DISSERTATION PROTOCOL by 9Dr3haxy

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									      DISSERTATION PROTOCOL


1. NAME OF THE            MR.JOSEPH NICLAVOSE,
   CANDIDATE AND          S/O C.O. NICLAVOSE,
   ADDRESS                CHIRAPARAMBAN (HOUSE),
                          KOOVAPPADY, P.O.
                          PERUMBAVOOR, ERNAKULAM DIST,
                          KERALA



2. NAME OF THE            HINA COLLEGE OF NURSING
   INSTITUTION            YELAHANKA NEW TOWN,
                          BANGALORE-560 064


3. COURSE OF STUDY AND    M. Sc. NURSING
   SUBJECT                (MEDICAL – SURGICAL NURSING)

4. DATE OF ADMISSION TO
   COURSE
                          05/ 06/ 2009.



5. TITLE OF THE TOPIC:
       “ASSESS THE EFFECTIVENESS OF THE STRUCTURED
   TEACHING PROGRAM ON KNOWLEDGE OF PERITONEAL
   DIALYIS AMONG CHRONIC KIDNEY DISEASE PATIENTS IN
   SELECTED HOSPITAL, AT BANGALORE”.




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6: BRIEF RESUME OF INTENDED WORK
6.1: NEED FOR THE STUDY:
       A successful Peritoneal Dialysis Program depends on patient survival,
technique, and maintenance of a reasonable lifestyle. Providing the appropriate
dialysis prescription lend a hand to ensure these goals. Continues ambulatory
Peritoneal Dialysis is the most commonly used form of Peritoneal dialysis now,
and after two years of therapy, almost 25% of patients discontinued Continuous
Ambulatory Peritoneal Dialysis because of non infectious Medical and
sociopsychological Problems. 4
       A study claimed that in India 6% end stage renal disease patients are
undergoing peritoneal dialysis. It came to notice during the research that none
of the nephrologists routinely discussed Peritoneal Dialysis in their pre dialysis
counseling.   According to the nephrologists factors affecting the use of
peritoneal dialysis are, financial constraints (100%), lack of patient enthusiasm
(100%), doubtful patient compliance (83.2%) and be short of an organized
Peritoneal Dialysis program (79.2%). 12
      A research study conducted on 676 patients with stage 3-5 Chronic
Kidney Disease who are receiving nephrology care for about 5 year’s, by
means of a completed a questionnaire to review their knowledge of Chronic
Kidney Disease and renal replacement therapies. Merely 23% of patients have
an immense or extensive knowledge about their Chronic Kidney Disease. 35%
of the patients have very little or no knowledge on the subject of their 35% of
patients replayed knowing the treatment options.6
       In a recent study shows that, the approximate prevalence of Chronic
Kidney Disease is 800 per million populations (PMP), and the frequency of end
stage renal disease is 150-200 per million populations. In India, current
statistics shows that 820 + nephrologists, 710+ hemodialysis units with 2500 +
dialysis station and 4800 + patients on Continuous Ambulatory Peritoneal
Dialysis. There are 172+ transplant centers of which two–thirds are in South
India and mostly privately run. Nearly 3,500 transplants are done annually, the




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total number of the cadaver donors being approximately 700 till now. In India
there is still a long way to go with respect to Chronic Kidney Disease. 1
      The study reported that Chronic Kidney Disease is a major health
problem for the underdevelopment countries of Southeast Asia, home to more
than 2 billion people. The majority of effect individuals are young and in the
most productive years of their lives. In Asia, there is an urgent need to develop
Chronic Kidney Disease detection and prevention programs. Investigations are
required to characterize the unique etiological factors in different geographic
regions so that prevention programs. Cost cutting strategies would mile renal
replacement therapy accessible to general population. According sufficient
prominence to Chronic Kidney Disease in education programs would help
increase awareness.8
       In world wide study, the average percentage of End Stage Of Renal
Disease patients on peritoneal dialysis has increased between 25 to 30%. In
particulars the increase in the number of patients who survive for longer period,
have become a reality as issues of adequacy of dialysis and management of
Co- Morbid conditions and complications are better understood, There are
several problems in starting a Continuous Ambulatory Peritoneal Dialysis
program in the developing world. There is still lack of awareness and
information about the benefits of Continuous Ambulatory Peritoneal Dialysis
both among the lay public and the medical community.3
      In consideration of PIL by an retired Air Engineer the High Court of
Delhi has asked the Health Ministry and the Delhi Government to consider
Peritoneal Dialysis as an alternative for hemodialysis. In the order the High
Court gave the government six months of time for the implementation of
peritoneal Dialysis in the government hospitals; from help of this the hospital
visits of the patients will reduce drastically.14
      With the above mentioned facts the investigator feels that there is a big
lack in the knowledge of chronic kidney disease patients in concern to
peritoneal dialysis. It is much advantageous to the chronic kidney disease
patients where the worry of travel to the hospitals is minimized. Here with the



