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Editorial
Multiple Ways of Knowing in Nursing (Vinitha Ravindran)

Concepts and Issues
Capacity Building in Nurse Educators (Meena Putturaj)
Speak Out and Unlock the Issue: Nurse as a Whistleblower (Rogina J. S. Savarimuthu)

Clinical Article
Caring for a Child with Bernard-Soulier Syndrome (Ida S. Priyadarshini)
Caring for a Family as They Journey Through the Loss of Their Child: A Spiritual Assessment Perspective (Vinitha Ravindran)

Research Article
Self Esteem, Stress, and Depression in Nursing Students (Rajesh K. Kataria)
Knowledge and Attitude of Nursing Personnel Regarding Patient Safety (Samarpita Pramanik, T. S. Ravikumar, Florence Segaran, Edwin Stephen)
Effectiveness of Virtual Reality Therapy on Cognition Among Old Age People (D. Chitra, K. Vijayalakshmi, Latha Venkatesan)

Continuing Education Series No: 30
Early Management of Severe Trauma (Jeyalindha Christopher, T. S. Ravikumar)

Student Section
Peripheral Arterial Occlusive Disease: A Case Report (Nancy Jenifa N, Anu B. B. Rao, Nirmala M. Emmanuel)

Research in Brief
Prevalence and Risk Factors of Postpartum Depression (Pooja S. Baby, Diana David, Ruby Jose)
Knowledge and Attitude of Staff Nurses Regarding Handling Sharps: A Descriptive Study 75 (Sheeba Rani P, Anbu S. Kumar, Henry Kirubakaran, Paul Hema, Ruby Jacob, Thenmozhi N.)

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Abstracts

CAPACITY BUILDING IN NURSING EDUCATORS
* Meena Putturaj, M. Sc (N), ** Research Officer, Institute of Public Health, Bangalore
ABSTRACT
Health manpower resources pose new challenges in today’s health care scenario. Nurses constitute a major proportion of the human resources in the health care industry. Despite the increase in the number of professional nurses, the competency of the nurses graduating from the nursing educational institutions is questionable and is highly variable. In this context, nurse educators are girded with the responsibility of equipping themselves to contribute towards efficient nursing workforce who is capable to adapt to today’s health care dynamics. The main objective of this concept paper is to analyse the need and strategies for capacity building of nurse educators in India.

Keywords: capacity building, nurse educators, nursing workforce
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SPEAK OUT AND UNLOCK THE ISSUE: NURSE AS A WHISTLEBLOWER
* Rogina J. S. Savarimuthu, M. Sc (N)., M. Sc (Psychology).,M. S (Counseling and Psychotherapy)
*Former Associate Professor, Christian College of Nursing, Ambilikkai
ABSTRACT
Whistleblowing is a deliberate act that involves voluntary disclosure of individual or organizational malpractice by a person who has had privileged access to anticipated wrongdoing within an organization. Nurses are involved in protecting the health and wellbeing of the patients under their care. Nurses as well as the patients whom they care should not be exposed to abuse. Nurses, in addition to being an advocate for their patients, need to advocate for themselves as well as each other. Nurses should whistleblow in situations where illegal, unethical or illegitimate practices occur and where internal mechanisms fail to respond to complaints made regarding these practices. Blowing the whistle, however, can be a life-altering incident and should be utilized as the last avenue.

Keywords: whistleblowing, nurse, nursing, barriers, challenges, protective disclosure
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CARING FOR A CHILD WITH BERNARD – SOULIER SYNDROME
* Ida S. Priyadarshini, M. Sc (N)., M.B.A.
*Junior Lecturer, College of Nursing, CMC, Vellore
ABSTRACT
Bernard-Soulier Syndrome (BSS) also known as hemorrhagiparous thrombocytic dystrophy is characterized by low platelet counts, abnormally large (giant) platelets, and impaired or absent platelet aggregation by the inducer antibiotic Ristocetin. This syndrome is extremely rare, and the occurrence is one case per million population. The syndrome is transmitted as an autosomal recessive trait. The underlying defect is a deficiency or dysfunction of the glycoprotein GP1b-VIX complex, a platelet restricted multi subunit receptor required for normal primary hemostasis. Clinical manifestations of BSS mainly include unexplained purpura, epistaxis, bleeding from gastrointestinal and urinary tract, menorrhagia, and prolonged bleeding during trauma or surgeries. Treatment usually requires blood or platelet transfusion. Tranexamic acid and factor VIIa administration have been shown to shorten the bleeding time in some patients. Caring for a child with hematological disorder such as BSS could be challenging for a pediatric nurse, and it is essential for the nurse to understand the underlying cause and the serious impact it has on the child for a life time. This paper is a case report of a four year old girl child with BSS who underwent cleft palate repair.

