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“A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE REGARDING
ALCOHOL ABUSE AMONG B.Sc. (NURSING) STUDENTS OF
SELECTED NURSING COLLEGE IN BELLARY, BELLARY DISTRICT
KARNATAKA.”
PERFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
SARASWATI PUROHIT
PSYCHIATRIC NURSING
INDIAN COLLEGE OF NURSING
TILAK NAGAR
BELLARY 2010- 2011
2 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. Name of the candidate and : SARASWATI PUROHIIT address 1ST YEAR M.Sc. Nursing INDIAN COLLEGE OF NURSING TILAK NAGAR BELLARY
2. Name of the institution : INDIAN COLLEGE OF NURSING TILAK NAGAR BELLARY
3. Course of study and subject : 1ST YEAR M.Sc. Nursing
4. Date of admission : 31-5-2010
5. Title of the topic : “A study to assess the knowledge and attitude regarding alcohol abuse among B.Sc. (Nursing) students of selected nursing college in Bellary district Karnataka.”
1 6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION:
“There is this to be said in favor of drinking that it takes the drunk and first out of
society then Out of the world.”
-Ralph Waldo Emerson
Alcohol is drug and may be classified as sedative, tranquilizer, depending upon the quantity consumed of all the drug alcohol is the only drug where self induced in toxic action is socially acceptable.1
Alcohol has marked effect on the central Nervous system. It is not stimulant as long believed but a primary and continuous depressant. Alcohol damages body tissues by irritating them directly, through changes that occur during its metabolism.2
Alcoholism is world wide social and medical problem over the past 30-40 years.
Alcohol consumption has increased quantity and frequency. The age at which people start drinking has also declined. The population group at great risk is those under going rapid socioeconomic and cultural changes, they view alcohol as a symbol of prestige and social status.1
According to current concepts alcoholism is considered a disease and alcohol a
“disease agent” which causes acute and chronic intoxication, cirrhosis of the liver, toxic psychosis, gastritis, pancreatitis, cardiomyopathy and peripheral neuropathy. Alcohol is an important etiological factor in suicide, automobile and other accidents and injuries and deaths due to violence. The health problem for which alcohol is responsible is only part of total social damage which includes family disorganization, crime and loss of productivity.1
2 MARION LNs, et al, (1996) A sample of 315 nursing students in yearly cohorts
(1988-1992) completed the Michigan. Alcoholism screening test (Mast). A simple and quick instrument with established reliability and validity, the MAST had a reliability coefficient of 78 with this sample the MAST scores of the nursing students indicated that
21.5% had probable alcoholism/ were alcoholic. Drinking problems among these nursing students were similar to those of other nursing students and college students in general
Implications for nurse educators includes recognition that nursing students need continuing self-assessment and monitoring to avoid drinking problems as a student and future practitioner. Alcoholism self screening is an excellent introduction to client assessment for drinking problems implications for future research include identifying the correlates and determinants of problems drinking behavior and ultimately developing and testing educational interventions to eliminate the problems.3
6.1 NEED FOR THE STUDY
Use and abuse of alcohol are present in all walks of life, on all economic levels, and in both men and women.4
National Institute of Mental Health and Neuro Science (NIMHANS) in Bangalore
(2000) reveals that 70% of HIV patients were alcoholics and they were teenagers. AIIMS in Delhi (2001) Showed that every 5th teenager’s b/w 15-19 age group in Delhi takes alcohol regularly 3, 00,000 is addicted and another lakhs needs medical attention for alcohol related disorders.5
Research suggests that there are 3 million elderly alcoholics in the United States, yet only 15% of this age group are receiving alcoholism treatment of any kind (Edwards,
1985). The consequences of this disease are tragic for any age group but are especially destructive for the elderly, who are more susceptible to the effects of the alcohol abuse because of existing problems and diminished financial resources. The complications
3 presented by elderly alcoholics are an enormous nursing challenge, yet they have been almost a completely ignored focus of study. American cultural ambivalence and misunderstanding about both alcoholism and old age not only contribute to a lack of interest in studying the problem but also enable patterns of abuse to go uninterrupted.
