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Karthik A
Karthik A
A DISSERTATION SUBMITTED TO
CHENNAI
OCTOBER -2017
A QUASI EXPERIMENTAL STUDY TO EVALUATE THE
MISS. K.KARTHIKA
A DISSERTATION SUBMITTED TO
CHENNAI,
OCTOBER-2017
CERTIFIED BONAFIDE WORK DONE BY
MISS K.KARTHIKA
ODDANCHATRAM,
DINDIGUL.
UNIVERSITY, CHENNAI.
1. 2.
CERTIFICATE BY RESEARCH GUIDE
NURSING
DATE:
PLACE:
ACKNOWLEDGEMENT
My great indebted thanks to the Lord Almighty for his abundant blessings,
endless grace and love showered on me in providing the strength to overcome all the
not have been possible. There are several hands behind in giving a shape to this
research study, which would be impossible to mention all by name. There are some
project successfully.
this study.
harvest .I would like to express my immense gratitude and whole hearted thanks to
Surgical Nursing, Sakthi College of Nursing, for diligent effort the best quality,
peaceful, her reassuring plan and a very approachable and inspiring quote, that can
never be forgotten .I consider it as a great honor and privilege to have completed
I profusely thank all medical and nursing experts who validated content and
tool which helped to incorporate their views this study especially extend my gratitude
Head of the Department of Medical Surgical Nursing for her constant encouragement,
Head of the Department of Obstetrics and Gynecological Nursing, our class co-
coordinators, Sakthi College of Nursing, for their valuable guidance, support and
of Nursing for their continuous encouragement, guidance and valuable suggestions for
this study.
I profusely thank all Medical and Nursing Experts who validated the content
M.Sc, librarian of Sakthi College of Nursing for helping me with literature work and
for his well-timed and opportune aid and backing in statistical analysis and
presentation of data.
permission to conduct the study and my special heartful thanks to all the participants
for their co-operation throughout the study. Without their co-operation it would not
Sakthi Arts and Science for editing this manuscript and tool in Tamil and English.
Mrs Sahaya Jovitha and my lovable friends and seniors for their co-operation and
beloved Mother and uncle who persuaded me to pursue Post Graduate study, I am ever
This study drew upon the knowledge and help, experience and expertise of
many persons of good will, though too numerous to name, each one of them is
remembered for their individual contributions without which the realization and
presentation of this research would not have been. So I shower my great deal of thanks
fulfillment of the requirement for the Degree of Master of Science in Nursing to the
The objective of the study were, to assess the breathing pattern before and
group. To find out the association between the breathing pattern with selected
In this study quasi experimental, non randomized control group pre test-post
test design was adopted. The study include 60 samples patients who were selected by
hospital at Dindigul district demographic data ,modified dyspnea Borg scale and
intervention for deep breathing exercise these are method used for data collection
procedure. the tool was finalized of five medical and nursing experts and pilot study
for the its clarity ambiguity and feasibility on similar subject to analyze the
experimental data statistical analysis was used Modified Borg scale was used to
group belongs to the age group of 51 to 60 years and 9(30%) in experimental group
and 9(30%) in control group belonged to the age group of above 60 years.
(46.6%) in the control group were females and the remaining were males.
7(23.3%) of them had illiterate in experimental group and 7(23.3%) of them had high
school education and 9(30%) of them had higher secondary education in control
group.
With regard to the occupation, 9(30%) were self workers and 9(30%) were
industrial workers in experimental group and 9(30%) were self workers and 8(26.7%)
group
subjects (6.7%) had moderate level of breathing difficulty and 5 subjects(16.7%) had
severe level of breathing difficulty . And the post test level of breathing difficulty in
control group , 2 subjects (6.7%) had somewhat severe level of breathing difficulty
Whereas in experimental group, the pre test level of breathing pattern 11 subjects
(36.7%) had maximum level of breathing difficulty and 2 subjects (6.7%) had
moderate level of breathing difficulty and the post test level of breathing difficulty, 12
subjects (40%) had very very slight level of breath difficulty, and 10(33.3%) had
The calculated ‘t’ values in the control group were 2.07which are not
significant. It is concluded that there was no significant differences between the pre
and post test level of breathing pattern among chronic obstructive pulmonary disease
patients
The calculated ’t’ value in the experimental group were 2.64was statistically
significant at p<0.05 level which clearly shows that there was a significant reduce in
the level of breathing pattern among patients among chronic obstructive pulmonary
The obtained ‘t’ values for level of pain between the control and experimental
group is 4.51which were highly significant at p<0.05 level. These findings revealed
that the subjects in experimental group had decreased level of breathing pattern after
accepted.
TABLE OF CONTENT
I INTRODUCTION 1-13
Need for the study 5
Statement of the problem 11
Objectives of the study 11
Hypothesis 11
Operational definitions 12
Assumptions 13
Delimitation 13
Project outcome 13
V DISCUSSION 74-78
REFERENCES 87-91
Book references 87
Journal references 88
Net references 91
APPENDICES
i-xxiv
LIST OF TABLES
TABLE PAGE
TITLE
NO NO
1. Frequency and percentage distribution of chronic obstructive 45
pulmonary patients according to their Demographic variables.
3. Mean, SD and paired ‘t” –test of pre and posttest level of breathing 64
pattern in control group
4. Mean, SD and paired “t” test of pre and post level of breathing 65
pattern in experimental group.
PAGE
FIGURE TITLE
NO
1. Conceptual Frame Work Based on Nola bender health promotion 29
model(1997)
IV List of Expertise vi
INTRODUCTION
Chinesage
In the history of medicine there have always been periods when one diseases
or group of related disease presented an unusually grave threat to the health of the
concerned by the growing number of men disabled by chronic respiratory disease and
by the disruption. Such illness are causing in the life of the individual.
“When you can’t breathe, nothing else matters”, is the mantra of the American
and pulmonary emphysema. The disease is disabling with symptoms such as chronic
respiratory passage. Changes in the lungs result in mucus hyper secretion, dysfunction
of the cilia, airflow limitation and hyper inflation of the lungs, gas exchange
1
Persons with COPD are greatly under estimated because the disease is usually
not diagnosed until it is moderately advanced .Patients usually seek medical help
when they have an acute respiratory infection, with dyspnea being the main concern.
Dyspnea is often progressive, and initially occurs with exertion, gradually interferes
with daily activities and in late stages dyspnea may be present at rest also. The person
becomes more of a chest breather, relying on the intercostals and accessory muscles
Breathing exercises may assist the patient during rest and activity by
the Incidence and prevalence of COPD in south India. The data reported that13680
patients who underwent PFT during the 3 year period there were 9702 males and 4164
females. 946 patients (6.8%)were diagnosed to have COPD according to COPD guide
lines of which 811were males (86%)and 135 more females (14%).smoking was seen
and 4.15years.out of 946 patients 284 had mild COPD 30%.286 had moderate
diseases30% and the remaining 387 patients 40% had sever COPD .The overall
Dechman, G., 2005 A study was conducted at Canada to assess the effects of
imposed pursed lips breathing on respiratory mechanics and dyspnea at rest and
during exercise in COPD. Eight patients with stable mild to severe COPD participated
in the study. The subjects underwent pulmonary function test and bicycle ergometry.
