A Study to assess the Effectiveness of Aloe Vera Gel Dressing on Wound Status among Patients with Diabetes Mellitus in Government Hospital, Dindigul

 

T. Linda Daphne¹, Vijayarani Prince²

¹Lecturer, Quality Healthcare College of Nursing, 4/5, Pp Layout, Subramanyapura Post, Utterahalli,

Bangalore-560061

²Former Principal, Bishop’s College of Nursing, C.S.I Mission Compound, Dharapuram-638656.

 

ABSTRACT:

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Among the various health problems Ulceration of the foot is common, disabling and requires extensive financial resources for its management. The aim of the study was to assess the effectiveness of Aloe Vera Gel dressing on wound status among patients with diabetes mellitus. An evaluative approach was used for the study. The design used for this study was quasi experimental non-equivalent pre-test post-test control group research design. The conceptual frame work was based on General system theory (Ludwig Von Bertlanffy, 1968). Sample size was 60 out of which 30 were in experimental group and 30 were in control group. The sample selected by non-probability purposive sampling technique and the wound status was assessed using Bates Jenson wound assessment scale (BWAT). The collected data were analyzed using descriptive and inferential statistics.  The paired ‘t’ value 18.333 showed that post test level of wound status was lower than the pre-test level of wound status in the experimental group which was significant at p<0.05. The Independent ‘t’ value 19.386 showed that the post-test level of wound status in the experimental group was lower than the post-test level of wound status in the control group which was significant at p<0.05 level. The result of the study concluded that the intervention given was effective in improving the wound healing among the patients with diabetes mellitus.

 

 

 

 

INTRODUCTION:

Diabetes mellitus is a chronic disease caused by the body’s inability to produce insulin, or by the ineffective use of the insulin produced. Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems. Diabetic foot problems are caused by changes in blood vessels and nerves that can lead to ulceration and subsequent limb amputation.

 

WHO projects that diabetes will be the 7th leading cause of death in 2030. Even though there are lot of health schemes and treatment with free of cost rendered by the government, the risk of complications developing in diabetes mellitus is increasing day by day due to poor knowledge, lack of exercises and improper diet. Diabetic foot ulcers are one among the complications of diabetes mellitus. They are frequently observed in medical practices and require extensive financial resources for its management. Simply controlling glucose levels, though essential, does not necessarily ensure these lesions will heal. There is a need for a topical management and it should be cost effective. The literatures show that the Aloe Vera gel has good effect in reducing level of wound status and promotes wound healing. Thereby the research was planned to conduct a study by using Aloe Vera gel in reducing the level of wound status among patients with diabetes mellitus.

 

NEED FOR THE STUDY:

Diabetic foot ulcers are the chronic leg ulcers. They are frequently observed in medical practices and require extensive financial resources for its management. Simply controlling glucose levels, though essential, does not necessarily ensure these lesions will heal. There is a need for a topical management and it should be cost effective. The investigator felt that there is a need to do some intervention to reduce the level of wound status and improve healing.  After reviewing related literatures the investigator came to know that the Aloe Vera gel has good effect in reducing level of wound status and promotes wound healing. So the researcher planned to conduct a study by using Aloe Vera gel in reducing the level of wound status among patients with diabetes mellitus.

 

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of Aloe Vera Gel dressing on wound status among patients with diabetes mellitus in Government hospital, Dindigul.

 

OBJECTIVES:

1.     To assess the pretest and posttest level of wound status among patients with diabetes mellitus in experimental group.

2.     To assess the pretest and posttest level of wound status among patients with diabetes mellitus in control group.

3.     To compare the pretest and posttest level of wound status among patients with diabetes mellitus in experimental group.

4.     To find out the effectiveness of posttest level of  wound status among patients with diabetes mellitus between experimental and control group

5.     To find the association between posttest level of wound status among patients with diabetes mellitus and their selected demographic variables in experimental group.

 

 

HYPOTHESES:

H₁:   The mean posttest level of wound severity score is significantly lower than the mean pretest level of wound severity score in the experimental group.

H₂:   The mean posttest level of wound severity score in the experimental group is significantly lower than the mean posttest level of wound severity score in the control group.

