RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.
1 / NAME OF THE CANDIDATE AND ADDRESS / Ms. SINI SUSAN JOSEPHI YEAR M.Sc. NURSING STUDENT,
N.D.R.K. COLLEGE OF NURSING
B.M. ROAD HASSAN, KARNATAKA.
2 / NAME OF THE INSTITUTION / N.D.R.K. COLLEGE OF NURSING, B.M. ROAD, HASSAN, KARNATAKA.
3 / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
(OBSTETRICS AND GYNAECOLOGICAL NURSING)
4 / DATE OF ADMISSION TO THE COURSE / 15/06/2010
5 / TITLE OF THE TOPIC / “EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING RISK FACTORS AND PREVENTION OF ENDOMETRIAL CANCER AMONG WOMEN THOSE WHO ARE RESIDING AT THE SELECTED RURAL COMMUNITY UNDER SHANTHIGRAMA, CHC, HASSAN”
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING RISK FACTORS AND PREVENTION OF ENDOMETRIAL CANCER AMONG WOMEN THOSE WHO ARE RESIDING AT THE SELECTED RURAL COMMUNITY UNDER SHANTHIGRAMA CHC , HASSAN”
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.
15
6 BRIEF RESUME OF INTENDED WORK
6.1 INTRODUCTION
“The greatest discovery of my generation is that a human being can alter his life by altering his attitudes” William James1
Cancer is a pharmaceutical pot of gold that we all buy into year after year. It is a worldwide problem .Recent times have seen an increase in the incidence of cancer. This is mainly attributed to urbanization, industrialization, lifestyle changes, population growth and increased life span.2
Cancer is currently the cause of 12% of all deaths world wide. In approximately 20yrs time, the number of cancer deaths annually will increase from about 6 million to 10 million. The myth that cancer affects people mostly in the developed countries is being broken by the fact that of the 10 million new cancer cases seen each year world wide, nearly 5.5 million are in the less developed countries. Cancer is the 2nd most common cause of death in the developed countries and a similar trend has emerged in the developing countries too. India has the maximum number of cancer patient among all developing countries. There are different types of uterine cancer. These are. , the most frequent being adenocarcinoma, adenocanthoma, adenosquamous carcinoma, clear cell carcinoma, papillary adenocarcinoma, and secretory carcinoma Endometrial cancer is the most common invasive cancer of the female reproductive system. Most cases of endometrial cancer are a type of adenocarcinoma.2
The female reproductive system is responsible for the production of estrogen and progesterone. During the menstrual cycle, the balance between these two hormones changes resulting in the thickening of the endometrium in the beginning of the monthly cycle and if no pregnancy occurs; the endometrial is shed at the end of the monthly cycle. Estrogen is the hormone that stimulates the thickening of the endometrium where as progesterone stimulates the endometrial shedding. If this hormonal balance leans towards the overproduction of estrogen, a women likely to develop endometrial cancer. Endometrial cancer is a disease in which malignant cells form in the tissues of the endometrium. 3
The exact cause of the process of endometrial cancer is unknown but it may be related to excessive exposure to hormone estrogen. Risk factors for the develop of endometrial cancer include obesity, estrogen excess, tamoxifen use, heredity, diabetes, high blood pressure, early menstruation or late menopause, irregular ovulation, ovarian tumors, high fat diet, estrogen replacement therapy. 4(a, b, c)
The main signs and symptoms of endometrial cancer are vaginal bleeding or spotting after menopause, late menopause, new onset of heavy menstrual periods, bleeding between periods, pain in the lower abdomen, pelvis or, legs may occur, vaginal discharge that can be thick or watery, pink or brown and foul smelling, pain during sexual intercourse, difficulty in urinating or pain during urination, enlarged uterus found upon medical exam, unexpected weight loss.5
Endometrial cancer is highly treatable, if. left untreated, endometrial cancer cells can continue to multiply and spread through the wall of the uterus. Endometrial cancer can also spread to near by lymph nodes and abdominal organs and to ovaries and fallopian tubes and become fatal.3
Endometrial cancer can be prevented to an extend by initiating primary prevention against known risk factors and through early detection which helps to reduce cancer mortality and morbidity To prevent the dangers of uterine cancer women should take preventive steps by consulting the gynecologists regularly. Avoiding stress conditions and tension can also be a prevention tool. . The continuous tension can lead to the problems of menses as well as make an individual diabetic. Both of which are the possibilities for the generation of endometrial cancer. 6
