Title of the Topic

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Mr. K.C.SOMASHEKHARA 1ST YEAR M.SC., NURSING MEDICAL SURGICAL NURSING YEAR 2008-2009

SHRI. H.D.DEVEGOWDA CO-OPERATIVE COLLEGE OF NURSING HASSAN 573201

1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

ANNEXURE – II

PROFORMA FOR THE REGISTRATION OF SUBJECT FOR DISSERTATION K. C. SOMASHEKAR, 1ST YEAR M. Sc. NURSING NAME OF THE CANDIDATE AND 01. SHRI. H.D.DEVEGOUDA CO- ADDRESS (IN BLOCK LETTERS) OPERATIVE COLLEGE OF NURSING, HASSAN. SHRI. H.D. DEVEGOUDA CO- 02. NAME OF THE INSTITUTE OPERATIVE COLLEGE OF NURSING, HASSAN. COURSE OF STUDY AND M. Sc. NURSING 03. SUBJECT MEDICAL SURGICAL NURSING 25th JULY, 2008. 04. DATE OF ADMISSION TO THE COURSE ASSESSMENT OF THE KNOWLEDGE ON SELF CARE MANAGEMENT AMONG DIABETES MELLITUS 05. TITLE OF THE TOPIC PATIENTS IN A VIEW TO DEVELOP AN INFORMATION BOOKLET IN SELECTED HOSPITAL AT HASSAN

1 6. BRIEF RESUME OF THE INTENDED WORK 6.1. NEED FOR THE STUDY “HEALTH FOR ALL, ALL FOR HEALTH” by World Health Organization. Diabetes mellitus is a multi system diseases related to abnormal insulin production, impaired insulin utilization or both. Diabetes mellitus is serious health problem through out world. Diabetes is the leading cause of heart disease, stroke, adult blindness and non traumatic lower limb amputation. People with diabetes mellitus have at least a twofold risk for their development of coronary artery diseases and more than 65% have hypertension.

Diabetes is a chronic illness that requires a life time of special self management behaviors as physical activities and emotional stress affects diabetic control. Patient must learn to balance a multitude of factors. They must learn daily self care skills to prevent acute fluctuations in blood glucose and they must also incorporate in to their lifestyle.

In United States an estimated 17 million peoples or 6.2% of the population have diabetes mellitus, more than 2 million Canadians have diabetes about 1/3rd of their people with diabetes mellitus are not diagnosed and these individuals are unaware they have the disease. Diabetes mellitus is the 5th leading cause of death in the United States with two lacks ten thousand deaths annually. The staggering annual cost due to medical expenditure attributable to diabetes is estimated at $99 billion in USA. Hospitalization cause account for the greatest proportions of medical cause of diabetic patients this dollars amounts do not reflect the impact diabetes mellitus as on the quality of the lives of the affected people and their family.

According to Redbard H. W; the incidence and prevalence of diabetes mellitus is rising dramatically due to the on going epidemic of over weight, obesity, insulin resistance and metabolic syndrome in pediatric and adolescence populations.

The perception straining reported practices and needs of the health care providers in the field of patient education in advance of the initiation of health care management network for diabetic patients were assessed in a survey of the 74 physicians and 63 nurses by using detailed structural questionnaires. Results revealed that, educational activities for patients are almost non-existent. Information and explanation given during a face to face encounter with a physician or nurses that combines technical and carrying approaches are

2 the main reasons reported for patient education. The obstacles reported by professional that need to be over come are limited available time. Patient passivity and inadequate staff training practitioners and nurses are poorly taught as regards patient education and self management of chronic disease, it was concluded that there are many gaps that hinder education for both patients and professionals the training of health professionals need to meet the challenge of chronic disease by integrating aspects from the fields of education and the social sciences.

A cross sectional anonymous survey of 500 randomly selected patients with diabetes mellitus and hypertension was conducted to determine the proportions of patients with diabetes having blood pressure target and to determine patients characteristics associated with having a blood pressure target. Result revealed that fewer that 60% of diabetic patients reported a blood pressure target, it was concluded that less than 2/3rd of diabetic hypertensive patients had blood pressure target encouraging patients to sets target blood pressure. Promote hypertension self management in this high risk patients population. Less educated patients are more benefited from interventions to increase awareness of blood pressure targets.

A previously validated foot care specific survey from 772 veterans with diabetic and high risk for foot conditions was utilized to evaluate variations in self reported knowledge of foot care practices among elderly diabetic patients at high risk for lower extremity complications. It was identified that, patients self reported foot care knowledge of self optimal and significantly varied across medical centers.

During the period of professional service researcher had an intimate therapeutic interaction with diabetic mellitus patients. Many of them had very low knowledge regarding self care management. Assessment of the knowledge of diabetes mellitus patients by using a structured questionnaire will identify learning needs of them and helps in providing an effective information booklet in order to increase their knowledge level.

