BACKGROUND OF THE STUDY
Human body is made up of several organs like brain, lung, liver, stomach etc and each organ is made up of cells. Organs and tissues are constituted by cells characteristic of that organ. Cells divide for growth of an organ, for repairing tissue damage and to maintain functions of the organ. Cancer is a common name for a group of diseases characterized by uncontrolled proliferation of abnormal cells. Cell division is the mainstay of human life. The divided cells are the exact replica of the parent cell. This is referred to as cancer. Sometimes due to some faulty mechanism or due to factors which are unknown yet, the divided cells are abnormal i. e., their structure is not the same as that of its parent cells. They cannot discharge the functions like the normal cells. (National cancer registry2009)Cancer is a generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumors and neoplasm. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs. This process is referred to as metastasis. Metastases are the major cause of death from cancer. (WHO 2012)Globally cancer is the major health problem and presently it is the 2nd largest killer disease in the world. The estimation in the world showed that 24. 6million were diagnosed as cancer in the past five years . The mortality rate due to cancer is 13%. Due to the growth and ageing of world’s population and based on various assumptions about the trends in cancer risk by 2030, it could be expected that the incidence of cancer will be 20 to 25 and the cancer deaths annually is at 13 to 16(International Agency for Research and Cancer 2010)In the United States, the cancer incidence is progressing due to growth of the population, aging and improvement in the survival rates. An estimated 13. 7 million Americans with a history of cancer were alive on January 1, 2012. It is estimated that number will increase to nearly 18 million in Jan 1, 2022(American Cancer Society 2012)Cancer is the major leading cause of death worldwide. The new cases diagnosed with cancer are 1, 638, 910. The incidence of cancer rates in men is declined slightly by 0. 6% per year and the rate is stable in women(WHO2012)SlnoType of cancerNo of deaths per Annum1Cervical275000 lakhs2Lung1. 37 million deaths3Stomach736000 deaths4Colorectal608000deaths5Liver695000 deaths6Breast458000 deathsTable 1. 1. 1(a): The mortality rate due to cancer (WHO2012)Most of the Asian countries including Singapore, South Korea, China, Japan, Australia etc have increased incidence of cancer during the past few decades. The reasons underlying the increase of cancer is the dietary habits and life style changes (University of Hong Kong 2007)SlnoType of cancerNo of deaths per year1Liver653, 000 million deaths2Lung14, 00, 000 million deaths3Stomach866, 000deaths4Colon677, 000 deathsTable1. 1. 1(b): Types of cancer leading to over all cancer mortality each year
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Fig 1: Burden of cancer by type (National Cancer Registry2009)
In India, the estimated number of new cancer cases per year is about 7 lakhs and 3. 5 lakhs people die of cancer each year. It is estimated that over half million deaths occur due to cancer is 5. 35lakh in 2011and about 5. 14 lakh in (2009) and about 5. 24 lakh in 2010. The estimated cancer deaths in India are projected to increase to 7 lakh by 2015. The incidence of cancer in Indian males are about 72. 1 per 1, 00, 000 population and female 82 per 100, 000 population(WHO 2010)The instruction that is given after getting discharge for their home care is important for both the patient and caregivers. The management of cancer is variable and dependent on a number of factors including the type, location and amount of disease and the health status of the patient. It is a team work that includes nurses, doctors. During the time of giving instruction patients and care givers are encouraged to ask questions about the home care management (National cancer institute 2012)In Tamilnadu, the male suffering from cancer is about 80. 9 per 100, 000 population and females about 95. 3 per 100, 000 population (Cancer Registry, 2007)In Chennai leading sites of cancer among men were lung(10. 9%), stomach(10. 2%), oesophagus (6. 6%), mouth(6. 4%) and tongue(5. 2%). In females leading cancer sites among females were breast(26. 5%) followed by cervix and uterus(15. 1%), ovary(6. 1%), stomach(4. 9%)and mouth(3. 6%). The two major sites of cancer namely breast and cervix constituted (47. 2%) of all cancers(National cancer Registry 2012)In cancer institute the total number of new patients registered with cancer both malignant and nonmalignant is 29, 568. Among males cancer of oral cavity is the commonest and among females cancer of cervix followed by cancer of breast and oral cavity is the commonest (Hospital cancer registry cancer institute Chennai 2008)
NEED FOR THE STUDY
Discharging patients from the hospital is a complex process that is fraught with challenges. Preventing avoidable re hospitalizations has the potential to profoundly improve the quality-of-life of patientsProtocol is rule which guides how an activity should be performed. It is described as a set of international courtesy rules. Part of protocol has always been the acknowledgement of the hierarchical standing of all present. (International Association of Protocol consultants and Officers, 2011)Home care education after discharge from the hospital will help the person to obtain the physical, psychological social and occupation related functioning during and after cancer treatment. The goal is to help the person to regain control over many aspects of their lives and remain as productive and independent as possible . Rehabilitation can be useful for those recovering from cancer treatment. Education at the time of discharge will helps toImprove physical strengthHelping the person to become more independent and less reliant on care giver. Reduce the Sleep problems (American society of clinical oncology, 2009)Lea knez etal(20110)conducted an exploratory research study among 21 head and neck cancer clients in Germany. The clients were given home care symptom management instruction at the time of discharge. The study findings revealed that majority(61%) of patients were not able to follow the instruction in their home setting The relevant influencing factors are patient characteristics mainly cognition emotion, behavior and social aspects and the health professional characteristics were content and efficacy of advice, behavior , communication , professional attitude. The study concluded that cancer patients tried but they struggled to fit the multitude and complexity of advice from health professionalQuing et al(2008) conducted an experimental study to assess the effectiveness of discharge instruction for patients to manage their own care. Intervention was given in form of pictogram through a participatory design process. The study result revealed that there was a statistically significant better recall rate and patient comprehension (p STATEMENT OF THE PROBLEM
A study to assess the effectiveness of self instructional discharge protocol for cancer patients on knowledge and practice among nurses at selected hospital, Chennai.
