A Study to Evaluate the Effectiveness of Structured teaching programme on knowledge regarding Pulmonary rehabilitation among COPD patients in selected hospital at Udaipur city

 

 

Mr. Digpal Singh Chundawat¹, Mr. Sanjay Nagda², Mr. Dinesh Kumar Patidar³

¹Principal, Tirupati College of Nursing, Bedla, Dist.: Udaipur.

 ²HOD of Medical Surgical Department, Tirupati College of Nursing, Bedla, Dist.: Udaipur.

³Second Year M.Sc. Nursing Student, Tirupati College of Nursing, Bedla, Dist.: Udaipur.

 

ABSTRACT:

Background: COPD Modern and effective pulmonary rehabilitation programs are global, multidisciplinary, individualized and use comprehensive approach acting on the patient as a whole and not only on the pulmonary component of the disease. In the last two decades interest for pulmonary rehabilitation is on the rise and a growing literature including several guidelines is now available. This review addresses the recent developments in the broad area of pulmonary rehabilitation as well as new methods to consider in the development of future and better programs. Modern literature for rationale, physic- pathological basis, structure, exercise training as well challenges for pulmonary rehabilitation programs are addressed. Among the main challenges of pulmonary rehabilitation, efforts have to be devoted to improve accessibility to early rehabilitation strategies, not only to patients with COPD but to those with other chronic respiratory diseases. Aims and Objective: To assess the pretest and posttest knowledge on pulmonary rehabilitation among patient with chronic obstructive pulmonary disease. To evaluate the effectiveness of structured teaching program regarding pulmonary rehabilitation among patient with chronic obstructive pulmonary disease. To find out association between pre-test and post-test knowledge of pulmonary rehabilitation with selected demographic variables. Methods: A quantitative approach using pre experimental one group pre-test –post-test design. 120 COPD patients were selected using non probability convenient sampling at Udaipur district. Structured teaching program was given to the COPD at Udaipur district. Self-structure questionnaire will prepare and used to assess the knowledge of COPD patients regarding pulmonary rehabilitation. Results: The maximum numbers of chronic obstructive pulmonary disease patients 40.0% were in the age group of 31-40 years.The maximum numbers of chronic obstructive pulmonary disease patients 66.0% were in the male.The proportion of 50 chronic obstructive pulmonary disease patients 36% were in secondary educationThe proportion of 50 chronic obstructive pulmonary disease patients 46%were earning Rs.5000-10000 per month The proportion of 50 chronic obstructive pulmonary disease patients 90% were married persons.The proportion of 50 chronic obstructive pulmonary disease patients 36% were farmer.The maximum numbers of chronic obstructive pulmonary disease patients 56.0% were in the 1-5 years duration of illness. The level of knowledge was inadequate among 28%, moderately adequate among 60.0% and it was adequate only in 12% before structured teaching program.The level of knowledge was adequate among 44% and it was moderately adequate in 56% after structured teaching program.The mean of knowledge regarding pulmonary rehabilitation in the pretest was 14.68 and in the posttest was 20.06% respectively.It revealed that structured teaching program was found to be effective in improving in knowledge regarding pulmonary rehabilitation among chronic obstructive pulmonary disease patients.There was a significant difference in the mean scores between pretest and posttest in relation to knowledge of chronic obstructive pulmonary disease patients regarding pulmonary rehabilitation.There is significant association Between the Knowledge and demographic variables education, types of occupation, duration of illness of the chronic obstructive pulmonary disease patient at P<0.05 level.

