The computer has become backbone of todays occupational settings. They are the heartbeats of the modern world. Computers are everywhere from kitchen to concrete mixers, from planes to pockets. Without computer, world has no global awareness. It has created a brand new environment. A new culture has been born- free, rapid and universal, where people share their knowledge and expertise. Computer has spread its wings within the nursing profession also and nurses are no longer passive users of computer technology, but are now becoming the innovators, developers and implementers of computer systems. (Suparna.K,et.al., (2005).
Vision is our most precious sense. Our eyes are in constant use every waking minute of every day. Over 80% of our learning is mediated through our eyes, indicating the important role our vision plays in our daily activities. Vision disturbance is a silent enemy that only appears after along period of continued stress.
The National Institute for Occupational Safety and Health (NIOSH) reported that computer operators, who view their Video Display Terminals, report more eye-related problems than non- Video Display Terminals office workers and also indicated that visual symptoms occur in 75-90% of Video Display Terminals workers with 22% of Video Display Terminals workers have musculoskeletal disorders.
A survey of optometrists indicated that 10 million eye examinations are annually given in American country because of visual problems at Video Display Terminals. This study delineated the series of symptoms which eventually known as Computer Vision Syndrome (CVS). This condition most often occurs when the viewing demand of the task exceeds the visual abilities of the Video Display Terminals user. The American Optometric Association defines computer vision syndrome as that 'complex of eye and vision problems related to near work which are experience during or related to computer use'. The symptoms can vary but mostly include eyestrain, headaches, blurred vision (distance or near), dry and irritated eyes, slow refocusing, neck and or backache, light sensitivity and double vision.
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Using computers for long hours put repetitive stress on body, muscles and joints especially to eyes. Problems related to eyes affect all those who spend a significant time working with computers. There are many IT professionals who spend most of their time in front of computer screen are at risk of computer vision syndrome. The computer technology has its own pros and cons, the majority of these issues are related to health. The increased use of computers in the workplace has brought about the development of a number of health concerns. Many individuals who work at a computer Video Display Terminal reports a high level of job related complaints and symptoms including ocular discomfort, muscular strain and stress. The level of discomfort appears to increase with the amount of video display terminal use. Visual discomfort and related symptoms occurring in Video Display Terminal workers must be recognized as a growing health problem. Lutron, (1998).
NEED FOR STUDY:
Computer Vision Syndrome holds the distinction of being called the number one occupational hazard of the 21st century. Prevention of injury and illness is obviously, the best approach, but comprehensive health care and safety programs can help to reduce corporate sector's workplace injuries, absenteeism or presenteeism and related expenses. A fitness program was designed to reduce the symptoms of computer vision syndrome in software professionals. A pre and post-test study was conducted to evaluate the effect of the fitness program. The study revealed that the fitness program helped to reduce the symptoms of computer vision syndrome in software professionals. Namrata Arora Charpe and Vandana Kaushik, (2009)
According to National Association of Software Companies, (2006) reported that number of workers is rapidly growing in information technology (IT) sector. Around one million computer professionals are graduating from various courses every year. While 10% of the work force was using computer for their occupational activities in 1980's, the percentage of users is expected to reach 100 million by the end of the 21st century.
A National Survey of Doctors of Optometry (NSDO), (1997) reported that more than 14% of the patients present with eye or vision related symptoms resulting from Video Display Terminals work. The most common symptoms are eyestrain, headache, blurred vision, and light sensitivity, double vision, and color distortion. High visual demands of Video Display Terminals work make many individuals susceptible to the development of eye and vision related symptoms.
American Optometric Association (2001) has reported that 90% of computer users had visual problems and 10% had musculoskeletal fatigue and also stated that there is an increase in employee complaints about computer vision syndrome. Despite the fact that 99.99% of the risk factors are 100% preventable, no concrete efforts are taken to ensure computer workers health.
Majority of population involved in computer related jobs, no significant research in computer related health problems has been carried out in India as compared to Western countries. The computer vision syndromes remain under estimated and poorly understood issue at the work place. The general public, health professionals, the government and private industries need to be educated about this computer vision syndrome. Therefore there is a need to have a comprehensive study on the subject in order to create awareness and diminish the risk factors in the industry.
