Pjn aug nov 2013 by Dept of Medical Informatics

Pondicherry Journal of Nursing

Chief Advisor Cum Editor – in- Chief Dr. S. Kamalam, Principal, Kasturba Gandhi Nursing College, MGMC&RI, Puducherry. Contributing Members Dr. Rebecca Samson, Dean, College of Nursing, PIMS, Puducherry. Prof. Muthamizh Selvi Principal, Vinayaka Mission College of Nursing, Puducherry. Dr. Dhanusu, Principal, Sri Manakula Vinayakar College of Nursing, Puducherry. Prof. P. Genesta Mary, Principal, Sabari College of Nursing, Puducherry. Co-ordination & Compilation Dr. Divya Choudhary, Professor Mr. Vijayaraj. R, Asst.Prof, Kasturba Gandhi Nursing College, MGMC&RI, Puducherry. Editorial Committee Members Prof. K. Renuka Gugan, Vice – Principal, Prof. Sumathy P, Prof. Annie Annal, Ms. A. Kripa Angeline, Asso.Prof Ms. Prabavathy S, Asso Prof, Kasturba Gandhi Nursing College, MGMC&RI, Puducherry.

Vol 6, Issue3, August’13 – November’13

Editorial message Epilepsy across the spectrum Epilepsy is a medical condition that produces seizures affecting a variety of mental and physical functions. It is also called a seizure disorder. When a person has two or more unprovoked seizures, they are considered to have epilepsy. Seizures happen when clusters of nerve cells in the brain signal abnormally, which may briefly alter a person's consciousness, movements or actions. According to the Centers for Disease Control and Prevention, epilepsy affects 2.2 million Americans. The Institute of Medicine, in their recent report "Epilepsy across the Spectrum," says "the 2.2 million prevalence estimate is most accurately viewed as approximating a midpoint in a wide potential range of 1.3 million to 2.8 million people with epilepsy." Epilepsy affects 65 million people worldwide. While medications and other treatments help many people of all ages who live with epilepsy, more than a million people continue to have seizures that can severely limit their school achievements, employment prospects and participation in all of life's experiences. It strikes most often among the very young and the very old, although anyone can develop epilepsy at any age. In the U.S., it affects more than 300,000 children under the age of 15--more than 90,000 of whom have seizures that cannot be adequately treated. The number of epilepsy cases in the elderly is climbing as the baby boom generation reaches retirement age. More than 570,000 adults age 65 and above have the condition. Our returning veterans are also affected as studies show an increased risk of developing epilepsy following traumatic brain injury. Epilepsy is the fourth most common neurological disorder in the U.S. after migraine, Stroke, and Alzheimer's disease. Its prevalence is greater than autism spectrum disorder, Cerebral palsy, Multiple sclerosis and Parkinson's disease combined. Despite how common it is and major advances in diagnosis and treatment, epilepsy is among the least understood of major chronic medical conditions, even though one in three adults knows someone with the disorder.

Dr. S. Kamalam Sd/1

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

Sl.No CONTENT REVIEW ARTICLES 1. DIABETES LINK WITH CANCER - SAY EXPERTS

Pg. No 4

Dr. S. Kamalam

NATURAL WAY TO OVERCOME VARIOUS DISEASES – EAT ADEQUATE FIBRE

Dr. A. Anbumalar

PATIENT SAFETY

Mrs. A. Seethalakshmi & Dr. B. Sreelekha CASE PRESENTATION - VASCULITIS

Ms. Kripa Angeline. A

MENKES KINKY SYNDROME Ms. G. Saritha & Ms. S. Bhavani RESEARCH ARTICLES

THE PSYCHOLOGICAL WELLBEING AMONG ADULTS AND ELDERLY SUBJECTED TO LAUGHTER THERAPY. Mr. N. Shanavaz. Dr. R. Shankar Shanmugam, Mrs. Shakila Shankar & Mrs. D. Anandhi 7. RELATIONSHIP BETWEEN CAREGIVER BURDEN AND COPING STRATEGIES AMONG CAREGIVERS OF PATIENTS WITH MOOD DISORDERS Ms. Monisha Mohan, Prof. Sreedevi P.A & Ms. Febu Elizabeth Joy 8. EVALUATE THE EFFECTIVENESS OF STRUCTURED COUNSELING PROGRAMME ON THE QUALITY OF LIFE AMONG HIV POSITIVE PATIENTS IN PUDHUCHERRY” Ms. Renuka. K & Dr. Indrani Dasarathan 9. EFFECTIVENESS OF NURSING INTERVENTIONS ON QUALITY OF LIFE AMONG PATIENT‟S WITH DIABETIC FOOT ULCER Ms. S. Chandrakala, Dr. Karaline Rajkumar & Dr. Felix 10. EFFECT OF LAUGHTER THERAPY ON DEPRESSION OF SENIOR CITIZENS RESIDING IN SELECTED OLD AGE HOMES Mr. Akhilkumar A, Prof. Sreedevi P.A, & Ms. Sreejamol M .G 11. YOGA PIVOTAL IN FIGHTING TYPE-2 DIABETES MELLITUS Mrs. S. Shanthi, & Dr. Karaline Rajkumar 12. PARENTAL SELF-EFFICACY AMONG PARENTS OF CHILDREN WITH INTELLECTUAL DISABILITY Ms. Liya Louis, Prof. Sreedevi P.A, & Mr. Rajeesh R Nair

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Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

13. EFFECTIVENESS OF ORAL HYGIENE PROGRAMME ON KNOWLEDGE AND ORAL HYGIENE AMONG LOWER PRIMARY SCHOOL CHILDREN Prof. Chitra P & Mr. Sajith S 14. EFFECT OF MUSIC THERAPY ON POST OPERATIVE PAIN AND ANXIETY AMONG PATIENTS SUBJECTED TO CABG Mr. K. Balasubramanian & Dr. Ratna Prakash,

FOODS TO BOOST OUR BRAINPOWER Dr. Divya Choudhary

MULTIPLE CHOICE QUESTIONS

COLLEGE EVENTS

47 SUBSCRIPTION FORM

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Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

DIABETES LINK WITH CANCER–SAY EXPERTS *Dr. S.Kamalam

Prevention of diabetes will reduce the risk of cancer. For long diabetes has associated with complications such as vision loss, kidney problems, heart attack and stroke. Increased sugar levels can put people at risk of cancer, than compared with those with normal blood sugar, say scientists.

lakh people in the age group of 50-71 after 11 year‟s it was found that there was  11% increased risk of dying among women and  17 % of men were found that diabetics may have lower tolerance for cancer treatment such as chemotherapy and steroid drugs  Infection rate are higher, healing process was slower people with diabetes often had urinary tract infection due to sugar retention in the bladder that increases the risk of cancer. Hence prevention is better than to get cancer

But oncologist and Diabetelogist are now quoting scientific data shows how Increased sugar levels in blood can put people at risk of cancer? Incidence of diabetes according to studies by Madras Diabetes Research foundation is nearly 18 % in Chennai. Clinical studies done in abroad revealed that preventing diabetes extends to reduction of risk of pancreatic, stomach colon, rectal and liver cancer. Whereas, city based studies revealed that women are at higher risk when compared to men. 275 out of 100,000 people have cancer according to the metropolitan city tumors registry. That is 1 in 8 persons have the risk of getting breast, cervical and uterine cancer. Of the 580 diabetics with cancer, 242 breast cancer, 67 uterine cancer and 34 had prostate cancer From the USA national cancer institute studies revealed that out of -5

*Principal, Kasturba Gandhi Nursing College, SBV, Puducherry. Kgnc2008@yahoo.com 4

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

Prevention of diabetes:  Try to modify your life styles behavior  Eat lot of fruits and vegetables as they will keep you hydrated  Get an early start between 5 to 6 am for a walk  Drinks lots of water  Avoid taking oily and fast foods  Have a regular checkup  Start your exercise 30 mts in the morning and 30 mts in the evening.  Avoid energy drinks which contain caffeine and have a dehydrating effect.

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

NATURAL WAY TO OVERCOME VARIOUS DISEASES – EAT ADEQUATE FIBRE *Dr. A. Anbumalar

 Promote chewing , decreases rate of ingestion.  Higher intake of fibre automatically cut down fat and calories. Dietary Fibre and Body Weight: British Nutrition foundation have established the effectiveness of dietary fibre intake in achieving significant reduction in body weights without any side effects. Dietary Fibre and Diabetes: Dietary fibre and complex Carbohydrates benefit Type I and Type II diabetics. High fibre diets lower, insulin requirements – Increase peripheral tissue insulin. Dietary Fibre and Lipid Profile: Dietary Fibre decrease serum cholesterol and triglyceride values. DietaryFibre and Heart Disease: Dietary fibre also reduces serum fibrinogen level, which in turn lower the risk of blood clot formation and myocardial infarction. High fibre in the diet reduces cholesterol, there by which will reduce the incidence of atherosclerosis. Dietary Fibre and Cancer: Several mechanisms have been proposed to explain the protective action of dietary fibre against colon cancer. The fibre dilutes bile acids or binds to it there by preventing its role in mutation or cell proliferation.

Dietary Fibre has been defined as the plant polysaccharides and lignin which are resistant to hydrolysis by the digestive enzymes in human beings. Fibres are the structural parts of plants and thus are found in all plant derived foods such as vegetables, fruits, grains and legumes. Fibres are described as non-starch poly saccharides, include cellulose, hemicelluloses, pectins, gums and mucilages. Fibres also include some non-poly saccharides such as cutins and tannins. Fibres are classified into soluble fibres and insoluble fibres depending on their solubility in water. Role of Soluble Fibre: Soluble Fibres delays gastro intestinal transit and delays glucose absorption and lowers blood cholesterol level. Role of Insoluble Fibre: Insoluble fibres, accelerates gastro intestinal transit, increases faecal weight, slows starch hydrolysis and delays glucose absorption. Dietary Fibre and Obesity: Inclusion of high fibre foods in diets for obese has many advantages. They are  low in calorie density.  Foods like greens provide many vitamins and minerals  Give Satiety.  Help in regulating bowel movements. Reduce blood cholesterol.

*Lecturer in Nutrition & Dietetics, RMCON, Annamalai University, Chindambram. 6

Pondicherry Journal of Nursing

Fermentation of dietary fibre results in production of short chain fatty acids lowering the intestinal PH. This inhibits conversion of primary bile acids to secondary bile acids. The secondary bile acids are believed to promote mutation in intestine. At lower PH level the carcinogenic activity will be low and during fermentation of dietary fibre results in production of butyrate which has been shown to be antineoplastic. Dietary fibre exerts its beneficial effect by speeding the passage of faeces through the large intestine so that carcinogens are in contact with the intestinal wall for much shorter period of time and the bulk and water of the faeces may dilute the carcinogen to a non toxic level. Prebiotic effect of Dietary Fibre: Many human studies find that the consumption of Fructooligo Saccharides (FOS) increases beneficial bifidobacteria in the gut this is prebiotic effect and it decreasing concentrations of potentially harmful E.oli and Clostridia. Recommended Dietary Allowance of Dietary Fibre: The Dietary fibre could also have some adverse effects on human nutrition by binding to trace minerals and preventing their absorption, when the intake is excess than the recommended dietary allowances. The normal intake of Total Dietary Fibre

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(TDF) is 25-40g / day or 12g – 14g TDF/1000 k.cal energy.

How to enhance Fibre Intake? The fibre content of the diet can be increased by making the following simple dietary changes. Eat a whole grain or bran enriched breakfast cereal. Eat adequate amount of whole legumes. Eat more fruits and vegetables. Eat more greens. Avoid refined cereal products for example Cakes, Biscuits. In refined foods, the dietary fibre is removed during processing e.g., whole cereal flour contains fiber but refined white flour does not. Conclusion: To lead a healthy life eat adequate amount of fibre rich foods Referece: M.Swaminathan (1998), Advanced Text Book on Food and Nutrition, The Bangalore printing and publishing Co.Ltd, 441-449. B.Srilakshmi (2000), Dietetics, New Age International (P) Ltd., Publishers 174, 197, 198, 242. Sheila John &D.Jasmine Jenifer (2007), Essentials of Nutrition and Dietetics for Nursing, BI Publications Pvt.(Ltd), 21-23. C.Copalan (2004), Nutritive Value of Indian Foods, Printed by NIN, ICMR, 26.

