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