A STUDY TO ASSESS THE KNOWLEDGE ,ATTITUDE AND …



A STUDY TO ASSESS THE KNOWLEDGE ,ATTITUDE ANDPRACTICE

OF LIFE STYLE MODIFICATION AMONG HYPERTENSIVE

PATIENTS AT SELECTED HOSPITALS

IN BANGLORE

M.Sc. Nursing Dissertation protocol submitted to

[pic]

Rajiv Gandhi University of health Sciences, Karnataka, Bangalore.

By

Mr. NOBLE M.S.

M.Sc. NURSING FIRST YEAR

YEAR 2009-2011

Under the guidance of

Mr. Biju Ramachandran

Principal and HOD, department of MSN

K.T.G. college of nursing,

Sreegandhadakavalu, Hegganahalli cross

Sunkadakatte road, Bangalore-560091.

RAJIV GANDHI UNIVERSITY OF HEALTH SCINCES,

BANGALORE , KARNATAKA.

SYNOPSIS PERMORMA FOR REGISRATION OF SUBJECT

FOR DISSERTATION

1.

NAME OF THE

CANDIDATE

AND ADDRESS

Mr. NOBLE M.S.

FIRST YEAR M.Sc. NURSING

K.T.G. COLLEGE OF NURSING.

SREERGANDHADAKALALU,

HEGGANAHALLI CROSS.

SUNKADAKATTE ROAD,

BANGALORE- 560091

2.

NAME OF THE

INSTITUTION

K.T.G. COLLEGE OF NURSING.

SREERGANDHADAKALALU,

HEGGANAHALLI CROSS.

SUNKADAKATTE ROAD, BANGALORE-

3.

COURSE OF THE STUDY AND SUBJECT

M.Sc. NURSING FIRST YEAR

MEDICAL SURGICAL NURSING

4.

5

DATE OF ADMISSION

TO THE COURSE

TITLE OF THE TOPIC

15- MAY- 2009

A STUDY TO ASSESS THE KNOWLEDGE ON LIFE STYLE MODIFICATION AMONG HYPERTENSIVE PATIENTS AT SELECTED HOSPITALS IN BANGALORE

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|6 |BRIEF RESUME OF THE INTENDED WORK |

| |INTRODUCTION |

| |“We cannot change our genes or sex, but we can definitely modify our life style there by protecting our self from hypertension.” |

| |Robert C Schlant (2000) |

| |Hypertension, the silent killer which remains asymptomatic until the damage effect of it can be seen . Hypertension .an important and common risk|

| |factor for considerable morbidity and mortality not only in the indusrialiased world but also in developing countries. Thus, the problem of |

| |hypertension can be truly considered as pandemic. |

| |A study conducted o prevalence of hypertension report that 972 million people in the world are suffering with this problem . incidents rate of |

| |hypertension range between 3 and 18% depending on the age ,gender ethnicity and body size of the population studied |

| |The factors contributing to the increased prevalence of hypertension is mainly based on environmental factors, genetic factors and factors like |

| |alcohol intake, high fat intake, body mass index and hormonal problems/ hypertensive when compared to normotensives develops twice as much as |

| |coronary heart disease, four times as much congestive heart failure and seven times as much stroke. This risk factors can be conquered through |

| |lifestyle modification |

| |Life style modifications are universally accepted, not only as the first step in the management of hypertension but also as a way to prevent |

| |hypertension. In addition to lowering blood pressure, this measures can also reduce other cardio vascular risk factors. This cost involved is |

| |minimal and there are hardly any risks. Hypertensive patients irrespective of this stage or grade should be motivated to adopt this measures. |

| | |

| |Knowledge regarding hypertension is an important measures used for decreasing the prevalence of hypertension . study conducted in maliuye, hazarika |

| |and et al(2005) reported that only 13.6% of the hypertensive were aware of their elevated blood pressure status only 8.7% were taking regular |

| |treatment. The increase level of knowledge on life style changes will help to have desired intervention goal in people who are most motivated |

