Prof. dr. rs mehta book

PUBLICATIONS

OF

PROF. DR. RAM SHARAN MEHTA

(Research Related)

CV, Abstracts, Research Articles, Proposals, Projects & Research Notes

CURRICULUM VITE

Name : Prof. Dr. Ram Sharan Mehta

Designation : Professor (Medical-Surgical Nursing Department)

Date of birth : 30-12-1962 (2019-09-15)

Sex : Male

Marital status : Married with one son.

Nationality : Nepali

Religion : Hindu

Language : Fluent in English, Nepali, Hindi, Bhojpuris and Maithili (both written and spoken)

Permanent address : District: Sunsari, Rajgunj Sinuwari, VDC–5, Nepal

ACADEMIC QUALIFICATION Degree Institution year percentage S. L.C. SLC Board, Nepal 2039(1982) 62.5(1

st div)

I. Sc. T. U. Institute of science 2044(1987) 57.7(2nd

div)

ROPFFESSIONAL QUALIFICATION Degree Institution Year Percentage

PCL (GNM) in nursing TU, IOM 046(1990) 77.2(1st

div)

Bachelor in Nursing TU, IOM 2054(1997) 85.7(distinction)

M. Sc. Nursing P. U. (PGIMER) 2059(2002) 70.47 (1st

div)

(Medical-surgical) Chandigarh, India

Doctor of Philosophy (PhD) TU, FOHSS, RD 2068 (2011)

JOB EXPERIENCE

Designation Institution Duration

Health-aid Koshi zonal hospital, Biratnagar 2046-11-3 to 2046-12-4 (1.0M)

Staff-Nurse Rukum district hospital 2046-12-10 to 2047-6-9 (6.0M)

Clinical In-charge NFPA, Nepalgunj. 2047-7-15 to 2048-3-27 (8.0M)

Staff Nurse Bir-hospital, Katmandu 2048-2-21 to 2048-9-20 (7.0M)

Staff Nurse ERH, Dharan 2048-8-22 to 2050-4-1 (1.5Y)

Staff Nurse BPKIHS, Dharan 2050-4-1 to 2054-10-16 (4.5Y)

Nursing officer BPKIHS, Dharan 2054-10-17 to 2060-1-5 (5.0Y)

Senior Nursing Officer BPKIHS, 2060-1-2 to 2060-5-7 (4.0M)

Assistant Professor BPKIHS 28-8-2004 to 23-12-2007 (3.5Y) Associate Professor BPKIHS 24-12-2007 to 13-3-2011 (3.2Y)

Additional Professor BPKIHS 14-3-2011 to 09-02-2014 (3.0Y)

Professor BPKIHS 10-02-2014 to continue

JOB DESCRIPTION: Presently involved in teaching learning activities of CN programme, Generic B.Sc. nursing programme, Bachelor in Nursing & M.Sc. Nursing Programme of the subjects Medical surgical nursing, Fundamental of nursing, Advance Nursing Concepts, Leadership & Management and Research. Completed the responsibility of deputy programme coordinator & coordinator of Certificate and B. Sc. Nursing. Involved in In-service Education Programme of College of Nursing. Supervisor of medical surgical nursing units, Provide clinical guidance on Basic nursing concepts, fundamental of nursing, Medical-Surgical Nursing, Leadership-Management and Research to the students. Assist in administrative activities and clinical Supervision of M. Sc. Nursing, B.Sc. and C.N. student. Trainer of various workshops and training within and outside the Institute. Involved as Member of various committees like, Entrance Committee, coordinator anti-raging rapid response team, quality control committee of BPKIHS, and actively involved in various research activities and research guide of M.Sc. Nursing & B.Sc. Nursing Students. At Present I am involved in teaching Certificate Nursing, B.Sc. Nursing and M. Sc Nursing students along with B.Sc. Radiology, B.Sc. in Laboratory Technology and B.Sc. OT at B.P. Koirala Institute of Health Sciences. At present I am the Coordinator of Post Graduate Nursing Programme (M.Sc. Nursing) at BPKIHS.

CORDINATOR/MEMBER OF SPECIAL COMMITTEE

1. Member, Quality Assurance Committee: 2061-4-10 to 2063-5-29

2. Member, Research Committee: 21st

April 2008 to 21st

April 2011

3. Coordinator, Certificate Nursing Programme: 1st

September 2008 to 1st

September 2010

4. Member, Scholarship & Loan for Students committee, 2004-2005.

5. Member: HIV/AIDS core committee, BPKIHS, 2009 till date

6. Coordinator: M. Sc. Nursing Programme: 1st

September 2012 to 1st

September 2014.

7. Member: Entrance Committee of BPKIHS 2013.

PARTICIPATED IN RESEARCH RELATED TRAINING AND WORKSHOPS:

1. Research Methodology Training: 19-23 September, 2005, Organized by NHRC.

2. Training of Trainers on Data management & Analysis: 24-28 October 2005 Organized by NHRC.

3. Clinical Epidemiology Training Programme: 11-13 July 2005, Organized at BPKIHS.

4. Training of Trainer’s on advanced statistical Measures used in Epidemiological Research Design

(13-22 dept. 06) conducted by NHRC.

5. Epidemiology training (15-17 Nov. 06) organized by INDIACLEN.

6. Statistical Methods in Medical Research and introduction to SPSS: 10-11 July 2010, NIMHANS,

Bangalore, India.

7. Medical Writing Training: 17-20 May, 2011, PHSI, New Delhi, India.

8. Organizer and Resource Person: Research Methodology Training 3-7 March 2013.

9. Design and Conduct of Observational Studies: 11-14 March, 2014, New Delhi.

CONGRESS/CONFERENCES/WORKSHOP/TRAINING/MEETING ATTAINDED:

1. International Conference on Pain: 25-26 February 2000.

2. M.Sc. Nursing Curriculum Development Workshop: 24-27 November 2003.

3. ONAI, Oncology Nursing Conference, 6-8 January 2005. Mumbai

4. ISCCM, Critical Care Congress 2012: 15-19 February 2012, Pune, India.

5. SARS Surveillance and Hospital Infection Control Training: 25-26 May 2004, MOH.

6. Short Term Training on HIV/AIDS: 17-18 January 2008.

7. Workshop: Nursing Management of Patient with Epilepsy. 10-19 September 2001.

8. Workshop: Nursing Management of Spinal Injury. 28th

August to 6th

September 2000.

9. Workshop: Palliative Care-Role of Nurse. 16-25 April 2001.

10. Workshop: Airway, Ventilation & Resuscitation. 13-14 March 2004. BPKIHS

11. Conference: Cancer Nursing 8-12, 2004, Sydney, Australia.

12. Primary Trauma Care: 3-5 October 2007, at BPKIHS

13. Logistic Management TOT for ARV drug and HIV test kits. 30th

May to 6th

June 2006.

14. Conference: ANEMECON-21, 5-8 March 2003. BPKIHS

15. Participation: INDIACLEN MEETING 2006. 15-17 November 2006.

16. Conference: GPAN.26-27 November 2006. Kathmandu.

17. Conference: 7th

Asian Cardiac Nursing. 20-22 February 2007, Escort, New Delhi.

18. Participation: National CME of Psychiatrics. 29-30 November 2007.

19. Conference: EMCON 2008, 14-16 November 2008, Salem, India.

20. Workshop: Head & Neck Live Surgery. 12-14 October 2007. BPKIHS.

21. Conference: 3rd

National AIDS conference. 4-7 July 2008. Kathmandu.

22. Conference: SAARC Tuberculosis, HIV/AIDS & Respiratory Disease. 15-18 December 2008.

Kathmandu, Nepal.

23. Conference: Cancer Nursing. 17-21 August 2008, Singapore.

24. Workshop: Trauma and Emergency Nursing Course. EMCON, 2008. Salem, India.

25. Participation: Holistic Health Conference for Nursing Professionals. 18-22 September 2009. Abu

Road, Rajasthan, India.

26. Course: Comprehensive Trauma Life Support, ITACCS, INDIA, 20-22 August 2009, Kolkata, India.

27. Teachers Training Completion: 2-4 May 2010.

28. European AIDS Conference, 12-15 October 2011, Belgrade, Serbia, Europe

29. 15th

WCTOH, Singapore, 20-24 March, 2012.

30. Criticare. 18-19 October 2012, Pune, India

31. Duty: International Conference, 3-5 Jaunary 2013, Kochin Kerala

32. Participated and Presented Paper on World Congress of Nephrology, 31 May to 4th

June 2013,

Hong Kong.

33. Global Nursing Leadership Training (GNLI), 7-13th

August 2013, Geneva, Switzerland.

34. 14th

European AIDS Conference, 16-19 October 2013, Brussels, Belgium.

FACILITATOR, RESOURCE PERSON OF WORKSHOPS/SEMINARS:

1. Resource Person: Training of Trainers on Clinical Management of Sever Malaria. 28-31October 2007, BPKIHS

2. Facilitator: Short Term Training for Ward Attainments & Hospital Aids.

3. Resource Person: Development of Nursing Procedure Manuel. 8-10 June 2011. BPKIHS

SPECIAL GUEST LECTURE, PLENARY TALKS & APPRECIATION:

1. Appreciation for participation in: Diabetes, Hypertension, and Kidney disease screening camp.

2. Appreciation for judge for 19th Scientific Session September 2012, BPKIHS.

3. Appreciation for conducting Entrance exam 2007. BPKIHS.

4. Appreciation: 7th Convocation Ceremony of BPKIHS. 22 January 2010.

VISITING CONSULTANT/FACULTY:

1. Chitwan Medical College, TU, for M.Sc. Nursing Programme.

2. National Medical College, TU, for Bachelor Nursing Programme.

COUNTRIES VISITED:

1. India: New Delhi, Mumbai, Chandigarh, Cheeni, Kanya Kumari, Kochin, Kerala, Selam, Pune,

Amritsar, Simla, Hariduar, Risikesh, Kolkata, Patna, & Others.

2. Singapore

3. Thailand

4. Sydney, Australia

5. Austria, Europe

6. Serbia, Belgrade, Europe

7. Hong Kong

8. Belgium: Brussels

9. Netherlands: Amsterdam

10. France: Paris

11. Switzerland: Geneva

PRIZE, AWARD, SCHOLARSHIP & MEDALS RECEIVED:

1. Awarded “VICE-CHANCELLOR GOLD MEDAL” in 1997- for topper in all bachelor programmes in

Tribhuvan University (TU).

2. MERA DEVI RANA GOLD MEDAL of 2055 of TU, IOM- For topper in medical-surgical nursing.

3. MAHENDRA BIDYA BHUSHAN (GA) of 2000-For distinction and topper in bachelor programme in

T.U.

4. Rup Kumari Gurng Nursing Scholarship, for 2052/2053 BS.

5. Mahendra Bidhya Bhusan (KA): Completing PhD, 2013

6. Ph.D. Scholarship, 2008, UGC, Sanothimi, Bhaktpur, Nepal

7. Travelling Scholarship: to attain 13th

Europian AIDS conference, Belgrade, Serbia

8. Travelling Scholarship: to attain ISNCC cancer conference at Sydney, Australia

9. EAC travelling grant, 2011 to attain 13th

EAC at Belgrade, Srbia, Europe

10. WCN travelling grant, 2013 to attain Nephrology Conference at Hong Kong

11. EAC travelling grant, 2013 to attain 14th

EAC at Belgium, Europe

12. ICN, leadership training grant 7-13 August 2013 at Switzerland, Europe

13. Best Teachers Award, 2014, BPKIHS & Parikarma Society, Nepal

EXAMINER:

Examiner of Practical examinations of “Fundamentals of Nursing”, “Basic Nursing Concepts”, “Medical-

Surgical Nursing”, “Research”, “Leadership & Management” and “Nursing Education” to the

Certificate Nursing, B. Sc. Nursing and M. Sc. Nursing Students and served as the external examiner in

other universities of Nepal like Tribhuvan University, Purbanchal University and Kathmandu University.

LIFE MEMBER/MEMBER/ADVISOR & OTHERS:

1. Life Member of Nursing Association of Nepal (No- 1011)

2. Life Member of Asian Association of Cardiac Nurses (No- 00611)

3. Nepal Nursing Council Registration No- 507

4. Founder President of Rural Awareness Center, Sunsari, HMG-Reg. No. 482/447(2054), SWC Reg. No-19039

5. Advisor and Members of various NGOs & INGOs of Sunsari & Morang District

8. President: Nursing Association of Nepal, BPKIHS Unit, Dharan (2010 till date)

9. Member: International AIDS Society (IAS)

10. Member: Academic Council, Purbachal Universtiy, 2011-2013.

RESEARCH/THESIS GUIDE/SUPERVISOR:

1. Change in the Knowledge and Attitude of ANMs Working at BPKIHS Regarding Cervical Cancer

after Educational Intervention. ( B. Sc. Nursing 2003)

2. Quality of Life of Patients of with Hypertension ( B. Sc. Nursing 2005)

3. Impact of Education Intervention on Knowledge Regarding Legal Issues among the Nursing

Personnel working in BPKIHS. ( B. Sc. Nursing 2006)

4. Knowledge and Practice of Universal Precaution among the nurses working in Medical-Surgical

Nursing Department of BPKIHS (B. Sc. Nursing, 2007).

5. Professional Satisfaction among the Pass-out B. Sc. Nursing graduates from BPKIHS. (B. Sc.

Nursing, 2008).

6. Knowledge Attitude and Practice Regarding Post Exposure Prophylaxis of HIV among the Nurses

Working in BPKIHS (B. Sc. Nursing, 2009).

7. Effectiveness of Education Intervention Programme on Hepatitis-B among the High School

students at Dharan (B. Sc. Nursing, 2010).

8. Nutritional status of the People Living with AIDS receiving ART at BPKIHS (B. Sc. Nursing, 2011).

9. Knowledge and Self Care Practice among the Clients of Chronic Liver Disease Attending B.P.

Koirala Institute of Health Sciences (B. Sc. Nursing, 2012).

10. Effectiveness of Educational Intervention on Knowledge Regarding CKD among the Nurses

working in a Tertiary Care Hospital in Eastern Nepal (Master Thesis, 2013)

SCIENTIFIC PUBLICATIONS:

1. Impact of training programme on care of people living with HIV/AIDS among the nurses working

in BPKIHS. Nursing Journal of Nepal. 2010; 5:11-17.

2. Patient’s attitude towards nursing students of BPKIHS. Journal of Nepal Health Research

Council. 2006; 4(2):45-50.

3. Risk factors, associated health problems, reasons for admission and knowledge profile of

diabetes patients admitted in BPKIHS. KUMJ; 2006; 4(1):11-13.

4. Effect of training programme regarding First-aid management among the high school students.

2005; 3(1): 17-22.

5. Satisfaction of patients and their relatives receiving nursing care at BPKIHS. Journal of Nepal

nursing council. 2004; 2(2): 45-47.

6. Analysis of Nursing work activities in relation to patient care in medical surgical wards of a

tertiary level super-specialty hospital of Nepal. Journal of the Hospital Administration. 2004;

16(2):19-22.

7. Socio-demographic profile and outcome of the admitted AIDS patients in BPKIHS Nepal. Journal

of Tuberculosis, Lung Disease, and HIV/AIDS. 2007; 4(1): 19-22.

8. Perception of nursing students about nursing Profession. Nursing Magazine of NNC. 2006;

(3):82-83.

9. An overview of nursing service in TUTH. Journal of nursing education of Nepal. 1998; 1(1): 1-6.

10. Job-related stress among the nurses working in PBKIHS, Nepal. Nursing and Midwifery Research

Journal. 2005; 1(2): 70-76.

11. Research article, "Overview of nursing service at TUTH”, published in Journal of Nursing

Education of Nepal, 1998.

12. Nurses responsibilities in pain management. Published in Journal of Nursing Education of

Nepal, 2000.

13. Satisfaction of client’s and their relatives receive nursing at BPKIHS published in journal of the

Nepal nursing council 2004.

14. Nursing standards. Published in the Journal of Nepal Nursing Council 2004

15. Stress and it’s management co-author. Published in Journal of NEN 2004

16. Biomedical waste and Hospital Acquired infection. Published in Journal of Nursing Education of

Nepal 2004

17. Article, “quality patient care and nursing audit”, published in SOVENIR 40th

anniversary

celebration of nursing campus, Lalitpur, 1st

January 1997:22-23.

18. Research article (co-author):-Initial experiences with intermittent peritoneal dialysis at BPKIHS.

(Published in Indian kidney society journals).

19. Article, "Nursing profession in Nepal: past present and future”, published in Vision of BPKIHS

2056. (In Nepali)

20. Article, "common legal issues related to nursing”, published in VISION of BPKIHS 2056.

21. A study about health hazards among nursing personnel working at TUTH. Published in NAN,

Journal, 2056.

22. Relationship between admission eligibility criteria and academic success of the B.Sc. nursing

students admitted at BPKIHS ( Co-author).(Published in Indexed Journal-JNMC)

23. Publication of booklets: [for public information & interest: Free distribution by author]

a. Diabetes Patient Care

b. First-Aid: Common Problems

c. Cancer: Education & Information

d. Renal Failure

e. Hypertension: Information

f. HIV/AIDS: Information

g. HBC to the People Living with HIV/AIDS.

24. Publication of Books: [By: Jaypee Brothers, India & Makalu Publication, Nepal]

a. NURSING CONCEPTS”: ISBN: 99946-679-5-5: 2nd

Edition on 2009

b. Hand book of Diagnostic Procedures: ISBN: 99946-705-6-5

c. Leadership and Management: ISBN: 99946-755-9-1: 3nd

Edition

d. Oncology Nursing, Jaypee Brothers, India: ISBN: 81-8448-098-9

e. Text Book of Nursing Research. ISBN:978-9937-503-76-1, 2012

f. Nursing Entrance Guide: 2012

SCIENTIFIC RESEARCH PROJECTS COMPLETED:

1. Knowledge and practice of Health Hazards among the nurses working in the general wards of

TUTH; 1997.

2. Satisfaction of patients and their relatives receiving nursing care at BPKIHS; 1998. (Under BPKIHS

grant.)

3. Initial experiences with intermittent PD at BPKIHS; 1998.

4. Effectiveness of maintaining oral hygiene nursing care among self-care deficit patient. (paper

presented on BPKIHS Scientific forum 2003)

5. Socio-Economic, cultural, and Knowledge profile of kala-azar patients from eastern Nepal.

(Paper presented on BPKIHS Scientific forum)

6. Prevalence of Breast cancer among the admitted patients at BPKIHS.

7. Satisfaction of patient and their relatives regarding Emergency-Nursing service (Under BPKIHS

research grant and paper presented at BPKIHS Scientific forum 2004)

8. Socio-demographic, Knowledge and Health profile of the patients undergoing dialysis at BPKIHS.

(Paper presented on BPKIHS Scientific forum 2003)

9. Risk factors, associated health problems, reasons for admission and knowledge profile of the

diabetic patients admitted in the BPKIHS. (Paper presented at BPKIHS Scientific forum 2004)

10. Confidence of ANMs on performing basic nursing skills before and after planned training

programme for newly appointed ANMs at BPKIHS.2003 (paper presented on BPKIHS Scientific

forum 2003)

11. Analysis of nursing care needed for the patients admitted in medical-surgical wards at

BPKIHS.2003. (Paper presented on BPKIHS Scientific forum 2003)

12. Opinion of Bachelor nursing graduates (B.Sc./BN) regarding M.Sc. nursing programme. (Findings

presented during M.Sc. Nursing Curriculum Development Workshop)

13. Relationship between admission eligibility criteria and academic success of the B.Sc. nursing

students admitted at BPKIHS (paper presented on BPKIHS Scientific forum)

14. Job-satisfaction among staff nurses working at BPKIHS

15. Effect of planned training programme on cervical Cancer among the nurses working at BPKIHS.

(Research co-guide)

16. Perception about nursing among the newly admitted nursing students in 2003 batch at BPKIHS

(paper presented on BPKIHS Scientific forum)

17. Reasons for turnover among the nurses working at BPKIHS. (Under BPKIHS research grant)

18. Effectiveness of informational booklet on Dialysis (under BPKIHS research grant)

19. Job related stress among the nurses working in critical care areas at BPKIHS.(Paper presented in

BPKIHS Scientific forum)

20. Satisfaction of clients in relation to hospital expenditure (Under BPKIHS research grant & Paper

presented in BPKIHS Scientific forum 2005)

21. Effectiveness of first-aid training programme among the high-school students. Under NHRC

Research grant. ( Among 696 Participants) (paper presented on BPKIHS Scientific forum 2006)

22. Effect of First Aid Training Program For School Teachers And School Management Committee

Members of Morang District Nepal

23. Effect of Training for Nurses Working In Teaching District Hospitals. (paper presented on BPKIHS

Scientific forum 2006)

24. Perception of Newly Admitted Nursing Students in 2005 Batch at BPKIHS about Nursing

Profession. (paper presented on BPKIHS Scientific forum 2006)

25. Patients’ Attitude towards Nursing Students of BPKIHS. (paper presented on BPKIHS Scientific

forum 2006)

26. Socio-Demographic Profile of the HIV/AIDS Patients Admitted In BPKIHS. (paper

presented on BPKIHS Scientific forum 2007)

27. Knowledge Profile About the Care of Spinal Cord Injury Patients & Their Caretakers at BPKIHS

(paper presented on BPKIHS Scientific forum 2007)

28. Reasons for Ingestion of OPP among the Admitted Clients in BPKIHS. (Paper presented

on BPKIHS Scientific forum 2007)

29. Effectiveness of Training Programme on Care of Patients with AIDS among the nurses

working in BPKIHS in 2007. (Paper presented in scientific session of BPKIHS in 2008)

30. Profile of the Admitted Cancer Patients in B.P. Koirala Institute of Health Sciences

Nepal. (Paper presented on BPKIHS Scientific forum 2007)

31. Knowledge and attitude towards the people living with HIV/AIDS among the nurses working in

BPKIHS. (paper presented on BPKIHS Scientific forum 2008)

32. Knowledge about HIV/AIDS among the nursing students studying in BPKIHS (Paper

presented in scientific session of BPKIHS in 2008) 33. Needs and Experiences of family members of the patients admitted in ICU/CCU of B. P. Koirala

Institute of Health Science (Paper presented in Scientific Session 2009)

34. Home-based Care to the People living with AIDS and their Effects on the Family in

Eastern Rural Nepal: An Aspects analysis (Paper presented in Scientific Session 2009)

35. Family Burden of the People living with AIDS getting treatment of BPKIH (Paper

presented in Research Forum Meet of BPKIHS 2009)

36. Professional Satisfaction among pass-out B.Sc. Nursing Students of BPKIHS. (Paper presented in

scientific session of BPKIHS 2009)

37. Impact of Education Intervention Programme on Care and Support to the People Living with

HIV/AIDS Receiving ART at BPKIHS.

38. Audit of the Patients Admitted in Critical Care Units of BPKIHS

39. Critical Care Nurses’ Knowledge on Adult Mechanical Ventilation Management

40. Impact of Education Intervention Programme on Care and Support to the People Living

With HIV/AIDS Receiving ART at BPKIHS

41. Critical Care Nurses’ Skill Working in B P Koirala Institute of Health Sciences

42. Nursing Care Times Required Providing the Care to the Patients on Adult Mechanical

Ventilator Admitted in ICU of BPKIHS

43. Home-based Care to the People living with AIDS and their Effects on the Family in

Eastern Rural Nepal: An Aspects analysis.

44. Strengthening leadership qualities among the nurses working in BPKIHS.

45. Enhancing the knowledge and practices on PEP of HIV among the Nurses working in

BPKIHS.

46. Nutritional Status of the People Living with AIDS Receiving ART at BPKIHS.

47. Enhancing the Knowledge and Practices regarding the prevention and care of Hepatitis-B

among the nurses working in Medical Units of BPKIHS.

48. Strengthening Knowledge and Practices Regarding Life Support Measures among the

Nurses Working in Medical Units of BPKIHS.

49. Lung Cancer Patients in Eastern Region of Nepal

50. Lifestyle Pattern among the People Living with AIDS in Eastern Nepal

51. Cancer in the People Living with AIDS.

52. Smoking, Alcohol and Sexual Practices among the PLWHA.

53. Economical Problems Faced by the People Living with AIDS. 54. Profile of the hospitalized Japanese Encephalitis Patients admitted in BPKIHS.

55. Telephone Health Service to Improve the Quality of Life of the People Living with AIDS

in Eastern Nepal. 56. Self-management Intervention to Improve the Quality of Life for People Living with AIDS.

57. Effectiveness of Education Intervention in Improving the QoL of the PLWA in Eastern Nepal

(Continue).

Contact Address:

Ram Sharan Mehta, Ph.D.

Professor

Medical–Surgical Nursing Department

College of Nursing

B. P. Koirala Institute of Health Sciences

Dharan, Sunsari, Nepal

Post Box No: 56701

Tel. No.: 00 977 – 25 – 525555 Ext. 5430(O), 3022 (R)

Fax No. 00 977-25-520251 Mobile: 00977- 9842040537

Email: [email protected], [email protected], [email protected]

Websites: www.bpkihs.edu & www.slideshare.net/rsmehta

Abstracts: 1. Satisfaction Of Clients And Their Relatives Regarding Emergency Service At BPKIHS

Mehta RS* 1, Sharma SK* 2, Mandal G* 3

Aims and objectives: Emergency nursing is a specialty in which nurse’s care for patients in the emergency or critical phase of their illness or injury and is adopt at discerning life threatening problems, rapidly and effective caring out resuscitative measures and other treatment, acting with a high degree of autonomy and ability to initiate needed measures without outside direction, educating the patient and his family with the information and emotional support needed to persevere themselves as they cope with a new reality. The activity of settings and not necessary in an “emergency room”. Materials and methods : Keeping in view, the increasing emphasis on the quality of nursing care in today’s health care setting, a study was undertaken to evaluate the, or satisfaction of client’s and their relatives regarding emergency services at BPKIHS. A descriptive exploratory research design was adopted to carry out the study among 300 samples with a population proportionate sampling method, among the client’s admitted in indoor (medial, surgical & Orthopaedic) after minimum stay of 3 Hrs. in emergency; using valid and reliable interview schedule by the trained interviewers. Results and conclusions: Majority of the subjects (83%) reported that the request and needs of the patients were raised and met properly. The most of the subjects reported nurses were of caring attitude, received patients in friendly atmosphere, maintained privacy, maintain proper communication with clients. They reported delay information about investigation results. Overall satisfaction was good. The reasons for dehumanization of patient care in emergency unit reported by various authors are: Differences in social classes between health care providers and population, standardized care, staff attitude, patient overload, hospital system, lack of supportive services, poor decision making autonomy and teaching environment.

2. Demographic Profile And Perceptions About Variou s Aspects Of Nursing Among The Newly Admitted Nursing Students At Bpkihs In 2003 .

Mehta RS, Khanal SS, Gautam A. Aims and objectives : In this fast moving society a change in both health care and higher education is needed. A look at nursing education is evident from the academic achievement of students. Nurses need additional preparation to work in educational settings, as they need to teach function as clinical practitioner to fulfill the expanded and emerging role of nurse. Nursing education and its quality, which is evident from the academic achievement of nursing students, foretells the efficiency of services to be provided by this students1

Materials and methods : To find out the demographic characteristics and explore the various motivating factors to select nursing profession among admitted nursing students in 2003 batch. It was descriptive exploratory study, conducted among the admitted nursing students in B.Sc. Nursing and Certificate

Nursing programme in 2003 batch at BPKIHS.A total enumerative sampling technique was adopted to carry out the study. All the 15 students of B.Sc. Nursing and 40 students of certificate nursing were included in the study. An opinionaire was prepared by the investigator to collect the data. After explaining the purpose of study, the verbal consent was obtained from the student. The students were assured that the information obtained will be highly confidential and anonymity will be maintained The study was conducted in their respected classes after the 2 weeks of orientation programme at BPKIHS by the investigator, who is the deputy programme coordinator of first year certificate nursing and the nursing subject teacher of basic nursing concepts of B.Sc. nursing first year. The tool was distributed among the students and the facts were collected. The collected data were analyzed using average, mean and percentage: and presented in the forms of tables.

Results and conclusions: The main reasons for selecting nursing as carrier among the B.Sc. Nursing students were: unable to get selected in MBBS (53%), has good scope & opportunity (40%) , to serve sick/ needy people (33%) , job security /easy job (27%) and thinking that it is also a medical line.(27%). Where as the reasons among the C.N students were: Interested to be a nurse (35%), to serve sick/ needy people (30%), force of the parents (18%) and others.

3. RELATIONSHIP BETWEEN ADMISSION ELIGIBILITY CRITERIA AND ACADEMIC SUCCESS OF THE B. SC. NURSING STUDENTS ADMITTED AT BPKIHS

Mehta R.S., Khanal S. S., Niraula S. R., Pokhrel N.,

New millennium has arrived. In this fast moving society a change in both health care and higher education is needed. A look at nursing education is expected in this quality of education is evident from the academic achievement of students. It foretells the efficiency of services to be provided by these students. Aims and objectives : Evaluation of the skill, knowledge and attitudes is measure with different tools in all-educational programmes. The examination scores quantify the students. This study analyses the performances of three senior batches of B. Sc. Nursing graduates from 1996 to 1998 from B.P. Koirala Institute of Health Sciences, Dharan, Nepal. BPKIHS established in 1993; as an autonomous, International health Sciences University with a mandate to work towards developing socially responsible and competent health work force best suited to look in the present scenario2.

The primary outcome of interest was the average percentage scores, of each B.Sc. Nursing students of first, second, third and fourth year.

Materials and methods : Karl-pearson correlation coefficient was used to identify the association of the variables. Findings show that the scores in different years of B. Sc. Nursing was significantly correlated with SLC scores, where as there was no association with I. Sc. Scores. The average B. Sc. Nursing scores were significantly associated with the performance of SLC, Entrance, B. Sc. – I, B. Sc.–II, B. Sc.–III and B. Sc.–IV except the I. Sc. Score. Therefore it can be concluded that performance in SLC can be a predictor for B. Sc. Nursing Scores. Results and conclusions: The percentage scores in SLC, Entrance, and average B. Sc. Nursing examination scores were significantly different between the three batches i.e. 1996, 1997 and 1998 (P<0.0001). But the I. Sc. Scores had no significant role in average B. Sc. Nursing scores.

The scores in different years of B. Sc. Nursing was significantly correlated with SLC scores, where as there was no association with I. Sc. Scores. The average B. Sc. Nursing scores was significantly associated with the performance of SLC, I. Sc., Entrance, B. Sc.- I, B.Sc.- II, B. Sc. III and B. Sc. IV. Findings of the study clearly indicate that competency and performance of students at the entry level influence their overall performance in theory and practical. In 21st century where the demand, needs, expectations, and awareness of the society has increased much, Nurses have to equip themselves to keep in pace with the expectations of the society. To achieve this goal only the competent candidates should be given chance to undergo Nursing Programme.

5. Risk Factors, Associated Health problems, Reason s For Admission and Knowledge Profile of Diabetes Patients Admitted in BPKIHS .

Mehta RS* 1, Karki P* 2, Sharma SK* 3

Aims and objectives : (DM) is a major non-communicable disease affecting approximately 150 million people in world in 2002,180 million in 2003 and expected to reach 330 million in 2025. The prevalence of DM is steadily increasing world wide, particularly in developing countries. It is projected to increase by 170%, out of which 76% will be from developing countries.

Materials and methods : 310 patient were admitted in medical units of BPKIHS between 1-3-2003 to 29-2-2004.The objective of the study was to find out the demographic profile, Identify the known risk factors, assess the associated health problems, find out the reasons for admission and explore the knowledge profile of the patients admitted with diabetes. It was hospital based exploratory study conducted among the admitted DM patients during the period of 1-3-2003 to 29-2-2004 in medical units using simple random sampling which included 35 samples.

Results and conclusions: About 53.6% subjects were of age group between 40-60 yr., Hindu 85.7%, married 92.9%, and non-vegetarian 75.9 %. About 50% of subjects were on Insulin. Majority of subject (60.69%) used mustard oil in cooking regularly. About 60.7 % subject had hypertension, 39.3 % had ocular problem, 25 % had renal problems. Majority of subject (82.1 %) knows about the disease (DM) they were suffering but limited subject had the knowledge about, causes, curability, treatment modalities, diet, and other aspects. As the knowledge regarding various aspects of DM is very low, there is need for informational booklet in Nepali and health education programme among public will be very useful.

Key Words : Risk Factors, Associated Health problems, Knowledge profile, Diabetes.

5. EFFECT OF PLANNED EDUCATIONAL INTERVENTION AMONG THE ANMs WORKING AT BPKIHS REGARDING CERVICAL CANCER.

Pokharel N, Dhungana L, Shrestha N, Piya S, Mehta R S

Cervical Cancer, the 2nd commonest cancer among female is a major health problem in the World today. Carcinoma of the cervix accounts for 11% of all cancer. Cervical cancer accounts for 50 – 65 percent of all malignant tumors of the female reproductive tract. It is the second top carcinoma among women. The study was conducted to evaluate the change in the knowledge and attitude of Auxiliary Nurse Midwives (ANMs) working at B.P. Koirala Institute of Health Sciences (BPKIHS) regarding cervical cancer after educational intervention in 2003.

The objectives of the study were to assess the level of knowledge and attitude regarding cervical cancer, to provide structured teaching and cervical cancer to evaluate the effectiveness of the structured teaching programme by assessing the change in the level of knowledge after intervention.

The study was a single group pretest posttest interventional research design with 66 ANMS and it was census study. Data were collected using a Semi-structured questionnaire, 15 regarding knowledge and 6

regarding attitude about cervical cancer. The teaching module was distributed to ANMs to study followed by structured interactive session (SIS). Second time data was collected after two weeks of SIS. Data were analyzed using graph, tables and Z test to test the hypothesis of the study.

The results indicated that there was significant increase in the level of knowledge on cervical cancer among ANMs working at BPKIHS after educational intervention (P<0.001). Attitude was more or less similar before and after the Educational Intervention.

The study recommends introducing cervical cancer in the curriculum of ANMs educational programme, training the ANMs working in different part of the country on cervical cancer and using them to provide health education to the public.

6. Socio-Demographic and Knowledge profile of the R enal Failure patients under Haemodialysis at BPKIHS.

Mr. Ram Sharan Mehta, Dr. Sanjeev Sharma, Ms. Bengm u Tamang. Introduction: Haemodialysis (HD) is a mechanical process of removing waste products from the blood and replacing essential substances in patients with renal failure. First artificial kidney developed in Netherlands in 1943 AD First successful treatment of CRF reported in 1960AD, life saving treatment begins for CRF in 1972 AD. In 1973 AD Medicare took over financial responsibility for many clients and after that method become popular. BP Koirala institute of health science is the only center outside the Kathmandu, where HD service is available. In BPKIHS PD started in Jan.1998, HD started in August 2002 till September 2003 about 278 patients received HD. Day by day the number of HD patients is increasing in BPKIHS as with institutional growth. No such type of study was conducted in past hence there is lack of valid & reliable baseline data. Hence, the investigators were interested to conduct the study on " Socio-Demographic and Knowledge profile of the Renal Failure patients under Haemodialysis at BPKIHS". Objectives: The objectives of the study were: to find out the Socio-demographic characteristics of the patients, to explore the knowledge of the patie nts regarding disease process and Haemodialysis and to identify the problems encounte red by the patients.

Methods: It is a hospital based exploratory study. The population of the study was the clients under HD and the sampling method was purposive. Fifty-four patients undergone HD during the period of 17 July 2002 to 16 July 2003 of complete one year were included in the study. Structured interview schedule was used for collect data after obtaining validity and reliability.

Results: Total 54 subjects had undergone for HD, having age range of 5-75 years and majority of

them were male (74%) and Hindu (93 %). Thirty-one p ercent illiterate, 28% had agriculture their

occupation, 80% of them were from very poor communi ty, and about 30% subjects were unaware

about the disease they suffering. Majority of subje cts reported that they had no complications

during dialysis (61%), where as 20% reported nausea and vomiting, 9% Hypotension, 4%

headache and 2%chest pain during dialysis.

Conclusions: CRF leading to HD is a long battle for patients, r equired to make major and

continuous adjustment, both physiologically and psy chologically. The study suggests that non-

compliance with HD regimen were common. The socio-d emographic and knowledge profile will

help in the management and early prevention of dise ase and evaluate aspects that will influence

care and patients can select mode of treatment them selves properly.

7. Confidence of ANMs on performing basic nursing s kills before & after planned training programme for Newly appointed ANMs at BPKIHS.

Mehta RS, Kumar N, Pokharel N

Aims and objectives: The main objective of the study was to evaluate the effectiveness of the planned teaching programme by assessing the change in the knowledge and skill on basic nursing.

Materials and methods: The research design used for the study was a single group pretest – posttest design. The populations of the study were all the newly appointed ANMs joined the BPKIHS on 11th June 2003. Data was collected using a semi – structured questionnaire to filled before the starting of training and at the end of training. The collected data were analyzed using statistical interventions.

Conclusions: Majority of the subjects (91%) reported that the training programme was very useful, where as only 9% reported that the programme was useful but none of them reported that programme was not useful. Regarding the conduction of programme (operation of programme) 69% subjects reported that the programme carried out was very effective, where as 31% reported good but none of the subject reported all right and poor.

The planned training programmes arranged by the inservice education committee regarding various components of basic nursing were found very effective.

8. Effectiveness of Nursing Care in maintaining ora l Hygiene Among self Care Deficit Patients Mehta RS

Aims and objectives: The objectives of the study were: to assess the oral hygiene nursing care needs, to develop a set of procedure for oral hygiene nursing care, to provide oral hygiene nursing care as per the needs and to evaluate the effectiveness of oral hygiene nursing care provided to the respondents.

Materials and methods: A quasi – experimental research design was adopted to carryout the study with a simple random sampling method, where 32 respondents were included in the control group and 36 in the experimental group having modified Barthel ADL Score more than 50 percent; of age more than 15 years, admitted in medical wards.

Assessment guide, modified Barthel ADL index, a str uctured interview schedule, observation

checklist, Beck's oral assessment scale, and planne d oral hygiene nursing care guidelines were

used to collect data.

Conclusions: Planned oral hygiene nursing care provided by the investigator to the respondents of experimental group were effective, where oral hygiene nursing care routinely provided to the respondents of the control group by the ward nurses/ relatives lacked effectiveness.

The reasons for poor oral hygiene nursing care reported by various authors are: Lack of standard oral assessment tool and oral nursing care procedure, professional nurses neglect the oral care and oral care provided is based on rituals.

9. Analysis of nursing care needed for the patients ad mitted in Medical – Surgical wards of BPKIHS .

Mehta RS , Pokharel N

Aims and objectives: The objectives of the study were to analyze the nursing care needed for the patients admitted in Medical – Surgical wards of BPKIHS.

Materials and Methods: A prospective survey study was conducted among all the admitted patients in the medical surgical units of BPKIHS from 1st May 2003 to 6th June 2003 i.e. of 37 days. Data was collected using checklist in the 8 to 9 AM morning on 24 hours recall basis.

Conclusions: In the Medical – surgical units 81% beds were occupied daily. DM (12%) HTN (11%), CVA (6%), TB (7%), Tetanus (5%), COAD (11%) were the diagnosis of the patient admitted in Medical units daily, which needs specialized nursing care. In Medical units 37% patients were on IV infusion, 8% needs suctioning, 18% needs Oxygen therapy, 24% completely bed ridden, 15% needs nebulization daily where as in Surgical units 33% on IV infusion, 9% Oxygen therapy and 11% having ET tube or on ventilation/tracheotomy. In spite of high bed occupancy rate (81%) and in availability of super specialty Medical services the LAMA (0.5%) and death (1%) rate are very low.

At the time of study there was two nursing staff in night duty two in evening duty and three to four in morning duty which is very less as compared with the nursing hour demands of the admitted patient.

9. EFFECTIVENESS OF INFORMATION BOOKLET ON DIABETE S AMONG THE ADMITTED DIABETES CLIENTS IN BPKIHS

Mehta RS* 1, Karki P* 2, Sharma SK* 3

B.P. kiorala Institute of Health Sciences, Nepal

ABSTRACT :

Introduction:

Diabetes is a major non-communicable Public health problem, rising prevalence of the disease in the developing countries, which was rare before, is due to industrialization, socio-economic development, urbanization and changing life-style. As the disease cannot be cured, it is a life long and it can only be controlled, hence there is need for self-motivation and knowledge to manage the disease. The Objectives of this study is to prepare an information booklet on Diabetes and to find out the effectiveness of it.

Research Design and Methodology:

It was single group pre-test post-test quasi-experimental research design, conducted among the admitted diagnosed diabetes cases admitted in medical units of BPKIHS in 2005. Using purposive sampling technique 50 subjects were selected. After the pre-test, Information booklet on diabetes (In Nepali) was given to subjects along with explanation. After 3 days of pre-test, post-test was taken and the collected data was analyzed using SPSS-4 package.

Results:

It was found that 76% clients were suffering with NIDDM, 22% on OHA, 72% on insulin, and 80% on diet therapy. About 80% subjects reported that they studied this type of booklet first time, and was easily understandable. Ninety percent subject reported that the booklet is very helpful, 10% mentioned it all right where as none of them reported not helpful, and 100% subjects mentioned that they refer others to study this booklet.

This booklet will be very beneficial for diabetes clients attending diabetes clinic, MOPD and admitted in medical units.

*1 Mr. Ram Sharan Mehta (Corresponding Author), Asst. Professor, Medical surgical Nursing department, College of Nursing. (Email: [email protected]) *2Prof. (Dr.) Prahlad Karki, HOD, Department of medicine & Hospital Director. *3Dr. Sanjeev Kumar Sharma , Department of Medicine, B.P. kiorala Institute of Health Sciences, Nepal

10. SOCIO-ECONOMIC, CULTURAL AND KNOWLEDGE PROFILE OF KALA-AZAR PATIENTS FROM ESTERN NEPAL

Mehta RS, Asst. Professor, College of Nursing

Email: [email protected]

Rijal S, Asso. Professor, Department of Medicine

B.P. Koirala Institute of health Sciences Dharan, Nepal

Abstract: Kala-azar is a Major public health problem in the Terai districts of Nepal. This study was conducted at B.P. Koirala Institute of Health Sciences (BPKIHS), when kala-azar project was first started in this institute. The main objective of this study was to to assess the socio-economic status of kala-azar patients, to explore the presence of known environmental factors which predispose to breading of sand flies, to assess the knowledge and attitude towards kala-azar and to identify any issues that hinders or delay in seeking prompt treatment.

It was an exploratory hospital based study. Patients admitted to the medical wards at BPKIHS during the period of 2056-4-1 to 2057-3-30, and diagnosed to suffer from kala-azar, by demonstrating leishmania donovani were included in the study. A total of 93 patients admitted over a period of one year were selected purposively for the study after obtaining verbal consent.

The study revealed that 53% study subjects were male. Maximum subjects were from morang 34% sunsari 32% and 29% from saptari. The majority of study subject i.e. 95% was from rural area and only 5% from urban. The occupation of 35% of study subjects were agriculture, where as 26% were housewives and 23% student. Majority of study subjects 77% lived in houses made up of mud and bamboo (fus) 75% had single store houses and 61% Respondents slept on a bed. Only 24% subject reported that they knew the cause of kala-azar and 50% subjects reported that disease is curable. For prevention, to decrease relapse rate and eradication of kala-azar, public awareness i.e. Health education, IEC regarding diseases process and available services; and community participation is essentials for prevention and eradication of kala-azar.

11. REASONS FOR TURNOVER AMONG THE NURSES WORKING AT BPKIHS

Mehta* 1 RS, Karki* 2 P, Paudel * 3 BH, Chaudhary* 4 R

B.P. Koirala Institute of Health Sciences

Dharan, Sunsari, Nepal

Abstract:

Introduction: Conflict is a natural phenomenon and is inevitable in any organization. Conflict in nursing organizations leads to turnover of nurses. Conflict, however, can also be valuable to an organization since it promotes innovative and creative problem solving, clarifies issues, and allows underlying problems to rise to the surface. The Objectives of this study were to explore the factors influencing Job satisfaction among the nurses working at BPKIHS, to investigate the reasons which have influences nurses in their decision to leave BPKIHS and to suggest recommendations for a more satisfying working environment by aiding staff retention.

Methodology: It was hospital based cross sectional Analytical study, conducted among the nurses working at BPKIHS for more than six months at the time of study and those who have resigned from BPKIHS. Stratified simple random sampling method was used to select the nurses working in BPKIHS and purposive for the resigned nurses. Total 150 nurses were included in the study. Using pre-tested questionnaire the data was collected, fulfilling all the ethical considerations. The collected data was analyzed using SPSS-4 package.

Results: It was found that majority of nurses (68.7%) were less the 25 years, Unmarried (49.3%), have job experiences less than 5 years (54.7%), from sunsari (48%), and living in quarter of BPKIHS (86%). Career opportunity elsewhere, Chance for further education, Negative attitude of nursing leaders, In-adequate salary and poor promotion opportunity are the Major reasons of nurses to leave or resign from BPKIHS.

Conclusion: To retain the nurses or decrease turnover there is need of increasing salary, Job security provisions, Immediate starting of BN programme, fair evaluation system and clear promotion policy. This study is useful for nursing leaders as well as BPKIHS authority to take corrective action in time to improve the situation and prevent the future consequences.

*1 Mr. Ram Sharan Mehta ,( Corresponding Author) Assistant professor, Medical-surgical nursing dept. College of Nursing, Email: [email protected], *2 Prof. Dr. Prahlad Karki , HoD, Dept. of Medicine and Hospital Director, *3 Dr. Bishnu Hari Paudel, Asso. Professor, Dept. of Physiology, *4 Mr. Ramanand Chaudhary , Master in Nursing, Paediatric Nursing dept. B.P. Koirala Institute of health sciences, Dharan, Sunsari, Nepal.

12. Patients’ Attitude Towards Nursing Students of BPKIHS

Mehta* 1 RS, Singh* 2 B B.P. Koirala Institute of Health Sciences

Abstract:

Introduction: Health care is a social role relationship between a helping agent and a person needing help. This relationship is considered psychologically and socially as half cures treatment procedure. Therefore the nature of relationship between nurses and patient has some degree of significant impact on the overall quality of health care.

Objectives: The objectives of this study were to assess the attitude of the patients regarding the presence and involvement of the nursing students in their clinical care in Medical–Surgical units of BPKIHS.

Methods: It was hospital based cross sectional study. The clients admitted in medical-surgical units in the day of data collection constitute the population of the study. The stratified simple random sampling method was used to select the sample and 75subjects were selected from all the wards of Medical-Surgical units of BPKIHS, where only 60 tools were returned back out of 75 tools. The collected data was entered in SPSS-10.5 software package and analyzed.

Results: The respondents reported that, presence of student nurses in ward make the clients glad (96.6%), know about own disease process (68.5%), behavior and temperament is good (93.2%), can ask most trivial questions (95%), learn while teach by senior nurses (96.7%), like to ask details of personal questions (93.3%), have more time for clients (51.7%), they examine in details (54.2%), help very much in treatment process (84.86%), and students also have knowledge about disease process (84.5%).

Conclusions: The development of technology has meant that hospital nurses are required to keep developing their skills to maintain professional standards and their understanding of new procedures and new equipment along with the need to develop the therapeutic relation with the patients to overcome the future challenges.

Key Words: Patients, Attitude, Nursing Students

Corresponding Author: * 1 Ram Sharan Mehta , Asst. Professor, Medical-Surgical Nursing Department, [email protected] , B.P. Koirala Institute of Health Sciences, *2 Babita Singh , Ward In-charge, Medical unit-I.

13.PERCEPTION OF NEWLY ADMITTED NURSING STUDENTS IN 2005 BATCH AT BPKIHS ABOUT NURSING PROFESSION

Mehta R.S.

Asst. Professor Medical-Surgical Nursing Department

B.P Koirala Institute of Health Science

Email: [email protected]

Introduction:

Nursing education and its quality, which is evident from the academic achievement of nursing students, foretells the efficiency of services to be provided by these students. The objective of this study was to find out the demographic characteristics and explore the various motivating factors to select nursing profession, among newly admitted nursing students of 2005 batch at BPKIHS.

Methodology:

It was descriptive exploratory study, conducted among the admitted nursing students in B.Sc. Nursing and Certificate Nursing (CN) programme in 2005 batch at BPKIHS.A total enumerative sampling technique was adopted to carry out the study. All the 20 students of B.Sc. Nursing and 41 students of certificate nursing were included in the study. After two weeks of orientation programme, using opinionaire the data was collected in their respective classroom maintaining confidentiality and explaining the purpose, by the investigator himself, as he is the nursing teacher.

Results & Discussion:

Total 61subjects (20 from B. Sc. Nursing and 41 form CN) were included in the study. It was found that the majority of the subjects were below 19 yrs. Ninety percent students of B. Sc. Nursing completed their schooling from English medium schools, where as 56.1% of CN. 100% B. Sc. nursing students completed their SLC and I. Sc. with first division where as 65.9% CN students completed SLC with first division. Majority of the students were self-motivated to study nursing. Easy access to job is the main reason for choosing nursing profession. Adequate infrastructure/facilities, competent teachers, healthy environment, safe place, reputed organization are the major factors that influences students to choose BPKIHS for study.

Conclusion:

Satisfaction level with getting seats in nursing course and nursing profession is higher among the CN students in comparison to B. Sc. Nursing students. Similar study can be conducted in large scale taking sample from many nursing schools. It is mandatory for nursing leaders to think on raising the professional standard so that society will give due respect to the nursing profession as well as nurses.

14. EFFECT OF TRAINING FOR NURSES WORKING IN TEACH ING DISTRICT HOSPITALS

Mehta* 1 R S, lama* 2 S, Parajuli* 3 P

B.P. Koirala Institute of Health Sciences Dharan, Sunsari, Nepal

Abstract:

Introduction:

Knowledge, like muscles, must be nourished-constantly and used frequently to retain function. Learning like motion, is more easily maintained if it’s momentum has not been interrupted. The objectives of this study are to discuss the recent trends and development in various fields of nursing practice and update knowledge and skills in concerned nursing practice areas for nurses working in these teaching district hospitals.

Research Design and Methodology:

It was single group pre-test post-test education i ntervention research design conducted among

the nurses working in district and zonal hospitals of eastern Nepal in two slots in 2004 and 2005.

Total 26 nurses (11 in first slot and 15 in 2 nd slot) were involved in one-week skill oriented tra ining

programme. After pre-test training programme was ta ken. The collected data was analyzed using

spss-4 package. The TA, DA and other allowances wer e provided to the participants as per WHO

policy.

Results: It was found that in average there is 46% incensement in the score value in posttest. Regarding

the programme evaluation most of the participants evaluated the content, duration, methods, clinical posting very good.

Conclusions:

The participants were highly appreciated this workshop and requested to continue in future as it is very useful and practical.

Authors: *1 Mr. Ram Sharan Mehta, (Corresponding author), Asst. Professor, Medical-Surgical Nursing Department. *2 Ms Sami Lama , Asso. Professsor, Psychatric Nursing Department, *3 Ms Pushpa Paraju li, Asso. Professor, Medical-Surgical Nursing Department, B.P.Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal

15. Impact of First Aid Training Program for School Teachers and School Management Committee Members of Morang District Nepal

Ram Sharan Mehta, Asst. Professor Medical-Surgical Nursing Department

B.P. Koirala Institute of health sciences Dharan, Sunsari, Nepal

E-mail: [email protected]

Abstract: For life time exposure the average person in a developed country have 1% risk of death and 30% risk of injury. In world’s rood daily 1,40,000 people injured, 3,000 die and some 15,000 disabled for life1. The cost of treatment and the complications after trauma can be decreased, if first-aid support is given and patient is transferred for the treatment in proper place as early as possible.

The objectives of this study was to train the schoolteachers and school management committee members regarding first-aid management of common problems requiring first-aid and evaluate the effectiveness of the training programme.

It was education intervention single group, pre-test post-test research design, conducted among the teachers and school management committee members of Selected schools of Morang district. Maintaining validity and reliability of the tool, pre-test was conducted. After pre-test training program on first-aid was conducted for two days and post-test was conducted at last. The findings were analyzed.

It was found that the training program conducted is very effective. The application of Mc Nemar’s chi squire test (P=0.0001) is highly significant in all the situations

Finally, it concludes that training program is highly effective and it can be implemented for all the teachers as well as high school students.

16.Satisfaction of clients in relation to THEIR hospital expenditure

Mehta RS* 1, Karki P* 2, Baral DD* 3

B.P. Koirala Institute of Health Sciences

Dharan, Sunsari, Nepal

ABSTRACT:

Introduction: Hospital costs can be a valuable guide to hospital management, if used intelligently.

Costing data, like other statistical data, can be collected only by expenditure of money and this should be

undertaken only if the data are going to be used as a tool of management.

Objectives: The objectives of this study were to find out the socio-economic status of the admitted

patients, explore their expenditure related to treatment and find out their satisfaction level.

Methodology: This was hospital based exploratory study, Conducted among the admitted patients in

wards of BPKIHS. Stratified simple random sampling method was adopted to collect data and 250

samples were included. Interview schedules were used after testing validity and reliability. The data were

analyzed using descriptive as well as inferential statistics.

Results: The Mean indoor hospital expenditure of the client is 10,895 Rs., whereas 65 % subjects

expended Rs. in between 1000-10,000 and 30.8% expended more than Rs. 10,000. About 7 % subjects

were satisfied more than their expenditure where as55.2% were fully satisfied and 32.8 % were just

satisfied and only 4.8 % were not satisfied.

Discussion and Conclusions: This study gives the real insight about hospital expenditure and client

satisfaction, so that aid in future management.

Investigators:

*1 Corresponding Author: Ram Sharan Mehta, Asst. Professor, Medical-Surgical Nursing Department, College of Nursing, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal. Phone: 00977-25-525555, Fax: 00977-25-520251, Email: [email protected]

*2 Prof. (Dr.) Pralahad Karki, HOD Dept. of Medicine and Hospital Director

*3 Mr. Dharnidhar Baral , Asst.Professor, Medical Record section & Statician

17. Demographic Profile and Outcomes of the Patients admitted in Critical care Units (ICU & CCU) of BPKIHS

Mehta* 1 RS, Karki* 2 P, Gupta* 3 PK, Rai* 4 HK

B.P. Koirala Institute of Health Sciences

Abstract:

Introduction: Critical care units, may be thought of as having context (the demographics and characteristics of the kind of work they do), structure (the grouping of people and the allocation of responsibility through specialization, expertise, formalization, and some degree of centralization or decentralization), process (intraorganizational relationships such as the flow of information and coordination), and outcomes (productivity, goal attainment, morale, and satisfaction of the members). B.P. Koirala Institute of Health Sciences (BPKIHS) has a 740 bedded tertiary care center hospital with 10 beds ICU and 4 beds CCU with modern facilities.

Objectives: The main objectives of this study were to find out the demographic profile and outcomes of the admitted patients in Intensive care unit (ICU) and critical care unit (CCU) of BP Koirala Institute of Health Sciences.

Methodology: It was a hospital based retrospective descriptive study design, conducted among the admitted patients (In ICU from 1-1-2003 to 31-12-2006 and in CCU from 15-3-2004 to 14-3-2006) of critical care units (ICU/CCU). The total number of patients admitted in critical care units during the study period constituted the population of the study. Total enumerative sampling technique was used to collect the data using the prepared Performa from the admission register of the ward. Total 1615 patients were included in the study i.e. 997 from ICU and 618 from CCU.

Results: In ICU among 997 patients 588 were transferred to ward after improvement, 262 expired, and 115 left against medical advice and 2 referred to better centers. In CCU among total 618 patients 426 transferred to ward after Improvement, 35 discharged, 93 expired, 61 left against medical advice and 7 were referred to better centers for treatment.

Conclusions: The number of admission in ICU/CCU is increasing yearly as the bed strength, patients load and complexity of cases increasing; hence the necessary management in ICU/CCU is mandatory to overcome the future problems.

Key Words: Demographic Profile, Outcomes, Critical Care

Authors: * 1 Ram Sharan Mehta, Asst. Professor, Medical-Surgical Nursing Department, *2 Prof. Prahlad Karki , HOD of Internal Medicine, *3Prof. P K Gupta , HOD, Dept. of Anesthsiology, *4Ms. Hari Kurmari Rai, In-charage, ICU/CCU unit.

18. Quality of Nursing Service in B. P. Koirala Institute of Health Sciences, Nepal

Ram Sharan Mehta, Asst. Professor Medical-Surgical Nursing Department

College of Nursing

B.P. Koirala Institute of health sciences Dharan, Sunsari, Nepal

E-mail: [email protected]

Abstract:

Quality nursing service means offering a range of nursing service as per the hierarchical needs of the clients in various settings. The success should be appropriate, safe, effective, and economical and should satisfy clients in all dimensions of health. Nursing with other health workers all over the world are facing difficult challenges. The public's expectation of them continues to rise. Nurses are asked to provide higher quality health services with fewer resources and different constraints. At the same time, the knowledge and skills-base needed to perform effectively in their chosen fields of endeavor continues to grow and change rapidly. Health care personnel will continue in the workforce for many years, while the information that they acquired during their education may rapidly become obsolete.

Health care institutions and their managers are also confronted with these realities. The challenge is to continue to maintain or improve the quality of the care and the comprehensiveness of health service converges, while introducing changes in care delivery system. Finally governments at local, regional and national levels are attempting to obtain greater value for the money they spend on health care. Faced with growing expectations of quality they are being asked to be more accountable for the results of their health care expenditures. Thus, they also have an important role to play in ensuring and improving the quality of health services provided in both the public and private sectors.1

The main objectives of this study were to assess the quality of nursing service provided by ward in-charges and nurses. It was hospital based descriptive exploratory study conducted in all the 28 wards of BPKIHS using five sets of Performa (tool) to evaluate their leadership qualities, functional capabilities, nursing care status, environmental sanitation of the unit and the documentation of clients. The data was collected in May and June 2006 by trained nurses, nurses working in the unit by participative observation methods. It was found that in average the ward in-charges were middle range performers (69.2%), performance level of ward in-charges are average (48.28%), nursing care status is satisfactory (72.32 %), cleanliness level is also satisfactory ( 65.9 %), and the level of documentation is above average ( 73.23 %).

The findings of the study clearly illustrate the need of continuous in-service education on managerial aspects of nurses so that quality of nursing service can be improved.

Key Words : Quality, Nursing, Service

19. Effect of Training Program Regarding First-Aid Management Among The High-School Students

Mehta* 1 RS, Sharma* 2 SS, Paudel* 3 RK B.P. Koirala Institute of Health Sciences

Abstract

Introduction: For life time exposure the average person in a developed country have 1% risk of death and 30% risk of injury. In world’s rood daily 1,40,000 people injured, 3,000 die and some 15,000 disabled for life1. The cost of treatment and the complications after trauma can be decreased, If first-aid support is given and patient is transferred for the treatment in proper place as early as possible.

Objectives: The objectives of this study was to train the high school students regarding first-aid management of common problems requiring first-aid and evaluate the effectiveness of the training programme.

Methods: It was education intervention single group, pre-test post-test research design, conducted among all the students studying in class 9 and 10 in the three selected high schools of sunsari district. It was census study and 696 students were selected. Maintaining validity and reliability of the tool, pre-test survey was conducted. After pre-test training program, first-aid training was conducted for two days. After two weeks post-test was taken. The collected data was analyzed.

Results: Out of 696 subjects 60.5% were Male and 39.5% were female. The mean age of students was 15.51 yrs. (Range=12-20 yrs and SD=1.41). It was found that the training program conducted was very effective. The application of Mc Nemar’s chi squire test (P=0.0001) is highly significant in all the situations except the management of unconscious patient (P=0.2148). Majority of the subjects (87.2%) reported that the training programme conducted was very useful and 12.8% reported useful.

Conclusions: Finally, it concludes that training program was highly effective and it can be implemented for all high school students. It will be beneficial if some important topics of first-aid included in curriculum of high school course.

Key words: First-aid, Training, High School, Students

Authors: * 1 Ram Sharan Mehta , (Corresponding Author), Asst. Professor, Medical-Surgical Nursing Department, Email: [email protected], *2 Prof. (Dr.) S.S. Khanal, Rector, *3 Dr. R.K.

Paudel, Dept. of Emergency, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal. Phone: 00977-25-525555, Fax: 00977-25-520251,

20. Socio-demographic Profile and Outcomes of the Admit ted AIDS Patients in BPKIHS

Ram Sharan Mehta, Asst. Professor

Medical-Surgical Nursing Department

Email: [email protected]

Babita Singh, Nursing Officer

B. P. Koirala Institute of Health Sciences, Nepal

Abstract: In world More than 40 million people are living with HIV/AIDS, 2.3 million are under 15 yrs , 14000 new infections each day , 1.7 million human infected with HIV/AIDS, 3.1 million deaths from AIDS , Million new HIV cases (13425) per day. In south East Asia 6.3 million PLWHA in 2005 (Source: WHO, UNAIDS).

It was retrospective descriptive study design condu cted at B.P. Koirala Institute of Health

Sciences (BPKIHS) among the admitted AIDS cases usi ng their case notes during the period of 1-

9-2003 to 30- 8-2006 using developed Performa. It w as found that Majority of the subjects (83.4%)

were of age group 20-40 years, Male (89.6%), and fr om sunsari district (47.9%). Half of the subjects

were improved after treatment and then discharged.

As the number of AIDS cases are increasing rapidly in eastern Nepal and BPKIHS is a centre for

treatment of AIDS cases, it is essential to conduct awareness activates regarding prevention of

disease and advocacy about available facilities of BPKIHS.

Key words: AIDS, Socio-demographic profile, BPKIHS

21. Knowledge Profile About the Care of Spinal Cord Inj ury Patients Among Their Caretakers at BPKIHS

Mehta RS* 1, Shrestha B* 2 , Khanal GP* 3, Rijal D* 4

B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Abstract: According to the National Spinal Cord Injury Association, as many as 450,000 people in the United States are living with a spinal cord injury (SCI). Other organizations conservatively estimate this figure to be about 250,000. Every year, an estimated 11,000 SCIs occur in the United States. Most of these are caused by trauma to the vertebral column, thereby affecting the spinal cord's ability to send and receive messages from the brain to the body's systems that control sensory, motor and autonomic function below the level of injury.

It is chronic disease condition which requires a lot of care during hospitalization as well as in the home. Special training to care the activities of daily living is vital. Keeping these issues in mind the investigator has planned to assess the training need of the SCI caretakers so that educational package can be planned and implemented in ward for better patient care. It was a hospital based descriptive analytical study conducted among the SCI patients and their caretakers admitted in orthopedic ward. Using purposive sampling technique 30 subjects were selected from 1st July 2006 to 31st December 2006. Using prepared semi-structured questionnaire data was collected. It was found that the most of the subjects were between age 20-60 years, male, married, middle economic group and from villages. Majority of cases admitted in first time (83%) having cervical and thoracic spine injury. The main reasons are fall injury. Most of the subjects have the ability to care manage the problems of bed sore, Paralysis, Nutrition where as very less no of care takers have knowledge about management of UTI, constipation, Pneumonia, and traction. This study concluded that the continuous in-service education programme on care of SCI patient to their caretakers is very essential for quality patient care.

Key Words: Knowledge Profile, Spinal Cord Injury, Caretakers

Note:

*1 Ram Sharan Mehta, Asst. Professor, Medical-Surgical Nursing Department,

*2 Dr. Bikram Shrestha , Associate Professor, Department of Orthopedics,

*2 Dr. Guru Prasad Knanal , Asst. Professor, Department of Orthopedics,

*3 Mrs. Dewa Rijal, Nursing Officer, orthopedic Ward

Corresponding Author: RS Mehta, Email: [email protected]

22. A Profile of Admitted Organophosphorus Poisonin g Patients in B.P. Koirala Institute of Health Sciences Nepal

MEHTA RS*1, KARKI P*2, SINGH B*3, SHAH I*4

B. P. KOIRALA INSTITUTE OF HEALTH SCIENCES, NEPAL

ABSTRACT:

Organophosphorus (OP) agents are used worldwide in increasing quantities as insecticides. Since agriculture is the main occupation in Nepal, OP compound are widely and easily available in ordinary shops and are often stored improperly.

The objectives of this study were to find out the socio-demographic profile of the admitted OPP clients, assess the details about the ingestion of Organophosphorus Poisoning (OPP) and explore the reasons for ingestion of OPP.

It was descriptive study conducted among admitted OPP clients in medical units, using convenient sampling technique. Thirty eight subjects were selected during the study period of 14th April 2006 to 13th April 2007 i.e. complete one year and interview was taken from them. The collected data was analyzed in SPSS-10 software package.

It was found that most of the subjects (94%) were age less than 40 years, female (57.9%), Hindu (78.9%), Married (57.9%), Non-vegetarian (94.7%) and belongs to middle class family (73.3%). The major brand names of poison used are Metacid (36%), Phorate (24%), and Thaimide (7%). About half of the clients (55.3%) were provided first-aid on spot, most of the clients (73%) brought to emergency within 2 hours of ingestion of poison and abut half of the clients (44.7%) were brought in unconscious state. The

main reasons of ingestion of poison are family problems (55.3%), personal problems (42.1%), followed by accidental (2.6%).

Based upon the findings we can conclude that it is common below age group of 40 years, female, farmers and middle class clients. Most of the clients not received first-aid on spot and brought to emergency in unconscious state. The public awareness on prevention of ingestion and first-aid management of OPP is vital to reduce the morbidity.

Key words: Profile, Organophosphorus, Poisoning

Note: *1 Ram Sharan Mehta, Assistant Professor, Medical-Surgical Nursing Department, College of Nursing. Email: [email protected] *2 Prof. Prahlad Karki , HOD, Dept. of Medicine. *3 Ms Babita Singh , Ward In-charger, Medical Unit-I. *4 Mr. Isrial Shah , Ward In-charge, Medical Unit-II.

23. Socio-demographic Profile of the Cancer Patients Treated at BPKIHS in 2004

Mehta*1 RS, Bhandari*

2 S, Jha*

3 CB.

B.P. Koirala Institute of Health Sciences

Abstract:

Introduction: The burden of cancer is increasing worldwide. About 100 types of cancer affect human

being. During the period of 1998-2002, there were 24.6 million people living with cancer. More than 10

million People developed cancer in 2000. World wide about 8 million cancer deaths a year. The number

of new cases annually is estimated to rise from 10.9 million in 2002 to more than 16 million by 2020, if

this trend continues. By applying existing evidenced based knowledge, it is possible to prevent at least

30% of cases and 30% cases could cured, If given earlier diagnosis and effective treatment. Hence,

cancer information and education programme is essential.

Objectives: The main objective of this study is to find out the socio-demographic profile of the cancer

patients treated in BPKIHS in 2004.

Methods: It is hospital based descriptive exploratory research design, conducted among the discharged

diagnosed cancer patients at BPKIHS, using their discharge file/record. Using prepared Performa the

socio-demographic profile of all the 528 diagnosed cancer patients of 2004 was collected, by identifying

the case notes using coding index card from Medical record section.

The collected data was analyzed and presented in tables and graphs. This study also provides the base line information for the cancer information and education activities at BPKIHS.

Results: As per the record it was found that the number of cancer patients diagnosed and treated in

BPKIHS is increasing i.e. 203 cases in 2054 BS where as 485 in 2060. Among the diagnosed cases: 62 %

were of age group 36-65 yrs, 50.7 % Male, 82.8 % Hindu, and 82.8 % patients were diagnosed by

histology report.

Discussion: The numbers of cancer patients are markedly increases in BPKIHS, especially in advanced

age and in late stage. As BPKIHS is tertiary care hospital of eastern Nepal having cancer diagnosis, It is

easier to diagnose cases in early stage and can be treated and refer to BPKMCH, Bharatpur and other

centers in time for proper management. As these data are hospital based, it could not reflect the true

picture of Nepal.

24. Knowledge Attitude and Practice Regarding Post-exposure Prophylaxis of HIV among the Nurses Working in B.P. Koirala Institute of Health Sciences

Email: [email protected] Mehta RS, Thapa S.

B. P. Koirala Institute of Health Sciences, Nepal

Background: Post Exposure Prophylaxis of HIV is a medical response given to prevent the

occupational transmission of pathogens after potential exposure to blood and body fluids. This

study was conducted to assess the Knowledge, Attitude and Practice Regarding Post Exposure

Prophylaxis of HIV among the Nurses Working in BPKIHS.

Materials & Methods: Descriptive cross sectional design was adopted for the study. The sample

size was 105 and Stratified systematic sampling technique was adopted to select the respondents

from various wards and OPD’s of BPKIHS which constituted of 13 SSN, 72 SN and 20 ANM.

Data were collected using pre-tested, self administered semi- structured questionnaire.

Results: The study results showed that the median percentage of overall knowledge regarding PEP

of HIV was 55.55% and that of attitude was 80.00%. The overall median percentage of practice was

33.33%. This shows that there is lack of proper practice in comparison to knowledge and attitude.

Majority of them i.e. 74.28% suggested that ISE/ training should be provided for improving KAP

regarding PEP of HIV among Nurses.