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investigator claims that the assessment of the effectiveness of a structured
teaching program on knowledge of peritoneal Dialysis among chronic kidney
disease patients is a sturdily necessitate. This research is able to be used for
educating the chronic kidney disease patients about peritoneal dialysis, for a
better life and a bright future. The study could be used as a tool for cultivating
better tool for responsiveness and knowledge.
6.2: REVIEW OF LITERATURE:-
     Continuous Ambulatory peritoneal dialysis was generally accepted as a
renal replacement therapy in the developed countries. In India the Peritoneal
Dialysis penetration among end stage renal failure parents was 5% in 1996, 7%
in 1997, and 10% in 1998. In India where 6% of the GDP is spent on health
care, the private sector contributes 4.3% and the governments 1.7%. Currently,
36 centers in the country are engaged in Continuous Ambulatory Peritoneal
Dialysis and Continuous Cyclic Peritoneal Dialysis for population of 960
million.The peritoneal dialysis society of India was formed for expansion of
Peritoneal Dialysis programs in India.7
       The study revealed that the chronic peritoneal dialysis patients have
better quality of life when compared to chronic hemodialysis patients. For this
a cross sectional study of 50 patients with End Stage Of Renal Disease, who
where on chronic peritoneal dialysis (Chronic Peritoneal Dialysis = 25) and
chronic hemodialysis (Chronic Hemodialysis Patient=25) was alone for level of
stress and stress coping ability. The result shows over all mean stress score in
Chronic Hemodialysis Patient patients was higher (78.3%) that in Chronic
Peritoneal Dialysis patients (43.3 %) P< 0.00) coping ability of Chronic
Hemodialysis Patient patients was 51 % and compared to Chronic Peritoneal
Dialysis patients (60.9%.P <0.001).15
       The study shows that Chronic Kidney Disease and stage renal disease
are energy public health problems in developing countries. And need changes
in health care policy. End Stage of Renal Disease incidence estimated for (2002
– 2005) among 572029 subject residing of 36 of the 56 wards of the city of
Bhopal. A total 346 new End Stage of Renal Disease patients were diagnosed



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during the study period. Average Crude and age adjusted incidence rates were
151 and 232 per million populations. The mean age was 47 years and 58%
were males. Changes are required in health care policy for optimal care of
Chronic Kidney Disease patients and efficient resource utilization for
management of those with End Stage of Renal Disease .10
      The study concluded that 10-15% of the population has chronic kidney
disease, resulting in significant health expenditure, which is regularly met by
out of pocket by the patients in India. Public health strategies are essential to
control the burgeoning problem. Lifestyle modifications can reduce the
incidence of obesity, hypertension and diabetes. These diseases account for
significant proportion of Chronic Kidney Disease cases. The role of community
health specialists is essential to organize health education and screening camps,
form active patient support groups, and incorporate the prevention programs in
the various heels of the health care system.2
       The descriptive study revealed that relationship between numbers of
peritoneal Dialysis Patient’s treated at a clinic and clinical outcomes. The
Peritoneal Dialysis Patient treated at Clinics with greater numbers of Peritoneal
Dialysis Patient may have better outcomes in terms of technique failure and
cardiovascular morbidity. Peritoneal Dialysis Clinic Size may act as a proxy of
grater Peritoneal Dialysis Experience, more focus on modality and better
Peritoneal Dialysis practices at the Clinic.9
       A study reported that the evaluation of the patient and technique
survival, and to analysis factors influencing survival in a large Thai Continuous
Ambulatory Peritoneal Dialysis Program. The major cause of Technique failure
was Peritoneal Dialysis related to infection. Age and baseline serum were the
strongest predictors of death.11
       A study revealed that, starting dialysis earlier in diabetic patients than in
other patients with chronic kidney disease slows the progression of some
diabetic complications, and could affect the survival outcome. The main aim of
this study is to assess the effect of starting dialysis in early in diabetic patients
on survival and hospitalization outcome .Early initiation of Peritoneal Dialysis



