1
SYNOPSIS FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
SUBMITTED BY:
Ms. ELIZABETH MATHEW
I M.Sc. NURSING
OBSTETRIC AND GYNAECOLOGICAL NURSING
(2010-2012 BATCH)
FORTIS INSTITUTE OF NURSING
#20/5, YELACHENAHALLI, KANAKAPURA ROAD
BANGALORE – 560 078
SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THECANDIDATE AND ADDRESS / Ms. ELIZABETH MATHEW,
1ST YEAR M.Sc NURSING,
FORTIS INSTITUTE OF NURSING,
#20/5, YELACHENAHALLI, KANAKAPURA MAIN ROAD,
BANGALORE - 560078.
2. / NAME OF THE
INSTITUTION / FORTIS INSTITUTE OF NURSING, BANGALORE.
3. / COURSE OF THE STUDY AND SUBJECT / MASTER’S DEGREE IN NURSING,
OBSTETRIC AND GYNAECOLOGICAL NURSING
4. / DATE OF ADMISSION TO COURSE / 31 MAY 2010
5. / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING UMBILICAL CORD BLOOD BANKING AMONG ANTENATAL MOTHERS IN SELECTED HOSPITAL, BANGALORE.”
6.0 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Nature offers the ability to create food; out of itself, by itself, for itself to all organisms for survival and self sufficiency.”
Scientists have been interested in cell biology since the advent of microscopes in 1800’s. Cell propagation and differentiation were witnessed for the first time and cells were recognized as the building blocks of life, capable of giving rise to other cells and key to understanding human development.11
In the early 1900’s European researchers realized that the various type of blood cells e.g. white blood cells, red blood cells and platelets all came from a particular ‘stem cell’. Stem cells have an amazing ability to create different kinds of tissues when they divide and develop. This power to produce different kinds of specialized cells makes them so unique and potent for medical therapy. In 1963, the first quantitative descriptions of the self-renewing activities of bone marrow cells were documented by Canadian researchers Ernest A McCulloch and James E Till. Bone marrow transplants – actually a transplant of adult stem cells – have been used in patients receiving radiation and chemotherapy since the 1950’s. Developments in biotechnology in 1980s and 1990s saw the introduction of methods for growing human cells in the laboratory. These advances really opened the doors for human stem cell research. The discovery of stem cells was one of the greatest achievements of modern medicine.11
Bone marrow transplantation has been used as a means to cure hematological disease, heamatological malignancy, malignant solid tumors, congenital immunodeficiency syndrome, and some metabolic diseases. When matched family donors for bone marrow are not available, the next line of preferable donors currently is matched unrelated donors. Searches for these donors are usually made through national and international bone marrow donor registries.6 The un-availability of bone marrow donors and the problems related to bone marrow transplantation including graft failure and graft- versus- host disease, have urged the search for alternative sources for marrow cells. Until recently, the placenta representing a significant source of fetal blood stem cells was discarded after birth. Since the evaluation by researchers of umbilical cord blood being a potential source for haemopoietic stem cells (HPSC), and the evidence of advantages over bone marrow, attention has shifted to the establishment of umbilical cord blood banks.2
In brief, the procedure of the umbilical cord blood banking involves the cutting and clamping of the umbilical cord. A specialized blood bag is then bar-coded for collection of cord blood. For the collection step, the needle of the blood bag is inserted into the umbilical vein and the bag is held at a lower level in order to allow the blood to drain into the bag. Stem cells are then harvested from the cord blood and stored in cryo-vials at -1960 C in liquid nitrogen. Molecular tests are conducted for tissue (HLA) typing.7
In Vitro studies have shown that enough stem cells appear to be present in 60-100 ml of cord blood obtained after delivery of the infant. For this purpose, umbilical cord blood is collected after delivery of the baby, from the residual blood in placental cord unit. The blood volume of term baby is about 70 ml/kg while the placenta contains 45ml of blood per kg of fetal weight.1
The first clinically documented use of cord blood stem cells was in the successful treatment of a six-year-old boy afflicted by Fanconi’s anemia by Dr. Elaine Gluckmen in 1988, in Paris. Since then, cord blood has become increasingly recognized as a source of stem cells that can be used in stem cell therapy.7
Umbilical cord blood contains the same kind of stem cells as found in bone marrow. It is thought that because the umbilical cord cells are immature immunologically, they adapt to the patient’s body better than mature bone marrow cells and thus don’t cause as many immunological problems. Umbilical cord cells are in abundance, are immunologically flexible, and can be used as a truly ethical therapy.7
