This document provides a summary of a dissertation presentation on the effectiveness of nursing interventions on treatment compliance and clinical outcomes among clients with type 2 diabetes mellitus. The presentation covers the introduction, need for the study, statement of the problem, objectives, hypotheses, operational definitions, conceptual framework, review of literature, research methodology, intervention description, data collection, data analysis, results and discussion. Key findings from the results include that nursing interventions like an informative education program and resistance exercise were effective in improving knowledge, treatment compliance and clinical outcomes like fasting blood sugar among the experimental group compared to the control group. Statistical analysis found significant differences between the groups, supporting the effectiveness of the nursing interventions.

1. WELCOME TO DISSERTATION
PRESENTATION
31 August 2021 VMCON, PDY. Registration No: 2521910201 1

2. Presented by,
Registration no: 2521910201
Effectiveness of nursing intervention on treatment compliance
and clinical outcomes among clients with type 2 diabetes
mellitus in selected hospital at Puducherry
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3. INTRODUCTION
• Diabetes Mellitus (DM) is a chronic incurable disease of the metabolic
process when the pancreas is unable to produce insufficient insulin or
when the body doesn’t use the insulin produced which is characterized
by a high level of blood sugar which in a long run will damage the many-
body system’s if not controlled properly.
• The most common type among the three is Type 2 Diabetes Mellitus
(T2DM) which is caused by obesity and a sedentary lifestyle mainly.
• WHO has taken up certain measures globally to prevent and control DM
particularly in middle and low-income countries such as the
development of norms and standards, awareness program, conducting
surveillance, and guidelines to prevent major non-communicable
diseases such as DM.
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4. NEED FOR THE STUDY
• Every year the World Diabetes Day is observed on 12th November
focusing on a particular theme with an aim to spread the awareness of
diabetes among people due to the enormous increase of prevalence
rate globally.
• World Diabetes Day 2020 theme was “Nurse and Diabetes”. With the
world facing the global pandemic COVID-19, DM patients have a higher
risk of getting affected by the disease with an increased mortality rate
as well as having difficulty in accessing the health care facilities.
• A global survey report explained that 49% of all the countries have
experienced disruptions in carrying out DM services and it is also
estimated that 6% of the world population is affected by diabetes.
• With world diabetes statistics more than 420 million adults, 96 million
are from South-East Asia Region. (WHO, 2020).
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5. STATEMENT OF THE PROBLEM
A study to assess the effectiveness of nursing interventions on treatment
compliance and clinical outcomes among clients with type 2 diabetes
mellitus in selected hospital at Puducherry.
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6. OBJECTIVES
 To assess the knowledge, treatment compliance, and clinical outcomes
of clients with T2DM.
 To evaluate the effectiveness of IEP and RE on treatment compliance
and clinical outcomes among clients with T2DM between the EG and
CG.
 To find out the association between pretest levels of knowledge,
treatment compliance, and clinical outcomes and their selected
demographic variables of clients with T2DM in the EG and CG.
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7. HYPOTHESES
• Hypothesis 1 (H1) - There is a significant difference in the level of
knowledge, treatment compliance, and clinical outcomes before and
after nursing interventions among clients with T2DM.
• Hypothesis 2 (H2) - There is a significant association between pretest
level of knowledge, treatment compliance, and clinical outcomes and
their selected demographic variables & health profile among clients
with T2DM.
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8. OPERATIONAL DEFINITIONS
• Assess: In this study, it refers to determine the level of knowledge, treatment
compliance, and clinical outcomes regarding DM among clients with T2DM.
• Effectiveness: In this study, it refers to the ability of the nursing interventions to
produce an intended result.
• Nursing interventions: Nursing Interventions is a systematically planned lecture cum
demonstration program for patients with T2DM, which is shown below:
 Informative Education Programme (IEP): It is a planned teaching program for
imparting knowledge regarding DM for about 20-30 minutes using the power
Point Presentation (PPT) for clients with T2DM in the EG.
 Resistance exercise (RE): It is a planned lecture cum demonstration program
using a laptop that included wall push-ups, side raises, bicep curls, triceps
extensions, and chair raise of RE for the clients with T2DM in the EG.
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9. contd:-
• Treatment compliance: In this study, it refers to determine treatment compliance
among the clients with T2DM by using nine modified items of the WHO adherence
scale for long-term therapies and eight modified items Morisky Medication
Adherence Scale (MMAS).
• Clinical outcomes: In this study, it refers to the find out the anthropometric
measurements: height, weight, and BMI-normal:18.5-25 kg/m2, Physiological
measurement: BP-normal: <120/80 mmHg and Bio- physiological measurement FBS-
normal: <100 mg/dl, among the clients with T2DM.
• Clients with type 2 diabetes mellitus: In this study, it refers to patients who are
diagnosed to have T2DM by a qualified physician and admitted for further
management in the wards of AVMC&H, Puducherry.
• Selected Hospital: In this study, the hospital refers to AVMC&H, Puducherry providing
medical, surgical treatment, and nursing care for clients with T2DM.
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10. CONCEPTUAL FRAMEWORK
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11. REVIEW OF LITERATURE
• Section I: Knowledge among clients with T2DM
• Section II: Treatment compliance among clients with T2DM
• Section III: Clinical outcomes among clients with T2DM
• Section IV: Effectiveness of IEP on treatment compliance and clinical
outcomes among clients with T2DM
• Section V: Effectiveness of exercise on treatment compliance and
clinical outcomes among clients with T2DM
Total-27
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12. RESEARCH METHODOLOGY
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Methodology Description
Research approach Quantitative approach
Research design Quasi experimental research design with pre test and
post test
EG: O-X-O1O2O3 CG: O-O1O2O3
Setting of the study All wards of AVMC&H, Puducherry
Independent
variables
Nursing interventions: IEP and demonstration of RE
Dependent
variables
Levels of knowledge, levels of treatment compliance and
levels of clinical outcomes such as BMI, BP and FBS.
Target population T2DM who were admitted to AVMC&H, Puducherry.