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in diabetic patients seems to improve patient survival. Initial serum albumin
and age, and the presence of Cerebrovascular Pathology and cardiac failure are
critical factors affecting survival outcome.5
       A study founded that Chronic Ambulatory Peritoneal Dialysis has been
an established form of therapy in adult patients with end stage renal failure in
India for more than a decade and has emerged as accepted form of renal
replacement therapy in urban areas. The objective of this study is to report the
experience with Continuous Ambulatory Peritoneal Dialysis as a modality of
renal replacement therapy from a tertiary care hospital in a hilly state of India.
It concluded that Continuous Ambulatory Peritoneal Dialysis is a safe and
viable mode of renal replacement in remote and rural places. It can be emerged
as a revolutionized procedure for End Stage Renal Disease patients dwelling in
remote and geographically difficult region in developing countries such as
India.113
STATEMENT          OF PROBLEM:-
       “Assess the effectiveness of structured teaching program on
knowledge of peritoneal dialysis among Chronic Kidney Disease patients
in selected hospital, at Bangalore.”


6.3: OBJECTIE OF THE STUDY:-
    To assess the knowledge of the Chronic Kidney Disease patient’s
       regarding peritoneal dialysis.
    To assess the effectiveness of the structured teaching program on
       knowledge of Chronic Kidney Disease patients regarding peritoneal
       dialysis.
    To compare the knowledge of the Chronic Kidney Disease patient’s
       regarding peritoneal dialysis with their demographic valuables.
6.4: HYPOTHESIS:-
       H0: These will be no difference between the pre and post test score of
       knowledge of Chronic Kidney Disease patients.




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       H1: There will be significant association between the knowledge score
       of Chronic Kidney Disease patients, their with demographic valuables.
6.5: OPERATION DEFINTIONS:-
ASSESS:-
       It refers to examine the knowledge of Chronic Kidney Disease patients
regarding peritoneal dialysis.
EFFECTIVENESS:-
       In this study if refers to the extent to which the structured teaching
program on peritoneal dialysis achieves the desired effect on improving the
knowledge of Chronic Kidney Disease patients.
STRUCTURED TEACHING PROGRAMME:-
       It refers to the systematically developed instructional method and
teaching aids, designed for Chronic Kidney Disease patients to provide
information regarding peritoneal dialysis.
KNOWLEDGE:-
       If refers to the amount of information or awareness of Chronic Kidney
Disease patients regarding peritoneal dialysis which is explored by the score of
knowledge questionnaires.
PERITONEAL DIALYSIS:-
       The process of removing metabolic wastes and water from blood by use
of the living semi permeable membrane, the peritoneum.
CHRONIC KIDNEY DISEASE PATIENTS:-
       The male and female individuals, those both kidney are progressive,
irreversible destruction of the nephrons happened.
6.6: ASSUMPTIONS:-
    Chronic Kidney Disease patients have some knowledge on peritoneal
       dialysis.
    Structured Teaching Program will improve the knowledge of chronic
       kidney patients regarding Peritoneal Dialysis.




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7: MATERIALS AND METHODS:-
7.1: SOURCE OF DATA:-
    Chronic kidney patients who is undergoing Peritoneal Dialysis in
      selected hospital at Bangalore.
7.2: METHODS OF COLLECTION OF DATA:-
   Data will be collected by the investigator himself using the structured
     interview Schedule.
7.2.1: RESEARCH DESIGN AND APPROACH:-
   The research design adopted for this study will be quasi experimental
     design and one group pre and post test approach, without control group.
7.2.2: SETTING:-
   Study will be conducted in selected hospital at Bangalore.
7.2.3: POPULATION:-
   The populations of the present study will be Chronic Kidney Disease
     patients who are undergoing peritoneal dialysis.
7.2.4: SAMPLE SIZE:-
   The sample size is around 50.
7.2.5: SAMPLING TECHNIQUES:-
   Purposive sampling technique will be used to select the samples for the
     study.
7.2.6: SAMPLING CRITERIA:-
INCLUSION CRITERIA:-
   Both male and female Chronic Kidney Disease patients who are under
     going peritoneal dialysis.
   Who are available during the period of data collection.
   Who are willing to participate in the study.
   Who are able to understand and speak Kannada and English.
EXCLUSIVE CREITERIA:-
   Who were not present during the period of data collection.
   Who were not willing participate in this study.