Generally, the health professions and other support people, including family and friends, are overwhelmed by the multiplicity, chronicity, and confusing nature of the disorders of the elder alcoholic (Kranch, 1990b). It is imperative for the nurse to consider every possible piece of information when working with the elderly alcoholic.
The first step that nurses must take to work with elderly successfully is to increase self-awareness; then it is possible to control and modify negative or ambivalent attitudes.
Nurses must also develop an intensive understanding of both the aging process and alcoholism to extract alcohol-related changes from those related to normal aging. This understanding leads to an ability to conduct comprehensive assessment; which in turn generates appropriate interventions.6
Use and abuse of drugs and alcohol by teens is very common and can have serious consequences. In the 15-24 years age range, 50% of deaths (from accidents , homicides and suicides) involve alcohol /drug abuse possible stage of teenage experience with alcohol and drugs include abstinence, experimentation , regular use, abuse and dependency repeated and regular recreational use can lead to other problems like anxiety and depression.
Teenagers regularly use alcohol to compensate for anxiety depression or lack of positive social skills. A teenagers with a family history of alcohol abuse and a lack of pro- social skills can move rapidly from experimentation may also progress to abuse.
- Warning signs of teenager’s drug abuse may include.
4 - A drop in school performance
- A change in group of friends
- Delinquent behaviors
- Deterioration in family relationships
Alcohol dependency many include blackouts withdrawal symptoms and further problems in functioning of home school or work.7
Media Vision India(2004), In India has been estimated that 40-50% of all males drink alcohol as compared to less than 1% female adults, so alcoholism appears to be predominantly a male disorder especially in India.
Because of the influence of urbanization peer pressure westernization, media curiosity and age the college students are more prone to alcohol abuse.5
Young adolescents are at risk of alcohol related problems and are noted as special population in need of services in the report by the institute of medicine (1990). Young adolescents as a group are heaviest drinkers in America and other Western Societies. In
India too the trend is increasing in favour of alcohol use among student population.
JOHANSON et al, (1988) also Environment influence on the formation of positive attitude. In college campuses, different living arrangements are associated with different patterns of drinking similarly socioeconomic status and family also influences the use of alcohol in youngsters.8
GRABOWSKA, et al, (2009) Alcohol abuse in one of the main causes of arterial hypertension, Alcohol is responsible for a few to more than 10% of all cases of primary hypertension, particularly in a persons consuming more than 20-30g of alcohol per day.9
Drinking by adults serves as a role model for the young. The identification of risk factor is essential for prevention.4
5 Alcoholism is a social evil for social upliftment; every person should try to avoid alcohol. Alcohol adversely affects Liver, Eyes & Physical and Mental Activities. This encourages violence against women, harassment, poverty, crime etc. In society many of the crimes are committed under the influence of alcohol.10
Alcohol harms the human body in many ways, by its action on the brain it interferes with the understanding and reasoning, by its action on the stomach, it causes gastritis, by its action on the Liver causes cirrhosis of Liver by its action the heart causes
Hypertension & Heart Failure. By its action on the Kidneys it causes urinary disorders.
The consequences of Alcohol abuse cover a wide spectrum, crime, murder, neglect of families, road accidents, unemployment, loss of friends and self esteem.
Excessive alcohol results in serious medical, psychological & sociological problems.11
It is a global problem over the past 50 year’s production, consumption and abuse has grown to such an extent to cause civil unrest. With the changes in a social order alcohol is being considered a symbol of civilization resulting in high alcoholism, Mild to serious health problems.12
So the researcher decided to assess the knowledge & attitude to find out, What a bachelor of nursing degree holders know about alcohol consumption styles and the effect of alcohol on blood pressure, as well as on the risk of arterial hypertension adults. The investigators felt that there are needs of adolescent assessment on alcoholism, which will contribute in reducing the problems of alcohol abuse.
For the above reason investigator felt that, there is need to assess the knowledge and attitude of B.Sc. (Nursing) students towards alcohol abuse.
