RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1) NAME OF THE CANDIDATE : Mrs. SREELATHA R,

MIRANDA STAFF QUARTERS,

SLIG-45,YELAHANKA 4TH PHASE,

YELAHANKA NEW TOWN,

BANGALORE-560106.

2) NAME OF THE INSTITUTION : MIRANDA COLLEGE OF NURSING,

CA-29, 5TH PHASE, KHB COLONY,

YELAHANKA NEW TOWN,

BANGALORE- 560106.

3) COURSE OF STUDY : M.Sc NURSING

AND SUBJECT MEDICAL SURGICAL NURSING.

4) DATE OF ADMISSION : 25/10/2010

TO THE COURSE

5) TITLE OF THE STUDY : A STUDY TO ASSESS THE

EFFECTIVENESS OF SELF INSTRUCTIONAL

MODULE ON PREVENTION OF RENAL CALCULI

AMONG SEDENTARY WORKERS IN

SELECTED SOFTWARE DEVELOPMENT

COMPANY, BANGALORE.

1

6. BRIEF RESUME OF THE INTENDED WORK :

BACKGROUND OF THE STUDY:

Information technology might not appear to be a high risk field, but a surprising

number of ailments can plague IT professionals in all job roles .Everybody seems to understand

the movers and construction workers can have serious neck and back problem from their

strenuous work. But people don’t expect IT professionals to moan and groan from sore back and

sore throat, as they sat at desk most of the day 1 . IT profession requires a sedenatary lifestyle

and this lead to several health problems and kidney stones are one among them.

Mankind has been affected by urinary stones since centuries, and has been the silent

cause of renal failure. Even in the 4th century BC, Hippocrates (father of modern medicine)

notes the presences of the renal stone together with renal abscess.2

Kidney stones, also called renal lithiasis, are pieces of a stone or crystal-like material.

These stones form inside the kidneys or urinary tract. Kidney stones begin as small specks and

can gradually increase in size. A person with a small kidney stone may be unaware of the

condition, and it may pass in the urine out of the body without causing pain or other problems3.

Anyone may develop a kidney stone, but people with certain diseases and conditions or

those who are taking certain medications are more susceptible to their development. It is

estimated that one out of every 10 people in the U.S will develop stones in the urinary tract at

some point in their lives. Most urinary stones develop in people 20-49 years of age, and those

who are prone to multiple attacks of kidney stones usually develop their first stones during the

second or third decade of life. 4

2

Having a sedentary lifestyle is mentioned as one of the commonest causes of kidney

stone by almost all literatures regarding kidney stones. Sitting around too much leaves the urine

in a stagnant state where crystals can form and grow. Moving around and being active keep

things flowing through the urinary tract. Daily exercise helps to control the chance of getting

kidney stone.5

Kidney stones may be prevented by ensuring good hydration and with prescribed

medication in some cases. Once a stone has developed, treatment may include hospitalization,

pain medication, and certain procedures that remove or crush large stones so that they pass more

easily out of the body. Small kidney stones may require no treatment3.

6.1. NEED FOR THE STUDY

In this computerization era, people are awfully busy in business activities and

other family and social obligations. There is a considerable lack of physical

exercise in their lives. Depending upon the nature of work one is prone to health

problems. Sedentary job doers get problems of obesity; overweight; blood

pressure; high cholesterol; hypertension; cervical spondylitis; troubles in spine;

back ache and muscular pains due to sitting in front of computers for prolonged

hours. 1 A sedentary lifestyle and lack of physical activity can contribute to or be a risk factor for

several diseases and kidney stone is one among them.6

There appears to be an increase in the number of cases of kidney stones in recent years.

About 7 to 21 people out of every 10,000 (or less than two tenths of one percent) of the

population will have a kidney stone attack each year. In 1985 there were 1 million cases of

kidney stones in the United States. These account for about 7 to 10 of every 1000 hospital

3

admissions (or nearly one percent). Four out of five kidney stone cases (80 percent) are among

men; only 20 percent are women. And more Caucasians have kidney stones than Afro-

American.7

The overall probability of forming kidney stone differ in various parts of the world and is

estimated as 1-5% in Asia, 5-9% in Europe, 13% in North America and the recurrence rate of

renal stone is about 75% in 20 year span. It occurs both in men and women, but the risk is

generally high in men and is becoming more common in young women.

