RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. NAME OF THE

CANDIDATE AND

ADDRESS

MS. LIKHILA ABRAHAM

1 YEAR M.SC. NURSING

ZULEKHA NURSING COLLEGE

ZULEKHA COMPLEX

BIBI ALABI ROAD

MANGALORE – 575 001

2. NAME OF THE

INSTITUTION

ZULEKHA NURSING COLLEGE

ZULEKHA COMPLEX

BIBI ALABI ROAD

MANGALORE – 575 001

3. COURSE OF STUDY AND

SUBJECT

M.SC. NURSING I YEAR

MEDICAL SURGICAL NURSING

4. DATE OF ADMISSION TO

COURSE

16TH JULY 2013

5. TITILE OF THE TOPIC“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME REGARDING KNOWLEDGE ON

VARICOSE VEIN AND PRACTICE OF BUERGER ALLEN EXERCISE

IN IMPROVING PERIHERAL PERFUSION AMONG WORKERS IN

THE TILE FACTORY AT MANGALORE”

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6 BRIEF RESUME OF THE STUDY

6.1 NEED FOR STUDY “The ground work of all happiness is good health” (LEIGH HUNT)

Blood is a bodily fluid in humans and animals that delivers

necessary substances such as nutrients and oxygen to the cells and

transports metabolic waste products away from the cells. Blood vessels are

intricate networks of hollow tubes that transport blood throughout the body.

Blood is circulated through the body via cardiovascular system. The

cardiovascular system is comprised of the heart and the circulatory system.

Blood vessels carry blood from the heart to all areas of the body. The blood

travels from the heart via arteries to smaller arterioles, then to capillaries or

sinusoids, then to venules, to the veins, and back to the heart.

Microcirculation deals with the flow of blood from arterioles to capillaries

or sinusoids to venules. As the blood moves through the capillaries,

substances such as oxygen, carbon dioxide, nutrients and wastes are

exchanged between the blood and the fluid that surrounds the cells. (1)

Varicose veins are permanently distended veins that develop from

the loss of valvular competence. Faulty valves elevate venous pressure

causing distention and tortuosity of the superficial veins. The greater and

lesser saphenous veins and perforator veins in the ankle are common sites of

Varicosities.(2)

In India Up to 25% of women and 18% of men  suffer from varicose

veins .If both parents have varicose veins, next generation chances to

develop the disease are close to 90%, daughters have, 60%chance

while sons have  25%  chance of developing the disease.60% of

leg ulcers are due to varicose veins left untreated, nearly 50% of patients

will eventually experience chronic venous insufficiency. Almost 90% of

venous blood in the leg is pumped through the deep veins by doing leg

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exercise.  Therefore, exercise significantly helps 12% of patients to improve

the quality of living and to prevent complications.(3)

Exercise is the fundamental principle for preventing peripheral

vascular disorders, varicose veins occur in the legs, quite painful and

unattractive. Moderate exercise increases blood circulation, which can

decrease the pain and appearance of varicose veins. It can also slow or

prevent the development of new varicose vein, found that buerger allen

exercises are effective among varicose vein patients. Exercise training helps

the varicose vein patients in potential mechanisms like formation of

collateral circulation and increased blood flow, Exercises used to empty

engorged vessels, stimulate circulation, and at least partially relieve

swelling (oedema) in patients with arterial insufficiency of the lower limbs

and feet. (4)

An epidemiological study conducted to find out the high risk

occupations(teachers, traffic police, factory workers etc) for varicose vein

development among people who spend most of their working day in a

standing or sedentary position at Harley street vein clinic. The study results

showed 87%people who spend their working hours more than 9 hours in a

standing sitting position have primary symptoms of varicose vein. People

who spend most of their working day in a standing or sedentary position (eg

police officers, teachers, sales assistance, tile factory workers) are

considered to be at a high risk for varicose vein development. The study

reported incidence of varicose veins in adults varies from 7% to 40% men

and from 14 % to 51 % in women. The study concluded that if the

condition can’t be prevented or treated in a timely manner varicose vein can

lead to more serious morbidities and medical complications .(5)

A cross sectional study was done to assess the prevalence of

varicose veins, risk factors and the complications of varicose veins among

100 school teachers in Thiruvananthapuram. The study results showed the

prevalence of varicose vein was 19% among the school teachers. Among

those affected with varicose veins, 89.5% had history of standing for long

duration and 26.3% had complications from varicose vein .Thus conclusion

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was made that standing for long hours was a major risk factor as compared

to other known risk factors. Health Education and cutting down of working

hours maybe recommended to bring down the prevalence of Varicose

veins. (6)

More commonly (waitresses, hair dressers, nurses, factory

workers, teachers) who does the job in a Standing or sitting for a prolonged

periods of time have an increased risk of developing varicose vein .varicose

vein need to treated primarily by primary prevention has better prognosis.

