“A DESCRIPTIVE STUDY TO ASSESS THE

KNOWLEDGE AND PRACTICE OF SELF-CARE

REGARDING TRANSMISSION, PREVENTION, AND
MANAGEMENT OF PULMONARY TUBERCULOSIS
AMONG STAFF NURSES WORKING AT GMC JAMMU
WITH A VIEW TO DEVELOP INFORMATION
BOOKLET”

PLAN OF DISSERTATION
FOR MASTER OF SCIENCE IN NURSING
(MEDICAL SURGICAL NURSING)
SUBMITTED
TO
UNIVERSITY OF JAMMU

BY
SHARAFAT MAJEED
STEPHENS COLLEGE OF NURSING
MIRAN SAHIB
JAMMU – 181101
 BIO-DATA

NAME OF THE CANDIDATE Sharafat Majeed

FATHER’S NAME Ab Majeed Parray

MONTH AND YEAR OF April, 2022
PASSING B.SC NURSING
INSTITUTE OF GRADUATION Stephens College of Nursing,
Jammu
PROPOSED TITLE “A Descriptive Study to Assess
the Knowledge and Practice of
Self-Care Regarding
Transmission, Prevention, And
Management of Pulmonary
Tuberculosis Among Staff
Nurses Working at GMC
Jammu with A View to
Develop Information Booklet”
PRESENT OCCUPATION Student of M.Sc. Nursing
Stephens College of Nursing,
Jammu
NAME AND ADDRESS OF THE Mrs. Sarla
GUIDE Medical-Surgical Nursing
Stephens College of Nursing,
Jammu

DATE:
PLACE: Stephens college of nursing,
Miran sahib, Jammu SIGNATURE OF THE CANDIDATE

I
 CERTIFICATE

Certified that I am willing to act as a guide for the title “A DESCRIPTIVE STUDY
TO ASSESS THE KNOWLEDGE AND PRACTICE OF SELF-CARE
REGARDING TRANSMISSION, PREVENTION, AND MANAGEMENT OF
PULMONARY TUBERCULOSIS AMONG STAFF NURSES WORKING AT
GMC JAMMU WITH A VIEW TO DEVELOP INFORMATION BOOKLET”. It
will be ensured that the data being included in the dissertation will be genuine and work
will be conducted by the candidate himself/herself under my supervision and guidance.
There will be no conflict of interest involved.

GUIDE
MRS. SARLA RAINA
Prof. Department of Medical-Surgical Nursing
Stephens College of Nursing, Jammu

II
 TABLE OF CONTENT

S.NO. CONTENT PAGE NO.

1 INTRODUCTION 1-6

2 PROBLEM STATEMENT 7-8

3 REVIEW OF LITERATURE 9-14

4 METHODOLOGY 15-18

5 BIBLIOGRAPHY 19-21

6 DESCRIPTION OF THE TOOL 22-23

SCORING PROCEDURE

7 CONSENT FORM 24

III
IV
 INTRODUCTION
“Tuberculosis is once again proving itself to be one of the smartest killers that humanity
has ever faced”
~ Kathryn Lougheed

Pulmonary Tuberculosis (PTB) is an infectious disease caused by

Mycobacterium tuberculosis, primarily affecting the lungs, and remains a significant
cause of morbidity and mortality globally. PTB, the most common form of tuberculosis,
has existed since ancient times and continues to persist in human populations,
demonstrating a dynamic balance between humans and the tuberculosis bacteria.
According to the Global Report on TB by WHO (2018), PTB spreads through the air
from person to person. When individuals with PTB cough, sneeze, or spit, they release
the tuberculosis bacilli into the air, and inhaling just a few of these bacilli can lead to
infection. Symptoms of active tuberculosis, such as cough, fever, night sweats, and
weight loss, may be mild for many months, leading to delays in seeking medical care
and facilitating the transmission of the bacteria to others. An individual with active
tuberculosis can infect 5 to 15 others through close contact over a year. People with
prolonged, frequent, or close contact with those infected are at particularly high risk,
with an estimated 22% infection rate. The probability of tuberculosis transmission
depends on several factors, including the number of infectious droplets expelled by the
carrier, ventilation effectiveness, duration of exposure, the virulence of the
Mycobacterium tuberculosis strain, and the level of immunity in the uninfected person. 1

