Biochemistry and Molecular
Biology Education. 2007; 35 (3):172-180. doi:
It has been a challenge to introduce POGIL in a 10.1002/bmb.39
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 7

3. Lamba RS. Information Overload, Rote 2010; 74(7): 1-6.

Memory and Recipe Following in Chemistry. 12. Brown P. Process-oriented guided inquiry
In R.S. Moog & J.N. Spencer (Eds.), Process learning in an introductory anatomy and
Oriented Guided Inquiry Learning (POGIL) physiology course with a diverse student
14-25. Washington, DC: American Chemical population. Advances in Physiology
Society; 2008 Education. 2010; 34: 150-155. doi: 10.1152/
4. Nuhoglu H, Yalcin N. The effectiveness advan.00055.2010. Retrieved from h�p://
of the learning cycle to increase students’ adva.physiology.org/content/34/3/150
achievement in the physics laboratory. Journal 13. Hale D, Mullen LG. Designing process-oriented
of Turkish Science Education 2006; 3(2): 28-30. guided inquiry activities. A new innovation for
5. Hein SM. Positive impact using POGIL marketing class. Marketing Education Review.
in organic chemistry. Journal of Chemical 2009; 19(1):73-80.
Education. 2012 89(7): 860-864. doi: 10.1021/ 14. Stefaniak JE, Tracey MW. An exploration
ed100217v. of student experiences with learner-centred
6. Barthlow M. The effectiveness of process instructional strategies. Contemporary
oriented guided inquiry learning to reduce Educational Technology. 2015; 6(2): 95-112.
alternate conceptions in secondary chemistry. Retrieved from h�p://www.cedtech.net/
(Doctoral dissertation). Paper 442. 2011. doi: articles/62/621.pdf
10.111/ssm.12076. Retrieved from h�p://digita 15. Daubenmire PL, Bunce DM. What do students
lcommons.liberty.edu/doctoral/442.08/2011. experience during POGIL instructions? In
7. Straumanis A, Simons EA. (2008). A multi- Moog RS, Spencer JN (Eds.). Process Oriented
institutional assessment of the use of POGIL Guided Inquiry Learning (POGIL).14-25.
in Organic Chemistry. In Moog RS, Spencer Washington, DC: American Chemical Society;
JN (Eds.), Process Oriented Guided Inquiry 2008.
Learning (POGIL). 14-25. Washington, DC: 16. Moore J, Kosciuk S. New traditions: End
American Chemical Society; 2008. of semester “before and after survey.” n.d
8. Douglas EP, Chiu CC. Implementation of Retrieved from h�p://www.flaguide.org/extra/
Process Oriented Guided Inquiry Learning download/tools/a�itude/ntstudba.pdf.
(POGIL) in Engineering. Advances in 17. Cresswell JW. Qualitative inquiry & research
Engineering Education. 2013; Winter: 1-16. design: Choosing among five approaches. (2nd
Retrieved from h�p://advances.asee.org/vol03/ ed.). Thousand Oaks, CA: Sage; 2007.
issue03/paper/all.vol13-issue03-03pdf
18. Merriam SA. Qualitative Research: A Guide to
9. Vacek JJ. Process Oriented Guided Inquiry Design and Implementation (2nd ed.). USA:
Learning, a teaching method from physical Jossey-Bass; 2009
sciences, promotes deep student learning
19. De Gale S, Boisselle LN. (2015).The effect
in aviation. Collegiate Aviation Review.
of POGIL on academic performance and
2011; 29(2): 78-88. Retrieved from h�p:
academic confidence. Science Education
//www.Iaguerrafinal.com/documentation/
International 2015; 26(1): 56-6. Retrieved from
journal
http://www.icaseonline.net/sei/march2015/
10. Johnson C. Activities using process-oriented p4.pdf.
guided inquiry learning (POGIL) in the
20. Ryan RM, Desi EL. Intrinsic and extrinsic
foreign language classroom. Unterrichtspraxis.
motivations: Classic definitions and new
2011; 44 (1), 32-38. Retrieved from h�p://
directions. Contemporary Educational
search.proqest.com.ezproxyy.rit.edu/docview/
Psychology. 2000; 25: 54-67. doi:10.1006/
878895308?accountid=108
ceps.1999.1020.
11. Brown SD. A process-oriented guide inquiry
approach to teaching medicinal chemistry.
American Journal of Pharmaceutical Education.
8 DOI Number: 10.5958/0974-9357.2016.00038.6

Effectiveness of Teaching Intervention on Knowledge and

Practices Regarding Endotracheal Tube Suctioning
among Staff Nurses

Kaur Harjot1, Saini Hemant Kumar2, Gupta Kewal Krishan3

MSc(N) Final Year, University College of Nursing, 2Associate Professor, University College of Nursing, 3Assistant
1

Professor, Department of Anaesthesia, Guru Gobind Singh Medical Hospital, Faridkot, Punjab, India

ABSTRACT

The aim of the study is to assess the effectiveness of teaching intervention on knowledge and practice
regarding endotracheal tube suctioning among staff nurses working at GGS Medical Hospital,
Faridkot. A pre experimental one group pretest post test research design was chosen for the study.
Convenient sampling technique was used to select 35 staff nurses to assess the effectiveness of
teaching intervention. The tool used was a structured questionnaire for assessing the knowledge and
observational checklist was used to assess the practice regarding endotracheal tube suctioning. The
findings of this study revealed that the teaching intervention was effective in increasing the knowledge
and practice regarding endotracheal tube suctioning. The mean pretest knowledge score of nurses who
was 19.23±4.180 and after teaching intervention the mean post test knowledge score was 27.26±4.046.
The mean pretest practice score of staff nurses was 6.91±1.772 and after teaching intervention the mean
post test practice score was 10.54±1.686. The study concluded that the teaching intervention brought
about a significant change in the level of knowledge and practice of staff nurses regarding endotracheal
tube suctioning.

Keywords: Knowledge and practice of ICU staff nurses, Endotracheal tube suctioning, Effectiveness of teaching
intervention.

BACKGROUND more common types of airways are oropharyngeal,

nasopharyngeal, endotracheal and tracheotomy. 1
Respiration is act of breathing. There are three
major alternations in respiration i.e. hypoxia, Endotracheal tubes are most commonly inserted
altered breathing pa�ern and obstructed or partially for clients who have had general anesthetics or for
obstructed airways. Assessing for and maintaining an those in emergency situations where mechanical
open/patent airway is nurses responsibility, one that ventilation is required. An endotracheal tube is
often require immediate action.1 inserted by the primary care provider, nurse, or
respiratory therapist with specialized education. It
Millions of people around the world suffering is inserted through the mouth or the nose and into
from respiratory diseases and certain respiratory trachea with the guide of laryngoscope. 1 One area
symptoms are among major causes of consultation of nursing practice that has caused concern is the
at various health care institutions, for instance endotracheal tube suctioning of intubated patients.3, 4
respiratory problems like Asthma and respiratory
allergies, COPD, Occupational lung diseases, Sleep In the ICU se�ing the accurate assessment and
apnea syndrome, Pulmonary hypertension etc application of invasive procedures can directly impact
associated with increased mortality.2 on the delivery of appropriate care for the patient
within this area. The safe delivery of quality patient
Artificial airways are inserted to maintain a patent care should underpin all components of nursing care
air passage for the client whose airway has become or in the acute care se�ing. The inadvertent delivery of
may become obstructed. A patent airway is necessary suboptimal care can lead to the occurrence of adverse
so that air can flow to and from the lungs. Four of events for the patient.5, 6
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 9

Airway management forms a crucial component any in-service education program etc.
in providing life support within the intensive care
se�ing. Advanced airway management can include FINDINGS
invasive support measures such as the placement A) Sample Characteristics (Frequency and
of ETT into a patient’s airway to enable mechanical Percentage distribution of socio-demographic
ventilation. When an ETT is in situ, a component of characteristics of study subjects)
nursing care is to perform suction to clear secretions
and maintain patency of the artificial airway.7 Majority of 42.9% (15) of subjects were in the age
group of 24-26 years, 40.1% (14) subjects were in the
MATERIALS & METHODS age group of 27-29 years and 17.1% (6) of subjects
A pre experimental one group pretest post test were in the age group of 30-32 years. 65.7% (23) of
research design was performed. Researcher took the subjects were GNM, 8.6% (3) were Post Basic
35 staff nurses by convenient sampling technique B.Sc. Nursing, 25.7% (9) were B.Sc. Nursing educated.
at GGS Medical Hospital, Faridkot. A structured About 11.4% (4) of the subjects had an experience of
questionnaire for assessing the knowledge and 1 year, 51.5% (18) had 2-3 years of experience and
observational checklist to assess the practice regarding 37.1% (13) of subjects had an experience of 4years
endotracheal tube suctioning were used. A structured or more. 34.3% (12) of the subjects had worked in
questionnaire comprising of 38 questions related to private hospital whereas 65.7% (23) had worked in
endotracheal tube suctioning was prepared to assess government hospital. About 31.4% (11) of the subjects
the knowledge of staff nursing working in ICUs. had a past clinical experience of Neuro ICU, 45.7%
(16) in Medical ICU, 8.6% (3) in Neonatal ICU and
An observational checklist consisting of 15 items 14.3% (5) in ICCU and 37.1% (13) of the subjects had
was prepared to assess the practice of staff nurses got in-service education related to endotracheal tube
regarding the endotracheal tube suctioning. 35 staff suctioning and 62.9% (22) of the subjects had not got
nurses who fulfilled the inclusion and exclusion in-service education related to endotracheal tube
criteria were selected from the ICUs of GGS Medical suctioning.
Hospital, Faridkot conveniently. Every subject
had given their socio demographic profile i.e. age, B) To assess the pre intervention knowledge
educational qualification, years of experience working and practice regarding endotracheal tube suctioning
in ICUs, hospital worked in, past clinical experience, among staff nurses.

Table 1: Frequency, Percentage distribution, Mean score and Standard Deviation of the pretest knowledge
and practice scores of staff nurses regarding endotracheal tube suctioning. N=35

Level of Mean
Criteria Frequency Percentage S.D.
knowledge Score
Adequate
Above mean 12 34.28%
knowledge
Inadequate 19.23 ±4.180
Below mean 23 65.71%
knowledge
Mean
Level of practice Criteria Frequency Percentage S.D.
Score

Adequate practice Above mean 14 40.0%

Inadequate practice Below mean 21 60.0% 6.91 ±1.772

C) The teaching intervention was effective on increasing knowledge and practice scores regarding
endotracheal tube suctioning among staff nurses which is statistically significant. N= 35
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 10

Table 2: Mean, standard deviation and paired ‘t’ test of knowledge and practice of effectiveness of the
teaching intervention regarding endotracheal tube suctioning

Knowledge Score Mean score ± SD Paired ‘t’ test Value Df p value

Pre test 19.23± 4.180
22.393 34 0 .000*
Post test 27.26 ± 4.046
Practice Score Mean score ± SD Paired ‘t’ test Value df p value
Pre test 6.91 ± 1.772
17.330 34 0.000*
Post test 10.54 ± 1.686

* = p< 0.05 level

D) The practice scores was found to be associated with educational qualification i.e. p value = 0.026.
N= 35

Table 3: Association between pretest knowledge and practice scores of staff nurses regarding
endotracheal tube suctioning with selected socio demographic variables

S.No. Socio-demographic Variables Knowledge scores Practice scores

?2 df p value ?2 Df p value

1. Age 4.269 2 0.118 0.579 2 0.275

2. Educational qualification 5.797 2 0 .055 7.262 2 0.026*

3. Years of experience in ICU 0.394 2 0.821 1.617 4 0.806

4. Type of hospital worked in 0.442 1 0.506 0.021 1 0.884

5. Past clinical experience 4.195 3 0.241 3.998 3 0.262

A�ended in-service education

6. program related to endotracheal 0.114 1 0.736 0.326 1 0.568
suctioning

* = p< 0.05 level best practice suctioning recommendations and

consequently provided lower-quality ETS treatment
DISCUSSION
than expected.9
Findings of the study revealed that the knowledge
So it was concluded that present status of
pretest mean score was 19.23, knowledge pos�est
knowledge and practice of staff nurses regarding
mean score was 27.26. The mean practice pretest
endotracheal tube suctioning, Majority of staff
score was 6.91, mean practice pos�est score was
nurses had inadequate knowledge and practices.
10.54. Phillips R (2010) demonstrated that the planned
The teaching intervention was effective in term of
teaching programme was effective in increasing
knowledge and practice gain. The difference between
knowledge from 18.35 to 22.45 and practice score
pretest and pos�est knowledge and practice was
from 19.85 to 34.80 regarding ET suctioning among
found statistically significant.
staff nurses.8
Ackowlegdement: I wish to acknowledge the
The present study showed that the study subjects
support of my parents S. Manjeet Singh & Mrs. Jagjeet
had inadequate level of knowledge (23) and practice
Kaur and deep thanks to my brother S. Arshdeep
(21) while performing endotracheal suctioning.
Singh for always being supportive during my whole
Kelleher, Andrews T (2008) found that the practices
time of my study.
followed by critical care nurses did not adhere to
11 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Conflict of Interest: None 4. Craig, J. and Smyth, R.The Evidence based

Practice Manual for Nurses London: Churchill
Source of Funding: Nil Livingstone.2002; 6(2):34-46.
Ethical Clearance: The ethical approval was 5. Baun, M.M. Physiological Determinants of a
taken from ethical commi�ee of University College Clinically Successful Method of Endotracheal
of nursing, Faridkot. Permission was taken from Suction. Western Journal of Nursing Research,
Medical superintendents of the hospital prior to final 1984; 6(2), 214-228.
data collection. Apart from this, informed consent 6. Knox, A. M. Performing Endotracheal suction:
was taken from each respondent to participate in the A literature review and implications for nursing
study. practice. Intensive and Critical Care Nursing.
1993; 9, 55-61.
REFERENCES
7. Curley, M.A.Q., & Moloney-Harmon, P.A. (2001).
1. Kozier, Berman, Snyder, Erb. Fundamental of Critical care nursing (2nd ed.) Philadelphia,
Nursing: Concepts Process and Practice. 2008; 8th W.B.Saunders Company.
edition; Published By Pearson Education Private
8. Phillips R. Effectiveness of planned teaching
Limited; Pp 546, 1363, 1379-80, 1382.
programme regarding endotracheal suctioning,
2. Heneretig F M, Chritopher M D. Textbook of Indian J nurse stud, 2010Jan-June; 1(1):20-5.
Emergency procedures. Pennsylvania: Williams
9. Kelleher S, Andrews J, An observational study on
& Wilkins publishers; 1997; Pp 123-27.
open- system endotracheal suctioning practices of
3. Smith K State-wide Guidelines for Intensive Care. critical care nurses; 2008 Feb;17(3):360-9.
NSW Health 2007; 2:4-50.
 DOI Number: 10.5958/0974-9357.2016.00039.8

Parents Influence on Quality of Life of Children with

Epilepsy: An Evaluative Survey

Poonam Joshi1, Manju VM2, Shefali Gulati3

1
Lecture, College of Nursing, AIIMS, New Delhi, 2Staff Nurse Grade 2, Pediatric Ward, AIIMS, New Delhi
3
Professor, Pediatric Neurology Division, Pediatric Department, AIIMS, New Delhi

ABSTRACT

An evaluative survey was conducted to investigate the influence of parents in the HRQOL of children
with epilepsy. Sixty children with epilepsy from pediatric neurology clinic (OPD) and 60 normal
children and their parents were enrolled for the study. The HRQOL of epilepsy children as assessed
by the children themselves and their parents was compared with normal children and their parents
using a standardized Peds QL 4.0 tool. Both, children with epilepsy and their parents, despite having
chronic illness like epilepsy, rated be�er quality of life than the comparison group. Parents had made
significant influence in the quality of life of children with epilepsy.

Keywords: Health related Quality of life, Epilepsy, Parents, Normal Children

INTRODUCTION in the brain. According to the World Health

Organization (WHO) definition, “a diagnosis of
Parents lay the foundation stone in the epilepsy is made in the presence of recurring seizures,
development of their children in their formative years. at least two unprovoked ones.” Approximately 45,000
Their presence place a positive impact on the physical, children under the age of 15 develop epilepsy each
emotional, cognitive and social development of year. Population based studies report prevalence
children, thus improving their academic performance rate of 3.6 to 4.2 per 1000 for children in developed
as well. Having parents to take care of the physical, countries; and approximately double these rates
emotional health, displace a tremendous amount of in developing countries.1-5 The prevalence rates of
stress out of children’s mind in growing years. It may epilepsy in India are similar to those of developed
also empower them to outgrow the limitations with nations.6
parents’ constant support and guidance. While being
affected by a chronic health problem like epilepsy While seizure’s experience itself is frightening,
children may show varied responses in various phases these children often face other problems too like
of development. But parents play an important role learning, cognitive and school difficulties, medication
in alleviating the negative impact of such a problem side effects, social stigma, psychiatric co-morbidity,
which could alter the perceived health related quality and behavioral problems7-9 Epilepsy can negatively
of life by these children. impact physical, social and psychological function in
the developing years. Traditionally, seizure control
Epilepsy is a neurological condition characterized has been the main focus of medical management
by recurrent seizures due to transient disturbances of of epilepsy, whereas the importance of assessing
cerebral function secondary to abnormal paroxysmal quality of life (QOL) has been ignored10 and certainly,
not the role of parents in it.
Corresponding author
Considering the above factors it is important
Mrs. Poonam Joshi,
to measure health-related quality of life (HRQOL)
Lecturer, College of Nursing, AIIMS. Email:
in children with epilepsy. Proxy ratings are often
[email protected] Mob: 9818039744;
used to assess HRQOL in young children. Children,
Tel: 011-26594457
13 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

however, may have different perspectives from 10-15 Km) were purposively selected between 12-15
that of their adult proxies. Identification of such years of age, who could go home during weekend,
potential differences is important for developing holiday vacation and during acute illness.
comprehensive treatment programs for children and
Considering the mean score of QOL in epilepsy
families with epilepsy.11
children as 75.5± 20.812 with 95% confidence and 5%
Epilepsy is a complex neurological condition absolute precision, the calculated sample size was
with many possible co-morbid features. The few 60 for epilepsy group. In order to study the role of
previous studies which have focused on the quality parents in care of epilepsy children, quality of life of
of life of children with epilepsy have mainly relied these children were compared with healthy children
upon parent-proxy reports.11 In the current shifting as a group of 60 constituting total of 120 children.
paradigm of giving more autonomy to children in
The inclusion criteria for enrolling sample
health care decisions, this study intends to explore
were: children with epilepsy between 5-18 yrs and
the perspectives of children regarding their quality
on treatment for 6 months or more, not having any
of life; and how things are perceived from their point
other chronic illness and for the normal children
of view which might be different from that of their
age between 5-18 years, not having any chronic
parents. Also studies explaining how quality of life
illness or not on any kind of medical treatment or
of children with epilepsy is affected by the presence
having no physical or mental disability, a�ending
of their parents are difficult to find in literature. So
school regularly, children and their parents who
this study intends to further expand the picture by
could understand/read/write Hindi and willing to
exploring this area.
participate in the study.
The objective of this survey was to find out
Ethical clearance was taken from ethics
the influence of parents in the HRQOL of children
commi�ee of the institute. Informed wri�en consent
with epilepsy and to compare the QOL of epilepsy
was taken from the parents and assent from children.
children with normal ones, who were not staying
Confidentiality of information and anonymity of the
with their parents regularly. This might also help
subjects was maintained. Subject data sheet was used
to get a comprehensive picture of the children who
to collect the demographic profile of respondents. The
are being treated in epileptic clinics, looking beyond
23-item PedsQL 4.0, Hindi version, a standardized
seizure control, and may assist in planning their
tool (alpha =0.88 child and 0.90 parent report) was
stay with parents during school education; giving
used to assess quality of life of children in epilepsy
special a�ention to convey parenting tips on taking
and normal children. Tool included scales: i) physical
care of these children for be�er physical, emotional,
functioning (8 items), ii) emotional functioning (5
social health, cognitive development and academic
items), iii) social functioning (5 items), iv) school
functioning.
functioning (5 items). The scales were composed of
METHODOLOGY both the child-self report and parent-proxy report
formats for children aged 5 to 18 years Items were
Sixty children with epilepsy and equal number
reverse-scored and linearly transformed to a 0-100
of normal children along with their parents were
scale (0=100, 1=75, 2=50, 3=25, 4=0). Higher scores
enrolled for the study. Data were collected from
indicated be�er health-related QoL. Data was
pediatric neurology clinic (OPD) between January-
analyzed using descriptive and inferential statistics
December 2013. The HRQoL of epilepsy children
using SPSS 17.0. The Chi-square test, coefficient of
as assessed by the children themselves and their
correlation, independent t test were used, p value <
parents was compared with normal children (from
0.05 was considered statistically significant.
a residential school) using a standardized Peds
QL 4.0 tool. Children with epilepsy were enrolled RESULTS
using consecutive sampling technique while normal
Mean age of children with epilepsy and normal
children studying in a residential government school
children (yr) was 9.06±2.68 and 12.7±1.33 respectively.
(having their parents staying within the vicinity of
Mean age (yr) at the time of onset of seizures
14 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

and diagnosis in epilepsy group was 5.9±3.5 and Majority PCG at home in epilepsy group were
6.17±3.5 respectively. Majority children in epilepsy mothers (53, 89.83%) while PCG in normal children
group were male 42 (70%) while in normal group group were both parents (38, 63.33%). Mean age of
were female 36(60%). Majority children in epilepsy parents (father and mother) in epilepsy and normal
group 49(81.67%) and all normal group were children was 39.39±5.8, 33.64±7.6 and 40.17±4.8,
a�ending school. Most of the children (31, 51.7%) 35.63±4.08 respectively. Both the groups were
had generalized seizures followed by partial seizures comparable in terms of place of residence, occupation,
(22, 36.7%) with the frequency less than 1 /month 47 education of mother and father, family income and
(78.3%), on one antiepileptic drug (24, 40%), followed health of siblings (p>0.05)
by 2 epileptic drugs (18, 30%) and remaining were on
more than 2 drugs.

Table 1: HRQOL in Normal Vs Epilepsy Children: Child and Parental Perception n=120

Child (n=120) Parent proxy (n=120)

Domain
p value With epilepsy Normal
p value
Mean±SD Mean±SD

Physical health 671.67 ±164.579 633.58 ±97.714 0.00* 696.25± 143.195 585.42±130.131 0.00*

Emotional health 402.08± 141.08 326.67±64.58 0.00* 397.08± 80.134 353.33± 91.881 0.01*

Social health 411.67±141.08 401.25±67.72 0.00* 432.08± 132.934 397.50± 86.566 0.09

School health 296.25±167.41 359.58±63.46 0.00* 299.17± 173.019 366.67± 89.332 0.00*

Overall health 1781.67±437.56 1695.83±231.89 0.00* 1824.58 ±403.231 1702.92±321.513 0.07

Independent t test (p<0.05)

Children with epilepsy perceived HRQOL be�er in which normal children did fairly well was school
than normal children overall and in the domains of health. Normal children did not have any problem
physical health, emotional health and social health related to a�entiveness, memory, doing home work
(p=0.00), while in school health domain normal and absenteeism form school due to sickness or
children perceived their HRQOL be�er than epilepsy hospital visit, while children with epilepsy had faced
children. Children with epilepsy did not have any all these problems.
problem in walking, running, doing exercise, weight
Similarly parents of children with epilepsy
lifting, self care, household activities and did not
assessed HRQOL of their children be�er than parents’
complain of pain and fatigue doing such activities.
of normal children in the domain physical health and
They also did not have any fear, sadness, anger,
emotional health (p=0.00) while in the domain of
sleeping problem or future worries due to the disease.
school health parents of normal children found be�er
No problem was felt by the children with epilepsy in
HRQOL.
maintaining friendship with others and did not have
the fear of being bullied by others. The only domain
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 15

Table 2: Comparison of HRQOL in normal Vs epilepsy children reported by child and parent

Domain Child (Mean±SD) Parent proxy, (Mean±SD)

p value
Group n= 60 n= 60

Normal 608.33±97.71 585.42±130.13 0.28

Physical health
Epilepsy 671.67±164.58 696.25±143.19 0.38

Normal 326.67±64.58 353.33±91.88 0.01*

Emotional health
Epilepsy 402.08±94.92 397.08±80.13 0.76

Normal 401.25±67.72 397.50±86.57 0.03*

Social health
Epilepsy 411.67±141.08 432.08±132.93 0.42

Normal 359.58±63.46 366.67±89.33 0.01*

School health
Epilepsy 296.25±167.41 299.17±173.02 0.93

Normal 1695.83±231.89 1702.92±321.51 0.01*

Overall health
Epilepsy 1781.67±437.56 1824.58±403.23 0.58

Paired t test (p<0.05) Besides, living with epilepsy or any chronic health
problem brings an expected range of compromises
Parents and children in epilepsy group assessed
in daily life which might subconsciously become
HRQOL similarly while in normal children parents
accepted as normal over time.
had overestimated HRQOL of their children in
the domain of emotional (p=0.01), school (p=0.01) Childhood epilepsy is a chronic neurological
and overall health (p=0.01), while normal children disorder also associated with profound psychosocial
assessed themselves be�er in social health domain limitations. Children with epilepsy generally have
(p=0.03) normal intelligence, which is no different from that
of non-epileptics. But epilepsy can affect child’s
DISCUSSION education, thereby leading to trouble learning and
In the present study, HRQOL was rated higher lower grades in the school. In the present study
in epilepsy children in physical, emotional and social school health was the only domain in which low
health (p=0.00). The reasons for this could be well scores were found in comparison to normal children
controlled seizures in majority children and being both by children and their parents (p=0.00).
on one or two AED, these findings are in contrast
In the present study child vs. parent proxy in
to the findings given by Malhi P, Singhi P13 in which
epilepsy group had similar HRQOL scores, which are
Children with epilepsy have a relatively compromised
in contrast to the findings given by Yong Li14 in which
quality of life, when put on multiple anti-epileptic
children rated their HRQoL be�er than their parents.
drugs. Similarly parents of these children assessed
In normal children, parents overrated HRQOL in the
HRQOL of their children higher in physical health
domain of emotional, school and overall health while
and emotional health (p= 0.00, 0.01).
children had higher HRQOL scores in social health.
It is important to note that the children with Normal children not staying daily with parents,
epilepsy were all living with their parents having spending most of the time with peer group could be
them to guide and compensate for their difficulties the probable reason for the difference in scores.
and ensuring compliance with anti-epileptic drug
The role of parents in the initial formative years
therapy giving higher ratings in perceived quality of
during childhood is very critical. The present study
life in physical, emotional and social health(p=0.00).
also surfaces the need for giving special a�ention to
16 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

parents of these children as they have an important 3. Sridharan R and Murthy BN. Prevalence and
role to play in the quality of life these children. So let pa�ern of epilepsy in India. Epilepsia 1999; 40:
the need of the hour be a comprehensive package of 631-6.
care and counseling to the duo. 4. Nicole�i A, et al. Prevalence of epilepsy in rural
Bolivia; A door-to-door survey. Neurology. 1999;
Small sample size, single centre cross-sectional
53:2064-9.
study with purposive and consecutive sampling
of the children limits the generalizability of the 5. Christianson AL, et al. Epilepsy in rural South
findings. The present study has several implications Africa children-prevalence, associated disability
and recommendations. Health care professionals and management. S Afr Med J 2000; 90:262-6.
should look beyond the seizures in children, its type, 6. Gadgil P, Udani V. Pediatric epilepsy: The Indian
medication and should pay a�ention to the key areas experience. J Pediatr Neurosci. 2011; 6:126-9.
of HRQOL in children with epilepsy and explore
7. Bailet LL, Turk WR. The impact of childhood
factors affecting HRQOL in these children such as
epilepsy on neurocognitive and behavioral
parental age & education, place of residence, type
performance: a prospective longitudinal study.
of family, socio-economic status etc. so as to provide
Epilepsia. 2000;41:426–31.
holistic care to these children along with education
and counseling to their parents. The study can be 8. Berg AT, Smith SN, Frobish D, et al. Special
replicated in larger group with qualitative component education needs of children with newly
in it. Longitudinal studies in this regard would reveal diagnosed epilepsy. Dev Med Child Neurol.
more valuable, meaningful and important issues 2005; 47:749–53.
related to HRQOL in children with epilepsy. The 9. Freilinger M, Reisel B, Reiter E, et al. Behavioral
study can be done with any other chronic illness like and emotional problems in children with
asthma, ESRD, cystic fibrosis and leukemia etc. epilepsy. J Child Neurol. 2006; 21:939–45.
10. Ronen GM, Streiner DL, Rosenbaum P. Health-
CONCLUSION
related quality of life in childhood epilepsy:
Parents have an important and influential role in Moving beyond control with minimal adverse
enhancing the quality of life of normal children and effects. Health Qual Life Outcomes. 2003; 1:36.
children with epilepsy. 11. CB Baca, et al. Differences in child versus parent
reports of the child’s health related quality of life
Acknowledgement : Author acknowledges the
in children with epilepsy and healthy siblings.
contribution of parents of epilepsy children in giving
Value Health. 2010; 13:778–86.
their precious time, without which the study would
not have been possible. 12. Haneef Z, et al. Correlation between child and
parental perceptions of health-related quality
Conflict of Interest - None of life in epilepsy using the PedsQL.v4.0
measurement model. Epileptic Disord 2010;12
Funding : Self Funded
(4): 275-82.
Competing Interest: None 13. Malhi P1, Singhi P. Correlates of quality of life
with epilepsy. Indian J Pediatr 2005; 72(2):131-5.
REFERENCES
14. Yong Li, Cheng-Ye Ji, Jiong Qin, Zhi-Xiang Zhang.
1. Beilmann A, et al. Prevalence of childhood Parental anxiety and quality of life of epileptic
epilepsy in Estonia. Epilepsia.1999; 40:1011-9. children. Biomed Environ Sci. 2008 June; 21(3):
2. Sidenvall R, Forsgren L and Heijbel J. Prevalence 228–232. doi: 10.1016/S0895-3988(08.
and characteristics of epilepsy in children in
Northern Sweden. Seizure.1996; 5:139-46.
 DOI Number: 10.5958/0974-9357.2016.00040.4

A Quasi Experimental Study to Assess the Effect of

Relaxation Technique on Stress Related to Adjustmental
Problems among Staff Nurses working in Selected
Hospitals of District Jalandhar, Punjab, 2015

Satvir Kaur1, Kishanth Olive2

Student, 2Assistant Professor, Department of Psychiatric Nursing, S.G.L. Nursing College, Semi, Jalandhar, Punjab.
1

ABSTRACT

Background of the study:- The stress and adjustmental problems are interrelated terms. So ‘Lazarus’
advocated a psychological view in which stress is “a particular relationship between the person and the
environment that is appraised by the person as the exceeding his or her resources and endangering his
or her well-being’’ that results in adjustmental problems.

Objectives: 1. To assess the stress related to adjustmental problems among staff nurses of control
group and experimental group before intervention.

2. To assess the stress related to adjustmental problems among staff nurses of control group and
experimental group after intervention.

3. To compare the stress related to adjustmental problems before and after the intervention among staff
nurses of control group and experimental group.

4. To find out the association of stress related to adjustmental problems among staff nurses with their
selected socio demographic variables.

Research Methodology: Quasi Experimental(Non Equivalent Pre Test Post Test Control Group) design
was used on 60 staff nurses of selected hospitals of District Jalandhar, Punjab by using convenience
sampling technique.

Result and Conclusion: The Pre test stress score in control group reveals that out of 30 samples,
16(53.3%) staff nurses had severe stress and 13(43.3) had moderate stress, where as in experimental
group, 18(60%) staff nurses had severe stress and 12(40%) had moderate stress score. After
implementation of relaxation technique on experimental group, the stress score was significantly
reduced that was 18(60%) staff nurses had mild stress and 12(40%) had moderate stress. The significant
mean difference was 19.502* in experimental group, at p<0.05 level of significance. Hence, it was
concluded that relaxation technique was useful in reducing stress related to adjustmental problems
among staff nurses. Education and income has impact on stress related to adjustmental problems
among staff nurses

Keywords: “Relaxation Technique” “Stress related to Adjustmental Problems” “staff nurses” “selected
hospitals”.

INTRODUCTION going through a process of change and are searching

for some level of balance or acceptance with the
Adjustment may be defined as a process of
environment, others, or themselves.1
altering behavior to reach a harmonious relationship
with the environment. When people say they are in Stress is defined as “a state of psychological
an “adjustment period” they typically mean they are and/or physiological imbalance resulting from
18 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

the disparity between situational demand and the RESULTS

individual’s ability and/or motivation to meet those
demands.’’ (Dr. Hans Selye).2 The first objective revealed that in control group,
majority (60%) staff nurses had severe stress, followed
According to WHO statement, the most stressful by moderate stress score (40%). Among experimental
type of work is that which values excessive demands group, majority (53.3%) staff nurses had severe stress,
and pressures that are not matched to workers’ followed by moderate stress score (43.3%).
knowledge and abilities, where there is li�le
opportunity to exercise any choice or control, and The second objective revealed that post test stress
where there is problems in adjusting to the work score after administration of relaxation technique in
environment and where there is li�le support from experimental group was (60%) of staff nurses had
others. 3 mild stress score,(40%) had moderate stress score and
no one had mild stress score. Among control group,
Work contents that leads to stress and adjustment majority (50%) of the staff nurses had severe stress
problems among nurses includes - job content score followed by moderate stress score (46.7%) and
(monotony, under-stimulation, meaningless of tasks (3.3%) had mild stress score.
etc) - work load and work pace (too much or too
li�le to do, work under time pressure, etc.) - working According to third objective in present study
hours (strict or inflexible, long and badly designed comparison, the post test mean stress score 21.07
shift systems) - Participation and control (lack of in experimental group was less than post test mean
participation in decision-making, lack of control over stress score 37.43 in control group and it was
work processes, pace, hours, methods, and the work statistically significant at p<0.05 level as calculated
environment). 4 ‘t’ value (t=19.502*) was more than the table value at
p<0.05 level of significance.
Progressive muscle relaxation is a systematic
technique for achieving a deep state of relaxation. The fourth objective revealed that in control group
It was developed by Chicago physician Edmond significant association were found with monthly
Jacobson who discovered that a muscle could be income variable whereas in experimental group,
relaxed by first tensing muscles for a few seconds significant association were found with education
and then releasing it. Tensing and relaxing of various and monthly income.
muscle groups throughout the body produces a deep CONCLUSION
state of relaxation which Doctor Jacobson found
capable of relieving a variety of conditions. Excellent A total number of 60 samples were selected for this
results have been observed with this method in the study. The Pre test mean stress score of experimental
treatment of muscle tension, anxiety, insomnia, group was 38.30 and Post test mean stress score was
depression, neck and back pain, high blood pressure, 21.07. The Pre test mean stress score of control group
mild phobia and stu�ering.5 was 38.47 and Post test mean stress score was 37.43.
The significant difference was 19.502* in experimental
MATERIALS AND METHOD group, research hypothesis was accepted at p<0.05
This study was conducted on staff nurses in level of significance and null hypothesis was rejected.
different hospitals of district Jalandhar .i. e S.G.L. Education and monthly income had impact on stress
Charitable hospital, Sacred Heart hospital, Capitol related to adjustmental problems among staff nurses
hospital, Johal hospital, Jalandhar, Punjab, India. knowledge. Hence, it was concluded that relaxation
Quasi - Experimental Design (non equivalent pre- technique was useful in stress related to adjustmental
test, post-test control group design) was adopted and problems.
a total of 60 staff nurses were selected for the study, DISCUSSION
who met the inclusion criteria. Self-structured rating
scale was used to assess the level of stress related to The first objective was to assess the effect of
adjustmental problems. relaxation technique on stress related to adjustmental
problems among staff nurses of control group and
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 19

experimental group before intervention. The findings ‘t’ value (t=8.183*) was more than the table value at
of the present study revealed that in control group, p<0.05 level of significance. It showed that the post
majority (53.3%) of staff nurses had severe stress score test of control and experimental were significantly
followed by moderate stress score (43.3%). Among related. Pre test and post test of experimental group
experimental group, majority (60%) of the staff nurses were also significantly related as calculated’ value
had severe stress score, followed by moderate stress (t=19.502*) was more than the table value at p<0.05
score (40%). level of significance. This objective is discussed with
a study conducted by Palak Patel (2014) to assess
The findings of the objective were supported
the effectiveness of Progressive Muscles Relaxation
by Ms. Palak Patel(2014), conducted to assess the
Therapy on Stress among Staff Nurses Working in
effectiveness of Progressive Muscles Relaxation
Selected Hospitals at Vadodara City, which revealed
Therapy on stress among Staff Nurses Working in
that the mean post-test stress score 36.67 was less than
Selected Hospitals at Vadodara City. The findings
the mean pre-test stress score 64.17,(t=20.580).
of pre test in this study shows that in pre-test13.33%
had severe stress, and 40% had moderate stress and The fourth objective was to find out the
46.67% had mild stress respectively. association between stress score related to
adjustmental problems among staff nurses with their
According to second objective was to assess the
selected socio demographic variables i.e age, gender,
effect of relaxation technique on stress related to
education, area of work, experience, religion, marital
adjustmental problems among staff nurses of control
status, type of family, residence and income. Present
group and experimental group after intervention. In
study revealed that in control group significant
the present study, training for Relaxation technique
association were found in income variable whereas
was taken from the expert and was implemented on
in experimental group, education and income had
the staff nurses through demonstration method. After
significant association with the selected demographic
that post test findings of the present study revealed
variables.
that in control group 50% had severe stress and 46.7%
had moderate stress, whereas in experimental group This objective of study was discussed with study
60 had mild stress and 40 had moderate stress. conducted by Palak Patel (2014), which shows a
significant association with the monthly family
Among control group, the mean score of stress
income. These findings are similar to present study
in post test was 37.30 and in experimental group
findings.
was 21.07 that shows that relaxation therapy had
impact on stress related to adjustmental problems Acknowledgement: I want to express my
among staff nurses. The findings of the study were gratitude especially to the Medical Superintendents
supported by study conducted by Palak Patel (2014) of hospitals, who allowed me to conduct study and
), conducted to assess the effectiveness of Progressive the subjects those who participated in the study. I also
Muscles Relaxation Therapy on Stress among Staff want to thank my affectionate and adoring Parents,
Nurses Working in Selected Hospitals at Vadodara sisters, my co-guide Ms. J. Sobiya and my friends for
City, which revealed that in experimental group, the their constant support and encouragement.
post test mean score 36.67 was less than pretest mean
Ethical Considerations:
score 64.17, that shows a significant difference in
stress score of nurses. 1. Wri�en permission was taken from principal
of S. G. L. Nursing College Semi Jalandhar.
The third objective was to compare pre test and
post test stress score related to adjustmental problems 2. Wri�en permission was taken from ethical
among staff nurses of control and experimental groups. clearance commi�ee of the S.G.L Nursing College
In present study comparison, the post test mean stress Semi Jalandhar.
score 21.07 in experimental group was less than post
test mean stress score 37.30 in control group and it 3. Wri�en permission was taken from Medical
was statically significant at p<0.05 level as calculated Superintendents of S.G.L Charitable hospital, Sacret
20 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Heart hospital, Capitol hospital and Johal hospital of 2. Stress. Available at h�p://kalyan-
District Jalandhar, Punjab. city.blogspot.com/2011/03/what-is-stress-
meaning-definition-and.html
4. Informed consent was taken from each study
3. Stress in medical or biological context. Available
sample.
at h�p://www.medicinenet.com/script/main/
5. Confidentiality and anonymity of study art.asp?articlekey=20104
samples maintained throughout study. 4. Stressful work and adjustmental problems
Source of Funding: Self among nurses. Available at h�p://www.who.int/
occupational_health/topics/stressatwp/en/
Conflict of Interest: Nil 5. progressive muscle relaxation technique.
REFERENCES Available at .h�p://www.camcommons.org/
progressive-muscle-relaxation-as-an-evidence-
1. Adjustment. Available at h�p:// based-cam- treatment.html
www.alleydovvqqg.com/glossary/definition.php
?term=Adjustment
 DOI Number: 10.5958/0974-9357.2016.00041.6

Analysis of Health Care Delivery System in

Pakistan and Singapore

Hina Nizar1, Parveen Chagani1

1
MScN Student, Aga Khan University School of Nursing and Midwifery, Karachi

ABSTRACT

Health plays a significant role in individuals’ life and in restoring this; health care system of a nation
contributes its major part. According to World Health Organization health system is defined as “all
the activities whose primary purpose is to promote, restore and/or maintain health”. This paper
primarily describes the health care delivery system of Pakistan and Singapore, analysis of both the
health care systems and discusses some of the recommendations in order to improve health care sector
of Pakistan.

Keywords: Health care, delivery, system, Pakistan, Singapore.

INTRODUCTION OF PAKISTANI HEALTH are well organized bodies offering services on charge
CARE DELIVERY SYSTEM bases. The health expenditure per capita in Pakistan is
reported to be 750-800 (US $ 12-13). It is estimated that
Pakistan is the six most populated country of 25% of this is contributed by public sector and rest of
the world with a population of 180.44 million people the 75% is invested by private service fee system.11
approximately.22 Pakistan came under the category of
low income countries with low human development SINGAPORE HEALTHCARE DELIVERY
index rank of 146. According to Pakistani constitution, SYSTEM
health is chiefly governs by the provisional authorities. Singapore, is an island country with a population
Federal government is responsible for various health of 5.2 million, it was founded as a British trading
laws/policy making at national level, collecting colony in 1819. It joined the Malaysian Federation
foreign funds to generate provisional health facilities, in 1963 but separated two years later and became
organizing public health and educational awareness independent. Singapore successively became one of
programs. The Pakistani health system is divided into the world’s most flourishing countries with strong
public and private sectors respectively. The mode international trading links and with per capita GDP
of health care delivery in Pakistan starts from basic equal to that of the leading nations of Western Europe.
health unit and rural health centers; are the primary It is well-known for its efficient and widely covered
health care services. Secondary care is provided healthcare system. The philosophy of Singapore’s
through Tehsil headquarter and district headquarter healthcare system consists of three pillars. Firstly,
hospital, where as tertiary care facilities are comprises the country is expected to build a healthy population
of teaching hospitals mostly located in big cities. In with focus on prevention and to encourage healthy
addition, Pakistan military, railways and airlines lifestyles. Secondly, Singapore also emphasizes
etc, also have their own health services available for its citizen to take responsibility towards healthy
their employees and families. Private health sectors living through the “3M” (Medisave, Medishield and
Medifund) health system. Lastly, the government has
Corresponding author: to keep the healthcare costs down by controlling the
Hina Nizar supply side of the healthcare services and providing
MScN Student in Aga Khan University School of heavy aids at public healthcare institutions. The three
Nursing and Midwifery, Karachi main healthcare regulators in Singapore are Ministry
email: [email protected] of Health (MOH), Central Provident Fund (CPF) and
22 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Monetary Authority of Singapore (MAS).25 applicable policies and mismanagement among

authorities etc. In addition, the health authorities are
HEALTH CARE INDICATORS
now striving to fulfill the millennium development
Key health indicators of Pakistan includes goals (2015), but due to the political and economical
demographic like total population, life expectancy uncertainties it seems unlikely to accomplish the
at birth, crude birth and death rates, fertility rates, task.
maternal mortality rate, education and literacy
On contrast, Singapore support achievement
rates and many more. Disease burden and outcome
of millennium developmental goal and recognizes
indicators comprised of maternal and child health,
challenges face by many low income countries.
communicable and non-communicable diseases etc.
Singapore and China are building eco city in Tianjin
input indicators involves the finance expendure
to promote environment sustainability.
on health and facilities. Moreover, emergency and
disaster management is one of the most indicators as FINANCING
Pakistan faced lots of natural and manmade crises in
Healthcare financing refers to the ways in which
last many years.12 Pakistan was and is still striving to
money is raised to fund health activities as well
meet all these needs but due to the political influences,
as how it is used (that is, the allocation of funds).3
corruptions and non-availability of financial and
Pakistan face a major challenge of improper financing.
human resources these targets are not achieved on
Pakistan belongs to a low socio-economic group of
allocated time. In addition, non-functional health
countries. The government has been spending only
information system (HIMs) is one of the significant
0.6-1.19% of GDP on health. Only 3.4% of the total
drawback to maintain, record and analysis of the
budget was allocated to the health sector and 80% of
health care indicators for further decision making
which spend on curative purpose in secondary and
process.
tertiary care services and rest to the primary health
In contrast, Singapore also has some health care services.17 Scarcity of resources, corruption and
indicators. The main categories for those are child accessibility issues are the common hindrances in the
malnutrition (e.g. low birth weight in children), delivery of effective health services.
malnutrition in women (e.g. anemia in pregnant
In Singapore healthcare financing is based on
women), health services (e.g. skill health a�endants,
two philosophies. Firstly, its individual citizen is
immunization and sanitation etc), and food security
responsible to contribute some amount for their
(e.g. consumption of iodine salt). The government
health through savings or life insurance. Second,
also records the data for caring practices (e.g. breast
the government is responsible to provide equal and
feeding), commitment /capacity and education.25
affordable healthcare to all. Singapore has a mixed
Singapore has well defined active HIMs which
financing system with multiple layers of shelter to
make their health care delivery system towards
confirm that no Singaporean is deprived of access
improvement and be�erment.
to basic healthcare because of affordability issues.
ANALYSIS OF BOTH THE HEALTHCARE In 2008, 32% of healthcare was funded by the
SYSTEM government. It accounts for approximately 3.5% of
Singapore’s GDP.25
This section is mainly focus on the comparative
analysis of both the healthcare system based on WHO HEALTH WORKFORCE
health system framework developed in 2000.
Health workforce includes all those responsible
HEALTH SERVICES to provide health care to public. It includes doctors,
nurses, lady health visitors, paramedic staff, educator
Pakistan is struggling to achieve the quality health
and managers. In term of quality, less a�ention has
care standards like other developing countries by
been paid by government on Pakistani population.
se�ing several goals and expectation. Unfortunately,
Today, the doctor to patient ratio in Pakistan is 1:1300,
Pakistan has failed to capture the target of “Health
having increased from a baseline of 1:60,000 in 1947.10,6
for All” 2000 due to the lack of resources, strong
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 23

On the other side, the nurse to population ratio is 1: and decision making process. Ministry of health
3568 for registered nurses and 1: 54, 276 for LHVs.14 of Pakistan has formulated HMIS in 1991-92 but
Moreover, there is also chronic shortage of senior unfortunately the system doesn’t work well.16 With
managers and health administrators.10 However few the collaboration of WHO Pakistan is working on
efforts are in progress to fill these gaps. the be�erment of HIMS. Currently, 80 people trained
from overall 134 districts and 77 districts are regularly
Working on its philosophy Singapore is also
reporting health related activities.23
strived its best to provide tremendous healthcare.
According to,16 Singapore occupies 6 out of 191 Singapore has an integrated health information
nations to provide good health facility whereas system (IHiS) that was built in 2000 with the mission
Pakistan is at 121. to lead and deliver technology for excellence
in healthcare. IHiS is a healthcare IT leader
MEDICAL PRODUCTS AND that transforms patient care through quality in
TECHNOLOGIES technology. Singapore has IT experts with over 700
To improve the health of poor people require IT professionals and more than 30,000 healthcare
many varieties of health innovations, such as new users’ at all public hospitals, specialty centers and
drugs, vaccines, devices, and diagnostic tools, as polyclinics. According to Professor Benjamin Ong,20
well as new techniques in process engineering “By implementing IT appropriately to optimize
and manufacturing, management approaches, workflows and processes, our people have ensured
software, and policies in health systems and that unnecessary administrative tasks have been
services.10 However Pakistan is very behind in reduced. This has translated into more time for
term of advance technology that caters the needs of patient care and enhanced patient safety”.
advance and complex surgeries. On the other hand,
SERVICE DELIVERY
health information management system is not very
well developed due to which health data are not In Pakistan the government health care facilities
recorded accurately or delayed. To overcome these consist of 1096 hospitals, 5527 basic health units,
issues telemedicine and the concept of e-health have 650 rural health centers and 5310 dispensaries
been implemented as pilot projects in rural areas approximately,15 altogether making efforts to
like Baltistan and Education Foundation, with the accomplish health of common people. According
technical assistance of Comsats.10 to the 18th amendment all responsibilities of health
care delivery system is a provisional mandate and no
Singapore health care delivery system is highly
more remains the federal part. Accept few national
technology focused. Demand for state of the art
programs all health programs in all four provinces
medical technologies is high as Singapore strives
are managed and financed by the provisional
to provide first class healthcare delivery systems
government. At provincial level, director general
and facilities to its residents as well as serve the
health services is the head regulatory person under
international patient market. The Government of
which comes the divisional director health and
Singapore is targeting 1 million foreign patients each
following that executive district officer- health and
year, contributing S$2.6 billion (US$1.55) of value-
medical superintendent.1
added or 1% of GDP.25The national healthcare plan
covers almost 100% of the population. This promises Singapore’s healthcare delivery system provides
well for the healthcare industry as Singaporeans all population the primary healthcare, hospital care,
have access to medical care. long-term care and other integrated care. Singapore
has a network of outpatient polyclinics and private
INFORMATION medical practitioner’s clinics to provide primary
The health management information system medical treatments, preventive healthcare as well
(HMIS) of a country is developed to collect, report as health education. 80% of primary healthcare
and analyze the health related data which helps services are offered by 2000 private medical clinics;
to identify gaps and used for further planning whereas the remaining is delivered by 18 government
polyclinics. Hospital care consists of inpatient,
24 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

outpatient and emergency services. By contrast to requires government a�ention to provide quality
primary healthcare, public hospitals provide 80% care at minimum cost. Lastly few health experts have
of hospital care. In 2010 there were 11,509 hospital identified that the strength of primary healthcare
beds, out of which 8881 beds are from public sector facility is low in country therefore people prefer to go
and 2628 beds are form private sector. The number of to private healthcare where cost is high.
registered doctors (excluding specialist) and nurses
serving in the public institutions are 8819 and 12994
RECOMMENDATIONS
respectively. Whereas, the corresponding numbers • The government of Pakistan should capitalize
for private sectors are 3292 and 5140.25 in producing professionally trained human resource
like doctor, registered nurses and lady health workers
CHALLENGES OF PAKISTANI HEALTH
in the health sector.1
CARE SYSTEM
• All the stakeholders should be involved in
Corruption and lack of accountability among top
the planning process, decision making process and
health care authorities are the main issues persist in
implementation of the programs at all levels for the
Pakistani health care system for years. It generates
efficiency and sustainability of the programs.10
numerous other problem which results in a weak
health care system. In Pakistan, health care receives • In Pakistan, private hospitals are leading
a very low amount from the total budget which in delivering effective healthcare services however;
mostly utilized for curative purpose rather investing there should be a proper monitoring and evaluation
in prevention which eventually increases the country system to sustain their effectiveness.1
disease burden.18 Moreover, insufficient resources
and mismanagement of available resources is another • There is an intense need to improve training
big concern in public sector which diverts the people of healthcare workforce especially in the remote areas
towards the utilization of private facilities instead of the country.
of it’s out of pocket expenditure. Lack of quality
• Granting autonomy at management level and
health care service, deficient health infrastructure,
introducing cost-sharing at the level of financing.
untrained and non-skilled health professionals and
their empowerment issue are the primary barriers • Establishment of medical / health insurance
in progression of health care.8 Furthermore, the law funds from public and government taxes.
and order situation in Pakistan and non-responsive
a�itude of national leaders towards the health care • Government should introduce an
adds fuel to the fire. Taxes are the main source for environment and policies that foster research
revenue generation for financing the health care. and development in medical sciences to uphold
People are not accountable for paying proper taxes, knowledge and growth of healthcare provider.
only 750,000 pay out of 180 million populations CONCLUSION
(Tribune, 2013) and the tax received is not properly
utilized for designated work. This paper emphasized health care delivery
system of Pakistan in comparison to Singapore
CHALLENGES OF SINGAPORE HEALTH followed by organizational structure, analysis of
CARE SYSTEM both the healthcare systems, and recommendations
With overall analysis of Singapore healthcare to improve healthcare reform and its utilization.
system few challenges has been identified. Firstly, Health care system includes various building blocks
with increasing population and with increase age which include leadership, service delivery, health
there is an urgent need of more healthcare facility in care finance, technology, health workforce and
Singapore especially with the facility of specialized information and research. Every country adopts
geriatric treatment. Secondly, with increase life its own healthcare delivery systems. Therefore, to
expectancy there is also a need of chronic disease achieve access and continuity of care; quality care;
management for elderly population. Further, the monitoring and evaluation plays an important role
rise in healthcare cost is another challenge that in improving health outcomes, and it will improve
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 25

efficiency in health care system of Pakistan. of health care systems in Singapore. Journal of
public health medicines
Conflict of Interest: The study was conducted as
10. Ministry of Health Singapore. 17 November
part of our Advance Theoretical Concept in Public
(2014). Health manpower. Retrieved from
/ Community Health Nursing course and not any
monitory or personal gain. https://www.moh.gov.sg/content/moh_web/
home/statistics/Health_Facts_Singapore/
Source of Funding: Not Applicable Health_Manpower.html
Acknowledgement: We would like to 11. Nishtar S (2006). The Gateway Paper; Health
acknowledge Dr Tazeen Saeed Ali for her guidance System in Pakistan - a Way Forward.Pakistan’s
and support. Health Policy Forum and Heartfile; Islamabad,
Pakistan.
Ethical Clearance: Nil
12. Nishtar, S. (2007). Health indicators of Pakistan:
REFERENCES gateway paper II. Heartfile. Retrieved from
h�p://www.who.int/chp/steps/Pakistan_Book_
1. Aslam, L., Abdullah, A., & Ayub, R. (2014). chapter.pdf
Analysis of Pakistan and Iran Health Care
13. Nishtar, S., Boerma, T., Amjad, S., Alam, A.
Delivery System. International Journal of
Y., Khalid, F., & Mirza, Y. A. (2013). Pakistan’s
Innovative Research and Development, 3(7),
health system: performance and prospects
308-312.
after the 18th Constitutional Amendment. The
2. Cus of Population 2010 Statistical Release Lancet, 381(9884), 2193-2206.
1. Demographic Characteristics, Education,
14. Pakistan Medical Student (2013). Nursing
Language and Religion. Retrieved from
shortage in Pakistan-Human resource
http://www.singstat.gov.sg/publications/
management in health system. Journal of
publications_and_papers/cop2010/census_
Pioneering Medical Sciences. Retrieved from
2010_release1/cop2010sr1.pdf
http://blogs.jpmsonline.com/2013/08/23/
3. City state (2012).Retrieved from h�p:// nursing-shortage-in-pakistan-human-resource-
en.wikipedia.org/wiki/Singapore management-in-health-systems/
4. Cheah, J. (2000).Department Clinical Pathways 15. Pakistan Economic Survey (2014). Health and
- An Evaluation of its Impact on the Quality Nutrition. Retrieved from h�p://finance.gov.pk/
of Care in an Acute Care General Hospital in survey/chapters_14/11_Health_and_
Singapore. Singapore Medical Journal, 41(7), Nutrition.pdf
335-346.
16. Qazi, M. S., & Ali, M. (2009). Pakistan’s health
5. Chin, M. (2007). Everybody business; management information system: health
strengthening health system to improve health managers’ perspectives. The Journal of the
Outcome Pakistan Medical Association, 59(1), 10-14.
6. Islam, A. (2002). Health Sector Reform in 17. Shaikh, B., Rabbani, F., Safi, N., & Dawar, Z.
Pakistan: Future Directions (2010). Contracting of primary health care
7. Khoo, H. S., limm, Y. W, & Vrijhoef, H.J.M. services in Pakistan: is up-scaling a pragmatic
(2014). Primary healthcare system and practice thinking. Journal of the Pakistan Medical
characteristics in Singapore. Asia Pacific Family Association, 60(5), 387-389.
Medicine, 13(1), 8. 18. Shaikh, B. T., Ejaz, I., Achakzai, D. K., & Shafiq,
8. Khowaja, K. (2009). Healthcare systems and Y. (2012). Political and economic unfairness in
care delivery in Pakistan. Journal of Nursing health system of Pakistan: a hope with the recent
Administration, 39(6), 263-265. reforms. Journal of Ayub Medical College, 25(1-
9. Meng Kin, M. L. (1998).healthcare system in 2), 198-203.
transition 11.Singapore, part 1.An overview 19. Thomson, A. (2013). Tax avoidance is cheating
26 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Pakistan. The Express Tribune. Retrieved populationstatistics.com/pakistan-population-

from h�p://tribune.com.pk/story/645112/tax- 2013/
avoidance-is-cheating-pakistan/ 23. World Health Organization. (2013). Pakistan
20. Transforming Healthcare with IT Innovation, health information system. Retrieved from h�p:
IHiS book (2011). Retrieved from h�ps: //www.emro.who.int/pak/programmes/health-
//www.ihis.com.sg/MediaCentre/publications/ managment-information-system.html
Documents/IHiS_Yearbook.pdf 24. World Health Organization.(2012), world
21. World Health Organization (2005), health health ranking report. Retrieved from h�p:
system strengthening glossary. Retrieved from //www.who.int/countries/sgp/en/
www.who.int/healthsystems/hss_glossary/en/ 25. World Health Organization. (2014). NLiS
index5.html. Country profile: Singapore. Retrieved from
22. World population statistics (2013), Pakistan http://apps.who.int/nutrition/landscape/
Population. Retrieved from h�p://www.world report.aspx?iso=sgp
 DOI Number: 10.5958/0974-9357.2016.00042.8

Outcome of Interventional Programme on Quality of Life

of Infertile Women with Polycystic Ovarian Syndrome

Beena MR1, Kochuthressiamma Thomas2

1
Associate Professor, Govt. College of Nursing, Medical College, Thiruvananthapuram,
2
Deputy Director of Nursing Education (Rtd) Kerala.

ABSTRACT

The aim of the present study was to assess the quality of life (QOL) of infertile women with polycystic
ovarian syndrome (PCOS) and to evaluate the outcome of interventional programme on QOL of infertile
women with PCOS. The results of the study showed that majority of subjects in the experimental
group (87%) and control group (93.9%) were having poor QOL during pre test. After assessing QOL
interventional programme was introduced to each subject in the experimental group which includes
lifestyle modification that is dietary calorie modification and exercise.

In the post test there was significant reduction in the percentage of women having poor quality of
life and there is significant increase in the percentage of women having average and good QOL in
the experimental group compared with control group (P=0.001) A significant decrease in weight of
subjects was observed in the experimental group and was statistically significant (F= 174.5 p= 0.000).

Keywords: Polycystic Ovarian Syndrome, Quality of life, Interventional Programme

INTRODUCTION Obesity was significantly associated with

an increased risk of hirsuitism, menstrual cycle
Pregnancy and child birth are precious moments
disturbances and elevated serum testosterone
in every woman’s life. It is the privilege of every
concentration and with an increased rate of infertility
woman which brings hope in the world and glory to
(Balen 2002).3 Study by Sundararaman 2008 in Chennai
her. Infertility is a struggle to have a family or to fulfill
showed women presenting with PCOS had increased
a dream. It is a devastating state that affects many
psychosocial distress (42%).4 Changes in the
aspects of human life. Many couples are disturbed,
physical appearance particularly obesity, excessive
depressed, anxious, lonely, experience mental stress
body hair as well as infertility have been identified
and withdraw socially and it may indirectly affect
as important contributions to psychosocial problems
their quality of life,
in PCOS which may result in altered self perception,
PCOS is a complex metabolic endocrine dysfunctional family dynamic and problems at work
and reproductive behavior affecting (Trent 2005). 5
5-10% of the female population. Clinical study by Roy
Study by VL Kumarapeli in Srilanka found
George (2011) in Central Travancore revealed that
that the mean score of physical psychological
PCOS is the major cause of female infertility (33.6%)1
and social relationship domains of WHO quality
Shameena (2012) in her study in Trivandrum showed
of life BREF were significantly lower in women
that 76% of infertile women with PCOS a�ending
with PCOS than in control indicating poor QOL.6
infertility clinic were overweight and 38% were obese
John C Mavropoulos in his study with 24 weeks of
and 72.45% of subjects were having the habit of taking
life style management among women with PCOS
rice containing food for more than 2 meals and there
found that there is 12.1% of reduction in body
is significant association between carbohydrate diet
weight. 7 Thomson RL in his study found that dietary
and impaired glucose tolerance among subjects with
restriction and exercise program helped in improving
PCOS (P= 0.040)2.
28 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

QOL in overweight and obese women with PCOS. 8 Syndrome in the experimental group after the
implementation of interventional programme.
Judy Griffin Mc Cook (2005) conducted a
cross sectional study to evaluate the influence of 3. There will be significant reduction in the
obesity, fertility status and hirsuitism on quality body mass index of infertile women with Polycystic
of life of women with polycystic ovary syndrome. Ovarian Syndrome in the experimental group after
The most common quality of life concern reported the implementation of interventional programme.
by women with PCOS was weight, followed by
4. There will be significant association between
menstrual problem, infertility, emotions and body
socio demographic variables and quality of life of
hair. They concluded that nursing has a pivotal role
infertile women with Polycystic ovarian syndrome.
in recognizing their concerns and implementing life
style therapy to improve quality of life of women MATERIAL & METHODS
with PCOS9. Thomsom RL (2010) in his study found
that dietary restriction and exercise program helped Research Approach : Quantitative approach.
in improving quality of life score in overweight and Research Design : Quasi experimental design.
obese women with PCOS.
The design was diagrammatically represented by
As PCOS is an arising problem now a days among Experimental group O1 X O2
adolescence and is one of the most important cause of Control group O3 - O4
infertility which effects quality of life of women the
O1- Pretest to assess quality of life of infertile
investigator felt the need to conduct the study in our
women with polycystic ovarian syndrome in the
se�ings.
experimental group.
Statement of the Problem X- Interventional programme implemented to
infertile women with polycystic ovarian syndrome in
Study to assess the outcome of Interventional
the experimental group.
programme on quality of life of infertile women
with polycystic ovarian syndrome at infertility clinic O2 - Post test to assess quality of life of infertile
of Tertiary care Hospitals in Thiruvananthapuram women with polycystic ovarian syndrome in the
District. experimental group.
O3- Pretest to assess quality of life of infertile
Objectives
women with polycystic ovarian syndrome in the
1. To assess the quality of life of infertile women control group
with polycystic ovarian syndrome. O4- Post test to assess quality of life of infertile
women with polycystic ovarian syndrome in the
2. Evaluate the outcome of interventional
control group.
programme on quality of life of infertile women with
polycystic ovarian syndrome Se�ing: Infertility clinics of Tertiary level
Government Hospitals in Thiruvannathapuram
3. To find out the association between quality district- Sree Avi�om Thirunal Hospital, Medical
of life of infertile women with polycystic ovarian College, Thiruvananthapuram and Women and
syndrome and selected sociodemographic variables. Children Hospita, Thycaud, Thiruvananthapuram.

HYPOTHESES Population: Infertile women with PCOS

a�ending infertility clinics.
1. There will be significant improvement in
Sample size: 230 (115 each in experimental group
the quality of life of infertile women with Poly cystic
and control group)
ovarian syndrome in the experimental group after the
Sampling technique: Multi stage random
implementation of Interventional programme.
sampling. Infertile women a�ending infertility
2. There will be significant reduction in the clinic satisfying inclusion criteria were recruited
weight of infertile women with Polycystic Ovarian consecutively.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 29

Inclusion criteria programme was introduced to each subject in the

1. Infertile women with PCOS between the age experimental group. It is a planned teaching cum
group 25-45 years of age who are living with their demonstration programme about the disease PCOS
husband for a minimum period of two years. , measures to reduce weight ie teaching dietary
calorie modification and demonstration of exercise
2. Subjects should be on regular treatment for
(brisk walking 45 minutes twice a day and arm and
infertility a minimum period of one year.
leg exercise 10 times twice a day). The investigator
Exclusion Criteria assessed the daily average calorie intake of subjects by
1. Infertile women with lean PCOS (BMI<20kg/ 24 hour recall for 5 days per week and then calculated
m2) the average calorie intake per day according to
2. Husbands of infertile women having weight and BMI of subjects. An instructional module
problems related to fertility and a food diary card was given to each subject.
The outcome was assessed by difference in QOL
Tool and Technique
assessment questionnaire score between experimental
1. Interview Schedule and control group at 6th month after intervention,
Section A : Socio demographic data differences in weight and BMI assessed at 3rd month
Section B: Clinical data and 6th month and rate of pregnancy at 8th month after
implementation of interventional programme.
Section C: Ferriman Gallway score to assess
hirsuitism RESULTS
2. Quality of life assessment questionnaire
Section I
developed by G Cromin (1998) 10 and validated by GL
Jones (2002) 11 The age of infertile women in both the group was
Technique : Interview between 25-39 years. Majority of women from both
the groups belonged to Hindu religion. Majority of
Clinical Assessment (weight , height, waist
women in the experimental group (97.4%) and all
circumference, hipcircumference and hirsuitsm)
women from control group are non vegetarian in their
Reliability : Reliability of the tool was estimated dietary habit and both the groups were homogenous
by Cronbach’s α a= 0.940 (P=0.25). Majority of women in the experimental
Data collection process group (61.7%) and control group ( 56%) were having
history of infertility for more than 4 years. Majority
Baseline demographic information and clinical
of women in the experimental group ( 80.9%) and
data were collected by personal interview followed
control group (88.7%) were having clinical evidence
by clinical assessment that is weight measured by
of acanthosis nigricans and both groups were
weighing machine height measured by stadiometre,
homogenous ( P=0.098) Moderate to severe degree
waist circumference and hip circumference by non
of hirsuitism was observed in 65.2% of women in the
stretchable tape and presence of hirsuitism assessed
study group and 60.9% of women in the experimental
by using Ferriman- Gallway score. Quality of life
group and 74.8% women in the control group and
was assessed by QOL assessment questionnaire
73% of women in the experimental group had waist
developed by Cronin G (1998) and validated by GL
hip ratio between 0.90 to 0.94.
Jones (2002). After initial assessment interventional
30 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Section II : Quality of Life

Table 1: Quality of life of infertile women with polycystic ovarian syndrome before implementation
of Interventional Programme

Experimental Control
Quality of life group group
Domains p
(115) (115)
N % N %
Poor
58 50.4 61 53.0
Body hair
Average 29 25.2 39 33.0 5.476 0.065
Good 28 24.3 15 13.0
Poor 115 100.0 115 100.0
Emotions Average - - - - - -
Good - - - -
Poor 99 86.1 97 84.3
Weight Average 16 13.9 18 15.7 0.138 0.710
Good - - - -
Poor 98 85.2 95 82.6
Infertility Average 15 13.0 18 15.7 0.319 0.852
Good 2 1.7 2 1.7
Poor 38 33.0 45 39.1
Menstrual
Average 60 52.2 46 40.0 3.635 0.162
problem
Good 17 14.8 24 20.9
Poor 100 87.0 108 93.9
Overall score Average 15 13.0 7 6.1 3.217 0.073
Good - - - -
Data presented in Table 1 shows that that the quality of life of infertile women in the domain emotion was
found to be poor among all subjects in both control group and experimental group 82.6% of women in the
control group and 85.2% of women in the experimental group had poor quality of life in the domain infertility
related problems and both the groups were homogeneous.

Section III : Effect of interventional programme on Quality of life infertile women with PCOS.

Table 2: Mean, Standard deviation and p value showing average change in quality of life assessment
score between experimental group and control group after implementation of interventional programme

Pre-test Post- test difference

Quality of life
domains Experimental group Control group t p

Mean Sd Mean Sd

Body hair 11.36 14.95 1.16 8.86 7.728 0.001

Emotions 22.98 28.42 .38 5.38 8.379 0.001

Weight 35.39 18.97 .87 5.69 19.634 0.001

Infertility 22.03 25.09 .87 6.82 8.726 0.001

Menstrual problems 20.68 19.15 3.00 16.62 7.477 0.001

Overall score 22.56 19.68 .22 3.93 11.937 0.001

 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 31

Table 2 shows that during post test there is significant reduction in the percent of women having poor
quality of life score in the experimental group and an increase was observed in the % of women having
average and good QOL. Changes in the score are at very slow rate in the control group and the interventional
programme was found to be statistically significant (P= 0.001).

Effect of Interventional programme on weight of infertile women with PCOS

Table 3: Mean, Standard deviation and p value showing effect of Interventional programme on weight
of infertile women with PCOS

Experimental Group Control Group

Period Sig.
N Mean Median sd Mean Median sd t p

Baseline to
115 69.31 69 10.18 68.12 67 8.68 0.961 0.34 NS
3rd month

3rd month
115 66.86 66 10.37 68.49 68.00 8.63 -1.301 0.195 NS
to 6th month

Baseline to 6
115 65.26 65 10.33 69.01 68.12 8.62 -2.988 0.003 HS
month

The mean total difference in the weight of experimental group was reduced from 69.31 to 65.26 and is
statistically significant ( p=0.003).

Table 4: Mean, standard deviation and p value showing percentage of change in weight between groups
after implementation of interventional proramme

Experimental Group Control Group

Period N
Mean SD Mean SD t p Sig.
Baseline to 3rd
115 3.62 2.03 -0.6 0.96 20.143 0.000 HS
month
3rd month to 6th
115 2.4 2.59 0.79 0.9 12.457 0.000 HS
month
Baseline to 6
115 5.95 2.92 -1.39 1.53 23.866 0.000 HS
month

Average percentage of weight reduction in the experimental group within 6 months after intervention
was 5.95% and that of the controls was -1.39 % Study subjects from experimental group experienced greater
percentage of weight reduction than controls and the interventional programme was found to be statistically
significant (p=0.000).
Table 5: Mean difference, Standard deviation and ‘t’ value showing effect of interventional programme
on BMI of infertile women with PCOS.

