RAJIVGANDHIUNIVERSITYOFHEALTHSCIENCES

KARNATAKA,BANGALORE

ANNEXURE–II

PROFORMAFORREGISTRATIONOFSUBJECTSFORDISSERTATION

1. / Nameofthecandidateandaddress(inblockletters) / RIBINBABY
IYEARM.Sc.NURSING
INDIRANURSINGCOLLEGE
FALNIR
MANGALORE–575002.
2. / NameoftheInstitution / INDIRANURSINGCOLLEGE
FALNIR
MANGALORE–575002.
3. / CourseofStudyandSubject / M.Sc.NURSING
MEDICALSURGICALNURSING
4. / DateofAdmissiontotheCourse / 28-06-2012
5. / Titleofthestudy
ASTUDYTOASSESSTHELEVELOFKNOWLEDGEANDATTITUDEONKIDNEYDONATIONAMONGADOLESCENTSINSELECTEDPREUNIVERSITYCOLLEGESATMANGALORE,WITHAVIEWTOPREPAREANINFORMATIONBOOKLET.
6. / Briefresumeoftheintendedwork
6.1Introduction
“Don'tthinkoforgandonationasgivinguppartofyourselftokeepatotalstrangeralive.It'sreallyatotalstrangergivingupalmostallofthemselvestokeeppartofyoualive.”
Lifeisadynamicprocess.Itstartsfrombirthandendswiththedeathoftheindividual.Kidneydonationisanissuewhicharousesethicaldilemmas.Itcanbeconsideredasagiftoflifeoracommodity1.
Kidneytransplantationorrenaltransplantationistheorgantransplantofakidneyintoapatientwithendstagerenaldisease.Onayearlybasis,nearlytwolakhIndiansrequireorgantransplants.Shockingly,noteven5%ofthevictimsareabletogettheorganstheyneed.NearlythreemillionIndianshavelosttheirlifeduetonon-availabilityoforgansfororgantransplant.Nearly1.5lakhIndiansarevictimsofkidneyfailureeveryyearandneedkidneytransplanttosurvive.Only3000amongtheseareabletosurvivewithkidneytransplants,andasfortherest,deathisinevitable,mainlyduetolackofkidneydonors2.
Diabetesisthemostcommoncauseofkidneytransplantation,commonanddatashowsthattheirincidencehasnotsignificantlychangedovertime.Renaltransplantationisnowwidelyconsideredthetreatmentofchoiceforpatientswithendstagerenaldiseaseduetoimprovedshort-andlong-termsurvivalbenefitsoverdialysistreatment.Onehastokeepinmindthatasyetno3.
Theindicationforkidneytransplantationisendstagerenaldisease(ESRD),regardlessoftheprimarycause.Thisisdefinedasaglomerularfiltrationrate<15ml/min/1.73 sqm. Common diseases leading to ESRD include malignant hypertension, infections, diabetes mellitus, and focal segmental glomerulosclerosis; genetic causes include polycystic kidney disease, a number of inborn errors of metabolism, and autoimmune conditions such as lupus4.
The first kidney transplantation was done in the United States performed on June 17, 1950, on Ruth Tucker, a 44-year-old woman with polycystic kidney disease, at Little Company of Mary Hospital in Evergreen Park, Illinois4.
Thefirstkidneytransplantsbetweenlivingpatientswereundertakenin1954inBostonandParis.TheBostontransplantation,performedonDecember23,1954,atBrighamHospitalwasperformedbyJosephMurray,J.HartwellHarrison,JohnP.Merrillandothers4.ThefirsteverhumankidneytransplantperformedinIndiawasdoneattheKingEdwardMemorialHospitalatBombayinMay1965,usingacadaverdonorinanon-renalfailurepatientwhohadhadhypernephroma.ThesecondkidneytransplantinApril1966-acadaverdonoronceagain-wascarriedoutbythesameteaminacaseofchronicrenalfailure5.
Kidneytransplantationhasbeenacknowledgedasapositiveactofhumanitarianism.AsarecommendationoftheEuropeanCommissionunderlinesorgandonationandtransplantationareissuesrequiringsociety‘sactiveparticipation.Nevertheless,thelowratesoforgansavailableshowthatpublicawarenesshastoberaisedtoahigherlevel1.
HenceurgentactionisrequiredonseveralfrontsiftheacuteshortageofhumanorgansinIndiahastobemet.Awarenessshouldbeincreasedaboutthebenefitsoforgandonationsthroughthemeansofmasscommunicationandsuperstitionsamongpeopleshouldbefoughtbythewayofreligiousinjunctions.
6.2Need for the study
“Today's Youth, Tomorrow's Leaders”
Dr. A. P. J. Abdul Kalam
Organ transplantation is one of the most spectacular endeavours till date. Medical advances have contributed tremendously to its success ratio and have led to a significant increase in the number of transplants being performed. But there is a shortage for organs and low response to cadaver organ donation. The shortage or organs has been due to the reluctance of many family members to donate due to the fear of surgery causing loss to their health, smaller nuclear families with unmatchable donors and a deceased donor programme that is still to evolve fully.
According to World health organization, kidney transplants are carried out in 91 countries. Around 66,000 kidney transplants were performed globally in 2005. In India,
