Narayana Nursing Journal-2013 JULY

Nursing has been called the oldest of the art, and the
youngest of the profession. Nurses will have an essential public
health role and patients will become more demand up. Healtheir
life styles, continuum of care, health environments and evidence
based practice will be emphasied and in the forefront of nursing
agenda.
Nursing is an invitable force in health care delivery system,
as the nurses are contributing more on promotion of health,
prevention of systemic and communicable diseases.
Health care is a business and that nursing should follow more
business like principles. The nurses need to appreciate the
importance of process and structures, but a laser focus and a near
reverence of tangible and valued outcomes that improve patients
experiences.
The nurses are on transformation of business, as
kerfool - rote, “we transform a frightened 4 year old girl in EMD
into a little person who can feel safe and stop cry. We transform
students into safe, skilled and self confident practitioners. So, too,
the health, well being, safety and experience of patients, clients,
and families are dependent upon the often visible and over looked
caring practics of nurses. In the 21st century information is
doubling every five years, if not tripling in quantity and quality.
Advances in nursing informatic are in the infancy stage, yet, show
promise for the future where this science will contribute
significently to envisioned new health care delivery system world
wide.
Indira. S, Ph.D.,
Nursing Principal

CONTENT
01. A study to assess the prevalence of diabetes mellitus among people attending OPD in Narayana
Medical College & Hospital, Chinthareddypalem, Nellore.
02. Aromatherapy On Anxiety.
Mrs. Dr. Indira. S
MS. Rajeswari. H
03. Title of the Research study: An Epidemiological Survey to determine the prevalence of con
sumption of fast food among children and their knowledge regarding the food they eat.
J. Edna Sweenie
04. Tubal Ligation Reversal .
Ms. Mekala. M.,
05. A study to assess the knowledge on first aid management among play school teachers at selected
playschools at Nellore District.
Mrs. Radhika
06. Mentally Healthy Person
Mr. A. Tamil Selvam
07. Stem Cell Transplantation
Mrs. A. Latha
08. Evidence Based Nursing Practice in Community Health Nursing Clinical Speciality & Research
Priorities
09. Yellow Fever
Mrs. Vanaja kumari
Ms. Sheela. E
10. A study to assess the knowledge and practices of the nurses on universal precautions to prevent
HIV/ AIDS at labour rooms in selected hospitals of Raichur.
Ms. N. Leena Madhura
11. A comparative study to assess the effectiveness of sacral massage versus hot application in
sacral area for pain during active first stage of labour among primi mothers Ms. Anu Thomas
12. Evidence Based Practice in Community Health Nursing
Mrs. B. Kalpana
13. Article On Public Relations
Ms. Mary Vineela .P
14. Diabetes
Ms. Manjula G.B
15. A study to assess the effectiveness of infrared light therapy on episiotomy wound healing among
post natal mothers with episiotomy in Narayana general Hospital at Nellore.
Ms. M. Sasikala
16. Reiki and Nursing
Mrs. K. Kantha
17. Effectiveness of structured teaching programme on control of obesity among obese women, at
N.T.R. Nagar, Hyderabad.
Ms. A. V. Deepika
18. Marfan Syndrom
Ms.M.Shunmuga Lakshmi
19. Needle Stick Injuries among Nurses
Mrs.A. Rathiga
A Study to assess the prevalence of Diabetes Mellitus among people attending OPD
in Narayana Medical College & Hospital, Chinthareddypalem, Nellore.
diabetes. A further 65 subjects were identified as diabetes
but were not on a register of cases.
Statement of the problem:- A study to assess the
prevalence of diabetes mellitus among people attending
OPD in Narayana Medical College Hospital, Chinthareddy
palem, Nellore.
Objectives:- 1. To assess random blood glucose level
among people attending OPD in Narayana Medical
college hospital.
2. To associate the level of random blood glucose level
with selected socio demographic variables.
Methodology: It is a descriptive design, conducted at
OPD Narayana Medical College Hospital, Nellore which
is 1210 bedded hospital. 100 people with age group of 30
and above were screened.
Sampling criteria:Inclusion criteria:People above 30 years of age
People willing to participate.
All Patients attender coming to Narayana Medical Hospital.
Exclusion criteria:People with known diabetes.
People unwilling to participate.
Description of tool:Tool for data collection:- The tool consist of two parts
Part I:- It consist of socio Demographic data which
includes age, sex, education, occupation, family history of
diabetes, Body mass index, exercise, personal habits and
history of co morbid disease
Part II:- Data regarding random blood glucose level
assessed by using glucometer.
Data collection procedure:Before starting the study, the researcher obtained
permission for conducting the study. The nature and
purpose of the study were explained to patients attender
and general public. Based on inclusion criteria the people
were taken as sample for assessing the random blood sugar
using by glucometer.100 samples were taken by
administering socio demographic data sheet.
Analysis and findings: Frequency and percentage
distribution of demographic variables
Table:I
N=100
Sno Demographic variables
Frequency percentage
1 Age
30 -40 years
41
41%
41-50 years
32
32%
51-60 years
16
16%
>61years
11
11%
Mrs. Dr. Indira. S
MSc.N, PhD,
Nursing Principal
Narayana College of
Nursing,
Nellore.
ABSTRACT: AIM :To assess the random blood glucose
level and to associate with socio demographic variables.
Methodology: Descriptive study was conducted in
Narayana Medical College Hospital, Nellore .100 people
with age group of 32 to 50 years those who are attending
OPD were selected by convenience sampling and
random blood glucose level were screened by using
glucometer. Results: Out of 100 people 15% were above
border line[>140],15%are borderline[120-140]and
remaining 70% had normal random blood sugar Level.
Conclusion :The study findings helped to identify and
diagnose fresh diabetic people and those who are at high
risk to develop diabetes.
Introduction: Morbidity level of developing countries are
increasing by diabetes. India today leads the world with
its, largest number of diabetic people. WHO estimates
that there are 32 million people are living with diabetes in
India on 2000,Which is projected to rise to 80 million by
the year 2015.
Need for Study: Diabetes affects 246 million people world
wide and is expected to affect some 380 million by 2025.
Each year another 7 million people develop diabetes.
Rammurthy (2009) reported that according to world
diabetic congress federation eight million cases would be
added to existing diabetic cases by 2010 in India which
works to 7% of the countries adult population. In India the
prevalence of diabetes mellitus in six cites like delhi 11.6,
Mumbai 9.3,Calcutta 11.7, Hyderabad 16.6, Bangalore
12.4, Chennai 13.5, in which Hyderabad in the top in the
prevalence of the diabetes in south India.
Review of literature: Davis M.F (2008) conducted
community screening for non insulin dependent diabetes
mellitus in UK among 13,000 subjects aged 45-70 years
above. It was found that glycosuria was detected in
343(75%) subjects, 330 (95.9%) attended for oral glucose
tolerance among them 99 (30%) had newly diagnosed
3
2
Sex
Male
60
60%
Female
40
40%
3 Religion
Hindu
81
81%
Muslim
11
11%
Christian
8
8%
4 Family
H/O yes
34
34%
Diabetes no
66
66%
5 Occupation
Farmer
10
10%
Coolie
30
30%
Business
10
10%
House wives
40
40%
Others
10
10%
6 Diet pattern
Vegetarian
13
13%
Non vegetarian
87
87%
7 Family type
Joint family
48
48%
Nuclear family
52
52%
8 Exercise
Meditation
3
3%
Walking
57
57%
Yoga
None
40
40%
9 BMI
Underweight
38
38%
Normal weight
50
50%
Obesity
12
12%
Overweight
4
10 Habits
Smoking
9
9%
Alcohol
10
10%
Smoking & Alcohol
35
35%
None
46
46%
11 H/O co morbid disease
1.Hyper tension
9
9%
2.CAD
3.Renal disease
4.None
91
91%
TABLE II:Frequency and percentage distribution of the random blood
glucose level.
N=100
S.No Random blood Glucose level Frequency Percentage
1. 80-120[normal]
70
70%
2. 121-140[border line]
15
15%
3. >140[above border line]
15
15%
Table2: Out of 100 sample 15% of them are found to
have random blood glucose level >140 and other 15% >120
who are at risk of developing diabetes.
4
Table 3: Percentage and frequency distribution of
awareness regarding practices among diabetic patients:
N=30
Sl. No
Practices
Diabetic (n=30)
No
%
1
Regular Medications
30
100
2
Consult Doctor regularly
3
10
3
Blood glucose monitoring
12
40
4
Regular Exercise
17
56.67
5
Efforts to reduce weight
11
36.67
6
Cessation of smoking or
alcohol habits
21
70
7
Using regular footwear
27
90
Table 3: 30 out of 30 diabetic patients were taking
regular medications and very minimal about 3(10%) were
consulting doctors regularly.
Table: 4 percentage and frequency distribution of
awareness regarding complications among non diabetics
and diabetics N=100
Sl.No Complications Non
Diabetic(n=30)
diabetic(n=70)
No
%
No
%
1
Eye
5
7.14
17
56.67
2
Heart
4
5.71
14
46.67
3
Kidney
5
7.14
13
43.33
4
Joint deformity 4
5.71
11
36.67
5
Stroke
3
4.29
9
30
6
Diabetic foot
4
5.71
23
76.67
7
Don’t Know
51
72.86
8
26.67
Table 4 out of 30 diabetic patients 56.67% were having
awareness regarding eye whereas 26.67% of diabetics
don’t know about the complications
FINDINGS:
It was found through the screening programme
out of 100 people 15% had random blood glucose level
>140[border line],remaining 15% percentage had >120 and
70%had normal blood glucose level. There was no significant association with demographic variables.
Recommendations :
1.The Study should be replicated on a large sample of
people
2. Protocols can be developed to prevent / postment of
diabetes in public
Reference :
1. MONAHAN,Sands, Neighbors, Marck, Green(2007)
"PHIPP'S MEDICAL - SURGICAL NURSING:
HEALTH AND ILLNESS PRESPECTIVES," 8TH Edition, MUSBY Elsveir Publication, Philadelphia, P.No:11101163.
2. http://www.nih.gov/pubs/factsheets.html
3. http://www.nlm.nih.gov/pubs/factsheets/factsubj.html
AROMATHERAPY ON ANXIETY
Aromatherapy Bible, Farrer-Halls (2005) recommends
key aromatherapy treatments which may be beneficial in
helping those suffering from anxiety. Perry, Nicolette
(2006) conducted a study on Aromatherapy in the
Management of Psychiatric Disorders.Experimental
design was adopted.sample size was 200. It is concluded
that aromatherapy provides a potentially effective
treatment for a range of psychiatric disorders like anxiety
,depression,stress, insomnia
STATEMENT OF THE PROBLEM
A study to determine the effectiveness of aromatherapy
on anxiety among adults in selected villages ,Nellore
OBJECTIVES
1. To assess the level of anxiety among adults
2. To determine the effectiveness of aromatherapy on level
of anxiety among adults
3. To compare the effectiveness of aromatherapy on level
of anxiety among adults between experimental & control
group
4. To associate the effectiveness of aromatherapy on
level of anxiety among adults with selected socio
demographic variables
OPERATIONAL DEFINITION
ANXIETY: Person who scores 15-56 on hamilton
anxiety rating scale
AROMATHERAPY: Sandalwood oil 2drops is added
to a cotton ball & individual is made to inhale through nose
for 5 minutes
ADULTS: Individual between the age group of
20 - 60 years
HYPOTHESIS
There will not be a statistically significant decrease in the
level of anxiety after aromatherapy among the adults
METHDOLOGY
Research approach: Quantitative research approach is
adopted to determine the effect of aromatherapy on
anxiety among psychiatric patients
Research design: Quasi experimental design was
chosen for the study
Setting of the study: The study was conducted in
venkatachalam
Population: Adults residing in venkatachalam village.
Sample: Male and female adults who have mild &
moderate level of anxiety & who fullfills the inclusion
criteria
Sample size: The sample size of the study is 60
Sampling technique: Non probability convenient
sampling technique was adopted
MS. RAJESWARI. H
M.Sc (N), M.Sc(Psy) Prof.,
Dept. of MHN,
Narayana College of
Nursing,
Nellore - 2.
INTRODUCTION
Anxiety (also called angst or worry) is a psychological
and physiological state characterized by somatic,
emotional, cognitive, and behavioral components. Anxiety
is considered to be a normal reaction to a stressor. It may
help an individual to deal with a demanding situation by
prompting them to cope with it.It is the displeasing feeling
of fear and concern. Anxiety also influences how we
behave. For instance, when we feel anxious, we often
avoid doing things that we want to because we are
worried about how they will turn out. Although short
experiences of anxiety are part and parcel of daily life, it
becomes challenging when anxiety begins to follow people
around and is a regular feature in their lives. Anxiety is a
very common symptom which may often accompany
depression or other mental health conditions, as well as
being a condition in its own right. While anti-anxiety
medications may help relieve symptoms, aromatherapy
uses essential oils to soothe, calm and relax.
Aromatherapy is one of the fastest growing modalities
in alternative medicine. Aroma has a powerful effect on
living organisms. Research concludes that smell is 10,000
times more powerful than taste. More important, scent
moves quickly to the brain and has a direct impact on the
limbic system. The limbic system converses with the
autonomic nervous system which has a direct connection
to the hypothalamus and emotions; thus, mental-health
professionals are now promoting the psychological
benefit of essential oils. The calming and relaxing effect
of the essential oils and massage can help to relieve
accumulated tensions and anxieties.
NEED FOR THE STUDY
Anxiety Disorders are the most common mental
illness in the world with 19.1million (13.3%) of the adult
ultguide (2007 ).In India it accounts to22.7 % of the
global burden of disease.In Andhra pradesh it is estimated
to be 42.7% Nilamadhab Kar(2010) .
5
4 Educational Status Illiterate
7
23.3
5
16.66
Primary
7
23.3
13
43.3
Secondary
14 46.7
11
36.7
Graduate
2
6.7
1
3
5 Occupation
Labor
7
23.3
12
40
Business
6
20
10
33.33
Private job
5
16.66 1
3.33
House wife
11 36.7
7
23.3
6 Marital status
Unmarried
8
26.7
6
20
Married
18 60
22
73.3
Widow/widower
4
13.3
2
6.7
7 Area of living
Urban
17 56.7
14
46.7
Rural
13 43.3
16
53.3
Table 1:Shows the frequency & percentage distribution
of demographic variables with regard to age, sex, religion,
educational status, occupation, marital status, area of
living
Table 2:Effectiveness of aromatherapy on level of
anxiety among adults in experimental & control group
Inclusion criteria:
1. Adults who are willing to participate
2. Adults who are available at the time of data collection
3. Adults who have mild & moderate level of anxiety
4. Adults between the age of 21-60yrs
Exclusion criteria:
1. Pregnant women
2. Adults with severe asthma
3. Adults with a history of allergies
4. Adults with high blood pressure
5. Adults with severe anxiety
DESCRPTION OF TOOL:Tool consist of two sections
Section-A: Demographic variables such as age, sex ,
marital status, educational qualification, religion, area of
living, occupation
Section-B: The tool used for the study was a standardized
Hamilton rating scale which comprises of 14 items
Not present: 0,Mild: 1,Moderate: 2,Severe: 3,Very severe:4
Score interpretation: Mild anxiety:15-29, Moderate
anxiety:30-43,Severe anxiety:44-56
DATA COLLECTION PROCEDURE
Permission was obtained from the institutional
ethical committe, Medical officer PHC to collect the data.
Informed consent was obtained from the adults .The
nature & the purpose of the study was explained. Hamilton
anxiety rating scale was administered to the adults. It took
15 minutes for the adults to fill the rating scale. Those
who fulfilled the inclusion criteria were given aromatherapy
th
for 10 days & posttest was conducted on the 11 day
DATA ANALYSIS
Statistical method used for the data analysis were
descriptive statistics that include frequency, percentage
,mean & standard deviation. Inferential statistics namely
chi-square was used to associate the level of depression
with the selected socio demographic variables
RESULTS:
Table - 1: Frequency & Percentage distribution of socio
demographic variables of the adults
Sl.no Demographic Experimental
Control
variables
group N=30
group N=30
No
%
No
%
1
Age in years 21-30
6
20
7
23.3
31-40
18
60
13
43.3
41-50
6
20
8
26.7
51-60
0
0
2
6.7
2
Sex
Male
11
36.7
14
46.7
Female
19
47.3
16
53.3
3
Religion
Hindu
22
73.3
18
60
Christian
6
20
8
26.7
Muslim
2
6.7
4
13.3
Table 2 shows that in experimental group 9(30%) had mild
level of anxiety & 21(70%) had moderate level of anxiety
in pretest & in posttest 14(46.7%) had mild level of
anxiety& 16(53.3%) had moderate level of anxiety.In
control group 11(36.7%) had mild level of anxiety
&19(63.3%) had moderate level of anxiety in pretest & in
posttest 12(40%) had mild level of anxiety &18(60%) had
moderate level of anxiety.
Table 3: Comparison of Effectiveness of aromatherapy
on level of anxiety among adults in experimental &
control group
Table 3 indicates that there is a statistically significant
difference between the mean post test score t-23.284 at
p<0.05 level of significance. Hence it is interpreted that
there a is significant reduction in the level of anxiety among
the adults after the aromatherapy
6
Table 4:Association of effectiveness of aromatherapy on
level of anxiety among adults with their selected socio
demographic variable
Table 4 shows that there is no statistically significant
Sl.no Demographic
variables
1
2
3
4
5
6
7
primary education. In the occupation majority of them in
experimental group 11 (36.7% ) are housewife & in
control group 12(40%) are labor. In marital status
majority of them in experimental group 18(60% ) & in
control group 22(73.3%) were married. In area of living
status majority of them in experimental group 17(56.7% )
live in urban area & in control group 16(53.3%) live in
rural area.
2. In experimental group 9(30%) had mild level of
anxiety & 21(70%) had moderate level of anxiety in
pretest & in posttest 14(46.7%) had mild level of
anxiety& 16(53.3%) had moderate level of anxiety.In
control group 11(36.7%) had mild level of anxiety
&19(63.3%) had moderate level of anxiety in pretest & in
posttest 12(40%) had mild level of anxiety &18(60%) had
moderate level of anxiety.
3. There is no statistically significant association between
the effectiveness of aromatherapy on level of anxiety with
the socio demographic variables like age, sex, religion,
education, occupation, marital status, area of living at p<
0.05 level of significance
CONCLUSION
Level of anxiety N=30 Chisquare X2
Mild
Moderate
anxiety
anxiety
No
%
No %
Age in years
21-30
3
31-40
3
41-50
3
51-60
0
Sex
Male
6
Female
3
Religion
Hindu
5
Christian
3
Muslim
1
EducationalStatus
Illiterate
2
Primary
3
Secondary
4
Graduate
00
Occupation
Labor
3
Business
2
Private job
0
House wife
4
Marital status
Unmarried
3
Married
6
Divorce /Separated 0
Widow/widower
0
Area of living
Urban
3
Rural
6
10
10
10
0
3
15
3
0
20
10
2 6.7 X²=3.903, df=
19 63.3 8.32 P<0.05 NS
16.7
10
3.3
6.7
10
13.3
2 6.7
15
3
3
10
50
10
0
50
10
10
X²=1.443, df
=5.99 P<0.05 NS
X²=4.792,df=
9.63 P <0.05 NS
5 16.7 X²=1.431,df=
4 13.3 5.67 P<0.05 NS
10 33.33
From this study it is concluded that aromatherapy is
effective in reducing the amount of anxiety among the
adults. Using aromatherapy for anxiety is a pleasurable
10
6.7
0
13.3
4
4
6
7
13.3 X²=2.013,df=
13.3 6.75 P<0.05 NS
20
23.4
10
20
0
0
5
12
0
4
16.7 X²=2.715,df=
40 5.99 P<0.05 NS
0
13.3
1. Farrer,halls 2006, retrieved on jan2012frombooks.
10
20
14
7
46.7 X²=0.0325,df
23.3 =3.84P<0.05 NS
2. Post-traumatic stress disorder and anxiety Indian
and effective complement to holistic natural remedies for
anxiety relief
REFERENCES
google.com /books/about/The_Aromatherapy_Bible.
html?id=nEYBCER-apYC
JPsychiatry 2010;52 retrieved on jan 2012 from
association between the effectiveness of aromatherapy
on level of anxiety with the socio demographic variables
like age, sex, religion, education, occupation, marital
status, area of living at p< 0.05 level of significance
FINDINGS OF THE STUDY
1. In the demographic variables majority of the adults age
in experimental group 18(60% ) & in control group
13(43.3%)were between 31-40yrs.In age majority of them
in experimental group 19 (47.3% ) & in control group
16(53.3%)were females. In religion majority of them in
experimental group 22 (73.3% ) & in control group
18(60%) were hindu. With regard to educational status
majority of them in experimental group 14 (46.7% ) had
intermediate education & in control group 13(43.3%) gad
academic.research.microsoft.com/Author/25462257/
anastasia-soureti 3
3.Perry N, Perry E ,Aromatherapy in the management of
psychiatric disorders: clinical and neuropharmacological
perspectives. 2006;20(4):257-80.retrieved on jan 2012 from
www.ncbi.nlm.nih.gov/pubmed/16599645
4.Seligman, M.E.P., Walker, E.F. & Rosenhan, D.L..Ab
normal psychology, (4th ed.) New York: W.W. Norton
& Company, Inc
7
Title of the Research study: An Epidemiological Survey to determine the prevalence
of consumption of fast food among children and their knowledge regarding the
food they eat.
food advertisements viewed by children. Vast majority of
working parents with school age children get less time to
spend with their children so the traditional food skills are
not passed on to them. Children are not aware of what
they eat affects how they grow, feel and behave, hence
the need for the study.
The aim of the study was to determine the
prevalence of consumption of fast food among children
and their knowledge regarding the food they eat.
METHODS: A total population from ten different schools
comprising of 2250 children aged between 11 and 15 years
(convenient sampling method), from schools in Chennai
were included in the study.
The primary hypothesis was that the subjects consumed
fast food more due to the advent of television leading to
promotion of such foods through television.
In this study, mothers of the children provided information
on their dietary intake. Knowledge regarding the type of
food consumed by them was obtained by a questionnaire
in the local language. The study also sought information
as to from where each food was obtained and if the
advertised food was included in the diet.
