STATEMENT OF THE PROBLEM:



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALURU, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

|1. |NAME OF THE CANDIDATE AND ADDRESS |Ms. S. A. Thanga Asha Aurelia |

| | |1st YEAR, M.SC.NURSING. |

| | |E.T.C.M. COLLEGE OF NURSING, |

| | |E.T.C.M. Hospital, Post Box No. 4, |

| | |Kolar – 563 101 |

|2. |NAME OF THE INSTITUTION | |

| | |E.T.C.M. COLLEGE OF NURSING, KOLAR |

|3. |COURSE OF STUDY AND SUBJECT |MASTER DEGREE OF NURSING. |

| | |MEDICAL SURGICAL NURSING. |

|4. |DATE OF ADMISSION TO COURSE |    |

| | |01-06-2009 |

|5. |TITLE OF THE TOPIC |“A study to evaluate the effectiveness of planned teaching programme on |

| | |prevention of complication of glaucoma in a selected hospital at Bangalore.”|

BRIEF RESUME OF THE INTENDED WORK

6. INTRODUCTION

Eyes are called the window to soul. Eyes helped us to smile affectionately at our loved ones. They helped us to watch the magnificent colors of a rainbow and the hilarious feathers of a peacock. From the very moment we opened our eyes after birth, they helped us to see, understand and communicate with this world.

The most expressive features of our face are eyes! Our vision is one of those wonderful gifts most of us take for granted. The only time we even have caused to think about our vision as such is when we think about a blind person who has no vision at all, or our own vision begins to fail us. Being aware of the importance of protecting your vision can help you to avoid problems with it in the future.

The number of people with visual impairment world wide in 2002 was in excess of 161 million. 37 million were blind and 124 million had 100 visions. Blindness increases with age. Most common causes of vision loss among elderly are: - Cataract, glaucoma, Age related macular degeneration (AMD) and Corneal opacities. 1

Loss of vision among elderly as a major health care problem. Blindness is considered as short of relatively loss of life.2 Approximately one in three elderly persons has some form of vision. Reducing eye disease by the age of 65 years, 3 vision impairment is associated with a decreased ability to perform activities of daily living and an increased risk for depression. 4

Globally glaucoma is accounting responsible for almost (12.3%) of blindness.

The number of blind persons in India in 2000 was estimated to be 18.7 million. In India prevalence of blindness is 15% per 1000 population (or) 1.84% of total population.

Glaucoma refers to untreated irreversible damage optic nerve and retinal fibers resulting in progressive permanent loss of vision due to increased intra ocular pressure.

Glaucoma progression is typically slow, with gradual loss of vision over days to months. Ageing D.M, exposure to UV rays, antioxidant deficiencies were thought to be causes and risk factor for development of glaucoma.

The number of blind people in the world and the proportion due to glaucoma is increasing results of population growth and increasing life expectancy.

Increased in the elders population will results in a greater number of people with visual loss and blindness from glaucoma.5 the prevalence of glaucoma is high in developing countries. It is mainly due to less awareness of glaucoma among people. Majority of people do not know or believe glaucoma is curable by early prevention.

The ignorance level of blind people can be solved by creating awareness of glaucoma among them. The process of creating awareness (or) making relevant information accessible needs a good understanding of target population in terms of their healthy behavior, literacy level, economic status and barriers to access and logistics of information transmission.

This understanding helps the researcher to create a sound awareness among the target population.

6.1. NEED FOR THE STUDY

We depend on sight more than any other of our senses to maneuver through the space around us. In a single glance, lasting a fraction of a second, our eyes work with our brains to tell us the size, shape, color, and texture of an object. They let us know how close it is, whether it's standing still or coming toward us, and how quickly it's moving. Every day, our eyes give us messages that help us understand the world around us.

Although the eyes are small compared with most of the body's other organs, their structure is incredibly complex. The eyes work together to perceive depth, enabling us to judge distance and the size of objects to help us move around them. Not only do the two eyes work together, they also work with the brain, muscles, and nerves to produce complicated visual images and messages. And our eyes constantly adapt to the changing environment — for example, they are able to adjust so that we can easily move around in a nearly dark room or bright sunlight

As per age related prevalence, old age > 50 years people had highest prevalence of visual impairment represented more than 30% of population in developed countries and 15% of them in developing countries. 6

As per sex related prevalence number of blind women was 24% higher than number of blind man if the current trend of age, sex, cause specific blindness rates continues, prevalence of blindness in India would increase to 2.06% in 2010 with 24.1 million blind persons and to 2.41% in 2020 with 31.6 million blind persons. 7

The rapid assessment of blindness in Karnataka survey 2003 results shows that prevalence rate of blindness 50 years and aged population was 7%. The prevalence rate was higher in females.

