RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME REGARDING RISK FACTORS AND HOME

CARE MANAGEMENT OF CHRONIC BRONCHITIS AMONG ADULTS IN

SELECTED HOSPITALS AT KOLAR DISTRICT.

PROFORMA FOR REGISTRATIOIN OF SUBJECT OF DISSERTATION.

M/S S.SUDHA DEVI AE & C.S. PAVAN COLLEGE OF NURSING KOLAR.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,

KARNATAKA.

PROFORMA FOR REGISTRATIOIN OF SUBJECT OF DISSERATATION.

1 NAME OF THE

CANDIDATE AND

ADDRESS

S. SUDHA DEVI

AE & C.S. PAVAN COLLEGE OF

NURSING KOLAR.

2 NAME OF THE

INSTITUTIOIN

AE & C.S. PAVAN COLLEGE OF

NURSING KOLAR.

3 COURSE OF STUDY AND

SUBJECT

MSC NURSING MEDICAL AND

SURGICAL NURSING

4 DATE OF ADMISSION

TO THE COURSE

16/08/2008

5 TITLE OF THE TOPIC A STUDY TO ASSESS THE

EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME

REGARDING RISK FACTORS AND

HOME CARE MANAGEMENT OF

CHRONIC BRONCHITIS AMONG

ADULTS IN SELECTED HOSPITALS

AT KOLAR DISTRICT.

INTRODUCTION

THE END OF PHYSICS ONE BODY’S HEALTH

(Dr. Faustus)

This statement tells that though the medicine can secure only our body’s

health good, a healthy body is essential to attain mental health or spiritual health.1

Healthy body needs good breath everyone wants to breath the air for leaving.2

Young and middle adulthood is a period of challenges rewards and crises.

Challenges may include the demands of working and raising families although

adults can also be rewards by successes in their career endeavors and in their

personal lives. Young adulthood is the period between the late teens and the

middle to late 30s young adults constitute approximately 27% of the population.

Young adult are active and must adopt to new experiences and newly acquired

independence. Faced with a societal structure that differs greatly from the norms of

20 (or) 30 years ago many men are challenged with determining what it means to

be a man and how to feel good about it is today’s society. Young adults are usually

quite active, experience severe illnesses less commonly than older age – groups,

tend to ignore physical symptoms and often postpone seeking health care. Physical

characteristics of young adults begin to change as middle age approaches. Unless

clients have illness, assessment findings are generally within normal limits. A

personal lifestyle assessment can help nurses and clients identify habits that

increase the risk for chronic disease. Personal lifestyle of young adults include

habits of smoking and occupational etc, and type of work, exposure to hazardous

substances and physical (or) mental status.3

Human being needs constant supply of oxygen to support metabolism.

Bronchial tree is a important role in respiratory system. The respiratory process

begins oxygen through the airway of the lungs into the Bronchial tree which ends

with alveoli where to the tissue. This process is so vital that difficultly in

experienced as a threat to life itself. People with respiratory disorders are often

very anxious threat full that they die.2

Chronic bronchitis is a important public health problem among chronic

respiratory disease in world wide. Inflammation of the Bronchi cause increased

mucus production. Chronic cough in contrast to those of acute Bronchitis the

clinical manifestation of chronic Bronchitis continue for atleast 3 months of the

year for 2 consecutive years in patient. It is characterized physiologically by

hypertrophy and hyper secretion of the Bronchial mucus glands and structured

alterations of the Bronchi and Bronchioles and impaired ciliary function which

induces mucous clearance which is response to prolonged (or) frequently recurring

irritation. The common irritants are tobacco smoke, infection, industrial fumes, and

smoke.4

Adult respiratory disease, particularly chronic respiratory disease, constitute

a major burden in terms of morbidity and mortality in the developing world. They

contribute to work – limiting health problems, lost work days, and premature death