Modern life style changes, sedentary habits, an unhealthy dietary plan and overweight

problems of the affluent societies emerge to be the important promoters of the " stone boom" in

the new millennium both in developed and under developed countries. Several studies from the

west indicated that in the industrial countries kidney stones are a common problem affecting 1

person in 1000 annually, and the incidence is increasing in tropical developing countries too .

Factors such as age, sex, ethnic and geographic distribution determines prevalence. The Afro -

Asian stone forming belt stretches from Sudan, Egypt, Saudi Arabia, The UAE, Iran, Pakistan,

Myanmar, Thailand, Indonesia and Philippines. The prevalence of calculi ranges from 4-20%.

Men are at greatest risk of developing kidney stone with incidence and prevalence rates between

2-4 times that of women8. Kidney and Urology Foundation of America, estimated the statistical

incidence of kidney stones as one million cases almost every year.9

Statistics has shown that there is increase in the incidence of renal stones in India as well

and it is stated as follows.

12% have stone in their lifetime.

12% of men will suffer from kidney stone by age of 70

4

5% of women will suffer from kidney stone by age of 70

50% have recurrence within 5-10 yrs

Highest incidence of kidney stone is in 30-45 years of age group, and

incidence declines after age of 50

7-10 of every 1000 hospital admission is of renal stone

Urinary stone constitute one of the commonest diseases in our country and pain due to

kidney stones is known as worse than that of labour pain. In India, approximately 5 -7 million

patients suffer from stone disease and at least 1/1000 of Indian population needs hospitalization

due to kidney stone disease.10

From being traditionally associated with people from the dry northern parts of Karnataka,

kidney stones are increasingly being detected among people from south Karnataka as well.

Doctors treating kidney diseases in the state are reporting a nearly 50 per cent rise in the number

of patients with kidney stones from southern districts like Bangalore, Mysore and Mandya, in the

past couple of years. The reason is changes in lifestyle and diets low in fiber content.

At the Nephro Urology Trust — formerly the Bangalore Kidney Foundation — the

percentage of people coming in with kidney stones has risen from around 15 per cent of all

patients a few years ago, to nearly 70 per cent. 11

A review was conducted in Osmania University, Hyderabad, to provide an update about

the most common risk factors and medical conditions associated with renal stone formation as

the incidence of kidney stones is increasing in the tropical countries. They found that sedentary

life style habits, an unhealthy dietary plan and overweight problem may be important promoters.

5

The role of occupation on stone formation is highly debated. Kidney related

complications are on the increase because of geographic factors, residence in the stone belt, and

occupation related lifestyle changes. In case of indoor occupation; sedentary habits, stress,

unhealthy dietary plan, irregular food habits and fluid intake are the reasons of this increase12.

Today’s busy and fast paced corporate life is taking a heavy toll on the working

professionals. Long and sedentary working hours, pressure of targets, deadlines, competition are

certain key factors which are affecting a working professional’s health and lifestyle to a great

extent. 13

The researcher during her clinical posting in the urology department have noticed that

the patients admitted with renal stones have almost no idea about kidney stone and that it can be

prevented to a large extent by modifying the lifestyle . It was also noticed that a significant

portion of hospitalized patients with kidney stones are engaged in some sort of sedentary

occupation. Therefore the investigator thought it is useful to provide educational material on

preventive aspects of kidney stones among sedentary workers.

6.2. REVIEW OF LITERATURE

A study was conducted to assess the effectiveness of calcium channel blockers and alpha

blockers to facilitate the stone passage. Medline, Pre-MEDLINE, CINAHL, EMBASE and

scientific meeting abstracts up to July 2005 was searched. The data was pooled from 9 trials

(n=693) where Ca channel blockers or alpha blockers were used to treat urethral stones. The

study found that the patients who were given Calcium channel blockers and alpha blockers had a

65% (absolute risk reduction = 0.31, 95% CI 0.25-0.38) greater likelihood of stone passage than

those not given such treatment (pooled risk ratio 1.65, 95% CI 1.45-1.88). The study concluded

6

that medical therapy is an option for facilitation of urinary stone passage for patients amenable to

conservative management potentially obviating the need for surgery. 14

A correlation study was conducted in Harvard University to determine the relationship

between calcium intake and the occurrence of renal calculi (the well-known Harvard Nurses'

Health Study). Harvard researchers studied nearly 92,000 nurses over a period of 12 years. The

conclusion of this massive study was that those nurses who consumed diets that were higher in

calcium were at lower risk for kidney stones, dietary calcium intake from food or supplements

reduced the risk for renal calculi; calcium supplementation must be taken with food and in small

dosages (< 400 mg); plant foods high in calcium, fiber, vitamins, minerals, antioxidants, and

some protein were an excellent source for dietary phytochemicals.15

A study was conducted in Spain to establish a relation between the intake of phylate and