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

PATIENT SAFETY *Mrs. A.Seethalakshmi & **Dr. B.Sreelekha When an individual enters the health care setting for the relief of health problems and their symptoms they also expect to be treated with dignity and safety. Safety is also a

prime concern both for the individual and his or her family Maslow‟s hierarchy places safety at the second level in the hierarchy of needs

Self actualisa tion Self esteem Love and belonging ness Safety and security

Basic physiological needs Air, water, food, sex,homeosta sis and excretion

Figure 1. Maslow‟s heirarchy of needs Amidst many of the public health issues in the world, patient safety is considered to be a serious one. Research studies made evident that in developed countries, around one in ten is harmed during their stay at hospitals and the situation is even worse in developing countries as the incidence is very high. Considering the need and importance many countries have initiated measures to ensure safety in hospitals. Patient safety Patient safety is an emerging healthcare discipline that emphasizes prevention

of medical errors, falls, prompt reporting and proper recording. Factors that may affect the safety of the patient Human factors 1. Qualification and Experience of the healthcare personnel 2. Fatigue 3. Burnout 4. Diverse patients 5. Time pressures 6. Less manpower 7. Inadequate knowledge 8. Failure to acknowledge the prevalence and seriousness of medical errors

*Reader, ** Reader, Faculty of Nursing, SRU, Chennai. 8

Pondicherry Journal of Nursing

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Admission Assessment

Discharge

Transfer

Education

Support

Patient safety

Treatment

Investigations or diagnostic tests

Medications care and cure

Figure 2. Patient safety in a tertiary care setting The risk factors for fall are: 1. Age: Below 16 years and above 60 years 2. Individuals who are unable to understand and follow instructions 3. Differently abled individuals 4. Individuals who are critically ill 5. Altered levels of consciousness 6. On medications as sedatives, antihypertensives, hypnotics and antihistamines 7. Special attention for individuals with alzheimers, parkinsonism, head injuries, sensory perceptual problems, undergone eye surgeries, pregnant women, and patients on dialysis, 8. Individuals with the complaints of vertigo, dizziness, blurring of vision and seizures, 9. Patients who have undergone surgery Assessment: The Morse fall risk assessment This includes information on any history of fall immediate or within 3 months 1. Presence multiple diagnosis

Environmental factors 1. Complicated technologies 2. Intensive care unit 3. Emergency care unit 4. Prolonged hospital stay 5. Newer settings Managerial factors 1. Unclear line of authority 2. Policies 3. Protocols 4. Poor communication system 5. Poor reporting system 6. Absence of education programs 7. Poor supervision Other factors 1. Look alike or sound alike drug names 2. Involvement of other health care personnel and role confusion 3. Inadequate systems to share and analyze the information about errors 4. Equipment failure The patient safety begins at the time of admission. This begins with the assessment for risk factors.

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

2. Use of ambulatory aids as crutches, cane and wall support 3. Presence of an IV line, 4. Weak , impaired or normal gait or mobility, 5. Mental status oriented or forgets limitations 6. The total score of all these aspects are taken into account, the higher the score the higher the risk for fall. Nurses role in patient safety 1. Assessment and identification of the high risk groups 2. Report adverse events as falls, medication errors, procedural errors and missing patients 3. Identify the type of injury if it is major or minor 4. Inform the physician 5. Incident report in an objective manner with specification of the type of injury and the measures taken 6. Education to the patient and family on the safety measures 7. Education to the health care team members on preventing occurrence 8. Root Cause Analysis (RCA) and Corrective And Preventive Actions(CAPA) 9. Follow safety measures

2. 3. 4.

5. Encourage family members to accompany the patient to the rest room 6. Use of support devices as crutch, cane and walker 7. Use of grab bars in the toilet 8. Encourage and instruct the appropriate use of call bells in case of dizziness 9. Placement of side rails at all times 10. Padded restraints to be used based on the need 11. Keep all the essential items within reach 12. Avoid sharp and injurious articles near the patients 13. Use of safety belts on stretchers, wheel chairs during transfer of patients 14. Safe disposal of sharps 15. Check the working condition of any care related equipment before use 16. Ensure that the patient avoids holding the IV stand, side rails, bedside lockers and movable objects during mobility Patient safety is an important concern for the nurse. It is imperative to ensure the well being of the individual and that he gets relief from his health problems and has a safe stay in the hospital. References 1. Taylor.C. Lillis.C.,Lemone.P.,Lynn.P., Fundamentals of Nursing,6th edition, Vol-1, Volters Kluwer, New Delhi.659-662. 2. psychology.about.com/od/.../a/hierarc hyneeds.htm 3. www.who.int/patient safety

Preventive measures to ensure patient safety: Check the vital signs and ask the patient‟s ability to get up and mobilize before ambulating Use of yellow I.D bands Avoid wet and slippery floors Placement of boards to identify wet floors and that cleaning is in progress 10

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

CASE PRESENTATION - VASCULITIS *Ms. Kripa Angeline.A

condition such as rheumatoid arthritis.The effects might be transient or result in longer-term damage to the vasculature. EPIDEMIOLOGY Vasculitis is rare. Accounting for regional variation, around 3,000 people in the UK develop one of its various forms every year. The incidence for giant cell arteritis (GCA) is higher with around 13,000 people developing this each year. ETIOLOGY Idiopathic (45-55%). Infection (15-20%) - eg, HenochSchönleinpurpura, septic vasculitis, upper respiratory tract flares of Wegener's granulomatosis, polyarteritisnodosa (PAN). Inflammatory disease (15-20%) - eg, systemic lupus erythematosus (SLE), rheumatoid arthritis, Crohn's disease and ulcerative colitis. Drug-induced (10-15%) eg, sulfonamides, beta-lactams, quinolones, non-steroidal antiinflammatory drugs (NSAIDs), oral contraceptives, thiazides, antiinfluenza vaccines. Chemicals such as insecticides and petroleum products. Neoplastic (<5%) - eg, as a result of a paraproteinaemia or lymphoproliferative disorder.

CASE PRESENTATION A 54-year-old female admitted in Mahatma Gandhi Medical College And Hospital, Puducherry on 29-6-13 presented with congestion of both the eyes, myalgia and arthralgia, itching, multiple petechial rashes over the palm and lower limb for one week with bilateral pitting edema , erythema present from mid arm upto hand bilaterally, fever since one week with axillary lymphnode enlargement in the left extremity. Fundus image of both the eye showed mild retinal hemorrhages and vasculitis-like angiopathy.Laboratory investigations revealed an inflammation with elevated erythrocyte sedimentation rate and neutrophil count. Tests for antineutrophil cytoplasmic antibodies (ANCA) were positive. Blood sugar values also were high. And the RFT was normal.Vasculitis with Granulomatosis due to connective tissue disorder was diagnosed and systemic therapy of Inj.predinisolone 250 mg IV and antibiotic Inj. Xone.1 gm IV , bd was initiated. With one week of follow-up, complete resorption of retinal hemorrhages was seen and general complaints as well as visual acuity improved during therapy. VASCULITIS-An over review Vasculitis can be primary (occurring on its own), or secondary as a result of infection, or in association with another

*Assoc . Prof, Kasturba Gandhi Nursing College, SBV, Pondicherry. 11

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CLINICAL PRESENTATION Vasculitis can affect any system, producing a wide range of symptoms. Although unspecific symptoms such as arthralgia and lethargy may be present for some time, frequently the first noticeable sign of a vasculitis will be as a skin lesion and will therefore present as such. History Length of symptoms/signs Recent illness Recent exposure to drugs, vaccines and chemicals Detailed review of all systems Physical Examination In view of the systemic nature of many vasculitic diseases, a complete physical examination should be carried out including CNS and ENT examination. Investigations Investigations should be tailored to the possible cause. For all patients suspected of having a vasculitic lesion consider: TC and differential cell count RFT LFTs Inflammatory markers Urine culture, microscopy Urine dip test for glucose, protein and blood Hepatitis serology (types B and C ) Complement levels Rheumatoid factor Special Investigation Chest X-ray Echocardiogram and blood cultures if there is cardiac murmur present.

Antinuclear antibodies (ANAs) if there is medium-sized vessel involvement and any suggestion of connective tissue disease. Skin biopsy taken during the acute stage. Renal biopsy if abnormal values of RFT is present Differential diagnosis There are several other conditions which may mimic cutaneous vasculitis and these must be considered when arriving at a diagnosis. Some of the more common ones include: Insect bites Trauma Pigmented lesions Purpura (eg, due to low platelet count) Disseminated intravascular coagulopathy Management The treatment will vary considerably according to the underlying cause, the severity of symptoms and their duration. It may include: Avoiding the precipitating factor, such as drugs or chemicals. In general, corticosteroids are administered to control acute symptoms and laboratory evidence of systemic inflammation. After control is achieved, attempts may be made to taper dosing over a month. Options such immunosuppression with cyclophosphamide, azathioprine, methotrexate or tumour necrosis factor blockade may be used.

Pondicherry Journal of Nursing

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Use of plasmaphoresis or intravenous immunoglobulin are options for refractory vasculitis. There is increasing evidence for biological agents in vasculitis. Surgical Management Occasionally, surgery might be indicated. The aims of this depend on the area affected but may be to open up or divert blood flow around an area of blockage, take a sample (biopsy) or to repair an area of organ damage.Example :Stenting of stenotic vessels, which is increasingly used to improve renovascular flow. Nurses Role Follow aseptic precautions in order to prevent infection as the patient is on immunosuppressants. Contantly monitor the ESR values for the disease activity Watch for complications. Provide reassurance to the patient. Teach the patient to avoid exposure to chemicals and other triggering factors

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Complications Complications depend on both the underlying cause and size of vessel and organs affected. They include: Renal insufficiency Digital gangrene Pulmonary haemorrhage CNS infarction Arterial or venous thrombosis Subglottic stenosis

Reference 1. Davidsons, “Principles And Practice Of Medicine”,Churchill livingstone,19 th edition, pp-1040-1047 2. Smeeth L, Cook C, Hall AJ; Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom, 1990-2001. Annal Rheumatoid Dis. 2006 Aug;65(8):1093-8. Epub 2006 Jan 13. 3. Jennette JC, Falk RJ, Bacon PA, et al; 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheumatoid. 2013 Jan;65(1):1-11. doi: 10.1002/art.37715. 4. Fiorentino DF; Cutaneous vasculitis. J Am Academic Dermatology. 2003 Mar;48(3):311-40. 5. Chen KR, Carlson JA; Clinical approach to cutaneous vasculitis. J Clinical Dermatology. 2008;9(2):7192.

Pondicherry Journal of Nursing

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MENKES KINKY SYNDROME *MS. G. Saritha &**Ms. S. Bhavani Introduction

Pathophysiology Copper is a trace metal in many essential enzyme systems, including cytochrome C oxidase, superoxide dismutase, lysyl oxidase, tyrosinase, ascorbic acid oxidase, ceruloplasmin, and dopamine beta hydroxylase. The deficiency or impaired function of these enzyme systems is thought to be responsible for the clinical findings of Menkes disease.

Menkes syndrome is an inborn error of metabolism that markedly decreases the cells' ability to absorb copper. The disorder causes severe cerebral degeneration and arterial changes, resulting in death in infancy. Definition Menkes kinky hair syndrome is a disorder that affects copper levels in the body, leading to copper deficiency [ It is an x-linked recessive disorder, and is therefore considerably more common in males: females require two defective alleles to develop the disease. Other names -Menkes disease (MNK), also called Menkes syndrome, copper transport disease, steely hair disease, kinky hair disease or Menkes kinky hair syndrome Prevalence International Incidence is 1 in 50,000 to 1 in 250,000; one third of cases result from new mutations. Sex It usually affects boys through unaffected carrier women. Age The onset of the classic form is in infancy.