Keywords: Bernard-Soulier Syndrome, autosomal recessive, platelet transfusion
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CARING FOR A FAMILY AS THEY JOURNEY THROUGH THE LOSS OF THEIR CHILD : A SPIRITUAL ASSESSMENT PERSPECTIVE
*Vinitha Ravindran, M.Sc (N), Ph. D (N)
*Professor, College of Nursing, CMC, Vellore
ABSTRACT
Spiritual dimension is an assimilating aspect of the physical, psychological, and social dimensions of a person. Many hospitalized patients and their families place high value on having their emotional and spiritual needs met and therefore spiritual assessment and care becomes an integral part of nursing practice. In this paper I reflect on a clinical encounter with parents whose child was admitted with nephroblastoma and apply a spiritual assessment tool to elucidate their spiritual issues. I attempt to demonstrate the integration of spiritual dimension in the everyday nursing care of this child and family.

Keywords: spirituality, health, religion, faith, culture
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SELF ESTEEM, STRESS AND DEPRESSION IN NURSING STUDENTS
* Rajesh K. Kataria, M. Sc (N)
*Assistant Professor, College of Nursing, AIIMS Rishikesh, Uttarakhand
ABSTRACT
Nursing education is a challenging and stressful process. This study explored self esteem, stress and depression in nursing students and the relationship between the three variables. A descriptive survey was conducted in April 2014 among 199 nursing students who were included in the study using simple random sampling for undergraduate students and total enumeration sampling technique for post graduate students. The Rosenberg Self Esteem Scale (RSES), Perceived Stress Scale (PSS-14), and Beck Depression Inventory (BDI) were used to collect data from nursing students. Data were analyzed using descriptive and inferential statistics. Findings revealed that 17.6% of nursing students had high self esteem and 81.4% had normal self esteem. The study found that 43.7% students had severe stress and equal number of students (28.1%) had mild and moderate stress. Among the subjects, 13.6 % had borderline depression, 10.6% had moderate depression, and 3.5% had severe depression. A significant but weak negative correlation was found between self esteem and depression (r= -.396, p)

Keywords: self esteem, stress, depression, nursing students
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KNOWLEDGE AND ATTITUDE OF NURSING PERSONNEL REGARDING PATIENT SAFETY
*Samarpita Pramanik, M.Sc. (N), **T. S. Ravikumar, M. Sc (N), ***Florence Segaran, M. Sc (N), ****Edwin Stephen, M.S (Vascular Surgery)
*Vice Principal, School of Nursing, Christian Hospital Bissmacuttack, Odisha, ** Professor, College of Nursing, CMC, Vellore, ***Professor, College of Nursing, CMC, Vellore, ****Professor, Vascular Surgery, CMC, Vellore
ABSTRACT
The concept of patient safety has gained global importance in response to the high prevalence of avoidable adverse medical errors. It is essential that all levels of healthcare providers are aware of patient safety. A descriptive approach was used to assess the knowledge and attitude of nursing personnel regarding selected aspects of patient safety. A total of 600 nurses were selected for the study using stratified systematic sampling technique. The data were collected using a self administered knowledge and attitude questionnaire developed by the researcher. The findings revealed that 70.8% of nursing personnel had moderately adequate knowledge and 60.8% had a favorable attitude regarding patient safety. A statistically significant weak positive correlation was identified between the overall knowledge and attitude of the nursing personnel (r = .36, p

Keywords: patient safety, knowledge, attitude, nursing personnel.
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EFFECTIVENESS OF VIRTUAL REALITY THERAPY ON COGNITION AMONG OLD AGE PEOPLE
* D. Chitra M.Sc (N), M.Sc (Psy), ** K. Vijayalakshmi M.Sc (N), M.A (Psy), MBA, Ph. D (N), *** Latha Venkatesan M.Sc (N), MBA, M. Phil., Ph. D (N)
* M.Sc (N) Student at the time of submission, Apollo CON, Chennai, ** Professor, Apollo CON, Chennai, *** Principal, Apollo College of Nursing, Chennai
ABSTRACT
Old age is a normal, inevitable, biological phenomenon. Old age is viewed both as a stage in the life span of individual and also a segment of the population of the society. Cognitive impairment is often seen in geriatric patients, which can be disabling. The aim of the study was to assess the effectiveness of virtual reality therapy upon cognition among old age people residing at selected old age homes in Chennai. Study was conducted using pre experimental, one group pretest posttest research design. The participants of the present study were selected using purposive sampling technique. Data were collected using demographic variable proforma, clinical variable proforma, and mini mental status examination scale. The collected data were statistically analyzed and the results revealed that cognition scores in old age people in posttest was higher (M=18.9, SD=2.032) than the pretest (M = 15.3, SD = 2.092). This difference was found to be statistically significant at p

Keywords : old age, cognition, virtual reality therapy, mini mental status examination
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EARLY MANAGEMENT OF SEVERE TRAUMA
* Jeyalindha Christopher, M. Sc (N), ** T. S. Ravikumar, M. Sc (N)
* Professor, College of Nursing, CMC, Vellore, ** Professor, College of Nursing, CMC, Vellore
ABSTRACT
Trauma is a global public health problem and the burden of ill health due to injuries is increasing. A systematic approach and team work are necessary for effective management of patients with trauma. Transportation of trauma patients to a trauma care centre within the Golden Hour improves survival rates. Primary survey and resuscitation helps to identify and address life threatening injuries. A simple mnemonic ‘ABCDEFGHI’ is used as a memory aid for the sequence in which problems should be addressed.

