Rajiv Gandhi University of Health Sciences s88

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU, KARNATAKA

PROFOMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 Name of the candidate and Mr. Don Abraham address 1st Year M.Sc (N)

Koshys College of Nursing

331/1, Hennur- Bagalur Road,

Kadusonnappanahalli,

Kannur Post, Bangalore – 562 149

2 Name of the Institution Koshys College of Nursing

3 Course of the study and subject 1st Year M.Sc Nursing

Medical Surgical Nursing

4 Date of Admission 16.06.2009

5 Title of the topic “A study to assess the knowledge of working

men on prevention of peptic ulcer in selected

areas of Bengaluru, with a view to develop

self instructional module”.

6. BRIEF RESUME OF THE INTENDED WORK

1 INTRODUCTION

“The beginning of habit is like an invisible thread,

but every time we repeat the act,

we strengthen the strand, add to it another filament,

until it becomes a great cable and binds us irrevocabily ,

both in thought & action”

- Orison swelt marden.

A peptic ulcer, also known as culcus pepticum. Peptic ulcer is a mucosal erosions equal to or greater than

0.5 cm of an area of the gastrointestinal tract, that is usually acidic and thus extremely or proximal duodenum but they may also occur in the esophagus, due to acid reflux, in jejunum at site of gastrointestinal anastomosis, and rarely in relation to ectopic gastric mucosa near a meckle’s diverticulum.

“Peptic ulcer is a term defined as a breach in the mucosa which extends through the sub mucosa up to the muscularis” in general, peptic ulcers are erosions in the lining of the stomach or the first part of the intestine.

Peptic ulcer is a world wide problem and its prevalence in India is quite high. Several field studies from different parts of our country suggest its occurrence in 4 to 10 per 100 populations. Karnataka, Tamil Nadu,

Andhra, Jammu and Kashmir are considered to be very high risk areas. The incidence of peptic ulcer in the western world is decreasing, most likely because of a change in the prevalence of Helicobacter pylori infection.

(Hazra B 1998). In India duodenal ulcers are 5 to 10 times more common than gastric ulcers. The incidence of peptic ulcer is more common in the working age >21 years among males than female The incidence of gastric ulcer is usually 50 and above. It is also more common in male than female. Duodenal ulcer is almost four times more common than gastric ulcer, the overall incidence of gastro duodenal ulcers being approximately

10% of the male population.

2 Biemond Izak (1995) conducted a study prove that Helicobacter Pylori is one of the causes of peptic ulcer. The disease results in chronic suffering loss of working hours and occasional fatality other potentially irritant substances like caffeine, ethanol, nicotine may delay healing but there is evidence show that these substance induce ulcer. Strong tea , coffee, chillies, Garam masala, pepper may increase the secretion of hydrochloric acid and aggravate the condition .Ulcers can also be caused or worsened by drugs such as aspirin and other NSAIDs.

6.1 NEED FOR STUDY

Many factors are contributing to the frequency of peptic ulcer are stress, use of tobacco, use of corticosteroids, and infections agents like Helicobacter pylori, irregular eating habbits, alcohol, minimal daily exercise and lack of fibre intake in the diet.

In the present world the working men are risk for all the above factors, which is a predicting change for them to go for peptic ulcer, and also may be the secondary cause of stress in the occupation area.

Peptic ulcer is a chronic disorder which producing several signs and symptoms like burning pain, vomiting, hematemesis etc. it is also proven that improper management of peptic ulcer will leads to complications like

Gastro intestinal hemorrhage, ulcer perforation, gastric outlet obstruction.

R.D Goodwin (2002)conducted a study on ”Impact of stress on development of peptic ulcer.”This study suggested that person who perceive their lives as stressful may be at increased chance for the development of peptic ulcer disease. Higher incidence of pepticulcer cases were observed more among the working men whose age more than 21 years. It is also occur in 10 percent of the population about 30,00000 new cases are diagnosed

3 each year in the united states. Death rate from duodenal ulcer has remained relatively constant at about 1/100,000 each year since 1980.

It is very important to understand the knowledge level of working men, who are getting more exposure of stress, irregular eating habits use of alcohol, and lack of exercise etc. From the literature reviewed with the available source the investigated identified the need on prevention of peptic ulcer especially on the working men was the priority. As the developing countries like India need more man power the increasing concept of disease should be prevented by adequate awareness.

