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JULY – DECEMBER 2016    VOL-17, NO.2

PAIN ASSESSMENT: CAN A NUMBER MEANINGFULLY DESCRIBE THE PAIN EXPERIENCE

*Asha Solomon, M. Sc (N) (N)
*Associate Professor, College of Nursing, CMC, Vellore

ABSTRACT

Pain as the 'fifth vital sign' highlights the significance of pain assessment in patient care, but has often been found to be mechanistic and devoid of meaningful significance in clinical settings. Due to the complex nature of pain experience, nurses and doctors rarely depend on the patient self-report of Numerical Rating Scale (NRS) alone to initiate, modify, supplement or discontinue analgesia. Hence, there is a need to supplement the existing pain assessment using NRS with more clinically-relevant strategies in pain assessment. The article depicts the issues with using NRS and encourages nurses to use clinically meaningful pain assessment methods, citing an example of Clinically Alligned Pain Assessment tool (CAPA©), a new pain assessment tool.

Keywords: fifth vital sign, pain assessment, Numerical Rating Scale, CAPA©

REFERENCES

American Pain Society. (1999). Principles of analgesic use in the treatment of acute pain and cancer pain. Glenview, IL. Retrieved from https://books.google.com/ books

American Pain Society Quality of Care Committee. (1995). Quality improvement guidelines for the treatment of acute pain and cancer pain. Journal of American Medical Association, 274(23), 1874-80. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7500539/

Ameringer, S., Serlin, R. C., Hughes, S. H., Frierdich, S. A., & Ward, S. (2006). Concerns about pain management among adolescents with cancer: Developing the adolescent barriers questionnaire. Journal of Pediatric Oncology Nursing, 23(4), 220-232

Ayasrah, S. M., O'Neill, T. M., Abdalrahim, M. S., Sutary, M. M., & Kharabsheh, M. S. (2014). Pain assessment and management in critically ill intubated patients in Jordan: A prospective study. International Journal of Health Sciences, 8(3), 287.

Clark, W. C., Yang, J. C., Tsui, S. L., Ng, K. F., & Clark, S. B. (2002). Unidimensional pain rating scales: A multidimensional affect and pain survey (MAPS) analysis of what they really measure. Pain, 98(3), 241-247. .

Cleeland, C. S., Reyes-Gibby, C. C., Schall, M., Nolan, K., Paice, J., Rosenberg, J. M., . . . Kerns, R. D. (2003). Rapid improvement in pain management: The Veterans Health Administration and the institute for healthcare improvement collaborative. The Clinical Journal of Pain, 19(5), 298 - 305.

Donaldson, G., & Chapman, C.R. (2013). Pain management is more than just a number. University of Utah Health/Department of Anesthesiology. Salt Lake City, Utah: Department of Anesthesiology.

Donovan, J. (2002). Learning disability nurses' experiences of being with clients who may be in pain. Journal of Advanced Nursing, 38(5), 458-466.

Ferrell, B. (2005). Ethical perspectives on pain and suffering. Pain Management Nursing, 6(3), 83-90.

Gélinas, C., Fortier, M., Viens, C., Fillion, L., & Puntillo, K. (2004). Pain assessment and management in critically ill intubated patients: a retrospective study. American Journal of Critical Care, 13(2), 126-136.

Gordon, D. B. (2015). Acute pain assessment tools: let us move beyond simple pain ratings. Current Opinion in Anesthesiology, 28(5), 565-569..

Jensen, M. P., Turner, J. A., Romano, J. M., & Fisher, L. D. (1999). Comparative reliability and validity of chronic pain intensity measures. Pain, 83(2), 157-162.

Katsma, D. L., & Souza, C. H. (2000). Elderly pain assessment and pain management knowledge of long-term care nurses. Pain Management Nursing, 1(3), 88-95.

Kim, H. S., Schwartz-Barcott, D., Tracy, S. M., Fortin, J. D., & Sjostrom, B. (2005). Strategies of pain assessment used by nurses on surgical units. Pain Management Nursing, 6(1), 3-9.

Krebs, E. E., Carey, T. S., & Weinberger, M. (2007). Accuracy of the pain numeric rating scale as a screening test in primary care. Journal of General Internal Medicine, 22(10), 1453-1458.

McCaffrey, M., & Ferrell, B. R. (1997). Nurses' knowledge of pain assessment and management: How much progress have we made?. Journal of Pain and Symptom Management, 14(3), 175-188

McCaffery, M., Ferrell, B. R., & Pasero, C. (2000). Nurses' personal opinions about patients' pain and their effect on recorded assessments and titration of opioid doses. Pain Management Nursing, 1(3), 79-87

Mendelson, G., & Mendelson, D. (2004). Malingering pain in the medicolegal context. The Clinical Journal of Pain, 20(6), 423-432.

Mularski, R. A., White-Chu, F., Overbay, D., Miller, L., Asch, S. M., & Ganzini, L. (2006). Measuring pain as the 5th vital sign does not improve quality of pain management. Journal of General Internal Medicine, 21(6), 607-612.

Newton, B. J., Southall, J. L., Raphael, J. H., Ashford, R. L., & LeMarchand, K. (2013). A narrative review of the impact of disbelief in chronic pain. Pain Management Nursing, 14(3), 161-171

Odhner, M., Wegman, D., Freeland, N., Steinmetz, A., & Ingersoll, G. L. (2003). Assessing pain control in nonverbal critically ill adults. Dimensions of Critical Care Nursing, 22(6), 260-267.

Schiavenato, M., & Craig, K. D. (2010). Pain assessment as a social transaction: beyond the "gold standard". The Clinical Journal of Pain, 26(8), 667-676.

Veterans Health Administration (2005). Pain as the 5th vital sign toolkit. Retrieved from http://www.va.gov/oaa/ pocketcard/pain.asp.

Vukmir R.B (2004). Drug seeking behavior. American Journal of Drug Alcohol Abuse, 30, 551-575. Retrieved from http://www.tandfonline.com/doi/abs/ 10.1081/ADA-200032294.

