mr. rafeek a c
TRANSCRIPT
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAM ON KNOWLEDGE REGARDING NURSES PERSONAL HEALTH HABITS
AND CARDIOVASCULAR DISEASE RISK FACTORS AMONG STAFF NURSES
WORKING IN SELECTED HOSPITAL AT BANGALORE.”
By
MR. RAFEEK A C
Dissertation Submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment
Of the requirements for the degree of
Master of Science in Nursing
In
Medical Surgical Nursing
Under the guidance of
MS. NISHA, M.Sc (N)
Head of the Department
Medical Surgical Nursing
SRI SHANTHINI COLLEGE OF NURSING
#188/B, PARVATHI NAGAR, OPP: SUB REGISTRAR OFFICE,
LAGGERE MAIN ROAD, LAGGERE
BANGALORE- 560058
Feb 2018
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “A study to assess the effectiveness of
structured teaching program on knowledge regarding nurses personal health habits and
cardiovascular disease risk factors among staff nurses working in selected hospital at
Bangalore.” is a bonafide and genuine research work carried out by me under the guidance of
MS. NISA, M.Sc (N), HOD, Department of Medical Surgical Nursing, Sri Shanthini College of
Nursing. Bangalore.
The dissertation has not formed the basis for the award of any degree to me previously by any
other university.
Date: 28/02/2018 Signature of the Candidate
Place: Bangalore [MR. RAFEEK A C]
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A study to assess the effectiveness of
structured teaching program on knowledge regarding nurses personal health habits and
cardiovascular disease risk factors among staff nurses working in selected hospital at
Bangalore.” is a bonafide research work done by MR. RAFEEK A C in partial fulfilment of the
requirement for the degree of Master of Science in Nursing (Medical Surgical Nursing).
Date: Signature of the Guide
Place: Bangalore [Ms. Nisha M.Sc (N)]
HOD, Department of Medical Surgical Nursing
ENDORSEMENT BY THE HOD.
PRINCIPAL/HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled “A study to assess the effectiveness of
structured teaching program on knowledge regarding nurses personal health habits and
cardiovascular disease risk factors among staff nurses working in selected hospital at
Bangalore.” is a bonafide research work done by MR. RAFEEK A C under the guidance of
MS. NISA, M.Sc (N), HOD, Department of Medical Surgical Nursing, Sri Shanthini College
of Nursing, , Bangalore.
Seal & Signature of the HOD Seal & Signature of the Principal
Ms. Nisa, M.Sc (N) Mr. ................., M.Sc (N)
Date: Date:
Place: Bangalore Place: Bangalore
COPYRIGHT
Declaration by the Candidate
I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall
have the rights to preserve, use and disseminate this dissertation in print or electronic format for
academic / research purpose.
Date: Signature of the Candidate
Place: Bangalore [MR. RAFEEK A C]
© Rajiv Gandhi University of Health Sciences, Karnataka
ACKNOWLEDGMENT
“Gratitude is the fairest blossom which springs from the soul”
- Henry Ward Beecher
It is not possible to prepare a research project without the assistance and encouragement
of other people. This one is certainly no exception
First I praise and thank God for the immeasurable grace and abundant blessings he
showered throughout my study.
I express my sincere thanks to our Management, Sri Shanthini College of Nursing, for
allowing me to carry out this study as a part of my post graduate programme and for all the
facilities provided to me in this institution.
I would like to extend my sincere thanks to Mrs. Pushpa H K, M.Sc (N) Principal &
HOD Pediatric Department, Sri Shanthini College of Nursing, for his invaluable direction,
untiring and expertise guidance, sincere support to conduct this study, providing necessary
facilities and encouragement which helped in the successful completion of this study
I am ineffably indebted to my guide Ms. Nisha, M.Sc (N), Lecturer, Department of
Medical Surgical Nursing, Sri Shanthini College of Nursing, for conscientious guidance and
encouragement to accomplish this study.
I thank Ms. Brinda Lakshmi, M.Sc (N) HOD Department of Community Health
Nursing, Sri Shanthini College of Nursing, for the suggestions during my study.
I am extremely thankful and pay my gratitude to Mr. Pramod, M.Sc (N) HOD Medical
Surgical Nursing, Sri Shanthini College of Nursing for her valuable guidance and support on
completion of this study in its presently.
It’s my privilege to convey my thanks to the Experts who have validated the research
tool and had guided me with their valuable suggestions and corrections.
I thank Mr. Suresh Bio-Statisticians and Mr. Rajesh M.A English for their invaluable
help extended to me to deal with all the work in this study.
I would like to extend my sincere & heartfelt obligations towards all personages at Sri
Shanthini College of Nursing for their help in this endeavour. Without their active guidance &
encouragement, I would not have made headway in this study.
At last but not least gratitude goes to all my friends who directly or indirectly helped me
to complete this study.
Date: Signature of the candidate
Place: Bangalore [MR. RAFEEK A C]
LIST OF ABBREVIATIONS USED
1. STP : Structured Teaching Programme
2. H1 : Hypothesis 1
3. H2 : Hypothesis 2
4. CVD : Cardiovascular Disease
LIST OF TABLES
Sl No Tables Page
no.
1 Research Design 32
2 Classification of respondent by demographic variables 47
3 Overall knowledge level of respondents 50
4 Aspect wise mean Pre & Post test Knowledge score 51
5 Effectiveness of STP 53
6 Association between demographic variables &
Knowledge 55
LIST OF FIGURES
Sl.No. Figures Page
no.
1 Conceptual Framework 14
2 Schematic Representation of Research Design 44
3 Classification of respondent by demographic variables 49
4 Overall knowledge score-pre & post test 50
5 Aspect wise knowledge score 52
ABSTRACT
Background:
Cardiovascular disease (CVD) is a general term for conditions affecting the heart or
blood vessels. It's usually associated with a build-up of fatty deposits inside the arteries – known
as atherosclerosis – and an increased risk of blood clots. It can also be associated with damage to
arteries in organs such as the brain, heart, kidneys and eyes. CVD is one of the main causes of
death and disability in India, but it can often largely be prevented with a healthy lifestyle.
Cardiovascular disease, one of the non-communicable diseases, has become a major
public health problem in many developing countries. About two-thirds of the global estimated
14.3 million annual cardiovascular disease deaths occur in the developing world. By the year
2015, cardiovascular diseases could be the most important cause of mortality in India. The
prevalence of coronary artery disease in India increased from 1% in 1960 to 9.7% in 1995 in
urban populations, and in rural populations it has almost doubled in the last decade.4
The centers for disease control have estimated that 50% of U,S deaths result from the 10
leading causes of death that are due to modifiable life style factors. Because many of the major
chronic disease have strong behavioral components such as smoking, diet and physical activity,
much of the emphasis in public health has turned recently to changing individual behavior.
Efforts have been directed toward encouraging individuals to adopt healthy behaviors and to
modify risk factors. Examples include community programs conducted by the American heart
association and the American cancer society to increase awareness of negative effects of
smoking, hypertension, hypercholesterolemia and physical inactivity.5
Health promotion and health maintenance are increasingly viewed as personal
responsibilities. The impact of individual lifestyle choices on the health destiny can be found by
investigating their associated risk factors. The promotion and maintenances of healthy lifestyle
establishes a foundation for prevention of chronic diseases.6
Nurses are the health providers in a society. The best provider is someone who sincerely
believes in their own health. Nurses must understand that their health performance has a
profound impact on the receivers of healthcare.[4] Nurses must have programs available to help
them, if necessary, to change their risky behavior habits.[5]
Nurses, due to the nature of their job, are prone to hard work, stress, burnout, and sleep
and eating disorders. This leads to various health complications, particularly cardiovascular
disease (CVD), neurological disorders, and immune decline.[6,7] In countries with limited
resources, effective strategies should be designed for the prevention of heart disease, individuals
should be classified in terms of risk factors, and the necessary measures must be taken to prevent
complications in at-risk individuals.[8] In a case-control study in 52 countries, which
investigated the risk factors for myocardial infarction (MI), 9 modifiable risk factors, including
smoking, diabetes, hyperlipidemia, central obesity, hypertension, diet, physical activity, alcohol,
and mental factors, were detected.[9] By controlling these 9 factors, up to 90% of the incidence
of heart attacks could be prevented.[2,9]. Hence the researcher felt the need to assess the
knowledge of staff nurse regarding cardiovascular disease risk factors.
Objectives:
To assess the knowledge regarding Nurses personal health habits and cardiovascular disease
risk factors among staff nurses in term of pre-test score.
2. To assess the knowledge regarding Nurses personal health habits and cardiovascular
disease risk factors among staff nurses in term of post-test score.
3. To assess the effectiveness of structured teaching program by comparing pre-test and
post-test level of knowledge score.
4. To determine the association between pre-test knowledge score and socio demographic
variables.
Method:
Pre experimental one group pre test and post test design was used to assess the
effectiveness of Structured Teaching Program regarding nurses’ health habits and cardiovascular
disease risk factors among staff nurses in selected hospital at Bangalore. Reliability of the tool
was tested and validity was ensured in consultation with guides and experts in the fields of
nursing. The study was carried out in selected hospitals, Bangalore. The samples were selected
by using convenient sampling technique. Collected data was analyzed by using descriptive and
inferential statistics.
Results:
The calculated value of the mean post test score (25.45) of the group was higher than the
mean pre test score (14.36) of the same group. The mean difference between pre test score and
post test score was significant at 5% level as the ’t’=21.82 (p<0.01).
1
INTRODUCTION
The heart has played an important role in understanding the body since
antiquity. In the fourth century B. C., the Greek philosopher Aristotle identified the
heart as the most important organ of the body. In the second century A. D., Galen
reaffirmed common ideas about the heart as the source of the body's innate heat and
as the organ most closely related to the soul.1
Before the Industrial Revolution, most people made their living through some
sort of manual labor. Modern conveniences made physical activity unnecessary.
Along with the change in lifestyle came a change in diet. The combination of a
sedentary lifestyle and a rich diet led to an increase in clogged blood vessels, heart
attacks, and strokes. The age of technology has made life easier and made people
more prone to heart disease and heart disease became common.2
Cardiovascular diseases (CVDs) have now become the leading cause of
mortality in India. A quarter of all mortality is attributable to CVD. Ischemic heart
disease and stroke are the predominant causes and are responsible for >80% of CVD
deaths. The Global Burden of Disease study estimate of age-standardized CVD death
rate of 272 per 100 000 population in India is higher than the global average of 235
per 100 000 population. Some aspects of the CVD epidemic in India are particular
causes of concern, including its accelerated buildup, the early age of disease onset in
the population, and the high case fatality rate. In India, the epidemiological transition
from predominantly infectious disease conditions to noncommunicable diseases has
occurred over a rather brief period of time. Premature mortality in terms of years of
life lost because of CVD in India increased by 59%, from 23.2 million (1990) to 37
2
million (2010). Despite wide heterogeneity in the prevalence of cardiovascular risk
factors across different regions, CVD has emerged as the leading cause of death in all
parts of India, including poorer states and rural areas. The progression of the epidemic
is characterized by the reversal of socioeconomic gradients; tobacco use and low fruit
and vegetable intake have become more prevalent among those from lower
socioeconomic backgrounds. In addition, individuals from lower socioeconomic
backgrounds frequently do not receive optimal therapy, leading to poorer outcomes.
Countering the epidemic requires the development of strategies such as the
formulation and effective implementation of evidence-based policy, reinforcement of
health systems, and emphasis on prevention, early detection, and treatment with the
use of both conventional and innovative techniques. Several ongoing community-
based studies are testing these strategies.
With the turn of the century, cardiovascular diseases (CVDs) have become the
leading cause of mortality in India.1 In comparison with the people of European
ancestry, CVD affects Indians at least a decade earlier and in their most productive
midlife years.2,3 For example, in Western populations only 23% of CVD deaths occur
before the age of 70 years; in India, this number is 52%.4 In addition, case fatality
attributable to CVD in low-income countries, including India, appears to be much
higher than in middle- and high-income countries.5,6 The World Health Organization
(WHO) has estimated that, with the current burden of CVD, India would lose $237
billion from the loss of productivity and spending on health care over a 10-year period
(2005–2015).7 Reasons for the high propensity to develop CVD, the high case fatality,
and the high premature mortality include biological mechanisms, social determinants,
and their interactions. Addressing this significant burden requires an understanding of
3
both the biological and social determinants, and the complex dynamics underlying
their interaction, as well. In this review, we summarize the CVD burden in India, the
reasons for the high burden, prevention and treatment strategies for CVD, and future
policy strategies to pursue.
The epidemiological transition in India in the past 2 decades has been
dramatic; in a short timeframe, the predominant epidemiological characteristics have
transitioned from infectious diseases, diseases of undernutrition, and maternal and
childhood diseases to noncommunicable diseases (NCDs).8 The disease burden
attributable to maternal disorders, measles, protein-energy malnutrition, and diarrheal
diseases decreased >50% in the past 2 decades, whereas life expectancy at birth
increased from 58.3 to 65.2 years, resulting in the ageing of the population during the
same period.8 Consequently, the NCD burden increased rapidly in India, with a
proportional rise in burden attributable to CVD.8 Nearly two-thirds of the burden of
NCD mortality in India is currently contributed by CVD-related conditions.9 Despite
wide heterogeneity in the prevalence of risk factors across different regions
(explained below), CVD is the leading cause of death in all parts of India, including
the poorer states and rural areas.10 The disease transition in India in the past 2 decades
resembles the accelerated epidemiological transition model with a rapid shift to the
age of delayed chronic diseases.
