JAN – JUN 2014    VOL-15, NO.1

LEADERSHIP FOR PROFESSIONALISM IN TRANSFORMING CHALLENGES INTO OPPORTUNITIES IN NURSING: A PERSONAL REFLECTION

* Ratna Prakash, M. Sc (N)., Ph. D

ABSTRACT

The growth of any profession depends on its ability to meet public expectations. The advent of health consumerism has imposed new demands on nursing. To keep pace, modern nursing education has developed its curriculum to include concepts of holistic health. But there remain many challenges and concerns in nursing practice areas. Some are related to the existing healthcare delivery system and its governance while others are innate, for example our aptitude, attitude, and personal way of life. The situation demands strong and committed nursing leadership to resolve these issues.

Keywords: leadership, professionalism in nursing, nursing education, transformation
* Principal, Pal College of Nursing and Medical Sciences, Uttarakhand

CYSTIC FIBROSIS : A CASE PRESENTATION

* Julie Thomas, MS., RN., FNP-BC

ABSTRACT

Traditionally, cystic fibrosis has long been viewed as a disease mainly affecting Caucasians. In India, the exact incidence of the disease is unknown. Treatment delays are likely if healthcare providers believe cystic fibrosis is nonexistent in the Indian community. Ultimately treatment delays can negatively affect the quality of life for patients and their families. This article provides an overview of the pathophysiology, diagnosis, treatment, and management options for cystic fibrosis, but illustrates this through the life of an Indian family living in United States affected by the disease. Healthcare providers have a tendency to view the inability to cure a disease as a treatment failure. By taking a retrospective look into the life of an Indian family affected by the disease, clinicians can begin to find purpose beyond treating an illness.

Keywords: cystic fibrosis, case presentation, autosomal-recessive disease, genetic disorder
* Family Nurse Practitioner, Concentra Medical Centres, Texas, U.S.A.

REFERENCES

Allen, J., & Visner, G. (2007). Lung transplantation in cystic fibrosis-primum non nocere? The New England Journal of Medicine, 357(21), 2186-8.

American Lung Association. (2010). Cystic fibrosis. Retrieved from http://www.lung.org /assets/documents/ publications/solddc-chapters/cf.pdf

Best, C., Brearley, A., & Gaillard, P., Regelmann, W., Billings, J., Dunitz, J., . . . Schwarzenberg, S. J. (2011). A pre-post retrospective study of patients with cystic fibrosis and gastrostomy tubes. Journal of Pediatric Gastroenterology and Nutrition, 53(4), 453-458.

Centre for Genetics Education. (2007). Autosomal Recessive Inheritance (Fact Sheet). Retrieved from Center for Genetics Education: http://www.genetics.edu.au/ Information/ Genetics-Fact-Sheets/Autosomal-Recessive-Inheritance-FS8

Elkins, M. R., Robinson, M., Rose, B. R., Harbour, C., Moriarty, C. P., Marks, G. B., . . . Bye, P. T. P. (2006). A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis. The New England Journal of Medicine, 3, 229-240.

Flume, P. A., O'Sullivan, B. P., & Robinson, K. A. (2007). Cystic fibrosis pulmonary guidelines Chronic medications for maintenance of lung health. American Journal of Respiratory and Critical Care Medicine, 10, 957-969. doi: 10.1164/rccm.200705-664OC

Gershman, A. J., Mehta, A. C., Infeld, M., & Budev, M. M. (2006). Cystic fibrosis in adults: An overview for the internist. The New England Journal of Medicine, 12, 1065-1074. doi: 10.3949/ccjm.73.12.1065

Grossman, S., & Grossman, L. C. (2005). Pathophysiology of cystic fibrosis: Implications for critical care nurses. Critical Care Nurse, 25, 46-51. Retrieved from http://www.cconline.org/

Konstan, M. W. (2013). Newborn screening for cystic fibrosis. Retrieved from http://www.netwellness .org / healthtopics/cysticfibrosis/cfnewborntesting.cfm

Moran, A., Pekow, P., Grover, P., Zom, M., Slovis, B., Pilewski, . . . Allen, H. (2009). Insulin therapy to improve BMI in cystic fibrosis-related diabetes without fasting hyperglycemia. Diabetes Care, 32(10), 1783-88.

National Center for Biotechnology. (2012). Genetic testing registry. Retrieved from http://www.ncbi.nlm. nih.gov / gtr/labs/?term=india

Navotdhan Ministries. (2009). Johny. Retrieved from http://www.navajeevodayam.com

Noke, C., & Kabra, S. K. (2006). Country close up: India. Retrieved from http://www.cfww.org/ docs/pub/edition07/10_india

Rowe, S. M., Miller, S., & Sorscher, E. J. (2005). Cystic Fibrosis. The New England Journal of Medicine, 19, 1992-2001.

Samuel, G. (2006). Rejoice in spite of sorrows. The Trumpet. Retrieved from http://www.trumpetmagazine. com/ read.aspx?lang=1&id=2&mid=50

Samuel, J. G. (1996). Impossible but for God. Tiruvalla, Kerala, India: Value Education Centre.

U. S. Department of Health & Human Services. (2011). What is cystic fibrosis. Retrieved from http://www.nhlbi. nih.gov/health/health-topics/topics/cf/

ACHONDROPLASIA : A CASE REPORT

* Priscilla R. Sam, M. Sc (N)

ABSTRACT

Achondroplasia is a congenital condition that is genetically inherited (autosomal dominant) that results in an abnormal stature associated with disproportionate short limbs. The average height of an adult with achondroplasia is 131 cm in males and 124 cm in females. Nursing management of patients with achondroplasia is mainly supportive. Understanding how genetics can affect families of these patients is important for nurses to provide adequate support to the families. This article highlights the nursing care that was provided for a patient with achondroplasia in the form of a case report.

Keywords: achondroplasia, autosomal dominant disorder, short limbs, genetic disorder, nursing care
* Professor, College of Nursing, Christian Medical College, Vellore

REFERENCES

Achondroplasia. (2008). Retrieved from http://peterswordoftheday.wordpress.com /2008/09/12/ achondroplasia/

Achondroplasia symptoms. (n.d.). Retrieved from http://library.thinkquest.org/06aug /00440/aachosymptoms.html

Achondroplasia symptoms and diagnosis 3 (n.d). retrieved from http://ahsmediacenter.pbworks.com /w/page /2027806/ Achondroplasia%20Symptoms%20and%20 Diagnosis%203

Aviezer, D., Golembo, M., & Yayon, A. (2003). Fibroblast growth factor receptor-3 as a therapeutic target for Achondroplasia Genetic short limbed dwarfism. Current Drug Targets, 4(5), 353 - 365.

Bhat, S. R. (2009). Achar's textbook of paediatrics (4th ed.). Hyderabad: University Press.

Gaillard, F. (2014). Achondroplasia. Retrieved from http://radiopaedia.org/cases/achondroplasia-2 Joyce, A. (2010). Achondroplasia and FGFR3. Retrieved from http://joycegen677s10.weebly.com/ discussion.html

Kaisermann, M. C. (2012). Treating achondroplasia: Concepts and misconcepts about the potential therapies in development. Retrieved from http://tratando-acondroplasia.blogspot.in/2013/01/treating-achondroplasia-concepts-and.html

Kliegman, R. M., Stanton, B. M. D., St. Geme, J., Schor, N., & Behrman, R. E. (2011). Nelson's textbook of paediatrics (19th ed.). Philadelphia: Saunders company.

Kyle, T., & Carman, S. (2008). Essentials of paediatric nursing (2nd ed.). China: Lippincott Williams & Wilkins.

