RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES …



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

|1. |Name of the candidate and address | |AMITHA P. R. |

| | | |FIRST YEAR M. Sc. NURSING |

| | | |KAILKERE RUKMINI SHETTY MEMORIAL COLLEGE OF NURSING |

| | | |SHAKTHINAGAR |

| | | |MANGALORE |

|2. |Name of the Institution | |KAILKERE RUKMINI SHETTY MEMORIAL COLLEGE OF NURSING |

| | | |SHAKTHINAGAR |

| | | |MANGALORE |

|3. |Course of study and subject | |M. Sc. NURSING, |

| | | |MEDICAL SURGICAL NURSING |

|4. |Date of admission to the course | |4.7.2011 |

|5. |Title of the study |

| |EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE OF SELF CARE PRACTICES REGARDING PREVENTION OF SPREAD OF TUBERCULOSIS AMONG |

| |NURSING AND PARAMEDICAL STAFF IN A SELECTED TUBERCULOSIS SANATORIUM AT MANGLORE. |

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|6. |Brief resume of the intended work |

| |Introduction |

| |“A good beginning makes a good ending.” |

| |An important occupational hazard of paramedical staff is their vulnerability to infections from which the patient suffers. |

| |Leprosy, tuberculosis, hepatitis B, and HIV infections are among those which commonly cause anxiety among service providers. If|

| |health care situations are not to place workers health in jeopardy, adequate measures have to be instituted. |

| |Recently many incidences of nosocomial tuberculosis have been reported among patients and paramedical staff. This is attributed|

| |to incomplete implementation of guidelines for handling transmission of tuberculosis in health care facilities. Some guidelines|

| |were provided by Centre For Disease Control. Reports have shown that the hospitals which are following these guidelines have |

| |reduced or eliminated nosocomial transmission of tuberculosis to paramedical staff. Thus health care facilities should be |

| |alerted to the need for preventing transmission of tuberculosis.1 |

| |Tuberculosis is a long standing disease and can affect anyone at any time. Within the last few years many molecular studies |

| |have provided evidence for the presence of mycobacterium tuberculosis complex DNA even in ancient skeletal and mummified |

| |material. Known as a "social evil" at the end of the 19th century, tuberculosis still haunts different countries all over the |

| |world, making victims and causing many deaths. |

| |6.1 Need for the study |

| |Tuberculosis (TB) is an established occupational disease of health care workers (HCWs) and those infected may transmit the |

| |disease to susceptible individuals. It is unfortunate that the prevalence and incidence rates are high even today and with |

| |increasing population, the number of tuberculosis cases has increased in several fields. |

| |A cross-sectional prevalence study was conducted in Tamil Nadu, India on 726 healthcare workers with no prior history of |

| |tuberculosis. The cohort comprised mainly on medical students (31 %), nursing students (17%), and nurses (22%). Fifty percent |

| |healthcare workers were found latently infected. Nurses, nursing students, orderlies, and laboratory staff showed higher |

| |prevalence of infection, and advancing age & employment duration were identified as risk factors.2 |

| |In 2009, out of the estimated global annual incidence of 9.4 million TB cases, 1.98 million were estimated to have occurred in |

| |India, thus accounting for a fifth of the global burden of TB. India is 17th among 22 High Burden Countries in terms of TB |

| |incidence rate. As per the WHO 2009 Global TB Control Report, TB mortality in the country was estimated 42/lakh population in |

| |1990 and 24/lakh population in 2009, and the prevalence of TB in the country has reduced by 67%, from 568/lakh population in |

| |1990 to 185/lakh population.3 |

| |A retrospective study was conducted in healthcare workers in a tertiary care hospital in Tamil Nadu, India. The study results |

| |identified 125 healthcare workers who had been treated for active TB The annual incidence of pulmonary TB was 0.35 to 1.80 per |

| |1,000 persons during this period. The annual incidence of extra pulmonary TB was 0.34 to 1.57 per 1,000. These rates may have |

| |been underestimated because only healthcare workers who underwent TB treatment were counted. In this hospital, a case-control |

| |study showed that low body mass index and employment in medical wards were risk factors for TB disease among healthcare |

| |workers. 4 |

| |Today, there is a growing concern about nosocomial transmission and there is a need to protect nurses and other allied |

| |personals from TB. The risk of transmission of Mycobacterium tuberculi from patients with TB to other patients and healthcare |

| |workers has been recognised for many years. The level of risk varies by patient population and effectiveness of TB infection |

