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1. INTRODUCTION He who has health, has hope, and he who has hope, has everything.[An Arabian Proverb]BACKGROUND OF STUDY Hypertension is one of mankinds most common diseases affecting 15-20% of all adults. Abnormally increased blood pressure is called hypertension. Essential (or primary) hypertension (HTN) is a disorder of the circulatory regulation. It is currently among the leading causes of morbidity and mortality in the world and is expected to have even greater impact on the health of the people specially in the developing world.Hypertension is a major cardiovascular problem world over. Its prevalence ranges from 100 to 200 per 1000 population. Most of the cases are of primary hypertension and many 2% could be accounted for as secondary hypertension Most of the cases of secondary hypertension are considered to be due to some and cardiovascular diseases. Hypertension is the most common disorder encountered in outdoor patients. The seventh report of the Joint National Committee or prevention, detection, evaluation and treatment of High Blood Pressure (JNC VII report) has recommended a new classification for adult 18 years or older. Normal 120/80 mm Hg, Pre Hypertension 120 139/90 mm Hg, Hypertension Stage 1 140 159/90 99 mm Hg., Hypertension Stage 2 > 160/ > 100 mm Hg, Hypertension Stage 3 > 180 / > 110 mm Hg. (JS Sandhu 2004) Hypertension can be defined as persistent levels of blood pressure in which the systolic pressure is above 140 mm Hg and the diastolic pressure is above 90 mm Hg. In elderly population hypertension is above 160/90 mm Hg. (Brunner & Suddarths 1998) Arterial hypertension is an important modifiable risk factor for cardiovascular, cerebrovascular and renal morbidity and mortality. Accurate and reliable information about prevalence of arterial hypertension and its risk factors is a prerequisite for designing strategies for its control and prevention. Coronary events such as a heart attack are still the most common result of hypertension. Increased blood pressure level is related to increased severity of atherosclerosis, stroke, nephropathy, peripheral vascular disease, aortic aneurysms and heart failure. If hypertension is left untreated, nearly half of hypertensive clients will die of heart disease, a third will die of stroke and the remaining 10% to 15% will die of renal failure. Hypertension is highly prevalent in India. The Indian Heart Journal give an idea about its increasing prevalence attributable to rapid alteration of life style in developing countries like India and Nepal. Health Planners, physicians, community leaders and public health practitioners should formulate region specific guidelines based on local health care priorities and economic realities. These regional guidelines should identify reality goals, such as the thresholds for treatment, the desirable level of blood pressure control, the affordable degree of hypertension control, the acceptable extent of hypertension control and the possible strategies for achieving these targets. Life style modification needs to be emphasized at all levels and there is no threshold of acceptability and affordability as it does not concern money but attitude, policies related to tobacco, alcohol, salt and education may be in the domain of the state, but individuals have a greater responsibility that needs to be constantly reminded at all levels. It is also time for the citizens to wake up and re-define priorities in life. (J. C. Mohan 2005).The high knowledge deficit among clients with hypertension indicates a low awareness regarding their disease. It implies that patient teaching is inadequate or ineffective and that the self-care potential of clients is not being fully used. Health teaching is an integral component of nursing practice. Hence, apart from the incidental teaching, nursing personnel should conduct planned teaching programmes for patients in order to enhance their self-care ability. Nursing personnel working in various health care settings should be given in service education to update their abilities in identifying learning needs of clients and in planning conducting and evaluating teaching for different categories of patients.(M. Prakasamma 1997)

1.2NEED OF THE STUDYHypertension is a common disease in world. The Prevalence of Hypertension in the world till year 2002 was estimated to be about 972 Millions form which 634 million patients belonged to the economically developing countries. It is also developed by a result of anxiety, tension, dietary pattern and life style. Now a days living standard is also changing. Hypertension affects vital organs like heart, lungs and kidneys.During the clinical experience the investigator had noticed that majority of patient who mainly belonged to urban areas did not know much about hypertension and its causes and prevention. They were not taking prescribed treatment, neglecting the dos and donts of diet and did not know the importance of exercise which lead to complications. The investigator observed that a number of hypertension patients were hospitalized because of uncontrolled blood pressure, nephropathy and arteriosclerosis, Hypertension complications are preventable and long and healthy life is possible despite hypertension. Education is the process of motivating self-care so that they can look after themselves without being dependent on trained health professionals and thereby reducing the complications and burden on the family, and society. Hence, the investigator felt the need to conduct this study.Niji J. Solomon (2000) conducted a study for the prevalence of selected modifiable risk factors of hypertension among adults at Balam village, Terunelveli. Descriptive design was used and samples of the study were 100 adults. Structured interview schedule was used to assess the prevalence of selected modifiable risk factors. Findings of the study revealed that the overall mean for modifiable risk factors were 57.16 with a moderate level risk of 90%. Conclusion of the study revealed that practice of preventive steps through healthy life style can prevent a major catastrophe in future.Joshi Clara (1997) conducted a study to assess the effectiveness of structured teaching on self-care of pregnancy induced hypertension among pregnant women in hospital. A structured teaching on the self- care of pregnancy in induced hypertension mothers. The samples comprise of pregnant women with pregnancy induced hypertension distributed.

1.3STATEMENT OF THE PROBLEM A study to assess the effectiveness of structured teaching programme on knowledge regarding hypertension among hypertensive patients at Peoples Hospital of Bhopal city.1.4OBJECTIVES1. To assess the pretest knowledge score regarding hypertension.2. To impart structured teaching program.3. To assessed post- test knowledge score regarding hypertension.4. To find out association between pre- test knowledge score and Socio-demographic variable1.5HYPOTHISIS H1 There will be some knowledge regarding hypertension among hypertensive patient. H2 There will be significance difference between pre and post test scores.