The Menkes gene is located on the long arm of the X chromosome at Xq13.3, and the gene product (ATP7A) . As the result of a mutation in the ATP7A gene, copper is poorly distributed to cells in the body. Copper accumulates in some tissues, such as the small intestine and kidneys, while the brain and other tissues have unusually low levels. The decreased supply of copper can reduce the activity of numerous copper-containing enzymes that are necessary for the structure and function of bone, skin, hair, blood vessels and the nervous system such as lysyl oxidase. In Menkes disease, transport of dietary copper from intestinal cells is impaired, leading to the low serum copper levels. Abnormal copper transport in other cells leads to paradoxical copper accumulation in duodenal cells, kidney, pancreas, skeletal muscle, and placenta.

*Lecturer, ** Assistant Prof, CON, PIMS, Pondicherry. 14

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Thrombosis &Pulmonary artery hypoplasia Skeletal changes Multiple congenital fractures& deformities Bleeding diathesis and renal calculi are also noted. Diagnostic evaluation -Urine homovanillic acid/vanillylmandelic acid ratio has been proposed as a screening tool to support earlier detection. Copper and ceruloplasmin levels The ratio of dihydroxyphenylacetic acid to DHPG is as follows (13 +/- 6.6 for affected infants1.5 +/- .4 for unaffected infants) Ratio of dopamine to norepinephrine is as follows(83 +/- .71 for affected infants .04 +/- .03 for unaffected infants) CT and MRI-White matter dysmyelination, Other white matter lesions, corpus callosum Tortuous blood vessels, Atrophy, Cerebrovascular accidents and Subdural hematomas and effusions Angiography and magnetic resonance angiography- elongated and tortuous vessels, both intracranially and extracranially Proton magnetic resonance spectroscopy- elevated lactate and reduced N -acetyl aspartate (NAA ) Cultured fibroblasts and lymphoblastsThese exhibit impaired copper metabolism, increased copper accumulation, and decreased copper release.

Clinical manifestation: Physical-Loss of developmental milestones, Profound truncal hypotonia, Epilepsy & Failure to thrive Abnormal kinky hair, eyebrows, and eyelashes Four-month-old patient with classic Menkes disease. His hair is depigmented and lusterless with pili torti and the skin is pale with eczema. Short, sparse, coarse, twisted, Shorter and sparser on the sides and back abnormally pigmented; can be white, silver, or gray Abnormal facies -Jowly with sagging cheeks and ears, Depressed nasal bridge, High arched palate & Delayed tooth eruption Progressive cerebral degeneration Loss of developmental milestones,Seizures, Profound truncal hypotonia with appendicular hypertonia &Temperature instability Ocular manifestations -Ptosis, Visual inattention, Optic disc pallor with decreased pupillary responses to light & Iris hypoplasia and hypopigmentation Connective-tissue abnormalities Loose skin at the nape of the neck and over the trunk, Joint hypermobility ,Polypoid masses, which can be multiple. Gastrointestinal tractUmbilical and inguinal hernias, which can be bilateral, Bladder diverticula & Dilated ureters Vascular defects -Arterial rupture, Brachial, lumbar, and iliac artery & Internal jugular vein aneurysms, 15

Pondicherry Journal of Nursing

EEG- - Multifocal and polymorphic slow waves or mixed slow spike-waves and slow waves Medical management Copper chloride and L-histidine solutions of 350-500 µg/d or qod injected intravenously or subcutaneously increase the serum and cerebrospinal fluid copper levels to the normal range after 6 weeks. However, the connective-tissue defects do not respond to parenteral copper histidine treatment. Newborns and fetuses treated in utero with copper histidine can avoid neurologic symptoms. Nursing management Genetics counseling Rehabilitation & psychological support Other treatment is symptomatic and supportive.

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5. 6.

References A.G.M.Campbell” forfar & arneills” text book of paediatrics,5th edition ,Churchill Livingstone publications , page no 1146 Abdelaziz elzouki et al.,” text book of clinical pediatrics ., Lippincott Williams and Wilkins publications., page no 56-57 Mhairi.G.Mac Dodald Et al “Avey‟s Neonatology-Pathology And th Management Of New Born “,6 edition ,Lippincott Williams and Wilkins publications, page no -1677 -1678 Gb Reed et al “Diseases‟ Of The Fetus And Newborn. 2nd edition.,volume-1., chapman and hall medical publishers, page no 765 www.wikipedia.com www.google.com

Pondicherry Journal of Nursing

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THE PSYCHOLOGICAL WELLBEING AMONG ADULTS AND ELDERLY SUBJECTED TO LAUGHTER THERAPY. *Mr.N.Shanavaz. **Dr.R.Shankar Shanmugam, *Mrs.Shakila Shankar & **Mrs.D.Anandhi Introduction: Mental wellness is generally viewed as a positive attribute, such that a person can reach enhanced levels of Mental health, even if they do not have any diagnosable mental health conditions. It is normally considered that „Laughter is the best Medicine‟, specific medical Theories attribute improved health & well-being to laughter. Laughter therapy provides a better sleep & reduces depression and present people with suicidal tendencies and have stated living with none people. Need for the study: Laughter therapy is considered as safe when used as long with conventional medical therapy. This improves as the body heals and causes no lasting. Research results indicate that after exposure to humour, there is a general increase in activity within the immune system, including. 1. An increase in the number and activity level of natural killer cells that attack viral infected and some types of cancer and tumor cells. 2. an increase in activated T cells. Laughter appears to tell the immune system to „turn it up a notch”.

3. An increase in the antibody IgA (Immunoglobulin A) which fights upper respiratory tract infections. 4. An increase in gamma interferon, which tells various components of the immune system to “turn on” Objectives: To assess the level of psychological wellbeing and adults and elderly subjected to laughter therapy at selected humor club. To compare the level of psychological wellbeing among adults and elderly subjected laughter therapy at selected humor clubs. To associate the level of psychological wellbeing with selected demographic variable of adults and elderly at selected humor clubs. Hypothesis: H1 - There is a significant difference in the level of psychological wellbeing among adults and elderly subjected to laughter therapy . H2 - There is a significant difference between Demographic variables and psychological well being among adults and elderly subjected to laughter therapy.

*Staff Nurse, NIRT (ICMR), Chetpet, Chennai ** Nursing Tutor, Chengalpattu Govt Medical College, Chengalpattu. 17

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METHODOLOGY: Research Design: Quantitative research design was adopted for the study. Research approach: Descriptive comparative study approach was used for the study. Setting: Selected laughter clubs in Chennai. Population: People attending laughter clubs Samples: All adults (30-60 yrs) and elderly (above 60 yrs) Sample size: The sample size is 60 in which adults were 30 samples and 30 were Elderly. Sampling technique: The sampling technique used was convenient sampling technique. Tool: The tool consist of 2 sections namely, Section I - Demographic data. Section II – Bhogle and Jaiprakash(1995) psychological wellbeing tool.

Data Collection procedure: Samples were selected as per the criteria of the study. The subjects were assessed and interviewed. Necessary information sought on the instrument was solicited and recorded in the questionnaire. Special care was taken to ensure confidentiality for all involved in the study. Conceptual Framework: Modified Weidenbach‟s Helping Art Theory (1970), Data analysis: The collected data from the samples were calculated and analyzed by descriptive and inferential statistical methods. The descriptive statistical analysis method was used to find out the frequency, percentage, Mean and standard deviation of the score. The inferential statistics includes chi-square test and t-test.

Levels of psychological wellbeing among Adults and elderly. Adults Elderly n=30 n=30 Levels of Psychological wellbeing No. % No % Inadequate Psychological wellbeing (0-40%) Moderately Adequate Psychological wellbeing (41-70%) Adequate Psychological wellbeing (71-100%) Total

3.3

16.7

36.7

83.3

0.0

100.0

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Comparison of Psychological wellbeing between Adults and Elderly: Group

Group

Independent t test & Mean S.D p value. Adults 65.36 58.33 t = 2.210 p=0.001 Elderly 58.33 9.01 (Significant at P<0.05). Major Findings of the study: laughter rooms in the hospital while framing policies& protocols. 1. Among adults, 60% of them has 4. A similar study can be carried on larger adequate Psychological wellbeing and samples for better generalization. 36.7% has moderately adequate Psychological wellbeing. Conclusion: 2. Among Elderly, 83.3% them has As laughter therapy has good moderately adequate Psychological impact over the of level psychological wellbeing and 16.7% has inadequate wellbeing, it needs to be practiced Psychological wellbeing. where the patients and care takers will 3. The comparison of level of have more stress and strain. Necessary Psychological wellbeing between plan of action can be drafted in the adults (65.36) is higher than the mean hospital policy at the earliest to benefit value of the elderly (58.33). This many clients seeking health care. shows the level of Psychological References: wellbeing is significantly increased among adults than the Elderly. It is 1. Bhuvaneswari.S&sangari.R(2009),”La statistically significant (P <0.001). ughter Therapy: The Priceless 4. It is found that Educational status has Medicine, Nightingale Nursing statistical significant with the level of Times:15(1);21-23. the Psychological wellbeing at P < 2. Backman H(2007),” Effect of work 0.005. place laughetr groups on personal Recommendation: efficacy beliefs”, Journal of Primary 1. Care takers of the Psychiatric patients preview: March 70(4);456-76. are under severe stress and strain, they 3. Adams patch (1998),”Bring good all need to undergo Laughter therapy. Health to you, Humor and Joy”, Inner Nurse in the clinical area need to trading International Limited;4(5);45recommend for the needy. 47. 2. Nursing curriculum need to incorporate 4. Chithra P et al (2008),” Nursing therapeutic modalities like laughter intervention in Laughter therapy”, therapy which will in turn benefit the Nightingale Nursing Times,4(8);28-30. patients and their care takers 5. www.laughteryoga.com 3. Nursing administrators should take 6. www.allmedicinezone.com. steps to include the laughter clubs, 19

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RELATIONSHIP BETWEEN CAREGIVER BURDEN AND COPING STRATEGIES AMONG CAREGIVERS OF PATIENTS WITH MOOD DISORDERS *Ms. Monisha Mohan, **Prof. Sreedevi P.A & ***Ms. Febu Elizabeth Joy

depressive not caused by any other physical or mental disorder. While taking care of mentally ill-patient caregivers are facing overburden ,stress ,anxiety and depression 3. The perceived distress can be seen as an outcome of the coping process of the caregiver when they experience consequences due to their relative‟s disease 4 Methodology The research approach was quantitative and design used was descriptive. The study was done on primary caregivers of 100 patients with mood disorders who were selected by convenience sampling. The setting of the present study is Amrita Institute of Medical Science, Kochi. Data was collected using two standardized tool Zarit Burden Scale developed by Steven Zarit in 1980 and Ways of Coping Checklist by Lazarus and Folkman in 1985. The collected data were analyzed using descriptive and inferential statistics. Descriptive Statistics was to summarize the collected information. Caregiver burden and coping was assessed using frequency and percentage. Relationship between care giver burden and coping strategies was assessed using Karl Pearson correlation coefficient.

