RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE Mr. MALLANAGOUDA L.K

AND ADDRESS I YEAR M.SC. NURSING STUDENT,
B.M.ROAD.HASSAN,KARNATAKA
2 NAME OF THE N.D.R.K. COLLEGE OF NURSING, HASSAN,
INSTITUTION KARNATAKA

3 COURSE OF STUDY AND MASTER OF SCIENCE IN NURSING

SUBJECT (MEDICAL SURGICAL NURSING.)

4 DATE OF ADMISSION TO 12TH MAY 2007

THE COURSE
5 TITLE OF THE TOPIC “THE EFFECTIVNESS OF STRUCTURED
TEACHING PROGRAMME ON HOME CARE
MANAGEMENT OF BRONCHIAL ASTHMA
AMONG PATIENTS ATTENDING MEDICAL
O.P.D IN SELECTED HOSPITALS, HASSAN,
KARNATAKA.”
5.1 STATEMENT OF THE “A STUDY TO ASSESS THE EFFECTIVNESS
PROBLEM OF STUCTURED TEACHING PROGRAMME
(STP) ON HOME CARE MANAGEMENT OF
BRONCHIAL ASTHMA REGARDING
KNOWLEDGE AMONG BRONCHIAL
ASTHMA PATIENTS ATTENDING MEDICAL
O.P.D IN SELECTED HOSPITALS, HASSAN,
KARNATAKA.”
6. BRIEF RESUME OF THE INTENDED STUDY
6.1 INTRODUCTION

The secrete of national health lies in the home of the people.

K. PARK
Asthma is known from the period of Hippocrates (430-330 BC) the father of
modern medicine. The word asthma derived from aazcin means to pant or exhale with
open mouth1.

The cells of body need energy for the chemical activity that maintains
homeostasis most of energy derived from chemical reaction. Which can only take place
in the presence of oxygen. The main waste product of this reaction is carbon dioxide the
respiratory system provides the route. Breathing is a regular inflation and deflation of the
lung. Which maintains a steady concentration of atmospheric gases. In the alveoli that is
the constant intake of oxygen and out put of carbon dioxide2. The lungs one of the pair of
conical organs of the respiratory system. Consisting of an arrangement of air tubes
(bronchi and bronchioles)terminating in air space(alveoli) they occupy most of the
thoracic cavity the lung supply the blood with oxygen inhaled from the out side air and
they dispose of waste carbon dioxide in the exhaled air as apart of the process known as
respiration.3

Respiration is a process of gaseous exchange between an organism and its

environment this includes external and internal respiration which involves breathing2.

Asthma is a disease characterized by recurrent attacks of breathlessness and

wheezing which vary in severity, and frequency from person to person symptoms may
occurs several time in a day or week in a affected individuals and some people became
worse during physical activity or at night .During an asthma attack the lining of bronchial
tubes swell causing the air way to narrow and sleeplessness day time fatigue reduced
activity levels and school and work absenteeism.4

Asthma is a inflammatory disease of air way resulting in air way

hyperresponsipeness mucosal edema and mucus production. This inflammation leads to
recurrent episodes of asthma symptoms. Allergy is strongest predisposing factor for the
development of asthma. Chronic exposer to air way irritants or allergens also increases
the risk for developing asthma. Common allergens can be seasonal example Grass, Tree
and weed pollens, Mold dust, Roaches or animal. Common triggers for asthma include
air way irritants Example Cold, Heat, Air pollutants, Weather changes. Strong odors,
Perfumes, Smoke, Stress or Emotional upset. Most people who have asthma are sensitive
to a variety of triggers5.

If persons is diagnosed with asthma. It is very important to reduce and

prevent the symptoms preventive measures include, having a healthy diet and nutrition,
exercise and managing environment , to eliminate triggers .This would help the patient to
maximize lung function. So home care management of bronchial asthma is health
education of awareness of the disease and its management it includes life style
modification ,diet management, breathing exercise, follow-up care, preventive measures
like avoidance of allergens exposure and air- pollution,. These are the information, To
improve the patient knowledge to control their asthma attacks and predicit their signs and
symptoms of bronchial asthma in home setting.