Cardio vascular disease (CVD) the leading cause of mortality in the U.S each
year, is newly diagnosed in approximately 1.5 million persons yearly, and accounts
for an estimated 47 billion in direct and indirect health care costs. Multiple risk
factors associated with CVD include genetic susceptibility, elevated serum
4
cholesterol, cigarette smoking, uncontrolled hypertension, obesity, diabetes mellitus
and physical in activity. An individual has no control over genetic susceptibility.
However, there are other risk factors over which an individual has some control
including cigarette smoking, hypertension high levels blood cholesterol. In addition
there are several contributing factors of which the precise roles have not been clearly
established. These include diabetes, excessive weight, lack o0f exercise and impact of
emotional stress.3
Heart disease is a major global health problem and is the cause of more than
50% and 25% of deaths in the developed and developing countries, respectively. It is
predicted that, by 2020, 25 million new cases of heart disease will be diagnosed
annually and it will become the first cause of death.[1] Many of the problems and
deaths caused by heart disorders are due to the adjusted risk factors, and lifestyle
changes can reduce the incidence and prevalence of this disease even if inherited.[2]
Providing an appropriate life model, along with other factors such as training and
raising awareness, can have an important role in reducing disability and death due to
heart disease by changing the lifestyle and motivation.[3]
Nurses are the health providers in a society. The best provider is someone who
sincerely believes in their own health. Nurses must understand that their health
performance has a profound impact on the receivers of healthcare.[4] Nurses must
have programs available to help them, if necessary, to change their risky behavior
habits.[5]
Nurses, due to the nature of their job, are prone to hard work, stress, burnout,
and sleep and eating disorders. This leads to various health complications, particularly
5
cardiovascular disease (CVD), neurological disorders, and immune decline.[6,7] In
countries with limited resources, effective strategies should be designed for the
prevention of heart disease, individuals should be classified in terms of risk factors,
and the necessary measures must be taken to prevent complications in at-risk
individuals.[8] In a case-control study in 52 countries, which investigated the risk
factors for myocardial infarction (MI), 9 modifiable risk factors, including smoking,
diabetes, hyperlipidemia, central obesity, hypertension, diet, physical activity,
alcohol, and mental factors, were detected.[9] By controlling these 9 factors, up to
90% of the incidence of heart attacks could be prevented.[2,9]
NEED FOR THE STUDY
Cardiovascular disease (CVD) is a general term for conditions affecting the
heart or blood vessels. It's usually associated with a build-up of fatty deposits inside
the arteries – known as atherosclerosis – and an increased risk of blood clots. It can
also be associated with damage to arteries in organs such as the brain, heart, kidneys
and eyes. CVD is one of the main causes of death and disability in India, but it can
often largely be prevented with a healthy lifestyle.
Cardiovascular diseases are leading cause of death in developing countries
accounting for 17% of the total deaths. Developing countries contributed 63% to the
global mortality due to cardiovascular diseases (CVD) in 1990. India contributed 17%
to the global mortality due to CVD. In India, CVD account for 31.7% of the deaths.
Deaths from coronary heart disease rose from 1.17 million in 1990 to 1.59 million in
2000 and are expected to rise to 2.03 million in 2010. In addition to high CHD
6
mortality in Indian subcontinent, it manifests almost 10 year earlier on average in this
region compared with the rest of the world, resulting in a substantial number of CHD
deaths occurring in the working age-group.7
Globally, ischemic heart disease (IHD) was the leading killer in the age group
≥60 years, and, with 1,332,000 deaths in adults aged 15–59 years. Recent estimates
suggest that 80% of Cardiovascular Diseases (CVD) deaths occur in developing
countries with substantial contribution from India. In India, the estimated adult
prevalence (of the age >30 yrs.) of cardio vascular disease(CVD) is around 8-10% in
urban settings and 3-4% in rural areas, reflecting a rise of six-fold and two-fold
respectively between 1960 and 2000. It is estimated that by 2020, CVD will be the
largest cause of disability and deaths in India. The burden of CVD risk factors is even
more alarming by 2025, unless urgent population vide preventive steps are taken.8
Asian Indians living both in India and abroad have one of the highest rates of
coronary artery disease (CAD) in the world, three times higher than the rates among
Caucasians in the United States.10 The overall impact is much greater because the
CAD in Asian Indians affects the "younger" working population. While the mortality
and morbidity from CAD has been falling in the western world, it has been climbing
to epidemic proportions among the Indian population.9
Cardiovascular diseases are the leading cause of death globally. This is true in
all areas of the world except Africa. Together they resulted in 17.3 million deaths
(31.5%) in 2013 up from 12.3 million (25.8%) in 1990.Deaths, at a given age, from
CVD are more common and have been increasing in much of the developing world,
7
while rates have declined in most of the developed world since the 1970s. IHD and
stroke account for 80% of CVD deaths in males and 75% of CVD deaths in females.9
CVD appears to be more prominent among young Asian Indians of working
classes. The incidence of CAD in young adults is increasing mainly due to tobacco
consumption, lack of physical activity, sedentary lifestyle, work stress and obesity.
Appropriate recommendations on diet, lifestyle, and acceptable levels of risk factors
may be needed. In India, mortality attributable to CVD is expected to rise by 103% in
men and by 90% in women from 1985 to 2015. More importantly, the disease catches
Indians young. Therefore, to stop the ruthless assault of CVD in developing countries,
there is an urgent need to represent the disease in the health agenda of that countries.10
The purpose of the study is to assess the knowledge of nurses on CVD risk
factors, measures CVD risk factors and determine whether or not a relationship exists
between nurse’s knowledge of CVD and their personal health habits. These findings
will add our knowledge concerning whether nurses in corporate their knowledge of
CVD risk factors in to their own lifestyles.
Registered nurses, as health professionals, are presumed to be knowledgeable
regarding CVD risk factors. As patient educators and care providers of health
services, nurses are in a unique position to promote positive health practice changes
among themselves as well as with the public. However, many nurses are overweight,
smoke and do not exercise. So the investigator decided to conduct this topic as a study
to assess the knowledge on Nurses personal health habits and cardiovascular disease
risk factors among staff nurses working in selected hospital
8
OBJECTIVES
STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAM ON KNOWLEDGE REGARDING NURSES PERSONAL
HEALTH HABITS AND CARDIOVASCULAR DISEASE RISK FACTORS
AMONG STAFF NURSES WORKING IN SELECTED HOSPITAL AT
BANGALORE.”
OBJECTIVES OF THE STUDY
1. To assess the knowledge regarding Nurses personal health habits and
cardiovascular disease risk factors among staff nurses in term of pre-test score.
2. To assess the knowledge regarding Nurses personal health habits and
cardiovascular disease risk factors among staff nurses in term of post-test
score.
3. To assess the effectiveness of structured teaching program by comparing pre-
test and post-test level of knowledge score.
4. To determine the association between pre-test knowledge score and socio
demographic variables.
OPERATIONAL DEFINITIONS
1. EFFECTIVENESS: In this study the effectiveness refers to the extent to
which the structured teaching program has attained the desired gain in
knowledge scores as measured by knowledge questionnaire.
9
2. STRUCTURED TEACHING PROGRAM: It refers to conducting a class
in a planned manner by conducting pre-test and then post –test after the
intervention.
3. KNOWLEDGE: It refers to the information gained by the participant before
and after teaching on nurses personal health habits and cardiovascular disease
risk factors.
4. NURSES PERSONAL HEALTH HABITS: The manner in which staff
nurses conduct their day to day activities that influence their health practices.
5. CARDIOVASCULAR DISEASE RISK FACTORS: Certain personal
characteristics associated with incidence of CVD including cigarette smoking,
hypertension, obesity, hypercholestrolemia, physical in activity, diabetes and
emotional stress.
6. STAFF NURSES: Refers to having Diploma or Degree of the Staff Nurse by
recognized institutions approved by Indian nursing council and Karnataka
nursing council with registered as a RNRM, in selected hospitals at Bangalore.
7. HOSPITALS: It’s an institution providing medical and surgical treatment and
nursing care for sick or injured people.
10
HYPOTHESES OF THE STUDY
H1. The mean post test knowledge score of Nurses personal health habits
and cardiovascular disease risk factors is significantly higher than the mean
pre test knowledge score by paired‘t’ test at 0.01 level.
H2. There is significant association between the knowledge with selected
demographic variables such as Age, Sex, Professional Qualification, year of
employment, working shift, working unit, working hours per week.
ASSUMPTIONS
Staff nurses may not have adequate knowledge regarding Nurses personal
health Habits and cardio vascular disease risk factors.
Structured teaching program will help to enhance the knowledge of staff
nurses on Nurses personal health habits and cardiovascular disease risk
actors.
Structured teaching program can bring about desirable changes in the
knowledge of staff nurses on Nurses personal health habits and
cardiovascular disease risk factors.
DELIMITATION
The study is delimited to,
Staff nurses working in selected hospitals at Bangalore.
Those who were participated in this study.
11
CONCEPTUAL FRAMEWORK
Conceptual framework is a theoretical approach to the study problems
that are scientifically based, which emphasizes the selection, arrangement and
classification of its concepts. A conceptual framework states functional
relationship between events and is not limited to statistical relationships.8
Conceptual framework acts as a building block for the research study. The
overall purpose of framework is to make scientific finding meaningful and
generalize. Conceptual frame work is a set of proportions that spell out the
relationship between them. It provides a certain framework of reference for
clinical practice, education and research. Conceptual framework deals with
abstractions (concepts) that are assembled by virtue of their relevance to a
common theme.8
A conceptual model is a group of concepts and set of propositions that
provides prescriptions on the major concepts. Conceptual model refers to set of
values, beliefs and preferences for research approach. Conceptual framework
plays several interrelated roles in the progress of science. Their overall purpose is
to make scientific findings meaningful and generalizable. The conceptual model is
also called as ‘conceptual framework’ or ‘system’.9
The conceptual framework of the present study was developed by the
investigator based on Von Bertanlanffy’s general system-theory.10 this consists of
components like,
12
Input
Process
Output
Feedback
Input:
The first component of a system is input, which is the information
energy or matter that enters a system. For a system to work well, input should
contribute to achieve the purpose of the system.10
In this study input refers to nurses’ demographic data like age, sex,
professional qualification, year of employment, working shift, working unit,
working hours per week. Input also includes preparation of lesson plan,
preparation of structured knowledge questionnaire and assessment of pre test
level of knowledge regarding nurses’ personal health habits and
cardiovascular disease risk factor among staff nurses.
Process:
Process is the action needed to accomplish the desired task.10 in this
study process refers to the administration of Structured Teaching Program
regarding nurses personal health habits and cardiovascular disease risk factors
among staff nurses working in selected hospitals at Bangalore.
Output:
After the process and the input, the system returns output to the
environment in an altered state, the end result or product of the system.10In
this study output refers to adequate gain in knowledge regarding nurses
13
personal health habits and cardiovascular disease risk factors among staff
nurses working in selected hospitals at Bangalore or inadequate gain in
knowledge regarding nurses personal health habits and cardiovascular risk
factors among staff nurses working in selected hospitals at Bangalore.
Feed back:
The process of communicating what is found in evaluation of the
system.10In this study feedback can be measured by the output i.e., whether
there is adequate or inadequate gain in knowledge. Adequate gain in
knowledge refers to increase in the post test knowledge score as compared
with pre test knowledge score. Inadequate gain in knowledge refers to
decrease in post test knowledge score or no change in pre test knowledge
score. If there is adequate gain in knowledge after the administration of
teaching material, it indicates that Structured Teaching Program was effective
and inadequate gain in knowledge indicates that Structured Teaching Program
was not effective and measures must be taken to improve it which is not the
part of this study.
14
FEEDBACK
Evaluation
INPUT
#Socio-demographic data on
age, sex, professional
qualification, year of
employment, working shift,
working unit, working hours
per week
#Structured Knowledge
Questionnaire.
#Development of Structured
Teaching Programme
THROUGHPUT
#Assessment of knowledge
regarding nurses’ health habits
and cardiovascular disease
risk factors among staff nurse.
#Administration of Structured
Teaching Program
#Conducting post-test by using structured knowledge
questionnaire.
OUTPUT
#Gain in knowledge based on
comparison of pre-test and
post-test knowledge scores.
- - - - - - - - not included
_________ included Figure - 1
CONCEPTUAL FRAMEWORK
15
REVIEW OF LITERATURE
Researchers almost never conduct a study in an intellectual vacuum;
their studies are usually undertaken within the context of an existing
knowledge base. “Review of Literature is a summary of research on a topic of
interest, often prepared to put a research problem in the context as the basis for
an implementation project”. A Literature Review helps to lay the foundation
for the study and can also inspire new research ideas.
Review of Literature is presented in following headings
1. Studies related to prevalence of cardio vascular diseases.
2. Studies related to knowledge on risk factors of cardio vascular diseases.
3. Studies related to health habits on cardio vascular diseases.
STUDIES RELATED TO PREVALENCE OF CARDIO VASCULAR
DISEASES.