6.2. REVIEW OF LITERATURES

A survey was conducted to assess differences in diabetes knowledge, diabetes self management and perceived control among depressed and non-depressed individuals in an indigent population. 201 subjects with diagnosed type-II diabetes enrolled in the study, approximately 20% of the sample was depressed. Subject with the depression were more likely to report self care control problem and less likely to report positive attitude. Self

3 care ability and self care adherence depressed patient were less likely to report perceived control of diabetes. There are no significant differences in diabetes knowledge, self care understanding, and perceived importance of self care between depressed and non- depressed patients. A study concluded that diabetes knowledge did not differ significantly by depression status in indigent population with diabetes but diabetes self care practices and perceived control of diabetes differed significantly by depression status. Patients who are depressed had poorer diabetes self care and felt they had less control over their disease.

A one to one interviewing approach was used to assess diabetic related knowledge and self care practices regarding medications, diet, physical activity and self monitoring blood glucose. Results showed that the majority of the diabetic patients with sub-optimal glycaemic control had deficits in diabetes related knowledge and had inadequate self care practices. A study suggested the development effective educational strategies come out health for adults with sub-optimal diabetes control.

A survey was conducted on 279 diabetic patients to assess method of diabetic care provided and methods of patients self monitoring of glycaemia, blood pressure and foot self care, results revealed that, the vast majority of the patients is treated only by general practitioners. Despite quite frequent medical visits related to diabetes. Educations of patients is still unsatisfactory which was demonstrated by patients lack of knowledge concerning basic parameter of laboratory monitoring as well as insufficient self management of glycemia and blood pressure.

A cross sectional survey was conducted on 398 adults with diabetes to examine association between the diabetes related numerous (quantitative skills) under glycaemic control and other diabetic measurements. Health literacy, general numeracy, and diabetes related numeracy were assessed. Results revealed that poor numeracy skills were common in patient with diabetes. Low diabetes related skills were associated with worse perceived self efficacy fewer self management behavior and poorer glycaemic control.

A pilot study of an innovative educational programme was conducted for supervisory of employees with diabetes to benefit employee’s health and diabetes control while meeting the legal requirements. Nine supervisors completed a 6 hours programme that included innovative teaching strategies. “Leaving the life of persons with diabetes for 2 days and case studies to practice decision making according to the American with

4 Diabetes Act.” This programme increased supervisors reported self efficacy for supervising employees with diabetes and should improve work life for employees with diabetes, ultimately increasing employers health care cost.

A descriptive postal survey using a self administered questionnaire on 254 doctors to assess the family doctors on the patients and health care system related factors contributing to non-adherents to diabetes mellitus. Clinical practice guidelines, no awareness of diabetes and its complications as well as patient low motivation to change their life styles were considered to be the biggest difficulties in managing individual patients. In addition to the most often listed problems non-compliances with medical regimen. Patients financial problems and their non-attendance were mentioned. The greatest health care system related barriers to practices providing desirable care were the lack of special diabetic education for nurses and inadequate number of patients educational materials, the patient related issues were regarded as problems in 96% of the cases and health care system related factors were mentioned in 79% of the cases.

A matched case control study was conducted to test the association between the vitamin D and diabetes mellitus. Information was collected from quatery nationals male and females by using structured interview schedules multivariate logistic regression analysis revealed that fathers and mothers occupation, family history of diabetes mellitus, physical activity, low duration of time under sunlight, breast feeding less than 6 months and low vitamin D level were considered as the main factors associated with type 1 diabetes mellitus.

6.3. STATEMENT OF THE PROBLEM

ASSESSMENT OF THE KNOWLEDGE ON SELF CARE MANAGEMENT AMONG DIABETES MELLITUS PATIENTS IN A VIEW TO DEVELOP AN INFORMATION BOOKLET IN SELECTED HOSPITAL AT HASSAN.

6.4. OBJECTIVES OF THE STUDY 1. To assess the knowledge regarding self care management of patients with diabetes mellitus. 2. To prepare an information booklet on self care management among diabetes mellitus. 3. To find out the association between the knowledge regarding self care management of diabetes mellitus patients with their socio-demographic variables.

5 6.5 OPERATIONAL DEFINITIONS  Knowledge – Refers the number of correct responses given by patients with diabetic mellitus.  Patients – Refers to the adults who are suffering from diabetic mellitus who attend OPD of a selected hospital, Hassan.  Self Care – It refers to the activities undertaken by an individual to maintain his or her holistic health.  Diabetes Mellitus –A disturbance in the oxidation and utilization of glucose, which is secondary to a mal-function of the beta cells of the pancreas, whose function is the production and release of insulin.  Information booklet – Refers to booklet having information regarding self care management among patients with diabetes mellitus.  Socio-demographic variables – Refers the age, sex, income, educational status, marital status, number of years suffering from diabetes mellitus.

6.6. ASSUMPTION Diabetic patients have inadequate knowledge on self care management. 6.7. HYPOTHESIS There will be significant association between level of knowledge of diabetic mellitus patients and their demographic variables. 6.8. DELIMITATION The study is delimited to – 1. The knowledge of patient suffering from diabetes mellitus. 2. The patients suffering from diabetes mellitus who attend OPD of selected Hospital, Hassan. 7. MATERIALS AND METHODS 7.1. SOURCES OF DATA Data will be collected from diabetic mellitus patients. 7.1.1. RESEARCH DESIGN Descriptive survey approach. 7.1.2. SETTING Medical OPD, in selected Hospital, Hassan.