6.2NEED FOR STUDY

Live a healthier life ….. Starting today!

Asthma is a common disease worldwide with significant ethnic and regional

variation. And increasing morbidity and mortality as well as health care burden from
asthma has been recognized lately. There has been a change in the epidemiology and
clinical spectrum of asthma with an apparent increase in overall prevalence along with
raise in incidence of difficult to treat case. Atopy the production of abnormal amounts of
IgE antibodies in response to common environmental allergens is the strongest
identifiable predisposing factors for developing asthma7.

Asthma is not just public health problem for high income countries . It occurs in
all countries regardless of level of development over 80% of asthma deaths occurs in low
and lower middle income countries. Asthma is under diagnosed and under treated
creating a substantial burden to individual activities for a life time.8
 About 42% of increase of asthma among males between 1982 and 1994.
Incidence of asthma cause is projected to double by 2010 predicits the American Lung
th
Association. Asthma is a 9 leading cause of hospitalization .Death from asthma was up
over 200% from 1979 to 1997 from 2596 deaths to 5434 deaths. According to WHO
estimates 300 million people suffer from asthma and 255000 people died of asthma in
2005.Asthma death will increase by almost 20% in the next 10 years if urgent action is
not taken. In India have been estimated 15 to 20 million persons of asthmatic. In India
low literacy rate and low socio economic status is prevailing which also can affect the
patient with asthma, so they are not able to afford treatment 8. In south Karnataka state has
the first position in the incidence of asthma that is 3.849 in 29.5% among total population
(5.27.33.950) this may due to climate with cold air humidity and rainfall 9

A study was conducted on to determine the level of practical knowledge of self

management of acute asthma. The sample were 80 patient which moderate and severe
asthma were interviewer administered questionnaire the result shows lack of knowledge
about treatment and self management to reduce asthma mortality and morbidities10

A study was conducted on factors influencing development of asthma in Hariyana

state they were screened for the presence of symptoms of asthma using questionnaire
suggested by international study of asthma and allergy it was found that passive smoking,
pets at home, absence of windows in living rooms., family history of asthma, history of
worm infestation fuel used for cooking, location of cooking and food allergy associated
with symptoms of asthma.11

A study was conducted on to evaluate self care efficacy in asthmatic patient

the result shows minority of the patient had satisfactory level of the knowledge the
patient attitude towards medication were negative a practical implication of study
findings is that asthma self management focus on developing spefic knowledge and
skills in the self treatment of asthma attack12

A nutritional supplement that may be helpful .Being overweight increases the

risk of asthma. Obeys people with asthma may improve their lung function symptoms
and overall health status by engaging in a weight loss programme .A control study found
that weight loss resulted in significant decrease in episodes of shortness of breath
increases in overall breathing capacity and decrease in the need for medication to control
symptoms13. In those who are having asthma the planned teaching programme may
helpful to reduce the prognosis of disease and increasing their knowledge about home
care management and improving their health status to lead there life and family survival
and build up a healthy family , healthy community and healthy nation.

When the investigator came to Hassan and posted in clinical, on a

communication with patient and professional experience of investigator, found that the
patient had lack of health awareness on self management of asthma episodes. And Hassan
environment is cold dust and heavy rain fall these are the risk factors which exacerbate
the disease condition. Hence this information made, to take this study among bronchial
asthma patient with health education in the form of planned teaching programme .There
is satisfactory evidence in number of patient attending medical out patient unit at selected
hospitals Hassan Karnataka.

6.3 PROBLEM STATEMENT

“A study to assess the effectiveness of structured teaching programme on
home care management of bronchial asthma regarding knowledge among bronchial
asthma patient attending medical O.P.D in selected hospitals, Hassan, Karnataka”.

6.4 OBJECTIVES OF THE STUDY

1) To assess the Knowledge of bronchial asthma patient regarding home care
management of bronchial asthma before and after implementation of structured
teaching programme in control and experimental group.
2) To compare the knowledge of bronchial asthma patient between before and after
implementation of structure teaching programme in control and experimental
group.
3) To find out the association between the knowledge of bronchial asthma patient on
home Care management of bronchial asthma with there selected demographic
Variables in control and experimental group.
6.5 HYPOTHESES :-
H1 :- There will be significant difference between pre-test and post-test knowledge.
scores of bronchial asthma patient regarding home care management of bronchial
asthma.
H2 :- There will be significant association between the post-test score of Knowledge of
bronchial asthma patients with selected demographic variables.

