RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA,
PROFORMA FOR REGISTRATION OF
SUBJECT FOR SYNOPSIS
SUBHADRA BHAGAT
1ST YEAR M.SC NURSING
MEDICAL SURGICAL NURSING
YEAR 2012-2014
ACHARYA COLLEGE OF NURSING
CHOLANAGAR, R.T.NAGAR
BANGALORE-32
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
NAME OF THE CANDIDATE
SUBHADRA BHAGAT
TEENTOLIA, BIRATNAGAR-13
NEPAL
2.
NAME OF THE INSTITUTION
ACHARYA
COLLEGE
OF
NURSING,
BANGALORE
3.
SUBJECT AND COURSE OF STUDY
M.Sc.NURSING 1st YEAR
MEDICAL AND SURGICAL NURSING
4.
DATE OF ADMISSION TO THE
13-06-2012
COURSE
5.
TITLE OF THE TOPIC
A
STUDY
TO
EFFECTIVENESS
EVALUATE
OF
THE
STRUCTURED
TEACHING PROGRAMME ON KNOWLEDGE
REGARDING SELECTED COMPLEMENTARY
THERAPIES
AMONG
CLIENTS
HYPERTENSION RESIDING IN
GERIATRIC
KARNATAKA
2
HOMES
AT
WITH
SELECTED
BANGALORE,
6.
BRIEF RESUME OF THE INTENTED STUDY
6.1 NEED FOR THE STUDY
“A healthy heart is the temple of God, so have a healthy heart and there by live longer”
P.Sathya
Human aging is defined as a process of change that occurs in an individual during
the course of time following maturity. Aging is a complex biological phenomenon which
involves progressive loss of different physiological functions of various tissues of living
organisms. 1
It has been shown that healthy elderly individual’s cardiovascular system
experience important age related changes that may determine how they respond to
exercise and other type of stress. High systolic blood pressure was the most important
modifiable risk factor contributing to the excess Coronary heart disease risk and that
occurs with aging in men and women. 2 Modern life has not only offered us convenience
and comfort but along with them, several complications increasing our indolence, anxiety
and stress.
Blood pressure is the force of blood pushing up against the blood vessel walls. The
higher the pressure the harder the heart has to pump. The normal level for blood pressure
is 120/80, where 120 represents the systolic measurement (peak pressure in the arteries)
and 80 represents the diastolic measurement (minimum pressure in the arteries). Blood
pressure between 120/80 and 139/89 is called pre hypertension (to denote increased risk of
hypertension), and a blood pressure of 140/90 or above is considered hypertension.
Hypertension can lead to damaged organs, as well as several illnesses, such as renal
failure, aneurysm, heart failure, stroke, or heart attack.3
3
Hypertension may be classified as essential or secondary. Essential hypertension is
the term for high blood pressure with unknown cause. Secondary hypertension is the term
for high blood pressure with a known direct cause. Though the exact causes of
hypertension are usually unknown, there are several factors that have been highly
associated with the condition. These include smoking, obesity or being overweight,
diabetes, sedentary lifestyle, lack of physical activity, high levels of salt intake.
Insufficient calcium, potassium, and magnesium consumption, vitamin D deficiency, high
levels of alcohol consumption, stress, aging, medicines such as birth control pills, genetics
and a family history of hypertension, chronic kidney disease, adrenal and thyroid
problems or tumors .3
The management of essential hypertension continues to pose a difficult problem
for the practicing physician, who is faced with patients who do not respond well to
pharmacologic treatment, many of them adhere poorly to the drug regimen. Moreover, the
long-term effects of taking antihypertensive agents are uncertain. These problems have led
to a search for effective non pharmacologic or complementary therapies to reduce blood
pressure, such as acupuncture, chocolate, coenzyme Q10, ubiquinone, melatonin, vitamin
D, meditation, and stress reduction.4
Alternative medicine or complementary therapy is any practice that is put forward
as having the healing effects of medicine, but is not based on evidence gathered with the
scientific method. Complementary therapy is based on tradition, belief in supernatural
energies, pseudoscience, errors in reasoning, propaganda, or fraud and complementary
medicine which, in general, refers to the same interventions when used in conjunction
with mainstream techniques, under the umbrella term complementary and alternative
medicine, or CAM. The US National Centre for Complementary and Alternative Medicine
4
(NCCAM) defines CAM as "a group of diverse medical and healthcare systems, practices,
and products that are not currently part of conventional medicine.”5
A study was conducted to assess the complementary and alternative medicine
approaches to blood pressure reduction to review the evidence supporting complementary
approaches like acupuncture, chocolate, cocoa, coenzyme Q10, ubiquinone, melatonin,
vitamin D and meditation used in the treatment of hypertension. Evidence from systematic
reviews supports the blood pressure lowering effects of. Acupuncture in 3 trials;
Melatonin was effective in 2 small trials. The researcher concluded that several
complementary and alternative medicine therapies can be considered as part of an
evidence-based approach to the treatment of hypertension.6
Worldwide prevalence estimates for hypertension is one billion individuals, and
approximately seven point one million deaths per year may be attributable to hypertension.
