SUBHARTI JOURNAL OF NURSING
REFLECTION
A journal of Panna Dhai Maa Subharti Nursing College,
Meerut
Contact Address:
Panna Dhai Maa Subharti Nursing College,
Subhartipuram, NH-58, Delhi Haridwar Meerut Bypass Road,
Meerut-250005
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1;September2016
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CONTENTS
Sl No: Topic Author Page No
1. Reflective Learning Prof. Geeta Parwanda 04-06
2. Value Based Education Mr. Tom Thomas 07-09
3. Challenges In Nursing Education Mrs. Tajnisha Banu 10-11
4. Inspiring Change In Nursing:
Challenges For Future Nurses
Mr. Arun Unnikrishnan 12-13
5. Effectiveness Of Planned Nursing
Intervention ( PNI) Regarding
Genetic Counselling In Terms Of
Knowledge And Attitude Among
Staff Nurses Working In Maternity
Unit In Selected Hospital At
Meerut
Ms. Annu Panchal 14-21
6. Effectiveness Of Self-Instructional
Module On Utilization Of
Contraceptive Devices In Terms
Of Knowledge And Attitude
Among Married Women
Mrs. Nisha Yadav 22-30
7. “A Study To Evaluate The
Effectiveness Of Video Assisted
Teaching Regarding Menopause In
Terms Of Knowledge And
Attitude Among Working Women
In Swami Vivekanand Subharti
University At Meerut”
Ms. Neha Tomar 31-40
8. “A Study To Evaluate The
Effectiveness Of Skill Competency
Programme Regarding Common
Obstetric Complications Among
Staff Nurses In Selected Hospitals
At Meerut. “
Mrs. Pooja Soni 41-50
9. “A Study To Evaluate The
Effectiveness Of Vatp In Terms Of
Knowledge & Attitude Regarding
Assistive Respiratory Home Care
Management Among Patients With
Copd Admitted In Selected
Hospital At Meerut.”
Ms. Rajni Emanwel 51-61
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10. A Study To Evaluate The
Effectiveness Of Self Instructional
Module (Sim) In Terms Of
Knowledge And Attitude
Regarding Home Care
Management Among Patients With
Cancer Admitted Selected Hospital
At Meerut.
Ms. Kusum 62-71
11. “A Study To Evaluate The
Effectiveness Of Video Assisted
Teaching On Knowledge And
Attitude Regarding Organ
Donation Among Selected Degree
College Students At Subharti
University Meerut”
Mrs. Sanju Solanki 72-85
12. “A Study To Evaluate The
Effectiveness Of Planned Teaching
Programme (Ptp) Regarding
Micronutrient Deficiency And Its
Prevention In Terms Of
Knowledge Among Adolescent
Girls In Selected Senior Secondary
Schools At Meerut”.
Ms. Khushboo Rani 86-95
13. A Study To Assess And Evaluate
The Effectiveness Of Structured
Teaching Program Regarding
Prevention And Management Of
Obstetric Near-Miss Events In
Terms Of Knowledge Among
Midwives In Selected Health
Centres, At Meerut.
Ms. Megha Mohan 96-106
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REFLECTIVE LEARNING
Introduction:
Modern society is becoming more
complex, information is becoming
available and changing more rapidly
promoting users to constantly rethink,
switch direction and change problem
solving strategies.
Reflective learning is ability to look
back over an experience and break it
down into its significant aspects, such
as any factors affecting success or
failure
Reflective learning enables us
To accept responsibility for
own personal growth
To see a clear link between the
effort put into development
activity and the benefits get out
of it.
To help see more value in each
learning experience, by
knowing why we’re doing it
and what’s in it for us
Reflecting on learning enables to link
professional development to practical
outcomes and widens the definition of
what counts as useful activity.
As a reflective learner, we’ll think
about how we’ll use new knowledge
and skills in future activities- so
learning is always linked to action, and
theory to practice. It’s also useful to
reflect on how you learn best. This
may be through private study,
networking with peers, formal courses,
mentoring, or a combination of
techniques.
Reflective practice is "the capacity to
reflect on action so as to engage in a
process of continuous learning".
According to one definition it involves
"paying critical attention to the practical
values and theories which inform everyday
actions, by examining practice reflectively
and reflexively. This leads to
developmental insight".
Reflective Practice was introduced by
Donald Schön in his book The Reflective
Practitioner in 1983, however, the
concepts underlying reflective practice
are much older. John Dewey was among
the first to write about Reflective Practice
with his exploration of experience,
interaction and reflection.
Reflective practice can be an important
tool in practice-based professional learning
settings where individuals learning from
their own professional experiences, rather
than from formal teaching or knowledge
transfer. It may be the most important
source of personal professional
development and improvement. Further, it
is also an important way to be able to bring
together theory and practice; through
reflection you are able to see and label
Prof. Geeta Parwanda, Principal, Panna Dhai Maa Subharti Nursing College,
Meerut
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1;September2016
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schools of thought and theory within the
context of your work (2007, McBrien).
Important fact about reflection throughout
the practice is that the person not just look
back on past actions and events, but rather
take a conscious look at the emotions,
experiences, actions, and responses, and
use that to add to the existing knowledge
base to draw out new knowledge, meaning
and have a higher level of understanding
(2013, Paterson, Chapman) As such the
notion has achieved wide take-up,
particularly in professional development
for practitioners in the areas of education
and healthcare. The question of how best
to learn from experience has wider
relevance however, to any organizational
learning environment. In particular, people
in leadership positions have a tremendous
development opportunity if they engage in
reflective practice.
Benefits to Reflective Practice (DAVIS
2012)
Increased learning from an
experience for situation
Promotion of deep learning
Identification of personal and
professional strengths and areas for
improvement
Identification of educational needs
Acquisition of new knowledge and
skills
Further understanding of own
beliefs, attitudes and values
Encouragement of self-motivation
and self-directed learning
Models of reflective practice
The concept of Reflective Practice centers
around the idea of lifelong learning in
which a practitioner analyses experiences
in order to learn from them. However it is
important to note that events experience
and events retold hold their own
importance.
1. Gibbs' reflective cycle or Gibbs'
model of reflection (1988) consist of
following six distinct stages.
Description
Feelings
Evaluation
Analysis
Conclusions
Action plan.
2. Rolfe 2001
Adaptation of the Rolfe Reflective Model
Rolfe’s reflective model is based around
Borton’s 1970 developmental model. A
simplistic cycle composed of 3 questions
which asks the practitioner, What, So
What and Now What. Through this
analysis a description of the situation is
given which then leads into the scrutiny of
the situation and the construction of
knowledge that has been learnt through the
experience. Subsequent to this, ways in
which to personally improve and the
consequence of one’s response to the
experience are reflected on.
3. Gänshirt 2007
Based on Schön's theory and writings of
Otl Aicher, Christian Gänshirt proposes
the concept of the Design Cycle to
describe the reflective and repetitive
structure of design processes, assuming
that this structure is underlaying all such
processes. The Design Cycle is understood
as a circular time structure, which may
start with the thinking of an idea, then
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expressing it by the use of visual and/or
verbal means of communication (design
tools), the sharing and perceiving of the
expressed idea, and starting a new cycle
with the critical rethinking of the perceived
idea.
Application of reflective learning for
health professional
Reflective Practice is associated with
learning from experience, and is viewed as
an important strategy for health
professionals who embrace lifelong
learning. Due to the ever changing context
of healthcare and the continual growth of
medical knowledge, there is a high level of
demand on healthcare professionals'
expertise. Due to this complex and
continually changing environment,
healthcare professionals could benefit from
a program of reflective practice. Price
(2004 ) recognizes that there are several
reasons why a healthcare practitioner
would engage in reflective practice: To
further understand yourself, motives,
perceptions, attitudes, values and feelings
associated with client care; To provide a
fresh outlook to practice situations and
challenge existing thoughts, feelings as
well as actions; To explore how the
practice situation may be approached
differently.
In the field of nursing there is concern that
actions may run the risk of habitualisation,
thus dehumanising patients and their
needs. In utilizing Reflective Practice,
nurses are able to plan their actions and
consciously monitor the action to ensure it
is beneficial to their patient.
The act of reflection is seen as a way of
promoting the development of
autonomous, qualified and self-directed
professionals. Engaging in Reflective
Practice is associated with the
improvement of the quality of care,
stimulating personal and professional
growth and closing the gap between theory
and practice. Activities to promote
reflection are now being incorporated into
undergraduate, postgrduate and continuing
medical education across a variety of
health professions Mann (2009) found
through her research that in practising
professionals the process of reflection
appears to be multifactorial and to include
different aspects. In addition to reflection
both on and during experiences that the
anticipation of a challenging situation also
stimulated reflection. Practicing
professionals vary in their tendency and
ability to reflect.
Thus reflective learning helps how to learn
and add new skill over time and evaluates
our learning experience.
References:
1. http://documents.hants.gov.uk/adultservices/workforce-
development/ProfDevCPDProjectResourcesNotesonReflection.doc
2. http://www.iosrjournals.org/iosr-jnhs/papers/vol4-issue4/Version-3/E04432833.pdf
3. https://www.ukessays.com/essays/business/individual-coaching-in-order-to-improve-
a-particular-aspect-of-employees-behavior-business-essay.php
4. http://www.childcentredpractice.co.uk/Websites/ccp1/Files/Content/1375756/reflective
%20practice%20model.doc
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1;September2016
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Value Based Education (VBE)
“Education means all-round drawing out of the best in child and man – body, mind and
spirit.” (Mahatma Gandhi)
What is mean by education in
modern era? What are the criteria for
quality education? In this modern era, we
giving a proper education or do we receive
a quality education? Education is not only
the things we are learning but also it helps
to understand a positive human values,
sense of direction and vision about how to
create a stable moral society. The thing we
learned doesn’t makes any changes in our
behaviour, compassion, humility,
responsibility or attitude means we have to
improve the quality of education
Today the education system, not
only in India but in all countries, has taken
the wrong turn. No single person is
responsible for this situation. Parents have
failed to bring up their children properly.
The nation’s leaders do not set them a
good example. Even teachers have failed
in their responsibilities. The student of
today is concerned with acquiring wealth,
strength and position, but not good
qualities.
Meaning of value based education:
A value based education seeks to
promote an educational philosophy based
on valuing self and others, through the
consideration of a values vocabulary as the
basis of good educational practices. This
process is called values education.
Education opens our mind, but value based
education (VBE) gives us purity of heart
too; education extends our relationship
with the world, but value based education
link us with our own family members too;
education makes our living better, but
value based education makes our life better
too; education teaches us to complete with
others, but value based education
encourages us to be complete too;
educational makes us a good professional,
but value based education makes us whole
human too; education may bring
limitations but value based education is for
liberation. Value education is simply a
matter of developing appropriate
behaviour and habits involving certain
virtues and habits. It is the `training of the
heart' and consists in developing the right
feelings and emotions.
After all right education means –
“SA Vidya Ya Vimuktye”. It means that
knowledge is what helps us to attain
liberation.
Why is Value Based Education Needed?
In the discussion of this point first of all I
want to ask some questions to you;
Mr. Tom Thomas,
Lecturer, Shri Vinoba Bhave College Of Nursing
Slivassa
Email: [email protected]
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1;September2016
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The quantity of education has
considerably increased, but the
quality has decreased. Why?
The number of educated people
has reached at a high level, but
murder, hatred, and selfishness
have spread out like wildfire
everywhere. Why?
Many institutions are opened,
but only few civilized people
are produced. Why?
Degrees are available for all,
but the dignity has gone down.
Why?
Trained people are produced
from many institutions, but
sincere people are very few.
Why?
Many books are written; much
research is done; many
professional achievements are
attained, but humanity is
threatened. Why?
From the following questions only
one solution is there, and that is the
education should be based on value.
Therefore, we needed VALUE BASED
EDUACTION.
How to implement Value Based
Education?
Talking about Value Based
Education is quite an easy job, but
implementing it is a daunting task, which
needs the strongest determination. First of
all we should all fully agree that without
value based education we can not have a
safe society, a develop country and a
harmonious family environment.
General education can be
transferred, but VBE should be
transformed. VBE is more teacher-based
than textbooks; it is more awakening, not
only informing. It is life-oriented, not
exam-oriented. Therefore, we need to
create a special environment in institutions
to transform VBE in students. First of all,
we need trained, committed and spiritually
motivated teachers for VBE. It is apparent
that all the festivals hold several values
such as environmental, social, scientific
and spiritual. It is therefore imperative to
integrate festivals into teaching / learning
process so as to make children realize
importance and values of the festivals. The
whole environment should be free
from stress, fear and confusion. Actually
VBE does not require any set text books;
rather than that, the whole institution
should be based on VBE.
My experience as a lecturer
and as a student, is that when a school or
college seriously develops the moral and
spiritual aspects of the curriculum is that
those positively contribute to the inner
world of thought, feelings and emotions
…The effect, of developing educational
values is that pupils take greater personal
responsibility for their learning
Value Based Education and nursing:
When we begin to look at nursing
exist is a health profession which is
concerned with promoting and maintaining
the health of the individual, families and
the public, preventing illness, helping
patient with recovery process relieving
suffering and so on. If the nurses are not
giving importance to humanity and the
emotional feeling of an individual or
family they can’t able to full fill the needs
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1;September2016
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of the client and provide adequate support
to them. That’s why it is consider that one
of most important profession which
require value based education to make
them to keep humanity and understand the
emotions of their clients.
References:
1. Dr. Nevil Hawkes:
http://www.valuesbasededucation.com/downloads/articles/vbe.what_is_values_educat
ion.pdf
2. Md. Sarwar Hossain, Value Education- In the Present Scenario,
http://www.academia.edu/3762645/VALUE_EDUCATION_IN_THE_PRESENT_SC
ENARIO
3. Value Based Education;
http://www.uri.org/files/resource_files/Value%20Based%20Education%20by%20Dr.
%20Yogi.pdf
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1;September2016
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CHALLENGES IN NURSING EDUCATION
Aligning Education with the
Practice Environment
As a critical component of the
healthcare industry, the nursing profession
must keep pace with changes in the
healthcare system to insure the continued
delivery of high quality, safe, and effective
patient-centered care. To stay current, new
nurses must be educated and equipped
with relevant and appropriate
competencies, knowledge, skills, and
attitudes. In order to plan for the future, it
is first necessary to assess requirements for
the workforce, based on expectations of
the work environment, and develop the
education required for nurses to fill those
roles.“Healthcare is facing dramatic
changes. An aging population, growing
diversity, the global health care system,
bio-medical advances, and new areas of
knowledge (i.e. genetics, environmental
health) will reshape how we provide care
in the future. To address these changes,
nurses will require more knowledge than
ever before
Use of healthcare information technology
(IT) is expected to continue to grow
significantly. The medical knowledge base
is currently doubling every 5 to 8 years
and that rate of growth is expected to
increase. Technology will assist nurses in
providing safer patient care environments
but will also require them to monitor,
synthesize, and manage greater amounts of
information for the patients entrusted to
their care. The demanding role of the nurse
of the future will require that an RN
possess an expanded knowledge base and
mastery of competencies that will allow
this individual to manage a highly
complex patient care journey in
collaboration and partnership with an
interdisciplinary team.
The American Health Care Association
(AHCA) represents nursing home and
assisted living facilities. Specific issues
that AHCA identified relating to nursing
training include:
Long-term care providers do not
believe that undergraduate nursing
programs are preparing nurses for
successful employment in long-
term care;
Both undergraduate and graduate
nurses need skill sets identified and
agreed upon by educators and
practitioners; and
More emphasis is needed on
community-based nursing and the
spectrum of care services available
to patients.
Faculty Development Challenges
Quality education depends on well-
prepared faculty members. Faculty
development and faculty vacancies are
critical challenges in nursing education.
The nursing shortage poses a significant
threat to healthcare delivery in the future.
Insufficient capacity in nursing schools is a
major contributor to the shortage of nurses
and the shortage of nursing faculty is a
major cause of the capacity constraints In
addition to increasing the number of
faculty members, those educators need the
training to enable them to incorporate
evidence-based teaching practices more
effectively and teach nursing students the
skills that will be required in the 21st
Mrs. Tajnisha Banu,
Reader, Panna Dhai Maa Subharti Nursing College, Meerut.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1;September2016
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century’s healthcare environment. Nursing
schools require faculty who are experts in
nursing education and who must possess
the knowledge to serve in an advanced
practice role. Furthermore, deans of
schools of nursing are needed to
complement these experts and act to create
systems that value and reward expertise in
nursing education.
Both now and in the future, nursing
schools will require faculty who have the
expertise to teach the content that students
will need for effective patient care in
practice environments. These faculties
don’t necessarily need to be experts’ in
particular clinical areas but must have
solid, foundations of understanding and be
able to demonstrate good teaching skills.
As evidenced by the persistent faculty
shortage, this is a difficult issue to address.
Among the major underlying causes
contributing to the nursing faculty shortage
are the aging of faculty, increasing
demands to be involved in non-teaching
university activities, and comparatively
low salaries. Various approaches for
addressing these challenges are discussed
in Section 3 of this report.
Nursing as Part of an Integrated
Healthcare Workforce
There is increasing evidence that inter-
professional healthcare practice
approaches can be effective in improving
patient outcomes and reducing healthcare
costs; however, there are a number of
barriers to establishing effective integrated
teams, including a lack of mutual
understanding of roles and lack of
interdisciplinary training among providers.
To operate effectively as part of these
teams, students need to be trained to
provide inter-professional care and to
participate as a member of inter-
professional teams.
References:
1. http://www.jhsph.edu/academics/residency-programs/prevmed_student_resource/
2. https://www.nursingtimes.net/roles/nurse-managers/without-time-to-think-the-fire-of-
innovation-dies-out/5046487.fullarticle
3. Nursing education : http://sameer-education.blogspot.in/2010/07/nursing-
education.html
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1;September2016
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INSPIRING CHANGE IN NURSING: CHALLENGES FOR FUTURE
NURSES
Introduction:
Change is a universal phenomenon. All
profession will achieve higher reputation
and standard by undergoing various
challenging changes. Presently nursing
profession is facing a lot of challenges in
developing countries like India to achieve
desirable changes to come to the standards
of developed countries. So let us discuss
future changes for the betterment of the
profession.
1. Fulfilling the client demands: In
future the demand and expectation of
clients will be increasing which
makes work force crisis. So the
nurses have to upgrade their
knowledge and skill to maintain
uniform standards of nursing care to
satisfy the increasing demands of
clients. But shortage of nurses and
heavy work load, frequent change in
nursing shifts makes the nurses tired
and along with that inadequate in-
service education facility also makes
it difficult for the nurses to upgrade
their knowledge.
2. Utilization of more advanced
technology in nursing care: Using
advanced technology will be time
saving, more effective in client care
and also brings accuracy in
documentation. But it needs time and
timely up gradation of technological
knowledge which will be too
difficult along with heavy workload
of nurses.
3. Balancing nurse patient ratio:
Presently the nurse patient ratio is
1:5 which is not adequate to provide
standard nursing care. Thus in future
the ratio should be 1:3, which create
crisis due to shortage of skilled,
qualified and experienced nursing
personnel. Mostly nurses are
overburdened and this practice
should be stopped, so that proper
client care can be provided by the
nurses maintaining the standards.
4. Power of authority and decision
making: In present scenario, nurse
administrators are not having the
independent decision making power.
The decisions come from higher
authorities and nurses have to follow
it, which should be changed.
