Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. NAME AND ADDRESS OF THE CANDIDATE MS.ASHWINI K M I YEAR M.SC. NURSING, RAJEEV COLLEGE OF NURSING K. R. PURAM. HASSAN-573201. 2. NAME OF THE INSTITUTION RAJEEV COLLEGE OF NURSING K. R. PURAM. HASSAN-573201. 3. COURSE OF STUDY AND SUBJECT MASTER OF SCIENCE IN NURSING OBSTRETIC & GYNAECOLOGICAL NURSING. 4. DATE OF ADMISSION TO THE COURSE 03-06-2008 5 TITLE OF THE TOPIC “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING FIBROID UTERUS AND ITS MANAGEMENT AMONG THE WOMEN IN SELECTED COMMUNITY AT HASSAN, KARNATAKA. 1 6. BRIEF RESUME OF THE INTENDED WORK 6.1 INTRODUCTION: “An alternate approach to have a happy uterus” --Jeanie 1 Uterus, the part of the female reproductive system in female is an important organ for each adolescent girl in order to complete her lively womanhood in their lifespan. Many changes occur in this organ, uterus as age advances which are pathological in nature. Among them the uterine fibroid is one of the most common tumors of the reproductive system. Uterine fibroids are the slow growing tumors made up of muscles and fibrous tissue attached to the wall of the uterus. Hence they are termed as uterine leiomyoma, myomas or fibromyoma. They appear and grow in women during their childbearing years. The tumor may vary in size from a pin head to the tip of a grape fruit. It may also grow as a single tumor or in clusters. Occasionally they can cause the uterus to grow to the size of a five month pregnancy.2 According to current studies it is estimated that leiomyoma are present in 20-25% of reproductive age women but are 3-9 times more frequent in black than in white women. However, epidemiological study of uterine fibroids by the National Institute of Environmental Health Sciences (NIEHS) found that by age 50 the cumulative incidence of uterine fibroid was over 80% for African American women and about 70% for white women. More than 2 million women world wide are operated for hysterectomy every year and approximately 1/3rd, that is 6, 00,000 are performed because of fibroids.3 Fast changing life style is taking toll on Indian women. The occurrence of fibroid uterus among Indian women has sharply risen in recent years and it is estimated to be around 25 million. 4 2 Annually, around, 150 cases are diagnosed with uterine fibroids in S C Hospital, Hassan. Most women with fibroids are asymptomatic. However they may become symptomatic in the future, so it may be wiser to treat fibroids before they grow to a size when they become symptomatic. The most commonly faced problems by the women with uterine fibroids are usually menorrhagia, pain especially during the menstruation, pressure symptoms such as frequency, urgency occurs. Rarely infertility and complications of pregnancy occurs.5 Though 21st century’s medical advancement have made non-surgical treatment of uterine treatment of uterine fibroid reach its height from which the shortfalls of the treatment could be escaped, there exist still a negligence in awareness level among Indian women.6 A Mumbai based fertility specialist conducted a 16 year long country wide research and a circulation was released to gynecologists by the federation of OBG Society of India (FOGSI).The aim of the circulation was increasing awareness among patients as well as health care providers to promote more women to go for regular checks. This will help doctor diagnose the problem and suggest treatment before it is too late. Nurses do play an important role in the attainment of this goal which can be through health visits and health teaching.7 A qualitative study was conducted to examine the illness experiences of women with the common gynecological condition- Uterine Fibroid, using interpretive phenomenological analysis (IPA) at London. The study enrolled semi-structured interview guided by Leventhal’s self- regulation model to explore 18 women’s understanding and experiences of having fibroids. The study revealed to higher-order themes-“managing uncertainty” struggling between defeat and optimism. This illustrated the multiplicity of experiences and meanings used by the women attempting to understand their condition treatment options and future health outcomes .The findings revealed that importance of considering individuals illness representations in order to facilitate the provision of appropriate need and psychological care to women with fibroids.8 As a saying goes “a reliable messenger is refreshing to the one who receives the message, like cold water in the hit of harvest time”-Nurses can be messengers 3 of relieving fear of women with inadequate knowledge about uterine fibroids and make them yield a healthy life with a good harvest. 