Pjn may aug 2014

Pondicherry Journal of Nursing

Vol 7, Issue2, May - August’14

Pondicherry Journal of Nursing Advisory Board Prof. Rajaram Pagadala,

Prof. K.R. Sethuraman,

Chancellor, Sri Balaji Vidyapeeth, Puducherry.

Vice-chancellor, Sri Balaji Vidyapeeth, Puducherry.

Prof. N. Ananthakrishanan,

Dr. S. Kamalam,

Dean Research &P.G Studies, Sri Balaji Vidyapeeth, Puducherry.

Principal, Kasturba Gandhi Nursing College, Sri Balaji Vidyapeeth, Puducherry.

Dr. Rebecca Samson,

Prof. G. Muthamizhselvi,

Dean, College of Nursing, Pondicherry Institute of Medical Sciences, Puducherry.

Principal, Vinayaka Missions College of Nursing, Puducherry.

Dr. R. Danasu,

Prof. P. Genesta Mary,

Principal, Sri Manakula Vinayagar College of Nursing, Puducherry.

Principal, Sabari College of Nursing, Puducherry.

Editorial Board Editor – in- Chief Dr. S.Kamalam, Principal, Kasturba Gandhi Nursing College, Puducherry.

Executive Editor Prof. K. Renuka, Vice – Principal,

Associate Executive Editor Ms. C. Geetha, Assoc. Prof

K.G.N.C, Puducherry.

K.G.N.C, Puducherry.

International Peer review Member Mr. Allan Seraj Senior Practice Educator in ICU Royal Brompton & Harefield Hospital NHS Trust, UK

Prof. P. Sumathy, K.G.N.C

Dr. Rachelle (Shelly) J. Lancaster Assistant professor of Nursing University of Wisconsin Oshkosh college of Nursing Oshkosh Wisconsin, USA.

Section Editors Prof. Annie Annal, Ms. A. Kripa Angeline, K.G.N.C

Assoc. Prof, K.G.N.C

Ms. S. Prabavathy Assoc. Prof, K.G.N.C

Technical & Managerial Executive Mr. R. Vijayaraj, Asst. Professor, K.G.N.C Ms. V. Mano Priya, Asst. Professor, K.G.N.C Circulatory Support Mr. K. Vengadesan, Senior librarian, K.G.N.C Mr. S. Veerakumar, Librarian, K.G.N.C

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Vol 7, Issue2, May - August’14

Editorial message This year's World Alliance for Breastfeeding Action (WABA) World Breastfeeding Week (WBW) theme asserts the importance of increasing and sustaining the protection, promotion and support of breastfeeding - in the Millennium Development Goals (MDGs) countdown, and beyond. We call on all celebrants of WBW to Protect, Promote and Support Breastfeeding: it is a vital Life-Saving Goal!

WBW 2014 Objectives :

Welcome to World Breastfeeding Week 2014!

In 1990 eight global goals, the Millennium Development Goals (MDGs), were set by governments and the United Nations to fight poverty and promote healthy and sustainable development in a comprehensive way by 2015. There are regular "countdowns" to gauge progress in achieving the goals.

This year's WBW theme responds to the latest countdown by asserting the importance of increasing and sustaining the protection, promotion and support of breastfeeding in the post 2015 agenda, and engaging as many groups, and people of various ages as possible.

The WABA Coordinated World Breastfeeding Week is part of the gBICS (Global Breastfeeding Initiative for Child Survival) Programme entitled: "Enhancing Breastfeeding Rates Contribute to Women's Rights, Health, and a Sustainable Environment". The gBICS Programme aims to contribute to the achievement of sustainable development - beyond the Millennium Development Goals - by scaling up breastfeeding and infant and young child interventions and transforming Policies into Practice Protect, Promote and Support breastfeeding: it is a vital, life-saving goal!

Editor in Chief

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Sl.No CONTENT REVIEW ARTICLES 1.

The Clinical Nurse Educator as Insider Researcher

Pg. No 6

Mr. Allan Seraj 2.

TELENURSING: A VISION IN INDIA

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Mrs. R. Rajeswari 3.

CARCINOID SYNDROME-CASE REPORT

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Mrs. Kripa Angeline A & Mrs. Janifer Xavier Albertina J 4.

TB MENINGITIS - CASE REPORT

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Ms. Rekha .E 5.

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Ebola Virus disease (EVD) - The Global Health Emergency Dr. R. Shankar Shanmugam & Mrs. Shakila Shankar

6.

COLOUR THERAPY

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Mr. Santhoshkumar RESEARCH PAPER 7.

THE FACTORS INFLUENCING BOTTLE FEEDING AMONG THE

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MOTHERS OF THE CHILDREN AGED BETWEEN 6 MONTHS AND 2 YEARS Ms. Soniya Chacko & Prof. P. Chitra 8.

EFFECT OF YOGA INTERVENTION ON HYPERTENSIVE PATIENTS

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WITH TYPE II DIABETES MELLITUS Ms.S. Shanthi & Dr. Karaline Rajkumar 9.

A

STUDY

TO

ASSESS

TEACHING

PROGRAMME

PATIENTS

REGARDING

EFFECTIVENESS ON

OF

KNOWLEDGE

DIABETES

4

OF

DIABETIC

COMPLICATIONS

PREVENTION AT SELECTED HOSPITAL, TUMKUR. Prof. K. Ramu & Dr. N.V. Muninarayanappa

STRUCTURED

AND

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EFFECTIVENESS OF REMINISCENCE THERAPY AMONG OLD

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AGE PEOPLE Mr. M. Dineshkumar 11.

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DESCRIPTIVE

STUDY

TO

ASSESS

THE

PRACTICE

OF

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BREASTFEEDING AMONG PRIMI MOTHERS AT SELECTED HOSPITALS, PUDUCHERRY. Mrs. V. Revathy 12.

EFFECTIVENESS OF VIDEO ASSISTED TEACHING MODULE ON

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KNOWLEDGE REGARDING FIRST AID MEASURES AMONG CONSTRUCTION

WORKERS

IN

SELECTED

CONSTRUCTION

SITES, PUDUCHERRY. Mrs. P. Hemavathi 13.

WHY EAT BEETS? 6 TOP REASONS

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Dr. Divyachoudhary COLLEGE EVENTS

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The Clinical Nurse Educator as Inside Researcher *Mr. Allan Seraj, RN the use of insider research, in the last decade, many articles have been cited which point to the use of insider research as a valid method of researching groups to which the researcher belongs. There are many advantages of insider research and these are now discussed.

My Position as a Clinical Nurse Educator Insider research has been utilized in qualitative research where professionals are seeking to study groups to which they belong. This definition has been substantiated by Breen(2007).

The evolution of the Clinical Nurse Educators‟ (CNE) role in clinical practice has augmented the way research is conducted within clinical environments. Clinical Nurse Educators‟ are well placed to advance the way educational research in clinical practice is conducted. As researchers in their own clinical settings, they are challenged to examine the issues associated with studying a group to which they belong.

They become endogenous or insiderresearchers. Nurses in clinical practice, according to Tolson et al (2006), are best situated to drive forward an insider based research agenda and engage in the research process. And as an educator, Roberts (2007) argued that we are linked to our learners.

Advantages of Insider Research There are three main advantages of being an insider researcher that have been identified by Bonner and Tolhurst (2002) (a) having an established intimacy: this promotes both the telling and the judging of truth: knowing first hand about the research site, its participants and the environment provides a richness to the data collectionand subsequent analysis. This also enhances the outcomes and relevance of the study to that environment. As a philosophical aspect of qualitative research, the researcher must underscore the truth that is being sought, where that truth is situated, how it is derived and its impact on the process (b) having a greater understanding of the culture being studied: this understanding augments, not only data analysis, but how the research is situated in the environment as it affords the researcher to reach into the core of the research group/environment. (c) not altering the flow of social interaction unnaturally: insider research allows for the participants to stay in their „native environment‟ and ultimately this allows the data to flow more naturally.

Therefore, as a Clinical Nurse Educators‟, being a part of the fabric of my clinical learning environment, and being actively involved in the change processes brought about by the everchanging evidence base, I am well placed to conduct research within my work setting.

This however has not been the case, as the use of insider research, according to Brannick & Coghlan (2007), has not been a widely reported approach for researching clinical settings.

Although there have been a lot of criticisms for

Also, according to Smyth & Holian (2008) insider-researchers generally know the politics

*Clinical Nurse Educator/Professional Doctorate Student, Bucks NewUni, England, United Kingdom.

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of the institution and how the system works.

They are best placed to engage participants and their knowledge of the institution is invaluable compared to someone coming from the outside.Other advantages of insider researching have been noted by Hockey (1993) which include (a) being in a familiar setting and feeling comfortable (b) a lack of culture shock can enhance engagement with participants and communication with participants (c) the inside researcher will have an augmented ability to judge how honest and accurate the responses are because they are part of the institution (d) there is a greater propensity to reflect more deeply with someone who is familiar and sympathetic about their situation thus making for richer data collection I participants‟ expectations of an insider may be greater as they are both in the same situation-there is the belief that insiders understand the culture and hence share the „sufferings‟ of the participants (f) as an insider, you will have better access to naturalistic data and to respondents (g) when using ethnographic approaches, there is potentially the opportunity to produce data that is meaningful to participants (h) because as an insider you understand the culture, you are better able to utilize naturalistic data, critical discourse analysis and phenomenography and (i) insider research is more practical, cheaper and easier.

Disadvantages of Insider Research DeLyser (2001) and Hewitt-Taylor (2002) identified some main disadvantages associated with being an insider researcher: (a) the loss of objectivity as a result of being too familiar with the subject matter. The argument is that being too close to the participant‟s situation may lead to the loss of the researcher‟s objectivity about the data (b) Bias can occur as a result of wrong assumptions being made about the research process based on the researcher‟s prior knowledge.

The phenomenon of role duality, as noted by DeLyser (2001) and Gerrish (1997), can occur with insider research. There is often the struggle to balance the insider‟s role (instructor, nurse, manager etc.) and the researcher role. They further went on to acknowledge that as an insider, the researcher may not receive or see important information as their judgment may be clouded.

Another risk, as noted by the authors above, may be that the insider researcher gains access to sensitive information. This also becomes an ethical issue as conflict may arise and confidentiality may need to be breached. In these cases, it is advised that the boundaries of confidentiality be made explicit at the start of the data collection.

The use of insider research according to Geertz (1973) empowers the researcher to offer a “thick description of lived realities, of the hermeneutics of everyday life”.

DeLyser (2001) and Gerrish (1997) warns of the relativity of the insider‟s status – there is a potential that partiality may arise because of insider knowledge and being wary of assuming their views are more widespread or representative than is the case. They further went on to add that insiders may lose the ability

Whilst insider research offers a wide range of advantages, there are disadvantages to the method. These are now explored.

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to produce good, culturally neutral accounts.

There is also the issue of finding it difficult to „see‟ some dimensions of social life because they have become normalised in the eyes of the insider researcher. There may also be conflicts between the role as a researcher and your professional role(„interview bias‟).

uncover sensitive data and use it against participants. The participants may also feel obliged and potentially coerced to take part in the research project which may lead to poor data collection and bias (c) as an inside researcher with „inside‟ knowledge, there is the potential for covering up material that is potentially harmful to the participants‟ wellbeing, and in the case of clinical practice, patient care (d) the insider researcher may fall prey to rhetoric: there is potential to engage in the research process and then give false promises to participants- they may be swayedby the charisma of the researcher and not fully comprehend the context of the research. This may lead to loss of faith in the researcher, the research process and can reflect negatively on the institution and I there is also the potential that the inside researcher may loose touch with reality: not understanding or overestimating the situation may lead to the researcher loosing touch with the reality of what the data are saying. This can skew the data or even present bias.

There is a caution by Holian and Brooks (2004) to insider researchers when they said:“Insider researchers may need to be cautioned and reminded that the research mantle may seem magical and may reveal earth-shattering insights, but it is not bullet proof” (Holian and Brooks 2004:14) It is acknowledged that there are disadvantages to be considered when attempting to undertake insider research. Another issue that presented during the ethics committee review of my study‟s proposal was that of power and this is discussed next.

Power Relations in Insider Research Power relations in insider research are important in order to fully understand the construct of the method. The insider researcher can, according to (Holian 1999)(a) face unexpected strength of the institution‟s politics that may hinder the research process. Being part of the system may not necessarily strengthen the insider researcher‟s position, but, having a greater understanding of the politics may cause the researcher to refrain from engaging wholeheartedly with participants, the data may be superficial or even skewed and bias may present itself (b) there may be abuses of power: researchers who hold positions of authority in the institution may utilize their position to

Power relations in insider research are crucial in understanding the construct of the method. The use of power in insider research presents with the potential for bias, data skewing and negative impact on the participants and patient care (Shaw 2003) As I reflected on the effect of power on inside research, I began to examine my role as a Clinical Nurse Educators‟ and the power dynamics that may present itself as I pursue my study in my own work environment. The use of a reflective diary and the exploration of the ethics surrounding insider research illuminated

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my journey. These augmented my fuller understanding and bridling of power towards enhancing the process.

Grey (2005) indicates that it is a common understanding that most inside researchers are “likely to be confronted with the dilemma of uncovering information that „nudges‟ at ethical boundaries, rather than blatantly transgresses them”

The Ethics of conducting Insider Research Insider researchers are faced with ethical boundaries that they have to overcome in order to fully understand the „gravity‟ of their method.

Insider researchers are constantly struggling with the concept of „normal‟ and „acceptable‟ according to Brannan and Worthington (2007).

These writers indicate that subjective attitudes and difficult situations are brought up in the research process that cannot be completely „bracketed out‟ and can potentially influence the interpretation of data.The issue of validity, therefore, is an important concept that the inside researcher must consider.

Holian and Brooks (2004) identifies four ethical „boundaries‟ of which insider researchers must be considerate (a) the owner of the data and who can „release‟ it for research purposes: there is the dilemma that even though the data is collected by the researcher, does it belong to him/her or the institution where the research was carried out and is it the sole responsibility of the inside researcher to give permission for dissemination of the findings or the institution? (b) The relationship between the participants and the researcher: if clear boundaries between participants and researcher are not set and respected, the relationship can break down and ultimately the research process (c) insider researchers must consider the nature and level of informed consent: it is crucial that consent is informed and ongoing throughout the research process. Respecting the participant‟s desire to take part in the research and equally his decision not to continue in the process is important both the researcher and participants and (d) the nature and extent of anonymity and confidentiality for individuals and the organizationis also a vital ethical boundary for the inside researcher: the value of anonymity and confidentiality remains as key ethical principles in the process. The awareness of these principle remains at the forefront of the research process.

