Peptic Ulcer. Effectiveness of the Structured Teaching Programme on Knowledge, Attitude and Practice in India

Index

1 INTRODUCTION
1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objectives
1.4 Need for the Study
1.5 Operational Definition
1.6 Assumption
1.7 Limitation of the Study
1.8 Projected Outcome

2 REVIEW OF LITERATURE
2.1 Review of Literature related to Peptic Ulcer
2.2 Review of Literature related to diet for Peptic Ulcer
2.3 Review of Literature related to Yoga for Peptic Ulcer
2.4 Conceptual Framework

3 METHODOLOGY
3.1 Research Design
3.2 Setting
3.3 Population
3.4 Sample
3.5 Criteria for sample selection Procedure
3.6 Description of the Instrument
3.7 Scoring Procedure
3.10 Scoring Interpretation
3.11 Report of Pilot Study
3.12 Techniques of Data Collection
3.13 Data Collection Schedule
3.14 Statistical Method

4 DATA ANALYSIS AND INTERPRETATION
Section- I Distribution of demographic variables of clients with peptic ulcer .
Section-I I : Comparison between pre and post test score on knowledge, attitude and practice of clients with peptic ulcer.
Section-III: Correlation coefficient of the level of knowledge, attitude and practice of clients with peptic ulcer .
Section-IV: Association between demographic variables and knowledge, attitude and practice of clients with peptic ulcer.

5 RESULT AND DISCUSSION

6 SUMMARY, CONCLUSION AND RECOMMENDATIONS

7 REFERENCES

ACKNOWLEDGEMENTS..

I am greatly and sincerely indebted to GOD Almighty, for showering upon me His loving mercies, kindness, blessings and abundant grace.

I thank to my parents Mr.Shanmugam Murugesan and Mrs.Seetha Shanmugam and My special thanks to my beloved wife Mrs. Gomathi Munusamy and my children Karthikayini Ramesh and Lingeswaran Ramesh for their encouragement and moral support throughout my course of study

The present book would not have been possible without the persistent effort and sustained interest evinced by my research guide Prof. Dr. N. Kokilavani , It has been a gratifying experience for me working with her and I would like to acknowledge her commitment to the vision of producing a qualitative work.

I also thank all the Clients who responded to my questionnaire for their readiness and co-operation in providing the required information for this Book.

I wish to express my profound thanks to Prof. Dr. P. Porselvan, HOD, Department of Statistics, Sri Ramachandra Medical College, Chennai, for his guidance.

Finally, my thanks are due to all those who have directly or indirectly helped me in completing this work in time.

Dr. Ramesh Shanmugam Mrs.Gomathi Munusamy Mr.Udessa Gemede Dukale

Preface

A Quasi-experimental study to evaluate a Knowledge, attitude, and Practice of clients with Peptic Ulcer., Melmaruvathur, Kanchipuram District, Tamil Nadu was undertaken by Mr. S.Ramesh, for the award of degree of Master of Sciences in Nursing at The Tamil Nadu Dr.M.G.R Medical University, Chennai.

The objectives of the study were:

1. To assess the knowledge, attitude and practice of clients with peptic ulcer.
2. To evaluate the effectiveness of structured teaching programme on clients with peptic ulcer.
3. To associate demographic variables with knowledge, attitude and practice of clients with peptic ulcer.

Research design used in this study was Quasi-experimental in nature. The main study was conducted from July 2005 to August 2005 at Adhiparasakthi Hospital and Research Institute at Melmaruvathur, Kanchipuram District, Tamil Nadu after obtaining legal and ethical clearance from ethical committee. The sample of 100 Clients with Peptic Ulcer who met the inclusion criteria were selected by using convenient sampling technique. Demographic variables of clients with Peptic Ulcer were collected and assessed their knowledge, attitude and practice by an interview schedule. Then structured teaching programme was conducted and educational intervention module was distributed to the Clients. After one week post test was conducted. The study subjects were randomly selected. But there was no control group. Thus the study is based on one group pre-test-post- test design.

The conceptual framework used in this study was Alabwign Von Bettanlaffy (1968).The instrument used for data collection was an interview schedule with structured questionnaire, five point Likert Scale, and check list were used to collect data on demographic variables, knowledge on Peptic Ulcer, attitude and practice on care of client with Peptic Ulcer in pre and post-test.

The time of data collection was 8.00 a.m. to 5.00 p.m. Each interview took about 40 minutes. The investigator first introduced him to the clients and established rapport with them. The investigator explained the purpose of the study and obtained informed consent, gained the confidence and then introduced the instruments to the clients. At the end of the teaching the doubts were clarified and then 10 minutes time was allotted for discussion.

All the Clients participated in the teaching programme with such a great interest that the same procedure was adopted for 6 weeks. They were cooperative and attentive. Each week 16 Clients were selected. After pre- test power point presentation and educational intervention module were distributed to the Clients. After seven days, post-test with the same questionnaire for the same group of Clients was conducted.

The outcome of the study were,

Demographic variables such as certain demographic variables like age, sex, religion, educational status, occupation, marital status, monthly income, types of family and health information, 43 (43%) of the clients were in the age group of 36-45 years and 64 (64%) were male and 75 (75%) were Hindu and 42 (42%) were non literate, 38(38%) were unemployed, 85(85%) were married, 48(48%) were below Rs.1000/-, 62(62%) were joint family and their source of information 54(54%) mostly from the radio/TV/Newspaper about Peptic Ulcer.

In pre -test out of 100 samples, 86% had inadequate, 7% moderately adequate and 7% had adequate knowledge. Regarding the post- test knowledge none of them have inadequate and 12% had moderately adequate knowledge and 88% had adequate knowledge.

In pre- test out of 100 samples, 83% had unfavourable attitude, 17 % had favourable attitude. Regarding the post test, 16% had favourable attitude and 84% had most favourable attitude.

In pre- test out of 100 samples, 92% had poor practice, 7% fair practice and 1% had good practice. Regarding the post -test 15% had fair practice and 85% had good practice.

The clients had statistically (P < 0.05) significant increase in knowledge. In relation to effectiveness of structured teaching programme, there has been markedly increased knowledge after the administration of structured teaching programme of clients with peptic ulcer.

Pearson Correlation co-efficient and Sig. (2-tailed) of the in the post test 12(12%) clients with peptic ulcer had moderately adequate knowledge and favourable attitude and 84 (84%) peptic ulcer clients have adequate knowledge and most favourable attitude and there is statistically a positive co-relation between knowledge and attitude of the clients with peptic ulcer.

The overall findings of the study showed that the structured teaching programme is very effective in improving the knowledge, attitude and practice of clients with peptic ulcer.

Based on research findings, the following recommendations were made:

- Experimental study can be done to assess the knowledge of people regarding peptic ulcer disease.
- A similar study can be conducted on people residing in community area.
- The study will help to conduct health education program regarding peptic ulcer disease.
- A comparative study can also be done between rural and urban peptic ulcer clients.
- A comparative study can be done on different age group and between male and female

Written by:

Dr. M. J. Kumari,

M.Sc.(N), M.Phil., Ph.D. (N),

Professor Cum Principal (Ag.), College of Nursing, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) (An Institute of National Importance under Ministry of Health & Family Welfare,

Govt of India), Puducherry.

CHAPTER - I INTRODUCTION

“TOO MUCH OF ANYTHING IS GOOD FOR NOTHING”

1.1 Background of the Study

Peptic ulcer is a break in continuity of esophageal, gastric or duodenal mucosa. It may occur in any part of the gastro intestinal tract that comes into contact with gastric juices. The incidence of peptic ulcer disease occurs in approximately 10% of the population. There are several types of peptic ulcer disease but principle types of peptic ulcer disease are duodenal ulcer and gastric ulcer. The duodenal ulcer is more common and it affects both male and female but men are more prone to develop peptic ulcer disease.