According to JNC seventh report, worldwide there were 84,363 deaths reported due to
primary hypertension. It is a non communicable disease and a major health problem in
urban India as in other developing countries.7
According to the National Centre for Health Statistics, more than one in two
adults ages 60 and above has primary hypertension. A population-based study conducted
in Taiwan reported that the prevalence of primary hypertension in elderly was 60.4%. A
similar study in India shows prevalence of systolic hypertension in rural community at
18.5% and diastolic hypertension at 15% among the elderly (above 60 years).8
According to a study published in the Lancet, projections indicate that by 2030
NCDs will account for almost 75% of all deaths in India and the years of life lost due
to coronary heart disease will be greater in that country than in China, the Russian
Federation and the United States of America combined. In India Cardiovascular mortality
5
is likely to rise by 103 % in men and 110 % in women during the period of 1985 -2015
and the cardiovascular disease will be the greatest killer by the year 2020.9
The latest statistics from the health ministry shows that the lifestyle diseases are
rampant in Bangalore and Chennai. In Bangalore, 21% people are suffering from high
blood pressure.8 In 2005, from a total of 23,312 available death records at Bangalore
Mahanagara Palike, 1,690 (7.5%) deaths could be categorized as probably due to stroke.
In a case study carried out in 2006 in Bangalore, out of 1,174 cases 18% of all stroke
patients were below 40 years of age, 48% were hypertensive.9
The investigator felt the need and interest to know the effect of complementary
therapy on hypertension among older adults and decided to select complementary therapy
as a non-invasive, non-pharmacological, therapeutic nursing intervention to control blood
pressure.
6.2 REVIEW OF LITERATURE
Review of literature is a brief summary of previous research and writings of recognized
experts provide evidence that the researcher is familiar with what is already known and with what is
still unknown and rested.
A review of literature involves a systemic identification, location, securitization and
summary of written materials that contains information on a research problem. The
review of
literature is divided into following sections.
6.2.1 Review of literature related to mediation as a complementary therapy.
6.2.2 Review of literature related to coenzyme Q10 and acupuncture as a
complementary therapy.
6.2.4 Review of literature related to structured teaching programme .
6
6.2.1 REVIEW OF LITERATURE RELATED TO MEDIATION AS A
COMPLEMENTARY THERAPY
A study was conducted on transcendental meditation in hypertension among seven
selected hypertensive patients who were stabilized on drugs at a research clinic. Subjects
learned transcendental meditation (T.M.), were seen weekly, and took their own blood
pressure several times daily. After 12 weeks of T.M. six subjects showed psychological
changes and reduced anxiety scores. Six subjects also showed significant reductions in
home and four in clinic blood-pressures. Six months later four subjects continued to derive
psychological benefit and two showed significant blood-pressure reductions attributable to
T.M. at home and clinic.10
A study was conducted on randomized, controlled trials comparing blood pressure
responses to the Transcendental Meditation technique with a control group . A specific
rating system (0–20 points) was used to evaluate studies and random-effects models were
used for meta-analyses. The study resulted that nine randomized, controlled trials met
eligibility criteria. The random-effects meta-analysis model for systolic and diastolic
blood pressure, respectively, indicated that Transcendental Meditation, compared to
control, was associated with the following changes: −4.7 mm Hg (95% confidence interval
(CI), −7.4 to −1.9 mm Hg) and −3.2 mm Hg (95% CI, −5.4 to −1.3 mm Hg). The study
concluded that the regular practice of Transcendental Meditation may have the potential to
reduce systolic and diastolic blood pressure by ~4.7 and 3.2 mm Hg, respectively.11
A study was conducted on Psychological treatment of essential hypertension: A
controlled comparison of meditation and meditation plus biofeedback. Twenty-one
patients with essential hypertension were randomly allocated to eight 1-hour sessions of
meditation training, meditation plus biofeedback-aided relaxation, or a no-treatment
7
control group. Statistically significant falls in systolic and diastolic blood pressure
occurred after both training programs. Meditation plus biofeedback-aided relaxation
produced falls in diastolic blood pressure earlier in the training program than did
meditation alone.12
A study was conducted on Biofeedback-aided relaxation and meditation in the
management of hypertension based on clinical, epidemiological, and experimental work, a