resulting from delayed diagnosis and treatment. The burden of acute and chronic

adult respiratory diseases has been rising throughout the world, it caused by

environmental exposure to tobacco smoke or unwanted coal – fired cook stoves. In

the developing world, preventive and therapeutic strategies may have greater

societal effect than managing the diseases after they arise.5

As estimated 10.7 million adults in the United States over age 18 have

chronic respiratory disease. Person with chronic respiratory disease one greatly

underestimated because the disease is usually not diagnosed until it is moderately

advanced. The number of women with chronic respiratory disease is on the rise

because of the increased number of women smoking cigarettes. It is the 4 th leading

cause of death in the United State. Since 2000 more women than men have died

from chronic respiratory disease. Chronic respiratory disease is the only lung

disease in which whites have more deaths than African Americans. Death rates

related to chronic respiratory disease for Hispanics are significantly lower than

other ethnic groups. More than one half of chronic respiratory disease patients die

within 10 years of diagnosis. However it has been a marked increased in cigarette

smoking in developing countries which will increased chronic respiratory disease

mortality rates world wide.6

NEED FOR STUDY

The need for study arises from the fact chronic bronchitis is an important

chronic respiratory problem worldwide world is presently facing the problem of air

pollution. Chronic respiratory disease are on the increase at alarming rate.7

A wide spread disorder, chronic respiratory disease affects more than 16

million American. It now accounts for 4% of all deaths in the United State making

it the fourth leading cause of death. Caring for clients with chronic respiratory

disease has been estimated at $14.5 billion annually in direct care costs alone,

however the burden of chronic respiratory disease is even greater from a global

perspective, where it is currently the sixth leading cause of death and the 12th

leading cause of morbidity world wide.8

In the United States, in 2002, an estimated 24 million adults had chronic

respiratory disease (127). A chronic respiratory disease prevalence model was used

to estimate the prevalence of chronic respiratory disease in 12 Asian countries of

this region, as projected by the model, is 56.6 million with an overall prevalence

rate of 6.3%. The chronic respiratory disease prevalence rates for the individual

countries range from 3.5% (China, Hong Kong Special Administrative Region, and

Singpore) to 6.7% (viet Nam)8.

In China, chronic respiratory diseases are the second leading cause of death

(32). It is estimated that over 50% of Chinese men smoke, whereas smoking rates

among women are lower in this country (159). The prevalence of chronic

respiratory disease in men and women in China is not very different (106), which

points to the importance of risk factors other than smoking in causing chronic

respiratory disease in Chinese women. A recent study sounds a prevalence of

physician-diagnosed chronic respiratory disease of 5.9% in the adult population8.

In India, study collecting data without spirometry assessment suggested that

12 million people were affected by chronic respiratory disease (161). Recent

studies form the same authors (162, 163) show a prevalence of respiratory

symptoms in 6%-7% of non-smokers and up to 14% of smokers and up to 14% of

smokers. In a recent study southern India, the prevalence rate of chronic

respiratory disease in adult was around 7%.The burden of chronic respiratory

disease study is currently being carried out in different parts of the world including

low and middle income countries (164). This very important study compares the

prevalence and burden of chronic respiratory disease across the world using the

same protocol, including the chronic respiratory diseases questionnaire and

spirometry. Some results are already available and show.8

Chronic respiratory disease is one of the leading causes of morbidity and

mortality in the industrialized and the developing countries. According to

prediction of WORLD HEALTH ORGANIZATION chronic respiratory disease

will become the third leading cause of mortality and the fifth cause of disability in

2020 worldwide. So that prevalence and mortality data may be inclusive of chronic

bronchitis chronic respiratory disease is determined by the action of a number of

various risk factors among which the most important is cigarette smoking.

However during the last few decades evidence from epidemiological studies.

Finding consistent association between air pollution and various outcomes

(respiratory symptoms) reduced lung function.9

The decrease in cigarette smoking in the United States should lead to a

decrease in chronic respiratory disease mortality rates in the future. Mortality has

suggested the outdoor air pollution is a contributing cause of morbidity and

mortality. It is prescribed in article 2006. It was concluded that epidemiological

studies suggest that air pollution plays a remarkable role in the exacerbation and in

the pathogenesis of chronic respiratory disease.10

A study was conducted in sapaldia on exposure to environmental tobacco

smoke is associated with increased reports of respiratory symptoms and reduced

lung function notably in healthy individual with Bronchial hyper responsiveness.

