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\title{Counseling Capability of Health Care Professionals in a Tertiary Level Hospital}
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             \author[1]{M Z  Hussain}

             \author[2]{Dr. Shahanaz Khanam  Chowdhury}

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\date{\small \em Received: 16 December 2019 Accepted: 4 January 2020 Published: 15 January 2020}

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\begin{abstract}
        


Attitude and behavior of medical personal towards the patient has a great influence on recovery and control the ailment. To assess the counseling capability in term of primary knowledge, attitude, and practices of health care professionals, and to recommended way of improvement, we carry out this study in Gynae & Obst department of a tertiary level hospital in Dhaka, Bangladesh.Study design: This study was designed as a descriptive perspective, hospital-based study crosssectional survey which conducts using a pretested, structured, and validated question. Methods:We have given a structured questioner to all participants, the questionnaire designed to evaluate the knowledge, attitude and practice on handling with pregnant Hypertensive and Diabetic patients regarding concerning variables such as causes of these diseases, clinical feature, investigation, treatment, complication and preventive measure. We assess the above variable among 309 health caregiver including doctors, nurses, medical assistants.

\end{abstract}


\keywords{counseling, hypertension, diabetes mellitus, medical staff.}

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\let\tabcellsep& 	 	 		 
\section[{Introduction a) Hypertension}]{Introduction a) Hypertension}\par
ustain elevation of blood pressure, systolic >130 and diastolic >80 or both defined as ypertension. \hyperref[b0]{1} If the cause of hypertension is unknown it's called primary hypertension, which is about 95\%. \hyperref[b1]{2} Hypertension with the known cause is secondary hypertension. Hypertension occurs in approximately 8-10\% of pregnancies. Two blood pressure measurements six hours apart of greater than 140/90 mm Hg is diagnostic of hypertension in pregnancy. \hyperref[b2]{3} usually hypertension is asymptomatic. Only a few patients shows clinical feature of hypertension if it is severe and long standing. \hyperref[b3]{4} Hypertension usually clinically diagnosed during routine check-up or incidental finding during follow up. \hyperref[b4]{5} there is no significant test for the diagnosis of hypertension. But few tests are routinely done to determine the cause, assess damage and scoring cardiovascular risk factors. \hyperref[b5]{6,}\hyperref[b6]{7} The treatment option is pharmacological and no pharmacological including lifestyle change, drugs including diuretics, beta-blockers, ACEI, ARB and calcium channel blocker. \hyperref[b7]{8}  
\section[{b) Diabetes Mellitus}]{b) Diabetes Mellitus}\par
Hyperglycemia due to impaired insulin secretion and variable degree of peripheral insulin resistance is defined as Diabetes mellitus. \hyperref[b8]{9} Patient usually present with high blood sugar with polydipsia, polyphagia, polyurea, and blurred vision. \hyperref[b9]{10} Longstanding diabetes mellitus may present with vascular disease, peripheral neuropathy, nephropathy and predisposing to infection. \hyperref[b10]{11} Two to ten percent of women without diabetes may develop diabetes during pregnancy called gestational diabetes, so those at normal risk, screening is recommended between 24 and 28 weeks' gestation. Prevention is by maintaining a healthy weight and exercising before pregnancy. \hyperref[b11]{12} Clinically the significant patient is diagnosed by measuring plasma glucose. Treatment is lifestyle modification by diet, exercise, smoking cessation and pharmacological including insulin and antihyperglycaemic agent. Early treatment plan prevent and delayed complication. \hyperref[b12]{13}  
\section[{c) Justification}]{c) Justification}\par
Hypertension and Diabetes mellitus is a global public health concern, and mortality excesses that of communicable, maternal and nutritional condition. \hyperref[b13]{14}  
\section[{S}]{S} 
\section[{Medical Research}]{Medical Research}\par
Volume XX Issue III Version I( D D D D ) E © 2020 Global Journals\par
Near about 80\% of global death occur due to no communicable disease.  {\ref 15} Health care professionals are frequently facing the patient of hypertension and Diabetes mellitus in their day to day practice. This research will improve the awareness of health care professionals. 
\section[{II.}]{II.} 
\section[{Objectives a) General objective}]{Objectives a) General objective}\par
