INTRODUCTION:

Abrasion is a wound caused by superficial damage to the skin, no deeper than epidermis. It is less severe than the lacerations and bleeding if present is minimal. Mild abrasion also known as grazes or scraps don’t scare or bleed but deep abrasions may lead to the formation of scar tissue. More traumatic abrasions that remove all the layers of skin called Avulsion.

Abrasion injuries most commonly occur in exposed skin comes into moving contracting with a rough surface area causing a grinding or rubbing away of the upper layers of epidermis.¹Cuts, scraps and puncture wounds were the most common injuries. The majority of injuries affected children in limbs and injuries, most often occurs in the morning. Boys were injured most often in rooms designated for play, and a majority of their injuries followed from misbehavior. Girls were most often injured in non play areas of the home, with the majority of injuries occurring during play activities. Boys experienced more frequent and severe injuries than girls, although girls reacted more than boys to their injuries.²

Global wide in most industrial countries including Canada and the united states unintentional injuries rank as the number one cause of death and a leading cause of hospitalization for children older than 1 year. Estimates indicate that one in four children in the United States experience a medically attended injury each year. Unintentional injuries were the second leading cause of hospitalization among youth under 25 years of age (National centre for health statistics).Not surprisingly because injuries pose such a significant threat to the health of the children.³

Global burden of injuries, nearly 50 lakhs people lost their lives due to injuries as per WHO estimates during the year 2002 ( WHO 2004 ).Injuries caused 9% of the total deaths. The global injury mortality rate is estimated to be 98/1,00,000 population, with male and female rates of 128/1,00,000 (38 lakhs deaths) and 67/1,00,000 (19 lakhs deaths ) respectively. Five of the top ten causes of death globally are due to injuries. Among the total disability – adjusted life – years (DALYS), 13% was due to injuries. Unintentional and intentional injuries contributed to three-fourth and one-fourth of total DALYS respectively.⁴

Epidemiological data reveal systematic variation in childhood injuries as a function of the child’s sex and age. One of the most common findings is that males experience more frequent and severe injuries than female. This sex difference emerges at around 2 years of age and persists throughout childhood and into adulthood.³

In India the majority of children 9 months and older (76.6%) had at least 1 recent skin injury, without a significant difference between the sexes.

Burden of injuries in India, the precise number of deaths in India are not available from any single source. The national crime records Bureau (NCRB) is the principal nodal agency under the ministry of home affairs, Govt.of India and is responsible for the collection compilation, analysis and dissemination of injury. Related information ( NCRB 2001 a,2001 b ) As per the report of 2001 the mortality rate among different age groups was : 8.2% ( < 14 yrs ) 62% ( 15- 44 yrs ), 20% ( 45 – 59 yrs ) and 9.2% ( 60 yrs ).Seventy three percent of total (73%) deaths occurred among men with a ratio of 3:1 between men and women.⁵

In India the incidence rate of accidents in the children studies was found to be 3.13/100 child per month or 0.35/child/year. The total no. of injuries recorded was 135.⁶

Prevention of abrasions is possible by wearing protective pads and covering any exposed skin with a layer of clotting. You can’t always predict when we will suffer with an abrasion, but sports such as cycling make it much more likely. It is wise to have the necessary first aid supplies available in the event of an emergency.

OBJECTIVES OF THE STUDY:

· To assess the knowledge and knowledge on practice of first aid management of minor abrasions.

· To evaluate the effectiveness of planned health education on first aid management of minor abrasions.

· To associate the relationship between the level of knowledge and practice of first aid management of minor abrasions among elementary school children and selected demographic variables.

OPERATIONAL DEFINITIONS:

· Assess: To determine or evaluate the efficacy of planned health education.

· Effectiveness: It is the outcome of planned health education identified with structured questionnaire given to the elementary school children on first aid management of minor abrasions.

· Structured teaching programme: It is systematically organized teaching program to provide information to elementary school children.

· Elementary school children: Those were studying 4^th standard belonging to 9-10years of age.

· Abrasion: Abrasion is a superficial wound involving scraping or rubbing of skin surface.

ASSUMPTIONS:

· Elementary school children studying 4^th standard might not have knowledge of first aid management of minor abrasions.