1661 never smokers from the sapaldia taken as sample results reveals that exposure

to tobacco smoke reported in the two surveys was strongly associated with the

development of cough odds ratio, 2.1;95% confidence interval 1.2 – 3.7; P=0.01).

in subjects with BHR exposed to tobacco smoke at both surveys, a trend for strong

association were observed for wheeze, cough, dyspnea, and chronic Bronchitis,

however the association reached statistical significance only for the symptoms of

dyspnea (P<0.01) lower FEV/FVC (mean + /- SD, 72.9+/-7.7VS. 76.8+/- 6.1%

P<0.01) and FEF (25.75) forced expiratory flow, midexpiratory phase / FVC

(mean +/- SD, 56.1+/- 22.5VS, 68.1+/- 21.6% P<0.01) were observed in subjects

with Bronchial hyper responsiveness exposed to tobacco smoke composed with

non exposed subjects without Bronchial hyper responsiveness, lower values were

found in subjects continuing exposure by the follow – up survey. Author concluded

that the exposure to tobacco smoke was strongly associated with the development

of respiratory symptoms in previously as symptomatic subjects with Bronchial

hyper responsiveness within 11 years. Further more, subjects with underlying

Bronchial hyper responsiveness had reduced lung function at follow – up, thus

suggesting a higher risk for the development of chronic respiratory disease in this

subject of the population.11

A study was conducted on the prevalence of respiratory morbidity and its

associated factors in urban Delhi results reveals that a total of 3465 individuals

were interviewed of which 1756 (50.68%) were males and 1709 (49.3%) were

females only 9.05% of the men smoked. The overall prevalence of chronic cough,

chronic phlegm and dyspnea was 2.0%, 1.2% and 3.4% respectively. The

prevalence of wheezing was 3.2%. All the symptoms increased the age (P<0.05).

No significant difference was observed in these symptoms between males and

females less educated and retired individuals were more likely to have respiratory

symptoms. The prevalence of chronic cough, phlegm dyspnea and wheezing was

5.8%, 2.9%, 9.9% and 8.7% respectively among smokers, which was significantly

higher than that observed in non smoker logistic regression analysis revealed that

age and smoking remained significant factors for occurrence of the respiratory

symptoms.12

A Random study was undertaken in USA to examine the association

between exposure to air pollution from domestic biomass fuel combustion and

chronic bronchitis in two rural Bolivian highland villages. Questionnaire method

was used on individual > 20 years of age in both villages (n=241) samples taken

results reveals that daily pollution exposure was significantly higher in the indoor

cooking village range for adults 98<10-15 120 mg/3h/m than in the outdoor

cooking village range for adults 5520-6240 u-h/m3 for both season and for men

and women. The overall prevalence of chronic bronchitis was 22% and 13% for

the indoor and outdoor. Cooking villages, respectively, logistic regression analysis

which excluded the few smokers present in the population showed a 60% reduced

risk of chronic Bronchitis in the outdoor cooking village compared with the indoor

cooking village or 0.4; 95% CI 0.2 to 0.8 p=0.0102 after adjusting for age sex,

individuals aged > 40years were 4.3 times more likely to have chronic benchitis

than the younger age group. OR=4.3, 95% (CI 12.0 to 9.3 P-0.0002) there was no

significant of difference in the prevalence chronic bronchitis in men and women

the author concluded that the result of their study suggest an association between

chronic Bronchitis and exposure to domestic biomas fuel combustion.13

A study was conducted in USA among farmers who use pesticide for

agriculture have increased risk factors for chronic Bronchitis we evaluate pesticide

as risk factor for chronic bronchitis using the agriculture health study enrocement

data on lifetime pesticide use and history of doctor diagnosed chronic bronchitis

from 20,908 private pesticide applications, primarily farmers. The results reveals

that a total of 654 farmers (3%) reported chronic bronchitis diagnosed after age of

19 years. After adjustment for correlated pesticides as well as confounders. 11

pesticides were significantly associated with chronic bronchitis research

concluded. These results provide preliminary evidence that pesticide use may

increase chronic prevalence14.

