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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 20 | Issue 2
Page Nos. 85-152

Online since Monday, June 1, 2020

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EDITORIAL  

Rekindling the focus on sustainable development goals p. 85
Vinitha Ravindran
DOI:10.4103/IJCN.IJCN_23_20  
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CONCEPTS AND ISSUES Top

Pre-intra-post-operative nursing care pathway: Fragments to fusion, isolation to integration p. 87
Dinesh Kumar Suganandam
DOI:10.4103/IJCN.IJCN_12_20  
Perioperative care refers to the care rendered during pre-operative, intra-operative and post-operative (PIP) care of patients undergoing surgery. A patient undergoes these three phases in different environments and also experiences much stress and anxiety. The relationship between patient and nurse during these phases significantly improves the outcome. Although the operating room (OR) nurses play a pivotal role in patient care, they are often unseen. With the view of linking alleviation of stress and anxiety of the patient and the visibility of OR nurses and also the fragmented and isolated care provision, the PIP nursing care pathway was developed based on the perioperative dialogue model. This pathway helps in connecting the three phases of transition, which ensures the fusion and integration of care. Based on this model, the OR nurse makes a pre-operative visit and explains about the OR environment. The same nurse receives the patient in the OR and assists in surgery. The post-operative visit is also made by the same nurse. Adapting this pathway influences patient and OR nurse satisfaction to a great extent. It also empowers the OR nurses to facilitate managed care. Visibility of OR nurses is improved by this pathway because of their interaction and involvement in all the phases. With the support of management, this pathway can be successful in order to provide effective perioperative care, which is fused instead of fragmented and integrated instead of isolated.
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Job stress among nurses p. 92
J Hepsi Bai, Vinitha Ravindran
DOI:10.4103/IJCN.IJCN_11_20  
It is well known that nursing as a profession is considered stressful. Multiple factors such as patient-care demands, professional issues, work environment, organisation policies and procedures are associated with job stress in nursing. Personal- and family-related issues also play a vital role in causing stress for nurses. Job stress can inadvertently affect patient care as well as health of nurses. Appropriate coping strategies are needed to mitigate job stress and ensure optimal patient-care outcomes. Organisational and nurse supervisor's support is essential to enable nurses to cope with job stress. In this article, the prevalence and associated factors of job stress and the general coping strategies adopted by nurses are discussed.
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CLINICAL ARTICLES Top

Agenesis of corpus callosum p. 97
Jeyasutha Chokkian
DOI:10.4103/IJCN.IJCN_13_20  
Having a child born with a congenital defect is traumatic for the parents and family. Some congenital anomalies can be corrected resulting in good quality of life, and few others may grossly affect the life of children because of the long-term effects. One such anomaly is agenesis of the corpus callosum which is a brain anomaly where the nerve fibres connecting the left and right hemispheres of the brain are completely or partially absent. Many factors are associated with the presence of the anomaly. The clinical manifestations and the extent of neurological dysfunctions are related to the magnitude of defect. Symptom-specific supportive management, enhancement of growth and development and parental support interventions are key to managing children with agenesis corpus callosum.
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Case study on heterotopic pregnancy p. 102
C Sangeetha
DOI:10.4103/IJCN.IJCN_14_20  
Heterotopic pregnancy (HP) is a rare form of pregnancy that is characterised by the coexistence of intra-uterine and extra-uterine pregnancy. The simultaneous presence of two gestational sacs is a rare event but with the advent of assisted reproductive technology, it is now an increasingly common complication. The prognosis for the extra-uterine foetus is very poor, having an estimated 90%–95% mortality rates. The mortality rate for the intra-uterine pregnancy is approximately 35%. Nurses have a challenging role to play in the management of women during acute and rehabilitative phase when HP occurs. For a comprehensive understanding of the disease condition, the definition, incidence, causes, clinical manifestation diagnostic criteria and management along with case report focusing on nursing management are presented in this article.
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RESEARCH ARTICLES Top