2
Breathlessness visual analogue scale, inspiratory capacity maneuvers and esophageal
balloon were the instruments used. The study result revels that the patients had no
dyspnea at rest, during exercise dyspnea was variably affected by pursed lip
breathing. Changes in the individual score were significantly correlated with changes
in the end expiratory lung volume (p=0.002) and mean inspiratory ratio of pleural
This study concluded that pursed lips breathing can have a variable effect on dyspnea
when performed volitionally during exercise by patients with COPD. The effect of
pursed lip breathing on dyspnea is related to the combined change that it promotes in
the tidal volume and end expiratory lung volume and their impact on the available
capacity of the respiratory muscles to meet the demands placed on them in terms of
pressure generation
responsible for more than 13.4 million physician visits and 13% of hospitalizations
(SOB), cough, wheezing and sputum production, that affects an individual’s quality of
life more than does the physiological impairment. Despite optimal medical and
pharmacological therapy, most people with COPD continue to suffer chronic and
The study result revels that the patients had no dyspnea at rest, during exercise
dyspnea was variably affected by pursed lip breathing. Changes in the individual
score were significantly correlated with changes in the end expiratory lung volume
(p=0.002) and mean inspiratory ratio of pleural pressure to the maximal static
3
inspiratory pressure generating capacity (P=0.001). This study concluded that pursed
lips breathing can have a variable effect on dyspnea when performed volitionally
during exercise by patients with COPD. The effect of pursed lip breathing on dyspnea
is related to the combined change that it promotes in the tidal volume and end
expiratory lung volume and their impact on the available capacity of the respiratory
failure due to pulmonary emphysema. 15 samples were selected for the program
stretch gymnastics and walking with synchronized breathing. Visual analogue scale,
6-minute walk. The study reveals that there is a significant decrease in dyspnea
total lung capacity (TLC) and residual volume (RV) (P<0.01). The findings suggest
that this program relieves dyspnea, increases functional exercise capacity, and
decreases
Total lung capacity and residual volume on patients with chronic respiratory
4
NEED FOR THE STUDY
people suffer from copd and 2, 55,000 people died of copd (WHO). The copd
statistics in India in 2004 details 57.5 estimated total deaths and 5.1 estimated deaths
per 1 lakh population. And 277 disability adjusted life year (DALYs) per 1 lakh and
268 age standardized disability adjusted life year (DALYs) per 1 lakh. The global
statistics of asthma (WHO 2004) details 2, 87,000 (0.5%) of total global deaths. In
this 1, 51,000 men, 1,36,000 women and DALYs includes 8,856,000 for men
7,461,000 women and 1.8 standardized death per 1 lakh and 19.4 million disability
and constitutes 6.6 million YLD among men and 1.8 million YLD in high income
countries.
trillion ,half of which occurring in the developing world .the 6th commonest cause of
death., males had a higher prevalence of COPD 11.1 percentage compared to females
leading cause of death and disability in the United States. Data from a national health
survey suggests that at least 24 million Americans were affected by the disease in
number of copd cases increased to 3.84 million in 2010 .this increased of 68.9 %was
mainly driven by global demographic changes .across the who regions the highest
prevalence was estimated in the American 13.3% in 1990 and 15.2%2010 and lowest
in south east.
5
United status(2011) Chronic obstructive pulmonary disease is one of the
leading cause of death, illness and disability in the united states and estimates 10
million American adults were diagnosed with the condition in 2000,but the data from
the national health survey suggest that as many as 24 million Americans were actually
hospitalizations and 1.5 million visits to hospital emergency rooms. A study was to
pulmonary disease resulting from sarcoidosis. The study concluded that self care
actions should be encouraged and thought and self care resources facilitated. The
breathing techniques used by patients with copd and those with sarcodosis should be
considered during patient and family education .Hence the investigator felt that it is
breathlessness in patients with COPD. The twenty two patients with mild to severe
COPD were studied. Dyspnea was assessed by a Modified Borg Scale. The patients
volume of the chest wall. Deep breathing exercises decreases end expiratory volume
of chest wall and reduces breathlessness. The study showed that a deep breathing
6
Das S, Mukherjee S, Kundu et al (2008) A comparative study was
exercise in COPD. The eight COPD patients (6male and 2 female) with a mean age of
11 years. Deep breathing exercises promoted a slower and deeper breathing pattern
both at rest and during exercise. Deep breathing have a variable effect on dyspnea
when performed voliticully during exercise by patient with COPD. The study showed
muscle strength and endurance, exercise capacity, dyspnea and quality of life for
trials, with adults with stable COPD, comparing IMT to sham IMT or no intervention,
low versus high intensity IMT, and different modes of IMT were included. Nineteen
of 274 articles in the original search met the inclusion criteria. The updated search
revealed 17 additional articles; 6 met the inclusion criteria, all of which compared
the sub-group analysis comparing IMT versus sham IMT was performed with 10
loading, MVV), exercise capacity Ve(max), Borg Score for Respiratory Effort,
7
(quality of life). Results suggest that targeted, threshold or normocapneic
endurance, improves outcomes of exercise capacity and one measure of quality of life,
Framingham (2007) study focused on the long term predictive power of vital
capacity and forced exhalation volume as the primary markers for life span and
vigour and literally to a measure of living capacity. Breathing exercises can be trained
for both negative and positive influences on health. Our exercise promotes relaxation
and proper breathing technique will strengthen the lungs. There are many benefits of
breathing exercise that is it cleanses the body diseases, steadies the mind and helps in
cause of death, illness and disability in the united states and estimates 10 million
American adults were diagnosed with the condition in 2000, but the data from the
national health survey suggest that as many as 24 million Americans were actually
affected .in 2000 chronic obstructive caused about 119,000 deaths, 726,000
hospitalizations and 1.5 million visits to hospital emergency rooms. A study was to
pulmonary disease resulting from sarcoidosis.the study concluded that self care
actions should be encouraged and thought and self care resources facilitated. The
breathing techniques used by patients with copd and those with sarcodosis should be
considered during patient and family education .Hence the investigator felt that it is
8
very essential to educate about breathing exercises to reduce the dyspnea in
asthma estimates approximately 300 million people worldwide currently have asthma.
The study suggested that asthma prevalence increases globally by 50% every decade.
With the projected increase in the proportion of worlds urban population from 45-
worldwide over the next two decades. It is estimated that there may be additional 100
million persons with asthma by 2025. Deep breathing exercise selected in this study
for improving the pulmonary function of the patients are simple, can be performed
without any expenses or complex devices and doesn’t require a particular area in a
pattern of chest wall muscle recruitment and improved ventilation with pursed-lip
breathing (PLB) in COPD. Pursed lip breathing led to increased rib cage and
muscle recruitment during expiration, decreased duty cycle of the inspiratory muscles
and respiratory rate, and improved SaO2. In addition, PLB resulted in no change in
pressure across the diaphragm and a less fatiguing breathing pattern of the diaphragm.
with PLB while protecting the diaphragm from fatigue in COPD. Alterations in the
pattern of respiratory muscle recruitment with PLB may be associated also with the
9
explore the relationship between the pattern of respiratory muscle recruitment during
structured questionnaire and prevalence of COPD in rural area of Mysore. The study
included 900 adults above 40 years. The instruments used were structured
questionnaire and spirometry. Data was collected by survey method. The study
reveals that the structured questionnaire is a useful tool for the screening of COPD
infield studies and the total prevalence of COPD was 7.1%. Males had a higher
the symptoms of dyspnea endured by people who suffer from airflow obstruction
as biofeedback also have been successfully used. The article described the
altered breathing patterns used by patients with COPD at rest and during physical
activity regarding techniques of breathing pattern retraining that have been developed
to improve the capacity of persons with COPD to perform activities of daily living, a
Angeles to assess the efficacy of pursed lip breathing: a breathing pattern retraining
functional performance was assessed by modified Borg after 6 minute walk distance
10
function scale of short form 36-item Health Survey. The study result reveals that there
is a significant reduction for the modified Borg Scale after 6 MWD (P=0.05) and
physical function (P=0.02) from baseline to 12 weeks were only present for pursed lip
with chronic obstructive pulmonary disease who are aged between 50-60 years years
To assess the breathing difficulty before and after breathing exercise among
group.
To find out the association between the pretest level of breathing difficulty
HYPOTHESIS
H1 : The mean post test level of breathing difficulty will be significantly lower
than the mean pre test level of breathing pattern among chronic obstructive
11
H2 : There is a significant difference between the mean pretest and mean post
OPERATIONAL DEFINITIONS
Assessment
Effectiveness
Location
In this study, patients’ who are those diagnosed as COPD and got admitted in
12
ASSUMPTION
respiratory diseases
DELIMITATION
PROJECT OUTCOME
This study will be able to evaluate the effectiveness of deep breathing exercise
13
CHAPTER-II
REVIEW OF LITERATURE
CHAPTER - II
REVIEW OF LITERATURE
of existing information on the topic of material for the study. The review of literature
was alone to collect maximum information for laying foundation of this study. The
critical analysis and reporting of existing information on the topic of material for the
study.
