RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
“The king, who cannot rule his diet, will hardly rule his realm in peace and quiet.”
The gastro intestinal system provides the body with adequate and continuous amount of nutrients from ingested food. Disorders of gastro intestinal functions interfere with normal maintenance of health. Gastritis is the one of the most common gastro intestinal disorder .It is the inflammation of the gastric mucosa. The statistical rate showing about 50%of the world population is suffering with gastritis ie, 2.7 million people1. Hence the prevention and management of gastritis plays an important role among the younger population.
The causes of gastritis are infection caused by bacteria(H. pylori ),virus(herpes simplex virus),irritants, auto immune disorders, life style changes, stress, intake of coffee and acidic beverages, spicy and carbonated foods, backflow of bile into the stomach (bile reflux),pernicious anemia, long term use of NSAIDs, smoking and alcoholism.2
The most common symptoms of gastritis are stomach upset and pain. Other possible symptoms include indigestion (dyspepsia), heart- burn, abdominal pain, hiccups, loss of appetite, nausea, vomiting (possibility of food or material that looks like coffee- ground), dark stools, belching, and a sour taste in the mouth. Frequent attacks of gastritis causes complication like peptic ulcer, anemia, gastric erosion and gastro intestinal bleeding.2
Making lifestyle changes, such as avoiding the long-term use of alcohol, NSAIDs, coffee, and drugs, may help to prevent gastritis and its complications. Further steps of prevention are reducing stress through relaxation techniques – including yoga and meditation, avoiding the hot and spicy foods and also the use of carbonated beverages. In order to that screening is the essential step in preventive measures.2
Management is categorized into four aspects such as life style modification, dietary management, pharmacological management and followup. In life style modification, should stop using alcohol, tobacco, smoking and taking NSAIDs, which irritates the stomach mucosa. The dietary management includes avoidance of hot and spicy foods, acidic beverages such as coffee, carbonated beverages and fruit juices with citric acid. Also avoid high- fat foods which increases inflammation in the stomach lining and eat a fiber rich diet and foods containing flavonoids like apples, cranberries, onions, garlic and tea may stop the growth of H. pylori. In pharmacological management most common treatment is with “triple therapy”, including a proton pump inhibitor to reduce acid production and two antibiotics, is commonly used to treat H. pylori related gastritis. Followup is also very important step because the H. pylori bacteria may increase the risk of stomach cancer. Be sure to see health care provider regularly if there is any change in the symptoms because early detection is the boost to proper management of chronic illness.1
Student life is golden life, is a time of critical growth since most of them are in the period of adolescents or adulthood. Adolescents are a particular nutritional risk because as they away from home to pursue their higher education. The peer group influences the unhealthy life styles and unhealthy dietary management tend to put the category at most risk. To avoid the being the part of this statistics the best solution is the appropriate preventive measures goes hand in hand with properly planned management such as life style modification, dietary management as well as medical management.3
A study was conducted in Germany (2005) with an aim to assess the prevalence of chronic atrophic gastritis in different parts of the world. Studies comprising at least 50 subjects through cross referencing studies. Result shows that prevalence rate widely between the populations screened by gastroscopy and prevalence were higher in Algeria and Japan (10.4%, 16.0% respectively) than European and US populations. Despite the limited number and comparability of studies, this review indicates that chronic atrophic gastritis is relatively common among adolescents and adults in different parts of the world.4
“An ounce of prevention is worth than a pound of cure.”