Wadensten, B., Fröjd, C., Swenne, C. L., Gordh, T., & Gunningberg, L. (2011). Why is pain still not being assessed adequately? Results of a pain prevalence study in a university hospital in Sweden. Journal of Clinical Nursing, 20(5-6), 624-634.

Watt-Watson, J., Stevens, B., Garfinkel, P., Streiner, D., & Gallop, R. (2001). Relationship between nurses' pain knowledge and pain management outcomes for their postoperative cardiac patients. Journal of Advanced Nursing, 36(4), 535-545.

Werner, A., & Malterud, K. (2003). It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors. Social Science & Medicine, 57(8), 1409-1419.

Zacharoff, K. L., Katz, N., & Pujol, L. M. (2010). A pocket guide to pain management. Newton: Inflexxion.

RE-FEEDING SYNDROME - A CASE REPORT

*Rogina J. S. Savarimuthu, M.Sc (N)., M.Sc (Psychology).,M.S (Psychotherapy &Counseling )., C.A.F.E.
*Sumathy Jayaraman, M. Sc (N)
**Jasmin Anand, M. Sc (N)
***Vimala Selvaraj, B. Sc (N) <

*Reader, College of Nursing, CMC, Vellore
**Professor, College of Nursing, CMC, Vellore
***Charge Nurse,CMC, Vellore

ABSTRACT

Re-feeding syndrome is a metabolic complication that can occur when enteral or parenteral nutritional rehabilitation is initiated for severely malnourished patients. It is fatal if not recognized and treated properly. This article discusses the body's adaptation to starvation, the pathophysiology, risk factors of re-feeding syndrome, adverse consequences which can occur in the early stages of re-feeding, and its management. It focuses on challenges faced in caring for patient during re-feeding. Starvation causes adaptive reductions in cellular activity and organ function, accompanied by electrolyte and micronutrient depletion. During starvation insulin decreases and glucagon levels rise, resulting in gluconeogenesis and the breakdown of protein and lipid. Free fatty acids and ketone bodies replace glucose as the major energy source. When nutritional rehabilitation is started the re-feeding triggers a shift from fat back to carbohydrate metabolism, with consequent insulin release, and increased shift of potassium, phosphate, magnesium, and water into the cells. In a starved individual, cardiac mass may be significantly depleted, leading to the risk of fluid overload and cardiac failure during re-feeding. Nurses play a significant role in identification and prevention of re-feeding complications.

Keywords: re-feeding syndrome, enteral, parenteral, nursing care, nutritional rehabilitation

REFERENCES

Akinsulure-Smith, A. M. (2009). Brief psychoeducational group treatment with re-traumatized refugees and asylum seekers. The Journal for Specialists in Group Work, 34(2), 137-150.

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing care plans: Guidelines for individualizing client care across the life span. Philadelphia: FA Davis Company.

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Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. Philadelphia: Elsevier Health Sciences.

Mehanna, H. M., Moledina, J., & Travis, J. (2008). Refeeding syndrome: What it is, and how to prevent and treat it. British Medical Journal, 336(7659), 1495-1498.

Mehler, P. (2016) Anorexia nervosa in adults and adolescents, Refeeding syndrome. Retrieved from www.uptodate.com

National Institute of Health and Care Excellence. (2006). Nutrition support for adults: Oral nutrition support, enteral tube feeding, and parenteral nutrition. retrieved from https://www.nice.org.uk/guidance/cg32

Norton, C., Taylor, C., & Nunwa, A. (2008). Oxford handbook of gastrointestinal nursing. USA: Oxford University Press.

Podolsky, K. D., Camilleri, M., Fitz, J.G., Kalloo, N.A., Shanahan, F., & Wang, C. T. (2016). Yamada's Text book of gastro enterology (6th ed.). USA: Wiley Blackwell Publishing.

Raoof, S., George, L., Saleh, A., & Sung, A. (2008). ACP Manual of Critical Care. McGraw-Hill Professional.

EFFECT OF CHEWING GUM THERAPY ON SELECTED POSTOPERATIVE OUTCOMES IN PATIENTS UNDERGOING ABDOMINAL SURGERY

*Arockiaseeli M. Annarani, M. Sc (N)
**Selva T. Chacko, M. Sc (N)., Ph.D (N)
***Valliammal Babu, M. Sc (N)
****Sukriya Nayak, M. S

*Lecturer, College of Nursing, CMC, Vellore
**Professor, College of Nursing, CMC, Vellore
***Professor, College of Nursing, CMC, Vellore
****Professor, Department of General Surgery, CMC, Vellore

ABSTRACT

People can tell a measure of their health by their bowel movement. Patients experience delayed bowel movement after the abdominal surgery because of an inevitable response to surgical trauma called postoperative ileus/paralytic ileus. Chewing gum is known to activate the cephalic phase of digestion mediated by vagus nerve, reducing the incidence of ileus. Postoperative ileus is also associated with prolonged hospitalization. Hence, a quasi experimental research was conducted to assess the effect of chewing gum therapy on selected postoperative outcomes among patients undergoing abdominal surgery in selected surgical wards of a tertiary hospital in South India. Totally 45 patients who underwent abdominal surgery were chosen by convenience sampling method. Patients shifted to intensive care unit and who had ileostomy/colostomy postoperatively were excluded. The participants in control group were given regular post operative care and observed for first three weeks. In the later three weeks of period, the experimental group were given one sugarless chewing gum three times a day along with regular post operative care till the participants were discharged. A bowel motility chart and an observation checklist were used to assess the effectiveness of chewing gum therapy in regard to the occurrence of bowel movement. The thirst distress scale and oral hygiene index were used to measure intensity of thirst and oral hygiene of the participants respectively from both control and experimental group. Results demonstrated that the mean time taken to pass first flatus and stool by the participants in the experimental group was 55.71 hours and 84.11 hours, and in the control group was 51.84 hours and 80.79 hours. The difference in the time taken to pass first flatus and stool in the experimental and control group was not statistically significant. The oral hygiene of the participants in the experimental group was significantly better in the control group (p <. 001). Thirst experienced by the participants in the experimental group with regards to dry mouth was significantly less than the control group (p < .05). There was a statistically significant association between the type of surgery and duration of surgery with postoperative ileus (p < .05). The study findings highlighted the advantages of having chewing gum therapy in the regular post operative care with the improved oral hygiene and reduced discomfort from thirst.

