SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON

KNOWLEDGE OF THERAPEUTIC LIFE STYLE MODIFICATION ON PREVENTION OF

HYPERTENSION AMONG SOFTWARE PROFESSIONALS OF SELECTED COMPANIES AT

BANGALORE.”

SUBMITTED BY

Mrs. RAGI RAVEENDRAN

1ST YEAR M. Sc. NURSING

RAJARAJAESWARI COLLEGE OF NURSING

KAMBIPURA

MYSORE ROAD

BANGALORE 560074

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE

AND ADDRESS

RAGI RAVEENDRAN

1ST YEAR M. Sc. NURSING

RAJARAJAESWARI COLLEGE OF NURSING

BANGALORE

2. NAMEOF THE INSTITUTION RAJARAJAESWARI COLLEGE OF NURSING,

BANGALORE

3. COURSE OF STUDY AND

SUBJECT

MASTER OF SCIENCE IN NURSING,

MEDICAL SURGICAL NURSING.

4. DATE OF ADMISSION TO

THE COURSE17-7-2013

5. TITLE OF THE STUDY A STUDY TO EVALUATE THE EFFECTIVENESS

OF SELF INSTRUCTIONAL MODULE ON

KNOWLEDGE OF THERAPEUTIC LIFE STYLE

MODIFICATION ON PREVENTION OF

HYPERTENSION AMONG SOFTWARE

PROFESSIONALS OF SELECTED COMPANIES

AT BANGALORE.

6. BRIEF RESUME OF THE INTENDED WORK

6.1. Introduction

2

Hypertension has become a major cause of morbidity and mortality worldwide and it is now ranked third

as a cause of disability-adjusted life. Hypertension is an increasingly important medical and public

health issue. It is among the most important life-threatening conditions in both industrial and developing

countries. While as many as one billion cases of hypertension are estimated worldwide, approximately

7.1 million deaths annually may be attributable to hypertension. The World Health Organization (WHO)

reported that hypertension is responsible for 62% of cases of cerebrovascular disease and 49% of cases

of ischemic heart disease. In addition, hypertension is the top most risk factor for death worldwide.

Moreover; hypertension is a main risk factor for stroke and Coronary heart disease and a major

contributor to the onset and progression of chronic heart disease. 4

Hypertension or high blood pressure is said to be present if it is persistently at or above 140/90 mmHg.

Hypertension is classified as either primary (essential) hypertension or secondary hypertension; about

90–95% of cases are categorized as "primary hypertension" which means high blood pressure with no

obvious underlying medical cause. The remaining 5–10% of cases (secondary hypertension) is caused

by other conditions that affect the kidneys, arteries, heart or endocrine system. Over 90% of those living

an average life span are expected to develop hypertension which is largely reflective of their sedentary

behavior, physical and mental stress, poor dietary habits, and obesity. 5

Stress is the one of the major cause of high blood pressure. Stress is a negative consequence of modern

living. Software professionals are stressed due to overwork; job insecurity, information overload, and

the increasing pace of life. These events produce distress: the degree of physiological, psychological and

behavioral deviation from healthy functioning. Software companies either stress or depression causes

rather than the effect of several physical, mental and emotional problems. When such situations prevail

in the software companies, it is negative when stress is associated with heart disease, alcoholism, drug

abuse, and marital breakdown, physical organizational and emotional problems. Stress is associated with

constraints and demands can lead to potential stress.15

IT company jobs are known to be more competitive and stressful because of their nature of work like

target achievements, night shift, work overload, role demands, interpersonal demands, organizational

structure, organizational leadership and the organizations life cycle. Also software development process

is a learning and communication process requiring greater interaction with the clients, deep

understanding of the business process, and insight into technological innovations. These situations put

3

pressure on the professionals resulting in professional stress. India being a forerunner in the IT industry

with lakhs involved as IT professionals. There is an urgent need to understand the dynamics of the IT

professional stress and it’s associated with major health problems like hypertension so as to prevent it

from assuming epidemic proportion. 15

A Descriptive study done to assess the factors Associated with Job Stress of Software professionals in

Bangalore city, Software job is stressful job. It is difficult to say what factors contribute to this stress,

because job stress may be caused by a complex set of reasons. Some of the most visible factors of job

stress are Work Stressors, Role Stressors, Personal development stressors, Interpersonal relation

Stressors and Organizational climate Stressors. The present study investigates factors that contributed to

stress and relations among the stress factors of software professionals .An analysis of about 100

professionals serving different software companies was carried out. The gathered data was analyzed

using descriptive correlation and regression analyses .The study reveals that the correlation of

organizational climate with all other stressors and that the software professionals are much concerned of

accommodating themselves to different roles in performing the work assigned. A regression is fitted

with different stress factors. These continuous stresses affect health and lead to several health problems

like hypertension. These things identify early and adopt therapeutic life style there by prevent the

complicated health problems. 20

Therapeutic life style is a set of lifestyle changes that can includes specific dietary recommendations,

weight management, and increased physical activity. Lifestyle modification is the foundation of

preventive management in individuals with cardiovascular disease risks such as obesity, hypertension,

dyslipidemia, and diabetes. In hypertensive individuals, lifestyle modification can be recommended as

an initial treatment before the start of drug therapy and as an adjunct to medication in those already on

drug therapy. Healthy changes include maintaining a normal weight, exercising regularly, quit smoking,

avoid stress, limiting alcohol consumption to no more than one or two drinks a day, reducing sodium

(salt) intake, increasing potassium intake and the DASH (Dietary Approaches to Stop Hypertension)

diet. 28

6.2. NEED OF THE STUDY

4

High blood pressure is a major public health problem in India and elsewhere. It is a major cardiovascular

risk factor and contributes significantly to cardiovascular mortality. Prospective Studies Collaboration

has reported that reducing BP can substantially decrease cardiovascular risk and cardiovascular as well

as all-cause mortality. This risk reduction is steeped in younger subjects than in the older subjects and is

more when baseline blood pressure levels are high. 9

Hypertension (HTN) is because of Smoking ,Obesity, overweight, Diabetes, Sedentary lifestyle, Lack of

physical activity ,High levels of salt intake (sodium sensitivity) ,Insufficient calcium, potassium, and

magnesium consumption ,Vitamin D deficiency, High levels of alcohol consumption ,Stress.

