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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 NAME OF THE CANDIDATE AND ADDRESS
V.SUMATHYD/O R.VARATHAN17/B NORTH RAJ STREET,TIRUVALLUR - 602001.TAMIL NADU.
2 NAME OF THE INSTITUTION SRI DEVARAJ URS COLLEGE OF NURSING,TAMAKA, KOLAR- 563101.KARNATAKA.
3 COURSE OF STUDY AND SUBJECT
1ST YEAR M.Sc. NURISNGMEDICAL SURGICAL NURSING SPECIALITY.
4 DATE OF ADMISSION TO COURSE
JUNE 1st 2007
5 TITLE OF THE TOPIC
EFFECTIVENESS OF PLANNED
HEALTH EDUCATION ON
KNOWLEDGE AND PRACTICE OF
CANCER PATIENTS REGARDING
MANAGEMENT OF SELECTED SIDE
EFFECTS OF RADIATION THERAPY IN
A SELECTED HOSPITAL, KOLAR AND
DEVELOP AN INFORMATIVE
BOOKLET.
1
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Cancer is increasing worldwide. More than 100 types of cancer affect
human being. During the period of 1998-2002, there were 24.6 million cancer
patients. More than 10 million people developed cancer in 2000. World wide
about 8 million cancer deaths occur in a year. The number of cases is
estimated to rise from 10.9 million in 2002 to more than 16 million by 2020, if
this trend continues. By applying existing evidenced based knowledge, it is
possible to prevent at least 30% of cases; and another 30% cases could be
cured, if given earlier diagnosis and effective treatment1.
Cancer is a universal disease that affects people without regard to
race, gender, socioeconomic status, or culture. However, different forms of
cancer strike specific age, ethnic, and gender groups with varying frequency
and severity2.
Radiation oncology nursing is a clinical and scientific discipline
devoted to the management of patients with cancer4. The nurses play a major
role in dispelling patient and family on fears of Radiation Therapy by
assessing their understanding of how the treatment will be used; conveying
correct information; and teaching about management strategies to employ
during the course of Radiation Therapy3.
It is estimated that 60% of individuals with cancer receive Radiation at
some point during the course of their disease. Radiation effects may be
categorized as acute (during treatment to 6 months), sub acute (after 6
months), and chronic (with variable time to expression). The effects are seen
sooner in cell lines with a high mitotic index (the skin, mucous membranes,
and hair follicles) and later in cell lines that divide more slowly (the vascular
system and muscles)2
2
6.1 NEED FOR THE STUDY
Nurses are in a strategic position to lead efforts at changing attitudes and
behaviours about cancer. Further more, it is clearly an important nursing goal
to implement educational interventions that will assist individuals to
understand, reduce or eliminate their risk of cancer development4.
Radiation as a treatment modality has started more than 100 years ago,
and with its earliest roots traced from the discovery of x-rays in 1895.
Radiation has a “mysterious” mystique fear, misconceptions and
misinformation because of media coverage of nuclear accidents5.
The general public has concerns about the potential lethal
consequences of exposure to Radiation6. The most common side effects of
Radiation Therapy are tiredness, skin reactions like rash, redness, permanent
pigmentation, and scarring in the treated area, and loss of appetite,
inflammation of tissues and organs in and around the body site radiated and
diarrhea. Radiation Therapy can also cause a decrease in the number of white
blood cells among which most of them are preventable7.
A study on the needs of oncology patients who had undergone
Radiation therapy revealed that the need to receive correct information about
to prevent its possible side effects, was the number one priority8.
A study on predicting anticipated acute and long term effects of
radiation therapy revealed that 60% of the patients had acute effects and 38%
had long term effects2.