An epidemiological study was performed in North India to determine
prevalence and age-specific trends in cardiovascular risk factors among
adolescent and young urban Asian Indians. Major risk factors-smoking or
tobacco use, obesity, truncal obesity, hypertension, dysglycemia and
dyslipidaemia using pre-specified definitions in 2051 subjects (male 1009,
female 1042) aged 15-39 years of age was evaluated. Age-stratified analyses
16
were performed and significance of trends determined using regression
analyses for numerical variables and Chi2 test for trend for categorical
variables. Logistic regression was used to identify univariate and multivariate
odds ratios (OR) for correlation of age and risk factors. The study concludes
that there is a low prevalence of multiple cardiovascular risk factors (smoking,
hypertension, dyslipidaemias, diabetes and metabolic syndrome) in
adolescents and rapid escalation of these risk factors by age of 30-39 years is
noted in urban Asian Indians.11
A total community cross sectional survey was conducted of 20
randomly selected streets in the city of Moradabad to determine the
association of social class with prevalence of coronary risk factors and cardio
vascular disease (CVD) among 1,806 urban (904 men and 902 women)
randomly selected subjects aged 25–64 years. The survey methods were
questionnaire, physical examination and electrocardiography. All subjects
were divided into social classes 1–5 based on attributes of education,
occupation, per capita income, housing condition and consumer durables and
other family assets as social classes 1, 2 and 3 were mainly high and middle
socioeconomic groups and 3 and 4 low income groups. Results show that the
prevalence of CVD and coronary risk factors hypercholesterolemia,
hypertension, diabetes mellitus and sedentary lifestyle were significantly
higher among social classes 1, 2 and 3 in both sexes compared to lower social
classes. Mean serum cholesterol, triglycerides, low density lipoprotein
cholesterol and blood pressure were significantly associated with higher and
middle social classes. Smoking was significantly associated with lower social
classes. Multivariate logistic regression analysis after adjustment of age
17
revealed that social class was positively associated with CVD (odds ratio: men
0.84, women 0.86), hypercholesterolemia (men 0.87, women 0.85),
hypertension (men 0.91, women 0.89), diabetes mellitus (men 0.71, women
0.68) and sedentary lifestyle (men 0.68, women 0.66). Smoking was
significantly associated with CVD in men. The study concludes that social
class 1, 2 and 3 in an urban population of India have a higher prevalence of
CVD and coronary risk factors hypercholesterolemia, hypertension, diabetes
mellitus and sedentary lifestyle in both sexes.12
A study was conducted in University of North Carolina School of
Medicine, USA for 1,22,458 patients enrolled in 14 international randomized
clinical trials of CVD conducted during the prior decade to determine the
prevalence of the 4 conventional risk factors (cigarette smoking, diabetes,
hyperlipidemia, and hypertension) among patients with cardio vascular disease
CVD. Prevalence of each conventional risk factor and number of conventional
risk factors present among patients with CVD, compared between men and
women and by age at trial entry. Among patients with CVD, at least 1 of the 4
conventional risk factors was present in 84.6% of women and 80.6% of men.
In younger patients (men ≤55 years and women ≤65 years), only 10% to 15%
of patients lacked any of the 4 conventional risk factors. This pattern was
largely independent of sex, geographic region, trial entry criteria, or prior
CVD. Premature CVD was related to cigarette smoking in men and cigarette
smoking and diabetes in women. Smoking decreased the age at the time of
CVD event (at trial entry) by nearly 1 decade in all risk factor combinations.
The study concludes that in direct contrast with conventional thinking, 80% to
90% of patients with CVD have conventional risk factors.13
18
In this cross-sectional study, which aimed to determine the prevalence
of cardiovascular risk factors among nurses census sampling was conducted
among nurses of Jahrom, Iran, in 2014. Data were collected through
interviews, blood pressure measurement, anthropometric parameters, and
blood sample collection. To analyze the data, descriptive statistical analysis,
and comparative (independent t-test) and correlation (Pearson) tests were
used; the significance level was considered to be P < 0.05. Results revealed
that in this study, 263 (89.76%) nurses participated, 79.8% of whom were
women. The mean age of the participants was 31.04 (6.97). In terms of body
mass index, 41.7% was the waist-to-hip ratio, 16.7% was the waist-to-height
ratio, and 63.1% were in the range of obesity. In addition, 5.7% had abnormal
triglyceride, 4.9% had high cholesterol, and 15.1% had high blood pressure.
The mean percentage of the Framingham risk score of the participants was
1.07 (1.84). This study concludes that the total mean percentage of the
Framingham risk score of the nurses was 1.07, which showed a low risk of
CAD in the study population over the next decade. On the other hand, heart
disease, in addition to its direct and indirect costs, leads to problems such as
burnout, absenteeism, loss of working time, leaving the service, or deciding to
change jobs.[9] Given that nurses have an important role in promoting public
health, their physical problems cause a reduction in their beneficial service
duration, pain, and suffering, as well as degradation of the quality and quantity
of work.[11]
19
Cardiovascular diseases (CVDs) have now become the leading cause
of mortality in India. A quarter of all mortality is attributable to CVD.
Ischemic heart disease and stroke are the predominant causes and are
responsible for >80% of CVD deaths. The Global Burden of Disease study
estimate of age-standardized CVD death rate of 272 per 100 000 population in
India is higher than the global average of 235 per 100 000 population. Some
aspects of the CVD epidemic in India are particular causes of concern,
including its accelerated buildup, the early age of disease onset in the
population, and the high case fatality rate. In India, the epidemiological
transition from predominantly infectious disease conditions to
noncommunicable diseases has occurred over a rather brief period of time.
Premature mortality in terms of years of life lost because of CVD in India
increased by 59%, from 23.2 million (1990) to 37 million (2010). Despite
wide heterogeneity in the prevalence of cardiovascular risk factors across
different regions, CVD has emerged as the leading cause of death in all parts
of India, including poorer states and rural areas. The progression of the
epidemic is characterized by the reversal of socioeconomic gradients; tobacco
use and low fruit and vegetable intake have become more prevalent among
those from lower socioeconomic backgrounds. In addition, individuals from
lower socioeconomic backgrounds frequently do not receive optimal therapy,
leading to poorer outcomes. Countering the epidemic requires the
development of strategies such as the formulation and effective
implementation of evidence-based policy, reinforcement of health systems,
and emphasis on prevention, early detection, and treatment with the use of
20
both conventional and innovative techniques. Several ongoing community-
based studies are testing these strategies.
With the turn of the century, cardiovascular diseases (CVDs) have
become the leading cause of mortality in India.1 In comparison with the people
of European ancestry, CVD affects Indians at least a decade earlier and in their
most productive midlife years.2,3 For example, in Western populations only
23% of CVD deaths occur before the age of 70 years; in India, this number is
52%.4 In addition, case fatality attributable to CVD in low-income countries,
including India, appears to be much higher than in middle- and high-income
countries.5,6 The World Health Organization (WHO) has estimated that, with
the current burden of CVD, India would lose $237 billion from the loss of
productivity and spending on health care over a 10-year period (2005–
2015).7 Reasons for the high propensity to develop CVD, the high case
fatality, and the high premature mortality include biological mechanisms,
social determinants, and their interactions. Addressing this significant burden
requires an understanding of both the biological and social determinants, and
the complex dynamics underlying their interaction, as well. In this review, we
summarize the CVD burden in India, the reasons for the high burden,
prevention and treatment strategies for CVD, and future policy strategies to
pursue.
The epidemiological transition in India in the past 2 decades has been
dramatic; in a short timeframe, the predominant epidemiological
21
characteristics have transitioned from infectious diseases, diseases of
undernutrition, and maternal and childhood diseases to non communicable
diseases (NCDs).8 The disease burden attributable to maternal disorders,
measles, protein-energy malnutrition, and diarrheal diseases decreased >50%
in the past 2 decades, whereas life expectancy at birth increased from 58.3 to
65.2 years, resulting in the ageing of the population during the same
period.8 Consequently, the NCD burden increased rapidly in India, with a
proportional rise in burden attributable to CVD.8 Nearly two-thirds of the
burden of NCD mortality in India is currently contributed by CVD-related
conditions.9 Despite wide heterogeneity in the prevalence of risk factors across
different regions (explained below), CVD is the leading cause of death in all
parts of India, including the poorer states and rural areas.10 The disease
transition in India in the past 2 decades resembles the accelerated
epidemiological transition model with a rapid shift to the age of delayed
chronic diseases.
STUDIES RELATED TO KNOWLEDGE ON RISK FACTORS OF
CARDIO VASCULAR DISEASES.
A cross sectional study was conducted at All India Institute of Medical
Sciences (AIIMS), a major tertiary care hospital in New Delhi, India.
Participants (n = 217) recruited from patient waiting areas in the emergency
room were provided with standardized questionnaires to assess their
knowledge of modifiable risk factors of cardio vascular Disease (CVD). The
22
risk factors specifically included smoking, hypertension, elevated cholesterol
levels, diabetes mellitus and obesity. Identifying 3 or less risk factors was
regarded as a poor knowledge level, whereas identifying 4 or more risk factors
was regarded as a good knowledge level. A multiple logistic regression model
was used to isolate independent demographic markers predictive of a
participant's level of knowledge. 41% of the sample surveyed had a good level
of knowledge. 68%, 72%, 73% and 57% of the population identified smoking,
obesity, hypertension, and high cholesterol correctly, respectively. 30%
identified diabetes mellitus as a modifiable risk factor of CVD. In multiple
logistic regression analysis independent demographic predictors of a good
knowledge level with a statistically significant (p < 0.05). No history of
smoking, a OR 8.25, and former smokers, a OR 48.28 (compared to current
smokers). Although statistically insignificant, a trend towards a good
knowledge level was associated with higher levels of education.14
A cross sectional study was conducted in Universities and colleges of
Karachi to elucidate knowledge of cardio vascular disease (CVD) risks factors
and coronary intervention in adult students. Questionnaires were distributed to
200 adult students of different non-medical universities and colleges. The
questionnaire contained assessment of knowledge of risk factors on CVD and
awareness about coronary angiography. Knowledge was assessed as a
continuous variable. Risk factors for CAD were taken as categorical variables.
The mean age of students was 20 yrs. ± 2.2 years and 62% were females. The
mean score of knowledge about risk factors of CVD was 11.47 ± 2.37. 60 %
students thought that heart diseases are the number one cause of death in our
population. 48% students correctly defined coronary angiography. 85%
23
students thought that cost is the major hindrance in getting timely treatment.
Knowledge of 50% students was based on personal and family experience of
heart disease. Conclusion of the study is that students graded smoking as the
topmost risk factor for CVD and cost as the major hindrance in getting timely
treatment for heart disease. Only half of the students were aware about
coronary angiography .The mean knowledge score among them was above the
median score but not up to the mark.15
A comparative study conducted to assess the knowledge with behavior,
for smokers and those who were overweight risk was not related to awareness.
Thus, the results suggested that knowledge does not necessarily lead to risk
reducing behavior in individuals. They evaluated knowledge attitudes and
practice patterns concerning cholesterol and heart disease kin an stratified,
Random sample 206 registered nurses at a major medical centre in new York
city. All nurses were consekllin of the importance of diet in reducing heart
disease. Despite their enthusiasm for heart disease prevention through diet
modifications, many nurses had substantial knowledge gsp, suggesting that
nurses may not be adequately prepared to counsel about diet or drug treatment
for high blood cholesterol.16
Knowledge, attitudes, and practice patterns concerning cholesterol and
heart disease were evaluated in a stratified, random sample of 206
registered nurses at a major academic medical center in New York City.
Virtually all nurses were convinced of the importance of diet in reducing heart
disease risk, and most (78%) agreed that nutrition counseling should be their
responsibility. Although only 19% reported that they were currently
24
counseling, many more felt prepared to counsel about diet or drug therapy
(43%). Nurses who were likely to counsel were those working in general
medicine, those who were certified nurse practitioners, those who knew their
own blood cholesterol level, and those with higher knowledge scores. Level of
overall knowledge was associated with the practice of counseling, an attitude
that counseling should be a nurse's responsibility, and personal health behavior
(knew own level), regardless of age or occupational or degree status. Despite
their enthusiasm for heart disease prevention through diet modification,
many nurses had substantial knowledge gaps, suggesting that nurses are
currently not adequately prepared to counsel about diet and/or drug treatment
for high blood cholesterol. Educational strategies and considerations in
integrating an expanded role for nurses with those of physicians and dietitians
are discussed.
The cornerstone of cardiovascular disease prevention is the promotion
of a healthy lifestyle and the identification and reduction of cardiovascular risk
factors. Cardiology nurses play a major role in counseling patients about
lifestyle and cardiovascular risk factors. We used an e-mail survey to elicit
self-reported prevalence of cardiovascular risk factors and healthy lifestyles
among the Preventive Cardiovascular Nurses Association (PCNA) members
and compared their risk profiles with published data for American
cardiologists, the Nurses' Health Study 2, and the Behavioral Risk Factor
Surveillance Survey data for women. A total of 1,345 complete surveys were
collected. The respondents were mostly women (96%), with mean (SD) age of
25
47.4 (8.7) years. More than 95% were not cigarette smokers, more than 50%
had a healthy body mass index (<25), and more than 56% achieved the
recommended levels of physical activity. Nevertheless, obesity (body mass
index ≥ 30) was a health risk in one-fifth of PCNA respondents. The rates of
hypertension (17%) and dyslipidemia (15%) were lower than rates reported in
other national samples; however, the rate for family history of premature heart
disease (20%) was similar to those reported in national samples. Since family
history of premature heart disease may be a more significant risk factor in
women, PCNA respondents with such a family history may require targeted
interventions to further reduce their risk and improve their lifestyle behaviors.
PCNA nurses have more favorable lifestyle profiles compared with national
samples. It can be expected that nurses who know their risk factors and who
follow healthy lifestyle behaviors will be more effective in these counseling
roles.
In a study conducted by Miller et al. on health risk factors of nurses,
more than 54% were obese, 96% considered their obesity as a cause of heart
disease, 26% were unaware of their diabetes, and approximately 90% were
also unaware of having hyperlipidemia.[5] In a study of the Cardiovascular
Nurses Association, 20%, 23%, and 17% of the nurses working in the field of
prevention of heart disorders had a history of hypertension, lipid disorders,
and obesity.[10]
26
STUDIES RELATED TO HEALTH HABITS ON CARDIO VASCULAR
DISEASES.