Gastric ulcers are more likely to occur during fifth and sixth decades of life. Duodenal ulcer is more commonly seen during fourth and fifth decades in men and in women occurrence is about 10 years later in life. Men are more likely to develop both gastric and duodenal ulcer.

The peptic ulcer disease has multiple causes, like coffee, alcohol, non steroid anti inflammatory drugs (NSAID) like salicylates, smoking, ‘O’ blood group people. Helicobacter pylori (H.pylori) organism can be found in the gastric antrum of atleast 90% of persons with duodenal ulcer and upto 70% of those with gastric ulcer.

Diseases of the digestive system are common in both the developed and developing countries. In India, it is more common in South India. These are also associated with geographical, ethnic and dietary factors.

In the ancient period there was not much incidence of peptic ulcer. This might be because of the simple and stress less life at that time. Consumption of alcohol and taking spicy foods was relatively low and thus the prevalence of disease was low.

Many health care professionals and a large part of the population are not aware of H. Pylori and believe that ulcers are caused in the stomach by stress or spicy food. The complications of peptic ulcer can be prevented by early detection of disease and by providing proper treatment.

Through effective management, peptic ulcer can be controlled and complications can be prevented by following activities like diet, exercise, medication, meditation, cessation of alcohol intake and cessation of smoking.

Acid peptic disease is one of the commonest problem encountered by the physician in the out-patient department. Past twenty years have seen a revolution in the treatment of acid peptic disease medically like H2 Blockers, Proton pump inhibitors. These medicines help in controlling the disease but are not a permanent cure. To validate this, there is now an increase in the number of cases of acid peptic disease due to clients’ miscompliance, over treatment by the quacks etc.

The role of elective surgery in uncomplicated ulcers is virtually nil both in the western world and in India. But still surgery has a very important role to control the complications like haemorrhage, perforation and gastric outlet obstruction.

Complications like perforation is about 7-8% in clients with peptic ulcer disease, bleeding 15-20% and obstruction about 2-4%. Other rarer complications like penetration into adjacent organs, malignant changes in benign ulcer (gastric ulcer) .

Mortality and morbidity rates are also increased in complicated peptic ulcer disease especially in the elderly and those who get surgically treated for surgery failure and never turn up for follow up.

Factors that prevent peptic ulcer:

Park. K, (2004) has suggested the following preventive measures regarding clients with peptic ulcer

Therapeutic Diet: Eating right kinds and amount of food, regular meals, avoiding alcohol, drinking adequate water.

Positive Mental Attitude: Positive out look on life, emotional stability, social support group and stress reduction.

Regular aerobic exercise: Sufficient sleep and rest.

Good personal hygiene and habits: Good posture, care of teeth, knowledge of self check for disease warnings.

Regular medical care: Recommended medications.

STATEMENT OF THE PROBLEM

EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE, ATTITUDE AND PRACTICE OF CLIENTS WITH PEPTIC ULCER AT ADHIPARASAKTHI HOSPITAL AND RESEARCH INSTITUTE, MELMARUVATHUR.

OBJECTIVES

1. To assess the knowledge, attitude and practice of clients with peptic ulcer.
2. To evaluate the effectiveness of structured teaching programme on clients with peptic ulcer.
3. To associate demographic variables with knowledge, attitude and practice of clients with peptic ulcer.

NEED FOR THE STUDY

The prevalence of peptic ulcer disease has changed dramatically over the last century. Duodenal ulcers were seldom encountered in the 19th century. Before the beginning of 20th century gastric ulcers were more common than the duodenal ulcer and found predominantly in young women. Since the turn of century, the incidence of gastric ulcer has decreased by the ratio 4:1. Gastric ulcer remains more prevalent in women and in older adults.

The mortality rate of gastric ulcer is found greater than duodenal ulcer and is attributed to the fact that peak incidence occurs in persons over 50 years of age. Duodenal ulcer occurs at any age but peak incidence is between 35- 45 years of age and the persons from lower socio economic class and manual or unskilled workers are prone to gastric ulcer.

This problem was rare in the 19th century but became common in the early 20th century. Almost half of the world’s population suffers from the Helicobacter Pylori infection.

Approximately 2-4% of long term NSAID users developed severe complications each year and approximately 25% NSAID users will develop ulcer. The lifetime prevalence for men is about 10-14 % and just slightly less for women. The current sex ratio is almost 1:1. The ratio of duodenal ulcer to gastric ulcer has also steadily declined since 1950 from nearly 4:1 to almost 1:1.

In recent year (2004) the silent peptic ulcer disease is common among adult and elderly clients. If the people have adequate knowledge about the prevention and control of peptic ulcer disease, it will help them to prevent the complication and promote the health status of the people.

In the western world incidence and prevalence of duodenal ulcer disease has increased from the turn of the century to reach a peak in 1969-2000. Even more important is that the role of surgery in elective ulcer disease has very much decreased. Despite these changes, neither the incidence nor need for surgery in emergency complications of ulcer (perforation, haemorrhage) has changed for the past 10-20 years.

World wide duodenal ulcers are more common and in India almost 90% of ulcers are duodenal, and stenosis with obstruction is a frequent complication. Gastric ulcers although less common, are more dangerous as they have a 1-2% chance of malignancy.

INCIDENCE AND PREVALENCE

At any arbitrary moment, the prevalence of acid peptic disease in the population is about 1.7%, duodenal ulcer is 1.4%, gastric ulcer is 0.3%. Incidence of complications in acid peptic disease is about 10%.

Haemorrhage is the commonest complication in the western world. About 20% of duodenal ulcers and 10% of Gastric ulcers bleed during the course of the disease.

Incidence of perforation is about 7-10% in clients with peptic ulcer disease and it is also mostly common in duodenal ulcers and in the anterior wall and the aphorism ‘ANTERIOR ULCERS PERFORATE, POSTERIOR ONES

BLEED’, is as relevant today as ever. In contrast gastric ulcers may penetrate freely through either wall.

Nearly 80% of gastric outlet obstruction is caused by chronic duodenal or channel ulcers and in India this is a very common complication of duodenal ulcers. Incidence of obstruction is about 2- 4% in chronic duodenal ulcers. Rest of the complications is penetration into nearby organs, fistula formation and malignancy.

Pimanov S.I and Makarenko E.V. (2004), revealed that the paper presents the results of an examination of 269 clients (including 205 males and 64 females) aged 18-62 years who had gastroduodenal ulcers; among them, 137 and 132 clients were treated in the in- and out-patient settings, respectively. It was ascertained that the pathomorphism of the clinical picture of peptic ulcer had occurred. About one third of all the exacerbations became asymptomatic or displayed few symptoms. In clients with duodenal ulcer, the epigastrium rather than the right hypochondrium is the most common site of pain on an exacerbation.

When investigator was posted at Adhiparasakthi Hospital and Research Institute, Melmaruvathur, investigator could see many clients with peptic ulcer, nearly 35 clients per week. So the investigator selected this topic for the study.

OPERATIONAL DEFINITION

Effectiveness

It is the effect to which the teaching programme given to clients has achieved the desired effect as expressed by increased knowledge, attitude and practice score as measured by post test.

Structured teaching programme

It refers to the systematically planned teaching strategy designed to provide information on peptic ulcer clients such as meaning, causes, risk factors, signs and symptoms, investigations, treatment, regular follow up, modification of lifestyle, stress management, exercise, and yoga and prevent complications of peptic ulcer.

Knowledge

It refers to the level of understanding of clients regarding peptic ulcer.

Attitude

It refers to the feeling and beliefs of clients regarding care of peptic ulcer.

Practice

It refers to various activities followed by healthy practices like: diet, yoga and avoid smoking, alcohol, excessive drug intake, etc.