McIntosh, N., Helms, P. J., Smyth, R. L., & Logan, S. (2008). Textbook of paediatrics (7th ed.). China: Elsevier Limited.

National Fragile X Foundation. (2014). What causes FXTAS. Retrieved from http://www.fxtas.org/ causes.htm

Potts, N. L., & Mandleco, B. (2012). Paediatric nursing: Caring for children and their families (3rd ed.). Delmar: Cengage Learning.

Schoenstadt, A. (2014). Genetics, Achondroplasia and FGFR3 gene. Retrieved from http://bones.emedtv.com / achondroplasia/achondroplasia-genetics.html

Wynn, J., King, T. M., Gambello, M. J., Waller, D. K., & Hecht, J. T. (2007). Mortality in Achondroplasia. American Journal of Medical Genetics - Part 1, 21, 2502 - 2511

Zhang,S., & Liu, M. (2007). FGFR3 in families with autosomal dominant achondroplasia. Retrieved from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?



KEY CONCERNS AND CHALLENGES OF NURSING AND MIDWIFERY TEACHING AND TRAINING IN INDIA

* Rajni Bagga, M.A., Ph.D., PGDPHM
** Vaishali Jaiswal, M.Sc., NET
*** Ritika Tiwari, M.B.A.

ABSTRACT

Pre-service and in-service education and training of nurses in India faces various challenges in the areas of understaffed educational institutions and skills deficits among managers and practitioners. These influence quality of health services. This paper is part of a World Health Organization (WHO) supported study, entitled “Study on nursing and midwifery in India: A critical review”. It aims to review and critically examine the issues and challenges related to nursing and midwifery teaching and training in India, and suggest suitable strategies for development of competent nursing and midwifery human resources. The study was descriptive and highly qualitative in nature with information collected from both primary and secondary sources. These sources included principals, faculty members, students of nursing educational institutions, state nursing council registrars, and nursing experts at state and central levels. Various reports and research documents were also reviewed. In-depth interviews, focus group discussions and observation were used to collect primary data. Review of the syllabuses of Auxiliary Nurse Midwife (ANM), General Nurse Midwife (GNM), and Bachelor of Science (B.Sc.) courses suggested that the actual midwifery clinical exposure and the hands-on training for conducting deliveries is very inadequate. Feedback received from students of nursing teaching institutions confirmed this. The major problem faced by the educational institutions was non-implementation of the syllabuses, due to numerous constraints and barriers, which are broadly management related. The findings revealed that there is a great need among teaching institutions to strengthen hands-on training of students through proper placement in the hospitals and the community. Measures must be taken to set up modern laboratories and demonstration rooms, and to create adequate infrastructure in the schools and colleges. This can be made possible if the teachers are also required to practice clinical skills themselves, so that they have up to date knowledge and practical skills.

Keywords: auxiliary nurse midwife training centres, general nursing and midwifery training centres, teaching and training nursing institutions, nursing and midwifery workforce
* Professor and Head, Dept. of Management Sciences, National Institute of Health and Family Welfare (NIHFW), New Delhi
** Assistant Research Officer, Dept. of Management Sciences, NIHFW
*** Programme Officer, Public Health Foundation of India, New Delhi

REFERENCES

Academy for Nursing Studies, Hyderabad. (2005). Situational analysis of public health nursing personnel in India -Based on national review and consultations in six states. India: Training Division, Ministry of Health and Family Welfare, Government of India with support from UNFPA.

Academy of Nursing Studies (ANSWERS), & National Health Systems Resource Centre (NHSRC). (2009). Study Reports on nursing workforce in Chhattisgarh, Rajasthan, Bihar, Orissa: Current situation, requirements and measures to address shortages. New Delhi: ANSWERS, NHSRC

Bagga, R., Tiwari, R., Jaiswal, V., & Abraham, A. (2013). The changing faces of nursing and midwifery from the ancient to the post independence period in India. Indian Journal of Continuing Nursing Education, 14(1), 10-24

Government of India, Planning Commission. (2011). Faster, Sustainable and More Inclusive Growth- An Approach to the Twelfth Five Year Plan (2012-17). New Delhi, India: Government of India.

Hatem, M., Sandall, J., Devane, D., Soltani. H., & Gates, S. (2008). Midwife-led versus other models of care for child bearing women. Cochrane Database of Systematic Reviews, 8(4), CD004667. doi: 10.1002/14651858. CD004667.pub2

Indian Nursing Council. (1963). Syllabus and regulations- Auxiliary Nurses and Midwives. New Delhi: Indian Nursing Council.

JIndian Nursing Council. (2001). Syllabus and regulations-General nursing and midwifery. New Delhi: Indian Nursing Council.

Indian Nursing Council. (2004a). Syllabus and regulations- Basic B.Sc. Nursing. New Delhi: Indian Nursing Council.

Indian Nursing Council. (2004b). Syllabus and regulations- Auxiliary Nurses and Midwives. New Delhi: Indian Nursing Council.

International Confederation of Midwives. (2011). Essential competencies for basic midwifery practice 2010. Retrieved from http://www.unfpa.org/sowmy/ resources/docs/ standards/en/R430_ICM_2011_ Essential_Competencies_ 2010_ENG.pdf

Kartar Singh Committee Report. (1973). Report of committee on multipurpose worker under health and family planning. Retrieved from http://nihfw.org/NDC/ DocumentationServices/Reports/Kartar%20Singh%20 Committee%20Report.pdf

Kumar D. (2005). Nursing for the Delivery of Essential Health Interventions in India: In Background paper for the National Commission on Macroeconomics and Health. New Delhi: Ministry of Health and Family Welfare, Government of India, 175-183.

Maine, D. (1993). Safe motherhood programs: options and issues. New York; Centre for Population and Family Health, Columbia University. Retrieved from http://www.amddprogram.org/v1/resources /SMProgOptions andIssuesEN.pdf.

Mavalankar, D., & Vora, K. S. (2008). The Changing Role of Auxiliary Nurse Midwife (ANM) in India: Implications for Maternal and Child Health (MCH). Ahmedabad, India: Indian Institute of Management .

Mavalankar, D., Vora, K., & Sharma, K. (2009). Strengthening midwifery services. Maternal and Newborn Health-Symposium on strategies to improve mother and child care. Retrieved from http://www.india-seminar.com/2009/604/604_dileep_at_al.htm

Mavalankar,D., Singh, A., Patel, S. R., Desai, A., & Singh, P. V. (2009). Saving mothers and newborns through an innovative partnership with private sector obstetricians: Chiranjeevi scheme of Gujarat, India. International Journal of Gynecology and Obstetrics, 107, 271276

National Health Mission. (2010). Rural Health Statistics Bulletin. New Delhi: Ministry of Health & Family Welfare, Government of India.

National Institute of Health and Family Welfare (n.d., a). Assessment of Nursing Management Capacity in the States of Uttra pradesh. Retrieved from www.nihfw.org/pdf/Nsg%20Study.../Uttar%20Pradesh% 20Report.pdf

National Institute of Health and Family Welfare. (n.d., b). Assessment of Nursing Management Capacity in the States of West Bengal. Retrieved from nihfw.org/pdf/Nsg%20Study-Web/West% 20Bengal%20Report.pdf

National Institute of Health and Family Welfare. (n.d., c). Assessment of Nursing Management Capacity in the States of Tamil Nadu. Retrieved from www.nihfw.org/pdf/ Nsg%20Study-Web/ Tamil%20Nadu%20Report.pdf

Starrs, A. (2006). Safe motherhood initiative: 20 years and counting. Lancet, 368, 1130- 1132.