there is a rising burden of chronic diseases like hypertension and diabetes. India has the largest number of diabetics in the world with a prevalence of 3.8% in rural and 11.8% in urban adults. The prevalence of hypertension has been reported to range between 20-40% in urban adults and 12-17% among rural adults. It is estimated that 25-40% of these patients are likely to develop chronic kidney disease, with a significant percentage requiring renal replacement therapy. The health care system in our country is not designed to provide the required level of care for chronic kidney disease at the primary or secondary level6.
On a yearly basis, nearly two lakh Indians require organ transplants. Shockingly, not even 5% of the victims are able to get the organs they need. Nearly three million Indians have lost their life due to non-availability of organs for organ transplant. Statistics of other nations show that Australia has 11 organ donors per million, Britain has 27, Canada has 14, Spain has 35.1 donors, USA has 26 donors per million. India's statistics leaves little to be desired at 0.08 donors per million populations2.
Nearly 1.5 lakh Indians are victims of kidney failure every year and need kidney transplant to survive. Only 3000 among these are able to survive with kidney transplants, and as for the rest, death is inevitable, mainly due to lack of kidney donors. It is not as if organs are not available2.
In 2011 the cases of legal transplant in India was highest in Delhi (254) followed by Kerala (123) Punjab (94) Karnataka (83) and Maharashtra (77). Kidney transplantation was the top transplant procedure in India in 2011. It was 262 as against 595 liver transplants 5 heart transplants and 106 other transplants. Delhi recorded the highest number of kidney transplant in 20111(830), followed by Maharashtra (507) Punjab (376) Gujarat (249) Kerala (209) and Haryana (180)18.
There are many complex socio-economic, urban-rural, legal, cultural and religious factors that contribute to low kidney transplant rates. Although an increase in transplantation rates will require strategies from various agencies, healthcare professionals, including nurses, can play a role in overcoming some barriers. Community education programmes improving their own education levels and by increasing empowerment in nursing we may contribute to improved kidney transplant rates.
A study was conducted on renal transplantation and organ donation in school students in Torino and Napoli in Italy. The sample size was 458 in Torino and 539 in Napoli. The data was collected by a semi-structured questionnaire. Only 36.3% of the students in Torino and 37.7% in Napoli answered that they would consent to organ donation. Opposition was 28% in Torino and 23.7% in Napoli; 35.7% in Torino and 38.6% in Napoli were blank uncertain7.
A cross-sectional study was conducted among secondary school students on organ transplantation and kidney donation in Italy. The sample size was 1776. The data was collected by a questionnaire. The result shows that at base line 78.8% students would donate a kidney to a relatives or friend in need. The answers were unaffected by type of schools but depend on sex. Males are more prone to donate kidneys. Only 31.5% of students were willing for cadaveric kidney donation. 33.7% are not willing for cadaveric kidney donation and 34.8% were uncertain8.
A study to assess the awareness of organ donation among secondary school students in Saudi Arabia. The sample size was 839 in those 745 males and 94 females. The data was collected by a questionnaire. The result shows that 23% knew about the Saudi Centre for Organ Transplantation. But 61% could only guess its function. However 38% agreed to donate organs of their own organ failure patients other than relatives. 35% knew about the organ donation cards but only 12% carried them. 91% would ready to donate a kidney to their relatives. This study suggest of the new generation about the importance of organ donation and the concept of brain death9.
There is a lack of awareness among the general public in India about how immensely beneficial donating organs can prove to be for the recipients and their families. Most of the people needing transplantation belong to the young and middle age groups. Hence donating vital organs to a person belonging to these age groups can save a whole family from being ruined. There is also superstition among people for donating organs they will be born deformed and disfigured in their next birth.
Donation is the only area in all of health that cannot exist without the participation of the public. The health care professionals are expected to come forward to motivate themselves and other public for kidney donation. Hence the investigator felt the need to conduct this study to improve the level of knowledge of students on kidney donation.
6.3Reviewofliterature
Reviewofliteratureissystemicidentificationselection,criticalanalysisandreportingofexistinginformationonthetopicofmaterialforthestudy.