possible pathogenesis of essential hypertension is outlined. Several controlled studies are
described in which experimental patients given such training show clinically significant
and lasting reductions in systolic and diastolic pressure. Following training, experimental
patients also show quicker recovery of blood pressures to baseline levels after exposure to
standardized laboratory stressors.13
A study was conducted on Systolic blood pressure and long-term practice of the
Transcendental Meditation and TM-Sidhi program: effects of TM on systolic blood
pressure. Systolic blood pressure was measured in 112 subjects practicing the
Transcendental Meditation (TM) and TM-Sidhi programs. A significant difference was
found between the systolic blood pressures of subjects practicing the TM and TM-Sidhi
programs and norms for the general population. This difference was independent of diet
and exercise patterns but related to length of time meditating. A significant difference was
also found between short-term (under 5 years) and long-term (over 5 years) participants of
the TM program, co varying for age, the findings suggest the beneficial effects of the
long-term practice of the TM and TM-Sidhi programs on systolic blood pressure.14
6.2.2 REVIEW OF LITERATURE RELATED TO COENZYME Q10
AND ACUPUNCTURE AS A COMPLEMENTARY THERAPY
8
A study was conducted on bioenergetics in clinical medicine. XVI Reduction of
hypertension in patients by therapy with coenzyme Q10 among six untreated hypertensive
patients and ten on therapy, but having elevated blood pressures, were treated with
coenzyme Q10(CoQ10); 14/16 patients showed reductions in systolic pressures; 11/16
showed reductions in diastolic pressure; 9/10 showed reductions of elevated pressures to a
normal range.15
A randomised, double-blind trial study was conducted on effect of hydrosoluble
coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with
coronary artery disease, the effects of the oral treatment with coenzyme Q10 (60 mg twice
daily) were compared for 8 weeks in 30 (coenzyme Q10: group A) and 29 (B vitamin
complex: group B) patients known to have essential hypertension and presenting with
coronary artery disease (CAD). After 8 weeks of follow-up systolic and diastolic blood
pressure was reduced. The finding indicate that treatment with coenzyme Q10 decreases
blood pressure .16
A study was conducted on Stop Hypertension with the Acupuncture Research
Program (SHARP). The pilot trial enrolled 192 participants with untreated blood pressure
(BP) in the range of 140/90 to 179/109 mm Hg. Participants were weaned off
antihypertensive before enrolment and were then randomly assigned to 3 treatments:
individualized traditional Chinese acupuncture, standardized acupuncture at preselected
points, or invasive sham acupuncture. Participants received ≤12 acupuncture treatments
over 6 to 8 weeks. During the first 10 weeks after random assignment, BP was monitored
every 14 days, and antihypertensive were prescribed if BP exceeded 180/110 mm Hg. The
mean BP decrease from baseline to 10 weeks.17
9
A study was conducted on Clinical observation on acupuncture for treatment of
hypertension of phlegm-stasis blocking collateral type in which sixty cases of
hypertension were randomly divided into a treatment group and a control group, 30 cases
in each group. The treatment group were treated with acupuncture at Fengchi (GB 20),
Quchi (LI 11), Neiguan (PC 6), Zusanli (ST 36), Fenglong (ST 40), Taicehong (LR 3),
and oral administration of Captoril, and the control group only with Captoril, for 4
therapeutic courses. The changes of blood pressure after treatment were observed. In the
treatment group, blood pressure significantly decreased. The researcher concluded that
Acupuncture treatment has obvious effect of decreasing blood pressure.22
A study was conducted on Acupuncture Reduces Experimental Reno vascular
Hypertension through Mechanisms Involving Nitric Oxide Synthases in which the authors
used the two-kidney, one-clip renal hypertension (2K1C) hamster model with electro
acupuncture treatment. The study resulted that thirty-minute daily electro acupuncture
treatment for 5 days reduced mean arterial pressure from 160.0 ± 7.6 to 128.0 ± 4.3 mmHg
, compared to 115.0 ± 7.2 mmHg in sham-operated hamsters. Electro acupuncture
prevented the reduction of eNOS and nNOS associated with hypertension and showed
even higher eNOS and nNOS expressions than sham-operated control .The researcher
concluded that activation of eNOS and nNOS is one of the mechanisms through which
ST-36 electro acupuncture reduces blood pressure.18
A study was conducted on The Effect of Acupuncture on Essential Hypertension in
which twenty-eight patients with essential hypertension were treated with acupuncture
therapy. Sixteen showed excellent improvement in terms of the lowering of blood pressure
to normal and the disappearance of original symptoms. Eight and moderate improvement
