RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE , KARNATAKA
ANNEXURE – I I
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
|1 |Name of candidate and Address |MR. JUSTIN V SEBASTIAN |
| |( In block letters ) |I YEAR MSc. NURSING |
| | |SHREE DEVI COLLEGE OF NURSING |
| | |MAINA TOWER , BALLALBAGH |
| | |MANGALORE - 575003 |
|2 |Name of the Institution |SHREE DEVI COLLEGE OF NURSING |
| | |MAINA TOWER , BALLALBAGH |
| | |MANGALORE - 575003 |
|3 |Course of Study and Subject |MSc NURSING |
| | |(MEDICAL SURGICAL NURSING ) |
|4 |Date of Admission to the Course |5-2-2012 |
|5 |Title of the Topic |
| |“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING LIFE STYLE MODIFICATIONS OF PATIENTS WITH HEART |
| |FAILURE AMONG STAFF NURSES WORKING IN SELECTED HOSPITAL, MANGALORE.” |
|6. |BRIEF RESUME OF THE INTENDED WORK |
| |6.1 INTRODUCTION |
| |BACKGROUND OF THE STUDY |
| |Heart failure is the inability of the heart to deliver adequate oxygen to the body’s peripheral tissues. Primarily a disease of elderly |
| |persons, heart failure affects more than five million Americans. It may be right sided or left sided. Most common proximate cause of heart |
| |failure is left ventricular dysfunction, which is marked by reduced myocardial contractility, resulting in low stroke volume. Diastolic |
| |dysfunction produces heart failure due to elevated ventricular filling pressure. It is usually due to hypertension and often occurs without |
| |associated systolic dysfunction.1 |
| |Advances in the treatment of heart failure and early intervention to prevent decompensation may delay disease progression and improve survival.|
| |Early intervention with lifestyle changes and drug therapy has proven reasonably effective in treating heart failure, and it is the cornerstone|
| |of nearly every heart failure treatment regimen.2 |
| |6.2 NEED FOR THE STUDY |
| |Changes to a heart failure patient’s dietary habits and lifestyle may be among the first and most important steps taken to treat the disease. |
| |Heart failure is estimated to affect 4 to 5 million Americans, with 5, 50 000 new cases reported annually. In the past three decades, both the |
| |incidence and prevalence of heart failure have increased. Factors that have contributed to this increase are the aging US population and |
| |improved survival rates in patients with cardiovascular disease due to advancements in diagnostic techniques and medical and surgical |
| |therapies. Heart failure is a chronic, progressive disease that is characterized by frequent hospital admissions and ultimately high mortality |
| |rates, because of its high medical resource consumption, heart failure is the most costly cardiovascular illness in the United States.3 |
| |Heart failure is third most common cardiovascular disease in the US affecting 2 per cent of the U.S. population, or almost 5 million people. |
| |The prevalence of heart failure increases with the age from less than 1 per cent in the 20-39 yr old age group to over 20 per cent in the |
| |people age 80 yr or older. The life time risk of developing heart failure is estimated at about 20 per cent both in men and women. The lifetime|
| |risk of developing HF at the age of 40 yr is 11.4 per cent for men and 15.4 per cent for women. More than 500,000 new cases are diagnosed each |
| |year. Around 30 to 40 per cent of patients die from heart failure within 1 year after receiving the diagnosis. Heart failure can be disabling |
| |and it can severely reduce a patient’s quality of life.4 |
| |Heart failure is a chronic and progressive disorder that is characterized by frequent hospital |
| |admissions and high annual mortality rates (25%–40%). Both the incidence and prevalence of heart failure have increased during the past 3 |
| |decades, and they will continue to increase. This increase is related to advances in diagnostic techniques in addition to medical and surgical |
| |therapies that have improved survival rates in patients with cardiovascular disease. Our aging population contributes further to this increase.|
| |Heart failure affects more than 400 000 Canadians, with over 50 000 new cases occurring annually.5 |
| |In India an estimated 2.27 million people died due to CVD during 2008. There were over 8 million persons suffering from CVD during 2011. The |
| |prevalence of CVD is reported to be 2-3 times higher in the urban population as compared to the rural population.6 |
| |Debbie Ehrmann Feldman and colleagues review trends in Montreal in admissions to hospital due to congestive heart failure in individuals aged |
| |65 years or more, between 2008 and 2010, the annual rate of admissions to hospital for this disorder increased by 35%. At the same time, the |
| |readmission rate within 6 months rose to almost 50%. The one saving grace was the reduction in annual length of stay in hospital by 26% to a |
| |mean of 12.2 days. At the same time, the age-adjusted mortality rates did not change significantly. Although this review did not address the |
| |issue of treatment or changes in therapy during the time of the study, it does highlight the prevalence of this increasingly common |