Many study shows that chronic bronchitis is one of the leading cause of the

mortality and mortality and some of these can be prevented by giving home care

education regarding risk factors and preventive aspects and the personal experience

in respiratory ward it was found that most of the adults suffering for chronic

bronchitis. Thus the investigator would like to explore on the effect of structured

teaching program on knowledge and practice regarding risk factors and home care

management of chronic bronchitis among the adults. The respiratory nurse place a

vital role in educating the patients in preventing risk factors and home care

management of the chronic Bronchitis and providing comprehensive care and

adopting preventive measures.

REVIEW OF LITERATURE

According to Polit and Back, comprehensive, in-depth, systematic and

critical review of scollery publications unpublished materials and personal

communication is called review of literature.

An extensive search of literature was done by the investigator of factual

information about prevention of risk factors and home care management of client

the chronic bronchitis patients. The related literature is organized and presented

under the following heading.

1) Literature related to risk factors of chronic bronchitis.

a) Smoking

b) Infection

c) Air pollution

d) Chemical hazards

e) Occupation environment

f) Socio-economic

g) Genetics

2) Literature related to adults respiratory disease

3) Literature related to home care management of chronic bronchitis.

4) Literature related to patients education on respiratory diseases

1) Literature related to risk factors of chronic bronchitis.

a) Smoking

This study was conducted in demark to investigate the interaction of

smoking and history of long term occupational exposure to organic solvents on the

prevalence of chronic bronchitis among middle aged elderly men. Structured

questionnaire was used among 3208 men aged 63+/10years were taken as sample

results indicates that 46% men had chronic bronchitis 14.4% had current smoking

habit and the interaction of smoking and long term occupational exposure to

organic solvents (>5years) were the factors most strongly associated with

prevalence of chronic bronchitis. In the solvent exposed group odds ratio for

chronic bronchitis was 7 comparing current smokers with nonsmokers against

potential contenders. The author concluded that current (or) previous occupational

exposure to organic solvents doubles the smoking related risk of chronic

bronchitis15.

Prospective analytic study was conducted in Chandigarh on serum surfactant

protein a levels in chronic bronchitis and its relation to smoking 30 patients with

clinical diagnoses of chronic bronchitis taken as sample results indicates that out of

30 patients in that 21were smokers and 9 were non smokers. The serum protein

level in smokers with chronic bronchitis is significially higher than the non

smokers researcher concluded that the increase in serum protein level in smokers

with chronic bronchitis suggests that tobacco smoking causes a chronic increase in

permeability of the lung parenchyma.16

Protection of the lung is basic for the preservation of lung function patient

with chronic respiratory disease should be informed unequivocally that for them

smoking is dangerous. Cigarette smoking G presses the activity of scavenger cells

and affects the cilia cleansing mechanism of the respiratory tract, the function of

which is to keep the breathing passages free of inhaled irritants bacteria and other

foreign matter. This is one of the major mechanisms of the body when the

cleansing mechanism is damaged by smoking air flow is obstructed and air

becomes trapped behind the obstructed air way. The air sacs greatly distend and

the lung capacity is diminished cigarette smoking also irritates goblet cells and the

mucus. The mucus accumulation of mucus. The mucus accumulation produces

more irritation, infection and damage to the lung capacity frequently the patient is

unaware of what is happening until he notices that extra physical effort produces

respiratory distress. At this point the damage may be irreversible. There fore

patients with chronic respiratory disease should definitely refrain from smoking.