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Methodology Description
Accessible
population
Clients aged between 40 and 70 years with T2DM who
were admitted to AVMC&H, Puducherry.
Sample Clients aged between 40 and 70 years with T2DM who
fulfilled the inclusion criteria.
Sampling
technique
Convenient sampling technique, which is a type of non-
probability sampling technique.
Sample size 60 clients (30-EG and 30-CG)
Content validity Seven experts
Reliability (r) Knowledge questionnaires-0.839, Treatment compliance-
0.791, Height-0.95, Weight-0.97, BP-0.94

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CRITERIA FOR SELECTION OF SAMPLES
Inclusion Criteria: Clients with T2DM
• who were willing to participate.
• of both gender.
• who were able to understand and
communicate Tamil and/or English.
• aged between 40 and 70 years.
• who were being admitted to
AVMC&H, Puducherry for treatment.
• who were willing to follow the nursing
interventions.
Exclusion Criteria: Clients with T2DM
• who were mentally, visually, and
physically challenged.
• who was critically ill.
• who already had diabetic foot ulcers.
• who had joint pain.
• who had a hearing impairment.
• who were already practising resistant
exercise.

15. DESCRIPTION OF TOOL
Section – A
• Part 1: Demographic variables (9)
• Part 2: Health profile variables (8)
Section – B
• Part 1: A structured questionnaire on
knowledge regarding DM (20)
• Part 2: Treatment compliance statements-
modified WHO adherence to long-term.
therapies and eight items from MMAS (15)
• Part 3: Clinical outcomes-
- Anthropometric measurements: height,
weight, and BMI
- Physiological measurement: BP
- Bio-physiological measurement: FBS
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16. INTERVENTION
DESCRIPTION
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17. DATA
COLLECTION
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18. DATA ANALYSIS
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Section A Section B Section C
• Numbers,
percentage,
mean and
standard
deviation used to
assess the level
of knowledge,
treatment
compliance, and
clinical
outcomes.
• Paired ‘t’ test was used to determine effectiveness of
nursing interventions on the knowledge, treatment
compliance, BMI, BP, FBS among clients with T2DM in the
EG.
• Repeated ANOVA F test was used to determine the
comparison of the effectiveness of nursing interventions
on the knowledge, treatment compliance, BMI, BP, FBS
among clients with T2DM in the EG between pretest and
posttests.
• Student independent ‘t’ test was used to determine the
comparison of the effectiveness of nursing interventions
on the knowledge, treatment compliance, BMI, BP, FBS
among clients with T2DM in both EG and CG.
• Chi-square test was
applied to ascertain
an association
between the
pretest level of
knowledge,
treatment
compliance, BMI,
BP and FBS among
clients with T2DM
with their
demographic and
health profile in
both EG and CG.