and 4 showed no response. The results of treatment seem to indicate that improvement is
closely related to the duration of disease and the history of drug treatment.19
10
A study was conducted on Effect of Acupuncture-Point Stimulation on Diastolic
Blood Pressure in Hypertensive Subjects: A Preliminary Study in which electrical
stimulation of four specific acupuncture points was examined in 10 subjects with diastolic
hypertension. Subjects were randomly divided into two groups: (1) an Acu-ES group,
which received electrical stimulation applied to the four antihypertensive acupuncture
points, and (2) a Sham-ES group, which received electrical stimulation applied to non–
acupuncture-point areas. A repeated-measures analysis of variance revealed a significant,
immediate poststimulation reduction of diastolic blood pressure for the Acu-Es group
versus the Sham-ES group.20
6.2.4 REVIEW OF LITERATURE RELATED TO STRUCTURED
TEACHING PROGRAMME
A study was conducted on perceived barriers and effectiveness of planned
teaching programme on life style modification practices of persons with hypertension.
The material and methods used for the study was an evaluative approach with pre
experimental design . 40 hypertensive adults were selected by purposive sampling
technique. Demographic proforma, knowledge checklist and 5 point rating scale were the
instruments used for the study. The study revealed that, 19(47.5%) of the hypertensive
adults had average knowledge, 18 (45%) had poor knowledge and only 3 (7.5%) had
good knowledge. 21 (52.5%) of the hypertensive adults faced severe barriers. A
significant improvement in the knowledge was found after the administration of the
structured teaching programme . The study concluded that education is a key component
in bringing about changes in health care behavior. 23
A study was conducted on effectiveness of two teaching strategies for patients
diagnosed with hypertension. Forty patients were assessed to determine their knowledge
level regarding the management of risk factors related to hypertension. A pre-test was
11
performed shortly after admission to hospital. Twenty patients in the test group received
a structured education programme, and 20 patients in the control group received the usual
ad hoc information. Two post-tests were performed, one at the time of discharge and the
other approximately 8 weeks after discharge, to determine the change in knowledge
levels. Comparison of the pre- and post-tests of the test group revealed a significant
increase in knowledge level at the time of discharge from hospital. Patients were found to
retain this new knowledge at 8 weeks and 1 year after discharge. This study has shown
that a structured approach to health education is more effective in improving patients'
knowledge about their condition than relying on the ad hoc information.24
An exploratory study conducted examined the effect of structured teaching about
essential hypertension on control of the diastolic blood pressure in individuals with a
diagnosis of essential hypertension. Using the pre-test, post-test design, study participants
were measured on knowledge about essential hypertension and diastolic blood pressure
before and after intervention. Six hypotheses were tested, three related to control of blood
pressure, and three related to knowledge about essential hypertension. The study
concluded that there was no significant difference between the experimental and control
groups on diastolic blood pressure readings, there was a significant difference between
the experimental and control groups on post-test scores on knowledge of essential
hypertension. Hence it was concluded that structured teaching had no significant effect
upon control of the diastolic blood pressure. Instruction increased knowledge, but not
blood pressure control.25
A experimental study, prospective, randomised, study was conducted on
effectiveness of
an
educational intervention on hypertension directed
at
elderly
hypertensive patients, among sample of 120 patients, 62 in the intervention group and 58
in the control group. The intervention group received a written and oral educational
12
program on hypertension and cardiovascular risk; the control group did not receive
any intervention. The study resulted that at the end of the intervention there was an
increase in the percentage of correct responses, with statistically significant differences
compared to the control group, as regards knowledge of hypertension. Hence the study
concluded that the implementation of an educational intervention on hypertension and
cardiovascular risk associated with the same care activity is capable of increasing the
level of knowledge by elderly hypertensive patients admitted to hospital.26
STATEMENT OF THE PROBLEM
A study to evaluate the effectiveness of structured teaching programme on
knowledge regarding selected complementary therapies among clients with
hypertension residing in selected geriatric homes at Bangalore, Karnataka.