United Nations Population Fund. (2011). Delivering health, saving lives. Retrieved from http://www.unfpa.org/sowmy/ resources/docs/main_report/en_SOWMR_Full.pdf

World Health Organization (WHO). (2010). Wanted: 2.4 million nurses, and that's just in India. Bulletin of World Health Organization, 88, 321-400.


AWARENESS PROGRAMME ON DISASTER PREPAREDNESS AMONG SCHOOL TEACHERS IN A SOUTH INDIAN SETTING

Eldho B. Rajan, M.Sc (N)
** Anice George, M.Sc (N)., Ph.D
*** Maxie Andrade, M.Sc (N)., M.Phil (N)

ABSTRACT

It is evident that mitigation and investment in disaster preparedness can save thousands of lives and vital economic assets, preserve livelihoods and reduce the overall cost of disaster relief. This study aimed to assess the impact of a programme to sensitize and empower school teachers as trained rescue volunteers by teaching them about disaster preparedness and selected rescue techniques. The study adopted a quasi-experimental, pretest posttest control group design and was conducted in selected schools of Udupi District, Karnataka. A sample of thirty subjects each were selected for the experimental and control group using convenience sampling technique. The experimental group participated in an awareness programme on disaster preparedness including a disaster mock drill as an intervention. Effectiveness of the awareness programme was assessed. Pre and post intervention in both groups using a knowledge questionnaire and rescue skill checklist. Data were analyzed using Wilcoxon Signed rank test and Mann Whitney U test. There was a significant improvement in knowledge (Z= 4.794, p= .001) and skill in selected rescue techniques (One rescuer human crutch: Z = 4.841, p= .001; Pack strap carry: Z = 4.830, p = .001; Fireman's lift: Z=4.807, p = .001; Two rescuer human crutch: Z=4.832, p= .001; Two handed seat: Z = 4.863, p = .001) among school teachers in the experimental group. There was no association between pre-test knowledge and the demographic variables. Disaster at school may involve a large number of young victims. Equipping school teachers with necessary rescue skills and knowledge can not only save lives and assets but will also serve as a ready manpower for rescue efforts at community level.

Keywords: disaster preparedness, knowledge, rescue technique

* Programme Officer, Jhpiego, Jabalpur, Madhya Pradesh
** Dean, Manipal College of Nursing, Manipal
*** Assistant Professor, Manipal College of Nursing, Manipal

REFERENCES

Burke, R. V., Ferrer, R. R., & Goodhue, C. J. (2010). Disaster preparedness among medical students: A survey assessment. American Journal of Disaster Medicine. 5(5), 275-84.

Government of India. (2002). Disaster risk management programme: Community based disaster reduction and recovery through participation of communities and local self governments. New Delhi: Ministry of Home Affairs, National Disaster Management Division. Retrieved from http://www.ndmindia.nic.in/eqprojects/goiundp2.0.pdf

IIan, L., & Tanya, P. (2008). Sparking up an old flame: A process evaluation of the fire awareness and intervention programme (FAIP) in New Zealand. New Zealand Fire Service Commission, 97, 221-225.

Liane, S. (2004). Home study program fire in the OR: Prevention and preparedness. Association of PeriOperative Registered Nurses Journal, 80(1), 41- 60.

National Institute of Disaster Management of India. (n.d). School safety. Retrieved from http://www. ndmindia.nic.in/WCDRDOCS/School%20Safety%20Version%201.0.pdf

Olivia, W. M., Alice, Y. L., & Claudia, K. Y. (2008). Disaster preparedness among Hong Kong nurses. Journal of Advanced Nursing, 62(6), 698-703.

Samuel, R. T. (2012). Saving lives: Hospital preparedness towards emergency. Indian Journal of Continuing Nursing Education, 13(1), 8-10.

KNOWLEDGE, PRACTICE, AND HEALTH PROBLEMS RELATED TO MENSTRUATION AMONG YOUNG WOMEN

* Mala Thayumanavan, M.Sc (N)

ABSTRACT

A cross sectional descriptive study was conducted on knowledge, practice, and health problems of 50 young women regarding menstruation in a selected urban area of Bangalore. A structured self administered questionnaire was used to collect the data (Cronbach's alpha = .75). Women in the age group of 19 35 years were selected by non probability convenience sampling technique. Pregnant and lactating women were excluded. Among the 50 women, 8% had adequate knowledge, 62% had moderately adequate knowledge and 30% had inadequate knowledge on various aspects of menstruation. Premenstrual syndrome (88%) and dysmenorrhea (90%) were the most prevalent menstrual problems identified. The common symptoms of premenstrual syndrome and dysmenorrhea reported were backache (60%), lower abdominal colicky pain (44%), muscle cramps on thigh and pelvic region (50%), breast tenderness (32%), irritability (42%), and decreased work performance (30%). The other reported symptoms were headache, pelvic congestion, pallor, syncope, nausea, vomiting, anger, and lack of concentration. The practice of young women regarding menstruation included consulting doctor for menstrual problems (44%), taking self -medication for menstrual pain (62%) and taking medicine regularly for menstrual pain (40%). There was a statistically significant association (p < .05) between the practice related to menstruation and educational status of young women. The study findings highlighted the need for educating women about healthy practices during menstruation which include appropriate nutrition, exercise and physical activity, personal hygiene, and appropriate use of medication based on physician's prescription.

Keywords: menstruation, premenstrual syndrome, dysmenorrhea, knowledge, practice, health problems, young women

* Dean, Manipal College of Nursing, Bangalore

REFERENCES

Baridalyne, N., & Reddaiah, V. P. (2004). Menstruation: Knowledge, beliefs and practices of women in the reproductive age group residing in an urban resettlement colony of Delhi. Health and Population- Perspectives and Issues, 27(1), 9-16.

Dasgupta, A., & Sarkar, M. (2008). Menstrual hygiene: How hygienic is the adolescent girl? Indian Journal of Community Medicine, 33(2), 77-80.

Lawan, U. M., Yusuf, N. W., & Musa, A. B. (2010). Menstruation and Menstrual Hygiene amongst Adolescent School Girls in Kano, Northwestern Nigeria. African Journal of Reproductive Health, 14(3), 201.

Omidvar, S., & Begum, K. (2010). Factors influencing hygienic practices during menses among girls from South India A cross sectional study. International Journal of collaborative Research on Internal Medicine & Public Health, 2(12), 411-423.

Pradhan, A. (2009). Is menstrual hygiene and management an issue for adolescent school girls? A comparative study of four schools in different settings of Nepal. Retrieved from http://www.indiahabitat.org/qefl/link/Practices/wa_nep_mhm_rep_march2009.pdf

Royal College of General Practitioners. (1990). 1981-1982 Morbidity statistics from general practice: Third national study: Socio-economic analysis, series 5. London: Office of Population Censuses and Surveys, Department of Health

Sharma, P., Malhotra, C., Taneja, D. K., & Saha, R. (2008). Problems related to menstruation amongst adolescent girls. Indian Journal of Pediatrics, 75(2), 125-9.

Singh, A. J. (2006). The place of menstruation in the reproductive lives of women of rural north India. Indian Journal of Community Medicine, 31(1), 10-14.

Singh, A., Kiran, D., Singh, H., Nel, B., Singh, P., & Tiwari, P. (2008). Prevalence and severity of dysmenorrhea: a problem related to menstruation. Indian Journal of Physiology and Pharmacology, 52(4), 389- 397

SAMPLING IN QUANTITATIVE RESEARCH

* Punitha Ezhilarasu, M.Sc. (N)., Ph.D

ABSTRACT

Sampling in quantitative research is highly significant and it is the responsibility of the researcher to select a sound sampling strategy to meet the goals of research. Selection of appropriate sampling strategy is important to make inferences and generalize the same to a larger population. The researcher needs to understand the significance and develop competence in making the best choice of the sampling strategy to make it highly representative of the population. This article explains the important concepts related to sampling and presents the various types of sampling strategies or methods illustrating with examples. The advantages and disadvantages of each method are also enumerated. The sampling bias or errors that can occur during sampling is highlighted. It is hoped that the novice researcher gains a clear understanding of the sampling strategies that can be used in quantitative research.