According to the World Health Organization (WHO), air pollution causes 8.1
million deaths per year, with 3.8 million (47%) attributed to household air pollution
(HAP) from burning biomass for domestic cooking, heating, and lighting. Vulnerable
populations, such as those at the extremes of age, the chronically ill, or individuals of
low socioeconomic status, are at high risk for pollution-related diseases like
pneumonia. Approximately 90% of the 10 million new tuberculosis (TB) cases in 2018
were from low and middle-income countries (LMICs). That year, around 1.3 million
people died from TB, including 251,000 deaths (nearly 20%) among people living with
HIV (PLHIV). In 2020, a similar trend was observed, with the COVID-19 pandemic
causing substantial disruptions to health services. Air pollution is one of the highest-

1
ranking independent risk factors in the global burden of disease. HAP negatively
impacts multiple organ systems and has been linked to an increased risk of developing
TB, according to the 2020 global burden estimation study. However, it is unclear if HAP
independently affects TB risk in PLHIV. Due to compositional similarities between
tobacco and biomass smoke, it is reasonable to expect that HAP's health effects may be
similar to those of tobacco smoke, which doubles the risk of developing TB among
PLHIV compared to their counterparts.2

Primary (initial) tuberculosis (TB) infection is typically identified by tuberculin

skin test (TST) or interferon-gamma release assay (IGRA) conversion, indicating a
delayed-type hypersensitivity reaction to Mycobacterium tuberculosis proteins. TST
conversion occurs 3–6 weeks post-exposure, with interpretation guidelines available on
the CDC website. Most primary infections remain undiagnosed due to mild, non-
specific, and self-resolving symptoms. A primary (Ghon) complex form, consisting of
a granuloma in the lung's middle or lower zones, accompanied by transient hilar or
paratracheal lymphadenopathy and pleural reaction. This complex usually resolves
within weeks or months, leaving detectable fibrosis and calcification on a chest X-ray.
Although the risk of disease progression is generally low, young children and
immunocompromised patients are at higher risk. The natural history of re-infection is
not well described but is likely common in TB-endemic areas. Molecular epidemiology
suggests many disease episodes result from recent infection or re-infection. Re-
infection likely triggers responses similar to primary infection, with a reduced risk of
progression, but may occur multiple times in TB-endemic areas, significantly
contributing to the disease burden.3

Infection with Mycobacterium tuberculosis, alcohol, and acid-fast

bacillus, causes active tuberculosis and belongs to the M. tuberculosis complex, which
includes M. canettii, M. microti, M. bovis, and M. africanum. This obligate-aerobic,
nonmotile, non-spore-forming, catalase-negative, and facultative intracellular
bacterium has high lipid content, granting it resistance to several antibiotics and the
ability to survive in extreme conditions. It divides slowly, taking 16 to 20 hours
compared to less than an hour for most bacteria. M. tuberculosis does not respond well
to Gram stain, appearing as "ghost cells" and is considered an acid-fast bacillus due to
its retention of stains after acid treatment. The Ziehl-Neelsen and Kinyoun stains

2
identify it by dyeing the bacilli bright red against a blue background. Humans are the
only natural hosts, and the bacterium primarily spreads through airborne aerosols from
infectious individuals, though transdermal and gastrointestinal (GI) transmission is also
possible.4

3
 NEED OF THE STUDY
Despite 90 years of vaccination and 60 years of chemotherapy, tuberculosis
(TB) remains the leading cause of death from an infectious agent, surpassing HIV/AIDS
(WHO 2015b, 2016a). The World Health Organization (WHO) estimates about 10.4
million new TB cases and 1.8 million deaths annually, with one-third of cases
undetected by health systems and many not receiving proper treatment. TB, caused by
Mycobacterium tuberculosis, spreads through respiratory transmission, primarily
affecting the lungs but capable of damaging any tissue. Only 10 percent of those
infected develop active TB, while the rest contain the infection. The bacterium can
remain latent for years and reactivate, especially in individuals with HIV/AIDS or other
immune-compromising conditions. Treatment involves multiple drugs over several
months, challenging for patients and healthcare systems, particularly in low- and
middle-income countries (LMICs). Drug-resistant TB, requiring longer and more
difficult treatments, is increasing. Diagnosis in LMICs often relies on smear
microscopy, which detects only 50–60 percent of cases. Delays in diagnosis and
treatment facilitate transmission. The widely used BCG vaccine has variable and
incomplete effectiveness, and more effective vaccines are needed to eliminate TB in
high-incidence areas.5

