DISSERTATION ON - EPrints@Tamil Nadu Dr MGR Medical ...

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DISSERTATION ON “A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING

PREVENTION OF VARICOSE VEIN AMONG POLICE

PERSONNEL WORKING IN CHENNAI”

M.SC (NURSING) DEGREE EXAMINATION

BRANCH- I MEDICAL SURGICAL NURSING

COLLEGE OF NURSING

MADRAS MEDICAL COLLEGE, CHENNAI-600 003

A dissertation submitted to

THE TAMIL NADU DR.M.G.R. MEDICAL UNIVERSITY,

CHENNAI- 600 032

In partial fulfillment of the requirement for the award of degree of

MASTER OF SCIENCE IN NURSING

OCTOBER – 2019

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“A STUDY TO ASSESS THE EFFECTIVENESS OF

PLANNED TEACHING PROGRAMME ON KNOWLEDGE

REGARDING PREVENTION OF VARICOSE VEIN AMONG

POLICE PERSONNEL WORKING IN CHENNAI”

Examination : M.Sc. (Nursing) Degree Examination

Examination Month and Year : OCTOBER 2019

Branch & Course : I – MEDICAL SURGICAL NURSING

Register Number : 301711253

Institution : COLLEGE OF NURSING,

MADRAS MEDICAL COLLEGE,

CHENNAI – 600 003.

Sd: __________________ Sd:___________________

Internal Examiner External Examiner

Date: ____________ Date: ____________

THE TAMILNADU DR.M. G. R MEDICAL UNIVERSITY

CHENNAI – 600 032.

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CERTIFICATE

This is to certify that this dissertation titled “A STUDY TO

ASSESS THE EFFECTIVENESS OF PLANNED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING PREVENTION

OF VARICOSE VEIN AMONG POLICE PERSONNEL WORKING

IN CHENNAI” is a bonafide work done by B. NAGALAKSHMI,

M.Sc. (N) II year student, College of Nursing, Madras Medical College,

Chennai-03 submitted to The Tamil Nadu Dr. M.G.R Medical

University, Chennai. In partial fulfillment of the requirements for the

award of degree of Master of Science in Nursing, Branch I - MEDICAL

SURGICAL NURSING, under our guidance and supervision during the

academic period from 2017 – 2019.

Mrs.A.Thahira Begum, M.Sc(N)., MBA., M.Phil.,

Principal,

College of Nursing,

Madras Medical College,

Chennai -03.

Dr.R.Jayanthi, MD, FRCP(Glasg)

Dean,

Madras Medical College

Chennai -03

CERTIFICATE OF PLAGIARISM

This is to certify that the dissertation work titled, “A STUDY TO ASSESS THE

EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON

KNOWLEDGE REGARDING PREVENTION OF VARICOSE VEIN AMONG

POLICE PERSONNEL WORKING IN CHENNAI” of the candidate

Mrs.B.NAGALAKSHMI for the partial fulfillment of M.Sc. Nursing

Programme in the branch of MEDICAL SURGICAL NURSING has been verified

for plagiarism through relevant plagiarism checker. We found that the uploaded

thesis file from introduction to conclusion pages and rewrite shows ______% of

Plagiarism (_____% uniqueness) in this dissertation.

CLINICAL SPECIALITY GUIDE / SUPERVISOR

Mrs.V.K.R.Periyar Selvi, M.Sc(N).,

Reader in Medical Surgical Nursing,

College of Nursing,


Chennai -03.

PRINCIPAL

Mrs.A.Thahira Begum, M.Sc(N).,MBA., M.Phil.,

Principal,

College of Nursing,


Chennai -03.

5

“A STUDY TO ASSESS THE EFFECTIVENESS OF

PLANNED TEACHING PROGRAMME ON KNOWLEDGE

REGARDING PREVENTION OF VARICOSE VEIN AMONG

POLICE PERSONNEL WORKING IN CHENNAI.”

Approved by the Dissertation Committee on 24.07.2018

CLINICAL SPECIALITY GUIDE

Mrs.V.K.R.Periyar Selvi, M.Sc(N)., _____________

Reader in Medical Surgical Nursing,

College of Nursing,


Chennai -03.

HEAD OF THE DEPARTMENT

Mrs.A.Thahira Begum, M.Sc(N)., M.B.A., M.Phil., _____________

Principal,

College of Nursing,


Chennai-03.

DEAN

DR.R.Jayanthi, MD., FRCP (Glasg)., ___________ Dean,


Chennai-03.

A Dissertation submitted to

THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY,

CHENNAI

In partial fulfillment of the requirement for award of the degree

MASTER OF SCIENCE IN NURSING

OCTOBER – 2019

6

ACKNOWLEDGEMENT

Gratitude calls never expressed in words but this only to deep

perceptions, which make words to flow from one’s inner heart.

First of all, I praise God Almighty, merciful and passionate, for

providing me this opportunity and granting me the capability to

complete this study successfully. I lift up my heart in gratitude to God

Almighty; I feel the hand of God on me, leading me through thick and

thin heights of knowledge. It is he who granted me the grace and the

physical and mental strength behind all my efforts.

This dissertation appears in its current form due to the assistance

and guidance of many professionals and non-professionals. I heartedly

indebted to her research advisors for their comprehensive assistance in

various forms.

I express my genuine gratitude to the Institutional Ethics

Committee of Madras Medical College for giving me an approval to

conduct this study.

I wish to express my sincere thanks to Dr.R.Jayanthi, M.D.,

FRCP (Glasg), Dean, Madras Medical College, Chennai for providing

necessary facilities and extending support to conduct this study.

At the very outset, I express my whole hearted gratitude to my

esteemed guide, Mrs.A.Thahira Begum M.Sc.(N)., MBA., M.Phil.,

Principal, College of Nursing, Madras Medical College, Chennai for

her academic and professional excellence, treasured guidance, highly

instructive research mentorship, valuable suggestions, prudent guidance,

moral support and patience that has molded me to conquer the spirit of

knowledge for sculpturing my manuscript into thesis.

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I would like to express my deepest sense of gratitude and heartfelt

thanks to Dr.R.Shankar Shanmugam, M.Sc.(N), MBA., Ph.D.,

Reader, H.O.D – Department of Nursing Research , College of

Nursing, Madras Medical College, for his highly instructive research

mentorship, his hard work, efforts, interest and sincerity to mold this

study in a successful way. His easy approachability and understanding

nature inspired me to laid strong foundation in research. It is very

essential to mention their wisdom and helping nature made my research

study a lively and everlasting one.

I am grateful to Prof.N.Sridhar, M.S., DNB., FRCS (Edin),

MCh(Vascular), Professor of Vascular Surgery, Institute of

Vascular Surgery, RGGGH, Madras medical college, Chennai, for

giving me the permission to conduct the study and for sharing his

experience in providing ideas and guide me to complete this study in

useful manner.

I am grateful to Mrs.T.R.Latha, M.Sc.(N)., Reader, Department

of Medical Surgical Nursing, College of Nursing, Madras Medical

College, for her valuable guidance, suggestions, motivation, timely

insightful decision, and correction of the thesis with constant motivation

and timely help and support throughout the completion of this study.

I am highly indebted to Mrs.V.K.R.Periyar Selvi M.Sc.(N).,

Reader, Department of Medical Surgical Nursing , College of

Nursing, Madras Medical College, for her great support, warm

encouragement, constant guidance, thought provoking suggestions, brain

storming ideas, timely insightful decision, correction of the thesis with

constant motivation and willingness to help all the time for the fruitful

outcome of this study.

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I am extremely grateful to Mrs.C.S.V. Uma Lakshmi, M.Sc.(N),

Lecturer; Mrs.J.Alamelumangai, M.Sc.(N), Lecturer; Mr.N.Muruganandan,

M.Sc.(N), Lecturer; Mrs. D. Anandhi, M.Sc.(N), Nursing Tutor,

Department of Medical Surgical Nursing for their encouragement,

valuable suggestion, support and advice given in the study.

I am grateful to Dr.G.Mala, M.Sc.(N)., MBA., Ph.D., (Retd.

Nursing Tutor) and Mr.Kannan.K, M.Sc.(N)., MBA., Nursing Tutor,

Department of Nursing Research, College of Nursing, Madras Medical

College, for their valuable guidance, suggestions, motivation and timely

help and support throughout the completion of this study.

I am thankful to all the Faculty of College of Nursing, Madras

Medical College, for their timely advice, encouragement and support.

It is my pleasure and privilege to express my deep sense of

gratitude to Dr.R.Rama Sambasivan, M.Sc.(N)., Ph.D. Principal,

Mohamed Sathak A J College of Nursing, Chennai; Dr.B.Tamilarasi,

M.Sc.(N)., MPhil., Ph.D., Principal, Madha College of Nursing,

Chennai, who validated the research tool and guided me with valuable

suggestions and corrections, constructive judgments while validating the

tool.

I render my deep sense of sincere thanks to Mr.Kalaiselvan, IPS,

Deputy Commissioner of Police, New Washermanpet, Chennai for

have given me the permission to conduct this study in their esteemed

area and also, for their valuable suggestions and guidance for this study.

I have much pleasure of expressing my cordial appreciation and

thanks to all police personnel who participated in the study with interest

and cooperation.

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I owe my deepest sense of gratitude to Mr.A.Venkatesan,

M.Sc.(Statistics)., P.G.D.C.A, Statistician for his suggestion and

guidance in statistical analysis.

I thank our librarian Mr.S.Ravi., M.L.I.S, College of Nursing,

Madras Medical College for his co-operation and assistance which built

the sound knowledge for this study.

I thank Mr.K.Umesh Kumar, M.A(E)., M.A(T)., B.T.

Asst.(English), Govt. High School, Kalpoondi, Arni (TK),

Thiruvannamalai. for editing and providing certificate of English

editing.

I thank Mrs.K.Uma, M.A(T)., B.T. Asst, Govt. High School,

Kalpoondi, Arni (TK), Thiruvannamalai for editing and providing

certificate of Tamil editing.

Words are beyond expressions for meticulous effort of my parent

Mr.G.Boopathy and Mrs.B.Rajeswari for their loving support,

dedication, encouragement, earnest prayer, which enabled me to

complete the study.

I immensely extend my gratitude to thank my husband

Mr.D.Kirubakaran and my lovable children K.Priyadharshini,

K.Dhaneshwaran and my father-in-law Mr.P.Doss, mother-in-law

Mrs.D.Lakshmi for their encouragement, constant support, timely help

to finish this study successfully.

I immensely extend my gratitude to thank my brother

Mr.B.Kumaravel and his wife Mrs.K.Renuga Devi, his children

K.Monisha, K.Niranjan and my cousin Mr.S.Prakash for their

encouragement, constant support, timely help to finish this study

successfully.

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I would be a lapse on my part if i fail to thank my beloved

Grandparents for their blessings showering from the heaven.

I would like to thank my friends and my all department friends for

their constant encouragement towards the successful completion of my

study.

I owe my great sense of gratitude to Mr.Jas Ahamed Aslam,

Shajee computers and Mr.Ramesh, B.A., MSM Xerox for their

enthusiastic help and sincere effort in typing the manuscript with

valuable computer skills and also bringing this study into a printed form.

At final note, I extend my thanks to all those who have been

directly and indirectly associated with my study at various stages not

mentioned in this acknowledgement.

I take this opportunity to thank all my Colleagues, Friends,

Teaching and Non-Teaching Staff Members, of Madras Medical

College – College of Nursing for their co-operation and help rendered in

the completion of my study.

I thank the one above, omnipresent God, for answering my

prayers, for giving me the strength to plod on each and every phase of

my life.

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ABSTRACT

INTRODUCTION: Varicose veins are one of the chief

preventable diseases which are associated with veins. It is a serious

disease, which poses threat to life of patient when effective and efficient

measures are not taken. Modern world a lot of occupations and

professions have designed up where people are required to either

continuously stand for a long time or made to sit hanging down for a

considerable time. The varicose vein sufferers the following professions

like computer professionals, security guards, traffic police, salesmen

working at counters in departmental stores, teachers, nurses,

paramedical workers working in various hospital set ups and persons

doing desk jobs day in and day out.

TITLE: “A study to assess the effectiveness of planned teaching

programme on knowledge regarding prevention of varicose vein among

police personnel working in Chennai.”

OBJECTIVES: To assess the pre-test level of knowledge on

prevention of varicose vein among police personnel. To evaluate the

effectiveness of planned teaching programme on prevention of varicose

vein among police personnel by comparing post-test knowledge scores.

To compare the pre-test and post-test level of knowledge on prevention

of varicose vein among police personnel. To find out the association

between post-test knowledge scores with selected demographic

variables.

METHODS AND MATERIALS: Planned questionnaire tool was

used to assess the level of knowledge of varicose vein and knowledge on

prevention of varicose vein among police personnel. 70 police personnel

were divided in to seven groups.10 members in each group. Pre-test

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level of knowledge on prevention of varicose vein was assessed in the

first day of first week. Following the assessment planned teaching

programme was administered in groups. Group sessions were conducted

for 45 minutes to 1 hour; planned teaching programme was administered

using visual troops, power point, flash card, pamphlet, exercise

demonstration, calendar. After planned teaching programme one-week

later post-test level of knowledge regarding prevention of varicose vein

was assessed. 10 police personnel not attend during the post -test. The

data was analyzed by using descriptive and inferential statistics.

RESULTS: The effectiveness of planned teaching programme on

knowledge regarding prevention of varicose vein among police

personnel to assessed by pre-test and post-test scored. Findings of the

study showed that the pre-test mean of (12.52) with the SD is (3.53) and

after the planned teaching programme the post-test mean value of

(24.35) with the SD is (2.28) so the computed t value is (25.9) which is

highly statistically significant.

CONCLUSION: Hence, planned teaching program is appropriate

and feasible to implement in all settings. It would help the persons to

improve their knowledge on preventive measures of varicose vein and

reduce risk of complication effectively and improve their health status.

Keywords: Varicose vein, PTP, Police personnel

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INDEX

Chapter Content Page

No

I INTRODUCTION 1

1.1 Background of the study 4

1.2. Need for the study 7

1.3. Statement of the problem 12

1.4. Objectives 12

1.5. Operational Definitions 12

1.6. Hypothesis 14

1.7. Assumptions 14

1.8. Limitations 14

1.9. Conceptual framework 15

II REVIEW OF LITERATURE 18

III

RESEARCH METHODOLOGY 33

3.1. Research approach 33

3.2. Research design 33

3.3. Duration of the study 34

3.4. Study Setting 34

3.5. Study population 34

3.6. Sample size 34

3.7. Criteria for Sample Selection

3.7.1 Inclusion Criteria

3.7.2. Exclusion Criteria

34

34

34

3.8. Sampling Technique 35

3.9. Research variables

3.9.1Independent variables

3.9.2Dependent variables

35

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Chapter Content Page

No

3.10. Development and description of the tool

3.10.1. Development of tool

3.10.2. Description of the tool

3.10.3. Scoring procedure

35

35

36

36

3.11. Content Validity 37

3.12. Reliability of the tool 37

3.13. Ethical considerations 38

3.14. Pilot study 39

3.15. Data collection procedure 39

3.16. Data entry and Data analysis 40

IV DATA ANALYSIS AND INTERPRETATION 42

V DISCUSSION 74

VI SUMMARY, IMPLICATION, LIMITATION,

RECOMMENDATIONS AND CONCLUSION

6.1. Summary of the Study

6.2. Major findings of the Study

6.3. Implications of the Study

6.4. Recommendations

6.5. Limitations

6.6. Conclusion

82

82

83

85

86

86

REFERENCES

APPENDICES

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LIST OF TABLES

Table

No. Title

Page

No.

3.1. Intervention of protocol 38

4.1. Demographic Profile 43

4.2. Each domain wise pre-test percentage of knowledge

on prevention of varicose vein among police personnel

51

4.3. Pre-test level of knowledge 53

4.4. Each domain wise post-test percentage of knowledge

on prevention of varicose vein among police personnel

54

4.5. Post-test level of knowledge 56

4.6. Comparison of domain wise pre-test and post-test

knowledge score

57

4.7. Comparison of overall knowledge score before and

after planned teaching programme

60

4.8. Comparison of pre-test and post-test level of

knowledge score

61

4.9. Percentage of knowledge gain score 63

4.10. Effectiveness of planned teaching programme 64

4.11. Association between police personnel post-test level

of knowledge and their demographic variables

66

4.12. Association between police personnel of knowledge

gain score and their demographic variables

72

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LIST OF FIGURES

Fig.

No. Title

1.1. Neuman’s system model (Level of prevention health care)

1.2. Conceptual framework (Ludwig vow Bertalanffe’s-general

system Theory (1962)

3.1. Schematic representation of the study Research methodology

4.1. Distribution of Age of the study participants

4.2. Distribution of Marital status of the study participants

4.3. Distribution of Food Habit of the study participants

4.4. Distribution of Habit of the study participants

4.5. Distribution of Education of the study participants

4.6. Distribution of occupation status of the study participants

4.7. Distribution of Income of the study participants

4.8. Distribution of Duration duty hours per day of the study

participants

4.9. Distribution of Family history of Varicose vein of the study

participants

4.10 Distribution of Doing Regular Exercise of the study participants

4.11 Distribution of Level of pre-test knowledge of the study

participants

4.13. Box plot compares the pre-test and post-test knowledge score

on prevention of Varicose vein among police personnel

4.14. Pre-test and Post-test level of knowledge score of the study

participants

4.15. Each domain wise percentage of knowledge gain

4.16. Association between post-test level of knowledge score and age

of the study participants

4.17. Association between police personnel post-test level of

knowledge score and their marital status of the study

participants

4.18. Association between Post-test level of knowledge score and

their monthly income of the study participants

4.19. Association between Post-test level of knowledge score and

their family history of the study participants

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LIST OF APPENDICES

S.