Experimental group Control Group t p

BMI N
Mean Sd Mean Sd

Baseline to 3rd month 115 1.05 0.58 0.17 -0.26 20.61 0.000

After 3rd month to 6th month 115 0.68 0.73 0.22 -0.26 12.436 0.000

Baseline to 6th month 115 1.73 0.83 0.4 -0.44 24.405 0.000
32 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

The average change in BMI after 6 months of CONCLUSION

intervention in the experimental group was 1.73 and
it was only -0.44 in control group and the programme PCOS is a complex reproductive disorder and
is statistically significant (P=0.000) is the common cause of anovulation. It has been
shown to cause a reduction in quality of life and a
Section IV : Comparison of rate of pregnancy negative impact on body image and self esteem. The
Interventional programme on lifestyle modification
Rate of pregnancy was assessed at 8th month after
was found to be effective in improving quality of
implementation of interventional programme. 35.7%
infertile women with PCOS and helped in improving
of women in the experimental group and only 10.4%
quality of life, reducing weight , BMI and improving
of women in the control group became pregnant
rate of pregnancy.
and the programme is statistically significant.
(p 0001) Acknowledgement: Researcher acknowledge
Prof. Dr. Sheila Balakrishnan, Head of Department,
Section V : Association between quality of life
Infertility clinic SAT Hospital, Medical College,
and selected socio demographic variables
Thiruvananthapuram for her support and all the
There was significant association between quality participants of the study.
of life and educational status of women and presence
Conflict of Interest : Nil
of hirsuitism
Source of Funding : Self funding
DISCUSSION
Ethical Clearance: Ethical clearance from
The present study reveal that the most important
Human Ethical Commi�ee, Medical College,
quality of life concern reported by infertile women
Thiruvananthapuram and consent from participants
with PCOS was emotional problems followed by
concern on weight, infertility related problems, REFERENCE.
menstrual problems and difficulties due to hirsuitism.
Emotional problems and weight difficulties are the 1. Roy George K, Malini NA: Infertility in females
greatest contributory factor for reduction in quality in context of antisperm antibodies in pelvic
of life. The findings of the study was almost similar inflammatory disease and polycystic ovarian
to the study conducted by Judy Griffin (2005). In syndrome. The Bioscan- an international
her study the most important quality of life concern quarterly Journal of life sciences. 2012, 7(i):
reported by women with PCOS was weight followed 47-51.
by infertility, menstrual problems and emotions. The 2. Shameena M, Research study to assess the
present study also reveals that there was significant prevalence of impaired glucose tolerance
improvement in quality of life score among subjects among patients with poly cystic ovarian
in the experimental group after implementation of
syndrome, Trivandrum 2012
interventional programme ( P=0.001). The findings
of the study was congruent with the study conducted 3. Balen A and Michelmore K. What is polycystic
by Thomson RL (2010) who proved that dietary ovarian syndrome. Are national view
restrictions compared with exercise had benefit in important. Human reproduction 2002, 17:2219-
improving quality of life score in overweight and 2227.
obese women with PCOS. 4. Sundararaman PG, Shweta , GR Sridhar.
Psychosocial aspects of women with
The average percentage of weight reduction in the
Polycystic Ovarian Syndrome from South
experimental group after 6 months of interventions
India. Journal of Association of physicians in
was 5.95%. This was in accordance with the study
conducted by John C Mavropoulose 2005 who found India. 2008, 56:945-948 available at:1. :h�p:
that there was 12.1% of reduction in body weight with /www.ncbi.nlm.nih.gov/pupmed.
24 weeks of life style management among women 5. Trent M, Austin SB, Rich M, Gordon CM.
with PCOS. Overweight status of adolescent girls with
polycystic ovarian syndrome, bodymass
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 33

index as mediator of quality of life. Adolescent FertilSteril. 2010, 94(5): 1812-16.

pediatrics, 2005, 107-111. 9. Judy Griffin McCook, Nancy E Reame and
6. VL Kumarapeli, A Senevirante, CN Samuel S Thatcher. Health related quality of
Wijeyaratne. Heath related quality of life and life issues in women with polycystic ovary
psychological distress in Polycystic ovarian syndrome. Journal of Obstetric, Gynaecologic
syndorme; A hidden facets in South Asian & Neonatal Nursing. Volume 34, issue 1. 12-2-,
women. Journal of Obstetrics Gynecology Vol 2005.
118, issue 3, 319-328. 2-11 10. Cronin L, Guya� G, Griffith L, Wong E, Azziz R,
7. John C Mavropoulos, William S Yancy and Fu�erweit W, Cook D, Dunaif A. Development
Eric C Westman. Effect of low carbohydrate of Health related quality of life questionnaire
ketogenic diet on the PCOS. Nutrition and for women with Polycystic Ovarian Syndrome.
Metabolism. 2005, 2:35. Journal of Clinical Endocrinology. Metab 83:
8. Thomson RL, Buckley JD, Lim SS, Neaker 1976-1987.
M. Cliffon PM, Norman RJ, Binkworth GD. 11. G.L. Jones et al. The polycystic ovary syndrome
Lifestyle management improves quality of health related quality of life questionnaire- a
life and depression in overweight and obese valuation . www.nebi.nlm.nib.gov/pubmed.
women with polycystic ovary syndrome.
 DOI Number: 10.5958/0974-9357.2016.00043.X

Soothing Crying Babies and Preventing

Shaken Baby Syndrome

Susamma Thomas
Principal, MOSC College of Nursing, Kolenchery, Ernakulam, Kerala

ABSTRACT

Crying is a baby’s primary way to communicate. A baby’s cry just for a short while may not be a
concern or bothersome for the mother or others. Long episodes of crying lead to sleepless nights for
parents, and it also doubles the risk of mothers suffering from feelings of depression. This can be
prevented by counseling parents on how and how not to respond to infant crying. Hunger, soiled
diaper, pain, Sleepiness, wanting to be held, tiredness, colicky abdomen, unpleasant weather, teething,
feeling unwell, overstimulation are some of the reasons often babies cry. It is essential that especially
first time mothers be aware of the reasons of baby’s cry and simple remedial measures to soothen them.
In an a�empt to quieting the crying babies, these babies are shaken violently which may cause severe
damage to the baby’s brain resulting in Shaken baby Syndrome. Parents and baby si�ers must be aware
of the danger in shaking the babies vigorously.

Conclusion: Shaken baby Syndrome [SBS] often results from shaking a baby vigoursly in an a�empt to
quieting a crying baby. Parents and care givers of the baby must be counseled against this as SBS can
result in permanent brain injury.

Keywords: Soothing Crying Babies, Hunger, Soiled diaper, pain, sleepiness, wanting to be held, tiredness,
colicky abdomen, unpleasant weather, teething, feeling unwell, overstimulation, Wants more stimulation, Shaken
Baby Syndrome[SBS].

INTRODUCTION respond meaningfully. Mothers, over time, are able

to l recognize particular cries as if they were spoken
It is through crying babies express or words
communicate to others about their needs and desires
as they cannot talk. Crying is a baby’s primary way to The crying of the newborns in the first few days
communicate. The babies cry normally in response to of life is believed to strengthen its heart and lungs.
physical needs such as temperature change, hunger,
Mothers’ experience of infant crying and
and pain or discomfort. It tells us that they need our
soothing vary socio-demographically. Much harm
help as something is wrong with them somewhere.
may be prevented by counseling parents on how and
A baby’s cry just for a short while may not be how not to respond to infant crying. Health education
a concern or bothersome for the mother or others. should start before the child’s birth, because some
Babies do not cry exactly the same way every time. soothing techniques can be fatal, even when practiced
Mothers are the best people to understand the for the first time, such as the prone sleeping position,
different pa�erns of crying of their babies and to allowing the baby to continue to cry, smothering, and
shaking.
Corresponding author
Nearly half of mothers with babies over six
Mrs. Susamma Thomas,
months of age report problems with their baby’s
Principal, MOSC College of Nursing,
sleep. This common problem not only leads to
Kolenchery, Ernakulam, Kerala. Pin 982311
sleepless nights for parents, but it also doubles the
[email protected]
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 35

risk that moms will suffer from feelings of depression. system. Colic occurs only to newborn babies, up to
This can be prevented by counseling parents on how about four to five months of age.
and how not to respond to infant crying. Following
Anti-gas drops for babies or gripe water (available
are some of the reasons why babies cry.
over r the counter) may be used but must be used
Hunger -Hunger is the most common reason for only with a doctor’s prescription. Even a snug elastic
baby’s cry. The baby is probably hungry if three or band of the trouser can make the baby have a colicky
four hours have passed since the last feeding and or type of cry. Look for pa�erns to your baby’s crying.
has after a long sleep with a dirty diaper. A feeding Milk allergy is the most common cause.
will most likely stop the crying.
If breastfeeding, feed on demand for nutrition as
Pain - The cry of a baby in pain is sudden and well as for comfort. Hold the baby in a more upright
shrill, just like when an adult or older child cries out position for feeding and directly afterwards. The
when they get hurt. The cries are followed by a pause mother must try to avoid certain foods in her diet
during which the baby appears to stop breathing, that may cause gas in the baby. Ayurveda prescribes
then catches his breath and lets out another long cry. the avoidance of certain food items such as oily fish,
Check the baby’s temperature and undress him for a garlic, certain pulses and roots in the mother’s food.
full-body examination. If planning to introduce top ups or solid foods, start
with it in the morning hours and offer more frequent
Sleepiness –Babies need to sleep when they are
but smaller meals. If bo�le feeding, try bo�les and
tired. After a bath or playing for some time they feel
nipples that prevent air from entering the baby as he
tired and they may fuss and cry, especially if they’re
drinks. Try burping to bring out the trapped air in the
overly tired. Pu�ing the baby to sleep as soon as she
stomach.
yawned the first time at any time of the day is best to
make her cry a lot less and have fewer problems of Offer feeds or meals in a quiet se�ing. Some
going to sleep. babies like a pacifier but remember to keep it clean
always. A sling or carrier [pram] may be used during
Wants to be held - Babies need a lot of cuddling.
colicky periods. Warm bath is most often helpful.
They like to see their parents’ faces, hear their voices,
Gently massage the baby’s tummy. If the weather is
and listen to their heartbeats, and can even detect
cold, swaddle the baby in a co�on blanket.
their unique smell. Crying can be their way of asking
to be held close. Keeping the baby’s abdomen down across the
mother’s lap and massaging or pa�ing her back often
Soiled diaper – Most babies feel very
helps. Humming or singing while walking or the
uncomfortable with a dirty diaper and this could be
baby in a sling in a quiet, dark room also is helpful.
one of the reasons they start crying. They may tolerate
Try keeping your baby away from highly stimulating
a wet diaper for a quite a while. So, remember to
situations during the day when possible to prevent
check the nappy of the crying baby. Change it if dirty
sensory overload. The mother can lie on her back and
or too wet.
keep the baby on her tummy and stroke the back of
Tiredness - The baby may be tired if it yawns, the baby.
looses interest in people and surroundings, rubbing
Unpleasant weather
eyes and looking dull with decreased activity. All it
needs is a good sleep. Babies cry if they feel too cold or too warm. In
warm weather regions like the south of India, the
Colicky Cry
babies do not need woolen clothes. Remember, if you
If the baby often fusses and cries right after being feel cold or warm, the babies do feel the same.
fed, he may be feeling some sort of tummy pain.
Teething
Colic can be suspected if the baby cries inconsolably
at the same time each day. Some experts believe that Some babies become tearful with teething. These
colic is related to the immaturity of a baby’s digestive Some babies have mild to moderate temperature
36 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

along with irritability. Teeth erupt in some babies as When babies associate something like feeding,
early at the age of 6 to 8 months but it can happen rocking, or bouncing with their transition to sleep,
earlier. The hard nub of a baby tooth can be felt on they often expect those same conditions when they
feeling his gums with a finger. wake during the night When a baby knows how
to self-soothe and falls asleep independently, she
Over stimulation
wakes in the night, checks her surroundings, and
Journeys make most babies irritable. Babies learn finding nothing to be alarmed about, she goes back
from the stimulation of the world around them, but to sleep without needing our help (Anders et al. 1992;
sometimes too much of it can be irksome to them. Goodlin-Jones et al. 2001)
The baby can be easily disturbed if the room is noisy,
Picking up and carrying a crying infant normally
too much lights and being passed from hand to hand.
calm the child. When an underlying reason for
The baby then closes her eyes and cries ( or turns
crying persists, such as hunger or sustained pain, the
her head away).. A quiet and dark room with some
infant may start crying again soon after the end of
cuddling would quieten the baby normally.
carrying. Young babies carried by a walking mother
Wants more stimulation - Some babies are fond were the most relaxed and soothed, compared with
of the colourful nature. It may be a bit exhausting for infants whose mothers sat in a chair and held them,
the mother to take the baby out always. Try carrying the study found.
them in slings or carriers. Babies also are fond of
Shaken Baby Syndrome [SBS]
peer groups. See if association with children can be
arranged. SBS can happen when an adult or older child
violently shakes an infant or young child. The baby’s
Not feeling well - Even after the baby’s basic
brain moves back and forth inside the skull, tearing
needs are met and comforted him and he’s still crying,
blood vessels and causing blood to pool inside
he could be having some health problem. When your
the skull. Shaking can cause brain injury, cerebral
baby is sick, he may cry in a weak, moaning way. The
palsy, blindness, hearing loss, learning and behavior
cry of a sick baby is quite different from one caused
problems, seizures, paralysis, and even death.
by hunger or frustration. If your baby’s crying “just
Newborn to one year (especially baby’s ages 2 to 4
doesn’t sound right,” trust your instincts and call or
months), are at greatest risk of injury from shaking
see a doctor.
Shaken a babies are victims of frustrated and
What to do if the baby continues to cry?
upset parents when the baby would not stop crying.
Hair wrapped tightly around a tiny toe or Personal issues such as money or problems at work or
finger, or even the tip of penis in boys cu�ing off in relationships can also make a caregiver frustrated
circulation can be reasons for baby’s cry. Look for enough to shake a child .Most perpetrators of SBS
hair wrapped around the penis in a boy baby whose didn’t mean to hurt the child, and did not realize
cry is inconsolable. Some babies are extra sensitive to that their actions could have this effect. In most cases
things like scratchy clothing tags or fabric. It is wise to the person who shakes a baby are male, usually the
wash new clothes before pu�ing on them child’s step father or the baby’s father. In a smaller
number of cases, a paid caregiver or babysi�er is
A new study released in the journal of Pediatrics responsible for shaking a baby. In some cases, the
suggests it is OK to let babies cry while trying to fall baby’s mother is the accused.
asleep [Brawn 2012].Scientists say allowing infants
to cry for a short time rather than immediately Signs of Shaken Baby Syndrome
comforting them does no harm, (Borland 2012).
There may not be any obvious marks or bruises
Rather than always going to comfort babies, mothers
on the baby’s head or skin. Common signs include:
and fathers should wait a bit longer before soothing
the babies. The parents or caregiver should make sure • The baby is not smiling
that they stay in the same room with the child rather • Unusual y sleepy and fussy.
than leaving them crying.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 37

• Poor feeding or vomiting for no apparent to feel frustrated especially when you are probably
reason. not sleeping much while trying to meet your baby’s
• The baby is no longer making eye contact, or needs around the clock.
babbling. If your baby continues to cry after you’ve made
• Stiff body or seizures (legs and arms become stiff sure there’s no specific problem, try to stay calm and
or move in a repetitive, jerky manner). be aware of how you feel. If you feel like you might
lose control, stop! Place your child safely in the crib.
• The baby’s body is limp.
Take slow and deep breaths.
• Difficulty breathing, or there is a change in
breathing pa�ern. • Try to relax, Take a shower.
SBS is not just a crime—it is a public health • Talk to a friend, family member, neighbor, or
issue. anyone else you trust, and get some support.
• Try to arrange for regular service of a maid. Try
If the baby presents with any two or three above
to get help of a family member who can look after
signs, immediate medical a�ention is needed.
your baby for periods while you get a break. If
What can parents do to help soothe a crying people that you trust offer help, accept it
baby? • Never leave your child with someone you don’t
trust, someone who has violent reactions, or
.Check to see whether the crying is a signal that
someone who is not baby friendly.
your baby needs something specific, like a diaper
change, feeding, relief from being too hot or too cold, • If you have concerns or questions, consult a
a�ention, or has a fever. doctor or a public health nurse.

• Hold your baby. However, some babies do not CONCLUSION

like being passed from person to person.
Not all caregivers are prepared to care for a baby.
• Wrap or swaddle newborn baby in a soft Baby’s Shaking most often occurs in response to a
blanket. baby crying, or other factors that can lead the person
• Turn off the lights and keep surroundings quiet. caring for a baby to become frustrated or angry. All
Too much stimulation can trigger crying or make babies cry and do things that can frustrate caregivers.
it worse. SBS resulting in head injury is a leading cause of child
• Soft music, white noise or a gentle shushing noise abuse death in the United States. Nearly all victims
can soothe some babies. of SBS suffer serious health consequences and at least
one of every four babies who are violently shaken
• Many babies are soothed by motion. Try walking
dies from this form of child maltreatment. From a
with baby in a pram.g or in a stroller. Rock or
public health perspective, creating greater awareness
sway with baby in a gentle, rhythmic motion. Or
about SBS is important. Keep n mind, that vigorously
try going for a ride in a car or a walk with baby in
shaking a baby can be fatal or result in a permanent
a pram.
disability.
• Sucking sometimes helps babies to calm and
relax. You can provide this by allowing your Everyone who is caring a young child should
baby to breastfeed or by offering a pacifier. know to never, ever shake a baby

• A warm bath often calms the baby. Conflict of Interest –None

• If you ever feel you may hurt your baby, call for
Source of Funding- Self
help: a family member, neighbour, or police. What
to do if the baby keeps crying inconsolably? Ethical Cearance – Not taken as this is a Review
Being a parent or caregiver is not always easy. A Article
baby’s constant crying can be stressful and cause you
Acknowledgement: - Nil
38 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

REFERENCES 7. Borland S. Le�ing babies cry rather than rushing

to comfort them is secret to longer sleep (for
1. Fannin, Ron, and Tiffany Hamble�.. Babie’s infants AND parents). Daily Mail, USA.Sept
brain: What care giver can do. Early years. 2006; 2012
28 (1):11-13.
8. Dr. BRAUN M. Parents Can Let Sleepless Babies
2. Solits, Joseph.. The Signal Function of early Cry It Out: Study. 2012. ABC News Medical Unit
infant crying, Behavioural and Brain Sciences via Good Morning America.
2004;.27940: 443-490.
9. Goodlin-Jones, B. L., Burnham M. M, Gaylor E.
3. Faris M & Carrol E, Crying Babies. Answering E. and. Anders T. F.”Night waking, sleep-wake
the call of Infant cries. Texas. Child Care Fall organization, and self-soothing in the first year
2010. of life.” J Dev Behav. Pediatr . (2001).22(4): 226
4. Dr. Braun M, Parents can Let Sleepless Babies 10. Cari Nierenberg C. Why Baby Calms Down When
Cry it Out: Study.2012Sept. ABC News Medical Carried My Health News Daily Contributor
Unit via GOOD MORNING AMERICA. | April 18, 2013 01:28
5. M F van der Wala, D C van den Boomb, H 11. Caring for kids.cps.ca. Information for parents
Pauw-Plompc, G A de Jonged Mothers’ reports from Canadian Paediatricians.
of infant crying and soothing in a multicultural
12. A Journalist’s Guide to Shaken Baby Syndrome:
population. Arch Dis Child 1998;79:312-317 doi:
A Preventable Tragedy. A part of CDC’s
10.1136/adc.79.4.312
“Heads Up” Series. US Dept of Health and
6. Anders T. F. Halpern L F, and Hua J.”Sleeping Human services Centre for Disease control and
through the night: a developmental perspective.” Prevention.
Pediatrics 1992; 90(4): 554-560.
 DOI Number: 10.5958/0974-9357.2016.00044.1

Relationship among Nurses Role Overload, Burnout and

Managerial Coping Strategies at Intensive Care Units

Fatma Rushdy Mohamed

Assistant Professor, Nursing Administration, Faculty of Nursing, Assiut University, Egypt

ABSTRACT

Aim: was to investigate relationship among nurses role overload , burnout and managerial coping
strategies at Intensive Care Units in Assiut University Hospital Se�ing & Subjects: Included all
nurses working in Causality, General & Postoperative Intensive Care Units and Coronary Care Unit
in Assiut University Hospital:. Tools: Four tools which includes Socio-demographic data sheet, role
overload questionnaire, managerial coping strategies & burnout questionnaires. Results: Showed that
role overload had highest mean score in General and Casuality ICUs. In addition, coping strategies
had highest mean scores of rational problem solving , resigned distancing, and seeking support/
ventilation in Casuality and post operative ICUs respectively except passive wishful thinking had
highest mean scores in General and Casuality ICUs respectively. Also, burnout had highest mean
scores in post operative and general ICU. Conclusions: Nurses employed at ICUs in Assiut University
Hospital reported high burnout and use managerial coping strategies as rational problem solving,
resigned distancing, seeking support/ventilation and passive wishful thinking to handle burnout and
role overload except passive wishful thinking coping strategy not used with role overload.

Keywords: Coping strategies, nurses, role overload, burnout, Intensive Care Units.

INTRODUCTION Coping behavior is a constantly changing

cognitive and behavioral efforts to manage specific
Nurses having an important role in the health external and/or internal demands that are appraised
care system. They are considered to be members of as taxing or exceeding the resources of the person.
a stressful job as a profession because they care for a Coping behavior affects well-being and adaptation.
stressful group comprising patients or those at health There is a growing understanding that coping
risk(1). When a professional is affected by burnout strategies, play an important role in influencing the
they feel drained and used up and have li�le desire to tangible and intangible outcomes of the stressor (4).
return to work the next day. It is generally perceived
that Intensive Care Nurses are particularly exposed Coping strategies may have a moderating effect
to burnout since they literally deal with life and death on the relationship between the stressor and its
situations most of the time. Therefore, it is suggested consequential strain. Role overload may be regarded
that nurses comprise the group that experiences as a form of stressor, and burnout is one relevant
the maximum stress, and burnout among health stress reaction (i.e. strain), coping strategies are
professionals. Burnout syndrome often occurs as a therefore likely to have a moderating effect on the
result of chronic work stress seen in Intensive Care relationship between role overload and burnout (5).
Units (2).
Significance of the study
Burnout as a phenomenon is defined as “a
Nursing is a sensitive job which includes
syndrome of emotional exhaustion, cynicism and
communicating with patients and caring after them.
reduced professional efficacy”. Researches suggest
The provision of Intensive Care can lead to a health
that burnout contributed to job stressors is associated
care provider’s physical, psychological and emotional
with a negative outcome in both individuals and
exhaustion, which may develop into burnout.
organizations (3).
40 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

The researcher noticed that there were no specific questionnaire which developed by Chan(7), it
studies regarding burnout syndrome done in Assiut included twenty nine items classified into four
University Hospital. So, the researched decided factors. rational problem solving, resigned distancing,
to investigate the relationship among nurses role seeking support/ventilation and passive wishful
overload, burnout and managerial coping strategies thinking. The Scoring system was four-point ranging
at Intensive Care Units in Assiut University Hospital. from “not used” (0) to “ used a great deal” (3), and

AIM • 4th tool :Burnout questionnaire which

developed by Maslach et al.,(8)), it included twenty
Was to investigate relationship among nurses two items. The Scoring system was five-point Likert-
role overload, burnout and managerial coping scale ranging from “Not important” (1) to “More
strategies (i.e. rational problem solving, resigned important” (5).
distancing, seeking support/ventilation and passive
wishful thinking) at Intensive Care Units in Assiut - Their reliability was assessed in a pilot study
University Hospital. by measuring their internal consistency using
Cronbach’s alpha coefficient method. This turned to
Research question be 0.88 for coping strategies , 0.90 for burnout , and
• Is there a relationship between managerial 0.96 for role overload, thus indicating a high degree of
coping strategies and nurses role overload and reliability. The validity was measured by five experts
burnout? in the field of Nursing Administration.

SUBJECTS AND METHODS Pilot study

Study design: A descriptive design was used. The pilot study served to test the feasibility,
clarity and practicability of the data collection tool. It
Se�ing: The study was carried out at four was carried out on 20 nurses from different inpatient
Intensive Care Units in Assiut University Hospital departments in Assiut University Hospital. The pilot
named : Causality ICU, General & Postoperative study collected on April 2015. The subjects included
ICUs, and Coronary Care Unit (CCU). in the pilot study were excluded. Data collected from
the pilot study were reviewed and no modifications
Subjects
done for the study tools
Includes all nurses working in aforementioned
Fieldwork
se�ings with a total number of 100 nurses.
An official permission was obtained from the
Tools of data collection
hospital director, the nursing service director, and the
Four tools were used to collect data for this study head of each Intensive Care Unit before embarking
as follows: on the study. The actual data collection was started in
June 2015 and ended in July 2015. The researcher met
• 1st tool :Socio-demographic data sheet: the eligible nurses, explained to them the purpose of
the study, and asked them for their oral consent to
This part included age, sex , unit name, marital
participate. Those who agreed to participate were
status, educational qualification, and years of
given the tools and asked to fill them out and return
experience.
them anonymously in the same se�ing or at most the
• 2ndtool :Role overload questionnaire which next day.
developed by Harris and Bladen (6), it included five
Ethical Considerations : The study protocol was
items. The Scoring system was five-point Likert-scale
approved by the pertinent authority. Participants’
ranging from “strongly disagree” (1) to “strongly
oral consent to participate was obtained after
agree” (5).
informing them about their rights to participate,
• 3rd tool :Managerial coping strategies refuse, or withdraw at any time. Total confidentiality
of any obtained information was ensured. The study
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 41

maneuver could not entail any harmful effects on were presented using descriptive statistics. Pearson
participants. correlation analysis was used for assessment of the
inter-relationships among quantitative variables, and
Statistical analysis
Spearman rank correlation for ranked ones. Statistical
Data entry and statistical analysis were done significance was considered at p-value <0.05.
using SPSS 16.0 statistical software package. Data

RESULTS

Table (1): Socio-demographic characteristics of studied nurses (n=100)

Frequency Percent
Age (years):
<30 79 79.0
30-35 14 14.0
>35 7 7.0
Mean±SD 25.28±0.58
Department:
Post operative ICU 20 20.0
General ICU 29 29.0
CCU 30 30.0
Causality ICU 21 21.0
Sex:
Male 2 2.0
Female 98 98.0
Marital status:
Single 50 50.0
Married 46 46.0
Divorced 3 3.0
Widow 1 1.0
Educational qualifications:
Nursing Secondary school 44 44.0

Technical Institute of Nursing 33 33.0

Bachelor degree of Nursing 23 23.0

Experience years:
<5 51 51.0
5-10 31 31.0
>10 18 18.0
Mean±SD 4.79 ±0.79
42 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Table (2): Mean scores of role overload, managerial coping strategies , and burnout among studied
nurses at ICUs (n=100)

Mean + SD

Study Variables
Post operative ICU General ICU Coronary Care Unit Causality ICU

- Role overload 15.50±2.43 16.51±3.18 15.30±3.21 15.71±3.18

- Managerial Coping strategies

33.50±7.68 30.37±6.52 30.96±6.71 34.80±4.08
-Rational problem solving

-Resigned distancing 10.55± 0.32 10.27±2.76 10.43±2.67 11.42±2.35

-Seeking support/ventilation 14.50±3.76 14.06±3.53 14.10±3.34 15.23±3.40

-Passive wishful thinking 12.20±3.90 12.68±3.08 11.46±2.80 12.28±3.63

- Burnout 66.30±14.54 63.17±14.72 60.90±12.89 57.38±15.23

Table (3): Correlation of role overload, managerial coping strategies , and burnout among studied nurses
at ICUs (n=100)

Pearson correlation coefficient

Variables Scores

Role overload Managerial Coping strategies Burnout

Role overload 0.13 0.16

Managerial coping strategies 0.13 0.49**
Burnout 0.16 0.49**

Table (4):Correlation matrix for scores of role overload, coping strategies, burnout and socio-demographic
characteristics of ICUs nurses(n=100)

Spearman rank correlation coefficient

Scores of managerial coping strategies

Characteristics Role Rational
Resigned Seeking support/ Passive
overload problem Burnout
distancing ventilation wishful
solving
thinking

Age# 0.04 -0.03 -0.09 -0.08 -0.12 -0.13

Marital status ( reference

0.02 -0.23* -0.18 -0.19 -0.26** -0.02
single)

Qualification (reference:
-0.14 0.37** 0.04 0.20 0.07 -0.02
diploma)

Experience years 0.05 -0.06 0.04 -0.08 -0.23* -0.14

Role overload ----- 0.10 0.14 -0.01 0.07 0.49**

Burnout 0.49** 0.34** 0.23* 0.32** 0.45** -----

 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 43

(#) Pearson correlation coefficient (*) Statistically managerial coping strategies ( r = 0.10, r = 0.14 & r =
significant at p<0.05 (**) Statistically significant at 0.07) respectively except seeking support/ventilation
p<0.001 coping strategy had a negative relation with role
overload (r = -0.01).
Table (1): Illustrated that more than three quarters
of study subjects were aged less than 30 yrs and more DISCUSSION
than one quarter worked at Coronary Care Unit , 98%
The results of the present study showed
were females and half of them were single. While,
that role overload had highest mean score in general
44% had a diploma degree and more than half of the
ICU followed by Casuality ICU . Also, burnout had
study subjects had less than 5 years of experience.
highest mean scores in post operative ICU followed
Table (2): Showed that role overload had highest by general ICU respectively (Table, 2). These results
mean score in general ICU followed by Casuality ICU indicated that nurses working in the intensive care
(16.51±3.18 & 15.71±3.18) . In addition, managerial unit and coronary care unit experienced lower
coping strategies highest mean scores of rational levels of personal accomplishment and high level
problem solving , resigned distancing, and seeking of stress and burnout due to these nurses face more
support/ventilation were in Casuality ICU followed death while exert more efforts so nurses use coping
by post operative ICU ( 34.80±4.08 & 33.50±7.68 ; strategies to overcome the effects of job stress and
11.42±2.35 & 10.55±0.32; and 15.23±3.40 & 14.50±3.76) burnout.
respectively except passive wishful thinking had
These results is supported by Chang, Bidewell,&
highest mean scores in General ICU followed by
Huntington (9) ; Lin, Probst &Hsu (10) who found that
Casuality ICU (12.68±3.08 & 12.28±3.63).Also, burnout
type of coping strategy was significantly associated
had highest mean scores in post operative ICU
with physical and mental health, after controlling
followed by general ICU (66.30±14.54 & 63.17±14.72)
for the effects of job stress. In addition, Gunusen
respectively.
& Ustun (11) reported that burnout among nurses is
Table (3): Illustrates that burnout had positive reduced when coping skills training was provided.
relations with managerial coping strategies with Nurses with habitual passive coping may experience
a highly statistically significant differences (r = li�le control over work and low support within the
0.49**(. While, there were no relation between role nursing team(12). While, Spooner-Lane & Pa�on (13)
overload & burnout (0.16) and role overload & coping found that burnout may develop in the individual as
strategies (0.13). a result of a long duration of the state of stress.

Table,(4): Demonstrates that burnout had The results of the current study demonstrates that
positive relations with role overload , rational burnout had positive relations with role overload and
problem solving, resigned distancing, seeking different types of managerial coping strategies with a
support/ventilation and passive wishful thinking highly statistically significant differences (Table,3&4).
coping strategies with a highly statistically significant These results might be a�ributed to the work in the
differences (r = 0.49** , r = 0.34** , r =0.23* ,r = 0.32**, ICUs is hard than other general units because nurses
and r = 0.45**) respectively. While, role overload in ICU provide intensive care for a long period (12
had weak negative statistically significant correlation hours) shift and after that patients may died so these
with qualifications (r= -0.14). In addition, burnout had situation is stressful and lead to burnout. These results
weak negative correlations with age, marital status, supported by Lashonda (14) who mentioned that
educational qualifications, and years of experience nurses when experiencing great stress, draw upon
(r= 0.13, r= -0.02, r= -0.02& r= -0.14) respectively. various coping strategies, and their manner of coping
Also, rational problem solving coping strategy had with stress, burnout and role overload influences the
weak negative statistically significant correlations quality of their professional performance. In the same
with age, marital status, and years of experience (r= line , GrusiFarshi & Moslemi (15) clarified that one of
-0.03, r= -0.23, & r= -0.06) respectively. Role overload the important factors in avoiding burnout is applying
had positive relations with rational problem solving, coping strategies.
resigned distancing, and passive wishful thinking
44 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

As shown in (Table,4) burnout and rational Acknowledgement : The researcher want to

problem solving coping strategy had weak negative acknowledge the study participants.
correlations with age, marital status, educational
Source of Funding: Self
qualifications, and years of experience. Role overload
had positive relations with rational problem solving, Conflict of Interest: Nil
resigned distancing, and passive wishful thinking
coping strategies except seeking support/ventilation REFERENCES
coping strategy had a negative relation with role
1. Tuna1, R & Baykal, U( 2014): The relationship
overload. These results might be a�ributed to most
between job stress and burnout levels of
of the studied nurses are young aged female with
oncology nurses, Asia-Pacifi c Journal of
limited years of experience, so they had not the
Oncology Nursing ,Vol 1 • Issue 1, Pp. 33-39.
ability to use the support /ventilation coping strategy
and may be unable to communicate effectively which 2. Chitura, D & Chitura, M (2014): Burnout
may reflected on their performance. In addition, syndrome in intensive care unit nurses in
women continue to do multiple roles, including Zimbabwe European Scientific Journal, Special
those roles related to the home and family, for which edition , Pp. 436- 457.
the women may have sole or major responsibility. 3. Yip, B & Rowlinson, S (2006): Job burnout
These findings were inconsistent with Foster(16) who among construction professionals in Hong
found that older nurses experienced a lower level of Kong, Journal of the Hong Kong Institute of
burnout in emotional exhaustion, depersonalisation, Construction Managers, October: Pp.11–14.
and reduced personal accomplishment than younger 4. Kato, T. (2014): Coping with interpersonal stress
nurses. and psychological distress at work: comparison
of hospital nursing staff and salespeople.
In addition, Xie , Zhang , Zheng et al., (17)& Bao ,
Psychol Res Behav Manag.7, Pp.31–6.
Liu & Wu (18) found that Chinese nurses apply different
coping strategies, such as wishful thinking, planned 5. Yip, Y., Rowlinson, S., & Siu, O. (2008): Coping
problem-solving, to deal with different stressors, strategies as moderators in the relationship
and apply avoidance strategies to cope with stress, between role overload and burnout. Construction
burnout resulting from the shortage of resources, role Management and Economics, 26(8),Pp. 871-882.
overload and interpersonal relationships. 6. Harris, M. and Bladen, A.(1994): Wording effects
in the measurement of role conflict and role
CONCLUSION
ambiguity: a multi-trait-multi-method analysis.
• Nurses employed at ICUs in Assiut University Journal of Management, 20: Pp.887–901.
Hospital reported high burnout and use managerial 7. Chan, D. (1994): The Chinese ways of coping
coping strategies as rational problem solving, questionnaire: assessing coping in secondary
resigned distancing, seeking support/ventilation teachers and students in Hong Kong.
and passive wishful thinking to handle burnout and Psychological Assessment, 6: Pp.108–16.
role overload except passive wishful thinking coping
8. Maslach, C., Jackson, S. & Leiter, M. . (1996):
strategy not used with role overload.
Maslach Burnout Inventory Manual, Palo Alto,
RECOMMENDATIONS CA: Consulting Psychologists Press. 3rd edn.
9. Chang, E. , Bidewell, J.& Huntington, A.(2007):
• Developing and implementing a training
A survey of role stress, coping and health in
program on managerial coping strategies to assist
Australian and New Zealand hospital nurses.
nursing staff in health service institutions in Egypt to
Int J Nurs Stud. 44(8), Pp.1354–62.
cope with burnout and role overload effectively.
10. Lin, H., Probst, J. &Hsu, Y. (2010): Depression
• Further researches should be done to among female psychiatric nurses in southern
investigate relations among job satisfaction, job stress, Taiwan: main and moderating effects of job
personality traits and burnout among ICU staff. stress, coping behavior and social support, J Clin
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 45

Nurs. 19(15–16), Pp.2342–54. 15. GrusiFarshi, M &Moslemi, M (2005): Investigate

11. Gunusen, N.& Ustun, B.(2010): An RCT of the relationship between burnout and coping
coping and support groups to reduce burnout techniques Nurses Kurdistan province.
among nurses. Int Nurs Rev. 57(4), Pp.485–92. Quarterly Journal of Psychological Studies, 1(4,
5), Pp.5-19.
12. Schreuder, J., Roelen, C., Groothoff, J., Van
der Klink, J., Magerøy, N., & Pallesen, S. 16. Foster, E (2003): Stress, burnout and coping
(2012): Coping styles relate to health and work strategies of nurses practicing in two state
environment of Norwegian and Dutch hospital public psychiatric hospitals in the New
nurses: A comparative study. Nursing outlook, York metropolitan area,. Waldon University
60, Pp.37-43. (Dissertation).

13. Spooner-Lane, R & Pa�on W (2007): 17. Xie W., Zhang Z., Zheng Z. & Liang B. (2005):
Determinants of burnout among public hospital Relationship among job burnout, job stressors,
nurses. Aust J Adv Nurs. ;25: Pp.8-16. and coping ways of nurses. Chinese Journal of
Behavioral Medical Science 14, Pp. 462–463.
14. Lashonda, L. (2004): Factors that most influence
job satisfaction among cardiac nurses in an acute 18. Bao M., Liu Y. & Wu J. (2011) : Study on job
se�ing. [Thesis]. USA. Marshall University. stressors and coping ways of Bachelor nurses
Article in Chinese). Chinese Journal of Disease
Control and Prevention 16, Pp. 937–939.
 DOI Number: 10.5958/0974-9357.2016.00045.3

Effectiveness of Structured Teaching Programme

on Knowledge and Practice Regarding Intravenous
Cannulation among the Staff Nurses

Naoroibam Jayalaxmi1, Mayengbam Benita Devi2, Nongmeikapam Monika3

1
M.Sc. (N) Student, 2Associate Professor, 3Lecturer, Sankar Madhab College of Nursing,
Gandhinagar, Panikhaiti, Guwahati-26, Assam

ABSTRACT

A pre-experimental study was undertaken to assess the effectiveness of structured teaching

programme (STP) on knowledge and practice regarding intravenous cannulation (IV) among the staff
nurses. A sample of 60 staff nurses were selected by using convenience sampling technique. A pre-test
was conducted using knowledge questionnaire to assess the knowledge and observational checklist
to assess the practice regarding intravenous cannulation which was followed by structured teaching
programme. On the 8th day, post-test was conducted using the same knowledge questionnaire and
observational checklist. The findings revealed that majority 52 (86.7%) of the staff nurses had adequate
knowledge and majority 47 (78.3%) of the staff nurses had improve in their practice in the post-test.
There was significance difference between the pre-test and post-test knowledge score (t=13.72 at
p<0.05level) and pre-test and post-test practice score (t=26.62 at p< 0.05 level). There was a high positive
correlation (r=0.9) between the pre-test knowledge and practice score of the staff nurses. The pre-test
knowledge score of the staff nurses was found to be associated with educational qualification. The pre-
test practice score of the staff nurses was found to be associated with age, educational qualification and
year of experience.

Keywords: Structured teaching programme, Intravenous cannulation.

INTRODUCTION OR BACKGROUND sectional study using a set of questionnaires, carried

out to determine the knowledge and practice towards
Vascular Access Devices are a common caring and maintaining peripheral intravenous (IV)
and important part of clinical practice for the cannulation among nurses in Pantai Hospital. The
administration of parenteral fluids, nutrients, data was collected from 120 staff nurses from various
medications and blood products. In addition, departments or wards using convenience sampling
vascular access devices provide a route to monitor technique. Almost all nurses have the knowledge
the hemodynamic status of a client. Nurses practicing how to care and maintain IV cannula but there are
vascular access care require knowledge, skill, and some nurses still do not know about this procedure.
judgment to manage vascular access devices. Nurses In this study, it was found out that 75.9 per cent of
with additional education and clinical expertise in them have the knowledge in caring and maintaining
infusion therapy serve as clinical champions and IV cannula and 24.1 still do not know. 83.7 percent
advocates. Hence, nurses should be aware of recent followed the correct practice of care and maintenance
changes in intravenous cannulation procedure, care of IV cannula. Nurses should know about this vital
of the patient by updating their knowledge to provide procedure in order to prevent risk and complication
high quality of care for individual that reduces on to the patient.2
instrumental complications.1
Kaur, Thakur, Kaur, Bhalla (2011) carried out a
REVIEW OF LITERATURE study to assess the risk factors leading to phlebitis
amongst the peripheral intravenous cannulated
Arbaee, Ghazali (2013) conducted a cross
patients. The study was conducted in Emergency
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 47

medical and surgical Out Patient Department of care and handling, and be�er documentation and
Nehru hospital, Post Graduate Institute of Medical information were found in the experimental group.
Education and Research (PGIMER), Chandigarh. Education in evidence-based care and handling gives
Total 200 patients were studied by using consecutive nurses the opportunity to improve their ability to use
sampling technique. Mean duration of cannula in situ theoretical knowledge in clinical problems.6
was 2.66 days. Out of total 200 subjects 113 (56.5%)
developed phlebitis. There was significant relationship
MATERIAL & METHODS
between the phlebitis and duration of cannula in situ, The objectives of the study were to -
administration of antibiotics and electrolytes (chi2 • To determine the effectiveness of structured
=21.74, 6.96, 14.18, p<0.01) respectively.3 teaching programme on intravenous cannulation.
• To find out the correlation between the
Nishanth, Sivaram, Kalayarasan, Kate,
knowledge and practice regarding intravenous
Ananthakrishnan (2009) the prospective, randomized, cannulation among staff nurses.
controlled unblinded study was conducted in the
• To determine the association between the
Department of Surgery, Jawaharlal Institute of
knowledge and practice with selected demographic
Postgraduate Medical Education and Research
variables.
(JIPMER), Puducherry between May and June 2006.
The study evaluated the effect of elective re-siting of The conceptual framework adopted for the
intravenous cannulae every 48 hours on the incidence study is based on “Ludwig Von Bertanlanffy General
and severity of peripheral venous thrombosis (PVT) System Theory (1968)”.
in patients receiving intravenous fluids/drugs. The Research Approach - An evaluative research
randomized 42 patients who were admi�ed for major approach was used for the study.
abdominal surgery to either the control or study Research design – Pre-experimental one group pre-
group (n=21 in either group). The study concluded test post-test design.
elective re-siting of intravenous cannulae every
Population - The target populations in this
48 hours results in a significant reduction in the
study were the staff nurses of down town hospital,
incidence and severity of PVT.4
Guwahati.
Malach, et al (2006) conducted an eight year Sample size - The sample for the current study
(1996 - 2003) nine-point prospective surveillance comprised of 60 staff nurses who fulfill the sampling
of phlebitis associated with peripheral intravenous criteria.
catheters on all the hospitalized patients with
Sampling technique - Non-probability convenience
peripheral intravenous cannula in Hebrew University
sampling technique.
– Haddasah Medical School, Jerusalem, Israel. In
between these surveys, findings and guidelines for DATA COLLECTION PROCEDURE
improvement were distributed among the staff.
During the surveys, 40% ± 8% of hospitalized patients The data collection procedure commenced from
had peripheral intravenous cannula. The rate of 4th November to 30th December, 2013. Prior to the data
peripheral intravascular catheter- associated phlebitis collection, the researcher obtained Ethical Clearance
decreased from 12.7% (20/157) in 1998 to 2.6% (5/189) from the Ethical Clearance Commi�ee of Assam
in 2003 (P < .01) throughout the study period.5 down town University, Panikhaiti, Guwahati, Assam.
A prior permission was obtained from the authority
Lundergren, Wahren (1999) in their study found of the down town hospital, Guwahati. The data
that nurses were deficient in the use, care, handling collection was carried out in the month of November,
and documentation of peripheral intravenous cannula 2013 in down town hospital, Guwahati. The staff
and about 50% to 75% of complications were noted. nurses from different areas were selected based
The study included 36 nurses from Faculty of Health on inclusion criteria. On the first day, the purpose
Sciences, Sweden were assigned to the experimental of the study was explained to the staff nurses and
and control group. After the education programme, wri�en consent was taken before starting the study.
fewer complications, more carefully performed A pre-test was conducted on the first day by using
48 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

knowledge questionnaire to assess the knowledge

and observational checklist to assess the practice
regarding intravenous cannulation among the staff
nurses which was followed by one hour structured
teaching programme on intravenous cannulation
by using demonstration on mannequin, charts and
slides. Post-test was conducted on 8th day by using
same knowledge questionnaire and observational
checklist.

FINDINGS

• The findings revealed that majority 37 (61.7%) of pre-test and post-test practice score on intravenous
cannulation
of the staff nurses belongs to the age group of 20-25
years, maximum 34 (56.7%) of the staff nurses were • The mean of post-test knowledge score (24.50)
having GNM qualification, maximum 38 (63.3%) was higher than the mean of pre-test knowledge score
of the staff nurses belongs to other areas of posting (17.93) with a mean difference of 6.57. The mean of
excluding ICU/ICCU, A & E and Recovery, maximum post-test practice score (26.63) was higher than the
mean of pre-test practice score (17.83) with a mean
47 (78.3%) of the staff nurses were having experience difference of 8.8. Thus, indicating an increase in the
of 1-3 years, majority 31 (51.7%) of the staff nurses post-test knowledge and practice of the staff nurses.
were not exposed to any in-service programme Hence, structured teaching programme was effective
related to intravenous cannulation. in improving the knowledge and practice of staff
nurses regarding intravenous cannulation.
• In pre-test 54 (90%) of the staff nurses had
inadequate knowledge and six (10%) had adequate • There was significance difference between
knowledge and in post-test 52 (86.7%) of the staff the pre-test and post-test knowledge score with the
nurses had adequate knowledge and eight (13.3%) paired-t value of 13.72 and found to be significant at
had inadequate knowledge as indicated in table 1. p<0.05 level. There was significant difference between
the pre-test and post-test practice score with the
Table 1: Frequency and percentage distribution paired t-value of 26.62 and found to be significant at
of Pre-test and post-test knowledge score of the staff p< 0.05 level.
nurses on intravenous cannulation.
n = 60 • There was a high positive correlation (r=0.9)
between the pre-test knowledge and practice score of
Knowledge the staff nurses. Thus, it indicates that knowledge and
Pre-test Post-test
Score practice are interdependent of each other.
%
f % f • The pre-test knowledge score of the staff
Adequate 6 10% 52 86.7% nurses was found to be associated with educational
Inadequate 54 90% 8 13.3% qualification and the pre-test practice score of the
staff nurses was found to be associated with age,
Total 60 100% 60 100%
educational qualification and year of experience.
Maximum score = 30
CONCLUSION
• In the pre-test 60 (100%) of the staff nurses
The study revealed that the structured teaching
had not improve in their practice and in post-test
programme was effective in improving the knowledge
47 (78.3%) of the staff nurses had improve in their
and practice regarding intravenous cannulation
practice, 13 (21.7%) of the staff nurses had not
among the staff nurses.
improved as indicated in figure 1.
Acknowledgement: The researchers acknowledge
Fig 1: Cone graph showing the percentage distribution
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 49

contribution and co-operation provided by the 3. Kaur P, Thakur R, Kaur S, Bhalla A. Assessment
authority of the institution and staff nurses who of risk factors of phlebitis among intravenous
participated in the study. cannulated patients. Nursing and Midwifery
Research J. 2011; 7(3): 106 – 114. Available from:
Conflict of Interest: The researchers declare that
www.medind.nic.in/nad.pdf
they have no financial or personal relationship(s)
4. Nishanth S, Sivaram G, Kalayasan R, Kate V,
which may have influenced them inappropriately in
Ananthakrishnan N. Does elective re-siting
writing of this study.
of intravenous cannulae decrease peripheral
Source of Funding: Self thrombophlebitis? A randomized controlled
study. Natl Med J India. 2009; 22(2): 60 – 62.
Ethical Clearance: Ethical clearance for the
Available from: h�p://www.ncbi.nlm.nih.org.pu
study was obtained from the Institutional Ethical
bmed
Commi�ee. In addition, informed wri�en consent
was obtained from the staff nurses and they were 5. Malach T, Jerassy Z,Rudensky B, Schlesesinger
assured of both anonymity and confidentiality. Y, Broide E, Olsha O, Yinnon M, Raveh D.
Prospective surveillance of phlebitis associated
REFERENCE with peripheral intravenous catheters. Am J
Infect Control 2006; 34(5): 308 – 312. Available
1. Registered Nurses’ Association of Ontario
from: h�p://www.ncbi.nlm.nih.org.pubmed
Nursing Best Practice Guidelines Program 111.
Richmond Street West, Suite 1100 Toronto, 6. Lundgren A, Wahren K. Effect of education on
Ontario: M5H 2G4. 2005; Available from: h�p: evidenced- based care and handling of peripheral
//www.rnao.org/bestpractices.pdf intravenous lines. J Clinical Nurs. 1999; 8(5): 577
– 585. Available from: h�p://www.ncbi.nlm.nih.o
2. Arbazee IF, Ghazali AN. Nurses Knowledge
rg.pubmed
and Practice towards Care and Maintenance of
Peripheral Intravenous Cannulation. Thesis for
Nursing Advisor. 2013. Available from: h�p:
//www.researchgate.net
 DOI Number: 10.5958/0974-9357.2016.00046.5

The Effect of Structured Teaching Programme among

Patients with Ankylosing Spondylitis

Jisha J1, Suneetha CJ2, Skandhan KP3

1
PG Student, 2Principal, Medical Surgical Nursing, Sri Ramana Maharshi College of Nursing, Tumkur India,
3
Professor, Physiology, Sree Narayana Institute of Medical Sciences, Chalaka, India

ABSTRACT

A study was conducted to assess the effectiveness of structured teaching programme (STP) among
patients with ankylosing spondylitis(AS). STP questionnaire was having 25 multiple questions to be
answered. Their demographic details were also collected. On the basis of encouraging results gained
from a pilot study of 10 patients, a major study with 70 similar cases was carried out. Education was
given to these patients to improve their health condition during illness.The results showed statistically
highly difference between pre and post ATP processing. The essential need of educating patients with
AS about their sickness, diet and exercise they required. Chi square test showed significant association
between STP and few demographic variables. We recommend similar educational programme to be
included in nursing education. The present study should encourage nurses as well as nursing students
to educate AS patients to assess their risk factors and help them to develop prevention strategies, as
well as to lead a be�er life.

Keywords: ankylosingspondylitis, structured teaching progamme, nursing education, nursing administration,

health education

INTRODUCTION sedimentation findings were considered1 was

reported as an important genetic marker for AS7.
Ankylosing spondylitis (AS) is an important
spinal cord disorder which leads to decreased Patients consent was taken prior to the study and
physical mobility. AS is a chronic inflammatory assurance was given that all collected data would be
disorder of the axial skeleton affecting the sacroiliac kept confidential. Each patient’s data was collected
joints and spine1.The exact cause of AS is unknown. during an interview which lasted approximately 35
HLA-27 was identified as a risk factor2. Prevalence of minutes. Data included patient’s age, sex, education,
AS in different continents as in 10,000 population was occupation, monthly income of family, hobbies,
23.8 in Europe, 16.7 in Asia, 31.9 in North America, knowledge about their illness as well as exercise to
10.2 in Latin America and 7.4 in Africa3.It is not a perform and duration of illness.
man’s disease as it is thought4. Though, in India AS
was more in male than in female (16:1)5.In China the A structured teaching programme (STP) was
ratio of AS was remarkably low6. prepared and employedon knowledge of AS patients
regarding their illness. The STP was translated to
The present study was to assess the effectiveness local language.Reliability and feasibility of STP
of structured teaching programme among was tested prior to the study proper. Questionnaire
hospitalized AS. consisted of 25multiple choice questions. Each
correct answer was given a score of one and wrong
MATERIALS & METHODS
answer zero.Reliability, was established by split
Selection of AS patients were done after half method by using Spearman Brown prophesy
studying the cases where physical examination formula. The reliability, feasibility and validity of tool
findings included sacroilitis, spinal muscle spasm obtained was (r =0.8).Patient was to fill questionnaire
and decreased hip mobility. X-ray and erythrocyte before and after STP.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 51

The method of instructions adopted was test and post-test knowledge scores were determined
lecture cum discussion using visual aids like flash by paired “t” test. The association between post-test
cards, hand outs, and posters. After collecting their level of knowledge and demographic variables were
demographic details on the same day STP was seen by using “Chi square”test.
conducted in their local language and which lasted
for 50 minutes.The post - test was conducted after a
RESULTS
week of the pre-test with interview schedule by using Majority of our patients were males (53.33%), and
the same questionnaire. they were educated upto high school class (33.33%).
Most of them (63.33%) did not do any exercise. By
As a pilot study 10 AS patients were tested
profession they belonged to agriculture or business
employing STP. Result was promising so we initiated
and some were unemployed. Their hobbies were
the present study where 70 male and female (age
gardening (23.33%), playing games (10%), reading
20-65) AS patients were included. They were selected
books (33.33%), and others (33.34%). Majority of them
by purposive sampling. The ten patients included in
gathered health information from radio and their
pilot study were excluded here.
mode of transport was (56.67%) four wheelers. Their
The knowledge of AS patients before and after illness varied from 1-5 years (90%).
participating in STP was analyzed in terms of
The paired “ t “ test showed that the STP was
frequencies, percentages, mean, median and standard
statistically significant ( p < 0.001 level) in AS patients
deviation.
(Table 1).
The results obtained was considered statistically
significant at ≤ 0.05% level. The difference between pre-

Table 1. STP: pre and post-test mean and standard deviation and t-value on AS patients

Paired
Know-ledge Mean SD Df p- value
t- test value

Pre-test 11.15 2.64

p<.0.001
Post-test 18.18 2.47
29.6 59
Paired mean (highly significant)
7.03 0.17
difference

The Chi square test showed a significant (p< leaflet on AS which examined four areas: (A) general
0.005) association between knowledge and only knowledge; (B) immunogenetic tests and inheritance;
demographic variables like in age, education, (C) general management; (D) joint protection, pacing
exercise, occupation, hobbies, health information, and priorities.
mode of travelling and duration of illness.
As is a kind of chronic inflammatory autoimmune
DISCUSSION disease and mainly involves axial joints9.Signs and
symptoms of AS include difficulty in sleeping,
The present study was carried out to identify
morning backache, stiffness, neurological changes
the effectiveness of structured teaching programme
such as bowel and bladder incontinence, fever,
(STP) on patients with AS. Which allowed us to
pulmonary fibrosis, uveitis and inflammatory bowel
assess AS patient’s level of knowledge, using a self-
disease2. Inflammation lead to fusion of articular
administered multiple-choice questionnaire. We
tissue. Extra articular inflammation may affect eyes,
preferred patients to use questionnaire in their own
lungs, heart, kidney and peripheral nervous systems10.
language. This is essential to exclude mistakes and
The inflammation of arthritis, affects the joint capsules
wrong answers8. The prepared questionnaire was
and their a�ached ligaments and tendons. Principally
consistent, reliable and easy to read and was based
affected is intervertebral and sacroiliac joints.
on the Arthritis and Rheumatism Council (ARC)
52 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Pyogenic bacteria could be a cause for inflammation11. of STP with each component by observing it before
If not treated early it would lead to blurred vision and and after STP.
shortness of breath12. AS patients suffer commonly
Table 1 undoubtedly confirm that the STP was
from peripheral arthritis and low back pain5. In our
significantly effective in improving the knowledge of
country increased frequency of peripheral arthritis
AS patients participated in this study.
among AS patients was reported13. Among females
juveniles which was associated with extensive extra The component wise pre- test knowledge score
axial movement14. Patients as well as society were 11.15%was inadequate in all areas like general
spending money for treating AS patients15. Thus information, signs and symptoms. Similar findings
health economy was affected by this disease16. were reported earlier26. The results showed AS
patients to have a high level of knowledge (mean =
AS is associated with HLA -B27 antigen. It is
19.4, maximum possible = 25), although some wrong
characterized by low back stiffness and possible
beliefs about the role of blood tests, the HLA-B27
occular, cardiac and pulmonary manifestations.
antigen and inheritance were observed. The data
Arthritis associated with inflammatory bowel
suggested that the present questionnaire was a simple
disease12.
way to detect the level of knowledge of patients with
Anemia is a common complication in AS. Using AS. The average score achieved by AS patients was
Aspirin17, Infliximfab18, TNF blocking drugs19, outstanding, reflecting the quality of educational
adalimumab for five years20 or balneotherapy21 were programme (STP) we parted and which they a�ended.
used and basically to improve working capacity of Patients’ confusion regarding blood tests, genetics
patient. Non-steroidal anti-inflammatory drugs are and inheritance was highlighted and we made them
suggested22. The modern medicine has no specific understand these points satisfactorily.
therapy23. Total hip arthroplasty was recommended
This present study is important in the nursing
in required cases24.
field of practice, education and administration and
Our aim to conduct a systematic study in a major nurses as members of health team have a major
group of AS patients (n=70) to access the effectiveness role in taking care of AS patients by preventing the
of structured teaching programme(STP) was based on possible immobility due to illness27,28. They should
a pilot study conducted earlier with 10 AS patients. make aware the details of AS to these patients and
The results showed poor knowledge of patients about their relatives.Monitoring of the AS patient in clinical
the disease. Association of post –test knowledge with daily should also include specific concepts pertaining
demographic variables was done using Chi square to the disease, which will aid in the detection of
test. Results showed that all variables except sex and disease, progression, the requirement of therapeutic
monthly income had highly significant association intervention and the response to therapy29. Essential
with the post- test findings among patients as shown nursing care include hot application, advice the
below. In a similar study done it was found poor patients to maintain good dietary habits sleep
functioning and physical health affected quality of without pillows in supine position, proper physical
life25. exercise, breathing exercise and monitor the physical
mobility and skeletal changes.
STP
Pre post
Findings of the study will be useful in nursing
education. Nurse educator should encourage the
% 43 73
students for care, prevention and helping AS patients
10.8 18.2 to do daily exercise. The students should beeducated
SP 2.32 1.73 for special exercise for AS and daily activities in these
patients. Teaching plan is a guide for the teacher
‘t’ test * *
because it helps to cover the topics comprehensively
*significant
with proper sequence of points.
The investigators had assessed the effectiveness
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 53

Nursing administration should make public Rheum Dis 43:381-385, 1984

awareness on AS and its preventive measures. 6. Dai SM, Han SX, Zhao DB, Shi YQ, Liu Y,
Towards this a protocol for nursing care of patients Meny JM. Prevalence of Rheumatic Symptoms,
with AS shall be prepared. The study shall be a Rheumatol id arthritis, Ankylosing spondylitis,
beginner in education programme and continuing and gout in Shanghai, China: a COPCORD
nursing education programmes to be initiated for study. Rheum atol 30:2245-2251, 2003
nurses to update the knowledge on AS patients.
7. Chang TC. Spondyloarthritis in Asian
The nurse administrators should organize the Countries-An overview. Current Rheumatol
programme and prepare the audio-visual aids and Rev 4:81-86, 2008
hand-out for effective health education. 8. Lampe S, Tsause B, Linguistic bias in multiple
–choice test questions. Creative Nursing, 16:63-
In conclusion STP improved the knowledge
67, 2010
of AS patients about their illness, required diet
and the exercise they had to perform. The study 9. Slobodin G, Rosner I, Rimar D, Boulman
showed implications made by this in the field of N, Rozenbaum M, Odeh M. Ankylosing
nursing practice, nursing education and nursing spondylitis: field in progress. Israel MedAsso J
administration. 14:763-767, 2012
10. Huetherm MC. Case Understanding
Acknowledgement: Patients selected for this
Pathophysiology. Pathogenesis of ankylosing
study were from 1.Sridevi Hospital and 2. Aditya
spondylitis. China: Mosby Elsevier publishers,
Orthopaedic and Trauma Hospital at Tumkur.
4th edition, p.254-268, 2008
Authors are thankful to authorities of these hospitals
for granting permission to conduct this study and to 11. Chandrasekhar AN. Infection and arthritis. J
AS patients for extending co-operation. Asso Physicians India54:27-31, 2006
12. Linden SVD, Heijde DVD. Ankylosing
Ethical Clearance : was granted for the study spondylitis clinical features. Rheumatol Dis
Source of Funding : Self Clin 24:663- 676, 1998
13. Aggarwal R, Malaviya AN. Clinical
Conflict of Interest: Nil characteristics of patients with ankylosing
REFERENCES spondylitis in India. ClinRheumatol 28:1199-
1205, 2009
1. Long P.Medical Surgical Nursing. Ankylosing
Spondylitis, Philadelphia, Lippinco� Williams 14. Nazarinia MA, Ghaffarpasand F, Heiran
and Wilkins, p.1245-48. 2007 HR, Habibagahi Z. Pa�ern of Ankylosing
spondylitis in Iranian population of 98 patients.
2. Black MJ. Medical Surgical Nursing. Ankylosing
Modern Rheum 19:309-315, 2009
Spondylitis. New Delhi, Elsevier publishers, 7th
edition, p.678-79, 2005 15. Boonen A, Linden MVD. The burden of
ankylosing spondylitis. J Rheumatol 78:4 -11,
3. Dean LE, Jones GT, MacDonald AG,
2001
Downhamm C, Sturrock RD, Macfarlave GJ.
Global prevalence of Ankylosing spondylitis. 16. Boonen A, Heijde DVD,Landewe R,
Rheumatol 53:653-657, 2014 Spoorenberg A, Schouten H, Ru�en M- Van
Monken, Guillemin F, Mielants H, de viam
4. Lee W, Reveille JD, Davis Jr JC, Learch
K, Vander Tempei H, Vander Linden SJ. Work
TJ, Ward MM, Weisman MH. Looking at
status and productivity cost due to Ankylosing
gender differences in severity of ankylosing
spondylitis: companion of three European
spondylitis. Ann Rheum Dis 66:633-638, 2007
Countries. Ann Rheum Dis 61:429-437, 2002
5. Prakash S, Mehra NK, Bhargava S, Vaidya MC,
17. Rosdahi CB, Kowalt MT. Text book of basic
MalaviyaAM.Ankylosing spondylitis in India:
nursing. Philadelpia: Lippinco� Williams &
A clinical and immunogenetic study. Ann
Wilkins, 2008
54 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

18. Caker E, Taskaynatan MA, Dincer U. Work 23. Bond D. “Ankylosing spondylitis: Diagnosis
disability in ankylosing spondylitis. Differences and management”. Nurs Stand 28:52-59, 2013
among working and work disabled patients. 24. Sweeney S, Gupta R, Taylor G, Calin A. Total
Clin Rheumatol 28:1309-1314, 2009 hip arthroplasty in ankylosing spondylitis:
19. Keats AC, Gaffney K, Gilbert AK, Harris C, Outcome in 340 patients. J Rheumatol 28:1862-
Leeder J. Influence of biologic therapy on 1866, 2001
return work in people with work disability due 25. Singh JA, Strand V. Spondyloarthritis is
to ankylosing spondylitis. Rheumatol 47:481- associated with poor function and physical
483, 2008 health related quality of life. J Rheumatol 36:
20. Heijde DVD, Breban M, Halter D, Divi�orio G, 1012-1020, 2009
Bra�s J, Cantin F, Kary S, Pangan AL, Kupper H, 26. Lubrano E, Helliwell P, Moreno P, Griffiths B,
Rathmann SS, Siepper J, Mease PJ. Maintanance Emery P, Veale D. Assessment of knowledge
of improvement in spinal mobility, physical in ankylosing spondylitis patients by a self-
function quality of life in patients with administered questionnaire. Rheumatol 37:
ankylosing spondylitis after 5 years in a clinical 437-441,1998
trial of adalimumab.Rheumatol53:263-272,
27. Krishna KV. Text book of medicine.
2014
Management of ankylosing spondylitis. New
21. Yurkuran M, Alev AY, Karakoc Y. Improvement Delhi, Jaypee Brothers Publishers. 3rd edition.
of the clinical outcome in ankylosing spondylitis p.1456,1997
by balneotherapy. Joint Bone Spine 72:303-308,
28. Dirksen, Heitkemper, Bucher. LewisMedical
2005
Surgical Nursing. Assessment and management
22. Sieper J, Braun J, Rudwaleit M, BoonenA, Zink of clinical problems. Philadelphia, Mosby
A. Ankylosing spondylitis: an overview. Ann Publications, 9th edition. 2014
Rheum Dis 61: 8-18, 2002
29. Mohanan. Text book of Medical Surgical
Nursing ankylosing spondylitis New Delhi,
Elsevier publishers, 8th edition. p.246-254. 2007
 DOI Number: 10.5958/0974-9357.2016.00047.7

An Exploratory Study to Assess the Psychosocial Problems

Experienced by Migrants Residing in Selected
Districts of Punjab, 2015

Kiranpreet Kaur1, Kishanth Olive2

1
M.Sc (Nsg.) Student, 2Assistant Professor, Department of Psychiatric Nursing,
S.G.L. Nursing College, Semi, Jalandhar, Punjab

ABSTRACT

Background of the study:- Migration (human) is the movement of people from one place in the world
to another for the purpose of taking up permanent or semi permanent residence, usually across a
political boundary. People can either choose to move (“voluntary migration”) or be forced to move
(“involuntary migration”). Punjab has recorded an above average growth rate of 10 percent over
the years due to migration. Various research reports reveal that today Punjab need outside workers
for various reasons. Therefore more reasonable thing is to understand the migrants also – their
compulsions, expectations.
Objectives
1. To explore the psychosocial problems experienced by migrants residing in selected districts of
Punjab.
2. To find out the association between the psychosocial problems experienced by migrants and their
selected socio demographic variables.
Research Methodology:
Design : Non Experimental, Exploratory design
Se�ing : Selected districts of Punjab.
Target Population : Migrant workers working in selected districts of Punjab.
Sample size : 200 students
Sampling Technique : Simple random sampling technique
Result and Conclusion: Mean score of psychosocial problems and Standard deviation of total 200
sample were 79.99 ± 12.76 respectively Median of 200 samples was 78. Majority 142 (71%) of migrants
experienced moderate psychosocial problems whereas 31(15.5%) migrants experienced severe
psychosocial problems and 27(13.5%) migrants experienced mild psychosocial problems.
Keywords: “Psychosocial problems” “Migrants”.

INTRODUCTION Although the Fifth EWCS (European Working

Conditions Survey)2 (2010) reveal a higher prevalence
Migrant is a person who moves from one place of workers in the agriculture sector and construction
to another in order to find work or be�er living sector that were on: a fixed term contract (16.8% vs.
conditions. According to American psychiatric council 12%), in temporary employment (2.8% vs. 1.3%)
(2010), the term ‘migrants’ refer to people with a wide Migrant workers are often employed in low-paid and
range of different types of status, including refugees, unskilled roles, which are typically characterized by
asylum seekers, refused asylum seekers, trafficked poor working conditions (e.g., working long hours,
persons, undocumented migrants, migrant workers, evenings or night work, working during weekends).
family migrants, international students1. Undoubtedly, collectively these factors may constitute
56 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

a significant risk for workers’ safety and physical accounts for 27 percent. Unlike the case of migration
or mental health. 4.1% of employees reported being for education which was primarily an intra-state
subjected to bullying or harassment at work in the phenomenon, 46 percent of individuals migrate to
present year. The highest prevalence was found work in other states where as 54 percent work in the
in France (9.5%), Belgium (8.6%), the Netherlands same state Moreover, 72 percent of these migrant
(7.7%), Luxemburg (7.2%), and Austria (7.2%). In workers are employed in rural areas.
some countries, very low prevalence was measured;
Ravi Srivastava and S.K Sasikumar6 (2006)
Bulgaria (0.6%), Poland (0.7%), Italy (0.9%), Slovakia
conducted a study on An overview of migration
(1.2%), Turkey (1.3%), Kosovo (1.4%), and Albania
in India and its impact and key issues revealed
(1.5%) In the EU level, bullying or harassment
that,Towns and villages of Punjab are the destination
seemed to be somewhat more common in the service
of large-scale spatial mobility of unskilled populations
sector (4.6%), as compared to in industry (3.1%).
from rural areas of backward states especially U�ar
In some countries (e.g., the Netherlands, France,
Pradesh and Bihar. These migrants reach Punjab from
Latvia, and Slovenia) the experience of bullying or
all over the country individually as well as in groups
harassment was observed to be more common in
with or without the help of contractors/agents, the
the service sector, than in industry. In a survey in 70
population of migrant labour in Punjab has reached
organizations from 18 sectors in Britain, bullying was
2.5 million within Ludhiana being its focal point.
found to be most common in prison service, post- and
Punjab’s entire agriculture, paddy, plantation and
telecommunications, and teaching.
allied fields such as poultry and dairy are almost fully
As per ILO3 i.e. International Labour dependant on migrant labour. The same is reflected
Organization (2007) Countries whose workers report in the case of small and medium scale industries. The
a high prevalence of physical violence were France steel, iron, sugar, wool, knitwear etc. are also heavily
(3.8%), the United Kingdom (3.3%), Ireland (3.2%), dependent on migrant labour.
Denmark (2.9%) and Belgium (2.9%). Low rates were
found in Italy (0.2%), Lithuania (0.3%), Hungary
MATERIALS & METHOD
(0.3%), Estonia (0,4%) and Cyprus (0.4%), exposure Quantitative approach and Non-Experimental,
to physical violence increased from 4% in 2005 to 6% Exploratory research design was adopted for
in 2012. the study.The study was conducted in selected
districts of Punjab (Coca Cola Industry, Dis�.
S Chandrasekhar, Ajay Sharma4 (2014)
Ludhiana (Majha region), Doaba Milk Industry,
conducted a study on Internal Migration for
Dis�. Jalandhar (Doaba region), Esperton Woolen
Education and Employment among Youth in India,
Industry,Dis�. Gurdaspur (Malwa region). Simple
results revealed that there are four migration streams:
random sampling technique was used to select 200
rural-rural, rural-urban, urban-rural and urban-
migrant workers.The tool consisted of two sections:
urban. Further, the stream can be intra-district, intra-
- Part-I Socio-Demographic Variables: Consists of 11
state and inter-state. Majority of the migrants move
items for obtaining information about the sample’s
within the state, i.e. move within same districts or
Age, Gender, Education, Marital status, Occupation,
move to other districts of the same state. Of the 110
Income (in Rs./month), Residence, Religion, Place
million individuals aged 15-32 years, over 70 percent
of origin, Language preference and Duration of
of them, i.e. 77.5 million report moving on account of
residing in Punjab (in years).Part-II Self Structured
marriage. While nearly 10 percent report moving in
Questionnaire: Consists of 40 questions. On the
search of employment, and 3.5 percent report moving
basis of response Agree contains 3 marks, Uncertain
on account of education.
contain 2 marks and Disagree contain 1 mark. The
National Sample Survey Organization5 (NSSO) maximum score was 120 and minimum score was 40.
(2009-2010) conducted a survey on the distribution The data will be analyzed according to objectives of
of workers by sector was as follows agricultural the study using description and inferential statistics
sector: 53.2 percent, secondary sector: 21.5 percent such as frequency, percentage, mean, standard
and tertiary sector: 25.3 percent manufacturing deviation, coefficient of correlation, ‘Z’ test, ANOVA
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 57

test. Criterion Measure: There were 40 items to assess 200 samples was taken. Simple random sampling
the psychosocial problems experienced by migrants. technique was used to collect data. The result was
Criterion measure used in the study was as follow: calculated by using descriptive and inferential
statistics. From the findings it was concluded that
Level of Psychosocial problems Scores
the majority of migrants 125(62.5%) belonged to
Mild 40-66 age group of 35-54years, 161(80.5%)were male and
39(19.5%) were females, highest i.e. 90(45%) migrants
Moderate 67-93 were illiterate, more than half 158(79%) were
married migrants, more than half of the migrants
Severe 93-120
120(60%) were unskilled and 80(40%) were skilled,
MAJOR FINDINGS out of 200 study subjects, 90(45%) of migrants were
having 10001-15000 monthly income, as per religion
• Maximum number 125(62.5%) of migrants maximum 95(47.5%) migrants were Hindu followed
belonged to age group of 35-54years. by 50(25%) Sikh migrants, as per place of origin
• Majority of respondents were male 161(80.5%) and maximum 60(30%) migrants originates from Bihar,
39(19.5%) were females. the findings of the present study revealed that mean
• Highest i.e. 90(45%) migrants were illiterate. psychosocial problems score of migrants is 79.99.

• More than half 158(79%) were married migrants. DISCUSSION

• More than half of the migrants 120(60%) were
A self structure three point Interview schedule
unskilled and 80(40%) were skilled.
was used to collect the data. Study was done to assess
• Out of 200 study subjects, 90(45%) of migrants the psychosocial problems experienced by migrants
were having 10001-15000 monthly income. residing in selected districts of Punjab, investigator
• As per religion maximum 95(47.5%) migrants were utilized Simple random sampling technique to select
Hindu followed by 50(25%) Sikh migrants. the subjects. The findings were discussed on the basis
• As per place of origin maximum 60(30%) migrants of demographic characteristics, objectives of the
originates from Bihar. research study.

• Out of 200 study subjects 110(55%) migrants First objective of the study was to explore the
resides in rural areas. Psychosocial problems experienced by Migrants
• Majority of the respondents 110(55%) prefer Hindi residing in selected Districts of Punjab, findings
language. of the study revealed that out of 200 migrants,
maximum 142(71%) migrants experienced moderate
• As per duration of residing in Punjab (in years)
level of psychosocial problems, followed by 31(15.5%)
80(40%) migrants resides in Punjab from 6-8
migrants experienced severe level of psychosocial
years.
problems and minimum 27(13.5%) migrants were
• The findings of the present study revealed that experience mild level of psychosocial problems .The
mean psychosocial problems score of migrants is finding of study was supported by, Economic and
79.99 Statistical Organization, Department of Planning,
• Level of psychosocial problems was not significant Government of Punjabin his study results revealed
with any of the socio-demographic variable other that out of 100 study samples Majority (60%)of the
than the occupation, income (in Rs./month), migrants experience moderate level of psychosocial
religion, place of origin and duration of residing in problems while (5%) of mothers were having severe
Punjab (in years). psychosocial problems and (35%) migrants experience
CONCLUSION mild psychosocial problems.

