INTRODUCTION:

Respiratory disorders is a pathological conditions affecting the organs and tissues that make gas exchange possible in higher organisms, and includes conditions of the upper respiratory tract, trachea, bronchi, bronchioles, alveoli, pleura and pleural cavity and the nerves and muscles of breathing Disorders of the lower respiratory system can be classified into four general areas: Obstructive conditions (emphysema, bronchitis, asthma attacks) restrictive conditions (fibrosis, Sarcoidosis, alveolar damage, and pleural effusion) vascular diseases (pulmonary edema, pulmonary embolism, pulmonary hypertension) infectious environmental and other disease (pneumonia, tuberculosis, asbestosis, particulate pollutants) coughing is of major importance, as it is the body’s main method to remove dust, mucus, saliva and other debris from the lungs. Inability to cough can lead to infection People over age of 50 years are more likely to be considered disabled; however the damage started years before. About 1.5 million emergency department visits by adults 25years and older. More emergency department visits were made by females then males. About 7,26,000 hospitalizations. Total estimated cost was $32.1 billion. Pulmonary rehabilitation is an individualized treatment program that the nurses teach chronic lower respiratory tract disorders management strategies to increase quality of life.

STATEMENT OF THE PROBLEM:

An experimental study to assess the effectiveness of incentive spirometry exercise on pulmonary parameters of patients with lower respiratory tract disorders in SMVMCH&RC, Puducherry.

OBJECTIVES:

1 To assess the pulmonary parameters among patients with lower respiratory tract disorders SMVMCH&RC

2 To evaluate the effectiveness of Incentive Spirometry Exercise on pulmonary parameters among patients with lower respiratory tract disorders in SMVMCH&RC

3 To associate the pulmonary parameters with the selected demographic variables of patients with lower respiratory tract disorders in SMVMCH&RC.

OPERATIONAL DEFINITIONS:

ASSESS:

Pulmonary parameters (Respiratory rate, Dyspnoea grade and Lung capacity) of the patients with lower respiratory tract disorders by using Modified American Medical Research Council Respiratory Assessment Scale.

EFFECTIVENESS:

Refers to the extent to which Incentive Spirometry Exercise will achieve the improvement in pulmonary parameters among patients with lower respiratory tract disorders.

INCENTIVE SPIROMETRY EXERCISE:

It is an exercise in which the investigator instructs the patient to keep the mouth piece of the device inside the mouth and take 10 inspirations and hold it for 3 seconds for each inspiration followed by expiration.

PULMONARY PARAMETERS:

Refers to the Respiratory rate, Dyspnoea grade and Lung capacity as measured by Modified American Medical Research Council Respiratory Assessment Scale.

LOWER RESPIRATORY TRACT DISORDERS:

Refers to the disorders of the lower respiratory tract which includes trachea, the lungs and all segments of the bronchial tree which leads to functional disability.

RESEARCH HYPOTHESES:

H1: There is a significant relationship between incentive spirometry exercise and pulmonary parameters of patients with lower respiratory tract disorders.

H2: There is a significant association between the pulmonary parameters with the selected demographic variables among patients with lower respiratory tract disorders.

ASSUMPTIONS:

1. Lower respiratory tract disorders may alter the pulmonary parameters.

2. Incentive spirometry exercise may improve the pulmonary parameters to some extent.

DELIMITATIONS:

1. This study is delimited to the adults who are aged 50 - 80 years.

2. The study is delimited to SMVMCH&RC, Puducherry.

3. The study is delimited to the period of four weeks of data collection.

METHODOLOGY:

RESEARCH APPROACH:

Quantitative research approach was used for this study.

RESEARCH DESIGN:

True experimental design (pretest – posttest only design) was used for this present study.

RESEARCH VARIABLES:

1. INDEPENDENT VARIABLE:

Effectiveness of Incentive spirometry exercise

2. DEPENDENT VARIABLE:

Pulmonary parameters of patients with lower respiratory tract disorders

SETTING OF THE STUDY:

The study was conducted in SMVMCH&RC, Puducherry.

POPULATION:

The study population comprise of patients admitted in pulmonary ward of SMVMCH & RC with lower respiratory tract disorders. On an average of 50-60 patients per month admitted with lower respiratory tract disorders.

SAMPLE:

The patient admitted with lower respiratory disorders, who are all fulfills the inclusion criteria they will be taken as samples.

SAMPLE SIZE:

The study samples include 30 will be assigned in the experimental group and the remaining 30 will be in the control group.

SAMPLING TECHNIQUE:

Simple random sampling technique was used and the Samples were assigned by using lottery method.

SAMPLING CRITERIA:

INCLUSION CRITERIA:

1. Patient in age group of 50- 80 years

2. Patients with lower respiratory tract disorders

3. Patient who are available at the time of data collection period

4. Patient can follow the command in Tamil or English.

EXCLUSION CRITERIA:

1. Patients who are all in immediate postoperative period

2. Patients with terminal illness

3. Patients who are not willing to participate in this study

TOOLS FOR RESEARCH:

The lower respiratory disorder was assessed with the following instruments: The structured demographic questionnaire and Modified American Medical Research Council Respiratory Assessment Scale was validated and the reliability of the tool is 0.84.

DATA COLLECTION PROCESS:

Through simple random sampling technique, 30 patients were selected for experimental group and 30 patients were selected for control group. Demographic and clinical variables were collected by using a structured questionnaire and their pre-test, post-test pulmonary parameters were assessed by Modified American Medical Research Council Respiratory Assessment Scale. In experimental group investigator used Incentive Spirometry exercise and for control group received routine hospital treatment. The collected data were analysed based on the above mentioned objectives using the descriptive and inferential statistics.