Keywords: Sampling, probability, non-probability, quantitative research
* Professor, College of Nursing, CMC, Vellore

REFERENCES

Burns, N., & Grove, S. K. (2011). Understanding nursing research: Building an evidence-based practice (5th ed.). Ist Indian reprint 2012, New Delhi: Elsevier.

Gnanarani, J., Vekatesan, L., Ambrose, N. S., & Yuvarani, P. (2013). Utilization, satisfaction and perception on use of complementary and alternative medicine therapies among nurses. Indian Journal of Continuing Nursing Education, 14(2), 29-34.

Houser, J. (2008). Nursing research: Reading, using, and creating evidence. USA: Jones & Bartlett Learning.

Jaicy., Lee, P., Simpson, C., & George, R. (2012). Relationship of health locus of control to perception of health seeking behaviors to prevent cervical cancer. Indian Journal of Continuing Nursing Education, 13(1), 22-26.

LoBiondo-Wood, G., & Haber, J. (2014). Nursing research: Methods and critical appraisal for evidence-based practice (8th ed.). St. Louis: Elsevier

Lobo, D. (2012). Knowledge of postmenopausal women on cervical cancer and its prevention n a south Indian setting. Indian Journal of Continuing Nursing Education, 13(2), 51-53.

Mamta, M., & Saini, S.K. (2013). Obstetric morbidities and treatment seeking behavior among pregnant women. Indian Journal of Continuing Nursing Education, 14(2), 73-76.

Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott Williams & Wilkins.

Schrank, B., Woppman, A., Sibitz, I., & Lauber, C. (2011). Development and validation of an integrative scale to assess hope. Health Expectation, 14(4), 417-428.

Shavro, S. A., Ezhilarasu, P., Augustine, J., Bechtel, J. J, & Christopher, D. J. (2012). Correlation of health related quality of life with other disease severity indices in Indian chronic obstructive pulmonary disease patients. International Journal of Chronic Obstructive Disease, (7), 291-296. DOI:///dx.doi.org/10.2147/COPD.S26405

Shetty, A. P, Prakash, R., & Prakash, N. (2012). Health status and its association with selected sociodemographics among South Indian adolescents. Indian Journal of Continuing Nursing Education, 13(2), 24-31.

Tappen, R. M. (2011). Advanced nursing research: From theory to practice. Sudbury: Jones & Bartlett Learning.

Willgerodt, M. A. (2008). Family and peer influences on adjustment among Chinese, Fillipino, and White youth. Nursing Research, 57(6), 395-405. doi: 10.1097/NNR.0B013e3181907175

NEONATAL RESUSCITATION

* Ebenezer E. Benjamin, M.Sc (N)
** Christy Simpson, M.Sc (N)
*** Julin Joseph, B.Sc (N)

ABSTRACT

Caring for a newborn at birth is a challenging task. Good knowledge and skills are essential for newborn care. Neonates make a physiological transition from intra-uterine to extra-uterine life without difficulty which is a natural phenomenon. Some may need support for physiological functions such as ventilation and circulation. This is called neonatal resuscitation. The newborn who needs assistance can be identified during labour by carefully monitoring the fetal heart rate of high risk women in labour. The nurses are in a position to identify the 'at risk newborn' at birth to meet the immediate needs during the critical stage. Immediate care is provided with continuous observation of breathing, heart rate, activity and color to determine the need for additional interventions. It is mandatory that each hospital should have newborn resuscitation policy at work and a team of trained personnel each with designated roles and skills. All equipment should be fully functional and available within the resuscitation area. Effective resuscitation is brought about through a sequence of evaluation, decision and action.

Keywords: newborn, resuscitation, immediate care, ventilation, endotracheal intubation
* Professor, College of Nursing, CMC, Vellore
** Professor (Retired), College of Nursing, CMC, Vellore
*** Tutor, College of Nursing, CMC, Vellore

REFERENCES

Cloherty, J. P. (2012). Manual of neonatal care (7th ed.). New Delhi: Lippincott publications.

Division of Neonatology and Department of Pediatrics. (n.d). Teaching aids on neonatal resuscitation. New Delhi: All India Institute of Medical Sciences.

Fraser, D. M., & Cooper, M. A (2009). Myles Textbook for midwives (15th ed.). China: Elsevier publications, 751.

Freeze, R. (2011). Neonatal resuscitation. Retrieved from http://rixarixa.blogspot.in/2011/03/neonatal-resuscitation. html

Kattwinkel, J. (Ed). (2009). Textbook of neonatal resuscitation (5th ed.). New Delhi: Jaypee Brothers Medcial Publishers (Indian Reprint).

Kattwinkel, J., Perlman, J. M., Aziz, K., Colby, C., Fairchild, K., Gallagher, J., . . . Zaichkin, J. (2010). Part 15: Neonatal resuscitation: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 122, S909 - S919.

Lindower, J., & Klein, J. M. (2012). Medications for neonatal resuscitation. University of Iowa Children's Hospital. Retrieved from http://www.uichildrens.org/ uploadedFiles/ UIChildrens/Health_Professionals/ Iowa_Neonatology_Handbook/Pulmonary/MedicationsForNeonatalResuscitation.pdf

NeoResus. (2011). Learning module 1: Key concepts and guidelines. Retrieved from http://www.neoresus.org.au/ pages/LM1-7-Circulation.php

Reeder, S. J., & Koniak-Griffin, D. (1997). Maternity nursing: Family, newborn, and women's health care. UK: Lippincott and Wilkins.

Simpson, K. R., & Creehan, P. A. (2001). Awhonn prenatal nursing (2nd ed.). Philadelphia: Lippincott Williams and Wilkins.

Singh, M. (2010). Care of the newborn (7th ed.). New Delhi: Sagar publications. 444- 447.

Tayade, S., & Kumar, N. (2012). Aetiology of perinatal mortality: A study in a rural setting. International Journal of Biomedical Research, 3(7), 327-330.

Tseng, C. J. (n.d). Immediate newborn conditions or problems. Retrieved from http://www.csh.org.tw/dr.tcj/ N%20teaching/Neonatal%20Resuscitation%20Supplies%20and%20Equipment.htm

University of Saskatchewan. (2006). Neonatal post-resuscitation stabilization and preparation for transport. Retrieved from http://www.babyfirst.com/en/ documents/ neonatal_transport/Neonatal_post-resuscitation_stabilization_and_preparation_for_transport.pdf

BEHCET'S DISEASE: AN AUTOIMMUNE DISEASE

* Angel R. Ruban, B.Sc (N)

ABSTRACT

Behcet's disease is a rare autoimmune disease. It is more commonly seen in Turkey, Middle Eastern countries and Japan. It is characterized by oral apthous ulcer, genital ulcer and uveitis. It causes systemic vasculitis. The cause is unknown, but it may be triggered by certain infectious agents. Carriers of human leucocyte antigen-B51/B5 have a higher chance of developing this disease. Some theories explain that increased production of cytokines leads to this disease and is fatal if it causes pulmonary artery aneurysms. The treatment includes immunosuppressants, steroids and immunomodulators. Nurses play a pivotal role in identifying the clinical features early to prevent various other complications.