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| |6.1 Need for the Study |

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| |Hypertension is an iceberg disease. It is continually disturbed variable in population. W.H.O. survey(2005) showed that in India the prevalence was |

| |59.9 and 69.9 per 1000 in males and females in urban area and 35.5 and 35.9 per 1000 in male and female in rural area. |

| |In order to reduce the high incident rate now the health system is giving more emphasis on life style modifications along with other measures. Life |

| |style is important because how we live determine our choices and this choice decide how healthy we are. Our daily routine may lead us to many risk |

| |factors. Habits like eating out at restaurant ant eating fast foods drinking alcohol, smoking staying up late and not get in enough sleep spending |

| |more time in front of TV, computer and more use of vehicles rather than walking. A study conducted by edyer, Thomas, Donna and et al(2005)revealed |

| |that in lifestyle group mean net reduction in 24 hors ambulatory systolic and diastolic blood pressure were 9.5mm Hg and 5.3mm Hg respectively . in |

| |conclusion among over weight adult already on antihypertensive medications, a comprehensive lifestyle intervention can substantially lower B.P. and |

| |improve B.P control |

| |Hypertension is an important risk factor for cardio vascular and renal diseases including stroke coronary heart diseases, heart failure and kidney |

| |failure . it has been estimated that almost a third of B.P. – related deaths occur from coronary heart disease. It is also estimated that a 3 mm Hg |

| |reduction in systolic B.P. could lead to an 80% reduction in stroke mortality and a 5 percent reduction in mortality from coronary heart disease |

| |Lifestyle can be modified only by individual ‘s own decision . this can be achieved through adequate knowledge. A study by Doris, Samuel and |

| |Stephen(2007) studied the relation between the knowledge about hypertension and life modification in 591 hypertensive patients were acquainted with|

| |non |

| |pharmacological treatment. Physical activity 49 percentage reduction of salt in take 54 percentage where saw relaxation techniques where only known |

| |to 17 percentage this study concluded that knowledge in our population insufficient. |

| |As per above studies increased knowledge about life style modification helps to control blood pressure level and prevent the complications hence the|

| |researcher selected the study to asses the knowledge on life style modifications. |

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| |6.2 Review of Literature |

| |Review of literature is a comprehensive description as well as an evaluation of the evidence related to the given topic[Polit,D.F1999].literature |

| |review foundation up on which two base knew knowledge generally conducted before and data is collected |

| |The review of literature on various studies related to hypertension is arranged under the following headings |

| |a) studies related to incidence and prevalence |

| |b) studies related to risk factors of hypertension |

| |c)studies related to complication of hypertension |

| |d) studies related to life style modifications |

| |e)studies related to life style modifications |

| | |

| |studies related to incidence and prevalence |

| |Kearney,Practicia, whelton and et al 2004 carried a study on world wide prevalence of hypertension a systematic review of published studies. result |

| |revealed was prevalence of hypertension of varied around the world , with the lowest prevalence in rural India 3.4%in men and 6.8%in women and |

| |highest prevalence in Poland 68.9 % in men and 72.5% in women and were concluded that hypertension is an important public health challenge in both |

| |economically developing and developed countries |

| |Burt,whelton,Rocella and et al (2000) conducted a study on prevalence on hypertension in US adult population . the study revealed that 24 % of US |

| |adults had hypertension. The need for intense campaign to reduce the prevalence of hypertension was explained in study |

| |Shyamal Kumar, Kalian and et al 2007 conducted a study of urban community survey in India; growing trend of high prevalence of hypertension in a |

| |developing country . participants were1609 under cross sectional survey of validated and structured questionnaire followed by blood pressure |

| |measurement result showed that systolic hypertension is greater than or equal to 140 mm of hg was present in 40.9% and diastolic hypertension |

| |greater than or equal to 90 mm of hg in 29.3% |

| |Deshmukh , guptha , barambe and et al conducted a study on the prevalence of hypertension in rural Wardha , central India it was a cross section |

| |study . the study revealed that over all prevalence of hypertension was found to be 20.6% and concluded that prevalence of hypertension is high an |

| |appropriate programme shall be launched considering modifiable risk factors in the area are BMI and waist and hip ratios . |

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| |Joshi , chowdary and et al 2007 done a simple randomized study to measure prevalence of hypertension in 20 villages broadly represent of east and |

| |west godawari region of Andhra Pradesh random sample of 4535 adults of age 30 years and over reported that 26.6 % are of male hypertensive patients |

| |and 27.5% are of female hypertensive the researcher emphasize the need of prevention of hypertension |

