Rajiv Gandhi University of Health Sciences s117

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE – KARNATAKA .

Proforma Synopsis for Registration of Subject for dissertation.

1. Name of the Candidate and Mrs. SUMATHI SAMPATH, address HIG-85, Phase I, TNHB, Rayakotta Road, Krishnagiri (Dist), Tamilnadu-635001

2. Name of the Institution GOLDFINCH COLLEGE OF NURSING, Kodige Halli,Bangalore, Karnataka-560092.

3. Course of Study and M.Sc., NURSING Subject Medical –Surgical Nursing- Dissertation Protocol

4. Date of Admission to 15/06/2008 Course

5. Title Of Topic A study to asses the effectiveness of structured teaching programme on knowledge regarding lifestyle modification of Post-Thrombolytic Myocardial Infarction patients in Intensive Coronary Care Unit at selected Hospitals, Bangalore 6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION As per Joyce M.Black 2004, from 1900, Cardio vascular disease has been the number one cause of death in the united states. In 1999,CVD accounted for 40.1% of all deaths or 1 in every 2.5 deaths; in the united states .Cardio vascular diseases is the leading cause of illness and death for people 65 years of age and older , the second leading cause of death for people 14 yrs of age and 25 to 64 years , and the fourth leading cause of death for people 15 to 24 years of age , Even though there has been a decline in heart diseases mortality rates, the numbers of women’s deaths caused by cardio vascular diseases is declining more slowly than men’s mortality rates . Cardio vascular diseases have been aptly called 20th Century diseases. According to World Health Organization estimates 17 million people worldwide die of cardio vascular diseases each year. In 1999, cardio vascular diseases contributed to one third of global deaths of all cardio vascular diseases deaths. 78% occurred in low and middle in come countries. By 2010,cardio vascular diseases is estimated to be the leading cause of death in developing countries.[ Joyce M.Black 2004]

PREVALENCE The prevalence and Complications of cardio vascular diseases have significant implications for nurses using their physical assessment skills for is estimated that 1 million Americans will have a new or recurrent acute Coronary Syndrome this year. Acute Coronary Syndrome are responsible for more than 250000 deaths as usually and result from a progressive atherosclerotic process that culminates I rupture of atherosclerotic plaques and thrombus formation .The Angina can also occur in clients with normal Coronary arteries ,but it is less common .Clients with aortic stenos is , hyper tension and hypertrophy Cardio myopathy .Can have angina pectoris.[ Joyce M.Black 2005]

There are very few studies done for the Cardio rehabilitation measures which focuses on identifying patients with cardiac risk factors and direct them to appropriate risk factors modification and helps in assisting patients and their families to take responsibility for life style factors that have an impact on coronary heart disease.[Asian Journal of Cardio vascular Nursing Vol.15 Jan .2007]. Important information may br over looked unless previous illnesses, manifestations. Habits, life styles. Socio economic Considerations ,and family history are examined. Significant Cardio Vascular Data are obtained by assessment of the following areas risk factor analysis ,biographical and demographic data current health, past health history. Family health history and reviews of systems.[Kathleen A Popelka year 2005] The client and family should be included in care. They need to understand that the purpose of the treatment is to prevent further myo cardial damage. [Linda S. Williams Paula D. Hopper 2005].

6.1 NEED FOR THE STUDY:

There are several methods to prevent future heart attacks as well as to help the patients to lead a comfortable life. But most often patients become cardiac cripples by restricting their own activities or by relying too much on others which may not be needed in much case. [AHA Scientific Statement 2004].

The essential components for preventing re- infarction are intake of correct drugs. Exercises, diet and a positive attitude towards health. Re- infarction rate is higher among, there who continued to ignore drugs as well as those who did not change their attitude towards drug in take. Nurses can play a major role in educating. Myocardial infarction patients about the need for taking drugs as well as to follow the correct dietary and exercise prescriptions.[Miller 2005].

In countries like India, people are unaware of the benefits of counseling (or) fitness centers; nurses by way of their familiarity with the patient, can play a leading role in motivating and correcting their attitudes in this regard. As of today, there exists no study that has been done in India which has investigated the knowledge, attitude and life style modification of Myocardial infarction. [Indian Heart Journal 2007].

Life style modification among post thrombolytic Myocardial Infarction diseases patients is an can integral part of holistic living and requires severity of one’s health and control of one’s life.

Life style ,than is a requirement and attribute of patients It is important for every individual ,regardless of age, to learn to assume an appropriate degree of responsibility for his/has own health .

There are seven assumptions in the life style modifications, namely.

