Pjn jan apl 2014

Pondicherry Journal of Nursing Chief Advisor Cum Editor – in- Chief Dr. S. Kamalam, Principal, Kasturba Gandhi Nursing College, MGMC&RI, Puducherry.

International Member Mr. Allan Seraj

Peer

review

Senior Practice Educator in ICU, Royal Brompton and Harefield Hospital NHS Trust, U.K. Contributing Members Dr. Rebecca Samson, College of Nursing, Puducherry.

Dean, PIMS,

Prof. Muthamizh Selvi Principal, Vinayaka Mission College of Nursing, Puducherry.

Dr. Dhanusu, Principal, Sri Manakula Vinayakar College of Nursing, Puducherry.

Prof. P. Genesta Mary, Principal, Sabari College of Nursing, Puducherry.

Co-ordination & Compilation Mr. Vijayaraj. R, Asst. Prof, Mr. Rajesh. R, Asst. Prof, Kasturba Gandhi Nursing College, MGMC&RI, Puducherry.

Editorial Committee Members Prof. K. Renuka Gugan, Vice – Principal, Prof. Sumathy P, Prof. Annie Annal, Ms. A. Kripa Angeline, Asso.Prof Ms. Prabavathy S, Asso Prof, Kasturba Gandhi Nursing College, MGMC&RI, Puducherry.

Vol 7, Issue1, January – April’14

Editorial message

World Health Day: Protect yourself from vectorborne diseases 10 March 2014 - More than half of the world's population is at risk from vector-borne diseases such as malaria and dengue. Yet, we can protect ourselves and our families by taking simple preventive measures, including vaccination.

Vectors are small organisms that carry serious diseases 40% of the world's population is at risk from dengue. An estimated 1.3 million new cases of leishmaniasis occur annually Vectors are organisms that transmit pathogens and parasites from one infected person (or animal) to another, causing serious diseases in human populations. These diseases are commonly found in tropical and sub-tropical regions and places where access to safe drinking-water and sanitation systems is problematic.

Vector-borne diseases account for 17% of the estimated global burden of all infectious diseases. The most deadly vector-borne disease, malaria, caused an estimated 6,27,000 deaths in 2012.

However, the world's fastest growing vector-borne disease is Dengue, Chikungunya, Leishmaniasis, Malaria with a 30-fold increase in disease incidence over the last 50 years.

Being a nurse, we have more responsibility in protecting ourselves and families in the community in preventing vector borne diseases such as malaria and dengue especially and also we have to create awareness among the public about how to use the protecting devices and measures through health education and mass education campaigns.

Let us join together and prevent vector borne diseases!

Editor in Chief 1

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

Sl.No CONTENT REVIEW ARTICLES 1.

DERMATOGLYPHICS Ms. Emil Reni 2.

TRANSCULTURAL PSYCHIATRY Ms. Jakkulin Lilly Priya C REFLECTIVE PRACTICE - A TOOL FOR QUALITY IMPROVEMENT 3.

Dr. R.Shankar Shanmugam, Ms. Shakila Shankar & Ms. R. Lakshmi 4.

INFORMATION BUNDLE TO PEOPLE LIVING WITH HIV / AIDS Prof. Renuka. K 5.

IMPACT OF MENOPAUSE ON BONE HEALTH Mrs. N .Gayathri 6.

LONELINESS – A DISEASE ?

Mrs. S. Prabavathy 7.

SUNDOWNER‟S SYNDROME Mrs. Mary Sathyasundari & Mr. P. Prakash RESEARCH ARTICLES 8.

A COMPARATIVE STUDY TO ASSESS THE PREVALENCE OF PRETERM LABOUR AMONG PRIMI AND MULTIPARA MOTHER ADMITTED IN MGMC&RI, PUDUCHERRY Dr. S. Kamalam, Mrs. S. Lavanya, Ms. S. Sankari devi, Ms. A. Saraswathy, Ms.S. Sasikala, Ms. K.Sasipriya & Ms. R. Saranya 9.

EFFECTIVENESS OF DISTRACTION TECHNIQUE ON PAIN RELIEF DURING INTRAVENOUS CANNULATION AMONG THE SCHOOL CHILDREN IN SELECTED PAEDIATRIC WARDS AT AIMS, KOCHI Ms. Sainu.V.Simon & Prof P. Chitra 10. ASSESS THE PREVALENCE AND COMPARE THE RISK FACTORS OF TYPE 2 DIABETES MELLITUS AMONG ALCOHOLIC AND NONALCOHOLIC MALES RESIDING AT MEDAVAKKAM, CHENNAI. Ms. Thivya 13. JOB MOTIVATION Ms. P. Subha Rani, Ms. Gisha john & Ms. Reena Vijayakumar 14. FOODS TO BOOST OUR BRAINPOWER Dr. Divya Choudhary MULTIPLE CHOICE QUESTIONS COLLEGE EVENTS

2

Pg. No 3 5 8 12 15 18 21

25

29

34

36 40 42 43

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

DERMATOGLYPHICS *Ms. Emil Reni Dermatoglyphics is the scientific study of fingerprints (from ancient Greek derma means "skin"and glyph means "carving").

Dermatoglyphics refers to the branch of science in the study of the patterns of skins (dermal) ridges present on the fingers, toes and the soles of human.

Arch: Showy, Talkative, Practical, Absorbing, Passionate, Center of Attention, Influential etc.

Loop: Peaceful, Calm, People Oriented, Relationship Oriented, Great Team Player etc.

Significance of Fingerprints Scientifically it has been proven that no two people can have the same fingerprints in this world. And once a child is born, his fingerprints are completely developed and they remain unchanged till the end of life.

Fingerprints start developing when the fetus is there in mother's womb from 13th week of gestation. This is the same period when the brain of the fetus also start developing. So, the development of fingerprints and the development of brain happen simultaneously

Accidental: May have a mix characteristics, depending upon the combination.

DERMATOGLYPHICS FEATURES Uniqueness : There are no two identical fingerprints. One's 10 fingers are not the same.

Dermatoglyphics style, striae height, density, quantity and location of the point are not the same for everyone.

No individual has ever displayed the same fingerprint from another digit even if taken from the same hand.

Why do we have only 5 Fingers in 1 hand?

The way we have 5 fingers in one hand, similarly each part of our brain (Left & Right) has 5 lobes named as Pre-frontal Lobe, Frontal Lobe, Parietal Lobe, Occipital Lobe & Temporal Lobe. Each finger represents one lobe of each part of brain.

Types of Fingerprints & Characteristics Whorl : Target centric, Goal oriented, very aggressive, Stubborn, Independent etc.

Invariance : The raised pattern network of lifetime from birth to death will not change even if it is due to the regeneration of the labour dermatoglyphics style, quantity and profile shape which determines the same later. * Lecturer, Tehmi Grant Institute of Nursing Education, Pune.

3

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14 assimilate, organize and arrange oral information.

- To recommend parent to place their child in courses or pre-school where its curriculum suits the child's inborn learning style - To eliminate the 'trial and error' situation parents send their child to a certain class (i.e. art class or music class) without knowing if the child is capable to comprehend.

Hereditary : According to science statistics, immediate family members may have similarity between the striae. Normal human cells have 23 pairs of chromosomes. If the chromosomes of the tree or structure are changed, it will cause the corresponding striae mutation. Therefore, the striae have inherited the mutation.

Application of Dermatoglyphics

NURSING IMPLICATIONS Expanded role of nurse can be implemented in this area by special training in Dermatoglyphics Multiple Intelligent Test (DMIT).

We all have talents. No one has all talents. With Dermatoglyphics Multiple Intelligent Test (DMIT), It is a system that identifies the most prevalent human intrinsic potential with the theory of human genetic inheritance. Through decades of research, scientists found out that our fingerprints implicit the simultaneousness of the development between our fingerprints and human brain.

CONCLUSION Dermatoglyphics has absolute scientific basis, with 200 years of research. It is analyzed and proven with evidence in anthropology, genetics, medicine and statistics.

Dermatoglyphics reveals the congenital links between our fingers and our intrinsic qualities and talents. Thus implement Dermatoglyphics Multiple Intelligent Test (DMIT), which helps the parents to develop an insight into their child and to groom them effectively to the talents they possess.

In developing this system, Dermatoglyphics Experts have conducted psychological and physiological pattern profiles with more than 500 thousand individuals since 1985 across world which helps individual to learn the way to discover their inner ability.

Know your child's inborn learning style or ability

REFERENCE Suzumori K (1998). "Dermatoglyphic analysis of fetuses with chromosomal abnormalities". American Journal of Human Genetics32 (6): 859–68.

Shiono H (1996). "Dermatoglyphics in medicine". Am J Forensic Med Pathol7 (2): 120–6. www.fingertiips.com

- A kinesthetic learner is good in expressing their feeling/thought through body language and prefers to learn/memorize through operation and movement.

- A visual learner has sharp observation/visual differentiation and prefers to learn through observation and reading.

- An auditory learner prefers to learn through auditory sense/oral practice and able to

4

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

TRANSCULTURAL PSYCHIATRY *Ms. Jakkulin Lilly Priya C INTRODUCTION Transcultural psychiatry in the strict literal sense of the term means that the vista of the observer extends beyond the scope of one cultural unit into others.

Human rights concerns CULTURE INFLUENCES PERSONALITY DEVELOPMENT AND GENESIS OF MENTAL ILLNESS: Too much of individual freedom Overvaluation of one sex. E.g. Hindu society Child rearing practices Societies where inbreeding is encouraged Low socio economic status Birth order

TRANSCULTURAL PSYCHIATRY: “The discipline that deals with the description, definition, assessment and management of all psychiatric conditions as they reflect and are subjected to the influence of cultural factors in a biopsychosocial context while using concepts and instruments from social and biological sciences to advance a full understanding of psychopathology and its treatment”

CULTURAL VARIANTS IN SYMPTOMATOLOGY Schizophrenia patients from African bush areas are different from those from the urban areas.

Depressive illness in some countries has major somatic contents.

Hysteria, both conversion and dissociation are more common in developing countries.

Obsessive compulsive neurosis is rare in some eastern countries

SCOPE AND CONTENT OF TRANSCULTURAL PSYCHIATRY Exploration of similarities and differences in the manifestations of mental illness in different cultures.

Identification of cultural factors that predispose to mental illness and mental health.

Assessment of the effect of identified cultural factors on the frequency, nature and distribution of mental illness.

Attitude toward the mentally ill in different cultures.

Study of the forms of care and treatment practised or preferred in different cultural settings.

Culture and clinical practice, including the clinician-patient relationship.

Design and evaluation of mental health services in multicultural societies.

CULTURAL- BOUND SYNDROMES 1. Amoke This is a sudden unprovoked outburst of wild rage that causes the affected person to run about, usually armed with knife, and to attack or maim or kill indiscriminately all men and animals in his way before he is overpowered, or kills himself.

*Lecturer, College of Nursing, PIMS, Puducherry.

5

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14 gods, evil spirits or spirits of close relatives and friends who have met with unnatural death.

2. Latah This is seen exclusively among Malays in Malaya. There are two clinical forms: Startle reaction, a sudden stimulus provokes the suspension of all normal activity and triggers a set of unusual inappropriate motor and verbal manifestations over which the affected person has no voluntary control.

Echo reaction: a sudden stimulus compels the affected person to imitate any action or words to which he is exposed.

7. Whindigo This is a rare condition reported among north American Indians. In times of starvation some get the extreme fear that they may be transformed into supernatural monster whindigo that eats human flesh and notorious in mythology.

The victim experiences imperious urge to satisfy a cannibalistic appetite.

3. Koro This is an acute anxiety reaction characterized by the patients desperate fear that his penis is shrinking and may disappear into his abdomen in which case he will die.

8. Voodoo This is a religious cult Africans and west Indians.

At a typical voodoo ceremony, which consist of dancing to the wild rhythm of drums, several people, usually women, gets attacks of trances, convulsions and excitement.

This is a dissociative reaction, very similar to possession states and provides emotional catharsis.

