MESSAGE. Hon ble Dr. Mansukh K. Shah Founder, Sumandeep Vidyapeeth The Chancellor, Sumandeep Vidyapeeth, Vadodara

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1 1 MESSAGE Hon ble Dr. Mansukh K. Shah Founder, Sumandeep Vidyapeeth The Chancellor, Sumandeep Vidyapeeth, Vadodara I am indeed very happy to note that the Workshop Conference On Evidence Based Nursing Education System Towards Future Challenges is being organized by the Sumandeep College of Nursing. Conference of such nature provide a great opportunity to Nursing fraternity, not only to update knowledge and keep obsessed with latest developmental scenario in the respective Nursing field, but also an occasion for the resource persons / delegates / observers to exchange ideas and interact with each other. It is a high time to create research activities among the nurses. I take this opportunity to extend warm welcome to the resource persons and delegates registered for the Workshop Conference. I wish the workshop all the success. Dr. Mansukh K. Shah Chancellor Sumandeep Vidyapeeth, Vadodara

2 2 MESSAGE Dr. Dixit M. Shah Hon ble Pro-Chancellor Sumandeep Vidyapeeth, Vadodara I am happy to note that Sumandeep College of Nursing under the aegis of Sumandeep Vidyapeeth are organizing SUVYSCON-2010, state level workshop on Evidence Based Nursing Education System Towards Future Challenges on 4 th and 5 th October The theme of the Workshop I Principal & wish all very prosperous present and still a happier future. Dr. Dixit M. Shah Pro-Chancellor Sumandeep Vidyapeeth, Vadodara

3 3 MESSAGE Dr. Jayshreeben Mehta Hon ble Vice Chancellor Sumandeep Vidyapeeth, Vadodara It gives me great pleasure that SUVYSCON as State Level Workshop Conference On Evidence Based Nursing Education System Towards Future Challenges on 4 th and 5 th October 2010 is organised by Sumandeep College of Nursing in our campus. A Nursing profession is a Nobel profession and is emerging day by day with development of innovative techniques and trends which will certainly benefits to our society. This conference would provide opportunities to the delegates to exchanges their ideas and involvement towards Nursing. success. I profoundly wish the Workshop-Conference for every Dr. Jayshreeben Mehta Vice Chancellor Sumandeep Vidyapeeth, Vadodara

4 4 MESSAGE Shree. N. N. Shah The Registrar, Sumandeep Vidyapeeth, Vadodara I am gratifying to know that Sumandeep College of Nursing is organizing a Workshop-Conference on Evidence Based Nursing Education System Towards Future Challenges on the 4 th and 5 th October Evidence based education system is an imperative part of any profession. Achievements and profession can gained only through researchable minds. It is extremely relevant and need of the hour that a profession like Nursing is also striving to reach heights through research. Globe is eagerly awaited the flow of human kind personals such as Nursing Professional. I extend my best wishes to the organizers and participants of the workshop-conference. Mr. Navin N. Shah The Registrar, Sumandeep Vidyapeeth, Vadodara

5 5 MESSAGE Dr. G.D. Mehta, Air commodore (Dr.) G. D. Mehta Director (Academics) Sumandeep Vidyapeeth FROM THE DIRECTOR S (ACADEMICS) DESK I write this message with a feeling of immense pleasure and satisfaction that Sumandeep College of Nursing is organizing a State level Workshop Conference on Evidence Based Nursing Education System in the campus. Organizing an event does not come without an effort. It requires vision, mission and hard work. I am proud to mention that under the guidance of the Principal of Sumandeep College of Nursing and her dedicated committee members have been able to organize the Workshop/ Conference in a shortest possible time. On this occasion, I take the opportunity to congratulate the Principal, teaching and non teaching staff, UG and PG students and interns for their sincere, dedicated contributions towards the success of this prestigious event and wish them all success in their future endeavors. JAI HIND My heartfelt felicitations to all of you on this occasion. Dr. G. D. Mehta, Air commodore Director (Academics) Sumandeep Vidyapeeth

6 6 MESSAGE Dr. (Col) S S Dhaliwal Hon ble Director, Dhiraj Hospital, Vadodara I am indeed very happy to note that the Workshop Conference On Evidence Based Nursing Education System Towards Future Challenges is being organised by the Sumandeep College of Nursing. It needs to be emphasized here that, Nursing is most pious but highly demanding profession. It has revolutionalized over last few decades and has grown from very simple Nursing care to highly technical nursing care. Therefore those who are associated with this profession have to be intelligent and their professional skills have to honed through exhaustive training and workshops / conferences on the latest techniques. I am sure that this conference-workshop on Evidence Based Nursing Education System Towards Future Challenges will generate necessary professional enlightenment in the minds of our faculty members and students to progress further. I extend my best wishes for the success of this workshopconference and to its organizers. Dr. (Col) S S Dhaliwal Director, Dhiraj Hospital, Vadodara

7 7 MESSAGE Dr. G.V. Shah, Dean, S.B.K.S.M.I.R.C. I am delighted to know that Sumandeep Nursing College is organizing a State Level Workshop on Evidence Based Nursing Education System towards Future Challenges on 4 th & 5 th October In Medical system, Nursing Care of patient plays an important role, and along with the advancement in Medical education, the nursing care has also witnessed significant changes. The Evidence Based Nursing Education is one step ahead in this direction. I extend my greeting to the all organizers & participants and convey my best wishes for the success of the workshop. Dr. G. V. Shah, Dean, S.B.K.S.M.I.R.C.

8 8 MESSAGE Dr. J. R. Patel Dean, K M Shah Dental College Sumandeep Vidyapeeth It is an honour and pleasure to write a few words for SUVYSCON Being professionals it is our moral duty to serve the society through various professional activities. The modern age education methods are completely revolving around the Evidence Based Education System. I am sure SUVYSCON-2010 will be a concrete milestone for the nursing faculty. I wish you all a grand success. Let s Learn Together! Let s Grow Together! With Best Wishes! Dr. J R Patel Dean, K M Shah Dental College, Sumandeep Vidyapeeth

9 9 MESSAGE Prof. Dr.B. Sankar Mani Principal, K.J.Pandya College of Physiotherapy Sumandeep Vidyapeeth I am very delighted to know that Sumandeep College of Nursing is going to organize a State Level Work Shop Conference on Evidence Based Nursing education System towards Future Challenges in the Campus of Sumandeep Vidyapeeth from 4/10/2010 to 5/10/2010. Nursing Care is an important part in the delivery of Health System to our Society. The theme of this Conference Evidence based Nursing Education will be very useful for all the Health Professionals and Delegates coming to attend this Conference. I wish Best wishes to the organizing Committee of Successful Event. K.J.Pandya College of Physiotherapy, Sumandeep Vidyapeeth

10 10 MESSAGE Prof. B. S. Patel. Director, School of Management I am extremely delighted to learn that Sumandeep College of Nursing is organizing a State Level Workshop on Evidence Based Nursing Education System Towards Future Challenges on 4 th & 5 th October Evidence Based Education is a revolutionary breakthrough in learning the modern sciences. I am confident that the workshop will produce fruitful deliberations which will benefit faculty as well as students. I wish the Workshop all the very best. Prof. B. S. Patel. Director, School of Management

11 11 MESSAGE Dr. A.K. Seth, Dean Allied Science, Sumandeep Vidyapeeth, It gives me immense pleasure to convey our best wishes to all the faculty membesr of Sumandeep College of Nursing for organizing State Level workshop SVUSCON 2010 on Evidence based Nursing Education System Towards Future Challenges on this occasion, I take the opportunity to congratulate the chair person and all the committees member of the event for their sincere and dedicated contribution to make the occasion memorable and fruitful. I assure that it is the right approch to develop the nursing profession at par with the globe. I hope the scientific persentations, discussions and other activities that are going to be held during that period would be of great help and will definitely leave new milestones. I wish SUVSCON 2010 a grand success. Dr. A.K.Seth Dean Allied AScience, Sumandeep Vidyapeeth

12 12 MESSAGE Prof. V. Rajeswari, Principal, Sumandeep College of Nursing It gives me immense pleasure to express my gratitude as Sumandeep College of Nursing is organizing the State Level Workshop Conference SUVYSCON-2010, with the theme of EVIDENCE BASED NURSING EDUCATION SYSTEM TOWARDS FUTURE CHALLENGES for the first time in the country in Nursing Profession. I hope the goal of this workshop conference will provide a road-map to follow EBNES with everyday inquiry to provide quality patient care. I am also confident that delegates will be enriched by innovative & scientific activity of SUVYSCON This symbolizes the globalization of our campus as well as standards being maintained in our Sumandeep Vidyapeeth. In addition this incorporates the body of evidence that includes quality, quantity & consistency to promote clinical practice. I wish the participants healthy stay in this beautiful campus of Sumandeep Vidyapeeth. I wish SUVYSCON-2010 to be a grand success & an exemplary event for the whole fraternity of Nursing Profession. Prof. V. Rajeswari Principal Sumandeep College of Nursing

13 13 MESSAGE Mr. Siva Subramanian Associate Professor HOD of Psychiatric Nursing, Sumandeep College of Nursing I am indeed happy to organize the state level workshop-conference on evidence based nursing education system in our institution which is a novel gift I hope it shall be useful for the participating delegates to learn new things in nursing profession and to share the views In the meet. There is always room for improvement and in academic world; no stage of attainment is the final stage. The more we achieve, the more we realize that there is a still bigger sphere us explored and undiscovered once we introspect, we find that we have not explored even our own selves completely. We need to analyze ourselves & find our dormant talents. Evidence based nursing education system has been one of the latest trends in nursing. Embracing EBNES for a nurse is not really a kiss to one s license goodbye. It only reflects the magnitude of possibilities that one is capable. I hope our humble effort will go a long way in putting the college at information super high way for making the institution a real instrument for improving the quality of nursing education and practice. Mr. Siva Subramanian M.Sc. Nursing, Associate professor HOD of Psychiatric Nursing Sumandeep College of Nursing

14 14 STATE LEVEL WORKSHOP CONFERENCE ON EVIDENCE BASED NURSING EDUCATION SYSTEM TOWARDS FUTURE CHALLENGES ON 4 TH & 5 TH OCTOBER 2010 ORGANIZING COMMITTEES Programme Chair Person : - Organizing committee : - Chair person: - Members: - Souvenir Committee: - Chair person: - Members: - Prof. V. Rajeswari (Principal) Mr. N. Siva. Subramanian Mr. Kalal Nipin Ramanlal Ms. Varsha Sharma Umashankar Mr. Vaishnav Dhawal Jagdishchandra Ms. Dola Bawali Gurudas Mr. Pavan Kumar Jain Mr. Patidar Rameshchandra Valji Ms. Shilpa Nair Mr. Gohel Mohit Ms. Rabari Nilam Reception and Registration Committee: - Chair person: - Ms. Simer Preet Kaur Members: - Ms. Himani Rathod Mr. Bhatt Priyakant Umeshanker Ms. Joshi Harshbhari Ms. Patel Ashita Invitation, Certificate & Sponsor ship Committee: : - Chair person: - Mr. Rajeev Sharma Members: - Mr. Rohit Tongariya Mr. Sharma Gaurav Yagyanarayan Mr. Khan Asif Mohamad Yusuf Ms. Chavada Preeti Ms. Christie Shelin E. Decoration Committee: - Chair person: - Mrs. Mahalaxmi B. Members: - Ms. Mamta Patel Ms. Linta Mary Methew

15 Mr. Kaushal Patidar Ms. Sojitra Khyati Hasmukhbhai Ms. Patel Neha Ms. Patel Rachana Transport Committee & Accommodation Committee: - Chair person: - Mr. Rajeev sharma 15 Members: - Scientific Session Committee: - Chair person: - Members: - Catering Committee: - Chair person: - Members: - Mr. Vishnu Patodiya Mr. Hardik Pandya Ms. Khyati Patel Mr. Kumawat Harishkumar Mr. Sandeep Choubisa Mr. Kapadiya Chintan Ms. Patel Ashita Ms. Ghandhi Hevin Ms. Patel Sejal Prof. V.Rajeswari Mr. Siva Subramanian Mrs. Maha Lakshmi Mr. Pavan Kumar Jain Mr. Rohit Tongariya Mr. Vipul Patel Mr. Virendra Kumar Jain Ms. Vidya Nair Mr. Patidar Kaushal Ravishankar Ms. Parmar Zankhana Ms. Patel Arati Cultural Committee: - Chair person: - Mrs. Mahalaxmi B. Members: - Ms. Mittal Patel Mr. Dixit Sanjaykumar Gopallal Ms. Pandya Priyanka Ms. Bhanderi Mamata D.

16 16 STATE LEVEL WORKSHOP CONFERENCE ON EVIDENCE BASED NURSING EDUCATION SYSTEM TOWARDS FUTURE CHALLENGES ON 4 TH & 5 TH OCTOBER :00 to 09:30 am Registration 09:30 to 10:30 am Inauguration PROGRAMME SCHEDULE :35 to 11:00 am EBNES - Preceptors and Role Model Prof. Anandi Chauhan. Principal, Civil Hospital, College of Nursing, Ahmedabad. 11:00 to 11:10 am Tea Break 11:10 to 11:30 am EBNES -Appraising the Evidence for developmental of nursing Profession Prof. Ramya, Principal J. G. College of Nursing, Ahmedabad. 11:30 to 11:50 am EBNES - Need for Strengthening towards in professional Nursing Prof. V. Rajeswari, Principal, Sumandeep College of Nursing. 11:50 to 12:10 pm Strategic of Evidence Based Nursing Education and Nursing Research Prof. Anand, Principal, Nurupur College of Nursing, Baroda. 12:10 to 12:30 pm EBNES - Purpose of finding evidence Why? where? how? - Mr. Rajeev Sharma, Lecturer, Sumandeep College of Nursing. 12:30 to 01:00 pm EBNES - Sources of evidence for nursing education and nursing Practice Mr. Siva Subramanian, Assos. Prof., Sumandeep College of Nursing. 01:00 to 02:00 pm Lunch 02:00 to 2:15 pm Discussion on Research Work 02:15 to 02:45 pm Practice of behavioral Science in nursing towards EBNES- Dr.Mamta Mahapatra, School of Management, Sumandeep Vidyapeeth to 3.15 pm Institutional Ethics Committee Roles & Responsibility Dr. Sandeep Shah, Research Director of Dhiraj Hospital. 03:15 to 05:00 pm Concurrent Session (Team) 05:30 to 08:00 pm Cultural Programme by participants.

