BANGALORE, KARNATAKA
MS. J.VIJAYAKALA
FIRST YEAR M.Sc (NURSING)
AND ADDRESS
2.
3.
COURSES OF STUDY
NURSING(MEDICAL SURGICAL
NSG)
4.
DATE OF ADMISSION
01-07-2008
A STUDY TO EVALUATE THE
EFFECTIVENESS OF A
STRUCTURED TEACHING
5.
More over Indian is developing county, 60% are women are considering to the
low and middle class family. Now a days cost of care is high. So Prevention is better
than cure. One ounce prevention is better than tones of cure.
At present simple, inexpensive, and early implant for the detection of breast
cancer is breast self examination. It is one of simplest and important health programmers
to promote early detection. Regular breast self examination can identify any abnormal
changes in breast to establish good prognosis.
6.2. NEED FOR THE STUDY
Breast cancer is the second commonest cancer in women in India, next to cancer
of cervix early diagnosis affords a better chance of survival and better prognosis several
methods are available for early diagnosis. Which give good results in early cancer stages?
This makes breast cancer a major problem requiring intensive health awareness
campaign and screening and detection prognosis. The most cost effective and long lasting
programme would be to teach women themselves and to motivate them to participate in
detection
In 2003, current guidelines accepted by the American College of Radiology,
American cancer society, National Cancer institute regarding breast surveillance practices
includes the following:
causes, risk factors, early diagnosis, prevention and procedure of breast self examination,
due to some reasons like lack of confidence, lack of time, inability to examine, alleged
complexity of the procedure forgetfulness fear of the possible discovery of a lump and
embarrassment, associated with manipulation of breast. The women should be told what
to look for while performing a breast self examination such as lump, nipple discharges
nipple retraction, redness, pain or tenderness dimpling of the skin or oedema. Finally the
women should be reminded that most breast problems are not related to malignancy and
they should be advises to reduce anxiety. As stated All guilty is not gold, and all the
breast problems are not related to breast cancer
In the year 2000, the largest every gathering of heads of state in the United
Nations in New York, USA adopted the UN millennium Declaration two of 8 millennium
developmental goals are related to improving maternal health respectively, pointing to the
importance of these health factor in global development and poverty reduction.
The WHO, the International confederation of midwives and the FIGO are pleased
to see the inclusion in the MDGs of the target to reduce by 3/4 th between 1990 and 2015,
the maternal mortality ration. This inclusion is the result of many years of advocacy for
the need to recognize the link between maternal health and development.
Dr. NIMMAGAD says, is that dreaded through the cancer may be, it is important
for patients to understand that various treatment options are available. In fact, scores of
women have overcome breast cancer to lead successful lives. Doctor recommended that
regular self breast examination after the age of 30 in necessary.
SHARON Mc DONALD evidence suggests that, for some women, DBE can be
an important complement to mammography in the earlier detection of breast cancer.
Mamma care method explained in greater proficiency in carrying out BSE, as
measure by execution of BSE components, and in higher sensitivity, as measured by
lump detection. It will helpful to avoid biopsies, medical visits, and it will assist to reduce
the stress for mothers.
Secondly. They are the source of information. So that assessment of breast cancer
becomes a part of health announcement in reproductive health lessons.
The investigator took this study to draw some implications. The findings of the
study will be useful for future students in dealing and understanding the importance of
breast self examination.
No study has been done so for on the impact of an admission of mothers in the
female medical ward, area hospital, Madanapalle. In this context in order to improve
holistic care it is essential to gain insights into factor influencing to do BSE.
Therefore the investigator feels that nurses have an educational role concerning
breast lesions. By allowing clients to take about breast cancer, correcting these
misconceptions and supplying accurate fact, nurses can reduce associated fear, anxiety
and create awareness. Women may then seek earlier assessment diagnosis and effective
treatment.
6.3 STATEMENT OF THE PROBLEM:A study to evaluate the effectiveness of a structured teaching progrmme on
breast self examination among women admitted in female medical word, Hinduja Sindhi
Hospital - Bangalore
6.4 OBJECTIVES
To evaluate women after giving planned health teaching regarding Breast self
examination.
To find out the relation between selected variables and pre-test and post-test
knowledge.
6.6 ASSUMPTIONS
It is assumed that the women will have knowledge on Breast Self Examination.
It is assumed that women selected for study will co-opearate and respond
appropriately before and after structured teaching programme regarding Breast
self examination.
It is assumed that the tool prepared by the investigator will gather reliable and
valid data for the study.
MAN OF SHARMA, 2004 in his study stated about cancer detection in that, a
through breast examination is always done with the patient in the erect and supine
position and with full relaxation of the patients shoulder and pectoral muscles.
SUSAN ALBRECHT, RUTH ANN MILLER, 2005 in their pilot study of 138
women with mastectomies that explored the consistent finding of more left breast cancer
in American women.
DILIP ROY, 2005, in his study state that malignancies of breast in highest in
women in U.K and U.S.A and other western countries where as in India carcinoma of
female genital tract has highest incidence.