The study was undertaken to assess the Second objective of the study was to find out
psychosocial problems experienced by migrants the association between the psychosocial problems
residing in selected districts of Punjab. A total of experienced by migrants and their selected socio
demographic variables, In the present study
58 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Age, Gender, Religion, Marital status, Education, 3. Wri�en permission will be taken from the higher
Occupation, income (in Rs./month), residence, place authorities where the migrants are working.
of origin, language preference, duration of residing in 4. Wri�en informed consent will be taken from each
Punjab (in years) as socio demographic variables and study sample.
revealed that occupation, income (in Rs.), religion,
5. Confidentiality and Anonymity of samples will be
place of origin and duration of residing in Punjab (in
maintained throughout the study.
years) was significant with the level of psychosocial
problems variable in the study. Otherwise, there Source of Funding: Self
was no other socio demographic variable which is
Conflict of Interest: Nil
significantly associated with the level of psychosocial
problems in the study and other than this there was Acknowledgement: Those who do not move, do
no significant association found between levels of not notice their chains.
psychosocial problems with other selected socio
demographic variables. The findings of the study
REFERENCES
was supported by the study conducted by Economic 1. ASK.COM. Meaning of Psycho-social problems,
and Statistical Organization, Department of Planning, kiranpreet 28th July 2015.docx
Government of Punjab as they revealed that there
2. Fifth European Working Conditions
is a significant relationship between psychosocial
Survey (2010)Available form:
problems and age, gender, occupation, income,
www.eurofound.europa.eu
religion, duration of residing in Punjab socio-
demographic variables and no association between 3. International Labour Organization
psychosocial problems and education, marital status, (2007)Available form: h�p//in.one.un.org
residence, place of origin, language preference socio- 4. Chandrasekhar S, Sharma A.Internal Migration
demographic variables. for Education and Employment among Youth
in India, h�p://www.igidr.ac.in/pdf/publication/
ETHICAL CONSIDERATIONS
WP-2014-004.pdf/.
1. Wri�en permission will be taken from principal 5. NSSO.Distribution of workers by sectors, .
S.G.L Nursing College, Semi, Jalandhar, Punjab. 6. Srivastava R.,Sasikumar S.K. An overview
2. Ethical clearance will be taken from Research of migration in India and its impact and key
Ethical Clearance Commi�ee of S.G.L Nursing issues,http://www.eldis.org/vfile/upload/1/
College, Semi, Punjab. document/0903/Dhaka_CP_2.pdf
 DOI Number: 10.5958/0974-9357.2016.00048.9

Communication: An Essence to Operating Room Nursing

Sonia P Abraham1, Anita Kiruba Jeyakumar2, Valliammal Babu3

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

ABSTRACT

Research suggests that inadequate communication is a primary cause of medical errors and that
communication among the professions in the operating room (OR) is essential to patient safety1, 2, 3.
Hence adequate and effective communication among team-members reduces risks and raises patient
safety. Being a part of OR team it is essential for a nurse to know how to communicate effectively. This
article will enable us to communicate effectively among OR team members and the patients.

Keywords: Communication, holding bay, operating suite, post anesthesia care unit and barrier.

INTRODUCTION comprises of patient’s name, hospital number,

name of the surgery, site and side of the surgery,
Excellent communication skills, both verbal and
informed consent, anesthesia consent, NPO status,
nonverbal, are needed throughout the perioperative
premedication, implants, loose tooth, articles for
experience to educate patients undergoing surgery
surgery sent with the patient. The holding bay nurse
and so ease their anxiety4. Nursing throughout ages
cross checks the details and documents the time of
has mastered the art of communication both with
arrival, patient’s health status and other significant
the patients as well as with the multidisciplinary
details pertaining to that individual in the peri-
team and other departments. Good communication
operative record.
skills always help in building good interpersonal
relationships. Good interpersonal relationships pave Holding bay is the face of OR, keeping this in
way for a conducive working environment, thereby mind the holding bay nurse communicates effectively
directly impacting both work as well as patient with the patient. Seeing a friendly, welcoming face,
outcomes at the same time. helps the patients to cope with their fears5.The nurse
providing care to the patient in the holding bay must
COMMUNICATION STATIONS IN OR
remember the following approach.
Patients, who enter the Operating Room complex,
H- Hold the hand
have a short encounter with its team members before
leaving the OR after the surgical intervention. These O- Observe the patient
encounters occur as the patients are wheeled from the L- Listen patiently to ease fear
ward till the patients reach back after being monitored D- Do not over communicate
in the Post Anaesthesia Care Unit.
I- Individual differences must be respected
The holding bay nurse receives a verbal report N- Never leave the patient’s alone
about the patient from the ward nurse, which
G- Greet the patient by name

COMMUNICATION AT THE HOLDING BAY

Fig. 1 Fig. 2
60 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

B- Be cautious about your facial expression f. Nurses role confusion

A- Avoid grape vine communication h. Physical barriers: Hearing difficulty, Noise
Y- Why? Clarify their doubts in simple-terms from audio system, power tools
2. Nurse- OR team
The holding bay nurse communicates the patient’s
name, hospital number, name of the surgery, site a. Inadequate knowledge
and side of the surgery, NPO status, premedication, d. Lack of assertiveness
and any other significant information to the team
c. Use of Jargon
members. OR team members re-affirm the details
with the patients. d. Abusive words by the team members
e. Lack of active listening by the team
The communication must be clear, concise,
members
relevant and timely.
f. Irrelevant comments and queries by the team
COMMUNICATION IN THE OPERATING members
SUITE
g. Fear of being ridiculed
h. Stress
i. Impolite response from team members
j. Unrelated conversation by staff
h. Serial distortion by the Nurse
Visible Effects of Communication Failure7
1. Procedural delay
2. Inefficiency
3. Procedural Errors
4. Team tension
Fig: 3 5. Wastage of Resources
Patient is the center of the communication
Strategies to enhance effective communication
process in the operating room. Each team member
in the operating suite
communicates with the patient as well as with one
another. Since multidisciplinary team is involved 1. Focus on updating nurse’s knowledge
clear, concise use of language is vital. Careful choice 2. Assess reasons for unwanted noise and avoid
of words is essential in maintaining interpersonal them
relationship and be�er patient satisfaction. Active 3. Obtain soft skill and continue to be polite
listening skills, probing and questioning skills are
5. Establish rapport among team members
important for effective communication in OR 6.
6. Train the nurses to be clear on nurse’s role in
Barriers of communication in the operating the operating suite
suite
7. Intervene promptly when conflicts among
1. Nurse-Nurse nurses occur
a. Expectation from the Nursing fraternity 8. Coordinate activities to reduce procedural
b. Inter personal conflicts delay and work stress

c. Prejudice 9. Ensure use of professional language

d. Language 10. Devout time for team building among nurse.

e. Serial Distortion
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 61

COMMUNICATION IN POST among the team members. As holding bay is the face
ANAESTHESIA CARE UNIT of the OR, remember to receive the patients with a
smile, and since the PACU is the heart of the OR,
handle patients with care. Communication is an art,
hence cultivate it.

Acknowledgement: Nil

Ethical Clearance: Ethical Clearance is not

obtained since it is a concept article

Fig:4 Source of Funding : Nil

Post anesthesia care unit is the heart of the OR. Conflict of Interest: The authors declare no
Patients admi�ed are highly vulnerable, as they conflict of interest as it is a concept article.
recover from the anesthetic effect. Communication
REFERENCES
among the post anesthesia care providers is critical.
The circulating nurse and the anesthetist providing 1. Gandhi TK. Fumbled handoffs: one dropped
care to the patient in the intra operative period must ball after another. Annals of Internal Medicine.
provide appropriate hand off information to the 2005;142(5):352–358.
PACU nurse8.Hearing is the first sense to return in the 2. Gawande AA, Zinner MJ, Studdert DM, Brennan
recovering patient hence whatever spoken near the TA. Analysis of errors reported by surgeons at
patient must be pleasant and polite. The PACU nurse three teaching hospitals. Surgery. 2003;133(6):
will have to react in a non- confrontational manner 614–621
towards confused and aggressive patients, offering
3. Joint Commission on Accreditation of Healthcare
continuous support and reassurance.
Organizations. 2008. Sentinel events statistics.
Characteristics of a good hand-off reporting skill Retrieved from h�p://www.jointcommission.org/
SentinelEvents/Statistics on 13th May 2015.
1. Clear
4. Saunders, S. (2004) Why good communication
2. Concise skills are important for theatre nurses. Nursing
3. Complete Times; 100: 14, 42–44, 13.05.15.
4. Correct 5. Hind. M, & Wicker, P. (2000) . Principles of
Peri-operative Practice. London: Churchill
5. Connected
Livingstone
Communication skills required for a PACU Nurse
6. Woodhead, K. & Wicker,P. (2005). A textbook
1. Speaking slowly of Peri-operative care. London: Churchill
Livingstone
2. Speaking clearly and not loudly
7. Lingard L, Espin S, Whyte S, Regehr G, Baker
3. Stopping to listen
GR, Reznick R, Bohnen J, Orser B, Doran D,
4. Specializing other languages Grober E. Communication failures in the
5. Sensitiveness and polite operating room: an observational classification
of recurrent types and effects.Qual Saf Health
CONCLUSION Care. 2004 Oct; 13(5):330-4. Retrieved from h�p:
//www.ncbi.nlm.nih.gov/pubmed/15465935,
Effective communication is vital in OR. It enables
13.05.15
its smooth functioning.Proper communication saves
time, efficiency and enhances good patient outcome. 8. Spry, C .(2011). Essentials of Peri-operative
A Peri-operative nurse must always take all effort to Nursing. 4th Edition. New Delhi: Jones and
ensure good communication with the patients and Bartle�.
 DOI Number: 10.5958/0974-9357.2016.00049.0

Effectiveness of Educational and Selected Exercise

Programme to Reduce Back Pain in Staff Nurses

Rakesh Sharma
Nursing Faculty, College of Nursing, AIIMS, Raipur, Chha�isgarh (India)

ABSTRACT

Aim. The study was aimed to evaluate effectiveness of educational & selected exercise programme
regarding back pain among staff nurses.

Material and Method: All the Staff Nurses from selected hospital of Mysore District were surveyed for 3
days to explore the incidence rate. Staff nurses those who were suffering from back pain were included
in the sudy. Participants were selected into a control group (n1=35) and an intervention group (n2=35).
The intervention programme involved educational component on knowledge and practice regarding
back pain emphasizing on the causes, symptomes and preventive aspects such as ergonomics, followed
by selected exercise programme for 15 days in the morning time for 30 to 40 minutes of duration.

Participants were asked to answer structured knowledge questionnaire, structured practice

questionnaire. Data were collocated befeore and after the intervention programme.

Analysis: Data was anlysed by using statistical software EPi- info. Quantiative data was expressed
in terms of mean±standard devation. Qualitative data was expressed in terms of frequency and
percentage. Independent t-test, paired t test, were used to anlyse the data at 5% level of significance.

Results: Two hundred sixty three staff nurses were surveyed. The incidence rate of back pain was
estimated 62.64%. It was estimated that the mean pre –test knowledge score (11.83±3.37) and practice
score (68.83±13.5) of staff nurses regarding prevation and management of back pain was lower than the
mean post test knowledge score (25.14±3) and practice socre (115.3±4.37). The difference were found
to be statistically significant at 5% level of significane. There was a stastically significant decrease in
the Intensity of back pain and related absentieesm at the end of 15 days in the intervention group
(P<0.05).

Conclusion: It was concluded that the planned teaching and selected exercise programme is an
effective strategy which can help nurses to increase their knowledge and practice regarding prevention
and management of back pain.

Keywords: Back Pain, Staff Nurses, Knowledge, Practice, prevention and management of Back Pain.

INTRODUCTION with symptoms and injuries of the musculoskeletal

system[3,4], thus the risk for occupational accidents of
One of the universal health problems today is the the back is higher among nurses than among working
back pain. It has become the second most reason after women in the general population. Work related back
common cold leading to the loss of work days among pains among nurses constitute a foremost cause of
people under the age of 45 years than any other morbidity in the health care environment. [5]
medical condition.and, almost one percent of work
force is chronically disabled due to of back pain[1, 2]. Patient management events have long been
accepted as being a major provider to the high
Repetitive work, posture, work control and work incidence of musculoskeletal injury, which results in
organisation are considered as having association
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 63

back pain, among nurses[6, 7, 8]. A range of educational knowledge and practice regarding prevention and
approaches have been used over the years to mangemrent of back pain among Nurses.
try and reduce this problem[9], and professional
bodies continue to produce direction on patient The experimental group received a 60 minutes
management[10]. Back pain being multifactorial planned teaching programme on prevention and
in origin requires an ergonomic approach, which management of back pain on day one followed by
a�empts to integrate equipment, repetitive work task, selected exercise programme for 15 days.
personnel, and the physical work environment.[11] The tools developed and selected for the data
collection were: (1) Survey questionnaire to explore the
AIM
incidence, (2) Structured knowledge questionnaire to
The study was aimed to explore incidence rate, assess the knowledge of Nurses regarding prevention
and evaluate effectiveness programme among staff and management of Back Pain; (3) Structured practice
nurses of educational & selected exercise programme questionnaire to assess the practice of body mechanics
among staff nurses. and performance of certain back strengthening and
stretching exercises for Nurses regarding prevention
METHODS and management of Back Pain. Content validation
and reliability was established for all tools.
An explorative and evaluative research approach
was used for the study. The research design adopted The teaching content was based on previous
was true experimental design. The sample consists of research studies. The planned teaching programme
70 nurses, 35 each in experimental group and control was conducted soon after pre-test in experimental
group. group.
The study was conducted in a multispecialty The exercise programme was designed with the
teaching hospital. A survey was conducted to explore help of Physiotherapist for experimental group for
incidence rate of back pain among Nurses. The a 45 minutes of duration in the every day morning
sample population included all the Nurses working for 15 days. Author has demonstrated the selected
at the dependent inpatient care units (Emergency, exercises (warm-up, stretching and strengthening)
Orthopedic, Operation theater, and ICUs) and and Nurses performed those exercises.
Abmulatory Units (Private ward, General Medicine
and Surgery wards and Gynecology Unit). DATA COLLECTION

The Nurses were involved in overall Nursing Survey questionnaire was prepared to collect
Care such as transportation, lifting, shifting, drug personal veriables data, question on presence or
administration, assisting in invasive procedres, absence of back pain, which was found reliable with
conducting delivery, personal hygiene care and test retest method and 96% similarity were found.
feeding patients. To assess the knowledge and practice regarding
prevention and management of back pain, a
Inclusion criteria for the study participants were structured knowledge and practice questionnaires
age less then 45 years, working as staff nurse, involved were prepared. Reliability was obtained by comuting
in directe patient care in different shift duties and, coeffiecient correlation, which was found to be 0.86
suffering from back pain from last 3 month or more for knowledge and 0.97 for practice questionnaire.
and willing to participate in the study. Exclusion
criteria were, spinal disorder or medically restricted STASTICAL ANALYSIS
for movements/exercises or medical history of spinal
The data was calculated by using statistical
surgery.
software Epi- info. Catgorigal data represented in the
The sample population was 171 Nurses with back form of Frequency and percentage. Quantitative data
pain. All the participants signed informed consent was expressed in the terms of mean and standard
forms and with Systematic Random Sampling devation. Paired t test was used to compare the pre
technique Nurses were enrolled into control group test score to post test score. Independent t test was
(n1=35) and experimental group (n2=35). The control used to comper the mean of control and experimental
and experimental group were pre-tested to assess group.
64 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

ANALYSIS and they were equally distributed, 34 in both the

groups experimental and control group.
The incidence rate of back pain among surveyed
among 263 nurses. Of 263 Nurses, 171 (62.64%) were With regards to area of work majority (67.14%) of
suffering from back pain. These 171 nurses having the Nurses were working in Ambulatory care units. In
back pain formulated the target population for the the present study majority (75.71%) of sample had ≥3
the study, from which 70 were selected as samples years of professional experience. Nurses were asked
for the study. about the duration they were suffering from back
pain, overall 52.86% samples were suffering from
Selected personal variables of nurses: In back pain for 1-2 years of duration and 47.14% were
the present study majority (75.71%) of the total suffering for ≥2 years of duration. Majority (55.71%)
sample were in the age group of 20-30 years. This of the sample had back pain in 2-3 locations. Same
indicates that majority of the nurses were in their trend was seen in experimental and control group
most productive and functionally active age group. (51.43% and 60% respectively) Table 1.
Whereas majority (97.14%) of the sample were female

Table 1: Demographic charecteristics, durationa and location of back pain among Nurses in experimental
and control group. N=70

Experimental group Control group

Total
(n1 = 35) (n2 = 35)
Sample characteristics
F % F % F %

a. 20-30 27 77.6 26 74.3 53 75.7

Age (Years)
b. 30-40 08 22.9 09 25.7 17 24.3

Gender a. Male 01 02.9 01 02.9 02 2.85

b. Female 34 97.1 34 97.1 68 97.1

Education
a. Diploma (GNM) 35 100 35 100 70 100
Qualification

a. Dependent care units 16 45.7 07 20 23 32.9

Area of working
b. Ambulatory care units 19 54.3 28 80 47 67.1

a. 1-3 Years 10 28.6 07 20 17 24.3

Years of professional
experience
b. ≥ 3 Years 25 71.4 28 80 53 75.7

Duration of back a. 1-2 Years 19 54.3 18 51.4 37 52.9

pain c. ≥2 Years 16 45.7 17 48.6 33 47.1

a. 1 Location 09 25.7 12 34.3 21 30

Location of back
b. 2-3 Locations 18 51.43 21 60 39 55.7
pain
c. > 3 Locations 08 22.86 02 5.7 10 14.3

There is significant mean difference between the pre-test to post-test knowledge and practice scores in
experimental group. p< (0.05) (Table 2)

To find significance of the gain in knowledge and practice scores from pre to post-test, paired ‘t’ test was
computed and the obtained values of ‘t’ (34) = 24.42 and 20.59 were found significant at 0.05 as well as at 0.01
level.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 65

Table 2: Effects of training programme in experimental group. (n=35)

Mean
Variables Mean D SEMD SDD Paired ‘t’ Test
Pretest Pos�est

Knowledge score 11.83 25.14 13.31 0.545 3.22 24.42

Practice score 68.83 115.3 46.47 2.25 13.34 20.59

‘t’ (34) =2.025 p< (0.05) and ‘t’ (34) =2.713 p< (0.01)

The data presented in Table 3 shows that modified practice score of the experimental and control groups
mean gain scores of post-test of knowledge and is 75.0 and 94.4.
practice scores of experimental group are 0.73, and
0.89 which were apparently much higher than that The statistical significance of the difference was
of control group (-0.02, and -0.054). The difference computed and the ‘t’(68) = 17.17 for the knowledge
between the modified mean gain in knowledge and and for practice 28.44 were found highly significant at
0.05 level of significance.

Table 3: Difference in control and experimental group (N=70)

Modified mean
Variables Group Mean D SDD SEMD ‘t’
gain

Experimental group 0.73

Knowledge
Control group -0.02 75.* 3.41 0.82 17.17

Experimental group 0.89

Practice
Control group -0.054 94.4* 7.36 1.76 28.44

Independent ‘t’(68) = 1.996 p < 0.05 number of years of experience more nurses suffer
from back pain. Li�le more than half (52.86%) of
* The modified mean score is multiplied by 100 nurse’s duration of back pain was 1-2 years. These
findings were consistent with the findings of other
DISCUSSION
study [12, 26,18] had back pain occurrence from the last
It was found that out of 263 nurses, 171(62.64%) 12 months. It was found that 55.71% nurses with back
were suffering from back pain. This finding was pain in 2-3 locations. Similar results were found in
consistent with the results of studies [12,13,14,15,16,17,18] a study[1] which showed 42% nurses had back pain
showed a high incidence rate of back pain (87.5%, among multiple site, 35% single site and 23% no
54.7%, 69.%, 70%, 66.8%, 52%, and 76%) among pain.
nurses and nursing personnel, which were rather
The mean post-test knowledge and practice scores
close to the studies in Western countries.
of nurses, who have a�ended Planned Teaching and
Maximum number of nurses were belongs to the Selected Exercise Programme was significantly
age group of 20-30 years and 67(97.14%) of samples higher than their mean pre-test knowledge and
were female. This trends were observed regarding the practice scores (t(34)=24.42, and 20.59, at 0.05 level of
age and gender in other studies [19, 20, 14 ,11,21, 22.] significance).

It was found that 75.71% of nurses had ≥3 years The knowledge and practice modified mean gain
of professional experience. Similar findings were scores of experimental group are 0.732, and 0.89,
observed in studies [6,8,23,13,24,18,25] where most of the and of the control group -0.021, and -0.054, which is
nurses with back pain had >3 year of professional apparently much less than the experimental group.
experience. This indicates that with increasing
66 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Mean gain in post-test knowledge and practice Work Environ Health 1998;24(6)449-464
scores of nurses in experimental group was 6. Cunningham C, Flynn T, Blake C. Low back
significantly high than the control group as evident pain and occupation among Irish health service
‘t’ value of 17.17 with post-test for the knowledge and workers. Occupational Medicine 2006;56(7):447-
for practice 28.44 at df (68) accordingly were found 54
highly significant at 0.05 level of significance.
7. Low back pain in nurses: Investigating causes
These findings were consistent with the findings in order to identify a solution. Available
of other studies1,27 which showed the significant at: h�p://www.qnc.qld.gov.au/research/
reduction in intensity and absenteeism after the research.aspx?Y=2005&RID
educational and exercises programme for the back 8. Edlich RF, Winters KL, Hudson MA, Bri�
pain among nurses. LD, Long WB. Prevention of disabling back
injuries in nurses by the use of mechanical
RECOMMENDATIONS
patient lift systems.1. . J Long Term Eff
Since this study was carried out on a small sample Med Implants. 2004;14(6):521-33
size, the results can be used only as a guide for further 9. Lloyd P, Fletcher, Holmes, et al. The Guide to
studies. the Handling of Patients, 4th edn. National
Back Pain Association/Royal College of
CONCLUSION
Nursing, 1998.
It was concluded that the planned teaching and 10. The Resuscitation Council. Guidance for safer
selected exercise programme is an effective strategy handling during resuscitation in hospital.
which can help nurses to increase their knowledge London: The Resuscitation Council, 2001
and practice regarding prevention and management 11. Neusa Maria C, et.al. Evaluation of a program
of back pain and reduces intensity of back pain. to reduce back pain in nursing personnel. Rev
Acknowledgement: Thanks to Dr Bharti M. for Saúde Pública 2001; 35(4):356-361.
her guidance during this research work. 12. Azize Karahan, Bayraktar N. Determination
of the usage of body mechanics in clinical
Ethical Clearance- Taken from JSS College of se�ing and the occurrence of low back pain in
Nursing nurses. International Journal of Nursing Studies
Source of Funding- Self 2004;41(1):67-75.
13. Shoko Ando, et.al. Association of self estimated
Conflict of Interest - Nil workloads with musculoskeletal symptoms
among hospital nurses. Occupational &
REFERENCES
Environmental Medicine 2000; 57:211-16.
1. Lal A. Understanding Major Pain. 1st edn. New 14. Omokhodion, Umar, Ogunnowo. Prevalence of
Delhi: Jaypee Brothers; 2003. p. 123. low back pain among staff in a rural hospital in
2. Charles B, et al. Concepts of Physical Fitness. Nigeria. Occup. Med. 2000; 50(2):107-10.
11th edn. Mc Graw-Hill; 2003. p. 228 15. Derek R. Smith, NingWei, Li Zhao, Rui-
3. Kilbom A. Repetitive work of the upper ShengWang. Musculoskeletal complaints
extremity, part 11: the scientific basis of the and psychosocial risk factors among Chinese
guide. Int J Ind Ergonomics 1994;14:59-86. hospital nurses. Occupational Medicine 2004;
4. Ando S, Ono Y, Shimaoka M, Hiruta S, Ha�ori 54: 579–82.
Y, Hori F, et.al. Associations of self estimated 16. Derek R. Smith, NingWei, Li Zhao, Rui-
workloads with musculoskeletal symptoms ShengWang. Musculoskeletal complaints
among hospital nurses. Occup Environ Med. and psychosocial risk factors among Chinese
2000 Mar; 57(3)211-16. hospital nurses. Occupational Medicine 2004;
5. Lagerström M, Hansson T, Hagberg M. Work- 54:579–82.
related low-back problems in nursing. Scand J 17. Philip Harber, Elizabeth Billet, Mary Gutowski,
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 67

Karen SooHoo, Myron Lew, Adele Romen. Occup Environ Med April 2003; 60(4):271-78.
Occupational Low-Back Pain in Hospital 22. Evangelos C, Alexopoulos, Alex Burdorf,
Nurses. Journal of Occupational Medicine. Athena Kalokerinou. A Comparative analysis
July1985; 27(7):518-24. on musculoskeletal disorders between Greek
18. Maul I, Laubli T, Klipstein A, Krueger H. Course and Dutch nursing personnel. Int Arch Occup
of low back pain among nurses: a longitudinal Environ Health 2006; 79:82-88.
study across eight years. Occup Environ Med 23. Chiou WK, Wong MK, Lee HY. Epidemiology of
2003; 60(7):497-503. low back pain in Chinese nurses. Int.J.Nurs.Stud.
19. Cunningham C, Flynn T, Blake C. Low back 1994; 31(4):361-36
pain and occupation among Irish health service 24. Robert B, Annalee Yassi, Cooper J. Predictore
workers. Occupational Medicine 2006; 56(7): of Time Loss After Back Injury in Nurses. Spine
447-54 1999; 24(18):1930-36.
20. Burton AK, Symonds TL, Zinzen E, Tillotson 25. Gundewall B, Lijeqvis M, Hansson T. Primary
KM, Caboor D, Van Roy, Clarys JP. Is Prevention of Back Symptoms and Absence
ergonomic intervention alone sufficient to limit from Work. Spine 1993; 18(5):587-94.
musculoskeletal problems in nurses? Occup.
26. Julia S, Peter E, Cyrus C, David C. Prospective
Med. 1997; 47(1):25-32.
cohort study of predictors of incident low back
21. Eriksen W, Bruusgaard D, Knardahl S. Work pain in nurses. BMJ 1997; 314:1225-28.
factors as predictors of sickness absence: a
27. Radisav Stankovic, Olof Johnell. Conservative
three month prospective study of nurses’ aides.
Treatment of Acute Low-Back Pain. Spine 1990;
15(2):120-23.
 DOI Number: 10.5958/0974-9357.2016.00050.7

Cognitive Function among Elderly Residing in

Families versus Old Age Homes

Gishy Vijayakumar1, Elsa Sanatombi Devi2, Preethy Jawahar3

1
Final Year M.Sc. Nursing, 2Professor, Department of Medical Surgical Nursing, Manipal College of Nursing,
Manipal University, Manipal, Udupi, Karnataka, India, 3Senior lecturer, MOSC College of Nursing,
Kolenchery, Ernakulam Dist, Kerala, India

ABSTRACT

Introduction: The demographic transition of the society into aging socities has taken place in the context
of changing family relationships, old age, income which in turn posess variety of social, economical
and health care challenges. Research Objectives: This study was undertaken to assess and compare
the cognitive function of the elderly living in families and old age homes. Material and Methods:
A comprartive study design was utilized in order to recruit 102 (51+51) elderly individuals residing
in families of Udupi and old age homes of Udupi and Mangalore districts. The tools used were
demographic proforma and Mini Mental Status Examination. Results: Findings of the study showed
that there was a significant difference between the two groups (p= .001), with a mean score of 26.57 for
the elderly in families and mean score of 24.20 for those living in the old age homes. Conclusion: The
findings signify that elderly living in old age homes has more cognitive impairment than those residing
in families. Thus it throws light in to the fact that there is an immediate need for checking into the
concern and implementing a strategy which would capacitate the elderly in these se�ings to maintain
their liberty and thus preserve their quality of life.

Keywords: Cognitive function, elderly, old age home, living in family

INTRODUCTION While assessing the life satisfaction of elderly

individuals living in family environment and nursing
The global proportion of people over 60 years homes in Turkey among 240 elderly individuals
of age was 8 per cent in 1950, rose to 11 per cent in residing in three nursing homes found that the mean
2009 and is projected to reach 22 per cent by 2050. scores of life satisfaction of women and men who live
“Globally, the population of older persons is growing in a family environment were higher than the mean
at a rate of 2.6 per cent per year (Gavrilov, 2007). scores of life satisfaction of women and men who
The mature society is thus transforming into aging live in nursing homes (OZER, 2012). In the present
societies, Thus elderly health problems are the major study, cognitive function primarily refers to things
concern of the society since some years. As we all like memory, the ability to learn new information,
know, aging is accompanied by multiple illness and speech, and reading comprehension. Steady decline
physical ailments, out of which aged are more likely in many cognitive processes is seen across the
to be the victims of deteriorating cognitive functions, lifespan, accelerating from the twenties or thirties.
affecting fluid intelligence, working memory capacity The decline or change may be both biological and
etc, affecting the elderly in all areas of living (Rajan, psychological. Therefore the present study aimed
2006). at assessing and comparing the cognitive function
among elderly living in families and old age homes
Corresponding author:
and thus provide data on the cognitive status of the
Dr. Elsa Sanatombi Devi
elderly living in two different se�ing which will
Professor, Department of Medical Surgical Nursing,
highlight the necessity of an interventional strategy
Manipal College Of Nursing, Manipal University,
for this section of vulnerable population.
Manipal, Udupi, Karnataka, India -576104, Mobile:
09739864293, E-Mail: [email protected]
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 69

MATERIALS & METHODS

With prior administrative permission, ethical

clearance and consent from the elderly aged 60 years
and above living in families as well as living in old
age homes of Udupi and Mangalore districts were
recruited using purposive sampling technique. The
sample size calculated was 51 in each group. Elderly
who were bed ridden, not able to perform activities of
daily living (ADL) and who were suffering from any Figure 1: Assess the cognitive function among elderly
mental disorders, paralysis, mental retardation and residing in families and old age homes
chronic illnesses like cancer, AIDS etc were excluded (n=51+ 51=102)
from the study. Using interview technique, the Mini
Data presented in the above figure show that,
Mental Status Examination (MMSE) was used to
90.2% of elderly lving in families had normal
assess the cognitive function which comprised of 5
cognitive function when compared to eldely (66.7%)
areas such as orientation, registration, a�ention &
living in old age home. Mild cognitive impairment
calculation, & recall and language. Maximum score
was seen in 9.8% of lederly in families and 19.6% of
that al elderly could score was 30. Less than 17 scores
the elderly living in old age homes. Severe cognitive
were considered having severe cognitive impairment.
impairment was observed in 13.7% of elderly living
Mild impaired score ranges from 18-23 and those who
in old age home.
scored between 24-30 scores were considered having
no cognitive impairment. DISCUSSION
RESULT AND DISCUSSION The present study findings are supported by
findings of Sethi V, Kritika S who conducted a survey
Findings revealed that majority, 66.7% of the
study which intended to find the effect of changes in
elderly were age between 60-70 years with female
the level of memory in subjects living in community
being majority in both the groups (68.6% & 56.9% in
& old age homes. Findings of the study showed
family and old age homes). All elderly knew to read
that there was a significant difference in between
and write. Majority, 22 (43.1%) of the elderly living
the groups i.e. the mean score of mini-mental state
at home were supported financially by their children
examination was 19.42 with S.D. value 3.522 in group
where as in the old age home, 13 (25.5) of them were
‘a’ living old age home & 22.63 with S.D. value of 2.894
supported by their pension and old age allowances.
in group ‘b’ living in community, p value is 0.000
In regard to history of diseases, 23 (45.1%) of elderly
which declares there is significant difference in Mini-
living at home and 17 (33.3%) living in old age home
Mental Status Examination scores, thus the memory is
reported no diseases. Majority of the elderly, 15
affected more in those from old age homes than those
(29.4%) living in family had hypertension and 16
living in families (Sethi, Kritika,, 2012). Findings of a
(31.4%) of elderly in old age home had hypertension
systematic review on cognitive decline in the general
and diabetes. Joint pain was reported by one elderly at
population (Park, O’Connell, Thomson, 2003) states
home and by two elderly in old age home. Two elderly
that prevalence of cognitive impairment and rate
at home complaint of having asthma and 2 (3.9%)
of decline increases with age. Although cognitive
reported backache, and one elderly living in the old
impairment is universal, neuropsychological test
age home reported having backache. Most, 44 (86.3%)
would help identify the true rate of cognitive decline
& 47 (92.2%) of elderly living at home and old age
so that appropriate diagnosis and management could
homes had no involvement in social organizations or
be incorporated in the clinical management.
club activities that would in fact keep them engaged
and improve their sense of wellbeing. Other supporting findings from a door to door
survey conducted by Tiwari et al in Lucknow, India
among 2283 elderly to identify the prevalence of
neuropsychiatric disorders revealed 7.6% elderly
with cognitive impairment (Tiwari, Rakesh, Aditya,
Kar, Ragini, 2014).
70 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

The present study showed cognitive function in Ethical Clearance– Institutional Ethical
elderly living in old age home is more affected than Commi�ee (IEC) Clearance: 540/2012, (Dated
individuals living with family members. Therefore, 11.12.2012)
it focuses on the fact that certain interventional
strategies need to be implemented for protection REFERENCES
and preservation of the cognitive function of the 1. Gavrilov L A, Heuveline P .Aging
elderly living in old age homes so that it would of Population. The encyclopaedia of
help them lead a self-sufficient life for the growing population.;2007
elderly population. The present study limits to only 2. Park HL, O’Connell JE, Thomson RG. A
elderly living in selected old age homes and also a systematic review of Cognitive decline in the
purposively selected homes of a particular village. general population. Int J Geriatr Psychiatry, 2003
Cultural and psychosocial factors may also play Dec; 18 (2):1121-34
as confounders and as mentioned, generalizability 3. Rajan. S .I. Population and aging in India. The
becomes a concern due to its small sample size. Centre for Enquiry into Health and Allied
However, the findings can serve as a useful tool to Themes (CEHAT), 2006
plan interventions for quality geriatric care across the
4. ÖZER M. A study on the life Satisfaction of
developing countries. Today, the nurse administrator
elderly Individuals living in Family environment
and educator have a major role to play in regard to
And Nursing homes. Biomed Central open
geriatric population management be it at home or
access; 2012 : 33-6
in instutionalized homes. In India 90 percent of
aged people live in unorganized sector, 40 percent 5. Sethi V, Kritika S. Comparison of Cognitive
live below poverty line, 80 percent of people live status of Elderly People Living in Old Age
in rural areas, 55 percent of the people are widows. Home and in Community on MMSE; (2012) 1:
National commission on population 2000, states 107. Available from : h�p://dx.doi.org/10.4172/
that composition of elderly population in India is scientificreports.107
reported and projected to be 8.94% in 2016. In India 6. S. C. Tiwari, Rakesh Kumar Tripathi, Aditya
the aged population i.e. 60 years and older is the Kumar, A. M. Kar,1 Ragini Singh,2 V. K. Kohli,3
second largest in the world (Central statistics office and G. G. Agarwal4 Prevalence of psychiatric
Ministry of Statistics & Programme implementation, morbidity among urban elderlies: Lucknow
Government of India, June 2011). For a country like elderly study. Indian J Psychiatry. 2014 Apr-Jun;
India rising elderly population becomes a challenge 56 (2): 154–160. doi: 10.4103/0019-5545.130496
in terms of elderly pension, health care expenditures, 7. Situation analysis of the elderly in India, June
nutrition, shelter or housing, psychosocial problems 2011. Central statistics office Ministry of statistics
and having no immediate family members to care for & Programme implementation, Government of
with the cognitive impairment. Therefore, it is the India.
need of the hour to pay greater a�ention towards
8. Kumar P, Das A, Rautela U. Mental and Physical
age related issues, and promote holistic approach to
Morbidity in Old age Homes of Lucknow,
geriatric care.
India. Delhi Psychiatry Journal 15(1) 111-117.
CONCLUSION 9. Flicker, Charles, Ferris, Steven H.; Reisberg,
Barry. A longitudinal study of cognitive function
The present study shows that there was a in elderly persons with subjective memory
significant difference between the two groups for complaints. Journal of the American Geriatrics.
the elderly in families and for those living in the Vol 41 (10):1029-1032. Available from: h�p:
old age homes. Future studies can be replicated by //psycnet.apa.org/psycinfo/1994-21052-001. P:
random sampling method with larger coverage and 1029-32
a multicentre study would prove differences in terms
10. Freidl W, Schmidt R, Stronegger WJ, Irmler A,
of elderly issues related to health and wellbeing.
Reinhart B, et al. Mini mental state examination:
Acknowledgement: Nil influence of socio demographic, environmental
Conflict of Interest: No conflict of interest & behavioral factors &vascular risk factors. J
intended Clinical Epidemiology, 1996; 49. P: 73-78.

Source of Funding- Self Financed

 DOI Number: 10.5958/0974-9357.2016.00051.9

Loneliness in Elderly and Non-elderly

Residents of Nursing Homes

Mohammad Heidari1, Mansureh Ghodusi2, Mina Shirvani3

Department of Medical-Surgical, Faculty of Nursing and Midwifery, Shahrekord University of
1

Medical Sciences, Shahrekord, Iran

Iran, 2Faculty Member, Department of Nursing, School of Nursing and Midwifery,
Islamic azad University, Abadeh Branch, Abadeh, Iran, 3Department of Nursing, Borujen Faculty of Nursing,
Shahrekord University of Medical Sciences, Shahrekord, Iran

ABSTRACT

Objective: Aging has become a global phenomenon and a�ention to ma�ers at this stage is a social
necessity. At this age, loneliness as result of lack of social relationships is one of the factors affecting the
mental health of the elderly. The aim of this study is assessment of loneliness and relation with some
demographic factors in elderly and non-elderly residents of nursing homes in Shahrekord city.

Methods: This study is a descriptive cross sectional study. The sample included 100 women and men
over 60 years. Data was collected by the two part questionnaire including demographic factors and
loneliness self-reported questionnaire. Collected data were analyzed with SPSS/16 software.

Results: The results showed that the rate of alone among elderly people in the nursing home is higher
than seniors living in households. According to the results of the independent t-test loneliness among
women elderly living in nursing homes compared with elderly woman was living in the household is
higher.

Conclusion: Living with other family members feel they have a positive impact on the mental health
of the elderly. Thus, according to Iranian orders mental and cultural status, home environment is the
best position to meet the psychological needs. Well as the need for more senior housing authorities in
order to formulate plans to investigate, detect and prevent the phenomenon of loneliness in old people
too is essential

Keywords: Loneliness, Elderly, Nursing homes.

INTRODUCTION With regard to an increase in life expectancy

index in Iran, and based on WHO report, the number
Nowadays, the population over age of sixty is an of Iranian geriatric population can predicted to
almost equal with those under five years of age. The be growing so much that Iran will face serious
geriatric population is estimated to reach over two problems of this group and solving their problems.2
billion people in the world in next 50 years.1 In Iran, Consideration of health promoting behavior and
based on national census of geriatric population over QOL improvement is an important issue, which has
65 years of age in 2006, this age group accounts for been neglected. Therefore, aging and the specific
5.2% of total population and it is predicted to reach condition of the elderly as well as provision of their
19% in 2030. mental and physical health need special a�ention.3
Corresponding author: Improvement of life conditions, health and treatment
Mansureh Ghodusi care, life expectancy and length of life have resulted
Department of Nursing, Islamic Azad University, in the phenomenon of the elderly in societies, which
Abadeh Branch, Young Researchers and Elite Club, needs improvement of health, hygiene, and social,
Abadeh, Iran recreational and rehabilitative promotion strategies
72 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

to enhance their QOL.4 Loneliness is a vast context selected through convenient sampling. They used
among the experts in all age groups, especially in to live with either their families or a nursing home
the elderly due to their physiologic changes, special in Shahrekord and met the inclusion criteria of the
aging conditions and vulnerability.5 Loneliness present study.
seems to be age-dependent as it increases through
Tools loneliness was built in 1386 by Dehshiri and
age in young adults and early adulthood, and
et al, 3 loneliness agent due to family ties, loneliness
reaches its peak in middle age while decreases after
resulting from emotional connect with friends
age of 60 years. Loneliness is a degree of ability for
and symptoms alone is formed. And a total of 38
self-control in having related functions. It refers to
questions with Likert scale of five options is very high
a sort of confidence about doing a certain action
to very low. Loneliness Scale and three subscales it is
the individuals face in a specific situation and
acceptable internal consistency. Cronbach’s alpha for
expectation for certain outcomes.6 Some researchers
the total scale of 0.91, 0.80 in scale resulting from the
and psychologists interpret the general concept of
relationship with family, with friends in scale only
Loneliness as individuals’ beliefs and judgments
by the 0.88 and emotional symptoms subscale alone
about their general capability and ability in facing
was 0.79. The convergent and divergent validity scale
stressful and threatening events or situations.7
by calculating the correlation between the scores of
On the other hand, high Loneliness brings about the UCLA Loneliness Scale and scale Oxford 0.60
feeling of easygoing when facing difficult tasks and and -0.68 reported. Validity through factor analysis
actions.8 Loneliness is of great importance among confirmed.12 Its validity in the present study was
the elderly. Research shows its effect on different measured by content validity in such a way that firstly,
dimensions of elders’ life. The positive association through referring to existing scientific references and
between Loneliness and physical functions has corresponding with authors of international articles
been reported by various studies so that the elders, and through use of the supervisors’ counseling
undergoing Loneliness promotion, had a be�er and statisticians’ indications, the primary draft was
physical function and life satisfaction.9 Elders’ care is prepared. Then, the tools were distributed among ten
among the issues having an impact on provision of academic members in nursing and midwifery school
their physical and mental needs. It should be noted of Shahrekord University of Medical Sciences. Next,
that Loneliness and self-care are lower among the after modification, the final tool was given to the
elders residing in a nursing home due to absence of supervisors and the counselors again. In the present
a close relationship and feeling of more Loneliness, study, Cronbach alpha was calculated for reliability.
compared to those living with their family members.10 The researcher distributed the questionnaires among
Despite the growth of geriatric population and 30 elders after referring to research environment,
changes of population pyramid in Iran, the needs and after collection of the questionnaires, calculated
of this vulnerable group have not been focused.11 Cronbach alpha of 0.9 through SPSS version 16.
As urban and rural various districts are culturally
The inclusion criteria were residing in the nursing
different, individuals’ psychological dimensions and
home for at least six sequential months (in case the
Loneliness can be influenced by cultural conflicts and
subject was residing in a nursing home), age equal
seem different.
or over 60 years, and no diagnosed acute or chronic
The present study aimed to investigate Loneliness disabling physical and mental diseases (blindness,
in the elderly residing in a nursing home and those deafness and cognitive disorders). The subjects had
living with their families in Shahrekord. identical counterparts in control group concerning
age, sex and residing location. To select the elders,
METHODS living with their families, the researcher referred
This is a cross- sectional comparative study to health care centers and extracted the related list
investigated Loneliness in the elderly residing in a from their medical records. To conduct sampling,
nursing home and those living with their families in the elders would refer to census centers and obtain
Shahrekord in 2014. Study population comprised 100 the related information. After selection of the
female and male elders over age of 60 years who were qualified subjects, the researcher introduced herself
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 73

to them and explained about the goal of study. After Table 1. Frequency distribution of demographic
a�aining their wri�en consent and assuring them characteristics of the elders’ in two groups
about the confidentiality of their information, the
questionnaires were distributed among the subjects. Frequency
Frequency
The researcher read out the questions to the subjects of the elders’
of the
elders’
and recorded the subjects’ responses word by word. residing
living with
Variable
in nursing
Sampling went on for about three months to complete home (%)
their family
(%)
the sample size. Data were analyzed by inferential
statistical tests through SPSS version 16. Descriptive
Male
statistical method was adopted to design tables. (20) 10 (20) 10 Sex
Female
(80) 40 (80) 40
RESULTS

Results showed that most of the subjects in (16) 8

(22) 11 60-69
both groups were 40 female subjects (80%). Mean (46) 23
(46) 23 70-80 Age
age of the subjects living with their families and in (38) 19
(32) 16 >80
the nursing home were 75.58 (8.22) and 77.78 (7.93)
years respectively. With regard to residing location,
31 subjects (62%) lived in urban and 19 (38%) in rural (26) 13 (42) 22 Married
areas. Demographic characteristics of the subjects (12) 6 0 Single
Marital status
(8) 4 (2)1 Divorced
have been presented in table 1. Mean and SD of
(54) 27 (56) 28 Widowed
Loneliness scores among those subjects living with
their families and those in nursing home were 51.76
(11.48) and 48.44 (5.26) respectively. Comparison of
Loneliness in two groups of elders showed that mean Illiterate
(96) 48 (86) 43 Under Education
Loneliness score was higher among the subjects living (2) 1 (12) 6 diploma
with their families, compared to those living in the (2) 1 19 (3) High school
nursing home. diploma
(62) 31 (2) 1 Residential
Independent t-test showed a significant difference (38) 18 (62) 31 Urban area location
in Loneliness scores between two groups (p<0.001). Rural area

Comparison of two main variables of the study

showed that women had high Loneliness. There was
an association between Loneliness and employment Home
(28) 24
(56) 28 maker
status and being satisfied with the family members (0) 0
Retired
Employment
(14) 7 status
in this group of elders. Independent t-test showed a (70) 35
(18) 8 Disabled
(2) 1
significant difference between Loneliness scores and (12) 6 Jobless
subjects’ gender and residential location in such way (40) 20
(54) 27 Yes
that those subjects, who used to live in rural areas (30) 15 Satisfaction
(18) 9 No with the family
and were residing in the nursing home at the time of (30) 15
Somehow members
(28) 14
the study, had a higher Loneliness. There was also a
significant association between self- efficacy, and age Satisfaction
(50) 25 with nursing
group and satisfaction with the nursing home (Table Yes
(6) 12 home
------- No
2). (38) 19
Somehow
74 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Table 2. Association of Loneliness with some Meanwhile, in studies of Torki et al and Callaghan
baseline variables et al, Loneliness was reported more among men.12,15
The results of the present study showed a significant
ANOVA and
ANOVA and
association between Loneliness and occupational
Loneliness independent
independent t- status of the elders living with their families. It also
t-test in the
test in the elders showed that the lowest score of Loneliness belonged
elders living
residing in
with their to the jobless subjects and the highest to those who
nursing home
families were either retired or a homemaker (p<0.05). This
T=0.599 T=1.181 finding is in line with that of Lam et al and Steinke
Sex et al.8,16 Individuals are involved in self blame due to
P<0.001 P=0.035
not having an appropriate job, which results in their
Employment F=1.881
-------- lower Loneliness.17 Our obtained results revealed a
status P=0.046
significant association between Loneliness with being
Satisfaction
satisfied with the family among the elders living with
with the family --------
members F=11.988 their families. Paul and Bradley obtained consistent
P<0.001 results with the present study, while Callaghan et al
Age group a�ained contrary results.15,18
F=1.539
------
P=0.025
Bradley and Paul stated that not being satisfied
Residing with the family, Loneliness and isolation affect
T=2.161
location ------- interpersonal communications and influence
P=0.041
Loneliness.18 Self- efficacy had a significant association
F=1.435 with age, residential location and satisfaction with
Satisfaction ------- nursing home among the elders residing in a nursing
with nursing P=0.48
home home, which is in line with the studies of Casper et
al and Liu et al.10,19 Meanwhile, Steinke et al found
DISCUSSION controversial results.16 In the present study, the elders
who used to live in rural areas and were residing in
Our findings, showed a minor significant increase
the nursing home at the time of study had a higher
in Loneliness score of the elders residing in the
Loneliness Morgan believes that the people living
nursing home, compared to those living with their
in a village have a be�er ability of overcoming their
families. Torki et al, in a study on general Loneliness
life, can make decisions more conveniently and take
of the elderly residing in a nursing home in Tehran,
risk of selection. So, when they are taken to a nursing
obtained results, consistent with the present study.12
home, they can go on with everyday life resulted from
There are several factors affecting the reduction of
their previous personality features.20 The elders with
elders’ Loneliness, which should be considered.
a higher age had higher Loneliness in the nursing
Deprivation from the family can be one of these
home. Research shows that the elders at lower ages
factors. Mc Dougall believes that higher Loneliness
evaluate themselves disable and inactive in relation
among the elders living with their family may be
with nursing home environment and feel dull and
due to the social support that helps them cope with
lonely, and consequently, have a lower Loneliness.
their reduced physical and psychological function
be�er.13 The environment, in which the elders living CONCLUSION
with their family are in, facilitates their needed social
communications and interaction and not only helps As mean Loneliness score of the elders, living in a
them detect their abilities but preserve their Loneliness nursing home, was lower, and there was a significant
as well. Our findings also showed the significant difference in mean scores of Loneliness in the elders
effect of gender on subjects’ Loneliness in both living with their families and those residing in a
group of elders. Loneliness mean score was higher nursing home, nursing homes authorities should pay
among female subjects, compared to males (p<0.001, close a�ention to the elders’ needs, public education
p=0.035). Change et al also obtained similar results.14 and prevailing the culture of taking care of the elderly
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 75

in the family unit. Therefore, all organizations aiming Related to Changes in Dynamic Gait Ability.
at having healthy elders and society should take a American Journal of Occupational Therapy.
step toward achieving their goal through planning 2010; 90(11): 1598-1606.
education and conduct counseling with the families 8. Lam S, Tracz S, Lucey Ch. Age, Gender,
with elders. and Ethnicity of Counselor Trainees and
Declaration: The authors declared no conflict of Corresponding Counseling Loneliness:
interests in this study. Research Findings and Implications for
Counselor Educators. International Journal for
Acknowledgement: This study was derived the Advancement of Counseling. 2012; 70(2):
from a research project approved by Shahrekord 562-573.
University of Medical Sciences (No 1482 and Ethics
9. Dougall M, Graham J. Memory Loneliness and
commi�ee code of 1392-6-9). We greatly appreciate
Memory Performance among Black and White
vice chancellery for research and technology in
Elders. 2005; 53(5): 323-331.
Sharekord University of Medical Sciences as well as
all nursing homes in Charmahal province and the 10. Liu, LJ, Guo Q. Loneliness and health-related
families who helped us with this research. quality of life for the empty nest elderly in the
rural area of a mountainous county in China.
REFERENCES Qual life res. 2007; 16(8): 1275- 80.

1. Caspar S, Rourke N. The Influence of Care 11. Kobalava P, Kotovskaya Y, Moiseev V. Efficacy
Provider Access to Structural Empowerment and Acceptability of Indapamide Sustained
on Individualized Care in Long-Term-Care Release in Elderly High-Risk Hypertensive
Facilities. American J of Physical Medicine & Patients. Annals of Behavioral Medicine. 2008;
Rehabilitation. 2008;25(2):46-53. 15(4): 275-282.

2. Jing K, Janissa N, Gladys Li, Chieh W. Nintendo 12. Sheybani F, Pakdaman SH, Dadkhah A,
Wii as an intervention: improving the well- Hasanzadeh M. Influence Music therapy on
being of elderly in long-term care facilities. J depression and loneliness in elders. J elderly in
Aging Health. 2009;90(12):34-60. Iran. 2010; 5(16): 54-60.

3. Prieto-Flores M, Mayoralas G, Forjaz M, 13. McDougall G, Montgomery K, Eddy N,

Rojo-Perez F, Martinez-Martin F. Residential Jackson E, Nelson E, Stark T, Thomsen C.
satisfaction, sense of belonging and loneliness Aging memory Loneliness: Elders share their
among older adults living in the community thoughts and experience. Geriatric Nursing.
and in care facilities. J Aging Health. 2011;17(6): 2007; 24(3): 162-168.
1183-1190. 14. Chang Su, Crogan N, Wung Sh. The Self-Care
4. Kong F, You X. Loneliness and Self-Esteem as Loneliness Enhancement Program for Chinese
Mediators between Social Support and Life Nursing Home Elders. 2007; 28(1): 31-36.
Satisfaction in Late Adolescence. International 15. Callaghan D. Healthy Behaviors, Loneliness,
J of Geriatric Psychiatry. 2013;110(1):271-279. Self-Care, and Basic Conditioning Factors in
5. Pe�igrew S, Roberts M. Addressing loneliness Older Adults. Journal of Community Health
in later life. Aging & Mental Health. 2008;12(3): Nursing. 2010; 22(3): 169-178.
302-309. 16. Steinke E, Wright D, Chung M, Moser D. Sexual
6. Bekhet A, Zauszniewski J. Mental Health self-concept, anxiety, and Loneliness predict
of Elders in Retirement Communities: Is sexual activity in heart failure and healthy
Loneliness a Key Factor? Archives of Psychiatric elders. The Journal of Acute and Critical Care.
Nursing. 2012; 26(3): 214-224. 2008; 37(5): 323-333.

7. Bishop M, Pa�erson T, Romero S, Light K. 17. Hemati Gh, Dehshiry Gh, Shijaei S, Hakimi E.
Improved Fall-Related Efficacy in Older Adults Comparative Loneliness and general health
76 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

in elders with family and residential care in 19. Caspar S, Rourke N. The Influence of Care
North on Tehran. .J elderly in Iran. 2009; 8(3): Provider Access to Structural Empowerment
557-564. on Individualized Care in Long-Term-Care
18. Paul D, Bradley J. Cardinal. Erratum to: Facilities. American Journal of Physical
Loneliness mediates the relationship between Medicine & Rehabilitation. 2008; 25(2): 46-53.
behavioral processes of change and physical 20. Morgan A, Levi N, Bernie C. Increasing
activity in older breast cancer survivors. Breast Loneliness–the effectiveness of a pain
Cancer. 2013; 20(1): 53-60. management programmed for children and
parents. Pediatric Rheumatology. 2011; 9(1): 14-
18.
 DOI Number: 10.5958/0974-9357.2016.00052.0

Quality of Life of Adolescents Studying in

Schools in Kerala

Cicily Joseph1, Chellarani Vijayakumar2

1
Associate Professor, Dept. of Community Health Nursing, Mar Baselios College of Nursing, Kothamangalam,
2
Former Professor and Dean, College of Nursing, Christian Medical College, Vellore

ABSTRACT

The main objective of the study was to assess the quality of life of adolescents studying in schools. The
study assesses the quality of life of adolescents studying in schools in Kothamangalam taluk in Kerala.
The research design was descriptive in nature. 128 adolescents who a�end 6th to 12th class formed the
sample. Quality of life was measured using the KIDSCREEN-52. Result represent that level of mean
score was high in social support(24.21) and parent relations(23.71). Least mean score was found in
social acceptance and bullying (5.79). The findings of the study suggest the ways to improve the quality
of life of adolescents by reducing bullying in schools, family and community.

Keywords: Quality of life, adolescents.

INTRODUCTION reported to be a useful tool to characterize the global

Adolescence is a very significant and vital stage burden of the disease4. A study conducted among
in the development of human being. Most of the the physically disabled shows that majority of the
physiological, psychological, and social changes disabled are having average quality of life. There
within the person take place during this stage of life is below average Psychological and environmental
1
. The period of adolescence can be looked upon as quality of life with disabled adolescents. The findings
a time of more struggle and turmoil than their early of the study suggest the ways to improve the quality of
days. Rapid physical and emotional growth, as well life of adolescents by reducing social, environmental
as the frequently conflicting and influential cultural barriers to promote integration of adolescents with
messages they receive from the outside world, account disabilities in schools, family and community5.
for the unique nature of their health concerns. Adolescence is a period of transition and
The World Health Organization has stated that experimentation, which necessitates Health-
‘the health of young people is significant for the well- Related Quality of Life studies to inform priorities
being of this age group and also for future public in adolescent health. A cross-sectional study was
health’2.. The perception of adolescents towards conducted among adolescents in February 2010 using
quality of life is due to many factors like physical, WHOQOL-BREF scale showed that score was lowest
psychological, environmental and social relationship for environment domain (63.5 [17.5]) and highest for
etc. social domain (77.3 [22.8]) 6. Adolescents face health
challenges that pediatric and adult physicians alike
Quality of life is an important subjective measure are often ill-equipped to handle. Rapid physical and
of one’s wellbeing.Quality of life includes several emotional growth, as well as the frequently conflicting
domains of subjective experience including physical and influential cultural messages they receive from
ability, psychological well-being, social interactions the outside world, account for the unique nature
and school or work performance3. Assessment of of their health concerns. Without proper education
health-related quality of life of healthy children, as and support, adolescents lack the knowledge and
well as children with cancer, asthma, cystic fibrosis, confidence to make decisions 7. Quality of life has
chronic headache, arthritis and obesity has been become an important concept in evaluating health
78 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

care, in both child and adolescent populations. As Sample and sample size
nurses concerned with quality of life and well-being, The sample size was 128. The sampling technique
it is important for us to identify the main factors was convenient sampling.
that contribute to the promotion and sustenance of
Selection criteria
adolescent’s well-being.
Samples were selected based on the following
Research problem
criteria.
A descriptive study to assess the health
Inclusion: Adolescents (12-17 years), female and
related quality of life of adolescents in a selected
male
community.
Exclusion: Parent/ adolescent refused to
Objectives of the study:
participate in the study.
• Assess the quality of life of adolescents.
Tools and technique
• Find out the association between quality
Section A - Demographic variables of
of life of adolescents with selected demographic
adolescents.
variables.
Section B - KIDSCREEN- 52 8 a standardized
METHODOLOGY
scale to assess the Quality of life. The scale assess
Research approach and design the quality of life in the 10 domains like physical,
Quantitative descriptive survey approach was psychological, home life, social relations, school
used. The study used a descriptive design to describe environment and financial ma�ers of adolescents. It
quality of life of adolescents who a�ends school. had a total of 52 questions.
Se�ing of the study Data collection procedure
The study was conducted among the adolescents Ethical approval was received from the
in a selected urban community. The community is institutional ethical commi�ee. Consent was obtained
located 3 km away from Kothamangalam Taluk. from parent and adolescents. The data was collected
Population by house to house survey. The purpose of the study
was explained to the adolescents and data was
The population of the study includes all school-
collected individually by using the questionnaire.
going children, male and female, aged 12-17 years.

Data Analysis
The collected data were analyzed and done the percentage analysis constructed in SPSS.

RESULTS OF THE STUDY

Table 1: Socio-demographic variables of the samples n=128

Frequency Percentage
S.no. Socio-demographic variables Categories
(f)) (%)
12 05 03.1
13 16 12.5
14 22 17.2
15 33 25.8
16 19 14.8
17 33 25.8
Urban 89 69.5
Location of school
Rural 39 30.5
Male 48 37.5
Gender
Female 80 62.5
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 79

Cont... Table 1: Socio-demographic variables of the samples n=128

Hindu 34 26.6
Religion Muslim 11 08.6
Christian 83 64.8
Nuclear 105 82
Family type
Joint 23 18
6 th class 01 00.8
7 th class 04 03.1
8 class
th
16 12.5
Educational level 9th class 22 17.2
10th class 33 25.8
11 class
th
19 14.8
12 class
th
33 25.8
Coolie 33 25.8
Agriculture 32 25
Health worker 08 06.3
Employment status of the father
Teacher 07 05.5
Govt .employee 07 05.5
Private employee 27 21.1
Others 14 10.9
Unemployed 68 53.1
Coolie 20 15.6
Agriculture 08 03.9
Health worker 05 03.9
Employment status of the mother Teacher 09 07
Govt .employee 01 00.8

Private employee 13 10.2

Others 04 03.1

Table 1 depicts that majority of the adolescents were females (62.5%). Majority of the adolescents (25.8%)
were in the age group of 15 & 17 years. Majority of the respondents were studying in schools located in urban
area 89 (69.5(%) and only 39 (30.5%) studying in rural school.

Table2: Distribution of samples according toperception of quality of life in different domains

n=128
S no. Domains of quality of life Mean Sd
1 Physical wellbeing 16.66 4.22
2 Psychological well being 21.13 5.43
3 Moods and emotions 11.60 4.06
4 Self perception 13.58 3.22
5 Autonomy 15.46 4.45
6 Parent relations and home life 23.71 4.58
7 Social support and peers 24.21 4.67
8 School environment 23.24 5.36
9 Social acceptance and bullying 05.34 2.53
10 Financial resources 08.90 3.46
Over all 163.88 22.29
80 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Mean knowledge score was highest in social support (24.21) and parent relations(23.71). Least mean score
was found in social acceptance and bullying (5.79)

Table 3: Mean scores of quality of life with gender n=128

Male Female
S no. Domains of quality of life
Mean

1 Physical wellbeing 17.75 16

2 Psychological well being 21 21.23

3 Moods and emotions 12 11.36

4 Self perception 14.04 13.31

5 Autonomy 16.58 14.83

6 Parent relations and home life 23.27 23.93

7 Social support and peers 24.97 23.81

8 School environment 21.68 24.18

9 Social acceptance and bullying 05.79 5.08

10 Financial resources 08.85 8.91

Over all 165.95 162.70

Table 3 represents the quality of life of adolescent in different genders. When compared to female(163)
male(166) enjoys be�er quality of life.

Table 4: Association between the quality of life of adolescents and selected demographic variables
n=128

No Socio-demographic variables Test value p-value

1 Age 0.01 0.96
2 Location of school 1.23 0.22
3 Gender 0.08 0.43
4 Religion 0.84 0.43
5 Family type 0.02 0.99
6 Educational level 0.55 0.77
7 Employment status of the father 1.20 0.31
8 Employment status of the mother 1.03 0.41

Statistically no significant association was not able to identify between socio demographic variables.

RESULTS AND DISCUSSION

The respondents include 48 males (37.5%) and 80 females (62.5%). Majority of the respondents were
studying in schools located in urban area 89 (69.5(%) domains represent that level of mean score was high
and only 39 (30.5%) studying in rural school. in social support(24.21) and parent relations(23.71).
Least mean score was found in social acceptance and
Table 2 elicits the quality of lifein different
bullying (5.79). Table 3 represents the quality of life
domains of an individual’s life. The various domains
of adolescent in different genders.When compared
assess the experiences in quality of life at their home,
to female(163) male(166) enjoys be�er quality of life.
school and environment. The findings in the various
Statistically no significant association was not able to
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 81

identify between socio demographic variables. The of Applied Psychology, 2007; 33 (1): 31-38.
finding clearly shows the need for more intervention 2. WHO, The Health of Young People: A
among adolescentsto improves their quality of life to Challenge and a Promise. Geneva: World Health
a�ain high quality of life in physical, psychological, Organization,1993.
social and environmental domains. The family,
3. Naughton MJ, & Shumaker SA. The case
school and the community as a whole need to go
for domains of function in quality of life
hand in hand to ensure a high quality of life for the
assessment. Qual Life Res 2003; 12: 73–80.
adolescents.
www.ncbi.nlm.nih.gov/pubmed/
SUMMARY & CONCLUSION 4. Sawyer MG, Reynolds KE, Couper JJ, French
DJ, Kennedy D & Martin J et al.. Health-related
The study was limited to128 samples in a selected
quality of life of children and adolescents with
urban community and the adolescents available at
chronic illness – a two year prospective study.
the time of data collection. Knowledge about the
QualLifeRes 2004; 13:1309
factors most significant to adolescents’ quality of
life is applicable to all clinical se�ings where nurses 5. Seena,Abraham. International research journal of
meet adolescents; i.e., hospitals, outpatient clinics and social sciences,2013;l 2(25),1-5
school health services. 6. Aswathi, s. K. Agnihotri, H. Chandra, U. Singh,
S. Thakur. Assessment of Health-Related Quality
In summary, adolescents showed be�er quality of
of Life in school-going adolescents: Validation
life in majority of the domains except social acceptance
of pedsql instrument and comparison with
and bullying. Investigator believe that programs
WHOQOL-BREF. The National Medical Journal
aimed at improving quality of life should be directed
of India,2012; 25(2).
to community also to have be�er understanding in
defining approaches to the management of adolescent 7. World Health Organization (WHO) meeting
problems. report, Caring for children and adolescents
with mental illness, se�ing WHO directions,
Acknowledgement –Nil Geneva 2003; 1-4.

Source of Funding- Self 8. Kidscreen-52.org.www.Kidscreen.org/English/

questionnaires/kidscreen-52-longversion.
Conflict of Interest – Nil

REFERENCES

1. Neerpal, Rathi, & Reni Rastogi. Meaning in Life

and Psychological Well-Being in Pre-Adolescents
and Adolescents, Journal of the Indian Academy
 DOI Number: 10.5958/0974-9357.2016.00053.2

Effectiveness of Structured Teaching Programme

on Knowledge Regarding Prevention and First Aid
Management of Insects Bite in Children among the
Primary School Teachers of Mysore, Karnataka

Sandeep K Raju
Assistant Professor, Teerthanker Mahaveer College of Nursing, Teerthanker Mahaveer University, Moradabad, UP

ABSTRACT

Background of the Study: Insect’s bites and stings are very common in children, especially during the
spring and summer months. Knowing how to prevent and treat common Insects bites and stings, and
knowing when to not overreact, can help keep the kids safe and healthy. The investigator felt the need
to conduct a study on Prevention and first aid management of Insects bite in children as it is assumed
that school teachers spend most of their time with children in schools next to parents.

Aim: The main objective of the study was to assess the knowledge regarding prevention and first aid
management of insect bite among primary school teachers using structured questionnaires before and
after administration of structured teaching programme

Materials and Methods: Pre-experimental with single group pre-test post-test design was adapted .The
study was conducted at primary school in Mysore district.60 primary teachers selected as a sample for
the study .Simple random sampling method was used for the selection of samples. The tool designed
to collect the data were sociodemographic Performa, structured knowledge questionnaire.

Results: Collected data was analyzed by using descriptive and inferential statistics. the study revealed
that 6.7% primary school teachers had poor knowledge , 80% of primary school teachers had average
knowledge ,13.3% primary school teachers had good knowledge and school none of them had
very good knowledge in pre-test, whereas in post-test 65% primary school teachers had very good
knowledge and 35% primary teachers had average knowledge.

Conclusion: Structured teaching programme prevention and first aid management of insect bite was
effective in enhancing the knowledge of primary school teachers.

Keywords: Effectiveness, STP, knowledge, insect bite, prevention, first aid management

INTRODUCTION being of your kid comprises of physical, mental and

social well-being. Children can become seriously
Children are the blessings for today and promises ill and any sort of infection may be dangerous, so
for the days to come! The body of children is the most don’t take chances because illness at this age requires
super sensitive, delicate and susceptible form which immediate a�ention.
can be easily be harmed if not taken care of. Well
Highly effective and often “low-tech” solutions,
Corresponding author: as well as improvements in health delivery systems,
Sandeep K Raju have enabled rapid declines in child mortality to
Teerthanker Mahaveer College of Nursing, occur, even in developing countries.
Teerthanker Mahaveer University, Moradabad
Since children playing outdoors are often bi�en
Email Id : [email protected]
or stung by Insects, when children are outside and
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 83

no ma�er what they are doing, it is important for ii. Knowledge of Primary school teachers
them to be protected. Knowing how to prevent and regarding Prevention and first aid management of
treat common Insects bites and stings, and knowing Insects bite in children.
when to not overreact, can help keep your kids safe
4. SETTING
and healthy.
The se�ings selected for the study is Selected
The symptoms that can be caused by Insects
Primary schools of Mysore
bites depend on the type of Insects and how sensitive
you are to it. Symptoms can vary from mild swelling, 5. POPULATION:
pain, itchiness and redness to large blisters or life
threatening anaphylactic reactions PRIMARY SCHOOL TEACHERS OF SELECTED
PRIMARY SCHOOLS AT MYSORE
First aid is the provision of initial care for an
illness or injury. It is usually performed by a non- 6. SAMPLE
expert person to a sick or injured person until
Primary school teachers, those who fulfil the
definitive medical treatment can be accessed.
inclusion criteria.
Certain self-limiting illnesses or minor injuries may
not require further medical care past the first aid 7. SAMPLE SIZE
intervention. It generally consists of a series of simple
and in some cases, potentially life-saving techniques Total sample size is 60 Primary school teachers
that an individual can be trained to perform with 8. SAMPLING TECHNIQUE
minimal equipment.4
Convenient sampling technique {Non-Probable
“Stay Safe! “ Sampling} will be used.
“Follow universal precautions and METHOD OF DATA COLLECTION
“Wear personal protective equipment if you have The study was done from AUGUST to
it. SEPTEMBER months. The subjects where explained
Keeping the same as the reference, the present about the purpose of the study. Consent was taken
study was planned to assess the knowledge level of from each subject for assessing knowledge in insect
the school teachers regarding prevention and first aid bite
management of Insects bite in children Data was collected through structured
RESEARCH METHODOLOGY questionnaire.

1. RESEARCH APPROACH - Pre Experimental PLAN FOR DATA ANALYSIS

approach 1. Descriptive statistics used to analyze the
2. RESEARCH DESIGN - One group pre-test variable and level of knowledge.
post-test design

3. VARIABLES:

Independent variable-

i. STP on Prevention and first aid management

of Insects bite in children.

Dependent variable-
84 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

2. Inferential statistics used to analyze and find out the association and D.V with knowledge Score

RESULTS AND DISCUSSION

SECTION I:-DESCRIPTION OF SAMPLE CHARACTERISTICS.
Table No:1 N=60
Demographic variables No.of teachers Percentage
20-25 Years 12 20.0%
26-30 Years 33 55.0%
Age 31-34 Years 0 0%
35-40 Years 12 20.0%
>40 Years 3 5.0%
Male 28 46.7%
Gender
Female 32 53.3%
Hindu 24 40.0%
Religion Christian 6 10.0%
Muslim 30 50.0%
General degree 6 10.0%
Educational Qualification Diploma 43 71.7%
B.Ed 11 18.3%
Unmarried 14 23.3%
Marital Status
Married 46 76.7%
0-4 Years 16 26.7%
5-8 Years 30 50.0%
Experience
9-12 Years 12 20.0%
>12 Years 2 3.3%
Vegetarian 16 26.7%
Type of Diet
Mixed 44 73.3%
Urban 18 30.0%
Area of Residence Semi urban 32 53.3%
Rural 10 16.7%
Family members / 6 10.0%
Friends
Source of Information Colleagues 28 46.7%
Mass media 24 40.0%
Health professional 2 3.3%
Previous information on Yes 28 46.7%
First aid No 32 53.3%

The majority of Primary School Teachers 55% Knowledge assessment on insect bite revealed
were in the age of 26-30 years,53.3% were females, that 6.7% primary school teachers had poor
76.7% were married, 50% of Primary School Teachers knowledge, 80% of primary school teachers had
belongs to 5 to 8 years experience,53.3%were belongs average knowledge, 13.3% primary school teachers
to semi urban area and 53.3% were did not have had good knowledge and school none of them had
previous information on first aid, 46.7% were got very good knowledge in pre-test, whereas in post-
information on insect bite from colleagues. test 65% primary school teachers had very good
knowledge and 35% primary teachers had average
Section II: ASSESSMENT OF KNOWLEDGE

Assessment of knowledge of Primary School

Teachers regarding prevention and first aid
management of insect bite.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 85

Section III:- COMPARISON OF OVERALL KNOWLEDGE

The mean post test score 24.18% was higher than the mean pre-test score knowledge score of 13.52%.
Table:2
Percentage differences in
Mean differences in knowledge with
Max score Mean score knowledge with 95% confidence
95% confidence interval
interval
Pre-test 30 13.52 10.66 35.50%

Post-test 30 24.18 (10.14-11.20) (33.8%-37.3%

*significant at p<0.05** highly significant at p<0.01***** very high significant at p<0.001

SECTION IV:- REFERENCES

ASSOCIATE THE DEMOGRAPHIC VARIABLES 1. Kid’s Health [Online]. Available from: URL:h�p:
WITH KNOWLEDGE REGARDING PREVENTION //health.indiamart.com/kidshealth/
OF INSECT BITE. 2. The Importance of Child Health
[Online]. Available from: URL:h�p://
Among the demographic variables age,
www.globalhealth.org/childhealth
educational qualification, experience, previous
information were significant with the knowledge 3. Vincent I. Insect Bites and Stings. July 05,
score. 2010.About.com Health’s Disease and
Condition content is reviewed by the Medical
Over all, it shows that Structured Teaching Review Board. Available from: URL:h�p://
Programme was very effective to improve the pediatrics.about.com/cs/safetyfirstaid/a/dnt_lt_
knowledge level of Primary School Teachers and it bugs_bte_3.htm
can reflect on their school children practice.
4. First aid [Online]. Available from: URL:h�p:
RECOMMENDATION AND SUGGESTIONS //en.wikipedia.org/wiki/First_aid
5. Rod Brouhard. How To Treat Common
1. A survey can be conducted to estimate the
Bug Bites. January 30, 2009. About.com Health’s
insect bite rates and factors influencing in promotion
Disease and Condition content is reviewed by
of prevention and first aid management of insect bite
our Medical Review Board. Available from:
in children.
URL:h�p://firstaid.about.com/od/bitesstings/ht/
2. A descriptive study can be conducted to assess 06_bugbites.htm
the knowledge of the teachers and community people 6. Vincent I. Don’t Let the Bugs Bite . July 05,
regarding prevention and first aid management of 2010.2010. About.com Health’s Disease and
insect bite in children. Condition content is reviewed by the Medical
Review Board. Available from: URL:h�p://
3. A similar study with a larger sample
pediatrics.about.com/cs/safetyfirstaid/a/dnt_lt_
Acknowledgement: I wish to acknowledge my bugs_bte_3.htm
guide Mrs.Kavimani for her dedication in motivating 7. Burns BO, Kavon C, Azadi MD. Oct
and encouraging me. 13, 2009. Available from: URL:h�p:
//emedicine.medscape.com/article/769067-
Ethical Clearance: Approval for the study was
overview Insect Bites
gained from college duration ethical commi�ee on
august 2011 8. Insect or Spider Bites and Stings. Available from:
URL:h�p://www.mdguidelines.com/insect-or-
Sources of Funding: - Self spider-bites-and-stings

Conflict of Interest: - None 9. Spider bite 25 November 2010. Available from:

URL:http://en.wikipedia.org/wiki/Spider_
86 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

biteAustralia incorporated long-lasting Insecticidal ne�ing,

10. Bee and insect stings. Pediatric Dental Health. against Anopheles minimus-transmi�ed malaria
August 17, 2002. Available from: URL:h�p: in Assam, Northeastern India. Vector Borne
//dentalresource.org/topic43stings.htm Zoonotic Dis. 2010 May;10(4):403-10.