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| |Studies related to the risk factors |

| |Nanette Lawrence Jeanne and et al 2005 studied the ethnic differences in th association between age and hypertension A randomized control trait |

| |shows that hypertension was present in 40% of elderly men and 50% of elderly women and 60% in non Hispanic white , 71%of non Hispanic African |

| |Americans and 61%of Mexican Americans older than 60 tears of age concluded that age and ethnicity is risk factor for hypertension. |

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| |Burke, hender,loe and et al 2007 done a study on alcohol intake incidence of coronary disease in Australians. The participants were 258 men and 256 |

| |women . the study reported that those who were drinking 41 to60 gram per day in men are 21 to 40 gram per day in women that hazard ratio is 95 % and|

| |91% respectively conclusion is that alcohol consumption should be limited to reduce the heart disease risk. |

| |Stevens, obarzanek, appel and et al (2001) conducted a study on association of BMI and hypertension . a random control trials shows that 65% of US|

| |adults have a body mass index greater than or equal to 25 kg meter square among 30% are of hypertensive, the study concluded that there is an |

| |increased association of BMI and hypertension |

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| |Studies related to complications of hypertension |

| |Giovinna ,leoneni, franeesa and et al 2003 conducted a study on renal dysfunction in renal hypertension in 358 untreated patients with hypertension |

| |.the study revealed the prevalence of renal dysfunction left ventricular hypertrophy and carotid plague was 18% , 48%,28% respectively the study |

| |concluded that the presence of renal dysfunction and cardio vascular mortality and morbidity rates in high in patients with hypertension. |

| |Toni Rizzo, Angela, Thomson and et al 2004 conducted a study on risk of coronary heart disease and stroke in hypertension . a prospective study with|

| |418,343 participant aged 25- 84 years. None of the study participants had clinical evidence of coronary heart disease and hypertension and they were|

| |followed for an average of 10 years the study revealed that prolonged difference in usual diastolic blood pressure of 5,7.5 and 10 mm of hg were |

| |respectively associated with at least 34 % ,46%,56%% lower incidence of stroke and at least a 21 % ,29% and 37% lower incidence of coronary heart|

| |disease |

| |Studies related to life style modifications |

| |Miller ,Erlinger,Young and et al 2002 done a study on the result of the diet, exercise and weight lose intervention trail .A randomized controlled |

| |trail of 44 hypertensive over weight adults on a single blood pressure medications , participants were randomized to a life style are controlled |

| |group. Result at the end of intervention was the mean weight loss in the life style group, met of control was 4.9 kg and also met reductions in |

| |systolic and diastolic blood pressure in conclusion among in hypertensive over weigh adults , already on anti hypertensive medications a |

| |comprehensive life style intervention can substantially lower blood pressure and improve blood pressure control |

| |Dekat and Balzo 2000 conducted a study on a 5 years follow up preventive approach patients with essential hypertension researcher examine the effect|

| |of a 4-56 week programmed consisting of hypertension control education, physical education and smoking cessation on a long time risk factor control |

| |participants were 220 hypertensive males .at 5 year follow up 80%of cases, the Bp was either the same or lower than initially , 84% of patients |

| |improve their general health. Thus intensive short term intervention studies made help to reduce some cardio vascular risk factor temporarily |

| |Stewart, noakes,Eales and et al 2005 conducted a study adherence to cardio vascular risk factors modification in patients with hypertension. A |

| |randomized control trial in patients with hypertension the thing primary outcome measured after the 24 weeks intervention was blood pressure change.|

| |Secondary outcome included patients adherence to the proggramme, their knowledge about hypertension exercise capacity, body weight, self reported |

| |ability control stress adherence to medication and salt restriction. Secondary outcomes did show positive changes as a result of the given |

| |intervention and concluded that patience in a supportive environment such as the one in this study were able to modify their cardio vascular risk |

| |factors |

| |Dunn, Marcus, Kampert and et al 2000 done a study on comparison on life style and structured intervention to increase the physical activity and |

| |cardio respiratory fitness , a randomized trail .participants were sedentary men N=116 and women N=119 the intervention was made for 6 months of |