6 7.1.3. POPULATION The adult patients suffering from diabetes mellitus 7.2. METHOD OF DATA COLLECTION 7.2.1. SAMPLING PROCEDURE Non probability convenient sampling technique will be used.

7.2.2. SAMPLE SIZE A sample size of the study includes 90 patients with diabetic mellitus.

7.2.3. INCLUSION CRITERIA This study will include diabetic mellitus patients who –  Attend medical OPD in selected Hospital, Hassan.  Can read and write Kannada.  Are willing to participate in the study.

7.2.4. EXCLUSION CRITERIA  Patients who are not willing to participate in the study.

7.2.5. INSTRUMENTS INTENDED TO BE USED A structured knowledge questionnaire will be used to determine the knowledge level of adult patients with diabetes mellitus regarding self-care management.

7.2.6. DATA COLLECTION METHOD Data will be collected from adult patients with diabetes mellitus by using knowledge questionnaire regarding self care management.

7.2.7. PLAN FOR DATA ANALYSIS The data will be analyzed by using both descriptive and inferential statistics.

7.3. DOES THE STUDY REQUIRE INVESTIGATIONS / INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? Study will be conducted on patients with diabetes mellitus, who attend medical OPD in selected, Hospital, at Hassan.

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3? Yes. Ethical clearance certificate will be taken from concerned authority.

7 8. LIST OF REFERENCES (VANCOUVER STYLE) [1] Balcou-Debussche M,Debussche X. Type-2 diabetes patient education in Reunion Island; Perceptions and needs of professionals in advance of the initiation of a primary care management network.Epub 2008 jul 16. [2] Bener A., Alsaid A, Al- Ali M,Al-KubaisiA, Basha B, Abhram A. et al High prevalence of Vitamin D deficiency in type 1 diabetes mellitus and healthy children. Acta diabetol. 2008 oct 10 .[epub ahead of print]. [3] Cavanough K, Huizinga MM, Wallston KA, Gebretsadik T, Shinani A,Davis D, et al Association of numercy and diabetes control.Ann intern med. 2008 may20;148(10):153. [4] Egede EL, Ellis C, .The effects of depression on diabetes knowledge , diabetes self management,and perceived control in indegent patients with type 2 diabetes. Diabetes Technol ther .2008,jun;10 (3);213-9. [5] Lews.S,M., Heitkemper.M,M.,Dirksen.S.R. Medical surgical nursing 6th Edition. Mosby St Louis 2004:pp-1268. [6] Malec K, Maledas P, Homa K, Stefanski A, Raczynski A, Majkowska L. Diabetes care and self monitoring of type 2 diabetic patients a rural districts of west- pomeranian province. Pol Arch Medwewn. 2008 jan-Feb;118 (1-2);29-3 [7] Rajan M, Pegach L, Tseng CL, Reberg G, Johnston M. Facility Level variations in patient-reported foot care knowledge sufficiency : implementation for diabetes performance measurement. Prim Care Diabetes 2007 Sep. : 1 (3) : 147-53. Eupb 2007 Jul 23. [8] Ratsep A, Oja l, Kada R ,Lember M. Family Doctor’s Assessment of Patient and Health Care System – Related factors contributing to non adherence to diabetes mellitus.idelines. So prime care Diabetes 2007. Jan;1 (2) : 93-7. Eupb 2007. May 10. [9] Redbard HW, Diabetes screening, diagnosis, and therapy in pediatric patients with type 2 diabetes. Medscope J med 2008:10 (8): 184; Quiz 184. Epub 2008. Aug 6. [10] Smetzer.S.C. Bare.B.G, Hinkle.J.L. Cheever.K.H Text book of Brunner and Suddarth’s. Text book of Medical and Surgical nursing 11th Edition. Wolter’s Kluwer (India) Ltd New delhi:2008: pp:1384 and 1402.

8 [11] Subramanian U., Hofer TP, Klamerus ML, Zikmund-Fisher BJ, Heisler M, Kerr FA. Knowledge of blood pressure target among patients with diabetes.Prim Care Diabetes, 2007. Dec; 1 (4),: 195-8, Epub 2007 Oct. 31. [12] Tan MY, Magarey. Self-care practices of Malaysian adults with diabetes and sub- optimal glycaemic control .patient edu couns, 2008 aug;72 (2);252-67 Epub 2008 may 7. [13] Wood FG, –Jacobson S. Educating supervisors of employees with diabete mellitus AAOHNJ. 2008 jun;56(6) :262 -7.

9 9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION (IN BLOCK LETTERS)

11.1. GUIDE

11.2. SIGNATURE

11.3. CO-GUIDE (IF ANY)

11.4. SIGNATURE

11.5. HEAD OF THE DEPARTMENT

11.6. SIGNATURE

12.1. REMARKS OF THE 12. CHAIRMAN AND PRINCIPAL

12.2. SIGNATURE