Modern nursing focuses on holistic approach. It involves teaching in all aspects of health. Nurses have the responsibility in this advanced world of technology to identify the symptoms of Computer Vision Syndrome and to create awareness regarding the management of such problems among computer professionals.
So, the researcher felt that it is one of the responsibilities of the community health nurses as a health care professional to start creating awareness among people who are at risk for developing Computer vision syndrome and also believes that the present study will be a stepping stone in this direction.
STATEMENT OF THE PROBLEM:
A study to assess the effectiveness of structured teaching programme on prevention of computer vision syndrome in terms of knowledge and practice among the computer professionals in selected a area at Salem.
To develop and validate the structured teaching programme on prevention of computer vision syndrome among the computer professional.
To assess and compare the pre-test and the post-test knowledge score on prevention of computer vision syndrome among samples.
To assess and compare the pre-test and the post-test practice score on prevention of computer vision syndrome among samples.
To find the association between the level of pre-test practice score on prevention of computer vision syndrome among the samples and their selected demographic variables (Age, years of working on computer, hours of daily working on computer.)
HYPOTHESES :( Level of significance at P<0. 05)
H1: The mean post-test knowledge score is higher than the mean pre-test knowledge scores on prevention of Computer Vision Syndrome among computer professionals.
H2: The mean post-test practice score is higher than the mean pre-test practice scores on prevention of Computer Vision Syndrome among computer professionals.
H3: There is a significant association between level of the pre-test practice score on prevention of the Computer Vision Syndrome and their selected demographic variables.
H3(a):There is a significant association between level of the pre-test practice score on prevention of the Computer Vision Syndrome among computer professionals and their age.
H3(b):There is a significant association between level of the pre-test practice score on prevention of Computer Vision Syndrome among computer professionals and their years of working on computer.
H3(c):There is a significant association between level of the pre-test practice score on prevention of Computer Vision Syndrome among computer professionals and their hours of daily working on computer .
1. Assess the effectiveness:
It refers to the difference between the mean pre-test knowledge and practice score and mean post-test knowledge and practice score of computer professionals regarding prevention of computer vision syndrome.
In this study knowledge refers to known information on prevention of computer vision syndrome which is assessed by using a structured knowledge questionnaire. The total scores was converted into percentage and interpreted as follows, above 75% adequate knowledge, 51-74% moderate knowledge, below 50% inadequate knowledge.
In this study the practice refers to the adopted practice on prevention of computer vision syndrome which is observed by researcher by using a observational check list on 15th day. The total scores was converted into percentage and interpreted as follows, above 75% adequate practice, 51-74% moderate practice, below 50% inadequate practice.
2. Structured Teaching Programme:
It refers to systematically well planned and prepared by the investigator, on prevention of computer vision syndrome for computer professionals in terms of meaning, definition, causes, signs and symptoms, prevention and management of computer vision syndrome.
It refers to the protective measures that need to be followed by the computer professionals to minimize the occurrence of computer visual problems.
4. Computer Vision Syndrome:
It refers the vision problems which occur for computer professionals those who spend more time in computer work.
Computer Vision Syndrome refers to the complex of eye and vision problems which include headache, blurred vision, neck pain, fatigue, eyestrain, dry eye, irritated eye and difficulty in refocusing the eyes related to near work during computer use experienced by the computer professionals working in a selected BPO(Business Process Outsourcing) centre.
Those who are working data entry operators on computer for more than 6 hours per day belong to age group of 21-40 years.
Computer professionals may have some knowledge and practice regarding prevention of computer vision syndrome.
Structured teaching programme will promote specific preventive measures in the management of computer vision syndrome.
Formal permission was to be obtained from the settings before the conduction of the study.
Written consent was to be obtained from the subjects prior to the data collection.
All the information was kept confidential.
The study is delimited to computer professionals working in BPO (Business Process Outsourcing) centre in at Salem.
The study is delimited to a period of 6 weeks.
The study is delimited to 30 samples.
This chapter dealt with the introduction, need for the study, statement of the problem, objectives, hypotheses, operational definition, assumption, ethical consideration and delimitation.
