RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

LAIPHRAKPAM SUJITA

1st YEAR MSC NURSING

2013-2015

SEA COLLEGE OF NURSING

K.R PURAM, BANGALORE

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 / Name of the Candidate and
Address
[In Block Letters] / Ms LAIPHRAKPAM SUJITA
1ST YEAR M.Sc NURSING
SEA COLLEGE OF
NURSING K.R PURAM
2. / Name of the Institution / SEA COLLEGE OF
NURSING, BANGALORE
3. / Course of the Study
Subject / 1ST YEAR M.Sc NURSING
MEDICAL AND SURGICAL NURSING
4. / Date of Admission to Course / 11/7/2013
5. / Title of the study / “A Study to Assess the Effectiveness of Structured Teaching Program on Knowledge regarding Assisted Human Conception among 3rd year BSc nursing students in selected nursing colleges, Bangalore.”

INTRODUCTION

“To create is divine; to reproduce is Human – Man Ray”

Reproductive health is a state of complete physical, mental and social well-being in all aspects relating to the reproductive system and to its functions and processes. This implies that individuals are able to have a satisfying and safe sex life, and the capacity to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of couples to have babies of their own and the right to access appropriate health-care services that will enable them to reproduce. Infertility, therefore, is a basic component of reproductive health and its prevention and appropriate treatment, where feasible, are essential.1

Infertility, a medical diagnosis of reproductive system, is defined as the inability to achieve pregnancy after 1 year of frequent unprotected intercourse. There are two types, primary and secondary. Primary infertility applies to man or woman who has never been able to conceive. Secondary infertility applies to the inability to conceive after one or both partners have conceived previously.2

It is a myth that infertility is always a “ women’s problem”, about one third of infertility cases are due to problem with the man (male factor) and one third are due to problems with the woman (female factor) other cases are due to a combination of male and female factors or unknown causes.

Knowledge of infertile couples about assisted reproductive technology is a fundamental parameter to optimize the infertility treatment and conduct it co-operatively.4 Infertility is a world-wide problem affecting people of all communities, though the cause and magnitude may vary with geographical location and socio-economic status. Approximately 8-10% of couples within the reproductive age group present for medical assessment, generally following two years of failed efforts to reproduce. It is estimated that globally between 60-80 million couples suffer from infertility every year of which probably between15-20 million are in India alone. The magnitude of the problem calls for urgent action, particularly when in the majority of cases the infertility is avoidable.1

Assisted reproductive technology (ART) is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. It is reproductive technology used primarily in infertility treatments. Techniques like in vitro fertilization and embryo transfer (IVF-ET), zygote intrafallopian transfer (ZIFT), gamete intrafallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI) etc therapies are available5

The birth of the world’s first test tube baby Louise Brown in 1978, where the oocyte was fertilized outside the body and then grown in the womb of the mother and India’s first scientifically documented test tube baby (Harsha) was born in 1986, this gave new hope to a large number of infertile couples. Since then the assisted reproductive technologies (ARTs) have advanced much farther allowing parenthood to all who had at one time lost hope of having a baby of their own.

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 as the first In-Vitro fertilisation baby was born in England, has been the milestone for thousand couple; which until then were not able to realize the dream of completing their family. Since then, science has continued to challenge and exponentially reveal the mysteries of the human genome and reproduction4

Some estimates suggest that worldwide between 3-7% of all couple or women have an unresolved problem of infertility. The incidence of infertility is 1/6 couples in United States. For IVF in UK roughly ½ fertility problems with the diagnosed cause are due to problem with the man and about ½ with woman and 99% of assisted reproductive used In-Vitro fertilisation. Assisted Reproductive Technology procedures perform in the US has more than doubled since 10 year ago, with 140.000 procedures in 2006, resulting in 55,000 infants born. In Australia 3.1% of babies now born is a result of ART5

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%6

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.