1.6OPERATIONAL DEFINITION 1. Knowledge - In this study it refers to the information with regard to hypertension obtained from hypertensive patient in term of correct responses to the items on pamplet.2. Effectiveness Refers to improvement is post test score of knowledge among hypertensive patients after administration of teaching programme compared to the pre-test knowledge score.3. Hypertensive Patients Persons of 20 to 80 years who are diagnosed as having hypertension by a physician and he/she is on treatment for the same.4. Structured Teaching Programme One to one individual health education with the help of structured teaching plan given to hypertensive patients.

1.5ASSUMPTION There is high prevalence of hypertension among the adult population in the Peoples Hospital at Bhopal city.

1.8DELIMITATIONS The study is delimited to adult patient with hypertension, living in Peoples Hospital in Bhopal.

1.9CONCEPTUAL FRAMEWORK (SYSTEM THEORY) A conceptual framework is a theoretical approach to the study of problems that are scientifically based and emphasizes the selection, arrangement and clarification of its concept.-Polit and Hungler (1999) Discussion of the relationship of concepts that underline the study problem and support the rational ( reasons) for conducting the study.-BT Basavanthappa (2007)A framework for a research study helps to organize the study an provides a context for the interpretation of the study findings. Conceptual framework provides a background or foundation for a study and it helps to explain the relationship between concepts. Since, this study is intended to evaluate the effectiveness of structured teaching programme in terms of improving knowledge of the hypertensive patient, the conceptual framework taken for the present study is based on general systems theory given by Ludwig Von Bertalanffly in 1968. According to this theory, a system is a group of elements that interact with one another in order to achieve the goal. An individual is an open system because he/she receives input from the environment. This input when processed provides an output. All living systems are open. There is a continual exchange of matter, energy and information. The system is cyclical in nature and continues to be so, as along as the four parts inputs, process, output and feedback keep interacting with each other. If there are changes in any of the parts, there will be alteration in all other parts. Feedback from within the system or from the environment provides information, which helps the system to determine its effectiveness.

Input Consists of information material or energy that enters the system. In this study investigator is a system with input from the environment. The input includes hypertension background age, sex, education, occupation, income/month (in rupees), marital status, dietary habits, and previous knowledge.Process After the input is absorbed by the system, it is processed in a way useful to the system. Here it refers to the administration of pamplet to hypertensive patient. In order to achieve the desired output, i.e. increase the knowledge of Hypertensive patient are following process is adopted. Using a structured knowledge questionnaire knowledge of hypertensive patient will be assessed and this will be followed by preparation and administration of pamplet. H.T. following this knowledge will be tested again. Output It refers to energy, matter or information disposed of by the system as a result of its process. In the present study, it refers to the improvement of knowledge of Hypertension. This is assessed through a comparison between the pre-test and post-test knowledge score of the Hypertension patient.Feedback It is the process that enables a system to regulate it save and provides information about the systems output and is feedback as input. It higher knowledge scores obtained by the hypertension patient in the post-test indicate that the structured teaching programme was effective in increasing the knowledge of Hypertension patient. A low score in post-test indicates that the Structured Teaching Programme was not effective an alternative measures may be needed to improve knowledge.

1.10SUMMARY This chapter dealt with the introduction, background, need of the study. It mentioned about the statement problem, objectives, operational definitions, assumption, hypothesis and delimitation of the study and plan of writing report.

