“A STUDY TO ASSESS THE KNOWLEDGE REGARDING POSTURAL DRAINAGE THERAPY AMONG BRONCHIECTASIS PATIENTS ADMITTED IN HARSHA

HOSPITAL, NELAMANGALA WITH A VIEW TO DEVELOP AN INFORMATION GUIDE SHEET.”

PROFORMA FOR REGISTRATION

OF

SUBJECT FOR DISSERTATION

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

HARSHA COLLEGE OF NURSING

NELAMANGALA

1

Rajiv Gandhi University of Health Science , Karnataka

Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 Name of the Candidate and Address

JINU XAVIER

1st YEAR MSC NURSING

HARSHA COLLEGE OF NURSING

NELAMANGALA,BANGALORE

2 Name of the Institution

Harsha College of Nursing

Nelamangala,Bangalore

3 Course of the Study andSubject

1st Year M.Sc Nursing

Medical Surgical Nursing

4 Year of the Admission2010

5

TITLE OF THE TOPIC

“A Study to Assess the Knowledge Regarding Postural Drainage Therapy Among Bronchiectasis Patients Admitted In Harsha Hospital Nelamangala ,With a view to Develop

an Information Guide sheet”

2

1. INTRODUCTION AND BACKGROUND

“Breath is the bridge which connects life to consciousness, Which unites your body to your thoughts”

Thich Nhat Hanh

When we breathe our lungs take in oxygen from the air and deliver it to the blood

stream. The cells in our body need oxygen to work and grow . Chronic respiratory diseases

represent a public health challenge in both industrialized and developing countries , because

of their frequency and economic impact in developing countries, where poverty and non

communicable respiratory disease have long been linked. Most patients have poor access to

health care , this is even true of the poorest minorities in industrialized countries. In

developing countries however an additional problem is that health planners have limited

resources.1

Bronchiectasis is a chronic lung disease , state defined by localized, irreversible

dilation of the bronchial tree . it is classified as an obstructive lung disease, involved bronchi

are dilated, inflamed and easily collapsible resulting in airflow obstruction and impaired

clearance of secretions. Bronchiectasis is associated with a wide range of disorders , but it

usually results from necrotizing bacterial infections such as infections caused by the

staphylococcus or klebisella species or bordetella pertussis . The hall mark of Bronchiectasis

is a chronic cough with mucopurulent or purulent sputum , lasting for months to years and

may progress to chronic respiratory failure .

Treatment of Bronchiectasis is aimed at controlling infections and bronchial

secretions, relieving airway obstruction and preventing complications. In active case of

Bronchiectasis includes fighting the infection with an antibiotic and eliminating the fluid with

postural drainage therapy.2

3

Postural drainage therapy is a component of bronchial hygiene therapy it consist of

postural drainage, positioning and turning and is some times accompanied by chest

percussion and or vibration. Cough or airway clearance techniques are essential components

of therapy. When postural drainage is intended to mobilize secretions. Postural drainage

therapy is often used in conjunction with aerosol administration and other respiratory care

procedures . this procedure has been commonly referred to as chest physiotherapy , chest

physical therapy ,postural drainage and percussion, and percussion and vibration

Postural drainage therapy is designed to improve the mobilization of bronchial

secretions and the matching of ventilation and perfusion and to normalize functional

residual capacity based on the effects of gravity and external manipulation of the thorax .

This includes turning , postural drainage , percussion, vibration and cough

Turning is the rotation of the body around the longitudinal axis to promote unilateral or

bilateral lung expansion and improve arterial oxygenation.

Postural drainage is the drainage of the secretions by the effect of gravity from one or more

lung segments to the central airways where they can be removed by cough or mechanical

aspiration

Percussion is also referred to us cupping , clapping and tapotement .The purpose of

percussion is to intermittently apply kinetic energy to the chest wall and lungs .

Vibration involves the application of a fine tremorous action (manually performed by

pressing in the direction that the ribs and soft tissues of the chest move during expiration)

over the draining area.