4. Dhat This is acute anxiety reaction, which has some resemblance to koro and which is reported in some parts of India. This is usually associated with frequent masturbation or coitus.

5. Piblokto This is also called „Arctic hysteria‟ and reported among Eskimos more common among women.

• The victims screams, shouts, tears off cloths, imitates birds or animals and runs about.

• This last about 1 or 2 hours, after which the victim settles down, become normal and has amnesia about the episode.

9. Cargo Cult • The „soul loss‟ is treated by black magic.

This is reported in New Guinea where a leader emerges and announces a great future events.

• Preparation are made to deal with the expected changes.

• New forms of morality are adopted.

• Preparations are made to receive the ancestral spirits to bring in the highly valued cargo.

6. Possession States In Chinese trance states, the victims identify themselves with the dead.

• It is commonly reported in Indian villages.

• The victims are usually middle aged women who behave as though they are possessed by

10. Susto • This is again an acute anxiety reaction in Peru.

6

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

• It is the belief that the soul has left the body and is kidnapped by earth, and is similar to Koro and Dhat.

 Ensure that essential data fields (e.g. country birth, COB of parents in CAMHS, English fluency) are included in routine data collections  Promote high quality service evaluation as an essential component of service delivery  Confront ethics of exclusion  Epidemiological and treatment efficacy studies should be based on truly representative samples of the population (NH&MRC, ARC, etc.)  Development of transcultural mental health research instruments and methods  Teaching programs in transcultural mental health research methods and ethics  Attract an increased number of Master and PhD students who are doing transcultural mental health research projects  Transcultural mental health research capacity  Competitive research funding for the field  Body of useful information

CULTURE AND TREATMENT PROGRAMMES: 1. Morita Therapy It directed behavior change is the objective of treatment.

4 Phases Of Treatment: 1. Absolute rest 2. Period of light work 3. Period of moderate work 4. Period of preparation to go back and lead a normal life.

2. Family Therapy  A family therapy practiced in Vellore (India).  Family involvement in the treatment in other places in India such as Amritsar and Bangalore.  Each patient will be given a small flat, so that the family can have their privacy.

REFERENCE 1. Sadock, Benjamin J.; Sadock, Virginia A.; Ruiz, Pedro Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition.

INCREASING TRANSCULTURAL MENTAL HEALTH RESEARCH

2. NEKI, J. S. (1976) An examination of the cultural relativism of dependence as a dynamic of social and therapeuticrelationships. II. Therapeutic. British Journal of Medical Psychology, 49: 11-22.

3. Burr J A & Chapman T (1998) Some reflections on cultural and social considerations in mental health nursing. Journal of Psychiatric and Mental Health Nursing 5:431-437

 More systematic and intelligent use of existing data collections  e.g. service use and outcomes data

7

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

REFLECTIVE PRACTICE - A TOOL FOR QUALITY IMPROVEMENT *Dr. R.Shankar Shanmugam, **Ms. Shakila Shankar & ***Ms. R.Lakshmi The quality care rests on the reflective practice which bridges/connects the Nursing Practice and Nursing Theory for better clinical outcome.

INTRODUCTION In the era of 21st century, Nursing is facing new developments & challenges in health care. The developments & Challenges need effective & consistent education to deal with them. The Continuing Nursing education is under pinned by Primary goal of nursing which is the provision of quality care to the clients.

However, in order to achieve this, it is important to come up with new teaching ideas or developing an innovative learning tool Reflective Practice is a valuable tool for professional development.

Implementing the theory into practice is a complex and Time consuming task. But, a refined form of reflective practice will be used to bring theory into practice in an easy way. Brook Field (1987) has described that, the reflective learning has a dimension of critical thinking. Bevis & Murray (1990) advocate the instilling of critical skills in nurses through emancipation and continuing education, as a way of empowering practitioners to transform some of the contradictory aspects of practice. Bout et al (1985) consider that, reflection in the context of learning is a generic form for the intellectual and affective, in which individuals engage to explore their experiences in order to lead new understandings. This topic focuses on the critical incident technique as a means of structured reflection.

REFLECTION Reflection is the examination of personal thoughts & actions. For practitioners, this means focusing on how they interact with their colleagues and with the environment to obtain a clear picture of their own behavior. It is therefore, a process by which a Nurse practitioner can better understand themselves in order to build on existing strengths and take appropriate further action. The aim of reflection is to develop professional actions that are aligned with personal beliefs and values.

Reflective Practice is a formal process that helps Nurses to maintain their competence in today‟s rapidly changing health care environment.

Basic forms of Reflection Practices: There are two fundamental forms of reflection practice namely, 1. Reflection on action.

2. Reflection in action.

Understanding the differences between these forms of reflections are important.

It will assist practitioners in discovering a range of techniques which can be used to develop their personal & professional competence.

Reflection on Action: (ROA- Reflection after the event/experience)

REFLECTIVE PRACTICE

It is the most common form of Reflection. It involves carefully re-running in our mind events that has occurred in the past.

Nursing practice

Nursing Theory Quality Care

*Nursing Tutor, Govt. Medical College, Chengalpattu, ** Staff Nurse, NIRT (ICMR) Chetpet, Chennai & *** Principal, CON, Madras Medical College, Chennai.

8

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14  Developing reflective Practice enables the Nurses to respond to the unique challenges of practice (Atkins-1994). It also enables Nurses to understand the world in which they practice, by allowing them to make sense of themselves, what they experience and how they act.  The importance of self awareness, among nurses is recognized not only during education and continuing clinical practice but also in doing research (Newell-1992).  Reflection has been advocated as a method by which the Nurse enhances his/her research practices.  Maeve (1994) discusses the “carrier bag theory of Nursing practice” and cogently describes development of reflective Practice to provide the Bridge between Theory And Practice.  Brook & McGill suggest that reflection has a potential to facilitate learning in higher education.  Nurses are responsible for providing care to the best of their ability to patients and their families.  Reflective practice is a part of the requirement for nurses constantly to update professional skills. Annual reviews enable nurses to identify their strengths and areas of opportunity for future developments.  Nurses should consider the ways in which, they interact and communicate with their colleagues. The profession depends upon a culture of mutual support. Nurses should aim to become self aware, self-directing and in touch with their environment.

The aim is to value their own strengths and to develop different number of effective ways to act in the future.

This is what we usually mean, when we refer to reflective practice. it is nothing but, reflecting the event after it occurs by , thinking through and discussing the incident with a colleague or Supervisor. It helps in Focus on identifying negative aspects of personal behavior with a view to improving professional competence.

Reflection in Action (RIA- Reflection during the event/experience) Reflection in Action is the hall mark of the experienced professionals. It means examining our own behavior and that of others while in a situation ( Schon-1995).

Reflection in Action is when we are working and being aware of what we are doing at the same time. This is the way, any confident, experienced nursing professionals will work.

This also helps us to develop skills in following aspects;    

Thinking one step ahead.

Being critical.

Storing experience for the future.

Analyzing.

BENEFITS OF REFLECTIVE NURSING PRACTICE  The process of RIA will produce an effective practitioner, who can be able to define and redefine problems in practice, and do a more complex activity than merely problem solving.” A reflective Practice should be a key element in professional education.

HOW TO BE REFLECTIVE? There are many tools that can assist us in the development of vital skills of reflection. The

9

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

following are the few ideas, tips and activities that will enrich our experience of reflection.

Feedback Feedback comes from other people in many different forms, both verbal and non-verbal forms. We receive feedback from others about our behavior, our skills, our values, and the way we relate to others and about our identity. It can be argued that, what are we? and who we are?‟ it is because of the feedback we receive from others. So feedback is central of the process of reflection.

We encourage people to take responsibility for gathering feedback about them. For example, we could ask,” May I know something about, how I spoke to that patient.”

What have I learnt?

Another invaluable approach to reflection is to ask self regularly,” What have I learnt today?

This is a positive approach of processing information and can be an event that might have been upsetting. It‟s another way in which we can work together with others to develop our reflective skills.

Valuing personal strengths The literature of reflection often focuses on an individual or group identifying their weakness and using reflection to address „areas of opportunity as managers. We should never overlook our many positive accomplishments.

Take time regularly to review the many satisfying things that you have achieved in recent past.

Viewing experience Objectively To view an objective of a picture as much as possible by our self, we should try the following exercise. Recall an incident from the recent past, one which involved us and another person or other persons. Practicing this way of looking back on our, can help us upon

developing reflection in our action skills. Being a participant, observer of our own experience is a sophisticated skill and can enable us to analyze the underlying element of our personal experience.

Empathy A useful way of reflecting of an interaction, through one that has involved you in conflict of some kind, try to adopt an empathic position to see, hear and feel what the other person might have experienced. This can rather be a strange, but, potentially enlightening exercise. It can add new perspective to the analysis of our experience.

Keeping a journal We Can Keep a private journal to log our own reflections. we can choose a book with unlined pages so that we can record our thoughts in a variety of forms-like, drawing, notes, pictures which connect with our thoughts and feelings.

Use variety of writing instruments- coloured pens, pencils, crayon & high lighter pens.

Another way of recording our thoughts are to give brief description of the best things and the worst things that happened during the day.

Exploring the Images If we write freely, we are very likely to contradict our self. This is natural. Value the contradictions and diary entries which easily reflect the complexity of our own personalities.

Diaries can be very enlightening when re-read at a later date. We can see how we have developed since the time we wrote the words. We may be able to identify how limiting beliefs served us poorly. The element of critical reflection is the vital component of reflective practitioner.

What do you do with all this material Our next task is to make connections.

Having written, drama or tape recorded our thoughts and feelings over a period of time 10

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

which could be for a few days, a few weeks or even months, try and see if there are any emerging patterns.

Planning for the future Planning future action is part of the learning and reflective process. Having made connections, identified pattern and made sense of reflections, we are likely to be excellent in planning and implementing the changes for the future. Don‟t be over ambitious.

Creating our own future A vital part of the reflective process is to plan for changes in our behavior. One way to tackle is to adopt the creative thinking strategy devised

by Walt Disney. He had 3 stages. His strategies are based on different characters, each of which surfaced at appropriate points in the process of creating new projects. These 3 characters are;

expressions. The critic is necessary as a filter for refining ideas and avoiding possible problems.

CONCLUSION The effectiveness of reflection as a learning tool has been explored by Educationist to use reflection as a component of learning through experience and helping the students to integrate the Theory & Practice. The Use of Reflective practice as a tool for enhancing Nurse‟s and Student nurses‟ ability to deal with death and dying. Working on personal and Professional development need not be chored if we have access to varied and informative techniques.

REFERENCES : 1.Chris Bulman,”Reflective practice in Nursing”, 1st edition, Weiley-Blackbell publishers: 2008; pp 45-100.

The Dreamer, The realist & The Critic.

The Dreamer - looked towards ideas for the future,,.I wish.., What if.., The realist - This action oriented, looking at how the dream can be turned into a practical workable plan ..,, How can I.. Have I time to.., The Critic - This is very logical and looks for the whys and why not to a given situation…., That‟s not going to work because.., what happens? when?.., Effective planning of personal learning is a synthesis of these different processes. The dreamer is needed in order to have new ideas and goals. The realistic is necessary as a means of transforming these ideas into concrete

2.Christober Johns,”Tranforming Nursing n Through Reflective Practice”, 2 edition, Black well publishers: 2006;pp 32-68.

3. David Somerville et al,” A practical approach to promote reflective practice within Nursing”, Nursing Times: 2004;100 (12), PP 42.

4. www.allnurse.com 6. www.nursingknowledge.org

11

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

INFORMATION BUNDLE TO PEOPLE LIVING WITH HIV / AIDS *Prof. Renuka. K  They need an outlet for emotions, exact management during crises and decision making.  The HIV status necessitates every positive individual to address each issued by himself, to change his / her life style to live physically and emotionally a healthy life, to address any doubts or concerns that may come up from time to time.

Information Bundle Helps in  Improving quality of life of people living with HIV / AIDS.  Reinforcing adherence to treatment and behaviour change.  Enabling the physical & psychological well being of clients.  Addressing several issues that impact their HIV status.  Identifying and prioritizing problem.

