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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. NAME OF THE
CANDIDATE AND
ADDRESS
MS. LIKHILA ABRAHAM
1 YEAR M.SC. NURSING
ZULEKHA NURSING COLLEGE
ZULEKHA COMPLEX
BIBI ALABI ROAD
MANGALORE – 575 001
2. NAME OF THE
INSTITUTION
ZULEKHA NURSING COLLEGE
ZULEKHA COMPLEX
BIBI ALABI ROAD
MANGALORE – 575 001
3. COURSE OF STUDY AND
SUBJECT
M.SC. NURSING I YEAR
MEDICAL SURGICAL NURSING
4. DATE OF ADMISSION TO
COURSE
16TH JULY 2013
5. TITILE OF THE TOPIC“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME REGARDING KNOWLEDGE ON
VARICOSE VEIN AND PRACTICE OF BUERGER ALLEN EXERCISE
IN IMPROVING PERIHERAL PERFUSION AMONG WORKERS IN
THE TILE FACTORY AT MANGALORE”
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6 BRIEF RESUME OF THE STUDY
6.1 NEED FOR STUDY “The ground work of all happiness is good health” (LEIGH HUNT)
Blood is a bodily fluid in humans and animals that delivers
necessary substances such as nutrients and oxygen to the cells and
transports metabolic waste products away from the cells. Blood vessels are
intricate networks of hollow tubes that transport blood throughout the body.
Blood is circulated through the body via cardiovascular system. The
cardiovascular system is comprised of the heart and the circulatory system.
Blood vessels carry blood from the heart to all areas of the body. The blood
travels from the heart via arteries to smaller arterioles, then to capillaries or
sinusoids, then to venules, to the veins, and back to the heart.
Microcirculation deals with the flow of blood from arterioles to capillaries
or sinusoids to venules. As the blood moves through the capillaries,
substances such as oxygen, carbon dioxide, nutrients and wastes are
exchanged between the blood and the fluid that surrounds the cells. (1)
Varicose veins are permanently distended veins that develop from
the loss of valvular competence. Faulty valves elevate venous pressure
causing distention and tortuosity of the superficial veins. The greater and
lesser saphenous veins and perforator veins in the ankle are common sites of
Varicosities.(2)
In India Up to 25% of women and 18% of men suffer from varicose
veins .If both parents have varicose veins, next generation chances to
develop the disease are close to 90%, daughters have, 60%chance
while sons have 25% chance of developing the disease.60% of
leg ulcers are due to varicose veins left untreated, nearly 50% of patients
will eventually experience chronic venous insufficiency. Almost 90% of
venous blood in the leg is pumped through the deep veins by doing leg
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exercise. Therefore, exercise significantly helps 12% of patients to improve
the quality of living and to prevent complications.(3)
Exercise is the fundamental principle for preventing peripheral
vascular disorders, varicose veins occur in the legs, quite painful and
unattractive. Moderate exercise increases blood circulation, which can
decrease the pain and appearance of varicose veins. It can also slow or
prevent the development of new varicose vein, found that buerger allen
exercises are effective among varicose vein patients. Exercise training helps
the varicose vein patients in potential mechanisms like formation of
collateral circulation and increased blood flow, Exercises used to empty
engorged vessels, stimulate circulation, and at least partially relieve
swelling (oedema) in patients with arterial insufficiency of the lower limbs
and feet. (4)
An epidemiological study conducted to find out the high risk
occupations(teachers, traffic police, factory workers etc) for varicose vein
development among people who spend most of their working day in a
standing or sedentary position at Harley street vein clinic. The study results
showed 87%people who spend their working hours more than 9 hours in a
standing sitting position have primary symptoms of varicose vein. People
who spend most of their working day in a standing or sedentary position (eg
police officers, teachers, sales assistance, tile factory workers) are
considered to be at a high risk for varicose vein development. The study
reported incidence of varicose veins in adults varies from 7% to 40% men
and from 14 % to 51 % in women. The study concluded that if the
condition can’t be prevented or treated in a timely manner varicose vein can
lead to more serious morbidities and medical complications .(5)
A cross sectional study was done to assess the prevalence of
varicose veins, risk factors and the complications of varicose veins among
100 school teachers in Thiruvananthapuram. The study results showed the
prevalence of varicose vein was 19% among the school teachers. Among
those affected with varicose veins, 89.5% had history of standing for long
duration and 26.3% had complications from varicose vein .Thus conclusion
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was made that standing for long hours was a major risk factor as compared
to other known risk factors. Health Education and cutting down of working
hours maybe recommended to bring down the prevalence of Varicose
veins. (6)
More commonly (waitresses, hair dressers, nurses, factory
workers, teachers) who does the job in a Standing or sitting for a prolonged
periods of time have an increased risk of developing varicose vein .varicose
vein need to treated primarily by primary prevention has better prognosis.
