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PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
Miss. SHAHAJAHAN BANU
I YEAR MSc NURSING
MEDICAL SURGICAL NURSING
YEAR 2007-2009.
PADMASHREE COLLEGE OF NURSING
GURUKRUPA LAYOUT, NAGARBHAVI
BANGALORE – 560 072.
0
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
NAME
OF THE CANDIDATE Miss. SHAHAJAHAN BANU
AND ADDRESS
I YEAR MSc NURSING
PADMASHREE
COLLEGE
OF
NURSING
GURUKRUPA LAYOUT
NAGARBHAVI,
BANGALORE – 560 072.
2.
NAME OF THE INSTITUTION
Padmashree College of Nursing
Bangalore
3.
COURSE OF THE STUDY AND I Year M.Sc Nursing
SUBJECT
Medical Surgical Nursing
4.
DATE OF ADMISSION
2nd June 2007.
5.
TITLE OF THE STUDY
A study to assess the effectiveness
of planned teaching programme on
knowledge regarding management
of side effects of radiation therapy
among oncologic clients admitted
in selected hospital, Bangalore
1
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
Health care should encompass all aspects of keeping a person in a state
of health. Nominally it is a form of prevention of sickness and a conscious effort
to maintain a healthy life style.
Cancer is a tumor, or an overgrowth of abnormal cells. These cells grow
by multiplying or dividing to rapidly make new tumor cells. This ability to
multiply without limits grows quickly and invades surrounding normal tissues
makes cancer cells different from normal cells.1
The Magnitude of the problem of cancer in our society is only partially
reflected by statistic on mortality and morbidity. Cancer is a major killing disease
in the beginning of the 20th century, cancer was the 6th cause of death in
industrialized countries, and today it stands as second leading cause of death.2
In 2005, 7.6 million people died of cancer out of 58 million deaths
world wide. More than 70% of all cancer death can occur in low and middle
income countries. Based on projection, cancer deaths will continue to raise with an
estimated 9 million people dying from cancer is 2015, 11.4 million dying in 2030.3
Cancer rates in India is rising due to increase in life expectancy, changes
in life style and increased migration from rural area to the cities, India is a vast
country with diverse lifestyle and therefore have varying cancer patterns and
incident rates.4
2
One way to stop the cancer from growing is to interfere with the cancer
cells ability to multiply there are several methods being utilized, in which
radiations, used at a high doses, causes changes in the cancer cells that stops the
cells ability to multiply and eventually kills the cancer cells.
Radiation therapy has been in use as a cancer treatment for more than
100 years with its earliest routes traced from the discovery of x-rays in 1895. The
concept of therapeutic radiation was invented by German physicist Wilhelm
Conrad Rontgen when he discovered that the x-ray was a powerful and effective
tool to treat cancer. Radiation therapy is one of the four approaches to the
treatment of cancer, the other three are surgery, chemotherapy and biological
therapy. The most common type of cancer that radiation therapy is used for are
brain tumors, head and neck cancer, breast cancer, lung cancer, prostate cancer,
skin cancer, rectal cancer, cervix and uterine cancer, lymphoma and sarcoma.
The doses of radiation are used to destroy cancer cells can also hurt
normal cells, thus the side effects are directly related to the area of the body being
treated. Most side effects are temporary; disappearing gradually after therapy is
complete. If side effects become severe treatment may be put on hold to allow the
tissue to heal before continuing.
There are several methods being utilized for the prevention of radiation
therapy side effects. These mainly include altering the manner in which radiation
is delivered and administering drugs that protects normal cells from radiation
damage. Two delivery methods that were originally used to reduce radiation side
effects include dose fractionation, or splitting the total dose or radiation therapy
3
into multiple doses and physical shielding with lead blocks to reduce the area of
exposure while preventing side effects from occurring. Sometimes side effects are
inevitable, in these situations several types of drugs can be used to decrease the
side effects of radiation 5.
6.2 NEED FOR THE STUDY
Radiation therapy is becoming the more acceptable modality of cancer
treatment; the use of Radiation Therapy leads to numerous side effects which
effects patient’s physical, psychological and social status. This also impairs his or
her life style and day to day activities. The cancer patients who are receiving this
treatment modality should be familiar to side effects of radiation therapy and the
measure to manage the side effects.
Radiation therapy engenders many fears for patient, families and
friends. Misinformation is common and patient, friends and families may reinforce
these concerns due to erroneous assumptions and lack of accurate information. It
is essential that radiation therapy nurses and physicians educate both the patient
and family before a course of treatment.