Information Bundle Involves Ways to live healthy with HIV a. Practice safe sex. b. Get tested for others STDs. c. Prevent infection and illness. d. Follow doctor‟s orders about your prescriptions. e. Don‟t abuse drugs or alcohol. f. Omit smoking g. Manage physical & emotional health problems.

Introduction: The HIV/AIDS is a major public health problem all over the world. In the overwhelming majority of HIV infected people, more than 90% live in developing world and most of them do not even know that they are infected. This epidemic has killed about 3 million people all over the world in the year 2004. The epidemic is going steadily and no signs of coming down globally. HIV/AIDS is a multi -faceted disease and is not only a problem of medical fraternity, also a problem to social, economic and industrial fronts. In 2009, the total number of people living with HIV (PLHIV) in India were estimated at 2.4 million. Among PLHIV, by sex approximately 61% were male and 39% were female. 4 % were children below the age of 15 years, 83% were adults, and the rest 13% were over 50 years of age. Supply of Information Bundle therefore, taken into an account not only the most immediate social and medical environment of clients, but also their social relationships, attitudes, beliefs about HIV / AIDS, life style modification and constructive adaptation to have good quality of life.

Need for Information:  It is of great importance, since the individual diagnosed with HIV is confronted with a condition for which there is no cure and he / she is heavily stigmatized.  The newly diagnosed patient may be in a state of shock or denial. It may take time to accept and understand the complexities associated with living with HIV.  Wide range of issues arise after HIV diagnosis ranging from biological, psychological, social, environment etc.,

Exercise mind & body Exercising will benefit to produce more blood cells, which means a better immune system. Swimming in a good exercise. Dancing is a great way to feel better. By dancing they

*Vice Principal, Kasturba Gandhi Nursing College, SBV, Puducherry 12

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14 o Eat nuts, seeds, dried beans or peas each day. o Drink plenty of water and limit how much alcohol, coffee, tea and colas you drink.

will feel happy and the body will benefit extra oxygen. Oxygen will help to kill infection.

Yoga & stretch exercises are excellent methods to destress the mind and strengthen the body.

ART – managing common side effects Like most medicines, ART can cause side effects. These unwanted effects are often mild but sometimes they are more serious and can have a major impact on health or quality of life.

Variation in side effects differ how commonly they cause particular side effects.

Diarrhea It is a common side effect of many ARV drugsespecially PI (Protease Inhibitors). 60% of people living with HIV report HIV severity of diarrhea also varies. Health educate the patients to Drink plenty of fluids to replace the electrolytes that will reduce dehydration.

Diluted fruit juices, soups and homemade rehydration mixtures (8 level teaspoon of sugar & 1 level teaspoon of table salt per lit of water) Eating bananas, potatoes, fish or chicken will help to replace potassium.

Eating bananas helps recovery from diarrhea.

Eat less insoluble fiber ( raw vegetables, fruit skin, whole grains, cereals & nuts) Eat more soluble fiber (wheat, oats) Cut down caffeine, alcohol & the sweetener.

Avoid greasy, fatty, spicy & sugary foods.

Nausea & vomiting: o Eat several small meals instead of a few large meals. o Avoid spicy, greasy and rich foods, choose bland foods. o Eat cold rather than hot meals. o Avoid alcohol, aspirin & smoking

Nutritional education o Eat something yellow (like pumpkin or carrot) something red (like beetroot or tomatoes) and something green (like spinach) every day. o Eat soya or eggs instead of meat. If you do eat meat, cook it well. Avoid pork. o Drink at least eight glasses of water every day. o Daily take 1) 1 glass of lemon juice, 2) 1 table spoon of fresh garlic.

3) 1 teaspoon of ginger (not raw) 4) 1 table spoon of pumpkin seeds 5) 6 table spoon of butter milk or yoghurt. o If they get cold, they can increase the amount to garlic to at least 5 table spoons a day. o Avoid sugar and cool drinks with sugar. o Drink unsweetened fruit juices. o Avoid peanuts and peanut butter. o Multivitamin supplements are very good for people with HIV/AIDS. Multivitamin are costly. Refer to NGOs/ART centers for free vitamins supplementation. o Eat 5 to 6 servings of fruits and vegetables each day or about 3 cups. o Eat whole grain such as whole wheat, whole bread or whole wheat pasta. o Choose skinless chicken breast. o Eat 2 to 3 servings of high protein foods each day, including meat. Fish, poultry, eggs and legumes. o Choose low fat dairy products and eat 2 to 3 servings of them each day. o Limit sugary foods & soft drinks.

13

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

o Avoid cooking smells o Ginger & peppermint may help against nausea Rash  Avoid hot showers or baths  Use mild soaps.  Wearing cool fibers such as cotton and avoiding wool.  Humidified air.  Apply moisturizers/emollients or calamine lotion.

Lipodystrophy It involves gaining body fat & also losing.

Losing fat on face, arms results in sunken eyes and shrunken buttocks. Treatment for lipodystrophy is limited.

Managing stress  Identify the factor that makes you stressful.  Be organized – organizing your life can put down stress in all perspective.  Learn to prioritize.  Manage your emotions.  Get depression under control, healthy lifestyle help to manage depression.  Set a daily goal of good health.

Spiritual health Qualities like faith, hope, forgiveness and social support and prayer seem to have a noticeable effect on health & healing.

Faith: It helps to reduce stress & lower the hormone level. Faith helps to cope up with stress.

Hope: It develops a positive attitude to face difficulties.

Forgiveness: Is a release of hostility and resentment from past hurt. Willingness to forgive oneself, feeling one have beneficial health effect.

Love & social support: Close network of family and friends that lends help and emotional support has been found to offer protection against many diseases.

Prayer: Putting oneself in the presence of conversing with a higher power has been used as a means of healing across all cultures throughout the ages.

Tips to improve quality of life  Never stop taking your medications.  Reach out to loved ones.  Love yourself.  Take advantage of group and individual therapy.  Get help for sexual health issues.  Look for assistance with financial issues.  Stay connected.  Practice healthy lifestyle habits.

REFERENCES: 1. www.healthline/aids.com 2. www.unaids.org 3. www.pubmed.com 4. www.sciencedirect.com 5. www.naco.gov.in

14

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

IMPACT OF MENOPAUSE ON BONE HEALTH “Better be safe than sorry” - Reiner Bartl,Endocrinologist. *Mrs. N .Gayathri & **Dr. Mrs. S. Kamala ranging from 5 to 8 yrs. In terms of bone remodeling, the lack of estrogen enhances the ability of osteoclasts (break down of bone) to absorb bone. Since the osteoblasts (formation of new bone) are not encouraged to lay down more bone, the osteoclasts win and more bone is lost than is produced.

Lack of estrogens decreases bone mass approximately one percentage per year from the age of 40 .It increases rapidly after menopause for the next 10 yrs. It is estimated that, on average women loses approximately 15% of her bone mass within 5 yrs. This rapid bone loss period is followed by slower bone mass loss such that she may lose up to 40% of her peak bone mass by 80 yrs of age. Research suggests that about half of all women over the age of 60 yrs experience atleast one fracture due to osteoporosis.

Introduction: Menopause is defined as the permanent cessation of menstruation due to loss of ovarian activity. Menopausal symptoms are associated with reduced functioning of the ovaries due to aging, resulting in lower levels of estrogen and other hormones. Menopause can increase women‟s risk of developing osteoporosis.

Osteoporosis is a disease that weakens bones, increasing the risk of sudden and unexpected fractures. By 2050, the international osteoporosis foundation estimates that half of the world‟s osteoporotic fracture will occur in Asia. Almost 70 million people over the age of 50 suffer from osteoporosis and the disease causes about 6,87,000 hip fractures among women in a year.

In India the number of osteoporosis is approximately 26 million (2003). and the number projected to increase to 36 million by 2013. The risk of suffering from osteoporotic fractures is 30-50% in women.

IMPACT OF MENOPAUSE ON BONE HEALTH: Bones are a dynamic tissue, constantly undergoing breakdown and formation. It can be affected by many factors such as diet, exercise, hormones (estrogen) and other life style factors.

Estrogen plays an important role in maintaining bone strength and it slows bone loss and improves the body absorption and retention of calcium. There is a direct relationship between the lack of estrogen after menopause and development of osteoporosis. This lack of estrogens accelerates bone loss for a period

PREVENTION OF MENOPAUSAL OSTEOPOROSIS: Five „E‟asy ways to prevent osteoporosis are:  Exercise  Eat foods rich in vit D, calcium, phytoestrogens, and proteins  Encourage to maintain healthy body weight  Early identification and treatment 15

*& **Professor, RMCON, Annamalai University, Chindambram

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

 Engage with preventive steps for fracture EXERCISE:  Establish a regular exercise programme.  Learn and practice weight bearing exercises such as walking, jogging, playing tennis and dancing.  Flexibility exercise, muscle strengthening exercise such as push up, dumbles etc...

EAT FOOD RICH IN CALCIUM, VITAMIN D, PHYTOESTROGENS, AND PROTEINS: CALCIUM

 US recommended daily allowances of calcium for women age31 to 50 are 1,200 mg and people over 50 should consume 1,500 mg of calcium.  Calcium rich sources are dairy products, seafood, dark green leafy vegetables such as broccoli, orange juice.  Consult physician and consume calcium supplements such as calcium carbonate and calcium citrate.  Calcium supplements should not exceed 2000mg/day which may produce renal calculi.

Some Calcium-Rich World's Healthiest Foods Food

Serving

Calcium (mg)

Quality

Sesame seeds

0.25 cup

351.0

Good

Milk(whole)

1 cup (200ml)

236

Very good

Turnip greens, cooked

1.0 cup

197.3

Excellent

Soybeans, cooked

1.0 cup

175.4

Excellent

Mustard greens, boiled

1.0 cup

103.6

Good

Broccoli cooked

1.0 cup

71.6

Very good

Almonds

0.25 cup

91.8

Good

4fruits(220g)

506

Excellent

Fig

Food Sources of Vitamin D: = International Units, ug = Microgram

VITAMIN D  Exposing the body to sun light for 20 mts every day helps to gain enough vit D  Eat foods such as egg, fatty fish like salmon, and milk  Consult physician and take vit D supplements 1000 to 2000 IU  Avoid certain medications such as steroids, anticoagulants and thyroid medications

Food with Vitamin D

16

*

IUs

IU per ug per serving* serving*

Salmon, cooked, 100 g

360

9

Egg, 1 whole (vitamin D is found in yolk)

20

0.5

Liver, beef, cooked, 100 g

15

0.37

Milk, whole, 100 ml

4

0.1

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

PROTEINS: Eat protein rich diet such as dhal, egg, meat, and fish. Framingham (2006) found in his study, lower protein intake were associated with loss of bone mineral density in the hip and spine.

ENGAGE WITH PREVENTIVE STEPS FOR FRACTURE:  Remove objects or hazards that can lead to falls eg: loose floor rugs  Installing hand rails in areas such as entrance way and bathrooms  Using non slippery mats in bath or shower  Padding to protect vulnerable parts of the body eg: use hip protectors to prevent hip fracture SUMMARY Osteoporosis is a silent killer disease causing fracture among women after menopause. Life style changes will guide the women to prevent osteoporosis and help them to build a strong bone during menopausal transition.

PHYTOESTROGENS: Phytoestrogens are a plant estrogen which has an action similar like estrogens.  Eat foods rich in phytoestrogens such as soy, peanut, oats, and gingili pomegranate, garlic, sesame seeds, dry dates.  Consume only 30 to 50 mg of phytoestrogens per day.  For better absorption of phytoestrogens women should poses healthy bacterial flora.

H. Arjmandi Bah ram et al., (2002) states that soy protein has greater effect on bone in post menopausal women as evidenced by reducing bone resorption and urinary calcium excretion.

REFERENCES: 1. Christianson MS (20013),”osteoporosis prevention and management: nonpharmacologic and lifestyle options”, clinical obstetric and gynecology, Dec, 56(4):703-10.

