SYNOPSIS FOR

REGISTRATION OF SUBJECT FOR

DISSERTATION

SUBMITTED TO:

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

IN PARTIAL FULFILLMENT

OF

M.Sc (N) IN MEDICAL- SURGICAL NURSING

SUBMITTED BY:

Ms. SHANTY VARGHESE

I YR M.Sc (N)

UNDER THE GUIDANCE OF:

Mrs.PRIYALATHA

ASSO.PROFESSOR

H.O.D

MEDICAL-SURGICAL NURSING

NARAYANA HRUDAYALAYA COLLEGE OF NURSING

NO: 258/A, BOMMASANDRA INDUSTRIAL AREA

ANEKAL TALUK, BANGALORE-99

1 NAME OF THE CANDIDATE AND

ADDRESS

Ms. SHANTY VARGHESE

I YEAR M.Sc NURSING,

NARAYANA HRUDAYALAYA

COLLEGE OF NURSING,

BOMMASANDRA INDUSTRIAL

AREA, BANGALORE – 99.

2 NAME OF THE INSTITUTION NARAYANA HRUDAYALAYA

COLLEGE OF NURSING.

3 COURSE OF STUDY AND SUBJECT 1ST YEAR M.Sc NURSING (MEDICAL-

SURGICAL NURSING)

4 DATE OF ADMISSION TO COURSE 08-06-2009

5 TITLE OF THE TOPIC THE EFFECTIVENESS OF A

STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE

REGARDING SWINE FLU AMONG

THE NURSING STUDENTS

PROBLEM STATEMENT

A STUDY TO ASSESS THE EFFECTIVENESS OF A STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING SWINE FLU

AMONG THE NURSING STUDENTS OF SELECTED COLLEGE OF

BANGALORE.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza

viruses) that infect the respiratory tract of pigs and result in nasal secretions, a barking-

like cough, decreased appetite, and listless behavior. Swine flu produces most of the same

symptoms in pigs as human flu produces in people. It can last about one to two weeks in

pigs that survive. Swine influenza virus was first isolated from pigs in 1930 in the U.S.

and has been recognized by pork producers and veterinarians to cause infections in pigs

worldwide. In a number of instances, people have developed the swine flu infection when

they are closely associated with pigs (for example, farmers, pork processors), and

likewise, pig populations have occasionally been infected with the human flu infection.1

Persons with swine influenza A (H1N1) virus infection should be considered

potentially contagious for up to 7 days following illness onset. Persons who continue to

be ill longer than 7 days after illness onset should be considered potentially contagious

until symptoms have resolved. Children, especially younger children, might potentially

be contagious for longer periods. The duration of infectiousness might vary by swine

influenza A (H1N1) virus strain. Non-hospitalized ill persons who are a confirmed or

suspected case of swine influenza A (H1N1) virus infection are recommended to stay at

home (voluntary isolation) for at least the first 7 days after illness onset except to seek

medical care.1

H1N1 virus will transmit through the air and it will produce the symptoms like

-fever, cough, or sore throat

-nasal congestion, rhinorrhea

-myalgia, headache

-chills, fatigue

-vomiting, diarrhea

-dyspnea, pneumonia

-conjunctivitis

-seizures

-respiratory failure

-exacerbation of underlying chronic medical conditions1

Swine flu can be diagnosed by the history of association with people known to

have the disease with their symptoms and a quick test (for example: nasopharyngeal swab

sample) is done to see if the patient is infected with influenza A or B virus.1

6.1: NEED FOR THE STUDY

Swine flu is a major health problem that occurs in people of all countries. The

WHO reports of 2009 shows that U.S. and Australia had the highest number of new cases

in the last reporting period (1,078 and 204, respectively).2

On 5-6-09 Wisconsin continues to report the highest number of confirmed and

suspected cases in the U.S. as 2,217, an increase of 603 cases in four days. Total cases

were 13,217 with 27deaths, in the US.2

In New Delhi: The sudden surge in public anxiety over H1N1 influenza swine flu

resounded in the Cabinet with the meeting dwelling on the situation for an hour and

taking a view that there was a need to instill a “common sense” approach to the flu .2

The death of a school girl due to swine flu in Pune had led to a big increase of

people turning up for testing. The flu discussion took over the cabinet meeting which

otherwise was to consider some fairly ordinary agenda items. Health minister Mr.

Ghulam Nabi Azad is understood to have stressed the need for wide publicity. Some

fairly straight forward sets of steps for those suspected of flu infections. Every cough and

cold was not swine flu and this message needed to be drilled into the public

consciousness.4

On 20-06-09 six people including two children tested positive for the influenza A

(H1N1) virus, taking the total number of people affected with swine flu in India to 50. At

least 16 of them have been discharged from the hospitals on complete recovery. The

World Health Organization has reported 44,287 laboratory confirmed cases of influenza

A (H1N1) infection from 89 countries as on June 17 2009 and there have been 180

deaths4.