Astudytoevaluatetheimpactofaneducationalprogrammetargetedtostudentsonopinionconcerningorgandonationandkidneytransplantationin16publicschoolsinTorino, Italy. The school were randomized as intervention (n=8) or controls (n=8). The result shows that knowledge on renal transplantation was low. Only 12.2% of students aware about the renal transplantation10.
A study to assess the knowledge and attitude of tissue donation and kidney transplantation among secondary school students, non medical university students, medical university students and physicians. The sample size was 444. The data was collected by non-randomly sampled respondents were surveyed. The awareness of tissue transplantation is narrower than the awareness of organ transplantation. The support for tissue transplantation is weaker than for organ transplantation. This study shows that there is an acute need for education in the legal aspects of transplantation11.
A study to assess the attitude towards kidney donation among students in a large northern Italian industrial city. The sample size was 1676 students from 14 schools. The data was collected by a semi structured questionnaire. The result shows that 78.2% were ready to donate kidney only for close relatives or partners needing dialysis. Receiving a living donor kidney is felt as disturbing. Only 57.5% of students would accept it mainly because of fear of long term problems for the donor12.
A study was conducted on knowledge regarding kidney transplantation and organ donation among students of Italy. The sample size was 65 students. The data was collected by a semi structured questionnaire. The intervention which is given for the students is the video assisted teaching programme. The pre test and post test knowledge were assessed using same questionnaire. The result shows that the attitude of the students becomes positive to the kidney donation13.
A study was conducted on knowledge regarding organ donation and kidney transplantation among Asian American adolescents residing on a big island of Hawaii. The sample size was 121. The data was collected by survey and the internal consistency and factor analysis were used to determine the reliability and validity. The result shows that the survey had adequate reliability for evaluating the knowledge about organ donation and kidney transplantation14.
AstudywasconductedonattitudetowardskidneydonationcardandlivingdonationamongpublicincludingthestudentsandteachersinSaudiArabia.Thesamplesizewas53SaudisandnonSaudis.Inthat36%werefemales.Thedatawascollectedbyastructuredquestionnaire.Theresultshowsthatonly18.25%ofpeoplesarealreadysignedinakidneydonorcardand52.7%arewillingtosignforkidneydonorcard15.
Astudywasconductedontheattitudetowardslivingkidneydonationamongchildrenwithmeanageof18inItaly.Thesamplesizewas7999students.Thedatawascollectedbyasemistructuredquestionnaire.Theresultshowsthat90%ofthestudentshadheardabouttransplantationviatelevision.80%ofstudentswerewillingtodonatetheirkidneysforfamilymembers.3.5%woundand16.5%uncertain.Over40%studentsconsiderlegallybuyingakidneyisapatientsrightand26.6%woulddiscouragethischoice16.
Across-sectionalstudywasconductedonorgandonationespeciallykidneydonationamongruralcommunityareasinIslamabad,Pakistan.Thesamplesizewas324.Thedatawascollectedbypre-testedquestionnaire.ThedatawasanalyzedusingSPSSandassociationsweretestedusingthechi-squaretest.Theresultshowsthatknowledgeaboutorgandonationwassignificantlyassociatedwithageandeducation.The69%ofpeopledidnotconsiderorganvendingtobeethicallycorrectbut25%thoughtitmaybeconsideredintimesoftheirneed17.
Across-sectionalstudywasconductedonattitudetowardskidneydonationamongNigerians.Thesamplesizewas316.Inthat96werefirstdegreerelativesofendstagerenaldiseasepatients69wereruraldwellersand151healthworkers.Thedatawascollectedbyinterviewmethod.Thestudyresultshowsthat62%ofhealthworkers,52.1%ofpatientrelativesand27.1%ofruraldwellersarewillingforkidneydonation18.
6.4Statementoftheproblem
AstudytoassessthelevelofknowledgeandattitudeonkidneydonationamongadolescentsinselectedpreuniversitycollegesatMangalore,withaviewtoprepareaninformationbooklet.
6.5Objectivesofthestudy
  1. Tofindouttheknowledgeregardingkidneydonationamongadolescentstudentsbyaknowledgequestionnaire.
  2. Tofindouttheattituderegardingkidneydonationamongadolescentstudentsbyanattitudescale.
  3. Tofindouttheassociationbetweenmeanknowledgescorewiththeirselecteddemographicvariables.
  4. Tofindouttheassociationbetweenmeanattitudescalewiththeirselecteddemographicvariables.
  5. Tofindoutthecorrelationbetweentheknowledgeandattituderegardingkidneydonationamongadolescentstudents.

