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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

A STUDY TO EVALVUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF MOTHERS REGARDING OPTHALMIC EMERGENCIES ON SELECTED EYE PROBLEMS IN CHILDRENS (5-13YRS) AT SELECTED RURAL COMMUNITY, KOLAR, KARNATAKA”.




PROFORMA FOR REGISTRATION OF

SUBJECT FOR DISSERTATION

MRS.USHA

E.T.C.M COLLEGE OF NURSING, KOLAR – 563101

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KOLAR, KARNATAKA.
PROFOMA FOR REGISTRATION OF SUBJECT DISSERTATION



1.


NAME OF THE CANDIDATE AND ADDRESS



MRS. USHA

I YEAR MSC(NSG)

E.T.C.M. COLLEGE OF NURSING,

P.O BOX NO.4,

KOLAR-563101,KARNATAKA


2.


NAME OF THE INSTITUTION



E T C M COLLEGE OF NURSING,P.O.BOX NO.4,

KOLAR-563101,KARNATAKA


3.


COURSE OF THE STUDY



MASTER DEGREE IN NURSING

CHILD HEALTH NURSING


4.


DATE OF ADMISSION TO THE COURSE



1\07\2011


5.


TITLE OF THE TOPIC

EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF MOTHERS REGARDING OPTHALMIC EMERGENCIES ON SELECTED EYE PROBLEMS IN CHILDREN (5-13YEARS).”





6. BRIEF INTRODUCTION OF THE INTENDED WORK


6.1: NEED FOR THE STUDY
Sarvendriyana Nayanam Pradanam
A child is a precious gift who has lots of potential within, who can be best resource of the nation if raised and molded in a good manner. The health of a growing child is always a matter of great concern to the parents. The physical health of a child is important because it is associated with the mental and social development. Health care aspects of children have been neglected over years when compared to adults. Infants first learn how to interact with others by watching their parents faces. They continue to depend on sensory input for stimulation throughout life. Good health is an important part of good vision. The healthier the child the better chance to avoid risk to his eyes.1

Children are our future, precious and valuable; the most appreciated gift that can be given to them is a healthy life. However, due to negligence arising from the lack of knowledge regarding the eyes, our children may encounter eye diseases that are becoming more and more difficult to treat. There is no age limitation for an eye examination. Any abnormalities having to do with the eyes should be examined regardless of one’s age. Even though children do not have any complaints, they should undergo a minimum of one eye examination early diagnosis and treatment is essential for a child’s eye health. Otherwise, they may be condemned to sight impairment forever as well as aesthetic problems. The ideal age for the first eye examination for a child is at age two, even when the child has no complaints. It is of critical importance that children who attend school undergo an eye examination at least once in a year.2

Good eye sight is every Childs birth right; Eye injuries occur frequently and can happen anywhere. In children eye injuries can occur at home, school or play ground and also during the festivals. Retinal burns can occur while viewing the solar eclipse without protection. They should always be aware of the best ways to protect their eye sight.3The trend of increased TV and computer exposure has led to an increase in vision-related problems in children. Very often parents don’t realize that their children are suffering from vision related problems.4

Parents are often the first to notice vision problems in a young child. A vision examination may be needed if your child is clumsy (beyond normal toddler clumsiness) and fails to notice new things around him or her. Rubs his or her eyes when the child is not tired (rubbing eyes when tired is normal). Has excessive tearing when not crying. Have frequent eye infections, swollen eyelids, or frequent sty’s. Conjunctivitis (pinkeye) is a common problem in children. Have eyes that seem to bulge, bounce, or dance in rapid regular movements. Often tilts the head to one side as though trying to see well. Often covers one eye or shuts one eye because he or she is uncomfortable. All children will sometimes cover or close an eye to experiment with their vision and see how the world looks with only one eye open. Avoids tasks or play that requires good vision, like looking at books. Holds books or toys too close or sits too close to the TV screen. Has an eye that look mismatched or crossed or that don't move together. Has a pupil that are not the same size or that appear white instead of black.5

Vision problems affect 1 in 20 per schooler and 1 in 4 school-age children. Since vision Problems begin at any age, it is very important that children receive proper eye care. Untreated eye problems can worsen & lead to other serious problems as well as affect learning ability, personality and adjustment in school. Without primary eye care only those individuals who present to secondary and tertiary facilities will be diagnosed and treated and little will be achieved in terms of prevention.5

Sight is precious, considered by many to be the most essential of the five senses. Children's eyesight is especially important, because good vision is related to learning. Regular eye examinations are needed to maintain proper eye health, since some serious eye disorders produce no early warning symptoms. Although prevention is the best defense, eye problems or injuries still occur suddenly and unexpectedly. When they do, recognizing their signs and symptoms and knowing what to do is vital to preserving sight.6