1. It is essential for every one 2. It involves meeting basic human needs. 3. It deviates from self - care results in disease (or) Injury. 4. It is a right and responsibility of every adult. 5. It is a learned behavior influenced by self concept and level of maturity. 6. It is a deliberate action 7. It necessitates awareness of important factors and the meanings. Cigarette smoking, Diabetes mellitus, hyperlipidemia, obesity, sedentary lifestyles, are the major risk factors leading to myocardial infarction. A supportive educative system to help the cardiac clients in decision making, behavior control and knowledge acquisition is definitely essential. The educative system can guide, teach and promote an environment for the cardiac clients to practice the preventive measures like diet control, exercises and lifestyle changes. So structured teaching was formulated. [AHA 2005]

6.2 REVIEW OF LITERATURE:

Extensive review was made on literature regarding incidence causes of myocardial infarction and the effectiveness of Structured Teaching Programme on life style modification measures after first attack of Myocardial Infarction. Each aspect of life style modification measures includes exercise, smoking, alcohol intake, diet, meditations were included in the review.

There are few studies related to post thrombolytic myocardial infarction which was published in Indian Heart Journal 2008. According to Naveer Kumar ,et al, done a study on clinical and Angiographic Profile of patient presenting with first acute myocardial infracion in a tertiary care centre in Northern India among 100 subjects and proved that Prevalence of coronary Artery disease has increased from 1.1% to about 7.5 % in the urban population and from 2.1 % to 3.1 %in the rural population. Also Sudhir Varma et.al 2004 done a study on a comparison of rural and urban population with myocardial infarction in the thrombolytic Era among 60 subjects and concluded that rural population had a statistically significant lower mortality rate and published in the same year [IHJ]. There are Studied related to life styles modification of post trombolytic myocardial infarction patient. Among that AHA Scientific Statement as released an article in the year 2004 saying that only life style modification coordinated ,multifaceted interventions designed to optimize a cardiac patients physical, psychological, and social functioning , in addition to stabilizing ,slowing ,or even reversing he progression of the underlying atherosclerotic processes, thereby reducing morbidity and mortality.

Also JACC NO.17 Vol.51 2007 has done a study on current status of Life modification measures among 100 subjects and proved that Multiple clinical trials have shown the benefit of lipid - lowering agents and lifestyle modification for patients with documented cardiovascular disease (39),A more aggressive low - density lipoprotein (LDL) target goal <70 mg /dl should be considered for persons with multiple cardiovascular risk factors ,particularly when they are under suboptimal control ( e.g., a patient with coronary artery disease who continues to smoke.

Studies related to educational programme of life style modification of post thrombolytic myocardial infarction patients. Among that J.A. Iestra ,et.al has done a study on 50 myocardial infarction diseases and proved that Effect size Estimates of Lifestyle and Dietary changes on All - Cause Mortality in Coronary Artery Disease patients .

According to the study by Setoguchi and colleagues,by cohort study and proved that combined life style and Dietary Interventions or combined determinants only reduced the morality rates after Myocardial Infarction in 2 United States to 3 % per year [2006 AHA Journal]. Nurses, a educators can continually strive to made patients responsible, so that they can learn to take control of their condition and of their conditions and of their lives. Participating in a programme for their own care in the way will probably have a positives beneficial effect on the patients overall physical & psychological well being, their hastening recovery. [ACN 2008 Journal Vol.15].

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of Stuctured Teaching Programme on knowledge regarding life - style modification of post - thrombolytic Myo cardial Infarction patients.

6.3 OBJECTIVES OF THE STUDY :

1. To asses the knowledge of patients with Myocardial Infarction regarding life - style modification measures before administering structured Teaching Programme. 2. To assess the knowledge of patients with myocardial infarction regarding life style modification measures after administering Structured Teaching Programme. 3. To asses the effectiveness of structured teaching programme on life - style modification measures upon the knowledge of patients with myocardial infarction. 4. To compare the pre-test and post-test level of knowledge in relation to various aspects of life - style modification measures. 5. To identify the association between the selected demographic variables and knowledge regarding life - style modification measures. 6.4 OPERATIONAL DEFINITIONS:

1. Effectiveness:

Refers to the ability to prevent and to brings modification in their life style regarding diet, ,medication ,stress tolerance ,stop smoking and alcohol, an follow- up’s.

2. Structured Teaching Programme: The act or process of educating or being educated or the knowledge or skill obtained or developed by a learning process.

3. Knowledge:

Knowledge is defined as expertise and skills acquired by a process through experience or education, the theoretical or practical understanding of a subject or knowledge is defined as awareness or familiarity gained by experience a factor situation.

4. Life style modification

Ref to modification of activities performed by the individuals them selves, related to diet, exercise and rest, medication and bowel movements.