The hospital selected for the study has an OPD rate of 28 to 30 patients
per day and 25 to 35 in-patients. Radiation unit which is well equipped and
consists of 1 bed, which delivers Radiations Therapy to 20-25 patients with
different types of cancer. During the clinical experience of the investigator, in
oncology wards and Radiation unit it was observed that, most of the patients as
well as the family members expressed anxiety, and fear related to post-
Radiation Therapy outcome, like fear of after effects of Radiation Therapy,
3
6.2
severity of pain, impairment in body, and return to normal activities of daily
living. It was also found that most of the radiation exposed patients were found
to have one or the other form of side effects like pain, nausea vomiting, skin
changes, respiratory and cardiac related complications, which resulted in poor
prognosis.
Based on the review of literature, personal experience of the investigator
in the oncology unit, it was found that there are very few studies dealing with
effectiveness of planned health education-on management of selected side
effects of Radiation Therapy, thus the investigator would like to explore on the
effects of planned health education-on management of selected side effects of
Radiation Therapy and make significant contribution to the field of radiation
oncology nursing in achieving a better quality of life for patients receiving
Therapy.
REVIEW OF LITERATURE
The literature will be reviewed from text books, Journals, electronic
resources, and articles for the present study.
Literature for the study will be organised under the following headings
a. Studies related to management of side effects of Radiation Therapy.
b. Studies related to quality of life of Radiation Therapy patients.
c. Studies related to effectiveness of planned health education.
a. Studies related to management of side effects of Radiation Therapy.
A study on cancer patients, revealed that, 60% of patients, developed
side effects. And highlighted that, adequate pre-Radiation Therapy information
on management of side effects would results in better quality of life9.
A study on management of acute skin reactions, 28 different trails were
used out of which washing the radiation exposed area repeatedly, resulted in
significant positive effects. The other trails like use of steroid cream, sucralfate
cream, were also found to have some effect on reducing skin reactions10.
4
b. Studies related to quality of life of Radiation Therapy patient
A study conducted on the role of Radiation Therapy in the management
of desmoids tumors. 28 patients with desmoids tumors treated were with
Radiation Therapy. All patients with intra abdominal tumors have been
controlled without severe side effects study revealed that: Radiation Therapy is
effective treatment after incomplete resection of desmoids tumors11.
A study conducted on 27 patients treated with intensity – modulated
radiotherapy for definitive management. Results revealed an inverse
relationship between radiation dose delivered to laryngeal structures and
speech and diet and quality of life outcomes after definitive radiation treat
ment12.
A study conducted on effectiveness of information on prevention of
side effects revealed that pre-information resulted in achieving a high quality
of life possible13.
A study on the management of pain and patient quality of life in a
radiotherapy department on 126 patients, revealed that 56% of the patients
experienced pain, 53% were satisfied with the listening skills of the
department staff, and 45.5% were satisfied with the psychological support,
where as only 37.78% were satisfied with the time invested in pain
management. Pain was inadequately treated in 39% of patients14.
c. Studies related to effectiveness of planned health education.
A study on the effectiveness of planned teaching programme on early
detection of selected malignancies of females among female high school
teachers of selected high schools of Bangalore south. From the findings it is
clear that the mean post test knowledge score 77.7% of experimental group
was significantly higher than that of pretest knowledge score 37.8%. This
indicates the planned teaching programme is effective is increasing the 5
knowledge among the patients15.
A study on effectiveness of planned teaching programme on holistic
life style among the undergraduate nursing student in the KLE’s institute of
nursing sciences, Belgaum. The structured questionnaire was used to assess
the level of knowledge among undergraduate student. The total sample of the
study consists of 58 undergraduate students. It was found that the mean post
test knowledge score of subjects was significantly higher than the mean pretest
knowledge scores at the level of p < 0.0001. Which was found to be highly
significant. Hence it was concluded that the planned teaching programme is
effective method to improve the knowledge of students on holistic health life
style16.
A study on effectiveness of planned teaching programme on selected
aspects of pre and post-operative self care among clients who are undergoing
abdominal hysterectomy in Jayanagar General Hospital, Bangalore from the
findings it is evident that the mean of post test knowledge score (51.16) of
experimental group was higher than the mean pretest knowledge score (8.32)
of control group. This indicates the planned teaching programme is effective in
increasing the knowledge of the clients who are undergoing abdominal
hysterectomy17.