(through consumption of typical Mediterranean diet) and its excretion in urine. The results

showed that the experimental group phylate consumption was (672 +/- 50 mg) significantly

higher than the control group (422+/- 34 mg) representing a 59% difference. Urinary phylate

excretion was also significantly higher (54%) in the experimental group (1,016+/- 70mug/L) than

the control group (659+/- 45 mug/L). The study concluded that the Mediterranean diet high in

whole cereals, legumes and nuts increases the urinary phylate excretion in humans .16

A 5 year randomized trial was conducted to compare the effects of 2 diets in preventing

the recurrence of stones in idiopathic hypercalciuria (1st diet- Normal calcium (30 mmol/day,

low animal- protein (52g/day) and low salt diet (50mmol/day) and 2nd diet- Low calcium diet-

10 mmol/day. At 5 year 12 of 60 men on the first diet and 23 of the 60 men on the second diet

had had relapses (n= 120). .During follow up , urinary calcium levels reduced significantly in

7

both groups, though the excretion of urinary oxalate increased by 5.4 mg/day in the second group

whereas it decreased by 7.2 mg/day in the first group. The study concluded that, in men with

recurrent calcium oxalate stones and hypercalciuria, restricted intake of animal protein and salt,

combined with normal calcium intake provides greater protection than the traditional low

calcium diet .17

A questionnaire survey was carried out in Singapore to determine the prevalence of

urinary stone disease in 406 male workers in several occupations. There were 119 quarry drilling

and crusher workers (outdoor, physically active), 77 quarry truck and loader drivers (outdoor,

physically inactive), 92 postal deliverymen (outdoor, physically active), 75 postal clerks (indoor,

physically inactive), and 43 hospital maintenance workers (indoor, physically active). The

prevalence of urinary stone disease was five times higher in outdoor workers (5.2 per cent)

compared to indoor workers (0.85 per cent, P<0.05). Contrary to expectation, no increased risk

of urolithiasis was apparent in physically inactive workers. Chronic dehydration is likely to be

the most important risk factor for the increased risk of urolithiasis in outdoor workers in the

tropics, and should be easily prevented by increased water intake. 18

A study was conducted in Italy to evaluate the clinical efficacy of therapy with potassium

citrate and potassium bicarbonate for dissolution of radiolucent stones. A sample of 8 patients

with a stone size of < or = 15mm were selected. During the first 6 week period, a daily water

intake of 1500 ml was suggested whereas during the following 6 week period on top of the 1500

ml water, potassium citrate 40 meq and potassium bicarbonate 20 meq was given. The results

showed that during the first period stone burden remained unchanged whereas after the second

period complete stone dissolution was found in 3 patients, and when the treatment continued 2

more patients had complete stone dissolution. The study concluded that urinary alkalinisation

8

with potassium citrate and potassium bicarbonate is a highly effective treatment, resulting in

dissolution of non obstructing uric acid stones.19

A comparative study was conducted in South Africa to evaluate the possible therapeutic

or prophylactic efficacy of mineral water containing calcium and magnesium in calcium oxalate

kidney stone disease. A French mineral water containing calcium (202 ppm) and magnesium (36

ppm) was selected as the delivery method. Twenty subjects of each sex who had previously

formed calcium oxalate renal calculi and 20 healthy volunteers of each sex participated in the

study. Each subject provided 24-hour urine collection samples each day during the study. The

mineral water was ingested over a 3-day period. Then the participants switched to tap water. The

cycle was repeated at least twice by each subject. The male stone formers received the most

benefit, showing nine risk factors that were favorably affected by the mineral water containing

calcium and magnesium 20

A descriptive study was conducted in Thailand to study the epidemiology of urolithiasis

in southern Thailand (2000).Sample size was 1,452 urolithiasis patients. The study found that the

ratio of male to female was 1.6:1, the most common age group was 41-50 years, ureteric calculi

was found most frequently than renal calculi. ESWL is the most common treatment for upper

urinary tract calculi and surgery was the most common treatment for lower urinary tract calculi.

