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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 22 | Issue 1
Page Nos. 1-105

Online since Wednesday, July 7, 2021

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EDITORIAL  

Biological Disaster: Roles of Nurse Managers p. 1
Vinitha Ravindran
DOI:10.4103/ijcn.ijcn_36_21  
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CONCEPTS AND ISSUES Top

Exploring issues in theory development in nursing: Insights from literature Highly accessed article p. 3
Chinomso Ugochukwu Nwozichi, Olaolorunpo Olorunfemi, Amarachi Marie Madu
DOI:10.4103/ijcn.ijcn_100_20  
Theory development in nursing profession continues to raise more debates about critical issues. The present study aimed to explore the critical and contemporary issues and concerns about theory viewed from both the discipline- and professional-related perspectives. This narrative literature review was done in 2020. English articles in the electronic databases of Medline, Scopus, PubMed, CINAHL and Google Scholar were searched using the keywords: concerns, issues, nursing theory development, nursing theory construction, nursing discipline and nursing profession, and literature was retrieved and screened for eligibility. The date limit considered in the literature search was from 2010 to 2019. In the initial search, a total of 179 studies were retrieved and assessed for eligibility; 163 studies were eliminated due to not meeting the exact criteria set, leaving only 16 studies that were finally included in the content analysis. Content analysis method was used to extract our findings. Four themes (issues) emerged and were grouped into two overarching categories of discipline-related issues/concerns and profession-related issues/concerns. The four themes were (1) philosophical issues, (2) issues with validation of nursing theories, (3) multiplicity of nursing theories and divergent practice paradigms of nursing and (4) integration of theory into professional practice. This paper offers a promising premise to reconcile various concerns arising from nurses' attempts to develop, use and test theories. Identification and discussion of these issues should inform the nursing profession to plan activities to resolve or reduce them systematically.
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CLINICAL ARTICLES Top

Case presentation on ROHHAD syndrome p. 10
Jeyasutha Chokkian
DOI:10.4103/ijcn.ijcn_30_21  
Rapid-onset obesity with hypothalamic dysregulation, hypoventilation and autonomic dysregulation (ROHHAD) is a rare, potentially life-threatening disorder of respiratory control and autonomic nervous system with endocrine system abnormalities. Aetiology is unknown, but some hypotheses suggest a genetic predisposition or an autoimmune reaction for the occurrence of the disorder. Patients with ROHHAD have impairment of respiratory centre in the brain stem which may cause respiratory depression. Children may experience the following symptoms such as rapid-onset obesity, hyperphagia and endocrine abnormalities. Along with these symptoms, children may experience central alveolar hypoventilation, intestinal abnormalities, body temperature irregularities, difficulty with mobility and eye abnormalities. Children should undergo many investigations to rule out the ROHHAD syndrome such as X-ray, magnetic resonance imaging, electroencephalography and gene analysis. There is no specific treatment for ROHHAD syndrome. Management of a child with ROHHAD syndrome is a multidisciplinary team approach based on the child's symptoms such as diet, exercise, hormone replacement, behavioural therapy, support with artificial ventilation and medication. Nurses have a vital role in supporting the children with ROHHAD syndrome and their families.
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Acute intermittent porphyria - A case presentation p. 16
Sasikala R Umesh
DOI:10.4103/IJCN.IJCN_36_20  
Acute intermittent porphyria (AIP) is a rare autosomal dominant metabolic disorder affecting the production of haem, resulting from deficiency of porphobilinogen (PBG) deaminase. It is the most common form of acute porphyrias. The major symptom of an acute attack is abdominal pain, often accompanied by vomiting, hypertension and tachycardia. Attacks are most common in young women but rare before puberty or after menopause. Severe acute attacks may require hospitalisation. The most common triggers for acute attack are medications, weight loss, diet and surgery. Elevated urine PBG confirms the diagnosis of AIP. The treatment for acute porphyria includes administering intravenous haemin or glucose. This article outlines the disease process and its management. A case report is presented focusing on the nursing management of a patient with AIP using nursing process approach.
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Preterm infant with COVID-19 - A case presentation p. 22
Leena Dorairaj, Preethi Precilla, Mories Sankar
DOI:10.4103/ijcn.ijcn_32_21  
The coronavirus disease-2019 (COVID-19) emerged as a pandemic in December 2019. Pre-natal, post-natal and early newborn periods are considered to be highly susceptible periods in terms of the COVID-19 infection. Although there is little evidence on vertical transmission from mother to her newborn, an infection can occur after birth. This case report highlights coronavirus infection in a newborn born to COVID positive mother.
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RESEARCH ARTICLES Top