REVIEW OF LITERATURE
Review of literature is a systematic identification, selection, critical analysis and written description of related materials pertaining to the area of study or topic of interest to expand existing knowledge or to develop new knowledge Polit and Hungler,(2006).
The related literature of the present study is organized and presented as follows:
Section-I: Studies related to incidence and prevalence of Computer vision syndrome.
Section-II: Studies related to risk factors and causes of Computer vision syndrome.
Section-III: Studies related to signs and symptoms of the computer vision syndrome.
Section-IV: Studies related to Preventive aspects of Computer vision syndrome.
SECTION-I: STUDIES RELATED TO INCIDENCE AND PREVALENCE OF COMPUTER VISION SYNDROME.
Mohamed Mabrouk Abdelaziz, et.al., (2009) conducted a study on the incidence and degree of visual defects among computer users. In this study, 100 subjects (50 computer users and 50 non computer users) were taken. Using standard Snellen's chart and Ishihara chart, visual acuity and colour vision tests were conducted. When compared to non computer users, the visual acuity of computer users showed a significant decrease (P<0.05). The incidence of colour vision is higher among computer users than non computer users. It has also revealed that there is a noteworthy difference between samples with visual defects that use computers and when compared to non computer users and the period of exposure with (P<0.01).Visual defects are correlated to duration of exposure to the use of computers and eye disease. The prolonged use of computers may cause eye strain which direct to visual defects.
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Banibrata Das and Tirthankar Ghosh, (2010) conducted a s study to assess the prevalence of musculoskeletal and visual disorders among the visual display terminal. The study was conducted in the different office premises in Kolkata. After selections of the locations, 100 visual display terminal (VDT) workers are selected randomly comprising 50 male and 50 female. A detailed study based on a modified Nordic questionnaire was performed among these visual display terminal workers for study period to measure the outcome of epidemiological studies on musculoskeletal disorders. The result of the study was that the Lower back problem is the main problem among visual display terminal workers. The both male and female visual display terminal workers also suffered pain in neck, shoulder, fore arm, wrist, elbow and the different parts of the upper extremities. This study revealed that the female visual display terminal workers suffer more discomfort feeling than male visual display terminal workers. In this study, it was clearly mentioned that the discomfort feeling was relatively high among the aged visual display terminal workers. The prolonged period of work in an uncomfortable posture mainly lead to discomfort feeling among the visual display terminal workers. Another finding of this study was that both male and female visual display terminal workers suffered from visual stress due to prolonged period of work and without using of antiglare screen in a monitor. The conclusion of this study was the visual display terminal workers suffered pain mainly in the upper extremities and lower back of the body. They also suffered from visual stress. Females have a higher discomfort feeling than male visual display terminal workers.
Mohamed Ali .K and Sathiyasekaran B.W.C, (2006) conducted a study on the prevalence of Carpal Tunnel Syndrome among computer professionals and risk factors. There were 648 subjects were selected from 4,276 computer professionals from 21 companies with a simple random sampling method. Carpal Tunnel Syndrome was diagnosed based on clinical features. The prevalence of Carpal Tunnel Syndrome was found to be 13.1% (95% CI 10.5-15.7%). Subjects with over 8 years of computer work, over 12 hrs of work per day and system administrators were at a higher risk for Carpal Tunnel Syndrome (OR 3.3, 4.9 and 2.5 respectively). Flexed or extended hand position had higher risk for Carpal Tunnel Syndrome. Higher risk for Carpal Tunnel Syndrome was found with higher exposure to computer work. Ergonomic considerations are important in facilitating proper positioning of hand while working with a computer.
Richa Talwar, et.al., (2009) conducted a study to assess the prevalence of health disorders among computer professionals and its association with working environment conditions. The study design was cross sectional. There were 200 computer professionals taken as sample size from Delhi which included software developers, call centre workers, and data entry workers. The prevalence of visual problems in the study group was 76% (152/200), and musculoskeletal problems were reported by 76.5% (153/200). The result of the study exposed that there was a gradual increase in visual complaints as the number of hours spent for working on computers daily increased and the same relation was found to be true for musculoskeletal problems as well. Visual problems were less in persons using antiglare screen and those with adequate lighting in the room. Musculoskeletal problems were found to be significantly lesser among those using cushioned chairs and soft keypad. A significant proportion of the computer professionals were found to be having health problems and this denotes that the occupational health of the people working in the computer field needs to be emphasized as a field of concern in occupational health.