Keywords: chewing gum therapy, postoperative outcomes, postoperative ileus, thirst, oral hygiene, early discharge DNA

REFERENCES

Bots , C.P. Brand, H. S., Veerman, E. C., Korevaar, J. C., Valentijn-Benz, M., Bezemer, P. D., . & Nieuw Amerongen, A. V. (2005). Chewing gum and a saliva substitute alleviate thirst and xerostomia in patients on haemodialysis. Nephrology Dialysis Transplantation, 20(1), 578 -584.

Carlson, G. L., & Dark, P. (2010). Acute intestinal failure. Current Opinion in Critical Care, 16(4), 347-352.

De Castro, S. M. M., van den Esschert, J. W., van Heek, N. T., Dalhuisen, S., Koelemay, M. J. W., Busch, O. R. C., & Gouma, D. J. (2008). A Systematic Review of the Efficacy of Gum Chewing for the Amelioration of Postoperative Ileus. Digestive Surgery, 25(1), 39-45.

Fitzgerald, J. E. F., & Ahmed, I. (2009). Systematic review and meta-analysis of chewing-gum therapy in the reduction of postoperative paralytic ileus following gastrointestinal surgery. World Journal of Surgery, 33(12), 2557-2566.

Faul, F., Felder, E., & Buchner, A. G. (2007). G*power 3: A flexible Statistical power analysis program for the social, behavioral, and biomedical sciences. Behaviour Research Methods, 39(2), 175-191.

Goldstein, J. L., Matuszewski, K. A., Delaney, C. P., Senagore, A., Chiao, E. F., Shah, M., & Bramley, T. (2007). Inpatient economic burden of post operative ileus associated with abdominal surgery in the U.S. P&T, 32(2), 82 90.

Hocevar, B. J., Robinson, B., & Gray, M. (2010). Does Chewing Gum Shorten the Duration of Postoperative Ileus in Patients Undergoing Abdominal Surgery and Creation of a Stoma? Journal of Wound, Ostomy and Continence Nursing, 37(2), 140-146.

Kalmanm, M. (2010). Does chewing gum after elective laparoscopic colectomy surgery decrease ileus? Retrieved from http://clinicaltrials.gov/ct2/show /NCT00632801.

Mukherjee., S. (2011). Ileus. Retrieved from http://eme dicine.medscape.com/article/178948-overview Quah, H. M., Samad, A., Neathey, A. J., Hay, D. J., & Maw, A. (2006). Does gum chewing reduce postoperative ileus following open colectomy for left-sided colon and rectal cancer? A prospective randomized controlled trial. Colorectal Disease: The Official Journal of the Association of Coloproctology of Great Britain and Ireland, 8(1), 64-70.

Sandhiya, S. (2006). Alvimopan: A novel peripheral opioid receptor antagonist. Indian Journal of Pharmacology, 38(6), 442. doi:10.4103/0253-7613.28220

Schuster, R., Grewal, N., Greaney, G. C., and Waxman, K. (2006). Gum chewing reduces ileus after elective open sigmoid colectomy. Archives of Surgery, 141(2), 174- 176. Szoke, J., Banoczy, J., & Proskin, H. M. (2001). Effect of After-meal Sucrose-free Gum-chewing on Clinical Caries. Journal of Dental Research, 80(8), 1725 -1729. .

KNOWLEDGE, ATTITUDE, AND PRACTICE OF NURSES REGARDING USE OF ANTI- EMBOLISM STOCKINGS

*Besty A. Varghese, M. Sc (N)
**Punitha Ezhilarasu, M. Sc (N)., Ph. D (N)
***Amala Rajan, M. Sc (N)
****Mark R. Jesudason, M. S.
*****Visalakshi Jeyaseelan, Ph. D

*Nursing Officer, All India Institute of Medical Sciences, New Delhi
**Consultant, Indian Nursing Council, New Delhi
***Professor, College of Nursing, CMC, Vellore
****Professor, Department of Surgery, CMC, Vellore
*****Lecturer, Department of Biostatistics, CMC, Vellore

ABSTRACT

Appropriate thromboprophylaxis can prevent venous thromboembolism - the most prevalent potentially preventable complication among surgical patients. Anti-embolism stockings are a simple and effective mechanical thromboprophylactic modality which is widely used. This study was undertaken to assess the knowledge, attitude and practice of nurses regarding the use of anti-embolism stockings. Convenience sampling was used to recruit nurses working in surgical wards of a tertiary hospital. A knowledge questionnaire, an attitude scale and an observation checklist were used in the study. Sixty four nurses were observed for knowledge / attitude and 72 nurses were observed for practice regarding the use of anti-embolism stockings. It was found that 65.6% had moderately adequate knowledge and 90.6% had highly favourable atttitude. Majority of the nurses (91.7%) demonstrated inadequate practice in the use of stockings. Prevention of venous thrombo-embolism and the use of anti- embolism stockings needs to be added as an in-service education topic for nurses and clinical teaching for the nursing students. It can also be considered as a component of health education to the patients. Use of a protocol and documentation form can ensure appropriate use of the anti- embolism stockings. Incorporating this topic in the syllabus and as a procedure in the log book can ensure mandatory learning about use and application of anti-embolism stockings.

