Rajiv Gandhi University of Health Sciences s92

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKAANNEXURE – IIPROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION1 Name of candidate and Address ABITHA JUSTIN. J( In block letters ) I YEAR M.Sc. NURSINGMASOOD COLLEGE OF NURSINGDOOR NO.3E-12-1084/1,BIKARNATAKA,KULSHEKAR POST, MANGALORE-575 005 2 Name of the Institution MASOOD COLLEGE OF NURSINGMANGALORE3 Course of Study and Subject M.Sc. NURSING,MEDICAL SURGICAL NURSING 4 Date of Admission to the Course 16.06.20125 Title of the Topic“ A STUDY TO ASSESS THE KNOWLEDGE, ATTITUDE AND PRACTICE OFSTAFF NURSES REGARDING THE RISK FACTORS AND PREVENTIVEMEASURES OF VARICOSE VEIN IN SELECTED HOSPITALS AT MANGALORE.”1 6. BRIEF RESUME OF THE INTENDED WORK 6.1 INTRODUCTION Varicose veins are swollen, twisted, and sometimes painful veins that have filled with an abnormal collection of blood. Normally veins have leaflet valves to prevent blood from flowing backwards (retrograde flow or reflux). Leg muscles pump the veins to return blood to the heart (the calf muscle pump mechanism), against the effects of gravity.When veins become varicose, the leaflets of the valves no longer meet properly, and the valves do not work (valvular incompetence). This allows blood to flow backwards and they enlarge even more. When a person stand up we can see varicose veins as large, bluish vessels that may feel like a rope.This process usually occurs in the veins of the legs, although it may occur in other parts of the body. Individuals spending most of the day on their feet every working day (e.g.Nursing staffs, teachers, sales assistants, traffic police etc) are at greater risk of health problems including varicose veins, poor circulation and swelling in the feet and legs, foot problems, joint damage, heart and circulatory problems and pregnancy difficulties. Workers in lower status jobs are for more likely to be required to stand for long periods. Whether employed in an emergency room or private room nurses tend to spend a large amount of time on their feet while conversing with patients, consulting doctors and performing medical procedures. This can put nurses at risk of developing varicose vein.Varicose veins greatly affect over all nursing wellness.6.2 NEED FOR THE STUDYVaricose veins are veins that have become enlarged and tortuous. Veins have leaflet2 valves to prevent blood from flowing backwards. Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing. Besides cosmetic problems, varicose veins are often painful, especially when standing or walking. Millions of workers spend majority of the working day on their feet and many hours in static positions. Standing uses 20% more energy than sitting and because human bodies are not designed to stand at work, prolonged standing, can lead to tiredness, loss of concentration and increased health risks. These risks include the swelling of feet and legs, feet and joint damage, varicose veins, heart and circulatory disorders, lower back problems and pregnancy complications.Severe varicose veins can have an impact on the lives of the people who work on their feet especially the teachers, nursing staffs, flight attendants, dental staff, traffic and bar workers, postal workers, construction workers and bank staff .1Varicose veins have been recognized as chronic disorder since ancient times.Hippocrates discussed those 2500 years ago. With increasing population, increased lifespan and changes in lifestyle and occupation it involves at least 1 out of 5 in the world.It is in developed countries where attire reveals more than it conceals; patients turn up for treatment because of cosmetic records. But in our Indian scenario it is complications not cosmetics reasons bring patient to doctor that is reason why though common varicose veins remain iceberg phenomenon.2Varicose Veins are present in 20 to 25% of adult females and 10 to 15 % of men in western Countries. This disease has attained national and industrial importance in western world because of its high prevalence. The disease is neglected by Indians. Varicose vein is3 a common surgical problem. The incidence of varicose veins varies among different populations. This condition is considered a national health problem in western countries.According to Callam, prevalence of varicose veins is 10-15% in men and 20-25% in women. We do not have statistical data of varicose veins in India but incidence in India is on the rise.3Current statistics reveal that nearly 2.7 million people worldwide, suffer from varicosities and the toll is ever increasing. Where India is concerned, experts are witnessing a growing prevalence of varicosities especially among women. Nearly, 20-15 per cent of women and 10-15 per cent of men suffer from varicose veins in India. 4The extrapolated prevalence rate of varicose vein in India providing warning in about47,928,177 in statistics.Researcher, during her clinical practice as a staff nurse found her colleague with the problem of varicose vein. Due to that colleague negligence and ignorance of varicose vein it ends up in long lasting leg ulcer.The list of occupational hazards just seems to be increasing. Varicose veins have become a serious threat to the lives of millions of people across the globe and is said to be ignored by people living across India. “There is an urgent need to spread awareness about varicose veins in India. Many people suffer from it, but most tend to ignore it and that is not good as it can lead to complications in the advanced stage”. 