Prehypertension :-systolic blood pressure between 120 and 139 or a diastolic pressure between 80 and

89.Doctor advise to begin lifestyle modifications to bring blood pressure down to the normal range.

Blood pressure medication isn't usually recommended unless the patient has diabetes or kidney disease

and recommended lifestyle changes are not working. Hypertension stage-1:-Systolic pressure is between

140 and 159 or diastolic pressure is between 90 and 99. Doctor will recommend the lifestyle changes,

but also probably need to take medication like thiazide -type diuretic. Hypertension Stage 2:- Systolic

pressure is 160 or higher or diastolic pressure is 100 or higher. People at this stage usually must modify

lifestyle habits and take a diuretic and another type of antihypertensive drug (maybe a third type if

necessary). 10

Hypertension can lead to damaged organs, as well as several illnesses. Hypertension is a risk factor for

all clinical manifestations of atherosclerosis since it is a risk factor for atherosclerosis itself. It is an

independent predisposing factor for heart failure, coronary artery disease, stroke, renal disease, and

peripheral arterial disease. It is the most important risk factor for cardiovascular morbidity and mortality,

in countries. Treating hypertension is important for reducing the risk of stroke, heart attack, and heart

failure. High blood pressure may be treated medically, by changing lifestyle factors, or a combination of

the two. Important lifestyle changes include losing weight, quitting smoking, eating a healthful diet,

reducing sodium intake, exercising regularly, and limiting alcohol consumption. Medical options to treat

hypertension include several classes of drugs. ACE inhibitors, beta-blockers, diuretics, calcium channel

blockers, alpha-blockers, and peripheral vasodilators are the primary drugs used in treatment. 11

Lifestyle measures are a crucial step in hypertension management. Dietary Approaches to Stop

Hypertension (DASH) study showed that a diet low in sodium and high in fruits, vegetables, and

5

calcium is helpful in treating hypertension. Exercise is critically important, especially in children and

young adults with hypertension who often have heightened sympathetic nervous system activity.

Patients with hypertension often feel stressed, and the stress aggravates their BP. 9

A recent meta-analysis of 27 randomized trials done at documented a 4mmHg net reduction in systolic

blood pressure among Indonesian individuals assigned to an aerobic exercise program. Interestingly, the

magnitude of the change in blood pressure appeared to be independent of exercise intensity. Regular

exercise is associated with an increase in high-density lipoprotein cholesterol and reductions in body

weight, waist circumference, body fat percentage, insulin resistance, systemic vascular resistance,

plasma nor adrenaline, and plasma rennin activity. A meta-analysis by Fagardand Cornelissen on the

effects of dynamic aerobic endurance training or resistance training in hypertensive and normotensive

patients showed that resistance training was associated with significant reductions in blood pressure and

cardiovascular risks, such as systemic vascular resistance, nor epinephrine levels, and plasma renin

activity. In a meta-analysis on the effects of resistance training on resting blood pressure, the authors

concluded that moderate intensity resistance training may be an effective intervention for preventing and

combating hypertension. Thus, exercise is a cornerstone for prevention, treatment, and control of blood

pressure. 12

The study was conducted in Bangalore, Karnataka with a sample of 250 women software professionals.

The sample selection was done by convenience sampling method. The data was analyzed using

descriptive one way analysis of variance and Pearson’s correlation test. Result showed that the women

software professionals experienced moderate level of stress and stress dimension. This study reveals that

85 percent of the respondents experience medium level of depression and also suggested the age and

experience significantly influence the overall stress and depression experienced by the employees. This

study shows that there might be a strong relationship between overall stress and depression. 13

A cross-sectional descriptive study carried out amongst the IT professionals at the Debscom Technology

Ltd, Ogbomoso, Oyo State, south-western Nigeria. The aim of the study was to discern the prevalence of

perceived work stress and to explore the relationship between perceived work stress and the presence of

hypertension. Methods used A total of 324 consenting software professionals of the institution were

administered the job demand-control questionnaire to assess work stress. A standardized questionnaire

was used to collect socio-demographic data and other personal data. Measurements of blood pressure,

6

weight and height were carried out and body mass indices were calculated. Results are more than a

quarter (26.2%) of the subjects perceived them self as stressed at work. The single largest group of

hypertensive subjects was seen among subjects with work stress. A significant number of software

professionals in this study is afflicted by work-related stress and perceived work stress was found to be

significantly associated with higher hypertension prevalence. 14

So the researcher go through the review of literature and by the experience come to know that ,In the

present day software professionals are constantly best with health problems and strain in everyday life,

because of high pressure in working environment and life style. So they easily fall into disease and

illness. Hypertension is most common health problem among them. Hypertension is not prevent and

treated at the earlier stage leads to serious health problems such as heart failure, coronary artery disease,

stroke, renal disease, and peripheral arterial disease. As prevention is better than cure, the investigator

feels that there is a need to increase the knowledge about therapeutic life style modification of

prevention of hypertension. Thereby reduce the risk of hypertension and lead a healthy life.

6.3. REVIEW OF LITERATURE

7

The review of literature is defined as a critical summary of research on a topic of interest often prepared

to put a research problem in context or as the basic for as implementation project. 2

Literatures relevant to the present study are mentioned under the following headings:-

1. Studies related to causes and risk factor for hypertension.

2. Studies related to the effect of therapeutic life style modification in prevention of

hypertension.

3. Studies related to the effectiveness of self-instructional module.

1. Studies related to causes and risk factor for hypertension :-

An analytical study of job stress among software professionals in India was carried out through survey

instrument, which was developed around ten stress factors. An analysis of about 200 professionals

serving different software houses in the local context was carried out. The gathered data was analyzed

using descriptive and correlation analyses which revealed interesting trends related with stress and age

group, gender, marital status and qualification. The insights developed through this study are useful to

many stakeholders in the local context, including software professionals, project managers, and the

Electronics and Computer Software Export Promotion Council (ESC). 15

A study conducted to assess the Lifestyle risk factors in an urban South African community the research

question addressed in the study was to determine the prevalence of the following lifestyle risk factors:

obesity, waist-hip ratio, physical inactivity, high blood glucose, and hypertension in an urban

community. The research objective for the study was to determine the prevalence of specific risk factors

in an urban community. Based on the results, a health intervention could be planned and implemented to

reduce the prevalence of the risk factors and the possibility of chronic non-communicable diseases in

later life. The design was a quantitative survey using physical measurement and a structured

questionnaire. The target population of the study was black urban adults (n=218). The sampling method

was convenient and purposive. The results of the study indicated that the prevalence of hypertension and

obesity were higher than the national prevalence for South Africa. The waist-hip ratio revealed that 20%

of the men and 49.7% of the women were at risk for cardiovascular disease. High blood glucose levels

were demonstrated for 21.6% of the group. Physical activity was also shown to be inadequate. In

