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The Effectiveness of Planned Educational Intervention on Knowledge and Skills in Home Care Management among Care Givers of Patients with Spinal Cord Injury

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The Effectiveness of Planned Educational Intervention on Knowledge and Skills in Home Care Management among Care Givers of Patients with Spinal Cord Injury
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  The Eectiveness of Planned Educational Intervention on Knowledge and Skills in Home Care Management among Care Givers of Patients with Spinal Cord Injury Nila KM 1  , Kanmani J 2 , Laly KG 3 1  Assistant Professor, 2  Professor, Head of the Department, 3  Assistant Professor, Department of Medical Surgical Nursing, Amrita college of Nursing, Amrita Vishwa Vidyapeetham , Kochi, Kerala, India ABSTRACT Introduction:  The eects of Spinal Cord Injury are variable and may be permanent; there is currently no cure, emphasizing the need for eective management to prevent potential complications. A Pre experimental study was conducted on the eectiveness of planned educational intervention on knowledge and skills in home care management among care givers of patients with spinal cord injury in selected wards, AIMS, Kochi. Purpose:  The Objectives of the study were to 1) compare the knowledge of care givers of patients with spinal cord injury before and after the administration of a planned educational intervention, 2) assess the skill of care givers of patients with spinal cord injury after the administration of a planned educational intervention, 3) nd the association between the knowledge and skills in home care management among care givers of patients with spinal cord injury and selected demographic variables. Materials and Method:  The research approach was quantitative research approach and the research design was pre experimental one group before-after design. The study was done on 30 caregivers of patients with Spinal Cord Injury in selected wards, AIMS, Kochi. The sampling technique used was convenience sampling. Results:  The mean pretest knowledge score of care givers of patients with spinal cord injury was 12.20, while mean post test knowledge score was 30. A signicant improvement in the post test knowledge scores were noted at 0.001 % level of signicance( t=34.61). Post test skill score shows 90% of subjects achieved a grade of good in areas like mouth care, skin care, NG tube feeding, and ROM exercise. 93.3% of subjects achieved grade of good in area like catheter care. Conclusion:  The study concludes that the planned educational intervention on home care management were eective in improving knowledge and skills of caregivers of patients with spinal cord injury. Keywords:  Spinal cord injury, Care givers, Planned educational Intervention Corresponding Author: Prof. Kanmani JProfessor Amrita College of Nursing, Amrita Vishwa Vidyapeetham AIIMS, Kochi Kerala, IndiaEmail: kanmanijob@aims.amrita.edu INTRODUCTION Spinal cord injury is a condition that aects the independence of an individual and makes him dependent on others. The world wide prevalence of spinal cord injury was 223-755 per million and world wide incidence of spinal cord injury was 60-83 per million. 2  In India, approximately 15,00,000 people live with spinal cord injury. Every year, 10,000 new cases add to this group of individuals. In Kerala, around 18,000 persons suer from spinal cord injury. Majority of them (82%) were males in the age group of 16-30 years. 3  The causes of spinal cord injuries (SCI) include motor vehicle accidents (44%), acts of violence (24%), falls (22%), sports (two-thirds of these are from diving accidents) (8%), and others (2%). 4  As a result of recent advances in medical technology, persons surviving a spinal cord injury (SCI) were living longer lives and often require varied degrees of assistance over their life span. 5  In response,  DOI Number: 10.5958/0976-5506.2019.00457.1   Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3  57 family members often become the primary sources of assistance for various activities of daily living, such as feeding, dressing, transfers, and bowel and elimination needs. 6  However, caregivers enter into this new role without formal preparation or training. 7 Considerable research has been conducted on the role of caregivers for older adults with chronic illness, for younger adults and children with brain injury, and for children with other chronic conditions. However, signicantly less research is available on this role with   regard to Spinal Cord Injury (SCI), which was the focus of this study.   The cases of neurotrauma potentially involve the need for very long-term support    provision. 8,9   In many cases, spinal cord injuries require substantial  physical therapy and rehabilitation, especially if the  patient’s injury interferes with activities of daily life 14 . Lower urinary tract symptoms in neurological disease may be at variance with the pattern expected based upon level of neurological lesion 15 . MATERIALS AND METHOD Research Design:  The research design used for the study was pre experimental one group pretest- post test design (01 X 02). This design was adopted for the study in order to avoid contamination between groups and to overcome the sample scarcity. Sample Size Estimation:  Sample size was calculated  by the formula ‘Sample size for paired t test’ at 95% condence and 80% power. The minimum sample size obtained was 18 and for increasing the generalizability it was nalized as 30. Study Population: Care givers of patients with spinal cord injury who are admitted in the selected wards of AIMS Hospital, Kochi from November 2012 were considered for the study. Data Collection Instruments and TechniquesDevelopment Tool ISection A: Sociodemographic data of the caregiver. It contains information related to caregivers such as age, religion, education, occupation, socioeconomic status, marital status and relationship