evaluate the pulmonary function showed the pulmonary function test values were
14
pulmonary disease patients. Chronic obstructive pulmonary disease (COPD) is the
fourth leading cause of death and 13th leading cause of burden of diseases worldwide
The global initiative for chronic obstructive lung disease (GOLD) has
classified COPD as ‘a disease state characterized by airflow limitation that is not fully
reversible. The airflow limitation is usually both progressive and associated with an
smoking is the major risk factor for COPD worldwide, and the risk attributable to
suggests the existence of other risk factors such as passive smoking, occupational
exposure, and indoor air pollution .Recently, exposure to biomass smoke resulting
from household combustion of solid fuels has been identified as an important risk
factor for COPD, with rural women in developing countries bearing most of this
results in high levels of pollutants such as carbon monoxide, oxides of nitrogen and
many males as females, this difference will diminish given the fact than more and
more females throughout the world have taken up smoking in the past few years in
developed countries, and non-smoking females are exposed to bio mass combustion
15
JOSHI J.M ETAL (2007) Recent studies have made important contributions
home. Collectively, the evidence from these studies shows that rural women, children
in solid fuel using settings experience extremely high levels of air pollutants often at
least an order of magnitude higher than what is commonly considered as safe levels of
exposure. WHO’s Comparative Risk Assessment (15) estimated that about 950,000
children die each year from acute lower respiratory infections as a result of these
exposures worldwide along with about 650,000 pre mature deaths of women from
have COPD and 3 million people died of COPD. WHO predicts that COPD will
become the third leading cause of death worldwide by 2030 The World Health
Organization (WHO) estimates that COPD as a single cause of death shares 4th and
5th places with HIV/AIDS (after coronary heart disease, cerebro vascular disease and
follows,
The WHO estimates that in 2007, 2.74 million people died of COPD
worldwide. In 1990, a study by the World Bank and WHO ranked COPD 12th as a
burden of disease; by 2020, it is estimated that COPD will be ranked 5th According to
the WHO, passive smoking carries serious risks, especially for children and those
chronically exposed. The WHO estimates that passive smoking is associated with a 10
16
primary cause of COPD, the WHO estimates that there are 400,000 deaths per year
decreased since 1965, but an increase in chronic respiratory diseases (asthma and
COPD) has been observed in the last decade. COPD is estimated to be 6.2 percent in
The use of biomass fuels, especially in the rural areas, contributes towards a higher
prevalence of COPD in some of these countries and suggests that COPD may be
chronic respiratory diseases are the 4th leading cause of death in large urban areas,
but the first leading cause of death in rural areas. In China, smoking rates among
women remain low (estimated at 6 percent), although the prevalence of COPD in men
and women is about the same. This point to the importance of risk factor other than
and outpatient hospital clinics. It is estimated that 50 percent of the male population
smokes, with higher rates in the rural areas than the urban areas. COPD is the third
leading cause of death in the U.S.(It was originally projected to be the third leading
cause of death for both males and females by the year 2020. - The Centers for Disease
Control (CDC) and Prevention's National Center for Health Statistics (NCHS)
released a report on Dec 10, 2010, "Deaths: Preliminary Data for 2008," confirming
that Chronic Obstructive Pulmonary Disease (COPD) became the third leading cause
17
The NHBLI reports 12.1 million adults 25 and older were diagnosed in 2001.It
is estimated that there may currently be 16 million people in the United States
additional 14 million or more in the United States still undiagnosed, as they are in the
beginning stages and have little to minimal symptoms and have not sought health care
yet. Men are 7 times more likely to be diagnosed with emphysema then women,
though the prevalence in women is on a steady increase and this number is lowering
with each year People over the age of 50 are more likely to be considered disabled,
however, the damage started years before About 1.5 million emergency department
visits by adults 25 and older were made for COPD in 2000.More emergency
department visits for COPD were made by adult females than adult males (898,000
vs. 651,000).
According to the Center for Disease Control (CDC), there were 124,816
It is the only major disease with an increasing death rate, rising 16% 9
COPD prevalence estimated based Global Initiative for COPD staging criteria
were adjusted for the target population. Logistic regression was used to estimate
adjusted odds ratios for COPD associated with 10 years increments and 10 year pack
increment. Meta-analysis provided pooled for these risk factors. The findings of stage
2 or higher COPD was 10.1% for men and 8.5 % for women. The ORs for 10 years
18
age increments were much the same across sites and for women and men. The pooled
estimate was 1.94% per 10 years increment. Sites- specific pack year ORs varied
common diseases, the early diagnosis of which allows effective management and
treatment. The prospective observational longitudinal study comprised 164 high risk
smokers aged 40 and 76 years. Age, sex, weight, height and smoking habits were
recorded and spirometry was performed. Patients were informed of their result and
given brief advice on how to stop smoking. After 3 years, the patients underwent the
same evaluation. The result of the study revealed that 22% of the smokers were
diagnosed with COPD. Three year later, an additional 16.3 % were diagnosed as
having COPD, and disease had worsened in 38% of those already diagnosed. Of the
patients with FEV1 less than 90%, 44.8% develops COPD. And accelerated decrease
in FEV1 was found in 18% of the patients. Mean tobacco consumption in 1999 was
28.1 pack years in subject without COPD and 31.7 packs years in those with COPD,
whereas in 2002, consumption was 30.6 packs in the patients with COPD and 31.9
packs year in those without . In the years, 22.8% had stopped smoking
retaining and exercise in persons with chronic obstructive pulmonary disease. They
also have been successfully used. The article described the altered breathing patterns
19
used by patients with COPD at rest and during physical activity. The literature is
asthma and breathing training. And the review found that the systematic documenting
abdominal breathing in asthma is not clear, and adverse effects have been reported in
positive effects of pursed-lip breathing and nasal breathing but clinical evidence is
lacking. Modification of breathing patterns alone does not yield any significant
benefit. There is limited evidence that inspiratory muscle training and hypoventilation
use. Breathing exercises do not seem to have any substantial effect on parameters of
basal lung function. They suggested additional research on the psychological and
daily life.
capacity, and lung function.15 patients with chronic respiratory failure due to
muscle stretch gymnastics, and walking with synchronized breathing. The results had
20
shown that dyspnea as measured with a visual analogue scale at the end of a 6-minute
walk before and after the program (49.7 +/- 4.0% to 24.2 +/- 3.8%) decreased
walking distance (226.9 +/- 32.4 m to 292.1 +/- 35.8 m) increased significantly (p <
incremental treadmill test did not improve. Spirometric data did not change during the
study. Total lung capacity (TLC) (8.44 +/- 0.70 L to 7.58 +/- 0.74 L) and residual
volume (RV) (5.13 +/- 0.53 L to 4.28 +/- 0.59 L) decreased significantly (p < 0.01).
The findings suggest that this program relieves dyspnea, increases the functional
capacity and decrease the functional exercise capacity, and decreases TLC and RV on
They used a randomized controlled trial technique in which forty-five in patients with
stroke (24 men, 21 women) were recruited for the study. The subjects were
underwent pulmonary function and cardiopulmonary exercise tests. The results shown
that after the training programme, the IMT group had significantly improved forced
expiratory volume at 1 second (FEV (1)), forced vital capacity (FVC), vital capacity
(VC), forced expiratory flow rate 25-75% (FEF 25-75%) and maximum voluntary
21
ventilation (MVV) values compared with the BRT and control groups, although there
were no significant differences between the BRT and control groups (P<0.01). Peak
expiratory flow rate (PEF) value was increased significantly in the BTR group
compared with the IMT and control groups. The IMT group also had significantly
higher peak oxygen consumption (VO (2peak)) than the BRT and control groups,
although there were no significant differences between the BRT and control groups
pressure (PI (max)) and maximum inspiratory and expiratory pressure (PE (max)) in
the BRT group and, PI (max) in the IMT group compared with baseline and the
control group. In the IMT group, this was associated with improvements in exercise
pattern of chest wall muscle recruitment and improved ventilation with pursed-lip
breathing (PLB) in COPD. Pursed lip breathing led to increased rib cage and
muscle recruitment during expiration, decreased duty cycle of the inspiratory muscles
and respiratory rate, and improved SaO2. In addition, PLB resulted in no change in
pressure across the diaphragm and a less fatiguing breathing pattern of the diaphragm.
with PLB while protecting the diaphragm from fatigue in COPD. Alterations in the
pattern of respiratory muscle recruitment with PLB may be associated also with the
22
explore the relationship between the pattern of respiratory muscle recruitment during
Van der Schans CP, et al (1992) conducted a study to assess the effect of
muscle, parasternal muscle, and abdominal muscles. Pulmonary function and EMG
obstruction. The results shown that simulated pursed lips breathing resulted in a
significant increase of functional residual capacity and tidal volume both at baseline
and during airway obstruction. Phasic respiratory muscle activity during PEP
function
conducted on breathlessness in patients with COPD. the twenty two patients with mild
to severe COPD were studied. Dyspnea was assessed by a Modified Borg Scale. The
expiratory volume of the chest wall. Deep breathing exercises decreases end
expiratory volume of chest wall and reduce breathlessness. The study showed that
deep breathing exercises are more effective in reducing dyspnea in COPD patients.