Improving the administrator power
of nurse administrators will upgrade
the status of nurses, increase the
standard of profession and also helps
Arun Unnikrishnan,
Asst. Professor, Panna Dhai Maa Subharti Nursing College, Meerut
Email: [email protected]
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1;September2016
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to make more suitable policies and
making appropriate decisions for the
betterment of the profession. But it
creates criticism and pressure from
higher authorities and lack of co-
operation from sub-ordinates and
other departments.
5. Political leadership: nursing
organizations should be strengthened
and they contest in elections. If
nurses are elected as members of
parliament or decorate higher posts
in the medical/health departments,
the demands of nurses will be
fulfilled by making new and
beneficial policies for nurses. Thus
the status of nurses will be increased.
But they have to struggle for survival
against the present political parties
and their dramas due to lack of
support, money, power and lack of
experience.
6. Involving politics in nursing
educational institutions: Like other
colleges, political involvement of
nursing students should be important
to obtain basic political knowledge
to involve in politics in the future.
The college management and other
political groups may not support the
nurse’s involvement in politics
which will be a challenge to
overcome.
7. Independent nursing practice: In
remote areas nurses can effectively
work as a nurse practitioner, which
will be beneficial for the society. But
the higher authorities are not
approving it and medical people are
trying to suppress it. Even though
INC has started many nurse
practitioner courses, time will show
how effective it is in Indian
Scenario, which is mostly dominated
by doctors. Nurses will have to
struggle a lot to freely work as a
nurse practitioner. Even the
mentality of the society should also
be change for the acceptance of
nurse practitioners.
8. Evidence based practice: Though it
is beneficial for the fast recovery,
satisfaction and cost effective client
care, the nurses are not getting
opportunity to apply it due to the in
acceptance from higher authority.
Nurses are not able to practice based
on evidences found from research
due to the authoritative nature of the
doctors and management which
makes it a challenge in India.
Conclusion:
Though inspiring change in nursing is
effective for client satisfaction as well as
upgrading the profession, the nurse
leaders have to overcome a lot of
challenges to achieve it. Thus we can
expect that our leaders will courageously
face these challenges and bring effective
changes in our profession.
Reference:
1. http://www.nursetogether.co
m/9-common-problems-
nursing-profession
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Effectiveness of Planned Nursing Intervention ( PNI) Regarding Genetic
Counselling in Terms Of Knowledge And Attitude Among Staff Nurses
Working In Maternity Unit In Selected Hospital At Meerut
ABSTRACT:
Aim: To assess the effectiveness of planned nursing intervention regarding genetic counselling
in terms of knowledge and attitude among staff nurses working in maternity unit in selected
hospital at Meerut. Material and Methodology:-. An evaluative research approach was adopted
under the study. The study was conducted in selected hospital at Meerut. Purposive sampling
technique was used to select the staff nurses. The sample comprised of 40 staff nurses of
maternity unit. The tools developed and utilized for the study was structured knowledge
questionnaires and structured attitude scale on genetic counselling was developed. A planned
nursing intervention was prepared to regarding genetic counselling for staff nurses. Reliability of
knowledge questions was established by (KR-20) Formula (r=0.80), and reliability of attitude
scale was established by Cornbach’s alpha (r=1.0) in pilot study was done to find out the
feasibility of the study. Results:- The study revealed that the mean post-test knowledge score
(35.07± 3.93) of staff nurses regarding genetic counselling were higher than the mean pre-test
knowledge (17.83±5.00).The mean post test attitude scores (83.35±6.55) is higher than the mean
pre-test attitude scores (54.27±8.71). The correlation co-efficient between post-test knowledge
and post-test attitude scores of staff nurses was 0.678 which indicated a significant positive
relationship between knowledge and attitude among staff nurses regarding genetic counselling.
Work place and attendance in any skilled training programme was found to be significant with
the level of knowledge of staff nurses. Conclusion:- The study concludes that the planned
nursing intervention was an effective strategy in improving knowledge and attitude of staff
nurses regarding genetic counselling. More educational strategies can be undertaken to enhance
the knowledge of staff nurses and improve the attitude of staff nurses towards the genetic
counselling.
Keywords:- Evaluate, Effectiveness, Knowledge, Attitude, Genetic counselling, Planned
nursing intervention, Staff nurses, Maternity Unit.
Ms. Annu Panchal,
MS.c Nursing Student, Dept. of OBG Nursing,
Panna Dhai Maa Subharti College of Nursing, Meerut. U.P, India
E-mail: [email protected]
GUIDE
Prof. Kalpana Mandal,
Dean, Panna Dhai Maa Subharti College of Nursing, Meerut. U.P, India
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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INTRODUCTION
God could not be everywhere, so he created mothers. Mother is the precious
person for any baby because of her unconditioned love and heartfelt care. Mother and
baby are interdependent. Pregnancy period could be the most exciting time because she used to
dream a healthy baby. No mother in the world likes her baby to get any kind of genetic
disorder. The happiness of a family depends on the health of the children. In order to prevent
these disorders , there are measures that help include avoidance of teratogenic exposures and
radiation, smoking, drinking alcohol, medical treatment of maternal illnesses, good nutrition,
and routine obstetrical care.
Indians represent one-sixth of the world population and India consists of ethnically,
geographically and genetically diverse populations with several thousand endogamous groups. In
some community the load of genetic disorder is relatively high due to consanguineous marriage
practiced in the community. This database has been created to keep track of mutations in the
causal genes for genetic diseases common in India and help the Physicians, Geneticists and other
professionals related to genetic disorders to retrieve and use the information for the benefit of the
families affected with the disorders.
The prevalence incidences of genetic disorders globally, at least 7.6 million children are
born annually with severe genetic or congenital malformations. The genetic and congenital
disorder is the second most common cause of infant and childhood mortality and occurs with a
prevalence of 25-60 per 1000 births. The higher prevalence of genetic diseases in a particular
community may, however, be due to some social or cultural factors. Such factors include
tradition of consanguineous marriage, which results in a higher rate of autosomal recessive
conditions including congenital malformations, stillbirths, or mental retardation. Furthermore,
maternal age greater than 35 years is associated with higher frequencies of chromosomal
abnormalities in the offspring
The study aims at assessing the knowledge regarding genetic counselling among staff
nurses of selected hospital. The main objectives of the study were to assess and evaluate the
knowledge and attitude of the staff nurses regarding genetic counselling before and after the
administration of planned nursing intervention (PNI). To determine the relationship between post
test knowledge and attitude of the staff nurses regarding genetic counselling. To find out the
association between post test knowledge and attitude with selected demographic variables.
Background: Though a newborn brings in its wake untold happiness to those around, there are
some unfortunate babies whose birth is clouded with sadness and worry for the parents because
of the birth defects. Most birth defects are present within the first three months of pregnancy,
when the organs are forming. Some birth defects require long-term medical treatment.
Prevalence and incidences of genetic disorders globally, at least 7.6 million children are born
annually with severe genetic or congenital malformations. The genetic and congenital disorder is
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:16
the second most common cause of infant and childhood mortality and occurs with a prevalence
of 25-60 per 1000 births. The higher prevalence of genetic diseases in a particular community
may, however, be due to some social or cultural factors.
METHODOLOGY
Research design: Pre-Experimental research design:- One group pretest-posttest design is
consider as most suitable design.
Research Approach: Evaluative approach
Population: The staff nurses working in maternity unit in selected hospitals at Meerut
Sample Size: 40 staff nurses of maternity unit.
Setting: The study was conducted in selected Hospital at Meerut.
Variables
Independent Variable: planned nursing intervention regarding genetic counseling.
Dependant Variable: knowledge and attitude of staff nurses regarding genetic counseling
Inclusion Criteria:
a) Staff nurses who are working in maternity unit. b) Staff nurses who are curious to participate
in the study and working in maternity unit. c) Staff nurses who are present at the time of data
collection and registered staff nurse.
Exclusion Criteria: a) Staff nurses who are on leave and sick during the time of data collection.
b) Staff nurses of other unit are not included in the study.
MATERIAL
The tool used for data collection was prepared by the researchers themselves after
extensive review of literature. The tool was then validated by experts in the field of nursing and
obstetrician and paediatrician, Hindi and English languages. The tool has two parts. Part A deals
with the data related to demographic variables of the study participants. Part B- Structured
questionnaire on knowledge of staff nurses regarding genetic counselling. It consists of 42
multiple choice items. The correct answer got score ‘1’ and the wrong answer got the score ‘0’.
The minimum score is 0 and the maximum score is 42. The levels of knowledge are categorized
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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as Score (0-14) -Below average knowledge, Score (15-28) -Average knowledge, Score (29-42) -
Good knowledge. The attitude scale consisted of 20 items concerning attitude related to the
genetic counselling. The levels of attitude are categorized as Score (20-46) -Unfavourable, Score
(47-73)-Favourable attitude, Score (74-100) - Highly favourable attitude. The reliability of the
structured attitude scale was calculated by using Cronbach’s alpha formula. The reliability was
found to be 1.0, which means that the tool was reliable.
METHOD OF DATA COLLECTION
A formal administrative approval from college & Hospital was obtained. A written consent
obtained prior to subjects’ recruitment in the study. They were made comfortable and oriented to
the study. Introduction to the nature of study was given to obtain cooperative response.
Purposive sampling was used to select 40 staff nurses of maternity unit. Confidentiality of their
responses was assured. Pre test of knowledge and attitude was done by administering structured
knowledge questionnaire and attitude scale on day one. On the Day two: Planned nursing
intervention i.e. Planned teaching programme was administered to the group. On the Day seven:
Post test of knowledge and attitude were administered.
Analysis
The present study was designed to assess the knowledge and attitude among staff nurses
regarding genetic counselling. Analysis and interpretation of data are based on the objectives of
study.
OBSERVATION & RESULTS
The distribution of study subjects according to their demographic variables reveals that most of
the subjects i.e. 15(37.5%) were in the age group of 26-30 years. Majority of the subjects i.e.
40(100%) were under the female category. Maximum numbers of subjects i.e. 19(47.5%) were
belongs to senior secondary qualification. Majority of subjects i.e. 35(87.5%) were qualified with
diploma in general nursing midwifery. Most of the subjects i.e. 21(52.5%) were belong to
neonatal unit. Maximum number of subjects i.e. 13(32.5%) had 0-1 year and 1-3 year working
experience and majority of subject i.e. 34(85%) attended any skilled training programme.
The distribution of study participants according to their levels of knowledge regarding genetic
counselling in pre-test 11(27.5%) had below average knowledge and 29(72.5%) had average
knowledge whereas in post- test it was seen that 40(100%) had good knowledge. Hence it can be
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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inferred that the planned nursing intervention was effective in enhancing the knowledge of staff
nurses.
Findings of the Frequency and Percentage Distribution of Pre Test And Post Test
Knowledge Of Staff Nurses Regarding Genetic Counselling
n=40
Knowledge
Level
Pre test Post test
Frequency Percentage% Frequency Percentage%
Below average (0-14) 11 27.5 0 0
Average (15-28) 29 72.5 0 0
Good (29-42) 0 0 40 100
Maximum Score= 42
Table 2 reveals that in pre-test 29(72.5%) were having favourable attitude and 11(27.5%) were
having unfavourable attitude whereas in post- test it was seen that the majority of the sample i.e.
40(100%) were having highly favourable attitude regarding genetic counselling among staff
nurses and none of them had unfavourable attitude and average attitude.
Findings of the frequency and percentage distribution of pre test and post test
attitude of staff nurses regarding genetic counselling
n=40
Attitude
Score
Pre test Post test
Frequency Percentage Frequency Percentage
Unfavourable (20-46) 11 27.5 0 0.0
Favourable (47-73) 29 72.5 0 0
Highly favourable (74-100) 0 0.0 40 100
Maximum Score= 100
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Correlation Co-efficient between Post test Knowledge and Post test
Attitude Score of staff nurses
n=40
Variables Mean SD ‘r’
Post-test knowledge
scores
35.07 3.93 0.678
Post-test attitude
scores
83.35 6.55
Significance at 0.05 level
Table 3 depicted that the correlation co-efficient between post-test knowledge and post-
test attitude scores of staff nurses was 0.678 which indicated a significant positive relationship
between knowledge and attitude among staff nurses regarding genetic counselling. Therefore,
research hypothesis H04 was accepted and the null hypothesis H4 was rejected. It can be inferred
that the planned nursing intervention regarding genetic counselling was effective to develop
highly favourable attitude of the staff nurses towards genetic counselling.
DISCUSSION
On the basis of the objectives of the study and the revealed findings discussion can
be framed as follows:
In relation of the second objective, the finding of the present study shows that the mean
post-test knowledge (35.07) of staff nurses regarding genetic counselling were higher than the
mean pre-test knowledge (17.83). The findings also revealed that post-test knowledge were more
homogenous (SD 3.93) than the pre-test knowledge (SD 5.00), indicating that the group became
more homogenous after the administration of planned nursing intervention.
These findings were consistent with the Swank C (2007)study that is to evaluate the
effectiveness of a self-instructional module in increasing nurses’ knowledge of genetics a study
was conducted on 65 registered nurses working at reproductive health centres using a pre-
test/post-test study design. There was significant increase of 20.8% in participants’ mean
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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knowledge score on the post-test (M = 89.0%, SD = 8%, range = 67%-100%) as compared with
the pre-test (M = 69.0%, SD = 12%, range = 42%-92%), based on paired t-test analysis (t =
11.74, SE = 0.426, p < 0.0001). This study reveals that the pre-test knowledge was inadequate
and post-test knowledge was adequate by using SIM regarding genetic counselling.
The present study findings regarding genetic counselling pre-test post-test knowledge
also consistent with Shobhy SI (2010) and A Gharaibeh (2008).
In relation of the third objective, the finding of the present study shows that the
correlation co-efficient between post-test knowledge and post-test attitude scores of staff nurses
was 0.678 which indicated a significant positive relationship between knowledge and attitude
among staff nurses regarding genetic counselling. It can be inferred that the planned nursing
intervention regarding genetic counselling was effective to develop highly favourable attitude of
the staff nurses towards genetic counselling. These findings consistent with Lalithapriya M
(2008) A study was conducted in Salem on the knowledge of students regarding assisted
reproductive technology. The result of the study revealed that there was significant relationship
between post test knowledge of the subjects and selected demographic variables. The mean
percentage knowledge score in pre-test was 39.8% and that of post-test was 74.5%, which shows
that the PTP was effective in increasing the knowledge. So the researcher recommended that
similar studies can be conducted for the clinical staff.
LIMITATION
The finding of the present study cannot be generalized due to small sample size 40 only which
limits the generalization of the study. The study sample was selected non-randomized purposive
sampling technique which limits the generalization of the findings. The study design lacks a
control group, hence the results of the study can not be generalized.
CONCLUSIONS:-
On the basis of the above findings of the study following conclusions could be drawn. Most the
staff nurses had average knowledge and unfavourable attitude towards genetic counselling. The
planned nursing intervention was effective in enhancing good knowledge of the staff nurses and
highly favourable attitude towards genetic counselling. There was a positive relationship found
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:21
between post-test knowledge and attitude of the staff nurses. There was a significant association
between post-test knowledge of staff nurses with working in neonatal unit
REFERENCES:-
1) G. P. Pal, “ Medical genetics” Published by- A.I.T.B.S. Publishers, India, Edition- 1st,
Page No. 173-175.
2) Kamal Jyoti, “ Genetics for Nurses”, Published by- Kumar Publishing House, Edition-
5th , Page No. 229-241.
3) Suresh K Sharma, “ Human Genetic in Nursing”, Published by- Jaypee Brothers
Medical Publishers (P) Ltd, Page No. 336-340
4) American Academy of Pediatrics, Clinical Practice, Guidance, Diagnosis and
Evaluation of Child with attention deficit hyperactivity disorder pediatric. 2000; 105;5,
1158
5) Am J Med Genet A et al, “Genetic counselling utilization by families with offspring
affected by birth defects” in 2007;143A:1045–1052.
6) Angadi SA, Dandagi SR et al, “A descriptive study on knowledge regarding
teratogenic effect of drugs among staff nurses working in maternity and paediartic
wards of k.l.e’s dr. prabhakar kore charitable hospital, belgaum, Karnataka”, Vol 2,
Issue 12, 2014.
7) Brian T Bateman et al, “Statins and congenital malformations: cohort study”, Published
17 March 2015.
8) Christianson, Howson and Modell, “March of dimes global report on birth defects”,
World Health Organization[ 2013].
9) JK Science, “Pattern of Congenital Anomalies in Newborn”, 2009 [Vol. 11 No. 1,
January-March 2009]
10) Muntaha Al-Alwani1, Ahmed Sameer Alnuaimi et al, “Prevalence of Major Fetal
Defects”, Open Journal of Obstetrics and Gynecology, 2014, 4.
11) National Institute of Health.(n.d.).Specific genetic disorders.Retrieved December 8,
202008, from the National Human Genome Research Institute Web site:
http://www.genome.gov/10001204
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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Effectiveness of Self-Instructional Module on Utilization of
Contraceptive Devices In Terms Of Knowledge and Attitude Among
Married Women
ABSTRACT:
OBJECTIVES: (1) To develops and validates the self-instructional module on utilization of
contraceptive devices for married women. (2) To assess and evaluate the knowledge and attitude
of married women before and after administration of self-instructional module. (3) To determine
the relationship between post-test score knowledge and post- test attitude score of married
women. (4) To find out the association between the post-test knowledge and post- test attitude of
married women with their selected demographical variables. Research design: One group pre-
test post-test pre experimental design. Material: Non- Probability convenience sampling.
Sample Size: Sample size included in the study was 50 married women in selected rural
community area at Baleni. RESULTS: Most of the numbers of married women (28%) were of
the age group of 23-27. The majority of married women were Hindu i.e. (76%). The majority of
married women were house wives i.e. (88%) belonging to family income between 3000-5000
The study revealed that the mean post-test knowledge score was increased (27.36+ 2.562) than
mean pre-test knowledge score (19.18+ 4.587). The mean post-test attitude score was increased
(76.4+ 5.01) than the mean pre-test attitude score (67.06+ 5.26). CONCLUSION: The SIM was
found to be effective in increasing the knowledge and developing favourable attitude of the
married women regarding utilization of contraceptive devices.
KEYWORDS: Evaluate Effectiveness, Knowledge, Attitude, contraceptive devices, Self-
instructional module, and married women.
Mrs. Nisha Yadav,
MS.c Nursing Student, Dept. of Community Health Nursing,
Panna Dhai Maa Subharti College of Nursing, Meerut. U.P, India
E-mail: [email protected]
GUIDE
Ex Capt. Geeta Parwanda,
Principal, Panna Dhai Maa Subharti College of Nursing, Meerut. U.P, India
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:23
INTRODUCTION
“Control the size of population, care about Mother Earth.”
Gulani K.K. (2000) India’s population is increasing very explosively. It contributes one
fifth of the world’s population by having more than one billion people. Population explosion is
found to be the main reason for short ages of resources and neutralization of the impact of
progress made in various development sectors. Hundreds and millions of people still are very
poor, illiterate and unhealthy. It is because resources are limited, population is very large and
every year around 17 million new mouths are added.
According to WHO(2013), family planning has been defined as: “a way of thinking that
is adopted voluntarily, upon the basis of knowledge, attitudes, and responsible decision by
individuals and couples, in order to promote the health and family welfare of the group and thus
contribute effectively to the social development of a country.”
Family planning helps individuals and married one to expect the number of children they
want and the spacing and timing of their births. Contraceptive methods and the treatment of
involuntary infertility can be used to achieve this. A woman’s health and well-being depends on
her ability to space and limit her pregnancies.