11. Namdev R, Du�a SR, Singh H. 18. LaBeaud AD, Glinka A, Kippes C, King CH.
Acute immune thrombocytopenic School-based health promotion for mosquito-
purpura triggered byinsectbite. 2009 borne disease prevention in children. J Pediatr.
Volume: 27 Available from: URL: 2009 Oct;155(4):590-2.Available from: URL: h�p:
h�p://www.jisppd.com/article.asp?issn=097043 //www.ncbi.nlm.nih.gov/pubmed/19773005
88;year=2009;volume=27;issue=1;spage=58;epag 19. Bilò BM, Bonifazi F. Epidemiology of Insects-
e=61;aulast=Namdev venom anaphylaxis. Curr Opin Allergy Clin
12. Honnungar, Ravindra S, Kumar, Lavlesh, Immunol. 2008 Aug;8(4):330-7.
She�y, Ashok K et al. A study of paediatric 20. Başer M, Coban S, Taşci S, Sungur G, Bayat M.
poisoning cases at District Hospital Belgaum, Evaluating first-aid knowledge and a�itudes of
Karnataka. . Available from: URLh�p:// a sample of Turkish primary school teachers.
www.indianjournals.com/ijor.aspx?target=ijor: J Emerg Nurs. 2007 Oct;33(5):428-32. Epub
mlu&volume=10&issue=1&article=016 2007 Aug 8. Available from: URL: h�p://
13. Fornadel CM, Dev V, Raghavendra K, Barman www.ncbi.nlm.nih.gov/pubmed/17884471
PA, Samb B, Doucoure S et al. First a�empt to 21. Michael E, Ramaiah KD, Hoti SL, Barker G, Paul
validate the gSG6-P1 salivary peptide as an MR Quantifying mosquito biting pa�erns on
immuno-epidemiological tool for evaluating humans by DNA fingerprinting of blood meals.
human exposure to Anopheles funestus bites. Am J Trop Med Hyg. 2007 Dec;65(6):722-8.
Trop Med Int Health. 2010 Oct; 15(10):1198- 22. Inskip H, Campbell L, Godfrey K, Coggon
203. doi: 10.1111/j.1365-3156.2010.02611.x. D. A survey of the prevalence of biting
Epub 2010 Aug 17. Available from: URL: h�p: by the Blandford fly. Br J Dermatol.
//www.ncbi.nlm.nih.gov/pubmed/20723184 2007Apr;134(4):696-9. Available from: URL:h�p:
14. Reithinger R, Mohsen M, Leslie T. Risk factors //onlinelibrary.wiley.com/doi/10.1111/j.1365-
for anthroponotic cutaneous Leishmaniasis at 2133.1996.tb06973.x/abstract
the household level in Kabul, Afghanistan. PLoS 23. Rebecca M, Peter W, Elli L. Longitudinal
Negl Trop Dis. 2010 Mar 23;4(3):e639. Available Evaluation of an Educational Intervention
from: URL: h�p://www.plosntds.org/article/info for Preventing Tick Bites in an Area with
%3Adoi%2F10.1371%2Fjournal.pntd.0000639 Endemic Lyme Disease in Baltimore
15. Glass GE, Norris DE. Analysis of Anopheles County, Maryland. Am J Epidemiol. 2006
arabiensis blood feeding behavior in southern Jun 1;157(11):1039-51. Available from: URL:
Zambia during the two years after introduction http://aje.oxfordjournals.org/content/157/11/
of Insectsicide-treated bed nets. Am J Trop Med 1039.short
Hyg. 2010 Oct;83(4):848-53. 24 Donnel Wong. Wong’s essential for pediatric
16. Logan JG, Cook JI, Stanczyk NM, Weeks Nursing. 6th ed. Harcourt pvt Ltd.
EN, Welham SJ, Mordue AJ. To bite or not to 25 Park K. Preventive and social Medicine 20th ed.
bite! A questionnaire-based survey assessing M/S Banarsidas Bhanot. 2009.
why some people are bi�en more than
26 Nelson. Essentials of pediatrics. 4th ed. Elsevier a
others by midges. BMC Public Health. 2010
division of reed Elsevier India Pvt Ltd. 2004.
May 25;10:275. Available from: URL: h�p://
www.ncbi.nlm.nih.gov/pubmed/20500852 27 Denise F, Polit, cherly tatano Beck. Nursing
research. 7th ed. New Delhi: JP Publishers Pvt
17. Phookan S, Dash AP. Wash-resistance and
Ltd.; 2003. P. 105.
field efficacy of Olyset net, a permethrin-
 DOI Number: 10.5958/0974-9357.2016.00054.4

Effectivenes of Awareness Programme on Prevention of

Vector Borne Diseases among School Age Children

Naresh Soni1, Dipti Y Sorte2, Atul Chaudhari3

Lecturer, Rajasthan College of Nursing, Jaipur, 2Associate Professor, 3Assistant Professor,
1

Himalayan College of Nursing, Dehradun

ABSTRACT

Baground of the study: Vector-borne disease” is the term commonly used to describe an illness caused
by an infectious microbe that is transmi�ed to people by blood-sucking arthropods1. Vector-borne
infections (VBI) are very common around the globe and they account for many devastating diseases2.

Vectors typically become infected by a disease agent while feeding on infected vertebrates (e.g., birds,
rodents, other larger animals, or humans), and then pass on the microbe to a susceptible person or
other animal3. Every year over 1 million people all around the world die due to vector borne diseases.
Focusing mainly on the increasing threat of viral and parasitic infections caused by insects, this year’s
World Health Day (April 7, 2014) highlights ‘Prevention of vector borne diseases4.

Methodology: A pre – experimental research approach with one group pre – test post-test design was
for the study. 60 school aged children was considered as a sample after fulfilment of inclusive criteria.
Convenient sampling technique was used. Tool made reliable with r=0.76 pilot testing done with 10%
of overall population. Pre – test done followed by intervention was given and after seven day post – test
was given. The data was analysed by using both descriptive and inferential statistics on the basis of the
objectives and hypothesis of the study.

Results: Mean pos�est knowledge score was 17.24 & Mean of pretest knowledge score 25.48 the
obtained’ value was statically significant at p<0.05 level. Hence the score predict the significant
difference between the mean of pretest and pos�est. Therefore there was no evidence to accept the null
hypothesis. Hence the researcher rejects the null hypothesis and alternative hypothesis was accepted
indicating the gaining knowledge was not by chance but because of the intervention.

Conclusion: The intervention was effective in improving knowledge of school age children regarding
prevention of selected vector borne diseases

Keywords: Knowledge, School age children, Awareness programme, Prevention, Vector -borne disease.

INTRODUCTION difficult to prevent because of several challenges

facing the control of vectors and transmissibility of
Vector borne diseases are diseases caused by
the pathogens. 7th April 2014 was World Health Day
pathogens that are transmi�ed to humans through
and the theme this year is ‘Vector-borne diseases —
insects and ticks carrying the pathogen. They are
small bite, big threat’. Simple preventive measures
like improving access to safe drinking water, proper
Corresponding author:
sanitation facilities and checking growth of pathogens
Mr. D. Y. Sorte
like mosquitoes and sand flies can control vector-
Associate Professor, Himalayan College of Nursing,
borne diseases like dengue and malaria. According to
Dehradun. Mail id. [email protected]
the World Health Organization (WHO), vector-borne
Contact No. +919456165815
diseases account for 17 percent of the estimated global
88 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

burden of all infectious diseases. Every year, more knowledge score. H0: There was no significant
than one billion people are infected and over one difference between the mean pretest knowledge
million die from vector-borne diseases worldwide. It score and post-test knowledge score. All hypothesis
is estimated that almost 70 percent of such diseases were tested at p<0.05level of significance. The se�ing
are reported from the low and middle income selected for the main study data collection was
countries5. Malaria, kala Azar, Dengue, Plague, selected from private school under Doiwala block,
Filariasis, Chikungunya, Lime disease, Yellow fever, Dehradun, (U�arakhand) population consisted
Japanese encephalitis are top vector borne diseases of school age children in Doiwala Block. The total
that contribute to increased morbidity and mortality6 sample size for the study was 60 school age children
Directorate of National Vector Borne Disease Control considered after fulfilling the inclusive & exclusive
Programme (NVBDCP) is the central nodal agency for criteria. Convenient sampling technique was used,
the prevention and control of vector borne diseases The data collection tool was divided into 2 parts- Tool
i.e. Malaria, Dengue, Lymphatic Filariasis, Kala-azar, 1:- Socio-demographic variables Tool 2:- Knowledge
Japanese Encephalitis and Chikungunya in India7In questionnaire consist of 32 questions related to
India, ca�le and buffaloes are frequently heavily prevention of selected vector borne disease to assess
infested with multi-species of ticks, which apart from the knowledge of school age children. Ensured the
transmi�ing diseases such as theileriosis, babesiosis content validity of tool from seven experts and seek
and anaplasmosis, also cause extensive damage to the their opinion and suggestions regarding the item of
livestock health and production8 The mosquito borne tool which included different departments, experts
diseases of public health importance are complex and are based on their experience and clinical expertise.
their occurrence depends on the interaction of various Pretesting was done with formal administrative
biological, ecological, social and economic factors9. permission was obtained before the pretesting. Hindi
Climate also affects like water, food, air quality, version of tool was administered to five participants
diseases, physical comforts and human health. Any i.e. 5 school age children of government school The
change in climatic conditions is likely to affect human reliability of tool- 2 was established split half method
health10. followed by Pearson’s co relation (r) formula and it
was found to be 0.76 and for tool-1 test retest method.
Methodology: The Research Approach was pre
A pilot study is a small preliminary investigation of
– experimental research approach with one group pre
the same general character of the main study. It is
– test post-test design used for the study
designed to acquaint the investigator with the problem
to be corrected in preparation for the larger research
Pre-test Treatment Post-test
project. Prior permission was taken from block
O1 X O2
education officer Doiwala. After obtaining informed
O1 :Assessment of knowledge of school age consent, tool-1,2 was applied on 10 participants
children before an awareness programme. i.e. school age children. It was conducted to assess
the feasibility of the study and also to determine
X: Awareness programme regarding prevention any major flaws in the research design used. It also
of selected vector borne diseases. helps to determine the plan of statistical analysis.
The pilot study didn’t show any problem. The
O2 :Assessment of the knowledge of school age
research tool was found to be feasible, practicable and
children after awareness programme.
acceptable. Wri�en permission was obtained from
Whereas, independent variable of study was ethical commi�ee of H.I.H.T, Principal Himalayan
an awareness programme regarding prevention college of nursing and block education officer. The
of selected vector borne diseases & Dependent wri�en consent was also obtained from each study
variable was knowledge level of school age children. participants before starting data collection. The data
Hypothesis of the study are. H1- The mean post-test was collected selected school from 4 April 2014 to 12
knowledge score of the school age children regarding April 2014 after obtaining permission from respected
prevention of selected vector borne diseases was authority. All subjects who fulfilled the inclusion
significantly higher than that of their mean pretest criteria were included in the study. The purpose of
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 89

the study was explained to the subjects. The data was planned to be analysed by using both descriptive (mean,
median, mean difference and standard deviation) and inferential (independent‘t’ test) statistics on the basis of
the objectives and hypothesis of the study.

Results: Results of study was as follows:

Table No.1: Frequencies and percentage distribution of sociodemographic variables of study participan
ts (N=60)

S.No. Variables Frequency Percentage(%)

Gender
1 • Male 35 58.3
• Female 25 41.7

Type of Family
2 • Nuclear 33 55
• Joint 27 45

Participation
3 • Yes 6 10
• No 54 90

Monthly income (Rs.)

• 5000-10000 4 6.7
4 • 10001-15000 10 16.7
• 15001-20000 17 28.3
• 20000 above 29 48.3

Education of father
• Primary 4 6.7
5
• Inter college 26 43.3
• Graduation 30 50

Education of Mother
• Not a�end school 2 3.3
6. • Primary 4 6.7
• Inter college 22 36.7
• Graduation 32 53.3

7. Presence of ca�le 31 51.7

8. Presence of water tank 59 98.3

Using Mosquito Repellent

9. 47 78.3

Table No. l illustrates the frequency and percentage distribution of socio-demographic variables of study
participants. Majority (58.3%) of the subjects were male and 55% lives in nuclear family. The monthly family
income of 48.3% participants was above Rs. 20,000/-.
90 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Father of every second participant is a graduate (50%) and 53.3% of mothers were graduate.

More than half (51.7%) of the households has presence of ca�le and more than three fourth (78.3%) were
using mosquito repellents. Only one participant reported that they don’t have water tank in home and only
10% of the subjects had earlier participated in health awareness programme regarding mosquito prevention.

Objective 1: To assess the knowledge regarding selected vector borne disease among the school age
children.

Table No. 2: Comparison of mean, median, mode and SD of pretest and post-test knowledge score of
participants (N=60)

Standard
Knowledge score Mean Median Mode Minimum Maximum
Deviation
Pre – test 15.52 2.46 16 16 9 21

Post – test 25.48 3.91 26 26 18 32

Table No.2 Mean, median and mode of both pretest and post-test knowledge score was nearly similar (16
for pretest and 26 for post-test) which shows the normal distribution of knowledge score in both pretest and
post-test evaluation. Hence the paired sample ‘t’ test was performed to compare the means of pretest and post-
test knowledge score.

Objective 2: To evaluate the Effectiveness of an awareness programme on prevention of selected vector

borne diseases among school age children.

Table No. 3: Comparison of mean pretest and post-test knowledge score regarding prevention of vector
borne disease (N=60)

95% Confidence Interval of

Knowledge Mean Difference
Mean ± SD ‘t’ value p value
score Difference
Lower Upper

Pre – test 15.52±2.46

Post – test 25.48±3.91 9.96 8.8 11.1 17.24 0.001

• *paired sample‘t’ test was used. T = 1.67 at df=59 and p<0.05 level

Table No.3 compares the mean pretest and post-test knowledge score. The mean post-test knowledge score

(25.48±3.91) was apparently higher than that of mean The significant improvement in knowledge
pretest knowledge score (15.52±2.46). Paired sample score can be a�ributed to the awareness programme
‘t’ test was performed to compare the means of pretest conducted between pretest and post-test knowledge
and post-test knowledge scores. assessment. Hence it can be concluded that the
awareness programme was effective in improving
The calculated ‘t’ value was 17.24 and p value was
the knowledge score of the participants regarding
0.001. As the p value was less than 0.05 (probability of
prevention of vector borne diseases.
type I error is less than 5%), the null hypothesis was
rejected and the research hypothesis was accepted. So Objective 3: Association between the pretest
the mean post-test knowledge score was significantly knowledge score of the school age children with their
(p=0.001) higher than that of mean pretest knowledge socio demographic variables.
score.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 91

Table No. 4: Association between pretest knowledge score of school age children with socio demographic
variables (N=60)

Mean ‘t’*
Variables n Mean+SD ‘p’ value
difference value

Gender
• Male 35 15.29±2.50
.55 .85 .672
• Female 25 15.84±2.41
Family
• Nuclear 33 15.82±2.36 .67
1.05 .396
• Joint 27 15.15±2.56

Participation
• Yes 6 15.33±1.50
.20 .91 .170
• No 54 15.54±2.55

Presence of Ca�le
• Yes 31 15.19±2.73
.66 1.05 .332
• No 29 15.86±2.11

Use of Mosquito Repellent

• Yes 47 15.47±2.43
.22 .28 .791
• No 13 15.69±2.62

Income status of family

• Lower income (<Rs. 15000) 14 16.29±2.6
1.0 1.34 .616
• Higher income (>Rs. 15000) 46 15.28±2.3

Educational status of father

• Primary 4 15.50±2.8
.01 .01 .978
• Secondary and above 56 15.52±2.4

Educational Status of mother

• Illiterate and primary 6 16.67±2.0
1.27 1.21 .386
• Secondary and above 54 15.39±2.4

*independent sample ‘t’ test was used. Ttab= 1.67 at df=58 and P=0.05level

Table No.4 compares the mean knowledge score difference in mean knowledge scores between male
of participants based on their socio-demographic and female participants (p=0.672), who lives in
variables. nuclear and joint family (p=0.39), who owns ca�le or
not (0.33), who use mosquito repellent or not (p=0.79),
Independent sample’t’ test was performed to
and participants from lower income and higher
compare the knowledge score of participants based
income family (p=.616 ).
on selected socio-demographic variables.
There was no significant association between
Table shows that there was no significant
knowledge score of participants and their parents
92 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

educational status (both father and mother). obtained ‘t’ value was 17.24 which was statically
There was no significant difference between mean significant at p<0.05 level. Mean of pretest knowledge
knowledge score of participants who had earlier was computed 15.52 and also post-test knowledge
a�ended any awareness programme and who had score was computed 25.48 which was higher than that
not a�ended (p=0.17). of the mean of pretest knowledge score. hence the
score predict the significant difference between the
This reveals that there was no significant
mean of pretest and post-test at p<0.05level. There for
association between pretest knowledge score and
there was no evidence to accept the null hypothesis,
any of the socio-demographic variables of the study
hence the researcher reject the null hypothesis and
participants.
alternative hypothesis was accepted indicating the
DISCUSSION gaining knowledge was not by chance but because of
the intervention.
The main aim of the study was to assess the
effectiveness of an awareness programme on CONCLUSION
the knowledge of school age children regarding
Mean pos�est knowledge score was apparently
prevention of selected vector borne diseases in a
higher than the pre-test knowledge scores and the
selected school in Doiwala, Dehradun.
obtained‘t’ value was 17.24 which was statically
A total of 60 school age children were selected significant at p<0.05 level. Mean of pretest knowledge
through convenient sampling technique. Pretest was was computed 15.52 and also pos�est knowledge
conducted by using structured questionnaire. An score was computed 25.48 which were higher than
instructional module was given by the investigator. that of the mean of pretest knowledge score. hence the
After seven days the post test was conducted by score predict the significant difference between the
using same questionnaire. An open module was mean of pretest and pos�est at p<0.05level. There for
given regarding prevention of selected vector borne there was no evidence to accept the null hypothesis.
disease to the school age children. After intervention Hence the researcher rejects the null hypothesis and
knowledge score were increased in post-test. The alternative hypothesis was accepted indicating the
findings of the study have been discussed with gaining knowledge was not by chance but because of
references to the objectives and hypothesis in lights of the intervention.
other study conducted in same area.
Acknowledgement - It is my pleasure to thanks
Baseline data presented show that Most of school my Principal Dr. Sanchita Pugazhendi as well as my
age children (98.3%) were in the age group 12-15 years Guide and Co-Guide for their constant support &
of age . more than half of children (58.3%) were male encouragement.
participants and more than half of children (55%)
Source of Funding- Self Financed.
were belongs to nuclear family. Majority of school
age children (90%) were didn’t participated in any Conflict of Interest - None
awareness program me. less than half of school age
children’s father’s monthly income was more than
REFERENCES
20,000. Half of the school age children’s father (50%) 1. h�p://www.vdh.state.va.us/epidemiology/dee/
had passed graduation. And more than half of school vectorborne/
age children’s mother (53.3%) had passed graduation.
2. Journal of Vector borne disease, 44, September
Most of school age children (51.7%) having ca�le in 2007, PP 157-167.
their home. Majority of school age children (98.3%)
3. h�p://www.vdh.state.va.us/epidemiology/dee/
were having water tank in their home and majority
vectorborne/
of school age children (78.3%) were using mosquito
repellents. 4. http://www.thehealthsite.com/diseases-
conditions/world-health-day-2014-top-10-
Mean post-test knowledge score was apparently vector- borne-diseases/
higher than the pre-test knowledge scores and the
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 93

5. http://www.thehealthsite.com/diseases- RC16IyeqPicp3ASJAB-vB-cpnn- pgqCkT3v

conditions/world-health-day-2014-simple- K6991as8ShLKoooG33SUG6FJCbQlThoC6Yzw
preventive-steps-can-control-vector-borne- _wcB
diseases/?gclid=CjwKEAjwhbCrBRCO7-e7vu 7. h�p://nvbdcp.gov.in/
XqiT4SJAB2B5u7B011PZVsZANTVnRfVYPX-
8. Journal of Vector borne disease, 51, September
qGE4DHfIOk19z9rx0fWARoCMPTw_wcB
2007, PP 259-270.
6. http://www.thehealthsite.com/diseases-
9. Journal of Vector borne disease, 47, December
conditions/world-health-day-2014-top-10-
2010, PP 249-256.
vector-borne-diseases/?gclid=CjwKEAjwndqrB
10. Journal of Vector borne disease, 49, June 2012,
PP 55- 60.
 DOI Number: 10.5958/0974-9357.2016.00055.6

Assessment of Compliance and Factors Influencing

Therapeutic Regimen among Patients with Heart Failure in
a Tertiary Care Hospital, Kochi, Kerala, India

Sreeja M S1, Laly K George2

1
Post Graduate Student, 2Assistant Professor, Department of Medical Surgical Nursing, Amirta College of Nursing,
Amrita Vishwa Vidyapeetham Health Science Campus, Amrita Institute of Medical Sciences AIMS, Kochi, India

ABSTRACT

A descriptive study was undertaken to assess the factors influencing compliance to therapeutic regimen
among patients with heart failure in a tertiary care hospital, Kochi. It was aimed to identify level of
compliance among patients with heart failure and to determine the factors influencing compliance
to therapeutic regime with a view to prepare an information booklet on therapeutic management of
patients with heart failure. A quantitative research approach has been used. The data was collected using
structured interview schedule to assess socio demographic profile and semi structured interview to
assess level of compliance and factors influencing compliance. The data was analyzed using descriptive
(frequency and percentage and mean and standard deviation) and inferential (chi – square test)
statistics. Among 70 subjects with heart failure, most of the subjects 34 (47.2%) have good compliance,
33(45.8%) subjects exhibited average level of compliance. Three among the 70 subjects (4.2%) identified
with poor compliance to therapeutic regimen. Among the factors influencing compliance, health care
system related factor is the prominent factor influencing compliance (76.5%). Followed by patient
related factor (70.7%) and therapy related factor (66.1%). It is evident that Economic factor is the crucial
factor leading to non compliance (30%). There is significant association between level of compliance
and individual factors influencing compliance to therapeutic regimen.

Keywords: compliance, therapeutic regimen, influencing factor, heart failure.

INTRODUCTION with a mean length of hospital stay of 6.5 days. Heart

failure is third most common cardiovascular disease
Heart failure (HF) has been described as one of the
in the US affecting 2 per cent of the U.S. population,
emerging pandemics of the 21st century. Heart failure
or almost 5 million people. Based on disease-specific
is a serious clinical syndrome with high mortality and
estimates of prevalence and incidence rates of heart
an important public health problem.HF is defined
failure, it is conservatively estimated the prevalence
as an abnormality of cardiac structure or function
of heart failure in India due to coronary heart disease,
leading to failure of the heart to deliver oxygen at
hypertension, obesity, diabetes and rheumatic heart
a rate commensurate with the requirement of the
disease to range from 1.3 to 4.6 million, with an
metabolizing tissues, despite normal filling pressure
annual incidence of 4.9 lakhs -18lakhs. In Kerala
or only at the expense of increased filling pressure. 1
approximately one in every hundred older adults has
The in-hospital mortality for these patients is 4.1 %,
HF.2

Corresponding author: Patient compliance with medical regimen is a

Sreeja M S behavioural problem of interest because it affects
Post Graduate Student, Amrita College of Nursing, the patient’s health. If the therapeutic regimen is
Amrita Vishwa Vidyapeetham Health Science to be effective, the patient must comply with the
Campus, Amrita Institute of Medical Sciences AIMS, regimen. The consequences of poor/non-compliance
Kochi-41, India, Email: [email protected]
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 95

are extensive. It negatively impacts treatment The sample size estimated was 70.
effectiveness thus resulting in poor therapeutic
Tools used for the study were Structured
outcomes. Non-compliance in some instances
interview schedule to assess the sociodemographic
could result in serious complications requiring the
and clinical variables, Semi structured interview
individual to be hospitalized. Compliance with
schedule to assess level of compliance to therapeutic
a complex health care regimen is required of most
regimen of heart failure. The scale has 12 items
of patients with heart failure. Non-compliance
with a five point response format never -1, rarely
with medication, exercise and diet contribute to
-2, sometimes - 3, usually -4 and always -5.Scoring
worsening of HF symptoms, in many cases leading to
was categorized into three: Good compliance 45-
hospitalization.3 It was estimated that the compliance
60, Average compliance 29-44, Poor compliance 12-
rate of long-term medication therapies was between
28. Tool 111: Semi structured interview schedule
40% and 50%. The rate of compliance for short-term
to assess the factors influencing compliance to
therapy was much higher at between 70% and 80%,
therapeutic regimen among patients with heart
while the compliance with lifestyle changes was the
failure.
lowest at 20%–30%.4 According to the HF guidelines
of the European Society of Cardiology and the Semi structured interview schedule consists of 46
American Heart Association/American College of Yes/No type questions organized under 7 domains
Cardiology (AHA/ACC) multiple medication (ACE- based on WHO’s adherence model(2003).
inhibitors, diuretics, beta-blockers, spironolactone,
digoxin) are beneficial for HF patients and should Patient related factor – 9 questions, Therapy
therefore be prescribed. Medication is the cornerstone related factor -9 questions,Health care system
of the treatment of HF patients nowadays. Non- related factor – 7 questions, Sociocultural factors – 5
pharmacological life style changes such as fluid- and questions, Economic factors - 4 questions, Disease
sodium-restriction, daily weighing, adjustment of related factor – 6 questions and Psychological factor
activity, smoking cessation and limitation of the – 6 questions
amount of alcohol are requested. Nonpharmacologic
The content validity index calculated for tool 11
management strategies represent an important
and Tool III was found to be 0.96 and 0.89 respectively.
contribution to HF therapy. They may significantly
Reliability analysis of level of compliance was
impact patient stability. 5
conducted by using Cronbach’s Alpha and the score
Successful management of HF usually requires obtained was 0.975. Reliability analysis of factors
major lifestyle adjustments by patients and their influencing compliance was done by Spearman
families. Lifestyle adjustments include modifications Brown Coefficient and score obtained was 0.914.
in diet and activities, compliance with a complex
RESULTS
medication regimen, and the need to monitor
symptoms. In this section, statistical analysis and
interpretation of collected data were organized under
MATERIALS & METHODS
five sections.
The present study was aimed at identifying the
Section 1(a) : Distribution of subjects based on
level of compliance and factors influencing compliance
demographic variables
to therapeutic regimen among patients with heart
failure. The quantitative research approach with Demographic Frequency Percentage
descriptive design was used to accomplish the aim of variables (f) (%)
the study. The study is conducted in outpatient and
(a) Age in Years
inpatient units of cardiology department of Amrita
Institute of Medical Sciences, AIMS, Kochi. The sample 20-35 4 5.7
was selected from the accessible population based on
36-50 9 12.9
the sampling criteria. The sampling technique used
for the study is non – probability purposive sampling. 51-65 37 52.9
96 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Cont.. Section 1(a): Distribution of subjects

History of
based on demographic variables hospitalisation
ONE TIME 19 27.1

66-80 20 28.5
2-3 TIMES 7 10.0
(b) Sex
>3 TIMES 7 10.0
Male 56 80.0
Female 14 20.0 NIL 37 52.9

e) Educational status
Section II (a) – Description of Level of
12.9
Primary 9 compliance to therapeutic regimen among patients
34.3 with heart failure
Secondary 24
25.7
Higher secondary 18

Diploma 5 7.1
12.9
Graduate 9

Post graduate 5 7.1

(g) Income per
month(Rs)
<5000 19 27.1

5001-15000 28 40.0
Pie diagram showing distribution of subjects
15001-25000 16 22.9 based on level of compliance to therapeutic regimen
25001-50000 6 8.6 among patients with heart failure.
>50001 1 1.4 Pie Diagram shows that most of the subjects 34
(47.2%) have good compliance. 33(45.8%) subjects
Section I (b): Distribution of subjects based on
exhibited average level of compliance. Three among
clinical variables
the 70 subjects (4.2%) identified with poor compliance
to therapeutic regimen.
Characteristics Category Frequency Percent
Section III Distribution of subjects according
Duration since 6MONTHS
15 21.4 to the factors influencing compliance to therapeutic
Diagnosis TO 1 YEAR
regimen among patients with heart failure
1-3YEARS 15 21.4
Mean
3-5YEARS 10 14.3 Dimensions Range Mean SD
%
Patient Related
>5YEARS 30 42.9 2 - 10 7.07 2.804 70.7
Factors
NYHA Therapy Related
NYHA II 34 48.6
Classification Factors 1-8 0.29 2.214 66.1
NYHA111 32 45.7 Healthcare
NYHA1V 4 5.7 System Related
Factors 0-7 5.36 1.745 76.5
EJECTION
31-40 52 74.3 Socio-cultural
FRACTION
Factors 0-5 2.57 1.528 51.4
21-30 15 21.4
Economic
0-4 1.20 1.389 30.0
11-20 3 4.3 Factors
Alternative Disease
Yes 1 1.4 Condition 0-6 3.71 2.114 61.9
therapy
Related Factors
No 69 98.6 Psychological
0-6 3.31 1.854 55.2
Factors
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 97

Among the seven factors health care system related factor is the highest factor influencing compliance
(76.5%). Followed by patient related factor (70.7%) and therapy related factor (66.1%). It is evident that
Economic factor is the crucial factor leading to non compliance (30%).

Section IV : Association of the factors affecting compliance with level of compliance n=70

Inadequate Adequate Calculated χ2

Factors
f % f % value
Inadequate 22 61.1 4 11.8
Patient related factors # 16.185**
Adequate 14 38.9 30 88.2
Inadequate 21 58.3 5 14.7
Therapy related factors 14.255**
Adequate 15 41.7 29 85.3

Health care system Inadequate 16 44.4 3 8.8

9.490**
related # Adequate 20 55.6 31 91.2
Inadequate 23 63.9 10 29.4
Socio-cultural factors 8.341**
Adequate 13 36.1 24 70.6
Inadequate 34 94.4 22 64.7
Economic factors# 7.896**
Adequate 2 5.6 12 35.3

Disease condition Inadequate 26 72.2 3 8.8

26.410**
related factor # Adequate 10 27.8 31 91.2
Inadequate 28 77.8 7 21.2
Psychological factors 22.041**
Adequate 8 22.2 26 78.8

Association between level of compliance and factos influencing compliance at 0.01 level of significance.
Table shows that there is highly significant association between level of compliance and factors influencing
compliance.

Section V(a): Association of selected demographic variables with level of compliance to therapeutic
regimen among patients with heart failure

Level of compliance
Demographic/ Clinical variables Inadequate Adequate
Calculated χ2 value
F % f %
Gender
Male 24 42.9 32 57.1
6.609**
Female 12 85.7 2 14.3
Income

< 5000 12 63.2 7 36.8

5001-10000 17 60.7 11 39.3 6.071*
> 10001 7 30.4 16 69.6
Occupation
Employed 8 30.9 18 69.2
Unemployed 14 82.4 3 17.6 10.953**
Retired 14 51.9 13 48.1
Level of compliance is associated with gender (χ2 = 6.609,p<0.01), income ((χ2 = 6.071,p<0.05) and occupational
status (χ2 = 10.953,p<0.01).
98 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Section V(b):Association of selected clinical variables with level of compliance to therapeutic regimen
among patients with heart failure

Level of Compliance
Demographic/Clinical Calculated χ2
variables Inadequate Adequate value
f % f %

History of hospitalisation

One time 15 78.9 4 21.1

18.709**
More than one time 11 78.6 3 21.4

There is significant association between

REFERENCE
frequency of hospitalization and level of compliance
((χ2 = 18.709, p<0.01) and the relationship is inversely 1. Moser R. Cardiac nursing, A companion to
proportionate. From the above table it is clearly Braunwald’s heart disease. Saunders Elsevier
evident that level of compliance of subjects with publications ; 2008.p.897-907
frequent hospital admission is lower when compared
2. Reddy S , Bahl A, Talwar K.K. Congestive heart
to other subjects without hospitalization.
failure in Indians. Indian J Med Res 2010Nov; 132.
CONCLUSION P. 549-60. Available from: h�p://icmr.nic.in/ijmr/
2010/november/1112.pdf
The study revealed that level of compliance of
3. Lorraine S E, Kathleen D. A closer look at
patients with heart failure is ranging from average
compliance research in heart failure patients
to good .Overall compliance level can be further
in the last decade. Prog Cardiovasc Nurs 2000
improved with modifying factors influencing
compliance. summer;15(3):97-103.Available from: h�p://
www.ncbi.nlm.nih.gov/pubmed/10951951
Ethical Clearance: Ethical clearance is taken 4. Jing J, Grant E S, Vernon M S, Shu C L. Factors
from thesis review commi�ee of Amrita Institute of
affecting therapeutic compliance: A review
medical sciences, Kochi.
from the patient’s perspective. Ther Clin Risk
Acknowledgement: I owe my profound gratitude Manag 2008 Feb; 4(1):269-86. Available from h�p:
to Dr. K U Natarajan, Head of the Department of //www.ncbi.nlm.nih.gov/pubmed/18728716
Cardiac Institute ,Bri.Sai Bala, Nursing Director,
5. Dirk J V. Non-compliance in patients with
Prof. K. T Moly, Principal, college of Nursing, AIMS,
Kochi and all the participants for their cooperation heart failure; how can we manage it? European
and valuable guidance. Journal of Heart Failure Volume 7, Issue
1, pages 5–17, January 2005.Avialble from
Source of Funding : Self http://onlinelibrary.wiley.com/doi/10.1016/
Conflict of Interest : Nil j.ejheart.2004.04.007/full
 DOI Number: 10.5958/0974-9357.2016.00056.8

Parental Alcoholism and Psychosocial Problems

of Adolescents

Chetana1, Sanjenbam Emon Chanu2, Mahalingam V2, Sanchita Pugazhendi3

1
Nursing Tutor, 2Assistant Professor, Himalayan College of Nursing, SRHU, Dehradun, U�arakhand, India,
3
Professor, Himalayan College of Nursing, SRHU, Dehradun, U�arakhand, India

ABSTRACT

The impact of parental alcoholism on adolescents is a psycho-social issue that urgently requires
research and public awareness. Purpose: The aim of this study was to find out the prevalence of
psychosocial problems of adolescents of alcoholic parents. Method: Case Control observational design
was selected for this study. Ninety adolescents were systematically (every 5th sample) selected from the
study population. Consecutively 41 adolescents of alcoholic parents were retained in the Case group
and 49 adolescents of non-alcoholic parents were in the Control group. The adolescents between 15-19
years of age were considered to be the study subjects. Standardized (r=.97) Pediatric Symptom checklist
was used to collect information regarding psychosocial problems from the adolescents. Result: Study
results show that every fifth adolescent of alcoholic parents was found to have severe psychosocial
problems. Also the logistic regressional figures state that adolescents of alcoholic parents were two
and half times more at risk of developing psychosocial problems than the adolescent of non- alcoholic
parents. Conclusion: Parental alcoholism has a negative impact on the psychosocial well-being of the
adolescents, and they also face a greater challenge in adjusting to the environment and to society. They
are highly vulnerable for developing psychosocial problems i.e. emotional, behavioral and cognitive.
Thus parental alcoholism hampers the normal psychosocial development of a child.

Keywords: Adolescents, Impact, Parental alcoholism, psychosocial problems.

INTRODUCTION influence in later life and in adjustment.(1)A

drinking habit may interrupt normal family tasks,
A human being goes through the various cause conflict and demand adaptive responses
stages of life and one of the most important stages from family members who do not know how to
is adolescence. Adolescence is a period when rapid respond appropriately. Alcoholism creates a series of
physiological and psychological changes take place escalating crises in the family structure and function.
and new social roles take place. It is the period of As a result, the members may develop dysfunctional
transition from childhood to adulthood and plays coping behaviors.(2)Marital conflict and a lack of
a decisive role in the formation of a pro or anti-social coping mechanisms were more frequent in these
adult. families and children of alcoholic (COAs) parents
There is strong evidence to suggest that family represented a group at risk for the early onset of
dysfunction during childhood can have a negative psychiatric problems.(3)

Corresponding author: There has been an increased focus on children of

Mr. Mahalingam Venkateshan alcoholics who are seeking to understand the adverse
Assistant Professor, Himalayan College of Nursing, impact of parental alcoholism on their growth and
SRHU, Jolly Grant, Doiwala (Post) Dehradun, psychosocial functioning. Indian literature from
U�arakhand, India, 248140, this perspective is scanty and there is a need for
Email: [email protected] more comprehensive investigation to explore the
[email protected] consequences of parental alcoholism particularly on
100 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

adolescent children. perspective associated with co-dependency, which

hypothesizes that the stress of living in a family with
It is well established that children of problem
an alcoholic parent could have adverse consequences
drinkers have an increased risk of developing
on the personality traits of adolescent children and
mental health problems, not only during childhood
may manifest deficiencies in their psychosocial
but also when they grow up into adolescents and
functioning.
adults.(4)Children of alcoholics exhibit high rates
of psychopathology and may be at risk specifically METHODOLOGY
for behavioral and conduct disorders.(5)Behavioral
A Case Control design with Observational
problems in adolescence have been shown to be
approach was chosen to study the psychosocial
associated with the presence of a positive family
wellbeing of the adolescents of alcoholic parents. Inter
history of alcoholism and negative parenting
and Degree colleges were preferred to gather subjects
practices.(6)
for the study. With the help of a systematic random
However, in the literature on alcoholism there is sampling technique 90 adolescents were recruited
a contention pertaining to children of alcoholics that from the study population. Among randomly
they manifest no significant differences in terms of recruited subjects 41 adolescents were consecutively
psychopathology or other behavioral and personality retained for the Case group and 49 adolescents were
deficits when compared to children of non- placed in the Control group. The 15-19 year old
alcoholics. Children may exhibit normal psychosocial adolescents were included in the study and it was
functioning despite having an alcoholic parent and decided to exclude the mentally and chronically ill
found no differences between adult children of from the study population. A standardized “Pediatric
alcoholics and the Control group.(7)The brief review Symptom Checklist” was used to interview every
of the literature in the field reveals that while a lot of individual study subject for 15-20 minutes to elicit the
investigation has been carried out with adult children information about their present psychosocial status.
of alcoholics those with a specific focus on adolescent Permission from the ethical commi�ee was obtained
children are not many. Further there is a dearth of and a wri�en informed consent taken from all the
exploration carried out on this issue in the Indian study subjects who were age above 18 years of and
socio-cultural context. This investigation was carried from the parents of all those who were under18 years
out against this background primarily from the stress of age.

RESULTS

Table: 1 Socio-demographic characteristics of the study subjects.

Control(non-
Case (alcoholic) group
S. No Sample Characteristics alcoholic) group p value
f (%)n1=41
f (%)n2=49

Gender
1.
Male 27 (65.9) 25 (51.0) 0.11
Female 14 (34.1) 24 (49.0)

2. Educational status
Secondary school 15 (36.6) 17 (34.7) 0.4
Graduate 26 (63.4) 32 (65.3)

3. Number of siblings
Two or less 08 ( 19.5) 03 (6.1) 0.3
Three or more 33 (80.5) 46 (93.9)
4. Family type
32 (78.0) 32 (65.3) 0.07
Nuclear
09 (22.0) 17 (34.7)
Joint
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 101

Table: 1 Socio-demographic characteristics of the study subjects.

5. Living with
Parents 38 (92.7) 46 (93.9) 0.3
Divorced parents, Relatives 03 (7.3) 03 (6.1)

Monthly family income

6.
Below 5000 31 (75.6) 40 (81.6)
0.35
5001and above 10 (24.4) 09 (18.4)

7. Father’s occupation
Laborer 22 (53.7) 22 (44.9)
0.29
Self , Government employee 19 (46.3) 27 (55.1)
8. Mother’s occupation
Housewife 36 (87.8) 45 (91.8) 0.48
Working 05 (12.2) 04 (8.2)

Any other habit

12. None 17 (41.5) 38 (77.6) 0.14
Tobacco, Smoking 24 (58.5) 11 (22.4)

9. Duration of taking alcohol

07 (17.1) Not applicable
Less than 5 yrs.
34 (82.9)
More than 5 yrs.

10. Pa�erns of taking alcohol

39 (95.1)
Only at night Not applicable
02 (4.9)
Binging, anytime

Frequency of taking alcohol

11. 33 (80.5)
3-4 times/wk Not applicable
08 (19.5)
Daily

Table no 1 show that the mean age of adolescents with their parents. In the Case group majority (68.3%)
of Case group is 17.5 ±1.4 and the mean age of the of study participants belonged to the group where
Control group is 17.3 ±1.5. In the Case group most of monthly family income was less than Rs 5000 and in
the study participants (65.9%) were male and only the Control group also (81.6%) belonged to the same
few (34.1%) were females. In the Control group both range of monthly family income.
male (51%) and female (49%) were more or less in
In the Case group majority (53.7%) of the
equal proportion. In the Case group two thirds of
adolescents’ fathers were laborers whereas in the
the study participants (63.4%) were graduates and
non-alcoholic group the majority (53.7%) of the
only (36.6%) had higher secondary schooling. In
adolescent’s fathers were self-employed. In the Case
the Control group also approximately every other
group a large proportion of the study participants
participant (65.3%) was a graduate. In the Case group
(89.8%) mothers were housewives and similarly in the
majority of the study participants (80.5%) had more
Control group also the (92.7%) adolescent’s mothers
than three siblings and the Control group also the
were housewives. Hence it can be interpreted that
participants (93.9%) had more than three siblings. In
the inferential statistics proved both groups were
the Case group most of the study participants (78%)
statistically homogenous.
belonged to a nuclear family and in the Control group
also the majority (65.3%) belonged to nuclear family. Majority (82.9%) of adolescent’s fathers was
In the Case group as well as the Control group the consuming alcohol for more than five years and
majority (92.9%) of the study participants were living (95.1%) they were night drinkers. Two thirds of the
102 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

study participants’ (70.7%) fathers were consuming alcohol 2-3 times a week. Approximately half of the (58.5%)
fathers also liked to chew tobacco and smoked whereas in the control group there were 75.6% adolescents
fathers who were not using tobacco or smoking.

Table No 2: Prevalence of psychosocial problems among Case (alcoholic) group and Control (non-
alcoholic) group. (n=90)

Control group
Psychosocial problem cut Case group (n1=41)
(n2=49) Total Relative Risk(RR)
off score f (%)
f (%)

Less than 28 33 (80) 49 (100) 82

Equal to greater 28 08 (20) 0 08
2.5
Total 41 49 90

Table no 2 shows that 20% of the adolescents of the alcoholic group had psychosocial problems against
standard definition whereas the adolescents of the non-alcoholic group were found not to have any psychosocial
problem. Also, the Logistic regression figures states that an adolescent of alcoholic parents were two and half
times more at risk at developing psychosocial problems than the adolescent of non- alcoholic parents.

Table No 3: Comparison of mean psychosocial problem score of Case (alcoholic) group and Control
(non-alcoholic) group. (n=90)

Mean
psychosocial Mean p value
Groups SE 95% CI t value
problem score ± difference
SD
6.68*
Lower Upper

Case group <0.001

17.56 ±10.3
(n1=41) 11.3 1.69 7.9 14.7

Control group
6.22 ± 3.3
(n2 =49)

t tab= 1.98 at df=88 at the level of P<0.05 *Significant

The data presented in Table No 3 show the mean psychosocial problem score of alcoholic and non-alcoholic
groups. The sphericity of the group was measured where as the ‘t’ value states the normal distribution of
the data. Parametric Independent‘t’ test was performed to compare the mean psychosocial problem score of
alcoholic and non-alcoholic groups. The psychosocial problems mean score of alcoholic group (17.56 ±10.3) was
significantly (p=0.001) higher than the mean psychosocial problems score of non-alcoholic group (6.22 ± 3.3).
Therefore it can be interpreted that the psychosocial problems are higher in the alcoholic group.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 103

Table No 4: Association between socio-demographic variables and the psychosocial Problem Score of case
(alcoholic) group. (n1=41)

Demographic variables
S. No <28 ≥28 p value#
Case (alcoholic) group

1. Gender
Female 22 05
1.0
Male 11 03

2. Educational status
Secondary 14 01
0.22
Graduation 19 07

3. Siblings
Two or less 05 03
0.15
Three or more 28 05
4. Mother’s occupation
Housewife 29 07
1.0
Working 04 01

5. Duration of taking alcohol

Less than 5 years 06 01
1.00
More than 5 years 27 07

6. Pa�ern of taking alcohol

only at Night 32 07
0.35
Binging, Anytime 01 01

7. Any other habit

None 14 03
1.00
Tobacco, smoking 19 05

8. Family type
Nuclear family 24 08
0.11
Joint family 09 0

9. Frequency of taking alcohol

3-4 times/wk 27 06
0.64
Everyday 06 02

Father’s occupation
10.
Labor 17 05
0.7
Self, Government employee 16 03
Monthly income
11.
<5000 24 07
0.65
5001 and above 09 01
Living with whom
12.
Parents 31 07
0.48
Divorced parents, Relative 02 01

p<0.05, df= 1
104 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

The data presented in Table No 4 show the esteem and poor adjustment were identified among
proportion of the demographic variables and adolescents of alcoholic parents.(11) In contrast, the
association with psychosocial problem score of results are congruent with that of Morey (1999)
alcoholic parent’s adolescents. who reports that self-esteem ratings for adolescents
of alcoholic parents were significantly lower in
Hence it can be interpreted that the psychosocial comparison to ratings for adolescents of non-alcoholic
problem was not statistically influenced by any of parents.(12)
their demographic variables i.e. gender, educational
status, number of siblings, father’s occupation, The study results correlate with Hossang and
mother’s occupation, family type, monthly income, Chassin (2004) where it was found that children of
living with whom, duration, pa�ern and frequency of alcoholics showed a statistically significant difference
alcohol consumption, and any other bad habit. in their emotional and behavioral aspects such as
shyness, insecurity and low self- esteem.(13) Haugland
DISCUSSION (2003), also reports that children of alcoholic fathers
The present study highlighted that nearly one fifth were found to have more adjustment problems
of the adolescents of alcoholic parents had identified compared to a general population sample. (14)It is
psychosocial problems against standard definition therefore important that the therapeutic needs of
whereas the adolescents of non-alcoholic parents these adolescents are addressed through individual
were not found to have any psychosocial problems. psychotherapy and other supportive therapies by
These findings were correlated with L.Hyunhwa’s providing an opportunity for ventilation of feelings
(2010) findings that, significant relationships between and integrating elements that will boost their self -
parental alcoholism, depressive symptoms, sense esteem and promote their psychosocial adjustment in
of belonging, resilience, social support, family different areas.
functioning, parental mental health problems, The investigator likes to recommend nurses
and domestic violence. Interestingly, the sense of working in the community areas can further
belonging was the only mediator between parental strengthen teaching programs for parents regarding
alcoholism and depressive symptoms.(8) the ill-effects of alcohol on their children’s
The results of the study parallel with Melanie psychosocial status and themselves too. School health
Chalder et al, (2005) that children of alcoholic parents nurses can focus more on the early identification
constituted almost one-fifth of the sample group and of the psychosocial problems of these children for
were found to drink more frequently, more heavily, necessary management or referral.
and more often alone, than children of non-alcoholic Limitations of the study were that the investigator
parents .(9) had to rely on the information taken from the
Also Wall T L et al (2000), study findings suggest adolescents. The investigator did not have any
that sons of alcoholics experience more behavioral control on other factors like parent child relationship,
problems than sons of non- alcoholics. (10) time spent with their children and communication
between parents which has also an influence on the
The study results also revealed that the severity psychosocial status of adolescents. As the sample size
of psychosocial problems among adolescents of was small, the scope of generalization of finding was
alcoholic parents was notably higher than in the limited.
adolescents of non-alcoholic parents. The adolescents
of alcoholic parents are about three times more at risk CONCLUSION
in developing the psychosocial problems than the The study results publicized an inordinate need
adolescents of non-alcoholic parents. to develop programs for adolescents of alcoholic
These results were supported by Fartein A parents with a strong focus on strengthening
Torvik, et al.(2011) that children of alcoholics had resilience in them and inculcating desirable
moderately elevated a�ention and conduct problem personality traits and enhancing their psychosocial
scores .5 The findings of this study agreed with that functioning through appropriate psychotherapeutic
of Stanly S. and Vanitha C. (2008) that lower self- procedures. The investigator statistically recognized
parental alcoholism hampers the normal psychosocial
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 105

development of an adolescent. Intervention with the children of alcoholics study in Pomerania.

adolescents of alcoholic parents must hence involve European Journal of Addiction Research, 10(1):
resolution of individualized issues pertaining to 8-14.
adolescence as well as parental alcoholism. 7. Segrin, C. &Menees, M. M. (1996). The impact of
coping styles and family communication on the
Acknowledgment: No
social skills of children of alcoholics. Journal of
Conflict of Interest: No Studies on Alcohol,57(1):29-33.
8. LHyunhwa, a study on relationships among
Source of Funding: Self
parental alcoholism, sense of belonging, resilience
Ethical Clearance: Ethical commi�ee permission and depressive symptoms in korean people,
was obtained from the HIHT Ethical commi�ee 2010.
before starting the study. 9. Melanie Chalder, Frank J. Elgar and Paul Benne�,
Drinking and Motivations to Drink among
REFERENCES
Adolescent Children of Parents, Alcohol &
1. Werner, L. J. &Broida, J. P. (1991). Adult self- Alcoholism Vol. 41, No. 1, pp. 107–113, 2006.
esteem and locus of control as a function of 10. Wall TL1, Garcia-Andrade C, Wong V, Lau P,
familial alcoholism and dysfunction. Journal of Ehlers CL, Parental history of alcoholism and
Studies on Alcohol, 52(3), 249-252. problem behaviors in Native-American children
2. Ranganathan, Shanthi. (2004). Families in and adolescents, Alcohol ClinExp Res. 2000
Transition: Victims of Alcoholism and New Jan;24(1):30-4.
Challenges Ahead. International Journal for the 11. Stanley S., Vanitha C. (2008). Psychosocial
Advancement of Counselling, 26(4),399-405. Correlates in Adolescent Children of Alcoholics-
3. Furtado, E. F., Laucht, M. & Schmidt, M. H. (2002). Implications for Intervention.International
Psychiatric problems in children of alcoholic Journal of Psychosocial Rehabilitation. 12 (2),
fathers. Journal for Child and Adolescent 67-80.
Psychiatry and Psychotherapy, 30(4), 241-250. 12. Morey, C. K. (1999). Children of alcoholics: a
4. Cuijpers, P., Steunenberg, B. & Van Straten, A. school-based comparative study. Journal of Drug
(2006). When children of problem drinkers grow Education, 29(1), 63-75.
old: Does the increased risk of mental disorders 13. Hussong, A. M. &Chassin, L. (2004). Stress and
persist? Addictive Behaviors, 31(12), 2284-2291. coping among children of alcoholic parents
5. Reich, W., Earls, F., Frankel, O. &Shayka, through the young adult transition. Development
J. J. (1993). Psychopathology in children of and Psychopathology, Special issue: Transition
alcoholics.Journal of American Academy of Child from Adolescence to Adulthood, 16(4), 985-1006.
and Adolescent Psychiatry, 32(5), 995-1002. 14. Haugland, B.S. (2003). Paternal alcohol abuse:
6. Barnow, S., Lucht, M., Hamm, A., John, U. relationship between child adjustment, parental
&Freyberger, H. J. (2004). The relation of a family characteristics, and family functioning. Child
history of alcoholism, obstetric complications Psychiatry and Human Development, 34(2), 127-
and family environment to behavioral problems 46.
among 154 adolescents in Germany: results from
 DOI Number: 10.5958/0974-9357.2016.00057.X

Qualitative Data Analysis: Making it Easy

for Nurse Researcher

Meena Ganapathy
Principal, Maharshi Karve Stree Shikshan Samstha’s Smt. Bakul Tambat Institute of Nursing
Education, Kavenagar, Pune, Maharashtra, India

ABSTRACT

Qualitative data analysis is less prescribed than statistical analysis as its goal is the discovery of
new ideas and their associations, a new nursing researcher of qualitative study may find it as a great
challenge. Fortunately, techniques, strategies, and procedures have been developed to help qualitative
researchers extract meaning from their data (including software) and interpret it in ways that enhance
our understanding of complex phenomena. This paper provides an overview of the process of coding
and category systems for qualitative data, which is an important part of developing and refining
interpretations in interview, focus group or observational data.

Keywords: qualitative data analysis; memoing, coding and steps of coding, pa�erns, themes and categories and
display.

INTRODUCTION analyzed. As a qualitative researcher you have to

transcribe your data; that is, you type the text (from
“Any researcher who wishes to become proficient
interviews, observational notes, memos, etc.) into
at doing qualitative analysis must
word processing documents. Then you develop
learn to code well and easily. The excellence of coding and category s systems, it is here that you
the research rests in large part on carefully read your transcribed data, line by line, and
divide the data into meaningful analytical units (i.e.,
the excellence of the coding.” segmenting the data). When you locate meaningful
segments, you code them.
(Anselm L. Strauss, 1987, p. 27)1
What is Coding? Coding is defined by Saldhana2
Generally, as a beginner qualitative researcher
as marking the segments of data with symbols,
you will face the task of recording data via a variety
descriptive words, or category names. A code in
of methods (interviews, observation, field notes, etc.),
qualitative inquiry is most often a word or short
coding and categorizing (using a variety of clustering
phrase that symbolically assigns a summative,
and classification schemes), a�aching concepts to
salient, essence-capturing, and/or evocative a�ribute
the categories, linking and combining (integrating)
for a portion of language-based or visual data. The
abstract concepts, creating theory from emerging
data can consist of interview transcripts, participant
themes, and writing and understanding.
observation field notes, journals, documents,
Data analysis tends to be an ongoing and iterative literature, artifacts, photographs, video, websites, e-
(nonlinear) process in qualitative research. mail correspondence, and so on.

Throughout the entire process of qualitative An order to arrive at explanations of situations

data analysis it is a good idea to engage in memoing or processes, you need to systematically reduce the
(i.e., recording reflective notes about what you are complexity of the information you have e generated
learning from your data). The idea is to write memos in the qualitative data collection. While it is absolutely
to yourself when you have ideas and insights and central to qualitative research to create this complexity
to include those memos as additional data to be in the first place, it is nevertheless essential to reduce
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 107

it in order to arrive at generalized explanations. If you Searching for pa�erns in the data
want to find explanations linking conditions, effects,
Coding for pa�erns
and mechanisms, you need to systematically reduce
complexity and bring our data in a form that supports In larger and complete data sets, you will find
pa�ern recognition. that several too many of the same codes will be used
repeatedly throughout. This is natural and deliberate
• Data Analysis: The goal is to analytically
– natural because there are mostly repetitive pa�erns
reduce the data. The steps are:
of action and consistencies in human affairs, and
• Identifying and Identifying and locating raw data deliberate because one of the coder’s primary goals
• Structuring raw data: Indexing themes, Indexing is to find these repetitive pa�erns of action and
content, Extracting content consistencies in human affairs as documented in the
data.
• Searching for pa�erns in the data
• Integrating pa�erns Integrating pa�erns
• Coding Pa�ern can be characterized by:
Identifying and locating raw data • Similarity (things happen the same way)
In qualitative processes, collecting qualitative • Difference (they happen in predictably
data inevitably includes the creation of large amounts different ways)
of unnecessary information—things that were said,
wri�en, or recorded but have nothing to do with the • Frequency (they happen often or seldom)
research question. This “dilution” of—the data—is
• Sequence (they happen in a certain order)
necessary of qualitative data collection because to
assign a high degree of control of data generation to • Correspondence (they happen in relation to
respondents. Since the frames of reference and frames other activities or events)
of relevance of respondents are different from ours,
they will also communicate information we don’t • Causation (one appears to cause another)
need. This is why the first step of qualitative data Look for above mentioned characteristics in your
analysis often is to identify and locate the relevant data. These pa�erns are converted into codes.
raw data in the abundance of information created in
the data collection process. This first step is based on Coding
an interpretation of the text by the analyst. Depending
Coding as a System of Organizing Your Data
on interpretation, the analysts will regard different
parts of a text as relevant, and will link parts of texts Coding is a very old technique that has been
to different variables/categories. Criteria of relevance widely used for a long time to structure text (Kelle,
may of course change in the course of the analysis, 1997)3 One easy way to think about coding is to see
which may necessitate a return to the initial steps and it as a system to organize your data. In essence, it is a
a revision of previous decisions. personal filing system. You place data in the code just
as you would file something in a folder. A systematic
Structuring raw data: Indexing themes, Indexing
way to code data is to ask yourself the following
content Extracting content
content,
questions as you read the text:
Structuring raw data means detailing the link
1. What is this saying? What does it represent?
between the data and the research questions and
identifying links between data. The major tool for a. What is this an example of?
this step is a system of categories. Categories are thus
similar to variables because they, too, are constructs b. What do I see is going on here?
that can assume different states depending on the
c. What is happening?
empirical phenomena they describe.
d. What kind of events is at issue here?
108 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

e. What is trying to be conveyed? Themes Categories - are similar codes aggregated

together to form a major idea in the data base.
Most commercial and freeware software
packages for the support of qualitative data analysis Description - is a detailed rendering of people,
(e.g. ATLAS.ti, MAXQDA, and NVIVO) support places or events in a se�ing in qualitative research.
coding and only coding, thereby contributing to
9. Describing and developing themes from
its transformation into a disembedded standard
the data consists of answering the major research
technique of qualitative data analysis (Coffey,
questions and forming an in depth understanding
Holbrook & Atkinson, 1996).4
of the central phenomena through description and
Purpose of coding thematic development.

1. To make sense out of text data.

2. To divide text data into image segments,

segments to code. Collapse codes into themes.

Coding Data Fig 1. Levels of coding by Christopher Hahn7

Coding Example: My mother cares about me. She’s
Tesch (1990)5 and Creswell (2007)6
always STABILITY
1. Get sense of the whole.
been there for me, even when my father was not there.
2. Pick one document and ask the question She’s one of the few things that I hold as a constant in
what is this person talking about? my life. So it’s nice. I really feel comfortable around
her. “COMFORTABLE”
3. Sentences and paragraphs that relate to a
single code are called text segments. Themes

4. Codes are labels used to describe a segment Description of themes

of text or an image.
A theme is an outcome of coding, categorization,
5. Codes can address many different topics and analytic reflection.
such as – a. se�ing /context b. Perspective held by
Rossman & Rallis (2003)8 explain the differences:
participants. (Perspective – Ways of thinking about
”think of a category as a word or phrase describing
people and objects by participants.) c.
some segment of your data that is explicit, whereas
Processes (description) d. Activities e. Strategies f.
a theme is a phrase or sentence describing more subtle
Relationships and social structure
and tacit processes” As an example, SECURITY can
6. After coding an entire text, make a list of all be a code, but A FALSE SENSE OF SECURITY can be
code words. Group them and reduce them to a small a theme.
number of themes.
Layering and interrelating themes
7. Go back data, try and check whether new
Layering the analysis – 1st and 2nd order
codes emerge.
abstractions means representing the data using
8. Reduce the codes to get 5-7 themes. interconnected levels of themes.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 109

You subsume minor themes with in major themes Summarize findings

and include major themes with in broader themes. The overall in text is to provide readers with the
The entire analysis becomes more and more complex overview findings to complement the more details
as the researcher works upward toward broader and results in the description and theme passages.
broader levels of abstractions.
Convey personal reflection.
Interrelating themes
You base your personal interpretation based on
Inter connecting themes means the researcher hunches, insights and intuition. Because you have
connects the themes to display a chronology or been at it at greater lengths you will be in a position to
sequence of events so as to generate a theoretical and reflect and remark on the larger meaning of the data.
conceptual model.
e.g. Wolco� (1983)10 in the meaning of learning:
Representing Findings Learning – In the broad acculturative sense of
Qualitative researchers display their findings coming to understand what one needs to know to
usually (Miles and Huberman, 1994)9 by using figures be competent in the role one may expect to fulfill in
or picture that argument the discussion. Example is society rather than in the narrow sense of learning
as follows done at school is a ongoing process person engages
throughout a life time.
Make comparison to the literature.
Interpretative studies, the researcher interprets
the data in view of past research, which may support
or contradict the present study.
Offer limitations and suggestions for future
research.
Validation
1. Triangulation – It is a process in which the
Fig 2. A conceptual framework o n teacher’s belief and researcher asks one or more participants to study to
behavior with dropout students check the accuracy of the account.
Reporting findings 2. External Audit – A person outside to conduct
A narrative discussion is a wri�en passage in a thorough review of the study and report back in
qualitative study in which analyzer summarize in writing, the strength and weaknesses of the project.
detail the findings from the data analysis.

Format of presentation by Creswell6

Qualitative Format Quantitative Format

Title page Title page

Abstract, Introduction – Statement of problem Abstract , Introduction - – Statement of problem
The purpose and research question The purpose and research question/ Hypothesis
Delimitation and limitation Theoretical perspective
Procedure – Qualitative methodology and design Definition of terms
Research site and purposeful sampling Delimitation and limitations
Data analyses procedure ROL
Researches vote and potential ethical issue Methods: Study design, procedure, instrument,
Methods of validation preliminary findings – Reliability, validity, data analysis, preliminary results
Anticipated outcome ] ethical issue.
Time line, Budget and tentative ROL preliminary chapter Time line, Budget, preliminary chapter outline
outline
Reference and Appendices Reference and Appendices
110 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Summary: This paper dealt with the concept of and representations. Sociological Research
qualitative data analysis. Its aim was to make a new Online, 1(1), http://www.socresonline.org.uk/
researcher to understand and become comfortable socresonline/1/1/4.html [Accessed: March 12,
with the process of qualitative analysis. 2013].

Acknowledgement - Nil 5. Tesch, R. (1990). Qualitative research: Analyses

types and software tool. Bristol, PA: Falmer
Ethical Clearance- College ethical commi�ee press.

Source of Funding- Self 6. Creswell, J.W. (2007) Qualitative inquiry and

research design: choosing among five approaches
Conflict of Interest - Nil (2nd ed.) Thousand Oaks, CA: Sage

REFERENCES 7. Christopher, H. (2008). Doing Qualitative

Research Using Your Computer: A Practical
1. Anselm L. Strauss, Qualitative Analysis for Social Guide. Sage.
Scientists, 1987.
8. Rossman, G.B., and Rallis, S. F., (2003) Learning
2. www.sagepub.com/upm-data/24614_saldhana_ in the Field: An Introduction to Qualitative
ch_01.pdf Research. (2nd ed.) Thousand Oaks, CA: Sage.
3. Kelle, U. (1997). Theory building in qualitative 9. Miles, M.B. and Huber man, A.M. (1994).
research and computer programs for the Qualitative data analysis: A source book for new
management of textual data. Sociological Research methods (2nd ed.) Thousand Oaks, CA: Sage
Online, 2(2), http://www.socresonline.org.uk/
10. Wolco� H.F. (1983). Adequate schools and
socresonline/2/2/1.html [Accessed: March12,
inadequate education: The life history of a sneaky
2013].
kid. Anthropology and Education Quarterly, 14,
4. Coffey, Amanda; Holbrook, Beverly & Atkinson, 3-32.
Paul (1996). Qualitative data analysis: Technologies
 DOI Number:10.5958/0974-9357.2016.00058.1

A Descriptive Study to Assess the Knowledge Regarding

Nosocomial Infections among the Second Year GNM
Students in D. Y. Patil Institute of Nursing Sciences,
Kadamwadi, and Kolhapur, Maharashtra

Kiran Patil1, Surekha She�y1, Shailesh Sawanth2

Registered Pediatric Nurse, 2Registered Nurse, D. Y. Patil Institute of Nursing Sciences,
1

Kadamwadi, Kolhapur, Maharashtra, India

ABSTRACT

Aims & Objectives: • To assess the knowledge regarding nosocomial infection among second year G
N M students.

Methods: 50 second year GNM Nursing Students were selected by non-probability purposive sampling
technique. The knowledge regarding Nosocomial infections by using the structured knowledge
questionnaire. A single pre test approach was used. Data was analyzed by descriptive statistics.

Results and Conclusion: The finding of study reveals that majority of the 30(60)% had an average
knowledge, while 12(24%) had good and 8(16%) had poor knowledge about nosocomial infection.

Keywords: Assess, Knowledge, Nosocomial infections, GNM students.

INTRODUCTION recognized as crucial factors bedeviling the quality

The term nosocomial comes from the Greek and outcomes of health care delivery. Renewed effort
word nosokomeian, “nosos” meaning disease and geared towards education in terms of training and
“komeian” meaning hospital. Nosocomial infection retraining about standard infection control, as well as
is thus any infection causing illness that was not strict adherence by health care staff and students to
present, or in its incubation period, during the aseptic practice can reduce the extent of these risks.[2]
time of admission and includes those infections, Student nurses are often exposed to various infections
which occur after 48 hours of admission to the during their clinical education. Knowledge and
hospital1. Nosocomial infections also known as a compliance with standard precautions is essential
Hospital Acquired infection, is an infection whose to prevent hospital associated infections and protect
development is favored by a hospital environment, patients as well as medical workers from exposure to
such as one acquired by a patient during a hospital infectious agents.[3] Healthcare associated infections
visit or one developed among hospital staff. Such are responsible for significant morbidity and late
infections include fungal and bacterial infections mortality. Thus nurses plays important in prevention
and are aggravated by the reduced resistance of of infection. This mainly focuses on assessing the
individual patients1. knowledge related to nosocomial infection.

Health care-associated infections have long been PROBLEM STATEMENT

“A Descriptive study to assess the knowledge

Corresponding author:
regarding Nosocomial infections among the second
Surekha She�y
year GNM students in D. Y. Patil Institute of Nursing
([email protected]), Registered Pediatric Nurse,
Sciences, Kadamwadi, and Kolhapur, Maharashtra”
Shailesh Sawanth, ([email protected]) Registered
Nurse, D. Y. Patil Institute of Nursing Sciences, OBJECTIVE: 1. To assess the knowledge
Kadamwadi, Kolhapur, Maharashtra, India regarding nosocomial infection among second year
112 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

G N M students. FINDINGS
ASSUMPTION: This study assumes that Part 1: Description of demographic characteristics of
nursing students.
nursing student possess some knowledge regarding
prevention of nosocomial infection. This part deals with distribution of participants
according to their demographic characteristics. Data
MATERIAL & METHOD was analyzed using descriptive statistics and are
summarized in terms of percentage.
In view of the nature of the problem under
study and to accomplish the objectives of the
study, descriptive survey approach was found to
appropriate to describe the knowledge on nosocomial
infections among second year GNM students. The
study participants were selected by Non probability
purposive sampling technique. 50 nursing students
were selected from 2nd year GNM students at D.Y
Patil Institute of Nursing Education, Kolhapur.
Tool was prepared on the basis of the objectives of
the study. A closed ended structured knowledge
questionnaire was prepared to assess knowledge of
Figure1; Cylinder diagram showing the age wise
second year GNM students. The questionnaire has
distribution of nursing students.
2 sections. Section A: Questionnaire focused on
The above diagram shows the distribution of the
Personal Data and Section B: structured knowledge
nursing students according to age where in majority
Questionnaire focused on nosocomial infections and
60% students were above 22 year old, 05 % were 21 -2
it consists of 30 multiple choice questions. Data was
2 year old and 35 % knowledge were 19-20 year old.
analyzed by Descriptive statistics for summarizing
empirical information.

Data will be analyzed by following steps

o Organizing the data in master sheet
o Frequency and percentage of data will be
calculated for describing demographic variables
o Mean; mean percentage and standard
deviation was used to present the knowledge scores
on nosocomial infections. Figure 2: Pie diagram showing the gender wise
distribution of nursing students.
o Analyzed data will be presented in the form
The above diagram shows the distribution of the
of tables and diagrams
samples according to Gender, where in majority 90%
In order to achieve the objectives of the study were female and 10 % were male.
opinion from statistician, guide and experts was
taken to categorize the samples according to their
knowledge.

Interpretation of knowledge scores:

S.no. Category Level of Knowledge

1.
Adequate knowledge 65 - 100%
2.
Moderate knowledge 35 - 65%
Figure 3: Cone diagram showing distribution of based on
3. Educational background.
Inadequate knowledge 0 - 35%
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 113

The above diagram shows the distribution of the RECOMMENDATIONS

nursing students according to previous educational
background 3% were from science, 36% were from Based on the findings of the study the following
arts, 52% were from commerce. recommendations were made

Part II: Analysis of existing knowledge of nursing • The study can be replicated among staff nurses.
students regarding nosocomial infection. • The experimental study can be replicated with
intervention and control group.
• Comparative study can be done between staff
nurses and student’s nurses.
• A descriptive study can be conducted to find out
the nature of problems related to nosocomial
infections in newborn.
• A similar study may be replicated on the large
sample for wider generalization.