17 17 STATE LEVEL WORKSHOP CONFERENCE ON EVIDENCE BASED NURSING EDUCATION SYSTEM TOWARDS FUTURE CHALLENGES ON 4 TH & 5 TH OCTOBER 2010 PROGRAMME SCHEDULE :00 to 10:30 am Concurrent Session (Team) 10:30 to 11:00 am Evidence Based Nursing Education in Past, Present, and Future Mrs. Maha Lakshmi, Assist. Prof., Sumandeep College of Nursing. 11:00 to 11:20 am EBNES - Life long learning and innovators Mr. Pavan Kumar Jain, Assist. Prof.,Sumandeep College of Nursing. 11:20 to 11:30 am Tea Break 11:30 to 12:00 pm Evidence Based Medicine for Rational use of medicine - Dr. Sagun Desai, Department of Pharmacology, S.B.K.S. Medical College and Research Institute, Sumandeep Vidyapeeth. 12:00 to 12:30 pm EBNES - Designs of Nursing Research to challenges Ms. Simer Preet Kaur, Assist. Prof. Sumandeep College of Nursing. 12:30 to 01:00 pm Barriers to connect EBNES and Research, Mr. Virendra Kumar Jain, Lecturer, Sumandeep College of Nursing. 01:00 to 02:00 pm Lunch 02:00 to 02:30 pm Discussion on Research Work 02:30 to 03:00 pm Poster Presentation & Exhibition 03:00 to 05:00 pm Valedictory Session..

18 18 Prof.Anandiben Chouhan, Principal, Govt. college of Nursing, Ahamedabad. PRECEPTOR AND ROLE MODEL IN EVIDENCE BASED NURSING EDUCATION SYSTEM An integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served. PRECEPTOR IN EBNES :- 1. A teacher; an instructor. 2. An expert or specialist, such as a specialized nurse, who gives practical experience and training to the students, especially of nursing. 3. One who gives commands, or makes rules; specifically, the master or principal of a school; a teacher; an instructor. 4. The word "preceptor" is defined as teacher or instructor. In the area of health care it means a licensed and experienced health care professional--such as a registered nurse--who takes on the responsibility to train and guide, usually newly registered nurses, who desire to become more competent in their area of expertise. Preceptors impart knowledge to nursing students in an experiential process. The need for a preceptor in EBNES :- 1) Statutory requirement of the Nursing and Midwifery Council. 2) To promote patient care. 3) To reduce the degree of stress you may experience as a newly qualified practitioner. 4) To ensure responsibilities are not placed on you too soon or inappropriately. 5) To minimize risk to yourself and the patients in the High Secure Service (HSS). The Preceptor : Attributes :- Criteria determined by the NMC to enable your preceptor to fulfill what is expected of him/her. 1) He/She must be a first level registered nurse. 2) He/She will have had at least 12 months experience within the HSS or an associated clinical field enabling them to support you. 3) He/She has been considered as a suitable role model for newly qualified practitioners in the HSS. 4) He/She will have undergone specific preceptorship training, being familiar with the requirements of support, goal setting, action planning and evaluation. 5) He/She will have met or be in the process of meeting the post registration requirements of the NMC, either in the form of 50 continuing education points or study days appropriate to their own professional development applicable to their field of clinical practice. Expectations in nursing practice :- 1) Your preceptor should have sufficient knowledge of your syllabus leading to registration to be able to help you identify your current learning needs.

19 19 2) He/She will be sufficiently experienced and competent, to help you apply theoretical knowledge to practice. 3) He/She will understand how you should integrate into the new practice area of the HSS and be committed to assist you with this process. 4) He/She understands and will assist with problems encountered in the transition from student to qualified practitioner. 5) He/She will, with you, formulate identified learning objectives to assist with this transition. Qualities of an effective nursing preceptor :- 1) Good communication skills. 2) A professional role model. 3) Willing to invest time in preceptee. 4) A good listener and problem-solver. 5) Sensitive to the needs and inexperience of the preceptee. Incentive for the Preceptor 1) Enhanced skills. 2) Recognition of role. 3) Sense of achievement. 4) Opportunity for professional development. 5) Opportunity to contribute to the development of the program. 6) Demonstration of responsibility. The Preceptee: Expectations of them within this programme 1) To communicate learning needs to the preceptor. 2) To fulfill the set learning needs / goals. 3) To communicate any concerns immediately. 4) To seek feedback and ask questions. 5) To attend meetings / lectures as programmed. Outcomes of Preceptorship 1) To be supported in orientation and adapting to your new role. 2) To consolidate pre-registration learning and competency outcomes. 3) To expand your repertoire of skills, under supervision. 4) To become a safe and confident practitioner. 5) To have had structured, collaborative support in your new role. 6) To pass through Agenda for Change gateways. Pathway for Preceptorship 1) Orientation to the Hospital / Ward / Unit, first meeting with preceptor, receipt of preceptorship guide and programme. 2) Mandatory training. 3) Formal meeting with your preceptor, and ward manager. a) Discussion on the preceptor role, and expectations of the preceptee. b) Shared setting of goals / learning outcomes, based upon your previous experience, qualifications and learning abilities. c) Setting of minimum hours working with the preceptor. d) Agreement on review periods / dates. e) Preceptorship Contract. 4) Full orientation to the ward.

20 20 5) Set-piece shadowing of experienced staff ie. Patient interviewing, Care Team meetings, documentation, computer work, external patient escorts etc. Nursing Preceptor Training For EBNES : Function :- Nursing preceptor training prepares the student, or preceptee, for adaptation to a new role in health care. Preceptors mentor the trainees and help them see the range of roles they will perform in an academic & clinical setting. They guide new nurses in the transition from student to working professional or from one nursing specialty to another. Qualities 1. Certain skills are required on the part of the preceptor in addition to having knowledge and experience in the subject matter being taught. 2. The effective nurse preceptor is a combination planner, coach, cheerleader, advocate and role model for the preceptee. 3. Nurse preceptors guide the nurse--whether newly graduated or changing specialties--in transitioning to her new role. Responsibilities 1. Preceptors provide supplemental information to strengthen the student's current knowledge. 2. Toward the goal of preparing preceptees, the nursing preceptor arranges for clinical space and a variety of clinical patient encounters within the rotation to ensure the student receives a wide clinical experience. 3. They help develop the student's skills by observing, demonstrating and advising during the clinical phase of the rotation. 4. Preceptors ensure that students do not practice outside of their known competencies and within state regulations. 5. Preceptors are required to be on-site to teach, consult and supervise the student. Training 1. Licensed registered nurses with experience in the specialty being taught the student can acquire the training to become a preceptor by attending courses provided by various medical institutions, via training materials available through online purchase or by participating in self-paced Internet-based training programs. 2. Qualification requirements for nursing preceptor training candidates, such as years of experience in the specialty area, vary from employer to employer. Benefits 1. The benefits realized by effective preceptors spread across multiple areas. 2. Nursing students benefit from support and encouragement of a practicing professional, individualized learning and increased confidence in nursing skills. 3. The nursing preceptor benefits from recognition as a role model and satisfaction of sharing knowledge and experience and opportunities to influence workplace changes. 4. The medical facility enjoys better retention of skilled nurses and recruitment of new nurses with recognized skills. 5. Nurse preceptors help students learn how to provide optimal patient care in clinical settings.

21 21 6. They use strong communications skills and demonstrate effective techniques and procedures to strengthen student skills. 7. The best preceptors teach, mentor and encourage students to leverage all available resources and model appropriate behavior and skills. 8. Nurses become better preceptors when they go beyond expectations and use innovative techniques to facilitate teaching and strengthen student learning. Things You'll Need To Be Preceptor Registered nurse licensure Clinical knowledge Experience Strong communications skills Leadership qualities Innovative thinking 1. The best nurse preceptors communicate with detailed information rather than only focusing on processes and tasks. The most effective nurse preceptors explain how and why things are done and ensure complete student understanding before moving to the next topic. They focus on benefits in addition to processes and help students gain a deeper understanding of patient needs. 2. Nurse preceptors exert greater influence when they teach students to be proactive and identify resources and information outside their specific realm of responsibility. They teach students to optimize facility-wide support services to ensure that patient and family needs are fully met. 3. Nurse preceptors are most effective when they pretend to be patients and direct students to assess their hypothetical clinical complaints, monitor blood pressure, take vital measurements and respond to requests for information. They allow students to use them as practice patients so they can become comfortable with specific procedures and situations instead of totally relying on textbooks and props. 4. Nurse preceptors improve their skills when they utilize a range of visual concepts to train students. They model appropriate behavior and demonstrate effective techniques that allow students to ask questions and interact with them. They take greater advantage of visual cues and color coded cards, personal hand-written notes and other innovative techniques to teach students and embed knowledge. 5. Nurse preceptors enhance teaching skills by encouraging frequent interaction, casual conversation and discussion with students to ensure complete understanding of procedures and make them more comfortable with tasks. Nurse preceptors strengthen their precepting role by encouraging students to interact with other professionals and engage in life-long learning. Nurses possess better precepting capabilities when they encourage creativity, demonstrate respect for students, acknowledge the difficult challenges they face and verbally encourage students by recognizing their progress and improved skills. Strong preceptors listen and communicate openly with students to build trust and increase confidence

22 22 Mrs. U. Ramya Principal, J.G. College of Nursing, Ahmadabad. APPRAISING THE EVIDENCE FOR DEVELOPMENT OF NURSING PROFESSION Introduction:- Research in nursing contributes not only scholarly but evidence to support and improve practice. As professional nurses should possess skills to evaluate the relevant research so as to generalize the findings. Nursing practice / Profession can be based on solid evidence only if critical appraisal of the research findings is done.. Usually we think that once the research results are published it is true and reliable. But we actually fail to understand the that all the studies have their own limitations and weaknesses. Hence, when the nurses would critically appraise the research report will lead to play a role in advancing the nursing knowledge in field of practice, education, administration etc. What is critical appraisal of evidence? Critical appraisal = quality assessment. It is the balanced assessment of the benefits/strengths, flaws/weakness of the study. Assessment of the research process and results. Consideration of quantitative and qualitative aspects. Critical appraisal is not: Negative dismissal of any piece of research Assessment of results alone. Based entirely on statistical analysis. Undertaken by experts only. Purposes of appraisal of the evidence: To find out the validity of the study( as close to truth as possible,) To find out the reliability of the study. To find out the applicability of the study To identify the adequacies & in adequacies. It is not only identifying the problems but also to give the alternatives and recommendations, Gain insight into potential comparison. Give interpretation of the findings. Tools of appraisal: 1. Extensive review of the journals,books, findings. 2. Systematic review. 3. Evidence based practice guidelines. 4. Critical thinking skills.

23 23 5. Questionnaire /checklists (standardized like appraisal of guidelines research and evaluation instrument AGREE to assess the methodological quality of clinical practice guidelines). 6. Access to the databases and sources. 7. Debates. Elements of appraisal: a. External Validity:- Check the applicability and the general is abilities the extent to which it is possible to generalize the results of the study/ suite the other setting /population which is determined by the exclusion & inclusion criteria of the study. b. Internal Validity: - The degree to which the design, conduct, analysis have minimized /avoided the errors. c. The appropriateness of the data analysis and interpretation. d. The ethical implication of the intervention. e. Precision. How to appraise? Type Of Study: Rate the study for the level of evidence : - Level I II III Definition (evidence obtained from ) Systematic review of all relevant RCT At least 1 RCT CT without randomization III.2 III.3 Cohort or case control analytic studies Multiple time series with/out intervention IV Opinion of respected authorities, based on clinical experience, descriptive studies or reports of expert committee. 2. Formulation of review question: Is the question focused in terms of Population studied Intervention/exposure given Outcomes considered e.g. Do anticoagulants prevent strokes in patients with atrial fibrillation? 3. IS THE HYPOTHESIS JUSTIFIABLE? 4. APPRAISAL OF RESEARCH DESIGN: How this design correspond to the design actually used.? Is there any intervention or not? Is the eligibility criteriaclearly specified? How were the subjects recruited into the samples? Is the sample sufficientl y large?