No Description

1. Certificate approval by Institutional Ethics Committee

2. Certificate of content validity by Experts

3. Letter seeking permission to conduct the study

4. Tool for data collection

Section A: Questionnaire regarding socio demographic

variables

Section B: Planned questionnaire used to assess the knowledge

on prevention of varicose veins

5. Planned teaching pamphlet and calender

6. Informed consent form- English

7 Informed consent form- Tamil

8. Certificate of Tamil Editing

9 Certificate of English Editing

10. Photos

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LIST OF ABBREVIATION

Abbreviation Expansion

U S A United States of America

WHO World Health Organization

UK United Kingdom

HUVEC Human Endothelial Cells obtained from umbilical cords

VV Varicose vein

PTP Planned Teaching programme

PAF Platelet-activating factor

PMN Poly Morpho Nuclear neutrophils

ATP Adenosine Tri-Phosphate

DVT Deep Vein Thrombosis

EVTL Endovenous Thermal Ablation

CHD Coronary heart disease

PAD Peripheral arterial disease

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CHAPTER-I

INTRODUCTION

"Prevention is better than cure." -Desiderius Erasmus

"He who cures a disease may be the skill fullest, but he that prevents it is the safest physician.

-Thomas Fuller

Health is referred to the level of functional or metabolic

efficiency of a living being. It is related to lifestyle. Today the

increasing importance is placed on health, health promotion, wellness

and self-care. workers more than millions of people spend most of the

working day on their standing for prolonged time and many hours in

static or same positions. 20% of energy is used for standing, actually it

uses more energy than sitting because human bodies are not designed to

stand continuously at work. Prolonged standing, develops high health

risk like tiredness, loss of concentration.

Nowadays diseases are more common all over the world due to

the changing of life styles. Creating awareness is the best way to lead

life successfully. Varicose veins are one of the chief preventable

diseases which are associated with veins. It is a serious disease, which

poses threat to life of patient when effective and efficient measures are

not taken.

As per the census report of WHO (2007), 2% of the Western

population have varicose vein and women have 3-4 times more than the

men. In Eastern population thepercentage of level varicose veins is less.

Statistics show that in a country the prevalence of varicose veins is 45

per 1000. In U S A it is 22 in 1000.

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Blood stasis in leg veins is a problem commonly linked to the

development of venous diseases such as varicose vein. this stasis would

provoke an ischemia, thus leading to insufficient oxygen availability to

tissues. The ischemia further damages the endothelium. The starting

point of a cascade of events leading to the disorganization of the vessel

wall. These pathologies are due to the effect of oxygen deprivation on

the functional state of the endothelium. When (HUVEC) venous human

endothelial cells obtained from umbilical cords are uncovered to

hypoxic conditions, they become activated without change in their

viability.During hypoxia incubation, the production of a pro-

inflammatory molecule (PAF, platelet-activating factor) and the

adhesion of human poly morpho nuclear neutrophils (PMN) on HUVEC

are predominantly increased. In that, two processes are related to a

calcium-dependent activation of endothelial cells due to a decrease of

adenosine triphosphate (ATP) availability during hypoxia. The first step

of diapedesis is Adherence of neutrophils to endothelial cells, which

leads to the infiltration of these cells in the media of the veins, where

they affect the smooth muscle cells and the connective tissue, leading to

tissue alterations typical of the venous pathologies. There is a sequential

process which is introduced from a reduction in oxygen availability and

which involves different cell types. This is one main cause of the venous

disorders, in addition to genetic, hormonal, and mechanical factors.

According to Mrs. Akoijam Sangita Devi and Mrs. Malar Kodi

Aathi-2014 varicose veins are twisted, enlarged veins near the surface of

the skin which are termed as Varicose veins. They commonly develop in

the legs and ankles. While sitting or standing for a prolonged time, the

blood in the veins of the legs can pool and the pressure in the vein s can

increase and cause stretching. the walls of the veins weaken due to

stretching of veins, it damages the vein valves resulting in varicose vein.

In this modern world, a lot of occupations and professions have been

3

designed in which where people are required to either continuously

stand for a long time or made to sit hanging down for a considerable

time. The common varicose vein sufferers are the following professions

like computer professionals, security guards, traffic police, salesmen

working at counters in departmental stores, teachers, nurses,

paramedical workers working in various hospital set ups.

Brunner, 2014 has explained excess weight, heavy lifting, and

pregnancy also increase the likelihood of developing varicose veins as it

increases pressure on the body. Increasing age, menopause, genetic

weaknesses in the walls of the vein or in their valves, excessive pressure

within the veins due to a low fiber diet which causes an increase in

straining during bowel movements, and damage to the veins or to their

valves resulting from inflammation also increase the risk of developing

varicose veins. Varicose veins may or may not be associated with the

symptoms such as fatigue, aching discomfort, feelings of heaviness or

pain in the legs, fluid retention, swelling and pain in the feet and ankles,

and discoloration. 50% of middle-aged adults are more prone to be

affected by these dilated often painful veins which affect twice as

common in women as in men. Sclerotherapy, elastic stockings, elevating

the legs, and exercise are the Non-surgical treatments. Vein stripping to

remove the affected veins are the traditionally used surgical treatments.

Alternative techniques, such as ultrasound-guided foam sclerotherapy,

radiofrequency ablation and endogenous laser treatment, are available as

well. Most of the blood in the legs is returned by the deep veins, the

superficial veins, which return only about 10 per cent of the total blood

of the legs. They can usually be removed or ablated without serious

complication.

Lewis, 2010 stated that the superficial veins of the legs

commonly affect Varicose vein which are subject to high pressure when

standing. Accumulation of more and more venous blood in the

4

superficial venous system makes the superficial veins dilated and

tortuous. This condition of dilated and tortuous veins in the leg due to

damaged value between the deep and superficial venous system is called

varicose veins.

The police personnel are the main pillars for the society safety.

They bear all types of responsibili ty of safety. There are a lot of

problems faced by the police personnel, since they stand most of the

day and it has a great effect on the lower limbs and it damages the

joints, make muscles ache and finally leads to ‗varicose vein‘. It is

estimated that 10-20% of the general population have varicose veins, out

of which most of them are working persons like police personnel.

1.1 BACKGROUND OF THE STUDY

One of the most common condition of venous disease in the

legs are varicose veins. As per American Society for Vascular Surgery,

at least 20 to 25 million Americans have varicose veins. In developed

countries, the prevalence of chronic venous disease is about 40e60% in

females and 15 to 30% in males, and the annual incidence is 2.6% in

women and 1.9% in men. The prevalence of varicose veins varies from

2% to 56% in men and 1% to 60% in women. In most countries half of

the adult population shows signs of venous diseases that are considered

to be disfiguring (women 50-55%,men 40-50%), but fewer than half of

these will have visible varicose veins (women 20-25%,men 10-155).

The prevalence rate of venous reflux disease is 2x more

prevalent than coronary heart disease (CHD) and 5x more prevalent than

peripheral arterial disease (PAD). The prevalence of varicose veins

(2016) was found to be high in northern Indian population with

approximately half of women and a third of men affected.

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In India, 46.7% of females and 27.8% of males were found to be

having varicose veins whereas 49.3% of females and 18.9% of males

were having venous symptoms.

Earliest record of varicose veins is in the papyrus of Ebers,

written 1550 BCE, where the author described them as ―tortuous and

solid, with many knots, as if blown up by air‖, and counseled folks leave

their veins in situ.

Depiction of a varicose vein – 400 BC

The first illustration of a varicose vein dated from 400 BCE; a

votive tablet found at the base of the Acropolis — so that gives you an

6

extra idea just how long varicose veins have been bothering people. It

was around this time that Hippocrates, the ―Father of Medicine‖,

suggested people do something about their varicose veins, because he

noticed a correlation between veins and leg ulcers. This was the

introduction of vein punctures, cautery (using a hot or caustic agent) and

compression bandages as a treatment.

Enter the modern age of venous treatment. Since the 1960s,

treatment of vascular disease has included the use of guidewires,

catheters, angioplasty and stents. If you had vascular issues these days,

you were fortunate to have surgeons with many cutting-edge treatment

options at their disposal. More recent and sophisticated treatments

tended to have impressive scientific titles, such as Duplex ultra sound

scanning,Radiofrequency ablation, foam scleritherapy,and Diode laser.

Compression stockings invented by engineer Conrad Jobst, who

had venous ulcers in his legs. He discovered that when he was in a pool,

his legs felt better due to the pressure from the water. In 2015, FDA

approves Venaseal, a system that seals varicose veins using an adhesive

agent. Does not require tumescent anesthesia.

In the modern era, life style changes and the working pattern of

the person is showering varieties of diseases. Among which Varicose

Veins are troubling the person a lot. Lower-limb varicose veins (VVs)

are common and known to have a higher prevalence among people who

work in occupations requiring prolonged standing. The work

environment constitutes an necessary part of man‘s total environment,

so health to a large extent is affected by work conditions.

Varicose Veins have become a serious threat to the lives of

millions of people across the globe and is said to be ignored by people

living across India. ―There is an urgent need to spread awareness about

Varicose Veins in India. Many people suffer from it, but most tend to

7

ignore it and that is not good as it can lead to complications in the

advanced stage". It is estimated that 10 to 20% of the general.

1.2 NEED FOR THE STUDY

Health is not something that one possesses as a commodity, but

connotes rather a way of functioning within one‘s environment (work,

recreation, and living). Millions of workers spend majority of the

working day on their feet and many hours in static positions. Standing

uses 20% more energy than sitting because human bodies are not

designed to stand at work. Prolonged standing, can lead to tiredness,

loss of concentration and increased health risks.

International statistics show that over the age of 50, 1 of 2 people

is affected by veins. Recent statistics show that nearly 2.7 million

people worldwide suffer from varicosities and the toll is ever increasing.

Varicose veins commonly affects three in 10 adults, and usually those

are harmless, but they may seem unsightly. Following the preventive

measures can be done to prevent from getting them and exercises can be

done to alleviate their appearance. Varicose veins are commonly

occurring in the lower limbs. Instead of a cosmetic problem, it can have

some serious complications if not treated in time. Different types of

surgical management exist for the disease. The surgery complications

are troublesome and difficult to treat.

Worldwide, the important cause of disease and disability are

chronic venous disorder including varicose vein. These disorders have

substantial medical and economic consequences. The cost of society is

also enormous. Despite extremity of the problem, little effort has been

made to meritoriously prevent such disorders.

Approximately,23% of US adults have varicose veins, Spider

telangiectasias and reticular veins, the prevalence has increases to 80%

in men and 85% in women. Generally, it is more common in women and

8

older adults, Varicose veins affect 22 million women and 11 million

men between the ages of 40 to 80 years. Of these, 2 million men and

women develop symptoms and signs of chronic venous insufficiency,

including venous ulceration. According to the World Health

Organization (WHO) statistical information system nearly 177 deaths

per year occurs in US, 152 deaths per year in Germany due to varicose

veins. If left untreated, 50% of the patients will eventually experience

complications such as chronic venous insufficiency, thrombophlebitis

and cellulitis.

In the developed countries, where attire reveals more than it s

conceal, patients turn up in sizeable numbers for treatment for cosmetic

reasons, while in our country, patients are hospitalized more for the

complications of the disease than for the disease itself. For that reason,

the incidence of varicose vein in India seems to be far less compared to

western population. The prevalence rate of varicose vein in India is 5%.

The prevalence of varicose veins was found to be high in Northern

Indian population with approximately 46.7%of females and 27.8% of

males were found to be having varicose veins.

According to Dr.Ravinder Singh Ranger (2017) Consultant

Vascular, Endovascular and General Surgeon, Great Western Hospital,

UK, said that the recurrence rate of varicose vein day to day has gone up

to 25 percent. The prevalence of varicose veins is increases along with

age. A study result shows that 40-years of had prevalence of 22%, 50-

years of had prevalence of 35%, and 60-years of had prevalence of 41%.

Venisha Pearl Tauro (2015) described that millions of workers

spend majority of the working day on their feet and many hours in static

positions. Standing uses 20% more energy than sitting and because

human bodies are not designed to stand at work, prolonged standing, can

lead to tiredness, loss of concentration and increased health risks. These

9

risks include the swelling of feet and legs, feet and joint damage,

varicose veins, heart and circulatory disorders, lower back problems and

pregnancy complications.

A study on the effect of standing in the workplace will lead to the

development of chronic venous insufficiency of the superficial venous

system in legs. Mechanical hydrostatic pressure generated by long

periods of standing at the work place is a major etiological factor for

this condition. Varicose veins on working while standing are very

common, so it is not surprising to find a high percentage of varicose

veins amongst those who work standing up. However this does not mean

they are directly related. Venous pressure in ambulatory while sitting is

about 60-80mm of water, as opposed to 20mm while walking, and the

number is only slightly higher (about 100) while standing.

Recent work by J. Bergan and his group (2017) demonstrated (in

laboratory animals) that increased venous pressures will lead to the

disappearance of the valve leaflets. Among the young people (13%)

there was a high frequency of venous reflux and even higher frequency

(35%) was found among the elderly population. Standing is as an

important and significant factor in the development of this complex

disease process so the persons should be aware of the conditions and its

prevention. Non-medical treatments are more effective for milder cases

of varicose veins. Some of these treatments are acupuncture and

acupressure, aromatherapy, compression stockings, massage, healthy

diet, taking vitamins and so on. Alternating between hot and cold baths

(hydrotherapy) can help with the blood circulation.

Neeta Mishra (2015) conducted a study which revealed that when

considering the age, with advanced age, the risk of getting varicose

veins is increased and the male female ratio among the aged nurses is 1

in 100. The above said statistical values when combined with other

10

demographic factors, has an evidence that aged ones are at high risk of

developing varicose veins.

Gregory Piazza, MD, MS (2014) conducted a study result which

shows that the sheer prevalence of varicose veins and the substantial

cost of treating late complications such as chronic venous ulcers

contribute to a high burden on health care resources. Chronic venous

ulcerations result in the loss of 2 million workdays and cost an estimated

$3 billion per year to treat in the United States. Even varicose veins

alone, without more advanced signs of chronic venous insufficiency,

result in important reductions in quality of life.

V. K. Shukla (2005) conducted the study results shows that

Comparatively our country people are quite ignorant of this disease. So

the severity of disease becomes increased. Health education is one of the

strategies in the prevention of varicose veins. Keeping the preventive

facts in view and the fact that health education has a significant effect

on knowledge of traffic police which in turn helps in the prevention of

varicose veins.

Fig 1.1 Neuman’s system model (Level of prevention health care)3

11

As per Neuman’s system model

The level of prevention of health care according to nursing

intervention is divided into three levels,

Primary prevention

Secondary prevention

Tertiary reactive prevention

During primary prevention, pro active health protection notes the

risk factors about varicose vein.

In secondary prevention, early detection or identification of early

symptoms regarding varicose vein. Helps to retrieve the health

well.

In tertiary prevention, the treatment protocal and surgical

management , preventive measures are used in varicose vein.

Nurses are pillars of health care team to motivate and educate the

people for the prevention of disease. In the preventive aspect for

delivering care to the society, nurses plays a crucial role to rendering the

prevention of disease through health education. The important role for

performing preventive care is done by the educator through health

education. For this reason, the investigator takes educator role to import

the knowledge regarding prevention of varicose vein.

The researcher found that importance of doing this study based on

the literature, statistical values and also based on her personal

experience she had while she was doing her clinical practice as a staff

nurse. For the past five years of clinical experience in vascular ward

most of the retired police personnel were admitted with varicose vein

symptoms. Those persons communicated that they were not aware about

risk factors and preventive measures of varicose vein during their

12

service period, since police persons were standing for a prolonged

period in their duty hours.

1.3 STATEMENT OF THE PROBLEM

―A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING

PREVENTION OF VARICOSE VEIN AMONG POLICE PERSONNEL

WORKING IN CHENNAI.‖

1.4 OBJECTIVES

To assess the pretest level of knowledge on prevention of varicose

vein among police personnel.

To evaluate the effectiveness of planned teaching Programme on

prevention of varicose vein among police personnel by comparing

posttest knowledge scores.

To compare the pretest and posttest level of knowledge on

prevention of varicose vein among police personnel.

To find out the association between posttest knowledge scores

with selected demographic variables.

1.5 OPERATIONAL DEFINITIONS

Assess

In this study it refers to the measure level of knowledge regarding

prevention of varicose vein among the police personnel by planned

knowledge questionnaire.

Effectiveness

In this study, effectiveness refers to the degree to which Planned

Teaching Programme achieve the desired effect in improving the

13


personnel

Planned Teaching Programme (PTP)

In this study it refers to the planned and organized teaching

programme by the investigator to educate police personnel about

prevention of varicose vein (compression stockings, leg exercise and

early detection).

Knowledge

Responses given by the police personnel for planned knowledge

questionnaire regarding prevention of varicose vein before and after the

planned teaching programme.

Prevention

It refers to hindering the fact from happening, by following

preventive measures one can able to avoid the occurrence of disease.

Avoiding standing and sitting for prolonged time, elevation of foot after

prolonged standing and sitting, leg exercise, swimming, maintaining

appropriate body weight, elevating the legs periodically, wearing

compression stockings and clothing choices and walking will help to

prevent the occurrence of varicose vein.

Varicose Vein

Varicose Veins are abnormally dilated veins with incompetent

valves occurring most commonly in the lower extremities and lower

trunk, usually in the great and small saphenous veins.

Police Personnel

It refers to the male participants who are on duty especially the

police personnel to protect safety in Chennai city.

14

1.6 HYPOTHESES

H1: There will be a significant difference between the pre and posttest

knowledge scores of police personnel regarding prevention of

varicose vein.

H2: There will be a significant association between the pre and

posttest knowledge scores of police personnel and their selected

demographic variables.