Keywords: knowledge, attitude, practice, venous thrombo-embolism, anti-embolism stockings

REFERENCES

Bowling, K., Ratcliffe, C., Townsend, J., & Kirkpatrick, U. (2015). Clinical thromboembolic detterrent stockings application: Are thromboembolic deterrent stockings in practice matching manufacturers application guidelines. Phlebology, 30(3), 200-203. doi:10.1177/ 0268355514542843

Central Bureau of Health Intelligence- India. (2011). Human resources in health sector. Retrieved from http: //www.cdhidghs.nic.in

Chapman, N. H., Lazar, S. P., Fry, M., Lassere, M. N., & Chong, B. H. (2011). Clinicians adopting evidence based guidelines: A case study with thromboprophylaxis. BioMedCentral Health Services Research, 11, 240.doi:10.1186/1472-6963-11-240.

Cock, K. A. (2006). Anti-embolism stockings: Are they used effectively and correctly? British Journal of Nursing, 15(6).

Donnelly, T., & McNeely, B. (2015). The shocking stocking audit: An audit on the use of thromboembolic deterrent stockings (TEDS) for patients having surgery at Sligo regional hospital. Journal of Perioperative Practice, 25(4), 83-86.

Gaston, S., & White, S. (2013). Venous thromboembolism (VTE) risk assessment: rural nurses' knowledge and use in a rural acute care hospital. International Journal of Nursing Practice, 19(1), 60-64.

Gao, F., & Kause, J. (2010). Thromboprophylaxis awareness among hospital staff. British Journal of Nursing, 19(18), 1175-1178.

Lewis S.L., Heitkemper, M.M., Dirksen, S.R., O'Brien, G.P., Butcher, L. (2007). Medical-surgical nursing: Assessment and management of clinical problems (7th ed.). Philadelphia: Mosby Elsevier Publishers.

McFarland, L., Murray, E., Harrison, S., Heneghan, C., Ward, A., Fitzmaurice, D., & Greenfield, S. (2014). Current practice of venous thromboembolism prevention in acute trusts: A qualitative study. British Medical Journal, 4(6). e005074. doi:10.1136/bmjopen-2014-005074

Miller, J. A. (2011). Use and wear of anti-embolism stockings: A clinical audit of surgical patients. International Wound Journal, 8(1), 7483. doi:10.1111/j. 1742-481X.2010.00751.x

Minet, C., Potton, L., Bonadona, A., Hamidfar-Roy, R., Somohano, C. A., Lugosi, M., Timsit, J.-F. (2015). Venous thromboembolism in the ICU: Main characteristics, diagnosis and thromboprophylaxis. Critical Care, 19(1). https://doi.org/10.1186/s13054-015-1003-9

Mitchell, P. H. (2008). Defining patient safety and quality care. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses. Rockville (MD): Agency for Healthcare Research and Quality (US). Retrieved from http://www.ncbi.nlm.nih.gov/ books/NBK2681/

National Institute for Health and Clinical Excellence. (2010). Venous thromboembolism: Reducing the risk. London: NICE

Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2012). Brunner and Suddharth's textbook of medical surgical nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins Publishers.

Thompson, A., Walter, S., Brunton, L. R., Pickering, G. T., Mehendale, S., Smith, A. J., & Bannister, G. C. (2011). Anti-embolism stockings and proximal indentation. British Journal of Nursing, 20(22).

Winslow, E. H., & Brosz, D. L. (2008). Graduated compression stockings in hospitalized postoperative patients: correctness of usage and size. The American Journal of Nursing, 108(9), 4050.

IMPACT OF FEEDING PRACTICES OF MOTHERS ON NUTRITIONAL STATUS OF CHILDREN

*Jaspreet Kaur, M. Sc (N)
**Maharaj Singh, M. Sc (N)., Ph. D (N)

*Jaspreet Kaur, M. Sc (N)
**Maharaj Singh, M. Sc (N)., Ph. D (N)

ABSTRACT

Child malnutrition is still a serious health problem in many developing countries including India. Feeding practices of mothers may play a significant role in improvement of nutritional status of children. A descriptive correlational study was conducted to find out correlation between nutritional status of children and feeding practices of mothers. A purposive sampling technique was used to recruit 60 male and female children between the age group of 6 months to 3 years along with their mothers. Nutritional status of children and feeding practices of mothers were assessed through anthropometric assessment and self-reporting feeding practice checklist respectively. The collected data were analyzed using descriptive and inferential statistics. The results according to weight-for-age calculation revealed that 75% of children had normal nutritional status and 18.3% and 6.7% of children had grade 1 and grade 2 malnutrition respectively. According to height-for-age calculations, 83.3% of children had normal height, 10% of children were short for age, and 1.7% children had gigantism. As per levels of feeding practices of mothers, 31.6% had satisfactory, 41.7% had partially satisfactory and 26.7% had unsatisfactory feeding practices. There was a significant moderately positive correlation (r = .64, p = .01) between weight for age and feeding practices and a non significant low positive correlation (r = .29, p = .14) between height for age and nutritional practices. Hence, there is a need for creating awareness about healthy feeding practices to combat the problem of malnutrition.

Keywords: Nutritional status, children, feeding practices, mothers

REFERENCES

Avachat, S. S., Phalke, V. D., & Phalke, D. B. (2009). Epidemiological study of malnutrition (under nutrition) among under five children in a section of rural area. Pravara Medical Review, 4(2), 20-2. Retrieved from https://doaj.org/article/cea1c436f7314393903749e0327bae99

Benjamin, A. I., & Zachariah, P. (1993). Nutritional status and feeding practices in under-3 years old children in a rural community in Ludhiana, Punjab. Health and Population-Perspectives and Issues, 16(1&2), 3-21.

Dasgupta, R., Sinha, D., & Yumnam, V. (2016). Rapid survey of wasting and stunting in children: What's new, what's old and what's the buzz?. Indian Pediatrics, 53(1), 47-49.

Gupta, M., & Jindal, R. (2016). Assessment of nutritional status of under five children attending outpatient department at a tertiary care hospital: A study from North India. International Journal of Scientific Research and Education, 4(05).