Keywords: Behcet's disease, Behcet's syndrome, Silk Road Disease, oral ulcers, uveitis

* M. Sc Nursing Student, College of Nursing, CMC, Vellore

REFERENCES

Adamantiades, B. (1930). A case of recurrent hypopyon iritis. Medical Society of Athens, 586-93. Retrieved from http://emedicine.medscape.com/article/329099-overview#a0101

Alnaimar, A. F., & Lisse, R. J. (2013). Behcet's disease. Retrieved from http://emedicine.medscape.com/ article/329099

Bang, D., Cho, Y., Choi H-J., Lee, S., Sohn, S, & Lee, E. S. (1996). Detection of herpes simplexvirus DNA by polymerase chain reaction in genital ulcer of patients with Behçet's disease. 7th International conference on Behçet's disease. Tunis.

Behçet, H. (1937). Uberrezidivierende, aphthose, durchein Virus verursachteGeschwure am Mund, am Auge und an denGenitalien. Dermatol Wochenschir, 36, 1152-1157. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/ articles/ PMC1741755/pdf/v076p00629.pdf

De Menthon, M., Lavalley, M. P, Maldini, C., Guillevin,. L, & Mahr, A. (2009). HLA-B51/B5 and the risk of Behçet's disease: A systematic review and meta-analysis of case-control genetic association studies. Arthritis Rheumatology, 61(10),1287-1296. doi: 10.1002/art.24642.

Direskeneli, H. (2001). Behçet's disease: infectious aetiology, newautoantigens, and HLA-B51. Annals of the Rheumatic Diseases, 60, 996-1002. doi: 10.1136/ard.60.11.996. Retrieved from http://www.ncbi. nlm.nih.gov/pmc/articles/PMC1753405/pdf/v060p00996.pdf

Feigenbaum, A. (1956). Description of Behçet's syndrome in the Hippocratic third book of endemic diseases. British Journal of Ophthalmology, 40, 355-357. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC509495/pdf/brjopthal00486-0057.pdf

Hatemi, G., Silman, A., Bang, D., Bodaghi, B., Chamberlain, A. M., Gul, A., . . . Yazici, H. (2008). EULAR recommendations for the management of Behçet disease. Annals Rheumatology Dieases, 67(12), 1656-1662. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/ 18245110doi: 10.1136/ard.2007.080432.

Krause, I., Yankevich, A., Fraser, A., Rosner, I., Mader, R., Zisman, D., . . . Weinberger, A. (2007). Prevalence and clinical aspects of Behcet's disease in the north of Israel. Clinical Rheumatology, 26 (4), 555-560. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16897122

Mehra, N. K., Taneja, V., Kailash, S., & Vaidya, M. C. (1986). Distribution of HLA Antigens in a sample of North Indianl Hindu Population. Tissue Antigens, 27, 64-74.

Singal, A., Chhabra, N., Pandhi, D., & Rohatgi, J. (2013). Behcet's disease in India: A dermatological perspective. Indian Journal of Dermatology, Venereology and Leprology, 199-204. Retrieved from http://search. proquest.com/health/ docview/ 1323440721/ fulltext/D27EB70908264C8BPQ/1?accountid=37964

Swierzewki, J. S. (2012). Overview of Behcet's disease. Retrieved from http://www.healthcommunities. com/ behcets-disease/index.shtml

TCMWELL.COM. (2011). Behcet's disease care points. Retrieved from http://www.tcmwell.com /TCM_News/ tcmnews/Behcet-s-disease-care-points.html

Yoshikawa, K., Kotake, S., & Matsuda, H. (1996). Behçet's disease and streptococcal antigens. Acta Societatis Ophthalmologicae Japonicae, 100, 173 - 180. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC1741755/pdf/v076p00629.pdf

SELF-ESTEEM AMONG URBAN INDIAN ADOLESCENTS

* Rogina J. S. Savarimuthu, M.Sc (N)

ABSTRACT

Healthy self-esteem or positive self-regard is feeling competent, lovable and approved. The adolescent period is a period of turmoil as the adolescent has to meet the demands of the changing self, the family and the society. A descriptive study was conducted to determine the degree of self-esteem among adolescents utilizing the Rosenberg self-esteem scale. Most of the adolescents had moderate degree of self-esteem. Nurses using this scale can identify adolescents with low self-esteem and intervene to improve their self-esteem. Positive self-esteem protects adolescents against mental distress and enables them to cope adaptively with difficult and stressful in life situations.

Keywords: self-esteem, adolescent, Rosenberg self-esteem scale
* Asst. Professor, Matha College of Nursing, Manamadurai

REFERENCES

Adolescent Self-Esteem. (2003). ACT for youth upstate center of excellence research, facts and findings. Retrieved from http://www.actforyouth.net/ resources/rf/rf_slfestm_ 0603.pdf

Aiger, A. (2011). The effects of low self esteem in children. Retrieved from http://www.livestrong.com/article/ 138859-the-effects-low-self-esteem-children

Chatard, A., Selimbegovic, L., & Konan, P. N. (2009). Self-esteem and suicide rates in 55 Nations. European Journal of Personality. 23(1), 19-32.

Darlington, R., Margo, J., Sternberg, S., & Burks, B. K. (2011). “Teenage girls' self-esteem is more than skin-deep…”- Through the looking glass. Retrieved from http://www.demos.co.uk/files/Looking_glass_-_web.pdf?1303410606

Deborah, P. (2005). Helping adolescents and adults to build self-esteem. London: Jessica Kingsley Publishers.

Dhal, A., Bhatia, S., Sharma, V., & Gupta, P. (2007). Brief report: Adolescent self-esteem, attachment and loneliness. Journal of Indian Association for Child and Adolescent Mental Health, 3(3), 61-63. Etcoff, N., Orbach, S., Scott, J., & D'Agostino, H. (2004). “The real truth about beauty: A global report”-Findings of the global study on women, beauty and well-being. Retrieved from http://www.strategyone.com/ documents/dove_white_ paper_final.pdf

Hinduja, S., & Patchin, J. W. (2010). Cyberbullying research summary-Cyberbullying and self-esteem. Cyberbullying research center. Retrieved from http://www.cyberbullying. us/cyberbullying_and_self_ esteem_research_fact_sheet.pdf

Karademir, T., Acak, M., & Coban, B. (2011). Self esteem levels of students who participate in special ability examinations to attend the department of physical education and sport teaching in Turkey. World Applied Sciences Journal. 12 (3), 279-286.

McClure, A. C., Tanski, S. E., Kingsbury, J., Gerrard, M., & Sargent, J. D. (2010). Characteristics associated with low self-esteem among U.S. adolescents. Academic Pediatrics. 10(4), 238 - 244.

McGee, R., Williams, S., & Nada-Raja, S. (2001). Low self-esteem and hopelessness in childhood and suicidal ideation in early adulthood. Journal of Abnormal Child Psychology, 29(4), 281-291

McGee, R., Williams, S., & Nada-Raja, S. (n.d.). Hope and self-esteem in childhood and suicidal thoughts in early adulthood. Retrieved from http://www.spinz.org.nz/file/ downloads/doc/file_218.doc

Miller, C. (2010). Low Self-Esteem in Children. Retrieved http://www.livestrong.com/article/204880-low-self-esteem-in-children/

Nagar, S., Sharma, S., & Chopra, G. (2008). Self esteem among rural adolescent girls in Kangra district of Himachal Pradesh. Anthropologist, 10(2), 151-154.

Raevuori, A., Dick, D. M., Keski-Rahkonen, A., Pulkkinen, L., Rose, R. J., Rissanen, A., . . . Silventoinen, K. (2007). Genetic and environmental factors affecting self-esteem from age 14 to 17: A longitudinal study of Finnish twins, Psychological Medicine, 37(11), 16251633. doi: 10.1017/S0033291707000840 Retrieved http:// www.ncbi.nlm.nih.gov/pmc/articles/ PMC2084483/ Robins, R. W., Donnellan, M. B., Widaman, K. F., & Conger, R. D. (2010). Evaluating the link between self-esteem and temperament in Mexican origin early adolescents. Journal of Adolescence, 33(3), 403 - 410.