Insider Research Validity As an actor within his own setting, insider research has been under scrutiny. The validity of insider research is complicated according to Lesson (2003). The issue of validity is complicated by the relationship that exists between the researcher and the participants.

There is the element of subjectivity when it comes to researching your own environment and it is difficult to reference this „subjectivity‟.

There have also been questions raised by Rooney (2005) about the complexities of insider research (a) the researcher‟s relationship with participants may have a negative impact on the subject‟s behaviour (b) researcher‟s biases, may threaten validity and trustworthiness of the research (c) the tacit knowledge of the researcher may lead to the misinterpretation of data or making of false assumptions about the findings (d) prior knowledge of the researcher

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may lead the inside researcher to miss potentially important information I misrepresentation of the whole picture may result from researcher‟s politics, loyalties, or hidden agenda and (f)data can subconsciously be distorted because of the researcher‟s moral/political/ cultural standpoint.

matters less than a revealing, insightful account and interpretation. Self-reflection is thus crucial.‟ One can therefore infer that in light of the complex nature of obtaining validity, perhaps it is an objective to be worked towards rather than fully achieving it.

Different views on the validity of insider Brannick and research have been Coghlan (2007) “An explicit awareness of the possible expressed.

Lewis argue that we are all effects of perceived bias on data (1973) argues that insiders of the outsiders cannot society in which we collection and analysis, respect the produce a valuable live and that the ethical issues related to the anonymity of research knowledge we have In the organization and individual perspective. of these systems we contrast, Wolff are a part of is deep participants and consider and address (1950), believes that and contextual. the issues about the influencing the stranger can more easily They further argue researcher’s insider role on coercion, critically observe that as inside compliance and access to privileged events and researchers, through information, at each and every stage of situations in the reflective research process awareness, “we the research” Smyth & Holian (2008). that an insiders may develop and utilize take for granted as tacit knowledge that become deeply segmented unquestionable “truths”. as a result of socialization in an organisational system and reframe it as theoretical knowledge One proposed resolution of this dilemma and that because we are close tosomething or according to Maruyama (1991) is to conduct know it well, that we can research it. research involving research teams from several „inside‟ and/or „outside‟ cultures- this however This, according to Brannick and Coghlan (2007) proves to be resource intensive. provides justification for the validity of insider research through recognized methods of Credible insider research, according to Smyth & reflexivity in line with the appropriate research Holian (2008), requires awareness of the process. possible effects of perceived or potential bias on data collection, analysis, consider and address The idea of self-reflection is supported by the issues about the influencing researcher‟s Lesson (2003, p. 190) by suggesting „a more insider role on coercion, respect the ethical reflective approach in which data management issues of anonymity forthe organization and

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participants and compliance and access to privileged information.

value. As an inside researcher, I must develop awareness of the possible effects of perceived or potential bias on data collection, analysis, consider and address the issues about the influencing researcher‟s insider role on coercion, respect the ethical issues of anonymity for the organization and participants and compliance and access to privileged information.

There is need for wide engagement of stakeholders to balance the potential conflicts associated with insider research. This coupled with reflective awareness will illuminate the researcher‟s journey and improve the research process.

„Insiderness‟ is not a fixed value. Labree (2002) however conceptualises the insider researcher as a fixed point which is contrary to many commentators of inside research who promote it as a continuum-the researcher can go in and out of the situation, both as insider and outsider, depending on the geography within the institution, collecting data from „colleagues‟ within the institution but not from your own profession and your substantive position in the institution during the research process.

Merton (1972) suggests that we are never completely an insider researcher and to believe this is a fallacy.

References Brannan, M., Worthington, F. (2007) Ethnographies of work and the work of ethnography. Ethnography; 8: 4, 395–402.

However, as educational research in clinical practice is concerned with human beings and their behaviour, it may be necessary to involve stakeholders, each of who will bring to the research process a wide range of perspectives.

In this way, a more balanced situation and „objective‟ view can develop, according to May (as cited in Porteli, 2008), thus enhancing the validity of the research process.

Brannick, T., & Coghlan, D. (2007). In defense of being native: the case for insider academic research. Organisational Research Methods, 10(1), 59-74.

Breen, L. J. (2007). The researcher „in the middle‟: Negotiating the insider/outsider dichotomy. The Australian Community Psychologist, 19(1), 163-174.

Conclusion Insider research presents issues of ethical, power relations and research validity to the researcher who opts to study his own working environment. As a Clinical Nurse Educators‟ choosing to study his own colleagues, it has become apparent that it is crucial to explore all the issues and apply the principles to the research process and the journey. I have learnt that „insiderness‟ is a continuum and not a fixed

Bonner, A., & Tolhurst, G. (2002). Insideroutsider perspectives of participant observation.Nurse Researcher, 9(4), and 7-19.

DeLyser, D. (2001). “Do you really live here?”

Thoughts on insider research.Geographical Review, 91(1), 441-453.

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Gerrish, K. (1997). Being a „marginal native‟: Dilemmas of the participant observer.Nurse Researcher, 5(1), and 25-34.

Merton, R. (1972) Insiders and Outsiders; A chapter in the sociology of knowledge, American Journal of Sociology, 78(July), 947.

Geertz, C. (1973) The Interpretation of Cultures: Selected essays. New York: Basic Books.

Porteli, J. (2008). Researching a secondary school in Malta. In P. Sikes & A. Potts (Eds.), Researching education from the inside (pp. 80–94). New York, NY: Rutledge.

Grey, C. (2005) A Fairly Short, Fairly Interesting and Reasonably Cheap Book About Studying Organisations. London: SAGE publications.

Roberts, D. (2007) Ethnography and staying in your own nest. Nurse Researcher; 14: 3, 15– 24.

Hewitt-Taylor, J. (2002). Insider knowledge: Issues in insider research. Nursing Standard, 16(46), 33-35.

Rooney, P. (2005). Researching from the insidedoes it compromise validity? [Electronic Version].Level 3, May 2005, 1-19. Retrieved 12.12.13 from http:// level3.dit.ie/html/ issue3/ rooney/ rooney. Pdf.

Hockey, J. (1993). Research methods: researching peers and familiar settings.

Research Papers in Education, 8(2), and 199-225.

Shaw, I. F. (2003).Ethics in qualitative research and evaluation.Journal of Social Work, 3(1), 9-29.

Labaree, R. V. (2002) The Risk of “Going Observationalist”: Negotiating the hidden dilemmas of being an insider participant observer, Qualitiative Research, 2, 1, 97- 122.

Smyth, A., & Holian, R. (2008).Credibility Issues in Research from within Organisations. In P. Sikes & A. Potts (Eds.), Researching education from the inside (pp.

33–47). New York, NY: Taylor & Francis.

Lesson, M. (2003). Methodology for close up studies – struggling with closeness and closure.Higher Education, 46, 167-193.

Tolson, d. et al (2006) constructing a new approach to developing evidence-based practice with nurses and older people.Worldviews on Evidence-Based Nursing; 3: 2, 62–72.

Lewis, D. K. (1973).Anthropology and colonialism.Current Anthropology, 14(5), 581602.

Maruyama, M. (1981)Endogenous Research: Rationale. In P. Reason & J. Rowan (eds) Human Inquiry: A sourcebook for new paradigm research. Chichester: John Wiley & Sons pp. 227-238.

Wolff, K. H. (1950). The sociology of Georg Simmel. New York, NY: Free Press.

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TELENURSING: A VISION IN INDIA *Mrs. R. Rajeswari, in coverage of health care to distant, rural, small or sparsely populated regions.

Introduction: “Technology doesnot drive change- it enables change”

Meaning :

Telenursing refers to the use of telecommunication and information technology in the provision of nursing services whenever a large physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telehealth, and has many points of contacts with other medical and nonmedical applications, such as telediagnosis, teleconsultation, telemonitoring, etc

Tele-nursing is the use of telecommunication technology to provide nursing practice at a distance. This can be something as simple as faxing medical records to the more complex delivery of nursing care to patients' home through the use of cameras and computer technologies.

Definition: It is defined as subset of telehealth in which its main focus is on profession‟s practice (i.e.

Nursing)

Currently, India is facing a shortage of more than million nurses, the nurse-per-bed ratio in India is 0.87 as against the world average of 1.2 nurses-per-bed (WHO).This scenario needs to be rectified. To meet the patient‟s need, many health care agencies are looking for innovative ways to care for a large number of patients.

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American Nurses Association

Significance:  Tele-nursing has also been used as a tool in home nursing. It is especially useful in cases of elderly and chronically ill patients who need to be nursed at home and are remotely located.  Tele-nursing can also provide opportunities for patient education, professional consultations, examination of test results and assisting physicians in implementation of medical treatment protocols.  Today nurses can offer consultation and comfort to patients whether they are in the same city or thousands of kilometers away.

Over the telephone, nurses can calm an anxious patient.  Tele-nursing, nurses manage the demand for health services

With over 70 per cent of India‟s population living in the villages and more than 75 per cent of the doctors are in the cities, it was pointed out that tele-medicine could emerge as a feasible bridge to minimize the rural-urban health divide in the country. It was stated that tele-medicine, if used effectively in nursing profession, had the potential to help improve the efficiency of both nurses and doctors as they would be able to treat more patients.

Telenursing is achieving a large rate of growth in many countries, due to several factors: the preoccupation in driving down the costs of health care, an increase in the number of aging and chronically ill population, and the increase

*Reader, Medical Surgical Nursing, Indrani College of Nursing, Ariyur, Puducherry.

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 Telephones also allow nurses to take their their urgency, educating and advising clients, services out into the community through and making safe, effective, and appropriate mobile health teams. dispositions all by telephone. Nurses may also  Telehealth technology offers increase in direct clients to obtain a second medical productivity for nurses by reducing the travel opinion, or advise them where to find relevant, time and increasing the daily census current health information. They might  Tele-nursing is a cost-effective strategy for counsel or perform crisis intervention for a making health care accessible to the whole threatened suicide. nation with dispersed or rural population  Counseling : counsel high risk population  Nurses also use state-of-the-art video conferencing equipment as a tool for the  Communication: Technology now also assessment and treatment of patients. enables nurses to deliver health care in rural  Tele-Nursing removes the barriers to health and remote locations, and areas without health care for people living in remote villages or care services. where adequate health  Nursing education: services are not Nursing education available. through two way HOME CARE  Nurses are able to spend audio video more time on direct conferencing. patient care rather than Implications for QUALITY indirect care, resulting student learners: HEALTH CARE in better use of their RURAL TRIAGE Telenursing is WITH SERVICES SERVICES time and education becoming new reality TELENURSING Applications of in nursing. Nurses in Telenursing: telehealth care, use HEALTH CARE  Home care :Patients nursing care plan to SERVICES who are immobilized, or provide care, but live in remote or they use internet, Quality Care and Telenursing Model difficult to reach places, computer, digital citizens who have chronic ailments, may stay assessment tools, and telemonitoring at home and be "visited" and assisted regularly equipments. Inclusion of Telenursing in by a nurse via videoconferencing, internet or nursing curriculummay enhance the use art of videophone. In normal home health care, one technology with internet, telephonic services nurse is able to visit up to 5-7 patients per day. in providing health care rather than direct Using telenursing, one nurse can “visit” 12-16 care. patients in the same amount of time.  Telephone triage :Telephone triage involves ranking clients' health problems according to

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Vol 7, Issue2, May - August’14 effectiveness over time as the workflow and business environment continue to evolve.

Issues in telenursing  No face to face contact  Visualization work - build a mental picture of the caller during triage  Getting simulated calls

References : Glinkowski. W, Pawlowska K, Kozlowska L(2013) telehealth and telenursing perception and knowledge among university students of nursing in Poland, Telemedicine JE health,19(7)523-539

Conclusion : According to the experts, telenursing will help cushion the impending shortage of trained nurses and also ensure a continuous flow of nursing staff who could also treat and nurse more number of patients at a given point of time with the assistance of tele-medicine and telenursing technology.

Leadership and collaboration among international nurses are necessary to outline the uses of Telehealth and telehealth technologies to provide nursing care in an interdisciplinary manner to patients, regardless of time, staffing and geographic boundaries.Continuous cycles of usability evaluation, modification of software issues, followed by repeated usability analyses are needed in order to ensure system efficiency and

Kushniruk AW, et al (2005). Technology induced error and usability: the relationship between usability problems and prescription errors when using a handheld application.

International Journal of Medical Informatics, 74(7–8): 519–526.

Mantas J., Hasman A.,(2002), Text book in health informatics: A Nursing Perspective, IOS Press, 504 Pong R.W. (1999).Licensing physicians for telehealth practices: issues and policy options, Health Law Review, 8(1), 3-14.

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CARCINOID SYNDROME-CASE REPORT *Mrs. Kripa Angeline. A & **Mrs. Janifer Xavier Albertina. J INTRODUCTION: Carcinoid syndrome is a set of symptoms caused by some carcinoid tumors, which grow out of cells of the Endocrine System. These tumors produce too many hormones (e.g., Serotonin) which cause the symptoms of Carcinoid Syndrome.

Carcinoid tumor was first characterized by Siegfried Oberndorfer, a German pathologist who coined the term “Karzinoide” or “carcinoma-like”, to describe the unique feature of behaving like a benign tumor though having a microscopic malignant appearance. Carcinoid tumor is a slow-growing type of Neuroendocrine tumor originating in the cells of the neuroendocrine system most commonly presenting in the midgut at the level of the ileum or in the appendix. Carcinoid tumors are APUDomas (Amine Precursor Uptake and Decarboxylation)that arise from the enterochromaffin cells throughout the gut.

Over 2/3rds of the tumors are found in the Gastrointestinal tract.