Moreover, the early age menses can be avoided by taking less dry fruits and intense food commodities. A balance diet is the primary means to healthy life. Excess and deficiency of any thing can be harmful for human health. So, to prevent risk factors of endometrial cancer, women should review and control their diet patterns and seek help of doctors and counselors to evade anxiety and stress conditions that appear in daily life. Obese women should take measures to reduce weight. Regular exercise and diet controlling can help reduce weight. In short, for old and middle aged women staying away from fatness, diabetes and anxiety is highly important in case they had immature and irregular patterns of menses. 6
Health education has a major role in the prevention of endometrial cancer. As the largest group of health care professionals, we nurses play a significant role in the control of cancer, and this can be attained by giving health education regarding how to “avoid the risk factors. and prevention of endometrial cancer”.7
6.2. NEED FOR THE STUDY
“An ounce of prevention is worth a pound of cure”
Henry de Bracton
Doctors cannot always explain why one person gets cancer and another does not. However, scientists have studied general patterns of cancer in the population to learn what things around us and what things we do in our lives may increase our chance of developing cancer6.
Cancer prevalence in India is estimated to be around 2.5 million with over 80,0000 new cases and 5,50,000 deaths occurring each year due to this disease. More than 70% of the cases report for diagnostic and treatment services in the advanced stages of the disease, which has lead to poor survival and high mortality rate. ..According to the reports by WHO nearly 40,000 new cases/year women are diagnosed with endometrial cancer .Every year, out of whom about 7000die per year,4th most common in women(U.S),2nd in (u.k),5th world wide. It is third in incidence after breast and colon cancer. Black women diagnosed with endometrial cancer are more likely to have more advanced disease at diagnosis and are more likely to die from endometrial cancer than white women. Between 75% and 80% of women diagnosed with endometrial cancer are postmenopausal and the mean age at diagnosis is about 60yrs. 8
Anything that increases a person’s chance of developing a disease is called a risk factor; anything that decreases a person’s chance of developing a disease is called a protective factor. Some of the risk factors for cancer can be avoided, but many cannot. Both smoking and inheriting specific genes could be considered risk factors for certain kinds of cancer, but only smoking can be avoided. Prevention means avoiding the risk factors and increasing the protective factors that can be controlled so that the chance of developing cancer decreases9
Although many risk factors can be avoided, it is important to keep in mind that avoiding risk factors doesn’t guarantee that you will not get cancer. Also, most people with a particular risk factor for cancer do not actually get the disease. Some people sensitive than others are to factors that can cause cancer. There is no known way to prevent the disease, but several known risk factors increase the risk of developing uterine cancer. These are nullipara, obesity, estrogen excess, tamoxifen use, heredity, diabetes, high blood pressure, early menstruation or late menopause, irregular ovulation, ovarian tumors, high fat diet, estrogen replacement therapy,. There are also some other protective factors which help to decrease developing cancer. There are physical activity, combination of oral contraceptives, pregnancy, breastfeeding and diet low in saturated fats and high in fruits and vegetables4
A study was conducted in Switzerland and Northern Italy about dietary factors and risk factors of endometrial cancer. The result shows that there is an association with (1) the total energy intake and, after allowance for energy intake, (2) the frequency of consumption of most types of meats, eggs, beans or peas, added fats and sugar. The study conclude that, aside from the predictable adverse effects of overeating and consequent overweight, some qualitative aspects of the habitual diet may also be associated with the risk of endometrial cancer, chiefly, the intake of animal proteins and fat (directly) and of fresh fruit, vegetables, and fibers (inversely) 10.
A study conducted by the state university of New Jersey Rutgers College of Nursing, New York, NJ, USA, 2009 about nurses role in cancer control, result shows that nurses have the ability to serve as a change agents in strengthening cancer control with in the systems they practice, regardless of the type of setting11.