The following should be assessed together to establish a need for postural drainage

therapy , they are excessive sputum production, effectiveness of cough, history of pulmonary

problems treated successfully with PDT(Postural Drainage Therapy) Example:

Bronchiectasis, Cystic fibrosis, lung abscess, decreased breath sounds or crackles or bronchi

4

suggesting secretions in the airway, abnormal chest x-ray consistent with atelectasis, mucus

plugging and deterioration in arterial blood gas values or oxygen saturation.3

NEED FOR STUDY

“Life is not measured by the number of breaths we take but by the movement that take our breath away”

HillaryCooper

Bronchiectasis is an uncommon disease that results in the abnormal and permanent

distortion of one or more of the conducting bronchi or airways bronchiectasis is usually is the

result of an infection or other condition that injures the wall of the airways or prevents the

airways from cleaning mucus. Mucus is a slimy substance that the airways produce to help

remove inhaled dust ,bacteria and other small particles. In bronchiectasis the airways slowly

lose their ability to clear out mucus when mucus can’t be cleared it builds up and creates an

environment in which bacteria can grow. This leads to repeated, serious lung infections.

Bronchiectasis can lead to serious health problems such as respiratory failure, atelectasis and

heart failure4.

Bronchiectasis is a major cause of respiratory morbidity especially in developing

countries. Respiratory exacerbations in people with bronchiectasis are associated with

reduced quality of life accelerated pulmonary decline hospitalisation and even death. It is a

shocking and alarming fact that approximately 973 deaths are occurring per year of the total

population that is 3%of all patients suffering from respiratory diseases .Bronchiectasis is

related to which of three types of the condition are present (i ) fusiform (cylindrical)

bronchiectasis (ii) varicose bronchiectasis (iii) cystic (saccular) bronchiectasis

Bronchiectasis most often begins in child hood as a complication from infection or

inhaling foreign object , it affects people of both sexes and all ages with proper treatment,

most people can lead normal lives without major disability5.

Today treating the problem seems easy but when we think about the cost of

medication and the side effects of antibiotics may lead to think natural ways to help the

5

bronchiectasis patient to provide airway clearance and to start breathing better. Postural

drainage technique is one of the best technique to get the mucus out and provide airway

clearance .A recent consensus statement describes airway clearance techniques is a

cornerstone for the management of bronchiectasis.

Brignall K , Jayaraman B,BirringSS.(2007oct.) Journal lung anatomy conducted an

explorative study at the department of respiratory medicine, king’s college hospital, London

Uk. According to these researchers the chronic cough and bronchiectasis are the common

causes of considerable physical and psychological morbidity. The physical symptoms of

cough are readily apparent, however, the psychosocial symptoms are often overlooked , there

fore there is a need for questionnaire and measures to assess cough, and bronchiectasis.

Specific quality of life which can be used as an ideal tool to assess physical and psychosocial

aspects6.

K.Lavery, B.ONeill J.S Eiborn, J.Reilly and J.M Bradley (2006 April) conducted an

explorative study at the department of respiratory medicine queen’s university Belfast Uk.

The aim of the study were to assess the physical and psychosocial impact of bronchiectasis ,

to determine whether the patients require self management and to indentify any obstacles or

sources to support for a disease specific self management programme. The data was collected

from thirty two patients with diagnosis of bronchiectasis attended four focus group. Each

focus group was subjected to qualitative analysis using the grounded theory approach. After

the study it was found that patients have the potential to self manage with strategies including

self regulation of medication and airway clearance technique. The perceived obstacles to self

management include lock of information and guidance, so it was concluded that the patients

has to provide information and guidance for the specific self management. So there is a need

for study to assess the knowledge regarding self management for airway clearance technique

in bronchiectasis patients7.

6

Pappalettera M, Alibertis, castellotti P, (2009) conducted an explorative study on

bronchiectasis, according to these researchers bronchiectasis is the abnormal and irreversible

dilation of the bronchi associated with chronic productive cough, airway obstruction and

recurrent infections, the prevalence seems to increase with age form 4.2 per 100000 parsons

aged 75 years older and the therapy is aimed to improve quality of life. This study concluded

by says bronchiectasis still remain a significant health problem and further studies are

required to improve the management of this condition.8

I have observed my neighbour friend, who was suffering from bronchiectasis and also

found that the airway clearance was improper due to inadequate knowledge of the patient

regarding postural drainage. So this inspired me to conduct a study to assess the knowledge

regarding postural drainage which is an easy and natural way for airway clearance and help

him to lead a better life and easy breathing.