There is a wide variety of smoking control strategies including prevention,

cessation and behavior modification.17

b) Infection

A study was conducted in New Zealand among adults on impaired lung

function is associated with systemic inflammation and is a risk factors for

cardiovascular disease in older adults cohort method used 1000 New Zealand at

age 26 and 32 years taken as sample results reveals that there were significant

inverse association between FEV (1) and CRP at both ages were found for the

forced vital capacity the association were similar in men and women were

independent of smoking and body mass index.18

c) Air Pollution

A multicenter study was conducted to investigate the association between

the prevalence and new onset of chronic Bronchitis and urban air pollution in

Spain random method was used and selected 3232 males and 3592 female average

response rate 65.3% as sample. Hierarchical models were used results reveals that

the prevalence and new onset of chronic phelgm during follow up were 6.9 % and

4.5%respectively 5.3% in males and 3.5%in females author concluded that

individual markers of traffic at household level such as sported intensity and

outdoor nitrous oxide were risk factors for chronic Bronchitis among females.19

d) Chemical hazards

A study was conducted on association between chronic exposure to volcanic

environmental and chronic bronchitis incidence in Portugal sample taken as two

population one exposed to active manifestation of volcanism (fuenas) and another

term an area where no volcanic activity took place for over three million years data

collection method used on the incidence of chronic bronchitis among both popular

on is volcanism grow another non volcanism group (1991-2001). Incidence rates

were extremely higher in the volcanically active area for both sexes and especially

in the youngest group risk of chronic bronchitis is higher in volcanically active

area that in volcanically in active area.20

Chronic bronchitis is due to the inhalative noxae (in most cases decades of

cigarette smoking ) management of chronic bronchitis consists primary in the

elimination of the noxae acute infection said by author German Jan driven

exacerbation of chronic bronchitis The article in Russian have been described they

have taken 36 patients as sample and measured VC,FVC,FEV,FEV1/VC/PEP

MEF-25 MEF-50 MEF-75 , TCL, TGV, RV ROW REX DLCO-SS Pao2, paco2

were determined in 36 patients with severe chronic lung disease all the patients

were found to have impaired Brachial patency and changes in lung volume and

capacities. Author concluded that reduced lung function is associated with

systemic inflammation in young adults . This association is not related to smoking,

asthma(or) obesity. The reason for the association are inexperienced , but the

findings indicates that the development of inflammation predates the development

of either chronic lung disease (or) clinically significant arthrosclerosis. The

association between poor lung function and cardiovascular disease may be

medicated by an inflammatory mechanism.21

e) Occupational environment

Article in Russia has been described about approaches to lower occurrence

of chronic bronchitis in railway workers subjected to occupational risk of

respiratory disorders. Analysis of peculiarities in morbidity and social importance

of chronic bronchitis as a leading Nasologic entity among railway workers whose

work is associated with constant exposure to risk factors of respiratory disease the

author compare clinical efficiency of various schemes concerning treatment of

chronic bronchitis and the relapses prevention.22

Respiratory consequences from occupational environmental disaster are the

result of inhalation exposure to chemicals, particulate matter (dusted fibers) the

incomplete products of combustion that are often liberated during disasters such as

fires building collapses, explosions and volcanoes the English literature was review

using key word disaster with bronchitis. Respiratory health consequences after

aerolized exposures to high concentrations of particulates and chemicals can be

grouped in to 4 major categories in that lower respiratory disease the review

describes several respiratory consequences of occupational environmental disaster

uses the world trade center disaster to illustrate in detail the consequence of

chronic respiratory infections.23

f) Socio-economic

A larged community based study conducted in Spain on socioeconomic

status and chronic bronchitis. Data method used and 9,023 people from European

community respiratory health survey taken as sample results bronchitis risk was

associated with low educational level 95% incident bronchitis also increased with

low educational level.24

A study was conducted in Delhi on the cause of death in a low

socioeconomic area over 11years to help identity changes in the pattern of disease

verbal autopsy questionnaire used and reported about death occurred from 1994 to

2004 by trained health workers considered as sample results reveals that a total of

