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   Table of Contents - Current issue
Coverpage
July-December 2022
Volume 23 | Issue 2
Page Nos. 111-205

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EDITORIAL  

End tuberculosis by 2025 in India Highly accessed article p. 111
Vinitha Ravindran
DOI:10.4103/ijcn.ijcn_122_22  
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REVIEW ARTICLES Top

Impact of COVID-19 on the care of pre-term babies: Issues, challenges and strategies for comprehensive care p. 113
K Kavitha, Mallanagouda M Patil, Basheerahamed J Sikandar
DOI:10.4103/ijcn.ijcn_94_21  
The impact of the pandemic on maternal and newborn health-care services is problematic given the target of sustainable developmental goals. The present review was undertaken to assess the status of pre-term care during the COVID-19 pandemic. The literature search was done using various databases. Standard guidelines were followed to extract, synthesise and report the findings. A total of 20 articles that met the selection criteria were included in the review. The recent research threw light on the decrease in antenatal care services and the increase in pre-term birth during the pandemic lockdown period. Pre-term babies are more vulnerable to infections and development-associated morbidities. During the beginning of the pandemic, there were no clear guidelines regarding the dos and don'ts of pre-term care and policies that were evidence-based that resulted in the disruption of routine care within a chaotic environment. Currently, child welfare agencies and governmental and non-governmental health-care organisations are undertaking vigorous research and providing updates on the care of pre-term babies. As updates on newborn care policies based on research emerged, the continuation of breastfeeding, promotion of rooming-in, hygienic practices, digital-based health care, counseling and follow-up care were advocated for promoting pre-term babies' health and reducing morbidity and mortality. Capacity-building of the health workforce in managing pre-term babies during the pandemic period is crucial. More research is warranted to face such kind of situations in the future also. Above all, there is an urgent need for multi-sectorial and multi-disciplinary coordination in rendering essential services to the most vulnerable population i.e. pre-term babies.
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Cornual pregnancy p. 118
Irene Dorathy
DOI:10.4103/ijcn.ijcn_66_21  
Ectopic pregnancy is one of the major causes of maternal morbidity and mortality. Most ectopic pregnancies are diagnosed very late when mothers present with symptoms of rupture, and it can be fatal. Cornual pregnancy is a rare type of ectopic pregnancy where the gestational sac is implanted in the cornua of the uterus. It is more dangerous than other ectopic pregnancies, contributing to significant maternal mortality and morbidity. It is most often misdiagnosed or diagnosed late. Here is a case report of a patient who presented with recurrent cornual pregnancy and was managed appropriately and effectively at a tertiary hospital.
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Pulmonary nocardiosis: A case presentation p. 122
Hilda Mercy Priyadarsini, Thilagavathi , Mary Jancy Joy
DOI:10.4103/ijcn.ijcn_114_21  
Nocardiosis is a rare, Gram-positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia. Nocardia species are not the part of normal human flora. Although the occurrence of Nocardiosis is predominant in immunosuppressed individuals, it has not failed to affect immunocompetent individuals. The organ that is most commonly affected is the lung but if left undiagnosed or untreated the infection can spread to other vital organs such as the brain and spinal cord and result in significant mortality. A thorough knowledge and a quick assessment skill are necessary to care for patients affected with such deadly diseases. The aetiology, risk factors, clinical manifestations, diagnosis and medical and nursing management of patients affected with Nocardiosis are discussed using a case study approach.
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RESEARCH SERIES NO. 26 Top

Latent profile analysis – An emerging advanced statistical approach to subgroup identification p. 127
Asha Mathew, Ardith Z Doorenbos
DOI:10.4103/ijcn.ijcn_24_22  
Latent profile analysis (LPA) is emerging as an advanced statistical clustering approach. It is a type of mixture modeling that uses a person-centred approach to classify individuals from a heterogeneous population into homogenous subgroups. LPA identifies the distinct patterns of responses to a set of observed continuous variables in a sample of individuals, and these response patterns are known as latent profiles. This article presents an overview of LPA with key assumptions, sample size considerations, advantages, and limitations. Using an example of LPA application in research, the article also presents the process of conducting LPA and its implications for nursing research. LPA has valuable potential in nursing and could provide new insights into a particular research concept and offer more nuanced information regarding patterns of responses. Further, researchers could examine the impact of targeted assessment and interventions, identify predictors of subgroup membership and explore differences in outcomes across the profiles.
