Effectiveness of Planned Teaching about Knowledge Regarding side Effects of Typical Antipsychotics among the Primary care givers of Psychiatric Patient in selected Hospital
Ms. Sayali Devidas Dambhe1, Mr. Muniyandi S2
1M.Sc Nursing Final year Student, Kasturba Nursing College, Sewagram, Kasturba Health Society, Sewagram, District- Wardha, Maharastra, 442102
2Associate Professor, and HOD, Kasturba Nursing College, Sewagram, Kasturba Health Society, Sewagram, District- Wardha, Maharastra,442102
*Corresponding Author Email: sayalidambhe1993@gmail.com
ABSTRACT:
OBJECTIVE:
● Assess the level of knowledge regarding side effects of typical antipsychotics among primary care givers of psychiatric patients.
● To assess the effectiveness of planned teaching on knowledge regarding typical antipsychotics among primary care givers of psychiatric patients.
● To find out the association between level of knowledge among primary care givers of mentally ill client with their selected demographic variables.
Research approach: Present study was conducted on quantitative approach is used in this study. This approach was selected because the aim of this research study was to evaluate the effectiveness of planned teaching in improving the knowledge of primary care giver regarding side effects of typical antipsychotics drugs. With this approach it would be possible to describe the knowledge of primary care givers regarding side effects of typical antipsychotic drug. The quantitative approach would help the investigator to evaluate the effect of “Planned teaching” on the variable that is knowledge of the primary care givers
Research Design: One group pre-test post-test design has been used to fine the effectiveness of planned teaching about knowledge regarding side effects of typical antipsychotics among the primary care givers of psychiatric patient in selected hospital and also to determine the association between knowledge of primary care givers regarding side effect of typical antipsychotics with their selected demographic variables. A pre test was administered on day 1 by means of structural questionnaire depicted as Q1 and then planned teaching also conducted on day 1 depicted as X. A post test was conducted on day 7 using the same structured questionnaire depicted as Q2. The study design depicted as (Q1,X,Q2)
Setting of the study: The study was conducted in a selected hospital. The rationale for selecting this setting was easy transport, familiarity with the setting, administrative approval, cooperation and availability of subject.
Sample and sampling technique: In this study sample size was 40 primary care giver of psychiatric patient who take typical antipsychotics. Sampling refers to the process of selecting the portion of the population to represent the entire population.
Tool: Knowledge questionnaire is used to gather information.
Validity and reliability:
Reliability of the tool is a major criterion for assessing the quality and accuracy. It is the degree of consistency with which it measures the attribute. Reliability analysis was done by KR20 formula,The reliability coefficient correlation for structured knowledge questionnaire was 0.70 To obtain content validity of the tool, the prepared tool with synopsis, planned on side effects of typical antipsychotics, evaluator’s response sheet and content validity certificate were submit to 14 experts in the field of psychiatric nursing and psychiatry. All validated contents of the tools were received back from the experts with their valuable suggestion and comments. Their suggestions were taken into consideration and the modifications were incorporated in the final preparation of the structured knowledge questionnaire and planned teaching.
Pilot study: The investigator conducted the pilot study in selected hospital from 23th December 2016 to 30th December 2016. For the present study, the investigator obtained formal approval from the medical superintendent of in selected hospital. The investigator selected 4 samples by non-probability convenient sampling technique. After a brief self-introduction, the investigator explained the purpose of the study and obtained consent from them. Good rapport was established. The investigator conducted the pre-test and doubts were clarified. After that, planned teaching was given to the primary
Finding of the study: The finding including of the study includes, the analysis and interpretation of data collected from the primary care givers in selected hospital . Among the total 40 sample of primary care givers out of 14(35% )in 29-38 years of age,most of samples were female 24( 60% ),12(50%) having secondary education, 26(65% )of subjects belonged to Hindu religion,21(52.5%) of sample was on private job, 22(55%) sample having upto10000, 22(55%) samples was from to urban area 26( 65%) were having length of stay of more than 2 year. The frequency and percentage distribution of level of knowledge among primary care givers in pre-test. Among 40 samples the pre test score 3(7.5%)subjects were having poor knowledge (0-6)regarding the side effects antipsychotics, while 29(72.5%) had average knowledge (7-12),whereas 8(20%)subject had good knowledge (13-18)and none of the subjects had excellent knowledge about it. While in the post -test,1(2.5%) of the subject had average knowledge,19(47.5%)subject had good knowledge and 20(50%)subject had excellent knowledge regarding the side effects of antipsychotics. The comparison between the mean difference in pre-test and post test score was 8.2. The calculated 't ' value was 13.71,whereas the tabulated 't' value was 2.02,shows that the calculated 't' value was much higher than the tabulated 't' value. It shows that the planned teaching was effective in significant improving the knowledge of primary care givers of psychiatric patient regarding side effects of typical antipsychotics,so the null hypothesis H0 is rejected and the research hypothesis H1 is accepted.
Conclusion: The analysis of the study revealed that there was a significant improvement in the knowledge of primary care givers. The planned teaching proved to be effective in improving the knowledge and attitude of the primary care givers of psychiatric patient in selected hospital.
KEYWORDS: Typical antipsychotics, primary care givers, side effects of antipsychotics, planned teaching.
