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Editorial
Nurse Leaders as Facilitators of Change and Innovation (Punitha Ezhilarasu)

Concepts and Issues
Leadership for Professionalism in Transforming Challenges into Opportunities in Nursing: A Personal Reflection (Ratna Prakash)

Clinical Article
Cystic Fibrosis: A Case Presentation (Julie Thomas)
Achondroplasia: A Case report (Priscilla R. Sam)

Research Article
Key Concerns and Challenges of Nursing and Midwifery Teaching and Training in India (Rajni Bagga, Vaishali Jaiswal, Ritika Tiwari)
Awareness Programme on Disaster Preparedness among School Teachers in a South Indian Setting (Eldho B Rajan, Anice George, Maxie Andrade)
Knowledge, Practice, and Health Problems related to Menstruation among Young Women (Mala Thayumanavan)

Research Series No.11
Sampling in Quantitative Research (Punitha Ezhilarasu)

Continuing Education Series No: 26
Neonatal Resuscitation (Ebenezer E. Benjamin, Christy Simpson, Julin Joseph)

Student Section
Behcet’s Disease: An Autoimmune Disease (Angel R. Reuban)

Research in Brief
Self-esteem among Urban Indian Adolescents (Rogina J. S. Savarimuthu)
Effect of an Innovative Training Program in Obstetric Care on Knowledge of Nursing Students: A Pilot Study (Komal P. Allagh, Anitha Thippaiah, Patti Herring, Shamanna B Ramaswamy, Murthy G. V. Ramaswamy)
Facilitated Tucking (Josephine M. Francis, Anantha K. Rajan, Alice Augustine, Jana A. Kumar)
Prevalence of Work-Related Musculoskeletal Pain among Indian Nurses: A Field Survey (Karvannan Harikesavan, Prem Venketesan., Karthikbabu Suruliraj, Syed Nafeez, Saroja Jaykumar)
Functional Dependence and Impairment of Patients with Spinal Trauma and Associated Complications (Japreet Kaur, Sukhpal Kaur, Rajesh Chabra)

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Abstracts

LEADERSHIP FOR PROFESSIONALISM IN TRANSFORMING CHALLENGES INTO OPPORTUNITIES IN NURSING: A PERSONAL REFLECTION
* Ratna Prakash, M. Sc (N)., Ph. D
ABSTRACT
The growth of any profession depends on its ability to meet public expectations. The advent of health consumerism has imposed new demands on nursing. To keep pace, modern nursing education has developed its curriculum to include concepts of holistic health. But there remain many challenges and concerns in nursing practice areas. Some are related to the existing healthcare delivery system and its governance while others are innate, for example our aptitude, attitude, and personal way of life. The situation demands strong and committed nursing leadership to resolve these issues.

Keywords: leadership, professionalism in nursing, nursing education, transformation
* Principal, Pal College of Nursing and Medical Sciences, Uttarakhand

CYSTIC FIBROSIS : A CASE PRESENTATION
* Julie Thomas, MS., RN., FNP-BC
ABSTRACT
Traditionally, cystic fibrosis has long been viewed as a disease mainly affecting Caucasians. In India, the exact incidence of the disease is unknown. Treatment delays are likely if healthcare providers believe cystic fibrosis is nonexistent in the Indian community. Ultimately treatment delays can negatively affect the quality of life for patients and their families. This article provides an overview of the pathophysiology, diagnosis, treatment, and management options for cystic fibrosis, but illustrates this through the life of an Indian family living in United States affected by the disease. Healthcare providers have a tendency to view the inability to cure a disease as a treatment failure. By taking a retrospective look into the life of an Indian family affected by the disease, clinicians can begin to find purpose beyond treating an illness.

Keywords: cystic fibrosis, case presentation, autosomal-recessive disease, genetic disorder
* Family Nurse Practitioner, Concentra Medical Centres, Texas, U.S.A.
REFERENCES

ACHONDROPLASIA : A CASE REPORT
* Priscilla R. Sam, M. Sc (N)
ABSTRACT
Achondroplasia is a congenital condition that is genetically inherited (autosomal dominant) that results in an abnormal stature associated with disproportionate short limbs. The average height of an adult with achondroplasia is 131 cm in males and 124 cm in females. Nursing management of patients with achondroplasia is mainly supportive. Understanding how genetics can affect families of these patients is important for nurses to provide adequate support to the families. This article highlights the nursing care that was provided for a patient with achondroplasia in the form of a case report.

