INTRODUCTION:-rguhs.ac.in/cdc/onlinecdc/uploads/05_N006_5929.doc · Web viewChallenges may...
Transcript of INTRODUCTION:-rguhs.ac.in/cdc/onlinecdc/uploads/05_N006_5929.doc · Web viewChallenges may...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME REGARDING RISK FACTORS AND HOME
CARE MANAGEMENT OF CHRONIC BRONCHITIS AMONG ADULTS IN
SELECTED HOSPITALS AT KOLAR DISTRICT.
PROFORMA FOR REGISTRATIOIN OF SUBJECT OF DISSERTATION.
M/S S.SUDHA DEVI AE & C.S. PAVAN COLLEGE OF NURSING KOLAR.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,
KARNATAKA.
PROFORMA FOR REGISTRATIOIN OF SUBJECT OF DISSERATATION.
1 NAME OF THE
CANDIDATE AND
ADDRESS
S. SUDHA DEVI
AE & C.S. PAVAN COLLEGE OF
NURSING KOLAR.
2 NAME OF THE
INSTITUTIOIN
AE & C.S. PAVAN COLLEGE OF
NURSING KOLAR.
3 COURSE OF STUDY AND
SUBJECT
MSC NURSING MEDICAL AND
SURGICAL NURSING
4 DATE OF ADMISSION
TO THE COURSE
16/08/2008
5 TITLE OF THE TOPIC A STUDY TO ASSESS THE
EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME
REGARDING RISK FACTORS AND
HOME CARE MANAGEMENT OF
CHRONIC BRONCHITIS AMONG
ADULTS IN SELECTED HOSPITALS
AT KOLAR DISTRICT.
INTRODUCTION
THE END OF PHYSICS ONE BODY’S HEALTH
(Dr. Faustus)
This statement tells that though the medicine can secure only our body’s
health good, a healthy body is essential to attain mental health or spiritual health.1
Healthy body needs good breath everyone wants to breath the air for leaving.2
Young and middle adulthood is a period of challenges rewards and crises.
Challenges may include the demands of working and raising families although
adults can also be rewards by successes in their career endeavors and in their
personal lives. Young adulthood is the period between the late teens and the
middle to late 30s young adults constitute approximately 27% of the population.
Young adult are active and must adopt to new experiences and newly acquired
independence. Faced with a societal structure that differs greatly from the norms of
20 (or) 30 years ago many men are challenged with determining what it means to
be a man and how to feel good about it is today’s society. Young adults are usually
quite active, experience severe illnesses less commonly than older age – groups,
tend to ignore physical symptoms and often postpone seeking health care. Physical
characteristics of young adults begin to change as middle age approaches. Unless
clients have illness, assessment findings are generally within normal limits. A
personal lifestyle assessment can help nurses and clients identify habits that
increase the risk for chronic disease. Personal lifestyle of young adults include
habits of smoking and occupational etc, and type of work, exposure to hazardous
substances and physical (or) mental status.3
Human being needs constant supply of oxygen to support metabolism.