SECTION II: STUDIES RELATED TO RISK FACTORS AND CAUSES OF COMPUTER VISION SYNDROME
Izquierdo JC,et.al., (2007) conducted an observational study to identify the risk factors leading to the computer vision syndrome . Twenty-eight participants answered a validated questionnaire and had their workstations observed. The questionnaire evaluated the personal, environmental, ergonomic factors and physiologic response of computer users. The distance from the eye to the computers monitor (A), the computers monitor height (B), and visual axis height (C) were measured. The difference between monitor height and visual axis height was calculated and labeled as D. Angles of look to the computer monitor were calculated using the formula [angle=tan-1(D/A)]. Angles were divided into two groups participants with angles of gaze ranging from 0 degree to 13.9 degrees were included in Group 1; and participants gazing at angles larger than 14 degrees were included in Group 2. Statistical analysis of the evaluated variables was done. The findings of this study revealed that computer users in both groups used more tear supplements (as part of the syndrome) than expected. This association was statistically significant (p < 0.01). Participants in Group 1 reported more pain than participants in Group 2. Associations between the computer vision syndrome and other personal or ergonomic variables were not statistically significant.
Zairina A. Rahman and Suhaila Sanip, (2011) conducted a study to identify sociodemographic and computer related predictors for computer vision syndrome .Computer vision syndrome (CVS) is an eyes and vision problems related to the activities that experienced in relation to the use of computer. Cross-sectional study and face-to-face interviews and workstation assessment was done. The finding of this study revealed that 68.1% reported computer vision syndrome symptoms. Among the samples, only 19.3% of the respondents put their computer on computer table and 61.9% took at least 10 minutes rest while on continuous one hour computer work. Multivariate logistic regression analysis revealed that the predictors for computer vision syndrome were female (OR=2.3), age <27 years old (OR=2.89), use correction spectacle/lenses (OR=1.91), not taking regular rest (OR=1.78) and use computer > 7 hours per day (OR=2.01). and also the study concluded that the use of correction lenses and long duration on continuous computer work predispose a person to get computer vision syndrome . Resting their eyes in between continuous computer work will be helpful to reduce possibility to get computer vision syndrome.
Rosenfield M, et.al., (2012) conducted a study on effects of induced oblique astigmatism on symptoms and reading performance on viewing a computer screen. The researcher recorded the symptoms of the computer user after a 10 minutes period of reading from a computer monitor either through the habitual distance refractive correction or with a supplementary of -1.00 or -2.00D oblique cylinder added over these lenses among 12 samples. The distance correction condition was repeated to assess the repeatability of the symptom and monitored the samples reading speed accuracy for the period of 10 min trial. The findings of the study revealed that there was no significant difference in reading rate or the number of errors between the three astigmatic conditions, but there was a significant change in the median total symptom scores for the 0, 1 and 2D astigmatic conditions being 2.0, 6.5 and 40.0 respectively (p < 0.0001). The coefficient of the total symptom score was ± 13.46. The study concluded that the presence of induced astigmatism produced a significant increase in post-task symptoms but did not affect reading rate or the number of reading errors. The correction of small astigmatic refractive errors is important in optimizing patient comfort during computer operation.
Chu C, et.al., (2011) conducted a study to identify computer vision syndrome signs are particular to computer function, or merely a symptom of executing a continued near-vision job. There are thirty young samples those who are visually normal were requested to read text audibly either from a standalone computer or on a paper at a screening distance of fifty centimeter for a constant twenty minutes time. For the two sessions the text were used and then the size and contrast were matched. For the two situations, the target angle and luminance were alike. After the reading sessions were over, the samples were requested to finish the written questionnaire based on their level of visual discomfort in the work time. The result of this study disclosed by discriminating the computer and hardcopy situations and confirmed that there was a noteworthy dissimilarity in median symptom scores with consider to blurred vision in the work time. (time=147.0; period =0.03) and average symptom score (time = 102.5; period = 0.04). In the two cases, symptoms were elevated when the use of computer. Symptoms when the prolonged computer use was considerably poorer than those reported after hard copy fascination under identical examining situations. The result of this study helps the practitioners to optimize visual comfort and efficiency during computer operation.