BACKGROUND OF THE STUDY:
According to WHO(2013), family planning has been defined as: “a way of thinking that is
adopted voluntarily, upon the basis of knowledge, attitudes, and responsible decision by
individuals and couples, in order to promote the health and family welfare of the group and thus
contribute effectively to the social development of a country.”
The world population which was around 2 billion (2000 million) in 1900, reached about 6 billion
by 2000. According to the 2001 census report, the population growth rate was still around 1.7
per cent, i.e., 17/1000/year, a rate at which our population could double in 33 years. Such an
alarming growth rate could lead to an absolute scarcity of food, shelter and clothing. Therefore,
the government was forced to take up serious measures to check this population growth rate.
METHODOLOGY
Research design: One group pre-test post-test pre- experimental research design
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Research Approach: Evaluative analytical approach
Population: The populations included in the study are the married women in selected rural
community area at Meerut
Sample Size: 50
Setting: The study was conducted in selected rural community area
Variables
Independent Variable: Self-instructional module on utilization of contraceptive devices.
Dependant Variable: Knowledge and attitude of the married women regarding contraceptive
devices.
Inclusion Criteria
Women who are in the age group of 19 – 38 years.
Married female who knows how to read and write Hindi.
Married women who are available at the time of data collection period.
Married women who are willing to participate
Exclusion criteria
Married women who had no formal education.
MATERIAL
The tool used for data collection was prepared by the researchers themselves after extensive
review of literature. The tool was then validated by experts in the field of community medicine,
community nursing faculty and statistics, English and Hindi languages. The tool has three parts.
Part I deals with the data related to demographic variables of the study participants. Part II of the
tool contained 34 items on various aspects such as awareness, contraceptive methods. Types,
uses, and importance, advantages and disadvantage. Part III of the tool 20 related contraceptive
devices.The items were multiple choice type statements. The correct answer got score ‘1’ and the
wrong answer got the score ‘0’. The minimum score is 0 and the maximum score is 34.
After the tryout on 10 married women. Reliability co-efficient of structure knowledge
questionnaire was calculated by using KR-20 formula and of Attitude scale by using Cornbach’s
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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alpha. The reliability of knowledge questionnaire was found to be (r=0.9) and attitude scale was
0.72. Thus the tools were found to be reliable.
METHOD OF DATACOLLECTION
Formal administrative permission was obtained from “Pradhan from community area at
Baleni (Bagphat)”. Data was collected from 16thFebruary to 7th march 2016.
Self-introduction was given.
Introduction to the nature of study was given to obtain free and frank response.
Purposive sampling technique was used to select 50married women.
Confidentiality of their responses was assured and verbal consent was taken.
On the Day-one pre-test was done by administering structured knowledge questionnaire
and attitude scale.
After pre-test Self-instructional module was administered to the group.
On the Day-seven post-test was conducted from knowledge and attitude scale.
Analysis
The data obtained were analyzed in the terms of the objective of the study using
descriptive and inferential statistics. The plan of the data analysis was as follows.
Organize the data on master sheet.
Compute Mean; Mean percentage, standard deviation to describe the data.
Inferential statistics such as paired’ test. The paired ‘t’ test was used to find out the
differences in the scores of Knowledge and skill between pre-test and post-test. The findings of
the study were presented in the form of tables and figures
OBSERVATION & RESULTS
Section I: Finding of demographic of the married women
Majority of the subjects (28%) were in age group 23-27 years. religion wise majority of
the married women were Hindu i.e. 38(76%) . regarding occupation of married women
the majority of respondents of married women were house wife i.e. 44(88%). The
majority of the married women were living in extended family i.e. 22(44%). The large of
the respondents married women education were primary i.e. 17(34%). The larger no. of
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the married women husband income between 3000-5000/ i.e.20 (40%). The majority of
the married women were no. of living children i.e.18 (36%). Regarding previous
knowledge of exposure, the majority of married women having knowledge related to
contraceptive devices i.e. 31(62%).
Section II: Findings related to knowledge scores of the married women
The mean post-test knowledge score (27.36%) of the married women was higher than
their mean pre-test knowledge score (19.18). there was reduction in the standard
deviation from pre-test (4.58) to post-test (2.56). the findings also revealed that the post-
test knowledge scores were more homogenous (SD-2.56) than the pre-test knowledge
scores (SD-4.58), indicating that the group become more homogenous after
administration of self-instructional module.
Section III: Findings related to attitude scores of the married women
The mean post-test attitude score (76.4) of married women was higher than their mean
pre-test attitude score (67.06). There is a reduction in the standard deviation from pre-test
(5.26) to post-test (5.01). The mean and median are closer to each other in both pre-test
and post-test.
Section IV: Findings related to relationship between post-test knowledge and
post-test attitude
That the coefficient of correlation between post-test knowledge scores and post-test
attitude scores is .057 which is less than the table value (.294), it shows that there is not
significant negative relationship exists between mean post-test knowledge and mean post-
test attitude of the married women, which is a true relationship not by chance, hence the
null hypothesis H03 was failed to rejected and research hypothesis H3 was rejected.
Association of Post-test knowledge score with Socio demographic variables(at
0.05 level significance)
S.
N
Demographic variables Sample Knowledge Chi sqr value Df
Level of
significance
at 0.05
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Category
Below
Mean
Above
Mean
Cal.
Value Table
Value
1 Age in years
19-22 3 9
2.2 7.81 3 NS
23-27 7 7
28-32 8 6
33-38 4 6
2 Religion
Hindu 17 27
3.05 7.81 3 NS
Muslim 4 7
Christian 0 0
Sikh 1 0
3 Occupational
House wife 21 23
3.12 5.99 2 NS
Employed
(govt.&prit.) 0 1
Self employed 1 4
4 Family income
3000-5000/ 5 15
7.92 7.81 3 S
5001-8000/ 10 6
8001-11000/ 2 5
12000 or more 5 2
5 Type 0f family
Nuclear family 8 6
1.48 5.99 2 NS
Joint family 6 8
Extended family 8 14
6 Education
Primary 6 11
8.16 7.81 3 S
Secondary 5 0
Higher education 3 8
Graduation or more 8 9
7.
No. of living children
Nil 6 4
7.81
Two 2 7
Three 7 11 3.44 3 NS
Three &more than
three 7 6
8 Previous knowledge of
contraceptive methods
Yes 12 19
0.91 3.84 1 NS No 10 9
Association of Post-test attitude score with Socio demographic variables(at 0.05
level significance)
S.N
Demographic
variables Sample Attitude chi sqr value Df
Level of
significance at
0.05
Category
Below
Mean
Above
Mean Cal.V
Table
V.
1 Age in years 19-22 10 2 8.96 7.81 3 S
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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23-27 4 10
28-32 5 9
33-38 5 5
2 Religion
Hindu 18 20
1.11 5.99 2 NS
Muslim 6 5
Christian 0 1
Sikh 0 0
3 Occupational
House wife 21 23
1.20 5.99 2 NS
Employed (govt.&prit.) 0 1
Self employed 3 2
4 Family
income
3000-5000/ 12 8
2.39 7.81 3 NS
5001-8000/ 7 9
8001-11000/ 2 5
12000 or more 3 4
5 Type 0f
family
Nuclear family 5 9
1.34 5.99 2 NS
Joint family 8 6
Extended family 11 11
6 Education
Primary 10 7
2.95 7.81 3 NS
Secondary 3 2
Higher education 3 8
Graduation or more 8 9
No. of living
children
Nil 6 4
7.81
Two 4 5
7 Three 10 8 2.57 3 NS
Three &more than
three 4 9
8
Previous
knowledge of
contraceptive
methods
Yes 15 16
0.003 3.84 1 NS No 9 10
DISCUSSIONS
The analysis result of the present study shows that the relationships between post-test
knowledge score and post-test attitude of married women regarding utilization of contraceptive
devices with r value of - .057 which was statically significant at P<0.05. Hence null hypothesis
H03 was failed to reject and research hypothesis H3 was rejected.
The finding of present study was supported Ajay Fernanda’s, Anita Anto1, et al 2014 on
Knowledge and Attitude Assessment on Family Planning Methods among Adults in South India:
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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A Correlation Study. The results 56% of the respondents’ are not willing to adopt permanent
family planning method. Regarding knowledge and attitude mean was found to be 63.96% and
72.05% respectively.
There was a positive relationship between knowledge and attitude score 0.321.The
overall findings of the study clearly showed that, adults had good knowledge and positive
attitude towards family planning methods.
LIMITATIONS:-
In this study, existing family planning was collected through likert scale questionnaire, as
per the samples statement. The assessment of physical and psychosocial problems was not
evaluated by researcher as no intervention was taken regarding the same. The researcher mainly
focused on the assessment of the knowledge and implemented the self-instructional module for
the improvement of knowledge regarding family planning.
RECOMMENDATIONS
The study can be replicated on a large sample to validate the findings and to make
generalizations.
A similar study can be done with an experimental research approach considering one
group pre-test- post-test.
A similar study can be conducted to compare the effectiveness of self-instructional
module with strategies like planned teaching programme.
A study can be conducted to carry out to identify the educational needs of the married
women.
A study can be conducted on effectiveness of an information booklet on utilization of
contraceptive devices in terms of knowledge and attitude of married women.
A study can be conducted to assess the incidence of contraceptive devices among married
women.
REFERENCES
1. Polit. DF, Hungler. BP (2000) nursing research: principles and method. 6th edition
Philadelphia: Lippincott publishers;.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:30
2. Suresh K. Sharma. (2008) nursing research and statistics, 1st edition, published by
Elsevier, a division of reed Elsevier India Pvt. Ltd.
3. AroraN.Mittal S, Emergency Contraception and prevention of induced abortion in India;
Journal of family planning Reproductive health care, 2010 Oct. 31(4) 29
4. Correia D.S, Ponter A.C. Adolescents:Contraceptive Knowledge and Use, A Brazilian
Study. Scientic World Journal. 2009 Jan 18(9):37-45.
5. WHO, family planning. Retrieved from, http://www.who.int/topics/family_planning/en/
6. Marriam on human society. Retrieved from http://www.merriam-
webster.com/dictionary/family%20planning
7. Malcolm potts 2012 population explosion. Retrieved from www.populationmatters.org
8. Ministry of health 2013 family welfare. Retrieved from
http://en.wikipedia.org/wiki/Ministry_of_Health_and_Family_Welfare
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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“A STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO ASSISTED
TEACHING REGARDING MENOPAUSE IN TERMS OF KNOWLEDGE
AND ATTITUDE AMONG WORKING WOMEN IN SWAMI
VIVEKANAND SUBHARTI UNIVERSITY AT MEERUT”
ABSTRACT:
Objectives: 1. To develop & validate VAT regarding menopause for working women. 2. To
assess and evaluate the knowledge and attitude of working women before and after
administration of VAT regarding menopause. 3. To findout the relationship between post test
knowledge and attitude of working women regarding menopause. 4. To determine the
association between posttest knowledge and attitude of working women regarding menopause
with their selected demographic variables. Research design: Pre-experimental design. Material:
Non- Probability purposive sampling Sample: working women at swami Vivekananad Subharti
University. Result: The calculated paired ‘t’ value was 17.74 greater then table value 2.01 at
0.05 level of significance which shows that there was a significant improvement in the
knowledge regarding menopause. The calculated paired ‘t’ value was 9.99 greater then table
value 2.01 at 0.05 level of significance which indicates that working women have favourable
attitude towards menopause. Conclusion: The result of the study reveals that VAT was found to
be effective in increasing the knowledge and developing favourable attitude of the working
women.
Keywords: Evaluate, Effectiveness, Knowledge, Attitude, Menopause, Video assisted teaching,
Working women.
Ms. Neha Tomer,
M.Sc. Nursing, Obstetrics & Gynecology Nursing,
Panna Dhai Maa Subharti Nursing College, Meerut, U.P.
E-mail: [email protected]
GUIDE
Ex Capt. Geeta Parwanda,
Principal, Panna Dhai Maa Subharti College of Nursing, Meerut. U.P, India
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:32
INTRODUCTION
“Menopause is a perfectly natural process. As family members and friends recognize that
this is a normal process and learn about the normal symptoms, they will then treat the women
like she’s normal and natural rather than crazy women.”
-Pamela Boggs
Women are the vital set up and heart of the family. When women have been tired, family
junction would be altered. Women are facing lot more problems through their life. One of most
common problem they are facing is menopausal symptoms due to hormonal changes during their
middle adulthood. The menopausal problems of women always make them so tired. So they need
treatment and health education regarding menopausal care and prevention of problems.
When a women’s hormone balance begins to shift, she may have menstrual cycles with
no ovulation called anovulatory cycles. She may begin to have menopausal symptoms.
Menopause is that stage in women’s life when both physiological and emotional changes in their
bodies are precipitated by hormonal deficiencies as a result of age. Menopause, estrogen levels
drop because the ovaries ability to produce enough estrogen has weakened.
VG Padubidri SN Daftary (2008), Menopause is the permanent cessation of menstruation
resulting in the loss of ovarian follicle development. It is considered to occur when 12 menstrual
cycles are missed. Menopausal transition, or perimenopause, is the period between the onset of
irregular menstrual cycles and the last menstrual period. This period is marked by fluctuations in
reproductive hormones as menstrual irregularities, prolonged and heavy menstruation intermixed
with episodes of amenorrhea, decreased fertility, vasomotor symptoms and insomnia. India has
large population, which has already crossed the 1 billion mark with 71 million people over 60
years of age and the no of menopausal women about 43 million.
MATERIALS & METHODS
Research Approach: Evaluative analytical approach
Research design: One group pre-test post-test pre-experimental design
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:33
Population: working women ( daily wagers working as labourer) in Swami Vivekanand Subharti
University
Sample Size: 50
Setting: Swami Vivekanand Subharti University
Variables
Independent Variable: In this research study, independent variable is Video Assisted Teaching
Programme regarding menopause.
Dependant Variable: The dependent variable is the condition or characteristics that appears or
disappear as a result of independent variable. In the present study the dependent variable is
knowledge and attitude of the working women regarding menopause.
Inclusion Criteria
(a)Women who are in the age group of 35 – 55 years. (b)Women who are willing to
participate the study.
Exclusion criteria
(a)Women who are not working in at Swami Vivekanand Subharti University. (b)Women
who are not available at the time of data collection. (c)Women who cannot understand Hindi.
TOOLS & METHODS OF DATA COLLECTION
Based on the conceptual frame work and objectives of the study the tools used to collect the data
are structured knowledge interview schedule to assess the knowledge and modified standardized
Bowle’s attitude scale to assess attitude regarding menopause. A written consent obtained prior
to subjects’ recruitment in the study. Subjects were made comfortable and oriented to the study.
Pretest was taken on day one followed by VAT & on 7th day posttest was taken.
Analysis
The present study was designed to assess the effectiveness of Video Assisted Teaching among
working women. Analysis and interpretation of data are based on the objectives of study.
OBSERVATION & RESULTS
The distribution of study subjects according to their demographic variables reveals that most of
the participants 16(32%) in age group 49-51yrs, 15(30%) in 43-45yrs, 12 (24%) in 46-48yrs and
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:34
7(14%) in 52-55yrs under the study. Educational status of working women was 50 (100%) non
formal education. Regarding marital status 50(100%) of working women were married.
Regarding religion 50 (100%) of working women belongs to Hindu religion. Most of the
working women were non vegetarian 33 (66%), and 17(34%) vegetarian. Monthly income of the
working women were 3000- 5000/- 22(44%), 5001-7000/- 15(30%) and 7001 and above
13(26%). As per menopausal status most of the working women were not in menopause i.e.
31(62%) and who have got menopause were 19(38%). As per source of information, 27(54%)
accepted family member as a source of information, 19(38%) accepted health care personnel as a
source of information and 04(08%) accepted TV/Radio/ Electronic media as source of
information.
According to knowledge of working women before and after administration of VAT
The mean pre-test knowledge score of working women was (14.54) with median (14.0) and
standard deviation of (2.69) against maximum scores of 30. The mean post-test knowledge score
of working women was (21.44) with median (21.0) and standard deviation of (3.69) against
maximum scores of 30. The mean difference between pre-test knowledge and post-test
knowledge of the Working women was 6.90. The paired ‘t’ value 17.74 for df (49) was found to
be statistically significant at 0.05 level.
Thus there was striking difference between the mean pre-test and post-test knowledge scores of
the working women which explains that the VAT on menopause was effective in enhancing the
knowledge of working women regarding menopause.
According to attitude of working women before and after administration of VAT
The mean pre-test attitude score of working women was (61.38) with median (62.00) and
standard deviation of (5.90) against maximum scores of 100. The mean post-test attitude score of
adolescents was (72.86) with median (73.00) and standard deviation of (7.32) against maximum
scores of 100. The mean difference between pre-test attitude and post-test attitude of the
Working women was 11.48. The paired ‘t’ value 9.99 for df (49) was found to be statistically
significant at 0.05 level. Thus there was striking difference between the mean pre-test and post-
test attitude scores of the working women which explains that the VAT on menopause was
effective in developing the favourable attitude of the working women regarding menopause.
Result reveals that the coefficient of correlation between post-test knowledge scores and post-test
attitude scores is .177 which was less than the table value (.294), it shows that there is not
significant relationship exists between mean post-test knowledge and mean post-test attitude of
the working women, which is a true relationship not by chance, hence the null hypothesis H03
was failed to rejected and research hypothesis H3 was rejected.
According to association between post-test knowledge and attitude with selected demographic
variables
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:35
There was association of post-test knowledge and attitude scores with monthly income and
menopausal status which was found to be statistically significant at 0.05 level of significance.
This showed that there was impact of these selected demographic variables on knowledge and
attitude of working women regarding menopause.
Whereas association of post-test knowledge and attitude scores with age, education status,
marital status, religion, dietary pattern and source of information were not found to be significant
at 0.05 level of significance. This showed that these demographic variables had no impact on
knowledge and attitude of working women regarding menopause and these were independent of
each other.
Frequency and Percentage Distribution of Demographic Characteristics of the
Working Women
Sl. No. Sample Characteristics n = 50
Frequency %
1. Age
a)
b)
c)
d)
43-45 years
46-48 years
49-51 years
52-55 years
15
12
16
7
30.0
24.0
32.0
14.0
2. Education
a)
b)
No formal education
Primary Education
50
0
100.0
0.0
3. Marital Status
a)
b)
c)
d)
Married
Unmarried
Divorced/Separated
Widows
50
0
0
0
100.0
0.0
0.0
0.0
4. Religion
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:36
a)
b)
c)
d)
Hindu
Sikh
Muslim
Christian
50
0
0
0
100.0
0
0
0
5. Dietary pattern
a)
b)
Vegetarian
Non vegetarian
17
33
34.0
66.0
6. Monthly Income
a)
b)
c)
Rs. 3,000 – 5,000
Rs. 5,001 – 7,000
Rs. 7,001 and above
22
15
13
44.0
30.0
26.0
7. Are you in menopause
a)
b)
Yes
No
19
31
38.0
62.0
8. Source of Information
a)
b)
c)
TV/Radio/ Electronic media
Health care personnel
Family members or Friends
4
19
27
8.0
38.0
54.0
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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Mean, Mean difference, Standard deviation difference, Standard error of mean
difference, paired ‘t’ value of pre-test and post-test knowledge scores of working women
n =50
KNOWLEDGE
TEST
MEAN MD SDD SE MD Paired
‘t’ value
Post-test
Pre-test
21.44
14.54 6.90 2.74 0.38 17.743*
Mean, Mean difference, Standard deviation difference, Standard error of mean
difference, paired ‘t’ value of pre-test and post-test attitude scores of the working women
n =50
ATTITUDE
TEST
MEAN MD SDD SE MD Paired ‘t’
value
Post-test
Pre-test
72.86
61.38
11.48 8.11 1.14 9.99*
DISCUSSION
The Video assisted teaching programme regarding menopause among working women was
developed and given to eleven experts from nursing, obstetrics and gynaecology and naturopathy
field for validation and their suggestions were incorporated. Video assisted teaching programme
regarding menopause is independent variable in the present study which is developed to assess
the effectiveness on knowledge and attitude towards menopause.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:38
The findings of the study revealed a significant knowledge score after administration of
video assisted teaching programme.