19. RESULTS AND DISCUSSION
Section A: Assess the knowledge, treatment compliance, and clinical outcome of
clients with T2DM.
Table 1: Levels of knowledge among EG and CG in the pretest
N=30+30
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Knowledge levels EG CG
Adequate knowledge (15-20) 20% 13.3%
Moderately adequate knowledge (8-14) 63.3% 53.4%
Inadequate knowledge (0-7) 16.67% 33.3%

20. Table2: Levels of treatment compliance among EG and CG in the pretest
N=30+30
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TREATMENT COMPLIANCE LEVEL EG CG
High (11-15) 10% 23.3%
Medium (6-10) 66.7% 63.4%
Low (0-5) 23.3% 13.3%
Hashimoto et al. (2019) conducted a cross-sectional study and found that a medium
level of adherence to medications was associated with high BMI with OR 1.159; 95%
CI 1.034–1.300 and poor diabetes knowledge with OR 0.844; 95% CI 0.741–0.961
(p=0.031).

21. Table 3: Levels of clinical outcomes among EG and CG in the pretest
N=30+30
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Clinical outcomes EG CG Clinical outcomes EG CG
BMI Under weight 3.3% 6.7% DBP Normal 10% 20%
Normal 70% 66.7% Pre HTN 56.7% 50%
Overweight 26.7% 23.3% Stage I HTN 33.3% 30%
Obese class 1 3.3% 3.3% Stage II HTN - -
SBP Normal 16.7% 23.3% FBS Normal - -
Pre HTN 76.7% 63.4% Pre- diabetes 3.3% 3.3%
Stage I HTN 6.7% 13.3% Diabetes 96.7% 96.7%
Muliyil et al. (2017) investigated compliance to treatment among T2DM receiving care at
peripheral mobile clinics in a rural block of Vellore District, Southern India, and study results
yielded that was a decrease by 0.09% for every 10% greater in compliance.

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TESTS KNOWLEDGE LEVEL TREATMENT COMPLIANCE
EG CG EG CG
Pretest 11.93±3.16 9.87±3.16 7.50±2.45 7.50±2.45
Posttest 2 14.20±1.83 11.33±3.08 9.87±1.55 8.33±1.83
Posttest 3 15.13±1.81 11.97±3.32 11.07±1.05 8.07±1.84
Mamta et al. (2016) conducted a pre-experimental study found that the knowledge
score was high in post-test (13±5.01) in comparison to the score with pre-test
(23.6±4.5). At the level of CI (95%), the difference was found statistically significant.
Section B: Evaluate the effectiveness of IEP and RE on knowledge, treatment compliance,
and clinical outcomes among clients with T2DM between EG and CG.
Table 4: Effectiveness of IEP and RE on knowledge, treatment compliance in the post-test
N=30+30

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TESTS BMI SBP DBP FBS
EG CG EG CG EG CG EG CG
Pretest 23.60±
2.48
23.19±
3.01
124.33±
8.58
122.33±
9.71
82.33±
6.26
81.00±
7.12
217.20±
63.93
214.07±
78.14
Posttest 1
-
123.60±
6.63
121.67±
9.49
81.67±
4.61
81±
4.81
185.67±
62.19
217.47±
76.30
Posttest 2 123.67±
7.18
122.63±
6.83
80.33±
4.90
80.67±
5.21
139.83±
30.63
158.47±
40.62
Posttest 3 23.52±
2.38
23.18±
2.97
122.33±
5.04
123±
6.51
80.33±
3.19
81.33±
6.29
117.30±
14
140.70±
31.46
Mookambika et al. (2016) study results observed that 54% had exercise can control
the disease (p=0.007) and 35.8% had exercise daily, 60% had the management of DM
includes diet, exercise, and drugs.
Table 5: Effectiveness of IEP and RE on clinical outcomes in the posttest
N=30+30