2. REVIEW OF LITERATUREMan can learn nothing except by going from the known to unknown.(Claude Bernard)Review of literature is an important step in the development of a research project. It is a complication of resources that provides the groundwork for the study. The investigator carried out an extensive review of literature on the research topic in order to gain deeper insight into the problem and to collect maximum relevant information for building up the study in a scientific manner so as to achieve the desired results. The literature review that was undertaken for the purpose of the conducting this study has been presented under the following headings Section 1: Literature related to incidence of Hypertension. Section 2: Literature related to Structured Teaching Programme on knowledge.Section 3: Literature related to other intervention. 2.1 Literature related to incidence at hypertensionLee Young (2006) conducted a study on the physical activity in older adults with border line 2hypertension. Data were collected from a multiethnic non probability samples of 267 men and women 60-75 years of age. The final model explained 44% of the variance in physical activity. Variable that indirectly predicted physical activity were perceived health status, barriers to physical activity, self-efficacy for physical activity intrinsic motivation for health and environmental influence. The significant associations between the cognitive appraisal and motivation concepts extend previous research and add to the understanding of the complex factors that influence regular physical activity. Soya K, Kumar Geetha V.P. (2003) conducted a quasi-experimental study to assess the self-care activities of pregnancy induced hypertension and maternal outcome. Based on sample criteria 70 primigravida with pregnancy induced hypertension (PIH) were selected by non-probability purposive sampling, 30 A pre-test post-test on equivalent Data was After selection pre-test was done using structured interview schedule. The bio-physiological markers such as blood pressure, weight gain, proteinuria and oedema of all the clients were also assessed at the time of selection. They were advised to contact the investigator during each of their subsequent antenatal visit up to delivery. On the same day of selection the experimental group were exposed to structured teaching programme; after the pre-test in one session of 45 minutes either individual or in group. A hand out was provided to them for further reference. The post test on both experimental and control group were done after two weeks, using the same structured interview schedule. All the clients were monitored during each follow up record. The findings concluded that before structured teaching programme the knowledge of primi gravida women with pregnancy induced hypertension was less. The structured teaching programme on selected self-care activity (SSCA) considerably enhanced the knowledge of primi gravida with pregnancy induced hypertension. The structured teaching programme helped the primi gravida women with pregnancy induced hypertension to practice selected self-care activity. The practice of selected self-care activity by primi gravid women with pregnancy induced hypertension helped to attain favourable self-care. There was an association between PIH and variables such as age and occupation i.e. PIH was prevalent more among the age group 21 to 25 years and most of the women pregnancy induced hypertension had no occupation. There was no relationship with pregnancy induced hypertension and variables such as religion educational status and family history of pregnancy induced hypertension. Henriksson KM (2002) conducted a prospective longitudinal study to explore the development of hypertension in a cohort of young middle-aged men. Using a hospital setting in Sweden, data were collected from a birth cohort study of men surveyed over 6 years. The sample included a total of 628 men born in 1953 to 1954, all of whom were surveyed at 37, 40 and 43 years of age at the same time of the year. The result indicated that at 37 years of age, 243 men (39%) had reference or normal blood pressure, 167 (26%) had high normal blood pressure and 218 (35%) were hypertensive. The individuals with high normal blood pressure at baseline were statistically associated with the development of hypertension both at 40 and 43 years of age, independent of other cardiovascular disease risk factors and ethnicity. Niji J. Solomon (2000) conducted a study for the prevalence of selected modifiable risk factors of hypertension among adults at Balam village, Terunelveli. Descriptive design was used and samples of the study were 100 adults. Structured interview schedule was used to assess the prevalence of selected modifiable risk factors. Findings of the study revealed that the overall mean for modifiable risk factors were 57.16 with a moderate level risk of 90%. Conclusion of the study revealed that practice of preventive steps through healthy life style can prevent a major catastrophe in future. Jasmine J. (1998) conducted a study to assess the effectiveness of structured teaching on knowledge and life style adopted by hypertensive patients at community health centre. Mannadipet, Pondicherry. Research design was non-equivalent control group pre-test and post-test design. Data was collected with the help of questionnaire on knowledge of patients on hypertension and their life style and structured teaching module on knowledge of hypertension and life style. The samples are 30 newly diagnosed male and female hypertensive patients belonging to Findings of study revealed that patients who were exposed to structured teaching have gained more knowledge and favorable attitude towards life style practices than those who did not have exposure to the structured teaching health teaching to an essential aspect of health care to individuals with hypertension. Singh R.B. (1990) conducted a study to assess the effect of diet and weight redu and magnesium than did groups B and D. Dietary compliance and drug intake was checked weekly. Weight loss was associated with a significant fall in systolic and diastolic pressures in both group A (22/18 mm Hg) and Group B (16/13 mm Hg) compared with Group D at the end of the study. Group C patients also showed a significant fall in pressure (13/10 mm Hg) compared with Group D.

2.2Literature Related to Structured Teaching Programme on knowledgeGrusser, Monika (2003) conducted a study to assess the effect of structured outpatient education and treatment programme for patients with diabetes mellitus and hypertension. Four different programmes have been implemented into the German health care system. Over 80% of the physicians rated the training courses as Very good or good and rated the teaching material and very good or good. Data collection on patients with diabetes mellitus or hypertension demonstrate the effectiveness of these programmes at the treatment level. The results also demonstrate the practicability an effectiveness of the implementation of programmes as an integral part of disease management in routine health care for patients with diabetes mellitus or hypertension.Zernike (1998) conducted a study for evaluating the effectiveness of two teaching strategies for patients diagnosed with hypertension. Experimental research design was adopted. Samples were drawn from 30 hypertensive patients. A pre-test was performed shortly after admission to hospital are collect information.Comparison of the pre and post-tests of the group revealed a significant increase in knowledge level at the time of discharge from hospital. Joshi Clara (1997) conducted a study to assess the effectiveness of structured teaching on self-care of pregnancy induced hypertension among primi para mother antennal clinic. A structured teaching on the self-care of pregnancy in induced hypertension mothers. The samples comprise of 30 primi para mothers with pregnancy induced hypertension distributed. Findings and of study revealed that the incidence of pregnancy induced hypertension was high among young primipara below 20 years and gravida mothers. The age factors and family size exhibited its relationship with knowledge gain. The pregnancy induced hypertension primipara mothers who received teaching gained highly significant knowledge. The structured teaching on self-care pregnancy induced hypertension primi para mothers was effective in increasing the knowledge and in prevention of complications. Gruesser M. (1997) conducted a study to assess the effect of structured patient education for out patients with hypertension in general practice. A one group pre-test, post-test approach was used. The project was carried out in co-operation with the German hypertension league and designed to evaluate the practicability and efficacy of the implementation in routine primary health care. A total of 466 patients were trained. Data was collected from 272 patients. Data collected 22 weeks after the intervention demonstrated the efficacy of the programme at treatment level : reduction of body weight (2 kg, p < 0.001) and blood pressure (from systolic 158 1500113.33%

Dietary habit

Vegetarian

Non vegetarian1343.33%

Previous knowledge1756.66%

Mass media13.33%

Friend and Relatives826.66%

Health professional1446.66%

Other723.33%

In this study 13 (43.33%) of the subjects were female and only 17 (56.66%) of subjects were male because most of the male went for work and they were not available during the data collection period. Regarding education most of the subjects 15 (50%) subject were illiterate, 03 (10%) subjects were primary education, 6 (20%) subject were secondary,4 (13.33%) subject were,2 (6.66%) post graduate.Regarding marital status most of the subject 28 (93.33%) subject were married,0 (0%) subject were unmarried,2(6.66%) subject were divorced,0 (0%) widowRegarding occupation 5 (16.66%) subjects were farmer, 4 (13.33%) subjects were government job, 8 (26.66%) subjects were private job, 5 (16.66%) subject were business, 8 (26.66%) subject were unemployed. Most of the subject were 8 (26.66%) monthly income less than Rs.5000/-, 9 (30%) subjects had Rs.5001-10,000/- and 12 (40%) subjects had income Rs.10001-15000 per month 1 (3.33%) subject had income above> Rs15000.Regarding dietary habit, 13(43.33%) were vegetarian and subjects 17 (56.66%) were non vegetarian. Regarding most of the previous knowledge 1(3.33%) subject were mass media, 8 (26.66%) subject were friends and relatives, 14 (46.66%) subject were health professionals ,7 (23.33%) subject were other were.