7

2. REVIEW OF LITRATURE

“Research is what I am doing when I don’t know what I am doing “

Wernher Vonbraun

“Literature review refers to the activities involved in identifying and searching for the

information on a topics and developing a comprehensive picture of the state of knowledge on

that topic”

Review literature is considered as an essential step of research processes. It involves

the systematic identification, location, seriating and survey of return material that contain

information on a research problem. The over all process review of literature is to develop a

strong knowledge is to carry out a research and other scholarly education and clinical practice

activities. It helps to determine the gaps consistencies and in consistencies in the literature

about a particular subject under study. Review of literature guides the investigator to design

the proposed study in a scientific manner so as to achieve the desired result, the literature for

the present study been reviewed under following headings.

1. Literature on Bronchiectasis

2. Literature on postural drainage

3. Literature on chest physiotherapy.

1. Literature on Bronchiectasis

Sethi GR, Batra.V,(2000Feb) conducted a study at Lok Nayak hospital New Delhi on

bronchiectasis causes and management and according to these researchers, Bronchiectasis is a

condition representing abnormal and permanent dilation and distortion of bronchi.

8

Bronchiectasis is very common condition in developing countries as a sequel to pulmonary

tuberculosis, whooping cough and severe measles with symptoms of chronic cough and

expectoration of foul smelling sputum. Treatment include management of airway secretions

and control of airway hyper activity9.

S. Rajasekharan, R. Bhanusree, V. Vallingyagi V.Gopal and S. Nirmala devi (1997)

conducted a study at Thanjavur Medical College and Govt. Raja Mirasudar Hopital

Thanjavur India to diagnosis and assess the bronchiectasis patients . Fifty patients with

clinical features suggestive of bronchiectasis were selected for this study. All these patients

had productive cough for more than six months and audible persistent coarse crepitations on

pulmonary auscultation and diagnosed as the commonest organism producing secondary

infection was H. influenzas, S pneumoniae and Beta haemolytic streptococci. The study

concluded that bronchiectasis may lead to respiratory failure and most of affected patients are

being managed with episodal drug treatment and physiotherapy.10

Kolbe J, wells Au (1996dec.) department of respiratory medicine green land

hospital ,Auckland Newland conducted a study regarding neglected cause of respiratory

morbidity and mortality due to bronchiectasis. According to these researchers bronchiectasis

is progressive condition characterized by irreversible destruction and dilation of airways

generally associated with chronic bacterial infections. There is a high prevalence in

indigenous population in the region and factors such as poverty, substandard housing,

malnutrition, barriers to medical care and inadequate education in management are all likely

to have a major impact on prevalence and out come of bronchiectasis. The study concluded

that the morbidity and mortality due to bronchiectasis is to be prevented by proper

management and therapeutic goals.11

Dogreu D,Nik-Ain A,KiperN,Gocmen, Ozceliku, YalcinE,Asian At (2005dec.)

department of paediatrics, pulmonary medicine unit, Hacettepe university, Turkey conducted

a study on Bronchiectasis and the researchers reported that bronchiectasis is a common

disease in developing countries and the study was aimed to evaluate the risk factors and to

emphasize early diagnosis and treatment. There were204 patients whose most common

9

presenting symptoms were cough ,sputum expectoration and dyspnoea. The cause could not

be determined in 49% of patients. among the identified causes ,infection was present in most

patients. It is possible to prevent bronchiectasis in children with vaccination and improved

nutrition in developing countries. After the study it was concluded that early diagnosis and

treatment will increase the quality of life and survival of patients with bronchiectasis which

has irreversible and progressive complications if untreated.12

KingP,Hold S, worths Freezer N, HolmesP,(2007march) department of respiratory and

sleep medicine monash medical centre melbourne Australia conducted a study on

bronchiectasis. According to these researchers bronchiectasis can be considered as a

heterogeneous condition characterized by irreversible airway dilation with chronic bronchial

infection or inflammation. It is a major cause of respiratory morbidity with clinical findings

of chronic productive cough , rhinosinusitis, fatigue and bi-basal crackles. The common

pathogens are non-typeable haemophilus influenzae and pseudomonas aeruginosa which is

diagnosed by high resolution computed tomography scanning. After the study it was

concluded that bronchiectasis should be treated with proper regimens which may lead to

decline in respiratory function despite treatment.13

2.Literature on postural drainage

Mutalithas K, Watkin G,(2008june) institute for lung health department respiratory

medicine leicester, UK,did a research regarding improvement in health status among

bronchiectasis patients after physiotherapy by using a new method called broncho pulmonary

hygiene physical therapy .The data was collected by using leicestar cough questionnaire

regarding cough. The total number of patients were 53 and during pre test the major

symptom was cough . after pre tests the patients was subjected to chest physiotherapy and

postural drainage therapy. After this the same questionnaire was administered to the patients

and it was found that cough and other symptoms decreased among 35 patients and

moderately reduced among 15 patients. so it was concluded that postural drainage and chest

