Effect of Structured Teaching Programme on Knowledge regarding Prevention and Warning signs of Stroke among High Risk Patients

 

Mrs. Sheeba Wiselin. C, Lekshmi C

Sivagiri Sree Narayana Medical Mission College of Nursing, Varkala

*Corresponding Author E-mail: sheebawiselin@gmail.com

 

ABSTRACT:

The study was conducted to assess the effect of structured reaching programme on knowledge regarding prevention and warning signs of stroke among high risk patients attending medical outpatient departments in selected hospitals at Varkala. The objective of the study were to assess the knowledge regarding prevention and warning signs of stroke among high risk patients, to determine the effect of structured teaching programme on knowledge of high risk patients regarding prevention and warning signs of stroke and to find out the association between the level of knowledge of high risk patients regarding prevention and warning signs of stroke and selected socio-demographic variables. Quasi experimental one group pre test post test design was employed in this study. Ninty high risk patients from S.S.N.M.M. Hospital and Taluk Hospital, Varkala were selected by simple random sampling technique. After assessing the existing knowledge, structured teaching programme was administered to the sample. Knowledge scores of high risk patients were assessed. Association between the level of knowledge of high risk patients and selected sociodemographic variables were also assessed. Data analysis revealed that there was significant improvement in the level of knowledge of high risk patient after structured teaching programme (p<0.001) and there was significant association between level of knowledge of high risk patients and selected socio demographic variables like age (p<0.05), education (p<0.001) and family history of stroke (p<0.001).

 

KEYWORDS: Structured teaching programme; prevention and warning signs of stroke: high risk patients.

 

 


INTRODUCTION:

Stroke is a major public health concern and it is a leading cause of serious long term disability. It is caused by the interruption of the blood supply to brain, usually because of bursts of blood vessel, or by a clot blocked in the blood vessel. This cuts off the supply of oxygen and nutrients, causing damage to brain tissue. The most common symptoms include sudden weakness or numbness of face, arm or leg (most often on one side of body).

 

Other symptoms include confusion, difficulty speaking, dizziness loss of balance or co-ordination, severe headache with no known cause fainting or unconsciousness5. American Stroke Association defined Transient Ischemic Attack (TIA) as a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction. Patients with TIA are at high risk of early stroke1.

 

Stroke is the third most common cause of mortality in the developed world and is also the leading cause of adult neurological disability. Worldwide, it has been estimated that by 2020, stroke will be the leading cause of mortality and morbidity2.

Stroke is becoming an important cause of premature death and disability in low- income and middle income countries like India, largely driven by demographic changes and enhanced by the increasing prevalence of the key modifiable risk factors3.

 

According to World Health Organization global status report on non communicable diseases 2014, 6.7 million deaths in the world was due to stroke6. A study conducted on incidence, types, risk factors and outcome of stroke in a developing country (2008) at Thiruvananthapuram found that, during 6 months period, 541 strokes were registered from 7,41,000 urban and 1,85,000 rural inhabitants of Thiruvananthapuram. Stroke occurred at a median age of 67 years; only 3.8% of stroke patients were aged≤40 years. Ninty percentage of the patients were having more than one modifiable risk factor. Habit of smoking was the most common modifiable risk factor among rural male patients7.

 

The investigator came across many hypertensive and diabetic patients during her clinical experience. She noticed that these patients knowledge on prevention and warning signs of stroke were very poor. Many patients were not aware of the importance of proper follow up treatment. Most of them never heard about the warning signs of stroke. Thus in the view of the importance of patient’s knowledge on prevention and warning signs of stroke the investigator has proposed to investigate this topic.

 

The objectives of the study (1) Assess the knowledge regarding prevention and warning signs of stroke among high risk patients, (2) Determine the effect of structured teaching programme on knowledge of high risk patients regarding prevention and warning signs of stroke and (3) Find out the association between the level of knowledge of high risk patients regarding prevention and warning signs of stroke and selected socio-demographic variables.

 

METHODOLOGY:

This chapter deals with research methodology adopted for the present study and includes research approach, research design, variables, setting of the study, population, sample and sampling technique, criteria for the selection of sample, data collection instruments, content validity, reliability, pilot study, data collection process and plan for data analysis.

 

Research Design:

The study was intended to assess the effect of structured teaching programme on knowledge regarding prevention and warning signs of stroke among high risk patients.

 

It is represented as follows:

O1 X O2

O1-pre test

X–Intervention

O2–Post test

 

Schematic representation of the study:

 

Schematic representation of the study is shown in figure 2.

 

Pilot study:

Pilot study is defined as a smaller version of a proposed study, using similar subjects, the same treatment, same data collection and analysis techniques. The main objective of the pilot study was to help the researchers to find out the feasibility of the study, to check the clarity of language of the tool and structured teaching plan and to finalize the plan of analysis.

