ࡱ> [ mbjbj 4ΐΐe+ )))))===8uA\=J1GGG&&& $מy2)&"&&&2))GGG&&&&8)G)G && &&*G:ƴ=^!<R]0"()D &&&&&&&&22$&&&&&&&&&&&&&&&& : RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE , KARNATAKA ANNEXURE I I PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1Name of candidate and Address ( In block letters )MR. JUSTIN V SEBASTIAN I YEAR MSc. NURSING SHREE DEVI COLLEGE OF NURSING MAINA TOWER , BALLALBAGH MANGALORE - 5750032Name of the InstitutionSHREE DEVI COLLEGE OF NURSING MAINA TOWER , BALLALBAGH MANGALORE - 5750033Course of Study and SubjectMSc NURSING (MEDICAL SURGICAL NURSING ) 4Date of Admission to the Course 5-2-20125Title of the Topic A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING LIFE STYLE MODIFICATIONS OF PATIENTS WITH HEART FAILURE AMONG STAFF NURSES WORKING IN SELECTED HOSPITAL, MANGALORE. 6. 7. 8. BRIEF RESUME OF THE INTENDED WORK 6.1 INTRODUCTION BACKGROUND OF THE STUDY Heart failure is the inability of the heart to deliver adequate oxygen to the bodys peripheral tissues. Primarily a disease of elderly persons, heart failure affects more than five million Americans. It may be right sided or left sided. Most common proximate cause of heart failure is left ventricular dysfunction, which is marked by reduced myocardial contractility, resulting in low stroke volume. Diastolic dysfunction produces heart failure due to elevated ventricular filling pressure. It is usually due to hypertension and often occurs without associated systolic dysfunction.1 Advances in the treatment of heart failure and early intervention to prevent decompensation may delay disease progression and improve survival. Early intervention with lifestyle changes and drug therapy has proven reasonably effective in treating heart failure, and it is the cornerstone of nearly every heart failure treatment regimen.2 6.2 NEED FOR THE STUDY Changes to a heart failure patients dietary habits and lifestyle may be among the first and most important steps taken to treat the disease. Heart failure is estimated to affect 4 to 5 million Americans, with 5, 50 000 new cases reported annually.In the past three decades, both the incidence and prevalence of heart failure have increased.Factors that have contributed to this increase are the aging US population and improved survival rates in patients with cardiovascular disease due to advancements in diagnostic techniques and medical and surgical therapies. Heart failure is a chronic, progressive disease that is characterized by frequent hospital admissions and ultimately high mortality rates, because of its high medical resource consumption, heart failure is the most costly cardiovascular illness in the United States.3 Heart failure is third most common cardiovascular disease in the US affecting 2 per cent of the U.S. population, or almost 5 million people. The prevalence of heart failure increases with the age from less than 1 per cent in the 20-39 yr old age group to over 20 per cent in the people age 80 yr or older. The life time risk of developing heart failure is estimated at about 20 per cent both in men and women. The lifetime risk of developing HF at the age of 40 yr is 11.4 per cent for men and 15.4 per cent for women. More than 500,000 new cases are diagnosed each year. Around 30 to 40 per cent of patients die from heart failure within 1 year after receiving the diagnosis. Heart failure can be disabling and it can severely reduce a patients quality of life.4 Heart failure is a chronic and progressive disorder that is characterized by frequent hospital admissions and high annual mortality rates (25%40%). Both the incidence and prevalence of heart failure have increased during the past 3 decades, and they will continue to increase. This increase is related to advances in diagnostic techniques in addition to medical and surgical therapies that have improved survival rates in patients with cardiovascular disease. Our aging population contributes further to this increase. Heart failure affects more than 400 000 Canadians, with over 50 000 new cases occurring annually.5 In India an estimated 2.27 million people died due to CVD during 2008. There were over 8 million persons suffering from CVD during 2011. The prevalence of CVD is reported to be 2-3 times higher in the urban population as compared to the rural population.6 Debbie Ehrmann Feldman and colleagues review trends in Montreal in admissions to hospital due to congestive heart failure in individuals aged 65 years or more, between 2008 and 2010, the annual rate of admissions to hospital for this disorder increased by 35%. At the same time, the readmission rate within 6 months rose to almost 50%. The one saving grace was the reduction in annual length of stay in hospital by 26% to a mean of 12.2 days. At the same time, the age-adjusted mortality rates did not change significantly. Although this review did not address the issue of treatment or