1.7 ASSUMPTIONS

The police personnel are having high risk to get varicose vein due

to long hours of standing during working hours.

The police personnel may have less knowledge regarding

prevention of varicose vein.

Any educational programme will increase the knowledge.

1.8 LIMITATIONS

The study will be limited to police personnel working in Chennai.

The study will measure only the knowledge of police personnel

about prevention of varicose vein.

The study will be limited to 4 weeks.

15

1.9 CONCEPTUAL FRAMEWORK

A conceptual frame work broadly presents an understanding of the

phenomena of the investigator interest and reflects the assumption and

philosophic views of the model designer. A conceptual frame work is

the theoretical approach of the study of problems that are significantly

based upon the emphasis and selection arrangements and classification

on its concept. This conceptual framework focuses on the goal of the

study structure and function resource and decision making. The current

study aims to evaluate the effectiveness of planned teaching programme

on knowledge regarding prevention of varicose vein among police

personnel working in Chennai.

The conceptual framework for this study was derived from system

theory Ludwig von Bertalanffy (1968) It serves as model for viewing

people as interacting with environment, according to the general system

theory for survival. The system must receive certain matter, energy and

information from the environment. The system continuously monitors it s

environment to guide its operations feedback may be positive or neutral.

INPUT

It refers to the security phase where a planned teaching

programme was given knowledge regarding prevention of varicose vein

on their demographic variables age, marital status, food habit, habit,

education, occupation, income, working hours, family history, exercise.

THROUGHPUT

In this study, the existing knowledge regarding prevention of

varicose vein among police personnel about varicose vein, preventive

measures, diet, diagnostic procedure, treatment modalities, exercise

were the knowledge is impacted.

16

Implementation of planned teaching programme.

PTP through video clipping, flash card, power point presentation

For future orientation issuing pamphlet, calendar

OUTPUT

After processing the input, the system returns the output to the

environment in the form of practicing in their daily activities . In this

study, the output was expected to gain knowledge regarding prevention

of varicose vein among the police personnel.

FEEDBACK

Feedback is the environment responses to the system. The

feedback is the process whereby the output of the system is redirected to

the input of the same system. A fairly low feedback may be neutral,

positive or negative. By this method, the negative and neutral output

could be rectified into positive gain.

17

FIG. 1.2 CONCEPTUAL FRAMEWORK

(LUDWIG VOW BERTALANFFE’S-GENERAL SYSTEM THEORY 1962)

Input Throughput Output

Demographic

variables

1.Age

2.Marital stasus

3.Food Habit

4.Habit

5.Education

6.Occupation

7.Income

8.Working

hours

9.Familyhistory

10.Exercise

Planned

Teaching

Programme

Regarding

Prevention Of

Varicose Vein

Among Police

Personnel

1.Pamphlet

2.Flash Cards

3.Exercise

Demonstration

4.Ppt, Video

5.Calender

Post-Test To

Assess After

Interventional

Level Of

Knowledge

Regarding

Prevention Of

Varicose Vein

Pre-Test

To Assess

Level Of

Knowledge

Regarding

Prevention

of

Varicose

Vein

Negative

outcome

No change in

the level of

knowledge

Feed Back

Positive

outcome

Increased

knowledge

level

18

CHAPTER-II

REVIEW OF LITERATURE

A literature review is termed as a description and analysis of the

literature relevant to a particular field or topic. with help of review

provides an overview of what has been said, who the key writers are,

what are the prevailing theories and hypotheses, what questions are

being asked and what methodologies appropriate and useful.

Review of literature is help to recognized authorities and of

previous research which provides the evidence that the researcher is

familiar with what is already known and what is still unknown.

substantial agreement maintained with the studies and those that seem to

prevent conflicting conclusions helps to sharpen and define

understanding of the existing knowledge in the problem area, provides

background for the research project and makes the reader aware of the

status of the issue.

This section consists of four parts

2.1.1. Literature related to varicose vein

2.1.2. Literature related to the risk factors and prevalence of varicose

vein

2.1.3. Literature related to knowledge on prevention and management of

varicose veins

2.1.4. Literature that related to effectiveness of Planned teaching

programme

19

2.1.1. REVIEW OF LITERATURE RELATED TO VARICOSE

VEIN

Matthew K.H.Tansharon et al (2019) were conducted a study in

systematic review was performed according to the PRISMA (Preferred

Reporting Items for Systematic Reviews and Meta-analyses) guidelines.

The reports shows that the relationship between great and small

saphenous vein diameters and clinical severity and/or HRQoL scores

measured using validated instruments were included. Eleven eligible

studies were identified, reporting on 2,732 limbs (range 22–681).

Multiple instruments were used to quantify HRQoL and clinical

severity. The seven studies used to assessed the relationship with CEAP

class, with the majority observing a positive correlation between vein

diameter and disease severity. There is no significant relationship

between diameters and HRQoL scores was reported.

Meghal R. Antani (2019) conducted a study regarding Venous

reflux disease or venous reflux, which may also be referred to as chronic

venous insufficiency, is a common condition. Venous reflux is usually

the underlying cause of varicose veins, reticular veins, and

telangiectasia‘s (spider veins). Risk Factors are Family history,

Increased age, Standing for long periods, Obesity, History of DVT.

Treatments include long-term compression stockings, Traditional

surgical treatment consisted of ligation and stripping of the greater

saphenous vein. In the United States, instead of surgical vein ligation

and stripping has largely been replaced by catheter-based endovenous

thermal ablation (EVTL). Foam Sclerotherapy, Supplemental

Procedures, Compression Therapy, Patients with milder symptoms of

venous reflux disease may obtain adequate symptomatic relief with

compression stockings.

https://www.sciencedirect.com/topics/medicine-and-dentistry/small-saphenous-vein

https://www.sciencedirect.com/topics/medicine-and-dentistry/small-saphenous-vein

20

Elizabeth Lumley (2018) carried out a systematic review of

qualitative research (Experiences of living with varicose veins)

Thematic synthesis of qualitative research reported according to

ENTREQ guidelines. The range and intensity of reported symptoms and

participant's experiences of living with varicose veins were varied. Five

overarching themes were identified: physical, psychological and social

impact of varicose veins, adapting to varicose veins and reasons for

seeking treatment. This review demonstrates that varicose veins have a

wide range of symptoms and may have a significant impact on quality of

life; people made significant adaptations to enable them to live their

lives as fully as possible.

Yetkin Ertan (2018) carried out a study in the absence of trauma,

hematologic disease and anti-platelet use, no attention has been paid to

elucidate the mechanism of ecchymosis. varicose vein have the sign of

ecchymosis on lower limb. For that the results shows Leg pain was the

most common symptom in our study population. Ecchymosis was

observed in 24 patients (5%). ecchymosis was significantly and

positively associated with muscle cramps (Odds ratio: 5.82,

p = 0.001) and female gender (Odds ratio: 5.17 p = 0,019 but

negatively associated with age (Odds ratio: 0.94, p = 0.004) which

determined by logistic regression analytical method. Large population,

ecchymosis and its association with muscle cramps with peripheral

varicose vein or chronic venous insufficiency was documented first

time. Novel sign of varicose vein should be considered with Ecchymosis

on lower limbs.

Gabriella Lucchi (2017) conducted observational study on 73

consecutive superficial vein thrombosis patients tested for inherited or

acquired thrombophilia. Sixty of 73 patients with superficial vein

thrombosis completed the testing protocol, while 13 dropped out; 46 of

60 patients were found to have a thrombophilia (76.6%). The types

21

detected were: factor V Leiden (31/60, i.e. 51.6%), prothrombin

mutation (2/60, i.e. 3.3%), antiphospholipid antibodies (5/60, i.e. 8.3%),

protein C deficit (1/60, i.e. 1.6%), protein S deficit (1/60, i.e. 1.6%), and

anti-thrombin deficit (0/60, i.e. 0%).

Maslivets I (2016) described that, the role of connective tissue

dysplasia in the development of varicose veins by Analysis of literary

sources. According to the literature, the role of magnesium deficiency in

the formation of undifferentiated connective tissue dysplasia is

described in sufficient detail. Thus, it is advisable to determine the

concentration of matrix metalloproteinase and the magnesium ion level

as an indicator of connective tissue dysplasia in patients with varicose

veins of the lower extremities to improve the results of treatment, to

optimize the prediction and diagnosis of this pathology.

2.1.2. LITERATURE RELATED TO THE RISK FACTORS

AND PREVALENCE OF VARICOSE VEIN

Number of potentially serious health outcomes occur associated

with prolong standing at work, such as lower back and leg pain,

cardiovascular problems, fatigue, discomfort, and pregnancy‐ related

health outcomes. There were recent studies conducted examining the

relationship between these health outcomes and the amount of time

spent standing while on the job. In the review of the health risks and

interventions for workers and employers that are involved in

occupations requiring prolonged standing.

Gorijavolu Naveen Kumar et al. (2019) conducted a study, the

data for the study was obtained from the patients admitted and treated in

Tertiary Care Hospital, Kurnool for a period of two years from

November 2015 to November 2017. The age of the patients ranged from

10 to 75. Commonest age group affected was between 31-40 yrs. Out of

50 patients 13 were female and 37 were male. In 7 patients (14%) there

22

was positive family history of presence of varicose veins and in 43

patients (86%) occupational influence was seen.

Robin Man Karmacharya et al. (2019) conducted a study cross

sectional study on risk assessment of varicose veins among the traffic

police of kathmandu metropolitan city, Nepal. Out of 200 respondents,

24 (12%) were at risk of varicose veins, out of which 22 were male and

the rest were female. The results of the study suggest that overall risk of

varicose vein is 12%, with males accounting for 12.3% and females for

9.5%. In the study, the risk of varicose veins is statistically significantly

associated with the family history of varicose vein and smoking.

Siddharth Mishra et al. (2019) carried out a prospective

observational study with a sample size of sixty patients was undertaken

at a Teaching Medical College and Hospital and Research Centre. In our

study, 70% of patients were males, and 30% of patients were females.

The age group for this study between 17-70 years. Maximum patients

were in age group of 45 to 54 years (21.67%).44 patients (73%) had a

history of prolonged standing out of with 17 had history of mainly

standing, 6 had history of standing and walking, 12 had history of

standing and sitting, 9 had history of standing, walking, and sitting.

David M.Antle (2018) carried out a study to compare changes in

lower limb discomfort, blood pressure and blood flow accumulation

during a light-load repetitive upper limb work task accomplished from

seated and standing postures 16 participants were outfitted with Laser

Doppler Flow (LDF) electrodes to measure blood flow in the lower

limb, and a sphygmomanometer to measure lower limb mean arterial

blood pressure (MAP). The participants completed simulated work over

34  min in standing and seated conditions. Repeated measures ANOVAs

(Posture x Time) were used to assess the differences. Both Posture

(p  =  0.003) shows significant effects and Time (p   =  0.007) for

https://www.sciencedirect.com/topics/medicine-and-dentistry/mean-arterial-pressure

https://www.sciencedirect.com/topics/medicine-and-dentistry/mean-arterial-pressure

23

LDF-measured of blood flow accumulation in the soleus and the foot,

over time in the standing posture there was 77% of blood flow compared

to seated work. interaction effect and a significant Posture

(p  =  0.0001) effect for MAP in ‗Posture   ×  Time‘ (p  =  0.0034),

with higher values in the standing posture by a mean of 37.2   mmHg

shows significant. Posture had a significant effect (p   <  0.001) on

lower limb discomfort, with standing posture reported higher levels.

Recommendations given through the results for using static standing

work postures should be tempered, and physicians' guidance on

workstation changes should consider the impacts on the lower limb .

Meulendijks A.M. (2018) conducted a cross sectional study on

Venous Leg Ulcers (VLU) occur in about 1% of the Western populat ion.

The aim of this study was to identify risk factors for developing a first

VLU in adults (aged > 18 years) by searching the literature. The

methodological differences of the studies made it impossible to perform

a quantitative analysis. The risk factors higher age (four studies), higher

body mass index (four studies), low physical activity (four studies),

arterial hypertension (four studies), deep vein reflux (three studies),

deep venous thrombosis (three studies) and family history of VLU (three

studies) were significantly associated with a VLU in the majority of the

studies.

Jitendra K. Meena et al. (2018) were carried out a cross-sectional

study across police stations located in a randomly chosen central district

of the NCR. studies have reported specific morbidities, e.g., anemia,

visual abnormalities, and varicose veins. Odds ratio with 95%

confidence interval was used to quantify the risk factors and a P value

<0.05 was considered statistically significant.

24

Edda MariaCapodaglio (2017) conducted an observational study

revealed that postural risk of sales assistants working in a prolonged

standing posture,.70 sales assistants employed among 9 apparel stores in

northern Italy participated in the study. An observational approach was

adopted Discomfort of the lower limbs was subjectively rated on the

Borg's Cr-10 scale at the end of the working time. Our data suggest that

an indefinite level of risk of developing discomfort and musculoskeletal

disorders of the lower limbs is real in sales assistants who work in a

prolonged standing posture.

Li Erding et al. (2017) carried out a descriptive study in 1198

nurses randomly selected from three 3A grade in east china. Descriptive

statistically analysis was performed to describe the current situation of

lower extremity varicose veins in nurses. explore the main risk factors

of lower extremity varicose veins in female nurses analyzed through

univariate and multivariate logistic analysis. Logistic regression analysis

showed that age (OR=1.317, 95%CI: 1.196-1.450), standing time

(OR=1.712, 95%CI: -2.423 1.209) and family medical history

(OR=2.706, 95%CI: 1.444-5.073) were main risk factors. Elastic

stockings (OR= 0.052, 95%CI: 0.025-0.107), legs-raising (OR=0.201,

95%CI: 0.095-0.425) and physical exercise (OR=0.141, 95%CI: 0.072-

0.274) were main protective factors. What‘s more, age (r=0.47, P <

0.01) and working years (r=0.51, P<0.01) were linearly related to lower

extremity varicose veins in nurse‘s population respectively. It was

concluded Age, standing time and family medical history are risk factors

of varicose veins among female nurses in east china hospitals. Protective

factors include stretch socks, legs-raising, physical exercise, no cross-

legged sitting, legs massage, eating few high-fat foods, wearing flat

shoes and knowing the risk factors of varicose veins .

25

Dr.Veerabhadra Radhakrishna (2016) conducted a cross-

sectional study on the 36-Whitefield traffic police personnel. Health

ailments detected were Eye irritation (14 persons- 38.9%), Chronic

Cough (8 persons- 22.2%), Wheeze (4 persons- 11.1%), Dermatitis (6

persons- 16.7%), Anxiety (4 persons- 11.1%), Varicose veins (4

persons- 11.1%). Only 11 policemen were using any personal protection

measures. Traffic police showed a high prevalence of various health

ailments due to occupational exposure which increases with the duration

of exposure. The study was used to increase group's awareness towards

preventive measures.

A literature search of PubMed and Cochrane libraries was

performed in accordance with PRISMA statement from 1946 to 2015,

with further article identification from following cited references for

articles examining the relationship between obesity and venous disease.

Search terms included obesity, overweight, thrombosis, varicose veins,

CEAP, chronic venous insufficiency, treatment, endovenous,

endothermal, sclerotherapy, bariatric surgery and deep vein thrombosis.

clinicians in many other specialties are going to be treating a wide range

of obesity-related health problems in people with or at risk of lower

limb venous disease.

Chin Chwen Ch'ng (2015) conducted a cross sectional study on

prevalence rate of varicose vein, there were 70 male and 54 female

patients, aged between 13 and 87 years (mean 57.23±12.854).

Thirty‐one of them (25%) had recurrent cellulitis. Fifty‐seven (46%)

had fever at presentation, 55 (44.4%) had bullous cellulitis. peripheral

vascular disease (p = 0.01), and varicose veins (p = 0.02) were

significantly higher in recurrent cellulitis. Thirty pat ients (24.2%) were

complicated with lipodermatosclerosis, and six (4.8%) had lymphostasis

verrucosa cutis.

26

Hossein Ebrahimi (2015) carried out a Cross Sectional Study on

prevalence and associated risk factors of varicose veins among 197

female hairdressers in Shahroud, north of Iran in 2012. Data were

collected by demographic information form the result showed that

Prevalence of varicose veins was 47.7%. Varicose veins were

significantly associated with age (OR=1.08; 95% CI: 1.03, 1.13); family

history of varicose disease (OR=1.99; 95% CI: 1.03, 3.82) and duration

of standing (OR=2.34; 95% CI: 1.05, 5.22) and it was associated with

increasing age, family history of varicose disease, and prolonged

standing.

Kakani Renitha (2015) carried out a cross sectional study among

150 security guards working in Udupi district. Interview method was

used to identify the risk factors of varicose veins. The result shows 5.3%

had family history of varicose veins, 56.7% maintaining standing

position during their work, not doing exercises daily 65.3%, no habit of

using the stockings 87.3%, no habit of elevating the legs while sleeping

95.3%.

Paresh Prajapati (2015) conducted a cross-sectional study to

interview traffic policemen in Ahmedabad city with prior permission.

The study included 482 individuals including men were 98.5% and

women were 1.5%. All were literate with 95% were Hindu. 56% had job

experience about 3-6 years. 3% had varicose vein, and 16% had

disturbed sleep due to various reasons.

Gregory Piazza, MD, MS (2014) conducted a study result

revealed that varicose veins Generally, more common in women and

older adults, varicose veins affect 22 million women and 11 million men

between the ages of 40 to 80 years.1 Of these, 2 million men and women

will develop symptoms and signs of chronic venous insufficiency,

including venous ulceration. The sheer prevalence of varicose veins and

27

the substantial cost of treating late complications such as chronic venous

ulcers contribute to a high burden on health care resources. Chronic

venous ulcerations result in the loss of 2 million workdays and cost an

estimated $3 billion per year to treat in the United States.3 Even

varicose veins alone, without more advanced signs of chronic venous

insufficiency, result in important reductions in quality of life.