SECTION IDISCRIPTION OF SOCIODEMOGRAPHIC DATA

Frequency and percentage distribution of ageN=30

Figure 3 Pie diagram showing sample distribution according to age

Frequency and percentage distribution of according to sex N=30

Figure 4 Bar diagram showing sample distribution according to sex

Frequency And Percentage Distribution Of According To Education N=30

Figure 5 Pie diagram showing sample distribution according to education.

Frequency And Percentage Distribution Of According To Marital Status N=30

Figure 6 - Pie Diagram Showing Of Simple Distribution According To Marital Status

Frequency And Percentage Distribution Of According To OccupationN=30

Figure 7 - Pie diagrame showing sample distribution according to occupation.

Frequency and Percentage Distribution Of According To Dietary HabitsN=30

Figure 8 -Pie diagram showing showing sample distribution according to dietary habit

Frequency And Percentage Distribution Of According To IncomeN=30

Figure 9 - Pie Diagram Showing sample distribution according to Income

Frequency and Percentage Distribution Of According To Previous KnowledgeN=30

Figure 10 - Pie Diagram Showing sample distribution according Previous Knowledge

Section II : Association between knowledge and selected demographic variables.This section deals with the details of the analysis and interpretation done to find out the association between knowledge and selected demographic variables of the patients.

Table No. 2The association between knowledge and selected demographic variables of the patients.N=30Sl. No.Demographic variableDFChi square valueprobabilityinference

1Age65.80%0.46%NS.

2Sex22.05%0.36%NS.

3Education83.13%0.93%NS.

4Marital status24.36%0.11%NS.

5Occupation88.80%0.36%NS.

6Income65.36%0.50%NS.

7Dietary habit20.17%0.92%NS.

8Previous knowledge64.15%0.657NS.

Table -2 reveals that the computed chi- square value shows significant association between pretest knowledge regarding hypertension with hypertensive patient at the level of > 0.05 and not found any significant association between pre-test knowledge with other demographical variable like age , sex, education, status, occupation, income ,dietary habit and previous knowledge2NS = Not Significant Table t value p < 0.05 12.59 significant No significant association was found between knowledge and selected demographic factors/variables.

Section IIIAssessing the knowledge regarding hypertension among hypertensive patients.Table No. 3Frequency and percentage , mean score, SD distribution of pre-test knowledge score regarding of hypertension among hypertensive patients.N=30Pre- test KnowledgeFrequencyPercentageMean ScoreSD

Poor1446.66%

Average1343.33%X= 9.33S D =5.577

Good310

Figure 11 Bar diagram showing sample distribution according to Pre - test

Frequency and percentage , mean score, SD distribution of post- test knowledge score regarding of hypertension among hypertensive patients.N=30Post- test KnowledgeFrequencyPercentageMean ScoreSD

Poor00

Average1033.33%X = 17.83S D = 3.410

Good2066.66%

Figure 12 Bar diagram showing sample distribution according to Post - test

4.2SUMMARYResearch Methodology revealed the oven of the research in a systematic and scientific manner. This chapter dealt with description of the research design , variables , settings , population , sample and sample size , sampling technique sampling selection , criteria, development and description of tool , pilot study procedure for data collection , and plan for data analysis .The analysis and interpretation of the same method presented in the following chapter.

5. DISCUSSION

Discovery consists of seeing what everybody has seen and thinking what nobody has thought.(Albert Szent)In this chapter findings of the study are discussed in line with objectives , review of literature and of other studies. Discussion of findings is based on the sample characteristics, clinical information, knowledge of patients about hypertension, effectiveness of individual planned teaching programme, association of knowledge and selected variables.

I - Socio-demographic variables of the hypertensive patientsThe finding of the study revealed that :The findings of the study revealed the 06 ( 20% ) were in the age group of 20-35 years, subjects 11 ( 36.66% ) were in the age group of 36-50 years, 10 ( 33.33% ) were in the age 51-65 years,03 ( 10% )were in the age group above 66-80 years.In this study 13 ( 43.33% ) of the subjects were female 17 ( 56.66% ) of subjects were male because most of the male went for work and they were not available during the data collection period. Regarding education most of the subjects 15 ( 50% ) were illiterate 3 (10%) subjects were primary education, and 06 ( 20% ) subjects were secondary education 4 (13.33%) subject were graduate,2 ( 6.66% ) subject were post graduate.Regarding marital status 28 ( 93.33% ) subject were married,0 ( 0% ) subject were unmarried,02 ( 6.66% ) subject were divorced 0 ( 0% ) subject were widow. Regarding occupation 05 ( 16.66% ) subjects were farmer 04 (13.33%) subjects were govt.job 8 (26.66%) subjects were private job,5 (16.66%) subject were business 08 (26.66%) subject were unemployed. Most of the subject were 08 (26.66%) monthly income less than Rs. 5000/-, 9 (30%) subjects had Rs. 5001-10,000/- and 12 (40%) subjects had income Rs.10001-15000/- only 1 (3.33%) subject had> Rs.15,000 Most of the subjects 13 (43.33%) were vegetarian and only subjects 17 (56.66%) were non vegetarian.Most of the subject previous knowledge, 1 (3.33%)mass media,8 (26.66%),subject were friendship and relatives 14 (46.66%), subject were health professional 7 (23.33%) subject were others.The above findings were supported by study done by Henrikson K.M. (2002) in which he reported that the total of 628 men born in 1953 to 1954, all of whom were surveyed at 20, 36 and 51,80 years of age at the same time of the year. The result indicated that at 20, years of age, 243 men (39%) had normal blood pressure 167 (26%) had high blood pressure and 218 (35%) were hypotensive.To find out association between pre-test knowledge score and selected demo-graphic factors/ variables.Association between knowledge and demographic variables The study shows that there is no significant relationship between age, sex, education occupation, income, marital status, dietary habits and previous knowledge.Thus the hypothesis formulated by investigator RH1 -That there will be significant relationship between knowledge and demographic factors/variables is rejected.RH2 -That there will be knowledge regarding hypertension among hypertensive patients has been retained.