Exercise is the primary treatment measure to reduce the risk of getting

varicose vein in long standing occupations. Approximately 15 to 40 %of

people with peripheral vascular disease having decreased ability to perform

activities of daily living(7)

Though there is high prevalence rate (40%) of varicose vein in

India, very few studies have been conducted in India. Researcher personally

observed during clinical experience many factory workers admitted to the

hospital with occurrence of varicose veins The investigator found that the

factory workers not having adequate knowledge regarding disease condition

and its preventive measures, thus the investigator felt the need to educate the

workers to prevent varicose vein from the primary stage so that

complications can be prevented.

6.2 REVIEW OF LITERATURE

Review of literature is the reading and organizing of previously written

materials relevant to specific problem to be investigated frame work and

methods appropriate to perform the study.

The literature has been organized under following headings,

Studies related to varicose vein

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Studies related to Buerger allen exercises

Literature related to varicose vein

A comparative research study was conducted to find the relations

between age, sex, lower limb symptoms among 350 (males and females) of

Japan. Results revealed that prevalence of symptoms like Heaviness or

tension was 16.0% in males and 28.6% in females, feeling of swelling was

9.2% in males and 23.0% in females, Aching – 32.5% in males and 53.8%

in females, restless legs 20.0% in males and 35.1% in females, cramps-

34.0% in males and 42.0% in females, Itching – 19.0% in males and 25.3%

in females, Tingling 16.0% in males and 19.8% in females. The study

concluded that the female population is more risk to develop varicose vein.(8)

A prospective randomized study was conducted on Prolonged

standing at work and hospitalization due to varicose veins among 9653

working adults in Denmark. The study results Reported that employees

with jobs that require prolonged standing or walking compared to all other

employees, the relative risk was 1.75% for men and 1.82 % for women. The

pooled estimate of the relative risk was 1.78% .The etiological fraction of

prolonged standing or walking at work was estimated as 22.5% for men and

22.6% for women. This prospective study concluded that prolonged

standing at work constitutes an excess risk of hospital treatment due to

varicose veins and accounts for more than one fifth of all cases of working

age.9)

A longitudinal cross sectional study conducted to find out the

prevalence of varicose vein among504 cotton workers from England and

467 from Egypt are selected for the study. The study results revealed that

English mill population exhibited a 10% higher incidence of varicose vein

compared with Egyptian population and 70% of women exhibited the

symptoms of varicose vein had history of prolonged standing posture at

work. The study concluded that ethnic factors have an effect on the

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occurrence of varicose vein (10)

An epidemiological study was carried out to establish the effect

of working conditions on the appearance of varicose veins on a sample size

of 1324 from different occupation sectors (catering, trade, light industry,

heavy industry and finances) in Croatia. The study results revealed that

varicose veins were more prevalent in trade industry and catering industry

than office workers. The study concluded that standing in the work place

(weight handling while working and working indoor were risk factors for

varicose veins.(11)

Studies related to buerger allen exercises

A clinical experimental study conducted to find out the

effectiveness of buerger allen exercise among peripheral vascular disease

patients. The study conducted among 13 patients admitted in hospital setting

at Italy. The study evidenced increased perfusion after doing the exercise

(pretest capillary refill (2-3sec) and post test capillary refill (1-2sec) and

extremity pulses increased 10%in 50%of total population .the overall

benefit seen in 7 patients after 24 hours evidenced by (increased perfusion

and activity). The study concluded that buerger allen exercise is effective

for improving lower extremity perfusion.(12)

An experimental study conducted among 25 peripheral

vascular disease patients to determine effectiveness of exercise training to

improve the symptoms of peripheral vascular disease at Chennai. The study

results showed that 18%of population increased the activity and perfusion

by reducing the symptoms. 4%of population illustrated a delayed effect to

exercise and 2%showed improvement with surgery. the study concluded

exercises are effective in reducing peripheral vascular disesase symptoms13

An article regarding conservative approach to the management of

lower extremity associated signs and symptoms (pain, edema, tenderness,

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cyanosis, coldness and stiffness) show the effectiveness of Buerger’s Allen

exercise. The treatment involve encouragement of blood flow during the

actively vasospastic phase by elevation of an active exercise part. The

researcher recommended that Buerger’s Allen Exercise for the improvement

of lower extremity blood supply. Another article regarding intermittent

claudication also highly recommended the importance of Buerger’s Allen

exercise (three 3 series of exercise repeat 6- 7 times in a day) among

peripheral vascular disease14).