INTRODUCTION:
Mental health as ‘simultaneous success at working, loving and creating with the capacity for mature and flexible resolution of conflicts between instincts, conscience, important other people and reality.’1
Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.2
Mental illness is defined as any disturbance of emotional equilibrium as manifested in maladaptive behavior and impaired functioning caused by physical, chemical, biological, psychological, genetic, social or cultural factor. Research studies from different part of the country have shown that the mental illness is common in India as it is elsewhere and is equally common in rural and urban areas.2
Antipsychotics are those psychotropic drugs, which are used in the treatment of psychosis and psychotic symptoms. The original drugs used to treat psychosis are called “typical or conventional” neuroleptic drugs. With the discovery of the newer antipsychotic drugs in the 1990s, the treatment of these debilitating brain disorders has been revolutionized. While there are advantages and disadvantages to both classes of these antipsychotic drugs, the atypical offer a different pharmacological mechanism of action, an expanded spectrum of therapeutic efficacy, and a more acceptable side effects profile.3
BACKGROUND OF THE STUDY:
An antipsychotic drug are administered to control the symptoms of psychosis such as hallucinations and bizarre or paranoid behavior. These drugs calm without sedation or reduction in alertness. A number of antipsychotic medication fall into two generations: first generation drugs and second generation drugs. Among the most important first generation drugs are haloperidol, chlorpromazine, thioridazine, fluphenazine, and trifluoperazie. In recent years the second generation antipsychotics drugs are atypical antipsychotic drugs such as ripiprazole, respiridone, colazipine, olanazipine, quetiapine, and ziprasidone have replaced the first generation drug nearly completely. The side effects of first generation drug including weight gain, diabetes, high blood pressure, heart diseases, and other complication. Side efects from second generation antipsychotics vary among different agents, but weight gain has proven among most troublesome complication. These drugs tend to stimulate appetite, and the result is often significant weight gain.4
Extrapyramidal syndromes:
Extrapyramidal syndromes are significant side effects of antipsychotic therapy due to their severity, frequent occurrence and complications. Neuroleptic malignant syndrome is an idiosyncratic, potentially life-threatening and often diagnostically unrecognized condition induced by antipsychotic, which manifests with sudden fever, autonomic nervous system instability, Extrapyramidal syndrome and altered state of consciousness.4
Dystonia sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It may appear either as an acute or delayed, i.e. tardive sign. The incidence of dystonia is 2-3% among the patients treated with antipsychotics, and 50% among the ones cured with conventional antipsychotics.4
NEED FOR THE STUDY:
Caring for someone with a mental disorders can affects the dynamics of family. It takes up most of the career time and energy. The family responsibility is providing care for people with mental disorders has increased in past three decades. This has been mainly due to trend towards community care and de-hospitalization of psychiatry patient.5
In India the reported rate of mental illness is 100 per thousand population. It has been estimated that 20% - 50% of any patient population is at least partially complaint and that in patients with schizophrenia and related psychotic disorders rates run as high as 70%-80%. The WHO is currently undertaking a global survey of 26 countries in all regions of the world, based on ICD and DSM criteria. The first published figures on the 14 country surveys completed to date, indicate that, of those disorders assessed, anxiety disorders are the most common in all but 1 country (prevalence in the prior 12-month period of 2.4% to 18.2%) and mood disorders next most common in all but 2 countries (12-month prevalence of 0.8% to 9.6%), while substance disorders (0.1%–6.4%) and impulse-control disorders (0.0%–6.8%) were consistently less prevalent. It has been estimated that of largest prevalence rate of psychiatric illness. In the U.S find the anxiety disorders affect 15.7 million people in united states each year.6
Antipsychotic drugs do not cure mental illness but can reduce some of the symptoms or make them milder. They are usually in pill or liquid form. Symptoms like delusions usually go away within a few weeks. After about six weeks, many people will see a lot of improvement. However, people respond in different ways to antipsychotic medications, and no one can tell how a person will respond. Sometimes a person needs to try several medications before finding the right one. Usually, relapse happen when people stop taking their medication, or when they only take it sometimes. Some people stop taking the medication because they feel better or they may feel they don't need it anymore.7
HYPOTHESIS:
H0:
There is no significant difference between the pre test and post test level of knowledge regarding side effects of typical antipsychotics among primary care givers measured at p<0.05 level of Significance.
H1:
There is significant difference between the pre test and post test level of knowledge regarding side effects of typical antipsychotics among primary care givers measured at p<0.05 level of Significance.
CONCEPTUAL FRAMEWORK:
Good research usually integrates researcher findings into an orderly, coherent system. Such integration typically involves linking research and existing knowledge through review of prior research on a topic and by identifying or developing an appropriate conceptual framework.
Conceptual framework deals with abstract that are assembled by virtue of their relevance to a common theme. A conceptual model broadly presents an understanding of the phenomenon of interest and reflects the assumption and philosophical view of the model designer.
It is a framework which provide the investigator the guideline to proceed in attaining the objectives of the study based on theory. It is a scientific representation of the steps, activities and outcome of the study.
Conceptual framework is a representation of concept that are assembled by virtue of their relevance to a common theme. Conceptual framework provide a perspective regarding interrelated phenomena, and is loosely structured so that it provides for flexibility. Conceptual framework can serve as a springboard for generating research hypothesis.
This study focused on assessing the effectiveness of planned teaching on knowledge regarding adverse effects of antipsychotic patient. This study was based upon by Nola j pender health promotion model. Model focuses on following three area individual characteristics and experience, Behavior -specific cognition and affects, behavior outcome.
The health promotion model notes that each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavioral specific knowledge and affect have important motivational significance. These variables can be modified through nursing actions. Health promoting behavior is the desired behavioral outcome and is the end point in the Health Promotion Model. Health promoting behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development. The final behavioral demand is also influenced by the immediate competing demand and preferences, which can derail an intended health promoting actions.