Venous thromboembolism risk and adequacy of thromboprophylaxis in surgical patients p. 28
Besty Ann Varghese, Punitha Ezhilarasu, Amala Rajan, Mark Ranjan Jesudason, Visalakshi Jeyaseelan
DOI:10.4103/ijcn.ijcn_33_21  
Venous thromboembolism (VTE) is the most prevalent potentially preventable complication amongst surgical patients. Appropriate prophylaxis is quite effective in its prevention. Mechanical and pharmacological thromboprophylaxis can be instituted based on risk categorisation. This study was undertaken to assess the risk for development of VTE in surgical patients and to assess the adequacy of thromboprophylaxis. A descriptive research design was used and was conducted in the general surgical wards of a tertiary hospital in South India. All 385 patients who were admitted in the surgical wards during the data collection period were included in the study, and the VTE Risk Assessment Tool by the Department of Health (2008b), UK, was used to assess the VTE risk in these patients. Eighty per cent of the patients were at high risk for developing VTE, and majority (62.7%) of them were not on any method of thromboprophylaxis. Only a minority (11.7%) of those who belonged to moderate or low risk were found to be on thromboprophylaxis. Majority of the patients who were found to be at high risk and were on prophylaxis for VTE were on anti-embolism stockings. More than half of the patients who were at low or moderate risk for VTE were found to be on injection heparin administered subcutaneously. There was a statistically significant association between age, type of occupation, the number of days of hospital stay, type of surgery, mobility level of patients and the VTE risk. Implementation of VTE risk assessment tool and a protocol for thromboprophylaxis helps in prevention of VTE and the complications associated with thromboprophylaxis. Incorporating this topic as a regular in-service education can ensure its mandatory learning and practice by nurses – the front line caregivers.
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Effectiveness of four-square breathing exercise on after-labour pain among post-natal mothers p. 35
Jayshree Satishbhai Vasava, Sapnaben Bhavin Patel, Anjali Tiwari
DOI:10.4103/IJCN.IJCN_16_19  
Post-natal period is a joyous yet a challenging period for all mothers. Minor ailments which are physiologically rooted may cause some disruption in the normal routines of motherhood. After-labour pain is one such ailment which often goes unrecognised. The objectives of this study were to assess the level of after-labour pain in post-natal mothers and evaluate the effectiveness of four-square breathing exercise on reducing this pain. This study was conducted on 80 multiparous women recruited from four different maternity hospitals and randomly assigned to experimental and control groups. Experimental group mothers were taught and performed four-square breathing exercise and the control group had standard care. Pre assessment was done at baseline and post-assessment was done on each of the 2 days the exercise or standard care was provided in both control and experimental groups. A visual analogue numerical pain rating scale was used to measure pain. The findings of the study revealed that both control and experimental groups reported significant reduction in pain on post-assessment on 2nd day. The difference in median pain score between control and experimental groups was significant in the post-assessment on the 2nd day. It is concluded that after-labour pain reduces naturally overtime. However, four-square breathing exercise can help in reducing the pain further.
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Knowledge and practice of rural mothers on oral hygiene for children p. 39
Blessy Mohandass, Himani Chaudhary, Gurleen Kel Pal, Simrandeep Kaur
DOI:10.4103/IJCN.IJCN_7_20  
Oral health is a condition in which the mouth and the teeth are healthy and free from any diseases. Improper maintenance of hygiene of the mouth is one of the risk factors for oral diseases. Researches showed that parents are responsible for inculcating good oral hygiene habits in children and mothers are considered to be the most accountable in educating the children about proper oral hygiene. This study was undertaken to explore the knowledge and practice of mothers regarding the importance of oral hygiene for children. A non-experimental descriptive research design was used, and 100 mothers of under-five children were randomly selected from the rural areas of Rajpura in Patiala District, Punjab. A self-structured knowledge questionnaire and practice checklist was used to collect the data. Analysis and interpretation of the data was done according to the objectives of the study using descriptive and inferential statistics. The present study revealed that 58 (58%) respondents had good knowledge and 57 (57%) mothers had average practices regarding the importance of oral hygiene for children. No significant relationship was observed between knowledge and practice scores. There was no significant association between the level of knowledge and the level of practice and socio-demographic variables. The study concluded that there is a lack of knowledge and practice regarding the importance of oral hygiene for children amongst the mothers residing in rural areas.
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Vocal fatigue among nurses working in hos pitals of Mangalore p. 44
Anjana Hoode, Lekshana Umesh, Gudambe Nellithaya Spoorthi
DOI:10.4103/IJCN.IJCN_28_20  
Vocal fatigue is outlined as a negative vocal adaptation that happens as a consequence of prolonged voice use. The prolonged voice use can result in vocal fatigue, causing a weak voice. Nurses are skilled persons to care for the sick or infirm and are considered as Grade-III Professional voice users, for whom a severe voice problem would interfere in their job performance. Hence, our study aimed at understanding the self-perceived vocal fatigue among nurses. A pilot study with convenience sampling was administered on 45 working nurses within the age group of 22–50 years. The participants had an average work experience of 3–4 years. In order to understand the vocal fatigue among participants, Vocal Fatigue Index, questionnaire was administered along with few additional questions. The results showed that 41.17% of the participants had moderate vocal fatigue after voice usage. The study revealed that 3.5% of the participants had severe fatigue where they complained of dryness and weak voice after voice usage. It was identified that 33.12% of the participants had no vocal complaints. This study was conducted to give an insight into the less focused problems of voice use in nurses. The overall result shows that voice is not a significant concern of this profession, but it cannot be ignored as well.
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Burden and quality of life among caregivers of patients with parkinson's disease p. 47
Mariamma P Baby, Selva Titus Chacko, Bala Seetharaman, Anil Kumar Patil
DOI:10.4103/IJCN.IJCN_38_20  
Parkinson's disease (PD) is the second most common neurodegenerative disease which affects not only the patients but also the caregivers due to the progressive nature of the disease. A quantitative descriptive research approach was used to assess the burden and quality of life (QOL) among caregivers of patients with PD. A total of 72 caregivers were enrolled using total enumerative sampling technique. Data were collected using Zarit burden interview scale and PD Questionnaire-Carer QOL scale. The findings revealed that majority (52.8%) of the caregivers were female. The mean burden score was 26.63 ± 17.09. Majority (45.84%) of them had less burden. Poor QOL was experienced by 25% of caregivers. Positive correlation was found between burden and QOL (r = 0.608; P < 0.001). Significant association was found between selected sociodemographic variables of caregivers such as education, occupation, locality, total number of children, hours spent in caregiving and comorbidities with their level of burden and QOL. Among the clinical variables of patients, activities of daily living were found to have significant association with burden (P = 0.005; P < 0.01) and QOL (P = 0.002; P < 0.01). Knowledge and understanding of caregivers' burden and QOL can provide insights into how nurses can support and empower caregivers to enhance their QOL and that of their care recipients.
