Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

ANNEXURE 1

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 Name of Candidate and

Address

Mr. AJAYA GHOSH R. U

I YEAR MSc. NURSING STUDENT,

SRI H.D.DEVEGOWDA CO-OPERATIVE

COLLEGE OF NURSING, MANICHANAHALLY

GATE, BELUR ROAD, HASSAN, 573207

2 Name of the Institution SRI H.D.DEVEGOWDA CO-OPERATIVE

COLLEGE OF NURSING, MANICHANAHALLY

GATE, BELUR ROAD, HASSAN, KARNATAKA.

3 Course of study and

Subject

MASTER OF SCIENCE IN NURSING,

MEDICAL SURGICAL NURSING

4 Date Of Admission To

The Course

19-06-2010

5 Title Of The Topic :

“EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON

KNOWLEDGE REGARDING THE PREVENTION OF BRONCHIAL

ASTHMA AMONG THE WORKERS IN SELECTED CEMENT

INDUSTRIES AT HASSAN DISTRICT”

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6. Brief Resume of Intended Work :

6.1 Need for Study :

“We know lots of thing we didn’t use to know, but we don’t know anyway to prevent’em happening” – Will Rogers.

Asthma, a Greek word meaning- "panting", is a common chronic

inflammatory disease of the airways characterized by variable and recurring

symptoms, reversible airflow obstruction, and bronchospasm. Symptoms

include wheezing, coughing, chest tightness, and breathlessness. Asthma

attacks all age groups irrespective of the gender.1

Asthma differs from the other obstructive pulmonary disease in that it is

largely reversible, either spontaneously or with treatment. Patients with

asthma may experience symptom free periods alternating with acute

exacerbations that last from minutes to hours or days. For most patients

asthma is a disruptive disease, affecting school and work attendance,

occupational choices, physical choices, physical activity and general quality

of life.2

According to World Health Organization between 100-150 million people

around the globe-roughly the population of Russian Federation-suffer from

asthma, the number is still rising. Worldwide, deaths from asthma have

reached over 18000 /a year. Studies show that 1 in 7 children, and 1 in 12

adults, suffer from asthma.3

As per the National Institute of Health and Family Welfare of India statistics,

there is 100 million occupational injuries causing 0.1 million deaths in the

world. It also estimated that in India 17 million occupational non –fatal

injuries, 17% of world, and 45000 fatal injuries i.e., 45% of total deaths due

to occupational diseases in world occur each year. Out of 11 million cases of

occupational diseases in world 1.9 million cases,17%, are contributed by

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India and out of 0.7 million death in the world 0.12 million is contributed by

India.4

According to National Institute of Health and Family Welfare the adverse

occupational factors have been estimated to cost 2-14 % of the gross national

products for various countries. As the incidence of occupational related

mortality is high in India it is false to say that out of total One million crore

Rupees of Gross National Product in the year 1999, occupational disease

caused a loss of 70000 crore. The amount paid as compensation for death and

disablement resulting from work related injuries in India has increased from

Rupees 8 million in 1961 to Rs.186 million in 1997.Occupational asthma

plays a very significant role in this diseases.4

A study conducted to thoroughly examine the effects of occupational

exposure to cement dust on the respiratory system. The study population

consisted of a group of 88, randomly selected, male workers with current

exposure to cement dust and 80 healthy male office workers without present

or past history of exposure to dust that served as the referent group. Subjects

were interviewed, underwent chest X-ray and lung function tests. X-ray

diffraction and X-ray fluorescence techniques were performed to determine

the silica phases and the SiO2 contents of the dust samples. The results

showed that symptoms like regular cough, phlegm, wheezing and shortness of

breath were significantly more prevalent among exposed workers. Similarly,

chest radiographs of exposed workers showed various degrees of

abnormalities including emphysematous changes, old calcified granulomas,

emphysematous changes associated with inflammatory processes, evidence of

chronic inflammatory processes, focusal calcification of the lungs and

infiltrative changes. The researchers concluded that, exposure to cement dust

is associated with respiratory symptoms and functional impairments.5

A study was conducted to assess the chronic respiratory symptoms and

chronic obstructive pulmonary disease /asthma among workers exposed to

cement dust at a Tanzanian cement factory. The study population consisted of

a total of 120 exposed workers and 107 control participants. Information on

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demographics, occupational history, chronic respiratory symptoms/asthma,