changes in therapy during the time of the study, it does highlight the prevalence of this increasingly common cardiovascular disorder. With its high consumption of medical resources, heart failure is becoming the most costly cardiovascular illness.7 Adherence to guidelines results in improved outcomes of heart failure patients. Education of caregivers on evidence based therapy is the cornerstone of a successful heart failure programme. Unlike western countries where heart failure is predominantly a disease of elderly, in India it affects younger age group. The important risk factors for heart failure include coronary artery disease, hypertension, diabetes mellitus, cardio toxic drugs, valvular heart disease and obesity. In India coronary artery disease, diabetes, hypertension, valvular heart diseases and primary muscle diseases are the leading causes for heart failure. Rheumatic heart disease is still a common cause of heart failure in Indians.8 An organized system of specialists heart care improve outcome including quality of life, the frequency and duration of follow up and survival of patient with heart failure. A multidisciplinary team approach involving several professional with their own expertise is important in attaining an optimal effect. Health care practitioners who treat heart failure patients often face the challenge of managing multiple conditions requiring multiple medications and lifestyle changes in an older, sometimes cognitively and psychologically affected patient group. An inter-professional team approach is needed to optimally diagnose, carefully review and prescribe treatment, educate and counsel patients and families in regard to medication use and lifestyle changes, and provide post-discharge follow up. Heart failure patients are discharged from the hospital for follow up care. All the patients should modify their lifestyle practices after their discharge. It is the major responsibility of the health care member especially nurses to prepare the patient for facing this situation. Thus educating the patient and family is the primary responsibility of the nurse. An explorative and descriptive was carried out to determine nurse knowledge on heart failure among 300 nurses who provided care for patient with heart failure as selected as sample. A 20 item true or false written survey was administered between February 2005 to April 2005. The result of the study revealed that out of 300 nurses survey majority of the nurse had inadequate knowledge on heart failure self management. The study concluded that nurses may not be properly educated in heart failure self management principles and must be provided with right information. So that they can improve the quality and amount of information they offer to patient. Nurses who are better prepare to educate patient with heart failure may be more likely to carry out their nursing function as a part of their daily job role.9 A descriptive study was conducted to estimate the level of nurses knowledge on basis of heart failure self care principles. 143 nurses was selected as samples, a questionnaire measuring knowledge on heart failure self care principle was administered among cardiology nurses. Data were analyzed by using descriptive statistics, T test and analysis of variants. The result of the study has shown that there is an urgent need for nurses to update their knowledge and enhance their educational skills.10 Based on the above findings and own experience the researcher identified the need to improve knowledge of staff nurses on lifestyle modification of patient with heart failure by using self instructional module. 6.3 THE REVIEW OF LITERATURE The review of literature of heart failure & its lifestyle modification is divided into: Literature related to incidence & prevalence of heart failure. Literature on lifestyle modification of patient with heart failure. Literature related to the knowledge of staff nurse on the management of heart failure. Literature related to SIM as an effective teaching module. Literature related to incidence & prevalence of heart failure. A population based study was conducted to determine the incidence and etiology of heart failure in general population. New cases of heart failure were identified from the population 1,51000 served by 82 general practitioner. The result of the study showed that incident rate increased from 0.02 cases per 1000 population per year in those aged 25 to 35 years to 11.6 in those aged 85 years and over. The incidence was higher in male than female. The medium age at presentation was 76 years. The primary etiology were coronary artery disease 36%, unknown 34%, hyper tension 14%, valve disease 7%, atrial fibrillation 5% and other 5%. The study concluded that within the general population new cases of heart failure occur in elderly and incidence is higher in men than women.11 A population based study was conducted to determine the prevalence of heart failure and left ventricular systolic dysfunction in the general population. 