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FACULTY OF NURSING
BSC (HONS) IN NURSING (POST REGISTRATION)

ASSIGNMENT COVER PAGE

Students Name Mrs. K.Shalina

Students ID 0007000026 Students NRIC

Year/Semester 2015/ 3rd Semester Lecturers Name Mr.Duke

Faculty Faculty of Nursing

Programme BSc. (Hons) in Nursing (Post Registration)

Subject Name LBNS 3206 (Research 1)

Assignment Title Research Proposal

No. of Page
(excluding this
page)

Required words 3000 Actual # of 3390

words

Date submitted February 2016 Due Date

Soft copy included Yes / No

DECLARATION BY STUDENTS:
I certify that this assignment is my own work in my own words. All resources have been
acknowledged and the content has not been previously submitted for assessment to
LINCOLN or elsewhere. I also confirm that I have kept a copy of this assignment.

Signed: Date:

Remarks: This assignment must be submitted in hard copy, either (1) in person to the
college
office or by post, ensuring that either the assignment or envelope is date
stamped. Also must sign this sheet as proof of submission.

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Title
An observation study on the increasing serum cholesterol level among adult obese
patients admitted to government hospitals in the eastern part of Sri Lanka the period of
April 2016 to October 2016.

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Table of Contents

Introduction 01
Background 06
Purpose of study 07
Objectives 08
Literature review 09
Methodology 12
Data analysis 13
References
Appendix
Permission letter 14
Questionnaire 16

Questionnaire (in Tamil)

Introduction
Research is a scientific process. It is called as scientific because the results are
verifiable. It is a systemic search for answers to questions about facts and relationship
between facts. The systemic method has an order and follows an acceptable procedure
for conducting research. Research is process systematically searches for new facts and
relationship (Notter, 1974).

This is the first progress report of the research study on an observation study on the
increasing serum cholesterol level among adult obese patients admitted to government
hospitals in the eastern part of Sri Lanka. In this progress report we wish to describe the
introduction to the research topic, back ground and significance of the problem, problem
statement, and purpose of the study, statement of the objectives, literature review,
conceptual and operational definitions and overall summary.

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Introduction to the research topic

Nursing research as a means of improving the health and welfare of the people.
(ICN, 1986). Nursing research involves a systematic research for knowledge about
issues of importance to the nursing profession. Much health care questions remain to
be answered by nurse researchers and many answers remain to be utilized by
practicing nurses. The study of elevating serum cholesterol level is one of the current
health problems in the world. We hope this mini nursing research also will take an
important place in solving the current health problem.
Human beings are the unique product of their creation and evolution. In contrast
to other forms of animal life, their more highly developed nervous system has enable
them to develop sounds and symbols that make possible the communication and
recording of their questions, observations, experiences and ideas.
Elevating serum cholesterol level is a major cause of morbidity and mortality in
world. Dietary intervention and life style changes are an important component of the
factors, and play a major role in reducing the risk of developing serum cholesterol level.
As elevated serum cholesterol level is the most important treatable risk factor. The
public has been advised to reduce dietary cholesterol intake as a strategy for reducing
serum cholesterol level.
Cholesterol is a solid, waxy substance product by all animals as part of their
normal metabolism. It is not a fat itself, but it is always found with fats in animal derived
foods cholesterol such as low density lipoprotein cholesterol. Low density lipoprotein
(LDL) and High density (HDL) do by liver are considered to be the carriers of cholesterol
molecules so that, cholesterol bind with them to travel through the blood stream. LDL
carries cholesterol out to all the tissue in the body, where it may use for various
metabolic functions, including productions of energy, repair of cell membrane and
hormone production. LDL bond cholesterol tends to stick to damaged artery linings,
accumulate and plugging up the arteries and blocking the blood flow and therefore LDL
called bad cholesterol. HDL carries cholesterol back to the liver from tissues and the
body. Therefore, HDL called good cholesterol. (Turkey and Dictschy, 1988).