6 6.2 REVIEW OF LITERATURE
Review of Literature is a key step in research process. Review of Literature refers to an extensive, exhaustive and systemative examinations of publications relevant to the research project.
The review of literature related to knowledge and attitude regarding alcohol abuse.
A descriptive – exploratory study was conducted about to verify the knowledge of nursing students regarding the use of alcohol and other drugs, particularly addiction, tolerance, withdrawal and intoxication, the reasons students give for drug addiction and commencement, and personal interest in the issue of drug use. A sample of 44 students, by applying a semi-structured questionnaire, constructed by the researchers based on the objectives, with open and closed questions, totaling 24 points, Ethical procedures were followed and data were submitted to exploratory descriptive analysis. This study reports that students knowledge is still limited, comprehension about a patients reasons for using and becoming addicted is incomplete and the interest is current.13
A study was conducted about to test the direction of effect in the relationship between parents' sources of knowledge (parental monitoring and child disclosure) and adolescent alcohol use. The participants were 215 adolescents and their mothers, randomly selected from urban and rural areas in Cyprus. A three-month, two-time point longitudinal design was used in which adolescents completed the alcohol use disorders identification test while mothers completed a parental knowledge questionnaire. The results of this study showed that parental monitoring did not predict subsequent adolescent alcohol use. However, child disclosure at Time 1 negatively predicted adolescent alcohol use at Time 2. Moreover, adolescents' alcohol dependence symptoms at Time 1 negatively predicted both sources of parental knowledge at Time 2.14
7 A study was conducted about what Bachelor of Nursing degree holders know about alcohol consumption styles and the effects of alcohol on blood pressure, as well as on the risk of arterial hypertension in adults. The study group comprised 116 qualified nurses (112 females, 4 males; age 21-50 years; work seniority 0-29 years). The study was done between June 2007 and January 2008 with the use of the diagnostic poll technique based on a questionnaire developed by the authors. The study reports that 8.62% of participants were informed about screening tools used for evaluating styles of alcohol consumption while 41.38% gave the correct definition of the standard portion of alcohol.
The alcohol consumption threshold above which the risk of hypertension becomes significant was known to 58.62% of respondents. The influence of alcohol (drunk directly before blood pressure measurement) on blood pressure was known to 89.66% of the nurses. They observed a statistically significant effect of work experience (p = 0.002), place of work (p < 0.001), and position held (p < 0.001) on the number of correct answers. No statistically significant differences depending on age, place of residence, family status or type of postgraduate education were noted.9
A case - control study was conducted about to assess the relationships of job hazards, individual characteristics, and risk taking behaviour to occupational injuries of coal miners. This study compared 245 male underground coal miners with injury during the previous two-year period with 330 matched controls without injury during the previous five years. Data were collected via face-to-face interview and analyzed using the conditional logistic model. Handling material, poor environmental/working conditions, and geological/strata control- related hazards were the main risk factors: adjusted ORs
5.15 (95% CI 2.42-10.9), 2.40 (95% CI 1.29-4.47), and 2.25 (95% CI 1.24-4.07) respectively. Their roles were higher among the face-workers than among the non-face- workers. No formal education, alcohol consumption, disease, big-family, and risk-taking
8 behavior were associated with injuries (2.36
A cross- sectional study was conducted of 1567 general practice attendees in Goa,
India. This study results that a total of 338 men (41%) and 597 women (81%) they never consumed alcohol. One hundred and twenty-eight people or 8.2% scored >or=8 on the
AUDIT [123 (15%) men and five (0.7%) women] and were classified as harmful or dependent drinkers. Doctors identified almost 60% of problem drinkers but misidentified approximately 5% of moderate drinkers as problem drinkers.16
A study was conducted about the views and beliefs of nursing students toward people who abuse alcohol. The three open-ended questions allowed for further qualitative exploration about relationships with others who have alcohol problems and beliefs about recovery. The chronic nature of alcoholism was clearly identified by students who described it as a lifelong process. Most students (79%) expressed belief that recovery was possible whether they had personal experience with people who have alcohol problems or not. The level of optimism was surprisingly high in this sample of nursing students, especially because many had had a personal experience with someone who abused alcohol. Students come to the educational setting with a clear and accurate view of the lifelong commitment that may be needed to recover from alcohol addiction, but they also come with an overly optimistic view of recovery. How this optimism impacts future care is unknown. If nursing students hold an unrealistically positive view of recovery, they may be ill prepared to handle the disappointments associated with treatment such as relapse, interpersonal conflict, health deterioration, or other related squeals.17
