RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / : / MS.VIVITHA.S.PINTO
1ST YEAR M.Sc NURSING
GOVERNMENT COLLEGE OF NURSING. FORT, BANGALORE-02
2. / NAME OF THE INSTITUTION / : / GOVERNMENT COLLEGE OF NURSING. FORT, BANGALORE-02
3. / COURSE OF STUDY & SUBJECT / : / M.Sc NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
4. / DATE OF ADMISSION / : / 14-08-2012
5. / TITLE OF THE TOPIC / : / “A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAME REGARDING COLLECTION OF CORD BLOOD FOR STEM CELL THERAPY IN TERMS OF KNOWLEDGE AMONG STAFF NURSES IN SELECTED HOSPITALS AT BANGALORE.”

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Healing is a matter of time, but it is sometimes also a matter of opportunity’’.
-HIPPOCRATES

Good health is not only about not being ill, it is about being happy and feeling whole from a physical, mental and spiritual point of view. The study and research of human body and related health issues, helps to understand how human function, and the application of that knowledge to improve health and to prevent and cure diseases.

Umbilical cord blood is special because it contains a lot of cells called hematopoietic stem cells. Cord blood banking is the practice of preserving for future use, fetal blood that remains in the umbilical cord at the time of birth1.

Umbilical cord blood banking, an important novel medical innovation, refers to the collection and long-term storage of hematopoietic stem cells obtained from the umbilical cord blood of a newborn child. Hematopoietic stem cells or blood stem cells are the cells responsible for the creation of blood2.

The placenta and the umbilical cord itself are one of the richest sources of stem cells. When mother gives birth, the blood that remains in the placenta and umbilical cord is referred as cord blood. This particular blood contains numerous hematopoietic stem cells that have the ability to differentiate into other cells and the ability to self degenerate3.

The blood (approximately 75ml) can be extracted from the fetal end of the cord within 10 minutes after birth or in- utero. The blood is taken to the cord blood bank. Before the blood is stored for later use, it undergoes viral testing which ensures whether the blood is suitable for storage or not. Then the blood is processed and cryopreserved in banks. Current literature states that it can be safely stored for at least 10 years. Cord blood can be called as regenerative medicine as this field of medical research is developing treatments to repair or re-grow specific tissue in the body. These cells can be safely infused back into that individual without being rejected by the body’s immune system4.

Stem cells have the remarkable potential to develop into many different cell types in the body during early life and growth. In addition, in many tissues they serve as a sort of internal repair system, dividing essentially without limit to replenish other cells as long as the person or animal is still alive5.

The present century is witnessing rapid changes in cellular medicine - Stem Cell therapy /Stem Cell treatments. Large number of patients around the world have already benefited from bio-technologies using stem cells, delivered safely by skilled physicians. Diseases once considered incurable are responding well to stem cell therapies and are restoring a quality of life to patients they thought they had lost forever6.

6.1 NEED FOR STUDY.

Patients who are diagnosed with abnormalities of nervous system, reproductive system, cardiac system, respiratory system and cancer suffer tremendously because these are very difficult to treat. Those patients and their relatives often desperately look everywhere for help and hope.

A joyous event for you could become the same for someone in need. In the past, when a baby was born, the umbilical cord was thrown away. But today, blood from the umbilical cord can be collected after the birth of the baby and donated to a public cord blood bank to help someone with a life-threatening disease7.

Stem cells are a part of the hematopoietic system or the system that is responsible for the production of various mature blood cells present in the body. Cord blood cells are currently used to treat blood and immune system related genetic diseases, cancers, and blood disorders 8.

Cord blood is an accepted source of stem cells for any of the diseases where stem cell transplants are a standard therapy. Cord blood transplants have been in use since 1988, and by the end of 2009 there had been about 20,000 cord blood transplants world-wide9.

A descriptive study was conducted on Awareness and acceptance of public cord blood banking among practicing obstetricians in United States. Obstetricians practicing in major metropolitan areas were randomly surveyed in 2009. The result of which Eighty percent of affiliated obstetricians feel confident discussing cord blood options with their patients; however 49% indicated that they have insufficient knowledge of cord blood donation to effectively answer patients' questions about donation. The study concluded that Obstetricians are generally familiar with the utility of donated cord blood in transplantation, but could benefit from additional information regarding how cord blood is used in transplantation. Further, obstetricians play an important role in encouraging women to donate their baby's cord blood to a public CBB, are willing to do so, and indicate a desire for more information so they can effectively educate their patients10.

Breast cancer is a devastating, destructive disease, robbing women and their families of their right to a healthy, happy life. There are answers available, though, for any woman suffering with breast cancer, and these answers lie in stem cell therapy11.cord blood is a rich source of stem cells which has a potential to cure breast cancer in the future. So if expectant mother has to be educated on the benefits of preserving their cord blood, the best person is to educate the mother is the nurse.

A Cross-sectional survey was conducted to assess the knowledge on commercial cord blood banking for their offspring (CCBB) among 2,000 pregnant women in antenatal clinics of two major public maternity units in Hong Kong. The survey explored knowledge about the use of self-stored umbilical cord blood (UCB) stem cells and attitude towards CCBB. The majority (78.2%) had no idea that there was the chance of using self-stored stem cells. Moreover, most of the respondents were unclear about which diseases other than leukemia are amenable to treatment with UCB stem cells in general. Only 20.3% of women knew that stem cells are available from the Red Cross in case their children need hematopoietic cell transplantation. The results of this study revealed inadequate knowledge on UCB stem cell banking and its applications among most of our pregnant women. The government and clinicians should combine efforts to provide accurate information on utilization of UCB stem cells during antenatal care12.