8

conclusion, the potential for cardiovascular and metabolic health problems in future is high. It is

recommended that an intervention, based on the results of the study, should and must be developed and

implemented. The more challenging question is to know what to do and how to do it. A framework is

suggested to guide the development of an intervention. 16

A case control study was conducted at ACR software tech Ltd. A proportional systematic random

sample of 120 cases matched with sex, and locality to 120 controls were chosen. Data was collected

using a questionnaire which included socio-demographic data, lifestyle, and health profile. Collected

data was analyzed using SPSS V13. The most common modifiable risk factors of hypertension were

physical inactivity (76.7% versus 15.9%), obesity (67.5% versus 29.2%), diabetes mellitus (19.2%

versus 7.5%), and ex-smoking (15.5% versus 1%). Cases and controls show statistical significant

differences in values for the lipid profile. Hypertension was significantly associated with low socio

economic status, education, and employment. The most common non-modifiable risk factors were age,

and family history (85.8% versus 71.7%). Multiple logistic analysis controlling for age showed that

significant predictors of hypertension were obesity, physical inactivity, low monthly income and family

history. Conclusion:- Most of the identified hypertension risk factors are preventable. 17

A study to assess the Work-related stress perception and hypertension among software professionals of a

Debscom Technology Ltd in Oyo State, south-western Nigeria Globalization. .Objective is to study was

a work site cross-sectional descriptive study carried out amongst the software professionals at the

Debscom Technology Ltd Ogbomoso, Oyo State, south-western Nigeria. The aim of the study was to

discern the prevalence of perceived work stress and to explore the relationship between perceived work

stress and the presence of hypertension. Methods:- A total of 324 consenting software professionals of

the institution were administered the job demand-control questionnaire to assess work stress. A

standardized questionnaire was used to collect socio-demographic data and other personal data.

Measurements of blood pressure, weight and height were carried out and body mass indices were

calculated. Results: More than a quarter (26.2%) of the subjects perceived them self as stressed at work.

The single largest group of hypertensive subjects was seen amongst subjects with work stress. 14

Work stress related lipid disorders and arterial hypertension in software professionals – A cross-

sectional study. Occupational stress is a term used to define ongoing stress that is related to the

workplace. The study was conducted to determine association of occupational stress index (OSI) and its

9

aspects with arterial hypertension and lipid disorders using data from a cross-sectional survey of

software professionals. Methods: - The cross-sectional study was performed in 439 software

professionals .The task demands, role demands, interpersonal demands, organizational structure,

organizational leadership and the organizations life cycle were calculated using the standardized

questionnaire. Determination of serum lipids, blood pressure (BP) and cardiovascular risk factors were

done. Results: - A significant difference in prevalence of diagnosed hypertension and dyslipidemia was

found along with a difference in several aspects among examined groups of software professionals.

Similar pattern showed triglycerides (TG), total cholesterol (TC) and LDL cholesterol and BP, while

HDL-cholesterol. 18

A study conducted Stress And Depression Experienced By Women Software Professionals In

Bangalore, Karnataka it explores the influences of age and experience on stress and depression and the

relationship between stress and depression among the women information technology (IT) professionals

in Bangalore, Karnataka. The present study aimed to find out the level of stress and depression

experienced by women IT professionals, to understand the impact of age and experience on stress and

Depression to study the relationship between Stress and depression, to know the factors causing of stress

in software companies. The study was conducted in Bangalore, Karnataka with a sample of 250 women

software professionals. The sample selection was done by convenience sampling method. The data was

analyzed using descriptive one way analysis of variance and Pearson’s correlation test .Results showed

that the women software professionals experienced moderate level of stress and stress dimension. This

study reveals that 85 percent of the respondents experience medium level of depression and also

suggested the age and experience significantly influence the overall stress and depression experienced

by the employees. This study shows that there might be a strong relationship between overall stress and

depression. 13

A study conducted on prevalence of professional stress, depression and alcohol use among Indian IT

professionals. A cross-sectional online study conducted using screening questionnaires like professional

life stress scale, centre for epidemiological studies depression scale and alcohol use disorders

identification test. This study was conducted specifically on professionals working in an IT firm with the

designation of a software engineer. Results:- A total of 129 subjects participated in the study. 51.2% of

the study sample was found to be professionally stressed at the time of the interview. 43.4% of the study

population was found to be at risk for developing depression. 68.2% of those who were professionally

10

stressed were at risk for developing depression compared with only 17.5% of those who were not

professionally stressed. Odds ratio revealed that subjects who were professionally stressed had 10 times

higher risk for developing depression compared to those who were not professionally stressed. Subjects

who were professionally stressed had 5.9 times higher prevalence of harmful alcohol use compared to

those who were not professionally stressed. Subjects who were at risk for developing depression had 4.1

times higher prevalence of harmful alcohol use compared with those who were not at risk for developing

depression. 19

A study on Factors Associated with Job Stress of Software professionals in Bangalore city Software job

is stressful job. It is difficult to say what factors contribute to this stress, because job stress may be

caused by a complex set of reasons. Some of the most visible factors of job stress are Work Stressors,

Role Stressors, Personal development stressors, Interpersonal relation Stressors and Organizational A

study climate Stressors. The present study investigates factors that contributed to stress and relations

among the stress factors of software professionals. An analysis of about 100 professionals serving

different software companies was carried out. The gathered data was analyzed using descriptive,

correlation and regression analyses. The study reveals that the correlation of organizational climate with

all other stressors and that the software professionals are much concerned of accommodating themselves

to different roles in performing the work assigned. A regression is fitted with different stress factors. 20

A systematic review and meta-analysis were conducted to examine the association between dairy food

intake during adulthood and the development of elevated blood pressure (EBP), specifically comparing

the association of EBP with consumption of low-fat dairy foods versus high-fat dairy foods, as well as

cheese versus fluid dairy foods (milk or yogurt). Seven databases were searched and five cohort studies

selected for inclusion, involving nearly 45,000 subjects and 11,500 cases of EBP. Meta-analysis of

consumption of dairy foods and EBP in adults gave a relative risk (RR) of 0.87 (95% confidence interval