The gastro intestinal system is a long, hollow tube that passes through the body providing an isolated environment for digestion and absorption of the nutrients. Gastritis is one of the leading diseases in India .It is the irritation or inflammation of the lining of the stomach. In India almost 11,000 populations are suffering with gastritis and the prevalence rate of Karnataka is 73 per 1000 person5. The statistical rate is showing that 39.73% of the nursing students are suffering with gastritis, by the use of carbonated food items.6
A study was conducted in 2009 with an aim to assess the knowledge, attitude and practices of medical as well as nursing students regarding carbonated drinks. A cross sectional study was conducted at Himalayan Institute of Medical Science (H.I.M.S.), Dehradun. A total of 137 students were randomly selected and included in the study. A self administered pre-tested structured questionnaire was introduced for the purpose of the study .The result shows that 27.14% medical students and 39.65% of the nursing students responded gastritis. Conclusion says that a holistic approach should be incorporated to combat the problems associated with the consumption of carbonated drinks. 6
Gastritis is a gastro intestinal disorder and also acts as symptoms of other diseases such as gastric cancer, peptic ulcer, hepatitis A and pernicious anemia. It can occur suddenly (acute gastritis) or gradually (chronic gastritis). The main causes of gastritis are infections, alcohol use, use of caffeine products and beverages, stress, unhealthy lifestyles and unhealthy dietary management.7
Nursing students have migrated to other areas of country to fulfill their dream profession. They have to adjust to the changing dietary pattern in the hostel set up. It is a task of psychological and physiological challenge. This makes the students to stick on to the junk foods which are of less nutritive value. Hostellers are at particular nutritional risk because as they stay away from home and they are more prone to lead an unhealthy lifestyle and dietary management. They tend to eat spicier, carbonated food that usually causes gastritis.
A study was conducted with the aim to examine the epidemiological characteristics of
H pylori infection among hostellers around 5000 population in Central Taiwan. A community based survey was carried out using stratified sampling in 10 colleges including the hostel students. The result shows that, a total of 55% were H. pylori antibodies positive. The study concluded that there were no difference in the seroprevalance of H pylori infection by gender, ethnicity, geographical area, parental education and source of drinking water.8
Since researcher was a hosteller, admitted to pursue her bachelor’s degree in Hyderabad, can clearly stated that students without a proper knowledge regarding prevention and management of gastritis may adhere to inappropriate measures .So the researcher felt the need to educate hostellers (nursing students) on preventive and management aspects such as screening, modification of life styles, relaxation techniques, proper dietary management, pharmacological management and follow-up according to the causative factors. So the investigator suggested that, this study will improve the knowledge of them regarding the prevention and management of gastritis.
“A study to evaluate the effectiveness of Knowledge on Self Instructional Module regarding Prevention and Management of Gastritis among the Hostellers in NDRK Institute of nursing, Hassan, Karnataka.”
6.4 OBJECTIVES OF THE STUDY
1. To assess the knowledge of hostellers, in NDRK Institute of nursing, Hassan, Karnataka regarding prevention and management of gastritis before administration of self instructional module.
2. To develop and administer self instructional module regarding prevention and management of gastritis among hostellers in NDRK Institute of nursing, Hassan, Karnataka.
3. To assess the knowledge of the hostellers in NDRK Institute of nursing, Hassan, Karnataka regarding the prevention and management of gastritis after the administration of self instructional module.
4. To evaluate the effectiveness of self instructional module by comparing pre-test and post-test knowledge scores of hostellers in NDRK Institute of nursing, Hassan, Karnataka regarding prevention and management of gastritis.
5. To associate the pre and post test knowledge scores with selected socio-demographic variables among hostellers in NDRK Institute of nursing, Hassan, Karnataka.
H0: There will not be any significant differences and association between pre test and post test knowledge score of who have received the self instructional module on prevention and management of gastritis.
H1: There will be a significant difference between pre test and post test knowledge score of who have received the self instructional module on prevention and management of gastritis.
H2: There will be a significant association between selected socio demographic variables and knowledge of hostellers regarding prevention and management of gastritis.
1. The study will improve the knowledge of hostellers (diploma as well as bachelor of nursing students) in NDRK Institute of nursing, Hassan, Karnataka regarding prevention and management of gastritis.
2. The study will improve the knowledge of hostellers regarding selected aspects of prevention and management of gastritis such as screening, life style modification, and dietary management, stress reducing techniques, pharmacological management and followup.
