RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
MS.ANITHA GRACE. P
I Year M. Sc Nursing
Medical Surgical Nursing
Year 2008-2009
PADMASHREE INSTITUTE OF NURSING
NAGARBHAVI CIRCLE, NAGARBHAVI
BANGALORE-560072
0
RAJIV GANDHI UNVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1 NAME OF THE CANDIDATEAND ADDRESS
MS.ANITHA GRACE.PI Year M.Sc Nursing Padmashree Institute of Nursing, Nagarbhavi circle,Bangalore-560072
2 NAME OF THE INSTITUTION Padmashree Institute of Nursing,Nagarbhavi circle,Bangalore.
3 COURSE OF THE STUDY AND SUBJECT
I Year M.Sc Nursing,Medical Surgical Nursing
4 DATE OF ADMISSION30 June 2008
5 TITLE OF THE STUDY Assessment of effectiveness of planned teaching programme on knowledge regarding dietary management among patient with gastritis in selected hospitals, Bangalore.
1
6. BREIF RESUME OF INTENDED WORK
6.1 INTRODUCTION
Gastritis is a broad term for inflammation of the stomach lining. This
condition can be caused by many factors, and in some cases may lead to an
ulcer. 1
Bacterial infection, most notably with Helicobacter pyloric is a major cause of
gastritis. Helicobacter pyloric is the same bacterium responsible for most cases
of peptic ulcer. When considering treatments for gastritis, many researchers now
look for substances that eradicate Helicobacter pyloric including bismuth and
antibiotics1
Other causes of gastritis include intake of poisons, alcohol, and some
medications (such as aspirin or adrenal corticosteroids), as well as physical stress
from the flu, major surgery, severe burns or injuries. For some people, a drug
allergy or food poisoning can cause gastritis. Atrophic gastritis is a form of
gastritis found particularly in the elderly where stomach cells are destroyed,
potentially leading to pernicious anemia2
Acute gastritis is typically characterized by non specific abdominal pain.
Since gastritis often occurs in severely ill, hospitalized people, its symptoms may
be eclipsed by other, more severe symptom. Gastritis that is caused by
Helicobacter pylori eventually leads to peptic ulcers, which are characterized by
a dull ache in the upper abdomen that usually occurs two or three hours after a
meal, the ache is typically relieved by eating3.
2
The gastrointestinal tract is primarily responsible for acquiring and digesting
food, absorbing nutrients and water, and expelling wastes from the body as
feces. A proper diet and normally functioning gastrointestinal tract are integral
for the delivery of nutrients, prevention of nutrient deficiencies and malnutrition,
repair of damaged intestinal epithelium, restoration of normal luminal bacterial
populations, promotion of normal gastrointestinal motility, and maintenance of
normal immune functions (e.g., both tolerance and protection from pathogens).4
The amount of food, its form, the frequency of feeding, and the composition
of diet each has important effects on gastrointestinal function and may be used to
help ameliorate signs of gastrointestinal disease. Although both nutrients and
non nutritional components of a diet are important to gastrointestinal health, they
also may cause or influence the development of gastrointestinal pathology (e.g.,
antibiotic responsive diarrhea, inflammatory bowel disease, dietary intolerance,
or sensitivity and/or allergy). The appropriate diet may have a profound effect on
intestinal recovery and successful management of chronic severe gastrointestinal
disease5
Helicobacter pylorus is an important human pathogen linked to peptic ulcer
and now to cardiovascular diseases. Control of this pathogen using synthetic
antimicrobials such as currently approved antibiotics has limitations due to
potential development of resistance and low compliance. We believe a profile of
antimicrobials compared to a single compound could be potentially more
effective in managing Helicobacter pylori infections. 6
The issue of Helicopylori induced gastritis and other types of gastritis
continue to be controversial. The prevalence of Helicobacter pylori is not
different than in the general population. The therapy of functional dyspepsia
remains difficult and somewhat emperic. In the published literature, the
definition of functional dyspepsia has been variable, different categories of 3
patients have been included in the studies and the response to placebo has been
high (30%-60%). Unfortunately the published trials some inadequacies in
experimental design, but there is no convincing evidence that the treatment of
Helicobacter pylori reliably relieves symptoms of dyspepsia better than placebo.7
Dietary management plays a vital role, but patients may obtain some benefit
if they avoid fatty foods and gastric irritants such as highly spiced foods, and
aggravating drugs such as non-steroidal anti-inflammatory agents. Therapy of
Helicobacter pylori is not reliable in relieving symptoms and is not
recommended as a first step unless peptic ulcer is or has been demonstrated.