10

physiotherapy can lead to improvement in cough and other symptoms among bronchiectasis

patients .14

Eaton T,YongP, Zeng I,Kolbej (2007),Respiratory services Auckland, New Zealand

conducted a study on the effectiveness of postural drainage in bronchiectasis patients. The

data was collected from 36 patients (mean age 62 years, range 33-83 ) with stable

bronchiectasis. Total sputum weight before and after postural drainage were evaluated and

the researches concluded that postural drainage have superior efficacy in the management of

bronchiectasis and knowledge regarding postural drainage could be improved by proper

guidelines.15

Patterson JE,BradleyJM, ElbornJS,(2004) school of rehabilitation sciences, UK,

conducted a study on airway clearance in bronchiectasis. The data was collected from 20

patients with stable productive bronchiectasis. Weight of the sputum were measured and

recorded. The result evaluated that the weight of the sputum expectorated is significantly

greater after postural drainage techniques than before applying postural drainage technique.

So it is concluded that knowledge regarding postural drainage is an effective method of

airway clearance in bronchiectasis.16

MC Mazzocco, GR Owens, LH Kirilloff RM rogers (1985 sept.)conducted a research on

use of chest percussion and postural drainage in patients with bronchiectasis. The data was

collected from 13 patients with stable bronchiectasis. To determine the effects of chest

physical therapy on pulmonary function and sputum production and the study concluded that

chest physical therapy was safe and tolerated and assisted the patients in mobilization of

their sputum. So proper guidelines is needed for the proper application of postural drainage.17

3.Literature on chest physiotherapy

MP Murray,JLPentland (2009june), conducted a study at Royal infirmary of edinbargh

and the researchers reported the efficiency of regular chest physiotherapy in bronchiectasis

patients .the data was collected by using Leicester cough questionnaire the total number of 20

patients not practising regular chest physiotherapy were enrolled in a randomised cross over

trial of 3month of twice daily chest physiotherapy which is compared with 3 months of no

11

chest physiotherapy .the treatment effect was estimated using the differences of the pairs of

observations from each patient and stated that there was a significant improvement in total

Leicester cough questionnaire score and 24 hours sputum volume also increased with regular

chest physiotherapy. After the study it was concluded that regular chest physiotherapy in

bronchiectasis patients having significant benefits.18

NHS Lothian (2008dec.) department of respiratory medicine royal infirmary of Edinbargh

UK conducted a study on effectiveness of regular chest physiotherapy in bronchiectasis

patients the data was collected by using Leicester cough questionnaire the data was collected

from two group which consist of 10 bronchiectasis patients in a group. The first group

received full instruction to use physiotherapy twice daily and other group will received the

current standard treatment regiment for bronchiectasis for 3 months. After that first group

will received the current standard treatment regiment for bronchiectasis and the second group

will received full instruction to use physiotherapy twice daily. At each review sputum

samples will be collected and health related quality of life questionnaires be completed and

the study concluded that chest physiotherapy in bronchiectasis patients having significant

benefits.19

DeBoeck ,vermeulenF, vreysM, MoensM, Presmansm(2008 june) department of

paediatrics, university hospital of leuven,Belgium conducted a study on airway clearance

techniques. The researchers reported that airway clearance techniques are an important part

of the respiratory management in children with bronchiectasis. The current review explores

that chest physiotherapy is an airway clearance techniques which play a role in the

management of children with an acute respiratory problems and concluded that knowledge

regarding chest physiotherapy could be improved by proper guidelines.20

Tang CY,TaylorNF, Black stock FC(2009sep.) department of physiotherapy maroondhah

hopital Australia conducted a study on the effect of chest physiotherapy on obstructive

diseases .The study consists of thirteen trials and the study suggested that chest physiotherapy

techniques may benefit patients who requiring assistance with sputum clearance so

concluded that proper guidelines is needed to improve the effectiveness of chest

physiotherapy in airway clearance.21

12

Balachendron etal ,(2005 june), Kanchi Kamakoti childs trust hospital Chennai conducted a

study on the application of chest physiotherapy in the airway clearance of acute and chronic

respiratory disorders with retained airway secretions, the researches reported that this therapy

is not difficult if one has a proper understanding of the basic concept and principle behind

the manoeuvre and concluded that chest physiotherapy is essential to improve and maintain

the well being of the patients with airway obstruction and proper knowledge regarding this

therapy is essential to make it simple and more effective.22

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3 OBJECTIVES OF THE RESEARCH

STATEMENT OF THE PROBLEM

For the present study the discussion with the experts, colleague’s

and all, review of literature, personal clinical experience of the researcher gave the basis for

the selection to the following research problem.

