TRAINING ON IMPROVING THE COMPETENCY LEVEL OF SELF- ADMINISTRATION OF INSULIN AMONG TYPE 2 DIABETES PATIENTS

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1 Origina Artice TRAINING ON IMPROVING THE COMPETENCY LEVEL OF SELF- ADMINISTRATION OF INSULIN AMONG TYPE 2 DIABETES PATIENTS Abstract : Swetha Shettigar, Ashwini Kamath, Gancy Linet Ava, Latha T. & Nevi Johnson Raju 1,2,3 4 5 P C B. Sc (N), Assistant Professor Senior Scae, Assistant Lecturer, Manipa Coege of Nursing Manipa, Manipa University Correspondence Latha T. Assistant Professor - Senior Scae, Manipa Coege of Nursing Manipa, Manipa University E-mai : atharadhakrishna@gmai.com The study was conducted with the objectives to assess the effectiveness of training on sef-administration of insuin among type 2 diabetes patients and to determine the reationship between knowedge and ski in sef administration of insuin. An evauative approach with quasi experimenta research (one group pre-test post-test) design was adopted for the study. A study was carried out with 30 patients from Kasturba Hospita Manipa. Demographic proforma, knowedge questionnaire and observationa checkist on sef administration of insuin were used to coect the data. Patients were trained after the pre-test by ecture cum demonstration method and post test was impemented after eight days of training. The study observed that the majority of the sampe was having a high schoo education (40%) maes (66.67%) with mean age of years. Most of them received information reated to heath from TV (63.33%). The duration of Diabetes was 5-10 years (30%) and astonishingy haf of them have a famiy history of Diabetes (50%). The computed paired t was statisticay significant in improving the knowedge (t =27.97, p< 0.001) and ski (t = 16.7, p< 0.001) in sef administration of insuin among type 2 diabetes patients. There was a weak positive statistica reationship (r=0.4, p<0.05) between knowedge and ski. Therefore, it is concuded that training was effective in enhancing both knowedge and ski in sef administration of insuin. The nursing personne need to take initiative in directing, teaching and educating patients about sef administration practices which can be better understood by the patients, famiy members and the community at arge. Keywords : effectiveness, training, sef administration of insuin, type 2 diabetes patients, ecture and demonstration. NUJHS Vo. 3, No.3, September 2013, ISSN Introduction : Diabetes Meitus, the commonest endocrine disorder affects deveoped as we as deveoping country. In 2011, 336 miion popuation have diabetes and estimated to reach 552 miion by 2030 gobay. Low and midde-income countries have 80% diabetes burden. Diabetes wi be the 1 seventh eading cause of death in WHO (2011) reports that the prevaence of diabetes is increasing in India. Diabetes accounts for 10% tota Access this artice onine Quick Response Code metaboic factors with 2% of mortaity in 2008 in 2 India. Though diabetes is prevaent in both urban (10-16%) and rura ( %), the incidence is increasing projected to 3 doube by A study on the prevaence of type diabetes in coasta Karnataka reports the overa prevaence of diabetes is 16% in which 11.2% are sef reported and surprisingy 4.8% were not aware of having diabetes. Eeven viages were surveyed and have noticed that 18.8% maes and 14.4% of 4 femaes were affected. Diet contro, reguar exercise and heathy ifestye practices aong with medication hep to contro diabetes. Ora hypogycemic agents and insuin are the major treatment modaities for the effective contro of gycemic index. The patient with diabetic is expected to take the medicines reguary. Taking ora medication is easy compared to insuin administration. There are different varieties of insuin that are used to treat peope having diabetes. The kind of insuin that is required wi depend on how much time is required for the insuin to work inside the body. They wi have to inject insuin in the body using a syringe, 5 pump or a pen.