Hien, N. N., & Kam, S. (2008). Nutritional status and the characteristics related to malnutrition in children under five years of age in Nghean, Vietnam. Journal of Preventive Medicine and Public Health, 41(4), 232-40. Retrieved from http://www.researchgate.net/ publication/23135306

Kuriakose, J. R. (2010). Nutritional status and feeding practices of infants. Nursing Journal of India, l (8), 28- 32. Retrieved from www.scribd.com/doc/35395961

Mahindra & Mahindra (2012, January 11). 42 percent of Indian children are underweight. The Hindu, 4. Retrieved from http://www.thehindu.com/news/national/42-per-cent-of-indian-children-are-underweight/ article2789902.ece

Mishra, B., & Mishra, S. (2007). Nutritional anthropometry and preschool child feeding practices in working mothers of Central Orissa. Studies of Home Community Science, 1(2), 139-144. Retrieved from http://www.krepublishers.com

National Family and Health Survey. (2009). National family and health survey - 3. Retrieved from http://rchiips.org/nfhs/nfhs3.shtml

Rosamma, K. J. (2007). A study to correlate feeding practices of mothers and nutritional status of their children in a selected area, Bangalore (Unpublished master's thesis). Rajiv Gandhi University of Health Science, Bangalore, Karnataka.

UNICEF. (2006). A report card on nutrition: progress for children. Retrieved from www.unicef.org/progress for children

Vinod, N., Swarnakanta, L., Smita, P., & Pushpa, D. (2011). Nutritional status and dietary pattern of underfive children in urban slum area. National Journal of Community Medicine, 2(1), 143-48.

World Health Organization. (2003). Guiding principles for complementary feeding of the breastfed child. Retrieved from http://www.who.int/nutrition.

SAMPLING AND METHODS OF DATA COLLECTION IN QUALITATIVE RESEARCH

*Bala Seetharaman, M. Sc (N)., Ph.D (N)

*Professor, College of Nursing, CMC, Vellore

ABSTRACT

Qualitative research deals with data collected in narrative form which requires an in-depth knowledge in selecting appropriate sampling techniques and data collection methods. Unlike quantitative studies, non-probability sampling techniques are used in qualitative studies to enhance information richness. Sample size is not determined using statistical formula, but is based on the principle of data saturation and the type of qualitative study methodology. Qualitative studies adopt flexible data collection plans which may evolve as the study progresses. Observation, in-depth interviews and focus group discussions are the primary data collection methods in qualitative studies.

Keywords: qualitative methods, purposive sampling, snowball sampling, theoretical, sampling, sample size, observation, in-depth interview, focus groups..

REFERENCES

Basch, C. E. (1987). Focus group interview: An underutilized research technique for improving theory and practice in health education. Health Education Quarterly, 14, 411-48.

Burgess, R. G. (1984). In the field: An introduction to field research. London: Unwin Hyman.

Burns, N., & Grove, S. K. (2004). The practice of nursing research: Conduct, critique, and utilization (5th ed.). Philadelphia: Saunders.

DeWalt, K. M., & DeWalt, B. R. (2002). Participant observation: A guide for field workers. Walnut Creek, CA: AltaMira Press.

Glaser, B. G. (1978). Theoretical sensitivity: Advances in the methodology of grounded theory. Mill Valley, CA: Sociology Press.

Holloway, I. (2005). Qualitative research in health care. Berkshire: England, Open University press.

Holstein, J. A., & Gubrium, J. F. (1997). Active interviewing in D. Silverman (Ed.), Qualitative research: Theory, method and practice. London: Sage.

Kitzinger, J. (1995). Introducing focus group. British Medical Journal, 311 (7000), 299 - 302.

Manoranjitham, S., & Jacob, K. S. (2007). Focus group dicussion. The Nursing Journal of India, XCVIII(6), 125 - 127.

Morgan, D. (1988). Focus groups as qualitative research. London: Sage.

Patton, M. Q. (2001). Qualitative research and evaluation methods (2nd ed.). Thousand Oaks, CA: Sage.

Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage.

Polit, D. F., & Beck, C. T. (2014). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins.

Rossman, G. B., & Rallis, S. F. (1998). Learning in the field: An introduction to qualitative research (3rd ed.). Thousand Oaks, CA: Sage.

Rubin, H. J., & Rubin, I. S. (1995). Qualitative Interviewing: The art of hearing data. Thousand Oaks, CA: Sage.

Ulin, P. R., Robinson, E. T., & Tolley, E. E. (2004). Qualitative methods in public health: A field guide for applied research (1st ed.). Philadelphia: Jossey-Bass. retrieved from https://commons.wikimedia. org/w/index. php?curid=37145513

Ravindran, V., Rempel, G., & Ogilvie, L. (2013). Parenting burn injured children in India: A grounded theory study. International Journal of Nursing Studies, 50(6), 786-796. doi:10.1016/j.ijnurstu.2012.06.011

GESTATIONAL DIABETES MELLITUS

*Dorathy Devakirubai.T, M.Sc (N)
**Anne Jarone, M.Sc (N)

*Professor, College of Nursing, CMC, Vellore
**Professor, College of Nursing, CMC, Vellore

ABSTRACT

Pregnancy may be complicated by a variety of disorders and conditions that can profoundly affect the health of a woman and her fetus. Some of them may exist prior to the woman becoming pregnant, while some may begin with pregnancy. Diabetes mellitus is the most common metabolic complication of pregnancy, which affects the progress of pregnancy and development the fetus. This article reviews the types, pathophysiology, risk factors, diagnosis, effects of diabetes on pregnancy and the fetus and aims to equip the nursing personnel with the knowledge required to provide appropriate care to such women with gestational diabetes mellitus.

gestational diabetes mellitus, pregnancy, metabolic disorder, fetus, nursing care

REFERENCES

American Diabetic Association. (2004). Gestational diabetes mellitus. Diabetic Care, 27(1), 588 - 590. Retrieved from http://care.diabetesjournals.org/ content/diacare/27/suppl_1/s88.full.pdf

Bhavadharini, B., Mahalakshmi, M. M., Anjana, R. M., Maheswari, K., Uma, R., Deepa, M., . . . & Ninov, L. (2016). Prevalence of gestational diabetes mellitus in urban and rural Tamil Nadu using IADPSG and WHO 1999 criteria (WINGS 6). Clinical Diabetes and Endocrinology, 2(1), 1.