In a follow-up Study of medical professionals in 1986 at Harvard
School of Public Health, Boston, prospective monitoring was done for 42,847
men of 40 to 75 years of age and free of disease. Lifestyle factors were
updated through self-reported questionnaires. Low risk was defined as (1)
absence of smoking, (2) body mass index <25 kg/m2, (3) moderate-to-vigorous
activity ≥30 min/d, (4) moderate alcohol consumption (5 to 30 g/d), and (5)
the top 40% of the distribution for a healthy diet score. Over 16 years, 2183
incident cases of CVD (nonfatal myocardial infarction and fatal CHD) were
documented. In multivariate-adjusted Cox proportional hazards models, men
who were at low risk for 5 lifestyle factors had a lower risk of CVD (relative
risk: 0.13; 95% confidence interval [CI]: 0.09, 0.19) compared with men who
were at low risk for no lifestyle factors. 62% (95% CI: 49%, 74%) of coronary
events in this cohort may have been prevented with better adherence to these 5
healthy lifestyle practices. Among men taking medication for hypertension or
hypercholesterolemia, 57% (95% CI: 32%, 79%) of all coronary events may
have been prevented with a low-risk lifestyle. Compared with men who did
not make lifestyle changes during follow-up, those who adopted ≥2 additional
low-risk lifestyle factors had a 27% (95% CI: 7%, 43%) lower risk of CVD.
The study concludes that a majority of CVD events may be preventable
through adherence to healthy lifestyle practices, even among those taking
medications for hypertension or hypercholesterolemia.17
27
A prospective cohort study was conducted in Massachusetts, USA to
examine the association between modifiable lifestyle factors and the lifetime
risk of heart failure in a large cohort of men using data from 20,900 men from
the Physicians' Health Study I (1982-2008) who were apparently healthy at
baseline. Six modifiable lifestyle factors were assessed: body weight,
smoking, exercise, alcohol intake, consumption of breakfast cereals, and
consumption of fruits and vegetables. Healthy lifestyle habits (normal body
weight, not smoking, regular exercise, moderate alcohol intake, consumption
of breakfast cereals, and consumption of fruits and vegetables) were
individually and jointly associated with a lower lifetime risk of heart failure,
with the highest risk in men adhering to none of the 6 lifestyle factors (21.2%;
95% CI, 16.8%-25.6%) and the lowest risk in men adhering to 4 or more
desirable factors (10.1%; 95% CI, 7.9%-12.3%). In this cohort of apparently
healthy men, adherence to healthy lifestyle factors is associated with a lower
lifetime risk of heart failure.18
A cross sectional study was conducted at St John's Medical College,
Bangalore to describe the detailed physical activity profiles of educated,
employed, urban Indians and to ascertain their knowledge about the benefits of
exercise, their concept of 'ideal' exercise, and the constraints in achieving it.
401 subjects (193 males, 208 females) between the ages of 25 and 58 years
were studied. Women were significantly more active than men (p < 0.05),
largely due to enhanced household activity (p < 0.05), which was not offset by
the higher leisure time-related exercise of males (p < 0.05). Over 50 % of
subjects were aware of the benefits of exercise in preventing heart disease.
28
The subjects' perceptions of 'ideal' exercise, based on exercise programs they
had drawn up for themselves, were adequate in terms of frequency and
duration, but inadequate in intensity, when compared with the current
recommendations for exercise in primary prevention of coronary heart disease.
Lack of time (men 53.4%, women 68.3%) and lack of motivation (men 26.4%,
women 28.4%) were the most-often cited reasons for being unable to achieve
'ideal' exercise goals. The data provides an important framework for
understanding physical activity profiles of urban, educated and employed
Indians on the basis of which behavioral strategies can be formulated to
enhance physical activity and reduce cardiovascular risk.19
To examine associations between rotating night shift work and all-
cause; cardiovascular disease (CVD); and cancer mortality in a prospective
cohort study of 74,862 registered U.S. nurses from the Nurses' Health Study.
Lifetime rotating night shift work (defined as ≥3 nights/month) information
was collected in 1988. During 22 years (1988-2010) of follow-up, 14,181
deaths were documented, including 3,062 CVD and 5,413 cancer deaths. Cox
proportional hazards models estimated multivariable-adjusted hazard ratios
(HRs) and 95% CIs. All-cause and CVD mortality were significantly
increased among women with ≥5 years of rotating night shift work, compared
to women who never worked night shifts. Specifically, for women with 6-14
and ≥15 years of rotating night shift work, the HRs were 1.11 (95% CI=1.06,
1.17) and 1.11 (95% CI=1.05, 1.18) for all-cause mortality and 1.19 (95%
CI=1.07, 1.33) and 1.23 (95% CI=1.09, 1.38) for CVD mortality. There was
no significant association between rotating night shift work and all-cancer
29
mortality (HR≥15years=1.08, 95% CI=0.98, 1.19) or mortality of any
individual cancer, with the exception of lung cancer (HR≥15years=1.25, 95%
CI=1.04, 1.51). Women working rotating night shifts for ≥5 years have a
modest increase in all-cause and CVD mortality; those working ≥15 years of
rotating night shift work have a modest increase in lung cancer mortality.
These results add to prior evidence of a potentially detrimental effect of
rotating night shift work on health and longevity.
To quantify the incidence of overweight and obesity in nursing
professionals and assess nurses' knowledge of obesity and associated health
risks. A mailed survey to 4980 randomly selected registered nurses from one
state in each of six geographic regions. Response rate was 15.5% (n= 760).
Descriptive statistics were calculated for continuous variables; categorical
variables were summarized with frequency counts. The results revealed that
the grand mean body mass index (BMI) of nurses surveyed was 27.2. Almost
54% were overweight or obese. Fifty-three percent of these nurses report that
they are overweight but lack the motivation to make lifestyle changes. Forty
percent are unable to lose weight despite healthy diet and exercise habits. Only
26% of respondents use BMI to make clinical judgments of overweight and
obesity. Although 93% of nurses acknowledge that overweight and obesity are
diagnoses requiring intervention, 76% do not pursue the topic with overweight
and obese patients. Many nurses provide weight-related health information to
the public. These data suggest that they may benefit from continuing education
on obesity and its risks. Because 76% of nurses do not pursue the topic of
30
obesity with patients, they may benefit from education on pursuing sensitive
topics during a professional encounter. Nurse practitioners may play a key role
in the education of both patients and registered nurses.
31
METHODOLOGY
Methodology of research includes the general pattern of organizing the
procedure, for gathering valid and reliable data for the problem under investigation. 13
Research methodology is a way to systematically solve research problems.
Research methodology includes steps, procedures and strategies for gathering and
analyzing the data in a research investigation13.
The methodology is the most important part of research as it is the frame work
for conducting the study. This chapter deals with the description of the methods and
different steps used for collecting and organizing data. It includes research design,
research approach, sample setting, sampling technique, development and description
of tool, development of teaching strategy, pilot study, data collection and plan for data
analysis.
Research approach
Research approach is the most significant part of any research. The
appropriate choice of the research approach depends on the purpose of the research
study.8Evaluative research approach was used for this study.
Research design
The research design refers to the researcher’s overall plan for obtaining
answers to the research questions and for testing the research hypotheses. It spells out
the strategies that the researcher adapts to develop information that is accurate,
objective and interpretable. The research design provides an overall blue print to
32
conduct the study.8The research design selected was pre experimental one group pre
test post test design.
Table: 1 Research design
Sample Pre test Intervention Post test
Staff Nurses O1 X O2
Key:
O1 – Assessment of pre test knowledge regarding nurses’ personal health
habits and cardiovascular risk factors among staff nurses working in selected hospitals
at, Bangalore.
X – Structured Teaching Program regarding nurses’ personal health habits and
cardiovascular risk factors among staff nurses working in selected hospitals at,
Bangalore.
O2 – Assessment of Post test knowledge regarding nurses’ personal health
habits and cardiovascular risk factors among staff nurses working in selected hospitals
at, Bangalore.
Variables
Variables are characteristics that vary among the subjects being studied. It is
the focus of the study and reflects the empirical aspects of the concept being
studied.8The investigator measures the variables.
33
Independent variable: It is the variable which influences the dependent
variable.8 in this study the independent variable was structured teaching program
regarding nurses’ personal health habits and cardiovascular risk factors among staff
nurses working in selected hospitals at, Bangalore.
Dependent variable: It is the response behavior or outcome predicted or
explained in research. Changes in the dependent variable are presumed to be caused
by the independent variable. In this study the dependent variable was the level of
knowledge regarding nurses’ personal health habits and cardiovascular risk factors
among staff nurses working in selected hospitals at, Bangalore.
Demographic variable:
Baseline characteristics such as age, sex, professional qualification, year of
employment, working shift, working unit, working hours per week.
Setting of the study:
Present study was conducted at selected hospitals, Bangalore.
Population of the study:
The population is the entire set of persons who meet the sampling criteria.8The
population of the study consisted staff nurses.
34
Sampling
Sample technique
Convenient sampling technique was used to select the sample.
Criteria for sample selection
The criteria for sample selection were mainly depicted under two heading
which include the inclusion and exclusion criteria.
Inclusion criteria: -
Staff nurses,
Who are available at the time of data collection
Who are willing to participate in the study
Who can able to read and write English
Exclusion criteria:
Staff nurses,
Who are not available at the time of data collection
Who are not willing to participate in the study
DEVELOPMENT OF TOOL
A structured knowledge questionnaire was prepared to assess the knowledge
regarding nurses’ personal health habits and cardiovascular disease risk factors among
staff nurses working in selected hospitals at Bangalore.
35
After exclusive and systematic review of literature the investigator developed
the structured knowledge questionnaire.
The steps followed in preparation of tool were
Review of literature
Preparation of blue print
Answer key
Validation
Pilot study
REVIEW OF LITERATURE
Related literature reviews like books, journals, articles periodicals, published
research studies and unpublished research studies were reviewed and opinions of
subject experts was considered for the development of the tool.
THE BLUE PRINT
The blue print was prepared to construct the tool. There were 25 knowledge
questions under aspects for knowledge assessment regarding nurses health habits and
cardiovascular risk factors among staff nurses.
DESCRIPTION OF THE TOOL
The structured questionnaire was constructed in two parts. Part I and Part II.
36
Part I: Includes 7 aspects related to the demographic variables of respondents.
Part II: Includes 25 structured knowledge questions regarding nurses personal
health habits and cardiovascular risk factors.
SCORING KEY
25 items were included in the structured knowledge questionnaire to assess the
knowledge, comprehension and applicability. Each question in the structured
knowledge questionnaire had three options, one being the right answer and carried
one mark. The total score allotted for questions was 25. A scoring key is prepared
showing item numbers and correct responses.
Obtained score
Percentage = ------------------- x 100
Total score
To find out the association with the selected variables, the knowledge.
High knowledge score : > 75%
Average knowledge score : 51%-75%
Low knowledge score : ≤50%
37
TESTING OF THE INSTRUMENT
Content validity of the tool:
Content validity refers to the degree to which an instrument measures what it
is intended to measure.39
The tool along with the statement of problem, objectives hypotheses and
operational definition, blue print of tool were submitted to 7 experts for validation.
The experts were 1 from the fields of Statistics 1 Cardiologist and 5 Nurse Educators
in Medical Surgical Nursing. The experts were requested to give their opinion
regarding relevancy, appropriateness and usefulness of the items of the tool. Tool was
finalized after adopting the suggestions given by the experts.
Reliability of the tool:
Reliability of the research instrument is defined as the extent to which the
instrument yields the same results on repeated measures. It is then concerned with
consistency, accuracy, precision, stability, equivalence and homogeneity.46
Reliability of the tool was established by using split half technique which
measures the coefficient of internal consistency. The reliability of the split half test
was marked by using Karl Pearson correlation by deviation method.
Spearman Brown’s prophecy formula: It is used to find out the reliability of the
tool. Spearman Brown prophecy formula rII=2r/1+r.
38
The reliability of co-efficient of correlation of the knowledge tool was found
to be 0.9524 and validity co-efficient is proved highly reliable. Hence the tool is
found reliable.
Spearman’s Brown Prophecy Formula for reliability:
2 r
r 11= ------------------------------
1 + r
r = the correlation co-efficient calculated on the split halves.
r11 = the estimated reliability of the entire test.
For computing the coefficient of correlation the formulas used were:
Raw score method:
N ∑ XY – (∑ X) (∑ Y)
r =-------------------------------------------------------
√[N ∑ X2 - (∑ X)2] [N ∑ Y2 – (∑ Y)2]
Deviation method:
∑ XY
r = -------------------
√∑ X2 x ∑ Y2
The reliability of the tool was found to be 0.90 which indicated that the tool
was reliable.
39
DEVELOPMENT OF STRUCTURED TEACING PROGRAM
Structured Teaching Program was developed based on review of literature.
The following steps were adopted to develop it:
Development of content and blue print
Development of Structured Teaching Program
Establishment of content validity by subject experts
Final draft prepared
PILOT STUDY
“Pilot study is a small scale version, or trial run, done in preparation for a
major Study”. 41 pilot study is the mini version of the actual study in order to find out
the feasibility of the study. It is designed to acquaint the researcher with the problem
that can be corrected in preparation for a larger project. The pilot study was conducted
from 18-12-2017 to 25-12-2017. The researcher selected FIVE staff nurses, by
convenient sampling technique. The researcher obtained data from pre test through
questionnaire method from samples. After that structured teaching program on
knowledge regarding nurses personal health habits and cardiovascular risk factors
among staff nurses was administered, after 8 days post test was conducted.
Purposes of the pilot study.
The main purposes of the pilot study were;
40
1. To assess the effectiveness of the data collection plan.
2. To identify the inadequacies of the plan and make due modifications as
required.
3. To find out the feasibility of conducting the final study and to determine the
methods of statistical analysis.
Findings of the pilot study.