An experimental study conducted to assess the effectiveness of

buerger allen exercise on improving lower extremity perfusion among

diabetic clients admitted in selected hospital at Bangalore. The researcher

adopted quasi experimental design with purposive sampling on a sample

size of 50.The result showed 75%of the type 2 diabetic patient improved

peripheral perfusion after the exercise and 10% showed faster wound

healing in diabetic ulcers and study concluded exercise is effective in

improving extremity perfusion among type 2 DM clients.(15)

6.3 STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of structured teaching programme

regarding knowledge on varicose vein and practice of buerger allen

exercise in improving peripheral perfusion among workers in a tile factory

at Mangalore”

6.4 OBJECTIVES OF THE STUDY1. To assess the knowledge regarding varicose vein among workers in tile

factory.

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2. To administer structured teaching programme on varicose vein and

burger allen exercise to the workers in tile factory

3. To evaluate the effectiveness of structured teaching programme in

knowledge regarding varicose vein among workers in tile factory.

4. To evaluate the effectiveness on practice of buerger allen exercise in

improving the lower extremity perfusion among workers in the tile

factory.

5. To find out the correlation between the post test knowledge on varicose

vein with practice of burger allen exercise among workers in the tile

factory

6. To find out the association between pre test mean knowledge score of

varicose vein with selected demographic variables like age, type of

family, education, Socio Economic Status, previous source of

information, bad habits, diet.

6.5 OPERATIONAL DEFINITION

Assess

In this study “assess “refers to the evaluation of knowledge of workers in

tile factory regarding varicose vein and buergerallen exercise.

Knowledge

In this study knowledge refers to correct responses given by the

workers regarding varicose veins.

Effectiveness

In this study effectiveness refers to gain in knowledge regarding

varicose vein and exercise training to improve the peripheral perfusion.

Structured teaching programme

In this study structured teaching programme refers to a systematic,

organized teaching programme prepared by investigator containing

information about various aspects of varicose vein and buerger allen

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exercise to improve peripheral perfusion.

Varicose vein

In this study varicose veins refers to dilated and twisted veins (usually

those of legs) caused by structural changes in the walls or valves of the

vessels.

Lower extremity perfusion

In this study lower extremity perfusion refers to the increased blood

circulation of the lower extremity as evidenced by skin colour changes,

decreased pain after administering the Buerger’s Allen exercise among

workers in tile factory.

Buerger allen exercise

In this study Buerger’s Allen exercise refers an active postural exercise,

which help in fills and empties the lower extremity blood vessels according

to gravity alternatives refers a three steps (elevation, dependency,

horizontal)

6.6 ASSUMPTION The study assumes that ,

1. The workers may have some knowledge regarding varicose vein

2. The knowledge regarding varicose vein and practice of buerger

allen exercise helps workers to prevent potential complications

resulting from varicose vein.

6.7 DELIMITATION

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The study will be limited to,

workers with 30 years and above

Workers who is in male gender.

Workers who can read and write kannada or English

6.8 HYPOTHESIS

H1:The mean post test scores will be significantly higher than pretest

knowledge score regarding varicose vein among workers at tile factory

H2:There will be a significant difference between the pretest and post test

interventional scores on varicose vein among workers at tile factory

H3: There will be a significant relationship between the knowledge score

and practice of buerger allen exercise among workers at tile factory.

H4. There will be a significant association between pre test knowledge

score regarding varicose vein with selected demographic variables like age,

gender, religion. Education, income, area of residence, previous source of

information, bad habits, diet.

7 MATERIALS AND METHODS

7.1 SOURCE OF DATAThe data will be collected from the male workers in the tile factory who are

above 30 years.

7.1.1RESERCH DESIGNResearch design for this study will be quasi-experimental one group pre test post test design

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7.1.2 SETTINGThe study will be conducted at a selected private tile factory at Kudroli, Mangalore

7.1.3 POPULATIONThe population will be workers in the tile factory

7.2 METHODS OF COLLECTION OF DATA

7.2.1 SAMPLING PROCEDURESimple random sampling technique will be used for this study

7.2.2 SAMPLE SIZEThe sample size will be 60 workers

7.2.3 INCLUSION CRITERIA FOR SAMPLING 1.The workers who are above 30 years 2.The male workers

7.2.4 EXCLUSION CRITERIA FOR SAMPLING 1.Female Workers 2.Workers who don’t know the regional languages3.Workers who are not available at time of data collection

4.Workers who had surgical management for varicose vein

7.2.5 INSTRUMENTS INTENDED TO BE USED Tools on varicose vein

Part 1; baseline Performa

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Part 2: structured questionnaire on varicose vein

Part 3: check list to assess the lower extremity perfusion

Intervention: Structured teaching programme on varicose vein and buerger

allen exercise.