24 5. APPRAISAL OF THE DATA COLLECTION PROCEDURE: How were the data collected? Who collected the data? Which method was used? Whether the tool used for the study adequately pretewsted/reliable? 24 6.APPRAISAL OF THE DATA: DO the statistical data sufficientl y describe the major characteristics? Was the statistical test appropriate,given the level of measurement of the variable? Are the findings logically & clearly organized? Were the results of any statistical test significant? What do the test tell you about the plausibility of the research hypothesis? 7. APPRAISAL OF THE ETHICAL ASPECTS OF THE STUDY: Were the study participants subjected toany physical harm,/discomfort,distress? Did benefits outweigh any potential risksthey experienced? Were participants were fully described about procedures in advance? Was the study approved by the ethical revi ew committee? CHALLENGES FOR APPRAISAL:- i. Criteria to appraise data. ii. Data base framework. iii. Skills for searching evidence. iv. Accessibility to data bases. CONCLUSION:- The questions of appraisal quoted here are few but it varies /increases according to the study under the appraisal/appraiser/need. I would like to conclude that Critical appraisal of systematic reviews and other research is well within your capabilities. Use a recognised checklist (eg CASP) Update your literature searching skills regularly (contact your library skills trainer). This will help in the growth of the profession when the nurses will utilize the research studies to the patient care /in education/ administration after a thorough appraisal. Appraisal would help to strengthen the body of knowledge of the profession. I would like to wrap up the article by the saying: The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn and relearn. Alvin Toffler

25 25 Mrs. V. Rajeswari Professor cum Principal Sumandeep College of Nursing, Sumandeep Vidyapeeth, Vadodara. EVIDENCED BASED NURSING EDUCATION SYSTEM NEED FOR STRENGTHENING TOWARDS PROFESSIONALISM Professionalism is how one deports oneself within the nursing profession. Sociologists have identified the criteria of a profession. They are 1. Autonomy 2. Education leading to higher education 3. Theoretical knowledge 4. Code of ethics 5. Professional organization 6. Service to the society Miller, Adams and Beck (1993) developed a behavioral inventory for professionalism in nursing to measure the following: a) Education and training including continuing education b) Skill based theoretical knowledge. c) A code of ethics. d) A professional organization, and e) Service Their inventory measures, Continuing education attendance, The number of journals read, Nursing books recently purchased, Professional organization memberships, Whether nursing theories are applied in ones practice and Participation in organization and community service These authors surveyed over 5000 nurses and found that 92.3%reported reading from 1 to 10 nursing articles per month: However only 15.9%belonged to a professional organization. In some institutions philosophy the wheel of professionalism in nursing depicts components to enhance professionalism.

26 26 Wheel of professionalism :- The wheel of professionalism indicates degree of professionalism: eg: active participation in a specialty organization, enhance theory application and education helps for competence and safe patient care. And this is one way to enhance professional autonomy.one uses newer research and theory continuously, will contribute to ongoing EBNES. A difficult component of professionalism involves information overload.learning how to manage technology vital. Incorporating EBNES will become a routine part of professional practice. When nurses develop a strong sense of inquiry are flexible towards change, become aware of self and implement good communication skills and they can be thus enhancing quality of patient care. Evidence for updated practice complex and learn to manage with in and out of institution through such as volumes of , numerous websites or through online discussions. Try to understand the level of support from the management because this is a key element for a nursing culture that embraces EBNES. Nurses have a duty to give back to the profession. As a nurse you must take advantage of formal and informal unities for professional growth. It may not be evident to you at this point in your carrier but nursing professionals have an obligation to develop self-awareness. Writing an editorial on a health topic that interests you.are passionate about is another way to make nursing more visible.

27 27 Ethics for nurses with interpretive statements holds nurses able for the development of the profession. Attending structural learning program is another formal way of developing as a professional. Professional organizations offer another excellent method to promote lifelong learning. The timing of lifelong learning is a factor that enters into ones personal and professional life, think about the professional benefits, if you attend a national conference in your specialty area. Ways for professional stimulation, such as connecting with others in a similar practice at a national conference or regional conference, tends to bolster current practice. Inquire about the research process and how evidence based changes are implemente The first criteria of any profession is autonomy.autonomy is an essential element of professional nursing,clearly communicating and organizing their work to ensure that they have the freedom to act on nursing decisions using sound clinical judgment. For each and everything we need evidence by creating learning environment through strategies such are teaching rounds, formal continuing education and a climate of inquiry in every day practice Conclusion:- The nurse educators and nurse administrator must be involved in the policy making process for our profession in collaboration with health profession for empowerment through Evidence Based Nursing Education System. The curriculum also should be developed for interpretation for exploration

28 28 Prof. Anand, Principal, Nrupur College of Nursing, Vadodara. STARTEGIES TO EVIDENCE BASED PRACTICE IN NURSING What is evidence-based practice? Evidence-based practice is the integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making. Evidence-based clinical decision making should incorporate consideration of the patient s clinical state, the clinical setting, and clinical circumstances. A model for evidence-based clinical decisions. 1) EBP is a problem-solving approach to clinical decision making within a health-care organization that integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. 2) EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of evidence to care of the individual patient, patient population, or system (Newhouse, Dearholt, Poe, Pugh, & White, 2005). 3) EBP uses the latest research evidence to produce high quality health care. The challenge for health-care providers is to implement the best interventions and practices informed by the evidence. VALUE OF EVIDENCE-BASED NURSING :- 1. EBP supports and informs clinical, administrative, and educational decision-making. 2. Combining research, organizational experience (including quality improvement data and financial data), clinical expertise, expert opinion, and patient preferences ensures clinical decisions based on all available evidence. 3. EBP ensures efficacy (the ability to reach a desired result), efficiency (the achievement of a desired result with a minimum of expense, time, and effort), and effectiveness (the ability to produce the desired result).

29 29 4. EBP weighs risk, benefit, and cost against a backdrop of patient preferences. This decision making encourages health-care providers to question practice and determine which interventions work and which do not. 5. EBP ensures that nurses use evidence to promote optimal outcomes or equivalent care at lower cost or in less time and that health-care provider promote patient satisfaction and higher health-related quality of life. MODELS OF EVIDENCED PRACTICE :- The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) depicts three essential cornerstones that form the foundation for professional nursing. These cornerstones are practice, education, and research. Practice is the basic component of all nursing activity (Porter-O Grady, 1984). Nursing practice is the means by which a patient receives nursing care. It is an integral component of health-care organizations. Education reflects the acquisition of the nursing knowledge and skills necessary to become a proficient clinician and to maintain competency. Research provides new knowledge to the profession and enables the development of practices based on scientific evidence. PROCESS OF EBP :- The process can be simply described as Practice question, Evidence, and Translation (PET). PRACTICE QUESTION: The process of translating evidence into practice begins with the identification of a practice question, issue, or concern. This is one of the most crucial steps, because how the question is posed drives the remaining steps in the process.

30 30 EVIDENCE:- After the question is determined, a search for evidence is conducted. The evidence is then synthesized and appraised. Based on this appraisal, a determination is made as to whether the evidence supports a change or improvement in practice. TRANSLATION: -If indeed the evidence supports a change in practice, then evidence translation occurs the practice change is planned for and implemented. The change is then evaluated to see if the desired outcomes were obtained. The final step in translation is the dissemination of the results to patients, staff, hospital stakeholders, and, if appropriate, the local and national community. PRACTICE QUESTION :- STEP 1: Identify an EBP question STEP 2: Define the scope of the practice question STEP 3: Assign responsibility for leadership STEP 4: Recruit an interdisciplinary team STEP 5: Schedule a team conference EVIDENCE :- STEP 6: Conduct an internal and external search for evidence STEP 7: Appraise all types of evidence STEP 8: Summarize the evidence STEP 9: Rate the strength of the evidence STEP 10: Develop recommendations for change in systems or processes of care based on the strength of the evidence STEP 11: Determine the appropriateness and feasibility of translating recommendations into the specific practice setting STEP 12: Create an action plan STEP 13: Implement the change STEP 14: Evaluate outcomes STEP 15: Report the results of the preliminary evaluation to decision makers STEP 16: Secure support from decision makers to implement the recommended change internally STEP 17: Identify the next steps STEP 18: Communicate the findings CONCUSION:- Evidence-based practice (EBP) positions nurses to be a significant influence on health-care decisions and a partner in improving quality of care. Beyond an expectation for professional practice, EBP provides a major opportunity for nurses to enlighten practice and add value to the patient experience

31 31 Mr. Rajeev Sharma, Lecturer, Sumandeep College of Nursing, Vadodara. Evidence Based Nursing education system PURPOSE OF FINDING EVIDENCE WHY, WHERE, HOW INTRODUCTION EBNES An approach to clinical and teaching practice&. A way to keep current with new developments. EBNES Use of current best evidence in making decisions about education of professional nurses EBNES Research is required to provide guidelines and models to direct decision making in nursing education. PURPOSE The general purpose of Evidence-Based Nursing is to select from the health-related literature those articles reporting studies and reviews that warrant immediate attention by nurses attempting to keep pace with important advances in their profession. These articles are summarized in value added abstracts and commented on by nurses. The specific purposes of Evidence-Based Nursing are to identify, using predefined criteria, the best quantitative and qualitative original and review articles on the meaning, cause, course, assessment, prevention, treatment, or economics of health problems managed by nurses and on quality improvement. To summarise this literature in the form of structured abstracts that describe the question, methods, results, and evidence-based conclusions of studies in a reproducible and accurate fashion. To provide brief, highly expert comment on the context of each article, its methods, and the clinical applications that its findings warrant. To disseminate the summaries in a timely fashion. Why EBNES It is one step toward making sure each client gets the best service possible. Some argue it helps keep your knowledge up to date, supplements clinical judgment, can save time and most important can improve care and even save lives. Some say it's unethical to use treatments that aren't known to work. (Of course, services may need to be so individualized in unique circumstances that what works generally may not be the most salient factor in helping any particular client. Still, using existing knowledge is always beneficial Advances quality of teaching and care provided by nurses. Increases satisfaction of student and patients Refocuses nursing practice away from habits and tradition to evidence and research Health care decisions needs to be made with appropriate knowledge of all relevant and up-to-date information.

32 32 Where E v i d e n c e B a s e d R e s o u r c e How sources are organized 1. Identify and use a variety of sources, both within and outside of the field of nursing, as appropriate. 2. Understand how the sources are structured 3. Distinguish between the different sources content, in both topic or subject matter and in format. How to begin EBNES Five Steps of EBNES& Practice Define the Question Identify Question ~ Search and Screen Literature ~ Refine Question Collect the Evidence Critically Appraise the Evidence for Validity and Relevance Integrate the Evidence and Factors Make & Carry Out the Decision Evaluate the Process Results ~ Self-reflection Define the Question The first step is to select a topic. Ideas come from different sources but are categorized in two areas: Problem-focused triggers and Knowledge focused triggers (see below). When selecting a topic, nurses should formulate

33 33 questions that are likely to gain support from people within the organization. An interdisciplinary medical team should work together to come up with an agreement about the topic selection. The priority of the topic should be considered as well as the severity of the problem. Problem focused triggers are identified by health care staff through quality improvement, risk surveillance, benchmarking data, financial data, or recurrent clinical problems. Problem focused triggers could be clinical problems, or risk management issues. Collect the Evidence Once the topic is selected, the research relevant to the topic must be reviewed, in addition to other relevant literature. It is important that clinical studies, integrative literature reviews, meta-analyses and well-known and reliable existing EBP guidelines are accessed in the literature retrieval process. After determining the internal and external validity of the study, a decision is arrived at whether the information gathered does apply to your initial question. Its important to address questions related to diagnosis, therapy, harm, and prognosis. The information gathered should be interpreted according to many criteria and should always be shared with other nurses and/or fellow researchers Critically Appraise the Evidence for Validity and Relevance Critiquing criteria are the standards, evaluation guides, or questions used to judge (critique) an article. In analyzing a research report, the reader must evaluate each step of the research process and ask questions about whether each step of the process meets the criteria. Remember when you are doing a critique, you are pointing out strengths, as well as the weaknesses. The study must either have external validity or internal validity. If the study has external validity then the study's findings have different settings, procedures, and participants. External validity will also question what types of subjects and conditions in which the same results can be expected to occur. If the study has internal validity then the findings are held true within the sample. The researchers will rule out factors or threats as rival explanations of the relationship between the variables that are present. Be careful with internal validity and external validity because there are a number of threats for both that can affect the outcome of the study. Integrate the Evidence An integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served. Evaluate the Process Impact of the change is measured Assess variables (health outcomes, efficiency, cost or satisfaction

34 34. Mr.Siva Subramanian, Associate professor, Sumandeep College of Nursing, Vadodara. SOURCES OF EVIDENCE BASE NURSING EDUCATION SYSTEM Introduction :- Over the years, a variety of sources of evidence have provided information for nursing practice. While it would be nice to claim that all nursing practice is based on substancial and reliable evidence. Millenson (1997) estimated that 85% of health care practice has not been scientifically validated. Although the percentage of validated practices may have increased since Tradition :- o It has long been accepted basis for information. o Why are vital signs taken routinely every 4 hours on patients who are clinically stable? o This is the way we have always done it. o Consistent use of tradition as a basis for practice limits effective problem solving and fails to consider individual needs and preference. Authority :- E.g. Because I said so!? Various sources of authority such as books, articles, web pages and individuals and groups. These are perceived as being meaning full sources of reliable information, Yet in reality, The information provided may be based in personal experience or tradition rather than scientific evidence. Trial And Error :- Eg. In long-term care the treatment of decubitus ulcers is often based on haphazard approach. Here nurses frequently try a variety of approaches to heal ulcers. After some time they settle on one approach that is more often than not effective. This approach reduced critical thinking and wasted time. Personal Experiences:- Making decisions based on their personal experience and it frequently influenced by Tradition, authority and Trial and error. Intuition :- Quick perception of truth without conscious attention or reasoning. Gut feeling may be reliable. Barrowed Evidence :- It can be useful because it fills gaps that exist in nursing science. Provides a basis on which to build new evidence, and can be a stronger type of evidence than sources that are not based on theory and science. It is important for nurses to consider its fit with the nursing phenomenon.