| |control measures. The risk is higher in places where large number of infectious TB patients are being treated, who are not |

| |rapidly diagnosed, isolated and treated, particularly in the absence of other infection control measures such as respiratory |

| |protection. |

| |An experimental study was conducted in United States to determine if an educational program could improve health care workers |

| |attitudes, level of knowledge, and compliance with infection control standards for patients diagnosed with TB. Participants |

| |included 50 staff nurses. The experimental group (35) and control group (15) completed a knowledge test and an attitude survey.|

| |Researchers observed participants for compliance with infection control standards pre-test and post-test. Following an |

| |educational program, the experimental group demonstrated a greater knowledge of TB than the control group who did not |

| |participate in the educational program (F [1.47] = 14.43, p = .000). In addition, the experimental group had a greater |

| |improvement in their Nursing Intervention Observation Tool adherence to respiratory isolation and universal precaution |

| |protocols scores as compared to the control group (F [1.47] = 8.95, p = .004). 5 |

| |The above descriptions, review of literatures and researcher’s own experience had shown that many nursing and paramedical staff|

| |had been infected with TB due to lack of knowledge and practice on self protection measures. |

| |This explains that any healthcare personnel, who are directly involved in patient care are at high risk of pulmonary |

| |tuberculosis if adequate self-protection measures are not followed. So the researcher felt a need to study the knowledge on |

| |practice regarding self-protection measures to prevent pulmonary tuberculosis among nursing and paramedical staff. |

| |6.2 Review of literature |

| |A cross-sectional comparison study was conducted in a rural medical school in India. About 726 healthcare workers aged 18 to 61|

| |years with no history of active tuberculosis were selected. A total of 493 of the healthcare workers had direct contact with |

| |patients with tuberculosis and 514 had BCG vaccine scar. The study aimed at estimating latent tuberculosis infection prevalence|

| |in healthcare workers using the tuberculin skin test (TST) and whole blood interferon γ (IFN- γ) assay. It was found that a |

| |large proportion of the healthcare workers were latently infected. The prevalence estimates of TST and IFN-[pic] assay |

| |positivity were comparable (41%; 95% [CI], 38%- |

| |45% and 40%; 95% CI, 37%-43%, respectively). Increasing age and years in the health profession were significant risk factors |

| |for both IFN-[pic] assay and TST positivity.6 |

| |A systematic review was conducted in to summarize the evidence on the incidence and prevalence of latent TB infection (LTBI) |

| |and disease among health care workers in Low And Middle Income Countries (LMICs), and to evaluate the impact of various |

| |preventive strategies. The prevalence of LTBI among HCWs was, on average, 54% (range 33% to 79%). The annual incidence of TB |

| |disease in HCWs ranged from 69 to 5,780 per 100,000. The attributable risk for TB disease in HCWs, compared to the risk in the |

| |general population, ranged from 25 to 5,361 per 100,000 per year. A higher risk of acquiring TB disease was associated with |

| |certain occupational categories like radiology technicians, patient attendants, nurses, ward attendants, paramedics, and |

| |clinical officers.7 |

| |At a tertiary care hospital in Chandigarh, India estimated the incidence of active TB among health care workers. Among health |

| |care workers already working in the hospital, TB developed in 9 (2%) of 470, for an incidence of 11.2 new cases per 1,000 |

| |person-years of exposure. Extrapulmonary disease developed in two thirds of the residents. Overall, this study showed a high |

| |rate of TB (predominantly extrapulmonary) among those who worked in medical subspecialties. However, most cases were identified|

| |by using clinical criteria, and few were bacteriologically confirmed.8 |

| |A cross-sectional survey was conducted in Melbourne on positive tuberculin skin test (Mantoux) responses among employees in 14 |

| |public hospitals. Healthcare workers were significantly more likely to have a positive tuberculin response than non-healthcare |

| |workers (19.3% versus 13.7%). Multivariable analysis revealed that age, country of birth (high versus low tuberculosis |

| |prevalence), history of BCG, years since last BCG, occupation (healthcare versus non-healthcare worker) and years of hospital |

| |employment were all significantly associated with a positive response. 9 |

| |A prospective cohort study was conducted in Serbian health care workers . A total of 24 HCWs developed active TB in the study |

| |period. The mean incidence rate was 413.2 per 100000 persons for hospital staff in the pulmonary department and 20.3 |

| |per 100000 for other departments. Nurses and technicians were at 7.8 times higher risk of developing TB than doctors. This |