To assess the need of self instructional discharge protocol for cancer patients among staff nurses in the experimental and control group. To assess and compare the post test level of knowledge and practice regarding self instructional discharge protocol for cancer patients among nurses in the experimental and control group. To correlate the post test level of knowledge with post test level of practice in the experimental and control group. To associate the posttest level of knowledge and practice regarding self instructional discharge protocol with selected demographic variables of the nurses in the experimental and control group.
It refers to the outcome in terms of change in the level of knowledge and practice regarding self instructional discharge protocol for cancer patients by nurses, assessed using structured knowledge questionnaire and observational checklist respectively.
SELF INSTRUCTIONAL DISCHARGE PROTOCOL FOR CANCER PATIENTS
It refers to the discharge education by the nurses for individuals diagnosed with cancer. It helps them to attain optimal living and prevent complications after dischargeIt was prepared by the investigator to enhance the nurses knowledge and practice regarding discharge education which includesPersonal hygiene instructions. Pain management. Safe use of medication. Dietary managementRest and activityManagement of selected adverse effect of radiation therapy and chemotherapyFollow up. Family responsibility.
It refers to the understanding ability of the nurses to answer questions regarding discharge protocol which was assessed using structured questionnaire.
It refers to utilization of discharge advices to the cancer patients by utilizing the self instructional discharge protocol for cancer patients by the nurses which was assessed using observational checklist.
Registered nurse with educational qualification of BSC(N), post BSC(N) or diploma in nursing involved in discharge procedures and taking care of the patients with cancer in oncology units
1. Nurses may have some knowledge and practice on self instructional discharge protocol for cancer patients. 2. Providing information on discharge protocol for cancer patients may enhance knowledge and practice among staff nurses. 3. Adequate information regarding self instructional discharge protocol provided by the nurses to the cancer patients may promote their quality of life. 4. The hospital nursing administration staff may use the same protocol to strengthen the nursing care services for patients.
NH1: There is no significant difference in the post test level of knowledge and practice regarding self instructional discharge protocol for cancer patients among nurses in the experimental and control group at p DELIMITATION
The study is delimited to a period of 4 weeks.
A conceptual framework is the abstract and logical structure of meaning that guides the development of the study which enables the researcher to link the findings to nursing’s body of knowledge. It is the symbolic depiction of the reality, providing a schematic representation of relationships among the phenomena and concepts (Betty M. Johnson and Pamela. B. Webber, 2005)In view of explaining and relating various aspects of the phenomena being studies relating to the interaction between the Nurse Investigator and the Staff nurses regarding the discharge protocol for cancer clients, the investigator has adopted a triangulation of theories by integrating the concepts of Hildegard E Peplau’s interpersonal relationships model and Robert R. Carkhuff’s Helping and Human Relationships theory to conceptualize the research study. In this study, the investigator has conceptualized the Orientation phase, Identification phase and Human Relationships, in which the helper (nurse investigator) and the helpee (staff nurses with demographic variables such as age, gender, professional educational status, years of experience dealing with cancer clients, position in the ward) have identified the felt need. The investigator has done the need assessment of the staff nurses by utilizing the dicotomous questionnaire. In the Exploitation phase and Helping process, the helper (nurse investigator) and helpee (staff nurses) together set the new goal which leads to new behavior for the person being helped. This nourishment prepares the person being helped to move in the direction initiated by the helper through a series of action such as: Exploration UnderstandingActionFeedback. Further explorationSelf understanding Real understanding Modification of action. In this study, the exploitation phase and helping process refers to the informal teaching to introduce the concepts of the discharge protocol and the administration of discharge protocol for cancer clients by the investigator (Helper) to the staff nurses (Helpee). In the Resolution phase and New behaviour, the helpee adopts new goals motivated by the helper which is the overall goal of helping. In exploring oneself, the personnel seeking help is attempting to understand where the personnel are in relation to where the personnel want to be. In this study, during the Resolution phase, the post assessment of Knowledge is done by structured questionnaire and the assessment of post test practice is done by observational check list. The new behaviour indicated by the positive helpee’s outcome is the attainment of adequate knowledge and favourable practice regarding discharge protocol for cancer clients which may be enhanced and negative outcome is indicated by the inadequate knowledge and unfavourable practice regarding discharge protocol for cancer clients, which may be reassessed and reinforced by further teaching. The nurse investigator believes that the positive helpee’s outcome will lead to the attainment of strengthened uniform evidence based practice among nurses through the continued utilization of self instructional discharge protocol for cancer clients in future which will improve the optimal quality of living of the cancer clients in the research settingOUTLINE OF THE REPORTCHAPTER I: Dealt with the back ground of the study, need for the study, statement of the problem, objectives, operational definitions, null hypotheses, assumptions, delimitations and conceptual frame work. CHAPTER II: Focuses on review of literature related to the present study. CHAPTER III: Enumerates the methodology of the study. CHAPTER IV: Presents the data analysis and data interpretation. CHAPTER V: Deals with the discussion of the studyCHAPTER VI: Gives the summary, conclusion, implications, recommendations and limitations of the study. The study report ends with selected Bibliography and Appendices.