5540 participants belongs to 55 to 95 years, were selected as samples. The presence of heart failure was determined by assessment of symptoms and sign and use of heart failure medications. The overall prevalence of heart failure was 3.9% and did not differ between men and women. The prevalence increased with age. The prevalence of left ventricular systolic dysfunction was approximately 2.5 times higher in men than women. The study concluded that the prevalence of heart failure is appreciable and does not differ between men and women.12 Literature on lifestyle modification of patient with heart failure. An experimental study was conducted to determine how an exercise adherence intervention affects the physiological, functional, and quality of life outcomes of patients with heart failure. Sixteen heart failure patients were randomly assigned to an exercise-only group or to an exercise-with-adherence group. Two of the 16 people died from no exercise related causes during the study and were not included in the analysis. The intervention was tested over a 24-week period in which patients participated in a 12-week supervised exercise program followed by 12 weeks of unsupervised home exercise. The intervention format was one of individualized graphic feedback on exercise goals and participation and problem-solving support by nurses. Results indicated that patients who received the intervention exercised more frequently and experienced improved outcomes during both phases. The adherence intervention may encourage HF patients to continue to exercise and thereby maintain the health benefits gained in both phases of an exercise program.13 A longitudinal study was conducted to ascertain the safety and effectiveness of a lifestyle modification program in patients with systolic heart failure and metabolic syndrome. 20 patients with systolic heart failure (ejection fraction < 50%) and metabolic syndrome were randomized to standard medical therapy (Control) versus medical therapy and lifestyle modification (Lifestyle) and followed prospectively for 3 months. Lifestyle modification involved a walking program and reduced calorie diet with 2 meal replacement products daily. Data collected at baseline and 3 months and included physical exam, laboratory values, quality of life questionnaire, 6 minute walk, and brachial ultrasound revealed that 3 months, 5 patients in each group had lost -0.84 3.82 and -0.50 3.64 kg on an average and no significant differences in the defined endpoints were noted. None of the patients had an adverse event that was related to weight loss or exercise. And the results pointed out that lifestyle modification in patients with systolic heart failure and metabolic syndrome was well tolerated, but did not result in significant weight loss.14 Literature related to the knowledge of staff nurse on the management of heart failure. A cross sectional study was conducted to evaluate the home care nurse knowledge in managing heart failure patient. 92 home care nurses were recruited from 4 home care agencies. A previously published 20 item heart failure knowledge questionnaire was administered to participants. The result of the study has shown that the nurses for lowest on knowledge related to asymptomatic hypotension and weight monitoring. The study concluded that home care nurse may not be sufficiently knowledgeable in evidence based education topic for managing heart failure. The result confirmed the need to develop educational programme for home care nurses in managing heart failure which may lead to improve quality of patient education.15 Literature related to SIM as an effective teaching module A study was conducted on 2009 to assess the effectiveness of Self Instructional Module regarding quality of life among patients following CABG surgeries in the elderly .A total number of 63 patients with 65 years of age group, both males and females were selected by convenience sampling technique. A detailed questionnaire was used to collect data about quality of life and improvement in lifestyle after CABG surgery . The study result showed that a high proportion of the patients experienced improvement (that is 45 patients) in life style modifications, while a substantial number (that is 15 patients) had exacerbations in cognitive function, lack of confidence and dependence. The study concluded that an important step is needed to improve the quality of life, might be through the institution of a structured multidisciplinary rehabilitation program, also the life style modification with focus on emotional support.16 6.4 STATEMENT OF PROBLEM A study to assess the effectiveness of self instructional module on knowledge regarding life style modifications of patients with heart failure among staff nurses working in selected hospital, Mangalore. 