Marilia Formentini Scotton (2014) conducted a retrospective

cohort study of patients with venous ulcers. Ulcer area was measured at

the first visit (T0) and after 6 months (T6) and 1 year (T12). poor

adherence to compression therapy (RR=4.04; 95%CI 1.31 to 12.41), and

infection episodes (RR= 0.42; 95%CI 0.23 to 0.76). At T12, lower

reductions were associated with longstanding ulcer (RR=0.95; 95%CI

0.92 to 0.98), longer topical antibiotic use (RR=0.93; 95%CI 0.87 to

0.99), and systemic antibiotic use (RR=0.63; 95%CI 0.40 to 0.99).

Longstanding ulcer, infection, poor adherence to compression therapy,

and longer topical and systemic antibiotic use were independently

correlated with worse healing rate.s

2.1.3. LITERATURE RELATED TO KNOWLEDGE ON

PREVENTION AND MANAGEMENT OF VARICOSE VEINS

Emily Boyle (2019) conducted an anonymous online questionnaire

was emailed to all members of the Irish Association of Vascular

Surgeons and the Northern Ireland Vascular Society. Moreover, 43.3%

of respondents claim to know their post-operative VTE rate and this

varies from 0 to 1% with one mortality reported. The majority of

respondents use single-dose thrombo prophylaxis pre-procedurally for

varicose vein ablation procedures.

Luciana Ventura Cardoso (2019) conducted a randomized

crossover study used bio impedance to evaluate variations in edema of

patients with chronic venous ulcers who used an Unna's boot and

28

conventional dressing on two different moments. totaling 60 results that

were compared and analyzed. The research was performed from

September 2014 to December 2016.In total, The authors of the literature

studied the main aspects related to the use of compressive therapy,

especially that of the Unna's boot, which was emphasized by its

effectiveness in reducing edema compared with conventional dressing.

Bioelectrical impedance analysis showed that compression therapy

(Unna's boot) more effectively prevented edema during the day than

non-compression therapy (conventional dressing) in patients with

chronic venous ulcers.

Maragadha et al. (2019) conducted an Observational study in

Thanjavur Medical College Hospital A total of 60 cases were included.

Most participants belonged to 2nd and 3rd decade of life. 55 (91%)

participants were male and5 (9%) participants were females. most

common clinical presentation of the study participants was varicosity

with 70.0%, followed by lipodermo sclerosis, leg pain,

hyperpigmentation, pruritus as 63.0%, 56.0%, 15% and 11.6%

respectively. 17 (28.33%) patients were present with a venous ulcer. 32

(53%) participants were managed surgically, and 28 (47%) participants

were managed conservatively. Most participants were treated with

multiple ligation 21.8% followed by trendelenburg operation+

stripping18.75%. Regarding the treatment, surgery is the treatment of

choice for primary varicose veins and conservative treatment for

secondary varicose veins.

Peter Glovicz (2019) conducted a systematic review of 44

randomized, placebo-controlled trials evaluating oral phlebotonics

suggested efficacy for some signs such as edema, although the global

evidence for their efficacy was insufficient to recommend routine use.

The potential value of interruption of pathologic perforators (>3.5 mm,

reflux ≥ 0.5 second, located near the ulcer bed) in C5–C6 disease cannot

https://www.sciencedirect.com/topics/medicine-and-dentistry/venous-ulcer

29

be excluded. Because of lack of controlled prospective studies, the

quality of evidence to support iliac vein stenting remains weak.

Huang T.W (2018) conducted a systematic review and meta-

analysis of randomized controlled trials (RCTs). Outcomes from short -

duration (3 to10 d) and long-duration (3 to 6 wk.) compression therapy

after GSV stripping and phlebectomies were evaluated Our study results

indicate after varicose vein surgery of the GSV regarding postoperative

pain, leg volume, incidence of complications, and duration of

absenteeism from work that there was no improve to long-term

compression therapy.

Huw O.B. Davies (2018) conducted a cohort study on a new

diagnosis of VV in each time period were analyzed in terms of

demographics, specialist referral, compression hosiery prescriptions, and

recorded SVI. Approximately two million patients from 285 GP

practices were included. In endothermal ablation after CG168 shows

significant. Age, sex, Townsend quintile, and body mass injury were

significantly related to the chance of referral and SVI through Cox

models.

Sharath Chandra Vikram Paravastu (2016) carried out a study to

compare the effectiveness of endovenous laser ablation (EVLA),

radiofrequency ablation (RFA) and ultrasound-guided foam

sclerotherapy (UGFS) versus conventional surgery in the treatment of

SSV varices When the data permitted, we performed either fixed-effect

meta-analyses with odds ratios (ORs) and 95% confidence intervals

(CIs) or random-effects meta-analyses where there was moderate to

significant heterogeneity.

https://www.sciencedirect.com/topics/medicine-and-dentistry/iliac-vein

https://www.sciencedirect.com/topics/medicine-and-dentistry/stenting

30

2.1.4. LITERATURE RELATED TO EFFECTIVENESS OF

PLANNED TEACHING PROGRAMME:

Chanchal Malviya (2018) carried out a descriptive study to assess

the knowledge regarding varicose vein and its management among 30

ICU nurses in selected hospital of indore city. Majority 20% of the ICU

Nurses had poor knowledge, 50% had average knowledge, 27% of ICU

Nurses had good knowledge, 3% of ICU Nurses had excellent

knowledge regarding varicose vein and its management.

Khalid Anwer Al-Mugheed (2018) conducted a descriptive study

with the registered nurses who currently work in a university hospital of

Northern Cyprus.165 voluntary participants included in this study. The

results of the study showed that nurses had a high level of general

knowledge on deep vein thrombosis. However, they had inadequate

knowledge on deep vein thrombosis risks, preventive measures, and

poor practices with respect to the prevention of deep vein thrombosis.

Based on the results of the study, implementation of

comprehensive, systematic, and continuous educational programs to

enhance the knowledge and practices of the nurses on deep vein

thrombosis was recommended .

Upendrababu Vinil et al (2018) conducted a pre experimental

study and the research design was one group pretest post-test design. 30

staff nurses were selected by using non probability convenient sampling

technique from the Rama hospital, Kanpur. The pretest knowledge was

assessed on the first day and information booklet was given on the same

day and post-test knowledge was assessed by using the same tool on the

7th

day. The study was Statistically significant at 0.005 level. The total

mean post-test knowledge score (12.6) was higher than the mean pretest

score (8.73). Therefore, the study result concludes that there was a

significant improvement in the knowledge level of staff nurses after the

https://www.sciencedirect.com/topics/nursing-and-health-professions/registered-nurse

https://www.sciencedirect.com/topics/nursing-and-health-professions/university-hospital

31

provision of information booklet. So, information booklet is an effective

strategy to improve the knowledge among staff nurses.

Ann Barnes (2016) carried out an evaluatory approach with pre–

experimental (one group pre-test post-test) design. The sample consisted

of 60 teachers selected by purposive sampling technique. The mean

post-test knowledge score (17.82) was apparently higher than the mean

pre-test knowledge score (13.9). Computed ‗t‘value (t59 = 12, p<0.05)

showed a significant difference suggesting that the self -instructional

module was effective in increasing the knowledge of teachers regarding

prevention and management of varicose veins.

Bhuvaneswari Krishnamoorthy (2016) conducted a study on

learning curve associated problems in endoscopic vein harvesting and

the requirement for a standardised training programme. Our recent

experience with the utilization of a structured training programme

highlights the potential benefits of this training pathway over current

standard training procedures. The whole process could be time

consuming but it is an essential element of obtaining a good quality vein

conduit for a better clinical outcome.

Sangeetha D (2016) conducted the study finding revealed an

increase in the knowledge level following the video assisted teaching

program regarding prevention of varicose vein. The statistical analysis

showed that there was a significant improvement (t = 29.25, p <0.05), in

the level of knowledge after implementation of video assisted teaching

programme and significant association ( x2 = 5.091, p < 0.05) between

pre test score of knowledge on prevention and management of varicose

veins with age, professional education and years of experience.

Steven E. Zimmet (2016) conducted a study on the development

of the ―Program Requirements for fellowship education in venous and

lymphatic medicine‖, recently approved for publication in Phlebology.

32

This document‘s format follows that used by the Accreditation Council

for Graduate Medical Education (ACGME) for all ACGME-approved

programs. The mission of the American Board of Venous & Lymphatic

Medicine ―through rigorous testing, reliable certification used to

improve the quality of medical practitioners and the care of patients

related to venous disorders, and improved educational standards. To

ensure patients receive quality care from physicians well trained in the

field this is the best way.

Kapil Sharma (2013) conducted a pre-experimental research

design study to evaluate the effectiveness of self -instructional module

on prevention of varicose veins among traffic police personnel in a

selected police station at Mangalore. One group pre-test post-test design

was used in this study. Further effectiveness of self -instructional module

was tested by inferential statistics using paired ‗t‘ test (t‘=24.93

P<0.0001) on the whole, the study showed that the self-instructional

module was very effective in increasing the knowledge of traffic police

personnel on prevention of varicose veins .

33

CHAPTER-III

RESEARCH METHODOLOGY

Research methodologies related to the respective approaches are

identified and discussed. This chapter gives a brief description of the

methods adopted by the investigator for the study. It includes the

research design, setting of the study, population, sample and sample

size, sampling technique, description of tool, pilot study, data collection

procedure and plan of data analysis.

The present study was designed to determine the effectiveness of

Knowledge regarding prevention of varicose vein among police


3.1 RESEARCH APPROACH

Quantitative approach

3.2 RESEARCH DESIGN:

The research design selected for this study was pre experimental

one group pre and post –test Design.

Pre-Test 01

Ist

day

Assessment

on knowledge

regarding

prevention of

varicose vein

among Police

personnel

Intervention X

Ist day

Administration

of planned

teaching

programme

among police

personnel with

help of flash

card, ppt,

pamphlet,

calendar

Post-Test 02

After 7 days

Assessment on

knowledge

regarding

prevention of

varicose vein

among police

personnel

34

KEY

01 Pre-test (O1) refers to pre assessment of the police personnel

knowledge on prevention of varicose veins

X Intervention (X) refers to the Planned teaching program on

prevention of varicose veins among police personnel about 30 to 45

minutes.

O2 Post-test (O2) refers to re-assessment of the same after one-

week using Planned questionnaire.

3.3 DURATION OF STUDY

The study was conducted for four weeks from 02.02.2019 to

04.03.2019.

3.4 STUDY SETTING

The study was conducted at New washermanpet police station

3.5 STUDY POPULATION

The population of the study will comprise Police personnel

working in Chennai.

3.6 SAMPLE SIZE

The sample consist of 60 Police personnel.

3.7 CRITERIA FOR SAMPLE SELECTION

3.7.1 Inclusion Criteria

1) Police personnel working in Chennai.

2) Police personnel who are willing to participate in the study.

3) Able to read and write Tamil or English.

35

3.7.2 Exclusion Criteria

1) Police personnel are on leave or not available during data

collection.

2) Who attended any educational programme regarding varicose

vein.

3) Police personnel who have been diagnosed and undergoing

treatment for varicose vein.

4) Police personnel working in another city.

5) Traffic police personnel, Women police, Military personnel are

excluded.

3.8 SAMPLING TECHNIQUE

Non-probability Convenient sampling technique will be used.

3.9 RESEARCH VARIABLES

Variables are characteristics that vary among the subjects being

studied.

3.9.1. Independent variable: Planned teaching Programme

regarding prevention of varicose vein.

3.9.2 Dependent variable : Knowledge scores about prevention

of Varicose Vein.

3.10 DEVELOPMENT AND DESCRIPTION OF THE TOOL

3.10.1 Development of Tool

Tool was collected after extensive literature review from the

various text books, internet search, guidance and discussion with experts

in the field of nursing, medicine and statistics. A planned questionnaire

was used to collect data from the police personnel working in Chennai.

36

3.10.2 Description of tool

The tool consisted of Section A and Section B

1) Section A: Socio-demographic data

It includes the demographic characteristics of the police personnel

such as age, marital status, food habits, habits, education, occupation,

monthly income, duration of duty hours, family history, exercise.

2) Section B: Planned Questionnaire

Planned questionnaire used to assess the knowledge on prevention

of varicose veins. Questions related to

Part A: Knowledge on Varicose veins, Risk factors, Diagnostic

method, Management

Part B: Prevention of Varicose vein –Diet, Exercise, Non-surgical

interventions.

3.10.3 Scoring procedure

S.No Aspects No.of. Items

1. Knowledge on Varicose Veins 3

2. Risk factors 5

3. Diagnostic method 2

4. Management 10

5. Diet 2

6. Exercise 2

7. Non-surgical interventions 6

Total 30

The level of knowledge about knowledge on varicose vein,

prevention on varicose vein was interpreted as follows. Min=0 Max=1

Total questions=30 Maximum marks= 30.

37

S.No. Grade Percentage Marks

1. Inadequate knowledge 0 – 50% 0.0-15.0

2. Moderate knowledge 51 – 75% 16.0-22.0

3. Adequate knowledge 76 – 100 % 23.0-30.0

3.11 CONTENT VALIDITY

Data collection tool is an instrument that measures the variables

of interest of the study accurately, precisely and sensitively. After

construction of questionnaire for ―A study to assess the effectiveness of

Planned teaching programme on knowledge regarding prevention of

Varicose vein among Police personnel working in Chennai‖. It was

tested for its validity and reliability. Validity of the tool was assessed

using content validity. Content validity was determined by experts from

Nursing and Medical. They suggested certain modifications in tool.

After the modifications they agreed this tool for assessing effectiveness

of Planned teaching programme on knowledge regarding prevention of

Varicose vein among Police personnel working in Chennai . Hence, the

investigator precedes the same tool.

3.11 RELIABILITY OF THE TOOL

After conducting pilot study, Reliability of the tool was assessed

by using Test retest method. Knowledge score reliability correlation

coefficient value is 0.79. This correlation coefficient is very high and it

is good tool for assessing effectiveness of Planned teaching programme

on knowledge regarding prevention of Varicose vein among Police

personnel working in Chennai‖.

38

Table 3.1 Intervention protocol

Place Police personnel working in Chennai

Intervention Planned teaching programme

Tool Planed teaching questionnaire

Duration Four weeks

Time

Morning 8am to 12 noon

Evening 3pm to 5pm

Administered by The investigator

Recipient Police personnel working in Chennai

Procedure Video troops

Flash cards

Pamphlet

Exercise demonstration

Calendar

3.13 ETHICAL CONSIDERATIONS

The study objectives, interventions, data collection procedures

approved by the Ethics Committee of Madras Medical College, Chennai.

The Police personnel were explained about the purpose and need of the

study. They were assured that their details and answers will be used only

for research purpose. Further they were ensured that their details will be

kept confidentially.Freedom of the samples can be relieved at any time

without giving any reason. Privacy will be maintained. His routine

activities were not disturbed. Thus the investigator followed the ethical

guidelines, which were issued by the Ethics Committee after getting a

written permission.

39

3.14 PILOT STUDY

In order to test the feasibility, relevance and practicability of the

study, pilot study was conducted among ten Police personnel working in

Chennai. In a manner in which the final study would be conducted. Data

were analysed, to find out the suitability of statistical method.

3.15 DATA COLLECTION PROCEDURE

The entire data collection procedure was spread out over a period

of four weeks from 02.02.2019 to 04.03.2019; initially the investigator

approaches each Police personnel after getting permission from the

Deputy Commissioner. The investigator selected 70 police personnel as

per the inclusion and exclusion criteria. The police personnel were

introduced with the whole programme after an introduction and then a

written informed consent was obtained from them for willingness to

participate in the study. They were assured that their responses and

details will be kept confidential and will be used only for the research

purpose, Before the tool was administered some informal discussion

were made with participants to establish rapport, so that they would be

relaxed.

Planned questionnaire tool was used to assess the level of

knowledge of varicose vein and knowledge on prevention of varicose

vein among police personnel. 70 police personnel were divided in to

seven groups.10 members in each group. Pre-test level of knowledge on

prevention of varicose vein was assessed in the first day of first week.

Following the assessment planned teaching programme was

administered in groups. Group sessions were conducted for 45 minutes

to 1 hour; planned teaching programme was administered using visual

troops, power point, flash card, pamphlet, exercise demonstration,

calendar. After planned teaching programme one week later post -test

level of knowledge regarding prevention of varicose vein was assessed.

40

10 police personnel did not attend during the post-test.Schematic

representation of data collection procedure is depicted in this chapter.

3.16 DATA ENTRY AND DATA ANALYSIS

Data collected from Police personnel daily and recorded in coding

sheets by using SPSS

Demographic variables in categories were given in frequencies

with their percentages.

knowledge score was given in mean and standard deviation.

Association between demographic variables and knowledge score

were analysed using Pearson chi-square test

Quantitative knowledge score in pre-test and post-test were

compared using student‘s paired t-test.

Qualitative level of knowledge in pre-test and post-test were

compared using Stuart-Maxwell test /extended McNemar test

Simple bar diagram, Multiple bar diagram, Pie diagram, Doughnut

diagram and Box plot were used to represent the data.

41

FIGURE 3.1 SCHEMATIC REPRESENTATION OF

THE STUDY

Research approach - Quantitative approach

Data collection period – Four weeks

Study design Pre-

experimental

one group

pre-test and

post test

Study

population

Police

personnel

working in

Chennai

Sample size-60 Police

personnel

Technique-Non probability convenient Sampling

Study setting

Police personnel

working in Chennai

Research variables

Independent variable: Planned teaching Programme regarding prevention

of varicose vein

Dependent variable : Knowledge scores about prevention of Varicose Vein.