Exercise is the primary treatment measure to reduce the risk of getting
varicose vein in long standing occupations. Approximately 15 to 40 %of
people with peripheral vascular disease having decreased ability to perform
activities of daily living(7)
Though there is high prevalence rate (40%) of varicose vein in
India, very few studies have been conducted in India. Researcher personally
observed during clinical experience many factory workers admitted to the
hospital with occurrence of varicose veins The investigator found that the
factory workers not having adequate knowledge regarding disease condition
and its preventive measures, thus the investigator felt the need to educate the
workers to prevent varicose vein from the primary stage so that
complications can be prevented.
6.2 REVIEW OF LITERATURE
Review of literature is the reading and organizing of previously written
materials relevant to specific problem to be investigated frame work and
methods appropriate to perform the study.
The literature has been organized under following headings,
Studies related to varicose vein
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Studies related to Buerger allen exercises
Literature related to varicose vein
A comparative research study was conducted to find the relations
between age, sex, lower limb symptoms among 350 (males and females) of
Japan. Results revealed that prevalence of symptoms like Heaviness or
tension was 16.0% in males and 28.6% in females, feeling of swelling was
9.2% in males and 23.0% in females, Aching – 32.5% in males and 53.8%
in females, restless legs 20.0% in males and 35.1% in females, cramps-
34.0% in males and 42.0% in females, Itching – 19.0% in males and 25.3%
in females, Tingling 16.0% in males and 19.8% in females. The study
concluded that the female population is more risk to develop varicose vein.(8)
A prospective randomized study was conducted on Prolonged
standing at work and hospitalization due to varicose veins among 9653
working adults in Denmark. The study results Reported that employees
with jobs that require prolonged standing or walking compared to all other
employees, the relative risk was 1.75% for men and 1.82 % for women. The
pooled estimate of the relative risk was 1.78% .The etiological fraction of
prolonged standing or walking at work was estimated as 22.5% for men and
22.6% for women. This prospective study concluded that prolonged
standing at work constitutes an excess risk of hospital treatment due to
varicose veins and accounts for more than one fifth of all cases of working
age.9)
A longitudinal cross sectional study conducted to find out the
prevalence of varicose vein among504 cotton workers from England and
467 from Egypt are selected for the study. The study results revealed that
English mill population exhibited a 10% higher incidence of varicose vein
compared with Egyptian population and 70% of women exhibited the
symptoms of varicose vein had history of prolonged standing posture at
work. The study concluded that ethnic factors have an effect on the
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occurrence of varicose vein (10)
An epidemiological study was carried out to establish the effect
of working conditions on the appearance of varicose veins on a sample size
of 1324 from different occupation sectors (catering, trade, light industry,
heavy industry and finances) in Croatia. The study results revealed that
varicose veins were more prevalent in trade industry and catering industry
than office workers. The study concluded that standing in the work place
(weight handling while working and working indoor were risk factors for
varicose veins.(11)
Studies related to buerger allen exercises
A clinical experimental study conducted to find out the
effectiveness of buerger allen exercise among peripheral vascular disease
patients. The study conducted among 13 patients admitted in hospital setting
at Italy. The study evidenced increased perfusion after doing the exercise
(pretest capillary refill (2-3sec) and post test capillary refill (1-2sec) and
extremity pulses increased 10%in 50%of total population .the overall
benefit seen in 7 patients after 24 hours evidenced by (increased perfusion
and activity). The study concluded that buerger allen exercise is effective
for improving lower extremity perfusion.(12)
An experimental study conducted among 25 peripheral
vascular disease patients to determine effectiveness of exercise training to
improve the symptoms of peripheral vascular disease at Chennai. The study
results showed that 18%of population increased the activity and perfusion
by reducing the symptoms. 4%of population illustrated a delayed effect to
exercise and 2%showed improvement with surgery. the study concluded
exercises are effective in reducing peripheral vascular disesase symptoms13
An article regarding conservative approach to the management of
lower extremity associated signs and symptoms (pain, edema, tenderness,
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cyanosis, coldness and stiffness) show the effectiveness of Buerger’s Allen
exercise. The treatment involve encouragement of blood flow during the
actively vasospastic phase by elevation of an active exercise part. The
researcher recommended that Buerger’s Allen Exercise for the improvement
of lower extremity blood supply. Another article regarding intermittent
claudication also highly recommended the importance of Buerger’s Allen
exercise (three 3 series of exercise repeat 6- 7 times in a day) among
peripheral vascular disease14).