To evaluate the knowledge, attitude, and practices of health care professionals toward pregnant hypertensive and diabetic patients in Gynae \& Obst Department of a tertiary hospital in Dhaka, Bangladesh. 
\section[{b) Specific objectives}]{b) Specific objectives}\par
1. To assess awareness of health care professionals about the cause, clinical feature, investigation, treatment of pregnant hypertensive and Diabetic patient.\par
To assess the practice of health care professionals. 3. To assess the attitude of medical staff toward pregnant patients suffering from Hypertension and Diabetes melli.\par
III. 
\section[{Methods a) Study design}]{Methods a) Study design}\par
This study was designed as a descriptive perspective, hospital-based study cross-sectional survey which conduct using a pretested, structured, and validated The questionnaire designed to evaluate the knowledge, attitude and practice on handling with pregnant Hypertensive and Diabetic patients regarding concerning variables such as cause of these diseases, clinical feature, investigation, treatment. 
\section[{b) Study Area, Duration}]{b) Study Area, Duration}\par
This study was conducted in Gynae \& Obst Department of a tertiary level, Dhaka, Bangladesh during the period from June 2019 to May 2020. 
\section[{c) Population}]{c) Population}\par
Total coverage for the health care workers who work in Gynae and Obst department of the hospital. A total 309 subjects were enrolled in this study. 
\section[{d) Inclusion criteria}]{d) Inclusion criteria}\par
All health care workers in concerning departments were included specifically house officer's doctors, Medical assistant and Nurses. 
\section[{e) Exclusion criteria}]{e) Exclusion criteria}\par
Physicians and employers who rejected to be a part of this study. 
\section[{f) Methods of data collection}]{f) Methods of data collection}\par
Data was collected using a questionnaire made specifically for the manner of the research and the data was next analyzed by using SPSS programmed. 
\section[{g) Ethical Clearance}]{g) Ethical Clearance}\par
This study was approved by the Ethical committee of the hospital.  
\section[{IV.}]{IV.} 
\section[{Results}]{Results} 
\section[{Discussion}]{Discussion}\par
This A cross-sectional survey will conduct using a pretested, structured, and validated questionnaire containing questions on causes, clinical feature, the investigation, treatment, counseling availability of pregnant hypertensive and diabetic patient. Descriptive statistics will carry out for assessing knowledge of the diseases, clinical feature, investigation, and treatment of Hypertension and Diabetes mellitus. Results shows doctor recorded 17 (56.6\%) good and 13(43.3\%) excellent, while nurse recorded 5 (  
\section[{Articles Review:}]{Articles Review:}\par
Research shows that one of the most important factors for the caregiver is to assess the patient's selfefficacy beliefs for behavioral change to make health practices easier.  {\ref 16,} {\ref 17} This is also a central part of motivational interviewing.  {\ref 18} In overall terms, it appears to be useful to work with the SOC model to obtain a structure for the consultation and counseling that is given in a patient-centered way may lead to treatment plans that are more centered around the patient's beliefs and therefore more likely to produce self-care .  {\ref 19} As the hypertensive patient is 'at risk', which is less obvious than being sick, the caregiver has to make the patient an active participant in decisions regarding treatment and goal-setting. It is crucial for the caregiver to make a deliberate assessment of the patient's self-care deficits in order to choose the appropriate nursing actions, such as health education.  {\ref 20} Counseling skills appear to be of value in caregiver empower mental attitudes, inpatient advocacy and in supporting the patient. The caregiver are good at giving support, as reported from Study in this thesis and other research, and this is included in the recommended stage-directed counseling in the preparation, action and maintenance tages.  {\ref 21} Supportive communication provided by healthcare personnel is also recommended by Burleson and McGeorge but Bell presents an objection to giving support, as it has limited meaning for the internalization of new behaviors.  {\ref 22} He proposes that new behavior that is only internalized at an integrated level is a prerequisite for maintenance. Glasgow  \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.85\textwidth}}
Regarding knowledge of the cause, clinical feature,\\
investigation and treatment of Hypertension and\\
Diabetes Mellitus doctor recorded 17(56.6\%)good and\\
13(43.3\%) excellent while nurse recorded 5(13.8\%) poor\\
and 31(86.11\%) good, while medical assistant\\
194(79.81\%) good and 84(19.4\%) are excellent. With\\
P.value = 0.000 using pearson Chi-square test.\end{longtable} \par
 