· Planned health education on first aid management of minor abrasions to elementary children could bring about a change in their knowledge and result in better health practices.

RESEARCH METHODOLOGY:

Pre experimental one group pre test- post design was conducted to assess the effectiveness of structured teaching programme on first aid management of Minor abrasions among elementary school children at Tirupati. Cluster random sampling technique each school was considered as a cluster and 50 children were selected by simple random sampling technique and assessed their knowledge by using structured questionnaire. After seven days of the structured teaching programme the post-test were conducted by using the same pre-test questionnaire.

Criteria for sample selection

Inclusive criteria

· Children who are studying 4^th standard

· Who can speak, read and write Telugu

Exclusive criteria

· Children more than 10 years

· Children less than 9 years

Tool description and scoring:

It consists of 3 sections,

Section-I:

This consists of socio-demographic data such as age, education and occupation of mother and father, family income per month and place of residence which were recorded.

Section II:

This consists of 10 multiple choice questions related to knowledge on First Aid Management of Minor Abrasions regarding definition causes, risk factors, types, and wound healing process, factors affecting wound healing, signs and symptoms and complications of minor abrasions.

Section III:

This consists of 15 multiple choice questions related to knowledge on practices regarding first aid management and prevention of minor abrasions.

Structured teaching programme on minor abrasions consists of definition, causes, risk factors, types, signs and symptoms, first aid management, home care management, dietary management, preventive measures and complications of minor abrasions.

Scoring:

< 50% inadequate knowledge, 50-70% moderately adequate knowledge and >75% adequate knowledge.

Method of Data collection:

Permission was obtained from Mrs. Jayamma, Head mistress S.V. Elementary school, Tirupati. Investigator introduced herself to the children and explained the significance of the study. Written consent was obtained from them after explaining the purpose of the study. They were divided into four groups. For each group 45 minutes pre-test and 30 minutes for post-test were allotted for structured questionnaire and 45 minutes for structured teaching programme was allotted for each group.

Data analysis:

Statistical method used for analysis were descriptive statistics that include Frequency, Percentage, mean distribution and standard deviation are used to analyze the study variables, the knowledge of the mothers of infants on constipation and its prevention. Inferential statistics namely Chi-square was used to analyze the association of demographic variables with knowledge scores. Paired‘t’ test was used for analyzing the difference between the pre-test and post test.

Table-1: Frequency and percentage Distribution of demographic variables among school children.

S.NO	DEMOGRAPHIC VARIABLE		NUMBER	PERCENTAGE
1.	Age of the child	1.9 years	36	72
1.	Age of the child	2.10 years	14	28
2.	Gender	1.Boys	29	58
2.	Gender	2.Girls	21	42
3.	Religion of the child	1.Hindu	44	88
		2.Muslim	2	4
		3.Christian	4	8
		4.Others	0	0
4.	Education of the mother	1.Illiterate	10	20
		2.Primary education	17	34
		3.Secondary education	18	36
		4.Collegiate	5	10
5.	Education of the father	1.Illiterate	8	16
		2.Primary education	16	32
		3.Secondary education	11	22
		4.Collegiate	15	30
6.	Occupation of the mother	1.Home maker	30	60
		2.Business	0	0
		3.Employee	4	8
		4.Labourer	16	32
7.	Occupation of the father	1.Business	15	30
		2.Employee	5	10
		3.Labourer	15	30
		4.Agriculture	15	30
8.	Family income for month in rupees	1.Less than 5000	33	66
		2.5001-10,000	17	34
		3.10001-15000	0	0
		4.15000 and above	0	0
9.	Place of residence	1.Urban	0	0
		2.Rural	0	0
		3.Semi Urban	50	100
10.	Do you have health facilities near to your home	1.Yes	45	90
10.	Do you have health facilities near to your home	2.No	5	10

RESULTS: Section-I Distribution of demographic variables among elementary school children.