Antisecretory drugs, such as the H2-receptor antagonists or the proton pump
inhibitors, are often tried first, but their utility is questionable.7
6.2 NEED FOR THE STUDY
Dietary changes are helpful in reducing the gastritis however most of the
people are unaware of these factors. Salt can irritate the stomach lining. Some
research suggests that eating salty foods increases the risk of developing a
Helicobacter pylori infection.8
A study has speculated that increased salt intake may also increase the risk of
other forms of gastritis. Doctors commonly suggest that people with gastritis
avoid spicy foods. However, capsaicin, the pungent ingredient in cayenne or
chili pepper, protected against aspirin –induced gastritis in healthy person .8
Researchers have suggested that food allergies or intolerance may cause
gastritis. In one double blind trial, people with proven food sensitivities showed
clear evidence of irritation of the stomach lining (including swelling, bleeding,
and erosions) when given foods to which they were known to react. However,
4
most of these people did not have abnormal results from standard blood tests for
allergies. People suspecting food sensitivities or allergies should consider
discussion an allergy elimination program with a health care professional. 9
A study was done and found that caffeine found in coffee, black tea, some
soft drinks, chocolate and many medication increases stomach acid, as does
decaffeinated coffee. Avoiding theses substances should therefore aid in the
healing of gastritis10
Consumption of blends of fruit juices with other fruit as well as herb extracts
can impart unique functional attributes and could be an effective strategy in
developing diet-based management of Helicobacter pylori infection as well as
other oxidation linked dieases.11
The patient should undertake a fast in both acute and chronic cases. In acute
cases, the patient will usually recover after a short fast of two or three days. In
chronic condition, the fast may have to be continued for a longer period of seven
days or so. In the alternative, short fasts may be repeated at an interval of one or
two months, depending on the progress being made11.
The fast may be conducted on fruit juices. By fasting, the intake of irritants
is at once effectively stopped, the stomach is rested and the toxic condition,
causing the inflammation, is allowed to subside. Elimination is increased by
fasting and the excess of toxic matter accumulated in the system is thrown out.11
After the acute symptoms subside, the patient should adapt an all fruit diet for
further three days. Juicy fruits such as apples, pears, grapes, oranges, pineapples,
peaches and melons may be taken during this period at five hourly intervals. The
patient can thereafter gradually embark upon a well-balanced diet of three basic
5
food groups, namely; seeds, nuts, and grains, vegetables and fruits on diet in
health and disease.11
Research has found that carrot juice in combination with the juice of spinach
is considered highly beneficial in the treatment of gastritis. Six ounces of spinach
juice should be mixed with ten ounces of carrot juice in this combination. Too
many different foods should not be mixed at the same meal. Meals should be
taken at least two hours before going to bed at night. Most of the patients are
unaware to follow the diet plan after discharge from the hospital and end in the
complication of gastritis. All these evidence made the investigator to do planned
teaching programme among patient with gastritis to improve their knowledge
and prevent them from complication of gastritis. 12 .
6.3 STATEMENT OF THE PROBLEM
A study to assess the effectiveness of planned teaching programme
on knowledge regarding dietary management among patients with gastritis in
selected hospitals, Bangalore.
6.4 OBJECTIVES:
1. To assess the existing knowledge regarding dietary management among
patients with gastritis.
2. To assess the post test knowledge regarding dietary management among
patients with gastritis.
3. To assess the effectiveness of planned teaching programme on knowledge
regarding dietary management among patients with gastritis.
4. To associate the post test knowledge regarding dietary management among
patients with gastritis with their selected demographic variables.
6
6.5 OPERATIONAL DEFINITIONS
1. EFFECTIVENESS:
In this study effectiveness refers to increase in the level of
knowledge regarding dietary management among patients with gastritis
after under going planned teaching programme.
2. PLANNED TEACHING PROGRAMME:
It refers to a systematically organized teaching strategy for duration
of one hour for patients with gastritis regarding dietary management
provided by verbal interaction with the use of instructional aid.
3. KNOWLEDGE:
It refers to the awareness and level of understanding of patients with
gastritis regarding the dietary management of gastritis as measured by
structured knowledge questionnaire.