Bronchial tree is a important role in respiratory system. The respiratory process
begins oxygen through the airway of the lungs into the Bronchial tree which ends
with alveoli where to the tissue. This process is so vital that difficultly in
experienced as a threat to life itself. People with respiratory disorders are often
very anxious threat full that they die.2
Chronic bronchitis is a important public health problem among chronic
respiratory disease in world wide. Inflammation of the Bronchi cause increased
mucus production. Chronic cough in contrast to those of acute Bronchitis the
clinical manifestation of chronic Bronchitis continue for atleast 3 months of the
year for 2 consecutive years in patient. It is characterized physiologically by
hypertrophy and hyper secretion of the Bronchial mucus glands and structured
alterations of the Bronchi and Bronchioles and impaired ciliary function which
induces mucous clearance which is response to prolonged (or) frequently recurring
irritation. The common irritants are tobacco smoke, infection, industrial fumes, and
smoke.4
Adult respiratory disease, particularly chronic respiratory disease, constitute
a major burden in terms of morbidity and mortality in the developing world. They
contribute to work – limiting health problems, lost work days, and premature death
resulting from delayed diagnosis and treatment. The burden of acute and chronic
adult respiratory diseases has been rising throughout the world, it caused by
environmental exposure to tobacco smoke or unwanted coal – fired cook stoves. In
the developing world, preventive and therapeutic strategies may have greater
societal effect than managing the diseases after they arise.5
As estimated 10.7 million adults in the United States over age 18 have
chronic respiratory disease. Person with chronic respiratory disease one greatly
underestimated because the disease is usually not diagnosed until it is moderately
advanced. The number of women with chronic respiratory disease is on the rise
because of the increased number of women smoking cigarettes. It is the 4 th leading
cause of death in the United State. Since 2000 more women than men have died
from chronic respiratory disease. Chronic respiratory disease is the only lung
disease in which whites have more deaths than African Americans. Death rates
related to chronic respiratory disease for Hispanics are significantly lower than
other ethnic groups. More than one half of chronic respiratory disease patients die
within 10 years of diagnosis. However it has been a marked increased in cigarette
smoking in developing countries which will increased chronic respiratory disease
mortality rates world wide.6
NEED FOR STUDY
The need for study arises from the fact chronic bronchitis is an important
chronic respiratory problem worldwide world is presently facing the problem of air
pollution. Chronic respiratory disease are on the increase at alarming rate.7
A wide spread disorder, chronic respiratory disease affects more than 16
million American. It now accounts for 4% of all deaths in the United State making
it the fourth leading cause of death. Caring for clients with chronic respiratory
disease has been estimated at $14.5 billion annually in direct care costs alone,
however the burden of chronic respiratory disease is even greater from a global
perspective, where it is currently the sixth leading cause of death and the 12th
leading cause of morbidity world wide.8
In the United States, in 2002, an estimated 24 million adults had chronic
respiratory disease (127). A chronic respiratory disease prevalence model was used
to estimate the prevalence of chronic respiratory disease in 12 Asian countries of
this region, as projected by the model, is 56.6 million with an overall prevalence
rate of 6.3%. The chronic respiratory disease prevalence rates for the individual
countries range from 3.5% (China, Hong Kong Special Administrative Region, and
Singpore) to 6.7% (viet Nam)8.
In China, chronic respiratory diseases are the second leading cause of death
(32). It is estimated that over 50% of Chinese men smoke, whereas smoking rates
among women are lower in this country (159). The prevalence of chronic
respiratory disease in men and women in China is not very different (106), which
points to the importance of risk factors other than smoking in causing chronic
respiratory disease in Chinese women. A recent study sounds a prevalence of
physician-diagnosed chronic respiratory disease of 5.9% in the adult population8.
In India, study collecting data without spirometry assessment suggested that
12 million people were affected by chronic respiratory disease (161). Recent
studies form the same authors (162, 163) show a prevalence of respiratory
symptoms in 6%-7% of non-smokers and up to 14% of smokers and up to 14% of
smokers. In a recent study southern India, the prevalence rate of chronic
respiratory disease in adult was around 7%.The burden of chronic respiratory
disease study is currently being carried out in different parts of the world including
low and middle income countries (164). This very important study compares the
prevalence and burden of chronic respiratory disease across the world using the
same protocol, including the chronic respiratory diseases questionnaire and
spirometry. Some results are already available and show.8
Chronic respiratory disease is one of the leading causes of morbidity and
mortality in the industrialized and the developing countries. According to
prediction of WORLD HEALTH ORGANIZATION chronic respiratory disease
will become the third leading cause of mortality and the fifth cause of disability in
2020 worldwide. So that prevalence and mortality data may be inclusive of chronic
bronchitis chronic respiratory disease is determined by the action of a number of
various risk factors among which the most important is cigarette smoking.
However during the last few decades evidence from epidemiological studies.