The Ministry of Health and Family Welfare has responded to the WHO Global
TB Report 2022, released on October 27, 2022, highlighting India's superior
performance on key metrics over time compared to other countries. For 2021, India's
TB incidence was 210 per 100,000 population, showing an 18% decline from the
baseline year of 2015 when the incidence was 256 per lakh population. This decline is
better than the global average of 11% and places India at the 36th position in incidence
rates globally. Despite the disruptions caused by the COVID-19 pandemic, India
successfully mitigated its impact on TB programs through critical interventions in 2020
and 2021, resulting in over 21.4 lakh TB cases being notified—18% higher than in
2020. Key measures contributing to this success include mandatory case notification
and intensified door-to-door Active Case Finding drives, screening over 22 crore people
in 2021. Enhanced diagnostic capabilities, with over 4,760 molecular diagnostic

4
machines across the country, have also played a crucial role. The Ministry
communicated to WHO those domestic studies are underway to provide more accurate
estimates of TB incidence and mortality, with data expected in early 2023. WHO
acknowledged this, noting that India's TB estimates for 2000–2021 are interim and
subject to finalization in consultation with India's Ministry of Health & Family
Welfare.6

A review of published literature commissioned by the Institute of Medicine

Committee on Regulating Occupational Exposure to Tuberculosis assesses whether
healthcare workers and others covered by OSHA's proposed regulations face a higher
risk of TB infection, disease, and mortality compared to the general community. The
primary focus is on the risk of infection, which has been declining in recent decades
due to modern infection control measures, now approaching community risk levels in
well-managed facilities. However, historically, the risk has been higher than the
community baseline, particularly in poorly ventilated settings or where exposure to
unsuspected TB cases occurs, sometimes resulting in infection rates as high as 50%.
Risk varies by job category, with those in direct patient contact, especially during
aerosol-generating procedures, at higher risk. Geographic location, demography, and
socioeconomic status also influence risk, with urban coastal areas and minority
populations experiencing higher TB incidence. Despite these variables, current
occupational TB risk in facilities adhering to CDC guidelines is not substantially greater
than community risk. The progression to TB disease and mortality among infected
healthcare workers, particularly immunocompetent individuals with drug-susceptible
TB, is low, with most TB mortality linked to delayed diagnosis or treatment,
immunocompromise, or multidrug resistance.7

Healthcare workers (HCWs) are at a significantly higher risk of acquiring

tuberculosis (TB) occupationally. To mitigate the transmission of TB to HCWs and
patients, TB infection control programs must be implemented in healthcare settings.
The foremost level of protection is administrative control, aiming to prevent TB
exposure and reduce infection transmission through rapid diagnosis and treatment of
affected individuals. Administrative control measures recommended by the United
States Centres for Disease Control and Prevention and the World Health Organization
include promptly identifying individuals with TB symptoms, isolating infectious

5
patients, controlling pathogen spread, and minimizing time spent in healthcare
facilities. Another essential measure is the baseline and serial screening for latent TB
infection in HCWs at risk of exposure. While the interferon-gamma release assay offers
some advantages over the tuberculin skin test, it also has significant limitations,
primarily due to its high conversion rate.8

PROBLEM STATEMENT
“A descriptive study to assess the knowledge and practice of self-care regarding
transmission, prevention, and management of Pulmonary Tuberculosis among
staff nurses working at GMC Jammu with a view to develop information booklet”

OBJECTIVES
1. To assess the level of knowledge regarding the transmission, prevention, and
management of Pulmonary Tuberculosis among Staff Nurses working at GMC
Jammu.
2. To assess the level of practice of self-care regarding the transmission,
prevention, and management of Pulmonary Tuberculosis among Staff Nurses
working GMC Jammu.
3. To determine the relationship between knowledge and practice of self-care
regarding transmission, prevention, and management of Pulmonary
Tuberculosis among Staff Nurses working at GMC Jammu.
4. To prepare an information booklet regarding transmission, prevention, and
management of Pulmonary Tuberculosis among Staff Nurses working at GMC
Jammu.