Clients

Those who are diagnosed to have peptic ulcer and are getting treatment at Adhiparasakthi Hospital and Research Institute.

Peptic Ulcer

Peptic ulcer is a condition characterized by erosion of the gastro intestinal mucosa resulting from the corrosive action of hydrochloric acid, pepsin and facilitated by H.pyloric infection.

ASSUMPTION

The clients with peptic ulcer in the age group of 25-65 years in Adhiparasakthi Hospital and Research Institute will have inadequate knowledge regarding peptic ulcer. The prevalence of peptic ulcer among the adults may be due to improper food habits, stressful life, low socio economic status, alcoholism, smoking and unnecessary medication.

LIMITATIONS OF THE STUDY

- This study was limited to the age group of 25 - 65 years.
- The duration of study was six weeks only
- The findings of this study cannot be generalized.

Projected outcome

The structured teaching programme will have an impact on the knowledge, attitude and practice about the peptic ulcer disease among the age group of 25-65 years. The clients would understand the importance of management to prevent the physical discomfort and complications. The study will help the nursing personnel to formulate the structured teaching programme for clients with peptic ulcer.

CHAPTER - II REVIEW OF LITERATURE

One of the most satisfying aspects of the literature review is the contribution which makes the new knowledge, insight and general scholarship of the researches.

“Literature review involves the systematic identification, location, scrutinizing and summary of written materials that contain information on the research problem under study”. (Polit & Hungler).

Research must be logical, controlled and systematic and it should have a purpose and be useful to society. A research must be unbiased and replicable and a researcher must beware of committing errors while planning the project, collecting the required data, analyzing and presenting his research.

The investigator carried out extensive review of literature relevant to the research topic to gain insight and to collect information for laying the foundation of this study.

This chapter comprises of three parts.

I) Review of literature related to peptic ulcer.
II) Review of literature related to diet for peptic ulcer.
III) Review of literature related to yoga for peptic ulcer.

I. Review of Literature Related To Peptic Ulcer

Auja V, et al., (2005), showed, in vitro activity of rifampicin has been shown against H. pylori. It has also been reported that the prevalence of H. pylori is low in clients with tuberculosis treated with rifampicin. Clinical trials are required to establish the efficacy of rifampicin as a salvage therapy for eradication of H. pylori. We aimed to evaluate the efficacy of rifampicin-based salvage therapy for eradication of H. pylori in clients with peptic ulcer disease.

Sun W.H, et al., (2005), have described about hundred clients who completed the entire course of therapy and returned for follow-up. The eradication rate of H. pylori for the per-protocol analysis was 89.3% (50/56) in OAC group and 84.1% (37/44) in Omeprazole 20mg, Amcoxicillin 1000mg, Metronidazole 400mg (OAM) group. Based on the intention-to-treat analysis, the eradication rate of H. pylori was 86.2% (50/58) in Omeprazole 20mg, Amcoxicillin 1000mg, Clarithromycin 500mg (OAC) group and 82.2% (37/45) in OAM group. There were no significant differences in eradication rates between the two groups on either analysis. The active ulcer-healing rate was 96.7% (29/30) in OAC group and 100% (21/21) in OAM group (per-protocol analysis, P>0.05). Six clients in OAC group (10.3%) and five in OAM group (11.1%) reported adverse events (P>0.05).

Lesur G, et al., (2005), identified that an analysis was possible in 279 (34% response rate) of the questionnaires. Forrest classification was used more frequently in university hospitals (83% vs 60%, P<0.01). Endoscopic hemostatic therapy was used more frequently in university hospitals for Forrest Ib (92% vs 81%, P=0.02), IIa (93% vs 73%, P<0.001), and IIb (58% vs 29%, P<0.001) ulcers. Injection therapy, mainly epinephrine, was the first-intention treatment for 99% of the responding gastroenterologists. Proportions of clinicians employing hemoclips (27%) or argon plasma coagulation (21%) were similar in both types of practice. Anti-secretory treatment included mainly omeprazole (82%), given intravenously (76%), sometimes as bolus i.v. doses followed by i.v. high-dose continuous infusion (15%) with some variations according to the type of hospital. In the event of recurrent or persistent bleeding, surgery was more frequent in non-university hospitals. When rebleeding occurred, a second endoscopic treatment was performed in about one quarter of clients.

Ozalp N, et al., (2004), revealed that the clients were aged from 17 to 80 years (mean 63 years, median 68 years) there were 210 males and 132 females. The mortality rate was 8.8% (30/342), and 62 clients had postoperative complications. Multivariate analysis showed that co-existing medical illness, preoperative shock, delay in treatment and low albumin concentrations were independent risk factors that significantly contributed to mortality.

Wasielica-Berger J, et al., (2004), showed, despite development of new diagnostic and therapeutic methods bleeding from peptic ulcer is still associated with high rate of complications and mortality. Apart from endoscopic therapy, pharmacological treatment is of great importance. Affecting platelet aggregation and fibrin formation low pH level of gastric juice impairs processes of coagulation. The fastest and most stable control of acid secretion is achieved by proton pump inhibitors. In the cases of active bleeding from peptic ulcer or signs of recent bleeding such as visible vessel or adhering clot, administration of high doses of proton pump inhibitors by continuous intravenous infusion significantly reduces bleeding recurrence rate. Among clients with Helicobacter pylori (H. pylori) infection, eradication of the bacteria after bleeding episode is mandatory.

Korukov B, et al., (2004), described that the haemorrhage of upper gastrointestinal tract was one of the serious problem in urgent surgery. Clinical effect of treatment with Quamatel purposely research was holded comparison of results in two groups clients. In group A with general medical treatment was include Quamatel--2 x 20 mg i.v. a day. In group B the clients was treated without H2 blocker. In cases of erosive gastritis was reported favorable effect in 76.47% at second day. The clients with stress stomach ulcer same effect was observed in third day-83.3%. In cases with peptic duodenal ulcer in I B-Forest group the bleeding was taken possession of 61.9%, in group II-79.31% and III- 90.91% of clients.

Tsumura H, et al., (2004), identified that, the postoperative durations of nasogastric tube insertion, ileus, analgesic requirement, resuming diet, and hospital stay were shorter in the clients with laparoscopic simple closure than in those with open simple closure and omental patch repair. Univariate regression analysis revealed that the age, American Society of Anesthesiologist classification, presence of concomitant disease, and length of free air or fluid collection shown in abdominal computerized tomography significantly correlated with the conversion of laparoscopic simple closure and omental patch repair to open simple closure and omental patch repair.

Jakobs R, et al., (2004), revealed that the clients were treated by injection of 12 (6 to 20) ml of adrenaline solution until Doppler scan was negative. During follow-up four pts (20%) had a clinically overt re-bleeding episode. At control endoscopy three ulcers were actively bleeding and another two were Doppler positive without re-bleeding (total: five of eighteen (27.7%) Doppler-positive ulcers). Two of the twenty pts required surgical therapy due to re-bleeding (10%).

Lu CL, et al., (2004), described that a total of 704 (10.9%) clients were found to have peptic ulcer disease, of which two thirds (n=496) were asymptomatic. Both uni-and multivariate analysis showed that the asymptomatic clients tended to have a larger body mass index, to be habitual tea drinkers, and to have an ulcer that was less than 1 cm in diameter and in a healing stage. Gender, blood group, history of hypertension and/or diabetes, ulcer location, Helicobacter pylori status, use of non-steroidal anti-inflammatories or sedative medications, habitual coffee drinking, and habits with respect to smoking of tobacco or ingestion of alcohol, had no association with symptoms.