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Post-menopausal symptoms: Reports from urban women p. 53
Manpreet Kaur
DOI:10.4103/IJCN.IJCN_54_20  
Menopause is a universal occurrence. Menopause refers to that time when woman's periods stop and her ovaries lose their reproductive function. Usually, this occurs between the age group of 45 and 55 years. A descriptive study was undertaken on post-menopausal symptoms among women in the selected urban community, Amritsar. This study included 100 post-menopausal women who were recruited by the convenient sampling technique. Tools for the data collection consisted of socio-demographic profile and the Standardised Women Health Questionnaire related to post-menopausal symptoms. The findings revealed that the mean age of post-menopausal women in the study was 64.13 ± 8.92 years, whereas the mean age at menopause was 47.11 ± 3.66 years. Majority (80%) of post-menopausal women had backache, followed by 76% had loss of appetite, 71% reported restlessness, 68% had difficulty in getting to sleep, and 64% felt miserable and sad. The findings of the study reveal that more than half (52%) of post-menopausal women were not able to cope up with symptoms and 43% agreed to have overall good quality of life. A large proportion of post-menopausal women also reported loss of appetite, loss of interest in things, dizzy spells, headache and poor memory. A larger study is required to generalise the findings.
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Effect of aerobic dance movement therapy on anxiety among first year B. SC. (N) students p. 57
Tamil Elakiya, Shankar Shanmugam
DOI:10.4103/IJCN.IJCN_75_20  
Anxiety disorders are becoming one of the most common mental health problems on college campuses worldwide. It is estimated that 1 in 13 people suffer from anxiety. Newly admitted college students are more anxious due to their transition to a new environment and a probable lack of proficiency in technology. Researchers reported that the anxiety levels among nursing students are high with a poor impact on their health and academic status. This study evaluated the effectiveness of aerobic dance movement therapy (ADMT) on anxiety level and to associate post-test level of anxiety with selected demographic variables among B.Sc. (N) first-year students. A Quasi-experimental non-randomised control group design was used. 60 students were selected by purposive sampling technique with 30 students in each group. Zung Self Rating Anxiety Scale was used. After pre-test, intervention was given to students in the study group for 45 min on alternate days for 4 weeks followed by post-test in both groups. In pre-test, the mean anxiety score in the study group and control group were 55.93 and 55.27. After administration of ADMT, the post-test mean anxiety score was 42.17 and 54.43 in the study and control group, respectively. The mean difference in the study group is 13.77 and found to be statistically significant (t = 13.63, P = 0.001). Variables such as age, type of family, area of residence and type of attending college were significantly associated with post-test anxiety level (P ≤ 0.05). ADMT was found to be cost-effective, appropriate and feasible to implement in all settings that would help the students to manage anxiety and improve their academic performance effectively.
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Perception of nursing students on recovery of persons with mental illness p. 64
Sailaxmi Gandhi, Maya Sahu
DOI:10.4103/ijcn.ijcn_104_20  
The concept of recovery assumes various meanings, depending on the context in which it is raised. The present study aimed at exploring the perceptions of the nursing students about recovery of persons with mental illness (PwMI). Based on convenience sampling and their willingness, 460 undergraduate (UG) and postgraduate nursing students from 85 colleges of nursing in India who came for Psychiatric Nursing clinical experience at the study institute, which is a tertiary care psychiatric institute in South India between May 2017 and December 2018, took part in the study. A semi-structured, self-administered questionnaire was distributed to the students. The data were analysed using statistical software (SPSS 22 version) and P < 0.05 was considered as the level of significance. Majority (86.5%) of the students were females and UGs (77.6%). Among them, 4% had a family history of mental illness. More than half (54.1%) of the students had experience of taking care of PwMI. Results revealed that more than three-fourth (76.1%) of the students had used the term 'recovery' in the psychiatric setting. Majority of them agreed that early detection of mental illness helps in recovery (90.4%), and patient's self-confidence can be increased by keeping him/her busy and engaging in meaningful activities (91.1%). However, nearly 70% agreed that isolating patients with mental illness from family/friends/support groups can be a barrier to recovery. The study provides the preliminary findings of the perception of nursing students on recovery from mental illness. The study has implications on improving the perception on the recovery of PwMI and the need for educating the public on mental illness.
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Impact of quality of nursing work life on turn over intention among staff nurses working in selected private hospital of South-Western Rajasthan p. 70
Swati Negi, Hitesh Vaishnav, Ranjit Nagar, Chris Thomas
DOI:10.4103/IJCN.IJCN_27_20  
Quality of work life (QWL) refers to an employee's satisfaction with working life. A high QWL is critical for healthcare organisations to attract and retain qualified, committed and motivated employees. The QWL and nurse turnover are challenging issues for health care organisation because of the consequences and impact on patient care. Low satisfaction of nurses with their quality of working life results in a high intention to leave. The objectives were to assess the level of quality of nursing work life (QNWL), to identify the turn over intention among staff nurses, to find out the association between QNWL, turn over intention and selected work-related characteristics and to determine the correlation between QNWL and turn over intention to leave the job among staff nurses. The research approach used was quantitative and the research design was non-experimental, correlational design. The data were collected from 100 staff nurses selected from private hospitals of South-Western Rajasthan using non-probability purposive sampling technique. The data were collected with the help of Brooks and Anderson's QNWL scale and Anticipated Turnover Scale. The highest percentage (58%) of staff nurses had moderate QNWL, 42% have high QNWL and none of the staff nurse had low QNWL. Majority (60%) of the staff nurses had the intent to leave. There was a significant association between current nursing position and QWNL (P < 0.05). Findings revealed that there was significant association between nursing position, type of unit and intention to leave and there was high significant association between salary, nature of job and intention to leave the job (P < 0.05). There was weak significant positive correlation (r = 0.33) between level of QNWL and level of intention to leave. Work-related characteristics can influence QNWL and intention to leave.
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RESEARCH SERIES NO. 23 Top