OPERATIONAL DEFINITIONS
Assess: It refers to estimating or judging the knowledge regarding awareness of
transmission, prevention, and management of Pulmonary Tuberculosis among Staff
Nurses.

Structured Teaching Program: It refers to the systematic plan of activities and on organized
group teaching program by lecture method to impart knowledge regarding awareness of
transmission, prevention, and management of Pulmonary Tuberculosis among Staff
Nurses.

6
Pulmonary tuberculosis (TB): It refers as a contagious bacterial infection caused by
Mycobacterium tuberculosis that primarily affects the lungs.

Transmission: It refers to the process by which an infectious agent is spread from one host
to another, often through direct or indirect contact.

Management: It refers to the organized and coordinated approach to addressing a specific

condition, including diagnosis, treatment, and monitoring.

HYPOTHESIS
H0 = There will be no significant difference in the level of knowledge between the pre-test
and post-test knowledge score regarding the effectiveness of knowledge regarding
awareness of transmission, prevention, and management of Pulmonary Tuberculosis
among Staff Nurses.

H1 = There will be a significant difference in the level of knowledge between the pre-test and
post-test knowledge score regarding awareness of transmission, prevention, and
management of Pulmonary Tuberculosis among Staff Nurses at P>0.05 level of
significance.

DELIMITATIONS
• The study will be limited to Staff Nurses working at GMC Jammu.
• The study will be limited to those who are willing to participate.

VARIABLES
• Sociodemographic Variables: age, gender, educational level, years of professional
experience, marital status, and department or unit of work within the hospital.
• Research variables: Knowledge and practice of self-care regarding transmission,
prevention, and management of pulmonary tuberculosis among staff nurses.

7
 REVIEW OF LITERATURE
Vigenschow A, Edoa JR, et al 2021 conducted a study on the survey to assess
knowledge, attitude, and practice among healthcare workers in 20 healthcare facilities
in Moyen-Ogooué province, Gabon. A total of 103 questionnaires were completed, with
knowledge questions scored and categorized into four levels. Factors associated with
high knowledge levels were identified using Fisher’s Exact test. Results showed that
40.8% of participants had intermediate knowledge, 28.2% had good knowledge, 21.4%
had poor knowledge, and 9.7% had excellent knowledge. High knowledge levels were
significantly associated with profession, education level, type of healthcare facility, and
previous TB training. Attitudes were generally positive, but 72.8% of participants
feared TB infection and 98.1% saw a need for improved TB control measures.9

Sharma SK, Mandal A, et al 2021 conducted a quasi-randomized study on the

Effectiveness of m-learning on the knowledge and attitude of nurses about the
prevention and control of MDR TB. The study involved 190 nurses from AIIMS
Rishikesh, divided into experimental and control groups (95 each). The experimental
group received the m-learning intervention. Results showed significant improvement
in knowledge (18.2 ± 5.4 vs. 12.4 ± 4.4; P < 0.001) but not in attitudes (10.3 ± 1.8 vs.
9.9 ± 1.8; P = 0.175). Most participants were 25-30 years old, male, unmarried, graduate
nurses with 1-3 years of experience.10

Akande PA 2020 conducted a cross-sectional study on Knowledge and practices

regarding tuberculosis infection control among nurses in Ibadan, southwest Nigeria.
The study utilized a self-administered questionnaire to collect data from 200 nurses in
two secondary health facilities. The nurses had mean knowledge and practice scores of
68.2% and 79.9%, respectively. Only a small proportion achieved good scores: 10.5%

8
for knowledge and 6% for practice. Knowledge was not significantly associated with
socio-demographic characteristics. However, work experience was significantly
associated with the practice, as nurses with over 18 years of experience had lower odds
of obtaining good practice scores (OR 0.25, 95% CI 0.06–0.94).11