RESULTS: Of the screened population nearly 55% were
males and 45% were females. Fast food prevalence was
high among all age groups and both the genders. Children
as fast food consumers, consumed less of fresh fruits and
vegetables with less of fluid milk intake (Fig. 1). Nearly
60% of these children consumed fast food on a daily
basis. All the children had an inclination for snacks and
J. Edna Sweenie,
MSc.N,(PhD)
Professor & HOD,
Dept of C H N,
MIOT College of Nursing,
Chennai-89.
ORIGINAL ARTICLE
Title of the Research study: An Epidemiological Survey to
determine the prevalence of consumption of fast food
among children and their knowledge regarding the food
they eat.
Abstract: The lure of convenience in addition to good
taste gets people to junk food addiction. With the advent
of television children have become more aware of the
fast food items available. Children watch television where
fast food continues to dominate the food advertisements
viewed by children. The easily available fast food in and
around school campus and with little knowledge of the far
reaching effects of these food items consumed, children
fall an easy prey to junk food. Children are unaware of
the food they eat and the effects it has on their growth
and development. This survey reflects the large
percentage of children who surrender to the temptation of
junk food consumption with little knowledge of its far
sighted effects on their health.
Key words: Junk food, Television, Nutritional behavior,
Children.
BACKGROUND
“Are we aware of what we are, we are what we eat”
Childhood years are a time of steady growth; good
nutrition is a high priority. Metamorphosis of food habits
has led to the replacement of nutritious food by things that
are tasty, convenient, in vogue-junk food. Food high in salt,
sugar, fat or calories and low nutrient content is called
junk food. Junk foods provide suboptimal nutrition with
excessive fat, sugar, or sodium per kcal. Such poor diets
can slow growth, promote obesity; sow the seeds of
diseases like diabetes, hypertension, cardiac problems and
osteoporosis. An increase in the energy density of food
consumed, a decrease in satiety, passive over consumption
is a significant outcome. Artificial food colors cause
learning disabilities due to lapses in concentration.
Convenience, fast foods and sweets continue to dominate
8
25% skipped meals for fast food. 58% of the children
were advised by their parents not to have these foods.
Inspite of advising the children, 75% of the parents bought
snacks for their children at least once a week. 23.52% of
the children purchased snacks for themselves as these
were readily available in the school premises (Fig. 2).
More than 50% of the children watched fast food
being advertised on the television. Candy, sweets, breads,
fast foods were advertised more frequently with little
representation of fruits and vegetables. As high as 70%
were not aware of the nutritional content of this food
consumed by them.
DISCUSSION: Fast food has become a prominent
feature of the diet of children in India and, increasingly,
throughout the world. Many studies have examined the
effects of fast-food consumption on any nutrition or
health-related outcome. This epidemiological study
comprised screening of two thousand two hundred and
fifty children of age 11-15 years depicting a high
prevalence of consumption of junk food by children . Some
previous studies have pointed out junk food eating gives
more total energy and poorer diet quality.
Children and junk food have a strange affinity to each
other and this addiction is made obvious by the percentage
of children fond of it. Nearly 50% of children had a daily
consumption of junk food without realising the ill effects
of it on their health. Junk food does not provide essential
nutrients but satisfies the appetite. Eating in between
meals is one of the causes of unwanted obesity. With over
sustained periods of junk food eating, blood circulation
drops due to fat accumulation, obesity a common problem
which has taken its toll along with malnutrition.
Statistics of the study show that parents themselves
purchased fast food for their children atleast once a week
which could be attributed either to the likeness expressed
for junk food or the undermining of food habits by the
busy jet age setting in. Vast number of children purchased
these unhealthy items themselves with very few knowing
that these choices were unhealthy. So, adults occupy a
central position in the process of modification of
nutritional behavior. Student scores regarding the
question if their parents advised them not to eat fast food
does not relate to the purchase of such food by parents
themselves. Parents are to be warned of the dangers of
giving their young children drinks, sweets and cakes
containing specified artificial additives. Findings confirm
their link with hyperactivity and disruptive behavior.
Junk food diet is a major cause of heart diseases as
pointed out by many studies. High cholesterol from junk
food strains liver and damages it eventually. In Indian
scenario, improved marketing strategies and increased
transport facilities have brought food materials like bread
and chocolates to even the remotest villages. Television is
one such medium of propagating many of these food items.
Awareness on junk food is lacking dramatically in
every part of society. Noticed in a large percentage of
children was daily consumption of more than one
chocolate. Most of the children believed that these
advertisements propagated food materials which were
healthy.
CONCLUSION: Children in schools liked junk food but
they preferred to have these in between meals. Parents
bought fast food items for the children and majority of
children bought it for themselves as it was readily
available around.Children had such food items almost daily
and parents were aware of it.Majority of the children
watched advertisements on television and believed that
the food advertised was healthy.
RECOMMENDATIONS
First and foremost step to be taken is to create awareness.
Prohibit fast food advertisements and promotions directed to
children on television. Consumers need more guidance in
making food choices for themselves and their children.
Nutritious and healthy food habits must be cultivated in
children. Even parents and schools can play a part by imparting
knowledge about nutrition.
Education of school children with audio visual aids on the
harmful of effects of this junk food eating is highly recommended.
Excellent food choices at schools provided in snack machines,
stores and cafeterias would foster their consumption.
Traditional, Indian diet is balanced with lots of fibrous
components and should not be replaced by high refined sugar
foods. Components in traditional diets that may favor oral health
need to be identified and propagated.
Communities,schools,legislative bodies,movies,television,and
food companies should partner in promoting healthful food
choices.
Potent organizations like World Health Organization should
deal with such universal problems aggressively.
Develop awareness for fitness.
Research and survey on a larger scale needs to be carried out
and the results made public effectively.
REFERENCES
1. Anderson W, Patterson. Snack foods: Comparing nutrition
values of excellent choices and “Junk foods”, Metabolic
Research Group, University of Kentucky, Lexington.
2. Bowman, et al. Fast food and obesity in children. Peadiatrics
2004;113(1),132.
3.Debby Demory. Fast food and children and adolescents:
Implications for Practitioners.Clinical Pediatrics,5 2005;vol.44:
279 - 88.
4. Harrison K,Marske AL,Nutritional content of foods
advertised during the television programmes children watch
most. Am J Public Health 2005;95(9):1568-74.
5. Hill, Andrew J. Developmental issues in attitudes to food.
Journal of the American College of Nutrition, 2005;24(3) 155- 56.
6. Jackson P, Romo MM, Castillo MA, Castillo-Duran C. Junk
food consumption and child nutrition.Nutritional anthropological
analysis. Rev Med Chil 2004;132(10): 1235-42.
7. Misra A,Basit,Vikram N,Sharma.High prevalence of obesity
and associated risk factors in urban children in India and Pakistan highlights immediate need to initiate primary prevention
program for diabetes and coronary heart disease in schools.
Diabetes Research and Clinical Practice,Volume 71,Issue1,Pages101-02.
9
TUBAL LIGATION REVERSAL
Ms. MEKALA. M.,
M.Sc(N)., Asst. Professor,
OBG Dept,
Narayana College of
Nursing, Nellore.
Tubal reversal, also called tubal sterilization reversal or
tubal ligation reversal, is a surgical procedure that attempts
to restore fertility to women after a tubal ligation. By
rejoining the separated segments of fallopian tube, tubal
reversal may give women the chance to become
pregnant again.
TUBAL REVERSAL SURGERIES: Tubal reversal
surgeries utilize the techniques of microsurgery to open
and reconnect the fallopian tube segments that remain after
a tubal sterilization.
Tubotubal anastomosis: Following a tubal ligation, there
are usually two remaining fallopian tube segments-the
proximal tubal segment that emerges from the uterus and
the distal tubal segment that ends with the fimbria next to
the ovary. After opening the blocked ends of the
remaining tubal segments, a narrow flexible stent is gently
threaded through their inner cavities or lumens and into
the uterine cavity. This ensures that the fallopian tube is
open from the uterine cavity to its fimbrial end. The newly
created tubal openings are then drawn next to each other
by placing a retention suture in the connective tissue that
lies beneath the fallopian tubes(mesosalpinx).Microsurgical
sutures are used to precisely align the muscular portion
(muscularis externa)and outer layer(serosa),while
avoiding the inner layer(mucosa)of the fallopian tube.The
tubal stent is then gently withdrawn from the fimbrial end
of the tube.
10
Tubouterine implantation: In a small percentage of
cases, a tubal ligation procedure leaves only the distal
portion of the fallopian tube and no proximal tubal
segment. This may occur when monopolar tubal
coagulation has been applied to the isthmic segment of
the fallopian tube as it emerges from the uterus. In this
situation, a new opening can be created through the
uterine muscle and the remaining tubal segment inserted
into the uterine cavity. This microsurgical procedure is called
tubouterine implantation.
Laparoscopic tubal reversal: Laparoscopic Tubal
Reversal is a minimally-invasive surgical procedure
(laparoscopy), using small, specially-designed instruments
to repair and reconnect the fallopian tubes.
After general anesthesia has been administered, a 10mm
(less than ½-inch) tube (trocar) is inserted just at the lower
edge of the navel, and a special gas is pumped into the
abdomen to create enough space to perform the
operation safely and precisely. The laparoscope
(a telescope), attached to a camera, is brought into the
abdomen through the same tube, and the pelvis and
abdomen are thoroughly inspected. The fallopian tubes
are evaluated and the obstruction (ligation, burn, ring, or
clip) is examined. Three small instruments (5mm each,
less than ¼-inch) are used to remove the occlusion and
prepare the two segments of the tube to be reconnected.
Once the connection (anastomosis) is completed, a blue
dye is injected through the cervix, traveling through the
uterus and tubes, all the way to the abdomen. This is to
make sure the tubes have been aligned properly and that
the connection is working well.
Patients are seen between 5–7 days after the operation to
look at the small incisions and remove any stitches if
necessary. Most of the time, the few stitches that were
placed will be under the skin and will be absorbed by the
body, without need for removal.
Patients should wait two to three months prior to
attempting pregnancy in order to give the tubes a chance
to heal completely. Trying to conceive before could result
in an increased risk of ectopic pregnancy (pregnancy
inside the fallopian tube instead of in the uterus).
When performed by a trained laparoscopic tubal reversal
surgeon, laparoscopic tubal reversal combines the
success rates of micro-surgical techniques with the
advantages of minimally-invasive surgery - namely faster
recovery, better healing, less pain, fewer complications,
and no large disfiguring scars.
Robotic assisted tubal reversal: Robotic assisted
tubal reversal surgery is a surgical procedure in which the
fallopian tubes are repaired by a surgeon using a remotely
controlled, robotic surgical system.
The robotic system involves two components: a patient
side-cart (also referred to as the robot) and a surgeon's
console. The robot is placed adjacent to the patient and
has several attached arms. Each arm has a unique
surgical instrument and performs a specialized surgical
function. The surgeon sits near the patient at the surgeon's
console and visualizes the surgery through a monitor. The
surgeon performs the entire reversal surgery using
controllers located inside the surgeon's console.
Robotic surgery experts have suggested robotic tubal
ligation reversal offers the advantage of smaller incisions
when compared to traditional laparotomy tubal reversal
surgery. These smaller incisions have been reported to
result in less pain and quicker return to work after robotic
tubal reversal when compared to traditional tubal ligation
reversal using larger abdominal incisions. The potential
disadvantages to robotic surgery are longer operating times
and higher costs.
A retrospective, Cleveland Clinic study compared 26
patients who underwent robotic assisted tubal reversal to
41 patients who underwent outpatient mini-laparotomy
(abdominal incision) tubal reversal. Robotic tubal reversal
patients, when compared to abdominal tubal reversal
surgery patients, had longer times under anesthesia (283
minutes vs 205 minutes) and longer times in surgery (229
minutes vs 181 minutes). On average, robotic tubal
reversal patients returned to work one week sooner than
abdominal tubal reversal patients and the robotic tubal
reversal surgeries were also more expensive than
abdominal tubal reversal surgeries.[4]
An Overview of Tubal Reversal Surgery
 Tubal reversal surgery is performed on women who
have previously undergone tubal ligation surgery and wish
to reverse the process.
 During tubal ligation surgery, the fallopian tubes are
typically blocked or tied so that the eggs cannot travel to
them, thus preventing fertilization. Tubal reversal surgery
allows for the blocked or tied fallopian tubes to be
reconnected so that women can restore their fertility.
 Surgeons use microsurgical tools, such as small
instruments and surgical magnification glasses, to repair
blocked fallopian tubes. These advanced tools allow for
smaller incisions and a faster recovery time.
 Recovery typically takes 1-3 days. Women who
undergo tubal ligation surgery should not engage in
vigorous exercise for a couple of days afterwards.
 According to the Department of Obstetrics and
Gynecology at the Penn State Milton S. Hershey Medical
Center, pregnancy rates range from 45-80% twelve months
after tubal ligation reversal.
Before surgery
11
 Getting Informed consent from the patient; Vital signs
should be checked
 The patient may be given medicine right before
procedure or surgery. This medicine may make her feel
relaxed and sleepy.
After surgery: After surgery the patient is watche closely
for any problems. The bandage keeps the area clean and
dry to help prevent infection.
 Food and drink after surgery: The patient will be
able to drink liquids and eat certain foods once stomach
function returns after surgery. The patient may be given
ice chips at first. Then they will get liquids such as water,
broth, juice, and clear soft drinks. If the stomach does not
become upset, they may then be given soft foods. Once
she can eat soft foods easily, may slowly begin to eat solid
foods.
 Medicines like Antibioics, analgesics, and antiemetics
can be provided.
Complications: The likelihood of actual complications
during surgery is small but include infection (1%),injury to
abdominal organs during surgery(<1%),failure of reversal
after surgery(10-30%)and the possibility that the
subsequent pregnancy may be an ectopic(tubal)pregnancy
(10-15%).
Post Tubal Ligation Syndrome : Sometimes, tubal
ligation reversal is desired not for the purpose of
having children, but to reverse the effects experienced
by many women of post tubal ligation syndrome. The
symptoms of post tubal ligaiton syndrome may include:
 Irregular, heavy, painful periods, and other menstrual
issues
 Symptoms of early onset menopause
 Severe or worsening of premenstrual syndrome
 Loss of libido Ectopic pregnancy
 Anxiety
 Vaginal dryness
 Palpitations  Hot flashes
 Cold flashes  Trouble sleeping
 Mood swings
BIBLIOGRAPHY:
1.http:/ /womenshea lth.a bout .com/ cs/su r ger y/a/
tubligreversalp.htm
2.http://www.qualitysurgeryindia.com/tubal-ligation-reversal-surgery-in-india/
3.http://www.webmd.com/infertility-and-reproduction/
guide/tubal-ligation-reversal?page=3
4.http://hospital.uillinois.edu/Patient_Care_Services/Obstetrics_ and_Gynecology/Our_Services/Reproductive_
Endocrinology_ and_Infertility/Tubal_Ligation_
Reversal.html
5.http://www.drugs.com/cg/laparoscopic-tubal-ligation-inpatient-care.html
6.http://www.uihealthcare.org/content.aspx?id=21838
7.http://www.mayoclinic.com/health/tubal-ligation-reversal/MY01048
“A study to assess the knowledge on first aid management among play school
teachers at selected playschools at Nellore District.”
Mrs. Radhika Anantha krishna,
Vice Principal,
Narayana College of Nursing,
Nellore.
INTRODUCTION
First aid management is the temporary and immediate
treatment given to a person who is injured or suddenly ill,
using facilities or materials available at that time before
regular medical help is impacted. The first aid itself
signifies that the casualty is in need of secondary aid.
School teachers have a pivotal role in dissemination of
knowledge and development of positive attitude towards
any disease among school children. There is a definite
need for an intensive health education considering every
disease as serious and take emergency care rather than
neglecting the myths and misconceptions. They can play
a key role in first aid management of accidental injury
and threats among school children. The teacher, can also
play a role of first aider, a first aider is just a common
person who may have learnt a standard method of
application of first aid best suited to his skill.
First aid is the provision of initial care for an illness or
injury. It is usually performed by non expert, but trained
personnel to a sick or injured person until definite medical
treatment can be assessed. Certain self limiting illness or
minor injuries may not require further medical care past
the first aid intervention. First aid makes the difference
between life and death, sometimes, more recently, with a
children , it is clear that a little knowledge of first aid will
go a long way in saving lives.
PROBLEM STATEMENT: “A study to assess the
knowledge on first aid management among play school
teachers at selected playschools at Nellore District.”
OBJECTIVES
 To assess the level of knowledge regarding first aid
management among play school teachers.
 To find association between the level of knowledge
and the selected socio demographic variables.
OPERATIONAL DEFINITIONS
PLAY SCHOOL: It refers to a regular supervised play
sector for children of 1-3years.
12
FIRST AID MANAGEMENT
First aid management is defined as the temporary and
immediate treatment given to a person who is injured or
suddenly becomes ill, using facilities or materials available
at that time before regular medical help is impacted.
TEACHER
It refers to the individual who provide care and guidance
for children in play schools.
ASSUMPTIONS
The play school teachers may have inadequate
knowledge regarding the first aid management of children.
DELIMITATIONS
1. The present study is delimited to selected play school
at Nellore only.
2. The sample size is limited to 30 teachers only.
PROGECTED OUTCOME
The study will help to determine the knowledge of play
school teachers regarding first aid management.
METHODOLOGY
RESEARCH APPROACH: Quantitative Approach .
RESEARCH DESIGN: Non experimental descriptive
design .
TARGET POPULATION: The population consists of
play school teachers.
SETTING
The study was conducted in selected play
schools - Mathru Sree play school at Venkatachalam and
Blossom school at Balaji Nagar.
SAMPLE SIZE
The sample size of the study was 30 play school
teachers who met the inclusion criteria.
SAMPLE TECHNIQUE
The convenient sampling technique was used for
selection of subjects for the study.
DESCRIPTION OF TOOL
The investigator developed a structured questionnaire
to assess the level of knowledge regarding first aid
management in children.
Tool consists of 2 parts.
Part-I: Deals with demographic variables consist of age,
sex, religion, experience in first aid management,
education of teachers and mothers etc.
Part-II: Consist of 36 questions on selected emergencies
among play school children to assess the knowledge
regarding first aid management.
METHOD OF DATA COLLECTION
Formal permission was obtained from concerned
authority. The purpose and benefits of the study was
explained to subjects and consent was obtained from the
play school teachers to participate in the study. The data collection procedure was carried out in the Mathura Sree play
school at Venkatachalam and Blossom School at Balaji Nagar.Data was collected by using the structured questionnaire
on first aid management. Data collection procedure was carried out for a period of 1 week(31/1/|12)-(6/2/12). The
time duration taken for each sample was 45 minutes.
Table 1. Frequency and percentage distribution of level of knowledge regarding first aid management.
Table-1 shows that among 30 teachers 16.7% (5) had good knowledge, 60% (18) had good moderate knowledge
and23.3% (7) had inadequate knowledge and had
moderate knowledge in first aid management.
Sl. Level of
Frequency Percentage Mean SD
The table - 1 Shows mean of good knowledge was 29.6
knowledge
with SD of 0.9 and the mean of moderate knowledge
was with 26.3 with SD of 14.4.and the mean of
1 Good
5
16.7%
29.6
0.9
inadequate knowledge 20.14 SD with 1.2.
2 Moderate
18
60%
26.33 14.4
Table - 2 Association between socio demographic
3 Inadequate
7
23.3%
20.14 1.2
variables and level of knowledge
Table.2 Shows that, association between socio demographic variables and level of knowledge was assessed by chi
S. No
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Demographic variables
Inadequate
F
%
Age
a) <20-25 yrs
0
0
b) 26-30 yrs
4
13.3
c) 31-35yrs
2
6.66
d) >35yrs
1
3.33
Gender
a) Male
0
0
b) Female
7
23.3
Education
a) Intermediate
5
16.6
b) Degree
1
3.33
c) Postgraduate
1
3.33
Income
a) 2000-3500
6
20
b) 3500-4000
0
0
c) 4000-5000
1
3.33
d) >5000
0
0
Religion
a) Hindu
5
16.6
b) Christian
1
3.33
c) Muslim
1
3.33
Place of residence
a) Urban
4
13.3
b) Rural
3
10
Experience at play school teachers
a) 1-2yrs
2
6.66
b) 3-4yrs
3
10
c) 5-6yrs
1
3.33
d) >6yrs
1
3.33
Training in first aid management
a) Yes
7
23.3
b) No
0
0
Have you given first aid treatement to anybody
a) Yes
7
23.3
b) No
0
0
Source of information
a) Television
4
13.3
b) Magazine
0
0
c) Others
3
10
Moderate
F
%
Good
F
Chi - Squre
%
2
13
3
0
06.66
43.3
10
0
0
4
1
0
0
13.3
03.3
0
0
18
0
60
0
5
0
16.6
8
8
2
26.6
26.6
06.66
0
5
0
0
16.66
0
12
5
1
0
40
16.6
3.33
0
4
0
1
0
13.3
0
3.33
0
14
3
1
46.6
10
3.33
5
0
0
16.66
0
0
5
13
16.6
43.3
1
4
3.33
13.3
8
9
1
0
26.6
30
3.3
0
1
3
1
0
3.3
10
3.33
0
18
0
60
0
5
0
16.6
0
18
0
60
0
5
0
16.6
0
4
6
8
13.3
20
26.6
2
2
1
6.66
6.66
3.33
Chi - Square = 5.68
S
NS
Chi - Square = 8.74
NS
Chi - Square = 4.67
NS
Chi - Square = 1.93
6df = 12.59
NS
Chi - Square = 2.43
NS
Chi - Square = 9.73
NS
Chi - Square = 0
13
Chi-square = 0
non significant
Chi - Square = 5.68
NS
square test. There is no significant relationship between
socio demographic variables such as age of the teacher,
gender, education, income, religion, place of residence,
experience year of play school teachers and training in
first aid management.
MAJOR FINDINGS OF THE STUDY
The first objective of the study was to assess the
level of knowledge regarding first aid management
among play school teachers:With regard to the level of
knowledge of play school teachers at Nellore
district,16.7%(5)good knowledge in first aid management,
60%(18)teachers had moderate knowledge,23.3%
(7)teachers had inadequate knowledge in first aid
management of children.
The second objective of the study was to find
association between the level of knowledge and the
selected socio demographic variables.
In this there is no significant association between the level of
knowledge regarding first aid management with demographic
variables such as age of the teacher, gender, education, income,
religion, place of residence, experience of play school teachers and
training in first aid management.