So the investigator performed the role on educating the working men in providing self instructional module which will in the increase the knowledge to decrease the risk of peptic ulcer. It is also identified that assessment of knowledge of working men regarding peptic ulcer will help the investigator to plan and prepare the self instructional plan and prepare the self instructional module related to the prevention of peptic ulcer disease.

Investigator can make an awareness among working men regarding prevention of peptic ulcer disease, hence can reduce the risk factor and mortality and morbidity related to the peptic ulcer.

4 6.2 REVIEW OF LITERATURE

Based on objective the study is arranged into following category :

 Studies and literature related to the knowledge on working men about disease peptic ulcer.

 Studies related to incidence, etiology, risk factors and prevention of peptic ulcer.

 Studies and literature related to clinical features , treatment and complications of peptic ulcer. a) Studies and literature related to the knowledge on working men about disease peptic ulcer.

Storm Netter(2005) conducted a study to assess the causes of peptic ulcer among Danish patients in

Denmark.59 patients were included in the study.They were given a questionnaire listing 16 possible causes of peptic ulcer and indicated for each.Whether they believed it as a contributory causes of the diseases.75% of the patients indicated that psychologic factors such as grief ,anxiety and stress were contributory causes of disease, where as only around 40% believed that coffee, alcohol,smoking,side effects of medicine and working conditions played casual role.

Juel K.et al(2003) performed a study to Assess the prevalence of abdominal pain alleviated by food intake among bus drivers in Denmark.”1978 subjects answered a postal questionnaire on health and working conditions.

The prevalence of abdominal pain alleviated by food intake was 12%.Some of the drivers mentioned that wage dissatisfaction, occupational and psychological factors and smoking were the causes of peptic ulcer disease.

Descriptive study has been conducted about peptic ulcer disease and Jamaican patient awareness on 2002. 51 patients with peptic ulcer disease were included in the study, which was regarding their awareness of their disorder. 63% of patient had known their ulcer location but 37% were unaware of their diagnosis. 76% thought that poor eating habits were a contributing cause of their illness. 39% thought that stress was a cause. 16% implicated heredity. The studies showed that awareness of Jamaican patients about peptic ulcer disease were inadequate.

5 Bhasin DK et al (2001) did astudy on patient with peptic ulcer and their knowledge of factors influencing the development and course has been conducted in hydrabad. Two hundred and ten patients were selected as sample. 48.2% indicated peptic ulcer was a significant health and social problem for person having it. It was found that all patients had definite view on the factors causing and influencing it. The most negative influence on the health condition of the patient was stress situation. The generally accepted negative influences of abnormal nourishment on peptic ulcer were identified by half of the response.

A descriptive study on knowledge about cause related to peptic ulcer disease was carried out in United

States. In 1996 72% of the general public was unaware of association between helicobacter pylori infection and peptic ulcer disease. To increase the awareness among general public, the health care providers has developed an awareness and education campaign in 1997. During late 1997 a population based survey was conducted, the findings indicated that only 27% of the general public were aware of the association between Helicobacter pylori infection and peptic ulcer disease. b) Studies related to incidence, etiology, risk factors and prevention of peptic ulcer.

B. Lal et al (2007) conducted a study among north Indian population. The aim of the study was to know the prevalence of duodenal ulcer promoting gene (Dupa) of Helicobacter pylori in patient with duodenal ulcer.

One hundred and sixty six patients were included in this study. Analysis indicated that dupa gene was present in

37.5% of H. pylori stains isolated from decubitus ulcer patients and 22.86% of functional dyspepsia patients, of these 35 patients with functional dyspepsia were infected by Helicobacter pylori. Result of the study shows that significant association of dupa gene with decubitus ulcer in the population.

S.P Mukhopadh etal ( 2007 ) conducted a study on smoking habits among slum dweller and the impact on health among the population of west Bengal. The study proves that there is ill effect smoking. It also revealed that smoking was a risk factor of peptic ulcer.

W. Wachirawat et al (2003) conducted a study conducted in Thai population. This study prove that there were significant relationship between peptic ulcer with stress and Helicobacte Pylori.

6 RDGoodwin (2002) conducted a study on anxiety and peptic ulcer disease among adults in United

States. The goal of study was to determine the relationship between generalized anxiety disorder and self reported peptic ulcer disease among adults in the community. The results showed that there was an association with generalized anxiety disorders and a significantly conducted increased risk (60%) of self reported peptic ulcer disease.

