INTRODUCTION:

A stroke is a serious life-threatening medical condition that occurs when a blood supplying artery becomes suddenly blocked and starts to bleed.¹ Due to rupture of blood vessels and blockage in the pathways there is restriction of blood and oxygen in reaching the brain’s tissues and leads to brain death.

Brain death can also lead to impairment such as speaking, thinking, movement, communication, sensation or emotion. The severity of defect depends upon the area and extent of the damage of brain.²

Most of the risk factors of stroke are associated with cerebral infarction and not cerebral haemorrhage. The effective ways for decreasing the chance of stroke is prevention and teaching about warning signs and especially about risk factors. Risk factors can be divided into modifiable and non-modifiable. Non-modifiable risk factor includes age, gender, and family history. About two third of all stroke occur in aged people over 65 years. Men is more common of having Stroke than in women. The individual with a family history of stroke has high risk of developing stroke. Ninety percent of stroke occurs due to modifiable risk factor which includes hypertension, heart disease, diabetes mellitus, smoking, obesity, metabolic syndrome, lack of physical exercise, poor diet, and uses of drug and alcohol abuse. Non-modifiable risk factors for stroke include age, gender, race, ethnicity and history.^3,4

The most common risk factor for stroke is hypertension because it causes about 80% of ischemic stroke as well as it increases the chance of haemorrhagic stroke. The strain given to all the blood vessels due to hypertension makes them weaken and can leads to damage. Once the blood vessels are weakened there is more chance of blockage in the vessels which leads to cause ischemic stroke. Less often but hypertension is also involved in causing haemorrhagic stroke when a blood-vessels present in the brain burst and blood leaks into the brain. Stroke symptoms associated with hypertension includes confusion, irregular heartbeat, ear noise or buzzing. Managing and controlling high blood pressure is very important to reduce the chance of having stroke.^5,6

OBJECTIVES OF THE STUDY:

1. To assess the knowledge regarding warning signs and prevention of stroke among hypertensive patients before and after the structured teaching programme.

2. To evaluate the effectiveness of structured teaching programme on knowledge regarding warning signs and prevention of stroke among hypertensive patients.

3. To find out the association between pre-test levels of knowledge regarding warning signs and prevention of stroke among hypertensive patients with selected socio demographic variable.

HYPOTHESES:

· H₀1: There is no significant improvement in knowledge regarding warning signs and prevention of stroke after the structured teaching programme than before.

· H₀2:There is no significant association between knowledge scores and selected socio demographic variables.

METHODOLOGY:

An evaluative research approach was adopted for this study. The research design selected was pre-experimental – one group pretest and posttest design. The study was conducted in Lakshmi Hospital& Specialist hospital, Bangalore, Karnataka. Sixty Hypertensive patients were selected by using convenient sampling technique. Data collection was done after obtaining permission from the management and written consent from the subjects. Self-structured knowledge questionnaire was used to collect data on demographic data such as Age, gender, educational qualification, dietary pattern, marital status, family history of hypertension, etc. and on knowledge regarding warning sign and prevention of stroke using 30 multiple choice questions. The computed reliability coefficient of the tool was found to 0.8588...The prepared tool was validated by different experts.

RESULTS:

The collected data was analyzed and organized according to the objectives of the study using descriptive and inferential statistics. Among 60 respondents,18 (13.0 percent) of the respondents were in the age group of 31– 45 years, 22 (36.7 percent) participants belongs to the age group of 46 – 55and20 (33.3 percent) respondents were in the age group of 56 – 67 years. In relation to gender category 38(63.3%) of the respondents were in the group of male and 22(36.7%) of the respondents were in the group of females. The educational qualification of sample shows that participants (10.0) were non literate,18 participants (30.0 percent) were completed primary and 20(33.3 percent) respondents were completed secondary 16 (26.7 percent) were completed PUC. In relation to occupation of hypertensive patients,21 (35.0%) were employed, 20 (33.3%) were unemployed and 19 (31.7%) of hypertensive patients were semi- skilled worker. The marital status reveals that 58 (96.7 percent) respondents were married and 2 (3.3 percent) participants were unmarried. The parity status shows 11 (18.3 percent) respondents don’t have child, 33 (55.0 percent) participants are having only one child, 16(26.7 percent) participants are having two children. That out of 60 respondents, with regard to type of religion 80.0% of respondents were Hindu. 6.7% were Muslim and 13.3 % of respondents were Christian.

In pretest, out of 60 respondents41 (68.3%) of the respondents had inadequate knowledge, 19(31.7%) of the respondents had moderate knowledge and none of the respondents had adequate knowledge.

In post-test out of 60 respondents 39 (65.0 %) had adequate knowledge, 21 (35.0%) respondents had moderate knowledge and there was no respondent with inadequate knowledge regarding warning signs and prevention of stroke.