Data collection and analysis

Summary of the results

42

CHAPTER-IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with the analysis and interpretation of the data

obtained from 60 police personnel working in Chennai. The collected

data were tabulated and presented according to the objectives under the

following headings

Section-I Socio demographic profile of the Police personnel

Section-II Level of knowledge regarding prevention of varicose

vein among police personnel before planned teaching

programme

Section-III Level of knowledge regarding prevention of varicose

vein among police personnel after planned teaching

programme

Section-IV Effectiveness of the planned teaching programme

Section-V Association of post test scores in the level of knowledge

regarding prevention of varicose vein with selected

demographic variables.

43

SECTION-I: SOCIO DEMOGRAPHIC PROFILE OF THE

POLICE PERSONNEL

Table 4.1: Demographic Profile

Demographic variables No. of Police

personnel %

Age in years 20 -30 years 17 28.33%

31 -40 years 29 48.33%

41 -50 years 14 23.34%

Marital status Married 48 80.00%

Unmarried 12 20.00%

Divorce 0 0.00%

Widow 0 0.00%

Food habits Vegetarian 3 5.00%

Non Vegetarian 57 95.00%

Habits Drinking 11 18.33%

Smoking 10 16.67%

Tobacco 8 13.33%

None 31 51.67%

Education Graduate 43 71.67%

Intermediate or diploma 3 5.00%

High school certificate 10 16.67%

Middle school certificate 4 6.66%

Occupation Constable 26 43.33%

Head constable 22 36.67%

Writer 11 18.33%

Circle inspector 1 1.67%

SI-sub inspector 0 0.00%

Inspector 0 0.00%

AC-Assistant commissioner 0 0.00%

44

Demographic variables No. of Police

personnel %

Monthly

income

Rs.5000-10000 0 0.00%

Rs.10001-15000 0 0.00%

Rs.15001-25000 12 20.00%

Rs.25000&Above 48 80.00%

Duration of

duty hours per

day

6 hours 0 0.00%

8 hours 7 11.67%

>8 hours 53 88.33%

Family history

of varicose

veins

Yes 7 11.67%

No 53 88.33%

Doing Regular

exercises

Yes 22 36.67%

No 38 63.33%

The above Table 4.1 indicates the demographic information of

police personnel who participate in this study

Among the 60 Police personnel-48.33% belongs to (31-40 years),

28.33% belongs to (20-30 years) and 23.34% belongs to (41-50

years).

In case of marital status 80.00% were married,20.00% were

unmarried.

As per the food habits most of the persons were Non-vegetarian

ie.95.00%, 5%of persons were vegetarian.

For habits of the police personnel 51.67%is not have any habits,

18.33%were the habit of drinking, 16.675% were the habit of

smoking, 13.33% were the habit of using tobacco.

45

As far as the educational status of the police personnel 71.67%

were graduate, 16.67% were high school certificate,6.66% were

middle school certificate, 5% were intermediate or diploma.

According to their occupational status 43.33% were constable,

36.67% were head constable, 18.33% were writer, 6.66% were

circle inspector, in sub-inspector 0.00%, inspector 0.00%,

assistant commissioner AC 0.00%.

Among 60 police personnel 80.00% were getting salary 25,000

&above, 20.00% were 15001-25000, 0.00% were 5000-10000,

0.00% were 10001-15000.

As per their duration of duty hours per day 88.33% were working

>8 hours, 11.67% were 8 hours, 0.00% were 6 hours.

Among the participants, 88.33% does not have family history of

varicose vein, 11.67% have the family history of varicose vein.

63.3% of the police personnel does not having the habits of

regular exercise, 36.67% of the police personnel regularly

practicing the exercise.

46

Fig 4.1 Distribution of Age of the study participants

Figure 4.2 Distribution of Marital status of the study participants

47

Fig 4.3 Distribution of Food Habit of the study participants

Fig 4.4 Distribution of Habit of the study participants

48

Fig 4.5 Distribution of Education of the study participants

Fig 4.6 Distribution of occupation status of the study participants

49

Fig 4.7 Distribution of Income of the study participants

Fig 4.8 Distribution of Duration of duty hours per day of the study

participants

50

Fig 4.9 Distribution of Family history of Varicose vein of the study

participants

Fig 4.10 Distribution of Doing Regular Exercise of the study

participants

51

SECTION-II LEVEL OF KNOWLEDGE REGARDING


PERSONNEL BEFORE PLANNED TEACHING PROGRAMME

Table 4.2: Each domain wise pre-test percentage of knowledge on

prevention of varicose vein among police personnel

Table 4.2: Reveals that each domain wise pre-test percentage of

knowledge regarding prevention of Varicose vein among police

personnel. They are having maximum knowledge in Exercise (56.50%)

and minimum knowledge score in knowledge on Varicose vein

(31.67%).

S.

No Domains

No. of

questions

Min –

Max

score

Knowledge score

Mean SD

% of

mean

score

1. Knowledge on

Varicose Veins 3 0 -3 0.95 1.06 31.67%

2. Risk factors 5 0-5 2.55 1.40 51.00%

3. Diagnostic method 2 0-2 0.81 0.86 40.50%

4. Management 10 0-10 3.63 1.90 36.30%

5. Diet 2 0 - 10 1.07 0.69 53.50%

6. Exercise 2 0 -2 1.13 0.60 56.50%

7. Non-surgical

interventions 6 0 -6 2.38 1.62 39.67%

TOTAL 30 0 -30 12.52 3.53 41.73%

52

Fig 4.11 Distribution of Level of pre-test knowledge of the study participants

53

Table 4.3: Pre-test level of knowledge

Level of knowledge No. of Police personnel %

Inadequate knowledge 49 81.67%

Moderate knowledge 11 18.33%

Adequate knowledge 0 0.00%

Total 60 100%

Table 4.3 shows the level of pre-test percentage of knowledge

regarding prevention of varicose vein among police personnel. 81.67%

of police personnel are having inadequate level of knowledge score,

18.33% of them having moderate level of knowledge score and none of

them are having adequate level of knowledge score.

Knowledge Score Interpretation

Min=0 Max=1 Total questions=30 Maximum marks= 30

S no. Grade Percentage Marks

1. Inadequate knowledge 0 – 50% 0.0-15.0

2. Moderate knowledge 51 – 75% 16.0-22.0

3. Adequate knowledge 76 – 100 % 23.0-30.0

54

SECTION –III LEVEL OF KNOWLEDGE REGARDING


PERSONNEL AFTER PLANNED TEACHING PROGRAMME

Table 4.4: Each domain wise post-test percentage of knowledge on

prevention of varicose vein among police personnel

Table 4.4: Reveals that each domain wise post-test percentage of


personnel. They are having maximum knowledge in Management

(83.3%), and minimum knowledge score in Diagnostic method

(77.50%).

S.

No Domains

No. of

questions

Min –

Max

score

Knowledge score

Mean SD

% of

mean

score

1. Knowledge on

Varicose Veins 3 0 -3 2.38 .61 79.33%

2. Risk factors 5 0-5 4.15 .71 83.00%

3. Diagnostic method 2 0-2 1.55 .50 77.50%

4. Management 10 0-10 8.33 1.23 83.30%

5. Diet 2 0 - 10 1.62 .52 81.00%

6. Exercise 2 0 -2 1.50 .50 75.00%

7. Non- surgical

interventions 6 0 -6 4.82 .89 80.33%

TOTAL 30 0 -30 24.35 2.28 81.17%

55

Fig 4.12 Level of post-test knowledge of the study participants

56

Table 4.5: Post-test level of knowledge

Level of knowledge No. of police personnel %

Inadequate knowledge 0 0.00%

Moderate knowledge 12 20.00%

Adequate knowledge 48 80.00%

Total 60 100.00%

Table 4.5: shows the level of post-test percentage of knowledge

regarding prevention of varicose vein among police personnel. none of

the police personnel are having inadequate level of knowledge score.

20.00% of them having moderate level of knowledge score and 80.00%

of them are having adequate level of knowledge score.

57

Table4.6: Comparison of domain wise pre-test and post-test

knowledge score

S.

No Knowledge on

Pre-test Post-test Mean

Diffe

rence

Student’s

paired t-test Mean SD Mean SD

1 Knowledge on

Varicose Veins 0.95 1.06 2.38 .61 1.43

t=9.61

P=0.001 ***

DF= 59 ,

Significant

2 Risk factors

2.55 1.40 4.15 .71 1.6

t=8.46

P=0.001 ***

DF= 59 ,

Significant

3 Diagnostic

method 0.81 0.86 1.55 .50 0.74

t=6.94

P=0.001 ***

DF= 59 ,

Significant

4 Management

3.63 1.90 8.33 1.23 4.7

t=17.52

P=0.001 ***

DF= 59 ,

Significant

5 Diet

1.07 0.69 1.62 .52 0.55

t=6.08

P=0.001 ***

DF= 59 ,

Significant

6 Exercise

1.13 0.60 1.50 .50 0.37

t=4.28

P=0.001 ***

DF= 59 ,

Significant

7 Non- surgical

interventions 2.38 1.62 4.82 .89 2.44

t=11.71

P=0.001 ***

DF= 59 ,

Significant

Total

12.52 3.53 24.35 2.28 11.83

t=25.80

P=0.001 ***

DF= 59 ,

Significant

DF= Degrees of Freedom *** very high significant at P≤0.001

58

Table 4.6: Shows the comparison of pre-test and post-test

knowledge score regarding prevention of Varicose vein among police

personnel.

Considering knowledge on varicose vein in pre-test participants

having 0.95 score whereas in post-test having 2.38 score. Difference is

1.43. This difference is large and it is stat istically significant difference.

Considering Risk factors in pre-test participants having 2.55score

whereas in post-test having 4.15 score. Difference is 1.6. This difference

is large and it is statistically significant difference.

Considering Diagnostic method in pre-test participants having

0.81 score whereas in post-test having 1.55 score. Difference is 0.74.

This difference is large and it is statistically significant difference.

Considering Management in pre-test participants having 3.63

score whereas in post-test having 8.33 score. Difference is 4.7. This

difference is large and it is statistically significant difference.

Considering Diet in pre-test participants having 1.07 score

whereas in post-test having 1.62 score. Difference is 0.55. This


Considering Exercise in pre-test participants having 1.13 score

whereas in post-test having 1.50 score. Difference is 0.37. This


Considering Non-surgical intervention in pre-test participants

having 2.38 score whereas in post-test having 4.82 score. Difference

2.44 is. This difference is large and it is statistically significant

difference.

Significance of difference between pre-test and post-test score

was calculated using student paired t-test.

59

Fig 4.13 Box plot compares the pre-test and post-test knowledge score

on prevention of Varicose vein among police personnel

60

Table 4.7: Comparison of overall knowledge score before and after

planned teaching programme

*significant at P < 0.05 ** highly significant at P < 0.01 ***

P≤0.001 very high significant at DF= Degrees of Freedom

Table 4.7: shows the comparison of overall knowledge before and

after the administration of Planned teaching programme.

Considering Knowledge of factors related to Varicose Veins, in

pretest Police personnel are having 7.93 score and in posttest they are

having 16.42 score, so the difference is 8.49. This difference is large

and statistically significant difference.

Considering Prevention of varicose veins , in pretest Police

personnel are having 4.58 score and in posttest they are having 7.93

score, so the difference is 3.35. This difference is large and statistically

significant difference.

Considering overall knowledge score, Police personnel are

improved their knowledge from 12.52 to 24.35 after the administration

S.

No

Knowledge

on

Pre-test Post-test Mean

Difference

Student’s

paired t-test Mean SD Mean SD

1 Knowledge

of factors

related to

Varicose

Veins

7.93 2.34 16.42 1.79 8.49

t=28.90

P=0.001 ***

DF= 59 ,

Significant

2 Prevention

of varicose

veins

4.58 1.88 7.93 1.38 3.35

t=11.67

P=0.001 ***

DF= 59 ,

Significant

Overall 12.52 3.53 24.35 2.28 11.83

t=25.80

P=0.001 ***

DF= 59 ,

Significant

61

of Planned teaching programme. Or we can say, in pretest they are

able to answer only 12 questions before administration of PTP, after

administration of PTP they are able to answer up to 24 questions. Due to

PTP they are able to answer 12 more questions correctly. This difference

is statistically significant. Statistical significance was calculated by

using student‘s paired ‗t‘test.

Table 4.8: Comparison of pre-test and post-test level of knowledge

score

Level of

knowledge

Pre-test Post-test Extended

McNemar’s test N % N %

Inadequate

knowledge 49 81.67% 0 0.00%

2=51.00

P=0.001***(S)

Moderate

knowledge 11 18.33% 12 20.00%

Adequate

knowledge 0 0.0% 48 80.00%

Total 60 100.00% 60 100.0%

*significant at p<0.05 level

Table 4.8: shows the pre-test and post-test level of knowledge

among Police personnel. Before PTP, 81.67% of the Police personnel

are having inadequate level of knowledge score, 18.33% of them

having moderate level of knowledge score and none of them are having

adequate level of knowledge score. After PTP, none of the Police

personnel are having inadequate level of knowledge score, 20.00% of

them having moderate level of knowledge score and 80.00% of them are

having adequate level of knowledge score. Level of knowledge gain

score between pre-test and post-test was calculated using Extended

McNemar‘s chi-square test.

62

Fig 4.14 pre-test and post-test level of knowledge score of the study participants

63

Table 4.9: Percentage of knowledge gain score

Max

score

Mean

score

Mean Difference of

knowledge gain score

with 95% Confidence

interval

Percentage of

knowledge gain

score with 95%

Confidence interval

Pre-

test 30 12.52

11.83

(10.91 – 12.75)

39.43%

(36.37% –42.50%) Post-

test 30 24.35

Table 4.9: shows the effectiveness of planned teaching

programme on knowledge regarding prevention of Varicose vein among

Police personnel working in Chennai. On an average, in post-test after

having PTP, Police personnel are gained 39.43%more knowledge score

than pre-test score. Differences and generalization of knowledge gain

score between pre-test and post-test score was calculated using and

mean difference with 95% CI and proportion with 95% CI.

64

SECTION-IV EFFECTIVENESS OF PLANNED TEACHING

PROGRAMME

Table 4.10: Effectiveness of Planned Teaching Programme

Table 4.10: Shows each domain wise prevention of Varicose vein

knowledge gain score among the Police personnel working in Chennai.

In pre-test Police personnel are having 41.73% of knowledge score and

in post-test they are having 81.17%. So they gained 39.44% knowledge

score after Planned teaching programme. This shows the effectiveness

of planned teaching programme on knowledge regarding prevention of

police personnel.

S.

No Domains

Pre-test

knowledge

Post-test

knowledge

% of

knowledge

gain

1. Knowledge on

Varicose Veins 31.67% 79.33% 47.66%

2. Risk factors 51.00% 83.00% 32.00%

3. Diagnostic method 40.50% 77.50% 37.00%

4. Management 36.30% 83.30% 47.00%

5. Diet 53.50% 81.00% 27.50%

6. Exercise 56.50% 75.00% 18.50%

7. Non-surgical

interventions 39.67% 80.33% 40.66%

TOTAL 41.73% 81.17% 39.44%

65

Fig 4.15 Each domain wise percentage of knowledge gain

66

SECTION-V

Table 4.11: Association between police personnel post-test level of

knowledge and their demographic variables

Demographic variables

Post-test level of knowledge score

n

Chi

square

test

Inadequate Moderate Adequate

n % n % n %

Age in

years

20 -30 years 0 0.00% 7 41.17% 10 58.83% 17 2=6.91

P=0.03*

(S)

31 -40 years 0 0.00% 4 13.79% 25 86.21% 29

41 -50 years 0 0.00% 1 7.14% 13 92.86% 14

Marital

status

Married 0 0.00% 7 14.58% 41 85.42% 48

2=4.40

P=0.04*

(S)

Unmarried 0 0.00% 5 41.67% 7 58.33% 12

Divorce 0 0.00% 0 0.00% 0 0.00% 0

Widow 0 0.00% 0 0.00% 0 0.00% 0

Food

habits

Vegetarian 0 0.00% 1 33.33% 2 66.67% 3 2=0.35

P=0.55

(NS) Non Vegetarian 0 0.00% 11 19.30% 46 80.70% 57

Habits Drinking 0 0.00% 3 27.27% 8 72.73% 11

2=1.56

P=0.66

(NS)

Smoking 0 0.00% 3 30.00% 7 70.00% 10

Tobacco 0 0.00% 1 12.50% 7 87.50% 8

None 0 0.00% 5 16.13% 26 83.87% 31

Education Graduate 0 0.00% 6 13.95% 37 86.05% 43

2=3.87

P=0.27

(NS)

Intermediate or

diploma 0 0.00% 1 33.33% 2 66.67% 3

High school

certificate 0 0.00% 4 40.00% 6 60.00% 10

Middle school

certificate 0 0.00% 1 25.00% 3 75.00% 4

Occupation Constable 0 0.00% 7 26.92% 19 73.08% 26

2=3.02

P=0.38

(NS)

Head constable 0 0.00% 2 9.09% 20 90.91% 22

Writer 0 0.00% 3 27.27% 8 72.73% 11

Circle inspector 0 0.00% 0 0.00% 1 100.00% 1

SI-sub inspector 0 0.00% 0 0.00% 0 0.00% 0

Inspector 0 0.00% 0 0.00% 0 0.00% 0

AC-Assistant

commissioner 0 0.00% 0 0.00% 0 0.00% 0

67


Post-test level of knowledge score

n

Chi

square

test

Inadequate Moderate Adequate

n % n % n %

Monthly

income

Rs.5000-10000 0 0.00% 0 0.00% 0 0.00% 0

2=4.40

P=0.03*

(S)

Rs.10001-15000 0 0.00% 0 0.00% 0 0.00% 0

Rs.15001-25000 0 0.00% 5 41.67% 7 58.33% 12

Rs.25000&Above 0 0.00% 7 14.58% 41 85.42% 48

Duration

of duty

hours per

day

6 hours 0 0.00% 0 0.00% 0 0.00% 0 2=0.16

P=0.68

(NS)

8 hours 0 0.00% 1 14.29% 6 85.71% 7

>8 hours 0 0.00% 11 20.75% 42 79.25% 53

Family

history of

varicose

veins

Yes 0 0.00% 0 0.00% 7 100.00% 7 2=1.98

P=0.15

(NS)

No 0 0.00% 12 22.64% 41 77.36% 53

Doing

Regular

exercises

Yes 0 0.00% 1 4.54% 21 96.46% 22 2=5.18

P=0.02*

(S) No 0 0.00% 11 28.94% 27 71.06% 38

NS=not significant S= Significant P> 0.05 not significant *P≤0.05 significant

Table 4.11: shows the association between post-test level of

knowledge and their demographic variables.