Finding consistent association between air pollution and various outcomes
(respiratory symptoms) reduced lung function.9
The decrease in cigarette smoking in the United States should lead to a
decrease in chronic respiratory disease mortality rates in the future. Mortality has
suggested the outdoor air pollution is a contributing cause of morbidity and
mortality. It is prescribed in article 2006. It was concluded that epidemiological
studies suggest that air pollution plays a remarkable role in the exacerbation and in
the pathogenesis of chronic respiratory disease.10
A study was conducted in sapaldia on exposure to environmental tobacco
smoke is associated with increased reports of respiratory symptoms and reduced
lung function notably in healthy individual with Bronchial hyper responsiveness.
1661 never smokers from the sapaldia taken as sample results reveals that exposure
to tobacco smoke reported in the two surveys was strongly associated with the
development of cough odds ratio, 2.1;95% confidence interval 1.2 – 3.7; P=0.01).
in subjects with BHR exposed to tobacco smoke at both surveys, a trend for strong
association were observed for wheeze, cough, dyspnea, and chronic Bronchitis,
however the association reached statistical significance only for the symptoms of
dyspnea (P<0.01) lower FEV/FVC (mean + /- SD, 72.9+/-7.7VS. 76.8+/- 6.1%
P<0.01) and FEF (25.75) forced expiratory flow, midexpiratory phase / FVC
(mean +/- SD, 56.1+/- 22.5VS, 68.1+/- 21.6% P<0.01) were observed in subjects
with Bronchial hyper responsiveness exposed to tobacco smoke composed with
non exposed subjects without Bronchial hyper responsiveness, lower values were
found in subjects continuing exposure by the follow – up survey. Author concluded
that the exposure to tobacco smoke was strongly associated with the development
of respiratory symptoms in previously as symptomatic subjects with Bronchial
hyper responsiveness within 11 years. Further more, subjects with underlying
Bronchial hyper responsiveness had reduced lung function at follow – up, thus
suggesting a higher risk for the development of chronic respiratory disease in this
subject of the population.11
A study was conducted on the prevalence of respiratory morbidity and its
associated factors in urban Delhi results reveals that a total of 3465 individuals
were interviewed of which 1756 (50.68%) were males and 1709 (49.3%) were
females only 9.05% of the men smoked. The overall prevalence of chronic cough,
chronic phlegm and dyspnea was 2.0%, 1.2% and 3.4% respectively. The
prevalence of wheezing was 3.2%. All the symptoms increased the age (P<0.05).
No significant difference was observed in these symptoms between males and
females less educated and retired individuals were more likely to have respiratory
symptoms. The prevalence of chronic cough, phlegm dyspnea and wheezing was
5.8%, 2.9%, 9.9% and 8.7% respectively among smokers, which was significantly
higher than that observed in non smoker logistic regression analysis revealed that
age and smoking remained significant factors for occurrence of the respiratory
symptoms.12
A Random study was undertaken in USA to examine the association
between exposure to air pollution from domestic biomass fuel combustion and
chronic bronchitis in two rural Bolivian highland villages. Questionnaire method
was used on individual > 20 years of age in both villages (n=241) samples taken
results reveals that daily pollution exposure was significantly higher in the indoor
cooking village range for adults 98<10-15 120 mg/3h/m than in the outdoor
cooking village range for adults 5520-6240 u-h/m3 for both season and for men
and women. The overall prevalence of chronic bronchitis was 22% and 13% for
the indoor and outdoor. Cooking villages, respectively, logistic regression analysis
which excluded the few smokers present in the population showed a 60% reduced
risk of chronic Bronchitis in the outdoor cooking village compared with the indoor
cooking village or 0.4; 95% CI 0.2 to 0.8 p=0.0102 after adjusting for age sex,
individuals aged > 40years were 4.3 times more likely to have chronic benchitis
than the younger age group. OR=4.3, 95% (CI 12.0 to 9.3 P-0.0002) there was no
significant of difference in the prevalence chronic bronchitis in men and women
the author concluded that the result of their study suggest an association between
chronic Bronchitis and exposure to domestic biomas fuel combustion.13
A study was conducted in USA among farmers who use pesticide for
agriculture have increased risk factors for chronic Bronchitis we evaluate pesticide
as risk factor for chronic bronchitis using the agriculture health study enrocement
data on lifetime pesticide use and history of doctor diagnosed chronic bronchitis
from 20,908 private pesticide applications, primarily farmers. The results reveals
that a total of 654 farmers (3%) reported chronic bronchitis diagnosed after age of
19 years. After adjustment for correlated pesticides as well as confounders. 11
pesticides were significantly associated with chronic bronchitis research
concluded. These results provide preliminary evidence that pesticide use may
increase chronic prevalence14.
