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 |MS.RAIZA RAJU |

| |( 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 ) |

| | |CARDIO THORACIC NURSING |

| 4 |Date of Admission to the Course | |

| | |13-10-2010 |

| 5 |Title of the Topic |

| | |

| | |

| |“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON CARDIOMYOPATHY AND ITS MANAGEMENTAMONG STAFF NURSES AT SELECTED HOSPITAL, |

| |MANGALORE.” |

| | |

|6 |BRIEF RESUME OF THE INTENDED WORK |

| |6.1 INTRODUCTION |

| |BACKGROUND OF THE STUDY |

| |“Health is like money, we never have a true idea of its value until we lose it” |

| |(Josh Billings) |

| |The health care needs of the world’s population are likely to undergo dramatic changes due to the ongoing demographic transition. Mostly |

| |people are facing various health problems due their stress filled professional lives that cause imbalances in their personal lives too. |

| |It’s high time for people to think and over check their daily activities and eating habits to keep safe on their heart5. |

| |"You have a really big heart" is usually a wonderful compliment — except when it comes from a cardiologist and the term cardiomyopathy |

| |crops up in the conversation. An oversized heart usually isn't a good sign. Cardiovascular disease (CVD) is the Nation's leading killer for|

| |both men and women among all racial and ethnic groups. Among cardiovascular diseases, cardiomyopathy is the leading cause of heart |

| |transplantation and sudden cardiac death. Cardiomyopathy (CMP) is an acquired disorder in which disease of the cardiac muscle fibers |

| |reduces myocardial contractility or dispensability. The World Health Organization has classified CMP conditions into three general types: |

| |dilated(congestive), hypertrophic and restrictive. Worldwide cardiomyopathy with high morbidity and mortality rate is a reason for the need|

| |of heart transplantation in persons under forty years of age3. |

| |Most people with cardiomyopathy lead normal lives with no significant problems, however in some cases of cardiomyopathy can cause dangerous|

| |complication such as heart failure, mitral valve problem and arrhythmia such as ventricular tachycardia, ventricular fibrillation etc. |

| |These abnormal heart rhythms can cause sudden death. Some people live long, healthy lives despite having cardiomyopathy. Some people don't |

| |even realize that they have the disease because they have no symptoms. In other people, the disease develops rapidly, symptoms are severe, |

| |and serious complications develop. Nurses can do much to reduce symptoms and help people live healthy lives. Care of patients with |

| |cardiomyopathy presents the cardiac nurse with many challenges. Anxiety levels are high, especially in symptomatic patients. Cardiomyopathy|

| |is genetically inherited in many cases, giving rise to fear of transmission and issues surrounding genetic counselling. The nurse is in an |

| |ideal position to help guide the family through the difficult stages of diagnosis and treatment and support the family through the |

| |screening process. It is vital that each patient continues to receive regular follow-up care and that their families have regular |

| |screening2. |

| | |

| |6.2 NEED FOR THE STUDY |

| |According to the American Heart Association 2009 publication on heart disease statistics, cardiovascular disease (CVD) remains the leading|

| |cause of mortality in the United States in men and women of every major ethnic group. It accounts for nearly 1.4 million deaths per year as|

| |of 2007 and was responsible for one in almost three deaths in the United States in 2009. In the United States, at least 0.7% of cardiac |

| |deaths are attributable to cardiomyopathy. The mortality rate for cardiomyopathy in males is twice that of females, and for blacks it is |

| |2.4 times that of whites6. |

| |In India, the prevalence of hypertrophic cardiomyopathy (HCM) in the general population is 0.2%. The annual rate of sudden cardiac death |

| |secondary to HCM ranges from 0.5% to 1.5%. Four-percent of patients with HCM die each year. Dilated cardiomyopathy (DCM) probably |

| |contributes the great majority of these cases. DCM (all types) causes one-third of chronic heart failure cases. In 2006, 24,703 deaths were|

| |attributed to cardiomyopathy, although no consensus exists on classification and diagnostic criteria for the disease6. |

| |Cardiomyopathy is also one of the life threatening risks leading to heart failure. It is also leading cause for heart transplantation. |

| |Hence appropriate nursing care of pre and post transplantation patient has become increasingly challenge for the clinical nurse |

| |specialists. Present standard of care treatment options for cardiomyopathy include medical management, lifestyle changes, and surgical |