Cultural practices and beliefs regarding newborn care in South India p. 106
Mary Jenifer, Ebenezer Ellen Benjamin
DOI:10.4103/IJCN.IJCN_18_20  
The days and weeks following child birth are a critical phase in the lives of mothers and newborn babies. According to the WHO, 45% of under-five deaths occur during the 1st month of life. Several factors contribute to neonatal mortality in India and one of the reasons is following harmful newborn care practices such as applying different unsterile material on the umbilical cord and instilling liquids and oils in the ears and nose. These practices are often associated with the cultural beliefs. The objective of this focused ethnography study was to bring forth a description of the cultural aspects of newborn care in South India and identify cultural themes related to newborn care which will help health professionals to understand and tailor interventions in the health-care setting. Three focus group discussions were conducted in the post-natal units of a tertiary hospital in South India using a semi-structured interview guide. Data from translated interviews were coded and categorised to identify cultural themes. Themes such as rituals, beliefs, resistance and adaptation and solutions evolved from the study. The study was successful in highlighting cultural practices and their meanings, which provides an insight for nurses on how to deliver educational messages, considering the cultural values and beliefs of the mothers.
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Assessment of maternal concerns, beliefs and infant attachment behaviour of mothers of pre term infants p. 111
Anupama Vadakke Purathayil, Deepa Premala
DOI:10.4103/IJCN.IJCN_22_20  
One of the major causes of neonatal mortality in India is prematurity. Although prematurity in itself poses multiple challenges for the neonate in the immediate newborn period, sustaining survival in the later period, after discharge from a newborn intensive care facility, remains a greater challenge for parents in low- and middle-income countries. The present study assessed the maternal concerns, beliefs and infant attachment behaviour of mothers of pre-term infants admitted in newborn nurseries. A quantitative approach with a descriptive cross-sectional design was used. The investigator used consecutive sampling to select 95 mothers of pre-term infants. The interview schedule was used to assess maternal concerns, neonatal intensive care unit (NICU) parental belief scale was used to assess maternal beliefs and the Index of parental behaviour in NICU was used to assess infant attachment behaviour. The findings revealed that 63.2% of mothers of pre-term infants belonged to the moderately concerned group, 62.1% of mothers of pre-term infants had strong parental belief and 94.74% of mothers of pre-term infants had appropriate infant attachment behaviour. The study found that there was no significant correlation between maternal concerns and infant attachment behaviour. There was a significant positive correlation (r = 0.23) between beliefs and infant attachment behaviour. Maternal concerns were associated with monthly family income and the number of children, beliefs and the infant attachment behaviour were associated with duration of hospital stay.
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Effect of campus-based emergency training on knowledge and skills regarding selected medical emergencies among college teachers in a selected college p. 117
Phiralynn KharKongor, Rajeswari Siva, Samuel Ravi Kumar, Reginald George Alex, Bijesh Yadav
DOI:10.4103/IJCN.IJCN_25_20  
College campus hems-in not only academic credentials but also provide opportunities for students to explore their interests and passions. Students are vulnerable to injuries and severe accidents. Timely, the administration of first aid in response to the medical emergencies will help to reduce disabilities, complications and the cost of treatment and mortality among them. Teachers are often the first to witness and handle these situations, hence, need to be equipped and empowered with knowledge and skills to be effective and efficient first respondents. A preexperimental study was conducted to assess effectiveness of campus-based emergency training (CBET) on knowledge and skills in the management of selected medical emergencies among college teachers. Fifty-three college teachers participated in the CBET which included lecture cum discussion, video presentation, booklet; skill demonstration and return demonstration as interventions. A self-administered questionnaire for knowledge and observational checklist for skills on the management of selected medical emergencies, constructed by the investigator, were used as data collection tools. Findings showed that majority of the college teachers had inadequate knowledge and skills during the pretest. There was significant improvement in knowledge (mean difference, −13.62) (P < 0.001) and skill (mean difference, −27.66) (P < 0.001) among the teachers after the CBET. Significant association was found between stream of teaching and knowledge (pretest) and skill (posttest) (P < 0.001). There was a strong positive correlation of post knowledge and post skills (P < 0.01). These findings, reiterated a strong need to train college teachers all over the country on the management of selected life threatening medical emergencies to have safe campus, save lives, and ensure a safe India.
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RESEARCH SERIES 20 Top

Getting to know the person: Interviews as a tool in eliciting narratives in healthcare and research settings p. 125
Rekha Ahuja
DOI:10.4103/IJCN.IJCN_21_20  
Interviews are built on collaboration and effective conversational skill. In the health-care settings, it is imperative to address the whole person, i.e., the emotional, social and psycho-spiritual aspects along with the physical body and health-related concerns. Asking the right kind of questions and having the right information-eliciting skills can make or break an interaction. Interacting with people who are struggling with illness requires a sensitive approach. Rapport created from the early stages of treatment goes a long way in determining crucial factors such as decision-making and treatment adherence. Research on patient experiences, and qualitative aspects of treatment rests heavily on obtaining rich, in-depth data from interviews. Planning for follow-up care involves assessing patient needs by considering the person recovering from the illness and making effort towards psycho-social rehabilitation. Therefore, interviews are a useful tool used at various points in time during the treatment and caregiving process, as well as while researching health and illness. Preparation for the interview and appropriate skills of the interviewer are important factors on which the outcome is dependent. This paper aims to throw light on the process of interviewing as a clinical skill as well as a research method, in the context of health-care settings.
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CONTINUING NURSING EDUCATION SERIES NO: 37 Top