Elder police personnel, married police personnel, more monthly

income personnel and Regular Exercise Police personnel are gained

more knowledge than others. Statistical significance was calculated

using chi square test.

68

Fig.4.16 Association between post-test level of knowledge score and age of the study participants

69

Fig.4.17 Association between police personnel post-test level of knowledge score and their

marital status of the study participants

70

Fig.4.18 Association between Post-test level of knowledge score and their monthly income of the study participants

71

Fig.4.19 Association between Post-test level of knowledge score and regularly doing exercise of the study participants

72

Table 4.12: Association between police personnel of knowledge gain

score and their demographic variables



n

Oneway

ANOVA

F-test/t-

test

Pre-test Post-test

Gain

score=

Post-pre

n % n % n %

Age in

years

20 -30 years 11.18 2.27 21.43 2.70 10.25 2.57 17 F=3.54

P=0.03*

(S)

31 -40 years 13.38 3.85 26.04 2.20 12.66 3.45 29

41 -50 years 12.36 3.79 25.43 1.95 13.07 4.01 14

Marital

status

Married 12.85 3.71 26.72 2.13 13.87 3.61 48

t=2.09

P=0.04*

(S)

Unmarried 11.17 2.41 22.75 2.73 11.58 2.27 12

Divorce 0.00 0.00 0.00 0.00 0.00. 0.00 0

Widow 0.00 0.00 0.00 0.00 0.00. 0.00 0

Food

habits

Vegetarian 12.67 4.93 23.33 4.51 10.67 3.21 3 t=0.57

P=0.56

(NS) Non Vegetarian 12.51 3.51 24.40 2.17 11.89 3.58 57

Habits Drinking 12.55 3.08 23.64 1.75 11.09 3.45 11

F=2.31

P=0.09

(NS)

Smoking 9.40 2.37 23.70 2.00 14.30 2.26 10

Tobacco 15.13 2.59 25.63 2.20 10.50 2.39 8

None 12.84 3.61 24.48 2.47 11.65 3.90 31

Education Graduate 13.05 3.72 24.84 2.18 11.79 3.78 43

F=0.46

P=0.71

(NS)

Intermediate or

diploma 13.33 .58 23.67 2.31 10.33 2.08 3

High school

certificate 11.20 2.62 23.00 2.54 11.80 3.29 10

Middle school

certificate 9.50 2.89 23.00 .82 13.50 2.52 4

Occupation Constable 13.08 3.49 24.23 2.49 11.15 2.99 26

F=2.67

P=0.06

(NS)

Head constable 11.95 3.59 24.59 2.17 12.64 3.90 22

Writer 11.45 2.11 24.00 2.19 12.55 3.30 11

Circle inspector 22.00 . 26.00 . 4.00 . 1

SI-sub inspector 0.00 0.00 0.00 0.00 0.00. 0.00 0

Inspector 0.00 0.00 0.00 0.00 0.00. 0.00 0

AC-Assistant

commissioner 0.00 0.00 0.00 0.00 0.00. 0.00 0

73



n

Oneway

ANOVA

F-test/t-

test

Pre-test Post-test

Gain

score=

Post-pre

n % n % n %

Monthly

income

Rs.5000-10000 0.00 0.00 0.00 0.00 0.00. 0.00 0

t=2.41

P=0.02*

(S)

Rs.10001-15000 0.00 0.00 0.00 0.00 0.00. 0.00 0

Rs.15001-25000 13.25 2.83 23.83 1.90 10.58 2.84 12

Rs.25000&Above 12.33 3.69 25.13 2.37 12.80 3.73 48

Duration

of duty

hours per

day

6 hours 0.00 0.00 0.00 0.00 0.00. 0.00 0 t=0.79

P=0.38

(NS)

8 hours 14.71 3.59 25.43 2.30 10.71 2.43 7

>8 hours 12.23 3.46 24.21 2.26 11.98 3.67 53

Family

history of

varicose

veins

Yes 15.57 3.41 25.00 1.83 9.43 2.51 7 t=1.90

P=0.06

(NS)

No 12.11 3.38 24.26 2.34 12.15 3.56 53

Doing

Regular

exercises

Yes 12.23 2.47 25.12 2.04 12.89 3.83 22 t=2.21

P=0.02*

(S) No 12.68 4.05 23.77 2.40 11.09 2.53 38

NS=not significant S= Significant P> 0.05 not significant *P≤0.05 significant

Table 4.12: shows the association between police personnel

knowledge gain score and their demographic variables.

elder police personnel, married Police personnel, more monthly

income personnel and regular exercise police personnel are gained more

knowledge than others.Statistical significance was calculated one-way

analysis of variance F-test and student independent t-test.

74

CHAPTER-V

DISCUSSION

This chapter is an attempt is made to highlight the important

findings of the present study and to discuss them by comparing and

contrasting with the findings of the earlier studies. The aim of the study

is to assess the effectiveness of planned teaching programme on



Planned questionnaire tool was used to assess the level of the

knowledge of varicose vein and knowledge on prevention of varicose

vein among police personnel. 70 police personnel were divided into

seven groups.10 members in each group. Pre-test level of knowledge on

prevention of varicose vein was assessed on the first day of first week.

Following it, the assessment planned teaching programme was

administered in groups. Group sessions were conducted for 45 minutes

to 1 hour; planned teaching programme was administered using visual

troops, power point, flash card, pamphlet, exercise demonstration,

calendar. After planned teaching programme of one week post-test level

of knowledge regarding prevention of varicose vein was assessed. 10

police personnel did not attend during the post-test. The data was

analysed by using descriptive and inferential statistics.

The findings of the study will be discussed based on the objectives

To assess the pretest level of knowledge on prevention of varicose


To evaluate the effectiveness of planned teaching programme on

prevention of varicose vein among police personnel by comparing

posttest knowledge scores.

75

To compare the pretest and posttest level of knowledge on


To find out the association between posttest knowledge scores

with selected demographic variables.

5.1 Findings of the socio demographic characteristics

60 Police personnel 48.33% belong to 31-40 years, 28.33% belong

to 20-30 years and 23.34% belong to 41-50 years.

80.00% were married,20.00% were unmarried.

Non-vegetarian was 95.00%, 5% of persons were vegetarian.

51.67 were not having any habits, 18.33% had the habit of

drinking, 16.675% had the habit of smoking, 13.33% had the habit

of using tobacco.

71.67% were graduate, 16.67% hadhigh school certificate holders,

6.66% were middle school certificates, 5% were intermediate or

diploma students.

43.33% were constable, 36.67% were head constable, 18.33%

were writers, 6.66% were circle inspector, in sub-inspector 0.00%,

inspector 0.00%, assistant commissioner AC 0.00%.

80.00% were getting salary 25,000 &above, 20.00% were 15001-

25000, 0.00% were 5000-10000, 0.00% were 10001-15000.

88.33% were working >8 hours, 11.67% were 8 hours, 0.00%

were 6 hours.

88.33% did not have family history of varicose vein, 11.67% had

the family history of varicose vein.

76

63.3% of the police personnel did not have the habits of regular

exercise, 36.67% of the police personnel regularly practised the

exercise.

5.2 Objective-1: To assess the pretest level of knowledge on

prevention of varicose vein among police personnel .

The pre-test knowledge on prevention of varicose vein among

police personnel showed that 81.67% are having inadequate level of

knowledge , 18.33% of them having moderate level of knowledge and

none of them are having adequate level of knowledge. pre-test value

12.52.

The above study findings were supported by the following studies

of Chanchal Malviya (2018) who carried out a descriptive study to

assess the knowledge regarding varicose vein and its management

among 30 ICU nurses in selected hospital of Indore city. Majority 20%

of the ICU Nurses had poor knowledge, 50% had average knowledge,

27% of ICU nurses had good knowledge, 3% of ICU Nurses had

excellent knowledge regarding varicose vein and its management.

Another study conducted was by Swank C Ellis, et. al (2012) to assess

the effectiveness of Information, Education and Communication

programme on prevention of Varicose Vein among 100 Leather

Industrial Workers in pre-test 75 (75%) of them had inadequate

knowledge and 25 (25%) of them had moderately adequate

knowledge.Venisha Pearl Tauro (2015) conducted a non-experimental

descriptive survey among 100 staff nurses. Many of the subjects (61%)

were having good knowledge regarding varicose vein, followed by 26%

who were having average knowledge, and 10% were having very good

knowledge. The mean percentage of overall level of knowledge was

59.64%.

77

Those study findings revealed that the prevalence of risk factors

knowledge is essential to reduce complication.

5.3.Objective-2: To evaluate the effectiveness of planned teaching

programme on prevention of varicose vein among police personnel

by comparing post-test knowledge scores

The level of post-test percentage of knowledge regarding

prevention of varicose vein among police personnel. None of the police

personnel were having inadequate level of knowledge score. 20.00% of

them were having moderate level of knowledge score and 80.00% of

them were having adequate level of knowledge score. Considering

overall knowledge score, the police personnel hadimproved their

knowledge from pre-test value of 12.52 to post-test value of 24.35 after

the administration of Planned teaching programme. Further effectiveness

of planned teaching programme was tested by inferential statistics using

paired ‗t‘ test (‗t‘=25.80 P<0.0001) on the whole, the study showed that

the planned teaching programme was very effective in increasing the

knowledge of police personnel on prevention of varicose veins.

The above study findings are supported by following studies of

Sangeetha D (2016) who conducted the pre experimental one group pre-

test post-test design on the knowledge level following the video assisted

teaching program regarding prevention of varicose vein among nurses.

The statistical analysis showed that there was a significant improvement

(t = 29.25, p <0.05), in the level of knowledge after implementation of

video assisted teaching programme and who had significant association (

x2 = = 5.091, p < 0.05). The above results were supported by a similar

study in structure teaching programme on prevention of Varicose Vein

done by Santopietro FA et al (2009) which demonstrated an increase in

post-test knowledge score 72 (72%) of them have adequate knowledge

and 28 (28%) of them have moderately adequate knowledge. (significant

level p < 0.05). Mrs. G. Jayapriya (2008) carried out a study on

78

knowledge regarding varicose vein IEC programme. one group quasi

experimental pre-test post -test design was undertaken on 100 Leather

Industrial Workers. The pretest knowledge had an overall score of 32%

and post- test knowledge had an overall score of 78%. and the mean

value 78.935 with SD 12.6609 of post-test projects 't' value 49.048 is

statistically highly significant.

Hence it was concluded that planned teaching programme was an

effective strategy to improve the knowledge in prevention of varicose


5.4.Objective-3: To compare the pretest and posttest level of

knowledge on prevention of varicose vein among police personnel

In pre-test knowledge regarding prevention of varicose vein

among police personnel. 81.67% of police personnel were having

inadequate level of knowledge score, 18.33% of them were having

moderate level of knowledge score and none of them were having

adequate level of knowledge score.The level of post-test percentage of


personnel. None of the police personnel were having inadequate level

of knowledge score. 20.00% of them were having moderate level of

knowledge score and 80.00% of them were having adequate level of

knowledge score. Considering the overall knowledge score, police

personnel had improved their knowledge from pre-test value 12.52 to

post-test value 24.35 after the administration of planned teaching

programme. Further effectiveness of planned teaching programme was

tested by inferential statistics using paired ‗t‘ test (‗ t‘=25.80 P<0.0001).

On the whole, the study showed that the planned teaching programme

was very effective in increasing the knowledge of police personnel on

prevention of varicose veins.

79

The above study findings are supported by the following studies

Upendrababu Vinil (2018) conducted pre experimental study and the

research design was one group pre-test post-test design on Information

booklet is an effective strategy to improve the knowledge regarding

prevention and management of varicose vein among the staff nurses.

The results concluded that the total mean post-test knowledge score

(12.6) was higher than the mean pre-test score (8.73). Therefore, the

study result concluded that there was a significant improvement in the

knowledge level of staff nurses after the provision of information

booklet. So, information booklet is an effective strategy to improve the

knowledge among staff nurses. Ann barnes (2016) carried out an

evaluatory approach with pre–experimental (one group pre-test post-

test) design. The sample consisted of 60 teachers selected by purposive

sampling technique. The mean post-test knowledge score (17.82) was

apparently higher than the mean pre-test knowledge score (13.9).

Computed ‗t‘value (t59 = 12, p<0.05) showed a significant difference

suggesting that the self-instructional module was effective in increasing

the knowledge of teachers regarding prevention and management of

varicose veins. Kapil Sharma (2013) conducted the study results shows

the effectiveness of self-instructional module was tested by inferential

statistics using paired ‗t‘ test (‗t‘=24.93 P<0.0001) on the whole, the

study showed that the self-instructional module was very effective in

increasing the knowledge of traffic police personnel on prevention of

varicose veins.

Those study results revealed that the planned teaching programme

is an effective strategy to improve the knowledge regarding prevention

on varicose vein.There will be a significant difference between the pre

and posttest knowledge scores of police personnel regarding prevention

of varicose vein. Hence, the hypothesis H1 was accepted.

80

5.5.Objective-4: To find out the association between posttest

knowledge scores with selected demographic variables

The association between post-test level of knowledge and their

demographic variables.Elder police personnel, married police personnel,

more monthly income personnel and regularly doing exercise police

personnel gained more knowledge than the others. Statistical

significance was calculated using chi square test. Persons between aged

41-50 years have adequate knowledge of 92.86% chi square value x2-

6.91 (p-0.03). It shows older age person are interest to gain knowledge

than the others. Married police personnel chi square value was x2-4.40

(p-0.04). more monthly income personnel chi square value x2-4.40(p-

0.03). Regular Exercise Police personnel chi square value was x2-4.40

(p-0.02).

The above study findings supported another study conducted by

Siddharth Mishra, et al-2019 The age of the patients ranged from 19 to

70 years. Maximum patients were in the age group of 45 to 54 years

(21.67%).44 patients (73%) had a history of prolonged standing out of

with 17 had history of mainly standing, 6 had history of standing and

walking, 12 had history of standing and sitting, 9 had history of

standing, walking, and sitting. Gorijavolu Naveen Kumar

201)conducted study also shows the same report , The age of the patients

ranged from 10 to 75. Commonest age group affected was between 31-

40 yrs. Out of 50 patients 13 were female and 37 were male. In 7

patients (14%) there was positive family history of presence of varicose

veins and in 43 patients (86%) occupational influence was seen. Li

Erding 2017 carried out a study that concluded that logistic regression

analysis showed that age (OR=1.317, 95%CI: 1.196-1.450), standing

time (OR=1.712, 95%CI: -2.423 1.209) and family medical history

(OR=2.706, 95%CI: 1.444-5.073) were main risk factors. Elastic

stockings (OR= 0.052, 95%CI: 0.025-0.107), legs-raising (OR=0.201,

95%CI: 0.095-0.425) and physical exercise (OR=0.141, 95%CI: 0.072-

81

0.274) were main protective factors. What‘s more, age (r=0.47, P <

0.01) and working years (r=0.51, P<0.01) were linearly related to lower

extremity varicose veins in nurse‘s population respectively. It was

concluded that age, standing time and family medical history are risk

factors of varicose veins among female nurses in East china hospitals.

Hossein Ebrahimi 2015 conducted a study and its result showed that

Prevalence of varicose veins was 47.7%. Varicose veins were

significantly associated with age (OR=1.08; 95% CI: 1.03, 1.13); family

history of varicose disease (OR=1.99; 95% CI: 1.03, 3.82) and duration

of standing (OR=2.34; 95% CI: 1.05, 5.22) and it was associated with

increasing age, family history of varicose disease, and prolonged

standing. Kakani Renitha (2015) conducted the study on risk factors.

The result shows 5.3% had family history of varicose veins, 56.7%

maintained a standing position during their work, not doing exercises

daily 65.3%, 87.3% had no habit of using the stockings, 95.3% had no

habit of elevating the legs while sleeping.

Those study results revealed that the knowledge must be need

based on the prevalence of risk factors in varicose veins like age, history

of prolonged standing, not doing exercise, no habit of using stockings,

no habit of elevating legs. There will be a significant association

between the pre and posttest knowledge scores of police personnel and

their selected demographic variables. Hence, hypothesis H2 was

accepted.