515 deaths occurred during the period 340 in men (66%) and 175 in women (34%)

due to 6 common cause of death in that chronic obstructive respiratory disease

(11.6%) cause specific mortality rate due to communicable disease showed a

decline while that due to non communicable disease in a low.25

g) Genetics

Twin study was conducted in Sweden on interaction between smoking,

genetic factors in the development of chronic bronchitis selected sample 44,919

twins older than 40 years who disease cause smoking habits identified taken from

the Swdish twin registry self reported method followed univeriable. Bivariate

structural equation models were used results revels than the heritability estimate

for chronic bronchitis was a moderate 40% and only 14% of the genetic influences

were shared with smoking researcher conclude that the genetic factors independent

of those related to smoking habits play a role in the development of chronic

bronchitis26.

2) Literature related to adults respiratory disease

Chronic bronchitis is one of the cause for morbidity and morbidity cohort

study was conducted on association between early life history of respiratory

disease and morbidity and mortality in adulthood who attended Glasgow

university between 1948 and 1968 and reported that among 9544 students 1553

death due to respiratory disease results reveals that a medical history of a

respiratory disease in early life was associated with a 57% greater risk of overall

respiratory disease mortality in adulthood. In addition students reporting a history

of bronchitis had a 38% higher risk of cardiovascular disease mortality 95%

research concluded that an early life history of respiratory disease is associated

with higher mortality and morbidity risk in adulthood the association being seen

particularly for respiratory related and cardiovascular deaths among those with a

history of bronchitis. All early life respiratory disease appeared to be negatively

associated with later adult respiratory health.27

3) Literature related to home care management of chronic bronchitis.

Exacerbations of chronic obstructive respiratory disease are a major cause of

hospital admission but don’t require intensive investigation (or) complex therapy.

We investigated the suitability of home care for severe uncomplicated

exacerbations. After formal assessment in a hospital respiratory unit many pts with

exacerbation of chronic respiratory disease can be treated at home by respiratory

nurses. Treatment of exacervations respiratory disease by of chronic respiratory

assessment service in UK over 3.5 years we assessed 962 patients with

exacerbations of chronic obstructive respiratory disease after referral to a hospital

respiratory department by had family physicians. All patients had chest

radiography oxygen- situation arterial gas analysis was through to be essential pts

were allowed home with a customized treatment package. Each patients was

visited daily by a respiratory nurse who monitored progress and treatment

compliance and provided education and reassurance. Findings are 145(15%) of

962 required admission at initial referral and 155(12%) were admitted rates. 653

(68%) pts were manages entirely at home and 49 (5%) were referred

inappropriately one pts died at home. All patients had severe disease with a mean

forced expiratory volume is 1s of 1-02 L and 395 (41%) had required hospital

admission in the patients of a year. This review found no evidence of significant

differences between hospital at home patients and hospital inpatients for

readmission rates and mortality at two to 3 months after the initial exacerbation.

Both the patients and careers preferred hospital at home schemes to inpatient

care.28

Hospital at home schemes are a recently adopted method of service delivery

for the mgt of acute exacerbations of chronic respiratory disease aimed at reducing

demand for acute hospital in pts beds and promoting a patients centered approach

through admission avoidance. However evidence in approach of such a service is

contradictory. To evaluate the efficiency of hospital at home compared to hospital

inpatients care in acute executions of chronic respiratory disease. The most recent

researchers were carried out in August 2003 only Randomised controlled trails

were considered where patients presented to the emergency department with an

exacerbation of their chronic respiratory disease studies much not have recruited

patients that are usually deemed obligatory admission results indicates seven

studies with 754 patients were included in the review studies provided data on

hospital readmission and motality both of which were not significantly different

when the two study groups were compared.29

Chronic respiratory disease is a leading cause of hospitalization in Danish

adults and admission rates are expected to increase in the future. A study was

conducted on associated homecare with disease monitoring and treatment by a

respiratory and treatment by a respiratory nurse may reduce time Span at hospital