Dyspnea at rest and during exercise in COPD. The eight COPD patients (6male and 2
23
female) with a mean age of 11 years. Deep breathing exercises promoted a slower and
deeper breathing pattern both at rest and during exercise. Deep breathing have a
variable effect on dyspnea when performed voliticully during exercise by patient with
COPD. The study showed effectiveness of deep breathing exercises in patient at rest
patients. The subjects of the study were 125 patients. This study shows deep breathing
cohort study was conducted on efficient integrated education for older patients with
COPD using deep breathing exercises. A total of 85 patients. This study shows
integrated education for older patients with COPD effectively improved patients deep
breathing exercises.
subjects were included among them 100 men and 45 women. Deep breathing
COPD self management among 142 patients. Out of which 74 intervention and 68
control patients were included. This study demonstrates that a hospital based re
severe COPD. Exercise tolerance capacity is more in COPD patients. A study was
respiratory illness. 220 subjects were included and the study revealed that
24
breathing exercise was one of the effective non pharmacological intervention in
treating dyspnea
deep breathing exercise on dyspnea in moderate COPD patients. The subjects of the
study were 240. Out of which 120 subjects were manipulated and the rest were getting
no intervention. According to the study, it revealed that there were considerably more
effective to the subject given exercise rather than those without intervention. Thus it
proved that deep breathing exercise was better than compared to other group .
25
CONCEPTUAL FRAME WORK
The conceptual frame work of the present study was developed by the
applicable while dealing with improve the breathing pattern and promoting deep
breathing exercise
Major concept
A. Person
Man has the ability to express human health potential and has the capacity for
B. Health
C. Nursing
The trend towards health promotion has created the opportunity for nurse to
26
D. Environment
Individuals are more apt to perform behavior if they are comfortable with
Key concept
Most of the person have breathing problem and less know about the deep
Personal factors
Interpersonal influences
Situational influences
barrier to action
27
Behavior outcomes
After deep breathing exercise, most of the person adequate information and
behavior
28
Cognitive
perceptual Perceived Health Perceived
factors status promoting benefits
service
DEMOGRAPHIC EXPERIMENTAL
POST TEST GROUP
VARIABLES
Administration of Assess the
Age, sex, religion, Positive response
Experimental deep breathing effectiveness
educational status,
group exercise among deep To improve the
occupational place of
chronic obstructive breathing breathing pattern
residence, family
pulmonary disease exercise among chronic
income, smoking
patients among obstructive
habits, duration of
chronic pulmonary disease
illness
obstructive patients
PRE TEST pulmonary
Control group No intervention
Assess the breathing disease
CONTROL GROUP
pattern among chronic patients
obstructive Negative response
pulmonary disease
patients No improvement in
breathing pattern
FEED BACK
METHODOLOGY
procedure for gathering valid and reliable data for the problem under investigation
logically project the research undertaken .research methodology is the systemic way
The chapter includes research design, sample, population, and sample size,
sampling technique, development of the tool, content validity, pilot study, ethical
RESEARCH APPROACH
RESEARCH DESIGN
The research design is the overall plan, structure and method of investigation
For this study research design is quasi experimental. Pre experimental (one
group pre and post test) design will be used for the study.
30
SCHEMATIC REPRESENTATION OF THE STUDY
Experimental Group O1 X O2
Control Group O1 - O2
(pretest)
(posttest)
measurable terms .In research, this term refers to the measurable characteristics,
studied.
There are two types of variables. were identified in this study. They are
31
Independent variables
Dependent variable
Demographic variables :
Setting is the general location and condition in which data collection takes
32
Sample
The sample selected for the present study was 60patients admitted in selected
Sample size
the criteria were selected (30samples for the experimental group and 30 samples for
Sample technique
The sampling technique adopted for this study was non probability purposive
sampling technique
Sampling criteria
The study samples will be selected keeping in view of the following pre-
determined criteria
Inclusion criteria
Patients who are available during the period and data collection.
study
33
Exclusion criteria
34
RESEARCH DESIGN
Quasi experimental design
TARGET POPULATION
Chronic obstructive pulmonary patients in selected hospital at Dindigul
district.
ACCESSIBLE POPULATION
Chronic obstructive pulmonary patients who were in oddanchatram
government hospital and Dindigul government hospital at Dindigul district
SAMPLING TECHNIQUE
Non probability purposive sampling technique
SAMPLE 60
Experimental group (30) Control group (30)
No intervention
Intervention (deep breathing exercise)
Data analysis
Descriptive and inferential statistics
Criterion measures
35
POPULATION
criteria.
Target population
Accessible population
The population research to which the researchers can apply their conclusions
Section I:
variables)
36
Section II:
Scoring
0 No breathlessness
2 Very slight
3 Slight breathlessness
4 Moderate
6 severe breathlessness
9 Maximum
10 Almost maximum
Scoring interpretation
1-2-mild
3-4-moderate
5-6-severe breath
9-10-Almost maximum
37
DATA COLLECTION METHOD
Data will be collected after obtaining prior permission from the hospitals.
Objective of the study will be explained and informed consent will be taken
patients ..
exercise .
SECTION I
Demographic variables
illness marital status, monthly income of the family, smoking habits and continuous
38
SECTION II
SCORING PROCEDURE
1-2-slight
3-4-moderate
5-6-severe breath
9-10-Almost maximum
Validity
measure. Validity of the tool was obtained from five experts in the field of
nursing.
Reliability
In order to established the tool .it was demonstrate to patient there are in
sample area .it was established through test and retest method .The reliability of the
39
tool was established by implementing the tool on chronic obstructive pulmonary
PILOT STUDY
A small scale version of a larger study that is conducted to prepare for the
study .a pilot study can involve pretesting a research tool, like a new data collection
method
Pilot study was conducted to evaluate the feasibility and reliability of the
study. The pilot study was conducted among chronic obstructive pulmonary disease in
selected hospital at Dindigul district. 6 sample were taken for pilot study. Pre test was
conducted then deep breathing exercise was given as intervention post test was
The investigator got formal permission from the college authority, Sakthi
College of nursing and concerned authority of both hospitals. The study participants
those who fulfill the inclusion criteria were selected by convenience sampling
Brief explanation about the purpose of the study is given to the subjects.
Assurance is given that the data will be utilized only for the purpose of the study. Oral
First investigator established the good rapport and introduced the study topic
to the patients. The investigator collected data regarding demographic variables. The
dyspnea scale was used to assess the level of breathing difficulty in experimental
40
group before each breathing exercise. The deep breathing exercise was given to the
experimental group twice daily for 15-20 minutes. The post test was conducted in
experimental group 1 hour after each breathing exercise .For control group, the
dyspnea scale was used to assess the pre test level of breathing difficulty twice before
giving exercise and post test level of breathing difficulty was assessed 1 hour of each
Samples
Weeks Activity
Control group Experimental
STATISTICAL ANALYSIS
Collected data were analyzed by descriptive and inferential statistics. The data
square test was used to associate the level of breathing difficulty among patients’
41
PLAN FOR DATA ANALYSIS
Data analyzed based on the objective of the study using descriptive inferential
statistics
Mean score ,percentage and standard deviation for the level of breathing
difficulty
Paired ”t”’ test used for find out the association of experimental and control
group.
committee of the college, chief of the hospital also after the consent from the study
42
CHAPTER-IV
DATA ANALYSIS
AND
INTERPRETATION
CHAPTER – IV
-George Eliot
examine each component of the data provided. This form of analysis is just one of the
many step that must be completed when conducting a research experiment. Data from
various source is gathered ,reviewed, and then analyzed to form some sort of finding
or conclusion. There are a variety of specific data analysis method, some of which
include data mining, text analytics, business intelligence and data visualizations.
disease in selected hospitals at Dindigul district .The collected data was organized,
analyzed and tabulated by using descriptive and inferential statistics. These data were
represented as follows.
43
3. Data on effectiveness of deep breathing exercise among chronic obstructive
44
OBJECTIVE – I
Table: 1 Frequency and percentage distribution of chronic
obstructive pulmonary patients according to their Demographic
variables.