smoking habits, and use of respiratory protection equipment was collected by

questionnaire. Ventilatory function testing and measurement of personal total

dust exposure were carried out. Chronic obstructive pulmonary disease was

diagnosed for workers with chronic bronchitis who also had spirometric

airflow obstruction. The results showed that the exposed workers had more

chronic cough, chronic sputum production, dyspnea, work-related shortness

of breath, and chronic bronchitis than the controls. The researchers concluded

that the cement workers seem to be at high risk of developing chronic

respiratory symptoms, asthma and, chronic obstructive pulmonary disease

probably caused by cumulative total dust exposure independent of smoking

habits.6

A cross-sectional study was conducted to determine the prevalence of

respiratory symptoms or diseases and chest x-ray changes consistent with

pneumoconiosis in the employees. A sample of 150 exposed and 355

unexposed employees were selected. A questionnaire about respiratory

symptoms was completed during an interview. Chest x-rays were read

according to the International Labour Organization criteria for

pneumoconiosis. The results showed that cough and phlegm are associated

with smoking habits. The researchers concluded that wheezing, shortness of

breath, and bronchial asthma were related to dust levels and engineering

measures be adopted to reduce the cement dust level in the company, together

with health monitoring of exposed employees.7

Researches In India Related To Cement Industries:

A study was done to evaluate the effect of cement exposure on ventillatory

function of workers in Diamond Cement factory. The study population

included 136 cement factory workers who were selected randomly. All

underwent extensive clinical and physical examination. After all exclusion

procedures 2 final study groups were constituted: that included a group of 40

smokers, group of 60 non smokers, and 50 controls. The results showed that

ventillatory functions were impaired more in patients exposed to cement

particles and smoking increases the impairments of ventilatory function. The

researcher concluded that in the study samples 15-20% cases were asthma and

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chronic obstructive pulmonary disease and the management should take

accurate measures to prevent or decrease respiratory diseases like asthma in

occupational settings because once the disease occurs then there is no cure.8

The above studies show that there is large percent learning needs among the

workers regarding the prevention of asthma. This study is to evaluate the

effectiveness of structured teaching programme regarding the prevention of

bronchial asthma among the workers in cement industries because same like

cement production company workers they also are facing the hazards from

cement dust along with other air pollutants in the work environment. Lack of

knowledge and non availability or improper use of personal protective

measures increases the risk.

6.2 Review of Literature :

A study was conducted to investigate the associations between "total" dust

exposure and acute respiratory symptoms and respiratory function among

cement factory workers.40 exposed production workers from the crusher and

packing sections and 20 controls from the guards were included as the

sample. Personal "total" dust was measured in the workers before and after

the shift. The results showed that highest geometric mean dust exposure was

in the crusher section: 38.6 mg/m3 followed by the packing section: 18.5

mg/m3 and the guards: 0.4 mg/m3. Of these samples 85% had stuffy nose,

47% shortness of breath and 45% had sneezing. Peak expiratory flow was

decreased significantly across the shift in the high exposed group. The

number of years of work in high-exposure sections was associated with cross-

shift decrease in peak expiratory flow. The researchers concluded that total

cement dust exposure was related to acute respiratory symptoms and 0acute

ventilatory effects.9

A study was conducted to assess the effects of cement dust exposure on acute

respiratory health. The study was conducted on 51 high exposed and 33 low

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exposed male cement workers. Acute respiratory symptoms were recorded by