6.3 OBJECTIVES
 To assess the existing level of knowledge regarding complementary
therapies on meditation, coenzymeQ10 and acupuncture among clients
with hypertension residing in selected geriatric homes at Bangalore.
 To evaluate the effectiveness of structured teaching programme on
complementary therapies on meditation, coenzymeQ10 and acupuncture
among clients with hypertension residing in selected geriatric homes at
Bangalore.
 To determine the association between level of knowledge with selected
socio demographic variables among clients with hypertension residing in
selected geriatric homes.
13
6.4 OPERATIONAL DEFINITION
 Evaluate - In this study it refers to the method of estimating and interpreting the
effectiveness of structured teaching programme on the knowledge of hypertensive
patients regarding complementary therapies on meditation, coenzymeQ10, and
acupuncture.
 Effectiveness - In this study, it refers to the significant gain in knowledge as
determined by the statistical difference between pre-test and post-test knowledge
score on complementary therapies on meditation, coenzyme Q10, and acupuncture.
 Structured teaching program – It is a systematically organized planned teaching
material to educate regarding care of hypertensive patients with complementary
therapies on meditation, coenzyme Q10, and acupuncture. It includes definition of
complementary therapy, its types, to whom it to be given.
 Knowledge - In this study it refers to the level of understanding of information
about complementary therapies on meditation, coenzyme Q10 and acupuncture
among the hypertensive patients which will be measured by structured interview.
 Complementary therapy - Alternative medicine is any practice that is put
forward as having the healing effects of medicine, but is not based on evidence
gathered with the scientific method. In this study complementary therapy refers to
meditation, coenzyme Q10 and acupuncture.
 Clients with hypertension: A male or female individual who has been diagnosed
as hypertensive (BP > 140/90 mmHg) by the physician and are between the age
group of 50-60 years.
 Geriatric home - The geriatric home is a social house equipped and furnished for
elderly to provide them with suitable social life and appropriate health,
psychological, cultural, social, vocational activities and entertaining programs.21
14
6.5 HYPOTHESIS
H1: The mean post-test knowledge level of hypertensive patients will be
significantly higher than the mean pre-test knowledge level regarding
complementary therapies on meditation, coenzyme Q10 , and acupuncture.
H2:
There will be a significant association between pre-test and post test
knowledge level with selected socio-demographic variable of the hypertensive
patients.
6.6 ASSUMPTION OF THE STUDY
•
The
hypertensive
patients
may
not
have
basic
knowledge
regarding
complementary therapies on meditation, coenzyme Q10 and acupuncture.
•
Structured teaching programme may help to enhance the knowledge level of
hypertensive patients regarding complementary therapies on meditation, coenzyme
Q10 and acupuncture.
6.7 DELIMITATIONS
•
The study is limited to the hypertensive patients in geriatric homes.
•
The period of study is limited to 4-6 weeks.
•
This study is de-limited to measurement of knowledge aspect only.
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA
In this study data will be collected from hypertensive patients residing in selected
geriatric homes at Bangalore.
15
7.2 METHODS OF COLLECTION OF DATA
7.2.1 RESEARCH APPROACH
In this study an evaluative research approach will be used.
7.2.2 RESEARCH DESIGN
The research design which is most suited for this study is Pre-experimental
approach and the design is one group pre-test post-test
Group
Pre-test
Intervention
Post-test
Hypertensive
O1
X
O2
patient
Key
O1- Pre-test to assess the knowledge level of the hypertensive patients regarding
complementary therapies on meditation, coenzyme Q10 and acupuncture.
X- Administration of structured teaching programme regarding complementary therapies
on meditation, coenzyme Q10 and acupuncture.
O2- Post – test to assess the knowledge level regarding complementary therapies on
meditation, coenzyme Q10 and acupuncture.
7.2.3 VARIABLES UNDER STUDY
INDEPENDENT VARIABLE
In this study it refers to structured teaching programme regarding complementary
therapies on meditation, coenzyme Q10 and acupuncture.
16
DEPENDENT VARIABLE
In this study it refers to knowledge level of hypertensive patients regarding
complementary therapies on meditation, coenzyme Q10 and acupuncture.
SOCIO DEMOGRAPHIC VARIABLE
Age, Gender, Occupation, Education, Marital status, Income, Type of family.
7.2.4 RESEARCH SETTING
The study will be conducted in selected geriatric homes at Bangalore.
7.2.5 POPULATION
TARGET POPULATION: In this study target population consists of all hypertensive
patients in selected geriatric homes, Bangalore.