RECOMMENDATIONS
1. The similar study can be conducted with a large samples
in different settings.
2. Interventional studies can be conducted on management
of common accidents among school teachers.
3. A comparative study can be done among school
children in rural and urban areas
4. Effectiveness of video assisted teaching on first aid
management can be conducted among school teachers.
5. Effectiveness of structured teaching programme on
first aid management can be done among school teachers
CONCLUSION: The study indicates that the play school
teachers must be educated and trained in first aid management of
common emergencies in children.
REFERENCES: 1. L.C Gupta, Abhitabh Gupta (2002)
st
Manual on first aid, 1 edition, New Delhi, Jaypee Publishers, Page no.1-5, 196, 255-271.
2. Kusum Samant (2004) “First aid manual accident and
st
emergency”, 1 edition, Vota Medical Publishers, New Delhi,
Page no.1-9, 119, 132.
3. Norman G. Kirby and stephen J Mather of Baillieres hand
th
book of first aid”, 7 edition Jaypee Publishers, New Delhi,
Page no.3-8, 258, 279.
th
4. Ghai O.P. “Essential paediatrics”, 6 edition published
by CBS publications, Page no388.
5.Denise F. Polit, Cherhatano Beck (2004) “Sampling
th
designs nursing research”, 7 edition, Philadelphia Lipincott,
Publications, Page no.300-496.
th
6.Wongs (2003) “Nursing care of infants children”, 7
edition, Elsevier, Publications, Page no.1343-1410.
14

WORLD POPULATION DAY
The World Population Day was organized
by District Medical Health Officer in Town Hall Nellore
at 9.00am to 1.00 pm.Narayana College of Nursing
2nd year students along with faculties Ms. Vineela,
CHN Dept. were participated in the programme,
THEME : SMALL FAMILY: HAPPY FAMILY, Chief guest
was Mr. SRIKANT I.P.S. and Joint - Collector
Mr.Lakshmi kantham Given awards to the students
for winners in Essay competition theme on - Small
family:Healthy family., our students from Narayana
College of Nursing got 1st prize and 2ndprize. Given
appreciation award for Narayana College of
Nursing f or voluntary, regular, and active
participation in all National health programmes.
MENTALLY HEALTHY PERSON
Prof., A.Tamil Selvam
Dept. of Psychology,
Narayana College Of Nursing,
Nellore.
The World Health Organization defines mental health as
a state of physical, mental, spiritual and social wellbeing in
which the individual realises his or her own abilities, can
cope with the normal stresses of life, and is able to make
a contribution to their community. Mental health and
wellbeing is a combination of both positive feelings and
positive functioning.
Mental health and wellbeing is an indivisible part of
general health and a fundamental right of every human
being. Essential for the optimal functioning of individuals,
families, communities and societies, it is everybody's
concern and responsibility.
CHARACTERISTICS OF MENTALLY HEALTHY
PERSON
They feel good about themselves:
1. They are not overwhelmed by their own emotions-fears,
anger, love, jealousy, guilt or worries.
2. They can take lifeÕs disappointments in their stride.
3. They have a tolerant, easy-going attitude towards the
selves as well as others and they can laugh at themselves.
4. They neither underestimate nor overestimate their abilties.
5. They can accept their own shortcomings.
6. They have self-respect.
7. They feel able to deal with most situations.
8. They can take pleasure in simple, everyday things.
They feel comfortable with other people:
9. They are able to give love and consider the interests of others.
10. They have personal relationships that are satisfying and lasting.
11. They like and trust others, and feel that others will like
and trust them.
12. They respect the many differences they find in people.
13. They do not take advantage of others nor allow
others to take advantage of them.
14. They feel they can be part of a group.
15. They feel a sense of responsibility to fellow human
beings.
15
They are able to meet the demands of life:
16. They do something about their problems as they arise.
17. They accept their responsibilities.
18. They shape their environment whenever possible; they
adjust to it whenever necessary.
19. They try to plan ahead and do not fear the future.
20. They welcome new experiences
and new ideas.
21. They use their talents.
22. They set realistic goals for
themselves.
23. They are able to make their
own decisions.
24. They put their best effort
into what they do, and get
satisfaction from doing it.
PRINCIPLES OF MENTALLY HEALTHY PERSON
1 RESPECT AND PARTICIPATION:People with
mental health problems /mental health illness,there
families and carers are treated with dignity and respect
and their participation all aspects of life is acknowledged
and encouraged as fundamental to build good mental health
and to enrich community life
2 ENGAGEMENT: People with mental health problems /
mental health illness,there families and carers are engaged
as genuine partners and advising and leading mental health
developments at individual,community and service system
levels.
3 DIVERSITY:the unique needs and circumstances of
the people from diverse backgrounds are acknowledged
including people with aboriginal or from culturally and
linguistically diverse backgrounds,people with disability and
people of diverse gender orientation and responsive
approaches developed to meet there needs.
4 QUALITY OF LIFE:by developing personal resilience
and optimism,maintaining meaningful relationships,having
access to housing and employment,opputunities
tocontribute and engage within the community and
access to high mental health services when
needed,individuals can build healthy and satisfying life
despite experiencing mental health problems
5 QUALITY AND BEST PRACTICE:Mental Health
Programmes Are Everywherebasd On Contemporary
Best Practice,easily accessed and delivered in a timely
and collaborative way.
PROTECTIVE AND RISK FACTORS FOR MENTAL
HEALTH WELLBEING
The Melbourne Charter for Promoting Mental Health and
Preventing Behavioural Disorders identifies the following
risk and protective factors for mental health and wellbeing.
PROTECTIVEFACTORS
Arts and cultural engagement
Childhood: positive early
childhood experiences,
maternal attachment
Cultural identity
Diversity: welcomed,
shared, valued
Education: accessible
Environments: safe
Empathy
Empowerment and self
determination
  Family: resilience,
parenting competence,
positive relationship with
parents and/or other family
members
  Food: accessible,
quality
  Housing: affordable,
accessible
Income: safe, accessible
employment and work
conditions
Personal resilience and
social skills
Physical health
Respect
  Social participation:
supportive relationships,
involvement in group and
community activity and
networks
 Sport and recreation:
participation and access
 Transport: accessible
and affordable
 Services: accessible
quality health and social
services
Spirituality
DETERMINANTS OF MENTALLY AND PHYSICALLY
HEALTHY PERSON
RISKFACTORS
  Alcohol and drugs:
access and abuse
Disadvantage: social and
economic
Displacement: refugee
and asylum-seeker status
Disability
  Discrimination and
stigma
  Education: lack of
access
Environments: unsafe,
ov ercrowded, poorly
resourced
Family: fragmentation,
dysf unction and child
neglect,post-natal
depression
 Food: inadequate and
inaccessible
Genetics
Homelessness
Isolation and exclusion:
social and geographic
  Natural and humanmade disasters
Peer rejection
Political repression
Physical illness
Physical inactivity
  Pov erty: social and
economic
Racism
 Unemployment: poor
employment conditions
and insecure employment
Violence: interpersonal,
intimate and collective; war
and torture
Work: stress and strain
POPULATIONS
Populations f or
mental health promotion include:
children
young people
  women and
men
older people
  Indigenous
communities
  culturally diverse communities
rural communities.
People at most
risk include: Indigenous people,
people with mental illness, children
and young people
(including same
sex attracted),
people with disabilities, elderly
people, homeless
people, refugees
and migrants,
SETTINGS
ACTIONS
Mental health pro- Health promotion
action
areas
motion occurs in include:
ÔeverydayÕ con- direct participation programs
texts, including:
 organisational
housing
development (including workforce
community
development)
education
strengthening of
communities and
workplaces
community
sport and rec- environments
legislative and
reation
policy reform
health
  communicatransport
tions and social
marketing
corporate
advocacy
public space research, monitoring and evaluaarts
tion.
 local governpromoting menment
tal health literacy
 targeted skills
justice
and resilience
technology.
building.
CONCLUSION
Internal or external factors have shaped your mental and
emotional health, itÕs never too late to make changes that
will improve your psychological well-being. Risk factors
can be counteracted with protective factors, like strong
relationships, a healthy lifestyle, and coping strategies for
managing stress and negative emotions.
BIBLIOGRAPHY
1. http://www.thehealthnews.co.uk/category/mental
health-news/
2. http://www.psychologytoday.com/blog/compassion
matters /201302/what-is-mentally-healthy-person
3.http://www.mentalhealth.wa.gov.au/mental_illness
_and_health/mh_whatis.aspx
4. http://motivcoach.wordpress.com/2011/08/22/6
charateristics-of-the-mentally-healthy-person/
5. http://www.healthypeople.gov/2020/LHI/mental
Health.aspx
6. http://www.helpguide.org/mental/mental_emotional
health. htm
16
STEM CELL TRANSPLANTATION
Mrs. A. Latha
M.Sc (N),
HOD, Medical Surgical
Nursing, Professore,
Narayana College of
Nursing, Nellore.
INTRODUCTION
Stem cell transplants are sometimes used to treat
lymphoma patients who are in remission or who have a
relapse during or after treatment. Although only a small
number of patients with lymphoma are treated with this
therapy, this number is growing. Stem cell transplants
allow to use higher doses of chemotherapy (and
sometimes radiation) than would normally be tolerated.
High-dose chemotherapy destroys the bone marrow, which
prevents new blood cells from being formed. This could
lead to life-threatening infections, bleeding, and other
problems due to low blood cell counts.Stem cells are very
primitive cells that can create new blood cells.
DEFINITION:
• A stem cell transplant is a procedure that is used in
conjunction with high-dose chemotherapy, which is
frequently more effective than conventional chemotherapy
in destroying myeloma cells. Because high-dose
chemotherapy also destroys normal blood-producing stem
cells in the bone marrow, these cells must be replaced in
order to restore blood cell production.
BLOOD-FORMING STEM CELLS USED FOR A
STEM CELL TRANSPLANT CAN COME FROM:
The blood (for a peripheral blood stem cell transplant,
or PBSCT)
The bone marrow (for a bone marrow transplant, or
BMT)
Umbilical cord blood (for a cord blood transplant)
Most stem cell transplants are now PBSCTs.
STEM CELLS
Stem cells are a remarkable type of cell that can divide
and develop into any one of the three main types of cells
found in the blood:
Red blood cells, White blood cells, and Platelets.
USES:
A stem cell transplant may be necessary if the bone
17
marrow stops working and doesn’t produce enough
healthy stem cells.
 A stem cell transplant also may be performed if
high-dose chemotherapy or radiation therapy is given in
the treatment of blood disorders such as leukemia,
lymphoma or multiple myeloma.
A stem cell transplant can help your body make enough
healthy white blood cells, red blood cells or platelets, and
reduce your risk of life-threatening infections, anemia and
bleeding.
TYPES OF STEM CELL TRANSPLANTS:
There are many types of stem cell transplants. This
section defines each of the various types of transplants.
First, stem cell transplants are defined by the source of
the stem cells.
Bone marrow transplants are those that are obtained from
the bone marrow. However, they are rarely performed
today in myeloma because of the ability to collect stem
cells from the peripheral blood (see below). Bone marrow transplants are sometimes used if insufficient numbers of stem cells can be obtained from the peripheral
blood.
Peripheral blood stem cell (PBSC) transplants are
obtained from the peripheral blood. PBSC transplants are
now performed much more often than bone marrow
transplants because they are easier to collect, they
provide a more reliable number of stem cells, the
procedure puts less strain on the donor’s system, and the
patient recovers more quickly
Cord blood transplants refer to transplants where the stem
cells are obtained from umbilical cord blood.
Historically they have not been used frequently due to
limited numbers of stem cells that can be collected from
each umbilical cord. Recently, however, exciting new data
have been generated using multiple cord blood units from
more than one donor.
There are 2 main types of stem cell transplants. The
blood-forming stem cells come from different sources.
AUTOLOGOUS STEM CELL TRANSPLANT
In an autologous stem cell transplant, the patient’s
own stem cells are removed from his or her bone marrow
or peripheral blood. They are collected on several
occasions in the weeks before treatment. The cells are
frozen and stored while the person gets treatment (high
dose chemotherapy and/or radiation) and are then reinfused
into the patient’s blood.This is the most common type of
transplant used to treat lymphoma, but it generally isn’t an
option if the lymphoma has spread to the bone marrow or
blood. If that occurs, it may be hard to get a stem cell
sample that is free of lymphoma cells. Even after purging
(treating the stem cells in the lab to kill or remove
lymphoma cells), it’s possible to return some lymphoma
cells with the stem cell transplant.
ALLOGENEIC STEM CELL TRANSPLANT
In an allogeneic stem cell transplant, the stem cells
come from someone else. The donor’s tissue type (also
known as the HLA type) needs to match the patient’s
tissue type as closely as possible to help prevent the risk
of major problems with the transplant. Usually this donor
is a brother or sister if they have the same tissue type as
18
the patient. If there are no siblings with a good match, the
cells may come from an HLA-matched, unrelated donor
a stranger who has volunteered to donate their cells.
The stem cells for an allogeneic SCT are usually
collected from a donor ’s bone marrow or peripheral
(circulating) blood on several occasions. In some cases,
the source of the stem cells may be blood collected from
an umbilical cord (the cord that attaches a baby to the
placenta) after a baby is born. This blood is rich in stem
cells. Regardless of the source, the stem cells are then
frozen and stored until they are needed for the transplant.
NON-MYELOABLATIVE TRANSPLANT
(MINI-TRANSPLANT):
This is a type of allogeneic transplant in which lower
doses of chemo and radiation are used than in a standard
SCT. These lower doses do not completely destroy the
cells in the bone marrow. When the donor stem cells are
given, they enter the body and establish a new immune
system, which sees the lymphoma cells as foreign and
attacks them (a “graft-versus-lymphoma” effect).
Doctors have learned that if they use small doses of
certain chemo drugs and low doses of total body radition,
an allogeneic transplant can still sometimes work with less
serious side effects.
This type of transplant may be an option for some
patients who couldn’t tolerate a regular allogeneic
transplant because it’s too toxic. In fact, a patient can
receive a non-myeloablative transplant as an outpatient.
The major side effect is graft-versus-host disease, which
can be serious .Non-myeloablative transplants are not a
standard treatment for patients with lymphoma, but they
may help some patients.
Possible side effects
Side effects from a stem cell transplant are generally
divided into early and long-term effects.
Low blood cell counts (with fatigue and increased risks
of infection and bleeding)
Nausea and vomiting,Loss of appetite,Diarrhea,Mouth
sores,Hair loss
 One of the most common and serious short-term
effects is the increased risk for infection. Antibiotics are
often given to try to keep this from happening. Other side
effects, like low red blood cell and platelet counts, may
require blood product transfusions or other treatments.
Long-term side effects: Some complications and side
effects can persist for a long time or may not occur until
months or years after the transplant. These include:
Graft-versus-host disease (GVHD), which occurs only in
allogeneic transplants, Infertility and premature menopausal
symptoms in female patients (caused by damage to the
ovaries),Infertility in male patients, Damage to the thyroid
gland that can cause problems with metabolism, Cataracts
,Damage to the lungs, causing shortness of breath,Bone
damage called aseptic necrosis (if damage is severe, the
patient may need to have part of the affected bone and
the joint replaced),Possible development of leukemia
several years later
Graft-versus-host disease (GVHD): This is one of the
most serious complications of allogeneic (donor) stem cell
transplants. It occurs because the immune system of the
patient is taken over by that of the donor. The donor
immune system then may recognize the patient’s own body
tissues as foreign and may react against them.
Symptoms can include severe skin rashes, itching, mouth
sores (which can affect eating), nausea, and severe
diarrhea. Liver damage may cause yellowing of the skin
and eyes (jaundice). The lungs may also be damaged. The
patient may also become easily fatigued and develop
muscle aches.
GVHD is often described as either acute or chronic,
based on how soon after the transplant it begins.Sometimes
GVHD can become disabling, and if it’s severe enough, it
can be life-threatening. Usually, immune-suppressing drugs
can be used to help control GVHD, although they may
have their own side effects.
THE TRANSPLANT PROCESS
There are several steps in the transplant process.
Patient evaluation and preparation
You will first be evaluated to find out if you are eligible for
a transplant. A transplant is very hard on your body. For
many people,transplants can mean a cure,bu
complications can lead to death in some cases. You will
want to weigh the pros and cons before you start.
Many different medical tests may be done, these might
include:
 HLA tissue typing,A complete health history and
physical exam,Evaluation of your psychological and
emotional strengths, Identifying who will be your primary
19
caregiver throughout the transplant process,Bone marrow
biopsy ,CT scan or MRI ,Heart tests, such as an EKG
(electrocardiogram) or echocardiogram, Lung studies, such
as a chest x-ray and PFTs (pulmonary function tests),
Consults with other members of the transplant team, such
as a dentist, dietitian, or social worker,Blood tests, such as
a complete blood count, blood chemistries, and screening
for viruses like hepatitis B, CMV, and HIV
Eligibility
Younger people, those who are in the early stages of
disease, or those who have not already had a lot of
treatment, often do better with transplants.
Some transplant centers set age limits. For instance,
they may not allow regular allogeneic transplants for people
over 50 or autologous transplants for people over 60or65.
Some people also may not be eligible for transplant if
they have other major health problems, such as serious
heart, lung, liver, or kidney disease.
PROCESS:The first step in the process of stem cell
transplantation is the collection of stem cells from a
patient or a donor. When a patient’s own stem cells are
used, they are frozen and stored until needed. Stem cells
can be collected from a donor when they are needed. The
patient then receives high-dose chemotherapy and the
stem cells are infused into the patient’s bloodstream. The
stem cells travel to the bone marrow and begin to produce
new blood cells, replacing the normal cells lost during high
dose chemotherapy.
Conditioning treatment
Conditioning, also known as bone marrow preparation
or myeloablation, is treatment with high-dose chemo and/
or radiation therapy. It’s done for one or more of these
reasons:
To make room in the bone marrow for the transplanted
stem cells
To suppress the patient’s immune system to lessen the
chance of graft rejection
To destroy all of the cancer cells anywhere in the
patient’s body
 No one conditioning treatment is used for every
transplant. Your treatment will be planned just for you
based on the type of cancer you have, the type of
transplant, and any chemo or radiation therapy you have
had in the past.
If chemo is part of your treatment plan, it will be given
in an intravenous (IV) line or as pills. If radiation therapy
is planned, it’s given to the entire body (called total body
irradiation or TBI).TBI may be given in a single treatment
session or in divided doses over a few days.
Infusion of stem cells: After the conditioning treatment,
you are given a couple of days to rest before getting the
stem cells. They will be given through your IV catheter,
much like a blood transfusion. If the stem cells were
frozen, you may get some medicines before the stem cells
are given. This is done to reduce your risk of reacting to
the preservatives that are used when freezing the cells. If
the stem cells were frozen, they are thawed in warm water
then given right away. For allogeneic or syngeneic
transplants, the donor cells may be harvested in an
operating room, and then processed in the lab. Once they
are ready, the cells are brought in and infused. The length
of time it takes to get all the stem cells depends on how
much fluid the stem cells are in.
Infusion side effects are rare and usually mild. The
preserving agent used when freezing the cells (called
dimethylsulfoxide or DMSO) causes many of the side
effects. You might have a strong taste of garlic or creamed
corn in your mouth. Sucking on candy or sipping flavored
drinks during and after the infusion can help with the taste.
Your body will also smell like this. The smell may bother
those around you, but you might not even notice it. The
smell, along with the taste, may last for a few days, but
slowly fades away. Often having cut oranges in the room
will offset the odor. Patients who have transplants from
cells that were not frozen do not have this problem because the cells are not mixed with the preserving agent.
Other short-term side effects of the stem cell infusion
might include:Fever or chills,Shortness of breath, Hives,
Tightness in the chest,Low blood pressure
Coughing,Chest pain,Less urine output and Feeling weak
References
1.Appelbaum FR.The current status of hematopoietic cell
transplantation.Annu Rev Med. 2003,pp 491–512.
2.Remberger M, Watz E, Ringdén O, Mattsson J, Shanwell
A, Wikman A. Major ABO blood group mismatch increases
the risk for graft failure after unrelated donor hematopoietic stem cell transplantation.Biol Blood Marrow
Transplant.2007,pp 675–682.
3. LaRoche V, Eastlund DT, McCullough J. Review: immunohematologic aspects of allogeneic hematopoietic progenitor cell transplantation. Immunohematology. 2004,pp
217–225.
20
Graduation Day
On 24.06.2013, programme began with inviting the Fresh
M.Sc(N) graduates (2010 - 2012) followed by the
yr B.Sc(N) graduates (2008 - 2012) to the auditorium.
The function started with prayer song. Prof. Rajeswari.
H, M.Sc. (N), Vice Principal of SNNC delivered the
welcome address. The chief guest of the program was
Mrs. Shamshad Begum, M.Sc. (N), Principal of Govt.
College of Nursing, Hyderabad. Dr. Subbarao,
Administrative office, NMCH, Dr. Narasimha Reddy,
Medical Superintendent, NMCH, Dr. Rammohan, Assist
Medical Superintendent NMCH were participate.
All the Graduates received Graduation certificate
from Chief guest, Principals of Sree Narayana Nursing
College. The dignitaries on the dias blessed and delivered
speech to the new graduates Dr. Indira. S, Ph.D.said about
5‘S’ (service, smile, selfishness, silent, simplicity) & 5 L’s
(Leadership, love for care, listening carefully, like social
services, learn for life.
The Chief guest Mrs. Shanmshad Begum, Principal, Govt.
College of Nursing, Hyderabad has congratulated the
graduates and their parents. She about confident, it wont
come within one day it need practice . The parents of the
graduate students shared their experience about Narayana
Nursing Institution. The vote of thanks was given by Prof.
Uma maheswari, M.Sc (N), H.O.D of OBG, The
program come to an end with National Anthem.

Food Fun Carnival
Uma Maheswari HOD of OBG dept, Ms. Leelarani, Asst.
As a part of SNA the staff and students in NNI organized
Food Fun Carnival On August 7th 8th & 9th varieties of
programmes were conducted special corner, food corner,
mehandhi corner photo corner & film show from 9 am - 7
pm. The delicious food items were prepared by SNA
committee members. The students has invited Nursing
Principal, VicePrincipal, All HODS, Faculties &
Non - Teaching faculties. Special juice, fish fry, cool drinks,
ice creams, puff & specially prepared snacks kept for
sale. Wonderful time has spent in photo corner, the
students taken snaps with their friends. Special songs were
dedicated by students for Nursing Principal, faculties &
their friends.