Keywords: achondroplasia, autosomal dominant disorder, short limbs, genetic disorder, nursing care
* Professor, College of Nursing, Christian Medical College, Vellore
REFERENCES

KEY CONCERNS AND CHALLENGES OF NURSING AND MIDWIFERY TEACHING AND TRAINING IN INDIA
* Rajni Bagga, M.A., Ph.D., PGDPHM, ** Vaishali Jaiswal, M.Sc., NET, *** Ritika Tiwari, M.B.A.
ABSTRACT
Pre-service and in-service education and training of nurses in India faces various challenges in the areas of understaffed educational institutions and skills deficits among managers and practitioners. These influence quality of health services. This paper is part of a World Health Organization (WHO) supported study, entitled “Study on nursing and midwifery in India: A critical review”. It aims to review and critically examine the issues and challenges related to nursing and midwifery teaching and training in India, and suggest suitable strategies for development of competent nursing and midwifery human resources. The study was descriptive and highly qualitative in nature with information collected from both primary and secondary sources. These sources included principals, faculty members, students of nursing educational institutions, state nursing council registrars, and nursing experts at state and central levels. Various reports and research documents were also reviewed. In-depth interviews, focus group discussions and observation were used to collect primary data. Review of the syllabuses of Auxiliary Nurse Midwife (ANM), General Nurse Midwife (GNM), and Bachelor of Science (B.Sc.) courses suggested that the actual midwifery clinical exposure and the hands-on training for conducting deliveries is very inadequate. Feedback received from students of nursing teaching institutions confirmed this. The major problem faced by the educational institutions was non-implementation of the syllabuses, due to numerous constraints and barriers, which are broadly management related. The findings revealed that there is a great need among teaching institutions to strengthen hands-on training of students through proper placement in the hospitals and the community. Measures must be taken to set up modern laboratories and demonstration rooms, and to create adequate infrastructure in the schools and colleges. This can be made possible if the teachers are also required to practice clinical skills themselves, so that they have up to date knowledge and practical skills.

Keywords: auxiliary nurse midwife training centres, general nursing and midwifery training centres, teaching and training nursing institutions, nursing and midwifery workforce
* Professor and Head, Dept. of Management Sciences, National Institute of Health and Family Welfare (NIHFW), New Delhi, ** Assistant Research Officer, Dept. of Management Sciences, NIHFW, *** Programme Officer, Public Health Foundation of India, New Delhi
REFERENCES

AWARENESS PROGRAMME ON DISASTER PREPAREDNESS AMONG SCHOOL TEACHERS IN A SOUTH INDIAN SETTING
Eldho B. Rajan, M.Sc (N), ** Anice George, M.Sc (N)., Ph.D, *** Maxie Andrade, M.Sc (N)., M.Phil (N)
ABSTRACT
It is evident that mitigation and investment in disaster preparedness can save thousands of lives and vital economic assets, preserve livelihoods and reduce the overall cost of disaster relief. This study aimed to assess the impact of a programme to sensitize and empower school teachers as trained rescue volunteers by teaching them about disaster preparedness and selected rescue techniques. The study adopted a quasi-experimental, pretest posttest control group design and was conducted in selected schools of Udupi District, Karnataka. A sample of thirty subjects each were selected for the experimental and control group using convenience sampling technique. The experimental group participated in an awareness programme on disaster preparedness including a disaster mock drill as an intervention. Effectiveness of the awareness programme was assessed. Pre and post intervention in both groups using a knowledge questionnaire and rescue skill checklist. Data were analyzed using Wilcoxon Signed rank test and Mann Whitney U test. There was a significant improvement in knowledge (Z= 4.794, p= .001) and skill in selected rescue techniques (One rescuer human crutch: Z = 4.841, p= .001; Pack strap carry: Z = 4.830, p = .001; Fireman’s lift: Z=4.807, p = .001; Two rescuer human crutch: Z=4.832, p= .001; Two handed seat: Z = 4.863, p = .001) among school teachers in the experimental group. There was no association between pre-test knowledge and the demographic variables. Disaster at school may involve a large number of young victims. Equipping school teachers with necessary rescue skills and knowledge can not only save lives and assets but will also serve as a ready manpower for rescue efforts at community level.