 

 

INTRODUCTION:

Chronic obstructive Pulmonary disease refers to several disorders that affect the movement of air in and out of the Lungs although, the most important of these obstructive, bronchitis, emphysema, and asthma-may occur in pure form, they most commonly coexist, with overlapping clinical manifestations. The term COPD is commonly used, but some pulmonologist think it is not completely accurate and the term chronic air flow limitations may be used in its place. It describes that it can occurs as a result of increased airway resistance secondary to bronchial mucosal edema or smooth muscle contraction. It may also be a result of decreased elastic recoil, as seen in emphysema. Elastic recoil, similar to the recoil of stretched rubber band, is the force. Used in passively to deflate the lung and eschale, decreased, elastic recoil results in a decreased driving force to empty the lung. Chronic Pulmonary disease poses enormous burdens to society both in terms of direct cost of health care services and indirect costs to society through loss of productivity. The exact prevalence of Bronchial Asthma is difficult to determine because of problems with definition and coding. Despite the high prevalence and enormous cost to health care and society. Bronchial Asthma is thought of as a self-inflicted disease and affects more elderly people. Bronchial Asthma is not such an obvious killer like lung cancer therefore receives a less emotive response

 

NEED OF THE STUDY:

The World Health Organization (WHO) estimates that COPD as a single cause of death shares 4th and 5th places with HIV/AIDS (after coronary heart disease, cerebrovascular disease and acute respiratory infection).

 

The WHO estimates that in 2000, 2.74 million people died of COPD worldwide. In 1990, a study by the World Bank and WHO ranked COPD 12th as a burden of disease; by 2020, it is estimated that COPD will be ranked 5th.

 

According to the WHO, passive smoking carries serious risks, especially for children and those chronically exposed. The WHO estimates that passive smoking is associated with a 10 to 43 percent increase in risk of COPD in adults.

 

Although cigarette smoking is the primary cause of COPD, the WHO estimates that there are 400,000 deaths per year from exposure to biomass fuels.

 

In Algeria, the prevalence of tuberculosis and acute respiratory infection has decreased since 1965, but an increase in chronic respiratory diseases (asthma and COPD) has been observed in the last decade. COPD is estimated to be 6.2 percent in 11 Asian countries surveyed by the Asian Pacific Society of respiratory diseases. The study was carried out in the pulmonary research laboratory. Department of Medicine, SMS Medical College and Hospital, Jaipur, forty patients participated in the study. Their mean age was 59.37 + 6.4 years (range 48 to 75 years). Out of these 32 (80%) were males and 8 (20%) females. Twenty patients were included in each group, control and experimental. Both the control and the experimental groups were comparable in respect of age and sex, as in one second (FEV), and forced vital capacity (FVC). In experimental group, the mean (+SD) FEV, was 28% (7.5) while in the control group it was 26% (7.1) of the predicted value.

 

STATEMENT OF THE PROBLEM:

“A Study to Evaluate the Effectiveness of Structure Teaching Program on Knowledge Regarding Pulmonary Rehabilitation Among Patient with Chronic Obstructive Pulmonary Disease in Selected Hospitals at Udaipur City Rajasthan".

 

OBJECTIVE:

·       To assess the pretest and posttest knowledge on pulmonary rehabilitation among patient with chronic obstructive pulmonary disease

·       To evaluate the effectiveness of structured teaching program regarding pulmonary rehabilitation among patient with chronic obstructive pulmonary disease.

·       To find out association between pre-test and post-test knowledge of pulmonary rehabilitation with selected demographic variables.

 

HYPOTHISIS:

H₁:    There is significant difference between pre-test and post-test knowledge of pulmonary rehabilitation.

H₂: There is a significant association between knowledge of pulmonary rehabilitation with selected demographic variables.

 

MATERIAL AND METHODS:

A quantitative research approach using pre experimental one group pre-test post-test design. 120 COPD patients were selected using non probability convenient sampling at Udaipur district. Structured teaching program was given to the COPD patients at Udaipur district. Self-structure questionnaire will prepare and used to assess the knowledge of pulmonary rehabilitation and chronic obstructive pulmonary disease.

 

RESULTS:

Demographic data was analyzed using frequency and percentage. Frequencies, percentage, mean, median, mean percentage and standard deviation was used to determine the knowledge score. The ‘T’ value was computed to show the effectiveness of structured teaching program and chi-square test was done to determine the association between the pretest knowledge of COPD patients with selected demographic variables.