Objectives The objectives of the study are to, determine the subjective burden of care givers of patients with mood disorders. identify the coping strategies used by the caregivers of patients with mood disorders correlate between burden and coping strategies among care givers of patients with mood disorders find the association between subjective burden of caregivers and selected demographic variables of caregivers and clinical variables of patients find the association between coping strategies of caregivers and selected demographic variables of caregivers and clinical variables of patients Introduction Mental illness is disturbance of cognition (thought) or conation (action) or affects (feeling) or any disequilibrium between these three domains.1 Severe and persistent mental illness, or SPMI, is the term mental Health professionals use to describe mental illnesses with complex symptoms that require ongoing treatment and management, most often varying types and dosages of medication and therapy.2 Mood disorders are group of mental disorders involving a disturbance of mood, may be manic or

*II year M.Sc (N), **Professor, ***Lecturer, Amrita college of Nursing, Kochi, Kerala. sreedevipa@aims.amrita.edu 20

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Association between perceived burden and coping strategies of caregivers and selected demographic variables and clinical variables of patients was found using Chi square test. Findings Of the 100 caregivers 52% of care givers had moderate to severe burden, 33% had severe burden and 15% had mild burden. The most frequently used coping strategies by the caregivers were accepting responsibility (36% of the subjects), planful problem solving (28% of the subjects) and seeking social support by (15% of subjects). A highly significant negative correlation was found between subjective burden and selected coping strategies of caregivers like accepting responsibility (r=-0.61, p<0. 01), planful problem solving (r=-0.745, p<0.01), seeking social support (r=0.83, p<0.01) and positive reappraisal (r=-0. 839, p<0.01). There was statistically significant association between caregiver burden an demographic variables of caregivers like gender. ( 2 =8. 44,df=2,p<0. 05). Statistically significant association was found between caregiver burden and clinical variables of patients like diagnosis of patient, duration of illness, number of illness episodes, number and compliance to treatment. There was statistically significant association between frequently used

coping strategies and caregivers relationship with the patient 2=11. 02, df=4,p<0. 05 No statistically significant association was found between frequently used coping strategies and clinical variables of patients. Conclusion The findings of the present study show that even though the most the caregivers were frequently using healthy coping strategy, majority of the caregivers had moderate burden. It concludes that caregivers should be made aware about the home care management of the clients with mood disorders and various services available to them. References 1. Ahuja N. A Short Text Book of Psychiatry, 6thed.New Delhi: Jaypee Publications; 2008.74-76 2. Definition of severe mental illness.[online].September2010;Availa ble from URL:http:// www.unccmh.org 3. Definition of mood disorders.[online].December2011;Ava ilable from URL:http:// www. Gale Encyclopedia of Medicine.org 4. Chakrabati S & Gill S Coping and Its Correlates Among Caregivers Of Patients With Bipolar Disorder: A Preliminary Study. Bipolar Disorder. 2002February; 4 (1): 50-60

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“EVALUATE THE EFFECTIVENESS OF STRUCTURED COUNSELING PROGRAMME ON THE QUALITY OF LIFE AMONG HIV POSITIVE PATIENTS IN PUDHUCHERRY” *Ms. Renuka. K & **Dr. Indrani Dasarathan INTRODUCTION: Until quite recently, there was a wide spread feeling that the struggle against infection diseases was almost won. The means of controlling most of them seemed either available or discoverable without undue difficulty. But tragically a false sense of security, which came with optimism, has helped many diseases to spread with alarming rapidity. In the past 20 years, more than 30 new and highly infectious diseases have been identified. HIV / AIDS is one of those, which spread throughout the country in a very ferocious way. AIDS is the fifth leading cause of death among persons between ages 25 to 44 in the United States of America. World Health Organization (WHO) has defined Quality Of Life (QOL) as “Individual‟s perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, standards, expectations and concerns”. With the recent advances in clinical tests and treatments for those suffering from HIV/AIDS, the survival has been increased and their QOL has become an important focus for researchers and health care providers.

NEED FOR THE STUDY: UNAIDS report on the global AIDS epidemic 2013 has denoted that more than 35 million people live with HIV/AIDS. Worldwide 1.6 million people died from AIDS. An estimated 2.3 million people were newly infected with HIV. PACS report (2012) states that about 2155 people are living with HIV/AIDS in Pudhucherry. To start with, counseling should be a fundamental right of the client in health care system. However, it is very necessary for health practitioners to build scheduled counseling sessions into care regimens for all the clients. There is an urgent need to expand the scope of counseling to reach many more people affected by HIV/AIDS and also other terminal diseases. Acknowledging the HIV/AIDS epidemic worldwide& the statistics of Puducherry; understanding the importance of counseling in improving the quality of life of HIV; reducing HIV related morbidity and mortality with idea of restoration and preservation of immunologic functions of HIV positive patients, Researcher took up an experimental study in 2007 entitled

*Vice-principal, Kasturba Gandhi Nursing College, ** Chennai. renukagugan@yahoo.co.in 22

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“Evaluate the Effectiveness of Structured Counseling Programme on the Quality Of Life among HIV Positive Patients in Pudhucherry”. Here the results of the Pilot Study has been put forth for dissemination.

Retroviral Therapy (ART) at ART center, Govt. General Hospital, Pudhucherry. Sample & Size - 60 HIV positive patients receiving ART at ART center, Govt. General Hospital, Pudhucherry. (30 samples in experimental group & 30 samples in control group) Sampling Technique -Cluster Sampling Technique. DATA COLLECTION PROCEDURE: The purpose of the study was explained and the written consent was obtained from the subjects. During the data collection period, 30 samples who satisfied the inclusive criteria on Mondays, Wednesdays and Fridays were selected as samples in Experimental group and 30 samples who presented on Tuesdays, Thursdays and Saturdays were selected as samples in Control group using Cluster Sampling Technique. The demographic and clinical variable were collected; staging was assessed; their CD4 count was determined using Flow Cytometer Technique, QOL was evaluated using WHOQOLBREF Scale during their first visit as pretest through interview technique. Followed by that, counseling was provided only to the samples in experimental group along with their regular treatment (ART). At one month intervals, totally 3 counseling sessions were held to the individuals. Samples in control group were only on regular treatment i.e., ART, no counseling was given to them. During 6th month after first counseling,

OBJECTIVES: To assess the quality of life of HIV positive patients in Experimental & Control group during pretest and posttest. To identify the staging of HIV positive patients in Experimental & Control group in terms of CD4 count during pretest and posttest. To evaluate the effectiveness of structured counseling programme on the quality of life among HIV positive patients in Experimental group during posttest. To evaluate the effectiveness of structured counseling programme on the staging in terms of CD4 count of HIV positive patients in Experimental group during posttest. To correlate between staging and quality of life of HIV patients in Experimental and Control group. To find out the association between quality of life and demographic variables of HIV positive patients. To find out the association between quality of life of HIV patients and their clinical variables. METHODOLOGY Research Design - Experimental Design Population & Setting HIV positive patients receiving Anti23

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CD4 count and QOL were evaluated as posttest using the same tool.

During posttest out of 30 samples in experimental group, 12 (40%) were in Stage1 having more than 500 cell/m3 CD4 count, 10 (33%) were in Stage2, 8 (27%) were in Stage3 and none were in Stage4. In control group, 12 (40%) were in Stage1, 3 (10%) were in Stage2, 10 (33%) were in Stage3 and 5 (17%) were in Stage4. Mean quality of life of HIV positive patients in experimental group was 114.6 with SD of 19.01 and in control group was 120.16 with SD of 31.58 in pretest. Mean CD4 count of HIV positive patients in experimental group was 380.1with SD of 158.2 and in control group was 537.5 with SD of 303 in pretest. Mean QOL of HIV positive patients in experimental group was 146.6 with SD of 19.2 and in control group was 126.9 with SD of 28.8 in posttest. Mean CD4 of HIV positive patients in experimental group was 462.3 with SD of 187.03 and in control group was 456.7 with SD of 262.2 in posttest. P value of QOL in comparison with pretest & posttest was 0.000 indicating that the structured counseling programme was highly significant at P < 0.001 in improving the QOL and CD4 count of HIV positive patients. There was a positive correlations between QOL and CD4 count value. Chi-square was 22.732 and its P value was 0.001 showing the significance at P < 0.01 interpreting that as CD4 increases, QOL of HIV infected patients also improve.

MAJOR FINDINGS: The data reveals that out of 60 samples, 28 (47%) were male and 32 (53.3%) were female. Majority 47 (78.3%) of HIV cases were in the age group between 30-50 years. Majority 57 (95%) of HIV patients were in low income group. The data analysis reveal that out of 60 samples, 17 (28%) samples were having HIV infection for 3 years and 18 (30%) samples were having more than 6 years. Majority 55 (91.7%) samples revealed that the cause through which they acquired HIV infection was unsafe sexual contacts. During pretest, out of 30 samples in experimental group, 5 (17%) were in Stage1. 12 (40%) were in Stage2 within the range of 350-500 cells/m3 CD4 count, 7 (23%) were in Stage3 and 6 (20%) were in Stage4 withCD4 count< 200 cells/m3. Out of 30 samples in control group, 15 (50%) were in Stage1 with more than 500 cells/m3, 7 (23%) were in Stage2 with 350-500 cell/m3, 5 (17%) were in Stage3 and 3 (10%) were in Stage4 having less than 200 cells/m3. During pretest, out of 30 samples in experimental group, 18 (60%) had poor QOL, 12 (40%) had average QOL. In control group, 17 (57%) had poor QOL and 8 (27%) had average QOL and 5 (17%) had good QOL.

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There was a significant association between QOL and number of children of HIV patients with P value of 0.016 at P < 0.05.

There was a significant association between QOL, self-perceived health status and presence of opportunistic infection at P < 0.05

Table 1: Mean & SD of QOL among HIV positive patients in Experimental & Control Group during Pre & Post Test Experimental Control QOL Mean SD t-test p-value Mean SD t-test p-value Pre-test 114.6000 19.0183 120.1667 31.5847 7.6137 0.0000 0.8686 0.3922 Post-test 146.6000 19.2131 126.9000 28.8544

Table 2: Mean & SD of CD4 count among HIV positive patients in Experimental & Control Group during Pre & Post Test Experimental CD4 Pre-test Post-test

Mean (cells/m3)

t-test

380.1000 158.2633 1.8734 462.3333 187.0300

Control Mean p-value (cells/m3) 0.0711

CONCLUSION: The pilot study results imply that structured counseling programme was very much effective on the Quality of Life of HIV positive patients. The CD4 count of HIV positive patients has also changed positively improving the quality of life through structured counseling programme that every health care professionals who care for HIV positive people could give for their qualitative life along with their regular Anti-Retroviral Therapy.

t-test

537.5667 303.2836 1.1149 456.7333 262.2572

pvalu e 0.27 41

REFERENCES: 1. Park J.E (2005) “Text book of preventive and social medicine”, 18thEdn. Jabalpur: BanarsidasBhanot. 2. Polit, F.D., and Hungler, P.B., (1999) „Nursing Research Principles and Methods”. 6thEdn., New York: Lipincott. J.B. 3. Usha K. Baveja. Etal (2004) “Diagnosis and Managementof HIV/AIDS – A clinicians perspective”, New Delhi: B.I. Publication, Pr. No:5 4. WHO (2000). “AIDS – No time for complacency”, Regional publication SEARO – No:26, Hyderabad, Pg.No:3. 25

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EFFECTIVENESS OF NURSING INTERVENTIONS ON QUALITY OF LIFE AMONG PATIENT‟S WITH DIABETIC FOOT ULCER *Ms. S. Chandrakala, **Dr. Karaline Rajkumar & ***Dr. Felix The findings of the study will be used to INTRODUCTION: Diabetes Mellitus is a chronic further developments of the nurse‟s role disease that requires life long medical in the management of patients with treatment and life style adjustment. diabetic foot ulcers. Management of diabetes mellitus life OBJECTIVES: long is challenging and daunting for 1. To assess the quality of life of subjects people who have managed their disease with diabetic foot ulcer before providing alone or with family members for more nursing interventions and drugs in all than 95% of their life span. four groups. (www.health.com) 2. To find out the effectiveness of nursing India had the highest number of interventions with drugs in terms of diabetic in the world in 2009. Diabetic improvement in quality of life of subjects foot care is one of the most ignored with diabetic foot ulcer in all four aspects of diabetes care in India groups. NEED FOR THE STUDY: METHODOLOGY: India is a land with unique culture Research Design: and tradition. It is also a developing Factorial design with 2 nation with lot of binding practices of interventional comparison designs. In culture and tradition. The quality of life this study four experiment groups were (QOL) for an average Indian is just used. The first group received Platelet survival for today with no relevance to Derived Growth Factor (PDGF) and the future. Quality of life is threatened nursing interventions, experimental when all the dimensions of health care group – II was treated with only PDGF. are in turmoil (Iynna, 2007). No nursing interventions was provided. The rise in the prevalence of Experimental group-III received diabetes mellitus and the negative Povidone Iodine (Betadine) and nursing consequences it has on the individual and interventions. Where as experimental community served as an impetus for the group-IV was treated with Povidone researcher to undertake the study on the Iodine and no nursing interventions was “Effectiveness of nursing interventions provided to this group. Nursing on Quality of Life (QOL) among patients interventions used in this study was with Diabetic Foot Ulcer (DFU)”. *Vice Principal, Sacred Heart Nursing College, Ultra Trust, Madurai, **Professor, RMCON, ***Statistician, Annamalai University, Chidambaram, ckala2004@yahoo.com 26