The health promotion model is based on the following assumption, which reflect both nursing and behavioral science perspectives:
1. Individual seek to actively regulate their own behavior.
2. Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transforming the environment and being transformed over time.
3. Health professional constitute a part of the interpersonal environment, which exerts influence on persons throughout their lifespan.
4. Self-initiated reconfiguration of person -environment interactive patterns is essential to behavior change
Individual Characteristics and Experiences:
Prior behavior and inherited and acquired characteristics influence beliefs, affect, and enactment of health-promoting behavior. In this study, the individual characteristics and experience are refers to background characteristics and knowledge regarding side effects of typical antipsychotics among care givers of psychiatric patients on that can be assessed through the pre test structure questionnaire on knowledge regarding side effects of typical antipsychotics, consists of side effects of antipsychotics, home management and family responsibility.
Behavior -specific cognitions and affect:
Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior. Behavior -specific cognitions and affect refers to process of transformation of knowledge regarding side effects of typical antipsychotics drugs through Planned teaching. The Behavior -specific cognitions and effect refers to improve in the level of knowledge of side effects of antipsychotics among primary care givers of psychiatric patients, it also beneficial to care givers to developed action plan. It also helpful in removing barriers of action, it develop self efficiency active related to effects.
Behavioral outcome:
Positive affect toward a behavior results in greater perceived self-efficacy, which can in turn, result in increased positive affect. The behavioral outcome that can be accessed through the post test questionnaire. Significant level of knowledge regarding side effects of typical antipsychotics. Feedback can be accessed through the statistical measurements of scores obtained by the subjects through pre test and post test questionnaire. It helps to assess the significant level of health promoting behavior, but the feedback is not included in the study.
REVIEW OF LITERATURE:
The review of literature has been organized under the following headings:
I. Review of literature related to side effects of typical antipsychotics.
II. Review of literature related to knowledge of care givers about side effects of typical antipsychotics.
III. Review of literature related to effectiveness of planned teaching knowledge regarding antipsychotics.
A prospective interventional study was conducted on identification and management of adverse effects of antipsychotics in a tertiary care teaching hospital. Objectives of the study was to identify the adverse drug reactions (ADRs) to antipsychotics and its management in psychiatric patients. A total 517 patients receiving antipsychotics. The result shows that total of 289 ADRs were identified from 217 patients at an overall incidence rate of 41.97%. Sixty-seven different kinds of ADRs were observed in the study patients. Central and peripheral nervous system was the most commonly affected system organ class (n = 59) and weight gain was the most commonly observed ADR.
Figure1 : Modified conceptual framework on health promotion model (1986)
Olanzapine was most commonly implicated in reported ADRs followed by risperidone. Of the 289 ADRs, 80% required interventions including cessation of drug specific symptom a tic non-pharmacological treatment. The researcher concluded that according to post marketing surveillance study provides a representative data of the ADR profile of the antipsychotics likely to be encountered in psychiatric patients in an Indian tertiary care hospital.10
A experimental study was conducted on effect of a psycho-educational intervention for family members on caregiver burdens and psychiatric symptoms in patients with schizophrenia in shiraz, iran. The objectives of the study was to explored the effectiveness of family psycho-education in reducing patients’ symptoms and on family caregiver burden. The sample was selected by researcher out off Seventy Iranian outpatients with a diagnosis of schizophrenia disorder and their caregivers were randomly allocated to the experimental (n = 35) or control groups (n = 35). Patients in the experimental group received antipsychotic drug treatment and a psycho-educational program was arranged for their caregivers. The psycho-educational program consisted of ten 90-min sessions held during five weeks (two session in each week). Each caregiver attended 10 sessions (in five weeks) At baseline, immediately after intervention, and one month later. Validated tools were used to assess patients’ clinical status and caregiver burden. Researcher observered that by Compared with the control group, the case group showed significantly reduced symptom severity and caregiver burden both immediately after intervention and one month later. So researcher concluded that even need based short-term psycho-educational intervention for family members of Iranian patients with schizophrenic disorder may improve the outcomes of patients and their families.11
A randomised controlled trial study was conducted on self-management family participation program for medication adherence among indonesian people with schizophrenia. The objectives of the study was examined the effect of the Self-management Family Participation Program for Medication Adherence, focusing on behavior and attitudes toward medication among people with schizophrenia. Research observed that there were significant differences in adherence behaviour and attitudes toward medication between the experimental and the control group. Researcher concluded that the Program could be used in nursing practice to enhance adherence behaviour and attitudes toward medication among people with schizophrenia in Indonesia.12
RESEARCH METHODOLOGY:
The research design is the arrangement of condition for collection and analysis of data in a manner that aims to combine relevance to the research purpose with economy in procedure. It is the overall plan for obtaining answers to the question being studied and for handling some of the difficulties encountered during the research process. The research design is the conceptual structure on the basis of which the research is conducted .It constitutes the blue print for the collection measurement and analysis of data. Quasi experimental one group pre-test post-test research design involve the manipulation of independent variable to observe the effect on dependent variable. These have an element of manipulation but at least one of the other two properties that characterize true experimental. These designs are generally used to establish the causality in situation where researchers are not able to randomly assign the subjects to group or for various reason like no control group is available for an experimental study.
Figure No-2: SCHEMATIC PRESENTATION OF RESEARCH METHODOLOGY
DATA ANALYSIS AND INTERPRETATION:
This chapter deal with the analysis and interpretation of the collected data from the selected hospital of psychiatric. Polit and Beck (2004), has denoted data analysis as the systematic organization, synthesis of research data and the testing of research hypotheses using those data. The purpose of analysis was to reduce the data in to an intelligible and interpretable from, so that the relation of the researcher problem can be studied and tested.