An experimental study conducted to assess the effectiveness of
buerger allen exercise on improving lower extremity perfusion among
diabetic clients admitted in selected hospital at Bangalore. The researcher
adopted quasi experimental design with purposive sampling on a sample
size of 50.The result showed 75%of the type 2 diabetic patient improved
peripheral perfusion after the exercise and 10% showed faster wound
healing in diabetic ulcers and study concluded exercise is effective in
improving extremity perfusion among type 2 DM clients.(15)
6.3 STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of structured teaching programme
regarding knowledge on varicose vein and practice of buerger allen
exercise in improving peripheral perfusion among workers in a tile factory
at Mangalore”
6.4 OBJECTIVES OF THE STUDY1. To assess the knowledge regarding varicose vein among workers in tile
factory.
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2. To administer structured teaching programme on varicose vein and
burger allen exercise to the workers in tile factory
3. To evaluate the effectiveness of structured teaching programme in
knowledge regarding varicose vein among workers in tile factory.
4. To evaluate the effectiveness on practice of buerger allen exercise in
improving the lower extremity perfusion among workers in the tile
factory.
5. To find out the correlation between the post test knowledge on varicose
vein with practice of burger allen exercise among workers in the tile
factory
6. To find out the association between pre test mean knowledge score of
varicose vein with selected demographic variables like age, type of
family, education, Socio Economic Status, previous source of
information, bad habits, diet.
6.5 OPERATIONAL DEFINITION
Assess
In this study “assess “refers to the evaluation of knowledge of workers in
tile factory regarding varicose vein and buergerallen exercise.
Knowledge
In this study knowledge refers to correct responses given by the
workers regarding varicose veins.
Effectiveness
In this study effectiveness refers to gain in knowledge regarding
varicose vein and exercise training to improve the peripheral perfusion.
Structured teaching programme
In this study structured teaching programme refers to a systematic,
organized teaching programme prepared by investigator containing
information about various aspects of varicose vein and buerger allen
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exercise to improve peripheral perfusion.
Varicose vein
In this study varicose veins refers to dilated and twisted veins (usually
those of legs) caused by structural changes in the walls or valves of the
vessels.
Lower extremity perfusion
In this study lower extremity perfusion refers to the increased blood
circulation of the lower extremity as evidenced by skin colour changes,
decreased pain after administering the Buerger’s Allen exercise among
workers in tile factory.
Buerger allen exercise
In this study Buerger’s Allen exercise refers an active postural exercise,
which help in fills and empties the lower extremity blood vessels according
to gravity alternatives refers a three steps (elevation, dependency,
horizontal)
6.6 ASSUMPTION The study assumes that ,
1. The workers may have some knowledge regarding varicose vein
2. The knowledge regarding varicose vein and practice of buerger
allen exercise helps workers to prevent potential complications
resulting from varicose vein.
6.7 DELIMITATION
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The study will be limited to,
workers with 30 years and above
Workers who is in male gender.
Workers who can read and write kannada or English
6.8 HYPOTHESIS
H1:The mean post test scores will be significantly higher than pretest
knowledge score regarding varicose vein among workers at tile factory
H2:There will be a significant difference between the pretest and post test
interventional scores on varicose vein among workers at tile factory
H3: There will be a significant relationship between the knowledge score
and practice of buerger allen exercise among workers at tile factory.
H4. There will be a significant association between pre test knowledge
score regarding varicose vein with selected demographic variables like age,
gender, religion. Education, income, area of residence, previous source of
information, bad habits, diet.
7 MATERIALS AND METHODS
7.1 SOURCE OF DATAThe data will be collected from the male workers in the tile factory who are
above 30 years.
7.1.1RESERCH DESIGNResearch design for this study will be quasi-experimental one group pre test post test design
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7.1.2 SETTINGThe study will be conducted at a selected private tile factory at Kudroli, Mangalore
7.1.3 POPULATIONThe population will be workers in the tile factory
7.2 METHODS OF COLLECTION OF DATA
7.2.1 SAMPLING PROCEDURESimple random sampling technique will be used for this study
7.2.2 SAMPLE SIZEThe sample size will be 60 workers
7.2.3 INCLUSION CRITERIA FOR SAMPLING 1.The workers who are above 30 years 2.The male workers
7.2.4 EXCLUSION CRITERIA FOR SAMPLING 1.Female Workers 2.Workers who don’t know the regional languages3.Workers who are not available at time of data collection
4.Workers who had surgical management for varicose vein
7.2.5 INSTRUMENTS INTENDED TO BE USED Tools on varicose vein
Part 1; baseline Performa
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Part 2: structured questionnaire on varicose vein
Part 3: check list to assess the lower extremity perfusion
Intervention: Structured teaching programme on varicose vein and buerger
allen exercise.