ACCESSIBLE POPULATION: In this study accessible population consists of
hypertensive patients in selected geriatric homes who meet the inclusive criteria.
7.2.6 SAMPLE
In this study the sample consists of hypertensive patients residing in selected
geriatric homes at Bangalore.
7.2.7 SAMPLE SIZE
In this study the sample size is 60 patients.
7.2.8 SAMPLING TECHNIQUE
In this study the purposive sampling technique will be used.
7.2.9 SAMPLING CRITERIA
INCLUSION CRITERIA
The study includes patient who
•
are willing to participate in the study
17
•
are hypertensive
•
are available at the time of data collection
•
can understand English or Kannada
EXCLUSION CRITERIA
The study excludes patient who
•
are critically ill
•
are deaf and dumb
•
underwent similar intervention recently
7.2.10 INSTRUMENT OF THE STUDY
In this study the data collection will be done with the help of a structured interview
schedule.
7.2.11 PLAN FOR DATA COLLECTION
Content validity will be ascertained in consultation with the guides and experts in
the field of medicine and nursing. Reliability of the tool will be established by test and retest method.
A prior permission will be obtained from the research committee of Acharya
College of
Nursing; written permission will be obtained from the concerned
authority of selected geriatric homes ; an informal consent will be obtained from the
subjects . The process of study will be explained to the subjects. After explaining the
process of study, demographic data will be collected by with the help of a structured
interview. The knowledge of patients (pre test) regarding complementary therapies on
meditation, coenzyme Q10 and acupuncture will be assessed by structured interview
method. Structured teaching programme will be conducted to the hypertensive patients
regarding complementary therapies on meditation, coenzyme Q10 and acupuncture on the
same day of pre test.
18
After 7 days post test will be conducted to evaluate the effectiveness of structured
teaching programme regarding complementary therapies on meditation, coenzyme Q10
and acupuncture.
7.2.12 PLAN FOR DATA ANALYSIS
The data obtained will be analyzed in terms of objectives of the study using
descriptive and inferential statistics.
DESCRIPTIVE STATISTICS:

Frequency and percentage distribution will be used to interpret demographic
variables of hypertensive patients in selected geriatric home , Bangalore.

Mean; mean percentage and standard deviation will be used for the overall
knowledge scores.
INFERENTIAL STATISTICS:

Chi square (χ2) test will be used to find out the association between pre test
knowledge scores with selected socio demographic variables.

Paired ‘T’ test will be used to compare between the mean pre test and post test
knowledge and attitude scores.
The result will be presented in the form of tables, graphs and diagrams.
7.3.
DOES
THE
STUDY
REQUIRE
ANY
INVESTIGATIONS
OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN
OR ANIMALS?
Yes, the structured
teaching
programme
will
be
hypertensive patients residing in selected geriatric homes , Bangalore.
19
conducted
among
7.4. HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM CONCERNED
AUTHORITIES?
Yes.
1. The ethical clearance will be obtained from the research committee of
Acharya College of Nursing.
2. Written permission will be obtained from the concerned authority of selected
geriatric homes to conduct the study at Bangalore.
3. The purpose of the study will be explained to the samples and written
consent will be received from them for their participation in the study.
4. Confidentiality and anonymity of the participants will be maintained.
20
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Changes.
International
Journal
of
Experimental,
Clinical,
Behavioural,
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5)
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URL-
http://www.indushealthplus.com/karnataka-
health-statistics/
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from
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and
Pharmacology
[1981,
31(1):129-140]
,Available
from
:
URL-
http://europepmc.org/abstract/MED/7255868
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22
http://europepmc.org/abstract/MED/10204818/reload=0;jsessionid=xXjjNgiTqcax
yfsdeoKR.10
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URL-http://hyper.ahajournals.org/content/48/5/838.short
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Acupuncture Reduces Experimental Renovascular Hypertension Through
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9.
SIGNATURE OF THE CANDIDATE
10.
REMARKS OF THE GUIDE
11.
NAME AND DESIGNATION OF THE MRS. PONNARASI
GUIDE (IN BLOCK LETTERS)
11.1.
SIGNATURE
11.2.
CO-GUIDE (IF ANY)
11.3.
SIGNATURE
11.4.
HEAD OF THE DEPARTMENT
11.5.
SIGNATURE
12.
REMARKS OF THE CHAIRMAN
HOD OF MEDICAL-SURGICAL NURSING
MR. PREM KUMAR
MRS. PONNARASI
AND PRINCIPAL
12.1.
SIGNATURE
25
26