35 35 Scientific Research :- It is considered the best source of evidence. There are many different research methods that can be used to describe and explain to nursing care. Best Resources For Evidence Base Nursing Education System 1. PRINTED SOURCES Encyclopedia Hard books Guides and care plan modules. 2. Electronic sources Professional journals Popular magazine News papers Industry bulletins 3. Subject -Specific Databases:- (1) TRIP-database database.com. It support of EBNES and simplify the assess to the web (2) EMBASE cover public health, occupational health, psychiatry and pharmacology. (3)CINAHL covering the area of nursing and allied health (4)PSYCINFO psyinfo International coverage of nursing, psychiatry, psychology, education & other areas (5) MEDLINE via Providing coverage of Pubmed and other medical sciences (6) Evidence-Based Help practicing nurses keep up with the nursing/ EB online based literature in a manageable manner

36 36 Dr.Mamata Mahapatra Associate Professor, Dept. Of Management, Sumandeep Vidyapeeth University. Psychology Needs of Nursing An EBNES Approach When you are a Nurse, you know that every day you will touch a Life or a Life will touch you. -Author known. Who so ever has said it,said it very rightly.as a Nurse one has to deal with every aspects of life from birth to death, sometimes within the same day or a couple of days.medical conditions,psychological conditions and the personal effects of people,social roles and responsibilities encountered on a day to day basis.to cope with the above demanding job requirements successfully,an understanding of human psychological development is vitally necessary. Psychology as a behavioural science is defined as the study of mental processes and Behaviour. Study of psychology helps in understanding the role of motives, desires, emotions and abilities on our behavior which in turn helps in understanding our own strengths and weaknesses.although psychology and Nursing are two different fields,are linked because to help people adequately to recover from health problems. Researches in the field of Nursing proved that psychological theory and practice are thoroughly integrated into the very essence of Nursing. As Gerow(2006) rightly defines psychology the study of human behavior,affect,and cognition and covers a broad range of subjects including sensation, perception, learning, memory, life development, motivation, emotion, personality, response to stress, psychological disorders, social roles and interpersonal communication. Hence there is an acute need to study psychology for a Nurse who can easil understand the behavior and emotional state of Patients. In the Book Psychology for the profession of Nursing the Author amply acknowledges that the Nurse ultimately developes a close personal relationship with patients. Thus it is Vital that a Nurse understands human emotional reactions and Psychology is the Key to comprehend this fully Psychology enhances Nursing by helping a person change behaviours such as mental thought patterns. Researches viewed that an optimistic Nurse who brings maximum comforts to the patient has even the ability to encourage positive thinking.herbert Benson an eminent Cardiologist and Professor at Harvard Medical School says that the brain s ability is to affect the body has been Scientifically proven. A positive attitude can boost the Immune System and contribute to physical Health and recovery. The field of Nursing incorporating psychology,begins to resemble a field called Biopsychology. It attempts to understand behaviour through biological theories,helps the Nurses to understand patients beyond a biological level.the expansion of fields like biopsychology continues to be an essential part in Nurse training and Nursing. Nurses are required to make diagnosis concerning the nursing needs of a client and what is considered to be human condition.an understanding of the basic processes of sensation and perception,memory and learning, motivation and emotional responses in people are of the utmost necessity in making accurate diagnoses and assisting clients in developing good health and managing diseases. The North American Nursing

37 37 diagnosis Association(NANDA)includes in its list of Nursing diagnosis conditions such as anxiety, care giver strain, ineffective coping, fear, hopelessness,disorganized infant behaviour, and loneliness just to name a few.(sundeen etal.1998). Psychology helps Nurses to manage the environment within which they work, interactions with co workers, bosses, and staff under the direction of a nurse all require interpersonal skills. The same learning that promotes a positive Nurse-client relationship is beneficial in developing a positive and productive work atmosphere in the health care institutions today. The efficiency of Nursing as a Prospective profession further demonstrates the need for self awareness, observational skills, facilitative communication and interpersonal competence. The Nurse must continuously clarify with the client behavior and the nature of his present needs and goals. The Nurse who is aware of his own dynamic being can then intervene more therapeutically in enhancing the health of another individual. As Hevern(2005)opined, ethical as well as psychological challenges necessarily accompany the practice arts. Last but not the least,a thorough orientation and systematic teaching Psychology as a behavioural science discipline will definitely give an Edge to the effective application of the Evidence Based Education system in the field of Nursing education.there is absolutely no doubt about it

38 38 Dr. Sandeep Shah, Research Director, Dhiraj Hospital, Vadodara. 1 INSTITUTIONAL ETHICS COMMITTEE ROLES AND RESPONSIBILITY (Indian council of medical research) Guidelines for preparing Standard Operating Procedures (SOP) for Institutional Ethics Committee for Human Research 1. Objective :- The objective of this SOP is to contribute to the effective functioning of the Institutional Ethics Committee (IEC) so that a quality and consistent ethical review mechanism for health and biomedical research is put in place for all proposals dealt by the Committee as prescribed by the Ethical guidelines for biomedical research on human subjects of ICMR. 2. Role of IEC :- IEC will review and approve all types of research proposals involving human participants with a view to safeguard the dignity, rights, safety and well being of all actual and potential research participants. The goals of research, however important, should never be permitted to override the health and well being of the research subjects. The IEC will take care that all the cardinal principles of research ethics viz. Autonomy, Beneficence, Non - maleficence and Justice are taken care of in planning, conduct and reporting of the proposed research. For this purpose, it will look into the aspects of informed consent process, risk benefit ratio, distribution of burden and benefit and provisions for appropriate compensations wherever required. It will review the proposals before start of the study as well as monitor the research throughout the study until and after completion of the study through appropriate well documented procedures for example annual reports, final reports and site visits etc. The committee will also exa mine compliance with all regulatory requirements, applicable guidelines and laws.the mandate of the IECs will be to review all research projects involving human subjects to be conducted at the Institute, irrespective of the funding agency. The role of IEC can be modified according to the requirement of each Institute 3. Composition of IEC :- IECs should be multidisciplinary and multisectorial in composition. Independence and competence are the two hallmarks of an IEC. The number of persons in an ethical committee should be kept fairly small (7-9 members). It is generally accepted that a minimum of five persons is required to compose a quorum. There is no specific recommendation for a widely acceptable maximum number of persons but it should be kept in mind that too large a Committee will make it difficult in reaching consensus opinions is the maximum recommended number.

39 39 Indian Council of Medical Research :- The Chairperson of the Committee should preferably be from outside the Institution and not head of the same Institution to maintain the independence of the Committee. The Member Secretary who generally belongs to the same Institution should conduct the business of the Committee. Other members should be a mix of medical / non-medical scientific and non-scientific persons including lay public to reflect the differed viewpoints. The composition may be as follows :- 1. Chairperson basic medical scientists clinicians from various Institutes 4. One legal expert or retired judge 5. One social scientist / representative of non-governmental voluntary agency 6. One philosopher / ethicist / theologian 7. One lay person from the community 8. Member-Secretary The ethical committee at any institution can have as its members, individuals from other institutions or communities if required. There should be adequate representation of age, gender, community, etc. in the Committee to safeguard the interests and welfare of all sections of the community / society. Members should be aware of local, social and cultural norms, as this is the most important social control mechanism. If required, subject experts could be invited to offer their views, for example for drug trials a pharmacologist, preferably a clinical pharmacologist, should be included. Similarly, based on the requirement of research area, for example HIV, genetic disorders etc. specific patient groups may also be represented in the Committee. The membership of IEC will include Epidemiologist(s), Sociologist(s), Lawyer(s), Theologian, Statistician(s), Clinician(s), Basic scientists, Pharmacist(s)/Clinical Pharmacologist(s) etc They should be appointed by the Head of the Institute based on their competencies and integrity, and could be drawn from any public or private Institute from anywhere in the country. IEC should be constituted in the following pattern: i) A Chairperson ii) A Deputy Chairman if need be, iii) A Member Secretary, iv) 5-15 members from different Departments / Specialties / disciplines or areas etc. 4. Authority under which IEC is constituted: The Institutional Head constitutes the IEC. 5. Membership requirements: a. The duration of appointment is initially for a period of 2-3 years Indian Council of Medical Research b. At the end of 2-3 years, as the case may be, the committee is reconstituted, and 50% of the members will be replaced by a defined procedure. c. A member can be replaced in the event of death or long-term nonavailability or for any action not commensurate with the responsibilities laid down in the guidelines deemed unfit for a member. d. A member can tender resignation from the committee with proper reasons to do so. e. All members should maintain absolute confidentiality of all discussions during the meeting and sign a confidentiality form. f. Conflict of interest should be declared by members of the IEC

40 40 6. Quorum requirements :- The minimum of 5 members are required to compose a quorum. All decisions should be taken in meetings and not by circulation of project proposals. 7. Offices:- The Chairperson will conduct all meetings of the IEC. If for reasons beyond control, the Chairperson is not available, the Deputy Chairperson or an alternate Chairperson will be elected from the members by the members present, who will conduct the meeting. The Member Secretary is responsible for organizing the meetings, maintaining the records and communicating with all concerned. He/she will prepare the minutes of the meetings and get it approved by the Chairman before communicating to the researchers with the approval of the appropriate authority. 8. Independent consultants :- IEC may call upon subject experts as independent consultants who may provide special review of selected research protocols, if need be. These experts may be specialists in ethical or legal aspects, specific diseases or methodologies, or represent specific communities, patient groups or special interest groups e.g. Cancer patients, HIV/AIDS positive persons or ethnic minorities. They are required to give their specialized views but do not take part in the decision making process which will be made by the members of the IEC. 9. Application Procedures :-a. All proposals should be submitted in the prescribed application form, the details of which are given under Documentation. b. All relevant documents should be enclosed with application form c. Required number of copies of the proposal along with the applicatio n and documents in prescribed format duly signed by the Principal Investigator (PI) and Coinvestigators / Collaborators should be forwarded by the Head of the Departments / Institution to the ethics committee. d. The date of meeting will be intimated to the researcher, to be present, if necessary to offer clarifications. Indian Council of Medical Research e. The decision will be communicated in writing. If revision is to be made, the revised document in required number of copies should be submitted within a stipulated period of time as specified in the communication or before the next meeting. f. Prescribed fee if any, should be remitted along with the application. 10. Documentation:- For a thorough and complete review, all research proposals should be submitted with the following documents : 1. Name of the applicant with designation. 2. Name of the Institute/ Hospital / Field area where research will be conducted. 3. Approval of the Head of the Department / Institution. 4. Protocol of the proposed research. 5. Ethical issues in the study and plans to address these issues. 6. Proposal should be submitted with all relevant enclosures like proformae, case report forms, questionnaires, follow - up cards, etc. 7. Informed consent process, including patient information sheet and informed consent form in local language(s). 8. For any drug / device trial, all relevant pre-clinical animal data and clinical trial data from other centres within the country / countries, if available.

41 41 9. Curriculum vitae of all the investigators with relevant publications in last five years. 10. Any regulatory clearances required. 11. Source of funding and financial requirements for the project. 12. Other financial issues including those related to insurance. 13. An agreement to report only Serious Adverse Events (SAE) to IEC. 14. Statement of conflicts of interest, if any. 15. Agreement to comply with the relevant national and applicable international guidelines. 16. Plans for publication of results positive or negative- while maintaining the privacy and confidentiality of the study participants. 17. Any other information relevant to the study. 11. Review procedures:- a. The meeting of the IEC should be held on scheduled intervals as prescribed and additional meetings may be held as and when the proposals are received for review. Indian Council of Medical Research b. The proposals will be sent to members at least 2 weeks in advance. c. Decisions will be taken by consensus after discussions, and whenever needed voting will be done. d. Researchers will be invited to offer clarifications if need be. e. Independent consultants/experts will be invited to offer their opinion on specific research proposals if needed. 12. Element of review a. Scientific design and conduct of the study. b. Approval of appropriate scientific review committees. c. Examination of predictable risks/harms. d. Examination of potential benefits. e. Procedure for selection of subjects in methodology including inclusion/ exclusion, withdrawal criteria and other issues like advertisement details. f. Management of research related injuries, adverse events. g. Compensation provisions. h. Justification for placebo in control arm, if any. i. Availability of products after the study, if applicable. j. Patient information sheet and informed consent form in local language. 13. Expedited review: - All revised proposals, unless specifically required to go to the main committee, will be examined in a meeting of identified members convened by the Chairman to expedite decision making. Expedited review may also be taken up in cases of nationally relevant proposals requiring urgent review. The nature of the applications, amendments, and other considerations that will be eligible for expedited review should be specified. 14. Decision-making a. Members will discuss the various issues before arriving at a consensus decision. b. A member should withdraw from the meeting during the decision procedure concerning an application where a conflict of interest arises and this should be indicated to the chairperson prior to the review of the application and recorded in the minutes. c. Decisions will be made only in meetings where quorum is complete. d. Only members can make the decision. The expert consultants will only offer their opinions.

42 Indian Council of Medical Research 42 e. Decision may be to approve, reject or revise the proposals. Specific suggestions for modifications and reasons for rejection should be given. f. In cases of conditional decisions, clear suggestions for revision and the procedure for having the application re-reviewed should be specified. g. Modified proposals may be reviewed by an expedited review through identified members. h. Procedures for appeal by the researchers should be clearly defined. 15. Communicating the decision:- a. Decision will be communicated by the Member Secretary in writing. b. Suggestions for modifications, if any, should be sent by IEC. c. Reasons for rejection should be informed to the researchers. d. The schedule / plan of ongoing review by the IEC should be communicated to the PI. 16. Follow up procedures a. Reports should be submitted at prescribed intervals for review. b. Final report should be submitted at the end of study. c. All SAEs and the interventions undertaken should be intimated. d. Protocol deviation, if any, should be informed with adequate justifications. e. Any amendment to the protocol should be resubmitted for renewed approval. 17. Record keeping and Archiving a. Curriculum Vitae (CV) of all members of IEC. b. Copy of all study protocols with enclosed documents, progress reports, and SAEs. c. Minutes of all meetings duly signed by the Chairperson. d. Copy of all existing relevant national and international guidelines on research ethics and laws along with amendments. 18. Updating IEC members a. All relevant new guidelines should be brought to the attention of the members. b. Members should be encouraged to attend national and international training programs in research ethics for maintaining quality in ethical review and be aware of the latest developments in this area

43 43 Mrs. Mahalakshmi B. Assist. Prof. Sumandeep College of Nursing, Vadodara. EVIDENCE BASED NURSING EDUCATION SYSTEM IN PAST, PRESENT AND FUTURE INTRODUCTION :- Evidence-based elements of nursing education that are essential for preparing new nurses for safe entry level practices. It involves identifying solid research findings and implementing them in nursing practices, in order to increase the quality of patient care. EBN is a process founded on collection, interpretation and integration of valid, important and applicable research. So, the nursing council of state boards of nursing began to study evidence-based nursing education that will provide for safe and effective entry to practices. GOLDEN MILESTONE OF EVIDENCE IN THE PAST Historical perspective pre-civilization:- Historical perspective pre-civilization theory of animism belief that good and evil spirits bring health or illness. Physician as medicine men. Nurse portrayed as mother caring for family. Historical perspective beginning of civilization:- That illness is caused by sin and gods displeasures. Temples were centre of medical care. Priest as physician. Nurse viewed as slave carrying out menial tasks ordered by priests. Historical perspective beginning of 16 th century:- In this period focus on religion exploration and expansion of knowledge shortage of nurses. Before 1900 Florence nightingale is considered by most to be the first nurse researcher. She was the first nurse to create an evidence based practices system. She disseminated her ideas in notes on nursing What it is? What it is not? The focus of nursing research was closely aligned with social and political climate. Nursing education becomes the focus of nursing research. Many nursing leaders such as LAVINIA DOCK et al were instrumental in reforming nursing education. The gold mark report (1923) identified many inadequacies in nursing education and recommended that advanced educational preparation for nurses was essential.

