RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the candidate and address : Madhura M.G

I Year M.Sc. Nursing

Mallige Institute of Nursing

Sector-II, HMT Post, Bangalore-13

2. Name of the Institution : Mallige Institute of Nursing

Sector-II, HMT Post, Bangalore-13

3. Course of Study and Subject : I Year M.Sc. Nursing

Community Health Nursing

4. Date of Admission to Course : 19.11.2011

5. Title of the Topic : “A study to evaluate the effectiveness of Video

assisted teaching programme regarding H1N1

Infection among school teachers at selected

schools under Hessaraghatta PHC, Bangalore”

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6. BRIEF RESUME OF THE INTENDED WORK :

“INFECTIOUS DISEASE WILL LAST AS LONG AS HUMANITY ITSELF”

William H. McNeill in Plagues and Peoples, 1976

6.1 NEED FOR THE STUDY:

The word Influenza comes from the Italian language meaning “INFLUENCE‘’ which refers

to the cause of the disease, change in medical led to its modification to Influenza meaning “Influence

of the cold”. Scientist by name J.Hugger in 1703 was the first person to use the word influenza in

English ,Influenza is truly an international disease.1 It occurs in all countries and affects millions of

people every year .Influenza commonly referred to as the flu, is an infectious disease caused by RNA

viruses of the family Orthomyxoviridae (the influenza viruses), that affects birds and mammals.2

Although it is often confused with other influenza-like illnesses, especially the common cold,

influenza is a more severe disease than the common cold and is caused by a different type of virus 3.

Influenza may produce nausea and vomiting, particularly in children, but these symptoms are more

common in the unrelated gastroenteritis, which is sometimes, inaccurately, referred to as "stomach

flu4. Flu can occasionally cause either direct viral pneumonia or secondary bacterial pneumonia.

Influenza viruses can be inactivated by sunlight, disinfectants and detergents. As the virus can be

inactivated by soap, frequent hand washing reduces the risk of infection.

The spectrum of infectious disease is changing rapidly in conjunction with dramatic societal

and environmental changes5. World- wide, explosive population growth with expanding poverty and

urban migration is occurring; international travel and commerce are increasing; and technology is

rapidly changing - all of which affect the risk of exposure to infectious agents and the seasonal

incidence is striking, H1NI is an infection usually occurring in winter months in the Northern

Hemisphere and in the winter or rainy season in the southern Hemisphere, now the epidemics have

often occurred in summer6.

In the spring of 2009, a new flu virus spread quickly across the United States and the world. The

first U.S. case of H1N1 (swine flu) was diagnosed on April 15, 2009. By April 21, the Centres for

Disease Control and Prevention (CDC) were working to develop a vaccine for this new virus. On

April 26, the U.S. government declared H1N1 a public health emergency7.

By June, 18,000 cases of H1N1 had been reported in the United States. A total of 74

countries were affected by the pandemic. H1N1 vaccine supply was limited in the beginning. People

at the highest risk of complications got the vaccine first8.

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By November 2009, 48 states had reported cases of H1N1, mostly in young people. That same

month, over 61 million vaccine doses were ready. Reports of flu activity began to decline in parts of

the country, which gave the medical community a chance to vaccinate more people. 80 million

people were vaccinated against H1N1, which minimized the impact of the illness9.

The CDC estimates that 43 million to 89 million people had H1N1 between April 2009 and April

2010. They estimate between 8,870 and 18,300 H1N1 related deaths10.

Around 123,397 people have been tested in India as on February 1, 2010. In India, 23.3%

people who have tested for Swine flu are found suffering from Swine flu.4% people who have tested

positive for Swine flu have died and could not be saved in India[13]. Maharashtra with 317 deaths has

seen maximum deaths from Swine flu in India. Gujarat has 242 deaths from Swine flu till February1,

2010. Other states are Rajasthan (176 deaths), Karnataka (141 deaths), Delhi (93 deaths) and has the

highest number of patients who are tested positive. Maharashtra has 5,116 cases affected, Rajasthan

has 2,101 patients who were tested positive till February 1, 201011.

  As on April 28, Karnataka has recorded the second highest number of H1N1 influenza

positive cases since January 2012. However, the State Health Department officials and experts say

there is no need to panic. Between January and April 2012, Maharashtra has recorded the highest

number of cases at 463, followed by Karnataka which has recorded 173 positive cases of H1N1

influenza. Meanwhile, in terms of death toll too Maharashtra has recorded the highest number of

deaths with 20, followed by Andhra Pradesh and Rajasthan at 12 each, and Karnataka standing third

with 9 deaths 12

The number of cases in Bangalore has been steadily rising with 22 cases. The total number of

positive cases crosses 3000 and now stands at 309513.