9 A longitudinal study was conducted to investigate the relationship between temperament (novelty seeking, harm avoidance and reward dependence), alcohol expectancies, membership in deviant/substance-using peer group and drinking behaviour of adolescents drawn from a general population. And 147 adolescents about 15 years of age were interviewed and completed several self-rating questionnaires, Gathered additional information by interviewing their parents. One year after the initial assessment the adolescents only were interviewed and given questionnaires again. and this study results that, adolescents with alcohol problems at the time of the second interview reported less harm avoidance, less reward dependence, and were more likely to be a member of a deviant/substance-using peer group a year before, compared to offspring without alcohol problems. Further more, they held more positive alcohol expectancies than adolescents without alcohol problems. Taking into account the quantity of alcohol consumed per occasional results were confirmed, but temperament did not predict the extend of alcohol consumed after one year.18
A study was conducted about the prevalence of alcohol dependence among excessive drinkers in New Mexico and results that of 4,761 respondents, 16.5% were excessive drinkers; 14.4% binge drank and 1.8% were alcohol dependent. While the rates of alcohol dependent were higher among the youngest age group, males, those with some college education, and those of race/ethnicity other than White, non-Hispanic, only differences by age were statistically significant. The prevalence of alcohol dependence was the highest among those who reported alcohol-impaired driving in the past 30 days
(15.9%) and was lower among those who reported heavy drinking (13.4%) and binge drinking (8.1%).19
A study was conducted about the drinking habits of Sikh, Hindu, Muslim and white men in the West Midlands: a community survey of random samples of 200 each of
10 Sikh, Muslim and Hindu men and 200 white English-born men, matched for age, were interviewed using a structural questionnaire containing a retrospective drinking diary.
Sikhs were most likely to be regular drinkers followed by whites and Hindus. The very few Muslim men who drank consumed the most alcohol on average. The frequently reported pattern of an inverse relationship between drinking and age was found for white men but not among Sikhs and Hindus. In both these groups older men reported consuming more alcohol than did young men. However, age was confounded with generation: heavier levels of consumption were reported by Sikhs and Hindus born in
India than by Sikhs and Hindus born in Britain. Among regular drinkers Sikhs had higher average Alcohol Problem Scale Scores than did white men or Hindus. The highest average scores were recorded for the (few) Muslim regular drinkers (who also consumed the most alcohol).20
A study was conducted about the Knowledge, Attitudes, and Reported Practices of
Medical Students and House Staff Regarding the Diagnosis and Treatment of
Alcoholism .This study reported that, received a self-administered survey of their attitudes, skills, perceived role responsibility, knowledge, and reported practices with regard to alcoholism. Results indicate a strong relationship between perceived role responsibilities, confidence in skills, and reported screening and referral practices among students and house staff. Knowledge levels strengthened the association between skills and practices for medical students. House staff perceived less of a responsibility for screening than medical students. There was a trend toward lower confidence and more negative attitudes among house staff than medical students. The results point to areas where educational interventions can be improved to enhance quality of care and outcomes for this major chronic disease.21
11 A study was conducted on Alcohol and adolescents. Knowledge, attitudes, and behavior of students (n = 3017) from the 6th, 8th, 10th, and 12th grades in six school districts throughout Georgia and South Carolina completed a questionnaire to determine their knowledge, attitudes, and behavior regarding alcohol use. Results suggest that knowledge, attitudes, and behavior are significantly correlated. Two distinct attitudes were discovered: acceptable use of alcohol and unacceptable uses of alcohol, and these interacted with knowledge and behavior in different ways. Students who reported school as their major source of information about alcohol were more knowledgeable and had the most conservative attitudes toward unacceptable use of alcohol (p less than 0.001). White students scored higher on the knowledge test and had more liberal attitudes than minority students (p less than 0.001). Females were more conservative than males (p 0.001), and older students had more liberal attitudes (p less than 0.001). Our results suggest that efforts to educate youth about alcohol should incorporate acceptable uses as well as the negative aspects of drinking.22
An epidemiological survey was conducted of alcohol abuse in 24 rural villages of community development blocks in districts of Punjab (India) State bordering Pakistan covering 1276 households, both the men and women reported the use of alcohol and tobacco. The commonest drug used was alcohol (58.3 %), female reported very small numbers use of alcohol.23
STATEMENT OF THE PROBLEM
“ A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE REGARDING
ALCOHOL ABUSE AMONG BSC (NURSING) STUDENTS OF SELECTED
NURSING COLLEGE IN BELLARY,KARNATAK”.
