Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate and address(in block letters) / SR. PRIYADARSINI MATHEW
I YEAR M. Sc. NURSING
ATHENA COLLEGE OF NURSING
FALNIR ROAD
MANGALORE – 575 001.
2. / Name of the Institution / ATHENA COLLEGE OF NURSING
FALNIR ROAD
MANGALORE – 575 001.
3. / Course of Study,
Subject / M. Sc. NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
4. / Date of Admission to the course / 01.06.2009
5. / Title of the Topic
A STUDY TO ASSESS THE EFFECTIVENESS OF A PLANNED TEACHING PROGRAMME (PTP) ON KNOWLEDGE REGARDING ASSISTED REPRODUCTIVE TECHNOLOGY (ART) AMONG THE STAFF NURSES WORKING IN SELECTED HOSPITALS OF MANGALORE
6. / Brief Resume of the Intended Work
6.1 Need for the Study
Growth of science and technology has given rise to rapid advancement in the field of medical and nursing science as well as in the nursing care. The year 1978 was the hallmark for the field of assisted reproductive technology. Since that time, science has continued to challenge and exponentially reveal the mysteries of the human genome and reproduction.1
In India, the incidence of male infertility is up to 30% and female infertility is up to 40%. Approximately one-third of the infertility problems include both partners. In Karnataka the infertility rate is 35-40%.2
Nurses are the vital members of the fertility healthcare team and often assume responsibility for health assessment, client education and counselling. Nurses must understand the current methods of diagnosis and treatment, and appreciate the important human issues related to infertility. The new advancement and technology increases the nurses’ responsibility to update their knowledge.
A study was conducted on the knowledge of the staff nurses regarding assisted reproductive technology. The mean post-test knowledge score (36.29) was higher than the mean pre-test knowledge score (16.18), suggesting that such a study is very important to improve the knowledge of the staff nurses who are the direct caregivers.1
A non-random study was conducted on the educational level, clinical activities, knowledge base, and skills of 336 nurses involved with in vitro fertilization. The Wilcox rank sum test compared nurses in the private practice setting with those in hospital-based services. No differences were found with regard to educational level or perceived level of proficiency with regard to the practice setting or geographic location in the US. Seventy-three percent of the respondents indicated their primary role was in direct patient care; 31% stated they had been active in artificial reproductive nursing less than 5 years.
Graduate level education was not correlated with perceived level of expertise but did correlate with length of clinical experience in assisted reproductive nursing and with certifications.3
It is a fact that most of the time the couple does not receive much emotional support and adequate information regarding the techniques, the results and the limitations. The obstetrician who performs this technique usually does it in most secrecy. Therefore, even the nursing staff is not much aware of the procedure. The couples thus do not receive adequate information.
The investigator from her own experience and discussion with colleagues and experts realised that infertility is a major problem. Many times it was noted that nurses had no proper opportunity to advance their knowledge to give correct information to the client. A few studies suggested that educating the nurses by a planned teaching programme would help them to gain further knowledge and cooperate with the multi-disciplinary health team for the wellbeing of the clients. This motivated the investigator to undertake this study.
6.2 Review of Literature
Review of literature provides a basis for future investigation, justifies the need for data collection, relates the findings from one study to another with the hope to establish a comprehensive body of scientific knowledge in a professional discipline from which valid and pertinent theories may be developed.4
The investigator reviewed related research and non-research literature to broaden the understanding and gain insight into the problem under study.
Today, ART has become a well-established and accepted method for the treatment of male and female infertility, and is practised widely in almost every country in the world.