44 44 Yale university school of nursing first university based on nursing programme in U.S.A. Nursing doctoral programme in education was started at Colombia university.(1924) Nurse continued to focus their research on educational issue. Recommended that nurses be educated in university settings. The innovation of moving nursing education into university and graduate curricula began to be incorporated into nursing research which provided a structure for the advancement of nursing science The hallmark of the 1970 s and 1980 s was the increased focus on the application of nursing research and focusing clinical problems. Important concept regarding new theories and new approaches to nursing education system 1990-Present Need for change in education system in nursing. How can we ensure patient satisfaction, safety and outcomes? Clinical analyst in the department of nursing informatics is registered nurses who assess opportunities for innovative technology to improve nursing education by first analyzing clinical workflow to determine current practices. Collaborative Approach to Nursing Education, Quality and Research :- Providing centralized application training to nursing staff in support of new or revised clinical application on the nursing education Classes favor independent learning Working collaboratively with all level of nursing units Progressive evaluation of patient outcome The knowledge explosion created by technological advances vastly influenced nursing research. CINAHL (cumulative index of nursing and allied health) became accessible to individuals through internet, so researchers to run more sophisticated analyses. Future challenges- Nursing education must prepare nurses to appreciate the importance of basing patient care on evidence. Educators need to create innovative strategies that teach students to identify clinical problems, use technology to retrieve evidence, read and analyze research, weigh evidence and implement change. Nurses must accept responsibility for creating their own evidence based nursing education system and collaborating with others to improve patient care. Doctoral prepared nurses in clinical setting are especially well positioned to move EBNES forward

45 45 Mr. Pavan Kumar Jain Assistant Professor (Med.-Surg. Nursing), Sumandeep College of Nursing Vadodara. EBNES: LIFELONG LEARNING (LLL) & INNOVATORS The term recognizes that learning is not confined to childhood or the classrooms, but takes place throughout life and in a range of situations. Learning can be seen as something that takes place on an on-going basis from our daily interactions with others and with the world around us. Lifelong learning simply means to continue adding skills and knowledge about the profession as it continue to evolve. Lifelong learning is the "lifelong, life wide, voluntary, and self-motivated" pursuit of knowledge for either personal or professional reasons. As such, it not only enhances social inclusion, active citizenship and personal development, but also competitiveness and employability. The process of lifelong learning can bring personal satisfaction and even joy to learning and practice, can enhance professional identity and value, and may prevent burnout. Lifelong learning and its partner, continuing education, thus offer not only enriching but also essential elements to healthcare reform. Students learn how to do basic nursing in their undergraduate program, but is imperative to continue to evolve as a professional nurse. Continued learning is up to each person. A Vision for Lifelong Learning :- We envision a continuum of health professional education from admission into a health professional program to retirement that values, exemplifies, and assesses lifelong learning skills. To achieve this vision, we encourage an understanding of and support for the need for change, and collaboration among stakeholders responsible for the interdependent elements of this vision academic institutions, healthcare systems, continuing education providers, accrediting bodies, licensing and credentialing boards, funders, and others. The main objectives of Lifelong Learning are :- 1) To improve patient care outcomes. 2) To engage learners in new knowledge and skill acquisition for practice setting application. 3) To validate individual practice and competence. 4) To provide the new updates and advances in technology, biomedical, and related fields. 5) To reduce practitioner-identified performance gaps. 6) To integrate knowledge, performance, competence and judgment. 7) To understand the shifts in the nation s patient population, growing complexity in the healthcare system.

46 46 8) To generate professional satisfaction and identity, potentially preventing or decreasing burnout. 9) To foster the self confidence and professionalism. Part I: Consensus on Lifelong Learning :- for the future to: deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics. This report is the product of a cooperative effort of a large number of individual stakeholders, representing basic, undergraduate training to continuing education from medicine and nursing. Hosted by the, the Association of American Medical Colleges (AAMC) and American Association of Colleges of Nursing (AACN). Part II: The Value and Competency of Lifelong Learning :- The Value of Lifelong Learning :- All health professions value as both a construct and a reality the notion of lifelong learning and the need for continuing education. For the most part, health professionals are hard-wired with a desire to perform with competence and confidence essential to the lives they touch. In this sense, the experts suggested that no health professional wants to deliver less than state-of-the science care, nor disappoint those entrusted to their care. The Competencies of Lifelong Learning :- The competencies of lifelong learning include several components: the ability to reflect on one s practice and thereby determine learning needs, the ability to efficiently and accurately search for learning resources and critically appraise them, skills in applying these resources to clinical and other questions, the management of large and changing bodies of evidence, and the ability to evaluate one s competencies and practice based on external feedback. Part III: The Process and Outcomes of Lifelong Learning :- The process of lifelong learning presents multiple facets. Pre-professional education and life experiences may lead to an individual s adoption of lifelong learning as a value and the development of skills needed to translate the value into behaviors. It is

47 47 expected that basic health professional education produces an accountable professional with learning skills internalized as a core value leading to optimal knowledge management, selfappraisal, information retrieval, and critical appraisal. THE PROCESS OF LLL: PREPARING AND SUPPORTING THE LEARNER i) The Process of Learning Together: Inter-Professional Education (IPE) :- Inter-professional education (IPE) is defined as any type of education, training, teaching, or learning session, in which two or more health and social care professions are learning interactively. The definition includes both instruction in formal training programs and continuing education efforts, including workplace learning. Any effective IPE model should be patientcentered and nimble, and provide a required and measurable component across the health professional educational continuum, from entry and throughout one s practice career. RECOMMENDATIONS: 1) Educators, curriculum planner and others should consider and incorporate meaningful, formal and experiential, Inter-professional education in entry-level and advanced training of all health professionals. 2) The development and deployment of inter-professional teams, in primary care, geriatrics, and other specialized areas of health care, particularly those who work together, as in team structures. ii) Continuing Education (CE) Methods and Activities :- Complementing and supporting the construct of lifelong learning, in nursing and medicine, are the traditional, formal products of continuing education: conferences, rounds, courses, lectures, and in-service training etc. a) Formal or Classroom Continuing Education :- Generally considered to be more effective than didactic methods, these interventions employ pro-active techniques and strategies to effect learning and change in health professionals. They include: community or practice-based efforts, e.g., academic detailing, opinion leaders, computer- generated reminders, protocols and decision-support systems, clinical database-driven audit and feedback methods, and multi-faceted educational programs/activities. b) Program Objectives and the Role of Needs Assessment :- There are two issues of importance to the pre-planning of classroom education for practicing professionals establishing appropriate learning objectives and determining learners and system needs. c) Didactic, Interactive, and Other Methods to Augment Classroom Education :- It is clear that didactic CE can increase knowledge, leading to awareness of new treatments and other findings, such methods include: - increasing and improving question and answer periods, using case discussion methods, encouraging small groups to form within the context of large group sessions, role playing, brainstorming, quizzes, inviting patients to participate, among others. In addition, the use of multiple media techniques (e.g., simulations, videotapes, role-playing) may provide advantages over the use of a single technique, and multiple exposures to a topic appear more effective than a single exposure.

48 48 RECOMMENDATIONS:- Beyond classroom education, educational interventions that employ pro-active methods and strategies to effect learning and change in health professionals. These methods include: outreach visits by experts, community-based efforts, (e.g., opinion leaders), point-of care interventions like reminders, protocols, practice audits and feedback, and multifaceted interventions. Part IV: Workplace Learning :- The Experts defined workplace learning as the way in which individuals or groups acquire, interpret, reorganize, change or assimilate a related cluster of information, skills and feelings, and a means by which health professionals construct meaning in their personal and organizational lives. This contingent nature requires workers to go beyond previously learned scripted approaches to resolve novel and poorly defined work challenges. They continuously add, replace, enhance, and retro-fit their expertise, as changes in technology and work. RECOMMENDATIONS:- Health system and related research foundations should support pilot studies and more extensive research in workplace learning. Part V: Point-of-Care Learning :- Point-of-Care Learning, a subset of workplace learning, defined as the learning that occurs at the time and place (whether virtual or actual) of a health professional/patient encounter. It may be through face to face, telephone calls, communications, and video conferencing. RECOMMENDATIONS: Health professions organizations, academic institutions, should train tutors, role models and teachers in the use of point-of-care learning. Integration of point-of-care information resources and learning activities into the electronic health record (EHR), at the right time, and in the place they need it. INNOVATORS :- OBJECTIVES:-At the end of this session, the group will be able to: 1. Define the innovator 2. Understand four characteristics of an innovator 3. Provide the examples of innovative behaviours in educational practice 4. Evaluating outcomes of Innovations WHO IS AN INNOVATOR? An innovator is one who willing to try new things in practice, using evidence, to enhance the quality of patient care and to foster nursing knowledge. Innovativeness is the degree to which an individual.is relatively earlier in adopting new ideas than other member of a social system Rogers (2003) INNOVATOR S CHARACTERISTICS :- 1) Flexibility to change 2) Sense of inquiry 3) Awareness of self & of unit 4) Good communication skills

49 INNOVATION IN NURSING EDUCATION: A CALL TO REFORM 49 What is needed now is dramatic reform and innovation in nursing education to create and shape the future of nursing practice. All levels of nursing education, undergraduate and graduate, are obligated to challenge their long-held traditions and design evidence-based curricula that are flexible, responsive to students needs, collaborative, and integrate current technology Faculty, students, consumers, and nursing service personnel must work in partnership to design innovative educational systems that meet the needs of the healthcare delivery system now and in the future. EVALUATING OUT-COMES OF INNOVATIONS An outcome is defined as the consequences or visible result. (Webster, 2001) CLASSIFICATIONS OF OUTCOMES :- A. Acc. to type: care-related, patient-related, performance- related. B. Acc. to time: Short-term, Intermediate, Long-term outcomes. WHAT ARE THE AREAS OF CONCERN OR ISSUES? 1. Ensuring that clinical education reflects current practice 2. Classroom teaching and content overload 3. Changing paradigms of health and health care: Prevention, chronic care, and community-based care 4. Integrating new technology: simulation labs, interactive and web-based media 5. Joint education with other healthcare professionals

50 50 Dr. Sagun Desai, Dept of Pharmacology, SBKS MI & RC Sumandeep Vidyapeeth University. EVIDENCE BASED MEDICINE FOR RATIONAL USE OF MEDICINES Evidence Based Medicine (EBM):- Evidence Based Medicine (EBM) simply means the need for judicious use of current, objective information in making decision about the care of individual patients. The term was coined to encourage proficiency in judgments by individual clinicians based not only on experience but also on experience informed by results acquired in systemic approach. In other words, it is nothing but more scientific and sophisticated version of Biostatistics and Epidemiology of recent past. In a way, EBM is not a new concept. Flexner, who in 1910, had set modern medical education on a scientifically sound footing, had also demanded that what was taught be predicted on hypothesis, experiment, analysis, refinement, refutation or validation of hypothesis, and, in aggregate, scientific method and scrutiny. And how can we forget Hippocrates- Father of modern medicine? Nearly 2500 years ago he made a clear distinction between the priesthood and the profession, and... chose the latter. However, it will still be prudent to consider EBM as a new paradigm in medical practice. EBM de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision-making, and stresses the examination of evidence from clinical research. EBM requires new skills of the physician, including efficient literature searching, and the application of formal rules of evidence in evaluating the clinical literature. The influence of EBM on clinical practice and medical education is increasing. In summary, EBM requires skills to find and critically appraise medical literature to get and apply the best evidence to clinical decision-making. Nursing profession is also the part and parcel of patient care and hence it should, along with nursing education, use the principles of EBM both in teaching and practice. Rational use of medicines (RUM):-If rational is something based on sound scientific principles and if evidence based medicine means medicine based on facts, the two mean the same thing. Rational use of medicine means use of a right medicine, in the right manner, in the right type of a patient, at a right cost i.e. The rule of right. Rational drug use also means using the drug when necessary ( chloroquine in vivax malaria) and more importantly, not using it when unnecessary (Azithromycin/ciprofloxacin in common cold). When the word right is replaced by word wrong it becomes irrational drug therapy which is more frequent than assumed. To practice RUM, one needs to know about the concept of Essential Medicines. Essential Medicines (EM):- Essential medicines are those that satisfy the health care needs of majority of population. Therefore they should be available at all times, in adequate amounts, in appropriate dosage forms and at affordable price. The 16 th Model list of Essential Medicines prepared by expert committee of the WHO includes only 352 drug molecules and 573 formulations made therefrom. Of these, only 27