Keywords: trauma, early management, primary survey, secondary survey, airway, breathing, circulation, disability, exposure
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PERIPHERAL ARTERIAL OCCLUSIVE DISEASE : A CASE REPORT
* Nancy Jenefa N, B.Sc (N), **Anu B. B. Rao, B. Sc (N) ***Nirmala M. Emmanuel, M. Sc (N)
*II year B.Sc (N) Student, College of Nursing, CMC, Vellore, **Tutor, College of Nursing, CMC, Vellore, *** Associate Professor, College of Nursing, CMC, Vellore
ABSTRACT
Peripheral Arterial Occlusive Disease (PAOD) affects the extremities. It is a chronic disorder affecting the arterial blood flow. There are modifiable and non-modifiable factors which are associated with PAOD. It is characterized by intermittent claudication pain on exercise or activity. Narrowing of the artery leads to decreased blood flow to the extremities which causes pain due to ischemia. The disorder is diagnosed by studying the arteries to detect narrowing or stenosis. Life style modifications such as quitting smoking, taking low fat low cholesterol diet, and relaxation therapy such as yoga, arrest the progression of the disease and reduce the symptoms. Compression therapy is useful to improve the blood flow to the extremity. Surgery becomes the option if the other modes of treatment fail to give significant relief from the pain.

Keywords: peripheral arterial occlusive disease, intermittent claudication, pain, ischemia, compression therapy
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PREVALENCE AND RISK FACTORS OF POSTPARTUM DEPRESSION
* Pooja S. Baby, M.Sc (N), ** Diana David, M.Sc (N), *** Ruby Jose, M.D., DGO
*Quality Assurance Nurse, Medical Trust Hospital, Ernakulum, ** Professor, College of Nursing, CMC, Vellore, *** Professor, Obstetrics & Gynaecology, C.M.C., Vellore
ABSTRACT
Undetected post partum depression affects the mother, her infant, her family and further affects the society through illness, social dysfunction, death, and the cost of medical services. It is estimated that only 20 % of mothers with post partum depression are diagnosed and treated, leaving thousands of new mothers to suffer in silence. A descriptive study was done to identify hospital based prevalence and risk factors related to postpartum depression among postnatal mothers in Well Baby Clinic and Obstetrics and Gynaecological Out Patient Departments of a tertiary level hospital. 250 postnatal mothers who were willing to participate in the study were recruited for the study. The Edinburgh Postnatal Depression Scale was used to identify mothers who were at risk for depression. The scale to assess the risk factors associated to the risk levels of postpartum depression was developed by the investigator. The content validity of the tool was 0.87. The prevalence of higher likelihood of having postpartum depression among mothers from six to ten weeks postnatally was found to be 52.4%. Need for migration during pregnancy, heavy house hold work, financial difficulties, thoughts of abortion in the antenatal period, expectation on specific gender of the child, perception of high stress during delivery, low birth weight babies, and presence of constant worry about the child were some of the factors that were significantly associated with a higher risk for depression. Mothers whose family were dependent on relatives for daily needs, who had an unhappy married life, and unplanned pregnancy were also found be at a high risk of developing postpartum depression. The study identifies the importance of early screening by nurses for postpartum depression and educating the family on the importance of early identification of symptoms and treatment of postpartum depression.

Keywords: postpartum depression, risk factors, prevalence, postnatal
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KNOWLEDGE AND ATTITUDE OF STAFF NURSES REGARDING HANDLING SHARPS : A DESCRIPTIVE STUDY
* Sheeba Rani P, M.Sc (N), **Anbu S. Kumar, M. Sc (N), *** Henry Kirubakaran,, ****Paul Hema, *****Ananda Ruby Jacob, M. Sc (N), ******Thenmozhi N, M. Sc (N)
* Reader, College of Nursing, CMC, Vellore, ** Professor, College of Nursing, CMC, Vellore, ***Professor, Staff & Student Health Services, CMC, Vellore, ****Professor, Hospital Infection Control Committee, CMC, Vellore, ***** Professor, College of Nursing, CMC, Vellore, ****** Lecturer, College of Nursing, CMC, Vellore
ABSTRACT
A needle stick or cut from a contaminated sharp can result in a health care worker being infected with Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus, and other blood borne pathogens. Nurses are more at risk to sustain sharps related injuries. The present study assessed the knowledge and attitude of nurses regarding handling sharps and the association of these variables with their years of experience. A descriptive study was conducted for a period of 6 weeks among 100 nurses working in multispecialty inpatient areas. Assessment of overall knowledge revealed that 39% had adequate knowledge, 57% had moderately adequate knowledge and 4% had inadequate knowledge. Assessment of overall attitude revealed that 70% had most favorable, 28% favorable, and 2% unfavorable attitude. There was a significant association between years of experience and knowledge of nurses but no significant association was found with attitude of nurses. Ongoing in-service education on handling sharps, post exposure evaluation, and follow up will enhance safe work practices.

Keywords : nurses, handling sharps, needle stick injuries, knowledge, attitude
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