It was found that there was significant association of knowledge with variables like previous

training on HIV/AIDS (p-value=0.001). Similarly attitude regarding PEP of HIV was

significantly associated with age (p-value=0.006) and total nursing experience after the

completion of study (p-value=0.04) and practice was also significantly associated with previous

training on HIV/AIDS (p-value=0.006). The three dependent variables (KAP) were positively

significantly correlated with each other.

Conclusions: Based on the study, it can conclude that there is difference in knowledge and

practice among the nurses who received previous training and those who do not.

25.

Home Based Care to the People Living with AIDS in Eastern Rural Nepal: An Aspects Analysis

Mehta RS*1, Silwal UK*2 . Email: [email protected]

Abstract: Background: Home based care (HBC) is the care in the home which responds to the physical, social,

emotional and spiritual needs of PLWA from diagnosis to death and through bereavement. The objective

of this study was to examine the aspects of HBC to the people living with AIDS (PLWA) and their effects

on caregiver and family in Eastern Rural Nepal

Methods: There is two parts in the study. The first part of the study, i.e. the situation analysis,

descriptive cross-sectional research design and in the second part, pre-experimental research design

was used.

Results: Most of the (72%) PLWA were male, whereas, most of the caregivers (69.6%) were female.

Most of the caregivers (84%) were married, illiterate (25.6%), and HIV positive (37.6%). Most of the

caregivers (67.2%) reported high caregiver burden and family burden (57.6%). Majority of the caregivers

were suffering with psychological problems (100%), financial problems (85.7%), stress (60%), insomnia

(56%), and headache (55.2%). Only 12% caregivers had received CHBC training. There are significant

relationships between demographic variables with HBC aspects, caregiver burden and family burden at

0.05 level of significance. The education intervention programme on HBC implemented was very

effective. The findings of the study obtained from caregivers of PLWA are supported by the results

obtained from Case Study, Focus Group Discussion, and Key Informant Interview.

Conclusions: The findings of the study have implications in the capacity building of caregivers of PLWA for enhancing the quality of life of PLWA. It is recommended that government continue to support increasing access to community and HBC as part of its national strategy and identify ways in which to expand and integration of these services into the public health care system.

1Ram Sharan Mehta,Ph.D. , Additional Professor, B. P. Koirala Institute of Health

Sciences, Dharan, Sunsari, Email: [email protected], 2Dr. Uma Kant Silwal, Associate Professor, Central Department of Rural Development, Tribhuvan University.

Introduction: In world More than 40 million people are living with HIV/AIDS, 2.3 million are under 15 yrs , 14000 new

infections each day , 3.1 million deaths from AIDS , Million new HIV cases (13425) per day. In south East

Asia 6.3 million PLWHA in 2005 as reported by UNAIDS1.

In Nepal the estimated number of PLWHA at end 2005 is 61,000, HIV prevalence in 2005 was 0.5,

estimated number of AIDS cases are 7,800, number of child (0-18) orphaned by HIV/AIDS is 18000,

receiving Anti Retroviral Treatment (ART) till December 2005 was 210.

Due to industrialization, modernization, labor migration, tourism, increase in IV drug users, the number

of PLWA is increasing in eastern Nepal. Most of the areas in eastern Nepal is deprived from HIV/AIDS

available services. The care of PLWA is mostly provided in home, hence trained caregiver can play vital

role and help in rural development.

The eastern region of Nepal is very prone area for HIV/AIDS because of increasing number of IV drug

users in Dharan, Lauhure is the main occupation of majority of Mangolians residing in Dharan, Ithari,

Damak, and eastern hilly districts. Eastern border of Nepal Kakarbhita is very near to Indian city of New

Jalpaigudi, Siliguri and Darjiling. Southern boarder of Nepal is also open and rural people used to go to

India especially in Punjab, Delhi, Mmumbi and other major cities of India frequently for earning and

labor work. In eastern Nepal, especially Jhapa and Morang there is major issues of Bhutanese refuses,

where the problems if HIV/AIDS is also evident.

In eastern region of Nepal the main towns are Dharan, Biratnager, Ithari, Damak, Inruwa, Rajbiraj,

Bhadrapur, and Kakarbhita, where the migration of people from urban to rural and rural to urban is very

high. The NCASC data shows that eastern region of Nepal is the prone area of HIV/AIDS. In eastern

region of Nepal there are four ART centers at Dharan, Biratnagar, Rajbiraj and Bhadrapur. Some other

centers are going to establish in near future as per the record of NCASC.

Objectives: 1. To find out the Socio-demographic profile of the people living with AIDS and their caregivers.

2. To explore the aspects of home-based care to the people living with AIDS.

3. To find out the association between Socio-demographic variables and home-based care aspects

of caregivers.

4. To investigate the effects of home-based care on their family.

Null Hypothesis:

Ho1: There is no association between socio-demographic variables and aspects of home-based

care of caregivers.

Ho2: There is no association between socio-demographic variables of people living with AIDS and

aspects of home-based care.

Ho3: There is no association between aspects of home-base care and effects on family.

Research design and methodology:

It was descriptive cross-sectional study conducted among the caregivers of people living

with AIDS in eastern region of Nepal. The data was obtained from the primary caregivers,

PLWA, and key informants. Interview Schedule guidelines, Case Study guidelines, Focus

Group Discussion guidelines and Key Informant Interview guidelines were used to

collect the relevant Information from concerned people involved in the care of PLWHA.

In the second phase pre-test post-test questionnaire was used to collect the data. It

was found that total 722 PLWHA were registered in all the four ART centers of eastern

region of Nepal and among those 299 were on ART and 139 clients were on ART belongs

to villages.

From the prepared list the subjects were approached individually with the help of VCT/ ART nurse and

after obtaining informed written consent the data was collected maintaining privacy.

The research instrument used for study was interview questionnaire. There are major four parts in

interview questionnaire. The first part consists of socio-demographic profile of PLWA and the second

part consists of socio-demographic profile of caregivers. The third part of the tool consists of the various

aspects of home based care and burden assessment scale. The part four of the interview questionnaire

consists of the questions to assess the effects of home based care on family. The tool was prepared from

the standard tools used by Zarit10

, Donabedian4, Montogometry

9 and Kipp

11

Content and face validity of the tool was established with the experts of concerned field like:

Academicians working in the areas of HIV/AIDS, family caregivers and qualitative researchers as well as

practioners working in the field of HIV/AIDS were review the research methodology and validity was

established.

Results:

Demographic profile of the PLWA: It was found that most of the PLWA were male (73.4%), age less than

40 years (85.9%), Hindu (92.2%) and Married (71.9%). Most of the PLWA were suffering with disease for

more than 6 months i.e. 76.6%, at WHO stage of disease four (81.3%), main route of the disease

transmission is commercial Sex–workers (50%) and most of them (95.3%) were adherent to ART

therapy. About 35.9% PLWA were infected with pulmonary TB, 45.3% were smoker, 37.5% had past

history of alcohol use, and 7.8% were suffering with HCV positive.

Demographic characteristics of caregivers: Most of the caregivers were female (64.1%), Hindu (90.6%),

Married (81.3%) and 35.9% care givers were HIV positive.

Home based care aspects of caregivers: Most of the (85.9%) caregivers were their direct family

members and their wife (51.6%). Most of the caregivers (51.6%) had received informal health education

on HIV/ AIDS and 21.9% reported they have high risk of transmission of HIV infection; where as 18.8%

were HIV positive. Most of the caregivers had knowledge about transmission of HIV infection i.e. vaginal

sex (89.1%), Blood transfusion (85.9%), virus is found in blood (87.5%) and 71.9% reported the disease is

communicable. The services provided by the caregivers to PLWA usually were emotional support

(15.6%), helping in ADL (20.3%), health care advocacy (21.9%) and nursing care (17.2%). The help and

support received by caregivers from others were, physical care support (40.6%), material support

(34.4%), financial support (42.2%), and network support (26.6%).

Effects on caregivers using burden assessment scale: There are fifteen components in burden

assessment scale in 4 likert scale. The full score is 60. The mean burden score is 36.1719 with SD

7.04983 and range 19-51. The details are in table – 1.

Effects on family based using burden assessment scale: Family burden was calculated using burden five

point rating assessment scale on 20 components. The total burden score is 80. The mean burden score

found was 44.6250 with SD 10.93342 and Range 18 – 72. The details are in table – 2.

Association between Demographic Variables of caregivers, mean caregiver burden score, mean family

burden score, knowledge score on HIV / AIDS and problems faced by the caregivers: The association

between selected demographic variables and mean burden score was calculated using Pearson chi-

squire test at 5% level found not significant. The association calculated between selected demographic

variables with mean family burden score found insignificant at 5% level of significance.

The association calculated with selected demographic variables with selected knowledge components

found significance on the association between age and blood transfusion (P = 0.014), Relationship with

Clint and blood transfusion (0.057), age and communicable nature of diseases (P = 0.002), Relation with

client and PEP (P = 0.042) at 5% level of significance. The associations between other variables are found

insignificant.

The association calculated between selected demographic variables and problems faced by caregivers

were found significant between the variables, type of family members and stresses / Anxiety (P = 0.005),

type of family members and insomnia (P = 0.035), Relation with client and insomnia (P = 0.012), and

type of family members with insomnia (P = 0.047). With other variables there is not significant

association at 5% level of significance.

The association calculated between mean caregiver burden scores and mean family burden scores

found significant (P = 0.014) at 5% level of significance using Pearson chi-squire test.

Discussion:

Most of the (73.4%) PLWA were male, age less than 40 years (85.9%), Hindu (92.2%), married (71.9%),

and adherence to ART (95.3%). The major route of transmission was CSW (50%) followed by IDU (15.6%)

and about 36% PLWA were infected with pulmonary TB, history of smoker (45.3%), and HCV positive

(7.8%). The study conducted by Dhungel10

reported the pulmonary TB is common infection among PLWA

and it was about 30, which is similarly to this study. The study conducted by Acharya11

reported that

60% patients were from lower socio-economic status and worked in Indian metropolis. As per NCASC12

report 95% PLWHA belongs to low and middle income countries and the major mode of transmission is

heterosexual. Similarly the reports of UNAIDS1 mentioned that 10% migrant workers returned from India

is HIV positive. Similarly Joshi13

in his study reported that the disease is common in male than female.

Similar findings were reported by Wade14

.

Most of the caregivers (64.1%) were female, Hindu (90.6%), Married (81.3%), and 35.9% were HIV

positive. Most of the care givers (51.6%) were their wife and most of them reported they were at risk of

getting HIV infection. The Orner15 reported that majority of caregivers were female, which is similar to

the findings to this study. Leana16

in her study reported that palliative care in the formal health services

was generally poor due mainly to lack of specific training in this field and the stigma associated with this

diagnosis, which is equally significant in our context also.

Most of the care givers had knowledge about the major route of transmission of HIV infection i.e.

vaginal sex (89.1%), blood transfusion (85.9%), and sharing raiser (50%). Only 32.8% reported the care of

HIV infection is virus, and it is found in blood (87.5%), semen (85.9%), and vaginal fluid (85.9%), where as

29.7% reported that it is also found in saliva. Most of the caregivers don’t have the knowledge about

taking temperature, pulse, etc. Chappell7

in his study reported that most of the caregivers had less

knowledge about disease process and management of it , which is similar to the findings of this study.

There is no association between selected demographic variables (age, Sex, type of caregiver, relation

with client, duration of providing care and HIV-sero-statas of caregiver) with the mean caregiver burden

sores at 5% level of significance. Similarly there is no association with selected demographic variables

with mean family burden score at 5% level of significance.

The association calculated between selected demographic variables with knowledge sores were found

significant with some variables like age and blood transfusion (P = 0.014), age and communicable nature

of disease (P = 0.002), relationship with client and PEP (P = 0.042). The study by Olley17, reported that

decreasing education, lower income, urban residence of the respondent and female gender were

associated with a negatively attitude to home based care to the PLWA.

The association calculated between mean caregiver burden scores and mean family burden scores

found significant (P = 0.014) at 5% level of significance using Pearson chi-squire test. The study

conducted by Bhardwaj19 found that female caregivers felt more burden than male caregivers. Gender

and family income is not associated but length of care giving is associated which is similar to the findings

to this study. Neena20

in her study found that well-being was directly affected by four variables:

perceived social support, burden, self-esteem, and hours of informal care. Burden was affected directly

by behavioral problems, frequency of getting a break, self esteem, and informal hours of care and was

not affected by perceived social support. She also reported the fact that social support is strongly

related to well-being but unrelated to burden affirms this view.

Conclusion:

HIV/AIDS is a disease with severe social consequences that primarily affects those who are already poor

and socially disadvantaged. HIV/AIDS is accompanied by bereavement, loss of relationships,

unemployment, disability, increased health care costs, stigma and ostracism, and fear of premature

death16. Home based care is recommended as an appropriate form of support for people live with

HIV/AIDS. Innovative strategies are required to establish effective partnerships between the NGOs,

INGOs and government agencies.

References:

1. UNAIDS Report 2008. Understanding the latest estimation of 2008 report on the global AIDS

epidemic

2. Mwinituo Prudence, Mill JE. Stigma associated with Ghanian Caregivers of AIDS patients. Western

Journal of Nursing Research. 2006; 28(4): 369-382.

3. Underwood, C. HIV/AIDS burdens more than patients. Express News. 2006; July-18

4. Vithayachockitikhum, N. Family caregiving of persons living with HIV/AIDS in Thailand. Caregiver

burden, an outcome measure. International Journal of Nursing Practice. 2006;12(3): 123.

5. Zarit, S.H., Todd, P.A., & Zarit, J.M. Subjective burden of husbands and wives as caregivers: A

longitudinal study. Gerontologist; 1986;26: 260–266.

6. Fitting, M., & Rabins, P.V. Men and women: Do they give care differently? Generations. 1985; 10:

23–26.

7. Reinhard, S.C. Living with mental illness: Effects of professional support and personal control on

caregiver burden. Research in Nursing and Health. 1994;17: 79–88.

8. Mushonga, R.P. Social support, coping, and perceived burden of female caregivers of HIV/AIDS

patients in rural Zimbabwe. Unpublished doctoral dissertation, Case Western Reserve University,

Ohio. 2001

9. Kipp W, Tindyebwa D, Karamagi E, Rubaale T. Family caregiving to AIDS patients: The role of Gender

in caregiver burden in Uganda. Journal of International women’s studies. 2006; 7(4): 1-13.

10. Chappell, N.L., Reid, R.C. Burden and well being among caregivers: Examining the distinction.

Gerontologist; 2002;42: 772–780.

11. Opiyo PA, Yamano T, jayne TS. HIV/AIDS and home-based health care. International Journal for

inquiry in heath. 2008:7(8):1-4.

12. NCASC . AIDS News letter: Quarterly (Asoj). Women, Girls, HIV & AIDS, 2061; 53:13-17.

13. Joshi, A.B., Banjara, M.R. Karki, Y.B., Subeddi B.K., & Sharma, M. Status and trends of HIV/AIDS

epidemic in Nepal. JNMA. 200443: 272- 76.

14. Aich, T.K., Dhungana, M., Kumar, A., & Pawha, V.K. Demographic and clinical profiles of HIV positive

cases: A Two year study report forms a tertiary teaching hospital. JNMA. 2004;43:125-129.

15. Orner, P. Psychosocial impacts on caregivers of people living with AIDS.AIDS Care. 2006;18(3): 236-

240.

16. Leana RU, Sc DS. Aspects of care of people with HIV/AIDS in South Africa. Public Health Nursing.

2003; 20 (4):271-280.

17. Olley BO, Ephraim OO, Lasebikan VO, Gureje O. Attitudes towards community based residential care

for people living with HIV/AIDS in Nigeria. Afr. J Med Med Sci. 2006; 35:1.3-1.8.

18. Uwimana J, Struthers P. Met and unmet palliative care needs of people living with HIV/AIDS in

Rwanda. Journal Des Aspects Sociaux du VIH/SIDA. 2007; 4(1):575-585

19. Bhardwaj, A., Biswas, R., & Shetty, K.J. HIV in Nepal: Is it rarer or the tip of an iceberg? Trop Doct, 2001;31: 211-213.

20. Neena LC, Reid RC. Burden and well-being among cargivers: examining the distinction. The

Gerontologist. 2000;42(6): 772-780.

Quality of Nursing Service in B. P. Koirala Institute of Health Sciences

Ram Sharan Mehta, Associate Professor

Medical-Surgical Nursing Department

B.P. Koirala Institute of Health Sciences, Nepal

Email: [email protected]

Introduction :

Knowledge, like muscles, must be nourished constantly and used frequently to retain function. Learning like motion, is more easily maintained if it's momentum has not been interrupted.

Quality of care simply means that what is done for the patient is necessary, and that what is necessary is

done. Coordination of care is displayed when the different parts of the care on different days by

different caregivers, and care from various departments are harmonized into the whole patient care

Leadership qualities: The quality of technical care consists in the application of medical science and

technology in a way that maximizes its benefits to health without correspondingly increasing its risk. The

degree of quality is, therefore, the extent to which the care provided is expected to achieve the most

favorable balance or risks and benefits. Proper performances of interventions are known to be safe,

affordable to the society and produce an impact on mortality, morbidity, disability and malnutrition.

The dimensions of quality are: Technical competence effectiveness (correct manner), efficiency (maximum benefit to client, use of available resources, cost affective, continuity service delivery, interpersonal relations (respect, confidentiality, courtesy, responsiveness and equality), safety (maximum risk of injury; infection and side effect), and Amenities. Some of the important quality assurance mechanism, which is considered, for providing health care in our country is: Licensure, credentialing (granting authorization to provide specific patient care and treatment), Accreditation, standards, indicators, continuous education, procedure and infection control.

Functional capabilities: In recent years, acquired a new philosophy of health, which may be stated as: Health is human fundamental rights, an essence of productive life, and not the result of ever increasing expenditure of medical care. Health is intersectorial, and integral part of

development, health is counter to the concept of quality of life, involves individuals, states and international responsibility. Health and it's maintenance is a major social investment and health is world-wide social goal. Nursing care status: Factors like overflow of patients, imbalanced nurse patient ratio, ineffective work distribution, inadequate facilities for in-service education training, inadequate supply of equipment and facilities, first contact care provider, unknown about diagnosis, advances in disease pathogens, new trends of disease, twenty four hour station duty etc. effects the health of nursing personnel14. Therefore, it's necessary to evaluate whether these factors are helping or hindering nursing care in the institute or not. With the ongoing emphasis on resource management, cost control, efficiency in patient care, quality

improvement, and accountability, we are required to provide quality patient care and documentation at

the same time. Nurses are expected to fulfill major and sometimes conflicting responsibilities with

reduced staffing. When we cannot fulfill both the responsibilities, we try to satisfy ourselves by fulfilling

the one with the higher priority.

Documentation: Documentation must be accurate, clear, concise, complete, and timely. Speed is of the essence when working in healthcare, but accuracy and completeness are imperative when

documenting. Do not let the patient’s health be compromised by worrying about the speed; make sure it gets done right the first time. Documentation must have meaning today, tomorrow, and in the

unforeseen future. One of the difficulties with documentation is that we never know when what we

document will be needed. You want to make sure the right information gets documented and that

documentation is done correctly. Nursing documentation is important and not just for legal purposes.

The results and benefits of nursing documentation are greater than the sum of the tasks themselves. It isn’t an easy task, but it is necessary and it is a way of giving high-quality patient care. The lack of

proper documentation can negatively impact patient care and can ultimately cause other problems.7

Transitions in health care have sparked public and professional concern regarding the status of inpatient hospital nursing and its effect on the quality of care in hospitals, prompting the Institutes inquiry into this issue. It has been well documented that the work environment affects nurse satisfaction and turnover; which in turn influences the organizational lost of replacing nurses. Theoretically, the environment in which care is delivered affects patient, nursing and institutional outcome. Nursing can be though of as an organization's surveillance system, in those nurses is present around the clock. In addition, nurses functioning in such an environment can apply resources as appropriate for best meeting patient needs and for communicating problems to the physician in a timely manner. Theoretically, these environmental factors are responsible for better patient, nurse and organizational outcomes.

Objectives:

The Objectives of the study was to find out the leadership characteristics ranking of the ward in-

charges, evaluate performance level of ward in-charges on various managerial activities, investigate the

nursing care status in the wards, assess the environmental sanitation status maintained in the ward and

evaluation of nursing documentation standard maintained in their respective wards.

Methodology:

It was hospital based descriptive exploratory study design conducted in all the 28 Wards/Units

(Medical-I, II, III, Surgical- I,II,III, Orthopedic, Eye, ENT, Paying, ICU/CCU, Dialysis, OT (Day Care, Routine,

Emergency, Gynae), Emergency, Antenatal/Labor, Postnatal, Gynae, Pediatric-I,II,

NICU/PICU/MICU/Nursery, CSSD, Tropical, Derma, Psychiatric, Dressing/Injection room) of BPKIHS,

where Nurses provide Nursing care to the clients. The In-charges, Nurses, documentation maintained in

the ward and Observation of real situation was the source of data collection. The main areas of study

were: leadership characteristics ranking of the ward in-charges, level of ward in-charges on various

managerial activities, the nursing care status in the wards, the environmental sanitation status

maintained in the ward and nursing documentation standard maintained in their respective wards.

Using total enumerative sampling technique all the wards/units of BPKIHS was selected for study

purpose.

To collect the data, Leadership Characteristics ranking Performa developed by ICN was used and the

Performance level Performa, Nursing care status evaluation Performa, Environmental sanitation

evaluation Perform and Nursing documentation (Recording/Reporting) evaluation Performa developed

by the investigators was used.

Method of data collection: 2-3 nurses working in the same unit were selected randomly from respective

wards are trained and involved in data collection under the guidance of investigators. The collected data

was entered in SPSS-10.5 software package and analyzed. The details of the findings are depicted in

tables and graphs in the results.

Results & Discussions:

Very few literatures were available on this study in world. No study was available in Nepalese context.

Leadership Characteristics: It was found that the mean score obtained was 55.37(69.2%) out of 80 full

score. The range score was 41-66, and SD =7.422. It was found that most of the ward in-charges were of

middle ranking that is (69.2%), which require a lot of effort to make them competent. The details are in

table I.

Performance level: It was found that the mean score obtained was 37(48.28%) out of total 75 full score.

The performance level of ward in-charges on various managerial activities is below average. This clearly

illustrates the poor quality of nursing management in ward and needs continuous nursing education on

management.

Nursing Care Status of ward: It was found that the mean score obtained was 47(72.32%) out of total 65

full score. The nursing care status in BPKIHS is satisfactory i.e. mean percentage score was 47(72.32%),

out of 65. which clearly illustrate that the nursing care level in BPKIHS is not compromised.

Environment Sanitation of ward: It was found that the mean score obtained was 19.77(65.9%) out of

total 30 full score. The environmental sanitation (cleanliness) of the ward was above average standard

i.e. mean score 19.77(65.9%), out of total score 30, which gives clearly picture of better environmental

sanitation.

Nursing Documentation Status of the Ward: It was found that the mean score obtained was

91.53(73.23 %) out of total 125 full score. The nursing documentation status was satisfactory i.e. mean

score was 91.53 (73.23%) out of total score of 125, which clearly illustrate the improved documentation

status at BPKIHS. The details are in table II.

In general we can conclude that the personal leadership characteristics and performance of ward in-

charges are average and need to improve. In spite of inadequate leadership characteristics the quality of

nursing service and nursing documentation status is satisfactory and above average.

Conclusions:

Based upon the findings it was concluded that the nursing leaders (especially ward In-charges) needs

improvement in leadership quality by continuous nursing education, where as the quality of nursing

service and documentation needs improvement in some parameters.

References:

1. Aiken LH, Patrician PA. Measuring organizational traits of Hospitals: The Revised Nursing work

Index: Nursing Research: 2000; 49(3): 146-153.

2. Staub MM. Quality of nursing diagnosis and patient satisfaction. A study of the correlation.

Pflege. 2002 Jun;15(3):113-21.

3. Boccoli E, Lavazza L, Tomaiuolo M, Brandi A, Melani AS, Trianni G. The content and structure of

nursing documentation in Careggi Hospital, Florence, 1998: results and perspectives. Epidemiol

Prev. 2001 Jul-Oct;25(4-5):174-80.

4 . Vanhaecht k, karel d w, roeland d e , walter s . Clinical pathway audit tools: a systematic

review. J o u r n a l o f N u r s i n g

M a n a g e m e n t . 2 0 0 6 ; 1 4 : 5 2 9

5. Vanhaecht, kris, witte, karel de, depreitere, roeland & sermeus, walter. Clinical pathway audit

tools: a systematic review. Journal of Nursing Management 14 (7), 529-537

6. Anupam Chattoraj*, S Satpathy**, R K Sarma. A study to Ascertain the Misuse/Wastage of

Medical Record Forms at a Tertiary Super-Speciality Hospital. 2004; 16(2): 7-12.

7. Nursing documentation must make sense, must have meaning, and must communicate.

8. Effect of Poor Documentation. Journal of the Academy of Hospital Administration, Volume 16

No. 2 July-December 2004

9. Thakur L. Factors affecting the role and functions of staff nurse in Nepal: TU, IOM, 1993.

10. Mehta RS, Pokhrel T. Leadership and Management. Makalu publication. 2007;Katahmandu,

Nepal.

Table: - I

Leadership Characteristics ranking of the ward In-c harges

N=27

SN Leadership

Characteristics

Obtained Score

Full Score= 5 (100%)

Mean Obtained

score

1 2 3 4 5 Mean

Score

Mean

Percentage

Score (%)

1 Vision 0 7.4 29.6 59.3 3.7 3.59 71.8

2 External Awareness 0 7.4 37 55.6 0 3.48 39.6

3 Customer Orientation 0 0 48.1 48.1 3.7 3.55 71

4 Political Skill 0 11.1 55.6 33.3 0 3.22 64.4

5 Motivation 0 11.1 29.6 48.1 11.1 3.59 71.8

6 Confidence and Trust 0 3.7 51.9 44.4 0 3.40 68

7 Influence and

Negotiation 3.7 14.8 44.4 37.0 0 3.18 63.6

8 Creative and Strategic

thinking 0 11.1 48.1 37.0 3.7 3.33 66.6

9 Interpersonal 0 11.1 11.1 74.1 3.7 3.70 74

10 Team Building 0 7.4 25.9 55.6 11.1 3.70 74

11 Oral Communication 0 7.4 22.2 51.9 18.5 3.81 76.2

12 Written Communication 0 11.1 40.7 40.7 7.4 3.44 68.6

13 Self Direction 0 19.5 42.7 25.9 11.8 3.70 74

14 Decisiveness 0 11.1 33.3 51.9 3.7 3.48 69.6

15 Problem Solving 0 7.4 40.7 48.1 3.7 3.48 69.6

16 Review and Change 0 3.7 59.3 37.0 0 3.33 66.6

Total Score Obtained

( full score=80) Mean=55.37 Range=41-66 SD=7.4222

55.37 69.2

Table: - II

Evaluation of Documentation (Recording/Reporting) M aintained in the Ward

N=26

SN Details of Documentation

Obtained Score Full Score= 5 (100%)

Obtained score Full Score= 5 (100%)

1 2 3 4 5 Mean Score

Percentage Score (%)

1 Vital Signs: (TPR, BP, HT. Wt.)

0 0 21.7 60.9 17.4 3.95 79

2 Drug Cardex 0 0 13.6 63.6 22.7 4.09 81.8 3 Inventories: store 0 0 32 40 28 3.96 79.2 4 Intake/output 0 13.6 18.2 59.1 9.1 3.63 72.6 5 Nursing care records 0 20.8 20.8 44.8 12.5 3.50 70 6 Incidental records 0 4.3 34.8 47.8 13.0 3.69 73.8 7 Daily expenditure

records 0 3.8 23.1 50 23.1 3.92 78.4

8 Round: doctors 5.3 5.3 26.3 36.8 26.3 3.73 74.6 9 Log book 37.5 0 25.0 37.5 0 2.62 52.4

10 Student's record: performance, teaching procedure checklist attendance, assignment evaluation formats

0 0 42.9 42.9 14.3 2.71 74.2

11 Duty roster 0 12 0 48 40 4.16 83.2 12 Office records: inter

office correspondence 0 4 24 60 12 3.478 69.56

13 Leave records 0 8 24 40 28 3.88 77.6 14 Census 4.5 13.6 18.2 36.4 27.3 3.68 73.6 15 Infection: Nosocomial 12.5 12.5 44.8 16.7 12.5 3.04 60.8 16 Consent: Informed *&

high risk 0 0 20.8 54.2 25.0 4.04 80.8

17 Pre operative checklist 0 5.6 11.1 44.4 38.9 4.16 83.2

18 Medico-legal records 0 13 13 47.8 26.1 3.86 77.2 19 Admission discharge

deaths, cases absconded

0 4.5 9.1 59.1 27.3 4.09 81.1

20 OT scrub/circulating nurse record

0 0 0 60 40 4.40 88

21 Nursing care plan 16.7 16.7 50 16.7 0 2.66 53.2

22 Nursing assessment records

22.2 16.7 22.2 33.3 5.6 2.83 56.6

23 Special records pupil GCS LOC MSE reflexes Edema chest sound heart sound

21.4 21.4 7.1 35.7 14.3 3.00 60

24 Performance record (AER) staff students’ helpers

0 17.4 17.4 65.2 0 3.47 69.4

25 Bills admission discharge investigations OT special

4.3 4.3 13 43.5 34.8 4.00 80

charge Total Score Obtained ( full score=125) 91.53 73.23

Nursing Care Time Required Providing the Care to the Patients on Adult Mechanical Ventilator

Admitted in ICU of BPKIHS

Mehta*1 RS, Bhattari*2 BK.

B.P. Koirala Institute of Health Sciences, Nepal

Email: [email protected]

Abstract:

Background: The primary goal of aggressive care in the ICU is to stabilize and restore patients to their

prior state of health. However, an increasing number of patients are receiving terminal care in ICU

settings, contrary to the original intent of an ICU.

Objectives: The objective of this study was to explore the time required to perform the various nursing

activities regarding care of patients on Adult Mechanical Ventilation admitted in ICU of BPKIHS.

Materials and Methods: It was hospital based descriptive exploratory study conducted among the

patients admitted in ICU on adult mechanical ventilation. Total 60 patients were selected during the

study period of 3 months (May to June, 2010) using random sampling (lottery) method. The data was

collected by the nurses involved in the direct care of those assigned selected cases.

Results: It was found that the average time spent on each patient on ventilator in critical care unit in

morning shift was 329 minutes; evening shift 317 minutes, night shift 356 minutes and in all the shift

total time spent was 1002 minutes out of 1440 minutes. For administrative activities total time spent

was 244 minutes, monitoring vital signs 92 minutes, providing personal hygiene care 104 minutes,

providing respiratory care 63 minutes, providing ventilator care 1oo minutes, prevention and care of

bedsore 82 minutes, management of nutrition and diet 39 minutes, dispensing drugs 48 minutes, and

performing specific nursing procedures was 165 minutes.

Conclusion: It can conclude that the nurses working in critical care unit spent most of the time in the

care of patient on ventilator.

Note: *1Ram Sharan Mehta, Associate Professor, Medical-Surgical Nursing Department, Email:

[email protected] , *2 Prof. Dr. Bal Krishna Bhattari, HOD, Department of Anesthesiology

and Critical Care Unit.

Introduction: The incidence of death in intensive care units (ICUs) is increasing. In the United States,

approximately 2.5 million people die each year, with over 60% of these deaths occurring in hospitals,1

with half of those deaths involving ICU care.2 A retrospective study reported that 1 in 5 Americans died

using ICU services.3 Moreover, recent studies indicate that the majority of these ICU deaths involved

withholding or withdrawing life-sustaining treatments.4 Complicating matters, the decision to withhold

or withdraw life support has dramatically increased, from 51% of all ICU deaths in 1987 to 90% in 1993. 1

The primary goal of aggressive care in the ICU is to stabilize and restore patients to their prior state of

health. However, an increasing number of patients are receiving terminal care in ICU settings, contrary

to the original intent of an ICU.5

Anyone entering an intensive care unit can feel bombarded by the huge array of sensory stimuli. Family

members in ICU are typically in a state of fear and shock. Studies have shown that caring for the families

of patients who are critically ill is believed to be an essential component of the nurse's role.4

Nursing care must address not only the needs of the patient, but those of the whole family. The needs

of patients in intensive care and those of their families are especially complicated by the physical and

emotional demands on all concerned. Families experience severe stress and anxiety, and may feel

helpless and unable to cope. Accurate assessment of their needs is one of the first steps in providing

appropriate care to ICU patients and their families.3

Study conducted by Dodck6 reported, out of 205 of total 308 ventilator patients 67% achieved ventilator

dependence during ICU admission and among those 83% met the set criteria. The most frequent reason

for failing criteria before ventilator independence was PaO2/FiO2 ratio less than 24 KPa (49% of Cases).

Study conducted by Eckerblad 5

reported Mechanical Ventilation withdrawal can amount up to 40% of

total ventilator time. Study conducted by David7reported, it is effectively implemented the guidelines

may decrease the morbidity, mostly and cost of ventilator associated pneumonia in mechanically

ventilated patients.

Objectives: The objective of this study was to explore the time required to perform the various nursing

activities regarding care of patients on Adult Mechanical Ventilation admitted in ICU.

Methodology: It was descriptive exploratory study, conducted among the patients on adult mechanical

ventilation admitted in ICU. The data was collected by the nurses (Staff-Nurses) involved in the direct

care of the patients admitted in ICU, on adult mechanical ventilation. All the 35 nurses working in ICU

had filled the pre-tested questionnaire during their duty period to their selected assigned patients.

Nurses were explained the purpose of the study prior to data collection and their informed verbal

consent was obtained. The confidentiality of information was assured to the nurses. Nurses were

requested to recall and note the time of activities during their duty hour. At the end of their duty in each

shift i.e. morning, evening and night they complete the tool and handover to the shift in-charge nurse.

Using random sampling technique (lottery method) all the 60 patients were selected during the study

period of three months (May, June and July 2010). Using lottery method subjects were selected in each

shift on Sunday. On each Sunday five patients were selected randomly. The selected patients were

accessed in all the three shifts. If the observation was not completed in all the three shifts that patient

was excluded. If the required number was not adequate on Sunday, the number of subjects was

increased on next Sunday. The patients on ventilator selected for study using lottery method is used for

data collection purpose. The allocated nurses were given the questionnaire and requested to complete

at the end of their shift duty hour. The tools were collected from the staffs and used for analysis. The

data collected was entered in Excel and analyzed using SPSS 11.5 software package.

Results: Most of the patents (56.7%) were of age below 40 years, male (53.3%), belongs to villages

(56.7%), illiterate (51.7%), Hindus (90%), married (81.7%), and they were from Sunsari (41.7%), Jhapa

(25%), Morang (21.7%), and Saptari (11.7%). The mean duration of stay of patients on the date of data

collection was 21.85, with range 1 to 79 days. Most of the patients (96.7%) were on SIMV mode and on

ETT (56.7%). The major diagnosis of selected patient was Organophosphorus poisoning (48.3%), GB

Syndrome (16.7%), Acute Coronary Syndrome (10%), Diabetic Keto-Acidosis (6.7%), Tetanus (6.7%) and

others (11.9%).

It was found that the average time spent on each patient on ventilator in critical care unit in morning

shift was 329 minutes; evening shift 317 minutes, night shift 356 minutes and in all the shift total time

spent was 1,002 minutes out of 1,440 minutes. For administrative activities total time spent was 244

minutes, monitoring vital signs 92 minutes, on personal hygiene care 104 minutes, providing respiratory

care 63 minutes, providing ventilator care 100 minutes, prevention and care of bedsore 82 minutes,

management of nutrition and diet 39 minutes, dispensing drugs 48 minutes, and performing specific

nursing procedures was 165 minutes.

Discussion: The average time spend by nurses on morning duty was 329 minutes (5.48 hrs), in evening

duty317 minutes ( 5.28 hrs) and in night duty 356 minutes( 6 hrs) and in total 1,002 minutes ( 16.7 hrs)

out of 1,040 minutes (24 hrs).

Many studies in the literature have indicated that nurses feel frustrated with their limited role in

decisions regarding the withdrawal or withholding of life support. 1,

Study conducted by Angus8,

describes comparable struggles with medication administration. The nurses express feeling of

abandonment and powerlessness, which may further contribute to difficulties in the delivery of terminal

care. It is hard to deal with death9.

Study conducted by Eckerblad5,

reported mechanical ventilation withdrawal can amount up to 40% of

total ventilator time. This picture clearly illustrate that patient on mechanical ventilator is time

consuming nursing job. Nursing care must address not only the needs of the patients, but those of the

whole families are especially complicated by the physical and emotional demands on all concerned10

. An

exploratory study can be conducted to calculate the total time required to care of patient on mechanical

ventilator, taking adequate sample in multicentre.

Conclusion: It can conclude that the nurses working in critical care unit spent most of the time in the

care of patient on ventilator and limited time was available for counselling and other professional

activities.

References:

1. Azoulay E, Pochard F, Chevret S, Lemaire F, Mokhtari M, Fall JL et al. Meeting the needs of

intensive care unit patient families: A multicenter study. Am. J. Respir. Crit. Care Med. 2002;

163: 135-139.

2. Espinosa L, Young A, Symes L, Haile B, Wsalsh T. ICU Nurses’ experiences in providing terminal

care. Critical Care Nurse. 2010; 33(3): 273-28.

3. Molter NC. Needs of relatives of critically ill patients. Heart Lung. 1979; 8: 332-339.

4. Hardcer J. Meeting the needs of families of patients in intensive care units. Nurse Times. 2003;

99(27): 26-7.

5. Eckerblad J, Kriksson H, Kamer J, Edeu GU. Nursess’ Conceptions of facilitative strategies of

weaning patients from mechanical ventilation: a phenomenographic study. Intensive Critical

Care Nurses. 2009; 25(5): 225-32.

6. Dodck P, Keenan S, Cook D et al. Evidence-based clinical practices guidelines for the prevention

of ventilator associated pneumonia. British Journal of Anesthesia. 2004; 92(6): 793-9.

7. David J, Monique W, Brenda C, Candice B, Debra G, Otto M. Measuring the ability to meet family

needs in an intensive care unit: Clinical Investigations. Critical Care Medicine. 1998; 26(2): 266-

271.

8. Angus DC, Barnato AE, Linde-Zwirble WT, et al. Use of intensive care at the end of life in the

United States: an epidemiologic study. Crit Care Med. 2004; 32(3):638–643.

9. Akinci SB, Salman N, Kanba KM, Ayparu. Assessement of family satisfaction in the ICU. European

Journal of Anesthesiology. 2004; 21:7-8.

10. Colleen EG, Diane IC, Jeanne SE, Patricia AF. Heather JV. Visiting presence of patients in the ICU

and in a complex, care medical unit. Americal Journal of critical. 2004; 13: 194 – 198.

Table 13

Average Total Time Spend by Nurses while Providing Care to the Patient on Ventilator

n=60

SN Activities

Time Spend for Each Shift Duty

Total

Time

Spend

(T=1440)

Morning

(8am-2pm)

(T=420)

Evening

(2pm-9pm)

(T=420)

Night

(9pm-7am)

(T=600)

1 Administrative activities 87 64 93 244

2 Monitoring vital Signs 31 29 32 92

3 Personal hygiene care 34 32 38 104

4 Respiratory care 21 19 23 63

5 Providing ventilator care 35 30 35 100

6 Prevention and care of Bed Sore 28 26 28 82

7 Providing nutrition and Diet 11 13 15 39

8 Treatment/Drug Dispensing 15 12 21 48

9 Performing specific nursing

procedures 47 62 56 165

10 Miscellaneous activities 20 30 15 65

Total Time Spent 329 317 356 1002

Critical Care Nurses’ Skill Working in B P Koirala Institute of Health Sciences

Mehta RS, Additional Professor

B.P. Koirala Institute of Health Sciences, Nepal Email: [email protected]

Abstract:

Introduction: Critical care units, may be thought of as having context (the demographics and characteristics of the kind of work they do), structure (the grouping of people and the allocation of responsibility through specialization, expertise, formalization, and some degree of centralization or decentralization), process (intraorganizational relationships such as the flow of information and coordination), and outcomes (productivity, goal attainment, morale, and satisfaction of the members). B P Koirala Institute of Health Sciences has 700 bedded tertiary care hospital having 8 beded ICU and 6 beded CCU with modern facilities.

Objectives: The objective of this study was to assess the skills to care the critically ill patients by the nurses working in critical care unit (ICU and CCU) of B P Koirala Institute of Health Sciences, Dharan, Nepal. Methodology: It was hospital based descriptive study conducted among the nurses (staff-nurses) involved in the care of critical patients working in ICU and CCU of B. P. Koirala Institute of Health Sciences for more than three months. Using total enumerative sampling technique all the 35 nurses working in ICU and CCU of BPKIHS was selected for study. Informed verbal consent was obtained prior to data collection. Subjects were assured about the confidentiality of the Informations they were provided and used for the study purpose only. Using pre-tested questionnaire the data was collected during the period of 1-7-2010 to 7-7-2010 for a week and special consideration was maintained to avoid the contamination of sample. The collected data was entered in Excel and analyzed using SPSS 11.5 soft ware package.

Results: Total 35 nurses were working in the unit and most of them (68.6%) had work experiences of one year and only 2 nurses (5.7%) had received basic life support (BLS) and advanced life support (ALS) training. It was found that most of the nurses had limited skill (score-0, 1) on the areas like, interpret arrhythmias (60%), intervene for arrhythmias (62.9%), temporary pacing care (82.9%), and patient care on hemodialysis (60%); where as the most of the nurses had adequate skill (score-2,3) on the areas like start peripheral IV (85.7%), assess heart sound and peripheral pulses (81.9%), and care of patient on arterial line (88.6%). The association calculated between the items of skill score (0, 1, 2, 3) with selected variables found significant association between interpret arrhythmia and age (≤ 20, >20) (p= 0.0001), perform defibrillation and age (p=0.002), and interpret arterial blood gas (ABG) and age group (p=0.016).

Conclusions: skill development training for nurses working in ICU is mandatory for quality care.

Key Words: Critical Care, Nurse, Skill

Introduction: High intensity fields of work, such as the airline industry and the military, already employ checklists to decrease errors of omission, improper implementation of procedures and protocols, and to decrease human error under stressful conditions. Examples include the prediction of successful weaning from mechanical ventilation in ICU patients, adherence to evidence-based best practices and in the improvement of patient safety in many clinical areas.1 Critical care nurses work in a wide variety of settings, filling many roles. They are bedside clinicians, nurse educators, nurse researchers, nurse managers, clinical nurse specialists and nurse practitioners. 2 Much information is available on patients’ satisfaction and perceptions of quality of care, and some information is available on patients’ perceptions of physicians’ skills, little information is available on patients’ perceptions of nurses’ skills. 3 The defining characteristics of good nursing care investigation mostly involved the demeanor of the nurses: gentle, calm, courteous, kind, attentive, available, empathetic, and reassuring. Although researchers have described nurses’ attributes that patients consider when judging nursing quality and good nursing care in general, little is known of patients’ perceptions specifically of the skill of nurses. 4 Rapid advances in healthcare and technology have contributed to keeping more people out of the hospital. As issues relating to patient care become increasingly complex and new technologies and treatments are introduced, critical care nurses will need to become ever more knowledgeable. 4 Objective: The objective of this study was to assess the skills to care the critically ill patients among the nurses working in critical care unit (ICU and CCU) of B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Methodology: It was hospital based descriptive study conducted among the nurses (staff-nurses) involved in the care of patients working in ICU and CCU of B. P. Koirala Institute of Health Sciences for more than three months. Using total enumerative sampling technique all the 35 nurses working in ICU and CCU of BPKIHS was selected for study. Informed verbal consent was obtained prior to data collection. Subjects were assured about the confidentiality of the information they were provided and used for the study purpose only. Using pre-tested questionnaire the data was collected during the period of 1-7-2010 to 7-7-2010 for a week and special consideration was maintained to avoid the contamination of sample. The collected data was entered in Excel and analyzed using SPSS 11.5 software package. Results: Age and experiences of the subjects: it was found that most of the subjects 25(71.4%) were of age group of 21-25 years, with mean age 22.26, SD 2.187 and range 19-30 years. Only 3(5.7%) subjects had the ICU experiences of more than 3 years. The mean ICU experiences were 13.29, with age SD 12.335 and range 3-60 months. Similarly, only 8.6% (3) nurses had total nursing experiences of more than 3 years, with mean 16.66, SD 123.604 and range 3-60 months. It was found that only 2(5.7%) nurses had received BLS as well as ALS training and 11(31.4%) nurses working in PBKIHS was trained from this institute it self. Skill of the critical care nurses: Using four point scale (0, 1, 2, 3), the extent of skill level was assessed among the nurses working in critical care units (ICU/CCU) of BPKIHS, in the different eight areas like, general (6-items), cardiovascular (22-items), pulmonary (15-items), Neurological (8-items), GI/ Renal/Endocrine (6-items), medications (21-items), pain/wound management (8-items) and experiences with age group (3-items). The details of the results are in depicted in table. Association between variables: The association calculated between the items of skill score (0, 1, 2, 3) and with other variables found significant association between the interpret arrhythmias and age group (≤

20, >20) (p=0.0001), intervene for arrhythmias and age group (p=0.001), assist and provide care with S/G insertion with age (p+0.001), temporary pacing patients care and age (p=0.001), perform defibrillation and age (p=0.002), interpret ABG and age group (p=0.016), obtain ICP/CPAP value and age (p= 0.0001), administer IV lidocane and age group (p=0.012), administer amiodarone and age (p=0.012), administer diltiazem and age (p=0.037), similarly ICU experiences (≤ 6 months, > 6months) with identify pacemaker malfunction (p=0.001), intervene arrhythmias (p=0.002), and care of post operative cardiac surgery patients (p=0.012). Discussion: Most of the nurses working in critical care unit were below age 25 years (94.3%). Most of the nurses had job experiences in ICU is up to 3 years (94.3%), and had total job experiences up to 3 years (91.4%). Only 2 nurses (5.7%) had received BLS and ALS training. The nurses had better skill on the areas like, start peripheral IV (85.7%), giving discharge teaching (91.4%), assess heart sound and peripheral pulses (81.9%), and care of arterial line (88.6%). The nurses had limited skills on the areas like, interpret arrhythmias (60%), intervene for arrhythmias (62.9%), temporary pacing care (82.9%), and haemodialysis patient care (60%). Study conducted by Perrie5 among 136 ICU nurses reported, the mean knowledge score was 47.56 (SD 11.61). The differences in knowledge among ICU training staffs (68) and non-ICU trained staffs (68) was statistically significant (P=0.0099). The correlation between knowledge and years of ICU experiences was poor (r=0.137). Similar findings were reported by Eckerball6, and Egerod7. Study conducted by Perrie5 reported pain management, glycemic control and weaning from mechanical ventilation are nursing care areas that can impact on patient outcome and are commonly guided by protocols. However, in order to ensure safe, optimal management of patients even when care is guided by protocols, nurses require a sound knowledge base. Conclusion: Most of the nurses were younger (<25) years and had lesser critical care experiences (<3Yrs) and very limited had received BLS and ALS training. The areas where nurses had more skill were start peripheral IV, giving discharge teaching, assessing heart sound and peripheral pulses, care of arterial line, where as nurses had limited skill scores on interpret arrhythmias, temporary pacing, intervene for arrhythmias and hemodialysis. The skill development training for nurses working in critical care is mandatory for quality care. Recommendations: Skill development training for nurses working in the unit is urgent need for quality nursing service in critical care unit. References:

1. Julian DG. The history of coronary care units. British Heart Journal. 1987; 57:497–502. 2. Wysong PR. Patient’s perceptions of Nurses’ skill. Critical Care Nurse. 2009; 29:24-37 3. Miller RS, Patton M, Graham RM, Hollins D. Outcomes of trauma patients who survive

prolonged lengths of stay in the intensive care unit. J Trauma. 2000; 48(2):229-34. 4. Mehta NJ, Khan IA. Cardiology's 10 greatest discoveries of the 20th century. Texas Heart

Institute Journal. 2002; 29:164-71. 5. Perrie H, Schmollgruber S. Knowledge of ICU nurses regarding selected care areas commonly

guided by protocols. Critical Care. 2010; 14:446. 6. Eckerblad J, Kriksson H, Kamer J, Edeu GU. Nursess’ Conceptions of facilitative strategies of

weaning patients from mechanical ventilation: a phenomenographic study. Intensive Critical Care Nurses. 2009; 25(5): 225-32.

7. Egerod I. Uncertain terms of sedation in ICU. How nurses and physicians manage and describe sedation for mechanically ventilated patients. Journal of Clinical Nurses. 2002; 11(6): 831-40.

Table 1 Skill/Experiences of Nurses Regarding Critical Care Activities

N= 35

SN Critical Care Skills

Responses in Percentage (%)

Th

eo

ry,

No

Pra

ctic

e

(0

)

Lim

ite

d

(1)

Co

nfi

de

nt

(2)

Ve

ry c

on

fid

en

t

(3)

1 General Critical Care Skills Admit unstable patient 11.4 17.1 54.3 17.1 Transport ICU patient within hospital for testing 17.1 8.6 57.1 17.1 Start peripheral IV 0 14.3 54.3 31.4

2 Cardiovascular Procedures related skills Assess heart sounds and peripheral pulses 0 17.1 48.6 34.3 Interpret arrhythmias 8.6 51.4 37.1 2.9 Provide care to the patient with an arterial line 8.6 2.9 65.7 22.9 Set up and run 12 Lead ECG 8.6 5.7 45.7 40 Provide care for the patient with acute MI 11.4 34.3 31.4 22.9 Provide care for the patient with acute heart failure 8.6 34.3 42.9 14.3 Provide care for the patient requiring temporary pacing 42.9 40 11.4 5.7 Provide care for the post-op cardiac surgery patient 40 48.6 8.6 2.9 Provide care for the patient in shock 20 28.6 45.7 5.7

3 Pulmonary Procedures Related Skills Assess lung sounds 11.4 45.7 34.3 8.6 Set up oxygen devices 8.6 22.9 37.1 31.4 Obtain pulse oximetry reading 2.9 8.6 48.6 40 Interpret ABG 11.4 20 42.9 25.7 Assess ventilator settings 8.6 28.6 51.4 11.4 Troubleshoot ventilator alarms 11.4 40 45.7 2.9 Suction using in-line suction catheter 8.6 8.6 60 22.9 Use Ambu bag 0 0 60 40 Assist with intubation 8.6 5.7 57.1 28.6 Assist with chest tube insertion 20 25.7 42.9 11.4 Provide care for the patient with mechanical ventilation 2.9 11.4 60 25.7 Provide care for the patient with PEEP therapy 20 25.7 42.9 11.4 Provide care for the patient with chest tube 8.6 22.9 42.9 25.7 Provide care for the patient with a tracheostomy 0 5.7 57.1 37.1

Table 1 (continue) Skill/Experiences of Nurses Regarding Critical Care Activities

N= 35

SN Critical Care Skills

Responses in Percentage (%)

Th

eo

ry,

No

Pra

ctic

e

(0

)

Lim

ite

d

(1)

Co

nfi

de

nt

(2)

Ve

ry c

on

fid

en

t

(3)

4 Neurological Procedures related skills Identify sudden change in loss of consciousness 2.9 25.7 62.9 8.6 Assess sensory, motor, speech 2.9 31.4 57.1 8.6 Assess reflexes (Babinski, Gag) 2.9 28.6 57.1 11.4 Identify and intervene for seizure 8.6 31.4 54.3 5.7 Obtain ICP and CPP values and care 40 37.1 20 2.9 Provide care for the post-op neurosurgical patient 22.9 45.7 31.4 0 Provide care for the patient with acute stroke 17.1 40 42.9 0 Provide care for the patient in a comatose state 20 28.6 45.7 5.7

5 GI, Renal and Endocrine Procedures related Skills Insert NG, duodenal tube 14.3 8.6 54.3 22.9 Provide care for the patient with GI bleed 8.6 31.4 48.6 11.4 Provide care for the patient with hemodialysis 22.9 37.1 25.7 14.3 Provide care for the patient with DKA 14.3 37.1 37.1 11.4 Provide care for the patient with TPN 28.6 17.1 40 14.3 Provide care for the patient with enteral-nutrition 5.7 25.7 51.4 17.1

6 Medication skills Calculate mcg/min and mcg/kg/min 8.6 17.1 48.6 25.7 Use IV infusion pump to calculate drug doses 5.7 11.4 54.3 28.6 Care of epidural catheter 5.7 31.4 45.7 17.1 Administer IV dopamine 5.7 8.6 48.6 37.1 Administer IV nitroglycerine 17.1 14.3 45.7 22.9 Administer IV atropine 11.4 14.3 40 34.3 Administer IV heparin 0 22.9 37.1 40

7 Pain/Wound management related Skills Assess pain level/tolerance 2.9 22.9 60 14.3 Care of patient with anesthesia/analgesia 5.7 22.9 57.1 14.3 Care of patient with sterile dressing changes 0 5.7 60 34.3

8 Experiences with age groups Calculate body weight to verify correct dosing 2.9 42.9 37.1 17.1

Critical Care Nurses’ Knowledge on Adult Mechanical Ventilation Management

Mehta*1 RS, Bhattari*2 BK. B.P. Koirala Institute of Health Sciences, Nepal

Abstract: Introduction: Critical care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems. Critical care nurses account for an estimated 37% of the total number of nurses working in the hospital setting. B P Koirala Institute of Health Sciences (BPKIHS) has 700 bedded tertiary care hospital having 8 beds ICU and 6 beds CCU with modern facilities.

Objectives: The objective of this study was to find out the knowledge on adult mechanical ventilation management among the nurses working in Intensive care unit of B.P. Koirala Institute of Heath Sciences.

Methodology: It was hospital based descriptive study conducted among all the 35 nurses working in critical care unit of BPKIHS having work experiences at least 3 months in the same unit. Using pre-tested questionnaire having 50 items of knowledge, the data was collected during the period of 1-7-2010 to 7-7-2010 for a week maintaining all the formalities.

Results: Most of the nurses had adequate knowledge on the items like, definition of mechanical ventilation (100%), care of tracheotomy (88.6%), risk of 100% oxygen (85.7%), management of acidosis (91.4%), weaning (82.9%), where as the limited nurses had knowledge on indication of CPR (25.7%), indication of laryngeal mask air-way (LMA) (5.7%), and indication of continuous positive air-way pressure (CPAP) (5.7%). The association calculated with items of knowledge score and other variables, it was found significant association between indication of non-invasive mechanical ventilation (MV) and training institute (p=0.034), LMA and ICU experiences (p=0.047), synchronized intermediate mandatory ventilation (SIMV) use and ICU experiences (p=0.042) and goal of tracheostomy care and ICU experiences (p=0.046).

Conclusions: Most of the nurses had average (score-1,2) knowledge on common knowledge components and very limited nurses had knowledge on the components that was not performed in our setting or very less frequently performed like, use of LMA, pacing and CPAP. Regular CNE is mandatory for the nurses working in ICU.

Key Words: Knowledge, Critical Care Nurse, Mechanical Ventilation

Key: * 1 Ram Sharan Mehta, [email protected], Associate Professor, Medical-Surgical

Nursing Department, *2 Prof. Dr. Bal Krishna Bhattari , HOD, Department of Anesthesiology and Critical Care. B. P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal. www.bpkihs.edu

Introduction: A critical care nurse is responsible for ensuring that acutely and critically ill patients and their families receive optimal care. Critically ill patients are defined as those patients who are at high risk for actual or potential life-threatening health problems. The more critically ill the patient is, the more likely he or she is to be highly vulnerable, unstable and complex, thereby requiring intense and vigilant nursing care.1

Critical care units, may be thought of as having context (the demographics and characteristics of the kind of work they do), structure (the grouping of people and the allocation of responsibility through specialization, expertise, formalization, and some degree of centralization or decentralization), process (intraorganizational relationships such as the flow of information and coordination), and outcomes (productivity, goal attainment, morale, and satisfaction of the members. 2

The first intensive care units emerged in the 1950s to provide care to very ill patients who needed one-to-one care from a nurse, from this environment the specialty of critical care nursing emerged.3 As issues relating to patient care become increasingly complex and new technologies and treatments are introduced, critical care nurses will need to become ever more knowledgeable. 4 Nurses need to develop a thorough understanding of these modes including their effects on underlying respiratory physiology to be able to deliver safe and appropriate patient care.5 Objective: The objective of this study was to find out the knowledge about adult mechanical ventilation management among the nurses working in Intensive Care Unit of B.P. Koirala Institute of Heath Sciences. Methodology: It was hospital based descriptive study, conducted among the nurses (staff-nurses) involved in the care of patients on ventilator, working in ICU for more than three months. Using total enumerative sampling technique all the 35 nurses working in ICU of BPKIHS was selected for study. Informed verbal consent was obtained from the subjects prior to data collection. Subjects were assured about the confidentiality of the Informations they were provided and used for the study purpose only. Using pre-tested questionnaire having 50 knowledge items, the data was collected during the period of 1-7-2010 to 7-7-2010 for one week and special consideration was maintained to avoid the contamination of data. The collected data was entered in Excel and analyzed using SPSS-11.5 software package.

Results: Age and experiences of the subjects: it was found that most of the subjects (71.4%) were of age group of 21-25 years, with mean age 22.26, SD 2.187 and range 19-30 years. Only 3(5.7%) subjects had the ICU experiences of more than 3 years. The mean ICU experience was 13.29, with age SD 12.335 and range 3-60 months. Similarly, only (3)8.6% nurses had total nursing experiences of more than 3 years, with mean 16.66, SD 123.604 and range 3-60 months. It was found that only 2(5.7%) nurses had received BLS as well as ALS training and 11(31.4%) nurses working in PBKIHS was trained from this institute it self. The details are depicted in table 1-4.

Knowledge about Adult Mechanical Ventilator: Using 50 MCQs the knowledge of nurses regarding adult mechanical ventilator was assessed. It was found that most of the nurses had adequate knowledge regarding definition of mechanical ventilation (100%), care of tracheotomy (88.6%), risk of 100% oxygen (85.7%), drugs used to correct acidosis (91.4%), definition of weaning (82.9%), indication of checking carotid pulse (88.6%), and respiratory status after extubation (85.7%); where as the limited nurses had knowledge on indication of CPR(25.7%), indication of LMA (5.7%), management of accidently extubated patients (17.1%), and indication of CPAP (5.7%). The details are depicted in table 5-11.

Association between variables: the association calculated between the items of knowledge score (0,1) with other variables and it was found significant association between indication of non-invasive mechanical ventilation and training institute (BPKIHS, Others) (p=0.034), similarly with use of LMA and ICU experiences (≤ 6 months, > 6 months) (p=0.047), SIMV use and ICU experiences (p=0.042), indication of non-invasive mechanical ventilation and ICU experiences (p=0.042), goal of tracheotomy care and ICU experiences (p=0.046), and correct positioning of ETT and total nursing experiences (≤ 6 months, > 6 months) (p=0.030). Except these mentioned variables there is no significant association between other variables. Discussion: Most of the nurses working in critical care unit were below age 25 years (94.3%). Most of the nurses had job experiences in ICU is up to 3 years (94.3%), and had total job experiences up to 3 years (91.4%). Only 2 nurses (5.7%) had received BLS and ALS training. Most of the nurses had average knowledge (score-1, 2) on common knowledge components and very limited nurses had knowledge on the components that was not performed in this setting very frequently like use of LMA, pacing and CPAP. Most of the nurses had adequate knowledge regarding definition of MV (100%), tracheotomy care (88.6%), correction of acidosis (91.4%), weaning (82.9%), and checking carotid pulse (88.6%). The limited nurses had knowledge on indications of CPR (25.73%), indication of LMA (7%), and indication of CPAP (5.7%). The study conducted by Khatib6 among physicians, nurses, and respiratory therapists reported similar findings. Similarly study conducted by Labeau7 among the European nurses reported that average score was 45.1% and knowledge about oral route of intubation among 55%, ventilator circuit should be changed for each patients (35%), close suctioning (46%), and suction tube should be changed in each patient separately, which is the similar findings to our study. Study conducted by Perrie8 reported pain management, glycemic control and weaning from mechanical ventilation are nursing care areas that can impact on patient outcome and are commonly guided by protocols. However, in order to ensure safe, optimal management of patients even when care is guided by protocols, nurses require a sound knowledge base.

Conclusions:

Most of the nurses were younger (<25) years and had lesser critical care experiences (<3Yrs) and very limited had received BLS and ALS training. The nurses had deficiencies in knowledge and application of mechanical ventilation, as evidenced by low scores on the assessment test. It is in the recognition of knowledge gaps that a foundation for remedial education can be built. This suggests that the quality of patient care cannot be assumed. More importantly, continued objective-based professional staff development that measures content, educational method and retention rate is critical to guide the teaching of concepts that are associated with lower mortality, improved patient outcomes and reduced health care costs. Recommendations: Regular continuous nursing education is mandatory for the nurses working in ICU. Periodical continuous medical education by the Anesthetics and other doctors from specialty department will be beneficial for the nurses to keep up to date the knowledge required for quality patient care in the unit.

References:

1. Yaseen A, Venkatesh S, Samir H, Abdullah Al S, Salim Al M. A Prospective Study of Prolonged Stay in the Intensive Care Unit: Predictors and Impact on Resource Utilization. International Journal for Quality in Health Care, 2002, 14:403-410.

2. Weissman C. Analyzing intensive care unit length of stay data: problems and possible solutions. Crit Care Med. 1997; 25: 1594–1600.

3. Mehta NJ, Khan IA. Cardiology's 10 greatest discoveries of the 20th century. Texas Heart Institute J. 2002; 29:164-71.

4. Wong DT, Gomez M, McGuire GP, Kavanagh B. Utilization of intensive care unit days in a Canadian medical-surgical intensive care unit. Crit Care Med. 1999; 27: 1319–1324.

5. Brilli, R. J., A. Spevetz, R. D. Branson, et al. Critical Care Delivery in the Intensive Care Unit: Defining Clinical Roles and the Best Practice Model. Critical Care Medicine. 2001, 29:7-9.

6. Khatib MF, Zeineldines, Ayoub C, Husan A. Critical care clinicians’ knowledge of evidence-based guidelines for preventing ventilator associated pneumonia. American journal of critical care. 2010; 19: 272-276.

7. Labeau S, Vandijck D, Rello J et al. Evidence-Based guidelines for the prevention of ventilator associated pneumonia: results of a knowledge test among European Intensive care nurse. Journal of Hospital Infection. 2008; 70(2): 180-5.

8. Perrie H, Schmollgruber S. Knowledge of ICU nurses regarding selected care areas commonly guided by protocols. Critical Care. 2010; 14:446.

Table 1 Knowledge about Various Aspects of Mechanical Ventilation

N=35 SN Knowledge about Adult Mechanical Ventilation Correct

Responses 1 Basic Knowledge on Mechanical Ventilation Number (%)

Indication of MV 26(74.3) Responsibility of care for MV 7(20) Indication of Non-invasive MV 12(34.3) Oxygen concentration in mouth to mouth respiration 10(28.6)

2 Knowledge about air-way management Indication of LMA 2(5.7) Confirmation of ETT placement 23(65.7) Communication during artificial airway 19(54.3) Goal of tracheotomy 22(62.9)

3 Drugs used during MV Indication of potassium 14(40) Use of sedation and neuromuscular blockage 23(65.7) Advantages of neuromuscular blockage 20(57.1) Drugs used to correct acidosis (sodium bicarbonate) 32(91.4)

4 Modes of MV Differences between SIMV with AC 12(34.3) Effects of PEEP 26(74.3) Modes of Ventilator 26(74.3) Knowledge about supported ventilator 22(62.9)

5 Knowledge about weaning Definition of weaning 29(82.9) Components of weaning criteria 14(40)

6 Management of complications Management of ETT bite 22(62.9) Management of suctioning complications 6(17.1) ABG values during acidosis 23(65.7) Management of accidently extubated patients 6(17.1) Complications of high I:E ration 9(25.7) Complications of high level PEEP 9(25.7) Decrease in TV 13(37.1) Results of circuit leak, disconnection, & T-tube 10(28.6) Indication of detoriation of patient on ventilator 18(51.4)

7 Knowledge CPR Displacement of sternum during CPR (4-5 cm) 10(28.6) Indication of checking carotid pulse 31(88.6) Drug of choice during CPR (adrenaline) 17(48.6)

A PROFILE OF ADMITTED ORGANOPHOSPHORUS POISONING PATIENTS IN B.P.

KOIRALA INSTITUTE OF HEALTH SCIENCES NEPAL

MEHTA RS*1, KARKI P*

2, SINGH B*

3, SHAH I*

4

B. P. KOIRALA INSTITUTE OF HEALTH SCIENCES, NEPAL

ABSTRACT:

ORGANOPHOSPHORUS (OP) AGENTS ARE USED WORLDWIDE IN INCREASING QUANTITIES AS INSECTICIDES. SINCE

AGRICULTURE IS THE MAIN OCCUPATION IN NEPAL, OP COMPOUND ARE WIDELY AND EASILY AVAILABLE IN ORDINARY

SHOPS AND ARE OFTEN STORED IMPROPERLY.

THE OBJECTIVES OF THIS STUDY WERE TO FIND OUT THE SOCIO-DEMOGRAPHIC PROFILE OF THE ADMITTED OPP CLIENTS,

ASSESS THE DETAILS ABOUT THE INGESTION OF ORGANOPHOSPHORUS POISONING (OPP) AND EXPLORE THE REASONS

FOR INGESTION OF OPP.

IT WAS DESCRIPTIVE STUDY CONDUCTED AMONG ADMITTED OPP CLIENTS IN MEDICAL UNITS, USING CONVENIENT

SAMPLING TECHNIQUE. THIRTY EIGHT SUBJECTS WERE SELECTED DURING THE STUDY PERIOD OF 14TH

APRIL 2006 TO 13TH

APRIL 2007 I.E. COMPLETE ONE YEAR AND INTERVIEW WAS TAKEN FROM THEM. THE COLLECTED DATA WAS ANALYZED IN

SPSS-10 SOFTWARE PACKAGE.

IT WAS FOUND THAT MOST OF THE SUBJECTS (94%) WERE AGE LESS THAN 40 YEARS, FEMALE (57.9%), HINDU (78.9%),

MARRIED (57.9%), NON-VEGETARIAN (94.7%) AND BELONGS TO MIDDLE CLASS FAMILY (73.3%). THE MAJOR BRAND

NAMES OF POISON USED ARE METACID (36%), PHORATE (24%), AND THAIMIDE (7%). ABOUT HALF OF THE CLIENTS

(55.3%) WERE PROVIDED FIRST-AID ON SPOT, MOST OF THE CLIENTS (73%) BROUGHT TO EMERGENCY WITHIN 2 HOURS

OF INGESTION OF POISON AND ABUT HALF OF THE CLIENTS (44.7%) WERE BROUGHT IN UNCONSCIOUS STATE. THE MAIN

REASONS OF INGESTION OF POISON ARE FAMILY PROBLEMS (55.3%), PERSONAL PROBLEMS (42.1%), FOLLOWED BY

ACCIDENTAL (2.6%).

BASED UPON THE FINDINGS WE CAN CONCLUDE THAT IT IS COMMON BELOW AGE GROUP OF 40 YEARS, FEMALE, FARMERS

AND MIDDLE CLASS CLIENTS. MOST OF THE CLIENTS NOT RECEIVED FIRST-AID ON SPOT AND BROUGHT TO EMERGENCY IN

UNCONSCIOUS STATE. THE PUBLIC AWARENESS ON PREVENTION OF INGESTION AND FIRST-AID MANAGEMENT OF OPP IS

VITAL TO REDUCE THE MORBIDITY.

KEY WORDS: PROFILE, ORGANOPHOSPHORUS, POISONING

NOTE: *1 RAM SHARAN MEHTA, ASSISTANT PROFESSOR, MEDICAL-SURGICAL NURSING DEPARTMENT, COLLEGE OF

NURSING. EMAIL: [email protected] *2 PROF. PRAHLAD KARKI, HOD, DEPT. OF MEDICINE.

*3 MS BABITA SINGH, WARD IN-CHARGER, MEDICAL UNIT-I. *

4 MR. ISRIAL SHAH, WARD IN-CHARGE, MEDICAL

UNIT-II.

INTRODUCTION:

ORGANOPHOSPHORUS COMPOUNDS ARE CHEMICAL AGENTS IN WIDESPREAD USE THROUGHOUT THE WORLD, MAINLY IN

AGRICULTURE. THEY ARE ALSO USED AS NERVE AGENTS IN CHEMICAL WARFARE (E.G. SARIN GAS), AND AS THERAPEUTIC

AGENTS, SUCH AS ECOTHIOPATE USED IN THE TREATMENT OF GLAUCOMA. THEY COMPRISE THE ESTER, AMIDE OR THIOL

DERIVATIVES OF PHOSPHORIC ACID AND ARE MOST COMMONLY USED AS PESTICIDES IN COMMERCIAL AGRICULTURE, FIELD

SPRAYS AND AS HOUSEHOLD CHEMICALS. ORGANOPHOSPHATES ARE OF SIGNIFICANT IMPORTANCE DUE TO THEIR

PRACTICAL USEFULNESS AND CHEMICAL INSTABILITY. THIS INSTABILITY MEANS A LACK OF PERSISTENCE IN THEIR

SURROUNDINGS1.