H₃:   There will be a significant association between the posttest level of wound severity score among patients with diabetes mellitus with their selected demographic variables in experimental group.

 

MATERIALS AND METHODS:

Research Approach:

An evaluative approach was used for this study.

 

Research Design:

The research design selected for the study was Quasi experimental non-equivalent control group pretest and posttest control group design.

 

Setting of the Study:

The study will be conducted in Government Hospital, Dindigul

 

Population:

In this study the target population was patients with diabetes mellitus with diabetic foot ulcer.

 

Sample:

Patients with diabetes mellitus with mild to moderate severity of wound who are admitted in surgical ward in government hospital, Dindigul.

 

Sample Size:

Sample size was 60. Among 60 patients, 30 were in experimental group and 30 were in control group

 

Sampling Technique:

Non probability purposive sampling technique was used to select the sample for the study.

 

Instrument and Scoring Procedure:

The tool consists of two parts,

 

PART-I:

It consists of demographic variables such as age, sex, educational status, occupational status, marital status, family  monthly  income, duration of illness, duration of treatment, habit of smoking, and habit of alcohol.

 

PART-II:

Bates-Jensen wound assessment tool (BWAT) by observational method was used to assess the wound status.

 

SCORING PROCEDURE:

Score was interpreted as follows,

Severity of wound	Bwat scale score	Percentage %
Minimal severity of wound	13-20	20-31
Mild severity of wound	21-30	32-47
Moderate severity of wound	31-40	48-62
Critical severity of wound	41-65	63-100

 

VALIDITY:

The validity of the tool was obtained from 4 Medical Surgical Nursing experts and from a chief surgeon. The standard scales are considered valid.

 

PROTECTING THE HUMAN SUBJECTS:

The research proposal was approved by the dissertation committee prior to conduction of study. The written permission was obtained from the Medical Superintendent. Oral consent was obtained from each participant after explaining the purpose of the study before collecting the data. Confidentiality of the information was maintained.

 

DATA COLLECTION PROCEDURE:

The study was conducted in Government hospital, Dindigul for a period of 5 weeks. The written permission was obtained from Medical Superintendent, Government Hospital, Dindigul and oral permission was obtained from each study participants prior to the study. Purpose of the study was explained to the participants. Samples were chosen by purposive sampling technique. The patients with mild to moderate severity of wound were selected by using BWAT scale by observational method. 30 samples were selected for experimental group and 30 samples were selected for control group. In experimental group 30 samples were selected in 3 groups, 10 samples in each group. Aloe Vera gel dressing was continued for 10 days in each group. On the first day demographic variables of the samples was collected by interview method then the pre assessment of the wound was done using BWAT scale. Aloevera gel dressing was done for 10 samples for 10 days and continued for 2 more groups in experimental group. The post test was done on 5^th and 10th^th day by using BWAT scale in experimental group. In control group 6-7 samples were selected daily. On the first day demographic variables of the samples was collected by interview method then the pre assessment of the wound was done using BWAT scale. Hospital routine was followed in control group, and the post test was done on 10^th day using BWAT scale.  Data obtained was tabulated, analyzed by using descriptive and inferential statistics.

 

RESULT ANALYSIS:

TABLE 1: Comparison of mean score, standard deviation and paired ‘t’ value of pre-test and post-test level of wound status among patients with diabetes mellitus in the experimental group.                          n=30

df=29                                                       (P<0.05)

 

TABLE 2:  Comparison of mean score, standard deviation and independent ‘t’ test value of post-test severity of wound status score among patients with diabetes mellitus between experimental and control group.                       n₁=30, n₂=30

df=58                                                                                                                        (P<0.05)

 

The Table (1) shows that the mean pretest wound status score in experimental group was 35 (SD ± 3.2) and posttest mean score was 21 (SD ± 2.1). The posttest mean score (21) was lower than the pretest mean score (35). The mean difference between pretest and post test score was 14. The ‘t’ value was 18.333 which was significant at < 0.05 level in the experimental group.