 

Finding related to demographic data:

The maximum numbers of chronic obstructive pulmonary disease patients 40.0% were in the age group of 31-40 years.The maximum numbers of chronic obstructive pulmonary disease patients 66.0% were in the male.The proportion of 50 chronic obstructive pulmonary disease patients 36% were in secondary educationThe proportion of 50 chronic obstructive pulmonary disease patients 46%were earning Rs.5000-10000 per month The proportion of 50 chronic obstructive pulmonary disease patients 90% were married persons.The proportion of 50 chronic obstructive pulmonary disease patients 36% were farmer.The maximum numbers of chronic obstructive pulmonary disease patients 56.0% were in the 1-5 years duration of illness.

 

Finding related to pre and post knowledge score:

SECTION I:

Table 2: Frequency and Percentage Distribution of Chronic Obstructive Pulmonary Disease Patients According to Demographic Variables

Demographic variables		No. of patients	%
Age	20 -30 yrs	15	10%
	30 -40 yrs	55	48%
	40- 50 yrs	30	25%
	Above 50 yrs	20	18%
Sex	Male	75	62%
	Female	45	38%
Educational Status	Illiterate	27	24%
	Primary	40	33%
	Secondary	28	23%
	Graduate	25	20%
	Others	0	0%
Socio Economic Status	Below Rs.5000/-	43	35%
	Rs.5000/- to 10000/-	50	45%
	Above Rs.10000/-	27	20%
Marital status	Unmarried	20	16%
	Married	75	62%
	Separated	16	14%
	Divorce	9	8%
Type of occupation	Unemployed	35	29%
	Labour	20	18%
	Farmer	40	33%
	Professional	13	10%
	Retired	12	10%
Duration of illness	Below 1 yrs	45	39%
	1 to 5 yrs	55	51%
	Above 5 yrs	20	19%

 

SECTION II:

Table 3: Pretest Percentage of Domains of Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Patient Knowledge

Domain	No. of questions	Min-Max score	Knowledge score
			Mean score	%
Disease Condition	5	1-5	2.62	52.40%
Avoid Triggers	5	1-5	2.32	46.40%
Diet	5	1-5	2.5	50%
Exercise	5	1-5	2.3	46%
Inhaler Therapy	5	1-5	2.4	48%
Home care	5	1-5	2.54	50.8%

 

 

Figure 10: Pyramid diagram depicting each domain pretest percentage of knowledge score

 

They are having pretest knowledge related disease condition (52.40%), avoid _{and triggers (46.40%), diet (50%), exercise (46%), inhaler (48%), home care (50.8%).}

 

Table 4: Posttest Percentage of Different Aspect of Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Patient Knowledge

Domain	No. of questions	Min-Max score	Knowledge score
			Mean score	%
Disease Condition	5	1-5	3.48	69.6%
Avoid Triggers	5	1-5	3.36	67.2%
Diet	5	1-5	3.34	66.8%
Exercise	5	1-5	3.26	65.2%
Inhaler Therapy	5	1-5	3.3	66%
Home care	5	1-5	3.32	66.4%

 

Figure 11: Cone diagram depicting each domain posttest percentage of knowledge score

 

They are having pretest knowledge related disease condition (69.6%), avoid and triggers (67.2%), diet (66.8%), exercise (65.2%), inhaler (66%), home care _(66.4%).

 

SECTION III:

TABLE 5: Total Pretest Level of Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Patients Knowledge

Knowledge	Number of Samples	Percentage
Inadequate	68	58%
Moderately adequate	37	30%
Adequate	15	12%

 

Figure 12: Cylinder diagram depicting pretest percentage of knowledge score

 

Level of pretest copd rehabilitation knowledge:

58% of the COPD patients are having inadequate knowledge 30% of the COPD patients are having moderately adequate knowledge _{12% of the COPD patients are having adequate knowledge}

 

Table 6: Total Post-test Level of Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Patients Knowledge

Knowledge	Number of Samples	Percentage
Inadequate	7	4%
Moderately adequate	48	40%
Adequate	65	56%

 

Figure 13: Cone diagram depicting posttest percentage of knowledge score

 