N=30+30
3. Educational status
a) Illiterate 8 26.7 8 26.7
b) Primary 6 20 7 23.3
c) High school 7 23.3 9 30
d) Higher secondary 9 30 6 20
4. Occupation
a) Industrial workers 8 26.7 9 30
b) Private employee 7 23.3 8 26.7
c) Government 6 20 4 13.3
employee 9 30 9 30
d) Self employee
5. Marital status
a) Married 15 56.6 22 73.3
b) Un married 6 20 6 20
c) Divorce 5 16.7 0 0
d) Widow 4 13.3 2 6.7
45
6. Family history of
chronic obstructive
pulmonary disease
a) Yes 6 20 12 40
b) No 24 80 18 60
7 Duration of illness
a) < 1 year 9 30 10 33.3
b) 2-5 year 9 30 10 33.3
c) 6- year 12 40 10 33.3
8 Treatment of chronic
obstructive pulmonary
disease
a) Regular 14 46.7 16 53.3
b) Irregular 16 53.3 14 46.7
9. Monthly income of the
family
a) < 5000 12 40 10 33.3
b) 5000-10000 9 30 10 33.3
c) >10000 9 30 10 33.3
10. Smoking habits
a) Yes 12 40 24 80
b) No 18 60 6 20
11. Continuous breathing
difficulty present at
a)wake up 5 16.7 6 20
b)walking 4 13.3 7 23.3
c)sleeping at night time 5 16.7 6 20
d) exercise 16 53.3 11 36.7
46
CONTROL GROUP
The above table shows that among 30samples, with regards to age majority
belonged to 51--60years 10(33.3%) and With regards to gender male 14(46.7%), and
female 16 (53.3%)
education, 6(20%) of them had high school education 7(23.3), and uneducated 9(30%)
About duration if illness <1year 9(30%) and 2-5 year 9(30%), 6 year 12
(40%) samples.
47
Regarding continuous breathing difficulty presented at wake up 5(16.7%) of
the samples belonged to and walking 4(13.3)of the samples of the sample belonged to,
EXPERIMENTAL GROUP
The above table shows that among 30samples,with regards to majority age
samples belonged to above 60 years where as 4(13.3%) of the sample belonged to the
4(13.3%) of them had primary school education, and 9(30%) of them had high school
married
About duration if illness <1year 10(33.3%) and 2-5 year 10(33.3%) ,6 year
10(33.3%) samples.
48
About income of the family monthly, 10(33.3%) samples of them <5000,
samples belonged to and walking 7(23.3)of the samples of the sample belonged to
49
35
33.3
30 30 30
30
26.7
25
20
20
10
0
50-52years 53-55years 56-58years >66
Figure 3: Distribution of subjects based on their age in experimental and control group.
50
60
56.6
53.3
50
46.7
43.3
40
30 control
experimental
20
10
0
male female
Figure 4: Distribution of subject based on their gender in experimental group and control group
51
35
30 30
30 28.7
26.7
25 23.3 23.3
20 20
20
control
experimental
15
10
0
Illerate primary High school Higher secondary
Figure 5: Distribution of subject based on their educational status in experimental and control group
52
35
30 30 30
30
26.7 26.7
25 23.3
20
20
control
experimental
15 13.3
10
0
Insdustrial worker private employee government employee self worker
53
80
73.3
70
60
50
50
40 control
experimental
30
20 20
20 16.7
13.3
10 6.7
0
0
married unmarried Divorce widow
Figure 7: Distribution of subject on their marital status in experimental and control group
54
90
80
80
70
60
60
50
contol
40
40 experimental
30
20
20
10
0
yes No
Figure 8: Distribution of subject on their family history of copd in experimental and control group
55
45
40
40
30 30
30
25
control
20 experimental
15
10
0
<1 year 2-5 years 6 years
Figure 9: Distribution of subject based on duration of illness in control group and experimental group
56
54
53.3 53.3
52
50
48 control
experimental
46.7 46.7
46
44
42
regular Irregular
Figure 10: Distribution of subject based on their treatment of copd in control and experimental
57
45
40
40
30 30
30
25
control
20 experimental
15
10
0
<5000 5000-10,000 > 10,000
Figure 11: Distribution of subject based on their monthly income of the family in control and experimental group
58
90
80
80
70
60
60
50
control
40
40 experimental
30
20
20
10
0
yes No
Figure 12: Distribution of subject based on their smoking habits in control and experimental group
59
60
53.3
50
40
36.7
30 control
experimental
23.3
20 20
20
16.7 16.7
13.3
10
0
wake up walking sleeping at night time exercise
Figure 13. Distribution of subjects based on continuous breathing difficulty in experimental and control group
60
OBJECTIVE-II
Table 2: Frequency and percentage for deep breathing exercise among chronic
N=30+30
No breathlessness - - - - - - - -
Somewhat severe - - - - 3 10 6 20
Severe breath - - - - - - - -
Maximum 6 20 12 40 9 30 - -
61
The above table shows that in control group the per test scores on the level of
breathing pattern very severe were 4(13.3%)had very very severe,8(26.7%) had
maximum, 6(20%) had almost maximum12(40%). whereas in post test scores on the
level of moderate breathing were 6(20%) had very severe breath,4(13.3%) had very
In experimental group the pre test scores on the level of breathing pattern
moderate were 2(6.7%) had somewhat severe,3(10%) had moderate very very severe,
5(16.7%) had maximum breathing pattern 9(30%) had almost maximum 11(36.7).
whereas in post test scores on the level of very very slight were 12(40%) had slight
breath 10(33.3%) had moderate breathing pattern 6(20%)had severe breathing pattern
This finding reveals that in experimental group after the deep breathing
62
45
40 40 40
40
36.7
35 33.3
30
30
26.7 26.7
25
slight
20 20 20 moderate
20
16.7 severe breath
15 13.3 13.3 very very severe breath
maximum
10
10
6.7 6.7
0
pre test post test pre test post test
Figure: 14: Distribution of subjects based on the pretest and posttest dyspnea in control and experimental group.
63
OBJECTIVE –III
Table 3: Mean, SD and paired ‘t” –test of pre and posttest level of breathing
N=30
(*- P<0.05, significant and ** -P<0.01 & *** -P<0.001, Highly significant)
The above table shows that the calculated t value’ in the control group was
2.07 which was not significantly at P<0.05 level. It can be concluded that there is no
64
Table 4: Mean, SD and paired “t” test of pre and post level of breathing pattern
in experimental group.
N=30
Experimental
8.36 1.83 2.43 1.60 5.93 2.64*
group
(*- P<0.05, significant and ** -P<0.01 & *** -P<0.001, Highly significant)
The above table shows that the calculated “t” value in the experimental group
was 2.64 which was statistically significant at P<0.05 level. Hence H1 is accepted. It
can be concluded that deep breathing exercise was effective in reducing the dyspnea
65
Table 5: Mean, SD and unpaired ‘t’ test of posttest dyspnea in control and
experimental group.
(N=30+30)
The above table shows that the obtained ‘t’ value between control and
accepted. It can be concluded that the deep breathing exercise was effective in
66
OBJECTIVE - IV
Table 6: Data on compare the pretest and posttest level of breathing difficulty
between the control and experimental group.
N=30+30
Experimental
8.36 1.83 2.43 1.60 5.93 2.64*
Breathing group
pattern
Control
8.43 1.43 5.9 1.49 2.53 2.07
group
Experimental group
The above table shows that the calculated “t” value in the experimental group
was 2.64 which was statistically significant at P<0.05 level .Hence H2 is accepted. It
can be concluded that deep breathing exercise was effective in reducing the dyspnea
Control group
The above table shows that the calculated ‘t value’ in the control group was
2.07which was not significantly at P<0.05 level. It can be concluded that there is no
67
9
8.43 8.36
5.9
6
3
2.43
0
pretest posttest
control experimental
Figure 15: Comparison effectiveness of deep breathing exercise among chronic obstructive pulmonary disease patients experimental and
control group.
68
OBJECTIVE – V
Data on association between the pretest breathing pattern in control group and
their demographic variables.