6.2. NEED FOR THE STUDY “Uterine Fibroid- A cause for menopause to hit earlier than usual.” -Sureka Sinha.1 Uterine fibroids are a major public health issue. It is the one of the condition which will deteriorate the women’s health. It may affect any phase of life but commonly during the reproductive age. Rarely there may be a benign metastazing leiomyoma without any indication of malignancy. In previous trends of treating fibroid uterus, hysterectomy was considered to be the only effective treatment. Today many women with symptomatic fibroids who fail medical therapy assumed that hysterectomy is their only recourse – despite the general availability of uterus sparing procedure such as myomectomy and embolisation. Women, for who child bearing remains an option, need to be aware of option other than hysterectomy.9 Uterine fibroid research and education act of 2003 would have directed the Director of NIH to expand and intensify research efforts on fibroids and to authorize the doubling of current expenditures for research on this condition. The developed an disseminate information regarding uterine fibroids to the public including information on the following The elevated risk for minority women and The availability of a range of treatment of treatment option.10 A case was also reported with rupture uterine leiomyoma presenting as an acute abdomen at Mumbai, India, in 2001.A women with a larger anterior wall uterine leiomyoma underwent a dilation and curettage for a threatened abortion. She had an uneventful recovery 3 weeks later, she represented with peritonitis. Computed tomography and magnetic resonance imaging optimally depicted the rupture fibroid 4 and excluded other causes of acute abdomen. This reported case conclude that their may be a ruptured degenerated fibroid causing acute abdomen outside of pregnancy.11 With over 25% of women aged 18-50 being affected by fibroids and exclusive clinic led by Dr. R. Sinha to remove uterine fibroid through laproscopy.Through the patients attending this clinic some of the associated factors were ruled out such as late marriage and child birth and sedentary lifestyle. Most of the women in reproductive age with fibroids feared that it could hamper pregnancy and child birth. According to Dr. R. Sinha, the availability of minimally invasive technique like laparoscopy has made an easy run away in the management. The success of laparoscopic surgery as extended to the removal of 3.4kg weighing fibroid. Dr. R Sinha from his clinical experience suggested that there is a need to create awareness among women about fibroids and the need of getting it removed.12 About 40% of the women residing in rural area do not perceive specifically that causation of gynecological disorder while some of them relate them as abnormality.50% of the women thought that no treatment was required for these problems. Scanty periods were deemed to be an important issue. Some population of women didn’t relate the bleeding usually associated with this problem as a prerequisite of good health-“as the washing away of bad blood”. Hence, prevalence of such believes shows that there is a need to create awareness among women in rural areas.9 With reference to the ignorance of the women, especially in rural areas regarding the problems associated with gynecological disorder among which fibroid uterus does one of the common, there exist an indication to create awareness. The investigator, during her community visits, experienced that the women residing in that particular region feared about uterine fibroid, for which they believed that it is cancerous and there exist no treatment. Indeed the investigator felt, though management is not something “IMPOSSIBLE”, prevention before curing, rather is more essential. 6.3 STATEMENT OF THE PROBLEM 5 “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING FIBROID UTERUS AND ITS MANAGEMENT AMONG THE WOMEN IN SELECTED COMMUNITY AT HASSAN, KARNATAKA”. 6.4 OBJECTIVES OF THE STUDY 1) To assess the level of knowledge about fibroid uterus and its management among the women before and after structured teaching programme. 2) To compare the level of knowledge between the pretest and post test scores. 3) To associate the post test level of knowledge score with selected demographic variables among women. 6.5 HYPOTHESES H I: There is a significant difference between the pre and post level of knowledge regarding the fibroid uterus and its management. 6.6 OPERATIONAL DEFINITIONS 1. ASSESS: It is the method of estimating the level of knowledge regarding the fibroid uterus and its management among the women. 