2. Jeanette Wang (2013),”Diet and life style changes key to protecting women against osteoporosis” 3. James Norman (2013), the effects of osteoporosis on bone strength, calcium and osteoporosis and the influence of estrogen on osteoporosis.

4. Dr. Leonard Condren (2010), an estrogen declines, world of Irish nursing, 10(3) pp31-32.

ENCOURAGE TO MAINTAIN HEALTHY BODY WEIGHT: Excessive thinness, malnutrition and loss of estrogen can devastate to bone health. Also excessive weight causes fracture, so women should maintain a healthy body weight to prevent fracture during menopausal transition.

EARLY IDENTIFICATION AND TREATMENT: Undergo bone density testing every one to two years after menopause which will helps to identify and treat the problem early.

17

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

LONELINESS – A DISEASE ? *Mrs. S. Prabavathy BBC news on January 31st, 2011 pronounced loneliness as a “hidden killer” of elderly. Loneliness has been defined in different ways. A common definition is “A state of solitude or being alone”. The other definition is “Loneliness is not necessarily about being alone. Instead, “it is the perception of being alone and isolated that matters most” and is “a state of mind”. “Inability to find meaning in one‟s life”, “Feeling of negative and unpleasant” and “A subjective, negative feeling related to the deficient social relations” “A feeling of disconnectedness or isolation.” etc., are the other ways to define loneliness.

Loneliness may be pathogenomic of depression in old age. It is reported to be more dangerous than smoking; high degree of loneliness precipitates suicidal ideation and para-suicide, Alzheimer‟s disease, and other dementia and adversely affects the immune and cardio-vascular system. It is a generally accepted opinion that loneliness results in a decline of well-being and has an adverse effect on physical health, possibly through immunologic impairment or neuro-endocrine changes. Loneliness is thus, among the latent causes of hospitalization and of placement in nursing homes.

Loneliness being a common human emotion is, however, a complex and unique experience to each individual. A person, who experiences loneliness does not find anyone with him/her and thus increases risk for developing biological dysfunctions, psychological distress, and behavioural problems as well. It is commonly seen in older adults and has its phenomenology, complications, etiology which needs proper diagnosis, care and management. This may be called as „pathological loneliness‟. The pathological loneliness has its roots in medical model consisting of a host, an agent, and an environment and is thus, a disease.

The current Indian demographic scenarios is testimony to the fact that the population of the elderly is growing fast, both in terms of proportion and absolute numbers (5.3% -12.5 million in 1957 to 7.6% -92 million in 2011, respectively). In addition to increasing population of elderly, changing living situations (living alone or living with relations and nonrelations) are the main demographic breeders of loneliness. Some other factors like widowhood, increasing dependency ratio (10.9% in 1961 to 13.1% in 2001) as well as economic dependency (86% rural and 83% urban females and 51% rural and 56% urban males); and solvency are major contributors for developing loneliness.

Till date loneliness is being treated as a symptom of mental health problems; however, for elderly (aged 60 years and above), loneliness has become a disease in itself. There are epidemiological, phenomenological, and etiological reasons to say that.

Further, environmental factors like type of family, social network, transportation issues

*Assoc. Professor, Kasturba Gandhi Nursing College, SBV, Puducherry 18

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

and place of residence, population migrations etc., are also some other significant correlates of loneliness. Women are reported to more at risk for loneliness and isolation than men.

Complete physical/mental health status Several researchers report interventions for loneliness. These interventions are to be individualized to control expectations as per personal efficiency and improve capacities to socialize, Behavioral training and feedback regulate behavior and improve the frequency and degree of loneliness positively. Thus, loneliness is a treatable, rather than an irreversible condition. Apart from planned interventions, there are some other useful strategies to fight against loneliness like keeping self-busy, sharing feelings, involving self in some activities (spending time together, discussing problems, maintaining interactions), helping others, avoiding escapes, developing quality relationships with people who share similar attitudes, interests and/or values, collecting good thoughts and managing unfortunate happenings, joining groups of self interest, pharmacological management of physical ailments, and staying in contact with family and friends.

Loneliness may be categorized into three types according to its causes.

Situational loneliness: Socio-economic and cultural milieu contributes to situational loneliness. Various environmental factors like unpleasant experiences, discrepancy between the levels of his/her needs and social contacts, and migration of population, inter personal conflicts, accidents, disasters or emptiness syndrome etc. lead to loneliness in old age.

Developmental loneliness: Personal inadequacies, developmental deficits, significant separations, social marginality, poverty, living arrangements, and physical /psychological disabilities often lead to developmental loneliness.

Internal loneliness: Being alone does not essentially make a person lonely. It is the perception of being alone which makes the person lonely. People with low self-esteem and less self-worth are seen to feel lonelier than their counterparts. Reasons for this type of loneliness are personality factors, locus of control, mental distress, low-esteem, feeling of guilt or worthlessness, and poor coping strategies with situations. Loneliness, which leads to distress and dysfunction in the elderly, may be assessed in many ways and is, thus ,can be diagnosed as a disease entity.

For diagnosing loneliness in elderly following measures may be used: Level of experience of separateness Levels of cumulative wear and tear

It is generally accepted that loneliness frequently results in a decline of well-being and may cause depression, suicidal behaviour, sleep problems, disturbed appetite, and so on. The pathological consequences of loneliness are found more among those adults who develop personality and adaptation disorders, such as overconsumption of alcohol, loss of self-esteem, extreme forms of anxiety, powerlessness, and stress. Loneliness predisposes a person to physical diseases too as it has an adverse impact on immune, cardiovascular, and endocrine system.

Consistent, overwhelming and pervasive loneliness develops stress and ultimately culminates into serious physical 19

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

disease. Feeling of loneliness and being alone were found to be independent predictors of motor decline in old age. Loneliness was also found to be an independent predictor of mortality and functional decline after controlling for depression. It also leads to memory impairment and learning difficulties, and makes the person prone to Alzheimer‟s disease. A Dutch study reports that people who feel lonely are more likely to develop clinical dementia over a period of 3years compared to those who do not experience loneliness.

Solitude and loneliness should not be explained in similar ways. Solitude is enjoyed by people and it leads to creativity, self realization, and is totally an approach for developing once own individual space. It is often considered as an essential component for spirituality and self growth but loneliness is a state of mind, a feeling of emptiness, separateness, and it often becomes a compulsion. When it develops dysfunction, is perceived as a stressful combined with physical ageing, the situation turns out to be a toxic cocktail.

epidemiology, phenomenology, etiology, diagnostic criteria, adverse effects, and management should be considered a disease and should find its place in classification of psychiatric disorders.

REFERENCE : o Derbyshire D. Loneliness is a killer: It‟s as bad for your health as alcoholism, smoking and over-eating, say scientists. Health mail online, updated 9:36 GMT July 28, 2010.

Available from: http://www.dailymail.co.uk/health/article1298225/Loneliness-killer-Its-bad-healthalcoholism-smoking‑eating‑say‑scientists[Last accessed on 2013, Feb 22]. o StravynskiA, BoyerR. Loneliness in relation to suicide ideation and parasuicide: A population-wide study. Suicide Life Threat Behav 2001;31:32-40. o WilsonRS, KruegerKR, Arnold SE, SchneiderJA, KellyJF, Barnes LL, etal.

Loneliness and risk of alzheimer disease. Arch Gen Psychiatry. 2007;64:234-40. o Radowitz JV. Loneliness can increase Alzheimer‟s risk‟. The Independent Dec 11, 2012.

Available from: http://www.independent.co.uk/life-style/healthand-families/healthnews/loneliness‑can‑increase‑alzheimers‑risk‑ 8405166 [Last accessed on 2013, Feb 22]. o HawkleyLC, CacioppoJT. Loneliness and pathways to disease. Brain 29. Behav Immune 2003;17:S98-105 o DonaldAW, KellnerR, and WestMM. The Effects of Loneliness: AReview of the Literature.

Comprehensive Psychiatry 1986;27:351-83.

Loneliness has now become an important public health concern. It leads to pain, injury/loss, grief, fear, fatigue and exhaustion.

Thus it also makes a person sick and interferes in day to day functions and hampers recovery. A few years back Mother Teresa quoted: “the greatest disease in the West today is not TB or leprosy; it is being unwanted, unloved, and uncared for. We can cure physical diseases with medicine, but the only cure for loneliness, despair, and hopelessness is Love....”.Loneliness, therefore, is no more an event or concept or factor. Loneliness with its

20

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

SUNDOWNER‟S SYNDROME *Mrs. Mary Sathyasundari & **Mr. P. Prakash INTRODUCTION This is the time to remember the patients who doesn’t remember “The nights are the hardest.” It is quite common phrase verbalized from the patients who are suffering from Sundowner‟s Syndrome.

The experience of extreme agitation and confusion during the early evening hours, often associated with the early stages of dementia and Alzheimer‟s disease. The exact cause of sundowner‟s syndrome remains a mystery.

While the episodes are most commonly found in dementia patients, the symptoms can also appear in those suffering from other conditions, such as degenerating eye conditions.

For people in the early stages of Sundowner‟s Syndrome, Alzheimer‟s, and forms of dementia, nighttime can be so much more than a bit too dark and quiet. In fact, sundown may be a trigger for extreme agitation and confusion that lasts throughout the night, preventing sleep, exacerbating Sundowner‟s symptoms (in this case) and rendering it impossible to be alert the following day.

3.

4.

5.

6.

7.

Common Sundowner's Triggers 1. End-of-day activity (at a care facility).

Some researchers believe the flurry of activity toward the end of the day as the

Low light. As the sun goes down, the quality of available light may diminish and shadows may increase, making already challenged vision even more challenging. It creates confusion and hallucinations, especially with common objects that look different when it is darker.

Internal imbalances. Some researchers even think that hormone imbalances or possible disruptions in the internal biological clock that regulates cognition between waking and sleeping hours may also be a principle cause.

Winter. In some cases, the onset of winter's shorter days exacerbates sundowning, which indicates the syndrome may have something to do with Seasonal Affective Disorder, a common depression caused by less exposure to natural sunlight.

Disruption of the Circadian cycle (sleep/wake pattern) because of the dementia (the person cannot distinguish day from night) Not as much or no activity in the afternoon compared to the morning (can lead to restlessness later in the day)

SYMPTOMS 1. Disorientation 2. Agitation 3. Anger 4. Depression 5. Restlessness 6. Paranoia and rapid mood changes 7. Some resultant behaviors to look out for are rocking, crying, pacing, hiding things, acting out violently and wandering

facility's staff changes shifts may lead to anxiety and confusion.

2. Fatigue. End-of-day exhaustion or suddenly the lack of activity after the dinner hour may also be a contributor. It can lead to an inability to cope with stress

*&**Lecturer, College of Nursing, PIMS, Pondicherry 21

Pondicherry Journal of Nursing 8.

The individual hallucinations

may

even

Vol 7, Issue1, January – April’14

experience

Establishing a routine of behavior management strategies will not only help you monitor the patient‟s functioning, but it will also be extremely beneficial to the patient. Structure and routine create a feeling of safety and comfort, while being in familiar surroundings helps keep feelings of anxiety and confusion at bay. Schedule more vigorous activities in the morning hours. Don't schedule more than two major activities a day. As much as possible, discourage napping, especially if your loved one has problems sleeping.

Monitoring diet. Watch for patterns in behavior linked to certain foods. Avoid giving foods or drinks containing caffeine or large amounts of sugar, especially late in the day. Watch for behavior patterns that can be linked to the patient‟s diet. Limit sugary foods and caffeinated beverages, particularly after midday.

If a full bladder causes nighttime incontinence or a continual need to rise during the night, restrict liquids for a few hours before bed.

Controlling noise. It may be helpful to reduce the noise from televisions, radios, and other household entertainment devices beginning in the late afternoon and early evening. Avoid having visitors come in the evening hours.

Activities that generate noise should be done as far away from your loved one's bedroom as possible.

Letting light in. Light boxes that contain fullspectrum lights (light therapy) have been found to minimize the effects of sundowning and depression. As the evening approaches, keep rooms well-lit so that your loved one can see while moving around and so that the surroundings do not seem to shift because of shadows and loss of color. Night lights often help reduce stress if he or she needs to get up in the night for any reason.

