1

SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

SUBMITTED TO:

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

IN PARTIAL FULFILLMENT

OF

M.Sc (N) in medical surgical nursing

SUBMITTED BY:

MS. BINCY VINCENT

I YR M.Sc(N)

UNDER THE GUIDANCE OF:

MRS.JESSY JACOB

ASSOCIATEPROFFESOR

MEDICAL SURGICAL NURSING

NARAYANAHRUDAYALAYACOLLEGE OF NURSING

NO: 258/A, BOMMASANDRA INDUSTRIAL AREA

ANEKAL TALUK, BANGALORE-99

1 / Name of the candidate and Address / Ms. BINCY VINCENT
I YEAR M.Sc NURSING,
NARAYANAHRUDAYALAYACOLLEGE OF NURSING,
BOMMASANDRA INDUSTRIAL AREA, BANGALORE – 99.
2 / Name of the Institution / NARAYANAHRUDAYALAYACOLLEGE OF NURSING.
3 / Course of study and subject / 1ST YEAR M.Sc NURSING (MEDICAL SURGICAL NURSING)
4 / Date of admission to Course / 8-6-2009
5 / TITLE OF THE TOPIC / EFFECTIVENESS OF A STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND SKILL REGARDING BREAST SELF EXAMINATION AMONG STUDENT NURSES.

STATEMENT OF THE PROBLEM:

“A study to assess the effectiveness o structured teaching programme on knowledge and skills regarding breast self examination among student nurses”

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Breast Cancer, is a malignant growth of breast tissue. It can spread to nearby lymph gland, pleura, bone, pelvis and liver. It can spread to other parts of the body without invading the axillary nodes even when the primary breast tumor is small. Breast cancer is the 3rd most common cancer in the world. In India breast cancer is the 2nd leading cancer in female. The magnitude of cancer problem is increasing day by day.1

In the year 2007 about 5.4 million cases reported in developed countries and 6.7 million reported in developing countries.1

6.1: NEED FOR THE STUDY

Breast self examination (BSE) involves feeling one’s breast in a specific way at the same time in each month and distinguish suspicious lumps from normal lumps and bumps.

The American cancer society and the national cancer institute recommended periodical mammograms, clinical breast examinations and monthly breast self examination to detect breast cancer at an early stage. The natural history of breast cancer can be altered when early diagnosis and treatment is under taken. The diagnosis of breast cancer in the early stages have a significant impact on therapy, which in turn can improve the quality of life of cancer patients. Women are at greater risk than men because 99 % of breast cancer occur in women. Increasing age also increases the risk of developing breast cancer.

An increase in knowledge regarding breast self examination helps the student nurses to improve their own health status and to impart knowledge and attitude in others. Hence the researcher would like to conduct a study to determine the effectiveness of a structured teaching programme on knowledge and skill regarding breast self examination among student nurses.

6.2:REVIEW OF LITERATURE

The relatedliterature is organized under following headings.

  1. Importance of Breast self examination.
  2. Knowledge on breast self examination.
  3. Effectiveness of structured teaching programme regarding breast self examination.

1.Importance of breast self examination :

Breast cancer is a common cause of cancer morbidity and mortality in women. Breast self examination have been promoted for many years as screening methods to diagnose breast cancer at an early stage, in order to decrease the risk of dying from breast cancer. Breast self examination is important not only for early detection of malignant lesion but also as a way to make nursing students responsible for their own health care.

Breast self examination is an important screening measure for detecting breast cancer. There is evidence that women who correctly practice breast self examination monthly are more likely to detect a lump in the early stage of its development. Early diagnosis has been reported to influence early treatment to yield a better survival.

A study conducted on 397 women with invasive carcinoma revealed that 57% of tumors were palpable at the time of diagnosis. The majority of the palpable tumors were discovered by breast self examination. Thirty one percentages of tumors were detected by mammography and those tumors were also palpable.The study concluded that performing breast self examination on a regular basis may contribute to early detection of breast cancer. Therefore teaching of women regarding breast self examination should be encouraged.2

2.Knowledge on breast self examination.

A study was designed to assess the practice of breast self examination in a sample of long-term breast cancer survivors, and to examine the personal, emotional, cognitive, and health-care provider factors that may contribute to its performance. Three hundred and forty-five breast cancer survivors diagnosed with in-situ stage II breast cancer between 1997-2004 at a community hospital provided answers to a mailed, self-report questionnaire. Seventy-six percent of respondents reported that they had performed a breast self examination in the last 30-days. Most of the women (90%) reported that a doctor or a nurse told them to perform a breast self examination once in a month since their diagnosis, although only 69% had actually been shown how to perform a breast self examination.