The mean post-test knowledge score was 21.44, standard deviation was 3.69. The mean
post-test attitude score was 72. 86, standard deviation was 7.32. There is the mean difference of
6.90 between pre-test and post-test of knowledge scores and mean difference of 11.48 between
pre-test and post-test of attitude scores. This indicated that the video assisted teaching
programme regarding menopause was effective in increasing the knowledge and developing
favourable attitude of working women.
This study was supported by Jipsy Sara Ninan (2015) study on effectiveness of video assisted
teaching programme on knowledge and health beliefs regarding osteoporosis among women in
selected hospitals, Chennai. The result reveals that the mean post-test knowledge score in study
group was 17.96 health beliefs score 21.83 were higher than mean pre-test knowledge score in
study group was 6.23 and health beliefs score was 11.83, hence Video Assisted Teaching was
found to be effective in improving the knowledge of women by 9.61% and health beliefs by
10%.
There was no correlation coefficient between knowledge and attitude with‘ r’ value of 0. .177
which was statistically signification at P < 0.05. The findings of present study was supported by
Ensieh Noroozi, (2013), study on Knowledge and attitude toward menopause phenomenon
among women aged 40–45 years. The results showed that the average knowledge score of
subjects was 63.57 ± 10.79, and their average attitude score was 61.21 ± 12.73. In this study, 8%
of the subjects had poor knowledge, 68% had moderate knowledge and 38.5% had good
knowledge. Meanwhile, 81.5% of the women had a positive attitude toward menopause. The
correlation test showed that knowledge and attitude are meaningfully related to economic status
and education level. But, the relationship between knowledge and attitudes of women under
study was not significant.
There was significant association between post-test knowledge score and selected demographic
variables such as monthly income X2 =
6.676 at P = 5.99 and menopausal status X2 =
7.402 at
P=
5.99.
There was significant association between post-test attitude score and selected demographic
variables such as monthly income X2 =
12.629 at P = 5.99 and menopausal status X2 =
6.585 at
P=
5.99.
This present study was supported by Vasundhara (2011) study to determine the knowledge and
attitude of selected groups of women in Andra Pradesh towards menopause and its relationship
with selected variables. Descriptive correlational survey was used for the study. Result revealed
that women lacked knowledge about menopause and negative attitudes in certain areas of
menopause. The knowledge of the women was influenced by their education occupation and
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:39
income. Income and occupation had influenced the attitudes of the women where as education
had on effect on attitude formation.
LIMITATIONS
The study was conducted on a small sample of working women i.e. 50 which limits the
generalization of the study.
The assessment of physical and psychosocial problems was not evaluated by researcher
as no intervention was taken regarding the same. The researcher mainly focused on the
assessment of the knowledge and implemented the video assisted teaching for the improvement
of knowledge regarding menopause.
CONCLUSION
The result of the study reveals that knowledge deficit and less favourable attitude existed
regarding menopause among working women. The VAT was found to be effective in increasing
the knowledge and developing favourable attitude of the working women.
REFERRENCES
1. BT Basavanthappa, “Nursing Research” 2nd edition (2007), Jaypee Publication – New
Delhi, pp 189.
2. BT Basavanthappa, “Nursing Theories” 1st edition (2007), Jaypee Publication – New
Delhi, pp 147-168.
3. D C Dutta, textbook o gynaecology, 5th
edition, 2008, published by new central book
agency (P) LTD, page no. 55-62.
4. A.J. Daley, H.J. Stokes-Lampard, C. MacArthur, (2009) “Exercise to reduce vasomotor
and other menopausal symptoms”, Retrieved : January 8, 2009; Accepted: February 5,
2009; Published Online: March 02, 2009.
5. Akanksha Singh and Shishir Kumar Pradhan (2014), “Menopausal symptoms of
postmenopausal women in a rural community of Delhi, India: A cross-sectional study”, J
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:40
Midlife Health. Retrieved on 2014 Apr-Jun; volume 5(2): page no. 62–67;, doi:
10.4103/0976-7800.133989; PMCID: PMC4071646.
6. Aust N Z J Obstet Gynaecol. 2009, Retrieved Feb 2009, Published online 2013 May 30.
7. Beth Skwarecki (2014), “Exercise Helps Menopause Symptoms and Quality of Life”,
Maturitas. Retrieved on- December 29, 2015; volume- 80: page no. 69-74.
8. B Graman Staery, 2012, “Menopause and mood disorders”, Retrieved April 12.
9. Beverley Ayers, Mark Forsha, Myra S. Hunter, 2010, “The impact of attitudes towards
the menopause on women's symptom experience”, Received: October 29, 2010;
Accepted: October 30, 2010; Published Online: November 19, 2010.
10. Gayathry Nayak, Asha Kamath, Pratap N. Kumar, and Anjali Rao (2014), “Effect of yoga
therapy on physical and psychological quality of life of perimenopausal women in
selected coastal areas of Karnataka, India”, J Midlife Health. 2014 Oct-Dec; 5(4): 180–
185. ; doi: 10.4103/0976-7800.145161; PMCID: PMC4264281
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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“A STUDY TO EVALUATE THE EFFECTIVENESS OF SKILL COMPETENCY
PROGRAMME REGARDING COMMON OBSTETRIC COMPLICATIONS AMONG
STAFF NURSES IN SELECTED HOSPITALS AT MEERUT. “
ABSTRACT:
Objectives: 1. To develop & validate skill competency programme regarding common obstetric
complications for staff nurses. 2. To assess & evaluate the knowledge & skill of staff nurses
before & after administration of skill competency programme regarding common obstetric
complications. 3. To find out the relationship between post test knowledge & skill of staff nurses
regarding common obstetric complication. RESEARCH METHODOLOGY: The research approach
was evaluative with one group pre-test post-test design. The sample consisted of 30 staff nurses.
Non probability purposive sampling method was used. The instrument for the data collection was
structured knowledge questionnaire and observational checklist. Result: The result of major
findings indicated that staff nurses had inadequate knowledge and ineffective skill. Skill
competency programme was found to be a very effective. The mean post-test level of knowledge
is significantly higher than the mean pre-test knowledge score that is 12.17% and 16.80% post-
test with paired “t” =7.598.at P=<0.05 Significant. The mean post-test level of population
comprised of staff nurses skill score is significantly higher than the mean pre-test skill score that
is 14.3% and 20.3% Post-test with paired “ t”8.16 at P= <.0.05 significance Conclusion: Thus
the skill competency programme was found to be effective in enhancing the knowledge & skill
of staff nurses regarding common obstetric complications based on the study finding the
recommendation for future research were also made.
Keywords: Common Obstetric Complications, Skill Competency Programme, Evaluative,
Effectiveness, Staff nurses, Hospital.
Mrs. Pooja Soni
MSC Nursing Student, Dept. Of OBG Nursing, Panna Dhai Maa Subharti College of Nursing,
Meerut.
E-mail: [email protected]
GUIDE
Panna Dhai Maa Subharti College of Nursing, Meerut. U.P, India
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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INTRODUCTION
Pregnancy is not a disease but a normal physiological process, it is associated with certain risks
to health and survival both for the woman and for the infant she bears.( world health
organization) These risks are present in every society and in every setting. In developed
countries they have been largely overcome because every pregnant woman has to take special
care during pregnancy and childbirth. The death of a woman during pregnancy and childbirth is
not only a health issue but also a matter of social injustice.
According World Health
Organization, it is estimated that 150 million pregnancies occur annually.
Worldwide, every minute of every day, one-woman dies of pregnancy related
complications. Nearly 6,00,000 women die each year, of these 99% of death occurs in
developing countries.
Every single woman who dies, 30 women develop life long illness and injuries related to
pregnancy and childbirth.
15% of the woman develops life-threatening complications.
Most maternal deaths in India are caused by complications such as haemorrhage (29%), anemia
(19%), sepsis (16%), obstructed labour (10%), unsafe abortion (9%) and (8%) hypertensive
disorders of pregnancy. Maternal mortality is disease of poverty, affecting woman and their
children, restricted by national borders and of little interest to anyone else.
Every year more than 1,00,000 women Die in india due to cause related to pregnancy.
Maternal death is a tragedy for individual women, for families and for their communities. In
developed countries, the maternal mortality ratio is around 27 per 100,000 live births and in the
developing countries the ratio is 20 times higher. It varies between 480 and 1000 per 100,000
live births depending on the region. Majority 80% of these deaths are preventable by nursing
care
METHODOLOGY
Research design: One group pre-test post-test design
Research Approach: Evaluative approach
Population: The population of present study comprise of all staff nurses who are qualified in
Diploma & Degree Nursing and working in selected hospitals.
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Sample Size: 30 Registered staff nurses working in maternity wards at subharti Hospital Meerut
Setting: The study will be conducting in selected hospitals at Meerut.
Variables
* Independent variable – skill competency programme on common obstetric complications.
. * Dependent variable – knowledge and skill of staff nurses
Inclusion Criteria: 1.. Staff nurses who had been registered from state nursing council. 2.
Staff nurses who are willing to participate in the study. 3. Staff nurses who can read & write
English , Hindi
Exclusion Criteria: 1. Staff nurses who are having managerial responsibility such as nursing
superintendent, ward in charge. 2. Staff nurses who are not available at the time of data
collection.
MATERIAL
The lesson plan on common obstetric complication was prepared based on the review of
literature and expert opinion. The content was made clear and comprehensive. The prepared
lesson plan was given for the content validity to the expert. Based on the suggestions and
opinions of the experts , the final lesson plan with A.V Aids was prepared Guidelines was made
for skill competency programme and procedure was discussed with the staff nurses for getting
frank responses. For the content validity of tools and lesson plan of skill competency programme
a criteria rating scale was prepared. It consist of items with three responses for rating against
each criterion like fully met the criteria, partially met the criteria, and mostly meet the criteria
and with the remark column for each criterion. The tools and lesson plans with request letters,
criteria rating scale was submitted to the nine experts from the field of nursing, education and
community medicine for validation, there was 100% agreement on the tools and lesson plans.
There were few corrections which were made and was incorporated.
After the tryout on 10 staff nurses .reliability co-efficient was calculated Structured Knowledge
questionnaire by using KR-20 & formula for skill inter-rater reliability method.
METHOD OF DATACOLLECTION
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For conducting main study formal administrative permission was obtained from the
OBSTETRICAL & GYENOCOLOGY DEPARTMENT IN SUBHARTI HOSPITAL for
selected staff nurses. Data was collected from 26 /2/16 to 5 /3/16
Self introduction was given to the staff nurses of hospital at Meerut.
Introduction to the nature of study was given to obtain free and frank responses
Non probability purposive sampling was used to select the samples.
Confidentiality of their responses was assured and written consent was taken.
On day one pre test done by using structured questionnaire and observation checklist
On day second Skill competency programme was completed by the help of A.V aids
and demonstration.
On day 7 post test knowledge and skill was administered in order to evaluate the
effectiveness of the skill competency programme on common obstetric complications
Analysis
The data obtained were analyzed in the terms of the objective of the study using
descriptive and inferential statistics. The plan of the data analysis was as follows.
Organize the data on master sheet.
Compute Mean, Mean percentage, standard deviation to describe the data.
Inferential statistics such aspaired ‘t’ test, The paired ‘t’ test was used to find out the
differences in the scores of Knowledge and skill between pre-test and post-test. The findings of
the study were presented in the form of tables and figures
OBSERVATION & RESULTS
SECTION I The Socio-demographic variable related to age indicates that maximum (70% ) of
the staff nurses were of aged 25-30 years, 16.7 % of them who were 31-35years,3.3% of them
who were 36-40 years and 10.0% of them who is above 41-45 years. The Socio-demographic
variable related to professional education indicates that 100% of the staff nurses were
professional educated The Socio-demographic variable related to income monthly indicates that
majority of the staff nurses income (n=93.3% ) were 10,000-15,000. 6.7 % were 20,000 and
Most of the (n=70.0%) of staff nurses have not take previous attended course regarding obstetric
emergencies/complications, 30 staff nurses have taken previous course attended regarding
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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emergencies/ complications, Most of the 36.7% staff nurses had 5 year experience 33.3% had 3
years experience, 20.0% had 1 year experience ,10.0 had 2 years experience.
SECTION- II This section represent the Assessment of pre-test level of Knowledge and skill
of staff nurses regarding common obstetric complications.
Area wise Knowledge Gain after skill competency programme
N=30
Assessment of Knowledge among staff nurse of pre-test scores regarding various aspects
of common obstetric complications.pre-test knowledge mean score of 12.17% post-test
knowledge score of 16.80 % They are having average knowledge on all aspects.
The staff nurses pre-test overall Knowledge on common obstetric complications. They are
having 3.30 %of Knowledge before the administration of skill competency Programme.
Assessment skill among staff nurses of pre-test scores 14.3% post-test score
20.0%regarding common obstetric complications aspects They were having initially ineffective
skill on all aspects.
SECTION-III Assessment of Post-test level of Knowledge and skill of staff nurses regarding
common obstetric complications.
KNOWLEDGE
ASSESSMENT
% OF PRE-
TEST
KNOWLED
GE
% OF POST-
TEST
KNOWLEDG
E
%OF
KNOWLEDGE GAIN
1.common obstetric
complications
57.1 84.0 26.9
2.Foetal monitoring 50.0 70.0 8.0
3. Measure blood pressure 90.0 98.0 20.0
4. Weight measure 38.0 58.0 20.0
5. Administration of drugs
in midwifery
74.0 82.0 8.0
Overall 58.4 80.6 22.2
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Assessment of Knowledge among staff nurses of post-test scores regarding various
aspects of common obstetric complications post mean score of 16.80% In Considering the
aspects of common obstetric complications. They are having adequate Knowledge on all
aspects. Table no.9 shows the staff nurses post-test overall Knowledge on common obstetric
complications. They are having 53.3 percent of Knowledge after the administration of skill
competency programme.
Assessment skill among staff nurses in terms of post-test scores regarding various aspects
of common obstetric complications. mean score of post-test skill 20.0%. They are having
effective skill on all aspects. Table no.12 shows the staff nurses post-test overall skill on
common obstetric complications. They are having 53.3% percent of skill after the administration
of skill competency programme.
SECTION IV Comparison of pre and post test Knowledge and skill scores regarding common
obstetric complications among the staff nurses.
Area wise Skill gain after Skill Competency Programme.
N=30
SKILL ASSESSMENT % OF PRE-
TEST SKILL
% OF POST-
TEST SKILL
%OF
SKILL GAIN
1.Foetal monitoring
inspection
48.0 74.0 26.0
2.Measure blood
pressure inspection
51.9 69.3 17.4
3. Measuring weight 40.0 62.0 22.0
4. Administration of
magnesium sulphate
injection
47.8 64.4 16.7
5. Administration of
iron injection
48.0 62.0 14.0
OVER ALL 47.8 66.7 18.9
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Comparison of overall Knowledge of staff nurses before & after Skill competency
ProgrammeOn an average staff nurses improved their Knowledge after Skill competency
Programme The difference between pre and post- test Knowledge score is t= 7.958 significant
and it was significant. Statistical significance was calculated by using paired ‘t’test.
SECTION –V Findings related to the correlation between post test knowledge and post skill
score of staff nurses regarding common obstetric complications represent the correlation in
knowledge and skill among the staff nurses , which is represented ‘r’ value. The calculated value
is r= .349 at the level P=.058 which shows negative correlation between knowledge and skill
which denotes by the investigator that the good knowledge shows effective skills among the
staff nurses after the skill competency programme on common obstetric complications .
DISCUSSIONS
On the basis of the objectives of the study and the revealed finding, discussion can be
framed as follows :
In relation to the second objectives, the findings of the present study shows that in pre-
test staff nurses 96.6% were having average knowledge on common obstetric complications &
3.3%were having good knowledge, where as in pre-test staff nurses were having poor skill
regarding common obstetric complications.
But in post-test 53.3% had good knowledge 46.6% of staff nurses had average knowledge
on common obstetric & post-test skill average staff nurses have 53.3% had good skill & 46.6%
had average skill re finding obstetric complication.
Their finding of knowledge is consistent with ASHLY BABY, JEEVAN(2014)where 54 had
satisfactory knowledge, 38 had poor knowledge & only 8 had good knowledge regarding
management of anemia during pregnancy.
On the basis of the objectives third of the study and the revealed finding, discussion
can be framed as follows :
In relation to the third objectiveThe present study pre-test Knowledge score was 12.17% and the
post test Knowledge score was 16.80%. The difference between pre-test and post-test
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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Knowledge score was 4.6%. Staff nurses’s pre-test level of Knowledge on common obstetric
complications and 96.6% of them were having average Knowledge. After administration of Skill
competency programme the post-test level of Knowledge on common obstetric complications
showed that 53.3% of the staff nurses were having good Knowledge and 46.6% of them were
having average Knowledge. This result is due to the effectiveness of Skill competency
Programme on common obstetric complication.
In the pre-test skill score was 14.3% & the post-test skill score was 20.0% The difference
between pre-test and post-test skill was 57% The level of skill in pre-test shown that 100% of
staff nurses were having average skill and none of them were having good skill towards common
obstetric complications. After Skill competency programme, none of them were having poor skill
and 46.6% staff nurses shown effective skill and 53.3% shows good skill towards common
obstetric complications.
The finding of third objective are supported by Sarika chaturvedi(19 may 2014)
competence of birth attendants at providing emergency obstetric care under
india’sJananisurakshayojana(JSY).
Jananisurakshayojana (JSY) conditional cash transfer program for institutional delivery
To Access emergency obstetric care by competent staff can reduce maternal mortality. India has
launched the JananiSurakshaYojana (JSY) conditional cash transfer program to promote
institutional births. During implementation of the JSY, India witnessed a steep increase in the
proportion of institutional deliveries-from 40% in 2004 to 73% in 2012.
Jananisurakshayojanawasimplemented in three districts of Madhya Pradesh (MP)
province training was arrange for assessing obstetric complications, hemorrhage and eclampsia,
there were 233 birth attendant nurses participated at 73 JSY facilities. Their competence at (a)
initial assessment, (b) diagnosis, and (c) making decisions on appropriate first-line care for these
complications was recorded.
The obstetric care competence score was obtained which showed 75% of participants
scored below 35% of the maximum score. The overall score, although poor, was marginally
higher in respondents with Skilled Birth Attendant (SBA) training, those with general nursing
and midwifery qualifications, those at higher facility levels, and those conducting >30 deliveries
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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a month. In all, 14% of respondents were competent at assessment, 58% were competent at
making a correct clinical diagnosis, and 20% were competent at providing first-line care.
LIMITATIONS
This study was confined to 30 staff nurses which limit the generalization of the findings
The research design lacks a control group hence the result of the study must be
generalized with caution
The sample selection was non- randomize Purposive sampling technique which limits
generalization of the findings.
CONCLUSION
The staff nurses initially had low level of knowledge & poor skill toward common
obstetric complications.
The maximum deficit was found in area of prevention of common obstetric
complications.
The minimum deficit was found in area of meaning of common obstetric complication.
The skill competency programme was found more effective in increasing the knowledge
after administration of skill competency programme regarding common obstetric
complication.
