MASTER OF SCIENCE IN NURSING MEDICAL SURGICAL NURSING.
DATE OF ADMISSION
TITLE OF TOPIC
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAM ON KNOWLEDGE OF STAFF NURSES TOWARDS CARE OF AUTOIMMUNE RETINOPATHY IMBALANCE ON DIABETIC MELLIUS PATIENTS IN SELECTED HOSPITALS AT BANGALORE”.
6. BRIEF RESUME OF THE INTENDED WORK.
6.1 NEED FOR THE STUDY.
Diabetic retinopathy is caused by complications of diabetes mellitus, which can eventually leads to blindness. It is an ocular manifestation of systemic disease which affects up to 80% of all patients who have had diabetes for 10 years or more.
Retinal capillary walls thicken and develop micro – aneurysms. Retinal vein widens and becomes tortuous. Small hemorrhages occur which leaves scars that decrease vision. As the disease worsens, neovascularization occurs and the new vessels grow into the vitreous tumor. These vessels are vulnerable to both obstruction and rupture. Vision decreases as “FLOATERS “are perceived in the eye.
The reading cause of blindness and mascular degeneration, diabetic retinopathy affects the eyes. The damage is in the retina and its surroundings blood vessels. Those that have had diabetics for a total of 15 years, 10% will have visual impairments and 21% will end up blind from the diabetes. Getting regular and frequent eye test at their best. (1).
All those that are diabetic should make sure to inform the person giving the eye test of this condition so that they can take special care to check for this condition.
The study conducted gives a report on intimidating statistics, the researches indicates that at least 90% of these new cases could be reduced if there was proper and vigilant treatment and monitoring of the eye. (2)
Oyama, Tu MD. Burt (2009) conducted a study on auto-immune-related retinopathy and optic retinopathy syndrome, in this report the researcher describes that the autoimmune-related retinopathy and optic neuropathy (ARROW) syndrome is characterized by visual loss and often the presence of antibiotics against retinal or optic nerve antigens in the absences of cancer. (3)
From the available literature viewed, it has been found that autoimmune retinopathy is very important for the staff nurses and should be educate about the effects of retinopathy, so the researcher found it is necessary to assess the effectiveness of a structured teaching programme among staff nurses in selected hospital.
6.2 REVIEW OF LITERATURE
Review of literature is the key step in the research process. Literature review is essential to locate similar of related studies that have already been completed which helped the investigator to develop deeper insight into the problem. Review of literature is a systematic identification, location and summary of the written materials that contain information on research and the problem.
Heckenlively, John, etal (2008) conducted a study on three main forms of autoimmune retinopathy (ATR) in this report the researcher has identified over the last 15 years, that the cancer-associated with retinopathy (CAR), melanoma0associated retinopathy (MAR) and non-neoplastic autoimmune retinopathy (np AIR). There are many forms of AIR tend to have common clinical features despite the fact that there has been uninformed set of anti-retinal antibody activity often with three to six different antibodies on immunoblots. (4)
Dr. Dinesh. K. Sahu (2007) conducted a study on an unusual presentation of lupus retinopathy, In this report the
researcher illustrates that ophthalmologists may play an important role in the diagnosis of SLE since ocular manifestations may precede or coexist with serious extra ocular manifestation of the disease. (5)
Grazyna Adams (2004) conducted a study on autoimmune retinal degeneration, this report shoes that the patient with sudden or subacute, unexplained loss of vision of retinal antibodies in a broad range of specificity and indicates the need for autoantibody screening. The follow up tests of antibody levels may be useful as a biomaker of disease activity associated with worsening of vision. These heterogeneity in autoantibody specificity explains the variation and complexity of clinical symptoms in retinopathy patient. (6)
S. Macleod (2003) stated that diabetic retinopathy is a microvascular disease that leads to capillary occlusion. This affects the retinal precapillary arterides, capillaries and venules. Persistent hyperglycemia is considered to be the primary cause of changes in the vascular endothelium. These capillary occlusion then occurs as a result of platelet and leucocyte activation. (7)
This study states that the retinopathy occurs when the small blood vessels (called capillaries) in the retina become damaged. The retina which is located at the back of the eye sends visuals images to the brain where they are perceived. It also states that there are many potential causes of retinopathy. The severity of retinopathy varies depending on the underlying cause, some cases such as retinopathy of prematurity, may go away without treatments. (8)
K. Sharma, P.K. Khosla (1991) conducted a study on anti-insulin antibodies and retinopathy in juvenile on set type – 1 diabetes the outcome of the higher prevalence of anti-retinal auto antibodies in retinopathy patients. Ninety – one patients sera (47.1%) showed auto antibodies of various significations with a higher incidence of antibodies present in retinopathy patients diagnosed with diabetic mellitus (33/52, 63.5% p=0.0009) than in retinopathy patients without diabetic mellitus (58/141, 41.1%). (9)
6.3 STATEMENT OF THE PROBLEM
A Study to assess the effectiveness of structured teaching program on knowledge of staff nurses towards care of autoimmune retinopathy imbalance in diabetic mellitus patient in selected hospital at Bangalore.