A study was done to evaluate health beliefs and breast self examination behavior of female academicians in a Turkish university. The sample consisted of 224 female academicians. Data were collected using a self-administered questionnaire. The percentage of participants who regularly performed breast self examination was 27.7 %. Single academicians perceived susceptibility and seriousness higher than their married counterparts. It is recommended that in order to increase the rates of regular breast cancer screening, mass health protective programme based on the Health belief model should be executed for women.3

A study was conducted among 244 female student nurses to determine the knowledge, attitude and behavior regarding breast self examination. The study revealed that nursing and midwifery education has a positive effect on student’s knowledge, attitude and behaviors regarding breast self examination. The study suggested that nursing and midwifery students should be thoroughly prepared to perform breast self examination on themselves. So that they can educate other women about breast self examination.4

A study was done to determine the knowledge level and practice frequency of breast self examination among healthcare workers. Data were collected via a questionnaire that was prepared based on information in the literature. The questionnaire was composed of 2sections: Socio-demographic characteristics and practice and knowledge related to breast self examination. The sample group included 246 healthcare workers. The practice of breast self examination was significantly associated with older, more educated medical secretaries; a positive personal history of breast problems; and a positive family history of breast cancer . Healthcare workers had a low mean level of knowledge about the practice of breast self examination .The scores of the women who stated that they practiced breast self examination were significantly higher than those who reported that they did not. Healthcare workers need to improve their knowledge of and sensitivity toward breast self examination.7

3.Effectiveness of structured teaching programme on breast Self Examination

A study conducted to determine effectiveness of structured teaching on breast self examination among women of low socio economic classes. There were experimental group and the control group. The findings of the study revealed that experimental group subject showed a significant increase in breast self examination knowledge and were able to perform breast self examination with grater accuracy than the control group.

A study was done to evaluate the effectiveness of training on the level of knowledge about breast self-examination and breast cancer among women attending a public education centre. This research was structured according to pre-test-post test. Of the 91 participants in the study,3.3% had a family history of breast cancer and 5.5% have had a lump in their breasts. In pre-test questions, the rate of correct answers was between 13.2% and 68.1%. After training, the rate of correct answers increased to between 79.1% and 96.7%. The finding of the study revealed that education administered by nurses can increase positive perceptions about breast self examination self-efficacy.5

A study was done to determine the effectiveness of an educational programmeon breast self-examination frequency, proficiency, and perceived control in middle-aged and older women at 6 and 12 months after instruction. There were significant differences between the initial interview and 6-month scores on breast self examination frequency, expert and self-rating of proficiency, and perceived skill. Self and expert ratings of proficiency and perceived skill continued to increase at 12 months postinstruction.

A study was done to determine the effectiveness of breast self examination (BSE)training programme. Fourty three female patients with breast cancer before and 39 patients after BSE training programme recruited into the study. The demographic data in both groups were same. Most of the patients were daily wageworkers, married and had only elementary education level. There were no previous history of Breast self examination practice in both groups before the Breast self examination training programme was given.Before Breast self examination training programme, the early stage of female breast cancer disease was diagnosed in 81.4% but after Breast self examination training programme, it was increasing to 89.7%. Almost all patients found their breast masses by themselves. There were 2 patients whose breast masses were found by village health volunteers. Ten patients detected their breast mass by themselves after received information about breast self-examination from primary health care providers.The proportion of early stage female breast cancer disease in this study was increased after Breast self examination training programme. This programme may help to promote the detection of early stage of female breast cancer.

6.3: OBJECTIVES OF THE STUDY:

  1. To assess the knowledge regarding breast self examination before and after structured teaching programme among student
  1. To assess the skillregarding breast elf examination before and after structured teaching programme among student nurses.
  1. To identify the association between knowledge and skill regarding breast self examination among student nurses.
  1. To determine the effectiveness of structured teaching programme on knowledge regarding breast self examination among student nurses.
  1. To determine the effectiveness of structured teaching programme on skill regarding breast self examination among student nurses.
  1. 6.4 OPERATIONAL DEFINITIONS
  • Knowledge:It refers, the understanding regarding examination of one`s own breast to detect any lump or abnormal discharge.
  • Skill: It refers, the ability to perform the palpation of breast in correct way.
  • Effectiveness:It refers, the change in scores of knowledge and attitude as a result of structured teaching programme.
  • Breast self examination: It refers, to a systematic examination of one’s own breast to detect lump or abnormal discharge.
  • Structured teaching programme: A planned teaching on breast self examination which include meaning, importance and steps of breast self examination.
  • Student nurses: Third and 4th year B.sc nursing students of Narayana Hrudayalaya college of nursing and 2nd and 3rd year General nursing students of Narayana Hrudayalaya school of nursing.