The skill competency were found more effective in developing the good skill toward
common obstetric complications.
REFERRENCES
BOOKS;-
1. Benett R, Linda K Brown. Myles Text book for Midwives. 12th ed. Edinburgh: Churchil
Living Stone; 1993.
2. DC DUTTA, textbook for gynaecology, 5th
edition , 2008 , published by new central book
agency (p) LTD,
3. Dutta D.C, Text book of obstetrics. 7th edition edited by hiralalkonar.
4. International Confederation of Midwives. Essential competencies for basic midwifery
practice. 2013. Available
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:50
5. Fullerton JT, Thompson JB, Johnson P. Competency-based education: the essential basis of
preservice education for the professional midwifery workforce. Midwifery. 2013;29:1129–
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1. Anandalakshmy PN, Buckshee K. Maternal Mortality in a referral hospital of northern India -
A sixteen year review. The Journal of Family Welfare: September 1997; 43 (3): 1-4.
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pregnancy.". Journal of obstetrics and gynaecologyCanada : JOGC = Journal d'obstetrique et
gynecologie du Canada : JOGC 36 (7): 628–31.
3. Fenne D, Essien E, Golji N, Sabitu K, Alti-Mu’azu M, Musa A et al., Improving the quality of
obstetric care at the teaching hospital. International Journal of Gynecology and Obstetrics.1997
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4. French. JI et. al. Gestational bleeding bacterial vaginosis and common reproductive tract
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INTERNET WEBSITES–
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&issue=4&page=597-601&id=2107.
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5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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“A STUDY TO EVALUATE THE EFFECTIVENESS OF VATP IN TERMS OF
KNOWLEDGE & ATTITUDE REGARDING ASSISTIVE RESPIRATORY HOME
CARE MANAGEMENT AMONG PATIENTS WITH COPD ADMITTED IN SELECTED
HOSPITAL AT MEERUT.”
ABSTRACT
Objectives: To prepare and validate VATP regarding assistive respiratory home care
management of COPD patients. To assess and evaluate knowledge & attitude before and after
the administration of VATP. To determine the relationship between post-test of knowledge &
attitude among COPD patients regarding assistive respiratory home care management. To find
out the association between post test knowledge & attitude among COPD patients with their
selected demographic variables. Research design: Pre-experimental design. Material: Non-
Probability purposive sampling Sample: COPD patient. Result: The calculated paired t value
was 13.37 greater then table value 1.699 at 0.05 level of significance which shows that there was
a significant improvement in the level of knowledge. The calculated paired t value was 21.39
greater then table value 1.699 at 0.05 level of significance which indicates that COPD have
favourable attitude, There was a significant relationship between post test knowledge and
attitude which was statically signification. Conclusion: The result reveals that VATP was
effective in increasing the knowledge and developing favourable attitude among COPD Patients.
Keywords: Knowledge, Attitude, COPD, Video assisted teaching Programme, Interview.
Ms. Rajni Emanwel
M.Sc. Nursing, Medical and Surgical Nursing, Panna Dhai Maa Subharti Nursing College,
Meerut, U.P.
E-mail: [email protected]
GUIDE
Ex. Capt. Geeta Parwanda,
Principal, Panna Dhai Maa Subharti College of Nursing, Meerut. U.P, India
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:52
INTRODUCTION:
Chronic obstructive pulmonary disease (COPD) is a major public health problem in India.
Although several International guidelines for diagnosis and management of COPD are available,
yet there are lot of gaps in recognition and management of COPD in India due to vast
differences in availability and affordability of healthcare facilities across the country. The Indian
Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined
hands to come out with these evidence-based guidelines to help the physicians at all levels of
healthcare to diagnose and manage COPD in a scientific manner.
Chronic obstructive Pulmonary Disease (COPD) is not one single disease but an
umbrella term used to describe chronic lung diseases that cause limitations in lung airflow. The
more familiar terms 'chronic bronchitis' and 'emphysema' are no longer used, but are now
included within the COPD diagnosis.The most common symptoms of COPD are breathlessness,
or a 'need for air', excessive sputum production, and a chronic cough. However, COPD is not
just simply a "smoker's cough", but a under-diagnosed, life threatening lung disease that may
progressively lead to death.
COPD is the fourth leading cause of the death worldwide, and it will become 3 rd
leading
cause of the disease by 2020.As per the estimation done by the WHO around 2.74 million
deaths occurs due to COPD, which is 5% of the total death worldwide. Out of this death rate
around 90% of the death occurs due to smoking. This shows that smokers are at the high risk of
developing COPD in their life span. The main reason for this much higher mortality is lack of
awareness of the disease worldwide. COPD is the disease which develops gradually and
generally it is very silent in the initial stages of the disease, so when the people come to know
about the severity and risk of the disease they loss their
50% of the lung functions.
METHODOLOGY
Research design: pre- experimental design
Research Approach: Evaluative research approach
Population: COPD patients
Sample Size: 30
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:53
Setting: selected hospitals at Meerut
Variables
Independent Variable: VATP regarding assistive respiratory home care management
Dependant Variable: The dependent variable is the condition or characteristics that appears or
disappear as a result of independent variable. In the present study, dependent variables are
Knowledge & attitude of COPD patients.
Inclusion Criteria: (a)Patients who were having Mild to Moderate type of COPD patients. (b)
Patients who were suffering from COPD since 1-5 yrs. (c) Patient those who were available
during the data collection period.
Exclusion Criteria: (a)Patients who had severe to very severe type of COPD. (b) Patients who
were on ventilator. (c) Patient who were not willing to participate in the study.
MATERIAL
The tool used for data collection was prepared by the researchers themselves after extensive
review of literature. The tool was then validated by experts in the field of Physiotherapy,
Medicine, nursing and statistics, English and Hindi languages. The tool has two parts. Part I
deals with the data related to demographic variables of the study participants. Part II of the tool
contained 30 items. The items were multiple choice type statements. The correct answer got
score ‘1’ and the wrong answer got the score ‘0’. The minimum score is 0 and the maximum
score is 30.
METHOD OF DATACOLLECTION
A written consent obtained prior to subjects’ recruitment in the study. They were made
comfortable and oriented to the study. Pre-test was given on the day one followed by VATP.
Posttest data was collected after 5 days in the same settings.
Analysis
The present study was designed to assess the knowledge and attitude of COPD patients. Analysis
and interpretation of data are based on the objectives of study.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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OBSERVATION & RESULTS
Distribution of participants according to demographic variables, Regarding age group maximum
numbers of COPD Patients 22 (73.4%) were in the age group between of 50-60 years, 7 (
23.3%) were in the age group of between 50-54yrs.
Regarding gender majority numbers of COPD Patients 25 (83.4%) were male, and 5 (16.6%)
were female.
Regarding educational status showed that most of the COPD patients 17 (56.7%) were had no
formal education, 9 (30%) were had primary education, 3 (10%), were had higher education.
Regarding occupation most of the COPD patients 13 (43.4%) were others (retired pensioner
coolie), 11 (36%) were unemployed, 2 (6.6%) were doing business 3 (10%) were private
employee.
Regarding marital status majority of the COPD patients 28 (93.4%) weremarried and 2 (6.66%)
were unmarried.
Types of the family showed that majority numbers of the COPD patients 26 (86.6%) were living
in joint family and 4 (13.4%) were living in nuclear family.
Regarding income of the COPD patients 13 (43.3%) of them were having monthly income 5001-
8000Rs. 11 (36.6%) were having monthly income above Rs. 8001
Most of the COPD patient 15 (50%) were not a smoker or alcoholic, 14(46.6%) were smoker.
Regarding source of the information about COPD majority of the COPD patients 26 (86.6%)
was obtained information from the health personnel, 3 (10%) from the family members or
friends.
Most of the COPD patients 16 (53.4%) were non vegetarian 8, (26.6%) were vegetarian and 6
(20%) were Eggetarian.
Majority of the COPD patients 27 (90%) were don’t have family history of COPD and 3 (10%)
were had family history of COPD.
Most of the COPD patients 10 (33.3%) were having duration of illness less than 2 yrs, 8
(26.6%) were having illness of 3-4yrs, 6(20%) were having illness of 2-3 yrs and 6(20%) were
having illness of 4-5yrs.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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The pre test mean knowledge score was 17.23 with the S.D. of 3.15. The post test mean
knowledge score was 21.96 with the S.D. of 2.25. The post test mean knowledge score was
higher than the pre test knowledge score.The paired‘t’ test value was 13.35 was greater than the
table value 1.699 which was statistically significant at P < 0.05. It can be inferred that the VATP
regarding Assistive respiratory home care management among patients with COPD was
effective in improving the knowledge which was statistically significant at P < 0.05.
The pre test mean attitude score was 47.51 with the S.D. of 3.766. The post test mean attitude
score was 60.10 with the S.D. of 3.703. The post test mean attitude score was higher than the pre
test attitude score. The paired‘t’ test value was (21.39) was greater than the table value 1.699
which was statistically significant at P < 0.05.
It can be inferred that the VATP on attitude regarding Assistive respiratory home care
management among patients with COPD was effective in developing favourable attitude which
was statistically significant at P < 0.05.
There was a significant relationship between post test knowledge and post test attitude with ‘r’
value of 0.42 which was statically signification at P < 0.05. It also implies that knowledge and
attitude were directly proportional to each other.
Frequency and Percentage Distribution of Demographic Characteristics of the COPD
patients n =30
S.NO SAMPLE
CHARACTERSTICS
FREQUEN
(f)
PERCENTAGE
(%)
1.
AGE IN YEARS
45-49 1 3.3
50-54 7 23.3
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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55-60 22 73.4
2. GENDER
Female 5 16.6
Male 25 83.4
3. Education
No formal education 17 56.6
Primary 9 30
Secondary 1 3.3
Higher education 3 10
4. OCCUPATION
Unemployed 11 36
Business 2 6.6
Govt. Employee 1 3.3
Private employee 3 10
Others ( Retired,
Pensioner, Coolie)
13 43.3
5. MARITAL STATUS:
Married 28 93.44
Unmarried 2 6.66
6. TYPES OF FAMILY
Nuclear family 4 13.4
Joint family 26 86.6
7. INCOME MONTHLY
Rs 2,000-5,000/- 6 20
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:57
Rs 5001-8,000/- 13 43.3
Rs 8,001 Above 11 36.6
8. PERSONAL HISTORY
Alcohol 1 3.33
Smoker 14 46.66
Non alcoholic/ non smoker 15 50
9. SOURCE OF
INFORMATION ABOUT
COPD.
By T V / Radio 1 3.4
By health personnel 26 86.6
By family members or
friends
3 10
10. DIETARY PATTERN
Vegetarian 8 26.6
Non- Vegetarian 16 53.4
Eggetarian 6 20
11. FAMILY HISTORY OF
COPD
Yes 3 10
No 27 90
12. DURATION OF
ILLNESS
Less than 2years 10 33.3
2-3 years 6 20
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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EFFECTIVENESS OF VATP ON KNOWLEDGE REGARDING ASSISTIVE
RESPIRATORY HOME CARE MANAGEMENT AMONG PATIENTS WITH COPD
n= 30
Knowledge
test
Mean Standard
deviation (S.D.)
Mean
Difference
SDD SED Paired ‘t’
value
Pre test 17.23 3.15
4.73 1.98 0.36 13.35
Post test 21.96 2.25
EFFECTIVENESS OF VATP ON ATTITUDE REGARDING ASSISTIVE
RESPIRATORY HOME CARE MANAGEMENT AMONG PATIENTS WITH COPD
n=30
FINDING RELATED TO CORELATION BETWEEN POST TEST LEVEL
KNOWLEDGE AND ATTITUDE
Table no. -10: Correlation between post test level of knowledge and attitude.
n=30
3-4 years 8 26.6
4-5 years 6 20
Attitude
test
Mean Standard
deviation
(S.D.)
Mean
Differen
ce
SDM SEM
D
Paired ‘t’
value
Pretest 47.51 3.766 12.59 3.1
0.57
21.39
Post test 60.10 3.703
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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Scores Mean SD ‘r’ value ‘P’ value
Post knowledge 47.57 2.25 0.42 0.05
Post Attitude 60.10 3.703
DISCUSSION
Result rveals that pre test mean knowledge score was 17.23 with the S.D .of 3.15. The
post test mean of knowledge score was 21.96 with the S.D. of 2.25. The paired‘t’ test value was
13.35 was greater than the table value 1.699 was statistically significant at P < 0.05.
The pre test mean attitude score was 47.51 with the S.D .of 3.766. The post test mean attitude
score was 60.10 with the S.D. of 3.703. The paired‘t’ test value was (21.39) was greater than the
table value 1.699 which was statically significant at P < 0.05.
The present study was supported by Chronic obstructive pulmonary disease is a major cause of
morbidity and mortality worldwide and global health concern. COPD self care knowledge is a
cornerstone for self-management of chronic illness. A descriptive, cross sectional design and
purposive sampling was applied in which 182 patients were interviewed by using semi-structure
interviews schedule at Chitwan Medical College, Teaching Hospital, Bharatpur. The study
findings revealed that 36.8% of the respondents were between age group 61-70 years, 54.4%
respondents were male, 59.9% were from Chitwan district, majority of the respondents (62.1%)
were outpatient, 48.4% had a history of COPD more than 5 years, 83.2% were hospitalized 1-2
times in last year, 63.2% had no history of COPD in family members and all respondents got
information from health personnel. Most of all respondents (90.7%) had poor level of knowledge
on self care of COPD. The respondents’ level of knowledge on self care is statistically
significant with family history (p=0.048), educational status (p=0.000), and types of patient
(p=0.017). So, there should be need of health education program for COPD patients about self
care to improve knowledge.
In present study correlation between knowledge and attitude with‘ r’ value of 0.42 which was
statically signification at P < 0.05.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:60
The finding of present study was supported by the assess knowledge, attitude, correct metered
dose inhaler (MDI) use and compliance with self management among patients with chronic
obstructive pulmonary disease (COPD). Methods: The participants of this study consisted of 109
COPD patients who were outpatients in C and K hospital located in G city from March 1 to
September 30th, 2010. Data were measured using self-administered questionnaires and
observational checklist. The data were analyzed using SPSS/WIN 18.0 program that included
mean, standard deviation, ANOVA test, and Pearson's correlation. Results: There were
significant relationships between knowledge and attitude (r=.33, p<.001), between knowledge
and correct MDI use (r=.37, p<.001), and between knowledge and self-management compliance
(r=.28, p=.003). There was significant relationship between attitude and self-management
compliance (r=.33. p<.001).
LIMITATIONS
This study was limited to small no of (30) this limit generalization of this finding.
CONCLUSION
The result of the study reveals that VATP was effective in increasing the knowledge and
developing favourable attitude among COPD Patients.
REFERRENCES
Book
1. Brunner and Siddhartha ’s “Textbook of medical surgical Nursing ” Eleventh edition
pg.no 1209.
2. Black Joyce.M,Jacob Esther Matassari. “Medical Surgical Nursing” Clinical
management and positive outcomes ;7th
ed.Elesiver publications, pg no :2171,& 390
.2004.
3. Basavanthappa BT, 2006, Research Metholodology, 2nd
edition J.P. Brothers Medical
Publishers Pvt.
JOURNAL :
1. Singh JM, etalCorticosteroid therapy for patients with acute exacerbations of chronic
obstructive pulmonary disease: a systematic review. Arch Intern Med.
2002;162(22):2527–2536.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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2. JemalA,etal. Trends in the leading causes of death in the United States, 1970–
2002.JAMA. 2005;294(10):1255–1259.
3. Stephens MB,eta. Diagnosis of chronic obstructive pulmonary disease.Am Fam
Physician. 2008;78(1):87–92.
4. Cazzola M, et al., for the American Thoracic Society, European Respiratory Society Task
Force on Outcomes of COPD. Outcomes for COPD pharmacological trials: from lung
function to bio-markers. EurRespir J. 2008;31(2):416–469
5. .Centers for Disease Control and Prevention. Annual smoking-attributable mortality,
years of potential life lost, and productivity losses—United States, 1997–2001. MMWR.
2005;54(250):625-628.
6. HoyertDL,etal. Deaths: preliminary data for 2011. Natl Vital Stat Rep. 2012;61(6):1-65.
Hyattsville, MD: National Center for Health Statistics.2012.
7. Centers for Disease Control and Prevention. Chronic obstructive pulmonary disease
among adults—United States, 2011.MMWR. 2012;61(46):938-943.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF INSTRUCTIONAL
MODULE (SIM) IN TERMS OF KNOWLEDGE AND ATTITUDE REGARDING HOME
CARE MANAGEMENT AMONG PATIENTS WITH CANCER ADMITTED
SELECTED HOSPITAL AT MEERUT.
ABSTRACT:
Objectives: (1) To prepare and validate of SIM regarding home care management among cancer
patient. (2) To evaluate the level of knowledge and attitude regarding home care management
among patient with cancer before and after administration of SIM. (3) To find out the
correlation between post test knowledge and post test attitude score regarding home care
management among patient with cancer.(4) To find out the association between selected
demographic variables with post test knowledge and post test attitude score regarding home care
management among patient with cancer. Research design: Pre experimental research design.
Material: Non probability Purposive Sampling, Sample: 50 cancer patients , Result: The mean
difference knowledge score and attitude score was found to be statistically significant as evident
from (‘t’ - 3.65 ,p<0.05,df-49) , (‘t’ - 3.00 <0.05,df-49). There is a significant association
between knowledge and modality of cancer treatment and attitude score with personal history.
Conclusion: result revealed that there is proper home care management in needed for
subsiding the side effects of cancer treatment (chemotherapy and radiation therapy).
Ms. Kusum
M.Sc Nursing, Dept. of Medical Surgical Nursing,
Panna Dhai Maa Subharti Nursing College, Meerut (U.P)– India
E-mail: [email protected]
GUIDE
Mrs. Arul Malar
HOD Medical surgical Nursing
Panna Dhai Maa Subharti College of Nursing, Meerut. U.P, India
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:63
Keywords: Evaluate Effectiveness, Self instructional module, knowledge, attitude, home care
management, patients with cancer.
INTRODUCTION:
In India, cancers account for about 3.3% of the disease burden and about 9% of all deaths.
Fairly conservative assumptions show that the number of people living with cancer will rise
by nearly one-quarter from 2001 to 2016. Cancer is the term used to define the diseases
which abnormal cells divide uncontrollably and ability to 'invade' tissues within the body and
are spread through the blood stream and lymph system. Recently, cancer morbidity rates are
increasing and most of the individuals are actively undergoing treatment and they were
having lack of awareness about management of adverse effects. So this study, aims to
improve the knowledge and attitude regarding home care management by self instructional
module.
METHODOLOGY
Research design: Pre experimental research design
Research Approach: Evaluative approach
Population: cancer patients
Sample Size: 50
Setting: Selected Hospital at Meerut
Variables
Independent Variable: self instructional module regarding home care management among patient
with cancer is the independent variables.
Dependant Variable: In this study, knowledge and attitude on home care management among
patient with cancer is the dependent variables.
Inclusion Criteria: Patients who are receiving cancer treatment ( chemotherapy and radiation therapy)
Patients who is willing to participate in this study.
Patients who are able to read and understand Hindi
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:64
Exclusion Criteria:
Patients who are not receiving cancer treatment
Patients who are in advance stage of cancer
Patient with psychiatric problem will not be included.
Material:
Tool- 1- demographic variables
Tool -2- Structured interview schedule to assess the knowledge regarding home care
management among patient with cancer
Tool-3-Grindler modified attitude scale regarding cancer, treatment regimen and home
care management
The knowledge score was categorized by: Good Knowledge: 18-25, Average Knowledge: 9-17,
Below Average Knowledge: 0-8.