(CI) 0.81-0.94). Separation of high- and low-fat dairy foods, however, indicated a significant association

with low-fat dairy foods only (RR of 0.84 (95% CI 0.74-0.95)). Additional analyses showed no

association between EBP and cheese, although fluid dairy foods were significantly associated with a

reduced development in EBP (RR of 0.92 (95% CI 0.87-0.98)). Little heterogeneity was observed

among the data presented. This meta-analysis supports the inverse association between low-fat dairy

foods and fluid dairy foods and risk of EBP. Understanding these relationships can aid in the

development of public health messages involving dairy foods, and supports current recommendations. 21

11

A study conducted to assess the low-fat dairy consumption and reduced risk of hypertension. Objective:

The aim of the present study was to assess whether total, low-fat, and whole-fat dairy consumption was

associated prospectively with the risk of hypertension. Design: This was a prospective study conducted

in 5880 university graduates in Spain, aged >20 y in 2000 (x̄ age: 37 y), free of hypertension and

cardiovascular disease at baseline, and followed-up with mailed questionnaires for a median of 27 mo.

Dairy consumption was assessed with a previously validated semi quantitative food-frequency

questionnaire. Results: One hundred eighty new cases of hypertension were identified. The hazard ratio

of hypertension between extreme quintiles of low-fat dairy product consumption was 0.46 (95% CI:

0.26, 0.84; P for trend = 0.02) after adjustment for the main known risk factors for hypertension and

several dietary factors. No significant association between whole-fat dairy products or total calcium

intake and incident hypertension was seen. Conclusion: In this Mediterranean cohort, low-fat dairy

consumption, but not whole-fat dairy consumption, was associated with a lower risk of incident

hypertension. 22

A study conducted to assess stress-induced blood pressure reactivity and incident stroke in middle-aged

men was examined in 2303 men (mean age, 52.8+/-5.1 years) from a population-based, longitudinal

study of risk factors for ischemic heart disease in eastern FINLAND: Reactivity was calculated as the

difference between blood pressure measured during the anticipatory phase of an exercise tolerance test

(before exercise) and resting blood pressure, measured 1 week earlier. Mean systolic reactivity was 20

mm Hg (+/-15.9), and mean diastolic reactivity was 8.6 mm Hg (+/-8.5). Socioeconomic status was

assessed as years of education. One hundred thirteen incident strokes (90 ischemic) occurred in 11.2 (+/-

1.6) years of follow-up. RESULTS: Men with exaggerated systolic reactivity (>/=20 mm Hg) had 72%

greater risk of any stroke (relative hazard ratio [RH], 1.72; 95% CI, 1.17 to 2.54) and 87% greater risk of

ischemic stroke (RH, 1.87; 95% CI, 1.20 to 2.89) relative to less reactive men. Moreover, men who were

high reactors and poorly educated were nearly 3 times more likely to suffer a stroke than better

educated, less reactive men (RH, 2.90; 95% CI, 1.66 to 5.08). Adjustment for stroke risk factors had

little impact on these associations. Diastolic reactivity was unrelated to stroke risk. Conclusions:

Excessive sympathetic reactivity to stress may be etiologically important in stroke, especially ischemic

strokes, and low socioeconomic status. 23

In a cohort study, 8334 of the Atherosclerosis Risk in Communities (ARIC) Study participants, aged 45

to 64 years at baseline, who were free of hypertension and coronary heart disease, had their blood

12

pressures ascertained after 6 years of follow-up. Alcohol consumption was assessed by dietary

interview. The type of alcoholic beverage predominantly consumed was defined by the source of the

largest amount of ethanol consumed. There was an increased risk of hypertension in those who

consumed large amounts of ethanol (>/=210 g per week) compared with those who did not consume

alcohol over the 6 years of follow-up. The adjusted odds ratios (95% confidence interval) were 1.2 (0.85

to 1.67) for white men, 2.02 (1.08 to 3.79) for white women, and 2.31 (1.11 to 4.86) for black men. Only

4 black women reported drinking >210 g ethanol per week. At low to moderate levels of alcohol

consumption (1 to 209 g per week), the adjusted odds ratios (95% confidence interval) were 0.88 (0.71

to 1.08) in white men, 0.89 (0.73 to 1.09) in white women, 1.71 (1.11 to 2.64) in black men, and 0.88

(0.59 to 1.33) in black women. Systolic and diastolic blood pressures were higher in black men who

consumed low to moderate amounts of alcohol compared with the non-consumers but not in the 3 other

race-gender strata. Models with polynomial terms of alcohol exposure suggested a nonlinear association

in white and black men. Higher levels of consumption of all types of alcoholic beverages were

associated with a higher risk of hypertension for all race-gender strata. The consumption of alcohol in

amounts >/=210g per week is an independent risk factor for hypertension in free-living North American

populations. The consumption of low to moderate amounts of alcohol also appears to be associated with

a higher risk of hypertension in black men. 24

A study to assess the physical activity in young adults and incident hypertension over 15 years of

follow-up: The CARDIA Study Objective is to examine the relation between physical activity and

incident hypertension in young adults over 15 years of follow-up in the Coronary Artery Risk

Development in Young Adults study. Method: - A total of 3993 Black and White men and women aged

18 to 30 years were examined at baseline, and 2, 5, 7, 10, and 15 years later. Blood pressure and

physical activity were measured at each exam. Hypertension was defined as systolic 140 mm Hg or

higher, diastolic 90 mm Hg or higher or antihypertensive medication use. Average physical activity and

incident hypertension over 15 years of follow-up were analyzed. Results: - There were 634 cases of

incident hypertension over 15 years of follow-up. Those who were more versus less physically active

experienced a reduced risk (hazard rate ratio = 0.83; 95% confidence interval = 0.73, 0.93) for incident

hypertension, after adjustment for race, sex, age, education, and family history of high blood pressure.

Conclusions: - Physical activity merits attention in the prevention of incident hypertension among young

adults, particularly as they move into middle age. 25

13

A cross-sectional study to assess the smoking status, obesity and hypertension in a general population

sample, Aim: -To examine the associations between hypertension and smoking status, when divided into

subgroups by overweight and obesity. Design: Cross-sectional study. Methods: We used data from a

national health survey with a probability sample of the national population of Germany aged 18 to 79 (n

= 6903 with complete data). Smoking status data were collected via questionnaire. Obesity and

overweight were assessed by body mass index, hypertension by blood pressure measurement and by

participants’ statements about antihypertensive treatment. Analyses were adjusted for gender, age,

history of coronary artery disease, serum cholesterol levels, alcohol drinking, exercise, and education.