“A study to assess the knowledge regarding postural drainage therapy among bronchiectasis

patients admitted in Harsha Hospital Nelamangala with a view to develop an information

guide sheet”

OBJECTIVES OF THE STUDY

1. To assess the knowledge of bronchiectasis patients regarding postural drainage

therapy

2. To develop and prepare information guide sheet regarding bronchiectasis and postural

drainage therapy with a view to improve knowledge of the patient.

3. To broadly categorize the patients on the basis of assessment scores and demographic

variables.

OPERATIONAL DEFINITIONS

1. Assess : it refers to the critical analysis and valuation or judgement of the status or

quality of a particular condition or situation.

2. Knowledge : it refers to the facts, information and skills acquired through experience

or education.

3. Patients: it refers to the individuals participating in the health care system for the

purpose of receiving therapeutic, diagnostic and preventive procedures.

4. Bronchiectasis : it refers to the localized, irreversible dilation of part of the bronchial

tree.

14

5. Chest physiotherapy: it refers to the group of therapies used to mobilize pulmonary

secretions.

6. Postural drainage: it refers to the drainage of secretion, by the effect of gravity, from

one or more lung segments to the central airways .

7. Information guide sheet: it refers to any learning material developed for the purpose

of achieving pre-specified objectives. It also refers to an independent learning

material. Which has organized content that enhances the knowledge of patients.

ASSUMPTIONS

1. The researcher assumes on the basis of literature, the knowledge regarding postural

drainage is limited among bronchiectasis patients

2. The knowledge can be improved by using information guide sheet

3. Bronchiectasis patients quality of life can be improved by modalities of therapy.

HYPOTHESIS OF THE STUDY

H2:- (RESSEARCH ALTERNATIVE HYPOTHESIS)

According to this hypothesis, there is a significant association between

demographic variable and knowledge scores of bronchiectasis patients

DELIMITATIONS OF THE STUDY

1. The study is limited to bronchiectasis patients in Harsha Hospital , Nelamangala.

2. The Study is limited to the patients who are present during the research.

3. The study is limited to the patients who can participate, listen and speak (excluding

non viable patients properly)

15

CONCEPTUAL FRAME WORK

Conceptual frame work serves as a springboard for theory development and as a

building block for the research study. As this is made up of concepts which are mental

images of a phenomenon, it provides for thinking and interpreting what is seen. A model is

used to depict symbolic representation of concepts.

The overall purpose of the frame work is to make scientific findings meaningful and

generalized. It provides certain frame work of reference for clinical practice, research and

education. Frame work can guide the researcher’s understanding of not only the ‘what’ of

natural phenomenon, but also the ‘why’ of their occurrence. They also give direction for

questions to practical problems.

The present study is aimed at assessing the knowledge regarding postural drainage therapy

among bronchiectasis patients. The researcher has adopted the Health Belief Model by

IRWIN.M, ROSEN STOCK (1988).

The present Health Belief Model is modified for this research as following:

1, Individual Perception of Susceptibility

2, Modifying Factors

3, Perceived Benefits

4, Perceived Barriers

5, Self Efficiency

1,Individual Perception of Susceptibility

It is susceptibility to the bronchiectasis patients which is the risk of occurring

bronchiectasis disease.

(a)Individual Perceived Severity

This step includes the severity of bronchiectasis and the symptoms of the disease.

16

2, Modifying Factors

This includes two steps

(a) Demographic variables

The demographic variables included in this study is age, gender, religion, area of

residence, family history, occupation, habits, educational status etc.

(b) Cues of action

This step contains the information guide sheet, questionnaire, hard vision media

regarding bronchiectasis and postural drainage.

3, Perceived Benefits

It contains the perceived benefits of information guide sheet on bronchiectasis and postural

drainage.