A study to assess the effectiveness of planned health education on
temporary family planning methods among prime gravida mothers attending
antenatal clinic in Jayanagar General Hospital, Bangalore and the findings
indicated that in experimental group the mean posttest knowledge score
61.17% was higher than the mean pretest knowledge score of 16.13%. This
evidenced that planned health education is significantly effective in increasing
the knowledge among the mothers18.
6
6.2.1
6.3
6.3.1
STATEMENT OF THE PROBLEM
Effectiveness of Planned Health Education on Knowledge and Practice
of Cancer Patients regarding Management of Selected Side Effects of
Radiation Therapy in a selected hospital, Kolar and Develop an Informative
Booklet.
OBJECTIVES OF THE STUDY
1) To assess the knowledge and practice of patients regarding management
of selected side effects of Radiation Therapy by using structured
knowledge and practice questionnaire.
2) To evaluate the effectiveness of planned Health education regarding
management of selected side effects of Radiation Therapy by comparing
pre and post test knowledge and practice scores of cancer patients on
Radiation Therapy.
3) To determine the association between knowledge and practice of cancer
patients with selected demographic variables, such as age, sex,
qualification, occupation, family history of cancer, family exposure to
Radiation Therapy and exposure to mass media.
4) To develop an informative booklet regarding management of selected side
effects of Radiation Therapy.
OPERATIONAL DEFINITIONS
EffectivenessIn this study effectiveness refers to the outcome of planned health
education which will be assessed by considering the improved knowledge and
practice scores of patients after administering the planned health education
about the management of selected side effects of Radiation Therapy.
7
Planned Health education
It refers to systematically developed instructional method and teaching
aids designed for cancer patient to provide information regarding the
management of selected side effects of Radiation Therapy.
Knowledge
It refers to the correct responses of the patients on the management of
selected side effects of the Radiation Therapy which is assessed by using
validated structured knowledge questionnaire.
Practice
It refers to the activities performed by the patients for managing selected
side effects of Radiation Therapy.
Cancer patients
In this study cancer patients refers to all the patients who are diagnosed
to have cancer and are on Radiation Therapy.
Selected Side effects of Radiation therapy
In this study selected side effects refers to nausea, vomiting, anorexia,
diarrhea, hairloss, skin changes and fatigue.
Management of Selected Side effects
It refers to the activities to be performed by the cancer patients in
management of selected side effects.
Radiation Therapy
It refers to the exposure of cancer patient to powerful and radio active
substances.
Informative booklet
In this study the informative booklet refers to the systematically planned
and printed material giving information regarding management of selected side
effects of Radiation Therapy.
8
6.3.2
6.3.3
ASSUMPTIONS
1) Patients have some knowledge about the side effects of Radiation Therapy.
2) Patients have some Knowledge about the management of side effects of
Radiation Therapy.
3) Knowledge of the patients about side effects of Radiation Therapy will
affect their practice.
4) Health education will improve the knowledge and practice of patients
regarding management of side effects of Radiation Therapy.
5) Informative booklet will improve the knowledge and practice of patients
regarding side effects of Radiation Therapy.
HYPOTHESIS
H1 There will be significant difference between pre and post test
knowledge scores after undergoing planned health education programme on
management of selected side effect of Radiation Therapy.
H2 There will be greater decrease in the side effects of Radiation Therapy
for patients who have received planned health education.
MATERIALS AND METHODS
9
7.
7.1
7.1.1
7.1.2
7.1.3
7.2
Source of data
The patient who are diagnosed to have cancer and are treated with
Radiation Therapy.
Research design and approach
The research design used for this study will be quasi experimental one
group pre and post test design. The approach is evaluative. The schematic
representation is
R 01 - I - 02
Setting
The study will be conducted in the radiation unit and the related wards of
R.L. Jalappa Hospital and Research Centre.
Population
The population in this study refers to all the cancer patients who are
undergoing Radiation Therapy in a selected Hospitals.