LUCKMANN & SORENSON, 2005, in his study explained that, breast cancer is
the leading cause of death in women between ages 39 to 44, it is also the leading cause of
cancer deaths in women between ages 35 to 74.
R.K.BHADURI, 2006 written new soviet theory about origin of cancer, in that he
stated that the disease develops under the influence of various physical and chemical
agents known as carcinogens.
PARAMESH KUMARKAR, M.D., d.g.o., Ph.D., 2006 in his study stated that,
the incidence of breast cancer is increasing world over. There is 2-3 fold increase in the
risk of breast cancer amongst the first degree relatives of the patient with the cancer in the
breast.
Breast cancer frequently metastasizes in the auxiliary nodes; metastasis
involvement of the mammary nodes info great importance as a prognostic factor. Many
breast cancer patients who remain disease free after initial treatment, eventually relapse
have recurrence of the disease and die of metastases;
J.E.DUFFY & R.CLYNN OWENS, 2004 the present findings indicate that
attempts to encourage self examination of breast are only moderately successful and even
its use is not necessarily strongly indicative of promptness of presentation. More over, it
is clear that not only are many women ignorant regarding the facts of breast cancer and
its treatment. In addition the findings suggest that wider knowledge of the availably of
breast conversation treatment could not only improve promptness and decrease anxiety in
women in general and particularly ion increasing womens knowledge of available breast
conversation treatments.
Dr. EMENS in currently (2007) conducting a clinical study that integrates a cellbased breast cancer vaccine with low, immune-modulating doses of chemotherapy in
patients with metastasis breast cancer. The study is designed to use low dose
chemotherapy to step away suppressive immune cells that help tumors to grow and
spread, and replace them with vaccine induced immune cells that are activated to seek
out and destroy breast cancer cells. This should ultimately shrink existing breast tumors,
and prevent others from forming. She will soon begin another clinical study that adds
chemotherapy-modulated vaccination to standard Trastuzumb (Herceptin) therapy for
patients with metastatic brest cancer that expresses high levels of the HER-2/nue also
takes advantage of the ability of Trastuzumab to further increase the numbers of activated
immune cells that fight breast cancer. Dr.Emern is also investigating immune based
therapies that target not only the malignant breast cancer cells, but also the tumorassociated blood vessels that support breast cancer growth and progression. These studies
are all designed to strategically integrate breast cancer vaccines with standard and novel
breast cancer drugs to achieve the greatest therapeutic impact, and to reveal not only that
they work, but also how they work. This research should pave the way for breast cancer
vaccines to become a unique but standard part of breast cancer treatment, and ultimately
breast cancer prevention.
No inherited (somatic) mutations also have been identified in breast tumors. For
example, somatic mutations in the ERBB2 (also called Her -2/neu), DIRAS3, and TP53
genes have been associated with some cases of breast cancer. Susan Orel, M.D. 2006
advised The biggest misconception about mammography is that is picks up every breast
cancer. In fact, mammography misses at least 10 percent of breast cancer. So if you feel a
lump that doesnt show up on a mammogram, bring it to your doctors attention. Get it
evaluated.
In 2007 American cancer research centre suggests that inherited variants of the
ATM, BARDI, BRIP1, CHECK2, NBN, PALB2, RAD50, and RAD51 genes, as well as
certain versions of the AR gene, may also be associated with breast cancer risk. Ot all
studies have shown these connections, however. Of these genes, ATM and CHEK2 have
the strongest evidence of being related to the risk of developing breast cancer.
CHICAGO (AFP) 2005 Researchers have identified a new target for drugs to
help treat the most common form of breast cancer in the developing world, a study
released Thursday said, the target is a molecular switch in the protein making
machinery of the cancer cell that enables a tumor to aggressively develop its won blood
supply. Women with what is called locally advanced breast cancer can develop tumors
that grow anywhere from 2 centimeters to 10 centimeters in diameter.
2006 according to the Deserved Health website, one of the most effective
breast cancer awareness programs is the breast cancer walk which is a Breast Cancer 3
Day benefit. The fund raising program is participated by men and women who want to
make a difference in the lives of these breast cancer victims. The program involves 60
miles of walking and is participated by millions of people nationwide. It is a chance for
the participants to learn about cancer and at the same time help in promoting awareness.
Medicines to reduce Breast cancer Risk center 2006 in US Results suggest
that selective estrogen receptor modulators (SERMs) such as tamoxifen and raloxifence
may lower breast cancer risk in women with certain breast cancer risk factors. But so far,
most women are reluctant to take these medications because of concern about possible
side effects.
findings revealed that 13% practiced Breast Self Examination monthly, 49% had
undergone clinical breast Examination and 46% had never had mammography. The
majority 54% said they did not know very much about breast cancer, 21% opined that
early detection of cancer was important. They reported 5% that cancer could cured early,
had no statically significant relationship with the breast health practice scores.
JEBBIN N.J. ADOTEY J.M. (2004), conducted a study on Attitudes to
knowledge and practice of Breast Self Examination among 200 women in Port Harcourt.