The analysis was done using descriptive statistics. The findings of the study
revealed that the overall mean knowledge score of respondents found to be 50.92 per
cent. The self administered knowledge questionnaire took 25-35 minutes. The tool
was found to be comprehensible, feasible and acceptable by the subjects. The data
collected was compiled for analysis.
Problems faced during pilot study.
The investigator did not face any significant problem and the tool was found
reliable.
PROCEDURE FOR DATA COLLECTION
Permission from the concerned authority
Formal permission was obtained from the Hospital Administrator and
approval was obtained to conduct the study.
Period for data collection
The data collection was done for a period of 4 weeks from 1/1/2018 to
30/1/2018. Data was collected with the help of structured knowledge questionnaire.
41
Pre-Test
The Pre-test was conducted to assess the knowledge of staff nurses regarding
personal health habits and cardiovascular disease risk factors by using structured
knowledge questionnaire on Day 1
Administration of Structured Teaching Program
The prepared Structured Teaching Program was administered to staff nurses
on the same Day 1.
Post-Test
The Post-test was conducted to evaluate the effectiveness of Structured
Teaching Program on Day 8.
PLAN FOR DATA ANALYSIS
The data obtained can be analyzed in terms of achieving the objective of the
study by using descriptive and inferential statistics.
STATISTICAL ANALYSIS OF DATA
Organization of data in master sheet.
Frequency and percentage to be used for analysis of demographic data.
Calculation of mean, standard deviation of pre-test and post-test scores.
Application of paired “t” test to test whether there is significant difference in
the mean knowledge score of pre-test and post-test values.
Application of Chi Square test to find the association of demographic
variables with pre-test and post-test knowledge scores.
42
42
SCHEMATIC REPRESENTATION OF STUDY DESIGN
PURPOSE POPULATION SAMPLE/ PRE-TEST INTERVENTION
TECHNIQUE
TESTING EFFECTIVENESS POST-TEST
OF SIM
The Effectiveness Of
structured teaching
program on knowledge
regarding nurses’
personal health habits
and cardiovascular
disease risk factors
among staff nurses
working in selected
hospitals at Bangalore.”
Staff
Nurses
60 staff
nurses’
selected by
convenient
sampling
1st Day
assessment of
knowledge
using
structured
knowledge
questionnaire
Administration of
Structured
teaching program
after pre-test
8th Day
assessment of
knowledge by
using same
structured
knowledge
questionnaire
Gain in knowledge based on
comparison of pre-test and
post-test knowledge scores. Figure - 2
45
RESULTS
In order to find a meaningful answer to the research questions, the collected data
must be processed, analyzed in some orderly coherent fashion, so that patterns and
relationships can be discussed.
Analysis is the categorizing, ordering, manipulating and summarizing of data to
obtain answers to the research questions. The interpretation of tabulated data can bring
light to the real meaning and effectiveness of the findings.
In this study, evaluative approach was adopted to assess the knowledge regarding
nurse’ health habits and cardiovascular disease risk factors among staff nurses. Data
collected from 60 selected respondents were tabulated, analyzed and interpreted by using
descriptive and inferential statistics based on the formulated objectives of the study.
These are:
1. To assess the existing level of knowledge regarding nurses’ health habits and
cardiovascular disease risk factors among staff nurses working in selected
hospitals at Bangalore by pretest.
2. To evaluate the effectiveness of Structured Teaching Program nurses’ health
habits and cardiovascular disease risk factors among staff nurses working in
selected hospitals at Bangalore
3. To find out the association between the pretest knowledge levels of staff
nurses regarding nurses’ health habits and cardiovascular disease risk factors
among staff nurses working in selected hospitals at Bangalore with their
selected demographic variables.
46
The findings were presented under the following sections:
Section 1: Demographic variables of respondents
Section 2: Overall knowledge & Aspect wise scores of respondents
Section 3: Effectiveness of Structured Teaching Program on knowledge regarding
nurses’ health habits and cardiovascular disease risk factors among staff nurses
working
Section 4: Association between knowledge level and selected demographic
variables
47
SECTION 1
Table 1: Classification of Respondents by Demographic Variables
n=60
Characteristics Category Respondents
Frequency Percentage %
Age group (years) 20-30 02 3.33
31-40 46 76.67
41-50 12 20
Sex Male 12 20
Female 48 80
Professional Education Diploma 18 30
Degree 42 70
years of employment
1-10 years 17 28.33
10 years
and above
43 71.67
working shift morning 50 83.33
night 10 16.67
working unit cardio dept 43 71.67
other dept 17 28.33
working hours per week
40-50 39 65
50-60 08 13.33
60-70 13 21.67
Table 1 reveal the respondents by demographic variables
48
The number of respondents found in the age group of
20-30 years were 2 (3.33%), majority of 46 respondents in the 31-40 years
(76.67%) of age, and 12 (20%) of them are in the 41-50 years of age.
48(80%) are female staffs and only 12(20%) of the total respondents are male
staff nurses.
42 respondents (70%) of respondents have a degree in nursing with only 30%
respondents having a diploma in general nursing
43(71.67%) respondents are employed and with experience of up to 10 years and
work in cardio department with 17% having employed for more than 10 years in
other departments.
83.33% respondents work in day or afternoon shift, with 16.67 % working night
shifts.
65% respondents have 40-50 hours of work per week with 21.67% working for
up to 60 hours per week and remaining 13.33% work for up to 70 hours per week.
49
Fig 3: Classification of respondents based on demographic variables
0
10
20
30
40
50
60
70
80
90
20
-30
31
-40
41
-50
Mal
e
Fem
ale
Dip
lom
a
Deg
ree
1-1
0 y
ears
10
yea
rs a
nd
abo
ve
mo
rnin
g
nig
ht
card
io d
ept
oth
er d
ept
40
-50
50
-60
60
-70
Age group
(years)
Sex Profession Exp shift unit working hrs/wk
3.33
76.67
20 20
80
30
70
28.33
71.67
83.33
16.67
71.67
28.33
65
13.33
21.67
50
SECTION 2
Table 3: Overall Knowledge level of respondents regarding
n=60
Knowledge Level Respondents
Frequency Percentage
Inadequate (< 50%) 38 63.33%
Moderate (51-75%) 22 36.67%
Total 60 100.0%
Table3 reveals the percentage distribution of staff nurses regarding nurses’
health habits and cardiovascular disease risk factors
The data reveals that 38(63.33%) of staff nurses had inadequate knowledge level
as compared to 22(36.67%) respondents with moderate knowledge level regarding
nurses’ health habits and cardiovascular disease risk factors.
Figure 4: Overall knowledge level of staff nurses
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
Knowledge %
63.33%
36.67%Inadequate (< 50%)
Moderate (51-75%)
51
Table 4: Aspect wise Mean Knowledge Scores of nurses’ health habits and cardiovascular
risk factors
n=60
No. Knowledge Aspects State-
ments
Max.
Score
Range
Score
Respondents Knowledge
Mean Mean(%) SD(%)
I Heart, cardiovascular
disease, prevalence
5 5 0-5 2.5 41.6 20.39
II Causes, Risk factors,
Signs & Symptoms
7 7 0-7 3.5 41.6 17.12
III Management &
Prevention
10 10 0-10 5 16.67 21.85
Combined 22 22 0-22 11 59 12.32
Table 4 depict the aspect wise mean knowledge of staff nurses regarding their health habits
and cardiovascular risk factors
41.6% of mean knowledge score was found in questions related to heart, cardiovascular
disease, prevalence 41.6% related to causes & risk factors with signs & symptoms. 16.67%
related to management and prevention.
52
Figure 5: Aspect wise Mean Knowledge on nurses’ health habits and cardiovascular risk
factors
0
5
10
15
20
25
30
35
40
45
Aspect wiseknowledge score
Heart, CVD Causes, Risk, S&S Management &Prevention
41.6 41.6
16.67
53
SECTION 3
Effectiveness of Structured Teaching Program regarding nurses’ health habits and
cardiovascular risk factors
The paired “t” value was computed to determine the effectiveness of structured teaching program
on knowledge regarding nurses’ health habits and cardiovascular risk factors. The following
hypothesis was stated.
H1: There is a significant difference between mean pre test score and mean post test score
regarding nurses’ health habits and cardiovascular disease risk factors.
Table 5: Effectiveness of Structured Teaching Program on knowledge regarding nurses’
personal health habits and cardiovascular disease risk factors
Knowledge
assessment
Mean Mean
difference
SD df Paired “t”
value
P value
Pre Test 14.36
11.08
19.10
59
21.82
<0.01 Post test 25.45 22.38
Table 5 illustrates that the mean pot test level knowledge score (25.45) was higher than the pre
test score (14.36) of the same group. The mean difference between pre test and post test score
(11.08) of knowledge was significant at 5% level as the paired value is 21.82(p<001). This
indicated that the structured teaching program was effective in increasing the knowledge of staff
nurses regarding their personal health habits and cardiovascular disease risk factors. Hence
research thesis was accepted.
54
SECTION 4
Association between variables and Knowledge Level of Respondents
on nurses’ personal health habits and cardiovascular disease risk factors
To establish the association between pre test knowledge score and selected demographic
variables, the following thesis was stated.
H2: There is a significant association between mean pre test score and selected demographic
variables regarding nurses’ personal health habits and cardiovascular disease risk factors
Table 6 reveals that, among the above demographic data all the variables were statistically not
significant with pre test knowledge score it thus shows there was no association between pre test
knowledge score and selected demographic variables. Hence hypothesis H2 rejected.
55
Table 6: Association between variables and Knowledge Level of Respondents
on nurses’ personal health habits and cardiovascular disease risk factors
Socio
demographic
variable
Category Frequency
Level of knowledge χ2
table
value
df
χ2
calculated
value
Inadequate Moderate
F F
Age group
(years)
20-30 2 2 0
3.84 1 0.44 NS 30-40 46 28 18
40-50 12 8 4
Sex
Male 12 10 2
3.84 1 0.05 NS
Female 48 40 8
Professional qualificatioin
Diploma 18 15 3
5.99 2 0.42 NS
Degree 42 32 10
years of
employment
1-10 years 17 14 3
3.84 1 0.18 NS more than 10
years 43 24 19
working shift
morning 50 33 17
3.84 1 0.74 NS
night 10 7 3
working unit cardio dept 43 38 5
3.84 1 0.18 NS
other dept 17 11 6
working
hrs/week
40-50 hrs 39 30 9
3.84 1 0.74 NS 50-60 hrs 8 6 2
60-70 hrs 13 10 3
NS: Not Significant
Table 6 reveals that there is no significant association between knowledge regarding
nurses’ personal health habits and cardiovascular disease risk factors. Hence we reject
hypothesis H2
56
DISCUSSION
In order to find a meaningful answer to research questions, the
collected data must be processed, analyzed in some orderly coherent fashion,
so that patterns and relationships can be discussed.
In this study, evaluative research approach was adopted to assess the
knowledge of respondents on nurses’ personal health habits and
cardiovascular disease risk factors. Data collected from 60 randomly selected
respondents were tabulated, analyzed and interpreted by using descriptive and
inferential statistics based on the formulated objectives of the study.
The discussion was presented under the following sections
Section 1: Demographic characteristics of respondents
Section 2: Aspect wise and overall knowledge level of respondents
Section 3: Association between knowledge levels with demographic variables
DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS
Regarding age the number of respondents found in the age group of
20-30 years were 2 (3.33%), majority of 46 respondents in the 31-40
years (76.67%) of age, and 12 (20%) of them are in the 41-50 years of
age.
Regarding gender 48(80%) are female staffs and only 12(20%) of the
total respondents are male staff nurses.
57
Regarding their professional qualification 42 respondents (70%) of
respondents have a degree in nursing with only 30% respondents
having a diploma in general nursing
Regarding their experience 43(71.67%) respondents are employed and
with experience of up to 10 years and work in cardio department with
17% having employed for more than 10 years in other departments.
Regarding working shifts 83.33% respondents work in day or
afternoon shift, with 16.67 % working night shifts.
Regarding hours per week 65% respondents have 40-50 hours of work
per week with 21.67% working for up to 60 hours per week and
remaining 13.33% work for up to 70 hours per week.
ASPECT WISE AND OVERALL KNOWLEDGE LEVEL OF
RESPONDENTS
The overall mean knowledge of respondents was 59.05% with SD of 12.32%.
41.6% of mean knowledge score was found in questions related to heart,
cardiovascular diseases & prevalence 41.6% related to causes, risk factors,
signs & symptoms. 16.67% related to management and prevention.
ASSOCIATION BETWEEN KNOWLEDGE LEVELS AND
DEMOGRAPHIC CHARACTERISTICS
The demographic variables analyzed in this study were age, sex, professional
qualification, years of employment, working shift, working unit and working
58
hours per week. The association between the demographic variables and
knowledge scores was computed using X2 test at 0.05% (5% level)
A non-significant association was found between knowledge level of
respondents and their age (0.44NS).
There is a non-significant association between knowledge level of
respondents and sex (0.05NS).
There is a non-significant association between knowledge level of
respondents and their professional qualification (0.42NS).
There is a non-significant association between knowledge level of
respondents and years of employment (0.18NS).
The statistical result established non-significant association between
knowledge level of respondents and working shift (0.74NS).
The statistical result again established non-significant association
between knowledge level of respondents and working units (0.18NS).
There is a non-significant association between knowledge level of
respondents and working hours per week (0. 74NS).
59
CONCLUSION
This chapter presents the conclusions drawn, implications and
recommendations. The main aim of the study was The Effectiveness of
Structured Teaching Program on knowledge regarding nurses’ personal health
habits and cardiovascular disease risk factors among staff nurses working in
selected hospitals at Bangalore.” The structured teaching program includes
information regarding cardiovascular disease risk factors. This helps the staff
nurses to gain more information about the personal health habits and risk
factors, so they can assess their risk factor for cardiovascular diseases.