OBJECTIVE:
· Assess the level of knowledge regarding side effects of typical antipsychotics among primary care givers of psychiatric patients.
· To assess the effectiveness of planned teaching on knowledge regarding typical antipsychotics among primary care givers of psychiatric patients.
· To find out the association between level of knowledge among primary care givers of mentally ill client with their selected demographic variables.
ORGANIZATION OF FINDINGS:
The analysis and interpretation of the observation are given in the following section:
Section I: Data on Demographic variables of primary care givers.
Section II: Assessment of knowledge regarding side effects of typical antipsychotics among primary care givers of psychiatric patients.
Section III: Evaluate effectiveness of planned teaching on knowledge regarding side effects of typical antipsychotics among primary care givers of psychiatric patients.
Section IV: Association between the level knowledge of primary care givers with their selected demographic variables.
SECTION I: DATA ON DEMOGRAPHIC VARIABLE OF PRIMARY CARE GIVERS:
This section deals with the frequency and percentage distribution of demographic variables of primary care giver psychiatric patient.
Table 1: Frequency and percentage distribution of Variable of primary care givers n=40
|
Sr. No. |
Demographic variables |
Experimental Group(n) |
Percentage (%) |
|
1. |
Age(years) |
|
|
|
|
a) 18-28 |
9 |
22.5% |
|
|
b) 29-39 |
14 |
35% |
|
|
c) 40-50 |
12 |
30% |
|
|
d) 51 and above |
5 |
12.5% |
|
2. |
Gender |
|
|
|
|
a) Male |
16 |
40% |
|
|
b) Female |
24 |
60% |
|
3. |
Education |
|
|
|
|
a) Illiterate |
3 |
7.5% |
|
|
b) Primary |
10 |
25% |
|
|
c) Secondary |
20 |
50% |
|
|
d) Graduation and above |
7 |
17.5% |
|
4. |
Religion |
|
|
|
|
a) Hindu |
26 |
65% |
|
|
b) Buddhist |
8 |
20% |
|
|
c) Muslim |
6 |
15% |
|
|
d) Other(specify) |
0 |
0% |
|
5. |
Occupation |
|
|
|
|
a) Government servant |
3 |
7.5% |
|
|
b) Daily labour |
10 |
25% |
|
|
c) Private job |
21 |
52.5% |
|
|
d)Other(specify ) |
6 |
15% |
|
6. |
Monthly income |
|
|
|
|
a) Up to 10000 |
22 |
55% |
|
|
b)10001 to20000 |
8 |
20% |
|
|
c) 20001 to 30000 |
6 |
15% |
|
|
d) 30001 and above |
4 |
10% |
|
7. |
Area of residence |
|
|
|
|
a) Village |
12 |
30% |
|
|
b) Semi urban |
6 |
15% |
|
|
c )City |
22 |
55% |
|
|
d)Other (specify) |
0 |
0% |
|
8. |
Length of stay with patient |
|
|
|
|
a) 6 month |
5 |
12.5% |
|
|
b) 2years |
2 |
5% |
|
|
c) 1years |
7 |
17.5% |
|
|
d) 2years and above |
26 |
65% |
SECTION II: ASSESSMENT OF KNOWLEDGE REGARDING SIDE EFFECTS OF TYPICAL ANTIPSYCHOTICS AMONG PRIMARY CARE GIVER OF PSYCHIATRIC PATIENTS
This section deals with the analysis of the data related to knowledge of primary care givers of psychiatric patient regarding side effects of typical antipsychotic before and after implementation of planned teaching. The statistical value of means, mean score percentage and standard deviation are used to describe the score.
Table 2: Frequency and percentage distribution of primary care givers according to level of knowledge n=40
|
Sr. No |
Level of Knowledge |
Pre-Test |
Post-test |
||
|
|
Score range |
n |
(%) |
n |
(%) |
|
1. |
Poor(0-6) |
3 |
7.5% |
0 |
0% |
|
2. |
Average(7-12) |
29 |
72.5% |
1 |
2.5% |
|
3. |
Good(13-18) |
8 |
20% |
19 |
47.5% |
|
4. |
Excellent(19-24) |
0 |
0% |
20 |
50% |
Fig:3 Percentage wise distribution of sample according to level of knowledge in pre and post test
SECTION III:
EFFECTIVENESS OF PLANNED TEACHING ON KNOWLEDGE REGARDING SIDE EFFECTS OF TYPICAL ANTIPSYCHOTICS AMONG PRIMARY CARE GIVERS OF PSYCHIATRIC PATIENT
Table 3: Mean, Standard deviation, mean of differences in scores and 't' value for knowledge regarding side effects of antipsychotics n=40
|
Sr. No |
Knowledge Level |
Mean |
Standard Deviation (S.D.) |
Mean differences in score |
't' value |
|
1. |
Pre-test |
10.1 |
2.74 |
8.2 |
13.71* |
|
2. |
Post-test |
18.05 |
2.34 |
* significant p<0.05 level
NS-not significant p<0.05 level
Frequency, Percentage and χ2 analysis of level of knowledge among primary care givers with their selected demographic variables
Fig:4 Mean level of knowledge for experiential group among sample during pre test andpost test