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One of the most important functions of the serum cholesterol is to serve as the basic
raw material from which your body makes many major steroid hormones, including
testosterone, estrogen, progesterone, cortisone and aldosterone. Without these first
three hormones you would not have a desire for sexual activities. Without cortisone your
body could not cope with stress, and without aldosterone your body could not properly
balance your sodium and water levels. Normal value of serum cholesterol is 220 240
mg / dl. When serum cholesterol is more than 240mg/dl, the people who are affected
with highest risk of heart diseases, stress, emotional perception (anger, fear, neutral and
happy). Age, gender, ethnic and genetics are the factors cannot control the elevating
serum cholesterol level but, diet and lifestyle can control the elevating serum cholesterol
level. (Kumar and Clerk, 1988). Serum cholesterol elevation has become an important
life threatening condition in Sri Lanka and also it becomes one of the major challenges
for health providers to reduce the cholesterol level among people who have its higher
values (Abeywardene, 2003). Lack of proper knowledge regarding the importance of
maintaining optimal serum cholesterol level, negligence of health advices and no
willingness to change their life style and diet patterns are the reasons among public for
increasing their serum cholesterol level (Sampath and Bernadette, 2010). Most of the
patients perceive that anti cholesterol drugs can reduce the serum cholesterol level
rather the dietary control and life style modification (Sampath and Bernadette, 2010).
When patients are affected by increasing serum cholesterol level they are admitted to
hospital and get complications such as cardiovascular diseases, stress, and
neurological disorders and affected economically and psychologically in turn (Mendis
and Lindholm, 2007).

Background
The present study was planned to investigate the level of cholesterol in obese adult
patients according to their body mass index (BMI) in different patients admitted to
Ashraff Memorial hospital in Eastern part of Srilanka.

Giving the critical nature of complicated conditions affected by high serum cholesterol
free services are provided by the government on reducing serum cholesterol level such

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as lifestyle modifications centers in each hospital and medical officers of health (MOH)
office, school health services and well woman clinics. Among the free services given by
their institutes are blood tests, monitor the blood pressure and advised to life style
modification and dietary pattern by handouts, leaflets, books, audio, video, visual aids.
Despite the above facilities given free of charge by the government. Most of the public
fail to obtain required knowledge to have expected health outcomes (Sampath and
Bernadette, 2010). This is resulted in increasing the number of admissions with
complications related to high serum cholesterol level. Therefore with the intention of
understanding why more people get admitted to hospitals with high cholesterol level.
Obesity poses a major public health challenge. Each year, obesity contributes to an
estimated 112,000 preventable deaths. Obese adults are at increased risk for many
serious health conditions, including high choledterol,high blood pressure, type 2
diabetes and its complications, coronary heart disease, stroke, gallbladder disease,
osteoarthritis and respiratory problems, as well as endometrial, breast, prostate, and
colon cancers. Obese adults also may experience social stigmatization and
discrimination, as well as psychological problems.

Problem statement
Elevated serum cholesterol level among people becomes a critical public health issue in
srilanka (Abeywardene, 2003). In spite of that there are many awareness programs and
free health services for the public, hospital statistics reported that number of number of
admission with high serum cholesterol and its complications are getting high.

Purpose of study
To observe the statistical evidence of an increase serum cholesterol level among adult
obese patients admitted to a government hospital in eastern part of Srilanka. Ashraff
Memorial hospital and Base hospital kalmunai were selected for this study as patients
will be from different ethnic, socio, cultural and economical background and also from
different age, gender and genetic are admitting the wards and clinic and they
represents the Sri Lankans.

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Significance of the study

In researches of srilanka and other countries there are many research studies are
related to increasing serum cholesterol level but, unfortunately, there is no one does
study related to increasing serum cholesterol level of adult obese patients. Someone
try to study the related between lifestyle and diet pattern and increasing serum
cholesterol level. But, there is a gap between patients knowledge, believes and
attitude and high serum cholesterol level

Research Question:
Is there statistical evidence on the increasing serum cholesterol level among adult
obese patients admitted to government hospital in eastern part of srilanka?