The following conclusions were drawn on the basis of the findings of
the study:
1. The knowledge scores among most of staff nurses were
inadequate and moderate.
2. The structured teaching program helps them to learn more
about their risk for cardiovascular diseases.
3. The chances for less incidence of cardiovascular disease could
be anticipated.
4. The study paved the path to gain the knowledge and
information regarding cardiovascular disease risk factors staff
nurses.
60
The major finding of the study was
In this study the number of respondents found
majority of 46 respondents in the 31-40 years (76.67%) of age, 48(80%) are
female staffs and 42 respondents (70%) of respondents have a degree in
nursing and 43(71.67%) respondents are employed and with experience of up
to 10 years and work in cardio department with 83.33% respondents work in
day or afternoon shift 65% respondents have 40-50 hours of work per week
Nursing Implications
The challenges faced by the staff nurses are enormous. Besides the
clinical area she also has to extend her hands to the community level. Their
working shifts and stressful hours contribute to health problem hence she has
to be more careful about their health. This study has several implications for
nursing practice, education, administration and research.
Nursing Practice
The current concept of expanded role in nursing practice indicates
changing role and function of the nurse. Expanded practice demands
increased skill and knowledge that results in significant patient outcomes. The
concepts of nurse practitioners and nurse clinicians are becoming very popular
in the western developed countries that have prescriptive authority. Such
dramatic changes in the nursing profession that is, from being a mere
physician’s handmaiden to an independent professional capable of taking
independent decisions and professional accountability demands that nurses not
61
only administers the medications monotonously but also have a thorough
knowledge of highly skilled work in every area of care.
The nurses who are knowledgeable is competent, assertive, and prompt
in decision making, can plan better nursing and implement skill with
confidence and are better ambassadors for their specialty (Blake, 1987).
The study shows various degree of deficiency in the knowledge of staff
nurses regarding personal health habits and cardiovascular disease risk
factors and the appropriate care needs to be an ongoing process.
The study highlights the need for special attention to educate about
cardiovascular disease risk factors among staff nurses.
Continuing education helps staff nurses to be updated about the
challenges they face in care and how to overcome them.
The structured teaching program prepared in the present study is one of
the means to improve the practice through appropriate knowledge. It
acts as a guideline for the staff nurses.
Nursing Education
Nurses should effectively participate in educating staff nurses
regularly.
There should be individualized teaching and ongoing feedback on their
performance.
62
The informational guide sheet can act as a good teaching and learning
material. More emphasis should be given to periodic updating of the
information. Preparing hand outs or pamphlets with more details.
Nursing Administration
The study highlights the need for nursing administrations to use
performance appraisal, nursing audit, and guidelines and updating of
nursing standards in care of their personal health habits of staff nurses.
The nursing administrators can take part in teaching and demonstrating
it to staff nurses regarding personal health habits of staff nurses.
The nurse administrator can plan and organize training program for
staff nurses in group when feasible.
Nursing Research
This study helps the nurse researcher to develop appropriate teaching
learning tools for nursing students to use this knowledge in care of
personal health habits of staff nurses.
Nursing researcher can explore in area for different factors affecting
knowledge and skills of respondents.
There is a need to have research based evidence to prove the cost
effectiveness of educating the respondents.
63
Limitations
The limitations of the present study are:
The study was confined to a small sample selected by simple random
sampling techniques which restrict the generalizability.
The study lacked experimental testing to know the effectiveness.
Recommendations
Based on the findings of the study, it is recommended that
Same study can be replicated by including a control group.
Same study can be replicated in larger setting.
A comparative study may be done between male & female staff nurses.
Similar study can be conducted to evaluate various teaching strategies
like self instructional module, information guide sheet.
Based on the study findings the investigator has drawn many
conclusions. In this chapter the investigator dealt with the various nursing
implications of the experience of the investigator during the study and the
study findings helped to give suggestions and recommendations for further
studies.
64
SUMMARY
This chapter deals with the statement of the problem, objectives of the
study, hypothesis to meet the objectives, limitations of the study and
conceptual frame work which provides a frame of reference. The statement of
the problem selected for the study and its objectives are as follows:
Statement of the problem
“A study to assess the effectiveness of structured teaching program on
knowledge regarding nurses personal health habits and cardiovascular disease
risk factors among staff nurses working in selected hospital at Bangalore.”
Objectives of the study
1. To assess the knowledge regarding Nurses personal health habits and
cardiovascular disease risk factors among staff nurses in term of pre-test
score.
2. To assess the knowledge regarding Nurses personal health habits and
cardiovascular disease risk factors among staff nurses in term of post-test
score.
3. To assess the effectiveness of structured teaching program by comparing
pre-test and post-test level of knowledge score.
4. To determine the association between pre-test knowledge score and socio
demographic variables.
65
Hypothesis
H1 The mean post test knowledge score of Nurses personal health habits
and cardiovascular disease risk factors is significantly higher than the mean
pre test knowledge score by paired‘t’ test at 0.01 level.
H2 There is significant association between the knowledge with selected
demographic variables such as Age, Sex, Professional Qualification, year of
employment, working shift, working unit, working hours per week.
Review of literature studies enabled the investigator to collect related
and relevant information to support the study, design the methodology,
develop the conceptual framework and in the development of tool.
The conceptual framework of the present study was developed by the
investigator based on Von Bertanlanffy general system-theory The 3 phases
of the model are Input, Process and Output. The research design used was Pre
Experimental one group pre test post test study design. The research tool was
structured knowledge questionnaire to assess knowledge regarding nurses’
personal health habits and cardiovascular disease risk factors. The structured
questionnaire was constructed in two parts. Part I and Part II.
Part I: Includes 7 aspects related to the demographic variables of
respondents.
66
Part II: Includes 22 structured knowledge questions regarding
cardiovascular disease and risk factors.
The pilot study was conducted from 18-12-2017 to 25-12-2017. The
researcher selected 5 staff nurses by sampling technique. The researcher
obtained data from pre test through questionnaire method from samples. After
that structured teaching program on knowledge regarding nurses’ personal
health habits and cardiovascular risk factors was administered, after 8 days
post test was conducted. The reliability co-efficient was found to be 0.675.
Hence the tool was found to be reliable.
Purposive sampling technique was used to select the samples. The
sample consists of 60 staff nurses working at selected hospitals, Bangalore.
The data collection was done for a period of 4 weeks from 1/1/2018 to
30/1/2018. The investigator personally explained the need and assuring them
of the confidentiality of their responses.
The pre test was conducted by administration of structured knowledge
questionnaire on day 1 and post test was conducted on 8th day after the pre test
was conducted by using the same questionnaire.
The Data gathered were analyzed and interpreted according to
objectives. Descriptive statistics were mean, and standard deviation. And
inferential statistics like X2-test was used to test the association at different
levels of significance and the data obtained are presented in the graphical
form.
67
Major findings of the study were as follows:
Regarding age the number of respondents found in the age group of
20-30 years were 2 (3.33%), majority of 46 respondents in the 31-40
years (76.67%) of age, and 12 (20%) of them are in the 41-50 years of
age.
Regarding gender 48(80%) are female staffs and only 12(20%) of the
total respondents are male staff nurses.
Regarding their professional qualification 42 respondents (70%) of
respondents have a degree in nursing with only 30% respondents
having a diploma in general nursing
Regarding their experience 43(71.67%) respondents are employed and
with experience of up to 10 years and work in cardio department with
17% having employed for more than 10 years in other departments.
Regarding working shifts 83.33% respondents work in day or
afternoon shift, with 16.67 % working night shifts.
Regarding hours per week 65% respondents have 40-50 hours of work
per week with 21.67% working for up to 60 hours per week and
remaining 13.33% work for up to 70 hours per week.
Major findings related to knowledge.
The overall mean knowledge of respondents was 59.05% with SD of
12.32%.
68
41.6% of mean knowledge score was found in questions related to
heart, cardiovascular disease and its prevalence
41.6% related to causes, risk factors, signs & symptoms
16.67% related to management & prevention
Major findings related to association between demographic variables and
knowledge level of respondents
A non-significant association was found between knowledge level of
respondents and their age (0.44NS).
There is a non-significant association between knowledge level of
respondents and sex (0.05NS).
There is a non-significant association between knowledge level of
respondents and their professional qualification (0.42NS).
There is a non-significant association between knowledge level of
respondents and years of employment (0.18NS).
The statistical result established non-significant association between
knowledge level of respondents and working shift (0.74NS).
The statistical result again established non-significant association
between knowledge level of respondents and working units (0.18NS).
There is a non-significant association between knowledge level of
respondents and working hours per week (0. 74NS).
69
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ANNEXURE - 6
Letter Seeking Consent of the Subjects for Participation in the Study
Dear Participant,
I am a student of post graduate nursing program at the Sri Shanthini College of Nursing.
As a part of this program I am doing a research study on “A study to assess the
effectiveness of structured teaching program on knowledge regarding nurses’
personal health habits and cardiovascular disease risk factors among staff nurses
working in selected hospital at Bangalore.”I would like to ask you to co-operate with
researcher in providing necessary information. I was explained information provided will
be used for only research purpose and will be kept confidential. The successful
completion of the study largely depends on your active cooperation and participation.
Thanking you, Yours Sincerely
(Mr. Rafeek A C)
Consent Form
I here with, consent for the above said study knowing that all the information provided by
me will be treated with utmost confidential by the investigator.
Date:
Place: Signature
CERTIFICATE OF ETHICAL CLEARANCE
This is to certify that, MR. RAFEEK C A II year M.sc (N) student in Obstetric &
Gynecological Nursing. Conducting the dissertation entitled “A STUDY TO ASSESS THE
EFFECTIVENESS OF STRUCTURED TEACHING PROGRAM ON KNOWLEDGE
REGARDING NURSES PERSONAL HEALTH HABITS AND CARDIOVASCULAR
DISEASE RISK FACTORS AMONG STAFF NURSES WORKING IN SELECTED
HOSPITAL AT BANGALORE.” Has been subjected to our ethical approval of our college.
The study carries minimal risk and may be permitted to conduct study.
Ethical committee chairperson/principal
90
90
LESSON PLAN ON
NURSES’ PERSONAL HEALTH HABITS AND CARDIOVASCULAR DISEASE RISK FACTORS
MR. RAFEEK AC
II Yr M.Sc (N)
Sri Shantini College of Nursing
91
91
STRUCTURED TEACHING PROGRAMME
Name of the teacher : Mr. Rafeek A C
Topic : Nurses’ personal health habits and cardiovascular disease risk factors
Group : Staff Nurses
Date : 01-1-2018 and 30-1-2018
Venue : Hospital
Duration : 1 Hour
Method of Teaching : Lecture cum Demonstration
Teaching Aids : LCD, Chalk Board, Flash Cards, Leaflets, Black board
92
92
General objectives:
At the end of the teaching session, the samples will be able to acquire knowledge regarding nurses’ personal health habits and
cardiovascular disease risk factors.
Specific objectives:
At the end of the teaching programme samples will gain knowledge about their personal health habits and risk for cardiovascular diseases.
1. Define circulatory system
2. Enumerate the function of the cardiovascular system?
3. Define cardiovascular disease
4. Enumerate the causes of cardiovascular diseases
5. List the risk factors of cardiovascular diseases
6. Enumerate the personal health habits causing CVD
7. Enumerate the symptoms of CVD
8. Explain the types of cardiovascular diseases
9. Explain the management of cardiovascular diseases
10. Enumerate how to prevent cardiovascular diseases
93
93
Time Specific
Objectives
Content Teachers activity Learners
activity
A V Aids Evaluation
3
min
Introduces the
topic
Cardiovascular
disease (CVD) is defined
as any serious, abnormal
condition of the heart or
blood vessels(arteries,
veins). Cardiovascular
disease includes coronary
heart disease (CHD),
stroke, peripheral
vascular disease,
congenital heart disease,
endocarditis, and many
other conditions.
Listens to
the lecture
2
min
Define
circulatory
system
The circulatory system, also called the cardiovascular
system or the vascular system, is an organ system that
permits blood to circulate and transport nutrients (such
Defines circulatory system
Notes
down
points
LCD
Define
circulatory
system
94
94
as amino acids and electrolytes), oxygen, carbon
dioxide, hormones, and blood cells to and from
the cells in the body to provide nourishment and help
in fighting diseases, stabilize temperature and pH, and
maintain homeostasis
2
min
Enumerate the
function of the
cardiovascular
system
The cardiovascular system consists of the
heart, blood vessels, and blood. This system has three
main functions: Transport of nutrients, oxygen, and
hormones to cells throughout the body and removal of
metabolic wastes (carbon dioxide, nitrogenous
wastes).
Enumerates the functions
of cardiovascular system
Notes
down
points
LCD
Black
board
what is the
main
function of
cardiovascu
lar system?
2
mins
Define
cardiovascular
disease
Cardiovascular disease (CVD) is a class of
diseases that involve the heart or blood vessels.
Cardiovascular Disease (CVD) is the most common
cause of death in the UK and includes coronary heart
disease (angina/heart attack), stroke (where normal
blood supply to part of the brain is cut off, damaging
the area affected); mini stroke (known as transient
Defines cardiovascular
disease
Points
down
lecture
notes
LCD
Flash
cards
what are
cardiovascu
lar
diseases?
95
95
ischaemic attack or TIA) and peripheral arterial
disease (narrowing of arteries usually in the legs).
Many of these diseases are called "lifestyle diseases"
because they develop over time and are related to a
person's exercise habits, diet, whether they smoke, and
other lifestyle choices a person makes.
3
mins
Enumerate the
causes of
cardiovascular
diseases
Important causes of cardiovascular
disease include atherosclerosis, when fatty deposits
accumulate in the arteries.