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CONTINUING EDUCATION SERIES NO. 43 Top

Safe insertion, maintenance and removal of chest tube: what every health-care professional must know p. 134
Neha Tiwari, Mohan Venkatesh Pulle, Arvind Kumar
DOI:10.4103/ijcn.ijcn_55_22  
Chest tube insertion is a vital, often life-saving procedure which may be required for any patient. A comprehensive knowledge about safe insertion, maintenance and removal of the chest tube is vital for every health-care professional. This article describes essential components of chest tube management such as type of chest tubes, drainage systems, how to perform safe insertion, connecting to the drainage system, fixation of chest tube, precautions during initial drainage, monitoring of patient, daily measurement and emptying of bottle, pain relief, chest physiotherapy, patient transport, method of collecting pleural fluid sample and steps of safe removal.
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ORIGINAL ARTICLES Top

Efficacy of modified ventilator-associated pneumonia prevention bundles on ventilator-associated pneumonia incidence rate in the intensive care unit: A pilot study p. 145
A Yuvaraj
DOI:10.4103/ijcn.ijcn_57_21  
Ventilator-associated pneumonia (VAP) is defined as pneumonia that develops in an intubated patient after 48 h of mechanical ventilation. In India, there is a paucity of literature in terms of compliance to VAP prevention bundles and their benefits. The aim of this study was to compare the reduction of VAP incidence rates amongst patients who received existing VAP prevention bundles and modified VAP prevention bundles. This pilot study was conducted in the adult intensive care unit of a tertiary care hospital. There were 60 patients in all, 30 patients in each group. The diagnosis of VAP was based on the clinical presentation and correlation with Clinical Pulmonary Infection Score. The incidence of VAP was 3/435 ventilator days (6.80%) in the patients receiving a modified VAP prevention bundle. In the conventional VAP prevention bundle group, the incidence of VAP was six episodes per 439 ventilator days (13.60%). Our study concluded that the modified VAP prevention bundle is effective in reducing the incidence of VAP amongst intubated patients.
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Prevalence and perceptions of gender-based violence amongst married women in India p. 149
Monica Banik, Ruchika Singh, Smriti Arora
DOI:10.4103/ijcn.ijcn_29_21  
Violence against women is experienced by women of all ages and social classes, all races, religions and nationalities across the world. It is overwhelmingly perpetrated by men. It is the most pervasive violation of human rights in the world today. Its forms are both subtle and blatant and its impact on development is profound and it is so deeply embedded in cultures around the world that it is almost invisible. The aim of this study was to assess the prevalence of gender-based violence (GBV) amongst married women and their perceptions towards GBV. An online survey was conducted with a semi-structured questionnaire using non-probability snowball sampling technique that surveyed 50 married women through social networking platform. The prevalence of GBV amongst married women was found to be 38% (n = 19) where married women were physically, economically, psychologically and sexually abused in their marital life and due to the fear of society and family, maximum of 74% (n = 37) do not report their sufferings to anyone. The perception regarding GBV amongst married women is perceived to be high. A finding of the study gives an insight that the married women are physically, economically, psychologically and sexually abused in their marital life. There is a need to develop awareness programmes on GBV to sensitise people so that violence can be mitigated.