Incidence:  10% of people who have carcinoid tumors develop Carcinoid Syndrome.  Carcinoid syndrome occurs in 8% of 8876 patients with carcinoid tumor.  Men are more prone than women (46 to 59% a presentation and 46-61% during course of the disease) Depending on location of carcinoid tumour the common sites are asfollows:

Tumor location

At Presentation

Foregut

5-9%

During the course of disease 2-33%

Midgut

78-87%

60-87%

Hindgut

1-5%

1-8%

Unknown

2-11%

2-15%

Etiology : Caused by a carcinoid tumor which secretes serotonin or other chemicals into the blood stream. But the cause of carcinoid tumor is unknown.Most tumors leading to carcinoid syndrome originate in the intestine and the syndrome usually does not appear until there is metastasis to the liver.

Aggravating Factors: Stress, Physical exertion, Alcohol consumption, Food items like cheese, meat and tyramine containing foods .

Pathophysiology Carcinoid tumor in any part of the bodySerotonin, a vasoactive substance is secreted by the carcinoid tumor, which causes flushing results from secretion of Kallikrein, the enzyme that catalyses the conversion of kininogen to lysyl-bradykinin.

Lysyl-bradykinin is converted to bradykinin, the most powerful vasodilator. The chemicals

*Assoc. Prof. & **Asst. Lect. Kasturba Gandhi Nursing College, SBV, Puducherry.

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Pondicherry Journal of Nursing enter the systemic circulation. The chemicals enter the liver where it is neutralized without manifestations.If tumors arise in the lung, bronchi, liver and metastasizes to the liver.Have direct access to the systemic circulation before being metabolized.Exhibition of symptoms of carcinoid syndrome.Carcinoid syndrome manifestations occur.

Signs and Symptoms:  Diarrhea  Flushing of the skin or face (dry and not associated with sweating)  Heart palpitations  Stomach cramps  Shortness of breath  Wheezing  Pain  Pellagra

Diagnosis: As the symptoms coincide with common conditions like Irritable Bowel Syndrome, the diagnosis is misinterpretated. The common tests are :  Serum Analysis: Serum analysis of chromogranin A, a glycoprotein that is secreted with other hormones by neuroendocrine tumors, appears to be the most promising, with specificity approaching 95 percent and sensitivity for carcinoid tumors approaching 80 percent.  Urine analysis: Urine 5-HIAA measures the amount of the hormone serotonin being made in the body over a period of 24 hrs.  Imaging studies :  Octreoscan,X-Ray, CT scan and MRI Scan.  Endoscopy . and ultrasonogram

Vol 7, Issue2, May - August’14  Biopsy may reveal hepatic lesions

Treatment:  Removing or shrinking the carcinoid tumor. In general treatments fall into one of the following categories:  Surgery is the usually the first choice of treatment. The type of surgery used depends on the location of the tumor and its size and the state of metastasis.  Medications are used for symptomatic relief of carcinoid syndrome when the tumor cannot be resected by surgery. The most common drug of choice is octreotide (sandostatin) which relieves flushing and diarrhea and also helps to slow the growth of tumors.  Alpha – Interferon  Chemotherapy  Radiation therapy.

Prognosis: As the tumors are slow growing it is possible to treat tumors at this stage. It is usual for people to live for 10 to 15 years with carcinoid syndrome.But the most common cause of carcinoid syndrome is metastatic liver disease arising from a small bowel carcinoid tumor. For these patients, the prognosis is uniformly poor.

Complications : Carcinoid heart disease, Bowel obstruction, Carcinoid crisis.

Nursing Management : Nursing management of carcinoid syndrome is discussed along with case report.

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Pondicherry Journal of Nursing CASE REPORT: Mr. A, 45yrs/Male, got admitted inMGMC&RI on 25/06/2014 with the complaints of Giddiness, drowsiness with slurred incoherent speech, non projectile not blood/bile stained vomiting containing food particles associated with abdominal pain around umbilicus, 3 episodes of non blood stained loose stools since 2 days. Patient history revealed recurrent hospitalization for the complaints of giddiness, vomiting, loose stools and decreased appetite, over the last 10 months which was relieved on hospitalization. He is a known case of Type II Diabetes Mellitus for the past 6 months and is on medication and he had present complaints of decreased appetite, gradual lowering of weight, generalized weakness, breathlessness and diffuse headache. On examination there were no any significant findings.Blood investigations showed elevated blood glucose values of 220 mg/dl and decreased serum potassium values of 2.6 mEq/dl.Chest x-ray study showed no abnormalities.Ultrasonography of abdomen revealed the evidence of tumor of the liver.

Liver biopsy revealed the evidence of Carcinoid tumor with hepatic lesions treated with Tab. Rantac 150 mg bd ,Tab. Vertin 16 mg bd , NS @ 75 ml/hr.

NURSING CARE : Nursing management of Mr. A with Carcinoid syndrome is presented as nursing process approach based on the problems and needs identified.

1.Nursing assessment : Complaints of breathlessness, decreased appetite, gradual lowering of weight, generalized weakness, and diffuse headache.

Vol 7, Issue2, May - August’14 2. Nursing diagnosis : I. Ineffective breathing pattern related to compression of lung secondary to liver metastases as manifested by increased respiratory rate.

II. Imbalanced nutrition less than body requirements related to anorexia secondary to liver metastases as manifested by weight loss III. Fatigue related to poor intake secondary to anorexia as manifested by verbalization of patient.

2. Nursing interventions: o Maintain fowlers position o Changed position 2nd hourly. o Encouraged to increase the food intake by advising the patient to take small frequent meals. o Provided foods according to the preferences of the patient o Administered Tab. Rantac 150 mg bd before meals. o Monitored and recorded the fluid intake and output daily. o Reduced noxious stimuli at the time of dining and water intake in between meals. o Avoided strenuous exercises. o Encouraged adequate periods of rest alternating with activity. o Monitored for complications.

4. Expected outcomes : o The patient experiences improved respiratory status. o Reports decreased shortness of breath. o Exhibits normal respiratory rate with no adventitious sounds.

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Pondicherry Journal of Nursing o Exhibits improved nutritional status by increased weight and improved laboratory data. o Reports improved appetite. o Exhibits increased interest in activities and events. o Plans activities to allow ample periods of rest.

CONCLUSION : Most patients with carcinoid tumors seek treatment for metastatic disease. hence awareness should be created regarding carcinoid syndrome among the nursing professionals. The prognosis for patients with these tumors is variable and related to the site of the primary tumor.

Comprehensive nursing care should be focused based on the site of metastases.

Vol 7, Issue2, May - August’14

Bibliography : Dan L. Longo (2010).

Harrison‟s Hematology and Oncology; McGraw Hill Medical Publications;584-589.

J. Larry Jameson, Dennis L. Kasper et al.

(2010).

Harrison‟s Endocrinology.

McGraw Hill Medical Publications; 354359 John A.A. Hunter, Nicholas A. Boon, et al.

(2006). Davidson‟s Principles and Practice of Medicine. 20th edition; Churchill Livingstone Publications;791,903.

Suzanne c. Smeltzer, Brenda G. Bare et al.

(2008). Brunner and Suddarth‟s Textbook of Medical and Surgical Nursing.12th edition; Lippincott Williams and Wilkins publications ;1323-1332.

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Pondicherry Journal of Nursing

Vol 7, Issue2, May - August’14

TB MENINGITIS - CASE REPORT

*Ms. Rekha .E TB MENINGITIS

PATHOLOGY Mycobacterium tuberculosis of the meninges is the cardinal feature and the inflammation is concentrated towards the base of the brain. When the inflammation is in the brain stem subarachnoid area, cranial nerve roots may be affected. The symptoms will mimic those of space-occupying lesions. Infection begins in the lungs and may spread to the meninges by a variety of routes.

Blood-borne spread certainly occurs and 25% of patients with miliary TB have TB meningitis, presumably by crossing the bloodbrain barrier, but a proportion of patients may get TB meningitis from rupture of a cortical focus in the brain ( a so-called rich focus); an even smaller proportion get it from rupture of a bony focus in the spine. It is rare and unusual for TB of the spine to cause TB of the Central Nervous System, but isolated cases have been described

Meningitis (from ancient Greek/ Meninks, “Membrane” and the medical suffix- its“Inflammation”) is an acute inflammation of the protective membranes covering the brain & spinal cord, known collectively as the Meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms and less commonly by certain drugs.

Tuberculous Meningitis is Mycobacterium tuberculosis infection of the Meninges.

EPIDEMIOLOGY Meningitis is annotifiable disease in many countries, the exact incidence rate is unknown.

As of 2010 it is estimated that it resulted in 4,20,000 deaths in worldwide.

RISK FACTORS It can develop in children & adult of all ages.  HIV/ AIDS  Excessive alcohol use  Weakened immune system  DM CAUSES Microorganisms-Bacteria-Neisseria meningitides Streptococcus pneumonia Haemophilus influenza type B Listeria monocytogenes Mycobacterium tuberculosis VIRAL - Entero virus Herpes simplex virus Varicella zoster virus FUNGAL – Histoplasmacapsulatum Candida PARASITIC – Angiostrongylus Schistosoma

CLINICALMANIFESTATION Fever and headache are the cardinal signs.

INITIAL SYMPTOMS  Headache  Low grade fever  Fatigue  Malaise  Nausea, vomiting  Neck stiffness  Positive kernig‟s sign  Positive Brudzinski‟s sign LATE SYMPTOMS  Irritability  Unconsciousness  Confusion

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

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Pondicherry Journal of Nursing

Vol 7, Issue2, May - August’14

 Changes in mental status  Coma

PREVENTION  BCG vaccination can be used to control the infection in young children.  To treat the positive patient to help control the spread of the disease.

ASSESSMENT HISTORY  Recent illness  Previous history of DM/HIV  History of use of alcohol  History of recurrent infection  Detailed review of all systems

NURSES ROLE     

PHYSICAL EXAMINATION Complete physical examination should be carried out including with neurological assessment.

INVESTIGATIONS Investigation should be tailored to the possible cause and symptoms.  Total count and Differential count  Renal Function Test  Liver Function Test  Chest X ray  Urine culture/ microscopy  Electrolytes

Maintain head or neck in midline position, support with small towel or roll or pillow.

Observe for seizure activity and protect from injury.

Restrict fluid intake as indicated.

Monitor temperature as indicated Decrease extraneous stimuli and provide comfort measures like back massage, quiet environment, soft voice.

COMPLICATION  seizures  hearing loss  increased pressure in the brain (intracranial pressure)  brain damage  stroke  death

SPECIAL INVESTIGATIONS  CT scan – Features consist of TB meningitis  MRI scan – To elicit features consist of TB meningitis  Lumbar puncture – CSF analysis – which may show low glucose, high protein level  USG Doppler study  Nucleic acid amplification tests  Skin test for tuberculosis (PPD)  Blood culture

Case Report A 26 year old male admitted in MGMC & RI, Puducherry presented with the complaints of head ache, since 10 days, Intermittent low grade fever with chills & rigor for past 15 days. He had history of involuntary movements of upper & lower limbs. Patient had one episode of focal seizures including right upper limb and lower limb, lasting for > 30 sec with uprolling of eyes and he was disoriented.He had a history of alcoholismsince 10 years.

Laboratory Investigations were suggestive of Inflammation with elevated ESR &Neutrophil count. LFT revealed elevated

TREATMENT  ATT therapy  Anticonvulsants  Steroids – Dexamethasone  Diuretics – Manitol

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Pondicherry Journal of Nursing

Vol 7, Issue2, May - August’14

Protein and SGPT levels.CSF analysis showed elevated Lymphocytes levels. MRI – BRAIN revealed TB Meningitis, with Acute Infarct in the Striato Capsular Region bilaterally & mildly prominent Ventricular cyst.

Finally Patient was diagnosed as TB Meningitis with Alcohol Withdrawal Syndrome.

Patient was put on, Inj.Ceftriaxone 1 gmIV bd, Inj.Vancomycin 1 gm IV bd, Inj.Dexa 8 mg IV tid, Inj.Artesunate 120 mg IV bd, Inj.Thiamine 100 mg IV bd, Inj.Levipill 500 mg IV bd, Inj. Haloperidol 5 mg IV bd, Tab. AKT- 4 1od.

With two weeks of follow up, general symptoms settled down. The patient went home stable.

2. NURSING ASSESSMENT He had history of involuntary movements of upper & lower limbs.

Nursing Diagnosis: Impaired mobility related to immobilisation.

Expected Outcome: Physical mobility is enhanced.

INTERVENTIONS:  Assess the range of motion of the extremities.  Encouraged to move the extremity as tolerated.  Demonstrated range of motion to full ability.  Maintained muscle tone by encouraging her to do muscle strengthening exercises.

Nursing Care Nursing management of Mr.A with TB Meningitis is presented using Nursing process approach based on the problems / needs identified.

1. Nursing Assessment: He complained headache and intermittent low grade fever with chills & rigor for past 15 days.

EVALUATION:There was only marginal improvement in mobility as he had to continue with muscle strengthening exercise.

3. Nursing Assessment: He was found to have one episode of focal seizures including right upper limb and lower limb, lasting for > 30 sec with uprolling of eyes and he was disoriented.

Nursing Diagnosis: Hyperthermia related to brain infection.

Nursing Diagnosis: High risk for injury related to seizural activity.

Expected Outcome: Maintains body temperature within normal limits.

Expected Outcome: Injury is prevented.

INTERVENTIONS:  Monitor the vital signs.  Maintain I/O chart.  Provide ample fluids orally or intravenously.  Administer antipyretic medications as per order.

INTERVENTIONS:  Monitored the level of consciousness by Neurological assessment.  Monitored for seizure activity .  Ensured safety awareness such as raising side rails at all times and frequent observation.  Administered anti convulsants as per ordered.

EVALUATION: There was a fluctuation in his temperature due to infection.

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Pondicherry Journal of Nursing

Vol 7, Issue2, May - August’14 Arthur Earl Walker, Edward R. Laws, George B. Udvarhelyi (1998). Infections and inflammatory involvement of the CNS. The Genesis of Neuroscience.

Theme. pp. 219–21.

Tunkel AR, Hartman BJ, Kaplan SL et al.

(2004).Practice guidelines for the management of bacterial meningitis. Clinical Infectious Diseases 39 (9): 1267–84.

EVALUATION: He did not develop any injury during his stay in the hospital.