Figure 4: Pie diagram showing distribution of level of

CONCULSION
knowledge
The preventive and promotive aspect of the health,
Above diagram shows that assessment of the student nurse must be competent and responsible to
knowledge of 2nd year GNM students reveals that promote health information and practice good health
majority of the students 30 (60) % had an average for patient and health professionals. So educational
level of knowledge while 12 (24%) had good and 8 sessions can influence on knowledge and can prevent
(16) % had poor knowledge on nosocomial infection nosocomial infection at hospitals.
DISCUSSION Acknowledgement: Sincere gratitude to Principal
and Vice Principal of D.Y Patil Institute of Nursing
The present study has been under taken to assess
Education and warm appreciation to all participants
the knowledge of 2nd year GNM students regarding
of the study.
nosocomial infection at selected college, Kolhapur,
Maharashtra. The data was collected from 50 nursing Source of Funding – Self
students and analyzed by descriptive statistics. The
results shows that in Pre test knowledge majority Conflict of Interest Statement: There is no
of the students 30 (60) % had an average level of conflict of interest exists in this study.
knowledge while 12 (24%) had good and 8 (16)% had
Ethical Clearance: The investigator obtained the
poor knowledge on nosocomial infection.
ethical clearance from the college research and ethical
A Similar descriptive study conducted by commi�ee prior to the study. The full information
Prathibha D”Souza.V & Umarani. J to assess the was provided to participant regarding the study and
knowledge of final year B.Sc. nursing students confidential. After that the consent was obtained
regarding prevention of nosocomial infection in from the participants about their willingness to
pediatric wards in selected colleges of Mangalore, undergo the study.
India is supporting the findings of present study
REFERENCE
and the results shows that majority (88%) of students
had moderate level of knowledge, only (12%) had 1. Chaudhuri A. K. Infection control in hospitals:
adequate knowledge and none of them were had has its quality-enhancing and cost-effective role
inadequate knowledge on prevention of nosocomial been appreciated? J Hosp Infect. 1993;25(1):
infection in paediatric wards. The overall mean 1–6. [PubMed]
knowledge score found was (84.63%) and there was
2. Kennedy M, Burne� E: Hand hygiene knowledge
no significant association between level of knowledge
and a�itudes: comparisons between student
and selected demographic variables. [ 7]
nurses.J InfecPrev 2011, 12(6):246-250. Leodoro
114 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

J. Labrague, Rheajane A. Rosales, Maricel M. in Ghana” Int J Gen Med. 2011; 4: 571–574.
Tizon; Knowledge of and Compliance with 5. Leodoro J. Labrague, Rheajane A. Rosales,
Standard Precautions among Student Nurses; Maricel M. Tizon; Knowledge of and Compliance
International Journal of Advanced Nursing with Standard Precautions among Student
Studies, 1 (2) (2012) ;84-97. Nurses; International Journal of Advanced
3. Naregal PM, Mohite VR, Hiremath P et. Nursing Studies, 1 (2) (2012) ;84-97.
al. Effectiveness of SIM (self instructional 6. Malihe Asadollahi, Mohammad Arshadi
module) on knowledge regarding prevention of Bostanabad, Mahnaz Jebraili, Majid Mahalle,
nosocomial infection in NICU among nursing Alehe Seyyed Rasooli, Marzieh Abdolalipour,
students. Int J Health Sci Res. 2015; 5(4):190-196. Nurses”Knowledge Regarding Hand Hygiene
4. Ajediran I Bello, Eunice N Asiedu, Babatunde and Its Individual and Organizational
OA Adegoke, Jonathan NA Quartey, Kwadwo Predictors”, Journal of Caring Sciences, 2015,
O Appiah-Kubi, Bertha Owusu-Ansah, 4(1), 45-53.
“Nosocomial infections: knowledge and source of 7. Prathibha D”Souza.V & Umarani.J , “awareness
information among clinical health care students of students on prevention of nosocomial infection
in pediatric wards,” International Journal of
Pharmacy and Biological Sciences; 4(2), Apr-Jun
(2014);66-71.
 DOI Number: 10.5958/0974-9357.2016.00059.3

Assessment of Knowledge among Caregivers on Safe

Feeding Practice in Infants Admi�ed in Pediatric Medical
Ward of a Tertiary Care Hospital

P Sinu1, Anitha Zacharias2

1
Post Graduate Student, 2Assistant Professor, Department of Medical Surgical Nursing, Amrita College of Nursing,
Amrita Vishwa Vidyapeetham Health Science Campus, Amrita Institute of Medical Sciences AIMS, Kochi-41, India

ABSTRACT

A descriptive study was undertaken to assess the knowledge of the caregivers of infants about the
safe feeding practice in a tertiary care hospital at Ernakulum. This study was aimed to determine
the knowledge among caregivers on safe feeding practice n infant as well as to identify relationship
between knowledge and selected demographic variables.. A quantitative research approach has been
used. The data was collected using socio demographic profile and self administered knowledge
questionnaire among caregivers of infants admi�ed in a tertiary care hospital. The data was analysed
using descriptive (frequency, percentage) and inferential (Fishers exact probability test) statistics.
Among 30 caregivers 86.7% (26) have average knowledge and 13.3% (4) have poor knowledge. There
is no significant association between knowledge of the care givers and selected demographic variables.
The investigation of knowledge of caregivers warranty’s the improvement of health of the infants
admi�ed with illness.

Keywords: Knowledge, safe feeding practice, caregiver, infant.

INTRODUCTION conducted by RW Byard, V Gallard on safe feeding

practice in infant and young children. Admission
Children are vulnerable to various illness due to of children to the health care institute due to food
their low immune power. If articles used for feeding induced airway obstruction. Asphyxia due to
a baby are not sterilized; virus, bacteria and parasite aspiration of feed that put forth the need of health
can gather and make the baby sick. Baby may develop education about safe feeding practice in parents4.
any illness from mild thrush to bout of vomiting and
diarrhoea1. According to statistics in India 26% of the Emphasizing benefits of breast feeding, promoting
illness in infants contributes to diarrhoea2. prepared foods and educating food preparers.
Resolution of water and food safety problem
Researches reveal that food contamination requires a collaborative interdisciplinary approach
causes serious illness in infants that increases the among health professionals and involvement of
infant mortality rate :Marino DD, conducted a community5.
study on water and food safety in the developing
world; global implications for health and nutrition of It is important to remember that the food
infants and young children(2007;Nov). Contaminated handling practices are used to prevent all food
food and water are the major causes of mortality poisoning diseases. Washing your hands with soap
and malnourishment. The strategies identified to and drying them on a paper towel or with a clean cloth
prevent diarrhoea in children are implementing low is the best way to stop the spread of bad bacteria6.
technology sanitizing water3. A similar study was
Health workers conducting infant feeding
Corresponding author: education is necessary to eradicate illness in infants,
P Sinu need to be aware of the infant feeding practices and
Email: [email protected] infant feeding beliefs held by their target group7.
116 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

MATERIALS & METHODS

The present study was aimed at determining

the knowledge of caregivers of infants admi�ed in a
tertiary care hospital, quantitative research approach
was found to be most appropriate. Descriptive design
was used to accomplish the aim of the study. The
study was conducted in the paediatric ward of a
tertiary care hospital, Kochi.

A convenience sampling technique was used Figure 1: Level of knowledge of caregivers on safe feeding
to recruit the sample. 30 samples were used. The practice.
reliability was analyzed by means of Cronbach’s The graph shows that 4% of subjects had poor
alpha and yielded reliability coefficients of as 0.939 knowledge,86.7 % had average and none of them had
and content validity index of 0.9.. The tools used good knowledge.
for the study were socio demographic profile of the
caregivers that deals with demographic variables Section: II Item wise analysis of safe feeding
such as Age, relationship, educational status, practice
occupation, number of children , types of family,
Table 1: Item wise analysis of the knowledge
age of the child. A semi structured questionnaire to
score with respect to components of semi- structured
assess the knowledge of the caregivers were of 25
questionnaire n = 30
in number, out of which 3 questions were from safe
utensils,2 from safe water, 5 from safe preparation of Mean
feed and 15 from safe feed. The knowledge level were Items Mean Median SD
%
been interpreted as 1 to 10 score is poor knowledge,
Safe Utensils 1.17 1 38.9 0.913
11 to 15 is average knowledge and 16 to 25 is good
knowledge. Safe Water 1.03 1 51.7 0.615

Data collection was done, after obtaining ethical Safe Preparation

1.87 2 37.3 1.137
clearance from the Thesis review commi�ee of AIMS. of Feed
Formal permission from the Head of paediatric Safe Feed 7.10 7 47.3 1.954
department. Then, the investigator visited the
paediatric ward on the given date and the purpose of Overall
11.17 11 44.7 2.052
the study was explained to the subjects. Assurance Knowledge
was given to the subjects that confidentiality would
be maintained and then assent was obtained before The subjects mean scores and mean percentages
conduction of the study. The tools were administered of scores in relation to various components of
and it took about twenty minutes to collect the data the semi structured questionnaire on level of
from a sample. Sample selection criteria were those knowledge. It is evident from the table that the
caregivers of infant admi�ed in the pediatric ward subjects have limited knowledge about safe utensils,
and who were available at the time of data collection. preparation of feed respectively, Where as highest
knowledge is evident in the area of safe feed.
RESULTS
Section III: Association between level of
In this section, statistical analysis and knowledge and selected demographic variables
interpretation of collected data were organized under
three sections.

Section: I Level of knowledge of caregivers on

safe feeding practice
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 117

Table 2: Association between level of knowledge among the caregivers and selected demographic
variables.

Sl.No Demographic knowledge level Total P-value

Variable poor average

1) Age of caregiver
18-23yrs 1(20%) 4(80%) 5
24-29yrs 1(5.6%) 17(94.4%) 18 0.254ns
30-35yrs 2(33.3%) 4(66.7%) 6
Above 35yrs 0% 1 (100%) 1
2) Educational status
Primary 0% 3(100%) 3
High school 4(16.7%) 20(83.3%) 24 0.990ns
Higher secondary 0% 2(100%) 2
Graduate 0% 1(100%) 1
3) Occupational status
Home maker 0% 14(100%) 14
Private Employee 4(26.7%) 11(73.3%) 15 0.166ns
Business 0% 1(100%) 1
4) Number of children
One 1(6.3%) 15(93.8%) 16
Two 3(23.1%) 10(76.9%) 13 0.393ns
More than three 0% 1(100%) 1
5) Type of family
Nuclear 3(11.5%) 23(88.5%) 26
Joint 1(25%) 3(75%) 4 0.454ns
6) Age of the child
6-7months 2(10%) 18(90%) 20
8-9months 2(25%) 6(75%) 8 0.667ns
10-12months 0% 26(86.7%) 2

ns= not significant *= p <0.05 , using Fisher exact test **= p<0.01

The calculated fishers exact test value in case status. One of the reason for illness in children may be
of association between the caregivers demographic due to lack of knowledge among caregivers.
variable and knowledge level, from that it is evident
that there is no significant relationship between the Acknowledgement: I owe my profound gratitude
demographic variables and the knowledge level. to Dr. Sasidharan Head of the pediatric department,
AIMS, Kochi and all the caregivers of children
CONCLUSION admi�ed in the pediatric ward, AIMS for their co-
operation and valuable feedback.
About 86.7% of caregivers are with average
knowledge level. The knowledge of the caregivers Source of Funding : Self
play a vital role in the prognosis of the child’s health
Conflict of Interest : Nil
118 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

REFERENCE 4. RW Byard, V Gallard, Safe feeding practice in

infant and young children. 2015 jan5:32,327-
1. United States department of health and 329. Available from h�p://www.researchgate
human service. Available from h�p:// 14359956.
www.archive.ahrq.gov
5. Infant feeding choice: Available from h�p://
2. WHO world water day report. Available from www.science.gov.
h�p://www.who.int.com
6. Food poisoning in children. Available from h�p:
3. Marino DD, water and food safety in the //www.health.gov.au
developing world; globle implication for
7. Disease caused by unhygienic habits. Available
health and nutrition in infant and young
from h�p://www.academic.edu
children.2007 nov;14(2):14-8. Available from h�p:
//www.research gate.net/publication/5882322.
 DOI Number: 10.5958/0974-9357.2016.00060.X

A Quasi Experimental Study to Assess the Effect of

Structured Teaching Programme on Knowledge Regarding
Nomophobia among Students of Selected Colleges in
District Jalandhar, Punjab

Priyanka Thakur1, Kishanth Olive2

1
Student, 2Assistant Professor, Department of Psychiatric Nursing, S.G.L. Nursing College, Semi, Jalandhar, Punjab

ABSTRACT

Background of the study:-Nomophobia is a relatively new phenomenon which literally refers to “no-
mobile phones- phobia” means fear of being out of mobile phone.Nomophobia is an overwhelming
fear of being out of mobile phone which causes anxiety when separated from phone, compulsive
checking of phone for messages or ba�ery life.

Objective

1. To assess the pre test knowledge score regarding Nomophobia among students in control and
experimental group.

2. To assess the post test knowledge score regarding Nomophobia among students in control and
experimental group.

3. To compare the pre test and post test knowledge score regarding Nomophobia among students in
control and experimental group.

4. To find out the association between post test knowledge score regarding Nomophobia among
students and selected socio-demographic variables in control and experimental group.

Research Methodology: Quasi Experimental (Non Equivalent Pre Test Post Test Control Group)
research design was used in the study. The sample size was 100 college students and was selected from
selected colleges of District Jalandhar, Punjab using Convenience sampling technique.

Result and Conclusion: The Pre test mean knowledge score of experimental group was 8.02 and Post
test mean knowledge score was 18.14. The Pre test mean knowledge score of control group was 7.98
and Post test mean knowledge score was 7.78. The significant difference between pre test and post
test knowledge score was 21.451* inexperimental group so research hypothesis (H1) was accepted at
p<0.05 level of significance. Hence, it was concluded that structured teaching programme was useful in
providing knowledge regarding Nomophobia.

Keywords: “Knowledge” “Nomophobia” “students” “selected colleges”.

INTRODUCTION psychological syndrome in which person is having

an overwhelming fear of being out of contact through
Nomophobia is a new phenomenon which refers
mobile phone which causes physical side effects
to “no-mobile phones- phobia” means fear of being
such as panic a�ack, shortness of breath, dizziness,
out of mobile phone.The term Nomophobia was
trembling, sweating, accelerated heart rate, chest
coined during a 2008 study by the UK Post Office
pain and nausea.1People, especially teenagers get
who commissioned YouGov. Nomophobia is a
120 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

very anxious when they lose their mobile phone, The second objective revealed that post test
run out of ba�ery or credit or due to less network knowledge score after administration of structured
coveragewhich adversely affects the concentration teaching programme in experimental group was
level of the person. 2 76% of students had good knowledge score, 24%
had average knowledge score and no one had poor
According to Dr. David Greenfield, an Assistant
knowledge score. Among control group, majority
Clinical Professor of Psychiatry at the University of
(60%) of the students had poor knowledge score
Connecticut School of Medicine, an a�achment to your
followed by average knowledge score (40%).
mobile phone is similar to other addictions in that it
involves a dysregulation of dopamine. Dopamine is According to third objective in present study
a neurotransmi�er that regulates the brain’s reward comparison, the post test mean knowledge score
center, meaning that it motivates people to do things 18.14 in experimental group was higher than post
they think they will be rewarded for doing. Every test mean knowledge score 7.78 in control group
time person get a notification from his mobile phone, and it was statistically significant at p<0.05 level as
there’s a li�le elevation in dopamine that says person calculated ‘t’ value (t=21.581*) was more than the
might have something that’s compelling, whether table value at p<0.05 level of significance.
that’s a text message from someone he like, an email,
The fourth objective revealed that in control group
or anything. 3
significant association were found in post test with
The emerging trend of mobile phones into college gender and monthly family income variable whereas
student’s life had made them to depend so heavily in experimental group, significant association were
on their mobile phone. The addictions on mobile found in post test with age and education pursuing.
phones of college students include behavior such
as obsessively checking on their phones if there are
CONCLUSION
missed calls, text messages, emails or updates, feeling A total number of 100 samples were selected
anxious when there is poor reception of network, for this study. The Pre test mean knowledge score
feeling panic when one cannot find his or her mobile of experimental group was 8.02 and Post test mean
phone, feel insecure when there is exhaustion of knowledge score was 18.14. The Pre test mean
ba�ery of mobile phones and etc (Peraza, 2012).4 knowledge score of control group was 7.98 and Post
test mean knowledge score was 7.78. The significant
MATERIALS & METHOD
difference was 21.451* in experimental group,
This study was conducted in college students research hypothesis was accepted at p<0.05 level of
in different colleges of district Jalandhar .i. e. A.P.S. significance and null hypothesis was rejected. Age
College of Nursing, C.T. Institute of Technology, and education pursuing had impact on knowledge
D.A.V. College and S.B.B.S. Institute of Engineering, regarding Nomophobia among college students.
Jalandhar, Punjab, India. Quasi - Experimental Hence, it was concluded that structured teaching
Design (non equivalent pre-test, post-test control programme was useful in providing knowledge
group design) was adopted and a total of 100 college regarding Nomophobia.
students were selected for the study, who met
the inclusion criteria. Self-structured knowledge
DISCUSSION
questionnaire was used to assess the knowledge of The first objective was to assess the pre test
college students regarding Nomophobia. knowledge score regarding Nomophobia among
college students. The findings of the present study
RESULTS
revealed that in control group, majority (68%) of
The first objective revealed that in control group, students had poor knowledge score followed by
majority (68%) of students had poor knowledge score, average knowledge score (32%). Among experimental
followed by average knowledge score (32%). Among group, majority (72%) of the students had poor
experimental group, majority (72%) of the students knowledge score, followed by average knowledge
had poor knowledge score, followed by average score (28%).
knowledge score (28%).
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 121

According to second objective in the present study brothers and sister and co-guide Ms. Amritpal
structured teaching programme was implemented Kaur and my friends for their constant support and
through lecture-cum-discussion method, and with encouragement.
audio-visual aids. After that post test findings of the
present study revealed that in experimental group
ETHICAL CONSIDERATIONS
76% of students had good knowledge score, 24% 1. Wri�en permission was taken from Principal,
had average knowledge score and no one had poor S.G.L Nursing College, Semi, Jalandhar, Punjab.
knowledge score. Among control group, majority
2. Ethical Clearance was taken from the Ethical
(60%) of the students had poor knowledge score,
Clearance Commi�ee of S.G.L. Nursing College Semi,
followed by average knowledge score (40%).
Jalandhar, Punjab.
In present study comparison, the post test mean 3. Wri�en permission was taken from Principals
knowledge score 18.14 in experimental group was of selected colleges i.e. A.P.S. College of Nursing, C.T.
higher than post test mean knowledge score 7.78 Institute of Technology, D.A.V. College and S.B.B.S.
in control group and it was statically significant at Institute of Engineering, Jalandhar, Punjab.
p<0.05level as calculated ‘t’ value (t=21.581*) was more 4. Wri�en informed consent was taken from
than the table value at p<0.05 level of significance. It each study sample.
showed that the post test of control and experimental
were significantly related. Pre test and post test of 5. Confidentiality and Anonymity of samples
experimental group were also significantly related as were maintained throughout the study.
calculated ‘t’value (t=21.451*) was more than the table
Source of Funding: Self
value at p<0.05 level of significance.
Conflict of Interest: Nil
The fourth objective was to find out the association
between knowledge score regarding Nomophobia REFERENCES
among college students and their selected socio
demographic variables .Present study revealed that 1. All about counseling.com. Nomophobia. 2008. A
in control group significant association were found vailable at http://www.allaboutcounseling.com/
in post test with gender and monthly family income library/nomophobia/
variable whereas in experimental group, significant 2. Janssen Cory. Nomophobia. Available at ht
association were found in post test with age and tp://www.techopedia.com/definition/28392/
education pursuing. nomophobia
3. Altaffer Mary. Smatphone Addiction Now
The finding of study were supported by Abraham
Has A Clinical Name. Available at h�p://
Nidhin, Mathias Janet, Williams Sheela (2014) to
www.businessinsider.in/Smartphone-Addiction-
assess the knowledge and effect of Nomophobia
Now-Has-A-Clinical-Name/articleshow/
among 200 students of selected degree colleges in
39375114.cms
Mysore, Karnataka. The results shown that majority
(83%) of the sample were 18-20 years of age, 41.5% of 4. Peraza, Mercola. Literature Review technology
them were interested in mobile games and 59.5% of And Communication English Language Essay.
the sample had never heard the term Nomophobia. It 2012. Available at h�p://www.ukessays.com/
was concluded that majority (89.5 %) of students had essays/english-language/literature-review-
poor knowledge and half (51%) of them had moderate technology-and-communication-english-
effect of Nomophobia.5 language-essay.php
5. Abraham Nidhin, Mathias Janet, Williams Sheela.
Acknowledgement: I want to express my
Asian Journal of Nursing Education and research
gratitude especially to the Principals of the colleges,
. 2014; 4(4):421-428. ISSN-2231-1149. Available at
who allowed me to conduct study and the subjects
http://www.indianjournals.com/
those who participated in the study. I also want
ijor.aspx?target=ijor:ajner&volume=4&issue=4&a
to thank my affectionate and adoring Parents,
rticle=008
 DOI Number: 10.5958/0974-9357.2016.00061.1

A Study to Assess the Effectiveness of Structured Teaching

Programme on Knowledge and Practice Regarding ET
Tube Suctioning among Pediatric ICU Staff Nurses in
Selected Hospital at Bangalore

Vinayaka A M1, Sheela Bernet2

Assistant Professor, Department of Pediatric Nursing, Geetanjali College of Nursing, Udaipur, Rajasthan,
1

2
Vice-Principal & HOD Department of Pediatric Nursing, Narayana Hrudayalaya College of Nursing, Bangalore

ABSTRACT

The management of endotracheal tubes covers a large part of work time of nurses involved in the
care of children. These procedures, although continuously performed, have not yet been scientifically
demonstrated. At many times nurses rely on deterioration in the patient’s condition to indicate when
suctioning is required. Hence practice guidelines and education is necessary for pediatric ICU staff
nurses on ET tube suctioning. Keeping this in mind, a quasi-experimental study was undertaken
to assess the effectiveness of structured teaching programme regarding ET tube suctioning among
pediatric ICU staff nurses in selected Hospital at Bangalore.

Methods: In this study quasi-experimental one group pretest pos�est research design was adopted.
The structured knowledge questionnaire and observational checklist was developed to collect the data.
The samples were selected by using simple random sampling technique and data collection was carried
out among 30 pediatric ICU staff nurses in selected hospital, Bangalore. Later pre-test & post-test was
conducted before and after structured teaching programme. The data collected was analyzed.

Results: Results showed that the pretest mean knowledge score was 18.60, pos�est mean knowledge
score was 29.40, and the pretest mean practice score was 22.07, pos�est mean practice score was 26.93.
The significance of the findings was obtained by using paired‘t’ test, the value of pretest and pos�est
of knowledge and practice was 12.565 (P<0.001) and 13.978 (P<0.001) respectively, emphasizing the
significant improvement. The study also revealed that there was no association found between the
mean pretest knowledge and practice score with selected baseline variables.

Conclusion: The study concluded that there was a significant gain in knowledge and practice among
pediatric ICU staff nurses following a structured teaching programme.

Keywords: Structured teaching programme, Knowledge, Practice, Pediatric ICU staff nurses, Endotracheal
suctioning

BACKGROUND OF THE STUDY For good breathing airway patency is necessary.

Normally, children and babies will keep their airway
“For breath is life, and if you breathe well you
patency clear by coughing, sneezing, blowing their
will live long on earth.”
noses and by the protective mechanisms of the gag
- Sanskrit Proverb
reflex. Where as in intubated child airway patency is
Corresponding author: achieved through the intervention of endotracheal
Mrs. Sheela Bernet M.Sc (N) suctioning, which is a necessary prerequisite for
Vice-Principal & HOD Department of Pediatric patient on mechanical ventilator. ₍₁₎
Nursing, Narayana Hrudayalaya College of Nursing
Suctioning of an artificial airway (ET Tube) clears
Bangalore
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 123

the airway by removing pulmonary secretions, blood, highlights complex nature of nurses’ assessment of
vomitus, saliva or other foreign material, potentially the need for ETS and it has implications for training
improving oxygenation and ventilation. ₍₂₎ and Education of nursing staff. (5)

The main indications of ET tube suctioning are, Therefore developing a teaching programme
excessive secretions, desaturation, any obstruction for pediatric ICU staff nurses will help to improve
in the respiratory tract poor cough mechanism. knowledge and practice regarding ET tube
There are some conditions also that can cause over suctioning.
production of mucus like cystic fibrosis, tracheo-
esophageal fistula before surgery. After ENT and
OBJECTIVES
oral surgery child may bleed postoperatively may a. To assess the knowledge of pediatric ICU
required ET tube suctioning. (1) staff nurses regarding ET tube suctioning before and
after structured teaching programme.
However, ET tube suctioning is not a benign
procedure; which has associated risks like b. To assess the practice of pediatric ICU staff
cardiac dysarrhythmias, hypoxemia, atelectasis, nurses regarding ET tube suctioning before and after
bronchospasm, infection, trauma to the mucosal structured teaching programme.
linings and cilia of the airway, and increased
intracranial pressure.(3) c. To determine the effectiveness of structured
teaching programme on knowledge and practice
Despite the risks associated with suctioning, of pediatric ICU staff nurses regarding ET tube
failure to suction when needed can result in a plugged suctioning among staff nurses.
ETT and the trauma of reintubation, atelectasis, and
decreased oxygenation and ventilation. (2) d. To identify the association between pre-
test knowledge score of pediatric ICU staff nurses
Also there is limited evidence regarding several regarding ET tube suctioning with selected baseline
points such as the frequency of endotracheal variables.
suctioning, the level of suction pressure, the duration
of suctioning, the depth of catheter insertion, e. To identify the association between pre-test
the sterility, and the use of normal saline during practice score of pediatric ICU staff nurses regarding
endotracheal suction. (3) ET tube suctioning with selected baseline variables.

Although many investigators have assessed the MATERIAL & METHODS

technique of endotracheal tube suctioning, the issue
In this study modified conceptual frame work
is how to assess? The need of ET suctioning remains
was used, which is based on Tobin, Wise and Hull’s
difficult. Study conducted at Edith Cowan University,
modified comprehensive model (1979) (Fig: 1). To
Australia, revealed that the assessment of the patient’s
accomplish the objectives of study qusi-experimental
clinical signs and symptoms is a complex process
one group pretest pos�est research design was
requiring skilled interpretation. It is a concern that
adopted. (Fig: 2)
many nurses rely on a deterioration in the patient’s
condition to indicate when suctioning is required. In this study, the structured teaching programme
A policy of suctioning is necessary to give clarity in on ET tube suctioning was the independent variable,
guidelines and for education of all staff. (4) knowledge and practice of pediatric ICU staff nurses
regarding ET tube suctioning were selected as the
In another study was conducted in children’s
dependent variable. Later 30 pediatric ICU staff nurses
cardiac Intensive care by Gilbirt M, which was aimed
were selected by using the simple random sampling
to investigate, how nurses in pediatric intensive
technique from the selected hospital, Bangalore.
care environment assess the need for endotracheal
suction. Results showed that large numbers of ETS After extensive review of literature the structured
were performed in response to an identified need knowledge questionnaire and observational checklist
based clinical signs and patient behavior. This study was developed as a tool, based on the subtopics in
124 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

the structured teaching programme. The structured Table 1: Description of baseline variables of
knowledge questionnaire consisted of 38 questions pediatric ICU staff nurses
on different knowledge variables and observational
checklist consisted of 34 practice variables of ET tube Sl.
Baseline Variables Frequency %tage
suctioning in children. No

Age
The content validity was obtained from the 10 1.
a) <25 yrs 26 86.66
experts in the field. The reliability of the tool was b) 25-35 yrs 4 13.33
calculated by doing split off method (r=0.71) for
questionnaire and by interrater method (r=0.79) for Educational
Qualification
observational checklist after pilot study. 2. 11 36.66
a) B.Sc nursing
18 60
After obtaining permission from the hospital b) GNM
1 3.33
authority, pre-test & post-test was conducted before c) P.B.B.Sc nursing

and after structured teaching programme. The data Years of experience

collected was analyzed and interpreted based on 3. a) <1 year 14 46.66
descriptive and inferential statistics. b) 1-3 year 14 46.66
c) 3-5 year 2 6.66
FINDINGS
In-service education.
4.
The findings of data was done in accordance with a) Yes 18 60
objectives of study and divided in following parts b) No 12 40

Part I: Description of baseline variables. Part II: Analysis of knowledge and practice score
of pediatric ICU staff nurses. This part consists of 4
Part II: Analysis of knowledge and practice score sections as follows:
of pediatric ICU staff nurses.
Ø Section A: Analysis of pre test and post
Part III: Evaluation of the effectiveness of test knowledge score of pediatric ICU staff nurses
structured teaching programme regarding ET tube regarding ET tube suctioning. N=30
suctioning.
Table 2: Analysis of pretest and pos�est
Part IV: Association of pretest knowledge levels knowledge percentage score of pediatric ICU staff
with selected baseline variables. nurses regarding ET tube suctioning.

Part V: Association of pretest practice levels with

Number of respondents
selected baseline variables.
Level of
Part I: Description of baseline variables: knowledge Pretest Pos�est
- As shown in table 1 greater percentages 86.66% (score)
(26) of subjects were in the age group of <25 years, Freq- Percen- Freq- percen-
uency tage uency tage
whereas 13.33% (4) were between 25-30 years of
age. In educational qualification 36.66% (11) of < 50% (Poor) 15 50 0 0
the respondents were B.Sc nursing, and 60% (18)
of the respondents were GNM and 3.33% (1) of 51-74%
15 50 10 33.33
(Average)
the respondent was P.B.B.Sc nursing. In Years of
experience 46.66% (14) had <1year experience, 43.33% 75% and
(14) had 1-3 years of experience and 6.66% (2) had 3-5 above 0 0 20 66.66
(Good)
years of experience in pediatric ICU. Where as in In-
service education 60% (18) of subjects have a�ended
The table 2 depicts that in pretest 15 (50%) subjects
the in-service education and 40% (12) subjects has not
had poor level of knowledge, 15 (50%) subjects had
a�ended the in-service education regarding ET tube
average level of knowledge and none of the subjects
suctioning.
had good level of knowledge, whereas in pos�est
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 125

20(66.66%) subjects had gained good level of knowledge, 10(33.33%) staffs gained adequate level of knowledge
while none had inadequate level of knowledge regarding ET tube suctioning.

Ø Section B: Mean, Standard Deviation, and mean percentage of the pretest and pos�est knowledge
score.

Table 3: Aspect wise pretest and pos�est knowledge score on ET tube suctioning. N=30

Subjects knowledge
Knowledge
variables Maximum
Mean Standard Mean percentage
Sl. No possible
aspect score Deviation score
score (38)
wise
Pre-test Post-test Pre-test Post-test Pre-test Post-test

Knowledge
1.
(Aspect 1) 5 2.77 4.40 0.971 0.621 55.4 88

Anatomy and
2. physiology.
6 3.03 4.67 1.245 0.758 50.5 77.83
(Aspect 2)

Indication.
3.
(Aspect 3) 5 2.40 3.73 1.003 1.202 48 74.6

Equipment
4.
(Aspect 4) 5 2.90 4.17 0.885 0.791 58 83.4

Preparation.
5.
(Aspect 5) 5 2.27 3.83 1.015 1.085 45.4 76.6

Procedure
6.
(Aspect 6) 8 3.30 5.53 1.149 1.717 41.25 69.12

Complication.
7.
(Aspect 7) 4 1.93 3.07 0.944 1.112 48.25 76.75

Table 3 shows that Pretest subjects obtained suctioning was 88% and obtained minimum mean
maximum mean percentage score in the aspect percentage score in the aspect related to Procedure
related to equipment regarding ET tube suctioning regarding ET tube suctioning was 69.12%.
was 58% and obtained minimum mean percentage
score in the aspect related to Procedure regarding ET Ø SECTION C: Analysis of pretest and
tube suctioning was 41.25%. Where as in the pos�est pos�est practice percentage score of pediatric ICU
subjects obtained maximum mean percentage score staff nurses regarding ET tube suctioning.
in the aspect related to knowledge regarding ET tube

Table 4: Analysis of pretest and pos�est practice percentage score of pediatric ICU staff nurses regarding
ET tube suctioning. N=30

Number of respondents
Level of practice
(score) Pretest Pos�est
Frequency Percentage Frequency Percentage
< 50% (Poor) 0 0 0 0
51-74% (Average) 30 100 2 6.66
75% and above (Good) 0 0 28 93.33
126 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

The table 4 depicts that in pretest none of the none had poor level of practice regarding ET tube
subjects had poor level of practice, 30 (100%) subjects suctioning.
had average level of practice and none of the subjects
had good level of practice, whereas in pos�est Ø SECTION D: Mean, Standard Deviation,
28(93.33%) subjects had gained good level of practice, and mean percentage of the pretest and pos�est
2(6.66%) staffs gained average level of practice while practice score.

Table 5: Area wise pretest and pos�est practice score on ET tube suctioning. N=30

Subjects skill
Mean Standard Mean percentage
Maximum score Deviation score
Sl. Practice variables possible
No area wise score (34)
Pre-test Post-test Pre-test Post-test Pre-test Post-test

Assessment
1.
(Area 1) 5 2.87 3.70 0.776 0.596 57.4 74

2. Preparation (Area 2)
8 6.13 7.40 0.681 0.675 76.62 92.5
Procedure
3.
(Area 3) 11 7.10 8.87 0.960 0.681 64.54 80.63
Post-procedure
4.
(Area 4) 10 5.97 6.97 0.890 0.615 59.7 69.7

Table 5 shows that Pretest subjects obtained mean percentage score in the aspect related to Post-
maximum mean percentage score in the aspect procedure regarding ET tube suctioning was 69.7%.
related to preparation regarding ET tube suctioning
was 76.62% and obtained minimum mean percentage Part III: Evaluation of the effectiveness of
score in the aspect related to assessment regarding ET structured teaching programme regarding ET tube
tube suctioning was 57.4%. Where as in the pos�est Suctioning.
subjects obtained maximum mean percentage score H1: The mean post-test knowledge score of
in the aspect related to Preparation regarding ET staff nurses who have received structured teaching
tube suctioning was 92.5% and obtained minimum programme will be significantly higher than their
mean pre-test knowledge score at 0.05 level.
Table 6: Comparison of pre test and post test knowledge score among the subjects.

Knowledge Mean Mean SD of Mean

Paired ‘t’ test value df Level of significance
score score difference difference

Pretest 18.60 0.000

10.80 0.859 12.565 29
Pos�est 29.40 Sig

Sig: significant accepted at 0.001 levels of significance.

The table 6 reveals that pretest mean score H2: The mean post-test practice score of staff
was 18.60, pos�est mean score was 29.40 with a nurses who have received structured teaching
mean difference of 10.80 and its SD of 0.859. The programme will be significantly higher than their
paired‘t’ test value is 12.565 at df=29 at <0.001 level of mean pre-test practice score at 0.05 level.
significance. Hence the formulated hypothesis (H1) is
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 127

Table 7: Comparison of pre test and post test practice score among the subjects.

Practice Mean Mean SD of Mean Paired ‘t’ test df Level of

score score difference difference value significance

Pretest 22.07 4.86 1.907 13.978

0.000
29
Pos�est 26.93 Sig

Sig: significant PART IV: Association of pretest Knowledge

practice levels with selected baseline variables.
The table 7 shows that pretest mean score was
22.07, pos�est mean score was 26.93 with a mean H3: There will be significant association between
difference of 4.86 and its SD of 1.907. The paired‘t’ test knowledge pre-test score with selected baseline
value is 13.978 at df=29 significant at <0.001 levels. . variables.
Hence the formulated hypothesis (H2) is accepted at
0.001 levels of significance.

Table 8: Association of Pretest knowledge score with their baseline variables N=30

Knowledge levels df
Sl. Fisher’s Chi-square
Baseline Variables Inference
No <40% exact value value
>40%

Age >0.05
5 21
1. a) <25 yrs
2 2 1 0.225 NS
b) 25-35 yrs

Educational Qualification
a) B.sc nursing
2. 9 χ2= 0.666 >0.05
2
b) GNM 2
5 13 P= 0.717 NS
c) PcB.sc 0 1

Years of experience
a) <1 year 1 13
3. χ2=5.643 >0.05
b)1-3 year 6 8 2
P= 0.060 NS
c)3-5 year 0 2

In-service education.
4. a) Yes
4 14 1 1.000 >0.05
b) No 3 9
NS

S- Significant NS- Non significant

The table 8 shows that there was no significant PART V: Association of pretest Practice levels
association between selected baseline variables with with selected baseline variables.
mean pretest knowledge score (p<0.05) of pediatric
ICU staff nurses regarding ET tube suctioning. H4: There will be significant association between
Therefore the research hypothesis (H3) was rejected. practice pre-test score with selected baseline
variables.
128 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Table 9: Association of Pretest practice score with their baseline variables N=30

Sl. skill levels df Fisher’s Chi-square

Baseline Variables Inference
No <60% >60% exact value value

Age
>0.05
1. a) <25 yrs 10 16 0.272
1 NS
b) 25-30 yrs 0 4

Educational Qualification
a) B.sc nursing
2. 4 7 χ2=0.545 >0.05
b) GNM
6 12 2 P=0.761 NS
c) PcB.sc
0 1

Years of experience
a) <1 year 5 9
3. χ2=1.071 >0.05
b)1-3 year 5 9 2
P=0.585 NS
c)3-5 year 0 2
In-service education
related to ET tube
4. suctioning
a) Yes >0.05
3 15 1 1.000
b) No NS
2 10

S- Significant NS- Non significant

The table 9 shows that, there was no significant Ethical Clearance - Taken from Ethical commi�ee
association between selected baseline variables with formed at Institution level
mean pretest practice score (p<0.05) of pediatric ICU
Source of Funding – Self
staff nurses regarding ET tube suctioning. Therefore
the research hypothesis (H4) was rejected. Conflict of Interest - Nil

CONCLUSION REFERENCES
1. Trigg E, Mohammed T A. Practices in children’s
Although endotracheal tube suctioning is a nursing. Philadelphia: Elsevier publisher Pvt Ltd;
hazardous procedure associated with numerous 2006
complications, it is mandatory procedure for
2. Heneretig F M, Chritopher M D. Textbook of
maintaining airway of intubated child. Due to this
pediatric Emergency procedures. Pennsylvania:
nature of the procedure it is imperative that pediatric
Williams & Wilkins publishers; 1997.
nurse should have thorough knowledge and skill
of the procedure. The study demonstrated that the 3. Kashef S. Evidence-Based Guideline for
structured teaching programme was effective in Suctioning the Intubated Neonate and Infant:
increasing the knowledge and practice regarding ET ETT Suctioning in Neonates and Infants.2004
tube suctioning among pediatric ICU staff nurses. Jan [cited in 2010 Jan19];5(2):73-8 Available from:
h�p://Md4rab.com
Acknowledgement: Sincere gratitude and 4. Davies K, Monterosso L, Leslie G. Determining
thanks to Prof. Dorothy Deena Theodore, - Principal, standard criteria for endotracheal suctioning
Asso Prof. Mrs. Priyalatha, - Research Coordinator in the paediatric intensive care patient: An
& HOD, Dept of Medical Surgical Nursing, Ass exploratory study,Inten and Crit Care nurs. 2011
Prof. Mrs Arulmozhi Baskarn P M, HOD, Dept of Apr; 27(2):85-93
Community health Nursing and the entire Pediatric
Nursing department faculty, Narayana Hrudayalaya 5. Gilbert M. Assessing the need for endotracheal
college of Nursing for their continuous guidance and suction, pediatr Nurs, 1999Feb; 11(1)14-7
support.
 DOI Number: 10.5958/0974-9357.2016.00063.5

Protein Energy Malnutrition among Children

Soja S L1, N Udaya Kiran2

Assistant Professor, Govt. College of Nursing, Ko�ayam, Kerala, 2Professor& HOD, Department of Community
1

Medicine, K.S. Hegde Medical Academy, Ni�e University, Deralaka�e, Mangalore

ABSTRACT

Protein energy malnutrition (PEM) previously termed protein calorie malnutrition has assumed
the position of being the leading cause of death directly or indirectly among children under five
years of age in the developing world in the past fourty years, in spite of our wide knowledge and
understanding of human nutritional requirements. A descriptive study was conducted among 109
under five children in Ko�ayam District. The main aim of the study was to determine the prevalence
of PEM, and its association with selected demographic variables. The study population consisted
of 109 under five children and their mothers a�ending selected anganwadiesofKo�ayam District,
during the period of data collection. Purposive sampling was used to select the samples. Data were
gathered by administering demographic proforma, observation record and dietary practice assessment
questionnaire. Among the samples 41.28% had grade I PEM. No significant association was observed
between protein energy malnutrition and age, gender, education of parents, occupation of parents,
monthly income, number of children and type of family.

Keywords : Protein Energy Malnutrition, Children – Soja.S.L

INTRODUCTION reduced work capacity, which in turn has an impact on

economic productivity of our Nation. Undernutrition
Protein energy malnutrition is the most common
among children varies greatly by mother’s education
form of nutritional deficiency among patients who
and household standard of living2.
are hospitalized in the developing countries. It is a
state of poor nutrition due to an insufficient or poorly Protein energy malnutrition (PEM) is a global
balanced diet to ill health and ill health contributes health problem, more prevalent in the developing
to further deterioration in nutritional status. These countries like India. It is a potentially fatal body
effects are most dramatically observed in infants and depletion disorder and is the cause of death in
young children, who bear the brunt of the onset of children in developing countries. It often starts in
malnutrition and suffer the highest risk of disability the womb and ends in the tomb. PEM is a disease
and death associated with it1. of multi deprivation and poverty, affecting nearly
150 million children under the age of five years in
Malnourished children who survive are
the world. Out of 120 million children in India, over
more frequently sick and show poorer scholastic
75 million are estimated to suffer from visible PEM.
performance, impaired intellectual and social
Almost half of children (47%) under three years
development. Childhood stunting leads to a significant
of age are underweight and among them 46% are
reduction in adult size. One of the consequences of
stunted. Severe underweight is observed for 18%
small adult size resulting from childhood stunting is
of children and severe stunting for 23%. Sixteen
percentage of children are excessively thin. Rural
Correspondence : children are much more likely than urban children to
Soja S L be undernourished3.
Assistant Professor, Govt. College of Nursing,
Ko�ayam, Kerala, Mob:09497661284, The prevalence varies across the States, and
E-mail :[email protected]. Kerala rates low (27%). This is to be viewed with
130 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

serious concern, and necessary steps are to be taken to rural India is even more alarming and is 90% as per
analyze the situation and arrive at feasible solutions. studies published by the Indian council for medical
Improved child health and survival are considered research (2001). The National Family Health survey
universal humanitarian goals. Understanding report show insignificant change in the prevalence
the nutritional status of children has far-reaching of iron deficiency anemia among adult women since
implications for the be�er development of future 1998.9
generations4.
India has the world’s largest number of
A study done by Rajaram, Sunil and undernourished infants and children,approximately
Zo�arelli (2003) to determine the nutritional status 61 million. Today, India has several programmesmeant
of children below 5 years and the confounding to overcome undernutrition. Yet in the given situation
factors that influence the nutritional status of children achieving the first millennium development
in two states of India, ‘Kerala and Goa’ showed goal(MDG) of eradicating extreme hunger and poverty
that the relative prevalence of under-weight and by 2015,remains unrealistic. ICDS , receives the major
wasting was high in Kerala, but the prevalence of share of funding. In most anganwadi centers food is in
stunting was medium. In Goa, on the other hand, the form of cooked meals for preschool children and
the relative prevalence of wasting and underweight macro/micronutrient powder for pregnant mothers
was very high, and that of stunting was high. Both and infants less than 2 years.Studies suggest that
socio-economic and family planning variables were nutrient powder is ineffective in meeting nutritional
significantly associated with malnutrition in these needs. Alternative and more effective methods are
states, but at varied levels5. needed to combat undernutrition.10

Majority of undernourished children can Objectives :

be treated effectively if the problem is detected
1. To determine the prevalence of protein
early. Identifying the risk factors associated with
energy malnutrition among children.
malnutrition helps in development of alternative
methods to combat its pathology. Protein energy 2. To determine the association of severity of
malnutrition continues to be significant problem for PEM and;
children and adults in India6.
2.1 socio demographic variables such as age,
The effects of PEM are multidimensional. The gender, education of parents, occupation of parents,
most important among them are reduced activity, monthly income and type of family.
reduced growth, increased susceptibility to infection,
reduced intellectual capability and performance, 2.2 child variables such as birth order, number of
reduced work efficiency and increased mortality7. children and immunization

Since malnutrition forms a major disease burden MATERIALS & METHODS

of childhood and constitutes about 50% of morbidity
In view of accomplishing the research objectives
and mortality among children, it is high time to take
descriptive survey approach was considered the
corrective and preventive actions to decrease the
best. The study population consisted of the children
burden on the country8. between 2-5 years who are a�ending in selected
It is estimated that anemia affects 1.62 billion anganwadies of Ko�ayam District, during the period
of data collection in 2013. Anganwadies were selected
people across the world. The figures from national
by systematic sampling and children were selected by
surveys show an alarming number of anemic
purposive sampling technique. Total sample size was
children and women in India . A third of the world’s
109.
anemic children live in India and close to two thirds
of pregnant Indian women are anemic . The reason The instruments used to collect data were
why there is anemia among these groups is the lack Demographic proforma and observation record. The
of bioavailability of iron, vitamin B12 and folic acid. demographic proforma consists of 2 parts. Part A,
The prevalence of anemia among adolescent girls in consists of 6 socio demographic items such as age,
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 131

gender, education of parents, occupation of parents, Description Of Demographic Characteristics

monthly income, and type of family. Part B-consists of
Table 1 : Frequency and percentage distribution
5 child variables such as number children, birth order
of sample characteristics with regard to
of the child, immunization, history of communicable
sociodemographic variables. n = 109
disease and type of diet.
SociodemographicVariables Freq-uency (f) (%)
The observation record consists of grades of
protein energy malnutrition as per weight for age Age in years

based on IAP classification. The score is divided into 2 - <3 32 29

five categories like Normal (>80%), grade I (71-80%), 3 - <4 55 51

4-5 22 20
grade II (61-70%), grade III (51-60%) and grade IV
Gender
(<50%).
Male 58 53
Procedure for data collection : The data were Female 51 47
collected from children studying in anganwadies Education of Father
and their mothers. The children and their mothers Illiterate 24 22
were contacted and administered the proforma and Primary level 32 29
the weight of the children were recorded in their Secondary level 36 33
respective anganwadies during working hours Diploma/Degree and above 17 16
according to their convenient time. Education of Mother

Ethical considerations : Wri�en permission was Illiterate 29 26.6

obtained from District ICDS officer and ICDS project Primary level 42 38.5
officer of E�umanoor block. The study proposal was Secondary level 23 21.1
presented to the ICDS district level officers and ethical Diploma/Degree and above 15 13.8
clearance was sought. Permission was also sought Occupation of Father
from the teachers of the anganwadies from where Physical worker 60 55 55
the subjects were selected. The researcher introduced Government Job 14 12.8
herself and the purpose of the study was explained Private Job 22 20.2
to the subjects and wri�en consent was taken. The Self employed 09 8.2
subjects were assured of the confidentiality of the Unemployed 03 03
information given. Social Service 01 01

Occupation of Mother
RESULTS
Physical worker 05 05
The gathered data were first coded and Government Job 29 26.6
summarized in a master sheet and then analyzed Private Job 35 32
using SPSS 20.
Self employed 19 17.4

Prevalence of Protein Energy Malnutrition Unemployed 21 19

Social Service 00 00

Average Monthly income of family

Rs> 20000-50000 0 0

Rs 19000-19999 0 0
Rs 5000-9999 15 13.7
Rs 2500-4999 25 23.
Rs 1000-2499 69 63.3
Type of family
Nuclear family 52 48
Joint family 33 30
Fig (1) : Bar diagram showing prevalence of protein
energy malnutrition Extended family 24 22
132 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Table 2 : Frequency and percentage distribution

Immunization 42 0.587 0.945
of sample characteristics with regard to Child
Completed
variables. n = 109
Not completed 10
percen-tage History of
Child Variables Frequency (f)
( %) communicable
Birth order of the disease
child Yes 17 1.472 0.755
First 21 19 No 35
Second 52 48 Type of diet
3rd or above 36 33 Vegetarian 01 4.896 0.477
Nonvegetarian 51
Number of children
in the family
DISCUSSION
One 08 7.3
In the present study the prevalence of protein
Two 46 42.2
energy malnutrition were 41.28% had grade I PEM,
Three 49 45
4.59% identified with grade II PEM, 1.83% had grade
More than three 06 5.5 III PEM. Similar finding is reported by Mukhopadhyay
Immunization (2013) where 35.9% children were under weight and
Completed 89 82 15.9% severely underweight. Stunting was found in
31.4% children and 15.1% were severely stunted11.
Not completed 20 18
Supportive findings are also reported by Saravanan
History of
(2013), who conducted an epidemiological study of
communicable
diseases malnutrition among under five children12. In this
study the prevalence of malnutrition as per the
Yes 40 37
weight for height index is more in the children of age
No 69 63
group of 13-24 (28.68%) and 49-60 moths (24.28%).
Type of diet Study conducted by Kumaramma (2013) tallies with
Vegetarian 01 01 the present study finding where the 44% of children
Non vegetarian 108 99 less than 2 years of age were malnourished, 23%.
16%, 4% belonged to grade I, grade II and grade III
Table 3 : chi-square value showing the malnutrition respectively13.
association between severity of PEM with respect to
The present study findings did not show any
Child variables. n = 109
significant association between severity of PEM and
Child Variable PEM P χ2 P value sociodemographic variables such as age, gender,
education and occupation of parents, monthly
Number of income, number of children, birth order and type of
Children
family at 5% level of significance. Study conducted
One 3 by Saravanan (2013), differs from the finding of
Two 27 3.959 0.271 the present study where female gender and poor
Three 20 (fishers exact) socioeconomic status were significant risk factors for
>Three 2 assurance of malnutrition in underfive children12.The
present study findings reveals an independent
Birth order association between severity of PEM and child
First 13 variables such as number of children, birth order of
Second 25 2.82 0.244 the child, immunization, history of communicable
Third/above 14 disease and type of diet. This contradicts the finding
of Kanani which reported that there is significant
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 133

association between protein energy malnutrition and proquest

child variables like birth order,birth spacing ,diet and 5. Elixebeth K E, Sathy N. The role of developmental
immunization14. stimulation in nutritional rehabilitation. J Indian
pediatric.1997;34(7):681-695
CONCLUSION
6. Sachdeva S, Amir A, Alam S, Khan Z, Khalique
Keeping in mind the results obtained in this N, Ansari MA. global developmental delay
study the investigator conclude that the prevalence of and its determinants among usban infants
protein energy malnutrition was high among under and toddlers ; A cross sectional study. Indian J
five children of the area studied. Multi pronged Pediatr. 2010;77(8):975-980
approach like maternal and child health care, nutriti
7. Kumar V, Chaudhry VP. From deficiency and
oneducation,growth monitoring etc will be beneficial
infection. Indian J pediatric . 2010; 77(7): 789-
to combat the problem of malnutrition among young
793.
children.
8. Gupta K, Bansal D, Mathi P, Das R.
Acknowledgement : Author is thankful to the Developmental Profile in Children with
teachers and helpers of the selected anganwadies, the crone deficiency anemia and its changes after
children and their mothers who have participated in thesapeutic crone supplementation. Indian J
the study willingly. Pediatr.2010; 77(4):375-379.

Ethical Approval: This research approved by 9. Prasad K, Kumar H. Combating malnutrition

ethical commi�ee of Ni�e University Mangalore. among mothers and children through people’s
Ethical consideration had obtained by taking nutritional formula. Kerala nursing forum.2009;
wri�en permission from the authority of the hospital 4(10):29-32.
and informed consent was obtained from the study 10. Roy SK, Jolly SP, Shafique S, Fuchs GJ,
samples for participating in the research. MuhmudZ,Chakraborty B and et al. Prevention
of malnutrition among young children in rural
Conflict of Interest : None
Bangladesh by a food health care educational
Source of Funding : Self Funding intervention: a randomized, controlled trial.
Food Nutr Bull.2007;28(4):375-83
REFERENCES
11. Mukhopadhyay DK, sinhababu A, Saren AB,
1. Arora RK, Arya N, Sarkar P. Shrivastava NM, Biswas AB. Association of child feeding practices
Khan N. Assessment of antioxidant Enzymes with nutritional of child feeding practices with
and trace elements status in children suffering nutritional status of under – two slum dwelling
from severe PEM in Western Madhya Pradesh. children: A community based study from west
Asian J Paediatric Practice.2012;14(3):7-10. Bengal, India. Indian J public health. 2013; 57 (3):
169-172.
2. Widespread child malnourishment in
India.Nightingale nursing times.2012:7(11):9 12. Sarvamangala K, Koujalgi MB, Manjunath TP.
Prevalence of anemia, morbidity and school
3. Health and nutrition profile of children in rural
absenteeism among lower primary of public
kerala: A call for an action (podcast on the
health research & development. 2014; 5(2):220-
internet) Munich personal Re PEC Archive; 2012
225
(cited 2012 fed 07). Available from: h�p;// mpra.
ub. uni -muenchen. de/27132 13. Kumaramma B. supplementary food for infants,
nightingale nursing Times. 2013; 9(6): 63-65
4. Malekafzali H, Abdollahi A, Mafi, Naghavi M.
Community based nutritional intervention for 14. Kanari S, Popat K. Growing Normally in an
reducing malnutrition among children under urban environment: Positive Deviance among
5 years of age in the Islamic republic of Iran. Slum Children of Vadodara, India. Indian J
Easter Mediterranean health J (Internet). 2011 Pediatric.2012;79(5):606-611.
(cited 2011 July 6) 6(2/3) ; 238-245. Available from;
 DOI Number: 10.5958/0974-9357.2016.00062.3

A Study to Assess the Knowledge on the Supplementary

Feeding among Mothers with Children age 6-24 Months
in Selected Rural Community at Mullana, Ambala

Rohitash Kumar1, Eenu 2, Neetu Dhanda3, Sharandeep Kaur4

1
Lecturer, UPRIMS & R Nursing College Saifai, Etawah U.P., 2Lecturer, M.M.CON, MMU Mullana, Ambala,
3
Lecturer, Rajan Hospital Yamuna Nagar, Student, Department of French & Francophone Studies, Punjab University

ABSTRACT

An evaluative study was conducted to assess the knowledge of mothers on supplementary feeding
who was having children aged 6-24 months in a selected rural community area at Ambala and also
to determine the association between pre test knowledge and baseline characteristics of mothers who
were having children aged 6-24 months.

Methods: An evaluative approach was used for the study. The research design was descriptive.
The sample comprised of 40 mothers who had children aged 6-24 months. The area was selected
by convenience sampling whereas subject was selected by purposive sampling technique. The data
collection was carried out from 13 May, 2010 to 21 May, 2010 under Primary Health Centre Mullana,
Ambala to conduct the study and informed consent was obtained from participants prior to the
collection process. Data was collected by administering the semi-structured interview schedule

Results: The results of this study revealed that a majority of the respondents had poor level of
knowledge (32.5%), (37.5%) had average, (15%) had good and (15%) had excellent knowledge on
supplementary feeding. The mean knowledge score of mothers was 15.9. The knowledge score of the
subjects on supplementary feeding was in range of 6-26. The mean ±S.D. of the knowledge score was 15.9
±3.48, and median was 16. It was concluded that the knowledge of mothers regarding supplementary
feeding had association with the baseline characteristics namely occupation of husband.

Conclusion: The findings of the study support the need for conducting health education, counseling
and mass awareness program on supplementary feeding to the public. Study proved that the mothers
had poor knowledge of supplementary feeding and there was an association between knowledge score
and baseline characteristics.

Keywords: Knowledge, Supplementary feeding, mothers with children age 6-24 months.

INTRODUCTION OR BACK GROUND child becomes malnourished2. Unhygienic feeding

practices may result in enteric infections and diarrhea,
Good nutrition is important at any time of further compromising the nutritional state3. A
development, but it is especially critical in infancy normal healthy baby requires 170 ml of milk per kg of
because the baby’s brain and body are growing so body weight till 6 months of age to get 120 kcal/ kg of
rapidly1. This is because 25% of infant’s total calories body weight4. During this period mother can secrete
intake is devoted to growth and extra calories are 450 – 600ml of milk to meet the demands, so for the
needed to keep rapidly developing organs of body first 6 months breast feed alone is sufficient for baby’s
functioning properly1, 8. It is a difficult period in requirements for normal growth and development5,
the infant’s life, because if the food supplements 6
. UNICEF recommends for supplementary feeding
or substitutes are not adequate in quantity and at about 6 months whereas delayed introduction of
quality, growth can be permanently stunted and supplementary food is known to cause malnutrition,
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 135

Protein Energy Malnutrition, Premature introduction headings:

of such foods exposes to the risk of infections and the
I. Baseline characteristics.
resultant morbidity and mortality7.
II. Knowledge of mothers.
Hence, mother should have knowledge about
supplementary feeding, parenting, immunization III. Association knowledge score of mothers with
and also be able to recognize the signs of malnutrition selected baseline characteristics
of infants. They must be aware of the normal
growth and development of infants and nutritional Section: I Baseline characteristics:
requirement of them at each stage.
Table 1: Frequency and percentage distribution
MATERIAL & METHODS of sample characteristics

“A Study to assess the knowledge on the S. Demographic

Freq-uency %
No. Variables
supplementary feeding among mothers with
1) Age (in years)
children age 6-24 months in selected rural a) 18-25 20 50
community at Ambala.” b) 25- 30 18 45
c) 30- 35 2 5
OBJECTIVES 2)
d) more than 35 0 -
Religion
a) Hindu 40 100
1. To assess the knowledge on supplementary
b) Muslim 0 -
feeding among mothers with the children age 6 – 24 c) Christian 0 -
months. d) Sikh 0 -
3)
Type of family
2. To determine the association between the a) Nuclear 10 25
b) Joint 30 75
knowledge scores and baseline characteristics on c) Extended 0 -
supplementary feeding among mothers with the Educational status of wife
4)
children age 6 month. a) Illiterate 1 2.5
b) Primary 6 15
c) Secondary 15 37.5
An evaluative research approach was selected to
d) Graduate and above 18 45
achieve the objectives. The descriptive research design
was adopted for the study. Purposive sampling 5) Educational status of husband
a) Illiterate 1 2.5
technique is used to select the sample. Forty mothers
b) Primary 6 15
having children 6-24 months of age were taken under c) Secondary 22 55
Primary Health Centre, Mullana. The tool used in this d) Graduate and above 11 27.5
6) Occupation of wife
study is a baseline characteristics and semi-structured
a) Employed 2 5
interview schedule. Base line a characteristic was b) Unemployed 38 95
consists of 8 Items. It included age, religion, type 7) Occupation of husband
of family, educational status, educational status of a) Govt. job 4 10
b) Unemployed 6 15
husband, occupation of wife, occupation of husband c) Private job 30 75
& no. of Children. Semi-structured Interview Schedule 8) Numbers of children
was consisted of 28 items. Based on the suggestion a) 1 22 55
b) 2 14 35
given by the validators necessary modification were c) 3 or more 04 10
done. The reliability was 0.8 which was significant.
Hence, the tool was found reliable. The interview was The data showing that majority of the respondents
conducted using semi- structured interview schedule. were in the age of group of 18-25 years (50%) followed
The average time taken was 30 minutes. by the 25-30 years (45%) and 30-35 years (5%).Most of
subjects (75%) belonged to joint family, 25% belonged
FINDINGS
to nuclear family. Below than half of the respondents
The data collected from the subjects have been (45%) had completed graduation, (37.5%) had
organized and presented under the following completed secondary education, (15%) had primary
136 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

education and (2.5%) were illiterates. More than the The data presented in the table 3 depicts that
half of the subject’s husband (55%) had completed majority of the respondents had poor level of
their secondary education, (27.5%) are graduate or knowledge (32.5%), (37.5%) had average, (15%)
above,(15%) had completed their primary education had good, (15%) had excellent knowledge on
and (2%) are illiterate. Majority of subjects (95%) supplementary feeding.
were unemployed and (5%) had skilled job. Most of
the subject’s husband were having private job (85%), Table - 4 : Range, mean, median, standard
were govt. job (10%) and were unemployed (15%). deviation of knowledge score of mothers. N=40

Nearly half of the subjects (55%) were having 1

child, (35%) were having 2 children, and only (10%) Knowledge Range
Mean Median S.D.
were having 3 or more than 3 children. All subjects
were Hindus.
Pretest 6-26 15.9 16 3.8
Section- II: knowledge score of mothers on
supplementary feeding.
Maximum score= 28
Data regarding knowledge score has been
presented using frequency and percentage in table 2. The data presented in the table 4 shows that the
knowledge score of the subjects on supplementary
Table - 2: Frequency and percentage distribution feeding was in range of 6-26. The mean ±S.D. of the
of mothers according to their knowledge scores. knowledge score was 15.9 ±3.48, and median was 16.
N=40
Section III: Association between knowledge
Knowledge Mothers score of mothers with baseline characteristics.
Score
Frequency Percentage The median of the knowledge score was
calculated and was found 16.The number of the
0-10 13 32.5% respondents who were above and below the median
11-20 15 37.5% were identified and grouped according to their
21-30 06 15% baseline characteristics like age, religion, type of
31-40 06 15% the family, educational status of wife, educational
status of husband, occupation of wife, occupation
Maximum score = 28 of husband and number of children. To find the
The data presented in table 2 reveals that 13 association between the knowledge score and
respondents out of 40 had scored between 0-10, 15 baseline characteristics, the following null hypothesis
respondents scored between 11-20, 6 respondents was formulated:
scored 21-30 and 6 respondents had scored between H01: There will be significant association between
31-40. knowledge score of mothers with selected baseline
Table -3 : Frequency and percentage distribution characteristics like occupation of husband at .05 level
of subjects according to their knowledge score on of significance.
supplementary feeding. N=40

Pre-test Knowledge Score

Grading Of
Knowledge Frequency Percentage
Score

Poor 13 32.5%
Average 15 37.5%
Good 06 15%
Excellent 06 15%
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 137

Table -5: Chi-square test showing association between pre-test knowledge score and baseline
characteristics of the subject N=40

Variable ≤Median >Median df X2

1. Age(in years)
a) 18-30 18 19
b) 30 or more 01 2 1 0.26
2. Type of family
a) Nuclear 2 7
b) Joint 17 14 1 2.9
3. Educational status of wife
a) illiterate 1 0
b) primary, secondary & graduate 18 21 1 1.13
4. Education status of husband
a) Illiterate 0 1
b) Primary, secondary & graduate 19 20 1 0.92

5. Occupation of wife
a) Employed 2 0
b) Unemployed 17 21 1 2.32

6. Occupation of husband
a) Employed 19 17
b) Unemployed 0 4 1 4.021
7. Number of children
a) 1 or 2 16 20
b) 2 or more 3 1 1 1.34

X2(1)=3.841,P<0.05 *significant

The data presented in the above table 5 shows The findings of the study support the need for
that association between the knowledge score of the conducting health education, counseling and mass
mothers on supplementary feeding and selected base awareness programme on supplementary feeding to
line characteristics. The calculated chi- square values the public. Study proved that the mothers had poor
for the selected variable was more than the table knowledge on supplementary feeding before the
value. Hence, it was concluded that the knowledge administering of Planned Teaching Programme and
of mothers regarding supplementary feeding had their knowledge improved to a remarkable extent
association with the baseline characteristics namely after giving.
occupation of husband.
Conflict of Interest – Nil
CONCLUSION
Source of Funding- Self financed
The results indicated that half of the participants
Ethical Clearance – For the study Ethical
were in the age group of 18- 25 years and most of
permission was taken from the college commi�ee,
37.5% and 32.5% had only poor or average knowledge
concerned village primary health centre. Informed
about the ma�er. This also shows that there may be a
consent was taken from mother participant.
risk of malnourishment in their children. The result
of this study revealed that mothers in general, lack REFERENCES
of knowledge on supplementary feeding. The mean
knowledge score of mothers was 15.9. 1- Aggarwal K.N. Pediatrics and Neonatology:
Modern Publishers: page no. 540-556.
138 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

2- Suraj Gupta, “ Textbook of paediatric nursing” 7- Kachondham et al (1992) institution of nutrition

10th edition, Jitender P vij , Jaypee Brothers Mahidal University Presented of UN, ACC/SCN,
publishers. and country case study supported by UNICEF
3- American Journal of Clinical Nutrition: Vol. 54, United Nations children’s fund.
62-68, Copyright 1991 by American Society for 8- Mrs.Jersie M Chellappa “ Paediatric Nursing”,
Clinical Nutrition edition 2004,Gajanana book publisher.
4- Jacob and Singh, “Peadiatric nursing” , 2nd 9- Burns N, Grove SK Understanding Nursing
edition, 2003, Published by- N.R Brothers. Research. 2nd edition, Philadelpia: W.B Saunders
5- New Born Care Week; the Nursing Journal of Company; 1995.
India Nov. 2009, Vol. C No. 11.. 10- Dorothy R. Marlow Barbara A. Reeding,
6- Park K. Textbook of preventive and social “Textbook of Paediatric nursing”, 4th edition
medicine. 18 ed. Jabalpur: Banarsidas Bhanot 2005, Elsevier Publisher.
Publishers; 2005
 DOI Number: 10.5958/0974-9357.2016.00064.7

Comparison of Patient Safety Measures Related to I.V

Infusion and I.V Injection Adopted by Staff Nurses of a
Government and a Private Hospital of Delhi

Anjali Kaushik1, Manju Chhugani2, E L Tamang3

1
Clinical Instructor, 2Principal, 3Tutor, Rufaida College of Nursing, Jamia Hamdard, New Delhi

ABSTRACT

Objectives: The objectives of the study were to: to assess the patient safety measures related to I.V
infusion and I.V injection adopted by staff nurses in selected units of a Government and a Private
Hospital, to compare the patient safety measures and to find the association between patient safety
measures related to I.V infusion and I.V injection adopted by staff nurses and selected demographic
variables, to assess and compare the general safety measures present in the selected units of a
government and a private hospital of Delhi and to develop and disseminate guidelines on patient
safety measures.

Method: Quantitative Research with descriptive comparative research design was used. Tools used for
data collection comprised of structured observation checklist to assess patient safety measures related
to I.V Infusion and I.V Injection and structured observation checklist to assess general safety measures.
Convenient sampling was adopted to select 100 staff nurses, 50 from each hospital and 12 units, 6
medical surgical units from each hospital. The study was conducted at a selected government hospital
and a private hospital in Delhi.

Results: Data was analyzed using Descriptive and Inferential statistics. The findings showed that there
was a significant difference in the patient safety measures related to I.V Infusion and I.V Injection
adopted by staff nurses in the government and private hospital. Patient safety measures were be�er in
the private hospital than the government hospital.Findings also revealed. that general safety measures
were be�er in the private hospital than the government hospital.

Conclusion: The study concluded that staff nurses in the private hospital adopted be�er patient safety
measures related to I.V Infusion and I.V Injection than those in government hospital. General safety
measures were be�er in the private hospital than the government hospital.

Keywords: Patient safety measures, I.V Injection, I.V Infusion.

INTRODUCTION or state of being resulting from the modification of

human behaviour and/or designing of the physical
Patient safety has become both a national environment to reduce hazards, thereby reducing the
and international imperative in recent years, with chance of accidents2.
increased emphasis across the world on patient
safety in policy reform, legislative changes and With the advancement of medical technology
development of standards of care driven by quality and rising community aspiration for quality services,
improvement initiatives. Studies of adverse events in there is growing public expectation for health care
numerous countries around the world demonstrate institutions to provide error free and safety services.
that between 4% and 16% of patients admi�ed to The objective is to ensure that the premises, the
hospital experience one or more adverse events, of systems of work and practices are safe. There is also
which up to half are preventable1. Safety is a condition greater awareness of danger and preparedness to deal
140 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

with emergencies through identification, analysis, The sampling technique adopted in the present
assessment, minimization and monitoring of risk.3 study was convenience sampling technique.
Inclusion Criteria
Nurses constitute the largest workforce of
professionals working in any health care se�ing. For Nurses
• Staff nurses willing to participate and
Their presence in the health care system plays a
available during the study.
vital role and helps in the speedy recovery of
For units
the patients from their illnesses.Medication errors
• General medical and surgical units of
can threaten patient outcomes and are a dimension
government and private hospital.
of patient safety directly linked to nursing care. It
is an integral part of the nurse’s role; therefore the Data collection Tools and Techniques:
nurses must adapt the principles and techniques Based on the conceptual framework and
of Intravenous (I.V) medication administration to objectives of the study, following tools were
ensure patient safety. developed to generate the data:
OBJECTIVES • Structured Observation Checklist for the
assessment of the patient safety measures related
• To assess the patient safety measures related
to I.V Infusion and I.V Injection adopted by staff
to I.V infusion and I.V injection adopted by staff
nurses.
nurses in selected units of a Government and a
Private Hospital. • Structured Observation Checklist to assess
General Safety Measures present in the Selected
• To compare the patient safety measures
Units.
related to I.V infusion and I.V injection adopted by
staff nurses in selected units of a Government and a Description of Tools
Private Hospital. Tool 1: (Structured Observation Checklist
• To find the relationship between patient to assess Patient Safety Measures related to I.V
safety measures related to I.V infusion and I.V Infusion and I.V Injection)
injection adopted by staff nurses and selected The tool was divided into 3 sections.
demographic variables.
Part 1: It consisted of items related to demographic
• To assess and compare the general safety data.
measures present in the selected units of a government
Part 2: It consisted of 29 items related to I.V
and a private hospital of Delhi.
Infusion.
• To develop and disseminate guidelines on
Part 3: It consisted of 29 items related to I.V
patient safety measures.
Injection.
METHODOLOGY Scoring for Tool 1 (Structured Observation
Research Approach and Design- A quantitative Checklist to assess Patient Safety Measures related to
research approach was adopted. The research design I.V Infusion and I.V Injection)
selected for the study was comparative descriptive
• Each item under part2 and part3 of structured
research design.
observation checklist was scored as “1” if the steps
Population- In the present study, population were fully and correctly performed and “0” if the steps
comprised of staff nurses, who were working in a are not fully performed and incorrectly performed by
the general medical and surgical wards of a selected the nurse. The possible range of score ranged from 0 -
government and a private hospital. 58. The patient safety measures related to I.V Infusion
Sample and sampling: In the present study and I.V Injection were categorized into four categories
total staff nurses were 100; 50 each from government viz. Poor, Average, Good and Very Good.
and private hospital and 12 units; 6 units each from
Tool 2: (Structured Observation Checklist to
government and private hospital.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 141

assess General Safety Measures present in the range of score ranged from 0-30. The general safety
selected units) measures were categorized into four categories viz.
Poor, Average, Good, Very Good.
• It consisted of 30 items related to general
safety measures present in the unit. Content Validity: In order to ensure the validity
of the structured observation checklists, the tools were
Scoring for Tool 2 (Structured Observation
given to 11 experts from fields of Nursing, Medicine,
Checklist to assess General Safety Measures present
Microbiology, Infection Control and Administration.
in the selected units)
Reliability of the Tool: Reliability of the tools
• Each item in Tool 2 under Structured
(structured observation checklists) were worked out
Observation Checklist was scored as “1” if the
by inter-rater reliability and were found to be 0.87
general safety measures are present and “0” if the
indicating high reliability of the tools.
general safety measures are not present. The possible

RESULTS

Table 1: Frequency and Percentage of Staff Nurses working in the Government and the Private Hospital
as per their demographic Characteristics n1 + n2 = 100

Government
Private Hospital
Hospital
S.
Sample Characteristics
No n1=50 n2=50
Frequency Percentage (%) Frequency Percentage (%)
1 Age (In Years)
20 -29 17 34 36 72
30 – 39 26 52 13 26
40 - and above 7 14 1 2
2 Gender
Female 44 88 45 90
Male 6 12 5 10
3 Professional Qualification
DGNM 43 86 38 76
Post Basic Nursing 3 6 0 -
B. Sc Nursing 4 8 12 24
4 Marital Status
Single 11 22 28 56
Married 39 78 22 44
5 Work Experience (in years)
0–4 9 18 30 60
5–9 17 34 13 26
10 – 14 13 26 6 12
15 and above 11 22 1 2
6 In-service Education
Yes 38 76 21 42
No 12 24 29 58
Experience in ISO certified
7
hospital
Yes 32 64 26 52
No 18 36 24 48
142 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Table 2: Mean, Median, Standard deviation, Mean Difference, Standard Error of Mean Difference and
‘t’ Value for Significance of Mean Difference between Patient Safety Scores of Staff Nurses working in the
Government and the Private Hospital n1+n2 =100

Standard
Mean Median Deviation Mean SEMD ‘t’
Category Group (SD) p value
Difference

Government
Hospital 17.10 17.00 3.55
n1=50
I.V 0.70 0.60 1.18 0.24
infusion Private Hospital
17.80 18.00 2.26
n2=50

Government
Hospital 17.52 18.00 2.46
n1=50
I.V 1.40 0.45 3.14 0.00**
injection Private Hospital
18.92 19.00 1.97
n2=50

Government
I.V Hospital 34.62 35.00 5.54
infusion
n1=50
I.V 2.10 0.95 2.21 0.02*
injection
Private Hospital
(total) 36.72 36.00 3.78
n2=50

** ‘t’value (98) = 2.62, p value< 0.01, significant at 0.01 level of significance

* ‘t’ value (98) =1.98, , p value< 0.05, significant at 0.05 level of significance

Table 2 shows that patient safety measures related to I.V injection and I.V infusion adopted by staff nurses
in the private hospital are be�er than the patient safety measures related to I.V injection and I.V infusion
adopted by staff nurses in the government hospital.