5Lot of awareness campaigns on varicose veins in the US are going on and but inIndia there is a lack of education on this subject as the common man doesn’t know what4 the problem is all about and what can happen if it is not treated on time.Though there is a high prevalence of varicose vein in India, very few studies have been conducted in India. Nurses are under the risk of development of varicose vein since they are forced to stand for long time for giving care. Lack of rest and exercise for calf muscles may lead to varicose vein. Researcher found the importance of doing this study based on the literature, statistical values and also based on her personal experience she had while she was doing her clinical practice as a staff nurse.6.3 THE REVIEW OF LITERATUREA literature is a body of text that aims to review the clinical points of knowledge on a particular topic of research(ANA,2000)5 Literature related to the risk factors and prevention of varicose veinA Cross sectional study has been done in order to investigate the relationship between the demographic and occupational fact. This study was conducted through on 203 nurses in Amol hospitals. Questionnaire was used to collect the required information. It was completed through interview and physical examination based on the standard CEAP forms. 145 of the subjects were female. 73.9% of the nurses had varicose with different levels (CI95%: 77- 65). Female gender, age, BMI (OR =1.21), regular exercise (OR=0.31), family history, weight, and overtime between job factors (OR =1.01), years of service, standing (OR =2.3) and sitting in the ward had significant relationship with the varicose intensity. The result of the study shows that the necessary training to reduce disability and treatment expenses to adjust risk factors and prevention of inducing varicose is essential according to the high number of the nurses who have lower varicose veins with different intensities and the effect of lots of demographic and occupational factors. A descriptive study was conducted to identify the incidence of Varicose veins in relation to occupation and working hours during January 2009 to April 2010. In this study retrospective cohort design applied, among 58 patients who were diagnosed with varicose veins.70.69% cases involved in mainly standing occupations while only 29.31% patients belonged to mainly sitting occupations. The male female ratio among the varicose vein patients was found to be 4:1.On an average, the patients who got the disease had worked standing or walking for 9.33 hours/day. The maximum incidence was seen in the age group of 30-39 years with as many as 17 cases out of 58 cases studied. The study concluded that a definite co relation between varicose veins and standing occupations, and taking care of6 the factors responsible for the disease will go a long way in increasing the productivity and efficiency of workers. People who work more than 9.33 hours per day standing or walking are more likely to develop the disease. 7 A pilot study was done to find out the occupational health problems among hospital nurses. He administered questionnaire on a study group of 300 nurses and on a reference group of 250 school teachers to determine the health problems associated with the nursing profession. Sensitivity to penicillin and other substances was found to be the most common health problem associated with nursing. Nearly 60% of the nurses were hospitalized for over three days for various types of illnesses as compared with 11% of teachers, the most common illness being typhoid fever. Recurrent sore throat, backache and varicose veins were more common in nurses and in fact, most of the illnesses were developed after joining the nursing profession. A considerable proportion of injuries, which involved leave for over three days, was seen among the nursing staff. The differences in prevalence rates of these diseases and disabilities are statistically significant. 8A survey was carried out to determine the prevalence of varicose veins among railway men doing identical work of sweepers in the North and South of India showed that the overall prevalence was significantly higher among sweepers of South Indian (25.08%) than among sweepers of North India (6.8%). Further a study was conducted to test the cause-and-effect relationship. The study suggested that prevalence of varicose veins is related to patterns of diet and eating and thus this disease may be prevented.9A study was undertaken to assess the prevalence of varicose vein in different7 Occupations. It was found difficult to obtain precise figures for the incidence of these conditions, but any physician who treats adult patients knows the extreme frequency of their occurrence .In a survey of 1,000 young industrial employees, it was found that10%had definite varicose veins. In a older group of departmental store employees, all over40 ,the incidence had risen to 40%among the men and 70%among the women.10Over a two year period all admitted patients to a government tertiary level district hospital of varicose veins were evaluated for demographics, clinical manifestations, treatment and outcome. This study reveals that the disease is more prevalent during the active adult life in their 3rd and 4th decades and males were more affected. The occupations needing prolonged standing and use of violent muscular efforts is found to be a contributing or precipitating factor for varicose veins. Hereditary factors may play an important role in the development of varicose veins. 