Robinson, J. P., & Shaver, P. R. (1973). Measures of social psychological attitudes. Ann Arbor, Michigan: Institute for Social Research, the University of Michigan.

Rosenberg, M. (1965). Rosenberg society and the adolescent self-image. Princeton, N.J: Princeton University Press. Retrieved from http://www.fetzer.org/sites/default/files/ images/stories/pdf/selfmeasures/Self_Measures_for_Self-Esteem_ROSENBERG_SELF-ESTEEM.pdf

Rosenberg, M. (1989). Society and the adolescent self-image. Revised edition. Middletown, CT: Wesleyan University Press. Retrieved from http://www.yorku.ca/rokada/ psyctest/rosenbrg.pdf Sears, W., & Sears, M. (2011). 12 ways to help your child build self-confidence. Retrieved from http://www. askdrsears.com/topics/child-rearing-and-development/12-ways-help-your-child-build-self-confidence

Thomas J. J., & Daubman, K. A. (2001). The relationship between friendship quality and self-esteem in adolescent girls and boys. Sex Roles. 45(1-2), pp 53-65. doi: 10.1023/A:1013060317766

Whitesell, N. R., Mitchell, C. M., Spicer, P & the Voices of Indian Teens Project Team (2009). A longitudinal study of self-esteem, cultural identity, and academic success among American Indian adolescents. Cultural Diversity & Ethnic Minority Psychology. 15 (1), p 38-50.

EFFECT OF A TRAINING PROGRAM IN OBSTETRIC CARE USING INNOVATIVE TEACHING METHODS ON KNOWLEDGE OF NURSING STUDENTS : A PILOT STUDY

* Komal P. Allagh, MBBS., MPH
**Anitha Thippaiah, MD., MPH
***Patti Herring, Ph.D., RN
****Shamanna, B.R., MD., DNB (MCH), DNB (SPM)., M.Sc.
*****Murtju, G.V.S., MD., M.Sc.,

ABSTRACT

Maternal mortality still remains a challenge in India. Pregnancy and child birth are normal events in the life of a woman. But, any pregnancy can develop complications at any stage, and so timely provision of obstetric care services by the nurses is extremely important. There is a need for enhancement of the capacity of nursing students to identify complications during pregnancy and labour, and to take timely action. A study was undertaken to assess the effect of a training program using innovative teaching methods to improve the knowledge of final year nursing students regarding obstetric care in Modern Government Maternity Hospital, Hyderabad, Andhra Pradesh. The final year nursing students (34) were included in the study. A pre intervention assessment to assess the knowledge of nursing students about obstetric care was done using a structured questionnaire. A training program with four modules on obstetric care was delivered over a period of one month using modified lectures with power point slides, practical exercises and video assisted teaching in addition to the regular training using traditional teaching methods. The post intervention assessment was done using the same instrument after the intervention (training program). The data were analysed using paired't' test. There was a significant increase in the mean knowledge score of nursing students regarding obstetric care following the training program (p < .05) and 91% of them demonstrated increase in knowledge. This program involving multiple innovative teaching methods was found to be useful among the nursing students in improving their knowledge regarding obstetric care.

Keywords: innovative teaching methods, training program, obstetric care, knowledge, nursing students
* Research Associate, Indian Institute of Public Health, Hyderabad
** Associate Professor, Indian Institute of Public Health, Hyderabad
*** Associate Professor, Department of Health Promotion and Education, Loma Linda University, California
***** Director, Indian Institute of Public Health, Hyderabad

REFERENCES

Blouin, R. A., Riffee, W. H., Robinson, E. T., Beck, D. E., Green, C., Joyner, P. U., . . . Pollack, G. M. (2009). Roles of innovation in education delivery. American Journal of Pharmaceutical Education, 73(8), 154.

Dhaliwal, U. (2007). A prospective study of medical student's perspective of training- learning media: Reiterating the importance of feedback. Journal of Indian Medical Association, 105(11), 621-23.

Hafeez, A., Zafar, S., Qureshi, F., Mirza, I., Bile, K., & Southall, D. P. (2009). Emergency maternal and child health training courses and advocacy to achieve millennium development goals in poorly resourced country; Challenges and opportunities. Journal of Pakistan Medical Association, 59(4), 243-246.

Indian Nursing Council. (2012). List of colleges of nursing for Basic BSc. (N) programme. Retrieved from http://www.indiannursingcouncil.org/pdf/bsc-recognized-Nursing-Institution.pdf

Kirkpatrick, D. L. (1998). Another look at evaluating training programs. Alexandria, VA: American Society for Training & Development.

Mavalankar, D. V., & Rosenfield, A. (2005). Maternal mortality in resource- poor settings: policy barriers to care. American Journal of Public Health, 95(2), 200-203.

Office of Registrar General, India. (2011). Maternal and child mortality and total fertility rates. Retrieved from http://www.censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_release_070711.pdf

Prakasamma, M. (2009). Maternal mortality-reduction programme in Andhra Pradesh. Journal of Health Population and Nutrition, 27(2), 220-234.

Verboom, P., Edejer, T. T., & Evans, D. B. (2005). The costs of eliminating critical shortages in human resources for health. Geneva: World Health Organization. Retrieved from http://who.int/choice/publications/d_human_ resources.pdf?ua=1

Vora, K. S., Mavalankar, D. V., Ramani, K. V., Upadhaya, M., Sharma, B., Iyengar, S., . . . Iyengar, K. (2009). Maternal health situation in India: A case study. Journal of Health, Population and Nutrition, 27(2), 184-201.

FACILITATED TUCKING : A PAIN RELIEVING MEASURE IN NEONATES

* Josephin M. Francis, M.Sc (N)
** Anantha K. Rajan, M.Sc (N)., Ph.D
*** Alice Augustine, M.Sc (N)
**** Atanu K. Jana, M.D. B.C.H.

ABSTRACT

Facilitated tucking is considered effective in providing pain relief among neonates. The effect of facilitated tucking on the pain response of neonates undergoing heel prick procedures was studied in the nurseries of Christian Medical College and Hospital, Vellore, South India. Sixty neonates from level I and II intensive care units were randomly allocated to control and experimental groups. The pain ECHO scale developed by the investigator was used to observe ECHOS pain indicators (E Expression [facial], C- Crying, H -Heart rate, O- Oxygen saturation, S- State of arousal) before, (10 minutes) during, and after heel prick (10 minutes) with and without tucking. The neonates demonstrated all the ECHOS pain responses after heel prick procedure. They demonstrated lower facial expression (p < .001), reduced crying state (p < .0001), but no significant changes in heart rate, O2 saturation and state of arousal with facilitated tucking. The findings support that the ECHOS indicators are good indicators of pain response in neonates and facilitated tucking is an effective pain relieving measure following heel prick procedure.

Keywords: facilitated tucking, pain response, non-pharmacologic pain relieving measure, heel prick procedure, neonates

* Assistant Nursing Teacher, College of Nursing, Public Authority of Applied Education and Training, Kuwait
** Professor (Former), College of Nursing, Christian Medical College, Vellore
***Professor (Former), College of Nursing, Christian Medical College, Vellore
****Professor (Former), Dept. of Neonatology, Christian Medical College, Vellore

REFERENCES

Axelin, A., Salantara, S., & Lehtonen, L. (2006). Facilitated tucking by parents in pain management of preterm infantsa randomized crossover trial. Early Human Development, 82, 241-247.