SECTION IV: ASSOCIATION BETWEEN THE LEVEL OF KNOWLEDGE REGARDING THE SIDE EFFECTS TYPICAL ANTIPSYCHOTICS AMONG PRIMARY CARE GIVERS PSYCHIATRIC PATIENT WITH THEIR SELECTED DEMOGRAPHIC VARIABLES
Table 4-Frequency, Percentage and χ2 analysis of level of knowledge among primary care givers with their selected demographic variables n=40
|
Sr. no |
Demographic Variables |
Knowledge score |
Chi square (χ2) |
|||||
|
Poor |
Satisfactory |
Good |
||||||
|
1. |
Age(years) |
N |
% |
N |
% |
n |
% |
|
|
|
a) 18-28 |
0 |
0 |
8 |
20 |
1 |
2.5 |
χ2=6.25NS df=6 |
|
|
b) 29-39 |
1 |
2.5 |
10 |
25 |
3 |
7.5 |
|
|
|
c) 40-50 |
0 |
0 |
10 |
25 |
2 |
5 |
|
|
|
d) 51 and above |
1 |
2.5 |
2 |
5 |
2 |
5 |
|
|
2. |
Gender |
|
|
|
|
|
|
|
|
|
a) Male |
1 |
2.5 |
11 |
27.5 |
4 |
10 |
χ2=2.73NS df=2 |
|
|
b) Female |
3 |
7.5 |
17 |
42.5 |
4 |
10 |
|
|
3. |
Education |
|
|
|
|
|
|
|
|
|
a) Illiterate |
0 |
0 |
2 |
5 |
1 |
2.5 |
χ2=4.139NS df=6 |
|
|
b) Primary |
0 |
0 |
8 |
20 |
2 |
5 |
|
|
|
c) Secondary |
2 |
5 |
13 |
32.5 |
5 |
12.5 |
|
|
|
d)Graduationand above |
1 |
2.5 |
6 |
15 |
0 |
0 |
|
|
4. |
Religion |
|
|
|
|
|
|
|
|
|
a) Hindu |
2 |
5 |
18 |
45 |
6 |
15 |
|
|
|
b) Buddhist |
0 |
0 |
6 |
15 |
2 |
5 |
χ2=2.807NS df=4 |
|
|
c) Muslim |
1 |
2.5 |
5 |
12.5 |
0 |
0 |
|
|
|
d) Other(specify) |
0 |
0 |
0 |
0 |
0 |
0 |
|
|
5. |
Occupation |
|
|
|
|
|
|
|
|
|
a) Govt. servant |
0 |
0 |
3 |
7.5 |
0 |
0 |
χ2=10.438NS df=6 |
|
|
b) Daily labour |
0 |
0 |
7 |
17.5 |
3 |
7.5 |
|
|
|
c) Private job |
2 |
5 |
14 |
35 |
5 |
12.5 |
|
|
|
d) Other(specify ) |
1 |
2.5 |
5 |
12.5 |
0 |
0 |
|
|
6. |
Monthly income |
|
|
|
|
|
|
|
|
|
a) Up to 10000 |
0 |
0 |
20 |
50 |
2 |
5 |
χ2=13.15* df=6 |
|
|
b) 10001 to20000 |
1 |
2.5 |
4 |
10 |
3 |
7.5 |
|
|
|
c) 20001 to 30000 |
0 |
0 |
3 |
7.5 |
3 |
7.5 |
|
|
|
d) 30001 and above |
1 |
2.5 |
3 |
7.5 |
0 |
0 |
|
|
7. |
Area of residence |
|
|
|
|
|
|
|
|
|
a) Village |
1 |
2.5 |
11 |
27.5 |
0 |
0 |
χ2=7.967NS df=4 |
|
|
b) Semi urban |
1 |
2.5 |
2 |
5 |
3 |
7.5 |
|
|
|
c) City |
1 |
2.5 |
16 |
40 |
5 |
7.5 |
|
|
|
d) Other (specify) |
0 |
0 |
0 |
0 |
0 |
0 |
|
|
8. |
Length of stay with patient |
|
|
|
|
|
|
|
|
|
a) 6 month |
1 |
2.5 |
3 |
7.5 |
1 |
2.5 |
χ2=3.011NS df=6 |
|
|
b) 2years |
0 |
0 |
2 |
5 |
0 |
0 |
|
|
|
c) 1years |
1 |
2.5 |
5 |
12.5 |
1 |
2.5 |
|
|
|
d)2years and above |
1 |
2.5 |
19 |
47.5 |
6 |
15 |
|
* =Significant NS= not significant df=degree of freedom
Fig:5 Percentage wise distribution of sample according to level of knowledge in pre and post test
SUMMARY:
This chapter present brief summary of the study and its significant finding. It also include and recommendations for further study and focus on main area of concern that the finding reveals. It reveals important interpretations that may guide to certain definitive intervention and further study in this area.
A quasi experimental study with one group pre test and post test without control group was conducted on 40 primary care givers of psychiatric patients in selected hospital to assess the effectiveness of planned teaching about knowledge regarding side effect of typical antipsychotics . A one group pre-test post-test design without control group was used for the assessment of the existing knowledge and improvement after the implementation of planned teaching within the interval of 7 days.
DISCUSSION:
The finding of the study were discussed with reference to the objective stated in chapter I and the finding of the other sections. The present study was undertaken as, "Effectiveness of planned teaching about knowledge regarding side effects of typical antipsychotics among primary care givers of psychiatric patient in selected hospital."
Distribution of sample according to the demographic variables shown that, out of the 40 primary care givers were assessed with the regard to age shows the9( 22.5%) of sample were in the age group of 18-28 years and 14(35% )in 29-38 years of age .12(30%) in 40-50 years of age and 5(12.5% ) in 51above years. Hence,it was interpreted that most of the samples under study were between the age group of 29-38year.In relation to sex both male16(40% )and female were24(60% ) each.