RESULTS AND DISCUSSION:

In experimental group 24(80%) and 6(20%) were in normal and poor pulmonary parameters respectively. In control group 4(13.3%) and 26(86.7%) were in normal and poor pulmonary parameters respectively. The calculated “t” value was 10.468 which was greater than the tabulated value at p<0.001. Hence the research hypothesis H1 was accepted. It was evident that Incentive Spirometry Exercise is effective in improving the pulmonary parameters among patients with lower respiratory tract disorders. There was no significant association found with age, gender, education, occupation, area of work, type of work, medication intake, habits, lifestyle practice, duration of illness, co-morbid illness, and alternative therapies. It indicates that there is no association between the pulmonary parameters with the selected demographic and clinical variables may be due to narrow sample size.

Table 1. Effectiveness of Incentive Spirometry Exercise on Pulmonary Parameters Among Patients With Lower Respiratory Tract Disorders

		Pulmonary Parameters
GROUP	Mean	SD	t-test	p-value
Experimental	2.8000	0.4068	10.468	<0.001
Control	1.2667	0.6915

Mean, standard deviation and ‘t’ value according to the post-test level of pulmonary parameters of samples in experimental and control group

(n=60)

Fig 1. Frequency and percentage distribution of samples according to the pulmonary parameters (n=60)

DISCUSSION:

The first objective was to assess the pulmonary parameters among patients with lower respiratory tract disorders in SMVMCH & RC, Puducherry.

In experimental group 6(20%) and in control group 26(86.7%) of them were in poor pulmonary parameters after the post-test. This reveals that experimental group patient had normal post-test level of pulmonary parameters than control group. Thus the above findings are consistent with the study conducted by Teddy. A. Appleton. M (2014) to determine the effect of lower respiratory tract disorders on pulmonary parameters among adult patients admitted in Sweden hospital. 60 adult patients admitted with lower respiratory tract disorders were included in the study under purposive sampling technique. Demographic data were obtained by using standard Johnson’s questionnaire and the pulmonary parameters of the patients were assessed by using Borg Visual Analogue Respiratory Assessment Scale on admission. The data was analysed under descriptive and inferential statistics the result shown 26(86.7%) of them with lower respiratory tract disorders had poor pulmonary parameters.

The second objective was to evaluate the effectiveness of “Incentive Spirometry Exercise” on pulmonary parameters among patients with lower respiratory tract disorders in SMVMCH & RC, Puducherry.

In post-test experimental group mean and SD score of respiratory status were 2.8000 and 0.4068 respectively. In control group mean and SD were 1.2667 and 0.6915 respectively. The calculated ‘t’ value was 10.468 which was greater than the p<0.001. With regarding the dyspnoea grade, in experimental group mean and SD score were 4.3667 and 1.1886 respectively. In control group mean and SD were 2.2000 and 1.0955 respectively. The calculated ‘t’ value was 7.342 which was greater than the p<0.001. On lung capacity in experimental group mean and SD score were 2.8000 and 0.6103 respectively. In control group mean and SD were 1.3333 and 0.6065 respectively. The calculated ‘t’ value was 9.337 which was greater than the p<0.001. In experimental group 24(80%) and 6(20%) were in normal and poor pulmonary parameters respectively. In control group 4(13.3%) and 26(86.7%) were in normal and poor pulmonary parameters respectively. The calculated ‘t’ value was 26.786 which was greater than the p<0.001. Hence the research hypothesis H1 was accepted. It was evident that Incentive Spirometry Exercise is effective on pulmonary parameters among patients with lower respiratory tract disorders in experimental group. These findings are similar to the study conducted by Sr. Sanguine (2013) an evaluation approaches to find out the effectiveness of incentive spirometry exercise on respiratory status of patients with lower respiratory tract disorders. Pre- experimental design was used for this study. Total 20 samples were selected using purposive random sampling technique and incentive spirometry exercise was given for two weeks. The data pertaining to respiratory status was collected using structured self administered questionnaire and respiratory assessment for respiratory rate, dyspnoea and lung capacity was done using Borg respiratory assessment scale. Among 20 patients 15(75%) of patients had poor respiratory rate, 5(25%) had poor lung capacity, 15(75%) had poor dyspnoea score before implementation of intervention. 18(90%) had normal respiratory rate, 12(60%) of patients had normal dyspnoea score, and all of them (100%) attained normal lung capacity. The result of this study proved that regular practice of incentive spirometry exercise can improve the respiratory status to a greater extent among patients with lower respiratory disorders.

The third objective was to associate the pulmonary parameters with the selected demographic variables among patients with lower respiratory tract disorders in SMVMCH&RC, Puducherry.

There was no significant association found between the pulmonary parameters of patients with lower respiratory tract disorders with the selected demographic variables. This study finding is similar to a hospital based study conducted by Uren Inghammar (2014) to identify the association of lower respiratory tract disorders with selected demographic variables admitted in a private hospital setting in Finland. All individuals above 40 years of age with lower respiratory tract disorders admitted in the hospitals were identified in the inpatient register (n=40) included in the study. Standard demographic Jacobson questionnaire was administered to the patients on admission and the data was analysed using inferential statistics and the results shown t value of 0.797 which was P<0.001. Thus the study concluded there was no significant association between the pulmonary parameters with the selected demographic variables.

CONCLUSION:

The study concludes that the incentive spirometry exercise had significant effect on improving pulmonary parameters in the experimental group than the control group. As by concluding that the stated research hypothesis was accepted.

JOURNALS REFERENCES:

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Received on 08.10.2019 Modified on 14.11.2019

Asian J. Nursing Education and Research. 2020; 10(1):05-08.

DOI: 10.5958/2349-2996.2020.00002.6