In Bangalore two more people died by 20th August, 2009. Toll due to HIN1

influenza related cases rose to 72 in Karnataka, with two more people succumbing to the

virus. A health department bulletin today said a 40-year-old man died in a private

hospital in Bijapur on September 12th 2009 and his test, which was positive for H1N1,

was received today. Similarly, a 35-year-old woman died in the city on September 15th

and the test results were received as confirmed .In Bangalore total number of death

confirmed with swine flu is 88 and in Karnataka 1045 detected. 6

On August 22 Pune recorded its 20th swine flu death with a 60-year old man

succumbing to the virus.3 The latest death toll in India is 403 as per October 19th 2009

statistics reported by Government of India.

As swine flu is a burning problem not only in India but also in every part of the

world, it is essential to bring awareness regarding swine flu and its effects. As nurses play

an important role in taking care of patients in the hospital, they are also more prone to

contract this communicable disease. Therefore it is important to enpower student nurses

about the transmission and its prevention. It becomes more imperative since it is not

included in their syllabus during their course of study.

6.2: REVIEW OF LITERATURE

Based on the objectives of the study the literature from various sources had been

reviewed & arranged under following categories.

SECTION A: Literature review on prevention and the treatment modalities

available in swine flu.

SECTION B: Literature review on public awareness programmes conducted

on swine flu globally.

SECTION A: Literature review on prevention and the treatment modalities

available in swine flu

SAN FRANCISCO —Researchers delivered a double dose of good news Sunday

in the fight against flu: successful tests of what could become the first new flu medicine

in a decade, and the strongest evidence yet that such drugs save lives, not just shorten

illness. A single intravenous dose of the experimental drug, peramivir, cleared up flu

symptoms as well as five days of Tamiflu pills did, a large study in Asia reported it. An

IV therapy is badly needed because many sick people can't swallow pills and because

illness hinders the body's ability to absorb oral medicines.4

On June 11th, 2009, the World Health Organization raised its pandemic alert level

to the highest level, phase 6, indicating widespread community transmission on at least

two continents. The pandemic that began in March 2009 was caused by H1N1 influenza

A virus that represents a quadruple reassortment of two swine strains, one human strain,

and one avian strain of influenza. Diagnostic studies are real- time reverse transcriptase

(RT)-PCR or culture. For patients requiring treatment, WHO recommend either

zanamivir or oseltamivir. Zanamivir is contraindicated in patients with asthma or chronic

obstructive pulmonary disease. In such cases, for patients who are unable to take

zanamivir can take the addition of an adamantine to oseltamivir.In pregnancy oseltamivir

is the drug of choice. Acetaminophen can be given when fever is present. Oseltamivir can

be given for children of 1 year and older. Zanamivir can be given for children of 7 years

and older.1

CDC recommended that oseltamivir (TAMIFLU) and zanamivir (RELENZA) are

effective against swine flu. Oseltamivir is approved to both treat and prevent influenza A

and B virus infection. It comes in capsule form and in liquid form that can be measured

for proper dosage. Zanamivir is approved to treat and in some cases prevent influenza A

and B virus infection. Zanamivir is packaged in a medicine disk called a Rotadisk and is

inhaled by mouth using a delivery device called a Diskhaler.1

FOLLOWING INDIVIDUAL MEASURES NEEDS TO BE TAKEN TO PREVENT

THE AIRBORNE TRANSMISSION OF THE VIRUS:

1) To cover nose and mouth with a tissue while coughing or sneezing. The same

tissue to be disposed off into the trash can after use.

2) To wash hands often with soap and water especially after cough or sneeze or use

alcohol-based hand cleaners and also avoid touching the eyes, nose or mouth

because germs spread this way.

3) To avoid close contact with sick people.

4) To stay home if they are sick for seven days after symptoms begin or until they

have been symptom free for 2 hours, whichever is longer. This is to keep from

infecting others and spreading the virus further.

5) To follow public health advice regarding school closures, avoiding crowds and

other social distancing measures.

6) If anyone must have close contact with a sick person (for example, hold a sick

infant), try to wear a facemask or N95 disposable respirator. 1

ABOUT FACEMASKS AND N95 RESPIRATORS

Facemasks and N95 respirators are devices that may help prevent the spread of germs

(viruses and bacteria) from one person to another. They are one part of an infection-

control strategy that should also include frequent hand washing and social distancing.

The ‘N95’ designation for respirators means that when subjected to careful testing, the

respirator blocks at least 95% of very small test particles. If properly fitted, the filtration

capabilities of N95 respirators exceed those of face masks. Facemasks and N95

respirators should not be shared because they may become contaminated with germs

(viruses and bacteria) that can spread between people. Individuals need to take

precautions while using a facemask or N95 respirators as follows:

1) To spend the least amount of time possible in close contact and try to wear a

facemask(for example, surgical mask) or N95disposable respirator, if you must

have close contact with a sick person (for example, hold a sick infant).