12 6.3 OBJECTIVES OF THE STUDY
To assess the knowledge regarding alcohol abuse among B.Sc (Nursing) students
of selected Nursing College in Bellary.
To assess the attitude regarding alcohol abuse among B.Sc (Nursing) students of
selected Nursing College in Bellary.
To find out the relationship between knowledge and attitude towards alcohol
abuse among B.Sc (Nursing) students of selected Nursing College in Bellary.
To find out the association between selected background variables, knowledge
and attitude towards alcohol abuse among B.Sc (Nursing) students of selected
Nursing College in Bellary.
6.4 OPERATIONAL DEFINITIONS
Knowledge: Refers to the drinking habit of B.Sc (Nursing) students, which is measured by using a self –administered questionnaire.
Attitude: Refers to the expressed feelings of B.Sc (Nursing) students regarding alcohol abuse, which is measured by using attitude scale.
Adolescence: It refers to the B.Sc (Nursing) students who are consuming alcohol between age group of 16-22 years.
Selected background variables: Refers to those factors which are thought to influence knowledge and attitude towards alcohol abuse among B.Sc (Nursing) students.
Alcohol abuse: Alcohol abuse is a chronic dependence characterized by compulsive drinking of alcohol to such a degree that it produces mental disturbance, interferes with social and economic functioning.
13 7. MATERIAL AND METHODS
7.1 SOURCE OF DATA:
Data collected from B.Sc Nursing students of selected Nursing College in Bellary.
7.2 METHODS OF COLLECTION OF DATA:
1. Research Design : A descriptive approach.
2. Setting: Selected Nursing College in Bellary.
3. Sampling technique: The researcher will use purposive sampling.
4. Sample size: 100 B.Sc. Nursing students.
5. Tool: Self -Structured questionnaire.
6. Collection of data: Interview method.
7. Methods of data analysis and presentation: To use both descriptive and
inferential statistics.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS TO BE
CONDUCTED ON PATIENTS
OR OTHER HUMAN OR ANIMALS? If so please describe briefly.
NO- Data includes only verbal response. No interventions are carried out.
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.3?
Informed consent will be obtained from institution, authorities and subjects, privacy confidentially and anonymity will be guarded. Scientific objectively of the study will be maintained with honesty and impartiality.
14 8. LIST OF REFERENCES:
1. Park k “Text book of preventive and social medicine” Nineteenth edition,
Banarasidas bhanot publication.
2. R.Sreevani “A guide to Mental Health and Psychiatric Nursing” Third edition,
Jaypee Brothers Medical publication.
3. Marion .L.Net al., (1996) “Drinking problem of Nursing Students”. Journal of
Nursing education may; 35(5)96-203.
4. Kathy Neeb, “Fundamentals of Mental health nursing”, Second edition, Library
of congress catalonging publication.
5. Selvaraj, p.2007 “A Study on alcoholism among students”. Nursing time’s
journal 31(95):9-19.
6. Beth Vaughan – Cole, “Family Nursing Practice” W. B. Saunders Compony
Publication, Sydney. 1st Edition 1998.