One of the causes of blindness among people is glaucoma. The glaucoma blindness creates social mal adjustment in patients by loss of productivity, breakdown of relationship, depressive manifestations, loss of self esteem. These problems will be managed by providing comprehensive eye care services (i. e) provision of services for prevention of preventable blindness, cure of curable blindness and comprehensive rehabilitation, integrated education and creation of public awareness about these services. 8

Glaucoma is the 2nd leading cause for blindness and it is also called as Ocular Alzheimer’s disease.

The recent study done by the international glaucoma association on 6th August 2009. Italy studies tells that 70 million people having glaucoma around the world.

6 million are blind in both eyes and 3 million are blind throughout the world by glaucoma.

A large number of blind people in a country denote, poor socio-economic development and on unresponsive or inefficient eye care service delivery net work in that country. This is because it is well known that 80 to 90 percent of blindness in developing countries today is completely avoidable as it is either preventable or treatable. If the available knowledge, interventions has been timely applied.

The effective way of creating awareness is through mass media communication and effective intervention strategies like condition of planned health education programme to the clients with glaucoma.

The investigator has made an goal directed sincere effort to conduct a study to assess the effectiveness of planned teaching programme on awareness of glaucoma among the clients with glaucoma.

6.2 REVIEW OF LITERATURE:

It is one of the major function of literature review is to ascertain what is already known in relation to problem of interest,

Review of literature is a written summary of the state of existing knowledge on a research problem.

A review of literature involves systematic identification, location scrutinization and summary of written material that contain information on a research problem.

The review of literature is presented under the following broad headings

6.2.1. Studies related to causes and risk factors

6.2.2. Studies related to awareness of eye disease

6.2.3. Studies related to effectiveness of structured teaching programme on glaucoma awareness

6.2.4. Studies related to prevention of complication.

6.2.1. STUDIES RELATED TO CAUSES AND RISK FACTORS

A population-based cohorts studies were done in East Boston, MA; New Haven, CT; and Iowa and Washington Counties, IA to examine the association of sociodemographic factors with functional blindness and visual impairment in an aged population. 71 years and older were screened for bilateral functional near and distant vision during an in-home interview in 1988. Screening was completed by 5335 participants. The results showed that the prevalence of functional blindness increased with age, from 1% at age 71 to 74 years to 17% in those 90 years of age and older. Functional visual impairment increased from 7% at age 71 to 74 years to 39% in those 90 years of age and older. In multivariate analyses, residence in a nursing home, older age, glaucoma, insulin-requiring diabetes at baseline, East Boston site, history of cataract, and lower 1982 income were independent and significantly associated with both functional blindness and visual impairment. Age and nursing home residence were significantly (P < 0.05) more strongly associated with blindness (odds ratios 4.8 and 6.1, respectively) than they were with visual impairment. Functional blindness and visual impairment are quite prevalent among the oldest old and the institutionalized. The number of affected individuals will increase as the population ages and life expectancy increases. Although visual problems were associated with aging, nursing home residence, health problems, and socioeconomic conditions, they may be readily remediable and may lead to immediate improvements in quality of life.9

6.2.2. STUDIES related to awareness OF EYE disease:

A randomized study was conducted in China regarding awareness of eye diseases of elderly population in rural Guangdong. The sample of this study was 535 samples aged 50 years and over were selected by using clustering sampling method were underwent the eye examination and the test of awareness of eye diseases. The study results was shown that 95% of them were aware of the occurrence of eye diseases more than one year, and only 24% of them realized that their eye diseases would be treated. The major barriers for seeking eye care were economic reason, fear of operation, far distance from a hospital, etc. The study concluded that only through patients education and low price services.10

A descriptive study was conducted in south Asian residential area regarding knowledge and awareness of ocular disease in brad fort. The participants were interviewed by a structured questionnaire regarding knowledge of eye diseases. The effectiveness of various sources of eye related information and the importance of early detection of eye diseases. The results was indicated that poor knowledge of self reported eye diseases and importance of early detection and inadequate knowledge of link between the control of systemic diseases and ocular complications. 11