| |study indicates that HCWs were at an increased risk of TB, most likely from nosocomial transmission in high-risk departments.10|

| |An experimental study was conducted at Malaysia in 200 health care workers, with tuberculosis diagnosed. Control group was |

| |health care workers without tuberculosis and working in the same facilities. The study attempted to identify the risk factors |

| |of tuberculosis among study population. Data were collected through structured interviews and receives of patient record. The |

| |results show that notification rate of tuberculosis among healthcare workers was significantly two times higher than in the |

| |general population. 11 |

| |6.3 Statement of the problem |

| |Effectiveness of planned teaching programme on knowledge of self care practices regarding prevention of spread of TB among |

| |paramedical staff of selected tuberculosis sanatorium at Mangalore. |

| |6.4 Objectives of the study |

| |To determine the knowledge of nursing and paramedical staff regarding self care practices on prevention of spread of |

| |tuberculosis as measured by structured knowledge questionnaire. |

| |To assess the effectiveness of planned teaching programe on self care practices regarding prevention of spread of TB among |

| |nursing and paramedical staff in terms of gain in knowledge score. |

| |To find the association of pre-test knowledge score with selected demographic variables. |

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| |6.5 Operational definitions |

| |Effectiveness: In this study it refers to the extent to which the Planned Teaching Programme has achieved the desired effect as|

| |assessed by gain in knowledge score. |

| |Planned Teaching Programme: In this study the planned teaching programme designed to provide information to paramedical staff |

| |on self care practices regarding prevention of spread of TB. |

| |Pulmonary Tuberculosis: In this study pulmonary tuberculosis is an infectious disease, which primarily affects the lung |

| |parenchyma, caused by mycobacterium tuberculii. |

| |Self care practice: In this study self care practice includes the practices such as protection of self, hygienic practices, |

| |health promotion practices, handling infected material and supervision of environment. |

| |Prevention : In this study it refers to measures which are taken to avoid the spread of TB. |

| |Nursing staff: In this study nursing staff refers to those who have completed Basic B. Sc. nursing or GNM nursing and working |

| |as a registered nurse in the TB sanatorium. |

| |Paramedical staff: In this study it refers to the staff supplementary to the medical profession such as laboratory technicians,|

| |X-ray technicians, physiotherapists and attenders. |

| |6.6 Assumptions |

| |Nursing and paramedical staff in a TB sanatorium have some knowledge on self care practices regarding prevention of spread of |

| |TB. |

| |Nursing and paramedical staff can be motivated to assume their responsibilities towards their health. |

| |6.7 Hypotheses |

| |The following hypotheses is tested at 0.05 level of significance: |

| |H1: There is a significant difference between pre test and post test level of knowledge on self care practice among nursing and|

| |paramedical staff on prevention of spread of TB. |

| |H2: There is a significant association of the pre test level of knowledge of self care practice on prevention of spread of TB |

| |with selected demographic variables. |

| |6.7 Delimitations |

| |The study is delimited to the nursing and paramedical staff who |

| |are willing to participate in the study. |

| |are working in a selected TB sanatorium at Mangalore. |

| |are available during the time of data collection. |

|7. |Material and methods |

| |7.1 Sources of data |

| |The data will be collected from the nursing and paramedical staff those who are working in selected TB sanatorium at Mangalore.|

| |7.1.1 Research approach |

| |An evaluative research approach will be used for the present study. |

| |7.1.2 Research design |

| |Pre-experimental one group pre-test, post-test design. |

| |7.1.3 Setting |

| |The study will be conducted in a selected TB sanatorium at Mangalore. |

| |7.1.4 Population |

| |Population of the study is the nursing and paramedical staff working in selected TB sanatorium at Mangalore. |

| |7.1.5 Variables |

| |Variables of the present study are : |

| |Independent variable: Planned teaching program on self care practices regarding prevention of spread of TB |

| |Dependent variable: Knowledge on self care practices of nursing and paramedical staff regarding prevention of spread of TB |

| |Extraneous variables: Personal characteristics which include age, qualification, experience, health of the staff, presence of |

| |any lung diseases or any chronic serious illness in the staff. |

| |7.2 Method of data collection |

| |7.2.1 Sampling procedure |

| |In this study non probability convenient sampling technique will be used to select the sample. |

| |7.2.2 Sample size |

| |The sample size of the study will be 40 nursing and paramedical staff working in TB sanatorium at Mangalore. |