Many study shows that chronic bronchitis is one of the leading cause of the
mortality and mortality and some of these can be prevented by giving home care
education regarding risk factors and preventive aspects and the personal experience
in respiratory ward it was found that most of the adults suffering for chronic
bronchitis. Thus the investigator would like to explore on the effect of structured
teaching program on knowledge and practice regarding risk factors and home care
management of chronic bronchitis among the adults. The respiratory nurse place a
vital role in educating the patients in preventing risk factors and home care
management of the chronic Bronchitis and providing comprehensive care and
adopting preventive measures.
REVIEW OF LITERATURE
According to Polit and Back, comprehensive, in-depth, systematic and
critical review of scollery publications unpublished materials and personal
communication is called review of literature.
An extensive search of literature was done by the investigator of factual
information about prevention of risk factors and home care management of client
the chronic bronchitis patients. The related literature is organized and presented
under the following heading.
1) Literature related to risk factors of chronic bronchitis.
a) Smoking
b) Infection
c) Air pollution
d) Chemical hazards
e) Occupation environment
f) Socio-economic
g) Genetics
2) Literature related to adults respiratory disease
3) Literature related to home care management of chronic bronchitis.
4) Literature related to patients education on respiratory diseases
1) Literature related to risk factors of chronic bronchitis.
a) Smoking
This study was conducted in demark to investigate the interaction of
smoking and history of long term occupational exposure to organic solvents on the
prevalence of chronic bronchitis among middle aged elderly men. Structured
questionnaire was used among 3208 men aged 63+/10years were taken as sample
results indicates that 46% men had chronic bronchitis 14.4% had current smoking
habit and the interaction of smoking and long term occupational exposure to
organic solvents (>5years) were the factors most strongly associated with
prevalence of chronic bronchitis. In the solvent exposed group odds ratio for
chronic bronchitis was 7 comparing current smokers with nonsmokers against
potential contenders. The author concluded that current (or) previous occupational
exposure to organic solvents doubles the smoking related risk of chronic
bronchitis15.
Prospective analytic study was conducted in Chandigarh on serum surfactant
protein a levels in chronic bronchitis and its relation to smoking 30 patients with
clinical diagnoses of chronic bronchitis taken as sample results indicates that out of
30 patients in that 21were smokers and 9 were non smokers. The serum protein
level in smokers with chronic bronchitis is significially higher than the non
smokers researcher concluded that the increase in serum protein level in smokers
with chronic bronchitis suggests that tobacco smoking causes a chronic increase in
permeability of the lung parenchyma.16
Protection of the lung is basic for the preservation of lung function patient
with chronic respiratory disease should be informed unequivocally that for them
smoking is dangerous. Cigarette smoking G presses the activity of scavenger cells
and affects the cilia cleansing mechanism of the respiratory tract, the function of
which is to keep the breathing passages free of inhaled irritants bacteria and other
foreign matter. This is one of the major mechanisms of the body when the
cleansing mechanism is damaged by smoking air flow is obstructed and air
becomes trapped behind the obstructed air way. The air sacs greatly distend and
the lung capacity is diminished cigarette smoking also irritates goblet cells and the
mucus. The mucus accumulation of mucus. The mucus accumulation produces
more irritation, infection and damage to the lung capacity frequently the patient is
unaware of what is happening until he notices that extra physical effort produces
respiratory distress. At this point the damage may be irreversible. There fore
patients with chronic respiratory disease should definitely refrain from smoking.