SECTION III: STUDIES RELATED TO SIGNS AND SYMPTOMS OF COMPUTER VISION SYNDROME.
Ranit Kishore and Ashish Arya (2011) conducted a review on studies related to signs and symptoms of computer vision syndrome. Millions of people around the world are using the computers not only as a business tool but as a recreational product as well. Predictions indicate that fully more than 70% of the working population will be using computers by the year 2011. There are also approximately 820 million internet users, with an expected explosion of users to over one billon in the next few years. This heavy computer use leads to various problems related to eyes. According to the report over 100 million people in the United States today use computers. More than 50 percent experience eyestrain, headaches, blurred vision and other visual symptoms related to sustained use of the computer the result might be quite similar for India. This type of stress on the visual system can also cause body fatigue and reduced efficiency at work. The authors have tied to conclude some of the major illnesses which may come during normal working hours on a computer with some of the possible solutions of those problems.
Loh K.Y and Reddy S.C, (2008) conducted a review on the various signs and symptoms related to the computer vision syndrome. The invention of computer and advancement in information technology has revolutionized and benefited the society but at the same time has caused symptoms related to its usage such as ocular sprain, irritation, redness, dryness, blurred vision and double vision. This cluster of symptoms is known as computer vision syndrome which is characterized by the visual symptoms which result from interaction with computer display or its environment. Three major mechanisms that lead to computer vision syndrome are extraocular mechanism, accommodative mechanism and ocular surface mechanism. The visual effects of the computer such as brightness, resolution, glare and quality all are known factors that contribute to computer vision syndrome. Prevention is the most important strategy in managing computer vision syndrome. Modification in the ergonomics of the working environment, patient education and proper eye care are crucial in managing computer vision syndrome.
MiljanoviÄ‡ B, et.al., (2007) conducted a cross sectional study on the visual related dry eye syndrome. Four hundred and fifty samples in Women's Health Study and two hundred and forty samples were taken for this study. The supplementary questionnaire consists of symptoms of dry eye in daily activities and their problems while reading, working with computer, watching television etc.The result of this study exposed that 1/3rd of study samples had clinically diagnosed dry eye syndrome or rigorous symptoms and 2/3rd did not. Logistic regression was employed to observe associations of dry eye syndrome with reported dilemmas with daily actions in every group and grouped guesses using meta-analysis methods. Out of the samples, eighty five percent completed the additional questionnaire, comprising one hundred and thirty five Women's Health Study and 55 Physicians' Health Study participants with dry eye syndrome, and 250 Women's Health Study and 149 Physicians' Health Study participants without dry eye syndrome. Controlling for age, diabetes, hypertension and other factors, those with dry eye syndrome were more likely to report problems with reading ([odds ratio] OR = 3.64, 95% [confidence interval] CI 2.45 to 5.40, P < .0001); carrying out professional work (OR = 3.49, 95% CI 1.72 to 7.09, P= 0.001); using a computer (OR = 3.37, 95% CI 2.11 to 5.38, P < .0001); watching television (OR = 2.84, 95% CI 1.05 to 7.74, P = .04); driving during the day (OR = 2.80, 95% CI 1.58 to 4.96, P < .0001); and driving at night (OR = 2.20, 95% CI 1.48 to 3.28, P < .0001).