interview using a structured optimal symptom score questionnaire. Peak

expiratory flow was measured preshift and post shift for each worker with a

Mini-Wright Peak expiratory flow meter. The results showed that geometric

means of personal respirable dust and total dust among high exposed were 4.0

and 13.2mg/m, respectively, and 0.7 and 1.0 mg/m among low exposed. High

exposed workers had more acute cough, shortness of breath and stuffy nose

than the low exposed. Mean percentage cross-shift decrease in Peak

expiratory flow was significantly more pronounced among high exposed

workers than low exposed. The researchers concluded that acute respiratory

health effects among the workers are most likely due to exposure to high

concentrations of irritant cement dust.10

A study was done to determine the occupational hazards of cement dust on

the lungs of cement mill workers. The study population consisted of 50;

apparently healthy volunteer male cement mill workers who were randomly

selected with an average of 13 years exposure with age ranging from 20-60

years. They were matched with 50, healthy male control subjects in terms of

age, height, weight and socioeconomic status. Radiology was performed by

Trophy radiology. The results showed that 12% of cases with interstitial lung

disease and 2% of cases with pleural thickening and chronic bronchitis

/asthma in cement mill workers. The researchers concluded that exposure to

cement dust cause asthma, interstitial lung disease and chronic bronchitis in

cement mill workers.11

A study was conducted to determine the prevalence of respiratory symptoms

and to propose some preventive measures among the workers in cement

factory. The study was done on a group of workers of whom 280 were

exposed to cement dust and 73 who were not. The results showed that 65% of

those exposed had clinical symptoms as opposed to 34.2% of the non-

exposed. Cough, expectoration rhinitis, chronic bronchitis and asthma were

significantly more common with incidences of 56.1%, 52.5%, 49.3%, 29.3%

and 14.3% respectively in the exposed against 19.2%, 24.6%, 26%, 9.6% and

6.8% in the non-exposed. Among the exposed the prevalence of chronic

bronchitis increased significantly with the degree of exposure, from 11.4% in

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category 1 to 41.6% in category 3. Age did not seem to influence the

development of chronic bronchitis but on the other hand a smoking history of

more than 10 years did. The researchers concluded that incidence of

abnormalities of respiratory function is significantly higher in the exposed

than in the non-exposed and prevention depends therefore on a programme of

technical; collective and individual and medical protection of the workforce.12

A study was conducted to investigate possible health effects, respiratory

symptoms and lung function in laborers, tunnel workers, and operating

engineers in highway and tunnel construction due to dust exposure. Based on

self-report, asthma and chronic bronchitis were categorized for asthma, (1)

physician-diagnosed or (2) undiagnosed likely, and (3) for chronic bronchitis

symptomatic. They checked the prevalence of asthma and chronic bronchitis,

lung function outcome. The results showed that from 389 workers: 186

laborers, 45 tunnel workers, and 158 engineers prevalence of asthma was 13

and 11.4% for laborers and engineers, respectively, and of symptomatic

chronic bronchitis, 6.5 and 1.9%, respectively. Undiagnosed asthma was

significantly elevated in workers compared to engineers, and marginally

elevated for chronic bronchitis. The study concluded that exposure to cement

products or its dust may predispose workers in developing asthma and

associated respiratory problems.13

Another study was conducted to the dust reactions resulting from the products

such as sand, gravel and cement .The study was conducted in a male

population: 120 employees working in cement production and 120 non-

exposed civil servants. The results showed that an increase in the prevalence

of exposed symptomatic subjects 57.5% compared to non-exposed subjects

24.2% and increased prevalence of all of the symptoms: cough 15.8% vs.