Method of data collection :
A ethical permission was obtained from ethical committee concerned to particular setting.
A written permission was obtained from concerned authorities of Valentis cancer Hospital,
Meerut for conducting the research project. The data collection was done from 17th
Feb to 8th
March. The total sample was 50 and sample selected by using non probability purposive
sampling technique. The purpose of the study was explained to the samples and the willingness
to participate in the study was assured by taking written consent from each samples.
On the day – 1, Pre-Test was conducted to assess the cancer patients for knowledge and
attitude regarding home management for cancer patients. Followed by pre test self instructional
modules was administered to sample regarding home care management. It consists of Unit-I
Introduction, Unit-II Myths regarding cancer, Unit –III treatment modality, Unit-IV Home care
management.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:65
On 5th
day Post-Test was conducted to assess the cancer patients for knowledge and
attitude regarding Home management. The average time taken by the cancer patients to fill the
questionnaire was 15-20 min.
Observation and result
Among 50 samples of cancer patients 21 of them were in between the age group of 55-
56 years (42%), 15 of them were of 43-54 yrs (30%), 11 of them were in 31-42yrs
(22%), 3 of them were in 19-30years (6%) .
50 samples, 21(42%) samples were female and 29(58%) were male.
Educational status showed that out of 50 samples, 19 of them (38%) were having Up to
8th, 15 of them (30%) were secondary education, 7 of them (14%) were having
intermediate, 9 of them (18%) were having graduate and above.
Occupational showed that out of 50 samples, 17 of them (34%) were self employed, 11
of them (22%) were employed(Govt./Pvt), 1 of them (2%) were pensioner, 21 of them
(42%) were others (housewife)
Among 50 samples, 33 of them (66%) of them were vegetarian, 16 (32%) of them were
non vegetarian and 1 (2%) of them were egitarian.
Table showed that the personal history out of 50 samples, 36 out of them (72%) were
habit of non alcoholic /non smoker, 1 out of them (2%) were habit of tobacco chewing, 6
out of them (12%) were habit of alcoholic, 7 out of them (14%) habit of smoker.
Family history of cancer showed that out of 50 samples, 47 out of them (94%) were no
history of cancer in family, 3 out of them (6%) were family history of cancer.
age of onset of cancer treatment out of 50 samples, 21 out of them were in between the
age of 55-56 years (42%), 15 of them were of 43-54 yrs (30%), 11 of them were in 31-
42yrs (22%), 3 of them were in 19-30years (6%) .
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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Modality of treatment for cancer table showed that out of 50 samples, 22 out of them
(44%) were depend on the combination of chemotherapy and radiation, 13 out of them
(26%) were depend on the chemotherapy, 12 out of them (24%) were depend on the
radiation therapy.
Source of information about home care management for cancer out of 50 samples, 46
(92%) was obtained by health personnel (physician /nurse or any other), and 8 (4%)
was obtained by family members or friends.
The mean post test knowledge scores (18.2) and S.D (2.94), is higher than the mean pre
test knowledge scores (15.32) and S.D (4.45), with a mean difference 2.88. The obtained
mean difference was found to be statistically significant as evident from ‘t’ value 3.65
which is greater than the table value of 2.02 at 0.05 level of significance.
The mean post test attitude scores (92.28), is higher than the mean pre test attitude scores
(86.62), the standard deviation of pre test is 10.02 while that of post test is 9.97, with a
mean difference 5.26. The obtained mean difference was found to be statistically
significant as evident from ‘t’ value 3.00 which is greater than the table value of 2.02 at
0.05 level of significance.
TABLE-1
Frequency and distribution of demographic characteristics of the subjects
regarding home care management among patients with cancer.
S.NO SAMPLE
CHARACTERISTICS
FREQUENCY
DISTRIBUTION
(f)
PERCENTAGE
DISTRIBUTION
(%)
1.
a)
b)
c)
d)
Age in years
19-30yrs
31-42 yrs
43-54 yrs
55-65yrs
3
11
15
21
6%
22%
30%
42%
2. Gender
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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a)
b)
Female
Male
21
29
42%
58%
3.
a)
b)
c)
d)
Education
Up to 8th
Secondary education
Intermediate
Graduate and above
19
15
7
9
38%
30%
14%
18%
4.
a)
b)
c)
d)
Occupation
Self employed
Employed
Pensioner
Others (housewife)
17
11
1
21
34%
22%
2%
42%
5.
a)
b)
c)
Dietary pattern
Vegetarian
Non –vegetarian
Egitarian
33
16
1
66%
32%
2%
6.
a)
b)
c)
d)
Personal history
Tobacco chewing
Alcoholic
Smoker
Non alcoholic / non smoker
1
6
7
36
2%
12%
14%
72%
7.
a)
b)
Family history of cancer
Yes , specify
No
3
47
6%
94%
8.
a)
b)
c)
d)
Age of onset of cancer
treatment
19-30yrs
31-42 yrs
43-54 yrs
55-65yrs
3
11
15
21
6%
22%
30%
42%
9.
a)
b)
c)
Modality of treatment
receiving for cancer
Chemotherapy
Radiation therapy
Combination of chemotherapy
and radiation
13
12
22
26%
24%
44%
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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10.
a)
b)
c)
d)
Source of information about
home care management about
home care management for
cancer.
By family members or friends
By newspaper, journal,
magazine
By T.V/Radio (Mass Media)
By health personnel
(Physician/Nurse or any other
4
0
0
46
8%
0%
0%
92%
Table no.2 Mean, Median, standard deviation (S.D.) and ‘t’ value computation to
determine the difference between mean pre test and post test knowledge scores regarding
home care management among patients with cancer.
Discussion :
The mean post test knowledge scores (18.2) and S.D (2.94), is higher than the mean pre test
knowledge scores (15.32) and S.D (4.45), with a mean difference 2.88. The mean post test
attitude scores (92.28), is higher than the mean pre test attitude scores (86.62), the standard
deviation of pre test is 10.02 while that of post test is 9.97, with a mean difference 5.26 .The
study has also revealed that subjects had average knowledge in almost all the components
included under the structured interview schedule like: general aspects of cancer, side effects of
treatment regimen, home remedies for side effects of cancer treatment. Hence null hypothesis
H01 was rejected and research hypothesis H1 was accepted.
Knowledge scores
regarding home care
management among
cancer patients
Mean SD Mean
Differ
e-
Ence
SDD SEMD Paired ‘t’ value
Pre test 15.32 4.45 2.88 5.57 0.78 3.654
Post test 18.2 2.94
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:69
The above finding were supported by Prathiba Sivakumar.et al; October 2015 a study
on effectiveness self instructional module on knowledge regarding side effects of
chemotherapeutic drugs and its self care measures among patients receiving chemotherapy at
selected hospital , Chennai. Objectives of study were assess the knowledge regarding side effects
of chemotherapy and self care measures. Quasi experimental research design was used. Sample
size was 100. Non–probability, purposive sampling technique was used. 30 structured
questionnaires regarding side effects of chemotherapy and self care measures on adverse effects
of chemotherapy was administered to the sample. The result was 80% had inadequate
knowledge, 20.0% had moderately adequate knowledge in experimental group. 90% had
inadequate knowledge, 10.0% had moderately adequate knowledge in control group. The mean
value 0.23, the SD value was 0.430 and t value 2.392 which shows there was significant
difference between the pre test and post tesThe result of this study showed that the group
experienced adequate knowledge on having self instructional module.
Another study conducted by Eldeek B et. al; (2014 ) This study was conducted to assess
knowledge, perception, and attitudes regarding cancer and treatment among healthy relatives of
cancer patients who attended an outpatient cancer clinic with their relatives who suffer from
cancers. The participants recruited in this cross-sectional, interview-based study were 846 (557
female and 289 male subjects), Saudi Arabia. Most of the participants answered that they
believed the causes of cancer were genetic (44.90 %), followed by environmental factors (30.10
%), diet (26.90 %), other causes (26.90 %), envy (26.90 %), and black magic (17.60 This study
demonstrated that still a large number of healthy participants had deficient perceptions and poor
attitudes about important issues concerning cancers such as different mode of treatments,
alternative treatment, biological causes, and prognosis, particularly among male respondents.
Prevention aspects education strategies should be considered, including targeted approaches that
aim to reduce disparities in cancer perception among the general population.
LIMITATION
The study is limited to:
Samples who were not enquired whether home care was adopted for managing the side
effects of cancer treatment according to self instructional module.
CONCLUSION:
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:70
The present study revealed that there is the proper home care management in needed for
subsiding the side effects of cancer treatment (chemotherapy and radiation therapy). Researcher
also observed that patients and their family members faced a tremendous stressed up situation
while dealing with cancer treatment and self instructional module was helped them to improve
knowledge regarding home care management. In future, bring the better outcome of the patient
educational programme should be conducted by the hospital to improve knowledge about home
remedies for side effects of cancer treatment.
REFERNECES:
1. Basavanthappa BT, 2006, Research Metholodology, 2nd
edition J.P. Brothers Medical
Publishers Pvt.
2. Black Joyce.M,Jacob Esther Matassari. Medical Surgical Nursing : Clinical management and
positive outcomes ;7th
ed.Elesiver publications, pg no :2171,217,335389 & 390 .2004.
3. Charistine, Miaskowski, Patriciabuchsel. Oncology nursing assessment ad clinical care. I ed.
Mosby publication; 1999; 305-306.
4. Dinshaw KA,Rao DN,Ganesh B.Tata Memorial hospital cancer Regestry Annual
Report,Mumbai,India:1999.
5. Jaypee Brothers, Medical Surgical Nursing, B.T. Bhasavanthappa, medical Publishers, New
Dehli 1st ed. Pg no 111,160 & 123, 2003.
6. Joyce.M. Black, Jane, Hokanson hawks Medical Surgical Nursing 7th
ed, pg no 351 395 365
& 375, 2005
7. K.S.Negi (2008) Biostatistics with latest MCQs, Published by A.I.T.B.S publishers, India 2th
edition.
8. Linda.S. Williams.paula.D.Hopper. Medical Surgical Nursing 2nd
ed pg no 123, 133, 135 &
137, 1999.
9. Lewis L.Sharon, Heitkemper Margaret; Medical Surgical Nursing, 2011, Elsevier, Noida.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:71
10. Vincent. T. Devita, Journal. Samuel hellman steven A. Rosenberg, principles and practice of
oncology. 7th ed. Lippincat pg no 2139, 2799, 49 & 50, 2005
11. Mehlesen MY, Jensun AB, Zachariae B. Psychocial problems and needs among cancer
clients. Ugeskr Laeger2007 Apr; 169(18): 1682-7.
12. Smeltzer, Suzanne C & Bare, Brinda G; 2010, “ Textbook of Medical Surgical Nursing”vol
– 1, 12th edition.Lippincott.Williams & Wilkins, Missouri.
13. Stewart BS ,Kleihues P,eds.Cancer of female reproductive tract; In world Cancer
Report.World Helth Organiza .Interanational agency for research in cancer ,Lyon ,France :
IARC 2003
14. Suresh K.Sharma, Nursing Research and Statistics, 1st
edition(2008), published by
Elservier, a division of reed Elsevier India Pvt.Ltd.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:72
“A STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO ASSISTED
TEACHING ON KNOWLEDGE AND ATTITUDE REGARDING ORGAN DONATION
AMONG SELECTED DEGREE COLLEGE STUDENTS AT SUBHARTI UNIVERSITY
MEERUT”
OBJECTIVES: 1.To develop and validate the video assisted teaching regarding organ
donation among degree college students. 2. To assess and evaluate the knowledge and attitude of
the degree college students regarding organ donation before and after the administration of video
assisted teaching. 3. To determine the relationship between post test knowledge and attitude of
degree college students regarding organ donation. 4. To find out the association of post test
knowledge and attitude scores of Degree College students with their selected demographic
variables METHODOLOGY:.The research design was pre experimental one group pre test post
test design.A structured knowledge questionnaire and attitude scale were developed and utilized
for data collection. RESULTS: The results of the study indicated that in pretest the mean
knowledge score was 13.8 with standard deviation 3.8 and in post test mean knowledge score
was 28.3 with the standard deviation of 4.9. This indicates that video assisted teaching is
effective in improving the knowledge of the students regarding organ donation. The paired‘t’ test
value was 18.16 which was statistically significant at P <0.00. In pretest the mean attitude score
was 73. 39 and in post test the mean attitude mean score was 13.42. The paired ‘t’ test value 1.59
which was statistically not significant at P <0.05. This indicates that video assisted teaching is
brought some improvement in attitude of the students regarding organ donation. The mean post
Mrs. Sanju Solanki
M.Sc Nursing, Dept. of Community Health Nursing,
Panna Dhai Maa Subharti Nursing College, Meerut (U.P)– India
GUIDE
Mr. Naveena JH
Asst. Professor, Community Health Nursing
Panna Dhai Maa Subharti College of Nursing, Meerut. U.P, India
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:73
test knowledge score is 28.3. Mean post test attitude score is 77.78. The r value for post test
knowledge and attitude shows 0.41 at p=<0.05 level of significance. Hence there is a correlation
between post test knowledge and post test attitude scores of degree college students on organ
donation. There was no significant association between any of the above selected demographic
variables with the post test level of knowledge. There was a significant association between
selected demographic variable such as age (2 =6.636) at P = <0.05, Religion (
2 =14.645) at P
= <0.05 and post test level of attitude of degree college students
INTERPRETATION & CONCLUSION: Thus, the Videos assisted teaching programme was
found to be effective in enhancing the knowledge and attitude of Degree college students
regarding organ donation.
KEY WORDS: Evaluate, Effectiveness, Knowledge, Attitude Video Assisted Teaching, Organ
Donation, Degree College Students
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:74
INTRODUCTION
“Don’t Take Your Organs To Heaven For God Known’s They Are Needed Here, You Have
The Power To Donate Life”
For many doctors, nurses, and the general public the term life support calls up the image of
a ventilator. However, there are many types of life support one of them being organ transplants.
As with any other type of life support, organ transplantation comes with its share of problems.
Forty years ago, many people died because doctors could not successfully complete a transplant
and prevent rejection of the new organ. The knowledge of anti-rejection drugs was limited, and
the surgery involved was extremely difficult. Today, science has made improvement in the field
of transplantation to the point that most transplant operations are considered low risk.
WHO (2014) Organ donation is the donation of biological tissue or an organ of
the human body, from a living or dead person to a living recipient in need of
a transplantation. Transplantable organs and tissues are removed in a surgical
procedure following a determination, based on the donor's medical and social history, of which
are suitable for transplantation. Organ donation is the process of surgically removing an organ or
tissue from one person (the organ donor) and placing it into another person (the recipient).
Transplantation is necessary because the recipient’s organ has failed or has been damaged by
disease or injury.
WHO (2014) Organ transplantation is one of the great advances in modern medicine.
The main factor limiting organ donation is the availability of suitable donors and organs.
Currently, most transplants follow multiple organ retrieval from heart beating brain-dead organ
donors. However, brain death is often associated with marked physiological instability, which, if
not managed, can lead to deterioration in organ function before retrieval. In some cases, this
prevents successful donation. This strategy of active donor management requires an alteration of
philosophy and therapy on the part of the intensive care unit clinicians and has significant
resource implications if it is to be delivered reliably and safely.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:75
U.S. National library of medicine (2012) Organ donation takes healthy organs and
tissues from one person for transplantation into another. Experts say that the organs from one
donor can save or help as many as 50 people. Organs can donated by people include.
Internal organs: Kidneys, heart, liver, pancreas, intestines, lungs
Skin
Bone and bone marrow
Cornea
Most organ and tissue donations occur after the donor has died. But some organs and tissues
can be donated while the donor is alive. People of all ages and background can be organ donors. If
the person is under age 18, His/her parent or guardian must give permission to become a donor. If
the person is 18 or older He/ She can show to be a donor by signing a donor card.
Institute of medicine of national academies (2006) Organ transplantation has grown
increasingly safe and effective; the demand for transplants has grown far faster than the supply of
available organs. In 1954, with the first successful organ transplantation in humans, transplanted
organs have given hundreds of thousands of people the chance for longer, more productive lives. In
2005 alone, slightly over 28,000 solid organs (kidney, liver, lung, heart, pancreas, and intestine)
were transplanted in the United States, up from approximately 12,600 organ transplants in 1988. As
organ transplantation has grown increasingly safe and effective, the demand for transplants has
grown far faster than the supply of available organs. Since 1988, the number of people on the U.S.
waiting list has increased more than five-fold, from 16,000 to its current total of more than 90,000.
Each year approximately 40,000 people are added to the transplant waiting list.
Organ shortage (2012) Organ transplantation is the best available established technique for
the treatment of end stage failure of most essential organs (liver, heart and lungs). Corneal
transplantation is similarly well established and tissue transplantation, particularly of bone but also
of skin, tendons, etc., is growing very rapidly. Over 1 million people world-wide have benefited
from successful organ transplantation. A number of transplant patients have survived well over 25
years and five years survival rates for most organ transplant programmes are around 70%. With
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:76
modern techniques of organ preservation and advances in immune-suppression, a significant
proportion of patients can now expect to achieve long-term survival with a high quality of life.
Pınar Dogan, Dilek Toprak, Nihal Sunal (2012) conducted a study on Knowledge,
attitude and behaviors of university students on organ transplantation, in Turkey. A stratified
random sample of 955 students were asked for six sociodemographic, seven personal information,
nine behavior and twenty attitude questions using a Likert-type scale survey form. Results revealed
that Totally 955 students participated the study and 85.6% reported that the most significant barrier
against organ transplantation was inadequate organ donation. While 363 students (38.0%) didn't
decide to donate any organs although they had positive views on organ donation, 209 students
reported that they would donate all of their organs and the organ chosen as likely to be donated the
most was kidney. When the reasons for negative views on organ donation were examined, the
primary reasons were found to be "presence of religious barriers" and "discouragement". Also, 719
(75.3%) students had no knowledge about where the organs were donated. This study Concludes
that University students have insufficient information about organ donation. Informing them about
the details of the organ donation will have an effect on increasing the donationrates.
Mohan Sivanand (2013) A huge gap exists between patients who need organ transplants
and potential donors. It's not that there aren't enough organs to transplant. Nearly every person
who dies naturally, or in an accident, is a potential donor. Even so, innumerable patients cannot
find a donor. Reader's Digest did an Asia-wide study of organ donations, and found that India
lags far behind other countries in this regard. As Dr Sunil Shroff of Chennai, managing trustee of
the Multi Organ Harvesting Aid Network foundation, an NGO that promotes organ donation,
says: "Healthy people are unaware of the sufferings of patients with organ failure." Organ
shortages are a global problem, but Asia lags behind much of the rest of the world. The organ
donation rate from dead bodies in India is estimated to be a minuscule 0.05 per million people
(although India has among the world's highest number of deaths from road accidents). Hong
Kong's organ donation rate is less than 5 per million, while it's 25 per million in the United
States.
METHODOLOGY
Research design: pre experimental one group pretest post test design
Research Approach: Evaluative approach
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:77
Population: Degree college students who are studying in selected degree colleges of swami
vivekanand subharti university Meerut.
Sample Size: 60
Setting: Acharya Vishnu gupt Subharti institute of management & commerce, Chhatrapati
shahuji Subharti institute of technology & engineering college at Subharti University, Meerut
Variables
INDEPENDENT VARIABLES:-
Independent variables are believed to care or influence the behavior and ideas. In this study the
independent variables is video assisted teaching programme on organ donation .