II - Assessing the knowledge regarding hypertension among hypertensive patients. The findings of the study revealed that majority of 13 (43.33%) patients had average .knowledge, 3 patients (10%) had good knowledge and 14 patients (46.33%) had poor knowledge.

The above findings is supported by Henderson A. (1998) conducting for evaluating the effectiveness of two teaching strategies for patients diagnosed with hypertension, samples was collected from 10 patient, 20 patients in the test group received a structured education programme and received the usual information. Comparison of the pre-test and post-test of the test group revealed a significant increased in knowledge level at the time of discharge from hospital. The study showed that a structured approach to health education is more effective in improving patients knowledge.The above findings is supported by Jasmine J. (1998) conducted a study to assess the effectiveness of structured teaching on knowledge and life style adopted by hypertensive patients. The samples were 30 male and female hypertensive patients belonging to the age group 20-80 years.30 patients in Peoples Hospital Bhopal. Findings of study revealed that patients who were exposed to structured teaching have gained more knowledge and favorable

III - Evaluate effect of structured teaching among hypertensive patients.Evaluate the effectiveness of Structured teaching among hypertensive patient The findings of study revealed that high knowledge scores mean (9.33) in post-test when compared to their pre-test scores mean (17.83). The mean difference (5.577) SD (23.410) and shows a highly significant improvement in the knowledge scores, thus the structured teaching pamplet was effective.

5.1IMPLICATIONS The findings of the present study have several implications in the field of nursing education, nursing administration and nursing research.

Nursing Research There is a need for extended and intensive nursing research in the area of physiological areas of hypertensive patient. Specially in India only a few studies were reported regarding hypertension. Extensive research is needed in this area so that nurses can detect the hypertension that may lead to improve means of reduction of morbidity mortality and prevent more severe complications and health problems.

Nursing Education Prevention is better than cure. The health care personnel should be given an opportunity to update their knowledge regarding hypertension, which is influenced by hypertensive patients emotional make up, sociological, dietary habits and cultural background and even his/her willingness to accept or reject of disease. Nurse educators need to know about causes of hypertension, signs and symptoms, complications, treatment and prevention of the hypertension. The effectiveness of structured teaching programme through pamplet was informational aid to hypertensive patients for prevention of complications.

Nursing AdministrationThe study helps to raise awareness among nurses and nurse educator to acquire knowledge and to understand the importance of care of hypertensive patient.Nursing Administration The nursing administrators may use the structure teaching pamphlet to improve their knowledge in order to ensure that the nurses may assume responsibility and accountability of hypertensive patients under their care. A copy of the structured teaching pamphlet may be provided to health worker and nurses planning to work in any peoples hospital during orientation programme. This shall ensure better professional standard of nursing. Health administrator should make the education department aware about the prevailing hypertensive patients care and should assign the health workers or nurse to conduct health teaching in the Peoples Hospital Bhopal

5.3LIMITATIONS 1. Purposive sampling was done which restricts the generalization of the study. 2. The size of the sample was only 30 patients hence3. it is difficult to make a broad generalization. 4. A structured questionnaire schedule was used for data collection which restricted the amount of information that could not be obtained from the patient. 5. No attempt was made to measure the retention of knowledge after the pre-test and post-test i.e. feed-back due to time short.

5.3 RECOMMENDATIONS On the basis of the findings of the study following recommendations have been made further study. 1. A similar study may be replicated on a larger scale. 2. A comparative study may be conducted to find out the effectiveness of using different teaching strategies and structured teaching programme regarding the same topic. 3. The study can be replicated with a pre test4. A study can be conducted to assess the knowledge and practices of other chronic diseases like diabetic, Tuberculosis, Arthritis, Asthma e

5.4SUMMARY The findings of the present study were analysed and discussed with the findings of the similar studies. This helped the investigator to proved that the findings were true and the structured teaching pamplet was effective in improving knowledge. It includes statement, objective, hypothesis, tool used for the study and the findings. A study to evaluate effectiveness of structured teaching regarding hypertension among hypertensive patients at selected Peoples Hospital Bhopal. The study made us approach with one group pre-test post-test design. The population of the study consisted of hypertensive patients at selected peoples hospital. Purposive sampling technique was utilized to selected 30 hypertensive patients based on certain predetermine criteria.