V N Joish et al (2005) conducted a study among population in USA. The objective of this study was to examine the relationship of work loss associated with peptic ulcer disease. The result depicts that there were significantly lower prescription, and out patient costs in the controls compared to the diseased groups, for work loss, a significantly higher rate of adjusted all cause absenteeism and sickness related absenteeism were observed between disease groups versus the controls. Direct medical cost and work absence in employee with GERD peptic ulcer disease represented a significant burden to employee and employers.

Hazra et al(2000) conducted a retrospective analysis of hospital records of in patients of medicine department of North Bengal Medical College and hospital during the period between 1998 – 2000 . The study revealed that 6.2% of all medical admissions were an account of peptic ulcer and or acute gastritis. Duodenal ulcer was prevalent accounting for more than 50% of the cases of peptic ulcer and acute gastritis. It also revealed that working men with >21 years is more prone to get peptic ulcer.

Biemond Izak et al (1998) conducted a population based prospective cohort study comprising 2416

Danish adults at Glostrup University hospital. Sample members were interviewed in 1994 and 1998. The study results showed that the main risk factors for peptic ulcer were Helicobacter pylori infection, Tobacco chews, smoking and use of minor tranquillizers.

Schlemper J Donald et al (1995) conducted a study among the Japanese employees. He found that the sample with the ulcer history had the infection due to helicobacter pylori.

Gyntelberg .G (1995) conducted a study was carried out in Helicobacter pylori, is a risk factor for peptic ulcer disease in cirrhotic patients at Barcelona.

7 The results indicated that the prevalence of Helicobacter pylori infection in patient with peptic ulcer disease was higher than in those without Helicobacter Pylori. Infection increases the risk of peptic ulcer disease in patient with cirrhosis.

Marshel J et al(1994) conducted a study on incidence and risk factors for self reported peptic ulcer disease was conducted on 1994 in United States. A population based sample of 42392 individual has been surveyed. The incidence of ulcer sample were 5.24 per 1000 adults, among this 8.7% had the peptic ulcer disease with the risk factors include increasing age, lower, income, educational attainment etc.

JN Ronald on 1996 conducted a study on peptic ulcer among workers in the engineering and chemical industries, in United State. The study covered 157 workers with peptic ulcer who reported themselves to outpatient clinics. This study indicates that peptic ulcer is more often diagnosed in manual that in office work and its incidence can be associated with work conditions and life style.

Siriraj H Bunkole (2002) conducted a study which was based on stress associated with peptic ulcer disease in Thai Population . The results showed that peptic ulcer was associated with chronic stress and conclude that stress and family history of Helicobacter pylori infection are important risk factors for peptic ulcer.

S. Swetha( 2001) conducted a study on epidemiology of helicobacter pylori and peptic ulcer at

Chandigarh. Study randomly covered all sectors of Chandigarh and screened 2649 persons. A questionnaire was administered to each subject by trained staff. The study result showed that there were 80 symptomatic and 67 asymptomatic individuals. The duodenal to gastric ulcer ratio was 12:1 and peptic ulcer was more common in elderly and dyspeptic individuals c) Studies and literature related to clinical features, treatment, and complications of peptic ulcer.

Kindlund Bert(2009), a Sweden biologist studied on peptic ulcer bacterium and body’s immune system .

This study shows that a type of cells in the immune system called regulatory T cells down – regulate the body’s defence against Helicobacter pylori and thereby enable the bacterium to develop a chronic infection. Controlling the regulatory T cells could strengthen the immune system and help the body eliminate the bacterium. This can be a new treatment strategy against Helicobacter Pylori.

8 L Edward (2007) studied on diet and the risk of duodenal ulcer in man. The study showed that higher consumption of fruits and vegetables was associated with lower risk of duodenal ulcer. It is also proved that dietary fiber and Vitamin- A prevents the possibility of peptic ulcer.

Bowman (2003) conducted a study about adverse effect of delayed treatment for perforated peptic ulcer.

One thousand two hundred, ninety two patients who were operated for perforated peptic ulcer in the Bergin area were studied. The study results showed that delayed treatment after peptic ulcer perforation reduced survival, increased complication rates and caused prolonged hospital stay.