Suzuki H. and Ishii H.A (2004), showed microcirculatory disorder and alterations of humoral factor are important in gastric mucosal lesion formation with liver cirrhosis, and degradation of a defense factor is important in ex-ulceration in the gastric mucosa. In terms of H. pylori infection, the liver cirrhosis about consequence may be to be good. It is important that degradation of a gastric mucosal defense by liver cirrhosis itself, gastric mucosal atrophy might greatly affect the ulcerogenic mechanism in the stomach.

Oganezova I.A., et al., (2004), revealed that the examination of 71 clients with ulcer has established correlations between psychological status of the clients (personality and reactive anxiety, neurotism, type of personality response to the disease) and numerous clinical characteristics of the diseases. Features of vegetative regulation of systemic hemodynamics in ulcer northerners and correlations between vegetative tonicity and psychological status of the clients are characterized.

Makovets'ka TI. (2003), stated that have studied various types of the personal attitude to the disease in 48 women with the peptic ulcer. The ergopathologic type is dominant in all women. Besides that, women of 40-49 years are neurotic and anxious types. Women of 50-59 years are neurotic type too, but not euphoric. Therapeutic tactic should consider the personality reactions to the disease.

Oganezova I.A, et al., (2003), showed that, the study of 71 clients with ulcer disease has found correlations between psychological status (personality and reactive anxiety, neurotism, type of personality response to the disease) and many clinical symptoms of the disease. Autonomic regulation features in ulcer

citizens of the European North, correlations between vegetative tone and psychological status of the clients are characterized.

Mochizuki Y. et al., (2003), described that, the clients was a 64-year- old man who had received subtotal esophagectomy for esophageal cancer reconstructed by a gastric tube via the thoracic route. He was referred to our hospital in a state of shock, with hematemesis. The bleeding site was not detected with studies of emergent endoscopy and angiography. Massive hemorrhage persisting, an immediate emergent operation was performed. However we were not able to locate the site of bleeding during the operation, and unfortunately we failed to save him. Autopsy showed a peptic ulcer in the gastric pedicle had perforated the thoracic aorta. Ulcers occurring in the gastric pedicle are accompanied by a risk of development of perforation of adjacent important visceras.

Wachirawat W, et al., (2002), described a high prevalence of H. pylori in the population but a low association with Peptic Ulcer, in contrast to developed countries. It remains to be seen whether the impact of a family history is due to genetic factors or shared life-style patterns.

Udd M, et al., (2002) revealed that the high dose of omeprazole, tests for the diagnosis of H. pylori became negative significantly more often than with the regular dose (60% versus 27.5%, P=0.001 (any test), 67.6% versus 31.7%, P=0.003 (histology) and 82.2% versus 43.6%, P=0.001 (urease test)).

Goodwin R.D and Stein M.B., (2002), identified that the gastric acid disease (GAD) was associated with a significantly increased risk of self-reported peptic ulcer disease PUD (odds ratio = 2.8, 95% confidence interval = 1.4-5.7; p = .0002) after adjusting for differences in socio demographic characteristics, comorbid mental disorders, and physical morbidity. Further analyses revealed a dose-response relationship between number of GAD symptoms (odds ratio = 1.2, 95% confidence interval = 1.1-1.4; p = .001) and increased risk of self- reported PUD.

II. REVIEW OF LITERATURE RELATED TO DIET FOR PEPTIC ULCER:

Novoderzhkina I.G, and Cherentsov A.M.,(2004) investigated real rations of clients with gastroduodenal ulcer. Chemical composition of diet was found unsatisfactory both by ascorbic acid and carbohydrates content responsible for low-caloric value of the diet. The ration correction with additional provision of vegetables, fruit, and greens raised vitamin C intake by the clients though the deficiency was not abolished.

Baranovskii AIu.(2004), it showed that diet with increased content of protein, fat and cellulose, administered to clients with the prognoses noncomplicated course and a favourable outcome of gastric ulcer disease, eliminates the necessity of drug therapy and provides a rapid dynamics of the disease relapse arresting, as well as a favourable course of the reparative regeneration.

Sharmanov T.S, et al., (2004), revealed that diets enriched with whole mare and camel's milk were used for the management of peptic ulcer clients. A total of 164 clients were examined. Of these, 59 received mare's milk, 40 camel and 65 cow's milk. On the basis of studying the time course of the clinical picture, secretory and motor functions of the stomach, as well as of the endoscopic appearance of the gastric and duodenal mucosa it was ascertained that apart from the improved clinical course of the disease, secretary and motor functions of the stomach there was a complete wound healing and remarkable decline of its size in 93, 90, and 70% of clients given mare, camel and cow's milk, respectively.

Welsh J.D., (2003), said that from 326 dietitians representing 50 states and Puerto Rico on the diet therapy of peptic ulcer disease (PUD) in their hospitals was analyzed. There were 74 teaching, 65 teaching/private, 46 private, 120 Veterans Administration, and 21 miscellaneous hospitals. A bland diet was the most commonly used diet for PUD in 250 (77%) of the hospitals. Of the 161 providing information on the type of bland diet, 72% used a bland I or II. Milk was given routinely or usually in 55% of the 326 hospitals. On discharge, dietitians in one-half of the hospitals instructed clients on a bland diet, usually a bland IV, whereas the remaining dietitians instructed their clients on a regular or modified regular diet. Outclients PUD instruction was similar. Review of bland diets in 105 manuals revealed marked variation in nomenclature and composition of even supposedly similar diets. Uniformity would benefit clients, dietitians, and physicians.

Nesterova A.P., and Bivol. G.K., (2003), showed that in 136 clients of young age features distinguishing the clinical course of peptic ulcer were studied. The diagnosis was established on the ground of roentgenological and endoscopic investigations. The nervous state was studied and the part played by psycho-emotional and a stress factor in the development of peptic ulcer was ascertained on the basis of an analysis into the results of some vegetovascular and electrophysiological investigations. For the category of clients in question a high-protein and fat-rich diet (120-130 g) was composed. It was found to have a beneficial effect on the course of peptic ulcer, a high percentage of scarred ulcerations (78%) having been obtained by comparison with controls, who were kept on a diet with normal amounts of protein and fat. It is suggested that the effect of the treatment with the described diet is achieved thanks to increased buffer properties of the food ration, to the inhibitory action of the fat on the gastric secretion, and on account of intensified reperative processes going on in the gastroduodenal mucosa.

III. REVIEW OF LITERATURE RELATED TO YOGA FOR PEPTIC ULCER:

Nayak N.N., and Shankar K., (2004), described that Yoga, practiced widely in the East, is now popular in the West as part of a healthy lifestyle. This article brings a medical perspective to the practice of yoga. Selected yoga postures that are believed to benefit certain medical conditions are highlighted.

Parshad O.(2004), revealed that the state of the mind and that of the body are intimately related. If the mind is relaxed, the muscles in the body will also be relaxed. Stress produces a state of physical and mental tension. Yoga, developed thousands of years ago, is recognized as a form of mind-body medicine. In yoga, physical postures and breathing exercises improve muscle strength, flexibility, blood circulation and oxygen uptake as well as hormone functions. In addition, the relaxation induced by meditation helps to stabilize the autonomic nervous system with a tendency towards parasympathetic dominance. Physiological benefits which follow, help yoga practitioners become more resilient to stressful conditions and reduce a variety of important risk factors for various diseases, especially cardio-respiratory diseases.

Ghoncheh S, and Smith J.C., (2004), showed this study compared the psychological effects of progressive muscle relaxation (PMR) and yoga stretching (hatha) exercises. Forty participants were randomly divided into two groups and taught PMR or yoga stretching exercises. Both groups practiced once a week for five weeks and were given the Smith Relaxation States Inventory before and after each session. As hypothesized, practitioners of PMR displayed higher levels of relaxation states (R-States) Physical Relaxation and Disengagement at Week 4 and higher levels of Mental Quiet and Joy as a posttraining aftereffect at Week 5. Contrary to what was hypothesized, groups did not display different levels of R-States Energized or Aware.