Vision is something, every individual is sensitive about, and we cannot imagine life without sight. In other Worlds it can be said that, Quality of life depends and directly influences, the quality of sight. The eyes are wonderful sensory organs. They help people to learn about the world in which they live. The eyes have many parts all of which must function in order to see properly. Most eye problem in children can be corrected if they are detected and treated early. Appropriate eye care is essential for maintaining good vision, some problem, if left untreated even for a short period can result in permanent vision loss.5

Statistic shows that Blindness is now major public health problem both in the developed & the developing countries. A blindness prevalence rate of more than 1% is widely acknowledged as indicative of a significant public health problem. The past few decades have seen an upsurge in the number of blind in population size, increase in life expectancy, lack of surgical services, inadequacy & under-utilization of available man power, lack of nutrients such as vitamin A, due to various diet associated factors, environmental factors such as unsafe water & sanitation & factors of gender socioeconomic status & religion and in adequate child care facilities.7

Visual impairment and blindness in children can be caused by various diseases depending on the actual geographical area and the socio-economic status of the population. In developing countries blindness in children is usually caused by conditions, which result in scarring of the cornea, such as vitamin A deficiency, measles infection, and conjunctivitis of the newborn and harmful traditional eye medicines. Elsewhere, the main causes are cataract, retinopathy of prematurity, genetic diseases and congenital abnormalities.8 this problem are confused by inadequate awareness of eye care and utilization of eye services.

According to WHO every minute a child somewhere in the world goes blind, worldwide approximately there are 1.5 million blind children. An estimated 127 million pre-school children are vitamin A deficient, and each year 350,000 children go blind.9 About 1.1 percent of population in India suffers from avoidable blindness; approximately 12 million are blind in country. Karnataka State has the highest number of people suffering from avoidable blindness in country It is estimated that 747 children are suffering from vitamin A deficiency and 979 children have defective vision in Bangalore District alone.10

A study was conducted to assess parental awareness regarding common childhood injuries and focus on preventive issues. Two hundred parents of children were interviewed and responses analyzed. The study revealed that awareness regarding common childhood injuries and their prevention was lacking. There was a felt need that pediatrician must counsel the parents on this aspect.11

The global initiative was launched by the WHO in Feb 1999. The objective is to make the member countries capable of taking sustainable initiatives for prevention of avoidable blindness by recognizing “Right for Vision”. The concept centers round the right to have vision. The target is to be achieved by the year 2020.12 since mothers are the primary care provider for their children at home; it is mother’s knowledge that greatly affects the care of the children. Hence the investigator felt the need to educate mothers regarding first aid measures on common eye problems.

6.2 REVIEW OF LITERATURE:
Review of literature is an important step in the development of a research project. It involves the systematic identification, factors and summary of written materials that contain information of research.

Review of literature is categorized under the following headings:



  1. Review of literature related to causes and prevalence of eye problems in children

  2. Review of literature related to ophthalmic emergencies on selected eye problems in children

  3. Review of literature related to mothers knowledge on eye problems in children

  4. Review of literature related to teaching programme on eye problems




  1. Review of literature related to causes and prevalence of eye problems in children

A study was conducted on childhood eye disease in Ibadan, Nigeria. Eye disease of 1028 children were assessed Refractive errors, viral conjunctivitis, measles, Keratitis and malnutrition were leading cause of eye problems. Squint, glaucoma, uveitis and trachoma were rare among children below 15years of age group.13

A study was conducted to determine the epidemiological characteristics of sever eye injuries in childhood in Greek. Population was children below 17years of age. The data were analyzed with respect to age, sex, type, cause and mode of injury. The study findings revealed that most common type of eye injuries were mechanical closed-globe injury 71.8%, mechanical open-globe injuries were found 21.3% and burns comprised of 6.7% of injuries.14

A study was conducted to provide epidemiological data on serious eye injuries among children that can be utilized in planning health education and safety strategies for preventing such injuries records were revived of 116 children who sustained serious eye injuries. The material was analyzed retrospectively with respect to various epidemiological features. The major causes of serious eye injuries among the children were unnecessary risk during play, the use of dangerous objects and insufficient supervision, especially at home. Health education should be directed towards prevention of such serious injuries.15

