Annexure II



Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

| |Name of the candidate and address |LOUISA VINITHA MONTEIRO |

| |(in block letters) |I YEAR M. Sc. NURSING |

| | |ATHENA COLLEGE OF NURSING |

| | |FALNIR ROAD |

| | |MANGALORE – 575 001. |

| |Name of the Institution |ATHENA COLLEGE OF NURSING |

| | |FALNIR ROAD |

| | |MANGALORE – 575 001. |

| |Course of Study, |M. Sc. NURSING |

| |Subject |MEDICAL SURGICAL NURSING |

| |Date of Admission to the course |20.05.2013 |

| |Title of the Topic |

| |A STUDY TO EVALUATE THE EFFECTIVENESS OF PRE PROCEDURAL TEACHING ON PROCEDURAL ANXIETY AMONG PATIENTS UNDERGOING |

| |COMPUTED TOMOGRAPHY (CT) SCAN IN A SELECTED HOSPITAL AT MANGALORE. |

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| |Brief Resume of the Intended Work |

| |Introduction |

| |In modern health care, medical imaging plays an irreplaceable role in the patient’s journey through illness and |

| |diseases.1 For many conditions and ailments, medical imaging, whether it is a simple chest x-ray or a complex scan, |

| |plays an essential role in the diagnosis, therapeutic management and surveillance of illness.2 Medical imaging is an|

| |ever changing field, and there have been significant advancements in imaging techniques and technologies over the |

| |years.3 The amount of imaging and the subsequent costs associated with it have been rising rapidly in many parts of |

| |the world for the last 30 years, leading to a larger percentage of people being exposed to these different imaging |

| |modalities.4-6 |

| |Everyone from the youngest child to the oldest adult experiences anxieties and fears at one time or another, while |

| |dealing with issues of work, school, or relationships with family, friends, or significant others. Feeling anxious |

| |is particularly uncomfortable situation which will never make us feels very good. Anxiety is a physiological and |

| |psychological state described by emotional, somatic, behavioural and cognitive components. It is regarded as a |

| |displeasing feeling of concern and fear. Anxiety is regarded as a standard reaction to the stressor.7 |

| |Advanced, high technology imaging in particular, such as CT, MRI, PET, and SPECT, have seen significant increase in |

| |their use. However, these improvements in imaging technology do not necessarily guarantee a similar advance in |

| |patient care. Due to this, the patient and patient care may often be ignored or overlooked, as the focus of the |

| |imaging technician is directed largely towards the technology and not the patient.8 Health care professionals |

| |involved in patient care may unwittingly objectify, and not necessarily see them as people in pain or distress, but |

| |as problems needing solving.9 This can be seen in medical imaging as well, patients can be seen as ‘a translucent |

| |screen through which we peer to find a diagnostic entity within.’ In no setting is this statement more fitting than |

| |within a medical imaging department.1 |

| |Heart palpitations, muscle weakness, tachycardia, nausea, fatigue, shortness of breath, pain in the chest, headache |

| |and stomach pain are some of the physical effects caused by anxiety. As the body has the ability to handle blood |

| |pressure, threat, perspiration, heartbeat and the flow of blood to important muscle groups are raised while the |

| |digestive and immune functions are reserved. Some of the external symptoms of anxiety are sweating, pallor, |

| |papillary dilation and trembling. Even if everyone suffering from anxiety does not suffer from panic attacks, it is |

| |a common symptom.7 |

| |There are studies that provide information on the patient experience in diagnostic imaging, reported in both |

| |quantitative and qualitative methodologies, as well as in articles based on expert opinion. It has been shown in a |

| |plethora of studies that anxiety and claustrophobia are issues that may arise during the imaging process, and |

| |patients who are to undergo diagnostic imaging procedures may experience a wide range of emotions.1 In a survey of |

| |radiographers, 71.6% of respondents stated that anxiety was a common issue in their imaging department when patients|

| |presented for MRI.10 High levels of anxiety or claustrophobia regarding imaging may lead to increased movement,11 |

| |resulting in motion artefacts decreasing the value of the resultant images. In extreme cases, scans may need to be |

| |aborted or patients may refuse to have the scan, sedation may need to be used, or additional sequences performed. |

| |These missed or increasing difficult scans have financial implications as valuable staff and equipment time is |

| |lost.12, 13 |

| |Hence patients having a CT scan may present with amplified levels of fear or anxiety, as they are unaware of what to|

| |expect during the examination. In this regard, the provision of written information can aid to improve patients' |

| |knowledge about the examination and reduce anxiety by eliminating any fears or misconceptions patients may have had |

| |or may experience. |

| |6.1 Need for the Study |

| |Anxiety is defined as an emotional state of fear, tension, panic, or anticipation of an unpleasant experience. It is|

| |an emotional response to a threatening situation and it is generally agreed that hospitalization and associated |

| |procedures produce various threats including possible disability, coping with new social situations and deprivation |

| |of normal freedom. Patients experience anxiety prior to C T procedures due to fear of pain or the negative past |

| |experiences of those around them. The best way to reduce the anxiety of the patient is to inform the patient about |

| |the procedure and provide psychological support during the procedure. Education of the patient prior to the |