Table-1: Shows that out of 50 students, 72% (36) were 9years, 28% (14) were 10 years. Among them 58% (29) were boys, 42% (21) were girls. Regarding the religion, 88% (44) were Hindu, 4% (2) were Muslims, 8% (4) were Christians, with regard to education of the mother, 20% (10) were illiterate, 34% (17) had primary education, 36% (18) had secondary education, and 10% (5) were collegiate. Pertaining to education of father, 16% (8) were illiterate, 32% (16) had primary education, 22% (11) had secondary education, and 30% (15) had collegiate education. In relation to occupation of mother, 60% (30) were house wives, 8% (4) were employees, and 32% (16) were labors. In relation to occupation of the father, 30% (15) were in business, 10% (5) were employees, 30% (15) were labors, and 30% (15) were in agriculture. In accordance with family income per month, 66% (33) earns less than 5000Rs/- -, 34% (17) earns 5001-10000Rs/-. With regard place of residence, 100% (50) were living in semi urban. In pertaining to health facilities near to their home 90% (45) were have health facilities near to their home, 10% (5) were not having health facilities near to their home.

Section-II: Distribution of level of knowledge and knowledge on practice related to prevention of minor abrasions among elementary school children in pre-test and post-test.

Table-2: Out of 50 children 60% (30) had inadequate knowledge and 2% (1) had adequate knowledge in pre-test. Regarding the knowledge on practices of prevention of minor abrasions 26% (13) had inadequate knowledge, 68% (34) had moderately adequate knowledge, and 6% (3) had adequate knowledge in pre test. Over all knowledge on minor abrasions and knowledge on practices indicated 18% (9) had inadequate knowledge, 80% (40) had moderately adequate knowledge and 2% (1) had adequate knowledge in pre test.

Table-3: reveals that out of 50 children 6% (3) had inadequate knowledge, 44% (22) had moderately adequate knowledge and 50% (25) had adequate knowledge on prevention of minor abrasion in post test. Regarding knowledge about practices on prevention of tetanus minor abrasions 4% (2) had inadequate knowledge, 42% (21) had moderately adequate knowledge, and 54% (27) had adequate knowledge in post test. The overall knowledge on minor abrasions and knowledge on practices related to prevention of minor abrasions shows, 2% (1) had inadequate knowledge, 34% (17) had moderately adequate knowledge, and 64% (32) had adequate knowledge

Table-4: indicates that there is a significant improvement in knowledge and knowledge on practices related to prevention of minor abrasions at 0.01 levels.

Table-2: Distribution of level of knowledge and knowledge on practice related to prevention of minor abrasions among elementary school children in pre-test. N=50

S. NO	VARIABLE	INADEQUATE (<50%)		MODERATELY ADEQUATE (50%-75%)		ADEQUATE (75%)
S. NO	VARIABLE	NO	%	NO	%	NO	%
1.	Knowledge	30	60	19	38	1	2
2.	Practice	13	26	34	68	3	6
3.	Over all knowledge on minor abrasions and knowledge on practices related to prevention of minor abrasions	9	18	40	80	1	2

Table-3: distribution of level of knowledge and knowledge on practices related to prevention of minor abrasions among elementary school children in the post test. N=50

S. NO	VARIABLE	INADEQUATE (<50%)		MODERATELY ADEQUATE (50-75%)		ADEQUATE 75%
S. NO	VARIABLE	NO	%	NO	%	NO	%
1.	Knowledge	3	6	22	44	25	50
2.	Practice	2	4	21	42	27	54
3	Over all knowledge on minor abrasions and knowledge on practices related to prevention of minor abrasions.	1	2	17	34	32	64

Table-4; Effectiveness of structured teaching programme on prevention of minor abrasions among elementary school children. N=50

SL. NO	VARIABLES	PRE-TEST		POST-TEST		PAIRED ‘t’ VALUE
SL. NO	VARIABLES	Mean	Standard deviation	Mean	Standard deviation	PAIRED ‘t’ VALUE
1.	Knowledge	5.300	1.063	7.460	1.043	12.714**
2.	Practice	8.580	1.457	11.680	1.679	9.507**
3	Knowledge and practices	13.880	1.669	19.140	2.341	14.005**

Section-III :

Effectiveness of structured teaching programme on prevention of minor abrasions among elementary school children.

Section-IV:

Association between demographic variables with the level of knowledge and knowledge on practices on prevention of minor abrasions in pre-test and post-post test.

There is no significant difference between demographic variables of pre test and post test scores of knowledge and knowledge on practice.