A survey was conducted in 12 blind schools in Nepal, to evaluate cause of visual impairment of blind students. The students were in the age group of 5 – 29years. All the students were examined by using standard protocols of World Health Organization Prevention of Blindness Programme. The findings of the study revealed that the major etiological factors of visual impairment and blindness were vitamin A deficiency, measles, hereditary, Corneal and retinal diseases.16


  1. Review of literature related to first aid measures on eye problems in children

A study was conducted that Use of lavage fluid containing diphoterine for irrigation of eyes in first aid emergency treatment. Eye irrigation is a widely accepted therapeutic must in first aid treatment. The burning agent is removed, diluted, and if possible neutralized. The first experiment (I) shows the effects of ocular rinsing with 500 ml Previn in ten healthy human subjects compared with phosphate buffer rinsing. Evaluation is done by slit lamp examination and confocal microscopy. Results showed that No harmful effect of irrigation with Previn could be found. Its compatibility with the eye is comparable to phosphate buffer rinsing. (II a) Buffering capacity was found to be stronger for Previn in acids and bases compared to phosphate buffer or Ringer's lactate saying Previn and phosphate buffer should only be used in first aid treatment and not for continued rinsing therapy.17

The first 24 hours are critical for a good surgical result from perforating eye injuries. The basic principles of initial management and transfer include prevention of vomiting, pain and infection, and avoidance of further injury. Where air transport is necessary it must be with the cabin altitude at sea level, or as low as is safe. Surgical repair should be undertaken as promptly as is practical.18

The various types of injury which may occur to the eye are described. These may be easily missed altogether, or their extent not realised, unless great care and vigilance is exercised by those who first see the patient. Emphasis has been placed on the immediate care required and the urgency with which the different categories of injury must be referred to a specialist.19



  1. Review of literature related to mothers knowledge on eye problems in children

An Exploratory Study using qualitative method was conducted to identify the level of Knowledge about blindness and visual impairment. Focus group discussions and semi-structured interviews were conducted with various community groups such as teachers, Church leaders, parents and employees of enterprises. The data showed that there is a lack of awareness of blindness and visual impairment. Certain eye conditions need to be understood by the community, therefore eye health promotion activities and strong primary health care important.20

A longitudinal, Experimental intervention study was conducted to compare the effect on perceived stress level of providing information about the implication of visual impairment to parents. The study findings reveled that parents do not know whom to approach to patient liaison team who could advice about the repercussion of visual impairment in children would be beneficial.21

A cross-sectional survey using self-administered questionnaires was conducted. 882 adults were questioned. The study findings revealed that poor knowledge of eye diseases and also suggest that innovative education programme in primary and secondary schools and in non-English language are needed to improve knowledge, attitude and practices.22

A quantitative survey was conducted to parents with children aged 5years. The total sample size was 2088. The results showed that 95% of parents reported that they personally take measures to avoid accidental injuries in their children. Lack of awareness or knowledge about the causes of accidents was the second response. Two-third of parents would like to see more help from the government to prevent childhood injuries. Three-quarters of parents agreed that child injuries can be avoided. It was concluded that parents want to be better informed about the causes of child accidents about actions they and society can take to reduce injury-related risk to children. 23

4. Review of literature related to teaching programme on eye problems

The aim of this study was to investigate whether a public education campaign can increase awareness and change help-seeking behaviour with respect to ocular health in an Indian population. This study has shown a significant increase in awareness from using different kinds of media and has shown radio to be the most effective in our target community.24

Community ophthalmology requires a comprehensive approach for primary, secondary and tertiary prevention of all eye diseases like vitamin A deficiency, trachoma, measles, diabetic retinopathy, refractive errors, etc. Community ophthalmology is based on the principles of primary health care approach.25

This review explores the role of health promotion in the prevention of avoidable blindness in developing countries. Using examples from eye health and other health topics from developing countries, the review demonstrates that effective eye health promotion involves a combination of three components: health education, infrastructure, and advocacy.26

Researches evaluated the impact of a health education program on the prevalence of active trachoma in children 3 to 9 years old. Overall, there was a small but statistically significant reduction in the prevalence of active trachoma between surveys, but differences between the 3 intervention arms were not statistically significant.27
STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of structured teaching programme on knowledge of mothers regarding ophthalmic emergencies on selected eye problems in children (5-13years) at selected rural community Kolar.



6.3 OBJECTIVES OF THE STUDY:

6.3.1 To assess the knowledge of Mothers regarding ophthalmic emergencies on selected eye problems in children by pre-test score

6.3.2 To determine the effectiveness of structured teaching programme on ophthalmic emergencies on selected of eye problems by comparing pre and post test knowledge scores

6.3.3 To determine association between pre test knowledge scores of mothers with children with selected demographic variables.