2. EFFECTIVENESS It is the significant increase in the level of knowledge after STP on fibroid uterus among the women . it will be assessed through semi-structured questionnaire. The score will be interpreted as below average (<50%), average (5175%) and excellent (>75%). 3. STRUCTURED TEACHING PROGRAMME The planned instructions regarding fibroid uterus and its management, which includes definition, types, symptoms, investigations and treatment. It will be given to the women systematically 6 4. KNOWLEDGE It refers to the information possessed by the women before and after STP as measured through questionnaire. 5. FIBROID UTERUS It is the extra growth of muscles and fibrous tissue within the uterine cavity. 6.7 ASSUMPTIONS Focused teaching on fibroid uterus will prevent the complications. Knowledge will influence the attitude and practice of the women. 6.8 CRITERIA FOR SELECTION OF SAMPLES 1. INCLUSION CRITERIA Women who are: -between age group of 30-45years. -willing to participate in the study. -belonging to selected community area. . 2. EXCLUSION CRITERIA Women who have developed fibroid uterus. Women with systemic diseases like hypertension, diabetes mellitus etc 6.9 DELIMITATIONS * Sample size is limited to 80 women between the age group of 30-45years. * Prescribed data collection is 4-6 weeks. 6.10. SIGNIFICANCE OF THE STUDY The significance of this study is to increase the knowledge of 7 women regarding fibroid uterus which will help them to prevent the complications and decision making about the surgery and also prevent the maternal mortality and morbidity. 6.11.CONCEPTUAL FRAMEWORK It is based on Pender’s Health Promotion model. . 6.12 REVIEW OF LITERATURE Literature review helps to lay the foundations for the study. It provides readers with a background for understanding current knowledge on a topic and illuminates the significance of the new study13. The investigator assembles knowledge by reviewing the literature of a selected problem and is presented under the following headings: a) Studies related to incidence and risk factors of fibroids. A study was conducted was conducted to observe the frequency of leiomyoma in relation to age, parity and clinical manifestation along with a review of its management at Manipal, India. A total 150 cases were observed during the study period. Greater frequency was found in the fourth (51%) and fifth (30%) decades of life.95% of women were parous and 5% were nulliparous. The commonest mode of presentation was menstrual disturbances (80.5%), such as menorrhagia and dysmenorrhea .Leiomyoma were multiple in 65% and commonest variety was intramural (52%) Therefore the study recommended that leiomyoma is a common benign gynecological tumor encountered by gynecologist.14 A longitudinal study was conducted to determine the incidence, etiology and epidemiology of uterine fibroids at UK, in 2008.Risk of fibroids in women over the age of 45 years is more than 60% with the incidence higher in blacks than in whites. The cause of fibroids remains unclear and their biology is poorly understood. The key regulators of fibroid growth are ovarian steroids. Black race, heredity, null parity, obesity, polycystic ovarian syndrome, diabetes and hypertension are associated with increased risk of fibroids and there is emerging evidence that familial predisposition to 8 fibroids is associated with a distinct pattern of clinical and molecular features compared with fibroids in families without this prevalence.15 A prospective study was conducted with an objective to investigate the risk of uterine leiomyoma in relation to reproductive factors and oral contraceptive use at USA. Premenopausal nurses (n=95,061) aged 25-42 years with intact uteri and no history of diagnosed uterine leiomyoma or cancer. Self reported leiomyoma were in 243 cases. During 326,116 persons years of follow up, 3006 cases of uterine leiomyoma was confirmed. The only notable association with any aspect of oral contraceptive use was significantly elevated risk among women who first used oral contraceptives at ages 13-16 years compared with those who had never used oral contraceptives. Therefore, the study recommended that reproductive factors and oral contraceptive use at a young age influence the risk of uterine leiomyoma among premenopausal women.16 A systematic literature review was performed to determine whether leiomyoma are associated with decreased fertility rates and whether surgical removal increases fertility rates postoperatively in Virginia in 2001.results of studies comparing women with fertility and fibroids versus infertile controls showed widely disparate results. Subgroups analysis failed to indicate any effect on fertility of fibroids that did not have a sub mucous component. Conversely, women with sub mucous myomas demonstrated lower pregnancy rates (RR 0.3; 95%CI 0.3—0.70) and implantation rates (RR 0.28: 95% CI 0.10—0.72) than infertile controls. Therefore the study data suggested that only those fibroids with a sub mucosal or an intra cavitary component are associated with decreased outcome, and that hysteroscopic myomectomy may be of benefit.17 b) Studies related to knowledge of women regarding fibroids and its management A study was conducted to discover how women found out about uterine fibroid embolisation for treatment of symptomatic uterine fibroids, at Durham, North Carolina, in 2007.The study retrospectively tracked women from the beginning of their illnesses and analyzed their information- seeking behaviors. 