Cord Blood storage is fast gaining momentum as a less traumatic alternative to waiting lists, as a way to treat neurological illnesses, and as an insurance for the family against a host of diseases4. Amniotic fluid is a plentiful source of non embryonic stem cells. These cells have demonstrated the ability to differentiate into a number of different cell-types, including brain, liver and bone13.

Nurses caring for patients who are undergoing peripheral blood stem cell transplantation need an understanding of all aspects of the process in order to competently manage the toxicities as well as to educate the patient’s families and other staffs14.

A descriptive study was conducted to explore the awareness of pregnant women regarding cord blood stem cells and their attitude regarding banking options in France, Germany, Italy, Spain, and the UK. Questionnaires were distributed (n = 1620). A total of 79% of pregnant women had little awareness of cord blood banking A total of 58% of women had heard of the therapeutic benefits of cord blood, of which 21% received information from midwives and obstetricians. A total of 89% of respondents would opt to store CBUs. Among them, 76% would choose to donate CBUs to a public bank to benefit any patient in need of a cord blood transplant. Twelve percent would choose a mixed bank, and 12%, a private bank. A total of 92% would donate their child's CBU to research when it is not suitable for transplantation. The study reveals a strong preference for public banking. Attitudes of pregnant women are not an obstacle to the rapid expansion of allogeneic banking. The extent of commercial marketing of cord blood banks in mass media highlights the importance for obstetric providers to play a central role in raising women's awareness early during their pregnancy with evidence-based medical information about banking options15.

A pre experimental study was conducted to investigate the knowledge of cord blood (CB) and attitudes toward CB banking among high-potential donors in Korea. 1001 women attended a maternity education program. The result of which is, more than 90% of women who planned to donate cited "altruism," and 75.0% of the "private preservation" group indicated that a desire to "safeguard for the future" was the reason for their decision. The study concluded that a considerable portion of educated pregnant Korean women has more than minimal knowledge of CB, but the levels of knowledge regarding the potency of the public bank and the current usefulness and limitations of CB are generally low; in addition, obstetricians play insignificant roles in disseminating knowledge. Providing accurate and detailed information to pregnant women not only via brochures and the media and/or Internet but also by obstetricians would encourage CB donation16.

Umbilical cord blood collection process is very simple, painless and safe. The whole process takes less than five minutes and doesn’t need any specifically trained medical professional. Existing health care provider can do it easily. Cord blood donation should be encouraged when the cord blood is stored in a bank for public use17.Many studies have proven that mothers do not have enough knowledge about cord blood banking and they expect their health professionals to give adequate information regarding cord blood banking .therefore it’s a necessity to teach the nurses about cord blood banking.

As it is a new approach in medical science most of the patients and their relatives are unaware about this clinical entity. The medical professionals also lack adequate knowledge about this new innovative approach. Most of the situations nurses at duty find it difficult to provide information to the patients who come and seek guidance. It has been established that patients tend to trust the nurses and follow the instruction given to them by the nurses. So nurses are in a good position to educate the patients. And there is a paucity of accurate and detailed information about nurses’ knowledge and fewer studies have been conducted regarding the knowledge of nurses on collection of cord blood for stem cell therapy. Hence the investigator felt that there is need to assess the knowledge and provide a structured teaching program for nurses regarding collection of cord blood for stem cell therapy.

6.2 REVIEW OF LITERATURE.

A descriptive study was conducted in two antenatal outpatient clinics in Istanbul to determine pregnant women’s knowledge and attitude towards placental stem cells and their banking among 334 pregnant women. Data was collected by interview method. At the end of the study, it was revealed that the majority (86.6%) of the participants had a lack of knowledge about stem cells and placental stem cell banking. It was determined that they wanted information before they conceived, more from their obstetrician but also from nurses and midwives. The majority (78.2%) also wanted to store their infants placental and cord blood and stated that they would be more likely to chose a public cord blood bank .The study concluded that those providing antenatal and perinatal care need to offer a accurate and scientific counseling services to the subjects and parents who need to be informed18.

A descriptive study was conducted to determine knowledge of umbilical cord blood banking (UCBB) among 425 patients in America. The questionnaire was administered. 37% had no knowledge of UCBB. Older patients and those with higher degrees of education were more aware of UCBB, and the greatest disparity of knowledge was noted among Native American patients of patients indicating familiarity with UCBB, 2.6% felt "extremely knowledgeable," while 74% felt "minimally informed." Fifty percent of the patients were misinformed that UCBB was only for "the child that I will deliver." Seventy-one percent of patients were not planning UCBB, with "expense" and "insufficient knowledge" as the primary reasons cited. Only 14% of patients were educated about UCBB by their nurse or obstetrician, although 90% of patients expected their obstetrician to answer their questions on UCBB. The study has concluded that there is lack of knowledge about UCBB and patients expect their obstetrician to be able to answer questions on UCBB. So the obstetric providers should be educated on UCBB19.

A descriptive study was conducted in Brazil to assess the knowledge and attitudes of pregnant women with regard to collection, testing and banking of cord blood stem cells. Data was collected from 650 pregnant women using questionnaire. The study results showed that more than half (70%) reported poor or very poor knowledge about cord blood banking. Many of respondents (68%) thought that physicians should talk to pregnant women about the collection of cord blood, and they wanted to receive information about this topic from healthcare professionals or prenatal classes. Most of women would elect to store cord blood in a public bank and a much smaller portion (14%) would elect private banking. The study has concluded that most women in this study supported the donation of cord blood to public cord blood bank for potential transplantation and research20.