ASSESSMENT ON SELF-CARE SKILLS OF DIABETIC CLIENTS.

Adescriptive study aimed to assess knowledge, practice and attitude on self-care skills among diabetic clients and to teach diabetic clients on self-care skills had been conducted in the out-patient department of ESI hospital, Puducherry. Structured interview was conducted for data collection from hundred participants and were selected by using purposive sampling technique. As per the descriptive statistical findings, the conclusions drawn were as half of the participants had poor knowledge and attitude. Considerable numbers of participants had both knowledge and attitude adequately whereas majority of them had adequate practice and only minimal numbers of participants had good knowledge, practice and attitude collectivelyon self-care skills on diabetes mellitus.The inference made out of this is that diabetic patients need to be given adequate information on disease condition; complication and its management to improve their attitude to take care by themselves there by improve practicing self-care skills.

Adescriptive study aimed to assess knowledge, practice and attitude on self-care skills among diabetic clients and to teach diabetic clients on self-care skills had been conducted in the out-patient department of ESI hospital, Puducherry. Structured interview was conducted for data collection from hundred participants and were selected by using purposive sampling technique. As per the descriptive statistical findings, the conclusions drawn were as half of the participants had poor knowledge and attitude. Considerable numbers of participants had both knowledge and attitude adequately whereas majority of them had adequate practice and only minimal numbers of participants had good knowledge, practice and attitude collectivelyon self-care skills on diabetes mellitus.The inference made out of this is that diabetic patients need to be given adequate information on disease condition; complication and its management to improve their attitude to take care by themselves there by improve practicing self-care skills.

…………………………………………………………………………………………………….... Introduction:-
Diabetes is a chronic, debilitating and costly disease associated with severe complications. Diabetes mellitusmeaning "Sweet urine" and Excess urine "Like a siphon". Diabetes mellitus is often due to Problem in insulin hormone either deficiency or inaction. Insulin is the hormone which reduces blood glucose levels, Produced by beta islets of the pancreas. Insulin is needed by body to use glucose. It sends glucose from blood to cells for use. When insulin level is decreased resulting in excess glucose in urine and blood; Pulls water through urine; Cells unable to use glucose leading to Peripheral insulin resistance in muscle and fat and increased hepatic glucose output.
The higher the blood sugar, the more sugar that sticks to red cells and the higher A1c results. An A1c measures how much sugar has been sticking to red blood cells over a 3 month period of time.

HbA1c
Fasting Blood glucose (3 month Blood 2 hour after Averageglucose 75 g oralGlucose) glucose Need For The Study:-Diabetes is certain to be one of the most common and challenging health problems in the twenty first century. According to the International Diabetic Federation (2012), India had 32 million diabetic subjects in the year of 2000, it would become 57.2 million in the year of 2025 and its number would increase to 80 million by the year 2030.
In Puducherry state, according to health statistics 2015, the incident rate of diabetes mellitus is 21.5 /1000 population. This incident rate is twice high in female. The highest incidence rate is being in an age group of 35 -50 years (38.01 /1000) and above 50 years of age (21.7 /1000).
Though diabetes is a non-communicable disease, it affects the large number of people as that of communicable diseases. This may be due to adopting western life-style, alcohol consumption, smoking habits, lack of exercise and poor dietary practices.
WHO gives prime importance to non-communicable diseases especially, diabetes mellitus and introduced the theme "HALT THE RISE AND BEAT THE DIABETES" in the world health day 2016. This goal may be achieved by creating awareness regarding self-care practices of diabetic clients.
The primary concept of health is prevention of disease and promotion of health with the emphasis prevention is better than cure. In order to help diabetic clients preventing complications development due to its chronicity, the investigator planned to provide teaching program on self-care skills on diabetes mellitus. Since knowledge is the base for skill learning, investigator has done assessment of knowledge, practice and attitude on self-care of diabetic clients.
Statement of the problem:-Assessment of knowledge, attitude and practice on self-care skills among diabetic clients.
Objectives:-1. To assess knowledge, practice and attitude on self-care skills among diabetic clients. 2. To teach diabetic clients on self-care skills.

Methodology:-
Research Design:-A research design is the conceptual structure within which research is conducted. Approach of this study was quantitative and research design used was a descriptive study.

Setting of the Study :-
The study was conducted in the out-patient department of ESI hospital, Puducherry which is one of the regions of Puducherry Union Territory having ten lacks population. An average of 300 diabetic patients attends as out-patients in a regular basis in this hospital.

Population:-
As the investigator decided to do study on diabetic patients, population referred here as, "all patients diagnosed as diabetes above 18 years of both sexes attending Government health institutions of Puducherry in out-patient department at the time of data collection".
Sample Size:-Sample size was100 patients with diabetes mellitus attending out-patient department of ESI hospital, Puducherry at the time of data collection.
Sampling Technique:-Samples for this study were selected by using purposive sampling technique.
Criteria for sample selection:-Inclusion criteria:Patients who have diabetes mellitus and regularly attend OPD of ESI hospital, Puducherry at the time of data collection, who is able to understand Tamil or English and who is willing to participate in this study.

Exclusion criteria:-
Patients with diabetes mellitus who were not willing to participate in the study.