To judge or determine the significant worth or quality of self instructional module on knowledge of prevention and management of gastritis among hostellers in NDRK Institute of nursing, Hassan, Karnataka.
It refers to significant increase in the level of knowledge of hostellers in NDRK Institute of nursing, Hassan, Karnataka regarding prevention and management of gastritis which is measure from the response of pre-test, self instructional module and post-test.
It refers to the systematically organized content on knowledge regarding prevention and management of gastritis among hostellers in NDRK Institute of nursing, Hassan, Karnataka.
It refers to the understanding of information regarding prevention and management of gastritis among hostellers in NDRK Institute of nursing, Hassan, Karnataka.
It refers to hindering the fact from happening
It refers to the inflammation of the gastric mucosa.
It refers to the nursing students who are residing at hostel.
It refers to an organization for the promotion of education.
1. Students who are residing at hostel, in NDRK Institute, Hassan, Karnataka.
2. Students those who are present at the time of study.
1. Students who are days scholars are excluded from the study.
2. Students who are absent during the time of the study
Study is limited to
1. 70 hostellers of NDRK Institute of nursing, Hassan, Karnataka.
2. A period of 4 -6 weeks.
6.10 SIGNIFICANCE OF THE STUDY
Based on Betty Neuman Theory.
6.12 REVIEW OF LITERATURE
Review of literature is a key step in research process. Review of literature refers to an extensive, exhaustive and systematic examination of publications relevant to the research project .Before any research can be started whether it is a single study or an extended project, literature reviews of previous studies and experiences related to proposed investigations should be done. One of the most satisfying aspects of the literature review is the contribution it makes to the new knowledge, insight and general scholarship of the researcher.
Review of literature is divided into 3parts:- Literature related to
6.12.3) Knowledge on effectiveness of self instructional module.
6.12.1. Literature related to knowledge on prevalence of gastritis
A study was conducted with an aim to investigate the health problems of the recently enrolled new university students in Celal Bayar University, Manisa, Turkey (2009). The study was conducted at 640 students by the Students’ Selection and Ranking Examination. Spearman correlation analyze and somer’s regression descriptive statistical techniques were used for this study. The result revealed that42.7% of males and 57.3% of females were showing the positive prevalence for gastritis. The conclusion of the study emphasized the importance of health screening of enrolling students in the registration.9
A study was conducted in Indiana (1996) with an aim to compare the prevalence of Helicobacter pylori seropositivity among gastro enterology nurses with that of general population. A comparative study was used in this study through 138blood samples from nurses and 112 samples from general population. Result showed that the prevalence of seropositivity for antibodies of H.pylori among nurses was 17.9% which was more that of the control group, who has 13.8%. Conclusion was that nurses have an increased prevalence of H. pylori than general population.10
A study was conducted in Scotland (1993) with an aim to analyze the increased prevalence of Helicobacter pylori antibodies among nurses. The comparative study estimated the prevalence of H.pylori antibodies among groups of asymptomatic nursing students and compares them with volunteer blood donors of similar age and sex. As sample 158 nurses and 441 blood donors had taken for this study. The result was 62(39%) of 158 nurses were found to be positive for H. pylori antibodies compared with 114(26%) of 441 specimens from the blood donor group. Conclusion was that nurses have an increased prevalence of H. pylori antibodies that is significantly higher than the comparable prevalence of volunteer blood donors and is evident in the youngest age group. In addition, the increased prevalence is related to a longer duration of patient exposure in the nursing group.11
^ .2. Literature related to knowledge on prevention and management
A study was conducted in Japan with an aim to investigate the association between atrophic gastritis and gastric cancer and to identify the risk and preventive factors for the progression of atrophic gastritis to cancer. In this prospective study was used and 5,373 people were taken as sample with a follow up of 6 years. The result revealed that 69 gastric-cancer cases were identified, 65 from the subjects with atrophic gastritis and 4 from the people without atrophic gastritis. The conclusion says that atropic gastritis increases the risk of gastric cancer but the dietary modification prevents the progression from atropic gastritis to gastric cancer, regardless of pre cancerous lesion.12