28 women who had the 9 procedure were interviewed. Median values and frequencies were calculated to represent information needs, sources and perceived helpfulness. Although women expressed a great need for almost all types of information, those with higher levels of education need to know the reasons that their doctor had for suggesting treatments.Theefore the study recommended that there is need to educate women through health sciences, librarians about their health and treatment options.18 A survey was conducted to evaluate the opinions of gynecological and interventional radiologist regarding uterine fibroid embolisation, at Toronto in 2006.The study evaluated whether they educated patients regarding uterine fibroid embolisation, together with their opinion of current and future effectiveness of uterine fibroid embolisation, self related knowledge of fibroid treatment options. A total of gynecologist (46.4% response rate) and 28 interventional radiologists (51.9% response rate) completed the survey. After applying exclusion criteria the final study population was 82 gynecologists and 17 radiologists. Therefore the study recommends that need to educate patients regarding uterine fibroid embolisation as a treatment option for fibroids.19 A study was conducted to develop the organized and effective implementation of uterine fibroid embolisation at Canada in 2004.Uterine fibroid embolisation has been evaluated in terms of patient satisfaction, risks of complications, and risks in subsequent frequency and rate of hysterectomy within a few months of the procedure .Patient preference is an important component of this evaluation. In evaluating costs of uterine fibroid embolisation, the calculations should take into consideration the cost of managing complications including subsequent hysterectomy. The study recommended that women considering the treatment of fibroids should be counseled that while the early results of uterine fibroid embolisation are encouraging and those who choose uterine fibroid embolisation as an alternative to hysterectomy should be counseled regarding complication of uterine fibroid embolisation.20 c) Studies related to management of fibroid 10 A study was conducted to determine the effectiveness of uterine artery embolisation as a primary treatment of symptomatic fibroids, at, New Delhi, India. The study was carried out in total of 32 patients aged 25-49 years (mean 40.9).Procedure was carried out through unilateral femoral puncture using poly vinyl alcohol particles 355-500 micron in size. All the 32 patients had successful procedures. Overall patients responded, giving a clinical success rate of 78.12%. Therefore the study revealed that uterine artery embolisation leads to good technical success and fibroid volume reduction.21 A prospective study was conducted to evaluate the feasibility, complication and conversion rate of laparoscopic excision of very large myomas at private endoscopic center, Mumbai, India. The patients were total 51 women with at least one myomas larger than 9 cm were selected to perform laparoscopic myomectomy.They removed 78 myomas lapraroscopically in these 51 patients. Three patients had two myomas larger than 9 cm, three had two myomas between 5 and 9 cm and one had three myomas between 5 & 9 cm. The largest myomas removed were 21 cm. Therefore the study recommended that myomectomy by laparoscopy is a safe alternative to laparotomy for very large myomas.22 A retrospective study was conducted to evaluate the pregnancy outcome following laparoscopic myomectomy and single layer myometrial closure at, Kerala, India. They evaluated outcomes of 115 women who had pregnancies subsequent to laparoscopic myomectomy.Of the 217 women followed up, 115 had pregnancies subsequent to laparoscopic myomectomy.Of 141 pregnancies, there were 87 caesarean section, 19 vaginal deliveries, 29 abortions and 6 ectopic pregnancies. There were no incidents of uterine scar rupture in any of these pregnancies. Therefore the study concluded that uterine rupture during pregnancies following laparoscopic myomectomy is rare following single-layer myometrial closure.23 7. MATERIAL AND METHOD OF STUDY: 11 7.1 SOURCES OF DATA: The data will be collected from the women in selected community at Hassan. 