REFERENCE Thwaites G, Chau TT, Mai NT, Drobniewski F, McAdam K, Farrar J (March 2000).Tuberculous meningitis. Journal of neurology, Neurosurgery, and Psychiatry 68 (3): 289–99

CASE SCENARIOS – Dept of MSN  Justify the statement of the nurse and outline

SCENARIO 1: Mr.Y 45 years old got admitted in ICU with the

the procedure for correct monitoring of

complaints of acute chest pain radiating to

CVP?  Identify the incidence where CVP reading can

shoulder that shows ECG changes?   

Identify the condition and presumptive ECG

be wrong due to faulty practices?

changes?

SCENARIO 4:

As a nurse what is your role in the assessing

Mrs.A 35 years old with dyspnea admitted in

and monitoring the ECG changes?

casualty for further evaluation.Patientis on

What

are

all

the

possible

continuous

nursing

cardiac

monitoring

.Patient

is

normotensive and manual pulse is 66 bt/mt but

interventions?

SCENARIO 2:

the saturation is not picking up and the waves

Mr.Ramu 55 years old with hypovolemic shock

are flat.

and patient is on ABP monitoring?

 Identify the reason for the above?



 What are the common errors occurring while

As a nurse how will you maintain the arterial catheter?

monitoring O2 saturation

SCENARIO 3: Mr. Y

40 years got admitted with severe

dehydration

Answers in page no. 49

admitted in ICU with CVP

monitoring .The nurse gets a CVP reading of 12mmHg and has a doubt whether this is correct reading?

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Pondicherry Journal of Nursing

Vol 7, Issue2, May - August’14

Ebola Virus disease (EVD) - The Global Health Emergency *Dr. R. Shankar Shanmugam &**Mrs. Shakila Shankar illness, with a death rate of up to 90%. The illness affects humans and nonhuman primates (Monkeys, Gorillas, and Chimpanzees).There are five types of Ebola virus. It gets its name from Ebola River in Congo, where the disease first appeared and near villages in central & western Africa near tropical forest.

Electron micrographs show long filaments, characteristic of the Filoviridae viral family.

The virus interferes with the endothelial cells lining the interior surface of blood vessels and the process of coagulation. As the blood vessel walls become damaged and the platelets are unable to coagulate, patients go in for hypovolemic shock.

Introduction: World Health Organization (WHO) declared Ebola Virus Disease (EVD) out beak in West Africa, a Global Public Health Emergency. As the world‟s most deadly Ebola virus outbreak continues to spread throughout Western Africa. Emergency Departments in many hospitals are on heightened alert for any patients who report travel histories and symptoms that indicate the risk of carrying the disease.

If a patient has traveled to Guinea, Sierra Leone, Liberia or Nigeria and also has symptoms such as a fever, headache, joint and muscle aches, diarrhea or vomiting. The public health experts are recommending that the triage nurses shall move forward towards isolating the patient Although the mortality rate for the disease can be as high as 90%, data from the CDC suggests that, the overall rate for this outbreak is about 55%, though it varies by country. The death rate in Guinea is the highest at about 74%. Death typically occurs about nine to 10 days after the onset of symptoms, but for patients who survive for two weeks after the onset, the chances of survival increases for them.

In August-2014, Deaths from the Ebola virus stand at 932 in four West African countries. This is the largest outbreak of the disease ever recorded.

Ebola virus disease Ebola virus disease (formerly known as Ebola hemorrhagic fever) is a severe, often fatal

Ebola Virus

Mode of transmission

 In the current outbreak in West Africa, the majority of cases in humans have occurred as a result of human-to-human transmission.  Direct contact through broken skin or mucous membranes with the blood, or other bodily fluids or secretions (stool, urine, saliva, semen) of infected people.  Infection can also occur if broken skin or mucous membranes of aMulti healthy person come *Senior Nursing Tutor /Coordinator-Nursing & PME, TamilNaduGovt Super

Speciality Hospital, OmandurarGovt Estate, Chennai. & **Staff Nurse, NIRT/ICMR, Chetpet, Chennai.

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Pondicherry Journal of Nursing

Vol 7, Issue2, May - August’14

into contact with environments that have become contaminated with an Ebola patient‟s infectious fluids such as soiled clothing, bed linen, or used needles.

Samples from patients are an extreme biohazard risk; testing should be conducted under maximum biological containment conditions.

Laboratory findings include low white blood cell and platelet counts, and elevated liver enzymes.

People at Risk:  Health Care Professionals & workers.  Family members or others in close contact with infected people.  Members who have direct contact with the bodies of the deceased as part of burial ceremonies.  Families or communities who care for individuals present with symptoms of Ebola virus disease in their homes.

TREATMENT:  Isolation and Intensive supportive care  No specific Treatment, only symptomatic Management is possible.  Oxygen administration  Intravenous Fluids for dehydration.  Strict infection control measures.

WAYS TO PREVENT INFECTION AND TRANSMISSION

Incubation Period: The incubation period, or the time interval  Understand the nature of the disease, how it is from infection to transmitted, and SIGNS & SYMPTOMS onset of symptoms, is how to prevent it from 2 to 21 days.  Sudden onset of fever, intense from spreading The patients become further. weakness, muscle pain, headache contagious once they  Listen to and sore throat. begin to show and follow symptoms. They are  This is followed by vomiting, directives issued by not contagious during Ministry of Health. diarrhoea, rash, impaired kidney the incubation period.  If you

and liver function, and in some cases, both internal and external bleeding.

suspect someone close to you or in your community of having Ebola virus disease, encourage and support them in seeking appropriate medical treatment in a health-care facility.  If you find ill person in your place, notify public health officials.Health Care professionals should use appropriate gloves and personal protective equipment (PPE)

Laboratory Investigation:  Antibody-capture Enzyme-Linked Immuno Sorbent Assay (ELISA)  Antigen detection tests  Serum neutralization test  Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) assay  Electron microscopy  Virus isolation by cell culture.

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Pondicherry Journal of Nursing (gloves, impermeable gown, boots/closed shoes with overshoes, mask and eye protection for splashes),  When visiting patients in the hospital or caring for someone at home, hand washing with soap and water is recommended after touching a patient, being in contact with their bodily fluids, or touching his/her surroundings.  People who have died from Ebola should only be handled using appropriate protective equipment and should be buried immediately by public health professionals who are trained in safe burial procedures.

    

 

Vol 7, Issue2, May - August’14 WHO’s general travel advice  





Hand Hygiene Hand hygiene is essential and should be performed.

Before donning gloves and wearing PPE on entry to the isolation room/area.

Before any clean or aseptic procedures is being performed on a patient.

After any exposure risk or actual exposure with a patient‟s blood or body fluids.

After touching (even potentially) contaminated surfaces, items, or equipment in the patient‟s surroundings.

After removal of PPE, upon leaving the isolation area.

It is important to note that neglecting to perform hand hygiene after removing PPE will reduce or negate any benefits of the PPE.

Travelers should avoid all contact with infected patients.

Health workers traveling to affected areas should strictly follow WHO-recommended infection control guidelines.

Anyone who has stayed in areas where cases were recently reported should be aware of the symptoms of infection and seek medical attention at the first sign of illness.

Clinicians caring for travelers returning from affected areas with compatible symptoms are advised to consider the possibility of Ebola virus disease.

REFERENCES: Ebola out Break, 09/08/2014.

The

Hindu

dated

WHO Calls-Ebola Outbreak, Times of India dated 09/08/2014. http://www.news-medical.net/health/What-isEbola.aspx http://www.who.int/mediacentre/factsheets/fs10 3/en http://www.independent.co.uk/ http://www.cdc.gov.

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Pondicherry Journal of Nursing

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COLOR THERAPY *MR. SANTHOSH KUMAR. J,

"Everything in life is vibration" -Albert Einstein INTRODUCTION Color therapy, sometimes called Colorology or Chromatherapy, is an alternative way of healing method, a technique in which Colorand light is used to balance energy in the person‟s physical, emotional, and spiritual or mental well being.

DEFINITION Color therapy is a system of alternative medicine in which Colors and their energy frequencies are used to correct physiological and psychological imbalances.

element has a definite color and characteristic.

Colors therapy helps in restoring these elements to their right colors and characteristics, an imbalance of which leads to an ailment.

3.Chakras are electrical energy centers which are created by the endocrine glands and the nerve centers in the body. The word Chakra comes from the Sanskrit language meaning a revolving wheel or vortex of energy. On the physical level each Chakra is connected to: a nerve center, one of the seven senses, and one of the seven endocrine glands vibrate with the Chakras.

INDICATIONS/ USES OF COLOR THERAPY  Depression (most common)  Stress related conditions  Aggression  Irritability  Emotional and behavioural problems  Insomnia PRINCIPLES OF COLOR THERAPY 1.It is a technique which uses colors and light to balance energy.

2.Our body is made of five basic components namely earth, fire, water, air and space. Each

*M.Sc Nursing II Year, Dept of Mental Health Nursing, College of Nursing, PIMS, Puducherry.

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Pondicherry Journal of Nursing

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BENEFITS/ADVANTAGES OF COLOR THERAPY Colors are light energy at certain wavelengths

This energy is translated into color by the photoreceptors in the retina, called cones Color& energy enters our bodies, it stimulates the pituitary and pineal glands to secrete certain hormones

Whichdirect influence on our thoughts, moods and behaviours HOW IT WORKS? According to the therapeutic aspect of color therapy, colors are infused with healing energies.

Every individual has five basic elements, and when one is thrown off, illness occurs. Each color has a unique effect on the body.

Red is associated with energy, empowerment, and stimulation. It is used for circulation and stimulation of red blood cell production.

Orange is associated with pleasure, enthusiasm, and sexual stimulation. It is used as an antibacterial agent and to ease digestive discomforts.

Yellow is associated with wisdom and clarity. It is used as a decongestant, antibacterial agent, and for the digestive and lymphatic systems.

Green is associated with balance and calmness. It is used for treatment of ulcers, as an antiseptic, a germicide, and as an antibacterial agent.

Blue is associated with communication and knowledge. It is used to eliminate toxins, and treat liver disorders and jaundice.

Indigo is associated with sedative qualities, calmness, and intuition. It is used to control bleeding and abscesses.

Violet is associated with enlightenment, revelation, and spiritual awakening. It is used to soothe organs, relax muscles, and calm the nervous system.

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Pondicherry Journal of Nursing

Vol 7, Issue2, May - August’14 The first chakra is associated with the color red and is located at the base of the spine.

The second chakra is associated with the color orange and is located at the pelvis and groin area.

The third chakra is associated with the color yellow and is located at the solar plexus.

The fourth chakra is associated with the color green and is located at the heart.

The fifth chakra is associated with the color blue and is located at the throat.

The sixth chakra is associated with the color indigo and is located at the brow.

The seventh chakra is associated with the color violet and is located at the crown of the head.

APPROACHES/WAYS TO ADMINISTER COLOR THERAPY 1.Practitioner assisted Color therapy: An approach in which practitioners administer therapy.

2.Self helpColor therapy: An approach in which individual practice therapy himself.

1. Practitioner assisted color therapy a. Color reflection reading (CRR):  The color reflection reading was developed in 1986 by Howard and Dorothy Sun.  The CRR is an effective and accurate tool for insight and self-development used by professional.  From a range of eight Colored cards (red, orange, yellow, turquoise, blue, violet, magenta), the practitioner asks to choose three.

The physical and psychological health is assessed from selection to provide clues as to which areas of the body are out of balance.

b. Illumination Therapy:  It is a computer-controlled Color therapy machine directs colored light at the client as she sits or lies in a darkened room.  E.g. in depression orangecolor is given alternatively with its complementary colorindigo, and each dose is precisely timed.Sessions are usually about an hour long, and a course of treatment may last several weeks, depending on the condition.

2. Self-Help Color Therapy:  Colored body wraps  Eating Colored foods  Drinking Colored water  Color Meditation  Color Visualization  Color Breathing  Colored Oils  Colored clothing

Some points to be remember:    

Self-help colortherapy can be practiced every day.

The most suitable place to practice self-help color therapy is quite environment.

The best time to practice self-help color therapy is in morning or evening.

Color therapy can be done in lying down or sitting position.

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Pondicherry Journal of Nursing A. Colored body wraps:  The individual is wrapped in a cloth of the necessary Colorto treat their ailment.  Make yourself comfortable by lying down in white undergarments, nightdress or if you prefer, naked, and then cover yourself with the Color of your choice. (If feeling cold place a white towel or cotton blanket over yourself before placing the silk on top).  Another way of working with silk is to place a white towel/sheet over a cushion or the back of a chair, and place the Colored silk of your choice on top.  Sit quietly and breath slowly.  Imagine you are drawing the Color into your body on each 'in' breathe, allowing it to flood your whole being and releasing any tension within the body on the 'out' breathe.  Continue for 2 - 3 minutes.

B. Eating Colored foods:  By eating fruits and vegetables of a variety of different Colors, one can get the best all-around health benefits.  Each different Color fruit and vegetables contains unique health components that are essential to our health.

C. Drinking Colored water/Solarised Water:  This is a simple and cheap way of applying Color to the body.  Water is exposed to sunlight in a Colored container for at least an hour (maximum for 6-8 hours) it becomes irradiated and takes on some of the vibrational energy of that particular Color. This is called solarised water.  Simply drink (solarised water should always be sipped) this water at regular intervals throughout the day.  The water can be kept in a refrigerator and will last up to 5 days.

Vol 7, Issue2, May - August’14 D. Color Meditation: Hold attention to one Color that you are drawn to, and meditate on this Color.

Steps of Color Healing Meditation:  Sit comfortably with your eyes closed.  Visualize a large ball of radiant Golden light a few inches over your head. Visualize that ball of light slowly descending through your crown, filling your entire being with golden light.  Imagine yourself absorbing that light as it nourishes, cleanses and heals your whole being your Spirit and all of your bodies - dissolving all blocked and toxic energies.  Repeat this exercise, visualizing a ball of Red light. Continue through the entire spectrum like this, visualizing a ball of Orange light; Yellow light; Green light; Blue light; Indigo light; and Violet light. Go through the spectrum at whatever pace feels appropriate.

Benefits of Color meditation:  Meditation relaxes the body and quietens the mind.  Cleansing, balancing, and healing at all levels such as spiritual, Mental, Emotional and Physical.  Develops concentration and visualization abilities.

E. Color Visualization:  This therapy helps us to direct Color energy to the body using visualization. Colors can be visualized to instil a sense of well being.