6.6 ASSUMPTIONS:-
1) The patient has some knowledge regarding home care management of bronchial
asthma.
2) The patient are willing to participate in teaching programme to enhance their
knowledge regarding home care management of bronchial asthma.
3) Teaching programme is an effective method of imparting knowledge
of patient regarding home care management of bronchial asthma .

6.7OPERATIONAL DEFINITIONS
1) Assess: - It is statistical measurement of knowledge of patient regarding home care
management of bronchial asthma observed by structured interview schedule.
2) Effectiveness:-It is a significant gain in the difference between pre-test and post-
test knowledge scores.
3) Structure teaching programme: - It is method of teaching with organized and
sequential representation of information regarding home care management of
bronchial asthma with some aid’s.
4) Knowledge: - It refers to correct responses of bronchial asthma patient to the
knowledge items in the close ended questionnaire regarding home care management
of bronchial asthma.

5) Bronchial asthma patient: - In this study bronchial asthma patient refers to the
persons who are 20 years and above diagnosed as bronchial asthma attending medical
O.P.D for follow-up.
6) Home care management; Home care management is a self care measures taken
by bronchial asthma patients to control and eliminate triggering factors by prediciting
signs and symptoms of bronchial asthma in home setting by adopting life modification
which includes healthy diet and nutrition, proper exercise and maintenance of healthy
environment .

6.8 INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria
1) Irrespective of gender
2) Diagnosed as having bronchial asthma.
3) Present during the period of data collection.
4) In the age group of 20years and above.

Exclusion criteria
Patients who are:-
1) Not willing to participate in the study.
2) Developed secondary complication.

6.9 DELIMITATIONS OF THE STUDY

1) Prescribed data collection period is only 4-6 weeks
2) Sample size is limited to 60 patients.
3) Study design is limited to Quasi-experimental design.

6.10 SIGNIFICANCE OF THE STUDY

This study signifies the importance of structured teaching programme to enhance
the knowledge of patients on home care management of bronchial asthma.

6.11) CONCEPTUAL FRAME WORK:-

Based on the “General system Theory”.

6.12 REVIEW OF LITERATURES

Review of literature is a key step in the research process. It refers to an
extensive, exhaustive and systematic examination of publications relevant to the research.
A literature review helps to lay the foundation for a study and can also inspire new
research ideas. It can help with orientation to what is known and not known about an area
of inquiry, to ascertain what research can best make a contribution to the existing base of
evidence.14
A study was conducted on to determine the effectiveness of providing return
health information in addition to verbal information on knowledge and satisfaction for
patient or significant other being discharged from hospital setting to home. Were slected
randomized control trials included 197 patients in United states and 123 in Canada .The
result showed provision of verbal and written health information significantly increased
knowledge and satisfaction scores. The study concluded that the use of verbal and written
health information which appears to improve knowledge and satisfaction15.

A study was conducted on to determine the efficacy of fish oil

supplementation on exercise induced bronchi constriction the result showed that the fish
oil diet improved pulmonary function with a concurrent reduction in bronchodilator use
the study concluded that fish oil supplementation may represents a potentially beneficial
for asthmatic subjects with EIB16.

A placebo controlled double blind cross over trial study was conducted on to
determine the effect of ascorbic acid supplementation on pulmonary and EIB on asthmatic
clients the study finding showed that the ascorbic acid diet significantly reduced the
maximum fall in post exercise compared to usual and placebo diet asthma symptom scores
significantly improved the study concluded that ascorbic acid supplementation provides a
protective effect against exercise induced air way narrowing in asthmatic subjects.17

A randomized controlled trial study to asses the effect of grass pollen

immunotherapy on asthmatic symptoms, bronchial hyper responsiveness and quality of life
in seasonal rhinitis and asthma .The study concluded that grass pollen immunotherapy
improves quality of life on seasonal allergic rhinitis and reduces seasonal asthma symptoms
and bronchial hyper responsiveness.18

A study conducted to determine the effectiveness of physiotherapy based breathing

retraining for patient with asthma on 33 adult patients with diagnosed and currently treated
with asthma the result concluded that the patient who have symptoms of dysfunctional
breathing shows a clinically relevant improvement in quality of life following with
physiotherapy based breathing intervention19.