The function of the Nurse in cancer Radiation therapy has greatly
expanded during the past decade. The Nurse meet Patient, who is receiving
Radiation Therapy, helps the patient in copying with Radiation Therapy and also
given information regarding management of side effects of Radiation Therapy.
4
This study will direct the nurse to form on patient education and
teaching about some of the common side effect from Radiation Therapy and
management of side effects with his or her available coping strategies so that the
patient can be enable to lead a normal and better quality of life.
Teaching and educating of the patient is extremely important part of the
nurses, related to Radiation Therapy. Being a cancer itself is a painful experience
for these patients and the discomfort due to the treatment adds to it. Hence it is
essential for the patients to know about Radiation Therapy, its side effects and the
relieving measures.
In the light of above fact and personal experience of the investigator as a
staff in the clinical area while caring for cancer patients receiving Radiation
therapy, it was observed that most of the patients have lack of information related
to management of the side effects of Radiation Therapy and were found to be
almost Physically sick mentally depressed and socially isolated. Hence the
research was interested in the above area and wanted to impact knowledge
regarding the management of side effects of Radiation therapy.
6.3 STATEMENT OF PROBLEM
A study to assess the effectiveness of planned teaching programme on
knowledge regarding management of side effects of radiation therapy among
oncologic clients admitted in selected hospital, Bangalore.
5
6.4 OBJECTIVES
1. To assess the pretest knowledge of oncologic clients on management of
side effects of radiation therapy.
2. To evaluate the effectiveness of planned teaching programme on
management of side effects of radiation therapy.
3. To associate post test knowledge of Oncologic clients with selected
demographic variables.
6.5 OPERATIONAL DEFINITIONS
1. Effectiveness
In this study effectiveness is defined as a significant increase in the
level of knowledge after undergoing planned teaching programme related to
management of side effects of Radiation Therapy for oncologic clients, measured
from the difference between pre test and post test score.
2. Planned teaching programme
Refers to a systematically organized teaching strategy for duration of 1
hour for oncologic clients on management of side effects of Radiation Therapy,
provided by Verbal Interaction with the use of flash cards.
6
3. Knowledge
It refers to awareness and understanding of oncologic clients regarding
the management of side effects of radiation therapy, as measured by structured
knowledge questionnaire.
4. Management
Refers to conservative and therapeutic measures taken by oncologic
clients in treating the side effects of radiation therapy such as nausea, vomiting,
skin reaction, alopecia, and diarrhea.
5. Side Effects
Undesirable effects such as hair loss, skin reaction, nausea, vomiting
and fatigue produced by the radiation therapy among oncologic clients admitted in
selected hospital, Bangalore.
6. Radiation therapy
The use of high energy rays, damage cancer cells, stopping them from
growing and dividing. In this study it refers to the oncologic clients receiving
radiation therapy, admitted in selected hospital, Bangalore.
7
7. Oncologic Clients
Are patients who are diagnosed of malignant growth of different types
of cells of any body organ undergoing radiation therapy as a treatment and
admitted in the selected Hospital.
6.6 ASSUMPTIONS
1. Oncologic clients may have inadequate knowledge regarding management
of side effects of radiation therapy.
2. Planned teaching programme may improve the knowledge of patients
regarding management of side effects of radiation therapy.
3. Clients knowledge may vary with the selected demographic variables
6.7 NULL HYPOTHESES
Ho1 – There will not be a significant difference between the mean pre test and
mean post test knowledge of clients receiving planned teaching programme.
Ho2 – There will not be a significant association between the knowledge score of
the clients and selected demographic variables.
8
6.8 REVIEW OF LITERATURE
This chapter deals with the literature reviewed in the area of Radiation
therapy, side effects of Radiation therapy and management of side effects of
radiation therapy
Literature review done for the study is presented under the following
headings,
 General information on cancer.
 Cancer treatment and radiation therapy
 Side effects of radiation therapy
 Nurses role in management of side effects of radiation therapy
 Effectiveness of planned teaching or health education in improving the
knowledge.
1. Literature related to general information cancer
Although cancer is often referred to as a single condition, it actually
consists of more than 100 different diseases. The diseases are characterized by
uncontrolled growth and spread of abnormal cells.