THERE ARE NO RULES AND REGULATIONS GOVERNING THE PURCHASE OF THESE PRODUCTS, AND THEY ARE THEREFORE

READILY AVAILABLE "OVER THE COUNTER", DESPITE THEM BEING A MAJOR CAUSE OF MORBIDITY AND MORTALITY.

EXPOSURE TO ORGANOPHOSPHATES IN AN ATTEMPT TO COMMIT SUICIDE IS A KEY PROBLEM, PARTICULARLY IN THE

DEVELOPING COUNTRIES, AND IS A MORE COMMON CAUSE OF POISONING THAN THE CHRONIC EXPOSURE EXPERIENCED BY

FARMERS OR SPRAYERS IN CONTACT WITH PESTICIDES. INTOXICATION OCCURS FOLLOWING ABSORPTION THROUGH THE

SKIN, INGESTION VIA THE GI TRACT OR INHALATION THROUGH THE RESPIRATORY TRACT. EARLY DIAGNOSIS AND PROMPT

TREATMENT IS REQUIRED TO SAVE THE PATIENT'S LIFE1.

ORGANOPHOSPHORUS INSECTICIDE SELF-POISONING IS A MAJOR GLOBAL HEALTH PROBLEM, WITH HUNDREDS OF

THOUSANDS OF DEATHS EACH YEAR. ALTHOUGH MOST SUCH DEATHS ARE IN THE DEVELOPING WORLD. THIS POISONING IS

ALSO AN IMPORTANT CAUSE OF FATAL SELF-POISONING IN DEVELOPED COUNTRIES.2

ACCORDING TO THE WHO, ONE MILLION SERIOUS ACCIDENTAL AND TWO MILLION SUICIDAL POISONINGS DUE TO

INSECTICIDES OCCUR WORLDWIDE EVERY YEAR, OF WHICH 200,000 PATIENTS DIE WITH MOST DEATHS OCCURRING IN

DEVELOPING COUNTRIES. IN INDIA, ORGANOCOMPOUNDS (OPCS)-ORGANOPHOSPHATES AND ORGANOCARBAMATES,

ARE THE COMMONEST PESTICIDES USED AND DUE TO THEIR EASY AVAILABILITY, THERE IS WIDESPREAD ABUSE OF THESE

COMPOUNDS WITH SUICIDAL INTENT.3

THE EMERGENCY DEPARTMENT (ED) PHYSICIAN MAY ENCOUNTER ORGANOPHOSPHOROUS COMPOUND (OPC) AND

CARBAMATE POISONING IN A VARIETY OF CLINICAL SCENARIOS. PESTICIDE POISONING IS THE MOST COMMON CAUSE OF

OPC AND CARBAMATE POISONING BECAUSE THE VAST MAJORITY OF PESTICIDES STILL CONTAIN OPCS AND CARBAMATES.

OPC NERVE AGENTS MAY BE USED IN THE MILITARY SETTING OR IN TERRORIST ATTACKS. AN EXAMPLE WAS SARIN USED IN

THE TOKYO SUBWAY ATTACKS OF 1995. 3

IN THE UNITED STATES, MORE THAN 18,000 PRODUCTS ARE LICENSED FOR USE, AND EACH YEAR MORE THAN 2 BILLION

POUNDS OF PESTICIDES ARE APPLIED TO CROPS, HOMES, SCHOOLS, PARKS, AND FORESTS. OCCUPATIONAL EXPOSURE IS

KNOWN TO RESULT IN AN ANNUAL INCIDENCE OF 18 CASES OF PESTICIDE-RELATED ILLNESS REPORTED FOR EVERY 100,000

WORKERS IN THE UNITED STATES. IN 2003, APPROXIMATELY 7500 CASES OF OPC AND 3700 CASES OF CARBAMATE

EXPOSURE WERE REPORTED TO POISON CONTROL CENTERS IN THE UNITED STATES. SIXTEEN OPC-RELATED DEATHS AND

2 CARBAMATE-RELATED DEATHS WERE REPORTED THAT YEAR. 3

BECAUSE OF THE INCREASED USE AND AVAILABILITY OF PESTICIDES (ESPECIALLY IN DEVELOPING COUNTRIES), THE

INCIDENCE OF OPC AND CARBAMATE POISONING IS HIGH. IN CHINA ALONE, PESTICIDE POISONING, MAINLY WITH OPCS,

CAUSE AN ESTIMATED 170,000 DEATHS PER YEAR. VIRTUALLY ALL OF THESE ARE THE RESULT OF DELIBERATE SELF-

POISONING BY INGESTION. 3

OVER 70,000 CHEMICALS AND PHARMACEUTICAL AGENTS ARE IN COMMON USE WORLD

WIDE 6

.

POISONING IS A COMMON PROBLEM IN NEPAL. AS PER B.P. KOIRALA INSTITUTE OF HEALTH SCIENCES MEDICAL RECORD

SECTION INPATIENT RECORD, IN YEAR 2063 (2006/07) A TOTAL 350 CASES OF OPP WERE ADMITTED, WITH MEAN AGE

OF 27.73 YEARS (RANGE 1-8 YEARS & SD 15.7433), MEAN HOSPITAL DAYS OF 5.6295 (RANGE 1-5, SD 5.6878),

MALE 50.6% AND FROM SUNSARI (27.7%), JHAPA(22.6%), MORANG (21.2%) AND FROM OTHER DISTRICTS 28.6%.

OUT OF 350 ADMISSIONS 69.7% WERE IMPROVED, 8.9% RECOVERED OR CURED, 10% EXPIRED, 2.9% ABSCONDED,

4.6% LAMA, 0.3% UNCHANGED AND 3.7% HAD OTHER OUTCOMES. THE CLIENTS DISCHARGED FROM MEDICINE

DEPARTMENT 85.7%, PEDIATRIC 13.6% AND 0.7% FORM OTHER DEPARTMENTS.

OBJECTIVE OF THE STUDY:

THE OBJECTIVES OF THE STUDY WERE: TO FIND OUT THE SOCIO-DEMOGRAPHIC PROFILE OF THE ADMITTED OPP CLIENTS

IN BPKIHS, TO ASSESS THE DETAILS ABOUT THE INGESTION OF OPP AND TO EXPLORE THE REASONS FOR INGESTION OF

OPP.

RESEARCH METHODOLOGY:

IT WAS HOSPITAL BASED DESCRIPTIVE EXPLORATORY RESEARCH STUDY CONDUCTED AMONG THE ADMITTED CLINICALLY

DIAGNOSED OPP CLIENTS IN THE MEDICAL UNITS OF BPKIHS DURING THE PERIOD OF 2064-1-1 TO 2064-12-30 I.E.,

FROM 14TH

APRIL 2006 TO 13TH

APRIL 2007 OF COMPLETE ONE YEAR. CONVENIENT SAMPLING TECHNIQUE WAS USED TO

COLLECT THE DATA FROM THE CLIENTS AND THEIR CARETAKER RELATIVES USING PRE-TESTED INTERVIEW SCHEDULE. TOTAL

38 CLIENTS WERE INCLUDED IN THE STUDY. THE PRINCIPLE INVESTIGATOR AND CO-INVESTIGATORS ARE THEMSELF

INVOLVED IN DATA COLLECTION. INFORMED VERBAL CONSENT WAS OBTAINED FROM EACH SUBJECTS BEFORE COLLECTION

OF THE DATA AND THE SUBJECTS WERE ASSURED ABOUT HE CONFIDENTIALITY OF THE INFORMATION THEY WERE GIVEN.

THE COLLECTED DATA WAS ENTERED IN SPSS-10 SOFTWARE PACKAGE AND ANALYZED. THE DESCRIPTIVE AS WELL AS

INTERFERENTIAL STATISTICS WERE USED TO DESCRIBE THE RESULTS.

RESULTS:

ABOUT HALF OF THE SUBJECTS (52.6%) WERE OF AGE GROUP OF 20-40 YEARS, FEMALE (57.9%), HINDU (78.9%),

MANGOLIAN (34.2%), AND FARMERS (47.4%). ABOUT 42% SUBJECTS ARE ILLITERATE/LITERATE ONLY. THE CLIENTS

WERE FROM MORANG (21.1%), THAPA (15.8%), SAPTARI (13.2%), AND SUNSARI DISTRICT (15.8%). MAJORITY OF

THE SUBJECTS (65.8%) WERE FROM VILLAGES, MARRIED (57.9%), AND BELONGS TO MIDDLE CLASS (73.7%) FAMILY.

IT WAS FOUND THAT ALL THE SUBJECTS INGESTED POISON BETWEEN 6 AM TO 12 MN AND COMMONLY USED BRANDS OF

OPP ARE METACID (36%), PHORATE (24%), AND THAMIDE (7%). ABOUT 55% CLIENTS ONLY RECEIVED FIRST-AID,

MOST OF THE CLIENTS BROUGHT TO EMERGENCY WITHIN 2 HOURS AND IN UNCONSCIOUS STATE (44.7%). THE MAJOR

REASONS FOR INGESTION OF POISON ARE FAMILY PROBLEMS ( 55.3%), PERSONAL PROBLEMS ( 42.1%) AND INGESTED

ACCIDENTALLY (2.6%).

DISCUSSION:

ORGANOPHOSPHORUS (OP) AGENTS ARE USED WORLDWIDE IN INCREASING QUANTITIES AS INSECTICIDES7. SINCE

AGRICULTURE IS THE MAIN OCCUPATION IN NEPAL, OP COMPOUND ARE WIDELY AND EASILY AVAILABLE IN ORDINARY

SHOPS AND ARE OFTEN STORED IMPROPERLY8. IT WAS FOUND THAT INGESTION OF POISON WAS COMMON BEFORE 40

YEARS (92%) OF AGE.

FEMALE (57.2%) CLIENTS ARE FOUND MORE IN NUMBER AS IN OUR SOCIETY FEMALE HAS MORE PROBLEMS IN

COMPRESSION TO MALE AND 18.4% OF THE SUBJECTS ARE HOUSEWIFE. MANGOLIAN (34.2%) ARE MORE PRONE AS

HOSPITAL IS LOCATED IN DHARAN AND HAVE THE POPULATION COMPOSITION ACCORDINGLY. AMONG THE TERAI ORIGIN

(34.2%) THE PERCENTAGE RATIO IS HIGH WHICH NEEDS FURTHER INVESTIGATIONS.

VILLAGERS (65.8%), FARMERS (47.4%), STUDENTS (23.7%), MARRIED (57.9%) AND ILLITERATE/LITERATE (71%) ARE

MORE SUFFERS AS THESE PEOPLE HAVE MORE PHYSICAL, PSYCHOLOGICAL AS WELL AS ECONOMICAL BURDEN.IT WAS

FOUND THAT MOST OF THE SUBJECTS (73.7%) WERE OF MIDDLE CLASS FAMILY AND FACES ECONOMICAL AS WELL AS

PSYCHOSOCIAL PROBLEMS. THE COMMON BRAND OF OPP USED WAS METACID (36%) AND PHORATE (24%), WHICH

WAS EASILY AVAILABLE AT LOCAL MARKET, AND KEPT IN HOUSE FOR AGRICULTURAL USE, HENCE IT IS EASILY AVAILABLE.

ONLY HALF OF THE SUBJECTS (55.3%) HAD RECEIVED FIRST-AID AS MOST OF THE PEOPLE DO NOT AWARE ABOUT IT.

ABOUT 45% SUBJECTS BROUGHT TO EMERGENCY IN UNCONSCIOUS STATE AS OPP IS VERY TOXIC AND EFFECTS VERY FAST.

CONCLUSIONS:

BASED UPON THE STUDY WE CAN CONCLUDE THAT FIRST-AID MANAGEMENT TRAINING FOR OPP IS ESSENTIAL AT

COMMUNITY LEVEL ALONG WITH THE PUBLIC AWARENESS ACTIVITIES FOR PREVENTION OF OPP BY SENSITIZING THE

MEDIA..

REFERENCES:

1. JOSHI S, BISWAS B, MALLA G. MANAGEMENT OF ORGANOPHOSPHORUS POISOINING. UPDATE IN ANESTHESIA.

2005,19(13): 13-14.

2. EDDLESTON M , EYER, P , WOREK, F, MOHAMED F, SENARATHNA L ET ALL. DIFFERENCES BETWEEN

ORGANOPHOSPHORUS INSECTICIDES IN HUMAN SELF-POISONING: A PROSPECTIVE COHORT STUDY. THE LANCET.

22-OCT-05

3. POOJARA L, VASUDEVAN D, ARUN KUMAR AS, KAMAT V. ORGANOPHOSPHATE POISONING: DIAGNOSIS OF

INTERMEDIATE SYNDROME. INDIAN J CRIT CARE MED 2003;7:94-102

4. SINGH B, UNNIKRISHNAN B. A PROFILE OF ACUTE POISONING AT MANGALORE (SOUTH INDIA). J CLIN FORENSIC

MED. 2006;13(3):112-6.

5. TENDOLKAR BA, KAMATH SK. ANAESTHETIC MANAGEMENT OF A PATIENT WITH ORGANOPHOSPHORUS

POISONING (A CASE REPORT). J POSTGRAD MED 1991;37:181-2

6. KISHORE PV, PAUDEL R, MISHRA D, OJHA P, MISHRA P. PATIENT PROFILE AND MANAGEMENT PATTERN OF

POISONING CASES ADMITTED TO TERTERY CARE TEACHING HOSPITAL IN WESTERN NEPAL. MANIPAL COLLEGE OF

MEDICAL SCIENCES. POKHRA, NEPAL.

7. KRALLIEDDE L, SENANAYAKE N. ORGANOPHOSPHORUS INSECTICIDE POISOINING. BR. J. ANAES. 1989; 63:

736-50.

8. KARKI P, HANSDAK SG, BHANDARI S, SUKLA A, KOIRALA S. A CLINICO-EPIDEMIOLOGICAL STUDY OF

ORGANOPHOSPHORUS POISONING AT A RURAL BASED TEACHING HOSPITAL IN EASTERN NEPAL. TROPICAL

DOCTOR. 2001; 31: 32-33.

9. KARALLIEDDE L, SENANAYAKE N. ACUTE ORGANOPHOSPHOURS INSECTIDE POISONING : A REVIEW. CEYLON

MED J. 1986; 31: 93-100.

10. KARKI P, ANSARI JA, BHANDARI S, KOIRALA S. CARDIAC AND ELECTROCARDIOGRAPHICAL MANIFESTATIONS OF

ACUTE ORGANOPHOSPHOURS POISOINING. SINGAPOOR MED J. 2004; 45(8): 385.

TABLE: - I

SOCIO-DEMOGRAPHIC PROFILE OF THE SUBJECTS

N=38

SN ITEMS/PARTICULARS PERCENTAGE (%)

1 AGE GROUP ( IN YEARS)

< 20 YRS 39.5

20-40 YRS 52.6

> 40 YRS 7.9

MEAN 21.63

SD 12.0974

RANGE 2-45

2 GENDER

MALE 42.1

FEMALE 57.9

3 RELIGION:

HINDU 78.9

KIRAT 15.8

BUDDHIST 2.6

MUSLIM 2.6

4 ETHNIC GROUP

BRAHMIN/CHHETRI 21.1

RAI/LIMBU/GURUNG/MAGAR 34.2

NEWAR 7.9

TERAI ORIGIN 34.2

KRISTIAN 2.6

5 OCCUPATION

HOUSEWIFE 18.4

AGRICULTURE 47.4

BUSINESS 2.6

STUDENT 23.7

SERVICE 7.9

6 EDUCATION LEVEL

ILLITRATE / IITRATE 42.2

PRIMARY 28.9

SECONDRY 26.3

HIGHER 2.6

7 RESIDENCE

VILLAGE/VDC 65.8

TOWN/NP 34.2

8 MARITAL STATUS

MARRIED 57.9

UNMARRIED 42.1

9 ECONOMIC STATUS OF THE FAMILY

POOR 26.3

MEDIUM 73.7

HIGH 00

10 FAMILY HISTORY OF INGESTION OF OPP

PRESENT 2.6

NOT PRESENT 97.4

11 PREVIOUS HISTORY OF INGESTION OF OPP

PRESENT 10.5

NOT PRESENT 89.5

TABLE: - II

DETAILS ABOUT THE INGESTION OF OPP

N=38

SN ITEMS/PARTICULARS PERCENTAGE (%)

1 TIME OF INGESTION

6 AM – 12 MD 36

12 MD – 6 PM 24

6 PM – 12 MN 7

12 MN – 6 AM 33

2 BRAND NAME OF OPP INGESTED

METACID 36

PHORATE 24

THAIMIDE 7

OTHERS 33

3 AMOUNT OF INGESTION OF OPP

< 10 24.2

10-30 27.3

30-50 21.0

50-100 18.2

> 100 9.3

MEAN 50.1515

SD 56.9896

RANGE 3-200

4 FIRST-AID PROVIDED ON SPOT

PROVIDED 55.3

NOT PROVIDED 44.7

IF PROVIDED: ( N= 55.3% )

INDUCE VOMITING 71.7

NPO 11.1

5 TIME TAKEN TO BRING EMERGENCY OF BPKIHS

< 1 HR 37.8

1-2 HRS 35.2

2-4 HRS 5.4

4-6 HRS 10.8

6-8 HRS 5.4

>8 HRS 5.4

6 STATE OF PATIENT ON ARRIVAL AT BPKIHS EMERGENCY

ALERT 44.7

VERBAL RESPONSE 7.9

PAIN RESPONSE 2.6

UNRESPONSIVE/UNCONSCIOUS 44.7

7 DRUGS USED DURING THE TREATMENT OF OPP:

ATROPINE 100

CHARCOAL 13.2

PAM 71.1

Table 1

Effects on caregivers of the people living with AIDS

n=64

SN Effects on Caregivers

Responses : Burden Score

Str

ong

ly

Ag

ree

Ag

ree

2

Un

de

cid

ed

Dis

ag

ree

Str

on

gly

Dis

ag

ree

Mean

Score

(%) (%) (%) (%) (%) (Full Score

= 4)

1 Negative effects on Physical health 3.1 71.9 18.8 6.3 0 2.72

2 Coping problems 4.7 53.1 21.9 18.8 1.6 2.41

3 Less time for social activities 6.3 65.6 21.9 4.7 1.6 2.70

4 Family frictions 12.5 50 28.1 9.4 0 2.66

5 Feel difficult to continue care for

much longer 10.9 36.9 31.3 9.4 1.6 2.56

6 Feel strain on the relationship with

patient related to excess demand 12.5 39.1 29.7 17.2 1.6 2.44

7 Worry about future 10.9 64.1 18.8 4.7 1.6 2.78

8 Cut down on leisure time 4.7 71.9 17.2 6.3 0 2.75

9 Providing more care than other

family members 7.8 60.1 28.1 3.1 0 2.73

10 Feeling depressed 10.9 45.3 31.3 16.9 1.6 2.53

11 Feeling of losing your control on

life 6.3 21.9 34.4 23.4 14.1 1.83

12 Consuming more alcohol, cigarettes,

& medications 0 9.4 32.8 28.1 29.7 1.22

13 Personal privacy is disturbed 0 54.7 21.9 17.2 6.3 2.25

14 Have adequate time for daily work 0 29.7 28.1 37.5 4.7 1.83

15 Facing financial problem 23.4 46.9 15.6 10.9 3.1 2.77

4 = Very High care burden (51-60) 1.6

3 = High care burden (41-50) 28.1

2 = Moderate care burden (31-40) 50

1 = No care burden (0- 30) 20.3

Mean Value 36.1719

SD 7.04983

Range 19-51

Table 2

Effects on Family of the people living with AIDS

n=64

SN Effects on Family

Responses (Burden)

4

Fu

lly

Ag

ree

3

Ag

ree

2

Do

no

t K

no

w

1

Dis

ag

ree

0

Fu

lly

Dis

ag

ree

Mean

Score

(%) (%) (%) (%) (%)

(Full

Score

= 3)

1 Problems in social gathering 1.6 48.4 35.9 12.5 1.6 2.36

2 Problems in marriage of family members 4.7 43.8 34.4 15.6 1.6 2.34

3 Interaction and communication with neighbors 7.8 42.2 35.9 12.5 1.6 2.42

4 Financial problems 21.9 53.1 12.5 10.9 1.6 2.83

5 Interaction and communication with relatives 4.7 51.6 32.8 7.8 3.1 2.47

6 Celebrating rituals and festivals 3.1 18.8 57.8 15.6 4.7 2.00

7 Socialization of children 4.7 32.8 45.3 15.6 1.6 2.23

8 Emotional problems among children 6.3 25 53.1 12.5 3.1 2.19

9 Family relationships and harmony 3.1 53.1 26.6 12.5 4.7 2.38

10 Religious practices 3.1 17.2 54.7 18.8 6.3 1.92

11 Image of family in society 3.1 31.1 46.9 7.8 3.1 2.31

12 Privacy of family members 4.7 56.3 28.1 7.8 3.1 2.52

13 Problems in occupation 7.8 57.8 18.8 13.1 1.6 2.56

14 Fear of transmission among other members 1.6 46.9 29.7 17.2 4.7 2.23

15 Dependence on alcohol among family 1.6 17.2 23.4 25 32.8 1.30

members

16 Dependence on smoking among family

members

3.1 15.6 23.4 23.4 34.4 1.30

17 Demand of PLWA on family 6.3 28.1 28.1 32.8 4.7 1.98

18 Providing health care services to PLWA 7.8 45.3 25 21.9 0 2.39

19 Fear of death of PLWA 4.7 59.4 17.2 17.2 1.6 2.48

20 Family friction and arguments 6.3 54.7 17.2 17.2 4.7 2.41

3 = Very High care burden (61-80) 4.7 %

2 = High care burden (41-60) 65.6 %

1 = Moderate care burden (21-40) 26.6 %

0 = No care burden (0-20) 3.1 %

Mean Value 44.6250

SD 10.93342

Range 18-72

A Pre-experimental Research to investigate the retention of Basic and Advanced Life Support Measures Knowledge and Skills by Nurses Following

a Course in Professional Development in a Tertiary Teaching Hospital

Mehta RS, Malla G, Gurung A, Aryal A, Labh D, Neupane H. B.P. Koirala Institute of Health Sciences, Nepal

Corresponding Author: Ram Sharan Mehta, Ph.D. Email: [email protected]

Abstract: Lack of resuscitation skills of nurses in basic life support (BLS) and advanced life support (ALS) has been identified as a contributing factor to poor outcomes of cardiac arrest victims. The hypothesis was that nurses’ knowledge on BLS and ALS would be related to their professional background as well as their resuscitation training. Pre-experimental research design was used to conduct the study among the nurses working in medical units of B.P Koirala Institute of Health Sciences, where CPR is very commonly performed. Using convenient sampling technique total of 20 nurses agreed to participate and give consent were included in the study. The theoretical, demonstration and re-demonstration were arranged involving the trained doctors and nurses during the three hours educational session. Post-test was carried out after two week of education intervention programme. The 2010 BLS & ALS guidelines were used as guide for the study contents. The collected data were analyzed using SPSS-15 software. It was found that there is significant increase in knowledge after education intervention in the components of life support measures (BLS/ALS) i.e. ratio of chest compression to ventilation in BLS (P=0.001), correct sequence of CPR (p <0.001), rate of chest compression in ALS (P=0.001), the depth of chest compression in adult CPR (p<0.001), and position of chest compression in CPR (P=0.016). Nurses were well appreciated the programme and request to continue in future for all the nurses. At recent BLS/ALS courses, a significant number of nurses remain without any such training. Action is needed to ensure all nurses receive BLS training and practice this skill regularly in order to retain their knowledge.

Authors: Dr. Ram Sharan Mehta, Additional Professor, Department of Medical Surgical Nursing; Dr. Gayanandra Malla, HOD, Department of General Practice and Emergency Medicine, Anita Gurung, Anu Aryal, Divya Labh, Hricha Neupane. B.P. Koirala Institute of Health Sciences, Nepal. Acknowledgement: we want to express heartfelt thanks to Dr. Gaynandara Malla, HoD of the department of General Practice and Emergency Medicine for his continuous present during the theoretical as well as demonstration sessions.

Introduction: It is well known that in the event of a person suffering a cardiac arrest, successful outcome is dependent on the time taken for resuscitation to commence.1 In cases of in-hospital cardiac arrest the most important predictor of a successful outcome is the ‘time to defibrillation’ interval.2 Although all health care providers in contact with patients should be proficient at basic life support (BLS), nurses in particular should be competent at BLS, being the health care providers most likely to be the first respondents to an in-hospital cardiac arrest.3 BLS proficiency includes the use of an automated external defibrillator (AED)4 and it is therefore expected that nurses trained in BLS should be able to use this device. BLS knowledge and skills tend to degrade and regular refresher training and practice is recommended.5 Despite these international guidelines, studies have shown that, in the developed world, nurses’ BLS skills can be surprisingly poor.6,7 Limited studies in the Asian environment have yet been published with regard to BLS competency among nursing staff. We decided to investigate BLS and ALS competence among nursing staff of medical units of B. P. Koirala Institute of Health Sciences, a tertiary level teaching hospital before and after education intervention programme, where cardiac arrest is very common and frequency of performing CPR is very high. Objective: The objective of this study was to examine retention of life support measures (BLS & ALS) knowledge and skills of nurses following education intervention programme. Method: The study was a cross-sectional study and participation was voluntary. Total 20 nurses working in the medical units were included in the study. A questionnaire with 10 questions regarding the knowledge and skills involved in BLS & ALS. Pre-test was obtained and baseline data was collected. After pre-test, the education programme was arranged on 17th May 2012 from 2pm to 5pm. The aspects on which they were interrogated were about the ratio of chest compression ventilation in BLS, components of BLS, correct sequence of CPR, rate of chest compression in ALS, the drug of choice in ALS, the depth of chest compression in adult CPR, position of chest compression in CPR, frequency of giving Adrenaline in ALS and intervention after cardiac arrest. Using prepared educational module with the help of trained doctors and nurses the education programme was arranged. It was three hours session including demonstration and return demonstration after theoretical sessions in demonstration room using all the resources needed for the training including CPR dummy. After two week of the education intervention programme the post-test was conducted. The level of knowledge of BLS/ALS was assessed via the number of correct responses to questions regarding ALS & BLS. After excluding the incomplete response forms the data was analyzed using SPSS-15 Software package. Permission was taken from all the heads before involving the nurses in the programme. The results were analyzed using an answer, key prepared from the advanced cardiac life support manual. Results: Majority of the participants (55%) were of age group of 18-21 years followed by 22-25 years (20%). Only 10% participants had previously taken training on life support measures. In all the components of life support measures there is significantly increase in knowledge and skills at 0.05 level of significance. The details are in Table 1.

Discussion: It was found that most of the participants (55%) were of age group of 18-21 years with mean age of 23.80, SD=5.88 and range 18-40 years. It was found that only 10% participants had previously taken the life support (BLS/ALS) training. The study conducted by Almeida9 among nurses on CPR reported that only 5.5% received ALS and 23.3% received BLS training, which is nearly similar to this study. A systematic review of 64 articles done by Ryynanen10 reported that outcome of BLS in pre-hospital is poor, which clearly demonstrate the need of BLS in hospital setting. After the education intervention programme there is significant increase in knowledge and skill components of life support measures like: ratio of chest compression to ventilation in BLS (p=0.001), sequence of CPR (p <0.001), maneuver avoided for airway maintenance in head and cervical injury (p=0.001), rate of chest compression in ALS (p=0.001), the depth of chest compression in adult CPR (p 0.016) and intervention after cardiac arrest (p=0.004). The study conduct by Almeida9 reported, more than 60% nurses do not know appropriate compression ventilation ratio and average score on Zero to Ten was 5.2 (± 1.4), which is similar to this study. Study conducted by Keenan11 among nurses on BLS reported, correct responses of ratio of chest compression to breath is 27.7% and only 8.2% respond use of clinical defibrillation correctly, which is similar to this study. Similarly study conducted by Chandrasekran12 on BLS found 84.82% Health workers scored less than 50% scores on BLS and ALS, and also reported severe lack of in BLS and ALS knowledge; which is similar to this study. Similar findings were reported by Josipovic13, that 34% nurses do not have knowledge about ventilation compression. Similar findings were reported by Moul14 and Harmond15 also. Opinion was collected from the participants and found the programme implemented was highly effective and useful. Most of the (90%) participants evaluated the overall programme is very good, all the respondents (100%) reported contents used was good; 95% reported the level of understanding was very good and 70% reported the knowledge and skill learned is very useful in daily practice. Study conducted by Harmond15 found, after 18 months 75% participants passed the practical skills of ALS, which clearly illustrate the training needs of ALS and BLS for nurses. Conclusion: At recent BLS & ALS courses (2010 guidelines), a significant number of nurses remain without any such training. Action is needed to ensure all nurses receive BLS training and practice this skill regularly in order to retain their knowledge. The most common reason for not attending a BLS course was that the participant was too busy with their daily duties. This could also be an indication that the participants or their unit managers did not place BLS as a priority in their continuing medical education. Staff shortages were highlighted as another factor, as well as the failure to offer courses to nurses. References:

1. Cummins RO, Sanders A, Mancini E, Hazinski MF. In hospital resuscitation. A statement for healthcare professionals from the American Heart Association Emergency Cardiac Care Committee and the Advanced Cardiac Life Support, Basic Life Support, Pediatric Resuscitation, and Program Administration Subcommittees. Circulation 1997; 95(8): 2210-2212.

2. Colquhoun M, Gabbot D, Mitchell S. Cardiopulmonary Resuscitation Guidance for Clinical Practice and Training in Primary Care. UK: Resuscitation Council, July 2001, 5: 2-4.

3. Coady EM. A strategy for nurse defibrillation in general wards. Resuscitation 1999; 42: 183-186.

4. Hazinski MF, Gonzales L, O’Neill L. BLS for Healthcare Providers Student Manual. American Heart Association 2006, 4:9-15.

5. Finn JC, Jacobs IG. Cardiac arrest resuscitation policies and practices: a survey of Australian hospitals. MJA 2003; 179: 470-474.

6. Crouch R, Graham L. Resuscitation. Nurses skills in basic life support: a survey. Nursing Standard 1993; 7(20): 28-31.

7. Nyman J, Sihvonen M. Cardiopulmonary resuscitation skills in nurses and nursing students. Resuscitation 2000; 47(2): 179-184.

8. Resuscitation Council of South Africa. Basic Life Support for Healthcare Providers (Adult and Child), 2006. http://www.resuscitationcouncil.co.za/AlgPage3.pdf (accessed 28 January 2009).

9. Almeida AO, Arauja IEM, Dalri MCB, Arauja S. Theoretical knowledge of nurses working in Non-hospital urgent and emergency care units concerning cardiopulmonary arrest and resuscitation. Rev.Lation-Am.Enfermagen. 2011; 19(2):261-8.

10. Ryynanen OP, Lirola T, Reitala J, Palve R, Malmivaara A. Is advanced life support better than basic life support in pre-hospital care? A systemic review. Scandian Journal of trauma, resuscitation and emergency medicine. 2010; 18:62.

11. Keenan M, Lamacraft G, Joubert G. A survey of nurses’ knowledge and training at a tertiary hospital. AJHPE. 2009;1(11): 34-39.

12. Chandrasekaran S, Kumars S, Bhat SA, Shabbir PM, Chandraskarn VP. Awareness of basic life support among medical, dental and nursing students and doctors. Indian Journal of Anesthesia. 2010; 54(2): 121-126.

13. Josipovic P, Webb M, Grath IM. Basic life support Knowledge of undergraduate nursing and chiropractice students. Australian Journal of Advanced Nursing 2008; 26(4):58-63.

14. Moul P. Evaluation of the BLS CD-ROM, it’s effectiveness as learning tool and user experiences. Educational Technology and society. 2002; 5(3).

15. Harmond F, Saba M, Simes T, Cross R. Advanced life support. Retention of registered nurses knowledge 18 months after initial training. Aust. Crit. Care. 2000; 13(3): 99-104.

Table 1 Differences in Knowledge and Practice on Life Support Measures after Education

Intervention Programme n=23

SN Components of ALS & BLS Pre-Test

Score (%)

Post-Test Score (%)

Percentage Difference

P-value

1 Ration to chest compression to ventilation in BLS

40 95 55 0.001

2 Components of BLS 50 65 15 0.109 3 Correct sequence of CPR 25 95 70 0.001 4 Maneuver avoided for airway

maintenance in head & cervical injury 25 75 50 0.001

5 Rate of chest compression in ALS 25 100 75 0.001 6 The drug of choice in ALS 65 100 35 0.016 7 The depth of chest compression in adult

CPR 15 95 80 0.001

8 Position (Place) of chest compression CPR

60 95 35 0.016

9 Frequency of giving Adrenaline during ALS

20 60 40 0.057

10 First intervention after cardiac arrest 50 95 45 0.004 Note: McNemar Chi Squire test was used to find out the differences in pre-test Post-test score.

Lifestyle Pattern among the People Living with AIDS in Eastern Nepal

Dr. Ram Sharan Mehta, Additional Professor Prof. Dr. Prahlad Karki, HoD, Internal Medicine

B.P. Koirala Institute of Health Sciences Email: [email protected]

Abstract: In world More than 40 million people are living with HIV/AIDS, 2.3 million are under 15 yrs and 14000 new infections each day. The objectives of this study was to assess the lifestyle Pattern among the people living with AIDS (PLWA) receiving Anti Retroviral Therapy at B.P. Koirala Institute of Health Sciences and find out the association between lifestyle pattern and the selected demographic variables. A descriptive cross sectional research design was used to assess lifestyle pattern of the PLWA receiving anti retroviral therapy at the ART clinic of Tropical ward at B.P Koirala Institute of Health Sciences (BPKIHS). The PLWA receiving ART at BPKIHS for more than or equal to three months at the ART clinic who met the selection criteria constituted the sample of the study. Using purposive sampling technique total 113 PLWA were selected. The patients who themselves were physically present during the data collection period were included in the study, after their consent for the purpose. It was found that most of the PLWA were of age less than 40 years, male (61.1%), residing in urban area (74.3%), married (75.2%) and Hindu (74.3%). It was found that 83.2% PLWA never perform the exercise, whereas 8.8% perform regularly. Majority (91.2%) of the PLWA feeling pressure and stress. About 57% PLWA only sleep less than 6 hours per day. About half (52.2%) of the PLWA never take food outside home whereas 34.5% take regularly. PLWA had habit of taking tobacco more in past (39.8%) in comparison of present (28.3%). Similarly only 0.9% PLWA had habit of taking alcohol at present and 63.7% in past; and 28.3% had habit of taking substances in past. The association calculated between selected demographic variables (age, sex, marital status, residence and religion) with lifestyle pattern (exercise, tobacco chewing, alcohol consumption, and food habit) found significant association between marital status and exercise (p <0.001), Tobacco consumption and age (p <0.001) only. The positive life style practices among the PLWA found more at present present in compression to past especially in relation to Tobacco, Alcohol and Substance abuse. Individual counselling and support is vital for improving the condition. Introduction: HIV/AIDS is a global epidemic which first emerged in 1981 in the USA. Since then, the epidemic has claimed lives of nearly 30 million people worldwide, the worst conditions being in the Sub- Saharan countries.1 There are 19 countries worldwide with the highest prevalence of reported infections, which are all African countries with more than 24.5 million HIV-infected populations. South Africa is reported to have the largest population living with the disease. In terms of prevalence, countries

such as Afghanistan, Saudi Arabia, and Cape Verde are reported to have the lowest prevalence of the disease among reported nations, at less than 0.1% of their population.2

According to UNAIDS/WHO, 47% of the established 14.2 million people eligible for the treatment in low and middle income countries were accessing ART( Anti Retro Viral) therapy in 2010.3

The AIDS picture in South East Asia is dominated by the epidemic in India. Migrants in particular are vulnerable and 67% of the infected in Bangladesh and 41% in Nepal are migrants returning from India.4 In a study done by the Department of Foods, Nutrition and Dietetics, Kenyatta University, among the HIV/AIDS infected two districts of South Africa , it was found out that majority of PLWHA consume foods that are low in nutrients to build up the immune system and help maintain adequate weight, and there is little variety in the foods they consume.5 In fact, the linkages between HIV/AIDS and food security are bi-directional: HIV/AIDS is a determining factor of food insecurity as well as a consequence of food and nutrition insecurity.6 Objectives: To assess the lifestyle Pattern among the people living with AIDS receiving Anti Retroviral Therapy at BPKIHS and find out the association between lifestyle pattern and the selected demographic variables. Methodology: A descriptive cross sectional research design was used to assess lifestyle pattern of the people living with AIDS receiving anti retroviral therapy at the ART clinic of Tropical ward at BPKIHS. The PLWA receiving ART at BPKIHS for more than or equal to three months at the ART clinic who met the selection criteria constituted the sample of the study. Total 113 PLWA were selected using purposive sampling technique. The patients who themselves were physically present during the data collection period were only included in the study, with their consent for the purpose. Results: it was found that most of the PLWA were of age less than 40 years, male (61.1%), residing in urban area (74.3%), married (75.2%) and Hindu (74.3%). It was found that 83.2% PLWA never perform the exercise, whereas 8.8% perform regularly. Majority (91.2%) of the PLWA expressed the feeling of pressure and stress. About 57% PLWA only sleep less than 6 hours per day. About half (52.2%) of the PLWA never take food outside home whereas 34.5% take regularly. PLWA residing in eastern Nepal receiving ART at BPKIHS had habit of taking tobacco more in past (39.8%) in comparison of present (28.3%). Similarly only 0.9% PLWA had habit of taking alcohol at present and 63.7% in past; and 28.3% had habit of taking substances in past. The association calculated between selected demographic variables (age, sex, marital status, residence and religion) with lifestyle pattern (exercise, tobacco chewing, alcohol consumption, and food habit) found significant association between marital status and exercise (p <0.001), and Tobacco consumption and age (p <0.001) only. The details of the results are depicted in the table 1 to 4. Discussion: it was found that most of the (31%) PLWA were of age group of 31-35 years, male (61.1%), residing in urban area (74.3%), married (75.2%) and Hindu (74.3%). Study conducted

by Sharma7 reported that out of 150 patients 66.7% were male, 33.3% were females. Most of them (41.3%) were illiterate, married (49.3%), and farmer (35.3%). The age group 21-30 years was predominant followed by 31-40 years (42%); which is similar to this study. Similar findings were also reported by Budhachandra8 and Dhungana9.

It was found that 83.2% PLWA never perform the exercise, whereas 8.8% perform regularly. Majority (91.2%) of the PLWA feeling pressure and stress. About 57% PLWA only sleep less than 6 hours per day. About half (52.2%) of the PLWA never take food outside home whereas 34.5% take regularly. PLWA residing in eastern Nepal receiving ART at BPKIHS had habit of taking tobacco more in past (39.8%) in comparison of present (28.3%). Similarly only 0.9% PLWA had habit of taking alcohol at present and 63.7% in past; and 28.3% had habit of taking substances in past. Similar study conducted by Dhungana9 reported, 41% PLWHA were smoker, 34% Alcoholics and 54% had weight loss, which is similar to this study.

The association calculated between selected demographic variables (age, sex, marital status, residence and religion) with lifestyle pattern (exercise, tobacco chewing, alcohol consumption, and food habit) only found significant association between marital status and exercise (p <0.001), and Tobacco consumption and age (p <0.001). Conclusion: The positive life style practices among the PLWA are more in present in compression to past especially in relation to Tobacco, Alcohol and Substance abuse. Individual counselling and support is vital for improving the condition. Limitations: Due to the proxy visits by the relatives instead of the patient, the sample collection was difficult as anthropometric measurements could not be taken. There was difficulty in obtaining data about the dietary patterns and lifestyle. The setting of the clinic could not ensure proper privacy. Patients who came in a hurry couldn’t be assessed in detailed related to their short stay at clinic. Recommendations: The supplementation of the nutritional supplement provided by WHO and distributed by the ART clinic can be improved and the target group can be encouraged to consume it. Similar study can be conducted at other ART centers and results can be compared. This study can be done on a larger sample and the association with diet patterns and lifestyle can be observed, which also affect the nutritional status in one way or the other. The BMI at the start of the therapy can be assessed and used to compare the improvement after the initiation of ART. Implications of the study: This study gives an overview of the nutritional status of the PLWHA receiving ART at BPKIHS. For patients at the risk of being malnourished, ART initiation can be an important step in attempt to increase their nutritional status. References: 1. UNAIDS, Global Report: UNAIDS report on Global AIDS Epidemic2010, Geneva 2010.

Available from www.unaids.org/documents/ (retrieved on 2010/11/23).

2. The Central Intelligence Agency World Fact book 2011, HIV/AIDS Adult prevalence rate. [online] Available from URL: https://www.cia.gov/ library/.../ the-world factbook/.../2155rank.html (retrieved on 2012/ 5/24).

3. UNAIDS World AIDS Report 2011(online). Available from URL: http://www.unaids.org/en/resourecs/publications/2011/(retrieved on: 2011/ November/ 23).

4. Samuel, Wagle S. Population mobility and HIV/AIDS: review of laws, policies and treaties between Bangladesh, Nepal and India.ODI background Notes. 2011 June. London. Available from URL: www.odi.org.uk/resources/docs/7108.pdf (retrieved on 2012/5/24).

5. Kurian EN. Food consumption and nutritional status of people living with HIV/AIDS (PLWHA): a case of Thika and Bungoma Districts, Kenya.Public Health Nutrition.2010 April;13(4):475-9.

6. Executive summary of Durban consultation meeting on Nutrition and HIV/AIDS, WHO 2006 Availabe from URL: www.who.int/.../nutrition/.../ Situation_Analysis_for_SEAR_Countries (retrieved on 2012/ 5/24).

7. Sharma S, Dhungana GP, Pokhrel BM, Rijal BP. Clinical Features of HIV/AIDS and various OI in related to antiretroviral status among HIV among sero-positive individuals from central Nepal. KUMJ. 2009;7(4):355-359.

8. Budhachandra Y, Ramesh K, Sumitra G. Personality profile among HIV positive and AIDS patients of injecting durg users. KUMJ. 2007; 5(1):38-41.

9. Dhungana GP, Ghimire P, Sharma S, Rijal BP. Tuberculosis and Other clinical presentations of HIV/AIDS in patients with or without undergoing antiretroviral therapy in Kathmandu. KUMJ. 2007; 5(11):22-26.

Table 1

Socio-demographic Characteristics of the People Living with AIDS n=113

SN Socio-demographic Characteristics Responses

Number percentage 1 Age group (in years)

≤ 25 15 4.4 26- 30 19 16.8 31- 35 35 31.0 36- 40 30 26.5 41- 45 12 10.6 ≥ 46 12 10.6 Mean = 36.3 SD= 8.268 Range= 19-73

2 sex Male 69 61.1 Female 44 38.9

3 Residence a. Rural 29 25.7 b. Urban 84 74.3

4 Marital Status a. Unmarried 85 75.2 b. Married 15 13.3 c. Divorced 12 10.6 d. Widow 1 0.9

5 Religion a. Hindu 84 74.3 b. Buddhist 17 15.0 c. Muslim 1 0.9 d. Christian 5 4.4 e. Kirata 6 5.3

6

Family Income / Month ( in Rupees)

4000- 14000 26 23.01

15000- 25000 26 23.01

26000- 36000 21 18.58

37000- 47000 23 20.35

≥48000 17 15.04

Mean = 29,982.30 SD= 18, 968.010 Range = 4000- 80,000

Table 2

Distribution of the Respondents according to HIV Status, Assessed Dietary Pattern & BMI n= 113

SN Characters Categories

( in months) ART consumption

Frequency (%)

1

Duration of ART consumption

3 – 12

30 (26.55)

13 – 36 42 (37.17) 37- 60 35 (30.97) > 60 6 (5.31)

Mean= 33.13, SD= 23.735, Range= 3- 142

2 CD4 count

At the Start of Therapy

≤ 50 10 (8.85)

51 – 250 79 (69.9)

251- 500 23 (20.35)

≥ 501 1 ( 0.9)

Mean: 184.24, SD: 101.692, Range: 2- 524

3 Diet Habit Non- Vegetarian 112 (99.1)

Vegetarian 1 ( 0.9)

4

Frequency of Eating/

day

3times 6 ( 5.31)

4 times 17 ( 15.04)

5 times 74 ( 65.49)

≥6times 16 ( 14.16)

5 Composition of Major

Meals is mostly

Carbohydrates 111 (98.23)

Proteins 2 ( 1.77)

6 Nutritional Supplement Consumption (NCASC)

Positive response 29 (25.66)

7 Body Mass Index (BMI) Frequency Percentage < 18.5 (malnourished) 28 24.79 18.5 – 24.9 (normal) 73 64.60 25- 29.9 (overweight) 12 10.62 ≥30 0 0

Mean: 20.85, SD: 3.13, Range: 14.17- 29.56

Table 3 Lifestyle Pattern, Tobacco Chewing, Smoking Habit, Alcohol & Drug Consumption Habit

among the PLWA n=113

SN Lifestyle Pattern Number Percentage 1 Exercise habit:

a. Daily 10 8.8 b. Alternate day 2 1.6 c. 1-2/week 7 6.2 d. Never 94 83.2

2 Feeling under pressure and stress: a. Often 103 91.2 b. Occasionally 2 1.8 c. Never 8 7.1

3 Hours of sleep per day: a. < 6 hrs 48 42.5 b. 6-8 hrs 64 56.6 c. >8 hrs 1 0.9

4 Taking food outside the home: a. Daily 39 34.5 b. Alternate day 11 9.7 c. 1-2/week 4 3.5 d. Never 59 52.2

5 Smoking/Tobacco Chewing habits: Present history:

a. Yes 32 28.3 b. No 81 71.7

Past history: a. Yes 45 39.8 b. No 68 60.0

Present consuming habits of different: a. Chewing tobacco 19 11.8 b. Cigarette smoking 13 11.5 c. Betal chewing 0 0 d. Hooka/Chilim 0 0 e. Bidi smoking 0 0

6 Present habit of Alcohol consumption a. Yes 1 0.9 b. No 112 99.1

7

Past habit of alcohol consumption a. Yes 41 36.3 b. No 72 63.7

8 Current habit of consumption of different types of alcohol: a. Beer 0 0 b. Wine 0 0 c. Rakshi/Jhad 1 0.9 d. Tongba 0 0 e. Whiskey/Rum 0 0

9 Drug abuse habit: a. Habit in present 0 0 b. Habit in past 32 28.3

Table 4 Association between Selected Demographic Variables and lifestyle Patterns

n=113

De

mo

gra

ph

ic Ch

ara

cteristics

Ch

ara

cte

rist

ics

Ca

teg

ori

es

Lifestyle Pattern

Exercise Feeling

Pressure Sleep

Tobacco

Consumption

Alcohol

Consumpti

on

Age

Oth

ers

Dai

ly

P-v

alue

Occ

asio

nal

ly /

neve

r O

ften

P-v

alue

Oth

ers

6-8

hrs

P-v

alue

No

yes

P-v

alue

No

yes

P-v

alue

>41 21 71

0.9

83

0 8

0.1

28

1 48

<0

.00

1

14 67

0.1

02

24 88

0.6

02

<41 3 16 24 81 23 41 10 22 0 1

sex Female 36 56

0.4

71

3 5

0.9

31

16 33

0.2

31

30 51

0.5

10

43 69

0.2

08

Male 6 13 41 64 28 36 14 18 1 0

Residence

Urban 72 2

0.0

72

6 2

0.9

64

39 10 0

.26

3 61 20

0.7

07

83 29

0.5

55

Rural 12 7 78 27 45 19 23 9 1 0

Marital

Status

UM/D/W 11 3

<0

.00

1

0 8

0.0

92

13 36

0.7

06

21 60

0.6

53

28 84

0.5

69

Married 17 2 28 77 15 49 7 25 0 1

Religion

B/C/M/K 21 73

0.0

72

0 8

0.0

85

13 36

0.8

54

22 59

0.5

62

28 84

0.0

87

Hindu 8 11 29 76 16 48 7 25 1 0

Nutritional Status of the People Living with AIDS receiving Anti-Retroviral Therapy in Eastern Nepal

Dr. Ram Sharan Mehta, Additional Professor

Sanuja Khatri, B.Sc.Nursing Email: [email protected]

Abstract: Patients who have been diagnosed as HIV/AIDS are prone to develop nutritional problems due to inadequate dietary intake, nutritional losses, metabolic changes, decreased immune response and increased requirements for calories and nutrients. The objective of this study was to find out the nutritional status of the people living with AIDS receiving ART at BPKIHS. Descriptive cross-sectional research design was adopted for the study. All the people living with AIDS receiving ART for more than three months physically present at ART clinic at the time of data collection constitute the population of the study. At the time of data collection total 476 clients were registered for ART. Population enumerative sampling technique 113 subjects were selected. Collected data were analyzed using SPSS-15 software package. It was found that majority (61.1%) of PLWA were male, married (75.2%), and Hindu (74.3%). The study result also showed that 64.60% of the total respondents had normal BMI. However, 24.79% were malnourished whereas 10.62% were found to be overweight and none to be obese. It was also found that the nutritional status was not significantly associated with variables like age (p=0.136), sex (p=0.094), family income (p=0.7) and duration of ART (p=0.472) at 0.05 level of significance. Based on the study, it can conclude that 35.4% PLWA still facing nutritional problems as shown by their poor nutritional status. Thus, effective nutritional programs need to be launched. Introduction: HIV/AIDS is a global epidemic which first emerged in 1981 in the USA. Since then, the epidemic has claimed lives of nearly 30 million people worldwide, the worst conditions being in the Sub- Saharan countries.1 There are 19 countries worldwide with the highest prevalence of reported infections, which are all African countries with more than 24.5 million HIV-infected population. South Africa is reported to have the largest population living with the disease, at well over 5 million people infected, followed by Nigeria in second place and India being the third largest population of HIV infected with more than 2 million people reported. Svalbard is reported as having no cases of HIV/AIDS. In terms of prevalence, countries such as Afghanistan, Saudi Arabia, and Cape Verde are reported to have the lowest prevalence of the disease among reported nations, at less than 0.1% of their population.2

According to UNAIDS/WHO, 47% of the established 14.2 million people eligible for the treatment in low and middle income countries were accessing ART( Anti Retro Viral) therapy in 2010.3

The AIDS picture in South East Asia is dominated by the epidemic in India. Migrants in particular are vulnerable and 67% of the infected in Bangladesh and 41% in Nepal are migrants returning from India.4 In a study done by the Department of Foods, Nutrition and Dietetics, Kenyatta University, among the HIV/AIDS infected two districts of South Africa , it was found out that majority of PLWHA consume foods that are low in nutrients to build up the immune system and help maintain adequate weight, and there is little variety in the foods they consume.5 In fact, the linkages between HIV/AIDS and food security are bi-directional: HIV/AIDS is a determining factor of food insecurity as well as a consequence of food and nutrition insecurity.6 A study conducted to assess nutritional status and dietary practices in people living with HIV/AIDS (PLWHA), concludes that PLWHA are at increased risk for poor intakes of fruits and vegetables and depleted lean body mass. HIV-positive persons had significantly lower mean weight, BMI, upper mid-arm circumferences, arm muscle area and arm fat area than persons in the control group. They were also less likely to use multivitamins, dietary supplements, fruit and vegetables than persons in the control group.7 In another study, it has been stated that nutritional status should be assessed at regular intervals as part of management of HIV infection.8 A study on diet quality of PLWA on highly active ART therapy, concludes that most of the adults living with HIV/ AIDS on ART had diets that required improvement and being overweight was associated with poorer diet quality.9 In the Regional Consultation on Nutrition and HIV/AIDS: Evidence, lessons and Recommendations for action in South East Asia, held in Bangkok Thailand, from 8th to 11th October, Raiten10 presented a paper on Nutrition and HIV: an Update on the Evidence Base, in which he discussed that a full integration of dietary and/or nutritional management is necessary into all aspects of care and treatment in patients receiving ART therapy as it may not only save lives but also bring about the metabolic changes in the body.

All PLWA require 20- 30 % more energy than normal requirements, which is a factor that is generally overlooked during the treatment with ART11. The study conducted by Mwamburi12 concluded that in the absence of ART the increase in viral load is associated with the decrease in body weight, however, during ART, virus load is not associated with the weight changes.

Mangili13 on Nutrition and HIV infection: Review of weight loss and wasting in the Era of HAART from the Nutrition For Healthy Living Cohort, suggests that the increased caloric demands and intake of the people living with HIV infection may be attributed to their HIV disease and its complication but they may also be associated with HAART. In the study carried out by Samuel14 on Nutritional status of the HIV positive people on free HAART therapy in a developing nation, which involved 120 HIV- positive people and a control group, for over a one-year period it was found out that malnutrition is common among the HIV- positive people of South-East Africa. When the nutritional status of the HIV sero- positive subjects was assessed in an AIDS clinic in Paris, it was found that among 124 subjects recruited, 62.1% had normal nutritional status whereas 8.1% had severe malnutrition15.

According to Nayepi16, in his study on The Risk of Developing Malnutrition in People Living With HIV/ AIDS, unintentional weight loss, gastrointestinal symptoms and other conditions are commonly associated with high risk of developing malnutrition. The results of the study showed that out of 145 PLWHA, 47.5% were found to be at a risk of developing malnutrition whereas 28.5% were actually malnourished.

When the weight and the body shape changes was observed in a treatment naïve population after 6 months of Nevirapine based generic HAART in South India, it was found that majority of the HIV positive patients gained weight and retained body shape symmetry with no change in the waist to hip ratio; however, several patients lost weight despite the initiation of ART.17

Dyslipidemia and hyperglycemia were the most commonly reported problems among the HIV positive patients on ART, both being the problems of nutritional origin, when a cross sectional study was carried out to assess lipodystrophy and dyslipidemia among the patients taking first line WHO recommended HAART in Western India .18

In an analysis of 469 HIV positive individuals in Nutrition for Healthy Living Cohort by Wanke19, more than 50% of the cohort were receiving ART at the time when they met clinical criteria for wasting.

Study conducted by Mustapa20 reported HAART treated PLWHA, the latter had higher BMI values indicating better nutritional status. In a study done by Kristy21 on Obesity in HIV infection: Dietary Correlates, out of 321 subjects13% of the males and 29% of the females infected with HIV were found to be obese.

Hence review and assessment of the nutritional status of the people living with AIDS, particularly those under ART therapy is a necessity to ensure that their nutritional status is good. This study has assessed the nutritional status of the People Living With AIDS receiving ART at BPKIHS. Objectives: To assess the nutritional status of the people living with AIDS receiving Anti Retroviral Therapy at BPKIHS and to find out the association between nutritional status and the selected demographic variables. Methodology: A descriptive cross sectional research design was used to assess the nutritional status of the people living with AIDS receiving anti retroviral therapy at ART clinic, Tropical ward at B.P Koirala Institute of Health Sciences. The total numbers of patients receiving ART were 480 (As per ART register record), out of them 113 were selected using population enumerative sampling technique, who met the selection criteria. The patients receiving ART for more than three months and physically present during the data collection period were included in the study after obtaining informed consent. The data was collected in July 2012. The data for the study was collected by an interview questionnaire after obtaining content validity form the concerned expert and pre-testing the tool. It consist a total of 46 questions

which have been divided into 4 categories: socio-demographic profile, anthropometric measurements, dietary pattern and life style questions. Permission was taken from the concerned departments, i.e. Department of Internal Medicine, Tropical Medicine, Infectious Disease, Ward In-charge of the Tropical Ward and VCT counselor of the ART clinic where the study would be conducted. Informed verbal consent was taken from each of the respondent prior to the data collection. Confidentiality and anonymity of the respondents were also maintained. The purpose of the study was revealed to the subjects before the interview. The collected data was then entered in Excel 2007 and analyzed using SPSS 15.0 version. Results: Majority of the respondents (61%) were male. About 31% were of the age group 31- 35 years. The range was 19-73 years and mean age was 36.3years. Among the respondents, 75.2% were married. Among those receiving ART, 69.9% had the CD4 count at the start of the therapy between 51-250, whereas the most recent count showed 47.79% had the count in the same range. Among the respondents, 64.60% had normal BMI, whereas 24.79% were found to be malnourished and 10.62% of the respondents were overweight. None of the respondents were found to be obese. The mean BMI is 20.85 with SD 3.13 and range 14.17 to 29.56. BMI and socio demographic variables like age (p-value= 0.136), sex (p-value= 0.094), marital status (p-value= 0.066), total family income per month (p-value= 0.700) and duration of ART in months (p-value= 0.472) were found to have no significant association, at 0.05 level of significance. The details of the results are depicted in table 1. Discussion: Among the respondents, 30.97% were of the age group 31- 35 years. The range was 19-73 years and mean age was 36.3years. Majority (61%) of the respondents were male. The above findings are similar to that of Swaminathan30. Among the respondents, 75.2% were married and none of the female respondents were pregnant or lactating mothers during the data collection period. Among them, 40.71% were Brahmin/Chhetri whereas 39.82% were of Mongolian origin. Out of 85.84% literacy rate, maximum (67.02%) had received education of secondary level, whereas only 22.68% had been educated up to higher secondary level. Among the respondents, majority (74.3%) were Hindu followed by Buddhist (15%) and Kirat (5.3%). Majority (53%) of the respondents came from Nagarpalika (municipality) whereas 46.9% came from VDC, which also included the town or city areas (urban) which have not yet been declared municipality by the government. Out of the total respondents, 23.01% had their family income between NPR 4000- 14000 and 15000- 25000 each. This may be due to the fact that the population consisted of people coming from Lahure family and having earning members abroad in a large number. The mean income per month was NPR 29,982.30 and the range was 4000- 80,000. Among the respondents, 37.17% were on ART since 13-36 months, the mean duration being 33.13 months and the range was found to be 3-142 months. Among those receiving ART, 69.9% had the CD4 count at the start of the therapy between 51- 250, whereas the most recent count showed 47.79% had the count in the same range.

Hepatitis C was the most common (15%) OI disease observed among the respondents, which may be due to past history of drug misuse. However, among the OI symptoms, majority (25.66%) had skin infections within the last three months of therapy. Infections like oral infection, sore throat, anxiety, nose bleed and tension headache were seen among 17.699% of the population. Majority of the patients (90.27%) took Cotrimoxazole as prophylaxis medication whereas, medications like Aciloc, Paracetamol, Anti-hypertensive constituted 15.04% of the prophylaxis drug being consumed, followed by vitamins (14.16%). Among the respondents, only one respondent was vegetarian. Majority (65.49%) of the population ate 5 meals per day. The composition of major meals was mostly carbohydrate (98.23%). When asked about the frequency of consumption of meat/fish/egg items, 61.09% responded that they consumed it 1-2 times per week, whereas 46.02% responded that they consumed milk and dairy products in the same frequency. Among the respondents, 65.40% responded that they had not eaten any kind of bakery items and 92.92% said that they had not eaten any kind of snacks (noodles, chips) within the last three months of ART therapy. Among the respondents, only 25.66% were consuming the nutritional supplement provided by WHO for ART receiving patients, supplied and distributed by the ART clinic, BPKIHS. Regarding the frequency of performing exercise, 83.2% responded that they never performed any kind of exercise (like yoga, vigorous fitness training and jogging), supported by the findings of Smit31. About 91% said that they occasionally felt under pressure and stressed out and 54% of them slept more than 8 hours per day followed by 41.6% who slept 6-8 hours per day. Among the respondents, 52.2% have not eaten with their friends and families outside their home, since the last three months of therapy. When asked about the substance use habit, 40% of the respondents currently had tobacco chewing habit whereas 28.30% had it before the start of therapy. Among those with tobacco use, 16.8% actually chewed tobacco compared to 11.5% who smoked cigarette. With regard to alcohol consumption habit, before the start of the therapy, 36.3% consumed alcohol which has been decreased to 0.9% after the start of the therapy. Among the respondents, 28.3% were in the habit of drug misuse before the start of the therapy, actually before contradicting the disease. One of the respondents was using drug even after the start of the therapy and had left both the therapy and drug 45 days back, who was excluded from the sample. The association calculated between the selected socio- demographic variables like age (p-value= 0.136), sex (p-value= 0.094), marital status (p-value= 0.066), total family income per month (p-value= 0.700) and duration of ART in months (p-value= 0.472) with the nutritional status, measured using the BMI, was found to be insignificant. This shows that the nutritional status of the PLWA receiving ART is not affected by age, sex, marital status, total family income and duration of ART. The above findings are supported by the findings of Mustapa28. In his study, he also found out that among the respondents on HAART, 48.10% had normal BMI, whereas 24.05% were malnourished and 18.99% were overweight, which is similar to the findings of this study in which majority (64.60%) had normal BMI and nearly 25% were malnourished. In the study done by Hendricks29, in which population was divided based on gender, 13% of the males and 29% of the females were found to be obese. Another study by Shevitz32 in which

population was again gender based found out that 275 of the women were overweight and 21% were obese whereas 33% of the males were overweight and 6% were obese. The above findings show that some kind of nutritional problems does exist in patients receiving Anti Retroviral Therapy. Even though 64.60% of the respondents had normal BMI, this study concluded that 35.4% had poor nutritional status (24.79% suffered from malnutrition and 10.62% from overweight). The association calculated between nutritional status and socio-demographic variables like age (p-value= 0.136), sex (p-value= 0.094), marital status (p-value= 0.066), total family income per month (p-value= 0.700) and duration of ART in months (p-value= 0.472) was found to be insignificant. Conclusion: Based on the study, it can conclude that 35.4% PLWA still facing nutritional problems as shown by their poor nutritional status. It was found that 64.60% have a normal BMI and 10.6% were obese. The nutritional status is insignificantly associated with the change in socio-demographic variables like age, gender, marital status, duration of treatment that is seen after the initiation of therapy. Limitations: Due to the proxy visits by the relatives instead of the patient, the sample collection was difficult as anthropometric measurements could not be taken. There was difficulty in obtaining data about the dietary patterns and lifestyle. The setting of the clinic could not ensure proper privacy. Patients who came in a hurry couldn’t be assessed due to their hurry for returning back. Recommendations: The supplementation of the nutritional supplement provided by NCASC and distributed by the ART clinic can be improved and the target group can be encouraged to consume it. Similar study can be conducted at other ART centers and results can be compared. This study can be done on a larger sample and the association with diet patterns and lifestyle can be observed, which also affect the nutritional status in one way or the other. The BMI at the start of the therapy can be assessed and used to compare the improvement in BMI after the initiation of ART. Implications of the study: This study gives an overview of the nutritional status of the PLWHA receiving ART at BPKIHS. For patients at the risk of being malnourished, ART initiation can be an important step in attempt to increase their nutritional status. References:

1. UNAIDS, Global Report: UNAIDS report on Global AIDS Epidemic2010, Geneva 2010. Available from www.unaids.org/documents/ (retrieved on 2010/11/23).

2. The Central Intelligence Agency World Fact book 2011, HIV/AIDS Adult prevalence rate. [ online] Available from URL: https://www.cia.gov/ library/.../ the-world factbook/2155rank.html (retrieved on 2012/ 5/24).

3. UNAIDS World AIDS Report 2011(online). Available from URL: http://www.unaids.org/en/resourecs/publications/2011/ (retrieved on: 2011/ November/ 23).

4. Samuel, Wagle S. Population mobility and HIV/AIDS: review of laws, policies and treaties between Bangladesh, Nepal and India.ODI background Notes. 2011 June. London. Available from URL: www.odi.org.uk/resources/docs/7108.pdf (retrieved on 2012/5/24).

5. Kurian EN. Food consumption and nutritional status of people living with HIV/AIDS (PLWHA): a case of Thika and Bungoma Districts, Kenya.Public Health Nutrition.2010 April;13(4):475-9.

6. Executive summary of Durban consultation meeting on Nutrition and HIV/AIDS, WHO 2006 Availabe from URL: www.who.int/.../nutrition/.../ Situation_Analysis_for_SEAR_Countries (retrieved on 2012/ 5/24).

7. Burgin J., Nicholas S., Dalrymple N. Nutritional status and dietary practices in people living with HIV/AIDS (PLWHA). Faculty report 008/009. The University of West Indies St. Augustine Campus. Available from URL: www.sta.uwi.edu/resources/documents/uwi_faculty_report_08-09.pdf (retrived on: 2012/5/24).

8. Duran AC., Almeida LB., Sequrado AA., Jaime PC. Diet quality of persons living with HIV/AIDS On Highly Active ART therapy. J Hum Nutrition Diet.2008 Aug; 1(4):346-50.

9. Tamsin AK., Sanders ZM., Gardner FC., Moen K., Johansen D., Paton N. Assessment of Nutritional Status, Body Composition, and Human Immunodeficiency Virus–Associated Morphologic Changes. Clinical Infectious Diseases 2003;36(2):63-8.

10. Raiten D. Nutrition and HIV: an update on the evidence base. Proceedings of the Regional Consultation on Nutrition and HIV/ AIDS: Evidence, Lesson and Recommendations for Action In South East Asia; 2007 October 8-11; Bangkok, Thailand.Available from URL: www.who.int/nutrition/topics/executive_ summary_bangkok.pdf (retrieved on: 2011/ 11/ 26)

11. World Health Organization. Nutrient Requirements for People Living With HIV/ AIDS: Report of a technical consultation. WHO: 2003,May13-15, Geneva. Available from URL: www.who.int/nutrition/publication/hivaids/ (retrieved on : 2011/ 11/ 26)

12. Mwamburi DM., Wilson IB., Jacobson DL., Spigelman D., Gorbach SL., Knox TA., Wanke CA. Understanding the role of HIV load in determining Weight Change in the Era of HAART. Clinical Infectious Disease.2005 Jan1;40(1):167- 73.

13. Mangili A, Murman DH, Zampini AM, Wankel CA, Mayer KH. Nutrition and HIV infection: Review of Weight Loss and Wasting in the Era of Highly Active Anti Retroviral Therapy from the Nutrition for Healthy Living Cohort. Oxford Journals Medicine Clinical Infectious Diseases. 2005 December 6; 42(6): 836-842.

14. Obi NS., Ngozi A., Onyubuchi KA. Nutritional Status of HIV positive individuals on free HAART in a Developing Nation J Infect Dev Ctries. 2010; 4(11):745-749.

15. Niyobgabo T, Bouchaud O., Henzel D., Melchior JC., Samb D., Dazza MC. et al. Nutritional Status of HIV seropositive subjects in an AIDS clinic in Paris. European Journal of Clinical Nutrition, 1997 September;51(9):637- 40.

16. Nayepi MS, The Risk of Developing Malnutrition in People Living With HIV/AIDS: Observations from six support groups in Botswana. S African Journal Clin. Nutrition 2009:22(2).

17. Saghayam S, Kumarasamy N, Cecelia AJ, Solomon S, Mayer K, Wanker C. Weight and Body Shape Changes in a treatment naïve population after 6 months of Nevirapine- based

generic Highly Active AntiRetroviral Therapy in South India. Clinical Infectious Disease 2007;44: 295-300.

18. Pujari SN, Dravid A, Naik E, et al. Lipodystrophy and dyslipidemia among patients taking First line WHO- recommended Highly Active Anti Retroviral Therapy regimens in Western India. Journal Acquired Immune Deficiency Syndrome.2005; 39; 199- 202.

19. Wanke CA, Silva M, Knox TA, Forrester J, Spiegelman D, Gorbach SL. Weight Loss and Wasting remain common Complications in individuals infected with Human Immunodeficiency Virus in the Era of HAART. Clinical Infectious Disease. 2000; 31:803- 805.

20. Mustapa KB, Ehianeta TS, Kirim RA, Osungwa FT, Oladepo DK. Highly Active Anti Retro viral Therapy (HAART) and Body Mass Index (BMI) relationship in People Living With HIV/ AIDS (PLWHA) in the Federal Capital Territory, Nigeria and the neighbouring States. Journal of AIDS and HIV Research. 2011 March;3(3): 57- 62.

21. Hendricks KM, Willis K, Houser R, Jones CY. Obesity in HIV infection: Dietary Correlates. Journal of the American College of Nutrition. 2006 August; 25(4): 321- 331.

Table 1

Association between selected Socio- Demographic Variables and Nutritional Status of the Respondents

n=113

Key: NS: Not significant *: Chi Square test ^: Yate’s Corrected Chi Square test

SN Characters Categori

es

Nutritional Status (BMI)

P-value Remarks Malnourished %

Normal %

Overweight %

1. Age ( in years)

<36 27.1 67.8 5.1 0.136* NS

≥ 36 24.1 59.3 16.7

2. Sex Male 18.8 71 10.1 0.094* NS

Female 36.4 52.3 11.4 3. Marital

Status Married 30.6 61.2 8.2

0.066^ NS Single 10.7 71.4 17.9

4.

Total Income/month (in rupees)

<30,000 44.8 45.8 58.3 0.700*

NS ≥30,000 55.2 54.2 41.7

5.