| |cardiovascular disorder. With its high consumption of medical resources, heart failure is becoming the most costly cardiovascular illness.7 |
| |Adherence to guidelines results in improved outcomes of heart failure patients. Education of caregivers on evidence based therapy is the |
| |cornerstone of a successful heart failure programme. Unlike western countries where heart failure is predominantly a disease of elderly, in |
| |India it affects younger age group. The important risk factors for heart failure include coronary artery disease, hypertension, diabetes |
| |mellitus, cardio toxic drugs, valvular heart disease and obesity. In India coronary artery disease, diabetes, hypertension, valvular heart |
| |diseases and primary muscle diseases are the leading causes for heart failure. Rheumatic heart disease is still a common cause of heart failure|
| |in Indians.8 |
| |An organized system of specialists heart care improve outcome including quality of life, the frequency and duration of follow up and survival |
| |of patient with heart failure. A multidisciplinary team approach involving several professional with their own expertise is important in |
| |attaining an optimal effect. |
| | Health care practitioners who treat heart failure patients often face the challenge of managing multiple conditions requiring multiple |
| |medications and lifestyle changes in an older, sometimes cognitively and psychologically affected patient group. An inter-professional team |
| |approach is needed to optimally diagnose, carefully review and prescribe treatment, educate and counsel patients and families in regard to |
| |medication use and lifestyle changes, and provide post-discharge follow up. |
| |Heart failure patients are discharged from the hospital for follow up care. All the patients should modify their lifestyle practices after |
| |their discharge. It is the major responsibility of the health care member especially nurses to prepare the patient for facing this situation. |
| |Thus educating the patient and family is the primary responsibility of the nurse. |
| |An explorative and descriptive was carried out to determine nurse knowledge on heart failure among 300 nurses who provided care for patient |
| |with heart failure as selected as sample. A 20 item true or false written survey was administered between February 2005 to April 2005. The |
| |result of the study revealed that out of 300 nurses survey majority of the nurse had inadequate knowledge on heart failure self management. The|
| |study concluded that nurses may not be properly educated in heart failure self management principles and must be provided with right |
| |information. So that they can improve the quality and amount of information they offer to patient. Nurses who are better prepare to educate |
| |patient with heart failure may be more likely to carry out their nursing function as a part of their daily job role.9 |
| |A descriptive study was conducted to estimate the level of nurses knowledge on basis of heart failure self care principles. 143 nurses was |
| |selected as samples, a questionnaire measuring knowledge on heart failure self care principle was administered among cardiology nurses. Data |
| |were analyzed by using descriptive statistics, T test and analysis of variants. The result of the study has shown that there is an urgent need |
| |for nurses to update their knowledge and enhance their educational skills.10 |
| |Based on the above findings and own experience the researcher identified the need to improve knowledge of staff nurses on lifestyle |
| |modification of patient with heart failure by using self instructional module. |
| | |
| |6.3 THE REVIEW OF LITERATURE |
| |The review of literature of heart failure & its lifestyle modification is divided into: |
| |Literature related to incidence & prevalence of heart failure. |
| |Literature on lifestyle modification of patient with heart failure. |
| |Literature related to the knowledge of staff nurse on the management of heart failure. |
| |Literature related to SIM as an effective teaching module. |
| |Literature related to incidence & prevalence of heart failure. |
| |A population based study was conducted to determine the incidence and etiology of heart failure in general population. New cases of heart |
| |failure were identified from the population 1,51000 served by 82 general practitioner. The result of the study showed that incident rate |
| |increased from 0.02 cases per 1000 population per year in those aged 25 to 35 years to 11.6 in those aged 85 years and over. The incidence was |
| |higher in male than female. The medium age at presentation was 76 years. The primary etiology were coronary artery disease 36%, unknown 34%, |
| |hyper tension 14%, valve disease 7%, atrial fibrillation 5% and other 5%. The study concluded that within the general population new cases of |
| |heart failure occur in elderly and incidence is higher in men than women.11 |
| |A population based study was conducted to determine the prevalence of heart failure and left ventricular systolic dysfunction in the general |