to the client. Section B: clinical data of the client which is filled  by the researcher. Section C: Structured questionnaire to assess the knowledge on home care management of care givers of patients with spinal cord injury under 6 dimensions includes general questions related to spinal cord injury and its self care needs, oral care, skin care, nasogastric tube feeding, catheter care and ROM exercises with a total of 35 items. The data was collected by self administered questionnaire. Data Collection Procedures: With prior permission for conducting the study, investigator selected the sample  based on sample selection criteria by convenience sampling technique. The investigator established a rapport with the caregivers and obtained informed consent. On Day 1, the demographic data and knowledge on home management of self care needs of the patients were assessed using a structured questionnaire. The tool consisted of 3 parts, part I - demographic data, part II - clinical data and part III - knowledge questionnaire. The caregivers were asked to put a tick mark against the correct answer and the questionnaire was collected  back after 40 minutes. On Day 2 and 3, the care givers were subjected to individualized demonstration and return demonstration of procedures such as mouth care, skin care, Ryle’s tube feeding, catheter care and ROM exercise for 1-2 hour daily. From Day 4 to 8, the care givers were doing the learned procedures, were assessed with the help of log book. On the 10 th  and l1 th  day post test assessment was done on skills and after that post test knowledge was assessed. Data Analysis:  Demographic data was analyzed using frequencies, percentage, mean, and standard deviation. Signicance of the dierence between pre test and post test scores was tested by Paired ‘t’ test. Association  between knowledge as well as skill score of care givers of  patients with spinal cord injury and selected demographic variables was done using oneway ANOVA test. FINDINGS Table 1: Demographic characteristics of subjects n = 30Sample CharacteristicsFrequencyPercentage1.Age in years 21-30 1343.3 31-40 620.0 41-50 826.7 51-60 310   58  Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3 Conted  … 2.Sex of the care giver Male 310Female2790 3.Educational status of the care giver Primary930Secondary1343.3Higher secondary516.7Graduate310.00 Figure 1: The mean knowledge score of subjects before and after the planned educational interventionFigure 2: bar diagram showing frequency and percentage of subjects according to knowledge scoresFigure 3: Bar diagram showing frequency of grades obtained by subjects in post skill assessment The mean and standard deviation of knowledge scores was calculated before and after the administration of planned   educational intervention and the mean dierence was found. From the present study, it was evident that there was improvement in the knowledge of care givers of patients with spinal cord injury after the administration of a planned rehabilitation intervention on home management of self care needs. The results suggested that the planned educational intervention on home management of self care needs was highly eective on improving the knowledge of care givers of  patients with spinal cord injury.Among the 30 subjects, it was statistically found that, in the pre test to assess knowledge, 24 (80%) subjects were with poor knowledge, 6 (20%) subjects were with good knowledge. In the post test all 30(100%) subjects were having excellent score. A similar study conducted by Rundquist J 10  et al (2011) on Nursing bedside education and care management time during inpatient spinal cord injury rehabilitation with the help of practice-based evidence (PBE) research methodology design. Six hundred patients with traumatic SCI were enrolled at six rehabilitation centers such as Craig Hospital, Englewood, CO; Shepherd Center, Atlanta, GA; Rehabilitation Institute of Chicago, Chicago, IL; Carolinas Rehabilitation, Charlotte, NC; The Mount Sinai Medical Center,  New York, NY; and National Rehabilitation Hospital, Washington, DC. They depicted the importance of each educational topic. Bladder management was the education topic that comprised the largest proportion of time (17% of total time), next were bowel management and skin (14% each), and medication and pain education (13% each). About 50% of all care management time in all injury groups was spent on psychosocial support of the patient and/or family. In this study they didn’t mention the outcome of teaching.A comparative study was conducted by Chen HY 11  et al in 2004 for the purpose of investigating rehabilitation nurses’ care for patients with spinal cord injury. 110 registered nurses selected from two hospitals of UK and two hospitals of Taiwan were the samples. Results show a high percentage of Taiwan nurses (88.9%) promote self care of patients with spinal cord injury through education whereas only 72.5% of UK nurses promote self care. They concentrated on enhancing self esteem.It was observed that ndings of the previous studies run parallel to the present study.By analyzing mean and standard deviation of skill score computed after the planned educational intervention, it is clear that the score achieved by the subjects are not deviated too much. That is the subjects are able to do the procedures eciently and they can render an eective home care management for their loved ones.   Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3  59 One group pre- and post-test design study conducted  by Yuen HK  12  with the objectives to examine both the short- and long-term eects of an oral home telecare  program on improving gingival health among 8 adults with tetraplegia. The oral home telecare program was given using personal computer-based videoconferencing  between each participant and an occupational therapist. Training was conducted on an average of ve 15-30 min sessions across 3 months. During these training sessions, supervised practice of oral hygiene, and  provision of immediate corrective feedback and positive reinforcement in the use of adaptive oral hygiene devices was emphasized. Gingival health assessment using the Löe-Silness gingival index (LSGI) was conducted at  baseline, 6 and 12 months. Results showed statistically signicant dierences (that is, improvement with less gingival inammation) in their LSGI scores (z=2.18, P=.03). From baseline to 12 months, participants also showed a statistically signicant dierence (that is, improvement, z=2.03; P=0.04) in their LSGI scores. It was observed that ndings of the previous studies run parallel to the present study. Inuence of sex, age, education and occupation in attaining knowledge and skill after the administration of  planned rehabilitation intervention were analyzed. The knowledge attained after the administration of planned rehabilitation intervention among the care givers based on age groups found to be non signicant at p<0.05 levels which indicated that there was no signicant dierence in the knowledge attained by the dierent subjects based on the age. A cross sectional study conducted by Naveen SR  13   in 2007 for the purpose of assessing quality of life and  burden of caregivers of patients with spinal cord injury. In this the caregiver’s age distribution shows 10% of caregivers are in the age group ‘up to 20’, 18% are in the age group 21-30, 36% are in the age group 31-40, 28% are in the age group 41-50, 8% are in the age group 51-60. The caregiver’s sex distribution shows 38% of the care givers were male and 62% of the care givers were females. The caregiver’s educational status shows 30% were illiterate, 52% were having secondary education, 8% were having higher secondary education and 10% were having education status of degree and above. The caregiver’s relationship with patient shows 42% of caregivers were wives, 14% were mothers, 2% were daughters. In the present study out of 30 subjects 13 (43.30 %) were in the age group of 21-30 years. Out of 30 subjects 13 (43.33%) were having educational status up to secondary classes. The relationship of care givers with the patients shows that 20 (66.67%) were wives. The remaining 2 (6.7%) were daughters, 5 (16.7%) were mothers, 3(10.00%) were others. Conict of Interest:  No conicts among authors Source of Funding:  Funding is by self. Ethical Clearance:  Ethical clearance was obtained from the institutional ethical committee. CONCLUSION In summary, the planned educational intervention on home care management was eective in improving the knowledge and skill of the care givers of patients with spinal cord injury. Hence this eective planned educational intervention can be implemented as a way of improving the knowledge, skill, and quality of life of the care givers of patients with spinal cord injury as well as patients with spinal cord injury after discharge. This study will direct and encourage the sta nurses as well as the student nurses to concentrate more on care and education of care givers and patients with spinal cord injury. The study ndings can be published in professional journal to assist in disseminating the ndings for further testing as well as for possible implementation. REFERENCES  1. Notara et al. Health related quality of life in care givers of patients with Spinal cord injury. International Journal of caring Sciences. 2011;13:63–80. 2. Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury:what learns a world wide literature survey? Spinal cord 2006 Jan 3;44(9);523-9. 3. Awareness and Prevention[online] 2010 Mar 15 [cited 2012 Jul 20]; Available from: [http://www. isiconline.org/aware.htm.] 4. Hickey JV, the clinical practice of neurological and neurosurgical nursing. 3 rd  edition. Philadelphia: Lippincott Williams and Wilkins; 2003.P369-440   60  Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3  5. DeVivo M, Stover S. Long-term survival and causes of death. In: Stover S, DeLisa J, Whiteneck G, editors. Spinal cord injury: Clinical outcomes from the model systems. Gaithersburg, MD: Aspen; 2005. pp. 289–316. 6. Robinson R, Whelen S, Rintala D. Informal care  providers for veterans with SCI: Who are they and how are they doing? Journal of Rehabilitation Research & Development 2003 Mar 4;40(4):511–  516.  7. Elliott TR, Rivera P, Berry J, Oswald K. Characteristics of family caregivers at risk for depression; Poster session presented at the annual meeting of the Rehabilitation Psychology, Division 22, of the American Psychological Association; Reno, NV. Mar 2006. 8. Elliott TR, Shewchuk RM. Recognizing the family caregiver: integral and formal members of the rehabilitation process. J Voc Rehabil.2006;10:123–132. 9. Shewchuk RM, Richards JS, Elliott TR. Dynamic  processes in health outcomes among caregivers of patients with spinal cord injuries. Health Psych.2006 ;17:125–129. 10. Rundquist J, Dimond P, McDonald C, Reyes I, et al. SCIRehab: the supplemental nursing taxonomy. J Spinal Cord Med 2011;32(3):328–34.  11. Chen HY et al.Investigating rehabilitation nurses’ care for patients with spinal cord injury. Spinal Cord. 2006;35:850–856. 12. Yuen HK. Eect of a home telecare program on oral health among adults with tetraplegia: a pilot study. Spinal Cord advance online publication. [Online]2013 [cited on 2013 Feb1];15(1); Available from: http://www .ncbi.nlm.nih.gov/ pubmed/doi:10.1038/sc. 2012.176. 23318557  13.    Naveen SR. Assessing quality of life and burden of caregivers of patients with spinal cord injury. Arch. Phys. Med. Rehabil. 1996;77:1226–1232. 14. Rahimkhani M, Nikfallah A, saberian M, Mordadi A , varmazyar S , tavakoli A.. urinary tract infection in spinal cord injuries. Asian J Pharm Clin Res. 2014; 7 (2), 178-182 15. Panicker JN, Menon L, Anandkumar A, Sundaram KR, Fowler CJ. Lower urinary tract symptoms following neurological illness may  be inuenced by multiple factors: Observations from a neurorehabilitation service in a developing country. Neurourol Urodyn 2010;29(3):378-381.
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