Table 7: Frequency and percentage distribution of chi-square value on
control group
N=30
Very
Severe
S. Demographic Moderate very Maximum
breath X2 P-value
no variables severe
f % f % f % f %
1 Age (in years):
a) 50-52 years 1 3.3 2 6.7 0 0 2 6.7
b)53-55 years 1 3.3 1 3.3 2 6.7 2 6.7 25.63 S
c)56-58 years 1 3.3 5 16.7 4 13.3 0 0 df-9 16.92
d) 59- 60years 1 3.3 0 0 0 0 8 26.6
2 Gender
a)Male 2 6.7 5 16.7 4 13.3 3 10 4.46 NS
b)Female 2 6.7 3 10 2 6.7 9 30 df-3 7.81
3 Educational status
a) Illiterate 2 6.7 2 6.7 1 3.3 3 10
b) Primary school 1 3.3 3 10 2 6.7 0 0 7.67 NS
c) High school 1 3.3 2 6.7 2 6.7 2 6.7 df-9 16.49
d) Higher 0 0 1 3.3 1 3.3 7 23.3
secondary
4 Occupation
a) Industrial 2 6.7 3 10 1 3.3 2 6.7
worker 4.48 NS
b) Private 1 3.3 2 6.7 3 10 1 3.3 df-9 16.49
employee
c) Government 1 3.3 1 3.3 1 3.3 3 10
d) Self worker 0 0 2 6.7 1 3.3 6 20
5 Marital status
a) Married 2 6.7 4 13.3 2 6.7 5 16.7
b) Unmarried 1 3.3 1 3.3 3 10 4 13.3 7.20 NS
c) Divorce 1 3.3 1 3.3 0 0 1 3.3 df-9 16.49
d) Widow 0 0 1 3.3 1 3.3 2 6.7
69
6 Family history of
copd
a) Yes 2 6.7 3 10 1 3.3 0 0 26.08 7.81***
b) No 2 6.7 5 16.7 5 16.7 12 40 df-3
7 Duration of illness
a) <1year 1 3.3 2 6.7 2 6.7 4 13.3 3.846 NS
b) 2-5 year 1 3.3 2 6.7 1 3.3 5 16.7 df-6 12.53
c) 6year 2 6.7 4 13.3 3 10 3 10
8 Treatment of copd
a) Regular 2 6.7 3 10 2 6.7 5 16.7 6.30 NS
a) Irregular 2 6.7 5 16.7 4 13.3 7 23.3 df-3 7.81
9 Monthly income
the family
a) Rs ,<5000 2 6.7 3 10 4 13.3 3 10 6.16 NS
b) Rs, 5000-1000 1 3.3 2 6.7 1 3.3 5 16.7 df-6 12.16
a) Rs,>10,000 1 3.3 3 10 1 3.3 4 13.3
10 Smoking habits
a)Yes 2 6.7 3 10 3 10 4 13.3 3.89 NS
b)No 2 6.7 5 16.7 3 10 8 26.7 df-3 7.81
11 Continuous
breathing difficulty
presented at
a)wake up 1 3.3 2 6.7 1 3.3 1 3.3 11.78 NS
b)walking 1 3.3 1 3.3 2 6.7 0 0 df-9 16.92
c)sleeping at night 1 3.3 2 6.7 0 10 2 6.7
time
d)exercise 1 3.3 3 10 3 10 9 30
*
( -P>0.05,significant) (NS=Not significant)S=(significant )
The above table shows that there was a significant association between
dyspnea among chronic obstructive pulmonary disease patients and their demographic
variables such as age family history of COPD, There was no association between the
70
Data on association between the pretest level of breathing difficulty in
experimental group.
N=30
Very
Severe
S Demographic Slight Moderate very Maximum P-
breath X2
no variables S.no severe value
f % f % f % f % f %
1 Age (in years):
a) 50-52years 1 3.3 2 6.7 0 3.3 1 3.3 0 0 25.72 S
b) 53-55 years 0 0 0 0 1 3.3 0 0 7 23.3 df-12 21.03
c) 56-58years 1 3.3 1 3.3 2 6.7 3 10 2 6.7
d)59-60years 0 0 0 0 2 6.7 5 16.7 2 6.7
2 Gender
a)Male 2 6.7 2 6.7 3 10 4 13.3 6 20 6.21 NS
b)Female 0 0 1 3.3 2 6.7 6 20 5 16.7 df-4 9.49
3 Educational
status
a) Illerate 1 3.3 1 3.3 2 6.7 1 3.3 3 10 12.45 NS
b) Primary 1 3.3 0 0 1 3.3 2 6.7 3 10 df-12 21.03
school
c) High school 0 0 2 6.7 1 3.3 4 13.3 2 6.7
d) Higher 0 0 0 0 1 3.3 2 6.7 3 10
school
4 Occupation
status
a) Industrial 1 3.3 1 3.3 2 6.7 4 13.3 1 3.3
worker 14.51 NS
b)Private 0 0 0 0 1 3.3 2 6.7 2 16.7 df-12 21.03
employee
c) Gover 0 0 1 3.3 1 3.3 0 0 2 6.7
employe
d)Self worker 1 3.3 1 3.3 1 3.3 3 10 4 13.3
71
5 Marital status
e) Married 2 6.7 2 6.7 3 10 8 26.7 7 23.3 15.16 NS
f) Unmarried 0 0 1 3.3 1 3.3 0 0 4 13.3 df-12 21.03
g) Divorce 0 0 0 0 0 0 0 0 0 0
h) Widow 0 0 0 0 1 3.3 1 3.3 0 0
6 Family history
of COPD
a) Yes 2 6.7 1 3.3 2 6.7 4 13.3 3 10 4.75 NS
b) No 0 0 2 6.7 3 10 5 16.7 8 26.7 df-4 9.49
7 Duration of
illness
a) <1 year 0 0 2 6.7 1 3.3 4 13.3 3 10 7.32 NS
b) 2-5 years 1 3.3 0 0 2 6.7 2 6.7 5 16.7 df-8 15.51
c) 6 years 1 3.3 1 3.3 2 6.7 3 10 3 10
8 Treatment of
COPD
a) Regular 1 3.3 2 6.7 3 10 4 13.3 7 23.3 2.3 NS
b) Irregular 2 6.7 1 3.3 2 6.7 5 16.7 4 13.3 df-4 9.49
9 Monthly
income the
family
c) Rs ,<5000 2 6.7 1 3.3 2 6.7 3 10 2 6.7 9.23 NS
a) Rs, 5000- 0 0 1 3.3 2 6.7 2 6.7 5 16.7 df-8 15.51
1000
b) Rs,>10,00 0 0 1 3.3 1 3.3 4 13.3 4 13.3
0
10 Smoking habits
a) Yes 2 6.7 2 1.7 3 10 8 26.7 9 30 4.56 NS
b) No 0 0 1 3.3 2 6.7 1 3.3 2 6.7 df-4 9.49
11 Continuous
breathing
difficulty
presented at
a)wake up 1 3.3 0 0 1 3.3 2 6.7 2 6.7 21.03 S
b)walking 0 0 1 3.3 2 6.7 1 3.3 3 10 df-12 21.33
c)sleeping at 1 3.3 0 0 0 0 3 10 2 6.7
night time
d)exercise 0 0 2 6.7 2 6.7 3 10 4 13.3
(* -P>0.05, significant) (NS= Non significant)
72
The above table shows that there was a significant association between
dyspnea among chronic obstructive pulmonary disease patients and their demographic
73
CHAPTER- V
DISCUSSION
CHAPTER –V
DISCUSSION
Dindigul District.
A convenience sampling technique was used to collect data from the study
control group.pre test and post was conducted .The Data were collected for a period of
hospitals in Dindigul District. The discussion was based on the objectives specified in
this study
The first objective was to assess the breathing pattern before and after breathing
The findings shows that the pre test level of breathing pattern in control group,
4subjects (13.3%) had very severe level of breathing difficulty and 8 subjects (26.7%)
had very very severe level of breathing difficulty had 6subjects (20%)maximum and
12 subjects (40%) almost maximum . And the post test level of breathing difficulty in
subjects(26.7%) had very very severe level of breathing difficulty, and 12 subjects
74
The findings shows that the pre test level of breathing pattern In experimental
very very severe level of breathing difficulty,9 subjects (30%) had maximum level of
difficulty..
The table 3 shows that the calculated “t”value 2.64 was significant at
p<0.05level.The pre test mean in case of control group was 8.43 whereas the post test
mean was 5.9 and its mean difference was 2.53 which had greater improvement than
other parameters. It clearly concluded that there was a significant improvement in the
level of breathing pattern among patients chronic obstructive pulmonary disease after
accepted.