There is a wide variety of smoking control strategies including prevention,
cessation and behavior modification.17
b) Infection
A study was conducted in New Zealand among adults on impaired lung
function is associated with systemic inflammation and is a risk factors for
cardiovascular disease in older adults cohort method used 1000 New Zealand at
age 26 and 32 years taken as sample results reveals that there were significant
inverse association between FEV (1) and CRP at both ages were found for the
forced vital capacity the association were similar in men and women were
independent of smoking and body mass index.18
c) Air Pollution
A multicenter study was conducted to investigate the association between
the prevalence and new onset of chronic Bronchitis and urban air pollution in
Spain random method was used and selected 3232 males and 3592 female average
response rate 65.3% as sample. Hierarchical models were used results reveals that
the prevalence and new onset of chronic phelgm during follow up were 6.9 % and
4.5%respectively 5.3% in males and 3.5%in females author concluded that
individual markers of traffic at household level such as sported intensity and
outdoor nitrous oxide were risk factors for chronic Bronchitis among females.19
d) Chemical hazards
A study was conducted on association between chronic exposure to volcanic
environmental and chronic bronchitis incidence in Portugal sample taken as two
population one exposed to active manifestation of volcanism (fuenas) and another
term an area where no volcanic activity took place for over three million years data
collection method used on the incidence of chronic bronchitis among both popular
on is volcanism grow another non volcanism group (1991-2001). Incidence rates
were extremely higher in the volcanically active area for both sexes and especially
in the youngest group risk of chronic bronchitis is higher in volcanically active
area that in volcanically in active area.20
Chronic bronchitis is due to the inhalative noxae (in most cases decades of
cigarette smoking ) management of chronic bronchitis consists primary in the
elimination of the noxae acute infection said by author German Jan driven
exacerbation of chronic bronchitis The article in Russian have been described they
have taken 36 patients as sample and measured VC,FVC,FEV,FEV1/VC/PEP
MEF-25 MEF-50 MEF-75 , TCL, TGV, RV ROW REX DLCO-SS Pao2, paco2
were determined in 36 patients with severe chronic lung disease all the patients
were found to have impaired Brachial patency and changes in lung volume and
capacities. Author concluded that reduced lung function is associated with
systemic inflammation in young adults . This association is not related to smoking,
asthma(or) obesity. The reason for the association are inexperienced , but the
findings indicates that the development of inflammation predates the development
of either chronic lung disease (or) clinically significant arthrosclerosis. The
association between poor lung function and cardiovascular disease may be
medicated by an inflammatory mechanism.21
e) Occupational environment
Article in Russia has been described about approaches to lower occurrence
of chronic bronchitis in railway workers subjected to occupational risk of
respiratory disorders. Analysis of peculiarities in morbidity and social importance
of chronic bronchitis as a leading Nasologic entity among railway workers whose
work is associated with constant exposure to risk factors of respiratory disease the
author compare clinical efficiency of various schemes concerning treatment of
chronic bronchitis and the relapses prevention.22
Respiratory consequences from occupational environmental disaster are the
result of inhalation exposure to chemicals, particulate matter (dusted fibers) the
incomplete products of combustion that are often liberated during disasters such as
fires building collapses, explosions and volcanoes the English literature was review
using key word disaster with bronchitis. Respiratory health consequences after
aerolized exposures to high concentrations of particulates and chemicals can be
grouped in to 4 major categories in that lower respiratory disease the review
describes several respiratory consequences of occupational environmental disaster
uses the world trade center disaster to illustrate in detail the consequence of
chronic respiratory infections.23
f) Socio-economic
A larged community based study conducted in Spain on socioeconomic
status and chronic bronchitis. Data method used and 9,023 people from European
community respiratory health survey taken as sample results bronchitis risk was
associated with low educational level 95% incident bronchitis also increased with
low educational level.24
A study was conducted in Delhi on the cause of death in a low
socioeconomic area over 11years to help identity changes in the pattern of disease
verbal autopsy questionnaire used and reported about death occurred from 1994 to
2004 by trained health workers considered as sample results reveals that a total of
515 deaths occurred during the period 340 in men (66%) and 175 in women (34%)
due to 6 common cause of death in that chronic obstructive respiratory disease
(11.6%) cause specific mortality rate due to communicable disease showed a
decline while that due to non communicable disease in a low.25
g) Genetics
Twin study was conducted in Sweden on interaction between smoking,
genetic factors in the development of chronic bronchitis selected sample 44,919
twins older than 40 years who disease cause smoking habits identified taken from
the Swdish twin registry self reported method followed univeriable. Bivariate
structural equation models were used results revels than the heritability estimate
for chronic bronchitis was a moderate 40% and only 14% of the genetic influences
were shared with smoking researcher conclude that the genetic factors independent
of those related to smoking habits play a role in the development of chronic
bronchitis26.