A study was conducted in Mexico with an aim to the determine the best serological screening method for chronic atrophic gastritis. Test characteristics of potential screening tests (antibodies to Helicobacter pylori or CagA, elevated gastrin, low pepsinogen, increased age) were used among 260 medical personnels. The result reveals that sensitivity for chronic atrophic gastritis was highest for antibodies to H.pylori was 92%. The conclusion says that, H pylori antibodies alone had the best combination of test characteristics for chronic atrophic gastritis screening. However, no screening test was both highly sensitive and highly specific for chronic atrophic gastritis.13
A study was conducted in Houston (2001) with an objective to examine the variation of ^ treatment success in adults worldwide. Data were analyzed in a cross-classified multi-level meta-regression method, 618 treatment groups were analyzed. The result shows that the treatment was less successful with shorter treatment duration and dual drug therapy than triple therapy and treatment of longer therapy. Conclusion that more effective treatments are needed for most populations of the world where H. pylori infection and drug resistance are common. Current treatment guidelines do not coincide with the best treatment regimens identified in this meta analysis.14
A study was conducted in two Italian hospitals between September 2003 and April 2006 with an aim to determine whether sequential treatment eradicates ^ infection better than standard triple therapy for adults with dyspepsia for adults with dyspepsia Randomized, double-blind, placebo-controlled trial was administered on 300 patients with dyspepsia. The result shows that the sequential therapy was significantly more effective in patients with dyspepsia(89%) than standard treatment (77%). The study concluded that sequential therapy statistically significant compared with standard therapy for eradicating H. pylori infection.15
A study was conducted in London (2004) with the aim to assess the use of proton pump inhibitors for gastric acid suppression in critical illness. Critically ill patients admitted to intensive care unit who are at risk of mucosal damage, were selected. The result of the study revealed that the proton pump inhibitors (PPI) achieve a more rapid and sustained increase in gastric pH.16
^ .3. Literature related to knowledge on effectiveness of self instructional module.
A study was conducted to determine the effects of using a self-instructional module on teacher perceptions of attitudes and values of disadvantaged inner-city black youth. The relationship between teacher perceptions of disadvantaged inner-city black youth, and various demographic variables, and the effects of using a self-instructional module on teacher perceptions of the attitudes and values of these same disadvantaged youth. Results of an analysis of variance showed that pre-professional teacher perceptions were not related to the following demographic variables; sex, race, socioeconomic background, father's educational level, size of childhood community, and previous contact with black youth. However, use of the self-instructional module caused a statistically significant difference in pre-professional teacher perceptions of the attitudes and values of inner-city black youth. Because teacher perceptions became more accurate with use of the self-instructional module, which presented positive attitudes and values of inner-city youth, the module is valuable for teacher development in pre-service or in-service training.17
A study was conducted to determine the effectiveness of Self Instruction Module in teaching palliative care to undergraduate medical students at the University of Western Australia in 2008. A two-hour workshop was designed and implemented to address certain shortcomings in the palliative care attachment of the students. Pre-workshop and post-workshop questionnaire showed a marked increase in the self rate competence and suggested this improvement was directly attributed to the workshop. The study revealed that the SIM was an effective instructional format in small group setting, and it was cost-effective with minimal use of resourses.18
7.1 SOURCES OF DATA COLLECTION
The data will be collecting from hostellers in NDRK Institute of nursing, Hassan, Karnataka.
7.2 METHOD OF DATA COLLECTION
Data will be collected from samples using a structured questionnaire
O1= Pretest knowledge of hostellers regarding prevention and management of gastritis
X = Self instructional module regarding prevention and management of gastritis
O2 = Post test knowledge of hostellers regarding prevention and management of gastritis.