82

CHAPTER-VI

SUMMARY, IMPLICATIONS, RECOMMENDATIOS,

LIMITATIONS AND CONCLUSION

In this chapter, the summary of the study, conclusion implication

and recommendations for further researches are presented

6.1 SUMMARY OF THE FINDINGS

The study was conducted to determine the effectiveness of

planned teaching programme on knowledge regarding prevention of

varicose vein among police personnel working in Chennai. A pre

experimental study one group pre-test and post-test design was used for

this study. On conceptual framework this research was based on Ludwig

vow Bertalanffes General system theory (1962). The instruments used

for data collection was planned semi-structured questions to assess the

level of knowledge of the samples which include a pre-test and post-test

regarding prevention of varicose vein. Among the police personnel, 60

samples were selected by non probability Convenient sampling

technique. Descriptive statistics (frequency percentage, mean, standard

deviation) and inferential statistics (paired t test and chi square) were

used to analyse the data to test the study hypothesis

6.2 MAJOR FINDINGS OF THE STUDY IS SUMMARIZED

BELOW

The effectiveness of planned teaching programme on knowledge

regarding prevention of varicose vein among police personnel was

assessed by pre-test and post-test scored. Findings of the study showed

that the pre-test mean of 12.52 with the SD is 3.53 and after the planned

teaching programme the post-test mean value was 24.35 with the SD is

2.28 So the computed t value is 25.9 which is highly statistically

significant. This shows that the planned teaching programme was

83

effective to improve the level of knowledge regarding prevention of

varicose vein among police personnel.

The pre-test levels of knowledge regarding prevention of varicose

vein among police personnel on their demographic variables age in

years, marital status, food habits, habits, education, occupation, monthly

income, duration of working hours, family history, doing exercise . None

of the demographic variables are significantly associated with their pre-

test level of knowledge score. Statistical significance was calculated

using Pearson chi-square test which was not significant.

The post-test level of knowledge regarding prevention of varicose

vein among police personnel on their demographic variables age in

years, marital status, monthly income, doing exercise gained more

knowledge score than others. Statistical significance was calculated by

using Pearson chi square test.

6.3 IMPLICATION OF THE STUDY

The investigator has drawn the following implications from the

studies which are of vital concern in the field of nursing practice,

nursing education, nursing administration and nursing research.

6.3.1 Implication for Nursing Practice

Imparting knowledge about prevention of varicose vein among

staff nurses especially operation theatre nurses should be done.

In the outpatient department, the nursing professionals must

educate the patients about the prevention of varicose vein, who

visit their outpatient department with the complaints of signs and

symptoms of varicose vein.

The nurses must organize the prevention of varicose vein

awareness programme emphasizing on lifestyle modifications.

84

Survey can be conducted to select the samples and planned

education programme can be conducted on the prevention of

varicose vein.

6.3.2 Implication for Nursing Education

The nurse educator must motivate the nurses to do a project

related to prevention of varicose vein.

The faculty of nursing in the college should plan for a continuing

nursing education programme on prevention of varicose vein.

Self-interest must be cultivated among student nurses to teach

their patients regarding prevention of varicose vein.

The investigator‘s education module can be used to educate the

patients in general.

Conferences, workshops and seminars can be held for nurses to

import and update recent advancement in treating varicose vein

clients.

6.3.3 Implication for Nursing Administration

The administrator can encourage the nurses for conducting

research aspects regarding varicose vein.

The administrator can organize conferences, workshops and

seminar for nurses working in the hospital.

Poster presentation competition on prevention varicose vein can

be conducted in the hospital for the health promotion of the

society.

Both government and private sector should provide an awareness

programme on the prevention of varicose vein to the public.

85

The Nursing councils may provide a check list to improve the

quality of life of varicose vein clients.

6.3.4 Implication for Nursing Research

Nursing research done on evidence-based practice related to

varicose vein preventive measures should be implemented in the

health care institutions.

The study will be a valuable reference material for future

researchers.

The result of my study may motivate the nurses to do research on

other aspects of prevention of varicose vein.

The findings of the study would help to expand the scientific body

of professional knowledge upon which further researchers can be

conducted.

6.4 RECOMMENDATIONS

The study recommended the following for further research

A similar study can be replicated on a largescale basis

A comparative study can be conducted to assess the effectiveness

of planned teaching programme on knowledge regarding

prevention of varicose vein among police personnel between

Traffic Police and Police

A longitudinal study can be conducted to assess the vulnerability

of knowledge regarding prevention of varicose vein among police

personnel

A longitudinal study can be conducted to identify and prevent

varicose vein.

86

An experimental study can be conducted based on varicose vein

preventive measures effectiveness.

6.5 LIMITATIONS OF THE STUDY

The study is only not to assess the attitude and practice of

varicose vein but also to show the ways to prevent varicose vein.

The number of samples is limited to 60 in the present study

The duration of the study was also limited in 4 weeks periods, so

the researcher could not implement the entire teaching programme

The investigator followed only pre experimental one group pre-

test post-test design; hence the investigator could not compare the

effectiveness of knowledge with the control group

6.6 CONCLUSION

The findings of the study revealed that there was a significant

difference between pre-test and post-test. A significant difference

between scores of police personnel. There was a significant difference

between selected demographic variables and post-test knowledge scores

of police personnel regarding prevention of varicose vein. It reveals that

the planned teaching programme was effective in improving the


personnel. Planned teaching programme is easily understandable and

cost effective programme, which improves the knowledge regarding


19

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9) www.sid.ir

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http://www.umsha.ac.ir/jrhs

http://www.recentsscientific.com/

http://www.anvpublication.org/

https://doi.org/10.1161/circulation%20NAHA.118.035584

https://www.ahajournals.org/journal/cir

https://dx.doi.org/10.1155/2012/538627

http://www.ahdbonline.com/

http://www.indjvascsurg.org/text.asp?2017/4/2/51/205703

http://www.sid.ir/

http://www.hazards.org/standing/index.htm

http://www.ecyclopedia.com/

TOOL FOR DATA COLLECTION

Section A

Demographic Data

1. Age in years

a) 20 years-30 years

b) 31 years-40 years

c) 41 years-50 years

d) Above 51 years

2. Marital status

a) Married

b) Unmarried

c) In Separation

d) Widow

e) Living together

3. Food Habits

a) Vegetarian

b) Non-Vegetarian

4. Habits

a) Drinking

b) Smoking

c) Tobacco

d) other

e) None

5. Education

a) Graduate

b) Intermediate or diploma

c) High school certificate

d) Middle school certificate

6. Occupation

a) Constable

b) Head constable

c) SI-sub inspector

d) Inspector

e) AC-Assistant commissioner

f) DC-Deputy commissioner

7.Monthly Income

a) 5000-10000

b) 10001-15000

c) 15001-25000

d) 25000&Above

8. Duration of duty hours per day:

a) 6 hours

b) 8 hours

c) more than 8 hours

9. Family history of varicose veins: Yes / No

10. Doing Regular exercises: Yes / No

Section: B Planned knowledge questionnaire to assess the knowledge on prevention of varicose veins.

Questions related to

Part A: Knowledge on Varicose veins (Q. No 01 to 20)

Part C: Prevention of Varicose veins (Q. No 21 to 30)

Instruction for participants:

Read the above instruction carefully and answer the questions.

Totally there are 30 questions and each question carry one mark.

Each question consists of five options. The participants are requested to write only one

answer on the bracket. More than one answer is considered as invalid.

The details will be kept confidentially.

Part A: Knowledge related to Varicose Veins

KNOWLEDGE ON VARICOSE VEIN

1. The following are reason for Varicose vein

a) Acute Arterial insufficiency

b) Acute Venous insufficiency

c) Chronic Arterial insufficiency

d) Chronic Venous insufficiency

e) Not known

2. The commonly affected vein in Varicose vein

a) Femoral vein

b) Popliteal vein

c) Cephalic vein

d) Greater and lesser saphenous vein

e) Not known

3. The meaning of Telangiectasia

a) Ruptured vein

b) Spider vein

c) Compressed vein

d) Reticular vein

e) Not known

RISK FACTORS

4. One of the following is important reason for varicose vein

a) Vigorous exercises

b) Low fluid intake

c) Prolonged standing

d) Inadequate sleep

e) Not known

5.. Most risk factor for induce varicose vein

a) Age

b) Lack of movement

c) Gender

d)Alcohol and smoking

e) Not known

6. The symptom that has not considered with varicose veins

a) Leg cramps

b) Itching

c) Cold legs or feet

d) Feeling of heaviness

e) Not known

7.The skin color changes seen in varicose veins

a) Cutis marmorata

b) Hypopigmentation

c) Hyperpigmentation

d) Stasis Pigmentation

e) Not known

8. The complication of spider vein

a) Rupture of spider vein

b) Paresthesia

c) Phlebitis

d) Swelling of limb

e) Not known

DIGNOSTIC METHODS

9. The diagnostic evaluation of Varicose veins

a) Angiogram

b) MRI Scan

c) Duplex ultrasound

d) CT Scan

e) Not known

10. The commonest test used to determine varicose veins

a) Fegan’s test

b) Trendelenburg test

c) Perthe’s test

d) Multiple tourniquet test

e) Not known

MANAGEMENT

11. The important Preventive measure for varicose veins

a) Early detection

b) Avoidance of prolonged standing and sitting

c) Wearing tight socks

d) Cross the legs

e) Not known

12. The time for wearing compression stockings

a) As soon as you get up in the morning

b) After your break fast

c) Before going to travel

d) Whenever you feel pain and discomfort

e) Not known

13. The reason for an individual should not wear compression stockings

a) Arterial occlusive disease

b) Healed Venous Ulcers

c) Post thrombotic syndrome

d) Lymphedema

e) Not known

14.The time required for removal of stockings to prevent complication

a) Every hour

b) Every fourth hours

c) Every eight hours

d) Every twelfth hours

e) Not known

15. compression stockings are helpful

a) To Reduces pain

b) To Inhibits blood flow

c) To Promotes venous return

d) To Increase venous stasis

e) Not known

16. The Ideal pressure of the compression stocking to manage varicose vein

a) 8 to 10 mmHg at the ankle

b) 10 to 20 mmHg at the ankle

c) 20 to 30 mmHg at the ankle

d) 30 to 40 mmHg at the ankle

e) Not known

17. Duration to wear compression stockings for varicose veins

a) Up to two years

b) Up to one month

c) Up to six months

d) Up to five years

e) Not known

18. Curative management for varicose veins

a) Ligation & Stripping

b) Sclerotherapy

c) Laser Surgeries

d) Peripheral vascular bypass surgery

e) Not known

19. An important measure after a varicose vein surgery

a) Adequate fluid intake

b) Elevate the legs

c) Dressing

d) Not elevate the legs

e) Not known

20. The meaning of Sclerotherapy

a) Cutting & anastomosis of vein

b) Injecting medicines into the vein

c) Harvesting the vein

d) Stenting of the vein

e) Not known

Part B: Prevention of varicose veins

DIET

21. Food Rich in Rutin

a) Guava

b) Blackberries

c) Garlic

d) Egg

e) Not known

22. The item that helps increase circulation and dissolves fibrin in the blood vessels

a) Onion

b) Ginger

c) Tomato

d) Apple

e) Not known

EXERCISE

23. One of the following exercises are used to prevent varicose veins

a) Leg exercises, calf raises and walking

b) Weight lifting

c) Deep squats

d) Running

e) Not known

24. Exercise helps in varicose veins

a) To Reduces muscle tone

b) To Reduces pain and discomfort

c) To Improve venous return

d) To Improve venous stasis

e) Not known

NON-SURGICAL INTERVENTION

25. The favorable degree of leg elevation during sleep to prevent varicose veins

a) 0 to 15 degree

b)15 to 30 degree

c) 30 to 45 degree

d) 45 to 60 degree

e) Not known

26. The following action that cannot prevent varicose veins

a) Adequate rest and sleep

b) Wearing compression stockings

c) Intermittent sitting and standing

d) Crossing legs while sitting

e) Not known

27. The activity to reduce pressure in lower limbs while working

a) Do not Shift your weight from one leg to other

b) Rest your legs on a stool alternately

c) Take adequate fluid intake

d) Stand straight

e) Not known

28. This may weaken the valves in your veins for prolonged uptake

a) Thyroxine Tablets

b) Steroids

c) Progesterone and Estrogen

d) Antiplatelet

e) Not known

29. The manner of place the legs, while sitting

a) Do not cross the legs when sitting

b) Cross the legs when sitting

c) Sit with the support of legs

d) Avoid pressure on legs

e) Not known

30. Best nonsurgical treatment for varicose vein

a) Compression Stockings

b) Loose Stockings

C)Wear loose stockings

d) Tight Stockings

e) Not known

ANSWER KEYS

QUESTION

NUMBER

ANSWER

SCORE

1. D 1

2. D 1

3. B 1

4. C 1

5. A 1

6. C 1

7. D 1

8. A 1

9. C 1

10. B 1

11. B 1

12. A 1

13. A 1

14. B 1

15. C 1

16. D 1

17. A 1

18. B 1

19. B 1

20. B 1

21. B 1

22. B 1

23. A 1

24. C 1

25. B 1

26. D 1

27. B 1

28. C 1

29. A 1

30. A 1

ANSWER KEYS

QUESTION

NUMBER

ANSWER

SCORE

1. 1

2. 1

3. 1

4. 1

5. 1

6. 1

7. 1

8. 1

9. 1

10. 1

11. 1

12. 1

13. 1

14. 1

15. 1

16. 1

17. 1

18. 1

19. 1

20. 1

21. 1

22. 1

23. 1

24. 1

25. 1

26. 1

27. 1

28. 1

29. 1

30. 1

LESSON PLAN

ON

PREVENTION OF VARICOSE VEIN

LESSON PLAN ON PREVENTION OF VARICOSE VEIN

TOPIC : PREVENTION OF VARICOSE VEIN

DURATION : 45 MINUTES

GROUP : POLICE PERSONNEL WORKING IN CHENNAI

VENUE : DEPUTY COMMISSIONER OFFICE, NEW WASHERMANPET,

CHENNAI

METHOD OF TEACHING : LECTURE CUM DISCUSSION

MEDIUM OF INSTRUCTION : TAMIL

TEACHING AIDS : FLASH CARDS, PPT, VIDEO, PAMPHLETS, CALENDAR

CENTRAL OBJECTIVE:

At the completion of the Planned teaching programme the Police personnel will gain knowledge regarding prevention of

varicose veins.

SPECIFIC OBJECTIVES:

At the completion of the teaching the Police personnel will be able to

enumerate the meaning of varicose veins

list down the causes of varicose veins

identify the risk factors of varicose veins

enlist the types of varicose veins

discuss about the clinical manifestations of varicose veins

describe the diagnostic evaluation of varicose veins

define telangiectasia and its features.

discuss the management of varicose veins, complication

detail about the preventive measures of varicose veins

demonstrate about exercises used to prevent varicose veins.

S.NO

Time Specific

objectives

Content

Teachers

activity

Police

personnel

activity

A.V.

Aids

1.

2.

2mts

Enumerate the

meaning of

varicose vein

INTRODUCTION:

Varicose vein commonly occurs in the

general population. The physical conditions

during the work and conditions of

employment are important risk factors that

induced prevalence varicose veins are

increased.

Varicose vein :

Varicose veins can be defined

as abnormally dilated tortuous

superficial veins caused by

incompetent valve closure

which results in venous

congestion and vein

enlargement. The reason is

chronic venous insufficiency.

Introducing

the topic

Explaining

listening

Video teaching

3.

4.

.

3mts

2mts

list the causes

of varicose vein

identify the risk

factors

ETIOLOGY:

Idiopathic

Prolonged standing or sitting

Congenital weakness of the vein structure

Female gender

Pregnancy

Obesity

Incompetent venous valves

Increasing age

Infections and trauma

RISK FACTORS:

Age

Female Gender

Family history

Obesity

Pregnancy

Prolonged Standing or sitting

Explaining

Explaining

Listening

Listening

Video teaching

Flash card

5.

6.

7.

2mts

2mts

3mts

Enlist the types

of varicose vein

discuss about

the clinical

manifestation

describe the

diagnostic

evaluation of

Types of Varicose vein

Greater saphenous varicose vein

Lesser saphenous varicose vein

Branch type

Reticular varicose vein

Web varicose vein

Groin area

CLINICAL MANIFESTATIONS:

Enlarged veins

Painful, achy or heavy legs.

Throbbing or cramping in legs.

Itchy legs especially in the lower leg and ankle

Discoloration of skin (stasis pigmentation)

Muscle cramps, muscle fatigue.

Ankle edema

Nocturnal cramps

Venous stasis

DIAGNOSTIC STUDIES:

History collection

Physical examination

Explaining

Explaining

Explaining

Listening

Listening

Listening

Flash card

Pamphlet

Pamphlet

varicose vein

Duplex Ultrasound Scan

Trendelenburg test I

Ask the patient to lie down,

Empty the veins by elevating the limbs,

Apply pressure at the SFJ-Using a finger/ tourniquet,

Ask the patient to stand up,

Suddenly release the pressure.

Rapid filling from above indicates SFJ incompetence.

TrendelenbergTest 2

Ask the patient to lie down,

Empty the veins by elevating

the limbs.

Apply pressure at the SFJ-

Using a finger/tourniquet, ask

the patient to standup,

maintain the pressure for 1

minute.

Filling of veins from below

indicates Perforator

Incompetence.

Fegan's test

In standing posture the places of excessive bulges within the

varicosities are marked.

Make the patient lie down. Elevate the limb to empty the

veins.

Palpate along the line of marked bulges to find out the

pits/defects in the deep fascia which transmits the incompetent

perforators

Perthe’s test

Elastic bandage is applied from toes to the groin. This causes

define

emptying of the vein.

Apply the tourniquet at the SFJ.

Remove the elastic bandage without removing the tourniquet.

Re apply the elastic bandage from above.

At the positions of perforators visible varices / Blow outs are

seen. The sites are marked.

Multiple tourniquet test

To localize the approximate site of incompetent perforator.

Ask the patient to lie down Empty the veins by elevating the

limbs

Apply 3 Tourniquets

One below SFJ and Mid-thigh

One just above the Knee joint

One just below the knee joint

Ask the patient to stand up.

Inspect for 30 sec

Take the tourniquet from below upwards

Veins dilate and fill up where the perforator is incompetent.

TELANGIECTASIA:

It also known as spider veins or angioectasias, are small dilated

8.