Results: Obese former smokers who were abstinent for 3 or more years had an adjusted odds ratio (OR)

3.6 (95% confidence interval, CI 2.3–5.7) for mild hypertension ( 140 mmHg systolic or 90 mmHg⩾ ⩾

diastolic blood pressure) and an adjusted OR 6.5 (95%CI 3.6–11.8) for moderate or severe hypertension

( 160 mmHg systolic or 100 mmHg diastolic). Normal weight never or former smokers did not differ⩾ ⩾

from normal weight current smokers smoking 15 cigarettes/day with regard to likelihood of⩾

hypertension (normal weight never smokers, OR 1.1, 95%CI 0.8–1.5; normal weight former smokers,

abstinent 3 or more years, OR 0.8, 95%CI 0.5–1.3.In this nationally representative sample, never or

former smoking was unrelated to hypertension among normal weight individuals. 36

A study to assess the Hypertension and Smoking Are Associated with Reduced Regional Left

Ventricular Function in Asymptomatic Individuals .The Multi-Ethnic Study of Atherosclerosis

Objectives: - This study sought to test the hypothesis that reduced regional left ventricular (LV) function

is associated with traditional risk factors including hypertension, hypercholesterolemia, and smoking in

asymptomatic individuals. Methods: - The Multi-Ethnic Study of Atherosclerosis (MESA) is a cohort

study designed to investigate the nature of atherosclerosis in asymptomatic individuals. A total of 1,184

participants (45 to 84 years old) underwent tagged cardiac magnetic resonance imaging. Regional LV

function was quantified by analyzing peak systolic circumferential strain (Ecc) in regions corresponding

to the left anterior descending (LAD), circumflex (LCX), and right coronary (RCA) territories. The

association between risk factors and strains was studied using multiple linear regressions. Results: -

Higher diastolic blood pressure (DBP) was associated with lower Ecc (p ≤ 0.002). The Ecc’s in the LAD

territory of participants with DBP <80, 80 to 84, 85 to 89, and ≥90 mm Hg were −15.6%, −14.8%,

−14.2%, and −13.7%, respectively (p < 0.001). Similar results were documented in other territories and

after multivariable analysis. Smokers had lower Ecc in the LAD and RCA regions compared with

14

nonsmokers. Furthermore, dose response relationship between cigarette consumption measured in pack-

years and regional LV dysfunction by Ecc was noted (p ≤ 0.01 in LAD and RCA territories). Finally,

combined diastolic hypertension and smoking was associated with a greater reduction of regional LV

function. Conclusions: - Higher diastolic blood pressure and smoking are associated with decreased

regional LV function in asymptomatic individuals. 26

2. Studies related to the effect of therapeutic life style modification in prevention of hypertension .

A study conducted at Baltimore to assess the effectiveness of Lifestyle Interventions Reduce

hypertension although trials of lifestyle interventions generally focus on cardiovascular disease risk

factors rather than hard clinical outcomes, A total of 810 healthy adults with untreated pre-hypertension

or stage I hypertension were randomized to 1 of 3 intervention groups: An “advice-only” group, an

“established” group that used established lifestyle recommendations for blood pressure control (sodium

reduction, weight loss, and increased physical activity), or an “established-plus-DASH” group that

combined established lifestyle recommendations with the DASH (Dietary Approaches to Stop

Hypertension) diet. The primary outcome was 10-year hypertension risk, estimated from follow-up data

collected at 6 months. A secondary outcome was 10-year hypertension risk at 18 months. Of the 810

participants, 62% were women and 34% were black. Mean age was 50 years, mean systolic/diastolic

blood pressure was 135/85 mm Hg, and median baseline Framingham risk was 1.9%. The relative risk

ratio comparing 6-month to baseline Framingham risk was 0.86 (95% confidence interval 0.81 to 0.91,

P<0.001) in the established group and 0.88 (95% confidence interval 0.83 to 0.94, P<0.001) in the

established-plus-DASH group relative to advice alone. Results were virtually identical in sensitivity

analyses, in each major subgroup, and at 18 months. Conclusions— the observed reductions of 12% to

14% in estimated CHD risk are substantial and, if achieved, should have important public health

benefits. 27

A review conducted at Greenwich to assess the Lifestyle Changes that reduce Blood Pressure:

Implementation in Clinical Practice Lifestyle modification is widely advocated as initial and adjuvant

therapy for the treatment and prevention of hypertension. In addition to exercise, nutritional changes

including sodium reduction, adoption of the Dietary Approaches to Stop Hypertension (DASH) diet,

alcohol reduction, and weight loss have significant blood pressure lowering effects. The current

challenge to clinicians has been developing and implementing practical and effective approaches for use

15

in clinical practice. This review discusses the evidence supporting each current lifestyle

recommendation, discusses evidence on specific programs or office based strategies, and provides

practical advice. 28

A study conducted at UK to assess the Adherence to risk factor modification in patients with

hypertension. Aim: The effectiveness of the support of a healthcare practitioner and a family member in

producing changes in risk factor modification was tested in a randomized, controlled trial in patients

with hypertension. Methods: The primary outcome measured after the 24-week intervention was blood

pressure change. Secondary outcomes included patients' adherence to the program, their knowledge

about hypertension, exercise capacity, body weight, and self-reported ability to control stress, adherence

to medication and salt restriction, as well as symptoms. Results: There were no marked improvements in

blood pressure regulation in either group. The differences between the experimental and control groups

were 3 mmHg (CI -6.18-12.18) for systolic blood pressure and 4 mmHg (CI -1.48-9.48) for diastolic

blood pressure. The estimated blood pressure effects were small increases in both diastolic and systolic

blood pressure, due to larger changes in the control group. The absolute difference in improvement

between the two groups was significantly greater for the experimental group than for the control group

for the following variables: 24%better adherence to the program (p = 0.007); 10% higher mean

percentage score of hypertension knowledge and its management (p = 0.04); 20% more patients could

control their stress levels (p = 0.05); 26% more patients could control their salt ingestion (p = 0.02); and