Keywords: disaster preparedness, knowledge, rescue technique
* Programme Officer, Jhpiego, Jabalpur, Madhya Pradesh, ** Dean, Manipal College of Nursing, Manipal, *** Assistant Professor, Manipal College of Nursing, Manipal
REFERENCES

KNOWLEDGE, PRACTICE, AND HEALTH PROBLEMS RELATED TO MENSTRUATION AMONG YOUNG WOMEN
* Mala Thayumanavan, M.Sc (N)
ABSTRACT
A cross sectional descriptive study was conducted on knowledge, practice, and health problems of 50 young women regarding menstruation in a selected urban area of Bangalore. A structured self administered questionnaire was used to collect the data (Cronbach’s alpha = .75). Women in the age group of 19 35 years were selected by non probability convenience sampling technique. Pregnant and lactating women were excluded. Among the 50 women, 8% had adequate knowledge, 62% had moderately adequate knowledge and 30% had inadequate knowledge on various aspects of menstruation. Premenstrual syndrome (88%) and dysmenorrhea (90%) were the most prevalent menstrual problems identified. The common symptoms of premenstrual syndrome and dysmenorrhea reported were backache (60%), lower abdominal colicky pain (44%), muscle cramps on thigh and pelvic region (50%), breast tenderness (32%), irritability (42%), and decreased work performance (30%). The other reported symptoms were headache, pelvic congestion, pallor, syncope, nausea, vomiting, anger, and lack of concentration. The practice of young women regarding menstruation included consulting doctor for menstrual problems (44%), taking self -medication for menstrual pain (62%) and taking medicine regularly for menstrual pain (40%). There was a statistically significant association (p

Keywords: menstruation, premenstrual syndrome, dysmenorrhea, knowledge, practice, health problems, young women
* Dean, Manipal College of Nursing, Bangalore
REFERENCES

SAMPLING IN QUANTITATIVE RESEARCH
* Punitha Ezhilarasu, M.Sc. (N)., Ph.D
ABSTRACT
Sampling in quantitative research is highly significant and it is the responsibility of the researcher to select a sound sampling strategy to meet the goals of research. Selection of appropriate sampling strategy is important to make inferences and generalize the same to a larger population. The researcher needs to understand the significance and develop competence in making the best choice of the sampling strategy to make it highly representative of the population. This article explains the important concepts related to sampling and presents the various types of sampling strategies or methods illustrating with examples. The advantages and disadvantages of each method are also enumerated. The sampling bias or errors that can occur during sampling is highlighted. It is hoped that the novice researcher gains a clear understanding of the sampling strategies that can be used in quantitative research.

Keywords: Sampling, probability, non-probability, quantitative research
* Professor, College of Nursing, CMC, Vellore
REFERENCES

NEONATAL RESUSCITATION
* Ebenezer E. Benjamin, M.Sc (N), ** Christy Simpson, M.Sc (N), *** Julin Joseph, B.Sc (N)
ABSTRACT
Caring for a newborn at birth is a challenging task. Good knowledge and skills are essential for newborn care. Neonates make a physiological transition from intra-uterine to extra-uterine life without difficulty which is a natural phenomenon. Some may need support for physiological functions such as ventilation and circulation. This is called neonatal resuscitation. The newborn who needs assistance can be identified during labour by carefully monitoring the fetal heart rate of high risk women in labour. The nurses are in a position to identify the ‘at risk newborn’ at birth to meet the immediate needs during the critical stage. Immediate care is provided with continuous observation of breathing, heart rate, activity and color to determine the need for additional interventions. It is mandatory that each hospital should have newborn resuscitation policy at work and a team of trained personnel each with designated roles and skills. All equipment should be fully functional and available within the resuscitation area. Effective resuscitation is brought about through a sequence of evaluation, decision and action.

Keywords: newborn, resuscitation, immediate care, ventilation, endotracheal intubation
* Professor, College of Nursing, CMC, Vellore, ** Professor (Retired), College of Nursing, CMC, Vellore, *** Tutor, College of Nursing, CMC, Vellore
REFERENCES

BEHCET’S DISEASE: AN AUTOIMMUNE DISEASE
* Angel R. Ruban, B.Sc (N)
ABSTRACT
Behcet’s disease is a rare autoimmune disease. It is more commonly seen in Turkey, Middle Eastern countries and Japan. It is characterized by oral apthous ulcer, genital ulcer and uveitis. It causes systemic vasculitis. The cause is unknown, but it may be triggered by certain infectious agents. Carriers of human leucocyte antigen-B51/B5 have a higher chance of developing this disease. Some theories explain that increased production of cytokines leads to this disease and is fatal if it causes pulmonary artery aneurysms. The treatment includes immunosuppressants, steroids and immunomodulators. Nurses play a pivotal role in identifying the clinical features early to prevent various other complications.