According to CDC’s 2008 ART Success Rates Report, 148,055 ART cycles were performed at 436 reporting clinics in the United States during 2008, resulting in 46,326 live births (deliveries of one or more living infants) and 61,426 infants. Although the use of ART is still relatively rare as compared to the potential demand, its use has doubled over the past decade. Today, over 1% of all infants born in the United States every year are conceived through ART7.

A cross sectional study was done in Iraq among 203 male patient on knowledge and attitude of Assisted Reproductive Technique. The data was collected by using questionnaire method. And data was analysed by using descriptive rates and percentages including Pearson’s product moment correlation. The result showed that most of the patient, 41% have lack of knowledge about various aspect of assisted reproductive technique and 80% don’t have favourable attitude. Hence the study concluded that there was lack of knowledge about many aspects of assisted reproductive technique and also the attitude8.

An experimental study was conducted on knowledge of the infertile couples about treatment modalities of infertility at a hospital at Iran. The sample size for this study was 200 couples. Sample was selected by purposive sampling method. Data was collected by using self – administered structured questionnaire. And the data was analysed by using descriptive rates and percentage. The study revealed that only 50 couples presented to be knowledgeable about the treatment modalities of infertility. The study concluded that there was lack of knowledge about treatment modalities of infertility9.

A co-relational study was conducted to assess the Knowledge of Infertile Couples Regarding Infertility in Selected Areas at Raichur by Padma B. The subjects were selected by using purposive sampling technique. The sample size was 100, out of which 50 were females and 50 were males. Data were collected by using structured questionnaire. Analysis of the data was done by using descriptive and inferential statistics The findings were-the mean score for knowledge on infertility was highest for the respondents, who belonged to the age group of 31-35 years (⎯x=19.45, S.D.=5.80); females (⎯x=18.66 S.D=4.96); post graduates (⎯x=25.2, S.D=6.38); who sought information through newspapers and health personnel (⎯x=21.6, S.D=5.60 and ⎯x=21.24, S.D=5.60 respectively); with income more than Rs. 10000 ( ⎯x=19.97, S.D=5.86); Hindus (⎯x=19.97, S.D=5.86); duration of infertility from 4-6 years (⎯x=19.70, S.D=6.17); male factors as reason for infertility according to wives (⎯x=9.72, S.D=2.72); male factors as the reasons for infertility according to husbands (⎯x=9.94, S.D=3.08); who opted for in-vitro-fertilization (⎯x=27.80, S.D=6.89). The study concludes that 1. The respondents had adequate knowledge regarding the meaning of infertility. But, they lacked knowledge in few aspects like causes, diagnosis, treatment and preventive measures for infertility. 2. The knowledge of infertile couples was influenced by age, sex, education, income, screening and treatment10.

The investigator, from discussion with expert found that Assisted Human Conception is the new trend in the treatment modalities of infertility and there is a need to impart the new knowledge to nursing student as they are going to be future nurses and 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. Therefore, the investigator felt a strong desire to assess the knowledge and render teaching programme regarding Assisted Human Conception to provide more information about Assisted Human Conception.

6.2. REVIEW OF LITERATURE

Reviews are divided into

A. Review of literature related to knowledge on Assisted Human Conception

B. Review of literature related to structured teaching programme on Assisted Human Conception

A .Review of literature related to knowledge on Assisted Human Conception

A study was conducted on knowledge of nursing students regarding assisted reproductive technology and effectiveness of planned teaching programme in improving the knowledge in the selected college in Tamil Nadu in January 2008. The data was collected by using structured questionnaire method and analysed by using descriptive and inferential statistics. The finding revealed that the mean percentage knowledge score in pre-test was 39.8 and post-test was 74.5. The study concluded that the planned teaching programme was effective method in terms of creating knowledge regarding ART 11.