F. Color Breathing:  It is a simplest form of Color meditation and visualization.  Color breathing exercises can be done in a „lying down‟ or „sitting‟ position.  Select the Color that best appeals to you and visualize it entering your body

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USE OF COLOR THERAPY IN MOOD DISORDERS For mania       

    

For depression In severe conditions:

Turquoise Colored water at morning, afternoon and evening.

White Colored water once a day.

Yellow Colored water before both meals.

Put sky-blue Colored light on head for 15 minutes daily.

Massage on back side of the head with sky-blue Colored sesame oil.

Light a blue Colored bulb in patient’s room.

Dress the patient in blue Colored silk clothes.

  

Apple Colored water at morning and at night after meals.

Sky-blue Colored water before lunch.

Yellow Colored water after dinner.

If the condition is not severe:  

PRECAUTIONS Always take this therapy under expertise guidance.

Never use this therapy instead of conventional care for serious problem.

In case of epilepsy, take care while looking at flashing light.

Look at an object illuminated by colored light instead of looking directly at light.

If someone is taking any drug simultaneously, make sure that there is no side effect due to exposure to bright light.

Blue Coloredwater at morning and evening before meals.

Orange Colored water after lunch and dinner.

&Rosenthal, N. E. (1991). Treatment of seasonal affective disorder with green light and red light. American Journal of Psychiatry, 148, 509-511.

Stone, N. J., & English, A. J. (1998). Task type, posters, and workspace color on mood, satisfaction, and performance. Journal of Environmental Psychology, 18, 175-185.

Wileman, S. M., Andrew, J. E., Howie, F. L., Cameron, I. M., McCormack, K., &Naji, S. A. (2001). Light therapy for seasonal affective disorder in primary care. The British Journal of Psychiatry, 178, 311-316.

REFERENCES Barber, Christopher F. (1999). The use of music and colour theory as a behavior modifier. British Journal of Nursing, 8, 443448.

Wilkins, Baker, Amin, Smith, Bradford, Zaiwalla, Besag, Binnie, & Fish.

(1999). Treatment of photosensitive epilepsy using coloured glasses. Seizure, 8, 444 - 449.

Oren, D. A., Brainard, G. C., Johnston, S. H., Joseph-Vanderpool, J. R., Sorek, E.,

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THE FACTORS INFLUENCING BOTTLE FEEDING AMONG THE MOTHERS OF THE CHILDREN AGED BETWEEN 6 MONTHS AND 2 YEARS *Ms. Soniya Chacko & **Prof. P. Chitra children aged between 6 months and 2 years.

3.To find the association between the practice of bottle feeding, among the mothers of the children aged between 6 months and 2 years, and the selected demographic variables.

Research methodology A non-experimental quantitative research approach was used for the study. The research design selected for the present study was descriptive study. The sample was selected using the convenience sampling method. A sample, of 100 mothers, was selected from the Pediatric Medical and Surgical Out Patient Departments.

The Mothers of the children, aged between 6 months and 2 years, were included in the study and the mothers who have critically- ill children were excluded.

Tool for the study The data collection tool was developed by the investigators. A semi-structured questionnaire was used to identify the feeding practices among the mothers.

A cafeteria questionnaire was used to find the factors influencing bottle feeding practice which contains 6 factors and 5 items under each factor.

The factors, considered, were biological, psychological, educational, socio-economic, environmental and cultural.

Data analysis The data were analyzed using descriptive and inferential statistics.

Results a) Identifying the feeding practices among the mothers of the children aged between 6

Introduction The feeding bottle, the tiny plastic container that has been viewed as a readymade solution, to most of the mothers, to soothe a wailing baby is seen, alarmingly, as an enemy.

The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 prohibits the promotion of feeding bottles. Medical articles by the Indian Academy of Paediatrics (IAP) have linked inappropriate methods of feeding infants to mortality and morbidity of infants. The risk of infection is high as the micro-organisms may stick to the neck and teat of the bottle and get transmitted to the infant, if the bottle is reused.

Bottle feeding is one of the major causes of diarrhea among the infants. The rate of bottlefeeding practice keeps on increasing among the mothers with infants older than four months due to early weaning. The major reasons for bottlefeeding practice include insufficient breast milk, the need to go back to work and the use of contraceptive pills.

Statement of the problem “A study on the factors influencing bottle feeding among the mothers of the children aged between 6 months and 2 years in selected pediatric departments at AIMS, Kochi.”

Objectives of the study 1.To identify the feeding practices among the mothers of children aged between 6 months and 2 years.

2.To find the factors influencing the practice of bottle feeding among the mothers of the

*II year M.Sc. Nursing & **Professor. Child Health Nursing,AIMS, Kerala.pchitraaims@amrita.edu 32

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months and 2 years.

The other factors influencing bottle feeding are recurrent hospitalization of the child with 36 (46%) mothers, the need to go for higher education with 17 (22) mothers and inevitable absence of the mothers, numbering 10 (13%).

There is a significant association between bottle feeding practice and the age of the mother, working nature of the mothers and the weight of the child.

Among the 79 subjects, 49 (62%) children have recurrent episodes of diarrhea, 41 (52%) have recurrent ear infections, most of the children are overweight, and 44 (100%) follow the practicing bottle feeding.

100 percentage

80

65

60 40 20 0

12

14

breast feeding only

bottle feeding only

9 breast feeding and bottle feeding

breast feeding and paladai feeding

b) Factors influencing bottle feeding practices in children 1. Biological factors (inadequate production of milk).

2. Psychological factors (breast milk does not fulfill all the requirements of the infants).

3. Educational factors (belief that if the bottle is cleansed properly, it will not cause any Disease).

4. Socio-economic factors (choosing bottle feeding for the need to go back to work).

5. Environmental factors (separation from the infants for a longer period of time cause difficulty to breast feed).

6. Cultural factors (mother/grandmothers decision to give breast milk only upto 3months).

Discussion Lukman, H et al. conducted a crosssectional analytical study on the factors influencing bottle-feeding practice among the infants at the Well-Child Clinic of Dr. Pirngadi Hospital, Medan. Among the 85 infants aged 0-3 months, 10 infants (11.7%) were exclusively bottle-fed, 35 (41.2%) bottle- and breast fed and 40 (47.1%), exclusively, were breast-fed.

Among the 85 infants aged 7-12 months, 28 (32.9%) were bottle-fed, 29 (34.2%) were breast and bottle-fed, and 28 (32.9%) were breast-fed.

The result of review shows the fact that 29 (34.2%) infants were breast and bottle-fed. But the present study findings identify 65(65%) mothers as practicing breast feeding along with bottle feeding which shows the fact that the practice of bottle feeding seems to be increasing in our society.

Dr. Abdul Kareem J Mohammad, et al. conducted a study in 3 Public Health Centers and Teaching Hospital in Baghdad city. The Mothers were interviewed to collect information on the practice of breast or bottle feeding and the

100 80

66

59

percentage

60 40

39

38

36 27

20 0

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causes of using bottle feeding.A total of2008 mothers were included, in this study, and 28 of them used bottle feeding which constituting 63.8%, a statistically significant value. The researchers found the causes, that lead to the increase in the percentage of bottle feeding ; namely inadequacy of breast milk with 72.4% subjects, underwent caesarian section in the case of 8.6%, on the physician‟s advice with 3.5%, personal decision with 2.8%, other causes with 1.9%, and the use of drugs in the case of 0.8% subjects.

Food Nutrition Bulletin. (2010) Jun;31(2):31433 Infant and young child feeding indicators and determinants of poor feeding practices in India: secondary data analysis of National Family Health Survey 2005-06.

Olympia Shilpa Gerald (2012). The Hindu, Health Policies& issues: Bottles, not the best way to feed your baby,TIRUCHI, August 10.

Jane Brotanek, (2000) Prolonged Bottle-Feeding Can Lead to Iron Deficiency in Toddlers, Pediatrics for Parents.

Conclusion The Indian Medical Association Society Act, 2003 prohibits the promotion of feeding bottles. But majority of the mothers use bottle feeding since they are not aware of the hazards of the bottle feeding. The hazards of bottle feeding needs to be studied thoroughly and, neglecting these will potentially affect the health of the babies. Nurses play a major role in educating the mothers about the adverse effects of bottle feeding. The researcher recommends the need for the mothers to get educated on the ill-effects of bottle feeding and be aware of the truth that the practice of bottle feeding can cause diseases to the children. This objective can be achieved through health education programs about the importance of breast feeding and the health professionals should educate the mothers about the disadvantages of bottle feeding and pay more attention in the promotion of breast feeding using the mass media as the strategy.

References Marilyn J Hockenberry (2006). Wong‟s Essentials of Pediatric Nursing, 7th edition, Elsevier Publishers, page no:205.

Hamdiya AS Al-Fadli, Layla Al-Jasem, Abdul Hameed A, Al-Jady, Gamal M Masoud(2006).

Factors Underlying Bottle-feeding Practice in Kuwait (2001),Kuwait Medical Journal, 38 (2): 118-121 Ojo M Agunbiade and Opeyemi V Ogunleye (2012).Constraints to exclusive breastfeeding practice among breastfeeding mothers in Southwest Nigeria: implications for scaling up International Breastfeeding Journal, 7:5 Mathews K, Maternal. infant-feeding decisions: reasons and influences.Canadian Journal Nursing Research.Summer;30(2):177-98 Breast feeding, April 2012.Available wikipedia.org/wiki/Breastfeeding

from

Diane M. Fraser, Margaret A. Cooper (2003).

Myles Textbook for Midwives, 14th edition. pp:752-753.

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EFFECT OF YOGA INTERVENTION ON HYPERTENSIVEPATIENTS WITH TYPE 2 DIABETES MELLITUS *Mrs.S. Shanthi & **Dr.Karaline Rajkumar many diabetic individuals.

Diabetic nephropathy, which occurs after 15 years of diabetes in one third of people with IDDM (type I diabetes) and 20% of those with NIDDM, is an important contributing factor to the development of hypertension in the diabetic individual. The high BP associated with diabetic nephropathy is usually characterized by sodium and fluid retention and increased peripheral vascular resistance.

Isolated systolic hypertension is considerably more common in diabetics, and supine hypertension with orthostatic hypotension is not uncommon in diabetic individuals with autonomic neuropathy. (http://hyper.ahajournals.org/).

Introduction: Diabetes mellitus and hypertension are interrelated diseases that strongly predispose an individual to atherosclerotic cardiovascular disease. An estimated 3 million Americans have both diabetes and hypertension. Hypertension is about twice as frequent in individuals with diabetes as in those without. Lifestyle and genetic factors are important factors contributing to both hypertension and diabetes mellitus. The prevalence of coexisting hypertension and diabetes appears to be increasing in industrialized nations because population and both hypertension and NIDDM incidence increases with age. Data obtained from death certificates show that hypertensive disease has been implicated in 4.4% of deaths coded to diabetes, and diabetes was involved in 10% of deaths coded to hypertensive disease.

Indeed, an estimated 35% to 75% of diabetic cardiovascular and renal complications can be attributed to hypertension. Hypertension also contributes to diabetic retinopathy, which is the leading cause of newly diagnosed blindness in the United States. For all these reasons, hypertension and diabetes should be recognized and treated early and aggressively.

Essential hypertension accounts for the majority of hypertension in individuals with diabetes, particularly those with NIDDM (type II diabetes), who constitute more than 90% of people with a dual diagnosis of diabetes and hypertension. Hypertension often likely contribute to the development of nephropathy in

Yoga is an ancient life style method to control and mastery the mind, through different yogic practices like Asanas, Pranayama and Meditation at physical, mental, emotional, intellectual and spiritual level. Few studies have proved the effect of yoga as an adjuvant in treatment of hypertension in diabetics, Yoga effectively switches off the response and brings down the adrenaline level down, thus reducing blood pressure among diabetic patients. (Sujit Chandra Treye 2002).

Statement of the problem A study to assess the effectiveness of yogasanas in reducing blood pressure among hypertensive patients with type -2 diabetes mellitus in a selected hospital at Chidambaram.

*Lecturer &**Professor, RMCON, A.U, Chindambaram.

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Objectives of the study  To assess the level of blood pressure before and after yoga training programme for hypertensive patients with type-2 diabetes mellitus  To assess the effectiveness of yoga on blood pressure level among hypertensive patients with type-2 diabetes mellitus in experimental and control group  To find out the association between posttest blood pressure level among hypertensive patients with type-2 diabetes mellitus with selected demographic variables such as age, sex, occupation, education, duration of illness and treatment in experimental group.

Methodology: True experimental design was adopted for this study. Systematic random sampling technique was used to select 50 subjects on type-2 diabetes mellitus with hypertension. 25 subjects assigned to control group and 25 subjects were assigned to experimental group at diabetic outpatient department in Raja Muthiah Medical College and Hospital, Chidambaram.

The pretest was conducted for both the groups to assess the demographic data and blood pressure (systolic and diastolic) was checked.

After the pretest yoga training such as Suryanamaskar, Halasana, Padmasana, Parvatasana, Vajrasana, Bhujangasana, Salabhasana, Makrasana, UttanapadasanaShavasana, Pranayama and Meditation were given for 45 minutes per day, for five days in a week to the experimental group, no yoga training but counseling was given to control group. The posttest systolic and diastolic blood pressure, level was checked on 3rd month.

Comparison of the Mean Systolic Blood Pressure between Control Group and Experimental Group 154 152 150 148 146 144 142

152.6 150.3

151.2 Control Group 146.2 Experimental Group

Pre Test

Post Test

Comparison of the Mean Diastolic Blood Pressure between Control Group and Experimental Group 92

90.489.9

90.2

90 Control group

88 84.6

86

Experimental Group

84 82 80 Pre test

Post test

Results and findings: Demographic profile of the samples:  Regarding age, majority of the subjects (36%) were belongs to 45-50 years in both the experimental and control group. 59.1% were male and 40.9% were female in the experimental group, 60.6% were male and 39.4 were female in the control group  In the experimental group 45% had high school level education and in the control group 48% had graduate level education.  As for the duration of illness 69.6% of the subjects were between 1-5 yrs in the experimental group and 63.4% were in the

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









Vol 7, Issue2, May - August’14  Paired„t‟ test shows that there was no significant difference in pretest and posttest blood pressure level in control group. But in the experimental group there is a significant difference in the pretest and posttest level of blood pressure.  There was no significant association found in posttest measures of blood pressure level and selected demographic variables.

control group. Regarding clinical problem 48.9% had giddiness, 21.1% had sweating, 30% had headache in the experimental group.