Development and description of the tools:-
Text book of medical surgical nursing, Journals, Manuals, Reports, Articles, Published and unpublished research studies, pamphlets and newspapers were referred to prepare the tools. Tool was given a final shape with inputs from the experts. The tool consists of four sections.

Section:-
A:Demographic data of the sample. It contains 14 items related to demographic variables of the samples like age, gender, education, income, occupation, dietary pattern, food habits, family history etc. The compiled data were decrypted in table and diagram.

Section -B:-
It contains 10 items of structured questionnaire on knowledge. Knowledge refers to the pre designed, validated questions related to information on nature of diabetes and its management. Four options were given for each item and only one is the most appropriate response. The maximum score for the correct response to each item was "one" and for the remaining three wrong responses was zero.
Section -C:-It contains 10 items of yes or no type structured questionnaire on attitude of the subject regarding self-care management of diabetes mellitus.

Section -D:-
It contains 10 items of yes or no type structured questionnaire on practice of the subject regarding self-care management of diabetes mellitus.

H. Data collection procedure:-
The Samples were selected as per inclusion criteria. Purpose of the study explained and informed consent taken from the samples after obtaining necessary permission from the concerned authority. The data were collected by administering a structured questionnaire by face to face interview (structured interview).

Analysis And Interpretation:-
The analyzed data had been organized and presented as Section A:-Distribution of samples according to demographic variables.
Section B:-Distribution and interpretation of samples according to their knowledge, attitude and practice.

Discussion:-
On the basis of the demographic variables, out of total 100 participants, 46 (46%) were less than fifty years of age, 40 (40%), were between 51 and 65 years and the remaining 14 (14%), were above 65 years of age.
According to the duration of diabetes, out of 100 participants, 31 were diagnosed with diabetes for less than two years only, 47 were between 2 -5 years of duration and the remaining 22 were with diabetes for more than 5 years.
The main objective was to assess the knowledge, attitude and practice of self care skills on diabetes mellitus. This study findings show that, out of 100 participants, 50 scored less than five (out of total ten), 39 scored between 5 and 7 and the remaining 11 scored above 8. With the above findings, it is revealed that 50% of the diabetic clients had poor knowledge on self-care skills of diabetes mellitus. 39% of diabetic clients had adequate knowledge on self-care skills of diabetes mellitus and the remaining 11% only had good knowledge on self-care skills of diabetes mellitus.
According to the practice, this study findings show that, out of 100 participants, 26 scored less than five out of ten, 63 scored between 5 and 7 and the remaining 11 scored above 8. With the above findings, it is revealed that 26% of the diabetic clients had poor practice on self-care skills of diabetes mellitus. 63% of diabetic clients had adequate practice on self-care skills of diabetes mellitus and the remaining 11% only had good practice on self-care skills of diabetes mellitus.
According to the attitude, this study findings show that, out of 100 participants, 49 scored less than five out of ten, 47 scored between 5 and 7 and the remaining 4 scored above 8. With the above findings, it is revealed that 49% of the diabetic clients had poor practice on self-care skills of diabetes mellitus. 47% of diabetic clients had adequate practice on self-care skills of diabetes mellitus and the remaining 8% only had good attitude on self-care skills of diabetes mellitus.

Summary And Conclusion:-
Summary:-A descriptive study was aimed to assess knowledge, practice and attitude on self-care skills among diabetic clients and to teach diabetic clients on self-care skills. Approach of this study was quantitative. The study was conducted in the out-patient department of ESI hospital, Puducherry. Regular attendants of diabetic patients were the population; sample size was 100 and was selected by using purposive sampling technique. Data collected by structured interview.
The tool consists of four sections. Section A containsDemographic data of the sample as 14 item questionnaire. Section B contains 10 items of structured questionnaire on knowledge of diabetes mellitus. Section C contains 10 items of yes or no type structured questionnaire on attitude of the subject regarding self-care management of diabetes mellitus. Section D contains 10 items of yes or no type structured questionnaire on practice of the subject regarding self-care management of diabetes mellitus.
Descriptive statistical findings reveal that regarding knowledge, out of 100 participants, 50% of the diabetic patients had poor knowledge, 39% had adequate knowledge and 11% had good knowledge on self-care skills of diabetes mellitus. Regarding practice, out of 100 participants, 26% of the diabetic patients had poor knowledge, 63% had adequate knowledge and 11% had good practice on self-care skills of diabetes mellitus. Regarding attitude, out of 100 participants, 49% of the diabetic patients had poor knowledge, 47% had adequate knowledge and 4% had good attitude on self-care skills of diabetes mellitus.

Conclusion:-
As per these descriptive study findings on assessment of knowledge, practice and attitude on self-care skills of diabetic patients, the conclusions drawn were as half of the participants have poor knowledge and attitude. Considerable numbers of participants have adequate knowledge and attitude whereas majority of them have adequate practice and only minimal numbers of participants have good knowledge, practice and attitude on self-care skills on diabetes mellitus.
The inference made out of this is that diabetic patients need to be given adequate information on disease condition; complication and its management to improve their attitude to take care by themselves there by improve practicing self-care skills.