The above findings are consistent with the findings of Einar Wilder Smith and
exercise among chronic obstructive disease patients ..105 patients were selected and
breathing exercise with 7consecutive days of morning, afternoon and evening . The
results deep breathing exercise was effective in reducing dyspnea . It was an effective
group.
75
The calculated ’t’ value in the experimental group were 2.64 was statistically
significant at p<0.05 level which clearly shows that there was a significant reduce the
level of breathing pattern among chronic obstructive pulmonary disease patients after
giving breathing exercise. The mean post test level of breathing pattern will be
significantly lower than the mean pre test level of breathing pattern among patients in
accepted.
The obtained ‘t’ value for level of breathing pattern between the control and
findings revealed that the subjects in experimental group had decreased level of
breathing pattern after giving breathing exercise compared to control group. The mean
post test level of breathing pattern in experimental group will be significantly lower
than the mean post test level of breathing pattern in control group among patients
The above findings are consistent with the findings of Judith A.Paice.,et,al
were randomly allocated as control and experimental group .Data was obtained by
using deep breathing exercise and dyspnea scale. Intervention was given to the
experimental group. Data analysis revealed that the comparison of dyspnea before
and after giving deep breathing exercise .The calculated ‘t’ value of the study was
4.51at p level 2.00 . They finally included that the values are highly significant it
shows deep breathing exercise was effective one for reducing dyspnea in chronic
76
The third objective was to find out the association between breathing
experimental group.
There was no association between the pre test level of breathing pattern and
,duration of illness ,smoking habits . There was a significant association between the
levels of breathing pattern and the other demographic variables among chronic
hypothesis H3 is accepted.
age, continuous breathing difficulty presented and their level of breathing pattern No
other demographic variables were shown any association with their level of breathing
longitudinal study comprised 164 high risk smokers aged 40 and 76 years. Age, sex,
weight, height and smoking habits were recorded and spirometry was performed.
Patients were informed of their result and given brief advice on how to stop smoking.
After 3 years, the patients underwent the same evaluation. The result of the study
revealed that 22% of the smokers were diagnosed with COPD. Three year later, an
additional 16.3 % were diagnosed as having COPD, and disease had worsened in 38%
of those already diagnosed. Of the patients with FEV1 less than 90%, 44.8% develops
COPD. And accelerated decrease in FEV1 was found in 18% of the patients. Mean
77
tobacco consumption in 1999 was 28.1 pack years in subject without COPD and 31.7
packs years in those with COPD, whereas in 2002, consumption was 30.6 packs in the
patients with COPD and 31.9 packs year in those without . In the years, 22.8% had
stopped smoking
Summary This chapter dealt about the major findings of this study which
were discussed based on their objectives of the study and supportive findings were
quota
78
CHAPTER- VI
SUMMARY AND
RECOMMENDATIONS
CHAPTER –VI
This chapter gives brief account of the present study along with the conclusion
The focus of the present study was to evaluate the effectiveness of deep
To assess the breathing pattern before and after breathing exercise among
group.
To find out the association between the breathing pattern with selected
HYPOTHESIS
H1: The mean post test level of breathing pattern will be significantly higher
than the mean pre test level of breathing pattern among chronic obstructive
79
H2 : There is a significant difference between the mean pretest and mean
group pretest –posttest design. The conceptual frame work was based on health
new era-leading health promotion into the 21st century ,meeting in Jakarta from 21to
25july 1997. It has provided an opportunity to reflect on what has been learned about
the direction and strategies that must be adopted to address the challenges of
promoting health in the 21st century the participants in the Jakarta conference hereby
The sample size of the study was 60 clients who have chronic obstructive
adopted for the selection of sample. Demographic data of the subjects were collected.
The investigator collected pre test data using modified dyspnea scale and for
both group. Experimental group received intervention of deep breathing exercise for
15minutes twice a day with daily routine exercise for copd patients before giving
oxygen therapy. Control group received routine exercise without intervention. Post
test was conducted by the investigator for both groups. For experimental group, post
80
test was conducted 1 hour after administration of deep breathing exercise . The data
group belongs to the age group of 51 to 60 years and 9(30%) in experimental group
and 9(30%) in control group belonged to the age group of above 60 years.
(46.6%) in the control group were females and the remaining were males.
7(23.3%) of them had iliterate in experimental group and 7(23.3%) of them had high
school education and 9(30%) of them had higher secondary education in control
group.
With regard to the occupation, 9(30%) were self-workers and 9(30%) were
industrial workers in experimental group and 9(30%) were self-workers and 8(26.7%)
group
81
Considering the duration of illness 10(33.3%) subjects having 6 years in and
10(33.3%) subject having 2-5years in experimental group and 12(40%) subject having
(6.7%) had moderate level of breathing difficulty and 5 subjects (16.7%) had severe
level of breathing difficulty. And the post test level of breathing difficulty in control
group , 2 subjects (6.7%) had some what severe level of breathing difficulty
subjects (36.7%) had maximum level of breathing difficulty and 2 subjects(6.7%) had
moderate level of breathing difficulty and the post test level of breathing difficulty ,12
subjects (40%) had very very slight level of breath difficulty ,and 10(33.3%) had
The calculated‘t’ values in the control group were 2.07which are not
significant. It is concluded that there was no significant differences between the pre
and post test level of breathing pattern among chronic obstructive pulmonary disease
patients
The calculated ’t’ value in the experimental group were 2.64was statistically
significant at p<0.05 level which clearly shows that there was a significant reduce in
the level of breathing pattern among patients among chronic obstructive pulmonary
82
The obtained‘t’ values for level of pain between the control and experimental
group is 4.51which were highly significant at p<0.05 level. These findings revealed
that the subjects in experimental group had decreased level of breathing pattern after
accepted.
There was no association between the pre test level of breathing pattern and
,duration of illness ,smoking habits . There was a significant association between the
levels of breathing pattern and the other demographic variables among chronic
hypothesis H3 is accepted.
age, continuous breathing difficulty presented and their level of breathing pattern No
other demographic variables were shown any association with their level of breathing
CONCLUSION
The main conclusion of this present study was the deep breathing exercise is
clients. This study clearly stated that deep breathing exercise plays a vital role to
reduce the dyspnea clients who have on chronic obstructive pulmonary disease.
83
IMPLICATIONS
The findings of the study have several implications in following field. It can
Nursing practice
Breathing exercise is one of touch therapy, which in this study has proved
Nurses can adopt simple interventions like breathing exercise while providing
Breathing exercise used in this study can be applied in the practice set up;
Nursing administration
pulmonary disease.
The findings of this study will help nurse administrator to plan and organize
surgical unit.
84
The nurse administrator can take part in developing protocols related to
breathing pattern.
Nursing education
Several implications can be drawn from the present study for nursing
education
The curriculum incorporating the recent trends and demands of the changing
massage and reflexology can be included in the nursing curriculum which will
Nursing research
field.
LIMITATIONS
85
RECOMMENDATIONS
The comparative study can be conducted with more than one intervention
86
REFERENCES
BIBLIOGRAPHY
BOOK REFERENCE
2. Basavanthappa B.T (2007). Nursing research (3rd edition ) new Delhi jaypee
brothers ,180-189
5. Barbara him (1997) statistical methods for health care research (3 rd edition)
10. George B.J (1990).Nursing theories , the base for professional nursing
11. Harkness & dincher (1996)medical surgical nursing –total patient care (9th
87
12. Jacqueline young. (2001) breathing for health ,a complete self care manual,
JOURNAL REFERENCES
1. Hall jc, tarala, tappier and hall j l, prevention of British medical journal 2001
UK London, 312(70):148-52
3. Prasanna kumari, the study to find out the effect of programmed breathing
7. Pam grout “jump starts your metabolism: how to loose weight by changing the
88
8. Jerkins and Souter C, a survey into the use of incentives spirometry following
after open abdominal surgery in the high risk patients. Aust J Physiotherapy
14. Jyothi T R a study to dig out the effect of programmed lung exercises on the
11
physiotherapy; its value in physiotherapy 1995 New York USA; 73(8) 427
89
16. Gosse link r, schemer k, cops, delay p foresters t, incentive spirometry does
not enhance recovery after thoracic surgery. Crit care med 2000. USA 28(3)
679
17. Wild P, Refregier m, Aubrtin A, Carten B and mountinn JJ, survey of the
18. Black and Jacob medical surgical nursing (5thedition) WB sounder’s company
Philadelphia
19. Levis, Collier and heithmper, medical surgical nursing: (4th edition) Missouri
21. Anaesth .J.Dyspnea underlying mechanism and treatment. The British journal
of Anesthesia 2007Jan;106(4):463-474.