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diabetic counseling on self care management which was provided in four sittings on diabetics diet, exercise, adherence to prescribed medications, foot care and the care of foot ulcer. Pre test was done on first day. Post test was done on 28th day. POPULATION: Patients with diabetic foot ulcer in and around Madurai attending selected hospitals. SAMPLE SIZE: 200 patients with diabetic foot ulcer, out of which 50 subjects were assigned to experimental group-I, 50 subjects were assigned to experimental group II, III and IV respectively. SAMPLING TECHNIQUE: Cluster randomization technique. INSTRUMENT: The instrument consists of two parts. Section I: Demographic data, information about the patients disease condition, and personal habits of the subjects. Section II: Modified world health organization quality of life brief questionnaire. (WHO QOL BREF). DATA ANALYSIS: Mean and standard-deviation ANOVA AND ANCOVA (Analysis of Covariance) Test. RESULTS AND DISCUSSION: The mean general quality of life in pre test among of four groups was 1.26, 1.20, 1.26, 1.46 with the „F‟ value

of 2.769 (P=0.043) in group I, II, III and IV respectively. With regard to mean physical domain of subjects with diabetic foot ulcer in all four groups were found to be 9.56, 11.82, 9.64, and 13.24 in all four groups (F=42.115, P=0.0). Regarding the mean psychological domain of subjects with diabetic foot ulcer was found to be 9.26, 10.54, 8.82 and 11.80 in group I, II, III and IV with F-value of 40.165, (P=0.0). The mean social domain of subjects with diabetic foot ulcer was found to be 6.60, 6.88, 6.32 and 6.50 respectively with F value of 1.180 (P=0.318). Regarding the mean environmental domains of all four groups were 18.36, 20.50, 18.34 and 20.74 with „F‟ value of 41.402 (P=0.0). The mean over all total quality of life of subjects with diabetic foot ulcer in all four groups found to be 45.04, 50.94, 44.38 and 53.74 with „F‟ value of 72.536 (P=0.0). The significant „P‟ value for all the domains were statistically different among the four groups before intervention. This indicated that the need for all the domains has to be included as „co-variate‟ for further analysis of comparisons between the four groups after the corresponding intervention The mean post test quality of life of all the domains were found to be higher among the group who had nursing interventions and PDGF application over the diabetic foot ulcer. The ANCOVA results of total quality of 27

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life score on 28th day after controlling the initial effect of pre test score of quality

of life was found to be F=7847.65 and P = 0.000 for “counseling effect”.

Figure – 1 Diagram Showing the Mean and Standard Deviation of Total Quality of Life Score on 28th Day by Drug and Nursing Interventions Effect 100 87.52

86.24

Mean Total Quality of Life

90 80 70 60

54.64

52.18

50 40 30 20 10 0 PDGF With Counselling

PDGF Without Counselling

Betadine With Counselling

Betadine Without Counselling

Total Quality of Life Score on 28th Day PDGF With Counselling

PDGF Without Counselling

The ANCOVA results of other domains were also found to be significant for “counseling effect”. General quality of life (F = 1358, P=0.000) physical domains (F=4845.056, P=0.000) psychological domain (F=1716.581, P=0.00). Social domain (F=916.18, P=0.000), environment domain (F=2158.39, P=0.000). So it can be inferred that the nursing interventions were effective in improving the total quality of life of the subjects with diabetic foot ulcer. CONCLUSION: The present study results imply that nursing intervention (diabetic counseling on self care management)

Betadine With Counselling

Betadine Without Counselling

along with drugs is effective in improving quality of life of subjects with diabetic foot ulcer. Hence it can be recommended that “Diabetic Nurse Specialist” role can be emphasized in India to have Patient Centered Approach (PCP). REFERENCES: 1. Shankhdhar K, and Shankhdhar S, (2011), Diabetic foot problems in India: an overview and potential simple approaches in a developing country, JAMA, 273 (7) 721-23. 2. Lynna (2007), Diabetes in the world, Asian Journal of Diabetology, 12 (5): 32-35. 3. http://www.health.com 28

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EFFECT OF LAUGHTER THERAPY ON DEPRESSION OF SENIOR CITIZENS RESIDING IN SELECTED OLD AGE HOMES *Mr. Akhilkumar A, **Prof. Sreedevi PA & ***Ms. Sreejamol M G. “Laughter is the most effective wonder drug”. –Bertrand Russell treatments, guided imagery, dietary supplements, hypnosis, massage therapy, meditation, relaxation and yoga. There is growing empirical literature on the effectiveness of laughter therapy on depression of elderly2.

INTRODUCTION Aging is an inevitable process and many factors like genes, lifestyles, diet and environment determine longevity. As humans grow older, physical conditions decline which lead to many illnesses and ailments. Some of the common health problems and ailments that generally affect senior citizens are blood pressure, cardiac problems, diabetes, joint pains, kidney infections, cancer, tuberculosis etc. Four to five million persons (about 2% of all ages and 15% of those over age 65) are estimated to have cognitive disorders, such as delirium or dementia. Depression constitutes the most common emotional disorder found in older people. Estimates of the prevalence of major depressive disorder in the elderly range from 2% to 10% of those 65 and older1. Depression can be treated by administering antidepressants, electro convulsive therapy, Transcranial magnetic stimulation, cognitive behavioural and interpersonal therapies, life style modifications and alternative therapies. The alternative therapies encompasses a variety of approaches which includes acupuncture, aromatherapy, laughter therapy, biofeedback, chiropractic

OBJECTIVES OF THE STUDY The objectives of the study were to 1. compare the mean pre test depression scores of senior citizens between the experimental and control group. 2. compare the mean pretest and post test depression scores of senior citizens in the experimental group 3. compare the mean pretest and post test depression scores of senior citizens in the control group 4. compare the mean post test depression scores of senior citizens between the experimental and control group. 5. find out the association between level of depression and selected socio demographic variables of senior citizens in the experimental and control groups. METHODOLOGY Research approach was quantitative and the design used was

*II Year MSc Nursing, ** Professor, ***Asst.Professor Amrita College of Nursing, AIMS, Kochi, Kerala. sreedevipa@aims.amrita.edu 29

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pre test - post test experimental design. The study was conducted in two old age homes. The participant for the experimental group was selected from Home for the aged and infirm, chunanganvelil, Aluva and Old age home, Aluva .The two old age homes were allocated to experimental and control setting by simple random (lottery) method. Yesavage Geriatric Depression Scale (1983) was administered to the inmates of both the setting to identify the client with depression and separate sampling frames were made. Using systematic randomization method, 30 subjects were selected from the experimental setting and 30 from control setting. Laughter therapy was administered for experimental group 30-45 minutes daily for 10 consecutive days. Post test was conducted using the Yesavage Geriatric Depression Scale sale on the 15th day of the therapy. Findings

in terms of mean pre test depression score. The mean post test depression score of experimental group was 13.9 with a standard deviation of 4.4 and that of control group was 17.6 with a standard deviation of 5.3 (table 3). While comparing the mean post test depression scores of experimental and control group by independent t test the obtained t value was 2.95 which is greater than table value 2.66 at p<0.01, rejecting the null hypotheses . So there is statistically significant reduction in post test depression scores of experimental group. The mean pre test depression score of control group was 16.9 with a standard deviation of 5.3 and the mean post test depression score of control group was 17.6 with a standard deviation of 5.3(table 4). The comparison of the mean pre test and post test depression score by paired t test showed the calculated t value as 3.34 which is less than table value 3.64 , hence the null hypotheses is accepted that is there is no significant difference between pre test and post test depression score of the control group as the control group did not undergo laughter therapy , no change occurred in depression score .

The mean pre test depression score of experimental group was 16.9 with a standard deviation of 4.0 and that of control group was 16.9 with a standard deviation of 5.3 (table 2).while comparing the mean pre test depression scores of experimental and control group by independent t test the obtained t value was 0.63 which is less than table value 1.67, that is no statistically significant difference between depression scores of experimental and control group. This means the two groups are homogenous

Statistically significant association was observed between level of depression and religion, marital status, type of family, socio economic status, and number of children. There is no statistically 30

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significant association between level of depression and variables like gender, length of stay, family members visit and presence of any diseases

with other stress management technique laughter therapy also should be practiced in old age homes and other public settings in order to keep the elderly away from depression.

Conclusion The ageing process is a biological reality which has its own dynamic, largely beyond human control .Old age should be regarded as a normal, inevitable, biological phenomenon. Laughter promotes many physiological changes; most notably, it stabilizes blood pressure, massages inner organs, stimulates circulation, facilitates digestion, increases oxygen supply to muscles, decreases muscle tension and promotes an overall sense of wellbeing. Laughter is a wonderful stress reducer and antidote to upsets.The present study on the Effect of laughter therapy on depression of senior citizens residing in selected old age homes at Ernakulam was a successful venture by the investigator .The results proved that there is significant reduction in the mean post test depression score of experimental group ,hence the laughter therapy was an effective treatment for reducing depression. It concludes that along

REFERENCES 1. Ageing - Exploding the myths. Ageing and Health Programme. Geneva:WorldHealthOrganization.[onli ne]January201;Availablefrom:http://w ww.who.int/agei-g/publications 2. BarryWR,RobinJC, MarkT.H,Benjami nE,WilliamST.Preventing Depression in Age-Related Macular Degeneration. Arch Gen Psychiatry. 2007; 64(8):886892 3. Lehman L, Kelley J H. Prevalence of depression factors associated with depression among institutionalized elders incolumbo district. Available from http://www.ncbi.nlm.hih.gov/pubmed 4. Walter M, Hänni B, Haug M, Amrhein I, Krebs-Roubicek E, Müller-Spahn F, Savaskan E. Int J Geriatr Psychiatry. In Humour therapy in patients with latelife depression or Alzheimer's disease.2004; Jan;22(1):77-83.

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YOGA PIVOTAL IN FIGHTING TYPE-2 DIABETES MELLITUS *Mrs. S. Shanthi & **Dr. Karaline Rajkumar Introduction Diabetes is now emerging as the king of all diseases for the reasons, i.e. to multi system involvement, complex metabolic abnormalities and varied clinical presentations. Diabetes causes substantial morbidity and mortality primarily through cardio vascular, eye, kidney diseases and limb amputation. More than 80% of persons with diabetes will be found in the developing countries by the year 2025. India, China and United States of America are the “top three” countries having the highest number of diabetes in the year 2025. India has a dubious distinction of being the country with highest population of diabetics.1 Type-2 diabetes is a disorder in which glucose accumulates in the blood, increasing the need for insulin. The pancreas gradually loses its ability to regulate glucose, causing cells to starve while excess glucose disrupts metabolic homeostasis. Patients must control their blood glucose levels with medication, diet, yoga and exercise.2 To manage overweight or obesity, one has to reduce the mental stress and has to practice sufficient physical activities. The practice of yoga can regulate all the body functions in a balanced manner and helpful in providing sustainable health.3 Statement of the problem A study to assess the effectiveness of yoga on body mass

index with type -2 diabetes mellitus in a selected hospital at Chidambaram. Objectives  To assess the body mass index (BMI) of diabetic patients before and after the yoga training programme  To identify the effectiveness of yoga training programme by comparing the pretest and the post test scores of the control and experimental groups. Methodology A true experimental design was used for this study. Systematic random sampling technique was used to select 60 subjects including 30 for experimental group and 30 for control group at RMMCH, Chidambaram. The pretest was conducted for both the groups to assess the demographic data. The height and weight were checked for each subjects for assessing the Body Mass Index ( BMI). 1ml blood was collected to assess the Ac (fasting) and Pc (postprandial) blood sugar level. After the pretest, yoga training was given for one hour per day for 5 days in a week which continued for a period of 6 months. The posttest level of BMI, and blood sugar level was assessed on 3rd and 6th months. The collected data were analyzed by using ANOVA 2×3 tests with last variable as repeated measure to compare the effectiveness of the intervention.