TTable 3: Category wise frequency and Percentage distribution of Staff Nurses working in selected Units
of the Government and Private Hospital as per Patient Safety Measures related to I.V Infusion and I.V.
Injection adopted by them
n1 + n2 =100
Government Hospital Private Hospital
S. n1=50 n2=50
Category
No
Percentage Percentage
Frequency Frequency
(%) (%)
Very good patient safety measures
1 0 0 0 0
(> 80 %)
Good Patient Safety Measures
2 6 12 9 18
( 70%- 79 %)

Average Patient Safety Measures

3 20 40 28 56
(60 % - 69%)

Poor Patient Safety Measures

4 24 48 13 26
(< 60 %)
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 143

The data in Table 3 reveal that in the government hospital 24 (48%) staff nurses adopted poor patient
safety measures related to I.V infusion and I.V injection followed by 20 (40%) staff nurses who adopted average
patient safety measures and only 6 (12%) adopted good patient safety measures. In the private hospital, most
of the staff nurses 28 (56%) adopted average patient safety measures followed by 13 (26%) staff nurses who
adopted poor patient safety measures and only 9 (18%) of staff nurses adopted good patient safety measures
related to I.V infusion and I.V injection.

Table 4: Association between patient safety measures related to I.V infusion and I.V injection adopted
by staff nurses in the government and private hospital and selected demographic variables viz. age, gender,
professional education, work experience, in-service education, experience in ISO certified hospital.
n1 + n2 =100

Good Average Poor

Test
Patient Patient Patient
Group Category Used p Value
Safety Safety Safety
(Value)
Measures Measures Measures

Age (In Years)

20 – 29 11 27 15 Fisher
exact 0.09
30 – 39 4 15 20 (1.3)

40 And above 0 6 2

Gender
Fisher
Female 15 42 32 exact 0.42
(3.8)
Male 0 6 5

Professional Qualification

DGNM 11 37 33 Fisher
exact 0.66
Post Basic 0 1 2 (7.4)
Government
and private B. Sc Nursing 2 10 4
hospital
Work Experience (In Years)
n1 + n2 =100
0–4 8 21 10
Fisher
5–9 3 14 13 exact 0.28
(8.9)
10 – 14 2 6 11

15 AND ABOVE 2 7 3

In-Service Education
Chi
Yes 8 29 22 Square 0.92
(3.5)
No 7 19 15

ISO Certified Hospital

Experience Chi
Square 0.76
Yes 9 26 23
(3.0)
No 6 22 14
144 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

In the Table 4, shows that there was no significant by the staff nurses and the selected demographic
association found between the patient safety measures variables viz. age, gender, professional educational,
related to I.V infusion and I.V injection adopted work experience, In-service education, experience in
ISO certified hospital.

Table 5: Mean, standard deviation, mean difference, standard error of mean difference, degree of
freedom, and ‘t’ value for significance of mean difference between general safety measures scores in the
selected units of government and private hospital. n3+n4 = 12

Government Private
Hospital Hospital
n3 = 6 n4 = 6 Mean Degree of P
Category SEMD
Difference Freedom ‘t’ Value

Mean S.D Mean S.D

General
Safety 17.33 1.97 23.33 2.42 6.0 1.27 10 4.71 0.00*
Measures

* ‘t’ value(10) = 3.17, p < 0.01, significant at 0.01 level of significance.

Table 5 shows that the general safety measures present in the private hospital are much be�er than the
general safety measures present in the government hospital. Unpaired ‘t’ test was used to find the significance
of difference of the means and was found to be significant at 0.01 level.

Table 6: Category wise frequency and Percentage distribution of units in the Government and Private
Hospitals as per general Safety Measures present in them n3 + n4 = 12

Government Hospital Private Hospital

n3=6 n4=6
S. No Category
Percentage Percentage
Frequency Frequency
(%) (%)
Very good general safety measures
1 0 - 4 66.67
( > 80 %)
Good general Safety Measures
2 1 16.66 1 16.67
( 70% – 79 % )
Average general Safety Measures
3 1 16.66 1 16.66
( 60 % – 69 % )
Poor general Safety Measures
4 4 66.67 0 -
( < 60 % )

The data in Table 6 reveal that in private hospital general safety measures were be�er than the government
hospital. • Staff nurses in the private hospital adopted
be�er patient safety measures related to I.V
CONCLUSION
infusion and I.V injection than the staff nurses in the
The conclusions drawn on the basis of study are government hospital.
given below: • No significant association was found between
• In the Government hospital, most of the staff the patient safety measures and selected demographic
nurses adopted poor patient safety measures. variables.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 145

• In the government hospital, majority 4 hand washing.There needs to be periodic updating

(66.67%) units had poor general safety measures of knowledge and skills of every health professional
whereas in private hospital most of the units, 4 related to patient safety measures working in various
(66.67%) had very good general safety measures. units. .
• There was statistical significant difference Acknowledgement: The author is thankful to all
found in the general safety measures present in the staff nurses who participated in the study and the
the selected units of a government and a private hospital administration for granting permission to
hospital. conduct the study.
Conflict of Interest: None.
DISCUSSION
Source of Funding: This study was self financed
The present study was aimed to assess and as it was conducted as a part of partial fulfillment of
compare the patient safety measures related to I.V the requirements for the degree of M.Sc. Nursing.
infusion and I.V injection adopted by staff nurses in
Ethical Clearance: Ethical permission was taken
selected units of government and private hospital and
from Jamia Hamdard Institutional Review Board. The
general safety measures.
study was conducted keeping all the ethical issues in
In a study conducted by Choudhary, Roy and et mind. Consent was taken from all the samples of
al, they explored the I.V Injection safety practices in
4 the study. The information provided by the sample
primary care hospitals (Government) in Bangladesh. was kept strictly confidential and were used for the
They observed 120 health care providers while giving purpose of research only.
I.V injection. The findings of the study showed that
REFERENCES
immediate disposal of syringe was not done in 83.5%
samples. The aspect of disposal of syringe was also 1. Report of the commission on patient safety and
observed in the present study and it was found that quality Assurance, 2008.
18% of the staff nurses in the government hospital did
2. Kha�ab, M., 2005. Development of manual for
not dispose the syringe immediately. Choudhary,
safety measures in general critical care units.
Roy and et al,4 also reported that none of the Injection
Unpublished Doctoral Dissertation. Faculty of
provider washed their hands properly with antiseptic
Nursing, Alexandria University.
soap. These findings are consistent with the present
study where hand-washing was performed only by 3. Institute of Medicine, (IOM); and Agency for
5% staff nurses in the government hospital. Paul Healthcare Research and Quality (AHRQ), 2005
Bobby, Roy Sima et al5, did a study on Safe Injection 4. Chowdhary Azad AK, Roy Tapash, A
Practices of Nursing Personnel in a Tertiary Care comprehensive situation assessment of injection
Hospital of Kolkata, West Bengal, India and found practices in primary health care hospitals in
that only 12.5% study subjects washed their hands Bangladesh, BMC Public Health 2011, 11:779
with soap and water before administering injection. 5. Paul Bobby, Roy Sima et al, A study on Safe
In a study done in Patiala only 20% of the samples Injection Practices of Nursing Personnel in a
studied followed correct hand washing technique6. Tertiary Care Hospital of Kolkata, West Bengal,
Implications of the Study: India Med Bull 2011; 10(6):681-686
Every Staff nurse needs to ensure that they 6. Tjon JA, Ansani NT. Transdermal nitroglycerin
adopt safety measures for their patients under care. for the prevention of intravenous infusion
Staff nurses need to refine their skills in all the steps failure due to phlebitis and extravasation. Ann
related to I.V Injection and I.V Infusion especially Pharmacother 2000
 DOI Number: 10.5958/0974-9357.2016.00065.9

Level of Satisfaction of Care among Patients

R Naganandini
Associate Professor and Hod, Department of Psychiatric Nursing, Vinayaka Mission’s Annapoorana College of
Nursing, Vinayaka Missions University, Chinnaseeragapadi, Salem, Tamil Nadu, India

ABSTRACT

Patient satisfaction is important to for quality assurance and measures health care agencies and
providers outcome. The purpose of the study to analyse the level of satisfaction of care among patients.
Fifty patients were selected by using non probability purposive sampling technique and interviewed
by using a semi structured interview schedule. The findings of the study on level of satisfaction of
care among patients shows that highest percentage (56%)were minimally satisfied, 34% of them
were moderately satisfied and 10% were fully satisfied. There is no significant association was found
between the level of satisfaction of care among patients and their demographic variables.

Keywords: Patients, Care, Level of Satisfaction

PURPOSE OF THE STUDY OBJECTIVES

Heath is a state of physical, mental, social and • To assess the level of satisfaction of care
spiritual wellbeing and not merely the absence of among patients
disease or infirmity (WHO)1. Physicians, nurses and
other tam members should have good planning and • To explore relationship between level of
intervention for patients for discharge and also for satisfaction of care among patients and their selected
their satisfaction about care (Railey et al, 1996)4. Hall demographic variables
and Steven(1995)5 has described that access to health
METHODOLOGY
care is not only to professional services but also
access to the knowledge, skills, support, safety and Descriptive design with survey approach was
resources that patients need to be healthy. Patients used to conduct the study. 50 patients were selected by
satisfaction regarding care in hospital is associated using non probability purposive sampling technique
with the improvement of quality of care (Van Essen in a selected private hospital, Salem. Rating scale
et al, 2002)2. Nursing is primarily concerned with were used as tool to assess the level of satisfaction
an individual to cope with daily activities of living of care among patients. Data were collected with
in such a way as to promote his optimal level of semi structured interview schedule among patients.
health or to cope with exigencies of terminal illness Level of satisfaction was graded as fully satisfied,
(Dugas,2004)3. Nair(2004)6 conducted a study on moderately satisfied, minimally satisfied and not
consumer satisfaction in holy family hospital, satisfied.
Mumbai. The findings reveals that high satisfaction
or delight creates an emotional bond with the FINDINGS AND DISCUSSION
hospital in the mind of the patient. Von Essen et Major of the findings reveals that majority
al,(2002)6, has conducted a study on satisfaction of the patients in the age group of 21 – 30 years
with care associations with health related life and (58%), males(56%), had school education (54%),
psychological functions among Swedish patients. It belongs to joint family(56%), from urban area(52%),
shows that patients were ge�ing high satisfaction in unemployed(40%), belongs to monthly income of Rs
doctor’s technical skills. 1001 - 3000(70%) and not having previous exposure
in hospitalization(62%).
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 147

Level of satisfaction of care among patients • Interventional study can be undertaken

shows that highest percentage (56%)were minimally to improve the level of satisfaction of care among
satisfied, 34% of them were moderately satisfied and patients
10% were fully satisfied(Fig No:1).
Acknowledgement : At the outset I tender my
humble and grateful thanks to the God Almighty
for showering his blessings and divine light to raise
me to the height of presenting this beneficial thesis
successfully, in the field of medical education within
an anticipatory period.

I owe a deep sense of gratitude to all those

who have contributed for the successful completion
of the study and I express my warm appreciation to
all those who have helped me directly and indirectly
to make the fruition of this study possible.

Ethical Clearance - Taken from Research

Fig No:1 Assessment of level of satisfaction of care among
patients
commi�ee, se�ing authority and samples

There is no significant association was found Source of Funding - Self

between the level of satisfaction of care among
patients and their demographic variables. Po�er Conflict of Interest - Nil
and Perry (2009) also recommended that patients are REFERENCES
expecting to fulfill their basic needs where ever they
are ge�ing treatment. 1. Barbara (2000), “Holistic nursing, A handbook
for practice”, As aspen publications, Maryland,
CONCLUSION 3rd edition, Pp 52-80.
From the findings it can be concluded that level 2. Croline Bunker Rosdhal (1999), “Textbook of
of satisfaction of care among patients shows that basic nursing”, Lippinco�, Philadelphia, 7th
highest percentage (56%)were minimally satisfied, edition, Pp 50-58.
34% of them were moderately satisfied and 10% were 3. Linda Pelz (1982), Social psychological
fully satisfied. There is no significant association was determinants of patients satisfaction, “Social
found between the level of satisfaction of care among science and medicine’, Vol:16, Pp 583-586.
patients and their demographic variables.
4. Po�er and Perry (1997), “Fundamentals of
RECOMMENDATIONS nursing”, Mosby, Philadelphia, 4th edition, Pp
48-56.
Based on the following study the following
5. Thomas LH et al,(1995), Obtaining patients views
recommendations have been made for further study,
of nursing care to inform the development of
• Similar study can be undertaken for large patients satisfaction scale, “International journal
sample to generalize the findings of quality in health care”, Vol:8, Pp: 82-95.
6. Young Mohan (1986), An analysis of the
• Study can be conducted to assess the level of
concept of patients satisfaction as it related to
satisfaction of care among postoperative patients
contemporary nursing, “Journal of Advanced
nursing”, Vol: 24, Pp; 1241- 1248
 DOI Number: 10.5958/0974-9357.2016.00066.0

A Study to Assess the Knowledge of Rural Adults

Regarding Selected Central Sponsored Schemes in
Selected Rural Community at Mysore

Mamatha G1, Murali Mohan A2, Munirathna K3, Bhavya S V3

Assistant Professor, 2Assistant Lecturer, Medical Surgical Nursing Dept, 3Assistant Professors,
1

Obstetrics and gynecological Nursing Dept, JSS College of Nursing, Mysore

ABSTRACT

Background : The Government of India is involved in a large number of programmes in sectors/area

such as education, health, labour, skill development etc. that are in the State List through operation
of Selected Selected Centrally sponsored schemes (CSS) and provision of Central Assistance to State
Governments. The CSS are operationalized by Central Ministries based on scheme specific guidelines
and are implemented by State Governments or their designated agencies. The CSSs are implemented
to achieve social objectives like poverty reduction, improving health services, raising food production
etc.

Aim and objectives: The aim of the study was to assess the knowledge regarding selected Selected
Centrally sponsored schemes among rural adults.

Methodology: Descriptive survey approach was used. 60 rural adults between the age group of 18-45
years were selected using non probability convenient sampling technique. Data was collected by using
structured knowledge questionnaire.

Results: study results revealed that majority of the rural adults 25(41.66%) had average knowledge,
21(35%) had good knowledge, 14(23.33%) had poor knowledge regarding central sponsored scheme.

Keywords:: CSS, Knowledge

Knowledge, NRHM,

INTRODUCTION proposes to facilitate increased access and utilization

of quality health services. This has been carried out
The main aim of the Central Sponsored Schemes
by increasing the spending on health and improving
are to provide accessible, affordable and quality
the health care services at the community level. The
health care to rural populations, especially vulnerable
mission also addresses issues on sanitation and
and underserved population groups in the Country.
hygiene nutrition, safe drinking water, gender,
Some of the Selected Centrally sponsored schemes
social concerns, and inter-state as well inter-district
which are included in this study are NRHM, RCH,
disparities in health care provision.
Total sanitation Camp, Mahatma Gandhi National
Rural Employment Guarantee Act (MGNREGA). Janani Suraksha Yojana (JSY) is a nationwide,
Selected Centrally sponsored schemes being
The National Rural Health Mission (NRHM) is
implemented with the objectives of reduction in
launched in April, 2005 (for seven years i.e. 2005 to
infant and maternal mortality by improving coverage
March 2012) seeks to provide accessible, affordable
of institutional delivery among pregnant women.
and quality health care to the rural population,
Under the scheme, cash assistance is provided to
especially the vulnerable sections. The mission
pregnant women for giving birth in a health facility.
Correspondence author
Mrs. Mamatha G Reproductive and Child Health programme is
Assistant Professor, JSS College of Nursing a comprehensive sector wide flagship programme,
Mysore, E-mail:mgshe�[email protected] which is being implemented under Government of
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 149

India’s National Rural Health Mission (NRHM), to HYPOTHESES

achieve the targets for reduction of maternal and
infant mortality and total fertility rates. H1-There will be significant association between
the level of knowledge regarding Selected Centrally
Central Rural Sanitation Programme was sponsored schemes among rural adults with
launched in 1986 with the objective of accelerating their selected personal variables viz: age, gender,
sanitation coverage in rural areas. Globally, 2.4 billion qualification, occupation, previous exposure to
people do not have access to adequate sanitation and mass media regarding Selected Centrally sponsored
most of them tend to be victims of poverty. In India, schemes.
the severity of sanitation problem has a long history.
So the Government of India endorsed priority to METHODOLOGY
sanitation by stating that, “the elimination of abject
The research design adopted for the study was
poverty will not be a�ained to certain acceleration
descriptive survey approach. 60 rural adults between
in the rate of growth of the economy alone, but
the age group of 18-45 years were selected using
improvements in drinking water and environmental
non probability convenient sampling technique.
sanitation have direct correlation with levels of living”.
Data was collected by using structured knowledge
Thus, providing public health facilities became part of
questionnaire.
poverty alleviation programme. This is, in fact an eye
opener for the policies regarding sanitation services. FINDINGS
The TSC (Total Sanitation Campaign), in addition to
households, extends support for community Sanitary Table 1 : Frequency and percentage distribution
Complexes, which will have multiple facilities such of subjects according to their selected personal
as toilets, washing platform, bathing rooms, etc. variables. n = 60
The CRSP (Central Rural Sanitation Programme)
Sl. Freq-
initiation was a precursor to many such programmes Sample characteristics %tage
No. uency
in Karnataka such as Nirmal Grama Yojane (NGY, 1 Age in years
1993), Integrated Rural Water Supply and Sanitation 18-25 24 40%
programme (IRWSS1993) and Swatcha Grama Yojane 26-33 11 18.33%
(SGY 2000).
34-41 19 31.66%
Mahatma Gandhi NREGA was launched in 200 42 and above 6 10%
2 Gender
selected districts on 2006 with the aims at enhancing
livelihood security of households in rural areas of the Male 28 46.60%
country by providing at least one hundred days of Female 32 53.33%
guaranteed wage employment in a financial year to 3 Educational qualification
every household whose adult members volunteer to Illiterate 11 18.33%
do unskilled manual work.12 And it was extended
Lower primary school 24 40%
to 130 additional districts during 2007-08. All the
remaining rural areas in the country have been Upper primary school 13 21.66%
covered under the Act. Presently, Mahatma Gandhi High school 6 10%
NREGA is being implemented in all the notified rural Degree 2 3.33%
areas of the country. 4 Occupation

OBJECTIVES Agriculture 19 31.66%

Business 23 38.33%
1 .To assess the knowledge regarding Selected Cooli 15 25%
Centrally sponsored schemes among rural adults. House wife 3 5%

2. To determine the association between the level Previous exposure to

mass media regarding
of knowledge regarding Selected Centrally sponsored 5
CSS(Selected Centrally
schemes among rural adults with their selected sponsored schemes)
personal variables. Yes 37 61.66%
No 23 38.33%
150 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

TABLE 2: Frequency and Percentage distribution of Conflict of Interest: The author declares that
Rural adults according to their level of knowledge. there is no conflict of interest
n = 60 Source of Funding: Self

Knowledge scores Frequency Percentage (%) Aknowledgement: We aknowledge Mr. Ameen,

Mr. Lejith, Mr. Mubhasir and Mr. Mahadevprasad
Good knowledge 21 35
who helped in data collection.
Average knowledge 25 41.66
Ethical Clearance: Obtained ethical clearance
Poor knowledge 14 23.33
from ethical commi�ee of our institution.

TABLE 3: Mean, median and standard deviation REFERENCES

of knowledge scores of rural adults regarding
central sponsored scheme. n=60 1. Sunderlal, Adarsh, Pankaj. Textbook of
Community Medicine. 2nd ed. Newdelhi: CBS
Knowledge
Mean Meadian
Standard Publishers & distributers; 2009.
Score deviation
2. sridhar Rao B. Principle of community medicine.
13.58 14 3.42 4th ed. Delhi: AITBS publishers & distributers;
2005.
CONCLUSION 3. kamalam S. Essentials in community health
The current study findings revealed that majority nursing practice. 2nd ed. London: Jaypee
of the rural adults had average knowledge. Effective Brothers medical publishers; 2012.
implementation of CSS demands participation 4. sunder Rao. An introduction to community
by users and beneficiaries in fine tuning scheme health nursing. 4th ed. Chennai: BI publications;
guidelines to local situations and requirements. 2009.
Special interventions should be undertaken on a 5. UNICEF, 2009; Dillingham and Guerrant, 2004.
priority basis to bridge the gaps so as to achieve
millennium development goals in all population 6. Towards Nirmal Bharat- Rural Sanitation and
groups Hygiene Strategy 2012-22, Ministry of rural
Development, 2011.
RECOMMENDATIONS 7. Available from h�p://www.nrega.nic.in
1. A large scale study can be conducted to 8. RCH- Available from h�p://tripuranrhm.gov.in/
generalize the findings. RCH.htm

2. A study can be conducted to explore the 9. Canessa A, Pantara�o F. Antibody prevalence to

factors influencing the knowledge of rural adults TORCH agents in pregnant women And relative
regarding CSS. risk of congenital infections in Italy (Liguria).
Biol Res Pregnancy Perinatol 1987;8
3. An experimental can be conducted to
10. Available from h�p://www.reproductive-health-
determine the utilization of CSS by rural adults.
journal.com
4. Study can be conducted to compare rural and
urban population.
 DOI Number: 10.5958/0974-9357.2016.00067.2

A Comparative Analysis of Academic Performance of

Diploma Nursing Students of Public, Private and
Faith based Schools in Tanzania

Kija Malale1, Elijah Nyangena2, Winfred K Kithinji3

1
Assistant Lecturer, School of Nursing-Catholic University of Health and Allied Sciences-Bugando: P.O. Box 1464
Mwanza Tanzania, 2Professor, Department of Nursing-Kenya Methodist University, 3Assistant Lecturer,
Department of Education-Kenya Methodist University, Kenya

ABSTRACT

As the current nursing practice increases concerns about students’ academic performance, there had
been high rate of failure among diploma nursing students in their final examinations in Tanzania. This
study aimed to make comparative analysis of academic performance of diploma nursing students
of public, private and faith based schools. An ex-post facto research design was used in which 116
students were randomly selected from 1154 pre-service diploma nursing students, who sat for their
final examination in July, 2013. A developed checklist form was used as research instrument and data
gathered were analyzed by using Statistical Package for Social Sciences 21 version (SPSS) computer
software. The findings revealed a significant difference in entry qualifications among students from
public, private and faith based nursing schools (ρ =0.000). A significant positive relationship between
students’ entry qualifications and academic performance in nursing schools was found (r = 0.212, p
=0.022). No significant difference in academic performance of students from public, private and faith
based owned nursing schools was also found (ρ =0.059).

Keywords: Comparative analysis, academic performance, pre-service diploma nursing students, nature of
school ownerships

INTRODUCTION and faith based owned institutions7. Likewise in

Tanzania, has been a serious discussion among tutors,
All nursing education programs aim to administrators and students in public nursing schools
provide unique professional education essential for as well as in private and faith based nursing schools8.
competent practice promoting caring a�itudes and
behaviors in the nursing profession1 and therefore, Previous studies account self-motivation, age
nursing schools are obliged to produce well of student, learning preferences9, class a�endance10,
educated, knowledgeable, and skilled nurses who students’ effort and previous schooling11, parents’
can make reasoned and informed patient oriented education, family income13, and entry qualifications
decisions in a variety of health care delivery se�ing2. as factors that have a significant influence on the
Measurement of students’ academic performance students’ academic performance in various se�ings.
itself is an effective way to assure that graduates meet For the sake of this study, only students’ entry
the required competencies3. Grade point average qualifications, nature of school ownerships and
(GPA), cumulative average point (CGPA) and results tutors’ educational qualifications were reviewed.
of each subject4, 5, 6 are used in measuring students’
academic performance. However, Overtime there has
STATEMENT OF THE PROBLEM
been serious discussion in this era of public-private As the current nursing practice increases concerns
partnership both in educational sciences, sociology about nursing students’ academic performance and
and economics not only in developed countries public-private partnership, there had been high rates
but also in developing countries about the quality of failure among diploma nursing students in their
of applicants, graduate and tutor in public, private
152 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

final examinations in Tanzania. The high failure rate 10% (116) of the total target population was used as
raises doubts on the professional competence of the the sample size. Stratified sampling technique and
graduate in providing nursing care. Therefore, this systematic sampling techniques were used to group
study aimed at performing comparative analysis of the target population into three groups or strata based
academic performance of diploma nursing students on their nature of ownership and to obtain students
to determine the influence of entry qualifications, from each stratum for the study sample respectively.
tutors’ educational qualifications and nature of school A total of 20 (15.9%) students was gathered from
ownerships in Tanzania. public, 5 (4.4%) from private and 91(79.7%) from faith
based owned nursing schools.
PURPOSE OF THE STUDY
Data Collection Instrument
The main purpose of this study was to do
comparative analysis of academic performance of A developed checklist form was used to collect
diploma nursing students of public, private and faith secondary data which were available in the records
based schools to determine the influence of entry (database) of the MoHSW training department.
qualifications, tutors’ educational qualifications and
Method of Data Collection
nature of school ownerships in Tanzania.
Extraction of secondary data from the database by
OBJECTIVES OF THE STUDY
administering checklist form to the head of training
• Compare entry qualifications of diploma department for nurses and midwives at the Ministry
students from nursing schools based on their nature of Health and Social Welfare was used.
of ownerships in Tanzania.
Operational definition of variables
• Determine relationship between entry
Academic performance; refers to a performance
qualifications and academic performance of diploma
of a candidate in each module examined and overall
students from nursing schools in Tanzania.
performance in the final examination as measured in
• Compare academic performance of diploma terms of grades and overall GPA respectively.
students from nursing schools based on their nature
Entry qualification; refers to a prerequisite that
of ownerships.
qualify a student for admission into diploma nursing
• Determine relationship between tutors’ program as measured through computing entry grade
educational qualifications and students’ performance point from three subjects such as Biology, Chemistry
in modules they taught. and Physics/Mathematics performed by the student/
applicant in CSEE conducted NECTA.
MATERIAL & METHODS
Nature of school ownership; refers to a type of
Research Design: An ex-post facto research school ownership in which the student was admi�ed
design was used to compare students’ entry to pursue diploma nursing program. This can be
qualifications, tutors’ educational qualifications and Public, Private or Faith Based owned nursing school.
academic performance of diploma nursing students
from public, private and faith based schools. Tutor’s educational qualification; refers to
the highest professional certificate achieved by the
Target Population nurse tutor from a respective institution/university
a�ended in a specified period of time at a time of data
1154 pre-service nursing students (183, 51 and 919
collection. This can be diploma, advanced diploma,
from Public, Private and Faith Based owned schools
bachelor, master or PhD in nursing profession
respectively) who sat for their final examination in
July, 2013 in Tanzania15 was the target population of Method of Data Analysis
this study.
A computerized data analysis software package
Sampling Procedure and Sample Size known as Statistical Package for Social Science (SPSS)
21 version was used in data analysis. Descriptive
As recommended by Birchall and Kothari14,,
statistics and inferential statistics were applied.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 153

Ethical consideration

The study started upon approval from Kenya

Methodist University and Catholic University
of Health and Allied Sciences Research Ethics
Commi�ees followed by permission to collect data
granted by the permanent secretary of the MoHSW.

FINDINGS OF THE STUDY Figure 3: Students’ mean overall GPA based on the nature
of school ownerships
All checklist forms administered (9) during data
collection were correctly filled and returned. This Tutors’ educational qualifications
gave a response rate of 100%. Majority of students’ As summarized in the Table 4, the findings
records accessed and recorded in the checklist forms showed that almost in all modules taught, the leading
were for female students (69.8%). population of tutors based on their educational
Students’ entry qualifications qualifications is the group of tutors with advanced
diploma (200) followed by those with bachelor (182),
Mean entry grade point for students from public master/ PhD (51) and finally with diploma (31).
nursing schools was higher than those of private and
faith based nursing schools as summarized in Figure
1.

Figure 4: Frequency of tutors based on their educational

qualifications
Inferential statistics

Figure 1: Mean entry grade points of diploma nursing Entry qualifications and nature of school
students ownerships
Academic performance
It revealed a significant difference in entry
Majority of students from almost all nature of qualifications of students in nursing schools based on
school ownerships were awarded with lower second their nature of ownerships at α = 0.05 (F = 11.066 and
class followed by pass class both in public, private ρ =0.000).
and faith based owned schools as summarized in
Figure 1. Table 1: One-Way ANOVA for comparing
students’ entry qualifications and nature of school
ownerships

Sum of Mean
df F Sig.
Squares Square

Between
132.171 2 66.085 11.066 .000
Groups

Figure 2: Frequency of students’ performance Within

674.820 113 5.972
Moreover, the mean overall GPA for students Groups
from public owned schools was higher than that
Total 806.991 115
of students from private and faith based schools as
summarized in Table 3.
154 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Post Hoc Analysis was also performed. It revealed a significant difference in mean entry qualifications only
between students from public and faith based diploma nursing schools at α = 0.05 (ρ =0.000) as summarized in
Table 6.

Table 2: Post Hoc Analysis for comparing students’ entry qualifications and nature of school
ownerships

(I) Nature 95% Confidence Interval

(J) Nature of School Mean Difference Std.
of School Sig.
Ownership (I-J) Error
Ownership Lower Bound Upper Bound
Private 1.853 1.111 .098 -.35 4.05
Public
Faith Based 2.614 *
.556 .000 1.51 3.72
Public -1.853 1.111 .098 -4.05 .35
Private
Faith Based .761 1.032 .463 -1.28 2.81
Public -2.614* .556 .000 -3.72 -1.51
Faith Based
Private -.761 1.032 .463 -2.81 1.28

*. The mean difference is significant at the 0.05 level.

Students’ entry qualifications and academic performance

Bivariate correlation analysis revealed a significant positive relationship between students’ entry
qualifications and academic performance at α = 0.05 (r = 0.212, ρ =0.022) as it summarized in Table 7.

Table 3: Bivariate correlation between entry qualifications and academic performance

Entry Qualification Overall Academic

Performance

Pearson Correlation 1 .212*

Entry Qualification Sig. (2-tailed) .022

N 116 116

Pearson Correlation .212*

1
Overall Academic
Sig. (2-tailed) .022
Performance
N 116 116
*. Correlation is significant at the 0.05 level (2-tailed).

Nature of school ownerships and students’ academic performance

One-way ANOVA revealed no significant difference in academic performance of students based of their
nature of school ownerships at α = 0.05 (ρ =0.059) as summarized in Table 8.

Table 4: One-way ANOVA for comparing nature of school ownerships and students’ academic
performance

Sum of Squares df Mean Square F Sig.

Between Groups 2.621 2 1.311 2.894 .059

Within Groups 51.175 113 .453

Total 53.797 115

 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 155

Tutors’ educational qualifications and students’ academic performance

Bivariate correlation analysis revealed no significant relationship between tutors’ educational qualifications
and students’ performance in all modules they taught as summarized in Table 9.

Table 5: Correlation of tutors’ educational qualifications and students’ performance in modules they
taught

Tutors’ educational qualification

Pearson Correlation (r) p-value

Performance in NMT 06225 .143 .125

NMT 06122 -.132 .159
NMT 06227 -.030 .745
NMT 06228 .154 .099

DISCUSSION This study indicated that despite the Ministry

of health to select only students with higher entry
Entry qualifications and Nature of school qualifications into public diploma nursing schools
ownerships but there is no significant difference in academic
In general, this study indicated that public owned performance with other students from private and
diploma nursing schools admit pre-service students faith based schools. It is in line with the findings of
with higher entry qualifications as compared to those the study conducted in Ondo state-Nigeria by Alimi,
admi�ed in private and faith based owned schools. It Ehinola and Alabi who found a significant difference
is in line with the findings of the study conducted in in resources but not in academic performance of
Europe by Romero and Del Rey and the study done students from public and private schools28. However,
at the University of Leicester by Oliveira that, due it is contrary to the findings of the study conducted
to government sponsorship and free tuition fees in in Katsina state-Nigeria by Olasehinde found that
public owned schools, give them chance to a�ract students from private schools outperform students
students with higher entry qualifications compared to from public schools in standardized examinations22.
those admi�ed in private and faith based schools15, 16. Academic performance and tutors’ educational
Entry qualifications and academic performance qualifications

This study indicated that entry qualifications It indicated that tutors’ educational qualifications
have significant positive relationship with academic have no significant influence on academic
performance in diploma nursing schools in Tanzania. performance of diploma nursing students on those
It is in line with the findings of the study done in modules they taught. It is in line with the finding of
Kenya by Mutonga, in Uganda by Martha, Enugu the study done in Kano state in Nigeria by Igwe as
state- Nigeria by Ogbonnaya, Okpuruka, et al, and cited in the article of Abel and the study conducted in
in Philippines by Oducado and Penuela that, there Punjab- Pakistan by Dahar, Dahar, Dahar and Faize
is a significant positive relationship between entry found no significant relationship between tutors’
qualifications of students admi�ed in schools and educational qualifications and academic performance
their academic performance17, 18, 19, 20. However, it is of students23, 24. However, it is contrary to the findings
contrary to the findings obtained by Alimi, Ehinola of the study conducted in Owerri west-Nigeria by
and Alabi in Ondo state-Nigeria found no relationship Unanma, Abugu, Dike and Umeobika which found
between entry qualifications of students with their a perfect positive relationship between tutors’
prospective academic performance21. educational qualifications and students’ academic
performance25.
Academic performance and Nature of school
ownerships Acknowledgement: My sincere gratitude goes to
Catholic University of Health and Allied Sciences
156 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

(CUHAS) for the financial support throughout my 7 Dronkers J, & Robert P. The Effectiveness of
project work. Public and Private Schools from a Comparative
Perspective. EUI Working Paper SPS No. 2003/13,
Conflict-of-Interest Statement : I declare that, I 2003.
have no any conflict of interest throughout writing
8 Tutors, Administrators, & Students. Factors
this work.
contributing to increasing failure rates
Source of Funding: The main source of fund for among diploma nursing students in their
this work was CUHAS. This is my employer. final examinations in Tanzania. (K. Malale,
Interviewer), 2014.
Ethical Clearance: This study gathered only
9 Aripin R, Mahmood Z, Zohaizad R, Yeop U, &
secondary data from the training department database
Anuar M. Students’ learning styles and academic
at the Ministry of Health and Social Welfare. Names
performance. 22nd Annual SAS Malaysia Forum,
of the selected files of students were not recorded
15th July 2008. Kuala Lumpur, Malysia: Luala
anywhere instead codes which bear no link to the
Lumpur Convention Center; 2003
identification of the student were used for statistical
purposes. As the study did not involve students 10 Romer D. Do students go to class? Should they?
direct, no risk for participation was anticipated. Journal of Economic Perspectives, 1993; 7(3), 167-
Furthermore, there was no direct benefit to the people 174.
who participated or involved in providing data 11 Anderson G, & Benjamin D. The determinants
for this study instead it was beneficial in creating of success in university introductory economics
awareness on comparison of academic performance courses. Journal of Economic Education, 1994;
and entry qualifications, nature of school ownerships 25(2), 99-119.
and tutors’ educational qualifications in diploma
13 Devadoss SF, & Fol� J.Evaluation of factors
nursing schools in Tanzania.
influencing students a�endance and performance.
REFERENCES American Journal of Agricultural Economics,
1996; 78(3), 499-507.
1 Ahmad MM, Rafadi RR. Entry Criteria and 14 Birchall M. Managing Surveys in Scientific Fields:
Nursing Students’ Success. J Med , 2009; 43(3), Are social scientists ready to experiment? Journal
189-196. of Operations Management, 2009; 4(2).
2 Ali PA, Gavino MI, & Memon AA. Predictors 15 Romero L, & Del Rey E. Completion Between
of Academic Performance in the First Year of Public and Private Universities:Quality, Prices
Basic Nursing Diploma Programme in Sindh, and Exams. Universidad Carlos III De Madrid
Parkistan. J Pak Med Assoc, 2007; 57(4). Working Paper, 2004.
3 Bell M J. Define academic performance. 2014 16 Oliveira T. Tuition Free and Admission Standards:
Retrieved from eHow: h�p://www.ehow.com/ How do Public and Private Universities Really
about_4740750_define-academic- Compete for Students? The University of
performance.html Leicester Working Paper No. 06/6, 2006.
4 Mushtaq I, & Khan SN. Factors Affecting 17 Mutonga JW. A Comparative Study of Student
Students’ Academic Performance. Global Journal Academic Performance underFace-to-face
of Management and Business Research, 2012; and Distance Learning Mode of Instructional
12(9). Delivery: A Case of theRegistered Community
5 Hijazi ST, & Naqvi SR. Factors Affecting Students’ Health Nurse Upgrading Program, Kenya.
Pefrormance: A Case of Private Colleges’ (Unpublished Master’s Project). Kenya:
Bangladesh. e-Journal of Sociology, 2006; 3(1). University of Nairobi, 2011.
6 Kuncel NR., Hezle� SA, & Ones DS. A 18 Martha K. Factors. Affecting Academic
comprehensive meta-analysis of the predictive Performance of Undergraduate Students
validity of the graduate record examinations: at Uganda Christian University. Masters
Implications for graduate student selection and Dessertation report, 2009.
performance. Psychology Bulletin, 2001; 127, 19 Ogbonnaya NP, Okpuruka PO, Iheanacho PN,
162-181.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 157

& Ndu A. Students’ Entry Qualification and 23 Abel T O. The effect of teachers’ qualifications
Academic Performance in Basic Schools of on students’ performance in mathematics. Sky
Nursing in Enugu State between 1995 and 1999. Journal of Educational Research, (2014); 2(1), 010-
Creative Education, 2014; 5, 719-727. 014.
20 Oducado RM, & Penuela AC. Predictors of 24 Dahar MA, Dahar RA, Dahar RT, & Faize FA.
Academic Performance in Professional Nursing Impact of Teacher Quality on the Academic
Courses in a Private Nursing School in Kalibo, Achievement of Students at Secondary Stage
Aklan, Philippines. Asia Pacific Journal of in Punjab- Pakistan. European Journal of Social
Education, Art and Sciences, 2014; 1(5). Sciences, 2011; 19(1).
21 Alimi OS, Ehinola GB, & Alabi FO. Type of 25 Unanma AO, Abugu H O, Dike RC, & Umeobika
schools, Facilities and Academic Performance of UC. Relationship between Teachers Educational
Students in Senior Secondary Schools in Ondo Qualifications and Student’s Achievement in
State, Nigeria. International Education Studies, Chemistry: A Case Study of Owerri West LGA.
2012; 5(3), 44-48. IOSR Journal of Research & Method in Education,
22 Olasehinde KJ. A Comparative Study of Public 2013; 1(1), 5-10.
and Private Senior Secondary School Students’
Science Achievement in Katsina State, Nigeria.
Journal of Educational and Social Research, 2014;
4(3), 203-207.
 DOI Number: 10.5958/0974-9357.2016.00068.4

Practice of Female Smoking among Older Females

in Rural Areas of U�arakhand

Mahalingam Venkateshan1, Ramandeep Kaur Panwar2, Priyanka Rawat2, Rakhi Rana2,

Prateek Diwedi2, Priyanka Panwar2, Shivani Verma3
1
Assistant Professor, Himalayan College of Nursing, SRHU, 2Student Nurse, Himalayan College of Nursing, HIHT,
3
Nursing Tutor, Himalayan College of Nursing, SRHU, Dehradun, U�arakhand, India

ABSTRACT

Introduction: Smoking is a leading risk factor for many types of diseases globally. Tobacco smoking
by women is culturally unacceptable in India, but still women smoke tobacco at various stages of their
life. The study was aimed to explore the current practices of smoking among older females in rural
areas of Northern state of India. Methods: Quantitative non experimental approach with exploratory
descriptive design was used to a�ain error free outcomes. Eighty (80 Nos.) older females were selected
by Snowball sampling technique from selected rural areas. The Older females aged more than 55 years
and who reside in the rural areas were only included in the study. Semi structured interview was
conducted to explore the current practices of smoking among Older females. Self developed practice
checklist was used during the data collection. Ethical commi�ee permission from Swami Rama
Himalayan University, Dehradun was obtained from the concerned authority and informed consent
was taken from the study participants. Results: Most (81.23%) of the Older Females smoke daily and
two-third (65%) smoke less than 10 times in a day. Half (50%) of the older females were inspired by
their friends to smoke, 82.50% feel energetic after smoking, 52.50% smoke to get relief from stress, 80%
like to smoke at home and majority (53.75%) like to smoke more in winter season as they feel energetic
after smoking. Conclusion: Awareness of adverse effects is quite low needing proper intervention and
education to decrease health complications for future generations.

Keywords: Older Females, Practice, Rural areas, Smoking.

INTRODUCTION Among them, more than 75% live in low and middle-
income countries.[1]
According to the World Health Report 2002,
among industrialized countries, where smoking is Information on prevalence of tobacco use in
common, the habit is estimated to cause over 90% India is available from surveys carried out in general
of lung cancer in men and about 70% of lung cancer community. According to the national cross-sectional
among women. In addition, in these countries, household survey, India has more than 200 million
the a�ributable fractions are 56%–80% for chronic tobacco consumers. However, prevalence of smoking
respiratory disease and 22% for cardiovascular and tobacco chewing varies widely between different
diseases [3]. Globally 20% of smokers are women and states, and has a strong association with individual’s
tobacco smoking cause 1.5 million deaths in women. socio-cultural characteristics. A recent nationwide
study on smoking and mortality in India estimated
Corresponding author: that smoking in persons between the ages of 30 and 69
Ms. Ramandeep Kaur Panwar, years is responsible for about 1 in 20 deaths of women
Himalayan College of Nursing, SRHU, Jolly and 1 in 5 deaths of men, totality to 1 million deaths
Grant, Doiwala (Post) Dehradun, U�arakhand, per year.[5]
India, 248140, Email: [email protected] In India, smoking is more prevalent in men
[email protected] than in women and among older people. Whereas
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 159

men smoke throughout their lives, women tend to RESULTS

become smokers at an older age. [4] Different cultural,
psychosocial and socioeconomic factors can be the Table No. 1 Frequency and percentage wise
reasons for tobacco use. Use of traditional tobacco distribution of socio demographic characteristics of
products like bidi, khaini, chutki, betel quid used by participants.
women in India is poorly understood and studied. [1] n = 80

Furthermore, it is found that smoking is more Frequency and

S.
prevalent among less-educated, poorer, rural, and Sample Characteristics percentage
No.
lower-caste men, and among women in urban areas. (f &%)
A greater decline in smoking over time among more-
educated women is documented. Health behaviors Nuclear 19(23.8)

such as smoking and physical inactivity are risk Type of

1. Joint 43(53.7)
factors for many chronic diseases and leading causes Family
of death and disability. [4] Smoking also increases the Extended 18(22.5)
incidence of clinical tuberculosis, a cause to half the
tuberculosis death in India.[5] Illiterate 74(92.5)

The statistics on cigare�e consumption do not Primary 5 (6.3)

reflect the widespread use of smokeless tobacco 2 Education
among rural women. In India, for example, 22% of Secondary 1 (1.2)
rural women in Kerala chew tobacco in pan (betel
Graduation 0 (0)
leaf). Women also smoke bidi (small indigenous
cigare�es) and hookahs, as in Bihar, parts of Punjab
Married 55(68.8)
and Haryana. Rural women in Goa are known to
rub and plug the inside of their mouths with burnt Unmarried 1 (1.2)
powdered tobacco. [2] Marital
3
Status Widow 24(30)
Hence, this study was designed to study the
practice of smoking among older females. Divorced 0 (0)

METHODOLOGY Farmer 18(22.5)

A quantitative approach with exploratory Housewife 39(48.8)

descriptive design was carried out to study 4 Occupation
the practice of smoking. The universe of study Labor 22(27.5)

population comprised of older females above 55

Any other 1 (1.2)
years of age who were selected by using snow ball
method. Participants who were practicing smoking
Bidi 71 (88.8)
at present were included in the study. Eighty
participants were recruited for the study after Cigrate 0 (0)
exclusions. The investigator used self developed Type of
5
Smoking Hookah 1 (1.2)
checklist to study practice of smoking among older
females. Ethical commi�ee permission from Swami
Bidi &
Rama Himalayan University, Dehradun was obtained 8 (10)
Hookah
from the concerned authority and informed consent
was taken from the recruited participants. The data Rs 300 41(51.3)

was analyzed by using descriptive and inferential Monthly

6 Expenditure < Rs 300 27(33.7)
statistics. on Smoking
>Rs 300 12(15)
160 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

• Approximately half (53.7%) of the study

participants belongs to the joint family.

• Maximum (92.5%) numbers of the study

participants were illiterate.

• Two third (68.8%) of the study participants

were married and (30%) were widows.

• 48.8% of the study participants were

housewife and 27.5% were laborers.
Figure: 3 Season in which smoking is more among older
• Majority (88.8%) of the study participants female.
were using bidi for smoking. Majority (53.75%) of the older females prefer to
• Approximately half (51.3%) of the study smoke in winter season followed by rainy season
participants spend rupees 300 per month on (33.75%) and very few (16.25%) older females prefer
smoking. to smoke in summer.

Figure: 4 Inspiration of smoking among older females.

Figure :1 Time and duration of smoking among older Every second (50%) older female reported that
female.
their smoking habits inspired from friends and every
Most (81.23%) of the older females smokes daily, third older female was inspired by relatives (31.25%)
60% prefers to smoke at evening, 45% smoke before or Husband (30%).
sleeping, 43.75% spend almost 5 minutes to smoke
at a time and approximately one-third (37.5%) of the
older females prefers to smoke at morning.

Figure: 5 Reasons of smoking among older female.

Most (82.50%) of the older females smoke to get
Figure: 2 Frequency of smoking among older female energy, approximately two-third (60%) smoke as
Approximately two-third (64%) of the older a hobby and enjoyment, half (52.50%) of the older
females reported they smoke less than 10 times a day females smoke for relief from stress and 23.75%
and remaining 36% smoke more than 10 times a day. older females smoke when they are ill. An important
finding that has come is that 21.25% of the older
females were also alcoholic.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 161

Table No: 2 Association between socio- demographic variables and practice of smoking among older
females.

Sr. No. Demographic Variables ≤10 >10 P value

Nuclear 9(11.25) 10 (12.5) 0.0703

1. Type of Family Joint 33(41.25) 10 (12.5)
Extended 13(16.25) 5 (6.25)
Non formal 51 (63.75) 23 (28.75) 0.618
2 Education
Formal 3 (3.75) 3 (3.75)
Married 36 (45) 19 (23.75) 0.56
3 Marital Status
Widow 18 (22.5) 7 (8.750
Farmer 8 (10) 10 (12.5) 0.0041
4 Occupation Housewife 25 (31.25) 14 (17.5)
Labor 21 (26.25) 2 (2.5)
Bidi 48 (60) 22 (27.5) 0.4861
Hookah 1 (1.25) 1 (1.25)
5 Type of Smoking
5 (6.25)
Bidi & Hookah 3 (3.75)

Rs 300 27 (33.75) 14 (17.5) 0.6087

Monthly Expenditure
6 < Rs 300 20 (25) 7 (8.75)
on Smoking
>Rs 300 7 (8.75) 5 (6.25)

The table no.2 shows the proportion of the studies and one half of subject smoke more than 20
demographic variables with practice of smoking of cigare�e per day.[6]
older females. According to the distribution of the
Half of the older females like to smoke during
data the inferential statistics like Chi Square, Fisher’s
winter season and remaining like to smoke during
exact and Yate’s correction was used to analyze the
rainy season These findings correlated with Chan
data. All the demographic variables like type of
Zuying, Bailey Linda Godfrey, Schiff Isaac, and
family, education, marital status, type of smoking
Hausor Russ(2004) that majority of females smoke
and monthly expenditure on smoking were not
during spring and winter season.[7]
significantly associated with the practice score, only
‘type of occupation’ statistically associated with Majority of older females like to smoke at home.
practice score at the level of p< 0.05. These findings were supported by Trevor Woollery,
Samira Asma, and Donald Sharp (2000) that majority
DISCUSSION
of countries had some form of restriction on smoking
A small sample size and unique composition in public place and work site. Smoking restriction
of the study makes it difficult to compare the study may also alter the perceived norm related to smoking
with other available studies that have larger sample by changing a�itude the social acceptability of
size and varying socio economic characteristics. smoking.[8]
Approximately two-third of the older females
Half of the older females were inspired by
reported they smoke less than 10 times a day and
their friend which was associated with Abdulghani
remaining smoke more than 10 times a day. The
Hamza M, Alhaqwi Ali, Takroni Redwan, Ahmad
study results were consistent with Abdullah Abu.s,
Farah and Zahir Mohammed Ali(2013) findings
stillman Frances A, yang Li, Zang Zhiyong, and Samet
that the majority (77%) of smoker’s parents were also
Jonathan M (2013-2014) that significant association
smokers. More than half (54%) of the smokers started
that categorized smokers as light, moderate or heavy,
their smoking habit from friends for entertainment,
with varying definitions, making comparison among
and 44.4% of the participants did know that smoking
162 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

causes serious health problems.[9] 2005 Oct-Dec47(4): 192-197; Medknow

Publications; h�p://www.ncbi.nlm.nih.gov/pmc/
Maximum of the study participants feel energetic
articles/PMC2921132/
after smoking. These findings were correlated with
4. Murray Cramm and Jinkook Lee; Smoking,
Jane Murray Cramm, and Lee Jinkook(2014) that
physical activity and healthy aging in India;
larger population of older female in poor health were
BMC Public Health 2014, 14:526 doi:10.1186/1471-
smokers and physically inactive.[10]
2458-14-526; h�p://www.biomedcentral.com/
This study was limited with few points. First, 1471-2458/14/526
investigator has to rely on the information taken 5. Ankur Garg, Mongiam Meghachandra Singh
from the older females. Second, investigator does not and Renuka Seha; Prevalence and correlates of
have any control on other factors like relationship tobacco smoking, awareness of hazards, and
between family members and psychosocial status of qui�ing behaviour among persons aged 30 years
older females. Third, as the study’s sample size was or above in a rese�lement colony of dehli,India;
small the scope of the generalization of findings will Lung India.2012 oct-dec;29(4): 336-340; h�p:
be questionable. //www.ncbi.nlm.gov/pmc/articles/PMC3519019/
#_ffn_sectitle
CONCLUSION
6. Abu.s Abdullah, Frances A. Stillman, Li Yang,
The current study highlights about the practice Hongye Luo, Zhiyong Zhang and Jonathan M
of smoking in older females. Majority of the older Samet;Tobacco Use and Smoking Cessation
females were inspired by their friends, smoke less Practice among Physicians in Developing
than 10 times a day mainly to get relief from stress Countries: A Literature Review (1987-
and like to smoke more in winter season as they feel 2010);Published:30 dec 2013; Int.J. Environ.
energetic after smoking. Awareness of adverse effects Res.Public Health 2014,11(1), 429-455; h�t:
is very poor needing intervention and education to //www.mdpi.com/1660-4601/11/1/429/htm
decrease health complications in future.
7. Zuying Chen,Linda Godfrey-Bailey,Isaac
Acknowledgment: No Schiff, and Russ Hauser: Impact of seasonal
variation age and smoking status on human
Conflict of Interest: No
semen parameters: The Massachuse�s General
Source of Funding: Self
Hospital experice:J Exp Clin Assist Reprod.2004;
Ethical Clearance: Ethical commi�ee permission 1:2 www.ncbi.nlm.nih.gov/pmc/articles/
was obtained from the SRHU Ethical commi�ee pmc524369/
before starting the study.
8. Trevor Woollery, Samira Asma, and Donald
REFERENCE Sharp: Clean indoor-air laws & youth access
restrictions:2000;273-286; siteresources.wo
1. S Kathirvel, S Sharma, JS Thakur; Women and rldbank.org/INTETC/Resources/375990…/
tobacco: A cross sectional study from North 273TO286.PDF
India; Indian Journal of Cancer,Vol.51. No.5,
9. Hamza M Abdulghani, Norah A Alrowais,
2014, pp.78-82;h�p://medind.nic.in/ici/t14/i5/
Ali I Alhaqwi,[…] Redwan Takroni, Farah
icit14i5p78.htm
Ahmad, and Mohammed Ali Zahir: Cigare�e
2. Virginia Ernster, Nancy Kaufman, Mimi Nichter, smoking among female in medical and non
Jonathan Samet, & Soon-Young Yoon; Women medical colleges:2013; Inj J Gen Med. 2013; 6:
and tobacco: moving from policy to action; Bull 719-727; www.ncbi.nlm.nih.gov/pmc/articles/
World Health Organ vol.78 n.7 Genebra Jul. 2000 pmc3754488/
; h�p://www.scielosp.org/scielo.php?pid=S0042-
10. Jane Murray Cramm ,and Jinkook Lee:
96862000000700006&script=sci_ar�ext
Smoking ,physical activity and healthy aging
3. Anil Goswami, V.P. Reddaiah, and Guresh in India:2014; BMC Public Health. 2014; 14:
Kumar; Tobacco and alcohol use in rural elderly 526. www.ncbi.nlm.nih.gov/pmc/articles/
Indian population; Indian Journal of Psychiatry; pmc4047779
 DOI Number: 10.5958/0974-9357.2016.00069.6

Untold Aspects of Accountability in Curriculum: Social

Accountability from the Experiences of Providers and
Receivers in the Health System

Masumeh Sanaei1, Leili Mosalanejad2, Saideh Rahmanian3

1
Anatomy Department, 2Assistant Professor, Mental Health Department, 3 Nursing Staff,
Jahrom University of Medical Sciences, Jahrom- Iran

ABSTRACT

Introduction: Social accountability is among important and updated issues in the scientific community
and medical education. Since Iran has undergone different changes in the way of medical education, it
is important to address this issue from different aspects and evaluate its challenges.

Methods: This study is a qualitative study with a phenomenological approach that has been carried
out through 23 individual interviews and working on 5 groups focusing on students, faculty, patients,
and their companions at the University of Medical Science of Jahrom. Sampling was performed in a
purpose-oriented fashion and by using a triangulation method with the aim of gathering information
from different groups ( different levels of students, professors of various groups, patients of different
units and their companions) with a maximum variation and it continued until saturation. The content
analysis method was used to analyze the data.

Results: Of all the 105 codes extracted from the data, 5 categories and 14 sub-fields were extracted that
these categories included some items such as informing (1), accountability (2), practical education (3),
professional ethics (4) and professional status (5).

Conclusions: With respect to the significance of accountability as the requirement of the present
and future community of the country and also as an important aspect in medical curriculum, So,
providing professional appropriate training along with offering practical models as the hidden aspect
of environment can be effective in its promotion and development.

Keywords: Social accountability, Qualitative study, Professionalism, Teachers, Students, Curriculum

INTRODUCTION In Social Accountability issue there are three

words used interchangeably in most papers
Although the issue of social responsibility in
incorrectly (3). These three words are: 1-Responsibility
recent decades has a�racted much a�ention, no
2- Responsiveness 3- Accountability
complete and accurate definition has been provided
yet (1). All medical education institutions are obliged Responsibility is the accountability of the
to conduct their activities, services, training and providers of medical education towards training
research to meet the concerns and health priorities of competent physicians who can meet the needs of the
their covered communities (2). community.

Corresponding author: Responsiveness includes the correct planning

DR leili Mosalanejad of the curriculum and clinical education practices in
Motahari Street, Jahrom University of Medical meeting health needs with regard to the priorities of
Sciences, Email: [email protected] each community.
Tel: 09177920813 Accountability is gathering evidence that
164 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

indicates the amount of graduates’ competency in it. Data collection was through semi-structured
order to meet the health needs of the community (3). individual interviews and using focused group, that
first started with determining the interested outlines
Accountability is one of the terms that has in this project by providing general interview inquiry
appeared in the third millennium with a new and questions in which this question was posed that
meaning and experts believe that medical education when people talk of social accountability what came
in Iran has not yet been able to respond to the real into their minds? And then continued with narrower
needs of society, as expected (4,5). questions like “from your perspective, what factors
Bolan and woolard(two experts in this issue) increase social accountability?”, and the rest of the
assert that medical universities can be evaluated questions were proportionate with and corresponds
only when they have been standardized on the to the initial question. The data gathering tools were
basis of social accountability (6). Accordingly, some using focus groups and individual interviews. Then,
researchers have tried to design a model to assess content analysis was conducted from their views.
the social accountability of medical universities, Qualitative content analysis was used in the content
including Ryan Meili et.al who presented CARE analysis.
model. CARE is an acronym for Clinical activity, In this method, key concepts and hidden pa�erns
Advocacy, Research, Education and training and they are extracted and collected from the content of the data
believe that universities must be held accountable in and the data analysis is performed simultaneously.
these areas (7). In 2013 Larkins et al designed a model
called the Training for Health Equity Network The accuracy criteria in the content analysis
(THEnet) to investigate the social accountability of are expressed by credibility, transferability,
medical universities .This model can help the medical dependability, and the ability of authentication.
universities in achieving social accountability (8)
To assess reviewing participants, apart from
A very important question posed in the field reflecting words and experiences of the participants,
of social accountability a physician is that what full-text codes and classes were submi�ed to two
the characteristics of a respondent doctor are? To masters who were familiar with qualitative research
answer this question, the researchers believe that: and their comments were used to correct or confirm
Since the problems of each community are different them. For conformability, the full-text with codes and
and the expectations of a physician differ in different categories were handed in to two faculty members
societies, and, on the other hand, time passage creates and the comments of two experts in the field of
new problems and changes in the expectations of the qualitative research were used.
community from the doctor, so no same criteria can
be held for accountable physicians and these criteria After reviewing the comments and provided
are dependent on time and community (9,10). literature, at first, two cooperators of the project
studied the expressed issues separately and then, in
But unfortunately, few independent researches addition to its compatibility with each other, themes
in our country have been done in the field of social and sub-themes were identified through resultant
accountability in medical field. This study aimed to content and analysis of the collection was dealt with.
investigate the experiences of providers and recipients To enhance the validity of the method, participants’
of medical care in the field of social accountability as confirmation was used in this part and was presented
an untold aspect of accountability in curriculum. after the final conclusion.

MATERIALS & METHODS The content analysis method was used to analyze
the data. Interviews were digitally recorded and
This study is a qualitative study with a then transcribed word by word, reviewed, coded
phenomenological approach to the experience of and analyzed immediately. For initial coding, the
professors, students, staff, patients and patients’ participants’ own words and indicating codes
companions that was conducted in the context of (the researcher’s impression of statements) were
social accountability. The use of heterogeneous used. Semantic units of the statements made by
groups determined the depth of experiences and participants were extracted in the form of original
helped the content validity of the data and enriched codes or the open codes from interviews and the
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 165

codes were reread several times, and the codes experience expressed by students, teachers and
expressing a single subject based on the similarities patients and all the people.
and the proportion were put in one group or class,
classification with separate applicable codes, and Providing the patient with appropriate
frequent review and integrating the same code were information, provide education about illness and
done. So the second level of coding (axial), or data disease from the perspective of patients and their
classification, was formed. And in the next step, companions are criteria of social responsiveness.
classes were compared and those classes that were Patient number 3 (35 years old): “the fact that
similar in terms of characteristics were combined the nurses answer any questions that the patient has,
to form a larger class and themes emerged. Ethical that what services the doctors or the nurses offer, and
consideration conclude Participants consent , ensure that they explain what they are doing, what are the
anonymity and confidentiality for the participant advantages, and if not done, “
and move on all strip and interview after research.
Also all human research ethical norm considered in The domain of informatics, from students and
this study . Jahrom Research commi�ee approved faculty perspectives, can contribute to a be�er
ethical consideration in this study. answer.

RESULTS Student of Medical Externship:”A doctor is

needed to have a good command of his field of study.
Totally, 5 professors, 10 patients, 7 companions, His knowledge is very important and some scientific
4 focused students groups (medical, anesthetic, and standard information that can be very helpful in
nursing, and operating room) and 10 individual the workplace, such as knowing how to announce
interviews with students of different levels and bad news.”
disciplines were used.
The second area of the extracted areas is
Of the total of 105 extracted codes, 6 themes and responsibility, which includes the fields like
11 sub-themes were obtained which encompass the commitment and work ethic.
following items.
Experienced professor in education states
Thems Subthemes that: “Sense of responsibility of medical staff is so
important that other 70-80% of cases depend readily
Purposeful Training
Informatics on it.
Patient’s Expectations

Commitment
Focus group of Anesthetic students: “democracy
Accountability Democracy is one of the symbols of accountability. In every job,
Self-direction the person should treat with the patient properly,
ethically and respectfully and in compliance with
Practical feedback standards. This means that being the personnel must
Practical training Effective Training not cause ignorance to the patient,….. .”
Role Model (Pa�erns)
Practical training is of other categories that
Internalized moral
Professional Ethics can be seen in the context of individual experience.
Love for humanity
This issue emphasizes deep and practical training,
Material and spiritual accountability of medical professionals practically,
Professional status dignity
pa�erns and sampling from the symbols of power
Professional motivation
and internalizing it through educational training.
Of the total of 105 extracted codes, 5 category
The companion of 32-year patient: “These issues
and 14 subclasses were extracted that classes include
should creep into the depth of courses that are given
areas such as communication, responsibility, practical
to the student; what taught her? What has he learnt?
education, medical ethics, and templates.
What has he wanted? ....”
The first class among the extracted classes
Student number 8: “se�ing the courses of medical
is informatics which can be seen in the depth of
166 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

ethics has an impact, but they are not applicable, they depth of this issue, a cultural change is needed in
probably have an effect on our actions but it is be�er which doctors and patients become familiar with
to practice and see them in the context”. their rights and duties (11).

The role of pa�erns in expressing responses, In a review of the others, it can be seen that the
according to a medical student has been explained inability of graduated doctors derives from medical
in this way: “pa�erns are a practical example of training drawbacks (12-14). In this regard, many
the response. When I see a patient teacher and his developed countries have started to make changes in
situation is not different I will act like him. “ medical education curriculum in order to empower
their physicians (10 & 15). However, the issue of training
One of the professors, in other words: “the faculty
doctors is still one of the most controversial issues in
has a very important role; students take model from
Iran and other countries (10). In another study in the UK
us. Unfortunately, some teachers have no specific
it was found that only 4% of the students agreed with
effect. And, if irresponsible people are put in this
the relevance of the curriculum to empower doctors
group.”
and about 40 percent were completely opposed to its
Professional status is another category that has effectiveness (12).
been identified at this location and it stresses that
Our respondents believed that teachers, as
maintaining the dignity of the medical staff, paying
practical models, played a vital role in medical ethics
a�ention to their financial and spiritual status and
education. Wallenburg also believes that the doctors
supporting their dignity can be effective in compliance
learn the professional ethics from experienced
with accountability.
physicians and asserts that promoting role models
Intern student: “the payment of a doctor is of among medical faculty should be invested (16,17 ).
importance; a physician who has spent seven years Regarding the professional status, our respondents
of his life, if he graduate from medicine at the age believed that the dignity of the physicians motivate
of 26, yet he has not taken a profit from life, so if them. By the same token, some researchers believe
the government does not address their destiny and that the curriculum should train doctors who have
future, that doctor who has got blind to humanity.” both the ability to work in underserved areas and
a positive a�itude and the desire to establish and
Focus group of nursing student group: “It is true provide services in these areas. (18-21)
that knowledge and experience are very important,
but it cannot be said that money is not important. The other raised class in this study is responsibility
with subclasses of democracy commitment and self-
Professional Ethics is among the last classes direction. Boelen believes that the current system
obtained from the results. This issue points to the of accepting medical students is not an appropriate
proper education of medical ethics and then its system and the elected person should have a
internalization as a professional responsibility and positive a�itude toward serving the community and
accountability which has been often emphasized in sympathizing with people (6). As in many universities
the statements. abroad, one of the conditions of entering to medical
field that he has already spent a period of time as a
Case No. 9: 38-year-old man: “Dealing with the
social worker in the service of the people (22).
sick, some nurses only want to meet their obligations,
and others willingly do this job and love to do it; this Another discussed class is practical training. Our
is a ma�er of morality that shapes these behaviors.” respondents believed that as long as the Advocacy
(physician advocacy of society) is not included in the
DISCUSSION
curriculum, it cannot be expected that these students
The issue that first appeared in interviews with turn out into accountable doctors the students in the
teachers, students, patients and their companions future. According to Dharamsi, Medical Colleges
was that many interviewees did not have a correct expect physicians and clinical students to maintain
definition and perception of the term social their professional values in society, while they do not
accountability. Experts of social responsibility also teach these issues to their students even superficially
believe that in order to analyze and understand the
(23)
.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 167

CONCLUSION accreditation: a new frontier for educational

institutions.Med Educ. 2009 Sep;43(9):887- 94
Considering the importance of social
7. MeiliR,etal.The CARE Model of Social
accountability in medical profession, we can offer
Accountability:Promoting Cultural
special workshops to make all providers of health
Change.Academic Medicine, Vol. 86, No. 9 /
care services in the community familiar with this
September 2011
discussion so that social accountability has gradually
become a mainstream culture. 8. LarinksSL,etal.Measuring social accountability
in health professional education: development
Medical Universities should require themselves and international pilot testing of an evaluation
to know and understand the problems and needs of framework.Med Teach. 2013;35(1):32-45.
their society, and change their curricula to meet those
9. Albanese MA, Mejicano G, Mullan P, Kokotailo
needs so as to train more competent and accountable
P, Gruppen L. Defining characteristics of
physicians in the future.
educational competencies. Med Educ. 2008;
Acknowledgment: This work was funded by an 42(3): 248-55.
award from jahrom University of Medical Sciences, 10. Gibbs T. Sexy words but impotent curricula:
Iran. Can social accountability be the change agent of
the future?Med Teach. 2011; 33(8): 605-7.
Conflict of Interest : No
11. Fleet LJ, Kirby F, Cutler S, Dunikowski L,
REFERENCES Nasmith L, Shaughnessy R. Continuing
professional development and social
1. Reddy AT, Lazreg SA, Phillips Jr RL, Bazemore
accountability: a review of the literature. J
AW, Lucan SC. Toward Defining and Measuring
Interprof Care. 2008; 22 (Suppl 1):15-29.
Social Accountability in Graduate Medical
Education: A Stakeholder Study. J Grad Med 12. Goodfellow P, Claydon P. Students si�ing
Educ. 2013; 5(3): 439-45.. medical finals—ready to be house officers?. J R
Soc Med.2001; 94(10): 516-20.
2. Chapagain ML1, Boelen C, Heck JE,
KoiralaS.Quest for Social Accountability: 13. Burch V, Nash R, Zabow T, Gibbs T, Aubin L,
Experiences of a New Health Sciences University Jacobs B, et al. A structured assessment of newly
in Nepal. Education for Health, Vol. 13, No. 2, qualifiedmedical graduates. Med Educ. 2005;
2000, 227–230 39(7): 723-31.

3. Boelen C, Dharamsi S, Gibbs T. The Social 14. Moercke AM, Eika B. What are the clinical
Accountability of Medical Schools and its skills levels of newly graduated physicians?
Indicators.Educ Health (Abingdon). 2012; 25(3): Selfeassessmentstudy of an intended curriculum
180-94. identified by a Delphi process. Med Educ. 2002;
36(5): 472-8.
4. yazdanish,hoseiniF,homayooniR.Reform in
general medical degree curriculum. Education 15. Are� HT. Some thoughts about creating
development Center.Shahidbeheshti university healthcare professionals that match what
of medical sciences Available from: h�p://h�p: societies need. MedTeach. 2011; 33(8): 608-13.
//medschool.umsha.ac.ir/uploads/21_386_1- 16. Wallenburg I, van Exel J, Stolk E, Scheele
reform%20book%20%20-version%205.pdf.[pers F, de Bont A, Meurs P. Between trust and
ian] accountability:different perspectives on the
5. Education development Center. North khorasan modernization of Postgraduate Medical
university of medical sciences. [Tarikhchehe Training in the Netherlands. AcadMed. 2010;
vahedeamuzeshepasokhgoo]. [cited 2014 Jun 85(6): 1082-90.
1]; Available from: h�p://nkums. ac. ir/index. 17. Burdick W, Amaral E, Campos H, Norcini J. A
aspx?Catid=3832.[persian] model for linkage between health professions
6. BoelenC ,woolard B.Social accountability and education and health: FAIMER international
faculty development initiatives. Med Teach.
2011; 33(8): 632-7.
168 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

18. McKimm J. Current trends in undergraduate 21. Worley P, Murray R. Social accountability in
medical education: program and curriculum medical education-An Australian rural and
design. Samoa Medical Journal. 2010; 2(1): 40-8. remote perspective. Med Teach. 2011; 33(8): 654-
19. University of Saskatchewan. College 8.
of Medicine Social Accountability 22. Cohen JJ. Professionalism in medical education,
Commi�ee Strategic Plan.Availablefrom: an American perspective: from evidence to
https://www.medicine.usask.ca/ accountability. Med Educ. 2006; 40(7): 607-17.
leadership/socialaccountability/ 23. Dharamsi S, Ho A, Spadafora SM, Woollard R.
pdfs%20and%20powerpoint/SAC%20Strategic The physician as health advocate: translating
%20Plan%202011-14%20FINAL_June_2011.pdf the quest for social responsibility into medical
20. John S.G. Biggs.The Social Responsibilities of education and practice. Acad Med. 2011; 86(9):
Medical Colleges in Pakistan.stan Journal of the 1108-13.
College of Physicians and Surgeons Pakistan
2013, Vol. 23 (1): 2-4
 DOI Number: 10.5958/0974-9357.2016.00070.2

Nursing Student’s Clinical Learning Experiences

and the Barriers Faced

Santa De1, Pravina Mahadalkar2, Lily Podder Bera3

1
Professor, Medical Surgical Nursing, 2Professor, 3Assoc. Professor, Gyn Ob. Nursing,
Bharati Vidyapeeth Deemed University College of Nursing, Pune

ABSTRACT

Training as a Professional nurse is a rigorous exercise. The student undergoes various learning
experiences out of which clinical is the most important. An exploratory study was conducted to
determine the student nurse’s clinical learning experience during their basic nursing education at
selected institutes of nursing education in Pune city, with the objective of determining student nurses’
clinical learning experience and recognizing the barriers in learning. The data was collected using a
semi structured questionnaire from 363 students, who had undergone at least one year of training.

Findings: Though 68.6% students had desired to be a nurse when they joined the course, 90.91%
expressed that theory classes generated interest for clinical. More than 80% of the students responded
positively regarding clinical learning experience in relation to nursing process, practicing clinical
procedures and clinical supervision. Barriers for learning were mainly in the area of clinical field
in particular lack of equipment (46.2%), over work (30.25%), excess number of health professionals
especially trainees (31.68%), overcrowded clinical activities (8.26%), uncooperative patient and
relatives(5.8%), inadequate clinical time(5.5%). The study findings also revealed that, insensitive ward
staff (29.75%), restriction to practice certain nursing procedure due to hospital policy (8%), current
practices expected to be done in the clinical area are not as taught in class (33%) are some of the
important areas contributing to the barriers in clinical experience.

Conclusion: Students have freely expressed their views which are important for the educators to
identify gaps and develop strategies to improve the clinical experience.

Key words: Clinical learning experience, Professional Nursing, Clinical skill, student nurse.

INTRODUCTION students experience problems and difficulties

throughout their clinical practice 1,2.
Professional nursing is the process of purposeful
action undertaken between the nurse and the client. It’s hard work to be trained as a nurse
Clinical practice is an indispensable part of nursing – combining the dual demands of studying and
student’s training. This preparation allows the practical experience. Clinical rotation in a basic
student to utilize the opportunity to correlate nursing program is provided with an aim to integrate
theoretical knowledge with clinical practice. Evidence skills and knowledge obtained from the classroom
obtained from research studies demonstrated that se�ing into the clinical practice se�ing.