On 8th & 9th film show was organized in English,
Hindi, Telugu & Malayalam. Students enjoyed the shows
a lot.
Lecturer, Medical Surgical Nursing Dept were participated
in this programme.
A Live exhibition on high calorie in the protein
rich diet a video presentation on Breast feeding technique
and KMC (kangaroo mother care) were projected on
06.08.2013 in Pediatric Ward at 11:30 am - 1pm.
competition on Poem writing was conducted on 04.08.2013
at 7-8 pm, was awarded to 1st prize Ms.Chikku Mol, and
2nd prize Ms. Mitty Mol, III Bsc (N).
Quiz competition was held on the theme Breast feeding
 BREAST FEEDING WEEK
Narayana College Of Nursing had celebrated Breast
support close to the mothers on 5-8-13 at 12 - 1 pm and
the winners were awarded, prizes 1st prize to Ms.
feeding week from Aug 1st to 7th 2013 by NSS
organization under the guidance of Principal Narayana
College Of Nursing Dr, Indira.S. Competitions were
conducted based on Theme -“BREAST FEEDING
SUPPORT; CLOSE TO MOTHERS” The theme was
Annamma and Ms. Elza Vinu Vergheese,III Bsc (N), 2nd
prize to Ms. Mitha and Ms. Maya Mary, III B sc (N) by
DR.Indira.S, Principal of Narayana College of Nursing.
Program came to end with National anthem.
unveiled by Prof. Mrs.B.Vanaja Kumari, vice principal,
Narayana Nursing Institutions
Narayana College of Nursing Prof. Ms. Rajeswari. H Vice
Chinthareddypalem, Nellore - 524 003.A.P. India.
Principal HOD of Mental Health Nursing, Prof. Mrs.
Radhika. M HOD of Research dept and Mrs. Prof. Mrs.
Ph : 0861 - 2317969.
e-mail: narayana_nursing@yahoo.co.in
Website: http://www.narayananursinginstitutions.com
Wanted Associate Professor Five for in each
Departments 5 Years Experience after M.Sc Nursing.
Apply Immediately with biodata, photo copies of
qualification experience, registration certificates and
one passport size photo, salary Negotiable.
21
EVIDENCE BASED NURSING " PRACTICE IN COMMUNITY HEALTH
NURSING CLINICAL SPECIALITY AND RESEARCH PRIORITIES
Mrs. Vanaja kumari
M.Sc (N), Vice Principal
Dept. of (Com H N )
Narayana College of
Nursing, Nellore.
EVIDENCE BASED HEALTH CARE
It is defined as the explicit and judicious use of current
conscientious best evidence in making decisions about the
care of the individual patients
EVIDENCE BASED NURSING
Evidence based nursing is the process by which nurses
make clinical decisions using the best available research
evidence, their clinical expertise and patient preferences
STEPS OF EBN IN SOLVING PROBLEMS
ENCOUNTERED BY NURSES
Clearly identify the issue or problem based on
accurate analysis of current nursing knowledge and
practice search the literature for the relevant research
evaluate the research evidence using established criteria
regarding scientific merit
choose interventions and justify the selection with the most
valid evidence
STEP – I
WHAT DOES A WELL BUILT CLINICAL
QUESTION INCLUDE?
The intervention - what is being done?
the condition or health problem - what is being treated or
prevented? the patient and setting - what is being affected?
STEP–II
SEARCHING FOR AN ANSWER
 Visit the local medical library
 Consult an expert
 Look for the answers in the text book
 Look for answers in practice guide lines
 Do a computer search
 Look for the answer in the randomised controlled trials
 Look for the answers in the systemic reviews
 Consult the available literature
EXAMPLES
 What is the health outcome of population based
approach to Diabetic care in Primary setting?
 Whether the intestinal parasitoses in pregnant women
22
have an effect on new born weight ?
 What is the effect of home based strength and balance
restraining programme for elderly people?
 Are Nurse care coordinating programmes effective than
MCO programme in clinical outcome of community based
long term care of elderly
STEP–III
FINDING THE EVIDENCE
 A Readable and understandable summary of all the
evidence relevant to a particular problem
 An unbiased summary of the evidence
 A Transperant summary showing clearly how the
evidence was collected clearly and summarized
 A Summary which is kept up-to-date.
TYPES OF LITERATURE REVIEW
1. Traditional review
2. Systematic review
1.The Traditional review is the generic term for any
attempt to synthesize the results and conclusions of two
or more publications on a given topic. Such topics are
usually produced by a “content expert”
2.The Systematic review in contrast to the Traditional
review,comprehensively locates, evaluates and synthesizes
all the available literature on a given topic using a strict
scientific design, which must it self be reported in the
review.
STEP-IV
INTERPRETATING INFORMATION META
ANALYSIS OF THE RESEARCH LITERATURE
The next step beyond critique and integration of research
is to conduct a meta analysis of the outcomes of similar
studies. Meta analysis pools the result from previous
studies into a single qualitative analysis that provides the
highest level of evidence for an intervention’s efficacy.
AREAS OF EVIDENCE BASED PRACTICE
NURSING IN COMMUNITY HEALTH NURSING
 Examining health problems and intensity of need for
care in family-focused community
 Why girls smoke: a proposed community based
prevention program
 Mothers ranking of clinical intervention strategies used
to promote infant health.
 Registered nurse experience with an evidence- based
home care pathway for myocardial infarction clients
 The information sources prescribed by community nurse
prescribers
 Predictors of acceptance of a postpartum public health
nurse home visit; findings from an Ontario survey.
 Utility of qualitative research findings in evidence-based
public health practice
 Tacit knowledge of public health nurses in identifying
community health problems and need for new services: a
case study.
 Nurse patient interaction and decision-making in care:
Patient involvement in community nursing.
 Addressing domestic violence through maternal-child
health visiting: What we do and do not know.
 The benefits of using the Neonatal Behavioral
assessment scale in health visiting practice.
 The significance of drinking context for home
detoxification
 Identifying approaches to meet assessed needs in health
visiting.
 Research and organizational issues for the
implementation of family work in community psychiatric
services
RESEARCH AREA OF PRIORITY
 Home based nursing care of patients with AIDS
 Community based research to explore safer sex
behaviour among women
 Tertiary care of children with AIDS
 Specialist home based nursing services for children with
acute and chronic illness
 Vitamin A supplementation and health outcomes of rural
children
 Home accident among children
 Antenatal care and pregnancy outcome
 Safe motherhood
 Teenage conception and abortion
 Emergency contraception
 Prevention of hypertension
 Risk factors for obesity and type II diabetics
 Changes in smoking behaviour and exposure to tobacco
intervention
 Evidence based homecare for myocardial infarction
clients
 Community based long term care of elderly
 Disease registration and diabetic management
 Knowledge transfer on communicable disease
 Dementia family care given training affecting beliefs
about care giver outcome.
CONCLUSION:
Health care that is evidence-based and conducted in a
caring context leads to better clinical decisions and
patient outcomes. Gaining knowledge and skills in the EBP
process provides nurses and other clinicians the tools
needed to take ownership of their practices and transform health care. Key elements of a best practice culture
are EBP mentors, partnerships between academic and
clinical settings, EBP champions, clearly written research,
time and resources, and administrative support.
23
INTERNATIONAL CONFERENCE
International Conference on “Group Dynamics” was
organized by Narayana College of Nursing on 26th & 27th
July, 2013. Dr. Josephine little flower Nursing Advisor, Govt
of India was the chief guest and Dr. Lalitha Krishnasamy,
NIMHANS was a guest of honor on the day of conference. Ms. S.M. Wright was the international speaker other
guest speakers are:- Dr. Vijayalakshmi, Principal, Vignesh
College of Nursing, Mrs. Vasanthakumari, Vice - Principal,
Vignesh College of Nursing, Mr. Ashok, Principal, Bollineni
College of Nursing, Mrs. P. Padmasree, Principal, SIMS
College of Nursing. Asymposion on Conflict resolution was
conducted by Dr. Rajeswari V, Dr. Indira. S and their team
members. Totally 651 delegates enriched their
knowledge and 76.3% has felt excellent satisfaction
regarding the conference.
The delegates were suggested topic for next
conference and the program ended with National
Anthem.
Yellow Fever
Ms. SHEELA
Asst. Professor,,
Medical Surgical Nursing
Narayana College Of
Nursing, Nellore.
Yellow Fever is a viral infection caused by RNA viruses
belonging to the Flavivirus genus. It is a zoonosis (an
animal disease that can spread to humans) primarily
transmitted by daytime biting Aedes Aegypti female
mosquitoes, but also by mosquitoes belonging to the
Haemagogus genus.Yellow fever, also known as
Yellow Jack or "Yellow Rainer" and other names,[1] is an
acute viral hemorrhagic disease.[2] The virus is a 40 to 50
nm enveloped positive-sense RNA virus, the first human
virus discovered and the namesake of the Flavivirus
genus.
Risk: Travellers are at risk when going to endemic areas
of Africa and South America.
Transmission: In the sylvatic cycle, Yellow Fever is
transmitted by mosquitoes that bite infected monkeys
passing the infection to humans living in or visiting jungle
areas. Yellow Fever is endemic in the sylvatic setting in
sub-Saharan Africa and the tropical regions of South
America. In the intermediate or savannah cycle, the
infection is transmitted to humans via mosquitoes that bite
infected monkeys or other humans living or working in
jungle border areas in Africa. In the urban cycle, infected
mosquitoes transmit Yellow Fever from person to person
that can cause large outbreaks in cities and suburbs.
Yellow Fever outbreaks occur periodically in Africa and
have occurred sporadically in South America.
Pathogenesis: After transmission of the virus from a
mosquito, the viruses replicate in the lymph nodes and
infect dendritic cells in particular. From there they reach
the liver and infect hepatocytes (probably indirectly via
Kupffer cells), which leads to eosinophilic degradation of
these cells and to the release of cytokines. Necrotic masses
(Councilman bodies) appear in the cytoplasm of
hepatocytes.[9][21]
When the disease takes a deadly course, a cardiovascular
shock and multi-organ failure, with strongly increased
cytokine levels (cytokine storm), follow.[14]
24
Symptoms: Yellow fever has three stages:
 Stage 1 (infection): Headache, muscle and joint aches,
fever, flushing, loss of appetite, vomiting, and jaundice are
common. Symptoms often go away briefly after about
3-4 days.
Stage 2 (remission): Fever and other symptoms go
away. Most people will recover at this stage, but others
may get worse within 24 hours.
Stage3(intoxication):Problems with many organs occur.
This may include heart, liver, and kidney failure, bleeding
disorders, seizures, coma, and delirium.
Symptoms may include: Irregular heart beats
(arrhythmias), Bleeding (may progress to hemorrhage),
Coma, Decreased urination, Delirium, Fever, Headache,
Yellow skin and eyes (jaundice), Muscle aches, Red eyes,
face, tongue, Seizures
Diagnosis: Yellow fever is a clinical diagnosis, which often
relies on the whereabouts of the diseased person during
the incubation time. Mild courses of the disease can only
be confirmed virologically. Since mild courses of yellow
fever can also contribute significantly to regional outbreaks,
every suspected case of yellow fever (involving
symptoms of fever, pain, nausea and vomiting six to ten
days after leaving the affected area) has to be treated
seriously.
If yellow fever is suspected, the virus cannot be
confirmed until six to ten days after the illness. A direct
confirmation can be obtained by reverse transcription
polymerase chain reaction where the genome of the virus
is amplified.[8] Another direct approach is the isolation of
the virus and its growth in cell culture using blood plasma;
this can take one to four weeks.
Serologically, an enzyme linked immunosorbent assay
during the acute phase of the disease using specific IgM
against yellow fever or an increase in specific IgG-titer
(compared to an earlier sample) can confirm yellow
fever. Together with clinical symptoms, the detection of
IgM or a fourfold increase in IgG-titer is considered
sufficient indication for yellow fever. Since these tests can
cross-react with other flaviviruses, like Dengue virus, these
indirect methods can never prove yellow fever infection. Regulations, travellers may find that it is strictly enforced,
Liver biopsy can verify inflammation and necrosis of particularly for people arriving in Asia from Africa or South
hepatocytes and detect viral antigens. Because of the America. Vaccination is strongly advised for travellers
bleeding tendency of yellow fever patients, a biopsy is outside urban areas of countries in zones where yellow
only advisable post mortem to confirm the cause of death. fever is endemic, even if these countries have not
In a differential diagnosis, infections with yellow fever officially reported the disease and do not require evidence
have to be distinguished from other feverish illnesses like of vaccination on entry. The actual areas of yellow fever
malaria. Other viral hemorrhagic fevers, such as Ebola virus activity far exceed the officially reported infected
virus, Lassa virus, Marburg virus and Junin virus, have to zones.
be excluded as cause.
Administration summary
Prevention: Yellow Fever is a vaccine preventable
Type of vaccine Live viral
disease. Vaccination is recommended for persons over 9
Number of doses One dose of 0.5 ml subcutaneously
months of age travelling to or living in endemic areas. The
Schedule
Routine immunization with measles
vaccine affords long term protection.
vaccine at nine months of age
Note that some countries require a valid Yellow Fever26
Vaccination Certificate for entry" vaccination administered
Booster
International health regulations require
at least 10 days before travel and no longer than 10 years
a booster every 10 years
ago" under International Health Regulations. Listed Contraindications Egg allergy; immune deficiency from
below are the countries requiring proof of Yellow Fever
medication or disease; symptomatic
vaccination certificates.
HIV infection; hypersensitivity to
If going to low risk Yellow Fever areas, travellers should
previous dose; pregnancy*
take measures to prevent mosquito bites both indoors and Adverse reactions
Hypersensitivity to egg; rarely,
outdoors, especially during the daytime. Insect-bite
encephalitis in the very young; hepatic
prevention measures include applying a DEET-containing
failure. Rare reports of death from
repellent to exposed skin, applying permethrin spray (or
massive organ failure (see above).
solution) to clothing and gear, wearing long sleeves and
Special precautions Do not give before six months of age;
pants, getting rid of water containers around dwellings and
avoid during pregnancy
For the Consumer: Check with your doctor or nurse
ensuring that door and window screens work properly.
Vaccination precautions: Children between the ages of immediately if any of the following side effects occur while
6 to 8 months, persons over 60 years, those with taking yellow fever vaccine:
asymptomatic HIV, pregnant, or breastfeeding.Vaccination Rare: Confusion, Convulsions (seizures), Coughing,
should only be given if travel to endemic area cannot be Difficulty with breathing or swallowing, Fast heartbeat,
Feeling of burning, crawling, or tingling of the skin,
delayed or avoided.
Vaccination contraindications: Children under 6 months Nervousness or irritability, Reddening of the skin, Severe
headache,Skin rash or itching,Sneezing,Stiff neck,Throbbing
of age, persons with immune deficiencies or on
in the ears, Unusual tiredness or weakness,Vomiting.
immunosuppressive therapies, allergies to egg proteins, Some side effects of yellow fever vaccine may occur
transplant recipients, and persons with symptomatic HIV that usually do not need medical attention. These side
infection. If vaccination is contraindicated for medical effects may go away during treatment as your body
reasons an exemption letter or waiver should be issued to adjusts to the medicine. Also,your health care professional
the traveller. However, acceptance of such a letter is at may be able to tell you about ways to prevent or reduce
the discretion of the destination country, and entry might some of these side effects. Check with your health care
professional if any of the following side effects continue
be denied.
Special issues: International health regulations: A or are bothersome or if you have any questions about them:
yellow fever vaccination certificate is now the only Less common
Difficulty with moving, Joint pain, Low fever,
vaccination certificate that should be required in
Mildheadache,
Muscle aching or cramping, Muscle pains
international travel, and then only for a limited number of
or
stiffness,
Pain
at the injection site, Swollen joints
persons. Many countries require a valid international
References
certificate of vaccination from travellers, including those
in transit, arriving from infected areas or from countries 01.Weir, E (October 2001). "Yellow fever vaccination: be sure
the patient needs it". CMAJ : Canadian Medical Association
with infected areas. Some countries require a certificate 165 (7): 941. PMC 81520. PMID 11599337.
from all entering travellers, even those arriving from 02.Mark Gershman, Betsy Schroeder, and J. Erin Staples.
countries where there is no risk of yellow fever. Although "Yellow Fever". Yellow Book. Center for Disease Control
this exceeds the provisions of International Health (Canada). Retrieved 1 July 2011.
25
A study to assess the knowledge and practices of the nurses on universal
precautions to prevent HIV/ AIDS at labour rooms in selected hospitals of Raichur.
Ms. N. Leena Madhura,
Professor,
SVS College of Nursing,
Raichur.
INTRODUCTION
Day to day work practices of the nurses are not very
safe while handling blood and fluids and secretions of all
patients. We may not know which patient is a carrier of
HIV infection in hospital (conducting deliveries,
performing operations upon them). To decrease the risk
of acquiring HIV/AIDS infection, it is important that safer
wor practices (universal precautions) are implemented with
all kinds of patient care activities.
NEED FOR STUDY: According to AIDS control
society, Hyderabad (1998) the delivery of a child is a more
or less crisis management as within a period of few
minutes there is an outpouring of approximately one litre
of amniotic fluid, half of a litre of blood, moreover the
child is slippery, the sharp instruments are around, and
everyone including the expectant mother in the delivery is
tense. Thus, at this time, the persons who are conducting
the delivery may get splashes of potentially infected blood
and amniotic fluid and even cuts. In view of all short time
available for delivery and related procedure the chances
of exposure to HIV and other bloodborn infections are
much higher during deliveries than any other situations. In
view of critically of the situation nurses who are working
in labour room have to follow the universal precautions to
protect themselves because, prevention is the mainstay of
strategy to avoid occupational exposure to blood and body
fluids while providing medical services.
OBJECTIVES
 To assess the knowledge and practices of nurses
regarding AIDS and universal precautions to prevent HIV/
AIDS.
To explore the relationship between the knowledge and
26
practices of nurses regarding universal precautions to
prevent HIV/AIDS.
To identify the relationship between the knowledge and
practices of nurses regarding universal precautions with
selected demographic variables.
HYPOTHESIS
H1. There will be significant association in the
knowledge and practices level of the nurses with selected
demographic variables such as professional education,
inservice training and working in different institutions.
H2. There is significant difference between knowledge
and application of universal precaution practices by nurses.
ASSUMPTIONS
1. The nurses will have some knowledge regarding
universal precautions.
2. The nurses will practice some of the universal
precautions to prevent HIV/AIDS at labour room.
3.The selected variables such as age, professional
education, work experience at labour room, in-service
training, type of institution will influence on the
knowledge and practices of the nurses regarding
universal precautions.
CONCEPTUAL FRAMEWORK
The theory chosen for the study is “Arther Coombs,”
humanistic learning theory.
REVIEW OF LITERATURE
Reviews was collected and organized under the following headings
Studies related to knowledge and practices regarding
universal precautions
Studies related to knowledge regarding HIV/AIDS
Studies related to practices of universal precautions at
labour rooms.
RESEARCH METHODOLOGY
Research approach : Descriptive survey approach
Research design : Non experimental design was selected
for the present study
Sample and sampling technique:
Sample:Sample size was 30 labour room nurses (6 from
Government hospital and 24 from private hospitals).
Sampling technique : Purposive sampling technique of non
probability sampling.
Inclusion criteria
Nurses working at labour rooms in selected government
and private hospitals.
Samples available during the period of data collection.
Nurses who are willing to participate in the study.
Exclusion Criteria
Nurses who are not willing to participate in the study.
Nurses who are not qualified to work at labour rooms
and are working at certain private hospitals.
Setting of the study: Government hospitals at Raichur,
private maternity hospitals at Nandini and Bandari.
Method of data collection: A self structured interview
schedule and observational check list.
Tool used for the study
section-A Consist 3 sections.
Demographic variables of the nurses.
Dealt with assessment of data in relation to knowledge
regarding HIV/AIDS
Dealt with assessment of data in relation to knowledge
regarding universal precautions.
Section–B Observational check list, to observe the
various universal precautional activities practiced by the
nurses.
Validity: the tool has given to 12 experts of obstetrics and
gynaecological nursing, obstetricians of preventive and
social medicine and AIDS control project.
Reliability:
knowledge
r = 0.95
Practice
r = 0.6
ANALYSIS AND INTERPRETATION
Section - I Frequency and percentage distribution was
used to analysis the demographic variables of nurses.
Section - II Distribution of knowledge and its application
scores of nurses.
Section - III Item wise analysis of nurses knowledge
and practices score
Section - IV Section wise analysis of knowledge and
Practices scores
Section - V Determining the relationship between nurses
knowledge and application of universal precautions
practices and selected variables.
Section - VI Correlation co-efficient of knowledge and
its application of practices by nurses.
Section -VII t - test is computed for Government and
private hospital nurses regarding to knowledge and
practices.
Distribution of mean percentage scores of
27
knowledge and practices of universal precautions
to prevent HIV/AIDS
MAJOR FINDINGS OF THE STUDY
The finding revealed that more than half of the nurses
i.e., 60% had above average knowledge 40% had below
average level.
On observation of universal precautions practices the
nurses at labour rooms 80% were found at below average level & only 20% were at above average level.
The nurses obtained knowledge score was high through
the mean percentage 43:97 and practices mean
percentage is 33:23
t- test is computed for Government and private hospital
nurses with regarding to knowledge and practices. The
obtained t value was 3.33 is significant at 0.05 level.
 Computed value of correlation co-efficient of
knowledge is its application in practice is 0.61 which is
positive correlation.
CONCLUSION
  Most of the nurses had lack of awareness and
knowledge regarding HIV//AIDS.
 Nurses were not aware of the universal precautions to
be taken by them when they were attending to the
patients and conducting deliveries.
Nurses were not practicing universal precautions while
conducting the deliveries.
Universal precautions knowledge and practices of nurses
were influenced by professional education, in-service
training and working in different institutions.
There is a positive relationship between knowledge VS
practices.
Government hospital nurses had higher knowledge and
practices of universal precautions compared to private
hospital nurses.
RECOMMENDATIONS
  A similar study can be done to develop the health
education package on universal precautions and to
evaluate its effectiveness.