and the economic burdens of chronic respiratory disease in order to evaluate

various types of assisted home care , the selection of patients, feasibility , effect,

safety and cost effectiveness the literature was received most information is

available on assisted home care following a hospital based assessment and led by a

respiratory. Nurse according to the literature assisted homecare is a well tolerated,

safe and economic alternative to hospital admission for about 25-30% of patients

referred to hospital.30

A study was conducted on Hospital at home for chronic obstructive

reparatory disease an integrated hospital and community based generic

intermediate care service foe prevention and early discharge 2006 recent

randomized controlled studies have reported success for Hospital at home for

prevention and early discharge of chronic obstructive respiratory disease using

hospital based respiratory nurse specialist . This observational study reports results

using an integrated Hospital and community based generic intermediate care

readmission with in 60 days and death with in 60 days in the early discharge 9.37

days,21.1%, 7%) and the prevention of admission (5 to 6 days 34.1% 3.8%)are

similar to previous studies we suggest that this generic community model of

service may allow hospital at home services for COPD to be introduced in more

areas.

A study was conducted on Hospitals a home for patients with acute

exacerbations of chronic obstructive respiratory diseases systemic review of

evidence to evaluate the efficiency of hospital at home schemes composed with in

patient care in pts with acute exacerbation of chronic obstructive respiratory

disease. A systematic section of randomized controlled trails. Main outcome

measures were mortality and readmission to hospital. Results reveal that seven

trails with 754 patients were included in the review. Hospital readmission and

mortality were not significant different when hospitals at home schemes were

compared with inpatient care (relative risk 0.89, 95% confidence interval 0.72 to

1.12 and 0.61, 0.36 to 1.05, respectively however compared with inpatient care ,

hospital at home schemes were associated with substantial cost savings as well as

freeing up hospital in patients beds the researchers concluded hospitals at home

schemes can be safety used to care for patients with acute exacerbations

obstructive chronic respiratory disease who would otherwise be admitted to

hospital.

4) Literature related to patients education on respiratory diseases

Although various interventions are indicated for each of these disease

categories, they can be costly and of limited efficacy in lowering premature

mortality. Patient education and home health care to help the patient with chronic

respiratory disease live better. It is essential that he be educated about his disease

process. One of the major teaching factors is helping the patient accept realistic

show term and long range goals. If the patient is severely disabled the objective of

treatment is preserve his present pulmonary function and leave the symptoms as

much as possible if disease is mild the objective is to increase his exercise

tolerance and prevent further loss of pulmonary function. The goals and

expectation of treatment must be shared and planed with the patient the patient and

those carrying for him need patience to achieve these goals. The patient is

instructed to avoid extremes of heat and cold heat increases the body temperature

there by raising the oxygen requirements of the body cold tends to promote

bronchospasm. High attitudes aggravate the hypoxia bronchospasm may be

initiated also by air pollutants such as fumes, smoke, dust and even talcum, lint and

aerosol sprays.31

Patient with chronic respiratory disease should restrict themselves to live of

moderate activity, ideally in a climate with minimal shifts in temperature and

humidity. Stressful situations that might trigger a coughing episode or emotional

disturbances should be avoid. Patients may be directed to community resources

such as pulmonary rehabilitation programs smoking cessation program and other

programs to help improve the ability to cope with their chronic condition and their

therapeutic regimen and to give them a sense of worth hope and well being.31

STATEMENT OF THE PROBLEM: - A study to assess the effectiveness of

structured teaching programme regarding risk factors and Home care management

of chronic bronchitis among adults in selected hospitals at Kolar Dist.

OBJECTIVES OF THE STUDY: -

1) To assess the existing knowledge regarding risk factors and Home care

management of Chronic Bronchitis among Adults.

2) To determine out the effectiveness of Structured teaching programme regarding

Risk factors and Home care management of Chronic Bronchitis among adults.

3) To find the association between post test Knowledge level with their selected

demographic variables

OPERATIONAL DEFINITIONS:-

ASSESS: - It refers to the evaluation of the level of knowledge regarding risk

factors and Home care management of Chronic Bronchitis among Adults.