7.2.6 DATA COLLECTION METHOD A prior formal permission will be obtained from the authority.
Informed consent permission will be obtained from the subjects after
explaining the purpose of the study
Pre test will be conducted using questionnaire and checklist to assess
the knowledge and peripheral perfusion
structured teaching programme on varicose vein with buerger allen
exercise administered
On 7th day post test on knowledge will be assessed using
questionnaire and practice of buerger allen exercise will be assessed
using check list.
7.2.7 PLAN FOR DATA ANALYSIS Collected data will be arranged using tables diagrams and graphs.
The knowledge of workers regarding varicose vein will be analyzed
using mean and standard deviation
The effectiveness of structured teaching programme among workers
analyzed by “t” Test.
The correlation between post test knowledge score on varicose vein
with practice of buerger allen exercise analyzed by “r”correlation test
(Karl Pearson)
The association of pretest knowledge score with selected demographic
variables assessed by “ 2 ” (Chi square test)
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7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION
OR INTERVENTION TO BE CONDUCTED ON
PATIENTS OR OTHER HUMAN OR ANIMALS? IF SO
PLEASE DESCRIBE BRIEFLY. Yes, the study includes structured teaching programme and practice
of Buerger’s Allen exercise, will be conducted among workers at tile factory
with the aim of improving the knowledge on varicose vein and to the
peripheral vascular perfusion.
7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED
YOU’RE YOUR INSTITUTION INCASE OF ABOVE
STATEMENT? Yes, informed consent will be obtained from authorities and Ethical
Committee clearance where the study will be intervened. Scientific
objectivity of the study will be maintained with honesty and impartiality.
8. BIBLIOGRAPHY 1. The blood vessels vascular system: (www.bilogy.com).(updated in 2009;
cited 2013 october13). Available from: http://biology. about.com/od
/humananatomybiology/ss/blood_vessels.htm
2. Black JM, Hawks JH. Medical Surgical Nursing: Clinical management
for positive outcomes ;2005.
3. Indian statistics of varicose vein. Epidemiology of varicose vein:British
medical journal (serialonline); 2011(cited2012Oct25).Availablefrom:-
http://bestpractice.bmj.com/best-practice/monograph/ 630/basics/
epidemiology.html.
4.Buergerallenexercise.(online);avilabile from http://jama.
Jamanetwork .com/ article.aspx?articleid=287862
5.Harley street vein clinic. Compression Stockings;Available from:
URL:www.dr-bull.com/compression-stockings.htm
6.Meera Shrutty, Divya Aleena Jacob, Vinitha T.V. Prevalence of
varicosity among people whose work demands standing for long hours:
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National conference on students’ medical research; 2008 April 11-12.
Available from: http://www.commedtvm.org/natconabstract.html.
7.Benefitsofbuergerallen exercise; available from: http://medical-dictionary.
the freedictionary .com/Buerger-Allen+e
8.Bradbury A, Evans C, Allan P, Lee A, Ruckley C, Fowkes F. symptoms
of varicose veins: Edinburg vein studycross ; 1999.
9.F Tüchsen, H Hannerz, H Burr, N Krause. Prolonged standing at work and
hospitalisation due to varicose veins: a 12 year prospective study of the
Danish population: Occupational and Environmental Medicine;2005.
10.Siza Mekky,R.S.F Schilling, Joan Walford. Varicose veins in women
cotton workers: An epidemiological study in England and Egypt;1969 .
11.Kontosic I, Vukelic M, Drescik I, Mesaros- Kanjski E, Materljan E ,
Jonjic A. work conditions : risk factors for varicose veins of the lower
extremities in certain professions; 2000 .
12. S Leonard Syme. The prevention of disease and promotion of health:the
need for a new approach,: European Journal of Public Health; 2009 :329-
330.
13. Treesak C , Kasemgup V, Treat Jacobson. Cost effectiveness of
exercise trining : improve claudication symptoms in patient with peripheral
arterial disease ;1993 .
14. R Vincent Dynamic. Chriopractic media :A conservative approach to
the management of Suedky’s Atropy ;1995.
15. Mr Cyril Thomas.effectiveness of buerger allen exercise on diabetics
patients in improving peripheral perfusion:interventional study on diabetcs
patients(unpublished dissertation)2009.banglore
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