Damage to the circulatory system can also result from
diabetes and as the result of other health conditions,
such as a virus, an infection, or a structural problem
that the person was born with.
It often involves high blood pressure, but this can be
both a cause and a result of cardiovascular disease.
Enumerates the causes of
cardiovascular diseases
Points
down
lecture
notes
LCD
Flash
cards
List any 2
causes of
cardiovascu
lar disease
5
mins
List the risk
factors of
cardiovascular
Non modifiable and modifiable risk factors can
increase the probability of developing CVD.
“Non modifiable” risk factors cannot be changed.
Lists the risk factors of
cardiovascular diseases
Observes
and
understan
LCD
Black
Board
List a few
risk factors
that
96
96
diseases
These are:
your age – risk increases as you get older,
your gender – before the age of 60 men are at
greater risk than women,
your family history – your risk may increase if
close blood relatives experienced early heart
disease.
But there are other modifiable risk factors that you can
change:
Raised or altered levels of blood cholesterol
Raised triglycerides with low HDL-cholesterol
High blood pressure
Diabetes
Smoking
Being overweight/obesity
Being inactive
Excessive alcohol
Excessive stress
Having more than one risk factor means the
overall risk of CVD is much higher. Your GP can
increases
risk of
CVD
97
97
work out what your 10 year risk is of developing CVD
using a risk assessment tool known as QRISK2 which
takes into account your modifiable and non modifiable
risk factors.
2
mins
Enumerate the
personal health
habits causing
CVD
Your lifestyle choices can increase your risk for
heart disease and heart attack. To reduce your risk,
your doctor may recommend changes to your lifestyle.
The good news is that healthy behaviors can lower
your risk for heart disease.
Unhealthy Diet: Diets high in saturated fats,
trans fat, and cholesterol have been linked to
heart disease and related conditions, such as
atherosclerosis. Also, too much salt (sodium)
in the diet can raise blood pressure levels.
Physical Inactivity: Not getting enough
physical activity can lead to heart disease. It
also can increase the chances of having other
medical conditions that are risk factors,
including obesity, high blood pressure, high
Enumerates the personal
health habits that may lead
to CVD
Listens to
the lecture
and points
notes
LCD
Flash
cards
What are
your
personal
health
habits?
98
98
cholesterol, and diabetes. Regular physical
activity can lower your risk for heart disease.
Obesity: Obesity is excess body fat. Obesity is
linked to higher “bad” cholesterol and
triglyceride levels and to lower “good”
cholesterol levels. In addition to heart disease,
obesity can also lead to high blood pressure
and diabetes. Talk to your health care team
about a plan to reduce your weight to a healthy
level.
Too Much Alcohol: Drinking too much
alcohol can raise blood pressure levels and the
risk for heart disease. It also increases levels of
triglycerides, a form of cholesterol, which can
harden your arteries.
Women should have no more than 1
drink a day.
Men should have no more than 2 drinks
a day.
Tobacco Use: Tobacco use increases the risk
99
99
for heart disease and heart attack. Cigarette
smoking can damage the heart and blood
vessels, which increases your risk for heart
conditions such as atherosclerosis and heart
attack. Also, nicotine raises blood pressure,
and carbon monoxide reduces the amount of
oxygen that your blood can carry. Exposure to
other people’s secondhand smoke can increase
the risk for heart disease even for nonsmokers.
2
mins
Enumerate the
symptoms of
CVD
There are many different types of
cardiovascular disease. Symptoms will vary,
depending on the specific type of disease a patient has.
However, typical symptoms of an underlying
cardiovascular issue include:
pains or pressure in the chest, which may
indicate angina
pain or discomfort in the arms, the left
shoulder, elbows, jaw, or back
Enumerates the symptoms
of cardiovascular disease
Listens to
lecture
and takes
notes
LCD
Black
board
Flash
cards
How can
you identify
if a person
suffers
cardiovascu
lar disease?
100
100
shortness of breath, also known as dyspnea
nausea and fatigue
light-headed or faint
cold sweat
Overall, symptoms vary and are specific to the
condition and the individual, but these are most
common.
5
mins
Explain the
types of
cardiovascular
diseases
Cardiac, or heart-related, diseases and conditions
include:
angina, considered both a cardiac and vascular
disease
arrhythmia, where there is an irregular
heartbeat or heart rhythm
congenital heart disease, when a problem with
heart function or structure is present from birth
coronary artery disease (CAD), which affects
the arteries that feed the heart muscle
dilated cardiomyopathy
heart attack
Explains types of
cardiovascular diseases
Listens to
lecture
and takes
notes
LCD
Flash
cards
Mention a
few
cardiovascu
lar diseases
101
101
heart failure, when the heart does not work
properly
hypertrophic cardiomyopathy
mitral regurgitation
mitral valve prolapse
pulmonary stenosis
rheumatic heart disease, which can be a
complication of strep throat
Vascular diseases are diseases that affect the blood
vessels: the arteries, veins, or capillaries.They include:
peripheral artery (arterial) disease
aneurysm
atherosclerosis
renal artery disease
Raynaud's disease (Raynaud's phenomenon)
Buerger's disease
peripheral venous disease
stroke, a type of cerebrovascular disease
venous blood clots
blood clotting disorders
102
102
5
mins
Explain the
management
of
cardiovascular
diseases
Treatment will depend on the type of condition
the person has. Options include:
lifestyle adaptations, such as weight control,
exercise, quitting smoking, and dietary
changes
medication, for example, to reduce
LDL cholesterol
surgery, such as coronary artery bypass
grafting (CABG)
cardiac rehabilitation, including exercise and
counseling
Treatment aims to:
relieve symptoms
reduce the risk of the condition recurring or
worsening
prevent complications
Depending on the condition, it may also aim to
stabilize heart rhythms, reduce blockages, and widen
the arteries to enable a better flow of blood.
Explains the management
of CVD
Listens to
lecture
and takes
notes
LCD
Black
Board
What are
the
treatment
options for
CVD
103
103
10
mins
Enumerate
how to prevent
cardiovascular
diseases
It is estimated that 90% of CVD is
preventable.[5] Prevention of atherosclerosis involves
improving risk factors through: healthy eating,
exercise, avoidance of tobacco smoke and limiting
alcohol intake.[2] Treating risk factors, such as high
blood pressure, blood lipids and diabetes is also
beneficial.
Currently practiced measures to prevent
cardiovascular disease include:
Tobacco cessation and avoidance of second-
hand smoke.[77] Smoking cessation reduces
risk by about 35%.[78]
A low-fat, low-sugar, high-fiber diet including
whole grains and fruit and
vegetables.[77][79][80] Dietary interventions are
effective in reducing cardiovascular risk
factors over a year, but the longer term effects
of such interventions and their impact on
cardiovascular disease events is uncertain.[81]
Enumerates preventive
measures of cardiovascular
diseases
Listens to
lecture
LCD
Pamplets
Mention a
few
preventive
measures
104
104
At least 150 minutes (2 hours and 30 minutes)
of moderate exercise per week.[82][83] Exercise-
based cardiac rehabilitation reduces risk of
subsequent cardiovascular events by
26%,[84] but there have been few high quality
studies of the benefits of exercise training in
people with increased cardiovascular risk but
no history of cardiovascular disease.[85]
Limit alcohol consumption to the
recommended daily limits;[77] People who
moderately consume alcoholic drinks have a
25–30% lower risk of cardiovascular
disease.[86][87] However, people who are
genetically predisposed to consume less
alcohol have lower rates of cardiovascular
disease[88] suggesting that alcohol itself may
not be protective. Excessive alcohol intake
increases the risk of cardiovascular
disease[89][87] and consumption of alcohol is
associated with increased risk of a
105
105
cardiovascular event in the day following
consumption.[87]
Lower blood pressure, if elevated. A 10 mmHg
reduction in blood pressure reduces risk by
about 20%.[90]
Decrease non-HDL
cholesterol.[91][92] Statin treament reduces
cardiovascular mortality by about 31%.[93]
Decrease body fat if overweight or
obese.[94] The effect of weight loss is often
difficult to distinguish from dietary change,
and evidence on weight reducing diets is
limited.[95] In observational studies of people
with severe obesity, weight loss following
bariatric surgery is associated with a 46%
reduction in cardiovascular risk.[96]
Decrease psychosocial stress.[97] This measure
may be complicated by imprecise definitions
of what constitute psychosocial intervention.
Nurses are the health
106
106
2
mins
Conclusion providers in a society. The
best provider is someone
who sincerely believes in
their own health. Nurses
must understand that their
health performance has a
profound impact on the
receivers of healthcare.
Nurses must have
programs available to help
them, if necessary, to
change their risky behavior
habits. ] By controlling
these 9 factors, up to 90%
of the incidence of heart
attacks could be prevented.
20-30 30-40 40-50 MALE FEMALE DEPLOMA DEGREE 1-10YRS
1 √ √ √2 √ √ √ √3 √ √ √4 √ √ √5 √ √ √ √6 √ √7 √ √ √ √8 √ √ √9 √ √10 √ √ √ √11 √ √12 √ √ √13 √ √ √14 √ √ √ √15 √ √ √16 √ √ √ √17 √ √ √18 √ √ √19 √ √ √20 √ √ √ √21 √ √ √22 √ √ √ √23 √ √24 √ √ √25 √ √ √26 √ √ √27 √ √ √ √28 √ √29 √ √ √ √30 √ √ √31 √ √ √ √32 √ √ √ √33 √ √ √34 √ √ √35 √ √ √36 √ √ √ √37 √ √ √38 √ √ √39 √ √ √40 √ √ √41 √ √ √42 √ √ √43 √ √ √44 √ √ √45 √ √ √46 √ √47 √ √ √
SECTION A : DEMOGRAPHIC VARIABLESMASTER DATA SHEET
ANNEXURE XI
SEX PROFESSIONAL QUALIFICATIONAGE YEARS OF
EMPLOYMENT
48 √ √ √49 √ √50 √ √ √51 √ √ √52 √ √53 √ √ √54 √ √ √55 √ √ √56 √ √ √57 √ √58 √ √ √59 √ √ √60 √ √ √
SAMPLE NO Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8
1 1 0 0 0 0 0 0 02 0 0 0 0 0 0 1 03 1 0 0 0 1 0 0 04 0 0 0 1 0 0 0 05 0 0 1 0 0 0 1 06 1 0 0 0 0 0 0 07 0 0 0 0 0 0 1 08 1 0 0 0 0 0 0 09 1 0 0 0 0 0 1 010 1 0 0 0 0 0 0 011 1 0 0 0 0 0 0 012 0 0 0 0 0 1 0 013 0 0 0 0 0 1 0 014 1 0 0 0 0 0 1 015 0 1 0 0 0 1 0 016 1 0 0 0 1 0 0 017 0 1 0 0 0 1 0 018 0 1 0 0 0 1 0 019 0 1 0 0 1 0 0 120 0 0 1 0 0 0 1 021 1 0 1 0 0 1 0 022 1 0 0 0 0 0 0 023 1 0 0 0 0 0 0 024 1 0 0 0 0 0 1 025 0 0 1 0 0 0 0 026 0 1 0 0 0 1 0 027 1 0 0 0 0 0 0 028 1 0 0 0 1 0 0 129 0 1 0 1 0 0 1 030 1 0 0 0 0 0 0 131 0 1 0 0 0 1 0 032 1 0 0 0 1 0 0 033 0 1 0 0 0 1 0 034 0 1 0 0 0 1 0 035 0 1 0 0 1 0 0 1
STRUCTURED KNOWLEDGE QUESTIONNAIRE
36 0 0 1 0 0 0 1 037 1 0 1 0 0 1 0 038 1 0 0 0 0 0 0 039 1 0 0 0 0 0 0 040 1 0 0 0 0 0 1 041 0 0 1 0 0 0 0 042 0 1 0 0 0 1 0 043 1 0 0 0 0 0 0 044 1 0 0 0 1 0 0 145 0 1 0 1 0 0 1 046 1 0 0 0 0 0 0 147 1 0 0 0 0 0 0 048 0 0 0 0 0 0 1 049 1 0 0 0 1 0 0 050 0 0 0 1 0 0 0 051 0 0 1 0 0 0 1 052 1 0 0 0 0 0 0 053 0 0 0 0 0 0 1 054 1 0 0 0 0 0 0 055 1 0 0 0 0 0 1 056 1 0 0 0 0 0 0 057 1 0 0 0 0 0 0 058 0 0 0 0 0 1 0 059 0 0 0 0 0 1 0 060 1 0 0 0 0 0 1 0
>10 YRS MORNING NIGHT CARDIO OTHERS 40-50 50-60 60-70
√ √ √√ √ √
√ √ √ √√ √ √ √
√ √ √√ √ √ √
√ √ √√ √ √ √√ √ √ √
√ √ √√ √ √ √√ √ √ √√ √ √ √
√ √ √√ √ √ √
√ √ √√ √ √ √√ √ √ √√ √ √ √
√ √ √√ √ √ √
√ √ √√ √ √ √√ √ √ √√ √ √ √√ √ √ √
√ √ √√ √ √ √
√ √ √√ √ √ √
√ √ √√ √ √
√ √ √ √√ √ √
√ √ √ √√ √ √
√ √ √ √√ √ √ √ √√ √ √ √√ √ √ √√ √ √ √√ √ √ √√ √ √ √√ √ √ √√ √ √ √√ √ √ √√ √ √ √
WORKING HRS/WEEK
SECTION A : DEMOGRAPHIC VARIABLESMASTER DATA SHEET
WORKING UNITYEARS OF EMPLOYMENT WORKING SHIFT
√ √ √ √√ √ √ √√ √ √ √√ √ √ √√ √ √ √√ √ √ √√ √ √ √
√ √ √√ √ √ √√ √ √ √√ √ √ √√ √ √ √√ √ √ √
Q9 Q10 Q11 Q12 Q13 Q16 Q17 Q18 Q19 Q20
0 0 1 0 0 0 0 1 0 10 1 0 0 1 0 0 0 1 11 0 0 0 0 0 0 1 1 11 0 0 0 0 1 1 1 1 10 0 1 0 0 0 0 1 0 00 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 00 1 0 0 1 0 1 0 1 00 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 0 0 00 0 0 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 00 1 0 0 0 0 1 0 0 10 0 0 0 0 0 1 0 0 00 0 0 1 0 1 0 0 1 00 0 0 0 0 0 0 1 0 00 0 0 0 1 0 0 0 0 10 1 0 0 0 0 0 0 1 00 0 1 0 0 0 0 1 0 00 0 1 0 1 1 0 0 1 01 0 0 0 0 0 0 1 0 01 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 00 0 1 0 0 0 0 1 0 00 1 0 0 0 0 0 0 0 00 0 1 0 0 0 1 0 0 00 0 1 0 0 0 0 0 0 00 0 0 1 0 0 0 1 0 00 1 0 1 0 0 1 0 1 00 0 0 0 0 1 0 0 0 10 0 0 1 0 1 0 0 1 00 0 0 0 0 0 0 1 0 00 0 0 0 1 0 0 0 0 10 1 0 0 0 0 0 0 1 00 0 1 0 0 0 0 1 0 0
STRUCTURED KNOWLEDGE QUESTIONNAIRE
0 0 1 0 1 1 0 0 1 01 0 0 0 0 0 0 1 0 01 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 00 0 1 0 0 0 0 1 0 00 1 0 0 0 0 0 0 0 00 0 1 0 0 0 1 0 0 00 0 1 0 0 0 0 0 0 00 0 0 1 0 0 0 1 0 00 1 0 1 0 0 1 0 1 00 0 0 0 0 1 0 0 0 10 0 1 0 0 0 0 1 0 10 1 0 0 1 0 0 0 1 11 0 0 0 0 0 0 1 1 11 0 0 0 0 1 1 1 1 10 0 1 0 0 0 0 1 0 00 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 00 1 0 0 1 0 1 0 1 00 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 0 0 00 0 0 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 00 1 0 0 0 0 1 0 0 10 0 0 0 0 0 1 0 0 0
Q21 Q22 Total
0 1 51 1 71 1 91 1 101 0 60 0 20 0 31 0 60 0 30 1 31 0 21 0 30 0 50 0 30 1 60 0 30 0 40 0 51 0 70 1 71 0 70 0 20 0 20 1 61 0 40 0 40 1 31 0 70 1 80 1 50 1 60 0 30 0 40 0 51 0 7
0 1 71 0 70 0 20 0 20 1 61 0 40 0 40 1 31 0 70 1 80 1 50 1 51 1 71 1 91 1 101 0 60 0 20 0 31 0 60 0 30 1 31 0 21 0 30 0 50 0 3
73
ANNEXURE – 1
LETTER SEEKING PERMISSION TO CONDUCT MAJOR STUDY
To,
Respected Sir/Madam,
Sub: Requisition for permission to conduct the dissertation at your college-REG
Mr. Rafeek A C is a finial year student of M.Sc (Nursing) course at Sri Shanthini
College of Nursing, Bangalore. He has selected the following topic for his research
project to submit to Rajiv Gandhi University of Health Sciences, Bangalore in partial
fulfillment of university requirement for the award of Master of Nursing degree.