Duration of ART (in months)

≤ 36 69 59.7 75 0.472* NS

>36 31 40.3 25

Lung Cancer Patients in Eastern Region of Nepal

Dr. Ram Sharan Mehta B.P. Koirala Institute of Heath Sciences, Dharan, Nepal

Email: [email protected] Abstract: The number of new cancer cases annually is estimated to rise from 10.9 million in 2002 to more than 16 million by 2020, if current trends continue. Much of this increase in absolute numbers derives from the ageing of populations worldwide. The objectives of this study were to find out the demographic characteristics of the admitted cancer patients in BPKIHS. It was hospital based descriptive cross-sectional study conducted reviewing all the records of admitted diagnosed cancer patients in BPKIHS from 15th October 2004 to 14th October 2012. Using total enumerative sampling technique all 1379 diagnosed cancer patients record were reviewed after obtaining the permission from concerned authorities. Using SPSS-15 software package data was analyzed. It was found that majority (71%) of cancer patients were of age more than 40 years and equal of both sexes. Most of the clients were form Sunsari (31.1% ), Morang (16.6% ) and Jhapa ( 17%) districts. The mean hospitalization day is 8.32 and very few patients (5.2 %) were only cured. The numbers of cancer patients are markedly increases in BPKIHS, especially in advanced stage. It is mandatory to start the cancer information and education programme in eastern region of Nepal and proper management of cancer patients using chemotherapy, radiotherapy and surgery at BPKIHS for quality patient care. Introduction: Cancer is one of the most common causes of morbidity and mortality today, with more than 10 million new cases and more than 6 million deaths each year worldwide. More than 20 million persons around the world live with a diagnosis of cancer, and more than half all cancer cases occur in the developing countries. Cancer is responsible for about 20% of all deaths in industrialized countries and 10% in developing countries. It is projected that by 2020 there will be every year 15 million new cancer cases and 10 million cancer deaths. Much of this increase in absolute numbers derives from the ageing of populations’ worldwide.1 The most frequent cancer type among males in the developing countries is in the lungs followed by stomach cancer accounting for about 430,000 and 350,000 new cases respectively in 2000.2 The incidence of lung cancer is rising dramatically in Asia. Cancer is currently placed 6th to 9th in the common causes of mortality in the SAARC region. The most common cancers in Asia are the cancers of head, neck and thorax, which can be directly attributed to the smoking and tobacco chewing habits in the region especially SAARC region. The pattern of cigarette smoking changed globally during last three decade. It is slowly decreasing in developed countries, at a rate of 1% annually and rising in developing countries, at a rate of 2%. Recent studies have shown in addition to the direct tobacco smoking, environmental tobacco smoke has a proven lung carcinogenic effect. As the single most important cause for lung cancer is tobacco smoke, every effort should be taken to control this menace, reported by Jha. 3

Study conducted by Binu 4 in Manipal Teaching Hospital, Pokhara, during 1st January 2003 to 30th May 2005 were used for the present study. A total of 957 cancer cases were identified with a male to female ratio of 1.1:1. The median age of male and female patients was 63 and 60 years, respectively. The proportion of microscopically confirmed cases, both from primary and metastatic sites was 87.5% and tobacco-related cancers constituted 48% of all cancers among males and 28% among females. For males the leading cancer sites were lung (22.2%), larynx (9.8%) and stomach (9%) and that for females was lung (20%), cervix (19.7%) and breast (7.8%). Among males, 33.1% of all cancers were in the respiratory system followed by digestive organ cancers (23.2%). Among females, 28.4% cancers were related to the reproductive system, 22.8% to the respiratory system and 14.1% to digestive organs. These findings clearly illustrate the epidemiology of cancer in Nepal. In B.P. Koirala Institute of Health Sciences (BPKIHS), As per the record of medical record section, the number of cancer patients admitted and treated are increasing yearly i.e. 203 in 2054 BS, 287 in 2055 BS, 427 in 2056 BS, 342 in 2057 BS, 335 in 2058 BS, 417 in 2059 BS, 485 in 2060 BS, and 385 in 2061 BS. These are only inpatients records. The OPD Non-registered cases may be numerous. In Nepal, As per the record of national cancer registry program report of the hospital based registries of cancer prevention, control and research dept of B.P. Koirala Memorial Cancer Hospital BPKMCH5, 2003, mentioned that in Nepal in 2003 total 3251 cancer patients were admitted. Among those 3257, majority of them were in BPKMCH i.e. 1869 (57.5%), BPKIHS 418 (12.9%), Bhaktpur cancer hospital 328 (10%), Tribhuvan University Teaching Hospital (TUTH) 328 (10%), Manipal Teaching Hospital 215 (7.6%), Bir-hospital 127 (6.6%) and Kanti Children Hospital 46 (i.e. 1.4%). Among those 54.3% were male and 45.7% were female. In Nepal, 2003 total 3257 cancer patients were admitted. These data clearly illustrate that BPKIHS is a second hospital of Nepal where cancer patients are admitted and treated. Cancer information and education project can play a major role in cancer prevention and control in the eastern part of Nepal. Study conducted by Chawala6 reported, Knowledge and beliefs about lung cancer and smoking varied significantly by socio-demographic factors amongst lake side residents of Pokhra. Most of the people continue to smoke. Results emphasize the need to develop health education programs that enhance lung cancer knowledge among men and women who currently smoke and are in low socioeconomic groups. So, the government and NGOs should gear up for a population based counselling programme in this community. These findings clearly illustrate the high risk of lung cancer among people living in Pokhra valley. Objectives of the study: To find out the demographic profile of the admitted cancer patients in B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Methodology: It was hospital based descriptive cross sectional study conducted reviewing all the records of admitted diagnosed cancer patients in BPKIHS from 15th October 2004 to 14th October 2012. Using total enumerative sampling technique all 1379 diagnosed cancer patients record were reviewed after obtaining the permission from concerned authorities. Using SPSS-15 software package data was analyzed.

Results: The data were collected from the files of admitted patients of BPKIHS between the duration of 15th October 2004 to 14th October 2012 i.e. of 7 years. It was found that total 235 patients were admitted during this period. Most of the patients were of age group of 51-70 years i.e. 61.7%, Male (55.7%), Female (44.3%), Mangolian (46%); and residing in Sunsari (31.1%), Jhapa (17%) and Morang (16.6%) districts. Majority of patients were admitted in Medicine (70.6%), followed by Surgery (24.6%), Otolaryngology (3.8%), Orthopedics (0.4%) and Pediatrics (0.4%). Most of the patients had hospital stay for 3-10 days (68.1%), and regarding the outcome 37.4% improved, 20% unchanged, 11.9% referred, 6.4% left against medical advice, 5.5% expired and 0.9% cured. The details are depicted in table 1 and 2. Discussion: Majority (61.7%) of the lung cancer patients were of age group of 50-70 years. Only 5.5% patients were less than 40 years and only 0.4% was of age more than 90 years. Most of them (55.7%) were male, from villages (63%), and Mongolians (46%). Most of the lung cancer patients were from Sunsari (31.1%), Jhapa (17%), and Morang (16.6%) district. A 3-year retrospective study was done to determine the prevalence and pattern of cancer in the eastern region of Nepal by Lakhey7 reported, total number of 10,068 biopsies was received in a 3 years period, out of which 928 biopsies were diagnosed as cancer (9.22 %). The common age group affected by cancer was 51 – 70 years. Cancer was slightly more prevalent in males with a male to female ratio of 1.08:1. Most common draining area for cancer was Sunsari (23.6 %) followed by Morang (20.9%), which is similar to this findings. Similarly Hashibe8 reported, Approximately 46.6% (n=48) of lung cancer patients were females and the largest proportion of cases were in the 60-69 year age group (35.0%), which is similar to this findings. Similarly Study conducted by Hashibe2, observed differences in lung cancer risk by ethnicity; the Rai, Limbu and Magar groups had a higher risk of lung cancer than Brahmin (OR=3.11, 95% CI=1.55-6.23). Out of total 235 admitted lung cancer patients 70.6% were discharged from medicine department followed by Surgery (24.6%), ENT (3.8%), Orthopedic (0.4%), and Paediatric (0.4%). It was found that 68.1% patients had infiltration in the lung parenchyma, where as 20% had cancer of trachea, 3% had cancer of main bronchus, 2% larynx and 1.7% esophagus. It was found that 68.1% patients were admitted in the ward for 3-10 days, where as 15.3% admitted for less than 3 days and 4.7% for more than 18 days. At the time of discharge it was found that 37.4% patients’ condition were improved, 20% had unchanged, 11.9% referred, 6.4% left against medical advice, 5.5% expired and only 0.9% cured. Similar finding were reported by Binu.4 Conclusion: It is mandatory to start the cancer information and education programme at eastern region of Nepal for cancer information, Prevention, early detection and proper management of cancer patients using chemotherapy, radiotherapy, and surgery must be available at BPKIHS for quality patient care. The numbers of cancer patients are markedly increases in BPKIHS, especially in advanced age and in late stage. As BPKIHS is tertiary care hospital of eastern Nepal having cancer diagnosis, it is easier to diagnose cases in early stage and can be treated and refer to BPKMCH, Bharatpur in time for proper management. As these data are hospital based, it could not reflect the true picture of Nepal.

Limitations of the study: Study is based only on hospital records of treated diagnosed cancer patients. Some of the vital information’s were incomplete, hence unable to give various important pictures. Recommendations: Similar study can be conducted taking other more variables like: treatment received, economic status, risk factors, outcome of treatment, prognosis of patient, and the knowledge profile in prospectively, so that clear picture can be drawn. It is mandatory to start the cancer information and education programme at BPKIHS for cancer information, Prevention, early detection and proper management of cancer cases. References:

• www.uicc.org • Joshi SK. Occupational Cancer in Nepal-an update. Kathmandu University Medical

College Journal. 2003; 1(2):144-151. • Jha R, Weerakkoon AP, Karki KB, Shrestha S, Gamage PWK. Lung Cancer and

Smoking in Asia. SAARC J. Tuber. Lung Dis. HIV/AIDS. 2008; 5:1-6. • Binu VS, Chandrashekher TS, Subba SH, Jacob S, Kakria A, Gangadharan P, Rites GM.

Cancer Pattern in Western Nepal: A hospital based retrospective study. Asian Pacific J Cancer Prev. 2007; 8: 183-186.

• www.bpkmch.org.np • Chawla R, Sathian B, Mehra A, Kiyawat V, Garg A, Sharma K. Awareness and

Assessment of Risk factors for lung cancer in Residents of Pokhra valley. Asian Pacific J. Cancer Prev. 2010; (11): 1789-1793.

• Lakhey M, Agrwal A, Lakhey S, Sinha AK, Sah SP, Gupta S, Panday SR. Cancer pattern in Eastern region of Nepal. JNMA. 2003; 42:284-289.

• Hashibe M, Siwakoti B, Thakur BK, Pun CB, Shrestha BM, Burningham Z, Sapkota A. Socioeconomic status and Lung Cancer risk in Nepal. Asian Pac J. Cancr Prev. 2011; 12(4):1083-8.

Table 1 Socio-demographic Characteristics and Disease Status of the Subjects

n=235 SN Socio-demographic Characteristics Responses

Number Percentage 1 Age (In Years)

<40 13 5.5 40-50 24 10.2 51-60 58 24.7 61-70 87 37.0 71-80 38 16.2 81-90 14 6.0 >90 1 0.4 Mean=62.46, SD=12.821, Range=5-95

2 Residence VDC 148 63.0 Municipality (Dharan 48=20.4%) 87 37.0

3 Caste a. Brahmin/Chhetri 64 27.2 b. Newar 16 6.8 c. Rai, Limbu, Gurung, Magar,

Tamang 108 46.0

d. Trai Caste 47 20.0 4 Part of Lung Cancer

Lung 160 68.1 Trachea 47 20.0 Main bronchus 7 3.0 Larynx 5 2.1 Esophagus 4 1.7 Others 12 5.1

5 Total duration of admission (hospital days)

< 3 36 15.3 3-6 101 43.0 7-10 59 25.1 11-14 20 8.5 15-18 8 3.4 >18 11 4.7 Mean=7.29, SD=7.338, Range=1-71

6 Outcomes 1. Improved 88 37.4 2. Unchanged 47 20.0 3. Refer 28 11.9 4. LAMA 15 6.4 5. Expired 13 5.5 6. Cured 2 0.9 7. Others 42 17.9

The Effects of an Educational Program on Nurses Knowledge and Practice Related to Hepatitis-B: A Pre-test and Post-test Pre-Experimental Design

Dr. Ram Sharan Mehta, Additional Professor Mr. Gayanand Mandal, Associate Professor

B. P. Koirala Institute of Health Sciences, Dharan, Nepal Email: [email protected]

Abstract: Hepatitis-B is the major infectious disease of mankind. In Nepal it is reported that more than 4.3% of Nepalese population at any time in their life has been infected with Hepatitis-B virus (HBV). Two billion people worldwide have been infected with the virus and about 600 000 people die every year due to the consequences of hepatitis-B. The hepatitis-B virus is 50 to 100 times more infectious than HIV. Hepatitis B is an important occupational hazard for health workers. Hepatitis-B is preventable with the currently available safe and effective vaccine. The objective of this study was to evaluate the effectiveness of planned educational programme regarding knowledge and practice of hepatitis-B among the nurses working at medical units of BPKIHS. Pre-experimental research design was used to conduct the study among the nurses working in medical units of BPKIHS. Total 40 nurses were included in the pre-test and 34 in the post-test. The education intervention was arranged on 24th May 2012 from 2:15 pm to 4:45 pm i.e. two and half hours. After two weeks of education intervention post-test was conducted. Most of the participants (60%) were of the age group of 18-22 years, Hindu (82.5%), and unmarried (65%). After education intervention there is significant differences in knowledge on the components of Hepatitis-B like: survival of virus (p=0.001), concentration of virus (p=0.001), and duration of acute Hepatitis-B (p=0.003) at 0.05 level of significance. There is no difference in the attitude components after post-test except the component patient contaminated with Hepatitis-B must be called as the last patient (p=0.035). It could be concluded that hepatitis-B educational program improved knowledge and practice and decrease occupational risk from blood borne infection. Introduction: Hepatitis-B is a viral disease affecting the liver is one of the most common infections in the world with approximately 2 billion people infected with it. Out of these approximately 5 % suffer from chronic liver disease. Also over two third of all cases of liver cancers worldwide are caused by HBV.1 Worldwide, it is estimated that more than 1 million people infected with HBV will die every year and approximately 25% of all patients with chronic HBV infection will die of liver disease.2 Transmission of HBV is predominantly by parenteral means, even though this infection is also transmitted by sexual contact and acupuncture. Mother to child transmission and occupational transmission from HBV infected patients to health care workers is also major modes of

transmission. For neonates and infants who acquire HBV, the risk of chronicity is almost 90%, while it decreases to 30% for children of 1-5 yrs and up to 2% for older children and adults.3 Hepatitis-B virus carrier rates among healthy population in Nepal is 0.9-1%. In this region, vertical transmission of HBV mostly occurs during childhood. It has been found that 8-15% of the population in this region is chronically infected with hepatitis-B virus.4 In a study done in Katmandu valley, the prevalence of hepatitis B among the high-risk groups was found to be 10.9%. In another study done in BPKIHS during a period of six months (feb 1998 to July 1998) total 300 patients sera was tested for hepatitis-B surface antigen, of which 15% were found to be positive. In Nepal it is reported that more than 4.3% of Nepalese population at any time in their life has been infected with HBV. The carrier rate of HbsAg in Nepal is 1%. The disease is important because it is easy to transmit, has high morbidity and causes prolonged loss of time for employment. Effective therapy is necessary to prevent the progression of chronic hepatitis-B to cirrhosis, hepatocellular carcinoma and death.5 Since the disease is rapidly increasing day by day, health workers are more vulnerable to get and transmit the infection. Hence to practice the proper technique for prevention of disease health personnels and staff are needed to be motivated. This information booklet will help all the clients, health workers and staff for proper care from the disease and its prevention by providing the knowledge regarding it.6 Hepatitis-B is a systemic infection in which necrosis and inflammation of liver cell produces a characteristic cluster of clinical, biochemical and cellular changes. It is present worldwide and has infected more than 2000 million people. There are an estimated 300 million carriers.1 It has a long incubation period. It is transmitted primarily through blood exposure from borne pathogens poses serious risk to the health workers, especially surgeons, nurses, helpers and health aids.4

Frequency of contamination ranges from 3-7%. Most commonly due to needle sticks (73%), knife cuts (5%) and gloves perforation. After contamination the probability of acquiring HIV is 0.3%, HBV is 6-30%, and HCV is 1.8% among the health workers.3

To minimize and reduce the risk of occupational transmission of blood-borne infection, it is necessary to change the attitude and practices regarding it. The number of Hepatitis-B patient is increasing in wards very rapidly. As the disease is very serious and can be transmitted to others easily, the health workers and staff of the wards are more susceptible to got the disease if proper universal precaution not followed. Objectives: The objective of this study was to evaluate the effectiveness of planned educational programme regarding knowledge and practice of hepatitis-B among the nurses working at medical units of BPKIHS. Research design and methodology: Pre-experimental research design was used to conduct the study among the nurses, working in medical units of BPKIHS. All the nurses working in Medical

units constitute the population of the study. Using total enumerative sampling technique total 40 nurses were included in the pre-test where as only 32 in the post-test. The education intervention was arranged after pre-test on 24th May 2012 from 2:15 pm to 4:45 pm i.e. two and half hours. After two weeks of completion of teaching session, post-test was conducted during the period of 7 June 2012 to 14th June 2012. Written permission was obtained from the Institute Ethical Review Board of BPKIHS. The name of the Subjects was not mention in the tools. Informed verbal consent was obtained from each subject. The information obtained from the participant was kept confidential. The participants were free to withdraw from the project any time if they wish. The NHRC ethical review guidelines were followed. Results: it was found that 60% nurses were of age group of 18-22 years, followed by 23-27 years (35%) and 28-39 years (5%) with mean age 22.40, SD 2.854, and range 18-32. Most of the nurses (85%) were staff nurses, where as 7.5% were nursing officers, 5% were senior staff nurses and 2.5% ANMs. Majority (65%) were unmarried. Only 27.5% nurses had job experiences in BPKIHS for more than one years, 37.5% had total nursing experiences for more than one years. Only 15% had participated in in-service education on Hepatitis-B but 95% had studied in the course. About 72% had vaccinated against Hepatitis-B, whereas only 40% had complete course. There is significant increase in the knowledge of hepatitis-B in most of the components at 0.05 level of significance. There is no significant difference in the attitude components of Hepatitis-B at 0.05 level of significance except one component. Similar findings were also found in the practice components. It was found that 72.5% nurses had needle prick within last 6 months, 77.5% received IM/IV injections, 22.5% had donated blood, 42.5% had immunized within last year and 45% had history of shaving body hair. The details of the results are depicted in table 1to 4. Discussion: Most of the participants (60%) were of the age group of 18-22 years, Hindu (82.5%), and unmarried (65%). Only 15% participants had participated in Hepatitis-B CNE or training previously. Majority (72.5) of the participants had vaccinated against Hepatitis-B, whereas 40% had only completed the full course. Study conducted by Kesieme11 reported 26.8% operating room staff had vaccinated against Hepatitis-B which is similar to this study. The study conducted by Mohamed13 reported that the 60% nurses had age group of 20-30 years in the similar study which has same findings to our study. Study conducted by Mohanmadi14 reported 96.4% nurses had vaccinated against Hepatitis-B, which is more than in this study of 72.5%. After education intervention there is significant differences in knowledge on the components of Hepatitis-B like: survival of hepatitis-B virus in room temperature (p=o.001), high concentration of HBV in wound exudates (p=0.001), and duration of acute Hepatitis-B (p=0.003). There is no significant difference in the components like: transmission, clinical features, complications, cure rate at 0.05 level significance. Study conducted by Singh12 among the medical students found 86.7% had knowledge about Hepatitis-B; which is similar to this study. Study conducted by Mohamed13 among nurses related to Hepatitis-C found the similar results. The study conducted

by Talpur16 reported lack of knowledge and attitude of the people about Hepatis-B. Most people use homeopathic or Ayurvedic treatment for it. Differences in Practices among the nurses about care of Hepatitis-B and standard precaution after education intervention: In all the eleven components of practices there is no significant differences in scores at 0.05 level of significance. It was found that 5% nurses had tattooing in the body in past three months, 72.5% had needle prick within last six months, 77.5% had IM or IV injections within last six months, and 42.5% had taken immunization within last one year. Study conducted by Mohammadi14 reported, the prevalence of needle stick injury among the nurses was 52.9%, which is less in comparison to this result (72.5%). There is no difference in the attitude components of Hepatitis-B among the participants after education intervention at 0.05 level of significance except the component patient contaminated with HBV must be called as the last patient (p=0.035). Study conducted by Akbulut17 dental clinical student reported, participants had high knowledge (77%) on Hepatitis-B, attitude was accepatible; however daily practice was moderate. Conclusion: Hepatitis-B education program improved knowledge and practice and decrease occupational risk from blood borne infection after implementation of program. This helps in better adherence to barrier protection such as hand washing, use of gloves and hand disinfection. It is recommended that continuing education programs are needed to increase awareness of hepatitis-B virus in various risk groups in the institute. Also replication of the study on a larger probability sample from different areas should be done to achieve more generalizable results. If the observation method was used to assess the practice of the nurses it will be more useful. Recommendations: It is recommended that continuing education programs are needed to increase awareness of hepatitis-B virus in various risk groups in the institute. Also replication of the study on a larger probability sample from different areas should be done to achieve more generalizable results. Limitations of the Study: The study was conducted in Medical units of BPKIHS only. If the observation method was used to assess the practice of the nurses it will be more useful. References:

1. Spence MR, Dash GP. Hepatitis B: perceptions, knowledge and vaccine acceptance among registered nurses in high-risk occupations in a university hospital. Infect Control Hosp Epidemiol. 1990;11(3):129-33.

2. Askarian M, Assadian O. Infection Control Practices among Dental Professionals in Shiraz Dentistry School, Iran. Arch Iran Med. 2009; 12: 48-51.

3. Erasmus S, Luiters S, Brijlal P. Oral Hygiene and dental student’s knowledge, attitude and behaviour in managing HIV/AIDS patients. Int J Dent Hygiene. 2005; 3: 213-217.

4. Norsayani MY, Hassim IN. Study on Incidence of Stick Injury and Factors Associated with this Problem among Medical Students. J Occup Health. 2003; 45: 172-178.

5. Beekmann SE, Henderson DK. Protection of healthcare workers from bloodborne pathogens. Curr Opin Infect Dis. 2005;18(4):331-6.

6. Askarian M, Shaghaghian S, McLaws ML. Needlestick injuries among nurses of Fars provaaince, Iran. Ann Epidemiol. 2007;17(12):988-92.

7. Banskota. H.K, Islan M.N, Et.Al.Vertical Transmission Of Hepatitis B Virus Infection; NMCJ. 2000; 20:37-40.

8. Banskota H.K ,Prevalence Of Hepatitis B Virus in Nepalese Population, NMCJ. 1998;1: 17-19.

9. Rondahl G, Innala S, Carlsson M. Nursing staff and nursing students' attitudes towards HIV-infected and homosexual HIV-infected patients in Sweden and the wish to refrain from nursing. J Adv Nurs. 2003;41(5):454-61.

10. Gerd R, Sune I , Marianne C. Nursing staff and nursing students' attitudes towards HIV-infected and homosexual HIV-infected patients in Sweden and the wish to refrain from nursing. Journal of Advanced Nursing; 2003, 41(5):454.

11. Kesieme E, Uwakwek, Irekita E, Dongo A, Bwala KJ, Alegbedeye BJ. Kowledge of Hepatitis-B vaccine among operating room personnel in Nigeria and their vaccination status. Hepatitis Research and Treatment. 2011; Article ID 157089; doi: 10.1155/20111/157089.

12. Singh A, Jain S. Prevention of Hepatitis-B; knowledge and practice among medical students. Helathline. 2011; 29(2):8-22.

13. Mohamed MS, Wafa AM. The effects of an educational programme on nurses knowledge and practice related to Hepatitis-C virus: A pre-test Post-test quasi-experimental design. Australian Journal of Basic and Applied Sciences. 2011; 5(11): 564-570.

14. Mohhammadi N, Allami A, Mohamadi RM. Percutaneous exposure incidents in nurses: knowledge, practice and exposure of Hepatitis-B infection. Hepat Mon. 2011; 11(3):186-190.

15. Franco E, Bagnato B, Marino MG, Meleleo C, Serino L, Zarati L. Hepatiti-B: epidemoiology and prevention in developing countries. WJU.2012;4(3): 74-80.

16. Talpur AA, Memon NA, Solangi RA. Knowledge and attitude of patients towards Hepatitis-B and C. Palistan Journal of Surgery. 2007; 23(3): 162-165.

17. Akbulut N, Oztas B, Kursun S, Colok G. Knowledge, Attitude and Behaviour regarding Hepatitis-B and infection control in Dental clinical students. AAOHN J. 2003; 51(8):347-52.

18. Biju IK, Sattar A, Kate M, etal Incidence and awareness of hepatitis B infection among and paramedical students. Indian J Gastroenterol 2002; 21 (1)104-5.

Table 1 Differences in knowledge about Hepatitis-B among the participants after Education Intervention

(Using McNemar Chi-squire Test)

SN Knowledge about Hepatitis-B

Correct Responses

Pre-Test (%) n=40

Post-Test (%) n=32

Differences (%)

P-value

1. Transmission of Hepatitis-B 95 100 5.0 0.500b 2. Common Presentations of

Hepatitis-B 100 100 0 1.000b

3. Treatment of the Hepatitis-B 62.5 71.5 9.4 0.648b 4. Complications of Hepatitis-B 87.5 100 12.5 0.250b 5. Availability of vaccine to prevent

Hepatitis-B 100 100 0 1.000b

6. Possibility of cure the disease from the body

27.5 50.0 22.5 0.167b

7. Isolation needed to prevent transmission

77.5 81.3 3.8 0.774b

8. Duration of acute Hepatitis-B 67.5 93.8 26.3 0.003b 9. Hepatitis-B virus can survive in

room temperature for 6 months 45.0 87.5 42.5 0.001b

10. Wound exudates contains highest concentration of HBV

42.5 100 57.5 0.001b

11. HBV can cause liver cancer 82.5 93.8 11.3 0.289b Using MacNemar Chi-squire test Key: b: Binomial Distribution is used

Table 2 Differences in knowledge about Different Modes of Transmission of Hepatitis-B among the

participants after Education Intervention

SN Knowledge about Different Modes of Transmission of Hepatitis-B

Correct Responses

Pre-Test (%) n=40

Post-Test (%) n=32

Differences (%)

P-value

1. Not transmit by saliva (T) 61.0 73.4 12.4 0.429 b 2. Transmit by Heredity (Gene) (F) 78.1 81.3 3.2 0.590 b 3. Transmit through air (Coughing) (F) 37.5 87.5 50.0 0.001b 4. Transmitted by sexual intercourse(T) 90.0 100 10.0 0.492 b 5. Transmitted from infected mother to

child (T) 68.8 68.8 0 1

6. Transmitted through sharing utensils. (F)

57.5 68.8 11.3 0.001b

7. HBV is more infectious than HIV(T) 90.0 100 10.0 0.218 b Using MacNemar Chi-squire test Key: b: Binomial Distribution is used

Table 3 Differences in Attitude among the Nurses about Hepatitis-B after Education Intervention

SN Attitude among the Nurses about Hepatitis-B

Correct Responses

Rem

ark

Pre

-Tes

t (%

) n=

40

Pos

t-T

est (

%)

n=32

Diff

eren

ces

(%)

P-v

alue

1. Heath personnel must be trained regarding hepatitis and infectious diseases. (P)

100 100 0 1

2. Patient contaminated with HBV must be called as the last patient.(N)

65 71.9 6.9 0.035

3. After instrument injuries; non-vaccinated health care workers should have immunoglobulin installation and three dose vaccination program. (P)

95 100 5.0 0.424a

4. After patient treatment procedure, materials which have contact with body fluids and blood must be checked to medical waste. (P)

100 100 0 1

5. Instruments should be washed right after treatment and before autoclaved. (P)

100 100 0 1

6. Every patient must be assumed to be a contagious disease risk; therefore, we must obey standard infection control measures. (P)

100 100 0 1

7. All the medical staff working with blood and body fluids in contact should be vaccinated. (P)

100 100 0 1

8 Hepatitis and AIDS patients’ information regarding systemic condition must be recorded on the patient file. (P)

100 100 0 1

9 Do you intend to make sure that everyone in your family receives hepatitis B vaccinations? (P)

100 100 0 1

Using MacNemar Chi-squire test Key: a: Binomial Distribution is used

Table 4 Differences in Practices among the Nurses about Care of Hepatitis-B and Standard Precaution

after Education Intervention

SN Practices among the Nurses about Care of Hepatitis-B and Standard Precaution

Correct Responses

Rem

ark

Pre

-Tes

t (%

) n=

40

Pos

t-T

est (

%)

n=32

Diff

eren

ces

(%)

P-v

alue

1. Wear gloves before touching membranes and non intact skin of patient.

82.5 87.5 5 0.508b

2. Wash my hands before and after treatment procedure.

95.5 100 5 0.508 b

3. Wash my hands after contact with patient’s body fluids.

97.5 97.5 0 1

4. Use protective gowns to protect myself when treating patient.

12.5 28.1 15.6 0.405 b

5. Use protective mask to protect myself when treating patient.

52.2 93.8 41.3 0.307 b

6. Bend needles after injections and discard them into a medical waste container.

77.5 77.5 0 1

7. Check patients’ blood tests for contagious diseases before a procedure.

40.0 59.5 19.5 0.307 b

8 Check the indicator showing whether or not instruments have been sterilized before using them.

62.5 68.8 4.3 0.134 b

9 Inform my patients about hepatitis and offer them to be vaccinated.

60.0 68.8 8.8 0.690 b

10. Usually use gloves while caring patients 100 100 0 1 11. Usually use gloves during invasive procedures 100 100 0 1 Using MacNemar Chi-squire test Key: b: Binomial Distribution is used

Needs and Experiences of Family Members of Patients Admitted in Intensive

Care Unit of B.P. Koirala Institute of Health Sciences Nepal

Mehta*1 RS, Basnet*

2 S, Bhattari*

3 BK, Rai*

4 HK

B.P. Koirala Institute of Health Sciences, Nepal

Email: [email protected]

Abstract:

Intensive care unit (ICU) caregivers should seek to develop collaborative relationships with their

patients’ family members, based on an open exchange of information and aimed at helping family

members cope with their distress and allowing them to speak for the patient if necessary.1 The objective

of this study was to explore the needs and experiences of family members of patients admitted in ICU of

BPKIHS.

It was hospital based descriptive exploratory study conducted among the family members or caretakers

of the patients admitted in ICU for more than three days at B.P. Koirala Institute of Health Sciences

during the period of 1st May 2009 to 31st July 2009, i.e. three months. Using random sampling method

twice weekly i.e. on Sunday and Wednesday, all the subjects who fulfill the set criteria and give consent

was selected for interview using pre-tested interview questionnaire.

Half of the patient admitted in ICU was on ventilator, male (63.3%), married (80%), and Hindu (90%).

Only 20% relatives reported they full understand the explanation given by Doctor/nurses and 73.3%

reported partially and 6.7% reported not at all. Most of the relatives ware satisfied with the ICU services

and information provided to them. The majority of relatives demand for toilet and bathroom nearby

(80%) waiting room (78%) and provision of drinking water (50%).

On the basis of study researcher concludes that there is need for explanation to the relatives at their

level of understanding by the Doctor/nurses. The facility of toilet, waiting room and drinking water is

urgent needs of the family members of ICU patients.

Note:

*1 Ram Sharan Mehta, Associate Professor, Medical-Surgical Nursing Department, Email:

[email protected] , *2 Sarsawti Basnet, ICUNurse, *

3 Prof. Dr. Bal Krishna

Bhattari, HOD, Department of Anesthesia and critical care unit, *4 Hari Kumari Rai, ICU

Nursing Incharge.

Introduction:

Meeting the needs of their patients’ family members is an essential part of the responsibilities of intensive care unit (ICU) physicians and nurses, who are committed to easing the pain and suffering of those who have a critically ill relative or close friend. A major task of ICU physicians is to provide family members with the appropriate, clear, and compassionate information they need to participate in making decisions about patients who are unable to speak for themselves. Evaluations of family needs supply valuable

information for improving the comprehension, satisfaction, and decision-making capacity of families.1

Molter2 in his study reported that, studies suggest that family members want honest, intelligible, and

timely information; liberal visiting policies; and the assurance that their loved one is being cared for by competent and compassionate people. Providing better information was associated with better results in terms of meeting the needs and increasing the level of satisfaction of family members. Similar study was reported by nelson3.

Anyone entering an intensive care unit can feel bombarded by the huge array of sensory stimuli. Family

members in ICU are typically in a state of fear and shock. Studies have shown that caring for the families

of patients who are critically ill is believed to be an essential component of the nurse's role. However,

despite the fact that the critical care nurse is cited as the one who is responsible for meeting the needs

of such families, little is known about how nurses view this role.4

Nursing care must address not only the needs of the patient, but those of the whole family. The needs

of patients in intensive care and those of their families are especially complicated by the physical and

emotional demands on all concerned. Families experience severe stress and anxiety, and may feel

helpless and unable to cope. Accurate assessment of their needs is one of the first steps in providing

appropriate care to ICU patients and their families.5

Every year in the United States, approximately 20% of all deaths occur in an intensive care unit (ICU),

and more than half of those occur after life-sustaining measures are withdrawn or

withheld. Many of

these patients are unable to communicate their wishes because they are sedated, receiving mechanical

ventilation, confused, or comatose. The non-communicative state of such patients places much of the

burden of decision making and treatment choices on the patients’ family members. This type of

experience may adversely affect family members by increasing their stress levels and increasing their

risk for psychological and physical symptoms.

6

In B.P. Koirala Institute of Health Sciences there are 12 bedded ICU services with all the modern

facilities. Insight into the needs and experiences of family members is an initial but necessary step in

providing appropriate care for both family members and patients.3 keeping these concepts in mind

investigator has conducted this study.

Objectives of the study:

The objective of this study was to explore the needs and experiences of family members of patients

admitted in Intensive Care Unit of BPKIHS.

Rationale of the study:

Having a family member admitted to Intensive Care Unit (ICU) is stressful for the whole family. Stress

can hinder family members' coping and thus affect the support that is given to patient. In order to lessen

the effect of stress, family members' immediate needs must be identified and met.

Concern for the family members of patients who are at high risk of dying in intensive care units is both a

necessary and integral part of providing holistic nursing care. When patients are at

high risk of dying,

their families experience burdens such as decision making and treatment choices that can cause the

families psychological and physical symptoms, most commonly stress, anxiety,

and depression. These

symptoms in turn can affect family members’ general well-being.

Family members of dying patients play an integral role in the patients’ care in the ICU. Patients families are expected to make unprecedented decisions and deal with many difficult situations. In turn,

they may have psychological symptoms such as stress, PTSD-related symptoms, anxiety, and

depression, which can affect their general well-being. Researchers have developed a knowledge base

on variables associated with an increase in family members’ symptoms. However, additional research

is critical to expand our knowledge of symptoms experienced by family members of patients in the

ICU, especially at the patients’ end of life. This research will help clinicians to develop supportive measures to assist patients’ family members during this difficult time.

Methodology:

It was hospital based descriptive exploratory study conducted among the family members of the

patients admitted in ICU of B.P. Koirala Institute of Health Sciences during the period of 1st

May 2009 to

31st July 2009, i.e. three months. The family members of admitted patients in ICU for more than 3 days

constitute the population of the study. Using random sampling method twice weekly i.e. on Sunday and

Wednesday, all the subjects who fulfill the set selection criteria and give the consent were selected for

interview. The informed verbal consent was obtained from each subject prior to the interview and

assured the relatives that this does not affect on the treatment of their patients. The interview was

taken in a separate room maintaining confidentiality, using pre-tested interview questionnaire.

The questionnaire consists of three parts i.e. Part-I, consists of the socio-demographic characteristics of

patients, Part–II consists the socio-demographic characteristics of the family members and Part-III

consists of satisfaction level and needs of family members. The interview questionnaire is prepared on

the basis of “Needs Assessment Questionnaire1” and “ICU patient understanding study Interview

2”

which is widely used for ICU family need assessment world wide.

The prepared questionnaire is pre-tested among 10% subjects i.e. on 4 subjects and few modifications in

terminology was made to for easy understanding in our setting. The interview was obtained from the

main family members who spent most of the time with the patients and involved in the care of patients.

The collected data was entered in Excel software and analyzed using SPSS-12.5 Software package. The

Results obtained was presented in appropriate table, graphs and charts.

Results:

Socio-demographic characteristics of patient’s:- The mean age of patients ware 47.33 with SD 21.658

and range 12-83 years. Majority (63.3%) ware male, educated (76.7%), married (80%) and Hindu (90%).

Majority of the patient’s (53.3%) duration of stay in ICU is 3-5 days with mean stay of 8.93, SD = 10.352

and range 3 – 43 days. Most of them (86.7%) were admitted in conscious state, and in 50% patient’s

ventilator was used, most of the patients (66.7%) had acute nature of illness.

Satisfaction of family members related to ICU services:-All the relatives reported that doctor/nurse had

talked about the care and condition of patient, 93.3% relatives reported ICU nurses had spoken about

the patient’s condition and they spent less than 15 minute to explain the condition. Most of the nurses

(93.4%) reported that they pay the ICU charges by self or with the help of relatives and 70% reported it

is difficult to pay ICU charges. Regarding the level of satisfaction in ten likert scales, most of the family

members are satisfied with the information about their patient’s condition and the information

provided to them. The details are depicted in table 1.

Understanding about the patient’s condition by the family members: - Most of the relatives are a ware

that their patient is in ventilator, receiving antibiotic, on N-G Tube, on ECU, and having Foly’s catheter.

The details are in Table 2.

Needs of the family members:- Most of the relatives reported in four points liken scale towards positive

side, which is 4 and 3, instead of 2 and 1. Regarding the prognosis of patients the responses of relatives

is differ than the reality of patient i.e. 10% relatives said prognosis is poor where as in reality 36.7%

patient’s condition is poor. Details are in Table 3.

Suggestions for better ICU patient care and welfare of family members: - Most of the family (80%)

suggested for needs of toilet and bath room, 78% suggested for waiting room, 50% demands for

p0rovision of drinking water and 50% request for round the clock security services.

Discussion:

Patients spent enormous amounts of energy trying to pull the pieces of the ICU experience together. At

times, families were the source of this information. Patients in families that withheld information from

them said they listened to the nurses and physicians during rounds to try to piece together that were

happening to them. Nurses can work closely with family members to build trusting relationships with

patients and families and they can include family members as part of the team. Family members in turn

can help to provide support for patients.

The age distribution of family members were between 12-83 years with mean 47.33 and SD 21.658,

similarly the age of patient were between 16–70 years with mean 38.48 and SD 16–70. Most of the

relatives were female (60%) and patients were male (63.3%). Similar demographic characteristics were

also reported by the study conducted by Azoulay 1 , Akinci

7 and Colleen

8.

The overwhelming need of ICU patients was to feel safe. The perception of feeling safe was influenced

by family and friends, ICU staff, religious beliefs, and feelings of knowing, regaining control, hoping and

trusting, reported by David 5 which is similar to this study.

Most of the relatives were satisfied with the information provided by the Doctor/nurses to them. They

are also satisfied with the services of Doctor and Nurses provide in ICU. The satisfaction level on various

components like: provided best possible care, explanation provided, understanding about therapies,

courteousness of staff is high. Similar findings were reported by A Zoulay1, David

5 and Akinci

7 . David 5

reported the majority of respondents were satisfied with overall care and with over all decision making.

The families reported the greatest satisfaction with nursing skill and competencies (92.4 +_ 14.0). The

least satisfaction with waiting room atmosphere and physician communication. Most of the relatives

were suggested for facilities of toilet (80%), waiting room (78%) and drinking water (50%). Similar Issues

were addressed by Akinci7 in his stay as he reported 24% relatives were dissatisfied with waiting room

services.

Conclusion:

Intensive care unit (ICU) caregivers should seek to develop collaborative relationships with their

patients' family members, based on an open exchange of information and aimed at helping

family

members cope with their distress and allowing them to speak for the patient if necessary. On the basis

of study researcher concludes that there is need for explanation to the relatives at their level of

understanding by the Doctor/nurses. The facility of toilet, waiting room and drinking water is urgent

needs of the family members of ICU patients

References:

11. Azoulay E, Pochard F, Chevret S, Lemaire F, Mokhtari M, Fall JL et al. Meeting the needs of intensive

care unit patient families: A multicenter study. Am J Respir Crit Care Med. 2002;163: 135-139.

12. Molter NC. Needs of relatives of critically ill patients. Heart Lung. 1979;8: 332-339.

13. Nelson JE, Walker AS, Luhrs CA, Cortez TB, Pronovost PJ. J.Clin Nurs.2005; 14(4):501-9.

14. Hardcer J. Meeting the needs of families of patients in intensive care units. Nurse Times. 2003;

99(27): 26-7.

15. David J, Monique W, Brenda C, Candice B, Debra G, Otto M. Measuring the ability to meet family

needs in an intensive care unit: Clinical Investigations. Critical Care Medicine. 1998; 26(2): 266-271.

16. Angus DC, Barnato AE, Linde-Zwirble WT, et al. Use of intensive care at the end of life in the United

States: an epidemiologic study. Crit Care Med. 2004; 32(3):638–643.

17. Akinci SB, Salman N, Kanba KM, Ayparu. Assessement of family satisfaction in the ICU. European

Journal of Anesthesiology. 2004 ; 21 :7-8.

18. Colleen EG, Diane IC, Jeanne SE, Patricia AF. Heather JV. Visiting presence of patients in the ICU and

in a complex, care medical unit. Americal Journal of critical. 2004 ; 13 : 194 – 198.

Table 1

Level of satisfaction about ICU services among the family members

N= 30

SN ICU services Satisfaction level

1 2 3 4 5 6 7 8 9 10 Mean*

1 Understanding about disease process / illness of the patient.

0 0 6.7 13.3 30 13.3 20 6.7 3.3 6.7 5.93

2 Understanding about therapies / treatment of the patient.

0 3.3 6.7 6.7 23.3 23.3 13.3 3.3 6.7 13.3 6.23

3 Communication received from ICU nurses.

0 3.3 3.3 3.3 13.3 23.3 23.3 3.3 10.0 16.71 6.83

4 Communication received from ICU doctors

0 0 3.3 16.7 16.7 23.3 10.0 13.3 3.3 13.3 6.40

* Full Score = 10

Table 2

Understanding about the patient’s condition by the family members

N= 30

SN Information about patient

Responses of family members

Chart reality

Yes (%)

No (%)

Yes (%)

No (%)

1. Patient on ventilator / breathing machine. 60 40 53.3 46.7

2. Receiving antibiotics. 66.7 33.3 70 30

3. On medication for pain or anxiety. 60 40 60 40

4. Have N-G tube insertion. 60 40 53.3 46.7

5. On N-G tube feeding. 26.7 69.3 16.7 83.3

6. Having EKG / cardiac monitor. 100 0 100 0

7. Receiving dialysis. 26.7 73.3 23.3 76.7

8. Having Foly’s catheter. 66.7 33.3 70 30

Table 3

Needs of the family members of patients admitted in ICU

N=30

SN Perception needs of the family members. Responses.

4 (%)

3 (%)

2 (%)

1 (%)

Mean* Score

1. Feeling that best possible care is given to the patient. 23.3 70 0 6.7 3.0

2. Hospital personnel care about the patients. 23.3 73.3 3.3 0 3.20

3. Understanding level of explanations given by ICU personnel. 30 56.7 13.3 0 3.17

4. Feeling that honest information is given about the patients. 36.7 56.7 6.7 0 3.30

5. Understanding about patient’s therapies. 40.0 36.7 23.3 0 3.17

6. Courteousness of the ICU personnel. 13.3 76.7 10 0 3.3

7. Interest of ICU personnel regarding family members. 13.3 73.3 13.3 0 3.0

8. Explanations of equipments used to the patient. 33.3 50 16.7 0 3.17

9. Satisfaction with medical services. 33.3 50 16.7 0 3.17

10. Feeling comfortable visiting the patient in ICU. 33.3 23.3 10 0 2.8

* Full Score= 4, 1= All most all of the time, 2= Most of the time, 3= Only some of the time, 4= None of the time

Professional Satisfaction Among Pass-out B.Sc. Nursing Graduates of B. P.

Koirala Institute of Health Sciences Nepal

Mehta RS, Additional Professor

Medical-Surgical Nursing Department

Email: [email protected]

Ruby Yadav, B. Sc. Nursing

B. P. Koirala Institute of Health Sciences

Abstract:

Professional Satisfaction is a measure of valuation or an inner estimation or judgment of whether the

expectations are met from the profession or not. This study was conducted to find out the professional

satisfaction among pass-out B.Sc. Nursing graduates from BPKIHS from batches 1996 to 2004.

Descriptive, cross-sectional study design was adopted to carry out the study. Using convenient and

snowball sampling technique, out of 104 graduates, 50 were included in the study. A pre-tested semi-

structured questionnaire was used by self administration method to collect the information.

Regarding satisfaction in different areas highest satisfaction was with status / security / respect (75%)

and lowest with working condition (54%). The areas with decreasing value of satisfaction were growth

and development, and interpersonal relationship (72%), achievement, recognition and accomplishment,

salary, and supervision (70%), autonomy / challenging work / increased responsibility (69%). The

majority of the respondents (54%) stated that there is job security in the profession and the opportunity

to help others (52%) was the reason for their satisfaction, but 28% said that there is no updating of

knowledge and there is no autonomy (30%) in nursing profession.

Based on this study we conclude that there is no difference in professional satisfaction of the

respondents living in Nepal and abroad. Satisfaction is dependent upon age but not upon other

independent variables. It is seen that though there are many problems and many areas of dissatisfaction

in nursing profession the respondents are satisfied to some extent with it and the reason for brain drain

among B.Sc. Nursing graduates were their personal interest.

Introduction:

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and

communities, sick or well in all setting. Nursing includes the promotion of health, prevention of illness,

the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research,

participation in shaping the health policy and in patient and health systems management, and education

are also key nursing roles. The goal of nursing is to restore, maintain and advance the health of the

patient. It is both a science and an art. The science is the application of nursing knowledge and the

technical aspects of the practice. The art is the establishment of a caring relationship through which the

nurse applies nursing knowledge and uses judgment in a compassionate manner. Both focus on the

whole person, not just a particular health problem.

According to the study conducted by Tzeng1, the level of job satisfaction among care workers is

positively correlated with client satisfaction. Similarly Watanabe2 stated that job satisfaction and

intention to turnover among care workers have been suggested as important factors determining the

quality of services. This provides the guidance for nursing administrators to plan strategies for attracting

and retaining a stable staff of care workers to ensure a quality of care sufficient to meet client

psychosocial needs.

A study conducted by Gleason3 stated that job satisfaction is a strong and significant predictor of

worker’s intention to leave the job. Similarly another study conducted by Gaur4 stated that those who

are not satisfied with their job are more likely to think about quitting their jobs. Even if they do not

actually take the action, just having such thoughts may have a negative impact on the quality of care

service.

With reference to the behaviors of nurses that lead to mistakes in public practice, a study conducted by

Zhong5 in California, USA demonstrated that the majority of nurses were not disciplined for system

errors i.e. 70% of the cases reported in the study (N=207) were unrelated to system errors. Instead, they

resulted from misjudgment, misconduct, or incompetence. These violations threaten the public safety.

According to Burton6, nurses perceive self-fulfillment and a sense of accomplishment or achievement as

factors which contribute to job satisfaction. In addition, educational opportunities, intellectual

motivation and the occasion to develop new skills, rank high on the list of job satisfiers.

The study by Storey7 reported that flexibility or its absence in working arrangements appear to be a key

factor influencing nurse’s decision to leave. Lack of autonomy, support and feeling valued are also

important while making the decision.

According to Weisman8, job dissatisfaction is the main reason why nurses leave their positions, while the

predominant issues associated with job dissatisfaction include nursing control and career opportunities.

Similarly a study conducted by Yamashita18

in studying Japanese nurses, found that little opportunity for

promotion negatively affected job satisfaction.

The Murrells10

in his study in UK reported that the impact of time on job satisfaction in early career is

highly dependent on specialization. Different contexts, settings and organizational settings lead to

varying experiences. Future research should focus on understanding the relationships between job

characteristics and the components of job satisfaction rather than job satisfaction as a unitary construct.

Research that further investigates the benefits of a formal one year preceptorship or probationary

period is needed. We conclude that the impact of time on job satisfaction in early career is highly

dependent upon specific jobs, even within the same profession.

Objectives

1. To identify the professional satisfaction among pass-out B.Sc. Nursing graduates of BPKIHS from

1996 to 2004 batch.

2. To compare the professional satisfaction of pass-out B.Sc. Nursing graduates working in Nepal and

abroad.

3. To find out the association between professional satisfaction and selected demographic variables

(age, gender, current residence, marital status, duration of employment, living with and

designation).

Research Design and Methodology:

A descriptive cross sectional research design was used to conduct the study. The research was

conducted among pass-out B.Sc. Nursing graduates from BPKIHS from 1996 to 2004 batch living in Nepal

and abroad and related to nursing profession. A convenient and snowball sampling technique was used

to collect the data. Fifty subjects were included in the study. A self prepared semi structured pre-tested

questionnaire was used for data collection.

Likert scale was used for rating the satisfaction in different areas. It consists of positive and negative

items. Positive items were rated as strongly disagree to strongly agree and the scoring was given

accordingly (1, 2, 3, 4 and 5). Reverse scoring was given for negative items i.e. strongly disagree to

strongly agree and scoring varied as 5, 4, 3, 2 and 1. Negative items included number 6, 21, 27, 28 and

29 and rest all was positive. Maximum obtainable score was 190. Different items were included to

assess the professional satisfaction in each area. Obtained scoring (overall and in specific areas) were

converted into percentages and interpreted by using median percentage and inter-quartile range.

A list of pass-out B.Sc. Nursing graduates was obtained from Academic Section and corresponding

address collected from college of nursing, available friends and relatives. For the pass-out students who

were in BPKIHS questionnaire was given directly. Postal, visiting, e-mailing was applied for those in

eastern region of Nepal and Kathmandu and e-mailing was done for those working abroad for data

collection. Convenient and snowball sampling technique was used for data collection. Data collection

period was of from 10th

January to 10th

June 2009.

Results: Half of the respondents were of age group 22-25 yrs, 88% were females, 98% were Hindus and

50% were Brahmin / Chettri, 30% Newar, 56% were married, 58% living in Nepal and rest abroad (USA,

Bangladesh, South Korea, Ireland, China, India and UK). With regards to work experience, 32% had 1-2

yrs of experience and 30% had > 3 yrs experience. With regards to qualification 70% had not done any

further study after B. Sc., 14% had done M. Sc. Nursing and 12% had done Masters in other nursing

related fields.

Majority of the respondents (44%) were working at the post of Nursing Instructor / Officer / Tutor /

Sister and 18% are at Assistant Lecturer / Researcher. Among the ones living in Nepal most (75.9%) were

at officer level post and the rest were at the post higher than officer level. Among the ones living abroad

majority (57.1%) were nursing students and 33.4% were working as RN / Staff Nurse.

Majority of the respondents (56%) said that nursing is a noble profession because of its caring nature

and dedication to make a difference in others life (10%). Thirty percent of the respondents did not

answer to this question and 2(4%) of the respondents said that there is nothing to quote noble for

nursing. In their view it is as respected as other professions.

The majority of the respondents (36%) said that there is lack of autonomy and self sustaining practices

in this profession and 36% mentioned that there is no updating of knowledge and skills. Most of them

(20%) quoted that there is a social stigma that nurses are assistant to the doctors and ego problems of

seniors which is also a problem of this profession. The majority of the respondents (54%) said job

security and 52% said opportunity to help as the major reason for their satisfaction with nursing

profession.

Few respondents (20%) said that there is less reward and it is overshadowed by medical profession and

18% also said that there is social stigma attached with this profession which is the reason for their

dissatisfaction with nursing profession. The majority of the respondents (24%) said that one should

respect and accept the profession and 16% said that the pass-out graduates should aspire for higher

studies as early as possible in order to improve professional satisfaction among pass-out B.Sc. Nursing

graduates from BPKIHS.

The majority of the respondents (44%) said that there should be adequate supervision and guidance

especially in clinical posting and 18% said that updated information should be given by nursing faculties

in their related departments in order to improve nursing training in BPKIHS.

Discussion:

Regarding the attitude of the respondents, only 6% of all the respondents stated that they regret for

choosing nursing profession whereas 6.8% of respondents living in Nepal and 4.8% of ones living abroad

regret for choosing nursing profession. Majority of the respondents (58%) aimed to become doctor

before joining nursing profession and this might be the reason that they regret for joining nursing

profession. Only 48% wanted to continue nursing profession and 12% wanted to switch to other

profession, 18% had still not decided what they are going to do in future. It might be because they

wanted to become doctor but joined nursing profession forcefully. Majority of the respondents (56%)

thought they have average status according to them and 42% thought they have high status according

to their people. None of them stated that they had very low status. So, regarding status they have

positive attitude.

The study results showed that the median percentage of satisfaction with achievement, recognition and

accomplishment was 70% and it was almost the same for the ones living in Nepal and abroad showing

that there is no difference in satisfaction with achievement, recognition and accomplishment in

comparison with residence. It might be because the expectations of the respondents are fulfilled in

these areas.

The median percentage of satisfaction with autonomy was found to be 69% and in Nepal and abroad it

was 71% and 63% respectively showing that the ones living in Nepal were more satisfied with autonomy

that the ones living abroad. This might be because the ones living in Nepal are at higher posts than the

ones living in abroad and have more autonomy.

The result is supported by the study conducted in England by Storey7 which stated that flexibility i.e.

autonomy or its absence in working arrangements appear to be a key factor influencing nurse’s decision

to leave. Similar finding was reported in a study conducted to assess the job satisfaction for nurses in

team and primary nursing delivery systems by Ruth11

which showed that primary-system nurses reported

greater job satisfaction than team-system nurses as the primary system offered more opportunity for

accountability and fulfilling higher level needs.

Findings revealed that the median percentage of satisfaction with growth and development in nursing

profession was 72% and it was the same for the ones living in Nepal and abroad showing that the

satisfaction with growth and development did not differ with the current residence of respondents. It

might be because the respondents get opportunity for growth and development not only abroad but

also in Nepal.

The study results confirmed that there was a significant relationship between age and professional

satisfaction and it showed that the respondents of age more than 25 years were more satisfied (median

percentage of satisfaction = 72) than the ones with age less than or equal to 25 years (median

percentage of satisfaction = 65). The findings of a study conducted in Japan by Watanabe2 in 550 female

nursing home care workers in 2005 confirmed results of some prior studies, showing a significant

positive relationship between age and overall job satisfaction. This finding is consistent with the finding

of this study.

The study results showed that there was no association between professional satisfaction and gender

which means that there is no significant difference in the professional satisfaction of male and female.

But it was observed that male (74.5) had a higher median percentage of satisfaction than female (67.5).

Studies done by Fitzenberger30

and Morinaga31

show that female work patterns, attitudes and values are

different from these of men. This might be the reason for lower satisfaction in females.

The study showed that there was no association between the professional satisfaction and post or

designation but there was an increasing trend in the median percentage of satisfaction among student

(63%), respondents at the post less than or equal to officer level (69%) and more than officer level

(74%). Certainly the ones who are employed are expected to be more satisfied than the ones who are

not employed at all i.e. students and when they are employed they thrive for higher post and the ones

in higher post are expected to be more satisfied as shown by the study.

Ho1: No significant difference was found between professional satisfaction and selected independent

variables (p-value = 0.076 for gender, 0.074 for marital status, 0.342 for duration of employment, 0.341

for living with spouse and 0.764 for designation) and significant difference was found between

professional satisfaction and age (p-value = 0.039) which showed that with increasing age professional

satisfaction was more (Spearman’s correlation coefficient = +0.392. Hence, at 5% level of significance

the researcher concludes that the null hypothesis I is partially accepted.

Ho2: There was no significant difference between professional satisfaction of B. Sc. Nursing graduates

living in Nepal and abroad (p-value = 0.992 for overall satisfaction, 0.721 for achievement, 0.532 for

recognition and accomplishment, 0.309 for autonomy, challenging work and increased responsibility,

0.906 for growth and development, 0.441 for salary, 0.813 for interpersonal relationship, 0.259 for

status, security and respect and 0.876 for supervision). Hence, at 5% level of significance the researcher

concludes that the null hypothesis II is not rejected meaning that professional satisfaction in not

affected by the country of residence.

Suggestion to improve professional satisfaction among B. Sc. Nursing graduates and nursing education

at BPKIHS: They suggested for higher studies as soon as possible (16%) and think positive (14%).

They also suggested to improve nursing training in BPKIHS, majority of the respondents (44%) said that

there should be adequate supervision and guidance especially in clinical posting and 14% said that there

should be continue training by nursing faculties in their related departments.

Conclusion:

This study concludes that there is no difference in professional satisfaction of the respondents living in

Nepal and abroad. Also satisfaction is dependent upon age but not upon other independent variables

like gender, current residence, marital status, living with and designation. It can be said that in spite of

many problems and areas of dissatisfaction in nursing profession the respondents are satisfied to some

extent with it.

References:

1. Treng HM, Ketefian S, Redman RW. Relationship of nurse’s assessment of organizational culture,

job satisfaction, and patient satisfaction with nursing care. Int J Nurs stud 2001;22:3-14.

2. Watanabe RN. Effect of age on job satisfaction and intention to turnover among female nursing

home care workers. Journal of Policy Studies. 2005 Mar; 19: 75-89.

3. Gleason WP, Mindel CH. A proposed model for predicting job satisfaction among nursing home

social workers. J Geronto Soc Work 1999;32:65-79.

4. Gaur L, Chandler B, Burton B, Kolditz D. Institutional loyalty and job satisfaction among nurse

aides in nursing homes. Journal of Aging and Health 1991; 3:47-65.

5. Mason D. Letters: Who’s watching nurses? Am J Nurs [Serial online] 2009 March [cited 2009 July

17] 14: Available from: URL: http://hinari_gw.who.int

6. Burton EC and Burton DT. Job expectations of senior nursing students. J Nurs Adm

1982;12(3):11-17.

7. Storey C, Cheater F, Ford J and Leese B. Retention of nurses in the primary and community care

workforce after the age of 50 years: database analysis and literature review. J Adv Nurs 2009

Mar;65(8):1596-1605.

8. Weisman CS. Recruit from within: hospital nurse retention in the 1980’s. J Nurs Adm

1982;12(5):24-31.

9. Yamashita M. Job satisfaction in Japanese Nurses. J Adv Nurs 1995;22(1):158-164.

10. Murrells T, Robinson S, Griffiths P. Job satisfaction trends during nurses' early career, BioMed

Central 2008;(7)7.

11. Ruth HC, James DM. Job satisfaction of staff registered nurses in primary and team nursing

delivery systems [serial online] 1981 Jan [cited 2009 July 17] Available from:

URL:http://www3.interscience.wiley.com/journal/114081992/abstract

12. Fitzenberger B and Wunderlich, G. The changing life cycle patterns in female employment: A

comparision of Germany and the UK. 2002; Discussion paper No. 02-70. Mennheim: The Center

for European Economic Research (ZEW).

13. Morinaga, Y. Work values and Career Patterns of Women College Graduates in Japan. Kobe

College Studies 1999;46:133-148.

Table 1

Association between Percentage Satisfaction in Various Components of Profession and Residence

S.N. Item/ Particulars

Median percentage of Professional

Satisfaction

(IQR)

p-v

alu

e

Re

ma

rks

Nepal

n=29

Abroad

n=21

1 Achievement 72 (60-82) 68 (60-76) 0.721 NS

2 Recognition and accomplishment 70 (60-80) 70 (62.5-80) 0.532 NS

3 Autonomy/Challenging work/

Increased responsibility

71 (63-77) 63 (55.5-77) 0.309 NS

4 Growth and development 72 (60-88) 72 (60-90) 0.906 NS

5 Salary 70 (60-70) 60 (60-75) 0.441 NS

6 Interpersonal relationship 72 (64-80) 76 (60-80) 0.813 NS

7 Working condition 52 (40-64) 64 (48-78) 0.068 NS

8 Status/Security/Respect 75 (65-85) 70 (57.5-77.5) 0.259 NS

9 Supervision 60 (50-80) 80 (40-80) 0.876 NS

Mann Whitney U Test Key: S = Significant, NS = Not Significant

Table2

Association between Professional Satisfaction and Selected Independent Variables

n=50

S.N. Characteristics Categories Median percentage of

satisfaction (IQR) p-value Remarks

1 Age <25 years

>25 years

65 (58-71)

72 (66-77.5)

0.039 S

2 Gender Male

Female

74.5 (71-77)

67.5 (58.25-74.75)

0.076 NS

3 Current residence Nepal

Abroad

68 (60-75)

68 (61-76)

0.992 NS

4 Marital status Single

married

66.5 (58-72)

73 (65-77)

0.074 NS

5 Duration of

employment

<1 yr

>1 yr

65.5 (57.75-77.25)

69 (64.25-75)

0.342 NS

6 Living Alone

With spouse / family

or others

67.5 (58.25-71)

68.5 (62-75.5)

0.341 NS

7 Post / designation >officer level

<officer level

74 (65.5-76.5)

69 (64.25-77)

0.764 NS

Mann Whitney U Test Key: S = Significant, NS = Not Significant

Patients’ Attitude Towards Nursing Students of BPKI HS

Mehta RS, Asst. Professor

Medical-Surgical Nursing Department

Singh B, Ward In-charge

Medical Unit-I

B.P. Koirala Institute of Health Sciences

Abstract:

Health care is a social role relationship between a helping agent and a person needing help. This relationship is considered psychologically and socially as half cure treatment procedure. Therefore the nature of relationship between doctor and patient has some degree of significant impact on the overall quality of health care. Images of nurses in crisp white uniforms and caps dispensing medications and emptying bedpans still persist. Not that nurses don't hand out pills or empty a bedpan, but today many nurses specialize in such areas as pediatrics, geriatrics, surgery, obstetrics/gynecology, rehabilitation, cardiology, anesthesiology, administration and more. In fact, the fastest growing specialty in nursing is critical care. Even the education of nurses has changed.

This study will design to assess the attitude of the patients to the presence and involvement of the student nurses in their clinical care. It will be the hospital based descriptive exploratory study conducted among the clients admitted in medical-surgical wards among 75 admitted patients, selected randomly. Using pre-tested semi-structured questionnaire data was collected. The collected data was analyzed using SPSS programme, and the findings were presented in table, graphs and charts.

Introduction:

Medical profession was considered to be a noble profession from time immemorial. While a medical student comes out of medical institution after the Hypocrite’s Oath, it is his duty to look after any patient irrespective of caste, creed, sex or even remuneration. In history we come across doctors and paramedical staff who spent their entire life for the prosperity of the patients and also the total health of the community. One notable example is the story of Florence Nightingale who spent her entire life for nursing the sick. In older days the primary objective of any medical institution was not to make exemplary profit. Over the year’s technology advanced and the hospitals became more technology oriented with a high cost. The high cost or investment of the hospitals compelled the management to increase the cost of service. On the other hand the number of hospitals increased which made the sector competitive. This in turn forced the hospitals to employ reputed doctors and Nurses to attract the patients. The branches of specialization made available micro-organ specialists. The superspecialists are demanded by the hospitals. The concept of hygenity motivated the hospitals to update the facilities to the status of star hotels. The higher education and increased awareness contributed the public to approach the hospitals. The nature of relationship between nurse and patient has some degree of significant impact on the overall quality of healthcare, the patient’s compliance and satisfaction is greatly influenced by the appearance, behavior and the communication skill of the nurses as nurses stay 24 hours with the clients4. With increasing in life expectancy and increasing numbers older patients utilizing the acute setting, attitudes of registered nurses caring for older people may affect the quality of care. Many negative attitudes reflect against stereotypes and knowledge deficits that significantly influences registered nurses practice and older patients quality of care. In the present setting, older patients experience reduced independence, limited decision-making opportunities, increased probability of developing complications little consideration so their aging-related needs, limited health education and social isolation. Available instruments to outdated, country specific and do not include either a patient focus or a caring perspective. This paper argues for the development and utilization of a research instrument that includes both a patient’s focus and a caring dimension.6 Hence, the investigators are decided to conduct the study on, “patient’s attitude towards nursing students of BPKIHS”.

With the emerging nursing colleges in the country and the out flowing number of nursing students in

many hospitals, this complex relationship has more importance and responsibility than even before.

In BPKIHS, patients are in contact with nursing students and they must have developed some attitude towards student nurses during their social and nursing interaction.

Till date, there has been no study of the attitude of the patients in the hospital to the presence and

involvement of the student in their nursing care in BPKIHS. So, we will try to find out the real scenario in

our context.

The origins of nursing date back to when the first mother or other close female, ministered to the sick

in the family. It was Florence Nightingale in the mid-1800s who founded modern nursing and structured professional duties into an orderly trained fashion. Before this, so-called nurses were

considered untrained servants. Nightingale established the first school of nursing in London, England in 1860, with the first school in the United States established in 1872 in Boston, Massachusetts.

Throughout the next 130 years, nursing schools flourished as mainly women were educated and

trained to take care of the sick. Nurses also distinguished themselves on the battlefield in all of our

conflicts. If you have watched reruns of the series Mash on TV, then you know that nurses were there in those battlefield units trying to save lives right alongside the doctors. They were, in fact,

ministering critical care to those wounded in battle, and they had to react quickly and make life and death decisions under unbelievable pressure and makeshift operating conditions. In fact, nurses have

been responding to critical care situations from the times of Florence Nightingale.

But nurses were still seeking respect for their profession. In addition to education and training, nursing

advocates sought for standards and regulations that would not only benefit patient care but also give

nursing the professional status it needed and deserved.

The objective of this study was to assess the attitude of the patients regarding the presence and involvement of the nursing students in their clinical care in Medical–Surgical units of BPKIHS.

Research design and methodology:

It was hospital based cross sectional study. The clients admitted in medical-surgical units in the day of data collection constitute the population of the study. The stratified simple random sampling method was used to select the sample and 75subjects were selected from all the wards of Medical-Surgical units of BPKIHS, where only 60 tools were returned back.

Using pre-tested semi-structured Questionnaire the data was collected. The clients selected for study, if unable to give response then the next bed client was selected. During the course of filling tool the client’s nearest relative or caretaker was involved for appropriate response. Opinion was taken only when students were not posted in the wards, especially in afternoon time to reduce the bias. The data was collected by trained nurses of other wards in the ordinary dress, to reduce the professional fear and bias. The clients able to fill the Questionnaire, own self, they were encouraged to fill and submit it on the same day or next day morning. For illitrate clients the help of literate/educated caretakers of side by client’s relatives help was advised to complete the questionnaire. The subjects were assured that their responses was not seen by the students and will not effect their training in any way. Explaining the purpose of study properly, the clients were assured about anonymity.

The collected data was checked, and coding completed. Coded data was entered in SPSS-4 package and

analyzed.

The Questionnaire was a kind of checklist with a dichotomonous rating scales (yes or no), will be

relatively simple to construct, easy for respondents and fairly reliable. The Questionnaire consisted of 10

unambiguously positive and 10 unambiguously negative statements. Actually each positive statement

was also asked negatively without changing the main concept or meaning, so that biasness could be

reduced.

Results:

This study was conducted in medical-Surgical units of BPKIHS: using stratified random sampling method. Seventy five tools were distributed to the subjects (i.e. medical– I =13, medical–II =13, medical–III =6, surgical–I =12, surgical–II =12, surgical–III = 6, Orthopedic= 6, Eye = 4 and ENT= 3) in all the selected wards and 60 tools were collected balk only (i.e. 10 from medical –I, 9 from medical –II, 6 from medical –III, 8 from surgical –I, 12 from surgical –II, 5 from surgical –III, 5 from orthopedics, 3 from Eye and 2 from ENT). Fifteen tools were lost due to discharge, transfer of patient and loosing the tool by patients. Demographic profile of the respondents: About 19% subjects were of age less than 20 yrs, 20-40 yrs. of 52.6%, 40-60 yrs of 24.6% and more than 60 yrs of 3.5%. The mean age is 32.6 yrs. Majority of the subjects were male i.e. 72.9%. Thirty one percent subjects were from Sunsari district, where as 29.3% from Jhapa, 8.6% from Morang, 5.2% from Dhankuta and 22.4% from other district of Nepal. About half the subjects 57.6% were from village (VDC) and 42.4% from town (NP). On the day of data collection the duration of hospitalization of clients were less than 3 day of 8.6%, 3-5 days of 33%, 5-7 days13.8, 7-15 days of 31% and >15 days of 13.8%. The mean duration of hospitalization is 8.793, SD = 7.2105 and Range=1-35 days. About 53% subjects were literate and 47% had education level SLC or above. Attitude of the patients towards nursing students: There were 10 unambiguously positive (Q.No: 3, 4, 6, 9, 13, 15, 17, 19, 21,13) and 10 unambiguously negative (Q.No: 5, 8, 10, 12, 14, 16,18, 20, 22, 24) statements. Actually each positive statement were also asked negatively without changing the main concepts or meaning so that biasness could be reduced. Positive statements: In responses to the positive statements the respondents reported that, presence of student nurses in ward make the clients glad (96.6%), know about own disease process (68.5%), behaviour and

temperament is good (93.2%), can ask most trivial questions (95%), learn while teach by senior nurses (96.7%), like to ask details of personal questions (93.3%), have more time for clients (51.7%), they examine in details (54.2%), help very much in treatment process (84.86%), and students also have knowledge about disease process (84.5%). Negative statements: In response to the negative statement the subjects reported that, student nurses donot have knowledge about disease process (37.9%), busy and always in hurry (62.1%), they donot like student nurse presence (19.6%), behave badly to the patients (25.4%), not benefited by them (16.9%), repeated and long time examination (57.9%), no point to asking questions to them as they donot know anything (59.3%), unable to get information about disease process in spite of presence of student nurse (47.5%), patient feel left out or bored (37.7%), and don’t like asking personal questions (54.4%) .