25% of patients had a family history of varicose veins occurring in close relatives. Majority of patients presented to the hospital for complications of the disease (60%) rather than for cosmetic purposes. The commonest symptoms in the study were prominent swellings in the lower limb and pain. Majority of the patients had combined valvular incompetence (71%). The most common post-operative complication observed was wound infection (25%).11A cross sectional study was conducted among teachers in 12 schools in Ahmadabad which revealed that 77% of the 138 teachers suffered from varicosity or enlargement of the veins of legs. Among these 107 nearly 84 people suffered from spider webs, the first stage of varicose veins. While 23 had severely established varicose veins which means they suffered from severe aches, swelling and heaviness in the legs. This study concluded that8 varicose veins is a condition that makes walking and standing extremely difficult and painful and if treated early at the stage of spider veins they are preventable. 12A prospective randomized study was conducted on Prolonged standing at work and hospitalization due to varicose veins among the Danish population with representative random sample of 9653 working age adults interviewed by telephone (response rate90%).Reported that respondents (2939 were men’s and 2708 were women’s). Risk ratios for VV were estimated by log-linear Poisson regression models separately for men and women with adjustment for smoking status, body mass index (BMI), heavy lifting, and, for females only, number of children at baseline During 12 years of follow up, 40 hospitalizations due to VV were observed among the men and 71 among the women. For employees with jobs that require prolonged standing or walking compared to all other employees, the relative risk was 1.75 (95% CI 0.92 to 3.34) for men and 1.82 (95% CI 1.12 to 2.95) for women. The pooled estimate of the relative risk was 1.78 (95% CI 1.19 to2.68). The etiological fraction of prolonged standing or walking at work was estimated as22.5% for men and 22.6% for women. This prospective study confirms that prolonged standing at work constitutes an excess risk of hospital treatment due to varicose veins and accounts for more than one fifth of all cases of working age.13A cross-sectional study was conducted in Finland to assess whether smoking, alcohol drinking and dietary factors are linked with varicose veins, A middle-aged general population of 4903 was studied, and prevalence rates at entry and five-year incidence of varicose veins were assessed. Lifestyle habits were recorded at entry and at the end of the follow-up. New varicose veins were significantly more common in individuals with regular9 alcohol intake, incidence odds ratio (OR) 1.5 (95% confidence interval [CI]: 1.05-2.3) in a multivariate analysis (of 2202 individuals). The association was particularly strong in women. Smokers had a higher incidence of varicose veins compared with non-smokers,OR 1.3 (95% CI: 0.9-1.8). Having daily meals of meat implied less new varicose veins than having 0-2 weekly meals of meat, and was concluded Alcohol was likely to increase the risk of varicose veins in women and smoking in both genders.14A cross-sectional community based study was conducted to the issue of working conditions and their health ramifications in Israel with special emphasis on occupations requiring prolonged standing. This review article discusses the physiological and medical aspects of prolonged standing in the workplace. Searching the literature, 19 studies were found which specifically examined the effect of prolonged standing versus prolonged sitting at work. Most of these studies suggested that prolonged standing may result in the development and aggravation of chronic venous insufficiency. The conclusion states that there is an association between prolonged standing and venous insufficiency. It was found to be more pronounced in women than in men.15A cross sectional study was conducted on the effect of standing in the workplace and the development of chronic venous insufficiency of the superficial venous system in the legs. Revealed that mechanical hydrostatic pressure generated by long periods of standing at the workplace is a major etiologic factor in the development of chronic venous insufficiency of the superficial venous system in the legs. Both varicose veins and working while standing are very common, so it is not surprising to find a high percentage of varicose veins amongst those who work standing up. Ambulatory venous