A study conducted on effect of two type breathing exercise 90 patient with asthma
taking inhaled corticosteroid were randomized after one two week run in period to buteyko
and pranayama exercise. The result showed that breathing exercise technique improves
respiratory function and reduce the use of bronchodilator20

A study was conducted on dietary antioxidant may influence the expression of

allergic disease and asthma the study was performed in rural general practice and a validated
dietary questionnaire was used to measure food intake if causes the study concluded that an
increased risk of symptoms associated with the lowest intake of zinc. The lowest intake of
vitamin c and manganese were associated with more than five fold increased risk of
bronchial reactivity the study provides evidence that diet may have a modulatory effect on
bronchial reactivity21.

A study was conducted, to assess the effectiveness of education programmes on self

management of asthma in morbidity and mortality rate. The samples were 323 adult to compare
changes in asthma symptoms due to self management and treatment regimn and knowledge on
self management was assessed through questionnaires the study finding shows that the self
management and education programme will improve control of environment and asthma
symptoms .22

A study was conducted on, to assess psychological and other factors that may affect
patients self care in acute asthma. The samples were 210 asthmatic adults and they were
interviewed through questionnaires the results shows that, stigma and pessimism feeling
towards in asthma patients .The results suggests that, there is no single important factors
governing patient management of acute asthma health education improves the patient
management and allow the stigma towards asthma .23
7. MATERALS AND METHODS OF STUDY

7.1) SOURCE OF DATA - Data will be collected from patients with bronchial
asthma in selected hospitals, Hassan.
 7.2) STUDY DESIGN: - A quasi- experimental research approach with pre-test
and post-test study with control group. Design which includes Manipulation,
Control and No randomization.

Group Pre-test Intervention Post-test

Asthma patients in Experimental O1 X O2

selected hospitals, group
Hassan.
Control O1 - O2
Group

KEY
O1=Pre-test on knowledge on home care management of bronchial asthma in
Control and Experimental group
X=Structured teaching programme on home care management of bronchial
asthma to Experimental group.
O2=Post-test knowledge on home care management of bronchial asthma in
Control and Experimental group

7.3 METHODS OF COLLECTION OF DATA: - The data will collected from 60

patients with bronchial asthma in selected hospitals at Hassan by using structured
interviewed schedule.
7.4) POPULATION;- The population selected for the study will be the patients with bronchial
asthma and attending medical O.P.D in selected hospitals, Hassan.
7.5 SAMPLE;- Patients who fulfills the inclusion and exclusion criteria are the sample.
7.6 SAMPLE SIZE;- Sample comprised of 60 patients with bronchial asthma attending
medical
O.P.D in selected hospitals, Hassan. .
7.7 SAMPLE TECHNIQUE;-Non-probability judgmental sampling technique’
7.8 SETTING; - The study will be conducted in selected hospitals, Hassan.

8 VARIBLES;-
8.1 Independent variable; - Structured teaching programme on home care management of
 bronchial asthma.
8.2 Dependent variable; - Knowledge of patient on bronchial asthma.

9 PLAN FOR DATA ANALYSIS

Descriptive and Inferential statistics are planned as follows
(i) Descriptive statistics; - descriptive describes the demographic variables and level of
knowledge by number (n) , frequency (f) ,Percentage (%) , Mean (x) and standard deviation
(SD) are planned.
(ii)Inferential statistics: - Chi-square test,t-test ,two sample binomial proportion test, one way
ANOVA F-test, student paired t-test, student independent t-test.

10 , PILOT STUDY;-Pilot study will be planned with 10% of population other than the sample
area, Hassan.