Discussion:

The outlook for hospital nurses looks good. There is a national and international shortage of nurses,

which means there are many employment opportunities in hospitals and hospital clinics. The number

of people employed in this occupation is expected to grow moderate to rapidly over the next two to

three years.

Several factors are contributing to the hospital nursing shortage, including the ageing nursing workforce,

which will lead to the retirement of senior nurses; entry requirements for nursing courses; and

competing career opportunities, especially for nurses with degree qualifications. Most nursing vacancies

are in public or private hospitals, both sectors offer different working conditions and remuneration

packages. To alleviate the nursing shortages health authorities and hospitals are improving their policies

for recruitment and retention of hospital nurses.

The development of technology has meant that hospital nurses are required to keep developing their

skills to maintain professional standards and their understanding of new procedures and new

equipment. Hospital nurses are now working more independently as their tasks have broadened to

include technical procedures, such as intravenous (IV) therapy.

Technology has also played an important role in caring for pre-term infants, who would not have

survived in the past, and health care for the elderly. Machinery, such as ventilators, can artificially

prolong life of these groups. Hospital nurses need to be competent in using this machinery.

References:

1. Rai. D, Suwal R. Patient’s attitude towards student doctors of IOM. Nepal health

Research council. 2001.

2. Richardson PH, Curzen P, Fonagy P. Patient’s attitude to student doctors. Medical-

Education. 1986; 20(4).

3. Murray M, Chambers M. Effect of contact on nursing student ‘s attitude to patients.

Nurse Educ Today. 1991, 11(5): 363-7.

4. Dunn SV, Hansford B. Undergraduate nursing student’s perception of their clinical

learning environment. Journal of Advanced nursing. 1997;25 (6):1299-1306.

5. Gates MF, Kaul M, Speece MW, Brent SB. The attitudes of beginning nursing and

medical students towards care of dying patients: a preliminary study. Hospital Journal.

1982;8(4): 17-32.

6. Courtney M, Tongs S, Walsh S. Acute-care nurse’s attitude towards older patients: A

literature review. International Journal of nursing Practice. 2000.6(2): 62-69.

7. Majumadar B. Medical and Nursing students’ knowledge and attitudes towards

violence against women in India. Educ. Health. 2004; 17(3):354-64.

Table: - I

Attitude of Student Nurses Mentioned by Subjects (MR)

N=60

S.N. Attitude Percentage (%)

1 Friendly/Social 66.7

2 Kind 45.0

3 Clever 41.7

4 Helpful 55.0

5 Gentle 47.6

6 Clean and Tidy 55.0

7 Empathetic 60.0

8 Soft spoken 60.0

9 Respectable 33.3

10 Unbiased 58.3

Table: - II

Suggestions to Improve Attitude of Nursing Students (MR)

N=60

S.N. Responses/Suggestions: Percentage (%)

1 No Response / No Suggestions: 32.5

2 Suggestions Given: 67.5

a. Develop helping attitude 37

b. Perform equal behaviour to all 29.6

c. Encourage clients 22.2

d. Counseling Clients and Relatives 18.5

e. Perform the duty without hesitancy 14.8

f. Use Soft tone voice 14.8

g. Be polite and avoid anger 11.1

h. Provide information about hospital services 11.1

I. Pay attention and Listen to clients problem 7.4

j.

Others: show maturity, provide prompt services, learn

language of clients etc.

25.9

Table:-III

Association Between Opposite Statements of Same Contents

N=60

S.N

.

Statement

True

(%)

False

(%)

Chi-Squire

Value

(Pearson/

Fisher’s

Exact test)

Significant

Difference

with opposite

statement

1 I am glad that there are student nurses in

the hospital

96.7 3.3 0.037 S (with S10)

2 Because of the student nurses being

around, you feel more in touch what is

going on about your disease.

76.7 23.3 0.200 S (with S20)

3 Student nurses donot know anything about

your disease.

96.6 3.4 0.707 NS (with S23)

4 Student nurses have good behaviour and

temperament.

68.5 31.5 0.273 S (with S12)

5 Student nurses are busy and always in hurry 37.9 62.1 0.104 S (with S18)

6 You can ask Student nurses the most trivial

questions.

93.2 6.8 0.264 S (with S17)

7 I would have preferred there to be no 89.6 10.4 0.370 S (with S3)

student Nurses in the hospital

8 Student nurses behave badly to the

patients.

62.1 37.9 0.602 NS (with S7)

9 You also get to learn something while the

senior nurses are teaching students nurses

in your presence

95 5 0.521 NS (with S22)

10 You did not really benefit from Student

nurses on your treatment process.

19.6 80.4 0.027 S (with S21)

11 You like Student nurses asking your every

detail and personal questions concerning

your disease.

90 10 0.118 S (with S24)

12 You donot like Student nurses examining

you repeatedly taking along time.

25.4 74.6 0.203 S (with S19)

13 Student nurses have more time to give 96.7 3.3 0.104 S (with S8)

14 There is no point asking questions to

students Nurses since they donot know

anything.

16.9 83.1 0.264 S (with S9)

15 You like Student nurses examine you

because they do it in detail

93.3 6.7 0.284 S (with S16)

16 Although student Nurses being around, you

did not get much to know about your

treatment process

57.9 42.1 0.249 S (with S4)

17 Student nurses helped very much in your 51.7 48.3 0.027 S (with S14)

treatment process

18 When Student nurses are being taught in

your presence, you rather feel left out or

bored.

59.3 4.7 0.521 NS (with S13)

19 Student nurses also know about your

disease.

54.2 45.8 0.707 NS (with S5)

20 You donot like student nurses asking you

personal questions regarding your disease.

47.5 52.5 0.118 S (with S15)

Note: S= Significant at 5% level of confidence (P < 0.005)

NS= Not Significant at 5% level f confidence (P<0.005)

Impact of First Aid Training Program for School Teachers and School Management Committee Members of Morang District Nepal

Ram Sharan Mehta, Ph.D. Additional Professor

B.P. Koirala Institute of health sciences E-mail: [email protected]

Abstract: For life time exposure the average person in a developed country have 1% risk of death and

30% risk of injury. In world’s rood daily 1,40,000 people injured, 3,000 die and some 15,000 disabled for

life1. The cost of treatment and the complications after trauma can be decreased, if first-aid support is

given and patient is transferred for the treatment in proper place as early as possible.

The objectives of this study was to train the schoolteachers and school management committee

members regarding first-aid management of common problems requiring first-aid and evaluate the

effectiveness of the training programme.

It was education intervention single group, pre-test post-test research design, conducted among the teachers and school management committee members of Selected schools of Morang district. Maintaining validity and reliability of the tool, pre-test was conducted. After pre-test training program on first-aid was conducted for two days and post-test was conducted at last. The findings were analyzed.

It was found that the training program conducted is very effective. The application of Mc Nemar’s chi

squire test (P=0.0001) is highly significant in all the situations

Finally, it concludes that training program is highly effective and it can be implemented for all the teachers as well as high school students.

Introduction: In Many developed countries fast emergency help can be provided on the spot within five minutes in urban areas and in 20 minutes in rural areas1. The situation in Nepal is very measurable. Every day as many as 140 000 people are injured on the world’s roads, More than 3 000 die and some 15 000 are disabled for life. Each of those people has a network of family, friends, neighbors, colleagues or classmates who are also affected, emotionally and otherwise. Families struggle with poverty when they lose a breadwinner, or have the added expense of caring for disabled family members2.

The victims of trauma and injury are increasing day by day. The cost of treatment and the

complications after trauma can be decreased if first-aid support is given and patient is transferred of

the treatment in proper place as early as possible. This can reduce the rate of disability also to a great

extent. In Nepal the victims are left alone for themselves and their family members. In order to

reduce the problem, the public needs to be aware so that helpful in such conditions. The teachers are

the educated forces of the county. If the teachers are equipped with the knowledge and skill they can

help victims, motivate family members, educate students and other peer groups.

Societal Influences help to shape us in to the kinds of people we become and affect the way we behave

in our daily life. Like many districts in Nepal, Morang district also needs poverty alleviation. About 65%

of the total populations are poor. Most of the VDCs are seen in measurable in condition and isolated

from the town.

This training Programme is beneficial because, Trauma and accidents increasing day by day as vehicle and modernization increasing, The area selected is far away from the city, town or hospital, hence aid in life saving and preventing complications. As they are school teachers, they will act as trainer at there own home and at there own villages, along with their school. They can manage first aid of common problems at their own setting, as these all schools are government and most of the teachers are from villages and middle economic group. It will be very beneficial to them. The cost of treatment and the complications after trauma can be decreased if first aid support is given in proper time. Participants are equipped with the knowledge and skill they can help victims, motivate family members, and educate peer group.

This First aid training program also Create awareness about the trauma and accident prevention. Make them aware about the importance of first aid, equip them with basic knowledge and skills of providing first aid and Supply them necessary resources commonly required for first aid management. Methodology: - A two days first aid training programme was arranged for school headmasters, teachers and members of school management committee for the schools of sixteen VDCs of Morang district in plan Nepal field area. The two days training program was conducted in seven times at Biratnagar in various training centers on 28-29 Dec.2005, 30-31 Dec. 2005, 6-7 Jan. 2006, 20-21 Jan.2006, 25-26 Feb.2006, 27-28 Feb.2006, and last on 11-12 March 2006. Twenty-five participants were involved in each group from the various schools of selected VDCs of plan area of Morang district. The participants were informed at their respective schools one week prior to training by calling the management-committee meeting in their respective schools by the community development society health workers along with official letter of invitation with all required information along with the utility of the training. All the participants were participated full time with great intrest.

All the necessary preparations of teaching learning resources like: information booklets, posters, charts, and other audiovisual aids were collected and make ready in advance with the support of trainer and experts. On the first day, the objects and contents were informed to all participants after the introductory inaugural session. Pre-test was taken and the session started, as per schedule. All the topics were covered as per planned schedule. The teaching learning was make practical by providing the information booklet to each individual, showing real demonstrations and taking re-demonstration from the participants. Participatory approach, adult learning principles and real demonstrations play an important role in making the training very fruitful and practical. A fully equipped kit bag made ready and demonstrated to all the participants in details and provided to them individually at the end of training. Along with the concerned trainers the district pubic health officer was also involved in the training. The chief of district education office was also involved in giving instruction to teachers. The district development committee officers also invited for better cooperation. The participants were also addressed and given instructions by various experts and supervisor of, plan-Nepal, Section officers of District Education Office, school supervisors and health personnels of community development society. At the end of schedule a free-session of one hour was kept for free interaction, discussion and question-answer, regarding common health problems. The free session was very practical, useful and teachers raised numerous questions. The answers provided to each questions raised by the concerned teachers. During the course of training extra health related information’s were also provided to them on Immunization, human anatomy, service available at health post and sub-health post, family planning, Environmental cleanliness, toilet cleaning, worm infestations, oral hygiene, cancer, diabetes, scabies, showing the posters, charts, pamphlets and providing the booklets to each participants. The real demonstration and re-demonstrations were performed on the topics like: Using thermometer, Applying bandages/dressing, Applying splints /sling /cervical-collar /pad, Controlling nasal bleeding, Removing foreign body from throat, Management of shock, assessing pulse/ respiration, CPR- demonstration, Recognize shock, Calculation of percentage of burn, techniques of inducing vomiting in Organphosphous poisoning, Controlling bleeding, Removing water from stomach, Jeevan Jal preparation, Cold sponging, Bandages in snake bite etc. Maintenance and supervision of the project: - The project was completed by the CDS (Community Development Society), with the effort of organization’s health committee members. A first-aid management committee was constituted who will look after the project under the direct guidance of Health advisor of the CDS. The cooperation and assistance from the district health office (DHO) and district education office and District development office was also obtains for better outcome and sustainability.

For the sustainability and continuity of the program the participants made the stratategies for implementation at their setting like: Constitution of first-aid management committee in each school, Maintenance of record of accidents and first-aid care provided to them, Adequate supply

of equipments and supplies in first-aid kit bag regularly, A trained teacher will be assigned the responsibility, Transparent record will be made so that CDS/Plan members can observe and Problems & needs identified will be communicated.

Results:

Data Analysis and Interpretation: - The collected data was analyzed using EXCEL and SPSS programme.

The total number of participants in all seven groups were 175 i.e. 25 participants in each group. Majority

of the participants were members of the school management committee i.e. 49.4%, Headmaster 22.3%,

and teachers 28.3%. The Majority of the participants were of age group 30-40 years i.e.53.7% and male

91.4%. In average the capabilities of performing (fully capable), first aid is increased in post-test i.e.

13.9% to 70.3%, and the gain is 56.4%. The capability of performing first aid in various situations or

conditions is greatly increased. The Maximum increase in the management of Epistaxis i.e. 84.4% and

Minimum in Chocking i.e. 55.2%. The Mc. Nemar’s Chi Squire test was used to evaluate effectiveness of

the training programme and found highly significant in each individual situations/conditions.

The Participants mentioned that the topics covered was adequate (69.2%), content taught was

adequate(59.8), teaching method used was good(91.3%), and overall management of the training was

good(88.3). In general Majority of the Participants i.e. 94.2% reported that this training was very useful,

where as 5.8% reported all right and none of them reported not useful. The details of the results are

mentioned in table I to V.

Discussion: About half the participants were the members of school management committee because

from each school one member was selected from school management committee and one from

headmaster or teacher. The majority of the participants were male i.e. 91.4%, because the schools

selected were from villages of Morang district, where the number of female teachers are also very less

and the communication and transport is another causes of less female participation. The maximum

knowledge gain is on the first-aid management of Epistaxis i.e. 84.4% and minimum is on chocking

55.2%. Majority of the participants mentioned that this training is very useful as the first-aid training is

unique, practical, needed in daily life and different from their daily professional life.

The training program was found highly effective among participants. If this training program is given to

each schoolteachers and high school students, it will certainly help in trauma prevention and care.

Hence, it is mandatory to conduct this training program for all the teachers and students of high school

in both Sunsari and Morang district, as well as in whole country.

Recommendation: First-aid training can be conducted for all high-school teachers. One chapter of first-

aid can include in the curriculum of class-8, 9 and 10. Similar study can be conducted among the

students, educated community people and industrial workers. Same study can be conducted taking

large samples of both urban and rural schools. A-V cassette can be prepared and used for training for

better results.

Acknowledgement: It is my proud privilege to express my profound sense off gratitude and sincere

thanks to the Chairman of community Development society Mr. Ganga prasad yadav and the team for

their support to make this study successful. I am extremely thankful to Plan Nepal Sunsari-Morang Unit

for their financial support to run this training programme.

REFRENCES:

1. Helen S. Susan W. Robert C etal. NHS emergency response to 999 calls. British medical Journal:

August. 2002, 325: 330-333.

2. Wook L J. World health day theme 2004: road safety is no accident. NJI, 2004.

3. Frederick K, Bixby E, Orzel MN, Stewart–Browns, Willett K. An evaluation of the effectiveness

of the injury minimization program for schools. Inj. Prev. 2000, 6 (2): 92–5.

4. Peterson BB. School injury trends. J. School nurs. 2002, 18 (4): 219 – 25.

5. Singh AJ. Kaur A. knowledge and practices of urban and rural high school children regarding

minor injuries. Indian J public health. 1995; 39 (1): 23 – 5.

6. Gagliardi M, Neighbors M, Spears C etal. Emergencies in the school setting: are public school

teachers adequately trained to respond? Pre hospital disaster med. 1994 oct.-Dec;9(4):222-5.

7. Aly SA, Ahmed NI. Assessment of physical education faculty students’ knowledge about first

aid. J. public health assec. 1993, 68 (1-2): 101 – 18.

8. Their MM, lee BW, Bun PY. Knowledge, attitude and practices of childhood injuries and their

prevention by primary caregivers in Singapore. Singapore med. J. 2005; mar; 46 (3): 122 – 6.

9. Kano M, Siegel JM, Bourque LB. First – aid training and capabilities of the lay public: a

potential alternative source of emergency medical assistance following a natural disaster.

Disasters. 2005 mar; 29 (1): 58 – 74.

10. Affintas KH, Asian D, Yildiz AN etal. The evaluation of first – aid and basic life support training for

the first year university students. Tohoku J exp med. 2005, 205 (2) : 157 – 69.

11. Uray T, Lunzer A, Ochsenhofer A etal. Feasibility of life – supporting first – aid training as a

mandatory subject inb primary schools. Resuscitation. 20031, 59 (2) : 211 – 20.

12. Havice AM, Clark JK. A preliminary survey of health education in Indian hones schools. J. Sch. Health. 2003, 73 (8) : 300 – 4.

13. Lazenby RB, Morton RC. Facilitating transformation through. Collaboration. NURS. Educ.

Perspect. 2003, 24 (2): 91 – 3 .

14. Perkins GD, hulce J, shore HR, bion JF. Basic life support training for health care students.

Resuscitation. 1999; 41 (1): 19 – 23.

15. Frederick RA, white DM. safety and first aid behavioral intentions of supervised and

unsupervised third grade students. J. School health. 1989; 59 (4): 146 –9.

16. Journal of Nepal medical Association (JNMA) ; 1997: 35 (122) .

17. Shankar PR, Mishra P. Influence of school education on attitude towards transferable skill in

medical undergraduate. Nepal medical college. 2001, 3 (2) : 94 – 7.

18. Affintas KH, Asian D, Yildiz AN etal. The evaluation of first–aid and basic life support training for

the first year university students. Tohoku J exp med. 2005, 205 (2) : 157 – 69.

Table: - I Demographic Profile of the Subjects

N=175 S.N. Item/Particular Percentage (%)

1 Post/Designation wise distribution of the Subjects: a. Headmaster 22.3 b. Teacher 28.3 C. Member of School Management Committee 49.4

2. Age group (In years) a. < 30 yrs.

21.15

b. 30-40 yrs 53.7

c. 40-50 yrs 19.2

d. > 50 yrs 5.7

Mean 36.46

SD 8.147 Range 19-59

3. Gender (Sex) a. Male (M) 91.4 b. Female (F) 5.6

Table No.: II

Differences In Capabilities Of Participants Regarding First-Aid Management, Before And After

Education Intervention (In average)

N=175

SN Capabilities Pre-test

(Percentage)

Post-test

(Percentage)

Differences

(Percentage)

1 Fully Capable

13.9 70.3 56.4

2 All right (OK) 39.8 21.5 38.3

3 Only few (Some extent) 41.6 8.1 -33.5

4 Not capable at all 4.8 0 -4.8

Table No.: III

Differences In Capabilities Of Performing First-Aid In Various Accidents/Conditions Among The Participants Before And After Educational Intervention As Per Their

Responses (In aggregate) N=175

Situations/ Conditions

Fully Capable All Right (Average) Not Capable at all

Pre-

test

Post-

test

Differences Pre-

test

Post

-test

Differences Pre-

test

Post-

test

Differen

ces

% % % % % % % % %

Fracture 6.4 56.6 50.2 72.1 43.4 -40.0 21.5 0 -21.5

Burn 6.0 64.0 58.0 78.3 36.0 -42.3 15.7 0 -15.7

Poisoning 4.1 56.4 52.3 72.7 41.9 -30.8 23.3 1.7 -21.6

Cut injury

/bleeding 25.6 62.9 37.3 72.1 35.4 -36.7 2.3 1.7 -0.6

Epistaxis 11.9 65.3 53.4 84.4 32.3 -52.1 15.7 2.4 -13.4

Drowning 15.1 65.6 50.5 67.5 32.5 -35.0 17.5 1.9 -15.6

Diarrhea/

Vomiting 27.1 73.8 46.7 65.7 26.2 -36.5 7.2 0 -7.2

Fever 25.0 62.9 37.9 62.8 34.9 -27.9 12.2 2.3 -9.9

F.B. in Eye

/ENT 7.0 60.5 53.5 61.1 39.5 -21.6 31.8 0 -31.8

Chocking 12.3 56.6 44.3 55.2 41.6 -13.6 32.5 1.8 -31.0

Snake bite 4.4 52.1 47.7 77.5 46.2 -31.3 18.1 1.8 -16.3

Shock 6.9 62.2 55.3 55.6 37.8 -17.8 37.5 0 -37.5

Table IV: Differences In The Knowledge Among The participants Regarding First-Aid

Management

Conditions

YY YN NY NN

Mc Nemar’s

Chi squire

P. Value

Fracture 167 8 143 32 118.914 0.000

Burn 157 18 104 71 59.221 0.000

Poisoning 157 18 59 116 20.774 0.000

Cut Injury 123 52 68 107 1.875 0.171

Epistaxis 163 12 75 100 44.148 0.000

Drowning 163 12 145 30 110.981 0.000

Diarrhea 171 4 156 19 142.506 0.000

F.B. Stomach 65 110 77 98 5.476 0.019

Snake bite 161 14 48 127 17.565 0.000

Shock 87 88 19 156 43.215 0.000

Dog bite 119 56 88 87 6.674 0.010

CPR 157 18 82 93 39.690 0.000

P < 0.001

YY = before correct, after correct. Exposed = correct.

YN = before correct, after wrong. Unexposed = in correct.

NY = before wrong, after correct. Case = before.

NN = before wrong, after wrong. Control = after.

Table: -V

Evaluation of the Training Programme

N=175

SN Item/Particular Responses (%)

Adequate/good All

right/OK

Inadequate/poor

1 Topics covered

69.2 29.1 1.7

2 Contents taught 59.8 34.8 5.5

3 Teaching methods 91.3 6.3 2.5

4 Time allocated 21.5 58.9 19.6

5 Organisation of the training 88.3 9.8 1.8

Demographic Profile and Outcomes of the Patients admitted in

Critical care Units (ICU & CCU) of BPKIHS

Mehta*1 RS, Karki*

2 P, Gupta*

3 PK, Rai*

4 HK

B.P. Koirala Institute of Health Sciences

Abstract:

Introduction: Critical care units, may be thought of as having context (the demographics and

characteristics of the kind of work they do), structure (the grouping of people and the allocation of

responsibility through specialization, expertise, formalization, and some degree of centralization or

decentralization), process (intraorganizational relationships such as the flow of information and

coordination), and outcomes (productivity, goal attainment, morale, and satisfaction of the members).

B.P. Koirala Institute of Health Sciences (BPKIHS) has a 740 bedded tertiary care center hospital with 10

beds ICU and 4 beds CCU with modern facilities.

Objectives: The main objectives of this study were to find out the demographic profile and outcomes of

the admitted patients in Intensive care unit (ICU) and critical care unit (CCU) of BP Koirala Institute of

Health Sciences.

Methodology: It was a hospital based retrospective descriptive study design, conducted among the

admitted patients (In ICU from 1-1-2003 to 31-12-2006 and in CCU from 15-3-2004 to 14-3-2006) of

critical care units (ICU/CCU). The total number of patients admitted in critical care units during the study

period constituted the population of the study. Total enumerative sampling technique was used to

collect the data using the prepared Performa from the admission register of the ward. Total 1615

patients were included in the study i.e. 997 from ICU and 618 from CCU.

Results: In ICU among 997 patients 588 were transferred to ward after improvement, 262 expired, and

115 left against medical advice and 2 referred to better centers. In CCU among total 618 patients 426

transferred to ward after Improvement, 35 discharged, 93 expired, 61 left against medical advice and 7

were referred to better centers for treatment.

Conclusions: The number of admission in ICU/CCU is increasing yearly as the bed strength, patients load

and complexity of cases increasing; hence the necessary management in ICU/CCU is mandatory to

overcome the future problems.

Key Words: Demographic Profile, Outcomes, Critical Care

Authors: *1 Ram Sharan Mehta, Asst. Professor, Medical-Surgical Nursing Department, *2 Prof.

Prahlad Karki, HOD of Internal Medicine, *3Prof. P K Gupta, HOD, Dept. of Anesthsiology, *

4Ms. Hari

Kurmari Rai, In-charage, ICU/CCU unit.

Introduction: B.P. Koirala Institute of Health Sciences (BPKIHS) established in 1993, upgraded to a

University in 1998, is an autonomous Health Sciences University having 700 bedded tertiary care

hospital with well equipped 14 bedded ICU/CCU services.

An intensive care unit (ICU) is a specialized section of a hospital that provides comprehensive and continuous care for persons who are critically ill and who can benefit from treatment. The purpose of the intensive care unit is simple even though the practice is complex. Healthcare professionals who work in the ICU or rotate through it during their training provide around the clock, intensive monitoring and treatment of patients seven days a week1.

The criteria for admission to an ICU are: Critically ill patients in a medically unstable state who require an intensive level of care i.e. monitoring and treatment, Patients requiring intensive monitoring who may also require emergency interventions and Patients who are medically unstable or critically ill and who do not have much chance for recovery due to the severity of their illness or traumatic injury.

ICU care requires a multidisciplinary team that consists of critical care specialists; pharmacists and nurses; respiratory care therapists; and other medical consultants from a broad range of specialties including surgery, pediatrics, and anesthesiology. The ideal ICU will have a team representing as many as 31 different health care professionals and practitioners who assist in patient evaluation and treatment. The intensive visit will provide treatment management, diagnosis, interventions, and individualized care for each patient recovering from severe illness1.

Despite tremendous resource utilization, the majority of trauma patients with prolonged ICU stays can eventually return to varying degrees of functional daily living and independence, but not to preinjury levels. A subgroup of severely injured elderly patients had a significantly higher mortality rate. However, elderly survivors that entered our rehabilitation facility fared as well as the younger patients.1

Coronary care units developed in the 1960s when it became clear that close monitoring by specially trained staff, cardiopulmonary resuscitation and medical measures could reduce the mortality from complications of cardiovascular disease. The first description of a CCU was given in 1961 to the British Thoracic Society, and early CCUs were located in Sydney, Kansas and Philadelphia. Studies published in 1967 revealed that those observed in a coronary care setting had consistently better. The main feature of coronary care is the availability of telemetry or the continuous monitoring of the cardiac rhythm by electrocardiography. This allows early intervention with medication, cardioversion or defibrillation, improving the prognosis. As arrhythmias are relatively common in this group, patients with myocardial infarction or unstable angina are routinely admitted to the coronary care unit. For other indications, such as atrial fibrillation, a specific indication is generally necessary, while for others, such as heart block, coronary care unit admission is standard.2

Early success in CCUs with resuscitation and with the detection and treatment of arrhythmias focused researchers' attention on left ventricular failure and cardiogenic shock. The Swan-Ganz flow-guided catheter was introduced, and its use for invasive monitoring of cardiac hemodynamics became routine in some centers. 3

Nursing care has an important role in a critical care unit. The nurse's role usually includes clinical assessment, diagnosis, and an individualized plan of expected treatment outcomes for each patient i.e. implementation of treatment and patient evaluation of results.

Objectives: To find out the demographic profile and outcomes of the admitted patients in critical care

units i.e. Intensive Care Unit (ICU) and Coronary Care Unit (CCU) of B.P. Koirala Institute of Health

Sciences, Dharan, Sunsari, Nepal.

Methodology: It was a hospital based retrospective descriptive study design, conducted among the

admitted patients in CCU and ICU of BPKIHS using the admission register of the ward. A Performa was

prepared and the required informations were collected in the Performa form the admission register. The

total number of patients admitted in critical care units during the study period constituted the

population of the study. Total enumerative sampling technique was used to collect the data using the

prepared Performa from the admission register of the ward. Total 1615 patients were included in the

study i.e. 997 from ICU and 618 from CCU.

ICU: All the patients’ record entered in the admission register from 1st January 2003 to 31

st December

2006 i.e. of four years was reviewed. The mentioned records of admitted patients were used as source

of data collection.

CCU: All the patients record entered in the admission register from 15th

March 2004 to 14th

March 2006

i.e. of 2 years. The record mentioned in the admission register was used as source of data collection.

The collected data was entered in SPSS-10 software package and analyzed. The details of the findings

are depicted in the tables and graphs.

Results:

Year wise distribution of the subjects:

ICU: Total 997 patients were admitted in ICU from 2004- 2006, i.e. 313 in 2004, 295 in 2005 and 389 in

2006. The minimum number of admission per month is 18 and Maximum number is 40, the mean was

27.7 and SD 5.74.

CCU: Total 618 patients were admitted in CCU from 15th

March 2004 to 14th

March 2006 i.e. 281 in

2061BS and 337 in 2062 BS. The minimum number of admission per month is 20 and Maximum number

is 36, the mean was 25.75 and SD 5.168.

Outcomes of the clients:

ICU: Among the total admitted patients 588 were transferred to wards i.e. 172 in 2004, 170 in 2005 and

246 in 2006. Total 262 Patients were expired during the course of their treatment in ICU i.e. 102 in 2004,

61 in 2005, and 99 in 2006. Minimum 2 cases were found to expired per month, where as maximum 16

cases, the mean expired per month was 7.28 and SD 3.185. The number of total cases left against

medical advice (LAMA) during their treatment period was 115 i.e. 37 in 2004, 41 in 2005 and 37 in 2006.

Only two patients were referred to other hospitals i.e. 1 in 2004 and 1 in 2006.

CCU: Among the total admission of 618, 362 patients were transferred to ward, 35 discharged from

CCU, 7 referred to better center, 93 expired and 61 left against medical advice (LAMA).

Correlation between Variables: There is highly correlation between total monthly admission with

transferred to ward, expired and referred cases in ICU and there is highly correlation between total

monthly admission with transferred to ward and expired in CCU.

Discussion: Critical care is specialized unit in which expert medical, nursing and technical staffs are

provided care with equipment for monitoring and immediate life saving intervention involved in

paralleled with advance invasive surgical, medical procedures. Principles of Critical Care are: Early

diagnosis and identification of problems, Anticipation of possible events and complication, A holistic

approach to critical illness, The considered use of technology and Recognition of the limit of critical care.

ICU patients are a heterogeneous group with severe illnesses, multiple system dysfunctions, and multiple coexisting medical problems. Agreement on a minimum care data set of clinical and physiological information can improve ICU audit and help identify effective care policies. Systematic evaluation information, while being a challenging task, provides information of practical and operational significance that is essential for such strategic planning.

Conclusions: The number of admission in ICU/CCU is increasing yearly as the bed strength, patients load

and complexity of cases increasing in BPKIHS; hence the necessary management in ICU/CCU is

mandatory to overcome the future problems.

Reference:

9. Miller RS, Patton M, Graham RM, Hollins D. Outcomes of trauma patients who survive

prolonged lengths of stay in the intensive care unit. J Trauma. 2000 Feb;48(2):229-34.

10. Mehta NJ, Khan IA. Cardiology's 10 greatest discoveries of the 20th century. Tex Heart Inst J

2002;29:164-71.

11. Julian DG. The history of coronary care units. Br Heart J 1987;57:497–502.

12. Yaseen A, Venkatesh S, Samir H, Abdullah Al S, Salim Al M. A Prospective Study Of Prolonged

Stay In The Intensive Care Unit: Predictors And Impact On Resource Utilization. International

Journal For Quality In Health Care, 2002, 14:403-410

13. Rosenberg AL, Hofer TP, Hayward RA et al. Who bounces back? Physiologic and other predictors

of intensive care unit readmission. Crit Care Med 2001; 29: 511–518.

14. Weissman C. Analyzing intensive care unit length of stay data: problems and possible solutions.

Crit Care Med 1997; 25: 1594–1600.

15. Wong DT, Gomez M, McGuire GP, Kavanagh B. Utilization of intensive care unit days in a

Canadian medical-surgical intensive care unit. Crit Care Med 1999; 27: 1319–1324.

16. Brilli, R. J., A. Spevetz, R. D. Branson, et al. "Critical Care Delivery in the Intensive Care Unit:

Defining Clinical Roles and the Best Practice Model." Critical Care Medicine 29 (October 2001):

2007-2019.

17. Pamela H, Mitchell MS, Sarah A, et al. American Association of Critical care Nurses

Demonstration project : profile of excellence in Critical care nursing. Heart & Lung. 1989; 18(3).

18. Praveen K, Devajit S, Reeta S et al. Demographic Profile and outcome analysis of a tertiary level

pediatric intensive care unit. 2004; 71(7): 587-591.

19. Kanus WA, Draper EA, Wagner DP et al. Comperission of Frequency distribution in

demonstratio0n unit and 13 tertiary hospitals. Crit Care Med. 1985; 13: 823.

Table: - I

Demographic Profile & Outcomes of ICU Patients Months Years Total Admission Transfer to ward Expired

LAMA Refer Still in Bed i.e. Later TRF

January 2004 27 12 9 0 0 6

Feb 2004 26 11 6 3 0 6

March 2004 22 7 9 4 0 4

Apr 2004 29 8 12 3 0 6

May 2004 32 14 7 4 1 6

June 2004 27 12 7 3 0 5

July 2004 37 13 16 3 0 2

Aug 2004 24 13 5 2 0 0

Sept 2004 18 5 7 3 0 5

Oct 2004 22 6 7 4 0 6

Nov 2004 27 9 6 6 0 6

Dec 2004 22 5 11 2 0 5

Total 313 115 102 37 1 57

January 2005 25 9 10 2 0 4

Feb 2005 24 16 3 4 0 0

March 2005 28 11 3 9 0 4

Apr 2005 28 13 6 5 0 4

May 2005 20 12 4 1 0 0

June 2005 30 18 3 3 0 0

July 2005 20 9 2 4 0 0

Aug 2005 19 10 3 2 0 0

Sept 2005 21 8 6 2 0 5

Oct 2005 28 10 8 4 0 6

Nov 2005 19 7 6 2 0 6

Dec 2005 33 18 7 3 0 0

Total 295 141 61 41 0 29

January 2006 26 11 6 2 0 6

Feb 2006 40 23 4 5 0 8

March 2006 29 20 5 2 0 5

Apr 2006 29 20 5 1 0 3

May 2006 39 18 12 2 1 6

June 2006 34 16 11 5 0 3

July 2006 29 15 8 1 0 5

Aug 2006 35 15 10 5 0 0

Sept 2006 33 18 7 3 0 0

Oct 2006 32 10 12 5 0 5

Nov 2006 34 16 11 5 0 3

Dec 2006 29 15 8 1 0 5

Total 389 197 99 37 1 49

Table: - II

Demographic Profile & Outcomes of CCU Patients

English

Months

Nepali

Months Year

Total

AdmissionTransfer Discharge Refer Expired LAMA Still in Bed i.e. TRF

3-Apr -

14 Baisakh 2061 20 7 2 1 2 4 4

May Jestha 2061 22 11 1 0 3 5 2

June Asadh 2061 30 15 2 0 7 4 2

July Shrawan 2061 21 15 0 1 3 1 2

Aug Bhadra 2061 21 12 2 1 2 0 4

Sept Asoj 2061 21 13 1 1 1 2 3

Oct Kartik 2061 28 18 1 0 5 2 2

Nov Mangsir 2061 23 16 1 0 2 3 1

04Dec

Jan Poush 2061 20 12 1 0 2 3 4

January Magh 2061 21 9 2 1 4 2 3

Feb Falgun 2061 28 16 0 0 4 5 3

March Chaitra 2061 26 15 0 2 4 2 4

Yearly Total 281 159 13 7 39 33 34

Apr Baisakh 2062 26 16 2 0 2 3 3

May Jestha 2062 28 17 2 0 4 1 4

June Asadh 2062 23 11 1 0 5 2 4

July Shrawan 2062 36 20 1 0 6 5 4

Aug Bhadra 2062 28 17 1 0 6 2 2

Sept Asoj 2062 28 17 1 0 5 3 2

Oct Kartik 2062 37 22 3 0 7 3 2

Nov Mangsir 2062 30 19 3 0 4 4 0

05Dec

Jan Poush 2062 24 13 5 0 3 3 0

Feb Magh 2062 35 26 0 0 6 1 2

March Falgun 2062 22 13 1 0 3 1 4

April 13 Chaitra 2062 20 12 2 0 3 0 3

Yearly Total 337 203 22 0 54 28 30

Grand Total 618 362 35 7 93 61 64

Patients’ Attitude Towards Nursing Students of BPKIHS Mehta* 1 RS, Singh*2 B

B.P. Koirala Institute of Health Sciences Abstract:

Introduction: Health care is a social role relationship between a helping agent and a person needing help. This relationship is considered psychologically and socially as half cures treatment procedure. Therefore the nature of relationship between nurses and patient has some degree of significant impact on the overall quality of health care.

Objectives: The objectives of this study were to assess the attitude of the patients regarding the presence and involvement of the nursing students in their clinical care in Medical–Surgical units of BPKIHS.

Methods: It was hospital based cross sectional study. The clients admitted in medical-surgical units in the day of data collection constitute the population of the study. The stratified simple random sampling method was used to select the sample and 75subjects were selected from all the wards of Medical-Surgical units of BPKIHS, where only 60 tools were returned back out of 75 tools. The collected data was entered in SPSS-10.5 software package and analyzed.

Results: The respondents reported that, presence of student nurses in ward make the clients glad (96.6%), know about own disease process (68.5%), behavior and temperament is good (93.2%), can ask most trivial questions (95%), learn while teach by senior nurses (96.7%), like to ask details of personal questions (93.3%), have more time for clients (51.7%), they examine in details (54.2%), help very much in treatment process (84.86%), and students also have knowledge about disease process (84.5%).

Conclusions: The development of technology has meant that hospital nurses are required to keep developing their skills to maintain professional standards and their understanding of new procedures and new equipment along with the need to develop the therapeutic relation with the patients to overcome the future challenges.

Key Words: Patients, Attitude, Nursing Students

Corresponding Author: * 1 Ram Sharan Mehta, Asst. Professor, Medical-Surgical Nursing Department, [email protected] , B.P. Koirala Institute of Health Sciences, *2 Babita Singh, Ward In-charge, Medical unit-I.

Introduction:

Medical profession was considered to be a noble profession from time immemorial. While a medical student comes out of medical institution after the Hypocrite’s Oath, it is his duty to look after any patient irrespective of caste, creed, sex or even remuneration. In history we come across doctors and paramedical staff who spent their entire life for the prosperity of the patients and also the total health of the community. One notable example is the story of Florence Nightingale who spent her entire life for nursing the sick. In older days the primary objective of any medical institution was not to make exemplary profit1. Over the year’s technology advanced and the hospitals became more technology oriented with a high cost. The high cost or investment of the hospitals compelled the management to increase the cost of service. On the other hand the number of hospitals increased which made the sector competitive. This interns forced the hospitals to employ reputed doctors and Nurses to attract the patients. The branches of specialization made available micro-organ specialists. The superspecialists are demanded by the hospitals. The concept of hygenity motivated the hospitals to update the facilities to the status of star hotels. The higher education and increased awareness contributed the public to approach the hospitals2. The nature of relationship between nurse and patient has some degree of significant impact on the overall quality of healthcare, the patient’s compliance and satisfaction is greatly influenced by the appearance, behavior and the communication skill of the nurses as nurses stay 24 hours with the clients3.

With increasing in life expectancy and increasing numbers older patients utilizing the acute setting, attitudes of registered nurses caring for older people may affect the quality of care. Many negative attitudes reflect against stereotypes and knowledge deficits that significantly influence registered nurses practice and older patients’ quality of care. In the present setting, older patients experience reduced independence, limited decision-making opportunities, increased probability of developing complications little consideration so their aging-related needs, limited health education and social isolation. Available instruments to outdated, country specific and do not include either a patient focus or a caring perspective. This paper argues for the development and utilization of a research instrument that includes both a patient’s focus and a caring dimension.4

The origins of nursing date back to when the first mother or other close female, ministered to the sick

in the family. It was Florence Nightingale in the mid-1800s who founded modern nursing and structured professional duties into an orderly trained fashion. Before this, so-called nurses were

considered untrained servants. Nightingale established the first school of nursing in London, England in 1860, with the first school in the United States established in 1872 in Boston, Massachusetts3.

Throughout the next 130 years, nursing schools flourished as mainly women were educated and

trained to take care of the sick. Nurses also distinguished themselves on the battlefield in all of our

conflicts. If you have watched reruns of the series Mash on TV, then you know that nurses were there in those battlefield units trying to save lives right alongside the doctors. They were, in fact,

ministering critical care to those wounded in battle, and they had to react quickly and make life and death decisions under unbelievable pressure and make shift operating conditions. In fact, nurses have

been responding to critical care situations from the times of Florence Nightingale3.

Nurses are still seeking respect for their profession. In addition to education and training, nursing

advocates sought for standards and regulations that would not only benefit patient care but also give

nursing the professional status it needed and deserved.

Till date, there has been no study of the attitude of the patients in the hospital to the presence and

involvement of the student in their nursing care in BPKIHS. So, we will try to find out the real scenario in

our context.

With the emerging nursing colleges in the country and the out flowing number of nursing students in

many hospitals, this complex relationship has more importance and responsibility than even before. In

BPKIHS, patients are in contact with nursing students and they must have developed some attitude

towards student nurses during their social and nursing interaction. Hence, the investigators are decided

to conduct the study on, “patient’s attitude towards nursing students of BPKIHS”.

The objective of this study was to assess the attitude of the patients regarding the presence and involvement of the nursing students in their clinical care in Medical–Surgical units of BPKIHS.

Methods:

It was hospital based cross sectional study. The clients admitted in medical-surgical units in the day of data collection constitute the population of the study. The stratified simple random sampling method was used to select the sample and 75subjects were selected from all the wards of Medical-Surgical units of BPKIHS, where only 60 tools were returned back.

Using pre-tested semi-structured Questionnaire the data was collected. The clients selected for study, if unable to give response then the next bed client was selected. During the course of filling tool the client’s nearest relative or caretaker was involved for appropriate response. Opinion was taken only when students were not posted in the wards, especially in afternoon time to reduce the bias. The data was collected by trained nurses of other wards in the ordinary dress, to reduce the professional fear and bias. The clients able to fill the Questionnaire, own self, they were encouraged to fill and submit it on the same day or next day morning. For illiterate clients the help of literate/educated caretakers of side by client’s relatives’ was advised to complete the questionnaire. The subjects were assured that their responses were not seen by the students and will not affect their training in any way. Explaining the purpose of study properly, the clients were assured about anonymity. The collected data was checked, and coding completed. Coded data was entered in SPSS-10.5 package and analyzed.

The Questionnaire was a kind of checklist with a dichotomonous rating scales (yes or no), will be

relatively simple to construct, easy for respondents and fairly reliable. The Questionnaire consisted of 10

unambiguously positive and 10 unambiguously negative statements. Actually each positive statement

was also asked negatively without changing the main concept or meaning, so that biasness could be

reduced.

Results:

This study was conducted in medical-Surgical units of BPKIHS: using stratified random sampling method. Seventy five tools were distributed to the subjects (i.e. medical– I =13, medical–II =13, medical–III =6, surgical–I =12, surgical–II =12, surgical–III = 6, Orthopedic= 6, Eye = 4 and ENT= 3) in all the selected wards and 60 tools were collected balk only (i.e. 10 from medical –I, 9 from medical –II, 6 from medical –III, 8 from surgical –I, 12 from surgical –II, 5 from surgical –III, 5 from orthopedics, 3 from Eye and 2 from ENT). Fifteen tools were lost due to discharge, transfer of patient and loosing the tool by patients. Demographic profile of the respondents: About 19% subjects were of age less than 20 yrs, 20-40 yrs. of 52.6%, 40-60 yrs of 24.6% and more than 60 yrs of 3.5%. The mean age is 32.6 yrs. Majority of the subjects were male i.e. 72.9%. Thirty one percent subjects were from Sunsari district, where as 29.3% from Jhapa, 8.6% from Morang, 5.2% from Dhankuta and 22.4% from other district of Nepal. About half the subjects 57.6% were from village (VDC) and 42.4% from town (NP). On the day of data collection the duration of hospitalization of clients were less than 3 day of 8.6%, 3-5 days of 33%, 5-7 days13.8, 7-15 days of 31% and >15 days of 13.8%. The mean duration of hospitalization is 8.793, SD = 7.2105 and Range=1-35 days. About 53% subjects were literate and 47% had education level SLC or above. Attitude of the patients towards nursing students: There were 10 unambiguously positive (Q.No: 3, 4, 6, 9, 13, 15, 17, 19, 21,13) and 10 unambiguously negative (Q.No: 5, 8, 10, 12, 14, 16,18, 20, 22, 24) statements. Actually each positive statement were also asked negatively without changing the main concepts or meaning so that biasness could be reduced. Positive statements: In responses to the positive statements the respondents reported that, presence of student nurses in ward make the clients glad (96.6%), know about own disease process (68.5%), behaviour and temperament is good (93.2%), can ask most trivial questions (95%), learn while teach by senior nurses (96.7%), like to ask details of personal questions (93.3%), have more time for clients (51.7%), they examine in details (54.2%), help very much in treatment process (84.86%), and students also have knowledge about disease process (84.5%).

Negative statements: In response to the negative statement the subjects reported that, student nurses donot have knowledge about disease process (37.9%), busy and always in hurry (62.1%), they do not like student nurse presence (19.6%), behave badly to the patients (25.4%), not benefited by them (16.9%), repeated and long time examination (57.9%), no point to asking questions to them as they do not know anything (59.3%), unable to get information about disease process in spite of presence of student nurse (47.5%), patient feel left out or bored (37.7%), and don’t like asking personal questions (54.4%) .

Discussion:

The outlook for hospital nurses is good. There is a national and international shortage of nurses, which

means there are many employment opportunities in hospitals and hospital clinics. The number of people employed in this occupation is expected to grow moderate to rapidly over the next two to three

years.

Several factors are contributing to the hospital nursing shortage, including the ageing nursing workforce,

which will lead to the retirement of senior nurses; entry requirements for nursing courses; and

competing career opportunities, especially for nurses with degree qualifications. Most nursing vacancies

are in public or private hospitals, both sectors offer different working conditions and remuneration

packages. To alleviate the nursing shortages health authorities and hospitals are improving their policies

for recruitment and retention of hospital nurses.

The development of technology has meant that hospital nurses are required to keep developing their

skills to maintain professional standards and their understanding of new procedures and new

equipment. Hospital nurses are now working more independently as their tasks have broadened to

include technical procedures, such as intravenous (IV) therapy.

Technology has also played an important role in caring for pre-term infants, who would not have

survived in the past, and health care for the elderly. Machinery, such as ventilators, can artificially

prolong life of these groups. Hospital nurses need to be competent in using this machinery.

Conclusions:

The development of technology has meant that hospital nurses are required to keep developing their

skills to maintain professional standards and their understanding of new procedures and new

equipment along with the need to develop the therapeutic relation with the patients to overcome the

future challenges. The nursing faculty must prepare to teach the nursing students with modern

approach so that they will be able to meet the future challenges.

References:

1. Richardson PH, Curzen P, Fonagy P. Patient’s attitude to student doctors. Medical-

Education. 1986; 20(4).

2. Murray M, Chambers M. Effect of contact on nursing student ‘s attitude to patients.

Nurse Educ Today. 1991, 11(5): 363-7.

3. Dunn SV, Hansford B. Undergraduate nursing student’s perception of their clinical

learning environment. Journal of Advanced nursing. 1997;25 (6):1299-1306.

4. Courtney M, Tongs S, Walsh S. Acute-care nurse’s attitude towards older patients: A

literature review. International Journal of nursing Practice. 2000.6(2): 62-69.

5. Gates MF, Kaul M, Speece MW, Brent SB. The attitudes of beginning nursing and

medical students towards care of dying patients: a preliminary study. Hospital Journal.

1982;8(4): 17-32.

6. Majumadar B. Medical and Nursing students’ knowledge and attitudes towards

violence against women in India. Educ. Health. 2004; 17(3):354-64.

Table: - I

Attitude of Student Nurses Mentioned by Subjects (MR)

N=60

S.N. Attitude Percentage (%)

1 Friendly/Social 66.7

2 Kind 45.0

3 Clever 41.7

4 Helpful 55.0

5 Gentle 47.6

6 Clean and Tidy 55.0

7 Empathetic 60.0

8 Soft spoken 60.0

9 Respectable 33.3

10 Unbiased 58.3

Table: - II

Suggestions to Improve Attitude of Nursing Students (MR)

N=60

S.N. Responses/Suggestions: Percentage (%)

1 No Response / No Suggestions: 32.5

2 Suggestions Given: 67.5

a. Develop helping attitude 37

b. Perform equal behavior to all 29.6

c. Encourage clients 22.2

d. Counseling Clients and Relatives 18.5

e. Perform the duty without hesitancy 14.8

f. Use Soft tone voice 14.8

g. Be polite and avoid anger 11.1

h. Provide information about hospital services 11.1

I. Pay attention and Listen to clients problem 7.4

j.

Others: show maturity, provide prompt services, learn

language of clients etc.

25.9

Table:-III

Association Between Opposite Statements of Same Contents

N=60

S.N

.

Statement

True

(%)

False

(%)

Chi-Squire

Value

(Pearson/

Fisher’s

Exact test)

Significant

Difference

with opposite

statement

1 I am glad that there are student nurses in

the hospital

96.7 3.3 0.037 S (with S10)

2 Because of the student nurses being

around, you feel more in touch what is

going on about your disease.

76.7 23.3 0.200 S (with S20)

3 Student nurses do not know anything about

your disease.

96.6 3.4 0.707 NS (with S23)

4 Student nurses have good behavior and

temperament.

68.5 31.5 0.273 S (with S12)

5 Student nurses are busy and always in hurry 37.9 62.1 0.104 S (with S18)

6 You can ask Student nurses the most trivial

questions.

93.2 6.8 0.264 S (with S17)

7 I would have preferred there to be no 89.6 10.4 0.370 S (with S3)

student Nurses in the hospital

8 Student nurses behave badly to the

patients.

62.1 37.9 0.602 NS (with S7)

9 You also get to learn something while the

senior nurses are teaching students nurses

in your presence

95 5 0.521 NS (with S22)

10 You did not really benefit from Student

nurses on your treatment process.

19.6 80.4 0.027 S (with S21)

11 You like Student nurses asking your every

detail and personal questions concerning

your disease.

90 10 0.118 S (with S24)

12 You do not like Student nurses examining

you repeatedly taking along time.

25.4 74.6 0.203 S (with S19)

13 Student nurses have more time to give 96.7 3.3 0.104 S (with S8)

14 There is no point asking questions to

students Nurses since they do not know

anything.

16.9 83.1 0.264 S (with S9)

15 You like Student nurses examine you

because they do it in detail

93.3 6.7 0.284 S (with S16)

16 Although student Nurses being around, you

did not get much to know about your

treatment process

57.9 42.1 0.249 S (with S4)

17 Student nurses helped very much in your 51.7 48.3 0.027 S (with S14)

treatment process

18 When Student nurses are being taught in

your presence, you rather feel left out or

bored.

59.3 4.7 0.521 NS (with S13)

19 Student nurses also know about your

disease.

54.2 45.8 0.707 NS (with S5)

20 You do not like student nurses asking you

personal questions regarding your disease.

47.5 52.5 0.118 S (with S15)

Note: S= Significant at 5% level of confidence (P < 0.005)

NS= Not Significant at 5% level f confidence (P<0.005)

Effect of Training Program Regarding First-Aid Management Among The High-

School Students

Mehta*1 RS, Sharma*2 SS, Paudel*3 RK B.P. Koirala Institute of Health Sciences

Abstract

Introduction: For life time exposure the average person in a developed country have 1% risk of death

and 30% risk of injury. In world’s rood daily 1,40,000 people injured, 3,000 die and some 15,000 disabled

for life1. The cost of treatment and the complications after trauma can be decreased, If first-aid support

is given and patient is transferred for the treatment in proper place as early as possible.

Objectives: The objectives of this study was to train the high school students regarding first-aid

management of common problems requiring first-aid and evaluate the effectiveness of the training

programme.

Methods: It was education intervention single group, pre-test post-test research design, conducted among all the students studying in class 9 and 10 in the three selected high schools of sunsari district. It was census study and 696 students were selected. Maintaining validity and reliability of the tool, pre-test survey was conducted. After pre-test training program, first-aid training was conducted for two days. After two weeks post-test was taken. The collected data was analyzed.

Results: Out of 696 subjects 60.5% were Male and 39.5% were female. The mean age of students was

15.51 yrs. (Range=12-20 yrs and SD=1.41). It was found that the training program conducted was very

effective. The application of Mc Nemar’s chi squire test (P=0.0001) is highly significant in all the

situations except the management of unconscious patient (P=0.2148). Majority of the subjects (87.2%)

reported that the training programme conducted was very useful and 12.8% reported useful.

Conclusions: Finally, it concludes that training program was highly effective and it can be implemented for all high school students. It will be beneficial if some important topics of first-aid included in curriculum of high school course.

Key words: First-aid, Training, High School, Students

Authors: * 1 Ram Sharan Mehta, (Corresponding Author), Asst. Professor, Medical-Surgical Nursing Department, Email: [email protected], * 2 Prof. (Dr.) S.S. Khanal, Rector,

* 3 Dr. R.K. Paudel, Dept. of Emergency, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal. Phone: 00977-25-525555, Fax: 00977-25-520251,

Introduction:

Every day as many as 1,40, 000 people are injured on the world’s roads. More than 3,000 die and some 15,000 are disabled for life. Each of those people has a network of family, friends, neighbors, colleagues or classmates. They are also affected, emotionally and otherwise. Families struggle with poverty when they lose a breadwinner, or have the added expense of caring for disabled family members1. The victims of trauma and injury are increasing day by day. The cost of treatment and the complications after trauma can be decreased, if first-aid support is given and patient is transferred for the treatment in proper place as early as possible. This can reduce the rate of disability also to a great extent. In Nepal the victims are left alone for themselves and their family members. In order to reduce the problem, the public needs to be aware and helpful in such conditions. The students are the basic forces of the county. If the students are equipped with the knowledge and skill they can help victims, motivate family members and educate other peer groups. This training Programme, was beneficial because: Trauma and accidents increasing day by day as vehicle and modernization increasing. The area selected is far away from the city, town or hospital, hence aid in life saving and preventing complications. As they are high school students, they will act as trainer at their own home and at their own villages. The students can manage first aid of common problems at their own setting and equip them with first aid materials in-group so that it will increase more concern and interest. It also trains the concerned teacher, as these all school is government and most of the students are from villages. The objectives of this study was to train the high school students regarding first-aid management of common problems requiring first-aid and evaluate the effectiveness of the training programme.

Methodology:

It was education intervention single group, pre–test post–test research design. All the students studying

in class–IX and X in the selected high–schools constituted the population of the study.

It was census study. Total 696 students were included using census method in the study.

The content validity of the tool was maintained by checking the tool from the experts in the field of emergency, family medicine, foreignsic medicine and nursing. The tool prepared was pre-tested among the 75 high school students of Dharan. The reliability of the tool was established by split half method and found reliable, and then the tool was finalized.

The information booklet on first–aid was prepared, in Nepali, on selected topics of common health

problems/situations requiring first–aid at local community level. The booklet was prepared consulting

various available first–aid books, consulting the experts of emergency and trauma management and the

available booklet or materials of American society of preventive medicine. The content validity of the

booklet was checked from the concerned doctors and nurses.

Using pre- tested questionnaire the baseline knowledge of the students was assessed before execution

of first aid training program. After the pre – test the concerned trainer introduced the first – aid training

program, using prepared module (information booklet) in their own class–room. A continuous two days

training program was provided to the students in their own classroom. A booklet was given to each

student for his or her reference and future use.

A first – aid kit box was also given in each school with required supplies after the demonstration in the

training. After two weeks of pre–test the post – test was taken using the same questionnaire. The

collected data was analyzed. Excel software program was used to entry the data, SPSS–4 programs were

used for statistical analysis. Descriptive statistics like mean, percentages, SD etc are used to describe the

variables.

The entire study was conducted under the guidance and supervision of principle investigator and co–

Investigators. First–aid training provided by a group of trained doctors and Nurses under the direct

supervision of Investigators in co-ordination with the physical- health teacher, student representatives

from each class of 9 & 10. A co-ordination team was formed of five members i.e. two students,

headmaster, health/science teacher, and Programme co-coordinator to coordinate the activities. Follow

up and supervision was provided periodically till Eight weeks and necessary guidance help was provided.

Besides the schedule programme, a lot of resource materials are prepared and collected from various

reliable sources especially in pictorial along with the description. This material are pasted in the walls

and notice board in library room, science laboratory room, class-rooms and other common places, so

that every students and teachers can read and get benefited easily. Common public attending these

places can be also benefited. A lot of pictorial on human anatomy and first aid management are also

pasted on the same places.

Results:

The total number of the students participants were 696, Among those 236 were from Harinagra

Madhamic Vidhyalaya, 284 from Kaptangunj Madhamic Vidhyalaya, and 176 from Amahibelha

Madhamic Vidhyalaya. The mean age of students were 15.51 yrs (Range: 12-20 yrs. and SD=1.41), and

60.5% were Male and 39.5% female.

Effectiveness of the training Programme: In the pre-test 30.4 % reported that they were fully capable of

performing first aid, where as in post-test 55.2 % were fully capable i.e. knowledge incensement is 24.8

%.

Differences in Knowledge regarding first-aid management of various problems/situations after

education intervention: There is markedly increase in the knowledge regarding first-aid

management of individual problems 8.8% to 55% after education intervention. The least

Knowledge increase is on the management of Diarrhea i.e. 8.8%, where maximum increase in

knowledge is in the cut injury i.e. 55%. There is also increase in knowledge in each school and

in each class also.

Usefulness of the training program: As 87.2% students reported that the training program is very

useful, 12.8% useful and none of them reported not useful. This finding clearly illustrates the

effectiveness of the training programme.

Evaluation of the training program: The students replied that the heading / topics covered were

adequate (64.2%), contents taught were adequate (75.1%), teaching learning methods were good

(73.7%), time allotted was adequate (69.1%) and overall management was good (78.2). These findings

clearly illustrates that the training program conducted was well planned and effective.

DISCUSSION:

Differences In The Knowledge Among The Students Regarding First-Aid Management: It was seen that

regarding the first-aid management of fracture, 245 students given the correct response both before

and after training interventions, where as 40 students given correct response before and incorrect

response in post test, similarly, 336 students given the incorrect (wrong) response in pre-test but correct

response in post-test; and 69 students given incorrect response in both pretest and post-test.

The application of MC Nemar’s chi squire test, value is 233.02 (P=0.0001), which is highly significant. It

signifies that the training programme conducted was highly effective. Similar findings were reported by

Frederick4, Peterson

5, Gagliardi

7, Singh

6, and Aly

8.

Similarly, in the first-aid management of burn, poisoning, Cut injury, Epistaxis, Drowning, Diarrhoea/vomiting, F.B. in Eye, Foreign body in stomach, snakebite, Dog bite, and CPR, there is significant incensement in the knowledge (P= 0.0001). These findings clearly imply that the training program conducted was very effective. But in the First-aid management of unconscious patient there is significant increase in the knowledge (P= 0.2148), but less in compare to the other situations.

Majority of the respondents i.e. 87.2% reported that the training programme is very useful, whereas

12.2% reported it useful and none of them reported not useful. Hence it clearly illustrates the

effectiveness and usefulness of the programme. Regarding the contents covered, teaching learning

methods used, time allocation, arrangement of the training. The majority of subjects mentioned in

adequate or good (64.2-78.2) and negligible percentage (0.3-0.6) mentioned it inadequate or poor.

These facts clearly demonstrate that the training was useful and applicable in daily life as well as in

course learning process. The positive impact of the training was verbalizes by the students along with

the participated teachers and demand for continuity in future.

Conclusions:

First-aid training is essential for all high school students, teachers and educated community members. Hence, it concludes that the training programme conducted was highly effective and it must be continued in future in all high schools of Nepal.

Acknowledgement:

It is my proud privilege to express my profound sense off gratitude and sincere thanks to the Nepal Health Research Council for their support to make my study successful. I am extremely grateful to Dr. Shankar Pratap Singh, Member Secretary of NHRC and Staffs of NHRC for their invaluable help, and support during the course of study. I also express heartfelt thanks to BPKIHS authorities for their help and support. I am also thankful to the headmasters of the high schools (Harinagra MV, Kaptangunj MV, and Amahibelha MV) for their valuable cooperation, help and support.

Refrences:

1. Wook LJ. World health day theme 2004: road safety is no accident. NJI, Vol.XCV,

Apr.2004.

2. Frederick K, Bixby E, Orzel MN, Stewart – Browns, Willett K. An evaluation of the

effectiveness of the injury minimization program for schools. Inj. Prev. 2000, 6 (2):92–

5.

3. Peterson BB. School injury trends. J. School nurs. 2002, 18 (4): 219 – 25.

4. Singh AJ. Kaur A. knowledge and practices of urban and rural high school children

regarding minor injuries. Indian J public health. 1995; 39 (1): 23 – 5.

5. Gagliardi M, Neighbours M, Spears C etal. Emergencies in the school setting: are public

school teachers adequately trained to respond? Pre hospital disaster med. 1994 oct.-

Dec; 9(4): 222-5.

6. Aly SA, Ahmed NI. Assessment of physical education faculty students’ knowledge

about first aid. J. Public health assec. 1993, 68 (1-2): 101 – 18.

7. Their MM, lee BW, Bun PY. Knowledge, attitude and practices of childhood injuries

and their prevention by primary caregivers in Singapore. Singapore med. J. 2005; mar;

46 (3): 122 – 6.

8. Kano M, Siegel JM, Bourque LB. First – aid training and capabilities of the lay public: a

potential alternative source of emergency medical assistance following a natural

disaster. Disasters. 2005 mar; 29 (1): 58 – 74.

Table: - I Demographic Profile of the Subjects

N=696 S.N. Item/Particular Percentage (%)

1 School wise distribution of the Subjects: a. Harinagra MV 33.91 b. Kaptangunj MV 40.81 C. Amahibelha MV 25.28

2. Age group (In years) a. 12-14 yrs

26.6

b. 14-16 yrs 49.1

c. 16-18 yrs 22.3

d. 18-20 yrs 2.0

Mean 15.51

SD 1.41 Range 12-20

3. Gender (Sex) a. Male (M) 60.5 b. Female (F) 39.5

Table No.: II

Differences In Capabilities Of Students Regarding First-Aid Management, Before And After Education

Intervention (In average)

SN Capabilities Pre-test

(Percentage)

Post-test

(Percentage)

Differences

(Percentage)

1 Fully Capable

30.4 55.2 +24.8

2 All right (OK) 43.0 37.8 -5.2

3 Only few (Some extent) 25.9 6.8 -19.1

4 Not capable at all 0.6 0.3 -0.3

Table No.: III

Differences In Capabilities Of Performing First-Aid In Various Accidents/Conditions Among The Students Before And After Educational Intervention As Per Their Responses

(In aggregate)

Situations/ Conditions

Fully Capable All Right (Average) Not Capable at all

Pre-

test

Post-

test

Differences Pre-

test

Post

-test

Differences Pre-

test

Post-

test

Differen

ces

% % % % % % % % %

Fracture 15.4 62.8 +47.4 58.7 35.6 -37.8 25.9 1.6 -24.3

Burn 23.0 63.4 +40.4 56.1 35.9 -20.2 20.9 0.7 -20.2

Poisoning 18.3 58.3 +40.0 53.6 39.7 -13.9 28.1 2.0 -26.1

Cut injury

/bleeding

25.1 63.2 +38.1 54.6 36.6 -18.0 20.3 0.1 -20.2

Epistaxis 21.2 62.4 +41.2 54.9 36.8 -18.1 23.9 0.9 -23.0

Drowning 21.3 61.9 +40.6 52.9 36.6 -16.3 25.8 1.4 -24.4

Diarrhea/

Vomiting

20.1 63.2 +43.1 55.2 35.9 -19.3 24.6 0.9 -23.7

Fever 16.4 61.8 +45.4 56.7 36.9 -19.8 27.0 1.3 -25.7

F.B. in Eye

/ENT

11.6 60.8 +49.2 59.4 38.2 -21.2 29.0 1.0 -28.0

Chocking 8.4 58.6 +50.2 59.7 40.7 -19.0 31.9 0.7 -31.2

Snake bite 9.4 59.2 +49.8 62.5 40.2 -22.3 28.1 0.6 -27.5

Shock 9.4 59.5 +50.1 60.3 39.9 -20.4 30.3 0.6 -29.7

Table IV:

Differences In The Knowledge Among The Students Regarding First-Aid Management

Conditions

YY YN NY NN

Mc Nemar’s

Chi squire

P. Value

Fracture 245 40 336 69 233.02 0.0001

Burn 216 27 405 48 330.75 0.0001

Poisoning 204 50 355 87 229.69 0.0001

Cut Injury 161 31 410 94 325.72 0.0001

Epistaxis 221 51 345 79 218.27 0.0001

Drowning 475 56 152 13 44.31 0.0001

Diarrhea 526 52 112 6 21.95 0.0001

F.B. Eye 73 187 105 331 23.03 0.0001

F.B. Stomach 74 193 107 322 24.65 0.0001

Snake bite 85 42 396 173 286.11 0.0001

Shock 41 140 120 395 1.54 0.2148

Dog bite 106 106 234 250 48.19 0.0001

CPR 316 65 264 51 120.37 0.0001

P = < 0.001 YY = before correct, after correct. Exposed = correct.

YN = before correct, after wrong. Unexposed = in correct.

NY = before wrong, after correct. Case = before.

NN = before wrong, after wrong. Control = after.

Socio-demographic Profile and Outcomes of the Admitted AIDS

Patients in BPKIHS

Ram Sharan Mehta, Asst. Professor

Medical-Surgical Nursing Department

Email: [email protected]

Babita Singh, Nursing Officer

B. P. Koirala Institute of Health Sciences, Nepal

Abstract: In world More than 40 million people are living with HIV/AIDS, 2.3 million are under 15 yrs ,

14000 new infections each day , 1.7 million human infected with HIV/AIDS, 3.1 million deaths from AIDS

, Million new HIV cases (13425) per day. In south East Asia 6.3 million PLWHA in 2005 (Source: WHO,

UNAIDS).

It was retrospective descriptive study design conducted at B.P. Koirala Institute of Health Sciences

(BPKIHS) among the admitted AIDS cases using their case notes during the period of 1-9-2003 to 30- 8-

2006 using developed Performa. It was found that Majority of the subjects (83.4%) were of age group

20-40 years, Male (89.6%), and from sunsari district (47.9%). Half of the subjects were improved after

treatment and then discharged.

As the number of AIDS cases are increasing rapidly in eastern Nepal and BPKIHS is a centre for treatment

of AIDS cases, it is essential to conduct awareness activates regarding prevention of disease and

advocacy about available facilities of BPKIHS.

Key words: AIDS, Socio-demographic profile, BPKIHS

Introduction:

In Nepal the estimated number of PLWHA at end 2005 is 61,000, HIV prevalence in 2005 was 0.5,

estimated number of AIDS cases are 7,800, number of child (0-18) orphaned by HIV/AIDS is 18000,

receiving Ant Retroviral Treatment (ART) till December 2005 was 210. HIV infection has taken root in

South Asia and poses a threat to development and poverty alleviation efforts in the region. HIV infection

is fueled by risk behavior, extensive commercial sex, low condom use and access, injecting drug use,

population movements (cross-border/rural-urban migration), and trafficking1.

Social and economic vulnerabilities, including poverty and illiteracy, highlight the need to act effectively

and aggressively to reduce it’s spread. South Asia has about 4.2 million of the world’s 36 million people

living with HIV/AIDS. While overall prevalence rates remain relatively low, the region’s large populations

mean that a rise of a mere 0.1percent in the prevalence rate in India, for example, would increase the

national total of adults living with HIV by about half a million persons2.

The current situation of HIV in Nepal is different from when the first case was diagnosed in 1988. There

are gaps and challenges to be addressed in the fight against HIV and AIDS. Nepal is low prevalence

country for HIV and AIDS. However, some of the groups show evidence of a concentrated HIV epidemic

e.g. sex workers (19.5%), migrant population (4-10 %), and intravenous drug users (IVDU's) both in rural

and urban areas (68 %). Since 1988 when the first case was diagnosed MoHP/DoHS and different

stakeholders came forward to address HIV and AIDS issues1.

A significant percentage (60%), of HIV positive patients belongs to lower socio-economic class and many

of them were mobile workers and contracted their illness while working in Indian metropolis in the past

reported by Aich5 in their study.