*Lecturer, **Professor, RMCON, Anamalai University, Chindambram. 32

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Mean and SD of Body Mass Index of the control group and experimental group BMI

Post – test I (3rd Month)

Post Test –II (6th Month)

Mean SD

Mean

Mean SD

30.43

30.70

4.05

30.75

Pre –test Group

Control Group N=10

3.98

4.05

ANOVA 2x3® with last variable as Repeated measure „F‟ Value „P‟ Value Group 0.002 =13.43 BMI=20.32

Experimental Group N=10

30.07

3.80

25.46

1.94

®ANOVA for the logarithmic value Results and Finding The mean BMI level before the intervention of yoga was found to be 30.43 and 30.07 for the control and experimental group respectively. Three months after the intervention, there was a significant reduction of BMI, Ac and Pc level in the experimental group. However, there was a significant increase in the BMI level in the control group. At the end of the 6th month there was a significant reduction from the 3rd month in the experimental group, whereas in the control group the average BMI level has increased. In the ANOVA 2 ×3 tests the last variable as repeated measure was applied to compare the effectiveness of yoga in reducing the BMI, Ac and Pc level. The significant effect between the two groups and BMI level indicates that in the experimental group there was a significant reduction in the BMI, Ac and Pc level after practicing yoga in the

24.89

1.82

<0.001 BMI &Group =62.52

3rd and 6th month when compared to the control group. Discussion The findings of the present study regarding the comparison of the reduction of BMI, Ac, Pc level between both the groups showed a statistically significant (P<0.001) difference in reduction of BMI, Ac and Pc level in the experimental group as compared to the control group Conclusion Therefore, it is concluded that the patients with type-2 diabetes mellitus who received yoga training such as Uttanapadasana, Pavanamukthasana, Bhujangasana, shalabhasana, Tolasana, Dhanurasana, Makarasana,Ustrasana, etc. along with pranayama showed reduction in the body weight, might be due to reduction in the deposited fat on adipose tissue.3 Hence, it is evident that the patients who received yoga training 33

<0.001

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significantly decreased body weight, Ac and Pc level of the subjects with type-2 diabetes mellitus. Recommendation  A similar study may be replicated in a large sample and the findings can be generalized for a large population.  A study would be conducted by including more number of variables with or without control. Reference 1. Codario R.A (2008) “type-2 Diabetes, Pre-diabetes, and the metabolic syndrome” The primary care guide to

diagnosis and management,Totowa, NJ.Humana. 2. American diabetes association (2005) National diabetes fact sheet, 2005 Retrieved November 27, 2005, from http;//diabrtes org/vedocuments/National diabetes Fact sheet.lev.pd/ 3. uchetha kumari N, et al. (2011) “ Effect of yoga therapy on body mass index and oxidative status” Nitte University Journal of Health Science,voi:1,No 1-3 September.

ANSWERS FOR MULTIPLE CHOICE QUESTIONS 1. Trophoblast 2. 500-600 ml/min 3. 60 mm hg, 10 mm hg 4. Major vestibular gland 5. Bitemporal 6. Polyhydromnios/ multiple gestation 7. Hyalouronidase 8. Suboccipito bregmatic (9.5cm) 9. Partogram 10. Cervical changes ANSWERS FOR JUMBLED LETTERS

1. 2. 3. 4. 5.

BRAXTONHICKS QUICKENING BLASTOMERE ENDOMETRIUM MENTOVERTICAL

6. DENOMINATOR 7. TROPHOBLAST 8. SUBOCCIPUTO BREGMATIC 9. PROGESTERON 10. PRESENTING PART

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

PARENTAL SELF-EFFICACY AMONG PARENTS OF CHILDREN WITH INTELLECTUAL DISABILITY *Ms. Liya Louis, **Prof. Sreedevi.P.A & *** Rajeesh R Nair. Parental self-efficacy was found to be low for the subjects in almost all components of the parental selfefficacy scale. Eighty five percent of subjects had low self-efficacy in managing age appropriate activities and situation specific tasks of their children. Low self-efficacy was found for parents in learning and knowledge(83%) ,implementing discipline and setting boundaries (81%) ,self acceptance (72%),self control (69%) and managing pressures /demands (65%).High parental selfefficacy was found in 72% of parents ,only in one component out of 10 components of parental self-efficacy, that is, emotion and affection. Statistically significant association was found between parental self-efficacy and sociodemographic variables like occupation of parent ( 2(4)=13.427, p<0.01) and attended training 2 programme( (2) =34.329, p<0.001). Significant association was found between parental self efficacy and child variable like Gender ( 2 (6) =14.373, p<0.05),IQ level ( 2 (2)=13.270, p=0.001),Co-morbid diagnosis( 2 (2)=28.440 ,p<0.001), and behavioral problems(16.032,p<0.001).The study concluded that parental self efficacy is low in parents of children with intellectual disability.

ABSTRACT Intellectual disability is a permanent condition unlike many other diseases. It is a highly prevalent and highly disabling condition. Caring for a child with a disability brings multiple challenges to parents. A Study to assess parental self-efficacy among parents of children with intellectual disability in a selected special, Thrissur was conducted with the Objectives: 1)determine parental self-efficacy among parents of children with intellectual disability, 2) find out the association between parental selfefficacy and selected demographic variables of subjects and 3) find the association between parental selfefficacy and clinical variable of the intellectually disabled children. Methodology: The approach was quantitative research and descriptive design was used for the study. The sample was parents who are the primary caregivers of 100 children with intellectual disability who were selected by simple random sampling method. The socio demographic data and parental self-efficacy scale were administered by self report method. Major findings : Among 100 sample, 78% of the subjects have low parental self-efficacy, 15% have moderate parental self-efficacy and only 7% have high parental self-efficacy.

*II Year MSc Nursing, ** Professor, ***Lecturer Amrita College of Nursing, AIMS, Kochi, Kerala. sreedevipa@aims.amrita.edu 35

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It shows the need for training programme for the parents regarding various aspects of care of intellectually disabled children inorder to improve their parental self efficacy. OBJECTIVES The objectives of the study were to, 1. determine the parental self efficacy among parents of children with intellectual disability 2. find out the association between parental self efficacy and selected demographic variables of subjects 3. find the association between parental self efficacy and clinical variable of the intellectually disabled child

level of satisfaction from raising children, parents need to feel as though they are efficacious in this role.2 METHODOLOGY The research approach was quantitative and design used was descriptive. The study was done on 100 parents of children with intellectual disability who were selected by simple random sampling method. The setting is Pope Paul Mercy home, Thrissur. Data was collected using parental self efficacy scale developed by the researcher. The cololected data were analyzed using descriptive and inferential statistics. Descriptive statistics was to summarize the collected information. Parental self efficacy was assessed using frequency and percentage. Association between parental self efficacy and selected demogreaphic variables of subjects and clinical variables of children was found using Chi square test.

INTRODUCTION

Parental self-efficacy has a direct impact on the behaviours parents‟ exhibit when they engage with their children as well as on the level of satisfaction parents experience from caring for their children. In order to feel successful and receive an adequate Parental self-efficacy among subjects

Percentage

100 80 60 40

20 15

MODERATE

HIGH

0 LOW

Parental self efficacy

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Vol 6, Issue3, August’13 – November’13

Findings

and behavioral problems( p<0. 001) of the children.

Of the 100 subjects,78% of the subjects have low parental selfefficacy, 15% have moderate parental self-efficacy and only 7% have high parental self-efficacy.

(2)=16.032,

CONCLUSION Intellectual disability is an extremely stigmatizing condition. Parenting a normal child and a child with intellectual impairment are very different and the later puts a lot of effort and strain on the parents. Bandura‟ s efficacy theory suggests that a parent‟ s sense of self-efficacy will enhance a child‟ s sense of selfefficacy and other positive future outcomes by creating a sense of being in control of his or her future.

Parental self-efficacy was found to be low for the subjects in almost all components of the parental selfefficacy scale. Eighty five percent of subjects had low self-efficacy in managing age appropriate activities and situation specific tasks of their children. Low self-efficacy was found for parents in learning and knowledge(83%) ,implementing discipline and setting boundaries (81%) ,self acceptance (72%),self control (69%) and managing pressures /demands (65%).High parental selfefficacy was found in 72% of parents ,only in one component out of 10 components of parental self-efficacy, that is, emotion and affection.

REFERENCES 1. Wicks-Nelson R, Israel AC. Behaviour disorders of childhood. Community Mental Health J. 1997 Nov; 4(2):32-36 2. Hess C R, Teti, D M & HusseyGardner B. Self-efficacy and parenting of high-risk infants: The moderating role of parent knowledge of infant development. Applied Developmental Psychology, 2004 Sep, 25: 423-424. 3. Gilmore, Linda Cuskelly, Monica. Parenting satisfaction and selfefficacy: A longitudinal study of mothers of children with intellectual disability, Journal of Family Studies, 2012 Jun. 18(1): 28-35. 4. Gallagher, Stephen Phillips, Anna C. Oliver, Christopher Carroll, Douglas ; Predictors of psychological morbidity in parents of children with intellectual disabilities. Journal of Pediatric Psychology, Nov-Dec 2008, 33(10):112

There was statistically significant association between parental selfefficacy and socio demographic variables like occupation of parents ( 2(4) =13.427, P<0.01) and attended training programme 2 ( (2)=34.329,P<0.001). Statistically significant association was found between parental self-efficacy and children‟s clinical variable like Gender ( 2(6)=14.373, p<0. 05), IQ level ( 2 p<0.001), Co-morbid (2)=13.270, 2 diagnosis( (2)=28. 440, p<0. 001),

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

EFFECTIVENESS OF ORAL HYGIENE PROGRAMME ON KNOWLEDGE AND ORAL HYGIENE AMONG LOWER PRIMARY SCHOOL CHILDREN *Prof. Chitra .P, **Mr. Sajith.S

diseases, intestinal of skin, eye and ear, dental caries as major areas of concern. Oral health is the key preventable solution for dental and periodontal diseases, in turn forms very important component of general health. The high prevalence of dental disease, like dental caries, periodontal disease, various forms malocclusion and lack of access to the required services leads to the significant absenteeism and economic loss, apart from the ill effects on the health of the person affected. In view the adverse effects of the poor oral, it is important to take preventive measures and create the required services.3 RESEARCH METHODOLOGY A Quantitative research approach and Pre experimental one group pre-test post-test design was used. Bhagavathi Vilasam Lower primary school, Nayarambalam kochi Kerala was the setting of the study and children studying in I and II standards in Bhagavathi Vilasam lower primary school were the sampes. The sample size was 53 and selected by total enumeration sampling technique. Sample Selection Criteria Inclusion criteria  Children with poor oral hygiene.( Oral Hygiene Index Simplified score 3.1 to 6

OBJECTIVES 1. Compare the knowledge scores on oral hygiene among lower primary school children before and after the oral hygiene programme. 2. Compare the oral hygiene status among lower primary school children before and after the oral hygiene programme. 3. Find the association between knowledge of the lower primary school children and selected demographic variables. 4. Find the association between oral hygiene of the lower primary school children and selected demographic variables. INTRODUCTION Today‟s children are tomorrow‟s citizen. As per 2011 census1 15, 87, 89, 287 of total population are school age children. The modern concepts describe school health service is an economical and powerful means of raising health, and more important of future generation. Health care needs of the children has to be carefully met to build a healthy future generation. School health services forms pivotal role in meeting such needs. The school health service is a personal health service. The beginning of school health service in India is dated back to 1909. School health surveys in India2 identified malnutrition, infectious

* Professor, ** II Year MSc Nursing, Amrita College of Nursing, AIMS, Kochi, Kerala. sajith016@gmail.com 38

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 Children between the age of ±6 months of 6yrs and ±6 months of 8yrs.  Children who knows Malayalam to read and write. Exclusion criteria  Children sick and with other oral problems at the time of study.  Children who is having dental carries.  Children those who are not having index tooth. DATA COLLECTION INSTRUMENTS  Tool-1: Standardized Oral Hygiene Index – Simplified (OHI-S index) scale for assessing the oral hygiene.  Tool –II: Questionnaire on Knowledge regarding Oral hygiene  Section-A: Socio demographic profile of Lower primary school children.  Section-B: Structured questionnaire for assessing lower primary students‟ knowledge regarding Oral hygiene.  Tool-III: Semi structured questionnaire for self reporting practice on Oral hygiene of lower primary school children.  TOOL IV: Observational check list for assessing brushing technique.