EFFECTIVENESS:- It refers to evaluate the result of planned teaching

programme by post test scores.

STRUCTURED TEACHING PROGRAMME

It refers to a system of planned instruction given to impart information in order to

bring a knowledge regarding risk factors and home care management of chronic

bronchitis

RISK FACTORS

It refers to pre-disposing factors like cigarette smoking, pipe-cigar and intense

exposure to occupational dusts, chemicals, indoor and out door air pollution and

allergents.

ADULTS

It refers to those who are in age group of 20-45 years

HOME CARE

It refers to the self care practices which the patient with chronic bronchitis

follows at home with regards to continuing medication and breathing exercise and

avoiding risk factors like smoking, making alteration in nutrition use of inhalers,

maintaining good environment, regular follow up in order to prevent recurrence of

severe breathing difficulties and promote well being and quality of life.

CHRONIC BRONCHITIS

It is the chronic inflammation of the bronchus.

HYPOTHESIS

There is no significant difference between pre and post test knowledge

scores of adults with chronic bronchitis regarding risk factors and home care

management of chronic bronchitis.

VARIABLES:

INDEPENDENT VARIABLE: - Structured Teaching Progarmme regarding risk

factors and home care management of chronic bronchitis.

DEPENDENT VARIABLE: - knowledge of adults regarding risk factors and

home care management of chronic bronchitis.

Attributed Variables :- Age, education, sex , marital status, economic status,

occupation, smoking habits, family history of allergy.

Source of Data:-Adults who are suffering with chronic bronchitis in selected

hospitals at Kolar.

Research Design:-Quasi experimental design (One group pre test and post test

design)

Research approach:-Evaluative approach.

Setting of the study:-It will be conducted in SNR Hospital at Kolar. Which is

500 bedded Hospital, and located 2 kms away from the Pavan College and

Devaraj Hospital, which is 700 bedded Hospital and located 5 km away from the

Pavan college.

Sampling technique:- Simple random sampling technique will be used to select

the sample.

Sample size: 60

Population:-Adults who are admitted with chronic bronchitis in the age group of

20 to 45 years.

Sample:-Male and female patients with chronic bronchitis between the age group

of 20 to 45 years in selected hospitals Kolar (SNR and Devaraj Hospitals).

SAMPLING CRITERIA:-

Inclusion Criteria:-

1) Adults between age group of 20 to 45 years of age and admitted with chronic

bronchitis.

2) Patient who are willing to participate.

3) Patient who can communicate in Kannada.

Exclusion criteria:-

1) Patient who are below 20 years and above 45years of age.

2) Critically ill patients.

3) Patient who are not willing to participate.

4) Patient who cannot communicate in Kannada.

Tool for data collection Structured interview schedule will be used to collect the

data from the adults.

Tool consists of two sections:- Section A & B

Section A:- Consists of Questions regarding sociodemographic data of subjects

(Age, Sex, Education, Occupation, Smoking habits, Family history of Allergy)

Section B:- Consists of two parts.

Part 1:-Questions regarding risk factors of chronic bronchitis.

Part 2:-Questions regarding home care management of chronic bronchitis.

METHOD OF DATA COLLECTION

Structured interview schedule will be used for data collection.

Data Analysis interpretation:

Descriptive and inferential statistics such as frequency, percentage, standard

deviation mean paired‘t’ test and chi square test will be used for data analysis and

it will be interpreted in the form of tables, graphs, diagrams.

Does the study require any investigation or intervention to be conducted on

patients or other human or animals?

Yes, The study will be conducted among the adults between the age group of

20 to 45 years in the selected hospitals in Kolar. Since it is a Structured Teaching

Programme.

Has ethical clearance been obtained from concerned authorities?

Yes, Prior permission will be obtained from the concerned authorities of

selected hospitals at Kolar, and research committee of AE & CS PAVAN

COLLEGE OF NURSING, KOLAR. The purpose of study will be explained to the

adults.

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