6.5 OBJECTIVES To assess the prior knowledge of staff nurses regarding life style modifications of patients with heart failure. To develop SIM regarding the life style modifications of patients with heart failure To find out the effectiveness of SIM in terms of gain in post test knowledge score regarding life style modification of patient with heart failure. To associate the pre test knowledge score with selected demographic variables. OPERATIONAL DEFINITION Assess: In the present study, assess means judging the status of pretest and post test knowledge of staff nurses on life style modification of patient with heart failure. Knowledge: In this study knowledge refers to the correct responses to the items on a structured questionnaire on life style modification of patient with heart failure which is measured and expressed in terms of knowledge scores. Effectiveness: In the present study, effectiveness refers to the extent to which the STP has achieved the desired objectives, that means improvement of post test knowledge scores among staff nurses regarding life style modifications of patients with heart failure Self instructional module: In the present study SIM is a learning package planned and prepared from lifestyle modification of patient with heart failure provided to staff nurses with an aim to facilitate self learning Heart failure: Heart failure is a physiologic state in which the heart cannot pump enough blood to meet the metabolic needs of the body. It includes left sided failure, right sided failure or both. Life style modification In this study lifestyle modification refers to the changes in the activities of daily living for reducing the risk factors of cardiac failure which includes dietary modifications, exercise, behavioral modifications, weight management, symptom management, stress management, medication and follow up. Staff Nurses: In the present study, staff nurse is a person who is having a diploma or basic degree in nursing from a recognized university or board, registered under a state nursing council and is working in selected hospital, Mangalore. Selected Hospital: In the present study selected hospital refers to the place where the researcher obtains permission & intents to conduct the study. 6.7 VARIABLES Independent Variable: The SIM on life style modifications of patients with heart failure Dependent Variables: Staff nurses knowledge on life style modifications of patients with heart failure 6.8 ASSUMPTION The study assumes that staff nurses will have some knowledge regarding life style modifications of patients with heart failure. knowledge may vary from person to person 6.9 DELIMITATION The study will be delimited to the staff nurses working in selected hospital, Mangalore. 6.10 HYPOTHESES All the hypothesis will be tested at 0.05 level of significance. H1: The mean post test knowledge score of the staff nurses will be significantly higher than mean pre test knowledge score. H2: There will be significant association between pre test knowledge score of the staff nurses on life style modifications of patients with heart failure with selected demographic variables. MATERIALS AND METHODS 7.1.1 SOURCE OF DATA: Data will be collected from the staff nurses in selected hospital, Mangalore 7.1.2 RESEARCH DESIGN: The research design selected for this study is pre experimental one group pre and post test design. The schematic representation of the design as follows O1---X --- O2 E = O2 - O1 O1= Pre test knowledge of staff nurses on life style modifications of patients with heart failure X = Intervention with Self Instructional Module on life style modifications of patients with heart failure O2= Post test knowledge of staff nurses on life style modifications of patients with heart failure E = Effectiveness of SIM 7.1.3 SETTING : The study will be conducted in selected hospital, Mangalore 7.1.4 POPULATION: The population of this study will be staff nurses in selected hospital, Mangalore 7.2 METHOD OF DATA COLLECTION 7.2.1 SAMPLING PROCEDURE: Purposive sampling technique will be adopted for this study. 7.2.2 SAMPLE SIZE: The sample size will be approximately 50 staff nurses in selected hospitals, Mangalore. 7.2.3 INCLUSION CRITERIA: Staff nurses who are willing to participate in the study available at the time of data collection 7.2.4 EXCLUSION CRITERIA Staff nurses who are not available during the period of data collection not willing to participate in the study 7.2.5 DEVELOPMENT OF TOOL Instrument Used 1.Closed ended questionnaire related to life style modifications of patients with heart failure 2. SIM on life style modifications of patients with heart failure. Description Of The Tools Closed ended questionnaire will be prepared to assess the knowledge of staff nurses on life style modifications of patients with heart failure The closed ended questionnaire will have two parts Part A- demographic characteristics. Part B- item on life style modifications of patients with heart failure. SIM will be prepared based on objectives, literature reviews and based on experts opinion. 