pressure while sitting is about 60-80 mm of water, as opposed to 20 mm while walking, and the number is10 only slightly higher (about 100) while standing. Recent work by J. Bergan and his group demonstrated (in laboratory animals) that increased venous pressure will lead to the disappearance of the valve leaflets. This can explain the high frequency of venous reflux amongst young people (13%) and the even higher frequency (35%) found amongst the elderly population. It has been explained that hydrostatic pressure along with muscle pumps failure and venous out flow obstruction is an important contributor of the increased venous pressure. thus it concludes that standing as an important and significant factor in the development of this complex disease process.16Dr. Rajmohan Nambiar in Singapore also noted that 67%of varicose vein patients had involved in profession of prolong standing.176.4 STATEMENT OF PROBLEM“A study to assess the knowledge, attitude and practices of staff nurses regarding the risk factors and preventive measure of varicose vein in selected hospitals at Mangalore.”6.5 OBJECTIVES1.To assess the knowledge of staff nurses regarding risk factors and preventive measures of varicose vein2.To assess the attitude of staff nurses regarding risk factors and preventive measures of varicose vein 3.To assess the practice of staff nurses regarding risk factors and preventive measures11 of varicose vein4.To find out the correlation between knowledge and attitude of staff nurses regarding risk factors and preventive measures of varicose vein5.To find out the correlation between knowledge and practice of staff nurses regarding risk factors and preventive measures of varicose vein6.To find out the association between knowledge, attitude and practice regarding risk factors and preventive measures of varicose vein with selected variables6.6 OPERATIONAL DEFINITION Knowledge: it is defined as the information known by the staff nurses regarding risk factors and preventive measures of varicose vein. Attitude: it refers to the opinion of staff nurses regarding risk factors and preventive measures of varicose vein.Practice: Measures followed by the staff nurses to prevent the occurrence of varicose vein during their clinical practice.Varicose vein: Varicose vein are the veins that have become enlarged and tortuous.Risk factors: a risk factor is a variable associated with an increased chance of varicose vein.Prevention: It refers to precautionary measures taken by the staff nurses to avoid the occurrence of varicose vein.12 Staff nurses: In this study staff nurse is a person who is having diploma or basic degree in nursing from a recognized university or board registered under a state nursing council and is working in a selected hospital at Mangalore.6.7 VARIABLESDependent Variables: Demographic variablesIndependent Variable: Knowledge, attitude and practice6.8 ASSUMPTIONThe study based on the following assumptionThe staff nurses may have a chance of occurrence of varicose vein because of the need of standing in their profession.Staff nurses may have some knowledge regarding risk factors and preventive measures of varicose vein. Staff nurses may be willing to express their knowledge, attitude and practice regarding risk factors and preventive measures of varicose vein. 6.9 DELIMITATIONStudy is limited only in selected hospitals in Mangalore.Staff nurses who were present at the time of the study only participated in the study.Age group between 25 -40 yrs.Study period limited only 4 weeks6.10 HYPOTHESES13 1. H1 - There is significant correlation between knowledge and attitude regarding risk factors and preventive measures of varicose vein among staff nurses.2. H2- There is significant correlation between knowledge and practice regarding risk factors and preventive measures of varicose vein among staff nurses.3. H3 – There is a significant association between knowledge, attitude and practice with selected demographic variables. MATERIALS AND METHODS7.1.1 SOURCE OF DATA:Data will be collected from the staff nurses in selected hospitals at Mangalore.7.1.2 RESEARCH DESIGN:Descriptive design.7.1.3 SETTING :The study will be conducted in selected hospitals at Mangalore.7.1.4 POPULATION:The population of study consists of staff nurses in selected hospitals at Mangalore.The sample of the study is the staff nurses who have an experience of 3 years and above as staff nurse.14 7.2 METHOD OF DATA COLLECTION 7.2.1 SAMPLING PROCEDURE:Simple random sampling procedure will be used to select the staff nurses of selected hospitals at Mangalore.7.2.2 SAMPLE SIZE:The sample size will be approximately 60 staff nurses in the age group of 25-40yrs of selected hospitals at Mangalore.7.2.3 INCLUSION CRITERIA:1. Staff nurses who are working in selected hospitals at Mangalore.2. Staff nurses who have an experience of 3 years and above.3. Staff nurses with age group of 25-60 yrs. 4. Staff nurses who are willing to participate in the study.5. Staff nurses present at the time of data collection.7.2.4 EXCLUSION CRITERIA1. Staff nurse who are not willing to participate.2. Staff nurses who is having less than 3 years of experience.3. Staff nurses who are already having varicose