4. DIETARY MANAGEMENT:
It refers to conservative and therapeutic dietary measures taken by
patients with gastritis.
GASTRITIS
It refers to the inflammation of lining of the stomach due to many
factors.
7
6.6 ASSUMPTIONS
1. Patients with gastritis may have inadequate knowledge regarding
dietary management of gastritis.
2. Planned teaching programme may improve the knowledge regarding
dietary management among patients with gastritis.
3. Patients knowledge regarding dietary management of gastritis may vary
with their selected demographic variables.
6.7 REASEACH HYPOTHESIS
H1- There is a significant difference between the mean pretest and post test
knowledge regarding dietary management among patients with gastritis
receiving planned teaching programme.
H2-There is a significant association between the levels of knowledge
regarding dietary management among patients with gastritis with their
selected demographic variables.
8
6.8 REVIEW OF LITERATURE
A good literature review is characterized by a logical flow of ideas; current
and relevant references with consistent, appropriate referencing style; proper use
of terminology and an unbiased and comprehensive view of the previous
research on the topic. It helps with all types of assignments as well. According to
Cooper (1988) "a literature review uses as its database reports of primary or
original scholarship, and does not report new primary13
A descriptive study was done on 25-year-old woman with severe anemia and
biopsies revealed autoimmune gastritis and typical megaloblastic changes in the
bone marrow. Vitamin B12 was administered parenterally and she was put on a
gluten-free diet. Early diagnosis, life-long gluten-free diet and vitamin B12
administration as well as appropriate aftercare prevent serious complications15
A descriptive study was done on Hemorrhagic gastritis due to cow's milk
allergy. Clinical findings in 10 patients reported with allergic gastritis were
vomiting, malnutrition, anemia, and hematemesis. Allergic compromise of upper
gastrointestinal tract might be considered in all vomiting patients particularly if
complicated by hematemesis. Diagnosis of allergic gastritis relies on clinical
suspicion helped by endoscopy and gastric biopsies.16
A descriptive study was done on 60 patients with chronic atrophic gastritis
and secretory insufficiency allied with chelicobacterial infection in combination
with chronic unlithic cholecystitis or diskinesia of choledoch ways were
explored with a view to study the efficiency of dietary cure including
biologically active food supplements--flavonoids source. Food supplements
benefits mucous membrane of gastroduodenal zone that is evidenced in decrease
9
of activity of pyloric chelicobacteriosis and resolvent and reparative effect; it
contributes to normalization of hepatobiliaric system condition and antioxidant
status.17
A quasi experimental study was done on the levels of diene conjugates and
Total bile acid-reactive substances were studied in serum blood of patients with
gastritis before and after including in diet of monosodium glutamate. For
investigation 15 patients were selected who had unacid or sub acid signs
determined by histamine test. It was shown that levels of diene conjugates and
Total bile acid-reactive substances were increased in serum of patients.
Monosodium glutamate increased the gastric secretion in patients but had no
effect of levels of diene conjugates and Total bile acid-reactive substances in
serum18
A descriptive study was done on the population of the United States continues
to shift toward the "oldest–old," often defined as 85 years old or more. Multiple
personal and environmental factors may contribute to suboptimal diets among
this group. However, practitioners are urged to assess each older patient on an
individual basis because many health-related problems that occur with advancing
age do not affect all older people at the same rate or in the same manner19
A descriptive study was done on the effect of cranberry; blueberry and grape
seed extracts on inhibiting helicobacter pylori have been investigated. The anti-
helicobacter pylori activity of cranberry juice extract was significantly improved
by its synergistic blending with blueberry, grape seed and oregano extract. The
lower efficacy of purified phenolics in inhibiting helicobacter pylori compared
with fruit powder at similar dosage levels suggests a synergistic mode of
functionality of these individual phenolics in whole food background.20
10
The experimental study was made of the effect of apple, grapefruit, orange
and beet juices on in vitro formation of N-nitrosodimethylamine from sodium
nitrite and amidopirin in human gastric juice. The patients had various forms of
gastritis and gastric cancer. It was found that fruit and beet juices may inhibit or
enhance N-nitrosodimethylamine formation depending on the gastric juice
composition, pH in particular. In acid medium (pH-1.3-3.4) there was a trend to
inhibition of N-nitrosodimethylamine synthesis, while in neutral and alkaline
(pH = 7.4-8.5) medium N-nitrosodimethylamine synthesis is activated.21
A descriptive study was done on dissimilar immunochemical, protein and
vitamin parameters were found in blood of patients with gastroenterological
diseases at the initial step of impairments under conditions of routine and special
diets. Specific alterations in content of transferrin, haptoglobin, and tocopherol
as well as in glutathione peroxidase and glucose-6-phosphate dehydrogenase
activities showed that compensatory mechanisms were maintained better under
conditions of the special diet therapy Clinico-biochemical evaluation of the
effectiveness of diet therapy in gastroenterologic patients. 22
An experimental study was done on a method of treatment of reflux gastritis
developing after vagotomy. This method includes diet N5, cerucal (0.01 g) and
allanton (1.0 g) three times daily before meals as well as 30 ml of almagel every