Clinical skills are any actions performed by a

Corresponding author: nurse involved in direct patient care which has a
Prof Santa De, definite impact on clinical outcome in a measurable
Medical Surgical Nursing, Bharati Vidyapeeth way. Clinical skills developed during basic nursing
Deemed University College of Nursing, Pune, education / training generally remains permanent,
Mob: 9921526290, [email protected] therefore, it should be ensured that it is accurate3
170 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

and the learner need to be encouraged and must get acquire their values and beliefs about what good
exposure to the appropriate practical scenario. patient care is and what a good nurse is.
• The student can develop their professional
Students of nursing have a responsibility to
self-image and this will help the student to go from
society in learning the academic theory and clinical
being able to achieve various tasks to becoming a
skills needed to provide safe, quality nursing care.
nurse who understands what their role entails and
The clinical se�ing presents unique challenges
someone who is an independent and competent
and responsibilities for the nursing student while
practitioner. They may identify a role model.
caring for human beings in a variety of health care
environments. PROBLEM STATEMENT
Need for the study: Exploratory study to determine the student
nurse’s clinical learning experience during their
• Clinical practice exposes the nursing student
basic nursing education at selected institutes of
to the work of the nursing profession and assists them
nursing education in Pune city.
in adopting professional ideologies and behaviors.
• Nursing is a practice-based profession. OBJECTIVES
Therefore clinical education carries about 75 to 80 %
1. To determine student nurse’s clinical learning
weightage in the undergraduate nursing curriculum.
experience during their basic nursing education.
The quality of nurse education depends largely on the
quality of the clinical experience4,5. Students require 2. To recognize the barriers in learning during
effective clinical placements to allow the application their clinical experience.
of theory into practice4. These experiences are central
to the student’s preparation for entering the workforce METHODOLOGY
as a competent and independent practitioner.
Research Design: Exploratory research design
Clinical practice is important because it provide
Research Tool: semi structured questionnaire
student nurses with:
consisting of 20 closed ended and one open ended
• The opportunity to privilege of direct access question .
to patients and experience the world of nursing and
Validity : The developed tool was validated by
also, to reflect on and to speak to others about what is
7 senior nursing faculty from various colleges of
experienced.
Nursing
• The reference system to critically evaluated
Reliability : was done by test retest method and
practice, to predict future actions.
r value was 9.6.
• The motivation essential to acquire the skills
Population: Student Nurses of Basic nursing
critical to delivery of quality patient care.
education courses
• The environment that enables them to
Sample: Student Nurses of Basic nursing
understand the integrated nature of practice and to
education courses, from the selected institutes, who
identify their learning needs.
have undergone at least one year of training
• The opportunity to take responsibility, work
Sample size: 363
independence and receive feedback on their practice.
Sampling technique: Purposive sampling
• A chance to learn Clinical decision making
skills and also to be accountable for the decisions Inclusion criteria:
made. 1. All students of second year and above of
• Ability to develop self motivation to be a Basic BSc Nursing course and RGNM programme
lifelong learner and develop habit of updating were included in the study.

• Possibility to form their vision of nursing. 2. Students who are available and willing to
Students are influenced by their placements they participate in the study.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 171

Exclusion criteria: ETHICAL CONSIDERATIONS

1. Students of first year RGNM and Basic BSc
Permission for data collection was sought from
Nursing course.
the Principals of the selected nursing institutes of
Limitation: Study is limited to the selected Pune. The students were informed about the aim of
institutes, the study, requested to facilitate in data collection
Students who have failed and not a�ending promising confidentiality and willingness to
regular classes are not included participate was considered as consent. The autonomy
of the student was protected; Identification in data
Research se�ing : Four institutes of Nursing
saving and analysis was done by a different person.
education of which three were colleges of Nursing
and one school of nursing.

FINDINGS

Analysis of the findings of the study is done and presented in two sections:

Section I: Demography of the students:

Table 1: Demographic Parameter N=363

DEMOGRAPHY OF STUDENTS TOTAL F %

Gender Male 25 6.8

Female 338 93.1

Hindi 284 78.23

English 314 86.50

Language proficiency
Marathi 12 0.03

Other languages 28 7.7

Maharashtra 53 14.6

Kerala 249 68.59

Rajasthan 23 6.33
Home Town
Gujarat 1 0.27

Punjab 4 0.01

Not mentioned 33 9.09

Final year B Sc nursing Students 115 31.68

TYBSC Nursing students 111 30.58

Course of study
SYBSC Nursing Students 92 25.34

TYGNM students 45 12.40

Section II: Analysis of the questionnaire: • 90.91% expressed that, the theory classes
generate interest for gaining experience in the clinical
• Most of the students (68.60%) stated that,
area.
they have joined nursing out of their own interest,
• 81.82% mentioned that, before doing a new
• 93.94% revealed that, the clinical instructors
procedure, students read whatever is taught in the
orient the students to the ward during first entry to
class .57.85 % expressed that, they do additional
the ward.
172 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

reading in the library for performing a new procedure The barriers expressed by students to practice
in the ward. nursing skill in the clinical area

• 80.44% said that they practice in the lab Only 57.85% of the students responded to the
well before performing any procedure on the patient open ended question.
and 88.71% mentally rehearse the procedure before The most common responses were categorized as
performing in the ward. 70.52% stated that, they follows
maintain a checklist of procedures to be learnt in a 1. Factors related to Clinical Area/Practice
particular clinical area.
• Shortage of equipments and supply of
• All the students felt free to clear their doubts materials for patient care (46.2%)
related to patient care from the clinical instructors
• High workload in the clinical area (30.25%)
(55.65%), senior students (20%), on duty nursing staff
(15.15%) and any of them (2.2%) • Current practices expected to be done in the
clinical area are not as taught in class (33%).
• 76.31% revealed that, they are supervised by
the clinical instructors while performing a procedure • Overcrowded clinical areas by students and
for the first time, 66% by senior students and 5% by staff (31.68%)
on duty nursing staff. • Uncaring a�itude of ward staff (29.75%)
• While enquired about the availability of • Overcrowded clinical activities (8.26%)
equipment and supplies to perform procedure in • Restriction to practice certain nursing
the ward, 49.59% of the students brought out the fact procedure due to hospital policy (8%)
that, the equipments were available, whereas 50.41
• Un- cooperative patients and relatives (5.8%)
expressed that they were not adequate.
• Inadequate clinical time (5.5%)
• 69.97% students reported that, they take a
chance to practice every procedure at least five times 2. Personal factors of the student
during their training. This reflects that 30.3% do not • Language problem (4.9%)
practice their procedure at least five times during • Lack of interest (0.4%)
their training.
• Lack of confidence (5.35%),
• 65.56% stated that, the nursing procedures
• Lack of respect as a student (3%)
are done in the same manner during examination
and daily practice, however it also reveals that a large 3. Factors related to teaching institution
group of students do not practice procedure as taught • Uncaring a�itude of college tutors (1.8%)
when not supervised [The above mentioned percentage is calculated
• 82.64% affirmed that, they practice performing based on total number of students (363)]
nursing assessment daily for their assigned patient.
DISCUSSION
• Majority of the students claimed that they
practice writing nursing process (71.35%) and writing • Though a majority of the students stated
nurses notes (84.59%) for the patient on whom they that they have joined the profession out of their
are not writing an assignment. own interest it is also worth noting that a substantial
• 66.12% declared that, they are able to number of students joined nursing without their own
communicate with the patients’ in local language interest. Even in this situation interest to practice
effectively, which is an essential component in nursing process as well as accuracy in performing
assessment of needs of the patient and also to deliver nursing procedure has been generated during the
nursing care efficiently. course of study.

• 95.59% expressed that, they are able to • Learning needs of the students are not
complete an assignment that involves a group /team adequately met at the clinical area due to shortage
of people. of equipment and supply, overcrowding of students,
uncaring a�itude of the hospital staff, Restriction to
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 173

practice certain nursing procedure due to hospital on the learning and study process of student nurses
policy, wide gap between theory and practice6,7, 1. 6,14,15
.

• But learning experience in the above CONCLUSION

mentioned constrains prepares the student to practice
The study finding revealed the student nurses
nursing ideally in an actual work situation6.
were aware of the gaps in their learning experience
• In a qualitative study conducted by Chapman and expressed freely when asked. This study has
and orb on Nursing student’s lived experience of implications for clinical supervisors, administrators
clinical practice it was elicited that hindrance in at the practice area and academic se�ing. Clinical
learning was due to personal difficulties feeling of learning experience is the most important component
frustration and being tired when students needs were in preparation of a professional nurse, for which
not recognized 8. nursing teachers and administrator both college and
hospital are important.
• A study done in Italy also shows finding
similar to the current study in the area of Learning Professional actions by the nursing student
process of Nursing students during apprenticeship enhance the image of nursing and contribute to build
36% of students stated that a very high workload in a trusting relationship between the nursing student
the ward does not allow the student to pursue the and the client, and between the nursing student and
aims of the educational project 9,10. the health care team.

• Findings of the present study revealed that, Acknowledgement: Our sincere gratitude to the
all students always had some nursing personnel principals of all the nursing institutions for giving
available to clear their doubts and supervising them permission to collect data. We appreciate the free
for the procedure that they are performing for the first response of the participants
time on the patient.
Conflict of Interest: Nil
• Apart from clinical supervision, studies have
Source of Funding: Self financed.
revealed that, peer support and social support as vital
elements in facilitating student’s learning (Kellys BIBLIOGRAPHY
2007 and Roberts 2008)11,12.
1. Mabuda BT, Potgitere, Alberts UU, Student
• The study findings reflect that educational Nurses Experiences During Clinical Practice
institution prepared the student well for the clinical, In The Limpopo Province. Curationis, 31 (1):19
generating interest for patient care during theory – 27
classes and adequately supervising them in the
2. Massarweh L J . Promoting a positive clinical
field, but a very small percentage of students did
experience. Nurse educator.1999. 24(3): 44 -47.
express about the uncaring a�itude of teachers. A
study conducted by Sharif and Masoumi in 2005 3. Quinn FM. The principles and practices of Nurse
reports that, the clinical nurse educators take a education, 4th edition. 1995.London: Stanley
role of evaluation more than supervision and the Thornes.
nursing staff who lacked teaching experience may be 4. Elliot,Napthine.Enhancing-support-for-nursing-
supervising the students and may not know the needs students-in-the-clinical-se�ing /203296.article
of the students 6,13. (online) 2006 Apr 102(14):35. Available from url:
h�p://www.nursing times .net.
• In contrast to this, the study by Fischer,
Boshoff and Elharin on student nurses need for 5. Napthine R. Clinical Education a system under
developing basic study skills concluded that the pressure. Australian nursing Journal. 1996 Apr 3:
student nurses needed more guidance to develop 20-4,.
basic study skill also mentioned about the language 6. Kaphagawani N C, Useh U. Analysis of Nursing
medium of the study material had a profound effect students learning experiences in clinical practice;
Literature Review, Ethno Med. 2013. 7(3): 181–5.
174 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

7. Bezuidenhout MC, Koch, and Netshandana 15. Beck CT Nursing student’s initial clinical
VO. The role of the ward manager in creating experience: a phenomenological study.
a conducive learning environment for nursing International Journal of Nursing Studies, 1993,
students. 1999. Curations, Sept:47 – 53. 30(6), 489 – 94.
8. Chapman R, Orb A. Nursing Students lived 16. Beck DL, & Srivastava, R. Perceived level and
experience of clinical Practice. Australian sources of stress in Baccalaureate Nursing
electronic Journal of Nursing Education .2000 students, Journal Of Advanced Nursing, 1991,
Mar: 5(11). 30(3), 127 - 133.
9. Dellai M, Saiani L, Zampieron. Abstract: 17. Rennie I, Exploring approaches to clinical skill
Factors influencing the learning process during development in nursing education. Nursing
apprenticeship: Study of the nursing student’s Times, 2009, 105:3, 20 – 22.
perception in the Trento nursing school [online], 18. Emanuel V, Karen D and Lorrein D. Developing
Article in Italian. Source: universitario per evidence based practice among students.
infermiere di triento. Pubmed: indexed for Nursing Times, 107:49/50, 21 – 23.
MEDLINE.
19. Fi�gerald C, Gordon K I, Ka� J, Hirsch A.
10. Maben J, Later S, Macleod CJ. Theory practice Advanced practice nursing education: challenges
Gap impact of professional - Bureaucratic work and strategies. Nursing research and practice,
conflict on newly qualified nurses. Journal of Vol. 2012 (2012), article ID854918, 8 pages, doi:
advanced Nursing 2006. 55: 465-7 10.1155/2012/854918.
11. Kelly C. Students perception of effective clinical 20. Evans C, Razia R, and Cook E, Building
teaching revisited. Nurse education Today. Nurse education capacity in India: Insights
2007. 27:885 – 92. from a faculty development programme
12. Roberts D. Learning in the clinical practice. The in Andhra Pradesh [online] BMC Nursing
Importance of Peers. 2008. Nursing Standard. 2013, 12:8 doi:10.1186/1472-6955-12-8. (h�p://
2007. 23:35 – 41. creativecommons.org/licenses/by/2.0) Received
13. Sharif F, Masoumi S. A qualitative study of 5th Dec 2011, accepted 18 March 2013, Published
nursing student’s experience of clinical practice, 27 Mar 2013.
BMC Nursing. 2005. 4: 4 – 6. 21. L E Heidgerken, Teaching and Learning in
14. Fischer M, Boshoff ELD, Ehlers VJ. On student Schools of Nursing, Konark Publishers, India,
nurses need for developing basic study skills, available on flipcart.
Curationis[online].sep 2001. 24 (1).66-73.
 DOI Number: 10.5958/0974-9357.2016.00071.4

Effect of Yoga and Raw Diet on Physiological Variables

and Quality of Life of Prediabetic Patients

Sr.Tresa Anto1, Rajeev Kumar N2

1
Vice Principal, Jubilee Mission College of Nursing, Thrissure-5, Kerala,
2
Associate Professor, MG University, Ko�ayam, Kerala

ABSTRACT

This study was an a�empt to understand the effect of yoga and raw diet on physiological variables
and quality of life of Prediabetic Patients. In this study the investigator used Pre-test Post test
control group design. Study Sample consist of 60 Individuals with Prediabetes,age30years and
above. Random sampling was used for the study. Raw diet and yoga was the independent variable.
Dependent variable were Physiological variables like Fasting blood sugar level, blood cholesterol,
Pulse rate, blood pressure, and quality of life. Descriptive and analytic statistics were used in the study.
Percentage were used to describe the study samples baseline characteristics. The significant difference
between the mean scores of the variables were calculated by paired t test. The findings of the study
highlighted that quality of life and physiological variables score were improved after yoga and raw diet
therapy in Prediabetic experimental group.

Keywords: yoga, raw diet, quality of life, physiological variables, Prediabetic patients.

INTRODUCTION taking a huge toll of human resource utilization. It

is believed that diabetes is the single most important
Type 2 diabetes is fuelled by rapid urbanization,
bodily disorder that can affect every organ system
nutrition transition and increasingly sedentary life
in the body 3.Yoga is an ancient science and a rich
styles, large intake of refined carbohydrates such
cultural heritage of India. Many earlier books cite the
as white rice, consumption of food low in nutritive
usefulness of yoga in treatment of certain diseases
value during pregnancy and in early life and in
as well as to maintain normal health in individuals.
contrast having over nutritious food in later life,
However, a detailed examination of the effect of yogic
all these play a big role in spreading Diabetes. It is
practices on the management of diabetes has not been
important to think aloud, how to prevent this in the
done. So the investigator a�empted to understand the
early stage of development?. The understanding and
effect of yoga and raw diet on physiological variables
insight about root cause of the disease condition
and quality of life of Prediabetic Patients 4.
helps to take remedial steps to prevent the disease
condition in more fruitful manner in the Prediabetic PROBLEM STATEMENT: effect of yoga and
state1.one of the major risk factors of diabetes is raw diet on physiological variables and quality of life
obesity. Observations predict that Indians who are of Prediabetic Patients .
lean and have a lower BMI are also are equal risk
as those who are obese2. High per capita income, OBJECTIVES
increasing life expectancy, urbanization, changes in 1. To find out the effect of raw diet and yoga on
lifestyle, food habits, sedentary lifestyle, mental stress physiological variables of Prediabetic experimental
all these lead to diabetes and its complications. The and control group before and after raw diet and
additional burden of decreasing cognitive abilities is yoga therapy.
Corresponding author 2. To find out the effect of raw diet and yoga
Sr.Tresa Anto, Vice Principal, Jubilee Mission College on quality of life of Prediabetic experimental and
of Nursing, Jubileegardens, Kachery, Thrissur-5 control group before and after raw diet and yoga
Kerala, E-mail: [email protected] therapy.
Mob.-9745686254, Fax:-04872422157
176 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

HYPOTHESES and evening during the camp period a basic course

in yogasana training were given to patients. which
Ho: There is no significant difference on includes different asanas like Halasana, Bhadrasana,
physiological variables of Prediabetic experimental Bugangasana, Dhanurasana, Matsyanthrasana,Vipari
and control group before and after raw diet and thakarani, Pachimudhrasana, Ardhamalsendhrasana,
yoga therapy. Ardhahalasana, Chakrasana, Salabhasana, Vakrasana,
Ho: There is no significant difference in the Naukasana, Vajrasana,Yogamudhra,Tree Pose,
quality of life of Prediabetic experimental and Sarvangasana and Savasana. Yoga practices done in
control group before and after raw diet and yoga morning and evening at least 30 minutes for40 days.
therapy. Campers gathered together on the 40th day to assess
MATERIAL & METHODS physiological and psychological variables.. A total
of 60 patients completed the study. In the present
A experimental study with pre-test post test study independent variable is the Yoga and raw diet.
control group design using random sampling Dependent variables were the physiological variables
technique. physiological variables and quality of and quality of life Patients. Physiological variables
life of Prediabetic patients were assessed using self like blood sugar level, blood cholesterol, high density
administered questionnaire to a total of 60 Prediabetic lipoprotein( HDL), low density lipoprotein (LDL),
patients between 30-60 years from medical and Triglyceride (TG), pulse rate and blood pressure
endocrinology OPD,s of a private medical college levels were collected from the medical charts. The
Thrissur. Participants were divided into experimental quality of life (WHOQOL)questionnaire was used to
group and control group. Adequate guidance and assess the quality of life It includes26 questions. The
council ling was given to all the Participants in the 26 questions were grouped into four domain scores
experimental group to compliance with raw diet and (physical, psychological ,social and Environmental).
yoga . The protocol was approved by the institutional Domain scores are calculated based on each item in
ethical commi�ee and all participants gave wri�en the particular domain. All questions had a range
informed consent. Details of the study were given to of 1-5 score. Upper scores indicate higher quality
the subjects before introducing the experiment. These of life. Descriptive statistics were used to measure
subjects had one week separate holistic health camp sociodemographic variables. Quality of life and
organized by the investigator in Thrissur districts physiological variables were calculated by using
of Kerala state. Their blood sugar levels and lipid paired t test.
profile were noted from the case sheets. The same RESULTS
measures were noted at subsequent follow ups of the
In order to evaluate the effect of raw diet and
camp. Raw diet and yogasana were the cure methods
yoga on the various physiological variables, the pre
followed in the camps. Naturally cultivated fruits,
intervention and post intervention score of samples
vegetables and nuts were preferred. Every morning
were compared using paired t test.
Table 1: Mean, Standard deviation and paired t value of Physiological (Hematological) values of
Prediabetic experimental and control group before and after raw diet and yoga therapy.
Prediabetic Experimental Group Prediabetic Control Group
Hematological Group Mean Mean
SD ‘t’ value SD ‘t’ value
Variables (Pre/Post) (n=30) (n=30)
Pre 207.03 42.53 186.20 42.64
Cholesterol 6.37*** 0.11
post 175.47 33.87 186.67 39.86
Pre 52.93 11.09 48.97 17.46
HDL 1.64 2.13*
post 50.33 8.59 43.00 10.45
Pre 131.67 38.22 112.90 34.04
LDL 5.77*** 0.21
post 107.23 32.86 114.00 38.17
Pre 104.43 36.19 123.80 31.85
TG 0.57 1.00
post 101.03 36.04 118.20 33.12
Pre 105.90 2.58 111.80 8.33
FBS 17.58*** 1.32
post 81.07 7.60 113.73 11.55

*p<.05;***P<.001
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 177

Table 1: shows the mean, standard deviation and the difference in the mean score in both groups,
t value of raw diet and yoga therapy on Physiological Prediabetic experimental group have statistically
values of Prediabetic experimental and control group significant results which shows that Prediabetic
before and after raw diet and yoga therapy. Paired t experimental group had a be�er outcome with Yoga
test showed a statistically significant result between and Raw diet therapy. There is no such significant
pre test and post test scores of the experimental group reduction in scores observed among control group
(P<.001) in cholesterol, LDL and FBS. On comparing who did not practice raw diet and yoga therapy.
the mean scores between pretest and post test of So the formulated null hypothesis that there is no
Prediabetic experimental group, it is observed that significant difference in the physiological variables
the difference in cholesterol(t = 6.37,P<0.001), LDL like blood sugar and cholesterol of Prediabetic
(t = 5.77, P<0.001) and FBS (t = 17.58, P<0.001) are experimental and control group before and after raw
statistically significant. But this type of reduction in diet and yoga therapy was rejected. Yoga and Raw
physiological values were not observed in the control diet therapy is effective in controlling Physiological
group, a significant change was observed in HDL variables in Prediabetic experimental group.
(t= 2.129,P<0.05) values of control group were not
in line with the expected value. When we consider

Table 2: Mean, Standard deviation and paired t value of Physiological (Vital signs) values of Prediabetic
experimental and control group before and after raw diet and yoga therapy.

Prediabetic Prediabetic
Experimental Group Control Group

Group Mean Mean

vital signs SD ‘t’ Value SD ‘t’ Value
(Pre/Post) (n=30) (n=30)

Pre 123.87 5.73 119.33 6.39

Systolic BP 7.85*** 1.98*
post 114.93 4.80 117.67 7.74
Pre 80.67 2.54 80.00 0.00
Diastolic BP 2.51* -1.96*
post 78.93 3.05 80.60 1.67
Pre 79.87 3.75 76.33 1.97
Pulse 15.03*** 7.74***
post 74.73 3.46 72.80 2.49

*p<.05;***P<.001 Diastolic Blood Pressure (t=2.51,P<.05) and Pulse

It is very clear from table 2 that among the rate (p=15.03P<.001) have statistically significant
experimental group pre-test Systolic blood pressure reduction in vital signs after yoga and Raw diet
score is high (123.87) compared to post test (114.93) therapy as compared to its Pretest values. However
Systolic blood pressure score. But in diastolic Blood a mean Systolic Blood Pressure (t=1.98,P<.05),
pressure pretest score (80.67) to post test score (78.93) Diastolic Blood Pressure(t=1.96,P<.05) and pulse
variation is shown slight difference. However, there rate (t=7.74,P<.001) of Prediabetic control subjects
is a remarkable reduction in pulse rate from pre test also shown a significant results. It can be due to
score (79.87) to post test score (74.73). In the case initial stress and anxiety of the subjects during the
of control group Pretest Systolic blood pressure measurement of vital signs for the control subjects.
score is (119.33) and after 40 days it is (117.67) with When we consider the difference in the mean score
some difference. diastolic Blood pressure pretest and P value in both groups Prediabetic experimental
score (80) to post test score (80.60) variation is very group had a be�er outcome with yoga and raw diet
minimal. However there is a remarkable reduction therapy. so the hypothesis that there is no significant
in pulse rate from pre test score (76.33) to post test difference in the physiological variables like pulse
score (72.80 ). Prediabetic experimental group Shows rate and blood pressure of Prediabetic experimental
that mean Systolic Blood Pressure,(t=7.85,P<.001) and control group before and after raw diet and yoga
therapy was rejected.
178 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

The following tables present the results about the of each of Prediabetic experimental and control group
effect of raw diet and yoga on quality of life variables before and after raw diet and yoga therapy.

Table 3: Mean, Standard deviation and paired t value of quality of life of Prediabetic experimental and
control group before and after raw diet and yoga therapy.

Prediabetic Prediabetic
Experimental Group Control Group

Quality of life Group Mean Mean ‘t’

SD ‘t’ Value SD
Variables (Pre/Post) (n=30) (n=30) Value

Pre 4.13 0.57 3.97 0.49

6.16*** 1.00
Overall quality of life
post 4.70 0.53 4.00 0.45

Pre 4.23 0.50 3.60 0.93

4.71*** 2.69**
Over all health
post 4.67 0.48 3.80 0.71

Pre 121.57 2.64 116.00 5.86

Physical Domain 7.25*** 0.21
post 138.00 5.16 115.86 5.55
Pre 125.83 4.45 113.17 12.32
Psychological Domain 18.65*** 1.17
post 139.17 5.15 115.17 8.35
Pre 124.67 6.03 123.00 2.00
Social Domain 2.23* 0.67
post 134.33 1.53 125.33 4.04
Pre 123.13 12.84 116.00 7.41
Environmental Domain 10.87*** 0.49
post 132.75 11.37 117.13 11.87

**P<.01;***P<.001
was a significant reduction in Fasting Blood Sugar,
Table 3: indicate that all quality of life domains cholesterol, LDL, systolic BP, Diastolic BP and pulse
had a significant change in the Prediabetic rate of Prediabetic experimental group after yoga
experimental groups overall quality of life and raw diet therapy; whereas control group had
[t=6.16,P<0.001], and overall health [t=4.71,P<0.001] statistically significant increase in Diastolic BP and
Physical domain[t=7.25,p<0.001], Psychological Doma significant reduction in HDL, systolic BP, and pulse
in[t=18.65,p<0.001], social domain[t=2.23,P<0.05], and rate. The findings of the muscle strengthening
Environmental Domain[t=10.87, p<0.001] ; whereas activities with the risk of T2 diabetes in women were
control group did not give any significant change observed from the nurses’ health study are in line
in four domains but Overall health [t=2.69,P<0.01] with present study findings. Women who performed
was statistically significant in the control group. It aerobics for a minimum of 150 minutes /week
discloses the effect of raw diet and yoga on quality and muscle strengthening exercise for 60 minutes
of life of experimental group after the intervention. /week had a much lower risk of Type 2 Diabetes as
So the null hypothesis that there is no significant compared to inactive women5.The ability of yoga to
difference in the Quality of life of Prediabetic reduce the risk factors for diabetes were assessed by
experimental and control group before and after raw 41 participants of which 20 were asked to a�end yoga
diet and yoga therapy is rejected. When we consider classes and the remaining 21 participants were asked
the difference in the mean score in both groups with to complete monitored walking 3-6 days a week
its normal values Prediabetic experimental group had for 8 weeks. Marked reduction in systolic diastolic
a be�er outcome with Yoga and Raw diet therapy.. blood pressure, total cholesterol, anxiety, depression
and perceived stress were seen as compared to the
DISCUSSION other group6. The restorative yoga intervention
was practiced for inactive and overweight adults
The present study findings shows that there with metabolic syndrome. The results showed a
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 179

trend towards decreasing blood pressure and a rural population in coastal Southern Karnataka,
greater increase in energy level as well as an overall India. The Australasian medical journal, .
improvement in general wellbeing compared to 2011,4(1), 53-57. doi: 10.4066/AMJ.2011.512.
control group 7.The usefulness of physical activity 3. Ku�y, B. M., & Raju, T. R. New vistas in treating
in the management of Type 2 Diabetes. Studies diabetes :insight into a holistic approach. Indian
indicated that advanced levels of bodily movement Journal of Medical Research, 2010, 131(5), 606-
evidently connected with a lesser occurrence of Type 607. Retrived from h�p://www.ijmr.org.in/temp/
2 Diabetes 8. IndianJMedRes1315606-1889067_051450.pdf.
Along with this study findings a study with 99 4. Sahay, B. K. Role of yoga in diabetes. JAPI, .
Type2 diabetes patients practiced 22 weeks vegan 2007,55, 121-126.
diet with 75% carbohydrate, 15% protein ,and 10% fat 5. Grøntved, A., Pan, A., Mekary, R. A., Stampfer,
and the control group consumed multi unsaturated M., Wille�, W. C., Manson, J. E., & Hu, F.
fa�y acids. Vegan group versus control group B. Muscle-strengthening and conditioning
body weight reduction 4.4kg vs 3.0kg(P<0.001); TC activities and risk of type 2 diabetes: a
reduction 20.4mg/dl vs 6.8%(P<0.01). Alternate prospective study in two cohorts of US women.
Healthy eating Index improved in vegans (P<0.001) PLoS medicine, 2014, 11(1), e1001587.doi:
and the control did not show the difference.The 10.1371/journal.pmed.1001587
effectiveness of the Mediterranean life style
6. McDermo�, K. A., Rao, M. R., Nagarathna,
Programme (MLP) in reducing cardiovascular risk
R., Murphy, E. J., Burke, A., Nagendra, R. H.,
factors in Type 2 diabetic menopausal women who
& Hecht, F. M.. A yoga intervention for type
were randomized to usual care (control) or treatment
2 diabetes risk reduction: a pilot randomized
( MLP) conditions.Then changes in biological
controlled trial. BMC complementary and
parameters like lipid profile, BMI, blood pressure,
alternative medicine, 2014, 14(1) 212.
plasma fa�y acids and flexibility impact of quality
of life was evaluated. MLP condition group was 7. Cohen, B. E., Chang, A. A., Grady, D., & Kanaya,
compared to usual care at the six month follow up. A. M . Restorative yoga in adults with metabolic
Favouring result in lipids profile, blood pressure syndrome: a randomized, controlled pilot trial.
and flexibility were observed10. The findings of the Metabolic syndrome and related disorders,
study highlighted that yoga and raw diet therapy 2008, 6(3), 223-229. doi:10.1089/met.2008.0016.
had a significant influence on quality of life and 8. Kelley, D. E., & Good paster, B. H. Effects of
physiological variables of Prediabetic patients. exercise on glucose homeostasis in Type 2
diabetes mellitus. Medicine and Science in
Acknowledgement: I express my gratitude and Sports and Exercise, 2001, 33(6 Suppl), S495-501.
thanks towards all who have directly or indirectly doi: 10.1097/00005768-200106001-00020.
helped me to complete this study and their support
9. Barnard, N. D., Cohen, J., Jenkins, D. J.,
in each major step of the study.
Turner-McGrievy, G., Gloede, L., Green, A.,
Conflict of Interest: Nil & Ferdowsian, H. A low-fat vegan diet and
a conventional diabetes diet in the treatment
Source of Funding: Self of type 2 diabetes: a randomized, controlled,
Ethical Clearance: Obtained permission from 74-wk clinical trial. The American journal of
institutional ethical clearance commi�ee. clinical nutrition, doi:10.3945/ajcn.2009.26736H
10. Toobert, D. J., Glasgow, R. E., Strycker, L. A.,
REFERENCES Barrera, M., Radcliffe, J. L., Wander, R. C., &
Bagdade, J. D. Biologic and Quality-of-Life
1. Hu, F. Globalization of Diabetes: The role of
Outcomes From the Mediterranean Lifestyle
diet, lifestyle, and genes. Diabetes Care, 2011,
Program A randomized clinical trial. Diabetes
34(6), 1249-1257. doi:10.2337/dc11-0442
Care, 2003,26(8), 2288-2293. doi: 10.2337/
2. Rao, C. R., Kamath, V. G., She�y, A., & Kamath, diacare.26.8.2288.
A . A cross-sectional analysis of obesity among a
 DOI Number: 10.5958/0974-9357.2016.00072.6

The Development and Psychometrics of SEAT

(Self-Efficacy Assessment Tool)

Kathleen Garrubba Hopkins1, Theresa A Koleck1, Dianxu Ren1, Alice M Blazeck1

1
University of Pi�sburgh School of Nursing, Department of Health Promotion and Development, Pi�sburgh, PA, USA

ABSTRACT

Background: There are limited high-fidelity simulation (HFS) framework-based tools for evaluating
students’ self-efficacy (SE) while assess signs and symptoms to determine when specific nursing
interventions are needed to promote positive patient outcomes.

Purpose: To develop and test psychometrics of Self-Efficacy in Assessment Tool (SEAT) within a HFS
environment.

Methods: During a five year period, over 800 sophomore nursing students completed SEAT pre- and
post-HFS. Factor structure and reliability were assessed using principal components analysis (PCA)
and Cronbach’s Alpha, respectively.

Results: The PCA identified two factors, labeled SE to Assess (pre- α=.871 and post- α=.904) and SE to
Assess and Intervene (pre- α=.855 and post- α=.868).

Discussion: Although limited in construct validity, the SEAT was found to be a reliable tool for use in
testing SE of undergraduate nursing students in HFS.

Keywords: Self-efficacy, nursing, education, simulation, psychometric

INTRODUCTION

Over the last decade, high-fidelity simulation myriad of clinical situations(1-4), Although competency
(HFS) has been shown to be an effective and safe tool and SE are viewed as essential a�ributes to promote
in evidence-based clinical education for both medical in the new nursing student, limited research has
and nursing schools(1, 2). Therefore, use of an interactive examined students’ SE in correctly assessing signs
manikin-based curriculum often complements and symptoms or identifying nursing interventions
traditional classroom course work(2). HFS allows needed for positive patient outcomes(4, 5). A review
educators to observe student behavior in critical of SE instruments (3-6) found few used in HFS clinical
situations in an appropriate and safe environment education(6, 7), fewer used in nursing (5, 8), and many not
that can be both controlled and changed(2). One framework based(3, 4). Thus, the purpose was to test
goal of these simulations is to improve student psychometrics of Self-Efficacy in Assessment Tool
competence by increasing their self-efficacy (SE) (SEAT) within a HFS environment.
when performing assessments and interventions in a
METHODS

SEAT Design and Development

Corresponding author:
Kathleen G Hopkins, After Institutional Review Board approval a
Assistant Professor, Carlow University, School of development team of five nursing experts in both
Health and Wellness, Department of Nursing, 101 simulation and SE were gathered(4-6, 9). The team
Curran Hall, 3333 Fifth Avenue, Pi�sburgh, PA consisted of two clinically based members (one
15213; 412-578-8805 (phone); 412-578-1313 (Fax); from the cardiac intensive care unit and one from
e-mail [email protected]. a traditional floor unit) and 3 nurse educators
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 181

(1 from the sophomore skills laboratory and two denoting situations where the patients is at risk and
whom had both sophomore class-room and student- some intervention is required to a�ain positive patient
clinical assignments). All team members were avid outcomes. This permi�ed the odd numbered items to
users of HFS, SE, and agreed on focusing on four ask students to rate their SE when assessing patient
systems: respiratory, cardiovascular, neurological, status. Even numbered items required students to
and gastrointestinal. The team selected Bandura’s assess their SE in both assessing signs and symptoms
model(8). and making appropriate initial interventions to assist
the patient. All 10 questions use a 5-point Likert
During development, the team reviewed rating scale (1, below average to 5, above average)(8,
Schwarzer and Jerusalem’s Generalized Self-Efficacy 10)
.
Scale (GSE) as a guide for question structure(10).
Structure of tool’s items in SEAT began in a similar SEAT ADMINISTRATION
manner, e.g., “I am self-confident that I can...”(10).
However, content of SEAT differed in its focus on Pre-administration of the SEAT, over a five year
SE in situations applicable to sophomore nursing period, 848 undergraduate sophomore nursing
students and had a set of system focused questions students completed a 10–12 week course taught
separating assessment only and assessment with using traditional methods, e.g., lecture, lab and
intervention(4). clinical experience. These courses, taught during
the initial term of the sophomore year, were the first
The Liverpool Undergraduate Communication that involved clinical experience. This traditional
Assessment Scale (LUCAS) was also reviewed during based instruction included lecture (42 hrs.), skills lab
instrument development. The LUCUS, a 10-item (28 hrs.) and clinical experience (56 hrs.). To insure
rating scale, is intended for use during structured consistency, all instructor(s) and course objectives
clinical examinations(7). The formative portion for lecture, skills lab, and clinical experience were
focuses on changes as the scenario progresses (e.g. held constant for the entire study period. Faculty
professional behavior, greeting and introduction, instruction in skills lab and clinical was focused on
identity check, audibility and clarity of speech, and assessment of student proficiency and remediation, if
other non-verbal behavior) and the subjective portion needed. Two theory and six competency exams were
on procedural aspects (e.g. questions, prompts used to test proficiency prior to practicing skills in the
or explanations, empathy and responsiveness, clinical se�ing. Key concepts in lecture lab and clinical
clarification and summarizing, and consulting became the foundation for the simulation scenarios(11).
style and organization)(7), p274. After discussions and After completing their traditional instruction, but
reviews, SEAT questions were based on a five-scale before the HFS, each student was given the option to
item selection method which was deemed more complete the pre- test SEAT on-line.
subjective and focused at a sophomore student level.
During a four hour period, six subgroups of
Prior to use, discussions continued and it was 4 (24 total) participated in a series of simulationss
noted that only covering the basic course and clinical grounded in HFS exemplars. These HFS exemplars
contents included both the basic skills in assessing used SimMan® and were based on the International
and the added skills necessary for the student Nursing Association for Clinical Simulation &
to decide when to intervene for each of the four Learning (INACSL) best evidence for simulation
systems(5). The review team decided that these system standards(12).During these simulations, the instructor
based parameters for assessment was insufficient vocalized both the patient and inter-professional
to portray a life-like crisis environment(5). Thus, a team’s responses to each of the four student actions.
fifth crisis item was added, which combined both The remaining 20 students observed the 4 students
respiratory and cardiovascular systems; plus the actions throughout the simulation through video
student’s administration of appropriate interventions feed in a separate room. This approach served two
to Basic Life Support (5). , Thus, the final version of purposes: 1) facilitated the scheduling of large groups
the SEAT consisted of five question pairs for a total and 2) promoted self-efficacy through peer modeling.
of 10 questions. The instrument structure is numeric, After participating in the simulation experience
with odd numbered items denoting situations where students were invited to complete SEAT. Completion
the patient is not at risk and even numbered items of both portions of SEAT were optional and not
182 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

a requirement of the course. Electronic versions the left, but approached normality.
of SEAT were hosted on a confidential web-based
interface, on the simulation center’s web-site and de- FACTOR STRUCTURE
identified at the time of submission. Inter-item correlations ranged from r=.295
to r=.742. The obtained KMO statistic (.835) and
DATA ANALYSIS
significant Bartle�’s test of sphericity (p=.000)
Using IBM SPSS Version 22 Armonk, NY, indicated an adequate sample size and sufficiently
descriptive and pre-post statistics were computed for strong inter-item correlations. Initially, PCA with
the demographic variables and each item on the SEAT; Varimax rotation was conducted using all items.
missing data, normality, and outliers were assessed. A A two factor structure (λ=4.188 and λ=2.494) that
principal components analysis (PCA) was conducted explained 66.82% of the total variance was revealed.
on both pre- and post-SEAT responses to summarize The second factor was comprised of items five and
interrelationships and reduce the dimensionality of six, which evaluated the confidence of the student
the items.(13) An inter-item correlation matrix was to assess gastrointestinal/genitourinary symptoms
generated to abstract interrelationships among the (item 5) and initiate appropriate clinical interventions
ten SEAT items. The Kaiser-Meyer-Olkin (KMO)(14) (items 6). This information was the only content area
statistic (>.6) and Bartle�’s test of sphericity(15) (p<.05) that had not been formally presented to students in
were obtained to ensure the appropriateness of factor lecture at the time of the simulation intervention.
analysis. Scree plots(13), eigenvalues ≥ 1(14), and total Due to the influence lack of instruction had on the
variance explained per factor (>5%)(13) were used to factor structure of the SEAT, items five and six were
determine factor structure. Factor loadings of greater removed and the factor analysis was re-conducted.
than .4 were considered adequate, with items having
The PCA with Varimax rotation, excluding
factor loadings of .4 or greater on multiple factors
items five and six, suggested two factors (Figure 1),
considered cross-loading(13). In all instances, PCA
accounting for 37.26% (λ=2.980) and 34.19% (λ=2.735)
was initially performed without rotation. However,
of the total variance, respectively. Four items (items 1,
in order to obtain more definitive results, rotation
3, 7, and 9) loaded onto Factor 1, three items (items 2,
was applied. Because extracted components were not
4, and 8) loaded onto Factor 2, and one item (item 10)
found to be correlated, an orthogonal (i.e., Varimax)
cross-loaded onto both factors (Table 2).
rotation was selected(13).
Item 10 loaded higher on Factor two and was
Cronbach’s alpha assessed internal consistency(13).
deemed to be more conceptually appropriate within
Both pre- and post-SEAT emergent factor reliabilities
the construct represented by the items comprising
were obtained. Cronbach’s alpha levels of .70 or
Factor 2. Factor 1 (items 1, 3, 7, and 9), SE to Assess,
higher were considered adequate as SEAT is a newly
evaluates the student’s SE to correctly assess signs and
developed instrument(13). The Cronbach’s alpha if an
symptoms that fall outside the range for health. Factor
item was deleted was also examined.
two (items 2, 4, 8, and 10), SE to Assess and Intervene,
FINDINGS evaluates the student’s SE to make appropriate initial
nursing interventions.
Of the 848 who participated, complete survey
data was available for 823 students pre-simulation The post-simulation factor structure analysis
and 826 students post-simulation, representing a presented correlations from the inter-item correlation
missing rate of less than 5% at both time points. The matrix ranging r=.380 to r=.822. The obtained KMO
average age was approximately 20 years (range=18-51 (.866) and significant Bartle�’s tests of sphericity
years; M=20 years). The majority (83%) of the students (p=.000) indicated that factor analysis was appropriate.
were female. Pre- and post-SEAT descriptive statistics PCA with Varimax rotation was first conducted with
for each item are provided in Table 1. No outliers all tool items. Two factors (λ=4.632 and λ=2.552)
or influential points were revealed by the graphical that explained 71.84% of the total variance resulted.
analysis. In contrast to the Shapiro-Wilk test results, In congruence with the pre-simulation analysis,
an examination of histograms and q-q plots indicated items five and six loaded exclusively onto Factor 2.
that the instrument responses were slightly skewed to Therefore, items five and six were again removed
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 183

from the analysis. cross loading on Factors 1 and 2 for both the pre-
and post-SEAT assessments. Item 10 of SEAT asked
PCA with Varimax rotation of the post-SEAT
students about their SE in assessing, intervening, and
without items five and six suggested the same factor
making initial interventions to a basic life support
structure indicted by the pre-simulation assessment
(BLS) standard until advanced life support arrived.
(Figure 1). Four items (items 1, 3, 7, and 9) loaded
This item identified the appropriate intervention as
onto Factor 1 (λ=3.20), two items (items 4 and 8)
cardiopulmonary resuscitation (CPR)(4). Considering
loaded onto Factor 2 (λ=2.81), and two items (items
that all sophomore nursing students at the institution
2 and 10) cross-loaded onto both factors (Table 2).
in which the instrument assessment took place are
Both items two and ten loaded more strongly on and
required to be certified in BLS, it is not surprising
were determined to be most theoretically appropriate
that students were equally confident in their ability
within Factor 2, with the resultant Factor 1 and Factor
to assess cardiovascular and respiratory compromise
2 conceptually representing SE to Assess and SE to
requiring CPR as in their ability to assess and initiate
Assess and Intervene, respectively.
CPR.
RELIABILITY LIMITATIONS
The internal consistencies for Factor 1 were α=.871
Our study has several limitations. To begin, this
and α=.904 for the pre- and post-SEAT, respectively.
study lacks construct validity. It is the first study to
Internal consistencies (Cronbach’s alphas) for Factor
examine the psychometric properties of the SEAT;
2 were α=.855 and α=.868. Omission of a single item
therefore, replications of these results are needed in
did not result in a notable change in reliability.
other institutions. Secondly, this study was conducted
DISCUSSION solely in sophomore nursing students, using nursing
evidence-based structured simulation scenarios.
This study’s goals were to develop and test an Future studies should test SEAT in healthcare
instrument that would measure SE of nursing students provider student populations other than nursing.
and, in particular, the contribution (or lack thereof) Thirdly, SEAT was evaluated in nursing students
of adding HFS following traditional instruction. who had not received didactic instruction on all of
Content provided in the initial term of this program the systems included in the simulations. However,
was designed to prepare students to assess patient this study had many strengths including a multiyear
response outside the range of health and to initiate sample of over 800 students and the development of a
appropriate initial nursing interventions. A review framework based tool.
of available instruments were either not available at
the time(9) or did not fit our goals(3). Therefore, we CONCLUSION
developed a new clinical assessment tool.
This study provides initial support for use of
This study revealed a two factor structure at SEAT to assess improvement in SE of undergraduate
pre- and post-SEAT assessments. Factor 1, Self- nursing students following traditional clinical
Efficacy to Assess, was comprised of the odd SEAT instruction and participation in evidence-based
questions which focused on the student’s SE to practice, simulation scenarios.
simply assess signs and symptoms that fall outside
the range of normal health. Factor 2, SE to Assess and
Intervene, consisted of even SEAT questions which
not only evaluated the student’s SE to assess signs
and symptoms, but also SE to make initial nursing
interventions. It is of interest to note that Item 2,
Respiratory: SE to assess, intervene, and make initial
interventions, cross-loaded on both Factor 1 and
Factor 2 in the post-SEAT. However, Item two loaded
much more strongly with Factor 2 and was deemed Figure 1 Scree Plots pre and post-test PCA extraction;
these plots exclude questions 5 and 6 and therefore the
more theoretically appropriate with SEAT construct.
plots only depict 8 components.
In contrast, Item 10 presented with almost equal
184 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Table 1. Descriptive statistics for survey items

Item Pre-SEAT survey n=823 Post-SEAT survey n=826

Mean SD 95% CI Mean SD 95% CI
1 3.87 .713 3.82-3.92 4.21 .613 4.17-4.25
2 3.42 .742 3.33-3.47 3.98 .651 3.94-4.03
3 3.76 .713 3.71-3.81 4.14 .643 4.10-4.19
4 3.24 .736 3.19-3.29 3.87 .665 3.82-3.91
5 3.12 .898 3.06-3.18 3.62 .857 3.56-3.67
6 2.83 .825 2.77-2.89 3.40 .840 3.34-3.45
7 3.81 .700 3.76-3.85 4.11 .681 4.06-4.16
8 3.23 .789 3.18-3.28 3.76 .734 3.71-3.81
9 3.82 .720 3.77-3.89 4.20 .626 4.15-4.24
10 3.47 .763 3.42-3.52 4.02 .678 3.97-4.06

Table 2. Pre and Post simulation Varimax rotation PCA factor loadings and rotated total variance
explained. (only factors >.400 are shown)

Item Pre-SEAT survey n=823 Post-SEAT survey n=826

Factor 1 Factor 2 Factor 1 Factor 2

1 .800 .828
2 .806 .404 .781
3 .801 .807
4 .831 .824
7 .739 .737
8 .818 .810
9 .817 .836
10 .466 . 589 .511 597

Acknowledgement: We would like to thank both 2. Rodgers DJ. High-fidelity patient simulation: A
the students and nursing faculty that give their time descriptive white paper report. Charleston, WV
to participate in this study. 25304: Healthcare Simulation Strategies, 2007.
Sources of Support: No funding. 3. Clark MC, Owen SV, Tholcken MA. Measuring
Disclosures: Authors have no conflicts of interest student perceptions of clinical competence.
to disclose. Journal of Nursing Education. 2004;43(12):548-
The study had Institutional Review Board (IRB) 54.
approval. 4. Roh YS, Issenberg SB, Chung HS, Kim SS.
All IRB procedures were followed. Development and psychometric evaluation of
the resuscitation self-efficacy scale for nurses.
REFERENCES Journal Korean Acadamy of Nursing. 2012;42(7):
1079-86.
1. Cheraghi F, Hassani P, Yaghmaei F, Alavi-Majed
H. Developing a valid and reliable self-efficacy 5. Stump GS, Husman J, Brem SK. The nursing
in clinical performance scale. International student self-efficacy scale: development using
Nursing Review. 2009;56(2):214-21. item response theory. Nursing Research.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 185

2012;23(7):976-84. editors. Measures in health psychology: A user’s

6. Zengin N, Pýnar R, Akinci AC, Yildiz H. portfolio Causal and control beliefs. Windsor,
Psychometric properties of the self-efficacy UK: NFER-NELSON; 1995. p. 35-7.
for clinical evaluation scale in Turkish nursing 11. Blazeck A, Zewe G. Simulating simulation:
students. Journal of Clinical Nursing. 2013;23(8): promoting perfect practice with learning
976-84. bundle–supported videos in an applied, learner-
7. Huntley CD, Salmon P, Fisher PL, Fletcher driven curriculum design. Clinical Simulation in
I, Young B. LUCAS: a theoretically informed Nursing. 2012.
instrument to assess clinical communication 12. INASCL BoD. Standards of best practice:
in objective structured clinical examinations. Simulation. Clinical Simulation in Nursing.
Medical Education. 2012;46:267-76. 2013;9(4 Sup.):1-9.
8. Bandura A. Guide for constructing self-efficacy 13. Pe� MA, Lackey NR, Sullivan JJ. Making sense
scales Urdan T Pajares F. (Editors). Self efficacy of factor analysis; the use of factor analysis for
beliefs in adolescents: Information Age. 2006. instrument development in health care research.
9. Williams DA. Outcome expectancy and Thousand Oaks: Sage; 2003.
self-efficacy: Theoretical implications of an 14. Kaiser H. An index of factorial simplicity.
unresolved contradiction. Personal Social Psychometika. 1974;39:31-6.
Psychology. 2010;14:417. 15. Barle� MS. A note on the multiplying factors
10. Schwarzer R, Jerusalem M. Generalized self- for various chi-square approximations. Journal
efficacy scale. In: Weinman SWJ, Johnston M, of Royal Statistical Society. 1954;16 (Series
B):296-8.
 DOI Number: 10.5958/0974-9357.2016.00073.8

Biochemical Value among Suicide A�empted Individual

A Arvin Babu1, Prasana Baby2, R Vijayaraghavan3

Ph.D Scholar, Saveetha University Chennai, India, 2Principal, Sri Ramachandra College of Nursing,
1

Chennai, India, 3Director, Research Department, Saveetha University, Chennai, India

ABSTRACT

Suicide is the act of death and people are not interested to commit suicide. Biochemical value threatens
the severity of illness and diverts the health care members a�ention towards patients. With this aim
a study was organized to identify the biochemical value among suicide a�empted individual before
and after information, education and communication package. Pre-experimental research design was
conducted with one hundred suicide a�empted individual. Biochemical value were assessed by using
observational rating scale. Results showed that during pretest majority of suicide a�empted individual
showed decreased mean oxygen saturation, hyperglycemia, increased blood urea and creatinine and
increased total count. F test showed that there were significant effectiveness on Po2, bicarbonate,
blood glucose, urea, creatinine and white blood cell count among suicide a�empted individual. The
concluded that psycho-education is needed to suicide a�empted individual to maintain adequate
physiological function.

Keywords : Biochemical value, suicide a�empted individual, Information, education and communication
package.

INTRODUCTION Suicide is the third leading cause of death for

people ages 15 to 24 and the second leading cause for
Suicide is the act of death and the people is not people ages 25 to 34. Men are less common to try for
interested to commit. Suicidal person asked for help suicide, but they are more likely to die from a suicide
from others and their problems are not resolved a�empt. Suicide is twice often when compared to
they a�empted to die. Most people who commit murder. Suicide prevention goal is to recognize
suicide don’t want to die but they give indication to the warning signs and take remedial action against
others that they find difficult to survive with existing problem.
problem.
Biochemical value among suicide a�empted
People prior to a�empt suicide, have thoughts threatens the severity of illness and diverts the
of death. Plan for suicide plays an important role in health care members a�ention towards patients.
commi�ing suicide. Most people see suicide is the Bio-psychosocial model proposes that biological,
solution for a problem. People feel hopeless, helpless psychological and social factors play a role in causing
and worthless seriously consider suicide. Personal suicide. Genes in neurotransmi�er have altered
or family history of suicide a�empts, anxiety, function in suicide and a�empted suicide. The
depression, manic depressive illness, schizophrenia neurotransmi�ers include serotonin, nor-adrenalin
and substance abuse disorder are the risk factors and dopamine and the hypothalamic-pituitary-
for suicide. People who a�empt suicide gives cues adrenal axis. The goal of understanding the role of
or warning, verbalizes that I cant see any way out, biology of suicide is to improve treatment1.
grief-stricken and has mixed feeling about death and
wavering until they a�empt. Suicide patient will not BODY OF ARTICLE
a�empt suddenly but they seek for medical help for Statement of problem
six months prior to commit. Suicide prevention is
possible when an individual is ge�ing an opportunity Biochemical value among suicide a�empted
to express their feelings. individual before and after information, education
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 187

and communication package. patients for the period of one month. It was conducted
during first follow-up(15 days after discharge) and
OBJECTIVES
second follow-up(30 days after discharge).
To assess the level of biochemical value among
Descriptive and Inferential statistics were used
suicide a�empted individual
to analyze the collected data. The demographic
To assess the effectiveness of information, variables were coded and analyzed. The data analysis
education and communication package on biochemical and interpretation consists of the following sections.
value among suicide a�empted individual.
Section-A : Distribution of the samples according
HYPOTHESIS to the demographic variables.

The information, education and communication Section-B : Distribution of biochemical values

package will result in significant improvement in among suicide a�empted individual before and after
the biochemical value among suicide a�empted Information, Education and Communication (IEC)
individual in the experimental group. package.

METHODS & MATERIALS Section-C: Effectiveness of Information,

Education and Communication (IEC) package
Quantitative approach was used to assess on biochemical values among suicide a�empted
the effectiveness of Information, Education and individual.
Communication package on biochemical values
among suicide a�empted individual. The research RESULTS
design used for the present study was based on Pre
According to age, majority (46%) of suicide
Experimental Research Design.
a�empted individual were in the age group of 26-40
The population was suicide a�empted years and 17% of them were in the age group of above
individual . The data were collected from suicide 40 years in experimental group. In control group
a�empted individual who were admi�ed in majority (52.8%) suicide a�empted individual were in
Dhanvantri critical care center, Erode and Sree the age group above 40 and 16% of suicide a�empted
Abirami Hospital Coimbatore. The total sample individual were in the age group of 15–25 years.
size was 100 and the samples were selected using
According to sex, majority (53%) of suicide
purposive sampling technique. Suicide a�empted
a�empted individual were male and 47% of them
individual with age 15 years and above, both
were female. In control group majority of subjects
sex, transfer from ICU to medical ward, willing
were both male (49.2) and female(51.8). This showed
to participate in the study and present during
that among normally distributed subjects male are
the period of data collection were the inclusion
prone to a�empt suicide.
criteria and suicide a�empted individual who were
uncooperative, neurological deficit and mentally ill According to education majority (36%) of
were exclusion criteria. suicide a�empted individual were graduate and
3% of them were illiterate, primary school and post
Immediately after the second day of
graduate. In control group majority of samples were
transferring ICU to ward, the data collection was done
studied schooling. Suicide is common among sample
by using demographic variables, Observational rating
studied upto schooling and graduate. Suicide is less
scale on biochemical values. Information, Education
common among illiterates and post graduates both
and Communication (IEC) package implemented
experimental and control group.
to patients for the first four days. From 5th day till
discharge follow up care will be given to patients. According to occupational status, majority(27%)
After discharge follow-up care given to patients over of suicide a�empted individual were private
telephone and oral discussions during their follow employee, 19% of them were student and 5% of
up visit to hospital. The total intervention given to them were unemployed. In control group majority
188 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

of samples were in private employee and 9.2% of and this indicated that they were planned for suicide
samples were student. This showed that in general and suicide was not a immediate response to stress.
population private employee were common and
According to mode of suicide, majority of suicide
suicide is also common among private employee.
a�empted individual consumed Generic drugs(33%),
Suicide is not common among government employee.
Pesticide substances(30%) and cow dong(28%).
Among student and house wife suicide rate is equally
According to reason for poisoning, majority (35%)
present between experimental and control group.
of patients were commi�ed suicide due to marital
According to type of family, majority(78%) of conflict, 17% were due to financial difficulties and
suicide a�empted individual were coming from others were commi�ed suicide due to love failure(7%),
nuclear family and 22% of them were from joint parental conflict(8%), occupational difficulties(10%),
family. In control group majority(74.8%) of sample alcoholism(9%), failure in exam(7%) and like.
were in nuclear family. This showed that nuclear
SECTION-B : Mean Distribution of bio-
family are common in general population and the
psychosocial variables before and after
suicide rate is also common among nuclear family.
Information, Education and
There was no difference in suicide rate among joint
Communication (IEC) package.
family both in experimental and control group.
Majority of suicide a�empted individual showed
According past history of suicide, majority(76%)
decreased mean oxygen saturation during pretest
of suicide a�empted individual were had a past
and mean oxygen saturation were increased during
history of suicide when compared to general
pos�est-1 and pos�est-2. There were no change in
population(24%). Among suicide a�empted
mean carbon-dioxide saturation and bicarbonate
individual majority(42%) of them were not having
during pretest, pos�est-1 and pos�est-2.
past history of suicide which is less compared to
control group(58%). This result showed that majority Mean value of suicide a�empted individual
of suicidal a�empted individual had a past history of showed hyperglycemia during pretest and mean
suicide when compared to control group. blood glucose were normal during pos�est-1 and
pos�est-2. There were no change in mean hemoglobin
According to family history of suicide, majority
level during pretest, pos�est-1 and pos�est-2.
(75%) of suicide a�empted individual were had a
family history of suicide and 25% of control group Mean blood urea and creatinine level were
had family history of suicide. Among suicide increased during pretest among suicide a�empted
a�empted individual 42% of them had no family individual and during pos�est-1 and pos�est-2 blood
history of suicide and 58% of control group had no urea and creatinine level came to normal.
family history of suicide. The result indicated that
majority of general population had family history of Mean platelet level were normal during pretest,
suicide. pos�est-1 and pos�est-2 among suicide a�empted
individual. Mean total count were increased during
According to marital status, 63% of suicide pretest and during pos�est-1 and pos�est-2 total
a�empted individual were married: time of suicide count came to normal.
and 72% of sample were married but no a�empt
for suicide. Among unmarried people 36% were Section C : Effectiveness of information, education
a�empted suicide and 19.2% of sample were not and communication package on biochemical value
a�empted suicide. It is interesting that 1% of suicide among suicide a�empted individual.
a�empted were divorcee and 8.2% divorcee but not
F test were calculated to identify the effectiveness
a�empted suicide.
of information, education and communication package
According to time of suicide, 59% of suicide on biochemical value among suicide a�empted
a�empted individual tried to kill themselves during individual. The result showed that Information,
day time and 41% of people tried during night time. education and communication package was highly
Individual a�empted suicide when they were alone effective among Po2 (F=159.2,), bicarbonate (F=6.9),
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 189

blood glucose (F=16.8), blood urea (F=13), creatinine DISCUSSION

(F=22.4), total count (F=27.1).
Suicide causes severe biological disturbance to
F test showed that there was no significant patients that cause self care deficit among suicide
effectiveness identified with Pco2 (F=0.7), hemoglobin a�empted individual. Participants were not able to
(F=0.3) and platelet (F=0.6) among suicide a�empted maintain self care, diet, rest and sleep.
individual.
Individual a�empted suicide by any methods
like, cow dung, natural chemical, chemical, tablets
or hanging, have identified changes in biochemical
values. They were decreased Po2 level, increased
bicarbonate, blood glucose, urea, creatinine and total
count. There were no disturbance in other biochemical
values like, Pco2, hemoglobin and platelet count.

Suicide a�empted individual have multiple

organic failure due to reaction of chemical substances.
This causes renal failure, liver failure, respiratory
failure and circulatory failure. Health care team
Figure 1 : Po2,Pco2 and Hco3 values in pretest, pos�et 1 should prioritize care in these related organs to
and pos�est 2 of the participants. Values are mean+SE prevent complications.
(n=100)
Information, education and communication
package were highly helpful in motivating the patient
to co-operate with treatment, takes balanced diet,
maintain comfortable sleep and rest, increases self
concept and self confidence, actively communicate
with health care team and family members. No
evidence were found Pco2, hemoglobin and platelet
among suicide a�empted individual .

Middle aged and late aged adults were taken

more time to come back the normal biochemical value
when compared to adolescent and early adults. Other
Figure 2 : Blood glucose, serum creatinine and serum
urea values in pre-test, post-test 1 and post-test 2 of the demographic variables among suicide a�empted
participants individual did not show any significant difference in
biochemical value.

Among suicide a�empted individual white blood

cells were increased and red blood cells decreased
during pretest. This finding was supported by Zohreh
Aminzadeh5 2011. He reported that white blood cells
increased in response to infection and white blood
cells slightly decrease in elderly.

The same finding were supported by Pia Natalya

Reyes4, 2007 with depressed patient with suicide.
Emel Kocert2, 2013 found that white blood cells were
Figure 3 : Haemoglobin, White Blood Cells and platelets negatively correlated with platelet among suicide
in pre-test, post-test 1 and post-test 2 of the participants. a�empted individual. Huan M3 et.al, 2004 found that
(n = 100).
red blood cells were decreased among patient with
190 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

suicidal a�empt. REFERENCES

CONCLUSION (1). Currier D and Mann JJ, “ Stress, genes and the
biology of suicidal bahaviour “, The psychiatric
Based on the findings of the study the following
clinic of North America, page 247-69, June
conclusions were drawn
2008.
1. Majority of suicide a�empted individual (2). Emel Kocer, Aytekin Alcelik, Gulsen Kocaman
were in the age group of 26-40 years, male, married. and Abdulkadir Kocer, A Study of Leukocyte
graduate, private employee, coming from nuclear and Platelet Activity in Patients with Suicide
family, don’t have the family and previous history A�empt Related to Acute Stres Reaction,
of suicide, consumed poison during night time, Journal of Mood disorders, Vol 3, No 2, 2013.
consumed Generic drugss to commit suicide and
(3). Huan M, Hamazaki K, Sun Y et.al, “Suicide
marital conflict is the reason for suicide.
a�empt and n-3 fa�y acid levels in red blood
2. Information, education and communication cells: a case control study in china”, Biochemical
package was highly effective on Po2, bicarbonate, value Psychiatry .Page 490-6, October 2004.
blood glucose, urea, creatinine and total count among (4). Pia Natalya Ryles, “Depression, medication and
suicide a�empted individual. bad blood”, Neuroleptic malignant syndrome
information service, Vol 6, No 5, May 2007.
3. There were no disturbance found on Pco2,
hemoglobin and platelet among suicide a�empted (5). Zohreh Aminzadeh and Elham Parsa,
individual. “Relationship between age and pheripheral
white blood cell count in patients with sepsis”.
Acknowledgement: Nil International Journal of Preventive Medicine,
Page 238-242, October-December 2011.
Ethical Clearance: Obtained from Institutional
human ethical commi�ee at Saveetha university,
Chennai, India.

Source of Funding: Nil

Conflict of Interest: Nil

 DOI Number: 10.5958/0974-9357.2016.00074.X

Knowledge and Practices Regarding Prevention of

Anaemia in Pregnant Women

S Swarna1, M Jayalakshmi2
1
Associate Professor, College of Nursing, SVIMS,Tirupati, AP, India, 2Assistant Professor,
Yasoda College of Nursing, Sarrornagar, Telangana, India

ABSTRACT

Anaemia is the most frequent maternal complication during of pregnancy which is associated with
maternal morbidity, mortality,perinatal morbidity and mortality.Antenatal mothers should equip
themselves to prevent anaemia during pregnancy. Cross sectional survey was undertaken to
assess the knowledge and practices regarding prevention of Anemia in registered pregnant
women at Government Maternity Hospital, Koti Hyderabad. Data was collected from 100 antenatal
mothers who were a�ending antenatal clinic of GMH, koti, Hyderabad, India. The tool used for data
collection was interview schedule Reliabllity and validity of the tool was established. Findings
are majority (60%) were in the age group of 20-24 years. Three fourth(77%) are educated. Sixty
nine percent of mothers registered during 2nd trimester. Most of sample are primigravida(63%).
63% of mothers had mild anaemia(9.1 to 11mg/dl).Nearly half of the mothers (53%) had moderate
knowledge regarding anaemia. Most of mothers (65%) are not aware of prevention of Anaemia. 48%
of mothers are following diet practices about prevention of anaemia, almost all practicing hygiene,
73% are following treatment practices. Significant association was found between education,
occupation of subjects and knowledge regarding anaemia. Significant relationship was found
with occupation and practices about prevention of anaemia. Improvement in the knowledge
level and dietary practices among the most vulnerable group is very important to decrease the
prevalence of anaemia. Awareness programmes should be conducted among the pregnant women for
their promotion of health. Anaemia being major contributor to the maternal mortality and morbidity
due to its complications in pregnancy, it is the need of the hour to disseminate basic knowledge on
prevention of anaemia which can have an impact on our health system.

Keywords- Anaemia, pregnant women. knowledge, practice

INTRODUCTION 2005, covering almost half the World’s population,

estimated the prevalence of anaemia worldwide at
The World Health Organisation defines anaemia 25% (2) Although the prevalence of anaemia estimated
in pregnancy as a haemoglobin (Hb) concentration at 9 percent in countries with high development,in
of less than 10 g/dl.Iron deficiency anaemia is the countries with low development the prevalence
most common type of anaemia in pregnancy. is 43%(3). In absolute numbers anaemia affects
Anaemia has significant impact on the health of 1.62 billion people globally with about 293 million
the fetus as well as that of mother. It impairs the children of preschool age,56 million pregnant women
oxygen delivery through placenta to the fetus and and 468 million non pregnant women estimated to be
interferes with the normal intrauterine growth anaemic (2) Africa and Asia account for more more
leading to fetal loss and perinatal deaths. Anaemia than 85% of the absolute anemia burden in high risk
is associated with increased preterm labour(28.2%), groups and India is worst hit( 2) .Anemia is estimated
pre-eclampsia (31.2%) and maternal sepsis.(1) to contribute to more than 1,15,000 maternal deaths
and 5,91,000 perinatal deaths globally per year.(4))
WHO Global data base on Anemia for 1993-
192 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

India is one of the countries with very high (73%).educated.63% are primigravida, 37% are
prevalence of anaemia in the world. Almost 58 per multigravida.63% had mild anaemia, 18 % had
cent of pregnant women in India are anaemic and it moderate anemia, 7% had severe anaemia.
is estimated that anemia is the underlying cause for
20-40 percent of maternal deaths. India contributes Knowledge regarding anaemia and various
to about 80 per cent of deaths due to anaemia in aspects
South East Asia(5)Anaemia is the major problem Table 1. Knowledge of women regarding
affecting 58% of pregnant women (NFHS -3,2005- anemia (percentages)
2006).Knowledge of different causes of anaemia and
its prevention in pregnant women is essential for
Inade- Mode- Ade
control of anaemia .The outcome of the study helped Variable
quate rate quate
to plan various health educational programmes to
promote health of women. Cocept of Anaemia 80 18 2

MATERIALS & METHODS Signs and symptoms

11 14 75
Of Anaemia
Cross sectional survey approach was used to
Effects of anaemia 24 10 66
conduct the study .The se�ing of the study was
antenatal OPD, GMH, Koti, Hyderabad,AP. It is a Prevention of
65 31 4
anaemia
speciality hospital in Obstetrics and Gynaecology
an educational and research centre .sample size was Overall knowledge
14 53 33
regarding Anaemia
100.purposive sampling technique was to select
the sample. The structured Interview schedule
Table one reveals majority (53%) were having
was used to collect the data. It consists of section
moderate knowledge ,33 % had adequate knowledge,
one on demographic data, section two consist of
14% had inadequate knowledge regarding anaemia.
questions on knowledge on various aspects of
Most of the women (75%, 66%) have adequate
anaemia. Section three consisted of questions
knowledge on signs and symptoms, effects of
on self reported practices of pregnant mothers
anaemia. Inadequate knowledge present in concept
regarding prevention of anaemia. Reliability of the
of anaemia (80%), and prevention of anaemia (65%).
tool was r=0.957. pilot study was conducted and
it was found feasible to carry out the study. The Table 2. Knowledge on signs and symptoms of
study was approved by research commi�ee college Anaemia
of nursing, formal permission was obtained from
Medical superintendent Koti, Government Maternity S.NO Signs and symptoms Percentage
Hospital, Hyderabad,, India. oral consent was taken 1 tiredness 88
from the respondents. 2 weakness 86
Objectives: To determine the knowledge 3 headache 72
regarding anaemia among pregnant women. 4 giddiness 86

To assess the practices about various aspects of 5 Pallor of eyes 81

anaemia 6 Pallor of lips and tongue 88
7 Pallor of face 89
To find out the association between knowledge
.practice with selected demographic variables 8 Pallor of nails 88
9 palpitations 74
FINDINGS
10 Breathing difficulty 79
Demographic and baseline variables 11 Oedema of legs 79

Majority (60%) of the mothers were in the

Table two shows most of them are aware of signs
age group of 20-24 years. Most of them were
and symptoms of anaemia.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 193

Table 3.Knowledge on Effects of Anaemia on mother and fetus

S.No Variable Percentage

1 Low birth weight 91
2 Preterm labour 72

3 Intrauterine growth retardation 72

4 Heart failure 83
5 Post partum haemorrhage 66
6 Abruption placenta 72

Table three illustrates 91 percent were aware that anaemia may result in birth of low birth weight babies.
83 percent are aware of this may result in heart failure.