PRACTICAL ADVICE FOR DEALING WITH SUNDOWNER’S SYNDROME The Alzheimer‟s Foundation of America suggests: 1. Allow for light exposure in the early morning to help set internal clock.

2. Discourage day-time napping to regulate sleep cycle.

3. Encourage exercise throughout the day to expend excess energy.

4. Limit caffeine intake, particularly in the evening to avoid potential Sundowner‟s symptoms.

5. Plan activities for the daytime so there is sufficient time to adjust to night.

6. Have a quiet nighttime activity ready and a private space for relaxing.

7. Consider purchasing a bedside commode.

Leaving his or her bed to use the restroom can start the cycle all over again, making it hard to get back to sleep.

8. Schedule regular medical appointments to ensure he or she is not in any physical pain and to check for worsening Sundowner‟s symptoms.

9. Take precautions to provide a safe space for him or her at night so that you can get a solid night‟s rest, even if he or she needs to stay awake and wander.

SUCCESSFUL APPROACHES TO MANAGE SUNDOWNERS SYNDROME: Establishing a routine: As Alzheimer's and dementia progresses, the patient‟s ability to reason and perform normal daily activities diminishes. Different functions and capabilities are lost, creating confusion and frustration.

22

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

Medication. In some cases of sundowning, especially when associated with depression or sleep disorders, medication may be helpful.

Consult a physician carefully, for some medications may actually disrupt sleep patterns and energy levels in a way that makes sundowning worse, not better.

Taking supplements. A few over-the-counter supplements may be of some benefit.

(Remember to consult with your loved one's doctor before giving him or her any dietary supplement.) The herbs ginkgo biloba and St. John's Wort have assisted people with Alzheimer's and dementia in the past. Vitamin E has also been found to minimize sundowning in some cases. Melatonin is a hormone in supplement form that helps regulate sleep.

Use redirection techniques. A person with Sundowner‟s Syndrome may exhibit uncharacteristic behaviors, such as using foul language, acting out violently, or simply acting more emotional than the situation warrants. As a part of the behavior management strategies, ask specific questions to understand why the patient is agitated. Speak in soothing tones and try to calm the patient, diverting his or her attention from the cause of the stress to something more pleasant. The primary goal of redirection techniques is to reduce stress and tension. Use the opportunity to try and engage the patient in a new activity.

Schedule structured activities Planning activities early in the day will help maximize the chance of engaging the elder‟s interest, and reduce the incidence of agitation. Those who experience sundowning symptoms in the afternoon and evening are likely to have more energy and clarity to focus during morning hours, so rigorous activities, particularly exercise, is ideal early in the day. Exercise, one

of the more effective behavior management strategies, will also help the patient expend excess energy and aid in sleeping at night. Quiet nighttime activities can help the patient focus any nervous energy before bed.

Make sure basic needs are met It‟s important to ensure the patient‟s physical comfort, and we can start by making sure that basic needs are met. Is the patient eating enough? Is the patient in any pain? If the patient is incontinent, are those needs being looked after? A bedside commode may be helpful so the patient won‟t have to navigate the path to the bathroom at night.

Consult with the patient‟s doctor Schedule regular appointments with the patient‟s doctor to discus pain management as well as options for treating the underlying conditions that may be causing the patient to sundown. Some cases of Sundowner‟s Syndrome have been successfully treated with antipsychotic medication. However, one major side effect is sedation, which can also make the situation worse, so discuss this possibility with the patient‟s doctor. Other drugs used to treat patients with Sundowner‟s Syndrome include cholinesterase inhibitors, psychotropic medications, mood stabilizers, anti-anxiety medications and antidepressants.

Make the home safe for the patient If we are caring for the patient at home, secure the house so that the patient will be safe if he or she wanders at night. We may need to take extra precautions to accommodate certain sundowning behaviors, ensuring that the entire home is a safe environment, including the bedrooms, bathroom, kitchen, living areas and any outdoor space. Sundowning behaviors can change and develop over time, so we will need to reevaluate the safety of the home periodically.

23

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

CONCLUSION: There is currently no “cure” for Sundowner‟s Syndrome, but it can be treated.

The best way to treat a person with Sundowner‟s Syndrome is through behavior management strategies. Finally, be creative in formulation of specific behavior management strategies for patients with Sundowner‟s Syndrome. In attempting to find solutions, try more than one thing, and focus on the individual.

Certain Specific behavior management strategies are more likely to work with one patient than another will help to achieve more headway .Success meant in serving hands those who are more willing to serve the patients with Sundowner‟s syndrome.

BIBLIOGRAPHY: 1. Alzheimer‟s Association, “Sleeplessness and Sundowning” alz.org, 2011. Web.14 May 2012.

2. Bliwise,D.L., “What is Sundowning?”

Journal of the American Geriatrics Society 42, no.9(1994): 1009 -1011.

3. Evans, L. K. “Sundwown Syndrome in Institutionalized Elderly” Journal of the American Geriatrics Society 35, no.2(1987): 101-108.

4. Gallagher-ThompsonD, Brooks and Yesavage, “The Relations among Caregiver Stress, Sundowning”, Journal and American Geriatrics Society 40, no.8(1992):807-810 5. Keller S. “Sundowning” WebMD LLC, 2012 Web. 14 May 2012. www.webmd.com

24

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

A COMPARATIVE STUDY TO ASSESS THE PREVALENCE OF PRETERM LABOUR AMONG PRIMI AND MULTIPARA MOTHER ADMITTED IN MGMC&RI, PUDUCHERRY *Dr. S. Kamalam, **Mrs. S. Lavanya, ***(Ms. S. Sankari devi, Ms. A. Saraswathy, Ms. S. Sasikala, Ms. K.Sasipriya & Ms. R. Saranya) habits, polyhydramnios, PROM, pre-eclampsia etc. As nursing professionals we must know the known causes of preterm labor so that we can create awareness among people regarding preterm labor.

INTRODUCTION: Preterm labour is defined as labour starts before completed 37 weeks of pregnancy.

Approximately 12% of babies in the United States are born by preterm labour that occurs on its own or after preterm premature rupture of membrane.

Not all women who develop preterm labor will deliver their baby early.

Estimates are that between 30 to 50% of women who develop preterm labor will go on to deliver their baby at term . If preterm labor leads to an early delivery of the premature newborns they are at risk for problems related to incomplete development of its organ. In India 24% of preterm labor occurring per year. Past child bearing experiences have an important part to play in predicting the possible outcome of the current pregnancy.

STATEMENT OF THE PROBLEM: A comparative study to assess the prevalence of preterm labor among the primi and multipara mothers admitted in MGMC & RI at Puducherry.

OBJECTIVES: 1. To assess the prevalence of preterm labor among primi and multi mothers.

2. To compare the prevalence of preterm labor between primi and multipara mothers.

3. To assess the contributing factors of preterm labor.

NEED FOR THE STUDY: Preterm labor is associated with significant long term disability and morbidity.

After 29-30 weeks of gestation birth weight is a good prediction of survival, prior to 29 weeks of gestation birth weight, gender, multiple pregnancy and gestation are all considered in the equation of risks of morbidity and mortality.

The incidence of preterm birth is increasing but currently stands at around 8%. In about 50% of the cause of preterm labor is not known. Often it is multifactorial, the following are however related with increased incidence of preterm labor such as previous history of induced or spontaneous abortion or preterm labor, smoking

METHODOLOGY: Research design: Descriptive research design was adopted for the study.

Settings: The study was conducted in MGMC & RI, at Puducherry.

Population: Women who underwent preterm delivery and got admitted in MGMC & RI during January to April 2013.Sample: All the primi and multi mother who underwent preterm labor in MGMC & RI during the period of January to April 2013.

Sampling technique: Purposive sampling technique.

*Principal, **Asst. Professor, ***B.Sc.(N) IV Year Students, Kasturba Gandhi Nursing College, SBV, Puducherry 25

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

Criteria for sample selection Inclusion criteria Women who underwent preterm normal vaginal delivery.

Patient‟s records available at the time of data collection.

Exclusion criteria Women who underwent preterm cesarean section.

Procedure for data collection The data was collected from the available patient records at a period from January to April 2013. Before starting data collection researchers obtained consent from the HOD department of OBG, Medical superintendent and Medical Record officer for conducting the study. Data was collected from the record based on the demographic variables that were listed out in the study. Then the list of contributing factor for preterm labor was also assessed.

TABLE. I FREQUENCY AND PERCENTAGE DISTRIBUTION OF PREVALENCE OF PRETERM LABOUR BETWEEN PRIMI AND MULTI MOTHERS N=40

SL.NO

GRAVIDA

NUMBER OF PRETERM LABOUR

1.

PRIMI

15

37.5%

2.

MULTI

25

62.5%

3.

TOTAL

40

100%

26

PERCENTAGE

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

FIGURE. I PERCENTAGE DISTRIBUTION OF TOTAL NUMBER OF WOMEN WHO UNDERWENT PRETERM LABOUR AND GOT ADMITTED IN MGMC&RI FROM JANUARY TO APRIL 2013 35.00% 30.00% 30.00% 28% 25% 25.00%

20.00% 17% 15.00%

10.00%

5.00%

0.00% JANUARY

FEBRUARY

MARCH

APRIL

TABLE. II FREQUENCY AND PERCENTAGE DISTRIBUTION OF CONTRIBUTING FACTORS OF PRETERM LABOUR. SI. NO

CONTRIBUTING FACTORS

NO.OF WOMEN

PERCENTAGE

Pregnancy Induced Hypertension Gestational Diabetes Mellitus

6

32

4.

Premature Rupture Of Membrane Polyhydramnios

6

15%

5.

Anemia

12

30%

6.

Urinary Tract Infection

1

2.5%

1.

2.

3.

8

27

15% 20% 80%

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14 that multipara mothers were more prevalent than primi and also premature rupture of membrane is a major cause for pre mature rupture of membrane

Major findings:

 The

data reveals that the total number of women who underwent preterm labor in each month from January to April 2013, the highest 12 (30 %) of women underwent preterm labor in the month of January and the lowest 7 (17.5%) of women underwent preterm labor in the month of April.



BIBLIOGRAPHY

 BENNT V RUTH ET AL,[1999], “ A text book for midwives‟‟, 12th edition, London‟s W.B sounders company.

The result shows that out of 40 women who underwent preterm labour, 15(37.5%) were primi and 25 (62.5%) were Multipara mothers.

 BURRONGHS

[1997], “Maternity nursing”, 7 edition, W.B squanders‟ company published, Tokyo. th

 The

 DUTTA.D.C

[2007], “ Text book of Obstetrics‟‟, 14th edition, New central book agency Calcutta.

findings denotes that among the 40 samples, 6(15%) were with the contributing factor of Pregnancy induced hypertension, 8(20%) were with Gestational diabetes mellitus, 32(80%) had Premature rupture of membrane, 6(15%) had polyhydramnios, 12(30%) were with the Anemia and one (2.5%) had Urinary tract infection. some mothers had more than one contributing factor.

 LOWDER

MILK [2007] PERRY, “Maternity & women‟s health care,‟‟ 9th edition mosby Elsevier publication, New York. Journal of midwifery and women‟s health volume 57, issue 2, March- April 2012.

 Indian

journal of midwifery, volume 62 no; 2 March- April 1995.  Jom, Man “Indian journal of midwifery” volume 62, no; November- December

CONCLUSION: The present study was conducted to assess the prevalence of preterm labour among primi and multipara mothers. The study concluded

28

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

EFFECTIVENESS OF DISTRACTION TECHNIQUE ON PAIN RELIEF DURING INTRAVENOUS CANNULATION AMONG THE SCHOOL CHILDREN IN SELECTED PAEDIATRIC WARDS AT AIMS, KOCHI *Ms. Sainu.V.Simon & *Prof. P. Chitra INTRODUCTION Pain is one of the most frequent complaints experienced by pediatric population.