4% of the COPD patients are having inadequate knowledge 40% of the COPD patients are having moderately adequate knowledge _{56% of the COPD patients are having adequate knowledge}

 

SECTION IV:

Table 7: Comparison of Mean Scores between Pretest and Post Test on Knowledge of Pulmonary Rehabilitation COPD Patients (Sub Section Wise)

Components	Observation	Mean	Mean Difference	SD	‘t’ value	Significance
Disease condition	Pre-test	3.95	0.46	0.7885	8.65	Significant P<0.05
	Post-test	3.58
Avoid triggers	Pre-test	1.72	1.09	0.5987	9.00	Significant P<0.05
	Post-test	2.47
Diet	Pre-test	2.9	0.69	0.8945	6.03	Significant P<0.05
	Post-test	2.98
Exercise	Pre-test	1.3	0.49	0.2354	10.54	Significant P<0.05
	Post-test	2.16
Inhaler therapy	Pre-test	2.74	0.7	0.4598	8.82	Significant P<0.05
	Post-test	3.76
Home care	Pre-test	3.84	0.97	0.5698	9.87	Significant P<0.05
	Post-test	3.52

 

The disease condition pre-test mean score was 3.95 and post- test mean score was 3.58, standard deviation was 0.7885, t= 8.65, The avoid triggers pre-test mean score was 1.72 and post- test mean score was 2.47, standard deviation was 0.5987, t=9.00. The diet pre-test mean score was 2.9 and post- test mean score was 2.98, standard deviation was 0.8945, t=6.03. The Exercise pre-test mean score was 1.3 and post- test mean score was 2.16, standard deviation was 0.2354, t=10.54. The Inhaler therapy pretest mean score was 2.74 and post - test mean score was 3.76, standard deviation was 0.4598, t=8.82. The Homecare pre-test mean score was 3.84 and post-test mean score was 3.52, standard deviation was 0.5698, t=9.87.

 

TABLE 8: Comparison of Mean Scores between Pretest and Posttest on Knowledge of Pulmonary Rehabilitation COPD Patients (Total)

Components	Observation	Mean	Mean Difference	SD	‘t’ value	Significance
Knowledge score Total	Pre-test	18.1	8.8	2.9848	20.69	Significant P<0.05
	Post-test	26.9

 

There is a significant increase in knowledge regarding pulmonary _{rehabilitation after structure teaching program than before.}

 

SECTION V:

Table 9: Association between Knowledge and Demographic Variables of COPD Patients Regarding Pulmonary Rehabilitation

Demographic variables		Level of Knowledge						Chi- Square Value	Significance
		Inadequate		Moderate		Adequate
		N	%	N	%	N	%
Age	20 -30 yrs	42	42.89	45	60.00	33	20.00	x2=4.386 P=0.6246	Significant
	30 -40 yrs	5	22.57	35	70.00	1	5.00
	40- 50 yrs	12	9.23	10	62.50	2	12.50
	Above50yrs	8	12.56	5	33.33	2	22.22
Sex	Male	45	32.25	55	49.78	18	12.12	x2= 0.589 P=0.5698	Not Significant
	Female	35	25.95	59	51.81	39	31.82
Education al Status	Illiterate	47	39.43	52	42.36.00	19	11.89	x2=11.89 P=0.258	Not Significant
	Primary	56	46.3600	36	29.75	28	21.28
	Secondary	29	21.58	52	42.52	31	22.97
	Graduate	11	8.50	55	39.00	50	41.56
	Others	0	0.00	0	0.00	0	0.00
Socio Economic Status	Below Rs.5000/-	45	31.56	49	41.88	26	20.84	x2=4.856 P=0.5689	Not Significant
	Rs.5000/-to 10000/-	56	45.84	54	44.84	10	3.52
	Above Rs.10000/-	21	16.25	65	54.56	35	27.893
Marital status	Unmarried	43	35.59	59	48.00	29	20.10	x2=7.568 P=0.536	Not Significant
	Married	54	44.84	39	28.92	30	19.82
	Separated	0	0.00	0	0.00	1	100.00
	Divorce	0	0.00	0	0.00	01	0.00
Type of occupation	Un-employed	50	41.00	49	39.97	18	12.45	x2=5.399 P=0.006	Not Significant
	Labor	61	54.96	30	23.95	32	26.58
	Farmer	82	70.45	18	11.85	20	14.89
	Professional	12	6.56	55	43.56	58	47.56
	Retired	0	0.00	0	0.00%	0	0.00
Duration of illness	> 1 yrs	48	38.80	61	56.70	10	6.80	x2 =12.76 P=0.004	Not Significant
	1 to 5 yrs	56	47.00	62	56.86	8	4.84
	< 5 yrs	25	17.54	85	71.43	12	8.43