Study conducted by Agrwal6 reported that there was a significant difference in the domain concerning

social relationship between the HIV positive individuals with the controls.

Study conducted by Parakh7 at BPKIHS among the health professionals showed that health

professionals had a hesitation in treating patients with HIV/AIDS, tempered by concerns regarding

provision of such care.

Study conducted by Asrath10

, among migrant workers in eastern Nepal found that, majority of migrant

workers (94.9%) had heard of HIV/AIDS, but only few know the symptoms of HIDS. Most of them aware

that use of condom prevent spread of HIV/AIDS but 25% of them do not use, while having pre/extra

marital sex. About 11.9 % workers were going to sex workers at a regular intervals and no one using

condoms.

H I V / A I D S i s e m e r g i n g a s a

m a j o r t h r e a t i n t h e s o c i o -

e c o n o m i c a n d h e a l t h s e c t o r s

o f N e p a l . T h e i r m u l t i p l e

e f f e c t s h a v e s o f a r b e e n

m i n i m a l i n t h e c o u n t r y , b u t

t h e i r p o t e n t i a l i m p a c t i s

i m m e n s e .

Objectives: To find out the socio-demographic profile and outcomes of the admitted AIDS patients

in B.P. Koirala Institute of Health Sciences.

M e t h o d s : It was retrospective descriptive study design, conducted at BPKIHS

among the admitted AIDS clients. The available Case-sheets of the diagnosed AIDS cases admitted

between 1st

September 2003 to 30th

August 20006 constituted the population of the study. All the case

notes of diagnosed discharged AIDS cases are samples and total 48 available case notes were included in

the study. Using total enumerative sampling technique all the case notes were collected from the

medical record section using coded numbers (B 24, ICD–10) of files after taking written permission from

the hospital director. The files not available and incomplete were excluded. Using standard semi

structured Performa the data was collected.

A list of diagnosed AIDS cases were prepared using coded index ( ICD-10, Code-B 24) files and than case

notes were collected from record section and information were collected in the prepared format. All the

case notes from September 1, 2003 to August 30, 2006 i.e. Bhadra 15, 2060 to Bhadra 14, 2063 were

studded. Anonymity of the subjects was maintained. The information obtained was kept confidential

and used only for this study. The collected data was entered in SPSS-10.5 software package and

analyzed. The findings are presented in tables and graphs. Using Percentage, Mean and SD the

demographic findings and outcomes were described.

Results: The number of AIDS cases admitted in BPKIHS is increasing day by day i.e. 10,12,& 16 in the

years 2061, 2062, and 2063 respectively as per the record but actual number is much more because the

files are coded on the basis of written diagnosis on the admission discharge sheet, which was usually

accurately filled and only the admitted diagnosis is mentioned. Now, BPKIHS is a centre for treatment of

AIDS cases of Eastern Nepal, where the facilities of HIV testing, ART, PMTCT, VCT, and regular OPD

services are available. Among all the 48 subjects, majority of them (83.3%) were of age group 20-40

years Male (89.6%), Mangolian (50%), from Sunsari district (47.9%) and among those 50% were

improved and discharged from the hospital.

The details of the findings are depicted in Table-I.

Discussion: The report on the pattern of demographic and clinical profiles of HIV positive persons in

Nepal are scarce5. HIV/AIDS is rapidly spreading in countries of Asia including Nepal. It could cause major

socio-economic impact in the country. It obviously has many health implications9. HIV/AIDS is a growing

public health problem with complex social and behavioral issues related to protection, prevention of

transmission and care for nursing and midwifery personnel caring for people living with HIV/AIDS8.

Demographic Profile of the subjects: Majority of the clients were of age group of 20-40 years i.e.

83.4%, which is similar pattern with national as well as international trends. Majority of clients were

male (89.6%) though the disease has equal prevalence. This low reporting may be due to social stigma

and ignorance of diseases among female. Majority of the clients were Mangolian (50%), as the hospital

is situated in Dharan, where IVDUs are endemic, major occupation of these groups of people are lahure,

and majority of people residing in Dharan are Mangolian. Similar demographic data were reported by

Agrwal6.

Most of the clients were from sunsari (47.9%), Morang (18.8%), and Jhapa (14.6%), as BPKIHS is situated

in Dharan which is easily arrival by the population of these three districts and there are three

municipalities are in Sunsari, one is Morang, and two in Jhapa. Most of the clients are admitted under

medicine department (89.6%) as the disease is cared by doctors of medicine departments being adult

patients.

Outcomes of the clients: Half of the clients were improved with the symptoms and discharged, where as

22.9% were unchanged. The disease is not curable but treatable; hence life long treatment is required

along with management of opportunistic infections if occurred. The symptoms persist and client will die

if the disease is not diagnosed in early stage and treatment (ART) started on time.

Conclusions: HIV/AIDS is no longer only a health issue; it is also a development issue. Tackling the

epidemic will require not only prevention and control of HIV infection among vulnerable and risk groups,

but a multi-sectoral approach addressing the lack of access by risk groups to health care and education

and recognition of the populations at risk. People living with HIV and AIDS should be brought to the

forefront in the fight against HIV/AIDS. Family members, local communities, civil society organizations,

donors, and government all have their own important role to play. Increasing trend of the disease

certainly has given pressure to focus on the use of comprehensive targeted intervention programs in risk

groups sub-populations.

AIDS is a treatable disease, which is common among age groups of 20-40 years of their productive life. If

proper treatment and care is provided the life of the clients can be prolonged with comfort. Keeping the

emerging trends in mind it’s mandatory to provide pubic awareness regarding the nature of disease,

prevention of further spread and advocacy about availability of services and their utilization among the

public like: HIV testing, screening OPD, VCT, PMTCT, ART, Management of opportunistic infection, CD-4

count services and other services of HIV/AIDS available at BPKIHS along with elimination of social stigma

so that clients can approach easily at hospital and will be benefited with available facilities.

References:

1. AIDS News letter: Quarterly (2061; Asoj). Women, Girls, HIV & AIDS, 53:13-17.

2. Bhardwaj, A., Biswas, R., & Shetty, K.J. (2001) HIV in Nepal: Is it rarer or the tip of an iceberg? . Trop Doct, 31: 211-213.

3. WHO, SERO (1992). Carrying out HIV Sentinel Surveillance.

4. Vithayachockitikhum, N. (2006) Family caregiving of persons living with HIV/AIDS in Thailand.

Caregiver burden, an outcome measure. International Journal of Nursing Practice; 12(3): 12

5. Aich TK, Dhungana M, Kumar A, Pawha VK. Demographic and clinical Profiles of HIV positive cases: A

Two-year study report from a tertiary teaching Hospital. JNMA, 2004,43(153).

6. Agrwal H, Mourya R, Shrestha RK, Agrwal S, Singh GK. Assessment of quality of life of HIV positive

individuals at Dharan Municipality, 13th annual celebrations scientific programme abstract book,

2006, Dharn, Nepal.

7. Parakh P, Gupta G, Rizal S. HIV/AIDS related knowkedge, attitudes and risk perception amongst

health professionals in BPKIHS. 13th annual celebrations scientific programme abstract book, 2006,

Dharn, Nepal.

8. Impact of HIV/AIDS on Nursing /Mideifery personnel. ICN Positin( www.ich.ch).

9. Acharya RP, Bhattari MD. HIV/AIDS prevention and control. J. Nep. Med. Asso. 1999: 38: 106-108.

10. Asrath U, Sah S, Jha N etal. Awareness and high risk behaviours among migrant workers in relation

to HIV/AIDS- a study from eastern Nepal. SAARC Journals of tubrculosis , lung diseases and

HIV/AIDS. 2006; III(1): 5-12.

11. Joshi AB, Banjara MR, Karki YB, Subedi BK, Sharmam M. Status and trends of HIV/AIDS epidemic in

Nepal. JNMA 2004; 43(152).

Table- I Socio-Demographic Profile and Outcomes of the Admitted AIDS Patients in BPKIHS

N= 48

SN Item/Particular Percentage (%)

1 Age group of the subjects: < 20 years 8.3 20-30 years 48.0 30-40 years 35.4 >40 years 8.3 Mean 29.26 SD 9.4 Range 2-50 Years

2 Gender: Male 89.6 Female 10.4

3 Caste of the subjects: Brahmin/ Chetri 29.2 Mangolian 50.0 Newar 2.1 Teri Origin 18.8

4 District Wise distribution of the subjects: Sunsari 47.9

Morang 18.8 Jhapa 14.6

Sirha 4.2 Others: ( Mahotari, Dhankuta, Dhanusa, Ilam, Taplagunj, Udapur) 10

5 Duration of hospitalization: < 5 days 41.7 5-10 days 29.1 10-15 days 20.9 > 15 days 8.3 Mean 7.98 SD 5.32 Range 1-28 days

6 Department wise distribution of the subjects: Medicine 89.6 Pediatric 6.3 Surgical 4.2

7 Outcome of the clients: Improved & discharged 50.0 Unchanged & discharged 22.9 Expired 14.6 LAMA 8.3 Discharge on Request 2.0 Absconded 2.0

Knowledge Profile About the Care of Spinal Cord Injury Patients

Among Their Caretakers at BPKIHS

Mehta RS*1, Shrestha B*2 , Khanal GP*3, Rijal D*4

B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Abstract: According to the National Spinal Cord Injury Association, as many as

450,000 people in the United States are living with a spinal cord injury (SCI). Other

organizations conservatively estimate this figure to be about 250,000. Every year, an

estimated 11,000 SCIs occur in the United States. Most of these are caused by trauma

to the vertebral column, thereby affecting the spinal cord's ability to send and receive

messages from the brain to the body's systems that control sensory, motor and

autonomic function below the level of injury.

It is chronic disease condition which requires a lot of care during hospitalization as well as in the home. Special training to care the activities of daily living is vital.

Keeping these issues in mind the investigator has planned to assess the training need of the SCI caretakers so that educational package can be planned and implemented in ward for better patient care. It was a hospital based descriptive analytical study conducted among the SCI patients and their caretakers admitted in orthopedic ward. Using purposive sampling technique 30 subjects were selected from 1st July 2006 to 31st December 2006. Using prepared semi-structured questionnaire data was collected. It was found that the most of the subjects were between age 20-60 years, male, married, middle economic group and from villages. Majority of cases admitted in first time (83%) having cervical and thoracic spine injury. The main reasons are fall injury. Most of the subjects have the ability to care manage the problems of bed sore, Paralysis, Nutrition where as very less no of care takers have knowledge about management of UTI, constipation, Pneumonia, and traction. This study concluded that the continuous in-service education programme on care of SCI patient to their caretakers is very essential for quality patient care.

Key Words: Knowledge Profile, Spinal Cord Injury, Caretakers

Note:

*1 Ram Sharan Mehta, Asst. Professor, Medical-Surgical Nursing Department,

*2 Dr. Bikram Shrestha, Associate Professor, Department of Orthopedics,

*2 Dr. Guru Prasad Knanal, Asst. Professor, Department of Orthopedics,

*3 Mrs. Dewa Rijal, Nursing Officer, orthopedic Ward

Corresponding Author: RS Mehta, Email: [email protected]

Introduction: Mobility is the most prized human capability. It denotes independence.

Impaired mobility due to trauma not only leaves the person dependent on others for

the activities of daily living but also hinders body’s normal physiological functions

apart from draining the person psychologically.

The human spine is more frequently exposed to the traumatic influences than one would expect. Traumatic injuries are becoming major public health problems, with ever increasing prevalence, imposing a great burden on society than other disease.1 Spinal Injuries are known to occur since time immemorial. Population growth and rapid industrialization leading to increased vehicular traffic, growing social tension leading to increase violence and modern day stress of daily living have greatly increased the number and rate of spinal injuries and the associated mortality and morbidity.2 Spinal injuries occur when excessive forces are exerted on the spinal column. These forces are the result of acceleration deceleration events which result in hyperflexon, hyperextension, deformation, axial loading and excessive rotation of spine.3,4,5 Injuries remain the leading cause of death each year, under 45 years of age, claiming more than 1,42,000 lives and causing 62 million people to seek medical help in America. Of course, spinal cord injuries are one of the leading causes of young deaths.6 The Incidence of spinal injuries in industrialized countries is approximately 3 per 1 lac population. Approximately 10,000-12,000 cases of SCI occur every year in U.S.A.6,7

The treatment of such injury begins at the outset and ideally these patients should be

transferred to specialized centers geared up to manage spinal trauma. Morbidity

(further injury to the spinal cord, pressure sores, pneumonia and urinary tract

infections) will be reduced and so will the mortality and thus in the long term there

will be money saved which would normally be used to treat complications related to

inadequate initial care. 8

The incidence of SCI is highest among persons age 16-30, in whom 53.1 percent of

injuries occur; more injuries occur in this age group than in all other age groups

combined. Males represent 81.2 percent of all reported SCIs and 89.8 percent of all

sports-related SCIs. Among both genders, auto accidents, falls and gunshots are the

three leading causes of SCI, in that order. Among males, diving accidents ranked

fourth, followed by motorcycle accidents. Among females, medical/surgical

complications ranked fourth, followed by diving accidents. Auto accidents are the

leading cause of SCI in the United States for people age 65 and younger, while falls are

the leading cause of SCI for people 65 and older. Sports and recreation-related SCI

injuries primarily affect people under age 29.

Persons with neurologically complete tetraplegia are at high risk for secondary medical complications. The percentages of complications for individuals with neurologically complete tetraplegia have been reported as follows: 60.3 percent developed pneumonia , 52.8 percent developed pressure ulcers , 16.4 percent developed deep vein thrombosis , 5.2 percent developed a pulmonary embolism and 2.2 percent developed a postoperative wound infection

Young males of age group 15-34 years form the majority of spinal injury patients.

Therefore these injuries place a great burden on society by claiming the young lives

and increasing permanent disabilities among the youth. 8

Most common areas of spinal injury are mid to low cervical and thoracic-lumbar

junction, as they are the areas of maximum mobility. Thoracic, lumbar and sacral

points are other commonly involved areas of spine. Cervical injuries are the most

devastating kind of spinal injuries constituting maximum morbidity and mortality

among these injuries. 3

B.P. Koirala Institute of health sciences is a center of excellence in the eastern region of Nepal for orthopedic services. Under the orthopedic department spinal cord injury patients are admitted and treated. The incidence of admitted SCI patients in orthopedic ward is very high. About 10-15 patients every day out of 34 patents of orthopedic are SCI patients. SCI patients need special attention, treatment and care. As problem is very life threatening and chronic in nature patient admitted in orthopedic wards for more than 4-6 weeks. The prognosis of SCI patients depends upon the services and nursing care provided to them. Usually SCI patients treated with bed rest traction, surgery, and conservative management, which require a lot of knowledge and skill to take proper, care, especially caretakers, as the number of nurses are limited.

Title of the study: Knowledge Profile about the Care of Spinal Cord Injury Patients

among their Caretakers at BPKIHS

Objectives: The Objectives of this study is to find out the socio-demographic profile of

the SCI patients, examine the various facts about SCI patients and explore the

knowledge regarding care of SCI patients among their care takers.

Methodology: It is hospital based descriptive analytical study, conducted among the

SCI patients admitted in Orthopedic unit of BPKIHS and their main caretaker during

the period of 1st July 2006 to31st December 2006 i.e. 6 Months. Using purposive

sampling technique all the diagnosed SCI clients admitted in orthopedic ward during

the study period was included in the study. Using self-prepared pre-tested interview

scheduled the data was collected from the SCI patients and their caretaker, who most

of the time involved in the care after three days of admission in ward by a trained

nurses working in orthopedic unit after obtaining informed verbal consent. The

collected data was entered in SPSS-10 software package and analyzed.

Results:

Socio-demographic Profile of the SCI patients: Majority of the SCI patients (76.7%)

were of age group 20-60 years. The mean age was 41.5 yrs, SD 14.926 and range 16-

68 years. Majority of the subjects were Male (73.3%), Hindu (90%), Villagers (76.7%),

married (83.3%), Non-vegetarian (73.3%), middle class family (60%), and heavy

physical workers.

The details about demographic profiles are depicted in table – I.

Details about injury and admission: Majority of the patients are admitted in first

time (83.3%), most of the injury occur between 6am to 12MD, i.e. 54.4%, most of the

Patients (69.7%) were admitted within 12 hours after injury. Fall Injury (73.3%) is the

main cause of SCI among the admitted clients.

The details about the injury are mentioned in table – II.

Opinion Regarding Knowledge profile about the care of SCI among the

caretakers:

Most of the caretakers reported that they have knowledge about the basic structure so

spinal cord ( 62.1%), functions of spinal cored (57.1%), reasons for paralysis (53.6%),

common complications of SCI (59.31%),and None of the caretakers mentioned proper

method of turning the spinal cord injury patients.

The details are described in table- III.

Opinion Regarding the Ability of caretakers to care/manage the problems of SCI

patients: It was found that the care takers are capable to manage the problems like:

Bed sore (83.3%), care of paralysis parts (79.3%), Nutrition/diet (86.7%), but not at all

able to manage the problems like: urinary tract infection(43.3%), constipation(43.3%),

incontinence bowel (43.3%), pneumonia(40%) and care of traction (40%).

The details are mentioned in table IV.

Discussion: It was found that most of the patients are of age group 20-60 years i.e. of

productive age group and most of the time they are involved in work. Male (73.3%)

subjects have more chance of SCI as they are involved in heavy and risky physical

works. Most of the subjects are villagers (76.7%), illiterate (40%), or literate/primary

education (36.7%) , from middle class (60%) family and heavy physical

workers(56.7%). This picture clearly explains that the spinal cord injury is common

among the heavy physical workers of middle class family may be due to nature of

work.

Most of the subjects are admitted for first time (83.3%). The most of the injury (54.4%),

occurs between 6am-12MD, because this is peak working hours for villagers. Most of

the subjects (67.9%), admitted in hospital within 12 hours as BPKIHS is a only center

of orthopedic patients of SCI in eastern Nepal and high awareness among the public.

About half of the caretakers have basic knowledge abut structure, functions, causes of

paralysis and complications of SCI, which may be due to learning in hospital as the

interview is collected only after 3 day. The mean duration of stay was 23.366 days,

SD14.4114, and range 3 to 48 Days.

Regarding the care of their patients most of the caretakers reported that they are

capable to care of bed sore, paralyzed parts, and Nutrition as relatives are involved in

these care inward by the sisters, where inadequate knowledge on management of

urinary tract infection, constipation, incontinence, pneumonia and traction, as these

complications require advanced knowledge and nurses themselves mostly provide the

care during hospitalization.

Conclusions: Skin Breakdown, pneumonia , Osteoporosis and Fractures, Heterotopic

Ossification, Spasticity, Urinary Tract Infections, Autonomic Dysreflexia, Deep Vein

Thrombosis, Pulmonary Embolism, Orthostatic Hypotension, Cardiovascular Disease,

Syringomyelia, Neuropathic / Spinal Cord Pain, Medication Problems, Hyperthermia

and Hypothermia are the areas of care for SCI patients. Continuous in-service

education programme for nurses involved in the care of SCI patients and all caretakers

of SCI is very essential.

References.

1. Junghanns HS. The human spine in health and disease. New York: Grune and Stratton, 1971. 2. Glass CA, Krishman KR, Bingley JD. Spinal Injury Rehabilitation: Do staff and patients agree on

what they are talking about. Paraplegia.1999; 29(5): 343-9. 3. Black JM, Jacobs EM. Medical surgical Nursing – Clinical Management for continuity of care.

Philadelphia: Saunders, 1997. 4. Errico TJ, Bauer RD, Waugh T. spinal Trauma. Philadelphia. JB Lipppincott comp. 1991. 5. Post MW, Bloemn J, Wittee LP. Burden for Partners of Person’s with spinal cord injuries. Spinal

cord. 2005; 43(5): 311-9. 6. Eyester EF, Kelker DB, Porter Rw, The national had and SCI prevention program Neurosurgry.

New York: Mc. Graw Hill Pub, 1996. 7. Devivo MJ. Causes and costs of spinal cord injury in US. In Gibbbs SR. Bradly WG ed. Yearbook

of Neurology and Neurosurgery. St. Louis: Mosby Inc, 1999. 8. Yashon D. spinal Injury. Norwalk: Appleton Century Crofts, 1986.

Table – I

Socio-demographic Profile of the Spinal Cord Injury Patients

N= 30

SN Item/Particular Percentage 1 Age ( In years)

< 20 10.0 20-40 33.3 40-60 43.4 >60 13.3

Mean 41.5 SD 14.9268

Range 16-68 2 Sex

Male 73.3 Female 26.7

3 Religion Hindu 90 Buddhist 6.7 Kirat 3.3

4 Ethnic Group Brahmin/Chhetri 33.3 Mangolian 40 Newar 3.3 Tetai Origin 20 Others 3.4

5 Occupation Agriculture 46.7 Business 10 Service/Job 10 Others 33.3

6

Education Level Illiterate 40 Literate/Primary 36.7 Secondary 20 Higher secondary and above 3.3

7 District ( Permanent address ): Basantpu 6.7 Bhojpur 6.7 Dhankuta 16.7 Janakpur 3.3 Jhapa 3.3 Kathmand 3.3 Mahendra 3.3 Morang 6.7 Sankhuwa 3.3 Sirha 10.0 Sunsari 20.0 Tanhu 3.3 Terathum 6.7 Udayapur 6.7

Table – I ( Continue)

Socio-demographic Profile of the Spinal Cord Injury Patients

N= 30

SN Item/Particular Percentage 8 Residence

Village(VDC) 76.7 Municipality ( NP) 23.3

9 Marital Status Married 83.3 Unmarried 16.7

10 Dietary Habit Vegetarian 20 Non-Vegetarian 73.3 Egg-Vegetarian 6.7

11 Yearly Saving Deficit Budget/Loan 10 No Saving/balanced 60 < 5000 10 5000-25000 20 > 25000 00

12 Economic Status Poor 40 Medium 60 High 00

13 Life style Heavy physical worker( farmer/labor) 56.7 Office worker 10 Sedentary life style 20 Others 13.3

14 Obesity Present 00 Not Present 100

Table – II

Details about Nature Spinal Cord Injury

N=30

SN Item/Particular Percentage

1 Frequency of Admission 1st time 83.3 2nd time 13.3 > 2 times 3.3

2 Duration of Diseases: till the day of admission 3 days 21.7 3-7 days 47.9 7-14 days 13 > 14 days 17.4

3 Time of Injury 6 AM-12 MD 54.4 12 MD-6 PM 35.6 6 PM-12 MN 6.7 12 MN-6 AM 3.3

Table – II (continue)

Details about Nature Spinal Cord Injury

N=30

SN Item/Particular Percentage 4 Interval between injury and admission

< 6 hrs 39.3 6-12 hrs 28.6 12-24 hrs 7.1 24-48 hrs 2.6 >48 hrs 21.4

5 Level of Injury Cranio-Vertebral Junction 0 Cervical 44 Cervico-thoracic 4 Thoracic 36 Thoraco-Lumber 4 Lumber 12 Lumbo-Sacral 0 Sacral 0

6 Causes of Injury Road Traffic Accident 13.3 Fall Injury 73.3 Gun Shot/Stab Injury 0 Work related Injuries 13.3 Sport Injuries 0

7 Mode of Immobilization applied Skeleton / Skull traction 42.9 Cervical color 9.5 Others: Skin traction, Conservative management etc. 47.6

Table – III

Knowledge Profile about Care of Spinal Cord Injury among the Caretakers

` N=30

SN Item/Particular Percentage 1 Have Knowledge about Structure of Spinal Cord 62.1

2 Have Knowledge about functions of Spinal Cord 57.1 3 Have Knowledge about Occurrence of Paralysis 53.6 4 Have Knowledge about Complications of SCI 59.3 5 Have Knowledge about Turning of the SCI Patients 0

Table – IV

Ability to Care/Manage the Problems of Spinal Cord Injury Patients

N=30

SN Problems Capability/ Ability to manage Problems Fully Some Extent Not at all

1 Bedsore 40 43.3 16.7 2 UTI 13.3 43.3 43.3 3 Paralysis 17.2 62.1 20.7 4 Nutrition 53.3 33.3 13.3 5 Pain 30 46.7 23.3 6 Constipation 26.7 30 43.3 7 Incontinent of bowel 20 36.7 43.3 8 Pneumonia 13.3 46.7 40 9 Care of traction 30 30 40

A PROFILE OF ADMITTED ORGANOPHOSPHORUS POISONING PATIENTS IN B.P. KOIRALA INSTITUTE OF

HEALTH SCIENCES NEPAL

MEHTA RS*1, KARKI P*

2, SINGH B*

3, SHAH I*

4

B. P. KOIRALA INSTITUTE OF HEALTH SCIENCES, NEPAL

ABSTRACT:

ORGANOPHOSPHORUS (OP) AGENTS ARE USED WORLDWIDE IN INCREASING QUANTITIES AS INSECTICIDES. SINCE

AGRICULTURE IS THE MAIN OCCUPATION IN NEPAL, OP COMPOUND ARE WIDELY AND EASILY AVAILABLE IN ORDINARY

SHOPS AND ARE OFTEN STORED IMPROPERLY.

THE OBJECTIVES OF THIS STUDY WERE TO FIND OUT THE SOCIO-DEMOGRAPHIC PROFILE OF THE ADMITTED OPP CLIENTS,

ASSESS THE DETAILS ABOUT THE INGESTION OF ORGANOPHOSPHORUS POISONING (OPP) AND EXPLORE THE REASONS

FOR INGESTION OF OPP.

IT WAS DESCRIPTIVE STUDY CONDUCTED AMONG ADMITTED OPP CLIENTS IN MEDICAL UNITS, USING CONVENIENT

SAMPLING TECHNIQUE. THIRTY EIGHT SUBJECTS WERE SELECTED DURING THE STUDY PERIOD OF 14TH APRIL 2006 TO 13TH

APRIL 2007 I.E. COMPLETE ONE YEAR AND INTERVIEW WAS TAKEN FROM THEM. THE COLLECTED DATA WAS ANALYZED IN

SPSS-10 SOFTWARE PACKAGE.

IT WAS FOUND THAT MOST OF THE SUBJECTS (94%) WERE AGE LESS THAN 40 YEARS, FEMALE (57.9%), HINDU (78.9%),

MARRIED (57.9%), NON-VEGETARIAN (94.7%) AND BELONGS TO MIDDLE CLASS FAMILY (73.3%). THE MAJOR BRAND

NAMES OF POISON USED ARE METACID (36%), PHORATE (24%), AND THAIMIDE (7%). ABOUT HALF OF THE CLIENTS

(55.3%) WERE PROVIDED FIRST-AID ON SPOT, MOST OF THE CLIENTS (73%) BROUGHT TO EMERGENCY WITHIN 2 HOURS

OF INGESTION OF POISON AND ABUT HALF OF THE CLIENTS (44.7%) WERE BROUGHT IN UNCONSCIOUS STATE. THE MAIN

REASONS OF INGESTION OF POISON ARE FAMILY PROBLEMS (55.3%), PERSONAL PROBLEMS (42.1%), FOLLOWED BY

ACCIDENTAL (2.6%).

BASED UPON THE FINDINGS WE CAN CONCLUDE THAT IT IS COMMON BELOW AGE GROUP OF 40 YEARS, FEMALE, FARMERS

AND MIDDLE CLASS CLIENTS. MOST OF THE CLIENTS NOT RECEIVED FIRST-AID ON SPOT AND BROUGHT TO EMERGENCY IN

UNCONSCIOUS STATE. THE PUBLIC AWARENESS ON PREVENTION OF INGESTION AND FIRST-AID MANAGEMENT OF OPP IS

VITAL TO REDUCE THE MORBIDITY.

KEY WORDS: PROFILE, ORGANOPHOSPHORUS, POISONING

NOTE: *1 RAM SHARAN MEHTA, ASSISTANT PROFESSOR, MEDICAL-SURGICAL NURSING DEPARTMENT, COLLEGE OF

NURSING. EMAIL: [email protected] *2 PROF. PRAHLAD KARKI, HOD, DEPT. OF MEDICINE.

*3 MS BABITA SINGH, WARD IN-CHARGER, MEDICAL UNIT-I. *

4 MR. ISRIAL SHAH, WARD IN-CHARGE, MEDICAL

UNIT-II.

INTRODUCTION:

ORGANOPHOSPHORUS COMPOUNDS ARE CHEMICAL AGENTS IN WIDESPREAD USE THROUGHOUT THE WORLD, MAINLY IN

AGRICULTURE. THEY ARE ALSO USED AS NERVE AGENTS IN CHEMICAL WARFARE (E.G. SARIN GAS), AND AS THERAPEUTIC

AGENTS, SUCH AS ECOTHIOPATE USED IN THE TREATMENT OF GLAUCOMA. THEY COMPRISE THE ESTER, AMIDE OR THIOL

DERIVATIVES OF PHOSPHORIC ACID AND ARE MOST COMMONLY USED AS PESTICIDES IN COMMERCIAL AGRICULTURE, FIELD

SPRAYS AND AS HOUSEHOLD CHEMICALS. ORGANOPHOSPHATES ARE OF SIGNIFICANT IMPORTANCE DUE TO THEIR

PRACTICAL USEFULNESS AND CHEMICAL INSTABILITY. THIS INSTABILITY MEANS A LACK OF PERSISTENCE IN THEIR

SURROUNDINGS1.

THERE ARE NO RULES AND REGULATIONS GOVERNING THE PURCHASE OF THESE PRODUCTS, AND THEY ARE THEREFORE

READILY AVAILABLE "OVER THE COUNTER", DESPITE THEM BEING A MAJOR CAUSE OF MORBIDITY AND MORTALITY.

EXPOSURE TO ORGANOPHOSPHATES IN AN ATTEMPT TO COMMIT SUICIDE IS A KEY PROBLEM, PARTICULARLY IN THE

DEVELOPING COUNTRIES, AND IS A MORE COMMON CAUSE OF POISONING THAN THE CHRONIC EXPOSURE EXPERIENCED BY

FARMERS OR SPRAYERS IN CONTACT WITH PESTICIDES. INTOXICATION OCCURS FOLLOWING ABSORPTION THROUGH THE

SKIN, INGESTION VIA THE GI TRACT OR INHALATION THROUGH THE RESPIRATORY TRACT. EARLY DIAGNOSIS AND PROMPT

TREATMENT IS REQUIRED TO SAVE THE PATIENT'S LIFE1.

ORGANOPHOSPHORUS INSECTICIDE SELF-POISONING IS A MAJOR GLOBAL HEALTH PROBLEM, WITH HUNDREDS OF

THOUSANDS OF DEATHS EACH YEAR. ALTHOUGH MOST SUCH DEATHS ARE IN THE DEVELOPING WORLD. THIS POISONING IS

ALSO AN IMPORTANT CAUSE OF FATAL SELF-POISONING IN DEVELOPED COUNTRIES.2

ACCORDING TO THE WHO, ONE MILLION SERIOUS ACCIDENTAL AND TWO MILLION SUICIDAL POISONINGS DUE TO

INSECTICIDES OCCUR WORLDWIDE EVERY YEAR, OF WHICH 200,000 PATIENTS DIE WITH MOST DEATHS OCCURRING IN

DEVELOPING COUNTRIES. IN INDIA, ORGANOCOMPOUNDS (OPCS)-ORGANOPHOSPHATES AND ORGANOCARBAMATES,

ARE THE COMMONEST PESTICIDES USED AND DUE TO THEIR EASY AVAILABILITY, THERE IS WIDESPREAD ABUSE OF THESE

COMPOUNDS WITH SUICIDAL INTENT.3

THE EMERGENCY DEPARTMENT (ED) PHYSICIAN MAY ENCOUNTER ORGANOPHOSPHOROUS COMPOUND (OPC) AND

CARBAMATE POISONING IN A VARIETY OF CLINICAL SCENARIOS. PESTICIDE POISONING IS THE MOST COMMON CAUSE OF

OPC AND CARBAMATE POISONING BECAUSE THE VAST MAJORITY OF PESTICIDES STILL CONTAIN OPCS AND CARBAMATES.

OPC NERVE AGENTS MAY BE USED IN THE MILITARY SETTING OR IN TERRORIST ATTACKS. AN EXAMPLE WAS SARIN USED IN

THE TOKYO SUBWAY ATTACKS OF 1995. 3

IN THE UNITED STATES, MORE THAN 18,000 PRODUCTS ARE LICENSED FOR USE, AND EACH YEAR MORE THAN 2 BILLION

POUNDS OF PESTICIDES ARE APPLIED TO CROPS, HOMES, SCHOOLS, PARKS, AND FORESTS. OCCUPATIONAL EXPOSURE IS

KNOWN TO RESULT IN AN ANNUAL INCIDENCE OF 18 CASES OF PESTICIDE-RELATED ILLNESS REPORTED FOR EVERY 100,000

WORKERS IN THE UNITED STATES. IN 2003, APPROXIMATELY 7500 CASES OF OPC AND 3700 CASES OF CARBAMATE

EXPOSURE WERE REPORTED TO POISON CONTROL CENTERS IN THE UNITED STATES. SIXTEEN OPC-RELATED DEATHS AND

2 CARBAMATE-RELATED DEATHS WERE REPORTED THAT YEAR. 3

BECAUSE OF THE INCREASED USE AND AVAILABILITY OF PESTICIDES (ESPECIALLY IN DEVELOPING COUNTRIES), THE

INCIDENCE OF OPC AND CARBAMATE POISONING IS HIGH. IN CHINA ALONE, PESTICIDE POISONING, MAINLY WITH OPCS,

CAUSE AN ESTIMATED 170,000 DEATHS PER YEAR. VIRTUALLY ALL OF THESE ARE THE RESULT OF DELIBERATE SELF-

POISONING BY INGESTION. 3

OVER 70,000 CHEMICALS AND PHARMACEUTICAL AGENTS ARE IN COMMON USE WORLD

WIDE 6

.

POISONING IS A COMMON PROBLEM IN NEPAL. AS PER B.P. KOIRALA INSTITUTE OF HEALTH SCIENCES MEDICAL RECORD

SECTION INPATIENT RECORD, IN YEAR 2063 (2006/07) A TOTAL 350 CASES OF OPP WERE ADMITTED, WITH MEAN AGE

OF 27.73 YEARS (RANGE 1-8 YEARS & SD 15.7433), MEAN HOSPITAL DAYS OF 5.6295 (RANGE 1-5, SD 5.6878),

MALE 50.6% AND FROM SUNSARI (27.7%), JHAPA(22.6%), MORANG (21.2%) AND FROM OTHER DISTRICTS 28.6%.

OUT OF 350 ADMISSIONS 69.7% WERE IMPROVED, 8.9% RECOVERED OR CURED, 10% EXPIRED, 2.9% ABSCONDED,

4.6% LAMA, 0.3% UNCHANGED AND 3.7% HAD OTHER OUTCOMES. THE CLIENTS DISCHARGED FROM MEDICINE

DEPARTMENT 85.7%, PEDIATRIC 13.6% AND 0.7% FORM OTHER DEPARTMENTS.

OBJECTIVE OF THE STUDY:

THE OBJECTIVES OF THE STUDY WERE: TO FIND OUT THE SOCIO-DEMOGRAPHIC PROFILE OF THE ADMITTED OPP CLIENTS

IN BPKIHS, TO ASSESS THE DETAILS ABOUT THE INGESTION OF OPP AND TO EXPLORE THE REASONS FOR INGESTION OF

OPP.

RESEARCH METHODOLOGY:

IT WAS HOSPITAL BASED DESCRIPTIVE EXPLORATORY RESEARCH STUDY CONDUCTED AMONG THE ADMITTED CLINICALLY

DIAGNOSED OPP CLIENTS IN THE MEDICAL UNITS OF BPKIHS DURING THE PERIOD OF 2064-1-1 TO 2064-12-30 I.E.,

FROM 14TH

APRIL 2006 TO 13TH

APRIL 2007 OF COMPLETE ONE YEAR. CONVENIENT SAMPLING TECHNIQUE WAS USED TO

COLLECT THE DATA FROM THE CLIENTS AND THEIR CARETAKER RELATIVES USING PRE-TESTED INTERVIEW SCHEDULE. TOTAL

38 CLIENTS WERE INCLUDED IN THE STUDY. THE PRINCIPLE INVESTIGATOR AND CO-INVESTIGATORS ARE THEMSELF

INVOLVED IN DATA COLLECTION. INFORMED VERBAL CONSENT WAS OBTAINED FROM EACH SUBJECTS BEFORE COLLECTION

OF THE DATA AND THE SUBJECTS WERE ASSURED ABOUT HE CONFIDENTIALITY OF THE INFORMATION THEY WERE GIVEN.

THE COLLECTED DATA WAS ENTERED IN SPSS-10 SOFTWARE PACKAGE AND ANALYZED. THE DESCRIPTIVE AS WELL AS

INTERFERENTIAL STATISTICS WERE USED TO DESCRIBE THE RESULTS.

RESULTS:

SOCIO-DEMOGRAPHIC PROFILE OF THE SUBJECTS:

ABOUT HALF OF THE SUBJECTS (52.6%) WERE OF AGE GROUP OF 20-40 YEARS, FEMALE (57.9%), HINDU (78.9%),

MANGOLIAN (34.2%), AND FARMERS (47.4%). ABOUT 42% SUBJECTS ARE ILLITERATE/LITERATE ONLY. THE CLIENTS

WERE FROM MORANG (21.1%), THAPA (15.8%), SAPTARI (13.2%), AND SUNSARI DISTRICT (15.8%). MAJORITY OF

THE SUBJECTS (65.8%) WERE FROM VILLAGES, MARRIED (57.9%), AND BELONGS TO MIDDLE CLASS (73.7%) FAMILY.

THE DETAILS ARE DEPICTED IN TABLE – I.

DISEASE PROCESS:

IT WAS FOUND THAT ALL THE SUBJECTS INGESTED POISON BETWEEN 6 AM TO 12 MN AND COMMONLY USED BRANDS OF

OPP ARE METACID (36%), PHORATE (24%), AND THAMIDE (7%). ABOUT 55% CLIENTS ONLY RECEIVED FIRST-AID,

MOST OF THE CLIENTS BROUGHT TO EMERGENCY WITHIN 2 HOURS AND IN UNCONSCIOUS STATE (44.7%). THE DETAILS

ARE DEPICTED IN TABLE-II.

REASONS FOR INGESTION:

THE MAJOR REASONS FOR INGESTION OF POISON ARE FAMILY PROBLEMS ( 55.3%), PERSONAL PROBLEMS ( 42.1%) AND

INGESTED ACCIDENTALLY (2.6%).

DISCUSSION:

ORGANOPHOSPHORUS (OP) AGENTS ARE USED WORLDWIDE IN INCREASING QUANTITIES AS INSECTICIDES7. SINCE

AGRICULTURE IS THE MAIN OCCUPATION IN NEPAL, OP COMPOUND ARE WIDELY AND EASILY AVAILABLE IN ORDINARY

SHOPS AND ARE OFTEN STORED IMPROPERLY8.

IT WAS FOUND THAT INGESTION OF POISON WAS COMMON BEFORE 40 YEARS (92%) OF AGE.

FEMALE (57.2%) CLIENTS ARE FOUND MORE IN NUMBER AS IN OUR SOCIETY FEMALE HAS MORE PROBLEMS IN

COMPRESSION TO MALE AND 18.4% OF THE SUBJECTS ARE HOUSEWIFE. MANGOLIAN (34.2%) ARE MORE PRONE AS

HOSPITAL IS LOCATED IN DHARAN AND HAVE THE POPULATION COMPOSITION ACCORDINGLY. AMONG THE TERAI ORIGIN

(34.2%) THE PERCENTAGE RATIO IS HIGH WHICH NEEDS FURTHER INVESTIGATIONS.

VILLAGERS (65.8%), FARMERS (47.4%), STUDENTS (23.7%), MARRIED (57.9%) AND ILLITERATE/LITERATE (71%) ARE

MORE SUFFERS AS THESE PEOPLE HAVE MORE PHYSICAL, PSYCHOLOGICAL AS WELL AS ECONOMICAL BURDEN.

IT WAS FOUND THAT MOST OF THE SUBJECTS (73.7%) WERE OF MIDDLE CLASS FAMILY AND FACES ECONOMICAL AS WELL

AS PSYCHOSOCIAL PROBLEMS.

THE COMMON BRAND OF OPP USED WAS METACID (36%) AND PHORATE (24%), WHICH WAS EASILY AVAILABLE AT

LOCAL MARKET, AND KEPT IN HOUSE FOR AGRICULTURAL USE, HENCE IT IS EASILY AVAILABLE.

ONLY HALF OF THE SUBJECTS (55.3%) HAD RECEIVED FIRST-AID AS MOST OF THE PEOPLE DO NOT AWARE ABOUT IT.

ABOUT 45% SUBJECTS BROUGHT TO EMERGENCY IN UNCONSCIOUS STATE AS OPP IS VERY TOXIC AND EFFECTS VERY FAST.

RECOMMENDATIONS:

• SIMILAR STUDY CAN BE CONDUCTED TAKING LARGE SAMPLE AND IN DIFFERENT INSTITUTIONS OF NEPAL TO

COMPARE THE RESULTS AND GENERALIZE THE FINDINGS.

• NEPAL BEING A DEVELOPING COUNTRY WITH MAJOR PSYCHO-SOCIAL DRIFT, MAY NEED TO BRING AWARENESS

IN PUBLIC REGARDING PROFESSIONAL PSYCHOLOGICAL SUPPORT FOR ANY PSYCHOLOGICAL DISTURBANCES

• ENCOURAGE THE COUNSELING CENTERS AND PSYCHOLOGICAL SUPPORT CENTERS ALL OVER THE COUNTRY

CONCLUSIONS:

BASED UPON THE STUDY WE CAN CONCLUDE THAT FIRST-AID MANAGEMENT TRAINING FOR OPP IS ESSENTIAL AT

COMMUNITY LEVEL ALONG WITH THE PUBLIC AWARENESS ACTIVITIES FOR PREVENTION OF OPP BY SENSITIZING THE

MEDIA..

REFERENCES:

11. JOSHI S, BISWAS B, MALLA G. MANAGEMENT OF ORGANOPHOSPHORUS POISOINING. UPDATE IN ANESTHESIA.

2005,19(13): 13-14.

12. EDDLESTON M , EYER, P , WOREK, F, MOHAMED F, SENARATHNA L ET ALL. DIFFERENCES BETWEEN

ORGANOPHOSPHORUS INSECTICIDES IN HUMAN SELF-POISONING: A PROSPECTIVE COHORT STUDY. THE LANCET.

22-OCT-05

13. POOJARA L, VASUDEVAN D, ARUN KUMAR AS, KAMAT V. ORGANOPHOSPHATE POISONING: DIAGNOSIS OF

INTERMEDIATE SYNDROME. INDIAN J CRIT CARE MED 2003;7:94-102

14. SINGH B, UNNIKRISHNAN B. A PROFILE OF ACUTE POISONING AT MANGALORE (SOUTH INDIA). J CLIN FORENSIC

MED. 2006;13(3):112-6.

15. TENDOLKAR BA, KAMATH SK. ANAESTHETIC MANAGEMENT OF A PATIENT WITH ORGANOPHOSPHORUS

POISONING (A CASE REPORT). J POSTGRAD MED 1991;37:181-2

16. KISHORE PV, PAUDEL R, MISHRA D, OJHA P, MISHRA P. PATIENT PROFILE AND MANAGEMENT PATTERN OF

POISONING CASES ADMITTED TO TERTERY CARE TEACHING HOSPITAL IN WESTERN NEPAL. MANIPAL COLLEGE OF

MEDICAL SCIENCES. POKHRA, NEPAL.

17. KRALLIEDDE L, SENANAYAKE N. ORGANOPHOSPHORUS INSECTICIDE POISOINING. BR. J. ANAES. 1989; 63:

736-50.

18. KARKI P, HANSDAK SG, BHANDARI S, SUKLA A, KOIRALA S. A CLINICO-EPIDEMIOLOGICAL STUDY OF

ORGANOPHOSPHORUS POISONING AT A RURAL BASED TEACHING HOSPITAL IN EASTERN NEPAL. TROPICAL

DOCTOR. 2001; 31: 32-33.

19. KARALLIEDDE L, SENANAYAKE N. ACUTE ORGANOPHOSPHOURS INSECTIDE POISONING : A REVIEW. CEYLON

MED J. 1986; 31: 93-100.

20. KARKI P, ANSARI JA, BHANDARI S, KOIRALA S. CARDIAC AND ELECTROCARDIOGRAPHICAL MANIFESTATIONS OF

ACUTE ORGANOPHOSPHOURS POISOINING. SINGAPOOR MED J. 2004; 45(8): 385.

TABLE: - I

SOCIO-DEMOGRAPHIC PROFILE OF THE SUBJECTS

N=38

SN ITEMS/PARTICULARS PERCENTAGE (%) 1 AGE GROUP ( IN YEARS)

< 20 YRS 39.5 20-40 YRS 52.6 > 40 YRS 7.9

MEAN 21.63 SD 12.0974

RANGE 2-45 2 GENDER

MALE 42.1 FEMALE 57.9

3 RELIGION: HINDU 78.9 KIRAT 15.8 BUDDHIST 2.6 MUSLIM 2.6

4 ETHNIC GROUP BRAHMIN/CHHETRI 21.1 RAI/LIMBU/GURUNG/MAGAR 34.2 NEWAR 7.9 TERAI ORIGIN 34.2 KRISTIAN 2.6 5 OCCUPATION

HOUSEWIFE 18.4 AGRICULTURE 47.4 BUSINESS 2.6 STUDENT 23.7 SERVICE 7.9

6 EDUCATION LEVEL ILLITRATE / IITRATE 42.2 PRIMARY 28.9 SECONDRY 26.3 HIGHER 2.6

7 DISTRICT MORANG 21.1 JHAPA 15.8 SAPTARI 13.2 SUNSARI 10.5 SIRHA 10.5 UDAPUR 7.9 ILAM 7.9 OTHERS 13.1

8 RESIDENCE VILLAGE /VDC 65.8 TOWN/NP 34.2

9 MARITAL STATUS MARRIED 57.9 UNMARRIED 42.1

10 ECONOMIC STATUS OF THE FAMILY POOR 26.3 MEDIUM 73.7 HIGH 00

11 FAMILY HISTORY OF INGESTION OF OPP PRESENT 2.6 NOT PRESENT 97.4

12 PREVIOUS HISTORY OF INGESTION OF OPP PRESENT 10.5 NOT PRESENT 89.5

TABLE: - II

DETAILS ABOUT THE INGESTION OF OPP

N=38

SN ITEMS/PARTICULARS PERCENTAGE (%) 1 TIME OF INGESTION

6 AM – 12 MD 36 12 MD – 6 PM 24 6 PM – 12 MN 7 12 MN – 6 AM 33

2 BRAND NAME OF OPP INGESTED METACID 36 PHORATE 24 THAIMIDE 7 OTHERS 33

3 AMOUNT OF INGESTION OF OPP < 10 24.2 10-30 27.3 30-50 21.0 50-100 18.2 > 100 9.3

MEAN 50.1515 SD 56.9896

RANGE 3-200 4 FIRST-AID PROVIDED ON SPOT

PROVIDED 55.3 NOT PROVIDED 44.7 IF PROVIDED: ( N= 55.3% ) INDUCE VOMITING 71.7 NPO 11.1

5 TIME TAKEN TO BRING EMERGENCY OF BPKIHS < 1 HR 37.8 1-2 HRS 35.2 2-4 HRS 5.4 4-6 HRS 10.8 6-8 HRS 5.4 >8 HRS 5.4

6 STATE OF PATIENT ON ARRIVAL AT BPKIHS EMERGENCY ALERT 44.7

VERBAL RESPONSE 7.9 PAIN RESPONSE 2.6 UNRESPONSIVE/UNCONSCIOUS 44.7

7 DRUGS USED DURING THE TREATMENT OF OPP: ATROPINE 100 CHARCOAL 13.2 PAM 71.1

SATISFACTION OF CLIENTS IN RELATION TO THEIR HOSPITAL EXPENDITURE

Mehta RS*1, Karki P*

2, Baral DD*

3

B.P. Koirala Institute of Health Sciences

Dharan, Sunsari, Nepal

ABSTRACT:

Introduction: Hospital costs can be a valuable guide to hospital management, if used

intelligently. Costing data, like other statistical data, can be collected only by expenditure of

money and this should be undertaken only if the data are going to be used as a tool of

management.

Objectives: The objectives of this study were to find out the socio-economic status of the

admitted patients, explore their expenditure related to treatment and find out their satisfaction

level.

Methodology: This was hospital based exploratory study, Conducted among the admitted patients in

wards of BPKIHS. Stratified simple random sampling method was adopted to collect data and 250

samples were included. Interview schedules were used after testing validity and reliability. The data

were analyzed using descriptive as well as inferential statistics.

Results: The Mean indoor hospital expenditure of the client is 10,895 Rs., whereas 65 % subjects

expended Rs. in between 1000-10,000 and 30.8% expended more than Rs. 10,000. About 7 % subjects

were satisfied more than their expenditure where as55.2% were fully satisfied and 32.8 % were just

satisfied and only 4.8 % were not satisfied.

Discussion and Conclusions: This study gives the real insight about hospital expenditure and client

satisfaction, so that aid in future management.

Investigators:

* 1 Corresponding Author: Ram Sharan Mehta, Asst. Professor, Medical-Surgical Nursing Department, College of Nursing, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal. Phone: 00977-25-525555, Fax: 00977-25-520251, Email: [email protected]

*2

Prof. (Dr.) Pralahad Karki, HOD Dept. of Medicine and Hospital Director

* 3 Mr. Dharnidhar Baral , Asst.Professor, Medical Record section & Statician

Introduction: Improved socio- economic status and easier access to medical care has led to high expectations and

demands from the consumer of hospital services. Medical services at public and private hospitals have

been under increasing strain to meet the expectations particularly because the medical care has come

to the ambit of “service” under the “Consumer Protection Act. “This has necessitated regular monitoring

of the quality of services in the hospital by the management. Assessment of care adequacy must go

beyond the usual measures of structure process and outcome variables to include consumer evaluation

of quality as well, indeed, any evaluation of care outcomes may be incomplete without including

outcomes as perceived by the patients. It has been suggested that patient satisfaction is a potentially

important factor in health care as it may influence whether or not a patient seeks medical care complies

with treatment and maintains a continuing relationship with the providers. In order to meet patient’s

expectations and to assess their satisfaction during their stay in hospital, patient feed back form has

been developed, which is used as one of the Total Quality Management indicators and helps the

management to improve the services to them.7

For a health care organization to be successful, monitoring customer’s perceptions is a simple but

important strategy to assess and improve their performance. Andaleeb proposed and tested a five-

factor model that included communication with patients, competence of the staff, their demeanor,

quality of the facilities and perceived costs. There are very few studies in India that measure patient

satisfaction with the services provided by health care organizations.8

With the healthcare market turning from a sellers market into a buyers market, healthcare providers are

turning more and more towards marketing of their services. This requires a marketing information

system, which provides information that is accurate, timely and need-based. Market research can

provide such information to hospital administrators. For this, a relevant tool for hospital administrators

today is a patient expectation survey, which reveals what patients actually desire from hospitals. Patient

satisfaction has been found to be a desired outcome in hospitals. When results of such patient

expectation surveys are applied to planning of healthcare services, it increases chances of achieving

patient satisfaction.

This study finds the economic status of the patients and also investigate the amount of money spend

for treatment during hospitalization. This study also explores the amount of money spend by the patient

in various items like: investigation, treatment, transportation, food and others.

This study provides the baseline data regarding economic status of patient and their affordability. The study also tries to investigate the source of payments of the patients. The study also explores the satisfaction in relation to their hospital expenditure. It provides baseline information about

economic status of patient and their affordability. The study also give some direction for hospital administration for planning, investigating & suggesting alternative sources of payments; and aid in raising the satisfaction of clients in relation to their expenditure.

Objectives: The objectives of this study were to find out the socio-economic status of the hospitalized

patients, to identify the expenditure of hospitalized patients, and to explore the satisfaction in relation

to expenditure.

Materials and Methods: This is Hospital based exploratory study, conducted among the admitted

patient's in the wards of BPKIHS among the discharged patients from the selected wards during the

study period of 3 month were constituted the target population of the study.

The sample comprises of all the discharged patients who fulfill the set criteria, 250 admitted patients

were included in the study using Stratified simple random sampling method. Patient discharged from

specified wards was included. Interview guide was used to collect the data. The tool was given to the

Nursing service administrator, Hospital Director, Hospital administrator for validity. Pre-testing was

done to assess the reliability of the tool.

After discharge sheet is ready and bill was cleared from bill counter, during specified date, days & time

the data was collected by the trained interviewer. The consent was obtained from the subject before

interview. The information obtained will be kept confidential & used only for this study.

Results and Discussions: The findings of the study shows that the mean duration of hospitalization of

the clients was 6.94 days and 77.6% clients were admitted for first time for their treatment. The mean

age of clients were 25.61 years, male 44.4%, Hindu 93.6% and most of them were from Sunsari (36.8%),

Morang (18.4%), and Jhapa (12%), Majority of clients (66.4%) were from villages and mean family size

was 6.04 person. Majority of the clients (78.8%) admitted in BPKIHS thinking that all facilities are

available. The mean expenditure of hospitalized clients is 10895 (range: 0-2,00,000). Most of the

subjects were satisfied with the services of doctor (95.6%), and Nurses (98.4%). Most of the subjects

(95.2%) were satisfied with the services in comparison to their expenditure.

Total 250 subjects were included in the study. The mean hospital stay day was 6.94. Majority of the subjects i.e. 77.6% were admitted for the first time. Majority of the clients (75%) were of age less than go yrs, and Hindu (93.6%). Most of the subjects were from Sunsari (36.8%), Morang (18.4) and Jhapa (12.0%). About 66% clients were from villages, and their main source of family income was agriculture (50%). About 70% subjects used fire word to look food in their home and 61% had radio & TV. The hospital expenditure was 10895 Rs (Range: 0-2,00,000). More

than half of the clients were fully satisfied with the service they receive in comparison to their expenditure, where as only 4.8% not satisfied. Majority of the subjects (88%) had paid from their own (self-payment), where as 8% free process, 2.4 insurance, 5.6% relatives & 2.8% NGO & INGO.

Discussions: This study gives the idea to hospital administration for planning and investigating

alternative sources of payments and aid in raising the satisfaction of clients in relation to their hospital

expenditure.

Satisfaction level of the clients with various Services / Facilities: Majority of the subjects were fully

satisfied with the services of Doctors (79.6%), Nurses (85.2%), Facilities of the unit (73.6%), dietetics

services (72%), Toilet (78.8%) and Cleanliness (69.6%); Where as 4.4% subjects were not satisfied at all

with the services of doctor, 1.6% with nurses service, 4% with facilities and 9.6% with Bill counter

services. High satisfaction rate were found in maternity, Gynae, NICU / PICU / JMICU, ENT, Eye, and

orthopedics, in comparison to medical and Surgical.

As the cure or recovery is better in Gynae, Maternity, ENT and Eye wards and the expenditure is less hence the satisfaction may high.

Hospital expenditure: The mean indoor hospital expenditure of the client is 10,895 Rs where as 65%

subjects expend Rupees in between 10,00-10,000 and 30.8% expended more than Rs 10,000. Major

source of expenditure during hospitalization is Drug, Investigation, caretaker expenditure, food for

patient and caretaker, Transport, OT charge and Bed charges.

As the hospital is referral, only critical or chronic patients are more admitted and investigation and drugs

are expensive the expenditure is not very high.

As the total expenditure out side BPKIHS regarding this illness is 8989 Rs. This signifies, Patient admitted only after long trial outside BPKIHS.

A study conducted by Sharma 16 reported that Per patient average cost was Nc Rs. 96496, which is

similar to our study.

Satisfaction levels according to their expenditure: About 88% clients were satisfied as per their

expenditure, but 7.2% reported that they were benefited more than expected; where as only 4.8%

subjects reported that they were not satisfied as per their expenditure.

Implications of the study:

The Nursing practice is based on mixture of research, anecdote, tradition, theory and hunch. A demand

for safe and effective health care requires nurses to develop the necessary skills in order to incorporate

findings of the research into practiced. To accomplish this, nurses require the skills to assess,

appropriate and pertinent findings of the research to apply into their practice. As Nurses are directly

involve in client care and involve in recommending free for patients, this study provide them insight

about the reality. This study also familiarizes them about the financial aspects and aid in cost reduction

of hosp9ital. In the instant study following have emerged:

• It would aid in resourced planning of hospital and cost reduction.

• This study gives the real insight about hospital expenditure and client satisfaction, so that aid in

future Management.

• This study also explores the public image regarding hospital expenditure.

• It would generate scientific literature for the nurses as well as student nurses for future

references and ultimately benefit the nursing profession.

Limitations:

The information collected regarding the expenditure was based upon the opinion of clients and their

caretakers. Only indoor clients were included. The data collection period was only 3 months i.e. sept.

2004 to NOV. 2004.

References:

1. Smith AB paying for health services. A study of the costs and sources of finance in six

countries. Geneva, WHO; 1967 (Public health paper no. 17)

2. Davies RL, Macaulary HMC. Hospital planning and administration. Jaypee brother, New

Delhi, 1995.

3. The world health reports 2000. WHO; Switzerland; 2000.

4. The world health reports 2002. WHO; Switzerland; 2002

5. Report: National Seminar on Health and poverty reduction in Nepal; Katmandu, Nepal, 14-

15 Feb. 2002. HMG Nepal, WHO/SEARO.

6. Amin TS, Qadri GJ. Cost Evaluation of construction at 500 Bedded Tertiary care teaching

hospital. Journal of Academy of Hospital Administration 1999; 11(2): 13-19.

7. Kumar R. Medical documentation- patient satisfaction document. JAHA: 15 (1): 54-56.

8. Bhattacharya A, Menon P, Koushal V, Rao KLN. Study of patient satisfaction in a tertiary

Referral hospital. JAHA. 15 (1); 29-32.

9. Bhaskaran VP, Satyashanker P, memon R. Cost of Medicare scheme in manipal. JAHA,

2000,12(2); 49-57.

10. Jain RK. Joint commission on accreditation of health cares organizations. JAHA 2000, 12(2):

59-61.

11. Silva FD. Perception of stressors of Hospitalized patients. 2000,91(7): 149.

12. Nurses: working with the poor, against poverty. IND Kit. 2004.

13. Wong FKY, Hom, chiu I etal. Factors contributing to hospital readmission in a Hong Kong

regional hospital. Nursing research. 2002,51(1): 40-48..

14. Khanal P. No head way in basic health services. Kathmandupost. 2004. July 9.

15. Lotka F. The importance of worker, staff and patient participation in hospital evolution.

Work hospitals and health services. 35(3): 20-23.

16. Sharma S, copra S. Hospitalized patients need for information. NJI 1997,98(11): 247-248.

17. Bhaskaran VP, Satyashankar P, Patankar RP. Study of the utilization Pattern of hospital

based health Insurance plan targeted towards lower socio-economic group. JAHA. 16(1): 5-

9.

18. Bedi S, Arya S, Sharma RK. Patent expectation survey – A relevant marketing tool for

hospitals. JAHA.16 (1): 15-24.

19. Annual report, BPKIHS, 2002

Table – I Reasons for seeking treatment and problems faced during hospitalization

N = 250 S.N. Item/Particulars Percentage (%)

1.

Reasons for seeking treatment in BPKIHS

a. Easily approachable 8.4

b. Nearly / Near be 17.2

c. Cheap 3.6

d. All the facilities are available 78.8

2.

Problems faced during hospitalization with:

a. Laboratory services 15.2

b. Radiology service 3.6

c. Medications / medicine 3.6

d. Bill counter 8.8

e. Administrative staff 2.8

f. Communication 4.4

g. Religious practice 1.6

h. Payments 8.0

Average (mean) 70.4

Table – II Satisfaction Level of the Subjects with Various Services / Facilities

S.N. Item / Particular Satisfaction Level

Fully satisfied

Partially satisfied Not satisfied at

all

1 Doctors 79.6 16.0 4.4

2 Nurses 85.2 13.2 1.6

3 Facilities of the unit 73.6 22.4 4.0

4 Security 67.6 24.8 7.6

5 Investigations / Tests 68.0 25.6 6.4

6 Dharmasala (If used) 60.0 34.4 5.6

7 Dietetics 72.0 22.0 6.0

8 Drinking water 75.2 18.0 6.8

9 Toilet 78.8 17.6 3.6

10 Cleanliness 80.8 15.6 3.6

11 Bill counter 69.6 20.8 9.6

12 Average (In total) 71.6 21.2 7.2

Table – III Average Hospital Expenditure of the subjects

N = 250 S.N. Item / Particular Expenditure (Rs.)

1.

Total Average Expenditure: (In Rupees)

≤500 1.2

500-1000 2.8

1000-5000 32.0

5000-10,000 33.0

≥10, 000 30.8

Mean= 10895

Range= 0-2,00,000

SD= 16145.65

2.

Drug / Medicine

Average total 3822

Range 0-50,000

SD 6981.54

3.

Investigations

Average total 1106

Range 0-12,000

SD 1567.08

6.

Ambulance / Transport

Average total 562.47

Range 0-7,000

SD 1032.07

7.

OT charge

Average total 616.16

Range 0-6000

SD 1065.85

8.

Bed charge

Average total 754.57

Range 0-9150

SD 1500.28

9.

Total expenditure for this illness before attending

BPKIHS

≤500 57.2

500-1000 0.8

1000-5000 22.8

5000-10,000 12.0

≥10, 000 7.2

Mean 8989

Range 0-2,00,000

SD 13932.31

Socio-demographic Profile of the Cancer Patients Treated at BPKIHS in 2004

Mehta*1 RS, Bhandari*

2 S, Jha*

3 CB.

B.P. Koirala Institute of Health Sciences

Abstract:

Introduction: The burden of cancer is increasing worldwide. About 100 types of cancer affect human

being. During the period of 1998-2002, there were 24.6 million people living with cancer. More than 10

million People developed cancer in 2000. World wide about 8 million cancer deaths a year. The number

of new cases annually is estimated to rise from 10.9 million in 2002 to more than 16 million by 2020, if

this trend continues. By applying existing evidenced based knowledge, it is possible to prevent at least

30% of cases and 30% cases could cured, If given earlier diagnosis and effective treatment. Hence,

cancer information and education programme is essential.

Objectives: The main objective of this study is to find out the socio-demographic profile of the cancer

patients treated in BPKIHS in 2004.

Methods: It is hospital based descriptive exploratory research design, conducted among the discharged

diagnosed cancer patients at BPKIHS, using their discharge file/record. Using prepared Performa the

socio-demographic profile of all the 528 diagnosed cancer patients of 2004 was collected, by identifying

the case notes using coding index card from Medical record section.

The collected data was analyzed and presented in tables and graphs. This study also provides the base line information for the cancer information and education activities at BPKIHS.

Results: As per the record it was found that the number of cancer patients diagnosed and treated in

BPKIHS is increasing i.e. 203 cases in 2054 BS where as 485 in 2060. Among the diagnosed cases: 62 %

were of age group 36-65 yrs, 50.7 % Male, 82.8 % Hindu, and 82.8 % patients were diagnosed by

histology report.

Discussion: The numbers of cancer patients are markedly increases in BPKIHS, especially in advanced

age and in late stage. As BPKIHS is tertiary care hospital of eastern Nepal having cancer diagnosis, It is

easier to diagnose cases in early stage and can be treated and refer to BPKMCH, Bharatpur and other

centers in time for proper management. As these data are hospital based, it could not reflect the true

picture of Nepal.

AUTHORS: *1 RAM SHARAN MEHTA, (CORRESPONDING AUTHOR), ASSISTANT PROFESSOR, MEDICAL-SURGICAL NURSING DEPARTMENT, ([email protected]). *2 DR. SANGITA BHANDARI, ASSOCIATE PROFESSOR, DEPT. OF OTOLARYNGOLOGY AND HEAD NECK SURGERY. *3 DR. CB JHA. ADDITIONAL PROFESSOR, DEPT. OF ANATOMY. B.P. KOIR ALA INSTITUTE OF HEALTH SCIENCES, DHARAN, SUNSARI, NEPA L

Introduction:

The burden of cancer is increasing worldwide. About 100 types of cancer affect human being. During the period of 1998-2002, there were 24.6 million people living with cancer. More than 10 million People developed cancer in 2000. World wide about 8 million cancer deaths a year. The number of new cases annually is estimated to rise from 10.9 million in 2002 to more than 16 million by 2020, if this trend continues. By applying existing evidenced based knowledge, it is possible to prevent at least 30% of cases and 30% cases could cured, If given earlier diagnosis and effective treatment. Hence, cancer information and education programme is essential.

Objectives:

The objective of this study was to find out the socio-demographic profile of the cancer patients treated

in BPKIHS in 2004.

Research Design And Methodology:

Hospital based descriptive exploratory research design was used to conduct the study. All the files

(Cancer patients record) of diagnosed cancer patients treated in BPKIHS in 2004 constituted the

population of the study. All 528 diagnosed cancer patients record was reviewed using total enumerative

sampling techniques with the help of Index card of record section. Using prepared pre-tested semi-

structured Performa all the required information’s were collected. The content validity of the tool was

maintained by consulting with the experts of concerned fields. After the permission from the concerned

authority the case sheets were collected using the index-coding sheet of record section, and the

necessary information’s were recorded in the semi-structured Performa using SPSS-4 package .The

collected data were analyzed and presented in tables and graphs.

Results:

As per the mentioned records there were 528 cancer patients diagnosed and treated in 2004 at BPKIHS. The diagnosed cases were referred in various cancer hospitals (esp. Bharatpur cancer hospital) for better management. The number of cancer cases is increasing yearly in BPKIHS. Among the diagnosed cancer cases majority of them were of between 35 to 75 years of age. About half of the diagnosed cases were (49.3%) male. Majority of the cases were Hindu (82.8%) and only 3.2% were Buddhist, 0.2% Christian, 2.8% Islam, 0.2% Kirat and 10.8% patient’s religion was not mentioned. Maximum number of cancer patients was from Morang district

(21.2%) followed by Sunsari (19.5%), Jhapa (12.7%), India (7.9%), Saptari (5.4%), Dhankuta (4.9%), Dhanusha (3.6%), Bhojpur (2%) and others (20.4%).

As per the mentioned record the occupation of the patients were housewife (38.2%), agriculture

(18.3%), office work (5.3%), student (3.6%), business (3.4%), child (1.9%), labour (0.4%) and 28.9%

patient’s occupation was not mentioned. In BPKIHS among the diagnosed patients 7.9% were of

stomach cancer, 7.2% lung cancer and 5.9% breast cancer. The Diagnostic tests and examinations

performed to confirm cancer was histology (82.8%), cytology / hematolology (0.2%) and others (17%).

Discussion and conclusions:

B. P. Koirala Institute of Health Science is a health science university of Nepal having 7oo bedded tertiary

care hospital, which services the people of eastern Nepal. Numbers of cancer patients are increasing at

BPKIHS as the number of total patients increasing yearly. BPKIHS is a referral center of eastern Nepal

having facilities of cancer diagnosis like, FNAC, Biopsy, cytology, histology, and others. In BPKIHS

majority of cancer cases reported at late stage. Surgery and chemotherapy services are only provided to

cancer patients by the respective departments. Due to inaccurate recording system the exact number of

cancer cases are unable to identify. Housewife (38.2%) is commonly suffering with cancer as cervical,

uterine and breast cancers are common among female. Stomach, long, breast and cervical cancers are

common among the diagnosed cases.

Keeping the facts in mind, it is mandatory to start oncology unit at BPKIHS with all the facilities of

chemotherapy, radiotherapy, surgery and others.

Limitations of the study: • Study is based only on hospital records of treated diagnosed cancer patients • Some of the vital information’s were incomplete, hence unable to give various important

pictures. • The number of cancer cases treated in 2004 is 528, hence it’s time consuming activity to

collect all the information from case sheets.

Recommendations: • Similar study can be conducted taking other more variables like: treatment received,

economic status, risk factors, outcome of treatment, prognosis of patient, and the knowledge profile in prospectively, so that clear picture can be drawn.

• It is mandatory to start the cancer information and education programme at BPKIHS for cancer

information, Prevention, early detection and proper management of cancer cases.

References:

1. Rao KB, Choudhary NNR. Clinical Gynecology, 4th

edi. 1999, Longman, Chennai.

2. Thomas HG. Gynecology: essentials of clinical practice. 3rd

edi.1986

3. Patil S, Shastri S. early detection “Global view point”. Abstract book: I international and VI

national oncology nursing conference, Mumbai. 2003.

4. European Journal of cancer – 2001, 37 (1)

5. Understanding Leukemia and related blood disorders Leukemia, foundation.

6. Harvard reports on cancer prevention causes and control. 1996

7. Sharma. S, Aryal RP Gynecological morbidities at Rukum and experience of a health camp. JIMA

1998 (37): 751-659.