2 Patients must know to draw insuin into the syringe, mix two insuins, seection and preparation of injection site, and correct injecting technique for safe administration of 6 insuin. Repeated practice is necessary if they have to safey administer accurate dose using sterie technique. But, diabetic patients are fearfu of sef injection and woud prefer to postpone earning. The nurse must teach the ski of administration of insuin irrespective of expressing the 7 difficuty or fear of insuin by patients. A study reports that diabetic patients have fear of sef administration of insuin and aso sef testing. Further study has noted that many of them were having moderate to 8 server depression. Though some diabetes patients inject themseves, most of the steps in performance of insuin administration were incorrect aarming that refresher 9 training is required for a. More than 60% of diabetes patients on insuin reported that insuin heps in better contro of diabetes. The survey adds that more than haf of the sampe considered that they are more energetic and reduces the compications of 10 diabetes The Diabetic patients who are on insuin need to be knowedgeabe regarding the disease and insuin therapy and aso they must have a competency and positive attitude towards Sef-administration of insuin injection to overcome the barriers of insuin injection and to have good gycemic contro. Therefore, a study was conducted to assess the effectiveness of training on improving the competency eve of sef-administration of insuin among diabetic patients receiving insuin, admitted in Kasturba Hospita, Manipa. The purpose was to improve the competency eve of sef administration of insuin, which in turn wi hep in better gycemic contro and avoid compications. Gycemic contro and prevention of compication wi reduce the cost of treatment and diabetes reated mortaity. Methodoogy : The objectives of the study were to assess the effectiveness of training on sef-administration of insuin among type 2 diabetes patients and to determine the reationship between knowedge and ski in sef administration of insuin. Independent variabe under the study was training on sef administration of insuin, dependent variabes were knowedge and ski of diabetic patients regarding sef - administration of insuin injection, and demographic variabes were age, education, gender, occupation, marita status, famiy income, duration of diabetes meitus, famiy history of diabetes meitus. An evauative approach with quasi experimenta design was used to determine the improvement of knowedge status on sef administration of insuin and ski in performing sef administration of insuin after teaching. The study was conducted in Kasturba Hospita Manipa, Karnataka. Thirty sampe was seected by using purposive samping technique. Samping criteria incuded type 2 diabetic patients with the age years, diabetes patient on insuin, have no visua and hearing probem and abe to do activities of daiy iving, and patients wiing to sefadministration of insuin. The data were coected using demographic proforma, knowedge questionnaire on sef administration of insuin and observationa checkist on sef administration of insuin on day one as pre-test and training was given on sef administration of insuin by one to one teaching (ecture and demonstration) on the same day. The patients were asked to re-demonstrate for next two doses. Post-test was done on day eight by using the same too except demographic proforma. Demographic proforma consisted of age of the subject, gender, education, occupation, famiy income, exposure to mass media, and famiy history of diabetes. Knowedge questionnaire on sef administration of insuin consisting of 29 mutipe choice questions about diabetes and insuin administration. Observation checkist was prepared for evauating the ski in performing the sef-administration of insuin. There were tota 25 items in the checkist with eight critica steps. Content vaidity of the toos was estabished by the suggestions of expert in the fied. 43

3 Interna consistency of the questionnaire was computed using spit haf technique and found to be reiabe ( r= 0.74). Inter rater reiabiity of observationa checkist on sefadministration of insuin found to be r= The training on sef administration of insuin was prepared by reviewing the iterature, seeking the opinion of the experts and vaidated by experts. Ethica consideration: permission was obtained from the Dean, Manipa Coege of Nursing Manipa and Head of the Department, Kasturba Hospita, Manipa, Manipa University. Informed written consent was taken from the participants. Resut : Sampe characteristics A sampe of 30 Diabetes patients on insuin were seected from medicine wards of Kasturba Hospita, Manipa by purposive samping. The sampe characteristics with respect to age, gender, education, occupation, income, exposure to mass media, duration of Diabetes, famiy history of Diabetes are presented in Tabe.1 Tabe 1: Frequency and Percentage Distribution of Diabetes Patients on Insuin n=30 SL No Sampe characteristics f % 1 Age in years : : : : > Gender : mae : femae Education : primary