 

Pilot study was conducted in medical outpatient departments in Sivagiri Sree Narayana Medical Mission Hospital, Varkala.

 

Ethical clearance was obtained from Institutional Ethical Committee of Sivagiri Sree Narayana Medical Mission College of Nursing, Varkala. Prior to the data collection permission was obtained from Secretary and Medical Director of Sivagiri Sree Narayana Medical Mission Hospital, Varkala. The selected patients were informed about the purpose of the study and informed consents were taken.

 

Pilot study was conducted from 24.12.2015 to 04.01.2016. The sample consisted of 5 high risk patient of Sivagiri Sree Narayana Medical Mission Hospital, Varkala. Initially pre test was done to the selected samples and structured teaching programme was given for 30 minutes. Post test was done after 1 week and the data was analysed using descriptive and inferential statistics.

 

After the conduction of the pilot study, the study was found to be feasible. The concerned authority and the sample were found to be co-operative. The questionnaire and structured teaching programme were relevant and the time and cost for the study was within limit. Because of the limitation of time and difficulty to obtain greater number of sample from a single hospital, it was suggested to conduct the main study in two separate hospitals from Varkala.

 

Section I:

Distribution of high risk patients according to demographic characteristics:

This section deals with the data pertaining to demographic characteristics of high risk patients with respect to age, sex, education, occupation, family history of stroke and source of health information.

 

Table I Distribution of high risk patients according to age (n=90)

Age

f

%

40–45yrs

15

16.7

46–50yrs

28

31.1

51–55yrs

11

12.2

56–60yrs

36

40.0

 

Table 2 Distribution of high risk patients according to gender (n=90)

Gender

f

%

Male

36

40.0

Female

54

60.0

 

Table 3 Distribution of high risk patients according to education (n=90)

Education

f

%

Primary Education

12

13.3

High School

42

46.6

Higher Secondary

24

26.6

Graduation and above

12

13.3

 

Table 4 Distribution of high risk patients according to occupation (n=90)

Occupation

f

%

Unemployed

15

16.7

Govt. employee

16

17.8

Private employee

29

32.2

Self-employee

30

33.3

 

Table 5 Distribution of high risk patients according to family history of stroke (n=90)

Family history of stroke

 f

%

Yes

 32

35.6

No

 58

64.4

 

Table 6 Distribution of high risk patients according to source of health information (n=90)

Source of health information

f

%

News paper

55

61.0

Television

14

15.6

Radio

14

15.6

Health related magazine

5

5.6

Health related professionals

2

2.2

 

Section II:

Knowledge of high risk patients regarding prevention and warning signs of stroke

 

Table 7 Distribution of high risk patients according to pre-test knowledge level (n=90)

Knowledge level

f

 %

Poor

60

 66.7

Average

26

 28.9

Good

4

 4.4

 

DISCUSSION, SUMMARY AND CONCLUSION:

This chapter gives a brief account of the major findings of the present study and discussion in relation to similar studies conducted by other researchers. It further includes summary, conclusion, nursing implication, limitation and recommendations for the study.

 

DISCUSSION:

The present study focuses on the effect of structured teaching programme on knowledge regarding prevention and warning signs of stroke among high risk patients attending medical outpatient departments in selected hospitals at Varkala. The finding of the present study is compared with the findings of other studies which the investigator reviewed.

 

The first objective of the study was to assess the knowledge regarding prevention and warning signs of stroke among high risk patients and the study results revealed that 66.7 % had poor knowledge, 28.9% had average knowledge and only 4.4% had good knowledge

 

The findings was supported by a study, conducted by Marceus BN, Amanda GT at Hyderabad on knowledge of risk factors and warning signs of stroke in 2005 revealed that knowledge about prevention and warning signs of stroke was not adequate.

 

Second objective was to determine the effect of structured teaching programme on knowledge of high risk patients regarding prevention and warning signs of stroke and the results revealed that the average knowledge score among the high risk patients after the structured teaching programme was 17.34. There is significant difference in mean knowledge score of high risk patients before and after teaching strategy which is significant at 0.001 level (t=9.76). So it is interpreted that structured teaching programme is effective in increasing the knowledge of high risk patients regarding prevention and warning signs of stroke.

 

A similar study was conducted by Wall H, Beaqan B M, O’Neill H J, Foel K M, Wills C B (2008) addressed stroke signs and symptoms through public education. The study findings revealed that the educational material was useful tool for improving knowledge of stroke signs and symptoms among Non Hispanic White and Non Hispanic black women age 40-60 years.

 

The third objective was to find out the association between the level of knowledge of high risk patients regarding prevention and warning signs of stroke and selected socio-demographic variables. The study findings revealed that there is association between level of knowledge regarding prevention and warning signs of stroke and selected socio demographic variables like age, education and family history of stroke.