Daftary, S. N., Chakravarti, S. & Daftary, G. S. (1998). Holland & Brews manual of obstetrics (16th ed.). New Delhi: Churchill Livingstone.

Erem, C., Kuzu, U. B., Deger, O., & Can, G. (2015). Prevalence of gestational diabetes mellitus and associated risk factors in Turkish women: The Trabzon GDM Study. Arch Med Sci, 11(4), 724 - 735. Retrieved from https://www.ncbi.nlm. nih.gov/ pmc/articles/PMC4548030

Fraser, D. M., & Cooper, M. A. (Eds). (2003). Myles text book for midwives (14th ed.). New Delhi: Churchill Livingstone

Gilmartin, A. B., Ural, S. H., & Repke, J. T. (2007). Gestational diabetes mellitus. Reviews in Obstetrics and Gynecology, 1(3), 129-134. Retrieved from https://www.ncbi. nlm.nih.gov/pmc/ articles/PMC2582643/ Gopalan, S., & Jain, V. (2005). Mudaliar & Menon's clinical obstetrics (10th ed.).Chennai: Orient Longman.

Goud, T. G., Kumar, K. P., & Ramesh, K. (2014). Risk factors of gestational diabetes in Karnataka. International Journal of Current Research and Academic Review, 2(9), 286 - 291. Retrieved from http://www.ijcrar.com/vol-2-9/T.Gangadhara% 20Goud1,%20et%20al.pdf

Jali, M. V., Desai, B. R., Gowda, S., Kambar, S., & Jali, S. M. (2011). A hospital based survey of prevalence of gestational diabetes mellitus in an urban population of India. European Review for Medical and Pharmacological Sciences, 15, 1306 - 1310. Retrieved from http://www.europeanreview.org/wp/wp-content/uploads/1069.pdf Mandal, A. (2016). Gestational diabetes pathophysiology. Retrieved from http://www.news-medical.net/ health/Gestational-Diabetes-Pathophysiology.aspx

Raja, M. W., Baba, T. A., Hanga, A. J., Bilqees, S., Rasheed, S., Haq, I. U., . . . Bashir, A. (2014). A study to estimate the prevalence of gestational diabetes mellitus in an urban block of Kashmir valley (North India).

International Journal of Medical Science and Public Health, 3(2), 191 - 194. doi:10.5455/ijmsp h.2013 .211120131

Rajput, R., Yadav, Y., Nanda, S., & Rajput, M. (2013). Prevalence of gestational diabetes mellitus & associated risk factors at a tertiary care hospital in Haryana. The Indian Journal of Medical Research, 137(4), 728. Retrieved from https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3724253

Reeder, S. J., Martin, L.L., & Griffin, D. K. (1992). Maternity nursing (18th ed.). Philadelphia: Lippincott.

Seely, E. W., & Zera, C. (2006). Gestational diabetes mellitus. UK: BMJ Best Practice. Retrieved from http://bestpractice.bmj.com/best-practice/monograph-pdf/665.pdf

Thomas, N., Jeyaraman, K., Asha, H. S., & Velavan, J. (2012). A practical guide to diabetes mellitus (7th ed.). New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.

Turner, E. (1999). Gestational diabetes: Pathophysiology and personal experiences. Journal of Diabetes Nursing, 3, 90-93. Retrieved from http://www.thejournalofdiabetesnursing.co.uk/media/content/_master/3027/files/pdf/jdn3-3-90-3.pdf

World Health Organisation. (1999). Definition, diagnosis, and classification of diabetes mellitus and its complications. Geneva: Department of Noncommunicable Disease Surveillance. Retrieved from http://apps.who .int/iris/bitstream /10665/66040/1/WHO_NCD_NCS_99.2.pdf

WILSON DISEASE: A CASE STUDY

*Merlin Prasad
**Deena David

*Third Year BSc (N)
**Reader, College of Nursing, CMC, Vellore

ABSTRACT

Wilson disease, also called hepatolenticular degeneration is an autosomal recessive defect in cellular copper transport. A defect in biliary excretion leads to accumulation of copper in the liver, causing progressive liver injury and cirrhosis. The recommended initial treatment for symptomatic patients or those with active disease is administering chelating agents such as D-Penicillamine. The definitive treatment is liver transplant. This article focuses on the nursing care of a patient with Wilson disease and using the nursing process approach, a case study is presented

Keywords: Wilson disease, hepatolenticular degeneration, accumulation of copper, chelating agents, liver transplant, nursing care

REFERENCES

European Association for the Study of the Liver. (2012). EASL clinical practice guidelines: Wilson's disease. Journal of Hepatology, 56(3), 671-685.

Ferenci, P., Czlonkowska, A., Merle, U., Ferenc, S., Gromadzka, G., Yurdaydin, C., . . . & Stremmel, W. (2007). Late-onset Wilson's disease. Gastroenterology, 132(4), 1294-1298. http://dx.doi.org/10.1053/j.gastro .2007.02.057

Gulanick, M., & Myers, J. L. (2010). Nursing care plans: Diagnoses, interventions, and outcomes. St. Loius: Elsevier Health Sciences.

Kliegman, R., Stanton, B., & Geme, J. (2015). Nelson textbook of pediatrics (20th ed.). St. Louis: Elsevier.

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2014). Medical-surgical nursing: assessment and management of clinical problems. Philadelphia: Elsevier Health Sciences.

Roberts, E. A., & Schilsky, M. L. (2008). Diagnosis and treatment of Wilson disease: An update. Hepatology, 47(6), 2089-2111.