It is evident that the calculated chi-square value forage group, gender, occupational status, number of children, dietary pattern, is lesser than the table values at 0.05 level of significance. So, there is no association between demographic variables such as age group, gender, occupational status, and number of children, with pre-test knowledge regarding warning signs and prevention of stroke

Table 1: Classification of Respondents by Personal Characteristics N=60

Characteristics	Category	Respondents
Characteristics	Category	Number	Percent
Age group (years)	31-45	18	30.0
	46-55	22	36.7
	56-67	20	33.3
Gender	Male	38	63.3
Gender	Female	22	36.7
Educational qualification	Non-literate	6	10.0
	Primary	18	30.0
	Secondary	20	33.3
	PUC	16	26.7
Occupational status	Employed	21	35.0
	Unemployed	20	33.3
	Semi-skilled worker	19	31.7
Marital status	Married	58	96.7
Marital status	Widow(er)	2	3.3
Number of children	No	11	18.3
	One	33	55.0
	Two	16	26.7
Religion	Hindu	48	80.0
	Muslim	4	6.7
	Christian	8	13.3
Total		60	100.0

Table :2 Over all Pretest and Posttest Mean Knowledge scores on Warning signs and Prevention of stroke N=60

Aspects	Max. Score	Knowledge Scores				Paired ‘t’ Test
Aspects	Max. Score	Mean	SD	Mean (%)	SD (%)	Paired ‘t’ Test
Pre test	30	11.03	4.09	36.8	13.6	29.60*
Post test	30	23.88	1.93	79.6	6.4	29.60*
Enhancement	30	12.85	3.36	42.8	11.2

* Significant at 5% level, t (0.05,59df ) = 1.96

DISCUSSION:

The mean percentage of post-test knowledge score (23.88) was apparently higher than its mean percentage of pre-test knowledge score (11,03), suggesting that STP was effective in increasing the knowledge of warning signs and prevention of stroke among hypertensive patients.

The mean enhancement between pre-test and post-test knowledge score was 12.85. It was evident that a comparison of pre-test and post-test level of knowledge score among hypertensive patients using paired “t” test(29.60*) to determine the effectiveness of structured teaching programme on warning signs and prevention of stroke shows a statistical significance at 5% level for 59 degrees of freedom. This confirms that STP is an effective strategy. Hence the research hypothesis H₀1 was rejected.

The association between demographic variables such as age group, gender, occupational status, number of children, dietary pattern, and knowledge level of pre-test on warning signs and prevention of stroke among hypertensive patients was significant at 0.05 levels. Hence H₀2 stating that there is no significant association between pre-test knowledge level and selected demographic variables is rejected. However, there was no significant association between pre-test knowledge and educational qualification, marital status, religion, bad habits, types of habits and duration of hypertension. Hence, H₀2 was accepted for the above selected variables.

IMPLICATIONS:

Nursing Education:

Education in its general sense is a form of learning in which knowledge, skills and habits of a group of people are transferred from one generation to the other through teaching, training research. Nurse educator should emphasis on preparing prospective nurses to impact health education on warning signs and prevention of stroke among hypertensive patients by using various methods of educational technology. In-service education programme, workshop, seminar, conference should be conducted on warning signs and prevention of stroke for better preparation to take up new challenges in field of nursing. The nursing student should be encouraged to provide science foundation relevant to theory, treatment, warning signs and prevention of stroke among hypertensive patients.

Nursing practice:

· The finding of the study indicate that health care members should be aware of the need of observing, supervising, teaching the healthy lifestyle practices such as diet, various exercise to reduce stroke and avoidance of bad habitual practices among hypertensive patients.

· Nurses should also create awareness about diet, exercise through various health education and demonstration. Health education should be given on the aspects of warning signs and prevention of stroke and make them aware of various exercise therapy available which are helpful in making certain changes in hypertensive levels.

Nursing Administration:

· They have to organize seminar, workshops and other health education programs for staff nurses as a part of in service education through which they can gain knowledge regarding the diet and effectiveness of exercise therapy among hypertensive patients.

· Nurse administrator should take part in the health policy making and developing protocols.

· Nurse administrators can arrange demonstration session for various diet plan and exercise therapy that can reduce hypertension.

Nursing Research:

· The study finding may motivate others researchers to conduct researches and implement the findings into their own practices.

· It is the responsibility of all health professionals to provide scientifically listed material of programme to improve the knowledge regarding warning signs and prevention of stroke. This study also brings about the fact that more studies need to be done at different setting which is culturally relevant with better teaching strategies. This study can be a baseline for future quantitative studies to build up.

CONCLUSION:

Early detection of warning signs of stroke is very much important to prevent the stroke and its complications. The study findings revealed that structured teaching programme is an effective strategy for improving the knowledge regarding warning signs and prevention of stroke among hypertensive patients.

REFERENCES:

1. Stroke, National Health Services, Available from URL: https://www.nhs.uk/conditions/stroke/

2. Dr Andrew Refshauge, David, Stroke and its management in Australia: an update. Cardiovascular disease series no. 37. Cat. no. CVD 61. Canberra: AIHW. Australian Institute of Health and Welfare publication, 2013; page no.1. Available from URL: https://www.aihw.gov.au/getmedia/3d56c949-68a4-46f3-bc7c c40c89904d38/13994.pdf.aspx?inline=true

3. Paresh Parmar, Sheetal Sumaria, Sagal Hashi. Stroke classification and diagnosis. Clinical pharmacy 2011 Jan.1; vol.3: Available from URL: https://www.pharmaceutical-journal.com/learning/learning-article/stroke-classification-and-diagnosis/11080450.article

4. Understanding Your Risk for Heart Disease, UCSF (University of California San Francisco) Medical Centre, Available from URL: https://www.ucsfhealth.org/education/understanding_your_risk_for_heart_disease/

5. Stroke and high blood pressure, Available from URL: https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure/how-high-blood-pressure-can-lead-to-stroke

6. World Health Federation, Stroke and Hypertension, Available from URL: https://www.world-heart-federation.org/resources/stroke-and-hypertension

Received on 24.04.2022 Modified on 19.05.2022

Asian J. Nursing Education and Research. 2022; 12(3):313-316.

DOI: 10.52711/2349-2996.2022.00065