A study was conducted in Salem on the knowledge of students regarding assisted reproductive technology. The result of the study revealed that there was significant relationship between knowledge of the subjects and selected demographic variables. The mean percentage knowledge score in pre-test was 39.8% and that of post-test was 74.5%, which shows that the PTP was effective in increasing the knowledge. So the researcher recommended that similar studies can be conducted for the clinical staff.4
To evaluate the effectiveness of a self-instructional module in increasing nurses’ knowledge of genetics a study was conducted on 65 registered nurses working at reproductive health centres using a pre-test/post-test study design. There was significant increase of 20.8% in participants’ mean knowledge score on the post-test (M = 89.0%, SD = 8%, range = 67%-100%) as compared with the pre-test (M = 69.0%, SD = 12%, range = 42%-92%), based on paired t-test analysis (t = 11.74, SE = 0.426, p < 0.0001).5
A qualitative study was conducted to investigate the roles and experiences of nurses caring for clients undergoing ART on a convenience sample of 15 nurses from New Zealand in 2007. Data were analysed using interpretive description. The overarching theme identified was that of the potential role of the nurse to ‘hold together’ multiple components of the assisted reproductive technology process: holding together clients’ emotional and physical experiences of assisted reproductive technologies; holding together the roles of different specialist team members; and holding together personal own emotions. It encompasses practices such as information-giving, interpreting, supporting and advocating.6
A study was conducted in Aziza Hospital, Tunis to evaluate the progression of the assisted reproductive technology and ICSI results during 2001 to 2008. The number of ICSI cycles was progressed, the fertilisation rate was 62%, and miscarriage rate was 28.4%. The take home baby rate was 67.95 so the number of couples undergoing ICSI was increasing.7
A study was conducted on the attitudes and knowledge concerning different aspects of sperm and oocyte donation among paediatric nurses at child health care centres (CHCs) in Sweden. A study-specific questionnaire, to be completed anonymously, was sent to 188 nurses, 141 of whom (75%) responded. Majority of the respondents (62%) stated that they had no professional experience of families created with the help of a donor. A majority (53%) stated that they had good knowledge of the procedure followed in sperm donation, whereas 43% stated that they had good knowledge of the procedure of oocyte donation. More than 80% agreed that the parents should be honest with their child with regard to the child’s genetic origin. Among the respondents who were in favour of disclosure, the preferred age for informing the child varied between 0 to 19 years (mean 7.2, SD 5.7).8
6.3 Problem Statement
A study to assess the effectiveness of a planned teaching programme (PTP) on knowledge regarding assisted reproductive technology (ART) among the staff nurses working in selected hospitals of Mangalore.
6.4 Objectives of the Study
1. To determine the pre-test and post-test level of knowledge of staff nurses regarding assisted reproductive technology as measured by a structured knowledge questionnaire.
2. To find out the association between mean pre-test knowledge score and selected demographic variables (age, educational qualification, years of experience, and source of information).
3. To evaluate the effectiveness of planned teaching programme on assisted reproductive technology as measured by the structured knowledge questionnaire in terms of gain in knowledge.
6.5 Operational Definitions
1. Knowledge: In this study knowledge refers to the correct responses of the staff nurses on the knowledge items regarding assisted reproductive technology.
2. Effectiveness: In this study, effectiveness refers to the extent to which the planned teaching programme on assisted reproductive technology has its impact on staff nurses as measured by the mean post-test score.
3. Planned teaching programme: In this study planned teaching programme refers to the information provided to the staff nurses regarding assisted reproductive technology to increase their knowledge.
4. Assisted reproductive technology: In this study, assisted reproductive technology includes procedures such as in- vitro fertilisation (IVF), gamete intra-fallopian transfer (GIFT), intra-uterine insemination (IUI), zygote intra-fallopian transfer (ZIFT), and intra-cytoplasmic sperm injection (ICSI) that will assist the process of reproduction.
5. Staff nurses: In this study, staff nurses are those who have passed the ANM, GNM or B. Sc. nursing course and are working in the selected hospitals.
6.6 Assumption
1. Planned teaching programme will be effective in increasing the knowledge of staff nurses regarding assisted reproductive technology.
2. Staff nurses will have some knowledge regarding assisted reproductive technology.
3. Planned teaching programme is an accepted teaching strategy.
6.7 Delimitations
The study will be delimited to the staff nurses who have passed ANM, GNM or B. Sc. nursing and are working in the selected hospitals.
6.8 Projected outcome (Hypotheses)
All hypotheses will be tested at 0.05 level of significance.
H1: The mean post-test knowledge score of the staff nurses regarding assisted reproductive technology will be significantly higher than the mean pre-test knowledge score.
H2: There will be significant association between the mean pre-test knowledge score and selected demographic variables.
7. / MATERIAL AND METHODS
7.1 SOURCE OF DATA
Data will be collected from staff nurses who are working in the selected hospitals.
7.1.1 Research Design
Quasi experimental one group pre-test – post-test design will be used for the study.
7.1.2 Setting
The study will be conducted in two selected hospitals of Mangalore (one government hospital and one private hospital).
7.1.3 Population
The population of the present study would consist of staff nurses who are working in the selected hospitals of Mangalore.