Regarding treatment 54.6% were taking treatment in the experimental group and 49.9% were in the control group. With regard to the history of hypertension with diabetes mellitus among family members 80.2% and 78.6% had positive history of hypertension with diabetes mellitus in the experimental group and control group respectively..

The mean pretest measures of systolic blood pressure were 150.3 and 152.6 in control and experimental group. The„t‟ test for the mean difference of systolic blood pressure was 2.369 at df (28) which was not significant.

The mean pretest diastolic blood pressure of control group was 90.4 and 89.9 mm of Hg in experimental group. The„t‟ test for the mean difference of diastolic blood pressure was 1.744 at df (28) which was not significant.

The mean posttest systolic blood pressure was 150.2mm of Hg and 146.2 mm of Hg in control and experimental group respectively.

The „t‟ test for the mean difference between systolic blood pressure of control and experimental group was 19.48 at df (28) which was significant at 0.001 level The mean posttest diastolic blood pressure in control and experimental group was 90.2 and 84.6 mm of Hg respectively. The „t‟ test value for the mean difference between the diastolic blood pressure of control and experimental was 14.42 at df (28) which was significant at 0.001 level.

Conclusion: Hypertension is a dangerous condition that does not have a cure, but it can be kept in check by taking medication regularly and by eating healthy meals and regular practice of yoga and meditation. Yoga training programme is effective and feasible, simple and economical therapeutic modality any one can do without exertion. The study findings provide the statistical evidence which clearly indicates that yoga training programme is one of the best alternatives and complementary therapies which may be used to lower blood pressure level among diabetic patients.

References: Karunamoorthi S, Seshasayee T (2013). Yoga for management of Hypertension among type-2 diabetes mellitus, online International interdisciplinary Research Journal, 3(3).

Krishna G, Seshari “Life style intervention to prevent diabetes. The Asian Journal of Diabetology Special issue Vol:9. http://en.wikipedia.org http://hyper.ahajournals.org/

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A STUDY TO ASSESS EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF DIABETIC PATIENTS REGARDING DIABETES COMPLICATIONS AND PREVENTION AT SELECTED HOSPITAL, TUMKUR. *Prof. K. Ramu &**Dr. N.V. Muninarayanappa when compared to Europeans. Life style modifications such as weight control, increase physical exercise & smoking cessation are also potentiality beneficial in preventing diabetes mellitus.

A research study by Harney etal suggested that some common risk factors like greater duration of diabetes, hypertension, poor metabolic control, smoking, obesity & hyperlipidemia were most prone to develop diabetic complications. Majority of subjects did not have their diabetes controlled. Therefore strategies to enhance & promote self efficacy & self management behaviors for patients are essential components of diabetes education programs. Further more behavior counseling & skill building interventions are critical for patients to become confident & be able to manage their diabetes.

In a research study conducted at B.M. Patil Medical Hospital, Bijapur, Karnataka, The researchers revealed that patientâ€&#x;s knowledge about diabetes & its complications is poor. The study recommended that awareness & education programmes are required to empower diabetic patients & also to increase their quality of life.

INTRODUCTION: According to recent World Health Organization report, India has the largest number of diabetic patients in the world. The rising trend in the prevalence of type 2 diabetes has also been reported in a series of epidemiological studies.

It has been estimated that the global burden of type 2 diabetes for 2010 would be 285 million people which is projected to increase to 438 million in 2030, a 65% increase. Similarly, for India this increase estimated to be 58% from 51 million people in 2010 to 87 million in 2030 (Snehalatha & Ramachandran 2009). The impacts of type 2 diabetes are considerable as a lifelong disease, it increases morbidity & mortality, decrease the quality of life. (Hoskote & Joshi 2008). At the same time the disease & its complications cause a heavy economic burden for diabetic patients themselves, their families & society.

The burden of diabetes is to a large extent the consequence of macrovascular (Coronary artery disease, peripheral vascular disease & atherosclerosis) and microvascular (like retinopathy, neuropathy & nephropathy) complications of diabetes. The complications of diabetes mellitus are major causes of hospital admissions. Asian patients had more evidence of macro & micro vascular complications at diagnosis of diabetes. Several studies showed that the prevalence of microvascular & macro vascular complications were more in Asians

NEED FOR STUDY: The incidence of diabetes is rising throughout the world. Adequate knowledge of diabetes is a key components of diabetic care.

Studies has show that increasing patients knowledge regarding diabetes & its

*Principal, Shridevi Institute of Nursing, Tumkur, Karnataka & **Principal &DeanSchool of Nursing Science & Research, Sharada University, Greater Noida Uttar Pradesh.

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complications has significant benefits with regard to patients compliance to treatment and to decreasing complications associated disease.

Many patients in Govt. District hospital, Tumkur are not aware of diabetes & its effects on health.

RESEARCH METHODOLOGY: Research Approach: An evaluative approach to assess the effectiveness of STP among diabetic patients in order to accomplish the objectives of study.

Research Design:One group pretest posttest experimental design.

Setting of the study: The study was conducted at Govt. District Hospital, inpatient & outpatient wards, Tumkur.

Population: Diabetic patients who were admitted to Govt. District Hospital, Tumkur.

Sample & Sample size: The sample selected for this study comprised of diabetic patients who were attending OPD &admitted inpatient wards.

Sample Size : 50 Diabetic Patients.

Sample Technique: A Non-probability purposive sampling technique was used.

STATEMENT OF THE PROBLEM: A study to assess effectiveness of structured teaching programme on knowledge of diabetic patients regarding diabetes complications and prevention at selected hospital, Tumkur.

OBJECTIVES: 1. To determine the level of knowledge of diabetic patients regarding diabetes complications & prevention.

2. To administer structured teaching programme on diabetes complications & prevention among diabetic patients.

3. To determine the effectiveness of structured teaching programme by comparing pre & post test scores.

4. To determine the association between pre-test knowledge score with selected demographic variables.

Criteria for sample selection inclusion criteria: 1. Type I& Type II diabetic patients who were willing to participate in the study.

2. Type I& Type II diabetic patients who were attending OPD &admitted Inpatient ward.

3. Those who can understand kannada & English.

Exclusion criteria: 1. Diabetic patients who were not willing to participate in the study.

RESEARCH HYPOTHESES: H1: There is a significant difference between pre and post knowledge scores of diabetic patients regarding diabetes complications & prevention.

Data Collection Technique: A structured interview schedule was used for assessing the knowledge of diabetic patients regarding diabetes complications & prevention.

Description of the tool: The structured questionnaire consisted of two (2) sections.

1.Section I: It consists of two parts.

H2:Thereis a significant association between pretest knowledge scores with selected demographic variables.

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a. Part I : It consisted of 10 items on demographic data such age, gender, education status, occupation, family income, religion, residential area, food habits, personal habits, duration of diabetes. b. Part II: It consisted of 5 items on clinical proforma of diabetes patients.

2. Section II: It consists of 40 Questionnaires related to knowledge on diabetes mellitus and diabetes complication and its prevention.

Income: It is observed that 20% of diabetic patients belongs to below 2000, 40% belongs to 2000- 4000, 20% belongs 4000 - 6000 & 20% belongs to above 6000.

Residential Area: It is observed that 30% of diabetic patients belongs to urban area & 70% belongs to rural area.

Food Habits: It is observed that majority of the diabetic patients (72%) are non-vegetarian & 28% belongs to vegetarian.

Personal Habits: It is observed that 30% of diabetic patients had habit of smoking, 30% had habit of alcohol, 20% had habits of tobacco chewing & 20% had no habits.

Duration of illness: it is observed that 6% diabetic patients belongs to below 2 years of illness, 30% of diabetic patients are having diabetes from 02 to 5 years, 50% belongs to 6-10 years 14% belongs to above 10 years.

PROCEDURE OF DATA COLLECTION: Prior permission was obtained from hospital authority and the purpose of the study was explained to subjects & informed consent was taken before starting the study.

Results: Age: It is observed that 20% of diabetic patients were in the age group of 40-49 years, 40% were in the age group of 50- 59, 20 % were in the age group of 60-69 & 20% were in the age group of 70-79 years.

Gender: It is observed that 72 % (36) were males & 28% (14) were female diabetic patients.

Education Status: Majority of diabetic patients were illiterate (60%), 30% had primary education & 6% had completed secondary level of education, 4% had completed graduation.

Occupation: It is observed that 20% diabetic patients belongs to Govt, 30% belongs to private, 30% belongs to business & 20% of belongs to no job/coolie.

ReligionItis observedthat46%diabetic patients are Hindus, 40%diabetic patientsare Muslims, 10% diabetic patients are Christians and 4% diabetic patients belong of other casts.

Duration of illness 14% 6% 50%

30%

<2years 2-5 years 6-10years >10 years

Fig:2Distributionofdiabetic patients according to duration of illness Major Findings: The Data reveals that 40% of diabetic subjects belong to age group of 50-59 years. 72% were males and 60% were illiterates. As per occupation is concerned 30% of subjects had to private job, 30% were doing business.

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Regarding income of the subjects majority 40% belong to income group of Rs 2000-4000 per month. Regarding religion 46% were Hindus.

70% were residing at rural areas and 72% were non vegetarians.

Related to personal habits of diabetic subjects, 30% were having habit of smoking and 30% were having habit of consuming alcohol.

Regarding duration of illness majority (60%) subjects were suffering from diabetes since 6-10 years

Conclusion: Theresults of the study concluded that many diabetic patients have poor knowledge regarding their diabetes complications & prevention & more concerned efforts would need to be made by nurses to help the diabetic patients to find out the causes of hypertension, poor frequently monitor this risk factors & give proper treatment so that the nurse can prevent the diabetic complications.

Discussion: The present study showed that Pretest knowledge among diabetic patients regarding diabetes complications & prevention was inadequate in 80% of subjects and moderate in 20% subjects. Posttest knowledge score regarding diabetes complications & prevention was moderate in 74% and adequate in 20% of subjects.

This showed that gain in knowledge among diabetic patients regarding complications & prevention of diabetes was moderate after STP. The overall mean is 13.16; standard deviation is 2.41 & mean percentage is 32.9 in pretest. whereas in post test, overall mean is 28.48, SD is 1.4 and mean percentage is 71.2.

Results of socio demographic characteristics & knowledge of diabetic patients regarding diabetes complication & prevention shows that, educational status, residential area, food habits, personal habits are significant. The other variables such as age, gender, occupations, monthly income, religion, duration of illness are not significant. The administration of STP can improve knowledge of diabetic patients regarding diabetes complications & prevention

World Health Organization study group: Prevalence of small & large vessels disease in diabetic patients. World health organization multinational study of vascular disease in diabetes.

Diabetologia.1985:28:615-40

REFERENCE:

Ramachandran. A., Snehalatha. C., Satyavani.

K., Latha. E., prevalence of vascular complications and their risk factors in type 2 diabetes. Journal of Assoc physicians India 1997:47:1152-6 Alkh Waldeh OA, A I- Hassan, self efficacy, self management& glycemic control in adults with type 2 diabetes, journal of diabetes & its complications. 2007,26, 10-16.

Vijaya Sorganvi, S.S. Devarmani, M. Angadi, RekhaUdgiri, (2013) Knowledge & its complications of diabetes among the known diabetic patients- A hospital based study, International Journal of Clinical Research 5 (22)

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EFFECTIVENESS OF REMINISCENCE THERAPY AMONG OLD AGE PEOPLE *Mr. M. Dineshkumar “Let’s add live to their years.” hospice convent old age home at laporte street puducherry”

INTRODUCTION The complete life, the perfect pattern, include old age as well as youth and maturity.

The beauty of the morning and the radiance of noon are good, but it would be a very silly person who drew the curtains and turned on the light in order to shut out the tranquillity of the evening. Old age has its pleasure, which though different, is not less than the pleasure of youth.

OBJECTIVE OF THE STUDY:  To assess the level of depression among old age people in selected old age home  To evaluate the effectiveness of reminiscence therapy on depression among old age people.  To associate the level of depression with selected demographic variables.

A man‟s age is something impressive, it sums up life: maturity reached slowly against many obstacles, illnesses cured, grief‟s and despairs overcome, and unconscious risks taken; maturity formed through so many desires, hopes, regrets, forgotten things, loves. A man‟s represents a fine cargo experiences and memories.

OPERATIONAL DEFINITION: 1) Effectiveness: Determining the extent to which the guided Imagery has achieved the desired effect in reducing Depression.

2) Depression: It is a mental state characterized by excessive sadness, activity is also slow and retarded, and behaviour is pessimistic despairing beliefs, disturbed sleep and appetite 3) Reminiscence: It refers to the thinking about or relating of past experience, it is used as a nursing intervention to enhance life .In this study reflection on elderly issues related to the events in childhood, work, marriage, social accomplishment and most memorable 10moments were done. Each day one area was focused using the probe specified in the reminiscence therapy guide for elderly 4) Reminiscence therapy: Reminiscence therapy is defined as conditional processes in which the practitioner ask the subject to

Old age is viewed as a stage, in the life span of an individual and also as a segment of a population in society. The public considers 50yrs and above as old age where as substantial proportion of persons who are in their 60‟s do not look upon themselves as old. Psychologists consider age 60 as the demarcating line between middle and old age, whereas socialists often set the boundary of old age at 50 years.

STATEMENT OF THE PROBLEM “An Experimental study to evaluate the effectiveness of reminiscence therapy on depression among the old people in cluny

*Lecturer, Indrani College of Nursing, SVMC, Pondicherry. sutharam@gmail.com 42

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reconstruct their life story examine both positive and negative experience, by using music and photographs or images to elicit a positive response.

5) Old age home: An old age home refers to structured building where in persons aged 60 years and above stay on payment.

HO2: There is no significant association between levels of depression with selected demographic variables.

DELIMITATION:The study was limited to.  Old age people in the selected old age home only.  Reminiscence related to activities like childhood days, work, marriage, social accomplishment, most memorable moment only.  Samples selected random method.