World wide there are over 10.9 million cases of cancer. Each year 4.7
million are reported in developed countries and nearly 5.5 millions are in the less
developed countries. In developed countries cancer is 2nd most common cause of
death and epidemiological evidence points to emergence of a similar trend in the
developing country. Cancer is currently the cause of 12% of all death worldwide.
9
Approximately 20 years time the number of deaths annually due to cancer will
increase from about 6 million to 10 million.6
Lung cancer has been the most common cancer world wide. Since 1985,
and by 2002 accounted for 1.35 million new cases (12.4% of world total) and 1.18
million deaths (17.6%) of world total. Although it is most frequent cancer in men
world wide. Lung cancer is second to prostate cancer incidence in developed
countries. Breast cancer is by far the most frequent cancer of women, accounting
for 23% of all cancers because of its high incidence and relatively good prognosis,
breast cancer is the most prevalent cancer in the world, with an estimated 4.4
million women alive who have had the disease diagnosed within the last 5 years,
compared to 1.4 million survivors men and women from lung cancer 7.
In India the estimated number of new cancer per year is about 7 lakhs
and over 3.5 lakhs people die of cancer each year, out of these 7 lakhs new cancer
about 2.3 lakhs (33%) cancer are tobacco related 8.
The national cancer registry project (NCRP) initiated in 1981-82
continued to collect authentic data on cancer occurrence in country. The data for
the year 1996 showed a crude incidence rate (per 1,00,000) in the metropolitan
cities from 53.7 in Bangalore to 79.6 in Chennai among men and from 68.7 in
Bangalore to 93.6 in Chennai among women.
A population revealed that the population of coverage of cancer cases
was 72% in Bangalore, 100% in Chennai and 78% in Mumbai. The five year
relative survival for female breast cancer was 46.8% in Bangalore, 49.5% in
Chennai and 55% in Mumbai.
10
The age adjusted incidence rate of esophageal cancer in women in a
Bangalore in one of the highest (8.3 per 100,000) in the world. In women, cancer
of the cervix and breast together account for over 40% of cancer in urban women
and 65% of cancer in the rural registry in Barshi 9.
Cancer develops gradually over many years due to the result of a
complex mix of environmental, nutritional, behavioral and hereditary factors. The
exact cause of cancer is not known but certain life style choices can dramatically
reduce the risk of developing most types of cancer. Not smoking, eating, eating
healthy diet and exercising moderately for at least 30 each day reduce the risk of
cancer by more than 60%.
Statistic shows that men are more likely to develop cancer than women
and some cancers are more prevalent in particular races than others for example.
Bladder cancer is twice as common in white people as it is in black people. White
women are more likely to develop breast cancer than are black women, but black
women are more likely to die of the disease 10.
2. Literature related to cancer treatment and radiation therapy.
The different modalities for treatment of cancer include surgery,
chemotherapy,
radiation
therapy,
immunotherapy
and
bone
marrow
transplantation.
Radiation therapy has been in use as a cancer treatment for more than
100 years with its earliest routs traced from the discovery of x rays in 1895. The
11
concept of therapeutic radiation was invented by German physicist Wilhelm
Conrad roentgen when he discovered that x-rays was powerful and effective tool
with which to treat cancer.
A study was conducted on radiation therapy effective against eye
cancer. The researchers have been treating patients with malignant melanoma of
uveal with radiation therapy. Study has done on 57 patients with uveal melanoma.
With this treatment, a small metal shield containing radioactive needs is sutured to
the out side of the eye over the tumor. The study found that a five year after
radiation treatment, 90% of patients had their tumors controlled. Researchers said,
the study results are very encouraging and these findings in this small series of
patients with melanoma treated by radiation is effective in controlling the primary
tumor, often with good visual out come 11.
A study was conducted on laparoscopic management of kidney cancer;
it has emerged as the preferred option for the surgical management of kidney
cancer. The review of literature was compiled regarding the long term oncology
results of laparoscopic radical nephrectomy. It has become the new standard of
care for most patients. The finds revealed that laparoscopy is a minimally invasive
option available to most patients with kidney cancer. The immediate benefits of
laparoscopy include less blood loss. Decreased pain, shorter preoperative
convalescence, and improved cosmoses 12.
An article was written on current role of radiation therapy in the
management of malignant brain tumors. The objective of this article is to explain
how the current management of malignant brain tumors has evolved. Using the
foundation of evidence based literature; it reveals that Radiotherapy plays a central
12
role in the multidisciplinary management of primary brain tumors and metastases.