A new strain of swine flu, (H3N2) v, was detected in 2011 currently it has not affected any

large numbers of people in the 2011-2012 flu season. Researchers have begun development of a

specific vaccine for (H3N2) v as a precautionary measure in case this strain predominates in either

the end of the 2011-2012 flu season or increases in the 2012-2013 flu season14.

So in current years, there has been a huge increase in the amount of resistance to certain

drugs, including the antiviral compound adamantine. In fact, its resistance has recently climbed from

2% to nearly 90%, this indicates antiviral drugs will not be useful against influenza virus15.

NIAID researchers found that “ H1N1 influenza was transmitted to humans several months

before recognition of outbreak” A team of Hong Kong University conducted an evaluator analysis on

the currently circulating 2009 novel H1N1 influenza virus to determine its origin and early

developments. Researchers found that the virus was derived from several viruses circulating in

swine, and that the initial transmission to humans occurred several months before recognition of the 3

outbreak16.

Awareness drive for PU Students Director of Pre University Education Shankar Narayan

asked principals of all PU Colleges in the state to take steps to create awareness among the students

and parents about Swine Flu. They also organized a meeting of students and informed them about the

symptoms of the disease and take them to nearest hospital for investigations incase they suffer and

found positive for disease the heads should arrange for suitable treatment17.

The investigator had come across many patients infected with swine flu in clinical field

practices. Since the investigator had found less study have been done by nursing professionals on

swine flu, the topic was selected for the benefit of common man for the welfare of the society.

Over the last few years H1N1 has spread widely through the United States and the world which has

prompted school closures and cancellation of school-related events.

As the flu spreads, the Department of Education (ED) encourages school leaders, parents and

students to know how to take action to reduce the spread of the virus and report illness and helps the

teachers to play an important role in helping school-aged children understand how immunization can

help them stay healthy.

The investigator is interested to take up this study on swine flu to enhance the knowledge

regarding swine flu among the high school teachers. Teachers, like nurse in hospitals have along

contact with the students, siblings of the students, parents and the family members of the students.

They have opportunity to educate common people on swine flu. As teachers act as a tool in health

propaganda, in fact they are an asset to the government in providing mass education. Since, droplet

infections are most common in high school children, as it spreads from one person to another leading

to absenteeism in them. So the investigator wants to conduct this study in order to impart knowledge

to school children and to promote their health.

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6.2 REVIEW OF LITERATURE

Review of literature is the process of reading, analyzing, evaluating, and summarizing

scholarly materials about a specific topic. The results of a literature review may be compiled in

a  report or they may serve as part of a research article, thesis, or grant proposal18.This literature

review explores the three dominant themes of the research questions: symbolic representation of

concepts, impact on academic achievement, and student attitudes, behaviors, and interactions19.

In a cross-sectional study conducted in South Korea during the current influenza A(H1N1)

pandemic to determine the knowledge, attitude and preventive measures among 2,333 school

children and their 2,089 parents. It was found that in terms of knowledge, 97.9% of participants

reported they knew of Novel Influenza A, and 80.2% reported mass media such TV and radio to be

their primary source of knowledge. For attitude, 39.4% reported considering Novel Influenza A to be

a very serious social problem, and 9.6% of participants showed seriously concern about the

possibility of infection. As for preventive behavior, since the public announcement of the Novel

Influenza A pandemic, 82.5% of the participants had increased their frequency of hand washing.

90.4% reported that the pandemic has changed their life patterns these findings indicate that children

are well aware of H1N120. A cross-sectional study was conducted in Bareilly UP among students of classes 9th to 12th,

among 400 students a total of 200 students were selected to find out the awareness, perception and

myth towards Swine flu. Chi square test was applied and found that 97.75% have heard and aware of

swine flu, 97% students mention use of mask as most effective way to prevent, knowledge of

available of medicine was present in less than half. 79% received knowledge from TV, 53.2% are

trying to get knowledge of Swine flu and 74% were taking precautions against Swine flu21.

A study conducted on hospital hygiene influenza says that influenza is a severe febrile disease

if airways that occur epidemically in winter months and caused a high number of infection and

deaths worldwide in 30 years. In order to prevent this situation called pandemic plan have been

developed worldwide. Beside vaccination, general hygienic precaution and antiviral therapies are the

most important measures in the management of influenza22.