Rodriguez-Castro, K. I., Hevia-Urrutia, F. J., & Sturniolo, G. C. (2015). Wilson's disease: A review of what we have learned. World Journal of Hepatology, 7(29), 2859. doi: 10.4254/wjh.v7.i29.2859

EFFECTIVENESS OF ACUPRESSURE ON IMPROVEMENT OF SLEEP QUALITY AMONG ELDERLY

*D. R. Rajkumar, M. Sc (N)
**Rogina J. S. Savarimuthu, M.Sc.(N) (Psychiatry), M.S.(Psychotherapy & Counselling), M.Sc. (Psychology)

*Associate Professor, Cheran's College of Nursing, Coimbatore
**Assistant Professor, Chettinad College of Nursing, Kanchipuram

ABSTRACT

Sleep quality is altered with the advance of age. Acupressure is a non-pharmacological therapy, which involves the stimulation of certain acupoints by pressing with the fingers. A study was conducted in two old age homes in Madurai to assess the effectiveness of acupressure on improvement of sleep quality among the elderly. Quantitative approach with one group pre-test post-test design was used. Pittsburg Sleep Quality Index (PSQI) was used to measure the sleep quality. All the subjects reported poor quality of sleep. Majority had moderate level of poor quality of sleep in pre-test (61.7%). Following acupressure 43.3% of subjects reported good quality of sleep. Acupressure was found to be significantly effective in improving sleep quality. As acupressure has no significant adverse effects or side effects, nurses can empower themselves with acupressure skills and intervene when elderly clients have poor sleep quality.

Keywords: acupressure, sleep quality, elderly patient, Pittsburg Sleep Quality Index

REFERENCES

Ancoli-Israel, S. (2000). Insomnia in the elderly: A review for the primary care practitioner. Sleep, 23, S23 - S30.

Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Journal of Psychiatric Research, 28(2), 193 - 213.

Carotenuto, M., Gallai, B., Parisi, L., Roccella, M., & Esposito, M. (2013). Acupressure therapy for insomnia in adolescents: A polysomnographic study. Neuropsychiatric Disease and Treatment, 9, 157 - 162.

Chen, J. H., Chao, Y. H., Lu, S. F., Shiung, T. F., & Chao, Y. F. (2012). The effectiveness of Valerian acupressure on the sleep of ICU patients: A randomized clinical trial. International Journal of Nursing Studies, 49 (8), 913 - 920.

Chen, M. L., Lin, L. C., Wu, S. C., & Lin, J. G. (1999). The effectiveness of acupressure in improving the quality of sleep of institutionalized residents. The Journals of Gereontology. Series A, Biological Science and Medical Sciences, 54(8), 389 - 394.

Lu, M. J., Lin, S. T., Chen, K. M., Tsang, H. Y., & Su, S. F. (2013). Acupressure improves sleep quality of psychogeriatric inpatients. Nursing Research, 62(2), 130 - 137.

Reza, H., Kian, N., Pouresmail, Z., Masood, K., Sadat Seyed Bagher, M., & Cheraghi, M. A. (2010). The effect of acupressure on quality of sleep in Iranian elderly nursing home residents. Complementary Therapies in Clinical Practice, 16(2), 81 - 85.

Roepke, S. K., & Ancoli-Israel, S. (2010). Sleep Disorders in the elderly. Indian Journal of Medical Research, 131, 302 - 310.

Shariati, A., Jahani, S., Hooshmand, M., & Khalili, N. (2012).The effect of acupressure on sleep quality in hemodialysis patients. Complementary Therapies in Medicine, 20(6), 417 - 423.

Smyth, C. (2007). The Pittsburgh Sleep Quality Index (PSQI). Try this: Best Practices in nursing care to older adults. Retrieved from www.ConsultGeriRN.org.

Sun, J. L., Sung, M. S., Huang, M. Y., Cheng, G. C., & Lin, C. C. (2010). Effectiveness of acupressure for residents of long-term care facilities with insomnia: A randomized controlled trial. International Journal of Nursing Studies, 47(7), 798 - 805.

Yang, M. H., & Lin, L. C. (2007). Acupressure in the care of the elderly. The Journal of Nursing, 54(4), 10 -15.

Yeung, W. F., Chung, K. F., Poon, M. M., Ho, F. Y., Zhang, S. P., Zhang, Z. J., Ziea, E. T., & Wong, V. T. (2012). Acupressure, reflexology and auricular acupressure for insomnia: A systematic review of randomized controlled trials. Sleep Medicine, 13(8), 971 - 984.

KNOWLEDGE OF NURSES IN CARING FOR PREGNANT WOMEN WITH HIV/AIDS INFECTION

*Neena Dondapati, M. Sc (N)., M. A. (Psychology)

*Program Officer, JHPIEGO, Gwalior, Madhya Pradesh

ABSTRACT

HIV is one of the most threatening acquired infections which can be transmitted from mother to baby. Women of reproductive age comprise more than half of the 33 million people currently living with HIV around the world. Amongst 0.48% of the antenatal mothers attending antenatal clinics it is estimated that 20,000 children are infected by HIV/AIDS contributing to 30% of vertical transmission. In India, stigma and discrimination towards HIV patients hinders them from seeking the best health care services. This descriptive study was done to assess the knowledge of staff nurses in caring for HIV infected pregnant women. Staff nurses working in a Government Hospital, Visakhapatnam were selected through purposive sampling. Questionnaire was administered and data was analyzed using descriptive and inferential statistics. The results showed that 16.67 % had inadequate knowledge, 60 % had moderately adequate knowledge, and 23.33% had adequate knowledge. This study highlighted the need for the knowledge of the nurses as they are the key persons in antenatal clinics providing awareness and Counselling for HIV mothers in order to increase the effective use of Antiretroviral therapy to prevent parent to child transmission.