24. Table 6: Effectiveness of IEP and RE with different inferential statistics in the posttest
Repeated
ANOVA-F value
(N=30)
Knowledge-27.799: ***p<0.001
Treatment compliance-50.400,: ***p<0.001
FBS- 38.835: ***p<0.001
Paired ‘t’ test
values
(N=30)
Knowledge- 4.682, 4.157, 5.845, p<0.001
Treatment compliance-6.814, 4.539, 7.944: ***p<0.001
FBS-2.579: *p<0.05, 4.326:***p<0.001, 4.359: ***p<0.001, 8.752:
***p<0.001
Student
independent ‘t’
test
(N=30+30)
Knowledge-2.279:*p<0.05, 4.387: ***p<0.00, 4.588: ***p<0.001
Treatment compliance- 1.039: p=0.303, 3.509: ***p≤0.001, 7.769:
***p≤0.001
FBS- 0.170: p= 0.866, 1.769:p=0.082, 2.006: *p<0.05, 3.722:
***p<0.001
The stated research hypothesis (H1) was accepted.
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25. Section C: Association between pre-test knowledge, treatment compliance, and clinical
outcomes and their selected demographic variables of T2DM between EG and CG.
EG
• There was an association between Pretest Knowledge Level with selected
Demographic Variable such as gender: female, marital status: married, type of
family: nuclear family, source of getting health information: family members
• There was an association b/w pretest Knowledge Level with selected Health Profile
such as no harmful habits
• There was an association b/w pretest Treatment Compliance with selected
Demographic Variables such as age
• There was an association b/w BMI and family monthly income, DBP and marital
status & type of family and FBS and family monthly income
• There was an association b/w BMI and food habits and FBS and food habits, any
harmful habits & any regular medication
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26. Contd…
CG
• There was an association b/w Pretest Treatment Compliance with
selected Health Profile such as use of any complementary and
alternative medicine
• There was an association b/w SBP and age & religion and DBP and
gender
• There was an association b/w BMI and any complementary and
alternative medicine SBP and any co-morbid conditions
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DISCUSSION: Mokabel et al (2017) concluded that there was corroboration of
ameliorated knowledge of routine blood sugar checkups, dietary charts, exercise, and
lifestyle characteristics.
The stated research hypothesis (H2) was accepted.

27. CONCLUSION
• The prevalence of DM is high and it majorly affects the quality of life. Timely diagnosis
using clinical criteria and effective intervention is of utmost importance.
• The purpose of this study was to assess the effectiveness of nursing interventions on
treatment compliance and clinical outcomes among clients with T2DM in a selected
hospital at Puducherry.
• The data revealed that the nursing interventions- IEP and demonstration of RE had
produced positive impact and found to be effective in improving the level of
knowledge and treatment compliance and clinical outcomes such as control blood
sugar and normal BP and BMI in the EG and less effectiveness was seen in BMI and BP.
• The study concluded that providing educative program will improve the knowledge of
both caregiver and the clients and also following a routine RE regularly at home also
will help in controlling the blood sugar levels, BP and ideal body weight and increase
the muscle strength as well.
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28. RECOMMENDATIONS
• Diabetic education should be given periodically and a diary can
be maintained for ensuring client participations in health
education programme related to diabetes mellitus.
• Diabetes mellitus self-management education material tailored
to the educational level of clients should be available in the
clinics.
• Diabetes mellitus self-management education should be made
mandatory in hospitals.
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29. IMPLICATIONS OF THE STUDY
Nursing Education
• Nursing education need to be strengthened to enable nursing students to know
about current knowledge on diabetes mellitus and utilize evidence based findings
(RE enhance good clinical outcomes), to promote treatment compliance among
clients with T2DM.
• Nursing curriculum should provide clinical experience regarding conduction of IEP in
various settings.
Nursing Practice
• Nurses play an important role in promotive, curative and preventive aspects of
health care system. Nurses should render IEP for T2DM clients in the hospital and
community.
• The nurses working in the hospital can provide health education and they can
conduct planned teaching apart from incidental teaching.
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30. IMPLICATIONS OF THE STUDY contd:-
Nursing Administration
• The nurse administrators in the hospital can develop guidelines for conducting IEP for type 2 diabetes
mellitus clients and encourage practice of the guidelines by nurses in the hospital to improve the
compliance among clients with T2DM.
• Continuous quality assessment can be done by the hospital on the quality of health education
provided to the patients.
Nursing Research
• The findings of the study serve as a basis for the nursing professional and the students to conduct
further studies in different aspects of T2DM treatment like compliance, diet, exercise, foot-care, eye
care and self-administration of insulin.
• Knowledge, attitude and practice study on prevention of diabetes mellitus complications can be
done.
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31. LIMITATIONS
 The study was limited to 60 clients-30 in the CG and 30 in the EG with
T2DM aged between 40 and 70 years admitted in AVMC&H, Puducherry.
 The period of study was limited to 6 weeks of study duration.
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32. REFERENCE
Book references-11
• Black, J.M., & Hawks, J.H. (2012). Medical-Surgical Nursing: clinical management for
positive outcomes. (8th ed., vol 1., pp.1063-65). Elsevier.
• Hinkle, J.L., & Cheever, K.H. (2017). Brunner & Suddarth’s textbook of medical surgical
nursing. (13th ed., vol 2., pp.1417-60). Wolters Kluwer.
• Park, K. (2017). Park’s textbook of preventive and social medicine. (24th ed., pp. 417).
Bhanot.
• Polit., & Beck. (2018). Nursing Research. (10th ed., pp. 120-121). Wolters Kluwer.
Journal articles- 36
Web references-12
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