A study conducted on the initial psychological response to H1N1 (“Swine Flue”): The

outbreak of the pandemic flu in 2009 provided a major challenge to health services around the world.

Previous pandemics have led to stockpiling of goods, the victimization of particular population group

and cancellation of travel and boycott of foods (ex: pork). Researches examined behavior and

attitudinal response towards influenza A H1N123.

A study conducted on Swine Flu (H1N1)-A Global Epidemic. Swine is a Swedish term means

pig. Swine Flu was first spotted in the year 1173 in pig, horses and also in birds like Swans and hens.

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Antivirals like Oseltamivir or Zenamivir are used for treatment and prevention of virus. Avoid

touching your eyes, mouth and nose, clean hands thoroughly and regularly. Avoid contact with

people who are ill. Reduce spending time in crowded areas. Practice good healthy habits and

nutritious diet11.

A study conducted by national pandemic influenza preparedness planning .The recent

outbreaks of influenza A H5N1and swine influenza AH1N1 caused a global concern over potential

for a new influenza pandemic24.

A study conducted on college football teams using preventive defense on virus in New York-

helmet shoulder pads and hand sanitizers with outbreaks reported at university of Mississippi and

Wisconsin players are under orders to wash their hands and cover their mouths when they cough or

sneeze, lest these teams joined those who have been hit hard by the bug as couple of their room

mates got sick on campus they prepared themselves by bringing big bottle of disinfectant for

cleaning at home25.

A study was conducted on a simple method for molecular detection of swine origin and

human origin Influenza A virus. A real time one step reverse transcriptase polymerase chain reaction

SYBR green assay derived from the method reported by Van Elden and collaborators 2001 ensures

the rapid sensitive and cost effective detection of both seasonal influenza virus and emerging H1N1

swine origin A virus S-OIV25.

An experimental study was conducted on “Increased risk of infection with zoonotic

influenza virus among swine workers in the United States”. The sample consisted of 263 swine

workers and 69 controlled group in which 111 were formers, 97 were meat processing workers and

65 veterinarians, the study analyzed that the serum sample were tested using a heamagglutination

inhibition assay against the influenza A the findings revealed that all 3 exposed study groups

demonstrated markedly elevated titers against wine influenza then control group and study also

revealed that the formers had the highest changes for exposure to swine flue than mean processors

and veterinarians. The study concluded that occupational exposure to pigs greatly increases workers

risk of swine influenza virus infection10.

An comparative study was conducted on “sever respiratory disease concurrent with the

circulation of H1N1 influenza at National Institute of Health, Bethesda, MD. USA”. The sample

consisted 2155 cases of severe pneumonia and 6662 cases of throat infection cases. The total

samples were 8817 patients, the nasopharyngeal specimens were checked 2582 cases were positive

for H1N1, they compared these cases according to age distribution about 71% of cases of severe

pneumonia involved patients between the age of 5 and 59 years. The study findings revealed that

during the early phase of this influenza pandemic, there was sudden increase in the rate of severe

pneumonia. If the vaccine supplies are limited, these findings suggest a rationale for focusing

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prevention efforts on younger population16.

An experimental study was conducted on “chest radiographic and CT findings in novel Swine

origin influenza A (H1N1) virus infection in U.S.A.”. The sample consisted 66 patients who

underwent chest radiographs. Study divides these samples into two groups, group 1 of 14 patients

and group 2 consisted 52 patients, group 1 required ICU admission and advanced mechanical

ventilation and group 2 did not, findings reveals that the group 1 had abnormal initial radiographs

than group 2. Study concluded that the chest radiographs were normal in more than half of patients

with H1N1 and progress to bilateral extensive lung diseases13.

A Cross sectional study was conducted on “Initial psychological responses to Influenza A,

H1N1, at Brunel University, U.K”. The sample consisted 328 respondents the data collected by

Internet and paper based questionnaire studying Malaysia or Europe. The study analyzed that the

measures assessed changes in transport usage, purchase of preparatory goods for a pandemic,

indicators of anxiety estimated rates for seasonal flu, and effectiveness of seasonal flue vaccination.