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Effect of warm water footbath on chemotherapy-induced fatigue among patients with cancer in a selected hospital at Mangaluru p. 153
Irene Thakuria, Sonia D'Souza, Victoria D'Almeida
DOI:10.4103/ijcn.ijcn_12_21  
Fatigue is experienced by most patients with cancer during chemotherapy. Warm-water footbath is one of the many non-pharmacological interventions which help in reducing chemotherapy-induced fatigue (CIF). This study aimed to assess the effect of warm water-footbath on CIF among patients with cancer. A time-series non-equivalent control group design was adopted. Thirty participants with CIF were selected from a selected hospital at Mangaluru by purposive sampling technique and were assigned to the intervention group (n = 15) and control group (n = 15) by random allocation using the closed envelope method. The pre-interventional CIF scores were assessed using the Piper Fatigue Scale-12. Warm-water footbath intervention was administered to the intervention group for 20 min two times a day with the interval of 6 h for 3 consecutive days. The post-intervention measure was administered 5 min after the second intervention on each day using the same fatigue scale. The same protocol was followed by the control group but no intervention was given. The one-way repeated measure analysis of variance value (F (5,10) = 215.63, P = 0.001) indicates that there was a highly significant difference between the mean pre-interventional and post-interventional scores in the intervention group at various time points. The unpaired t values (t (28) =15.9, P = 0.001) on day 3 showed that there was a highly significant difference in the post-interventional scores between the intervention and control groups. Warm-water footbath is an effective and simple strategy to reduce CIF among participants with cancer-receiving chemotherapy.
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Empathic communication skills: A methodological study to develop a validated video p. 159
Rashmi Rawat, Suresh K Sharma, Ravi Gupta, Manisha Mohan, Dinesh Kumar Sharma
DOI:10.4103/ijcn.ijcn_99_21  
Healthcare industry has seen technological revolution in the strategies of treatment and care which has resulted in fading away of the value of human touch in delivering quality care. Empathy shown by nurses in their communication is still a foremost component driving the satisfaction with the care received by the patients. The present study is conducted with an aim to develop a validated video as an educational tool to teach empathic communication skills to nurses. A methodological design was used to develop video in three phases: Preproduction, production, and postproduction phase. Seven judges having expertise in the field has validated the video and 11 nurses have evaluated the understanding and comprehensiveness content of the video. Content validity index (CVI) was calculated for the video and mean and standard deviation was calculated for the understanding of the video by the target audience. The final version of the video is of 33 min in duration. All the aspects of the video have shown an agreement among the judges between 85% and 100% which is an acceptable range for an instrument to be valid. Furthermore, CVI of the video was calculated which came out to be 0.89 and evaluation of understanding of the content of the video by the participants has shown a mean score of 9.73 ± 0.467 indicating a good understanding of the video by the target audience. Educational video is found to be a valid tool to teach empathic communication skills for nurses. Video has a potential to be utilized as a teaching strategy as part of in-service nursing education on communication skills for nurse.
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Influence of online education programmes on parents' knowledge regarding human papilloma virus vaccination p. 164
CT Abra Pearl, M Navaneetha, S Malarvilizhi, K Mony, R Chinnadurai
DOI:10.4103/ijcn.ijcn_37_22  
Cancer ranks as a leading cause of death and an important barrier to increasing life expectancy in every country of the world. Human papilloma virus (HPV) infection is identified as a preventable cause of genital cancer. HPV vaccination for adolescents helps in prevention of HPV infection, but vaccine uptake is poor due to lack of knowledge amongst parents. The objective is to evaluate the effectiveness of online education programme regarding HPV vaccination on the knowledge of parents of school-going adolescents. Applying the conceptual framework developed based on King's goal attainment theory, an experimental study was conducted amongst a sample of 360 parents. Samples were selected in three groups and were given online education on HPV vaccination using three different methods, namely lecture, short film and self-learning booklet. Pre- and post-intervention knowledge was assessed with a structured questionnaire. The mean score in pre-test for the three groups was 4.95 (standard deviation [SD] = 4.17), 6.33 (SD = 4.76) and 5.73 (SD = 4.91) which increased to 14.27 (SD = 4.68), 17.45 (SD = 4.14) and 12.04 (SD = 3.47), respectively, in the post-test which was significant at P < 0.001. All the three methods of education were effective in improving the knowledge. The maximum increase was seen in Group 2 educated using the short film. The conceptual model developed based on King's goal attainment theory was an excellent guide in the conduction of the study. All three methods of online education programmes were effective in influencing the parent's knowledge regarding HPV vaccination, and the short film had a better effect compared to the lecture and self-learning booklet.