^ - N D R K Institute hostel, Hassan, Karnataka.
3. Population: - Hostellers in N D R K Institute of nursing, Hassan, Karnataka
4. Sample: - Hostellers who are fulfilling the inclusion criteria.
5. Sample size: - 70 Hostellers at N D R K Institute of nursing, Hassan, Karnataka
^ - Probability sampling- Stratified random sampling.
7. Collection of data:-Data will be collected from samples by using structured questionnaires.
Self instructional module on prevention and management of gastritis.
Knowledge of hostellers regarding the prevention and management of gastritis.
Descriptive statistics include percentage, frequency, mean and standard deviation for hostellers regarding prevention and management of gastritis.
It include independent ‘t’-test and paired ‘t-test’ with chi- square test and “ANOVA” “f” test for the assessment of knowledge and to associate the socio demographic variable is planned .
10% of sample size is planned for the pilot study.
11. ETHICAL CONSIDERATION
1. Does the study require any intervention to be conducted on hostellers?
2. Has ethical clearance been obtained from your institution?
3. Has the consent been taken from the hostel?
1. www. wrong diagnosis. com
3. Joyce M Black, “Medical Surgical Nursing”, 7th edition (2005), Elsevier publications,
New Delhi, Pp; 747-748.
4. Melanie Nicole Weck and Hermann Brenner, “Prevalence of Chronic Atrophic Gastritis in
Different Parts of the World”, Cancer Epidemiol Biomarkers Prev 2006, vol 15(6). June 2006.
Students at teaching hospital”. JK Science, vol11 (4). Pp. 196-199. ISSN 0972-1177.
7. Suzanne C. Smeltzer, Brunner and Suddarth’s Text Book Of Medical Surgical Nursing, 11th
Edition, (2009), Lippincott-Raven Publishers, Pp; 1204-1208.
8. Chen CY etal, Seroprevalence of Helicobacter pylori infection among hostellers in Taiwan,
School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung,
9. Haluk Mergen, etal, “Medical Check-Up Useful for Physician among New University Students
During Enrolling Time to University” Gen Med 2009; vol6 (2), Pp: 69-73.
10. Ellet, Marsha L. DNS, RN, CGRN “Prevalence of Immunoglobulin G to Helicobacter pylori
Among endoscopic nurses” Intern med.1996; vol 23(5), Pp512-514.
11. Scott L.Wilhoite MD, etal, “Increased Prevalence of Helicobacter pylori Antibodies Among
Nurses”, Arch Intern Med. 1993; vol 153(6), Pp708-712.
12. Kobayashi S and Suzuki T “Protective factor against progression from atrophic gastritis to
gastric cancer--data from a cohort study in Japan.” Division of Epidemiology, Aichi Cancer
Center Hospital, Nagoya, Japan.
13. Catherine Ley2 and Alejandro Mohar, “Screening Markers for Chronic Atrophic Gastritis in
Chiapas” Virchows Archiv, 2005, Vol 446, No: 1, Pp.1-9.
14. Lori A Fischbacha, “Sources of variation of ^ treatment success in adults
worldwide: a meta-analysis”, October 5, 2001
15. Dino Vaira, “Sequential Therapy versus Standard Triple-Drug Therapy for Helicobacter pylori
Eradication (2006),” From the University of Bologna, Bologna, Italy.
16. Stephen Brett, “Science review: The use of proton pump inhibitors for gastric acid suppression
in critical illness,” Critical Care, October 2004, vol 9, Pp 45-50doi:10.1186/cc2980
17. Bames & Evelyn M, “the effects of using a self instructional module on teacher perceptions of
attitudes of values of disadvantaged inner city black youth”, U.S department of education
publication. Pp 138.
18. K.Auret, etal; “using structured instructional module in teaching palliative care to
undergraguate medical students,” journal of cancer education, 2008, vol 23(3), Pp 149-155.