The findings revealed that Initial responses to Influenza A show large regional differences in anxiety

and more likely to reduce travel and to by the masks and food. The study concluded that the

discussion with family and friends may reinforce existing anxiety leve13

An experimental study was conducted on “Development of a new disinfectant with very

strong anti influenza viral activity”. The study consisted ovo as samples. The study analyzed that

the acute toxicity of this disinfectant to two different cultured cell lines were investigated. The

findings revealed that the new disinfectant shown very strong anti influenza viral activity the ovo

test. The study had concluded that this new disinfectant is expected to be useful for preventing viral

infection during a new influenza pandemic14

A cross- sectional survey study conducted on Sydney residents to ascertain the beliefs, perceived

risks and initial attitudes of the Australian community towards the influenza at university of new

south Wales, Sydney. the sample consisted 620 respondents. the findings reveals that about 447 were

aware of pandemic H1N1,but 273 felt they did not have enough information about the situation. The

study suggested to emphasize the efficacy of recommended actions such as hand hygiene27.

The investigators at the university of Wisconsin-Madison found that infection with human H1N1

viruses that are antigenic ally related to viruses were circulating in 1918 confers neutralizing

antibody activity against the currently circulating 2009 novel H1N1. These findings suggests that

people alive during the 1918 influenza pandemic have the most protection against the current 2009

H1N1 influenza because of their prior exposure. Finally the team confirms the antiviral drugs like

Tami flu and Relenza are effective against the new H1N1 pandemic virus27.

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6.3 STATEMENT OF THE PROBLEM

A Study to evaluate the effectiveness of Video Assisted Teaching Programme regarding

H1N1 infection among school teachers at selected schools under Hessaraghatta PHC, Bangalore.

6.4 OBJECTIVES OF THE STUDY

1. Assess the existing knowledge of school teachers regarding H1N1 infections

2. Evaluate the effectiveness of video assisted teaching program regarding H1N1 infections

3. Find out the association between knowledge of School teachers regarding H1N1 infections

with selected socio- demographic variables.

6.4.1 HYPOTHESES

H1 There will be significant difference in pre-test and post- test knowledge scores of school

teachers exposed to video assisted teaching programme on H1N1 infections.

H2 There will be significant association between pre test know scores of school teachers

regarding H1N1 with selected socio demo variables.

6.4.2 RESEARCH VARIABLES

Independent variable: In this study the Independent variable refers to video assisted teaching

programme on H1N1 infection.

Dependent variable: In this study the dependent variable is knowledge among school teachers

regarding H1N1 infection.

6.5 OPERATIONAL DEFINITIONS

Evaluate : Refers to the positive changes that the video teaching programme will produce in the

knowledge level of school teachers regarding H1N1 and its ill effects on effects on health.

Effectiveness: Refers to determining the extent to which the video assisted teaching programme

has achieved the desired effect in improving the knowledge of school teachers on swine flu

prevention by comparing pre-test and post test scores.

Video Assisted Teaching programme : Refers to the systematically developed instructional

method and teaching aids designed for school teachers to provide information regarding swine

flu by using relevant teaching techniques and appropriate audio visual aids.

Knowledge : It refers to the information of the school teachers possess regarding H1N1 as

evidenced by the correct responses on the items in the questionnaire.

H1N1: H1N1 is otherwise called as Swine flu also known as flu pork is an infectious disease

caused by any virus belonging to the Orthomyxoviridae which is endemic in population of 8

pigs. These strains of virus are known as swine influenza virus.

School teachers: In this study it refers to teachers working at selected schools teaching 1st to 10th

standard under Hesarghatta Bangalore.

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA

The sources of data in this study are school teachers of selected schools under Hessarghatta

PHC, Bangalore.

7.2 METHODS OF DATA COLLECTIONS

7.2.1 SAMPLING CRITERIA

1. INCLUSION CRITERIA

Teacher’s of primary and high school in selected schools at Bangalore.

Teachers willing to participate in the study.

Both male and female teachers.

Teachers who can read and write English or Kannada.

2. EXCLUSION CRITERIA

Teachers not willing to participate in the study.

Teachers not available during data collection.

7.2.2Research design and Evaluative approach

One Group Pre-test - post-test ,Quasi Experimental design.

7.2.3 SETTING OF THE STUDY:

Study will be conducted in selected schools under Hessarghatta PHC, Bangalore.

7.2.4 SAMPLING TECHNIQUE

A convenience Sampling Technique will be used to select 70 school teachers of selected schools

at Bangalore.

7.2.5 SAMPLE SIZE

70 school teachers of selected schools Bangalore.

7.2.6 TOOLS FOR DATA COLLECTION

Structured self administered questionnaire on H1N1.