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   Who were not able to read and speak Kannada and English.
7.2.7: DATA COLLECTION TOOL:-
     Structured interview schedule will be prepared and used for data
     collection.
  PERIOD OF THE DATA COLLECTION:-
   The Period of data collection will be from Sep/Oct 2010
7.2.8: DATA ANALYSIS METHOD:-
   Appropriate descriptive and inferential statistics will be used for data
     analysis and presented in the form of tables, Graphs and figures etc.
   The effectiveness of pare and post test scores of knowledge will be
     analyzed by paired ‘T’ test.
   The significance of relationship between the selected demographics
     available and knowledge scores will be analyzed by using chi-quire test.
7.3: DOES THE STUDY REQUIRES ANY INVESTIGATIONS OR
    INTERENTIONS TO BE CONDUCTED ON PATIENTS OR
    OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE
    BRIEFLY.
                                         NO
7.4: HAS THE ETHICAL CLEARENCE BEEN OBTAINED GIVEN
    YOUR INSTITUTION IN CASE OF 7.3
      Required ethical clearance will be obtained from the concerned
      authority before conducting the study.




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8: LIST OF REFERENCES:-
1. Agrawal SK and Srivastava RK. Chronic Kidney Disease in India:
   Challenges and solutions. Nephron clin pract. 2009, 111(3); pages 197-203.
2. Bhowmik D, Panday CS. Public health strategies to stem the tide of chronic
   kidney disease in India. Indian J Public Health.2008, (4); pages 224-9.
3. B.Pratap. and A Gupta. Peritoneal Dialysis in Developing Countries. Nolph
   and Gokal’s Textbook of Peritoneal Dialysis. 2009, Pages 885-886.
4. Charles R and Zbylut. J. Continues Ambulatory Peritoneal dialysis.
   Dialysis Therapy. 1995, pages151-158.
5. Coronel F and Herrero JA. Early initiation of peritoneal dialysis in diabetic
   patients. Scand J Urol Nephrol.2009;43(2); pages 148-153.
6. Finkelstein. Chronic kidney disease patients claim to know nothing about
    the condition. Peritoneal Dialysis International. 2008, 28, pages 38-43.
7. Georgia Abraham, G. Padma, Milli Mathew. How to set up a peritoneal
   dialysis program: Indian experience. Peritoneal Dialysis
   International.1999,Vol 19 Supplement 2, pages 89-95.
8. Jha V .Current status of chronic kidney disease care in southeast Asia.
   NSemin Nephrol. 2009; Sep: 29( 5 ), pages 487–96.
9. Laura C.Plantga. Clinical out comes of Peritoneal Dialysis patients.
   Peritoneal Dialysis International.2009, 29: page285- 291.
10. Modi GK & Jha V. The Incidence of End-Stage Renal Disease in India.
   Kidney Int. 2006; Dec. 70(12), pages 2131-3.
11. Pongskul C, Sirivongs D. Survival and technical failure in a large cohort of
   Thai CAPD patients. J Med Assoc Thai.2006, Supply 2 : pages 98-105.
12. S. Mahajan. SC Tiwari and SK Agarwal. Factors affecting the use of
    peritoneal dialysis among the ESRD population in India: a single-center
    study. Peritoneal Dialysis International.2004, 24(6): pages 538-541.
13 S. Vikrant. Continuous ambulatory peritoneal dialysis: A viable modality of
   renal replacement therapy in hilly state of India. Indian J Nephrol.2007Vol;
   17(4),pages165-9.




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14. The author, HC order on dialysis. Times of India News paper, 2009, June
     4th,pP-4.
15. TR Daye Kumar, A. Amalagi, P. Soundarajan, Level of stress and coping
     abilities in patients on chronic hemodialysis and peritoneal dialysis. Indian
     J for Nephrol. 2003; 13: pages 89-95.




9:     SIGNATURE OF THE STUDENT:-




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10:   REMARKS OF THE GUIDE:
          The study is useful for improving the knowledge of Chronic
      Kidney Disease patients regarding Peritoneal Dialysis. The need for
      study explained is appropriate; methodology is as per the statement of
      problem. Hence can be approved for undertaking this study.


11:   NAME AND DESIGNATION :-

11.1: GUIDE:-                              Mrs. FAIROZA.M
                                           Associate Professor& HOD
                                           Medical-surgical Nursing
                                           Hina college of Nursing,
                                           Bangalore.


11.2: SIGNATURE:-

                                           Mrs. FAIROZA.M
11.3: HEAD OF THE                          Associate Professor & HOD
      DEPARTMENT:-                         Medical-surgical Nursing
                                           Hina college of Nursing,
                                           Bangalore.


11.4: SIGNATURE:



12.1: REMARKS OF THE CHAIRMAN AND PRINCIPAL:-
               The study is based on newer approach and approved by the
      research committee. Hence the study can be conducted.

12.2: SIGNATURE:-




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