METHODS OF DATA COLLECTION
The data will be collected in the following steps
Step I - The formal permission from the authorities of R.L. Jalappa Hospital
and Research Centre, HOD of Radiation unit and the consent from the study
participants will be obtained.
Step II - The study participants will be selected by using simple random
technique that is by, lottery method, who fulfill the inclusion criteria.
Step III - Structured knowledge and practice questionnaire will be used as
pre-test to assess the knowledge and practice of cancer patients by using
interview technique.
Step IV - The planned health education will be implemented.
Step V – Post test will be conducted by using interview technique with the
same structured knowledge and practice questionnaire after 5-7 days.
SAMPLING PROCEDURE
10
7.2.1
7.2.2
7.2.3
7.2.4
Simple Random sampling technique will be used .
SAMPLE SIZE
The sample size consists of 30 patients who are coming for Radiation
Therapy in Radiation unit of R.L. Jalappa Hospital and Research Centre,
Tamaka, Kolar, Karnataka.
CRITERIA FOR SELECTION OF SAMPLE
Inclusion criteria : Cancer patients who are;
1) Undergoing Radiation Therapy.
2) Willing to participate in the study.
3) Between the age group of 18 – 70 years.
4) Can read and understand Kannada and English language.
Exclusion criteria : Cancer patients who are;
1) Below 18 years of age,
2) Having mental illness,
3) Critically ill like unconscious, unable to talk and respond.
4) Develop complications during the course of Radiation Therapy.
DATA COLLECTION TOOL
The researcher will develop the following tools
Structured Knowledge and practice Questionnaire, which includes the
following sections.
Section – A : Demographic data : It includes age, sex, qualification,
occupation, family history of cancer, family exposure to Radiation Therapy,
mass media.
Section – B : Structured knowledge questionnaire on management of selected
side effects of Radiation Therapy.
Section – C : Structured practice questionnaire – on management of selected
side effects of Radiation Therapy.
11
7.2.5
7.3
7.4
METHOD OF DATA ANALYSIS
Data analysis will use descriptive and inferential statistics.
DESCRIPTIVE STATISTICS
Percentage, mean, median, mode and standard deviation will be used to
explain demographic variables and to compute pre and posttest knowledge
level.
INFERENTIAL STATISTICS
1) Para metric test :
Paired ‘t’ test to compare pre and posttest knowledge scores.
2) Non-parametric Test:
Chi-square (X2) test will be used to find the association between pre and
post test knowledge score with selected demographic variables.
Does the study require any investigation or interventions to be
conducted on patients or other humans or animals?
Yes - the study requires non-invasive intervention. The study has a
planned health education programme on management of side effect of
Radiation Therapy.
Has ethical clearance been obtained from your institution in case of 7.3?
1) Permission from the ethical committee of the selected hospital will be
obtained.
2) Permission from medical superintendent and the departmental head of
Radiation unit will be obtained.
3) Informed consent will be obtained from the study participants.
12
8.REFERENCES
1) Sharan D. Mehta Ram., Oncology Nursing, Jaypee Brothers Medical
Publishers Ltd, New Delhi, 2007; 1-427.
2) Belcher E. Anne., Cancer Nursing, Mosby’s Clinical nursing series,
Mosby year book, New York, 1992; 1-272.
3) Lewis Sharon, Marget Heirdkumper., Medical Surgical Nursing, 6th
Edition, Mosby Publication, Missuri, 2004; 1-1867.
4) Casciat A. Dennis, Lowitz B. Barry., Manual of Clinical Oncology, 3 rd
Edition, Brown and Company Publication, America, 1995; 1-698.
5) Smeltzer C. Suzanne, Bare Brenda, Brunner and suddarth’s., Text Book
of Medical Surgical Nursing 10th Edition, Lippincott Williams and
Wilkins, New York, 2004; 1-2234.
6) Phipps J. Wilma, Virgima L, Cassmeyer, Judith K. Sands, Mary Kay L.,
Medical Surgical Nursing, Concepts and clinical practice, 5th Edition,
Mosby Publication, New York, 1995; 1-2490.