The tool consists of two parts.

Part A: Socio demographic variables.

Part B: Questionnaire on H1N1

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7.2.7 Collection of data The data will be collected by investigator himself/herself by using structured self administered

questionnaire among school teachers. Later, the teachers are educated with the help of Video

Assisted Teaching on H1N1 infection. After seven days, post test will be conducted by using same

structured questionnaire to evaluate the effectiveness of Video Assisted Teaching Programme. The

data collection period will be four weeks.

7.2.8 Method of data analysis and presentationData analysis will be done through descriptive and inferential statistics.

Descriptive statistics: The investigator will use descriptive statistical technique like mean,

median, mode, percentile and standard deviation for data analysis. The analysed data will be

presented in the form of tables, diagrams and graphs based on finding.

Inferential statistics: Test of significance such as t-test and chi square test will be used

depending on results obtained.

.

7.3 Does the study require any investigations or interventions to be conducted on patients or

other humans or animals? If so, please describe briefly.

Yes, as the investigator is giving video assisted teaching programme on swine flu for teachers of

selected schools of Bangalore.

7.4 Has ethical clearance been obtained from your Institution?

Yes, the ethical clearance has been obtained from our college that is Mallige Institute Of

Nursing, Bangalore .Consent will be obtained from particular colleges as well as subjects.

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8.1 LIST OF REFERENCES:

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www.nap.edu/openbook.php?record-id=11756

2. K.Park, Textbook of Preventive and Social Medicine, 21st edition, MS Banarasidas Bhanot.

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3. Rao S.Papineni and Frank S. Rosenthal. The size distribution of droplets in the exhaled

breadth of healthy human subjects. Journal of Aerosol Medicine volume 10 No.2,1997.

4. Nicki L.Potts, Barbara L Mandleco. Pediatric Nursing Caring for Children and their

Families 2nd edition, 2007.

5. Infection control guidelines for early learning and childcare. Available at

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6. S.C Chen, C-F Chang, C-M Liao. Predictive models of control strategies involved in

containing indoor airborne infections. Indoor Air 2006 volume 16; pg no. 469.

7. Trisha Torrey, 2011-Overview and updates on seasonal and H1N1 swine flu. Updated on

February 22, 2011.

8. Amanda Cohn, Michael L Jackson, Infectious disease related to travel. Available at

wwwnc.cdc.gov/travel/yellowbook/2008/ch4/menin.htm.

9. Girish L Dandagi, Sujata M Byahatti. An insight into the Swine influenza A (H1N1) virus

infections in humans. Short Reviews 2011;volume 28(1) : 34-38.

10. Polit F.Dennis, Hungler BP. Nursing Research Principles and method.5th edition.

Philadelphia:J.P.Lippincott Company 2006:49.

11. Committee of secretaries reviews state of preparedness. Available at

www.Pib.nic.in/newsite/erelease.aspx.

12. News & Resources about Influenza, Infectious diseases and public health. Available at

crofsblogs.typepad.com/.../2012/.../india-920-cases-of-h1n1-flu-repo..

13. Fernandez Rodriguezs, Mendez NavasI, Esteban-Vasallo MD, Rodero Garduno MI, Lopaz

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pandemic influenza (H1N1) 2009 from school outbreaks in the Madrid region, Spain May-

June 2009, Revista Espanola de salud publica 2010 sep-oct; volume 84(5) : 609-621.

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9. Signature of the candidate :

10. Remarks of the guide : The research topic selected is appropriate as it helps

to enrich the knowledge of school teachers

regarding H1N1 infections and its prevention

11. Name and Designation of

11.1. Guide : Mrs. Suseela R

Assoc. Professor, Community Health Nursing

Mallige Institute of Nursing

Sector II, HMT Post, Bangalore -13.

11.2 Signature :

11.3 Co-guide : Mrs. Mariam Jaisy G

Assoc.Professor,

Mallige Institute of Nursing

Sector II, HMT Post, Bangalore -13.

11.4 Signature :

11.5 Head of the Department : Mrs. R.Suseela

Assoc. Professor, Community Health Nursing

Mallige Institute of Nursing

Sector II, HMT Post, Bangalore -13.

11.6 Signature :

12. Remarks of the Chairman/Principal : This study is appropriate as it enriches the knowledge

of school teachers regarding H1N1 infection. Since

children are prone for infections as a teacher she can

take remedial measures and educate the children.

12.1 Signature :

14