The body mass index of 48.1% was between18.5 and 24.9. The study of calculi composition

showed that oxalate was found in most upper urinary tract calculi and uric acid was found in

most lower urinary tract calculi. The study concluded that ureteric calculi were most common in

the South of Thailand. The BMI of urolithiasis patients was higher than the population average.21

9

A study was conducted in China, to study the epidemiological characters and risk factors

of renal calculi. The study found that the prevalence rates of renal calculi were 8.00% in males

and 5.12% females. The results of LISEREL showed that the total effect of age and sex affecting

the development of renal calculi was 0.4614, with direct effect 0.3600 and indirect effect 0.1014.

The direct effects of blood uric acid, blood calcium and body mass index, blood cholesterol,

blood sugar were 0.3400 and 0.3200 respectively. The indirect effect of education, exercise and

dietary habit affected the development of renal calculi through index of biochemistry and

obesity, were -0.0416 and 0.1882.The study concluded that Sex, age, obesity and high blood

cholesterol, high blood sugar, high blood uric acid, high blood calcium were the direct

influencing factors to renal calculi. At the same time, education, exercise and dietary habit were

also associated with the disease.22

A study was conducted to identify the personal characteristics associated with renal stone

formation. 161 patients with idiopathic renal stone disease and 254 age and gender-matched

healthy subjects were individually interviewed with regard to their sociodemographic

characteristics and family medical history. The study found that of patients with renal stones,

66.5% were male; the male to female ratio was 1.98 to 1. The prevalence of renal stone was

highest in men aged 30–50 years and in women aged 40–60 years. The main differences between

stone formers and healthy subjects were that stone formers had higher body mass index (p =

0.007), lower educational (p = 0.001) and economic (p = 0.037) levels, and more positive family

history of urinary stones (p < 0.0001), especially in their siblings. The percentage of unemployed

subjects and housekeepers were higher in the case group. The type and duration of employment

were significantly different in the two groups (p = 0.014 for type and p = 0.003 for duration).

10

With regard to the job environment (i.e. workplace), most of the individuals in the case group

worked outdoors (p = 0.021) and in warm places (p < 0.0001).23

A correlational study was done to examine the relation between 6 beverages and history

of kidney stones. The study found significantly inverse association with caffeinated coffee,

decaffeinated coffee, tea, beer, and wine and direct association with risk was noticed with apple

juice and grape fruit juice.24

A prospective cohort study was conducted to examine the association between dietary

factors and the risk of incidence of kidney stones in men. Self administered food frequency

questionnaire was given to 45619 men. The study concluded that sodium phosphorous, sucrose,

phytate, Vitamin B (6), Vitamin D and supplemental calcium were not independently associated

with risk. Magnesium intake decreases and total Vitamin C intake increases the risk of

symptomatic nephrolithasis.25

A study was conducted in RGUHS, Bangalore to evaluate the effectiveness of STP

regarding prevention of infection among haemo dialysis clients at Victoria Hospital, Bangalore.

And the study concluded that the mean post test knowledge which was 78% was significantly

higher than the pre test score of 31%.26

A study was conducted in Wardha district, to assess the effectiveness of SIM on

knowledge regarding prevention of musculo skeletal discomfort in computer professionals. The

study found that there is significant difference( improvement in post test knowledge ) between

the pretest and post test knowledge of computer professionls.26

11

STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL

MODULE ON KNOWLEDGE REGARDING PREVENTION OF RENAL CALCULI

AMONG SEDENTARY WORKERS IN A SOFT WARE DEVELOPMENT COMPANY IN

BANGALORE.

6.3. OBJECTIVES OF THE STUDY

1. To assess the knowledge level of sedentary workers regarding prevention of renal

calculi.

2. To determine the effectiveness of SIM on level of knowledge of sedentary workers

regarding prevention of renal calculi in terms of post test results.

3. To find out the association between the knowledge levels of sedentary workers

regarding prevention of renal calculi with selected demographic variables.

OPERATIONAL DEFINITIONS

Effectiveness:

Effectiveness refers to the extent to which the SIM will achieve the desired result in

enhancing the knowledge level of sedentary workers regarding prevention of renal calculi.

Self Instructional Module:

SIM is the self contained instruction unit prepared by the researcher to promote self

learning of sedentary workers regarding the prevention of renal calculi in terms of meaning,

clinical manifestations, causes, risk factors and preventive measures.

12

Knowledge:

Knowledge is the awareness or information gained by the sedentary workers through SIM

regarding prevention of renal calculi.

Prevention:

It is the act of hindering the occurrence of renal calculi.