Day 1 to 4 was exclusively for screening the subjects for oral hygiene. It was done by using standardized Oral Hygiene Index Simplified (OHIS-S) scale. Pre test of the oral hygiene knowledge was assessed using structured questionnaire, self reported practice by semi structured questionnaire and brushing technique by observation check list. assessed. The researcher interviewed the subject‟s knowledge regarding oral hygiene, self reported practice by using a structured and semi structured questionnaire. After that brushing technique was assessed by using an observational check list. Each subject‟s brought their own tooth brush and demonstrated the daily brushing technique. After the pre test the subjects were taught on importance of oral hygiene and brushing technique was demonstrated in a model of tooth. The post test was conducted after 10 days. The oral hygiene was reassessed with the help of OHI-S and knowledge assessed by same pre test questionnaire.The return demonstration of the brushing technique assessed by observation check list. FINDINGS AND DISCUSSIONS Majority of the subjects 49 (92.5%) had poor knowledge, only very few subjects had average knowledge 4 (7.5%) and none of them had good knowledge regarding oral hygiene. After the oral hygiene programme 53 (100%) of the subjects showed good knowledge regarding oral hygiene

DATA COLLECTION PROCEDURES The school was selected by convenience sampling. In Devi Vilasam school, I and II standard has four divisions. The total number of children was 91. They were screened for oral hygiene by OHI-S scale. 53 samples were in the category of poor oral hygiene (3.1- 6 score) were selected for the study. 39

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Annexure Comparison of oral hygiene status before and after intervention using paired ttest (n=53) Std. Degrees of Group Mean t-value Deviation freedom Before intervention

4.292

0.443

After 2.070 0.373 intervention t(52) =2.675 ** Significant p=0.01 There was statistically significant improvement in the post knowledge scores (pre test knowledge score was 3.04 where as the mean post test knowledge score was 9.74) of the lower primary school children regarding oral hygiene. (p value<0.01) All subjects 53 (100%) had poor oral hygiene status before intervention. After the oral hygiene programme 53 (100%) of the subjects attained fair oral hygiene status There was statistically significant improvement in the oral hygiene status (mean pre intervention score was 4.29 where as the post intervention score was 2.07)of the lower primary school children. (p value<0.01) Conclusion About a million new cases of poor oral hygiene are being diagnosed each year making it about 2000 children every day or one child each minute for a day. The present study was conducted to find out the effectiveness of oral hygiene programme among lower primary school children. It is concluded that health education and proper brushing

1. 2.

27.631**

technique is very effective among children in improving the knowledge and oral hygiene status. References Census.2011. http://censusindia.gov.in/ Park K. Text book of preventive and social medicine. 21st edition. Bhanot publishers, Jabalpur 2011. Pp: 425-428 National Oral Health Survey and Fluoride Mapping. An Epidemiological Study of Oral Health Problems and Estimation of Fluoride Levels in Drinking Water. Dental Council of India, New Delhi, 2004. United States Department of Health and Human Services (USDHHS). Oral Health in America: A Report of the Surgeon General. National Institute of Health, 2000. Sheiham A. Oral health, general health and quality of life. Bulletin of World Health Organization. 2005 Sep; 83(9):644 Goval A, Gauba K, Chawla HS, Kaur M and Kapur A. Epidemiology of dental caries in Chandigarh school children and trends over the last 25 years. J Indian Soc Pedod Prev Dent. 2007 Jul-Sep;25(3):115-8.

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

EFFECT OF MUSIC THERAPY ON POST OPERATIVE PAIN AND ANXIETY AMONG PATIENTS SUBJECTED TO CABG *Mr. K. Balasubramanian & **Dr. Ratna Prakash,

Introduction: Pain and Anxiety are the common phenomenon after any surgery. Both are significantly higher especially among patients subjected to Cardiac Surgeries. Pharmacological agents are not completely relieving the pain and anxiety. Pain and anxiety have influence on each other, which may predispose the complications and even may increase the hospital stay

and treatment expenses. Along with the pharmacological therapy, non pharmacological therapy also can be instituted to reduce the post operative pain and anxiety. Rhythmic Music therapy is a non invasive, simple, safe, easily administrable, and likable by all human beings and it increases the release of endorphin and encephalin; chemicals which reduce the pain perception and keeps the mind happy. Objectives: To find out the effect of Music Therapy on post operative Pain and Anxiety among patients subjected to CABG.

Hypotheses: 1. There will be a significant difference in post operative Pain among CABG patients who receive Music Therapy and who do not receive Music Therapy. 2. There will be a significant difference in post operative Anxiety among CABG patients who receive music therapy and who do not receive Music Therapy. Methodology: Research design: The researcher adopted QuasiExperimental pre test post test control group design. Sample size: The study was conducted among 120 patients underwent CABG. First Sixty patients were selected for control group and another 60 patients for experimental group. Sampling technique: Consecutive sampling technique was adopted to select the subjects for the study. Setting of the study: The study was conducted in Cardio Thoracic Surgical Unit of Kovai Medical Center and Hospital, Coimbatore, Tamilnadu.

*Professor, KMCH College Of Nursing, Coimbatore & ** Principal, Pal College of Nursing & Medical Sciences, Uttarakhand. Inclusion Criteria: vishnubala2009@gmail.com 41

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1. Both male and female patients 2. Age between 40 to 75 years 3. Patient underwent elective CABG 4. Patients those who read and write Tamil or English Exclusion criteria: 1. Patients with hearing impairment 2. Patients with psychiatric illness 3. Patients those who needed IABP Description about data collection Tool: Tool 1: Numerical Pain Rating Scale. The 11 point Numerical Rating Scale (0-10) was used to measure the post operative pain among patients underwent CABG. The pain was rated by the patients. Tool 2: Spielberger‟s State Anxiety Inventory: This tool consists of 20 items measuring the post operative anxiety of the patients. The maximum score was 80. Minimum score was 20. High score indicates severe anxiety. The state anxiety tool was translated into Tamil. The reliability of the translated version was .83. Description about the Intervention: Non-lyrical Veena based instrumental music composed in the raga “Hamsadhwani” and Misra Sivaranjani”. The tempo of music is between 60-80 beats per minute. The music was played through the cassette player and the patients listened to the music through head phone in a relaxed state. The patients‟ environment was kept very calm and quiet. The duration of Music Therapy was 30 minutes per session for three consecutive days. The subjects in experimental group received

music therapy in morning and evening sessions. Data collection procedure: The formal permission was obtained from the administrative authority of the Hospital and head of the Cardio Thoracic Surgical Unit. The purpose of the study was explained to the study participants and written consent was obtained during pre operative period itself. According to the selection criteria patients were selected for the study. The first 60 patients were considered as control group and next 60 patients as experimental group. Pre test assessment of State Anxiety was done in the morning of first post operative day before administration of Music therapy and the post test State anxiety was measured after administration of music in the evening of third post operative day among subjects in experimental group. Pretest assessment of pain was done before music therapy and post test pain was measured immediately after 30 minutes of therapy among experimental group. The pre and post test pain was measured in morning and evening sessions of three consecutive post operative days. In the same manner data was collected among control group also. But the subjects in control group were advised to take only rest in the bed. Findings: Majority of the subjects in experimental and control groups were male; 52 (87%) and 50(83 %) respectively. Regarding age, most of 42

Pondicherry Journal of Nursing

the patients; 43(72%) and 45 (75%) were in the age group of 55-65 years in experimental and control group respectively. There was no significant difference in pretest post operative anxiety scores among subjects in experimental and control group. The mean post test post operative anxiety among experimental group was 32.3(S.D 5.35). The mean post test post operative anxiety among control group was 37.2 (S.D 4.964). Highly significant difference was found between the mean post test post operative anxiety scores among patients who received music therapy and who did not receive music therapy ( P ≤ .001) There was no significant difference in pretest post operative pain scores among experimental and control group. The mean pre and post test post operative pain scores among experimental group were 4.66 (S.D 1.73) and 2.83 (S.D 1.23). There was a highly significant difference between mean pre and post test post operative pain scores among experimental group ( P ≤ .001). The mean post test post operative pain score among experimental group was 2.83(S.D 1.23). The mean post test post operative pain score among control group was 4.1 (S.D 1.27). Highly

Vol 6, Issue3, August’13 – November’13

significant difference was found between the mean post test post operative pain scores among patients who received music therapy and who did not receive music therapy ( P ≤ .001). Conclusion: The present study results imply that music therapy is effective intervention for post operative pain and anxiety among patients undergone CABG. Since, Music therapy is the cheapest and easily administrable harmless non pharmacological intervention for reducing post operative pain and anxiety, Nurses may use music therapy for the patients subjected to CABG. References: 1. Barry B. Bittman, Lee S Berk, David L, Felten, James W, Carl Simonton (2001).Composite effects of group drumming music therapy on modulation of 2. Iblher P, Maher H, Heinze H, Huppe M, Klotz K F, Eichler W (2011). Does music harm patients after cardiac surgery? A randomized controlled study; Applied Cardiopulmonary pathophysiology 15: 1423.neuroendocrine-immune parameters in normal subjects; Alternative Therapies, 3. Ulrica Nilsson, (2008), The anxiety and pain reducing effects of music intervention: a systematic review; AORN Journal; 18(5) 34-39.Vol. 7 No.1 (38-47).

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FOODS TO BOOST OUR BRAINPOWER *Dr. Divya Choudhary Eating well is good for your mental as well as your physical health. The brain requires nutrients just like your heart, lungs or muscles do. Wholegrains- Like everything else in our body, the brain cannot work without energy. The ability to concentrate and focus comes from the adequate, steady supply of energy - in the form of glucose in our blood to the brain. Opt for 'brown' cereals, wheatbran, granary bread and brown pasta. Oily fish- Essential fatty acids (EFAs) cannot be made by the body and must be obtained through diet. The most effective omega-3 fats occur naturally in oily fish as EPA and DHA. Good sources include linseed (flaxseed) oil, soya bean oil, pumpkin seeds, walnut oil and soya beans. They are good for healthy brain function, the heart, joints and general wellbeing. Oily fish contains EPA and DHA in a readymade form, which enables the body to use it easily. Low DHA levels have been linked to a higher risk of developing Alzheimer's disease and memory loss. Blueberries- Evidence accumulated at Tufts University in the United States suggests that the consumption of blueberries may be effective in improving or delaying short term memory loss.

Tomatoes- There is good evidence to suggest that lycopene, a powerful antioxidant found in tomatoes, could help protect against the kind of free radical damage to cells which occurs in the development of dementia, particularly Alzheimer's. Vitamins- Certain B vitamins - B6, B12 and folic acid – are known to reduce levels of homocysteine in the blood. Elevated levels of homocysteine are associated with increased risk of stroke, cognitive impairment and Alzheimer's disease. Blackcurrant - Vitamin C has long been thought to have the power to increase mental agility. One of the best sources of this vital vitamin are blackcurrants. Pumpkin seeds-Just a handful of pumpkin seeds a day is all you need to get your recommended daily amount of zinc, vital for enhancing memory and thinking skills. Broccoli- A great source of vitamin K, which is known to enhance cognitive function and improve brainpower. Sage- Sage has long had a reputation for improving memory Nuts- A study published in the American Journal of Epidemiology suggests that a good intake of vitamin E might help to prevent cognitive decline, particularly in the elderly. Nuts are a great source of vitamin E along with leafy green vegetables, asparagus, olives, seeds, eggs, brown rice and wholegrains *Professor, Kasturba Gandhi Nursing College, Puducherry. 44

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MULTIPLE CHOICE QUESTIONS DEPARTMENT OF OBGY 1. Placenta and fetal membranes are developed from? 2. Intervillous blood flow at term 3. Pressure in umblical artery and umblical vein? 4. The other name of Bartholian gland ? 5. The shortest diameter of fetal skull? 6. The fundal height is more than the period of gestation in which condition? 7. During fertilisation, penetration of corona radiata is facilitated by? 8. In a well flexed head, the engaging diameter is ? 9. Assessment of progress of labour is best done by? 10. What is the character of true labour?