Designing the literature review: Historical, narrative, theoretical, integrative, and scoping reviews p. 75
Sheela Durai
DOI:10.4103/ijcn.ijcn_51_21  
The design of a literature review can be considered as the blueprint of the review which can determine the quality of the review. The need for bringing together different pieces of information and research results together in one place gave rise to the concept of literature review. Over the years, different designs of literature review developed based on various factors. These factors which determine the design of review are the goal of the review, the comprehensiveness required and the rigor involved in the review. This article describes five of the reviews, namely historical, narrative, theoretical, integrative and scoping reviews. An attempt is made to summarise the purposes, the steps in the process of reviewing, the limitations as well as methods, if any, to overcome those limitations. It is hoped that an understanding regarding these designs will enable the nursing scholar to choose the design best suited to the aim of the literature review.
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CONTINUING EDUCATION SERIES NO. 40 Top

Nursing management of patients with psychiatric emergencies p. 80
Aruna Gnanapragasam, Dani Paul, Jeeva Sebastian, Manoranjitham Sathiyaseelan
DOI:10.4103/ijcn.ijcn_40_21  
Psychiatric emergencies are situations in which individuals' thoughts and behaviours are acutely altered causing potential or actual risks to the life of the person or others in the environment. Prompt identification and appropriate interventions will reduce the mortality and disability caused due to psychiatric emergencies. This article reviews the major psychiatric emergencies such as suicide, violence, delirium tremens, stupor and drug-related emergencies and highlights the nursing care of patients with these psychiatric emergencies.
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STUDENT SECTIONS Top