 

table (2) depicts that the mean post-test severity of wound status in the experimental group is 21(SD±2.1) and the mean post-test severity of wound status in the control group is 33(SD±2.7).The mean post-test score of wound status in the experimental group 21(SD±2.1) was significantly lower than the mean post-test severity of wound status in the control group 33(SD±2.7). The mean difference was 12. The Independent ‘t’ value was 19.386 which was significant at p<0.05 level.

 

DISCUSSION:

The data analysis showed that the paired ‘t’ value was 18.333 which was significant at < 0.05 level in the experimental group, and the Independent ‘t’ value was 19.386 which was significant at p<0.05 level between the experimental and control group.

 

The Chi square values calculated to find the association between the post-test wound severity score among the patients with diabetes mellitus and their selected demographic variables in the experimental group revealed that there was no significant association with their selected demographic variables.

 

Rose.D. Santham., (2012) Patients with type II Diabetes foot ulcer endure a debilitating health because of the chronicity of ulcer. A true experimental study design was used to assess the cost effectiveness by the use of Aloe gel among 50 patients in the experimental group against 50 patients in the control group (betadine gel) with type II diabetic foot ulcer. Cluster random sampling was used to segregate the subjects. The total cost of the ulcer management was reduced significantly with the use of Aloe gel (t value of 4.03, p<.001 level) when compared with the control group.

 

CONCLUSION:

The present study assessed the effectiveness of Aloe Vera Gel dressing on the level of wound status among patients with diabetes mellitus in Government hospital, Dindigul. The paired ‘t’ value 18.333 showed that posttest level of wound severity score was lower than the pre-test level of wound severity score in the experimental group which was significant at p<0.05. The Independent ‘t’ value 19.386 showed that the post-test level of wound severity score in the experimental group was lower than the post-test level of wound severity score in the control group which was significant at p<0.05 level. The result of the study concluded that the intervention given was effective in reducing the wound severity and in improving the wound healing among the patients with diabetes mellitus.

 

IMPLICATIONS:

Nursing service:

§       The nurses can practice Aloe vera gel application and dressing on reducing the severity of wound status among patients with diabetes mellitus as a evidence based practice.

§       Nurse as the change agent can update knowledge to the nurses on alternative therapies to promote wound healing among diabetes mellitus patients

 

Nursing research:

1.       The study findings can be a base line for further studies to build upon for improving the body of knowledge in nursing.

2.       The study findings can effectively be utilized by the emerging researchers to implement the similar intervention on non-diabetic wounds.

 

RECOMMENDATIONS:

·         A comparative study can also be done between the effectiveness of various non – pharmacological measures on reducing the severity of wound status.

·         A similar study can be conducted on larger samples there by findings can be generalized to a larger population.

·         A similar study can be conducted in home care setting.

 

REFERENCE:

1.      Basavanthappa, B. T. (2003) “Medical surgical nursing”, (1^sted) New Delhi: Jaypee Brothers medical publishers (p) Ltd.  P.P = 734– 744

2.      Black, M. Joyce et. al (2005) “Medical surgical nursing”, (7^thed) Missouri, sounders. P.P=649-664,

3.      Brockop, Y. Dorothy, et. al (2003) “Fundamental of nursing research” (3^rded) USA, Jones and Bartlett publishers P.P =105 – 111

4.      Gurumani, N,(2005) “An introduction to biostatistics”, (2^nded) New Delhi, MJP  publishers (p) Ltd P.P =211 – 213, 347 – 369

5.      Jarrelllstephens B, (1994) “Basic statistics”, (1 ed) W.M.C Brown publishers, P.P =108 – 141.

6.      Lewis, et. al, (2007) “Medical surgical nursing” 7^thed, Missouri, Mosby publication, P.P 292 – 301

7.      http://www.who.int/diabetes/action_online/basicslen/index.html

8.      http://www.salisburypost.com/article/20131206/SP03/131209772/

9.      http://clinical.gov/ct2/shoeNCT_00615420

10.   http://www.cochranelibrary.com

11.   http://en.wikipedia.org/aloevera

12.   http://en.wiktionary.org/wiki/diabeticfoot

 

 

 

Received on 20.03.2019         Modified on 10.04.2019

Accepted on 30.04.2019       ©A&V Publications All right reserved