| |procedure about the things they will see, hear and feel during C T procedures has a significant role in reducing |

| |their anxiety and fear.14 |

| |Although the method is non-invasive and considered painless, both adults and children experience anxiety during |

| |Computed Tomography. During the CT scan examination adult patients use different kinds of coping strategies. |

| |However, not all patients can cope with the situation and interrupt the examination prematurely due to panic attacks|

| |and some need sedation or anaesthesia to be able to go through the examination. The narrow space and loud clicking |

| |noise is above all considered to be the cause of anxiety or prematurely terminated examinations for adults. The |

| |lived experience of going through CT scan was perceived as a feeling of “being in another world”, which had an |

| |influence on the patients’ self-control, their handling of the situation, and their need for support.14 |

| |Working of CT scan machine is slightly same as x-ray machine. CT scanners are just like a large sized ring shaped |

| |doughnut which turn around and tilt for patient. Patient lay down on a table and that table moves slowly. This table|

| |is attached with the central ring but, all this procedure followed is not comfortable. Now the patient’s table |

| |slides towards the center ring and scanner of the machine begins rotating. By doing this, it continuously keep on |

| |taking pictures of human body through all angles. After completion of one |

| |series, table moves for an inch and scanner starts to take images for second series. Within some minutes all |

| |procedure is done and technicians get all the cross section capture of all the body part of that patient. During the|

| |process the technicians will stay with the patient via an intercom. When the scanner is taking pictures the |

| |technicians will ask to hold the breath and stay constant. After CT scan is completed, patient resumes all normal |

| |activities. There will be no ill-side effects. The only thing recommended is to drink plenty of liquids/water after |

| |test is complete (if given contrast). This is so that the contrast dye can be quickly flushed from your body and you|

| |do not become dehydrated.14 |

| |Severe anxiety would result in cancellation of the procedure or rescheduled, that would increase costs and delaying |

| |medical evaluation. Over 14% of patients require sedation to complete the examination, adding new costs and risks to|

| |the procedure. Many studies have shown that relaxation with CT scan can reduce patient anxiety and movement, |

| |increase patient tolerance of and satisfaction with the procedure.2 Patients who experience a psychological reaction|

| |during a scan may either discontinue the procedure altogether, refuse to undertake CT scan procedures in the future |

| |and may also influence other patients needing at medical CT scan in the future. Therefore, measures are taken aimed |

| |at reducing this anxiety during CT scan.14 |

| |Since many patients experience anxiety, sometimes so strong that the scan has to be terminated, prior knowledge of |

| |what is expected during the procedure can effectively decrease anxiety during the procedure. Nurses have an |

| |important role in reducing patient anxiety before, during and after any diagnostic procedure. They must know how to |

| |prepare the patient for each test, the appropriate requirements, and nursing measures to perform how to interpret |

| |each test. Patient anxiety is one of the most significant problems faced by nurses while preparing patients for CT |

| |scan. Considering the above factors and reviewing the literature, the investigator felt there is need to provide |

| |coping strategies to patients to prepare them for CT scan. The anxiety |

| |level may vary with the personality of the individual but coping strategies can help all the individuals to overcome|

| |their worries.14 |

| |To improve the scan experience, and reduce feelings of anxiety, claustrophobia and fear prior to scanning, a number |

| |of interventions have been tested. These interventions vary significantly in terms of their case of implementation |

| |and burden on staff time and costs. These include information/education, different positions, manipulation of the |

| |environment, prism glasses, lighting levels, movement of air/fans, company, panic buttons, music, closed design of |

| |CT, psychological preparation, hypnosis, aromatherapy, sedation and screening of patients for claustrophobia, or a |

| |combination of different methods in an anxiety reduction protocol.11 It is therefore the aim of the investigator to |

| |determine the strategies that are effective in reducing fear, anxiety and claustrophobia in persons undergoing |

| |imaging with technology.14 |

| |Hence the investigator felt need to determine the effectiveness of pre procedural teaching on procedural anxiety |

| |among patients undergoing Computed Tomography (CT) scan in a selected hospital at Mangalore. |

| |6.2 Review of literature |

| |A study was conducted to evaluate the incidence of claustrophobia and premature termination of computed tomography |

| |examination at department of radiology, Berlin. In this study a total of 5798 computed tomography scan reports of |

| |4821 patients were evaluated. A total of 95 patients (1.97%) suffered from claustrophobia and 59 (1.22%) prematurely|

| |terminated the scanning.15 |

| |A non-experimental study was conducted at endoscopy centre, James Cook University hospital, Middlesbrough, UK, on |

| |information, social support and anxiety before endoscopy. Structured interviews were conducted with 113 hospitals |

| |out patients about to undergo gastrointestinal endoscopy. Participants indicated their perceptions of how much |

| |support and how much clear and |

| |useful information they had received. Anxiety was measured with a population-specific trait and state adaptation of |

| |the Hospital anxiety and Depression scale (HADS-A).Results showed psychometric exploration of the HADS-A revealed a |

| |single general anxiety factor with Cronbach’s α = 0.91. The majority of the sample experienced high anxiety levels. |

| |Gender, but not age, differences emerged, showing females to be more anxious than males, F (1, 84) = 5.68, p ................
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