Pre-test knowledge score and selected demographic factors/variables .1. To assess the pre -test knowledge score regarding hypertension2. To impart structured teaching programme3. To asses post- test knowledge score regarding hypertension4. To find out association between pre- test knowledge score and selected socio demographic variable

HYPOTHESISH1. There will be same knowledge regarding hypertension among hypertensive patient.H2.There will be significance difference between pre and post test scores.The present study attempted to assess the knowledge regarding hypertension among care hospital in hypertensive patient peoples hospital . The study made to use of evaluator y approach with descriptive pre- test and post - test probability stratified random sampling technique was 30 sample form peoples hospital Bhopal knowledge assessment by using structured pamphlet and questionnaire. The collected data analyzed by using descriptive and inferential statistics. The result revealed that 33.33% have average 66.66% good knowledge and 0.0 % regarding hypertensive patient on the carrying out of study .The constant encouragement guide , co-operation and inert of the respondents to participate to the study ,contributed to the completion of the study.Review literature was divided into three parts i.e., literature related to hypertension, literature related to structured teaching programme and literature related to evaluative study. In research methodology pre experimental research approach using one group pre- test and post- test design was adopted. The setting was Peoples Hospital Bhopal. Populations were 30 hypertensive patients were selected by purposive sampling technique, structured knowledge questionnaire was used to collect data. Pre-test was given and planned teaching was given through pamlet on first day and after seventh day post test was conducted. The analysis and findings of this study shows that educating the hypertensive patient will help them to improve their knowledge regarding hypertension. that there was a highly significant difference between pre-test and post-test knowledge scores.

5.5CONCLUSION After the detailed analysis, this study leads to the following conclusions Pre test mean knowledge score of hypertensive patient was 43.33(9.33) and post- test mean knowledge score was 33.33 (17.83%). Structured teaching through pamplet was an effective method of improving knowledge of hypertensive patients. There was no significance association was found between knowledge and demographic factors/variables like age, sex, education, occupation, income, marital status dietary habits and previous knowledge.

6. REFERENCES 1. Bare B. Smltezer C. Suzanne. (2004), Text Book of Brunners Medical Surgical Nursing 10th ed. London, Lippincott Williams & Wilkins. 2. Basavanthappa B.T. (2004), Medical Surgical Nursing, Delhi Jaypee brothers. 3. Basavanthappa, B.T. (2003), Nursing Research, 2nd ed., Jaypee Brothers Medical Publishers (P) Ltd. 4. Billings D. Gooem M.C. & Strokes (1782), Medical Surgical Nursing 7th ed. London, Mosby Co. 5. Black Joyce M. (2005); Medical Surgical Nursing, Volume 2, 7th ed. Singapore, W.B. Saunders Company. 6. Bloom Arnold, (1981), Tooheys Medicine for Nurses, 13th ed., The English Language Book Society and Churchill Livingstone. 7. Brunner and Suddarths (1999), Medical Surgical Nursing 7th ed; J.B. Lippincott Company, Philadelphia. New York London Hagerstown. 8. Calfee, R.C. and Valencia, R.R. (1999) APA guide sto preparing manuscripts for journal publication. Washington, DC : American Psychological association. 9. Chapman Christine M. (1983), Medical Nursing 9th ed. N.R. Brothers India. 10. Clara, J. (2004), Effectiveness of Structured teaching on self care of pregnancy induced hypertension among primipara mothers, Communicating Research Omayal Achi College of Nursing. 39-40. 11. Donvan, F. & Neighbors, M. (1998), Medical Surgical Nursing, 2nd ed. Philadelphia: W.B. Saunders Company. 12. Elhart Dorothy, (1984), Scientific Principles in Nursing, 8th ed. The C.V. Mosby Co. N.R. Brothers India. 13. Karch Amy M. (1997), Lippincotts Nursing Drugs Guide, Lippincotts Philadelphia, New York. 14. Kothari, C.R. (2006), Research Methodology. 2nd ed., New Delhi, New Age International (P) Limited, Publishers. 15. Lewis S.M. & Colli M. (1987); Medical Surgical Nursing 2nd ed. New York M.C. Ground Hill Co. 16. Luckman & Sorensen (1987), Medical Surgical Nursing 3rd ed. Philadelphia : W.B. Saunders Company. Luckman, (1997), Sauders Manual of Nursing Care, Philadelphia; W.B. Saunders Company. 17. Luckmans (1890), Medical Surgical Nursing 2nd ed; Philadelphia W.B. Saunders Co. 18. Macleod John, (1974), Principles and Practice of Medicine. 11th ed, The English Language Book Society and Churchill Livingstone. 19. Mahajan B.K. (2002); Methods in Priostatisties, for medical students and Research Workers, 6th ed, Jaypee Brothers Medical Publishers. 20. Mehta P.J. (1997), Practical Medicine. The National Book Depot, Mumbai. 21. Mosbys Medical Surgical Nursing & Allied health Dictionary (1994), 4th ed. New York, Mosbey. 22. Nalson R.M. (1997), Nurses Notes Medical Surigical Lippincott, Philadelphia. New York. 23. Parker; Marilyn E; Nursing Theories and Nursing Practice; Philadelphia; F.A. Davis Company. 24. Philip Wilma & Shafers J. (1980), Medical Surgical Nursing, 7th ed. St. Lewis, e.v. Mosby & Co. 25. Polit, D.F. & Hungler B.P. (1999); Nursing research principles and methods; 6th ed, Philadelphia, New York, Baltimore Lippinlott. 26. Raman A.V. (2004), Communicating Nursing Research, Omayalachi College of Nursing Avadi. 27. Smeltzer Suzanne, C. Medical Surgical Nursing, 10th edi.; Lippincott Williams Wilkings. 28. Swaminathan M. (2001), Food and Nutrition Volume II; The Banglore printing and Publishers Co. Ltd. N 88, Mysure Road, Banglore 560018. 29. Tgnataveius Donna, S. (1995), Medical Surgical Nursing, 2nd ed. Philadelphia; W.B. Saunders Company. 30. Watson Jeannettee. (1979), Medical Surgical and Related Physiology, 2nd ed. Philadelphia, W.B. Saunders Company. 31. Williams & Wilkins (2001) Menual of Nursing Practice, 7th ed. Lipincott.