Twenty years ago, only one disease could be treated with umbilical cord stem cells; ten years ago only a handful. Today, umbilical cord stem cells have been successfully used in the treatment of more than 80 life-threatening diseases (primarily blood diseases). The amazing speed of research and clinical trials using umbilical cord stem cells has led to diseases being treated that no one could have predicted. Many of these new treatments use the patient’s own stem cells.12
6.1 NEED FOR THE STUDY
Cord blood is a biological insurance against diseases. The umbilical cord blood is a rich source of stem cells that can be derived from two sources: cord blood and cord tissue. The stem cells derived from the cord blood are called hematopoietic stem cells- these have immense potential in curing blood related disorders like blood cancer, thalassemia etc. the cells derived from the cord tissue are called mesenchymal stem cells- these can be useful in treating tissue related disorders of heart, bone, spinal cord, etc.9Investigators also speculate that cord blood stem cells could be used to revitalize a damaged immune system, making them nearly as versatile as embryonic stem cells for treating such immune disorders as type 1 diabetes and rheumatoid arthritis.7
Kang et al have reported the use of cord blood stem cells to restore ‘feeling and mobility’ to a spinalcord injury patient, who had been a paraplegic for 19 years due to an accident. Forty-one days after stem cell transplantation, ‘test’ showed the regeneration of the spinal cord at the injured site and below it.7
As stem cell therapy breaks new ground and stem cells derived from the umbilical cord blood are proving to be such a boon to stem cell therapy, it is natural that the prospect of preservation of umbilical cord blood is gaining momentum. Thus, so called, umbilical cord blood banking is being touted as insurance for life. Storage of the stem cells derived from umbilical cord blood means one can preserve and use genetically matched stem cells on hand, in case the child or someone else in the family suffers from a treatable blood disorder or needs a bone marrow transplant. There is a 25% genetic match between the siblings and parents, which proves to be the most alluring prospect for expectant couples to bank their child’s cord blood (thus ultimately their stem cells). The use of these stem cells more or less ensures absence of graft versus host reaction, which is a huge drawback in cases of organ transplantation. In India, there are approximately 72000 births daily, which results in discarding 72000 umbilical cords a day. The storage of stem cell rich blood derived from these umbilical cords can prove to be the best possible insurance against life threatening diseases.7
Umbilical cord cells show great promise of being an effectivetreatment for heamatological malignancies. Normally, leukemia patients mustrely on receiving bone marrow transplants from donors, and the donor must be a close match or the patient developsserious immunological problems. Closely related donors,such as siblings, have the best chance of being a good match.Laughlin et alconducted a study of 68 patients with leukemiaor with other blood disorders. Most of the patients receivedtransplants of umbilical cord cells from unrelated donors.About 90% of the patients grew new, healthy blood cellsfrom the “mismatched” cord blood cells. Only 20% of thepatients developed severe immunity problems compared to55% of the patients who developed such problems afterreceiving perfectly matched bone marrow.4
As there is increasing number of options regarding collection and banking of umbilical cord blood, more pregnant women are likely to be asked to make decision about umbilical cord blood banking. A study found that, while feeling confident in making an anticipatory decision about cord blood banking, women expressed a clear desire to learn much more about collection, storage, and use of umbilical cord blood banking.3
The studies have shown that, though most women want to do the best for their children, they lack information on the benefit of umbilical cord blood collection and banking. So encouragement during antenatal period is very important.
So, by the above statements and previous clinical experience, to impart scientific information on umbilical cord blood banking the investigator rightly justifies the need for preparing a teaching programme on umbilical cord blood banking.
6.2 REVIEW OF LITERATURE
Review of literature for the present study has been organized under the following headings.
6.2.1Studies related to knowledge of antenatal mothers on umbilical cord blood banking.