Distribution of sample shows that the3(7.5%) of the subjects were having illiterate, 10(25%) having primary education,12(50%) having secondary education and7(17.5%) of subjects were graduates and above. Distribution of sample shows that the 26(65%) of subjects belonged to hindu religion,8(20%) to Buddhist,6(15%) of subjects to Muslim and none of sample belongs to other religion .
Distribution of sample shows that the3(7.5%)of subject were government servant,10(25%) of subject were daily labour,21(52.5%) of private job and 6(15% )of other job.
Distribution of sample shows that the 22(55%) upto10000,8(20%) of 10001 to 20000,6(15%) of 20001 to 30001 and 4( 10%) of 30001.
Distribution of sample shows that 12(30%)of subjects belonged to rural area,6( 15% )to semi-urban and remaining 22(55%) to urban area and none of the sample belongs to other area.
Distribution of sample shows that5( 12.5%) of up to 6month,2(5%) of 2 year,7(17.5%) of 1year and26( 65%) of more than 2 year.
A cohort study conducted on influence of income on the association between cognitive impairment and polypharmacy. The aim of the study was to evaluate the prevalence of polypharmacy and the influence of income on the association between medication use and cognitive impairment among elderly people. In total sample out of the 1,606 baseline members of the Bambuí cohort of elderly people, which started in 1997, 1,554 took part in the study. The Mini-Mental State Examination was applied to all the participants. The association between cognitive impairment and polypharmacy was tested by means of multivariate ordinal regression, performed for the whole population and for each of the income strata. The result was prevalence of polypharmacy (two or more medications consumed) was 70.4% and the number of medications used presented an independent negative association with cognitive impairment (OR=0.72; 95%). When this was stratified according to personal income (<2 minimum monthly salaries versus > 2 minimum monthly salaries), a negative association was observed between medication use and cognitive impairment among elderly people with lower income (OR=0.64; 95% ), but not among those with higher income (OR=1.74; 95%).The researcher concluded that with regard to the association between cognitive impairment and number of medications consumed, the results indicate social inequality in the use of medications. It is possible that these elderly people are not consuming the medicines needed for appropriate treatment of their health problems.9
A descriptive study was conducted on educational disparities in antipsychotic drug use among older people with and without dementia in Sweden. The aim was to investigate if socioeconomic position was associated with antipsychotic drug treatment among older adults with and without dementia. The method used in the by record linkage of the Swedish Prescribed Drug Register, Patient Register, and Educational Register, we obtained information on antipsychotics, dementia status, and educational level for 641 566 persons aged 75–89 year old in Sweden. The result was among persons diagnosed with dementia (n = 32 092), 21% used antipsychotics compared with 4% in the total sample (n = 641 566). Lower education was associated with a higher probability of antipsychotic use in the total sample (adjusted odds ratio low vs. high education: 1.56; 95% confidence interval [CI]: 1.48–1.64). In the dementia subpopulation, lower education was also associated with a higher likelihood of use of antipsychotics. So researcher concluded that people with dementia were five times more likely to use antipsychotic drugs than the general population of older adults. Also, lower education was associated with a higher use of antipsychotics, both in the general population and in the subgroup of persons with dementia. This finding highlights the importance of investigating healthcare inequalities also among cognitively impaired older adults.8
The researcher also have identified as per above two studies findings reveals that there is a significant association between level of knowledge regarding side effects of typical antipsychotics with their selected demographic variable i.e income among primary care givers of psychiatric patients.
A study was conducted on assess the effectiveness of informational booklet for caregivers regarding the care of patients receiving antipsychotic drugs at selected hospital of Gwalior. The objective of the study was conducted to find out the effectiveness of informational booklet for caregivers regarding care of a patient receiving antipsychotic drugs. The study was conducted in Mansik Arogya sala, Mental Hospital Gwalior with 250 beds. The method used to collect data was with one group pre-test – post-test design was used for the study. The sample consisted of 30 caregivers selected by convenience sampling method. Data were collected by administering a structured knowledge questionnaire prepared by the investigator. The collected data were analyzed by using descriptive and inferential statistics (‘t’ test). This study revealed that the mean post-test knowledge score (x2 = 24) was higher than the mean pre-test knowledge scores (x2 = 16). The ‘t’ value computed (‘t’ = 13.38; P < 0.05) showed a significant difference suggesting that the IB was effective in increasing the knowledge of caregivers. The mean post-test area-wise scores x2 = 2.43, 1.8, 3.73, 2.3, 4.03, and 10.13 respectively were higher than the mean pre-test area-wise scores(x1 = 1.6, 1.06, 2.46, 1.76, 2.83, and 3.96. There was no association between the pre-test knowledge scores and selected variables like education, religion, income and previous experience of caring for mentally ill patients.13
The researcher also have identified as per above study findings reveals that there is a significant effectiveness of informational booklet for caregivers regarding side effects of antipsychotics among primary care givers of psychiatric patients.
In present study results also reveals there is a significant effectiveness of planned teaching on level of knowledge regarding side effects of typical antipsychotics among primary care givers of psychiatric patients
MAJOR FINDINGS:
The analysis and interpretation of the observation are given in the following section:
Section I: Data on Demographic variables of primary care givers.
Section II: Assessment of knowledge regarding side effects of typical antipsychotics among primary care givers of psychiatric patients .
Section III: Evaluate effectiveness of planned teaching on knowledge regarding side effects of typical antipsychotics among primary care givers of psychiatric patient.
Section IV: Association of the level knowledge of primary care givers with their selected demographic variables.