6.4 OBJECTIVES OF THE STUDY
1. To assess the existing knowledge (Pre test) of autoimmune retinopathy in balance in diabetic mellitus and its care among staff nurses.
3. To implement structured teaching program among staff nurses.
4. To evaluate the post test effectiveness of structured teaching program.
5. To associate knowledge between pretest and post test with demographic variables.
H1=There will be significant difference-between the pre-test and post-test knowledge scores on the care of autoimmune retinopathy imbalance in diabetic mellitus among staff nurses in selected hospitals.
H2=There will be a significant association between the knowledge score of staff nurses regarding the care of autoimmune retinopathy imbalance in diabetic mellitus with selected demographic variables.
6.6 OPERATIONAL DEFINITIONS
Assess = To find out the outcome in tense of numerical score.
Effectiveness = Outcome of the interventions measures in the terms of
Knowledge = Refer to correct response of staff nurses regarding the care of autoimmune retinopathy imbalance in diabetic mellitus.
Program = It is a set of information consist of different aspect of care
Of patient undergoing auto immune retinopathy imbalance.
Staff Nurses = Registered nurses working in selected hospitals.
Care = The work of providing treatment for or attending to some or something.
Auto immune = One group of otherwise unrelated disorder caused by destruction of tissues by the bodys own immune response.
Retinopathy = Resulting from diabetes in which hemorrhage or exudation may occur.
Imbalance = The state or condition of lacking balance, as in proportion or distribution.
Diabetic Mellitus = Disorder of carbohydrate metabolism in which sugar in the body are not oxidized to produce energy due to lack of the
pancreatic hormone insulin.
The investigator assumes that this structured teaching program will improve the knowledge among staff nurses for providing better care of patient undergoing autoimmune retinopathy imbalance in diabetic mellitus.
6.8 DELIMITATIONS 1. The study is limited to 50 samples.
2. The duration of study is delimited to 4 weeks.
3. Those who are available at time of data collection.
6.9 PROJECT OUTCOME 1. The findings of the study will reveal the staff nurses knowledge on auto immune retinopathy imbalance in diabetic mellitus patient.
2. The intervention assigned for the study will remain as a protocol that could be practiced by the staff nurses and improve the quality of patient care.
A prior formal permission will be obtained from the hospital authority for conducting the study. The purpose of the study will be explained and consent of the participant will be obtained to involve in the study. The investigator will administer the structural knowledge questionnaire in the pretest then implement structured teaching programme and conduct post test after 7 days using the same tool the purposed study duration in 30 days.
7.2.3 METHOD OF DATA ANALYSIS.
The investigator will obtain data by using descriptive and inferential statistics and the plan of data analysis will be as follows.
Organize the data is a master sheet / computer.
Frequencies and percentage for the data analysis of the background of the data.
Paired “t” test will be used to test the significance between the pre test and post test knowledge scores.
Chi – square test to determine the association.
7.3 DOES THE STUDY REQUIRE ANY INTERVENTION?
In Intervention as a structural teaching programme on care of autoimmune retinopathy imbalance in diabetic mellitus patient will be conducted for the staff nurses.
No other invasive procedures are performed as an intervention in this study.
7.4HAS ETHICAL CLEARANCED BEEN OBTAINED?
Confidentiality and anonymity of the subject will be maintained.
Informed consent will be obtained from the subject.
A written permission from institutional authority will be obtained prior to the study.
8.LIST OF REFERENCES:
1. B.T Basavanthappa, Medical Surgical Nursing, Second Edition, (2007)
pg 984 – 986
2. Dorian, D. Newman. The value of autoimmune retinopathy function test (2009), pg 491 – 498.