DEPENDENT VARIABLES:
Dependent variables are knowledge and attitude level of degree college students studying in
subharti university at Meerut.
INCLUSION CRITERIA:-
- Degree college students of Acharya Vishnu gupt Subharti institute of management &
commerce, Chhatrapati shahuji Subharti institute of technology & engineering college
aged between 18-25 years.
- Both boys and girls who are willing to participate in the study.
- Degree college students who are available at the time of data collection.
EXCLUSION CRITERIA
- Degree college Students who are absent on the particular day of data collection.
- Degree College students who are sick during the time of study.
- Degree college students who are not willing to participate in the study.
MATERIAL
The conceptual framework adopted for the study was based on J.W Kenny’s Open system model
(1990) .The research design was pre experimental one group pre test post test design. The study
was conducted in Acharya Vishnu gupt Subharti institute of management & commerce,
Chatrapati shahuji Subharti institute of technology & engineering colleges Subharti university at
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:78
Meerut. The independent variable was Video assisted teaching and the dependent variables were
the knowledge and attitude of degree college students regarding organ donation.A structured
knowledge questionnaire and attitude scale were developed and utilized for data collection. Data
gathered were analysed and interpreted in the light of objectives and hypothesis using descriptive
and inferential statistics.
METHOD OF DATACOLLECTION
To conduct this study a structured questionnaire was prepared for collecting data
regarding demographic variables and knowledge aspect of degree student regarding organ
donation. And a attitude scale was prepared to collect data regarding skill aspect of degree
college student about organ donation.
OBSERVATION & RESULTS
The results of the study indicated that in pretest the mean knowledge score was 13.8 with
standard deviation 3.8 and in post test mean knowledge score was 28.3 with the standard
deviation of 4.9. This indicates that video assisted teaching is effective in improving the
knowledge of the students regarding organ donation. The paired‘t’ test value was 18.16 which
was statistically significant at P <0.00. In pretest the mean attitude score was 73. 39 with
standard deviation 18.69 and in post test the mean attitude mean score was 13.42 with the
standard deviation of 13.42. The paired ‘t’ test value 1.59 which was statistically not significant
at P <0.05. This indicates that video assisted teaching is brought some improvement in attitude of
the students regarding organ donation.
The mean post test knowledge score is 28.3 and Standard deviation is 4.1. Mean post test
attitude score is 77.78 and Standard deviation is 13.42. The r value for post test knowledge and
attitude shows 0.41 at p=<0.05 level of significance. Hence there is a correlation between post
test knowledge and post test attitude scores of degree college students on organ donation. There
was no significant association between any of the above selected demographic variables with the
post test level of knowledge. There was a significant association between selected demographic
variable such as age (2 =6.636) at P = <0.05, Religion (
2 =14.645) at P = <0.05 and post test
level of attitude of degree college students.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:79
Association between Post-Test Level of Knowledge and their Demographic Variables
N=60
Demographic variables
Average
knowledge
Good
knowledge
Total
P
value
Chi square
test
N % N %
Age in
year
19-21years 25 41.66 32 53.33 57 0.13 2=
2.256
df-1
Not
Significant
22-24years 0 00 03 5 03
25-27years 0 00 0 00 0
28-30years 0 00 0 00 0
Gender
31 & above 0 0 0 .281 2=
1.164
df = 1
Not
Significant
Male 19 22 41
Female
06 13 19
Religion
Hindu
22 31 53 .642 2=0.886
Df=2
Not
Significant
Christian
Any other
3
0
3
1
6
1
Area of
residence
Rural
Urban
11
12
13
19
24
31
.866
2=
0.289
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:80
Semi-urban 2
3
5
Df=2
Not
Significant
Type of
Family
Nuclear
family
Joint family
Extended
family
10
13
2
11
23
1
21
36
3
.464
2=
1.535
Df=2
Not
Significant
Occupatio
n of father
Un employee
Government
employee
Private
employee
Self
employee
Agriculture
3
4
3
10
5
3
10
6
8
8
6
14
9
18
13
.575
2=
2.900
Df=4
Not
Significant
Occupatio
n of
mother
Housewife
Un employee
Government
Private
employee
self employee
24
0
0
0
1
27
0
5
2
1
51
0
5
2
2
.129
2=
5.667
Df=3
Not
Significant
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:81
Family
income per
month
Below 5000
5001to
10,000
10,000 to
15,00
150001 to
20,000
Above 20001
6
8
5
3
3
6
8
7
7
7
12
16
12
10
10
.750
2=
1.920
Df=4
Not
Significant
Type of
diet
Vegetarian
Mixed 15
10
24
11
39
21
.493 2=
0.471
Df=1
Not
Significant
Previous
knowledge
on organ
donation
Yes
No
7
18
15
20
22
38
.239
2= 1.386
Df=1Not
Significant
Source of
health
informatio
n
Family
members/
friends
11
12
23
.642
2=
0.887
Df=2
Not
Significant
Relatives &
Nabougrous
0
0
0
New/T.V/
Radio/ Other
12 18 30
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:82
Media
Health
Professional 2 5 7
DISCUSSION
Based on the objectives of the study the findings of the pre-test Knowledge score of the Degree
college students regarding Organ donation shows that they were able to answer the questions to
some extent. In pretest 50.0% students were having average knowledge, none of the students
were having good knowledge and 50% students were having below average knowledge
regarding organ donation. Attitude score of degree college students shows in pretest 1.7 %
students were having un favourable attitude, 30 % students were having moderately favourable
attitude and 68.3% students were having highly favourable attitude regarding organ donation.
In post test 41.7 % students were having average knowledge, 58.3 % students were
having good knowledge and none of the students were having below average regarding organ
donation. Attitude score of degree college students shows in post test 1.7 % students were
having un favourable attitude, 6.7 % students were having moderately favourable attitude and
91.7 % students were having highly favourable attitude regarding organ donation.
In pretest the mean attitude score was 73. 39 with standard deviation 18.69 and in post test the
mean attitude mean score was 13.42 with the standard deviation of 13.42. This indicates that
video assisted teaching is brought some improvement in attitude of the students regarding organ
donation. The paired ‘t’ test value 1.59 which was statistically not significant at P <0.05. It
indicates that video assisted teaching was not effective to improve attitude of degree college
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:83
students regarding organ donation which was not statistically at P <0.05. Hence Null Hypothesis
H02 was failed to rejected and research hypothesis H2 was not accepted.
The mean post test knowledge score is 28.3 and Standard deviation is 4.1. Mean post test attitude
score is 77.78 and Standard deviation is 13.42. The r value for post test knowledge and attitude
shows 0.41 at p=<0.05 level of significance. Hence there is a correlation between post test
knowledge and post test attitude scores of degree college students on organ donation.
LIMITATIONS
This study is limited to degree college students between the age group of 18-25 years.
Research design is limited to pre experimental single group pre test post test design
Sample size is limited to 60 students of selected degree colleges at Subharti university
meerut.
Data collection period is limited to 4-6 weeks
CONCLUSION
As the part of the study 60 degree college student were given the video assisted teaching
programme. The programme helps the degree college students to improve their knowledge and
attitude on organ donation. This will ultimately helps to reduce the burden of organ shortage in
the earth.
REFERRENCES
1. Alarcon R, Blanca MJ, Frutos MA. Assessment of an educational program for adolescents
about organ donation and transplantation. Transplant Proc. 2008 Nov;40(9):2877-8. doi:
10.1016/j.transproceed.2008.09.013. Available From:
http://www.ncbi.nlm.nih.gov/pubmed/19010133
2. Amber Rithalia, Catriona McDaid, Sara Suekarran, et,al. Impact of presumed consent for
organ donation on donation rates: a systematic review. BMJ. 2009; 338: a3162. Published
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Page:84
online 2009 Jan 14. doi: 10.1136/bmj.a3162 Available From:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628300/
3. Berry C, Ley EJ et.al,. In-house coordinator programs improve conversion rates for organ
donation. J Trauma. 2011 Sep;71(3):733-6. doi: 10.1097/TA.0b013e31820500e6.
Available From: http://www.ncbi.nlm.nih.gov/pubmed/21399548
4. Baughn D, Rodrigue JR, Cornell DL. Intention to register as organ donors: a survey of
adolescents. Prog Transplant. 2006 Sep;16(3):260-7. Available From:
http://www.ncbi.nlm.nih.gov/pubmed/1700716
5. Clive O Callender, MD, FACS and Patrice V Miles, National Minority Organ Tissue
Transplant Education Program (MOTTEP), Washington, DC. J Am Coll Surg.
2010 May; 210(5): 708–717. Available From:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861044/
6. Chen JX, Zhang TM, Lim FL, Wu HC, Lei TF, Yeong PK, Xia SJ.Current knowledge
and attitudes about organ donation and transplantation among Chinese university
students. Transplant Proc(abstract). 2006 Nov ;38(9):2761-5. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/17112824
7. C.L. Albright , K. Glanz, L. Wong, et,al. Knowledge and Attitudes About Deceased
Donor Organ Donation in Filipinos: A Qualitative Assessement. Transplantation
Proceedings, Volume 37, Issue 10, December 2005, Pages 4153-4158. Available from;
http://www.sciencedirect.com/science/article/pii/S0041134505011723.
8. Callender CO, Hall MB, Branch D. An assessment of the effectiveness of the Mottep model
for increasing donation rates and preventing the need for transplantation--adult findings.
Semin Nephrol. 2008 Jul;21(4):419-28. Available From:
http://www.ncbi.nlm.nih.gov/pubmed/11455531
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9. Dardavessis T, Xenophontos P, Haidich AB. Knowledge, attitudes and proposals of
medical students concerning transplantations in Greece. Int J Prev Med. 2011
Jul;2(3):164-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21811659.
10. Dr. Sumana Navin, Dr. Sunil Shroff & Ms. Sujatha Niranjan. Deceased Organ
Donation in India. Mohan Foundation. 2015. Available From:
http://www.mohanfoundation.org/organ-donation-transplant-resources/organ-donation-
in-india.asp
11. Haustein SV, Sellers MT. Factors associated with (un)willingness to be an organ donor:
importance of public exposure and knowledge. Clin Transplant. 2004;18:193–200.
12. Harrison TR, Morgan SE, Di Corcia MJ. Effects of information, education, and
communication training about organ donation for gatekeepers: clerks at the Department of
Motor Vehicles and organ donor registries. Prog Transplant. 2008 Dec;18(4):301-9.
Available From: http://www.ncbi.nlm.nih.gov/pubmed/19186584
13. Institute of medicine of national academies, report brief.may 2006.
14. Mohan Sivanand, Reader’s Digest November issues exhorts citizens to give the “gift of
life” 2013 Available from; http://www.karmayog.org/publichealth/
publichealth_3204.htm.
15. Organ Donation. U.S. National library of medicine NIH National institutes of health.
2012 Available from; http://www.nlm.nih.gov/medlineplus/organdonation.html
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:86
“A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED
TEACHING PROGRAMME (PTP) REGARDING MICRONUTRIENT
DEFICIENCY AND ITS PREVENTION IN TERMS OF KNOWLEDGE
AMONG ADOLESCENT GIRLS IN SELECTED SENIOR SECONDARY
SCHOOLS AT MEERUT”.
ABSTRACT
OBJECTIVES: 1. To develop and validate Planned Teaching Program (PTP) regarding
micronutrient deficiency and its prevention for adolescent girls. 2. To evaluate the knowledge
regarding micronutrient deficiency and its prevention among adolescent girls in experimental
group before and after administration of planned teaching program. 3. To compare the
knowledge of adolescent girls in experimental and control group regarding micronutrient
deficiency and its prevention. 4. To find out the association between post-test knowledge of
adolescent girls with selected demographic variables in experimental group. METHODOLOGY:
The research design was Quasi-experimental pre-test post-test control group design. The sample
was selected through non-probability purposive sampling technique. The sample of the study
consisted of 60 adolescent girls. RESULTS: The 80% of adolescent girls were having good
knowledge after administration of planned teaching programme in experimental group. Post-test
knowledge score of experimental group and control group of adolescent girls were found to be
statistically significant. There was no any significant association found in the demographic
variable with the pot-test knowledge score of experimental group adolescent girls.
Ms. KHUSHBOO RANI
M.Sc Nursing, Dept. of Community Health Nursing,
Panna Dhai Maa Subharti Nursing College, Meerut (U.P)– India
E-mail: [email protected]
GUIDE
Prof. Kalpana Mandal
HOD, Community Health Nursing
Panna Dhai Maa Subharti College of Nursing, Meerut. U.P, India
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:87
CONCLUSION: The study concluded that there was knowledge deficit in adolescent girls
regarding micronutrient deficiency and its prevention before intervention and planned teaching
programme was an effective method to improve the knowledge of adolescent girls.
KEY WORDS: Effectiveness, knowledge, micronutrient deficiency, prevention, adolescent girls,
senior secondary schools.
INTRODUCTION:
Micronutrient Deficiencies (MNDs) are of great public health and socioeconomic
importance worldwide. They affect low-income countries but are also a significant factor in
health problems in industrialized societies with impacts among wide vulnerable groups in the
population, including women, children, the middle-aged, and the elderly. They affect all
populations in Europe and more severely in the transition Countries of Eastern Europe (CEE),
the former Soviet Union, and Countries of Central Asia (CAR). They significantly contribute to
chronic diseases as the major causes of morbidity and mortality in these countries.
The World Health Organization (WHO) considers that more than 2 billion people
worldwide suffer from vitamin and mineral deficiencies, primarily iodine, iron, vitamin A and
zinc, with important health consequences. WHO publication goes on to emphasize that
micronutrient malnutrition is not, as was widely assumed, only a problem of developing
countries. WHO defines food fortification as the practice of deliberately increasing the content of
an essential micronutrient, i.e., vitamins and minerals (including trace elements) in a food, in
order to improve the nutritional quality of the food supply and provide a public health benefit
with minimal health risk.
METHODOLOGY
Research design: Quasi-experimental research (non-randomized control group design) design.
Research Approach: Evaluative approach
Population: The population of present study comprise of adolescent girls in senior secondary
schools.
Sample Size: 60 adolescent girls (30 of each in experimental group and control group) are
studying in selected senior secondary schools at Meerut.
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Setting: The study will be conducting in selected senior secondary schools at Meerut.
Variables
* Independent variable – planned teaching programme regarding micronutrient deficiency
and its prevention
. * Dependent variable – knowledge of adolescent girls regarding micronutrient deficiency and
its prevention
Inclusion Criteria: 1. Adolescent girls who are willing to participate in a study. 2. adolescent
girls present at a time of study. 3. adoelscent girls those are studying in IX & XI class.
Exclusion Criteria: Adolescent girls those are studying science side was excluded.
MATERIAL
The lesson plan on micronutrient deficiency and its prevention was prepared based on the
review of literature and expert opinion. The content was made clear and comprehensive. The
prepared lesson plan was given for the content validity to the expert. Based on the suggestions
and opinions of the experts, the final lesson plan with A.V Aids was prepared Guidelines was
made for planned teaching programme was discussed with the adolescent girls for getting frank
responses. For the content validity of tools and lesson plan of planned teaching programme a
criteria rating scale was prepared. It consist of items with three responses for rating against each
criterion like fully met the criteria, partially met the criteria, and mostly meet the criteria and
with the remark column for each criterion. The tools and lesson plans with request letters,
criteria rating scale was submitted to the seven experts from the field of nursing, education and
community medicine for validation, there was 100% agreement on the tools and lesson plans.
There were few corrections which were made and was incorporated.
After the tryout on 10 adolescent girl’s reliability co-efficient was calculated Structured
Knowledge questionnaire by using KR-20.
METHOD OF DATACOLLECTION
For conducting main study formal administrative permission was obtained from the SENIOR
SECONDARY SCHOOLS AT MEERUT for adolescent girls.
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EXPERIMENTAL GROUP
The researcher introduced herself and the purpose of study was explained to the group.
All the adolescent girls were explained about the nature of the study and their expected
participation.
Written consent was taken and confidentiality was assured.
To obtain free and frank response the purpose of the study was explained.
Purposive sampling technique was used for the selection of thirty adolescent girls.
On first day pre-test of knowledge of adolescent girls were taken and PTP was
administered regarding micronutrient deficiency and its prevention.
On 7th
day post-test was taken.
CONTROL GROUP
The researcher introduced herself and the purpose of study was explained to the group.
All the adolescent girls were explained about the nature of the study and their expected
participation.
Written consent was taken and confidentiality was assured.
To obtain free and frank response the purpose of the study was explained.
Purposive sampling technique was used for the selection of thirty adolescent girls.
On first day pre-test of knowledge of adolescent girls were taken micronutrient
deficiency and its prevention.
On 7th
day post-test was taken.
Analysis
The data analysis was planned so as to use both descriptive and inferential statistics. The plan of
the data analysis was as follows.
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Frequency and percentage distribution of demographic characteristics of the adolescent
girls in experimental and control group.
Mean and standard deviation of pre-test and post-test knowledge of experimental group.
Mean, mean difference, standard deviation, standard error of mean difference and ‘t’
value of pre-test post-test knowledge in experimental and control group.
Chi-square square value to be computed to be find out the association between post-test
knowledge of experimental group and selected demographic factors.
OBSERVATION & RESULTS
SECTION I The Socio-demographic variable related to age indicates that majority of the
adolescent girls in experimental and maximum number in control group were in the age group of
(15-16 years) i.e. 93.4% and 63.4% respectively.. The Socio-demographic variable related to the
type of family in experimental group 16 (50%) were joint family where as in control group 22
(73.3%) were nuclear family. The Socio-demographic variable related to Maximum of the
adolescent girls in experimental group had their education status of mother i.e 11 (36.6%) ,
whereas maximum of the sample in control group also had their education status of mother i.e.
13 (43.4%). The Socio-demographic variable related to the dietary pattern majority of the
adolescent girls in the experimental and control group were intermediate i.e. 28 (93.4%) and
24(80%) respectively. Most of the adolescent girls in the experimental group belong to a
monthly family income of below 5000 i.e. 16 (53.3%), whereas in control group belong to
monthly family income of 5001 to 15000 i.e.16 (53.3%). Regarding the occupational status of
father most of the adolescent girls in the experimental and control group were private employee
i.e. 20 (66.6%) and 12(40%) respectively.
SECTION- II This section represent the Assessment of the knowledge scores of adolescent
girls in experimental group
The mean pre-test knowledge score of experimental group adolescent girls was (18.86) with
median (11) and standard deviation (3.07) against the maximum score of (35). The range of
obtained score was between (0-12) indicating there was knowledge deficit exists regarding
micronutrient deficiency and its prevention.
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The mean post-test knowledge score of experimental group adolescent girls was (27.19) with
median (27) and standard deviation (1.8) against the maximum score of (35). The range of
obtained score was between (26-35) indicating there was knowledge gain exist regarding
micronutrient deficiency and its prevention after administration of planned teaching programme
on micronutrient deficiency and its prevention.
The mean difference between pre-test knowledge and post-test knowledge was (16.3). The‘t’
value of (26.29) for df (29) was found to be statistically significant at 0.05 level.
SECTION-III Finding related to compare the knowledge of adolescent girls of
experimental and control group
The mean post-test knowledge of experimental group was (27.16) and mean post-test knowledge
score of control group (19.2). The mean difference between the post-test knowledge scores of
both the group was found to be (4.08) the ‘t’ value of (6.68) for the df (58) was found to be
statistically significant at 0.05 level of significant. Thus it was inferred from the findings that
planned teaching programme regarding micronutrient deficiency and its prevention was effective
in increasing the knowledge of experimental group of adolescent girls.