4, Perceived Barriers

It contains perceived barriers like communication problem, lack of education, cost

effectiveness etc.

5, Self Efficiency

It contains the information guide sheet which is perceived to improve patients knowledge

regarding bronchiectasis and postural drainage and it also encourages patients to adopt or to

accept postural drainage on bronchiectasis management.

17

18

4 METHODOLOGY

Methodology is a way to systematically solving the problem. It may be

understood as a science of studying how research is doing systematically (Kothari,1990)

This chapter provides a brief description of different steps taken to conduct the study . it

includes research approach research design, Setting of study population, criteria for sample

selection technique ,development and description of tool, scanning procedure plan for data

collection and data analysis.

RESEARCH APPROACH

Research approach is the basic procedure for the research of enquiry. It

helps the researcher regarding what data to be collected and how to analyze it. It also suggest

possible conclusion to be drawn from the data the present research is based on the problem

selected that is

A study to assess the knowledge regarding postural drainage therapy among

bronchiectasis patients admitted in Harsha Hospital Nelamangala. With a view to develop an

information guide sheet.

This study is explorative descriptive study and analyses patients score with a

relation to various demographic variables.

The descriptive study is considered appropriate for the present study.

Standardized questionnaire is used for conducting the study and to assess the knowledge

regarding postural drainage therapy in bronchiectasis patients. The research is to be

conducted with a view to develop an information guide sheet to improve the knowledge

RESEARCH DESIGN

Research design incorporate most important methodology, plan for organization

for the research study. Research design for present study is descriptive explorative study of

the 50 cases suffering from bronchiectasis and selected through purposive sampling

technique.

19

Schematic representation of research desig

20

SETTING

Harsha Hospital Nelamangala, Bangalore

TARGET POPULATION

Bronchiectasis Patients

ACCESSIBLE POPULATION

50 Samples of Bronchiectasis Patients

SAMPLING TECHNIQUE

Probable random method of collecting data

DATA COLLECTION PROCEDURE

Questionnaires on knowledge regarding

postural drainage

DATA ANALYSIS

Descriptive Statistics

CRITERION MEASURE

Knowledge Regarding Postural Drainage and Bronchiectasis

RESEARCH SETTING

It is the probable geographical area where the research/study is planning to conduct. For the

present study research setting is Harsha Hospital Nelamangala, Bangalore.

RESEARCH SAMPLE

It is the small representation of a very large group or population. For the present study a

small group of sample bronchiectasis patients to be selected randomly from patients admitted

with bronchiectasis in Harsha Hospital Bangalore

TARGET POPULATION

It is the large population related to the problem of the research. For the present study target

population are the bronchiectasis patients.

SAMPLE SIZE

50 representive sample with bronchiectasis have to be selected.

CRITERIA FOR SAMPLE SELECTION

INCLUSION CRITERIA FOR SAMPLE

- Patients with bronchiectasis admitted in Harsha Hospital Bangalore

- Patients who are present during data collection

- Patients who are willing to participate in this study

- Patients who are 10 years of age and above

- Patients who can understand/communicate kannada or English

EXCLUSION CRITERIA FOR SAMPLE

- Patients who are not willing to participate in this study

- Patients who are not present during data collection

- Patients who are below the age 10 years

- Patients who cannot understand/communicate kannada or English

21

SELECTION AND DEVELOPMENT OF TOOL

The tool will be selected and developed based an experience ,expert’s guidance, review of

literature so the tool will be broadly divided into two parts

1. Demographic variables

2. Questionnaire

The tool will be a structured questionnaire in both English and kannada

REVIEW OF LITERATURE FOR TOOL

The tool will be developed by thoroughly reviewing books, journals, news papers etc.

BLUE PRINT AND RELIABILITY OF TOOL

The blue print of the tool prepared, with be given to experts for validation. The reliability of

the tool will be examined by using KARL PEARSON co- relation based on Spearmann

Brown’s prophecy formula.

METHOD OF DATA COLLECTION

The data will be collected directly from the sample by using self administered/researcher’s

administered questionnaire

DURATION OF THE STUDY

The research is intended to complete the research with in a time from of twelve weeks

ETHICAL CLEARANCE

The research is intended to obtain prior permission and ethical clearance for the present study

form the

Patients family

Nursing superintend

Staff nurse /ward in charge concerned

Hospital

22

The safety, confidentiality, self respect and liberty of the patient will be given importance

during the present study.