A study was conducted on Chickwawa District on eye care knowledge and practices among Malawian traditional healers including the blindness prevention programme. Representative sample surveys of hundred and seven samples were selected from chickwawa district. Structured interview was conducted regarding eye care knowledge and practice. The experienced of healers practice, literacy and great distance to a health facility were positively related with provision of eye care and most healers were aware of availability of treatment for common eye condition at biomedical health facilities and were interested in collaborating with existing biomedical eye care providers. 12

6.2.3. STUDIES related to effectiveness of structured teaching programme on glaucoma awareness

The study was conducted in the rural underserved community of Oyo state at university of London regarding social cultural influence on eye health results of this study indicated that enhance planning of eye health programme for rural underserved community, their socio cultural factor knowledge was important in design of the programme. Planned intervention of eye health education helps to discover the use of additional eye medicines and understand the importance of glaucoma

6.2.4. Studies related to prevention of complication.

The study was conducted in Mainland China to assess the blindness and low vision rates, and these estimates are likely accurate. However, due to lack of standardization of techniques for assessing cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy, estimates of the burden of these diseases on the population are less reliable. Resources to address eye care problems are more likely to be available. Therefore, an accurate assessment of the burden of various eye diseases is needed in order to improve blindness prevention planning and program development.

STATEMENT OF THE PROBLEM:

“A study to evaluate the effectiveness of a planned teaching programme on prevention of complications of glaucoma among glaucoma patients in a selected hospital at Bangalore.”

6.3. OBJECTIVES OF THE STUDY:

6.3.1. To assess existing level of Knowledge of clients with glaucoma regarding glaucoma.

6.3.2. To evaluate effectiveness of planned teaching programme on prevention of Complication of glaucoma.

6.3.3. To determine association between / selected socio demographic variables of clients with glaucoma with their knowledge and regarding glaucoma.

6.4. OPERATIONAL DEFINITIONS:

i. Evaluate – to find the value or amount of knowledge about prevention of complications of glaucoma.

ii. Effectiveness - In the study it Measures the improvement score in post test when compare with the pre test score after exposing to planned teaching programme.

iii. Planned teaching programme – A Teaching programme on Prevention of Complication of glaucoma which is designed to impart Knowledge specifically for the study.

iv. Awareness - It refers to existing Knowledge regarding glaucoma it is verbal responses of clients with glaucoma, regarding glaucoma as measured by responses for items in structured Interview schedule.

v. Glaucoma – It is a untreated irreversible damage optic nerve & retinal fibers resulting in progressive perm ant loss of Vision. Due to Increased Intraocular pressure.

vi. Clients– Persons who are having glaucoma

vii. Selected Area – It refers to the place for conduction of study i.e. OPD in Bangalore Hospital.

6.5. ASSUMPTIONS:

➢ The Clients with glaucoma will be willing to participate in the study actively.

➢ Clients with glaucoma will have some Knowledge about glaucoma.

➢ The planned teaching programme will improve the knowledge

➢ The response measured by a structured tool will represent the actual knowledge level of clients with glaucoma.

6.6. HYPOTHESIS:

H1: There will be a significant statistical difference between the posttest knowledge scores of experimental and control group.

H2: There will be a significant statistical association between knowledge scores and selected demographical variable.

6.7. VARIABLES UNDER THE STUDY:

1. Independent variable: Planned teaching programme on prevention of complication of glaucoma.

2. Dependent variable: Knowledge of glaucoma patients regarding prevention of complication of glaucoma.

3. Extraneous Variable: Selected socio demographic variables of sample were considered as attribute variable such as age, sex, religion, education, occupation, monthly family income, previous exposure to information.

7.0. MATERIALS AND METHODS:

7.1. SOURCES OF DATA:

Data will be collected from the glaucoma patients attending at the OPD in selected hospital at Bangalore.

7.2.1. RESEARCH APPROACH:

Evaluative research approach.

7.2.2. RESEARCH DESIGN:

True experimental research design with two group pre post test.

7.2.3. SETTINGS:

The study will be conducted in a selected hospital in Bangalore.

7.2.4. POPULATION:

The population for the study comprises of all the patients with glaucoma who are attending the OPD in a selected hospital at Bangalore.

7.2.5. SAMPLING technique:

Simple random sampling technique.