Keywords: Behcet’s disease, Behcet’s syndrome, Silk Road Disease, oral ulcers, uveitis
* M. Sc Nursing Student, College of Nursing, CMC, Vellore
REFERENCES

SELF-ESTEEM AMONG URBAN INDIAN ADOLESCENTS
* Rogina J. S. Savarimuthu, M.Sc (N)
ABSTRACT
Healthy self-esteem or positive self-regard is feeling competent, lovable and approved. The adolescent period is a period of turmoil as the adolescent has to meet the demands of the changing self, the family and the society. A descriptive study was conducted to determine the degree of self-esteem among adolescents utilizing the Rosenberg self-esteem scale. Most of the adolescents had moderate degree of self-esteem. Nurses using this scale can identify adolescents with low self-esteem and intervene to improve their self-esteem. Positive self-esteem protects adolescents against mental distress and enables them to cope adaptively with difficult and stressful in life situations.

Keywords: self-esteem, adolescent, Rosenberg self-esteem scale
* Asst. Professor, Matha College of Nursing, Manamadurai
REFERENCES

EFFECT OF A TRAINING PROGRAM IN OBSTETRIC CARE USING INNOVATIVE TEACHING METHODS ON KNOWLEDGE OF NURSING STUDENTS : A PILOT STUDY
* Komal P. Allagh, MBBS., MPH, **Anitha Thippaiah, MD., MPH, ***Patti Herring, Ph.D., RN, ****Shamanna, B.R., MD., DNB (MCH), DNB (SPM)., M.Sc., *****Murtju, G.V.S., MD., M.Sc.,
ABSTRACT
Maternal mortality still remains a challenge in India. Pregnancy and child birth are normal events in the life of a woman. But, any pregnancy can develop complications at any stage, and so timely provision of obstetric care services by the nurses is extremely important. There is a need for enhancement of the capacity of nursing students to identify complications during pregnancy and labour, and to take timely action. A study was undertaken to assess the effect of a training program using innovative teaching methods to improve the knowledge of final year nursing students regarding obstetric care in Modern Government Maternity Hospital, Hyderabad, Andhra Pradesh. The final year nursing students (34) were included in the study. A pre intervention assessment to assess the knowledge of nursing students about obstetric care was done using a structured questionnaire. A training program with four modules on obstetric care was delivered over a period of one month using modified lectures with power point slides, practical exercises and video assisted teaching in addition to the regular training using traditional teaching methods. The post intervention assessment was done using the same instrument after the intervention (training program). The data were analysed using paired’t’ test. There was a significant increase in the mean knowledge score of nursing students regarding obstetric care following the training program (p

Keywords: innovative teaching methods, training program, obstetric care, knowledge, nursing students
* Research Associate, Indian Institute of Public Health, Hyderabad, ** Associate Professor, Indian Institute of Public Health, Hyderabad, *** Associate Professor, Department of Health Promotion and Education, Loma Linda University, California, ***** Director, Indian Institute of Public Health, Hyderabad
REFERENCES

FACILITATED TUCKING : A PAIN RELIEVING MEASURE IN NEONATES
* Josephin M. Francis, M.Sc (N), ** Anantha K. Rajan, M.Sc (N)., Ph.D, *** Alice Augustine, M.Sc (N), **** Atanu K. Jana, M.D. B.C.H.
ABSTRACT
Facilitated tucking is considered effective in providing pain relief among neonates. The effect of facilitated tucking on the pain response of neonates undergoing heel prick procedures was studied in the nurseries of Christian Medical College and Hospital, Vellore, South India. Sixty neonates from level I and II intensive care units were randomly allocated to control and experimental groups. The pain ECHO scale developed by the investigator was used to observe ECHOS pain indicators (E Expression [facial], C- Crying, H -Heart rate, O- Oxygen saturation, S- State of arousal) before, (10 minutes) during, and after heel prick (10 minutes) with and without tucking. The neonates demonstrated all the ECHOS pain responses after heel prick procedure. They demonstrated lower facial expression (p