JOURNALS 1. Biswas Tamal Kumars (2003). Managing Hypertension A real Challenge in the New Millennium, J. Indian Med ASSOC Vol. 101, No. 4 pp 250-252. 2. Linnethe, Jutiana (2002). Conducted a study to evaluation of a problem based Learning Package on Pregnancy Induced Hypertension for B.Sc. Nursing Students, The Nursing Journal of India, Volume No. 11, pp 261-262. 3. Jaya Kumar R.V., (2004) Hypertension and Diabetes Mellitus, Health Action, Volume No. 101, pp. 254-256. 4. Lee Young Shin, Laffery Shirley Clourier, (2006), conducted of study of Physical Activity in older. Adults with Borderline Hypertension. Nursing Research. March-April 2006 Vol. 55, No. 2 pp 110-112. 5. M. Prakasamma, (1997). Conducted a study to assess the knowledge and learning needs of clients with hypertension; The Nursing Journal of India. Volume No. 4, pp 74-76. 6. Soya, K. (2003). Conducted Study to Self care Activities of pregnancy induced Hypertension and maternal outcome. The nursing Journal of India. Volume No. 3, pp. 58-60. 7. Yadav Rohtas K. (2002). A profile of Renal/Renovascular Abnormalities in patients of Hypertension, J. Indian Med. Assoc Vol. 100, No. 6 pp 363-364.

ONLINE PERIODICALS1. Eoin O Brien; Neil Atkins; Jan Staessen. (1995). A Review of Ambulatory Blood Pressure monitoring Devices. Retrieved on 2nd Feb. 2007, from http://www.ncbi.ncm.nih.gov/entrez/guery. 2. Singh R.B. (1990), Effect of diet and weight reduction in hypertension, 6 (4); 297-302, Retrived on 2nd 2007, from http://www.medscap.com/medline/abstract. 3. Vasam R.S. (1966), The progression from hypertension to congestive heart failure, Retrived on 3rd Feb. 2007, from http://www.medscap.com/ medline/abstract. 4. Zernike W. (1998), conducted a study to evaluating the effectiveness of two teaching strategies for patients diagnosed with hypertension, 7 (1) : 37-44. Retrived on 2nd Feb. 2007, from http://www.medscape.com/medline/abstract.

ANNEXURE - ILETTER SEEKING PERMISSION FOR CONDUCT THE STUDYTo,

Subject - Request permission to conduct the pilot study and main study.Respected mam,We Bs.C (N) IVth year student of Peoples College Of Nursing And Research Centre, Bhopal selected the following topic for research project to be submitted to Barkatullah University ,Bhopal in partial fulfilment of the university of the university requirement for the award of the Bachelor of Science in Nursing Degree.Topic- A study to assess the effectiveness of Structured Teaching Programme regarding hypertension among hypertensive patients at Peoples Hospital Of Bhopal CityKindly grant permission to conduct the pilot study and main study on adults at your area.

Thanking youYours SincerelyProf. (Mrs.) Karesh PrasadPrincipalPCN & RC, BHOPAL

ANNEXUR-II

LETTER REQUESTING FOR CONTENT VALIDATION OF THE TOOL .

Subject - Request for the content validation of the tool.We the students of Bachelor of Science (Nursing),4th year and members of the IInd group of research(Medical Surgical Nursing Group) of Peoples College Of Nursing And Research Centre, Bhanpur, Bhopal have taken a research project on A study to assess effectiveness of structured teaching programme on knowledge regarding hypertension among hypertensive patients at peoples hospital of Bhopal city. Which is to be submitted in Barkatullah University for the partial fulfilment of university requirement for the award of Bachelor of Science (Nursing) degree.We request you to kindly go through the content and give your expert and valuable opinion and suggestion for any modification and improvement. We also request your to kindly sig the certificate that you have validated the tool. Your kind co-operation and expert opinion will be very much appreciated.Thanking you

Yours SincerelySignature Of PrincipalGroup members -II Lt. col. (Mrs. ) Karesh Prasad Principal, PCN&RC

Date:Place: Bhopal

ANNEXURE-III

CERTIFICATE OF VALIDITY

This is to certify that the tool and Self Structured Teaching Programme by group II, B.sc. Nursing 4th year student of Peoples College Of Nursing And Research Centre, Bhopal (M.P.) to be used in her research titled A study to assess the effectiveness of structured teaching programme on knowledge regarding hypertension among hypertensive patients at peoples hospital of Bhopal city. Has been validated by me.

This tool is up to the mark and can be used for the above mentioned study.

Signature:Name:Designation:Date:

ANNEXURE-IV

CERTIFICATE OF LANGUAGE TRANSLASTION

This is to certify that the tool used by the Research Group-IInd Medical Surgical Nursing of B.Sc. Nursing 4th year of Peoples College of Nursing and Research Centre ,A study to assess the effectiveness of structured teaching programme on knowledge regarding hypertension among hypertensive patient at peoples hospital of Bhopal city.Bhopal for their data collection on the research study titled has been seen and translated by us in Hindi. It yields the same meaning as in English.

Signature-Name-Qualification-

ANNEXURE-VCONSENT FORMI, Named.. agree to participate in the study, on A study to assess the effectiveness of structured teaching programme on knowledge hypertension among hypertensive patients at peoples hospital of Bhopal city. I have been explained and made understood the purpose of the study. My participation in this study is entirely voluntary and can withdraw from the study at any time as I wish .Researcher assured that data will be kept confidential. However this information will be used in nursing publication and presentations.