51 51 drugs (35 formulations) are in the form of Fixed Dose drug Combinations (FDC). Even the 2 nd national list of essential medicines of India (2003) has included only 354 drugs of which only 15 are FDCs. Against this, what is the scenario of drugs available in India? Even the highest authority of Government of India, the Drug Controller General of India (DCGI) could not say with confidence or certainty about how many pharmaceutical units are there in India and how many drugs are produced and marketed by them. The available studies estimate that the number of drug formulations in India range from 60,000 to 80,000, made using about 2500 to 3000 drug molecules. The essentiality and rationality of many of these molecules are lacking on evidence base. Of these available drugs, about 50-70% are in the form of FDCs. Whereas most of the FDCs of WHO contain only 2 ingredients, many of the FDCs in India contain 4 or more ingredients and sometimes upto 15 ingredients. All these FDCs severely lack evidence base and hence rationality. As a result of this, many of these FDCs tend to be useless at the best and positively harmful at the worst. In short, availability of many medicines creates a therapeutic jungle posing a tough challenge for a doctor to choose the right medicine for a patient. This is one of the major reasons for irrational use of medicines. On the top of this, medicines in India are largely prescribed by brand or trade names, despite the well known advantages of prescribing by generic or official names. This also contributes to irrational use of medicines and sometimes may lead to Medication Errors. An old woman died following ingestion of Copamide (chlorpropamide, an oral hypoglycaemic agent) in place of Lopamide (loperamide, an antidiarrhoeal medicine). Role of Nursing profession :- Nurses are not only persons to receive orders from doctors and implement in patients without thinking. As stated earlier, they are also part of medical care team, they should also apply mind, search for evidence base about use of medicines so as to make use of medicines more rational and also avoid medication errors. The discovery of modern day diuretics is credited to an observant nurse about 100 years ago. Nurses are involved in administering injections of penicillin to patients and testing for allergy before that. I have yet to see a nurse who does it correctly. I have not seen any nurse asking for rationale of testing penicillin allergy in all patients nor trying to find out the correct way of doing allergy test. Doctors only see the patients and write the orders for nurses to carry out. They spend very little time with patients as compared to nurses who not only spend a lot of time caring for patients, but also doing the important task of administering medicines. While performing this important duty if a nurse raises the following questions in the mind, it will be prudent. What is this medicine? Why is it given to this patient? Is it a rational medicine? Is it essential medicine? Is it a FDC? If yes, is it rational? After raising the questions, a nurse may try to find the evidence for it from appropriate sources. This way a nurse can also certainly contribute to practice of RUM based on evidence. I hope this is not too much to expect from a professional colleague who follows the path of Lady with the Lamp

52 52 Ms Simer Preet Kaur, Asst.Prof., Sumandeep College of Nursing, Vadodara. DESIGNS OF NURSING RESEARCH TO CHALLENGES INTRODUCTION :- A research design is the framework or guide used for the planning, implementation, and analysis of a study. It is the plan for answering the research question or hypothesis. Different types of questions or hypotheses demand different types of research designs, so it is important to have a broad preparation and understanding of the different types of research designs available. Strategies for non-experimental and experimental research designs used to generate and refine nursing knowledge are described. In addition, the importance of quantitative designs and the role they play in developing evidence-based practice are discussed. Nursing care needs to be determined by the results of sound research rather than by clinical preferences or tradition. QUANTITATIVE RESEARCH DESIGNS:- Quantitative research designs adopt objective, rigorous, and systematic strategies for generating and refining knowledge. Quantitative research is most often about quantifying relationships between or among variables the independent or predictor variable and the dependent or outcome variable. NON-EXPERIMENTAL DESIGNS :- Non-experimental designs do not have random assignment, manipulation of variables, or comparison groups. The researcher observes what occurs naturally without intervening in any way. There are many reasons for undertaking non-experimental designs. Non-experimental designs are typically classified as either descriptive or correlation Descriptive, or exploratory studies are used when little is known about a particular phenomenon. The researcher observes, describes, and documents various aspects of a phenomenon. There is no manipulation of variables or search for cause and effect related to the phenomenon. Case control studies involve a description of cases with and without a pre existing condition or exposure. The cases, subjects, or units of study can be an individual, a family, or a group. Case control studies are more feasible than experiments in cases in which an outcome is rare or takes years to develop. This design is also known as case report or case study. Comparative Studies : Comparative studies are also called ex post facto or causalcomparative studies. These studies describe the differences in variables that occur naturally between two or more cases, subjects, or units of study. The main difference between this approach and the quasi-experimental design is the lack of researcher control of the variables. EXPERIMENTAL DESIGNS Experimental design typically uses random assignment, manipulation of an independent variables, and strict controls. These characteristics provide increased confidence of cause and- effect relationships. Random assignment means that

53 53 each subject had equal chance to be assigned to either the control or experimental group. To be classified as true experimental, there must be randomization, a control group, and manipulation of a variable when examining the direct causal or predicted relationship between variables. True-Experimental Designs :- True experimental designs examine the cause and effect relationships between independent (predictor) and dependent (outcome) variables under highly controlled conditions. Post-test only control group design. subjects are randomly assigned (R) to either a control or an experimental group. The groups are not pretested. One group is exposed to a treatment (X) or series of different treatments (X1, X2), and then both groups are post tested (O 2 ). R X O 2 R O 2 Pretest-Posttest Control Group Design. In the pretest-posttest control group design, or classic experiment, subjects are randomly assigned (R) to either a control or experimental group. Both groups are pretested (O). The experimental group is exposed to a treatment (X) or different treatments (X1, X2), and then both groups are posttested (O). R O 1 X O 2 R O 1 O 2 Solomon Four-Group Design. In Solomon four-group design, subjects are randomly assigned (R) to one of four different groups. Two of the groups are pretested (O) and two are not. Only one pretested and one not pretested group are then exposed to a treatment (X). All of the groups are postested (O). R O 1 X O 2 R O 1 O 2 R X O2 R O 2 Cross-over Design. In the cross-over, or counterbalanced, switchover, or rotation design, subjects are given two treatments, one being the experimental treatment (XE), the other a control or reference treatment (XC). The subjects are randomly assigned to one of two groups. One group receives the experimental treatment first and the other group receives the experimental group second. After a period of time, sufficient to allow for any treatment effect to wash out (W), the treatments are crossed over. R O XE O W XC O R O XC O W XE O QUASI EXPERIMENTAL DESIGNS Quasi-experimental, like true-experimental designs, examine cause-and-effect relationships between or among independent and dependent variables. However, one of the characteristics of true experimental design is missing, typically the random assignment of subjects to groups. The most common used quasi-experimental designs are: non-equivalent group pretest-post-test group design, time series design, group is exposed to a treatment (X) at some point in the series while the control group is not. NR O 1 O 2 O 3 X O 4 O 5 O 6 NR O 1 O 2 O 3 O 4 O 5 O 6

54 54 QUALITATIVE RESEARCH DESIGNS ;- Often involves a merging together of various data collection strategies. Tends to be holistic, striving for an understanding of the whole. Requires researchers to become intensely involved, often remaining in the field for lengthy periods of time. Requires ongoing analysis of the data to formulate subsequent strategies and to determine when field work is done. Ethno Nursing Research :- The study and analysis of the local or indigenous people s viewpoints, beliefs, and practices about nursing care behavior and processes of designated cultures. Ethnosciences: This type of ethnography concentrates on understanding cultural knowledge human experience.cognitive anthropologists assume that a group s cultural knowledge is reflected in its language. Phenomology :- Phenomenology, rooted in a philosophical tradition developed by Husserl and Heidegger, is an approach to discovering the meaning of people s life experiences. Phenomenologists investigate subjective phenomena in the belief that critical truths about reality are grounded in people s lived experiences. Phenomenologists believe that lived experience gives meaning to each person s perception of a particular phenomenon. Grounded theory is an approach to the study of social processes and social structures. The focus of most grounded theory studies is the development and evolution of a social experience, the social and psychological stages and phases that characterize a particular event or episode. Historical research is the systematic collection, critical evaluation, and interpretation of historical evidence. In general, historical research is undertaken to answer questions about causes, effects, or trends relating to past events that may shed light on present behaviors or practices. OTHER TYPES OF RESEARCH DESIGNS: Case studies are in-depth investigations of a single entity or a small number of entities. The entity may be an individual, family, group, institution, community, or other social unit. In a case study, researchers obtain a wealth of descriptive information and may examine relationships among different phenomena, or may examine trends over time. Survey research a survey is designed to obtain information about the prevalence, distribution, and interrelations of variables within a population. Delphi Surveys were developed as a tool for short term forecasting. The technique involves a panel of experts who are asked to complete a series of questionnaires focusing on their opinions, predictions, or judgment about a topic of interest. Secondary analysis Secondary analysis involves the use of data gathered in a previous study to test new hypotheses or explore new relationships. In a typical study, researchers collect far more data than are actually analyzed

55 55 Mr. Virendra Kumar Jain Lecturer Sumandeep college of nursing, Vadodara BARRIERS TO CONNECT NURSING RESEARCH AND EVIDENCE BASED NURSING EDUCATION SYSTEM (EBNES) Mainly 4 types of barriers to connect nursing research and evidence based nursing education system (EBNES) 1. NURSE BARRIERS: - Lack of: 1. Time 2. Motivation 3. Confidence 4. Research Knowledge regarding evidence-based strategies 5. Interest/Value for Research 6. Awareness of Current Research 7. Confidence in Findings Research 8. Flexibility/Willingness to Change 9. Resistance to change in the work setting 10. Lack of rewards for implementing the findings into clinical practice. 11. lack of relevance of research for practice. 12. Lack of expectations and reward systems for nurses to participate in research. 13. Lack of understanding or agreement with the conclusions of research reports. 14. Not only do physicians lack trust in nursing research, but so do other members of the health care team, including nurses. 2. RESEARCH BARRIERS Lack of: 1. Relevance to Practice 2. Replication 3. Rigorous Methodology 4. Believable Findings 5. Lack of collaboration between researchers and clinicians. 6. Appropriate Recommendations. 3. ORGANIZATIONAL BARRIERS Lack of: 1. Access to Journals/Research Resources 2. Funding to Support New Technology 3. Expectations for Research Participation 4. Rewards/Positive Reinforcement Staff 5. Time Allocated for Research Participation 6. Staff Empowerment to Make Changes 7. Support from Administrators or MDs

56 56 8. Acceptance of Risk-Taking and Change 9. limited research presentations and publications targeted for clinicians 4. COMMUNICATION BARRIERS Lack of: 1. Collaboration Between Researchers & Clinicians 2. Presentations to Audiences in Practice 3. Publications in Clinical Journals 4. Understandable Research Publications 5. Availability of Consultants to Help Critique FACILITATING RESEARCH-BASED PRACTICE Strategies to Promote Research-Based Nursing Practice 1. As an Educators: - 1. Use Research to Support Lectures 2. Incorporate Research in Clinical Assignments 3. Strive to Make Research Exciting. 2. As a Researchers 1. Focus on Current Clinical Problems 2. Disseminate Results Quickly 3. Present Locally, Regionally, and Nationally level conference, workshops and seminar 4. Publish in Clinical Journals, as well as Scientific 5. Clearly Delineate Practice Implications of Results. 3. As an Administrators 1. Establish a Research-Friendly Culture 2. Encourage Clinicians to Question Traditions 3. Reward Risk-Taking and Innovation 4. Require Research Basis for Practice Changes 5. Incorporate Research Role in Job Descriptions 6. Provide Research Resources: Literature, Internet Access, Consultants 7. Encourage and Support: Continuing Education, Conference Participation, and Publishing 8. Role Model Research Collaboration. 4. As a Clinicians: - 1. Question Practice Traditions 2. Stay Abreast of the Literature 3. Commit to Continuous Learning: Continuing Education, Professional Organizations, and Advanced Degrees. 4. Collaborate with Researchers: Relay Clinical Issues and Questions 5. Support Research Conduct in the Clinical Setting 6. Take the Risks to Make Changes and Improve Practice

57 57 Mrs.Jayapriya k. M.Sc (N), OBG, Lecturer Sharda college of Nursing, Pansar, Gujarat A Study to Evaluate the Effectiveness of Preventive Information regarding Cancer Cervix among Women in a Selected Hospital at Coimbatore. ABSTRACT Women are smart and savvy. Striving to live up to their potentials. They are curious about the world they live in and want to make a difference. They cherish the gift of womanhood, but it is a period women struggle with the issues of care and responsibility and in turn neglect themselves. (Gillian 1993). Hence the research study was conducted among women in relation to cervical cancer, which was aimed to screen the women through Pap smear method, to evaluate the effectiveness of preventive information regarding cancer cervix. The research design adapted to this study was pre experimental one group pretest post test design. The conceptual frame work for this study was based on Betty Neuman s Health Care systems theory (2001). The study was conducted in NRP hospital at Coimbatore. Non probability purposive sampling technique was adopted to select the desired sample. The sample size was 40. The structured preventive information and data collection tool were validated by the experts and was valid. The reliability of the tool to assess the level of knowledge regarding cancer cervix was determined by split half method, using spearman brown formula which indicated high reliability. The data was collected through structured interview schedule to assess the level of knowledge regarding various aspects of cancer cervix. Pap smear was obtained among the samples to screen possible infections, dysplasia (precancerous condition) and frank malignancy. Preventive information regarding cancer cervix was educated, which consist of general aspects, signs and symptoms, early detection and aspects with the help of laptop with compact disc. The collected data s were analyzed by using both descriptive and inferential statistical methods paired t test was used to evaluate the effectiveness of preventive information regarding cancer cervix. The findings of the study revealed that among 40 samples, most of the Pap smear screening resulted that 25(62.5%) were inflammatory smear, 15(37.5%) were healthy smear and none were dysplastic smear. It also revealed that the preventive information regarding cancer cervix helped and improved the level of knowledge among the samples. The inflammatory smear samples were referred for further management. The healthy smear samples were reinforced to undergo Pap smear screening for two consequent years and if found healthy further Pap smear screening was advised once in 5 years. Key words: Evaluate Effectiveness, Preventive Information, and Cancer Cervix.