Keywords: facilitated tucking, pain response, non-pharmacologic pain relieving measure, heel prick procedure, neonates
* Assistant Nursing Teacher, College of Nursing, Public Authority of Applied Education and Training, Kuwait, ** Professor (Former), College of Nursing, Christian Medical College, Vellore, ***Professor (Former), College of Nursing, Christian Medical College, Vellore, ****Professor (Former), Dept. of Neonatology, Christian Medical College, Vellore
REFERENCES

PREVALENCE OF WORK-RELATED MUSCULOSKELETAL PAIN AMONG INDIAN NURSES: A FIELD SURVEY
* Karvannan Harikesavan, M.P.T, ** Prem Venketesan, P.T., Ph.D, *** Prem Venketesan, P.T., Ph.D, **** Nafeez Syed, M.P.T, ***** Saroja Jaykumar, M.Sc (N)
ABSTRACT
Nurses working in India are at risk for developing work-related musculoskeletal pain (WMSP). The prevalence rates however are not documented in this population. The aim of this survey was to determine the prevalence of WMSP amongst nurses in India. A self-administered questionnaire namely, the Standard Nordic Questionnaire was distributed to 600 Nurses. The questionnaire included demographic data, musculoskeletal pain in the past 12 months, last one week and pain affecting the activities of daily living in the past 12 months. Descriptive statistical tests (mean ± standard deviation), were used to determine the prevalence rates. Chi-square analysis was done to determine the association between years of experience and prevalence of self-reported musculoskeletal disorders. Out of the 391 who were included in the study, 77% respondents had WMSP at 12 month pain at any-body region with lower back pain (56%) being the most common problem, 53% and 33% of nurses had pain in the past one week and pain affecting activities of daily living in the past 12 months respectively. WMSP related pain in the low back was the commonest among nurses in India.

Keywords: prevalence, work-related musculoskeletal pain, nurse, Standard Nordic Questionnaire
* Research Associate, Indian Institute of Public Health, Hyderabad, ** Associate Professor, Indian Institute of Public Health, Hyderabad, *** Associate Professor, Department of Health Promotion and Education, School of Public Health, Loma Linda University, California, **** Associate Professor, School of Medical Sciences, University of Hyderabad, ***** Director, Indian Institute of Public Health, Hyderabad
REFERENCES

FUNCTIONAL DEPENDENCE AND IMPAIRMENT OF PATIENTS WITH SPINAL TRAUMA AND ASSOCIATED COMPLICATIONS
* Jaspreet Kaur, B.Sc (N), ** Sukhpal Kaur, M.Sc (N)., Ph.D., *** Rajesh Chabra, M.Ch.. (Neurosurgery)
ABSTRACT
The Patients with spinal cord injury develop various types of complications. A study was carried out to assess the functional dependence and impairment of patients with spinal trauma and associated complications. Nineteen subjects were selected by convenience sampling. Structured interview technique was used to collect data. The data included demographic profile, injury details such as cause, mechanism, site and complications faced by the patients namely bladder and bowel dysfunction, deep vein thrombosis, chest infection, bedsore, urinary tract infection, contractures and spasticity. Katz Index of Independence in Activities of Daily Living was used to evaluate the level of functional dependence of patients in their activities of daily living. ASIA impairment scale was used to measure the functional impairment. The mean age of the subjects was 32.2+1.03, 63.2% were male and 73.7% were married. The main cause of injury was fall (63.2%) and mechanism of trauma was compression (73.7%). The major complications seen among the patients were pressure ulcers (52.6%) followed by bowel and bladder dysfunction (47.4%) and urinary tract infection (42.1%). Among those who had bladder involvement 88.9% of them developed UTI. Bedsore and urinary tract infection were the common complications. Females were found to be more prone to develop UTI and all the patients who had bowel involvement developed bedsore. With regard to functional independence, 52.7% were independent in carrying out activities of daily living. As per ASIA impairment scale, 21% of patients had complete impairment. There is a need for intense public education regarding spinal cord injury, its prevention, care and complications.

Keywords: spinal trauma, complications, functional dependence, functional impairment, pressure ulcers, bowel and bladder dysfunction, urinary tract infection
* Nursing Sister, Grade II, PGIMER, Chandigarh, ** Lecturer, National Institute of Nursing Education, Chandigarh, *** Additional Professor, PGIMER, Chandigarh
REFERENCES