Results suggest the value of supplementing traditional somatic conceptualizations of relaxation with the psychological approach.

Pettinati P.M. (2001), showed that an introduction to insight or mindfulness meditation, yoga, and guided imagery from theoretical and practical perspectives. She provides clear, easy-to-follow steps to begin using sitting meditation, walking meditation, and yoga for the health care provider and for the clients. She presents the material first for self-knowledge and self-care and secondarily for connecting to others in healing relationships.

Alter J.S.(2001), in this article focus on the relationship between concepts of self and health in modern North India. Drawing on field research in a popular yoga society, argue that yoga therapy, as practiced by the Bharatiya Yog Sansthan of Delhi, provides a reconceptualization of what can be meant by public health. Using studies that challenge both the essentialist and epistemological facticity of the self, show how the discourse and practice of yoga is implicated in, and derived from, a complex search for self definition in terms of health; health which is conceived of as a public regimen that seeks to reconnect that which modernity has broken apart: mind and body.

Nespor K. (2000), described the use of yoga and yoga related techniques in pain management is reviewed and discussed. Self-awareness, relaxation, approaches which use respiration, increased self-understanding and self-acceptance, changed context of pain, increased control, life style improvements, group and social support proved beneficial. The use of yoga in pain management has its transpersonal and philosophical dimensions. Independence and self-confidence of suffering people may be protected in this way.

CONCEPTUAL FRAME WORK

Conceptual models are made up of concepts, which are words describing mental images of phenomena and prepositions. General systems theory developed by Alabwign Von Bettanlaffy (1968), offers a perspective looking at man and nature as interacting wholes with integrated sets of properties relationship.

All living systems which are open to the systems are open to the exchange of matter and to the matter and information. The investigator used the model based on these theories.

INPUT

A system imparts products known as input in this study after assessing

the existing knowledge, attitude and practices the investigator giving structure teaching programme regarding peptic ulcer and its management in the input process.

THROUGHPUT

A system transforms, creates and organizes the process known as throughput which results in a reorganization of the input that is after a structured teaching programme there is a change taking place in the subject regarding knowledge, attitude and practice of peptic ulcer.

OUT PUT

A system exports views in a process known as output. Is a product given of outside the system, which can be detected and related to the system. This output is mentioned as post teaching stage in this study. This stage

encompasses the improved adequate knowledge, most favourable attitude and good practice related to prevention of peptic ulcer.

FEEDBACK

The feed back is the environmental response of the system. Feed back may be positive or negative or neutral. Feedback emphasizes to strengthen the input and throughput. It is necessary if the result showed any inadequate knowledge, attitude and practice.

CHAPTER - III METHODOLOGY

In this section, the investigator discusses the research design, setting, population, sample, Criteria for sample selection procedure, description of the instrument, score procedure, score interpretation, report of pilot study, technique of data collection and statistical method in relation to adapted for the present study.

RESEARCH DESIGN:

Research design of this study is Quasi-experimental in nature. Knowledge, attitude and practice of clients with peptic ulcer were assessed. Then structured teaching programme was conducted. Following that the post assessment of knowledge, attitude and practice was done after one week. The study subjects were randomly selected. But there was no control group. Thus the study is Quasi-experimental in nature.

SETTING:

This study was conducted at Adhiparasakthi Hospital & Research Institute at Melmaruvathur.

POPULATION:

The population for the study was detected from both male and female clients with peptic ulcer between the age group of 25-65 years attending Adhiparasakthi Hospital and Research Institute.

SAMPLE:

A total number of 100 samples were selected by using convenient sampling technique.

CRITERIA FOR SAMPLE SELECTION PROCEDURE

Inclusion criteria

1. The clients who were diagnosed to have peptic ulcer
2. The clients who were understand Tamil and English
3. The clients who were admitted at Adhiparasakthi Hospital and Research Institute.

Exclusion criteria

1. The Clients who were having other serious illnesses.
2. The clients who were un cooperative
3. The Clients who had undergone other major abdominal surgery.

DESCRIPTION OF THE INSTRUMENT

The instrument used for data collection was an interview schedule. This was developed based on the objectives of the study and through review of literature. The instrument consists of four parts

Part I Questionnaire for demographic variables.

Part II Questionnaire to assess the knowledge of clients with peptic ulcer.

Part III A three point Likert Scale was used to assess the attitudes of clients with peptic ulcer

Part IV Questionnaire to assess the practice of clients with peptic ulcer.

Part I

Demographic variables include age, sex, religion., educational status, occupation, marital status, income, type of family and source of informations. They were collected by interviewing the clients and based upon their answers, a tick mark (ü) was put for the appropriate response of each item.

Part II

Assessment of knowledge was done by using multiple choice questions prepared by the investigator. It consists of 20 questions and the total score was 20. The content validity of the instrument was established with guidance of experts. Reliability was checked during the pilot study.

Part III

Assessment of attitude was done by using three point Likert Scale. It consists of 15 statements of which some are positive and others are negative statements.

Part IV

Assessment of practice was done by using 25 questions and the total score was 25.

SCORE PROCEDURE :

Part I

The information on demographic data was collected from the selected clients with peptic ulcer on nine variables and this was not scored but used for descriptive analysis.

Part II

It consists of 20 multiple choice questions. The peptic ulcer clients were interviewed and answers were written in the box provided against each question. Each correct answer was given a score of ‘one’ and wrong answer was given a score of ‘zero’.

Part III

Peptic ulcer clients in the age group between 25-65 years were interviewed for collecting the information regarding their attitudes. The scores of positive and negative statement are as follows

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Part IV

Peptic ulcer clients were interviewed for collecting information regarding diet. It consists of 10 multiple choice questions.

Peptic ulcer clients were interviewed for collecting information regarding yoga. It consists of 15 yes or no type questions. For the answer ‘Yes’ score value ‘1’ was given and for ‘No’ ‘0’ was given.

SCORE INTERPRETATION:

Part II

The instrument of part II consists of 20 multiple choice questions regarding peptic ulcer. The maximum score was 20 and the minimum score was 0 based on the scoring the percentage of knowledge was calculated using the following formula.

Obtained Score ´100 Total Score

The scores were interpreted as follows:

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Part III

The instrument consists of 15 items of positive and negative statement of peptic ulcer. The maximum score was 45 and the minimum score was 15. Based on the scoring the percentage of the attitude was calculated using the formula.

Obtained Score ´100 Total Score

The scores were interpreted as follows:

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The content validity of this instrument was obtained from medical and nursing experts.

Part III

The instrument consist of 25 questions regarding diet and yoga of peptic ulcer. The maximum score was 25 and minimum score was 0.

Obtained Score ´100 Total Score

The scores were interpreted as follows:

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REPORT OF PILOT STUDY:

The pilot study was conducted to test the reliability, content validity and practicability of the tool. Pilot study was conducted for 10 days. The was conducted at Adhiparasakthi Hospital and Research Institute at Melmaruvathur. Ten peptic ulcer clients who met the inclusion criteria were selected by using convenient sampling technique. The knowledge, attitude and practice of clients with peptic ulcer were assessed with the structured questionnaire. The structured teaching programme was given to enhance the knowledge, attitude and practice of the clients with the help of education model, flash cards, through lecture and demonstration method. one to one teaching was given to the peptic ulcer clients. The result of the pilot study shows there was a positive correlation between the knowledge, attitude and practice of clients with peptic ulcer.

TECHNIQUE OF DATA COLLECTION

The main study was conducted from 1.7.2005 to 15.8.2005 at Adhiparasakthi Hospital and Research institute at Melmaruvathur and the clients who met the inclusion criteria were selected by using convenient sampling technique.

The time of data collection was 8.00 a.m. to 4.00 p.m. Each interview took about 30 to 45 minutes.