The techniques of radiation therapy continue to refine to optimize local control
while minimizing potential treatment related neuro cognitive toxicities 13.
A study was conducted among patients who received both radiation
treatment and surgery. Findings revealed that 2.4% of the patients show
reappearance of their cancer. But a group of Patients who have under gone
radiation therapy before the surgery having the less chances of reappearance of the
disease. Study conclude that radiation before surgery can improve local control of
the disease 14.
3. Literature related to side effects of radiation therapy
According to university of California medical center, the radiation will
still kill some healthy cells in that area of the body. Radiation causes some various
things to happen, it may cause skin changes such as redness or peeling, vaginal or
rectal pain, nausea, loss of appetite, fatigue, diarrhea, hair loss and or softening of
bones.
A study was conducted on effect of radiotherapy on sexual activity in
women with cervical cancer over a period of 3 to 12 months. The study sample
was women who are under treatment for cervical cancer. Main outcome measured
were changes of sexual activity in sexual desire, arousal, dyspareunia and
satisfaction. The study was concluded that sexual activities were significantly
reduced following radiation therapy 15.
A study conduct on radiation therapy and chemotherapy induced oral
mucositis. Current studies define oral mucositis has a very frequent and painful
13
inflammation with ulcer on oral mucosa. The incidence and severity of lesion are
influenced by patient and treatment variable 16.
An article states that radiation therapy induced fatigue is a common
early and chronic side effect of irradiation. 80% of the patients reported this side
effect respectively during radiation therapy and at follow up visits. The factors that
cause fatigue and the exact mechanism responsible for its production, sustenance
are not well understood. The findings revealed that patients who receive radiation
therapy can induce fatigue 17.
A study was conducted on radiotherapy induced nausea and vomiting as
many as 40-80% of patients undergoing radiotherapy will experience nausea and
or vomiting, depending on the site of irradiation fractionated radiotherapy may
involve up to 40 fractions over a 6-8 weeks period, and prolonged symptoms of
severity depend on radiotherapy related factors (dose, radiation therapy
techniques) and patient related factors (such as gender, general health, age,
psychological state, tumor stage) 18.
An article reviewed on cardiac toxicity associated with cancer therapy.
It may be life threatening. Limit the dose and duration of the treatment can
adversely affects on short term and long term quality of life. A group of patients at
risk of cardiac complication are patients with breast cancer. Hodgkin’s and non
Hodgkin’s lymphomas and soft tissue sarcoma 19.
A study was conducted on radiation induced skin fibrosis after treatment
of breast cancer. Profilometric analysis of the skin of breast cancer patients
undergoing radiotherapy was done 20 women’s, age 45-55 years old were enrolled
14
in the study 6-16 months after the end of treatment associating radiotherapy.
Imprint using silicon rubber material were performed over treatment breast and the
normal breast. The results were, the comparison of the imprint shows slight
increase of skin roughness, increase of furrows depth along with an increase of the
residual length. Study conclude that a breakdown effect of irradiation on the skin
with the fibrous inducing by ionizing radiation 20.
A population based retrospective cohort study was conducted to
examine the association between radiation therapy for breast cancer and
subsequent esophageal squamous cell carcinoma. 2,20806 women in whom breast
cancer were diagnosed, who had received radiation therapy for breast cancer. The
relative risk for esophageal carcinoma is increased in women who receive
radiation therapy for breast cancer 21.
4. Literature related to nurses role in management of side effect or radiation
therapy.
When undergoing treatment for cancer, especially radiation therapy and
chemotherapy, there are a number of complications, symptoms or side effects that
patient may experience. The patient should inform any side effects which he
comes across and the nurse plays important role in helping patient in managing the
side effects.
An article states on information source used to learn about side effects,
why patients believe they will experience some side effects but not others,, and the
meaning side effects have in terms of treatment efficiency. 31 Ovarian cancer
15
patients and 81 men and women with variety of cancer diagnoses completed a
questionnaire prior to their treatment assessing their expectations about
experiencing specific side effects of radiation therapy and information source
used. The findings revealed that the doctors or nurse was the most frequently cited
source of side effects information, with readings as the second 22.