2) Literature related to adults respiratory disease
Chronic bronchitis is one of the cause for morbidity and morbidity cohort
study was conducted on association between early life history of respiratory
disease and morbidity and mortality in adulthood who attended Glasgow
university between 1948 and 1968 and reported that among 9544 students 1553
death due to respiratory disease results reveals that a medical history of a
respiratory disease in early life was associated with a 57% greater risk of overall
respiratory disease mortality in adulthood. In addition students reporting a history
of bronchitis had a 38% higher risk of cardiovascular disease mortality 95%
research concluded that an early life history of respiratory disease is associated
with higher mortality and morbidity risk in adulthood the association being seen
particularly for respiratory related and cardiovascular deaths among those with a
history of bronchitis. All early life respiratory disease appeared to be negatively
associated with later adult respiratory health.27
3) Literature related to home care management of chronic bronchitis.
Exacerbations of chronic obstructive respiratory disease are a major cause of
hospital admission but don’t require intensive investigation (or) complex therapy.
We investigated the suitability of home care for severe uncomplicated
exacerbations. After formal assessment in a hospital respiratory unit many pts with
exacerbation of chronic respiratory disease can be treated at home by respiratory
nurses. Treatment of exacervations respiratory disease by of chronic respiratory
assessment service in UK over 3.5 years we assessed 962 patients with
exacerbations of chronic obstructive respiratory disease after referral to a hospital
respiratory department by had family physicians. All patients had chest
radiography oxygen- situation arterial gas analysis was through to be essential pts
were allowed home with a customized treatment package. Each patients was
visited daily by a respiratory nurse who monitored progress and treatment
compliance and provided education and reassurance. Findings are 145(15%) of
962 required admission at initial referral and 155(12%) were admitted rates. 653
(68%) pts were manages entirely at home and 49 (5%) were referred
inappropriately one pts died at home. All patients had severe disease with a mean
forced expiratory volume is 1s of 1-02 L and 395 (41%) had required hospital
admission in the patients of a year. This review found no evidence of significant
differences between hospital at home patients and hospital inpatients for
readmission rates and mortality at two to 3 months after the initial exacerbation.