| |population. 5540 participants belongs to 55 to 95 years, were selected as samples. The presence of heart failure was determined by assessment |
| |of symptoms and sign and use of heart failure medications. The overall prevalence of heart failure was 3.9% and did not differ between men and |
| |women. The prevalence increased with age. The prevalence of left ventricular systolic dysfunction was approximately 2.5 times higher in men |
| |than women. The study concluded that the prevalence of heart failure is appreciable and does not differ between men and women.12 |
| |Literature on lifestyle modification of patient with heart failure. |
| |An experimental study was conducted to determine how an exercise adherence intervention affects the physiological, functional, and quality of |
| |life outcomes of patients with heart failure. Sixteen heart failure patients were randomly assigned to an exercise-only group or to an |
| |exercise-with-adherence group. Two of the 16 people died from no exercise related causes during the study and were not included in the |
| |analysis. The intervention was tested over a 24-week period in which patients participated in a 12-week supervised exercise program followed by|
| |12 weeks of unsupervised home exercise. The intervention format was one of individualized graphic feedback on exercise goals and participation |
| |and problem-solving support by nurses. Results indicated that patients who received the intervention exercised more frequently and experienced |
| |improved outcomes during both phases. The adherence intervention may encourage HF patients to continue to exercise and thereby maintain the |
| |health benefits gained in both phases of an exercise program.13 |
| |A longitudinal study was conducted to ascertain the safety and effectiveness of a lifestyle modification program in patients with systolic |
| |heart failure and metabolic syndrome. 20 patients with systolic heart failure (ejection fraction < 50%) and metabolic syndrome were randomized |
| |to standard medical therapy (Control) versus medical therapy and lifestyle modification (Lifestyle) and followed prospectively for 3 months. |
| |Lifestyle modification involved a walking program and reduced calorie diet with 2 meal replacement products daily. Data collected at baseline |
| |and 3 months and included physical exam, laboratory values, quality of life questionnaire, 6 minute walk, and brachial ultrasound revealed that|
| |3 months, 5 patients in each group had lost -0.84 ± 3.82 and -0.50 ± 3.64 kg on an average and no significant differences in the defined |
| |endpoints were noted. None of the patients had an adverse event that was related to weight loss or exercise. And the results pointed out that |
| |lifestyle modification in patients with systolic heart failure and metabolic syndrome was well tolerated, but did not result in significant |
| |weight loss.14 |
| |Literature related to the knowledge of staff nurse on the management of heart failure. |
| |A cross sectional study was conducted to evaluate the home care nurse knowledge in managing heart failure patient. 92 home care nurses were |
| |recruited from 4 home care agencies. A previously published 20 item heart failure knowledge questionnaire was administered to participants. The|
| |result of the study has shown that the nurses for lowest on knowledge related to asymptomatic hypotension and weight monitoring. The study |
| |concluded that home care nurse may not be sufficiently knowledgeable in evidence based education topic for managing heart failure. The result |
| |confirmed the need to develop educational programme for home care nurses in managing heart failure which may lead to improve quality of patient|
| |education.15 |
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| |Literature related to SIM as an effective teaching module |
| |A study was conducted on 2009 to assess the effectiveness of Self Instructional Module regarding quality of life among patients |
| |following CABG surgeries in the elderly .A total number of 63 patients with 65 years of age group, both males and females were |
| |selected by convenience sampling technique. A detailed questionnaire was used to collect data about quality of life and |
| |improvement in lifestyle after CABG surgery . The study result showed that a high proportion of the patients experienced |
| |improvement (that is 45 patients) in life style modifications, while a substantial number (that is 15 patients) had exacerbations in |
| |cognitive function, lack of confidence and dependence. The study concluded that an important step is needed to improve the quality of|
| |life, might be through the institution of a structured multidisciplinary rehabilitation program, also the life style modification |
| |with focus on emotional support.16 |
| |6.4 STATEMENT OF PROBLEM |
| |“A study to assess the effectiveness of self instructional module on knowledge regarding life style modifications of patients with heart |