15%, dyspnea 21.6% vs. 5%, chronic bronchitis 11.7% vs. 6.7%, asthma

14.2% vs. 7.5%, rhinitis 40% vs. 19.2%, conjunctivitis 48.3% vs. 10% and

dermatitis 22.5% vs. 6.7%. Changes in lung function parameters were much

more frequent among the workers at the two factories than among the non-

exposed workers 40.8% and 11.7% respectively. Tobacco also seemed to

have an effect on respiratory deficit. Analysis of the chest radiographs of the

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exposed subjects, using the international classification, revealed 15.8%

abnormal films. The researchers concluded that working conditions in cement

factories must be improved rapidly and recommended setting up of medical

service for regular management and follow-up of the workers.14

A study was conducted to investigate the effect of dust exposure on

ventilatory lung function of Portland cement factory workers. The study

group included 62 male workers, exposed to cement dust and 70 subjects

from unexposed group of workers. The result showed that significant

differences in spirometry values between the exposed and unexposed groups.

The workers showed (i)significantly lower forced expiratory volume 1% and

forced expiratory flow 25-75%, and ii) reduced forced expiratory volume 1%

with increasing level of dust exposure and iii) higher prevalence of respiratory

symptoms like asthma. The researchers concluded that exposure to dust in the

cement factory leads to higher incidence of respiratory symptoms and

impaired lung function.15

A study was conducted to assess respiratory symptoms and pulmonary

function in a cross-sectional survey of 348 Portland cement workers in

Jordan. About 42% of the workers reported various chronic respiratory

symptoms, but cough, dyspnea, and asthma were most prevalent 18.7%,

17.5% and 15.8%, respectively. The results showed that asthma was

significantly associated with the age of 30-39 years and showed a

proportionate association with exposure level. The researchers concluded that

inhalation of cement dust irritates the respiratory tree without markedly

affecting lung function, and smoking aggravates the effect.16

A study was conducted to assess the relationship between occupational

Portland cement dust exposure and respiratory health. Respiratory symptoms

and ventilatory function were studied in a group of 591 male Portland cement

workers employed in four cement plants. The prevalence of chronic

respiratory symptoms was higher in exposed than in control workers. The

results showed that exposed group had a significantly lower mean forced vital

capacity, forced expiratory volume and forced expiratory flows after

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exhalation of 50% and 75% of the vital capacity than the control group. The

researcher concluded that occupational exposure to Portland cement dust may

lead to higher prevalence of chronic respiratory symptoms and the reduction

of ventilatory capacity.17

6.3 Statement of Problem :

“A study to evaluate the effectiveness of structured teaching programme

on knowledge regarding the prevention of bronchial asthma among the

workers in selected cement industries at Hassan district.”

6.4 Objectives of the Study :

1. To assess the pretest and posttest knowledge of cement workers regarding

the prevention of bronchial asthma as measured by the structured

knowledge questionnaire.

2. To evaluate the effectiveness of structured teaching programme in terms

of gain in mean post test knowledge score regarding the prevention of

bronchial asthma.

3. To find out the association between the mean pre test knowledge score of

the workers with selected socio demographic variable.

6.5 Operational Definitions :

1. Evaluate :

In this study, evaluate refers to judge or determine the significant worth or

quality of structured teaching programme on the prevention of bronchial

asthma given to cement workers.

2. Effectiveness :

In this study effectiveness refers to significant increase in the level of

knowledge of cement workers on prevention of bronchial asthma which is

measured from the response of pre-test, structured teaching programme and

post-test.

3. Structured Teaching Programme :

In this study it refers to systematically organized instruction on knowledge

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regarding prevention of bronchial asthma among cement workers.

4. Prevention :

In this study, it refers to the measures that can be taken by the workers to

avoid the occurrence of bronchial asthma due to cement dust.

5. Bronchial Asthma :

Bronchial asthma can be defined as the reversible air flow obstruction

precipitated by intake of allergens, infection, vigorous exercise or emotional

stress –Churchill Livingstone Nurses’ Dictionary.

6. Workers :

In this study workers can be defined as the persons who are involved in the

preparation of cement products and working in selected industries at Hassan.