7.2.6. SAMPLING SIZE:

The sampling size consists of 60 patients (30 are control and 30 in experimental group).

7.2.7. CRITERIA FOR SELECTION OF SAMPLE :

i. Inclusion criteria

✓ Both male and female glaucoma patients.

✓ The patients those who are willing to participate in the study.

✓ The patients were able to understand English and Kannada.

ii. Exclusion criteria

✓ Patients who were not available during data collection.

7.2.8. DATA COLLECTION TOOL:

The researcher will collect through structured interview schedule. It consists of 2 parts:

PART I: Demographic variables like age, sex, religion, occupation exposure to previous information, education and income.

PART II: Structured interview schedule regarding prevention of complication of glaucoma.

7.2. METHOD OF DATA COLLECTION:

Structured interview schedule will be used to collect data.

The data will be collected in the following stages:

❖ Ethical consideration: The written permission from the authorities of the selected hospitals will be obtained prior to data collection.

❖ The study participant will be selected by using simple random sampling technique who fulfills the inclusion criteria.

❖ Formal permission will be obtained from study participants after explaining the objectives of study.

❖ Pre test data will be collected by the researcher herself using structured interview schedule regarding prevention of complication of glaucoma.

❖ Conduct post test after 8 days after the teaching programme using the same structured interview schedule.

7.2.9. METHOD OF DATA ANALYSIS:

← Demographic data will be analyzed using descriptive statistics frequency distribution and percentage.

← Knowledge of patients regarding prevention of complication of glaucoma will be analyzed by using descriptive statistics – mean and standard deviation.

← Effectiveness of planned teaching programme analyzed by comparing posttest knowledge scores of experimental and control group using‘t’ test.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUECTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

Yes, non-invasive intervention will be done. The patients with glaucoma will be assessed using structured interview schedule prevention of complication of glaucoma will be conducted for the same group.

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROm INSTITUTION?

1. Permission will be obtained from the authorities of the selected hospitals.

2. Permission will be obtained from the research committee.

3. Informed concerned will be obtained from the subjects enrolled

before the study.

8. LIST OF REFERENCE

1. World health organization. Prevention of blindness and deafness, global mirative for the elimination of anidahle blindness.Henva: WHO: 2000. WHO/pb2/97061.Rev 2.

2. Taylor.A.Association between Nutrition and cataract Nutr Rev 1999; 47: 8,225-34

3. Klaver CL, Wolter RC, Vingerling JR, Hot man A, de Jong PT, Age specific prevalanance and cause of blind ness and vision impairment in an older population.Arch opthamol,2002;116: 653 -8

4. Shumley – Dulitzki y, Rouner B.W, Screening for depression in older persons with low vision, AMJ, Geriatr psychiatry 2000; 5:216-20

5. Foster A, Johnson G. Magnitude and causes of blindness the developing world. Int opthalmol 1990: 14: 135-40

6. Taylor HR. Epidemiology of age related cataract. Eye 2000; 13:445-448

7. Dienn BP, Bourne RRA, Ali S.M. Prevalance and causes of blindness. Br J opthalmol 2003; 87: 820-8

8. Bala Subramaniam R. Population Ageing- A public health challenge journal of public health 2001 ; June : 23(2) ; 112-117.

9. saliv ME, Guralink J, Christen W, Glynn RJ, Closher P,Ostfeld AM

10. Zhongua van ke za zh: patient awareness study of elderly population in rural Guangdong. 2001 Jan; 37 (1): 28-30

|9. |SIGNATURE OF THE CANDIDATE | |

| | | |

|10. |REMARKS OF THE GUIDE |The topic which is selected by the candidate is relevant and appropriate and is attempts |

| | |to increase knowledge of patients about prevention of complication of glaucoma. |

|11. |NAME AND DESIGNATION OF GUIDE |MRS. Anuradha. Y |

| | |Principal |

| | |Medical surgical nursing. |

| | | |

| |ADDRESS : |E.T.C.M college of nursing, Kolar – 563101. |

| |SIGNATURE OF GUIDE | |

|12. |HEAD OF THE DEPARTMENT | |

| | |MS. BEENA MARREL. M |

| |SIGNATURE OF HOD | |

|13. |REMARKS OF CHAIRMAN AND PRINCIPAL |Topic selected is relevant as it empowers the patients knowledge about prevention of |

| | |complications of glaucoma. |

| |SIGNATURE OF PRINCIPAL | |

| | | |

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