Corff, K. E., Venkataraman, P. S., Lutes, L., & Yates, B. (1995). Facilitated tucking: A nonpharmacologic comfort measure for pain in preterm neonates. Journal of Gynecologic and Neonatal Nursing, 24 (2), 143-147.

Hill, S., Engle, S., Jorgensen, J., Kralik, A., & Whitman, K. (2005). Effects of facilitated tucking during routine care of infants born preterm. Pediatric Physical Therapy,17 (2), 158-63.

Liaw, J. J., Yang, L., Lee, C. M, Fan, H. C., Chang, Y. C., & Cheng, L. P. (2012). Effects of combined use of non-nutritive sucking, oral sucrose, and facilitated tucking on infant behavioral states across heel-stick procedures: A prospective randomized controlled trial. International Journal of Nursing Studies, 50(7), 883-95. doi:1016/j.ijnurstu.2012.08.021.

Mahendra, P. (2012). A touch may go a long way for preterm babies. Springer Healthcare News, 1, 762. doi:10.1007/ s40014-012-0762-3

Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 19(150), 971 - 979.

Rushfort, J. A. P., & Levene, M. I. (1994). Behavioral response to pain in healthy neonates. Archives of Disease in child hood, 70, 174-176.

Ward-Larson, C., Horn, R. A., & Gosnell, F. (2004). The efficacy of facilitated tucking for relieving procedural pain of endotracheal suctioning in very low birth weight infants, The American Journal of Maternal Child Nursing, 29(3), 151-6.

PREVALENCE OF WORK-RELATED MUSCULOSKELETAL PAIN AMONG INDIAN NURSES: A FIELD SURVEY

* Karvannan Harikesavan, M.P.T
** Prem Venketesan, P.T., Ph.D
*** Prem Venketesan, P.T., Ph.D
**** Nafeez Syed, M.P.T
***** Saroja Jaykumar, M.Sc (N)

ABSTRACT

Nurses working in India are at risk for developing work-related musculoskeletal pain (WMSP). The prevalence rates however are not documented in this population. The aim of this survey was to determine the prevalence of WMSP amongst nurses in India. A self-administered questionnaire namely, the Standard Nordic Questionnaire was distributed to 600 Nurses. The questionnaire included demographic data, musculoskeletal pain in the past 12 months, last one week and pain affecting the activities of daily living in the past 12 months. Descriptive statistical tests (mean ± standard deviation), were used to determine the prevalence rates. Chi-square analysis was done to determine the association between years of experience and prevalence of self-reported musculoskeletal disorders. Out of the 391 who were included in the study, 77% respondents had WMSP at 12 month pain at any-body region with lower back pain (56%) being the most common problem, 53% and 33% of nurses had pain in the past one week and pain affecting activities of daily living in the past 12 months respectively. WMSP related pain in the low back was the commonest among nurses in India.

Keywords: prevalence, work-related musculoskeletal pain, nurse, Standard Nordic Questionnaire

* Research Associate, Indian Institute of Public Health, Hyderabad
** Associate Professor, Indian Institute of Public Health, Hyderabad
*** Associate Professor, Department of Health Promotion and Education, School of Public Health, Loma Linda University, California
**** Associate Professor, School of Medical Sciences, University of Hyderabad
***** Director, Indian Institute of Public Health, Hyderabad

REFERENCES

Alexopoulos, E. C., Burdorf, A., & Kalokerinou, A. (2003). Risk factors for musculoskeletal disorders among nursing personnel in Greek hospitals. International Archives of Occupational and Environmental Health, 76(4), 289-94.

Barboza, M. C., Milbrath, V. M., Bielemann, V. M., & de Siqueira, H. C. (2008). Work-related musculoskeletal disorders and their association with occupational nursing. Revista Gaúcha de Enfermagem, 29(4), 633-38.

Caboor, D. E., Verlinden, M. O., Zinzen, E., Van Roy, P., Van Riel, M. P., & Clarys, J. P. (2000). Implications of an adjustable bed height during standard nursing tasks on spinal motion, perceived exertion and muscular activity. Ergonomics, 43, 1771 - 1780.

Charney, W. (1997). The lift team method for reducing back injuries: A 10-hospital study. American Association of Occupational Health Nurses, 45(6), 300 - 304.

Collins, J. W., Wolf, L., Bell, J., & Evanoff, B. (2004). An evaluation of a “best practices” musculoskeletal injury prevention program in nursing homes. Injury Prevention, 10(4), 206 - 211.

Crawford, J. O. (2007). The Nordic Musculoskeletal Questionnaire. Occupational Medicine, 57(4), 300-301.

Davey, M. M., Cummings, G., Newburn-Cook, C. V., & Lo, E. A. (2009). Predictors of nurse absenteeism in hospitals: a systematic review. Journal of Nursing Management, 17(3), 312-30.

Engels, J. A., Van der Gulden, J. W. J., Senden, T. F., & Van't Hof, B. (1996). Work-related risk factors for musculoskeletal complaints in the nursing profession: results of a questionnaire survey. 1(9), 636 - 41.

Fabunmi, A. A., Oworu, J. O., & Odunaiya, N. A. (2008). Prevalence of musculoskeletal disorders among nurses in university college hospital, Ibadan. West African Journal of Nursing, 19(1), 21-25.

Gamperiene, M., & Stigum, H., (1999). Work related risk factors for musculoskeletal complaints in the spinning industry in Lithuania. Occupational and Environmental Medicine, 56(6), 411 - 416.

Gundewall, B., Liljeqvist, M., & Hansson, T. (1993). Primary prevention of back symptoms and absence from work: A prospective randomized study among hospital employees. Spine, 18(5), 587 - 594.

Guo, H. R., Tanaka, S., Cameron, L. L., Seligman, P. J., Behrens, V. J., Gen, J., … Putz-Anderson, V. (1995). Back pain among workers in the United States: National estimates and workers at high risk. American Journal of Industrial Medicine, 28(5), 591-602.

Hales, T. R., & Bernard, B. P. (1996). Epidemiology of work-related musculoskeletal disorders. Orthopaedics Clinics of North America, 27(4), 679 - 09.

Harber, P., Billet, E., Gutowski, M., SooHoo, K., Lew, M., & Roman, A. (1985). Occupational low-back pain in hospital nurses. Journal of Occupational Medicine, 27(7), 518-24.

Klussmann, A., Gebhardt, H., Liebers, F., & Rieger, M. A., (2008). Musculoskeletal symptoms of the upper extremities and the neck: A cross-sectional study on prevalence and symptom-predicting factors at visual display terminal (VDT) workstations. BMC Musculoskeletalal Disorders, 9, 96.

Knibbe, J. J., & Friele, R. D. (1996). Prevalence of back pain and characteristics of the physical workload of community nurses. Ergonomics, 39(2), 186 - 98.

Kuorinka, I., Jonsson, B., Kilbom, A., Vinterberg, H., Biering-Sorensen, F., Andersson, G., … Jorgensen, K. (1987). Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Applied Ergonomics, 18(3), 23 - 37.

Mooney, V., Kron, M., Rummerfield, P., & Holmes, B. (1995). The effect of workplace based strengthening on low back injury rates: a case study in the strip mining industry. Journal of Occupational Rehabilitation, 5(3), 157 - 167.

Silverstein, B. A., Fine, L. J., & Armstrong, T. J. (1987). Occupational factors and carpal tunnel syndrome. American Journal of Industrial Medicine, 11, 343-358.

Smith, D. R., Kondo, N., Tanaka, E., Tanaka, H., Hirasawa, K., & Yamagata, Z. (2003). Musculoskeletal disorders among hospital nurses in rural Japan. Rural and Remote Health Journal, 3(3), 241-43.