7.2 RESEARCH DESIGN A Pre- experimental, one group pre test and post test design. Group Pretest Intervention Post test O1 X O2 Purposively selected women in a selected community. Key: O1 = Pretest on knowledge. X = Structured teaching programme regarding fibroid uterus and its management. O2 = Post test on knowledge. 7.3 METHODS OF DATA COLLECTION: The collection of data will be through SECTION A- Structured questionnaire to seek information about Demographic data. SECTION B- Structured closed ended questionnaire to seek information on knowledge regarding various aspects of fibroid uterus. 7.4 SAMPLING TECHNIQUE Purposive sampling technique will be used. 7.5 POPULATION All women aged between 30-35years. 7.6 SAMPLE 12 Women who fulfills the inclusion criteria. 7.7 SAMPLE SIZE Sample size comprises of 80 women. 7.8 SETTING The study will be conducted in selected community, Hassan. 8. VARIABLES 8.1 INDEPENDENT VARIABLE Structured teaching programme on knowledge of fibroid uterus. 8.2 DEPENDENT VARIABLE Knowledge of women regarding fibroid uterus. 9. PLAN FOR DATA ANALYSIS 9.1. DESCRIPTIVE OF INTERVENTION Descriptive statistics: Demographic information and level of knowledge on fibroid uterus will be given in frequencies with their percentage. Knowledge score will be given in mean and standard deviation Inferential statistics: Pretest and post test knowledge differences will be analyzed using paired t- test and McNemars test. Association between demographic variables and level of knowledge will be analyzed using Pearson chi-square test. 9.2. PILOT STUDY Pilot study is planned with 10% of population. 10. ETHICAL CONSIDERATION: 1. Does the study require any intervention to be conducted on women in a selected community at Hassan? 13 Yes. 2. Has ethical clearance being obtained from your institution? Yes. 3. Has consent taken from community area authorities? Yes. 10. LIST OF REFERENCES 1. www.google.com 2 Philips T.Leiomyoma Uterus(Fibroid), North America, 2008 ,May 6 3 Statement by the society of Interventional radiology. Virginia. 4. Prakash T.Fibroids and infertility. Mumbai.2008, March 10. 5 Narendra K H. Research conclusion on treatment for the uterine myomas ( tumours) and ovarian cysts by Homeopathic Medicine.India. [email protected] 6. [email protected]. 7. Geetanjali J .More aware now, women check for Fibroids before Conceiving. 2008 October 19. 8. Nicholls.C, Glover L, Pistrang N.Jourenal of psychosomatic Obstetrics and Gynaecology ,London 2004 September:295-304. 9.-Status of research on Uterine Fibroids (Leiomyomata uteri) at the National Institute of Health 2006 March. . . 10. Stephenie T J, Mikulski.Uterine Fibroid research and Education Act of 2003. 2003 May 28.www.google.com 11. Nikil V K, Hemanth B. T Subash K R, Ajay P T.Obstetrics and Gynaecology 2001:98:[email protected]. 14 12. The HINDU- Staff Reporter Exclusive clinic to treat fibroid in Bangalore. Friday September 22, 2008.. 13. Polit D. F, Beck C T,Hungler B.T.Essentials of Nursing Research-Methods appraisal utilization.5th edition.Pliadelphia: Lipiincot; 2001. 14.Rani A B, Pratap K N.Journal of Gynaecologic Surgery.2006 December 1;22(4):143150. 15. Okolos. Best practice Research Clinical and Obstetrical Gynaecology.2008 August:24 (4):571-88,E Pub 2008 June 4. 16 .Marshall L M.A prospective study of reproductive factors and oral contraceptive use in relation to to the risk of Uterine Leiomyomata.1998. 17 . Pritts E A. Fibroids and Infertility: a systemic review of the evidence.2001 August: 56(8):483-91. 18. Ankem K. Information-seeking behavior of women in their path to an innovative alternate treatment for symptomatic uterine fibroids. USA. 2006 June: 57(3):140-6. [email protected]. 19. Plaskos N P, Kachura J R. Survey of Gynaecologist and Interventional Radiologist opinion of Uterine Fibroid Embolisation. Toronto.2000 March- April;29(2):188-91. 20. Kaiser P. Women hear about Uterine Fibroid Embolisation Treatment Option Directly from Gynaecologist.2008 March.www.google.com. 21. Jain T P, Srivastava D N,Thulkar S, Sherma S, Mittal S et al. Uterine Artery Embolization for Symptomatic fibroids with imaging follow up.India.2007 Jan- Feb: 14(1):123-7. 22. Sinha R, Hegde A, Warty N,Patil N.Laproscopic Exicision of very large myomas.India.2007 Jul-Aug:14(4):453-62. 23. Paul P G, Koshy A K, Thomas T.Pregnancy outcomes following laproscopic Myomectomy and single layer myometrial closure. India.2006 December:21(12):327881.E pub 2006 July 31. 15 “ 16 . 17