6.6Operationaldefinitions
Kidneydonation:Kidneydonationistheprocessofremovalandtransplantationofkidneyfromdonortorecipient.Recipienthastobematchedwiththedonorkidneyinordertoreducetherecipientrejectionofthenewkidney
Knowledgeandattitude:Knowledgeistoawarenessof adolescents regardingkidneydonation.
Attitudeisthepositiveornegativeevaluationofpeopleandtheirideasregardingkidneydonation
Adolescents:Itreferstothechildrenwhoarestudyingin11thand12thstandardwiththeagegroupof16–18years.
Information booklet: Information booklet refers to the booklet prepared by the investigator to improve the knowledge regarding kidney donation
Pre university colleges: The colleges offering pre university course are known as PU Colleges orJunior collegesin India.
6.7Assumptions
  1. Adolescentsmayhavesomeknowledgeregardingkidneydonation
  2. Theknowledgeandattituderegardingkidneydonationmaydifferfromindividuals.

6.8Hypotheses
H1:Therewillbesignificantassociationbetweentheknowledge regarding kidney donation among adolescents with theirselected demographicvariables.
H2:Therewillbesignificantassociationbetweentheattitude regarding kidney donation among adolescents with theirselecteddemographicvariables.
H3:Therewillbesignificantcorrelationbetweentheknowledgeandattituderegardingkidneydonationamongadolescents.
6.9Delimitations
Thestudywillbedelimitedto:
  • Adolescentstudentswhoareintheagegroupof16-18years.
  • AdolescentstudentswhoareattendingthepreuniversitycollegesatMangalore.

7. / Materialandmethods
7.1Sourceofdata
DatawillbecollectedfromadolescentstudentswhoareattendingthepreuniversitycollegesatMangalore.
7.1.1Researchdesign
The research design which is using for this study is descriptive design.
7.1.2Setting
Thestudywillbeconductedattheselectedpre-universitycollegesatMangalore.
7.1.3Population
Adolescentsintheagegroupof16-18whoarestudyinginpreuniversitycollegesatMangalore,Karnataka.
7.2Methodofdatacollection
7.2.1Samplingprocedure
Thesamplingtechniqueadoptedforthestudyispurposivesampling.
7.2.2Samplesize
Thesamplesizeforthepresentstudyis100.
7.2.3Inclusioncriteriaforsampling
  1. AdolescentswhoarestudyinginpreuniversitycollegesatMangalore.
  2. Adolescentswhoarepresentandwillingtoparticipateinthestudyatthetimeofdatacollection.
  3. Adolescentswhoareintheagegroupof16-18years.

7.2.4Exclusioncriteriaforsamplings
  1. Adolescentswhoarenotwillingtoparticipateinstudy.
  2. Adolescentswhoareagedlessthan16yearsormorethen18yearsofage.