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Nursing care needs assessment of persons with substance use disorder: A qualitative case study approach p. 172
L Iris Devi, Arunjyoti Baruah
DOI:10.4103/ijcn.ijcn_77_21  
Substance use is a major concern in many parts of the world. It affects people across all strata and classes. This study uses a qualitative case study approach to gain an in-depth understanding of the needs of patients with substance use disorder (SUD) and to synthesise the outcome from each of the cases. Five cases of inpatients admitted with diagnosis of SUD in a tertiary mental healthcare institute were selected through purposive sampling technique, and data were collected through observations, interviews and documents. Participants were the patients and their caregiver. Individual cases were analysed and their needs were identified in categories and finally the identified common needs were organised into broader themes. The themes that emerged were grouped into biological, physical health, social, familial, disease-related and psychological needs. These findings can be put to use to give effective care to patients with SUD and further interventions can be designed with these specific aspects in mind.
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Exploring the concept of good death among the terminally ill patients p. 179
Devakirubai Earnest, Angela Gnanadurai
DOI:10.4103/ijcn.ijcn_46_22  
Transition in disease epidemiology has led to a significant increase in non-communicable diseases worldwide. This had led to an increase in patients with a terminal illness that requires quality EOL care. Providing excellent care for a dying patient is something all patients deserve. Recent studies have suggested that good death is the primary endpoint of end-of-life (EOL) care. The aim of the study was to assess the concept of good death amongst terminally ill patients. A descriptive research design was adopted for the study. The study was conducted in a hospice in Chennai. A total of 120 terminally ill patients were selected purposively. An open-ended question was used to assess the concept of good death. Frequency and percentage for each of the responses were calculated. Three-fourth (75%) of the patients considered 'death without pain' as a good death. Following this, death during sleep (21.66%), death in the presence of a loved one (17.5%) completion of responsibilities (10%), death without suffering (9.16%), sudden death (5%) and death while being independent (4.16%) were termed as a good death. Quality EOL care is synonymous with holistic compassionate EOL care. Study findings conclude that nurses may be utilised in a more formalised and systematic way to deal with the psychosocial existential issues during EOL care and thus enhancing good death in patients.
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Impact of mental health first aid training for primary health care nurses on knowledge, attitude and referral of mentally ill patients p. 184
Sreevani Rentala, Sunanda Govinder Thimmajja, Savitha S Vasudevareddy, P Srinivasan, Mahesh Desai
DOI:10.4103/ijcn.ijcn_62_22  
Increasing prevalence of mental illnesses worldwide, nurses' competence and preparedness in addressing patients' mental health needs urgent particular attention. However, nurses who receive general nursing training may have inadequate knowledge and beliefs about mental health disorders. The aim of this study was to examine the effectiveness of short-term in-service training programme on improving nurses' knowledge and attitude related to prevention and first aid management of mental illnesses. A quantitative, quasiexperimental one group pre- and post-test design was carried out at a tertiary mental healthcare setting, Karnataka, with the sample consists of 50 registered nurses working at primary healthcare centres and Taluk hospitals located in North Karnataka, India. The results indicate a significant increase in the nurses knowledge (t =−15.70, P < 0.001) and favourable attitude (t = −2.63, P = 0.01) regarding the prevention and first aid management of mental illness among community. There was also a significant improvement in the referring of the cases to mental health care settings at 1 month after attending short-term in-service training programme on prevention and first aid management of mental illness.((t = −14.23, P < 0.001). The study concludes that well-designed in-service training programme for a nurses not only improves the knowledge and attitude of the nurses but also improves referrals of the mentally ill patients to higher centres.