 A study could be conducted to find out the attitudes of
nurses towards universal precautions.
IMPLICATIONS
The findings of the study have implications in the areas of
nursing education, nursing practice, nursing administration
and nursing research.
Nursing education
In-service and continuing educational programmes for
nurses regarding prevention of HIV transmission and
universal precaution practices to protect themselves from
the infection.
Nursing curriculum should be updated and AIDS related topics should be integrated at different levels along
with other subjects. Sothat adequate knowledge is imparted
to nursing students and the future nurses.
Nursing practice
Good supervision and appreciation of correct practices
need to be encouraged by senior nurses in the labour rooms
to ensure safe measures in practice.
Nurses should adopt and practice universal precautions
in labour rooms to minimize risk of acquiring HIV/AIDS.
Nursing administration
Administrators should take the initiative in organizing
in-service and continuing educational programmes for
nurses regarding HIV/AIDS and universal precautions.
Appropriate teaching- learning materials need to be
prepared and make them available for nurses in labour
rooms regarding different aspects of HIV/AIDS and
universal precautions to increase knowledge and
awareness in practicing.
The administrators should take in to consideration about
facilities available for universal precaution practices and
should see that there will be adequate supplies of
protective barriers, disinfectants, color coding containers
with polythene bags for disposal of waste and needle
cutter are made available for use.
Clear policies should be defined related to universal
precautions and bio-medical disposal of wastes by the
authorities and all the nurses should be aware.
Nursing research
Research on nurses knowledge and practices should be
carried out continuously to strengthen the practices of universal precautions for prevention of HIV/AIDS at labour rooms.
 Study findings revealed that there is a need for
research on nurse’s attitude towards practicing universal
28
precautions.
LIMITATIONS
The size of the sample was small. Hence it restricted
generalization.
The study was limited to labour room nurses which
limited generalization of findings to other groups like
theatre nurses, intensive care unit nurses etc..
Only knowledge and practices were assessed and no
attempt was made to identify the other attributes like
attitudes.
No attempt was made to educate the labour room nurses
on aspects of universal precautions and assess their
knowledge again.
REFERENCES
Books
1. Abdullah,F.G. and Levine, E. Better patient care through
nursing research. London: collier macmillan publishers,.
1979, 753-755.
2. Best,J.W. Research in education. New Delhi; practice
hall of India Pvt Ltd., 1986.77-78.88
3. Bobak,Irene. M. Maternity and Gynaecologic Care.
St.Louis: the C.V.Mosby company.1993.666
4. Datta,D.C Text book of Obstetrics. Calcutta: New
Central Book Agency Pvt.Ltd., 1995.300
JOURNALS
5. Chamane, N.J. 1997 “Nurses knowledge and
understanding of HIV/AIDS”. the article in curationis. 20
(2): 43-6.
6. Chan, R, et al: “ Nurses knowledge and compliance
with universal precautions”. International journal of Nurses
study.39 (2): 157-63.
7. Cockcroft,A.et al; 1994 “ Clinical practice and the
perceived importance of identifying High Risk Patients”.
Journal of Hospitals infection. 28(2):127-36
MANUALS
8. AIDS control organization, hospital-acquired infection.
Hyderabad, India: 1998.15.
9. National AIDS control organization, manual for control
of hospital associated infections. New Delhi. India: 2000.
10-28.
REPORTS
10. Centres for disease control. Recommendations for
prevention of HIV transmission in health care settings.
MMWR 1998.
11. National AIDS control organization. Government of
India. AIDS cases in India 2001.
A comparitive study to assess the effectiveness of sacral massage versus hot
application in sacral area for pain during active first stage of labour among primi mothers
Ms. ANU THOMAS
Lecturer, Dept. of OBG
Narayana College of
Nursing, Nellore.
INRTODUCTION
Pregnancy is a special event it is an important
aspect of women’s life and it is a journey in which the
mother along with her fetus has to travel towards the
ultimate destiny of safety. It is a time of great hope and
joyful anticipation.
Labour is a wondrous act of nature and unique to every
child bearing women. Labour is likely the hardest work
women will endure in her lifetime, but it also holds all the
beauty magic and power of life. The time of labour and
child birth though short in comparison with the length of
pregnancy, is the most dramatic and significant period for
the expectant women.
Most pain during childbirth results from normal
physiologic events. If nurses understand the nature and
effects of pain during the labour process, they will be
better prepared to provide supportive care, physical
comfort includes offering a variety of non-pharmacologic
and pharmacologic intervention. Among the non
pharmacologic methods of pain relief massage,
acupuncture and hot application are effective techniques
for management of labour pain.
Objectives of the study
 To assess the existing level of pain perception during
active first stage of labour among primi mothers in Group
A and Group B.
 To assess the effectiveness of sacral massage on level
of pain perception during active first stage of labour among
primi mothers in Group A.
 To assess the effectiveness of hot application on level
of pain perception during active first stage of labour among
primi mothers in Group B.
 To compare the effectiveness of sacral massage and
hot application on level of pain perception during active
first stage of labour among primi mothers.
Hypothesis:H1: There is a significant reduction in the
intensity of pain experienced by the mothers during active
29
first stage of labour with sacral massage and hot application.
H2: There is a significant difference in the effectiveness
of sacral massage and hot application in sacral area for
reduction of pain during active first stage of labour.
METHODOLOGY
 Research approach- Quantitative approach
 Research design: True experimental pretest posttest
design
 Setting of the study: The study was conducted in labour
room of Rajarajeswari Medical Collage and Hospital,
Bangalore
 Population: Primi mothers in the active first stage of
labour admitted at Rajarajeswari Medical College and
Hospital .
 Sampling technique: Simple random sampling
technique.
 Sample size: 60 primi gravida mothers
Variables
 Independent variable: sacral massage and hot
application in sacral area .
 Dependent variable: labour pain.
Sampling criteria
a) Inclusion Criteria
 Primi mothers admitted with labour pain during active
first stage (cervical dilatation 3-7 cm) of labour.
 Mothers who is willing to participate in the study .
 Mothers who are available during the time of the study.
b) Exclusion Criteria
 Multi gravida mothers
 Mothers who are in latent and transitional phase of
labour.
 Mothers who receive epidural analgesia.
 Pregnant women who are with medical (DM, epilepsy,
Cardiac diseases, respiratory diseases etc) and obstetric
(APH, gestational DM etc) complications.
Data collection instruments: In this study, the data
collection instrument was combined numerical
categorical pain scale. It is a 10 point scale with ‘0’- no
pain at one end and ‘10’- excruciating pain on the other
end.
Description of the tool The tool has two parts :
Part I: Demographic and clinical data which contain 8 items
for obtaining baseline information about primi mothers in
active first stage of labour.
Part II: Assessment of effectiveness of sacral massage
and hot application by using combined numerical
categorical pain scale. This is divided into section A and
section B
Section A: assessment of effectiveness of sacral
massage for labour pain for group A
Section B: assessment of effectiveness of hot application
for labour pain for group B
The combined numerical categorical pain scale is a ‘10’
point scale. The scale is scored from ‘0’ at one end and
‘10’ on the other end. Here ‘0’ score indicates ‘NO PAIN’
and 10 score indicates ‘EXCRUCIATING PAIN’
Criteria for grading of pain scale score
1-3 = mild pain, 4-6 = moderate pain, 7-8 = severe
pain and 9-10 = excruciating pain
Data collection process
The primi mothers in the active first stage of labour
were selected to sacral massage and hot application group
by simple random sampling. The pretest pain score was
assessed by using the combined numerical categorical pain
scale before sacral massage and hot application and it
was recorded as Q1. In the sacral massage group, (Group
A) massage was given in a circular manner in the sacral
area by using palm for 15 minutes. Immediately after
intervention intensity of pain perception was assessed by
using the combined numerical categorical pain scale and
it was recorded as Q2. In the hot application group (Group
B) the hot application was given to the sacral area with
hot water bag at a temperature of 480C for 15 minutes.
Immediately after the intervention intensity of pain
perception was assessed by combined numerical
categorical pain scale and it was recorded as Q2
Plan for data analysis
The data obtained would be analyzed using both
descriptive and inferential statistics based on the
objectives and hypothesis of the study.
RESULTS
The first objective was to assess the existing level
of pain perception during active first stage of labour
among primi mothers in Group A and Group B.
The existing level of pain perception before sacral
massage revealed that 72% of respondents from sacral
massage group and 64% of respondents from hot
application group experienced excruciating pain (pain scale
score 9-10) and 28% of respondents from sacral
massage group and 36%of respondents from hot
application group experienced severe pain (pain scale score
7-8) and no respondents were experienced mild (pain scale
score1-3) and moderate pain (pain scale score 4-6) in both
group.
The second objective was to assess the
effectiveness of sacral massage on level of pain
perception during active first stage of labour among
primi mothers in Group A.
The level of pain perception after sacral massage
revealed that 12% of respondents experienced
excruciating pain (pain scale score 9-10), 64% of
30
respondents experienced severe pain(pain scale score
7-8), 24% respondents were experienced moderate
pain(pain scale score 4-6) and no one experienced mild
pain. The findings of the study showed that in the sacral
massage group the mean intensity level of posttest pain
scores was 2.88 and SD was 0.63. So, it is evident that
mean post-test intensity level of pain score of primi
mothers were significantly lesser than their mean pre-test
intensity level of pain score. ‘t’ {24} = 6.66 is greater than
the table value at P < .01 level.Hence the research
hypothesis was accepted. The results showed that the
sacral massage was effective in reducing labour pain
during active first stage of labour.
The third objective was to assess
the
effectiveness of hot application on level of pain
perception during active first stage of labour among
primi mothers in Group B.
The level of pain perception after hot application
revealed that no respondents experienced excruciating
pain (pain scale score 9-10), 32% of respondents
experienced severe pain (pain scale score 7-8), 64%
respondents were experienced moderate pain (pain scale
score 4 - 6) and 4% of respondents experienced mild pain
(pain scale score 1 - 3). The findings of the study showed
that in the hot application group post-test mean was 2.88
and SD was 0.489. So, it is evident that mean post-test
intensity level of pain score of primi mothers were
significantly lesser than their mean pre-test intensity level
of pain score ‘t’ {24} = 2.49 is greater than the table value
at P < .01 level. Hence the research hypothesis was
accepted. The results showed that hot applicationin
sacral area was effective in reducing labour pain during
active first stage of labour.
The fourth objective was to compare of the
effectiveness on Group A and Group B on level of pain
perception during active first stage of labour among
primi mothers.
The findings of the study showed that the mean
post-test of sacral massage group i.e., {Group-A} were
2.88 was higher than the mean post-test score of hot
application group {Group-B} were 2.28.It showed that
the post test pain perception score is more for sacral
massage group comparing to hot application group. Since
the computed ‘t’ value {‘t’ (48) = 3.75} was greater than
the table value‘t’(48)=1.64 at .05 level, it inferred that
there is a highly significant differences between the post
test scores of both the groups.The result revealed that
hot application was more effecctive than sacral massage
for reducing labour pain during active first stage of labour.
The null hypothesis was rejected and research hypothesis
was accepted.
Paired‘t’ test showing the significant difference
between the pre-test and post-test of Group - A
subjects (Sacral massage)
Paired‘t’ test showing the significant difference
between the pre-test and post-test of Group - B
subjects (Hot application)
Independent‘t’ test showing the significance of
difference between pain level in the sacral massage
and hot application subjects
N = 25 + 25 = 50
CONCLUSION
2009 Oct 14(4):16-8.
6. Lowe N, Hannah M, Hodnett E, William A stevens B,
Weston J. Effecetiveness of Nurses as providers of
Labour support in North American Hospitals. JAMA 2006;
288: 1373-81.
7. Taghinejad H, Delpisheh A, Suhrabi Z. Comparison
between massage and music therapies to relieve the severity of labour pain. Clinical obstetrics and Gynecology
2001 Dec; 44(4) 704—32.
8. Ranta P, Spaldin. Experience of labour pain among Indian women. Journal of midwifery women’s health 1998;
18(4): 121-8.
9. Gentz, Brenda A. Alternative Therapies for management of pain in Labour and delivery. Can Journal of Nursing Research 2005 Aug 26 (8) : 36-9.
10. Field T, Hernandaz-Reif M, Taylor S,Quintino O, Burman I. Labour pain is reduced by massage therapy. J
Psychosom Obstet Gynaecol 1997 Dec; 18(4): 286-91
11.Patterson M, Maurer S, Shelley R, Andrew L. Nonpharmacological strategies on pain relief during labour. e
CAM advance access. Paris; 2008 Jun 16(3): 169-76.
67th INDEPENDENCE DAY
This study revealed that sacral massage and hot
application in sacral area during active first stage of labour
were effective interventions for reducing labour
pain.Among this hot application was more efffective than
sacral massage for reducing labour pain during active first
stage of labour.
REFERENCES
1. Rajkumari AG, Julie A. Effectiiveness of music therapy
for labour pain. Nightingale Nursing Times. New Delhi;
2008 Nov 8(2):48-50.
2. Pilliteri A. Maternal and child health nursing: care of
the child bearing and child rearing family.6th ed.
Phiiladelphia: Lippincott Williams; 2006: 182-4.
3. Cignacco E, Hamers JP, Stoffel L, Van Lingen RA,
Gessler P. The efficacy of Non- Pharmacological interventions in the management of pain. Eur J Pain 2007 Feb;
11(2): 19-52.
4. Padmavathi R. Effectiveness of back massage on pain
relief during first stage of labour. Nightingale nursing times.
New Delhi; 2007 Dec 3 (9): 54-6.
5. Maddocks, Jennings, Wilkinson. Randomized control
study of different alternative therapies in labour. Journal
of alternative and complementary medicine. New Delhi;
31
67th Independence day was organized by NNI on 15th
August 2013 Dr. Subramanyam Director Narayana
Medical Institutions, raised the flag in the morning & given
message. The delicious sweet was shared among
everyone enjoying the honey of independence. The
program began with prayer song & NNI song in NNI
auditorium. Dr. Indira. S, Principal, HOD of various
specialties & SNA advisor welcomed as a dignitaries for
the program on independence.
The cultural program has started with active students
participation skits, dance, song, slide show was presented
by students and the vote of thanks given by students SNA
secretary. The program ended with National Anthem.
EVIDENCE BASED PRACTICE IN COMMUNITY HEALTH NURSING
Mrs. B. Kalpana
Vice Principal,
Sree Narayana Nursing College,
Nellore.
Knowing is not enough-we must apply. Willing is not
enough- we must do
In the area of health and illness, these can pertain
to health promotion, prevention of illness, control of
symptoms, managing chronic conditions, enhancing
quality of life, providing and testing nursing interventions
and measuring outcomes of care. Public health nurse will
use interventions that have a research basis, Evidence
based practice is a process of using current evidence to
guide practice and clinical decision making: it is piece of
out comes management and the application of available
research evidence.
The culture has been changing over the last few
decades to emphasize the importance of evidence-based
care giving for nurses. Many Registered Nurses are well
educated and well experienced and are expected to take
continuing education throughout their profession.
Evidence-Based Practice: A way of providing
health care that is guided by a thoughtful integration of the
best available scientific knowledge with clinical expertise.
This approach allows the practitioner to critically assess
research data, clinical guidelines, and other information
resources in order to correctly identify the clinical
problem, apply the most high-quality intervention, and
re-evaluate the outcome for future improvement.
Evidence-Based Nursing: A way of providing
nursing care that is guided by the integration of the best
available scientific knowledge with nursing expertise. This
approach requires nurses to critically assess relevant
32
scientific data or research evidence, and to implement
high-quality interventions for their nursing practice.
Rychetnik et al. (2003) define evidence-based public
health as "a public health endeavor in which there is an
informed, explicit, and judicious use of evidence that has
been derived from any variety of science and social
science research and evaluation methods"
Goals of evidence based practice in community
 To Provide practicing nurses with evidence based data
 To Resolve problems in community setting
 To Achieve excellence in nursing cares
 To Introduce innovation
 To Reduce variation in nursing care
 To Assist with efficient and effective decision making
 To Resolve regulatory problems and achieve
excellence in regulation
Steps of Evidence-Based Public Health
Brownson et al.(2011)describe the evidence-based
public health process bys using the following framework.
Step 1: Conduct a community assessment.
Step 2: Develop an initial statement of the issue.
Step 3: Quantify the issue.
Step 4: Search the scientific literature and organize information.
Step 5: Develop and prioritize intervention options.
Step 6: Develop an action plan and implement interventions.
Step 7: Evaluate the program or policy.
Barriers to practice evidence based practice in
community health nursing
Research related barriers: As we have repeatedly
stressed, most studies have flaws and so if nurses were to
wait for perfect studies before basing clinical decisions on
research findings, they would have a very long wait
indeed.
Nurse related barriers: Nurses attitude toward research
and their motivation to engage evidence based practice
have repeatedly been identified as potential barriers. Some
nurses see research utilization as little more then a
necessary evil but there has been a trend toward more
positive attitude.
Organizational barriers: Organizations, perhaps to an
even greater degree than individual, resist unless there is
a strong organizational perception that there is something
fundamentally wrong with the status quo. Thus
organizations have failed to motivate or reward nurses to
seek ways to implement appropriate findings with the
clients.
Professional barriers: Some impediments that
contribute to the gap between research and practice are
more global than those discussed previously and can be
described as reflecting the state of the nursing profession
or even more broadly the state of western society. It some
times been difficult to encourage clinicians and
researchers to interact and collaborate.
Models for evidence based nursing practice
Stelter model of research utilization
Iowa model of research in practice
Ottawa model of research use
Evidence-based multidisciplinary practice model
Model for change to evidence based practice
Centre for advanced nursing practice model
Sources of Evidence- Based Nursing information
Systemic reviews
Cochrane Collaboration
Evidence based Journal
Evidence based practice guidelines
National guidelines clearing house (WWW.guidelines.gov)
Limitations
Resistance to changes in nursing practice
Ability to critically appraise research findings
Time work load pressure, and competing priorities
Lack of continuing nursing education programs
Fear of stepping of on ones toes
Poor administrative support
Conclusion
Evidence based nursing started in the 1800s with Florence
Nightingale. Evidence based nursing started in the 1800s
with Florence Nightingale. Research can be incorporated
in to the nursing practice by undertaking evidence –based
practice projects. The end result of this process is a
decision about whether to adopt the innovation, to modify
33
it for ongoing use to revert to prior practices.
Journal abstract
Fineou-Overholt E, Melnyk BM, Schultz A (2011) Center
for the advance of Evidence-Based Practice, Arizona State
University College of Nursing, Tempe.
Health care is in need of change. Major professional and
health care organizations as well as federal agencies and
policy making bodies are emphasizing the importance of
Evidence Based Practice. Using this problem solving approach to clinical care that incorporates the conscientious
use of current best evidence from well designed studies, a
clinician’s expertise, and patient values and preferences,
nurses and other health care providers can provide care
that goes beyond the status quo. Health care that is
evidence based and conducted in a caring context leads
to better clinical decisions and patient outcomes. Gaining
knowledge and skills in the EBP process provides nurses
and other clinicians the tools needed to take ownership of
their practices and transform health care. Key elements
of a best practice culture are EBP mentors partnerships
between academic and clinical settings, EBP champions,
clearly written research, time and resources, and
administrative support. This article provides an overview
of EBP and offers recommendations for accelerating the
adoption of EBP as a culture in education, practice and
research.
Reference:
1. Brownson, R.C.,Baker, E.A., Leet, T.L.,Gillespie,K. N.,
True, W. R. (2011). Evidence-based public health. New
York, NY: Oxford.
2. Rychetnik, L., Hawe, P., Waters, E., Barrat, A.,
Frommer, M.(2004). A glossary of evidence based public
health. Journal of Epidemiology and Community Health,
58, 538-545. doi:10.1136/jech.2003.011585
3. Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes,
R. B., Richardson, W. S., (1996). Evidence based
medicine: what it is and what it isn't. British Medical
Journal, 312, 71-72.
4. Nightingale nursing times, vol-5,p.p-39-41
5. Journal of Nursing research, vol-7, p.p- 49-52
ARTICLE ON PUBLIC RELATIONS
complexity of these services render communication with
the public is imperative. The public has to be made aware
of the various facilities offered by the organization.
Urgent attention paid to the public and private
Ms. Mary Vineela .P
MSc (N) Lecturer C H N
Naryana College of
Nursing, Nellore.
iniquity: The organizations are under constant pressure
to defined themselves against public criticism. So the
organizations need to function efficiency and convince
public that it is being well done.
The organizations occupies public change role
INTRODUCTION:
During recent years a plethora of organizational
information have come into existence and their number is
constantly on the increase. Good public relations has come
to be regarded as an important attributes of the present
day leadership, and significance can hardly be overstressed.
Meaning of public relations: The term public relation
with the public. The term public is not easy to define, though
frequency in use. The general public is really not one but
a collection of publics. The ordinary citizen, who is the
unit of public, comes in contact with the hospital
administration needs information on many aspects. Here
It is not enough for hospitals to implement polices,
it has to be explained to the people and build up a popular
support for them.
Primary functions of public relations:
According to millet, public relations of management
has four primary functions.
1. Learning about public desires and aspirations.
2. Advising the public about what they should desire.
3. Ensuring satisfactory contact between public and
hospital organizations.
4. Informing the public about what facilities they are
providing.
comes the importance of hospital public relations.
Definition: “Public relations is the skilled communication
of ideas to the various public with the objective of
5. Evaluating reactions of the public.
Tools and techniques of public relations: There can
possibly be no exhaustive list of tools, instrumentalists and
producing a desire result”.
“Public relation is the art of making your organization liked
and respected by its employees, customs, the people who
techniques of maintain good public relations. Time, place
and person always make a difference,. There are times
when gimmicks work wonders, and there are persons who,
buy from it and the people it sells to.”
Factors that contribute to the importance of public
relations: Vast increase in organization: The modern
welfare state, with its philosophy of looking after the
citizens from the crable to the grave is rendering
innumerable services to the public. The very size and
with their original approach and imaginative devices, win
spectacular success in the field of public relations. Such
things, may be listed publicity, advertising, personal
contact, public speech and direct mail.
Publicity: It is the most important aspect of public
relations, and has become a must for every large
34
organization, including the department. There is hardly a
with its patients, their relatives and their friends. Attaining
government today with out a department of information
both of these depend upon the aptitudes the competence
or publicity. Both democratic and totalitarian regimes make
and the sprit of every employee.
full use of this powerful weapon of influencing and
molding public or to disseminate knowledge of facts.