8. Rao A. Health Promotion and education in south East Asia. IVHPE-SEARB at Banglor.

9. PARKWAY Medical. Oct. 2003 (Cancer Special Supplement issue).

10. www.uicc.org

Figure: I Number of cancer Patients treated at BPKIHS in different Years

Figure: II

Age wise Distribution of the Subjects (N=528)

203

287

427

342 335

417

485

385

0

100

200

300

400

500

600

2054BS 2055BS 2056BS 2057BS 2058BS 2059BS 2060BS 2061BS

Num

ber

of p

atie

nts

years

year wise distribution of cancer patients

Figure: III

Distribution of the subjects according to their diagnosis of Parts involved (N=528)

3.4 4.2

8.5

18.220.2

23.9

14.8

6.8

0

5

10

15

20

25

30

<15 15-25 26-35 36-45 46-55 56-65 66-75 >75

Per

cent

age(

%)

Age group

Age wise distribution of the subjects

7.9 7.2 5.9 4.5 3.8 3.8 3.8 3.6 3.3

56.2

0

10

20

30

40

50

60

perc

enta

ge

Parts Involved/Diagnosis

Diagnosis or Parts involved with cancer

SATISFACTION OF CLIENTS AND THEIR RELATIVES REGARDING

EMERGENCY SERVICE AT BPKIHS

Mehta*1 R.S., Sharma*2 SK, Mandal*3 GN

B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Abstract:

Introduction:

Emergency nursing is a specialty in which nurse's care for patients in the emergency or critical phase of their illness or injury and is adopt at discerning life threatening problems, rapidly and effective caring out resuscitative measures and other treatment, acting with a high degree of autonomy and ability to initiate needed measures without outside direction, educating the patient and his family with the information and emotional support needed to persevere themselves as they cope with a new reality. The activity of settings and not necessary in an "emergency room". Objectives: Keeping in view, the increasing emphasis on the quality of nursing care in today's health care setting, a study was undertaken to evaluate the satisfaction of client's and their relatives regarding emergency services at BPKIHS. Methodology: A descriptive exploratory research design was adopted to carry out the study among 300 samples with a population proportionate sampling method, among the client's admitted in indoor (Medial, Surgical & Orthopaedic) after minimum stay of 3 Hrs. in emergency; using valid and reliable interview schedule by the trained interviewers. Results: Majority of the subjects (83%) reported that the request and needs of the patients were heard and met properly. The most of the subjects reported nurses were of caring attitude, received patients in friendly atmosphere, maintained privacy, maintain proper communication with clients. They reported delay information about investigation results. Overall satisfaction was good. Conclusions: The reasons for dehumanization of patient care in emergency unit reported by various authors are differences in social classes between health care providers and population, standardized care, staff attitude, patient overload, hospital system, lack of supportive services, poor decision making autonomy and teaching environment. This study concludes that the information system needs to strength in emergency unit.

Authors: *1

Mr. Ram Sharan Mehta, (Corresponding Author) Asst. Professor, Medical-Surgical

Nursing Department, Email: [email protected] *2

Dr. Sanjeev Kumar Sharma,

Additional Professor, Dept. of Medicine, *3

Mr. G.N. Mandal , In-charge, Emergency Ward, B.P.

Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal.

Introduction:

Emergency nursing is a specialty in with nurse's care for patients in the emergency or critical

phase of their illness or injury and is adept at discerning life threatening problems, prioritizing

the urgency of care, rapidly and effectively caring out resuscitative measures and other

treatment, acting with a high degree of autonomy and ability to initiate needed measures without

outside direction, educating the patient and his family with the information and emotional

support needed to preserve themselves as they copy with a new reality. The activities must be

carried out in a variety of settings and not necessary in an "Emergency room".

Even under the best conditions, the emergency department can be like a power keg. The

department’s 24 hours accessibility, it's lack of adequately trained or armed security guards and

the many people sharing the cramped and often chaotic spacer make it vulnerable to violence.

In addition long waiting times increases emotional tension, and in such situation

disagreements, misunderstandings, discourteous remarks, or unnecessary roughness can easily

ignite aggression9.

B. P. Koirala Institute of Health Sciences (BPKIHS) was established in 1993 and upgraded to a health science university in 1998. It is an autonomous institute with a mandate to work towards “developing a socially responsible and competent health work force striving continuously to meet the health needs of the eastern region of Nepal at the primary, secondary and tertiary levels”. This is its primary responsibility.

The BPKIHS has been providing high quality care to the suffering population of this region with

a quality human approach and delivery as its guiding principle. At the same time attempts are

being made to provide a wide spectrum of services from primary care to super-specialty based

tertiary care. The hospital provides its various services- viz. therapeutic, diagnostic, supportive,

and administrative and day care at a very affordable rate.

The total bed strength of BPKIHS is six hundred and forty. Out of these, there are five hundred and seventy five general beds and seventy-one paying beds. The number of patients examined in the period 2001-2002 in different areas were OPD-1,73,504, Paying clinic – 2,009; Emergency -19,374, & Inpatient admissions - 1,86,285. The average length of stay was 5.62 days / patient,

Deliveries conducted – 3,521. Total hospitalization days - 1,03,714 days and Total operations performed - 13,567.

Emergency is considered the heart of BPKIHS. It is situated in the northern part of BPKIHS and

occupies a broad area with a modern infrastructure including laboratory, x-ray and operating

theatre facilities. Emergency has its own observation ward that contains two separate isolation

cabins. Most beds and examination tables are well equipped with central O2, suction and

compressed air and three resuscitation trolleys and a cardiac monitor are available as needed.

A separate dressing room is available for repairs of wounds and minor procedures as needed.

An average of seventy patients is seen in the Emergency each day

Emergency nursing demands expertise and specialty, which is unique. The nurses in emergency

department are vital members of health care delivery system. It is necessary for them to posses

a high degree of knowledge, skill and clinical experiences, with a strong emphasis on

communication skills, patients assessments and setting of priorities. He/ she must be skillful,

aggressive, and alert, and show flexibility.

In recent years, the emergency department nurse managers role has evolved from serving as a head nurse in a white uniform and being counted as part of nursing care hours for patient care in the ED, to that of a nurse manager of today who has operational, personnel, and financial responsibilities and accountability.

The role of the ED nurse manager is very complex. We must wear many hats for each distinct

aspect of our roles. We must serve as a: authority figure, planner, supervisor, leader, counselor,

planner, entrepreneur, liaison, mentor, education, resource person, consultant, controller,

advocate, researcher and also as a student.

In ED, the treatment provides must be immediate and appropriate according to the condition of

the patients competent. If the condition is serious, it can make all the difference between life

and death. A person with minor injury, if treated promptly and properly, will be put back to

work quickly. If the treatment is delayed or is not compliant, the person can be out of job for a

long time. Prolonged and expensive rehabilitation may be necessary to put the person back on

the job. Hence, a casualty service must avoid delay in attending to the management of patients

seeking emergency services.

A proportion of the patients especially with bodily injury due to accidents will be medico-legal.

When in doubt, it is best to treat them patients as medico-legal. All records must be complete

and kept in safe custody. Entries must be made in the appropriate registers and police should

be informed. Do not delay in commencing treatment, just because the police have not arrived.

The patient care must be personalized and individualized. The staff members must be aware

and sensitive to all patient needs and perform as patient advocates. Increased sensitivity can be

achieved by group discussion with the staff or by utilizing resources persons trained for this

purpose. Behavioral expectations of the staff must be defined, communicated and enforced.

The image that is perceived by patients is often more important than the reality. Many large

companies and individuals achieve success because of their image. An example of the

importance of a good image was the election of John F Kennedy to the presidency. His image

was that of a young attractive, enthusiastic, family oriented, energetic person who cared, for

the people. This helped him to be elected to the office of the president.

In the ED, patients wait for various reasons. They wait to be register, to be put into a treatment

room, for a nurse, for a doctor, for diagnostic studies to be complete, for the test results, for

communication about their progress or disposition, for an available bed for one to be admitted, or

for the aid to escort them to their hospital room. Decreasing waiting time is extremely important

for patient satisfaction.

Improper documentation especially in medicolegal cases creates serious problems sometimes. A research report T Subramanian (1998) reported that, problems due to hospitalization were: home sickness 34%, boredom 20%, lack of social life 10%, financial problems 81%, only 30% reported no personal problems and 20% reported not financial problems. These problems may be similar in our setting.

Now the casualty department of BPKIHS is well sophisticated in structure. The number of cases

gradually increasing yearly. The data shows as follows:

Fiscal Year No of patients 2050/51 5828

2051/52 7011

2052/53 8540

2053/54 8480

2054/55 10698

2055/56 13157

2056/57 15212

2057/58 18235

2058/59 19374

The above figure shows the increasing number of clients in the emergency department day by

day. Hence, this study helps to examine the satisfaction of clients about the casualty service. This

study attempts to find out the facts about quality of service in the emergency department of the

BPKIHS, which will aid in planning.

Emergency department is heart of hospital, but it is no man's land. The number of casualty patients increasing yearly. Now, BPKIHS has a well set-up casualty department. It is necessary to evaluate the quality of service of casualty department. This study also focused on the nursing service quality and examines the areas needs improvement. This study gives ideas for effective casualty service by exploring the areas of improvements, so that satisfaction level can be raised.

The main objective of the study was to examine the satisfaction of clients and their relatives

regarding emergency services. The study also focuses on the satisfaction regarding emergency

nursing services among the clients and their relatives.

Research Methodology.

It was a descriptive and exploratory research study. The primary methodology of this research was

interview. The population of the study was the clients admitted in Indoor (i.e. medical units, surgical units

and orthopedic ward of BPKIHS) after minimum stay of 3 hours in emergency unit. Those who are not

admitted and not stay more than 3 hours will not included in the study. The sampling method used was

population proportionate and the size will be about 300 respondents. The tool was open and close-ended

questions. Content validity of the tool was maintained by consulting experts and practicability with pre-

testing the instruments. The Interview was conducted at Indoor wards after admission within the 24 hours

by the trained staff nurses. The interview was taken form the patient along with their relatives present

during course of treatment in emergency. The Paediatric patients and those who are unable to give

response, the data was obtain form their care taker/relatives present during the emergency unit. The

prepared tool was pre tested among 5% of total sample in a similar setting at BPKIHS. Explaining clearly

and properly the right of the subject, was protected before asking the questions. Taking their consent and

maintain their confidentiality proper care was taken to reduce the bias. The collected data was tabulated

and analyzed by utilizing statistical tools. Analyzed data was interpreted through tables, charts diagram

accordingly. Some recommendations was made according to the findings of the study.

Results:

Majority of respondent’s i.e. 27 % was of age group 15-30 years. The mean ages of respondents were 42.16 and SD 19.25. Majority of the respondent’s i.e.88.5% was Hindu. About 38% respondents had agriculture their occupation. About 31.5% subjects were illiterate, where as 12.5 % had higher education i.e.+2 and above. Most of the subject had yearly family saving less then RS. 5000. Forty- percent subjects belong to Sunsari district; where as 1.5 % from India. Majority of the subjects (71 %) were from villages. The majority of the subjects (73 %) visited the emergency for first time. Most of the subjects i.e. 65% spent less than 6 hours in the emergency unit; where as range of stay in emergency unit was 3-43 hours. Majority of the subject's i.e.56.5 % used Ambulance to arrive the emergency. Majority of the subject i.e. 80% reported the reasons of seeking treatment in emergency unit are due to good reputation of the hospital. About 30.5 % subjects arrived at emergency between 12 noon to 4 PM. Majority of the patients (64 %) was seen by the triage nurse within 5 minutes. The doctor saw most of the patients within 20 minutes. The majority of the subjects (91.5) reported bill counter staffs were courteous, while 8.5 % reported they were not courteous. Majority of the subjects (64%) mentioned that the expenditure of the emergency unit is all right, only 5 % reported expansive. The mean expenditure was RS. 2976.60, where as range was 80-9200 RS. Majority of the subjects (<50 %) graded the sanitation facilities, nursing care services, attention by the doctor, security service, and toilet facilities good, where as physical facilities i.e. bed, furniture, equipment etc are fair. The majority of the subjects (83.5%) reported that they strongly

recommended the existing emergency services to their friends/relatives. Majority of the subjects reported that the Emergency services were similar as previous visit. Majority of the subjects (62.5 %) did not give any comments, where as some recommended: Reduction of hospital charges, more attention towards serious patients, and improvement of bill counter services. Discussions and Conclusions: The present study was undertaken to evaluate the satisfaction of clients and their relatives regarding emergency nursing services at BPKIHS. Measuring and linking patient outcomes to nursing intervention is an important task that has professional, financial and political ramifications. The importance and complexity of measuring patient outcomes accurately should not be overlooked, as there are a number of emergent factors that influence this process. These include the turbulent context of practice, variations in care due to the large number of health professionals, individual patient characteristics impacting on outcomes, determining appropriate nursing outcomes measures, nursing lack of autonomy within the system and difficulties experienced while trying to link patient outcomes to nursing Interventions. So that the results reflect reality, it is important for researchers in the field to take note and consider these factors when measuring patient outcomes 1. The present study aimed to examine and discuss a number of these factors as they relate to the evaluation of patient care. The present study indicates that most of the subjects belong to low socio-economic brasket similar to our national economic situation. Majority of the subjects (40%) belongs to Sunsari. Seventy one percent subjects were from villages similar to the national demographic figure. The most of the subject (67.5%) rated the overall emergency services as good. Majority of the subject (>50%) rated the sanitation facilities, nursing care services, attention by doctor, security services, physical facilities and toilet facilities as good Majority of the subjects (62.5%) did not give any comments for future improvements: where as 37.5% given some comments like; reduction of hospital charges, attention should be given to serious patients, etc. The difference in social class between health care providers and the client; standardized instead of individualized approaches by staff: staff's attitudes, morale and working conditions; physical design of the unit; patient over load; hospital system problem; lack of support services; exclusion of patient form decision making; and teaching environment, are some of the causes of dehumanization of patient care in emergency unit.

References: 1. Oconnel BO, Warelow PJ. Challenges of measuring and linking patient outcomes to nursing interventions in

acute care settings. Nursing health science. 2001, 3(3): 113-7. 2. Buschiazzo L. The Handbook of Emergency nursing management. Aspen publication, marycan; 1st ed. 1996 3. Basnet S, Tomita M. A study report on time utilization of nurses in nursing and Non-nursing activities in

general ward at TUTH; 1993 4. Basnet S, Tomiyoshiy. A study report on expected and received nursing care as perceived by patients' and their

relatives at TUTH, 1992 5. Barnard A. Technology and nursing: an anatomy of definition. International Journal of nursing studies. 1996;

33(4): 438. 6. Cooper A, saxe M, Anthony R. Verbal abuse of hospital staffs. The Canadian nurse in Nepal; 1993: 22-26.

7. Thakur L. factors affecting he roles and functions of staff nurse in Nepal; 1993; 22-26. 8. Tamsang J etal. A study of the performance of nursing staff in relation to their job description, 1988: 1-42. 9. Mehta RS, Singh S. satisfaction of client and their relatives receiving nursing care at BPKIHS; 1999. 10. Grossman V. Gang members in the emergency department. American nursing Journal. 2003; 103 (2): 52-53. 11. Brostpw DP, Herrick CA. Emergency department case management: The dyad team of nurse case manager and

social worker improve discharge planning and patient and staff satisfaction while decreasing inappropriat4e admissions and costs. Lipponcotts case management. 2002,7(6): 243-51.

12. Cooper MA, Lindsay GM, Kinn S, Swann IJ. Practioner services: A Randomized controlled. Journal of advance nurses. 2000; 40(6): 721-30.

13. New TD. Clinical decision support tools in A and E nursing: a pre liminary study. Nursing standard. 2000; 14(34): 32-9.

14. Tye CC, Ross FM. Blurring boundaries: Professional perspectives of the emergency nurse practioner role in a major accident and emergency department. Journal of advance nursing. 2000; 31(5): 1089-96.

Table – I Socio – Demographic profile of the subjects

N = 300 SN Particular/Item Percentage (%)

1 Age group (In years)

< 15 6

15 – 30 27

31 – 45 24

46 – 60 26

> 60 17

Range: 2 – 81

Mean: 42.16

SD: 19.25

2 Religion

A. Hindu 88.5

B. Buddhist 7.5

C. Christian 1.5

D. Muslim 2.5

3 Occupation

A. Agriculture 38.0

B. Service 9.0

C. Business 7.5

D. Student 12.5

E. Labour 8.5

F. House wife 16.5

G. Others 8.0

4 Education

A. Illiterate 31.5

B. Primary (up to 5) 28.5

C. Secondary (up to 8) 13.5

D. High school (up to SLC) 14.0

E. College (+ 2 & above) 12.5

5 District

A. Sunsari 40.0

B. Mornag 18.0

C. Jhapa 12.0

D. Saptari 5.5

E. Udapur 4.0

F. Other district 19.0

G. India 1.5

6 Residence

VDC (Village) 71.0

N/P (Municipality) 29.0

Table – II Reasons for seeking treatment in emergency unit of BPKIHS

N – 300

SN Particular/Item Percentage (%)

1 The hospital has good reputation 80

2 My doctor sent me 60

3 It is close to my home/work place 25

4 Knowledge and skills of the physicians & nurses 25

5 To be seen quickly by the doctor 18

6 Reasonable costs 9

7 The police has brought 2

8 Others: equipments, caring staff, etc. 2.5

Table – III

Responses regarding nursing care components of the subject

N – 300

SN Particular/Item Percentage (%)

1 Request & need of the patient

A. Heared and met properly 83.0

B. Heared and not met properly 15.0

C. No attention was paid 2.0

2 Caring nature of triage nurse

A. Yes 95.0

B. No 5.0

3 Patient were received in friendly atmosphere

A. Yes 91.5

B. No 8.5

4 Privacy was maintained

A. Yes 95.5

B. No 4.5

5 Did the nurse keep you informed of your progress

A. Yes 70.0

B. No 30.0

Table – IV

Opinion regarding the existing facilities/services of emergency unit

N – 300

SN Facilities/Services Scale/Grade

Excellent

(%)

Good

(%)

Fair

(%)

Poor

(%)

1 Sanitation Maintained 24.5 57.5 16.5 1.5

2 Nursing Care provided 19.5 69.0 11.0 0.5

3 Attention given by Doctor 16.0 69.0 13.0 1.5

4 Security service available 10.5 68.5 19.5 1.5

5 Physical facilities (e.g. bed,

furniture equipment etc) available

20.0 60.5 18.5 1.0

6 Toilet facilities 13.0 58.5 24.5 4.0

EFFECTIVENESS OF INFORMATION BOOKLET ON DIABETES AMONG THE ADMITTED DIABETES

CLIENTS IN BPKIHS

Mehta RS*1, Karki P*2, Sharma SK*3

B.P. kiorala Institute of Health Sciences, Nepal

ABSTRACT:

Introduction:

Diabetes is a major non-communicable Public health problem, rising prevalence of the disease in the developing countries, which was rare before, is due to industrialization, socio-economic development, urbanization and changing life-style. As the disease cannot be cured, it is a life long and it can only be controlled, hence there is need for self-motivation and knowledge to manage the disease. The Objectives of this study is to prepare an information booklet on Diabetes and to find out the effectiveness of it.

Research Design and Methodology:

It was single group pre-test post-test quasi-experimental research design, conducted among the admitted diagnosed diabetes cases admitted in medical units of BPKIHS in 2005. Using purposive sampling technique 50 subjects were selected. After the pre-test, Information booklet on diabetes (In Nepali) was given to subjects along with explanation. After 3 days of pre-test, post-test was taken and the collected data was analyzed using SPSS-4 package.

Results:

It was found that 76% clients were suffering with NIDDM, 22% on OHA, 72% on insulin, and 80% on diet

therapy. About 80% subjects reported that they studied this type of booklet first time, and was easily

understandable. Ninety percent subject reported that the booklet is very helpful, 10% mentioned it all

right where as none of them reported not helpful, and 100% subjects mentioned that they refer others

to study this booklet.

This booklet will be very beneficial for diabetes clients attending diabetes clinic, MOPD and admitted in medical units.

*1

Mr. Ram Sharan Mehta (Corresponding Author), Asst. Professor, Medical surgical Nursing

department, College of Nursing. (Email: [email protected]) *2Prof. (Dr.) Prahlad Karki,

HOD, Department of medicine & Hospital Director. *3Dr. Sanjeev Kumar Sharma, Department of

Medicine, B.P. kiorala Institute of Health Sciences, Nepal

Introduction:

Diabetes Mellitus (DM) is a chronic disease caused by inherited and/or acquired deficiency in

production of insulin by the pancreas. It is a syndrome caused by an imbalance between insulin supply

and demand, characterized by hyperglycemia and associated with abnormal carbohydrate, fat and

protein metabolism. Insulin deficiency results in increased concentrations of glucose in the blood, which

intern damage many of the body’s systems, in particular the blood vessels and Nerves1.

As the number of people with diabetes grows worldwide the disease takes an ever-increasing

proportion of national health care budget. Without primary prevention, the diabetes epidemic will

continue to grow. Even worse, diabetes is projected to become one of the world’s main disablers and

killers within the next twenty-five years. Immediate action is needed to stem the tide of diabetes and to

introduce cost effective treatment strategies to reverse this trend2.

DM is a chronic disease that affects approximately 14 million people and among those 14 million, 7

million were un-diagnosed. Among older people (>65 years) 86% had type-II DM. Type-I DM

approximately account for 10% and type-II 85-90% of all known cases of DM in United States2.

There is rising prevalence of the disease in the developing countries, which was rare before, is due to

industrialization, Socio-economic development, and urbanization and changing life style3. Type-II DM is

more prevalent than type-I DM and constitutes nearly 90% of cases among the diabetes2. The

prevalence of diabetes increases with age. The prevalence2 of type-II DM in female was relatively lower

(5.57%) than males (6.73%).

The high incidence (new cases) of type-II DM in Nepal was found due to lack of public awareness

regarding the problems and poor medical service in country. From 28th

oct.1997, to 27th

Oct. 1998, in

Medical OPD of B.P. Koirala Institute of Health Sciences, 1840 patients (1040 M & 800 F) attended with

DM1 .

The investigators had conducted the study on “ socio-demographic and knowledge profile among the

diabetes patients admitted in medical units” and found the urgent need of an informational booklet on

Nepali. Hence the investigators had conducted this study. The Objectives of this study is to prepare an

information booklet on Diabetes and to find out the effectiveness of it.

Research Design and Methodology:

Single group pre-test post-test quasi-experimental research design was implemented to conduct the

study. The study was conducted among the admitted diagnosed cases of diabetes in medical units of

BPKIHS. The purposive sampling technique was used to select 50 subjects, who fulfill the set criteria. The

admitted patients willing to participate in the study was only selected. The patients, who were unable to

read, their relatives were involved in teaching session and explanation on information booklet was given

to client and their educated relatives. The contents of the Information booklet are: Introduction of

Diabetes, Types of Diabetes, Causes of Diabetes, Signs & Symptoms of Diabetes, Treatment of Diabetes,

Effect of Diabetes, Important Information for Patients, Information about food, Information abut

exercise, Foot care, Eye care, Hypoglycemia, Sugar test, Insulin Injection, Regular examinations,

Ketoacidosis, Social life, Situations to contact doctor, Information about traveling, Information about

OHA, Myths and Facts about DM and References for further information.

Interview schedule was used to collect the data. The content validity of the tool was established by

consulting with the experts from the field of nursing education, nursing research, physician, dietician

and psychologist. The practicability of the tool was established by pre-testing the tool.

By using interview schedule in pre-test details of identification data, along with Socio-demographic profile was obtained. After pre-test, information booklet was given to the client with proper information and explanation. A minimum after 3 days of pre-test, the post-test was taken. The difference in knowledge was assessed. Verbal consent was obtained from the concerned authority. Before pre-test informed verbal consent was obtained from each subject. The collected data was analyzed using SPSS-4 package and presented in tables and graphs.

Results:

Majority of the subjects were of age more than 40 years (Mean=54.35, SD=13.19, and Range=24-80 years), Male (68%), and Hindu (96%). About 37% subjects were uneducated, 40% from sunsari district, 56% were from villages and 98%were married. Majority of the subjects (84%) were Non-vegetarians. About 60% subjects were suffering with diabetes for more than 5 years and majorities were of type-II i.e.76%. About 8% subject has family history (brother and sister) of diabetes and 18% had positive parental history. Majority of the subjects (72%) were on insulin therapy. Majority of the subjects (80%) reported that they found this type of booklet first time, which is easily understandable (80%), covered appropriate contents (90%), recommend others to study (100%), and evaluated the booklet useful (96%).

The details of the results are depicted in table: I-V.

Discussion:

Diabetes is a major non-communicable public health problem increasing rabidly in developing countries

including Nepal. Disease can only control hence self-motivation & knowledge to manage the disease is

essential. Majority of subjects (76% were suffering with type – II DM, and duration of illness is

prolong i.e. 1-26 yrs. (mean =8 yrs). Eighty Percent Subjects reported that they got the chance of getting

information from this type of booklet is first time, and is very useful. Various studies (conducted by

smith 7, funnel 8, Bruni9, and Pieffee 11) supported the findings of this study. It generate scientific

literature, Helpful for: doctors, nurses, students, diabetes clients and general public and also Aid in

prevention & care of diabetes.

Recommendations: A similar study can be conducted among the diabetes clients in OPDs and in

community will be more useful. Use of Videotapes and slide tapes for diabetes education will be more

effective. One to one counseling, Skill training, and diabetes content sessions are effective methods of diabetes education.

Limitations of the study: The diagnosed diabetes client’s admitted in medical units during the data

collection period of 8 weeks were included in the study. Only 50 subjects were purposively selected for

the study. Preparing booklet on Nepali language is difficult as many English terms have not exact Nepali Meaning. It was difficult to grade the facilities available with the subjects and to recall the past

events. It is also difficult to measure the quantitative form exactly. Measurement of individual

differences found difficult to grade.

References:

1. Roman PG, Maitra S. A comparative study of oral glucose tolerance test and Glycated hemoglobin in high-risk patients for diabetes mellitus. INT.J. DIAB.DEV. Countries 2000; (1) 23-28.

2. Mehta RS, Karki P, Sharma SK. Socio-demographic and knowledge profile among the diabetes clients admitted in medical units of BPKIHS. 2004.

3. Karki P, Barel N, Lamsel M, Rijals, Koner BC, Dhungel S, and Koirala S. prevalence of NIDDM in urban areas of Eastern Nepal: A hospital based study. South East Asia J Trop. MED. Public health .2000; 31 (1): 163-166.

4. Bruni B, Barbero PL, carlimim etal. Principles, means and evaluation of a programme for diabetes education Ann. Osp. Maria. Vifforia torino. 1981 JAN-JUN; 24 (1-6); 43-74.

5. Nova Nordisk Education Foundation Consensus guidelines – Minimum basic care for persons with DM. INT.J.DIAB. DEV. Countries 2000; 20 (1): 1-7.

6. Kapur A, Jorgensen LN. Diabcare Asia study- comparative status of current Diabetes cares in Asia. Nova Nordisk diabetes update. 2001; 3-13.

7. Smith DM, Norton JA, weinberger M, Mc Donald C2, Kat2 BP. Increasing prescribed office visits: A controlled trial in patients with diabetes mellitus. Med. Care. 1986, mar; 24 (3): 189-99.

8. Funnel MM, Donnelly MB, anclerson RM, Johnson PD, Oh MS. Perceived effectiveness, cost, and availability of patient education methods and materials. Diabetes education 1992 MAR-APR; 18 (2): 139-45.

9. Svoren BM, Butter D, Levine BS etal. Reducing acute adverse outcomes in youths with type-I diabetes: a randomized controlled trial. Evi. Based Nurs. 2004. APR. 7 (2): 42.

10. Pietfe JD, weinberger M, creamer FB etal. Impact of automated calls with nurse follow-up on diabetes treatment outcomes in a department of veterans affairs health care system: a randomized controlled trial. Diabetes care. 2001 feb; 24 (2): 202-8.

11. Berg AO. Screening for type-2 diabetes mellitus in adults: recommendations and rationale. American Journal of Nursing (AJN). Mar 2004, 104 (3): 83-89.

12. Christian medical association of India, New Delhi, health dialogues. Issue no. 37, April-June 2004. 13. Soundarya M, Asha A, Mohan V. roles of a Diabetes educator in the management of Diabetes. Ibt. J.

DIAB. DEV. Countries. 2004, m4: 65-74. 14. Susan L, Michael m, Venkat KM. Effectiveness of self-management training in type-2 Diabetes.

Diabetes care. 2001;24(3):362-7.

Table – I Age and sex distribution of the subjects

N=50

S. N. Item/particular Percentage (%)

1. Age group (In years):

< 40 14

40-50 18

51-60 27

61-70 25

71-80 14

> 80 2

Mean 54.35

SD 13.19

Range 24-80

2. Sex

Male 68

Female 32

Table – II Frequency of Admission and duration of the disease

N=50

S. N. Item / Particular Percentage (%)

1. Frequency of admission

1st Time 52

2nd Time 22

3rd Time 18

>3 Time 8

Mean 2.10

SD 2.05

Range 1-12

2. Duration of disease (In years)

<5 40

5-10 28

11-15 20

16-20 4

>20 8

Mean 8

SD 6.34

Range 1-26

Table – III

Distribution Of Subjects According To The Known Risk Factors N=50

S. N. Item /Particular Percentage (%)

1. Family history (brother/sister) of diabetes

a. Present (yes) 8

b. No/ not sure 92

2. Parents with diabetes

a. Present (yes) 18

b. No/ not sure 82

3. Birth of large baby (Wt.> 35kg) (only female Pt.,

N=16)

a. Yes (H/O large baby) 6.25

b. No 62.5

c. Not sure 31.25

4. H/O using oral contraceptives (only female Pt.,

N=16)

a. Yes 12.5

b. No/not used 87.5

5. History of having following Habits

a. Tobacco chewing 50

b. Betel chewing 34

c. Guttca chewing 20

d. Smoking (Bidi/Hukka, cigarette etc) 60

e. Alcohol consumption 44

6. Life style

a. Heavy physical worker (farmer/labor) 34

b. Office worker 16

c. Sedentary life style 40

d. Others 10

7. Obesity (H/W ratio)

a. Present (yes) 28

b. Not present (no) 72

8. History of stress (eg. surgery/trauma/others etc)

a. Present (yes) 28

b. Not present (no) 72

Table – IV

Distribution Of Subjects According To The Treatment Or Therapies

N=50

S. N. Item /particular Treatment/therapies (%)

1. Oral hypoglycemic agent (OHA) 22

2. Insulin 72

3. Diabetic diet 80

4. Weigh loss therapy 30

5. Quit smoking 50

6. Herbal /traditional remedy 10

Table – V Evaluation of the information booklet on diabetes

N=50

S. N. Item/particular Percentage (%)

1. Studied this type of booklet earlier

a. Yes (studied) 20

b. No (not studied) 80

2. Understanding level of this booklet

a. Easily understandable 80

b. Understandable with little difficulty 20

c. Not understandable 0

3. Content covered

a. Very appropriate 54

b. Appropriate 36

c. All right 10

d. Not appropriate 0

SOCIO-ECONOMIC, CULTURAL AND KNOWLEDGE PROFILE

OF KALA-AZAR PATIENTS FROM ESTERN NEPAL

Mehta RS, Asst. Professor, College of Nursing

Email: [email protected]

Rijal S, Asso. Professor, Department of Medicine

B.P. Koirala Institute of health Sciences Dharan, Nepal

Abstract: Kala-azar is a Major public health problem in the Terai districts of Nepal. This study was conducted at B.P. Koirala Institute of Health Sciences (BPKIHS), when kala-azar project was first started in this institute. The main objective of this study was to to assess the socio-economic status of kala-azar patients, to explore the presence of known environmental factors which predispose to breading of sand flies, to assess the knowledge and attitude towards kala-azar and to identify any issues that hinders or delay in seeking prompt treatment.

It was an exploratory hospital based study. Patients admitted to the medical wards at BPKIHS during the period of 2056-4-1 to 2057-3-30, and diagnosed to suffer from kala-azar, by demonstrating leishmania donovani were included in the study. A total of 93 patients admitted over a period of one year were selected purposively for the study after obtaining verbal consent.

The study revealed that 53% study subjects were male. Maximum subjects were from morang 34% sunsari 32% and 29% from saptari. The majority of study subject i.e. 95% was from rural area and only 5% from urban. The occupation of 35% of study subjects were agriculture, where as 26% were housewives and 23% student. Majority of study subjects 77% lived in houses made up of mud and bamboo (fus) 75% had single store houses and 61% Respondents slept on a bed. Only 24% subject reported that they knew the cause of kala-azar and 50% subjects reported that disease is curable. For prevention, to decrease relapse rate and eradication of kala-azar, public awareness i.e. Health education, IEC regarding diseases process and available services; and community participation is essentials for prevention and eradication of kala-azar.

Introduction:

Visceral Leishmaniasis (VL) also termed, as kala-azar (KA) is a protozoal disease caused by parasites of

the genus leismania, which is transmitted, to man by the bite of an infected female phlebotomy sandy. It

is considered a major public health problem with 12 districts in the southern terai districts of central and

eastern Nepal being endemic1. Despite of intensive government efforts using various measures eg-

control of vector borne disease project, free drugs to kala-azar patients, selective indoor residual

spraying (IRS) of insecticides, IEC activities the incidence, morbidity and mortality is continuing to

increase 2. The female sand fly phlebotomy argenttipes is the main vector of kala-azar in Nepal. 4;5 the

adult sand fly are unable to very far and are seldom found beyond 200 meters from their breeding place.

As they are unable to hop very high the risk of getting infection with kala-azar could be avoided if people

avoid sucking on the ground floors.

For successful control programme it is important not only for early case detection and treatment but also essential to bring about changes in behavior and practices of the rural people about kala-azar. As there is limited information available on the socio-economic, attitudes and cultural practices towards kala-azar from Nepal we feel the need of this study. Objectives of the study: General objectives: To study the socio-economic status, cultural of patients their knowledge and attitudes towards kala-azar. Specific objectives:

• To assess the socio-economic status of kala-azar patients. • To explore the presence of known environmental factors which predispose to breading of

sand flies. • To assess the knowledge and attitude towards kala-azar. • To identify any issues that hinders or delay in seeking prompt treatment.

Research design and methodology: This was a hospital-based study. Patients admitted to the medical wards at BPKIHS during the period of 2056-4-1 to 2057-3-30, and diagnosed to suffer from kala-azar, by demonstrating leishmania donovani were included in the study. A total of 93 patients admiffed over a period of one year were selected purposively for the study after obtaining verbal consent. The person who don’t give consent was excluded form the study. The data was collected by face to face interview by investigator using a pre tested structured Interview schedule in the local language. One patient was interviewed only once. Interview was done on the 1st day of starting treatment for kala-azar. Results: The study revealed that 53% study subjects were male. The majority of subjects belongs to Chaudhary caste i.e. 36%, followed by 25% from Yadav, Mehta, Das etc, 22% from Brahmin and Chhetri, 13% Rai, Limbu, Gurung etc. 2% Muslim and 2% Newar. The majority in the study subject were from the neighbiring district morang 34% sunsari 32% and 29% from saptari. The majority of study subject i.e. 95% was from rural area and only 5% from urban. 43% of study subjects were uneducated, 28% had primary education, 20% had secondary and only 9% had higher education. Almost half of head of family i.e. 44% were illitrate. In 38% of family there was no single literate aduct family member.

The occupation of 35% of study subjects were agriculture, where as 26% were housewives and 23% student. The majority of family of study subjects depended on agricultural as the main source of income. Only 28% families were able to sustain without any financial difficulties. Majority of study subjects 77% lived in houses made up of mud and bamboo (fus) 75% had single storey houses and 61% Respondents slept on a bed. Although 77% Respondents used a mosquito net with no insecticide impregnation only 15% used it regularly. Majority of the Respondents 74% had domestic animals mainly cattle and pig. 24%, 19% Respondents used to keep their animals in same house. Almost all the respondents 95% used cow dung for cleaning their house regularly. Forty one percent of the study subjects received information about kala-azar for the first time after learning to BPKIHS, 32% from neighbor, 16% from Hospitals and 11% from Health workers. Only 24% subject reported that they knew the cause of kala-azar and 50% subjects reported that disease is curable. Forty three percent subjects reported the existence of the kala-azar patients in their community, and 10% reported existence of cases in their own family. Forty two percent subjects reported that they first consult the traditional faith healers (Dhami/Jhakri/Pandit etc) if any body get sick in family; where as 58% reported that they go to H.P/Hospital or consult Health worker. At the time of the interview more than 50% were suffering with symptom. For more than 1 year. The Reasons for the delay in starting treatment and 43% did not go early to the health facility due to economical constraints, 42% visited local health facility as a diagnosis was not made and 15% dueto non response to treatment for other health facility. Discussion: About 36% of study subjects were from chaudhary caste, which may be due to their socio-economic status, and their cultural practices. The details regarding this needs to be evaluated. The majority of subjects (95%) were from villages of sunsari, Morang and saptari, which is similar as reported by joshi et al in their studies. It was found that majority of study subjects were illiterate or have primary education and they were from low socio-economic status. Majority of study subjects (78%) had agriculture their main source of income; which is congruence with study 1 conducted by joshi et al. It was found that majority of subjects had their houses made up of mud and bamboo (Fus) with only ground floor. They used to sleep on ground flood (39%) and only 15% use mosquito net regularly. They also teemed pets like pig (24%), and other animals. Few subjects (19%) keep their animals in the same house on which they sleep and majority i.e. 95% clean their Houses with cow dung regularly. These all are due to the poverty and their cultural practices; and are source of breading sand fly. As kala-azar is a priority area of government for treatment and eradication, many programme are on action under government hospital as well as BPKIHS. Only 24% subjects reported that they knew the. Causes of kala-azar they do not know there the treatment is available, and only 41% reported that treatment available is free & 33% respondents reported that they know the preventive measures of kala-azar. These all are due to low educational level, lack of awareness among the public about kala-azar and attitude of public to wards traditional faithhealers. The economical problems are the main constrain of family for the treatment. Hence, for prevention, to decrease relapse rate and eradication of kala-azar, public

awareness i.e. Health education, IEC regarding diseases process and available services; and community participation is essentials for prevention and eradication of kala-azar. Bibliography:

1. Joshi DD, shrestha JD, pradhan SP, Joshi AB. kala-azar in morang district, epidemiological situation. Journal of Nepal medical Association; 1999; 12: 205-209.

2. Report of the Annual Internal assessment of malaria and kala-azar control activities VDRTC, EFCD, DHS; 1997.

3. Devkota UN. Descriptive epidemiolay of visceral Leishmaniasis in Nepal. JNMA; 1993. 4. Das ML. sandfly vectors of kala-azar. Paper presentation in workshop seminar on Entomology

and parasitology. Hetauda, Nepal. July-Aug, 1982. 5. Pradhan SP. phlenomine shadflies of Nepal and notes on their biology and distribution. J. Inst.

Med; Nepal; 19; 58-66. 6. Control of the Leishmaniasis. Report of a WHO expert committee. Technical report series, 793,

Geneva, WHO. 7. Koirala S, parija SC. kala-azar epidecuiology, diagnosis and control in Nepal: BPKIHS

monograph series 1998. 8. WHO/MOH, HMG. Annual Reort-2000. Epidecuiology and Disease control Division.

Kathmando Nepal.

REASONS FOR TURNOVER AMONG THE NURSES WORKING AT BPKIHS

Mehta*1 RS, Karki*2 P, Paudel *3 BH, Chaudhary*4 R

B.P. Koirala Institute of Health Sciences

Dharan, Sunsari, Nepal

Abstract:

Introduction: Conflict is a natural phenomenon and is inevitable in any organization. Conflict in nursing organizations leads to turnover of nurses. Conflict, however, can also be valuable to an organization since it promotes innovative and creative problem solving, clarifies issues, and allows underlying problems to rise to the surface. The Objectives of this study were to explore the factors influencing Job satisfaction among the nurses working at BPKIHS, to investigate the reasons which have influences nurses in their decision to leave BPKIHS and to suggest recommendations for a more satisfying working environment by aiding staff retention.

Methodology: It was hospital based cross sectional Analytical study, conducted among the nurses working at BPKIHS for more than six months at the time of study and those who have resigned from BPKIHS. Stratified simple random sampling method was used to select the nurses working in BPKIHS and purposive for the resigned nurses. Total 150 nurses were included in the study. Using pre-tested questionnaire the data was collected, fulfilling all the ethical considerations. The collected data was analyzed using SPSS-4 package.

Results: It was found that majority of nurses (68.7%) were less the 25 years, Unmarried (49.3%), have

job experiences less than 5 years (54.7%), from sunsari (48%), and living in quarter of BPKIHS (86%).

Career opportunity elsewhere, Chance for further education, Negative attitude of nursing leaders, In-

adequate salary and poor promotion opportunity are the Major reasons of nurses to leave or resign

from BPKIHS.

Conclusion: To retain the nurses or decrease turnover there is need of increasing salary, Job security provisions, Immediate starting of BN programme, fair evaluation system and clear promotion policy. This study is useful for nursing leaders as well as BPKIHS authority to take corrective action in time to improve the situation and prevent the future consequences.

*1

Mr. Ram Sharan Mehta,( Corresponding Author) Assistant professor, Medical-surgical nursing dept.

College of Nursing, Email: [email protected], *2

Prof. Dr. Prahlad Karki, HoD, Dept. of

Medicine and Hospital Director, *3 Dr. Bishnu Hari Paudel, Asso. Professor, Dept. of Physiology, *

4 Mr.

Ramanand Chaudhary, Master in Nursing, Paediatric Nursing dept. B.P. Koirala Institute of health

sciences, Dharan, Sunsari, Nepal.

Introduction: Health care delivery system, both curative & preventive, heavily depends on nursing

profession. The nurses are to pass on to a strong, socially relevant, vocationally satisfied profession for

future generation of nurses and citizens 1

.

Twentieth century saw nursing as a profession, and a distinct discipline. Many nursing theories were propounded, research work was undertaken, standards were set by different nursing associations, and educational levels of nursing were streamlined, current issue and trends found their place in nursing and expanded roles of nursing practice paved the way towards new directions for nursing with increased autonomy 2. Job satisfaction is a critical issue for nurses and hospital administrators. However, nurses job satisfaction

has not been measured adequately in most hospitals of Nepal. Since the onset of restructuring

measures, despite numerous and conflicting comments from nurses and nursing managers about

satisfaction and dissatisfaction with these measures. A shortage of nurses negatively affects the safety

and effectiveness of services provided. Job–satisfaction varies intensively with staff turnover.

The desire to care for people, a family history of professional health care work, and security in career

choice are documented reasons for entering nursing. Reasons for leaving include: workload, unsafe

work environment, and harassment 3.

As per the annual report of BPKIHS, the number of nursing staff working in BPKIHS in 1993/1994 to

2003/2004 was 67, 94, 105, 116, 151, 224, 282, 257, 244, 327 and 415. The accurate record of

resignation of nurse’s year wise from 1993 was not available but as per the mentioned record number of

nurses (staff nurses and nursing officers) resigned for BPKIHS were: in BS 2056–1, 2057–17, 2058–52,

2059–68, 2060–35 and in 2061 BS 7. This evidence shows high turn over of nurses working at BPKIHS.

Objectives: The Objectives of this study were to explore the factors influencing Job satisfaction among the nurses working at BPKIHS, to investigate the reasons which have influences nurses in their decision to leave BPKIHS and to suggest recommendations for a more satisfying working environment by aiding staff retention.

Methodology: It was Hospital based cross sectional Analytical study design, conducted among the

nurses working at BPKIHS and the nurses who resigned from BPKIHS. All the nurses working in BPKIHS

for more than 6 months, at the time of study and who have resigned during the study period constitute

the target population of the study. Total population of the study was 256. Sample was comprise of all

the nurses working in BPKIHS who fulfill the set criteria and all the nurses who resigned during the study

period and willing to participate in the study were included and 150 Nurses were included in the study.

Nursing faculties and ANMs were not be included in the study. Nurses who give consent to participate

were only included in the study.

Stratified simple random sampling method was adopted to select the sample from the working nurses

and purposive sampling technique were used for resigned nurses. Semi-structured Questionnaire (Job

satisfaction and communication survey Questionnaire) developed, tested and used by Bonnie W4,

Kunaviktikul5

(Turn over of Professional Nurses tool), and Brannon D6

(Job satisfaction and Turn over

tools) were used after modification to collect the data

The tool was given to nursing service administrators, hospital administrators, psychologist and nurse-researchers for content validity. Necessary modification was made after the feedback from the concerned experts. Pre-testing was done among 20 subjects and found practicable. Some modifications were also made after pre-test. Written permission was obtained from the concerned higher authority. Lists of nurses working in all the units/wards were prepared separately. By using stratified simple random sampling technique the specified numbers of Nurses were selected from each ward. Using purposive sampling technique all the nurses resigned during the study period was also included in the study. After taking verbal consent from them individually a questionnaire and blank self addressed envelope was given. They were requested to fill up the Questionnaire and put in envelope and seal it; and return to the Investigator.

Individual responses were scored. A total score was then obtained for each factor on the questionnaire

by adding the numerical responses on the Likert scale.

Once all the data were collected then, focus group discussion was arranged. Focus groups i.e. one group for nursing officers, one group for senior staff nurse and four groups for staff nurses were arranged. In-depth discussion was made on focus group on various components of Job satisfaction and turnover. Feedback and suggestions were collected and analyzed.

Verbal informed consent was obtained from each subject before giving her Questionnaire. The

information given by subjects was kept confidential and used only for this study. Anonymity in the

Questionnaire was maintained. Self-addressed envelope also facilitates confidentiality.

The data collected was based on the opinion of the working nurses, hence it might not reflect true

picture, but there is not feasibility of contacting each nurses, who left. Hence, we have to rely on

data/opinions given by currently working nurses.

Results:

Socio-demographic profile of the subjects: The majority of the nurses i.e. 68.7% were of less than 25 yrs

of age; only 14% were of more than age 35 yrs. About half of the subjects were unmarried. Among the

married only 52% was living with their husband.

About half of the nurses had experiences of nursing for less than 5 yrs. and only 9.3% had experiences of more than 20 yrs. Majority of the nurses i.e. 86% were staying in the residence / Quarter provided by BPKIHS as this institute is residential institute having very good facility of quarter for employees. About half of the subjects were from sunsari district, as there is three municipalities i.e. Dharan, Ithari and Inruwa lie in this district.

Motivating factors to work in BPKIHS: The main motivating factors to work in BPKIHS are Big institution

or university (51.3%), Quarter facilities (48%), safe place (48%), chance of further education (32%),

educational benefits (25.3%), Non-transferable job (23.3), whereas only 9.4% only mentioned that pay

scale is motivating factor. Only 48% subjects reported that they would stick to nursing profession in

future. These findings clearly illustrate the reasons for turnover of nurses. Majority of the subjects (66%)

mentioned that they joined nursing profession, as they are intrested to be nurse; where as 55.3%

mentioned the reasons for joining nursing is easy access to job and 35% mentioned the parental force to

join nursing. In contradictory to this only 48% reported that they want to stick to this profession.

Job satisfaction among the nurses: Twenty-six items of job satisfactions were analyzed using four point

likert scale. Very few percentages of subjects were fully satisfied with the components of job-

satisfaction. Majority of the subjects were moderately satisfied or just satisfied with the available

facilities. The percentage of not satisfied at all with various comments of job-satisfaction is also high.

With pay scale none of the subjects were fully satisfied, 24.7% were moderately satisfied, 40% just

satisfied and 35.3 were not satisfied at all. Which clearly shows the need of incensement of salary. The

positive motivating factors to work in BPKIHS are, prestige of organization, work it self, responsibility,

quarter facilities and achievements. The satisfaction with pay scale/salary, monetary benefits,

recognition of good work done, promotion opportunity, general administration, nursing administration,

job description and evaluation system is not good.

More than half of the subjects (56.7%) mentioned that they want to serve in BPKIHS Less than 5 yrs only.

About 15% reported that they want to serve more than 15 years; this picture clearly illustrates the

higher incidences of nurses to leave BPKIHS. About 77% nurses were intrested to go abroad to serve,

which clearly illustrate the scope of nursing in world and may create manpower crisis in future. Majority

of the nurses (80%) were only just satisfied with nursing profession as carrier and 48% wants to stick to

this profession in future, where as 66% nurses became nurse with their own intrest. This picture clearly

illustrates the poor motivating job factors, which needs detailed exploration.

Reasons influence nurses to leave BPKIHS: The Turnover of nurses at BPKIHS is very high. The major

reasons influencing nurses to leave BPKIHS are: Career opportunity else where, further education

opportunity, Attitude of nursing leaders, frequent night duty, attitude of medical team., stress at work

place, pay scale / salary, poor promotion opportunity, and administrative problems.

Suggestions to improve nurses’ retention at BPKIHS: At present the high turnover of nurses is a burning

issues for nursing administration. It is crucial time to initiate the appropriate nursing action to take

corrective action, to retain the nursing manpower at BPKIHS. The main action needed for initiations are:

Increase the pay scale / salary, immediate starting the BN course at BPKIHS, investigate and eradicate

partiality and favorism, fair evaluation system, starting continuous in-service education program in each

specialty areas, routine clinical supervision system, strengthen inter and intra department

communication, and increase the moral of the nurses.

Improved communication, feedback both positive and negative, increasing socializing amongst the unit

members and the creation of a more relaxed working environment were suggestions proposed to

overcome the turnover found by mathew8 in her study. Similar suggestions were reported by the nurses

in this study to increase Job satisfaction and decrease turnover.

The details of the results are mentioned in table-I to IV.

Discussion:

Nurses’ turnover is expensive. It affects the safety and effectiveness of service in hospital. Recruitment

and retention of sufficient number of nurses to work is a major challenge for nursing administrators 8. A

recent survey of nearly 1,000 nursing homes estimated the annual turnover among nurses is almost 1 in

5, or 20% according to American nurse’s association9.

A study conducted by Irvine 16

, reported that, a strong positive relationship was indicated between

behavioral intentions and turnover; a strong negative relationship between job satisfaction and

behavioral intentions, and a small negative relationship between job-satisfaction and turnover.

Variables related to nursing job satisfaction, work content and work environment has a stronger

relationship with job satisfaction than economic or individual difference variables.

A study conducted by Davidson 18

among 736 hospital nurses reported that, important determinants of

low satisfaction were poor instrumental communication within the organization and too great a

workload. Intent to leave was predicted by the perception of little promotional opportunity, high

routinization, low decision latitude and poor communication. Predictors of turnover were fewer years

on the job expressed intend to leave, and not enough time to do the job well.

A study conducted by Symes 19

among 183 new graduates reported that, 47% new graduates had

unspecified personal stressors related to lack of confidence and discomfort, 35% with dying patients,

46.5% with personal finances, and 43% reported traumatic life events before the age of 16 and 50%

after the age of 16.

Mathews 8 found in her study that frequent night duty considered the highest scoring factors,

influencing nurse’s decisions to leave hospital. Which is similar to this study.

Psychological effects are immense, lack of participation in social activates leads to a feeling of Isolation,

for some nurses a good self image is hard to maintain due to chronic fatigue, anxiety results from going

to work in shift busy duty and feeling of neglect arise from inadequate time spent with family and

friends mentioned by Mathews8 in her study, which are similar to this study. Similar findings were

reported by Irvine16

and Davidson18 .

Implications: Nursing practice is based on mixture of research, anecdote, tradition, theory, and hunch.

Job satisfaction is a key indicator of good working environment, employee retention and management

of the institute. This study help to implement policies and practices to optimize staff satisfaction, staff

retention, quality care provision and co-ordination. The study also gives the insight and feedback to

nursing administrator and authority of BPKIHS to think the problem seriously and take corrective action.

The study also helps supervisors to change their attitude so that quality patient care can be provided.

This study emphasis the need of continuous in-service education in their respective specialty. The study

explores the immediate need to start BN Nursing programme at the institute. Regular interactions

between the supervisors and their subordinates are essential in fostering employee relationship that

increases the likely hood of productivity of organizations. The effective communication is essential in

any institute to eradicate the misconceptions and raise satisfaction. Finally, the result can be used for

planning and implementing the remedial measures to improve nursing service at BPKIHS, and decrease

the turnover rate of nurses.

Recommendations:

1. This study can be conducted in similar setting hospitals like: TUTH, BPKMCH, Bir-hospital, Patan

hospital, Manipal and others to compare the results.

2. This study can also be conducted at similar government hospitals to find the differences in

results.

3. Periodically, conducting this type of study gives insight to take corrective action in time. Hence,

this type of study must be repeated every 3-4 years.

4. This study can be conducted among nursing faculties and ANMs working at BPKIHS as well as

other institutions.

5. Similar study can be conducted among doctors and other technicians and paramedics to

compare the differences.

Problem Faced During The Study:

Following problems were encountered during the study: 1. Few respondents were hesitated to give the answers of the questions.

2. It was found difficult to grade the satisfaction level and perception level because different

individual perceives it differently.

3. Measurement of individual differences found difficult to grade.

4. It was found difficult to grade the facilities available with the subjects and to recall the past

events. It is also difficult to measure quantitative form exactly.

5. Some problems were encountered for arranging the focus group discussion, because of busy

schedule of nurses and shift duty.

Limitations of the study:

The limitations of the study are as follows:

Subjects: the staff nurses, senior staff nurses and nursing officer / sisters were only included in the

study. The nursing faculties, senior nursing officers and ANMs were not included in the study.

Period: The data collection period was from 1 August 2005 to 30 August 2005.

Sample size: Only 150 nurses were involved in the study.

References:

1. Mehta RS Nursing. A Challenging Profession. VISION, B.P. Koirala Institute of Health Sciences; Dharan, Nepal; 2000: 30-31.

2. Mehta RS. VISION: SOUVENIR, B.P. Koirala Institute of Health Science, Dharan, Nepal; 1999: 1-3.

3. Duffield C, Pallas LO, Aitkin LM. Nurses who work outside nursing. J. Adv. Nurs. 2004. 47 (6): 664-71.

4. Bonnie W. Manual for Job communication satisfaction Importance (JCSI) Questionnaire. 1980. B.W. Grant. Dalat-Batter-Batter. ( www.samuelmitt.edu)

5. Kunavikthikul W, Nuntasupawat R, Srisuphan W, Booth R2. Relationship among conflict, conflict management, Job satisfaction, intent to stay, and turnover of professional nurses in Thailand. Nursing and Health Science. 2003; (2): 9-16.

6. Brannon D, Zinn JS, Mor V, Davis J. An Aploration of Job, organizational, and Environmental Factors Associated with high and low Nursing Assistant Turnover. The Gerontologist. 2000; 42(2): 159-168.

7. Diane MI, Martin GE. Model of nurse Turnover behaviors. Nursing research. 1995; 44(4): 246-251.

8. 9. Mathews N, Campbell J, Nursing staff turnover in intensive care. Intensive care 1990. 10. Sherman DW. Nurses’ stress and Burnout. AJN. 2004; 104(5): 48-55. 11. Pataliah BA. Aptitude about nursing among nursing profession. NJI. 2004, XCV (11):

253-255. 12. Cavanaugh SJ, coffin DA. Staff turnover among hospital nurses. J. Adv. Nurs. 1992 nov.;

17 (11): 1369-76. 13. Dimeglio K, padula C, piatek etal. Group cohesion and nurse satisfaction: examination of

a team-Building approach. J nurs Adm. 2005, 35 (3): 110-120. 14. Lu H, while AE, Barriball KL. Job satisfaction among nurses: a literature review. Int. J.

nurs. stud. 2005; 42 (2): 211-27.

15. Lageson C. Quality focus of the first line nurse manager and relationship to unit outcomes. J. Nurs. Care. Qual. 2004; 19 (4): 336-42.

16. Maureen FB, Norma ET. Measuring nurse job satisfaction. JONA. 2004; 34(6): 283-290. 17. Irvine DM, Evans MG. Job Satisfaction and turnover among nurses: integrating research

findings across studies. Nurses Res. 1995; 44 (4): 246-53.

18. Yaktin, Umayma S. Personal characteristics and Job satisfaction Among Nurses in Lebanon. Journal of Nursing Administration. 2003; 33 (718): 384-390.

19. Davidson H, Patricia H., Crawford S. etal. The effect of Health care reforms on Job Satisfaction and volunt any Turnover among hospital-Based Nurses. Medical care. 1997; 35 (6): 634-645.

20. Symes L, Krepper KR, Lindy C etal. Stressful fife Events Among new nurses: Implications. for retaining new graduates. College of Nursing, Texas Woman’s University, Houston. (Internet).

Table: - I

Distribution of subjects according to the various motivations Factors to work in BPKIHS

N=150

S. N. Item/Particular Percentage (%)

1. Motivating factors to work in BPKIHS (MR)

a. Pay scale 9.3

b. Quarter facilities 48.0

c. Safe – place 48.0

d. Non – transferable job 23.3

e. Big institution /university 51.3

f. Educational benefits 25.3

g. Chance for further education 32.0

h. Others 10.0

Table: -II

Reasons for choosing nursing profession (MR):

N=150 S. N. Item/Particular Percentage (%)

1. Reasons for choosing nursing profession (MR):

a. For easy access to Job 55.3

b. Because my parents wanted me to join nursing 36.0

c. I was very interested to become a nurse 66.0

d. There is glamour in this profession 8.0

e. Due to financial problems 4.0

f. Thinking I would join other profession later 4.7

g. Due to peer pressure 4.0

I. Others. 8.0

Table – III

Reasons for turnover /resignation of nurses at BPKIHS

N=150

S. N. Reasons for turnover of nurses Percentage (%)

1. No Responses (N = 35) ---------

2. Responses (N = 115) 100

a. Carrier opportunity else where 60

b. For further education 55

c. Permanent in HMG 52

d. Poor cooperation & attitude of nursing leaders 48

e. Unfair evaluation 43

f. Poor promotion opportunity 42

g. Favorism and partiality from supervisors 41

h. Rules and regulations not transparent 35

I. Salary/pay inadequate 32

Table – IV

Suggestions to improve staff retention at BPKIHS

N=150

S.N. Suggestion for staff retention Percentage (%)

1. No response (N=36) ...........

2. Responses (N=114) 100

a. Increase salary/pay scale 80

b. Job security (permanent) 75

c. Avoid partiality & favorism 62

d. Immediate starting of BN course 60

e. Fair and proper facilities for nurses 57

f. Adequate further education opportunities 57

g. Regular & impartial evaluation system 56

h. Continuous in-service education in related are as 55

I. Establish transparent rules for promotion 42

Socio-Demographic and Knowledge profile of the Renal Failure patients under Haemodialysis at BPKIHS

Mehta 1RS, Sharma2Sk B.P. Koirala Institute of Health Sciences

Sunsari, Dharan, Nepal

Abstract

Introduction: Haemodialysis (HD) is a mechanical process of removing waste products from the blood

and replacing essential substances in patients with renal failure. BP Koirala institute of health science

(BPKIHS) is the only center outside the Kathmandu, where HD service is available. In BPKIHS PD started

in Jan.1998 and HD started in August 2002. Till September 2003 about 278 patients received HD. Day by

day the number of HD patients is increasing in BPKIHS as with institutional growth.

Objectives: The objectives of the study were: to find out the Socio-demographic characteristics of the

patients, to explore the knowledge of the patients regarding disease process and Haemodialysis and to

identify the problems encountered by the patients.

Methods: It was hospital based exploratory study. The population of the study was the clients under HD

and the sampling method used was purposive. Fifty-four patients undergone HD during the period of 17

July 2002 to 16 July 2003 of complete one year were included in the study. Structured interview

schedule was used for collect data after obtaining validity and reliability.

Results: Total 54 subjects had undergone for HD, having age range of 5-75 years and majority of them

were male (74%) and Hindu (93 %). Thirty-one percent illiterate, 28% had agriculture their occupation,

80% of them were from very poor community, and about 30% subjects were unaware about the disease

they were suffering. Majority of subjects reported that they had no complications during dialysis (61%),

where as 20% reported nausea and vomiting, 9% Hypotension, 4% headache and 2% chest pain during

dialysis.

Conclusions: The study will help in the management and early prevention of renal disease and evaluate

aspects that will influence care and patients can select mode of treatment themselves properly.

Key: Renal failure, Haemodialysis

Authors: Mr. Ram Sharan Mehta, (Corresponding Author) Asst. Professor, Medical-Surgical Nursing

Department, Email: [email protected], Dr. Sanjeev Sharma, Additional Professor, In-charge,

Nephrology Unit. B.P. Koirala Institute of Health Sciences, Sunsari, Dharan, Nepal

Introduction:

Haemodialysis (HD) is a mechanical process of removing waste products from the blood and replacing

essential substances in patients with renal failure. First artificial kidney developed in Netherlands in

1943 AD First successful treatment of CRF report in 1960AD, life saving treatment begin for CRF in

1972AD. In 1973AD, Medicare took over financial responsibility for many clients and after that method

become popular.

BP Koirala institute of health science (BPKIHS) is the only center outside the Kathmandu, where HD

service is available. In BPKIHS PD started in Jan.1998, HD started in August 2002. Till September 2003

about 278 patient received HD at BPKIHS.

The majority of population in Nepal has agriculture their main occupation and are not conscious about

health due to lack of education. The economic status of the Majority of people is low. The average

expenditure of one cycle (event) of dialysis is about Rs.3000. and requires 3-4 cycles per week.

The disease conditions like ARF, CRF, and ESRD occurs mostly due to the lack of health consciousness. If

the awareness among the public can increase, the incidence of disease can be decreased. The

availability of the HD for client with ESRD has become more prevalent. Generally self-selection is the

only criterion used now. As a result, the population receiving HD now represents a wide cross-section in

terms of age, rehabilitative-potential, and socioeconomic status.

Expertise and technical facilities exist to perform all modalities of treatment for ESRD, but such

treatments are costly. Renal transplantation costs Rs.250, 000, azatguiorube costs Rs. 10,000 a year, and

cyclosporine costs RS. 1,00,000 against this per capita income of Rs. 12,989 per year. About 36% of the

population earns less than Rs. 5040 and only 2.2% earn more than Rs, 50,000. The country can not

afford the treatment of ESRD1.This figure is of India the situation is very poor in Nepal, hence it is not

possible for general Nepalese to perform HD regularly. 30% CRF is due to diabetic nephropathy and 10%

each to hypertension nephropathy and chronic pyelonephritis. Diabetes and HTN are increasingly

prevalent in the population8.

No, such type of study regarding HD was available, hence the investigator decided to conduct study on

“socio-demographic and knowledge profile of the renal failure patients under HD at BPKIHS.

Materials and methods:

It was a hospital based exploratory study. The population of the study was the clients under HD and the

sampling method used was purposive. All the 54 patients under gone haemodialysis during the period

of 17July 2002 to 16July 2003 of complete one year were included in the study. Structured (open and

close ended) interview schedule were prepared and content validity of the tool were maintained by

consulting with the expert doctors and nurses from the concerned field. Reliability was established by

pre testing the instrument among 5% subjects at BPKIHS. One subject is only once interviewed during

their dialysis period. The rights of subjects were protected by explaining them clearly and properly

before asking the questions and confidentiality maintained. Informed written consent was also

obtained from the clients. The unit In-charge and the nurses were given orientation regarding the data

collection. The collected data were analyzed using statistical tools.

Results:

Total 54 subjects had undergone for HD during the one-year period. Among the 54 subjects the age

range were 5-75 Yrs, majority of them (74%) were male and Hindu (93%). Majority of subjects were

form Sunsari (33%) and Morang (39%) district; and illiterate (31%); having agriculture (28%) their main

occupation. Majority of respondents (80%) reported that they had no yearly saving. About 62% subjects

had renal problem for less than 1 year, and 6% had for more than 10 years. Maximum i.e. 72% subjects

were on HD for less than 3 month and 8% for 1-3 years. Many patients (48%) were expanding less than

3000 Rs. for one cycle of dialysis, where as 15% expand more than Rs. 5000 for one cycle. About 30%

subjects were unaware about the disease they suffering and majority of them were first explained by

doctors at BPKIHS (44%). Forty four percent subjects reported that thy do not know why dialysis had

started. Majority of subjects (61%), reported that they had no any complications during dialysis where

as some reported nausea and vomiting (20%) hypotension (9%), headache (4%) and chest pain (2%).

Similarly 57% subjects had no any complication at home; where as 17% had nausea and vomiting; 9%

headache and 9% weakness.

Discussion and conclusions:

Majority of subjects was male (74%), which may be due to more exposure of males to renal problems

and brought for treatment promptly. Majority of subjects were form Sunsari, Morang and Jhapa district,

which may be due to the catchments area of BPKIHS. Maximum subjects (57%) were form Nagapalika

i.e. Town (city); as there is more awareness to high literacy rate. It is seen that all educational level

subjects had renal problem. Majority of subjects were form low soico-economic brasket; which is similar

to the population of Nepal.

Along with CRF and ESRD, DM and HTN were associated with a great number of subjects; as these may

lead to CRF. About 62% subjects had renal problems for less than 1 year and receiving dialysis for les

than 3 month (72%); which may be due to early detection of cases and HD is used as therapeutic

approach. Thirty percent subjects reported that they do not had knowledge regarding the renal

problem they suffering with, 52% do not know the case of renal problem, these all are due to low socio-

economic status, low educational level, poor propaganda regarding renal problems, and poor

explanation by the health personals.

CRF leading to HD is a long battle for patients, required to make major and continuous adjustment, both

physiologically and psychologically. This study suggests that non-compliance with HD regimen were

common. The socio-demographic and knowledge profile will help in the management and early

prevention of disease and evaluate aspects that will influence care and patients can select mode of

treatment themselves properly1. This base line information obtained will aid to develop the

informational booklet for the patients; which will help in discharge teaching and managing complication

at home. Number of HD patients is increasing day by day, hence the obtained base line information will

aid in patient management.

References:

1. Chunlertrith D, seetaso K, wiengnon P etal. The effect of counseling on decision making on end-

stage renal disease on therapeutic modality selection. Journal of the international society

for peritoneal dialysis. Canada, 2002,22(2):38.

2. Black JM. Jacob EM. Medical-surgical Nursing, 5th edition, 1997, W.B, Saunders Company, USA.

3. Smelter Sc, Bare B.G. Burners and suddarths Textbook of medical-surgical nursing. 8th edi,

1996,Lippincott, USA.

4. Fauci AS, Braunwald EB, Isselbacher kJ, Ed. Harrison principles of internal medicine. 14th

edi,

1998, Mc graw- hill, New York.

5. Nursing procedure manual, Tribbuvan university teaching hospital, dept. of nursing, 2nd

edi.

2000, Kathmandu.

6. Tediosi f, Bertolkini G, parazzini fetal. Cost analyusis of dialysis modaliteees in Italy. Health

service managfement research, 2001,14(1): 9-17.

7. Edwards's crw, Bouchier IAD, Haslett c edi. Davidson's principles and practice of medicine,

churchil livimgstone, london, 1995.

8. Phipps wj, Long BC, woods, NF. Shafers medical surgical nursing. 7th

edi. 1980. CV Mosby

Company, London.

Analysis

Table I

Socio-demographic profile of the subjects

N = 54

S. NO. Characteristics. Number (%)

1. Age groups (In years):

Less than 40

40-50

51-60

More than-60

Range: (5-75 years)

11 (20)

14 (26)

18 (34)

11 (20)

2. Educational status:

Uneducated/illiterate

Primary/literate

Secondary (till SLC)

Higher (after SLC)

17 (31)

10 (19)

12 (22)

15 (28)

3. Occupation of the subject:

Agricultural

Service

House wife

Business

Student

Driver

Others

15 (28)

13 (24)

10 (19)

9 (17)

3 (6)

2 (3)

2 (3)

4. Yearly saving:

No saving (deficit)

Balanced

43 (80)

8 (15)

Less than 25,000 Rs.

More than 25,000 Rs.

2 (3)

1 (2)

5.

6.

7.

8.

Place of starting 1st

Dialysis:

BPKIHS

India

Kathmandu

Aboard (S. Arab, Quait)

36(67)

10(18)

6(11)

2(4)

Total cycle of H. D. till date:

Less than 5

5-50

51-100

More than 100

32(59)

15(28)

6(11)

1(2)

Average total expenditure at one time:

Less than 3000 Rs.

3000-5000 Rs.

More than 5000 Rs.

26 (48)

20(37)

8(15)

Average total expenditure on dialysis till date;

Less than 1,00,000

1-2,00,000

2-3,00,000

More than 3,00,000

23(42)

12(22)

8(16)

11(20)

9. Effects of Renal problem on family Income:

Yes (had effected)

No (had not effected)

38(70)

16(30)

Table – II

Knowledge profile of the subjects

N = 54

SN Characteristics Number (%)

1.

2.

3.

Knowledge regarding the renal problem

suffering with:

Have knowledge

Do not have knowledge

38(70)

16(30)

Opinion regarding curability of the disease

suffering with:

Curable

Not curable

Not sure

29(54)

11(43)

2(43)

First informant doctors:

BPKIHS

India

Kathmandu

Local practioner

24(44)

16(20)

4(8)

15(28)

4. Have knowledge regarding the cause of renal

problems suffering with:

Have knowledge

Do not have knowledge

26(48)

28(52)

5.