| |intensive and 18 months of maintenance. Intervention on either a life style physical activity on a traditional structured exercise program. They |

| |concluded that both the life style and structured activity groups had significant and comparable improvements in physical activity and cardio |

| |respiratory fitness. |

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| | |

| |Svelte, Erlanger, voliner and et al 2005 conducted a study on effect on life style modifications on blood pressure by race , sex, hypertension |

| |status and age . A randomized trail tested multy component life style interventions on BP in demographic and clinical sub groups . this study |

| |population was 810 individuals they concluded that divorce groups of people can adopt multiple life style changes that can lead to improved BP |

| |control and reduced coronary vascular risk . |

| |Study related to knowledge on life style modification |

| |Jiang, Tang, lie and et al 1999 studied on the awareness treatment and control of hypertension in patients attending hospital clinics in China. |

| |Participants were the patients over the age of 35 years who were attending out patients clinics in 18 major hospitals in China a cross sectional |

| |survey , a total of 9703 volunteers enrolled , of which 4510(46%)were hypertensive . among of those hypertensive 24% were unaware of control of |

| |hypertension |

| |Megan, eynolds,kristi and et al 2004 conducted a study on level of awareness , treatment and control of hypertension in different world regions . it|

| |was the systematic review of published studies and the search was restricted to studies published from in January 1980 through July 2003. result was|

| |awareness of hypertension was reported for 46% of studies and varied from 25.2% in Korea to 75% in Barbados. |

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| |Annette and stantum 2001 carried a study on determinants of adherence to medical regiments by hypertensive patients.50 adults hypertensive patients |

| |at health maintenance organization as attend the questionnaires and home interviews over a ten week period. Structural modeling procedures revealed |

| |that greater expectancy for internal control over health and hypertension, greater knowledge treatment regimen and stronger social supports were |

| |significant determinants of adherence, in turn higher level of adherence facilitated blood pressure reduction |

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|6.3 |STATEMENT OF PROBLEM |

| |“A study to assess the knowledge, attitude and practice of lifestyle modification among hypertensive patients at selected hospitals in Bangalore |

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|6.4 |Objectives of the study |

| | 1 To assess the Knowledge of hypertensive patients regarding life style modification |

| |To assess the attitude of hypertensive patients regarding life style modification |

| |To assess the practice of hypertensive patients regarding life style modification |

| |To associate the knowledge and practice of hypertensive patients |

| |To associate the knowledge of hypertensive patients with their demographic variables |

| |6 To associate the knowledge of hypertensive patients with their demographic variables(age, sex, education, occupation, income, family history of |

| |hypertension and dietary pattern) |

| | |

|6.5 |Operational Definitions |

| | ● Assess; gathering information about knowledge on lifestyle modifications among |

| |Hypertensive patients |

| |●Knowledge; verbal response from hypertensive patients regarding lifestyle modifications |

| |●Attitude; It refers to complex mental state evolving believes , feelings, values, and |

| |disposition to act in certain ways |

| |●Practice; It refers to a learning method the act of rehearsing a behavior over and over a |

| |engaging in an actively again and again for the purpose of improving it or |

| |mastering it |

| |●Lifestyle modification; changing the activities of life such as physical activity, diets, and |

| |Behavioral modification which maintain healthy living |

| |●Hypertensive patients; a person (male or female) who is between 35 to55 years of age and |

| |Having systolic blood pressure more than 140 mm Hg and diastolic blood |

| |Pressure more than 90 mmHG at the time of data collection |

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|6.6 |Hypothesis |

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| |H0-There is no significant relation ship between knowledge attitude and practice regarding life style modification among hypertensive patients |

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| |H1-There is significant difference between knowledge and attitude regarding prevention of hypertension |

| |H2- There is significant difference between knowledge and practice regarding prevention of hypertension |

| |H3- There is significant difference between attitude and practice regarding prevention of hypertension |

| |H4- There is significant difference between knowledge and attitude regarding prevention of hypertension |