Hypotheses:
There is significant information of an increasing serum cholesterol level among adult
obese patients admitted to government hospital in eastern part of srilanka

Variables:
Cause: [independent] because of obesity (BMI)
Effect: [depend] serum cholesterol level

Objective
to investigate on the widespread of level of serum cholesterol among adult
obese patients admitted to government hospitals in eastern part of sri lanka
To identify the number of adult obese patients admitted with diagnosis of
increasing serum cholesterol level

Significance of the study

This research study to analyze reasons for increase serum cholesterol level
among adult obese patients.

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Findings of the study help to understand obesity how increasing serum

cholesterol level.
In researches of srilanka and other countries there are many research studies
are related to increasing serum cholesterol level but, unfortunately, there is no
one does study related to an increasing serum cholesterol level among adult
obese patients admitted to government hospital in eastern part of srilanka.
Someone try to study the related between lifestyle and diet pattern and
increasing serum cholesterol level. But, there is a gap between patients
knowledge, believes and attitude and high serum cholesterol level

Literature review

The main objectives of doing this progress reports are to improve my knowledge
regarding to how to give the introduction to my research topic and classify the literature
review related to my research topic in local and international.

Control of serum cholesterol level helps to reduce the rate of morbidity and
mortality in the world.
Dietary intervention and lifestyle changes are an important component of the
factors, and play a major role in reducing the risk of developing serum cholesterol
level.

The task of reviewing research literature involves the identification, selection, critical
analysis, and written description of existing information on the topic of interest. It is
usually advisable to undertake a literature review on a subject before actually
conducting a research project. Such a review can play a number of important roles.
First, in the start up phase of a project, a review of work conducted in an area of general

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interest can help in the formulation or clarification of a research problem. Second, a

scrutiny of previous work acquaints the researcher with what has been done in a field,
thereby minimizing the possibility of unintentional duplication. Third, the review provides
a conceptual context or frame work for the research community, thereby facilitating the
cumulation of scientific knowledge. Fourth, the researcher may be in a better position to
assess the feasibility of a proposed study by becoming familiar with related work.
Finally, the review can be highly useful in providing methodological suggestions for the
actual conduct of the investigation.

Source of review literature are journal, abstracts and experts, bibliography, dictionaries,
encyclopedias and internet. (Indrani, 2005). In this mini research, web based literature
search has been conducted. It was found more articles from Google, Google scholar,
Yahoo, Firefox and Internet explorer search and using the combination of following key
words, increase serum cholesterol level among adult obese patients 20700 result
Google scholar.
There were adequate research articles related to this topic but not in the local literature.
The researcher found literature from other countries related to this topic. There were
few research articles available during past five years. Therefore, searched the articles
up to ten years back and it was impossible to find even one nursing research article
related to this topic in Sri Lanka Theoretical literature also searched to find out related
details such as books, journals, conference reports and other disciplines. Initially found
02 studies related to this topic.

First one is Increased Plasma Cholesterol Ester Transfer Protein in Obese Subjects
A Possible Mechanism for the Reduction of Serum HDL Cholesterol Levels in Obesity.
Authors are Takeshi Arai, Shizuya Yamashita, Ken-ichi Hirano, Naohiko Sakai, Kazuaki
Kotani, Shigenori Fujioka, Shuichi Nozaki, Yoshiaki Keno, Mitsukazu Yamane, Etsuko
Shinohara, A.H.M. Waliul Islam, Masato Ishigami, Tadashi Nakamura, Kaoru Kameda-
Takemura, Katsuto Tokunaga, and Yuji Matsuzawa