schoo : midde schoo : high schoo : pre-degree : graduate Occupation : empoyed : unempoyed Income ( Rs /month) : < : : : > SL No Sampe characteristics f % 6 Exposure to mass media (daiy) : reads newspaper : watches TV Duration of Diabetes ( in years) : < : : : > Famiy history of Diabetes : yes : no The data presented in Tabe 1 showed that the majority (36.67%) were in years of age with mean age of years. The majority of the patients were mae (66.67%), high schoo educated (40%). Empoyees are more (63.33%) and most of their famiy income is above rupees 10,000 (40%). Most of the patients received information reated to heath from TV (63.33%). The majority of the patients' Diabetes duration was 5-10 years (30%). Haf of the sampe were having a famiy history of Diabetes (50%). Effectiveness of teaching Tabe 2: Range, Minimum, Maximum, Mean, and Standard deviation of pre-test and post-test knowedge and ski scores of Diabetes patients n=30 Range Minimum Maximum Mean Standard deviation Knowedge Pre-test Post-test Ski Pre-test , Post-test , Note: Maximum possibe score: knowedge 29 and ski 33 The data presented in Tabe 2 indicate that, the post-test mean knowedge score (25.8) is significanty higher than the pre-test mean knowedge score (13.8) and the post-test mean ski score (31.67) is significanty higher than that of the pre-test mean ski score (20.3). This difference in mean signifies the effectiveness of training on sef administration of insuin among type 2 diabetic patients. The pre-test mean knowedge and ski score and post-test knowedge and ski score were cacuated. In order to find the difference between the two correated means of pre-test and post-test scores, paired t was computed. The data are presented in Tabe 3. 44

4 Tabe 3: Mean, Mean difference, standard deviation and 't' vaues of pre-test and post-test knowedge and ski scores of the Diabetes patients on insuin. n=30 S No Test Mean Mean Standard t p difference deviation Knowedge Pre-test scores Post-test 25.8 Ski scores Pre-test Post-test Tabe 3 shows that the computed paired t is significant for both knowedge (t =27.97, p< 0.001) and ski ('t' = 16.7, df 29, p< 0.001) is significant. This statistica anaysis shows that the gain in knowedge and ski on sef administration of insuin among type 2 diabetes patients were not by chance and the diabetes patients have improved ski in sef-administration of insuin after teaching. Reationship between knowedge and ski in sef administration of insuin Person's r was computed to find the reationship between knowedge and ski scores. Cacuated vaue (r=0.4, p<0.05) shows a weak positive correation between knowedge and ski. So, knowedge and ski in sef administration of insuin are dependent on each other. Investigators have noted some of the important findings during the study. Patients have expressed that they experience very minima pain whie sef-administration of insuin compared to others prick them for injection. Though initiay some patients were having fear of injection, they coud do it successfuy after teaching and they were confident in their ski. Some of them have articuated that sef administration of insuin heps them to improve their quaity of ife since they need not to be dependent on other peope for injection Teaching was successfu to overcome some of the myths which they had regarding insuin administration. The majority of the diabetes patients vaued that disposa of biomedica waste is a new concept to them and they were peased to know the disposa of injection reated waste. Discussion : A descriptive cross sectiona study was conducted by Raj CKP and Angadi MM in Bijapur, Karnataka with 730 type diabetes patients aged above 20 years to assess the knowedge, attitude and practice of diabetes patient showed mean age was ± years, 67% were 11 maes. Sr. Paracatty reported that 36 % of diabetic patient 12 were in years of age and 53% of them were mae. The present supports the finding reveaing mean age was years, 67% were maes. The present study showed poor ski on sef-administration of insuin before training. However, the knowedge and ski have improved significanty after training. The study supports the research conducted by Thais SG, Ana EP, Vanderei JH, et a on Insuin sef-administration technique with a disposabe syringe among patients with diabetes meitus foowed by the famiy heath strategy. Investigators identified errors in most of the steps of the 13 safe administration of insuin. The outcome of this study shows that training on sef administration of insuin was effective in improving knowedge (t =27. 97, p< 0.001) and ski ('t' = 16.7, p< 0.001). Sr. Paracatty T, reported that individuaized panned teaching was effective (t=12.98, p<0.001) in improving the technique of sef administration of insuin. The Author has confirmed that there is a positive correation (r-0.74, p<0.05) between knowedge and ski of sef administration of insuin where as present study has a weak positive 12 correation in the same area. The present study has noticed that the sampe were feared of insuin neede initiay and were asking for better methods of insuin administration. Summers KH, Szeinbach SL, Lenox BM in a survey concuded that the overa preference for the insuin injection pen device appeared to 14 be higher compared with the via and syringe. Most persons are fearfu of sef injection and woud prepare postpone earning. Repeated practice is necessary if they have to safey administer accurate dose using sterie technique. This study supports the research conducted Moema et a on diabetes fear of injecting and sef testing 45