Both the patients and careers preferred hospital at home schemes to inpatient
care.28
Hospital at home schemes are a recently adopted method of service delivery
for the mgt of acute exacerbations of chronic respiratory disease aimed at reducing
demand for acute hospital in pts beds and promoting a patients centered approach
through admission avoidance. However evidence in approach of such a service is
contradictory. To evaluate the efficiency of hospital at home compared to hospital
inpatients care in acute executions of chronic respiratory disease. The most recent
researchers were carried out in August 2003 only Randomised controlled trails
were considered where patients presented to the emergency department with an
exacerbation of their chronic respiratory disease studies much not have recruited
patients that are usually deemed obligatory admission results indicates seven
studies with 754 patients were included in the review studies provided data on
hospital readmission and motality both of which were not significantly different
when the two study groups were compared.29
Chronic respiratory disease is a leading cause of hospitalization in Danish
adults and admission rates are expected to increase in the future. A study was
conducted on associated homecare with disease monitoring and treatment by a
respiratory and treatment by a respiratory nurse may reduce time Span at hospital
and the economic burdens of chronic respiratory disease in order to evaluate
various types of assisted home care , the selection of patients, feasibility , effect,
safety and cost effectiveness the literature was received most information is
available on assisted home care following a hospital based assessment and led by a
respiratory. Nurse according to the literature assisted homecare is a well tolerated,
safe and economic alternative to hospital admission for about 25-30% of patients
referred to hospital.30
A study was conducted on Hospital at home for chronic obstructive
reparatory disease an integrated hospital and community based generic
intermediate care service foe prevention and early discharge 2006 recent
randomized controlled studies have reported success for Hospital at home for
prevention and early discharge of chronic obstructive respiratory disease using
hospital based respiratory nurse specialist . This observational study reports results
using an integrated Hospital and community based generic intermediate care
readmission with in 60 days and death with in 60 days in the early discharge 9.37
days,21.1%, 7%) and the prevention of admission (5 to 6 days 34.1% 3.8%)are
similar to previous studies we suggest that this generic community model of
service may allow hospital at home services for COPD to be introduced in more
areas.
A study was conducted on Hospitals a home for patients with acute
exacerbations of chronic obstructive respiratory diseases systemic review of
evidence to evaluate the efficiency of hospital at home schemes composed with in
patient care in pts with acute exacerbation of chronic obstructive respiratory
disease. A systematic section of randomized controlled trails. Main outcome
measures were mortality and readmission to hospital. Results reveal that seven
trails with 754 patients were included in the review. Hospital readmission and
mortality were not significant different when hospitals at home schemes were
compared with inpatient care (relative risk 0.89, 95% confidence interval 0.72 to
1.12 and 0.61, 0.36 to 1.05, respectively however compared with inpatient care ,
hospital at home schemes were associated with substantial cost savings as well as
freeing up hospital in patients beds the researchers concluded hospitals at home
schemes can be safety used to care for patients with acute exacerbations
obstructive chronic respiratory disease who would otherwise be admitted to
hospital.
4) Literature related to patients education on respiratory diseases
Although various interventions are indicated for each of these disease
categories, they can be costly and of limited efficacy in lowering premature
mortality. Patient education and home health care to help the patient with chronic
respiratory disease live better. It is essential that he be educated about his disease
process. One of the major teaching factors is helping the patient accept realistic
show term and long range goals. If the patient is severely disabled the objective of
treatment is preserve his present pulmonary function and leave the symptoms as
much as possible if disease is mild the objective is to increase his exercise
tolerance and prevent further loss of pulmonary function. The goals and
expectation of treatment must be shared and planed with the patient the patient and
those carrying for him need patience to achieve these goals. The patient is
instructed to avoid extremes of heat and cold heat increases the body temperature
there by raising the oxygen requirements of the body cold tends to promote
bronchospasm. High attitudes aggravate the hypoxia bronchospasm may be
initiated also by air pollutants such as fumes, smoke, dust and even talcum, lint and
aerosol sprays.31
Patient with chronic respiratory disease should restrict themselves to live of
moderate activity, ideally in a climate with minimal shifts in temperature and
humidity. Stressful situations that might trigger a coughing episode or emotional
disturbances should be avoid. Patients may be directed to community resources
such as pulmonary rehabilitation programs smoking cessation program and other
programs to help improve the ability to cope with their chronic condition and their
therapeutic regimen and to give them a sense of worth hope and well being.31
STATEMENT OF THE PROBLEM: - A study to assess the effectiveness of
structured teaching programme regarding risk factors and Home care management
of chronic bronchitis among adults in selected hospitals at Kolar Dist.
OBJECTIVES OF THE STUDY: -
1) To assess the existing knowledge regarding risk factors and Home care
management of Chronic Bronchitis among Adults.
2) To determine out the effectiveness of Structured teaching programme regarding
Risk factors and Home care management of Chronic Bronchitis among adults.
3) To find the association between post test Knowledge level with their selected
demographic variables
OPERATIONAL DEFINITIONS:-
ASSESS: - It refers to the evaluation of the level of knowledge regarding risk
factors and Home care management of Chronic Bronchitis among Adults.