7) Corkle Mc Ruth., Grantmarcia, Pocket Companion for Cancer Nursing,
Tokya, Saunders Company Publications, West Bengal, 1994; 1-515.
8) Rath K. Goura, Mohanti K. Bidhu., Text Book of Radiation Oncology,
Saunders Company Publications, India West Bengal. 15 May 2000;
1-1700.
9) Perez A. Carlos, Brady W. Luther., Principles and Practice of Radiation
Oncology, 3rd Edition, Lippincott Raven Publication, New York, 1998;
1-234.
10) Josiln C.A.F., Cancer Topics and Radiation Therapy, Pitman Books
Limited Publications, Britain, 1982; 1-822.
11) Daniela Schulz-Ertner, Dietmar Ziehut, Ulrich Mende, Wolfgang Harms,
Pierre Branitzki, Michael Wannenmacher., University of Heidelberg, The
Role of Radiation Therapy in the Management of Desmoids Tumors,
Germany, 2007; 432-469.
12) Dornfeld K, Simmons JR, Karnell L, Karnell M, Funk G, Yao M, Wacha
13
J, Zimmerman B, Buatti JM., Radiation doses to Structures within and
Adjacent to the Larynx are Correlated with Long-Term Diet-and Speech-
Related quality of Life, Lowa City, USA, 2007; 134-143.
13) WWW.@ Supportive Care Guidelines Group Members, Managing the
Effects of Gynecologic Cancer Treatment on Quality of Life and
Sexuality, Canada, 2001; 337-339, 802-17.
14) Nora Janjan., To Evaluate the factors that can affect the Management of
Pain and Patient quality of life in a Radiotherapy Department, Houston,
USA, 2004; 1204-1210.
15) Roopa Lakshmi M.R., A study to determine the effectiveness of planned
teaching programme on early deduction of selected malignancies of
females among female high school teachers of selected high schools of
Bangalore south, Unpublished Master of Nursing Dissertation, Rajiv
Gandhi University of Health Sciences, Bangalore, India, 2004.
16) Meenakshi., A study to determined the effectiveness of planned teaching
programme on holistic life style among the undergraduate nursing study
in the KLE’s institute of nursing sciences, Belgaum, Unpublished Master
of Nursing Dissertation, Rajiv Gandhi University of Health Sciences,
Bangalore, India, 2003.
17) Pula Grijamba Devi., A study on the effectiveness of the planned
teaching programme on selected aspects of per and post operative self
care among clients who are undergoing abdominal hysterectomy in
Jayanagar General Hospital, Bangalore, 2004.
18) Swarnalatha . P., A study on effectiveness of planned teaching
programme on temporary family planning methods among prime Gravida
mothers attending clinic in Jayanagar General Hospital, Bangalore, 2004.
9. SIGNATURE OF THE CANDIDATE Ms. SUMATHY .V
14
10. REMARKS OF THE GUIDE
11.
11.1
11.2
NAME & DESIGNATION
GUIDE
SIGNATURE
Mrs. ZEANATH CARIENA JOSEPHPROFESSOR, SRI DEVARAJ URS COLLEGE OF NURISNG TAMAKA, KOLAR – 563 101.
11.3
11.4
CO – GUIDE (IF ANY)
SIGNATURE
DR. V. LAKSHMAIAH PROFESSOR, HOD MEDICINE, SRI DEVARAJ URS MEDICAL COLLEGE, TAMAKA, KOLAR – 563 101.
11.5
11.6
HEAD OF DEPARTMENT
SIGNATURE
Mrs. ZEANATH CARIENA JOSEPH PROFESSOR,SRI DEVARAJ URS COLLEGE OF NURSING,TAMAKA, KOLAR – 563 101.
12 12.1 REMARKS OF THE PRINCIPAL
12.2 SIGNATURE
Mrs.CHANDRAMANI.B.N.PROFESSOR,SRI DEVARAJ URS COLLEGE OF NURSING,TAMAKA, KOLAR – 563 101.
15