The investigator first introduced himself to the clients and established rapport with them. The investigator explained the purpose of the study and gain the confidence and then introduced the instruments to the clients.

The data was collected regarding demographic variables such as age, sex, religion, educational status, occupation, marital status, family’s monthly income type of family, source of information, structured knowledge questionnaire, three point Likert Scale and observation scale through one to one teaching by lecture and demonstration with the help of chart, flash card, handout and booklet information. Data collection was done in tamil and english used each questionnaire and demonstrate for each clients. At the end of the teaching the doubts were cleared then 10 minutes was allotted for discussion.

All clients participated in the teaching programme with great interest that the same procedure was adopted for six weeks. They were cooperative and attentive. Each week 21 clients were selected. After seven days, post test with the same questionnaire for the same group of clients was conducted.

For the convenient of the research the subject was divided into 33 groups with 100 samples. Teaching programme was prescribed as scheduled below

DATA COLLECTION SCHEDULE

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STATISTICAL METHOD

The statistical methods used for analysis were number, percentage, mean, standard deviation, paired‘t’ test, and chi-square and correlation coefficient

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CHAPTER IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with analysis and interpretation of data collected from 100 samples who were attending inpatients, effectiveness of structured teaching programme on knowledge, attitude and practice of clients with peptic ulcer at Adhiparasakthi Hospital & Research Institute Melmaruvathur.

Data analysis includes both descriptive and inferential statistics. The items were scored after the pre-test and post-test and the results were tabulated. The statistical methods used for analysis were mean, standard deviation, paired ‘t’ test and chi square test.

Section A : Distribution of demographic variables of clients with peptic ulcer.

Section B : Comparison between pre and post test score on knowledge, attitude and practice of clients with peptic ulcer.

Section C : Correlation coefficient of the level of knowledge, attitude and practice of clients with peptic ulcer.

Section D : Association between demographic variables and knowledge, attitude and practice of clients with peptic ulcer.

Section A : Demographic variables of clients with peptic ulcer.

Table 1 :Frequency and percentage distribution of demographic variables of clients with peptic ulcer.

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From Table 1 it is implied that certain demographic variables like age, sex, religion, educational status, occupation, marital status, monthly income, types of family and health information, 43 (43%) of the clients were in the age group of 36-45 years and 64 (64%) were male and 75 (75%) were Hindu and 42 (42%) were non literate, 38(38%) were unemployed, 85(85%) were married, 48(48%) were below Rs.1000/-, 62(62%) were joint family and their source of information 54(54%) mostly from the radio/TV/Newspaper.

Section B : Comparison between pretest and post-test scores on Knowledge, Attitude & Practice of clients with peptic ulcer.

Table 2 :Level of knowledge of clients with peptic ulcer.

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Table 2 shows that 86 (86%) peptic ulcer clients had inadequate knowledge, 7(7%) clients had moderately adequate knowledge and 7(7%) clients had adequate knowledge in pre test. In the post test (12%) 12 clients had moderately adequate knowledge and 88(88%)had adequate knowledge.

Table 3 : Level of attitude of clients with peptic ulcer

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Table 3 shows that in pretest 83(83%) peptic ulcer clients had unfavorable attitude towards peptic ulcer and 17(17%) clients had favourable attitude about peptic ulcer. In the post test 16(16%) clients had favourable attitude and 84(84%) had most favourable attitude towards peptic ulcer.

Table 4 : Level of practice on diet and yoga of clients with peptic ulcer

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Table 4 shows that 92(92%) clients had poor practice about diet and yoga, 7(7%) clients had fair practice towards diet and yoga and 1(1%) clients had good practice about diet and yoga in pretest. In the post test 15(15%) clients had fair practice and 85(85%) clients had good practice towards diet and yoga for clients with peptic ulcer.

Table 5 : Comparison between pre test and post test score mean and standard deviation of clients with peptic ulcer.

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Table 5 shows that in pre test inadequate knowledge, unfavourable attitude and poor practice is found of clients with peptic ulcer, the mean is 36 with standard deviation 17.49 in knowledge and the mean is 40.35 with standard deviation 10.39 in attitude and the mean is 36.0 with standard deviation 11.08 in practice. In post test the mean is 86 with standard deviation 7.42 in knowledge and the mean is 81.64 with standard deviation 10.54 in attitude and the mean is 78.40 with standard deviation 8.67 in practice.

Table 6 : Improvement mean and standard deviation of pre and post test scores of clients with peptic ulcer.

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** P< 0.05 level significant.

Table 6 shows that improvement mean and standard deviation in the knowledge aspects, the mean was 50.00 with standard deviation of 18.62 and in the attitude aspects, the mean was 41.28 with standard deviation of 15.99 and in the practice aspects the mean was 42.40 with standard deviation of 13.47 are highly significant p<0.05 level.

Section C : Correlation coefficient of the level of knowledge, attitude and practice of clients with peptic ulcer.

Table 7 :Correlation co-efficient of the level of knowledge and attitude of clients with peptic ulcer.

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** P< 0.05 level significant.

Table 7 shows that, in the post test 12(12%) clients with peptic ulcer had moderately adequate knowledge and favourable attitude and 84 (84%) peptic ulcer clients have adequate knowledge and most favourable attitude and there is statistically a positive co-relation between knowledge and attitude of the clients with peptic ulcer.

Table 8 :Correlation co-efficient of the level of knowledge and practice of clients with peptic ulcer.

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Table 8 shows, in the post test 12 peptic ulcer clients had moderately adequate knowledge and fair practice and 85(85%) peptic ulcer clients had adequate knowledge and good practice and 3(3%), peptic ulcer clients had adequate knowledge and fair practice and there is statistically a positive correlation between knowledge and practice of clients with peptic ulcer.

Table 9 :Association between the level of knowledge and demographic variables of clients with peptic ulcer.

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Table 9 shows that in the pretest most of the clients in all the age groups had in adequate knowledge and less clients had moderately and adequate knowledge. Statistically there is significance association between the level of knowledge and age group of clients with peptic ulcer was found. In posttest 38(88.4%) clients in the age group 36-45 years and 25(89.3%) clients in the age group of 46-55 had adequate knowledge. Statistically there is no significance association between level of knowledge and age of clients with peptic ulcer.

In pretest 57 (89%) Male clients had inadequate knowledge 3(4.7%) had moderately adequate knowledge and 4(6.3) had adequate knowledge and 29(80.6%). Female clients had inadequate knowledge, 4(11.1%) female clients had moderately adequate knowledge and 3(8.3%) female clients have adequate knowledge. In post test 58(90.6%) male clients and 30(83.3%) female clients had adequate knowledge. Statistically there is no significance association between level of knowledge and sex of clients with peptic ulcer.

In pretest 63(84.0%) peptic ulcer clients had inadequate knowledge and 14(87.5%) Christian clients had moderate adequate knowledge. In post test 65(86.7%) Hindu clients and 15(93.8%) Christian clients had adequate knowledge. Statistically there is no significance association between level of knowledge and religion of clients with peptic ulcer.

Most of the peptic ulcer clients had inadequate knowledge in the pretest. In the post test 37(88.1%) non literate clients had adequate knowledge, 21(87.5) primary school clients had adequate knowledge and 16(94.1%) middle school clients had adequate knowledge. There is no significance association between the level of knowledge and educational status of clients with peptic ulcer.

In the pre test clients with peptic ulcer who were unemployed coolie, clerical works and others had inadequate knowledge. There is no significance in the level of knowledge and occupation of clients with peptic ulcer. In the post test 34(89.5%) clients who were coolie had adequate knowledge and 4(10.5%) coolie had moderately adequate knowledge. Statistically there is no significance association between the level of knowledge and occupation of clients with peptic ulcer.