2) To wear an N95 respirator if they help a sick person with respiratory treatments

using a nebulizer or inhaler in a separate room away from common areas of the

house.

3) To avoid re-using disposable face masks and N95 respirators. Used facemasks

and N95 respirators should be taken off and placed immediately in the regular

trash so they don’t touch anything else.

4) If individuals use a reusable fabric facemask, it should be laundered with normal

laundry detergent and tumble-dried in a hot dryer.

5) Clean the hands with soap and water or an alcohol-based hand sanitizer.1

SECTION B: Literature review on public awareness programmes conducted on

swine flu globally:

Assab — the Southern Region Branch of the Ministry of Agriculture (MoA)

conducted a seminar to improve public knowledge regarding the Bird and Swine flu.

Pointing out that the inhabitants of the Southern Red Sea region are particularly

vulnerable due to the port traffic and avian migration, the participants of the seminar

underlined the need for the intensive promotion of information regarding these diseases.

In a speech he gave during the seminar, head of the MoA Branch, Dr. Yonas Woldu

stated that it is proving difficult to control the transfer of communicable diseases from

animals to human beings around the world today and called for increased focus on such

diseases. Director General of the region's economic development department, Mr.

Gebreselasie Ar'adom on his part emphasized the importance of awareness promotion in

combating diseases like the Bird and Swine flu and called for strengthened efforts in this

case.5

Sharjah Commerce and Tourism Development Authority (SCTDA) on july1st

2009 in collaboration with the UAE Ministry of Health has launched a public awareness

campaign about the H1N1 virus (swine flu) among UAE residents and tourists. The

initiative was launched in response to the Who Health Organization’s recent raising of

the worldwide pandemic alert level to Phase 6, indicating that a global pandemic is

underway. Over 55,000 confirmed cases have been reported all over the world, posing a

real threat to the global travel and tourism industries. The awareness campaign includes

the distribution of leaflets on the virus - including information about the illness, modes of

transmission, symptoms and prevention .All hotel premises and tourism facilities in the

emirate of Sharjah in order to provided tourists with necessary information on preventive

measures to help combat the outbreak. The move reflects the SCTDA’s keenness to

educate residents and tourists on ways to prevent contracting and spreading the virus.4

In India ,2009 May 7th at KAMJONG in Manipur -- Veterinary doctors and other

authorities have geared up to combat swine flu outbreak by launching awareness

campaign among residents and by organizing massive vaccination for pigs in villages

near India-Myanmar border in Manipur. Doctors are highlighting the probable threats of

transmitting the disease from the livestock animals that are illegally imported from

Myanmar to the village. “Especially here people of this place are doing business of

livestock trade especially pig or avian’s and other livestock,” as this place is important

place for transportation of animals from international border area, so we like to give

message to people for taking precautionary measures of the dreaded disease of swine

flu,” said Dr. K. Gopal Singh, a disease specialist4.

KGH Chest Hospital in Visakhapatnam conducted an awareness programme as it

was a Herculean task to screen patients at the railway station and bus stations. People

having cold, cough and throat pain are advised to go to the screening centres. They were

also advised to keep themselves away from crowds and wash their hands frequently.

Teachers are also asked to grant leave to children showing swine flu symptoms and to tell

their parents to keep them in isolation at home. People are also advised not to neglect if

they showed swine flu symptoms after taking a homoeo swine flu-prevention drug.4

An awareness programme on ‘swine flu’ was conducted for students at Ayya

Nadar Janaki Ammal College, Sivakasi. M.K. Rajan, Head, Department of Zoology (PG),

and D. Prabhu, Head, Department of Microbiology, were the resource persons. The

trained students disseminated information on the mode of spread, preventive measures

and necessary action to be taken to their peers.4

On August 21st 2009, organizers of the hugely popular Ganesh Chaturthi festival

in Pune took up swine flu as festival theme to spread awareness among the people. The

highlights of the festival are fibre mannequins wearing swine flu masks erected by

talented artists in the Pune. These special mannequins had audio-visual support to convey

the message regarding swine flu precautions. Some of them were portrayed as school

going kids, teachers, doctors all are shown wearing masks. The aim was to create

awareness among people about the flu. Also, there will be allopathic, homeopathic and

ayurvedic doctors in the festival, who will provide medication to those who need," said

Srikant Shete, President of Kasba Sarwajanik Ganesh Mandal, Pune.Another motive is to

remind people to take precautions and avoid swine flu infection during the celebration.