Barar A, et.al., (2007) gathered the data in the ophthalmologic literature from the Internet.. It was noted that the complex of eye and vision symptoms occurred due to prolonged use of computer and stress. The following are the recurrent complaints from the computer users i.e., blurred distance or near vision, neck and backache, dry and irritated eyes, eye-strain - asthenopia, headaches, slow refocusing. In most of the developed countries, there are recommendations issued by renowned medical associations with regard to the definition, the diagnosis, and the methods for the prevention, treatment and periodical control of the symptoms found in computer users, in conjunction with an extremely detailed ergonomic legislation whereas in developing countries like India, it is necessary to rouse the interest of ophthalmologist colleagues in understanding and recognition of these symptoms and in their treatment, or at least their improvement, through specialized measures or through the cooperation with specialist occupational medicine colleagues.
SECTION IV: - STUDIES RELATED TO PREVENTIVE ASPECTS OF COMPUTER VISION SYNDROME
Ostrovsky A, et.al., (2012) conducted a study on effects of job related stress and burnout on computer vision syndrome among high tech workers. 106 samples were included in this study. All participants completed self-report questionnaires including demographics, computer vision syndrome, and satisfaction with work environmental conditions, job-related stress and burnout. The finding of this study revealed that there was a significant between-group difference in the intensity of computer vision syndrome, but not in its frequency. Burnout appeared to be a significant contributing factor to the intensity and frequency of computer vision syndrome and also the study showed that burnout is a significant factor in computer vision syndrome complaints among high-tech workers. The study concluded the ergonomic impact to improve health, safety and comfort of the working environment among computer users, for better perception of the job environment.
Gangamma.M.P, et.al., (2010) conducted a experimental study on computer vision syndrome and its management with triphala eye drops and SaptamritaLauha tablets. There were one hundred and fifty one patients were taken for this study. From this, one hundred and forty one finished the treatment. Forty five patients had been advised to take Triphala eye drops in Group A; Fifty three patients had been advised to take the Triphala eye drops and also prescribed them to take internally SaptamritaLauha tablets. Forty three patients had been suggested to take the placebo eye drops in Group 3. The result of the study exposed that there was a significant progress with triphala eye drops in the computer vision syndrome management and also improvement in 48.89, 54.71 and 06.98% patients in groups A, B and C with triphala eye drops and saptamritaLauha tablets.
Richardson.S, (2007) conducted a cross sectional study on computer related upper limp pain and computer vision syndrome in Malaysia. In this study, there were one hundred and thirty six computer users were taken as samples who were the University students and office staff. A rapid upper limp evaluation for the office method was employed for assessment of work-related overuse syndrome. The frequency of computer vision syndrome was reviewed by including a 10-point scoring system for every of its different symptoms. The result of this study disclosed that many were using typical keyboard and mouse without a few ergonomic changes. About 50% of them had a little low back pain as of not having an modifiable backrest. Numerous users had higher scores of the wrist and neck recommending raised hazard of increasing occupational overuse syndrome, which required additional interference. Several (64%) were utilizing refractive corrections and still had high scores of computer vision syndrome commonly including eye fatigue, headache and burning sensation. The increase of computer vision syndrome scores (suggesting more subjective symptoms) correlated with increase in computer usage spells. The study concluded that further onsite studies are needed, to follow up this survey to decrease the risks of developing computer vision syndrome amongst young computer users.
Yee.R.W, et.al., (2007) conducted a research in signs and symptoms of computer users and preventive measures. The researcher also assessed the eye related problems through the clinical tests for prolonged computer users. There were 40 samples taken for this study for three hours in a day. The scores had been computed based on Ocular Surface Disease Index. The assessment had been done based on the scores. The samples were requested to play the computer games for half an hour and the 4 treatment had been applied in the random order i.e artificial tears, MEGS, no treatment, artificial tears with MEGS(microenvironment glasses). Once the sessions were over, the samples were requested to answer the questionnaire. The result of the study exposed that there was a noteworthy association found in the in the index value. The p values were calculated. They were constantly dissimilar in fluorescein and lissamine green discoloration with P>0.05. There was a noteworthy improvements in the scores and TBUT(Tear breakup time) and also there was a steady development of progress in lissamine green staining and in fluorescein staining. The computer users those who have ocular complaints should went for ocular surface examination and they were treated with separation of environmental manipulations, ocular surface and artificial tears.
Shirley Telles, et.al., (2006) suggested that the yoga practice appeared to diminish visual anxiety. Dry eye occurs due to computer vi
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