2 hours. The result was positive in 55 of 56 patients. Average hospitalization
time was 12.9 days, out-patient treatment-14.5 days.23
7 MATERIALS AND METHODS7.1 SOURCES OF DATA.
11
The data will be collected from the patients with gastritis who are admitted
in selected hospitals, Bangalore.
7.2 METHODS OF DATA COLLECTION
i. Research design
Quasi experimental - one group pre-test post-test design
ii. Variables
Dependent variables: Level of knowledge regarding dietary management
among patients with gastritis.
Independent variables: Planned teaching programme regarding dietary
management among patients with gastritis.
iii. Setting
Medical wards of selected hospitals, Bangalore.
iv. Population
All patients admitted in medical wards with gastritis
v. Sample
Patients with gastritis who fulfill the certain inclusive criteria are
selected for the study .The sample size is 60.
vi. Criteria for sample selection
Inclusive criteria
12
The study includes
1. Patients admitted with gastritis.
2. Patients who can understand kannada/English.
Exclusive criteria
The study excludes
1. Patients who are critically ill.
2. Patients who are not willing to participate.
vii) Sampling technique
Non probability – convenience sampling technique
viii) Tools for data collection
The tools consists of two section
Section A: Demographic data of patients with gastritis such as age, gender,
educational status, dietary habits, personal habits, disease condition,
duration of illness, sources of information.
Section B: Structured questionnaire will be used to asses the knowledge
regarding dietary management among patient with gastritis.
ix. Methods of data collection
13
After obtaining the permission from concerned authorities and
informed consent from the samples, the data will be collected in three
phases.
Phase I: A pre test will be conducted among patients with gastritis using a
questionnaire to assess their knowledge regarding dietary management of
gastritis.
Phase II: A planned teaching programme regarding dietary management of
gastritis will be conducted for one hour on the same day immediately after
the pretest
Phase III: After an interval of seven days a post test will be conducted for
the sample using the same questionnaire.
Duration of data collection will be 4 to 6 weeks
x. Plan for data analysis
The data collected will be analyzed by means of descriptive
statistics and inferential statistics24
Descriptive statistics
Frequency, mean, percentage distribution and standard deviation
will be used to analyze the level of knowledge regarding dietary
management among patients with gastritis.25
Inferential statistics
14
Paired‘t’ test will be used to compare the pre-test and post test
knowledge regarding dietary management among patient with gastritis.
Chi-square test will be used to analyze the association between post test
knowledge regarding dietary management among patients with gastritis
with their selected demographic variables.25
xi. Projected outcomes
This study will help the investigator to know the existing
knowledge of gastritis on dietary management among patient with gastritis.
Administration of planned teaching programme will help to improve their
knowledge on dietary management and its significance in preventing the
further complications of gastritis.
7.3 Does the study require any investigation or interventions to be
conducted on patients or other human or animals?
Yes, planned teaching programme will be administered as an intervention
for the patients with gastritis.
7.4 Has ethical clearance been obtained from your institution?
Yes, permission will be obtained from concerned authority of the hospital
and informed consent will be obtained from samples. Confidentiality and
privacy of data will be maintained.
8. LIST OF REFERENCES15
1. Joyce M Black, Jane Hokanson Hawks. Medical Surgical Nursing:
Gastritis. St Louis. Saunders; 7th Edition.Vol I. 2005; 743-76
2. Suzanne C Smeltzer, Brenda G Bare. Medical Surgical Nursing:
Gastritis. Philadelphia: Lippincott; 9th Edition. 2001; 460-65
3. G.E Bergonzelli, D.Donnicola, N.Porta, and I.E Corthesy theulaz.
Antimicrobial agents and chemotherapy: Essential oils as components
of a diet based approach to management of Helicobacter infection.