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|6.7 |ASSUMPTION; |

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| |The study based on the following assumptions |

| |● Hypertensive patients have inadequate knowledge regarding practice about prevention and |

| |Control of hypertension |

| |● Knowledge about life style modifications helps in reduction of hypertension and to better |

| |Prevention |

| |● Patients are the best conveyors of information to other patients and to family |

| |● To find out the selected demographic variables. |

| |● Adopting lifestyle modification can prevent complication of hypertension |

| |●Adopting lifestyle modification can prevent complication of hypertension |

|6.8 |DELIMITATION |

| |Study is limited to patients with hypertension who are attending the out patient department and general wards of the selected hospitals at |

| |Bangalore |

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|6.9 |PROJECTED OUTCOME |

| |The study will provide knowledge to patient about the lifestyle modification |

|7 |MATERIALS AND METHODS |

|7.1 |SOURCE OF DATA patient those who are attending OPD |

|7.2 |METHOD OF DATA |

| |COLLECTION |

|7.2.1 |SAMPLING CRITERIA |

| |INCLUSION CRITERIA | 1 Patient suffering with hypertension |

| | |2 Patient between the ages of 35 to 55 years of both the sex. |

| | |3 Patients of out patient departments and general wards |

| |EXCLUSION CRITERIA | 1) Patient suffering from hypertension with |

| | |other than cardio vascular disease |

|7.2.2 |RESEARCH DESIGN | Descriptive design |

| | | |

|7.2.3 |VARIABLES UNDER STUDY |In this study the demographic variables are age, sex, |

| |INDEPENDENT VARIABLE |education, occupation, economic status, family history, |

| | |habits |

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|7.2.4 | | |

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| |DEPENDENT VARIABLES |The dependent variables are in this study knowledge, |

| | |attitude and practice |

|7.2.5 | | |

| |SETTING |The study will be conducted in selected hospital in |

| | |Bangalore |

| | | |

|7.2.6 | | |

| |POPULATION |All the hypertensive patients between the ages of 35-65 years come to out patient department in|

| | |general hospitals |

|7.2.7 | | |

| |SAMPLE SIZE |100 Hypertensive patients at both sex |

|7.2.8 | | |

| |SAMPLE TECHNIQUE |The convenient sampling technique will be used in this study |

|7.2.9 | | |

| |TOOL OF RESEARCH |Appropriated structured knowledge questionnaire to assess the knowledge and likert type of |

| | |attitude scale to assess the attitude and practice of lifestyle modification of hypertension |

| | |constructed and validated by experts and it will be used to collect the needed data |

| | | |

| |SECTION A |Deals with the demographic variables |

| | | |

| | | |

| |SECTION B |Includes the structured questionnaire regarding attitude, practice |

|7.2. 10 | | |

| |COLLECTION OF DATA |1-A prior formal permission will be obtained from the selected hospital authorities of |

| | |Bangalore for collecting the required data |

| | |2- Informed consent will be obtained from the out patients |

| | |3- Structured questionnaire will be administered to collect the data regarding knowledge about |

| | |life style modification |

| | |4- Likert type of attitude scale will be administered to assess the attitude and practice of |

| | |lifestyle modification |

| | |5- Duration of data collection is 4 weeks |

|7.2. 11 |METHODS OF DATA ANALYSIS AND PRESENTATION |1.Descriptive and inferential statistics will be used. |

| | | |

| | |2. Mean , median and mode will be used to explain demographic variables |

| 7.3 | |

| |DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY. |

| | |

| |No, The study requires to analyze the knowledge, attitude and practice of life style modification in hypertensive patients at selected hospital in |

| |bangalore |

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|7.4 |HAS ETHICAL CLEARENSE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3? |

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| |1.Ethical clearance will be obtained from the research committee of K.T.G. college of nursing |

| | |

| |2.permission from the hospital authority |

| | |

| |3. Consent will be obtained from the patients who are willing to participate in the study |