| |failure among staff nurses working in selected hospital, Mangalore.” |
| |6.5 OBJECTIVES |
| |To assess the prior knowledge of staff nurses regarding life style modifications of patients with heart failure. |
| |To develop SIM regarding the life style modifications of patients with heart failure |
| |To find out the effectiveness of SIM in terms of gain in post test knowledge score regarding life style modification of patient with heart |
| |failure. |
| |To associate the pre test knowledge score with selected demographic variables. |
| |OPERATIONAL DEFINITION |
| |Assess: In the present study, assess means judging the status of pretest and post test knowledge of staff nurses on life style modification of |
| |patient with heart failure. |
| |Knowledge: In this study knowledge refers to the correct responses to the items on a structured questionnaire on “life style modification of |
| |patient with heart failure” which is measured and expressed in terms of knowledge scores. |
| |Effectiveness: In the present study, effectiveness refers to the extent to which the STP has achieved the desired objectives, that means |
| |improvement of post test knowledge scores among staff nurses regarding life style modifications of patients with heart failure |
| |Self instructional module: In the present study SIM is a learning package planned and prepared from lifestyle modification of patient with |
| |heart failure provided to staff nurses with an aim to facilitate self learning |
| |Heart failure: Heart failure is a physiologic state in which the heart cannot pump enough blood to meet the metabolic needs of the body. It |
| |includes left sided failure, right sided failure or both. |
| |Life style modification In this study lifestyle modification refers to the changes in the activities of daily living for reducing the risk |
| |factors of cardiac failure which includes dietary modifications, exercise, behavioral modifications, weight management, symptom management, |
| |stress management, medication and follow up. |
| |Staff Nurses: In the present study, staff nurse is a person who is having a diploma or basic degree in nursing from a recognized university or |
| |board, registered under a state nursing council and is working in selected hospital, Mangalore. |
| |Selected Hospital: In the present study selected hospital refers to the place where the researcher obtains permission & intents to conduct the |
| |study. |
| |6.7 VARIABLES |
| |Independent Variable: The SIM on life style modifications of patients with heart failure |
| |Dependent Variables: Staff nurses knowledge on life style modifications of patients with heart failure |
| |6.8 ASSUMPTION |
| |The study assumes that |
| |staff nurses will have some knowledge regarding life style modifications of patients with heart failure. |
| |knowledge may vary from person to person |
| |6.9 DELIMITATION |
| |The study will be delimited to the staff nurses working in selected hospital, Mangalore. |
| | |
| |6.10 HYPOTHESES |
| |All the hypothesis will be tested at 0.05 level of significance. |
| |H1: The mean post test knowledge score of the staff nurses will be significantly higher than mean pre test knowledge score. |
| |H2: There will be significant association between pre test knowledge score of the staff nurses on life style modifications of patients with |
| |heart failure with selected demographic variables. |
| |MATERIALS AND METHODS |
| |7.1.1 SOURCE OF DATA: |
| |Data will be collected from the staff nurses in selected hospital, Mangalore |
| |7.1.2 RESEARCH DESIGN: |
| |The research design selected for this study is pre experimental one group pre and post test design. |
| |The schematic representation of the design as follows |
| |O1---X --- O2 |
| | |
| |E = O2 - O1 |
| |O1= Pre test knowledge of staff nurses on life style modifications of patients with heart failure |
| |X = Intervention with Self Instructional Module on life style modifications of patients with heart failure |
| |O2= Post test knowledge of staff nurses on life style modifications of patients with heart failure |
| |E = Effectiveness of SIM |
| |7.1.3 SETTING : |
| |The study will be conducted in selected hospital, Mangalore |
| |7.1.4 POPULATION: |
| |The population of this study will be staff nurses in selected hospital, Mangalore |
| |7.2 METHOD OF DATA COLLECTION |
| |7.2.1 SAMPLING PROCEDURE: |
| |Purposive sampling technique will be adopted for this study. |
| |7.2.2 SAMPLE SIZE: |
| |The sample size will be approximately 50 staff nurses in selected hospitals, Mangalore. |
| | |
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| |7.2.3 INCLUSION CRITERIA: |
| |Staff nurses who are |
| |willing to participate in the study |
| |available at the time of data collection |
| |7.2.4 EXCLUSION CRITERIA |
| |Staff nurses who are |
| |not available during the period of data collection |
| |not willing to participate in the study |
| |7.2.5 DEVELOPMENT OF TOOL |
| |Instrument Used |
| |1.Closed ended questionnaire related to life style modifications of patients with heart failure |
| |2. SIM on life style modifications of patients with heart failure. |