In pre test 74(87.1%) married peptic ulcer clients had inadequate knowledge and 11 unmarried clients had inadequate knowledge. There is no significance difference between the level of knowledge and marital status of clients with peptic ulcer. In post test 74(87.1%) Married clients had adequate knowledge and 13(92.9%) unmarried clients had adequate knowledge. Statistically there is significance association between the level of knowledge and the marital status of clients with peptic ulcer.

In pre test 44(91.7%) peptic ulcer clients with family income of Rs. Below 1000 and 32(86.5%), peptic ulcer clients with family income of Rs.1001- Rs.3000/- had inadequate knowledge. Statistically there is no significance difference between level of knowledge and economic status of clients with peptic ulcer. In post test 40(83.3%) peptic ulcer clients with below Rs.1000 36(97.3%) peptic ulcer clients with Rs.1001 – Rs.3000/- had adequate knowledge. But statistically there is no significance association between the level of knowledge and economic status of clients with peptic ulcer.

In pre test 32(97.0%) are nuclear family, 52(83.9%) joint family, 1(25.0%) are extended family have inadequate knowledge. Statistically there is no significance association between level of knowledge and types of family of clients with peptic ulcer. In post test 27(81.8%) nuclear family, 56(90.3%) joint family, 4(100.0%) had adequate knowledge. Statistically there is no significance association between the level of knowledge and types of family of clients with peptic ulcer.

In pretest 20(83.3%) health personnel, 48(88.9%) Radio/T.V./ News paper, 16(80.0%) had inadequate knowledge. Statistically there is no significance association between the level of knowledge and previous health information. In post test 19(79.2%) Health personnel, 48(88.9%) Radio/TV/Newspaper, 20(100.0%) had adequate knowledge. Statistically there is no significance association between the level of knowledge and previous health information of clients with peptic ulcer.

Table 10 :Association between the level of Attitude and demographic characteristics of clients with peptic ulcer.

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Table 10 shows that in the pre test most of the peptic ulcer clients in all age group had unfavourable attitude and less clients had favourable attitude. Statistically there is no significance association between the level of attitude and age group of clients with peptic ulcer. In post test 19(90.5%) clients in the age group of 25-35 years and 37(86.0) clients in the age group of 36-45 years and 23(82.1%) clients in the age group of 46-55 years had adequate knowledge. Statistically there is no significance association between the level of attitude and age of clients with peptic ulcer.

In the pre test 57(89.1%) male clients and 26(72.2%) Female clients had unfavourable attitude and 7(10.9%) male clients and 10(27.8%) female clients had favourable attitude. In post test 57(89.1%) male clients and 27(75.0) female clients had most favourable attitude. Statistically there is no significance association between the level of attitude and the sex of clients with peptic ulcer.

In the pre test 62(82.7%) Hindu clients with peptic ulcer 13(81.3%) Christian clients with peptic ulcer had unfavourable attitude. There is significance association between the level of attitude and the religion of clients with peptic ulcer. In the post test 61(81.3%) Hindu clients and 15(93.8%) Christian clients with peptic ulcer had most favourable attitude. But statistically there is no significance between the level of attitude and the religion of clients with peptic ulcer.

Most of peptic ulcer clients had unfavourable attitude and less clients had faouvrable attitude. There is no significance difference found between the level of attitude and the educational status of clients with peptic ulcer. In the post test, most of the clients had most favourable attitude and 36(85.7%) Illiterate 21(85.5%) primary school clients had most favourable attitude. But statistically there is no significance association between the level of attitude and the education status of clients with peptic ulcer.

In the pre test most of peptic ulcer clients were unfavourable attitude and less clients had favourable attitude. There is no significance difference between the level of attitude and the occupation of clients with peptic ulcer. In the post test 16(84.2%) peptic ulcer clients who were unemployed and 34(89.5%) peptic ulcer clients who were coolie had most favourable attitude. There is no significance association between the level of attitude and the occupation of clients with peptic ulcer.

In pretest 13(92.9%) unmarried peptic ulcer clients and 69(81.2%) married clients had unfaouvrable attitude there is no significance association between the level of attitude and the marital status of clients with peptic ulcer. In post test 13(92.9%) clients, 70(82.4%) clients had most favourable attitude. There is no significance association between the level of attitude and the marital status of clients with peptic ulcer.

In pretest 40(83.3%) peptic ulcer clients with income below Rs.1000/- and 33(89.2%) clients with income Rs.1001-Rs.3000/- had unfavourable attitude. In the pretest there is no significance association between the level of attitude and the family income of clients with peptic ulcer. In the post test 40(83.3%) clients with family income below Rs.1000/- and 33(89.2%) clients with family income Rs.1001 – Rs.3000 had most favourable attitude. There is no significance association between the level of attitude and the family income of clients with peptic ulcer.

In pretest 26(78.8%) nuclear family, 52(83.9%) Joint family and 4(100.0%) extended family had unfavourable attitude. There is no significance association between the level of attitude and the type of family clients with peptic ulcer. In the post test 26(78.8%) nuclear family, 55(88.7%) joint family, and 3(75.0%) extended family had most favourable attitude. Statistically there is no significance association between the level of attitude and the type of family of clients with peptic ulcer.

In the pretest 17(70.8%) health personnel, 48(88.9%) Radio/TV/ Newspaper, 16(80.0%) friends and relatives had unfavourable attitude. Statistically there is no significance association between the level of attitude and the exposure of previous health information of clients with peptic ulcer. In posttest 19(79.2%) health personnel, 46(85.2%) Radio/TV/Newspaper, 18(90.0%) friends and relatives had most favourable attitude. Statistically there is no significance association between the level of attitude and the exposure of previous health information of clients with peptic ulcer.

Table 11 :Association between the level of practice and demographic characteristics of clients with peptic ulcer.

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Table 11 shows, most of peptic ulcer clients in all age group had poor practice and less clients had fair practice. Statistically there is no significance between the level of the practice and age group of clients with peptic ulcer. In the post test 19(90.5%) clients in the age group of 25-35 years and 37(86.0%) clients in the age group of 36-45 years had good practice. Statistically there is no significance association between the level of practice and age group of clients with peptic ulcer.

In pretest that 58(90.6%) male clients and 34(94.4%) female clients had poor practice. Statistically there is no significance association between the level of practice and the sex of clients with peptic ulcer. In the post test 58(90.6%) male clients and 27(75.0%) clients had good practice statistically there is no significance association between the level of practice and the sex of clients with peptic ulcer.

In the pre test that 69(92.0%) Hindu, 14(87.5%) Christian, 9(100.0) Muslim had poor practice. Statistically there is no significance association between the level of practice and the religion of clients with peptic ulcer. In the post test 62(82.7%) Hindu, 15(93.8%) Christian 8(88.9%) Muslim had good practice. Statistically there is no significance association between the level of practice and the religion of clients with peptic ulcer.

Most of the peptic ulcer clients had poor practice and less clients had fair practice. Statistically there is no significance association between the level of practice and the educational status of clients with peptic ulcer. In the post test 36(85.7%) Illiterate, 21(87.5%) primary school, 14(82.4%) Middle school had good practice. Statistically there is significance association between the level of practice and the educational status of clients with peptic ulcer.

Pre test that 19(100.0%) unemployed, 38(100.0%) coolie, clerical work 17(89.5%) and others 18(75.0%) had poor practice. Statistically there is no significance association between the level of practice and the occupation of clients with peptic ulcer. In the post test 16(84.2%) unemployed, 34(89.5%) coolie, 16(84.2%) and others 19(79.27%) had good practice. Statistically there is no significance association between the level of practice and the occupation of clients with peptic ulcer.