JUMBLED LETTERS 1.

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MOTERIUNDEM

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NANOMETDROIE

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CUSBCOITOPU MEGRATBIC

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10.

SREPENGNTI TARP

Answers in page 34

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

SHRIDEVI CHARITABLE TRUST (R ) SHRIDEVI INSTITUTE OF NURSING, TUMKUR-572106 REPORT ON WORLD POPULATION DAY CELEBRATION – 2013 Shridevi Institute of Nursing, Tumkur has celebrated world population day 2013 on 20-07-2013, Saturday at 10.AM in Shridevi Institute of Nursing auditorium, Tumkur. Inaugural function: The function was inaugurated by Dr. Channamallaiah, Honourable District Health & Family welfare officer, Tumkur District & He is accompanied by Dr. Raman Hulinayakar, Trustee, Medical Director, Shridevi Institute of Medical Science & Research Hospital, Tumkur, who was the president of the programme & other dignitaries present in the function were, Dr. Sagorika Mullick, professor & HOD Dept. of Community Medicine, Shridevi Institute of Medical Science & Research Hospital, Tumkur. Prof .K.Ramu, Principal, Shridevi Institute of Nursing, Tumkur, Sri. T.V.Bramhadevaiah, CAO, Shridevi Charitable Trust, Tumkur, Mr.Arun Kumar S.R., Asst professor, Dept. of Community Health Nursing, Shridevi Institute of Nursing, Tumkur.

Scientific session: Honorable chief guest & Resource person by name Dr. Sagorika Mullick professor & HOD Dept. of Community Medicine, Shridevi Institute of Medical Science & Research Hospital, Tumkur, conducted scientific sessions on the theme of world population day 2013, “Focus is on Adolescent Pregnancy” The programme was ended by vote of thanks & with great success.

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Vol 6, Issue3, August’13 – November’13

KASTURBA GANDHI NURSING COLLEGE COLLEGE EVENTS World Population Day The Department Of Community Health Nursing and the Department Of Community Medicine in Association with the Ministry Of Health And Family Welfare Commemorated The World Population Day on 11 .7.13. The Theme of the Year was “Focus Is On Adolescent Pregnancy”.A Rally was organized by Ministry of Health and family welfare at Puducherry from Bharadidasan thidal to Gandhi Statue. Various schools, Nursing Colleges and Medical colleges participated . Our B.Sc(N) II Year students took an active participation in the rally by using various IEC materials like balloon posters, models on small family norm, face painting, posters on slogans. KGNC bagged the shield for Best Rally Team from our honourable Minister Of Health. CONGRATULATIONS DEAR KASTURBIANS. On 16/07/13 poster Competition was organized by Department of Community Medicine at Registration block, MGMC & RI, totally 18 posters were displayed by Medical, Dental and Nursing students in that 8 posters belongs to Nursing students. I Prize won by Ms. Valli and II Prize by Ms. Umarani from B.sc(N) IIyear students.

In-Service Training Programme The first In-Service training programme for nurses was inaugurated on 29.07.2013 by the Vice-Chancellor Prof K. R. Sethuraman, SBV University. The theme for the In-service Training programme was “Role and Responsibilities of Nurses in Emergency Service”. The theme was unfolded by the Nursing director Prof. Dr. S. Kamalam. It was a one week training programme from 29.07.2013 to 03.08.2013. Most of the classes were handled by the Doctors of MGMC & RI and few by the Nursing Faculty. 47

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On 03.08.13 a feedback and posttest was obtained. The response was good and it was found it to be very useful and informative. The trainees were awarded with a certificates. World Breast Feeding Week Celebration (Aug 1 -7) The Department of Child Health Nursing and OBG Nursing in unison commemorated the World Breast Feeding Week focusing on the theme “Breast Feeding Supports –Close To Mothers.” Various activities were carried out in this regard. A poster competition was organized on 5.8.13 for the students. An role play was enacted on the theme by the final year B.Sc.(N)., Students in the OPD on 6.8.13 and the same was performed in the community in Kirumampakkam PHC on 7.8.13. A panel discussion on the theme was organized by the Dept Of OBG Nursing to post natal mothers at Primary Health Centre, Kirumampakkam on 08.08.2013. World Alzheimer‟s Day The Department Of Mental Health Nursing Commemorated The “World Alzheimer‟s Day” On 21.9.13 on the Theme “Dementia- A Journey Of Caring”. The B.Sc.(N)., III Year Students acted out a Role Play regarding the Care Of Elderly People in the community area Pillaiyarkuppam, Puducherry. Pamphlets were distributed to the people in the community. Scientific and Academic Forum The SAF of KGNC in association with the Department of MENTAL HEALTH NURSING organized a quiz programme on the Theme “Transgenders and sexual disorders” on 30th august 2013.The BSc. (N) students participated and won the prizes.Dr. Sukanto Sakar Associate professor, Department of Psychiatry gave a talk on Trans Gender And Sexual Disorders. Ms. Sheethal, President of SCOHD Soceity was the guest speaker of the day.She Presented topic on “Environmental and Psychological Issues of Transgenders”. Scientific and Academic Forum The SAF of KGNC in association with the Department of OBGY NURSING organized a quiz programme on the Theme “Assessment and management of normal pregnancy and labour” on 05th November 2013. The BSc. (N)., students participated and won the prizes. Dr. Lopa Associate professor, Department of OBGY gave a talk on Recent advances in Assessment of Foetal Wellbeing. Ms. Lavanya, Assistant Professor, presented a case report on Multiple Pregnancy (Triplet). Cocurricular Mr. N. Shiva subramanium, B.Sc. (N)., IV year student of KGNC National Service Scheme unit, attended the Inter-state leadership camp held at Annamalai University from 25.09.13 to 27.09.13. 48

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

The UG students of KGNC had an enthusiastic participation in the poster competition organized by the Department of Opthalmology on Eye Donation Day in MGMC&RI on.29.8.13 Extracurricular B.Sc.(N)., IIyr, IIIyr & IVyr students participated in UDAY-ARUN MEMORIAL TROPHY-13 organised by MGMC&RI on 27.08.2013.Mr.Krishnamoorthy, Mr.Rajasekar, Mr. Harish Mohan, Mr.Siva Subramanian, Mr.Shyam Pradeep, Mr. Kota Satheesh from IV years, Mr. Suman Raj, Mr. Dinesh babu, Mr. Isaivanan, Mr. Kalidass and Mr. Parthip from III year & Mr. Gopal, Mr. Bhuvanesh, Mr, Vijayabalan from II Year were enthusiastically participated in the event of cricket, Volley ball & Football. Alumni Association of KGNC The first Alumni meet was conducted on 30.09.2013 at First Floor Lecture Hall, KGNC at 9:00AM. Prof. Dr. S. Kamalam, Principal, KGNC inaugurated the Kasturbians- Blood Donation Day the first endeavour of the alumni to commemorate our Decennial Year celebration. Key note address was given by Prof. Renuka. K, Vice-Principal, KGNC. On behalf of Alumni Panthom Mike was donated to the College. Five Alumni Members of Kasturbians donated blood in our hospital MGMC&RI. DECENNIA FEST -30-9-13 KGNC takes its pride in completing a decade in its path in the soil of Puducherry. At this joyful moment of this ten year journey Principal and the KGNC fraternity express their gratitude to our Honourable Chancellor Shri M.K Rajagopalan who sowed the seed of KGNC and still continues to be an anchor in our growth till date. The mission is being carried out successfully by Dr. S. Kamalam who commands the support from the management by her strong commitment and devotion to this profession. The collective efforts of KGNC faculty is another boon for this achievement. To commemorate this landmark decennia fest was celebrated on 30.9.13. The decennia fest was presided by our Vice Chancellor Prof. K.R. Sethuraman, Dr. Annie Grace Kalaimathi, Registrar [FAC] Tamilnadu Nurses and midwives Council was the special guest of the day who kindled the spirits of all through her motivational speech. Dr. S. Kamalam presented the decennial report. Dr. S. krishnan, Dean MGMC RI, and Dr. Narayanan, Vice Principal Mahatma Gandhi Medical College, felicitated the gathering. Prizes were distributed to the winners in various competitions like sports and cultural conducted in earlier week to commemorate the decennial year. This day created an longlasting impression in the hearts of Kasturbians.

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

AUTHOR GUIDELINES In order to standardize the quality of PJN the following guidelines have been formulated based on expertise opinion. The Editorial Process The manuscripts will be reviewed for possible publication with the understanding that they are being submitted to one journal at a time and have not been published, simultaneously submitted or already accepted for publication elsewhere. The Editors review all submitted manuscripts initially. Manuscripts with insufficient originality, serious scientific and technical flaws or lack of a significant message are rejected. All manuscripts received are duly acknowledged. Manuscripts are sent to two or more expert reviewers without revealing the identity of the contributors to the reviewers. Each manuscript is also assigned to a member of the editorial team, who based on the comments from the reviewers takes a final decision on the manuscript. The contributors will be informed about the reviewer‟s comments and acceptance/ rejection of manuscript. Types of Manuscripts and Limits 

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Original articles: Randomized controlled trials, intervention studied, studies of screening, outcome studies, case-control series, and surveys with high response rate. Up to 3000 words excluding adequate references and abstract. Review articles (including for Ethics forum, Education forum, Health related science, E-Medicine, E-Nursing etc.): Systemic critical assessments of literature and data sources. Up to 2000 words excluding with adequate references. Research articles critical review, advertisement, functions celebrated, puzzles and innovation related items. Case reports: new/ interesting/ very rare cases can be reported. Cases with clinical significance or implications will be given priority. However, mere reporting of a rare case may not be considered. Up to 1000 words excluding references and abstract and up to 05 references. Announcements of conferences, meetings, courses, and other items likely to be of interest to the readers should be submitted with the name and address of the person from whom additional information can be obtained with supportive images.

Presentation and format  Double spacing, TIMES NEW ROMAN  Margins 2.5 cm from all four sides  Title contains all the desired information  Abstract page contains the full title of the manuscript  Introduction of 75 words.  Headings in title case ( not ALL CAPITALS)  The references cited in the text & should follow Vancouver both for journals & look reference. 50

Pondicherry Journal of Nursing

Vol 6, Issue3, August’13 – November’13

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Send the final article file without „Track changes‟ & send hard & soft copy for the articles. Language and grammar  Write the full term for each abbreviation at its first use in the title, abstract, keywords and text separately unless it is a standard unit of measure.  Numerals at the beginning of the sentence spelt out.  Check the manuscript for spelling, grammar and punctuation errors Tables and Figures  No repetition of data in tables and graphs and in text  Actual numbers from which graphs drawn, provided  Figures necessary and of good quality ( color)  Table and figure numbers in Arabic letters (not Roman)  Write the full term for each abbreviation used in the table as a footnote. Article from Graduate and Post Graduate will also be accepted. Please follow the same format for research articles. Title Abstract Objectives Introduction Text- methodology - Finding - Conclusion References Tables / Figure / Illustration in a separate page

Author information in a separate page as follows: Name , Academic degree, Designation Name of the institution Address for correspondence including phone number and Email Id. All articles will be peer reviewed. The Editorial board and chief editor will decide on suitabililty of publication of a material which is final. The last minute submission of article will not be considered for current issue.

Correspondence Address: Prof.Mrs.S.Kamalam Chief Editor , Pondicherry Journal of Nursing Principal, Kasturba Gandhi College of Nursing, MGMC&RI Campus, Pillaiyarkuppam, Puducherry - 607 402. Ph: 0413-2615449 (Ext.511), 2615809, Fax: 0413-2615457 E-mail- kgncpjn@yahoo.com