 

The findings of the present study was supported by an integrated review of published studies on stroke knowledge and awareness by Jones S P, Jenkinson A J, Lethley M J, Walkins C L (2009). The results of the study revealed that, older members of the population, ethnic minority groups and those with lower levels of education had consistently poor level of knowledge about recognizing and preventing stroke.

 

SUMMARY:

The present study was intended to assess the effect of structured teaching programme on knowledge regarding prevention and warning signs of stroke among high risk patients at medical out patient departments in selected hospitals at Varkala.

The objectives of the present study were to:-

1.      Assess the knowledge regarding prevention and warning signs of stroke among high risk patients

2.      Determine the effect of structured teaching programme on knowledge of high risk patients regarding prevention and warning signs of stroke

3.      Find out the association between the level of knowledge of high risk patients regarding prevention and warning signs of stroke and selected socio-demographic variables

 

The investigator adopted Pender’s Revised Health Promotion Model (2006) as the conceptual framework for the present study. An extensive review of related literature was done to develop the conceptual framework and selection of the tool. The literature review also helped in determining the effectiveness of intervention and plan for determining the analysis.

 

In this study quasi experimental one group pre-test post-test design and simple random sampling method were used and sample consisted of 90 high risk patients. The tool used for the study was a structured knowledge questionnaire. The reliability of the tool was obtained by using split half method, in which the reliability was 0.81.

A pilot study was conducted to find out the feasibility of proposed study among 10 samples. It was found that the tool was unambiguous and data obtained were amenable to statistical analysis.

 

The main study was conducted in Taluk Hospital, Varkala and Sivagiri Sree Narayana Medical Mission Hospital, Varkala. Based on the inclusion criteria samples were selected from the hospitals. Socio demographic data and pretest knowledge was assessed among high risk patients using the questionnaire. The investigator administered the structured teaching programme to the selected samples. The doubts were cleared during the session. After 2 weeks, post-test knowledge was assessed with the same questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) 16 version.

 

CONCLUSION:

Based on the findings of the study the following conclusions were drawn. High risk patients had inadequate knowledge regarding prevention and warning signs of stroke. Structured teaching programme was effective in improving knowledge of high risk patients regarding prevention and warning signs of stroke. There is significant association between knowledge of high risk patients and their age, education, occupation and family history of stroke. There is no significant association between knowledge of high risk patients and other demographic variables.

 

NURSING IMPLICATIONS:

The present study has got implications in nursing service, nursing administration, nursing education and nursing research.

 

Nursing practice:

1.    The nurses can utilize the structured teaching programme prepared for this study as a model for preparing other teaching material

2.    The findings of the study can be used to make the high risk patients aware about warning signs of stroke in a patient centered way

3.    The planned teaching programme prepared in the study can be used by nurses working in Community Health Center for giving health education to high risk patients

 

Nursing Education:

1.      The study findings can serve as a background for further study

2.      Teachers can utilize the findings to teach students in class room and clinical settings

3.      The research report can be kept in the college library for reference

4.      Nurse educators can encourage the students to conduct health education programmes regarding prevention and warning signs of stroke.

 

Nursing Administration:

1.      Nurse administrators can use this planned teaching programme to conduct awareness programmes for the public regarding prevention and warning signs of stroke

2.      Nurse administrators can utilize the planned teaching programme to organize continuing education programme for health team workers in various healthcare settings

3.      Nurse administrators can organize hypertension and diabetes clinic in each hospital where the patients can directly have contact with the nurses who are in charge of these clinics. Such clinics should be organized in community settings also.

4.      Nurse administrators can motivate the nursing personnel to participate and conduct health education programmes on various strategies to prevent the development of stroke

5.      Health information can be imparted through printed materials and small group teaching to the hypertensive patients

6.      Nurse administrators can arrange for health education on prevention and warning signs of stroke in community settings

 

Nursing Research:

1.      The study findings can be utilized as a background for further study

2.      The findings of the study can be published in a journal so that dissemination of the information is possible

3.      Tool used in the study can be standardized by conducting further studies

4.      More researches can be conducted in this area using other methods of teaching and the perceived barriers faced by the high risk patients on life style modification practices

 

LIMITATION:

The limitations of the present study are

1.      The influence of extraneous variables during the period between pre-test and post-test in the samples cannot be explored

2.      As the study was conducted in small number of samples generalization of findings is restricted

 

RECOMMENDATION:

In the light of present study, the following recommendations were put forwarded.

1.      The same study can be conducted on a larger sample over a longer period of time which might yield more reliable results

2.      Similar study can be conducted in different settings

3.      Similar study can be replicated in different population with cluster sampling technique

 

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Received on 07.07.2018       Modified on 18.08.2018

Accepted on 28.09.2018       ©A&V Publications All right reserved

Int.  J. of Advances in Nur. Management. 2018; 6(4): 293-298.

DOI: 10.5958/2454-2652.2018.00067.7