6.4 OPERATIONAL DEFINITION:

  1. Assess: It refers to valuation or judgment of mother on ophthalmic emergencies on selected eye problems in children.

  2. Knowledge: Refers to the correct response from the mothers on ophthalmic emergencies on selected eye problems in children.

  3. Effectiveness: Refers to extent to which the structured teaching programme on ophthalmic emergencies on selected eye problems in children achieves the desired effect in improving the knowledge of mothers as evident from gain in knowledge scores.

  4. Structured teaching programme: Refers to systematically developed instructional method and teaching aids designed for mothers to provide information on ophthalmic emergencies on selected eye problems in children.

  5. Mothers: Refers to Women who have children in age group 5-13years.

  6. Eye problems: Refers to disease condition affecting Eye such as Conjunctivitis, Blepharitis, Trachoma, Eye injuries, and foreign bodies in eye.

6.5 RESEAREH HYPOTHESIS:

H1: There will be a significant difference between pre and post test knowledge scores.

H2: There will be significant association between pre-test knowledge scores with

selected demographic variable.



6.6 ASSUMPTIONS:

  1. Mothers may have some knowledge about eye problems.

  2. The knowledge of mothers regarding ophthalmic emergencies on eye problems will help to prevent blindness in children.

6.7 VARIABLES UNDER THE STUDY

1. Independent variable: structured teaching programme on ophthalmic emergencies on selected eye problems in children.

2. Dependent variable: Knowledge of mothers on opthalmic emergencies on selected eye problems in children.
6.8 DELIMITATION:

The study is delimited to Mother with children (5-13years)



7. MATERIALS AND METHODS

7.1 Source of data:

Mother with children (5-13years) residing in Selected rural community.



7.2 Method of data collection:

Structured interview schedule to assess the knowledge of mothers on ophthalmic emergencies on selected of eye problems in children.



7.2.1 Research approach:

Evaluative research approach will be adopted



7.2.2 Research design:

Quasi experimental (one group pre – post design)



7.2.3 Setting:

The study will be conducted in selected rural community Kolar.



7.2.4 Population:

The target population of the study is mother with children (5-13years).



7.2.5 Sample size:

The total sample of study will be 60 mothers.



7.2.6 Sampling technique:

Convenient sampling technique will be adopted to select the samples for the present study based on inclusion criteria.



7.2.7 CRITERIEA FOR SELECTION OF THE SAMPLE

Inclusion criteria:

  1. Mothers who are willing to participate in the study

  2. Mothers those who are available during data collection.

  3. Mothers with children in the age group of 5-13 years.

Exclusion criteria:

  1. Mothers whose children had suffered from eye problem.

7.2.8 TOOL FOR DATA COLLECTION:

Structured interview schedule will be used to assess the knowledge of mothers on ophthalmic emergencies on selected eye problems in children which consist of two parts,



PART I: Demographic variable such as age, education status, Family income, occupation, Number of children, religion, Type of family, history on Eye injuries and Sources of information on eye problems.

PART II: Knowledge items on eye problems its cause’s, risk factors, signs and symptoms and ophthalmic emergencies of eye problem.
7.2.9 DATA ANALYSIS METHOD:

Data analysis will be through descriptive and inferential statistics.



Descriptive statistics

  • Frequency, percentage, mean, mean percent and standard deviation will be used to compute demographic variable.

Inferential statistics

  • Parametric test- paired‘t’ test to compare pre and post-test knowledge score.

  • NON parametric test- chi-square test will be used to associate between pre -test knowledge scores with selected demographic variables.

7.3 Does the study require any investigation or interventions to be conducted on patients or other humans or animals?

Yes, structured teaching programme will be conducted to mothers on ophthalmic emergencies on selected of eye problems in children.



7.4 Has ethical clearance been obtained from your Institution?

Yes, Ethical clearance will be obtained from the research committee of ETCM college of Nursing.

Permission will be obtained from the concerned authority of selected rural community Kolar.

Informed consent will be obtained from the mothers who are willing to participate in the study.



8. LIST OF THE REFERENCES:

1. Sasikala T, Jayagowri subash. Effectiveness of Structured Teaching programme on

Acute Respiratory infection. Nightingales Nursing Times. Volum-4 Issue-3 June 2008.

2. Elana Pearl Ben-joseph MD.Yours Eyes Kids Health.Nov 2006.http://kidshealth.org.

3. DGHS ministry of health and family welfare. For your eyes only. Govt of India.2006

4. Dr Rajashekar Y.L.An eye on your child’s vision. Deccan Herald. Oct 18, 2008.

5. Chicago. Release National platform to help protect children’s vision. Prevent Blindness

America. July 2008. http://www.preventblindness.org.