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|8 |LIST OF REFFERENCES; |

| | |

| |1) Black J. M. (2005) medical surgical nursing, 7 th edition. New Delhi, B. I. publications private Ltd, 1489-1507 |

| |2) Elliot , H. L., Connel, J.M.C. and Mc Inner, G.I. (2000) “The year in hypertetension 1 st Edition Bangalore. Panther publisher Pvt Ltd , 1-11 |

| |3) ghafoor unnissa and Kamala Krishna swamy (1998) “ Diet and Heart disease” 3 rd edition. Hyderabad .National institute of Nutrition, |

| |14-15,30-38,65-70, |

| |4) Susan Wods L. (2005) “ cardiac nursing” 5 th Edition. Philadelphia;Lippincott Williams and wilkins publishers 85 |

| |5)Appel , L.J., Champagne, C.M.,and Harsha, D. W.(2003) “ A STUDY ON DETERMINATIONOF EFFECT OF COMPREHENSIVE LIFE STYLE MODIFICATION ON BLOOD |

| |PRESSURE CONTROL” JOURNAL OF |

| |AMERICAN MEDICAL ASSOSSIATION 289(16):2083-2093. |

| | |

| |6) Benjamin, emilia J. AND RICHARD, S, (2002) “A STUDY ON MAGNITUDE OF THE PREVENTION PROBLEM, OPPERTUNITIES AND CHSLLANGES” Journal of American |

| |college of cardiology 40;588-603 |

| |7) Kearney, Patrica, and Whelton (2004) “ A STUDY ON WORLDWIDE PREVALENCE HYPERTENSION” JOURNAL OF HUPERTENSION, 22(1);11-19 |

| |8) Alexander, C,N, and Smith , J. (1995) .” A STUDY ON SRESS REDUCTION FOR HYPERTENSION IN OLDER AFRICANS-AMERICANS” RETRIEVED FROM |

| | |

| |9)BURKE,V. Lee A. and Hunter,E( 2007)” A STUDY ON ALCOHOLINTAKE INCIDENCE OF CORONARY DISEASE IN ASTRIANS’, retrived from |

| | |

| |10)Hasarika, and alhawat(2005),” A STUDY ON AWARENESS AND TREATMENT OF HYPERTENSION’ RETRIVED FROM http:/jhpdc.unc.edu/ |

| | |

|9 |NAME & SIGNATURE OF THE CANDIDATE |NOBLE M.S |

|10 |REMARKS OF THE GUIDE |The study is suitable & feasible |

|11 |NAME AND DESIGNATION | |

|11.1 |GUIDE |Mr.BIJU RAMACHANDRAN |

| | |PRINCIPAL, |

| | |K.T.G. COLLEGE OF NURSING |

| | |SREEGANDHADAKAVALU,BANGALORE. |

|11.2 |SIGNATURE | |

|11.3 |CO-GUIDE | |

|11.4 |SIGNATURE | |

|11.5 |HEAD OF THE DEPARTMENT |Mr.BIJU RAMACHANDRAN |

| | |PRINCIPAL, |

| | |K.T.G. COLLEGE OF NURSING |

| | |SREEGANDHADAKAVALU,BANGALORE |

|11.6 |SIGNATURE | |

| | | |

|12 |REMARKS OF THE PRINCIPAL |The study is suitable & feasible |

| | | |

|12.1 |NAME & SIGNATURE OF THE PRINCIPAL |Mr.BIJU RAMACHANDRAN |

| | |PRINCIPAL, |

| | |K.T.G. COLLEGE OF NURSING |

| | |SREEGANDHADAKAVALU,BANGALORE |

| Rajiv Gandhi University of Health Sciences, Karnataka |

|Curriculum Development Cell |

|CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION |

| |

|Registration No. ; |

|Name of the candidate ; |

| |

|Address ; K.T.G. College of Nursing |

|; Sreegandhadakavalu, Bangalore |

|Name of the institution ; K.T.G. College of Nursing |

|Sreegandhadakavalu, Bangalore |

|Date of admission to Course ;15/05/2009 |

|Title of the topic ;A study to assess the knowledge,attitude and practice of life |

|style Modification among hypertensive patients at selected |

|hospitals in Bangalore |

| |

|Brief Resume of The work ; Attached |

|Signature of the student ; |

|Name of the Guide ;;BIJU RAMACHANDRAN |

|Signature of the Guide ; |

|Name of the Co- Guide ; |

|Signature of the co-Guide ; |

|Name of the HOD ; |

|Signature of the HOD ; |

|Name of the principal ; |

|Principal mobile number ; |

|Principal E-mail ID ; |

|Remark of the Principal ; |

|Signature of the Principal ; |

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