| |procedures including left ventricular assist devices as a destiny therapy or bridging to heart transplantation. Even despite advances in |

| |drug therapy, mechanical assist devices, and organ transplantation, more than half of the persons with cardiomyopathy will die within 5 |

| |years of diagnosis16. |

| |The Center for Health Services Research, United Kingdom suggested that, nurses should be provided with sound knowledge on cardiac symptoms |

| |and risks so that they can increase their knowledge and educate patient accordingly and in particular, can correct cardiac misconception |

| |about the condition, prognosis and appropriate life style changes. Advanced training personnel should recognize the need to enhance nurse’s|

| |skills in patient education and rehabilitation10. |

| |A study was conducted in selected hospitals, England to assess the nurse’s knowledge on cardiomyopathy symptoms among 160 patients with |

| |cardiomyopathy cared for by 157 registered nurses working in coronary care or medical ward. The percentage of nurses who correctly |

| |estimated the incidence of symptoms was low, 25% of nurses did not make any correct estimates, and the mean number of correct estimates was|

| |not associated with nurses experience or qualifications. The overall knowledge scale was 9.6 (SD-1.9) Thus the researcher concluded that |

| |nurses should be provided with sound knowledge on cardiomyopathy symptoms so that they can educate patients accordingly7. |

| |An article on heart failure and pharmacological treatment of systolic left ventricular dysfunction to provide nurses the knowledge of |

| |current treatment recommendations. American Heart Association has implemented guidelines to improve the care of heart failure patients. |

| |Nurses would be expected to be familiar with these guidelines, as regulatory agencies will be using these guidelines as a benchmark to |

| |evaluate the quality of care provided to patients with this diagnosis9. |

| |According to the fact and findings, cardiomyopathy is a leading cause of heart transplantation and sudden cardiac death in hospital |

| |admission. It is very essential for staff nurses to provide comprehensive care to minimize severe complication of cardiomyopathy. Above |

| |studies shows that nurse have less knowledge and practice to manage critical condition of cardiomyopathy. |

| | |

| | |

| |Many of the studies and researcher’s own experience reveal an inadequate knowledge among the staff nurses. Hence the researcher wants to |

| |improve the knowledge of staff nurses regarding cardiomyopathy and its management by using a Self Instruction Module. |

| | |

| |6.3 REVIEW OF LITERATURE |

| |The literature review will be presented under the following headings |

| | |

| |Incidence and prevalence of cardiomyopathy. |

| |Management of cardiomyopathy. |

| |Complications of cardiomyopathy. |

| |SIM as an effective teaching strategy. |

| | |

| |Literature related to incidence and prevalence of cardiomyopathy. |

| | |

| |A comparative study was conducted in Madhurai, among 14 hypertrophic cardiomyopathy (HCM) patients with clinical symptoms to study the |

| |association of gene in HLA among patients from South India. The HLA antigen frequency observed among HCM patients is compared with that |

| |found in the control. It was noticed that halotype B51-DR2-DQ3 was significantly associated with HCM patients from South India. Thus the |

| |researcher suggested that HLA-B51 and the related halotype may play a role in the pathogenesis of HCM in Indian patients. |

| |An epidemiological study was conducted in Minneapolic Heart Institute, California among 4111 men and women between 23-35 years of age to |

| |assess the prevalence of Hypertrophic Cardiomyopathy in a General Population of Young Adults. Probable or definite echocardiographic |

| |evidence of HCM was present in 7 subjects (0.17%) on the basis of identification of a hypertrophied, nondilated left ventricle and maximal |

| |wall thickness ≥15 mm that were not associated with systemic hypertension. Prevalence in men and women was 0.26:0.09%; in blacks and |

| |whites, 0.24:0.10%. Ventricular septal thickness was 15 to 21 mm (mean, 17 mm) in the 7 subjects. Only 1 of the 7 subjects had ever |

| |experienced important cardiac symptoms attributable to HCM. ECGs were abnormal in 5 of the 7 subjects. Five other study subjects had left |

| |ventricular wall thicknesses of 15 to 21 mm that were a consequence of systemic hypertension. The results revealed that HCM was present in |

| |about 2 of 1000 young adults. These unique population-based data will aid in assessments of the impact of HCM-related mortality and |

| |morbidity in the general population and of screening large populations for HCM7. |