Individually and collectively they mould the image and
opinion of the hospital in the community. No group with in
The various activities of the ministry and the
important services rendering by it can be briefly
described under the following heads:
the hospital is in a more favorable position to create good
PR than is the personnel of nursing department.
A comfortable waiting place be provided for the
All india radio.
patient and the attendant who accompanies the patients,
Doordarshan.
to help him in admission. Therefore, it represents a
Press information Bureau
microcosm of the life of a community. If the OPD can
Directorate of adverting and visual publicity.
produce a favorable impression on the patient, he is likely
Films division.
to prove more co-operative.
Research and reference division.
The nurse has a lot to do with ironing out the rough edges
Directorate of field publicity.
and rounding off the corners among different categories
PUBLIC REALTIONS ( P.R.) AND NURSES: The
of staff in the OPD. The nurse is a central figure in the
term has been defined by the Encyclopaedia American.
ward and she comes in close contact with patients.
“The act of analyzing, influencing and interpreting a
PR applied to the people of a community must of
person, idea, group or business so that he,or it be will be
necessity utilize the methods and channels of
recognized as servicing the public interest and will benefit
communication which people understand.
from so doing. It operates in many different and constantly
GOOD PUBLIC RELATION PRODUCE IN A
and the object.”
HOSPITAL ENTAILS.
Public relation is an administrative functions. Its aim is
 Determination of what the community want to know.
to earn public understanding. Hospitals have their
 Expressing the factors in a form that is easily
problems and the patients their expectations. It is here,
comprehended.
where PR can play a vital and meaningful role to bring
 Evaluating reactions.
about a harmonious adjustment of hospitals to its
 Revamping the program to meet public interest and
community.
approval.
The common aim of PR is not only to its public but also
Conclusion:
to get information and evaluate attitudes of public opinion.
The public relations are essential for the nurse for
The importance of hospital PR is well recognized. The
maintain good relationships among patients to rendering
most productive means the hospital has for creating and
her care to developing the skills, and attitude based on
maintaining good community relations are to render high
health status in the community set ups along with health
quality of professional service and to establish kindly,
team members.
sympathetic and understanding relationship relationship
35
DIABETES
Prof. Manjula G.B,
Vice Principal,
Sree Gokulam Nursing College,
Sree Gokulam Medical College,
Trivandrum
It has been estimated that the global burden of type 2
diabetes mellitus (T2DM) for 2010 would be 285 million
people which is projected to increase to 438 million in 2030.
It is estimated that total number of people with diabetes in
India will rise to 87 million by 2030. However, the status
of diabetes control in India is far from ideal. This has
resulted in several complications. Moreover, majority of
the times, the disease is diagnosed and managed only when
complications arises. In this scenario it becomes
increasingly necessary to explore the existing situation,
problems with regard to managing diabetes, possible
solutions and the scope of a nurse in this regard. It is also
interesting to note that diabetes related national data is
lacking and also there is a lack of streamlined approach in
care of Type 2 diabetes mellitus. Being a disease which
can be managed in the primary care setting, it is often
seen that a major chunk of patients are being treated in
high tech tertiary care centers which in turn affects the
family budget and national productivity. Considering the
fact that the care provided by nurses can be delivered in
an outpatient setting, and at primary care level, nurses
should explore their scope of practice with regard to this
approach which would not only reduce the number of
hospital visits, but also reduce expenditures particularly
on diabetes complications.
Diabetes mellitus in India: Scope for nursing
practice in the current scenario.
Introduction
India is home to world’s largest number of
diabetics. Life styles have changed from what it was in
the past. Risk-association studies demonstrate that lifestyle
factors such as urbanisation, socioeconomic status, stress,
sedentary lifestyle, dietary calorie excess, certain specific
dietary factors and generalised central obesity are
36
The impacts of TODM are considerable: as a lifelong
disease, it increases morbidity and mortality and decreases
the quality of life. Disparity in the availability and
affordability of diabetes care, as well as low awareness
of the disease, lower age at onset and a lack of good
glycemic control are likely to increase the occurrence of
vascular complications causing a heavy economic burden
for diabetic patients themselves, their families and
society.
Based on the available data, the mean glycated
hemoglobin levels are around 9% which is at least 2%
higher than the goal currently suggested by international
bodies.
This has resulted in several complications. In a study
conducted among urban South Indian type 2 diabetes
population, retinopathy was present in 17.5%, neuropathy
in 25.7%, overt nephropathy in 5.1%, and microalbuminuria
in 26.5% subjects.
In this scenario it becomes increasingly
necessary to explore the existing situation, problems with
regard to managing diabetes, possible solutions and the
scope of a nurse in this regard.
EXISTING SITUATION
 The absence of a systematic and scientific health
statistics data-base is a major deficiency in the current
scenario. The health statistics collected are not the
product of a rigorous methodology. Statistics available from
different parts of the country, are often not obtained in a
manner which make aggregation possible or
meaningful.(NHP-2002).
In developing countries, less than half of people with
diabetes are diagnosed. Without timely diagnoses and
adequate treatment, complications and morbidity from
diabetes rise exponentially. Most of the time diagnosis is
made while seeking treatment for associated
complications. (IDF)
Wide disparities in socioeconomic levels, educational
background, and the availability of diabetes care pose major
hurdles in the management of this disease in India.
 Lack of awareness about the disease is a major
problem hampering the efforts to contain the disease. The
information on healthy lifestyle practices have still not
percolated into the minds of educated Indians. The limited
studies available on diabetes care in India indicate that 50
to 60% of diabetic patients do not achieve the glycemic
target of HbA1c below 7%. Awareness about and understanding of the disease is less than satisfactory among
patients, leading to delayed recognition of
complications .
Treatment compliance is an important issue. The cost
of treatment, need for lifelong medication, coupled with
limited availability of anti-diabetic medications in the
public sector and cost in the private sector are major
reasons.
In delivery of diabetic services, the Indian scenario is
such that qualified primary care physicians, who are to be
the pivotal points for addressing the issue at the
community level, get bypassed or even shunted as lesser
qualified to address the issue. The simple modalities for
detection, management and monitoring are often ignored
and are not provided due emphasis.
POSSIBLE SOLUTIONS
 Inadequate and incomplete data on diabetes can be
addressed to an extent by the use of diabetes electronic
medical record (DEMR) to connect data from different
clinics in different geographic areas in India. The DEMR
helps track diabetes care, occurrence of complications and
can be a valuable tool for research.
The most pressing need in India currently is the primary
prevention of diabetes. Screening for glucose intolerance
using simplified Indian Diabetes Risk Score and creating
awareness on lifestyle modification is an effective tool for
the primary prevention of diabetes in Asian Indians.
Policy regulations should come up to promote physical
activity, especially active transport by providing footpaths
for walking and cycling routes, and tax advantages
Modify agricultural policies/ practices to encourage
production and consumption of fruits and vegetables and
healthier oils, create R&D policies that focus on
innovative ways to deliver affordable fruit and vegetables
on mass scale
Spearhead national effort to reduce salt/fat/sugar in
processed foods, and implement streamlined, national
labeling system.
Increase media coverage for heightened awareness and
education.
Expand healthy school programs by imposing ban on
junk food and incorporate physical activity into curricula.
Prioritize research that explores innovative ways to
prevent and control diabetes and other NCDs.
Build capacity in public health schools, medical schools,
other academic institutions and work places for primary
prevention.
37
 Workable strategies for ensuring timely and
appropriate management require extensive linkage and
support for enhancing the availability of trained manpower,
7
investigational facilities and drugs
A health system strengthening approach with standards
of care at all levels, nationally accepted management
protocols and regulatory framework can help in tackling
the diabetic challenge.
The National Rural Health Mission (NRHM) launched
in 2005 and the new pilot National Programme for
prevention and control of Diabetes, Cardiovascular
diseases and Stroke (NPDCS) offer opportunities for
improving care for diabetes and other non-communicable
diseases through service provision at the primary and
secondary levels of care. Guidelines for the management
of type 2 diabetes mellitus in the Indian context have also
now been developed through a joint consultation by the
Indian Council for Medical Research (ICMR) and WHO
in 2005
 Blood tests to detect diabetes are likely to be made
compulsory at health centres across India following the
internationally followed “opportunistic screening” norm.
The scheme is in its pilot stage in 10 states.
Redefine the job responsibilities of primary healthcare
workforce in detection, monitoring and health education
of the life style related disorders like Diabetes and
Hypertension.
Develop algorithms and management protocols and also
to streamline the referral linkages. Make use of
tele-medicine facilities which will bridge the gap between
the practitioner at the remotest village and specialist
centers in towns.
 The public need to be kept abreast of the latest
developments and the latest of the technologies. But, the
cheap and alternate options are also to be highlighted.
NURSING IMPLICATIONS: Nurses in primary care
can help bring down the incidence of diabetes with proper
awareness and education and also help those affected
manage the disease and maintain quality of life with drugs,
exercise and a healthy diet.
Nurses play a key role in primary, secondary and tertiary
prevention in diabetes by helping to:
Screening: Regular screening of public using Indian
Diabetes Risk Score and subjecting them to fasting blood
sugar helps to identify prediabetic patients. They should
be informed about their risk status and inform the effect
of weight loss on lowering their risk status.
Create awareness and educate: Nurses help in
preventive healthcare by making public aware of the
existence of this disease. They identify those at a high
risk-obese people, those with a familial history of
diabetes, and those who lead sedentary lifestyles - and
educate them about the disease and in self care. They
can help them to lead a more active lifestyle with regular
exercise, follow a healthy diet, and reduce weight and keep
it down.
Support: Nurses should empower their patients to
monitor their blood glucose levels and accordingly adjust
their medications
Treat/aid in treatment: Nurses help doctors treat
diabetic patients by monitoring their blood sugar regularly,
ensuring that they take their medication as prescribed, give
them injections if needed, and provide care if they are
hospitalized for related complications.
Maintain quality of life: Nurses must help patients
accept responsibility for their care by following strict
instructions like regular exercise, healthy diet and lifestyle
changes (no smoking or alcohol in large amounts) will help
maintain the quality of life.
Nurses are also in a position to assess health beliefs and
behavior and identify personal barriers to self
management of diabetes, based on which problem solving
techniques can be applied and a personal action plan
charted out to improve their compliance.
Nurses and other healthcare providers must be equipped
with systematic education required for providing more
organized care in hospitals, educational and social
settings such as schools, and work places aiming to
overcome the existing gap in treating diabetic patients in
our country
Camps can be organized in collaboration with social
organization like Lions club, rotary club etc for screening
of patients for diabetes.
Establishing diabetes club would help in increasing
compliance to physical activity and dietary adherence
thereby controlling their blood sugar.
 Telephone care provided by nurses has also been
reported to be effective in controlling diabetes and its
complications as well as alleviating diabetes-induced
depression
Skilled general practitioners and nurses can control some
two third of diseases even in the absence of a specialist
Many studies have shown that the care delivered by nurse
educators is superior to that delivered by physicians;
using this group of health care providers also lowers the
38
cost of health care
Considering the fact that the care provided by
nurses can be delivered in an outpatient setting, and at
primary care level, this approach would not only reduce
the number of hospital visits, but also reduce expenditures
particularly on diabetes complications .
BIBLIOGRAPHY
1.Ajay VS, Prabhakaran D, Jeemon P, et al. Prevalence
and determinants of diabetes mellitus in the Indian
industrial population. Diabet Med. 2008 Oct;25(10):
1187-94.
2. The Expert Committee on the Diagnosis and
Classification of Diabetes Mellitus: Follow-up report
on the diagnosis of diabetes mellitus. Diabetes
Care 26: 3160–316.
3.Hoskote SS, Joshi SR. Are Indians Destined to be
Diabetic? Journal of Associations of Physicians of India,
2008, 56: 225–226.
4. Joshi SR, Das AK, Vijay VJ, Mohan V. Challenges in
diabetes care in India: sheer numbers, lack of awareness
and inadequate control. J Assoc Physicians India. 2008
Jun;56:443-50
5. Ohman-Strickl PA, Orzano J, Hudson L, Solberg L, Di
Ciccio-Bloom B, O’Malley D. et al. Quality of Diabetes
Care in Family Medicine Practices: Influence of NursePractitioners and Physician’s Assistants. Ann Fam Med
2008; 6(1): 14- 21.
6. Mohan V, Shanthirani CS, Deepa M, et al. Mortality
rates due to diabetes in a selected urban south Indian
population-the Chennai Urban Population Study
[CUPS-16]. J Assoc Physicians India. 2006 Feb;54:1137.
7. Kavitha V, Kannan AT, Viswanathan M. Challenges in
diabetes management with particular reference to India.
Int J Diabetes Dev Ctries. 2009 Jul-Aug; 29 (3): 103-109
8. Piette JD, Weinberger M, Mcphee SJ. The effect of
automated calls with telephone nurse follow-up on
patientcentered out comes of diabetes care(a randomized
control trial). Med Care2000; 38: 218-30.
9. Khatib OMN.Guidelines for the prevention,management
and care of diabetes mellitus. EMRO Technical
Publications Series; 321, WHO Regional Office for the
Eastern Mediterranean, World Health Organization 2006.
A study to assess the effectiveness of infrared light therapy on episiotomy wound
healing among post natal mothers with episiotomy in Narayana general Hospital at
Nellore.
Ms.M.SASIKALA
M.Sc(N), Asst. Professor
Dept. of OBG Nursing,
Narayana College of
Nursing, Nellore.
INTRODUCTION(BACK GROUND OF THE
STUDY)
Motherhood is the only act that manifests in human form
the cosmic wonder of creation. Imagine a life growing
within the body of the mother, nurtured with her life blood,
And then there is the greatest wonder of all, this vague
motion within her womb blooms into tiny human being
reaching out. Most of all normal vaginal delveries will be
conducted with the help of an episiotomy. Suramanjary
th
(2007) states that until 20 century the routine use of
episiotomy was believed to have multiple benefits for both
mothers and infant. D.C Dutta (2004) A surgically
planned incision on the perineum and the posterior vaginal
wall during the second stage of labour it is called episiotomy.
An incision is begun at the posterior fourchette and
continued downward at an angle of at least 45° relative to
the perineal body either right or left and is generally 3 - 4
cm in length.
RinaBhowal (2010) Infrared light therapy is a very
powerful new technology that relieves pain is probably
due to the sedative effect on the superficial sensory nerve
endings.
Scientists believe that the mechanism of action of
photonic stimulation is related to its ability to excite
electrons within the energy producing mitochondria of cells
in injured tissues. This process is thought to enable these
cells to increase their production of ATP,the energy
currency of our cells, and thereby stimulating the return
of more normal cellular physiology. Accompanying this is
a more normal regulation of the autonomic nervous
system that increases blood flow to injured tissues - this
promotes both pain relief and faster healing.So,infrared
39
therapy is necessary to promote episiotomy wound
healing, In many setting the research had undergone, The
researcher had intention to do this study in Nellore
district, to promote quick episiotomy wound healing on
postnatal mothers who had undergone episiotomy.
OBJECTIVES
 To assess the episiotomy wound among postnatal
mothers with episiotomy.
 To assess the effectiveness of infrared light therapy
on episiotomy wound healing among postnatal mother with
episiotomy.
To compare the effectiveness of infra red light therapy
on episiotomy wound healing among experimental and
control group.
DETAILED RESEARCH PLAN (METHODOL
OGY)
Research approach: A quantitative research approach
was utilised for this research,
Research Design: pre and post-test design was adopted
for this study
Setting of the study : postnatal ward of Narayana
General Hospital had adopted for research,which has 12
bed strength.
population of the study: postnatal mothers with
episiotomy had selected for the study.
Sampling technique: Probability sampling technique was
used for the study.
Sample method: Simple random sampling method was
utilised to select the sample in this study.
Sample: Postnatal mothers who have given normal
vaginal birth with episiotomy
Sample size: 60,30 experimental group,30 control group.
TOOL AND TECHNIQUE: The tool is divided into two
parts:
Part-1: It deals with socio demographic data including age,
education, family income, religion, type of family, residence,
and number of deliveries and source of health informa
tion.
Part-2: It deals with observational checklist for episiotomy
wound healing assessment by using REEDA scale.It stands
for R- Redness,E- Edeme/oedema, E-Ecchymosis,
D- Discharge, A- Approximation
SCORING KEY AND INTERPRETATIONS
According to length of the wound,the wonud healing is
classified.
Good healing-less than2cm
Moderate healing-2.1to3cm
Poor healing-3.1to4cm
DATA COLLECTION PROCEDURE
Formal permission was obtained from the Medical
Superintendent, HOD of obstetrical and gynaecological
ward, the Nursing Superintendent, and the ward in charge
of the postnatal ward. The data was collected period of
6weeks. The samples were informed by the investigator
about the nature and purpose of the study. 60postnatal
mothers were selected by using simple random sampling
technique. 30 postnatal mothers were assigned to
experimental group and 30 postnatal mothers were to
control group. Intervention was given to the experimental
group by exposing infrared light therapy 230V ,45cm away
from episiotomy wound for 15 minutes twice a day
continuously for 3 days. After intervention the post test
was conducted for both experimental and control group
by using REEDA scale.
MAJOR FINDING OF THE STUDY
Total 60 sample,in that 30 in experimental,30 in control
group. In experimental group, the mean pre-test score
was 5.1 , post-test 13.2 and standard deviation for
pre-test is1.4, post-test score is 1.97.In control group 5.4
in pre-test and 4.7 in post-test standard deviation pre-test
1.93 and post-test 1.4. Independent t test value was 9.1
which is significant at p=0.05 level.
Effectiveness of infra red light therapy on episiotomy
wound healing among post natal mothers with
episiotomy among experimental group:
Test
Mean Sd
PRE TEST 5.1
Independent
‘T’ Test
1.4
9.1
Remarks
Significant at
p=0.05 level
POST TEST 13.2 1.97
RECOMMENTATIONS
The present study can be done with large sample size
The present study can be done to assess episiotomy wound
pain
40
The present study can be done in other setting
CONCLUSION
Before intervention in experimental group 25
mothers(83.3%) had poor healing and 5 mothers(16.7%)
were in satisfactory healing.After intervention
2 mothers(6.7%) had satisfactory healing and 28
mothers(93.3%) had good healing.Finally it concludes the
infrared light therapy is very effective on episiotomy wound
healing.
REFERENCES:
BOOK REFERENCE:
1.Bobak, Lowdermilk “Maternity Nursing” 4th edition
1995, Mosby publishers, Newyork.
th
2.Burroughs (1992) “Maternity Nursing”, 6 edition,
London, saunders.p236.
3.D.c.dutta (2010) textbook of “Obstetrics and Neonatolth
ogy includes Contraception”, 4 edition, London, New
central book agency, p567.
4.Fraser D M, Cooper M.A. “Myles text book for Midwives”. 14th edition: Philadelphia; Churchill
Livingstone;2003.p.632
th
5.Helen varney (1987) “Nurse Midwifery”, 4 edition,
NewDelhi, all india, p777
6.Jayne klossner (2006) “Introductory to Maternity Nursnd
ing”, 2 edition, London, Lippincott Williams and Wilkins
publications, p320
7.Katharyn. A. May5, “Comprehensive Maternity
Nursing”,2nd edition, Mosby publishers
th
8.Lowdermilkperry (2006), “Maternity Nursing”, 7 edition, Canada, mosby, p445
9.Novak,betty (1995), “Maternity and Child Health Nursth
ing” 8 edition London, mosby, p337.
10.Susan scottricci (2007) “Essentials of Maternity Newst
born and womens health nursing”, 1 edition, London,
Lippincott Williams Wilkins, p368
JOURNAL REFERENCES:
11.American journal of “Maternal child nursing” march/
april 2007-vol32. Issue, pp47-49
12.Kymplova J, Novratil L, Knizek J. “Contribution of phototherapy to the treatment of episiotomies”. Journal of clinical Laser Medicine and surgery [ONLINE] 2003. [Cited
2003 Feb 01].vol 21. pp35-39.
NET REFERENCE
13.http://www.sma.org.sg/smj/4009/articles/4009a5.html
14.http://www.ahrq.gov/clinic/epcsums/epissum.htm
REIKI AND NURSING
Mrs. K. Kantha
Asst. Prof. M.sc (N).
Community Health Nursing
Narayana College of
Nursing, Nellore.
History: The English word reiki derives from the
Japanese loanword reiki meaning “mysterious
atmosphere” or “supernatural influence”. Its earliest
recorded usage in English dates to 1975. Instead of the
usual transliteration, some English-language author’s
pseudo-translate reiki as “universal life energy”.
Reiki is a spiritual practice developed in 1922 by
Japanese Buddhist Mikao Usui, which has since been
adapted by various teachers of varying traditions. It uses
a technique commonly called palm healing or hands on
healing as a form of alternative medicine and is
sometimes classified as oriental medicine by some
professional medical bodies. Through the use of this
technique, practitioners believe that they are transferring
universal energy (i.e., reiki) in the form of qi (Japanese:
ki) through the palms, which they believe allows for
self-healing and a state of equilibrium.
Branches of Reiki: There are two main branches of
Reiki, commonly referred to as Traditional Japanese
Reiki and Western Reiki. Though differences can be wide
and varied between both branches and traditions, the
primary difference is that Westernised forms use
systematised hand-placements rather than relying on an
intuitive sense of hand-positions, which is commonly used
41
by Japanese Reiki branches. Both branches commonly
have a three-tiered hierarchy of degrees, usually referred
to as the First, Second, and Master/Teacher level, all of
which are associated with different skills and techniques.
In Western Reiki, it is taught that Reiki works in
conjunction with the meridian energy lines and chakras
through the use of the hand-positions, which normally
correspond to the seven major chakras on the body. These
hand-positions are used both on the front and back of the
body, and can include specific areas (see localised
treatment). According to authors such as James Deacon,
Usui used only five formal hand-positions, which focused
on the head and neck. After Reiki had been given first to
the head and neck area, specific areas of the body where
imbalances were present would then be treated. The use
of the chakras is widespread within Western Reiki, though
not as much within Traditional Japanese Reiki, as it
concentrates more on treating specific areas of the body
after using techniques such as Byosen-hô and Reiji-hô,
which are used to find areas of dis-ease (discomfort) in
the auras and physical body.