11. ETHICAL CONSIDERATION

1. Does the study require intervention to be conducted on patients?
-----Yes, appropriate permission will be obtained from authorities and bronchial asthma
patient attending medical O.P.D in selected hospital Hassan.
2. Has ethical clearance been obtained from your institution?
----Yes,
3. Has the consent been taken from the hospital?
---Yes,

12. LIST OF REFERENCES (VANCOUVER STYLE)

1. www. Indiandoctorsforum.org (www. Google.com ) Dr P.C. Nair.
2. Ross and Wilson , Anatomy and Physiology, 8th Edition, Publication- Churchill
Livingstone. Page no- 260.
3. Bailliere’s Midwives dictionary , 10th Edition , Author- Dense tiran , Page no- 151.
4. www. who.int/medicenter/factshects/fs 307/en Index/html.
5. brunner And suddarth’s, A text book of Medical surgical Nursing, Author-smeltzer s c and
 Bare B G , 9th edition , Publisher- lippincott, page no 460.
6. http://www.healthasthma.com, article source – http:// EzineArticals.com.
7. http://www.traester health.com Notes/10/2000 html.
8. www.kickasthma . com/ asthma info.html.
9. department of health and family welfare Karnataka state .table6 :1:C.
10. kalbc J , vamos M , james F ,et, al, “ Assessment of practical knowledge of self
management of acute asthma” , 1996 Jan , 109( 1) :86-90.
11. pokhard P K , Panday R M , Kapoor S K , “ Risk factors associated with bronchial
asthma.” Indian Journal of Pediatrics 2001 Octo , 98 (2): 108-12.
12. Lee K A , Lim Y W , N G T P , “ Asthma self care efficacy and morbidity in poly clinic
out patient .” Ann Acad Mad, singapoor 1995 Nov -24 (6) 846-50.
13. www. wildoats.com./ redesign / hn.php.
14. B.T Basavatappa, “Text book of nursing research” J.P Brothers 2nd edition;2007:p 92.
15. Johnsona,.sandford J , Tyndall S , “ Written and verbal in formation versus verbal in
formation only for patients being discharged from acute hospital setting to home”
Cochrane data base syst, Re 2003;(4):CD003716.
16. Mickleborough T D , Lindlay M R , Ioneseu A Fly A D , “ Protective effect of fish oil
Supplementation on exercise induced bronchoconstriction in asthma.”, Chest 2006 Jan
; 129(1):39-49.
17. Teckelenburg S L , Fly A D , Baiy et al, Ascorbic acid supplementation alternates
exercise induced bronchoconstriction in patients with asthma.” Respir med 2007 Aug-
101(8) :1770-8 Epub 2007 April-5.
18. Walker S M , Pajno G B , Lima M T , et al, “ Gross pollen immunotherapy for seasonal
Rhinitis and asthma: a randomized controlled trail J Allergy clin Immunol,
Jan; 107(1):87-93.

19. Thomos N, McKinley R K, fremen E, Foy C, “ Breathing retraining for dysfunctional

breathing in asthma a Randomized control trail.” , thorax 2003 Feb ;58(2):110-5.
20. copper S, oborne J, Newtson S, Harrison B , et al , “ Effect of two breathing exercise (
Buteyko and pranayama) in asthma.” , American Journal of public health 2003 Aug ;
58(8);674-9.
21. soutar A , seaton A, Brown K, et al “ bronchial reactivity and dietary antioxidants.”
Thorax 1997 Feb-; 52(2):166-70.
22. Wilson S R, Scamagas P, german D F , et al, “ A controlled trail of two forms of self
management education for adult with asthma .” , Am J med 1993 Jun; 94(6):561-3, Am J
med 1995 May :98(5): 517-8.
23. sibbald B, “Patients self-care in acute asthma .” Thorax 1989 Feb ;44(2):97-101.
 Mr.MALLANAGOUDA.L .K
13 Signature of the candidate

FEASIBLE TO CARRY OUT THE

STUDY
14 Remarks of the guide

PROF.R NIRMALA M.Sc

NURSING(Ph.d)
15 Name and designation

PROF.R NIRMALA

15.1 Guide

15.2 Signature

PROF.R NIRMALA
MEDICAL SURGICAL
15.3 Head of the department NURSING

15.4 Signature

Forwarded and approval for

registration
16 Remarks of the principal

16.1 Signature