A descriptive study was done to evaluate how patients diagnosed with
uterine cancer, experience fatigue, psychological distress, coping resource and
functional status before, during and after treatment with radiation therapy. 60
women taken as a sample, receiving radiotherapy. Data were collected through
self report. Findings were patients fatigue scores increased significantly. Nurses
mist inform patients receiving radiation therapy about the expected changes in
fatigue and functional status.23
A study was conducted on ionizing radiation: safety for patients, visitors
and staff. Diagnostic radiology and sealed and unsealed sources of radiation
therapy are valuable in the treatment of cancer. However, unwanted consequences
can result from excessive exposure to ionizing radiation. Therefore, nurses
involved in patient care. Nurses should be aware of the safety issues in the
diagnostic and therapeutic use of ionizing radiation so that they can work safely
and confidentially 24.
A review of literature published from 1979 to 1990 on information,
education and communication needs of patients with cancer and their families.
This review incorporate a sample of 66 articles published from 1990 to 1997, of
these 44 articles address the information, education and communication need of
patients with cancer and their families. The discussion focuses on how health
16
professionals can maximize patients comprehension and retention of information,
encourages patients participation in health decision making, and for set dialogue
with patients and families. The findings revealed that steps should be taken within
health care organization to ensure that ongoing informational need assessment and
education are a routine part of comprehensive cancer patient care25.
A study was reviewed on current applications of radiotherapy in the
treatment of persons with lung cancer, providing the scientific basis for nursing
management of disease and treatment effects. Nurses have a major responsibility
in patient’s family education, and in providing the supportive care and self help
techniques needed for patients treated with radiation therapy 26.
A study was conducted on impacting quality of life (QOL) for patients
with cancer with a structured multidisciplinary interception: randomized
controlled trial. The clients were randomly assigned to an 8 session structured
multidisciplinary intervention arm with 5 domains of QOL including cognitive,
physical, emotional, spiritual and social functioning. The study concluded that
participants maintained and actually improved their QOL during radiation therapy;
a structured multidisciplinary intervention can help maintain or even improve
QOL in patients with advanced cancer who are undergoing cancer treatment 27.
A study was conducted on the prevention and management of acute skin
reaction related to radiation therapy. The method that was in used is a systemic
review of literature on this topic. 28 trial meeting the inclusion criteria of the 23
trials that evaluated preventive method, washing practice prevented skin reaction.
Some evidence suggested topical steroid cream or dressings. The study was
concluded that skin washing with plain water, use of non scented, lanolin free
17
hydrophilic cream may helpful in preventing radiation reaction. In addition, a low
doses corticosteroid cream may be beneficial in the reduction of itching and
irritation 28.
5. Literature related to effectiveness of planned teaching or health education
in improving the knowledge.
According to world health organization, health behavior is a major
target of teaching and it is ensured that teaching helps in changing behavior
through cognitive and effective behavior changes. Each individual is responsible
for the maintenance of his or her own health. Moreover each individual has self
cares which are potential in assuring their responsibility. Thus the personal health
approach involves face to face education.
A study was conducted to evaluate the effectiveness of a planned
reaching programme regarding prevention of nutritional anemia in adolescent girls
of selected rural pre University College at Mangalore. The study revealed that
planned teaching programme increased the knowledge regarding prevention of
anemia in which the post test knowledge score was 84.4% with the pre test score
being 43.88% 29.
A study was conducted to asses the effectiveness of planned teaching
programme on knowledge about management of side effects for cancer patients
undergoing chemotherapy at oncology OPD of MSRMTH, Bangalore. The study
revealed that planned teaching programme increased the knowledge of the patients
regarding the management of side effects of chemotherapy in which the post test
knowledge score was 68% with the pre test score being 32%30.
18
A study was conducted to evaluate the effectiveness of planned teaching
programme on complication of intravenous therapy among first year basic BSc
nursing students in KTG College of nursing, Bangalore. The study revealed that
planned teaching progremme increased the knowledge of the students of first year
BSc nursing regarding the complications of intravenous therapy in which the post
test knowledge score was 72% with pre test score being 48% 31.
A study was conducted on effectiveness of planned teaching programme
on Bio medical waste management among staff nurses working in selected
hospital at Mangalore. The study revealed that planned teaching programme
increased the knowledge and awareness among staff nurse regarding the
management of biomedical waste in which the post test knowledge score was 83%
with pre test score being 46%32.
19
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA
The data will be collected from oncologic clients undergoing Radiation
therapy admitted in selected hospital in Bangalore.
7.2 METHODS OF COLLECTION OF DATA
i.
Research design
Experimental design:
Pre-experimental: One group pre-test and post test design
ii.