58 58 R. KRISHNAVENI, M.Sc. Nursing, (Community Health Nursing) Lecturer, Sharda College of Nursing, Pansar, Gujarat ABSTRACT A Study to Evaluate the Effectiveness of Protein Rich Diet on Improving Physical Parameters among Undernourished Children in a Selected School at Coimbatore. The main aim of the present study was to evaluate the effectiveness of protein rich diet in improving physical parameters among undernourished children. The objectives of the study were, To evaluate the effectiveness of protein rich diet in improving physical parameters among undernourished children. To find out the relationship between weight and Midarm Circumference (MAC) among undernourished children. The research design adopted was pre experimental one group pretest post-test design. The conceptual framework for this study was based on Orlando nursing process theory (1961). The study has been conducted in Shri Meenakshi Matric Higher Secondary School at Coimbatore. Non randomized purposive sampling technique has been adopted to select the desire sample. The sample size was 40. The samples were selected according to Gomez classification 89 % weight and mid arm circumference < 13.5 cm. As an intervention planned for 30 days in between 15 th day of intervention weight and MAC were measured. On 30 th day also weight and MAC were measured. The collected data were analyzed by using both descriptive and inferential statistical method. F test was used to evaluate the effectiveness of protein rich diet in improving physical parameters among undernourished children. The finding of the study revealed that protein rich diet helps in improving physical parameters among undernourished children. Hence the stated hypothesis (H1) was accepted. The r test was used to find the relationship between weight and MAC. The finding was inferred that positive co-relation between the weight and MAC. Hence the stated hypothesis (H 2 ) was accepted. Key words (Effectiveness, Protein rich diet, physical parameters, undernourished children)

59 59 Ms. Rathod Himani, Clinical Instructor, Sumandeep College Of Nursing Ms. Patel Mittal, Clinical Instructor, Sumandeep College Of Nursing A Study To Assess The Effectiveness Of Planned Teaching Programme (PTP) On Bio-Medical Waste Management In Terms Of Knowledge Of 2 nd Year Nursing Students From (B.Sc. Nursing &General Nursing Midwifery) Civil Hospital Campus, Ahmedabad. ABSTRACT Incidence & prevalence of infectious diseases increases due to inappropriate use, storage, treatment, transport & disposal of bio-medical waste. In 2009, Hepatitis epidemic occurred in Sabarkantha district due to faulty handling of of bio-medical waste by the local private practitioners. Reuse of untreated disposal articles such as syringes, needles, catheters, IV & dialysis sets etc. cause the spread of infection from health care establishment to the general community. Especially the nursing personnel s have the responsibility too look for the proper segregation & treatment of the used disposable articles. As the B.Sc. Nursing & G.N.M. students practice the nursing care in clinical setting they should possess the precise knowledge about of bio-medical waste management. Therefore, we assessed the effectiveness of Planned Teaching Programme among 30students of 2 nd year B.Sc. Nursing as well as G.N.M. which are selected by purposive sampling followed by simple randomization by the means of structured knowledge questionnaire. The research approach was evaluative.one group pre test post test research design was used. The mean pre test score for B.Sc. nursing as well as GNM students were &21.50 respectively. The mean post test score for B.Sc. nursing as well as GNM were &32.50 respectively, which indicates that Planned Teaching Programme on Bio- Medical Waste Management was quite effective in improving knowledge. There is no significant difference about knowledge on bio-medical waste management between B.Sc. Nursing & G.N.M. students. Both the B.Sc. Nursing & G.N.M. students have no clear concept about black bag & green bag. To increase the knowledge &awareness about Bio-Medical Waste Management among nursing students, content should be included precisely in curriculum & planned teaching programme should be used as teaching method. Along with knowledge practical aspect with correct technique of Bio-Medical waste management within clinical setting should emphasized

60 60 Mr. Siva Subramanian Associate Professor HOD of Psychiatric Nursing, Sumandeep College of Nursing THE EFFECTTIVENESS OF SELF INSTRUCTIONAL MODULE (SIM) ON ELECTRO CONVULSIVE THERAPY AMONG THE RELATIVES OF THE MENTALY ILL PATIENTS ADMITTED IN SELECTED HOSPITAL AT MADURAI. Back ground of the study Care of the human mind is the most noble branch of medicine. Mental illness is shrouded in the gloom of ignorance, superstition, feelings of mystery and fear among the family members. Though there is advancement and technological improvement in the field of psychiatry, still there is lack of awareness among public regarding mental illness. Even today, majority of the patients are taken to temples, mandrawathies and faith healers and very few of them realize that it is a type of illness and consider the treatment for mental illness by psychiatrist. There is also a lack of knowledge, misconception and ignorance regarding ECT not only among public even among the population of mentally ill patient and their relatives. So, it is essential to adopt some measures to improve the knowledge and attitudes among the family members. OBJECTIVES To assess the level of knowledge and attitude among relatives, of the patients undergoing ECT. 1. To find out the effectiveness of the self instructional module in terms of increasing knowledge and change in attitude. 2. To determine the relationship between the post test knowledge and the post test attitude score of relatives, of the patients undergoing ECT. 3. To find out the association between post test knowledge scores, post test attitude score and selected demographic variables such as age, gender, marital status, religion, area of living, education, occupation, income, relationship to patient and where they first heard / read about ECT. HYPOTHESIS 1. There will be significant increase in the mean post test knowledge score of relatives of mentally ill patients then the mean pre test knowledge score. 2. There will be significant increase in the mean post test attitude score of relatives of mentally ill clients towards ECT then the mean pre test attitude score. 3. There will be significant relationship between the post test knowledge score post test attitude score of the family members of patients undergoing ECT who have SIM. 4. There will be significant association between the level of post test knowledge score, post test attitude score and the selected demographic variables such as age, gender, marital status, religion, area of living, education, occupation, income, relationship to patient and where they first heard / read about ECT.

61 61 METHODS Descriptive survey approach One group pre test and post test design is used for it s study CONCLUSION :- The overall knowledge of the relatives of the mentally ill patients initially was less compared of the post test score of the knowledge questionnaire. This shows that the relatives are provided the less of information regarding the treatment regimen and the therapy. In the present study, the mean post test score were seen to be higher after the administration of the self instructional module. The relatives can be further enlightened on the therapy by constantly revising the facts of the ECT in the all the non medical publication by the means of mass media and by health education. - The SIM met the leaning needs of the relatives and had helped in the gain of knowledge in each area of ECT. - Self instructional module can be used as a teaching strategy for the relatives as evident from the positive gain in knowledge in post test in all areas of knowledge on ECT. - In other findings, the co relation computed between the knowledge and attitude has shown significant positive co relations

62 62 Mr. Rajeev Sharma, Lecturer, Sumandeep College of Nursing, Vadodara. A descriptive study to assess the attitude of nursing students studying at M.S. Ramaiah Institute of Nursing Education and Research, Bangalore towards volunteering in disaster management, in a view to prepare disaster preparedness team. INTRODUCTION :- Man has been endowed with reason, with the power to create, so that he can add to what he's been given. But up to now he hasn't been a creator, only a destroyer. Forests keep disappearing, rivers dry up, wild lives become extinct, the climates ruined and the land grows poorer and uglier every day. Uncle Vanya. NEED FOR THE STUDY :- With a wide range of geography and climatic conditions. India is the highly disaster prone country in Asia pacific region with a average of 8 major natural calamities a year. While floods, cyclone, draught, earthquakes and epidemics are frequent from time to time, major accidents happen in railways mines, and factories causing extensive damage to human life and property. By Roger Carr :- Volunteering a portion of our time is something we should do. There are reminders all around us, that our help is needed. Other people will significantly benefit from any time we contribute. OBJECTIVE OF THE STUDY :- 1) To assess the attitude of nursing students towards volunteering in disaster management studying at MS Ramaiah Institute of Nursing Education and Research Bangalore. 2) To find association between the finding and selected socio demographic variable. 3) To prepare a disaster preparedness team of nursing students in M.S Ramaiah Institute of Nursing Education and Research. METHODOLOGY :- The study design consisted of Non-experimental descriptive design and survey approach. The study population consisted of 100 nursing students studying in M.S. Ramaiah college of Nursing Education and Research towards volunteering in disaster management, Bangalore, anon-probability convenient sampling techniques was adopted. The Tools developed and used for data collection was structured Attitude scale. The tool consisted of section A and B. Section A pertained to the socio demographic profile of nursing students, Section B consist of 40 structured Attitude scale questionnaire. The content validity of tool was established by 9 experts. The tool was found to be reliable and feasible. The reliability of the structured Attitude scale was established by spilt half method, which was r =0.93, Hence the tool was found reliable for the study. FINDING OF THE STUDY :- The study includes quality of attitude of nursing students regarding volunteering working in disaster management found that 62(62%) had neutral attitude and 38(38%) subject had favourable quality of attitude towards volunteering working in disaster management. whereas none of them had exhibited unfavorable attitude.the overall attitude mean percentage was 79.0,standard deviation 7.0.

63 63 The present study revealed that mean percentage was obtained for includes. Overall mean percentage of attitude was 79.0 with standard deviation 7.0 which showed that subjects had favourable attitude towards disaster management. NURSING IMPLICATIONS :- The investigator has drawn the following implications from the study which is of vital concern to the field of nursing education, nursing service, nursing service, nursing administration and nursing research. NURSING EDUCATION :- The knowledge of the health professional can be improved by conducting special disaster training in their curriculum to update the nurses knowledge and opportunity has to be provided to the students to participate in the disaster management services and also opportunity has to be provided to the students to conduct health education campaigns in the community NURSING PRACTICE :- Nurses play a vital role in providing services to the victims to save the valuable lives at the time of disaster and also to decrease the mortality and morbidity of the victims physiologically and psychology Participating in the special disaster training courses which will improve nurses knowledge practices and attitude on disaster management. NURSING ADMINISTRATION :- The nurse as an administrator enhances the accessibility, availability and quality of services with the sincerity, commitment and involvement of health professionals in disaster management. She has to plan and organize IEC activity to motivate the nursing personnel in conducting health education programmes which is beneficial to the community, more information can be given to the public through mass media for enhancing more knowledge on disaster management. NURSING RESEARCH :- 1) Researchers can conduct studies on effectiveness of training programmes on disaster management. 2) Research has to be done on practicing newer methods of teaching, focusing on interest, quality and cost effectiveness. 3) This study will serve as a valuable reference materials for future investigators RECOMMENDATION :- On the basis of the study that had been conducted, certain suggestions are given for future studies. 1) The similar study can be replicated in different settings with larger samples. 2) A similar study can be conducted in other part of Bangalore and other states to validate and generalize the findings. 3) A similar study can be conducted by using different teaching strategies i.e. SIM, Drill and simulation. 4) A study can be conducted to find out the knowledge and practiceof public regarding disaster management and it s management 5) A long term longitudinal study can be carried out to assess the effects of long term exposure to disaster 6) A comparative study can be done in different settings. 7) Regular in-service educational programme should conduct for the public regarding the preventive measures of disaster

64 64 Mrs. SAJITHA R. SHARMA Nrupur College Of Nursing, Vadodara A Descriptive study to assess the knowledge and practice of computer users regarding prevention of computer vision syndrome in M.S Ramaiah Institute of Technology, Bangalore. INTRODUCTION Every day you must arise and say to your heart, I have suffered enough and now I must live because the light of the sun must not be wasted, it must not be lost without an eye to appreciate it. Simone Schwarz-Bart Vision is our most precious sense organ. Our eyes are in constant use every waking minute of every day. The way we use our eyes can determine how well we work throughout our lifetime. Over eighty percentage of our learning is mediated through our eyes, indicating the important role of our vision plays in our daily activities. The history of computing starts from the time of origin of human. In ancient time, the people use stones for counting. Abacus is considered as one of the counting machines. Discovery of numbers makes a revolutionary change. Now technology have reached to a highly sophisticated machines called computer, as its turn back to the history of invention of analytic engine by Charle`s Babbage in 1884 NEED FOR THE STUDY :- Computer have revolutionized the work place by streamlining the various process of virtually all jobs, combining a large range of activities such as typing, reading, filing, and drawing into one process. It is estimated that 75% of all jobs in the year 2000 involved computer usage (costanza, 1994). Although this greatly enhanced the efficiency of workers, it eliminated the natural breaks between activities that kept workers fresh and focused. Due to such prevalent computer usage both at work and at home numerous medical studies have attempted to address health and safety concern for video display terminals users. Most studies have shown that eye-related symptoms are the most frequently occurring health problems among VDT users (Bleum, 2005). The main visual symptoms include eyestrain, tired eyes, irritation, burning sensation, redness, blurred vision and so the term Computer vision syndrome was coined OBJECTIVES :- 1) To assess the level of knowledge of computer users regarding prevention of CVS. 2) To assess the practice of computer users regarding prevention of Computer Vision Syndrome. 3) To find the relationship between the knowledge and practice regarding prevention of computer vision syndrome. 4) To determine the association between the level of knowledge and selected sociodemographic variables. 5) To determine the association between the practices and selected socio-demographic variables

65 65 METHODOLOGY The study design consisted of Non-experimental descriptive design and survey approach. The study population consisted of 100 computer users working in M.S.R.I.T, Bangalore. Non-probability convenient sampling technique was used to obtain subjects. Tool for data collection comprises of socio demographic variables, structured knowledge questionnaire, observational checklist. The tool consisted of section A, B & C. Section A pertained to the socio demographic profile of computer users, Section B consist of 30 structured knowledge questionnaire and Section C consists of observational checklist to assess the practice of computer users regarding prevention of computer vision syndrome. The content validity of tool was established by 9 experts. The tool was found to be reliable and feasible. The reliability of the structured knowledge questionnaire was established by spilt half method, which was r =0.93 and 0.85 for observational checklist respectively. Hence the tool was found reliable for the study. FINDING OF THE STUDY OF THE STUDY :- The present study revealed that mean percentage was obtained for Overall knowledge was mean percentage was 45.5%, mean percentage was 46.5% for overall practice the study shows revealed there is a positive relationship exist between the knowledge and practice regarding computer vision syndrome. The result shows that r value is o.548 ` r` with table value 0.19 which was highly significant at P<0.05 level.hence, null hypothesis H0 1 stated that there is a no significant relationship between the knowledge and practice of computer users regarding prevention of computer vision syndrome was rejected and restated that there is a significant relationship between the knowledge and practice of computer users regarding prevention of computer vision syndrome and it shows that as knowledge increases practice will also increases. NURSING IMPLICATIONS :- The investigator has drawn the following implications from the study which is of vital concern to the field of nursing education, nursing service, nursing service, nursing administration and nursing research. NURSING EDUCATION :- 1) Nurse educator to give importance to currently involving work related health problems like computer vision syndrome in nursing. 2) Specialization courses in office ergonomics to be given. 3) In collaboration with the regulation bodies, educational institutions can arrange and conduct workshops and seminars on computer vision syndrome as evolving health problem to be tackled. NURSING PRACTICE :- 1) The study has got a long term visionary implication for nursing practice. Advanced nursing Practice is one of the evolving trends in nursing practice in which definite specified roles of Nurse clinician, nurse practitioner etc are emerging. Studies like present one contribute to development of a new specialization itself in nursing of that of nurse ergonomist (Ergonomics is known as the science of human factor engineering, it studies the relationship Of the work place and work practices and human wellbeing) a specialist role of nurse who tackles the ergonomics case management in all work setting. 2) Healthy computing can be followed by the nurses themselves.