Wishes/ preferences regarding renal

transplant:

Likes transplant

Do not like/ wish transplant

No response (no wish)

9(17)

22(40)

23(43)

6. Future Plan of the subject:

Not decided

Haemodialysis (H.D)

Transplant (Renal)

Peritoneal dialysis (PD

28(52)

12(22)

9(17)

5(9)

1. EFFECT OF PLANNED EDUCATIONAL INTERVENTION AMONG THE ANMs WORKING AT BPKIHS REGARDING CERVICAL CANCER.

Pokharel N, Dhungana L, Shrestha N, Piya S, Mehta R S

Cervical Cancer, the 2nd commonest cancer among female is a major health problem in the World today. Carcinoma of the cervix accounts for 11% of all cancer. Cervical cancer accounts for 50 – 65 percent of all malignant tumors of the female reproductive tract. It is the second top carcinoma among women. The study was conducted to evaluate the change in the knowledge and attitude of Auxiliary Nurse Midwives (ANMs) working at B.P. Koirala Institute of Health Sciences (BPKIHS) regarding cervical cancer after educational intervention in 2003.

The objectives of the study were to assess the level of knowledge and attitude regarding cervical cancer, to provide structured teaching and cervical cancer to evaluate the effectiveness of the structured teaching programme by assessing the change in the level of knowledge after intervention.

The study was a single group pretest posttest interventional research design with 66 ANMS and it was census study. Data were collected using a Semi-structured questionnaire, 15 regarding knowledge and 6 regarding attitude about cervical cancer. The teaching module was distributed to ANMs to study followed by structured interactive session (SIS). Second time data was collected after two weeks of SIS. Data were analyzed using graph, tables and Z test to test the hypothesis of the study.

The results indicated that there was significant increase in the level of knowledge on cervical cancer among ANMs working at BPKIHS after educational intervention (P<0.001). Attitude was more or less similar before and after the Educational Intervention.

The study recommends introducing cervical cancer in the curriculum of ANMs educational programme, training the ANMs working in different part of the country on cervical cancer and using them to provide health education to the public.

Introduction and Review of the Literature Uncontrolled multiplication of cells of any part of the body either local or systemic or generalized form is known as cancer. Worldwide prevalence of c ancer is more than ten million (1) . Increase in tobacco consumption among population seems to be one of the reasons for cancer mortality. WHO indicates that more males (5.3 million) than fe male (4.7 million) developed a malignant tumor & 6.2 million died from the disease. More than half of Cancer patient belong to developing countries.

Cervical cancer, the 2nd commonest cancer is a major health problem in the world today. It is less in developed countries and more in developing countries. e. g. 47,000 in Europe, under 16,000 in North America, under 10,000 in Japan, 1200 in Austria more than 130,000 in China over 70,000 in India(1) .

Cancer is one and the 10th leading cause of death in Nepal. For tackling the problem of cancer the national cancer control programme is to be launched in whole of the country. In the cancer awareness community registry and orientation courses, the involvement of non-government organization (NGO) and professionals (paramedics) is very important. Sato states that in 2001, 300,000 number of Japanese died due to cancer, resulting in a mortality rate of 31% in Japan. Cancer ranks in the top common causes of deaths among adults' ages 35 to 84, which includes those in the workforce. (17)

In developed countries 75% of cancer cases are diagnosed & treated early where as in developing countries 75% are diagnosed in advanced stage and cure is less (1) Cervical cancer developed roughly in 2% of all women each year in the united state.

Among different causative factors, sexual behaviour has been identified as the major factor for cervical cancer. Risk is more among women who are exposed to first intercourse at early age or having numerous life time sexual partners. Male factor is important to this disease. Two to seven fold-increased risk of developing cervical neoplasia for a woman whose husband has previously been married to a woman with cervical cancer has been described. Hormonal factors in the etiology of cervical cancer is evidenced by multiple births .The role of possible cofactor, including the herpes viruses, hormonal factors and smiling are investigated. Long term use of oral contraceptives may be more complex to affect the risk of cervical cancer. In the study of risk factors for cervical intraepithelial neoplasia during 1994 to 1997 among South Western American Indian Women Thomas and Becker et al used multiple logistic regression analysis and found the strongest risk for CINII/III with papilloma virus type 16 infections,human papilloma virus infection, low income and history of any sexually transmitted disease. Low intake of either vitamins or betacarotine and deficiency in folacin (one of the B. Complex vitamins) especially among oral contraceptive users are identified as risk factors among cervical cancer.

The Harvard Centre for Cancer Prevention listed the percentage of cancer deaths due to tobacco, diet/obesity 30% each, sedentary life style, occupational factors, family history of cancer, virus and other biological agents, perinatal factors, growth 5% each and the rest reproductive factors, socio-economic status, environmental pollution, ultra violet radiation, drug, food additive, and contaminants in descending order (3)

In a cross sectional study of cervical cytological abnormality of 1050 women without hysterectomy, squamous intra epithelial lesions were more common among women infected with HIV virus than among uninfected women (18.8% vs. 5.3, P<0.001) .This is an important point to be dessiminated among public by the agencies working in HIV, cancer & health agencies.

The most common presenting features of cervical cancer are postcoital or inter-menstrual bleeding, a foul smelling vaginal discharge, anaemia, pelvic and leg pain, blood in urine, pain during urination, rectal bleeding tenesmus, cachexia & fistula formation in the later stage . Cervical cancer is hard, friable , irregular, enlarged, bleeds on touch or becomes fixed as the tumor spreads into parametria . Diagnostic test for cervical cancer is clinical presentation, cervical cytological examination (pap smear) (2) Pap smear

screening should begin when a women becomes sexually active or reaches 18 years of age. The screening should be done every 1 – 3 years after two normal annual smears up to the age 60. Retrospective study of histopathological specimens of 321 cases of gynecological malignancy in BPKMCH.During July 1999 to 2001 indicated almost all cases 84.73 % case of cervical cancer than,vulval ovarian, vaginal and endometrial cancer in descending order.

Radiation treatment of cancer of the Cervix with an optimal dose heals the cancer. The radiation dose therefore, must be adjusted to the tolerance of the individual patient. The megavoltage technique has altered the primary intracavitary radiation and complementary external radiation verses primary full pelvic external radiation and after shrinking of tumours additional intracavitary radiation (2)

Shibuya, Shinkai at el found that radical hysterectomy for uterine cancer causes physiological dysfunction and 6 types of living disabilities related to reproductive, urinary, sexual, movement due to lymphedema in lower extremity, intestinal movement and menopausal disorder. They developed the care model of clinical pass by changing process in these disabilities, based on ICFDH-2 (International Classification of Functioning and Disability, Beta – 2 drafts Full version WHO .

Sookhee, Jeungim et all states that Women with cervical Cancer expressed the condition in their life was a very distressing, stressful, difficult thing before cancer diagnosis. They felt it like a lie when they informed having Cancer and felt sorrow, shameful to have this disease, cried day after day for a few weeks. They felt fear like they could not be alive or could not be awaken, when they were moved into the operation room. They decided they would live positively under their families warm help and for people with difficulty in living such as disabled man. They understood the necessity of change in their live pattern such as diet, religion and thought .

Nurses care the cancer patient and can help for cost effectiveness. This stems from a decrease in length of hospital stay, along with the expansion and construction of out patient oncology health care services and out patient based community nursing services. They need to be trained in developing the role of oncology home care nurses, palliative care providers both within the hospital and in the home care setting.

Nurses also need knowledge about the normal functioning of the human body, the treatment methods and their side effects, the recent advances in the support system for cancer patient.

Some of the preventive measures of cancer are avoidance of early marriage and frequent sexual intercourse, restricting the number of children, maintaining genital hygiene, strict monogamous relationship, good obstetric care, better management of pelvic inflammatory disease, adequate intake of vitamin C & A, periodical clinical cytology screening of high risk cases and early treatment of cases, circumcision of male sexual partner and total hysterectomy for non-malignant condition.

Therefore, training of health professionals, paramedics, social leaders, and health education to general population is the only one and best approach to prevent, to diagnose and treat the case early. Awareness programme are being launched at various schools of Kavre and Chitwan district of Nepal (7)

Women's knowledge about cervical cancer and preventive strategies are significant to their screening attendance practice.The present study focuses on the ANMs who are the grass root health workers of the country working at BPKIHS.

Objectives and Hypothesis The objectives of the study were to assess the level of knowledge and attitude regarding cervical cancer, to provide structured teaching, to evaluate the effectiveness of the structured teaching programme by assessing the change in the level of knowledge after intervention. The null hypothesis of the study was "There will be no significant difference in the knowledge and attitude regarding Cervical Cancer among ANMS working at BPKIHS before and after the educational intervention."

Methodology The study was a single group pretest posttest intervenational research design. All the 66 ANMs were included in the study.

A Semi structured instrument was developed and given to experts for content validity. The developed tool was pretested and distributed to each subject maintaining ethical considerations such as informed consent, confidentiality and anonymity. The instrument consisted demographic variables, 15 questions related to subjects knowledge regarding causative factors, signs, diagnostic tests, treatment modalities and preventive measures of cervical cancer, 6 questions were on the attitude of subjects regarding cervical cancer.

A written teaching module was distributed to the subject to study followed by structured interactive session (SIS). Second time data was collected after two weeks of SIS.

Data were analyzed using descriptive as well as interventional statistics (Z test) and presented in table and graphs.

More than half of the ANMs were unmarried. Among married less than half married during 20 –24 yrs. of age & others after the age 25.

Knowledge of Subjects regarding Cervical Cancer Less than one third (29.41%) ANMs during pretest and all during posttest mentioned that cancer is abnormal multiplication of cells that destroy healthy tissue which is statistically significant (Z=5.41) and the null hypothesis was rejected (P<0.001)

More than half of ANMs during pretest mentioned only one factor causing cancer where as all during posttest mentioned multiparity AIDS and STDs, low intake of Vitamins A & C which is highly significant P<0.0001.

Majority of ANMS (80.88%) mentioned exercise,vaginal bleeding during menstruation and low abdominal pain while all in posttest added foul smelling, vaginal discharge and cachexia as clinical features of cervical cancer. (p<0.0001).

Majority of the ANMS (75%) responded that the diagnostic test of cervical cancer is biopsy in pretest where as all mentioned biopsy and Pap smear both during post test (P<0.001).

Half of respondents reported surgery as a treatment modality at pretest where as all reported radiotherapy and chemotherapy at posttest. The difference between pretest and posttest is statistically significant.

Very few ANMs during pretest mentioned avoidance of early sex & restriction of number of children as preventive measures of cervical cancer while all added better management of STDS and AIDS and avoidance of early sex and multiple sexual partners during post test.

Attitude of respondents Towards Cervical Cancer Majority of respondents, during pretest mentioned that cervical cancer is not spread while living with the victim unless there is sexual relations. The difference after educational intervention is statistically not significant (P>0.05)

About 2/3 of the respondents in pretest and all during post test felt necessary to perform Pap smear test which is significant P<0.0001.

Eighty four percent of respondent during pretest & 88% during posttest showed interest to care the cancer patient.

Thirty eight percent respondents would report to the mother and 40% spouse if they suffer from cervical cancer and some to close friend (23%) few to fathers both in pre test and post test.

Ninety percent of respondent during pretest and 98 during posttest felt useful to expend money in the treatment of cervical cancer.

Discussion Cervical cancer is a major health problem in the world today. It has engulfed lots of innocent women's lives in spite of it being curable if detected and treated early. In Nepal due to lack of adequate facilities, poverty, ignorance and inadequate awareness programs, cervical cancer goes unrecognized in its early stage. Being one of the preventable diseases, several strategies may be employed even at community level to combat the dreadful consequences of the disease. Keeping these in mind investigators selected ANM's as the study group so that they can at least refer the cases at early stage to tertiary centers and could launch the awareness program.

The finding of the study revealed similar finding as with study of impact of an intervention on the knowledge, attitude and practice of cervical screening in the population of 126Labanese/Armenian woman who received higher knowledge in women who received the intervention compared to those who did not. No difference in attitude or practice was seen (15) (P<0.05).

Conclusion and Recommendation In Nepal cervical cancer goes unrecognized in its e arly stage, and the reason may be lack of

adequate facilities, poverty, ignorance, inadequate awareness programme. Being one of the

preventable diseases, many women are suffering and are diagnosed in advanced stage only when

the health professional (ANMs) has inadequate knowl edge about meaning, symptoms diagnosis

and treatment of cancer during pre test. The knowle dge of laymen is supposed to be low than this

group. Therefore study suggests having more interve ntions programme for health professionals

as well as public.

The study recommends having similar study in larger population and among the general population.

Reference:

1. Acta Cytologica. The journal of clinical cytology and cytopathology 2002, 46( 4). 2. Fletcher Gh. Super voltage radiotherapy for cancers of the uterine cervix British Journal of

Radiology, 1902, 35, (5) 3. Harvard Report on cancer prevention; cancer causes and control 1996. 4. Shibayu M, Shinkai, F et al., Care Support System in Changing Process for Uterine Cancer

Patients with Difficulties of Daily Living Functions After Radical Hysterectomy. Proceedings of 1st International Conference Janpanese Society of Cancer Nursing. February 8- 10, 2003

5. Sato R. Cancer Nursing Embracing Changes in Health Care within the Japanese Culture. Proceedings of 1st International Conference Janpanese Society of Cancer Nursing. February 8 –10, 2003

6. A Grounded Theory Approach to the Process of life Adaptation in Women with Cervical Cancer. Proceedings of 1st International Conference Janpanese Society of Cancer Nursing 2003.

7. Christopherson WM, Parker JE. Relation of cervical cancer to early marriage and child bearing. N Eng, 1965; (273): 235 –239

8. Fidler hk, Boyes DA, Worth AJ. Cervical caner detection in British Columbia. Journal of Obstetric Gynaecology Br Commonn, 1908, (75): 392 –404

9. Sharma S, Aryal RP. Gynecological Morbidities at Rukum, and Experience of a Heath Camp. JNMA 1998; (37): 651–659.

2.

EFFECT OF TRAINING FOR NURSES WORKING IN TEACHING DISTRICT HOSPITALS

Mehta* 1 R S, lama*2 S, Parajuli*3 P B.P. Koirala Institute of Health Sciences

Dharan, Sunsari, Nepal

Abstract:

Introduction:

Knowledge, like muscles, must be nourished-constantly and used frequently to retain function. Learning

like motion, is more easily maintained if it’s momentum has not been interrupted. The objectives of this

study are to discuss the recent trends and development in various fields of nursing practice and update

knowledge and skills in concerned nursing practice areas for nurses working in these teaching district

hospitals.

Research Design and Methodology:

It was single group pre-test post-test education intervention research design conducted among the

nurses working in district and zonal hospitals of eastern Nepal in two slots in 2004 and 2005. Total 26

nurses (11 in first slot and 15 in 2nd

slot) were involved in one-week skill oriented training programme.

After pre-test training programme was taken. The collected data was analyzed using spss-4 package. The

TA, DA and other allowances were provided to the participants as per WHO policy.

Results: It was found that in average there is 46%

incensement in the score value in posttest. Regarding the programme evaluation most of the

participants evaluated the content, duration, methods, clinical posting very good.

Conclusions:

The participants were highly appreciated this workshop and requested to continue in future as it is very useful and practical.

Authors: *1 Mr. Ram Sharan Mehta, (Corresponding author), Asst. Professor, Medical-Surgical Nursing Department. *2 Ms Sami Lama, Asso. Professsor, Psychatric Nursing Department, *3 Ms Pushpa Parajuli, Asso. Professor, Medical-Surgical Nursing Department, B.P.Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal

Introduction:

Knowledge, like muscles, must be nourished-constantly and used frequently to retain function. Learning like motion, is more easily maintained if it’s momentum has not been interrupted. B.P. Koirala Institute of Health Sciences (BPKIHS) is a only one health sciences university of Nepal, situated in eastern region of Nepal at Dharan. BPKIHS has the provision to establish teaching district and facilitate the hospitals of eastern Nepal by providing the health Manpower, and training for health workers. The objectives of this study are to discuss the recent trends and development in various fields of nursing practice and update knowledge and skills in concerned nursing practice areas for nurses working in these teaching district hospitals.

Methodology:

It was single group pre-test post-test education intervention research design conducted among the nurses working in hospitals of eastern Nepal. One week training programme was arranged for nurses working in teaching district hospitals of BP Koirala Institute of health Sciences (BPKIHS) from eastern Nepal. After approval of the project from WHO, the first slot training was arranged in BPKIHS on 1-7 Dec. 2004 and second slot on 13-19 Nov. 2005. In the first slot 11 Nurses and in 2nd slot 15 nurses were participated. After obtaining official permission from Eastern regional health director, the information with all detailed programme was circulated to the concerned selected participants. On the first day after inauguration session, the Details of the programme were highlighted to all participants. In the morning session participants were posted in the specialty clinical areas like: Emergency, ICU, CCU, Psychiatric, Antenatal, Labour, NICU, PICU, MICU, in rotation from 8 Am-12MD, in rotation. Daily from 2 pm to 5 pm the theoretical and demonstration classes were arranged in training hall. The availability of refreshment, lunch, and dinner along with residence facilities was arranged in the institute premises. After the pretest the training was started. At the end of training post-test was taken. The collected data was analyzed using spss-4 package. The results obtained and conclusions drawn are presented.

Methods used during the workshop:

Training programme conducted by involving faculty from various departments such as family medicine, Anesthesiology and Nursing. During the training programme teaching learning methods used were Structural interactive session, Presentation, Hospital/Field visit, Demonstration, Simulation, Group discussion and Clinical posting in various supper Specialties areas. A.V. aids like: OHP, Posters, Pamphlets, Handbooks, Resource materials, multimedia (LCD), and demonstration were used to facilitate learning. List of topics covered in training Program: Introduction to Nursing, Nursing Profession & Hospital, Effective communication, Ethical and legal aspects in nursing, & patient’s right. Recording reporting and nursing audit, Counseling. Care of patient with HIV/AIDS, hepatitis ‘B’ & STD, Need of hospitalized patient’s and their relatives, Cardio Pulmonary Resuscitation, Concept of IMCI. Psychological aspects of nursing & IPR, Organizational behaviour. Snake bite, Legal aspect of abortion. Supervision, Introduction to Reproductive health, Patient assignment system, Stress and its management, Poisoning. Nosocomial infection/Universal precaution, Evaluation and monitoring system while students posted in various teaching district hospitals,

Triage/Disaster management, Burn injury and its management, Care of bed ridden/critically ill patients, Quality assurance in health care and Public relation, NGO/INGO & others organization.

Results:

Total 26 nurses were participated in this training programme from various district and Zonal hositals of eastern Nepal like: Dhankuta, Ilam, Bhadrapur, Inruwa, Biratnagar, Ithari and Sagarmatha Zonal hospitals. It was found that in average there is 46% increasement in the score value. The details of the findings are dipcted in table I & II. Strengths of workshop:

1. Well Planned/ Managed training =54 %

2. Interactive T/L Process = 45 %

3. Contents covered useful = 33%

4. Well selected topics = 18%

5. Clear Language = 18 %

6. Conducive Environment Maintained = 18 %

7. Good IPR between Teachers and participants = 13 %

8. Clinical posting is very useful = 13 %

9. Discussion & demonstration = 9 %

10. Allowances provided beneficial =7 %

11. Accommodation provided = 7 %

Weakness of workshop:

1. No responses/ No complains – 73.2 %

2. Duration of training needs to increases – 13 %

3. Needs more group work – 13 %

4. Visual materials needs to added – 7 % Suggestions/ Recommendations for further improvement:

• No responses (No suggestion) = 86.5 %

• Continue in future = 27 %

• Increase duration of training = 18 %

• Focus on disease process = 9 %

• Involve More nurses = 9 %

• Group work to be added = 9 %

Discussion and Conclusion: Overall it was very interesting and interactive training programme. All

participants were actively participated in theory as well as clinical areas. All the set objectives were met.

As suggested by participants they would like to have this type of training programme on regular basis.

This training is helpful to improve professional knowledge and skill in the field of nursing. Nursing faculty

also strongly recommended having this type of training programme in future.

Plan for follow-up mechanism: Faculties from college of nursing would visit time to time to all districts

hospitals, when the students are posted. Faculty would take suggestions and feedback from the nurses

working in teaching district hospitals for the future improvement of the training programmes. Nursing

faculty also willing to organize next training programme in future as per need of the teaching district

hospitals.

Acknowledgement: This training was completed with the financial assistance of WHO and technical

support from BPKIHS. Hence, we heartily express our sincere thanks to WHO and BPKIHS authorities for

their support and cooperation.

Refrences:

20. Lotka F. The importance of worker, staff and patient participation in hospital evolution.

Work hospitals and health services. 35(3): 20-23.

21. Sharma S, copra S. Hospitalized patients need for information. NJI 1997,98(11): 247-248.

22. Bhaskaran VP, Satyashankar P, Patankar RP. Study of the utilization Pattern of hospital

based health Insurance plan targeted towards lower socio-economic group. JAHA. 16(1): 5-

9.

23. Bedi S, Arya S, Sharma RK. Patent expectation survey – A relevant marketing tool for

hospitals. JAHA.16 (1): 15-24.

24. Amin TS, Qadri GJ. Cost Evaluation of construction at 500 Bedded Tertiary care teaching

hospital. Journal of Academy of Hospital Administration 1999; 11(2): 13-19.

25. Kumar R. Medical documentation- patient satisfaction document. JAHA: 15 (1): 54-56.

26. Oconnel BO, Warelow PJ. Challenges of measuring and linking patient outcomes to nursing

interventions in acute care settings. Nursing health science. 2001, 3(3): 113-7.

Table – I

Pre Test/ Post Test Score Analysis N= 26

PRE- TEST POST –TEST

Full Marks 60 60

Marks obtained

Av (mean)

18.5 (30%) 46 (76%)

Minimum 4 (6.6%) 41 (68%)

Maximum 43 (71.6%) 60 (100%)

Range 4-43 41-60

Table – II

Program Evaluation by the participants N= 26

Particular Responses

F/G/E* P.A.G* N.P*

Content 100 00 00

Duration of Training 100 00 00

T/L Methods used 80.0 6.7 13.3

Clinical posting 80 20 00

Use of T/L Materials 66.7 33.3 0

Language 33.3 60.0 6.7

Environment 53.3 47.7 00

Refreshment 73.3 26.7 00

Accommodation 26.7 60.0 13.3

Key: * F/G/E= fully satisfied/good/Excellent.,

PAG= Partially / Average//Good,

NP= Not good / Partially satisfied

Proposals:

B. P. Koirala Institute of Health Sciences, Dharan Nepal

APPLICATION FORMAT FOR RESEARCH GRANT

Section–A

1. Title of the research project:

Family Burden of the People Living with AIDS Getting Treatment in BPKIHS

2. Name and designation of:

a. Principal investigator:

Name: Mr. Ram Sharan Mehta

Designation: Asst. Professor, Medical-Surgical Nursing Department

S.N. Name Designation Department

1. Prof. Dr. Prahlad Karki HoD Medicine

2. Dr, Rabin Shrestha Asst. Professor Medicine

In-charge, Tropical and Infectious Disease Unit

3. Expected duration of the proposal: 1 Year

4. Amount of grant in – aid asked RS. = 25,000/-

5. This is new project: Yes.

Declaration 1. I/we have read the terms and the terms and conditions of BPKIHS research

grants, and agree to abide by them.

2. I/we agree to submit, within three months from the date of termination of the project, a report on the work done.

3. I/we agree to maintain a stock book for purchases made for he project. I/we shall submit the complete statement of account within three months of the termination of the project, and at any other time as required by the accounts section.

4. I/we agree to acknowledge the grant in any publication resulting from the project if it is approved for financial assistance.

5. I/we declare that no research grant is already available for the research project from any other source.

6. I/we declare that the project will be conducted as per the highest ethical standards applicable to animal/human experiments.

Signatures (with seal and date):

Principal Investigator Signature Date

Ram Sharan Mehta ……………………………………………………… Co-investigator Signature Date Prof. Dr. Prahlad Karki …………………

Dr, Rabin Shrestha ………………..

Remarks form the HoD of the Principal Investigator:

Date: Signature & Seal of the HoD

Remarks for the HoD of the Co-investigator:

Section-C

Details of the research project

1. Title of the research project

Family Burden of the People Living with AIDS Getting Treatment in BPKIHS

2. Objectives.

General Objectives:

To find out the family burden of the people living with AIDS getting treatment in BKIHS

Specific Objectives:

5. To find out the demographic profile of the people living with AIDS (PLWA) and their family

members.

6. To explore the principal care providers problems of the people living with AIDS.

7. To find out the association between demographic variables and family burden. 8. To suggest the ways and means to develop and Implement the strategies for better patient care.

Null Hypothesis:

There will be no association between family burden and caregiver characteristics and social

stigma.

3. Summary of the research project.

The Family: The concept of family need not be limited to ties of blood, marriage, sexual partnership or

adaptation. Any group whose bonds are based on trust, mutual support and a common density may be

regarded as a family. All families, traditional or non-traditional, can help stop AIDS spreading by making

sure that their members understand and action the facts about HIV and safer behavior and if on of their

members does fall ill with AIDS, families are often the best sources of compassionate care and support.

It will be exploratory research study design, conducted among the caregivers’ family

members of AISDS clients getting treatment at BPKIHS, selecting 30 subjects using continent

sampling technique. The data will be collected using interview schedule and focus group

discussion along with he use of Family Burden Assessment Scale and the collected data will

be analysed using SPSS-10.5 and STATA software package, conclusion will be drawn.

4. Review of the literature pertaining to the project.

Burden is one of the most commonly used variables in care giving research both as a predictor and as an outcome. However, much published research has identified the determinants in the effort to predict or explain caregiver burden. Several definitions of caregiver burden have been defined in the literature. Zarit and colleagues1 defined caregiver burden, an outcome measure, as 'the extent to which caregivers perceive their emotional or physical, social life, and financial status as suffering as a result of caring for their relative'. Caregiver burden might be defined as a predictor such as 'an external demand or potential threat that has been appraised as stressor'. Furthermore, caregiver burden might be defined as 'the consequences of the activities involved with providing necessary direct care to an ill relative or friend that result in observable and perceived costs to the caregiver2. Caregiver burden is a multidimensional phenomenon reflecting the physical, psychoemotional, social and financial consequences of caring for an impaired family member. Based on Donabedian3, who originally proposed the structure, process, outcome framework for the purpose of quality assessment, and the Outcome Model for Health Care Research that extended the work of Donabedian, burden of care of PLWHA can be linked to an outcome of care. Structure, which equals 'input' of care, related to non-clinical influences on outcomes is composed of two categories: (i) characteristics of the caregiver; and (ii) characteristics of the patient. The latter are being the stronger predictor of caregiver outcomes. The process of care is patient self-care and self-care burden. The outcome of care is caregiver burden and quality of life of caregivers. Caregiver characteristics that might influence caregiver outcomes include age, gender, socioeconomic status, duration of caregiving and family relationship between the patient and the caregiver. Many researchers have reported that caregiver characteristics have inconsistent effects on caregiver burden. Some studies have found that younger caregivers experience greater burden than older caregivers4 In contrast, Reinhard did not find any associations between caregivers' age and overall burden.5

The evidence from cross-sectional studies indicates that female caregivers are more likely to experience burden than are male caregivers.4 However, researchers also reported that the caregivers' gender was not associated with burden.5 Family income was not associated with objective burden,6 subjective burdens or overall burden.8 Moreover, in the study that investigated caregiver–patient relationships, the findings have shown that spousal caregivers experienced greater personal burden than adult daughter or son caregivers.7 The length of time in the caregiving role has yielded various findings as to caregiver burden. The caregivers' ability to tolerate problem behaviours increased with time as disease progressed in caregivers of dementia patient.1 Conversely, Gaynor14 found feelings of perceived burden to be higher among women who had been involved in caregiving for an extended time. Patient characteristics that have been cited in the literature as having an influence on caregiver outcome include patient's age, ADL, activity of instrumental tasks and stigma. Few studies within the caregiving literature have evaluated patient's age and caregiver burden. No studies were found in the relation of patient characteristics and burden of HIV/AIDS caregivers in Nepal. The effects of societal stigmatization, as well as the degree of caregiving demands, might become overwhelming for the caregivers.9 Stigma attached to HIV/AIDS and the association of HIV infection with sexual practices, with injection drug use and with death have placed the disease in societal taboos. In Nepali culture, the perception of AIDS as a frightful contagious disease, resulting from immoral behaviour, leads to the view that HIV/AIDS patients are 'bad people'. The family caregivers felt that they are shunned by people around them, including their family members, relatives, friends and health-care providers, as well as society. Caregivers of HIV/AIDS patients share some of the burdens related to a stigmatized person. Mushonga10 found that stigma was associated with perceived burden in HIV/AIDS caregivers in Zimbabwe. Caregiving is a demanding responsibility. Research in caregiving seems to be an accumulation of diverse points of views. Over the past decade, many studies have emphasized the negative consequences of caregiving, generally referred to as caregiver burden,17 caregiver stress and caregiver strain. Some studies used positive terms such as caregiver esteem, caregiver satisfaction and uplifts of caregiving. Other research used neutral terms including health, mental-health outcomes, caregiver appraisal, caregiver well being and quality of life.11 The current situation of HIV in Nepal is different from when the first case was diagnosed in

1988. There are gaps and challenges to be addressed in the fight against HIV and AIDS. Nepal

is low prevalence country for HIV and AIDS (0.5 percent). However, some of the groups show

evidence of a concentrated HIV epidemic e.g. sex workers 19.5 percent, migrant population 4-

10 percent, and intravenous drug users (IVDU's), both in rural and urban areas, 68 percent.

Since 1988 when the first case was diagnosed MoHP/DoHS and different stakeholders came

forward to address HIV and AIDS issues. The main focus was given to preventive aspects. In

1995 MoHP in consultation with different stakeholders developed a policy for the control of

HIV and AIDS. However, the activities were implemented in a sporadic and disorganized

manner.

In Nepal, knowledge about family caregiving of PLWHA is sparse and research in family caregiving is in the infant stages. Prior studies in Nepal indicate that the most common place for adult AIDS persons to spend the advanced stage of their illness is in their parents' homes and the most common caregiver is a parent—particularly a mother—providing care for almost two-thirds of the Nepali adults who died of AIDS. For married PLWHA, the spouses, especially wives, often play a major role. As more complex care is offered at home, mothers and wives will continue to be the main caregivers of PLWAs.12 Similarly, in other countries, such as Uganda and Zimbabwe, researchers found the same phenomena of parents as the primary caregivers of PLWHA. PLWHA who are single (or non-partnered) often have no one on whom they can depend for care and support other than their parents, siblings or other relatives. Hence, many PLWHA who live away from their place of origin are likely to return to their family home when they can no longer earn a living or when they need extensive care because the symptoms worsen.2 The new strategy spotlights the following main areas: Vulnerable groups, Young people,

Treatment, care and support, Epidemiology, research and surveillance and Management and

implementation of an expanded response

Broad political commitment, a multi-sectoral approach, civil society involvement, public-private

partnership, reduction of stigma and discrimination against people infected and affected by HIV/AIDS

and human rights based approach have been outlined as some of the guiding principles in the

development of the strategy. HIV infection has taken root in South Asia and poses a threat to

development and poverty alleviation efforts in the region. HIV infection is fueled by risk behaviour,

extensive commercial sex, low condom use and access, injecting drug use, population movements

(cross-border/rural-urban migration), and trafficking13

. Social and economic vulnerabilities, including

poverty and illiteracy, highlight the need to act effectively and aggressively to reduce its spread. South

Asia has about 4.2 million of the world’s 36 million people living with HIV/AIDS. While overall prevalence

rates remain relatively low, the region’s large populations mean that a rise of a mere 0.1percent in the

prevalence rate in India, for example, would increase the national total of adults living with HIV by about

half a million persons14

.

H I V / A I D S i s e m e r g i n g a s a m a j o r t h r e a t i n t h e s o c i o -e c o n o m i c a n d h e a l t h s e c t o r s o f N e p a l . T h e i r m u l t i p l e e f f e c t s h a v e s o f a r b e e n m i n i m a l i n t h e c o u n t r y , b u t t h e i r p o t e n t i a l i m p a c t i s i m m e n s e . T h e f i r s t A I D S c a s e i n N e p a l w a s d e t e c t e d i n 1 9 8 8 . S i n c e t h e n t h e n u m b e r o f H I V / A I D S c a s e s h a s b e e n i n c r e a s i n g g r a d u a l l y . I n N e p a l H I V t r a n s m i s s i o n i s m a i n l y h e t e r o s e x u a l . S o m e o f t h e s u r v e y s r e v e a l t h a t t h e r e i s c o n c e n t r a t e d e p i d e m i c a m o n g I n j e c t i n g D r u g U s e r s a n d C o m m e r c i a l S e x W o r k e r s14.

In world More than 40 million people are living with HIV/AIDS, 2.3 million are under 15 yrs ,

14,000 new infections each day , 1.7 million human infected with HIV/AIDS 3.1 million deaths

from AIDS , Million new HIV cares – 13425/day. In Nepal the estimated number of PLWHA at

end 2005 is 61,000, HIV prevalence in 2005 is 0.5, estimated number of AIDS cares are 7,800,

number of child orphaned by HIV/AIDS is (0-18) is 18000, receiving ART till December 2005 is

210. In south East Asia 6.3 million PLWHA in 2005 (Source: WHO, UNAIDS).

In Nepal there are 6990 HIV the including AIDS, 1085 leaving with AIDS, New infection 30/day and 336

death (Source: NCASC June 2006 National statistics) Cumulative HIV/AIDS situation by category as of

Jan, 2005 : Clients of SW/STD – 53.7% , House wives – 12.7% , IDUs – 19.2% , Sex worker (SW) – 12.1% ,

Perinatal Transmission – 2.1% and Blood & blood products – 0.2% .

Stigma is a powerful tool of social control. Stigma can be used to marginalize, exclude and exercise power over individuals who show certain characteristics. While the societal rejection of certain social groups (e.g. 'homosexuals, injecting drug users, sex workers') may predate HIV/AIDS, the disease has, in many cases, reinforced this stigma. By blaming certain individuals or groups, society can excuse itself from the responsibility of caring for and looking after such populations. This is seen not only in the manner in which 'outsider' groups are often blamed for bringing HIV into a country, but also in how such groups are denied access to the services and treatment they need. In the majority of developing countries, families are the primary caregivers to sick members. There is clear evidence of the importance of the role that the family plays in providing support and care for people living with HIV/AIDS. However, not all-family response is positive. Infected members of the family can find themselves stigmatized and discriminated against within the home. There is also mounting evidence that women and non-heterosexual family members are more likely to be badly treated than children and men. The substantial increase in the number of persons living with HIV/AIDS (PLWHA) in Nepal has important implications for providing care. Because AIDS is a fatal illness, supportive care continues to be a crucial issue, influencing the government's attempt to develop appropriate policies to address the care needs of patients with HIV/AIDS. With a high number of PLWHA, the demands of family caregivers who take responsibility for the care of these patients at home are escalating. The care of these patients can place a significant burden on family caregivers. Thus, the degree of burden experienced by family caregivers is an important concern. The concept of outcome emphasizes the patient's well being. However, there is a growing body of research related to the outcomes of family caregiving. Caregiver burden is one of the patient-related outcomes, which is the most common outcome measure in caregiver research. The study concerning caregiver burden as an outcome is important to nurses who work with families in communities. The knowledge of caregiver burden can help nurses develop specific intervention strategies for family caregivers in order to prevent the negative burden and enhance quality of life6. The purpose of this study is to examine the outcome of family burden among of people living with AIDS getting treatment in BKIHS

5. Rational of the study.

The demands and outcomes on the family caregivers of HIV/AIDS patients are enormous and need to be

addressed in terms of public health policy, health economics and patient-care perspectives. The second

perspective highlights health-care economic problems. The care for HIV/AIDS patients is provided

through general and infectious disease hospitals in Nepal. Finally, the increasing demand of family

caregivers involves the patient care. The studies have shown that HIV/AIDS patients would rather stay

with their families at home than in a hospital15

. The necessary emphasis on family caregiving is even

more significant because the family member is given the responsibility of the care of people living with

HIV/AIDS.

There has been a growing interest over the past 20 years in exploring the caregiving

experience. Over the course of the AIDS epidemic, family caregivers have provided an

essential source of care to PLWHA. The assessment of burden has become a challenging task

for most researchers. The literature suggests that the characteristics of the caregiver, the

characteristics of the patient, stigma and the nature of the caregiving relationship are the

determinants of caregiver burden6. Nurses are in an excellent position to minimize the

burden of care experienced by family members. This information can help nurses' knowledge

so that they can plan innovative, promotional and proactive care strategies to treat the

burden of caregivers. Measure of caregiver burden is one of the components of the significant

quality of care outcome.

Care giver’s took responsibilities for PLWHA including providing physical care, assisting with

activities of daily living (ADLs), cooking, giving medicine, physical exercise, wound care,

providing basic care for general symptoms such as fever, headache, oral thrush, cough,

diarrhea, skin infection and giving emotional support. The families experienced enormous

burdens related to financial limitations, inadequate resources, and insufficient support4.

AIDS stigma had a profound and negative impact on the lives of informal carvers. Caregivers

were compelled to give care under cover. Most of the caregivers wanted to keep their

experiences secret and not disclose anything to any body. The demands of caregiving led

many caregivers to with draw from friends, family and work place. This resulted in isolation

and loss of productive ventures16

.

This study will assess problems of caregiver family members of PLWHA, educational packages

can be prepared for caregivers, national policy can be developed to decrease caregiver

burden and aid in providing quality care to AIDS patients, along with AIDS patient’s various

training programme can be arranged for their caregivers, caregiver’s training can play a vital

role in minimizing social stigma; adhere to ARV therapeutic regimen, and minimizing

symptoms. The findings of the study help in quality patient care by training the caregivers

using education package and IEC materials and changing the government policy.

6. Research design and methodology.

A. Research design: This study will be exploratory research design.

B. Research Setting/Sample Area: The study will be conducted among the family members of AIDS

cases getting treatment in BPKIHS.

C. Target population: The family members of people living with AIDS will constitute the population

of the study.

D. Sample and sample size:

Sample: Family members of people living with AIDS. Who fulfill the set selection criteria will be

sample of this study.

Sample size: About 30 family members of PLWA will be included in the study.

E. Criteria for sample selection/Procedure:

The principle care provider family member of diagnosed AIDS client’s for more than 3 months

willing to participate in the study will be included. The family member of PLWA will be

interviewed.

F. Criteria for sample exclusion:

a. Those who refuse to participate in the study.

b. Diagnosed cases of HIV positive for less than 3 months will be excluded.

c. Clients living alone will be excluded.

G. Sampling technique:

Using convenient sampling technique the diagnosed cases for more then 3 months, their principle

care provider family member will be selected for interview.

H. Research instrument:

Interview schedule: To find out the demographic profile of client’s and their primary care giver.

Family Burden Assessment scale: To evaluate the family burden. The family burden assessment

scale for caregivers is taken from the tool used by Kipp17

etal, Montogomery8, and Zarit

1 after some

modification in the statements as per our context. The tools are well practical, tested, reliable, valid,

and universally used in worldwide. Three questions (Q.N. 13, 14, 15) are added in tools used by

Kipp17 etal from the tools of Zarit1, and Montgomery8, which are appropriate in this context.

Focus group discussion: To evaluate the problems of the family regarding care of their patients and,

social stigma. Two to three focus group discussion sessions will be arranged.

• Detailed guidelines are prepared for focus, along with Preset questions.

• One interviewer will ask the question and another will document the responses.

• One interviewer will be trained for data collection especially those who are involved in AIDS

care, along with the investigators.

• Focus group will be arranged at BPKIHS or in public places where the caregivers can attain easily

and feel free to express their views.

• The collected information’s will be compiled and analyzed.

I. Validity of the tool:

Content and face validity of the tool will be again established with the experts of concerned

field. Pre-testing of the tool will be done among 3-4 subjects. Nepali version of the tool will be

prepared and again it will be translated to English for validity.

J. Methods of data collection/Data collection Procedure:

• A detailed list of all the cases will be prepared before starting the data collection.

• Ethical clearance from concerned authorities (BPKIHS ethical review board) will be obtained.

• Permission from concerned authorities i.e. HODs, In-charges etc.

• Informed written consent from each subject will be obtained prior to interview.

• The family members of PLWA will be separately interviewed.

• The interview will be taken from the primary (Main) caregiver of PLWA using convenient

sampling technique. The interview will be also taken at ARV, VCT, PMTCT centers, and at their

home as per feasibility, practicability and convenient of care giver.

• 2-3 slots of focus group discussion will be arranged among 2-3 family members group to

explore the facts in details, especially social stigma

K. Statistical Analysis of data:

a. Descriptive data analysis: Percentage, Mean and SD will be used for describing

demographic Profile.

b. Inferential data Analysis: Chi-squire, t-test / z-test, ANOVA, Bivariate and Multivariate linear

regression and Correlation will be used to find out association and draw the conclusions.

L. Limitations of the study:

The HIV/AIDS positive cases getting treatment in BKIHS will be only included in the study.

About 30 subjects will be only included in the study. The people living with AIDS living alone

will be excluded. The People living with HIV positive with symptoms free and not facing any

problems will be excluded.

M. Ethical Issues for the Research:

i. Written permission will be obtained from the concerned authority.

ii. Anonymity of the subjects will be maintained.

iii. The informed written permission will be obtained from subjects.

iv. The subjects will be assured of the confidentiality of the information.

v. Ensure privacy and confidentiality and to hide the patient’s diagnosis from extended family

members. Interview conducted in caregiver in alone, not with patients and other family

members.

5. Results and Discussion: The collected data will be entered in SPSS-10.5 software package and will be

analyzed. The STATA will be also used to analyze the data. The findings will be presented in table and

graphs. Inferential statistics will be used to analyze and draw the conclusion. The results will be

compared with the findings of study conducted by various investigators on related fields.

6. ORGANIZATION OF THE STUDY: (TIME SCHEDULE) SN Activities Duration/Time

1. Literature review and finalization of the project 2 Months

2. Pre-testing and finalization of tool 1 Months

3. Data collection and Focus group discussions 6 Months

4. Analysis of Data 1 Months

5. Report writing and Submission 2 Months

……………………….

1 Year

Section-D

Details of the Budget:

References.

1. Zarit, S.H., Todd, P.A., & Zarit, J.M. (1986) Subjective burden of husbands and wives as

caregivers: A longitudinal study. Gerontologist; 26: 260–266.

SN Item/Particular Details

Amount (In NP Rs.)

1 Personnel cost:

Interviewer: 1 persons for 6 monts 1x6x500 3,000

2 Tool: Preparation, Printing & Testing. 1,900

3 Data Collection

a. Focus group discussion:

Arrangement and Refreshments 3x1000 3000

b. Incentives for Participants 200x30 6000

4 Traveling

a. Data collection: traveling 2000

5 Data Processing: coding and entry 800

6 Report preparation and Typing

3000

7 Data Analysis

2000

8 Photocopy, Printing and Binding

1800

9 Miscellaneous

1500

Grand Total 25,000 /-

Rs. Twenty Five Thousand Only

2. Vithayachockitikhum, N. (2006) Family caregiving of persons living with HIV/AIDS in Thailand.

Caregiver burden, an outcome measure. International Journal of Nursing Practice; 12(3): 123.

3. Donabedian, A. (1980) Explorations in Quality Assessment and Monitoring, Ann Arbor, MI, USA:

Health Administration.

4. Fitting, M., Rabins, P.V. (1985) Men and women: Do they give care differently? Generations; 10:

23–26.

5. Reinhard, S.C. (1994) Living with mental illness: Effects of professional support and personal

control on caregiver burden. Research in Nursing and Health; 17: 79–88.

6. Reinhard, S.C. (1994) living with mental illness: Effects of professional support and personal

control on caregiver burden. Research in Nursing and Health; 17: 79–88.

7. Grafström, M., Fratiglioni, L., & Sandman, P.O. (1992) Health and social consequences for

relatives of demented and non-demented elderly. A population-based study. Journal of Clinical

Epidemiology; 45: 861–870.

8. Montgomery, R.J.V., Kamo, Y. (1989) Parent care by sons and daughters. In: Mancini JA (ed.).

Aging Parents and Adult Children. Lexicon, MA, USA: Lexington Books, 213–230.

9. Moffatt, B.C. (1986) When Someone You Love Has AIDS. New York: NAL Penguin.

10. Mushonga, R.P. (2001) Social support, coping, and perceived burden of female caregivers of

HIV/AIDS patients in rural Zimbabwe. Unpublished doctoral dissertation, Case Western Reserve

University, Ohio.

11. Hughes, S.L., Giobbie-Hurder, A., & Weaver, F.M. (1999) Relationship between caregiver burden

and health-related quality of life. Gerontologist; 39: 534–545.

12. Burintramart, P., Lerdmaleewong, M., & Nilmanat, K. (1982) Uncertainty in illness and coping of

family caregivers of hospitalized symptomatic HIV patients. Thai Journal of Nursing Research; 2:

76–90.

13. Hunt, C.K. (2003) Concepts in caregiver Research. Journal of Nursing Scholarships, 35(1): 27-32.

14. Bhardwaj, A., Biswas, R., & Shetty, K.J. (2001) HIV in Nepal: Is it rarer or the tip of an

iceberg? . Trop Doct, 31: 211-213.

15. AIDS Division, Ministry of Public Health. (1996). Health Care and Social Service, Received by

HIV/AIDS Patients at Home: Lampang Province. Bangkok.

16. Mwinituo Prudence, Mill JE. Stigma associated with Ghanian Caregivers of AIDS patients.

Western Journal of Nursing Research. 2006; 28(4): 369-382.

17. Kipp W, Tindyebwa D, Karamagi E, Rubaale T.(2006),. Family caregiving to AIDS patients: The

role of Gender in caregiver burden in Uganda. Journal of International women’s studies. 7(4): 1-

13.

B. P. Koirala Institute of Health Sciences, Dharan Nepal

APPLICATION FORMAT FOR RESEARCH GRANT

Section–A

3. Title of the research project:

A Study on Socio-demographic and Knowledge Profile of the Admitted

Japanese Encephalitis Patients in BPKIHS”

4. Name and designation of:

a. Principal investigator:

Name: Ram Sharan Mehta

Designation: Asst. Professor

S.N. Name Designation Department

1. Ramanand Chaudhry Senior Nursing Office Pediatric Nursing

6. Expected duration of the proposal: One year

7. Amount of grant in – aid asked RS. = 25,000/-

8. This is new project. Yes.

Declaration 7. I/we have read the terms and the terms and conditions of BPKIHS research

grants, and agree to abide by them.

8. I/we agree to submit, within three months from the date of termination of the project, a report on the work done.

9. I/we agree to maintain a stock book for purchases made for he project. I/we shall submit the complete statement of account within three months of the termination of the project, and at any other time as required by the accounts section.

10. I/we agree to acknowledge the grant in any publication resulting from the project if it is approved for financial assistance.

11. I/we declare that no research grant is already available for the research project from any other source.

12. I/we declare that the project will be conducted as per the highest ethical standards applicable to animal/human experiments.

Signatures (with seal and date):

a. Principal Investigator Signature Date

Ram Sharan Mehta……………………………….

Co-investigator (S) Signature Date

Ramanand Chaudhary

Remarks form the HoD of the Principal Investigator:

Date: Signature & Seal of the HoD

Remarks for the HoD of the Co-investigator:

Section-C Details of the research project

7. Title of the research project:

Socio-demographic and Knowledge profile of hospitalized Japanese Encephalitis Patients in BPKIHS

8. Objectives.

General To assess the socio-demographic and Knowledge profile of hospitalized Japanese Encephalitis (JE) patients in BPKIHS.

Specific 1. To find out the socio-demographic characteristics of the admitted JE Patients.

2. To assess the Knowledge regarding disease and It’s Preventive measures.

Research Questions (if relevant) 1. Is there a difference in socio-demographic characteristics of JE Patients?

2. Is there a difference in knowledge profile of JE patients?

2. Research Hypothesis

1. There is No difference in Knowledge in various education status groups of JE Patients.

2. There is no difference in demographic and knowledge factors among JE patients

9. Summary of the research project.

Japanese encephalitis (JE), a mosquito-borne infection, is the leading cause of viral encephalitis

in Asia. An estimated 30,000 to 50,000 cases and 10,000 deaths occurred each year, mostly

among children. In endemic areas, the annual incidence of clinical disease ranges from 10-100

per 100,000 populations. The majority of people living in JE-endemic areas are infected with the

virus before the age of 15. JE occurs primarily in three areas the Indian subcontinent. It will be

hospital based qualitative cross sectional study, conducted among the admitted clinically

diagnosed JE patients in medical and pediatric units using purposive sampling technique and

data will be collected from the clients and their care takers/relatives using interview schedule

and will be analyzed and conclusion will be drawn.

10. Review of the literature pertaining to the project:

The majority of infections are sub clinical, resulting in mild symptoms or no symptoms at all. It is estimated that, on average, 1 in 300 infections results in symptomatic illness. Symptoms usually appear within 4-14 days after infection and are characterized by a flu-like illness, with sudden onset of fever, chills, headache, tiredness, nausea, and vomiting. In children, gastrointestinal pain and dysfunction may dominate the early stage of the illness. After 3-4 days signs of neurological involvement occur with a change in the level of consciousness ranging from confusion to coma. Children often present with seizures. The illness can progress to a serious infection of the brain (encephalitis) and can be fatal in 30 percent of cases. Thirty to fifty percent of those who survive the disease will have serious neurological and psychiatric squeal including brain damage and paralysis. In endemic areas, about 85% of cases happen in children less than 15 years of age. Most deaths and residual neurological and psychiatric squeal occur in children under 10 years of age. Infection during the first and second trimesters of pregnancy may result intrauterine infection and abortion. Infections that occur during the third trimester of pregnancy have not been associated with adverse outcomes in newborns.

Diagnosis of JE is mainly based on serological tests of blood and spinal fluid. Other diagnostic

methods include recently developed dot-blot or immunoprecipitation IgM assays.

In Nepal a total number of 8874 cases and 1264 deaths have been reported, with an average

case fatality rate of14.2% in an aggregate since 1998. Case started to appear from April-May

and reach their peak during late august to early September. Cases started decline during

October. 4

A study of a Japanese encephalitis (JE) outbreak in the southwestern part of Nepal in 1997. A high density of JE infections was found and it was estimated that 27.9% of the total population were infected with JE virus in the study area. The fatality rate was 13.2% and there was no difference in the fatality rate between males and females over 5 years old. However, the case fatality rate was 2.1 times higher in females than in males (14.6% vs. 6.9%) among children under 5 years of age. Fifty-three blood samples were collected from suspected JE cases during the epidemic period in 1998. Findings for JE specific IgM revealed that clinical diagnoses of JE were serologically confirmed in an average 78% (70-93%) of patients in three collaborating hospitals.5

Approximately 50,000 cases and 10,000 deaths are estimated to have occurred every year in the Asian continent 7. The clinical disease of JE in man occurs in an approximately one on every 20 to 1000 infections with the mean one case for every 300 infections.6

In the South East Asia region (SEAR), JE is prevalent in northern Thailand, as well as Bihar, Utter Parades, Tamil Nadu and West Bengal states in India, in the Terai areas of Nepal and in Srilanka. Cases have been reported in Bangladesh, Indonesia and Myanmar as well.7

Table: -I

Region-wise distribution of JE & death (1993-1997)

Year E C W ME F.W. Community

C-D

1993 103-22 100-29 33-10 101-23 109-24 446-108

1994 335-37 89-22 172-47 918-218 325-59 1826-383

1995 204-37 216-53 179-33 401-92 246-50 1246-255

1996 493-84 166-26 179-37 420-29 192-34 1450-260

1997 387-43 219-30 192-27 1247-62 908-145 2953-407

Table: - II

District wise JE case & Deaths of E-T-N (1993-1997) District 1993 1994 1995 1996 1997

C-D C-D C-D C-D C-D

Jhapa 12-6 78-11 9-3 127-29 122-22

Morang 50-8 197-21 148-19 214-26 151-9

Sunsari 8-1 36-2 26-1 100-14 84-8

Saptari 24-6 14-0 1-0 15-2 2983-407

Total 446-108 1836-383 1236-255 1450-260

Table – III

(1993-1997) (Case low & Death)

Hospital Cases Death

KZH 760 83

BPKIHS 189 24

DAMAK 142 39

Table – IV

Distribution of JE deaths in Nepal (1993-1997: Hospital Data, MOH)

Year JE case Death

1993 446 108

1994 1836 283

1995 1246 255

1996 1450 260

1997 2953 407

11. Rational of the study:

Japanese encephalitis (JE) is a disease caused by a flavivirus that affects the membranes around the brain. Most JE virus infections are mild (fever and headache) or without apparent symptoms, but approximately 1 in 200 infections results in severe disease characterized by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and death. The case fatality rate can be as high as 60% among those with disease symptoms; 30% of those who survive suffer from lasting damage to the central nervous system. In areas where the JE virus is common, encephalitis occurs mainly in young children because older children and adults have already been infected and are immune. This study will be very useful because of following reasons,

I. It will explore the socio-demographic background of the people suffering with JE. II. The study will explore the knowledge profile among the JE Patients and their family

members.

As the disease is preventable and environmental sanitation and knowledge regarding JE prevention can play a vital role in prevention. The investigators will raise the awareness among those respondents and information and education materials can be prepared based on that. A base line data will also be available and will aid in planning and delivering health services. From this study the government, health institutions, hospitals/health care centers, clients and general public will be benefited.

12. Research design and methodology:

It will be qualitative cross sectional study design conducted among the clients and their caretakers of JE patients in BPKIHS.

Study Variables

Independent Variables: Age, •Sex, •Ethnicity, •Occupation, •Income, •Housing, •Environment, •Knowledge

Dependent Variables: Japanese Encephalitis Type of Study: Analytical Cross sectional Study.

Target Population: All the clinically diagnosed JE Patients admitted during study period from July to October 2007 constitute the Population of the study.

Sampling Methods: All the diagnosed JE Patients admitted during study period constitute the

Sample of the study who full fill the set criteria. Purposive sampling technique will be used to

collect the data.

Sample Size: About 50 samples will be collected randomly.

Sampling Frame (if relevant) and Sampling Process including Criteria for Sample Selection: The trained staff nurses along with the investigator will prepare a list of all diagnosed JE patients on Sunday and Wednesday each week in the wards and interviewed with them. Duplication of cases will be avoided.

Tools and Techniques for Data Collection: Semi–structured interview schedule will be used to collect the data. Permission will be obtained from concerned authority. Sun/Wed day the list will be

prepared. All the subjects will be interviewed. Details of the tools are attached in Annex:

Pre-testing the Data Collection Tools (if relevant): Among 10% of the subjects i.e. 5 pre-test will be conducted at similar settings before 2 weeks prior to study i.e. June Mid. and lasts within two weeks. Especially to make modification in Knowledge Profile questions. Investigators will be involved in Pre test process and analysis.

Validity and Reliability of the Research (if relevant): Validity of the tool will be established by checking the tools with concerned experts.

Biases (if relevant): If the patient is child or unable to give response their caretaker will be involved in obtaining data.

Limitation of the Study (if relevant)

• Only clinically diagnosed admitted cases by the doctors will be included

• Unconscious/Unresponsive Patients-Relatives or caretaker will be interviewed

• Information will be based upon Opinion

• Death, LAMA, Absconded will be excluded.

Plan for Supervision and Monitoring: The entire study will be conducted under the guidance and supervision of principal investigator along with the co-investigators. The experts of concerned field like: physicians, pediatrician, psychiatric, psychologist, epidemiologist, entomologist and other needed experts will be conducted as per the need during the project.

Periodically the principal investigator and co-investigators tern by tern will supervise, and guide

the data collector and needful help from hospital director will be sought.

A written plan of supervision will be made and strictly followed during the time of data

collection. About 5 in-depth interviews will be taken to explore the details of the facts.

Limitations of the study: - The caretakers or nearest relatives will be interviewed if clients will be unconscious or unable to answer. Plan for Data Management : The collected data will be checked and re-checked for completeness and will ensure the completeness of the data. The collected data will be than entered in SPSS package and will be analyzed used SPSS software package. The descriptive as well as interferential statistics will be applied to compare the results and draw the conclusions. Before analysis proper coding will be done. The collected data in each hospital will be computed and coding will be done by the respective data collected in their own setting.

Plan for Data Analysis

• Data entry on Excel Programme

• Descriptive statistics: mean, median, mode,

SD to describe demographic and Knowledge profile

• Interferential Statistics: Chi squire, odds ratio, Z test.

Expected Outcome of the Research: This research study will give as the base line information about the demographic profile of the clients and their families suffering with JE as demographic factors plays an important role in the transmission of diseases. This study also gives the picture about knowledge profile of the JE among the clients and their caretakers. The prevention of JE is based upon the knowledge profile of the subjects, hence it’s essential to explore the knowledge profile so that educational interventions can be produced and distributed among those target populations. The information’s obtained about demographic profile, knowledge and practices will help to prepare the information booklet on JE and implement the educational interventions.

Plan for Utilization of the Research Findings (optional): Based upon the findings a information booklet on Nepali will be prepared for common public, so that aid in JE prevention and control.

The community awareness programs regarding JE can be started based on the findings.

Various preventive, promotive and educative health awareness campaigns can be conducted as

per the need of community.

Work Plan

(should include duration of study, tentative date of starting the project and work schedule / Gantt chart)

SN ACTIVITES TIME PLAN

1 Final Project Preparation April 1 to June 7, 2007

2 Staff Training and Orientation June 7 to June 15, 2007

3 Pre-Test June 158 to 30 June 2007

4 Data collection July 1 to October30, 2007

5 Data Processing Nov. 1 to Dec. 30,2007

6 Data Analysis Jan.1 to Jan 15, 2008

7 Final Report Preparation Jan 16 to March 15, 2008

8 Publication and dissemination March 16 to March 30, 2008

References:

1. Tsai TR, Chang GW, Yu YX. JE Vaccine. In plotkin SA and Orenstein WA, eds., Vaccine

3rd edi., WB Saunders, Inc. Philadelphia, PA, 1999.672-710.

2. Adhikari SR, Sharma BP. A Study on socio-economic determents and economic burden

of JE in Kailali District of Nepal. 2002, NHRC.

3. Bista MB, Bastola SP, Shrestha SB, Gupta p. Japanese encephalitis in Nepal. (1993-

1997)[Epidemiological analysis and review of literature WHO 1998)

4. JE live vaccine protocol. 1999, Boran pharma, Soeol, Korea

5. Kirk C. India, Nepal Fight outbreak of JE. VOA Special English Health Report, 14 Sept,

2005.

6. Nepal: Encephalitis deaths on the rise. IRIN. 8 Sept. 2005

7. Tsai TR, Chang GW, Yu Yx. Japenese encephalitis vaccine. In Plotkin SA and orenstein

WA, eds., vaccine- 3rd edi, WB Saunders, Inc, Philadelphia, PA, 1999;672-710

8. www.cdc.gov/ ncidod/ dvbid/ jencephalitis

9. www.cdc.gov/ travel/ seasia.htm

10. Lowry PW, Truong DH, Hinh LD, Ladinsky JL, Karabatsos N, Cropp CB, Martin D, and

Gubler DJ. Japanese encephalitis among hospitalized pediactric and adult patients with

acute encephalitis syndrome in Hanoi, Vietnam 1995. Am. J. Trop. Med. Hyg,

1998;58(3):324-329.

11. Tsai TF. Factors in the changing epidemiology of Japanese encephalitis and West Nile

fever. In: Saluzzo JF ed., Factors in the Emergence of Arboviral Diseases. Amsterdam:

Elsevier, 1997;179-189.

12. Tsai TF. Japanese encephalitis. In: Feigin RD and Cherry JD (eds.), Textbook of Pediatric

Infectious Diseases, 4th edition, Philadelphia: W.B. Saunders, 1997;1993-2001.

13. Tsai TF. Japanese encephalitis vaccines. Plotkin SA, Mortimer E, eds., Vaccines. 2nd

edition. Philadelphia: W.B. Saunders, 1994;671-713.

14. Rosen L. The natural history of Japanese encephalitis. Annu. Rev. Microbiol.,

1986;40:395-414.

TOOLS OF THE STUDY Interview Schedule

Code No:•

Name of the interviewer:-…………………………… Date: / /

Name of respondents:…………………………………Relation with Client: ...........

A. Identification of the data

1. Name of the patient

2. I.P No.

3. Hospital

4. Age in years

5. Sex

6. Education

i) Illiterate ii) can read and write iii) primary iv) secondary (6-10)

v) Higher secondary (10-12) vi) higher (>12) vii) child (<5 years)

7. Religion

8. Ethnic group/ caste B Demographic profile

9. District

10. VDC/ NP

11. Village/ Tole

12. W. No-

14. What kind of work do you do?

a Work in the field (ones own or for wages)

b service (Gov./ private/ NGO/ INGO)

c business/ Household work

d Study

e Others ( specify)

f Doing nothing

15. Income of family a. <20,000/ years

b. 20,000- 40,000/ years

c. >40,000

16. Is the income sufficient to run the family? a. Deficit budget (need loan)

b. Balanced (ok)

c. Saving (some)

d. Sufficient (saving)

17. House made up of a. Fuss/ thacked/ mud

b. Tiled/ Tina

c. pukka (building)

18. Do you have tamed following pets?

Name of pet Response /Yes or No Number if yes a. Pig

b. Duck

c. Horse

19. Occupation of the family member (>15 years)

a. Main occupation

b. Subsidiary occupation

c. Source of family income

i) Agriculture ii) animal husbandry iii) business iv) labour v) others (specify)

20. How long have you been residing in this place? [ ] Less of equal to 1 years [ ] More than 1 year to up to 3 years [ ] More than 3 years to 5 years [ ] more than 5 years to 10 years [ ] More than 10 years Knowledge profile:

1.Have you heared about JE?

a. Yes b. No

If yes since when

From which source first you know

2. When did you know you had JE?…………years back

3. Do you know how JE is transmitted?

a. No b. Yes

If yes how?

4. Do you know how people get JE?

a No b. Yes

If yes how?

5.Do you know the basic transmission cycle of JE?

a No b. Yes

If yes how?

6.Could you get the JE from other person?

a. Yes b. No

7. Could you get JE from animal other than domestic pig, or from insects other than mosquitoes?

a. Yes b. No

8. What are the symptoms of JE?

a. Headache b. High fever c. Neck stiffness d. stupore. e. Disorientation f.

tremor g. convulsions h. spastic paralysis

i . Others (specify)

9. What is the IP of JE? Usually… days

10. What is the cure rate of JE? …%

11. How is JE treated?

a No b. Yes

If yes how?

12. Is the disease seasonal in its occurrence?

a No b. Yes c. vary country from country

13. Who is at risk for getting JE?

14.Do you know that vaccination against JE is available?

a. Yes b. No c. If yes who should be vaccinated?

15. What was the complication of JE? [ ] Death [ ] Mental retardation [ ] Weakness of limbs [ ] Deaf [ ] Blind [ ] Others.

15. If you have not keeping pigs in the house, then how far in the nearest pig farm from yours house? [ ] Within 100 meter distance [ ] 100 to less than 500 meters [ ] 500 to 1000 meters [ ] 1000 2000 meters [ ] More than 2000 meters

16. Where did the subject sleep most of the time? [ ] On ground floor inside the house [ ] Outside the house [ ] On the varanda [ ] On the second floor

How often subject sleep outside the house? [ ] Always [ ] Occasionally

[ ] Certain month ……………………………………. 17. Had the subject household been sprayed with insecticide before having JE.

[ ] Yes [ ] No 18. Where do the subject go for defecation?

[ ] Latrine [ ] Agriculture farm [ ] Near bush or Jungle [ ] Bank of river 19. Do you know any case of JE in your village? [ ] Yes [ ] No

Practices:

1.Do you use the mosquito net?

a. Yes b. No c. If yes i) usually ii) seasonally

iii) sometimes iv) rarely

2. Do you have .pig tamed nearby your home?

a. Yes b. No

3. Do you have refuge disposal place nearby your home?

a. Yes b. No

4. Do you spray insecticides like Malathion in your nearby?

a. Yes b. No c. If yes i) sometimes ii) rarely

5. Do you usually stay outside in evening?

a. Yes b. No

6. Do you have mosquito in your home?

a. Yes b. No c. If yes i) a lot ii) less

Information Sheet and Informed consent form (d+h"/Lgfdf d+h"/Lgfdf d+h"/Lgfdf d+h"/Lgfdf )

dnfO{ o; h]klgh OG;k]mnfO{l6; sf] cg';+Gwfg (Socio-demogrfaphic and knowledge profile of

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lj/fdL gft]bf/ / s'?jlj/fdL gft]bf/ / s'?jlj/fdL gft]bf/ / s'?jlj/fdL gft]bf/ / s'?jfsf] fsf] fsf] fsf]

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Details of the budget

S.N. Item/Particular Amount (In Rs.) 1 Tool preparation , printing, pre-test and finalization 1800 2 Interviewer ( 50 x50) 2500 3 In-depth interview (5x150) 750 4 Refreshment 1200 5 Stationary 2500 6 Data entry 2200 7 Typing and report preparation 4500 8 Statistical analysis of data 3000 9 Photocopy and binding 2800

10 Editing and consultancy 1450 11 Miscellaneous 2300 Grand Total 25,000

Explanation of the Budget: The budget will be used entirely for the research purposes. The

incentives for principal investigator and co-investigators are not allocated and it will be tree of

cost services. A office clerk of BPKIHS with computer knowledge will given the responsibility

regarding the data recording, maintaining files and paper work. Principal investigator will

maintain all the statement of expenditure with original bills and documents. The local cheapest

mode of communication will be used for transport purposes.

B. P. Koirala Institute of Health Sciences, Dharan Nepal

APPLICATION FORMAT FOR RESEARCH GRANT

Section–A

5. Title of the research project:

EFFECTIVENESS OF BED SORE PREVENTION PROGRAMME IN ICU AT BPKIHS

6. Name and designation of:

Principal investigator:

Name: Hari Kumari Rai

Designation: Ward In-charge, ICU/CCU

Co- investigators: S.N. Name Designation Department

A. Dr. Bal Krishna Bhattaari Associate Professor Dept. of Anesthesiology

& Critical care

B. Mr. Ram Sharan Mehta Assistant Professor Med-Surg. Nsg. Dept.

9. Expected duration of the proposal: 1 YEAR

10. Amount of grant in – aid asked RS. = 25,000/-

11. This is new project. Yes.

Declaration 13. I/we have read the terms and the terms and conditions of BPKIHS research

grants, and agree to abide by them.

14. I/we agree to submit, within three months from the date of termination of the project, a report on the work done.

15. I/we agree to maintain a stock book for purchases made for he project. I/we shall submit the complete statement of account within three months of the termination of the project, and at any other time as required by the accounts section.

16. I/we agree to acknowledge the grant in any publication resulting from the project if it is approved for financial assistance.

17. I/we declare that no research grant is already available for the research project from any other source.

18. I/we declare that the project will be conducted as per the highest ethical standards applicable to animal/human experiments.

Signatures (with seal and date):

Principal Investigator Signature Date

Hari Kumari Rai ………………………………………………………................................

Co-investigator Signature Date

Dr. Balkrishna Bhattari...............................................................................

Ram Sharan Mehta………………………………………………………………………

Remarks form the HoD of the Principal Investigator:

Date: Signature & Seal of the HoD

Remarks for the HoD of the Co-investigator:

Section-C

Details of the research project

13. Title of the research project

EFFECTIVENESS OF BED SORE PREVENTION PROGRAMME IN ICU AT BPKIHS

14. Objectives.

1. To find out the incidence of bedsore patients in ICU of BPKIHS.

2. Assess the knowledge regarding bed sore prevention and care among the nurses working in ICU.

3. To explore the known risk factors among the clients with bedsore.

15. Summary of the research project:

Bed bund patients with pressure ulcers are almost twice as likely to die, as are those without pressure

ulcer often untreated. A pressure ulcer is a break in the in sure to skin and muscles. Site most commonly

affected are trochannteric, ischial, heal and sacral are as. Pressure ulcer can cause pain and loss in

economic productivity and also can result in huge expenditure for patients as well as hospitals. Since all

bed bourd patients are risk for developing pressure ulcers, daily examination of pressure points is

essential. If the slightest break is deteded, treatment must be initiated immediately followed by daily

documentation of subsequent changes. Its hospital based Quasi-experimental study design, conducted

at BPKIHS. The bed-ridden clients and the nurse’s working in the selected units constitute the population

of the study. Incidence and risk factors of bed sore will be evaluated using profoma. Knowledge of

Nurses will be assessed using Questionnaire & intervention program will be arranged both for nurses

and the patients. The obtained results will be analyzed and conclusion drawn.

16. Review of the literature pertaining to the project:

Skin breakdown is a common and serious complication affecting usually frail, disabled, acutely ill or

immobile elderly patients, especially within long-term care settings. Most common sites are over bony prominences, such as elbows, hips, heels, outer ankles, and base of spine. Over 95% of ulcers

develop on lower part of body. Median length of hospital stay to treat pressure sore is 46 days. Risk of death in elderly patient increases fourfold when sores heal and six fold when sores do not heal.1

Incidence/Prevalence in USA: 9% of all hospitalized and 20-40% of all nursing home patients,