| |Description Of The Tools |
| |Closed ended questionnaire will be prepared to assess the knowledge of staff nurses on life style modifications of patients with heart failure|
| |The closed ended questionnaire will have two parts |
| |Part A- demographic characteristics. |
| |Part B- item on life style modifications of patients with heart failure. |
| |SIM will be prepared based on objectives, literature reviews and based on expert’s opinion. |
| |7.2.6 DATA COLLECTION METHOD |
| |Prior to the data collection permission will be obtained from the concerned authority for conducting the study. |
| |The data will be collected from approximately 50 staff nurses, after obtaining their consent. |
| |Pretest will be conducted using structured knowledge questionnaire and a SIM will be planned to the staff nurses on the same day and post test |
| |will be conducted by using the same questionnaire. |
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| |7.2.7 DATA ANALYSIS PLAN |
| |The data will be planned and analyzed using differential and inferential statistics |
| |the differential statistics will be used are mean, median, standard deviation, and mean percentage etc |
| |inferential statistics will be used are paired ‘t’ test and chi- square.(P > 0.05) |
| |7.3 DOES THE STUDY REQUERE ANY INVESTIGATION TO BE CONDUCTED ON PATIENTS OF OTHER HUMANS OR ANIMALS? |
| |Yes, a self instructional module on life style modifications of patients with heart failure will be carried out to improve the knowledge level |
| |of staff nurses. |
| |7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTE IN CASE OF 7.3? |
| |Yes, ethical clearance has been obtained from the concerned authority. |
|7. | |
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| |REFERENCES |
| |Hunt SA, Baker DW, Chin MH, et al. Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. The Am jour of nurs. |
| |2001[internet]; 64(3). Available from . |
| |Young JB. The cardiac response to injury. In: Mills RM, Young JB. Approaches to the Treatment of Heart Failure. Baltimore, Md: Williams & |
| |Wilkins: 1998:18–30. |
| |O’Connell JB. The economic burden of heart failure. Clin Cardiol.2000;23(6). |
| |Owan TE, Redfield MM. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis 2005; 47: 320-32. |
| |Naylor CD, Slaughter. Cardiovascular health and services in Ontario:an ICES atlas. 1st ed. Toronto: ICES; 1999. p. 111-22 |
| |Jessup M, Brozena S. Heart failure. 2. N Engl J Med 2003; 348 : 2007-18. |
| |Ehrmann Feldman D, Thivierge C, Guérard L, Déry V, Kapetanakis C, Lavoie G, et al. Changing trends in mortality and admissions to hospital for |
| |elderly patients with congestive heart failure in Montreal. CMAJ 2001;165(8):1033-6. Available: cma.ca/cmaj/vol-165/issue-8/1033.asp |
| |Jessup M, Brozena S. Heart failure. N Engl J Med 2003; 348 : 2007-18 |
| |Knopp AM. Nurses’ knowledge of heart failure guidelines in a western montana hospital[internet]. Available online from: URL: |
| | pdf |
| |Kalogirou F, Lambrinou E, Middleton N, Sourtzi P. Cypriot nurses' knowledge of heart failure self-management principles. European Journal of |
| |Cardiovascular Nursing [internet] 2012. Available from URL: |
| |Senes S, Britt H. A general practice view of cardiovascular disease and diabetes in Australia[internet] .Available from URL: |
| |mm/pcpi/hfset-12-5.pdf |
| |Mosterd A,Hoes AW, Bruyne MC, Deckers JW. Prevalence of heart failure and left ventricular dysfunction. European Heart Journal.1999; 20(4): |
| |447–455 |
| |Duncan K, Pozehl P B. Effects of an Exercise Adherence Intervention on Outcomes in Patients with Heart Failure. Rehabilitation Nursing.2003 |
| |july;28(4):117-122. |
| |Pritchett AM, Deswal A, Aguilar D. Lifestyle Modification with Diet and Exercise in Obese Patients with Heart Failure. J Obes Weig los |
| |Ther.2012;2(2):118-120. |
| |Delaney C, Apostolidis B, Lachapelle L, Fortinsky R. Home care nurses' knowledge of evidence-based education topics for management of heart |
| |failure. Heart & Lung : the Journal of Critical Care 2011;40(4):285-292 |
| |Merkouris A. Quality of life after coronary artery bypass graft surgery in the elderly. Euro Journ of card vasc nur. 2009 Mar; 8(1): 74-81 |
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|8. | |
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|9. |Signature of the candidate | |
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|10. |Remarks of the guide | |
| | |TOPIC IS RELEVANT TO CONDUCT THE RESEARCH STUDY |
| | | |
|11. |Name and designation of (in block letters) |
| | Guide |MR. GIREESH G. R. |
| | |HOD, MEDICALSURGICAL NURSING |
| | |SHREE DEVI COLLEGE NURSING |
| | |MANGALORE |
| | Signature | |
| | Co-guide (if any) |----- |
| | | |
| | Signature | |
|12. | Head of the department |MR. GIREESH G. R. |
| | |HOD, MEDICALSURGICAL NURSING |
| | |SHREE DEVI COLLEGE NURSING |
| | |MANGALORE |
| | Signature | |
|13. |13.1 Remarks of the Chairman and Principal | |
| | |RECOMMENDED FOR APPROVAL |
| |13.2 Signature | |
| | | |
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