| |7.2.3 Inclusion criteria |

| |Nursing and paramedical staff those who are working in the TB sanatorium at Mangalore |

| |Those who are in between the age group of 20-60 years. |

| |7.2.4 Exclusion criteria |

| |Those who are not available on the day of data collection. |

| |7.2.5 Instruments intended to be used |

| |Demographic Proforma |

| |Planned Teaching Programme |

| |Structured knowledge questionnaire |

| |7.2.6 Data collection method |

| |Permission will be obtained from the concerned authority |

| |By using non –probability, convenient sampling technique 40 samples will be selected from the nursing and paramedical staff who|

| |are working in the TB sanatorium. |

| |Purpose of the study will be explained and consent will be taken from the subjects. |

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| |7.2.7 Data analysis plan |

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

| |Descriptive statistics |

| |Frequency and percentage distribution were used to analyze the demographic data of nursing and paramedical staff and their |

| |level of knowledge of self care practices on prevention of spread of TB. |

| |Mean, median, percentage and standard deviations were used to assess the knowledge on self care practices of nursing and |

| |paramedical staff |

| |Inferential statistics |

| |Paired t- test to assess the effectiveness of planned teaching programme on knowledge of self care practices of nursing and |

| |paramedical staff regarding prevention of spread of TB. |

| |Chi-square tests to study the association of pre- test knowledge score with selected demographic variables of nursing and |

| |paramedical staff. |

| |7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals? |

| |Yes, this study involves the intervention of self care practices to prevent the spread of TB among nursing and paramedical |

| |staff working in the TB sanatorium at Mangalore. |

| |7.4 Has ethical clearance been obtained from your institution in case of 7.3? |

| |Yes, ethical clearance will be obtained from the institutional ethical committee. |

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|8. |List of references |

| |Bhanu NV, Banavalikar JN, Kapoor SK, Seth P. Suspected small-scale interpersonal transmission of Mycobacterium tuberculosis in |

| |wards of an urban hospital in Delhi, India. Indian Journal of Tuberculosis. 2004 May; 70(12):527–31. |

| |Ashutosh NA. Tuberculosis transmission at healthcare facilities in India. Indian Journal of Infectious Disease 2009 |

| |Apr–Jun;26(2):33–4. |

| |Chakraborthy AK. Epidemiology of TB: Current status in India. IMJ 2004 Oct;120(4):248-76.[online]. Available from: |

| |URL:ncbi.nlm.pubmed/15520481 |

| |Rajpal S, Mittal A, Dhingra VK. Knowledge, attitude and practices regarding tuberculosis and dots among healthcare workers, |

| |India. Indian Journal of Public Health 2007 Aug;17(8):457-61. |

| |Maciel ELN, Meireles W, Silva AP. Nosocomial Mycobacterium tuberculosis transmission among healthcare workers. American Journal|

| |of Tuberculosis Jul-Aug 2007;40(4):397-9. |

| |Madhukar P, Kaustubh G, Sandeep D. Mycobacterium tuberculosis Infection in Health Care Workers in Rural India Comparison of a |

| |Whole-Blood Interferon gamma Assay With Tuberculin Skin Testing. JAMA 2005;293(22):2746-55. [online]. Available from: |

| |URL: |

| |Rajnish J, Arthur LR, Dick M, Madhukar P. Tuberculosis among health-care workers in low- and middle-income countries: a |

| |systematic review. Journal of Research in Medical Sciences 2006 Dec;3(12):494-8. [online]. Available from: |

| |URL:article/info:doi/10.1371/journal.pmed.0030494 |

| |Hashim DS, Kubaisy W, Dulayme A. Knowledge, attitudes and practices survey among health care workers and tuberculosis patients.|

| |East Mediterranean Health Journal 2005 Jul;9(4):718-31. |

| |Stuart RL, Bennett NJ, Forbes AB. Assessing the risk of tuberculosis infection among healthcare workers: the Melbourne Mantoux |

| |Study. Medical Journal of Australia 2004 Jun 4;174(11):569-73. |

| |Skodric TV, Markovic DL, Nagorni OL. The risk of occupational tuberculosis in Serbian health care workers. International |

| |Journal of Tuberculosis and Lung Diseases 2009 May;13(5):640-5. [online]. Available from: |

| |URL:ncbi.nlm.pubmed/19383199 |

| |Arokiasamy JT. Communicable diseases: a continuing threat in Malaysia. Medical Journal Malaysia 2006 Sep;45(3):45-8. |

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