RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATEAND ADDRESS / JAI MR. JAIN BABY,
1ST YEAR M.SC. NURSING ,
SOFIA COLLEGE OF NURSING, BANGALORE, KARNATAKA.
2 / NAME OF THE INSTITUTION / SOFIA COLLEGE OF NURSING.
3 / COURSE OF THE STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING,
MEDICAL SURGICAL NURSING.
4 / DATE OF ADMISSION TO COURSE / 12/10/2010
5 / TITLE OF TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF SELF-INSTRUCTIONAL MODULE (SIM) ON KNOWLEDGE REGARDING ORAL CANCER AND ITS MANAGEMENT AMONG STAFF NURSES WORKING IN ONCOLOGY DEPARTMENT OF SELECTED HOSPITALS, BANGALORE.
6.BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
"The best way to predict the future is to invent it" -John Fischer.
Oral cancer is a heterogeneous group of cancers arising from different parts of the oral cavity, with different predisposing factors, prevalence, and treatment outcomes. The majority of malignancies in oral cavity consists of squamous cell carcinomas of oral mucosa, while the remaining include malignant tumors of salivary gland, lymphoreticular disorders, bone tumors, malignant melanomas, sarcomas, malignant dontogenic tumors, and metastases from tumors elsewhere in the body. About 2% of all malignancies that can occur in the body arise in the oral cavity. In some areas of the world, this percentage is higher. It is the sixth most common cancer reported globally with an annual incidence of over 300,000 cases, of which 62% arise in developing countries.1
There is a significant difference in the incidence of oral cancer in different regions of the world. The age-adjusted rates of oral cancer vary from over 20 per 100,000 population in India, to 10 per 100,000 in the United States., and less than 2 per 100,000 in the Middle East countries.2
In comparison with the United States population, where oral cavity cancer represents only about 3% of malignancies, it accounts for over 30% of all cancers in India. The variation in incidence and pattern of oral cancer is due to regional differences in the prevalence of risk factors. Tobacco use and alcohol are known risk factors for cancers of the oral cavity. In India, 57% of all men and 11% of women between 15-49 years of age use some form of tobacco.3
A comparison of oral cancer incidence in India and the United states has shown a similar downward trend in both countries. However, the reduction is much more dramatic in India, where there is a much higher prevalence of oral cancer. An analysis of oral cancer incidence from 1990 to 2005 in Chennai, India has revealed the benefit of such public health interventions, demonstrating a significant parallel reduction in oral cancer incidence.1
Recently, a trend has been observed towards increased incidence of oral cancer among young adults. This increase in incidence is only observed in patients with tongue cancer. In an analysis of 482 consecutive patients presenting with head and neck cancer to a tertiary care cancer center in India, 135 out of the 286 (47%) oral cavity cancer patients did not have any known risk habits.1
6.1. NEED FOR THE STUDY
Cancer is the result of DNA mutations arising spontaneously and from the action of various mutagens, especially in tobacco and alcohol. A sequence of genetic changes leads eventually to loss of growth control and autonomy.