Loescher et al (2003) conducted a study peptic ulcer oncomplications of peptic ulcer disease indicated that even though the incidence of complications were similar in the aged and other patients, and their course is much more serious in the elderly and the ulcer perforation is the most serious complications.

A perspective study was conducted on risk factors predicting operation mortality in perforated peptic ulcer disease among the patients who under gone surgery at institute for peptic ulcer perforation between September

1999 and August 2001. One hundred seventy four patients underwent surgery for perforated peptic ulcer. Study results showed that risk of death was related to age, delaying more than 24 hrs prior to the surgery and size of perforation more than 5 mm.

6.3 STATEMENT OF THE PROBLEM

‘ ’ A study to assess the knowledge of working men on prevention of peptic ulcer in a selected area of

Bengaluru,, with a view to develop a self instructional module”.

6.4 OBJECTIVES

The objectives of the study are:

 Assess the knowledge of peptic ulcer in working men in the age group of 25-55 years.

 Identify association between the knowledge on prevention of peptic ulcer with selected demographic

variables

 Develop self instructional module on peptic ulcer disease and its prevention.

9 6.5 HYPOTHESIS

H1 There will be significant relationship between the selected socio-demographic variables (age, occupation, experience, religion , monthly family income habits like diet, smoking, and alcohol) and knowledge of working men regarding peptic ulcer.

H2 There will be significant relationship between the knowledge on peptic ulcer and knowledge on prevention of the working men.

6.6 OPERATIONAL DEFINITIONS Knowledge: It refers to the correct responses of the working men to the investigators questionnaire.

Peptic Ulcer : It refers to the ulceration in the mucosa of the lower esophagus, stomach or duodenum.

Prevention: Avoiding the occurrence of risk factors which causes peptic ulcer disease.

Working men: Men having employment and whose age falls on 25 – 55 yrs .

Assessment: It refers to the process used to identify, evaluate and analysis the level of knowledge component of working men in relation to prevention on peptic ulcer disease.

Self Instructional Module: It refers to the systematic and scientific information and specific instructions related to peptic ulcer disease prepared by the investigator to educate working men.

6.7 ASSUMPTION It is assumed that,  Working men will have certain knowledge about peptic ulcer and its prevention.

 Working men from higher social class have more knowledge on peptic ulcer and prevention.

 Working men with higher education will have higher knowledge related to peptic ulcer.

 Working men with more experience has more knowledge on peptic ulcer.

 Working men with high family income will have higher knowledge about peptic ulcer.

 Working men has association with the knowledge of peptic ulcer and the knowledge on prevention of

peptic ulcer. 10 6.8 DELIMITATION

This study will be delimited to ;

 Working men with in the area of Bengaluru

 Working men whose age is 25 -55 years.

 Working men who are willing to participate in the study.

 Working men who are available during the period of study .

 The study is limited to five weeks.

 Working men who has read or write Kannada or English.

7. MATERIALS AND METHODS

7.1 Source of Data: The source of data will be collected from working men between 25-55 years of age of selected areas of Bengaluru.

7.2 Methods of Data Collection:

Research methodology : Non experimental descriptive method .

Sampling technique : Convenient sampling Sample size : 100 working men between 25-55 years of age Population : Working men coming under the selected areas of Bengaluru. Setting : Selected area of Bengaluru.

11 7.2.1 CRITERIA FOR SELECTION OF SAMPLE:

Inclusion Criteria:

This study includes working men,

 From selected areas of Bengaluru.

 Whose age between 25 – 55 years of age

 Individual who are willing to participate in the study.

 Who are able to read or write Kannada or English.

Exclusion Criteria:

This study excludes:

 Men who are not available at the time of data collection.

 Men who are not willing to participate in the study.

 Men who cannot read or write Kannada or English.

7.2.2 DATA COLLECTION TOOLS:

A structure knowledge questionnaire will be prepared to assess the knowledge of working men regarding peptic ulcer, and its prevention. The structured questionnaire is comprised of two parts.

Part I : It consists of describing demographic variables of working men.

Part II : This part consists of two section.

Section A : Consists of closed ended questions which is regarding the peptic

ulcer disease.

Section B : Closed ended questions regarding the prevention of peptic ulcer disease.

The data will be collected by the investigator himself.

12 7.2.3 DATA ANALYSIS METHOD

Data analysis will be done in terms of the objectives of the study using descriptive and inferential statistics.