Their responses were then collected and analyses; 98% had formal education, 85.5% of
then had heard of Breast self examination but 39.0% practiced Breast self examination
only occasionally, 24.0% did not practice. Most of women aware of breast self
examination and its usefulness never practice it. It suggests that there is a need for
vigorous health education programme for women. It was hoped this will help to reduce
the morbidity and mortality associated with Carcinoma of breast.
Lecy, Kim H.S, et, at., (2003) conducted a quasi- experimental study on
evaluation of a community based programme for Breast Self examination among 1997
community nurse practitioners in Korea. The results of study reveals 30.5% of women in
the intervention group performed regular Breast Self Examination compared to 10.2% in
control group. The mean knowledge score related to Breast cancer and Breast self
examination was significantly higher for the women in the intervention group than in
control group.
Haji-Mahmoodi, M.Montazeri A.(2002) conducted study on breast self
examination among 410 female health care workers from seven health centers in Tehran,
Iran. Most 58% were married 75% of the women knew about breast cancer and
prevalence 63% percent of the respondents claimed that they know how to examine their
breast, but only 6% performed breast self examination monthly. The practice of breast
self examination monthly. The practice of breast self examination was significantly
associated with are, level of education, personal history of breast problems and
knowledge of how to examine the breast. The study finding suggest that the knowledge
and behavior of female health workers concerning Breast Cancer is relatively poor and it
needs to be information about Breast Self Examination.
Madnat H, Merrill R>M (2002) did survey method study on breast cancer risk
factor and screening of health and human performance among 163 nurses, 178 teachers in
Brighten Young University. The findings of study nurses were more aware than teachers
of the importance of breast cancer screening and its techniques mean screening awareness
score for nurses was 88.3% compared with 73.1% for teachers. These results prove
important information about the level of breast cancer awareness among women nurses
and teachers in Jordan and may be useful for developing future prevention and screening
education programme.
Wood R.Y, Duffy M.E, et, al., (2002) conducted quasi-experimental pre-test and
post-test design study among 328 African American and Caucasian Women on the effect
of an educational intervention aged 60 or older, on effect of an educational intervention
aged 60 or older, on effect of an educational intervention on promoting Breast Self
examination. Pre-test and post test interviews conducted by nurses at two-week intervals;
statistically significant differences in outcome variables between the intervention and
control group. The findings reveal statistically significant differences in outcome
variables between the intervention and control groups.
Sadler G.R., et, al., (2201) conducted descriptive study on 194 Asian Indian
Women; knowledge attitude and behaviors towards breast cancer early detection.
Monthly breast self examination adherence was own only 40.7 percent, 61.3 percent of
women 40 and older, and 70 percent of women 50 and older. The majority of these
women reported that their breast cancer knowledge was inadequate.
III. POPULATION
According to Polit & Hungler a population comprises of entire set of individuals
having some common characteristics. The populations of the study comprised of the
womens admitted in female medical ward in Hinduja Sindhi Hospital Bangalore.
IV. SETTING
The pre-test study to be conduct in Female medical ward Hinduja Sindhi Hospital
Bangalore. The Hinduja Sindhi Hospital is having the bed strength of 100. the female
medical ward has total sanction bed strength of 20. The average nurse patient ratio is 1:10
V. SAMPLE
The present study comprised of 50 women who are admitted in female medical
ward.
VI. CRITERIA FOR SAMPLE SELECTION
INCLUSION CRITERIA
The women
-
EXCLUSION CRITERIA :
The women who
-
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JOURNALS
1. Dr.K.K.Singh., Awareness regarding Breast Self Examination in school teacher
effect of Health education Programme. The Indian Journal of Nursing and
Midwifery Vol.6 September 2003, 52-57.
2. Drakshyani Devi. K., Teachers knowledge and practice of Breast Self
Examination. Indian Journal of Medical Sciences. Vol. 45. No-12 December
1994,284-287.
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2002, 24.
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earliler women in Hong Kong Patient Education counseling Vol.33 No-3, March
1998,233-243.
5. Goergia Robina Sadler et. Al.., Chinese women Behaviours and attitudes towards
Breast Caner education and screening. Womens Health Issues vol. 10. No-1,
February 2000, 20-23.
6. Jebbin NJ. Attitudes to knowledge and practice of Breast Self Examination in
port Harcourt. Niger Journal Medicine. Vol. 13 No-2, April 2004, 166-170.
7. K.S Bairwa., A study to develop and evaluate the effectiveness of an
information booklet on cancer risk Nursing Journals of India. Vol. LXXXIII,
No.1 10 October 2002, 227-228.
WEBSITE
Budden@jcu.edu.au
zylu@um.edu.tw
jclark@gw.bsu.edu
woodr@bc.edu
gasalbde@shu.edu
cylee@yumc.yonsei.ac.kr.
jaz@cast.sdu.dk
bobbie@siu.edu.
THE STUDY
11.NAME AND DESIGNATION OF
11.1 GUIDE
:MRS.LAKSHMI PRIYA,
11.3 CO GUIDE
:MRS.THANUJA, THE
:MRS.LAKSHMI PRIYA,