Renal calculi:

Renal calculi are solid concretions or calculi formed in the kidneys from the dissolved

urinary minerals.

Sedentary workers:

Those workers whose occupation or profession is characterized by or requires much

sitting.

HYPOTHESIS:

RH1: There is significant difference between the mean pre test and post test level of

knowledge of sedentary workers regarding prevention of renal calculi before and after the

treatment.

RH2: There is significant association between the demographic variable and knowledge

of sedentary workers regarding prevention of renal calculi.

13

7. MATERIAL AND METHODS:

7.1. SOURCE OF DATA:

Data will be collected from sedentary workers working in a software development

company, Bangalore.

7.2. METHODS OF DATA COLLECTION:

7.2. a. DEFINITIONS OF THE STUDY SUBJECT

Sedentary workers in the age group of 30- 50 years, who are working in a selected

software development company, Bangalore.

7.2. b. CRITERIA FOR SELECTION OF SAMPLE:

INCLUSION CRITERIA

1) Sedentary workers who are present during the period of data collection.

2) Sedentary workers who are willing to participate.

3) Sedentary workers who are in the age group of 30-50 years.

4) Sedentary workers who can read write and understand English.

EXCLUSION CRITERIA

1) Sedentary workers who are not willing to participate.

2) Sedentary workers who are above 50 years.

14

3) Sedentary workers below 30 years.

4) Sedentary workers who are not present during the period of data collection.

5) Sedentary workers who cannot read write and understand English.

7.2. c. RESEARCH DESIGN:

The research design selected for the study is one group pre test post test experimental

design.

7.2 .d. SETTING OF THE STUDY:

The study is conducted in selected software development company, Bangalore.

7.2. e. SAMPLING TECHNIQUE:

Convenient sampling technique will be used for this study.

7.2. f. SAMPLE SIZE:

A sample of 50 software professionals.

7.2. g. DURATION OF THE STUDY:

30 days.

7.2. h TOOLS OF RESEARCH:

The tools used for the data collection in this study will be

Tool 1: Demographic data

Tool 2: Structured knowledge questionnaire

15

TOOL 1: Demographic data

The baseline porforma consists of name of the worker, age, sex, any existing health

issues, history of renal stones, educational qualification, medications, etc.

TOOL 2: Structured knowledge questionnaire

The tool used by the investigator to assess the knowledge of the sedentary

workers which includes preventive aspects renal calculi.

7.2. i. DATA COLLECTION PROCEDURE:

To collect the data regarding knowledge level of computer professionals regarding

prevention of renal calculi by using structured knowledge questionnaire among workers of a

selected office in, Bangalore.

7.2. j. METHODS OF DATA ANALYSIS AND PRESENTATION:

Frequencies and percentage distribution for the analysis of demographic data. Mean and

standard deviation will be used to assess the pre and post test score. Paired T test will be used to

assess the effectiveness if SIM Chi- square test will be used to find out association between post

test score and the selected variables.

7.2.k .DATA COLLECTION TECHNIQUE

The investigator collects the data by using structured knowledge questionnaire.

16

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE

CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS?

Yes, the study will be conducted on sedentary workers (30-50 years) who are working in

a software company in Bangalore.

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION IN CASE OF 7.3.

Ethical clearance will be obtained from concerned authority and written consent from

participants for study. Anonymity and confidentiality of the subject will be maintained.

17

8. LIST OF REFERENCES:

1.” Thornberry S (2006).April 24 (4). Ten IT health risks and how to combat

them.Journal of Information technology: 16-18

2. Dr. Raja D. “Stones" available at C:\Users\Home\Downloads\Stones Bladder, Kidney

Stones Renal Calculus, Lithotripsy.mht

3.Parker .J(2000) April 58(4) .Statistics for kidney stones.British Journal Of

Urology:1021-1029.

4. Kidney Stones (Renal Stones, Nephrolithiasis). Available at

http://www.medicinenet.com/kidney_stone/article.htm

5.Blangy S . (1989) ‘The top five causes of kidney stones .Urological Research.:387-389

6. ‘Sedentary life style’ .Available at http://en.wikipedia.org/wiki/sedentary _lifestyle

7. Roger, B. An Educational Resource for Sufferers with Kidney stones ' available at

www.rogerbaxter.com/kidney/stone/index.shtml

8. Sandhya A, et.al.(2010) May-July1 (1). Kidney Stone Disease: Etiology and

Evaluation. International Journal of Applied Biology and Pharmaceutical

Technology. :175-181.