7.2 METHOD OF DATA COLLECTION
7.2.1 Sampling Procedure
The hospitals will be selected using purposive sampling technique and 30 staff nurses will be selected using simple random sampling technique.
7.2.2 Sampling Size
The sample for the present study would consist of 30 staff nurses working in the selected hospitals (15 from the government hospital and 15 from the private hospital).
7.2.3 Inclusion criteria for sampling
1. Nurses who are working in the selected hospitals.
2. Staff nurses who are available during the time of the study.
3. Staff nurses who are willing to participate.
7.2.4 Exclusion Criteria for sampling
1. Staff nurses who are not present in the ward during the time of the study.
2. Staff nurses who are not willing to participate in the study.
7.2.5 Instrument Used
The tool would consist of two sections:
1. Section I: Demographic proforma
2. Section II: Structured knowledge questionnaire regarding assisted reproductive technology.
7.2.6 Data collection method
After obtaining administrative sanction from the concerned authority of the selected hospitals, the investigator will select the staff nurses. The purpose of the study will be explained to them and informed consent will be obtained. Pre-test will be conducted with the structured questionnaire followed by the administration of the planned teaching programme on assisted reproductive technology. Post-test will be conducted with the same structured knowledge questionnaire after seven days.
7.2.7 Data Analysis Plan
Based on the objectives, data analysis will be done using descriptive and inferential statistics. Descriptive statistics such as mean, percentage and frequency will be used to depict the demographic data as well as the knowledge score. ‘t’ test will be used to find the effectiveness of the planned teaching programme. Chi square test will be used to find the association between the mean pre-test knowledge score and the demographic variables. The findings will be presented in the form of Tables and Figures.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
The study does not involve any investigation or intervention to be conducted on the sample. However, a planned teaching programme on ART will be given to the sample.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Ethical clearance will be obtained from the ethical committee of the college of nursing prior to the conduction of the study. Administrative permission will be obtained from the concerned authorities. Written consent will be obtained from the sample and confidentiality will be assured.
List of References
1. Valsa. Effectiveness of SIM among staff nurses regarding assisted reproductive technology. Unpublished M. Sc. nursing dissertation submitted to Rajiv Gandhi University of Health Sciences, Bangalore; 2002.
2. http://www.google.com/news. [cited 20.8.2009].
3. Mitchell A, Mittelstaedt ME, Wayner C. A survey of nurses who practice in infertility settings. J Obstet Gynaecol Neonatal Nurs 2005 Sep-Oct;34(5):561-8.
4. Lalithapriya M. A study of nursing students on assisted reproductive technology and the effectiveness of a planned teaching programme. Nightingale Nursing Times 2008 Jan;3(1):65-6.
5. Swank C, Christianson CA, Prows CA, West E, Warren NS. Effectiveness of a genetics self-instructional module for nurses involved in egg donor screening. J Obstet Gynaecol Neonatal Nurs 2001 Nov-Dec;30(6):617-25.
6. Payne D, Goedeke S. Holding together: caring for clients undergoing assisted reproductive technologies. J Adv Nurs 2007 Dec;60(6):645-53.
7. Fourati S, Chaker A, Fadhlaoui A, Ben Hamida A, Kacem O, Merdassi G, et al. A retrospective study of 339 ICSI cycles: assessment of the two first years of activity of the Assisted Reproductive Technology Centre of Aziza Othmana Hospital. Tunis Med 2009 Mar;87(3):173-9.
8. Sydsjo G, Lampic C, Sunnerud S, Svanberg AS. Nurses promote openness regarding the genetic origins after gamete donation. Acta Paediatr 2007 Oct;96(10):1500-4.
8. / Signature of the Candidate
9. / Remarks of the Guide
10. / Name and Designation of
(in block letters)
10.1 Guide / MRS. ASHA K. VARUGHESE
ASSISTANT PROFESSOR
ATHENA COLLEGE OF NURSING
FALNIR ROAD
MANGALORE.
10.2 Signature
10.3 Co-guide (if any)
10.4 Signature
11 / 11.1 Head of the Department / MRS. ASHA K. VARUGHESE
ASSISTANT PROFESSOR
ATHENA COLLEGE OF NURSING
FALNIR ROAD
MANGALORE.
11.2 Signature
12. / 12.1 Remarks of the Chairman and Principal
12.2 Signature
12