Techniques of reiki therapy:
Usui Reiki Ryôhô does not use any medication or
instruments, but uses looking, blowing, light tapping,
and touching. According to Frank Arjava Petter, Usui
touched the diseased parts of the body, he massaged them,
tapped them lightly, stroked them, blew on them, fixed his
gaze upon them for two to three minutes, and specifically
gave them energy, and used a technique commonly
referred to as palm healing as a form of complementary
and alternative medicine. Through the use of this palm
healing (sometimes referred to as “tenohira”
(meaning “the palm”), practitioners believe that they are
transferring universal energy (reiki) in the form of ki
through the palms that allows for self-healing and a state
of equilibrium.
Whole body treatment
In a typical whole-body Reiki treatment, the Reiki
practitioner instructs the recipient to lie down, usually on a
massage table, and relax. Loose, comfortable clothing is
usually worn during the treatment. The practitioner might
take a few moments to enter a calm or meditative state of
mind and mentally prepare for the treatment, that is
usually carried out without any unnecessary talking.
The treatment proceeds with the practitioner placing the
hands on the recipient in various positions. However,
practitioners may use a non-touching technique, where
the hands are held a few centimetres away from the
recipient’s body for some or all of the positions. The hands
are usually kept in a position for three to five minutes before
moving to the next position. Overall, the hand positions
usually give a general coverage of the head, the front and
back of the torso, the knees, and feet. Between 12 and 20
positions are used, with the whole treatment lasting
anywhere from 45 to 90 minutes.
Many Western practitioners use a common fixed set of
12 hand positions, while others use their intuition to guide
them as to where treatment is needed as is the practise in
Traditional Japanese Reiki, sometimes starting the
treatment with a “scan” of the recipient to find such
areas. The intuitive approach might also lead to individual
positions being treated for much shorter or longer periods.
A Western Reiki treatment is considered a type of
large-scale treatment in comparison to the more
localised-style treatment of Traditional Japanese Reiki.
The use of the 12 hand positions are believed to energise
on many levels, by:
 Energising on a physical level through the warmth of
the hands,
 Energising on the mental level through the use of the
Reiki symbols,
 Energising on the emotional level through the love that
flows with the use of the symbols,
 Energising on the energetic level though the presence
of an initiated practitioner as well as the presence of the
Reiki power itself.
It is reported that the recipient often feels warmth or
tingling in the area being treated, even when a non-touching
approach is being used. A state of deep relaxation,
combined with a general feeling of well-being, is usually
the most noticeable immediate effect of the treatment,
although emotional releases can also occur. As the Reiki
treatment is said to stimulate the body’s natural healing
processes, instantaneous “cures” of specific health
problems are not normally observed. A series of three or
more treatments, typically at intervals of one to seven days,
is usually recommended if a chronic condition is being
addressed, and regular treatments on an on-going basis
can be used with the aim of maintaining well-being. The
42
interval between such treatments is typically in the range
of one to four weeks, except in the case of self-treatment
where daily practice is common.
Localised treatment
A Reiki treatment in progress.
Localised Reiki treatment involves the practitioner’s
hands being held on or near a specific part of the body for
a varying length of time. Recent injuries are usually treated
in this way, with the site of injury being targeted. There is
great variation in the duration of such treatments, though
20 minutes is typical. Takata described “localised
treatment” as ‘hands-on work,’ compared to distant or
“absent healing.
Some practitioners use localised treatments for certain
ailments, and some publications have tabulated
appropriate hand positions, However, other practitioners
prefer to use the whole body treatment for all chronic
conditions, on the grounds that it has a more holistic
effect. Another approach is to give a whole body
treatment first, followed by a localised treatment for any
specific ailments.
Usui used specific hand positions to treat specific ailments
and dis-eases (discomfort), which included disorders of
the nervous system (such as hysteria),respiratory
disorders (such as inflammation of the trachea), digestive
disorders (such as gastric ulcers), circulatory disorders
(such as chronic high blood pressure), metabolism and blood
disorders (such as anaemia), urogenital tract disorders
(such as nephritis), skin disorders (such as inflammation
of the lymph nodes), childhood disorders (such as measles),
women’s health disorders (such as morning sickness), and
contagious disorders (such as typhoid fever).
Breathing
Though the specific use of breath and breathing is central
to many styles of Japanese Reiki, it is often a neglected
topic in Western Reiki. Usui taught a technique called
Joshin Kokyu-ho, which roughly translates as “the
breathing method for cleansing the spirit,” though literally
translates as “Goddess Breath Method”. Joshin
Kokyû-hô is performed by sitting straight, with the back
aligned, breathing in slowly through the nose. As the
practitioner inhales, s/he also breathes the Reiki energy in
through the crown Chakra in order to purify the body and
make it fit for the flow of Reiki, and is drawn down into
the tanden.
Reiki benefits:
Reiki for nurses:
As nurses, we all have a week, a day, or even a
shift where things go any way but smooth. We are faced
with sadness, anger, worry, and even death. We must “be
strong” through the unknowns of disease. We must wear
the “brave face” at all times and are expected to do our
best in every situation.
So what can we do to break free from stress?
How can we lighten the heaviness of tension? What can
we do to shift our own experience so that the next time
we walk onto our unit and feel tension in the air, we are
able to continue with our shift but from a space of love,
healing, and acceptance.
As a nurse who has had a very intimate
experience with burnout and poor health, I have been on
my own healing journey. My path has led me to embrace
and understand many modalities of wellness: from eating
well to exercising, from journaling to reading, from
meditation to acupuncture. Yet I have found, healed,
trained, and embraced one modality above any other: the
healing energy of Reiki.
Reiki is a Japanese healing modality that shifts energy on
a physical, emotional, and spiritual level so that your whole
43
mind-body-spirit is in balance. Reiki helps clear blocks so
the energy can flow smoothly. When our energy is
free-flowing, without disruption, we are healthier and more
whole. Mrs. Takata, who was responsible for bringing
Reiki from Japan to the West, often said, “Reiki you first.”
She understood the importance of being balanced and
caring for oneself, before offering the gift of Reiki to
another. Now how can Reiki relate to nursing? Where
and when can this practice tie into my busy nursing
career? Here’s how Reiki can be experienced and used:
Uses of reiki therapy in nursing:
Reiki as a self-care modality. At the first level, Reiki is
only to be used on the self. Practicing self-Reiki can be a
great way for any nurse to recharge, heal, rebalance, and
grow. Doing Reiki on the self allows one to bring a state
of peace and healing to any situation. So like my story
above, when we walk onto our unit and feel the tension in
the air, if you have been practicing Reiki on yourself you
have the ability to shift your energy within so that you
assist the outer circumstances and environment in a
healing process.
Reiki with patient care. As the more advanced levels
are learned, Reiki can be used as a complementary
addition to the standard and usual care practices of every
nursing role. Since Reiki energy can do no harm and only
is used for healing and good, it can be given to a patient to
help reduce stress, ease pain, and aids healing. Reiki can
rekindle the bond between nurse and patient and bring the
healing touch back to our profession.
Reiki in a health care system. Once one person
embraces and accepts the healing energy of Reiki into
their practice their thoughts, feelings, and actions will shift.
Others will take notice and question how or why that
person is so patient, loving, and trusting. Health care
professionals will desire the balance, peace, and joy that
others exude. When the vibration of energy is raised, an
entire nurses health care system has the potential to shift.
Carolyn Myss, a well-known medical intuitive and healer,
has reminded us that we cannot drink from a well if the
well is empty. This indicates the importance of filling one’s
own vessel first before inviting another to drink from it.
And the old saying “Physician, heal thyself” is also
another good reminder of how important it is to take care
of oneself so that we can come from our abundance and
not our lack. Nursing is a rewarding profession. Many
believe it is a call to service: a desire to help and/or
reduce the suffering of others. For many it is not just
another J.O.B. When a nurse is a Reiki practitioner.
as well, their dedication to being of service is
often intensified, making them even more susceptible to
burnout and stress. Not only can it be stressful to the
body (long hours; physical workload; over whelming
responsibilities), it can also be draining on one’s mind and
spirit. Being with people every day who are in pain and
suffering, dealing with death and dying, dealing with
challenging situations can be draining for a person with a
compassionate heart.
A recent study discussed the importance of a single
Reiki treatment for nurses diagnosed with Burnout
Syndrome. Diaz-Rodriguez et al.(2011)investigated the
immediate effects on immunoglobulin a(sIg A) (an
indicator of immune system function), a - amylase activity
and blood pressure levels after a 30 minute Reiki or
placebo session. The Reiki treatment showed a
statistically significant improvement of both immune
system function and blood pressure regulation. It also
suggested that Reiki treatments could be a cost effective
way to manage and prevent job stress for those at risk for
burnout.4 Bringing Reiki to our working world can be
rewarding. But it is important to start with ourselves first.
As we give Reiki to ourselves,it automatically radiates out
into our energy field causing our clients and patients to
feel better just by being in our presence. Being in a state
of health and well-being allows one to provide greater
benefit to those one is caring for.
REIKI YOU FIRST: Three minute pick me up Here is
a simple yet effective three minute pick me up to nourish
your spirit. It can be done before you begin your work day
or during a break, or it can be modified so that you can do
it while working, like a moving meditation.
• Find a place where you can be quiet for a few minutes.
• Begin by becoming aware of your breath. You can close
your eyes or leave them open. (Depending on how much
time you have take 10-25 deep breaths as you do this.)
• Place one or both hands on your power center (solar
plexusor 3rd chakra).
• Allow the Reiki to begin to flow. Observe it filling that
chakra.
• As you inhale, say to yourself “I fill myself with Reiki. It
restores and replenishes my energy.” or “I breathe in Reiki
energy. It restores and replenishes my energy.”
• As you breathe out focus on allowing any tension or
stuck energy to release.
44
•Then move your hands to your heart chakra. Become
aware of your breath again, and this time say to yourself:
“I fill myself with Reiki. It restores and replenishes my
spirit.” Or…. “I breathe in Reiki energy. It restores and
nourishes my spirit” This should take you anywhere from
two to five minutes and keep you fueled for your work
day. And this is not just for nurses it’s a quick way to keep
anyone balanced throughout the day.
References:
1. “Reiki and the Helping Professions, Part I,” Reiki News
Magazine (Fall 2006); “More on Reiki and Nursing,”
www.reiki.org, Fall 2005; “Enhancing Nursing Practice
with Reiki,” www.reiki.org, 1997.
2. “Reiki and the Helping Professions, Part I,” Reiki News
Magazine (Fall 2006).
3. “Reiki: A supportive therapy in nursing practice,” Journal of the New York State Nurses Association (Spring/
Summer 2003), 11.
4. L. Diaz-Rodriguez, “The Application of Reiki in nurses
diagnosed with Burnout Syndrome has beneficial effect
on concentration of salivary IgA and blood pressure.”
Revista Latino-Am. De Enfermagem (2011 Sep.–Oct.)
19 (5):1132-8., www.eerp.usp.br/rlae.
5. Kahlil Gibran, The Prophet, (New York, NY: Alfred A.
Knopf, Inc, 1923), 13.
6. www.Nurse.com News, Tuesday, December 13, 2011.
7. Alice Moore, RN, “Reiki Energy Medicine: Enhancing
the Healing Process,” Hartford Hospital Dept.of Integrative Medicine, Hartford, CT, www.harthosp.org/portals/
1/images/38/reikienergymedicine.pdf, www.harthosp.org
/intmed.
8. www.centerforreikiresearch.org/.
9. www.centerforreikiresearch.org/.
10. http://reikiinmedicine.org/medical-papers/.
11. Kathie Lipinski, “Reiki and the Helping Professions:
Part II,” Reiki News Magazine, Winter 2006, p. 37.
12. R. McCraty, R. T. Bradley, D. Tomasino, “The Resonant Heart Shift: At the Frontiers of Consciousness,” Dec.
2004–Feb. 2005, No. 5: 17, www.noetic.org/library/magazines/shift-issue-5/2/.
Effectiveness of structured teaching programme on control of obesity
among obese women, at N.T.R. Nagar, Hyderabad.
Ms. A. V. DEEPIKA
M.Sc (N), Lecturer,
Dept. of MHN,
Sree Narayana Nursing
College,
Nellore - 2.
INTRODUCTION
Obesity is a leading preventable cause of death
worldwide, with increasing prevalence in adults and
children, and authorities view it as one of the most serious
public health problems of the 21st century. Obesity is a
medical condition in which excess body fat has
accumulated to the extent that it may have adverse
effects on health leading to reduced life expectancy and/
or increased health problems. Body mass index (BMI), a
measurement which compares weight and height, defines
people as overweight (pre obese) when their BMI is
between 25kg/m2, and obese when it is greater than 30
kg / m2.1
Obesity is strongly linked to the surrounding
environmental, social and behavioral factors. Obesity and
lack of physical activity during adolescent period
contribute to one third of all cancers such as cancer of
colon, breast, kidney, stomach and gall bladder disease
(WHO, 2000). The author suggested that balanced diet
and physical activity would help in checking obesity
related problems and prevent them from becoming major
health problems. Family support, long-term behavior
modification, dietary change, and increased physical
activity and decreased sedentary behavior are most
effective for weight loss and maintenance.9
NEED FOR THE STUDY:
Obesity is a serious health hazard and causes a great
deal of morbidity in community. Hippocrates wrote about
lean people having fewer incidence of sudden death than
obese individuals. Being obese is not a part of a
cosmetic disadvantage but a health hazard with multiple
implications such as cardio vascular disease, arthritis,
asthma, diabetes. Thus obese people frequently suffer from
low self-esteem, impaired body image, and suicidal
feelings.
A research study was conducted to test the
relationships between relative bodyweight and clinical
45
depression, suicide ideation, and suicide attempts among
40,086 men and women in African Americans and white
population sample in U.S.A. Results showed that relative
bodyweight was associated with major depression,
suicide attempts,and suicide ideation, although relationships
were different for men and women. Among women,
increased BMI was associated with major depression and
suicide ideation. Among men, lower BMI was associated
with major depression, suicide attempts,and suicide
ideation.
OBJECTIVES:
1. To assess the knowledge of women regarding obesity.
2. To evaluate the effectiveness of structured teaching
programme in lifestyle modification and control of obesity
3. To determine the association between the post test
knowledge levels with the selected demographic variables.
OPERATIONAL DEFINITIONS
STRUCTURED TEACHING PROGRAMME: It
refers to systematically planned teaching activity
specifically designed to provide information which
improves the knowledge of the women regarding obesity
and its control through lecture cum discussion.
OBESITY: Obesity is the generalized accumulation of
excess fat in the body with BMI more than 30KG/M2.
WOMEN: Refers to females above 20 years who are
staying at the N.T.R. Nagar, Hyderabad.
HYPOTHESIS: H1: There is a significant difference
between post test knowledge scores and pre test
knowledge scores of obese clients regarding obesity
before and after administering structured teaching
programme.
METHODOLOGY:
Research approach: Evaluative approach is applied to
determine the effectiveness of structured teaching
programme on control of obesity among obese women.
Research Design: One group pre-test, post-test research
design was selected for the present study.
Setting of the study: The study was conducted at
N.T.R.Nagar, Hyd.
Population: Accessible population-Obese women of
N.T.R. Nagar, Hyd.
Sample: 30 obese women between the age group of
20-60 years.
Sample size: The sample size of the study is 30 obese
women
Sampling technique: Purposive sampling technique was
adopted
Inclusion criteria:
1. Obese women of more than 20 years and less than 60
years of age with body mass index more than 25 residing
at N.T.R. Nagar.
2. Women who were willing to participate in this study.
Exclusion criteria:
Women who were currently taking treatment for obesity.
DESCRIPTION OF TOOL:
Section- A: structured questionnaire on demographic data
of obese women such as age, sex, marital status,
educational qualification, religion, area of living,
occupation.
Section- B: Lifestyle modification on obesity, its
prevalence and management of obesity.
DATA COLLESTION PROCEDURE:
Prior permission was obtained from the samples and
Medical officer, primary health centre, N.T.R. Nagar,
Hyderabad. Time schedule for data collection and
structured teaching programme was submitted to the
medical officer. The purpose of the study was explained
to them. Consent was obtained from study subjects and
they were assured of confidentiality and privacy was
provided throughout the programme. Those who fulfilled
the inclusion criteria were given structured teaching
programme for 7 days & posttest was conducted on 8th
day.
DATA ANALYSIS:
Statistical method used for the data analysis were
descriptive statistics that include frequency, percentage,
mean & standard deviation inferential statistics namely
chi-square was used to associate between the knowledge
levels of the obese women and selected demographic
variables.
RESULTS:
Table 1: Frequency and Percentage distribution of
demographic data of obese women.
Demographic data
1. Age
20 - 30 Years
30 – 40 Yrs
40 – 50 Yrs
Above 50 Yrs
2. Religion
Hindu
Christian
Muslim
Others
3. Education
Uneducated
Under Graduate
Graduate
Post Graduate
Frequency
Percentage
15
10
4
1
50.00%
33.33%
13.33%
3.33%
1
11
5
13
3.33%
36.67%
16.67%
43.33%
10
9
5
6
33.33%
30.00%
16.67%
20.00%
4. Family Income
Below Rs 5000
Rs 5001 – Rs 7000
Rs 7001 – Rs 9000
Rs 9001 - Rs 11000
Above Rs 11000
5. Area of Residence
Rural
Urban
6. Occupation
Sedentary
Moderate
Daily Worker
Business
7. History of Obesity
Yes
No
8. Food Habits
Vegetarian
Non Vegetarian
22
3
3
2
0
73.33%
10.00%
10.00%
6.67%
0.00%
11
19
36.67%
63.33%
20
7
1
2
66.67%
23.33%
3.33%
6.67%
19
11
63.33%
36.67%
23
7
76.67%
23.33%
Table 1: shows the frequency and percentage
distribution of demographic variables with regard to age.
Religion, education, family income, area of residence,
occupation, history of obesity & food habits
Table 2: Comparision of Frequency distribution of overall
knowledge of obese women regarding the control of
obesity before and after implementing structured
teaching programme.
Performance
Levels
Knowledge
Score
Below Average 0 – 10
Average
11 – 20
Above Average 21 – 30
Total
Pre Test
F % F
24 80.00%
06 20.00%
00 00.00%
30 100.00%
Post Test
%
05 16.67%
19 63.33%
06 20.00%
30 100.00%
Table – 2 showed that the total knowledge score of obese
women about obesity. The knowledge scores shows that
the there is a difference between the pre test and post
test knowledge scores in before & after receiving the
structured teaching programme.
Fig III: Comparison of Percentage distribution of the obese
women regarding the control of obesity before and after
implementing the structured teaching programme.
46
Fig -3: Showed that the total knowledge score of obese
women about obesity was 30 with a maximum score of
30 and least score 0. The scores ranging from 0-10 fall
under below average knowledge of obese women about
obesity and were 05 (16.67%) in the posttest as
compared to 24 (80.00%) in the pretest. The scores ranged
between 11-20 indicate average knowledge of obese
women about obesity and were 19 (63.33%) in the posttest
as compared to 06 (20.00%) in the pretest. Obese women
and scores ranged between 21-30 indicated above
average knowledge about obesity 06 (20.00%) in the
posttest as compared to none in the pre test.
FINDINGS OF THE STUDY
1. It includes demographic data findings like subjects
majority 15 (50.00 %) were in the age group of 20-30
Years and least 1 (3.33 %) were in the age group of above
50 Years. In regard to religion majority i.e.13 (43.33%)
belongs to other religion and least 1 (3.33%) from Hindu
religions. In regard to education out of 30 samples
majority were illiterates 10 (33.33%) and the least were
graduates 5 (16.67%). In regard to monthly income
majority were earning below Rs 5000 22 (73.33%) and
least were earning above Rs 110000 0 (0.00%). In regard
to area of residence majority were living in urban area
19 (63.33%) and least were living in rural area 11
(36.67%). In regard to occupation majority of women were
having sedentary lifestyle 20 (66.67%) and the least were
daily worker 1 (3.33%). In regard to the history of obesity
in the family is present for majority of women 19 (63.33%)
and the least were 11 (36.67%). In regard to the food
habits majority of the women were vegetarian 23 (76.67%)
and the least were non vegetarian 7 (23.33%).
2. It represents the comparison of area wise mean,
standard deviation and paired t value of post test and pre
test knowledge scores in specific areas of the control of
obesity among obese women. In the area of overall
knowledge in posttest was increased from 14.800 mean
with 4.310 S.D as compared to the pretest 8.700 mean
with 2.246 S.D and paired t value was 8.285.
3. It indicates that there is no association between the
knowledge scores and demographic variables.
RECOMMENDATIONS:
1. Replication of present study can be conducted using
true experimental design.
2. A similar study can be conducted among obese women
in rural and urban settings.
3. A comparative study can be done to assess the
effectiveness of structured teaching programme among
obese women.
4. The same study can be conducted with a post test after
one month, three months and one year intervals to
evaluate the retention of preventive measures on control
of obesity.
CONCLUSION: The present study is aiming at
creating the awareness among the obese women about
obesity As per peplau’s theory one of the roles of the
psychiatric nurse is to educate the individual since obesity
is more prevalent among women than men which lead to
depression with suicidal feelings. So an attempt is made
to create awareness as well as lifestyle modification among
women with obesity. Hence the present study is planned
to educate the women in community regarding prevalence
and causes, effects and awareness of obesity.
REFERENCES:
1. Park K. Preventive and social medicine.18th ed.
Jabalpur: Banarsidas bhanot publishers. 2005; 316-18.
2. Rinderknecht, R., & Smith Obesity related knowledge,
attitude and behavior in obese and non-obese urban
Philadelphia female adolescents. Obesity research. 2002;
315-27.
3. Noreen Cavan Frish, Lawrence E. Frish. Psychiatric
Mental Health Nursing. 3rd ed. sanat, Haryana
publishers.335.
4. Sandra Drummon. Prevention and treatment of obesity
in the community. Journal of Community Nursing. 2000;
10-14.
XXV SNA BIENNIAL STATE CONFERENCE
Narayana Nursing Institution students had attended the XXV SNA Biennial state conference in Guntur, which
was held on 19th and 20th August, 2013, 53 students along with 3 faculties from Narayana Nursing Institutions
participated in the SNA Biennial state conference. Spot painting, Floor decoration (Rangoli) Health education,
Recitation / poetry, sports, Personality contest, Talent Night and poster presentation were the events conducted.