PRACTICES ON PREVENTION OF ANAEMIA

Table 4.Dietary practices regarding prevention of anaemia

S.No Diet Percentage

1 Pregnancy needs extra energy and nutrients 100
2 Change in dietary pa�ern during pregnancy 52
3 Strict meal schedule during pregnancy 59

Habit of taking food which is left over after consumption of all family
4 28
members

5 Fasting during pregnancy 32

6 Special food preparations taking during fasting 89

Avoid food items which are considered hot foods like mango, egg,
7 37
jaggery,during pregnancy

8 Habit of eating ash,mud and charcoal 7

9 Include meat ,fish,eggs,in diet regularly 90
10 Including green leafy vegetables and sprouted grams in diet regularly 97
11 Washing vegetables before cu�ing 100
12 Include seasonal fruits like apple,Orange,grapes,and dry fruits 98
13 Drinking atleast six to eight glasses of water per day 95
Including fibre rich diet drumsticks,carrots and radish
14 82
In the diet
15 Use of Ragi and Jaggery in diet 25

All the mothers agreed pregnancy needs extra 90 percent stated green leafy vegetables, fruits, meat,
energy andnutrients. More than half of subjects fish eggs are essential to take during pregnancy.25
reported change in dietary pa�ern and strict meal percent only stated use of jiggery and ragi in the
schedule is essential during pregnancy. More than diet.
194 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Table 5: Hygienic Practices regarding prevention

of Anaemia

S.No Hygiene %

1 Practicing open air defecation 8

2 Wearing chapels for open air defecation 98

Washing hands with soap and water

3 97
after defecation

4 Cu�ing nails once a week 96 Fig 1. Practices on Prevention of Anaemia

Fig –one reveals 98 percent are taking hygienic
5 Bathing every day regularly 99
measures to prevent anaemia. 78 percent are
following treatment practices to prevent anaemia.48
Table five reveals only eight percent are practicing
percent are observing dietary practices to prevent
open field defecation. Almost all practicing washing
anaemia.
hands, bathing regularly, cu�ing nails once a week
.This indicates improved facilities provided by the Association between knowledge, practices
Government and socioeconomic development. about prevention of anaemia with selected
demographicvariables.
Table 6: Treatment Practices in prevention of
anaemia Significant association was found between
knowledge and education of mothers (chi-square-
S.No Treatment practices Percentage 22.119), occupation (chi-square-20.131) at 1%, 5%
level.This is in line with the findings of Ghimire N,
Seeks medical help during
1 99 Pandey N study (p=0.002 ) at (p=<0.05). significant
pregnancy
association was found between occupation of
Takes Iron and Folic acid tablets pregnant women with practices (chi-squre 13.962) at
2 94
daily
1% level.
Know the purpose of iron
3 99 Development of Information booklet
tablets

Regular intake of iron tablets As the pregnant women have moderate

4 99
leads healthy babies knowledge on anaemia, less than half are following
Forget taking Iron tablets any
necessary dietary practices, information booklet was
5 30 prepared in local language (Telugu) And explained
day
it to the mothers.
Keeps time schedule to take
6 96
iron tablets
DISCUSSION
Stops iron tablet due to dark
7 8 Anaemia during pregnancy is a global public
stools
health problem facing world today,especially in the
8 Skips Iron tablets wontedly 4 developing countries.It is an important contributor
to maternal mortality/morbidity as well as to the
Knows that Iron tablets to be
9 34 low birth weight which in turn might contribute
continued after delivery
to increased percentage for Infant mortality. (8).The
Almost all taking medical help.and also present study showed majority (77%)of the mothers
taking Irontablets.but 30 percent forget to take iron are literates that indicates increase in female literacy
regularly.34 percent only are aware Iron tablets in urban areas. As there is rise in age at marriage
have to be continued even after delivery. majority of mothers (60%) of mothers were married
between 20-24 years of age. Majority (69%) registered
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 195

during second trimester in spite of government Financial Support: Nil

conducting educational programmes.
Ethical Clearance: Research commi�ee, College
Overall majority (53%) 0f mothers had moderate of Nursing approved the research topic, permission
knowledge regarding anaemia The study findings was obtained from Medical Superintendent, Govt.
are co related with the findings of (9), 2014 where all Maternity Hospital, Koti, Hyderabad. Oral consent
mothers reported moderate knowledge Anita(2005) was taken from participants
also reported 72.3% had moderate knowledge.The
study findings of Thressiamma ( 11 ) revealed pre test
REFERENCES
mean score of 23.79%. Abiselvi et al (12) also reported 1. Dash B.B.Anaemia of Pregnancy: Advantages
57.7% mothers had moderate knowledge about of Supplementation with carbonyl Iron.Obst
anaemia. Ghlimire et al(13) also reported 51.3% of and Gynac Today.2007:127-129
mothers had inadequate knowledge about anaemia,
2. World Wide prevalence of anaemia 1993-
66% of mothers had poor practice on prevention
2005.WHO Global Database on Anaemia.
of anaemia .Kalimbira AA et al study found a large
majority of the rural women in Malwai (96.8%) knew 3. McLean E, Cogswell M, Eglil et al.Worldwide
about anaemia and most of them correctly indicated prevalence of anemia.WHO Vitamin and
its signs, causes, prevention, and treatment. This Mineral Nutrition Information System.1993-
study also identified 80% of mothers had inadequate 2005.
knowledge on meaning and concept of anaemia,it 4. Ezzati M .et al .Comparative quantification
is corelating with the results of Abiselvi et al where of health risks global and regional burden
only 19.3% knew about meaning of anaemia. 65% of of disease a�ributable to selected major risk
mothers have inadequate knowledge on prevention factors ,Geneva,Swi�erland:WHO,2014.
of anaemia. Anita study also showed 49.1% of 5. Ezzati M et al.Selected major risk
mothers had knowledge regarding disease aspect factors and global regional burden of
of anaemia, 56.27% showed Knowledge regarding disease.LANCET,2002.
prevention of anaemia .With regard to practices 48%
6. NRHM. Guidelines for Control of Iron
are following dietary practices, 73% are following
Deficiency Anaemia. National Iron +Initiative
treatment practices, almost all practicing hygeine.
towards infinite potential in an Anaemia free
30 percent mothers reported forge�ing to take tab
India.
iron in between so necessary methods have to be
informed to the mothers so that they will not forget 7. NNMB, NIN. Diet and Nutritional Status of
to take iron tablets .only 33 percent are aware of Rural population and prevalence of HTN
tab Iron has to be continued even after delivery so among adults in rural areas. NNMB technical
there is a need to impart knowledge that tab Iron report,24,2006.
has to be continued even after delivery. Almost all 8. Noronha JA et al .Anemia in pregnancy—
told fruits,vegetables are essential. These results are consequences and challenges :A review of
supported by Maj Sivapriya S and Lt Col Laxmipriya literature. J South Asian Feder Obst Gynae
Parida(14) where 98% are including green leafy 2012;4(1):64-70.
vegetables in the diet. The present study highlighted 9. Darling B.Jiji and Rajgopal K. A study to assess
the importance of providing information to all the knowledge and risk factors of Anaemia
the antenatal women in the clinics. There should be among the pregnant women a�ending
mandatory preconception and antenatal counselling women selected health care facilities in Sebha,
sessions on prevention of anaemia. Libya.Journal of Science.4(1)2014:19-22.
Conlict of Interest: Nil 10. Anitha, M. A study to assess the knowledge
and practices regarding prevention of anemia
Acknowledgement: Authors acknowledges among registered pregnant mothers a�ending
the pregnant mothers who co operated in data antenatal clinics in selected hospital of
collection. Belgaum, Rajiv Gandhi University of Health
196 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Sciences, Karnataka, Bangalore 2005. 14. Kalimbira AA et al.Maternal Knowledge

11. Thereisamma PM.Iron and Folic Acid and practices Related to Anaemia and iron
Deficiency Anaemia. Nurses of India . 2007;6- Supplementation in Rural Malwai:A Cross-
7. sectional study. African Journal of Food,Agri
culture,Nutrition, and Development.9(1).2009;
12. Abiselvi A et al .A Cross Sectional Study
550-564.
on prevalence of Knowledge about Anaemia
among Pregnant Mothers in A Urban Health 15. Maj Sivapriya S,Lt Col Laxmipriya Parida. A
Centre Chennai,TamilNadu,India.Research study to assess the knowledge and practices
Journal of Pharmaceutical, Biological and regarding Prevention of Anaemia among
Chemical Sciences.2015;6(1):638 Antenatal Women A�ending a Tertiary Level
Hospital In Pune. International Journal of
13. Ghimire N,Pandey N. Knowledge and practice
Science and Research.2015:4(3).
of mothers regarding the prevention of
anaemia during pregnancy, in Teaching Hosp
ital,Kathmandu.Journal of Chitwan Medical
College.2013;3(5):14-17.
 DOI Number: 10.5958/0974-9357.2016.00075.1

Effect of an Instructional Module Regarding Knowledge

and A�itude on Childrearing Practices among Mothers of
Infants in Tribal Areas of Kannavam, Kannur, Kerala

Himamol
Lecturer, College of Nursing, Kannur Medical College, Anjarakandy, Kerala, India

ABSTRACT

The present study was aimed to assess the effect of instructional module regarding knowledge and
a�itude of mothers of infants on childrearing practices.
Objectives
1. Assess the existing level of knowledge on childrearing practices among mothers.
2. Identify the existing level of a�itude on childrearing practices among mothers.
3. Determine the effect of instructional module on knowledge and a�itude of mothers on childrearing
practices.
4. Find out the association between the level of knowledge and a�itude with selected sociopersonal
variables.
5. Identify the relationship between knowledge and a�itude on childrearing practices among mothers.
The conceptual framework used in the present study is Rosenstock and Becker’s Health Belief Model.
A quantitative research approach with one group pre test post test design was used in the study.
The population under study were mothers of infants at tribal areas. Sixty tribal mothers of infants
at Kannavam within the age group of 18-38 years were the samples selected through simple random
sampling. Structured questionnaire and a�itude assessment scale were the tool used to collect data by
self report technique. The data was collected for a period of 6 weeks in 6, 9 and13 wards of Kannavam,
Kannur district. The findings of the study revealed that, 46.6% and 50% samples were having average
and below average knowledge and 28% were having positive a�itude on childrearing practices during
pre test. After the administration of instructional module 51.6% and 10% were having average and
below average knowledge respectively and 68.4% were having positive a�itude during post test. The
calculated ‘t’ value for level of knowledge (t=31.16) and level of a�itude (t=23.789) was greater than
the table value (2.00) at P <0.05 level. The present study revealed that there is a significant positive
correlation with knowledge and a�itude in pre test and post test.
Keywords: Childrearing practices; knowledge; a�itude.

INTRODUCTION It goes without saying that enabling all children

to realize their full creative potential is critical for
India touched the 1.2 billion population mark in
sustaining India’s economic growth and accelerating
20111. The 2011 Indian census revealed some shocking
human development. Not all children have benefited
data about our child population. The child population
equitably from the remarkable progress and
in India has declined, whereas overall population has
transformation that the country has witnessed in
increased about 17.64% in the last 10 years2.India
recent years. Tens of millions still face basic challenges
is home to 158.8 million children. Kerala made a
of survival and healthy development3.
remarkable demographic transition within a short
period of time, where child population is only 9.5% of The tribal population of India is 8,43,26,240 and
its total population2. of Kerala is 3,64,189, which works out to 1.14 percent
198 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

of the state population4. The tribes are concentrated Tribals are one of the most exploited and deprived
on the hill regions of Kerala5. The child mortality rate sections of the population in the Indian society.
among the tribal group is high. The per capita health In all indicators of development, they remain the
expenditure of the tribes is higher than that of the most excluded despite the fact that various kinds of
general population6. Reports on daily shows that tribal policies and programmes have been pursued for their
groups allege more infant deaths in Melekandiyoor upliftment in the post-Independence India. Needless
tribal hamlet in Agali grama Panchayat limits in to say that exclusion from fruits of development has
Palakkad district of Kerala, where 42 infants have adversely affected the quality of life of the tribal
had died in the A�appady hills during the past 16 people. Tribal children are no exception3.
months7.
Childrearing is probably the most challenging
A child’s first line of protection and care should responsibility for a mother during her child’s infancy.
be the family8.Childrearing is the biggest and most Successful childrearing is essential for the child’s
important business parents are engaged in, all overall development and realization of self esteem. As
over the world. Human babies are most vulnerable a primary care giver for infant, mother is responsible
compared to babies of all other animal species9. There for a�ending to all the needs of infant14.
is considerable individual variation in practice from
The important aspects of childrearing practices
family to family, depending on the psychological
are maternal activities that promote the child’s
make-up of parents, including their own personality,
physical, physiological, psychological, social,
the experiences they had as children and the
economical and spiritual well being so that they may
conditions under which they are living10.
grow up to express their full potential15-17. Mother is an
While childrearing practices may be different important primary care provider and, therefore, it is
across cultures, scientific knowledge would suggest her education and access to information that will help
that there are basic needs that all children have and a her, about care of her infant and to develop positive
predictable pa�ern of development during the early a�itude towards childrearing practices18. Thus, there
years is universal. Studies from different parts of is gap in knowledge and a�itude about childrearing
world reveal that all young children need adequate practices among the tribal mothers of infants due to
nutrition, health and care from birth onwards. their social isolation.
The lack of these supports during early years has
The researcher experienced that, by systematically
permanent negative effects on later development11.
evaluating the childrearing knowledge and a�itudes
In India, Ayurveda was the first document to of tribal mothers, it is possible to identify areas of
describe childrearing rituals mainly as preventive inadequacy and institute remedial programs, and
measures. In short, childrearing practices are thereby ensure proper growth and development of
conductive to positive mental health12. the babies. With the help of an instructional module
on childrearing practices, researcher is trying to
Tribal communities are isolated and are educate the tribal mothers of infants and to develop
geographically distinct from general population by most positive a�itude towards childrearing and to
their own physical, socioeconomic environment, with create an awareness that childrearing is a changing,
each tribe having its own unique customs, traditions, dynamic behavioural process that need to be
beliefs and practices. Though science and technology modified to adjust to the child’s continued growth
have brought about advancement in life situations, and development.
still tribal families are unaware of it. They hold on
to the traditions and practices even though it has no MATERIAL & METHOD
scientific footing. The family rituals and symbols are
Research approach: Quantitative
extremely significant and are valued very highly and
are continued even when members do not see them Research design: One group pre-test-post-test
as important13. design

Se�ing of the study: ward 6, 9 and 13 of tribal

 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 199

areas of Kannavam 25) were based on spiritual aspects of childrearing

practices. The score interpretation was done as very
Population: mothers of infants at tribal areas
poor a�itude (1-25), poor a�itude (26-50), positive
Sample and Sampling technique: 60 mothers of a�itude (51-75), more positive a�itude (76-100), and
infants at tribal areas of Kannavam. Simple random most positive a�itude (101-125). In regard to positive
sampling (lo�ery method) and self report was the statement scoring was done 5, 4, 3, 2, 1 as interpreted
technique. as strongly agree, agree, uncertain, disagree, stongly
disagre respectively. With regard to negative
Description of tool statement, scoring was done 1, 2, 3, 4, 5 as interpretes
as strongly agree, agree, uncertain, disagree, strongly
Structured questionnaire and a�itude scale was
disagree respectively.
the tool.
SECTION IV- Instructional module on
Tool I: Structured Questionnaire on knowledge
childrearing practices, which included physical,
regarding childrearing practices.
physiological, psychological, social, economical and
Tool II: A�itude assessment scale (rating scale) on spiritual aspects of childrearing.
childrearing practices.
Content validity
The tool consists of four sections.
Research tool and instructional module was sent
SECTION I- Sociopersonal variables; which to subject experts for content validity. Their valuable
include age in years, religion, subcaste of tribals, suggestions and opinion was collected on relevancy,
educational status, occupation, type of marriage, type appropriateness and accuracy of the tool.
of family, number of children, period of residency,
Reliability of tool
income of the family per month and source of
information regarding childrearing practices. To establish the reliability of the tool, Karl Pearson
formula was used. Correlation coefficient, was found
SECTION II- Knowledge questionnaire on
to be 0.84. Thus the tool was found reliable.
childrearing practices
Pilot study
It consists of 30 self reporting type of structured
multiple choice questionnaire related to knowledge The pilot study was conducted in Peruva tribal
on child rearing practices. Questions (1-11) are based area (ward 13) of Kolayadu Panchayat, Kannur to
on physical aspects, (12-20) are based on physiological assess the feasibility of the study. The investigator
aspects, (21-29) are based on psychosocial aspects and obtained the wri�en permission from the Integrated
question number 30 is based on the economical aspect Tribal Development Project office, Kannur prior
of child rearing practices.The score were interpreted to the pilot study. The purpose of the study was
as below average knowledge (<50%), average explained to the sample and confidentiality was
knowledge (51-75%) and above average knowledge assured. Wri�en informed consent were obtained
(76-100%). from mothers of infants. Tool was administered to 6
mothers of infants, who fulfilled the inclusion of the
Tool II- 5 point A�itude assessment scale (Rating
study. The instructional module was given to mothers
scale) on childrearing practices.
on the same day of pre-test. Lecture class taken
SECTION III- It consisted of a�itude assessment regarding child rearing practices on physical,physio
scale consisting of 25 a�itude statements. There were logical,psychological,social,economical and spiritual
16 positive and 9 negative statements. Statements aspects of child rearing for the duration of 45 minutes
(1-8) were based on physical aspects , (9-12) based and distributed the instructional module to them. On
on physiological aspects, (13-17) are based on the seventh day, the post-test was conducted with
psychological aspects, (18-22) were based on social the same tool to assess the knowledge and a�itude
aspects, 23 were based on economical aspect and (24- regarding childrearing practices. Analysis of the data
was done and study report was presented. The study
200 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

was found feasible and practicable. FINDINGS

Data collection process Assessment of existing level of knowledge of

mothers on childrearing practices
The investigator obtained wri�en permission from
Integrated Tribal Development Project office, Kannur Among 60 samples, only 3.4% were having above
and 6, 9 and 13 wards of Kannavam tribal areas, of average knowledge, 46.6% were having average
Pa�yam Panchayat, Kannnur were selected for the knowledge, whereas 50% were having below average
study. The sample were selected by simple random knowledge regarding childrearing practices.
sampling technique through lo�ery method. Mothers
Assessment of existing level of a�itude of mothers
information was collected from immunization and
on childrearing practices
postnatal registers maintained by the Primary Health
Center, Kannavam. By lo�ery method 60 samples Among 60 samples, 8.3% were having poor
were selected as per the inclusion of the study. a�itude, 46.7% were having positive a�itude and
Before administering the tool, the investigator self only 45% were having more positive a�itude and
introduced to mothers of infants and the purpose none of the samples were having most positive
of the study was explained and an informed wri�en a�itude on childrearing practices.
consent was obtained from the subjects. On the first
day, pre-test was conducted by using the structured Assessment of level of knowledge of mothers
knowledge questionnaire to assess knowledge level on childrearing practices after administration of
of mothers on childrearing practices and a�itude instructional module
assessment scale was used to assess the a�itude
Among 60 samples, 51.6% were having average
of mothers of infants on child rearing practices.
knowledge, 38.4% were having above average
Instructional module was administered to the
knowledge, but only 10% were having below average
mothers of infants by lecture method which include
knowledge regarding child rearing practices.
lecture on various aspects of child rearing practices
which includes physical, physiological, psychological, Assessment of level of a�itude of mothers
social, economical and spiritual aspects of child on childrearing practices after administration of
rearing practices for the duration of 45 minutes and instructional module
distribution of instructional module to mothers. Post-
tests were conducted on the 7th day by administering Among 60 samples, 68.4% were having more
the same tool used in pre test to assess the knowledge positive a�itude, 25% were having positive a�itude
and a�itude score of mothers of infants regarding and 6.6% were having most positive a�itude on
childrearing practices. The data collection period was childrearing practices.
6 weeks. Assessment of effectiveness of instructional
Analysis of data module on childrearing practices

The data obtained was analysed in terms of The mean level of post test knowledge score
achieving the objectives of the study, by the descriptive (21.38) and post test a�itude score (86.53) was
and inferential statistics. Effectiveness of instructional significantly higher than their mean pre test level
module on knowledge and a�itude of mothers on of knowledge (15.17) and a�itude score (72.57). The
childrearing practices was determined with the help calculated ‘t’ value (t=31.16) for level of knowledge
of paired ‘t’ test. The association between the level of and ‘t’ value (t=23.789) for level of a�itude was greater
knowledge and a�itude with selected sociopersonal than the table value (2.00) at P< .05 level.
variables was found out by using Chi square test. The findings revealed that there is a highly
The relationship between knowledge and a�itude on significant gain in knowledge and change of a�itude
childrearing practices among mothers was calculated of mothers of infants on childrearing practices after
with the help of Spearman’s correlation coefficient. the administration of instructional module. Hence
it is revealed that there is a highly significant gain
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 201

in knowledge and change of a�itude through and cost effective tool for bringing about a change in
instructional module. knowledge and a�itude of mothers on childrearing
practices and thus improving infant survival.
Association between level of knowledge and
Therefore, educative programmes can be used as an
socio personal variables
effective nursing initiative in helping mothers to rear
The Chi square value calculated between their children into a responsible citizen.
knowledge and selected socio personal variables
Acknowledgement – Investigator owes sincere
revealed that there was a significant association
gratitude to Jesus Christ for his grace, deep sense
between knowledge on childrearing practices and
of gratitude to Prof. Bindu B esteemed teacher and
type of marriage, type of family and number of
research guide. Indebted to parents, sister, classmates
children.
for support and prayers.
Association between level of a�itude and socio
Ethical Clearance- Taken from institutional ethics
personal variables
commi�ee, Kannur Medical College, Anjarakandy,
The Chi square value calculated between level Kerala. Integrated Tribal Development Project
of a�itude and selected socio personal variables Officer, Kannur District, Kerala and Informed wri�en
revealed that there is a significant association with consent from the mothers of infants.
type of marriage. Therefore, H2 is accepted.
Source of Funding- Self
Correlation between pre test knowledge and
Conflict of Interest - Nil
a�itude scores
REFERENCES
Spearman’s Correlation coefficient for knowledge
and a�itude among 60 samples showed a significant 1. Statistical division. Family Welfare Statistics
positive correlation, rs =0.0878 indicating that those in India, 2011. Ministry of Health and Family
with a higher level of knowledge had a conservative Welfare. New Delhi: IEC Division; 2011.
high a�itude toward childrearing practices. 2. Census India. State wise child population
Correlation between post test knowledge and in India-2011 census. [cited 2011 Aug 1].
a�itude scores Availablefrom: h�p://updateox.com/india/state-
wise-child-populati on-in-india-2011.
Spearman’s Correlation coefficient for knowledge 3. Xaxa V. The status of tribal children in India:
and a�itude among 60 samples showed a significant a historical perspective. Available from: h�p:
positive correlation, rs =0.134 indicating that those //www.ihdindia.org/pdf/virginius_xaxa.pdf
with a higher level of knowledge had a conservative
4. Tribal population. State wise tribal population
high a�itude toward childrearing practices.
in India. [cited 2011 Aug 20]. Available from:
This finding shows that there is a positive http://deshgujarat.com/2011/08/20/state-wise-
correlation between level of knowledge and a�itude tribal-popul ation- in-india-gujarat-at-fourth-
on childrearing practices among mothers of infants. place-from-top/
Hence, it is revealed that as knowledge level increases 5. Mookerjee SK. Tribes of India. New Delhi:
a�itude is also changing to positive, more positive Oxford university press; 1985.
and most positive levels. Therefore H3 was accepted.
6. Rath GC. Tribal development in India. 2nd ed.
CONCLUSION New Delhi: Sage publications; 2006.
7. Staff reporter. Tribal groups allege more infant
In the light of the findings of the study, it is clearly
deaths. The Hindu. 2013 May 20; 1.
highlighted that instructional module was effective
in improving knowledge and changing a�itude of 8. Annan KA. We the children- meeting the
mothers of infants regarding child rearing practices. promises of the World Summit for Children.
Thus, health education and IEC materials are simple New York: UNICEF publishing house; 2001.
202 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

9. Liampu�ong P. Childrearing and infant care vulnerable groups. Available from: h�p:
issues: a cross cultural perspective. Australia: //planningcommission. nic.in/plans/planrel/
Nova science publishers;2007. Available from: fiveyr/11th/ 11_v1/ 11v1_ch6.pdf
https://www.novapublishers.com/catalog/ 14. Thomas SV, Saramma PP. Childrearing
product_info.php?products_id=5561 knowledge and practice scale for women
10. Evan JL, Myers RG. Childrearing practices: with epilepsy. Ann Indian Acad of Neuro.
creating programmes where traditions and 2010 Jul-Sep;13(3):171-79. Available from:
modern practices meet [Internet]. Available http://www.ncbi.nlm.nih.gov/pmc/articles/
from: PMC2981753
11. Ramji S. Impact of infant and young child 15. Dixon SD, Stein MT. Encounters with children-
feeding and caring practices on nutritional status pediatric behaviour and development. 4th ed.
and health. Indian J Med Res. 2009 Nov;130:624- California: Mosby; 2006.
26. Available from: h�p://icmr.nic.in/ijmr/2009/ 16. Prabhakar. Short textbook of preventive and
november/1124.pdf social medicine. Delhi: Jaypee; 2003.
12. Kapoor M. Mental health of Indian children. 17. Dharr GM, Robbani I. Foundations of community
New Delhi: Sage publications; 1995. medicine. 2nd ed. Noida: Elsevier; 2008.
13. Eleventh five year plan report. Social 18. Sr. Edith. Infant rearing practices and health
justice: Scheduled caste, scheduled tribes, problems. The Nursing Journal of India. 1998
other backward classes, minorities, other Mar;L39(3):59-60.
 DOI Number: 10.5958/0974-9357.2016.00076.3

A Pre Experimental Study to Assess the Effect of Emotional

Intelligence Skill Training on Emotional Intelligence of
Undergraduate Nursing Students

Vishavdeep1, Sunita Sharma2, Karobi Das3, PrahbhjotMalhi4, Sandhya Ghai5

MSc Nursing Student (Psychiatry), 2Lecturer, National Institute of Nursing Education, 3Lecture (Clinical
1

Psychology), NINE, 4Professor (Child Psychology) Department of Pediatrics, 5Principal,NINE, PGIMER, Chandigarh

ABSTRACT

As a part of nursing curriculum students have both academic and clinical working hours. Nursing
students works in various conditions and come across various stressors during their professional
training. There is evidence of increased level of stress in nursing students and the positive impact
of Emotional intelligence on performance of nursing students both academically and in patient care
The study was conducted on students of B.Sc. Nursing students. A protocol of Emotional intelligence
skill training was made based on Goleman’s model of Emotional Intelligence and seven sessions were
planned. Total 325 subjects were enrolled for study but data analysis was done only for 224 subjects
who a�ended all the seven sessions of Emotional Intelligence skill training. Pre test score at baseline
before the intervention was assessed and post test score was assessed one month after the intervention.
The outcomes were assessed on pre and post test score using statistical methods. In distribution of
subjects according to Emotional Intelligence test score in high, average and below average level in
pretest and post test, significant improvement after intervention was found in Emotional Intelligence(p
value<0.001). In comparison of pretest and post test scores of Emotional Intelligence , the results of the
study showed a significant improvement in the score of Emotional Intelligence(p value=0.007).

Keywords: Emotional Intelligence, Emotional Intelligence Skill Training.

INTRODUCTION OR BACK GROUND Intellience.2Emotions are connected to intelligence as

in our day to day life we meet a variety of people whom
Emotional Intelligence is a cluster of traits or
we label as emotional geniuses, emotional idiots and
abilities relating to the emotional side of the life.
people with moderate emotional competency.3
Daniel Goleman was the one who termed this kind
of intelligence as Emotional Intelligence and defined CONCEPT OF INTELLIGENCE
it as a cluster of traits or traits or abilities relating to
emotional side of life.1 From one of the pioneer theories of intelligence
was the faculty theory of intelligence in 18th and 19th
Earlier the focus of Emotional Intelligence century which believed in the presence of different
was on emotions and rationality which has now and independent faculties which can be developed
shifted to the intellectual component of Emotional by training. Followed by this was the single factor
theory of intelligence which believed in single
general intelligence uniting all the different abilities
Corresponding author:
and capacities of mind which was supported by
Vishavdeep,
psychologists like Binet and Terman. Next came
MSc Nursing Student (Psychiatry), National Institute
the two factor theory by Charles Spearman in 1904
of Nursing Education, PGIMER, Chandigarh.
according to which intelligence has two factors
Email- [email protected],
namely General or ‘g’ factor which is inborn and
[email protected]
204 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Specific or ‘s’ factor which is acquired from one’s and integrated self) and EQ outcomes (general
environment. health, quality of life, relationship quotient and
optimal performance). Baron (1997) called emotional
This was followed by the concept of system
intelligence as “an array of non cognitive capabilities,
theories of Intelligence. First was the theory of
competencies and skills that influence one’s ability to
multiple intelligences by Howard Earl Gardner
succeed in coping with environmental demands and
(1983) in which he said that the traditional notion of
pressures,” it can be improved by training and lack of
intelligence based on I.Q. testing, is far too limited.4,5
which can lead to emotional problems and failure.9
THE CONCEPT OF EMOTIONAL Emotionally intelligent people are having lower
INTELLIGENCE stress in their lives. This is because they handle
Emotional Intelligence is not a new concept. It is themselves and their environmental events in such a
present from the Vedic times. A numbers of texts are way that there are fewer stressful events in their lives.
available in these about it.6 They handle their mistakes more effectively and they
know adaptive strategies so they cope up with the
In modern concept Alfred Binet who was one of failures and mistakes. They regulate and repair the
the pioneers of intelligence test believed that general negative and destructive thoughts and emotions and
intelligence might not be the only factor important for they have more constructive thought pa�ern.4
social intelligence and emotional intelligence can be
viewed as a subset of social intelligence as explained Emotional Intelligence is not fixed at birth. It can
by many psychologists. Emotional intelligence has be improved and it is learned throughout life with
been discussed in work of various psychologists and experiences. This growth of Emotional Intelligence is
other workers in this field like in Howard Gardener’s called ‘maturity’. It can be upgraded by a person by
theory of multiple intelligences (1983) the association knowing its elements and then upgrading them but in
can be seen between emotional intelligence and a group it’s managing the relationships with the group
interpersonal intelligence and intrapersonal and at organizational level. Emotional Intelligence
intelligence. 3 does not mean merely nice but its handling oneself
and others effectively.10,8
The word ‘Emotional Quotient’ was first used
by Dutch fiction author Carl Lans in her two novels REVIEW OF LITERATURE
published in 1960’s. But in scientific psychology
According to a study conducted by Kumar R
the first use was by German psychoanalyst Barbara
and Nancy on 180 students showed 34% of nursing
Leuner in 1966 in her writing in which she suggested
students in nursing colleges in Punjab have moderate
that the hallucinogenic drug LSD might help women
stress and 33% have mild and severe stress and
with low emotional intelligence.4 The first use of term
majority tend to use healthy coping strategies as
Emotional Intelligence is a�ributed to Wayne Payne
compared to negative and unhealthy.11 Another study
in 1985.3,7 Daniel Goleman in 1995 further elaborated
conducted by Sharma S, Singh C and Sharma RK on
this concept of Emotional Intelligence and divided
44 nursing interns showed the same results in which
Emotional Intelligence into five basic emotional and
majority of the nursing interns had moderate level
social competencies-self-awareness, self-regulation,
of stress related to their clinical work for which they
motivation,empathy and social skills.8
use coping strategies like avoidance, transference,
Cooper(1997) divided Emotional Intelligence problem solving and optimism.12 Similar results were
into five a�ributes namely current environment also replicated by another research study conducted
(life pressures and situations), emotional literacy by Dhar R, Walia I, Das K which was done on 43 B.Sc.
(self awareness, emotional awareness, emotional Nursing first year students in which majority of the
expression and emotional awareness of others), EQ subjects showed to have stress and along with this
competencies (intentionality, creativity, resilience, factors leading to this is due to long college hours
interpersonal connections and constructive and shortage of time of self study and more academic
discontent), EQ values and a�itudes (outlook, work load nursing students which was found to have
compassion, intuition, trust radius, personal power difficulty in participation in social life.13 Kaur S, Das
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 205

K, Amrinder, Neha, Kanika, Sukhjit et al further the more students used avoiding21 and a study on 571
reported in a research study that the major stressors undergraduate nursing students by Senyuva E, Kaya
in nursing students are academic in nature.14 Even H, Isik B, Bodur G has shown a co relation between
the substantial suicidal risk was reported in 14% self compassion and Emotional Intelligence which
of nursing students in a research study done by includes the individual perceiving one’s emotions
Aradilla-Herrero A, Tomas-Sabado J, Gomez-Benito and using the knowledge one gained from them
J.along with negative association with self esteem to function while directing thoughts, actions and
with emotional clarity and repair15 professional applications has positive contribution
to the features with developed self compassion.22
Importance of Emotional Intelligence for nursing
Another study by Ruiz-Aranda D, Extremera N,
students:
Pineda-Galan C has shown a between Emotional
According to Shanta LL, Connolly M. in an Intelligence and person’s wellbeing which is indicated
article Emotional Intelligence is a crucial component by life satisfaction and happiness and an underlying
in the nurses’ ability to provide care to the patient, process by which high Emotional Intelligence may
peers and themselves and maintaining interpersonal increase well being in female students in nursing and
relationships.16 In a study done by Carmona- allied health sciences by reducing the experience of
Navarro MC, Pichachardo-Martinez MC on 81 stress.23
nursing professionals from which 52 were working
MATERIAL & METHODS
at emergency services and 29 were working at
mental health services it was seen that high level of A pre experimental study was designed to assess
Emotional Intelligence is associated with positive the effect of Emotional Intelligence skill training on
a�itude of nursing professionals towards patients Emotional intelligence of nursing students. The study
with suicidal behavior.17 And in a study by Fernandez was conducted on B.Sc. Nursing students of PGIMER,
R, Salamonson Y, Griffith on 81 subjects has shown Chandigarh. All the students of B.Sc. Nursing four
that in academics higher level of understanding their years studying during year 2014 were enrolled as
own emotions have a positive impact on students’ study samples. The conceptual framework of the
academic achievement and Emotional Intelligence is study was based on Roy’s adaptation model and
a significant predictor of academic achievement and Goleman’s model of Emotional Intelligence.
in terms of critical thinking, help seeking and peer
learning.18 in a study done on 243 nursing students by A protocol was made based on Goleman’s model
Aradilla-Herrero A, Tomas-Sabado J, Gomez-Benito of Emotional Intelligence and training was planned
J has shown a co-relation between self compassion in total seven sessions which were on Introduction
and Emotional, which includes the individual and need of Emotional Intelligence, self awareness,
perceiving one’s emotions and using the knowledge self management, social awareness, relationship
one gained from them to function while directing management and termination session respectively.
thoughts, actions and professional applications, has Each session was of one hour which included teaching,
positive contribution to the features of nurses with activities and discussion which was validated by the
developed self compassion.19 and according to study experts from the fields of Nursing, Psychiatry and
conducted by Beauvias AM, Stewart JG, Denisco S, Psychology.
Beauvais JE there is a significant relationship between The data was collected at baseline in first sessions
psychological empowerment, resilience, spiritual and one month after the completion of all the seven
well-being and academic success and between total sessions of Emotional Intelligence skill training.
emotional intelligence and with academic success, Total 325 subjects were enrolled in the research study
resilience with academic success and psychological but data analysis was done only for 224 subjects
empowerment with academic success20. In a study who a�ended all the seven sessions of Emotional
by Chan JC, Sit EN, Lau WM. showed that higher Intelligence skill training. Descriptive and inferential
the Emotional Intelligence, the more students statistics were used for data analysis.
used integrating, obliging, compromising and
dominating. The lower the Emotional Intelligence,
206 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

FINDINGS Comparison of Pre-test and Post-test values of

Emotional Intelligence:
Socio demographic profile of subjects:
Table 2 compares pre and post intervention
The subjects were in the range of 17 years to 23 assessment of the Emotional Quotient of the subjects.
years of age with mean age 19.33±1.235. Among the The comparison of the pre test and post test scores
subjects majority are aged 17 years (30%) followed by was done using paired t test and the results showed
subjects of age 20 years(26.8%).There were 120(53.6%) that in Emotional Quotient the mean score in pre
subjects from urban and 104(46.4%) from rural test was 208.68±10.67 and after intervention it was
background. Majorityi.e.167 (74.6%) of the subjects 210.56±11.61. So there was a significant improvement
belonged to the nuclear and 34(59.8%) of the subjects in the Emotional Quotient of the subjects after
were eldest in their birth order. intervention (p value = 0.007).
Academic Profile of subjects: Table 2: Comparison of Pre test and Post test
The subjects were enrolled from all the four values of Emotional Intelligence: N=224
years of B.Sc. Nursing with maximum number of
subjects were from B.Sc. Nursing First year 77(34.4%)
Pre test Post Test Paired t
followed by second and third year with equal number Variables Mean±SD Mean±SD df
of subjects 61(27.2%) from each year. Majority of the Range range p value
subjects which were more than half 133(59.4%) opted
for nursing profession due to their own interest. Emotional
208.68±10.67 210.56±11.61
Quotient -2.70
180-237 175-238
Distribution of subjects according to scores of 223
Emotional Intelligence Test (EIT): 0.007*

In Table 1 McNemar chi square test was applied

on the distribution of the subjects in various levels Minimum and Maximum a�ainable score: ,
i.e. below average, average and high as given in Emotional Quotient = 60-300 *p<0.01
Emotional Intelligence Test (EIT) to test the difference CONCLUSION
after the intervention. According to results statistical
significant improvement after the intervention was Total 224 subjects were included in the study
found in Emotional Intelligence (p value<0.001). from all the four years of B.Sc. Nursing and the
results have shown that after Emotional Intelligence
Table 1: Distribution of subjects according to skill training there was significant improvement in
scores of Emotional Intelligence Test (EIT) the Emotional Intelligence (EQ) of the undergraduate
N=224 nursing students.

Acknowledgement: I’m thankful to all the

χ2
Pre Test Post Test faculty members of National Institute of Nursing
Level df
n(%) n(%) Education, PGIMER, Chandigarh and all the students
p# value
of National Institute of Nursing Education, PGIMER,
Emotional Quotient Chandigarh for their support and co-operation in my
Below Average(60- research work.
- - 12.071
140)
193(86.2) 179(79.9) 1 Conflict of Interest: Nil
Average(141-220)
31(13.8) 45(20.1) <0.001*
High(221-300)
Source of Funding: Self

*p<0.01 Ethical Clearance: Taken from Institute Ethics

Commi�ee, PGIMER, Chandigarh.
#
p = McNemar p value
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 207

REFERENCES &cad=rja&ved=0CDEQFjAB&url=http%3A%2
F%2Fmedind.nic.in%2Fnad%2Ft11%2Fi4%2Fn
1. Baron RA. Psychology. 5th ed. India: Dorling adt11i4p152.pdf&ei=EeXnUv_2Fs3qrQefnoDQ
Kindersley Pvt. Ltd. Pearson; 2000. Ag&usg=AFQjCNGW-FKNrzPlm-EYJE-SqH-
2. Chakraborthy A, Konar A. Emotional DqyKNKA&sig2=HXydX5s_oxwaDrtIjPsXXw&
Intelligence:A Cybernetic Approach. Chennai: bvm=bv.60157871,d.bmk.
Springer/Scientific publishing services; 2009. 13. Dhar R, Walia I, Das K. A descriptive study to
3. Zeidner M, Ma�hews G, Roberts RD. What assess the causes of stress and coping strategies
we know about Emotional Intelligence. How used by the newly admi�ed basic B.Sc. Nursing
it affects learning, work, relationships and our students. Nursing and Midwifery Research
mental Health. London: Bradford; 2009. Journal [Internet] 2009 Jan [cited 2014 Jan 15];
4. Tavris C, Wade C. Psychology. 8thed. New 5(1):31-37. Available from: h�p://medind.nic.in/
Delhi: Dorling Kindersley Pvt. Ltd Pearson; nad/t11/i4/nadt11i4p141.pdf.
2006. 14. Kaur S, Das K, Amrinder, Neha, Kanika, Sukhjit
5. Papalia DE, Olds SW. Psychology. 2 ed. New
nd et al. Stress and coping in nursing students
York: McGraw Hill; 1988. . JMHHB [Internet] 2009 [cited 2014 Jan 15];
14(1):51-58. Available from: h�p://ipsnz.org/
6. Gayathri N, Meenakshi K. Emotional
journal_2009_1.html.
intelligence through the Bhagavad-Gita.
Int J Res Stud Psychol [Internet]. 2012 Oct 2 15. Aradilla-Herrero A, Tomas-Sabado J, Gomez-
[cited 2014 Dec 24];1(2). Available from: h�p: Benito J. Association between emotional
//www.consortiacademia.org/index.php/ijrsp/ intelligence, depression and suicide risk in
article/view/83. nursing student. [Internet] 2013 July [cited
2014 Jan 15]; 6917(13). Available from: h�p://
7. Mishta KS, Upadhya P, Dubey R. Cognitive and
www.ncbi.nlm.nih.gov/pubmed/23886906#.
Affective correlation of Emotional Intelligence.
Allahabad: LaljiMaurya; 2012. 16. Shanta LL, Connolly M. Using Kings interacting
systems to link emotional intelligence and
8. Goleman D. Working with Emotional
nursing practice. J Prof Nurs [Internet] 2013
Intelligence. London: Bloomsbury; 1998.
May-Jun [cited 2014 Jan 15]; 29(3):174-80.
9. Bar-on R. The Bar-On model of emotional-social Available from: h�p://www.ncbi.nlm.nih.gov/
intelligence (ESI). Psicotherma[Internet]. 2006 pubmed/23706971.
[cited 2014 Dec 24]; 8: 13-25. Available from:
17. Carmona-Navarro MC, Pichachardo-Martinez
h�p://www.psicothema.com/pdf/3271.pdf
MC. A�itude of nursing professionals towards
10. Singh D. Emotional Intelligence at work-A suicidal behavior: influence of emotional
professional guide. 2nded. New Delhi: Response intelligence. Rev Lat Am Enfermagem [Internet]
books; 2001. 2012 Nov-Dec [cited 2014 Jan 15]; 20(6):
11. Kumar R, Nancy. Stress and coping Strategies 1661-8. Available from: h�p://www.scielo.br/
among Nursing Students. Nursing and scielo.php?script=sci_ar�ext&pid=S0104116920
Midwifery Research Journal [Internet] 2011 12000600019&lng=en&nrm=iso&tlng=en.
Oct [cited 2014 Jan 15]; 7(4):141. Available 18. Fernandez R, Salamonson Y, Griffith R.
from: URL: h�p://medind.nic.in/nad/t11/i4/ Emotional intelligence as a predictor of
nadt11i4p141.pdf. academic performance in first-year accelerated
12. Singh C, Sharma S, Sharma RK. Level of stress graduate entry nursing students. Lat Am
and coping strategies used by nursing interns. Enfermagem [Internet] 2012 Dec [cited 2014
Nursing and Midwifery Research Journal Jan 15]; 21(23-24):3485-92. Available from: h�p:
[Internet] 2011 Oct [cited 2014 Jan 15]; 7(4): //www.ncbi.nlm.nih.gov/pubmed/23145518.
152. Available from:h�ps://www.google.co.in/ 19. Aradilla-Herrero A, Tomas-Sabado J, Gomez-
url?sa=t&rct=j&q=&esrc=s&source=web&cd=2 Benito J. Death a�itude and emotion intelligence
208 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

in nursing students. Omeqa (Westport) [Internet] S0260-6917(13):00388-2. Available from: h�p:

2012-2013 [cited 2014 Jan 15]; 66(1):39-55. //www.ncbi.nlm.nih.gov/pubmed/24225346.
Available from:h�p://www.ncbi.nlm.nih.gov/
22. Senyuva E, Kaya H, Isik B, Bodur G. Relationship
pubmed/23495536#.
between self-compassion and emotional
20. Beauvias AM, Stewart JG, Denisco S, Beauvais intelligence in nursing students. Int J NursPrac
JE. Factors related to academic success among [Internet] 2013 Oct 11 [cited 2014 Jan 15].
nursing students: A descriptive correlational Available from: h�p://www.ncbi.nlm.nih.gov/
research study. Nurse Educ Today [Internet] pubmed/24118163.
2013 Dec [cited 2014 Jan 15]; 6917(13):00435-8.
23. Ruiz-Aranda D, Extremera N, Pineda-Galan
Available from: h�p://www.ncbi.nlm.nih.gov/
C. Emotional intelligence, life satisfaction and
pubmed/24380623.
subjective happiness in female student health
21. Chan JC, Sit EN, Lau WM. Conflict professionals: the mediating effect of perceived
management styles, emotional intelligence stress. J Psychiatrment Health Nurs [Internet] 2013
and implicit theories of personality of nursing Apr 12 [cited 2014 Jan 15]. Available from: URL:
students: A cross-sectional study. Nurse Educ h�p://www.ncbi.nlm.nih.gov/pubmed/23578272.
Today [Internet] 2013 Oct 28 [cited 2014 Jan 15];
 DOI Number: 10.5958/0974-9357.2016.00077.5

Assessment of Adjustment Problems among

Adolescents Residing in Orphanage

Anju P Thampi1, Sreejamol M G2, Febu Elizabeth Joy2

1
Post Graduate Student, 2 Assistant Professor, Department of Mental Health Nursing, Amirta College of Nursing ,
Amrita Vishwa Vidyapeetham Health Science Campus, Amrita Institute of Medical Sciences AIMS, Kochi-41, India

ABSTRACT

A descriptive study was undertaken to assess the adjustment problems among adolescents residing
in selected orphanage at Kerala, India. This study was aimed to identify adjustment problems of
adolescents residing in orphanage as well as to find out the association between adjustment problems
of adolescents residing at orphanage with their socio - demographic variables. An information booklet
was also developed on adjustment problems of adolescents residing in the orphanage and it’s coping
strategies. A quantitative research approach has been used. The data was collected using socio
demographic profile and self administered rating scale on adjustment problems among adolescents
residing in the orphanage. The data was analyzed using descriptive (frequency, percentage) and
inferential (chi – square test and fisher exact probability test) statistics. Among 100 adolescents in the
orphanage, 71% of subjects had good adjustment and the remaining 29% had moderate adjustment.
None of them had poor level of adjustment. There were significant association between three
demographic variables, education level of the adolescents ((χ2 = 3.918, df = 1, p< 0.05), parents living
(χ2=8.114, df = 3, p<0.05) and visit by parents (p = 0.035). The investigation of adolescent adjustment
problems among those residing in the orphanage is warranted to facilitate the development and
implementation of established support system that prevents and decrease emotional and behavioural
problems among institutionalized adolescents.

Keywords: adjustment problems, adolescents and orphanage.

result of their family problems or life events may have

INTRODUCTION increased adjustment problems.4

Adolescence is the second decade of life, marking A study by Shrivastava in 2007 reports that
the period of transition from childhood to adulthood.1 approximately 18 million children who live or
According to WHO, it is said to be a crucial period of work on the streets of India, are involved in crime,
one’s life, which covers roughly from 10-19years.2 It is prostitution, gang related violence and drug trafficking of
also a time of new challenges and new opportunities. which majority are orphans.5

Some adolescents do not negotiate these Therefore considering the above background
challenges positively and develop personal and social it was felt that, researches on adjustment problems
problems which lead towards their maladjustment.3 among adolescents residing in the orphanage
An orphanage plays a pivotal role, to care for children are limited and thus identifying their adjustment
whose parents are deceased or otherwise unable or levels at the earliest would warrant to facilitate the
unwilling to care for them. Researches reveal that development and implementation of established
adolescents who live in an institutional se�ing as a systems that prevent and decrease violent behaviours
among adolescents, who are the future treasurers of
Corresponding author: our society.
Anju P Thampi
Email: [email protected]
210 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

MATERIALS & METHODS areas covering emotional, social, health and institution
were also used to identify the adjustment problems.
The present study was aimed at identifying the Higher the score indicates good adjustment. With
adjustment problems among adolescents residing the total score of 150, data was interpreted as 50 – 79
in selected orphanage, the quantitative research indicating poor adjustment, 80 – 109 moderate and
approach was found to be more appropriate. 110 – 150 with good adjustment.
Descriptive design was used to accomplish the aim of
Data collection was done, after obtaining ethical
the study. The study was conducted in Janaseva boys
clearance from the Thesis review commi�ee of
home, Aluva (Kerala).
AIMS. Formal permission from the authority of the
A convenience sampling technique was used orphanage was also obtained. Then, the investigator
to recruit the sample. Hence, 100 subjects residing visited the orphanage on the given date and
in the orphanage were recruited for the study. The introduced to them and the purpose of the study was
reliability was analyzed by means of Cronbach’s also explained. Assurance was given to the subjects
alpha, and yielded, reliability coefficients of as 0.939 that confidentiality would be maintained and then
which was reliable and content validity index of 0.9. assent was obtained before conduction of the study.
The tools used for the study were socio demographic The tools were administered, from two groups in
profile that deals with demographic variables such as two sessions on a single day by the researcher and
age, education, hobbies, favourite subject, admirable with the help of care takers to maintain discipline. It
person, parents alive, visit by parents, siblings stay, took about one hour to collect the data from a group.
age of first admission to the institution, reason for Sample selection criteria were that those adolescents
admission and duration of stay in the institution. A between 10 to 18 years of age who are living in the
50 item rating scale consisting of 20 positive and 30 orphanage for about 3 months and those who were
negative statements developed by the researcher on available at the time of data collection.

RESULTS
In this section, statistical analysis and interpretation of collected data were organized under four sections.
Section I : Sample Characteristics
Table 1: Distribution of subjects based on socio demographic characteristics n = 100
Sl.No Demographic Variables Frequency (f) Percentage (%)
1. Age
(a) 10-12years 58 58
(b) 13-15years 30 30
(c) 16-18years 12 12
2. Education
(a) Primary school 40 40
(b) High school 51 51
(c) Higher secondary 9 9
3. Hobbies
(a) Listening music 16 16
(b) Playing with friends 65 65
(c) Reading books 19 19
4. Favourite subject
(a) English 42 42
(b) Maths 30 30
(c) Science 8 8
(d) Malayalam 20 20
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 211

Continued...
n = 100
Sl.No Demographic Variables Frequency (f) Percentage (%)
5. Admired person
(a) Parents 40 40
(b) Guardian 50 50
(c) Friends 10 10
6. Parents alive
(a) Father 6 6
(b) Mother 21 21
(c) Both 65 65
(d) None 8 8
7. Visit by parents
(a) Father 9 9
(b) Mother 32 32
(c) Both 38 38
(d) None 21 21
8. Siblings stay
(a) Home 64 64
(b) Same orphanage 17 17
(c) Other orphanage 13 13
(d) No siblings 6 6
9. Age of first admission
(a) Up to 5years 34 34
(b) 6-10 years 52 52
(c) 11-15 years 14 14
10. Reason for admission
(a) Family conflicts 36 36
(b) Financial crisis 47 47
(c) No house 12 12
(d) Death of parents 5 5
11. Duration of stay
(a)Up to 5years 54 54
(b) 6-10 years 41 41
(c) 11-15years 4 4
(d) Above 15years 1 1
212 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Section II : Level of adjustmentn = 100

Figure 1: Distribution of subjects based on level of adjustment

Among the subjects, 71 (71%) had good adjustment and the remaining 29(29%) had moderate adjustment.
None of them had poor level of adjustment. The mean adjustment score was 115.49, mean percentage 76.99% ,
standard deviation 10.11 and the median value was 116.

Section III: Area wise analysis of the adjustment score

Table 2: Area wise analysis of the adjustment score with respect to components of self administered
rating scale n = 100

Sl.No Area of Maximum possible Mean Standard Mean score

Adjustment score deviation percentage(%)

1. Emotional 51 36.56 3.95 71.68

2. Social 30 22.83 3.24 76.10

3. Health 36 28.16 3.49 78.22

4. Institution 33 27.94 3.44 84.66

The subject’s mean score and mean percentage were able to deal well with problems but 7 (7%)
in relation to various components of the self always felt that they are a failure in life. Still, 44 (44%)
administered rating scale on level of adjustment. It is felt that their dreams can be accomplished in future.
evident from the table that, the subjects had emotional
• In the social domain, about 70 (70%) enjoy
adjustment with a mean of 36.56 (71.68%) where
making friendship with others, 51(51%) felt being
the maximum possible score was 51and standard
cohesive in a group and also 50 (50%) found it easy in
deviation 3.95. Adjustment in social area and health
asking help from others.
area were, with a mean score of 22.83 (76.10%) and
28.16(78.22%) as well as the standard deviation of 3.24 • Within the subjects, 85(85%) had their meals
and 3.49 respectively. The subjects have adjustment to in time and about 78(78%) could sleep well at night
the institution with mean of 27.94 (84.66%) which was which indicates the satisfaction in meeting their basic
comparatively good. needs in life.
OTHER RELEVANT FINDINGS • Most of the subjects, i.e 80 (80%) felt that they
are protected, 68(68%) were comfortable and about
• Among the 100 subjects, 34 (34%) had only
82 (82%) agree that there is love and affection within
felt confident in doing all activities and 15 (15%) felt
the institution. Whereas only 4 (4%) and 3(3%) had
they get upset easily.
felt like running away and ashamed of being in the
• Twenty nine percentage reported that, they institution.
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 213

• More than half of the subjects i.e 79 (79%) and (69%) of the subjects always felt the need for the
64 (64%) felt that that their guardians are much kind presence of their parents.
and understanding them respectively.
Section IV: Association between level of
• So, of all the significant factor is that majority adjustment and selected demographic variables.
of the adolescents residing in the institution i.e 69

Table 3: Association between adjustment problems of adolescents residing at orphanage with their
socio - demographic variables
214 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

χ2 (1) = 3.84, χ2 (2) = 5.99, χ2 (3) = 7.82, *= p <0.05, # = using Fisher exact test, ns = not significant

The calculated chi square value in case of the support that is rendered to the adolescents in the
education level of the adolescents (χ2 = 3.918, df = 1, orphanage cannot be compared to the parental love,
p< 0.05), parents living (χ2=8.114, df = 3, p<0.05) and care and support.
visit by parents (p = 0.035) were less than p value Acknowledgement: I owe my profound gratitude
0.05. So, there is significant association between these to Mr. Jose Maveli, Chairman, Janaseva Sisu Bhavan,
socio demographic variables and level of adjustment. Aluva and all the adolescents, care takers and social
No statistical association found between other socio workers of Janaseva Boys home, Aluva for their co-
demographic variables of the subjects to the level of operation and valuable feedback.
adjustment. Source of Funding : Self
CONCLUSION Conflict of Interest : Nil

About 29% of adolescents had moderate REFERENCES

adjustment may be because of their poor peer group
1. Hockenberry, Wilson, Winkelstein. Wong’s
relationships and accepting guidance from guardians
nursing care of infants and children. 7 th ed.
and also teachers. They may be expecting their
Missouri: Mosby publication; 2003.p. 802-3
parental guidance and support, love and affection
2. UN system in India. Adolescents in India. [
from them. Some adolescents not accepting guidance
Online]. December 2003; Availablefrom: URL:
in problematic situations may demonstrate harmful
h�p://www.whoindia.org/linkfiles/Adolescent_
behavioural problems. Adolescents showed good
health_anddevelopment_(AHD)_UNFPA_
adjustment in the overall score i.e. 71% may be
country_report.pdf
accepting guidance from guardians and maintains
good peer group relationship. 3. Irshad Ali Dar Latief Ahmad Tali international J
of Eng Lan and Liter Volume 1 Issue V Feb 2014 (
The significant factor is that, majority i.e 69 (69%) online)
of the subjects always felt the need for the presence 4. Altshuler S and Poertner J. (2002). The child
of their parents. As a health care provider giving health and illness profile- adolescents’ edition;
psychological support at the earliest by establishing assessing well- being in group homes and
support systems, community awareness programs, institutions: Child welfare, 81(3
providing information and voluntary support may 5. Shrivastava D (2007). Child trafficking–A human
help the adolescents to overcome the crisis. However
right abuse. Indian Police J. p.65.
 DOI Number: 10.5958/0974-9357.2016.00078.7

Assessment of Psychosocial Problems among Parents of

Dyslexic Children A�ending Child Guidance Clinic

P Sinu1, Sunil Moothedath2

Post Graduate Student, 2Professor, Department of Child Health Nursing, Amrita College of Nursing,
1

Amrita Vishwa Vidyapeetham Health Science Campus, Amrita Institute of Medical Sciences AIMS, Kochi, India

ABSTRACT

A descriptive study was undertaken to assess the psychosocial problems among parents of children
a�ending child guidance clinic in a tertiary care hospital at Ernakulum. This study was aimed to identify
the psychosocial problems of parents of dyslexic children as well as to find out the association between
problems faced by parents of dyslexic children and selected demographic variables. An information
booklet was also developed on care of children with dyslexia. A quantitative research approach has
been used. The data was collected using socio demographic profile and self administered rating scale
on psychosocial problems among parents of dyslexic children a�ending the Child Guidance Clinic. The
data was analysed using descriptive (frequency, percentage) and inferential (Fishers exact probability
test) statistics. Among 70 parents, 11.4% had mild psychosocial problem, 75.7% had moderate
psychosocial problem and the remaining 12.9% had severe psychosocial problem. There were significant
association between two demographic variables, duration of disability (p value=0.011) and number of
therapy sessions a�ended (p value=0.039). The investigation of psychosocial problems among parents
of dyslexic children a�ending Child Guidance Clinic is warranted to facilitate the implementation
of established adaptive system that prevents and decrease emotional, social, physical, cognitive and
spiritual problems among the parents by providing awareness about their child’s condition.

Keywords: psychosocial problems, parents, dyslexic children.

INTRODUCTION Parents especially mothers can often be affected

quite profoundly and emotionally by the fact that
Early care and education is what many their child has dyslexia. Parents may feel more
professionals are calling child care. All children can concern about what the future will hold for their son
succeed with the right support. There is a need to or daughter. Parents may have anxiety when they
understand the root of all difficulties. According to see their child’s distress and frustration over events
American Dyslexia Association- approximately 70- that have happened to them. Researches reveal that
80% of children with poor academic skills are likely to there arise psychosocial problems among parents of
be dyslexic. One in five students (approximately 15- children with learning disability2.
20%) of the population has a language based learning
disability and dyslexia is the most common of these A study by Abasiubong F and Obembe A in2002
disabilities1. reports that parents of children diagnosed as dyslexia
undergo psychosocial problems. Studies reveal
that parents of children with learning disability are
Corresponding author. prone for emotional and psychological disorders.
P Sinu In order to improve the well being of the children
Post Graduate Student, Amrita College of Nursing, with learning disability, there is need to look into the
Amrita Vishwa Vidyapeetham Health Science mental and physical health of mothers3 caring adults
Campus, Amrita Institute of Medical Sciences AIMS, must understand the cognitive and affective problems
Kochi-41, India. Email: [email protected] caused by dyslexia. Then they must design strategies
216 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

that will help the dyslexic, like every other child, of the study was explained to the subjects. Assurance
to find joy and success in academics and personal was given to the subjects that confidentiality would
relationships4. be maintained and then assent was obtained before
conduction of the study. The tools were administered
MATERIALS & METHODS
and it took about twenty minutes to collect the data
The present study was aimed at identifying the from a sample. Sample selection criteria were those
psychosocial problems among parents of children parents of children with dyslexia between 8 to 18
with learning disability a�ending Child Guidance years of age who are a�ending the Child Guidance
Clinic, quantitative research approach was found to Clinic and those who were available at the time of
be most appropriate. Descriptive design was used data collection.
to accomplish the aim of the study. The study was
RESULTS
conducted in Child Guidance Clinic of a tertiary care
hospital, Kochi. In this section, statistical analysis and
interpretation of collected data were organized under
A convenience sampling technique was used
three sections.
to recruit the sample. 70 samples were used. The
reliability was analyzed by means of Cronbach’s Section I : Level of psychosocial problems n=70
alpha and yielded reliability coefficients of as 0.939
and content validity index of 0.9.. The tools used for
the study were socio demographic profile of parents,
sociodemographic variable of children that deals with
demographic variables such as Age, sex, occupation,
family income, duration of disability, number of
therapy sessions, type of syllabus, number of siblings,
Medium of instruction of the child, learning disability
in parents. A 42 item rating scale developed by the
researcher consisting of emotional (16), physical (6),
cognitive (7), spiritual (6) and social (7) areas were
used to identify the psychosocial problems. Higher
the score indicates severe psychosocial problem.
With a total score of 126, data was interrupted as
42-70 indicating mild psychosocial problem, 71-98 Figure 1: Level of psychosocial problems among parents.
moderate and 99-126 with severe. The graph shows that 75.7% of subjects had
moderate psychosocial problems, 11.4% had mild
Data collection was done, after obtaining ethical
and the remaining 12.9% had severe psychosocial
clearance from the Thesis review commi�ee of AIMS.
problem
Formal permission from the Head of Child Guidance
Clinic. Then, the investigator visited the Child Section II: Area wise analysis of the psychosocial
Guidance Clinic on the given date and the purpose problem score
Table 1: Item wise analysis of the psychosocial problem score with respect to components of semi-
structured questionnaire n = 70

Sl.No Domains/Areas Total score Mean SD Mean%

1 Emotional 48 32.89 5.989 68.5
2 Physical 18 11.44 3.352 63.6
3 Cognitive 21 14.11 2.423 67.2
4 Spiritual 18 14.70 1.697 81.7
5 Social 21 13.80 2.164 65.7
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 217

The subjects mean scores and mean percentages almost the same level of psychosocial problem with
of scores in relation to various components of a mean percentage 67.2% and 68.5% respectively,
the semi structured questionnaire on level of Where as highest psychosocial problem is evident in
psychosocial problems. It is evident from the the spiritual area (81.7%).
table that the subjects have limited psychosocial
Section III: Association between level of
problems in physical and social area with a mean
psychosocial problem and selected demographic
of 11.44(63.6%) and 13.80(65.7%) respectively.
variables
Problems in Cognitive and emotional area are in

Table 2: Association between level of psychosocial problems among the parents and selected
demographic variables of children.

Sl.No Demographic Psychosocial problems Total P-value

Variable Mild Moderate Severe

1) Duration of disability

1-6 months 0% 8(61.5%) 5(38.5%) 13

7-12months 0% 4(66.7%) 2(33.3%) 6 0.011*

13-24 months 1(7.1%) 12(85.7%) 1(7.1%) 14

Above 24 months 7(18.9%) 29(78.4%) 1(2.7%) 37

2) Number of therapy

Sessions

None 0% 10(71.4%) 4(28.6%) 14 0.039*

One 0% 5(62.5%) 3(37.5%) 8

Two 1(33.3%) 2(66.7%) 0% 3

Three 1(10.0%) 8(80.0%) 1(10.0%) 10

Four and Above 6(17.1%) 28(80%) 1(2.9%) 35

3) Medium of instructions

State Board 1(3.6%) 25(89.3%) 2(7.1%) 28

CBSE 7(18.9% 24(64.9%) 6(16.2%) 37 0.146ns

ICSE 0% 4(80.0%) 1(20.0%) 5

ns= not significant *= p <0.05 , using Fisher exact test **= p<0.01

The calculated fishers exact test value in case these socio demographic variables and level of
of duration disability(p=0.011,p<0.05),number of psychosocial problems. No statistical association
therapy sessions(p=0.039,p<0.05) were less than p found between other socio demographic variables of
value 0.05. So, there is significant association between the subjects to the level of psychosocial problems.
218 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

CONCLUSION Source of Funding : Self

About 75.7% of parents are with moderate Conflict of Interest : Nil

psychosocial problems may be because of learning
REFERENCE
disability in their children. The psychosocial well
being of the parents play a vital role in the prognosis 1. Dyslexia statistics by American Assocition
of the child’s academic level performance. The reason of Dyslexia; 2010. Available from h�p://
for psychosocial problem is lack of knowledge www.dyslexia.com/dyslexia_statistics.
regarding dyslexia and its management. The
2. Abigail M.Parenting Children with dyslexia,2012:
researcher ruled out the need for booklet regarding
Available from. h�p://www.dyslexiaparenting.co
care of children with dyslexia.
m.
Acknowledgement: I owe my profound gratitude 3. Abasiubong F, Obembe A, Anxiety and depression
to Dr. Geethanjali Natarajan Head of the Department in mothers of children with learning disability:
of Child Guidance Clinic, AIMS, Kochi and all the A cross sectional study.2006 Apr;15(2):124-
parents of children with dyslexia a�ending the Child 7.Available fromh�p://www.ncbi.nlm.nih.gov/
Guidance Clinic, AIMS for their co- operation and pubmed/16805166
valuable feedback. 4. Social and Emotional Problems Related to
Dyslexia, fromh�p://www.idonline.org/article.
 DOI Number: 10.5958/0974-9357.2016.00079.9

A Case Report on Childhood Dysthymia-

Low Mood Triggers The End

Jidhun P1, P Chitra2

II Year MSc Nursing, Amrita College of Nursing, Amrita Institute of Medical Sciences, Kochi, Kerala,
1

2
Professor, Department of Child Health Nursing, Amrita College of Nursing, Kochi, Kerala

ABSTRACT

Dysthymia is a chronic form of depression that lasts for at least two years (one year for children), but
often lasts for many years. Although the symptoms that are associated with this type of depression
are fewer and less severe than those that are associated with major depression, they can still seriously
reduce the quality of life for anyone who suffers from it. In some cases it will lead to end of life also.
Over the long term, these symptoms can negatively impact normal functioning as much as major
depression.

Keywords: M D- Mood disorder, REM- Random Eye movement, MDD- Major Depressive Disorder, DD-
Dysthymic disorder, NIMH- National Institute of Mental Health, CBT- Cognitive Behaviour Therapy, IPT-
Inter Personal Therapy, CWD- Coping With Depression, TADS- Treatment for Adolescents with Depression

INTRODUCTION twice as likely as males to experience depression.4

Dysthymia is a type of low-grade depression that ETIOLOGY

lasts for at least two years. Dysthymia is less severe • Research with adults with and without
than major depression, but the chronic symptoms depression has also revealed differences in
often have negative effects on work, relationships, production levels of the hormone cortisol, which is
and family and social interactions. Though dysthymia often associated with stress. This finding has been
may result in an intense, short-term depressive only partially supported in children and adolescents.
episode, the symptoms are more constant and long 3

term. People with dysthymia may even believe their

depressive symptoms are their normal state of being. • Depressed children and adolescents,
however, are similar to depressed adults in that, like
Dysthymia is a MD in which the symptoms are adults, they have an abnormal production of growth
less severe than MDD, but more chronic and persistent hormone.3
1, 2.
The disorder occurs when youth experience a
persistent depressed mood for most of the day, for • Genetics contributes to the child’s
more days than not, for at least one year (compared vulnerability to a M D. School-aged children and
to two years for adults), when symptom-free intervals adolescents having family members who are
last no longer than two consecutive months. depressed are more likely to experience depression
themselves, although this does not appear to be the
Between 1 and 2 percent of people experience case for preschoolers.3
dysthymia (or DD) at some time during their lives.
By the age of 18, it is estimated that between 15 to 20 • Adrenal and thyroid axes have been
percent of all youth experience depression 3. According studied in cases of DD. More patients with DD
to research compiled by the NIMH, during childhood show abnormalities on thyroid axis as compared to
(pre-puberty), both males and females are equally controls, and these abnormalities probably represent
at risk for mood disorders. During adolescence and a trait variable that is associated with chronic illness.5
continuing through adulthood, however, females are
220 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

• Sleep studies show decreased REM latency up all his friends and a�empted for suicide. Following
and increased REM density in the first part of sleep.5 this he was taken to the hospital and was treated with
anti-depressants.
• Psycho dynamic theories posit that the
disorder results from faulty personality and ego Symptoms of dysthymia often overlap with
development, culminating in difficulty in adapting to symptoms of other depressive disorders, but they
adolescence and young adulthood.6 tend to be less intense. Symptoms include

• According to Freud, depression can be • Feelings of hopelessness, sadness, or pessimism

caused by an interpersonal disappointment early in • Excessive sleeping or having difficulty sleeping
life that leads to threatened losses in adult life that
• Extreme fatigue, which causes the person to feel
trigger depression.6
too physically drained to complete even small
• Research on adults has pointed to a link tasks
between depression and serotonin and norepinephrine • Feelings of worthlessness, guilt, or constant self-
neurotransmi�ers, but this research has not been fully criticism
supported in children and adolescents.3
• Inability to concentrate or focus
CASE REPORT • Irritability and frustration

A 14 year old boy predominantly slow to warm • Indecisiveness

temperament presented with complaints of poor • Altered appetite (eating too much or too li�le)
scholastic performance since 9 years, poor social • Risk for suicide.
interaction since 3 years, and having low mood since
2 years. He also has suicidal ideations and had history INTERVENTION
of two a�empts. Parents noticed that he is not having
The NIMH asserts that treating depressive
any concentration in his studies and is not interested
disorders in children and adolescents often involves
to go to school. He was having an irritable mood
short-term psychotherapy and/or medication and
and had episodes of aggression. The client was not
targeted interventions addressing the home or school
interested to do any activities and is complaining of
environment.4
fatigue.
The evidence-based psychological treatments for
Past history reveals that he was not able to
depressive disorders are CBT and IPT. In their review
concentrate in his studies. The client said that others
of treatments for youth with depression, David-
used to make fun of him as he did not have the big
Ferdon and Kaslow reported that standardized
body size of other boys in his class.
treatments which adhered to a treatment manual
Teachers used to punish him frequently as he and were standardized led to greater gains than
got poor marks in the exams. Then he was shifted to treatments that were not standardized. The research
hostel as his parents had moved to different place for also has indicated that treatment gains were realized,
job and was found to have crying spells frequently in regardless where the treatment was provided (school,
order to bring him home. The warden was too strict community clinics, primary care clinics, hospitals, or
in the hostel and used to punish him for not doing research se�ings). It should be noted that the youth
work properly. Gradually he was found to have reported greater treatment gains than did their
minimal interaction with others and was alone in parents and clinicians.7
his own world. When coming home he had frequent
arguments with sister and mother. After few months
on refusing to bring him home on weekend he called
 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2 221

Psychosocial Interventions for Adolescents with Depression

What Works Description

Cognitive Behaviour Therapy (CBT) provided in a group CBT for depression focuses on identifying thought
se�ing and behavioural pa�erns that lead to or maintain the
problematic symptoms.
(negative thoughts, feelings of helplessness, hopelessness,
suicidal ideations )

Interpersonal Therapy (IPT) provided individually In IPT, the therapist and patient address the adolescent’s
interpersonal communication skills, interpersonal
conflicts, and family relationship problems.
(family problems, expressed emotions in family )

What Seems to Work Description

CBT in a group or individual se�ing with a parent/family CBT for depression focuses on identifying thought
component and behavioural pa�erns that lead to or maintain the
problematic symptoms.

Adolescent Coping with Depression CWD-A includes practicing relaxation and addressing
(CWD-A) maladaptive pa�erns in thinking, as well as scheduling
pleasant activities, and learning communication and
conflict resolution skills.
(activity schedule which includes entertainment, play
activities, diversion techniques )

Interpersonal Psychotherapy for Depressed Adolescents IPT-A addresses the adolescent’s specific interpersonal
(IPT-A) relationships and conflicts, and helps the adolescent be
more effective in their relationships with others.
(relationship with peers, family members, and his
surroundings)

Source: David-Ferdon & Kaslow, 2008. effective in reducing depressive symptoms and both
were be�er than the placebo. This study further
PHARMACOLOGICAL TREATMENTS indicated that the use of tricyclic antidepressants for
Currently, only one pharmacological treatment the treatment of youth with MDD is not supported
for depression has been approved for use with (TADS).8
youth by the Food and Drug Administration. This CONCLUSION
medication, fluoxetine (a selective serotonin reuptake
inhibitor [SSRI]), has been approved by the FDA for Dysthymia is not just the typical feelings of
treating children eight years of age or older2. sadness or withdrawal from other people; instead it
is more pervasive and sensitive in nature. If untreated
A large, multisite study with important it may lead to a state of major depression and even
implications, TADS examined the effectiveness of ends up in suicide. But in most cases it remains
fluoxetine alone, CBT alone, a combined treatment unnoticed. So it is necessary to identify dysthymia in
of fluoxetine and CBT, and a placebo. Study results its earlier stage and there by the future problems can
indicated that a combined SSRI and CBT treatment be prevented.
approach is superior to SSRI or CBT treatment
alone and be�er than the placebo. Additionally, the
SSRI treatment and the CBT treatment were equally
222 International Journal of Nursing Education, April-June 2016, Vol.8, No. 2

Ethical Clearance: Taken psychopathology (pp. 477-509). Hoboken, NJ:

Source of Funding: Self John Wiley & Sons, Inc.

Conflict of Interest: Nil 4. National Institute of Mental Health (NIMH).

(2000). Depression in children and adolescents.
Acknowledgement: Nil
NIH Publication No. 00-4744.
REFERENCES 5. Howland R H, Thase M E. Biological studies of
dysthymia. Biol Psychiatry 1991;30: 283-304
1. American Academy of Child & Adolescent
Psychiatry. (AACAP). (1998). Practice parameters 6. J.N Vyas, Niraj Ahuja. Text book of post graduate
for the assessment and treatment of children and Psychiatry, Vol 1, Dysthymic and cyclothymic
adolescents with depressive disorders. Journal of disorder, 2003: 210-11
the American Academy of Child and Adolescent 7. David-Ferdon, C., & Kaslow, N. (2008). Evidence-
Psychiatry, 37 based psychosocial treatments for child and
2. American Psychiatric Association (APA), & the adolescent depression. Journal of Clinical Child
American Academy of Child and Adolescent and Adolescent Psychology, 37, 62-104.
Psychiatry (AACAP). (n.d.). The use of 8. Treatment for Adolescents with Depression
medication in treating childhood and adolescent Study (TADS) Team. (2004). Fluoxetine,
depression: Information for physicians. [Online]. cognitive-behavioral therapy and their
Available: h�p://www.physiciansmedguide.or combination for adolescents with depression:
g/parentsmedguide.html. [January 2011]. Not treatment for adolescents with depression study
available May 13. (TADS) randomized controlled trial. Journal of
3. Klein, D., Torpey, D., & Bufferd, S. (2008). the American Medical Association, 292, 807-820.
Depressive disorders. Child and adolescent
 Call for Papers/ Article Submission

Article submission fee

• Please note that we charge manuscript handling charges for all publications.Charges can
be enquired by sending mail.
• In cases of urgent publication required by author, he /she should write to editor for
discretion.
• Fast tracking charges are applicable in urgent publication
• Please note that we charge only after article has been accepted for publication, not at the
time of submission.
• Authors have right to withdraw article if they do not wish to pay the charges.

Article Submission Guidelines

Please submit paper in following format as far as applicable

1. Title
2. Names of authors
3. Your Affiliation (designations with college address)
4. Corresponding author- name, designations, address, E-mail id
5. Abstract with key words
6. Introduction or back ground
7. Material and Methods
8. Findings
9. Discussion / Conclusion
10. Acknowledgement
11. Conflict of Interest
12. Source of Support
13. References in Vancouver style.
14. Word limit 2500-3000 words, MSWORD Format, single file
15. Please quote references in text by superscripting.

Our Contact Info

Prof (Dr) R K Sharma
International Journal of Nursing Education
Institute of Medico-Legal Publications
4th Floor, Statesman House Building,
Barakhamba Road, Connaught Place, New Delhi-110001
Mob: 09971888542, Fax no.: +91 11 3044 6500
E-mail: [email protected], Website: www.ijone.org