vein.4. Staff nurses who are not available during the period of data collection.15 7.2.5 DEVELOPMENT OF TOOL Instrument UsedSelf administered questionnaire, attitude scale, and check list.Description Of The Tools Appropriated structured knowledge questionnaire to assess the knowledge and likert type of attitude scale to assess the attitude and practice of staff nurses regarding risk factors and preventive measures of varicose vein constructed and validated by experts and it will be used to collect the needed data.7.2.6 DATA COLLECTION METHODA prior formal permission will be obtained from the selected hospital authorities ofMangalore for collecting the required data.Objectives of the study will be explained to the participants and a formal written consent will be taken from the subjects.Structured questionnaire will be administered to collect the data regarding knowledge about risk factors and prevention of varicose vein.Attitude scale will be administered to assess the attitude and practice of risk factors and prevention of varicose veinDuration of data collection is 4 weeks 7.2.7 DATA ANALYSIS PLANDescriptive and inferential statistics will be used16 Mean median and mode will be used to explain demographic variablesChi square test to associate the knowledge score with selected demographic variablesTo correlate between knowledge attitude and practice by using Karl Pearsons moment correlation.7.3 DOES THE STUDY REQUERE ANY INVESTIGATION TO BE CONDUCTEDON PATIENTS OF OTHER HUMANS OR ANIMALS?Yes. The study requires to analyses the knowledge, attitude and practice of regarding the risk factors and preventive measures of varicose vein of selected hospitals at Mangalore7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTEIN CASE OF 7.3? Yes. Ethical clearance is obtained on 08.11.2012 from the ethical committee ofMasood College of Nursing.17 REFERENCES1. Neill R.Standing problem. Hazard magazine (online). 2005 Aug10. (cited 2011Oct24): URL http://www.hazards.org/standing/index.htm2. Mukunda NK. Clinical evaluation and management of lower limb varicose vein: a study at KIMS. Unpublished doctoral dissertation submitted to Rajiv GandhiUniversity of Health Sciences:2006.3. S.P Despandae, G.C Gupta , P.D. Banodea East and Central African Journal ofSurgery ,15(2) July-Aug ,2010, pp:65.4. Express Health Care Jan 2011.URL: http://www.expresshealthcare.in/201101/knowledge01.shtml5. Cox , Sara ,Jane Awareness of varicose vein among general public. URL: http://www.timeswellness.com/18 6. Rahul Khilnani ,Killer disease – zero awareness , Mumbai mirror (news paper on the internet) 2010 Jan 23rd , para 1-4.URL: http://www.mumbaimirror.com/article/9/2010012320100125184545283b3363c3a/k iller-disease-zero-awareness.html7. Amir Mohammad. The incidence of varicose vein in relation to occupation and working hours (cited 2011 Nov 11).URL: http://www.slideshare.net/amir9935varicose-veins-47762708. G.Samarawickrama Apilot study of occupational health problems among hospitalNurses ,Asia Pac J Public Health 1987:1(1) 47-52.9. Malhotra SL.An epidemiological study of varicose vein Indian rail road workers from the south and north of India with special reference to causation and prevention of varicose vein.Int J Epid 2011 Oct 23;1(2):177-183 10. Merle scott ,W.J. Post phebitic and varicose vein stasis clinical results of treatment by pulsatile air pressure principle 1951;147(13):1195-120111. Pramod Mirji shailesh Emmi , Chhaya Joshi study of clinical features and management of varicose vein of lower limb journal of clinical and diagnostic19 Research 2011 Nov 5(7);1416-142012. Sharma R. New worry for teachers: varicose vein. The Times of India(internet)2010 Nov 29 (cited 2011 Oct 24)URL: http://www.epaper.timesofindia.com/repository/ml13.F Tüchsen, H Hannerz, H Burr, N Krause. Prolonged standing at work and hospitalisation due to varicose veins: a 12 year prospective study of the Danish population, Occupational and Environmental Medicine, 2005;62:847-85014. Ahti TM, Mäkivaara LA, Luukkaala T, Hakama M, Laurikka JO.. “Lifestyle factors and varicose veins: does cross-sectional design result in underestimate of the risk?”Phlebology. 2010 Aug;25(4):201-6.15.Shai A, Karakis I, Shemesh D. Possible ramifications of prolonged standing at the workplace and its association with the development of chronic venous insufficiency,Harefuah 2007 Sep;146(9):677-85, 734.16.Bass A., The effect of standing in the workplace and the development of chronic venous insufficiency, Harefuah. 2007 Sep; 146(9):675-676, 734-735.17.Nambiar Rajmohan The incidence of varicose vein in Singapore.(1968) SingaporeMedical Journal 9(3):167-169 20 Signature of the candidate21 Remarks of the guideName and designation of (in block letters)11.1 Guide MRS. WILMA D’ SOUZA PROFESSOR MASOOD COLLEGE OF NURSINGMANGALORE.11.2 Signature11.3 Co-guide (if any) MRS. LAVINA JULIA PEREIRA PROFESSOR MASOOD COLLEGE OF NURSING MANGALORE11.4 Signature12.1 Head of the department MRS. LAVINA JULIA PEREIRA PROFESSOR MASOOD COLLEGE OF NURSINGMANGALORE12.2 Signature1 3.1 Remarks of the Chairman and Principal13.2 Signature22

Rajiv Gandhi University of Health Sciences s92

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