SECTION-IV Finding related to association between post test knowledge score of
experimental group and selected demographic variables : The findings in the table 8, it is
evident that there was no significant association between knowledge of adolescent girls and age
in years, type of family, education status of mother, dietary pattern, monthly family income and
occupational status of father. So these factors are independent of each other.
Mean, Mean difference, standard deviation of difference, standard error of mean
difference and ‘t’ value of pre-test and post-test knowledge scores of adolescent girls in
experimental group.
N=30
Knowledge score of
experimental group
Mean Mean
difference
SDD SEMD
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‘t’
Pre-test 10.86
16.3
3.4
0.62
26.29* Post-test 27.16
Table – 2
Mean, Mean difference, standard deviation of difference, standard error of mean
difference and ‘t’ value of post test knowledge scores of adolescent girls in experimental
and control group.
N1 + N2 = 60
Post-test Knowledge score Mean Mean
difference
SEMD
‘t’
Control group (N2-30) 19.2
4.08
0.61
6.68 Experimental group (N1-
30)
27.16
DISCUSSIONS
On the basis of the objectives of the study and the revealed findings discussion can be
framed as follows.
In relation of the second objective the finding of the present study shows that mean pre-
test knowledge was experimental group (10.86 ) and mean post-test knowledge (27.16 ). It shows
that post-test knowledge of higher then pre-test knowledge in experimental group. These finding
were consistent with the Savita S. M (2013) finding that Thirty percent of the subjects scored
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low (< 17), 42.31 per cent scored medium (17-23) and 27.56 per cent scored high (> 23) before
the education. Assessment of the knowledge immediately after the education programme
revealed that 97.44 per cent of subjects scored high (> 23) where as 2.56 per cent scored medium
(17-23) and one month later, the knowledge level revealed that 95.51 per cent scored high (> 23)
and 4.49 per cent scored medium (17-23) reflecting that the retention of knowledge is quite
satisfactory during follow up assessment. The response improved after education intervention
that could help to combat micronutrient malnutrition.
In relation of the third objective the present study while comparing the knowledge of
adolescent girls of experimental and control group on micronutrient deficiency and its
prevention. It was found that experimental group had gained knowledge after the introduction of
planned teaching programme. These findings consistent with Barberger-Gateau P (2006),
conducted a study to assess the impact of a nutritional education intervention on knowledge and
practices among home support assistants for the elderly. Results revealed that the intervention
(experimental) group significantly improved its knowledge score (mean gain 2.5 points, p <
0.001) after the training period, whereas the score remained unchanged in the control group
(mean gain 0.5 points, p = 0.06). The impact of the nutritional education was very significant (p
< 0.0001) after adjustment for the characteristics which differed between the two groups.
In relation of the fourth objective the finding of the present study shows that there was
no association between post test knowledge of experimental group with demographic variables.
These finding were not supported with the Premalatha T, Valarmathi S, (2012) conducted a
study in Tamil Nadu India to assess the prevalence of iron deficiency anemia among adolescent
school girls in the age group of 13-17 years in Chennai and to study the associated factors. A
cross-sectional survey was executed among 400 female school students in the age group of 13-17
years in Chennai. Sociodemographic details, anthropometric measurements were obtained.
The result showed that the prevalence of anemia was found to be 78.75% among school
students. Chi-square statistics showed significant association (p<0.05) of anemia is with type of
family, socioeconomic status and diet. The study concludes that a high prevalence of anemia is
found in female students from nuclear families and whose mothers’ education is low.
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Thus the study suggested that there is a need to have survey on regular basis to assess the
knowledge of adolescent girls regarding micronutrient deficiency and its prevention.
LIMITATIONS
This study was confined to a small number of adolescent girls i.e. 60 adolescent girls (30
each in experimental and control group) which limits the generalization of the study.
The study sample was selected non-randomized purposive sampling technique which
limits the generalization of findings.
CONCLUSION
There was knowledge deficit in adolescent girls regarding micronutrient deficiency and
its prevention.
The planned teaching programme was found to be effective in increasing the knowledge
of adolescent girls in experimental group regarding micronutrient deficiency.
The post-test knowledge of experimental group of adolescent girls were significantly
higher than the control group of adolescent girls.
There was no association found between post-test knowledge and demographic variable
of adolescent girls in experimental group regarding micronutrient deficiency and its
prevention.
REFERRENCES
1. Basvanthappa BT(2007), Nursing research, 2nd edition, jaypee publishers(new Delhi)
page no 132- 140.
2. Darshan sohi, “A text book of nutrition” , 2nd edition, publisher by peevee publication,
page no 19-22.
3. K.S. Negi (2008), “ text book of statistics with latest MCQs” , 2nd edition, A.I.T.B.S.
Publishers, India, Page no 230-232.
4. Ruma singh, “Food & nutrition for nurses”, (2010 edition), Publisher by jaypee
publication, Page. No 20-25.
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
Page:95
5. Suresh k Sharma, “Text book of Nursing Research and statistics”, (2011 edition),
published by ELSEVIER Publication, Page no 53, 94, 405, 180.
6. Aguayo vm, paintal k, singh g. “the adolescent girls' anaemia control programme: a
decade of programming experience to break the inter-generational cycle of malnutrition
in india.” Public health nutr. 2013 sep;16(9):1667-76. Doi: 10.1017/s1368980012005587.
Epub 2013 jan 24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23343620
7. Ajitha sharma, shalini adiga, ashok m. “knowledge, attitude and practices related to
dietary supplements and micronutrients in health sciences students” Available from :
http://www.jcdr.in/articles/pdf/4683/9329_ce(ra)_f(sh)_pf1(snak)_pfa(ak).pdf
8. Barberger-gateau p, helmer c, ouret s, gendron b. Quasi-experimental evaluation of a
nutritional educational intervention among home support assistants for the elderly.2006
jun;54(3):233-43. Available from - http://www.ncbi.nlm.nih.gov/pubmed/16902384
9. http://anemia.org/patients/feature-articles
10. http://en.wikipedia.org/wiki/health
11. http://en.wikipedia.org/wiki/disease#terminology
12. http://en.wikipedia.org/wiki/adolescence
13. http://emedicine.medscape.com
14. http://www.fao.org/docrep/x0245e/x0245e01.htm
Subharti Journal of Nursing Reflection Volume: 1, Issue: 1; September 2016
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A STUDY TO ASSESS AND EVALUATE THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAM REGARDING PREVENTION AND MANAGEMENT OF
OBSTETRIC NEAR-MISS EVENTS IN TERMS OF KNOWLEDGE AMONG
MIDWIVES IN SELECTED HEALTH CENTRES, AT MEERUT.
ABSTRACT:
Title: A study to assess and evaluate the effectiveness of structured teaching program regarding
prevention and management of obstetric near-miss events in terms of knowledge among
midwives in selected health centers, at Meerut. Objectives: 1. To develop and validate Structured
Teaching Program (STP). 2. To assess and evaluate the knowledge of midwives before and after
administration of STP. 3. To compare the knowledge of midwives in experimental and control
group 4. To find out the association between post-test knowledge scores of midwives with
selected socio demographic variables in experimental group. Research design: Quasi
experimental Pretest Post-test Control Group design. Material: Non- Probability Purposive
sampling Sample: The sample consisted of 60 midwives (30 in experimental and 30 in control
group) working in selected community health centers at Meerut Result: Post test knowledge
score of experimental group and control group of midwives were found to be statistically
significant as calculated value‘t’ (8.61) for df (58) {‘t’=2.0017} at 0.05 level of significance.
Conclusion: The STP was found to be effective in increasing the knowledge of midwives
regarding prevention and management of obstetric near-miss events as evidenced by the post test
knowledge scores of midwives in experimental group after administration of STP.
Keywords: effectiveness, midwives, obstetric near-miss events, community health centre.
Ms. Megha Mohan
M.Sc Nursing, Dept. of Community Health Nursing,
Panna Dhai Maa Subharti Nursing College, Meerut (U.P)– India
E-mail: [email protected]
GUIDE
Prof.(Ms).Kalpana Mandal HOD, Community Health Nursing
Panna Dhai Maa Subharti College of Nursing, Meerut. U.P, India
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INTRODUCTION
Around 529,000 maternal deaths occur every year mostly in developing countries from
peri-natal complications and childbirth. Maternal mortality refers to deaths due to complications
from pregnancy or childbirth. Almost 80% of the causes are direct causes like haemorrhage,
eclampsia, pre-eclampsia , shock, sepsis, complications of unsafe abortion, obstructed labor etc.
For every woman who dies, many more suffers from disability and disease ( AbouZahr C,
Wardlaw T(2003)). According to the WHO estimates (2014), the global maternal mortality
ratio is- 380 deaths to 210 deaths per 100,000 live births from 1990-2013. This estimate is less
than half the 5.5 per cent rate needed to achieve the three-quarters reduction in maternal
mortality targeted for 2015 in Millennium Development Goal. This shows that still more has to
be achieved.
Maternal deaths in Indian scenario also show a significant similar picture with the world
where the data shows a marked decline (1990-2013) from 560 deaths to 190 deaths per 100,000
live births. The table below shows the Maternal Mortality ratio 1990-2013, WHO, UNICEF,
The World Bank, UNFPA, The United Nation Population Division Maternal Mortality
Estimation Inter-Agency Group India:
Maternal Mortality ratio 1990-2013, WHO, UNICEF, The World Bank, UNFPA,
The United Nation Population Division Maternal Mortality Estimation Inter-Agency
Group India
Year Maternal
Mortality
Ratio(MMR)
Mater
nal
Deaths
Number of
AIDS-related
indirect
maternal
deaths
Live
births
Proportion of deaths
among women of
reproductive age that
are due to maternal
causes(PM)
Per
100,000
live
Numbers Numb
ers
Numbers Thousands Percent
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WHO,UNICEF,UNFPA,World bank estimates (2013).
Strategies like Janani Suraksha Yojna , Skilled Birth Attendant programme, and many
more had played a significant role in decreasing the maternal mortality, but the goal is yet to be
achieved. According to a recent case study (2014)conducted by Kranti S.Vora India’s maternal
health goal is to lower the maternal mortality to less than 100 per 100,000 live births but that is
still far away despite the efforts and rapid economic progress over the past two decades. The
study recommends better reporting of maternal deaths and implementation of evidence-based,
focused strategies along with effective monitoring for rapid progress in achieving the goal. This
again points towards the road to improvement towards the maternal health goals.
METHODOLOGY
Research design: Quasi Experimental pre-test post-test control group design.
Research Approach: Evaluative approach
Population: Midwives working in selected Community Health Centers Meerut.
Sample Size: 60
Setting: Selected Health Centers of Meerut (U.P.)
Variables
Independent Variable: Structures Teaching Program regarding prevention and management of
obstetric near-miss.
births(lb)
2013 190[130-300] 50,000 310 25,568 6.7
2005 280[180-430] 73,000 480 26,196 9.2
2000 370[240-560] 97,000 270 26,697 12.1
1995 460[300-720] 123,00
0
60 26,689 15.5
1990 560[360-870] 148,00
0
6 26,632 19.2
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Dependant Variable: knowledge of midwives regarding prevention and management of obstetric
near-miss events .
Inclusion Criteria: Midwives working in the selected health centres
1. Who can read, write and speaks Hindi.
2. Midwives those who were available in the selected health centres during study.
Exclusion Criteria:
1. Midwives those who were not willing to participate in the study.
MATERIAL
The tool was prepared based on an extensive review of research and non-research literature, peer
group discussion, taking the expert opinion.
The tool consists of:
Part 1: Consisting of items on sample characteristics such as age in years, education, working
area, working experience, type of center, Category of health personnel, past experience with
obstetric near-miss cases, attended any skilled training programme.
Part 2: Comprises of 35 knowledge questions with a maximum score of 35. The questions are
MCQ type having only one correct answer and correct answer carries a score of one, the wrong
answer score zero.
There was Categorization of knowledge:
Score between 23-35 = good knowledge
Score between 13-22 = average knowledge
Score between 0-12 = below average knowledge
METHOD OF DATACOLLECTION
Formal administrative permission was taken from Chief Medical Officer of Community Health
Center Hastinapur, Meerut dist. Final data collection was done from 20 feb 2016 to 5th March
2016. Thirty midwives in each group were selected by the purposive sampling technique. To
obtain free and frank response, the purpose of the study was explained and the subjects were
assured about the confidentiality of their responses.
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Pre-test Knowledge of experimental group and control group midwives was assessed on the first
day. Structured teaching program was administered on prevention and management of obstetric
near-miss events on day first to the experimental group midwives. The post test was taken on
fifth day in both experimental and control group.
Analysis
The present study was designed to assess the knowledge regarding prevention and management
of obstetric near miss events. Analysis and interpretation of data are based on the objectives of
study.
OBSERVATION & RESULTS
According to the age group maximum of the sample in experimental group and control
group were in the age of (36 & above) years i.e. 40% and 53% respectively.
As per the professional qualification in experimental group and control group were
having Diploma in Auxilliary Nursing and Midwifery i.e. 22 (73%) and 25 (83%).
Majority of the sample in experimental group and control group were in other working
area 15(50%) and 20(67%).
Regarding working experience majority of the sample in experimental group and control
group were having more than 5 years of working experience i.e 12 (40%) and 16 (53%).
Most of the sample in the experimental group and control group were working in PHC
i.e. 16 (53%) and 14 (47%).
As per the category of health personnel majority were ANMs both in experimental group
and control group i.e. 18 (60%) and 22 (73%).
Majority of the sample in experimental group and control group have attended skilled
training program i.e. 30 (100%) and 28 (93%).
The mean post-test knowledge score (25.0) of midwives in experimental group were
significantly higher than mean pre-test knowledge score (17.0) on prevention and
management of obstetric near-miss events. (Fig.1)
87% of midwives were having good knowledge after administration of STP in
experimental group.(Fig.2)
Post test knowledge score of experimental group and control group of midwives were
found to be statistically significant as calculated value of ‘t’ (8.61) for df (58)[‘t’=2.0017]
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at 0.05 level of significance. Hence research hypothesis H1, H2 was accepted and null
hypothesis H01 and H02 was rejected. (Table-2)
There was only one significant association found with type of centre in the demographic
variable with the post test knowledge score of experimental group midwives. Hence
research hypothesis H3 was accepted for this demographic variable association and null
hypothesis H03 was rejected.
Table-1
Frequency and percentage distribution of demographic characteristics of the midwives
Sample Characteristics
Experimental Group
(N=30)
Control Group
(N=30)
Frequency Percentage Frequency Percentage
1. Age in years:-
21-25 2 7 3 10
26-30 6 20 3 10
31-35 10 33 8 27
36 and above 12 40 16 53
2. Professional Qualification
Diploma in Auxilliary Nursing and
Midwifery 22 73 25 83
Diploma in General Nursing and
Midwifery 2 7 2 7
Diploma in Public Health Nursing 6 20 3 10
3.Working area
Labour Room 6 20 4 13
Post Natal Ward 4 13 3 10
Antenatal Ward 5 17 3 10
Other 15 50 20 67
4.Working Experience
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0-1 year 2 7 3 10
1-3 years 6 20 3 10
3-5 years 10 33 8 27
above 5 years 12 40 16 53
5.Type of Centre
Sub-centre 6 20 4 13
PHC 16 53 14 47
CHC 8 27 12 40
6.Category of Health Personnel
ANMs 18 60 22 73
LHVs 10 33 6 20
Staff Nurses 2 7 2 7
7.Attended any skilled training
programme
No 0 0 2 7
Yes 30 100 28 93
Figure.1- Cylinder graph showing the mean pre-test and post-test knowledge score of
experimental group.
Pre-Test
Post-Test
17.0 25.0
Mean Knowledge Score
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Figure 2- Bar graph showing the interpretation of knowledge score of pre-test and post-test of
experimental group midwives.
Table-2
Mean, mean difference, standard deviation of difference, standard error of mean difference
and ‘t’ value of pre-test and post-test knowledge scores of midwives in experimental group
and control group.
N=60
Post-test Knowledge Score Mean
Mean
Difference SDD SED ‘t’
Control group (N=30) 16.3
4.48 4.03 0.52 *8.61 Experimental group (N=30) 25.0
*df-58, p<0.05 level of significance,‘t’=8.61
DISCUSSION
On the basis of the objectives of the study and the revealed findings discussion can be framed as
follows:
In relation with the second objective the finding of the present study shows that mean post-test
knowledge of experimental group (25.0) was higher than the mean pre-test knowledge (17.9).
7%
90%
3%
0
13%
87%
Below Average (0-12)
Average (13-22)
Good Knowledge (23-35)
KNOWLEDGE SCORE OF PRE-TEST AND POST-TEST
Post-test Pre-test
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These findings were consistent with study of Sharon Maslovit, Gad Barkai (2007) to assess the
effectiveness of simulation based training programme among midwives and obstetric doctors in
Israeli Center for Medical Simulation, United Kingdom. One hundred and sixty five samples
have selected by random method. Questionnaire responses showed that post-test score (79.4 ±
4.3) were more than pre-test score (70 ± 5.3).
Findings of the present study shows that in pre-test there was inadequate or lack of knowledge of
midwives regarding prevention and management of obstetric near-miss events. This findings
were also supported by studies conducted by Khosla A , Dahiya V, Sangwan K, Rathore S
(2013) where the result of the study demands timely and co-ordinated management in case of
massive obstetric haemorrhage. Every nurse must have the capability to develop comprehensive
plans & interventions to tackle the situations such as obstetrical haemorrhage (ante-partum and
post trauma). Nurses should update their knowledge by getting and knowing the latest
information on disease conditions and their management.
Another supportive study by Kausar F and Morris J.L (2012) shows that once the nurses can
rule out the complications, the management would be tackled easily and it depends on proper
knowledge and training regarding “near-miss” events and their identification at an early stage.
The findings of present study were also supported by study conducted by Neil A.M (1999). The
findings of this study showed that only 48% of health care practitioners had adequate knowledge
regarding community based care in managing obstetric emergencies. Thus it was consistent with
the present study.
The findings were also consistent with the study of Kimberly Susanne Garcia (2012) to
evaluate the effect of culturally sensitive teaching on midwives knowledge on nursing
interventions to manage PPH. The findings showed that teaching improved midwives’
knowledge and skills about nursing interventions to manage PPH (pre-test M=1.385/8, post-test
M=4.846/8).
LIMITATIONS
This study was confined to a small number of midwives i.e. 60 midwives (30 each in
experimental and control group) this limits generalization of the findings.
The study sample was selected non-randomized purposive sampling technique which
limits the generalization of the findings.
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CONCLUSION
1. There was knowledge deficit in midwives regarding prevention and management of
obstetric near-miss events.
2. The structured teaching program was found to be effective in increasing the knowledge of
midwives in experimental group regarding prevention and management of obstetric near-
miss events.
3. There was a significant association between post test knowledge score of midwives with
type of centre they are currently working in.
REFERRENCES
1. AbouZahr C, Wardlaw T(2003). Maternal mortality in 2000. Estimates developed by
WHO, UNICEF and UNFPA. Geneva: WHO.
2. Anitha C Rao, PrasannaKumar Shetty: “Effectiveness of maternal and child health care
participatory training program among staff nurses, auxiliary nurse midwives and lady
health visitors. Journal of South Asian Federation Obstetrics and Gynaecology , May-
August 2012; 4(2),120-122,
3. Kalra P, Kachhwaha CP: Obstetric near miss morbidity and maternal mortality in a
Tertiary Care Centre in Western Rajasthan. Indian J Public Health. 2014 Jul-
Sep;58(3):199-201
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