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Effectiveness of foot reflexology on blood pressure among patients with hypertension in a Selected Hospital, Mangaluru p. 190
Joseph Ann, D'Almeida Victoria, Rashmi Shwetha, Fernandes Preethi
DOI:10.4103/ijcn.ijcn_1_22  
Hypertension has emerged as a major health problem in developing countries. Reflexology can lower a high blood pressure through effects on relaxation, through blood vessel dilation and through a diuretic effect. The aim of the study was to find the effectiveness of foot reflexology on blood pressure among patients with hypertension. An experimental study design was adopted. Thirty-six in-patients with hypertension were selected from a selected hospital at Mangaluru by purposive sampling technique and were assigned to the intervention and control group by random allocation using closed envelope method (n = 18 + 18). Foot reflexology was administered to the subjects in the intervention group, whereas the control group received the routine care. The blood pressure was checked before and after the intervention or standard care using a digital sphygmomanometer in both the groups. Data collection was continued for three consecutive days. The one-way repeated measures analysis of variance showed that there was a significant difference between mean pre-test and the mean post-test level of systolic (F (5,13) = 77.30, P = 0.001) and diastolic blood pressure (F (5,13) = 40.98, P = 0.001) of the intervention group at various time intervals. The unpaired t-test showed that there was a significant difference in the mean post-test level of systolic (t (34) = 6.55, P = 0.001) and diastolic (t (34) = 8.46, P = 0.001) blood pressure between the intervention and control groups. Foot reflexology as a complementary therapy is effective in reducing hypertension, which also is cost-effective and safe.
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Effectiveness of education intervention on nurse's knowledge regarding the prevention of central line-associated bloodstream infection in the intensive care and haemodialysis units in selected hospitals, Kanpur p. 196
Harshita Sachan, Jasmi Manu, A Monika
DOI:10.4103/ijcn.ijcn_81_22  
According to the Centres for Disease Control and Prevention, central line-associated bloodstream infection (CLABSI) is defined as recovery of the pathogen from blood culture in the patient who had the central line at the time of infection or within 48 h. The objectives of the study were to evaluate the level of knowledge regarding the prevention of CLABSI among staff nurses, to assess the effectiveness of the educative intervention on knowledge regarding the prevention of central line-associated bloodstream infection among staff nurses and to associate the level of knowledge with selected demographic variables of staff nurses. A pre-test–post-test one-group design was adopted by the researcher, and 60 staff nurses working in the intensive care and haemodialysis units in selected hospitals in Kanpur were selected using a purposive sampling technique. A structured knowledge questionnaire was used to collect data. The result of the study showed that the post-test mean score (17) was high compared to the pre-test mean score (11) of knowledge. There is a statistically significant difference between pre-test and post-test knowledge. The Chi-square test revealed that there was no significant association of knowledge with selected demographic variables such as age, gender, educational status or exposure to previous class on CLABSI. The overall findings of the study clearly showed that there is a need for continuous educational intervention to enhance the knowledge level of nursing staff.
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STUDENT SECTION Top

A cross-sectional study to identify the depression among widowed in a rural community p. 201
V Kavya, B Suganya, M Alagarsamy, A Kalaivanan, Ponnambily Chandy
DOI:10.4103/ijcn.ijcn_106_21  
There is a limited understanding of depression among widowed in the literature. Thus, the investigators conducted a study to explore the level of depression among widowed in a rural community. Using the Zung Self-Rating Depression Scale, the investigators identified the level of depression among 80 widowed who had lost their spouse more than 1 year ago and had not married again. It is shown that the majority of the widows 28 (70%) and widowers 22 (55%) are moderately depressed. However, 3 (8%) widows and 4 (10%) widowers are severely depressed. In the present study, 25 (63%) of the widowers and 18 (45%) widows reported feeling downhearted and discouraged by their family members. Similarly, half a portion of the study participants stated that the family would feel better if they were dead 40 (50%) and the majority of the widows had suicidal thoughts 32 (80%). The findings showed that widows are more moderately depressed than widowers. The study concluded with a recommendation that the widowed population needs special attention in mental health programmes.
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EVIDENCE BASED GUIDELINES Top

Evidence Based Guidelines p. 205
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