PROJECTED OUTCOMES: 

The reminiscence therapy technique can be benefited as a method in reducing the depressive symptoms and it helps to reduce the level of depression among old age people.



The study will enable to develop optimism in depressive patients



The findings of the study of effectiveness of reminiscence therapy will help to implement in the educational plan for mental health



The findings the study will help the nurse to plan appropriate measure for reducing the depression.



The study will help to reduce the use of psychopharmacological management



The findings of the study will help the nurse to understand the importance of reminiscence therapy in reducing the depression among old age people.

RESEARCH METHODOLOGY: Research approach: The research design selected for the study was one group pretest posttest design (O1 – X - O2). In this design the investigator introduces base measures before and after treatment. This design is widely used in educational research.

In this present study the base measure was level of depression among old age people and the treatment was a reminiscence therapy to reduce the level of depression.

The design adopted for the present study can be represented as O1 = assessment of level of depression before reminiscence therapy.

X= administration of reminiscence therapy.

HYPOTHESES: H0: There is no significant difference between level of depression among old age people before and after reminiscence therapy.

O2 = assessment of level of depression after reminiscence therapy Research design: Quasi experimental research design

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Sampling technique: Simple random sampling technique (lottery method) was applied for this study

Depression scale, first developed by J.A Yesavage in 1982, the scale consist of 30 questions are answered "yes" or "no", this simplicity enables the scale to be used with ill or moderately cognitively impaired individuals.

The scale is commonly used as a routine part of a comprehensive geriatric assessment. One point is assigned to each answer and the cumulative score is rated on a scoring grid. A diagnosis of clinical depression should not be based on Geriatric Depression Scale results alone.

Although the test has wellestablished reliability and validity evaluated against other diagnostic criteria, responses should be considered along with results from a comprehensive diagnostic work-up.

CRITERIA FOR SELECTION OF SAMPLING Inclusion criteria:  Old age people above 65 years of age.  Includes both male and female old age people Exclusion criteria:  Those who are all having severe physical and co morbid mental illness

SCORING TECHNIQUE: Based on the score of Geriatric depression scale, the patients are categorized in to the following types the grid sets a range of 0-9 as "normal", 10-19 as "mildly depressed", and 2030 as "severely depressed".  0-9 indicates normal  10-19 indicates mildly depressed  20-30 indicates severely depressed

DATA COLLECTION INSTRUMENTS It consists of section-A and Section-B Section A Deals with demographic variables which includes Sex, Age, Educational Qualification, religion, previous occupation, pension, marital status, areas of residence, Duration of stay in old age home Section B Deals with assessment the level of depression among old age people using Geriatric depression scale, The Geriatric

Data collection process Reminiscence intervention Reminiscence is an independent nursing therapy used by variety of health and social care professionals, involving re-collection of previous events and feelings which aim to facilitate pleasure, quality of life or adaptation of new circumstances through the process of reminiscence therapy. The reminiscence intervention consists of issues related to childhood days; work, marriage, social accomplishment, and most memorable

Independent variables In the present study the independent variable is reminiscence therapy used for to reduce the level of depression.

Dependent variables Level of depression among old age people who are admitted in hospice convent old age home at Puducherry.

Sample size: 30 samples were taken who satisfied the inclusion criteria.

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moments. Pre-test on level of depression is done by geriatric depression scale. The clients were encouraged to reminiscence on the specific areas listed in the reminiscence guides.

Discussion on specific issues was with the people, five sessions on 5 issues will be conducted separately for each person as specified in the reminiscence guide. Each day one issue was reminisced by the old age people.

SESSIONS

reminiscence therapy was essential for all the old age people, The figure point out the effectiveness of reminiscence therapy in that pretest mean level of depression were 19.06 and the standard deviation were 3.947.

Comparatively the posttest mean values were 9.06 and the standard deviations were 2.82, finally the mean differences were calculated the value was 2.867. from that mean difference the „t‟ value was obtained that was 10.267

SECTIONS REFERENCES:

I

Childhood days

II

Work

III

Marriage

IV

Social accomplishment

Dr. Mrs. K. Lalitha (2007), Mental Health and Psychiatric Nursing, V.M.G House publications.

V

Most memorable moment.

Gail. W. stuart, Michile T. Lara, principles and

Cary.s. Kart et.al, (1985), Aging and Health, Ohio, Addision Wesley publishing companyPp-1-330.

th

practice of Psychiatric Nursing, 7 edition, Mosby publications. Pp-866.

RESULTS The present study indicated that the posttest mean value (9.66) of depression was lower than the pretest mean value (19.06) of depression. The obtained „t‟ value was significant at (10.264). Hence the stated hypothesis H0:1 was rejected.

Since the reminiscence therapy is highly effective among the old age people I felt that

AnupamHazara, (2009) Status of elderly, journal of Social welfare, Vol.56,No.7 Pp: 5-13.

Baines. S, Saxby (1987), The British journal of Psychiatry. vol. 151 Pp: 222-231.

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A DESCRIPTIVE STUDY TO ASSESS THE PRACTICE OF BREASTFEEDING AMONG PRIMI MOTHERS AT SELECTED HOSPITALS, PUDUCHERRY *Mrs. V. Revathy INTRODUCTION “There is no substitute for mother’s love, there is no substitute for mothers milk.”William Gouge The birth of the baby is an important event in the family. It is therefore important for the mothers to have a healthy baby. Breast milk is the best food for the babies as breast fed babies are healthier than formula fed babies Breast milk is a species specific complete food. It is easily digested and well absorbed by the newborn. Protection against infection and facilitate mother infant bonding and promotes better brain growth. For the mother breast feeding helps in involution of uterus, delays pregnancy and lower risk of breast and ovarian cancer. In countries with high infant mortality rate, artificially fed infants are 14 times more likely to die of diarrhea than are breast fed and 4 times more likely to die of pneumonia. Artificially fed infants are 5 times likelyto require hospitalization for treatment of infectionsglobally, less than 40% of infants under six months of age are exclusively breastfed.

STATEMENT OF THE PROBLEM: A descriptive study to assess the practice of breastfeeding among primi mothers at selected hospitals, Puducherry

2) To determine the association between the practice of breastfeeding among primi mothers with selected demographic variables

OBJECTIVES 1) To assess the practice of breastfeeding among primi mothers

Sampling technique In this study Purposive sampling technique was used

ASSUMPTIONS  Primi mothers are not aware of proper technique of breast feeding  primi mothers will vary in breastfeeding practices according to socio- cultural factors MATERIALS AND METHODS Research approach A descriptive approach was considered most suitable for the study, as the aim was to assess the practice of breast feeding among primipara mothers.

Research design Non experimental descriptive survey research design Settings of the study The study was conducted in post natal ward at selected hospitals, Puducherry Population Post natal mothers

*M.Sc., Nursing II year, Vinayaka Missions College of Nursing, Puducherry.

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Samples & Sample size In this study 30 Primipara mothers were selected who fulfil the inclusion criteria.

CRITERIA SAMPLE

FOR

SELECTION

OF

a) Inclusion criteria:  Primipara mothers who can understand either English or tamil language.  Primipara mothers who are willing to participate for study b) Exclusion criteria:  mothers who have undergone caesarean section  mothers who are not available at the time of study INSTRUMENTS USED FOR THE STUDY Based on the objectives of the study observational checklist was developed to assess the practice regarding technique of breastfeeding among primi mothers.

Description and development of the tool In this study the data collection instrument consists of two sections. They are Section A: Itconsists of demographic variables which includes age, educational status, type of family, religion, area of residence, occupation, family monthly income and source of information on breastfeeding.

SectionB: Assessment of practice regarding technique of breastfeeding. This section was observed using a checklist consists of 15 questions to assess the practice of primi mothers regarding technique of breastfeeding. Each question has „yes” or “no” response.For each correct response score 1 was given and for each incorrect response score 0 was given.

MAJOR STUDY FINDINGS The Major findings are summarized as follows i) Description of demographic variables  Higher percentage 14(47%) of primi mothers regarding breastfeeding wasin the age group of 25-30 years.  Majority of primi mothers (30%) had both primary and secondary education.  Majority of primi mothers 18 (60%) belongs to nuclear family.  19(73%) of the mothers belongs to Hindu,4(14%) of the mothers belongs toChristian and 7(23%) of the mothers belongs to Muslim.  Majority of primi mothers 21 (70%) were from rural and 9(30%) were from urban community respectively.  Most of the primi mothers were homemakers15(50%).  Monthly income of majority of primi mothers 14(47%) were below Rs.5,000/ Half of the primi mothers 15(50%) had no previous informationon breast feeding.

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ii. Practice of breast feeding  11(37%) of primi mothers had done appropriate level of breast feeding and19 (63%) of primi mothers had done inappropriate level of breast feeding.

 The mean and standard deviation were 6 and 1.95

PERCENGAGE

100 50

63%

37%

0 Appropriate

Inappropriate

LEVEL OF ADEQUACY Bar diagram on percentage distribution of level of adequacy of breast feeding among Primi para mothers

iii) Association between practice of breast feeding and selected demographic variables  The study shows that there was statistically significant association between the practice of breastfeeding among primi mothers with selected demographic variables such as age, educational status, type of family, religion, area of residence, occupation, family monthly income a n d t h e r e w a s n o a s s o c i a t i o n f o r previous source of information.

CONCLUSION: In this study,majority of primi mothers follow inappropriate level of breastfeeding practices.

Statistically significant association was found between the practice of breastfeeding among primi mothers with selected demographic variables

such as age, educational status, type of family, religion, area of residence, occupation, family monthly income a n d there was no association for previous source of information.

It indicates that the practice of breastfeeding technique have to be improved.To reinforce their practice,adequate health education and health awareness programmes will be more effective among primipara mothers.

BIBLIOGRAPHY: Achar S. (2000). Text book of Pediatric. 6th edition, Orient Long Man: Chennai.

BT Basavanthappa(2006).Midwifery and Reproductive health Nursing, New Delhi, Jaypee brothers.

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Pondicherry Journal of Nursing Ministry of Health and Family welfare Government of India, Basic newborn care and Resuscitation program training manual Denise Polit, Cheryl Beck, (2006).Essentials of nursing research methods, appraisal

Vol 7, Issue2, May - August’14 and utilization. 6thedt, London: Lippincott Williams and Wilkins.

Terri Kyle, (2008).Essentials of pediatric nursing. 4thedt, New York: Wolters Kluwer.

CASE SCENARIO KEY POINTS to right side to rule out Ventricular Fibrillation

Case scenario 1 Key Points:  Identify the normal and abnormal ECG  Ask for the complaints  Check the vitals for every 15 mts  Follow the physician orders  Continuous cardiac monitoring  Send routine blood investigations  Assess for ST elevation  Monitor 12 leads ECG check for ECG changes  Presence of ST changes indicates MI ,other changes indicates ACS  Do cardiac enzymes investigation to rule out MI  If there is no ST changes with II and III Lead change the III and IV lead

Case scenario 2Key points:  Checking of distal pulses  Arterial line flushing  Changing of AVP dressing  Assess for complication  Know the normal and abnormal \ABP values Case scenario 3 Key points  

Monitoring CVP Faulty practice

Case scenario 4 Key points  Placement of Probe  Position of the Finger

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EFFECTIVENESS OF VIDEO ASSISTED TEACHING MODULE ON KNOWLEDGE REGARDING FIRST AID MEASURES AMONG CONSTRUCTION WORKERS IN SELECTED CONSTRUCTION SITES, PUDUCHERRY. *Mrs. P. Hemavathi bodies in the eyes, wounds, head injury and crush injury.

Construction workers: Persons who are all involved in building construction work such as Mason, Electrician, Carpenters and Plumbers.

Video assisted teaching module: It refers to a systematically organized Compact Disc (CD) prepared by the investigator on first aid among construction workers it includes meaning, principles of first aid, first aid kit, responsibility of the first aider, various first aid measure such as controlling bleeding, fracture management etc.

METHODOLOGY Research design and approach: A quasiexperimental design Population & Setting : construction workers involved in construction work at Pondicherry.

Sample size & Sampling Technique: 103 & convenient sampling technique

INTRODUCTION Accidents are the leading cause of death among persons from 1 year old to 38 years old.

Accidents in construction sites are about three times more than that in manufacturing industries. Fifty percentage of accidents caused by fall of persons from height. The growing population and expanding health needs have not been balanced by a proportional increase in numbers of doctors, nurses, and allied health workers. It is not enough to say, "Call the doctor"; a doctor may not be available to come to the scene of the emergency. First aid training is of value in both preventing and treating sudden illness or accidental injury.

Objectives 1. To assess the knowledge of construction workers regarding first aid measures before implementation of video assisted teaching module 2. To find out the effectiveness of video assisted teaching module on first aid measures among construction workers.

3. To find out the association between pretest knowledge scores with their demographic variables.

Operational definition First aid measures: It is a temporary and immediate treatment given to a injured construction workers before definitive medical treatment. It includes first aid measures for fracture, fainting, sprain, muscles strain, electrical shock, heat stroke, bleeding, foreign

The tools used for this study are  Structured interview schedule consists of two parts Part – A: It consists of demographic characteristics of sample such as age, sex, education, religion, marital status, family monthly income, nature of work, year of experience and previous source of information.

Part- B: It consists of 38 items regarding first aid measures. Each item has four options with one most appropriate answer.

*Lecturer, College of Nursing, Pondicherry Institute of Medical Sciences, Puducherry.

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Vol 7, Issue2, May - August’14 Time period was approximately 30 minutes for each presentation. After 7 days of implementation of the video assisted teaching module posttest was conducted by using the same tool for the same participants.

FINDINGS AND DISCUSSIONS  Majority of the subjects were males 79 (76.69%) and 41 (39.82%) of them were in the age group of 15 - 25 years. Regard to educational status, 42 (40.8%) of them had primary school education and 12 (11.7%) of them had higher secondary education.  Out of 103 construction workers majority 56 (54.37%) of them were Mason, 22 (21.36%) were Carpenter, 18 (17.4%) were Electrician and only 7 (6.8%) were Plumber.

percentage of construction workers

Scoring procedure The maximum score for the correct response to each items was “one” and wrong response “zero”. The level of knowledge categorized based on the percentage of score obtained.

Methods of data collection Samples were selected from 5 different construction sites by using convenient sampling method based on inclusion criteria and procedure was explained to them in detail.