7.2.6 DATA COLLECTION METHOD Prior to the data collection permission will be obtained from the concerned authority for conducting the study. The data will be collected from approximately 50 staff nurses, after obtaining their consent. Pretest will be conducted using structured knowledge questionnaire and a SIM will be planned to the staff nurses on the same day and post test will be conducted by using the same questionnaire. 7.2.7 DATA ANALYSIS PLAN The data will be planned and analyzed using differential and inferential statistics the differential statistics will be used are mean, median, standard deviation, and mean percentage etc inferential statistics will be used are paired t test and chi- square.(P > 0.05) 7.3 DOES THE STUDY REQUERE ANY INVESTIGATION TO BE CONDUCTED ON PATIENTS OF OTHER HUMANS OR ANIMALS? Yes, a self instructional module on life style modifications of patients with heart failure will be carried out to improve the knowledge level of staff nurses. 7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTE IN CASE OF 7.3? Yes, ethical clearance has been obtained from the concerned authority. REFERENCES Hunt SA, Baker DW, Chin MH, et al. Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. The Am jour of nurs. 2001[internet]; 64(3). Available from  HYPERLINK "http://www.jstor.org/pss/3419010" http://www.jstor.org/pss/3419010. Young JB. The cardiac response to injury. In: Mills RM, Young JB. Approaches to the Treatment of Heart Failure. Baltimore, Md: Williams & Wilkins: 1998:1830. OConnell JB. The economic burden of heart failure.Clin Cardiol.2000;23(6). Owan TE, Redfield MM. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis 2005; 47: 320-32. Naylor CD, Slaughter. Cardiovascular health and services in Ontario:an ICES atlas. 1st ed. Toronto: ICES; 1999. p. 111-22 Jessup M, Brozena S. Heart failure. 2. N Engl J Med 2003; 348 : 2007-18. Ehrmann Feldman D, Thivierge C, Gurard L, Dry V, Kapetanakis C, Lavoie G, et al. Changing trends in mortality and admissions to hospital for elderly patients with congestive heart failure in Montreal. CMAJ 2001;165(8):1033-6. Available: www.cma.ca/cmaj/vol-165/issue-8/1033.asp Jessup M, Brozena S. Heart failure. N Engl J Med 2003; 348 : 2007-18 Knopp AM. Nurses knowledge of heart failure guidelines in a western montana hospital[internet]. Available online from: URL: http://etd..montana.edu/2009/knopp/ pdf HYPERLINK "http://europepmc.org/search/?page=1&query=AUTH:%22Kalogirou+F%22&restrict=All+results"Kalogirou F,HYPERLINK "http://europepmc.org/search/?page=1&query=AUTH:%22Lambrinou+E%22&restrict=All+results"Lambrinou E,HYPERLINK "http://europepmc.org/search/?page=1&query=AUTH:%22Middleton+N%22&restrict=All+results"Middleton N,HYPERLINK "http://europepmc.org/search/?page=1&query=AUTH:%22Sourtzi+P%22&restrict=All+results"Sourtzi P. Cypriot nurses' knowledge of heart failure self-management principles. European Journal of Cardiovascular Nursing [internet] 2012. Available from URL: http://europepmc.org/abstract/MED/21429581 Senes S, Britt H. A general practice view of cardiovascular disease and diabetes in Australia[internet] .Available from URL:www.amaassn.org/ mm/pcpi/hfset-12-5.pdf Mosterd A,Hoes AW, Bruyne MC, Deckers JW. Prevalence of heart failure and left ventricular dysfunction. European Heart Journal.1999; 20(4): 447455 Duncan K, Pozehl P B. Effects of an Exercise Adherence Intervention on Outcomes in Patients with Heart Failure. Rehabilitation Nursing.2003 july;28(4):117-122. Pritchett AM, Deswal A, Aguilar D. Lifestyle Modification with Diet and Exercise in Obese Patients with Heart Failure. J Obes Weig los Ther.2012;2(2):118-120. Delaney C, HYPERLINK "http://europepmc.org/search/;jsessionid=s03Tmj2JOk6C0qJIxyn2.16?page=1&query=AUTH:%22Apostolidis+B%22" Apostolidis B, HYPERLINK "http://europepmc.org/search/;jsessionid=s03Tmj2JOk6C0qJIxyn2.16?page=1&query=AUTH:%22Lachapelle+L%22" Lachapelle L, HYPERLINK "http://europepmc.org/search/;jsessionid=s03Tmj2JOk6C0qJIxyn2.16?page=1&query=AUTH:%22Fortinsky+R%22" Fortinsky R. Home care nurses' knowledge of evidence-based education topics for management of heart failure. Heart & Lung : the Journal of Critical Care 2011;40(4):285-292 Merkouris A. Quality of life after coronary artery bypass graft surgery in the elderly. Euro Journ of card vasc nur. 2009 Mar; 8(1): 74-81  9. Signature of the candidate 10.Remarks of the guide  TOPIC IS RELEVANT TO CONDUCT THE RESEARCH STUDY 11.Name and designation of (in block letters) Guide MR. GIREESH G. R. HOD, MEDICALSURGICAL NURSING SHREE DEVI COLLEGE NURSING MANGALORE Signature Co-guide (if any) ----- Signature12. 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