\caption{\label{tab_0}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.85\textwidth}}
Regarding practice of Hypertension and\\
Diabetes mellitus, doctor recorded 8(26.6\%) poor\\
3(43.3\%) good and 9(30\%) excellent while nurse\\
recorded 6(16.6\%) poor, 8(22.2\%) good and 22(61.11\%)\\
excellent, while medical assistant 130(53.4\%) good and\\
112(46\%) excellent. With P.value = 0.008 using Pearson\\
Chi-square test.\end{longtable} \par
 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.85\textwidth}}
Regarding attitude towards Hypertension and Diabetes\\
patient doctor recorded 12(40\%) poor,10(33.3\%) good\\
and 8(26.6\%) excellent. while nurse recorded 10(7.4\%)\\
poor, 17(47.2\%) good and 9(25\%)excellent, while\\
medical assistant 18(7.4\%) excellent, 56(23\%) good and\\
169(69.54\%) excellent. With P.value = 0.000 using\\
Pearson Chi-square test.\end{longtable} \par
 
\caption{\label{tab_2}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_3}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_4}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.85\textwidth}}
V.\end{longtable} \par
 
\caption{\label{tab_5}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.7618395303326809\textwidth}P{0.026614481409001956\textwidth}P{0.06154598825831702\textwidth}}
\multicolumn{2}{l}{cardiovascular disease in patients with type 1}\\
diabetes". N.\tabcellsep \\
\tabcellsep \tabcellsep Volume XX Issue III Version I\\
\tabcellsep \tabcellsep D D D D ) E\\
\tabcellsep \tabcellsep (\\
\multicolumn{2}{l}{RE et all used RE-AIM framework as a method of systematically considering the strengths and weaknesses of chronic illness (HTN, DM) management interventions in order to guide}\tabcellsep Medical Research\\
\multicolumn{2}{l}{program planning. The RE-AIM dimensions of Reach, Efficacy, Adoption, Implementation and Maintenance are used to rate one-on-one counseling interventions, group sessions, interactive computer-mediated interventions, telephone calls, mail interventions, and health system policies. The RE-AIM ratings suggest that, although often efficacious for those participating, traditional face-to-face intervention modalities will have}\tabcellsep Global Journal of\\
\multicolumn{2}{l}{limited impact if they cannot be delivered consistently to}\\
\multicolumn{2}{l}{large segments of the target population. Interventions}\\
\multicolumn{2}{l}{using new information technologies may have greater}\\
\multicolumn{2}{l}{reach, adoption, implementation, and maintenance, and}\\
\multicolumn{2}{l}{thereby greater public health impact. 23}\\
VI.\tabcellsep Conclusion\\
\tabcellsep © 2020 Global Journals\end{longtable} \par
 
\caption{\label{tab_7}}\end{figure}
 			\footnote{Counseling Capability of Health Care Professionals in a Tertiary Level Hospital} 		 		\backmatter  			 \par
Conflict of interest: None declared.			 			  				\begin{bibitemlist}{1}
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