7.2.6 DATA COLLECTION METHOD A prior formal permission will be obtained from the authority.

Informed consent permission will be obtained from the subjects after

explaining the purpose of the study

Pre test will be conducted using questionnaire and checklist to assess

the knowledge and peripheral perfusion

structured teaching programme on varicose vein with buerger allen

exercise administered

On 7th day post test on knowledge will be assessed using

questionnaire and practice of buerger allen exercise will be assessed

using check list.

7.2.7 PLAN FOR DATA ANALYSIS Collected data will be arranged using tables diagrams and graphs.

The knowledge of workers regarding varicose vein will be analyzed

using mean and standard deviation

The effectiveness of structured teaching programme among workers

analyzed by “t” Test.

The correlation between post test knowledge score on varicose vein

with practice of buerger allen exercise analyzed by “r”correlation test

(Karl Pearson)

The association of pretest knowledge score with selected demographic

variables assessed by “ 2 ” (Chi square test)

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7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION

OR INTERVENTION TO BE CONDUCTED ON

PATIENTS OR OTHER HUMAN OR ANIMALS? IF SO

PLEASE DESCRIBE BRIEFLY. Yes, the study includes structured teaching programme and practice

of Buerger’s Allen exercise, will be conducted among workers at tile factory

with the aim of improving the knowledge on varicose vein and to the

peripheral vascular perfusion.

7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED

YOU’RE YOUR INSTITUTION INCASE OF ABOVE

STATEMENT? Yes, informed consent will be obtained from authorities and Ethical

Committee clearance where the study will be intervened. Scientific

objectivity of the study will be maintained with honesty and impartiality.

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cited 2013 october13). Available from: http://biology. about.com/od

/humananatomybiology/ss/blood_vessels.htm

2. Black JM, Hawks JH. Medical Surgical Nursing: Clinical management

for positive outcomes ;2005.

3. Indian statistics of varicose vein. Epidemiology of varicose vein:British

medical journal (serialonline); 2011(cited2012Oct25).Availablefrom:-

http://bestpractice.bmj.com/best-practice/monograph/ 630/basics/

epidemiology.html.

4.Buergerallenexercise.(online);avilabile from http://jama.

Jamanetwork .com/ article.aspx?articleid=287862

5.Harley street vein clinic. Compression Stockings;Available from:

URL:www.dr-bull.com/compression-stockings.htm

6.Meera Shrutty, Divya Aleena Jacob, Vinitha T.V. Prevalence of

varicosity among people whose work demands standing for long hours:

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National conference on students’ medical research; 2008 April 11-12.

Available from: http://www.commedtvm.org/natconabstract.html.

7.Benefitsofbuergerallen exercise; available from: http://medical-dictionary.

the freedictionary .com/Buerger-Allen+e

8.Bradbury A, Evans C, Allan P, Lee A, Ruckley C, Fowkes F. symptoms

of varicose veins: Edinburg vein studycross ; 1999.

9.F Tüchsen, H Hannerz, H Burr, N Krause. Prolonged standing at work and

hospitalisation due to varicose veins: a 12 year prospective study of the

Danish population: Occupational and Environmental Medicine;2005.

10.Siza Mekky,R.S.F Schilling, Joan Walford. Varicose veins in women

cotton workers: An epidemiological study in England and Egypt;1969 .

11.Kontosic I, Vukelic M, Drescik I, Mesaros- Kanjski E, Materljan E ,

Jonjic A. work conditions : risk factors for varicose veins of the lower

extremities in certain professions; 2000 .

12. S Leonard Syme. The prevention of disease and promotion of health:the

need for a new approach,: European Journal of Public Health; 2009 :329-

330.

13. Treesak C , Kasemgup V, Treat Jacobson. Cost effectiveness of

exercise trining : improve claudication symptoms in patient with peripheral

arterial disease ;1993 .

14. R Vincent Dynamic. Chriopractic media :A conservative approach to

the management of Suedky’s Atropy ;1995.

15. Mr Cyril Thomas.effectiveness of buerger allen exercise on diabetics

patients in improving peripheral perfusion:interventional study on diabetcs

patients(unpublished dissertation)2009.banglore

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