6.2.2Studies related to effectiveness of structured teaching programme.
6.2.1 STUDIES RELATED TO KNOWLEDGE OF ANTENATAL MOTHERS ON UMBILICAL CORD BLOOD BANKING
Patricia E. Paltenand Joachim W. Dudenhausen (2010) conducted a study among 300 German speaking pregnant women in Berlin to know whether a correlation between women’s knowledge about umbilical cord blood banking and level of education. The data collected by using anonymous questionnaire. Among them 3 quarters of the population heard of umbilical cord blood banking, most had no further knowledge about the method. Only one third of the interviewed women were informed about whether certain diseases had been treated with umbilical cord blood banking by the time the survey was being conducted, whereas 50-60% did not know how to answer these questions.5
Dinc H. and SahinN.H (2009) conducted an exploratory descriptive studyamong 334 pregnant women to determine pregnant women’s knowledge and attitudes about stem cells and cord blood banking in Istanbul, Turkey. The datacollected through interviews. The study revealed that majority of participants had lack of knowledge regarding stem cells and cord blood banking and wanted more information.10
Conrad V. Fernandez, Kevin Gordon et al (2001) conducted a study among 443 pregnant women on knowledge and attitudes with regard to collection, testing and banking of cord blood stem cells in antenatal assessment clinics at the IWK Health Centre, Halifax, NS. Datacollected by structured questionnaire. The study revealed that about 70% of the women reported poor or very poor knowledge about cord blood banking.8
6.2.2STUDIESRELATED TO EFFECTIVENESS OFSTRUCTURED TEACHING PROGRAMME.
Yanichin(2002) conducted a study to assess the effectiveness of structured teaching programmeon knowledge and practice of breast feeding among primi-postnatal mothers of maternity wards in C.M.C Vellore hospital, research design employed descriptive survey method, simple random sampling used, sample size were 100 primi-postnatal mothers, tools used were observation checklist and interview guide. The study’s results shows that mother who had teaching programme showed highly significant knowledge gain, good practice of breast feeding(P<0.01).15
Poornaranjitham(2001) conducted an experimental study to determine the effectiveness of pre-natal structured teaching on knowledge, attitude, and practice of breast feeding among primi-para mothers, design is experimental design setting in C.M.C Vellore hospital, sample 37 mothers at term, sample size 60 women, 30 for experimental and 30 for control group, sample selection by random number table, tool prepared based on Tamilnadu health development forum 1993, data collection done for 6 weeks. A paired T-test revealed that there was significant difference on knowledge, attitude and practice in the experimental group after structured teaching on breast feeding (P< 0.05).13
Sarojamma(2000) conducted a study to assess the effectiveness of structured teaching programmeon knowledge and practice of breast feeding and its problems among lactating mothers in Vani Villas Hospital, Bangalore. A descriptive evaluation study was conducted on 20 lactating mothers of hospitalized children, data collection done using a structured interview schedule and observational checklist, analysis of data revealed that 50% of mothers had satisfactory level of knowledge about the advantages of colostrums. The desirable mothers and child relationship before was 15% and after instruction was 50%, significant at P<0.01 level.14
6.3 STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING UMBILICAL CORD BLOOD BANKING AMONG ANTENATAL MOTHERS IN SELECTED HOSPITAL, BANGALORE.”
6.4OBJECTIVES OF THE STUDY
1. To assess the pre-test knowledge scoresof antenatal mothers regarding umbilical cord blood banking.
2.To find out the effectiveness of structured teaching programme regarding umbilical cord blood banking by assessing post test knowledge scores of antenatal mothers.
3. To find out the association between pre-test and post-test knowledge scores regarding umbilical cord blood banking and selected demographic variables.
6.5 OPERATIONAL DEFINITIONS:
6.5.1 ASSESS
Refers to measure the level of knowledge about umbilical cord blood banking among antenatal mothers.
6.5.2 EFFECTIVENESS
Refers to the significantimprovement in knowledge regarding umbilical cord blood banking among antenatal mothers after the implementation of structured teaching programme.