In the pretest that 13(92.9%) unmarried and 78(91.8%) married had poor practice. Statistically there is significance association between the level of practice and the marital status of clients with peptic ulcer. In the post test 13(92.9%) unmarried 71(83.5%) married had good practice. Statistically there is significance association between the level of practice and the marital status of clients with peptic ulcer.

In the pre test that 48(100.0%) clients with family income below Rs.1000/- 33(91.9%) clients with family income Rs.1001-Rs.3000 had poor practice. Statistically,there no significance association between the level of practice and the family monthly income of clients with peptic ulcer. In the post test 40(83.3%) clients with family income below Rs.1000/- and 33(89.2%) clients with family income Rs.1001 – Rs.3000, had good practice. Statistically, there is no significance association between the level of practice and the family monthly income clients with peptic ulcer.

In the pretest that 33(100.0%) nuclear family, 54(87.1%) joint family, 4(100.0%) extended family had poor practice. Statistically, there is no significance association between the level of practice and the type of family of clients with peptic ulcer. In the post test 27(81.8%) nuclear family, 55(88.7%) joint family, 3(75.0%) had good practice. Statistically, there is no significance association between the level of practice and the type of family of clients with peptic ulcer.

In the pre test that 21(87.5%) peptic ulcer clients were exposed by health related person and 50(92.6%) peptic ulcer clients were exposed by mass media had poor practice. Statistically there is no significance association between the level of practice and the source of information of clients with peptic ulcer. In the post test 19(79.2%) peptic ulcer clients were exposed by health related personnel and 47(87.0%) peptic ulcer clients were exposed by mass media had good practice. Statistically, there is no significance association between the level of practice and the source of information of clients with peptic ulcer.

CHAPTER V

RESULTS AND DISCUSSION

The aim of the present study was to evaluate the effectiveness of structured teaching programme of clients with peptic ulcer between 25-65 years of age.

A total number of 100 samples were selected for the study. Pretest was conducted by using structured interview guide. A structured teaching programme was conducted by the investigator. After seven days the post test was conducted by using the same questionnaire.

1. The first objective was to assess the knowledge, attitude and practice of clients with peptic ulcer.

In the pre test the data analysis showed that 86% possessed inadequate knowledge, 7% possessed moderately adequate knowledge, and 7% possessed adequate knowledge.

Regarding attitude, 83% possessed unfavourable attitude, 17% possessed favaourable attitude.

Regarding practice 92% possessed poor practice, 7% possessed fair practice and 1% possessed good practice.

In overall, the pre test knowledge mean score was 36 with the standard deviation of 17.49. The post test knowledge mean score was 86 with the standard deviation of 7.42. The pre test attitude was 40.35 with standard deviation of 10.39 and post test attitude was 81.64 with standard deviation of 10.54. In the pre test practice the mean was 36.00 with standard deviation 11.08 and post test practice mean 78.40 with standard deviation of 8.67.

2. The second objective was to find out the effectiveness of structured teaching programme of clients with peptic ulcer.

Table 5, revealed that most of the clients with peptic ulcer had inadequate knowledge with the mean of 36, attitude with the mean of 40, practice with the mean of 36.00. During the post test, it was found that the clients with peptic ulcer gained knowledge with the mean value of 86, attitude of 81.64, and practice of 78.40. Total knowledge means score is pre test was 33.7. These results showed the lack of knowledge and awareness of clients with peptic ulcer. In post test, table 5 revealed clients with peptic ulcer had adequate knowledge. The total knowledge mean score in post test was high that of 86. This showed that the knowledge has increased markedly after structured teaching programme.

This result was supported by Miss. Aruna A., 2001. In the Effective structured teaching programme of clients with peptic ulcer between the age group of 25-65 years, the result revealed that clients with peptic ulcer should adequate knowledge regarding life style modification and treatment of peptic ulcer. Total knowledge mean score in post test was high 80 and above with standard deviation of 7.42. This showed knowledge has increased markedly after structured teaching programme.

3. The third objective of the study was to associate demographic variables with knowledge, attitude and practice of clients with peptic ulcer.

There was no significant association between the demographic variables and knowledge, attitude and practice of clients with peptic ulcer like age, sex, religion, educational status, occupation, marital status, family monthly income, types of family, and sources of information.

The overall findings of the study showed that the structured teaching programme is very effective in improving the knowledge, attitude and practice of clients with peptic ulcer.

CHAPTER VI

SUMMARY, CONCLUSION AND RECOMMENDATION

The present study was conducted to assess the knowledge, attitude and practice of clients with peptic ulcer. The study was quasi experimental. A total 100 clients with peptic ulcer who met the inclusion criteria were selected from the inpatients by using the convenient sampling technique. The investigator first introduced him-self to the clients and developed a rapport with them. After the selection of sample, the interview was being conducted with the instrument.

CONCLUSION:

In pre test out of 100 sample, 86% had inadequate, 7% moderately adequate and 7% had adequate knowledge. Regarding the post test knowledge none of them have inadequate and 12% had moderately adequate knowledge and 88% had adequate knowledge.

In pre test out of 100 sample, 83% had unfavourable attitude, 17 % had favourable attitude. Regarding the post test, 16% had favourable attitude and 84% had most favourable attitude.

In pre test out of 100 samples, 92% had poor practice, 7% fair practice and 1% had good practice. Regarding the post test 15% had fair practice and 85% had good practice.

The clients had statistically (P < 0.05) significant increase in knowledge. In relation to effectiveness of structured teaching programme, there has been markedly increased knowledge after the administration of structured teaching programme of clients with peptic ulcer.

Nursing implications

IMPLICATIONS FOR NURSING PRACTICE

The nurses working in clinical setting should practice health education as an integrated part of nursing profession.

The planned health teaching programmes are to be scheduled in the clinical setup in the fixed date with time for the clients as well as to the family members.

Handout was given to the clients and family members in simple language with appropriate pictures and explanations to improve their knowledge, attitude and practice.

The study also implies the need for integral services, feedback, follow up and collaborative services of both hospital and community health team. Peptic ulcer can be prevented by public awareness, which implies the need for change that has to be introduced by the nursing professionals.

Implications for nursing education

The present trends in the health care delivery system emphasis more on prevention than curative aspects. The study also implies that health personnel have to be properly trained as how to teach the public regarding peptic ulcer. Nursing students to assess the lifestyle practices to identify the warning signs of clients with peptic ulcer and to provide supportive educative care for the self care in preventing complication.

Nurse educators when plan to instruct the students, should provide adequate opportunity for them to develop themselves for handling of clients with peptic ulcer and provide health education both community and clinical settings.

The study calls for strengthening for client’s education in the present study of the nursing education. The study findings suggest that the content of subjects should include the new views of clients with peptic ulcer and in prevention, complication and management.

Implications on nursing administration

The leaders in nursing are confronted to undertake the health needs of the most vulnerable by effective organization and management. The nurse administration should take active part in health policy making, developing protocol, procedures and standing orders related to clients education.

The nurse administration should give attention on the proper selection, placement and effective utilization of the nurses in all areas with in the available resources giving importance for their creativity, interest, ability in education of the clients.

The educational programme on educative role of the nurses along with the adequate supervision of nursing services would motivate nurses to carry out educative roles.

Implications for the nursing research

The finding of the study helps the professional nurses and students to develop the inquiry by providing a base line. The general aspects of the study result can be made by further replication of the study. This study help the nurse researchers to develop in depth into the development of teaching module and set information of clients with peptic ulcer towards promotion of healthy life and prevention of complication.

Recommendations

Based on research findings, the following recommendations were made:

1. Experimental study can be done to assess the knowledge of people regarding peptic ulcer disease.
2. A similar study can be conducted on people residing in community area.
3. The study will help to conduct health education program regarding peptic ulcer disease.
4. A comparative study can also be done between rural and urban peptic ulcer clients.
5. A comparative study can be done on different age group and between male and female.

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