7. Cement Industry :

In this study cement industry can be defined as the industries which are using

cement as a raw material for the preparation of products.

6.6 Variables under Study :

1. Independent variable :

Structured teaching programme on the prevention of bronchial asthma among

the cement workers.

2. Dependent variable :

Knowledge of the cement workers regarding the prevention of bronchial

asthma.

3.Extraneous variables :

In this study extraneous variables include age, sex, type of family,educational

status, religion, monthly income, residence, sources of information and

duration of work.

6.7 Assumption :

1. The cement workers have some knowledge regarding prevention of

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7.

bronchial asthma.

2. The structured teaching program is the effective strategy for improving

the knowledge of cement workers regarding prevention of bronchial

asthma.

6.8 Limitations of the Study :

Study will be limited to

1. 60 workers from the selected industries at Hassan District

2. A period of 4 -6 weeks.

6.9 Research Hypothesis (Projected Outcome)

All hypotheses will be tested at 0.05 level of significance

H1- The mean post test knowledge score is higher than the mean pretest

knowledge score of cement workers regarding the prevention of bronchial

asthma.

H2-There will be significant associations between the mean pre-test

knowledge score of cement workers with selected demographic variables.

Material and Methods of Study :

7.1 Sources of Data :

The data will be collected from the workers of selected cement industries at

Hassan district of Karnataka State.

7.1.1. Research design: -

Quasi experimental one group pretest-post test design is planned for the

research study. Schematic plan of the study:-

O1 X O2

Key:-

O1 = Pretest knowledge of cement workers regarding bronchial

asthma and its prevention.

X = Structured teaching programme on prevention of bronchial

asthma.

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O2 = Post test knowledge of cement workers regarding prevention

of bronchial asthma.

7.1.2. Research Setting:

The study will be conducted in cement industries at Ramanathapura,

Arakkalgodu Taluk, which has 40 km distance from Hassan.

7.1.3. Population:

In this study population consist of 75 workers from cement industries at

Ramanathapura,Arakkalgodu Taluk of Hassan District.

7.2 Method of Data Collection

7.2.1. Sampling Technique:

Non -Probability sampling method by purposive sampling technique will be

used for the study.

7.2.2. Sample Size:

A group 60 workers from cement industries at Ramanathapura, Arakkalgodu

Taluk of Hassan district, Karnataka State.

7.2.3. Inclusion criteria for sampling:

1. Workers in cement industries at Ramanathapura, Arakkalgodu Taluk,

Hassan District.

2. Cement workers those who are present and willing to participate in the

study.

3. Cement workers who can read Kannada.

7.2.4. Exclusion criteria for sampling:

1. Workers in cement industries who are not working in Ramanathapura,

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Arakkalgodu Taluk, Hassan District.

2. Cement workers those who are absent and not willing to participate in the

study.

3. Cement workers who cannot read Kannada.

7.2.5 Instrument Intend to be Used:

Data will be collected using structured questionnaire.

Tool consists of :

Section 1 : sociodemographic data.

Section 2 : knowledge questionnaire.

7.2.6 Data Collection Method:

Written permission will be obtained from the concerned authority. The

purpose of the study will be explained to the subjects and informed consent

will be taken and should be kept confidential. Pre test will be conducted to

assess the knowledge of workers regarding prevention of bronchial asthma

using structured questionnaire and a structured teaching programme will be

given to the cement workers. The post test will be conducted with the same

structured knowledge questionnaire after seven days.

7.2.7 Plan for Data Analysis :

Inferential statistics will be used for data analysis. Findings will be presented

in the form of tables and figures. Demographic data will be presented in

percentage, frequency, mean and standard deviation. independent ‘t’-test and

paired ‘t-test’ with chi- square test and “ANOVA” “f” test for the assessment

of knowledge, analyzing effectiveness of structured teaching programme and

to associate the socio demographic variable is planned.

7.3 Does the study require any investigations or interventions to be

carried out on patients or other humans or animals?