Oral cancer appears to be increasing in incidence, and mortality has hardly improved over the past 25 years. Better understanding of the etiopathogenesis should lead to more accurate and earlier diagnosis and more effective treatments with fewer adverse effects. Diagnosis is increasingly aided by detection of cellular and now molecular changes. Treatment is increasingly looking towards chemotherapy and now gene therapy. However, there is no doubt that prevention is the most important aspect, particularly patient education and the reduction of lifestyle risk habits and environmental factors.4
A study was conducted to assess the level of awareness and knowledge about oral cancer among patients referred to Mashhad Dental School. 320 individuals completed a 15 item written questionnaire that focused on oral cancer risk factors, signs and symptoms, epidemiology, and treatment. Statistical analyses were performed. There was a significant correlation between the level of education and knowledge. The study concluded that the information regarding oral cancer knowledge is quite low. Therefore, it seems necessary to increase the level of public awareness with the use of various educational programs in order to reduce morbidity and mortality.5
A study was aimed to investigate whether nursing staff are aware of risk factors for oral cancer, its clinical signs, and could therefore provide a screening service for oral cancer. Through the use of a questionnaire 121 nursing staff were assessed on oral health check behavior and attitudes; their knowledge of risk factors for oral cancer. Nurses within 3 years of qualification were significantly better at recognizing risk factors for oral cancer than their colleagues. Study concluded that nurses awareness about oral cancer was, poor. This study highlighted a need for improved education of nurses on oral cancer to make the oral health check on admission viable for oral cancer screening.6
A study was conducted in Philippines to evaluate long-lasting changes in the nursing staff understanding of oral health care for cancer patients after an oral health care intervention. The nursing staff on five wards at different hospitals providing cancer care took part in a four-hour oral healthcare training session, including the use of an oral assessment guide and answered a questionnaire initially and after this intervention. The data were statistically analyzed and it found that a four-hour oral health training session and subsequent activities improve the nursing staff's understanding of oral health care for patients with cancer. Study concluded that oral healthcare education and training activities for nursing staff can produce some improvements in the understanding of oral health care for cancer patients but not in attitudes and specific oral knowledge.7
A study done on nurses knowledge and education in relation to oral care and oral health assessment for patients undergoing cancer treatment. An oral care questionnaire was administered to a non-random sample of 100 general and cancer nurses employed in an oncology Centre, North Carolina district with a response rate of 72%. Information was collected on knowledge and education in relation to oral care, management of oral care, and influences on nurses knowledge of oral care and performance of oral care. The study concluded that nurses require more education if they are to manage the oral care of patients with cancer effectively.8
A descriptive cross-sectional study was conducted to determine oral health knowledge, attitudes and behavior among nurses in Lesotho, using a random sampling method. A self-administered questionnaire with open and closed-ended questions was used to collect the data. The response rate was 87%, while knowledge of oral cancer was found to be satisfactory. Nurses reported positive attitudes towards the provision of oral health education and oral hygiene practices. Most nurses themselves were found to be symptom-orientated in their utilization of the oral health services. It is recommended that oral health have given greater attention in the nursing curriculum, with more clinical hands-on training in oral examination and diagnosis of oral diseases.9
Oral cancer remains a major health problem in India, and only dedicated, sustained efforts towards early detection and prevention will reduce the burden of this disease. The above need for study clearly suggests that oral cancer is a major health concern. So the investigator found it relevant to evaluate the effectiveness of Self-Instructional Module on knowledge of management of oral cancer among staff nurses.
6.2. REVIEW OF LITERATURE
Review of literature is the key step in the research process. Review of literature is the analysis and synthesis of research sources to generate a picture of what is known about a particular situation. The primary purpose of reviewing relevant literature is to gain broad background or understanding of the information that is available related to a problem in conducting research, the literature review facilitates selecting a problem and purpose, developing a framework and formulating a research plan.10
In order to attempt this goal in the present study, an attempt has been made to review and discuss the related literature.