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It is well known that obesity is frequently associated with low levels of serum high
density lipoprotein (HDL) cholesterol. However, the mechanism for this reduction has
not been fully clarified. Cholesteryl ester transfer protein (CETP) transfers cholesterol
ester from HDL to apolipoprotein B-containing lipoproteins and plays an important role
in regulating the concentration and composition of HDL. To elucidate the mechanism for
the reduction of serum HDL cholesterol in obesity, we analyzed serum lipoproteins,
CETP, and postheparin lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL)
activities in 30 obese subjects (17 women and 13 men, age 4414 years, meanSD).
We also investigated the relationship between these variables, total adiposity, and
indices of body fat distribution. The average body mass index of the obese subjects was
33.14.8 kg/m2 (range, 26.4 to 43.8 kg/m2). The obese subjects showed significantly
lower serum HDL cholesterol levels than control subjects (1.040.28 versus 1.500.34
mmol/L, P<.01). In the obese subjects, both activities and protein mass of CETP and
postheparin HTGL activities were significantly increased, whereas postheparin LPL
activities were significantly decreased. CETP activities, independent of postheparin
HTGL and LPL activities, werecorrelated negatively with HDL cholesterol (r=-.39, P<.05)
And the cholesteryl ester to triglyceride ratio of HDL2 and HDLj (r=-.36, P<.05; r=-M,
P<.05, respectively). CETP activities were correlated positively with body mass index
(r=.38, P<.05), body fat ratio (r=.42, P<.05), and subcutaneous fat area determined by
abdominal CT scan imaging (r=.49, P<.05) and negatively with visceral
fat/subcutaneous fat ratio (r=-.52, P<.01). After body weight reduction by caloric
restriction, both activities and protein mass of CETP were reduced. These results
suggest that high levels of plasma CETP may partly explain the reduction of serum HDL
cholesterol in obese subjects and that plasma CETP levels may be regulated by the
degree of total body fat accumulation. (Arterioscler Thromb. 1994; 14:1129-11M.)
Key word is cholesteryl ester transfer protein fat distribution HDL obesity reverse
cholesterol transport

2nd is Environmental contributions to obesity epidemic. Science 280

Authors are Hill, J.O. & Peters, J.C

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The current epidemic of obesity is caused largely by an environment that promotes

excessive food intake and discourages physical activity. Although humans have evolved
excellent physiological mechanisms to defend against body weight loss, they have only
weak physiological mechanisms to defend against body weight gain when food is
abundant. Control of portion size, consumption of a diet low in fat and energy density,
and regular physical activity are behaviors that protect against obesity, but it is
becoming difficult to adopt and maintain these behaviors in the current environment.
Because obesity is difficult to treat, public health efforts need to be directed toward
prevention

Summary of the reviewed literature

According to the above reviewed literature. While studies have focused to identify
the relationship between certain diets and serum cholesterol levels, very few studies
attempted to identify the relationship between high serum cholesterol levels and risk of
CVD. While all these studies were carried out in other countries, Srilankan literature is
not available to evident that research attention has paid to this issue in Srilanka.

Conceptual definitions
Patient is defined as, a person who is ill or is undergoing treatment for disease.
(Barbara, nurses dictionary, 2000, p. 301)
Cholesterol defined as, a waxy substance made by the liver and acquired
through diet. It is found in the blood and in all cells in the body. The body uses
cholesterol to produce bile, some hormones, vitamin D, cell membrane and myelin. A
high level of cholesterol in the blood is called hypercholesterolemia. High blood
cholesterol has been linked to heart diseases. (Medical dictionary)
Believes is defined as, thoughts, ideas and concepts developed by an individual
over a period of time from cultural influences, education, religion, parents and family.
(Barbara, nurses dictionary, 2000, p. 47)

Key word:

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Increase serum cholesterol level of among obese adult patient

20700 result Google scholar

Methodology

Focus Quantitative Research Approach

Method- observation
Sample random
Design cross sectional
Settings Ashraff Memorial Hospital and Base hospital kalmunai