India recorded its first H1N1 case in Hyderabad in May and since then the virus has

spread across the country with dozens of cases from western Pune city. The latest death

toll in India is 403 as per October 19th 2009 statistics reported by Government of India.4

6.3: OBJECTIVES OF THE STUDY

1) To assess the knowledge regarding swine flu among the nursing students.

2) To develop and provide structured teaching programme regarding swine flu and its

prevention.

3) To assess the effectiveness of structured teaching programme about swine flu.

4) To determine the association between the selected demographic variables on

knowledge of swine flu.

6.4: OPERATIONAL DEFINITION

Assess- It refers to the appraisal of knowledge score of nursing students

attending structured teaching programmme regarding swine flu.

Effectiveness- It refers to the improvement in knowledge score after the

structured teaching programme.

Structured teaching programme- It refers to systematically organized teaching

strategy on cause, spread, prevention, complications and the management of

swine flu.

Knowledge- It refers to the information and understanding of nursing students

on swine flu, as measured by a structured questionnaire.

Swine flu-it is a respiratory disease caused by viruses (influenza viruses) that

infect the respiratory tract of pigs and result in nasal secretions, a barking-like

cough, decreased appetite, and listless behaviour.

Nursing students- students who are pursing nursing studies and are in I year to

IV year period.

6.5: ASSUMPTIONS

1) Students may have some knowledge regarding swine flu on pre-test.

2) Implementation of structured teaching programme may provide practical

guidelines to the students.

3) The post-test score may be higher than the pre-test.

6.6: HYPOTHESIS

H1- The mean post test knowledge score of nursing students attending structured

teaching programme will be higher than the mean pre test knowledge score at 0.05 level

of significance.

H2-There will be a significant association between the level of knowledge of nursing

students with the selected demographic variables.

7. MATERIALS AND METHODS

7.1 Sources of data : Students who are pursuing General Nursing and

Midwifery course and Bachelor of Science in nursing

7.2 Methodology

7.2.1 Type of study : Quasi-experimental study

7.2.2 Research design : One group before-after design

7.2.3 Sample size : 50

7.2.4 Sampling technique : Two stage sampling

- List of the colleges will be obtained and one college will be randomly selected

from the sample frame. By systematic sampling selection of students will be done.

7.2.5 Sampling criteria

Inclusion criteria : Students who are willing to participate in the study

Exclusion criteria : Students who have attended educational programme

on swine flu within 6 months

7.2.6 Variables

Dependent variable : knowledge

Independent variable : Structured teaching programme

7.2.7 Setting : Selected Nursing colleges of Bangalore

7.2.8 Data collection technique

Data will be collected by administering a questionnaire regarding causes, spread,

prevention and management of swine flu

Description of tool

Researcher prepared questionnaire on swine flu, its causes, spread, prevention,

complications and management.

The validity and reliability of the tool will be ensured through content validity by

experts and pilot study.

Data collection procedure

Students who fall in to the inclusion criteria will be selected randomly.

Assessment of level of knowledge on swine flu will be done using a

questionnaire.

Structured teaching programme will be given and the knowledge will be

reassessed through the same questionnaire after a period of one week.

7.2.9 Data analysis

Data obtained will be analyzed in terms of objectives. Plan of data analysis include

descriptive and inferential statistics.

Data analysis will be done as follows:

1) The level of knowledge of students regarding swine flu before and after structured

teaching will be evaluated using, frequency, percentage, mean and standard

deviation.

2) Effectiveness of structured teaching programme will be evaluated using paired

‘t’test.

3) The association between the selected demographic variables such as educational

status on knowledge of swine flu will be calculated by chi square test.

7.3 Does the study require any investigation or interventions to be conducted on

patients or other humans or animals? If so, please describe briefly.

Intervention provided to the nursing students will be a structured teaching programme on

swine flu its causes, clinical manifestations, treatment and prevention.

7.4 Has ethical clearance been obtained from your Institution?

Ethical clearance is obtained from the Institution.

8. REFERENCES

1)http://www.medicinenet.com

2)http://www.cdc.gov/swineflu

3) Two more captured by swine flu. Times of India 2009August20; Page (1)

4)http://www.uptodate.com/home/content/topic.do

5) http://allafrica.com/stories

6) Death crossed 88. Mathrubhumi 2009 October 2; Page (3)

9. Signature of Candidate

10. Remarks of the Guide

11. Name & Designation of

a. Guide : Mrs.PRIYALATHA

ASSO.PROFESSOR

MEDICAL-SURGICAL NURSING

NARAYANA HRUDAYALAYA

COLLEGE OF NURSING

b. Signature :

c. Co-Guide (if any) :

d. Signature :

e. Head of Department : Mrs.PRIYALATHA

HOD

MEDICAL-SURGICAL NURSING

NARAYANA HRUDAYALAYA

COLLEGE OF NURSING

f. Signature :

12. 12.1 Remarks of the Chairman & Principal

12.2 Signature