| |Literature related to management of cardiomyopathy |

| |A prospective study was conducted in USA to determine the effectiveness of surgical management of hypertrophic obstructive cardiomyopathy |

| |among 178 patients. The 5-year late survival of patients undergoing valve operation plus septal myectomy was 51%, and multivariate testing|

| |confirmed the adverse influence on late survival (p=0.008), as well as adverse influences of increasing age (p=0.016) and return to |

| |cardiopulmonary bypass for mitral valve replacement (p=0.038). At follow-up 136 patients (94%) had New York Heart Association class I or II|

| |symptoms. Thus the investigator concluded that for patients with hypertrophic obstructive cardiomyopathy, septal myectomy alone or in |

| |combination with coronary artery bypass grafting produces effective symptom relief, excellent long-term survival, and a low risk of late |

| |cardiac death13. |

| |An interventional study was conducted in France to examine the impact of carvedilol on cardiac neuronal function using |

| |123I-metaiodobenzylguanidine (MIBG) scintiography in dilated cardiomyopathy. Twenty-two patients with chronic heart failure (19 men, 3 |

| |women; mean age, 54 y; age range, 34-64 y) assessed as New York Hospital Association (NYHA) class II or III and with initial resting |

| |radionuclide LV ejection fractions (LVEF) < 0.40 were enrolled in the study. Over a 6-month period, 50 mg/day carvedilol was administered |

| |to these patients. Planar 123I-MIBG scintigraphy provided measurements of cardiac neuronal uptake (as heart-to-mediastinum count activity |

| |ratio [HMR]), 4h after intravenous injection of 185 MBq MIBG. Hemodynamic, clinical, radionuclide LVEF and HMR data were measured at the |

| |outset and after 6 month of carvedilol were compared. The results revealed that Resting heart rate decreased from 81 +/- 13 to 71 +/- 9 bpm|

| |(P = 0.003). Thus the researcher concluded that Carvedilol induces improvements of clinical symptoms and cardiac neuronal and systolic |

| |functions in patients with dilated cardiomyopathy and chronic optimal treatment14. |

| |A study was conducted in Institute of Biomedical research, Austin among 43 patients to evaluate the effectiveness of Coenzyme Q10 in |

| |treatment of cardiomyopathy. The biopsy samples were obtained from the patients after a routine heart catheterization. Six patients were of|

| |class I, 18 of class II, 11 of class III, and 8 of class IV (classified according to guidelines of the New York Heart Association). |

| |Patients of class IV had lower (P less than 0.01) levels of CoQ10 than those of class I. Patients of classes III and IV had a lower (P less|

| |than 0.0001) level than those of classes I and II. Biopsy samples were obtained from five patients after treatment with CoQ10 for 2-8 |

| |months. The increases of CoQ10 levels ranged from 20% to 85%; the mean value was higher (P less than 0.02) than before treatment. Blood |

| |deficiencies also increase with severity of disease, but not as markedly as for the biopsies. The results revealed that therapy with CoQ1o |

| |can result in a profound increase both in cardiac function and in the quality of life of a failing cardiac patient. Thus the researcher |

| |concluded that myocardial deficiency of CoQ10, which is higher with increasing severity of disease and is reduced by therapy. This |

| |biochemistry shows the effective treatment of cardiomyopathy with CoQ1O8. |

| |Literature review regarding complications regarding cardiomyopathy |

| |A cohort study was conducted in a referral clinic, UK to determine whether pregnancy is well tolerated in hypertrophic cardiomyopathy among|

| |127 consecutively referred women with hypertrophic cardiomyopathy. Forty (31.5%) underwent clinical evaluation before pregnancy. The |

| |remaining 87 (68.5%) were referred after their first pregnancy. All underwent history, examination, electrocardiography, and |

| |echocardiography. Pregnancy related symptoms and complications were determined by questionnaire and review of medical and obstetric records|

| |where available. Thirty six (28.3%) women reported cardiac symptoms in pregnancy. Over 90% of these women had been symptomatic before |

| |pregnancy No complications were reported in 19 (15%) women who underwent general anaesthesia and in 22 (17.4%) women who received epidural |

| |anaesthesia, three of whom had a significant left ventricular outflow tract gradient at diagnosis after pregnancy. Three unexplained |

| |intrauterine deaths occurred in women taking cardiac medication throughout pregnancy. No echocardiographic or clinical feature was a useful|