Topic : “A study to assess the effectiveness of structured teaching program on
knowledge regarding nurses personal health habits and cardiovascular
disease risk factors among staff nurses working in selected hospital at
Bangalore.”
Mr. Rafeek A C is in need of your permission and your esteemed help, as he is intend
to conduct the study for the staff nurses at your hospital.
I am herewith to request you to kindly grant permission and inform the concerned
person to extend necessary facility for him at your area to enable work on proposed study.
Thanking you,
Yours faithfully,
PRINCIPAL
74
ANNEXURE - 2
LETTER SEEKING EXPERT’S OPINION FOR THE CONTENT
VALIDITY OF THE TOOL AND THE STRUCTURED TEACHING
PROGRAM.
From,
Mr. Rafeek A C
II year M.Sc. Nursing,
Sri Shanthini College of Nursing,
Bangalore
To,
_____________________
_____________________
Forwarded through:
The Principal,
Sri Shanthini College of Nursing,
Bangalore
Respected Sir/Madam,
Sub: Requisition for expert opinion on content validity of the research tool.
I Mr. Rafeek A C, student of II year M.Sc Nursing in the above
mentioned institution. As a part of partial fulfillment of M.Sc. Nursing program
(Medical Surgical Nursing), I have selected the below mentioned topic for the
dissertation to be submitted to Rajiv Gandhi University of Health Sciences,
Bangalore.
Topic: “A study to assess the effectiveness of structured teaching program on
knowledge regarding nurses’ personal health habits and cardiovascular disease
risk factors among staff nurses working in selected hospital at Bangalore.”
Objectives of the study:
1. To assess the knowledge regarding Nurses personal health habits and
cardiovascular disease risk factors among staff nurses in term of pre-test score.
75
2. To assess the knowledge regarding Nurses personal health habits and
cardiovascular disease risk factors among staff nurses in term of post-test
score.
3. To assess the effectiveness of structured teaching program by comparing pre-
test and post-test level of knowledge score.
4. To determine the association between pre-test knowledge score and socio
demographic variables.
I request you to kindly go through the content and give your expert opinion and
valuable suggestions in the columns given and mark () if you agree. Your expert
opinion and kind co-operation will be highly appreciated and thankfully accepted.
Thanking you,
Place: Yours faithfully,
Date: (Mr. Rafeek A C)
Enclosures:
Structured questionnaire.
Structured Teaching Program
Evaluation criteria checklist for content validity of tool.
Content validity certificate.
Blue print with key answers
Signature of the Principal
Place:
76
ANNEXURE - 3
Evaluation criteria checklist for the validation of tool and
Structured Teaching Program
Respected Sir/ Madam,
I request you to examine the research tool and give your
valuable opinion and suggestions on the developed structured knowledge
questionnaire. There are four responses. Please tick () mark in the appropriate
column and give your remarks in the columns.
Interpretation of columns:
1. Column 1. Completely meets the criteria,
2. Column 2. Partially meets the criteria,
3. Column 3. Does not meet the criteria.
4. Remarks
Your valuable opinion and kind cooperation will be highly appreciated.
Thanking you in anticipation,
Sl.
No
.
Evaluation Criteria
1
2
3
Remarks
I.
II.
Section – 1. Demographic Data
The items on demographic information
over all aspects necessary for the study
Section – 2. Structured Questionnaire
to Assess the Knowledge regarding
nurses’ personal health habits and
cardiovascular disease risk factors
(1) Relevant to the topic of the study
(2) Content organization
(3) Language is simple and easy to
understand.
(4) Clarity of items used.
(5) Any other suggestion.
77
III
Section – 3. Structured Teaching
Program regarding nurses’ personal
health habits and cardiovascular
disease risk factors
(1) Relevant to the topic of the study
(2) Content organization
(3) Language is simple and easy to
understand.
(4) Clarity of items used.
(5) Any other suggestion.
Date:
Place: Signature of the Evaluator
78
ANNEXURE - 4
CONTENT VALIDITY CERTIFICATE
This is to certify that the tool and STP developed by Mr. Rafeek A C, II year
M.Sc. Nursing student of Sri Shanthini College of Nursing, Bangalore (Affiliated to
Rajiv Gandhi University of Health Sciences) is validated by undersigned and can
proceed to conduct the main study for dissertation entitled “A STUDY TO ASSESS
THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAM ON
KNOWLEDGE REGARDING NURSES PERSONAL HEALTH HABITS AND
CARDIOVASCULAR DISEASE RISK FACTORS AMONG STAFF NURSES
WORKING IN SELECTED HOSPITAL AT BANGALORE.”
(Signature of the Validator with Designation)
Place:
Date:
79
ANNEXURE – 5
LIST OF EXPERTS FOR CONTENT VALIDITY
1. Mrs. Sumathi
Asst Professor
Prajwal College of Nursing,
Bangalore.
2. Mrs. Manjunath
Asst. Professor,
Kempegowda Institute of Nursing,
Bangalore.
3. Mrs. Blessy
Assistant Professor,
Dr. B.R. Ambedkar Institute of Nursing
Bangalore.
4. Mrs. Bhagya
Asso. Professor,
Rajiv Gandhi Chest Institute of Chest Disease,
Bangalore.
5. Mrs Manju
Asst. Professor,
Srilakshmi College of Nursing
Bangalore.
7. Mr. Melbin Michael
Asst. Professor,
Shantidhama College of Nursing
Mysore
80
8. Dr. Rudrappa Mudgal
Cardiologist, Panacea Hospital.
Bangalore
9. Mr. Rajesh
MA Literature,
Bangalore.
81
ANNEXURE - 6
Letter Seeking Consent of the Subjects for Participation in the Study
Dear Participant,
I am a student of post graduate nursing program at the Sri Shanthini College of
Nursing. As a part of this program I am doing a research study on “A study to
assess the effectiveness of structured teaching program on knowledge
regarding nurses’ personal health habits and cardiovascular disease risk
factors among staff nurses working in selected hospital at Bangalore.”I
would like to ask you to co-operate with researcher in providing necessary
information. I was explained information provided will be used for only
research purpose and will be kept confidential. The successful completion of
the study largely depends on your active cooperation and participation.
Thanking you, Yours Sincerely
(Mr. Rafeek A C)
Consent Form
I here with, consent for the above said study knowing that all the information
provided by me will be treated with utmost confidential by the investigator.
Date:
Place: Signature
82
ANNEXURE - 7
Instructions to the participants
There are two parts in the questionnaire. Part I consists of
demographic variables and Part II consists of structured knowledge
questionnaire. Kindly tick ( √ ) the answers which you find appropriate
from the options given. The data collected will be used only for research
purpose and information provided will be kept confidential.
PART I – DEMOGRAPHIC VARIABLES
1. CODE : ------------------------------
2. Age : 20-30
30-40
40-50
3. Sex : Male // Female
4. Professional
qualification : Diploma // Degree
5. Years of employ : 1-10 years // > 10 years
6. Working shift : Morning // Night
7. Working unit : Cardio // Others
8. Working hrs/week : 40-50 hrs
50-60 hrs
60-70 hrs
83
PART II: STRUCTURED QUESTIONNAIRE FOR STAFF NURSES’
REGARDING PERSONAL HEALTH HABITS AND CARDIOVASCULAR
DISEASES RISK FACTORS
1. A h?ollow muscular organ that helps in maintaining nutrition in body is?
A heart
B stomach
C lungs
2. Main function of cardiovascular system is?
A nutrition
B protection
C transportation
3. Diseases that involve heart or blood vessels is termed..........?
A cardiac arrest
B cardiovascular disease
C diseases of cardiovascular system
4. The other name for cardiovascular disease is?
A Health habit diseases
B Habit diseases
C Lifestyle diseases
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5. Atherosclerosis is...................
A fatty deposits in the blood vessels
B fatty deposits on the heart muscle
C fatty deposits on the blood vessels
6. Causes of atherosclerosis?
A Hypertension
B Arthritis
C Both
7. Modifiable & Non modifiable are 2 types of ..............
A causes
B health habits
C risk factors
8. ...............&............. are also considered non modifiable risk factors for CVD
A hypertension & DM
B age & gender
C both
9. More then ............. risk factors raises your overall risk of CVD
A 4
B 3
C 2
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10. Risk for CVD in next 10 years is calculated using...................
A CVD risk score
B Framingham risk score
C risk assessment scale
11. 2 personal habits that raise risk of CVD
A Unhealthy diet & physical inactivity
B Alcohol & Tobacco
C both
12. .................is a type of cardiovascular disease
A coronary artery disease
B cardiomyopathy
C both
13. Dialation of blood vessels occur in............
A aneurysm
B stroke
C cardiomyopathy
14. Treatment for atherosclerosis is.............
A medications
B CABG
C none of the above
15. Cardiac rehabilitation includes..............
A excercise
B councelling
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C both
16. Prevention of ............... reduces risk for CVD?
A hypertension
B atherosclerosis
C alcohol
17. Smoking & Tobacco cessation reduces risk by ............%
A 25%
B 35%
C 50%
18. .................minutes of exercise per week reduces 26% of CVD risk
A 300
B 250
C 150
19. Statin treatment is for ...............
A reducing non HDL cholesterols
B reducing obesity
C reducing arteriosclerosis
20. Reducing alcohol consumtion reduces risk by ..........%
A 31%
B 37%
C 41%
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21. Which type of cholesterol is good for health
A triglycerides
B LDL
C HDL
22. Best way to reduce risk for CVD is...........
A medical treatment
B prevention
C surgical treatment
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ANNEXURE - 8
BLUE PRINT OF STRUCTURED QUESTIONNAIRES
Area No of
Items
Total Percentage
(%)
Heart, Cardiovascular diseases &
prevalence
1-10 10 45.45
causes, risk factors, signs & symptoms 11-17 7 31.81
management & prevention 18-22 5 22.72
Total 22 22 100
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ANNEXURE - 9
ANSWER KEY FOR STRUCTURED QUESTIONNAIRE REGARDING
NURSES’ PERSONAL HEALTH HABITS AND CARDIOVASCULAR
DISEASE RISK FACTORS
Knowledge score
Q.no Ans Q.no Ans
1 A 16 B
2 C 17 B
3 B 18 C
4 C 19 A
5 A 20 A
6 A 21 C
7 C 22 B
8 B
9 C
10 B
11 C
12 C
13 A
14 B
15 C