DISCUSSION:

The study revealed that out of 50 children 60% (30) had inadequate knowledge and 2% (1) had adequate knowledge in pre-test. Regarding the knowledge on practices of prevention of minor abrasions 26% (13) had inadequate knowledge, 68% (34) had moderately adequate knowledge, and 6% (3) had adequate knowledge in pre test. Over all knowledge on minor abrasions and knowledge on practices indicated 18% (9) had inadequate knowledge, 80% (40) had moderately adequate knowledge and 2% (1) had adequate knowledge in pre test.

6% (3) had inadequate knowledge, 44% (22) had moderately adequate knowledge and 50% (25) had adequate knowledge on prevention of minor abrasion in post test. Regarding knowledge about practices on prevention of tetanus minor abrasions 4% (2) had inadequate knowledge, 42% (21) had moderately adequate knowledge, and 54% (27) had adequate knowledge in post test. The overall knowledge on minor abrasions and knowledge on practices related to prevention of minor abrasions shows, 2% (1) had inadequate knowledge, 34% (17) had moderately adequate knowledge, and 64% (32) had adequate knowledge in post test.

There is a significant improvement in knowledge and knowledge on practices related to prevention of minor abrasions at 0.01 levels. There is no significant difference between demographic variables of pre test and post test scores of knowledge and knowledge on practice.

CONCLUSION:

Out of 50 children 18% (9) had inadequate knowledge, 80% (40) had moderately adequate knowledge and 2% (1) had adequate knowledge in pre test. 2% (1) had inadequate knowledge, 34% (17) had moderately adequate knowledge, and 64% (32) had adequate knowledge in post test. There was a significant improvement in knowledge and knowledge on practices related to prevention of minor abrasions at 0.01 levels. The data proved that the knowledge of children had markedly improved after health education. Irrespective of demographic variables, children improved their knowledge after health education. Hence, direct education helps to improve their knowledge and change them into a much desirable behavior.

NURSING IMPLICATIONS:

NURSING PRACTICE:

Structured teaching programme is an integral part of the medical services. Nurses can be instrumental in helping the school children by teaching about first aid management of minor abrasions. The teaching which was given for the study showed that there was an increased impact on the knowledge of the school children regarding minor abrasions. Nurses must plan for similar structured teaching programme based on the needs of the awareness among school children about minor abrasions.

In the community, public health nurses should plan structured teaching programme on prevention of minor abrasions by using newer health education to children.

In pediatric wards and OPDs, health education programme could be planned with the use of an LCD projector, skits or puppet shows.

NURSING EDUCATION:

· The ability to access valid structured teaching program on prevention of minor abrasions is to be demonstrated.

· The students should be trained in putting their efforts to reduce children mortality and involve them in various national programmes.

· Teaching modules should be introduced in the curriculum of the primary level of nursing education

NURSING ADMINISTRATION:

· There should be an increase in the proportion of health care organization that provides family education on prevention of minor abrasion.

· There should be an increase in the proportion of abrasions preventive measures.

NURSING RESEARCH:

· Nursing research on newer methods of teaching focusing on interest quality and cost effectiveness.

· There is a great need for nursing research in the areas of parent’s education particularly about prevention of minor abrasions.

RECOMMENDATIONS:

· A longitudinal study could be conducted using the post test after one month, six months and one year to see the retention of knowledge.

· As the structured teaching programme was effective in school children, similar structured teaching programmes could be initiated in all schools.

· A descriptive study on prevention of minor abrasions among elementary school children could be conducted at rural areas.

· A comparative study could be done between urban and rural areas.

REFERENCES:

1. www.c.medicinehealth.com.2009January

2. www.indianpediatrics.net

3. http://jpepsy.oxfordjournal.org/content/29/6/415

4. http://whoindia.org/linkfiles

5. http://pediatrics.applications.org/content/108/2/271

6. http://www.ijcm.org.in/article.asp

7. www.llen.wikipedia.org.com

8. http://www.prohealthcare.org/skininj

Received on 21.05.2015 Modified on 30.06.2015

Int. J. Adv. Nur. Management 3(3): July- Sept. 2015; Page 225-230

DOI: 10.5958/2454-2652.2015.00008.6