| |indicator of pregnancy related complications. Thus the investigator concluded that most women with hypertrophic cardiomyopathy tolerate |

| |pregnancy well. However, rare complications can occur and therefore planned delivery and fetal monitoring are still required for some |

| |patients11. |

| |A prospective study was conducted in UK to evaluate the prognosis and mortality associated with cardiomyopathy among 119 patients with |

| |hypertrophic obstructive cardiomyopathy, have been followed up for an average of 4·6 years. Familiar or suspected familial disease was |

| |present in 39 patients. Patients with angina pectoris as a sole complaint were found to have a better prognosis than those with dyspnœa at |

| |rest. The commonest complications were embolism (11 patients), atrial fibrillation (10 patients), arterial hypertension (5 patients), and |

| |infective endocarditis (3 patients). The intensity of the systolic murmur tended to decrease during the follow-up period. The commonest |

| |mode of death was sudden (19 patients). Young males with familial disease tended to be more prone to die suddenly than other groups. |

| |Beta-blockade, in small doses at least, does not protect patients from dying suddenly. The estimated mortality was 15% at five years and |

| |35% at ten years. The development of atrial fibrillation may represent a natural progression in the course of the disease. Thus the |

| |investigator concluded that hypertrophic cardiomyopathy is associated with some major complications that lead to poor prognosis and |

| |increased mortality12. |

| |Literature related to the effectiveness of SIM |

| |A study was conducted to evaluate the effectiveness of self instructional module in increasing nurse knowledge on cardiomyopathy in |

| |intensive care units. The design was pretest posttest design. Participants were 65 registered nurses working at intensive care department. |

| |There was a significant increase of 20.8%in participant mean knowledge score on the post test based on t-test analysis. This study |

| |concluded that a self instructional module for registered nurses was effective in increasing knowledge of emergency medicine and risk |

| |assessment15. |

| |A study conducted to evaluate the effectiveness of a self instructional module in increasing nurses knowledge of identifying cardiomyopathy|

| |symptoms. Sample size was 262 registered nurses. The study has shown a significant increase of 25.6 percentage in participants mean |

| |knowledge score on the post-test as compared with pre-test. The study concluded with self instructional module for registered nurses was |

| |effective in increasing knowledge of nurses regarding identification of cardiomyopathy symptoms10. |

| | |

| |6.4 STATEMENT OF PROBLEM |

| |“A study to assess the effectiveness of self instructional module on cardiomyopathy and its management among staff nurses at selected |

| |hospital, Mangalore.” |

| | |

| |6.5 OBJECTIVES |

| |To assess the prior knowledge of students regarding cardiomyopathy and its management. |

| |To develop SIM regarding cardiomyopathy and its management. |

| |To find out the effectiveness of SIM in terms of gain in post test knowledge score. |

| |To associate the pre test knowledge score with the selected demographic variables. |

| |6.6 OPERATIONAL DEFINITION |

| |Assess: In the present study, assess refers to valuing the quality of knowledge of staff nurses regarding cardiomyopathy and its |

| |management. |

| |Effectiveness: In the present study, effectiveness refers to the extent to which the SIM has achieved the desired objective. |

| |Self Instructional Module: In the present study, SIM is a learning package planned and prepared on cardiomyopathy and its management |

| |provided to staff nurses with an aim to facilitate self learning. |

| |Cardiomyopathy: In this study, cardiomyopathy refers to a group of heart muscle diseases that primarily affect the structural and |

| |functional ability of the myocardium. |

| |Management of cardiomyopathy: In this study, management of cardiomyopathy refers to those measures which are undertaken to control |

| |symptoms, stop the disease from getting worse, reduce complication and the chance of sudden cardiac death by delivering holistic care. |

| |Selected Hospital: In the present study, selected hospital is the place where the researcher obtains permission and intends to carry out |

| |the study. |

| |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 in a selected hospital, Mangalore. |

| | |

| |6.7 VARIABLES |

| |Independent Variable: In the present study, independent variable refers to SIM on cardiomyopathy and its management. |

| |Dependent Variable: In this study, dependent variable refers to staff nurse’s knowledge regarding cardiomyopathy and its management. |

| | |

| |6.8 ASSUMPTION |

| |The study assumes that, |

| |Staff nurses will have some knowledge regarding nursing management of clients with cardiomyopathy. |