 

CONCLUSIONS:

The following conclusions were derived based on the study findings:

Structure teaching program was effective to increase the knowledge regarding pulmonary rehabilitation among chronic obstructive pulmonary disease patients.

 

As per the study findings, the level of knowledge was adequate only in 12% in the pretest, whereas during posttest; the level of knowledge of study subjects was adequate among 54% and 5% was inadequate level of knowledge.

 

There was a significant difference in the mean scores between pretest and posttest in relation to knowledge of chronic obstructive pulmonary disease patients, regarding pulmonary rehabilitation.

 

There is significant association between the knowledge and demographic variable with Age of the chronic obstructive pulmonary disease patient at p<0.05 level.

 

REFERENCES:

1.      Alberta’s, (2000), “Pulmonary and rehabilitation”, 1^st edition, Lippincott Williams Publication, Pp.: 143, 158.

2.      Basavanthappa.B.T. (2005), “Nursing research”, Jaypee Brothers medical publisher Pvt. Ltd., Pp.: 153-219.

3.      Brunner and Suddhanths (2004), “Text Book of Medical Surgical Nursing”, 10^th edition, Lippincott Williams and Wilkins, Pp.: 416-465.

4.      Craig L, Scanion, Charles B, Spearman, Richard L. Sheldon (1990) “Egan’s Fundamentals of Respiratory Care” (6^th edition) North California. Mosby Company. Pp: 21-45

5.      David H.E, Roger C and Bone, (1995) “Comprehensive Respiratory Care, A learning System” The 856 illustration, U.S.A. The Vc Mosby Company.

6.      Dr. David Bellary, (2004), “COPD Primary care”, 3^rd edition, British Library, Pp.: 220-235

7.      Hodgkin E.J. Celli, R.B. Connors L.G., (2000) “Pulmonary Rehabilitation Guide lines to success” (3^redition) Philadelphia; Lippincott Williams and Wilkins company. Pp; 34-48

8.      James, (2005), “Principles of exercise testing”, 4^th edition, Library of congress cataloging, Pp: 585, 230.

9.      JOCE M. BLACK, (2005), “Medical Surgical Nursing”, 7^th edition, Elsevier publications, India Pp: 1691-1704.

10.   John R. (1996), “Pulmonary Rehabilitation”, 1^st edition, Philadelphia Mosby Company, Pp: 173.

11.   Kothari. C.R., (2002), “Research Methodology methods and technique”, 3^rd edition, K.K. Gupta of Newage International (P) Ltd Publication, Pp: 277-299.

12.   Krause, (2000), “Food, nutrition and diet therapy”, W.B. Saunders company Publisher, Pp:815-832.

13.   Lewis, S. M. Heit Kemper M.L. and Derik son, S.R. (2000) “Medical Surgical Nursing, Assessment and Management of Clinical problems” (5^th edition) Philadelphia Mosby Company.

14.   Madame C and Vincent (1998) “Pulmonary Function Testing and Cardio Pulmonary stress testing”, (2^nd edition,) Washington: Thomson publishing company. Pp; 845-856

15.   Morgan M. and Singh S. (1997) “Practical Pulmonary Rehabilitation” 1st edition London Chapman and Hall Medical Company.

                                                                                                                              

Received on 24.07.2020         Modified on 22.08.2020

Accepted on 15.09.2020       ©A&V Publications All right reserved