2003/oct 13; vol 4;240-246
4. Adrinne Dill Lindon.Introduction to Medical Surgical Nursing:
Gastritis. Missouri, Saunders, 2007, p: 836-881,4th Edition.
5. B.T.Basavanthappa “Medical Surgical Nursing” Gastritis. Jaypee
publication; 713-755
6. Sharon Mantik Lewis, Margaret Mc Lean Heitkemper, Shannan R
Dirksen. Medical Surgical Nursing: Gastritis. St Louis: Mosby; 6th
edition. 2004. P. 637,650.
7. Henery J. B. Clinical diagnosis and management by laboratory
methods; Treatment of Helicobacter pylori infections. Louis.
Saunders; 12th edition.2001.P 750-776
16
8. Gastritis diet available from:
URL:http://www.diethealthclub.com /health.Issues and
diet/gastritis/diet.html
9. Gastritis available from: URL:http://en.wikipedia.org
10. Gastritis available from : URL:http:// www. Merck .com /
mmhe /secog/ch121/ch121.b.html
11. Gastritis available from :URL :http: //www .emedicine .com /
med/topic 852.htm
12. National digestive disease information available from
:URL:http://www.digestive.niddk.nih.gov
13. B T Basvanthappa. Nursing research: Review of Literature. New
Delhi: Jaypee brothers; 2003. p -48
14. D.A.Vattem, Y.T.Lin, R.Ghaedian and K.Shetty. Process
biochemistry: Cranberry synergies for dietary management of
Helicobacter pylori infection. 2005 April 5; 40(5):1583-92.
15. Kleine G, Severe anemia in a young woman. Description of a rare
coincidence.2007 July 30; 132(30):1571-74
16. Machodo, Rodrio, Strehi, Kawakami, Elisabete, .Jornal de
Pediatria: Hemorrhagic gastritis cow’s milk allergy.2003 Aug
6;79 :363-68
17
17. Tutelian VA, Vasilev AV, Kochekkov AM, Pozheva, Alko’zlna
et al .Clinical use of flavnoid enriched biologically active food
supplement in patient with chronic atrophic gastritis.Russain:2003
Jan 5;72(1): 30-33
18. Shirinall, Maltsel GI, Malikova, Shakhovskaia, Kochetkov
A.V .A study of lipid per oxidation in patients with chronic gastritis
during administration of food additive monosodium glutamate,
Russain;1996 Dec 10; 24(1): 34-36
19. Kyitnitskill, Shiykovia,Julin AV, Clinico.Instructional studies of
the digestive system during diet therapy using culinary
products ;1984 Jan-Feb 5;3:18-21
20. Novederzhkina IG, Cherentsov A M.Effect of fruits on various
clinical and metabolic in patient with gastrointestinal diease; 1994
Jul4; 40:33-36.
21. Ilnitskil AP , Iurchenko VA.Effect of fruit and vegetable juice on
the changes in the production of carcinogenic N-nitrosomethylamine
compounds in human gastric juice;1993 Sep 4;4:44-46
22. Maltsev GI, Bilasheva IR, Orlova LA, Pogozheva. Clinico-
biochemical evaluation of the effectiveness of diet therapy in
gastroenterologic patient; 1990 Sep-Oct 30; 36(5):53-55
23. Vdovichenko VI, Ishmuratova SA.A method for treating reflux
gastritis after vagotomy.1989 Jun 6; 6:8-9
18
24. Denise F.Polit and Cheryl Tatano Beck. Nursing Research: Data
analysis and Interpretation. William and Willkims Publication: New
Delhi; 2008.506-642.
25. P.S.S.Sundar Rao. Introduction to biostatistics and research
methods: Basis of statistical. New Delhi: Prentice-Hall of India;
2006.p 66-9.
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9. Signature of the Candidate :
10. Remarks of the guide :
11.1 Name and Designation of the Guide :
11.2 Signature :
11.3 Co-guide :
11.4 Signature :
11.5 Head of the Department :
11.6 Signature :
12.1 Remarks of the Principal :
12.2 Signature :
20