7. Dr (mrs) K.Lalitha “Mental Health And Psychiatric Nursing An Indian
Perspective, 4th edition,VMG Book house publication.
8. Jhonson E.H.,Social Problem of urban man Illionosis, Dorsey press.1973.
9. Grabowska H., Nurses with a bachelor of nursing degree knows about the
“effect of alcohol on blood pressure and risk of arterial hypertension”. Cad med
stelin 2009:55(2)77-8. (Article in polish).
10. Vilela M V., et al “Nursing students knowledge about knowledge &drugs”.Rev
tat Am-2010 May –Jun; 18 spec No; 529-34. (Article in Spanish).
11. Keshav Swarnakar “Text book of Community Health Nursing”. N. R. Brother’s
publication 2nd Edition 2006.
12. K. Park, “Essentials of Community Health Nursing.” 5th edition 2008,
Banarsidas Bhanot Publication.
15 13. G. N. Prabhakara “Short Text Book of Community Health Nursing,” Peepe
Publication 1st Edition 2007.
14. Stavrinides PET AL., (2010) “Longitudinal association b/w adolescents alcohol
use and Parents Sources of Knowledge”.Br Jn Dr v. Psychology 2010 sept; 28
(pt3)643-55.
15. Kunal BM., et al., (2008) Relationships of job hazards,lack of
knowledge,alcohol abuse health status andrisk taking behavior to work injury of
coal mines :a case control study in India .”Journal of Occupational Health .2008
May; 50 (3):236 -44 E Pub 2008 April 21.
16. D’Cost G,et al ,2007 “Harmful alcohol use in Goa ,India,and its association
with violence ;A stdy in primary case”, Alcohol Alcohol ;42 (2) ;131-7 & put
2006 Dec.15.
17. Murphy Parker D,et al,(2005) “Nursing Students Personal Experiences Involving
Alcohol Problems.” Arch psychiatric Nsg 2005, Jun, 19(3); 150-8.
18. Barnow S,et al.,(2004) “effect of temperament ,effect of alcohol experiences and
peer group on amount of drinking and alcohol –related problems in
adolescence”, Z Kinder Jungend Psychiatry Psychohes;32(2): 85-95.
19. WOERLES,et al.,(2002) “ Prevalence of alcohol dependence among excessive
drinkers” National Institute Of Justice ,Washington,journal of alcohol 38
(4):452-458.
20. Cochrane R,Bal,S,1990 “The Drinking Habits Of Sikhs ,Hindu, Muslim &
White men in the west midlands : a community survey ;Br Journal addiction;85
(6):759-769.
21. Gail Geller ,et al., (1989) “ Knowledge Attitude And Reported Practices Of
Medical Students And House Staff Regarding The Diagnosis And Treatment Of
16 Alcoholism”.(Department Of Public Health Nursing ,College Of Nursing,
University Of Illinois At Chicago 60612-7350,USA)JAMA 1989;261(21) :
3115-3120.
22. Forney PD, et al., (1988) “Alcohol and Adolescents, Knowledge, Attitudes and
Behavior”. Journal adolescent health care 1988, may9 (3):194-202.
23. Sundran K.R et al., 1984 “alcohol abuse in a rural community in India Part I:
epidemiological study”; Drug Alcohol Depend; 14(1):27-36.
17 9 SIGNATURE OF THE STUDENT :
10. REMARKS OF THE GUIDE : Selected for the study is relevant and forwarded for the needful action.
11. NAME AND DESIGNATION OF : 11.1 GUIDE NAME AND ADDRESS : Indian College of Nursing
11.2 SIGNATURE OF GUIDE : 11.3 CO – GUIDE (IF ANY) : 11.4 SIGNATURE : 11.5 HEAD OF THE DEPARTMENT : NAME : ADDRESS :
11.6 SIGNATURE OF H.O.D :
12. REMARKS OF THE CHAIRMAN : AND PRINCIPAL 12.1 SIGNATURE OF PRINCIPAL :
18