66 66 3) Nurses as primary care givers have the supreme responsibility in prevention of work related health complication among computer professionals. NURSING ADMINISTRATION :- 1) Nursing leaders must utilize available resources which are technologically sound in teaching the computer professionals through mass health education programme. Nursing leaders should enhance nursing services through reinforcement of teaching through the readymade video package. 2) Professional interaction between the nurses and the public will help to improve professional standards and creates better image in the community. 3) Specialized teaching package in specific topic create interest among public and serve as reference materials. NURSING RESEARCH :- 4) Promote more research in innovative areas like computer related health problems. 5) Efforts can be made by nurse researcher to conduct interactive sessions with computer professional for maintenance of healthy working practices and also to disseminate the finding of research on health problems related to prolonged computer use. 6) This study will serve as a valuable reference material for future investigators. RECOMMENDATION :- On the basis of the study that had been conducted, certain suggestions are given for future studies 1) A prevalence study can be carried out to assess the signs and symptoms among the computer users. 2) A long term longitudinal study can be carried out to assess the effects of long term exposure to video display terminals (VDT). 3) A comparative study can be done in different settings. 4) Regular in-service educational programme should conducte for the computer users regarding the prevention of computer vision syndrome. 5) A study can be done to assess the attitude of computer users regarding the prevention of computer vision syndrome

67 67 Mr. Ramesh C. Patidar First year M.Sc. Nursing (Medical Surgical Nursing) Sumandeep College of Nursing

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69 69 Mr. Vipul Patel, First year M.Sc. Nursing (Medical Surgical Nursing) Sumandeep College of Nursing ARTICLE EVIDENCE BASED NURSING PRACTICE: FROM DEVELOPMENT TO IMPLEMENTATION As a PG nursing student, I learned to shave patients in preparation for surgery; as a public health nurse, I taught mothers to clean their infants' umbilical cords with surgical spirit and showed patients newly diagnosed with diabetes how to wipe the skin with before injecting insulin. Since then, high-quality research has shown that pre-operative shaving increases rather than decreases post-operative infections (Kjonniksen, 2002), that cleaning umbilical cords with sterile water shortens the time to cord separation without increasing infections and that insulin can be safely injected through clothing (Flaming, 1997). These are only three of innumerable examples of how high-quality studies of nursing care can influence our practice and while it is heartening to know that new evidence is constantly emerging to inform our nursing practice, it is disheartening to learn that many nurses continue to rely on the increasingly dated knowledge they acquired as nursing students. The majority of nurses have a positive attitude about evidence-based practice. However, there are substantial barriers to evidence based nursing are from at both the levels: individual and organizational. At the individual level, nurses lack skill in evaluating the quality of research, are isolated from knowledgeable colleagues with whom to discuss research and lack of confidence to implement change. At the organizational level, characteristics of healthcare settings are overwhelmingly the most significant barriers to research use among nurses (Parahoo, 2000). Nurses speak about not having enough time to go to the library to read or to implement findings from research. Related to this complaint is the inadequacy of library holdings in healthcare institutions, with many lacking nursing research journals (Parahoo K., 2000, Journal of Advanced Nursing 31: 89-98). Nurses have identified a lack of organizational support for evidence based nursing practice, noting lack of interest, lack of motivation, lack of leadership and lack of vision, strategy and direction among managers. Yet, this organizational support is crucial in situations where nurses do not believe they have the authority or autonomy to implement change in patient care. Grounding nursing practice in evidence, rather than tradition, is necessary to meet nursing's social obligation of accountability, to gain and maintain credibility among other health disciplines and to build a nursing knowledge base that can be used to influence policy at agency and governmental levels. Governments around the world are encouraging evidence-based practice.

70 70 Various activities have been initiated to facilitate EBN practice, including the development and offering of undergraduate courses on locating and critically appraising research evidence, the development of clinical practice guidelines, and the development of EBN committees in clinical settings and research to identify the most effective strategies for disseminating research findings to nurses. But there is a long way to go. How do we create a culture shift that ensures that a nursing student knows how to search the literature for high-quality studies as proficiently as she can measure a patient's blood pressure, and that a staff nurse has access to the best research evidence to incorporate into clinical decision-making? So, the development of an evidence-based profession is an extremely important initiative in nursing, one that warrants national attention and collaboration. In this paper, I will describe how high-quality evidence fits into clinical decisionmaking in nursing practice, and I will call upon key professional groups, such as associations of nursing educators, executive nurses and national nursing organizations, to combine forces and create blue ribbon panels or task forces charged with making recommendations for changes in nursing education and practice that will advance us towards full development as an evidence-based profession

71 71 Mr. Nipin Kalal, First year M.Sc. Nursing (Medical Surgical Nursing) Sumandeep College of Nursing, Vadodara. Fundamentals of communication (AIDET MODEL) A I D E T Acknowledge Introduce Duration Explanation Thank You A - Acknowledge Make patient and family feel personally engaged- Eye Contact Call by Name Smile Be Genuine In the patient s home or room, we must: Knock, ask: Is it OK if I come in? Let the patient/family own their room So glad to visit with you today Thanks for having me in your home Thanks for making time to visit with me I: Introduce A First Generation Name Department Introduce Next Generation Self, Skill Set, Experience and Certification Co-workers Other Departments

72 Positioning Others in a Positive Light Makes Each of Us Better Makes Our Hospice Better Aligns Everyone 72 Managing Up D- Duration: how long How long will the work procedure, appointment or action actually take? How long will the customer need to wait before they can expect you to be finished? What disruption (noise, mess, etc.) will the work likely create? How long until they resume business as usual? Until I get my medications? Will I be sitting here? Until the nurse gets here? Does the referral process take? Before an assessment can be completed? Four Basic Questions What Do Our Patients Want to Know? What Do Our Patients Need to Know? How Can We Make People Feel More Comfortable? Are We Delivering Clear Messages, Every Time? Advantages of AIDET Decrease Anxiety with Increased Compliance

73 73 EYE DONATION Ms. Khyati Patel, Nursing Tutor, Sumandeep College Of Nursing, Vadodara The eye is an important organ of our body. The blindness associated with eye is corneal blindness. It can be cured by replacing cornea. For this, we need a donor who can donate eye after death. Today, in world, there are many eye banks available and many people are donating their cornea after death. Also, advance technology in medical science has improved its success rate. Introduction :- The eyes are organs that detect light, and convert it to electro-chemical impulses in neurons. The person is called blind when he loses his eye sight. The cornea contributes between 65-75% of the eye's total focusing power. Diseases affecting the cornea are a major cause of blindness worldwide, second only to cataract in overall importance. In some areas of Africa as much as 90% of all blindness is a direct result of corneal pathology. Corneal Transplants :- A corneal transplant involves replacing a diseased or scarred cornea with a new one. When the cornea becomes cloudy, light cannot penetrate the eye to reach the lightsensitive retina resulting in Poor vision or blindness. In corneal transplant surgery, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear cornea, usually donated through an eye bank. Corneal transplants are very common in the United States; about 40,000 are performed each year. The chances of success of this operation have risen dramatically because of technological advances, such as less irritating sutures, or threads, which are often finer than a human hair; and the surgical microscope. Corneal transplantation has restored sight to many, who a generation ago would have been blinded permanently by corneal injury, infection, or inherited corneal disease or degeneration. In the area of corneal transplantation, eye banking and training of corneal surgeons are two challenges ahead of India. Both have been initiated and parallel progress of these two vital segments at an accelerated pace is needed to create an impact. Here again, collaboration between the profession, government and the public holds the key for the successful outcome of such efforts in India. Eye Donation :- Eye donation and restoration of sight through corneal transplant is a very exciting combination of selfless charity and the miracle of medical technology. There are about 1.1 million corneal blind persons in India. Another 25,000 are added each year. Eye donation in India today meets less than 5% of the demand for corneal transplants. Though there are 171 eye banks in India, only 51 are working in true sense. An eye bank is an organization which deals with the collection, storage and distribution of donor eyes for purpose of corneal grafting, research and supply of the eye tissues for other ophthalmic purposes.

74 74 Removal of eyes takes only 20 minutes while the cornea transplant surgery can be performed in half an hour. Yet it must be remembered that eyes/corneas are human tissue and like other organs needs sincere and sustained technical expertise and dedicated commitment to quality and systematic procedures to handle. Donated human eyes and corneal tissue are also used for research and education. This is a very important aspect of the eye donation movement. More than 35,000 eyes are used annually for research and education. Research into glaucoma, retinal disease, complications of diabetes and other sight disorders benefit from donations because many eye problems cannot be simulated and only human eyes can be used. These studies advance the discovery of the causes and effects of specific eye conditions and lead to new treatments and cures. Eye Bank Association of India :- Eye Bank Association of India (E.B.A.I.) is a national organisation acting as a resource centre for all eye banks and organisations involved in eye donation. The objectives of E.B.A.I. are to increase the collection of eyes, introduce uniform standards in Eye Banks and to educate the public about eye donation and prevention of corneal blindness. Over the past few years, E.B.A.I. has been receiving support from several quarters. Celebrities like Amitabh Bachchan endorse eye donation. International organisations have supported many of its activities. The government has helped conduct many seminars and workshop to educate the public about eye donation. Corporate have provided financial and other resources. There are about 404 organisations, registered with E.B.A.I. Many organisations that are not registered also partner in spreading awareness about eye donation and facilitating eye donation in whatever way they can. We might be one of the fastest growing economies in the world. But we also harbour one-fourth of the world's blind population. Even though we had about 9,500,000 deaths last year, only 10,000 actually donated their eyes, which is only 0.11% of the death. As compared to this, 1.5% of the population are blind. Gujarat is 5 th in number of eye banks in the state. From 2000 to 2006, Gujarat topped nationally in the number of eye donations. The report by indiastat says that In the current year the numbers have already touched 3,590 in Gujarat by July 2010, while Tamil Nadu stands at 3, 286. [8] This indicates that Gujarat is likely to top in the number of eye donations this year as well. However, Development of infrastructure is a major requirement for Gujarat to again become the topmost state for eye donations in the country. Conclusion :- As a growing economy, we will require healthy Indians to develop our nation. The government is doing many efforts to increase eye donation awareness. Medical science has improved much to store the eyes for longer time. The operations are becoming matter of minutes. The success rates of transplants are also increasing. One should take pledge to donate eyes after the death. Two things about eye banking do remain the same - the smile recipients have when their sight is restored and their gratitude to the generous donors who made it possible. So let us take a pledge to donate eye and give vision to development of India

75 75 Ms Mittal Patel, Nursing Tutor, Sumandeep College of Nursing, Vadodara DO YOU KNOW? Alien Hand Syndrome is an unusual neurological disorder in which the sufferer s hand seems to take on a mind of its own. After sustaining trauma to the brain such as an injury, stroke, or infection some people develop alien hand syndrome, a condition where the victim can feel sensation in the hand, but has no control over movement and does not sense the hand as a part of the body, as if it belonged to an alien being The Strong Contraction of Your Heart Creates Enough Pressure To Squirt Blood As Far As 30 Feet. Your heart beats 101,000 times a day. During your lifetime it will beat about 3 billion times and pump about 400 million liters (800 million pints) of blood. An adult human body contains approximately 100 trillion cells. Three Hundred Million Cells Die in Your Body Every Minute. It does sounds like a lot but this is actually less than % of the amount of cells being replaced in your body every day. (About trillion cells are being replace in your body every day) Babies Have More Bones than You Do. When a baby is born, they have 300 bones in their body. When they reach adulthood they are left with only 206 bones. This is because the smaller bones eventually join together to form stronger single bones. Your Hair Is Almost Indestructible. The average human head has about 100,000 hairs. Apart from having it burnt, human hair decays at such a slow rate that it is almost impossible to get rid of. Do you remember those documentaries about Egypt, the pyramids and Mummies on Discovery Channel? Well the mummies are left with no flesh, practically nothing but bones and yes hair. It might look fragile but hair cannot be destroyed by cold, change of climate, water, or other natural forces and it is resistant to many kinds of acids and corrosive chemicals. As humans grow older, the lens in the eye grows thicker. This is why people who once had perfect vision often need glasses in their 40s. DNA, the basic building block of life, is a long molecule containing four chemical bases: adenine (A), guanine (G), thymine (T), and cytosine (C).The human genome half the DNA contents of a single nucleus contains about 31 billion base pairs: 31,000,000,000 A's, G's, T's, and C's.Six billion steps of DNA are contained in a single cell

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