A study was conducted regarding the clinical aspects of oral cancer in India, revealed that the disease ranks number one among all cancers in male patients and number three among cancers in female patients. Causal association between oral cancer and the chewing of betel quids containing tobacco leaves or stem and other tobacco habits has been extensively studied.. Sex ratio reveals a 2: 1 preponderance of male patients. Only 10% to 15% of cases present in localized stages. The poor survival revealed by existing studies is mainly due to the overwhelming proportion of advanced cases.11
A retrospective study was conducted to determine whether the incidence of oral cancer is continuing to rise in the United Kingdom. There were 32,852 oral cancer cases registered and had significant increases in incidence of 18% and 30% were seen in males and females respectively. The trend was observed in younger (<45 years) and older (45+ years) age groups with 3.5% and 2.4% average annual increases respectively. These increases were consistent for the majority of regions in the older group. For the younger group the increases in incidence were more rapid and differed geographically. Incidence remains higher in men than women.12
A study was conducted to understand the picture of premature death from oral cancer, they estimated years of life lost (YLL) and average years of life lost (AYLL) of this cancer for the years 1995 and 2005 in Japan. The result showed that both men and women combined, 4099 and 5679 deaths due to oral cancer were recorded for the years 1995 and 2005. Study showed that cancer of pharynx, tongue, and gum were the most frequent oral cancers in both sexes and responsible for a remarkable number of years of life expectancy lost. Deaths due to those cancer sites occurred about 16-21 years earlier than expected in men, and 14-22 years in women.13
A study demonstrated that the habits of chewing panmasala, gutkha or plain tobacco by students and adolescents are on the increase, which may lead to deterioration of oral health and other organ systems. Based on the experimental as well as clinical studies available on panmasala as well as on different components of panmasala, this review suggested that it has the potential in causation of oral cancer.14
A study was done to determine the knowledge and experiences among clinical dental students, University of Lagos, Nigeria related to the management and prevention of oral malignancy and pre-malignancy. A self-administered questionnaire was distributed to all clinical dental students. Most of the students (87.7%; n=57) had witnessed at least a patient with oral malignancy, while 61.5 % (n=40) had witnessed or examined a patient with oral pre-malignancy. While 61.5 % of the students had observed biopsies of malignant and premalignant lesions, only 13.8 % (n=9) had ever performed one under supervision. All the respondents believed that oral malignancy is always or sometimes associated with pain, and most of the students were more familiar with the late signs of oral malignancy than the early signs. Almost two-thirds (64.6 %) of the respondents believed that oral screening programs were effective for early diagnosis and management of oral malignancies. This study revealed a need for a more structured teaching program with increased emphasis on the early signs and symptoms of oral malignancies and involvement of the students in the examination and biopsies of malignant and premalignant lesions.15
The above literatures reviewed the awareness of staff nurses regarding oral cancer. This review indicates that most of the staff nurses are unaware of the management of oral cancer. Therefore the investigator felt to conduct a self instructional module among staff nurses to create an awareness of oral cancer and its management.
6.3. STATEMENT OF THE PROBLEM
A study to assess the effectiveness of Self-Instructional Module (SIM) on knowledge regarding oral cancer and its management among staff nurses working in oncology department of selected hospitals, Bangalore.
6.4 . OBJECTIVES OF THE STUDY
1. To access the knowledge level of staff nurses regarding oral cancer and its management of before Self-Instruction Module.
2. To evaluate the effectiveness of Self-Instructional Module on knowledge regarding oral cancer and its management among staff nurses.
3. To determine the association between pretest knowledge scores regarding oral cancer and its management among staff nurses with their selected demographic variables.
6.5. HYPOTHESIS
H1- The posttest knowledge score will be significantly higher than the pretest knowledge score regarding oral cancer and its management among staff nurses after administration of self-instructional module.
H2- There will be significant association between pretest knowledge scores regarding with their selected demographic variables.
6.6. OPERATIONAL DEFINITION OF THE TERMS
In this study it refers to,
1. Assess: Analyzing the knowledge of staff nurses regarding oral cancer and its management.
2. Effectiveness: The desired changes that can be brought by self-instruction module as measured by self-administered questionnaire.
3. Self-Instructional Module: Which include booklet prepared by the investigator and validated by experts, containing information about oral cancer, its type, causes, risk factors, signs and symptoms, diagnostic tests, various aspects of management and prevention.
4. Knowledge: The attainment of skill and expertise through the theoretical understanding about oral cancer and its management, which is assessed by self administered questionnaire.
5. Oral Cancer: Any malignant tumor including carcinoma and sarcoma which may occur on the lips or anywhere within the mouth.
6. Staff Nurses: A nurse who holds a degree or diploma currently working in oncology department.
7. Oncology department: The department of medicine that deals with tumors, including study of their development, diagnosis, treatment, and prevention.
6.7. ASSUMPTIONS
1. The staff nurses have some knowledge regarding management of oral cancer.
2. Self-instructional module is an effective method of imparting knowledge to the staff nurses.