Sample Size 150 Patients from ward and clinic

Analysis-data will we collected by questionnaire and collected data well be
analysis with soft ware spps
Ethical Permission Approval from Hospital Administration was granted
Protection of Participants Informed Consent Anonymity
Free to refuse

Inclusion sampling:
Admitted to the government hospital in eastern part of Srilanka, and also Clinic
attendance
Adult obese patients (Age between 35-60).
Must be want serum cholesterol report on patients hand.
Exclusion:
Below 34 and above 61 age patients
Adult Obese patient, they do not have serum cholesterol report
Obese patients in the community

Data collection
Method: observational data collection via questionnaire

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Tool: researcher administrated questionnaire

K.Shalina,
Ashraff memorial Hospital,
Kalmunai.
27.02.2016.
To:
The Medical Superintend
Ashraff memorial hospital,
Kalmunai
Through: Visiting physician
AMH, Kalmunai.
Through: The Chief Nursing Officer
AMH, Kalmunai
Through: The ward manager / clinic in-charge
AMH, Kalmunai

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Dear Sir,
Request for Permission to collect data

Im Mrs.K.Shalina working as a nursing officer at AMH kalmunai ,following BSC (HONS)

IN NURSING (POST REGISTRATION)direct at Lincoln university of Malaysia study
continue of addalachenai ICBS.
Parcel fulfillment of my degree I have to submit a research thesis. My research topic is
an Observational study on increasing serum cholesterol level among adult obese
patients admitted to a government hospital in eastern part of Srilanka the period of April
2016 to October 2016.
So please grand me the permission to do the research at AMH.

Thank you
You faithfully
.

K.Shalina,
Base Hospital,
Kalmunai.
27.02.2016.
To:
The Medical Superintend
Base hospital,
Kalmunai
Through: Visiting physician
BH, Kalmunai.
Through: The Chief Nursing Officer
BH, Kalmunai
Through: The ward manager / clinic in-charge
BH, Kalmunai
Dear Sir,

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Request for Permission to collect data

Im Mrs.K.Shalina working as a nursing officer at AMH kalmunai ,following BSC (HONS)

IN NURSING (POST REGISTRATION)direct at Lincoln university of Malaysia study
continue of addalachenai ICBS.
Parcel fulfillment of my degree I have to submit a research thesis. My research topic is
an Observational study on increasing serum cholesterol level among adult obese
patients admitted to a government hospital in eastern part of Srilanka the period of April
2016 to October 2016.
So please grand me the permission to do the research at BH Kalmunai.

Thank you
You faithfully
.

QUESTIONNAIRE ON THE INCRESING SERUM CHOLESTEROL LEVEL

AMONG ADULT OBESE PATIENTS

Venue: Medical wards and medical clinics- ..

Please write the correct answer to the question and mark () sign to give your correct
answer.

01 .Age of the patient :-

02. Ethnicity :-

03. Sex :-

04. Educational level :-

05. Body weight :-

06. Height :-

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07. Waist circumference :-

08. Familial position :-

09. Are you an employee? Yes (.) No (.)

10. If your answer for above question

is yes what is your occupation?...................................

11. Do you have increase in cholesterol? YES NO

12. What are the diseases you have?

I. Diabetes mellitus (.)

II. Hyper tension (.)

III. Bronchial Asthma (.)

IV. Others. Please specify

13. Are you aware of diagnosis with hypercholesterolemia?

I. Yes (.) II. No (.)

14. Do you have any relatives who are having hypercholesterolemia?

I. Yes (.) II. No (.) III. Not known ()

15. Are you attending clinics?

I. Yes, regularly (.)

II. Yes, once in a while (.)

III. Yes, when I have complications on severity (.)

IV. No, not regularly (.)

16. Do you know about hypercholesterolemia?

I. Yes (.) II. No (.) III. No clear idea ()

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Researcher
BMI:
Report (cholesterol level):

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