Place: BhopalSignature of the participantDate: Signature of Researcher

PEOPLES COLLEGE OF NURISNG AND RESEARCH CENTER, BHANPUR, BHOPALQUESTIONNARIESSECTION-ACode No. Date:This questionnaire consists of two sectionSection A Questionnaire related to Socio-Demographic variablesSection B Questionnaire regarding the knowledge of hypertensive patientsINSTRUCTIONS1. Select only one alternative, which suits you, and tick mark ( ) against it.2. Please do not leave any question unanswered.3. Your answer will remain strictly confidential.SOCIO DEMOGRAPHIC VARIABLES1) Age (in Year)a) 20-35()b) 36-50()c) 51-65()d) 66-80()2) Sex-a) Male()b) Female()3) Education-a) Primary()b) Secondary()c) Graduate()d) Post graduate()4) Marital statusa) Married()b) Unmarried()c) Separat()d) Divorced()e) Widow()5) Occupation-a) Farmer()b) Govt. job()c) Private job()d) Business()e) Unemployed()6) Monthly income (in rupees)-a) 15001()7) Dietary habits-a) Vegetarian()b) Non vegetarian()8) Previous knowledge about hypertension is obtained througha) Mass media (T.V. Newspaper) ()b) Health professionals()c) Friends & relatives()d) Others()

PEOPLES COLLEGE OF NURISNG AND RESEARCH CENTER, BHANPUR, BHOPALQUESTIONNARIESSECTION-BCode No. Date:This questionnaire consists of two sectionSection A Questionnaire related to Socio-Demographic variablesSection B Questionnaire regarding the knowledge of hypertensive patientsINSTRUCTIONS1. Select only one alternative, which suits you, and tick mark ( ) against it.2. Please do not leave any question unanswered.3. Your answer will remain strictly confidential.KNOWLEDGE REGARDING HYPERTENSION1) Meaning of hypertension1) What is average range of blood pressurea) 140/90mmhg ()b) 120/80mmhg()c) 130/100mmhg()d) 150/100mmhg()2) What do you mean by hypertension-a) High blood pressure()b) Low blood pressure ()c) Normal blood pressure()d) Average blood pressure()3) Which organs is affected by hypertensiona) Bone()b) Heart()c) Skin()d) Lungs()4) How many stages in hypertensiona) Primary stage ()b) Secondary stage()c) Both A&B()d) None()5) Which age group is mostly affected by hypertension-A) 10-30 years()B) 31-50 years()C) 51-70 years()D) 71-90 years()

CAUSES O HYPERTENSION6) What is the cause of hypertensiona) Plevritis()b) Diabetes mellitus()c) Peptic ulcer()d) Shock()7) Which dietary factor can lead to hypertension-a) Pickle and papad()b) Gulab jamun()c) Tea & cold drinks ()d) Chicken. ()8) which systemic disease can cause hypertension-a) Renal disease ()b) Skin disease()c) Respiratory disease()d) Reproductive disease()9) which type of medication increases the risk of hypertension a) Birth control pills ( mala-D, Mala M) ()b) Antipyretic ( Paracetamol ) ()c) Analgesic ( ibugesic plus ) ()d) Antiemetic( domperidone) ()

10) Which type of life style can lead to hypertension-a) Farmer ()b) Labor()c) Sedentary workers (sitting work) ()d) Students. ()

SYMPTOMS OF HYPERTENSION

11) What is the average range og systolic blood pressure- a) 100-110mmhg ()b) 110-120mmhg()c) 120-130mmhg()d) 130-140mmhg()12) What is the average range of diastolic blood pressurea) 160-70mmhg()b) 70-80mmhg()c) 80-90mmhg()d) 90-100mmhg()13) What is the main symptom of hypertension a) Severe headache & dizziness ()b) Blood spot in eyes()c) Itching & rashes()d) Loss of appetite ()14) Which health problem is associated hypertensiona) Arthrosclerosis()b) Renal failure()c) Stroke()d) Arthritis()15) How can you identify that you have hypertensiona) Sweating, restlessness()b) Anxiety()c) Polyuria()d) Pyros is()16) Common methods used to diagnose hypertension a) Checking B.P. at regular interval()b) USG()c) X-RAY()d) Blood test()

TREATMENT OF HYPERTENSION-17) Which dietary factors can control hypertension.a) Low sodium diets ( low salt intake) ()b) High fat diet (samosa) ()c) High fluid die (juices) ()d) Low sweet diet ( low sugar intake) ()18) When should you can yours doctor about hypertension a) Itching()b) Stomach ache()c) Dehydration()d) Sweating & luring vision()19) How can you control hypertensiona) Limiting alcohol consumption()b) Regular aerobic exercise()c) Quit smoking()d) Proper medication()20) How long the anti-hypertensive drugs could be continues a) Till sign & symptoms disappear ()b) Life long()c) For 5 year()d) According to doctors advise()21) Which type of activity is required for hypertension a) Strict bed rest()b) Self-case activities()c) Unsupervised ambulatingd) Light exercise & daily routine.

22) What are the most important long term goal for a client & hypertension-a) Learn how to avoid stressb) Explore a job change & early retirement c) Make commitment to ling term therapy d) Take balanced diet23) What is the dash diet ( dietary approach to stop hypertension)-a) Eating more fruits vegetables and low fat diary floodsb) Spicy food high fluid intakec) Eating food more sodiumd) Eating red meat & sweets24) Which type of exercise helps to reduce hypertensiona) Brisk wallingb) Gymmingc) Yogad) Aerobic exercise25) What is the side effect of hypertensive medicationa) Hemoptysisb) While pigmentation of skinc) Nausead) Sleep apnea

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