Tinubu, M. S., Mbada, C. E., Oyeyemi, A. L., Ayodele, A. & Fabunmi, A. A. (2010). Work related musculoskeletal disorders among nurses in Ibadan, south west Nigeria: a cross sectional survey. BMC Musculoskeletal Disorders, 11, 12.

Vieira, E. R., Kumar, S., & Narayan, Y. (2008). Smoking, no-exercise, overweight and low back disorder in welders and nurses. International Journal of Industrial Ergonomics, 38(2), 143-149.

Wilkinson, W. E., Salazar, M. K., Uhl, J. E., Koepsell, T. D., DeRoos, R. L., & Long, R. J. (1992). Occupational injuries: a study of health care workers at a north western health science center and teaching hospital. American Association of Occupational Health Nurses, 40, 287-293.

Winkel, J., & Mathiassen, S. E, (1994). Assessment of physical work load in epidemiologic studies: concepts, issues and operational considerations. Ergonomics, 37(6), 979 - 988.

FUNCTIONAL DEPENDENCE AND IMPAIRMENT OF PATIENTS WITH SPINAL TRAUMA AND ASSOCIATED COMPLICATIONS

* Jaspreet Kaur, B.Sc (N)
** Sukhpal Kaur, M.Sc (N)., Ph.D.
*** Rajesh Chabra, M.Ch.. (Neurosurgery)

ABSTRACT

The Patients with spinal cord injury develop various types of complications. A study was carried out to assess the functional dependence and impairment of patients with spinal trauma and associated complications. Nineteen subjects were selected by convenience sampling. Structured interview technique was used to collect data. The data included demographic profile, injury details such as cause, mechanism, site and complications faced by the patients namely bladder and bowel dysfunction, deep vein thrombosis, chest infection, bedsore, urinary tract infection, contractures and spasticity. Katz Index of Independence in Activities of Daily Living was used to evaluate the level of functional dependence of patients in their activities of daily living. ASIA impairment scale was used to measure the functional impairment. The mean age of the subjects was 32.2+1.03, 63.2% were male and 73.7% were married. The main cause of injury was fall (63.2%) and mechanism of trauma was compression (73.7%). The major complications seen among the patients were pressure ulcers (52.6%) followed by bowel and bladder dysfunction (47.4%) and urinary tract infection (42.1%). Among those who had bladder involvement 88.9% of them developed UTI. Bedsore and urinary tract infection were the common complications. Females were found to be more prone to develop UTI and all the patients who had bowel involvement developed bedsore. With regard to functional independence, 52.7% were independent in carrying out activities of daily living. As per ASIA impairment scale, 21% of patients had complete impairment. There is a need for intense public education regarding spinal cord injury, its prevention, care and complications.

Keywords: spinal trauma, complications, functional dependence, functional impairment, pressure ulcers, bowel and bladder dysfunction, urinary tract infection

* Nursing Sister, Grade II, PGIMER, Chandigarh
** Lecturer, National Institute of Nursing Education, Chandigarh
*** Additional Professor, PGIMER, Chandigarh

REFERENCES

Agarwal P., Upadhyay P., & Raja K. (2007). A demographic profile of traumatic and non-traumatic spinal injury cases: a hospital-based study from India. Spinal Cord, 45, 597 - 602.

Cabrere, R. H., Arrazola, A. L., Alcaise, M. J. V., Arjona, M. F., & Calero, J. R. (1994). Analytic epidemiology of clinical urinary tract infection in spinal cord injury. European Journal of Epidemiology, 10(1), 23-27.

Chacko, V., Joseph, B., Mohanty, S. P., & Jacob, T. (1986). Management of spinal cord injury in a general hospital in rural India. Paraplegia, 24(5), 330-335

Chappell, P., & Wirz, S. (2003). Quality of life following spinal cord injury for 20-40 year old males living in Sri Lanka. Asia Pacific Disability Rehabilitation Journal, 14(2), 162-178.

Gibson, K. L. (2003). Caring for a patient who lives with a spinal cord injury. Nursing Management, 33(7), 36-41.

Gosselin, R. A., & Coppotelli, C. (2005). A follow-up study of patients with spinal cord injury in Sierra Leone. International Orthopaedics, 29(5), 330 - 332.

Gosselin, R. A., & Coppotelli, C. (2005). A follow-up study of patients with spinal cord injury in Sierra Leone. International Orthopaedics, 29(5), 330 - 332.

Gupta, N., Solomon, M. J., & Raja, K. (2008). Demographic characteristics of individuals with paraplegia in India- A survey. Indian Journal of Physiotherapy and Occupational Therapy, 2(3), 24 - 28.

Jain, A. K. (2007). Spinal trauma: A challenge ahead. Indian Journal of Orthopaedics, 41(4), 253 - 254.

Katz, S., Down, T. D., Cash, H. R., & Grotz, R. C. (1970). Progress in the development of the index of ADL. The Gerontologist, 10(1), 20 - 30.

Maharaj, J. C. (1996). Epidemiology of spinal cord injury in Fiji: 1985-1994. Spinal Cord 34(9), 549 - 559.

Marino, R. J., Barros T, Biering-Sorensen, F., Burns, S. P., Donovan, W. H., Graves, D. E., Priebe, M. M. (2003). ASIA Neurological Standards Committee 2002. International standards for neurological classification of spinal cord injury. The Journal of Spinal-Cord Medicine, 26(1), 50 - 6.

Medical Research Council. (1981). Aids to the examination of the peripheral nervous system, Memorandum no. 45. London: Her Majesty's Stationery Office.

Nwankwo, O. E., & Katchy, A. U. (2003). Outcome of a 12-week programme for management of the spinal cord injured with participation of patient's relations at Hilltop Orthopaedic Hospital, Enugu, Nigeria. Spinal Cord, 41, 129 - 133.

Pandey, V. K., Nigam, V., Goyal, T. D, & Chhabra, H. S. (2007). Care of post-traumatic spinal cord injury patients in India: An analysis. Indian Journal of Orthopaedics, 41(4), 295 - 299.

Rathore, F. A. (2010). Spinal cord injuries in the developing world. International Encyclopedia of Rehabilitation. Retrieved from http://cirrie.buffalo.edu/ encyclopedia/en/article/141/.

Rathore, M. F., Hanif, S., Farooq, F., Ahmad, N., & Mansoor, S. N. (2008). Traumatic spinal cord injuries at a tertiary care rehabilitation institute in Pakistan. Journal of the Pakistan Medical Association, 58(2), 53 - 57.

Robinson-Whelen, S., & Rintala D. (2003). Informal care providers for veterans with SCI: Who are they and how are they doing? Journal of Rehabilitation Research and Development, 40(6), 511 - 516.

Singh, P. K., Sakale, H., Shrivastva, S., & Dulani, R. (2010). Palliative surgical approach to rehabilitate spinal injury patient in Indian rural setup. Indian Journal of palliative care, 16(3), 160 - 163.

Singh, R., Sharma, S. C., Mittal, R., & Sharma, A. (2003). Traumatic spinal cord injuries in Haryana: An epidemiological study. Indian Journal of Community Medicine, 28(4), 184 - 186.

Surkin, J., Gibert, J., Harkey, H. L., Sniezek, J., & Currier, M. (2000). Spinal cord injury in Mississippi. Findings and evaluation 1992-1994. Spine, 25, 716 - 21.

Whiteneck, G., Tate, D., & Charlifue, S. (1999). Predicting community reintegration after spinal cord injury from demographic and injury characteristics. Archives of Physical Medicine and Rehabilitation, 80, 1485 - 1491.