6.5.3 STRUCTURED TEACHING PROGRAMME
Refers to systematically developed instruction designed for a group of antenatal mothers to provide information regarding umbilical cord blood banking.
6.5.4KNOWLEDGE
Refers to acquiring information regarding umbilical cord blood banking among antenatal mothers.
6.5.5 UMBILICAL CORD BLOOD BANKING
Refers to the collection, processing, and cryopreservation of the remaining blood within the umbilical and placental circulation following the birth of a child and typically prior to placental delivery.
6.5.6 ANTENATAL MOTHERS
All pregnant mothers who are attending antenatal clinic of selected hospital, Bangalore.
6.6 HYPOTHESIS
H0-There is no significant difference between mean pre-test knowledge scores and post-test knowledge scores.
H1-There is an increase in the mean post-test knowledge scores among the antenatal mothers compared to pre-test knowledge scores after the structured teaching programme.
6.7 VARIABLES IN THE STUDY
Independent variable:Structured teaching programme regarding umbilical cord blood banking.
Dependent variable:Knowledge of antenatal mothers regarding umbilical cord blood banking.
Demographic variables:Age, education, occupation, income, religion, family type, place of residence and gravida.
7.0 MATERIALS AND METHODS
7.1.0Source of data: / Antenatal mothers in selected hospital, Bangalore.7.1.1Research approach: / An evaluative research approach.
7.1.2 Research design: / A quasi experimental research with one group pre-test and post-test study design.
7.1.3Research setting : / Selected hospital, Bangalore.
7.1.4Population: / Antenatal mothers.
7.1.5 Sample: / Antenatal mothers attending antenatal clinic in selected hospital, Bangalore.
7.1.6 Sampling technique: / Non probability convenient samplingtechnique.
7.1.7Sample size: / 100 Antenatal mothers.
7.1.8 Sampling criteria
Inclusion criteria: / 1.Antenatal mothers who are willing to participate in this study.
2.Antenatal mothers who are available during the period of data collection.
Exclusion criteria: / 1. Antenatal mothers who are not willing to participate in this study.
7.2.0 TOOL FOR DATA COLLECTION
Data collection tool contain items on the following aspects
PART 1- Will contain the items of demographic characteristics of antenatal mothers comprising age, education, occupation, religion, income, family type, place of residence and parity.
PART 2- Knowledge assessment questionnaire regarding umbilical cord blood banking.
7.2.1 METHOD OF DATA COLLECTION
The data will be collected personally using structured questionnaire on knowledge of antenatal mothers regarding umbilical cord blood banking.
7.2.2 METHODS OF DATA ANALYSIS
The investigator will analyze the data obtained, by using the descriptive and inferential statistics.
The plan of data analysis as follows:
Descriptive statistics:
Mean, mean%, Median, and standard deviation will be used for assessing the demographic characteristics.
Inferential statistics:
Student’s paired T- test is used for measuring any enhancement or increase in knowledge level from pre-test to post-test.
Chi-Square test for measuring association between knowledge level and selected demographic variables. The results will be statistically significant whenever P ≤ 0.05 level of significance.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON OTHER HUMAN OR ANIMALS?
-No-
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM THE INSTITUTION?
- The ethical clearance is obtained from the research committee of Fortisinstitute of Nursing.
- Written permission will be obtained from concerned authorities of selected hospitals.
- Written permission will be obtained from the samples who are involved in the study before collecting the data.
8. LIST OF REFERENCE
1. Bonilla Nayar, DeepikaDeka, Vinod Kumar Paul, Deep Takkar. Effect onthe newborn of umbilical cord blood collection at delivery.Obs and Gynae Today 2004 July; volume(7) 9:454-456.
2. Ealias M, Choudhury N, SmitSibingaCTh. Cord blood from collection to expansion: feasibility in a regional blood bank. Indian journal of paediatrics 2003 April; volume 70:327-336.
3. Jeremy Sugarman, Lyla Kaplan, Betty Cogswell, Janice Olson. Pregnant women’s perspectives on umbilical cord blood banking. Journal of women’s health 1998 August; 7(6):747-757.
4. Laughlin M J, Eapen M, Rubinsterin P et al. Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia. N Engl J Med 2004; 351:2265-2275.