Quality of life amongst general public during COVID-19 Lockdown, Tamil Nadu, India p. 93
Rogina J S. Savarimuthu, A Preetha, D Princy Petrishya, L Praveen, K Praveen Kumar, M Iswariya
DOI:10.4103/ijcn.ijcn_95_20  
COVID-19 is a pandemic disease emerged from Wuhan, Hubei Province, China, in December 2019 and has spread across the globe in an ever rapid rate. An e-survey was conducted to assess the quality of life amongst general public during COVID-19 lockdown, Tamil Nadu, India. The objectives were to assess the quality of life amongst general public during lockdown and to associate the quality of life amongst general public during lockdown with their demographic variables. Majority of the respondents reported moderate-to-good quality of life in all four domains of Quality of Life measured by the Health-Related Quality of Life scale. Domain 3 which is concerned with social relationship was significantly associated with physical illness.
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Assessment of knowledge regarding birth spacing method among married women visiting outpatient department in selected hospital at Mangaluru p. 96
SP Agaya, Aishwariya Philip, Aleena Joy, Aleesha Tom, Alisha Babu, Pramila D'Souza
DOI:10.4103/ijcn.ijcn_34_21  
Decisions regarding family planning cannot be forced but need to adopted willingly. Countries with many customs and traditions prefer interval method than sterilisation as a method of family planning. Awareness on benefits and ways of family planning will help to control overpopulation, increase life expectancy and reduce the maternal and neonatal mortality. The aim of the study was to identify the knowledge of married women on birth spacing methods visiting the outpatient department of tertiary hospital at Mangaluru. Non-probability sampling technique was used to select 323 married women. The baseline characteristics showed that 36.6% of subjects were in the age group of 32–38 years, 41.9% were Hindus and 65.6% were educated up to SSLC. About 42.9% of the subjects were multigravida and 37.5% subjects were married for <5 years. The findings also revealed that majority of the subjects (78%) were not using birth spacing method at the time the data collection was done for this study and 59.4% did not have previous information on birth spacing methods. About 22% of the subjects had an average knowledge, whereas 78% had good knowledge about birth spacing method. Although many subjects had good knowledge on birth spacing, majority were not using any birth spacing methods. Spreading awareness on birth spacing as well as encouraging them to choose any one method prevents unplanned and untimely as well as high-risk pregnancies.
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SHORT COMMUNICATION Top

Susceptibility and immunity: Race or racism? p. 101
Shibu Sasidharan, Harpreet Singh Dhillon, Shalendra Singh, M Babitha, Gurpreet Dhillon
DOI:10.4103/ijcn.ijcn_6_21  
As the world navigates through this unprecedented time of the COVID-19 pandemic, everything has been pushed to a staggering halt. What catapulted is the health-care services as increasing number of patients flocked for medical care after being diseased by the virus. Even in the eye of such a peril, there have been major misconceptions and misunderstandings about racial disparities and the illness. Black people immunity is one such. This article tries the unravel the history, understanding and science of black immunity for the benefit of health-care providers to iron out the ethical dilemma and bias that impacts the quality of care.
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EVIDENCE BASED GUIDELINES Top

Prevention of intravascular catheter-related infections p. 104

DOI:10.4103/2230-7354.320831  
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