9. Statistics for kidney stones ' available at http://www.1888articles.com/statistics-for-

kidney-stones-OnOzi5g462.html

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10.Black.J.M.et.al(2001) Medical Surgical Nursing,6th edition. Harcourt pvt Ltd,

India:821-829.

11.TNN, (2003) November 20.'Kidney Stones Common in South Karnataka '.Times of

India.:9

12. Sanovide Ayurveda The complete Health Studio.Available from

http://www.sanovide.com/corporate.php

13. Hollingsworth .et.al. (2006) 368(9542)’Medical therapy to facilitate urinary stone

passage ; a meta analysis. Lancet: 1171

14. Prieto RM. et.al.(2010) September 49(6), Effects of mediterranean diets with low and

high proportions of phylate rich foods on the urinary phylate excretions. Eur J Nutr: 321-

326. 15. Kidney health. Available at http://www.lef.org/protocols/prtcl-065.shtml

15. Kidney health. Available at http://www.lef.org/protocols/prtcl-065.shtml

16. Loris B et.al. (2002) January; 346(2): Comparison of 2 diets for the prevention of

recurrent stones in idiopathic hypercalciuria. New England Journal of Medicine: 77-83.

17. Ng Tze Pin et.al. (1992), 42(1) Dehydration from outdoor work and urinary stones in

a tropical environment. Oxford Journal: 30-32.

18. Trincheri A.et.al.(2009) september 81(3) Dissolution of radiolucent renal stones by

oral alkalinization with potassium citrate and potassium bicarbonate. Arch Ital Urol

Androl:188-191.

19

19. Rodgers et.al. (1997) 58(2) Effect of mineral water containing calcium and

magnesium on calcium oxalate urolithiasis risk factors. Urol Int: 93-99.

20. Monthira T.et.al.(2005) 88(1),Urinary Tract Calculi in Southern Thailand. Journal of

Medical Association of Thai: 80-85

21. Peng J.et.al.(2003) Dec24(12)’ Study on the epidemiology and risk factors of renal

calculi in special economic zone of Shenzhen city.’ Chinese Journal:1112-1114.

22.Shirazi.F (2009)Vol 11(1) 'Personal characteristics and urinary stones' ,Hongkong

Journal Of Nursing: 14-19

23.Blangy S .et.al (1998) November 60 (5). Effect of changes in epidemiological factor

on the composition and racial distribution of renal calculi. British Journal of

Urology:387-392.

24. Gary. C.et.al(1996) Vol 143 (3). The intake of 6 beverages and the history of kidney

stones over a period of 14 years. American Journal Of Epidemiology :240-247.

25. Taylore.E.N.et.al (2004)December 6, 15 (12). Dietary factors and the risk of incident

kidney stones in men . J Am Soc Nephro :3225-3232.

26.Basavanthappa BT(2003), Nursing Research, Jaypee Bothers medical Publishers Pvt

Ltd, 75- 147.

27. Polit DF .et.al (1999), Nursing research principles and methods, 6th edition,

Lippincott publication, 356- 376.

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9. SIGNATURE OF THE CANDIDATE:

10. REMARKS OF THE GUIDE:

11.1. NAME AND DESIGNATION

OF THE GUIDE : Prof. Bosco Sunder Raj

Head of the Department,

Department of Medical Surgical Nursing,

Miranda College of Nursing,

Bangalore.

11.2. SIGNATURE :

11.3. CO-GUIDE IF ANY :

11.4. SIGNATURE :

21

As there is an increasing need to expand professional horizons to

suit the challenges of renal calculi and changes in health care delivery, this study is

highly recommended to be registered as the study addresses the same.

11.5. HEAD OF THE : Prof. Bosco Sunder Raj

DEPARTMENT Head of the Department,

Department of Medical Surgical Nursing,

Miranda College of Nursing,

Bangalore.

11.6. SIGNATURE :

12. REMARKS OF THE CHAIRMAN AND PRINCIPAL:

This study is highly recommended to be registered.

13. SIGNATURE OF THE PRINCIPAL:

MRS. ANBARASI

PRINCIPAL

22

RESEARCH PROJECT

SUBMITTED BY : SUBMITTED TO:

Ms. SREELATHA R Ms. SHOBHA RANGAPPA

1st YEAR M.Sc [N] M.Sc NURSING COORDINATOR

MIRANDA COLLEGE OF NURSING MIRANDA COLLEGE OF NURSING

BANGALORE. BANGALORE.

23

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