20% had better adherence to their given medication regimen (p = 0.05). The experimental group had a

statistically significant weight reduction of 1 (+/- 4) kg relative to the control group (p = 0.03). Both

groups increased their exercise capacity during the trial (p = 0.03). On the completion of the

intervention, significantly fewer patients in the experimental group than in the control complained of

tiredness (p = 0.05). Patients who had a 75% adherence or more to the program were found to have

maintained their knowledge and their exercise capacity, but not their weight loss after a maintenance

phase of 12 weeks, during which time there was no intervention. 29

A study to assess the effect of aerobic exercise on blood pressure: a meta-analysis of randomized,

controlled trials. Physical activity has been associated with reduced blood pressure in observational

epidemiologic studies and individual clinical trials. This meta-analysis of randomized, controlled trials

was conducted to determine the effect of aerobic exercise on blood pressure.54 randomized, controlled

trials (2419 participants) whose intervention and control groups differed only in aerobic exercise. Using

16

a standardized protocol and data extraction form, three of the investigators independently abstracted data

on study design, sample size, participant characteristics, type of intervention, follow-up duration, and

treatment outcomes. In a random-effects model, data from each trial were pooled and weighted by the

inverse of the total variance. Aerobic exercise was associated with a significant reduction in mean

systolic and diastolic blood pressure (-3.84 mm Hg [95% CI, -4.97 to -2.72 mm Hg] and -2.58 mm Hg

[CI, -3.35 to -1.81 mm Hg], respectively). A reduction in blood pressure was associated with aerobic

exercise in hypertensive participants and normotensive participants and in overweight participants and

normal-weight participants. Aerobic exercise reduces blood pressure in both hypertensive and

normotensive persons. An increase in aerobic physical activity should be considered an important

component of lifestyle modification for prevention and treatment of high blood pressure. 30

A study conducted to assess the effects of Comprehensive Lifestyle Modification on Blood Pressure

Control among software professionals. Objective is to determine the effect on BP of 2 multi component,

behavioral interventions. Design, Setting, and Participants Randomized trial with enrollment at 4 clinical

centers (January 2000-June 2001) among 810 adults (mean [SD] age, 50 [8.9] years; 62% women; 34%

African American) with above-optimal BP, including stage 1 hypertension (120-159 mm Hg systolic

and 80-95 mm Hg diastolic), and who were not taking antihypertensive medications. Conclusion

Individuals with above-optimal BP, including stage 1 hypertension, can make multiple lifestyle changes

that lower BP and reduce their cardiovascular disease risk. 31

A study to assess the Blood pressure responses to lifestyle physical activity among young, software

professionals hypertension-prone African-Americans. Physical inactivity and obesity increase the risk

for hypertension, and both are more prevalent in African-Americans than Caucasians. Performed a

randomized, parallel, single-blind study to examine the effect of lifestyle physical activity (LPA) on

blood pressure indices in sedentary African-Americans aged 18 to 45 years with pre-hypertension or

untreated stage 1 hypertension. Mean changes in cuff, ambulatory, and pressure load indices were

compared using paired t tests, and physical activity adherence was expressed as percentages. Results:

software professionals in the Exercise group had a significant reduction in systolic blood pressure (-6.4

mm Hg, P = .036), a decrease in diastolic blood pressure status to the pre-hypertensive level (90.8 vs.

87.4 mm Hg), and greater reductions in nighttime pressure load compared with the No Exercise group.

Given the excess burden of pressure-related clinical sequel among African Americans and the strong

17

correlation between pressure load and target organ damage, LPA may represent a practical and effective

strategy in this population. 32

3. Studies related to the effectiveness of self-instructional module

A study was conducted “to develop and test the effectiveness of a Self-Instruction Module on breast

cancer and its early detection” selected a sample of unmarried thirty women in Kerala state through

purposive sampling technique. The structured questionnaire was used to collect data. The research

design used to conduct the study was pre-test post-test design. The findings revealed that the mean post

test knowledge score 66.50% was found to be significantly higher than their mean pre test knowledge

score 50.68% with ‘t’ value 27.9,p 0.05 level suggesting effectiveness of self instructional module. 33

A study was conducted in Delhi to assess the effectiveness of a Self-Instruction Module on home care

management of diabetes mellitus. 50 samples were selected by purposive sampling technique. The

findings revealed that the mean post test knowledge score 30.06% was higher than the pre test

knowledge score 19.50% with the‘t’ value of 12.91 and found to be significant at the level of p<0.001.

This supports that the a Self-Instruction Module is effective method of providing information on home

care management of DM. 34

Another study was conducted in Chennai, Tamil Nadu to assess the effectiveness of Self Instruction

Moduleon improving the knowledge about therapeutic life style modification of prevention of hyper

tension among software professionals. The data was collected from 100 subjects through structured

knowledge questionnaire. The result of the study revealed that the overall post-test knowledge score

(34.36±2.09) was higher than the pre-test knowledge score (29.22±4.39). The difference in mean

percentage score between pre- and post-test was around 48.30 which indicate that the self instructional

module was effective in improving the knowledge of software professionals. 35

6.4. STATEMENT OF THE STUDY

A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON

KNOWLEDGE OF THERAPEUTIC LIFE STYLE MODIFICATION ON PREVENTION OF

18

HYPERTENSION AMONG SOFTWARE PROFESSIONALS OF SELECTED COMPANIES AT

BANGALORE.

6.5. OBJECTIVES OF THE STUDY

1. To assess the existing knowledge of software professionals regarding therapeutic life style

modification in prevention of hypertension among software professionals.

2. To develop self instruction module on therapeutic life style modification in prevention of

hypertension.

3. To evaluate the effectiveness of self instructional module on knowledge regarding therapeutic

life style modification in prevention of hypertension among software professionals by post test.

4. To find the association between pre test score of knowledge regarding therapeutic life style

modification in prevention of hypertension among software professionals with their selected

demographic variables.

6.6. HYPOTHESIS

H1 - There will be a difference between mean pre test score and post test score of knowledge regarding

therapeutic life style modification in prevention of hypertension among software professionals.

H2 – There will be a significant association between pre test score of knowledge regarding therapeutic

life style modification in prevention of hypertension with selected demographic variables.

6.7. ASSUMPTIONS

The study assumes that:

1. Hypertension is common among software professionals.

2. Software professionals will be having some knowledge on therapeutic life style modification in

prevention of hypertension.