Mean and standard deviation will be done to assess the knowledge regarding peptic ulcer and its prevention. The chi-square test will be done to find out the association between the mean knowledge score with selected demographic variables. The findings will be presented in the form of table, diagram and graphs.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN’S OR ANIMALS? IF SO DESCRIBE. YES: only a structured self instructional module and a structured knowledge questionnaire any physical or mental harm to the sample will be sued in the study.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED? YES: a) A written permission from the concerned authority will be obtained prior to the study. b) Consent will be taken from the clients before conducting the study. c) Confidentiality and anonymity of the subject will be maintained.

13 8. REFERENCES

Books

1. Burns Nancy, “Understanding Nursing Research”, 2nd edition, 2002, Harcourt Publishers, Page No. 103-

126.

2. Burns Nancy, “The practice of Nursing research”, 2nd edition, 1993, Harcourt Publishers, Page No. 141 –

170.

3. Basavanthappa BT, “Nursing Research”, 1st Edition 2003, Jaypee brothers medical publishers, Page No. 49

– 65.

4. Black M. Joyce, “Medical –surgical Nursing”, 7th Edition 2005, Page No. 750 – 760.

5. Basavathappa BT, “Medical Surgical Nursing”, 1st Edition 2003, Jaypee brothers , Medical Publishers,

Page No. 263 – 564.

6. F.A “Golwalla Medicine for students”, 20th Edition, Dr A.F Golwalla Publishers Page No. 17-21.

7. Dixit .J.V, “Principles and Practice of Biostatistics”, 3rd Edition, 2005, M/S Banarsidas Bhanot Publishers

Page No. 234.

8. Lewis et al, “Medical Surgical Nursing Assessment and Management of clinical Problem”, 6th Edition ,

Mosby publication, 2004, Page No. 1028-1044.

9. Kothari R.C,, “Research Methodology Methods and Techniques”, 2nd edition, New age international

publishers, Page No. 185 – 186.

10. Lippincott, “The Lippincott Manual of Nursing Practice”, 7th Edition, 2001,Page No. 607-608.

11. Mahajan B.K “ Methods in Biostatistics for medical students and research workers”, 6th edition, 1997,

Jaypee Brothers Publishers, Page No. 11.

12. Phipps et al, “Shaffers Medical Surgical Nursing”, 7th Edition, 2004, BT Publishers, Page No. 594 – 600.

13. Polit .F Denise et al, “Nursing Research Principles and Methods”, 7th Edition, Lippincott Williams and

wilkins publishers, Page No. 115-116. 14 14. Smeltzer C Suzanne et al, “Suddarth’s & Brunner’s Textbook of Medical Surgical Nursing “, 10th Edition,

Lippincott Williams and wilkins publishers Page No, 1015-1021

15. Stein H. Jay, “ Internal Medicine,” 5th Edition, mosby publishers, page No. 2035 – 2041.

JOURNAL AND MAGAZINES:

Weblinks;

1) www.pubmed.com through “ Journal of Gastroenterology and Hepatology”, volume 10, issue 6, Page No.

633-638.

2) www.webmel.com through “scandivian journal of Gastroenterology”, volume 32, issue 12 Page No. 1195-

1200.

3) www.google.com through, “American journal of Epidemiology“ Volume 145, Page No. 1:42-50.

4) www.news.medicalnet through “Peptic ulcer bacterium alters the body’s defence system”, page 1-5.

15 9 SIGNATURE OF THE CANDIDATE

10 REMARKS OF THE GUIDE This is a descriptive study empowers the knowledge on the preventive aspects of peptic ulcer disease.

11 NAME AND DESIGNATION Mrs. Sheeba.A

11.1 GUIDE

11.2 SIGNATURE

11.3 HEAD OF THE DEPARTMENT Mrs. Sheeba.A

11.4 SIGNATURE

12 REMARKS OF THE PRINCIPAL The study helps working men to focus on prevention of peptic ulcer.

16 9 SIGNATURE OF THE CANDIDATE

10 REMARKS OF THE GUIDE This study helps in the inexpensive spread of knowledge through school children.

11 NAME AND DESIGNATION Pro. Rachel .P George

11.1 GUIDE

11.2 SIGNATURE

11.3 HEAD OF THE DEPARTMENT Pro. Rachel .P George

11.4 SIGNATURE

12 REMARKS OF THE PRINCIPAL School children are the future of the nation and this study helps to empower them