Research Variable
Dependant variable:
Level of knowledge of clients regarding management of side effects of
radiation therapy.
Independent variables:
Planned teaching programme on management of side effects of radiation
therapy
Demographic variables:
It includes baseline information of Oncologic clients such as age, sex,
educational status, occupation status, economic status, type of cancer, stage of
cancer, kind of radiation therapy and duration of radiation therapy.
20
iii.
Settings
KIDWAI MEMORIAL INSTITUTE OF ONCOLOGY, BANGALORE.
iv.
Population
In the present study population comprises of the clients who are
diagnosed to have cancer of any kind and receiving radiation therapy in selected
hospital, Bangalore.
v.
Sample
Oncologic clients who fulfill the certain inclusion criteria will be
considered as sample and sample size is 50.
vi.
Criteria for sample selection.
Inclusion criteria
-
Oncologic clients who are diagnosed to have cancer of any of the
body system and undergoing radiation therapy in selected hospital.
-
Oncologic clients who are willing to participate in the study.
-
Oncologic clients, who are able to read, write and understand
Kannada or English Language.
Exclusion criteria
-
Oncologic clients who are admitted other major systemic
complications such as congestive cardiac failure, renal failure, and
pulmonary edema.
-
Oncologic clients who are in immediate post operative period.
-
Oncologic clients who are not willing to participate in study.
21
vii.
Sampling technique
Non Probability convenient sampling technique.
viii.
Tool for data collection
Section A
Demographic proforma of Oncologic clients consisting of items on age,
gender, educational status occupation, economic status, type of cancer, stage of
cancer, kind of radiation therapy and duration of radiation therapy.
Section B
Structured questionnaire to assess to the knowledge of oncologic clients
management of side effects of radiation therapy used to assess the knowledge level
of clients.
Section C
It consist of planned teaching programme regarding management of side
effects of radiation therapy administered to oncologic clients with the use of flash
cards to improve their knowledge and to help the client to cope with the side
effects of radiation therapy.
ix.
Methods of data collection
After obtaining the permission from the concerned authorities and
informed consent from the samples, the investigator will collect the data pertaining
to the demographic variables.
Phase I
Assess the existing knowledge of oncologic clients with the help of
structured questionnaire.
22
Phase II
Planned teaching programme on management of side effects of radiation
therapy will be given to the Oncologic clients per about 1 hour, using flash cards.
Phase III
After a period of one week, post test level of knowledge will be assessed
within the same group using same questionnaire.
x.
Plan for data analysis
The data collected will be analyzed by means of descriptive and
inferential statistics.
Descriptive statistics: Frequency, percentage distribution, mean and standard
deviation will be used.
Inferential statistics: Paired ‘T’ test will be used to determine the significance of
the difference between the mean pre test and post test knowledge scores.
Chi-square will be used to determine the association between pre test knowledge
level and selected variables.
xi.
Projected outcome
The study will improve the knowledge of clients on management of side
effects of radiation therapy among oncologic clients. This could help to create
awareness regarding the proper care and management of side effects of radiation
therapy, prevent further complication among oncologic clients.
23
7.3 Does the study require any investigations or interventions to the patients
or other human beings or animals?
Yes, planned teaching programme will be administered as intervention
for the oncologic clients.
7.4 Has ethical clearance been obtained from your Institutions?
Yes permission will be obtained from the concerned authorities in the
selected cancer hospital.
24
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30. Cherian Christeena. Effectiveness of planned teaching programme on
knowledge about management of side effects for cancer patients undergoing
chemotherapy. Rajiv Gandhi University of Health Science; 2004: NNMSN0092.
31. Joseph Merlin. Effectiveness of planned teaching programme on complication
of intravenous therapy among first year basic BSc nursing students in KTG
college of nursing, Bangalore. Rajiv Gandhi University of Health Science; 2005:
NNMSN00110.
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32. Rani Ruby. Effectiveness of planned teaching programme on Bio medical
waste management among stff nurses working in selected hospital at mangalore.
Rajiv Gandhi University of Health Science; 2006: NNMSN00130.
29
9. Signature of the candidate
:
10. Remarks of the guide
:
11. Name and Designation of
:
11.1 Guide
:
11.2 Signature
:
11.3 Co-guide (if any)
:
11.4 Signature
11.5 Head of the Department
:
11.6 Signature
:
12.12.1. Remarks of the principal
:
12.2. Signature
:
30