Badriah Alotaibi, Yara Yassin, et al 2019 conducted a cross-sectional study on

tuberculosis knowledge, attitude and practice among healthcare workers during the
2016 Hajj. This study was conducted, among healthcare workers (HCWs) from 13
hospitals serving pilgrims during the 2016 Hajj season (September 2-12). With an
estimated 13,000 HCWs mobilized during Hajj, the study targeted a sample size of 374,
adjusted to 540 to account for errors and non-responses. Data was collected from 540
non-administrative HCWs from 17 countries, including physicians and nurses. Nearly
half had experience with TB patients. The findings revealed average knowledge (mean
score of 52%), above average attitude (mean score of 73%), and good practice (mean
score of 85%) regarding TB. Knowledge gaps included definitions of MDR-/XDR-TB,
LTBI, smear microscopy results, TB treatment duration, 2nd line anti-TB drugs, BCG
vaccination, and appropriate PPE. Poor attitudes involved willingness to work in TB
wards and management of TB patients. Poor practices were initiating anti-TB treatment
before confirmation and not increasing ventilation in TB rooms. Knowledge scores
were linked to age, gender, nationality, occupation, work experience, and TB patient
experience; attitude scores to age and occupation; and practice scores to work
experience and occupation. There was a weak but significant positive correlation
between knowledge and attitude (rs = 0.11, p = 0.009) and between attitude and practice
(rs = 0.13, p = 0.002).12

Janagond Anand Bimari, Ganesan Vithiya, et al 2019 conducted a prospective

longitudinal cohort study on the high risk for latent tuberculosis infection among
medical residents and nursing students in India. This study included 200 healthcare
workers (HCWs) comprising postgraduate medical residents and nursing students. The
median age was 25 years, with 56% female participants. At study entry, 24% had a BMI
>25 kg/m², 15% reported alcohol use, 10% smoked, 45% had prior exposure to sputum
smear-positive TB, and 19% had exposure to active TB outside the healthcare setting.
The prevalence of latent TB infection (LTBI) was 30%, with 35% among medical
residents and 23% among nursing students. LTBI was detected in 21% by TST, 22.5%

9
by QFT-GIT, and 13.5% by both. Prior exposure to sputum smear-positive TB doubled
the risk of LTBI. Three participants (1.5%) developed active TB during the study, all
with positive TST and QFT-GIT at baseline.13

Vijaya Kumar, Deepika Das, et al 2018 conducted a cross-sectional study to assess

the knowledge regarding tuberculosis and its prevention among nursing students posted
in selected hospital of Vadodara. This study involved 224 nursing staff who completed
a pre-tested self-administered questionnaire. The research design used in this study was
descriptive research design. Results showed high awareness (71.8%) about TB being
caused by bacteria, its airborne spread, and overcrowding as a risk factor. However,
fewer participants knew that TB does not spread through breastfeeding (54.9%) or
handshaking (33%) and that anti-tubercular treatment (ATT) should continue during
pregnancy. Knowledge about TB's preventability (56%) and ATT availability was also
low.14

Go U, Park M, et al 2018 conducted a study on tuberculosis prevention and care in

Korea: Evolution of policy and practice. 236 public health officials and over 210 nurses
provided TB patient counseling and education in 254 centers and 127 PPM hospitals,
respectively. The PPM program improved smear-positive TB treatment success rates
from 68.0% in 2011 to 88.3% in 2016 and MDR-TB success rates from 54.1% in 2014
to 64.3% in 2016. The government supported TB treatment costs, spending 7.6 million
USD annually since 2011, with insurance covering all medical expenses since July
2016. Public health officials and nurses conducted TB and LTBI examinations for
contacts of TB patients, with rates rising from 74.5% in 2013 to 99.1% in 2016. The
KCDC's TB epidemic investigation team increased contact investigations from 1,142
in 2013 to 3,502 in 2016, identifying 146,911 contacts and 202 secondary TB cases in
2016. TB incidence spiked at age 15, notably in high schools, highlighting the need for
targeted interventions.15

Cho KS. 2018 conducted a study on the republic of Korea has the highest tuberculosis
(TB) incidence and mortality rates among OECD countries, with rates of 77 and 5.2 per
100,000 people, respectively (2016). Despite a significant decline in TB cases among
teens and individuals in their 20s due to school screening and contact investigation, the
incidence among the elderly remains high and is increasing. Older individuals represent

10
42% of all TB cases and 82% of TB-related deaths. Improvements in TB treatment
success are attributed to enhanced programs, including compliance control and
insurance coverage. The study advocates for policymakers to concentrate on strategies
to further reduce TB incidence, guided by the 2nd National Strategic Plan for
Tuberculosis Control (2018–2022).16