A study was carried out in Gunasheela IVF center, Bangalore by Gundla Sowjanya on the knowledge and attitude of infertile women regarding assisted reproductive techniques. Around 50 infertile women were selected by non-probability convenient sampling technique. Collected data was analyzed by using descriptive and inferential statistics. Majority of infertile women had moderately adequate knowledge (64%) and neutral attitude (80%) regarding Assisted Reproductive Techniques. There was a statistically significant association found between level of knowledge and demographic variables such as education, occupation, past obstetrical history and type of infertility. There was a statistically significant association found between level of attitude and demographic variables such as occupation and monthly income of the family.12

A prospective comparison trial, was done in UK to compare the outcomes of twin pregnancies conceived by artificialreproductive techniques(ART) with those of spontaneous conception of 1001 twin pairs, [763/1001 (72.7%) were spontaneously conceived and 238/1001(27.3%) were conceived by Assisted reproductive technique]. Result showed that there were 13 per 1000 (20/1504; 1%) perinatal deaths in the spontaneously conceived group and 6 per 1000 (3/466; 0.6%) in the Assisted reproductive technique group (p = 0.8141. . Conclusion: The study concluded that there were no differences in the rate of adverse obstetric or perinatal outcomes between twins conceived naturally compared with twins conceived byassistedconception.13

A retrospective cohortstudy was conducted to compare body length and head circumference at birth of neonates [81 IVF/ICSI neonates,102 OSa neonates, 91 neonates after NC] conceived after in vitro fertilization/intracytoplasmic injection (IVF/ICSI), ovarian stimulation alone (OSa) or by natural conception (NC).purposive sampling technique was used. And the study results show that mean neonatal length was 50.0 ± 2.1 cm in the IVF/ICSI group, 49.7 ± 2.6 cm in the OSa group and 50.3 ± 2 cm in the NC group (p = 0.123). Corresponding mean head circumference was 34.4 ± 1.5, 34.2 ± 1.8 and 34.5 ± 1.2 cm (p = 0.287).Theresearcherconcluded that no significant difference in body length or head circumference at birth related to the mode of conception.14

B .Review related to structured teaching programme on Assisted Human Conception

A study was conducted on the effectiveness of planned teaching programme on assisted reproductive technology among 55 GNM III year students of selected nursing school at Mangalore. Purposive sampling technique was used and data was collected by using structured questionnaire and analysed by using descriptive and inferential statistics. The mean difference between pre-test (15.25) and post-test (30.50) knowledge score of students on ART was found to be statistically significant (t54=30.9, p≤ 0.001). The study concluded that the planned teaching programme was effective15

An experimental study was conducted on the effectiveness of a structured teaching programme in improving knowledge and attitude on reproductive health among 200 adolescent school students. The data was collected using structured questionnaire and analysed by using descriptive and inferential statistics. The mean pre-test score of the experimental group on knowledge of reproductive health was 39.83±16.89 and that of the control group was 39.47±0.08. The post-test score of the experimental group after administration of the structured teaching programme was 84.60±10.60 and that of the control group with conventional teaching method was 43.93±10.08. The difference was statistically significant (p<0.001). The use of structured teaching programme was effective in improving knowledge and attitude of the adolescents on reproductive health16

A retrospective analysis was conducted to assess the quantitative and qualitative outcomes ofassistedreproductivetechnologies in Italy by the ItalianAssistedReproductiveTechnologies Register (IARTR) by analysing 121,708 ART treatments. The result showed that number of total cycles (all homologous) reported was 121,708 including 110,074 fresh (FRESH), 8682 frozen/thawed oocytes (FO) and 2952 frozen embryo (FER). Pregnancy rates per cycle with respect to FRESH, FO and FER treatments were 19.1%, 10.2% and 15%, respectively. Delivery rate per cycle with at least one live birth was 10.8%, 5.8% and 8.4%, respectively, per type of procedure. Twin and "triplet or more" birth rate per delivery was 21% and 2.8%; 12% and 0.4%; 14.9% and 0.8%, respectively. During thestudyperiod 15923 Assisted Reproductive Technology infants were born (0.95% of all newborn in Italy). Hence the study concludes that there was a strong increase in Assisted Reproductive Technique procedures concomitantly with a qualitative improvement leading to increased pregnancy and live birth rates per cycles. Remarkably, pregnancy loss to follow-up decreased drastically during the three yearsstudy-period.1