EFFECTIVENESS:- It refers to evaluate the result of planned teaching
programme by post test scores.
STRUCTURED TEACHING PROGRAMME
It refers to a system of planned instruction given to impart information in order to
bring a knowledge regarding risk factors and home care management of chronic
bronchitis
RISK FACTORS
It refers to pre-disposing factors like cigarette smoking, pipe-cigar and intense
exposure to occupational dusts, chemicals, indoor and out door air pollution and
allergents.
ADULTS
It refers to those who are in age group of 20-45 years
HOME CARE
It refers to the self care practices which the patient with chronic bronchitis
follows at home with regards to continuing medication and breathing exercise and
avoiding risk factors like smoking, making alteration in nutrition use of inhalers,
maintaining good environment, regular follow up in order to prevent recurrence of
severe breathing difficulties and promote well being and quality of life.
CHRONIC BRONCHITIS
It is the chronic inflammation of the bronchus.
HYPOTHESIS
There is no significant difference between pre and post test knowledge
scores of adults with chronic bronchitis regarding risk factors and home care
management of chronic bronchitis.
VARIABLES:
INDEPENDENT VARIABLE: - Structured Teaching Progarmme regarding risk
factors and home care management of chronic bronchitis.
DEPENDENT VARIABLE: - knowledge of adults regarding risk factors and
home care management of chronic bronchitis.
Attributed Variables :- Age, education, sex , marital status, economic status,
occupation, smoking habits, family history of allergy.
Source of Data:-Adults who are suffering with chronic bronchitis in selected
hospitals at Kolar.
Research Design:-Quasi experimental design (One group pre test and post test
design)
Research approach:-Evaluative approach.
Setting of the study:-It will be conducted in SNR Hospital at Kolar. Which is
500 bedded Hospital, and located 2 kms away from the Pavan College and
Devaraj Hospital, which is 700 bedded Hospital and located 5 km away from the
Pavan college.
Sampling technique:- Simple random sampling technique will be used to select
the sample.
Sample size: 60
Population:-Adults who are admitted with chronic bronchitis in the age group of
20 to 45 years.
Sample:-Male and female patients with chronic bronchitis between the age group
of 20 to 45 years in selected hospitals Kolar (SNR and Devaraj Hospitals).
SAMPLING CRITERIA:-
Inclusion Criteria:-
1) Adults between age group of 20 to 45 years of age and admitted with chronic
bronchitis.
2) Patient who are willing to participate.
3) Patient who can communicate in Kannada.
Exclusion criteria:-
1) Patient who are below 20 years and above 45years of age.
2) Critically ill patients.
3) Patient who are not willing to participate.
4) Patient who cannot communicate in Kannada.
Tool for data collection Structured interview schedule will be used to collect the
data from the adults.
Tool consists of two sections:- Section A & B
Section A:- Consists of Questions regarding sociodemographic data of subjects
(Age, Sex, Education, Occupation, Smoking habits, Family history of Allergy)
Section B:- Consists of two parts.
Part 1:-Questions regarding risk factors of chronic bronchitis.
Part 2:-Questions regarding home care management of chronic bronchitis.
METHOD OF DATA COLLECTION
Structured interview schedule will be used for data collection.
Data Analysis interpretation:
Descriptive and inferential statistics such as frequency, percentage, standard
deviation mean paired‘t’ test and chi square test will be used for data analysis and
it will be interpreted in the form of tables, graphs, diagrams.
Does the study require any investigation or intervention to be conducted on
patients or other human or animals?
Yes, The study will be conducted among the adults between the age group of
20 to 45 years in the selected hospitals in Kolar. Since it is a Structured Teaching
Programme.
Has ethical clearance been obtained from concerned authorities?
Yes, Prior permission will be obtained from the concerned authorities of
selected hospitals at Kolar, and research committee of AE & CS PAVAN
COLLEGE OF NURSING, KOLAR. The purpose of study will be explained to the
adults.
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