Venipuncture is one of the most common procedures for administering medications, intravenous fluids of hospitalized children and 50% of them experience significant levels of distress during venipuncture. Pain management interventions, given to children undergoing acute painful procedures, include pharmacological and non-pharmacological interventions to relieve or minimize. Among these, the distraction technique, a nonpharmacological intervention can be an effective way of handling the children‟s behavioral response, since it is easy, economical and requires only limited training.

METHODOLOGY Research Design The research design used for the study was experimental design. In the post- test only the control group design was used.

Research Setting Pediatric Medical Ward „B‟ block at AIMS, Kochi.

Population Target population All school aged children who are undergoing venipuncture.

Accessible population School aged children admitted in the Pediatric Ward at AIMS hospital Sample and sampling technique Sample The sample consists of 60 school-aged children distributed in the experimental and control groups equally( 30 in each group) Sampling technique Simple random sampling Sample Selection Criteria Inclusion criteria School children aged between 7 to 12 years, who are undergoing venipuncture.

Exclusion criteria Children who receive more than one prick of IV cannulation Children who are under pain medication Children who are critically ill Mentally challenged children.

Statement of the Problem A study to assess the effectiveness of distraction technique, on pain relief during the intravenous cannulation among the school children in selected Pediatric Wards at AIMS, KOCHI. Objectives of the Study 1. To determine the pain score of the children, both in the experimental and control groups, who are undergoing the IV cannulation 2. Find the association between the level of pain and the selected demographic variables among the children in the control group

* II year M.Sc. Nursing & **Professor, Amrita College of Nursing, AIMS, Kochi, Kerala 29

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

Intervention The distraction technique was a video of Tom and Jerry cartoon for 20 minutes. Tom and Jerry are favorite cartoon shows used by children.. The animated cartoon of Tom and Jerry was chosen and was shown on the laptop to the subjects during the IV cannulation of 30 subjects.

Section B: Oucher Pain Intensity Scale- Asian Version Male and Female (Pediatrics) Oucher scale Asian version male and Asian version female were developed by Dr. Chao Yeh of Taiwan. It consists of both numerical and six picture photographic scale.

This pain scale was used to assess the pain among the children aged five years and above.

The score recorded 0-1 indicates the state of „no hurt‟, 2-3 indicates „a little hurt‟, 4-5 indicates „little more hurt‟, 6-7 indicates „even more hurt‟, 8-9 indicates „a lot more hurt‟ and 10 indicates the „biggest hurt‟.

Data collection instruments and Techniques Tool consists of two sections.

Section A: Socio-demographic data It consists of information related to the child, such as age, sex, diagnosis, education, birth order, previous hospitalization, reason for IV cannulation, and previous IV cannulation.

Table 1: Time schedule Time

Experimental group

Control group

10 minutes before Starting the cartoon show.

IV cannulation ( Intervention-distraction)

No intervention given. ( No distraction)

10th minutes

IV cannulation done. Pain assessed during the insertion of IV cannula using Oucher pain intensity scale.

20 minutes After the procedure

Performed IV cannulation. Pain assessed using Oucher pain intensity scale at the time of insertion IV cannula. Cartoon show continued.

Cartoon show finished.

Child allowed to go to bed

Child allowed to go to bed

Section I: Distribution of the subject‟s characteristics.

Section II: Comparison of the pain level among the subjects in the experimental and control group.

Section III: Comparison of the pain scores among the subjects in the experimental and control group.

ANALYSIS AND INTERPRETATION OF DATA

The frequency and percentage distribution of the subjects, in the experimental and control group, was done using the descriptive statistics.

The analysis and interpretation of the data collected are presented under the following sections.

30

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

Section IV: Association between the pain levels among the children in the control group and the selected demographic variables.

Section I: Distribution characteristics.

of

children comprised the group. In relation to the diagnosis, in the experimental group, the majority 22(73.3%) of them were cannulated with medical diagnosis only 2 of them were cannulated with surgical purpose. Where as, in the control group, 20(66.7%) children were admitted for medical diagnosis and 10 (33.3%) of them were admitted for surgical diagnosis.

With regard to education, in the experimental group, 17(56.7%) were in the lower primary and 13(43.3%) were in the upper primary school.

Whereas, in the control group, the majority of them 18(60%) of them were in the lower primary school and only 12(40%) were in the upper primary school.

subject‟s

Majority of the subjects in the experimental group, 17(56.7%) belonged to 7-9 age group and 13(43.3%) belonged to 9-12 age group where as in the control group, 18(60%) children belonged to 7-9 age group and 12(40%) belonged to 10-12 age group. With regard to gender, in the experimental group, 15 of them (50%) males and 15 female children equally distributed in the group. In the control group 17(56.7%) males and 13(43.3%) female

Section II: Comparison of pain scores among subjects in the experimental and control group N=60 Dependent Experimental variable group Pain level

Mean 3.9

SD 1.28

Control group Mean 8.7

SD 1.0

t(58)=3.46

Mean difference

„t‟ value

4.83

16.22** p<0.001

The above table depicts the fact that the „t‟ value of 16.22 with the mean difference in the pain score of experimental and control group is found greater than the table value of 3.46. On comparison the result is statistically significant at p<0.001.

Section IV: Association between the pain levels in control group children and the selected demographic variables.

In the present study, there was no association found between the pain level and the age, sex, diagnosis, education, birth order, reason for cannulation, and previous cannulation together.

31

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

Section III: Comparison of the pain level among the subjects in the experimental and control groups

PERCENTAGE

120 100

3.3

severe hurt

80 60

63.3

moderate hurt

83.3

40 20 0

mild hurt

33.3

16.7

The children, in the experimental group, who were distracted with cartoon, only 1(3.3%) had severe hurt and 19(63.3%) had moderate hurt, 10(33.3%) experienced mild hurt. Whereas the children, in the control group, who were not distracted with cartoon, a majority of 25(87.3%) had severe hurt and 5(16.7%) had moderate hurt. None of them had mild level pain.

In the present study the pain level was not associated with any of the demographic variables. The review also showed that the pain level was not associated with the demographic variables like, age and sex.

CONCLUSION The study proved the fact that, the pain experiences got minimized / relieved for children who were distracted by cartoon video show during the intravenous prick for therapeutic purpose. The findings of the study strongly recommended that the cartoon show (distraction technique) could be implemented for routine nursing intervention for pediatric setting .

DISCUSSION The first objective of the study was to compare the pain score of experimental and control group.

The present study results showed the point that the pain score (Mean=3.9, SD=1.28), comparatively, were found less among the school-aged children, who received distraction technique during IV cannulation, than the pain score (Mean=8.7, SD=1.0) of the school-aged children who did not receive any distraction technique or p <0.001 level.

The second objective of the study was to associate the pain level in the control group with the selected demographic variables.

REFERENCES 1. Children‟s hospital of Philadelphia. Kid’s and Hospitals-Children’s Miracle Network. 2010; March.21(1):1-2 2. Morton NS. Pain assessment in children.

Pediatric Anaesthesia.1997. 7(4): pp.

267–272.

32

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

3. McGrath PJ, Frager G. Psychological barriers to optimal pain management in infants and children. The Clinical Journal of Pain.1996; 12(2): pp. 135– 141.

4. Abu-Saad HH, Hamers JPH. Decisionmaking and pediatric pain: a review.

Journal of Advanced Nursing. 1997; 26( 5):pp. 946–952, 1997.

5. Jill E Maclaren , Lindsey L Cohen.

Intervention for pediatric procedure

related pain in primary care. Pediatric Child Health. 2007 ; February :12(12):111-116 6. Peripheral venous cannulation of children: International journal of pediatrics. July 2003.pp:4 7. Bellieni CV, Cordelli DM. Analgesic effect of watching T V during venipuncture. Journal of disease in childhood.2006 December;91(12) :10151017

SUBSCRIPTION FORM Please fill this form in capital letters and mail to The Chief Editor, PJN, Kasturba Gandhi Nursing College, MGMC &RI, Pillaiyarkuppam, Pondicherry – 607 402.

Individual / Institutional Subscription Name of individual / institution: ----------------------------------------------------------------------Address : ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ _____________________________ Pin code: _______________________________ Tel. No. _________________________ Fax No. _____________ E-mail: ___________________________ SUBSCRIPTION RATE Individual & Institution – Including Bank Charges 1 Year - (3 Issues)

Rs. 1000

5 Years - (15 Issues)

Rs. 4,500

Payment by DD in favour of “Pondicherry Journal of Nursing” Indian Bank, Kirumapakkam, Pondicherry – 607 402.

33

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

ASSESS THE PREVALENCE AND COMPARE THE RISK FACTORS OF TYPE 2 DIABETES MELLITUS AMONG ALCOHOLIC AND NONALCOHOLIC MALES RESIDING AT MEDAVAKKAM, CHENNAI *Mrs. Thivya INTRODUCTION: The prevalence of type 2 diabetes mellitus is rapidly increasing all over the globe at an alarming rate. Besides several risk factors there is growing consensus that alcohol consumption has an influencing factor for developing Type 2 Diabetes mellitus. The biological mechanism is uncertain but there are several factors including increase in insulin sensitivity after alcohol consumption, changes in the level of alcohol metabolites which increase the high density Lipoprotein cholesterol concentrations. Therefore drinking heavy alcohol in people may cause blood glucose to rise.

RESEARCH METHODOLOGY:  Research Design: Non- Experimental exploratory design  Population: Adult males having the habit of Alcohol consumption with the history of Type 2 Diabetes mellitus residing at Medavakkam rural area.  Sample size: 100 males ( 50 alcoholic and 50 non alcoholic males) with known Type 2 Diabetes mellitus  Sampling Technique: Simple Random Sampling using lottery method

INSTRUMENT: Part I- It consists of demographic data which includes age, type of family, marietal status, religion, educational status, Occupation, Family income, Habit of Alcohol consumption.

Part II- it consists of multiple choice questions to assess the risk factors of Type 2 Diabetes mellitus like physical parameters, Hereditary, Dietary pattern, lifestyle, stress.

STATEMENT OF PROBLEM: Assess the prevalence and compare the risk factors of type 2 diabetes mellitus among alcoholic and nonalcoholic males residing at Medavakkam., Chennai.

OBJECTIVES OF THE STUDY: To assess the prevalence of Type 2 Diabetes Mellitus among adult males To compare the risk factors of Type 2 Diabetes Mellitus among alcoholic and non alcoholic males.

To associate the selected demographic variables with the risk factors of type 2 Diabetes Mellitus among alcoholics and non alcoholic males.

RESULTS AND DISCUSSION:  The present study reveals that among the male population 13.6% of the males are having diabetes and the percentage proportion of the diabetes is 95% with the confidence interval of 11.92-14.88.  Regarding the comparison of risk factors like family history of Hypertension and Obesity, habit of taking fast food, using palm oil for

*Asst. Professor, Kasturba Gandhi Nursing College, SBV, Puducherry.

34

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

cooking, habit of fasting, not doing exercise regularly, stress and recurrent infection are found to be significant among alcoholic and non alcoholic males.  The findings reveals that on association of risk factors with the demographic variables of age was found to be significant with family history diabetes and Body mass Index and there is a significance among history of Hypertension and doing exercise and also stress factor is associated with Marital status and Educational status

and history of hypertension are at greater significance. Hence alcoholic and nonalcoholic males must be aware of their risk factors associated with Type 2 Diabetes Mellitus in order to promote their health by being on regular treatment and periodical follow up.

REFERENCES: Black M.Joyce (2005), Medical Surgical Nursing, Philadelphia; J.B , Lippincott publishers.

Claudia and Smith (2000), Community Health Nursing Theory and practice, Philadelphia; W.B. Saunders publishers.

Marica Stanhope Lancaster (1992), Community Health Nursing London, Mosby Publishers.

Watia Kapoor (2004) Diabetes Education Course Diabetes Education for Health care professionals, Interaction Diabetes Federation, Chennai.

Ajani UA et al (2000), Alcohol consumption and risk of Type 2 Diabetes Mellitus, archieves of internal Medicine Volume 160: 1025- 1030 WHO technical report series 646, 2008 WHO expert committee on Diabetes mellitus, Second Report.