6.5 ASSUMPTIONS

The study is based on the following assumption.

  • Breast self examination is an important screening measure for detecting breast cancer.
  • Early detection of breast cancer will have a significant impact on the quality of life of Breast cancer patients.
  • Student nurses have some knowledge on breast cancer.
  • The structured teaching programme will improve the knowledge and skill regarding breast self examination

6.6 HYPOTHESIS

H1: The mean post test knowledge score of students regarding breast self examination will be significantly higher than their mean pretest knowledge score, at 0.05 level of significance.

H2:The mean post test skill score of students regarding breast self examination will be significantly higher than their mean pretest skill score at 0.05 level of significance.

H3: There will be a significant positive relation ship between knowledge and skill of student nurses regarding breast self examination.

6.7 DELIMITATION

  • The study is delimited to students of Narayana Hrudayalaya College of Nursing.
  • Period of data collection is only for 6 weeks.
  • Generalization of the finding is delimited to the population studied.

7. MATERIAL & METHODS

7.1 Sources of data

Third and 4th year B. Sc Nursing students of Narayana Hrudayalaya college of nursing and 2nd and 3rd year General nursing students of Narayana Hrudayalaya school of nursing.

Methodology:

Research approach: Evaluative approach

Research Design: One groupPretest-post-test design

Variables:

Independent variable: structured teaching programme

Dependent variable: knowledge and skill regarding breast self examination.

Setting of the study:

Narayana Hrudayalaya college of Nursing and Narayana Hrudayalaya School of Nursing.

Population:students who are studying in Narayana Hrudayalaya college of Nursing and Narayana Hrudayalaya School of Nursing.

Sample: 30

Sampling technique: simple random sampling

Criteria for selection of sample:

Inclusion criteria

-Students who are willing to participate

Exclusion criteria

- Students who have attended similar teaching programme in the last six months.

Tool:

Structured questionnaire consisted of two sections.

  • Section A : Demographic proforma (year of study,course of study,socio economic status and religion)
  • Section B1 : Questionnaire on knowledge regarding breast self examination
  • Section B2 : Check list on skills regarding breast self examination

Data collection procedure:

  • Obtain formal administrative permission.
  • Obtain consent for participating in the study
  • Select the samples using simple random sampling.
  • Assess the level of knowledge & skill(pretest) using structured questionnaire and checklist.
  • Provide planned teaching programme
  • Reassess the knowledge and skill using the same structured questionnaire after 1 week (post test)

Plan for Data Analysis

Data obtained will be analyzed in terms of objectives. Plan of data analysis include, descriptive & inferential statistics

Data analysis will be as follows:

Descriptive statistics: Frequency, percentage,mean, standard deviation.

Inferential statistics:

-‘t’ test

-Chi-square test.

-One way analysis of variance

7.3. Does the study require any investigation or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

Yes. The knowledge and skill of samples regarding breast self examination will be assessed by using a structured questionnaire and check-list(pretest and post test).A Structured teaching will be given to the samples.

7.4 Has ethical clearance been obtained from your institution?

Ethical clearance is obtained from the institution (Narayana Hrudayalaya College of Nursing)

8.LIST OF REFERENCES

  1. Lewis S M, Heitkemper M M, Dirksen S R. Medical Surgical Nursing. Missouri; 6th edition: Mosby publication, a division of read Elsevier: 2008: 428.
  2. Prev-Med 2005; 41(1):167-178.
  3. Ceber, Yucel U.Asian parj cancer prev 2009. AP- JU: 10(2): 213-8.
  4. Memis S, Balkaya N A. Nurs Forum- 2009; 36(1): 39-46.
  5. Eur Joncol Nurs.2008;12(1): 58-64.
  6. Commedtvm.org/nat/09/nationabs63.
  7. http;similar ml product.aspxid=32

9. / Signature of Candidate
10. / Remarks of the Guide
11. / Name & Designation of
11.1 Guide : Mrs. Jessy Jacob
Associate professor
Medical-surgical nursing
NarayanaHrudayalayaCollege of Nursing.
11.2 Signature :
11.3 Co-Guide (if any) :
11.4 Signature :
11.5 Head of Department : Mrs. Priya Latha
HOD, Medical-surgical Nursing,
Narayana Hrudayalaya college of nursing.
11.6 Signature :
12. / 12.1 Remarks of the Chairman & Principal
12.2 Signature