| |Knowledge may vary from person to person. |

| | |

| |6.9 DELIMITATION |

| |The study would be delimited to 50 staff nurses in a selected hospital, Mangalore. |

| | |

| |6.10 HYPOTHESES |

| |All hypothesis will be tested at 0.05 level of significance. |

| |H1: The mean post test score of staff nurses will be significantly higher than mean pre |

| |test knowledge score. |

| |H2: There will be significant association between pre test knowledge score of staff nurses on cardiomyopathy and its management with |

| |demographic variables. |

| |MATERIALS AND METHODS |

| | |

| |7.1.1 SOURCE OF DATA: |

| |Data will be collected from staff nurses in a 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. |

| |O1 --- X --- O2 |

| |E = O2 - O1 |

| |O1= Pre test knowledge of staff nurses on cardiomyopathy and its management. |

| |X = Intervention with SIM in terms of gain in post test knowledge score regarding |

| |cardiomyopathy and management. |

| |O2=Post test knowledge of staff nurses on cardiomyopathy and its management. |

| |E =Effectiveness of SIM |

| | |

| |7.1.3 SETTING : |

| |The study will be conducted in a selected hospital, Mangalore. |

| | |

| |7.1.4 POPULATION: |

| |The population of this study is the staff nurses in a 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 for the present study will be approximately 50 staff nurses in a selected hospital, Mangalore. |

| | |

| |INCLUSION CRITERIA: |

| |Staff nurses who are |

| |able to speak and understand English. |

| |willing to participate in the study. |

| |available at the time of data collection. |

| | |

| |EXCLUSION CRITERIA |

| |Staff nurses who are not |

| |available during the period of data collection |

| |willing to participate in the study |

| | |

| |7.2.5 DEVELOPMENT OF TOOL |

| |Instrument Used |

| |Closed ended questionnaire related to cardiomyopathy and its management |

| |SIM on cardiomyopathy and its management. |

| | |

| |Description Of The Tools |

| |Closed ended questionnaire will be prepared to assess the knowledge of staff nurses regarding cardiomyopathy and its management. |

| |The closed ended questionnaire will have two parts. |

| |Part A- Demographic characteristics. |

| |Part B- Items on cardiomyopathy and its management. |

| |SIM will be prepared on the basis of objectives, literature reviews, pretest knowledge score and 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 in a selected hospital, Mangalore. |

| |The objectives of the study will be explained to the participants and a formal written consent will be taken from the subjects. |

| | |

| | |

| |Pretest will be conducted using structured knowledge questionnaire and a SIM will be given based on the need as found by pretest knowledge |

| |score. The post test will be conducted by using the same questionnaire on the seventh day. |

| | |

| | |

| |7.2.7 DATA ANALYSIS PLAN |

| |The data will be planned and analyzed using descriptive and inferential statistics. |

| |Demographic data will be analyzed by descriptive statistics by using mean, median, standard deviation and mean percentage etc. |

| |Data will be tested at 0.05 level of significance. |

| |Paired ‘t’ test will be used to find the promotion of knowledge through the structured teaching programme. |

| |Association between pre test knowledge scores and selected demographic variables will be found using chi-square test. |

| | |

| |7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? |

| |Yes, a self instructional module on cardiomyopathy and its management will be required to assess the knowledge of staff nurses, in selected|

| |hospital, Mangalore. |

| | |

| |7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTE IN CASE OF 7.3? |

| |Yes, ethical clearance will be obtained from the concerned authority. |

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| |REFERENCE: |

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| |Smeltzer SC, Bare BG. Text book of medical surgical nursing. 10th ed. New Delhi: Lippincott Williams &wilkins; 2004. p. 675-76. |

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| |Lewis SM, Heitkemper MM. Textbook of medical surgical nursing, 6th ed. Missouri: Mosby; 2004. p. 774. |

| | |

| |Hypertrophic cardiomyopathy: Optimism tinged with caution.[cited 2011]. Available from . |

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| |Stephanie C, Naomi.M, Cardiomyopathy. Nursing Times.J.2005 [cited Nov2005]; 101(45):26. Available from |

|7. | |

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| |Shah.B, Mathur.P . Surveillance of cardiovascular disease risk factors in India: The need & scope .Indian J Medical research [cited 2010].|

| |Available from |

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| |Cardiomyopathy.[cited2011].Available ................
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