Table 1: Distribution of Prevalence of Type 2 Diabetes Mellitus among males.

Total population of Males

2029

Males with Type 2 diabetes Mellitus Percentage Proportion Confidence Interval

271 95% 13.36% (11.9214.88)

CONCLUSION: The study findings reveal that alcoholism is one of the major factors for causing Type 2 Diabetes mellitus. Among the alcoholic and nonalcoholic males level of stress

35

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14 JOB MOTIVATION

*Ms. P. Subha Rani, **Ms. Gisha john & **Ms. Reena Vijayakumar BACKGROUND OF THE STUDY Nursing Personnel form a large work force in the hospital and motivation plays an important role in retaining them and thereby enabling the organization to attain its goals.

Four central domains namely work content, working conditions, social and labor relations, and conditions of employment, which possibly will increase or diminish the work motivation of nurses. Thus, motivation plays a major role in ensuring the smooth functioning of the patient services.

STATEMENT OF THE PROBLEM A study to assess the level of job motivation among Nursing Personnel at selected hospitals, Chennai.

NEED FOR THE STUDY According to a 2012 survey conducted in Indian Hospitals, it was found that there was a shortage of 50% of Nursing Personnel in India.

Inadequate motivational strategies such as low pay, low incentives, and poor recognition for work, long working hours and lack of autonomy in patient care services have all led to the BrainDrain phenomenon that has caused the migration of nurses to other countries thereby resulting in a low retention in hospitals at India.

This will also affect the patient care services in the long run. Thus, from the point of view of a nursing manger, it becomes her sole responsibility in assessing the motivation level of Nurse Personnel at regular intervals to ensure the satisfaction of staff at work and to offer promotional measures for the personal and professional development of Nurses.

METHODOLOGY

OBJECTIVES The objectives of the study are to 1. Assess the level of job motivation among Nursing Personnel.

2. Associate the level of job motivation among Nursing Personnel with the selected demographic variables.

Research Design A quantitative descriptive design was selected for this study. The survey approach was used.

Sample All the Nursing Personnel employed were selected, both males and females who fulfill the inclusion criteria.

Sample Size The sample size was 30.

Sampling Technique Convenience sampling technique, a type of non-probability sampling was used.

Development and Description of the Tool The instrument is divided into two parts.

1. PART-A: socio –demographic variables 2. PART-B: Motivation at work scale

*Assoc. Professor, **M.Sc, (N) II Year Students, College of Nursing, Saveetha university, Thandalam, Chennai 36

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

PART-A: Socio Demographic Variables The socio demographic variable consists of Age, Gender, Income, Marital Status, Unit of Work, Education, and total years of experience in Nursing

Data Collection Procedure

Part-B: Motivation at Work Scale

RESULTS

The motivation at work scale was used to assess the level of job motivation. It was 11 item scale.

1. Among the study participants about 63% were aged between 20-24 years 2. Female contributed to 77% 3. 37% of them were working in wards 4. Nearly 83% of them earn Rs.5000-10,000 5. About 77% have 1-5 Years of experience 6. Among the study participants out of 30 subjects, 10% had high level of motivation, 43.3% had satisfactory level of motivation, 33.3% had low level of motivation and 13.3% had very low level of motivation.

7. Association of demographic variables with level of job motivation among Nursing Personnel reveals that, the level of job motivation has statistical significance with personnel with the following selected demographic variables. (i.e.) the age, unit of work, income, education and total years of experience in Nursing had statistical significance at P<0.05.

The data collection was carried for 6 days at the selected hospital; samples were selected using Convenience sampling technique.

Tool Description The motivation at work scale was developed by Deci and Ryan in the year 2005. It consisted of 11 items which was graded on a 7 Likert scale.

Score Interpretation: 68 – 77 – Very High Motivation 58 – 67 – High Motivation 48 – 57 – Satisfactory Motivation 38 – 47 – Low Motivation 37 and less – Very Low Motivation Ethical Consideration Formal permission was obtained from Saveetha Medical College Hospital, Chennai.

The participants were clearly explained about the purpose of the study. Formal written consent was taken from the participant‟s parents.

Confidentiality was maintained.

37

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

Frequency and Percentage distribution of the level of Job Motivation among nursing personnel (N=30) S.No

Level of Motivation

Frequency

Percentage %

1.

Very High

-

-

2.

High

3

10

3.

Satisfactory

13

43.3

4.

Low

10

33.3

5.

Very Low

4

13.3

Percentage Distribution of Level of Job Motivation Among Nursing Personnel

Percentage Distribution of Level of Job Motivation Among Nursing Personnel

High Satisfactory Low Very Low

Association Of Demographic Variables With Level Of Job Motivation Among Nursing Personnel Association of demographic variables with the level of job motivation among nursing personnel reveals that, the level of job motivation has significance with nursing personnel with the following selected demographic variables. (i.e.)

Age, unit of work, income, education and total years of experience in Nursing had statistical significance at P<0.05.

DISCUSSION Out of 30 subjects, 10% had high level of motivation, 43.3% had satisfactory level of motivation, 33.3% had low level of motivation and 13.3% had very low level of motivation.

REFERENCES Denise F. Polit and Cheryl Tatano Beek.

(2004). “Nursing Research: Generating and Assembling Evidence for Nursing Practice”, 38

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14 Mary Ann Boyd. (1998). “Psychiatric Nursing – Contemporary Practice”. New York: Lippincott – Raven Publishers. 530540 Rao. S.P. (2001). “Introduction to Biostatistics”. New Delhi: Prentice Hall of India Pvt. Ltd. 100-105 Susan H. Shearouse. (2011). “Conflict 101”.

United States: American Management Association.

Srivastava.

(2009).

“Statistics for Management”. New Delhi: Tata McGraw Hill Education Private Limited.

Treece. (1999). “Elements of Research in Nursing”. Philadelphia: Mosby Publishers.

25-42.

ninth Edition, Lippioncott, Williams and Wilkins.

Gail.W.Stuart. (2011). ”Principles and Practice of Psychiatric Nursing”. 9th Edition. Missouri: Reed Elsevier india Private Limited. 667-680.

Kapalan and Sadock.

(2005).

“Comprehensive text Book of Psychiatry”.

Philadelphia: Lippincott Williams and Wilkins Publication. 430-445.

Mahajan, B.K. (1994). “Methods of Biostatistics”. New Delhi: Jaypee Brothers Publishers. 35-50.

Manju Mehta. (2006). “Behavioral Sciences In Medical Practice”. New Delhi. Jaypee Publishers. 29-34.

ANSWERS FOR MULTIPLE CHOICE QUESTIONS 1. Flavi virus fibricus 2. 5 to 15 days 3. Kyasanur forest disease 4. Steroids and aspirin 5. Tetracycline sulfonamide 6. Rota virus vaccine 7. Vibrio chloerae 8. Wuchereria bancrofti, brugia malayi, brugia timori 9. Break -bone fever 10. After 3 Years

ANSWERS FOR JUMBLED LETTERS 1. Dichloro diphenyl tricholoroethane 2. Faeco-oral-route 3. Primaquine 4. Aedes aegypti mosquito 5. Bubonic plague 6. Wuchereria bancrofti 7. Malathion 8. Diethyl carbamazine 9. Gambusia fish 10. Enteric fever 39

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

HEALTH BENEFITS OF STRAWBERRIES *Dr. Divya Choudhary The red colour fruit is not only delicious to eat but is packed with nutrients that offer a range of health benefits..

Boosts your immunity Strawberries are packed with Vitamin C, which helps boost your immunity and protects you from infections. Just one cup of strawberries meets 100% of your daily requirement of Vitamin C. Prevents heart disease Shaped like a heart, strawberries have nutrients like flavonoids and antioxidants which prevent the build-up of bad cholesterol which can clog your arteries.

Additionally, these nutrients have antiinflammation properties which is good for the heart.

Prevents constipation and diabetes When you have constipation, it is important that you consume fibre in order to

Good for skin When you age, your skin and other body parts suffer from damage due to free radicals.

This process is similar to the process of a metal rusting due to exposure to air. Vitamin C and antioxidants present in strawberries can help slow down this process and keep your skin wrinkle-free for longer.

Helps you lose weight Strawberries are extremely low in calories, with a cup having just 53 calories.

Also, they have fibre which can leave you feeling fuller if you have them before a meal.

Not only this, the high Vitamin C content help boost your metabolism which helps your body burn the calories faster.

Great for pregnant woman Pregnant women are often confused as to what they should eat during pregnancy that‟ll both be good for them and the baby. Folate present in rich quantities in strawberries helps in the baby‟s brain, skull and spinal cord development. In addition, it also has folic acid which can save the child from having certain birth defects.

Great for bones Strawberries have nutrients like manganese, potassium and some minerals that not only help promote bone growth, but also helps keep them in mint condition. These properties also make strawberry a good fruit for growing children.

clear your bowel movements. Also, fibre helps regulate your blood sugar levels making it a great food for diabetics and those who want to prevent diabetes alike. Strawberries have a lowly glycemic index of 40, which means diabetics can consume it without worrying too much.

Fights cancer Like most fruits and vegetables, strawberries too are high in antioxidants which help in fighting cancer. In particular, strawberries have antioxidants like lutein and zeathanacins which suppresses the growth of cancer cells.

*Professor, Kasturba Gandhi Nursing College, SBV, Puducherry.

40

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

Prevents hair loss Hair loss can be quite a depressing condition for anyone. Folic acid, Vitamin B5, Vitamin B6 and ellagic acid present in strawberries helps prevent your hair from falling and thinning. Furthermore, minerals like copper and magnesium helps prevent dandruff and fungal growth on your scalp. If that wasn‟t enough, many home made packs can be made using strawberries that‟ll add shine and glow to your hair.

Boosts memory Fisetin, a naturally occurring flavonoid present in strawberries helps enhance memory by stimulating the signaling pathways. A research published in Annals of Neurology also proved that eating 2 or more servings of strawberries per week can delay memory decline in ageing women So, why wait? Go to your nearest fruit seller and get a delicious box of strawberries home!

41

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

STATE CORRECT ANSWERS DEPARTMENT OF COMMUNITY HEALTH NURSING

1. Name the organism which causes yellow fever 2. The incubation period of japanese encephalitis is--------3. Name the disease which is called as monkey disease?

4. Name the drugs which is contraindicated in treatment of chikungunya?

5. Drug of choice in treatment of human plague are 6. Name the vaccine used in the prevention of diarrheal disease

7. Name the causative organism of cholera 8. Name any one of the nematode worm which is responsible for lymphatic filariasis 9. Classical dengue fever is otherwise known as _______ 10. The person infected with malaria (eligible to) can donate blood after--------

JUMBLED LETTERS 1. LCDROHOI- ELDNPYIH-HTCEORTIALNHORE 2. CAFOE-RLOA-UEROT 3. INQMERUPIA 4. EDSEA TYEIAPG OUSIMTQO 5. UOCBNIB AGPELU 6. EIURWAHCER TCAFBONIR 7. IHANLMOAT 8. YLEDHTI IACZMRANBEA 9. BIAGSAMU IFHS 10. IRETCNE VEEFR Answers in page No. 38

42

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

COLLEGE OF NURSING Pondicherry Institute of Medical Sciences Lamp Lighting Ceremony College of Nursing – Pondicherry Institute of Medical Sciences organized “Lamp Lighting Program” 2013 batch students on 8th November 2013 between 10.30 am to 12.00 noon at PIMS auditorium. The dignitaries on the dais lighted the Traditional Kuthuvillaku. Prayer song was sung by SNA choir and prayer by Rev. Prime Sarojini, Chaplain and Pastoral care.

The Honorable Chairman Dr. K. Jacob, in his presidential address expressed about need for the dedicated services of the nurses and also greeted the fresher‟s for choosing such noblest profession as their the carrier.

Dr. John Abraham, Director - Principal highlighted the importance of holistic approach in nursing and significance of the lamp and the lamp lighting ceremony in nursing.

Dr. Rebecca Samson, Dean, College of Nursing along with the Chief Guest passed light to faculty members and 60 fresher.