The present study does not include any invasive scientific investigation on patients, other

human beings or animals.

VARIABLES

For the present study the following variables are considered

1.Dependent variable:

Knowledge of patients with bronchiectasis regarding postural drainage therapy(present

knowledge)

2.Independent variable

Assessment of bronchiectasis patients

Questionnaire

3.Demographic variables

The demographic variables included in this study is age, gender, religion, area of

residence, family history, occupation, habits, educational status etc.

PILOT STUDY It is a miniature of main study. It is a small preliminary investigation of some aspects

of major study like sample characteristics , tool effectiveness etc.

DATA ANALYSIS Plan for data analysis :the data obtained from the subjects will be analyzed in

terms of objectives of the study. Using descriptive and inferential statistics . the plan for data

analysis as follows

- Organize data in master sheet or computer

- To obtain percentages, averages and frequencies.

23

- To obtain mean, median and standard deviation to determine association between

knowledge levels and demographic variables

- Represent the data in tables and graph.

24

LIST OF REFERENCE

1.Nadiat Ait-k haled, chronic respiratory disease in developing countries, Bulletin of the

world Health organization 2001, 79: 971-979

2.Wikipedia the free encyclopaedia, article on bronchiectasis. Available from the URL:

http://en.wickipedia.org

3.AARC clinical practice guide line, Article on postural Drainage therapy ;1991 Dec;

36(12):1418-1426 available from URL:htt://Rcjournal.com

4.Joshua, Benditt MD.Bronchiectasis;2008 Feb Available from URL:http://www.merck.com

5.Wrong Diagnosis, prevalance and incidence statistics of Bronchiectasis. Available from

URL:http://www.wrongdiagonosis.com

6.Brignall K, Jayaraman B, Birringss. Quality of life and psychosocial aspects cough. The

department of respiratory medicine; 2007 oct ;supplimentary edition 1; 57-58

available from URL: http://www.pubmed.com

7.K Lavery.B, Oneil, J.S Eiborn, J.reilly, JM Brodley. Physical and psychosocial impact of

bronchiectasis, publication of Eur Respir Journal; 2006 April; 29(3); 541-547,

Available from URL: http://www.pubmed.com

8.Pappalettera M, Alibertis, Castellotti P. bronchiectasis; the clinical respiratory journal;

2009; 3(1); 126-134. Available from URL: http://www.pubget.com

25

9.Sethi GR, Batra.V.Bronchiectasis: causes and management; Indian journal of paediatrics;

2000 Feb; 67(2);133- 139.Available from URL: http://www.pubmed.com

10.S.Rajasekharan,R.Bhanusree, V.Vallingyagi, V.Gopal and S.Nirmala Devi. Value of

HRCT diagnosis and assessment of Bronchiectasis; Indian journal of tuberculosis;

1997; 44; 129

11.Kolbej, Wells AU. Bronchiectasis: a neglected cause of respiratory morbidity and

mortality. Department of respiratory medicine; 1996 Dec; 1(4); 221-225. Available

from URL: http://www.pubmed.com

12.Dogru D, Nik-Ain, Kiper N, Gocmen, Ozceliku, Yalcin E, Asian AT. Risk factors and to

emphasize early diagnosis and treatment,department of paediatrics; 2005 Dec;

51(6). Available from URL: http://www.pubmed.com

13.Kings P, Hold S, Worths Freezer N, Holmes P. Bronchiectasis is generally classified into

cystic fibrosis and non cystic, department of respiratory and sleep medicine; 2007

march;37(3); 208-209. Available from URL: http://ww.pubmed.com

14.Mutalithas K, Watkin G. improvement in health status amoung Bronciectasis patients;

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1 NAME OF THE CANDIDATE

2 SIGNATURE OF CANDIDATE

3 REMARKS OF THE GUIDE

4 NAME AND DESIGNATION OF GUIDE

4.1 SIGNATURE OF THE GUIDE

4.2 NAME OF THE CO-GUIDE& DESIGNATION(IF ANY)

4.3 SIGNATURE OF CO-GUIDE

4.5 HEAD OF THE DEPARTMENT

4.6 SIGNATURE

5 REMARKS OF THE CHAIRMAN OR PRINCIPAL

SIGNATURE

NAME AND ADDRESS OFTHE COLLEGE

DATE:

PLACE:

HARSHA COLLEGE OF NURSINGNELLAMANGALA, BANGALORE

29