Lydia Uden, Ella Barber, et al 2017 conducted a review study on the risk of
tuberculosis infection and disease for healthcare workers. A systematic review
identified 21 studies from the past decade, encompassing data from 30,961 HCWs
across 16 countries. The prevalence of LTBI among HCWs was 37%, with an average
incidence rate of active TB at 97 per 100,000 per year. HCWs had a higher risk of LTBI
(odds ratio [OR] 2.27; 95% confidence interval [CI] 1.61–3.20) and active TB
(incidence rate ratio 2.94; 95% CI 1.67–5.19) compared to the general population. The
odds ratio for LTBI was 1.72 with the tuberculin skin test and 5.61 with the interferon-
gamma release assay.17

Andrés Noé, Rafaela M. Ribeiro, et al 2017 conducted a descriptive cross-sectional

study on knowledge, attitudes and practices regarding tuberculosis care among health
workers in southern Mozambique. The district's 14 healthcare facilities serve a
population of approximately 160,000. The survey, consisting of 79 questions on
demographics, TB knowledge, attitudes, and practices, took 30–45 minutes to complete
without external assistance. The study sample included 170 healthcare workers. The
average knowledge score was 14.89 out of 26 points (SD = 3.61), with less than 30%
of respondents aware of Xpert MTB/RIF®. Seventy percent agreed there was stigma
associated with TB, and 48.2% believed this stigma was greater than that associated
with HIV. The average practice score was 3.2 out of 9 points (35.6%, SD = 2.4).18

Janagond Anand Bimari, Ganesan Vithiya, et al 2017 conducted a prospective study

on the Screening of health-care workers for latent tuberculosis infection in a tertiary
care hospital. The study used a structured questionnaire covering sociodemographic
characteristics, TB prevention knowledge, and professional history. A tuberculin skin
test (TST) with 5 international units of tuberculin was administered, with a TST
induration ≥10 mm indicating TB infection. TST-positive participants underwent
clinical evaluation and chest radiography to rule out active TB. Chi-square tests

11
assessed associations between TB infection and various factors, with P < 0.05 indicating
significance. Of the 206 HCWs who completed the questionnaires, ages ranged from
18 to 71 years (mean age 27.13 years). The mean TST induration size was 6.37 mm,
and 36.8% (76/206) had TB infection based on TST results. No TST-positive HCWs
had active TB upon further evaluation. However, two initially TST-negative HCWs
developed pulmonary.19
Surie D, Interrante JD, et al 2017 conducted a study on policies, practices, and
barriers to implementing tuberculosis preventive treatment. This study assessed
Tuberculosis preventive treatment (TPT) implementation in 42 countries supported by
the US President's Emergency Plan for AIDS Relief (PEPFAR). From July to December
2017, TB-HIV program staff at US CDC offices in these countries were surveyed about
TPT policies, practices, and barriers. Of the 42 eligible countries, 35 (83%) completed
the survey. TPT was included in national guidelines in 33 (94%) countries, but only 21
(60%) had nationwide programmatic implementation. HIV programs led TPT
implementation in 20 of 32 (63%) countries, while TB programs led drug procurement
in 18 of 32 (56%) countries. Frequent stock outs were reported, with 21 of 28 (75%)
countries experiencing at least one isoniazid shortage in the past year.20

Carrie Tudor, Martie L. Van der Walt, et al 2016 conducted a case-control study on
occupational risk factors for tuberculosis among healthcare workers in KwaZulu-Natal,
South Africa. This case-control study was conducted among healthcare workers
(HCWs) in three district hospitals with specialized multidrug-resistant (MDR)
tuberculosis wards in KwaZulu-Natal, South Africa, researchers reviewed 1,427
occupational health records over a five-year period (January 2006–December 2010).
The hospitals, which varied in size from 170 to 280 beds and employed between 332
and 700 HCWs, reported 117 (8%) cases of tuberculosis. By July 2011–January 2012,
83 of these cases were still alive and working. Of 307 distributed questionnaires, 145
(47%) were returned, with 54 (37%) from cases and 91 (63%) from controls. Cases
were more likely to respond than controls (65% vs. 41%, P < .01), and responders had
longer hospital tenures and higher HIV infection rates (12% vs. 7%, P = .04).21

Satyanarayana S, Subbaraman R, et al 2015 conducted a review study on the quality

of tuberculosis care in India. We searched multiple sources to identify studies (2000–
2014) on healthcare providers' knowledge and practices regarding TB care, using the