3. Self instructional module is an effective method to improve the knowledge.

6.8. DELIMITATIONS

1. Software professionals at selected software companies.

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2. Period of study four weeks.

6.9. VARIABLES

1. Independent variable - self instructional module on knowledge of therapeutic life style

modification of hypertension.

2. Dependent variable – Increasing knowledge of therapeutic life style modification in prevention

of hypertension.

6.10. OPERATIONAL DEFINITIONS

Assess–: In this study it refers to determine the knowledge of software professionals regarding therapeutic life style modification in prevention of hypertension.

Effectiveness –: In this study it refers to the extent to which the self instructional module will be

attained the desired gain in knowledge scores as measured by structured knowledge questionnaire.

Knowledge –: In this study, it refers to the scores obtained by the software professionals by giving

correct responses to structured knowledge questionnaire regarding therapeutic life style modification in

prevention of hypertension.

Self instructional module–: In this study, it refers to the systematically planned instructional module

on the importance of therapeutic life style modification in prevention of hypertension.

Prevention–: In this study it refers to the measures to modify the therapeutic life style to reduce the

occurrence of hypertension among software professionals.

Hypertension –: In this study it is defined as a persistent elevation of systolic blood pressure (SBP)

≥140mm Hg, diastolic blood pressure (DBP) ≥90mm Hg based on the average of two or more accurate

blood pressure measurements.

Therapeutic life style changes (TLC)–: In this study it is a set of lifestyle changes that can includes

diet management, weight management, and increased physical activity which will helps to decrease BP.

Software professionals –: In this study it refers to the computer professionals who are prone to get

physical and mental stress due to continuous works during the working hours (9 hrs per day) such as to

system designs, write programs and tests it with the computer.

20

6.11. PILOT STUDY

10 % of population will be planned for the pilot study.

7. MATERIALS AND METHODS

7.1. Sources of data–: Data will be collected from software professionals of selected software

companies at Bangalore.

7.2. Method of collection of data

7.2.1. Definition of the study subject–:

The software professionals who are meet the criterias from the selected software companies will be the

sample.

7.2.2. Research approach–:

Evaluative approach will be used as research approach.

7.2.3. Research design–:

One group pre test - post test design will be used to conduct the study.

7.2.4. Settings–:

The study will be conducted in selected software companies at Bangalore.

7.2.5. Sampling technique –:

Purposive sampling technique will be used to select the sample.

7.2.6. Sample size–:

Software professionals who meet inclusion criteria shall be considered as sample and the sample size

is 50.

21

7.2.7. Inclusion and Exclusion criteria–:

A. Inclusion criteria–:

1. Software professionals who are willing to participate.

2. Software professionals who are free from hypertension.

B. Exclusion criteria–:

Software professionals who are not present during the time of data collection.

7.2.8. Duration of study–: 4 weeks

7.2.9. Tool for data collection–: Structured knowledge questionnaire

Section A: -demographic variables

Section B: - knowledge questionnaire on therapeutic life style modification in prevention of

hypertension will be used for data collection.

7.2.10. Collection of data–:

Before data collection informed consent will be obtained from the authority and from each participant

by explaining the procedure. Data will be collected by the prepared structured self instructional module

on therapeutic life style modification in prevention of hypertension will be issued to each sample

separately, then post test score will be collected after seven days of pre test by using the same structured

knowledge questionnaire.

7.2.11. Method of data analysis and presentation–:

1. The investigator will use descriptive statistical techniques such as mean, median, mode,

standard deviation.

22

2. Inferential statistics like chi- square test will use to find the association between the

variables.

3. The analyzed data will be presented in the form of tables, diagrams and graphs.

7.3. Does the study require any investigations or interventions to be conducted on patients, or

other animals? If so please describe briefly.

Yes, the investigator needs to evaluate the effectiveness of self instructional module on knowledge

regarding therapeutic life style modification in prevention of hypertension among software

professionals.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, ethical clearance will be obtained from authority of the selected software companies and from each

participants and make sure that the participant’s datas and informations which will be collected from

them will keep confidentially and anonymity will be maintained.

23

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limited, New Delhi, 2005

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3. Polit and Hungler, "Nursing Research: principles and methods", 6th Edition, Lippincott

Publishers, 1999.

4. Black JM. Medical surgical nursing. 7th ed. Philadelphia: Elsevier Publications; 2004

5. Lewis S. Medical surgical nursing. 6th ed. Philadelphia: Mosby Publications; 2006

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Publishers; 2008

7. Shaini GS, Venkateshan L. Effectiveness of self instructional module on home care management

of DM. The nursing journal of India 2007 Dec;XXVIII (12)

8. Basanth M. To develop and test the effectiveness of a Self-Instruction Module on breast cancer

and its early .The nursing journal of India, 2007 Dec; XCVIII (12): 12-15

9. Rajeev Gupta and Soneil Guptha. Strategies for initial management of hypertension.

Indian J Med Res. 2010 November; 132(5): 531–542.

URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028941/

10. Christian Nordqvist , Medical News Today

URL: http://www.medicalnewstoday.com/articles/150109.php

11. Mayo Clinic Staff. High blood pressure dangers: Hypertension's effects on your body

URL: http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-

pressure/ART-20045868

12. Sima Ghezelbash , Azam Ghorbani. Lifestyle modification and hypertension prevention

ARYA Atherosclerosis Journal 2012; Volume 8, Special Issue in National Hypertension

Treatment.

URL: http://eprints.arums.ac.ir/4112/1/HTN.pdf

13. Dr. Mohan N,Dr.Ashok J. Stress and Depression Experienced by Women employess in software

companies at Bangalore , Karnataka Vol 11, No 6 (2011)

URL: http://journalofbusiness.org/index.php/GJMBR/article/view/516

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14. African Journal of Primary Health Care & Family Medicine; Vol 4, No 1 (2012),

15. Surendra Kumar,AN ANALYTICAL STUDY OF JOB STRESS AMONG SOFTWARE

PROFESSIONALS IN INDIA. March 2012

16. UK PubMed Central (United Kingdom), Lifestyle risk factors in an urban South African

community.

URL: http://worldwidescience.org/topicpages/c/community+risk+factors.html

17. SRN Epidemiology. Volume 2013 (2013), Article ID 720760

18. Directory of Open Access Journals (Sweden). Occupational Work stress related lipid disorders

and arterial hypertension in professionals

19. Darshan MS, Raman R, Rao TS, Ram D, Annigeri B.A study conducted on prevalence of

professional stress, depression and alcohol use among Indian IT professionals.