9.

3mts

5mts

telangiectasia

and its features.

appreciate the

management of

varicose veins

blood vessels near the surface of the skin or mucous membranes,

measuring between 0.5 and 1 millimeters in diameter.

The Causes are aging, heredity, oral birth control pills, hormonal

changes during puberty or menopause, hormone replacement

therapy, pregnancy, standing or sitting for long periods of time,

wearing a girdle or clothing that is too tight, obesity and sun

exposure etc.

The complications are

Skin ulcers

Bleeding

Phlebitis

Thrombosis

MANAGEMENT:

Pharmacological Management:

Diosmin (oral phlebotropic drug))

Hesperidin found in citrus fruits (such as oranges, lemons)

Anti-inflammatory medication such as ibuprofen or aspirin for

superficial thrombophlebitis

Analgesics

Conservative Management:

Explaining

Explaining

Listening

Listening

Pamphlet

Power point

presentation

Elevation of the legs.

Avoid prolonged sitting and standing.

Compression stockings.

Exercise

Lose weight

Unna boot

Compression Stockings:

• Compression stockings are made of a special elastic fabric.

• They are very tight at the ankle and are less tight as the stocking

moves up the leg.

• This graduated tightness helps the leg muscles squeeze fluid up

the leg, which improves blood flow from the leg back to the heart

and decreases leg swelling and pain.

• The most common recommended pressure is 30 to 40 mmHg

pressure.

• Put your stocking on first thing in the morning, before you are up

on your feet.

• Remove stockings at bedtime and every fourth hours to prevent

complications.

• Compression stockings should be worn for 6 months.

• The contraindications of compression stockings are peripheral

obstructive arterial disease, heart failure, septic phlebitis, oozing

dermatitis and advanced peripheral neuropathy.

Surgical Management:

Sclerotherapy

Vein Stripping and Ligation

Laser Treatment

Endogenous ablation therapy

Cryosurgery

Sclerotherapy:

Sodium tetradecyl sulphate 0.25 - 1ml at one site and maximum

can be 4 ml at 4 different sites in superficial vein.

Vein Stripping and Ligation:

This procedure involves tying of all varicose veins associated with

the leg's main superficial vein and removing it from the leg.

Laser Treatment:

This procedure uses no incisions or injections. Light energy from a

laser is used to make the vein fade away.

Endovenous ablation therapy:

A tiny incision is made in the skin & small catheter is inserted into

the vein. A device at the tip of the catheter heats up inside the

vein, which causes it to close off.

Cryosurgery:

A cryo probe is passed down the long saphenous vein following

saphenous femoral ligation. Then the probe is cooled with NO2 or

CO2 to a temperature of −85o. The vein freezes to the probe and

can be retrograde stripped after 5 second of freezing. It is a variant

of Stripping.

COMPLICATIONS:

Eczema & Dermatitis

Lipo-dermatosclerosis

Hemorrhage

Thrombophlebitis

Venous Ulcer

10.

5mts

discuss about

the preventive

measures of

varicose veins

Calcification

Periostitis

Marjolin’s ulcer

PREVENTION OF VARICOSE VEINS:

• Avoid prolonged standing.

• Avoid wearing tight clothing such as girdles or belts.

• Do not cross the legs when sitting.

• Walking is good exercise.

• Encourage her to maintain a normal body weight.

• To elevate her legs periodically throughout the day.

• Eat a healthy diet high in fiber and low in salt.

• Avoid wearing high heels.

• To elevate the legs 15 to 30 degree while sleeping

Quit smoking

Smoking contributes to many health problems. Studies have

shown that the high blood pressure associated with smoking also

helps cause varicose veins. Smoking is also associated with “lower

limb venous insufficiency,” where blood does not flow properly

and pools into the legs.

Avoid taking high-estrogen birth control pills

Long-term use of birth control pills containing high levels

Explaining

Listening

Video

Teaching

of estrogen and progesterone may increase your risk of

developing varicose veins.

Hormone replacement therapy may have similar effects.

Talk with your doctor about the best option for you.

Prolonged use of estrogen and progesterone may weaken

the valves in your veins and alter circulation in your legs.

Birth control that uses lower doses of estrogen is less

likely to result in varicose veins or blood clots.

Stay out of the sun

In fair-complexioned people, excessive sun exposure can

cause spider veins. Exposure to the sun also poses risks

such as the possibility of developing skin cancer.

The Centers for Disease Control and Prevention (CDC)

recommends that you always wear sunscreen when

outdoors. Stay out of the sun during midday, when the sun

is highest.

Avoid prolonged standing

Standing in one place for a long time increases venous pressure in

the legs and feet. Over time, this pressure weakens the blood

vessel walls. This will worsen existing varicose veins and could

contribute to the development of new ones. Since prolonged

standing is almost unavoidable in some jobs, mitigate the harm by

shifting your position as frequently as possible. Try to walk around

at least every 30 minutes.

Sit properly

don’t cross your legs

Sit up straight and don’t cross your legs. Good posture

improves circulation, while crossed legs may restrict blood

flow to and from the legs.

Avoid sitting for long stretches of time without taking a

break. Get up every half-hour or so to stretch or walk

around.

Keep your legs elevated when possible

Relaxing and “putting your feet up” can help reduce your

risk of developing varicose veins.

Try to raise your legs above your heart for 15 minutes, 3-4

times per day. This will help improve circulation and

reduce pressure

https://www.wikihow.com/Sit

When possible, keep your legs elevated (15-30 degree)

when sitting or sleeping.

Other options include using an inversion table or elevating

the foot of your bed so that your feet are slightly higher

than your head when you sleep

Consult with your doctor before trying these methods.

Redesign your wardrobe

Improve circulation to your lower body by avoiding tight-

fitting clothes.

Be especially careful to avoid tight fits around your waist,

legs, and groin area.

Tight clothing can make existing varicose veins worse,

and may increase your risk of developing them.

Wear comfortable, low-heeled shoes instead of high heels.

Low-heeled shoes can help tone your calves, which will

help your blood move easily through your veins. Make

sure your shoes are properly fitted to avoid pinching or

tightness.

Wear compression stockings

Developing varicose veins, try regularly using compression

stockings or hose. These can be purchased at medical supply stores

or pharmacies and come in a variety of different compressions.

Consult with your doctor before buying or wearing compression

stockings. Use a tape measure to measure your legs so that you get

the right size. Compression stockings should provide firm

compression, but shouldn’t necessarily feel tight If you will be

flying for a long trip, discuss getting compression hose with your

medical adviser.

These can help reduce strain on your legs and may be helpful for

preventing the worsening of existing varicose veins.

EXERCISES FOR VARICOSE VEINS:

• Walking-

The single best exercise for your lower extremity

circulation.

Demonstration

• Leg Lifts –

Sit on the floor or lie on your back with your feet

straight out. Slowly, lift one leg at a time from the floor. Hold your

leg in the air, letting the blood run down and back up your leg.

Slowly, lower your leg back down to the floor. Repeat on the

opposite leg.

• Calf Raises –

Stand with your legs straight. Slowly, rise on to

your tiptoes and then lower back down.

• Bicycle Legs –

Lie on your back, bringing your legs in the air and bending them

at the knee. Slowly, begin to pedal your legs as if you were riding

a bicycle.

Best Foods That Can Prevent Varicose Veins

Foods High in Rutin.

Many specialists agree that the best foods for varicose veins are

those high in rutin. The miraculous flavonoid has an array of

benefits that has many effects on the body. One of the most

essential is the ability to strengthen capillaries that are weak and

most apt to develop varicose veins. As well, rutin is a

vasoprotective (protects of blood vessels), anti-inflammatory,

antithrombotic, (protect against blood clots) and antioxidant.

Natural sources of rutin are apple, buckwheat, grapes, cherries,

apricots and blackberries.

Watercress

Watercress is an ancient remedy for a large variety of ailments. It

dates back to Hippocrates (400 BC) who called it the “cure of

cures”. It is also used quite often in modern herbal medicine to

treat varicose veins. Watercress is a rich source of vitamin K

offering 312% of the daily recommended value. It is high in B1,

B2, B6, C, E, manganese and carotenes plus iron, calcium, copper

and fiber. Watercress has a nice peppery tastes that is ideal in

salads or sandwiches.

Avocados Avocado contains vitamin C and E; both natural

elements that are excellent for vascular health. Avocados are also

rich in glutathione, which helps protect the arteries, veins and

heart from oxidant damage.

Asparagus

Asparagus is an excellent vegetable for vein health. It helps

prevent rupturing and also strengthens the capillaries and veins.

Asparagus is rich in numerous vitamins and minerals like vitamins

A, C, E and K, as well as fiber, folate and chromium. It is also

high in calcium, niacin, phosphorus and amino acids. Often found

in supermarkets in the spring. You can add this delectable treat to

a salad or steam it with a touch of lemon and butter.

Beets

Numerous specialists claim that consuming beets regularly can

help prevent varicose veins. These nicely colored vegetables

contain betacyanin, a phytochemical compound that can

drastically lower the levels of homocysteine in the body.

Homocysteine is a natural amino acid that can harm blood vessels.

To include beets in your diet, add them to salads, steam or juice

them. Also add the tops to your salad, the greens are very

nutritious.

Ginger

Ginger has been on the shelves as a spice and for its medicinal

properties for many centuries. It is widely used to treat varicose

veins and other vein issues. This is because it helps increase

circulation and dissolves fibrin in the blood vessels. It is best to

consume fresh ginger; it has a more robust flavor and is said to be

more effective in vein health. Use ginger in a variety of meals both

sweet and spicy.

Rosemary

Rosemary is often recommended for treatment of varicose veins

because it stimulates the circulation. It also contains rosmarinic

acid, a compound that can help prevent damage to your tissues

from free radicals. Rosemary is excellent in soups, potatoes and

bread. It can be used dry or fresh.

CONCLUSION:

Till now we have discussed about varicose veins definition, causes, risk factors, types, clinical manifestations, diagnostic

evaluation, pharmacological management, conservative management, surgical management, complications, preventive measures and

exercises used to prevent varicose veins.

BIBILIOGRAPHY:

• Barley & love “Short Practices of Surgery” Ed.24th; Edward Arnold publisher; 2004; 956-63.

• Black M. Joyce “Medical-Surgical Nursing” Ed.6th; Saunders publication; 2007; (2); 1426-27.

• Harrison, Principal of Internal Medicine, 12th edition, McGraw hill, Inc page number: 1024-1025.

• Lewis, Heitkemperer, Medical Surgical Nursing, 7th edition, Mosby, Elsevier, page number: 917-919.

• Smeltzer Suzanne “Brunner & Suddarth’s Textbook of Medical Surgical Nursing” Ed 11th; Lippincott; 2008; 1014-16

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9.

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:

:

:

:

10.

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:

, , , ,

, ,

:

• Barley & love “Short Practices of Surgery” Ed.24th; Edward Arnold publisher; 2004; 956-63.

• Black M. Joyce “Medical-Surgical Nursing” Ed.6th; Saunders publication; 2007; (2); 1426-27.

• Harrison, Principal of Internal Medicine, 12th edition, McGraw hill, Inc page number: 1024-1025.

• Lewis, Heitkemperer, Medical Surgical Nursing, 7th edition, Mosby, Elsevier, page number: 917-919.

• Smeltzer Suzanne “Brunner & Suddarth’s Textbook of Medical Surgical Nursing” Ed 11th; Lippincott; 2008; 1014-16

INFORMED CONSENT FORM

Title of the study: “A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF

VARICOSE VEIN AMONG POLICE PERSONNEL WORKING IN CHENNAI”.

Sample no :

Name of the participant :

Name of the principle instigator : B. Nagalakshmi.

Whether the participant’s consent was asked; yes/no

[ If the answer to the above question is yes, write the following phrase:

You agree with the manner to participate in the study].

Name and signature of/ thumb impression of the participant/ parent/guardian.

Name ___________________________signature ______________________

Date __________________________

Name and signature of the investigator or his representative obtaining consent:

Name____________________________signature___________________

Date _________________________-

INFORMATION TO PARTICIPANTS

Title: “A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF VARICOSE VEIN

AMONG POLICE PERSONNEL WORKING IN CHENNAI”.

Investigator : B. Nagalakshmi

Name of the Participant :

Date :

Age/sex

You are invited to take part in this study. The information in this document is meant to help

you decide whether or not to take part. Please feel free to ask if you have any queries or

concerns.

You are being asked to Cooperative in this study being conducted in selected Institute of

mental health hospital at Chennai.

What is the Purpose of the Research (explain briefly)?

This research is conducted to evaluate to assess the effectiveness of Planned teaching

programme on knowledge regarding prevention of Varicose vein among Police personnel

working in Chennai.

We have obtained permission from the Institutional Ethics Committee.

Study Procedures

Study will be conducted after approval of ethics committee

A written formal permission will be obtained from authorities of Rajiv Gandhi

Government General Hospital at Chennai to conduct study.

The purpose of study will be explained to the participants.

The investigator will obtain informed consent.

Possible benefits to other people

The result of the research may provide benefits and also empathetic care to them by

investigator.

Confidentiality of the information obtained from you

You have the right to confidentiality regarding the privacy of your personal details. The

information from this study, if published in scientific journals or presented at scientific

meetings, will not reveal your identity.

How will your decision not to participate in the study affect you?

Your decisions not to participate in this research study will not affect your activity of

daily living, medical care or your relationship with investigator or the institution.

Can you decide to stop participating in the study once you start?

The participation in this research is purely voluntary and you have the right to withdraw

from this study at any time during course of the study without giving any reasons.

Your Privacy in the research will be maintained throughout study. In the event of any

publications or presentation resulting from the research, no personally identifiable

information will be shared.

Signature of Investigator Signature of Participants

Date Date

CERTIFICATE FOR TAMIL EDITING

This is to certify that the dissertation work topic titled “A study to assess the

effectiveness of planned teaching progrmme on knowledge regarding prevention of

varicose vein among Police personnel working in Chennai” done by B.Nagalakshmi,

M.Sc (N)., II Year student, College of Nursing, Madras Medical College, Chennai-03 was

edited for the Tamil language appropriateness.

ள் ைர (நரம் ட் ) த ப் ைறகள்:

நீண் ட ேநரமாக நிற்பைத

த ரத்்தல் . பâ ல் இ க் ம் bgh

ப் ட்ட இைடெவளி ல்

(2 மâ ேநரத் ற் )

கால்க க் அைசைவ

ஏற்ப த் தல்.

கால் ேமல் கால் ேபாட்

அமரவ்ைத த ரத்த்ல்.

நைடப ற் க றந்த

உடற்ப ற் .

சரியான உடல் எைடைய

பராமரிதத்ல். கால்கைள கால இைடெவளி ல்

உயரத்் ண் ம் பைழய நிைலைய அைடதல்.

நார ் சத் அ கமாக ம் ,

உப்

ைறவாக ம் உள்ள

உண கைள உடெ்காள்ளல் . உயரந்்த கால் உைடய

ெச ப் கள் அâவைத த ரத்்தல். கால்கைள உறங் ம்

ேபா 15 தல் 30 ரி வைர ல் உயரத்் ைவத்தல்.

ெச யர ்கல் ரி

ெசன்ைன ம த் வக் கல் ரி,

ெசன்ைன - 600003.

ள் ைர (நரம் ட் ) - த ப் ைறகள்

(prevention of varicose vein)

INSTITUTE OF VASCULAR SURGERY, RGGGH, CHENNAI-03.

GUIDED BY HOD (Institute of Vascular Surgery) ASST.PROFESSOR All NURSING FACULTIES CON, MMC, CH-03.

. நாகலட் நிைல ெச ய இரண்டாமாண் மாண ,

ெச யர ்கல் ரி ெசன்ைன ம த் வக் கல் ரி, ெசன்ைன - 600003.

சிைர (நர )

சிைர எ ப ேம பர பி உ ள

சிைரயா ன இய நிைலைய கட

ம பித த னிைல இழ சிைரயான

வைள , ெநளி , விாி அைம

அ ேவ சிைரயி த (அ) த ம ம

இர த ஒ ட சிரம தி காரணமாகிற .

காரணிக : • த நிைல அறியாைம. • நீ ட ேநர நி த ைம அ ல நீ ட ேநரஅம தி த . • பிற பி ேபாேத சிைரயான தள வாக அைம வி த . • ெப க , க ற நிைல. • உட ப ம • சிைர ம பித ெசய திறன ேபாத • அதிக வய . • ேநா ெதா ம காய க .

அறி றிக : · ெபாியதான சிைர · வ மி த த மனான,அதி கிற வ ட ய கா க

· கீ கா ப தியி அாி றி பாக

க கா அாி

· ேதா நிற தி மா ற . · தைச பி ,தைசவ ,க கா க . இரவி ஏ பட ய கா பி , திேயா ட நி த

சிைர (நர ) ேநா க டறி ைறக

· ெச ற கால நிக க ப றி

· உட பாிேசாதைன ெதா

· இர ைடயான கமான அைல

வா ட ெப ேசாதைன-1

· ப க ெச

· கா கைள உய வதா

சிைரைய வறிதா

· விரலா அ ல தி

நி க வியா அ க.

· எழ ெச .

· தி ெர அ த ைத வி வி.

· உடன யாக ஒ ட ஏ ப த .

அ ைவ சிகி ைச பராமாி :

· ெலெராெதரபி

· சிைர உண ம க க த

· ேலச சிகி ைச,

· உ சிைரயி ேத மான ம

சிைத சிகி ைச

· ளி நிைல அ ைவ.

பா கா நடவ ைகக

கா கைள உய த .

நீ ட ேநர நி ப ம

அம வைத தவி த .

ெம ைமயான அ தமளி

கா ைறகைள பய ப த .

உட பயி சி, எைடைய ைற த .

உ னா அணி ெகா த .

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