5. Post Thrombolytic Myocardial Infarction Patients

Ref to those individuals who are diagnosed by the cardiologists and also undergone thrombolytic therapy.

6.5 NULL HYPOTHESES:

HO1 : There is no significant different between pretest and post - test assessment scores of 50 subjects HO2 : There is no significant difference in the post - test scores of 50 subjects.

HO3: There is no significant association between findings of study and demographic variable

Performa and a self - administered questionnaire.

7. MATERIALS AND METHODS:

7.1 SOURCES OF DATA:

 Post - Thrombolytic Myocardial Infarction patients admitted in Intensive Coronary Care Unit.  Myocardial Infraction patients who are developing cardiac risk factors and having cardiac risk factors already.

7.2. METHODS OF DATA COLLECTION:

7.2.1. Type of Study : Evaluation Study

7.2.2. Research Design : Non - Experimental research design using questionnaire.

7.2.3. Variables under study Dependent Variables : Post - Thrombolytic Myocardial Infarction Independent variables : By using questionnaire Attribute variables : Patients who are at cardiac risk factors.

7.2.4: Sampling techniques : Purposive sampling techniques 7.2.5. Sample size : Accessible population-50 subjects

7.2.6. Follow-up : Pretest will be done on the 3rd day of admission using questionnaire and educating them with audio visual aid and then post test assessment will be done on the 7th day and evaluation technique is followed.

7.2.7. Duration of study : One month.

7.2.8. Inclusion criteria and exclusion criteria:

Inclusion Criteria : Post thrombolytic Myocardial Infarction patients who are in Intensive Coronary Care Unit. Myocardial infarction patients who are having cardiac risk factors

Exclusion criteria : Post - thrombolytic Myocardial Infarction patients Who are not willing to participate in the study.

7.2.9. Instruments : Structured teaching programme Questionnaire and Audio Visual Aids 7.2.10. Date collection procedure : After obtaining prior ethical and legal permission from the concerned authorities, subjects implemented on the accessible population. A brief introduction given to the subjects about self and the study. Data collected by using purposive sampling.

7.2.11. Statistical method used : Descriptive and Inferential statistics.

7.3. Does study require any investigation or intervention to conducted on patients /humans /animals Yes.

7.4. Has ethical clearance been obtained from institution?

Yes. Ethical clearance will be obtained from concerned authorities and consent will be taken from the subjects. Confidentially and Anonymity will be maintained. 8. BIBLIOGRAPHY:

1. M.S.N Joycee M.Black ,Volume 2, Published 2004, Page No.1560- 1561, 1701-1702. 2. Cardiac rehabilitation, adult fitness and exercise testing, 3rd edition. 3. Medical Surgical Nursing Assessment and management of clinical problems, Lewis, S.M.Kemper, Issouri Mosby Publication. 4. Text Book of “Cardiovascular Nursing” by Aleyamma Eapen, Sr. Mary Lucita. Page No : 97 5. Medical Surgical Nursing Lindas. Williams Paula D.Hopper, Volume 2, Page No. 334. 6. Brunner & Suddarth’s Text book of Medical Surgical Nursing Suzanne C. Smeltzer Brenda Bare, 6th Edition. 7. Charlene J. Reeves, Gayle Roux, Robin Lockhart “Text book of Medical Surgical Nursing International Edition. Page No. 71. 8. Asian Journal of cardiac-vascular nursing 3(1), 17. 9. www.indianheartjournal.com 10. Asian journal of clinical cardiology. 4(3), 55. 11. American Journal of cardiac pulmonary rehabilitation. 24 (1), 27-33. 12. Scottish Intercollegiate Guidelines Network (SIGN) Royal College of Physicians.9Queen Street ,Edinburgh EH21JQ Available on the SIGN. website : www.sign.ac.uk 13. http://circ.ahajournals.org/cgi/content/full/112/6/924 14. www.circulationaha.org 9. SIGNATURE OF THE CANDIDATE

10 REMARKS OF THE GUIDE THIS STUDY IS USEFUL TO PREVENT FUTURE HEART ATTACKS AS WELL AS TO HELP THE PATIENTS TO LEAD A NORMAL LIFE. 11. NAME AND DESIGNATION OF : MRS. S.SHARMILA (GUIDE IN BLOCK LETTERS ) ASSISTANT PROFESSOR MEDICAL - SURGICAL NURSING 11.1 GUIDE

MRS.S.SHARMILA 11.2 SIGNATURE

11.3 CO- GUIDE (if any)

11.4 SIGNATURE

11.5 HEAD OF DEPARTMENT

11.6 SIGNATURE

12. REMARKS OF THE CHAIRMAN AND PRINCIPAL

12.1 SIGNATURE