For personality contest Ms. Ninja from III rd B.sc (N), Sree Narayana Nursing College won the 1st Runner
up for Ms.SNA competitions. In sports Ms. Binnimol Baby from IInd year B.sc (N) Narayana college of Nursing
won 2nd prize on 100 meters running race. The classical solo dance Ms. Rekha Mol from IIIrd year B.sc (N) Sree
Narayana Nursing College won 2nd prize and For poetry Recitation Ms. Shyno Reba Cherian from IVth year B.sc (N)
Narayana College of Nursing won 2nd prize.
47
MARFAN SYNDROME
Ms.M. Senthila
Shunmuga Lakshmi
Asst. Prof. M.Sc (N)
Narayana College of
Nursing, Nellore.
WHAT IT IS ?
Marfan syndrome (MFS) is an autosomal dominant
heritable disorder of connective tissue that involves
primarily the skeletal, ocular, and cardiovascular systems.
Connective tissue supports many parts of your body. It as
a type of “glue” between cells that:
PHelps bring nutrients to the tissues
PGives tissues form and strength
PHelps some tissues do their work.
HOW MANY ARE AFFECTED?
1 per 5,000 people is affected by Marfan’s syndrome
worldwide.
WHAT CAUSES IT?
Marfan syndrome is caused by defects in a gene called
fibrillin-1. Fibrillin-1 plays an important role as the building
block for connective tissue in the body. In most cases,
Marfan syndrome is inherited, which means it is passed
down through families. However, up to 30% of patients
have no family history, which is called "sporadic." In
sporadic cases, the syndrome is believed to be caused by
a new gene change.
WHO GETS MARFAN SYNDROME?
Men, women, and children can have Marfan syndrome.
It is found in people of all races and ethnic backgrounds.
WHAT ARE THE SYMPTOMS?
Marfan syndrome affects people in different ways.
Some people have only mild symptoms, and others have
severe problems. Most of the time, the symptoms get worse
as the person gets older.
Skeleton: People with Marfan syndrome are usually tall
with long, thin arms and legs and spider-like fingers called
arachnodactyly. When they stretch out their arms, the
length of their arms is greater than their height. They may
have:
Bones (arms, legs, fingers, and toes) that are longer than
normal
A long, narrow face
Crowded teeth because the roof of the mouth is arched
A breastbone that sticks out or caves in
A curved backbone
Flat feet.
Heart and blood vessels: Most people with Marfan
syndrome have problems with the heart and blood
vessels, such as:
A weak part of the aorta (the large artery that carries
blood from the heart to the rest of the body). The aorta
can tear or rupture.
Heart valves that leak, causing a “heart murmur.” Large
leaks may cause shortness of breath, fatigue, and a very
fast or uneven heart rate.
Eyes: Some people with Marfan syndrome have
problems with the eyes,such as:
Nearsightedness
Glaucoma (high pressure within the eye)at a young age
Cataracts (the eye’s lens becomes cloudy)
A shift in one or both lenses of the eye
A detached retina in the eye.
Skin: Many people with Marfan syndrome have:
 Stretch marks on the skin.These are not a health
problem.
A hernia (part of an internal organ that pushes through
an opening in the organ’s wall).
Nervous system: The brain and spinal cord are covered
by fluid and a membrane. The membrane is made of
connective tissue. When people with Marfan syndrome
get older, the membrane may weaken and stretch. This
affects the bones in the lower backbone (spine).
Symptoms of this problem include:
*Painful abdomen
*Painful, numb, or weak legs.
Lungs: People with Marfan syndrome do not often have
problems with their lungs. If symptoms in the lungs do
arise, they may include:
*Stiff air sacs in the lungs.
*A collapsed lung if the air sacs become stretched or
swollen.
*Snoring or not breathing for short periods (called sleep
apnea) while sleeping.
HOW IT IS DIAGNOSED?
There is no single test to diagnose Marfan syndrome,it
may need,
†Medical history
†Family history (any family members who have Marfan
syndrome or who died at a young age from heart
problems)
†A physical exam, including the length of the bones in the
48
arms and legs There may be hypermobile joints and signs
of aneurysm, collapsed lung and heart valve problems.
†An eye exam, including a “slit lamp” test and may show
defects of the lens or cornea,retinal detachment and
vision problems
†Heart tests such as an echocardiogram every year to
look at the base of the aorta.
†Fibrillin-1 mutation testing (in some people).
HOW IT IS TREATED?
There is no cure for Marfan syndrome, but certain
activities can help treat and sometimes prevent related
problems.
Skeleton
Getting a yearly exam of the spine and breastbone
 Using a back brace or having surgery for severe
problems.
Heart and blood vessels
Getting regular checkups and echocardiograms
Seeing a doctor or going to an emergency room for pain
in the chest, back, or abdomen
Wearing a medical alert bracelet
Taking medicine for heart valve problems
Having surgery to replace a valve or repair the aorta if
the problem is severe.
Eyes
Getting yearly eye exams
Wearing eyeglasses or contact lenses
Having surgery if needed.
Lungs
No to smoking
Consult a doctor if there is any problem with breathing
during sleep.
Nervous system
†Taking medicine for pain if the membrane of spinal cord
swells.
Diet
†Eating a balanced diet can help to maintain a healthy
lifestyle, even though no vitamin or supplement can slow,
cure, or prevent Marfan syndrome.
WHAT DO PREGNANT WOMEN WITH MARFAN
SYNDROME NEED TO KNOW?
Women with Marfan syndrome can and do have
healthy babies. Because pregnancy can stress the heart,
pregnant women should see an obstetrician and other
doctors familiar with Marfan syndrome, to help prevent
problems with heart while pregnant.
WHAT ARE SOME OF THE EMOTIONAL AND
PSYCHOLOGICAL EFFECTS OF MARFAN
SYNDROME?
A genetic disorder can cause social, emotional, and
financial stress. It often requires changes in outlook and
lifestyle. People with Marfan syndrome may feel many
strong emotions, including anger and fear. They may also
be concerned about whether their children will have
Marfan syndrome. Genetic counseling may also help to
learn about the disease and the risk of passing it on to the
children.
WHAT IS THE ROLE OF NURSE ?
The nurse’s role in caring for people with Marfan
syndrome is varied and depends largely upon each
individual’s symptoms and particular health problems. Apart
from specialised care afforded to each affected organ,
the nurse’s main role is to provide support and education
- both for patients and their families and loved ones. Nurses
can provide emotional support, which will be vital during
any hospital admissions, and assist with education on
subjects such as family planning and genetic counselling,
fitness and exercise, diet and nutrition, and any special
precautions or follow-up treatment and examinations
required. Feelings of isolation, resentment for being
‘abnormal’ and depression can be common among this
group of patients, so nurses should focus on positive
aspects of people’s lives by encouraging them to join groups
appropriate to their physical capabilities, follow a healthy
diet and lifestyle, and lead as full and active a social and
personal life as possible.
WHAT IS THE PROGNOSIS?
Heart-related complications may shorten the lifespan
of people with this disease. However, many patients
survive well into their 60s. Good care and surgery may
extend the lifespan further.
WHAT ARE THE POSSIBLE COMPLICATIONS?
Complications may include:
† Aortic regurgitation
† Aortic rupture
† Bacterial endocarditis
† Dissecting aortic aneurysm
† Enlargement of the base of the aorta
† Heart failure
† Mitral valve prolapse
† Scoliosis
† Vision problems
HOW TO PREVENT IT?
Spontaneous new gene mutations leading to Marfan
(less than 1/3 of cases) cannot be prevented. Those who
have Marfan syndrome must consult doctor at least once
every year.
ANY SUPPORT GROUPS?
National Marfan Foundation -- www.marfan.org
REFERENCES
Doyle J, Dietz III H. Marfan syndrome. In: Kliegman RM,
Behrman RE, Jenson HB, Stanton BF. Nelson Textbook
of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier;
2011:chap 693.
Pyeritz RE. Inherited diseases of connective tissue. In:
Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed.
Philadelphia, Pa: Saunders Elsevier; 2011:chap 268.
49
Needle Stick Injuries among Nurses
numerous occupational hazards. Needle - stick injuries
Mrs.A. RATHIGA,
among health care workers are a recognized occupational
M.Sc (N), MSc Psychology, Reader:
Medical Surgical Nursing Dept.,
Chettinad College of Nursing
Kelambakkam,
Kangipuram Dist.
health hazard. Health care workers in all types of settings
are at risk for needle - stick injuries (richard Fairfax,1999)
Needle-stick injuries have been an unfortunate healthcare
reality for decades. For the past 20 years the needle-stick
prevention story has evolved to encompass new
legislation, new technologies and an emphasis on sharps
safety education among healthcare providers. Still, the
issues remain as to whether these measures are working;
ABSTRACT
The cross sectional study was undertaken to assess
what has been learned from history; and what can be done
the prevalence of Needle stick injuries among nursing
to ensure the optimal safety for healthcare workers and
personnel, the circumstances under which these occur and
the patients they are for. As a result of sharps injuries,
to explore the knowledge of nurses on prevention of needle
more than three dozen US healthcare workers a year
stick injuries in selected tertiary care hospital at Chennai.
contract HIV, two thousand workers a year become
The sample consisted of 80 Nurses. The results showed
infected with HCV and 400 contracts HBV (Mike Brown).
large percentage (49.09%) of nurses reported having had
Needle-stick or sharps injury is a common occurrence
on NSIs in their last 12 months. The commonest clinical
among healthcare professionals and a significant health
activity to cause NSI was emergency situation (76.36 %),
risk, especially for nurses and laboratory workers.
followed by recapping of needle (51.82%) and suturing
Canadian Centre for Occupational Health and Safety
(44.55%).The practice of recapping of needle still preva-
(CCOHS) data indicate that some hospitals report
lent among Nurses (78.18%).Some nurses also revealed
one-third of nursing and laboratory staff suffer
that they disassemble the used needles before discarding
needle-stick injuries annually (CCOHS 2004). Whenever
(61.82%). It was alarming to note that only (61.82%)
systems containing needles are used, disassembled or
nurses knew about the post exposure prophylaxis and
discarded, healthcare professionals are risk to get
(72.73%) of Nurse didn’t report the Needle stick injuries.
accidental needle-stick injury. Needle-stick injury carries
The present study showed a high occurrence of NSI in
the possibility of exposure to any of more than 20 blood
nurses with a high rate of ignorance and apathy. These
borne illnesses(Alam2002). The most clinically significant
issues need to be addressed, through appropriate
of these illnesses are hepatitis caused by the hepatitis B
education and other interventional strategies by the
virus (HBV) or the hepatitis C virus (HCV) .As a result,
hospital infection control committee.
prevention of needle-stick injury is a key occupational health
Key words: Knowledge, Needle-stick injury
objective (Lee JM, 2005).
SAVE NEEDLES SAVE LIVES IT IS THE LAW
OBJECTIVES
(ANA)
1.To determine the prevalence of needle -stick injury
Healthcare settings are constantly exposed to
2.To assess the factors associated with needle-stick
50
injury
method was used for assessing the knowledge, attitude
3.To assess the existing knowledge of the nurses
and practice questionnaires. Respondents were randomly
regarding needle-stick injuries.
chosen and the questionnaire was administered twice with
4.To find out the relationship of knowledge on
the gap of one week between the first and second
needle-stick injuries among nurses with selected
administration. Karl Pearson’s correlation ‘r ’ was
demographic variables.
computed for finding out the reliability. It was found that
METHODOLOGY
reliability of questionnaire was 0.90.Which was highly
Research design: The study adopted cross sectional
positively correlated.So the tool was found to be highly
research design used to assess the prevalence and the
reliable for final study.
knowledge of the nurses on needle stick injuries.
Pilot Study:
Sample and Sampling Technique:
The researcher conducted the pilot study to find out
For this study according to yamane’s formula, sample
the feasibility of undertaking final study and to decide plan
size was 80 nurses. Simple random sampling technique
of statistical analysis.It was effective and feasible. The
were used
pilot study subjects were not included in the study.
Setting of the Study
RESULTS AND DISCUSSION
The study was conducted in selected tertiary care
Majority of the Nurses were female(60%).The
Hospital situated in Chennai.
majority of the respondents comes under age group of
Tools:
20-30yrs. 64% of respondents had below 10 years of
The tools were well prepared and expert validated. It
working experience. Among 80 Nurses (79.09%) of the
contains two sections.
subjects have received hepatitis B vaccine and (90.91%)
Section A: Demographic data
had attended training on universal precaution.
The first section of the tool consists of items related to
In relation to analysis of overall knowledge score on
data regarding personal and baseline charecteristics of the
biological hazards and preventive measures of needle-stick
Nurses.It includes age, sex, marrital status, professional
injuries among nurse shows that 100% of the respondents
qualification, experience, previous training on universal
were aware about needle-stick injury. Only minority did
precaution, hepatitis vaccination done.
not know hepatitis B (13.64%) and hepatitis C (26.35%)
Section B: it consists of 19 closed ended questions
can be transmitted by needle-stick injuries. (26.36%) did
regarding Knowledge on needle stick injuries
not know that they need to wear gloves during
Data Collection
withdrawing needle from a patient. Majority (20.90%) of
The purpose of the research and procedure of data
the Nurse were of the impression that needle should be
collection was explained to the concerened authorities in
recapped after use. Majority of the respondents also stated
the hospital.Before investigation the researcher introduced
that they throw needles or sharps immediately after use in
her and the purpose of the study was explained and the
sharp bin (74.55%), and (61.82%) were disassemble
confidentiality of the subjects was assured and oral
needles or sharps with hand after use. Majority also stated
consent was obtained from nursing Personnel. Data were
that 101 (111.1%) they were separate the needles from
collected by using a structured interview schedule.
syringes prior to disposal. Among respondents (80.91%)
Validity and reliability:
had needle-stick injury in the last one year. (90.91%) of
In order to establish the reliability of the tool,test-retest
the nurses participated the training on standard
51
precaution. (86.36%) of the respondents had considered
needle-stick injury has to be reported.
Regarding, frequency of needle stick injuries in the last
one year. Among 80 staff nurses(49.09%)had needle-stick
injury at least one time. (9.09%) had more time in the last
one year. (24.55%) respondents can’t remember how many
times they had needle-stick injury.
Association between knowledge scores of the nurses with
selected demographic variables the result showed
significant association p>0/.05 between education status
and experience of the nurses.
CONCLUSION
Occupational disease burden in India is growing at
unprecedented pace. As a result of market liberalization
and globalization, the profile of occupational disease has
changed. Proportionate training of human resources in
occupational health and safety has not taken place in our
country. The results of this study confirm the importance
of the need for an increased awareness of the risk of
needle-stick injury, the need to provide the training and
OCCUPATIONAL
education of health care workers in the reporting of
HYGIENE, 1999; 14: 15-17.
2.B. Braun Medical, Indian nursing council. Awailable at
http://www.bbraunusa.com/
3.Lee JM, Botteman MF, Xanthakos N, Nicklasson L.
Needlestick injuries in the Unites States – epidemiologic,
economic and quality of life issues. AAOHNJ 2005;
53:11733 (abstract).Available at Http://www.ncbi.nih.gov/
Entrez/query.
4.Hanarahan A,Reutter.L.A, Critical review of literature
on sharps injuries: epidemiology ,management of exposures and prevention, Journal of Advanced Nursing
,1997,25(1):144-154.
5.Centres for disease control, Acquired immune deficiency
syndrome (AIDS), precautions for clinical and laboratory
staffs, MMWR, 1982; 31:577-580.
6.Clarke.SP, Sloane DM, Needle stick injuries to nurses
in context, LDI issue brief, 2002; 1:1-4.
7.Ruben FL, Norden CW, Rockwell K, Epidemiology of
accidental needle puncture wounds in hospital workers,
AM J ED SCI, 1983: 286;26-30
injuries and in standard operating procedures and also to
put in place a proper framework to provide support and
follow-up for those who sustain needle stick injuries.
Several suggestions have been made for preventing and
limiting sharp injuries among health care workers.
Lastly, exposure to blood borne pathogens is a harsh
reality that one has to comprehend and be committed to
prevent. Clearly transmission of these potentially
infectious pathogens can be minimized by adopting
effective precautionary measures. As needle-stick
injuries are the commonest source of occupational
exposures to blood and body fluids. We need imaginative
thinking, diligent commitment, renewed advocacy,
innovative funding and more efficient implementation.
REFERENCES
1.Richard Fairfax, A new approach to needle-stick
injuries among health care workers. APPLIED
52
AND
ENVIRONMENTAL
For Qualifing Examinations
Mental Health Nursing
Dr. Indira . S, Ph. D,
Narayana College of Nursing Principal
Answers for Previous Issue Questions
01. During a one - to - one interaction with a nurse, the
client states, "Im worried about going home," The nurse
responds, "Tell me more about this." This response is an
example of:
Ans: a) Clarifying
02. The most advantageous therapy for a preschool age
child with a history of physical and sexual abuse would
be:
Ans: a) Play
03. To prevent relapse in a client with a psychiatric illness,
the most important information the nurse should teach the
client is to:
Ans: d) Follow the prescribed medication regimen
04. A depressed client has been started on a triclic
antidepressant. The nurse teaches the client to expect to
notice a significant change in the depression within:
Ans: c) 1 to 4 weeks
05. Neuroleptics are the drugs of choics to relieve
symptoms of:
Ans: a) Psychosis
06. A brupt withdrawal from barbiturate use could cause a
person to experience:
Ans: b) Seizures
07. A client with diabetes, who has been taking insulin, is
psychotic and now is to receive Hadol. Which is the major
concern with this drug combination?
Ans: d) Decreased control of diabetes with this drug combination
08. Drugs such as trihexphenidy (Artane), diperiden
(Akineton), and benztropine (Cogntin) are often prescribed
in conjunction with:
Ans: d) Antipsychotic agents / neuroleptics
09. Photosensitization is a side effect associated with the
use of:
Ans: d) Chlorpromazine hydrochloride (Thorazine)
10. The relationship that is of extreme importance in the
formation of the personality is the:
Ans: c) Parent - Child
11. In the process of development, the individual strives to
maintain, protect, and enhance the integrity of the self.
This normally is accomplishe through the use of:
Ans: d) Defense mechanisms
12. Problems with dependence versus independence
develop during the stage of growth and development known
as:
Ans: c) Toddlerhood
13. Play for the preschool - age child is necessary for the
emotional development of:
Ans: b) Introjection
14. Resolution of the Oedipal complex takes place when
the child:
Ans: c) Identifies with the parent of the same sex
15. Evidence of the existence of the unconscious is best
demonstrated by:
Ans: b) Slips of the tongue
16. The ability to tolerate frustration is an example of one
of the functions of the:
Ans: b) Ego
17. Incidents of child molestation that come out years later
when the victim is an adult are best explained by the ego
defense mechanism of:
Ans: a) Repression
18. The level of anxiety that best enhances an individual's
power of perception is:
Ans: a) Mild
19. The problem of separation anxiety becomes most
problematic for children hospitalized during the age of:
Ans: a) 6 to 30 months
20. The nurse should observe the autistic child for signs of:
Ans: a) Not wanting to eat
53
QUESTIONS FOR QUALIFYING EXAMINATIONS
01. The Psycho Analytical Theory was developed by ?
a. Ivon pavlor
b. Sigmund freud
02. Who is the first psychiatric nurse ?
a. Florence Nightingale b. Linda Richard
c. White house
c. Dorothea dix
03. The theory of Logitrac development was framed by ?
a. Jean piaget
b. Kohlberg
c. Freud
04. Pathological repetition by imitation of the speech of another person ?
a. Echopraxia
b. Echolalia
c. Egocentric
Dr. Indira . S, Ph. D, Nursing Principal
(
)
(
)
(
)
(
)
d. None of the above
d. Freud
d. Roy
d. Ego dysteric
05. Pathological persistance of an irresisible thought (or) feeling that canot be eliminated from consciousness by logical
effect is called ?
(
)
a. Obsession
b. Compulsion
c. Panic
06. The description of the personality, before the onset of illness is known as ?
d. Paranoid
(
)
a. Aggressive
b. Morbid
07. I.Q (intelligence quotient) ?
d. Anxious
(
)
(
)
(
)
(
)
(
)
(
)
(
)
(
)
(
)
(
)
17. A false perception of touch(or) surface sensation is what type of hallucination ?
a. Auditory
b. Visual
c. Tactile (Haptic)
d. Somatic
(
)
18.
(
)
(
)
(
)
c. Premorbid
08. All of the following factors are affecting the therapeutic relationship except ?
a. Self fawarenum
b. Practicing
c. Linking
09. The factors affecting therapeutic relationship are the following except ?
a. Warmth
b. Seclusion
c. Empathy
10. Anti psychotics is otherwise known as ?
a. Neoroleptirs
b. Major tronquilizers
c. D2 receptor blockers
11. Mood stabilizers are used for the treatment of ?
a. BDAD
b. OCD
c. Phobia
12. The usual range of lithium dose per day is ?
a. 300 - 600 mg
b. 600 - 900 mg
c. 900 - 2100 mg
13. The therapeutic levels of blood lithium are ?
a. 0.6 - 1.2 mEq
b. 0.8 - 1.2 mEq
c. 0.6 - 0.8 mEq
14. The concept of therapeutic community was first developed by ?
a. Freud's
b. Piaget
c. Maxwell Jones
15. Hebephrenic schizophrenia is otherwise known as ?
a. Paranoid
b. Catatonic
c. Disorganized
16. The first rank symptoms of schizophrenia is developed by ?
a. Eugen bleuler
b. B F Skinner
c. Kurt schneider
flight of ideas are seen in ?
a. Depression
b. Mania
c. Schizophrenia
19. The old and eccentric personality is otherwise known as ?
a. Cluter 'A'
b. Cluster 'B'
c. Cluster 'C'
20. Schizotypal personality disorder consists of ?
a. Inappropriate affect
b. Odd thinking
c. Schizotype
54
d. patronzing
d. Self awareness
d. All of the above
d. Schizophemia
d. 2100 - 2500 mg
d. 0.8 - 1 mEq
d. Hoblbery
d. Residue
d. Iron pavol
d. OCD
d. All of the above
d. All of the above
Guidelines to Publish in the House of Narayana
1.
2.
3.
4.
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The article, Abstract should be, Original and not have been Published nor sent for Publication
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The articles, abstracts etc. may be submitted through E- Mail : narayananursingjournal@gmail.com
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