7.2.5Instrumentsintendedtobeused
Followingtoolswillbepreparedandusedfordatacollection
Tool1:Demographicvariables
Tool2:Knowledgeassessmentquestionnaire
Tool3:Attitudescaleonkidneydonation.
7.2.6Datacollectionmethod
Thedatawillbecollectedusingastructuredknowledgequestionnaireandattitudescale.TheinvestigatorwillobtainthewrittenpermissionfromthehigherauthoritiesoftheselectedpreuniversitycollegesatMangalore.Thepurposeofstudywillbeexplainedtothestudents.Confidentialitywillbeassuredtoallthesubjects.
7.2.7Planfordataanalysis
DatawillbeanalyzedbyusingDescriptiveandinferentialstatistics.
7.3Doesthestudyrequireanyinvestigationsorinterventionstobeconductedonpatients,orotheranimals?Ifsopleasedescribebriefly.
No.
7.4Hasethicalclearancebeenobtainedfromyourinstitutionincaseof7.3?
Priortocollectionofdatawrittenpermissionwillbeobtainedfromtheadministrativeauthoritiesoftheselectedpre-universitycollegestoconductthestudyandconsentwillobtainfromtheparticipants.
8. / References
  1. NationalKidneyandUrologicDiseaseInformationClearinghouse(NKUDIC)[online].Availablefrom:URL:
  2. ArıkanH.MarmaraMedicalJournal2005;18(3);143-150.
  3. NationalKidneyandUrologicDiseaseInformationClearinghouse(NKUDIC)[online].Availablefrom:URL:
  4. Soragna G, Carrano R, Putaggio S, Bergamo D, Burdese M, Mezza E, Opinions on renal transplantation and organ donation in high school students in two large northern (Torino) and southern (Napoli) Italian cities.Transplant Proc. 2004 Apr;36(3):428-30.
  5. Giorgina Barbara Piccoli, Giorgio Soragna, Stefania Putaggio, Elisabetta Mezza, Manuel Burdese, Elisa Vespertino Efficacy of an educational programme for secondary school students on opinions on renal transplantation and organ donation: a randomized controlled trial Oxford JournalsMedicineNephrology Dialysis TransplantationVolume 21, Issue 2Pp. 499-509
  6. Olender E, Palczynska A, Rykowski M, Uhrynowska-Tyszkiewicz I, Kaminski A. Knowledge and opinions about tissue donation and transplantation among Polish students and physicians.Cell Tissue Bank. 2010 May;11(2):173-81. doi: 10.1007/s10561-009-9146-z.

  1. Piccoli GB, Novaresio C, Mezza E, Soragna G, Rossetti M, Burdese M Making a movie on kidney transplantation: a medical school graduation thesis to explain kidney transplantation from students to students.Transplant Proc. 2004 Nov;36(9):2550-2.
  2. 12J.A.TrompetaJ.-L.Chen, B.A.Cooper, N.L.Ascher, S.M.Kools Development of the Organ Donation and Transplantation Knowledge Survey for Use in Asian AmericanAdolescentsTransplantationProceedingsVolume 42, Issue 5 , Pages 1427-1431, June 2010
  3. Al-Shammari S. Public attitude and accessibility concerning kidney donation card and living related donation in Riyadh, Saudi Arabia. Ann Saudi Med. 1991 May;11(3):336-40.
  4. Piccoli G, Segoloni GP, Soragna G, Mezza E, Burdese M, Tognarelli G, Putaggio S, Teenagers' point of view on living donor kidney transplantation: Cinderella or princess? J Nephrol. 2004 Nov-Dec;17 Suppl 8:S47-54.
  5. The Times of India, P. 1, Dec 13, 2012.

9. / Signature of the candidate
10. / Remarks of the guide
11. / Name and designation of (in block letters)
11.2 Guide / MRS. P. PRABAVATHY
ASSISTANT PROFESSOR
MEDICAL SURGICAL NURSING
INDIRANURSINGCOLLEGE
FALNIR, MANGALORE – 575 002.
11.2 Signature
11.3 Co-guide (if any)
11.4 Signature
12 / 12.1 Head of the department / MRS. P. PRABAVATHY
ASSISTANT PROFESSOR
MEDICAL SURGICAL NURSING
INDIRANURSINGCOLLEGE
FALNIR, MANGALORE – 575 002.
12.2 Signature
13. / 13.1Remarks of the Chairman and Principal
13.2Signature

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