SECTION I: Data on Demographic variables of primary care givers.
Among the total 40 sample, with the regard to age shows the9( 22.5%) of sample were in the age group of 18-28 years and 14(35% )in 29-38 years of age .12(30%) in 40-50 years of age and 5(12.5% ) in 51above years. Hence,it was interpreted that most of the samples under study were between the age group of 29-38year.
With regard to gender among 40sample,shows that both male16(40% ) and female were 24( 60% ) each.
With regard to educational status among 40sample shows that the3(7.5%) of the subjects were having illiterate, 10(25%) having primary education, 12(50%) having secondary education and7(17.5%) of subjects were graduates and above.
With regard to religion among 40 sample shows that the 26(65% )of subjects belonged to hindu religion,8(20% ) to Buddhist, 6(15%) of subjects to Muslim and none of sample belongs to other religion.
With regard occupation among 40 sample shows that the 3(7.5%) of subject were government servant, 10(25%) of subject were daily labour, 21(52.5%) of private job and 6(15%)of other job.
With regard to monthly income among 40 sample shows that the 22(55%) upto10000, 8(20%) of 10001 to 20000, 6(15%) of 20001 to 30001 and 4(10%) of 30001.
With regard to residential area among 40 sample shows that 12(30%)of subjects belonged to rural area,6(15% to semi-urban and remaining 22(55%) to urban area and none of the sample belongs to other area.
With regards to length of stay with patient among 40 sample shows that 5(12.5%) of upto 6month, 2(5%) of 2 year, 7(17.5%) of 1year and 26(65%) of more than 2 year.
SECTION II: Assessment of knowledge regarding side effects of typical antipsychotics among primary care givers of psychiatric patients.
The frequency and percentage distribution of level of knowledge among primary care givers in pre-test. Among 40 samples the pre test score 3(7.5%)subjects were having poor knowledge (0-6)regarding the side effects antipsychotics, while 29(72.5%) had average knowledge (7-12), whereas 8(20%)subject had good knowledge (13-18)and none of the subjects had excellent knowledge about it. While in the post -test, 1(2.5%) of the subject had average knowledge, 19(47.5%)subject had good knowledge and 20(50%)subject had excellent knowledge regarding the side effects of antipsychotics.
SECTION III: Effectiveness of planned teaching on knowledge regarding side effects of typical antipsychotics among primary care givers of psychiatric patient.
In order to prove the hypothesis H1 that there will be significant improvement in the knowledge of primary care givers of psychiatric patient after planned teaching. The data presented in the table shows that the mean pre-test score was 10.1 with the standard deviation of 3.94, whereas in post test it was 18.05 with the standard deviation of 2.34. The mean difference in pre-test and post test score was 8.2. The calculated 't ' value was 13.71.whereas the tabulated 't' value was 2.02, shows that the calculated 't' value was much higher than the tabulated 't' value. It shows that the planned teaching was effective in significant improving the knowledge of primary care givers of psychiatric patient regarding side effects of typical antipsychotics.
Thus the null hypothesis (H0) i.e. "There is no significant difference in knowledge of primary care givers of psychiatric patient regarding side effects of typical antipsychotics after planned teaching measured at p<0.05 level of significances" is rejected and the research hypothesis(H1)," There is a significance difference in knowledge in knowledge of primary care givers of psychiatric patient regarding side effects of typical antipsychotics after planned teaching measured at p<0.05 level of significance", is accepted.
SECTION IV: Association of the level knowledge of primary care givers with selected their demographic variables:
The calculated chi square value for age was 6.25 which was less than the tabulated value at degree of freedom =6at p<0.05 and thus the started research hypothesis is rejected. Hence it was inferred that there is no statistically significant association between age and level of knowledge among primary care givers.
The calculated chi square value for gender was 2.73 which was less than the tabulated value at degree of freedom =2 at p<0.05 and thus the started research hypothesis is rejected. Hence it was inferred that there is no statistically significant association between gender and level of knowledge among primary care givers.
The calculated chi square value for educational status was 4.139 which was less than the tabulated value at degree of freedom =6 at p<0.05 and thus the started research hypothesis is rejected. Hence it was inferred that there is no statistically significant association between educational status and level of knowledge among primary care givers.
The calculated chi square value for religion was 2.807 which was less than the tabulated value at degree of freedom =4 at p<0.05 and thus the started research hypothesis is rejected. Hence it was inferred that there is no statistically significant association between religion and level of knowledge among primary care givers.
The calculated chi square value for occupation was 10.438 which was less than the tabulated value at degree of freedom =6 at p<0.05 and thus the started research hypothesis is rejected. Hence it was inferred that there is no statistically significant association between occupation and level of knowledge among primary care givers.
The calculated chi square value for monthly income was 13.15 which was more than the tabulated value at degree of freedom =6 at p<0.05 and thus the started research hypothesis is accepted. Hence it was inferred that there is statistically significant association between monthly income and level of knowledge among primary care givers.
The calculated chi square value for area of residence was 7.967 which was less than the tabulated value at degree of freedom =4 at p<0.05 and thus the started research hypothesis is rejected. Hence it was inferred that there is no statistically significant association between area of residence and level of knowledge among primary care givers.
The calculated chi square value for area of residence was 3.011 which was less than the tabulated value at degree of freedom =6 at p<0.05 and thus the started research hypothesis is rejected. Hence it was inferred that there is no statistically significant association between length of stay with patient and level of knowledge among primary care givers.
IMPLICATIONS OF THE STUDY:
According to Tolima, (1995) the section of the research report that focuses on nursing implication usually includes specific suggestion for nursing practice, nursing education, nursing administration and nursing research.