Pretest data was collected for first three days of data collection. Average time spent for each interview was 15-20 minutes. Immediately after pretest, video assisted teaching module presented and also informed about the posttest.

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

91.3% Pretest 58.2%

posttest 38.9%

2.9%

0%

very Poor

1.9%

0% Poor

Average

0% Good

6.8% 0% Execellent

Level of knowledge

reveals that during pretest the subjects had poor knowledge on first aid measures. During posttest the mean score was 29.4 ± 2.65 which is 77.3% of the total score depicting difference of 37.9% increase in mean percentage of scorerevealing the effectiveness of video assisted teaching module.Area wise highest posttest mean percentage (90.6%) was obtained for thearea “fracture” and lowest mean percentage (66.9%) was for “electrical injury”.

Fig:1 Distribution of construction workers according to their level of knowledge During pretest out of 103 samples, 60 (58.2 %) had poor knowledge, 40 (38.9%) of them had average knowledge and only 3 (2.9%) had very poor knowledge regarding first aid. After video assisted teaching module on first aid, majority of the subjects 94 (91.3%) had good knowledge and only 2 (1.9%) of them had average knowledge.Overall mean score was (14.98 ± 4.14) which is 39.4% of the total mean score

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50 45 40 35 30 25 20 15 10 5 0

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Pre test Post test

43.68% 36.89%

25.24%

9.7%

3

6

9

12

14.56%

3.88% 1.94%

15

Mean =29.3 Medain = 30

20.38%

0 36

22.33% 18.44%

Mean & Median=15

Percentage of construction workers

Pondicherry Journal of Nursing

0.97%

1.94%

18

21

Knowledge scores

Line graph shows that during pretest mean and median were similar values 15 whereas, during posttest it was 29.3 and 30, respectively revealing the difference of approximately 15 scores showing effectiveness of video assisted teaching module.

Highly significant difference found between the pretest and posttest knowledge score (P<0.01) but no significant association was found between the pretest knowledge score when compared with the demographic variables of construction workers (P>0.05).

24

27

30

33

promote among them a reasonable safety attitude, and to assist them wisely if they are stricken. There is always an obligation on a humanitarian basis to assist the stricken and the helpless.

REFERENCE Bondy J. et.al, (2008).Prevention of building site accidents.Journal of occupational Environmental medicine , 99(2), 136-44 Kazi Fausi Jawaid (2007), Effectiveness of a planned teaching programme on first aid for selected accidents and emergenciesJournal of Nightingale nursing time, 3(9),30-32

CONCLUSION : From the findings, it can be concluded prior to implementation of video assisted teaching module the construction workers had poor knowledge whereas, after implementation of video assisted teaching module the construction workers had good knowledge with the difference of 37.9% of mean percentage revealing effectiveness of video assisted teaching module. Having studied first aid, construction workers are prepared to give others some instruction in first aid, to

Buskin .SE (2007), Towards good practice in health, environment and safety management in industrial and other enterprises, DAL publication, Europe, Pp 57-69 Thomas M. Kiley, (2008), Issue of transafety reports, Road injury prevention and litigation Journal, 7(2), Pp. 134-3

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WHY EAT BEETS? 6 TOP REASONS *Dr. Divyachoudhary Beet roots improveour health in the following ways.

1. Lower Blood Pressure Drinking beet juice may help to lower blood pressure.The benefit likely comes from the naturally occurring nitrates in beets, which are converted into nitric oxide in our body.

Nitric oxide, in turn, helps to relax and dilate our blood vessels, improving blood flow and lowering blood pressure.

2. Boost Stamina The benefit is thought to also be related to nitrates turning into nitric oxide, which may reduce the oxygen cost of low-intensity exercise as well as enhance tolerance to high-intensity exercise.

3. Fight Inflammation Beets are a unique source of betaine, a nutrient that helps protects cells, proteins, and enzymes from environmental stress. It's also known to help fight inflammation, protect internal organs, improve vascular risk factors, enhance performance, and likely help prevent numerous chronic diseases.

4. Anti-Cancer Properties The powerful phytonutrients that give beets their deep crimson color may help to ward off cancer. Research has shown that beetroot extract reduced multi-organ tumor formations in various animal.

5. Rich in Valuable Nutrients and Fiber Beets are high in immune-boosting vitamin C, fiber, and essential minerals like potassium (essential for healthy nerve and muscle function) and manganese (which is

  

   

good for your bones, liver, kidneys, and pancreas). Beets also contain the B vitamin folate, which helps reduce the risk of birth defects.

6. Detoxification Support The betalin pigments in beets support our body's detoxification process, which is when broken down toxins are bound to other molecules so they can be excreted from our body. Traditionally, beets are valued for their support in detoxification and helping to purify our blood and our liver.

Eat BeetGreensToo Besides containing important nutrients like protein, phosphorus, zinc, fiber, vitamin B6, magnesium, potassium, copper, and manganese, beet greens also supply significant amounts of vitamin A, vitamin C, calcium, and iron. Beet greens actually have even more iron than spinach (another leafy green in the same botanical family) as well as a higher nutritional value overall than the beetroot itself. Research shows beet greens may: Help ward off osteoporosis by boosting bone strength Fight Alzheimer's disease Strengthen the immune system by stimulating the production of antibodies and white blood cells There are many ways to enjoy beets: Grate them raw over salads Add them to the fresh vegetable juice Lightly steam them Marinate them with lemon juice, herbs, and olive oil.

*Professor of Nutrition, KGNC, SBV, Puducherry.

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KASTURBA GANDHI NURSING COLLEGE COLLEGE EVENTS

SCIENTIFIC AND ACADEMIC FORUM The SAF of KGNC was organized in Association with the Department of Medical Surgical Nursing on 20/06/14 focussing on the theme “Emergency Management and care of patient with stroke”. Dr. Murugesan, HOD, Dept of Neuromedicine, MGMC & RI gave a guest lecture on “Emergency Management of patient with Ischemic stroke”. Mr. Dhandapani.S III Year B.Sc (N) presented a case on Head injury. Followed by a Quiz program was conducted for III & IV year B.Sc(N) students who had active participation and won the prizes. There were new rounds introduced in quiz like clinical reasoning, differential diagnosis to correlate theory and practice which provoked the interest of the audience and the participants.

Ms. RumaShanthini K, Asst. Professor, Dept of Medical Surgical Nursing, was a resource person deputed by INC &NACO for Trainer for Nurses on HIV/ AIDS under GFATM-7 at College of Nursing (Sub – Sub recipient), JIPMER, Puducherry on 13th&14th of May 2014.

Mr. Vijayaraj R, Asst. Professor, Dept of Medical Surgical Nursing, was a resource person deputed by INC &NACO for Trainer for Nurses on HIV/ AIDS under GFATM-7 at College of Nursing (Sub – Sub recipient), JIPMER, Puducherry on 21st , 22nd& 23rd of July 2014.

LITERARY CLUB In commemoration of “World No-Tobacco day”, LITERARY CLUB of KGNC conducted “Ensayo – concorrenza” (Essay competition) for B.Sc.,(N) students on 12-6-14 at 11am to 12pm at II floor lecture hall, KGNC on the following topics. i)

Smoking is injurious to health – Youngster‟s role

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Say No to smoking – Adolescent‟s responsibility Prevention of smoking through legal enforcement – Individual views.

Passive smoking – view of the public.

42 students from I, II, III, IV year B.sc., (N), IIyearM.sc.,(N)., II P.B.B.Sc.,(N)., had an enthusiastic participation . The competition was evaluated by Mrs. Uma, Professor in English. Ms. Valli from III year B.Sc,(N), Ms. SriGowri from II year B.sc.,(N) and Mr. Promoth from I Year B.Sc.(N) bagged the first three places.

OUT REACH ACTIVITIES  World Health Day-8-4-14 The Department of Community Health Nursing, P.B.B.Sc (N) II yr & B.Sc (N) II yr students participated in the Awareness Rally on “World Health Day “ programme organized by Government of Puducherry, Dept. of Health & Family Welfare services, National Vector Borne Disease Control Programme (NVBDCP). The chief guest Dr. Raman, Directorate of Health & Family Welfare Services, Puducherry inaugurated the Rally at Bharathidhasan women‟s college. A total number of 86 students participated in Rally. The rally started from Bharathidhasan women‟s college & ended at Kamban Kalaiyarangam. Students were holding placards bearing slogan on NVBDCP (filarial & malaria). They created awareness to the public through the slogan & distributed pamphlets. Followed by that, they conducted Workshop on “NVBDP”under the guidance of Ms. Aruna Devi, Lecturer & Ms. Jhansi, Asst. Lecturer, KGNC.  Rally on Ill Effects of Drug Abuse - “A Day of KGNC” The Department of Psychiatric Nursing, KGNC joined hands with Bharat Matha Detoxification and Treatment Centre for Alcoholic & Drug Dependence, Ariyankuppam, Puducherry to organize a Rally and Essay competition. The rally focused on the theme “Ill Effects of Drug Abuse and Student’s Participation in

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Prevention of Drug Abuse” The rally was organized on 26th June 2014. The event was flagged by Former Minister Mr. Nehru and Mr. Uttaman, Director of social service who accompanied the occasion. Mr. Rajavelu, Minister of Social service, Mr. Uttaman, Director of Social service, Mrs. Shanthi, Joint Director of social service were present in the closing ceremony. In the closing ceremony Minister & Director of social service congratulated the students for their creative efforts and appreciated KGNC for encouraging the students in co-curricular activities.

Many local and National Media networks covered the footage for telecasting the good work which is as follows  Jaya plus TV has telecasted a video of rally at 12:30 pm and a brief description was given by Mr. Dhandapani, III year B.Sc. nursing about the rally and the day against drug abuse, bringing fame to the institution.  Vijay TV has telecasted a short footage about rally in News at 10:00pm highlighting KGNC.  Pudhiya Thalaimurai channel has telecasted the video of rally at 7:30 pm and a brief description was given by Ms. Sasi Priya, III year B.Sc. nursing about the rally and the day against drug abuse..  AMN TV, Sakthi Channel, Raghava TV, Deepam Channel and many other local channel has telecasted the creative works of students‟ in rally.  Daily news edition like Thinamalar, Thinakaran, PuduvaiKural, Tamil Murasu, Indian Express has written about the works of students and their participation in rally with captured pictures and our institution on 27/06/14.

INTERNAL QUALITY ASSURANCE CELL (IQAC) -KGNC UNIT “Workshop on haemodynamic monitoring of patient in critical care units” KGNC IQAC unit in association with Department of Medical Surgical Nursing organized a workshop on Haemodynamic Monitoring of patient in critical care units on 11.04.14. The program was inaugurated by Dr. S. Kamalam, Principal, KGNC. The Principal and Dr. Hemanth, Asso.

Professor, Dept. of Anesthesiology released the Self Learning guide on Hemodynamic Monitoring for the students. Ms. Remya, M.sc(N)II Year hosted the whole programme. Dr. Rani, Asso. Professor, Dept. of Anesthesiology, gave a broad view on Haemodynamic Monitoring of patient in CCU. Skill session was conducted. Dr. AnandMonickam, Simulation Centre Incharge, MGMC &RI conducted a live demonstration session on cardiac Monitors and other equipments used in CCU. The students had gained

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adequate knowledge on haemodynamic monitoring. The overall feedback about the in-service training programme was graded as excellent.

Alumni Association of KGNC (KASTURBIANS) „All men are liars‟, said Roberta Muldoon, who knew this was true because she had once been a man.

- John Irving The Alumni Association of KGNC (KASTURBIANS) came forward to help transgenders. On behalf of our Alumni Office bearers donated Rs.2000/- and Student Nurses Association of K.G.N.C also donated Rs. 3000/-to Ms. Sheethal, President, SCHOD society, Puducherry for Transgender Short film festival 2014 which was held on 21nd and 22rdjune 2014 at St. Antony‟s multipurpose Hall, Puducherry.

By this, our Alumni is dedicated to serve the society including Transgender.Mr. Vijayaraj, Alumni Secretary Cum Asst.Professor and Mr. Mufeeth Khan, Alumni Member Cum Asst.Professor Attended the Transgender Film festival 14.

REGISTRATION Our Alumni Association of KGNC (KASTURBIANS) has been Registered under the Socities of Registration Act, 1860 (Act No.XXI of 1860) on 26.06.14. Our Alumni Registration No.239 of 2014.

Congratulations to the effort of the office bearers. .

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OTHER HIGHLIGHTS INTERNATIONAL NURSES DAY CELEBRATION 2014 KGNC and Nursing fraternity of MGMC&RI celebrated the International Nurses Day celebration on 19/05/2014 at II floor lecture hall, college block, MGMC&RI. The theme of the Day “Nurses-A Force For Change- A Vital Resource for health” was unfolded by Dr. S. Kamalam, Director of Nursing. She also brought fort the avatar of film director by telecasting a short film on Qualities of a Nurse – Do’s and Dont’s. This film was brought into full form by the efforts of our Director and Vice Principal Prof. Renuka k and her team from KGNC. Dr. S. Kamalam received applause from the dignitaries on her new role as director. Another film “VIDHAI – A awareness on Prevention of Female Infanticide” directed by final year BSc( N) also was telecasted which was also appreciated.

The special message was given by the chief guest Prof. K.R. Sethuraman, Vice Chancellor, Sri Balaji Vidyapeeth University. The programe was felicitated by Dr. Lakshmana Perumal, Residential medical officer and Dr. Nirmal Coumare, Medical Superintendent, MGMC&RI followed by which there was prize distribution for nurses and faculty for different games and competition. The program was concluded with a vote of thanks rendered by Mrs. Therasa, Asst. nursing Superintendent, MGMC&RI. The celebration came to an end with a colorful culturals by staff nurses and nursing students of KGNC.

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Vol 7, Issue2, May - August’14 AUTHOR GUIDELINES

The Editorial Process PJN is an international peer – reviewed, professional journal for nurses. Welcomes articles on all aspects. 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 and international peer 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.

Presentation and Submission of Article  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.  Send the final article file without „Track changes‟ & send hard & soft copy for the articles.

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Pondicherry Journal of Nursing

Vol 7, Issue2, May - August’14

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  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 Nursing College, MGMC&RI Campus, Pillaiyarkuppam, Puducherry - 607 402.

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

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