There are so many measures which help to reduce the occurrence of cancer. such as eating fruits and vegetables, exercising, quitting smoking or taking certain medicines, vitamins, minerals, or food supplements. New ways to prevent endometrial cancer are being studied in clinical trials. The awareness regarding the risk factors and protective factors help to take preventive care and early identification of the disease, help in seeking medical aid in time. There are mainly 4 approaches to cancer control. 7
1) Prevention 2) Early detection 3) Diagnosis and treatment. 4) Palliative care.
Prevention should be the key element in any disease control programme. Prevention means eliminating or minimizing exposure to the causes of cancer and includes reducing individual susceptibility of the effect of such cases. This approach offers the greatest public health potential and the most cost effective long term method of cancer control. Prevention can be done by giving health education. Educating people regarding the disease will help to drive away the fears and stigma associated with the disease. The primary prevention of disease including cancer has been a major part of health promotion and health education for decades. Nurses has an important role in helping ourselves, individuals, groups and communities, change behavior7
The studies conducted by various researchers have shown that women in rural areas have limited knowledge about endometrial cancer. So as a nurse researcher I strongly felt the need to enhance the knowledge of women in rural areas about risk factors and prevention of endometrial cancer through structured teaching programme. This study is a humble attempt towards the big goal of creating awareness among women in selected rural community under Shanthigrama at Hassan.
6.3 STATEMENT OF PROBLEM
“A study to evaluate the effectiveness of structured teaching programme on knowledge regarding risk factors and prevention of endometrial cancer among the women those who are residing at the selected rural community under Shanthigrama CHC,Hassan”
6.4 OBJECTIVES OF THE STUDY:-
1. To assess the knowledge of women regarding prevention and risk factors of endometrial cancer before giving structured teaching programme.
2. To develop and administer structured teaching programme regarding risk factors and prevention of endometrial cancer
.3. To assess the knowledge of women regarding prevention and risk factors of endometrial cancer after giving structured teaching programme
4. To compare the pretest and post test knowledge of women to evaluate the effectiveness of structured teaching programme regarding risk factors and prevention of endometrial cancer.
5. To associate the pretest and post test knowledge of women with selected demographic variables.
6.5 HYPOTHESIS
· NULL HYPOTHESIS
H0: There will not be any significant difference between pretest and post test knowledge score regarding risk factors and prevention of endometrial cancer among women.
· RESEARCH HYPOTHESIS
H1: There will be a significant difference between pretest and post test knowledge score regarding risk factors and prevention of endometrial cancer among women..
H2: There will be significant association between pretest and post test score with selected socio-demographic variables.
6.6 ASSUMPTIONS-
1. Women in rural area have less knowledge regarding risk factors and prevention of endometrial cancer.
2. Structured Teaching programme will improve the awareness of women regarding the risk factors and prevention of endometrial cancer.
6.7 OPERATIONAL DEFINITIONS
Assess:
An activity to estimate the worth of an STP on knowledge of the women regarding risk factors and prevention of endometrial cancer.
Effectiveness:
It refers to improvement in knowledge scores of women after structured teaching programme regarding the risk factors and prevention of endometrial cancer.
Structured Teaching Programme:
It refers to a set of systematically organized instructions and discussions regarding the risk factors and prevention of endometrial cancer.
Knowledge:
State of knowing, understanding, getting awareness and acquaintance with risk factors and prevention of endometrial cancer.
Women:
It refers to women between the age group of 40-60years.
6.8 CRITERIA FOR SAMPLE SELECTION
Inclusion criteria-
The study will include women’s who are
· . Present at the time of study.
· Age between 40-60years.
Exclusive criteria-
The study will not include women’s who are
· Not present at the time of study.
· Age below 40yrs and above 60yrs.
· Women who have undergone total hysterectomy.
6.9 Limitations of the study
Study is limited to:
1. Women have aged between 40-60yrs.
2. Sample size of 100.
3. Period of 4-6weeks.
6.9 SIGNIFICANCE OF THE STUDY
Prevention should be the key element in any disease control programme. Prevention means eliminating or minimizing exposure to the causes of cancer and includes reducing individual susceptibility of the effect of such cases. Prevention can be done by giving health education. Educating people regarding the disease will help to drive away the fears and stigma associated with the disease. This study signifies the importance of creating awareness on the risk factors and prevention of endometrial cancer among women to reduce the occurrence of endometrial cancer and promote women’s health.