22. Taren Saxena, Manjra Saxena. Improving quality of life of patients with
review.Allergy.1999;54:1022-41.
2008;Dec;102(12):1715-29.
90
26. Collins EG et al .breathing pattern retaining and exercises training and
27. Sanchez RieraH et al. The effect of target –flow inspiratory muscle training on
NET REFERENCE
1. http://allnurses.com/general-nursing discussion/Adhd
2. http://www.medicine.com
3. http//en.wikipedia.org/wiki/adhd.
4. http://www.google.com
6. http://www.ncbi.nim.nih.gov/Pubmed/(accessed
91
APPENDICES
APPENDIX – I
Letter -1: Letter Seeking Permission to conduct the study
i
Letter -2: Letter Seeking Permission to conduct the study
ii
Letter -3: Letter Seeking Permission to conduct the study
iii
APPENDIX-II
From
Miss .K Karthika
M.Sc (Nursing) II Year,
Sakthi college of Nursing,
Oddanchatram, Dindigul.
To
Respected Madam/Sir,
Sub: Requisition for expert opinion and content validity regarding.
I am sending the tool for content validity and for your expert & valuable opinion.
I will be very thankful if you return it at the earliest. Here with I have enclosed the
necessary documents.
Thanking you,
Yours
sincerely,
Enclosure: K. Karthika
1. Statement of the problem & objectives of the study.
2. Tool for data collection.
3. Brief note on the research methodology and intervention tool.
4. Certificate of content validity.
iv
APPENDIX-III
This is to certify that the tool prepared by Ms.K.Karthika. MSc (N) II Year
student of Sakthi College of Nursing for the conduction of the research study on “A quasi
Signature
Place:
Date:
v
APPENDIX – IV
LIST OF EXPERTS
1. Dr.sivakumar.M.d,
General medicine Dindigul headquarter hospital
Dindigul.
5. Asso.prof.KalpanaM.Sc(N)
Department of medical surgical nursing,
Bishop’s college of nursing,
Dharapuram.
vi
vii
viii
APPENDIX – V
Dear Participants,
study to evaluate the effectiveness of deep breathing exercise among chronic obstructive
pulmonaar disease who are aged between 50-60 years at selected hospitals in Dindigul
I hereby seek your consent and co- operation to participate in the study. Please be
frank and honest in your responses. The information collection will be kept confidential
Thanking you,
Place:
ix
APPENDIX – VI
This is to certify that the dissertation “A quasi experimental study to assess the
disease at selected hospitals in Dindigul district” by Ms.K.Karthika, M.Sc (N) –II year
student of Sakthi College Of Nursing was edited for English language appropriateness by
Signature
Place:
Date:
x
APPENDIX – VII
This is to certify that the dissertation “A quasi experimental study to assess the
year student of Sakthi College Of Nursing was edited for Tamil language
Signature
xi
APPENDIX -VIII
Committee members
Chairman
1. Mrs. V.Janahi Devi,m,sc (N) This is to certify that Ms. K. Karthika.,
M.Sc (N) in Pediatric Nursing M.Sc Nursing II year Student, Medical
Principal, Surgical Nursing, Submitted a Protocol
Sakthi College Of Nursing. on study as
Members Effectiveness deep breathing exercise
1. Dr. Vembanan .M.B.B.S, M.S., among chronic obstructive disease
President, patients
Sakthi Educational Institution. The above protocol was received by
2. Mrs. D.Thulasimani m,sc(n) ethical committee approved and
M.Sc (N) in Medical Surgical Nursing, mentioned that the study is feasible to
Associate Professor carry out under the guidance of an
3. Mr. V.Palanichamy, eligible guide.
B.A.B.L., Advocate.
4. Mr.Diaz Prabhakaran,
M.A., Sociology,
5. Ms. Mariyammal,
Ph.D., Psychology Signature of the Chairman
xii
APPENDIX – IX
DEMOGRAPHIC DATA
INTRODUCTION TO PARTICIPATE
Dear participations
This section of personal information and you are requested to answer the questions
a)50-52years
b)53-55years
c)56-58years
d)59-60years
2) Gender
a)male
b)female
3) Educational status
a) IIllerate
b)primary school
c) High school
4) Occupation
a)industrial worker
b) private employee
c) Government employee
d)Self employee
xiii
5 )Marital status
a) Married
b) Un married
c) Divorce/separated
d) Widow
a)yes
b) No
7) Duration of illness
a) < 1year
b) 2-5 year
c) 6years
8) Treatment of copd
a) Regular
b) Irregular
a) < 5000
b) 5000-10,000
c) > 10,000
a) Yes
b) No
a) Wake up
b) Walking
d) Exercise
xiv
,e;j gFjpapy; cq;fisg;gw;wpa nrhe;j tpguq;fs;
nfhLf;fg;gl;Ls;sJ ,jw;F jFjpahd tpilaspf;FkhW
Nfl;Lf;nfhs;fpNwd;. ,e;j tpguq;fs; ufrpakhf
itj;Jf;nfhs;sg;gLk;
gq;Nfw;gth; vz; [ ]
1. taJ
m) 50-52taJ [ ]
M) 53-55taJ [ ]
,) 56-58 taJ [ ]
<) 59-60 taJ [ ]
2. ghypdk;
m) Mz; [ ]
M) ngz; [ ]
3. fy;tpj;jFjp
m) gbf;fhjth; [ ]
M) Muk;gf;fy;tp [ ]
,) cah;epiyf; fy;tp [ ]
<) Nky;epiyf; fy;tp [ ]
4. gzp epytuk;
m) njhopy;Jiw [ ]
M) jdpahh;Jiw [ ]
,) muRJiw [ ]
<) Ra njhopy; [ ]
5. jpUkzk;
m) jpUkzk; Mdth; [ ]
M) jpUkzk; Mfhjth; [ ]
,) jpUkzkhfp gphpe;jth; [ ]
<) fztid ,Oe;jth; [ ]
xv
6. FLk;gj;jpy; Rthrk; njhlh;ghd Neha; cs;sjh?
m) Mk; [ ]
M) ,y;iy [ ]
7. FLk;gj;jpy; Rthrk; njhlh;ghd Neha; vj;jid tUlq;fshf
cs;sJ?
m) 1tUlk; [ ]
M) 2 Kjy; 5 tUlk; [ ]
,) 6 tUlk; [ ]
8. Rthr Neha;f;fhd rpfpr;ir vg;gb Nkw;nfhs;fpwPh;fs;?
m) njhlh;r;rpahf [ ]
M) mt;tg;NghJ [ ]
9. FLk;g tUkhdk;
m) &.5>000;Fs; [ ]
M) &.5>000 Kjy; &.10>000 tiu [ ]
,) &.10>000f;Fs; Nky; [ ]
10. Gifg;gpbf;Fk; gof;fk; cs;sjh?
m) Mk; [ ]
M) ,y;iy [ ]
11. njhlh;r;rpahf Rthr Neha; njhe;juT cs;sjh> my;yJ
vt;ntg;NghJ njhe;juT cs;sJ?
m) vOe;jpUf;Fk; NghJ [ ]
M) elf;Fk; NghJ [ ]
,) ,utpy; J}q;Fk; NghJ [ ]
<) clw;gapw;rp nra;Ak; NghJ [ ]
xvi
Modified Borg dyspnea scale
0 No breathlessness
2 Very slight
3 Slight breathlessness
4 moderate
6 severe breathlessness
9 Maximum
10 Almost maximum
Scoring inturputation
1-2-mild
3-4-moderate
5-6-severe breath
9-10-Almost maximum
xvii
%r;R jpzwy; msTKiw (Borg)
kjpg;ngz;
2 rpwpa mstpy;
4 kpjkhd mstpy;
10 fpl;ljl;l mjpfgl;rk;
kjpg;ngz;
1) 1-2 kpjkhd mstpy;
2) 3-4 kpfTk; fLikahd %r;Rj;; jpzwy;
3) 5-6 kpf kpf fLikahd %r;Rj; jpzwy;
4) 7-8 mjpfgl;r mstpy; cs;sJ
5) 9-10 fpl;ljl;l mjpfgl;rk;
xviii
APPENDIX – X
xix
xx
xxi
APPENDIX – XI
PHOTO GALLERY
xxii
xxiii
xxiv