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No. The study does not require any investigation or intervention. However a

structured teaching programme will be given to the workers of cement

industries regarding prevention of bronchial asthma.

7.4. Has ethical clearance been obtained from your institution in case of

7.3?

Ethical clearance will be obtained from the College of Nursing prior to

conduction of the study. A written consent will be obtained from the

industrial institutions and confidentiality will be maintained.

List of References (Vancouver style) :

1. www.wikepedia.com

2. Joyce M Black, Jane Hokanson Hawks “Medical Surgical Nursing

Clinical Management for Positive Outcomes”, Elsevier Publishers,

Seventh Edition volume 2, page no: 1807-1814

3. WORLD HEALTH ORGANISATION-FACT SHEET Indian J Chest

Dis Allied Sci 2000; 42,Pp126-128

4. www.nihfw.org

5. Neghab M, “Work-related respiratory symptoms and ventilatory

disorders among employees of a cement industry in Shiraz, Iran.” J

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8. Occup Health. 2007 Jul; 49(4): Pp273-8.

6. Mwaiselage etal, “Respiraory symptoms and chronic obstructive

pulmonary disease among cement factory workers” scand J Work

Envmt Health 2005 aug 31 (4) Pp316-23

7. Ballal SG, “Pulmonary effects of occupational exposure to Portland

cement: a study from eastern Saudi Arabia.” Int J Occup Environ

Health. 2004 Oct-Dec; 10(4):470-1

8. www.google.com

9. Zeleke et al, “Cement dust exposure and acute lung function: A cross

shift study” BMC Pulm Med. 2010; 10: 19.

10. Mwaiselage etal, “Acute respiratory health effects among cement

factory workers in Tanzania: an evaluation of a simple health

surveillance tool.” Int Arch Occup Environ Health. 2006 Jan;

79(1):Pp49-56. Epub 2005 Jul 28.

11. Meo SA, “Chest radiological findings in Pakistani cement mill

workers.” Saudi Med J. 2003 Mar; 24(3):Pp287-90.

12. Laraqui Hossini CH etal, “Respiratory symptoms and ventilatory

disorders among a group of cement workers in Morocco” Rev Mal

Respir. 2002 Apr; 19(2 Pt1):Pp183-9.

13. Oliver LC, “Respiratory symptoms and lung function in workers in

heavy and highway construction: a cross-sectional study.” Am J Ind

Med. 2001 Jul; 40(1):Pp73-86.

14. Laraqui Hossini CH etal,“Prevalence of respiratory problems in

workers at two manufacturing centers of ready-made concrete in

Morocco” Int J Tuberc Lung Dis. 2001 Nov;5(11)Pp1051-8.

15. Noor H, “Effect of exposure to dust on lung function of cement

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factory workers.” Med J Malaysia. 2000 Mar; 55(1):Pp51-7.

16. AbuDhaise BA et al“Pulmonary manifestations in cement workers in

Jordan.”Med Environ Health. 1997; 10(4):Pp417-28.

17. Yang CY et al, “Effects of occupational dust exposure on the

respiratory health of Portland cement workers” J Toxicol Environ

Health. 1996 Dec 27; 49(6):Pp581-8.

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9. Signature of the Candidate

10. Remarks of the Guide

11. Name and Designation of

(In Block Letters)

11.1. Guide

11.2 Signature

11.3 Co – Guide (If any)

11.4 Signature

Mr. M. ANANDASSOCIATE PROFESSOR &H.O.D. OF MEDICAL SURGICAL NURSING, SRI H.D.DEVEGOWDA CO-OPERATIVE COLLEGE OF NURSING, MANICHANAHALLY GATE, BELUR ROAD, HASSAN, KARNATAKA.

12. 12.1 Head of Department

12.2 Signature

Mr. M. ANAND

13. 13.1 Remarks of the Chairman and

Principal

13.2 Signature

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