12
International Standards for TB Care as a benchmark. Of the 47 studies included, 35
were questionnaire surveys and 12 used chart abstractions; none assessed actual
practice using standardized patients. Due to heterogeneity, meta-analysis was not
possible. Among 22 studies on provider knowledge of sputum smears for diagnosis, 10
found less than half had correct knowledge. Three of four studies on self-reported
practices showed less than a quarter ordered smears for patients with chest symptoms.
In 11 of 14 studies on treatment knowledge, less than one-third of providers knew the
standard regimen for drug-susceptible TB. Adherence to standards in practice was
generally lower than correct knowledge of those standards. Eleven studies comparing
public and private providers found higher levels of appropriate knowledge and practice
in the public sector.22

Girma Demissie Gizaw, Zewdie Aderaw Alemu, et al 2015 conducted a cross-

sectional study on the assessment of knowledge and practice of health workers towards
tuberculosis infection control and associated factors in public health facilities of Addis
Ababa, Ethiopia. A study was conducted from February 29 to April 15, 2014, in public
health facilities in Addis Ababa, Ethiopia's capital, which spans 54,000 hectares and is
administratively divided into 10 sub-cities and 116 woredas, with a population
exceeding 4 million. At the time, the city had 13 public hospitals, 70 functional public
health centers, and 7,563 health professionals. Using Epi Info version 3.5.1 and
considering a design effect of 1.5 and a 10% non-response rate, a sample size of 590
health workers was determined. From this, 582 participants responded (98.6%). The
respondents had a mean age of 29 years, with 60.5% female and 51.9% holding a first
degree. Nurses constituted 56.4% of respondents, and 58.6% had less than three years
of experience. Training in tuberculosis (TB) related topics was reported by 23%. The
study found that 63.9% had good overall knowledge of TB infection control, lower than
studies in West Gojam and South Africa. Nearly all respondents (96%) knew to keep
doors and windows open for TB patients, and 91.4% knew the importance of separating
suspected TB cases.23

13
 METHODOLOGY
Research methodology refers to the systematic approach used to conduct research. It
encompasses the principles, techniques, and procedures for collecting and analyzing data.
This includes defining the research problem, selecting appropriate research designs (e.g.,
experimental, observational), and choosing methods for data collection (e.g., surveys,
interviews). It also involves deciding on data analysis techniques to interpret the results and
ensure validity and reliability. A well-defined methodology helps ensure that the research
findings are credible, reproducible, and applicable. It guides researchers in systematically
addressing their research questions and drawing meaningful conclusions.

RESEARCH APPROACH
Research approach is the umbrella term that covers the basic procedure for conducting
research. It involves the description of the plan to investigate the phenomenon under
study in a structured (quantitative), unstructured (qualitative) or combination of the
two.

A quantitative research approach will be adopted in this study.

RESEARCH DESIGN
Research design is a master plan specifying the methods and procedures for collecting and
analyzing the needed information in a research study.

14
A descriptive design will be used in this study.

RESEARCH SETTING
The setting is the physical location and condition in which data takes place in the study.
The present study will be conducted in GMC Jammu.

STUDY POPULATION
The population of the study will be both male and female staff Nurses.

TARGET POPULATION
The target population consists of the total number of population or objects which are
meeting the designated set of criteria. The population of this study will be both male
and female staff Nurses of GMC Jammu.

ACCESSIBLE POPULATION
Staff Nurses of GMC Jammu who will be available during data collection and who
fulfil the inclusion and exclusion criteria.

SAMPLING TECHNIQUE
A purposive sampling technique will be used for the present study.
SAMPLE SIZE
The total sample size for the present study will be 100 participants (staff Nurses).

INCLUSION CRITERIA
• Participants should be regular working staff nurses at GMC Jammu.
• Participants staff nurses who will be willing to participate in this study.

EXCLUSION CRITERIA
• Students who will not be available during data collection
• Participants who are not interested in the study.
• Participants who had a major physical illness during data collection.

15
SELECTION AND DEVELOPMENT OF TOOL
The tool used in the study will be divided into three parts:

PART A - SOCIODEMOGRAPHIC VARIABLES: age, gender, educational level,

years of professional experience, marital status, and department or unit of work within the
hospital.