Key words: HIV, knowledge, staff nurse, antiretroviral therapy, prevention of parent to child transmission

REFERENCES

Agrawal, A., Saoji, A., & Kasturwar, N. B. (2013). Knowledge among nurses towards HIV/AIDS in a tertiary care hospital, Nagpur. International Journal of Recent Trends in Science and Technology, 9(2), 281-284. Retrieved fromhttps://www.statperson.com /Journal/ScienceAndTechnology/Article/Volume9Issue2/9_2_37.pdf

Avert. (2016). HIV and AIDS in India. Retrieved from http://www.avert.org/professionals/hiv-aroundworld/asia-pacific/india

Biswas, D., Borkakoty, B., Mahanta, J., Walia, K., Saikia, L., Akoijam, B. S., . . . & Zomawia, E. (2011). Seroprevalence and risk factors of herpes simplex virus type-2 infection among pregnant women in Northeast India. BioMedCentral Infectious Diseases, 11(1), 1.

Chen, W. T., Han, M., & Holzemer, W. L. (2013). Nurses' knowledge, attitudes, and practice related to HIV transmission in northeastern China. AIDS Patient Care and STDs, 18(7), 417-422.

HIV AIDS Asia Pacific Research Statistical Data Information Resources AIDS Data hub. (2013). Retrieved form http://www.aidsdatahub.org/country-profiles? India

Masci, J. R. (2016). Outpatient management of HIV infection. London: CRC Press.

Mohammed, E, F., Kever, R. T., Martins, S. D., Afolabi, O., & Bulama, K. (2016). Knowledge, attitudes and practices of nurses' on prevention of mother-to-child transmission (PMTCT) of human immuno-deficiency virus (HIV) in State Specialist Hospital, Maiduguri, Borno State. International Journal of Nursing and Midwifery, 8(2), 12 - 17. Retrieved from file:///C:/Documents% 20and%20 Settings/cmc/My%20Documents/ Downloads /HIV%20AIDS%2 0Nurses% 20knowledge%20(3).pdf

United Nations International Children's Emergency Fund. (2013). Preventing mother to child transmission of HIV. Retrieved from http://www.unicef.org/esaro/5482_ pmtct.html

World Health Organisation. (2015). Mother to child transmission of HIV. Retrieved from http://www.who. int/hiv/topics/mtct/en/

World Health Organization. (2016). HIV/AIDS. Retrieved from http://www.who.int /features/qa/71/en/

CONSTRUCTION AND VALIDATION OF HINDUMATHI, THEODORE AND PHILIP: PRIMARY CARE GIVERS PERCEIVED PSYCHOSOCIAL WELLBEING SCALE

*Hindumathi Bheeman, M. Sc (N)
**Dorothy Deena Theodore, M. Sc (N)
*** Mariamma Phillip, M. Sc., Ph. D (Stat)
*Lecturer, Narayana Hrudyalaya College of Nursing, Bangalore
**Principal, Narayana Hrudyalaya College of Nursing, Bangalore
*Statistician, Narayana Hrudyalaya College of Nursing, Bangalore

ABSTRACT

Primary caregivers of hemodialysis patients experience burden of care giving because they are obliged to play an important role in supporting patients on hemodialysis. The patient prognosis and maintenance is dependent on the characteristics of the caregiver and the patient. Care giving is an important factor that determines psychosocial wellbeing of the primary caregivers. Psychosocial wellbeing comprises of their physical, psychological, spiritual and social dimension. The objective of this study was to evaluate the validity and reliability of the researchers' prepared tool to assess the psychosocial wellbeing of the primary care givers of patients on hemodialysis. Fifty six samples were selected for the study through complete enumeration. The tool was compared with the standard WHO prepared subjective wellbeing inventory. The psychosocial wellbeing tool had a strong positive correlation with the subjective wellbeing inventory. This instrument can be used by the nurses in assessing psychosocial wellbeing of the primary care givers of patients on hemodialysis.
Keywords: Hindumathi, Theodore and Phillip Scale, validation, psychosocial wellbeing, primary care giver, hemodialysis

REFERENCES

Belasco, A., Barbosa, D., Bettencourt, A. R., Diccini, S., & Sesso, R. (2006). Quality of life of family caregivers of elderly patients on hemodialysis and peritoneal dialysis. American Journal of Kidney Diseases, 48(6), 955-963. Campbell, D. T., & Fiske, D. W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin, 56(2), 81.

Christensen, A. J., & Ehlers, S. L. (2002). Psychological factors in end-stage renal disease: An emerging context for behavioral medicine research. Journal of Consulting and Clinical Psychology, 70(3), 712.

Cicolini, G., Palma, E., Simonetta, C., & Di Nicola, M. (2012). Influence of family carers on haemodialyzed patients' adherence to dietary and fluid restrictions: an observational study. Journal of Advanced Nursing, 68(11), 2410-2417.

ESRD Patients in 2012. (2012). A global perspective. Retrieved from http://www.vision-fmc.com/files/pdf_2/ESRD_Patients_2012.pdf

Global Scenario of Chronic Kidney Disease. Advances in CKD.Retrieved from http://www.renalcareindia.org/ Statistics.aspx on December 10, 2014

Jha, V. (2013). Current status of end-stage renal disease care in India and Pakistan. Kidney International Supplements, 3(2), 157-160.

Jha, V., Wang, A. Y. M., & Wang, H. (2012). The impact fo CKD identification in large countries: The burden of illness. Nephrology Dialysis Transplantation, 27(suppl 3), iii32 - iii38.

Schieppati, A., & Remuzzi, G. (2005). Chronic renal diseases as a public health problem: Epidemiology, social, and economic implications. Kidney International, 68, S7-S10.

Suri, R. S., Larive, B., Garg, A. X., Hall, Y. N., Pierratos, A., Chertow, G. M., . . . & FHN Study Group. (2011). Burden on caregivers as perceived by hemodialysis patients in the Frequent Hemodialysis Network (FHN) trials. Nephrology Dialysis Transplantation, gfr007.

Tong, A., Lowe, A., Sainsbury, P., & Craig, J. C. (2010). Parental perspectives on caring for a child with chronic kidney disease : An in - death interview study. child care, Health and Development, 36 (4), 549 - 557

World Health Organization. (1992) Assessment of subjective wellbeing. The subjective well being inventory (SUBI). Regional health paper. SEARO No. 24. Retrieved from http://apps.searo.who.int/PDS_DOCS/B0081.pdf