6. Davis R. Ocular emergencies: a quick reference. School Nurse News. 2002

Mar; 19(2):34-7.


7. Gupta MC, Mahajan BK. Text book of preventive and social Medicine. 3rd edition.

Jaypee publisher. Newdelhi. 2005

8. Piyush Guptha, Ghaio.p. Text book of Community Medicine. 2nd edition. Vorma

publication.

9. WHO. Vision 2020 Priority eye disease. http://www.who.int/ncdvision2020-actionplan.

10. Staff Reporter. Project launched to prevent blindness in children. The Hindu. Mar 13

2006.

11. Sehgal A, et al. Parental awareness regarding childhood injuries. Indian journal



pediatrics Feb; 71 (2):125-8.

12. K.Park. Preventive and Social Medicine. 19th edition. M/s Banarsidas Bhanot

Publishers, Jabalpur New Delhi. 2007.

13. Ajaiyeoba A. Childhood eye diseases in Ibadan. African journal of medical science.

1994 Sep; 23(3):227-31.

14. Mela EK, et al. Sever ocular injuries in Greek children. Ophthalmic Epidemology.2003

Feb; 10(1):23-9

15. Al-Bdour MO, Azab MA. Childhood eye injuries in North Jordan. International

Opthalmology.199822 (5):269-73

16. Kansakar I, Thapa HB, et.al. Causes of vision impairment and assessment of need for

low vision services for students of blind school in Nepal. Katathmandu University

Medical Journal. 2009Jan-Mar; 7(25):44-9.

17. Langefeld S, Press UP, Frentz M, Kompa S, Schrage N. Use of lavage fluid containing

diphoterine for irrigation of eyes in first aid emergency treatment.Ophthalmology. 2003

Sep; 100(9):727-31.

18. Colvin J, Langford S, Emonson D, Kister M. Initial management and transport of

patients with perforating eye injuries. Aust Fam Physician. 1995 Jun;24(6):1017-20.

19. Ellingham TR. The immediate care of eye injuries. Ophthalmology. 2003 Sep;

100(9):727-31.

20. Luz Maria Ortiz Amezquita. Knowledge, attitudes and beliefs concerning visual

impairment and eye care services in the state of Chihuahua, Mexico. Community Eye

Health Journal. Vol 18 No. 56 Dec 2005.

21. Speed well L, Stanton F, Nischal KK. Informing parents of visually impaired children:

Who should do it and when? Child care health development. 2003 May; 29 (3): 219-24.

22. Noertjojo K, Maberley D, Bassett K, et,al. Awareness of eye diseases and risk factors:

identifying needs for health education and promotion in Canada. Canada journal

ophthalmology.2006 Oct; 41 (5):617-23.

23. Vincenten JA, Sector MJ, Rogmans W, Bouter L. Parent’s perception, attitudes and

behavior towards child safety: a study in 14 European Countries. International journal

Injury control Safety Promotion. 2005 Sep; 12(3): 183-9.

24. Baker H, Murdoch IE. Can a public health intervention improve awareness and health-

seeking behaviour for glaucoma? Br J Ophthalmol. 2008 Dec; 92(12):1671-5. 

25. Johnson GJ. Overview on community ophthalmology. J Indian Medical Associaton

1999 Aug; 97(8):305-8. Review.

26. Hubley J, Gilbert C. Eye health promotion and the prevention of blindness in

developing countries: critical issues. Br J Ophthalmol. 2006 Mar; 90(3):279-84.

Review.
27. Edwards T, Cumberland P, Hailu G, Todd J. Ethiopia. Ophthalmology. 2006

Apr; 113(4):548-55.




9.

SIGNATURE OF THE CANDIDATE



10.

REMARKS OF THE GUIDE

The research topic selected is relevant and feasible for the study.


11.

NAME AND DESIGNATION OF

11.1 GUIDE

MRS.NANDYALA RAMANJAMMA.

ASSOCIATE PROFESSOR, PAEDIATRIC NURSING



ETCM COLLEGE OF NURSING,KOLAR-563101




11.2 SIGNATURE OF THE GUIDE







11.3 CO-GUIDE(if any)







11.4 SIGNATURE OF THE CO-GUIDE







11.5 HEAD OF THE

DEPARTMENT

MRS.NANDYALA RAMANJAMMA.






11.6 SIGNATURE




12.

12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL

The topic was discussed with the members of research committee and was finalized. She is permitted to conduct the study.




12.2 SIGNATURE









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