PART B: It consists of a self-structured knowledge questionnaire that will be used to

assess the knowledge regarding transmission, prevention, and management of
Pulmonary Tuberculosis among Staff Nurses

PART C: It consists of a self-structured checklist that will be used to assess the

knowledge regarding transmission, prevention, and management of Pulmonary
Tuberculosis among Staff Nurses

VALIDITY OF THE TOOL

The designed self-structured questionnaire will be submitted to the research supervisor
forgetting correction and approval before distributing it to the respondents. The
prepared tool will be sent to experts for the establishment of content validity. The
permission for tool validation will be obtained by sending requisition letter and
acceptance form to the validators for giving their opinion on the appropriateness,
accuracy and relevance of the items of tool in terms of acceptance or non-acceptance

PILOT STUDY
The pilot study will be conducted to ensure the tool’s reliability and feasibility of the
study on one-tenth of the sample.

RELIABILITY OF THE STUDY

The reliability of the tool will be computed by split half method.

DATA ANALYSIS METHOD

16
Analysis and interpretation of data will be based on objectives and done by using
descriptive and inferential statistics.
.
ETHICAL CONSIDERATION
• Ethical clearance obtained from the hospital.
• Permission will be taken from in charge of ward and CMO
• Written informed consent from participants.

SYSTEMATIC PRESENTATION OF RESEARCH DESIGN

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 RESEARCH APPROACH AND RESEARCH DESIGN
Quantitative research approach and descriptive research design

RESEARCH SETTING
GMC Jammu

POPULATION
male and female staff Nurses

TARGET POPULATION
male and female staff Nurses of GMC Jammu

SAMPLE SIZE AND SAMPLING TECHNIQUE

purposive sampling technique and 100 staff nurses

TOOL AND METHOD OF DATA COLLECTION

Section A: Socio-Demographic Variables
Section B: Self-structured questionnaire
Section C: Self-structured checklist.

DATA ANALYSIS AND INTERPRETATION OF DATA

Descriptive Inferential Statistics
Mean, Median, Frequency, Percentage, and Chi-Square
Standard Deviation

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 DESCRIPTION OF THE TOOL
In the current study, the data collection will be done by using the self-structured
questionnaire. The tool will help the researcher, to assess the level of knowledge
regarding the transmission, prevention, and management of Pulmonary Tuberculosis
among Staff Nurses working at GMC Jammu.

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 DEMOGRAPHIC VARIABLES
PART A
Age, gender, educational level, years of
professional experience, marital status, and
department or unit of work within the hospital.

A self-structured questionnaire will be

administered to the selected samples,
consisting of 36 questions to assess
PART B
knowledge regarding the transmission,
prevention, and management of
Pulmonary Tuberculosis

A self-structured checklist that will be

used to assess the knowledge regarding
PART C transmission, prevention, and
management of Pulmonary Tuberculosis
among Staff Nurses

SCORING PROCEDURE
For a knowledge questionnaire to assess the knowledge regarding the transmission,
prevention, and management of Pulmonary Tuberculosis among Staff Nurses working
at GMC Jammu.

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Maximum Score = 36
Minimum Score = 0

Each question carries four answers. Each correct answer carries one mark (1) and the
wrong answer carries a zero mark (0)

LEVEL OF KNOWLEDGE SCORE PERCENTAGE

Inadequate (≥1-12) (≥3-36%)

Moderate (≥12-24) (≥36-70%)

Adequate (≥25-36 (≥70-100%)

CONSENT FORM
The subject ________________________________ has been fully informed about the
nature and purpose of the study. The subject has been asked if any questions have arisen

24
regarding the study and these questions have been answered to the best of the
investigation ability. A signed copy of this form will be made available to the subject.

Investigator’s signature:

____________________

I agree to participate in the study, “A descriptive study to assess the knowledge and
practice of self-care regarding transmission, prevention, and management of Pulmonary
Tuberculosis among staff nurses working at GMC Jammu with a view to develop
information booklet”

I have been allowed to ask questions and have been answered to my satisfaction.

I furthermore recognize the fact that I am free to withdraw this consent and to
discontinue participation in this project at any time without prejudice to care.

I voluntarily give consent to participate in this study.

Name of the Participant: ________________________________

Signature: ______________________________

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