Nursing Services:
● Regular health education program should be carried out by hospital Nurse, in psychiatric ward.
● Mental health educator can assess need of primary care givers of psychiatric patient regarding side effects of antipsychotics and provide knowledge to them.
● Organize health camps to assess the side effects of typical antipsychotics.
● Mass health education camping should be organized regularly by the health teams to provide education on side effects of typical antipsychotics.
Nursing Education:
Health personnel may separate the theory and practice while providing knowledge about side effects of typical antipsychotics and improve the care of psychiatric patient. So nursing educators should motivate student to:
● Ensure the nursing student learn to assess the side effects of typical antipsychotics and provide treatment on it.
● Provide adequate clinical exposure to students, where know the side effects of typical antipsychotics.
Nursing Administration:
● Nurse administrator should take the initiative in organizing continuing education programs for Nurse regarding various aspects of side effects of typical antipsychotics.
● Appropriate teaching /learning material need to be prepared and made available for nurse.
● Helping in early identification of side effects of typical antipsychotics in the primary care givers from other setting by providing proper tool and aids.
Nursing Research:
Research should be conducted to assess the knowledge about side effects of typical antipsychotics among primary care givers of psychiatric patient .So that we can develop health education package related to side effects of typical antipsychotic. It also help in the finding out treatment related to side effects of typical antipsychotics.
LIMITATION:
This study was limited to the primary care givers of psychiatric patient in selected hospitals.
Assessment of knowledge only once before and after administration of planned teaching.
RECOMMENDATION:
· The study can be replicated with large sample size.
· Such study can be carried out using information booklet, self instruction model, computer- assisted instrument on side effects of typical antipsychotics.
· Formal education programme should be conducted in nursing college and schools.
PERSONAL EXPERIENCE:
The entire study gave an enriching experience to the investigator. It helped her to develop her skill in critical thinking and analysis and realize the importance of effectiveness communication with respondents.
The entire study was varied and rich learning experience which enabled the investigator to develop her skill in dealing with different personalities.
The concept clarity about research as a whole was increased.
At every stage the investigator received guidance and support from her guide.
This boosted confidence to go ahead and carry out the planned activities.
The research was a great learning opportunity for the investigator.
CONCLUSION:
The main conclusion from the present study is that majority of primary care givers have average and poor knowledge about side effects of typical antipsychotics and after planned teaching knowledge level improve up to good and average. This shown that the primary care givers had significantly gain in knowledge regarding side effects of typical antipsychotics.
An association was found between monthly income of primary care givers. Rest of the demographic variables did not show any association with the knowledge score.
Hence, based on the above finding, it was concluded undoubtedly that the written prepared material by the investigator in the form of planned teaching helped the primary care givers of psychiatric patient regarding side effects of typical antipsychotics.
REFERENCE:
1. Sreevani R, Prasanthi N. A guide to mental health and psychiatric nursing. New Delhi: Jaypee Brothers Medical Publishers; 2004.
2. Mental disorders. Availablefrom: http://www.ufrgs.br/imunovet/molecular_immunology/psychiatry.html
3. Lally J, MacCabe JH. Antipsychotic medication in schizophrenia: a review. British Medical Bulletin | Oxford Academic. Oxford University Press; 2015. Available from: https://bmb.oxfordjournals.org/content/114/1/169
4. Erratum: Scott et al., Wandering Neuronal Migration in the Postnatal Vertebrate Forebrain. Journal of Neuroscience. 2012Jun; 32(23):8105–.
5. Sep|British Journal of Medical Practitioners. Available from: http://www.bjmp.org/category/month/sep?page=4
6. Balabanov NB, Boggs JE. Ab Initio Study of Structure and Spectra of MnH 2, MnH 2 -, and MnH 3. The Journal of Physical Chemistry A. 2002; 106(29): 6839–43.
7. Masthead. The Journal of Organic Chemistry. 1970; 35(1).
8. Educational disparities in antipsychotic drug use among older people with and without dementia in Sweden. Acta psychiatrica Scandinavica. U.S. National Library of Medicine; Available from: https://www.ncbi.nlm.nih.gov/ pubmed/25532774
9. SciELO - Scientific Electronic Library Online. SciELO - Scientific Electronic Library Online. Available from: http://www.scielo.br/scielo.php?pid= S0034...scrit
10. Identification and management of adverse effects of antipsychotics in a tertiary care teaching hospital. Journal of research in pharmacy practice. U.S. National Library of Medicine Available from: https://www.ncbi.nlm.nih.gov/ pubmed/25114936
11. Effect of a psycho-educational intervention for family members on caregiver burdens and psychiatric symptoms in patients with schizophrenia in Shiraz, Iran. BMC Psychiatry. Available from: http://bmcpsychiatry.biomedcentral.com/ articles/10.1186/1471-244X-12-48
12. Self-Management Support. Agency for Healthcare Research and Quality. U.S. HHS: Agency for Healthcare Research and Quality; 2013. Available from: https://www.ahrq.gov/professionals/prevention-chronic-care/improve/ self-mgmt/index.html
13. Indian Journals. Indian Journals. Available from: http://www.indianjournals.com/ijor.aspx?target=ijor%3Aijnerandvolume=4andissue=1andarticle=016
Received on 23.09.2017 Modified on 18.10.2017
Accepted on 30.10.2017 ©A&V Publications All right reserved
Asian J. Nursing Education and Research. 2018; 8(1): 81-93.
DOI: 10.5958/2349-2996.2018.00019.8