5 questionnaire. The study describes the psychometric properties of the diabetes fear of injecting and sef testing 15 questionnaire. Two groups of patients were studied. Concusion : The study was conducted with the objectives of assessing the effectiveness of training on sef-administration of insuin among type 2 diabetes patients and in determining the reationship between knowedge and ski in sef administration of insuin. The study concuded that the diabetes patient had an average knowedge regarding sefadministration of insuin injection and improved after training. The study findings revea that there is the weak positive reationship between the knowedge and ski eve of sef administration of insuin. Investigators have noticed some of the interesting findings during the study. Though initiay some patients were having fear of injection, they coud do it successfuy after teaching and they were confident in their ski. Patients have expressed that they experience very minima pain whie sef-administration of insuin compared to others prick them for injection and heps them to improve their quaity of ife since they need not to be dependent on other peope for injection. Training was successfu to overcome some of the myths which they had regarding insuin administration such as insuin injection taken for onger duration makes them tired, traveing is not advisabe for the patient who is on insuin, etc. Majority of the diabetes patients vaued that disposa of biomedica waste is new concept to them and they were peased to know the disposa of injection reated waste. The findings of the study have greater impications for heath care professionas in the areas of practice, administration education, and research. The nurses pay a key roe in patient care from the day of admission to the day of discharge; nurse is with the patient, caring and consoing. So, the nurse is expected to give nursing care as we as heath teaching regarding sef practice of insuin administration. Heath care professiona needs to take initiative in directing, teaching and educate the patients about sef administration practices it can be better understood by the patients, famiy members and the community at arge. Hospita administrators can formuate a poicy for a heath education program for diabetic patients in order to improve the patient's knowedge and ski towards sefadministration of insuin injection. However, more researches shoud be done reated to insuin therapy and sef administration in order to prevent the compications and reduce the rate of mapractice. The study was performed among 30 diabetic patients who were on subcutaneous insuin in Kasturba Hospita, Manipa and there was no contro group, imits generaization. References : 1. The goba burden. Accessed on Word Heath Organization - NCD Country Profies, Accessed on o Pradeepa R, Mohan V. The changing scenario of the diabetes epidemic : impications for India. Indian J Med Res. 2002;116: Rao CR, Kamath VG, Shetty A, Kamath A. A study on the prevaence of type 2 diabetes in costa Karnataka. Int J Diab Dev Ctries Apr;30 (2): Diabetes management. management. Accessed on N.S. Monaham. Medica Surgica Nursing heath and iness th perspectives, 8 edn. A division of reed Esevier India private imited: India; 2009.p nd 7. M.L. Burke. Medica Surgica Nursing care. 2 ed. Library of congress cataoging-in-pubication data: Newjersey; p Moema ED, Sonek FJ, Pouwer F, Heine RJ, Poeg HMVD. Diabetes Fear of Injecting and Sef-Testing Questionnaire. Diabetes care Jun:23(6); Stacciarini TS, Pace AE, Haas VJ. Insuin sef-administration technique with disposabe syringe among patients with diabetes meitus foowed by the famiy heath strategy. Rev Lat Am Enfermagem Ju-Aug;17(4): Accessed on Over 60% of insuin users in contro of diabetes: Survey. Avaiabe at URL: Accessed on Raj CKP, Angadi MM. Hopsitpa based KAP study on Diabetes in Bijapur, Karnatak. Indian journa of medica speciaities. 2010;1(2): Avaiabe at URL: Accessed on Parecatty T. Effectiveness of individua panned teaching on sefadministration of insuin for patients with diabetes meitus, receiving insuin in a seected hospita at Mangaore. Avaiabe at URL: 46

6 Thais.SG, Ana EP, Vanderei JH, Insuin sef administration technique with disposabe syringe among patients with Diabetes Meitus foowed by the famiy heath strategy. Rev Lat Am Enfermagem Ju-Aug;17(4): Summers KH, Bzeinbach SL, Lenox BM. Preference for insuin Deivery systems among current insuin users and non users. Cinica therapeutics Sept;26(9): Moema ED, Sonek FJ, Pouwer F, Heine RJ, Poeg HMVD. Diabetes Fear of Injecting and Sef-Testing Questionnaire. Diabetes care Jun;23(6):