Organophosphate poisoning: Overview, management and nursing care p. 131
Mary Jancy Joy, Bharathy Radhakrishnan, Meenakshi Sekar, Shirley David
DOI:10.4103/IJCN.IJCN_24_20  
Acute poisoning by organophosphates (OPs) for suicidal purpose poses a major problem, leading to high mortality in the developing countries. This occurs as OPs irreversibly bind to acetylcholinesterase, leading to the accumulation of acetylcholine at the neuromuscular junction and subsequent over-activation of cholinergic receptors in various parts of the body. Early identification of the signs and symptoms and prompt management enhance better outcomes reducing mortality. Atropine, oximes, neuroprotection and quality care remain the mainstay of treatment for OP poisoning and can reverse the life-threatening features of acute poisoning. Supportive treatment includes maintaining airway, breathing, circulation and decontamination of the poison. Nurses working in the critical care units play a vital role in monitoring the patient closely, providing quality nursing care and thereby preventing complications.
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STUDENT SECTION Top

A study to assess the insight and motivation towards quitting alcohol among patients with gastrointestinal and hepatological conditions p. 141
Beninal Pillai, Sumathy Jayaraman
DOI:10.4103/IJCN.IJCN_15_20  
Alcoholic beverages have been a part of social life for thousands of years, yet societies have always found it difficult to restrain its use. Alcohol dependence syndrome and alcohol abuse are the dreaded alcohol-related morbidity. In India, 20%–30% of hospital admissions are due to alcohol-related problems, and the burden is rising. Realising the need to seek treatment forms an important bridge between the problem and its solution among those with alcohol-related morbidity. Therefore, a descriptive study was done to assess the insight and level of motivation to quit alcohol consumption among alcoholics affected with gastrointestinal and hepatological conditions admitted in inpatient general ward of a tertiary care hospital. Participants who were enrolled for the study using total enumerative sampling technique were 25. The Readiness to Change Questionnaire developed by Prochaska and DiClemente and the Hanil's Alcohol Insight Scale were used to collect data. The study results showed that 12% were in pre-contemplation stage, 32% were in contemplation stage and 56% were in action stage. About half the proportion of the participants (56%) had fair insight regarding their dependency in alcohol and none had good insight. Poor insight on alcohol as the risk factor of their disease was identified in 44% of the participants. This study highlights the need for an effective education and support programme for individuals with alcohol dependence and alcohol-related morbidity.
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RESEARCH IN BRIEFS Top

Effect of structured exercise sessions on post-operative problems related to immobility in post-caesarean patients p. 144
Jyoti Thakur
DOI:10.4103/IJCN.IJCN_16_20  
As the well-being of maternal and child health occupies a paramount place in the healthcare delivery system, caesarean section (CS) has become the most common intervention in obstetrics care, in many countries. Although the indicated and timely CS has tremendous advantages for the mother and the baby, there are several consequences of caesarean delivery in comparison to normal delivery. Being one of the major abdominal surgeries, it also carries the risk associated with general surgeries. Non-probability sampling design was used to recruit 500 participants, who were allotted to experimental and control groups. With the routine post-caesarean care as per hospital routine, the planned structured exercise session was initiated for the experimental group on the day of lower segment caesarean section and was followed twice a day for the first 5 post-caesarean days. The study participants of the control group were given the routine care only. At the end of each day, the selected data for the presence of post-operative complications were collected by structured observation and self-report techniques. It was evident that the selected post-operative problems related to immobility were less in the experimental group as compared to that of the control group. The study concluded that structured post-operative exercise sessions are effective in reducing the potential post-operative problems associated with immobility in post-caesarean period. It can be implemented effectively to enhance the recovery of women after CS.
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A study on knowledge of mothers on lead poisoning among children at selected hospital, Mangalore p. 149
Jadriya Fernandes, Lincy Kurian, MV Jancy, Shainy Angadiyath, Priya Janifer Fernandes
DOI:10.4103/IJCN.IJCN_17_20  
Lead is a highly toxic and poisonous metal. It can cause severe mental and physical impairment. Young children are most vulnerable because they absorb four to five times more ingested lead compared to adults from a given source. Children's curiosity behaviour and their age-appropriate hand-to-mouth behaviour results in their mouthing and swallowing lead-containing objects, such as contaminated soil or dust flakes from decaying lead-containing paints further increasing the risk of lead poisoning. Awareness about lead poisoning and a deeper understanding of its effect on children among caregivers can prevent lead poisoning. The aim of this study was to assess mothers' knowledge regarding lead poisoning in children. Descriptive study design and convenience sampling technique were used to select 99 mothers to assess their knowledge on lead poisoning among children. The data were collected with structured knowledge questionnaire. Findings show that 54.5% had average knowledge, 27.3% had good knowledge, 14.1% had very good knowledge and 4% had poor knowledge. Study reveals that nearly half of the mothers (54.5%) have average knowledge on lead poisoning which shows that there is a need for conducting health education and other awareness programmes on lead poisoning in the community.
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