Indian J Psychiatry. 2013 Jans; 55(1):63-9s

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20. Ankireddy Sailaja ,Dr.Narayana Reddy T. ,Dr.Pradeep Kumar D. Factors Associated with Job

Stress of Software professionals in Bangalore city

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of elevated blood pressure and consumption of dairy foods.2012 Jan;

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22. Alvaro Alonso1, Juan José Beunza1, Miguel Delgado-Rodríguez1, J Alfredo Martínez1, and

Miguel Angel Martínez-González1

Low-fat dairy consumption and reduced risk of hypertension: the Seguimiento Universidad de

Navarra (SUN) cohort1, 2, 3, 2005 American Society for Clinical Nutrition

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23. Everson SA, Lynch JW, Kaplan GA, Lakka TA, Sivenius J, Salonen JT. Stress-induced blood

pressure reactivity and incident stroke in middle-aged men. 2001 Jun;

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24. Fuchs FD, Chambless LE, Whelton PK, Nieto FJ, Heiss G. Alcohol consumption and the

incidence of hypertension: The Atherosclerosis Risk in Communities Study.

Hypertension. 2001 May; 37(5):1242-50.

URL: http://www.ncbi.nlm.nih.gov/pubmed/11358935

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25. Emily D. Parker, MPH, Kathryn H. Schmitz, PhD, MPH, David R. Jacobs, Jr, PhD, Donald R.

Dengel, PhD, and Pamela J. Schreiner, PhD.

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CARDIA Study. Am J Public Health. 2007 April; 97(4): 703–709.

26. Rosen BD, Saad MF, Shea S, Nasir K, Edvardsen T, Burke G, Jerosch-Herold M, Arnett DK, Lai

S, Bluemke DA, Lima JA. Hypertension and smoking are associated with reduced regional left

ventricular function in asymptomatic: individuals the Multi-Ethnic Study of Atherosclerosis

Hypertension and smoking are associated with reduced regional left ventricular function in

asymptomatic: individuals the Multi-Ethnic Study of Atherosclerosis

27. Maruthur NM, Wang NY, Appel LJ. Lifestyle interventions reduce coronary heart disease risk:

results from the PREMIER Trial. Circulation. 2009 Apr 21;119(15):2026-31. doi:

10.1161/CIRCULATIONAHA.108.809491. Epub 2009 Apr 6.

28. Miller ER Jr, Erlinger TP, Young DR, Prokopowicz GP, Appel LJ.

Lifestyle Changes That Reduce Blood Pressure: Implementation in Clinical Practice.1999 Nov.

URL: http://www.ncbi.nlm.nih.gov/pubmed/11416612

29. Stewart A, Noakes T, Eales C, Shepard K, Becker P, Veriawa Y.

Adherence to cardiovascular risk factor modification in patients with hypertension.2005 Mar-Apr

URL : http://www.ncbi.nlm.nih.gov/pubmed/15915277

30. Whelton SP, Chin A, Xin X, He J.

Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled

trials.2002 Apr 2

31. Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, Stevens VJ,

Vollmer WM, Lin PH, Svetkey LP, Stedman SW, Young DR

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PREMIER clinical trial. Apr 23-30;

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32. Staffileno BA, Minnick A, Coke LA, Hollenberg SM. Blood pressure responses to lifestyle

physical activity among young, hypertension-prone African-American women.2007 Mar-Apr.

African-American women.2007 Mar-Apr

33. Shaini GS, Venkateshan L. Effectiveness of self instructional module on home care management

of DM. The nursing journal of India 2007 Dec;XXVIII (12)

26

34. Basanth M. To develop and test the effectiveness of a Self-Instruction Module on breast cancer

and its early .The nursing journal of India, 2007 Dec; XCVIII (12): 12-15

35. Prof. Talwar K.K. Assess the effectiveness of Self Instruction Module on improving the

knowledge about therapeutic life style modification of prevention of hyper tension among IT

professionals JaypeeJournals.

36. U. John, C. Meyer, M. Hanke, H. Völzke and A. Schumann, Smoking status, obesity and

hypertension in a general population sample: a cross-sectional study Oxford Journals

URL: http://qjmed.oxfordjournals.org/content/99/6/407.short

27

9. SIGNATURE OF THE CANDIDATE :

10. REMARK OF THE GUIDE : The present study will improve the knowledge of

hypertension and prevent the complications among

software professionals

11. NAME AND DESIGANTION

OF GUIDE : Mrs. P.Parvathi. M.Sc. (N)

Associate Professor and HOD

Department of Medical Surgical nursing

RajaRajeswari College of nursing

Bangalore 560074

11.1. SIGNATURE :

11.2. CO GUIDE : Dr. B.T. Basavanthappa.M.N.,Ph.D

Principal

RajaRajeswari College of nursing

Bangalore 560074

11.3. SIGNATURE :

11.4 HEAD OF THE DEPARTMENT : Mrs. P.Parvathi. M.Sc. (N)

Associate Professor and HOD

Department of Medical Surgical Nursing

RajaRajeswari College of nursing

Bangalore 560074

11.5 SIGNATURE :

12.1 REMARK OF THE PRINCIPAL : The topic selected for the study is relevant and forward

for needful action.

12.2 SIGNATURE OF THE PRINCIPAL :

28

ETHICAL CLEARANCE COMMITTEE

1. Title of dissertation : A study to evaluate the effectiveness of self instructional module on knowledge of therapeutic life style modification on prevention of hypertension among software professionals of selected companies at Bangalore

2. Name of the candidate and

Address : Ragi Raveendran

1ST Year M.Sc. Nursing

RajaRajeswari College of nursing

Kambipura, Mysore road

3. Subject : Medical and Surgical nursing

4. Name of the guide : Mrs. P. Parvathi. M.Sc. (N)

5. APPROVED/NOT APPROVED

(If not approved, suggestion)

Head of the department of Head of the department of

Community Health Nursing Medical surgical nursing

RajaRajeswari College of nursing RajaRajeswari College of nursing

Head of the department of Head of the department of

Child Health Nursing OBG nursing

RajaRajeswari College of nursing RajaRajeswari College of nursing

Head of the department of

Mental Health nursing

RajaRajeswari College of nursing

29

LAW EXPERT PRINCIPAL

30