After Lamp lighting the entire fresher took Oath as Dr. Rebecca Samson recited it and a special song was given by the fresher.

The Chief Guest Dr. Ani Grace Kalaimathi, Registrar- TNNMC addressed the gathering and fresher in particular about the Professional Qualities that is expected from every Nurses. Ms. Kiruba Prasanna, Asst.Professor- College of Nursing acknowledged with thanks. The program came to an end with the closing prayer by Rev. Fr. John Mathew, Chaplain – PIMS and National Anthem.

43

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

KASTURBA GANDHI NURSING COLLEGE COLLEGE EVENTS FACULTY TRAINING PROGRAMME GFATM project(Global Fund To Fight AIDS, Tuberculosis, Malaria) and National AIDS Control Organization(NACO) in collaboration with Indian Nursing Council (INC) organised Training Of Trainers (TOT) for 1 week (9.12.13 to 14.12.13) in Christian Medical College (CMC), Vellore.

KGNC was nominated by INC to depute two faculty to undergo this training programme.which broadly focused on HIV/AIDS. Mr.Vijayaraj.R.,Asst.Prof.& Ms.Ruma Shanthini.K., Asst.Prof.from Dept of Medical Surgical Nursing underwent the training programme and received the certificates. Our faculty are now empowered with knowledge and skill to become Trainers for nurses and students on this project in and around the state.

Scientific and Academic Forum The Department of Child Health Nursing organized Scientific Academic Forum on 31.1.14 focussing on National Health programs related to children. A quiz program was conducted in this regard and III &IV yr B. Sc (N) students enthusiastically participated and won the prizes. Dr. Jayamohandoss, CMO, Industrial Medical Officer, NLC, Neyveli was the guest speaker of the day. He gave an enlightening talk on “Nutritional programs in India”.He threw light on the importance of providing a nutritional diet to new born and infants. Ms. B. Sahana III year B.Sc(N) student presented a case report on Nephrotic Syndrome which sought the attention of the gathering.

Scientific and Academic Forum The SAF of KGNC in association with the Department of Community Health Nursing organized a quiz programme on the Theme “Vector Borne Disease” on 04th March 2014. The BSc. (N)., students participated and won the prizes. Dr. Baskar, Senior Entamologist from Cuddalore has been invited as an resource person and he had given valuable talk on Vector borne disease control and its prevention 44

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

CAREER GUIDANCE PROGRAMME Career guidance programme was organized on 02.12.2013 under the guidance of our respected Principal/ Director of Nursing Dr. S. Kamalam. Mrs. Vijiyalakshmi, Students Counselor gave a talk on “Professional Outlook Through Personality Development”. Mr. Bernard Ryder, International Educational Consultant from United Kingdom gave a broad outlook on “Global career opportunities and placements in Nursing”. Students actively participated in programme and gained an insight on the choice of career in future.

Out Reach Activities Creating a World of Compassion for the Mentally Ill The Department of Mental Health Nursing organised a role play on “Stress Management “ by IIIYear B.Sc(N) on 17thJanuary 2014 in fraternal Life Service Home (FLSH), Ousteri, Puducherry. All aspects of stress management were brought forth in a theatrical performance. Various cultural activities like songs, solo dance, group dance & story telling were also conducted for the mentally ill patients .

The patients were entertained and the prizes were awarded for the winners.A symposium on “Prevention Of Suicide” was organised on 24th January 2014 by III Year B.Sc(N) students. They gave expound knowledge about suicidal preventive measures to the mentally challenged patients.

The students provided a holistic care to the patients in Sacred Heart Hospital, Payankulam, Kerala during their clinical posting from 1-2-14 to 28-3-14.Occupational therapy was conducted to the mentally ill and de-addicts. Activities like cover making, flower vase making, file making etc., was taught to them which was very beneficial to the patients Intensified Pulse polio campaign As a part of Community Health service, B.Sc(N) II year students of KGNC actively participated in the Pulse polio campaign 1st phase on 19.01.14. Students were divided into small groups & rendered their services in Kirumampakkam PHC. 10 booths were covered by this PHC. They

45

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

immunized nearly 2219 underfive children in the area. Students were guided by Ms. Rekha, Asst Lecturer & the PHN Ms. Sumathi.

Women‟s Day Rally Department of Family welfare services, Govt of Puducherry conducted rally on 8.3.14 that focused on the theme “Safety of Women” at Gandhi Thidal, Puducherry. 1st year B. Sc (N) students and Ms. Sujatha, Asst.Lecturer took part in the rally, and raised their voices towards the safety of women.

World Tuberculosis Day Department of Community Health Nursing commemorated World Tuberculosis Day in Kirumampakkam Primary Health centre on 25.03.14. In this programme they have done the role play and Health talk on the theme “Importance of DOTS”. Nearly 30 TB positive cases in that area were benefited by this programme.

NSS Special Camp NSS volunteers of KGNC unit organized a special camp on the theme “Maternal and Child Care” in adopted village Pillayarkuppam from 24.01.14 to 30.01.14. During the camp they were involved in various activities such as survey on basic sanitation facilities, well baby clinic, anti plastic awareness rally, Health Education for antenatal and mothers of under five children, Nutritional exhibition for school children etc., IQAC-KGNC UNIT KGNC has restarted its mission in 2014 to work for the improvement of quality of nursing in all dimensions. The following activities were carried out in this quarter.

1. SYMPOSIUM ON RESEARCH METHODOLOGY KGNC IQAC unit organized a symposium on research methodology for M.Sc (N) I year & II Year students P.B.B.Sc (N) II Year students B.Sc (N) IV Year Students & all faculty of KGNC on 10/01/14 & 11/01/14 9.00 am to 4.30 pm @ 1st Floor Lecture Hall The symposium opened up with the college anthem. Prof. Annie Annal. M, KGNC welcomed the gathering followed by the introductory message delivered by Dr. S. Kamalam, Principal, KGNC. The programme proceeded with 4 sessions covering all aspects of research methodology. At the end of the programme post test and feedback was obtained from the students. The students expressed their need to conduct further such programmes in future.

2. INSERVICE TRAINING PROGRAMME on HIV/ AIDS – 2014 KGNC IQAC unit in association with department of Community Health Nursing organized an inservice training programme on HIV/ AIDS on 03/02/2014 to 07/02/2014 wherein 10 Staff Nurses from MGMC & RI and Faculty of KGNC were the beneficiaries. The programme was inaugurated by Dr. S. Kamalam, Principal, KGNC. The 5 days session was handled by Ms. Rumashanthini. K and Mr. Vijayaraj. R, Dept of Medical Surgical Nursing who are certified trainers of GFATM (Global Fund for AIDS Tuberculosis and Malaria) sponsored by Indian Nursing Council and NACO. The participants were very active and enthusiastic in receiving the information and taking part in skill session. After the 46

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

end of the session, Dr. S. Kamalam, Principal, KGNC gave the valedictory message and distributed certificates to all participants. A post test was conducted on 07/02/2014 as a feedback of training programme. Most of the candidates have done well. The overall feedback about the in-service training programme was graded as excellent.

3. WORKSHOP ON “SETTING THE QUALITATIVE QUESTION PAPERS IN NURSING”

KGNC in collaboration with SBV, IQAC &Medical Education Unit organized the Workshop on “Setting The Qualitative Question Papers In Nursing” on 01/03/2014 @ 1st Floor Lecture Hall, KGNC, Principal, Vice-principal, all faculty of KGNC (including non-nursing Faculty), HODs of Dept of Pathology, Pharmacology, Psychology, Genetics & English were the beneficiaries. The programme commenced by 9.30 am by lighting of kuthuvillaku by the dignitaries Prof. K. R. Sethuraman, ViceChancellor, SBV Prof. K. A. Narayan, Vice-Principal, MGMC & RI Dr. V. N. Mahalakshmi, Controller of Examinations, SBV, Dr. S. Kamalam, Principal, KGNC. The programme began with an Introductory session on need for the workshop set induction by Dr. S. Kamalam. The faculty of KGNC enacted a role play on COE‟s Dilemma. Prof. Sumathy. P andMrs. Kripa Angeline from KGNC gave a talk on “Tips & Tricks for setting effective LAQ‟s, SAQ‟s,VSAQ‟s”. Prof. K.A. Narayan, Vice-Principal, MGMC & RI gave a brief talk on Blueprint of the question paper followed by Dr. V. N. Mahalakshmi, COE, SBV who gave a speech on “Checklist and validation of the question bank introduction of the new pattern question paper”. All the session was very interactive and doubts were clarified on the concept. Vote of thanks was delivered by Mrs. Gerald Roseline.M, Asst. Prof, KGNC.

47

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

AUTHOR GUIDELINES In order to standardize the quality of PJN the following guidelines have been formulated based on expertise opinion.

The Editorial Process The manuscripts will be reviewed for possible publication with the understanding that they are being submitted to one journal at a time and have not been published, simultaneously submitted or already accepted for publication elsewhere.

The Editors review all submitted manuscripts initially. Manuscripts with insufficient originality, serious scientific and technical flaws or lack of a significant message are rejected. All manuscripts received are duly acknowledged. Manuscripts are sent to two or more expert reviewers without revealing the identity of the contributors to the reviewers. Each manuscript is also assigned to a member of the editorial team, who based on the comments from the reviewers takes a final decision on the manuscript. The contributors will be informed about the reviewer‟s comments and acceptance/ rejection of manuscript.

Types of Manuscripts and Limits 







Original articles: Randomized controlled trials, intervention studied, studies of screening, outcome studies, case-control series, and surveys with high response rate. Up to 3000 words excluding adequate references and abstract.

Review articles (including for Ethics forum, Education forum, Health related science, EMedicine, E-Nursing etc.): Systemic critical assessments of literature and data sources. Up to 2000 words excluding with adequate references. Research articles critical review, advertisement, functions celebrated, puzzles and innovation related items.

Case reports: new/ interesting/ very rare cases can be reported. Cases with clinical significance or implications will be given priority. However, mere reporting of a rare case may not be considered. Up to 1000 words excluding references and abstract and up to 05 references.

Announcements of conferences, meetings, courses, and other items likely to be of interest to the readers should be submitted with the name and address of the person from whom additional information can be obtained with supportive images.

Presentation and format  Double spacing, TIMES NEW ROMAN  Margins 2.5 cm from all four sides  Title contains all the desired information  Abstract page contains the full title of the manuscript  Introduction of 75 words.  Headings in title case ( not ALL CAPITALS)  The references cited in the text & should follow Vancouver both for journals & look reference.

48

Pondicherry Journal of Nursing

Vol 7, Issue1, January – April’14

 Send the final article file without „Track changes‟ & send hard & soft copy for the articles.

Language and grammar  Write the full term for each abbreviation at its first use in the title, abstract, keywords and text separately unless it is a standard unit of measure.  Numerals at the beginning of the sentence spelt out.  Check the manuscript for spelling, grammar and punctuation errors Tables and Figures  No repetition of data in tables and graphs and in text  Actual numbers from which graphs drawn, provided  Figures necessary and of good quality ( color)  Table and figure numbers in Arabic letters (not Roman)  Write the full term for each abbreviation used in the table as a footnote.

Article from Graduate and Post Graduate will also be accepted. Please follow the same format for research articles.

Title Abstract Introduction – Objectives/Need for the study with justification Materials and methods-includes Research design, approach, setting, population, sample size & techniques, Conceptual Framework and Data collection procedure Major Findings with Tables and Figures for objectives References

Author information in a separate page as follows: Name , Academic degree, Designation Name of the institution Address for correspondence including phone number and Email Id. All articles will be peer reviewed. The Editorial board and chief editor will decide on suitabililty of publication of a material which is final. The last minute submission of article will not be considered for current issue.

Correspondence Address: Prof. Dr. S. Kamalam Chief Editor , Pondicherry Journal of Nursing Principal, Kasturba Gandhi College of Nursing, MGMC&RI Campus, Pillaiyarkuppam, Puducherry - 607 402.

Ph: 0413-2615449 (Ext.511), 2615809, Fax: 0413-2615457 E-mail- kgncpjn@yahoo.com

49